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10|FH_F97561_30030_0|0.00|25
10|FH_F97562_29803_0|0.00|25
10|FH_F97563_83201_0|0.00|25
10|FH_F97564_52246_0|0.00|25
10|FH_F97565_83301_0|0.00|25
10|FH_F97566_79902_0|0.00|25
10|FH_F97581_60141_0|0.00|25
10|FH_F97582_46307_0|0.00|25
10|FH_F97600_46151_0|0.00|25
10|FH_F97601_67218_0|0.00|25
10|FH_F97602_40121_0|0.00|25
10|FH_F97603_77901_0|0.00|25
10|FH_F97620_75904_0|0.00|25
10|FH_F97621_75801_0|0.00|25
10|FH_F97622_75051_0|0.00|25
10|FH_F97623_38008_0|0.00|25
10|FH_F97640_37043_0|0.00|25
10|FH_F97660_29401_0|0.00|25
10|FH_F97700_0_0|0.00|5
10|FH_F97720_70084_0|0.00|25
10|FH_F97721_01053_0|0.00|25
10|FH_F97740_01605_0|0.00|25
10|FH_F97761_04072_0|0.00|25
10|FH_F97780_43614_0|0.00|25
10|FH_F97840_54729_0|0.00|25
10|FH_F97861_62223_0|0.00|25
10|FH_F97880_63501_0|0.00|25
10|FH_F97881_38703_0|0.00|25
10|FH_F97882_32407_0|0.00|25
10|FH_F98000_59102_0|0.00|25
10|FH_F98001_27603_0|0.00|25
10|FH_F98002_27103_0|0.00|25
10|FH_F98020_50138_0|0.00|25
10|FH_F98021_07012_0|0.00|25
10|FH_F98022_89015_0|0.00|25
10|FH_F98040_89406_0|0.00|25
10|FH_F98041_10027_0|0.00|25
10|FH_F98042_10468_0|0.00|25
10|FH_F98060_0_0|0.00|4
10|FH_F98101_0_0|0.00|3
10|FH_F98161_0_0|0.00|16
10|FH_F98280_31015_0|0.00|8
10|FH_F98300_30236_0|0.00|43
10|FH_F98360_11554_0|0.00|25
10|FH_F98361_12065_0|0.00|25
10|FH_F98380_43055_0|0.00|25
10|FH_F98480_0_0|0.00|7
10|FH_F98600_91730_0|0.00|13
10|FH_F98620_43920_0|0.00|25
10|FH_F98621_41042_0|0.00|25
10|FH_F98622_45005_0|0.00|25
10|FH_F98623_97006_0|0.00|25
10|FH_F98624_15701_0|0.00|25
10|FH_F98625_08103_0|0.00|25
10|FH_F98626_29118_0|0.00|25
10|FH_F98640_0_0|0.00|23
10|FH_F98741_0_0|0.00|4
10|FH_F98780_35022_0|0.00|25
10|FH_F98800_85021_0|0.00|25
10|FH_F98801_93274_0|0.00|25
10|FH_F98820_81401_0|0.00|25
10|FH_F98840_31021_0|0.00|25
10|FH_F98860_96706_0|0.00|25
10|FH_F98880_50158_0|0.00|25
10|FH_F98900_42001_0|0.00|25
10|FH_F98920_46526_0|0.00|25
10|FH_F98921_64503_0|0.00|25
10|FH_F98922_40351_0|0.00|25
10|FH_F98940_70506_0|0.00|25
10|FH_F99021_0_0|0.00|14
10|FH_F99100_0_0|0.00|24
10|FH_F99101_24614_0|0.00|3
10|FH_F99142_80233_0|0.00|6
10|FH_F99161_0_0|0.00|15
10|FH_F99281_81147_0|0.00|4
10|FH_F99320_0_0|0.00|2
10|FH_F99380_90503_0|0.00|16
10|FH_F99420_91326_0|0.00|16
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_F99522_0_0|0.00|2
10|FH_F99523_80016_0|0.00|4
10|FH_F99528_0_0|0.00|2
10|FH_F99541_0_0|0.00|2
10|FH_F99720_0_0|0.00|31
10|FH_F99760_0_0|0.00|2
10|FH_F99920_63141_0|0.00|22
10|FH_F99960_0_0|0.00|28
20|FH_F111594_0_0|SrvcGrp|98495|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F132544_0_0|SrvcGrp|97099|2022|PDM|8007.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F119526_60435_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137951_0_0|SrvcGrp|80063|2022|PDM|1228.00|99|0.00|HEMORRHOIDECTOMY|
20|FH_F92676_15063_0|SrvcGrp|78961|2022|PDM|2235.60|99|0.00|MON VALLEY ASC 501|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|621.75|99|0.00|ASPG 402|
20|FH_F142027_37217_0|SrvcGrp|46605|2022|PDM|140.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F142970_43055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117993_32054_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OP SERVICES (POS 72)|
20|FH_F145881_46011_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F128312_45230_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F124608_0_0|SrvcGrp|77021|2022|PDM|5865.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F55113_0_0|SrvcGrp|9939|2022|PDM|1500.00|99|0.00|ACUTE MEDICAL SVCS|
20|FH_F97201_15068_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|AETNA WESTARM HOMECARE ANCD|
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1075.00|99|0.00|AEG 8 (NO REV)|
20|FH_F113261_38464_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F72859_0_0|SrvcGrp|15403|2022|PDM|111.54|99|0.00|SPEECH THERAPY SVCS INITIAL EVAL|
20|FH_F42168_0_0|SrvcGrp|20534|2022|PDM|500.00|99|0.00|SKILLED NURSING|
20|FH_F134497_47126_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F111809_93003_0|CSTM-ALL|CSTM-00|2020|PDM|4729.00|99|0.00|AEG 2 (NO REV)|
20|FH_F35368_0_0|SrvcGrp|72|2022|PDM|443.00|99|0.00|NEWBORN NURSERY|
20|FH_F128699_0_0|SrvcGrp|84185|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F127217_29650_0|SrvcGrp|73842|2022|PDM|228.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F91155_16105_0|SrvcGrp|82369|2022|PCT|1.00|99|0.00|AETNA LABORATORY|
20|FH_F120753_61701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F119775_0_0|SrvcGrp|73008|2022|PDM|353.00|99|0.00|AEG 10|
20|FH_F34998_0_0|SrvcGrp|439|2022|PDM|1467.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F149652_37212_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133396_72301_0|SrvcGrp|108484|2022|PDM|583.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F97042_64804_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31928_0_0|SrvcGrp|3271|2022|PDM|790.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F51438_0_0|SrvcGrp|9984|2022|PDM|80.00|99|0.00|URGENT CARE|
20|FH_F133493_90255_0|CSTM-ALL|CSTM-00|2020|PDM|1867.00|99|0.00|AEG 2 (NO REV)|
20|FH_F130593_48103_0|SrvcGrp|84185|2022|PDM|145.00|99|0.00|RESPITE CARE|
20|FH_F139825_0_0|SrvcGrp|109764|2022|PDM|4590.00|99|0.00|REPAIR EYELID DEFECT|
20|FH_F120058_0_0|CSTM-ALL|CSTM-00|2020|PDM|626.00|99|0.00|AEG 2 (NO REV)|
20|FH_F130553_18640_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F133261_78041_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F93561_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F46352_0_0|SrvcGrp|26742|2022|PDM|147.00|99|0.00|PT|
20|FH_F118379_32079_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F144011_60616_0|CSTM-ALL|CSTM-00|2020|PDM|1207.00|99|0.00|AEG 2 (NO REV)|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|144.00|99|0.00|HAPA EPA ASC 24|
20|FH_F146116_34233_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49354_0_0|SrvcGrp|36807|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER QW (DME)|
20|FH_F148886_60621_0|SrvcGrp|73605|2022|PDM|830.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F133257_72088_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F35368_0_0|CSTM-ALL|CSTM-00|2020|PDM|1590.00|99|0.00|ONE DAY SURGERY|
20|FH_F57372_0_0|SrvcGrp|17100|2022|PDM|546.00|99|0.00|SKILLED NURSING|
20|FH_F136393_0_0|SrvcGrp|103638|2022|PDM|6400.00|99|0.00|AETNA OPEN/PERQ PLACE STENT 1ST|
20|FH_F69104_0_0|SrvcGrp|17071|2022|PDM|1273.92|99|0.00|ASPG IV|
20|FH_F128648_44256_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F134467_84321_0|SrvcGrp|76501|2022|PDM|260.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F39844_0_0|SrvcGrp|38|2022|PDM|1910.00|99|0.00|NORMAL DELIVERY|
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|ASPG IV|
20|FH_F35176_0_0|SrvcGrp|10410|2022|PDM|42.25|99|0.00|SKILLED NURSING CARE|
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1780.00|99|0.00|ASPG VIII|
20|FH_F106540_26330_0|SrvcGrp|537|2022|PDM|4384.00|99|0.00|OBSERVATION SERVICES|
20|FH_F42117_0_0|SrvcGrp|38005|2022|PDM|2200.00|99|0.00|UNLISTED PROCEDURE, MATERNITY CARE AND DELIVERY|
20|FH_F97140_91730_0|SrvcGrp|90854|2022|PDM|2398.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F133474_0_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F144011_60616_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F120825_66204_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142897_07018_0|SrvcGrp|113300|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - MODERNA|
20|FH_F41392_0_0|CSTM-ALL|CSTM-00|2020|PDM|1149.00|99|0.00|ASPG VIII|
20|FH_F126762_91311_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|431.00|99|0.00|AEG 1 (NO REV)|
20|FH_F117725_38036_0|SrvcGrp|33165|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F148556_13206_0|SrvcGrp|14945|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F133271_72204_0|SrvcGrp|46903|2022|PDM|662.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F133460_63031_0|SrvcGrp|109949|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
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_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE NO MOD|
20|FH_F123096_28210_0|SrvcGrp|46903|2022|PDM|1250.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F101751_25302_0|SrvcGrp|78420|2022|PDM|1680.00|99|0.00|INTERIM LABOR|
20|FH_F44350_0_0|SrvcGrp|13811|2022|PDM|300.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F107120_22560_0|SrvcGrp|3809|2022|PDM|610.06|99|0.00|HOSPICE CARE|
20|FH_F39180_0_0|CSTM-ALL|CSTM-00|2020|PDM|1112.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92977_64067_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F97560_23249_0|SrvcGrp|73461|2022|PDM|12286.00|99|0.00|AETNA NICU IV|
20|FH_F73230_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|ASPG II|
20|FH_F120437_85202_0|SrvcGrp|86833|2022|PDM|33.77|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F67192_0_0|SrvcGrp|9537|2022|PDM|3249.00|99|0.00|CARDIAC CARE UNIT|
20|FH_F119602_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F134487_14843_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F132032_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F67379_0_0|SrvcGrp|20902|2022|PDM|11300.00|99|0.00|MS DRG 249 ONLY|
20|FH_F43330_0_0|SrvcGrp|28284|2022|PDM|75.00|99|0.00|SUBSEQUENT  SPECIALTY NURSING S9123 MOD TF|
20|FH_F143197_34957_0|SrvcGrp|90854|2022|PDM|750.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F139156_30060_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139584_10281_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F150882_84041_0|SrvcGrp|86844|2022|PDM|92.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F114848_50533_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F131942_50833_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F138017_73129_0|CSTM-ALL|CSTM-00|2020|PDM|1266.00|99|0.00|AEG 2 (NO REV)|
20|FH_F139927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS|
20|FH_F147080_02446_0|SrvcGrp|91070|2022|PDM|284.00|99|0.00|AETNA MH CRISIS INTERVENTION (HCFA)|
20|FH_F35990_0_0|SrvcGrp|108|2022|PCT|0.75|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN|
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F113826_51445_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F38742_0_0|SrvcGrp|14893|2022|PDM|50.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F76826_0_0|SrvcGrp|76012|2022|PDM|1042.00|99|0.00|EMERGENCY ROOM SVCS LEVEL V|
20|FH_F138453_74135_0|SrvcGrp|112868|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F139247_77657_0|SrvcGrp|14096|2022|PCT|0.73|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F36343_0_0|SrvcGrp|10649|2022|PDM|4.00|99|0.00|HOME INFUSION|
20|FH_F98000_59102_0|SrvcGrp|88977|2022|PDM|6795.00|99|0.00|C-SECTION DELIVERY|
20|FH_F136541_0_0|SrvcGrp|112812|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER|
20|FH_F98940_70506_0|SrvcGrp|90854|2022|PDM|1974.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F119310_20850_0|SrvcGrp|92760|2022|PCT|1.68|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131495_77407_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F41808_0_0|SrvcGrp|12403|2022|PDM|788.55|99|0.00|CONTINUOUS HOMECARE|
20|FH_F113545_11201_0|SrvcGrp|89023|2022|PDM|76.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F39443_0_0|SrvcGrp|30365|2022|PDM|1803.00|99|0.00|HAPA WPA ASC 9|
20|FH_F150313_78666_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F133519_0_0|SrvcGrp|112208|2022|PDM|94.00|99|0.00|DESTROY VAGINAL LESIONS SIMPLE|
20|FH_F94643_90501_0|SrvcGrp|86853|2022|PDM|33.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F122377_91007_0|SrvcGrp|109113|2022|PCT|1.05|99|0.00|CROTALIDAE POLY IMMUNE FAB|
20|FH_F149373_0_0|SrvcGrp|109036|2022|PDM|726.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F97280_20018_0|SrvcGrp|73656|2022|PDM|776.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.00|99|0.00|AEG 2 (NO REV)|
20|FH_F120083_13501_0|SrvcGrp|76501|2022|PDM|250.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F142327_0_0|CSTM-ALL|CSTM-00|2020|PDM|985.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 4 (NO REV)|
20|FH_F103109_33462_0|SrvcGrp|73841|2022|PDM|365.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F92454_0_0|SrvcGrp|90798|2022|PDM|6000.00|99|0.00|IMPLANT SPINE INFUSION PUMP19|
20|FH_F148860_0_0|SrvcGrp|115535|2022|PDM|5900.00|99|0.00|CYSTOURETHROSCOPY|
20|FH_F147303_70508_0|SrvcGrp|48396|2022|PDM|89.00|99|0.00|OT SERVICES|
20|FH_F151699_01752_0|SrvcGrp|21920|2022|PDM|67.50|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F92151_74104_0|SrvcGrp|79699|2022|PCT|0.58|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F128550_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124316_28112_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F114568_08097_0|SrvcGrp|86648|2022|PCT|1.05|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F98000_59102_0|SrvcGrp|73605|2022|PDM|2103.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F34853_0_0|SrvcGrp|20096|2022|PDM|64635.00|99|0.00|MS DRG 222-223 ONLY|
20|FH_F40690_0_0|SrvcGrp|6|2022|PCT|0.92|99|0.00|OP SURGERY|
20|FH_F132160_0_0|SrvcGrp|114443|2022|PDM|10328.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F40899_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|292.86|99|0.00|SALLY BALIN,999182,ASC 106|
20|FH_F117762_0_0|SrvcGrp|92819|2022|PDM|3620.00|99|0.00|HIP ARTHOSCOPY|
20|FH_F134847_0_0|SrvcGrp|41334|2022|PDM|13619.00|99|0.00|TOTAL KNEE|
20|FH_F147303_70508_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 4 (NO REV)|
20|FH_F134732_0_0|SrvcGrp|109136|2022|PDM|2248.00|99|0.00|AV FISTULA REVISION|
20|FH_F35167_0_0|SrvcGrp|115|2022|PDM|1430.00|99|0.00|SKILLED NURSING CARE|
20|FH_F91799_15010_0|SrvcGrp|79458|2022|PDM|0.25|99|0.00|MED RECORD COPY|
20|FH_F150982_0_0|SrvcGrp|109132|2022|PDM|2202.00|99|0.00|ARTHROSCOPIC FRACTURE TX|
20|FH_F147221_49442_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141287_14830_0|SrvcGrp|86444|2022|PCT|0.93|99|0.00|CHEMOTHERAPY AND RADIATION|
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|AEG 5  (NO REV)|
20|FH_F150999_20678_0|SrvcGrp|82981|2022|PDM|137.50|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F97260_06111_0|SrvcGrp|73601|2022|PDM|4490.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F147321_24523_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|79583|2022|PDM|1382.00|99|0.00|CPT 45381|
20|FH_F90455_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F147140_89103_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F111266_30339_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F36202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|MSDRG 619-621 BARIATRIC SERVICES|
20|FH_F52092_0_0|SrvcGrp|12401|2022|PDM|76.00|99|0.00|RN VISIT|
20|FH_F149273_0_0|SrvcGrp|115606|2022|PDM|5098.00|99|0.00|REVISE CERV ARTIFIC DISC|
20|FH_F110727_34994_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|AEG 5  (NO REV)|
20|FH_F146765_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|AETNA OBSERVATION|
20|FH_F39443_0_0|SrvcGrp|30334|2022|PDM|221.00|99|0.00|HAPA WPA ASC 218|
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_F139928_37228_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F140097_19145_0|SrvcGrp|86722|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F140097_19145_0|SrvcGrp|73842|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F143348_16214_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F120512_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F101709_0_0|SrvcGrp|26278|2022|PDM|3045.00|99|0.00|CPT 29881|
20|FH_F130918_01606_0|SrvcGrp|114826|2022|PDM|258.00|99|0.00|INTENSIVE OP (0-17 YRS)|
20|FH_F151720_03301_0|SrvcGrp|74694|2022|PDM|999.00|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F47600_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F48937_0_0|SrvcGrp|10623|2022|PDM|65.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD KN)|
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F120233_24368_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132373_47130_0|SrvcGrp|92760|2022|PCT|0.75|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116756_77477_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F118950_33312_0|SrvcGrp|106048|2022|PDM|1275.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F118815_61021_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F49029_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC|
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|1145.00|99|0.00|ASPG IV|
20|FH_F59732_0_0|SrvcGrp|24747|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F125249_0_0|SrvcGrp|67072|2022|PDM|2500.00|99|0.00|CPT 22845|
20|FH_F53932_0_0|CSTM-ALL|CSTM-00|2020|PCT|53.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93119_0_0|SrvcGrp|592|2022|PDM|1032.08|99|0.00|SUB-ACUTE CARE|
20|FH_F131236_84041_0|SrvcGrp|87799|2022|PDM|93.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F94942_0_0|SrvcGrp|73004|2022|PDM|1257.63|99|0.00|AEG 8|
20|FH_F38341_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|1440.00|99|0.00|AEG 6 (NO REV)|
20|FH_F33712_0_0|SrvcGrp|15370|2022|PCT|0.60|99|0.00|OTHER DIAGNOSTIC|
20|FH_F60072_0_0|CSTM-ALL|CSTM-00|2020|PDM|26200.00|99|0.00|MS DRG 456-482, 490-494|
20|FH_F126678_44870_0|SrvcGrp|95660|2022|PDM|550.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F113410_0_0|SrvcGrp|36591|2022|PDM|3152.00|99|0.00|CPT 63685|
20|FH_F82714_18848_0|SrvcGrp|86444|2022|PCT|0.72|99|0.00|CHEMOTHERAPY AND RADIATION|
20|FH_F125028_19061_0|SrvcGrp|86843|2022|PDM|63.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F133099_66801_0|SrvcGrp|104363|2022|PCT|0.80|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F136510_0_0|SrvcGrp|53703|2022|PDM|2142.00|99|0.00|REVISE AQUEOUS SHUNT TO EXTRAOCULAR RESIVOIR|
20|FH_F88254_33411_0|SrvcGrp|14944|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F124018_75067_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F137943_0_0|SrvcGrp|109738|2022|PDM|2300.00|99|0.00|OCULR RECNSTR; LIMBL CONJNCT|
20|FH_F102302_0_0|SrvcGrp|98592|2022|PDM|10850.00|99|0.00|SPINAL CORD DECOMPRESS LUMBAR|
20|FH_F135249_73114_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F98920_46526_0|CSTM-ALL|CSTM-00|2020|PCT|0.47|99|0.00|OP SVCS|
20|FH_F127567_44070_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F140967_20735_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116237_43235_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130207_33458_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131420_29693_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F96902_0_0|SrvcGrp|90707|2022|PDM|165.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F71070_0_0|SrvcGrp|47532|2022|PDM|2200.00|99|0.00|TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE|
20|FH_F32804_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|25000.00|99|0.00|MSDRG 231-232 CORONARY BYPASS|
20|FH_F54793_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110086_21742_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F33120_0_0|SrvcGrp|3967|2022|PCT|0.80|99|0.00|UNGROUPABLE INPATIENT|
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|AEG 2 (NO REV)|
20|FH_F93094_21227_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F99960_0_0|SrvcGrp|78911|2022|PDM|1760.00|99|0.00|LAPARO HERNIA REPAIR RECUR|
20|FH_F137451_62002_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145815_30540_0|SrvcGrp|113220|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS 22 TRGT SARS-COV-2|
20|FH_F93881_15009_0|SrvcGrp|63457|2022|PDM|237.00|99|0.00|ULTRASOUND|
20|FH_F115020_67301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122536_0_0|CSTM-ALL|CSTM-00|2020|PDM|10964.00|99|0.00|ASPG IV|
20|FH_F36767_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143903_06249_0|SrvcGrp|90397|2022|PDM|300.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F130747_0_0|SrvcGrp|88163|2022|PDM|29131.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47963_0_0|SrvcGrp|25939|2022|PDM|99.00|99|0.00|SPEECH THERAPY|
20|FH_F130747_0_0|SrvcGrp|88820|2022|PDM|4682.00|99|0.00|CPT 24359|
20|FH_F82714_18848_0|CSTM-ALL|CSTM-00|2020|PDM|2403.00|99|0.00|AEG 7 (NO REV)|
20|FH_F71686_0_0|SrvcGrp|47583|2022|PCT|0.85|99|0.00|HOSPICE SVCS|
20|FH_F84215_0_0|SrvcGrp|82572|2022|PDM|961.00|99|0.00|CYSTOSCOPY/CYSTOURETHROSCOPY|
20|FH_F72546_0_0|SrvcGrp|537|2022|PCT|0.63|99|0.00|OBSERVATION SERVICES|
20|FH_F31594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F111288_0_0|SrvcGrp|88737|2022|PDM|8670.00|99|0.00|LAPARO PROC|
20|FH_F120952_25303_0|SrvcGrp|111241|2022|PDM|110.00|99|0.00|PT ASSISTANT|
20|FH_F141794_50548_0|SrvcGrp|112064|2022|PCT|0.75|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F129255_34952_0|SrvcGrp|106048|2022|PDM|702.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F141507_0_0|SrvcGrp|84931|2022|PDM|3000.00|99|0.00|KERATOPLASTY|
20|FH_F92276_32308_0|SrvcGrp|20252|2022|PDM|79170.00|99|0.00|MS DRG 224-225 ONLY|
20|FH_F97540_32114_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F150699_0_0|SrvcGrp|109495|2022|PDM|12296.00|99|0.00|INSERT PULSE GEN DUAL LEADS|
20|FH_F142073_0_0|SrvcGrp|82107|2022|PDM|1700.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F130487_98004_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37945_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2007 LAB/RAD/OTHER DIAG TESTING F/S (MOD TC) - CPD 1365022|
20|FH_F141588_60062_0|SrvcGrp|46903|2022|PDM|989.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F130523_04605_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|GENERAL ACUTE CARE|
20|FH_F143888_32205_0|SrvcGrp|87077|2022|PDM|170.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F38526_0_0|SrvcGrp|23958|2022|PCT|0.65|99|0.00|PHARMACY|
20|FH_F77042_0_0|SrvcGrp|74383|2022|PDM|18.00|99|0.00|SPEECH THERAPY|
20|FH_F32413_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.00|99|0.00|OP SVCS|
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 7 (NO REV)|
20|FH_F139302_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|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_F50218_0_0|SrvcGrp|46240|2022|PDM|120.00|99|0.00|HOME VISIT STOMA/COLOSTOMY/CYSTOSTOMY CARE|
20|FH_F36280_0_0|CSTM-ALL|CSTM-00|2020|PDM|65.00|99|0.00|5781263-GA-PT/OT/ST-CPT|
20|FH_F31840_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F141510_95123_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F50873_0_0|SrvcGrp|44083|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F148266_45419_0|CSTM-ALL|CSTM-00|2020|PDM|699.00|99|0.00|AEG 3 (NO REV)|
20|FH_F92034_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F77544_0_0|SrvcGrp|3809|2022|PDM|575.00|99|0.00|HOSPICE CARE|
20|FH_F76171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135078_73119_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F113410_0_0|SrvcGrp|105258|2022|PDM|946.00|99|0.00|UPPR GI SCOPE DILATE|
20|FH_F129334_43016_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122642_72212_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122688_19904_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130721_04769_0|SrvcGrp|114916|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132925_84041_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F112082_30720_0|SrvcGrp|24761|2022|PDM|75.64|99|0.00|HOME INFUSION THERAPY|
20|FH_F146590_77449_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111908_07677_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F126063_43078_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F117208_0_0|SrvcGrp|106265|2022|PDM|4015.00|99|0.00|NSL/SINS NDSC TOTAL|
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_F51039_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|2010 RADIOLOGY (GLOBAL)|
20|FH_F138147_18018_0|SrvcGrp|89149|2022|PDM|127.00|99|0.00|OP INTENSIVE|
20|FH_F31714_0_0|SrvcGrp|11223|2022|PDM|10700.00|99|0.00|DRG 558 PERC CV PX W/DRUG-ELUTING STENT W/O MAJOR CV DX|
20|FH_F122243_30655_0|SrvcGrp|109037|2022|PDM|958.00|99|0.00|IP PSYCH EATING DISORDERS|
20|FH_F85353_16407_0|SrvcGrp|63764|2022|PDM|1816.62|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1402|
20|FH_F93076_85016_0|SrvcGrp|12030|2022|PDM|1291.40|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F90501_71101_0|SrvcGrp|16429|2022|PDM|550.00|99|0.00|OBSERVATION SVCS|
20|FH_F97840_54729_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F33645_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134170_33410_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F145604_14850_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F145965_50325_0|SrvcGrp|75419|2022|PDM|440.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F134904_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F143742_60410_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|AEG 10 (NO REV)|
20|FH_F110223_31750_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F150536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F81835_0_0|SrvcGrp|74664|2022|PDM|658.54|99|0.00|AETNA SLEEP STUDIES|
20|FH_F133808_73401_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F143561_16001_0|SrvcGrp|48394|2022|PDM|43.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F114525_72401_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F51115_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100782_0_0|SrvcGrp|105073|2022|PDM|587.30|99|0.00|WINDBER MEDICAL CNTR ASC 118|
20|FH_F139169_0_0|SrvcGrp|104911|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F124829_75231_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145942_72019_0|SrvcGrp|89337|2022|PDM|899.00|99|0.00|DETOXIFICATION|
20|FH_F48754_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144248_0_0|SrvcGrp|78046|2022|PCT|1.04|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F118803_0_0|SrvcGrp|68546|2022|PDM|1156.98|99|0.00|CPT 36558|
20|FH_F136359_0_0|SrvcGrp|71666|2022|PDM|8500.00|99|0.00|CPT 63655|
20|FH_F149048_77090_0|SrvcGrp|12659|2022|PDM|960.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F124146_46321_0|SrvcGrp|27968|2022|PDM|25.00|99|0.00|SKILLED NURSING LPN|
20|FH_F76022_0_0|SrvcGrp|11000|2022|PCT|0.85|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F134655_14221_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F108160_0_0|SrvcGrp|82498|2022|PDM|200.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS|
20|FH_F111908_07677_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120608_19901_0|SrvcGrp|46605|2022|PDM|136.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F42799_0_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|OP SVCS|
20|FH_F111986_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F127090_45601_0|SrvcGrp|16750|2022|PDM|127.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F117208_0_0|SrvcGrp|81571|2022|PDM|3410.00|99|0.00|NASAL ENDOSCOPY W/ SINUS OSTIA DILATION|
20|FH_F86112_63501_0|SrvcGrp|74694|2022|PCT|0.47|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.20|99|0.00|AEG 3 (NO REV)|
20|FH_F112082_30720_0|SrvcGrp|26869|2022|PDM|76.22|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F148659_28134_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109405_73106_0|SrvcGrp|90854|2022|PDM|715.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F34182_0_0|SrvcGrp|18148|2022|PDM|2729.00|99|0.00|MS DRG 249|
20|FH_F114526_33401_0|SrvcGrp|86722|2022|PDM|192.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F39015_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F121225_98902_0|SrvcGrp|73602|2022|PDM|1500.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F148521_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F148600_30328_0|CSTM-ALL|CSTM-00|2020|PDM|710.00|99|0.00|AEG 3 (NO REV)|
20|FH_F115616_0_0|SrvcGrp|90063|2022|PDM|3121.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.32|99|0.00|HAPA WPA-NWPA 2012-13 ASC 314 W/O REV|
20|FH_F134650_07921_0|SrvcGrp|82981|2022|PDM|155.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F125244_0_0|SrvcGrp|101526|2022|PDM|5500.00|99|0.00|LAPARO-ASST VAG HYSTERECTOMY|
20|FH_F110980_53566_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F121225_98902_0|SrvcGrp|24754|2022|PCT|0.85|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|2132.00|99|0.00|AEG 8 (NO REV)|
20|FH_F83978_66739_0|SrvcGrp|105465|2022|PCT|1.00|99|0.00|AETNA THERAPIES|
20|FH_F143650_0_0|SrvcGrp|35672|2022|PDM|4000.00|99|0.00|CPT 23412|
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2448.00|99|0.00|AEG 4 (NO REV)|
20|FH_F100782_0_0|SrvcGrp|105085|2022|PDM|461.72|99|0.00|WINDBER MEDICAL CNTR ASC 130|
20|FH_F82591_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134509_14075_0|SrvcGrp|76501|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PDM|751.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F85211_0_0|SrvcGrp|72994|2022|PDM|699.60|99|0.00|AEG 3|
20|FH_F98800_85021_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F105145_75075_0|SrvcGrp|75507|2022|PCT|0.00|99|0.00|CHEMOTHERAPY|
20|FH_F115893_08002_0|SrvcGrp|74615|2022|PDM|450.00|99|0.00|INTENSIVE OUTPATIENT|
20|FH_F115909_38133_0|SrvcGrp|106092|2022|PCT|1.00|99|0.00|DEVELOPMENT SCREEN|
20|FH_F66782_0_0|SrvcGrp|47183|2022|PDM|80.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F146605_72205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146667_37110_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F146673_19085_0|SrvcGrp|109036|2022|PDM|630.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F120795_27514_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F115966_16801_0|SrvcGrp|105581|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F116088_46410_0|SrvcGrp|89149|2022|PDM|161.00|99|0.00|OP INTENSIVE|
20|FH_F131668_97526_0|SrvcGrp|99064|2022|PCT|1.13|99|0.00|RADIOLOGY SERVICES|
20|FH_F117132_0_0|SrvcGrp|104357|2022|PDM|1400.00|99|0.00|DACRYOCYSTORHINOSTOMY|
20|FH_F151053_17602_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151058_18064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151059_60435_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F121385_89102_0|SrvcGrp|105465|2022|PCT|2.07|99|0.00|AETNA THERAPIES|
20|FH_F122007_30701_0|SrvcGrp|57968|2022|PDM|34.91|99|0.00|CONTINUOUS HOMECARE|
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)|
20|FH_F35212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F98040_89406_0|SrvcGrp|73602|2022|PDM|3772.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F98040_89406_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F110000_0_0|SrvcGrp|29285|2022|PCT|1.00|99|0.00|KS FS 1698 RAD MOD 26|
20|FH_F91818_02828_0|SrvcGrp|89149|2022|PDM|171.00|99|0.00|OP INTENSIVE|
20|FH_F114566_46224_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100640_48097_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F103780_64804_0|SrvcGrp|75506|2022|PCT|0.68|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1946.00|99|0.00|AEG 8 (NO REV)|
20|FH_F131494_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F37294_0_0|SrvcGrp|23|2022|PCT|0.80|99|0.00|BONE MARROW TRANSPLANT|
20|FH_F38450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
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_F129597_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|PDM|1028.00|99|0.00|AEG 6 (NO REV)|
20|FH_F141207_0_0|SrvcGrp|80920|2022|PDM|995.00|99|0.00|HOSPICE SERVICES|
20|FH_F42161_0_0|SrvcGrp|3349|2022|PCT|0.88|99|0.00|LITHOTRIPSY SVCS|
20|FH_F47694_0_0|SrvcGrp|58762|2022|PDM|1295.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F82432_0_0|SrvcGrp|65720|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F114389_50131_0|SrvcGrp|43567|2022|PDM|225.33|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F125946_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F124180_0_0|SrvcGrp|77490|2022|PDM|1900.00|99|0.00|AETNA SEPTOPLASTY|
20|FH_F146895_28751_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146972_17931_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F36318_0_0|SrvcGrp|537|2022|PCT|0.45|99|0.00|OBSERVATION SERVICES|
20|FH_F39753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F150910_0_0|SrvcGrp|113854|2022|PDM|4740.00|99|0.00|REMOVE/REINSER SPINE FIXATION DEVICE|
20|FH_F132247_0_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F97040_31901_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F76163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136355_0_0|SrvcGrp|87077|2022|PDM|155.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F113791_32055_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F139113_21804_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F100664_03104_0|SrvcGrp|73485|2022|PDM|3326.00|99|0.00|AETNA REHAB|
20|FH_F148553_85016_0|SrvcGrp|108173|2022|PDM|4409.00|99|0.00|FEM/POPL REVASC STNT & ATHER|
20|FH_F132721_0_0|SrvcGrp|3409|2022|PDM|600.00|99|0.00|NEWBORN NURSERY|
20|FH_F122635_06410_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F42954_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS APC GROUPED|
20|FH_F134727_30650_0|SrvcGrp|73659|2022|PDM|2334.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F136786_25302_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F136930_73114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F136930_73114_0|SrvcGrp|109156|2022|PDM|1346.00|99|0.00|NUCLEAR MEDICINE|
20|FH_F112268_19087_0|SrvcGrp|48396|2022|PDM|84.00|99|0.00|OT SERVICES|
20|FH_F112371_19047_0|SrvcGrp|104748|2022|PDM|2992.00|99|0.00|REPAIR OF ANKLE LIGAMENTS|
20|FH_F112378_60505_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F113713_17013_0|CSTM-ALL|CSTM-00|2020|PDM|85.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION MOD AJ (HCFA)|
20|FH_F115157_06851_0|SrvcGrp|73842|2022|PDM|189.75|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115210_21043_0|SrvcGrp|34606|2022|PDM|3077.00|99|0.00|CPT 29827|
20|FH_F116345_78626_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F132088_34981_0|SrvcGrp|89417|2022|PDM|387.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F133491_74012_0|SrvcGrp|97507|2022|PDM|130.00|99|0.00|AETNA HOSPICE|
20|FH_F134823_33135_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F34477_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DURABLE MEDICAL EQUIPMENT (DME) W/MOD KF - WINN|
20|FH_F35404_0_0|CSTM-ALL|CSTM-00|2020|PDM|4200.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F120635_22903_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F37257_0_0|SrvcGrp|13199|2022|PCT|0.95|99|0.00|TRAUMA CARE|
20|FH_F41013_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F138992_72703_0|SrvcGrp|10365|2022|PDM|974.00|99|0.00|CPT CODE 99285|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|422.69|99|0.00|HAPA WPA-NWPA 2012-13 ASC 217 W/O REV|
20|FH_F151382_30501_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151514_35242_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 4 (NO REV)|
20|FH_F132205_45342_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F132268_07060_0|SrvcGrp|94739|2022|PDM|56.65|99|0.00|NOS FLU VACC IM (>=3 YRS)|
20|FH_F122087_62684_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F135389_43123_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135447_53226_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136186_46307_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F131463_19096_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116431_76104_0|SrvcGrp|88920|2022|PDM|2678.00|99|0.00|AETNA MATERNITY CARE (NORMAL DELIVERY)|
20|FH_F31881_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101819_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|OP SVCS|
20|FH_F127399_0_0|SrvcGrp|100040|2022|PDM|4162.00|99|0.00|REPAIR HUMERUS FRACTURE|
20|FH_F140629_0_0|SrvcGrp|82111|2022|PDM|2497.00|99|0.00|KNEE ARTHROSCOPY SURGICAL|
20|FH_F33785_0_0|SrvcGrp|411|2022|PDM|2800.00|99|0.00|OP CARDIAC CATH|
20|FH_F67425_0_0|SrvcGrp|30135|2022|PDM|7165.00|99|0.00|LAP SURGERY|
20|FH_F99101_24614_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F111341_80501_0|SrvcGrp|104336|2022|PCT|1.00|99|0.00|DENOSUMAB INJECTION|
20|FH_F111363_33169_0|SrvcGrp|82738|2022|PDM|14.00|99|0.00|NON-AUTOMATED WITHOUT MICRO|
20|FH_F134315_89106_0|SrvcGrp|17015|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134315_89106_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|AEG 2 (NO REV)|
20|FH_F34864_0_0|CSTM-ALL|CSTM-00|2020|PDM|3728.00|99|0.00|ASPG IX|
20|FH_F51272_0_0|SrvcGrp|47593|2022|PDM|9000.00|99|0.00|OBSTETRICAL CARE CESAREAN DELIVERY|
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|847.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132328_0_0|SrvcGrp|83641|2022|PDM|4276.00|99|0.00|CPT 29889|
20|FH_F62579_0_0|SrvcGrp|41461|2022|PDM|60.00|99|0.00|ROUTINE SERVICE - INFUSION DEVICE|
20|FH_F63275_0_0|SrvcGrp|22954|2022|PDM|130.61|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F131612_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F130755_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|AEG 2 (NO REV)|
20|FH_F130755_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|AEG 9 (NO REV)|
20|FH_F98002_27103_0|SrvcGrp|88978|2022|PDM|6486.00|99|0.00|VAGINAL DELIVERY|
20|FH_F88698_18951_0|SrvcGrp|43523|2022|PDM|152.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F93076_85016_0|SrvcGrp|3044|2022|PDM|1874.90|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F138348_04096_0|SrvcGrp|108484|2022|PDM|800.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F70883_0_0|SrvcGrp|14372|2022|PDM|30.00|99|0.00|AMBULATORY INFUSION PUMP|
20|FH_F74024_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F120930_0_0|SrvcGrp|83641|2022|PDM|3500.00|99|0.00|CPT 29889|
20|FH_F120123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F93122_01854_0|SrvcGrp|72602|2022|PDM|413.00|99|0.00|ECT|
20|FH_F126042_97005_0|SrvcGrp|73842|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138050_52301_0|SrvcGrp|87800|2022|PCT|1.36|99|0.00|CHEMOTHERAPY ADMINISTRATION|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|177.46|99|0.00|HAPA WPA-NWPA 2012-13 ASC 239 W/O REV|
20|FH_F112791_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88744_71103_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F111957_30024_0|SrvcGrp|472|2022|PDM|775.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F96160_32207_0|SrvcGrp|14948|2022|PCT|0.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F85213_02840_0|SrvcGrp|3378|2022|PCT|1.03|99|0.00|OBSERVATION SVCS|
20|FH_F149027_60402_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F70863_0_0|SrvcGrp|17140|2022|PDM|205.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F133801_87107_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F150222_98026_0|SrvcGrp|74668|2022|PDM|235.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F83995_16748_0|SrvcGrp|12290|2022|PDM|827.00|99|0.00|DETOXIFICATION|
20|FH_F92477_0_0|SrvcGrp|73485|2022|PDM|945.00|99|0.00|AETNA REHAB|
20|FH_F85353_16407_0|SrvcGrp|63903|2022|PDM|156.28|99|0.00|HAPA WPA-NWPA 2012-13 ASC 137|
20|FH_F136359_0_0|SrvcGrp|112852|2022|PDM|5350.00|99|0.00|ORTHOPEDIC SERVICES|
20|FH_F32926_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F133585_0_0|SrvcGrp|103638|2022|PDM|7918.00|99|0.00|AETNA OPEN/PERQ PLACE STENT 1ST|
20|FH_F114409_18447_0|SrvcGrp|93099|2022|PDM|573.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY|
20|FH_F139443_37705_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134326_14094_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134593_60007_0|SrvcGrp|24754|2022|PDM|12.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F85340_98195_0|CSTM-ALL|CSTM-00|2020|PCT|2.83|99|0.00|AETNA - APC GROUPER G|
20|FH_F138240_64114_0|SrvcGrp|48394|2022|PDM|48.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F90453_65203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F81698_10457_0|SrvcGrp|10577|2022|PDM|31.50|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|363.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 121 W/O REV|
20|FH_F87812_33919_0|SrvcGrp|82846|2022|PCT|1.10|99|0.00|AETNA DME|
20|FH_F89323_63033_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148186_0_0|SrvcGrp|13595|2022|PDM|300.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F119227_01752_0|SrvcGrp|26868|2022|PDM|38.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F146207_73139_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150301_23236_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F112712_63005_0|SrvcGrp|104936|2022|PCT|1.00|99|0.00|ALL DRUGS/AGENT/INJ DRUG/NUTRITIONAL SOLUTIONS|
20|FH_F134353_84123_0|SrvcGrp|97506|2022|PDM|94.50|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F125870_0_0|SrvcGrp|72990|2022|PDM|375.00|99|0.00|AEG 1|
20|FH_F121476_0_0|SrvcGrp|108863|2022|PDM|199.00|99|0.00|PERMANENT/LONG TERM NON-DI|
20|FH_F149199_73005_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F134174_63141_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134604_64050_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113368_37752_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F95631_33705_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127526_62917_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114823_15701_0|SrvcGrp|89149|2022|PDM|150.00|99|0.00|OP INTENSIVE|
20|FH_F63398_0_0|SrvcGrp|12591|2022|PDM|150.00|99|0.00|CD FULL DAY|
20|FH_F145604_14850_0|SrvcGrp|24754|2022|PDM|35.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F81483_0_0|SrvcGrp|40307|2022|PDM|1448.00|99|0.00|CVTY ENHANCED ASPG 5|
20|FH_F145641_06902_0|SrvcGrp|114235|2022|PDM|5814.00|99|0.00|BUTTOCK FASCIOTOMY|
20|FH_F85353_16407_0|SrvcGrp|63800|2022|PDM|867.10|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1201|
20|FH_F133951_48310_0|SrvcGrp|81779|2022|PCT|1.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU KL"|
20|FH_F51135_0_0|SrvcGrp|3809|2022|PDM|657.00|99|0.00|HOSPICE CARE|
20|FH_F114525_72401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F43863_0_0|SrvcGrp|37403|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F31524_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149272_64057_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F90594_63304_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F143650_0_0|SrvcGrp|90360|2022|PDM|2800.00|99|0.00|REPAIR FRACTURE OF ULNA|
20|FH_F139380_33062_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132544_0_0|SrvcGrp|97239|2022|PDM|7850.00|99|0.00|DISKECTOMY CERVICAL SINGLE|
20|FH_F119538_60959_0|SrvcGrp|472|2022|PDM|309.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148644_06890_0|SrvcGrp|114442|2022|PDM|7810.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F51859_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|162.28|99|0.00|HAPA WPA-NWPA 2012-13 ASC 236 W/O REV|
20|FH_F37562_0_0|SrvcGrp|26160|2022|PDM|19.50|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F73705_0_0|SrvcGrp|42869|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F149999_33150_0|SrvcGrp|108484|2022|PDM|775.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F88956_0_0|SrvcGrp|82369|2022|PCT|1.33|99|0.00|AETNA LABORATORY|
20|FH_F125471_34471_0|SrvcGrp|46903|2022|PDM|705.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F149940_02645_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F145328_90301_0|SrvcGrp|113326|2022|PDM|5365.00|99|0.00|MED ASSIST TX IMPLANT|
20|FH_F38039_0_0|SrvcGrp|9829|2022|PDM|82.50|99|0.00|PT SVCS|
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|954.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F48929_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136751_0_0|SrvcGrp|97730|2022|PDM|20500.00|99|0.00|REVERSE HIP JOINT|
20|FH_F133391_61032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115505_21014_0|SrvcGrp|473|2022|PDM|320.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F49049_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F97140_91730_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F107082_21015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F133535_32110_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F150532_16801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145881_46011_0|SrvcGrp|74668|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F78542_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F49046_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING|
20|FH_F133021_00910_0|SrvcGrp|112260|2022|PDM|18595.00|99|0.00|MITRAL VALVE REPLACEMENT|
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|740.00|99|0.00|AEG 10 (NO REV)|
20|FH_F133473_21702_0|SrvcGrp|29347|2022|PDM|70.02|99|0.00|HOME HEALTH AIDE|
20|FH_F33096_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F141802_17042_0|SrvcGrp|72984|2022|PCT|0.68|99|0.00|CHEMOTHERAPY|
20|FH_F118025_60641_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F56793_0_0|SrvcGrp|29826|2022|PCT|1.00|99|0.00|AWP  J & Q CODES|
20|FH_F97140_91730_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F105842_70433_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148494_0_0|CSTM-ALL|CSTM-00|2020|PDM|10000.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL|
20|FH_F72859_0_0|SrvcGrp|10573|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F115312_78550_0|SrvcGrp|94879|2022|PDM|87.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F47433_0_0|SrvcGrp|3029|2022|PDM|950.00|99|0.00|NEWBORN NURSERY|
20|FH_F65359_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F145884_72113_0|SrvcGrp|12659|2022|PDM|670.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F40154_0_0|CSTM-ALL|CSTM-00|2020|PDM|2056.00|99|0.00|OBSTETRICAL SERVICES|
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|1356.00|99|0.00|AEG 7 (NO REV)|
20|FH_F103360_68845_0|CSTM-ALL|CSTM-00|2020|PDM|7659.00|99|0.00|AEG 10 (NO REV)|
20|FH_F144468_45236_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100661_63640_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F31530_0_0|SrvcGrp|9539|2022|PDM|375.00|99|0.00|SUBACUTE CARE|
20|FH_F119437_0_0|SrvcGrp|58993|2022|PDM|4750.00|99|0.00|DISKECTOMY|
20|FH_F80532_0_0|SrvcGrp|64838|2022|PDM|130.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F111809_93003_0|SrvcGrp|103913|2022|PCT|9.10|99|0.00|OP DIALYSIS|
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141411_0_0|SrvcGrp|113759|2022|PDM|1500.00|99|0.00|REMOVAL OF SKIN LESION|
20|FH_F97564_52246_0|SrvcGrp|73605|2022|PDM|2103.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F141870_85224_0|SrvcGrp|26869|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F133350_39532_0|SrvcGrp|87317|2022|PDM|1750.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F39517_0_0|CSTM-ALL|CSTM-00|2020|PDM|6100.00|99|0.00|CV SURGERY (MS DRG)|
20|FH_F38977_0_0|CSTM-ALL|CSTM-00|2020|PDM|1043.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149840_80002_0|SrvcGrp|53145|2022|PDM|135.00|99|0.00|SOCIAL WORKER|
20|FH_F41976_0_0|CSTM-ALL|CSTM-00|2020|PDM|360.00|99|0.00|MARLBORO GASTRO GI PROCEDURES 360|
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 3 (NO REV)|
20|FH_F67763_0_0|SrvcGrp|64297|2022|PDM|280.00|99|0.00|CAPD|
20|FH_F133367_40065_0|CSTM-ALL|CSTM-00|2020|PDM|1129.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F150019_19380_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F92676_15063_0|SrvcGrp|78942|2022|PDM|3190.46|99|0.00|MON VALLEY ASC 7|
20|FH_F67680_0_0|CSTM-ALL|CSTM-00|2020|PDM|135.00|99|0.00|OP SVCS|
20|FH_F87577_80016_0|SrvcGrp|9263|2022|PDM|330.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F91194_33511_0|SrvcGrp|38004|2022|PDM|4750.00|99|0.00|CPT CODE 59400|
20|FH_F92676_15063_0|SrvcGrp|78946|2022|PDM|3125.01|99|0.00|MON VALLEY ASC 1406|
20|FH_F141947_63367_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118541_15222_0|SrvcGrp|107714|2022|PDM|113.00|99|0.00|HOSPITAL OBSERVATION PER HR|
20|FH_F141612_19605_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F133167_82930_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|2028.00|99|0.00|AEG 8 (NO REV)|
20|FH_F106540_26330_0|SrvcGrp|101601|2022|PDM|730.00|99|0.00|ULTRASOUND W/ER|
20|FH_F38663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|BURMANS APOTHECARY IV THERAPY MOD 53|
20|FH_F34719_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F41845_0_0|SrvcGrp|110|2022|PDM|475.00|99|0.00|CD - REHABILITATION|
20|FH_F78003_0_0|SrvcGrp|30094|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY|
20|FH_F132544_0_0|SrvcGrp|97019|2022|PDM|4186.00|99|0.00|ARTHROSCOPY BICEPS TENODESIS|
20|FH_F119507_92627_0|SrvcGrp|108484|2022|PDM|750.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F119413_95123_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F137951_0_0|SrvcGrp|90365|2022|PDM|1436.00|99|0.00|REPAIR METACARPAL FRACTURE|
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|713.00|99|0.00|AEG 2 (NO REV)|
20|FH_F148544_60439_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148548_37909_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 10 (NO REV)|
20|FH_F148554_85016_0|SrvcGrp|115457|2022|PDM|1530.00|99|0.00|REMOVE ELECTRODE TRANSVENOUSLY|
20|FH_F142775_72801_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128130_10027_0|CSTM-ALL|CSTM-00|2020|PDM|7166.00|99|0.00|AEG 7 (NO REV)|
20|FH_F148907_01810_0|SrvcGrp|109036|2022|PDM|500.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F148493_38008_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MOD TC|
20|FH_F146132_76801_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125049_44131_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F133493_90255_0|SrvcGrp|13187|2022|PCT|0.25|99|0.00|INTRAOCULAR LENSES|
20|FH_F67560_0_0|SrvcGrp|17079|2022|PCT|0.83|99|0.00|ASPG VIII|
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|3059.00|99|0.00|AEG 9 (NO REV)|
20|FH_F132571_24739_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148556_13206_0|SrvcGrp|10578|2022|PDM|31.00|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F129535_0_0|SrvcGrp|75489|2022|PDM|645.00|99|0.00|AEG 6|
20|FH_F127412_15301_0|SrvcGrp|46884|2022|PDM|700.00|99|0.00|REPAIR EYELID DEFECT|
20|FH_F124928_04210_0|SrvcGrp|27969|2022|PDM|19.81|99|0.00|HOME HEALTH AIDE|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|129.00|99|0.00|PSYTX W PT 60 MINS|
20|FH_F81737_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120437_85202_0|SrvcGrp|108455|2022|PCT|1.12|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O VL|
20|FH_F102561_75146_0|SrvcGrp|82720|2022|PDM|4903.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F39517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F98060_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F68622_0_0|SrvcGrp|58642|2022|PDM|415.00|99|0.00|DIALYSIS|
20|FH_F123096_28210_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PDM|709.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F101104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F50297_0_0|SrvcGrp|42971|2022|PDM|87.00|99|0.00|SKN RN|
20|FH_F133167_82930_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150059_54494_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F126733_83713_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F132547_39180_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37573_0_0|SrvcGrp|3066|2022|PCT|0.83|99|0.00|HIGH-COST DRUGS|
20|FH_F111467_33761_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F123872_75006_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F119128_93619_0|SrvcGrp|89149|2022|PDM|350.00|99|0.00|OP INTENSIVE|
20|FH_F148881_33018_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F108700_63857_0|SrvcGrp|89783|2022|PDM|108.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F141870_85224_0|SrvcGrp|86842|2022|PDM|35.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117368_68114_0|SrvcGrp|33165|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F134490_62801_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 5  (NO REV)|
20|FH_F56792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1173.00|99|0.00|ASPG III WITH MOD SG|
20|FH_F100700_20110_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F88280_0_0|SrvcGrp|13185|2022|PDM|1916.00|99|0.00|ICU/CCU|
20|FH_F89851_83854_0|SrvcGrp|31028|2022|PDM|12641.00|99|0.00|MS DRG 489 ONLY|
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1561.00|99|0.00|AEG 5  (NO REV)|
20|FH_F117855_62246_0|SrvcGrp|88621|2022|PDM|70.00|99|0.00|SKILLED NURSING LPN|
20|FH_F118363_30305_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|740.00|99|0.00|AEG 3 (NO REV)|
20|FH_F102681_34237_0|SrvcGrp|29830|2022|PDM|1500.00|99|0.00|PERCUT NEEDLE INSERTION|
20|FH_F126663_91423_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 2 (NO REV)|
20|FH_F136752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151521_45882_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138054_0_0|SrvcGrp|48385|2022|PDM|146.00|99|0.00|SPEECH THERAPY|
20|FH_F126560_43606_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F69610_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F100788_01420_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F44314_0_0|SrvcGrp|33165|2022|PDM|325.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F131974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F100700_20110_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130652_51101_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F56793_0_0|SrvcGrp|29462|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE - MOD TF|
20|FH_F120658_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F49732_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|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_F125176_20785_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F92648_90248_0|SrvcGrp|48396|2022|PDM|89.25|99|0.00|OT SERVICES|
20|FH_F111815_35904_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F127011_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92641_34994_0|SrvcGrp|75545|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F134234_49525_0|SrvcGrp|89149|2022|PDM|150.00|99|0.00|OP INTENSIVE|
20|FH_F51039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1112.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97840_54729_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F124917_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|346.45|99|0.00|AEG 10 (NO REV)|
20|FH_F98741_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F126308_44515_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132969_84003_0|SrvcGrp|86828|2022|PDM|10.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F112041_19020_0|SrvcGrp|472|2022|PDM|477.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F119379_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F126085_76002_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119864_63141_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F54592_0_0|SrvcGrp|27969|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE|
20|FH_F134489_90305_0|SrvcGrp|89149|2022|PDM|315.00|99|0.00|OP INTENSIVE|
20|FH_F85894_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|JERSEY SHORE RAD- GH|
20|FH_F72768_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|P.R. HORTON IV THERAPY MOD SJ|
20|FH_F72963_0_0|SrvcGrp|11258|2022|PCT|0.44|99|0.00|DRUGS|
20|FH_F79644_0_0|CSTM-ALL|CSTM-00|2020|PDM|1379.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115936_75093_0|SrvcGrp|104079|2022|PCT|1.06|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F146501_68025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120528_60559_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F120811_53525_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132928_64114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139368_57043_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150662_20901_0|SrvcGrp|48398|2022|PDM|153.00|99|0.00|PT SERVICES|
20|FH_F150782_19444_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150862_75082_0|SrvcGrp|74668|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1575124_HCPCS_  MOD KN|
20|FH_F149003_62208_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F125656_92868_0|SrvcGrp|17007|2022|PDM|40.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS|
20|FH_F76826_0_0|SrvcGrp|76008|2022|PDM|294.00|99|0.00|EMERGENCY ROOM SVCS LEVEL I|
20|FH_F39450_0_0|CSTM-ALL|CSTM-00|2020|PDM|1921.00|99|0.00|MS DRG 216-221, 228-236|
20|FH_F130813_85014_0|SrvcGrp|87317|2022|PDM|795.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F35967_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|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_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132160_0_0|SrvcGrp|106235|2022|PDM|6885.00|99|0.00|CYPASS|
20|FH_F35557_0_0|SrvcGrp|15515|2022|PDM|54.00|99|0.00|HYDRATION THERAPY|
20|FH_F32236_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|803.00|99|0.00|ASPG V - GNADEN HUETTEN|
20|FH_F111266_30339_0|SrvcGrp|86846|2022|PDM|30.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F136779_0_0|SrvcGrp|91522|2022|PDM|1380.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F34792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149582_01534_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39772_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (HCFA)|
20|FH_F109160_63129_0|SrvcGrp|86722|2022|PDM|203.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F124441_0_0|SrvcGrp|77444|2022|PDM|2185.00|99|0.00|VASECTOMY|
20|FH_F150982_0_0|SrvcGrp|88596|2022|PDM|1976.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE|
20|FH_F72788_0_0|CSTM-ALL|CSTM-00|2020|PDM|1541.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F97080_85122_0|SrvcGrp|73559|2022|PDM|11720.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F39082_0_0|SrvcGrp|997|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F151024_30024_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F36323_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114825_32789_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F98860_96706_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F150323_68847_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131942_50833_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F35557_0_0|SrvcGrp|11791|2022|PDM|52.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F147220_49417_0|SrvcGrp|42622|2022|PDM|638.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F122333_67010_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|1997.00|99|0.00|AEG 5  (NO REV)|
20|FH_F109470_15370_0|SrvcGrp|73643|2022|PDM|690.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F35384_0_0|CSTM-ALL|CSTM-00|2020|PDM|1830.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36343_0_0|SrvcGrp|22399|2022|PDM|24.00|99|0.00|A4663|
20|FH_F148181_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149579_95815_0|SrvcGrp|72602|2022|PDM|1200.00|99|0.00|ECT|
20|FH_F142370_0_0|SrvcGrp|113549|2022|PDM|35.92|99|0.00|COVID-19 DIAGNOSTIC|
20|FH_F147303_70508_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F131261_19111_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F97082_90012_0|SrvcGrp|73485|2022|PDM|7661.00|99|0.00|AETNA REHAB|
20|FH_F132512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F42979_0_0|SrvcGrp|3405|2022|PDM|54.00|99|0.00|CPT 99212|
20|FH_F35369_0_0|SrvcGrp|16|2022|PDM|1100.00|99|0.00|ACUTE REHABILITATION|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1502.00|99|0.00|AEG 7 (NO REV)|
20|FH_F123570_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F126735_38018_0|SrvcGrp|108484|2022|PDM|1200.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F148001_15601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109242_18466_0|SrvcGrp|98040|2022|PDM|12.24|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F139428_65270_0|SrvcGrp|48385|2022|PDM|97.85|99|0.00|SPEECH THERAPY|
20|FH_F139666_26175_0|SrvcGrp|75506|2022|PCT|0.94|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F139673_63011_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139680_76006_0|SrvcGrp|73841|2022|PDM|473.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F150767_34741_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150768_03054_0|SrvcGrp|46104|2022|PDM|164.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F150861_92592_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F150881_52722_0|SrvcGrp|74668|2022|PDM|277.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F113545_11201_0|SrvcGrp|90643|2022|PDM|20.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F143668_0_0|SrvcGrp|114069|2022|PDM|11.00|99|0.00|SEGMENTAL PNEUMATIC (MOD RR)|
20|FH_F110783_93013_0|SrvcGrp|104141|2022|PCT|1.00|99|0.00|AETNA - ALL OUTPATIENT DRUGS|
20|FH_F137731_92262_0|SrvcGrp|108484|2022|PDM|650.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F97640_37043_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F142694_0_0|SrvcGrp|82981|2022|PDM|250.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F33566_0_0|SrvcGrp|20075|2022|PDM|7427.00|99|0.00|MS DRG 286 ONLY|
20|FH_F148667_0_0|SrvcGrp|98003|2022|PDM|2727.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F130309_17044_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F111038_62960_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS|
20|FH_F35732_32308_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS|
20|FH_F38007_0_0|SrvcGrp|27889|2022|PCT|0.95|99|0.00|TRAUMA|
20|FH_F114825_32789_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_F42352_0_0|SrvcGrp|269|2022|PCT|0.65|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F101280_63111_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115982_0_0|SrvcGrp|26275|2022|PDM|1800.00|99|0.00|CPT 29826|
20|FH_F75207_0_0|SrvcGrp|21815|2022|PDM|120.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F130202_68003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134869_08854_0|SrvcGrp|105047|2022|PDM|300.00|99|0.00|AETNA PSYCH DIAG EVAL W/ MED SVCS (HCFA)|
20|FH_F132860_0_0|SrvcGrp|72|2022|PDM|466.00|99|0.00|NEWBORN NURSERY|
20|FH_F120040_72703_0|SrvcGrp|12659|2022|PDM|914.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F124739_64429_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150941_68124_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F86714_0_0|SrvcGrp|45540|2022|PDM|177.61|99|0.00|PHYSICAL THERAPY|
20|FH_F117615_30525_0|SrvcGrp|75491|2022|PCT|0.85|99|0.00|AEG 7|
20|FH_F39443_0_0|SrvcGrp|30361|2022|PDM|1120.00|99|0.00|HAPA WPA ASC 6|
20|FH_F147080_02446_0|SrvcGrp|88905|2022|PDM|1167.00|99|0.00|PSYCHIATRIC CARE (AGE 0-17)|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|33122.00|99|0.00|MS DRGS 222-227 AICD INSERTION|
20|FH_F114206_37203_0|SrvcGrp|86838|2022|PDM|15.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F119946_36109_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F40490_0_0|SrvcGrp|10944|2022|PCT|0.58|99|0.00|EMERGENCY ROOM|
20|FH_F151619_73505_0|SrvcGrp|75493|2022|PDM|1124.00|99|0.00|AEG 8|
20|FH_F34882_0_0|SrvcGrp|17548|2022|PCT|0.60|99|0.00|HIGH COST DRUGS|
20|FH_F98000_59102_0|SrvcGrp|73603|2022|PDM|9293.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F122396_90024_0|SrvcGrp|75419|2022|PDM|964.47|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F119897_78229_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F107980_08005_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1461.00|99|0.00|AEG 8 (NO REV)|
20|FH_F50100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F56813_0_0|SrvcGrp|16|2022|PDM|2197.00|99|0.00|ACUTE REHABILITATION|
20|FH_F128821_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F110783_93013_0|SrvcGrp|86852|2022|PDM|35.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F76522_0_0|SrvcGrp|16719|2022|PCT|0.45|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F138478_0_0|SrvcGrp|109509|2022|PDM|6974.46|99|0.00|REMOVE PACEMAKER SYSTEM|
20|FH_F35753_33770_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147359_54911_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45226_0_0|SrvcGrp|27767|2022|PDM|40.00|99|0.00|SKILLED IV NURSING HOURLY|
20|FH_F138018_17313_0|SrvcGrp|24762|2022|PDM|98.64|99|0.00|HOME INFUSION THERAPY|
20|FH_F37385_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|GENERAL ACUTE CARE|
20|FH_F116806_0_0|SrvcGrp|107086|2022|PDM|1780.06|99|0.00|REPAIR OF FACIAL NERVE|
20|FH_F98820_81401_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94643_90501_0|SrvcGrp|86840|2022|PDM|38.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F147260_53227_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F138017_73129_0|CSTM-ALL|CSTM-00|2020|PDM|2802.00|99|0.00|AEG 8 (NO REV)|
20|FH_F140295_0_0|SrvcGrp|93431|2022|PDM|13261.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F147216_48307_0|SrvcGrp|42622|2022|PDM|625.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F138017_73129_0|SrvcGrp|77021|2022|PDM|8949.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|HAPA EPA ASC 43|
20|FH_F137986_0_0|SrvcGrp|34606|2022|PDM|3223.00|99|0.00|CPT 29827|
20|FH_F111080_18103_0|SrvcGrp|86723|2022|PDM|330.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F150419_64119_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F34882_0_0|SrvcGrp|18124|2022|PCT|0.65|99|0.00|MS DRG 004|
20|FH_F117617_80439_0|SrvcGrp|48385|2022|PDM|150.00|99|0.00|SPEECH THERAPY|
20|FH_F130182_0_0|SrvcGrp|109450|2022|PDM|1457.00|99|0.00|R HRT ART/GRFT ANGIO|
20|FH_F139928_37228_0|SrvcGrp|3178|2022|PDM|1269.00|99|0.00|ACUTE PSYCH|
20|FH_F143249_89801_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F143494_34474_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103140_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F114931_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F151755_03303_0|SrvcGrp|473|2022|PDM|391.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F151764_03801_0|SrvcGrp|473|2022|PDM|391.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F46893_0_0|CSTM-ALL|CSTM-00|2020|PDM|1482.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F47056_0_0|SrvcGrp|3809|2022|PDM|550.00|99|0.00|HOSPICE CARE|
20|FH_F47056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48473_0_0|SrvcGrp|9828|2022|PDM|44.00|99|0.00|HOME HEALTH AIDE|
20|FH_F120799_92651_0|SrvcGrp|87317|2022|PDM|1250.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F112712_63005_0|SrvcGrp|14945|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F125479_17501_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F84411_32063_0|SrvcGrp|3066|2022|PCT|0.52|99|0.00|HIGH-COST DRUGS|
20|FH_F44438_0_0|SrvcGrp|11199|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER|
20|FH_F39355_0_0|SrvcGrp|16718|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS|
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_F100783_03431_0|SrvcGrp|73485|2022|PDM|4185.00|99|0.00|AETNA REHAB|
20|FH_F33381_0_0|SrvcGrp|18143|2022|PDM|16926.00|99|0.00|MS DRG 247|
20|FH_F128031_0_0|SrvcGrp|73616|2022|PDM|1141.00|99|0.00|AETNA WRIST ENDOSCOPY|
20|FH_F37626_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BERKELEY ASC FS|
20|FH_F49895_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F59732_0_0|SrvcGrp|21711|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F77463_0_0|SrvcGrp|33164|2022|PDM|275.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F82714_18848_0|SrvcGrp|113831|2022|PDM|56.44|99|0.00|INFECTIOUS AGENT DETECTION|
20|FH_F121535_60018_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F117484_15601_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F141527_36830_0|SrvcGrp|86839|2022|PDM|26.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F130527_66044_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F129408_48034_0|SrvcGrp|82222|2022|PDM|140.00|99|0.00|HOSPICE CARE|
20|FH_F78343_0_0|SrvcGrp|35964|2022|PDM|45.00|99|0.00|SPEECH THERAPY|
20|FH_F82714_18848_0|CSTM-ALL|CSTM-00|2020|PDM|1066.00|99|0.00|AEG 3 (NO REV)|
20|FH_F32704_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151780_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82753_18840_0|SrvcGrp|111930|2022|PDM|14.30|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|7482.00|99|0.00|AEG 7 (NO REV)|
20|FH_F123468_63384_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147941_06023_0|CSTM-ALL|CSTM-00|2020|PDM|4320.00|99|0.00|AEG 1 (NO REV)|
20|FH_F128272_60640_0|SrvcGrp|63156|2022|PCT|0.85|99|0.00|IMMUNE GLOBULIN INTRAVENOUS|
20|FH_F140427_0_0|SrvcGrp|109507|2022|PDM|2500.00|99|0.00|INSRT PULSE GEN W/ MULT LEADS|
20|FH_F90157_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F87619_0_0|SrvcGrp|73008|2022|PDM|567.00|99|0.00|AEG 10|
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|980.00|99|0.00|AEG 3 (NO REV)|
20|FH_F103100_47150_0|SrvcGrp|73002|2022|PDM|1897.00|99|0.00|AEG 7|
20|FH_F130138_02915_0|CSTM-ALL|CSTM-00|2020|PCT|0.96|99|0.00|OP SVCS|
20|FH_F100984_0_0|SrvcGrp|97440|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F148483_94087_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115985_0_0|SrvcGrp|79804|2022|PDM|1585.00|99|0.00|AETNA MEDICAL/SURGICAL|
20|FH_F126964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111826_0_0|SrvcGrp|72998|2022|PDM|1100.00|99|0.00|AEG 5|
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139551_0_0|SrvcGrp|67072|2022|PDM|4411.00|99|0.00|CPT 22845|
20|FH_F138416_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|HOSPICE SVCS|
20|FH_F141410_13045_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F93880_95476_0|SrvcGrp|73483|2022|PDM|1110.00|99|0.00|AETNA SUBACUTE III|
20|FH_F143783_0_0|SrvcGrp|83522|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F75382_0_0|SrvcGrp|72759|2022|PCT|0.50|99|0.00|IMPLANTS/PACEMAKER/PROSTHETICS/ORTHOTICS|
20|FH_F149866_07401_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F113546_0_0|SrvcGrp|88620|2022|PDM|90.00|99|0.00|SKILLED NURSING RN|
20|FH_F60019_0_0|SrvcGrp|3259|2022|PDM|1342.00|99|0.00|ACUTE REHABILITATION|
20|FH_F126439_92627_0|SrvcGrp|46903|2022|PDM|935.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|2318.00|99|0.00|AETNA CPT 49560|
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|501.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132779_0_0|SrvcGrp|73602|2022|PDM|517.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F47656_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F98920_46526_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F37679_0_0|SrvcGrp|14949|2022|PDM|80.00|99|0.00|HOME INFUSION|
20|FH_F92276_32308_0|SrvcGrp|103699|2022|PDM|821.00|99|0.00|ECT (AGE 18-64)|
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|SKILLED NURSING SERVICES (15 MINS)|
20|FH_F31968_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 5  (NO REV)|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 471-473 CERVICAL FUSION|
20|FH_F126784_80809_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F36993_0_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|DBPT PT-OT-ST|
20|FH_F145884_72113_0|SrvcGrp|46903|2022|PDM|540.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F146241_91326_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PDM|654.00|99|0.00|EATING DISORDER PARTIAL HOSPITAL|
20|FH_F38394_0_0|SrvcGrp|17073|2022|PDM|1140.00|99|0.00|ASPG V|
20|FH_F133561_70364_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117891_19034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97560_23249_0|SrvcGrp|90854|2022|PDM|4049.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F36579_0_0|SrvcGrp|23235|2022|PCT|0.65|99|0.00|DME (GLOBAL)|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|336.92|99|0.00|ASPG 106|
20|FH_F97201_15068_0|SrvcGrp|73701|2022|PDM|27.50|99|0.00|AETNA - SKILLED NURSING|
20|FH_F132551_39194_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
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_F92676_15063_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|GENERAL ACUTE CARE|
20|FH_F112862_46176_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132543_79549_0|SrvcGrp|91177|2022|PDM|300.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F126560_43606_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|PSYTX W PT 30 MINS (HCFA)|
20|FH_F81494_0_0|SrvcGrp|10419|2022|PDM|827.00|99|0.00|SKILLED NURSING CARE|
20|FH_F108940_15642_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151048_15122_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151122_10462_0|SrvcGrp|23683|2022|PDM|42.00|99|0.00|SKILLED NURSING RN|
20|FH_F139159_76011_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139597_07009_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F151000_20707_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137748_95231_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F35097_16508_0|SrvcGrp|33414|2022|PDM|255.00|99|0.00|SNF VENTILATOR SUPPORT|
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|1314.00|99|0.00|AEG 9 (NO REV)|
20|FH_F134847_0_0|SrvcGrp|65625|2022|PDM|2774.00|99|0.00|CPT 30520|
20|FH_F99920_63141_0|SrvcGrp|97705|2022|PDM|110.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F127553_44321_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|1942.00|99|0.00|AEG 9 (NO REV)|
20|FH_F140295_0_0|SrvcGrp|84939|2022|PDM|18025.00|99|0.00|SHOULDER JOINT|
20|FH_F150982_0_0|SrvcGrp|111803|2022|PDM|1927.00|99|0.00|EXCISION OF URETHRA LESION|
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 4 (NO REV)|
20|FH_F142327_0_0|SrvcGrp|95819|2022|PDM|2800.00|99|0.00|GONIOTOMY|
20|FH_F123745_0_0|SrvcGrp|16289|2022|PDM|2200.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F136376_0_0|SrvcGrp|73841|2022|PDM|447.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|4500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139814_24333_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|1592.00|99|0.00|ASPG II|
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|589.00|99|0.00|AEG 4 (NO REV)|
20|FH_F35387_0_0|SrvcGrp|15361|2022|PDM|3351.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F139576_0_0|SrvcGrp|113721|2022|PDM|2308.00|99|0.00|CYSTOURETHROSCOPY|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F149619_81008_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145863_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS|
20|FH_F147532_0_0|SrvcGrp|87798|2022|PDM|144.84|99|0.00|HOSPICE CARE (ALL OTHER)(HCFA)|
20|FH_F127418_0_0|SrvcGrp|110768|2022|PDM|5009.38|99|0.00|3RD LEVEL INJ PARAVERT F JNT L/S|
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|AEG 6 (NO REV)|
20|FH_F134847_0_0|SrvcGrp|65403|2022|PDM|2785.00|99|0.00|CPT 42830|
20|FH_F139715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|OP SVCS|
20|FH_F116753_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F147220_49417_0|SrvcGrp|42623|2022|PDM|539.00|99|0.00|SUBACUTE - LEVEL III|
20|FH_F47037_0_0|SrvcGrp|16302|2022|PDM|42.00|99|0.00|VENIPUNCTURE|
20|FH_F56054_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP CLINIC|
20|FH_F110828_32757_0|SrvcGrp|81779|2022|PCT|1.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F37304_0_0|SrvcGrp|26183|2022|PCT|1.00|99|0.00|IMPLANTS W/O ASC SC 8981 8985|
20|FH_F37312_0_0|SrvcGrp|11796|2022|PDM|71.50|99|0.00|DIETICIAN|
20|FH_F97183_25304_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F36343_0_0|SrvcGrp|22595|2022|PDM|90.00|99|0.00|SPECIAL NURSE VISIT (SUBSQ. W/O INFUSION)|
20|FH_F97880_63501_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F41342_0_0|SrvcGrp|16173|2022|PDM|275.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F111246_80027_0|SrvcGrp|75545|2022|PDM|450.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F138018_17313_0|SrvcGrp|14949|2022|PDM|41.72|99|0.00|HOME INFUSION|
20|FH_F122419_37043_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F40624_0_0|SrvcGrp|11336|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F32393_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F117617_80439_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147080_02446_0|SrvcGrp|17698|2022|PDM|1104.00|99|0.00|ACUTE PSYCH (>=18 YRS)|
20|FH_F92300_37303_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F36634_0_0|SrvcGrp|3029|2022|PDM|370.00|99|0.00|NEWBORN NURSERY|
20|FH_F39443_0_0|SrvcGrp|30341|2022|PDM|116.00|99|0.00|HAPA WPA ASC 225|
20|FH_F105221_01757_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F76171_0_0|SrvcGrp|48381|2022|PDM|250.00|99|0.00|ST SVCS INITIAL EVAL 92506 VISIT LEVEL|
20|FH_F93881_15009_0|SrvcGrp|81404|2022|PDM|37.00|99|0.00|THERAPEUTIC DRUG ASSAYS|
20|FH_F123331_45373_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148255_72703_0|SrvcGrp|115361|2022|PCT|1.05|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F107782_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F78165_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116747_0_0|SrvcGrp|48398|2022|PDM|91.00|99|0.00|PT SERVICES|
20|FH_F125011_74467_0|SrvcGrp|73000|2022|PDM|2415.00|99|0.00|AEG 6|
20|FH_F135065_08043_0|SrvcGrp|89337|2022|PDM|1200.00|99|0.00|DETOXIFICATION|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|481.86|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26 AND TC)|
20|FH_F151541_01436_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92276_32308_0|SrvcGrp|26690|2022|PDM|167370.00|99|0.00|MS DRG 215 ONLY|
20|FH_F78048_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F135236_02840_0|SrvcGrp|115762|2022|PCT|1.01|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F40043_0_0|SrvcGrp|9506|2022|PDM|2792.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F118194_50841_0|SrvcGrp|14944|2022|PDM|16.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F129345_60623_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143894_70001_0|SrvcGrp|113191|2022|PCT|0.00|99|0.00|HOME HEALTH|
20|FH_F123278_20850_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F83592_17837_0|CSTM-ALL|CSTM-00|2020|PCT|1.46|99|0.00|AETNA IP MCARE2 OCN F/S PRICING|
20|FH_F100790_10512_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F81481_0_0|SrvcGrp|75479|2022|PDM|945.00|99|0.00|AEG 1|
20|FH_F132559_0_0|SrvcGrp|27344|2022|PDM|1635.00|99|0.00|OP SURGERY (CPT 42821)|
20|FH_F128276_66441_0|SrvcGrp|108484|2022|PDM|250.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F116923_85259_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149404_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F148221_06477_0|SrvcGrp|46605|2022|PDM|105.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F124388_0_0|SrvcGrp|77444|2022|PDM|1254.00|99|0.00|VASECTOMY|
20|FH_F127567_44070_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F63541_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F117783_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|21843.00|99|0.00|MS DRG 237|
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)|
20|FH_F66501_0_0|SrvcGrp|10544|2022|PDM|70.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F141802_17042_0|SrvcGrp|113084|2022|PCT|0.00|99|0.00|CARDIAC CATH NOT REIMBURSED|
20|FH_F33642_0_0|SrvcGrp|15355|2022|PCT|0.60|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)|
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG IX|
20|FH_F87092_60101_0|SrvcGrp|72992|2022|PDM|1523.00|99|0.00|AEG 2|
20|FH_F57073_0_0|SrvcGrp|16|2022|PDM|1140.00|99|0.00|ACUTE REHABILITATION|
20|FH_F89736_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|1423.00|99|0.00|AEG 10 (NO REV)|
20|FH_F88635_32955_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|2455.00|99|0.00|AEG 4 (NO REV)|
20|FH_F148425_01507_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F148501_21550_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148554_85016_0|SrvcGrp|15026|2022|PDM|3641.00|99|0.00|CARDIOVERTER DEFIBRILLATOR INSERTION (SINGLE OR DUAL)|
20|FH_F148644_06890_0|SrvcGrp|104006|2022|PDM|8487.00|99|0.00|LAPS ABLATION UTERINE FIBROIDS|
20|FH_F150600_44270_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148040_90631_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|2658.00|99|0.00|ASPG VIII|
20|FH_F55375_0_0|SrvcGrp|51470|2022|PDM|140.00|99|0.00|SOCIAL WORKER VISIT|
20|FH_F44607_0_0|SrvcGrp|17071|2022|PDM|2300.00|99|0.00|ASPG IV|
20|FH_F38410_0_0|SrvcGrp|10540|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133293_49085_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F68479_0_0|SrvcGrp|103389|2022|PDM|25.00|99|0.00|PT INITIAL VISIT|
20|FH_F141217_0_0|SrvcGrp|27261|2022|PDM|9500.00|99|0.00|CPT 27446|
20|FH_F80362_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F34706_0_0|SrvcGrp|11107|2022|PDM|2917.00|99|0.00|CARDIAC CATH|
20|FH_F43433_0_0|SrvcGrp|32444|2022|PDM|3592.00|99|0.00|JACKSON MADISON HOSP ASPG 8|
20|FH_F144318_32696_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.05|99|0.00|ASPG 305|
20|FH_F129535_0_0|SrvcGrp|82307|2022|PDM|550.00|99|0.00|COLORECTAL CANCER SCREENING|
20|FH_F37575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45932_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|ASPG X|
20|FH_F149999_33150_0|SrvcGrp|46903|2022|PDM|775.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132272_16127_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|OP SVCS|
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|432.00|99|0.00|AEG 2 (NO REV)|
20|FH_F57592_0_0|SrvcGrp|14280|2022|PDM|2400.00|99|0.00|PET SCAN|
20|FH_F141870_85224_0|SrvcGrp|86836|2022|PDM|25.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F87436_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS|
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145941_64119_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F89015_74017_0|SrvcGrp|87396|2022|PDM|110.00|99|0.00|HCPCS G0155 (HCFA)|
20|FH_F97581_60141_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F144888_15370_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133271_72204_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F114585_11501_0|SrvcGrp|90643|2022|PDM|20.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F125182_0_0|SrvcGrp|79583|2022|PDM|2028.00|99|0.00|CPT 45381|
20|FH_F149619_81008_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35174_0_0|SrvcGrp|3818|2022|PDM|4507.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F128698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F130661_04441_0|SrvcGrp|81779|2022|PCT|4.24|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|6.00|99|0.00|PICC LINE CATHETER CARE (MOD SD/SH)|
20|FH_F36079_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SHEEPLESS NIGHTS MOD UE|
20|FH_F132008_85226_0|SrvcGrp|111916|2022|PCT|0.80|99|0.00|EXPANDABLE CONTROLLER|
20|FH_F108080_77081_0|SrvcGrp|87317|2022|PDM|926.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F93287_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|AEG 2 (NO REV)|
20|FH_F125249_0_0|SrvcGrp|58993|2022|PDM|5000.00|99|0.00|DISKECTOMY|
20|FH_F101540_0_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|REPAIR EPIGASTRIC HERNIA REDUCED|
20|FH_F131040_47715_0|SrvcGrp|81779|2022|PCT|1.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F131067_57105_0|SrvcGrp|12920|2022|PDM|2243.00|99|0.00|EMERGENCY CRITICAL CARE|
20|FH_F116629_83467_0|SrvcGrp|103913|2022|PCT|0.82|99|0.00|OP DIALYSIS|
20|FH_F119843_14103_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F125350_81050_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F113649_01752_0|SrvcGrp|86827|2022|PDM|90.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F118792_63379_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F84394_17402_0|SrvcGrp|114227|2022|PDM|14232.00|99|0.00|JOINT REPLACEMENT-KNEE|
20|FH_F39028_0_0|SrvcGrp|29960|2022|PCT|1.00|99|0.00|DME MOD KN|
20|FH_F128186_43230_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139515_0_0|SrvcGrp|77021|2022|PDM|8196.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F93880_95476_0|SrvcGrp|11000|2022|PCT|0.30|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.18|99|0.00|AEG 4 (NO REV)|
20|FH_F79212_0_0|SrvcGrp|3809|2022|PDM|652.80|99|0.00|HOSPICE CARE|
20|FH_F101021_0_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F121149_76021_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F63391_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F43242_0_0|SrvcGrp|31931|2022|PDM|1241.00|99|0.00|SKILLED NURSING CARE|
20|FH_F128073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82753_18840_0|SrvcGrp|80137|2022|PDM|26336.00|99|0.00|IMPLANT SPINAL INFUSION|
20|FH_F132675_53154_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41133_0_0|SrvcGrp|13811|2022|PDM|311.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F69322_0_0|SrvcGrp|12778|2022|PDM|321.00|99|0.00|ADULT PSYCH PARTIAL HOSP|
20|FH_F102500_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31815_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109346_0_0|SrvcGrp|103606|2022|PCT|0.00|99|0.00|NURSERY|
20|FH_F90362_0_0|SrvcGrp|73000|2022|PDM|1119.00|99|0.00|AEG 6|
20|FH_F35513_0_0|SrvcGrp|11328|2022|PDM|75.00|99|0.00|RN VISIT|
20|FH_F93881_15009_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F40332_0_0|SrvcGrp|11259|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F139515_0_0|SrvcGrp|33985|2022|PDM|1250.00|99|0.00|CPT 19120|
20|FH_F73985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|LITHOTRIPSY OULTIER|
20|FH_F56137_0_0|SrvcGrp|36093|2022|PDM|1200.00|99|0.00|ACUTE REHABILITATION|
20|FH_F114511_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F113546_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39740_0_0|SrvcGrp|21350|2022|PDM|5158.00|99|0.00|MS DRG 287 ONLY|
20|FH_F93384_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F40689_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78603_0_0|SrvcGrp|3029|2022|PDM|738.69|99|0.00|NEWBORN NURSERY|
20|FH_F95021_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F135219_68506_0|SrvcGrp|101520|2022|PDM|9648.84|99|0.00|T1H W/T/O (<250G)|
20|FH_F39857_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F98922_40351_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F79483_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS|
20|FH_F116203_63901_0|SrvcGrp|73701|2022|PDM|25.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F128358_46072_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F126439_92627_0|SrvcGrp|74668|2022|PDM|523.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148265_06067_0|SrvcGrp|78096|2022|PDM|6775.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F137490_62226_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F82696_16335_0|SrvcGrp|10111|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F77983_0_0|SrvcGrp|68779|2022|PCT|1.00|99|0.00|IMMUNOHISTO ANTIBODY STAIN|
20|FH_F148320_02130_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F109601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F41665_0_0|SrvcGrp|32403|2022|PCT|0.65|99|0.00|OCN F/S PRICING: POS FACILITY MOD TC (RADIOLOGY)|
20|FH_F40272_0_0|SrvcGrp|97|2022|PDM|3800.00|99|0.00|C-SECTION|
20|FH_F117044_37352_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F131254_92211_0|SrvcGrp|86833|2022|PDM|12.50|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F120172_92653_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139241_0_0|SrvcGrp|35667|2022|PDM|1311.00|99|0.00|CPT 20680|
20|FH_F115669_07652_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F63444_0_0|SrvcGrp|3259|2022|PDM|645.00|99|0.00|ACUTE REHABILITATION|
20|FH_F110086_21742_0|SrvcGrp|77449|2022|PDM|2500.00|99|0.00|CPT 52352|
20|FH_F131220_08062_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F75425_0_0|SrvcGrp|33166|2022|PDM|650.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F133287_40215_0|SrvcGrp|107807|2022|PCT|0.53|99|0.00|LABORATORY SERVICES|
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F67136_0_0|SrvcGrp|38818|2022|PCT|0.70|99|0.00|ROBOTIC ASSISTED IP SURGERY|
20|FH_F102561_75146_0|SrvcGrp|98012|2022|PDM|1875.00|99|0.00|DEBRIDEMENT-BONE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|146.82|99|0.00|HAPA WPA-NWPA 2012-13 ASC 134 W/O REV|
20|FH_F45513_0_0|SrvcGrp|26216|2022|PDM|1750.00|99|0.00|ARTHROSCOPY|
20|FH_F97560_23249_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F101568_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|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_F34706_0_0|SrvcGrp|11187|2022|PDM|32180.00|99|0.00|DRG 550 CORONARY BYPASS W/O CC W/O|
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_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|855.00|99|0.00|AEG 1 (NO REV)|
20|FH_F148886_60621_0|SrvcGrp|72984|2022|PDM|491.00|99|0.00|CHEMOTHERAPY|
20|FH_F40851_0_0|SrvcGrp|31512|2022|PCT|1.75|99|0.00|LABORATORY|
20|FH_F133533_33901_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC|
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132080_0_0|SrvcGrp|97703|2022|PDM|169.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F97562_29803_0|SrvcGrp|73643|2022|PDM|1604.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F113326_80014_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INJECTION, PEGFILGRASTIM 6MG|
20|FH_F115889_0_0|SrvcGrp|72990|2022|PDM|542.00|99|0.00|AEG 1|
20|FH_F128605_20910_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F133271_72204_0|SrvcGrp|90854|2022|PDM|925.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F145988_06105_0|SrvcGrp|114497|2022|PDM|28480.00|99|0.00|INSERT INTRACORONARY STENT|
20|FH_F130108_0_0|SrvcGrp|15369|2022|PCT|0.60|99|0.00|LABORATORY|
20|FH_F128571_29532_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126808_15005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97042_64804_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F120437_85202_0|SrvcGrp|86830|2022|PDM|23.64|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|41.00|99|0.00|HAPA EPA ASC 10|
20|FH_F92972_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F136002_0_0|SrvcGrp|22596|2022|PDM|110.16|99|0.00|HOSPICE CARE|
20|FH_F120407_84070_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F81373_64064_0|SrvcGrp|537|2022|PCT|0.66|99|0.00|OBSERVATION SERVICES|
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|478.00|99|0.00|AEG 2 (NO REV)|
20|FH_F148039_92629_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F102561_75146_0|SrvcGrp|88977|2022|PDM|4400.00|99|0.00|C-SECTION DELIVERY|
20|FH_F36993_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD UE|
20|FH_F117613_08221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132647_60067_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132503_73086_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F57396_0_0|SrvcGrp|46583|2022|PDM|80.00|99|0.00|CPT 99202|
20|FH_F133478_40165_0|SrvcGrp|26470|2022|PDM|206.00|99|0.00|SELF DIALYSIS TRAINING CAPD|
20|FH_F127325_0_0|SrvcGrp|73004|2022|PDM|941.00|99|0.00|AEG 8|
20|FH_F126889_57030_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97563_83201_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F123144_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132331_89107_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F67192_0_0|SrvcGrp|20752|2022|PDM|2367.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F132338_18901_0|SrvcGrp|74668|2022|PDM|315.19|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F44257_0_0|CSTM-ALL|CSTM-00|2020|PDM|291.00|99|0.00|PARTIAL HOSPITAL|
20|FH_F51129_0_0|SrvcGrp|4020|2022|PCT|0.92|99|0.00|TRAUMA CARE|
20|FH_F70487_0_0|SrvcGrp|30623|2022|PDM|6000.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F113261_38464_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F71271_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119070_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1741.00|99|0.00|AEG 9 (NO REV)|
20|FH_F148599_98034_0|SrvcGrp|115514|2022|PCT|1.00|99|0.00|PACKAGE INCIDENTAL CODES|
20|FH_F150002_28761_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|1042.00|99|0.00|ASPG III|
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 9 (NO REV)|
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 3 (NO REV)|
20|FH_F142970_43055_0|SrvcGrp|2067|2022|PCT|0.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F68974_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F113586_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F148639_0_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F88956_0_0|SrvcGrp|84439|2022|PDM|4800.00|99|0.00|AETNA MATERNITY CARE (NORMAL DELIVERY)|
20|FH_F133627_89113_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148864_81303_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62867_0_0|SrvcGrp|3934|2022|PDM|150.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS|
20|FH_F97660_29401_0|SrvcGrp|73656|2022|PDM|421.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F111001_0_0|CSTM-ALL|CSTM-00|2020|PDM|12.00|99|0.00|LVN HIGH TECH HOURLY|
20|FH_F80711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|(DME) OCN F/S PRICING: ALL|
20|FH_F86911_0_0|SrvcGrp|44703|2022|PDM|90.00|99|0.00|NURSING CARE|
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|729.30|99|0.00|AEG 3 (NO REV)|
20|FH_F115264_0_0|CSTM-ALL|CSTM-00|2020|PDM|812.00|99|0.00|OLD MOULTRIE SURGERY GROUPER 3|
20|FH_F142312_62301_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F112704_0_0|SrvcGrp|101320|2022|PDM|1030.00|99|0.00|PARAVERTEBRAL FACET JOINT NERVE|
20|FH_F105623_77901_0|SrvcGrp|88779|2022|PDM|115.00|99|0.00|PHYSICAL THERAPY|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY POS FACILITY GLOBAL|
20|FH_F110205_64012_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F129597_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F95282_77975_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F132627_0_0|SrvcGrp|10578|2022|PDM|64.26|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F132988_0_0|SrvcGrp|94904|2022|PDM|4493.01|99|0.00|REPAIR/REVISE WRIST JOINT|
20|FH_F87482_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141018_70125_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114389_50131_0|SrvcGrp|22594|2022|PDM|102.25|99|0.00|IMIGLUCERASE|
20|FH_F40370_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|ACUTE PSYCH|
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|CD - FULL DAY (8-12 HR)|
20|FH_F121426_0_0|SrvcGrp|10391|2022|PDM|2076.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F124180_0_0|SrvcGrp|86036|2022|PDM|3500.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F148488_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F39066_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH|
20|FH_F41035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41885_0_0|SrvcGrp|701|2022|PDM|1600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|6482.00|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_F132864_71101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F118848_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F133694_89117_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F55694_0_0|SrvcGrp|23477|2022|PDM|9712.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
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|420.00|99|0.00|AEG 9 (NO REV)|
20|FH_F136568_92562_0|SrvcGrp|73842|2022|PDM|365.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114629_19131_0|SrvcGrp|94879|2022|PDM|155.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F114666_30342_0|SrvcGrp|27261|2022|PDM|10500.00|99|0.00|CPT 27446|
20|FH_F114727_44512_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F139662_51106_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|659.00|99|0.00|AEG 1 (NO REV)|
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)|
20|FH_F43249_0_0|SrvcGrp|299|2022|PCT|0.54|99|0.00|GAMMA KNIFE|
20|FH_F43249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|ADULT CD OUTPATIENT SVCS|
20|FH_F117085_40207_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F134727_30650_0|SrvcGrp|72984|2022|PCT|1.00|99|0.00|CHEMOTHERAPY|
20|FH_F134770_14420_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F136913_68803_0|SrvcGrp|79699|2022|PCT|0.70|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F136930_73114_0|SrvcGrp|72994|2022|PDM|5393.00|99|0.00|AEG 3|
20|FH_F112268_19087_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112378_60505_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F113713_17013_0|SrvcGrp|105367|2022|PDM|45.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MINS|
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|WELLPATH PROPIETARY ASC III|
20|FH_F116393_07002_0|SrvcGrp|106513|2022|PDM|69.93|99|0.00|VIT D 1 25-DIHYDROXY|
20|FH_F147586_44124_0|SrvcGrp|92409|2022|PDM|2000.00|99|0.00|PERQ CERVICOTHORACIC INJECT|
20|FH_F111602_17102_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F111602_17102_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F111829_32257_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134826_19067_0|SrvcGrp|104441|2022|PDM|50.00|99|0.00|AETNA DRUG TEST PRSMV DIR OPT OBS (HCFA)|
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|3085.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|1895.00|99|0.00|AEG 7 (NO REV)|
20|FH_F119262_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1696.00|99|0.00|AEG 9 (NO REV)|
20|FH_F98361_12065_0|SrvcGrp|73461|2022|PDM|13800.00|99|0.00|AETNA NICU IV|
20|FH_F120683_80238_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F120683_80238_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F113585_20155_0|SrvcGrp|86852|2022|PDM|60.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F138876_25302_0|SrvcGrp|86844|2022|PDM|40.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F138936_01040_0|SrvcGrp|112676|2022|PCT|1.00|99|0.00|COVID-19 SARS-COV-2 ANTIBODY|
20|FH_F138407_60025_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F57953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F91641_0_0|SrvcGrp|91460|2022|PDM|2392.92|99|0.00|LAPAROSCOPY|
20|FH_F31890_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62876_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113390_0_0|SrvcGrp|105233|2022|PDM|2475.00|99|0.00|REMOVAL OF THYROID|
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|1378.75|99|0.00|AEG 4 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.88|99|0.00|HAPA WPA-NWPA 2012-13 ASC 5 W/O REV|
20|FH_F151412_71909_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151427_04106_0|SrvcGrp|27287|2022|PDM|662.08|99|0.00|CHEMOTHERAPY ADMINISTRATION|
20|FH_F151461_38063_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F145148_60162_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F144928_02703_0|SrvcGrp|113928|2022|PDM|354.00|99|0.00|PARTIAL HOSPITAL (>=18 YRS)|
20|FH_F135388_48601_0|SrvcGrp|106317|2022|PDM|908.21|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F135453_70726_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F135584_10977_0|SrvcGrp|79237|2022|PDM|2800.00|99|0.00|VBAC DELIVERY|
20|FH_F135923_60453_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130670_32204_0|SrvcGrp|46903|2022|PDM|546.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F130756_04901_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 3 (NO REV)|
20|FH_F131132_44077_0|SrvcGrp|16429|2022|PCT|0.59|99|0.00|OBSERVATION SVCS|
20|FH_F131132_44077_0|SrvcGrp|99161|2022|PDM|22889.00|99|0.00|CPT 27138|
20|FH_F140629_0_0|SrvcGrp|82110|2022|PDM|2497.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC|
20|FH_F121719_63122_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F75205_0_0|SrvcGrp|45965|2022|PDM|120.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F129329_07039_0|SrvcGrp|89149|2022|PDM|208.00|99|0.00|OP INTENSIVE|
20|FH_F111292_33136_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111363_33169_0|SrvcGrp|73559|2022|PDM|2965.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F111363_33169_0|SrvcGrp|88142|2022|PDM|268.00|99|0.00|AETNA ULTRASOUND BREAST(S)|
20|FH_F111363_33169_0|SrvcGrp|72984|2022|PCT|0.84|99|0.00|CHEMOTHERAPY|
20|FH_F111390_32960_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|1041.88|99|0.00|2005 ASPG GROUPER VI|
20|FH_F150619_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F69806_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.18|99|0.00|GENERAL ACUTE CARE|
20|FH_F41780_0_0|SrvcGrp|28919|2022|PDM|34.00|99|0.00|CPT 97750|
20|FH_F132328_0_0|SrvcGrp|26278|2022|PDM|2195.00|99|0.00|CPT 29881|
20|FH_F87557_33309_0|SrvcGrp|22592|2022|PDM|30.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F125054_16365_0|SrvcGrp|48396|2022|PDM|106.00|99|0.00|OT SERVICES|
20|FH_F102325_62691_0|SrvcGrp|24761|2022|PDM|42.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129240_10028_0|SrvcGrp|86830|2022|PDM|5.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F102960_50613_0|SrvcGrp|13595|2022|PDM|721.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F102960_50613_0|SrvcGrp|89412|2022|PDM|685.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F101320_26062_0|SrvcGrp|24744|2022|PDM|108.00|99|0.00|PICC LINE INSERTION|
20|FH_F143542_0_0|SrvcGrp|109346|2022|PDM|4590.00|99|0.00|EXCISION OF CHALAZION DIFFERENT LIDS|
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 3 (NO REV)|
20|FH_F102881_0_0|SrvcGrp|99084|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F106980_0_0|SrvcGrp|73000|2022|PDM|1250.00|99|0.00|AEG 6|
20|FH_F87411_0_0|SrvcGrp|77440|2022|PDM|189.00|99|0.00|HOME SLEEP TEST TYPE III|
20|FH_F82381_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2010 B CODES (MOD RR)|
20|FH_F123783_03860_0|SrvcGrp|73742|2022|PDM|8.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F62577_0_0|SrvcGrp|13297|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F136368_62711_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120490_64133_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F120490_64133_0|SrvcGrp|86836|2022|PDM|10.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F120475_81052_0|SrvcGrp|75545|2022|PDM|318.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F134126_11554_0|CSTM-ALL|CSTM-00|2020|PDM|3846.00|99|0.00|AEG 9 (NO REV)|
20|FH_F137130_46168_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137237_33304_0|SrvcGrp|86723|2022|PDM|420.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F137242_52722_0|SrvcGrp|89337|2022|PDM|884.00|99|0.00|DETOXIFICATION|
20|FH_F138168_63084_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142448_15701_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F142449_62220_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F53732_0_0|SrvcGrp|29075|2022|PDM|50.00|99|0.00|HYDRATION THERAPY|
20|FH_F138584_30912_0|SrvcGrp|113379|2022|PDM|1500.00|99|0.00|RECONSTRUCTION OF MANDIBULAR|
20|FH_F138584_30912_0|SrvcGrp|113395|2022|PDM|1050.00|99|0.00|MANDIBULAR CONDYLAR FRACTURE TREATMENT|
20|FH_F138627_82901_0|SrvcGrp|88825|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F74763_63010_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS|
20|FH_F140615_73013_0|SrvcGrp|109057|2022|PCT|1.35|99|0.00|CARDIAC STUDIES|
20|FH_F140787_66427_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132738_0_0|CSTM-ALL|CSTM-00|2020|PDM|326.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F149441_28401_0|SrvcGrp|108484|2022|PDM|613.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F119023_91406_0|SrvcGrp|34566|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118818_19808_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F117255_68520_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147741_80012_0|SrvcGrp|114924|2022|PCT|1.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F129504_02871_0|SrvcGrp|95660|2022|PDM|720.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F129514_79605_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F117154_43017_0|SrvcGrp|89149|2022|PDM|150.00|99|0.00|OP INTENSIVE|
20|FH_F137898_46540_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F109652_0_0|SrvcGrp|37324|2022|PCT|1.00|99|0.00|BABY BIG|
20|FH_F90833_62821_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F90880_15108_0|SrvcGrp|90491|2022|PCT|1.00|99|0.00|EVALUATE SPEECH PRODUCTION|
20|FH_F124754_84403_0|SrvcGrp|108484|2022|PDM|500.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F129053_0_0|SrvcGrp|26275|2022|PDM|2861.00|99|0.00|CPT 29826|
20|FH_F112817_37027_0|SrvcGrp|92518|2022|PDM|105.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F130978_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F37478_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F135840_0_0|SrvcGrp|75493|2022|PDM|1022.00|99|0.00|AEG 8|
20|FH_F47173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F79623_0_0|SrvcGrp|72994|2022|PDM|3511.00|99|0.00|AEG 3|
20|FH_F85777_77030_0|SrvcGrp|113637|2022|PCT|0.25|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F92153_74017_0|CSTM-ALL|CSTM-00|2020|PCT|0.58|99|0.00|OP SVCS|
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.00|99|0.00|AEG 5  (NO REV)|
20|FH_F137729_19703_0|SrvcGrp|90854|2022|PDM|644.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F111723_0_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F34853_0_0|SrvcGrp|9511|2022|PCT|0.60|99|0.00|OBSERVATION SVCS|
20|FH_F150442_28451_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F140137_15235_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143347_16001_0|SrvcGrp|114042|2022|PDM|6132.00|99|0.00|ARTHROSCOPY|
20|FH_F143536_47546_0|SrvcGrp|100268|2022|PCT|1.00|99|0.00|ADENOVIRUS ASSAY W/ OPTIC|
20|FH_F62713_0_0|SrvcGrp|26001|2022|PDM|139.76|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F101709_0_0|SrvcGrp|21978|2022|PDM|506.00|99|0.00|CPT 77003|
20|FH_F101709_0_0|SrvcGrp|26273|2022|PDM|2985.00|99|0.00|CPT 29880|
20|FH_F101540_0_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F102224_0_0|SrvcGrp|67066|2022|PDM|2300.00|99|0.00|CERVICAL SURGERY|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|177.00|99|0.00|GA RETINA SURG CTR ASC 3|
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_F132479_90290_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F116579_45822_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F83292_0_0|SrvcGrp|537|2022|PDM|29.00|99|0.00|OBSERVATION SERVICES|
20|FH_F120050_92626_0|SrvcGrp|75419|2022|PDM|600.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F120887_78750_0|SrvcGrp|75545|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F120921_75835_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F118874_29926_0|SrvcGrp|87131|2022|PDM|411.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F84394_17402_0|SrvcGrp|36591|2022|PDM|26626.00|99|0.00|CPT 63685|
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F51276_0_0|SrvcGrp|27049|2022|PDM|24.66|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS (MOD SJ)|
20|FH_F143467_0_0|SrvcGrp|100045|2022|PDM|3140.00|99|0.00|REVISION OF FOOT TENDON|
20|FH_F147005_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.45|99|0.00|OCN F/S PRICING: GLOBAL|
20|FH_F147403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F49895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F46258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|WALGREENS S CODE MOD SH|
20|FH_F59732_0_0|SrvcGrp|23683|2022|PDM|125.00|99|0.00|SKILLED NURSING RN|
20|FH_F128902_53105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148184_29527_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143900_63303_0|SrvcGrp|75419|2022|PDM|335.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F91575_0_0|SrvcGrp|78448|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
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_F124017_0_0|SrvcGrp|108275|2022|PDM|4500.00|99|0.00|SP BONE ALGRFT MORSEL ADD-ON|
20|FH_F127165_32112_0|SrvcGrp|108484|2022|PDM|593.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F129653_0_0|SrvcGrp|73002|2022|PDM|2405.00|99|0.00|AEG 7|
20|FH_F145537_02061_0|SrvcGrp|17698|2022|PDM|1104.00|99|0.00|ACUTE PSYCH (>=18 YRS)|
20|FH_F135290_60115_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG X|
20|FH_F35975_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F135165_15728_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F82696_16335_0|CSTM-ALL|CSTM-00|2020|PCT|3.10|99|0.00|HAPA WPA/NWPA 2017 LAB 100%|
20|FH_F38034_0_0|SrvcGrp|12359|2022|PDM|2797.00|99|0.00|TELEMETRY SVCS|
20|FH_F121925_0_0|SrvcGrp|79577|2022|PDM|1044.65|99|0.00|CPT 43244|
20|FH_F145537_02061_0|SrvcGrp|16069|2022|PDM|504.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F118741_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F125249_0_0|SrvcGrp|100019|2022|PDM|1200.00|99|0.00|TREATMENT OF FRACTURE|
20|FH_F147941_06023_0|SrvcGrp|74609|2022|PDM|242.00|99|0.00|AETNA FOLLOW UP VISIT CPT 90834|
20|FH_F97540_32114_0|SrvcGrp|88978|2022|PDM|7475.00|99|0.00|VAGINAL DELIVERY|
20|FH_F125820_66436_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135006_63353_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135016_37203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125249_0_0|SrvcGrp|92370|2022|PDM|700.00|99|0.00|FUSION OF KNUCKLE JOINT|
20|FH_F145537_02061_0|SrvcGrp|46903|2022|PDM|473.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F110086_21742_0|SrvcGrp|48160|2022|PCT|1.00|99|0.00|BOTULINUM TOXIN TYPE A, PER UNIT|
20|FH_F147661_0_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1722.00|99|0.00|AEG 1 (NO REV)|
20|FH_F120362_23321_0|SrvcGrp|73701|2022|PDM|35.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F123915_0_0|SrvcGrp|30609|2022|PDM|43.86|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F77883_0_0|SrvcGrp|74922|2022|PDM|199.12|99|0.00|HOME INFUSION|
20|FH_F135236_02840_0|SrvcGrp|111928|2022|PDM|290.30|99|0.00|COVID-19 BARTONELLA|
20|FH_F135236_02840_0|SrvcGrp|79786|2022|PCT|1.01|99|0.00|SLEEP STUDIES|
20|FH_F40063_0_0|SrvcGrp|16|2022|PDM|1933.00|99|0.00|ACUTE REHABILITATION|
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|1291.00|99|0.00|AEG 10 (NO REV)|
20|FH_F121495_92009_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F148320_02130_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F32509_0_0|SrvcGrp|14063|2022|PDM|14359.00|99|0.00|PACEMAKER|
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F81033_0_0|SrvcGrp|78661|2022|PDM|892.50|99|0.00|AETNA CONIZATION OF CERVIX|
20|FH_F135264_40272_0|SrvcGrp|74668|2022|PDM|270.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131128_0_0|SrvcGrp|98006|2022|PDM|2122.00|99|0.00|PHALANGEAL SHAFT FRACTURE|
20|FH_F41201_0_0|SrvcGrp|941|2022|PCT|0.73|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F43858_0_0|SrvcGrp|30958|2022|PDM|65.00|99|0.00|SKILLED LPN VISIT|
20|FH_F86112_63501_0|SrvcGrp|78504|2022|PCT|0.47|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F119864_63141_0|SrvcGrp|73701|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F109367_32751_0|SrvcGrp|90573|2022|PDM|285.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F149322_19023_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147980_0_0|SrvcGrp|95660|2022|PDM|450.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F112791_0_0|SrvcGrp|73004|2022|PDM|1102.00|99|0.00|AEG 8|
20|FH_F134359_36904_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_F114526_33401_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F145641_06902_0|SrvcGrp|97730|2022|PDM|20500.00|99|0.00|REVERSE HIP JOINT|
20|FH_F119646_65804_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F129509_0_0|SrvcGrp|72996|2022|PDM|924.00|99|0.00|AEG 4|
20|FH_F121476_0_0|SrvcGrp|108894|2022|PDM|145.00|99|0.00|CONTRACEPT IUD|
20|FH_F146103_63851_0|SrvcGrp|88977|2022|PDM|2400.00|99|0.00|C-SECTION DELIVERY|
20|FH_F146590_77449_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F117206_0_0|SrvcGrp|62740|2022|PDM|1485.00|99|0.00|SURGERY CARVE OUTS|
20|FH_F124395_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120291_0_0|SrvcGrp|83857|2022|PDM|1084.00|99|0.00|IP HOSPICE SVCS|
20|FH_F134324_26354_0|SrvcGrp|73643|2022|PDM|451.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F144228_0_0|SrvcGrp|114144|2022|PDM|3617.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F143067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146124_06112_0|SrvcGrp|99190|2022|PCT|0.00|99|0.00|NORMAL DELIVERY|
20|FH_F148439_0_0|SrvcGrp|87537|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F111732_33771_0|SrvcGrp|78420|2022|PDM|2300.00|99|0.00|INTERIM LABOR|
20|FH_F85353_16407_0|SrvcGrp|63784|2022|PDM|1336.10|99|0.00|HAPA WPA-NWPA 2012-13 ASC 706|
20|FH_F138024_40509_0|SrvcGrp|89417|2022|PDM|290.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F77184_0_0|SrvcGrp|48398|2022|PDM|18.00|99|0.00|PT SERVICES|
20|FH_F125870_0_0|SrvcGrp|28547|2022|PDM|2445.00|99|0.00|VITRECTOMY|
20|FH_F149121_01520_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134587_64114_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130763_0_0|SrvcGrp|55084|2022|PDM|4043.00|99|0.00|CPT 52648|
20|FH_F132969_84003_0|SrvcGrp|27969|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE|
20|FH_F49459_0_0|SrvcGrp|11232|2022|PDM|384.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD RR KE"|
20|FH_F129273_57783_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129638_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138951_41101_0|SrvcGrp|86834|2022|PDM|15.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F99522_0_0|CSTM-ALL|CSTM-00|2020|PCT|47.00|99|0.00|OP SVCS|
20|FH_F125164_15206_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147502_0_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F96721_99504_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127080_77520_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F149219_01966_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|1785.00|99|0.00|AEG 9 (NO REV)|
20|FH_F81835_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119627_27288_0|SrvcGrp|75506|2022|PCT|0.75|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F110420_60649_0|SrvcGrp|8950|2022|PDM|2000.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F144248_0_0|SrvcGrp|84280|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F134328_13088_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F133727_33511_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F150301_23236_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_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|691.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F112712_63005_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F83113_0_0|SrvcGrp|10648|2022|PDM|6.00|99|0.00|HOME INFUSION|
20|FH_F120626_0_0|CSTM-ALL|CSTM-00|2020|PDM|2113.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126003_79403_0|SrvcGrp|89149|2022|PDM|327.00|99|0.00|OP INTENSIVE|
20|FH_F31595_0_0|SrvcGrp|360|2022|PCT|0.95|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F70804_0_0|SrvcGrp|10648|2022|PDM|8.32|99|0.00|HOME INFUSION|
20|FH_F111681_62702_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121687_04401_0|SrvcGrp|108920|2022|PCT|1.00|99|0.00|THER/PROPH/DIAG IV INF|
20|FH_F149219_01966_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F145781_0_0|SrvcGrp|110860|2022|PDM|1500.00|99|0.00|CONJUNCTIVORHINOSTOMY|
20|FH_F145604_14850_0|SrvcGrp|86853|2022|PDM|70.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|410.07|99|0.00|HAPA WPA-NWPA 2012-13 ASC 211 W/O REV|
20|FH_F144848_0_0|SrvcGrp|97139|2022|PDM|3700.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133747_80634_0|SrvcGrp|81779|2022|PCT|0.92|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F110589_70809_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148923_71854_0|SrvcGrp|108484|2022|PDM|620.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F119379_0_0|SrvcGrp|107836|2022|PDM|1100.00|99|0.00|REPAIR FOREARM TENDON/MUSCLE|
20|FH_F144228_0_0|SrvcGrp|114152|2022|PDM|13158.00|99|0.00|OSSEOINTEGRATED IMPLANT|
20|FH_F111744_32514_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F93176_73750_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147502_0_0|SrvcGrp|82223|2022|PDM|150.00|99|0.00|HOSPICE CARE|
20|FH_F66406_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120291_0_0|SrvcGrp|87799|2022|PDM|243.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F72784_0_0|SrvcGrp|12290|2022|PDM|787.40|99|0.00|DETOXIFICATION|
20|FH_F125890_43054_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127415_45822_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F62869_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129023_15501_0|SrvcGrp|472|2022|PDM|464.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148265_06067_0|SrvcGrp|100065|2022|PDM|3372.00|99|0.00|DEEP ANT OR POSTER TIBIAL|
20|FH_F32509_0_0|SrvcGrp|12438|2022|PDM|16970.00|99|0.00|PTCA WITH STENT|
20|FH_F49338_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F130747_0_0|SrvcGrp|88156|2022|PDM|26010.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AEG 10 (NO REV)|
20|FH_F129408_48034_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122433_0_0|SrvcGrp|72998|2022|PDM|717.00|99|0.00|AEG 5|
20|FH_F127567_44070_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1877.00|99|0.00|ASPG VIII|
20|FH_F148170_04005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135220_21532_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|AEG 5  (NO REV)|
20|FH_F103902_89118_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F89779_0_0|SrvcGrp|73000|2022|PDM|3000.00|99|0.00|AEG 6|
20|FH_F140995_33040_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|3125.00|99|0.00|REPAIR HERNIA (<5 YRS)|
20|FH_F90362_0_0|SrvcGrp|72992|2022|PDM|520.00|99|0.00|AEG 2|
20|FH_F121547_46805_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117378_16148_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F79800_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F106020_0_0|SrvcGrp|42472|2022|PDM|1681.00|99|0.00|CPT 58670|
20|FH_F88212_20151_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F150982_0_0|SrvcGrp|93637|2022|PDM|3971.00|99|0.00|LAPAROSCOPY SURGICAL|
20|FH_F37679_0_0|SrvcGrp|22594|2022|PDM|61.00|99|0.00|IMIGLUCERASE|
20|FH_F116327_75701_0|SrvcGrp|90040|2022|PDM|150.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F60019_0_0|SrvcGrp|29146|2022|PCT|0.75|99|0.00|HIGH COST DRUGS|
20|FH_F31464_0_0|CSTM-ALL|CSTM-00|2020|PDM|5000.00|99|0.00|OP SVCS|
20|FH_F139515_0_0|SrvcGrp|27261|2022|PDM|12200.00|99|0.00|CPT 27446|
20|FH_F37679_0_0|SrvcGrp|26855|2022|PDM|30.50|99|0.00|HOME INFUSION THERAPY (MOD SH)|
20|FH_F72143_0_0|SrvcGrp|31134|2022|PDM|2300.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F128896_53209_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115047_78526_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151225_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148166_0_0|SrvcGrp|92502|2022|PDM|980.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F63249_0_0|SrvcGrp|57649|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS MOD GP|
20|FH_F130755_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|AEG 6 (NO REV)|
20|FH_F119864_63141_0|SrvcGrp|73700|2022|PDM|52.50|99|0.00|AETNA - SKILLED NURSING|
20|FH_F111064_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F148799_50125_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F123646_91350_0|SrvcGrp|90573|2022|PDM|371.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F145817_88101_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F127071_82435_0|SrvcGrp|108484|2022|PDM|1600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F134655_14221_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|361.88|99|0.00|HAPA WPA-NWPA 2012-13 ASC 105 W/O REV|
20|FH_F100782_0_0|SrvcGrp|97512|2022|PDM|1583.05|99|0.00|WINDBER MEDICAL CNTR ASC 5|
20|FH_F83995_16748_0|SrvcGrp|18025|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.46|99|0.00|HAPA WPA-NWPA 2012-13 ASC 214 W/O REV|
20|FH_F135670_01749_0|SrvcGrp|31973|2022|PDM|12.50|99|0.00|HOME THERAPY|
20|FH_F100782_0_0|SrvcGrp|105172|2022|PDM|2314.86|99|0.00|WINDBER MEDICAL CNTR ASC 912|
20|FH_F126341_27284_0|SrvcGrp|26869|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F111942_92647_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F31714_0_0|SrvcGrp|3288|2022|PDM|28900.00|99|0.00|DRG 496 COMB ANTI/POST SPINAL FUSION|
20|FH_F77943_0_0|SrvcGrp|62153|2022|PCT|0.70|99|0.00|RADIOLOGY SVCS|
20|FH_F119107_22601_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F119810_31525_0|CSTM-ALL|CSTM-00|2020|PDM|152.20|99|0.00|HOSPICE ROUTINE HOME CARE (DAYS 0-60)|
20|FH_F127343_0_0|SrvcGrp|87059|2022|PDM|3105.00|99|0.00|REPAIR OF TENDON|
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)|
20|FH_F135610_06451_0|SrvcGrp|82223|2022|PDM|89.12|99|0.00|HOSPICE CARE|
20|FH_F88935_0_0|SrvcGrp|57968|2022|PDM|31.38|99|0.00|CONTINUOUS HOMECARE|
20|FH_F116753_0_0|SrvcGrp|72984|2022|PCT|0.63|99|0.00|CHEMOTHERAPY|
20|FH_F120484_31419_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F86131_28215_0|SrvcGrp|75545|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F143581_02130_0|SrvcGrp|113171|2022|PCT|1.00|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F133749_84604_0|SrvcGrp|112412|2022|PDM|10.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F109242_18466_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F134608_18017_0|SrvcGrp|112610|2022|PDM|200.00|99|0.00|EXAMINATION OF VAGINA (HCFA)|
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AEG 5  (NO REV)|
20|FH_F69744_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|OP SVCS|
20|FH_F50494_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS|
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|2315.00|99|0.00|AEG 10 (NO REV)|
20|FH_F98741_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F85353_16407_0|SrvcGrp|63859|2022|PDM|369.90|99|0.00|HAPA WPA-NWPA 2012-13 ASC 116|
20|FH_F133798_20774_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118042_33401_0|SrvcGrp|75522|2022|PDM|550.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD|
20|FH_F134235_70403_0|CSTM-ALL|CSTM-00|2020|PCT|0.17|99|0.00|OP SVCS|
20|FH_F145742_64862_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.44|99|0.00|HAPA WPA-NWPA 2012-13 ASC 16 W/O REV|
20|FH_F100782_0_0|SrvcGrp|97515|2022|PDM|2186.84|99|0.00|WINDBER MEDICAL CNTR ASC 8|
20|FH_F110420_60649_0|SrvcGrp|10393|2022|PDM|2500.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F63312_0_0|SrvcGrp|3809|2022|PDM|525.00|99|0.00|HOSPICE CARE|
20|FH_F51039_0_0|SrvcGrp|26036|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F85652_98034_0|SrvcGrp|31072|2022|PDM|2459.00|99|0.00|MS DRG 794 ONLY|
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|6885.00|99|0.00|DEVICE INSERTION|
20|FH_F118469_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F149263_0_0|SrvcGrp|35670|2022|PDM|4058.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F129316_65066_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F47473_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116753_0_0|SrvcGrp|75506|2022|PCT|0.63|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|2026.41|99|0.00|HAPA WPA-NWPA 2012-13 ASC 901 W/O REV|
20|FH_F150142_76018_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F87333_0_0|SrvcGrp|72994|2022|PDM|903.31|99|0.00|AEG 3|
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97840_54729_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F118270_30606_0|SrvcGrp|92502|2022|PDM|604.59|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F138302_15701_0|SrvcGrp|24752|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F133867_84075_0|SrvcGrp|46691|2022|PDM|17.50|99|0.00|HOME HEALTH AID SERVICES|
20|FH_F126555_44906_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F131100_0_0|SrvcGrp|108260|2022|PDM|856.00|99|0.00|AETNA FIXATION OF KNEE JOINT|
20|FH_F51135_0_0|SrvcGrp|22954|2022|PDM|148.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F118253_89052_0|SrvcGrp|73841|2022|PDM|390.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F116126_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F143561_16001_0|SrvcGrp|46605|2022|PDM|126.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F148923_71854_0|SrvcGrp|74668|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F35571_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84935_0_0|SrvcGrp|3934|2022|PDM|330.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS|
20|FH_F75842_0_0|SrvcGrp|29570|2022|PDM|9406.88|99|0.00|KYPHOPLASTY|
20|FH_F146605_72205_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120795_27514_0|SrvcGrp|10363|2022|PDM|955.00|99|0.00|CPT CODE 99283|
20|FH_F66705_0_0|SrvcGrp|43432|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE HOURLY|
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133415_90066_0|SrvcGrp|74668|2022|PDM|435.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133494_90023_0|SrvcGrp|106251|2022|PCT|1.40|99|0.00|LABORATORY SERVICES|
20|FH_F133170_50501_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|916.00|99|0.00|AEG 6 (NO REV)|
20|FH_F121338_37756_0|SrvcGrp|473|2022|PDM|340.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F121897_28144_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F113866_0_0|SrvcGrp|93100|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|1390.00|99|0.00|AEG 7 (NO REV)|
20|FH_F37823_0_0|SrvcGrp|18091|2022|PCT|0.80|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F85002_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98041_10027_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F112943_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|GENERAL ACUTE CARE|
20|FH_F89037_0_0|SrvcGrp|72990|2022|PDM|401.37|99|0.00|AEG 1|
20|FH_F113130_0_0|SrvcGrp|92597|2022|PDM|1200.00|99|0.00|GI PEGFILGRASTIM|
20|FH_F100640_48097_0|SrvcGrp|73605|2022|PDM|2488.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F43694_0_0|SrvcGrp|3577|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F134317_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|700.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132627_0_0|SrvcGrp|53987|2022|PDM|143.00|99|0.00|PHOTOTHERAPY|
20|FH_F132627_0_0|SrvcGrp|31973|2022|PDM|43.86|99|0.00|HOME THERAPY|
20|FH_F132988_0_0|SrvcGrp|100079|2022|PDM|4493.01|99|0.00|RECONSTRUCT ULNA/RADIOLULNAR|
20|FH_F130274_63033_0|SrvcGrp|23683|2022|PDM|30.00|99|0.00|SKILLED NURSING RN|
20|FH_F118909_0_0|SrvcGrp|93098|2022|PDM|123.60|99|0.00|HOSPICE CARE|
20|FH_F93252_0_0|SrvcGrp|93022|2022|PDM|3500.00|99|0.00|LUMBAR LAMINECTOMY|
20|FH_F114389_50131_0|SrvcGrp|17009|2022|PDM|137.28|99|0.00|HOME INFUSION THERAPY|
20|FH_F124180_0_0|SrvcGrp|98363|2022|PDM|2859.50|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F124927_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F77944_0_0|CSTM-ALL|CSTM-00|2020|PDM|3725.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F81731_0_0|SrvcGrp|31854|2022|PDM|1207.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F124082_78526_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F124082_78526_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F146914_75032_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F33558_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ASPG III|
20|FH_F124611_64804_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F118848_0_0|SrvcGrp|102120|2022|PDM|4800.00|99|0.00|REVISE EYE MUSCLE|
20|FH_F150959_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
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_F67172_0_0|SrvcGrp|3982|2022|PDM|5710.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F122200_0_0|SrvcGrp|108152|2022|PDM|650.00|99|0.00|HEMODIALYSIS INCLUDES TRAINING|
20|FH_F136570_32084_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136607_68632_0|SrvcGrp|103913|2022|PCT|0.97|99|0.00|OP DIALYSIS|
20|FH_F113787_31909_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F113910_16508_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139655_17078_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PDM|30.00|99|0.00|MANUAL BODY MUSCLE TESTING|
20|FH_F144039_0_0|SrvcGrp|42429|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 66761|
20|FH_F117195_0_0|SrvcGrp|13715|2022|PCT|0.90|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F122635_06410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43295_0_0|CSTM-ALL|CSTM-00|2020|PDM|929.00|99|0.00|ADULT CD OUTPATIENT SVCS|
20|FH_F117069_15236_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F134689_60190_0|SrvcGrp|112073|2022|PDM|1375.00|99|0.00|RESIDENITAL TREATMENT EATING DISORDER (AGE 18-99)|
20|FH_F134690_46237_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134694_94945_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F136807_43220_0|SrvcGrp|48394|2022|PDM|32.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F136930_73114_0|SrvcGrp|43924|2022|PDM|376.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F112268_19087_0|SrvcGrp|48385|2022|PDM|84.00|99|0.00|SPEECH THERAPY|
20|FH_F113713_17013_0|SrvcGrp|105559|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F31996_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|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_F39622_0_0|CSTM-ALL|CSTM-00|2020|PDM|1770.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F41672_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|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 - CHILD|
20|FH_F132545_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F46433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|HOME INFUSION (HYDRATION THERAPY)|
20|FH_F47999_0_0|SrvcGrp|22954|2022|PDM|132.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F134087_0_0|SrvcGrp|95559|2022|PDM|10455.00|99|0.00|HIP JOINT|
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PDM|930.00|99|0.00|AEG 1 (NO REV)|
20|FH_F120635_22903_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F150939_0_0|SrvcGrp|100261|2022|PDM|135.00|99|0.00|TREAT WOUND DEHISCENCE|
20|FH_F138734_0_0|SrvcGrp|90854|2022|PDM|842.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F138681_39301_0|SrvcGrp|108484|2022|PDM|675.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F57953_0_0|SrvcGrp|36809|2022|PCT|1.00|99|0.00|OCN F/S PRICING:POS FACILITY  GLOBAL (DME)|
20|FH_F151307_63127_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151513_44718_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F132206_67152_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F122088_75098_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F122116_60942_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F144928_02703_0|SrvcGrp|87441|2022|PDM|504.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F145408_43920_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123191_15012_0|SrvcGrp|73701|2022|PDM|25.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F135427_19610_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F97142_94535_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135792_60143_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135948_60471_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136081_71742_0|SrvcGrp|88274|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F119885_13753_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F100763_24202_0|CSTM-ALL|CSTM-00|2020|PCT|0.35|99|0.00|OP SVCS|
20|FH_F116463_76501_0|SrvcGrp|89417|2022|PDM|324.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F130766_04967_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|AEG 6 (NO REV)|
20|FH_F121466_84057_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F33785_0_0|SrvcGrp|897|2022|PDM|950.00|99|0.00|ACUTE REHAB W/ VENTILATOR|
20|FH_F42347_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F75205_0_0|SrvcGrp|43428|2022|PDM|60.00|99|0.00|RN HOURLY|
20|FH_F111292_33136_0|SrvcGrp|110047|2022|PCT|2.24|99|0.00|DRUGS|
20|FH_F111301_33122_0|SrvcGrp|82744|2022|PDM|72.00|99|0.00|URINE CULTURE COLONY COUNT|
20|FH_F111363_33169_0|SrvcGrp|72994|2022|PDM|1559.00|99|0.00|AEG 3|
20|FH_F111363_33169_0|SrvcGrp|3378|2022|PDM|762.00|99|0.00|OBSERVATION SVCS|
20|FH_F58173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48215_0_0|SrvcGrp|22954|2022|PDM|94.50|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F132328_0_0|SrvcGrp|45583|2022|PDM|3839.00|99|0.00|CPT 65730|
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.90|99|0.00|AEG 9 (NO REV)|
20|FH_F102902_33764_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F102940_35034_0|SrvcGrp|48396|2022|PDM|125.00|99|0.00|OT SERVICES|
20|FH_F132090_60915_0|SrvcGrp|101103|2022|PDM|9500.00|99|0.00|REVIS SHOULDER JOINT|
20|FH_F134202_0_0|SrvcGrp|15473|2022|PDM|1890.00|99|0.00|CPT CODE 42820|
20|FH_F40855_0_0|SrvcGrp|526|2022|PDM|1600.00|99|0.00|CARDIAC CARE UNIT|
20|FH_F98621_41042_0|SrvcGrp|73485|2022|PDM|2307.00|99|0.00|AETNA REHAB|
20|FH_F33381_0_0|SrvcGrp|6|2022|PDM|4219.00|99|0.00|OP SURGERY|
20|FH_F70762_90805_0|CSTM-ALL|CSTM-00|2020|PDM|210.00|99|0.00|YOUTH INTENSIVE OP PSYCH|
20|FH_F142087_0_0|SrvcGrp|84939|2022|PDM|15000.00|99|0.00|SHOULDER JOINT|
20|FH_F133107_73071_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F50635_0_0|SrvcGrp|38223|2022|PDM|690.00|99|0.00|ADULT DETOX|
20|FH_F138713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1549.00|99|0.00|AEG 8 (NO REV)|
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_F88398_15601_0|SrvcGrp|43567|2022|PDM|83.65|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F123735_32708_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F58856_0_0|SrvcGrp|54975|2022|PDM|42500.00|99|0.00|MS DRG 223 ONLY|
20|FH_F136367_72210_0|SrvcGrp|74694|2022|PDM|621.00|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F136373_17055_0|SrvcGrp|46605|2022|PDM|150.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F136377_75240_0|SrvcGrp|89149|2022|PDM|195.00|99|0.00|OP INTENSIVE|
20|FH_F136491_08068_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F118152_20151_0|SrvcGrp|86844|2022|PDM|40.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F118178_37909_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F120490_64133_0|SrvcGrp|46104|2022|PDM|50.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F134075_78230_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F137048_60714_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F137147_75006_0|SrvcGrp|80838|2022|PDM|22479.00|99|0.00|MSDRG 519 ONLY|
20|FH_F137147_75006_0|SrvcGrp|105809|2022|PDM|200.00|99|0.00|PT OT ST|
20|FH_F142390_20866_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142690_31774_0|SrvcGrp|90339|2022|PDM|125.00|99|0.00|SKILLED NURSING RN|
20|FH_F142737_77703_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97600_46151_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F97602_40121_0|SrvcGrp|73461|2022|PDM|14266.00|99|0.00|AETNA NICU IV|
20|FH_F138584_30912_0|SrvcGrp|113385|2022|PDM|1300.00|99|0.00|TEMPOROMANDIBULAR JOINT ARTHROPLASTY|
20|FH_F120152_0_0|SrvcGrp|108346|2022|PDM|5500.00|99|0.00|SKELETAL FIXATION|
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149441_28401_0|SrvcGrp|46903|2022|PDM|650.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F149586_77535_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149646_71129_0|SrvcGrp|74668|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119067_94080_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F118914_43015_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F109982_33592_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F86815_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F117255_68520_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F147725_06002_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|AEG 1 (NO REV)|
20|FH_F147839_33983_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147726_18017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129483_77030_0|SrvcGrp|14893|2022|PDM|35.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F129483_77030_0|SrvcGrp|24744|2022|PDM|60.00|99|0.00|PICC LINE INSERTION|
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|377.00|99|0.00|AEG 1 (NO REV)|
20|FH_F137898_46540_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39893_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93512_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F51016_0_0|SrvcGrp|43892|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F148554_85016_0|SrvcGrp|108172|2022|PDM|2691.00|99|0.00|AETNA FEM/POPL REVASE W/ATHER|
20|FH_F45977_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 640|
20|FH_F112854_53225_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F71594_15644_0|SrvcGrp|13985|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F112848_06032_0|SrvcGrp|76501|2022|PDM|334.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F123096_28210_0|SrvcGrp|108484|2022|PDM|1250.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F144011_60616_0|SrvcGrp|91245|2022|PCT|0.43|99|0.00|AETNA EMERGENCY ROOM LEVEL 5|
20|FH_F145960_33414_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F70026_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71162_0_0|SrvcGrp|17754|2022|PDM|67.00|99|0.00|DRESSING SET FOR  NEG PRESSURE WOUND THERAPY ELEC PUMP|
20|FH_F80855_0_0|SrvcGrp|15473|2022|PDM|1100.00|99|0.00|CPT CODE 42820|
20|FH_F130573_02882_0|SrvcGrp|88621|2022|PDM|125.00|99|0.00|SKILLED NURSING LPN|
20|FH_F92676_15063_0|SrvcGrp|78975|2022|PDM|1390.32|99|0.00|MON VALLEY ASC 201|
20|FH_F142028_45714_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142897_07018_0|SrvcGrp|105323|2022|PCT|1.00|99|0.00|ESTABLISH PATIENT OFF/OP VST|
20|FH_F128657_19008_0|SrvcGrp|76501|2022|PDM|302.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F145964_10993_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38700_0_0|SrvcGrp|18154|2022|PCT|0.80|99|0.00|MS DRG 251|
20|FH_F92676_15063_0|SrvcGrp|79091|2022|PDM|116.93|99|0.00|MON VALLEY ASC 247|
20|FH_F131282_0_0|SrvcGrp|85566|2022|PDM|817.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F38089_0_0|SrvcGrp|24537|2022|PDM|496.00|99|0.00|DIALYSIS|
20|FH_F148494_0_0|SrvcGrp|113843|2022|PDM|15500.00|99|0.00|REVISE KNEE|
20|FH_F37042_0_0|SrvcGrp|17069|2022|PDM|885.00|99|0.00|ASPG III|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|2011 DALLAS TX RAD (MOD 26)|
20|FH_F71323_68114_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|486.00|99|0.00|HAPA EPA ASC 2|
20|FH_F38770_0_0|SrvcGrp|27831|2022|PDM|2596.00|99|0.00|MS DRG 003-004 ONLY|
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|2160.00|99|0.00|AEG 9 (NO REV)|
20|FH_F132785_17961_0|SrvcGrp|11663|2022|PCT|0.11|99|0.00|IMPLANTS|
20|FH_F127422_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F42340_0_0|SrvcGrp|29021|2022|PCT|1.00|99|0.00|DME AND SUPPLIES|
20|FH_F115889_0_0|SrvcGrp|73006|2022|PDM|2240.00|99|0.00|AEG 9|
20|FH_F117346_75093_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F118672_29036_0|CSTM-ALL|CSTM-00|2020|PDM|6615.00|99|0.00|AEG 8 (NO REV)|
20|FH_F74084_15206_0|SrvcGrp|81878|2022|PCT|1.00|99|0.00|RADIOLOGY W/ REV/HCPC|
20|FH_F149840_80002_0|SrvcGrp|89781|2022|PDM|144.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F133490_90650_0|SrvcGrp|81779|2022|PCT|1.40|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F128144_45697_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F44607_0_0|SrvcGrp|131|2022|PCT|0.50|99|0.00|PACEMAKER DEVICE|
20|FH_F133287_40215_0|SrvcGrp|73559|2022|PDM|2537.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F89932_10940_0|SrvcGrp|13130|2022|PDM|1815.00|99|0.00|TRAUMA EMERGENCY ROOM SVCS|
20|FH_F67763_0_0|SrvcGrp|43534|2022|PDM|350.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F46255_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F150523_20877_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F128597_37129_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F37565_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89851_83854_0|SrvcGrp|47034|2022|PDM|11960.00|99|0.00|MS DRG 741 ONLY|
20|FH_F117891_19034_0|SrvcGrp|88620|2022|PDM|110.25|99|0.00|SKILLED NURSING RN|
20|FH_F150001_33064_0|SrvcGrp|47183|2022|PDM|63.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F149840_80002_0|SrvcGrp|93098|2022|PDM|144.00|99|0.00|HOSPICE CARE|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.59|99|0.00|ASPG 403|
20|FH_F41441_0_0|SrvcGrp|97|2022|PDM|1273.00|99|0.00|C-SECTION|
20|FH_F117880_91730_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F97566_79902_0|SrvcGrp|73605|2022|PDM|1636.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F37035_0_0|SrvcGrp|33828|2022|PDM|1045.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 6|
20|FH_F132420_84660_0|SrvcGrp|46903|2022|PDM|1120.36|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F127432_18015_0|SrvcGrp|12491|2022|PCT|0.10|99|0.00|PACEMAKER|
20|FH_F125049_44131_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F101802_17201_0|SrvcGrp|23683|2022|PDM|40.12|99|0.00|SKILLED NURSING RN|
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|29100.00|99|0.00|MSDRG 233-234 CORONARY BYPASS|
20|FH_F41988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
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_F36350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1326.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63618_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151119_66018_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151155_26508_0|SrvcGrp|113337|2022|PDM|228.00|99|0.00|INTAKE ACT W/MED EXAM (HCFA)|
20|FH_F138745_29642_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139215_32218_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F150764_33919_0|CSTM-ALL|CSTM-00|2020|PCT|1.12|99|0.00|HSS ASC|
20|FH_F150799_44041_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F138852_75228_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|1128.00|99|0.00|AEG 3 (NO REV)|
20|FH_F115705_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97881_38703_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F97084_91911_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F37181_0_0|SrvcGrp|701|2022|PDM|1900.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F116583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114206_37203_0|SrvcGrp|86841|2022|PDM|80.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F137986_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F149662_85015_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 10 (NO REV)|
20|FH_F137728_47203_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F139867_70816_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114676_91911_0|SrvcGrp|86749|2022|PCT|1.20|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|1456.00|99|0.00|ASPG VI|
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|2799.00|99|0.00|AEG 5  (NO REV)|
20|FH_F131113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140295_0_0|SrvcGrp|35668|2022|PDM|2912.00|99|0.00|CPT 29824|
20|FH_F40490_0_0|SrvcGrp|8950|2022|PDM|3295.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F125207_32904_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147143_18706_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149529_68102_0|SrvcGrp|3178|2022|PDM|938.00|99|0.00|ACUTE PSYCH|
20|FH_F42395_0_0|SrvcGrp|32633|2022|PDM|477.00|99|0.00|SKILLED NURSING|
20|FH_F128029_48154_0|SrvcGrp|83857|2022|PDM|550.00|99|0.00|IP HOSPICE SVCS|
20|FH_F131595_58103_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128091_37129_0|SrvcGrp|87317|2022|PDM|830.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F122364_67203_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F112128_63017_0|SrvcGrp|89417|2022|PDM|299.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F116549_0_0|SrvcGrp|103550|2022|PDM|425.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F98900_42001_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F140295_0_0|SrvcGrp|84318|2022|PDM|4948.00|99|0.00|SPINE INFUSION|
20|FH_F124287_43160_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97184_26101_0|SrvcGrp|73601|2022|PDM|7570.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F31912_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47212_0_0|SrvcGrp|42974|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|153.12|99|0.00|SALLY BALIN,999182,ASC 118|
20|FH_F124703_65711_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PDM|2949.00|99|0.00|ASPG VI|
20|FH_F110732_31513_0|SrvcGrp|3178|2022|PDM|1150.00|99|0.00|ACUTE PSYCH|
20|FH_F36323_0_0|SrvcGrp|472|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F149662_85015_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AETNA OP PET SCANS (PET)|
20|FH_F101280_63111_0|SrvcGrp|43523|2022|PDM|170.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F94643_90501_0|SrvcGrp|86851|2022|PDM|60.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F110732_31513_0|SrvcGrp|79099|2022|PDM|1478.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F125022_67035_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117711_73080_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F123377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS|
20|FH_F40917_0_0|SrvcGrp|30941|2022|PDM|235.00|99|0.00|NEWBORN NURSERY|
20|FH_F97082_90012_0|SrvcGrp|73602|2022|PDM|3672.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F150982_0_0|SrvcGrp|79101|2022|PDM|2478.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F138410_19130_0|SrvcGrp|113173|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - PFIZER|
20|FH_F39450_0_0|SrvcGrp|361|2022|PDM|1741.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|268.00|99|0.00|HAPA EPA ASC 36|
20|FH_F35735_33870_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F110725_48047_0|SrvcGrp|73842|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149662_85015_0|SrvcGrp|35950|2022|PDM|1021.00|99|0.00|CD DETOX|
20|FH_F113524_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97080_85122_0|SrvcGrp|90854|2022|PDM|2551.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F99420_91326_0|SrvcGrp|62395|2022|PCT|0.90|99|0.00|TRAUMA|
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1458.00|99|0.00|AEG 6 (NO REV)|
20|FH_F93254_0_0|SrvcGrp|76094|2022|PDM|140.09|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F36590_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F119795_0_0|SrvcGrp|108072|2022|PDM|21590.00|99|0.00|SPINE PROCEDURE|
20|FH_F124714_64081_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150982_0_0|SrvcGrp|83642|2022|PDM|2202.00|99|0.00|CPT 29883|
20|FH_F41457_0_0|SrvcGrp|34343|2022|PDM|2750.00|99|0.00|OP LITHOTRIPSY|
20|FH_F113545_11201_0|SrvcGrp|86722|2022|PDM|240.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F38496_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.50|99|0.00|OP SVCS|
20|FH_F124413_30067_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136191_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F117626_0_0|SrvcGrp|35670|2022|PDM|6500.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F132585_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|384.00|99|0.00|HAPA EPA ASC 45|
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F122416_72364_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109515_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124470_90025_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F128191_28642_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F137458_08857_0|SrvcGrp|89417|2022|PDM|318.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F131498_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F116437_0_0|SrvcGrp|78046|2022|PCT|1.10|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F139912_04101_0|SrvcGrp|86722|2022|PDM|185.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F140027_61031_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143536_47546_0|SrvcGrp|100249|2022|PCT|1.00|99|0.00|REMOVAL OF SKIN TAGS|
20|FH_F90559_0_0|SrvcGrp|79757|2022|PDM|1040.00|99|0.00|ESOPHAGUS ENDOSCOPY REPAIR|
20|FH_F102224_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130918_01606_0|SrvcGrp|86638|2022|PDM|1035.00|99|0.00|AETNA IP PSYCHIATRIC (>=18 YRS)|
20|FH_F48459_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP|
20|FH_F132431_79606_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F116699_46347_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F119918_38201_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F120887_78750_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F36439_0_0|SrvcGrp|23009|2022|PDM|1300.00|99|0.00|V5252|
20|FH_F40091_0_0|SrvcGrp|17065|2022|PDM|1053.00|99|0.00|ASPG I|
20|FH_F31991_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F66412_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F36263_0_0|SrvcGrp|13298|2022|PCT|0.83|99|0.00|LABORATORY|
20|FH_F40049_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97104_53545_0|SrvcGrp|73603|2022|PDM|9293.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F102500_0_0|SrvcGrp|98684|2022|PDM|2582.00|99|0.00|OSSEOINTEGRATED IMPLANT REPL|
20|FH_F72907_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F143819_29485_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|1375.00|99|0.00|AEG 5  (NO REV)|
20|FH_F122687_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_F137451_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F99720_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F35806_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F128272_60640_0|SrvcGrp|24744|2022|PDM|100.00|99|0.00|PICC LINE INSERTION|
20|FH_F135219_68506_0|SrvcGrp|72121|2022|PDM|7103.73|99|0.00|ARTHOSCOPY|
20|FH_F137574_68130_0|SrvcGrp|73524|2022|PCT|1.00|99|0.00|PHYSICAL THERAPY|
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|760.00|99|0.00|AEG 10 (NO REV)|
20|FH_F151540_17055_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148182_23324_0|SrvcGrp|48385|2022|PDM|84.00|99|0.00|SPEECH THERAPY|
20|FH_F88254_33411_0|SrvcGrp|26868|2022|PDM|30.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F50873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130497_33321_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121547_46805_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F102267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102302_0_0|SrvcGrp|98575|2022|PDM|29900.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL|
20|FH_F135010_46342_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F118271_46052_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F93741_85006_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F72143_0_0|SrvcGrp|37018|2022|PDM|450.00|99|0.00|BOARDER BABY|
20|FH_F125938_0_0|SrvcGrp|73606|2022|PCT|0.75|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F125965_66720_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1005.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 703 W/O REV|
20|FH_F118194_50841_0|SrvcGrp|22589|2022|PDM|145.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F113410_0_0|SrvcGrp|88155|2022|PDM|4728.00|99|0.00|REVISE KNEECAP WITH IMPLANT|
20|FH_F122433_0_0|SrvcGrp|99073|2022|PDM|1.28|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F116760_68512_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121525_78613_0|SrvcGrp|75419|2022|PDM|700.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F141515_50010_0|SrvcGrp|73841|2022|PDM|412.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F66501_0_0|SrvcGrp|24289|2022|PDM|70.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F125028_19061_0|SrvcGrp|86830|2022|PDM|105.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F116161_28112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126033_15301_0|SrvcGrp|48394|2022|PDM|44.15|99|0.00|SKILLED NURSING SERVICES|
20|FH_F89211_0_0|SrvcGrp|88398|2022|PDM|950.00|99|0.00|ACUTE SURGICAL SVCS|
20|FH_F131228_01826_0|SrvcGrp|21350|2022|PDM|11112.45|99|0.00|MS DRG 287 ONLY|
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.00|99|0.00|AEG 8 (NO REV)|
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116747_0_0|SrvcGrp|27969|2022|PCT|0.00|99|0.00|HOME HEALTH AIDE|
20|FH_F128272_60640_0|SrvcGrp|24761|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1815.00|99|0.00|AEG 7 (NO REV)|
20|FH_F128170_61920_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|899.00|99|0.00|AEG 10 (NO REV)|
20|FH_F150982_0_0|SrvcGrp|116048|2022|PDM|4451.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F150982_0_0|SrvcGrp|104449|2022|PDM|3853.00|99|0.00|CYSTOURETHRO W/ IMPLANT|
20|FH_F42706_0_0|SrvcGrp|472|2022|PDM|766.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F123466_93420_0|SrvcGrp|89417|2022|PDM|550.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F98920_46526_0|SrvcGrp|73601|2022|PDM|5251.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131420_29693_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136195_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F148324_93101_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_F37756_0_0|SrvcGrp|3327|2022|PDM|276.00|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F60073_0_0|SrvcGrp|16|2022|PDM|2400.00|99|0.00|ACUTE REHABILITATION|
20|FH_F125546_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.50|99|0.00|OP SVCS|
20|FH_F38718_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)|
20|FH_F143528_0_0|SrvcGrp|92416|2022|PDM|2520.00|99|0.00|CERVICAL LAMINOTOMY|
20|FH_F91994_0_0|SrvcGrp|72990|2022|PDM|500.00|99|0.00|AEG 1|
20|FH_F129653_0_0|SrvcGrp|103590|2022|PDM|4000.00|99|0.00|CAROTID ART|
20|FH_F110925_01104_0|SrvcGrp|86126|2022|PDM|25.18|99|0.00|AETNA GAMMA GLOBULIN|
20|FH_F51358_0_0|SrvcGrp|44427|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS (VISIT LVL)|
20|FH_F72206_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|GENERAL ACUTE CARE|
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|AEG 1 (NO REV)|
20|FH_F39339_0_0|SrvcGrp|941|2022|PDM|2245.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F121177_33407_0|SrvcGrp|89412|2022|PDM|280.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F91876_0_0|SrvcGrp|90822|2022|PDM|2345.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F132190_0_0|SrvcGrp|107495|2022|PDM|1600.00|99|0.00|AETNA - ARTHROSCOPY OF JOINT|
20|FH_F93413_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63464_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73985_0_0|SrvcGrp|26217|2022|PDM|7973.00|99|0.00|LAPAROSCOPY|
20|FH_F147994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F118373_21205_0|SrvcGrp|12512|2022|PDM|3091.00|99|0.00|ACUTE REHABILITATION|
20|FH_F123259_54501_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|725.00|99|0.00|AEG 3 (NO REV)|
20|FH_F98922_40351_0|SrvcGrp|73605|2022|PDM|2572.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F135248_84651_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|1061.00|99|0.00|AEG 6 (NO REV)|
20|FH_F137367_89139_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F97102_83501_0|SrvcGrp|73656|2022|PDM|586.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F122705_33351_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F62579_0_0|SrvcGrp|24754|2022|PDM|19.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F117887_0_0|SrvcGrp|93736|2022|PDM|100.00|99|0.00|URGENT CARE|
20|FH_F38411_0_0|SrvcGrp|18288|2022|PCT|0.80|99|0.00|MS DRG 462|
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)|
20|FH_F129300_54541_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133727_33511_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127071_82435_0|SrvcGrp|46903|2022|PDM|1600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F135670_01749_0|SrvcGrp|86836|2022|PDM|12.50|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F52713_0_0|SrvcGrp|16|2022|PDM|3110.00|99|0.00|ACUTE REHABILITATION|
20|FH_F100782_0_0|SrvcGrp|105176|2022|PDM|1450.75|99|0.00|WINDBER MEDICAL CNTR ASC 1302|
20|FH_F120698_75082_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F99442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109266_33319_0|SrvcGrp|86748|2022|PCT|1.25|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|957.00|99|0.00|ACUTE PSYCH|
20|FH_F41660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109266_33319_0|SrvcGrp|86746|2022|PCT|1.25|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F88744_71103_0|SrvcGrp|20926|2022|PDM|23508.00|99|0.00|MS DRG 235 ONLY|
20|FH_F79743_0_0|SrvcGrp|359|2022|PDM|929.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F130364_01331_0|SrvcGrp|91177|2022|PDM|1200.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F127957_89521_0|SrvcGrp|100499|2022|PDM|779.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F146103_63851_0|SrvcGrp|3178|2022|PDM|1139.00|99|0.00|ACUTE PSYCH|
20|FH_F109577_0_0|SrvcGrp|23681|2022|PDM|135.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|501.11|99|0.00|AEG 2 (NO REV)|
20|FH_F115347_0_0|SrvcGrp|93750|2022|PDM|1550.00|99|0.00|ERCP REMOVE FOREIGN BODY DUCT|
20|FH_F127418_0_0|SrvcGrp|89842|2022|PDM|31737.62|99|0.00|LUMBAR|
20|FH_F119110_91773_0|SrvcGrp|48396|2022|PDM|120.00|99|0.00|OT SERVICES|
20|FH_F149603_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HSS ASC|
20|FH_F85213_02840_0|SrvcGrp|112676|2022|PDM|238.30|99|0.00|COVID-19 SARS-COV-2 ANTIBODY|
20|FH_F124219_0_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F149099_23901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F80224_0_0|SrvcGrp|3273|2022|PCT|0.76|99|0.00|IMPLANTS|
20|FH_F54532_0_0|SrvcGrp|3938|2022|PDM|973.00|99|0.00|ACUTE PSYCHIATRIC|
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F69708_0_0|SrvcGrp|42824|2022|PDM|124.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F81861_0_0|SrvcGrp|64104|2022|PDM|1720.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 5|
20|FH_F145604_14850_0|SrvcGrp|24745|2022|PDM|85.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1533.57|99|0.00|HAPA WPA-NWPA 2012-13 ASC 13 W/O REV|
20|FH_F144848_0_0|SrvcGrp|97279|2022|PDM|1119.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY|
20|FH_F138050_52301_0|SrvcGrp|73603|2022|PDM|555.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F77943_0_0|SrvcGrp|22106|2022|PCT|0.70|99|0.00|CAT SCAN|
20|FH_F81698_10457_0|SrvcGrp|14947|2022|PDM|31.50|99|0.00|HOME INFUSION|
20|FH_F146590_77449_0|SrvcGrp|48396|2022|PDM|118.00|99|0.00|OT SERVICES|
20|FH_F70208_0_0|SrvcGrp|12290|2022|PDM|825.00|99|0.00|DETOXIFICATION|
20|FH_F85353_16407_0|SrvcGrp|63902|2022|PDM|159.50|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1501|
20|FH_F149259_64050_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F51039_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|2010 RADIOLOGY (MOD 26)|
20|FH_F81698_10457_0|SrvcGrp|17014|2022|PDM|31.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F145641_06902_0|SrvcGrp|100067|2022|PDM|3802.00|99|0.00|ANKLE ARTHROSCOPY SURGERY|
20|FH_F138302_15701_0|SrvcGrp|73742|2022|PDM|2.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F134593_60007_0|SrvcGrp|112588|2022|PCT|1.05|99|0.00|NALTREXONE|
20|FH_F122243_30655_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F120670_0_0|SrvcGrp|93431|2022|PDM|12000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F119227_01752_0|SrvcGrp|108047|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F117208_0_0|SrvcGrp|89853|2022|PDM|3410.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG|
20|FH_F125244_0_0|SrvcGrp|33965|2022|PDM|5000.00|99|0.00|CPT 58552|
20|FH_F76146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110420_60649_0|SrvcGrp|72990|2022|PDM|383.00|99|0.00|AEG 1|
20|FH_F114444_19602_0|SrvcGrp|105369|2022|PDM|45.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MINS|
20|FH_F146657_01105_0|SrvcGrp|104186|2022|PDM|22.12|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116806_0_0|SrvcGrp|107042|2022|PDM|1923.16|99|0.00|REPAIR MOUTH/NOSE FISTULA|
20|FH_F146543_89511_0|SrvcGrp|75419|2022|PDM|478.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F143669_78577_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141167_0_0|SrvcGrp|107748|2022|PDM|500.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F138447_22041_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F145722_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110905_54452_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F143742_60410_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F111986_0_0|SrvcGrp|104120|2022|PDM|1442.00|99|0.00|CYSTOURETHROSCOPY|
20|FH_F84712_0_0|SrvcGrp|82745|2022|PDM|87.00|99|0.00|CULT BACT NO URINE/BLD/STOOL|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|322.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 223 W/O REV|
20|FH_F47140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116055_59804_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F131737_15025_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F133478_40165_0|SrvcGrp|20075|2022|PDM|13957.00|99|0.00|MS DRG 286 ONLY|
20|FH_F132088_34981_0|SrvcGrp|108484|2022|PDM|603.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F132088_34981_0|SrvcGrp|73841|2022|PDM|387.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F133219_89119_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F121385_89102_0|SrvcGrp|73601|2022|PDM|5472.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F115990_0_0|SrvcGrp|73006|2022|PDM|1750.00|99|0.00|AEG 9|
20|FH_F40230_0_0|CSTM-ALL|CSTM-00|2020|PDM|1014.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113741_63303_0|SrvcGrp|48398|2022|PDM|81.60|99|0.00|PT SERVICES|
20|FH_F82933_0_0|SrvcGrp|68062|2022|PDM|7072.58|99|0.00|ICU/CCU|
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)|
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PDM|2106.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F142070_0_0|SrvcGrp|113580|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F77923_0_0|SrvcGrp|46633|2022|PDM|45.00|99|0.00|SPEECH THERAPY|
20|FH_F91873_12723_0|SrvcGrp|12840|2022|PCT|0.68|99|0.00|PACEMAKER|
20|FH_F97780_43614_0|SrvcGrp|73461|2022|PDM|8092.00|99|0.00|AETNA NICU IV|
20|FH_F111001_0_0|CSTM-ALL|CSTM-00|2020|PDM|15.00|99|0.00|RESPITE CARE (MOD TD)|
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|OP SVCS|
20|FH_F85039_0_0|SrvcGrp|75479|2022|PDM|366.00|99|0.00|AEG 1|
20|FH_F142318_21218_0|SrvcGrp|89412|2022|PDM|205.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F100640_48097_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F119435_0_0|SrvcGrp|107878|2022|PDM|4300.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F138929_0_0|SrvcGrp|85792|2022|PDM|5005.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AEG 6 (NO REV)|
20|FH_F134270_0_0|SrvcGrp|67065|2022|PDM|18000.00|99|0.00|CERVICAL SURGERY|
20|FH_F136832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128027_0_0|SrvcGrp|110954|2022|PDM|1050.00|99|0.00|UPPER GI ENDOSCOPY W/ SUBMUC INJ|
20|FH_F141014_29732_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F141134_84720_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|661.50|99|0.00|AEG 4 (NO REV)|
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 8 (NO REV)|
20|FH_F124067_15425_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124067_15425_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS|
20|FH_F62624_0_0|SrvcGrp|3932|2022|PDM|6500.00|99|0.00|LITHOTRIPSY|
20|FH_F39066_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49943_0_0|SrvcGrp|42974|2022|PDM|140.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F100703_0_0|SrvcGrp|99073|2022|PDM|1.43|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F132864_71101_0|SrvcGrp|73601|2022|PDM|2083.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F124173_66215_0|SrvcGrp|47183|2022|PDM|83.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F124227_01230_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124237_95023_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F132037_66002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66388_0_0|SrvcGrp|44106|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|2797.00|99|0.00|ASPG IV|
20|FH_F76163_0_0|SrvcGrp|57968|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F136546_33176_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136667_23603_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F136736_65483_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113870_10536_0|SrvcGrp|73842|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139655_17078_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114985_32073_0|SrvcGrp|104815|2022|PDM|102.00|99|0.00|NEUROBEHAVIORAL STATUS EXAM|
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|582.42|99|0.00|2005 ASPG GROUPER I|
20|FH_F127448_0_0|SrvcGrp|72994|2022|PDM|920.00|99|0.00|AEG 3|
20|FH_F137447_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122608_84123_0|SrvcGrp|33722|2022|PDM|29.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F136778_62034_0|SrvcGrp|10363|2022|PDM|1293.00|99|0.00|CPT CODE 99283|
20|FH_F136807_43220_0|SrvcGrp|48396|2022|PDM|83.00|99|0.00|OT SERVICES|
20|FH_F136927_45690_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136930_73114_0|SrvcGrp|67944|2022|PDM|376.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F112505_51503_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F115664_72758_0|SrvcGrp|106311|2022|PCT|0.00|99|0.00|VBAC DELIVERY|
20|FH_F116383_63026_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F147522_64114_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147701_31093_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F147541_44805_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41675_0_0|SrvcGrp|18076|2022|PDM|760.00|99|0.00|MRI|
20|FH_F42176_0_0|SrvcGrp|22461|2022|PCT|0.88|99|0.00|INPATIENT HOSPICE SVCS|
20|FH_F42837_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD KN|
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PDM|1128.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 8 W/O REV|
20|FH_F71165_0_0|SrvcGrp|31213|2022|PCT|0.90|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F46433_0_0|SrvcGrp|26869|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F46433_0_0|SrvcGrp|24934|2022|PDM|75.00|99|0.00|NUTRITIONAL ASSESSMENT (INITIAL)|
20|FH_F107360_0_0|SrvcGrp|82037|2022|PDM|1807.00|99|0.00|AETNA ICU|
20|FH_F135351_0_0|SrvcGrp|82107|2022|PDM|4382.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)|
20|FH_F144648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150939_0_0|SrvcGrp|100276|2022|PDM|121.00|99|0.00|MCV4 MENACWY VACCINE IM|
20|FH_F72445_0_0|SrvcGrp|9228|2022|PDM|60.00|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F80511_0_0|SrvcGrp|78183|2022|PDM|1643.00|99|0.00|AETNA MRI|
20|FH_F110940_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|510.00|99|0.00|AEG 3 (NO REV)|
20|FH_F44459_0_0|SrvcGrp|38676|2022|PDM|45.00|99|0.00|SPEECH THERAPY|
20|FH_F54552_0_0|SrvcGrp|33164|2022|PDM|485.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F113585_20155_0|SrvcGrp|86849|2022|PDM|50.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F138707_44138_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138784_32216_0|SrvcGrp|89149|2022|PDM|253.00|99|0.00|OP INTENSIVE|
20|FH_F138936_01040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138936_01040_0|SrvcGrp|113453|2022|PDM|1236.00|99|0.00|CRITICAL CARE|
20|FH_F138992_72703_0|SrvcGrp|10364|2022|PDM|591.00|99|0.00|CPT CODE 99284|
20|FH_F91641_0_0|SrvcGrp|26281|2022|PDM|3953.52|99|0.00|CPT 58353|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.98|99|0.00|HAPA WPA-NWPA 2012-13 ASC 908 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|741.86|99|0.00|HAPA WPA-NWPA 2012-13 ASC 403 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|503.31|99|0.00|HAPA WPA-NWPA 2012-13 ASC 205 W/O REV|
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113527_31023_0|SrvcGrp|12659|2022|PDM|292.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F151342_90272_0|SrvcGrp|74668|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151426_90028_0|SrvcGrp|108484|2022|PDM|740.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F151503_30067_0|SrvcGrp|100067|2022|PDM|2090.00|99|0.00|ANKLE ARTHROSCOPY SURGERY|
20|FH_F47212_0_0|SrvcGrp|16304|2022|PDM|630.39|99|0.00|HOSPICE CARE|
20|FH_F135485_20171_0|SrvcGrp|48398|2022|PDM|84.00|99|0.00|PT SERVICES|
20|FH_F135609_37027_0|SrvcGrp|46903|2022|PDM|1012.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F136074_67206_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136226_28638_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131228_01826_0|SrvcGrp|10361|2022|PDM|276.14|99|0.00|CPT CODE 99281|
20|FH_F130756_04901_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AETNA OP CT SCANS (CTSCAN) - HCFA|
20|FH_F130766_04967_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|AEG 2 (NO REV)|
20|FH_F140629_0_0|SrvcGrp|26277|2022|PDM|2497.00|99|0.00|CPT 29874|
20|FH_F140629_0_0|SrvcGrp|104108|2022|PDM|1016.00|99|0.00|EXCISION OF BREAST LESION ID|
20|FH_F101200_19020_0|SrvcGrp|98041|2022|PDM|9.38|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F121704_90405_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F33791_0_0|SrvcGrp|89297|2022|PDM|300.00|99|0.00|INPATIENT DETOXIFICATION SERVICES|
20|FH_F42098_0_0|CSTM-ALL|CSTM-00|2020|PDM|26.00|99|0.00|HOME HEALTH MOD TD|
20|FH_F128370_76132_0|SrvcGrp|9811|2022|PDM|580.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F111292_33136_0|SrvcGrp|73006|2022|PDM|8270.00|99|0.00|AEG 9|
20|FH_F111292_33136_0|SrvcGrp|82737|2022|PDM|41.00|99|0.00|URINALYSIS|
20|FH_F111292_33136_0|SrvcGrp|82765|2022|PDM|58.00|99|0.00|ELECTROLYTE PANEL|
20|FH_F111292_33136_0|SrvcGrp|104285|2022|PDM|62.00|99|0.00|DRUG SCREEN|
20|FH_F111363_33169_0|SrvcGrp|109057|2022|PCT|0.84|99|0.00|CARDIAC STUDIES|
20|FH_F148243_0_0|SrvcGrp|100923|2022|PDM|400.00|99|0.00|DRUGS|
20|FH_F45793_0_0|CSTM-ALL|CSTM-00|2020|PDM|80.00|99|0.00|OP SVCS|
20|FH_F36344_0_0|SrvcGrp|11798|2022|PDM|54.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F51272_0_0|SrvcGrp|47595|2022|PCT|0.75|99|0.00|MENTAL HEALTH SERVICES|
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1116.00|99|0.00|ACUTE PSYCH|
20|FH_F116430_0_0|SrvcGrp|36591|2022|PDM|4244.00|99|0.00|CPT 63685|
20|FH_F116430_0_0|SrvcGrp|106705|2022|PDM|1353.00|99|0.00|ENT SURGERY|
20|FH_F132073_0_0|SrvcGrp|29155|2022|PDM|143.00|99|0.00|HOSPICE SVCS|
20|FH_F112105_24924_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127713_30012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141035_0_0|SrvcGrp|85792|2022|PDM|21661.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F102901_85006_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|GENERAL ACUTE CARE|
20|FH_F102960_50613_0|SrvcGrp|60623|2022|PCT|3.13|99|0.00|(HIGH COST DRUGS) OCN F/S PRICING: ALL|
20|FH_F41158_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F98625_08103_0|SrvcGrp|88977|2022|PDM|8414.00|99|0.00|C-SECTION DELIVERY|
20|FH_F111186_15213_0|SrvcGrp|110641|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F140007_0_0|SrvcGrp|3932|2022|PDM|4505.00|99|0.00|LITHOTRIPSY|
20|FH_F66880_25301_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F57073_0_0|SrvcGrp|177|2022|PDM|1591.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129975_0_0|SrvcGrp|111422|2022|PCT|5.90|99|0.00|PHYSICAL MEDICINE|
20|FH_F89912_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|944.29|99|0.00|ASPG VIII|
20|FH_F123733_70714_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F58856_0_0|SrvcGrp|22410|2022|PCT|0.55|99|0.00|ASPG X (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_F115166_0_0|SrvcGrp|86722|2022|PDM|165.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F136398_23502_0|SrvcGrp|89417|2022|PDM|375.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F136542_02446_0|CSTM-ALL|CSTM-00|2020|PDM|887.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F93292_62234_0|SrvcGrp|66264|2022|PDM|76.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F93358_63084_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F137231_25550_0|SrvcGrp|48394|2022|PDM|37.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F137247_40160_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142313_14788_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F142247_61244_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97582_46307_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F97600_46151_0|SrvcGrp|73605|2022|PDM|2132.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F140568_46506_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS|
20|FH_F140572_46526_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F140844_48083_0|SrvcGrp|53144|2022|PDM|129.00|99|0.00|SPEECH THERAPY|
20|FH_F120152_0_0|SrvcGrp|92007|2022|PDM|11000.00|99|0.00|PROXIMAL HUMERAL|
20|FH_F149374_38855_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149583_98930_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118959_44830_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F119004_06850_0|CSTM-ALL|CSTM-00|2020|PDM|1081.00|99|0.00|AEG 4 (NO REV)|
20|FH_F92593_21031_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F109884_36117_0|SrvcGrp|86748|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F109920_39180_0|SrvcGrp|75495|2022|PDM|1815.00|99|0.00|AEG 9|
20|FH_F117261_43543_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F129411_24540_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129467_45449_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F117219_77515_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F117126_12801_0|SrvcGrp|10363|2022|PDM|1365.00|99|0.00|CPT CODE 99283|
20|FH_F137815_15501_0|SrvcGrp|90854|2022|PDM|775.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F137938_29036_0|SrvcGrp|112722|2022|PCT|0.66|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F34371_0_0|SrvcGrp|10534|2022|PDM|85.00|99|0.00|NURSING CARE|
20|FH_F39303_0_0|SrvcGrp|16|2022|PDM|737.00|99|0.00|ACUTE REHABILITATION|
20|FH_F107926_0_0|SrvcGrp|103544|2022|PDM|1875.00|99|0.00|LASER TREATMENT RETINA|
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)|
20|FH_F112080_0_0|SrvcGrp|72992|2022|PDM|647.00|99|0.00|AEG 2|
20|FH_F120210_0_0|CSTM-ALL|CSTM-00|2020|PDM|496.00|99|0.00|AEG 2 (NO REV)|
20|FH_F111594_0_0|SrvcGrp|67065|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY|
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 6 (NO REV)|
20|FH_F101840_76054_0|SrvcGrp|80837|2022|PDM|15216.00|99|0.00|MSDRG 518 ONLY|
20|FH_F44225_0_0|SrvcGrp|20534|2022|PCT|0.90|99|0.00|SKILLED NURSING|
20|FH_F142008_74301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F126735_38018_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F42779_0_0|SrvcGrp|1214|2022|PDM|351.00|99|0.00|AMBULATORY DETOXIFICATION|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD RR KC"|
20|FH_F129965_0_0|SrvcGrp|65559|2022|PCT|1.10|99|0.00|E&M CODES|
20|FH_F120924_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
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_F36118_0_0|SrvcGrp|12263|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F133550_90630_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F133307_14580_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F150039_34236_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F36409_0_0|SrvcGrp|3327|2022|PDM|94.50|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F117855_62246_0|SrvcGrp|27969|2022|PDM|14.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133005_32726_0|SrvcGrp|38006|2022|PDM|1000.00|99|0.00|CPT CODE 59426|
20|FH_F92636_90230_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111809_93003_0|SrvcGrp|10362|2022|PDM|2089.00|99|0.00|CPT CODE 99282|
20|FH_F141835_78676_0|SrvcGrp|46903|2022|PDM|670.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F139607_0_0|SrvcGrp|106264|2022|PDM|2598.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION|
20|FH_F111802_22003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111809_93003_0|SrvcGrp|87448|2022|PDM|18761.00|99|0.00|AETNA KYPHOPLASTY (2015 HIPPA)|
20|FH_F127422_0_0|SrvcGrp|91759|2022|PCT|1.00|99|0.00|OCULAR IMPLANT|
20|FH_F97882_32407_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS|
20|FH_F79902_0_0|SrvcGrp|13359|2022|PDM|159.00|99|0.00|EMERGENCY ROOM SVCS LEVEL I|
20|FH_F33285_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS|
20|FH_F90831_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97622_75051_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PDM|801.00|99|0.00|ASPG III|
20|FH_F145988_06105_0|SrvcGrp|112052|2022|PCT|1.47|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F120707_0_0|SrvcGrp|75505|2022|PCT|0.89|99|0.00|CARDIAC STUDIES|
20|FH_F133490_90650_0|SrvcGrp|89417|2022|PDM|410.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F141890_64865_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136393_0_0|SrvcGrp|109508|2022|PDM|4800.00|99|0.00|REMOVAL OF PM GENERATOR|
20|FH_F149581_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F135690_20814_0|SrvcGrp|75419|2022|PDM|575.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148886_60621_0|CSTM-ALL|CSTM-00|2020|PDM|2114.00|99|0.00|AEG 9 (NO REV)|
20|FH_F40980_0_0|SrvcGrp|13292|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F87293_18702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F34706_0_0|SrvcGrp|2981|2022|PDM|9821.00|99|0.00|DRG 520 CERVICAL SPINAL FUSION W/O CC|
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|498.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F46352_0_0|SrvcGrp|24639|2022|PDM|147.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F119104_44870_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2457.00|99|0.00|AEG 9 (NO REV)|
20|FH_F40980_0_0|SrvcGrp|2105|2022|PDM|215.00|99|0.00|NEWBORN HEARING SCREENING|
20|FH_F117550_0_0|SrvcGrp|29993|2022|PDM|36.00|99|0.00|POOL THERAPY|
20|FH_F129535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F45214_71103_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F36921_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS|
20|FH_F48475_0_0|SrvcGrp|474|2022|PDM|489.50|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F133530_11237_0|SrvcGrp|75505|2022|PCT|2.20|99|0.00|CARDIAC STUDIES|
20|FH_F148886_60621_0|SrvcGrp|79786|2022|PCT|0.00|99|0.00|SLEEP STUDIES|
20|FH_F43411_0_0|SrvcGrp|9539|2022|PDM|725.00|99|0.00|SUBACUTE CARE|
20|FH_F92677_08003_0|SrvcGrp|86843|2022|PDM|63.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F67803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F106700_02906_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|729.00|99|0.00|AEG 3 (NO REV)|
20|FH_F113261_38464_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97565_83301_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
20|FH_F132543_79549_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F37568_0_0|SrvcGrp|12263|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE- HOURLY|
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_F114519_0_0|SrvcGrp|73000|2022|PDM|1398.00|99|0.00|AEG 6|
20|FH_F150884_75503_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44225_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F111444_33401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125540_19462_0|SrvcGrp|86723|2022|PDM|407.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F133214_75024_0|SrvcGrp|109330|2022|PCT|1.15|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133530_11237_0|SrvcGrp|15386|2022|PDM|166.00|99|0.00|CLINIC VISIT|
20|FH_F97181_33143_0|SrvcGrp|73849|2022|PDM|1000.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F144348_22601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78682_0_0|CSTM-ALL|CSTM-00|2020|PDM|568.07|99|0.00|ASPG I|
20|FH_F148906_79336_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120838_01603_0|SrvcGrp|89417|2022|PDM|302.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F111522_81067_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F32913_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F145937_75240_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F39859_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F91155_16105_0|SrvcGrp|74662|2022|PDM|517.00|99|0.00|AETNA SLEEP STUDIES|
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|ASPG IV|
20|FH_F129688_74066_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F40542_0_0|SrvcGrp|32644|2022|PCT|1.50|99|0.00|RADIOLOGY - CPT/GLOBAL|
20|FH_F37554_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F148023_34471_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148740_93230_0|SrvcGrp|108484|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F151063_44094_0|SrvcGrp|87317|2022|PDM|579.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F151144_35801_0|SrvcGrp|90369|2022|PDM|915.43|99|0.00|PROBE NASOLACRIMAL DUCT|
20|FH_F151154_91761_0|SrvcGrp|66264|2022|PDM|119.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F151155_26508_0|SrvcGrp|113329|2022|PDM|559.00|99|0.00|MED TX REMOVE IMPLANT (HCFA)|
20|FH_F151200_10001_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F151201_90020_0|SrvcGrp|46903|2022|PDM|800.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F139128_49503_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139209_22556_0|SrvcGrp|104351|2022|PCT|1.00|99|0.00|STREP A/DNA/AMP PROBE|
20|FH_F150768_03054_0|SrvcGrp|48385|2022|PDM|167.00|99|0.00|SPEECH THERAPY|
20|FH_F125656_92868_0|SrvcGrp|14893|2022|PDM|55.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F141156_04401_0|CSTM-ALL|CSTM-00|2020|PDM|545.00|99|0.00|AEG 2 (NO REV)|
20|FH_F129340_43212_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F98880_50158_0|SrvcGrp|73643|2022|PDM|2454.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F43485_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35416_0_0|SrvcGrp|51672|2022|PDM|4620.00|99|0.00|MS DRG 286-287 ONLY|
20|FH_F114206_37203_0|SrvcGrp|28630|2022|PCT|1.00|99|0.00|HOME INFUSION SKILLED NURSING|
20|FH_F40579_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F78185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39756_0_0|SrvcGrp|31091|2022|PDM|71.50|99|0.00|NOMINAL FEE CODES|
20|FH_F132512_0_0|SrvcGrp|89149|2022|PDM|408.00|99|0.00|OP INTENSIVE|
20|FH_F147219_48207_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41033_0_0|SrvcGrp|17069|2022|PDM|561.00|99|0.00|ASPG III|
20|FH_F138017_73129_0|SrvcGrp|97480|2022|PDM|5901.00|99|0.00|BASAL/SINUS ENDOSCOPY|
20|FH_F52092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|HCPCS_HHI_INFUSION|
20|FH_F124413_30067_0|SrvcGrp|74668|2022|PDM|375.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132160_0_0|SrvcGrp|109766|2022|PDM|2869.00|99|0.00|COVER EYE W/ MEMBRANE|
20|FH_F102365_0_0|SrvcGrp|92537|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F122248_33441_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F89674_18640_0|SrvcGrp|23683|2022|PDM|31.50|99|0.00|SKILLED NURSING RN|
20|FH_F132126_08037_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1595.00|99|0.00|AEG 3 (NO REV)|
20|FH_F40490_0_0|SrvcGrp|9984|2022|PCT|0.58|99|0.00|URGENT CARE|
20|FH_F147237_40006_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F146266_0_0|SrvcGrp|93432|2022|PDM|8501.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|1289.00|99|0.00|AEG 7 (NO REV)|
20|FH_F128091_37129_0|SrvcGrp|75419|2022|PDM|650.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F101640_32218_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F133569_17202_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F110783_93013_0|SrvcGrp|14949|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F146283_0_0|CSTM-ALL|CSTM-00|2020|PDM|2617.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132132_77040_0|SrvcGrp|86722|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F100540_0_0|SrvcGrp|72998|2022|PDM|1035.00|99|0.00|AEG 5|
20|FH_F40644_0_0|SrvcGrp|705|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F117762_0_0|SrvcGrp|10985|2022|PDM|2891.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)|
20|FH_F133922_70563_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116473_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F73864_0_0|SrvcGrp|46605|2022|PDM|12.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F127418_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F72543_0_0|SrvcGrp|69019|2022|PDM|47.25|99|0.00|LPN|
20|FH_F122526_22203_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F105143_26062_0|SrvcGrp|73008|2022|PDM|5988.00|99|0.00|AEG 10|
20|FH_F105143_26062_0|SrvcGrp|73498|2022|PDM|1080.00|99|0.00|AETNA ER LEVEL III|
20|FH_F80513_0_0|SrvcGrp|28119|2022|PDM|34514.00|99|0.00|MS DRG 466 ONLY|
20|FH_F127504_22556_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116023_10027_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F116040_24637_0|SrvcGrp|86836|2022|PDM|10.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F131628_26505_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F131698_01862_0|SrvcGrp|27969|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133478_40165_0|SrvcGrp|705|2022|PCT|0.28|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F139268_36695_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F150745_03301_0|SrvcGrp|104226|2022|PDM|208.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F150768_03054_0|SrvcGrp|43567|2022|PDM|158.00|99|0.00|SKILLED NURSING - POSTNATAL|
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_F90199_24083_0|SrvcGrp|76501|2022|PDM|278.25|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F137748_95231_0|CSTM-ALL|CSTM-00|2020|PDM|3624.00|99|0.00|AEG 5  (NO REV)|
20|FH_F117799_0_0|SrvcGrp|84932|2022|PDM|1891.00|99|0.00|VITRECTOMY|
20|FH_F124739_64429_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F137986_0_0|SrvcGrp|90365|2022|PDM|1436.00|99|0.00|REPAIR METACARPAL FRACTURE|
20|FH_F134427_64014_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|VERTICAL PLUS MRI OP SERVICES MOD TC|
20|FH_F147166_03444_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F124695_33401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114848_50533_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40899_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F138995_0_0|SrvcGrp|36991|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F90223_0_0|SrvcGrp|86832|2022|PDM|3.60|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F90817_0_0|SrvcGrp|90380|2022|PDM|2280.00|99|0.00|ARTHROSCOPIC FRACTURE TX|
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132008_85226_0|SrvcGrp|107233|2022|PCT|0.80|99|0.00|POWER WHEELCHAIR GROUP 3|
20|FH_F119940_60126_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F41342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F110732_31513_0|SrvcGrp|70399|2022|PDM|169.00|99|0.00|PSYCHIATIC/PSYCHOLOGIC SERVICE|
20|FH_F119940_60126_0|CSTM-ALL|CSTM-00|2020|PCT|0.22|99|0.00|OP SVCS|
20|FH_F124760_34997_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F75606_0_0|SrvcGrp|1943|2022|PDM|2605.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F144651_0_0|SrvcGrp|114171|2022|PDM|1250.00|99|0.00|STENT PACEMT ANTE COROTID|
20|FH_F120848_20912_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F33566_0_0|SrvcGrp|2738|2022|PCT|0.75|99|0.00|IMPLANTS|
20|FH_F150926_17404_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97280_20018_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F124719_64093_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F151699_01752_0|SrvcGrp|29075|2022|PDM|40.00|99|0.00|HYDRATION THERAPY|
20|FH_F148667_0_0|SrvcGrp|89980|2022|PDM|2727.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F150982_0_0|SrvcGrp|101525|2022|PDM|2527.00|99|0.00|MYOMECTOMY|
20|FH_F75944_0_0|SrvcGrp|68191|2022|PDM|1917.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 7|
20|FH_F36992_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD AW|
20|FH_F127292_85705_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F141270_89103_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F117762_0_0|SrvcGrp|98498|2022|PDM|4992.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC|
20|FH_F120057_0_0|SrvcGrp|73002|2022|PDM|1194.00|99|0.00|AEG 7|
20|FH_F146266_0_0|SrvcGrp|35672|2022|PDM|3300.00|99|0.00|CPT 23412|
20|FH_F147341_19720_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148667_0_0|SrvcGrp|90975|2022|PDM|1207.00|99|0.00|INJECTION OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE|
20|FH_F147227_48302_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SUPPLEMENTAL. OCN F/S PRICING: ALL|
20|FH_F138018_17313_0|SrvcGrp|24754|2022|PDM|41.10|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F151001_80501_0|SrvcGrp|75419|2022|PDM|2100.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F129773_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F37708_0_0|SrvcGrp|13631|2022|PDM|90.00|99|0.00|CPT 99213|
20|FH_F90183_80031_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F149579_95815_0|SrvcGrp|115708|2022|PDM|12.31|99|0.00|VIRTUAL CHECK-IN (HCFA)|
20|FH_F35475_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|618180-OPGH-DME|
20|FH_F125656_92868_0|SrvcGrp|86844|2022|PDM|35.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F117583_21208_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134887_33409_0|SrvcGrp|112692|2022|PDM|21.00|99|0.00|MULTI DEN INSERT DIRECT FORM|
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 10 (NO REV)|
20|FH_F47212_0_0|SrvcGrp|71162|2022|PDM|8.00|99|0.00|CATHERER CARE|
20|FH_F98820_81401_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1075.00|99|0.00|AEG 10 (NO REV)|
20|FH_F91076_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F35432_0_0|SrvcGrp|16870|2022|PDM|2081.00|99|0.00|ICU|
20|FH_F147359_54911_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125656_92868_0|SrvcGrp|99037|2022|PDM|40.00|99|0.00|ANTIBIOTIC Q6H (HCFA)|
20|FH_F124548_12414_0|SrvcGrp|89149|2022|PDM|125.00|99|0.00|OP INTENSIVE|
20|FH_F84433_0_0|SrvcGrp|27968|2022|PDM|35.01|99|0.00|SKILLED NURSING LPN|
20|FH_F129256_89146_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F112128_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F125214_12428_0|SrvcGrp|111924|2022|PCT|0.00|99|0.00|C-SECTION DELIVERY INCLUDES NEWBORN|
20|FH_F36683_0_0|SrvcGrp|701|2022|PDM|2077.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F97521_30824_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F90455_0_0|SrvcGrp|43569|2022|PDM|128.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F38172_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|GA STANDARD MRI CODES|
20|FH_F115269_0_0|SrvcGrp|46903|2022|PDM|520.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F127418_0_0|SrvcGrp|110760|2022|PDM|15165.94|99|0.00|POSTERIOR OPEN TX OF VERTEBRAL FX|
20|FH_F71468_0_0|SrvcGrp|10543|2022|PDM|70.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F139847_66205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97280_20018_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F122267_62656_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F150929_17325_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|GROUP BEHAVIOR TREATMENT (HCFA)|
20|FH_F111122_63376_0|SrvcGrp|27968|2022|PDM|25.00|99|0.00|SKILLED NURSING LPN|
20|FH_F67764_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F128764_57501_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_F37075_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F139147_0_0|SrvcGrp|89404|2022|PDM|14057.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.00|99|0.00|AEG 9 (NO REV)|
20|FH_F90817_0_0|SrvcGrp|91028|2022|PDM|2444.00|99|0.00|KNEE ARTHROSCOPY/SURGERY (HCFA)|
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_F124487_89502_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)|
20|FH_F94643_90501_0|SrvcGrp|93900|2022|PCT|1.00|99|0.00|DRUGS|
20|FH_F112794_01040_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F134397_27513_0|SrvcGrp|73842|2022|PDM|234.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147360_06415_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90223_0_0|SrvcGrp|88832|2022|PDM|18.75|99|0.00|HOME VISIT (MOD SJ) (HCFA)|
20|FH_F143347_16001_0|SrvcGrp|16|2022|PDM|1066.00|99|0.00|ACUTE REHABILITATION|
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_F101806_0_0|SrvcGrp|86863|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F131107_43140_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F151745_27312_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1455.00|99|0.00|GA RETINA SURG CTR ASC 30|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD UE KF|
20|FH_F48513_0_0|SrvcGrp|44348|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL)|
20|FH_F116698_07470_0|SrvcGrp|14949|2022|PDM|10.50|99|0.00|HOME INFUSION|
20|FH_F116869_15146_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F116908_33461_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F120887_78750_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F113649_01752_0|SrvcGrp|86832|2022|PDM|10.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F39274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46732_0_0|SrvcGrp|12264|2022|PDM|80.00|99|0.00|DIETICIAN OR LPN SERVICES|
20|FH_F73985_0_0|SrvcGrp|8950|2022|PDM|3987.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F137527_31322_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F139551_0_0|SrvcGrp|104450|2022|PDM|1750.00|99|0.00|CYSTOURETHRO W/ ADDL IMPLANT|
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|894.00|99|0.00|AEG 4 (NO REV)|
20|FH_F111288_0_0|SrvcGrp|90420|2022|PDM|7677.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F143528_0_0|SrvcGrp|107099|2022|PDM|1914.15|99|0.00|TREATMENT OF NOSE FRACTURE|
20|FH_F143783_0_0|SrvcGrp|90707|2022|PDM|105.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F125323_43213_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92276_32308_0|CSTM-ALL|CSTM-00|2020|PDM|12600.00|99|0.00|AEG 9 (NO REV)|
20|FH_F114930_71101_0|SrvcGrp|45751|2022|PDM|102.00|99|0.00|INDIVIDUAL THERAPY|
20|FH_F31508_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F35476_0_0|SrvcGrp|18944|2022|PDM|6407.00|99|0.00|MS DRG 776|
20|FH_F137557_33437_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124017_0_0|SrvcGrp|102360|2022|PDM|3500.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY|
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|4093.00|99|0.00|AEG 7 (NO REV)|
20|FH_F44582_0_0|SrvcGrp|3029|2022|PDM|600.00|99|0.00|NEWBORN NURSERY|
20|FH_F84911_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|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_F131357_17545_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F83635_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F31218_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SURGERY|
20|FH_F97102_83501_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F121525_78613_0|SrvcGrp|74668|2022|PDM|500.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121925_0_0|SrvcGrp|95115|2022|PDM|743.05|99|0.00|BIOPSY OF LIVER|
20|FH_F149529_68102_0|SrvcGrp|74668|2022|PDM|206.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F126189_89129_0|SrvcGrp|89417|2022|PDM|441.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F124687_64024_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140233_35216_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 5  (NO REV)|
20|FH_F143249_89801_0|SrvcGrp|46104|2022|PDM|120.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F143407_75021_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143529_84737_0|SrvcGrp|65720|2022|PDM|93.00|99|0.00|RESPITE CARE|
20|FH_F101700_0_0|SrvcGrp|87677|2022|PDM|862.19|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F102341_0_0|SrvcGrp|73485|2022|PDM|1379.00|99|0.00|AETNA REHAB|
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|504.00|99|0.00|AEG 1 (NO REV)|
20|FH_F115443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120225_29644_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132414_30571_0|SrvcGrp|108484|2022|PDM|725.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F116683_64730_0|SrvcGrp|105316|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F116698_07470_0|SrvcGrp|16750|2022|PDM|99.75|99|0.00|HOME INFUSION THERAPY|
20|FH_F113649_01752_0|SrvcGrp|24752|2022|PDM|15.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F84394_17402_0|SrvcGrp|13880|2022|PCT|0.29|99|0.00|IMPLANTS|
20|FH_F36420_0_0|SrvcGrp|97|2022|PDM|4500.00|99|0.00|C-SECTION|
20|FH_F51276_0_0|SrvcGrp|28637|2022|PDM|32.50|99|0.00|HOME INFUSION THERAPY (MOD SH)|
20|FH_F36372_0_0|SrvcGrp|10569|2022|PDM|0.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F43156_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F38476_0_0|SrvcGrp|10624|2022|PDM|68.00|99|0.00|CPT CODE 99347|
20|FH_F151002_0_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F140007_0_0|SrvcGrp|44461|2022|PDM|8045.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F48772_66044_0|SrvcGrp|65645|2022|PDM|100.00|99|0.00|NURSING CARE IN HOME - S9123|
20|FH_F50516_15014_0|SrvcGrp|81879|2022|PCT|1.00|99|0.00|LABORATORY W/ REV/HCPC|
20|FH_F143467_0_0|SrvcGrp|108095|2022|PDM|1424.00|99|0.00|PARTIAL REMOVAL FOOT FASCIA|
20|FH_F143467_0_0|SrvcGrp|114044|2022|PDM|1424.00|99|0.00|REMOVAL OF ANKLE/HEEL LESION|
20|FH_F149679_0_0|SrvcGrp|106314|2022|PDM|594.21|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F151526_28208_0|CSTM-ALL|CSTM-00|2020|PDM|1342.00|99|0.00|AEG 5  (NO REV)|
20|FH_F111288_0_0|SrvcGrp|85778|2022|PDM|7676.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F82696_16335_0|SrvcGrp|20071|2022|PDM|1861.00|99|0.00|MS DRG 945-946|
20|FH_F145542_70503_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97500_32025_0|SrvcGrp|90854|2022|PDM|3745.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F141592_80233_0|SrvcGrp|10365|2022|PDM|4120.00|99|0.00|CPT CODE 99285|
20|FH_F137943_0_0|SrvcGrp|85906|2022|PDM|1379.00|99|0.00|CPT 66710|
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|AEG 10 (NO REV)|
20|FH_F123282_03222_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F102800_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F98920_46526_0|SrvcGrp|90854|2022|PDM|2637.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F109180_18015_0|SrvcGrp|102981|2022|PDM|131.00|99|0.00|PSYTX WPT W E/M 45 MIN|
20|FH_F130850_67401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F149888_68506_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|1008.00|99|0.00|AEG 6 (NO REV)|
20|FH_F116697_11703_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F120300_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89779_0_0|SrvcGrp|72992|2022|PDM|2100.00|99|0.00|AEG 2|
20|FH_F37067_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131995_04730_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112374_0_0|SrvcGrp|16|2022|PDM|832.00|99|0.00|ACUTE REHABILITATION|
20|FH_F123953_84003_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123278_20850_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F39385_0_0|SrvcGrp|11000|2022|PCT|0.65|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
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_F135268_11231_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F102302_0_0|SrvcGrp|98578|2022|PDM|29900.00|99|0.00|VERT CORP THORACOLUMBAR SING|
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)|
20|FH_F38377_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|AEG 10 (NO REV)|
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|2833.00|99|0.00|AEG 7 (NO REV)|
20|FH_F124388_0_0|SrvcGrp|63469|2022|PDM|1254.00|99|0.00|CPT 55700|
20|FH_F35276_0_0|SrvcGrp|13807|2022|PDM|34.00|99|0.00|OBSERVATION SVCS|
20|FH_F93212_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F87254_0_0|SrvcGrp|104617|2022|PDM|921.00|99|0.00|INCISION OF RECTAL ABSCESS|
20|FH_F93880_95476_0|SrvcGrp|73559|2022|PDM|6731.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F57032_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F140762_0_0|SrvcGrp|112817|2022|PCT|1.00|99|0.00|INJ BIMATOPROST INTRACAMERAL IMPLANT|
20|FH_F120876_85250_0|SrvcGrp|89337|2022|PDM|1300.00|99|0.00|DETOXIFICATION|
20|FH_F44114_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F128012_64628_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123265_68154_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F77722_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140910_53005_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|AEG 7 (NO REV)|
20|FH_F87254_0_0|SrvcGrp|73008|2022|PDM|755.00|99|0.00|AEG 10|
20|FH_F32532_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148139_48328_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131311_64804_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F31798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|CV SURGERY|
20|FH_F61332_0_0|SrvcGrp|23132|2022|PDM|495.00|99|0.00|DIALYSIS/CHEMOTHERAPY/RADIATION|
20|FH_F148260_0_0|SrvcGrp|78286|2022|PDM|9449.00|99|0.00|CPT 49322|
20|FH_F82753_18840_0|SrvcGrp|113624|2022|PDM|6232.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F125118_99201_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F148121_21734_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F121524_87111_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F32885_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F129782_0_0|SrvcGrp|95107|2022|PCT|1.00|99|0.00|INTRAOCULAR LENS PROSTHESIS|
20|FH_F138010_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F135231_90265_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|2601.00|99|0.00|AEG 8 (NO REV)|
20|FH_F40519_0_0|SrvcGrp|32649|2022|PCT|1.50|99|0.00|OTHER DIAGNOSTIC TESTING - CPT/MOD TC|
20|FH_F58215_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F148265_06067_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F121177_33407_0|SrvcGrp|89149|2022|PDM|170.00|99|0.00|OP INTENSIVE|
20|FH_F137459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F38341_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111288_0_0|SrvcGrp|11669|2022|PDM|5724.00|99|0.00|OP SURG|
20|FH_F148165_29169_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137615_16335_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F124388_0_0|SrvcGrp|77452|2022|PDM|19908.90|99|0.00|CPT 54405|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD KM) - PMRS|
20|FH_F100761_02539_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F115739_78722_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F123407_04605_0|SrvcGrp|109359|2022|PDM|521.00|99|0.00|RESIDENTIAL TREATMENT (<= 17 YRS)|
20|FH_F135065_08043_0|SrvcGrp|112626|2022|PDM|103.00|99|0.00|ORAL MEDICATION ADMINISTRATION (HCFA)|
20|FH_F150982_0_0|SrvcGrp|97467|2022|PDM|2835.00|99|0.00|PARTIAL EXCISION THYROID|
20|FH_F86332_75081_0|SrvcGrp|10583|2022|PDM|65.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F128580_0_0|SrvcGrp|74670|2022|PCT|0.00|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F121819_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F145590_45242_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149888_68506_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|856.00|99|0.00|AEG 2 (NO REV)|
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|2209.00|99|0.00|ASPG IX|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL|
20|FH_F129666_71901_0|SrvcGrp|88620|2022|PDM|155.00|99|0.00|SKILLED NURSING RN|
20|FH_F62892_0_0|SrvcGrp|15850|2022|PDM|120.00|99|0.00|HOSPICE SVCS|
20|FH_F115121_32250_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F51672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F136510_0_0|SrvcGrp|49205|2022|PDM|3882.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F89563_29407_0|SrvcGrp|90485|2022|PCT|1.00|99|0.00|COGNITIVE SKILLS DEVELOPMENT|
20|FH_F84215_0_0|SrvcGrp|26275|2022|PDM|1623.00|99|0.00|CPT 29826|
20|FH_F116115_14437_0|SrvcGrp|89023|2022|PDM|76.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F123507_63869_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F39479_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F82714_18848_0|CSTM-ALL|CSTM-00|2020|PDM|1618.00|99|0.00|AEG 5  (NO REV)|
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 7 (NO REV)|
20|FH_F151562_26003_0|SrvcGrp|104229|2022|PDM|103.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F82714_18848_0|CSTM-ALL|CSTM-00|2020|PDM|2333.00|99|0.00|AEG 8 (NO REV)|
20|FH_F126900_61924_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F89563_29407_0|SrvcGrp|472|2022|PDM|433.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116747_0_0|SrvcGrp|88621|2022|PDM|91.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132768_0_0|SrvcGrp|22529|2022|PDM|550.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F38473_0_0|SrvcGrp|10542|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F89453_75069_0|CSTM-ALL|CSTM-00|2020|PDM|95.00|99|0.00|HCPCS G0154 (HCFA)|
20|FH_F114977_78550_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F97540_32114_0|SrvcGrp|73602|2022|PDM|1392.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F141527_36830_0|SrvcGrp|86832|2022|PDM|2.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F36171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F93114_85016_0|SrvcGrp|34173|2022|PDM|48.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F141527_36830_0|SrvcGrp|86835|2022|PDM|11.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F65159_0_0|CSTM-ALL|CSTM-00|2020|PDM|2043.00|99|0.00|ASPG II|
20|FH_F62579_0_0|SrvcGrp|24745|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F130801_57717_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130841_49315_0|SrvcGrp|90707|2022|PDM|130.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F130891_41175_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F87775_15106_0|SrvcGrp|53987|2022|PDM|29.00|99|0.00|PHOTOTHERAPY|
20|FH_F130327_03867_0|SrvcGrp|53987|2022|PDM|75.00|99|0.00|PHOTOTHERAPY|
20|FH_F143771_0_0|SrvcGrp|82222|2022|PDM|133.00|99|0.00|HOSPICE CARE|
20|FH_F143578_63033_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149341_39194_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145594_02809_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F33642_0_0|SrvcGrp|9937|2022|PCT|0.75|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F62915_0_0|SrvcGrp|34049|2022|PCT|1.64|99|0.00|OCN F/S: LAB POS FAC GLOBAL (HCFA)|
20|FH_F111288_0_0|SrvcGrp|41335|2022|PDM|25602.00|99|0.00|TOTAL HIP|
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148202_47933_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F100762_51104_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F130985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|GENERAL ACUTE CARE|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHYSICIAN CLINIC VISIT NATL F/S (MOD 53)|
20|FH_F127152_50636_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133099_66801_0|SrvcGrp|75506|2022|PCT|0.80|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F39476_0_0|SrvcGrp|41404|2022|PDM|2700.00|99|0.00|ANGIOPLASTY / PTCA W/ ICD 9|
20|FH_F31836_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F113410_0_0|SrvcGrp|105256|2022|PDM|1839.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F49338_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F38473_0_0|SrvcGrp|10545|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F134995_37055_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F32935_0_0|SrvcGrp|3066|2022|PCT|0.35|99|0.00|HIGH-COST DRUGS|
20|FH_F118338_94952_0|SrvcGrp|73842|2022|PDM|500.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115685_64064_0|SrvcGrp|86844|2022|PDM|55.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F99960_0_0|SrvcGrp|72994|2022|PDM|785.00|99|0.00|AEG 3|
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|2300.00|99|0.00|AEG 4 (NO REV)|
20|FH_F120352_52556_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F38900_0_0|SrvcGrp|16|2022|PDM|1240.00|99|0.00|ACUTE REHABILITATION|
20|FH_F148254_89503_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F40438_0_0|SrvcGrp|3069|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 5  (NO REV)|
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|1171.00|99|0.00|AEG 4 (NO REV)|
20|FH_F124788_0_0|SrvcGrp|73002|2022|PDM|995.00|99|0.00|AEG 7|
20|FH_F126678_44870_0|SrvcGrp|93098|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F51520_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115685_64064_0|SrvcGrp|92185|2022|PDM|25.00|99|0.00|HCPCS S9372 (HCFA)|
20|FH_F122705_33351_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F87092_60101_0|SrvcGrp|73004|2022|PDM|4095.00|99|0.00|AEG 8|
20|FH_F89736_0_0|SrvcGrp|12104|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F89495_0_0|SrvcGrp|36591|2022|PDM|1530.00|99|0.00|CPT 63685|
20|FH_F72544_0_0|SrvcGrp|50322|2022|PCT|0.80|99|0.00|HOME HEALTH|
20|FH_F119507_92627_0|SrvcGrp|46903|2022|PDM|750.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F39627_0_0|SrvcGrp|27906|2022|PDM|21000.00|99|0.00|GAMMA KNIFE|
20|FH_F86434_0_0|SrvcGrp|35669|2022|PDM|6000.00|99|0.00|CPT 63650|
20|FH_F89851_83854_0|SrvcGrp|90364|2022|PDM|1150.00|99|0.00|AETNA MRI/MRA|
20|FH_F46197_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|321.40|99|0.00|ASPG I|
20|FH_F37566_0_0|SrvcGrp|23387|2022|PDM|60.00|99|0.00|PT/OT/ST|
20|FH_F62627_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49354_0_0|SrvcGrp|32386|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKL (DME)|
20|FH_F106540_26330_0|SrvcGrp|101600|2022|PDM|1206.00|99|0.00|CAT SCAN W/ER|
20|FH_F82475_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (HCFA)|
20|FH_F103360_68845_0|CSTM-ALL|CSTM-00|2020|PDM|2769.00|99|0.00|AEG 2 (NO REV)|
20|FH_F38061_0_0|SrvcGrp|15986|2022|PCT|1.00|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F42248_0_0|SrvcGrp|110|2022|PDM|193.00|99|0.00|CD - REHABILITATION|
20|FH_F36579_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALLIED MED-MOD KM|
20|FH_F95360_08720_0|SrvcGrp|87899|2022|PCT|1.00|99|0.00|AMPHOTERCIN B 50MG|
20|FH_F119096_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48374_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148881_33018_0|SrvcGrp|90898|2022|PDM|75.00|99|0.00|TREATMENT OF SPEECH|
20|FH_F141910_70809_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123324_0_0|SrvcGrp|77348|2022|PDM|6557.00|99|0.00|CARDIAC CATH|
20|FH_F132794_40324_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F43141_0_0|SrvcGrp|36977|2022|PDM|55.00|99|0.00|SPEECH THERAPY|
20|FH_F97103_53295_0|SrvcGrp|73461|2022|PDM|6498.00|99|0.00|AETNA NICU IV|
20|FH_F97103_53295_0|SrvcGrp|73643|2022|PDM|1611.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F147998_07030_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130615_95350_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F98620_43920_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146211_68144_0|CSTM-ALL|CSTM-00|2020|PDM|728.00|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|559.00|99|0.00|AEG 3 (NO REV)|
20|FH_F141871_33024_0|SrvcGrp|74668|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F128445_85704_0|SrvcGrp|74668|2022|PDM|243.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120605_0_0|SrvcGrp|73002|2022|PDM|1590.00|99|0.00|AEG 7|
20|FH_F32869_0_0|SrvcGrp|16|2022|PDM|700.00|99|0.00|ACUTE REHABILITATION|
20|FH_F148921_91356_0|SrvcGrp|89337|2022|PDM|1200.00|99|0.00|DETOXIFICATION|
20|FH_F112627_26062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73705_0_0|SrvcGrp|8950|2022|PDM|1740.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F41739_0_0|SrvcGrp|97|2022|PDM|8025.00|99|0.00|C-SECTION|
20|FH_F103106_04101_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F142897_07018_0|SrvcGrp|111928|2022|PCT|1.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F80855_0_0|SrvcGrp|72990|2022|PDM|525.00|99|0.00|AEG 1|
20|FH_F67136_0_0|SrvcGrp|31009|2022|PCT|0.65|99|0.00|OP SURGERY|
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_F110232_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149839_80002_0|SrvcGrp|66265|2022|PDM|115.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F37679_0_0|SrvcGrp|26856|2022|PDM|15.25|99|0.00|HOME INFUSION THERAPY (MOD SJ)|
20|FH_F95200_16201_0|CSTM-ALL|CSTM-00|2020|PCT|2.66|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F125913_66762_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F103902_89118_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F54052_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F38051_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|CD DAY TREATMENT|
20|FH_F39992_0_0|SrvcGrp|12401|2022|PDM|85.50|99|0.00|RN VISIT|
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|847.00|99|0.00|AEG 2 (NO REV)|
20|FH_F40416_0_0|CSTM-ALL|CSTM-00|2020|PDM|1209.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92659_0_0|SrvcGrp|92544|2022|PDM|842.00|99|0.00|FOLLOW-UP SURGERY OF EYE|
20|FH_F139515_0_0|SrvcGrp|3378|2022|PDM|2200.00|99|0.00|OBSERVATION SVCS|
20|FH_F72183_0_0|SrvcGrp|12118|2022|PDM|650.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F118338_94952_0|SrvcGrp|73841|2022|PDM|800.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F127209_45365_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139515_0_0|SrvcGrp|58636|2022|PDM|14420.00|99|0.00|CPT 62362|
20|FH_F93136_0_0|SrvcGrp|89239|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F125893_78245_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127415_45822_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F49338_0_0|SrvcGrp|43318|2022|PDM|435.00|99|0.00|MRI|
20|FH_F141367_57104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135307_73142_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125249_0_0|SrvcGrp|34603|2022|PDM|1200.00|99|0.00|CPT 24341|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER MS|
20|FH_F50218_0_0|SrvcGrp|46239|2022|PDM|120.00|99|0.00|HOME VISIT CATHETER CARE|
20|FH_F92091_0_0|SrvcGrp|72990|2022|PDM|645.00|99|0.00|AEG 1|
20|FH_F111288_0_0|SrvcGrp|65625|2022|PDM|2488.00|99|0.00|CPT 30520|
20|FH_F91994_0_0|SrvcGrp|55084|2022|PDM|4712.00|99|0.00|CPT 52648|
20|FH_F139509_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F130157_84049_0|SrvcGrp|89412|2022|PDM|611.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F80067_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F121427_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F110923_54768_0|SrvcGrp|90204|2022|PCT|0.85|99|0.00|AETNA EXTENIVE BURNS W/ SKN GFT|
20|FH_F122911_92240_0|SrvcGrp|87317|2022|PDM|1100.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|754.14|99|0.00|AEG 1 (NO REV)|
20|FH_F114064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89372_0_0|SrvcGrp|23703|2022|PCT|0.71|99|0.00|IP/OP TRAUMA|
20|FH_F89372_0_0|SrvcGrp|88667|2022|PCT|1.00|99|0.00|AETNA PATIENT CONVENIENCE ITEMS|
20|FH_F129975_0_0|SrvcGrp|35982|2022|PDM|36.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|878.72|99|0.00|ASPG IV|
20|FH_F62754_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45052_0_0|SrvcGrp|9829|2022|PDM|125.00|99|0.00|PT SVCS|
20|FH_F112726_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127556_66725_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131127_0_0|SrvcGrp|111745|2022|PCT|0.00|99|0.00|REVISE BREAST RECONSTRUCTION INCIDENTAL|
20|FH_F110268_02891_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F110441_60062_0|SrvcGrp|73841|2022|PDM|578.60|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F148541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143681_61938_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51039_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|2010 RADIOLOGY (MOD TC)|
20|FH_F127589_45459_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F120603_66112_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F85353_16407_0|SrvcGrp|63765|2022|PDM|1807.35|99|0.00|HAPA WPA-NWPA 2012-13 ASC 904|
20|FH_F143567_62207_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145604_14850_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F127918_45640_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149199_73005_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F44278_0_0|SrvcGrp|22461|2022|PCT|0.85|99|0.00|INPATIENT HOSPICE SVCS|
20|FH_F145791_67205_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121225_98902_0|SrvcGrp|21920|2022|PDM|100.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F83978_66739_0|SrvcGrp|72992|2022|PDM|625.00|99|0.00|AEG 2|
20|FH_F149199_73005_0|CSTM-ALL|CSTM-00|2020|PDM|688.00|99|0.00|AEG 1 (NO REV) WITHOUT BONE TESTING/BLADDER PROC|
20|FH_F70883_0_0|SrvcGrp|9228|2022|PDM|66.00|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F109264_33431_0|SrvcGrp|89417|2022|PDM|443.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F143620_81504_0|SrvcGrp|48385|2022|PDM|120.00|99|0.00|SPEECH THERAPY|
20|FH_F150219_38578_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114444_19602_0|SrvcGrp|105367|2022|PDM|45.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MINS|
20|FH_F116806_0_0|SrvcGrp|107019|2022|PDM|1923.16|99|0.00|RECONSTRUCT UPPER JAW BONE|
20|FH_F133585_0_0|SrvcGrp|107879|2022|PDM|3829.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F138024_40509_0|SrvcGrp|16069|2022|PDM|739.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F124173_66215_0|SrvcGrp|26869|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F148186_0_0|SrvcGrp|106317|2022|PDM|823.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F118138_60532_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146064_17331_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|892.00|99|0.00|ASPG II|
20|FH_F119379_0_0|SrvcGrp|107843|2022|PDM|885.00|99|0.00|NEUROVASCULAR PEDICLE GRAFT|
20|FH_F133749_84604_0|SrvcGrp|48397|2022|PDM|85.50|99|0.00|PT SERVICES|
20|FH_F132969_84003_0|SrvcGrp|65720|2022|PDM|93.00|99|0.00|RESPITE CARE|
20|FH_F126341_27284_0|SrvcGrp|22592|2022|PCT|1.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F114683_0_0|SrvcGrp|88065|2022|PDM|6000.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F91777_29577_0|SrvcGrp|53144|2022|PCT|1.00|99|0.00|SPEECH THERAPY|
20|FH_F120720_24541_0|SrvcGrp|104226|2022|PDM|125.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F130364_01331_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 1 (NO REV)|
20|FH_F134205_33410_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC|
20|FH_F148668_33177_0|SrvcGrp|88857|2022|PDM|75.00|99|0.00|THERAPEUTIC ACTIVITIES|
20|FH_F143579_43160_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F112863_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F146543_89511_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|AEG 10 (NO REV)|
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|1342.12|99|0.00|AEG 7 (NO REV)|
20|FH_F138507_62208_0|SrvcGrp|48385|2022|PDM|113.00|99|0.00|SPEECH THERAPY|
20|FH_F139299_0_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F50832_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.30|99|0.00|OP SVCS|
20|FH_F128828_44122_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F112665_0_0|SrvcGrp|98493|2022|PDM|7699.00|99|0.00|THORACIC|
20|FH_F49197_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134992_34112_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F126188_59404_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F126427_77082_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125328_0_0|SrvcGrp|79590|2022|PDM|1884.00|99|0.00|CPT 43248|
20|FH_F133207_0_0|SrvcGrp|84182|2022|PDM|3192.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE|
20|FH_F71273_0_0|SrvcGrp|20071|2022|PDM|1647.00|99|0.00|MS DRG 945-946|
20|FH_F71273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS|
20|FH_F110509_71351_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F146200_70815_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150179_23124_0|SrvcGrp|80|2022|PDM|1108.00|99|0.00|ACUTE PSYCH|
20|FH_F109577_0_0|SrvcGrp|26160|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F129509_0_0|SrvcGrp|67065|2022|PDM|7175.00|99|0.00|CERVICAL SURGERY|
20|FH_F145642_15108_0|SrvcGrp|26869|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F147962_85008_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|1771.00|99|0.00|AEG 8 (NO REV)|
20|FH_F145555_72204_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114444_19602_0|SrvcGrp|91780|2022|PDM|65.00|99|0.00|AETNA GROUP THERAPY MOD (MOD AJ)(HCFA)|
20|FH_F121601_47446_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F84450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F114407_19002_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F146586_71602_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127157_43614_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F121476_0_0|SrvcGrp|107348|2022|PDM|3237.00|99|0.00|EXTERNAL RECHARG SYS INTERN|
20|FH_F120555_68405_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F67180_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F146657_01105_0|SrvcGrp|114681|2022|PDM|19.72|99|0.00|FAMILY TRAINING & COUNSELING (MOD EP)|
20|FH_F85353_16407_0|SrvcGrp|63788|2022|PDM|1202.05|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1303|
20|FH_F133207_0_0|SrvcGrp|72121|2022|PDM|3809.00|99|0.00|ARTHOSCOPY|
20|FH_F121225_98902_0|SrvcGrp|73462|2022|PDM|6190.00|99|0.00|AETNA NICU III|
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 3 (NO REV)|
20|FH_F51258_0_0|SrvcGrp|43285|2022|PDM|81.00|99|0.00|SPEECH THERAPY|
20|FH_F138828_78629_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|481.00|99|0.00|AEG 10 (NO REV)|
20|FH_F127080_77520_0|SrvcGrp|89417|2022|PDM|468.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F134472_84624_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134488_14086_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F78705_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.23|99|0.00|OP SVCS|
20|FH_F101084_15459_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F101100_50314_0|SrvcGrp|58649|2022|PDM|271.00|99|0.00|INTENSIVE OUTPATIENT|
20|FH_F115814_53235_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F115893_08002_0|SrvcGrp|106479|2022|PCT|1.00|99|0.00|AETNA  OUTPATIENT THERAPY|
20|FH_F115907_12206_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F75842_0_0|SrvcGrp|73860|2022|PDM|6411.32|99|0.00|C-SECTION|
20|FH_F75842_0_0|SrvcGrp|46518|2022|PDM|9406.88|99|0.00|ELECTROPHYSIOLOGY STUDIES|
20|FH_F146422_80210_0|SrvcGrp|114600|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F146582_75146_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146655_80226_0|SrvcGrp|74668|2022|PDM|412.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F146808_44641_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125440_04043_0|SrvcGrp|86648|2022|PCT|1.03|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F115972_92675_0|SrvcGrp|86753|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F116040_24637_0|SrvcGrp|19742|2022|PDM|55.00|99|0.00|MID-LINE INSERTION|
20|FH_F116088_46410_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F116088_46410_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133272_23834_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)|
20|FH_F133710_21811_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F127432_18015_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F60101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F138236_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143199_33403_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133368_61401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87577_80016_0|SrvcGrp|26690|2022|PDM|13838.00|99|0.00|MS DRG 215 ONLY|
20|FH_F136728_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39535_0_0|CSTM-ALL|CSTM-00|2020|PDM|2530.00|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_F142051_06604_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F64943_0_0|SrvcGrp|3087|2022|PDM|1850.00|99|0.00|CD - DETOX|
20|FH_F69648_0_0|SrvcGrp|48385|2022|PDM|11.25|99|0.00|SPEECH THERAPY|
20|FH_F132487_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F132272_16127_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F119775_0_0|SrvcGrp|73002|2022|PDM|1056.00|99|0.00|AEG 7|
20|FH_F141870_85224_0|SrvcGrp|29076|2022|PDM|35.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F57592_0_0|SrvcGrp|28120|2022|PDM|22000.00|99|0.00|MS DRG 467 ONLY|
20|FH_F91198_46714_0|SrvcGrp|73849|2022|PDM|287.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F106241_93309_0|SrvcGrp|79720|2022|PDM|1268.00|99|0.00|ACUTE REHAB II|
20|FH_F42807_0_0|SrvcGrp|10107|2022|PCT|0.75|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 2 (NO REV)|
20|FH_F92676_15063_0|SrvcGrp|79031|2022|PDM|800.38|99|0.00|MON VALLEY ASC 309|
20|FH_F83053_0_0|SrvcGrp|72990|2022|PDM|2158.00|99|0.00|AEG 1|
20|FH_F82813_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F124505_0_0|SrvcGrp|109899|2022|PDM|311.00|99|0.00|MEDICARE OUTPATIENT GROUPER 9 & 10|
20|FH_F148886_60621_0|CSTM-ALL|CSTM-00|2020|PDM|1228.00|99|0.00|AEG 10 (NO REV)|
20|FH_F133005_32726_0|SrvcGrp|86728|2022|PCT|1.00|99|0.00|RHOGAM INJECTION|
20|FH_F145988_06105_0|SrvcGrp|114480|2022|PDM|25891.00|99|0.00|IMPLANT/REPLACE HEARING DEVICE|
20|FH_F148760_12953_0|SrvcGrp|66264|2022|PDM|120.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F151144_35801_0|SrvcGrp|115968|2022|PDM|915.43|99|0.00|EYELID REPAIRS|
20|FH_F151179_84074_0|SrvcGrp|72992|2022|PDM|735.00|99|0.00|AEG 2|
20|FH_F91873_12723_0|SrvcGrp|91177|2022|PDM|1495.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F117299_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F77067_0_0|SrvcGrp|12787|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F86911_0_0|SrvcGrp|85651|2022|PDM|140.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F89037_0_0|SrvcGrp|73006|2022|PDM|1613.92|99|0.00|AEG 9|
20|FH_F142344_16693_0|SrvcGrp|75419|2022|PDM|367.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F110803_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F113537_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F104840_32565_0|SrvcGrp|73483|2022|PCT|0.69|99|0.00|AETNA SUBACUTE III|
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145784_0_0|SrvcGrp|64517|2022|PDM|3500.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F94786_07974_0|SrvcGrp|86830|2022|PDM|31.50|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F131047_0_0|SrvcGrp|67621|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F131047_0_0|SrvcGrp|63|2022|PDM|1710.00|99|0.00|SUBACUTE CARE|
20|FH_F132988_0_0|SrvcGrp|85778|2022|PDM|5841.62|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 8 (NO REV)|
20|FH_F72162_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F141018_70125_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|2315.25|99|0.00|ASPG IX|
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|321.40|99|0.00|ASPG I|
20|FH_F64180_0_0|SrvcGrp|12023|2022|PDM|147.00|99|0.00|HOSPICE RESPITE SERVICES|
20|FH_F115971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124059_64055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146907_24521_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F69923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F91898_0_0|SrvcGrp|91657|2022|PDM|9373.00|99|0.00|AETNA MATERNITY CARE (C- SECTION)|
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|92359|2022|PDM|12999.53|99|0.00|REMOVAL OF TAIL BONE|
20|FH_F124222_92625_0|SrvcGrp|75442|2022|PDM|900.00|99|0.00|OBSERVATION - REV 762|
20|FH_F126817_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136729_62704_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114629_19131_0|SrvcGrp|105439|2022|PDM|449.00|99|0.00|AETNA TERANIAL MAGN STIM TX DELI|
20|FH_F138055_16146_0|SrvcGrp|90854|2022|PDM|644.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F81893_23114_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148553_85016_0|CSTM-ALL|CSTM-00|2020|PDM|942.00|99|0.00|AEG 6 (NO REV)|
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_F43352_0_0|CSTM-ALL|CSTM-00|2020|PDM|713.00|99|0.00|WELLPATH PROPRIERARY ASC II 731315|
20|FH_F117069_15236_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F134672_44060_0|SrvcGrp|73842|2022|PDM|165.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136796_24016_0|SrvcGrp|88162|2022|PDM|5396.49|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F136820_65483_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136927_45690_0|SrvcGrp|48385|2022|PDM|83.00|99|0.00|SPEECH THERAPY|
20|FH_F112371_19047_0|SrvcGrp|104747|2022|PDM|5388.00|99|0.00|INCISION OF HEEL BONE|
20|FH_F115144_71373_0|SrvcGrp|73601|2022|PDM|1530.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F147362_33137_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F41795_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133176_32751_0|SrvcGrp|73841|2022|PDM|470.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F111563_02116_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
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|699.00|99|0.00|AEG 4 (NO REV)|
20|FH_F35216_0_0|SrvcGrp|9984|2022|PCT|0.75|99|0.00|URGENT CARE|
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|3014.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.23|99|0.00|2005 ASPG GROUPER VIII|
20|FH_F68322_0_0|SrvcGrp|17073|2022|PDM|1265.00|99|0.00|ASPG V|
20|FH_F71502_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
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|1345.30|99|0.00|AEG 6 (NO REV)|
20|FH_F120612_23314_0|SrvcGrp|29347|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
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_F36854_0_0|SrvcGrp|119|2022|PCT|1.10|99|0.00|PROSTHETICS/IMPLANTS|
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 6 (NO REV)|
20|FH_F114853_0_0|SrvcGrp|71666|2022|PDM|6737.00|99|0.00|CPT 63655|
20|FH_F113585_20155_0|SrvcGrp|22589|2022|PDM|50.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F138876_25302_0|SrvcGrp|14948|2022|PDM|55.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138992_72703_0|SrvcGrp|10363|2022|PDM|486.00|99|0.00|CPT CODE 99283|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|308.79|99|0.00|HAPA WPA-NWPA 2012-13 ASC 309 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|124.63|99|0.00|HAPA WPA-NWPA 2012-13 ASC 240 W/O REV|
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|2423.00|99|0.00|AEG 3 (NO REV)|
20|FH_F151380_90701_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F151420_60654_0|CSTM-ALL|CSTM-00|2020|PDM|1917.00|99|0.00|AEG 7 (NO REV)|
20|FH_F151503_30067_0|CSTM-ALL|CSTM-00|2020|PDM|1466.00|99|0.00|AEG 8 (NO REV)|
20|FH_F151503_30067_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 10 (NO REV)|
20|FH_F132268_07060_0|SrvcGrp|104965|2022|PCT|0.95|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F122032_32413_0|SrvcGrp|90854|2022|PDM|711.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F122032_32413_0|SrvcGrp|108484|2022|PDM|599.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F97501_31501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F135439_33825_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135453_70726_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F135972_18509_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136180_92253_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F131265_84106_0|SrvcGrp|108484|2022|PDM|880.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F131407_07607_0|SrvcGrp|24750|2022|PDM|30.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F131407_07607_0|SrvcGrp|13929|2022|PDM|10.00|99|0.00|GROWTH HORMONE|
20|FH_F116485_17033_0|SrvcGrp|110042|2022|PDM|31.83|99|0.00|BEHAVIOR IDENTIFICATION ASSESSMENT 15 MINS|
20|FH_F121873_54303_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131407_07607_0|SrvcGrp|86825|2022|PDM|55.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F130817_18103_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 5  (NO REV)|
20|FH_F111292_33136_0|SrvcGrp|10107|2022|PCT|0.63|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F134256_36117_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F47906_0_0|SrvcGrp|43848|2022|PCT|1.00|99|0.00|DME POS FACILITY GLOBAL|
20|FH_F69202_0_0|SrvcGrp|39522|2022|PDM|43600.00|99|0.00|MS DRG 216-218 ONLY|
20|FH_F87153_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148243_0_0|SrvcGrp|84971|2022|PDM|879.00|99|0.00|CPT 43245|
20|FH_F41780_0_0|SrvcGrp|31188|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC (DME)|
20|FH_F42026_0_0|CSTM-ALL|CSTM-00|2020|PDM|273.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|2222.00|99|0.00|AEG 9 (NO REV)|
20|FH_F132328_0_0|SrvcGrp|99154|2022|PDM|2383.00|99|0.00|ELBOW ARTHROSCOPY/SURGERY|
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_F32285_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F87532_32110_0|SrvcGrp|472|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F87557_33309_0|SrvcGrp|86851|2022|PDM|30.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F136698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F102862_30606_0|SrvcGrp|26664|2022|PDM|13556.20|99|0.00|MS DRG 481 ONLY|
20|FH_F101320_26062_0|SrvcGrp|29023|2022|PDM|54.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F141471_0_0|SrvcGrp|68546|2022|PDM|1613.00|99|0.00|CPT 36558|
20|FH_F130302_0_0|SrvcGrp|73006|2022|PDM|1008.00|99|0.00|AEG 9|
20|FH_F148344_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F128430_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131235_36049_0|SrvcGrp|87317|2022|PDM|1072.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F109963_0_0|SrvcGrp|73004|2022|PDM|981.00|99|0.00|AEG 8|
20|FH_F88639_80204_0|SrvcGrp|73497|2022|PDM|3156.50|99|0.00|AETNA ER LEVEL IV|
20|FH_F42633_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|NORMAL DELIVERY|
20|FH_F32995_0_0|SrvcGrp|10923|2022|PDM|7532.00|99|0.00|PTCA W/DRUG ELUTING STENT|
20|FH_F46832_0_0|SrvcGrp|24761|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F136358_06070_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136383_98118_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136487_71269_0|SrvcGrp|89149|2022|PDM|240.00|99|0.00|OP INTENSIVE|
20|FH_F136542_02446_0|SrvcGrp|109612|2022|PDM|398.00|99|0.00|PARTIAL HOSPITALIZATION (<=17 YRS)|
20|FH_F118154_17042_0|SrvcGrp|471|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134011_84102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134011_84102_0|SrvcGrp|86839|2022|PDM|25.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F133544_78227_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F133007_76010_0|SrvcGrp|86722|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)|
20|FH_F129130_92562_0|SrvcGrp|79786|2022|PCT|4.23|99|0.00|SLEEP STUDIES|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2504030 MOD 53 (HCFA)|
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|CRISIS EVALUATION|
20|FH_F40144_0_0|SrvcGrp|3056|2022|PCT|0.73|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)|
20|FH_F98041_10027_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F117525_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.01|99|0.00|AETNA SLEEP STUDIES|
20|FH_F115264_0_0|SrvcGrp|3932|2022|PDM|3500.00|99|0.00|LITHOTRIPSY|
20|FH_F142312_62301_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F115808_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|3817.00|99|0.00|AEG 9 (NO REV)|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41539_0_0|SrvcGrp|33830|2022|PDM|888.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 8|
20|FH_F116525_26003_0|SrvcGrp|106257|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F120901_0_0|SrvcGrp|27261|2022|PDM|4682.00|99|0.00|CPT 27446|
20|FH_F50415_0_0|SrvcGrp|46642|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- ALL|
20|FH_F149719_0_0|SrvcGrp|113580|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F124180_0_0|SrvcGrp|109741|2022|PDM|2433.00|99|0.00|SINUS ENDO W/ BALLOON DILATION|
20|FH_F55812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F32620_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS|
20|FH_F122181_66538_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F124059_64055_0|SrvcGrp|13929|2022|PDM|10.00|99|0.00|GROWTH HORMONE|
20|FH_F146991_80918_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F44341_0_0|SrvcGrp|110|2022|PDM|362.00|99|0.00|CD - REHABILITATION|
20|FH_F49937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133674_30350_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F124246_71655_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F124618_32340_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131101_45840_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F72390_0_0|SrvcGrp|15472|2022|PDM|1292.00|99|0.00|CPT CODE 62284|
20|FH_F43786_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37743_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37743_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F136657_70806_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114684_80547_0|SrvcGrp|69075|2022|PDM|99.50|99|0.00|CPT 99213|
20|FH_F114764_78214_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113847_20910_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F138527_64506_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148553_85016_0|SrvcGrp|115439|2022|PDM|1873.00|99|0.00|UPGRADE OF IMPLANTED PACEMAKER|
20|FH_F148553_85016_0|SrvcGrp|114206|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F43249_0_0|SrvcGrp|3165|2022|PCT|0.54|99|0.00|EMERGENCY ROOM|
20|FH_F134734_90068_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F135715_32073_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F135720_90025_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F136913_68803_0|SrvcGrp|3378|2022|PCT|0.70|99|0.00|OBSERVATION SVCS|
20|FH_F136913_68803_0|SrvcGrp|112862|2022|PCT|2.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F112371_19047_0|SrvcGrp|98588|2022|PDM|3284.00|99|0.00|REMOVE SPINE INFUSION DEVI16|
20|FH_F115708_15317_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147699_83704_0|SrvcGrp|46903|2022|PDM|640.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F41832_0_0|SrvcGrp|24934|2022|PDM|85.00|99|0.00|NUTRITIONAL ASSESSMENT (INITIAL)|
20|FH_F42522_0_0|SrvcGrp|36144|2022|PDM|13230.00|99|0.00|OP SURGERY|
20|FH_F42837_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD AW|
20|FH_F102641_0_0|SrvcGrp|73004|2022|PDM|1679.00|99|0.00|AEG 8|
20|FH_F133579_0_0|SrvcGrp|71666|2022|PDM|3248.00|99|0.00|CPT 63655|
20|FH_F133579_0_0|SrvcGrp|28547|2022|PDM|2175.00|99|0.00|VITRECTOMY|
20|FH_F38955_0_0|CSTM-ALL|CSTM-00|2020|PDM|1036.41|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F39098_0_0|SrvcGrp|24|2022|PCT|0.75|99|0.00|CARDIAC CATH|
20|FH_F40088_0_0|SrvcGrp|439|2022|PDM|1273.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F41989_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43867_0_0|SrvcGrp|37406|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F89580_0_0|SrvcGrp|88424|2022|PCT|1.00|99|0.00|OP REFERENCE LABORATORY|
20|FH_F39018_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|444.41|99|0.00|HAPA WPA-NWPA 2012-13 ASC 101 W/O REV|
20|FH_F151501_30265_0|SrvcGrp|98003|2022|PDM|6186.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F151515_77901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123184_20906_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F135572_89106_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F97142_94535_0|SrvcGrp|88978|2022|PDM|15862.00|99|0.00|VAGINAL DELIVERY|
20|FH_F91735_92653_0|SrvcGrp|53145|2022|PDM|110.25|99|0.00|SOCIAL WORKER|
20|FH_F135929_02919_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100763_24202_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F100880_67735_0|SrvcGrp|88792|2022|PDM|35170.00|99|0.00|ARTHRODESIS|
20|FH_F116501_17801_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134167_10032_0|SrvcGrp|107859|2022|PCT|1.05|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F137147_75006_0|SrvcGrp|28119|2022|PDM|60057.00|99|0.00|MS DRG 466 ONLY|
20|FH_F137247_40160_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F142448_15701_0|SrvcGrp|29077|2022|PDM|180.00|99|0.00|HOME TRANSFUSION|
20|FH_F142320_07747_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142741_03264_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142741_03264_0|SrvcGrp|111348|2022|PCT|1.10|99|0.00|OP THERAPY SERVICES|
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|ASPG III|
20|FH_F83831_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|106% OF ASP DRUGS/IMMUN UPDATE QUARTERLY|
20|FH_F97601_67218_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F139267_30253_0|SrvcGrp|113174|2022|PDM|31.23|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - PFIZER|
20|FH_F140652_92626_0|SrvcGrp|46903|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F140846_48207_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137530_0_0|SrvcGrp|77290|2022|PDM|721.00|99|0.00|AETNA REMV TUNNLD CVC W/O SUBQ PORT|
20|FH_F149563_75840_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119003_78070_0|SrvcGrp|107483|2022|PCT|1.10|99|0.00|OP THERAPY SERVICE|
20|FH_F119018_47802_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F109982_33592_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117371_77059_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F117218_32025_0|SrvcGrp|89149|2022|PDM|186.00|99|0.00|OP INTENSIVE|
20|FH_F137905_91364_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F137937_20032_0|SrvcGrp|49682|2022|PCT|1.70|99|0.00|HSS DRG GROUPED|
20|FH_F137982_68510_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F35210_0_0|SrvcGrp|903|2022|PCT|0.65|99|0.00|PTC ANGIOPLASTY|
20|FH_F37878_0_0|SrvcGrp|100948|2022|PDM|52.00|99|0.00|HOME HEALTH LPN SERVICE|
20|FH_F109652_0_0|SrvcGrp|22966|2022|PDM|5892.00|99|0.00|GAMMA KNIFE|
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|889.00|99|0.00|AEG 5  (NO REV)|
20|FH_F91472_96001_0|SrvcGrp|103714|2022|PCT|0.40|99|0.00|ANTERIOR THORACIC/THORACOLUMBAR FUSION|
20|FH_F91472_96001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114567_43235_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130978_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F31783_0_0|SrvcGrp|1121|2022|PCT|0.70|99|0.00|OP PTCA ANGIOPLASTY|
20|FH_F62579_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F130905_60187_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63796|2022|PDM|979.77|99|0.00|HAPA WPA-NWPA 2012-13 ASC 12|
20|FH_F138147_18018_0|SrvcGrp|98040|2022|PDM|27.31|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F85212_71075_0|SrvcGrp|72998|2022|PDM|1071.00|99|0.00|AEG 5|
20|FH_F120719_27540_0|CSTM-ALL|CSTM-00|2020|PDM|5876.00|99|0.00|AEG 3 (NO REV)|
20|FH_F143669_78577_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F148885_23226_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F83380_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|HOME HEALTH AIDE MOD TF|
20|FH_F129316_65066_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90391_33774_0|SrvcGrp|471|2022|PDM|472.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F147962_85008_0|SrvcGrp|78823|2022|PDM|2550.00|99|0.00|EMERGENCY ROOM LEVEL 4|
20|FH_F120740_45817_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.00|99|0.00|AEG 5  (NO REV)|
20|FH_F149261_75457_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.61|99|0.00|OP SVCS|
20|FH_F110453_0_0|SrvcGrp|73006|2022|PDM|1434.00|99|0.00|AEG 9|
20|FH_F31612_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.10|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_F133895_61530_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|GENERAL ACUTE CARE|
20|FH_F89323_63033_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F127157_43614_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F145593_92660_0|SrvcGrp|87131|2022|PDM|700.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F79763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133867_84075_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132723_61265_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F81852_0_0|SrvcGrp|537|2022|PDM|1435.00|99|0.00|OBSERVATION SERVICES|
20|FH_F147959_33573_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F110604_0_0|SrvcGrp|55071|2022|PDM|1650.00|99|0.00|ARTHROSCOPY SHOULDER|
20|FH_F96160_32207_0|SrvcGrp|86842|2022|PDM|61.90|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 8 (NO REV)|
20|FH_F150303_19150_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138951_41101_0|SrvcGrp|86839|2022|PDM|40.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F134656_02852_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F51121_0_0|SrvcGrp|12403|2022|PDM|36.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F126341_27284_0|SrvcGrp|86118|2022|PDM|1.02|99|0.00|AETNA FACTOR VIII RECOMBINANT|
20|FH_F118469_0_0|SrvcGrp|107793|2022|PDM|3500.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F146160_52803_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42446_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89680_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.87|99|0.00|OP SVCS|
20|FH_F82393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F51318_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51393_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PERSONAL CARE IV SERVICES LEASED|
20|FH_F77943_0_0|SrvcGrp|9511|2022|PCT|0.70|99|0.00|OBSERVATION SVCS|
20|FH_F132969_84003_0|SrvcGrp|86779|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F127957_89521_0|SrvcGrp|87131|2022|PDM|455.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|487.91|99|0.00|HAPA WPA-NWPA 2012-13 ASC 223 W/O REV|
20|FH_F135670_01749_0|SrvcGrp|86853|2022|PDM|42.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F135670_01749_0|SrvcGrp|14949|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F144248_0_0|SrvcGrp|109761|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESIONS|
20|FH_F132728_0_0|SrvcGrp|3078|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F147962_85008_0|SrvcGrp|12659|2022|PDM|1000.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F83617_0_0|CSTM-ALL|CSTM-00|2020|PCT|4.85|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F150305_18848_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114415_16509_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150165_06032_0|SrvcGrp|59840|2022|PDM|2250.00|99|0.00|TYMPANOSTOMY|
20|FH_F134568_12946_0|SrvcGrp|471|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F85311_18702_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F85353_16407_0|SrvcGrp|63825|2022|PDM|531.08|99|0.00|HAPA WPA-NWPA 2012-13 ASC 305|
20|FH_F120670_0_0|SrvcGrp|80617|2022|PDM|12000.00|99|0.00|ARTHOPLASTY|
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F150221_63131_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F70208_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|ASPG IV|
20|FH_F121476_0_0|SrvcGrp|108847|2022|PDM|16599.00|99|0.00|IMPLT NROSTM PLS GEN SNG NON|
20|FH_F149031_80525_0|SrvcGrp|89337|2022|PDM|1050.00|99|0.00|DETOXIFICATION|
20|FH_F118265_46268_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|652.90|99|0.00|HAPA WPA-NWPA 2012-13 ASC 204 W/O REV|
20|FH_F127157_43614_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F141347_52807_0|SrvcGrp|89417|2022|PDM|406.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118252_32216_0|SrvcGrp|108484|2022|PDM|914.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F95440_0_0|SrvcGrp|72992|2022|PDM|1169.00|99|0.00|AEG 2|
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1366.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F148600_30328_0|SrvcGrp|78098|2022|PDM|1829.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F109577_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134324_26354_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS|
20|FH_F127849_43920_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F142930_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F125105_67361_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114823_15701_0|SrvcGrp|73841|2022|PDM|250.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138056_64055_0|SrvcGrp|88620|2022|PDM|115.00|99|0.00|SKILLED NURSING RN|
20|FH_F116653_0_0|SrvcGrp|82498|2022|PDM|164.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS|
20|FH_F148644_06890_0|SrvcGrp|26275|2022|PDM|2791.00|99|0.00|CPT 29826|
20|FH_F70863_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|106% OF ASP DRUGS/IMMUN UPDATE QUARTERLY|
20|FH_F54592_0_0|SrvcGrp|26869|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F73084_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|GENERAL ACUTE CARE|
20|FH_F134492_85201_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F134495_84321_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F122553_92705_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F83937_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84454_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|289.89|99|0.00|HAPA WPA-NWPA 2012-13 ASC 407 W/O REV|
20|FH_F98780_35022_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F102200_06416_0|SrvcGrp|17016|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F105145_75075_0|SrvcGrp|75926|2022|PDM|2500.00|99|0.00|OBSERVATION SERVICES|
20|FH_F120811_53525_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F40903_0_0|SrvcGrp|14557|2022|PDM|47.25|99|0.00|AMBULANCE SVCS - WHEELCHAIR VAN|
20|FH_F116114_37033_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131741_19037_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133478_40165_0|SrvcGrp|10107|2022|PCT|0.28|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F139673_63011_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F150782_19444_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150929_17325_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134819_0_0|SrvcGrp|19923|2022|PDM|2241.00|99|0.00|HYSTEROSCOPY|
20|FH_F148859_0_0|SrvcGrp|80523|2022|PDM|14566.00|99|0.00|PENILE PROSTHESIS IMPLANTATION|
20|FH_F39211_0_0|SrvcGrp|28919|2022|PDM|34.00|99|0.00|CPT 97750|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F124441_0_0|SrvcGrp|38364|2022|PDM|9500.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F65100_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP|
20|FH_F122390_29550_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F127418_0_0|CSTM-ALL|CSTM-00|2020|PCT|3.00|99|0.00|HSS ASC|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|464.86|99|0.00|SALLY BALIN,999182,ASC 404|
20|FH_F101441_0_0|SrvcGrp|96959|2022|PDM|3497.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F45798_0_0|SrvcGrp|360|2022|PDM|2160.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F139247_77657_0|SrvcGrp|11306|2022|PCT|0.62|99|0.00|IMPLANTS|
20|FH_F120677_0_0|CSTM-ALL|CSTM-00|2020|PDM|2724.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|264.00|99|0.00|HAPA EPA ASC 35|
20|FH_F147221_49442_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IP MULTI ROOM COMPARISON|
20|FH_F139824_24801_0|SrvcGrp|3378|2022|PCT|0.95|99|0.00|OBSERVATION SVCS|
20|FH_F35452_0_0|SrvcGrp|72|2022|PDM|350.00|99|0.00|NEWBORN NURSERY|
20|FH_F126189_89129_0|SrvcGrp|90854|2022|PDM|1004.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F45798_0_0|SrvcGrp|11191|2022|PDM|27000.00|99|0.00|DRG 551 PERMANENT CARDIAC PACEMAKER|
20|FH_F35770_33511_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F124759_34108_0|SrvcGrp|106248|2022|PDM|345.00|99|0.00|PARTIAL HOSP PSYCH|
20|FH_F117629_06514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132254_40207_0|SrvcGrp|22593|2022|PDM|40.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F125022_67035_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117576_21207_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124329_37874_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130970_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F132235_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F125214_12428_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F38753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F134900_72450_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|1597.00|99|0.00|AEG 1 (NO REV)|
20|FH_F138018_17313_0|SrvcGrp|17302|2022|PDM|105.00|99|0.00|HYDRATION THERAPY - 3+ LITERS|
20|FH_F150922_02452_0|SrvcGrp|113171|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F97100_23462_0|SrvcGrp|73603|2022|PDM|4162.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F108080_77081_0|SrvcGrp|3178|2022|PDM|926.00|99|0.00|ACUTE PSYCH|
20|FH_F132732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F117714_94301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F97080_85122_0|SrvcGrp|73485|2022|PDM|4006.00|99|0.00|AETNA REHAB|
20|FH_F139147_0_0|SrvcGrp|79593|2022|PDM|1804.00|99|0.00|CPT 45378|
20|FH_F41161_0_0|SrvcGrp|34207|2022|PDM|658.00|99|0.00|ELECTROCONVULSIVE THERAPY|
20|FH_F97420_75052_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT HH|
20|FH_F50461_0_0|SrvcGrp|10681|2022|PDM|182.00|99|0.00|INTENSIVE  SVCS|
20|FH_F76124_0_0|SrvcGrp|9934|2022|PDM|800.00|99|0.00|GENERAL ACUTE CARE W/VENTILATOR SVCS|
20|FH_F36992_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD AU|
20|FH_F142370_0_0|SrvcGrp|113175|2022|PDM|16.94|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - MODERNA|
20|FH_F35847_0_0|SrvcGrp|997|2022|PCT|0.63|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F128369_72901_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F132160_0_0|SrvcGrp|109761|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESIONS|
20|FH_F124722_66067_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114206_37203_0|SrvcGrp|86848|2022|PDM|35.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F36222_0_0|CSTM-ALL|CSTM-00|2020|PDM|979.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71108_0_0|SrvcGrp|19048|2022|PCT|0.80|99|0.00|MS DRG 999 ONLY|
20|FH_F147231_49440_0|SrvcGrp|92501|2022|PDM|187.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F45226_0_0|SrvcGrp|11068|2022|PDM|80.00|99|0.00|PT SVCS|
20|FH_F137731_92262_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F110121_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F128821_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F35369_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|ACUTE PSYCH|
20|FH_F50621_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|OP SVCS|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SAINT ALEXIUS FH BASE|
20|FH_F147216_48307_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|1820.00|99|0.00|ASPG III|
20|FH_F140292_06902_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113826_51445_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F98900_42001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140233_35216_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 7 (NO REV)|
20|FH_F140268_17960_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F72749_0_0|SrvcGrp|31074|2022|PDM|761.00|99|0.00|MS DRG 795 ONLY|
20|FH_F112448_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130925_34652_0|SrvcGrp|89149|2022|PDM|189.00|99|0.00|OP INTENSIVE|
20|FH_F131173_17043_0|SrvcGrp|80920|2022|PDM|550.00|99|0.00|HOSPICE SERVICES|
20|FH_F48224_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F120205_53545_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F116579_45822_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F116683_64730_0|SrvcGrp|94735|2022|PCT|1.00|99|0.00|AFLURIA VACC IM (>=3 YRS)|
20|FH_F116698_07470_0|SrvcGrp|86848|2022|PDM|39.90|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F116915_30308_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F125479_17501_0|SrvcGrp|90573|2022|PDM|212.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F51276_0_0|SrvcGrp|17007|2022|PDM|74.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS|
20|FH_F35685_0_0|CSTM-ALL|CSTM-00|2020|PDM|52920.00|99|0.00|DRG 104 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH|
20|FH_F38808_0_0|SrvcGrp|17075|2022|PDM|826.00|99|0.00|ASPG VI|
20|FH_F40972_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|SPINAL CORD REHABILITATION|
20|FH_F100681_73104_0|SrvcGrp|73659|2022|PDM|4867.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F70762_90805_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|ADULT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 5  (NO REV)|
20|FH_F149679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F66420_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F61292_0_0|SrvcGrp|57202|2022|PDM|2499.00|99|0.00|SPINE SURGERY|
20|FH_F118194_50841_0|SrvcGrp|48396|2022|PDM|190.00|99|0.00|OT SERVICES|
20|FH_F115019_78414_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F54212_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|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_F135065_08043_0|SrvcGrp|102239|2022|PDM|42.00|99|0.00|AETNA METHADONE MAINTENANCE|
20|FH_F130766_04967_0|SrvcGrp|113939|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F33785_0_0|SrvcGrp|15539|2022|PDM|400.00|99|0.00|VENTILATOR|
20|FH_F44754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111301_33122_0|SrvcGrp|12491|2022|PCT|0.63|99|0.00|PACEMAKER|
20|FH_F134263_15628_0|SrvcGrp|73841|2022|PDM|352.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F65882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: ALL|
20|FH_F132328_0_0|SrvcGrp|89885|2022|PDM|2819.00|99|0.00|AETNA REPAIR HERNIA|
20|FH_F114569_0_0|SrvcGrp|105720|2022|PDM|52.40|99|0.00|AETHA ALCOHOL/SUBS INTERV > 30 MINS (MOD GT)(HCFA)|
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)|
20|FH_F87557_33309_0|SrvcGrp|86841|2022|PDM|80.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F125253_15601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132877_06105_0|SrvcGrp|471|2022|PDM|588.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132791_44122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128031_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F123445_0_0|SrvcGrp|30609|2022|PDM|43.86|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F66880_25301_0|CSTM-ALL|CSTM-00|2020|PCT|0.33|99|0.00|OP SVCS|
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|990.00|99|0.00|AEG 4 (NO REV)|
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AEG 8 (NO REV)|
20|FH_F106980_0_0|SrvcGrp|705|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|422.00|99|0.00|ASPG II|
20|FH_F74602_0_0|SrvcGrp|48085|2022|PDM|120.00|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PDM|638.00|99|0.00|AEG 2 (NO REV)|
20|FH_F88545_78734_0|SrvcGrp|87540|2022|PCT|1.05|99|0.00|WOUND CARE|
20|FH_F88639_80204_0|SrvcGrp|16319|2022|PDM|27244.34|99|0.00|TRAUMA CARE|
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|113.49|99|0.00|AETNA SLEEP STUDY CPT 95801|
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ASPG X|
20|FH_F46832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2010 B CODES (MOD UE)|
20|FH_F47495_0_0|SrvcGrp|35054|2022|PDM|1450.00|99|0.00|SKILLED NURSING - LEVEL 2|
20|FH_F118152_20151_0|SrvcGrp|86842|2022|PDM|40.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F120490_64133_0|SrvcGrp|86852|2022|PDM|22.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F134032_19611_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F142667_63017_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F53732_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|PEDIATRIC OCCUPATIONAL THERAPY|
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|1867.00|99|0.00|AEG 9 (NO REV)|
20|FH_F73403_0_0|SrvcGrp|62537|2022|PDM|130.00|99|0.00|SPEECH THERAPY|
20|FH_F78402_15905_0|SrvcGrp|3157|2022|PDM|1484.00|99|0.00|ACUTE REHABILITATION|
20|FH_F140567_46350_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120152_0_0|SrvcGrp|100066|2022|PDM|16500.00|99|0.00|REPAIR RADIUS FRACTURE|
20|FH_F149701_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128270_0_0|SrvcGrp|42785|2022|PDM|80.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F149375_26101_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F151606_64772_0|SrvcGrp|46903|2022|PDM|536.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F119023_91406_0|SrvcGrp|21920|2022|PDM|35.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F118914_43015_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41481_0_0|SrvcGrp|17079|2022|PDM|1076.00|99|0.00|ASPG VIII|
20|FH_F147921_19083_0|SrvcGrp|74668|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129483_77030_0|SrvcGrp|22389|2022|PDM|25.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F101945_0_0|SrvcGrp|59841|2022|PDM|1025.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137938_29036_0|SrvcGrp|75507|2022|PCT|0.66|99|0.00|CHEMOTHERAPY|
20|FH_F45303_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F109652_0_0|SrvcGrp|60112|2022|PDM|5868.00|99|0.00|ICU/CCU 200-203, 208-213, 219|
20|FH_F109652_0_0|SrvcGrp|941|2022|PDM|4347.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F109652_0_0|SrvcGrp|29817|2022|PDM|4347.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F109652_0_0|SrvcGrp|73002|2022|PDM|4591.00|99|0.00|AEG 7|
20|FH_F109652_0_0|SrvcGrp|16069|2022|PDM|1004.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F124757_45750_0|SrvcGrp|81839|2022|PDM|0.25|99|0.00|AETNA MEDICAL RECORD|
20|FH_F135653_0_0|SrvcGrp|84442|2022|PDM|14000.00|99|0.00|REVISION KNEE|
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|3559.00|99|0.00|AEG 8 (NO REV)|
20|FH_F119417_78212_0|SrvcGrp|26160|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 7 (NO REV)|
20|FH_F148425_01507_0|SrvcGrp|115384|2022|PCT|1.00|99|0.00|COVID-19 INFUSION ADMINISTRATION COMBINATION - ELI LILLY|
20|FH_F116324_0_0|SrvcGrp|106742|2022|PDM|600.00|99|0.00|ENDOSCOPY|
20|FH_F97621_75801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F101840_76054_0|SrvcGrp|58421|2022|PDM|14641.00|99|0.00|MS DRG 738 ONLY|
20|FH_F38865_0_0|SrvcGrp|941|2022|PDM|1860.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F34706_0_0|CSTM-ALL|CSTM-00|2020|PDM|4061.00|99|0.00|C-SECTION (MOTHER ONLY)|
20|FH_F38700_0_0|SrvcGrp|18618|2022|PCT|0.80|99|0.00|MS DRG 418|
20|FH_F116145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119775_0_0|SrvcGrp|73000|2022|PDM|887.00|99|0.00|AEG 6|
20|FH_F103360_68845_0|SrvcGrp|98239|2022|PDM|9134.00|99|0.00|MASTECTOMY RADICAL|
20|FH_F143191_17512_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119229_90804_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119079_41018_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F48032_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
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_F92977_64067_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F75307_0_0|SrvcGrp|59414|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY SVCS EXCLD MOD GP|
20|FH_F39349_0_0|SrvcGrp|109|2022|PDM|568.00|99|0.00|CD - DETOX|
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|823.39|99|0.00|AEG 9 (NO REV)|
20|FH_F135171_22601_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F64559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F121525_78613_0|SrvcGrp|87317|2022|PDM|1100.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F143894_70001_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F60019_0_0|SrvcGrp|26036|2022|PCT|0.75|99|0.00|DRUGS|
20|FH_F40421_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F65440_0_0|SrvcGrp|27346|2022|PDM|2571.00|99|0.00|REPAIR BLADDER DEFECT|
20|FH_F100320_0_0|SrvcGrp|75497|2022|PDM|674.00|99|0.00|AEG 10|
20|FH_F38591_0_0|SrvcGrp|12837|2022|PCT|0.70|99|0.00|INTRAOCULAR LENSES|
20|FH_F123898_45121_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126042_97005_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F89475_71202_0|CSTM-ALL|CSTM-00|2020|PDM|1999.00|99|0.00|AEG 5  (NO REV)|
20|FH_F39992_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F84778_0_0|SrvcGrp|73004|2022|PDM|1995.00|99|0.00|AEG 8|
20|FH_F35276_0_0|SrvcGrp|19963|2022|PDM|1950.00|99|0.00|LAP HERNIORRHAPY|
20|FH_F118194_50841_0|SrvcGrp|17013|2022|PDM|240.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F73402_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F135236_02840_0|SrvcGrp|112223|2022|PDM|565.70|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F150462_30458_0|SrvcGrp|115817|2022|PCT|1.00|99|0.00|DRUGS|
20|FH_F128970_54729_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120362_23321_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F93881_15009_0|SrvcGrp|80778|2022|PCT|0.00|99|0.00|AETNA ER SERVICES W/ OBSERVATION|
20|FH_F41776_0_0|CSTM-ALL|CSTM-00|2020|PDM|2414.00|99|0.00|ASPG IV|
20|FH_F78603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F79625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83253_33511_0|SrvcGrp|33166|2022|PDM|420.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F128371_40207_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F98922_40351_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F117010_10549_0|SrvcGrp|86747|2022|PCT|1.05|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F116269_92627_0|SrvcGrp|89417|2022|PDM|500.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F118057_47906_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F37443_0_0|SrvcGrp|110|2022|PDM|910.00|99|0.00|CD - REHABILITATION|
20|FH_F134876_0_0|SrvcGrp|57968|2022|PDM|58.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F130810_54728_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141550_33619_0|SrvcGrp|89417|2022|PDM|385.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|2838.00|99|0.00|AEG 7 (NO REV)|
20|FH_F148162_29412_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F39212_0_0|SrvcGrp|13168|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OTHER OP  SERV MOD QW|
20|FH_F148222_18603_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F142073_0_0|SrvcGrp|88161|2022|PDM|5980.00|99|0.00|LAMINECTOMY W/FACE-THORACIC|
20|FH_F148339_71303_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130145_98043_0|SrvcGrp|90489|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|ASPG V|
20|FH_F149888_68506_0|SrvcGrp|68000|2022|PDM|3562.00|99|0.00|CPT 58561|
20|FH_F125703_02907_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F90818_0_0|SrvcGrp|76243|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130317_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|DME F/S (MOD KM) - MHAC|
20|FH_F83493_21220_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F141527_36830_0|SrvcGrp|14949|2022|PDM|11.00|99|0.00|HOME INFUSION|
20|FH_F109645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120952_25303_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F69766_0_0|SrvcGrp|10503|2022|PDM|47.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F83198_44125_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F78762_0_0|SrvcGrp|79678|2022|PCT|0.57|99|0.00|BURN SERVICES|
20|FH_F130747_0_0|SrvcGrp|107361|2022|PDM|26010.00|99|0.00|SECOND LEVEL CER DISKECTOMY|
20|FH_F72746_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117392_0_0|SrvcGrp|75479|2022|PDM|385.00|99|0.00|AEG 1|
20|FH_F143788_21230_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F141607_27021_0|SrvcGrp|48385|2022|PDM|135.00|99|0.00|SPEECH THERAPY|
20|FH_F130138_02915_0|SrvcGrp|9500|2022|PDM|2115.30|99|0.00|PSYCH INTENSIVE CARE UNIT|
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|909.00|99|0.00|AEG 6 (NO REV)|
20|FH_F147941_06023_0|SrvcGrp|94423|2022|PCT|1.26|99|0.00|IMMUNIZATIONS|
20|FH_F130452_48801_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40304_0_0|SrvcGrp|3099|2022|PCT|0.77|99|0.00|OP SURGERY|
20|FH_F90872_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36822_0_0|SrvcGrp|12274|2022|PDM|329.00|99|0.00|ACUTE PSYCH|
20|FH_F131254_92211_0|SrvcGrp|17013|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F82955_34266_0|SrvcGrp|74719|2022|PCT|0.66|99|0.00|AETNA OBSERVATION SERVICES W/ER|
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 7 (NO REV)|
20|FH_F151543_95630_0|SrvcGrp|12659|2022|PDM|1146.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
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_F55854_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150905_01608_0|SrvcGrp|115859|2022|PDM|35.92|99|0.00|SKILLS TRAINING DEV (MOD HO) (0-21 YRS)|
20|FH_F111444_33401_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F46914_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|0.70|99|0.00|AEG 10 (NO REV)|
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|ASPG IV|
20|FH_F36207_0_0|SrvcGrp|19609|2022|PDM|38.50|99|0.00|NONEMERGENCY TRANSPORTATION, WHEELCHAIR VAN|
20|FH_F91255_19401_0|SrvcGrp|12290|2022|PDM|2247.00|99|0.00|DETOXIFICATION|
20|FH_F45516_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142897_07018_0|SrvcGrp|113301|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - ASTRAZENECA|
20|FH_F111403_37167_0|SrvcGrp|89337|2022|PDM|1058.00|99|0.00|DETOXIFICATION|
20|FH_F106580_33321_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F141830_92592_0|SrvcGrp|75419|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F127412_15301_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 5  (NO REV)|
20|FH_F40542_0_0|SrvcGrp|473|2022|PDM|285.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F117900_19118_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146362_76048_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ACUTE PSYCH|
20|FH_F112853_22408_0|SrvcGrp|41452|2022|PDM|0.70|99|0.00|ENTERAL FORMULA - SPECIAL METABOLIC NEEDS|
20|FH_F42984_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|CHILD PSYCHIATRIC|
20|FH_F117950_37110_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133329_40202_0|SrvcGrp|79720|2022|PDM|1564.00|99|0.00|ACUTE REHAB II|
20|FH_F133021_00910_0|SrvcGrp|8950|2022|PDM|1335.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F116988_0_0|SrvcGrp|75487|2022|PDM|971.00|99|0.00|AEG 5|
20|FH_F123324_0_0|SrvcGrp|11259|2022|PCT|0.52|99|0.00|DRUGS|
20|FH_F119079_41018_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F81494_0_0|SrvcGrp|12403|2022|PDM|43.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F125471_34471_0|SrvcGrp|108484|2022|PDM|705.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F97882_32407_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F46197_0_0|SrvcGrp|17000|2022|PCT|0.83|99|0.00|OUTPATIENT SURGERY|
20|FH_F120707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|OP SVCS|
20|FH_F99720_0_0|SrvcGrp|107546|2022|PDM|3072.00|99|0.00|TREATMENT OF JOINT|
20|FH_F45915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F34706_0_0|SrvcGrp|3489|2022|PDM|12927.00|99|0.00|DRG 498 SPINAL FUSION EXCEPT CERVICAL|
20|FH_F92977_64067_0|SrvcGrp|92807|2022|PDM|430.00|99|0.00|AETNA RESIDENTIAL TREATMENT PYCH & CD (AGE 13-17)|
20|FH_F102681_34237_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146061_24502_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|369.44|99|0.00|HAPA WPA-NWPA 2012-13 ASC 109 W/O REV|
20|FH_F97103_53295_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F142888_77095_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F80859_65616_0|SrvcGrp|88799|2022|PCT|0.56|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F117450_63131_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139825_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F88280_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HAPA WPA/NWPA 2018 LAB 100%|
20|FH_F56533_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F123539_65265_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F137639_0_0|SrvcGrp|27210|2022|PDM|1500.00|99|0.00|SKILLED NURSING LEVEL I|
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|1957.00|99|0.00|AEG 5  (NO REV)|
20|FH_F123069_75070_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F76284_0_0|SrvcGrp|26001|2022|PDM|167.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F109242_18466_0|SrvcGrp|93919|2022|PDM|533.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F142078_73110_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123373_0_0|SrvcGrp|20752|2022|PDM|2367.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F106540_26330_0|SrvcGrp|107674|2022|PCT|0.43|99|0.00|AETNA RADIOLOGY|
20|FH_F46357_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|OP SVCS|
20|FH_F118541_15222_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87592_85614_0|SrvcGrp|78680|2022|PDM|2652.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F71145_0_0|SrvcGrp|44243|2022|PDM|395.00|99|0.00|HOME HEMO TRAINING|
20|FH_F150119_34205_0|SrvcGrp|87077|2022|PDM|145.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125672_92663_0|SrvcGrp|104796|2022|PDM|600.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F100661_63640_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F72859_0_0|SrvcGrp|10570|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1760.00|99|0.00|AEG 10 (NO REV)|
20|FH_F149940_02645_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F129176_48098_0|SrvcGrp|33722|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F133368_61401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101840_76054_0|SrvcGrp|53603|2022|PDM|12170.00|99|0.00|MS DRG 494 ONLY|
20|FH_F106580_33321_0|SrvcGrp|58509|2022|PDM|292.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F39689_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)|
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F115289_90057_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F38394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|ASPG X|
20|FH_F117945_78957_0|SrvcGrp|73841|2022|PDM|350.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F131190_21042_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F74467_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116188_72211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F47733_0_0|SrvcGrp|43562|2022|PDM|55.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F40032_0_0|SrvcGrp|109|2022|PDM|425.00|99|0.00|CD - DETOX|
20|FH_F139515_0_0|SrvcGrp|88147|2022|PDM|2075.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA|
20|FH_F55054_0_0|SrvcGrp|51266|2022|PCT|0.57|99|0.00|CD UNIT REHAB OUTIER|
20|FH_F82931_18847_0|SrvcGrp|68539|2022|PCT|0.74|99|0.00|OP SURGERY|
20|FH_F120296_97223_0|SrvcGrp|82846|2022|PCT|0.70|99|0.00|AETNA DME|
20|FH_F33913_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139689_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88398_15601_0|SrvcGrp|46104|2022|PDM|83.65|99|0.00|HOME VISIT - PRENATAL|
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PDM|1907.00|99|0.00|AEG 8 (NO REV)|
20|FH_F119538_60959_0|SrvcGrp|108149|2022|PCT|1.00|99|0.00|ALEMTUZUMAB INJECTION|
20|FH_F76662_0_0|SrvcGrp|59427|2022|PDM|85.00|99|0.00|OT|
20|FH_F91155_16105_0|SrvcGrp|53987|2022|PDM|39.30|99|0.00|PHOTOTHERAPY|
20|FH_F44855_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|NEBULIZER (DME) (MOD NU)|
20|FH_F102561_75146_0|SrvcGrp|72992|2022|PDM|1750.00|99|0.00|AEG 2|
20|FH_F133380_46254_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F41392_0_0|SrvcGrp|69399|2022|PCT|1.05|99|0.00|PREVENTATIVE CODES|
20|FH_F149881_03038_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42377_0_0|CSTM-ALL|CSTM-00|2020|PDM|552.00|99|0.00|ACUTE PSYCH|
20|FH_F125352_90034_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F112953_06066_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86293_0_0|SrvcGrp|70749|2022|PDM|2794.00|99|0.00|CPT 29823|
20|FH_F111784_32901_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F50297_0_0|SrvcGrp|42974|2022|PDM|82.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F87155_04105_0|SrvcGrp|10577|2022|PDM|57.78|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F41392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139825_0_0|SrvcGrp|42550|2022|PDM|5738.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F117906_91606_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F146244_76028_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36576_0_0|CSTM-ALL|CSTM-00|2020|PDM|1232.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL|
20|FH_F111809_93003_0|SrvcGrp|111931|2022|PDM|35.91|99|0.00|COVID-19 CDC TESTING LAB|
20|FH_F132528_64014_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F103360_68845_0|SrvcGrp|73498|2022|PDM|1915.00|99|0.00|AETNA ER LEVEL III|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 417-419|
20|FH_F118196_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119559_0_0|SrvcGrp|82981|2022|PDM|128.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F69071_0_0|SrvcGrp|13681|2022|PDM|488.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F46372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|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_F42340_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F41679_0_0|CSTM-ALL|CSTM-00|2020|PDM|380.00|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_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|ANTI-SPASMOTIC THERAPY|
20|FH_F128919_48075_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117346_75093_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F111316_0_0|SrvcGrp|73841|2022|PDM|400.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F119070_0_0|SrvcGrp|106799|2022|PDM|3500.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F133487_24293_0|SrvcGrp|27968|2022|PDM|45.00|99|0.00|SKILLED NURSING LPN|
20|FH_F44607_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F148556_13206_0|SrvcGrp|22589|2022|PDM|55.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F133214_75024_0|SrvcGrp|114008|2022|PDM|654.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F142038_45152_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141217_0_0|SrvcGrp|80617|2022|PDM|9500.00|99|0.00|ARTHOPLASTY|
20|FH_F118496_92627_0|SrvcGrp|89149|2022|PDM|315.00|99|0.00|OP INTENSIVE|
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|477.62|99|0.00|AEG 1 (NO REV)|
20|FH_F142967_65065_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78682_0_0|CSTM-ALL|CSTM-00|2020|PDM|1074.73|99|0.00|ASPG IV|
20|FH_F147982_65706_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F55375_0_0|SrvcGrp|12591|2022|PDM|170.00|99|0.00|CD FULL DAY|
20|FH_F69648_0_0|CSTM-ALL|CSTM-00|2020|PDM|11.25|99|0.00|SKILLED NURSING HCPC|
20|FH_F51548_0_0|SrvcGrp|14254|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F149513_0_0|SrvcGrp|80098|2022|PDM|55.94|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE|
20|FH_F117906_91606_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F92676_15063_0|SrvcGrp|79084|2022|PDM|254.66|99|0.00|MON VALLEY ASC 244|
20|FH_F87577_80016_0|SrvcGrp|73463|2022|PDM|7198.00|99|0.00|AETNA NICU II|
20|FH_F148599_98034_0|SrvcGrp|21359|2022|PDM|57321.00|99|0.00|MS DRG 460 ONLY|
20|FH_F126935_33615_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F39558_0_0|SrvcGrp|17073|2022|PDM|836.00|99|0.00|ASPG V|
20|FH_F132934_63005_0|SrvcGrp|103913|2022|PCT|0.71|99|0.00|OP DIALYSIS|
20|FH_F47834_0_0|SrvcGrp|3409|2022|PDM|257.00|99|0.00|NEWBORN NURSERY|
20|FH_F126911_62301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118373_21205_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F99720_0_0|SrvcGrp|104743|2022|PDM|4403.00|99|0.00|KNEE ARTHRO/ ANTER CLIG REP|
20|FH_F143200_91602_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.84|99|0.00|HAPA WPA-NWPA 2012-13 ASC 12 W/O REV|
20|FH_F142897_07018_0|SrvcGrp|111927|2022|PCT|1.00|99|0.00|COVID-19 NON CDC|
20|FH_F117346_75093_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F96120_67207_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F34688_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|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_F80855_0_0|SrvcGrp|38707|2022|PDM|2650.00|99|0.00|HYSTEROSCOPY|
20|FH_F142904_50322_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120437_85202_0|SrvcGrp|86835|2022|PDM|33.77|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F151061_02720_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F151141_24014_0|CSTM-ALL|CSTM-00|2020|PDM|1803.00|99|0.00|AEG 6 (NO REV)|
20|FH_F151259_16505_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139676_76901_0|SrvcGrp|89417|2022|PDM|250.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F139676_76901_0|SrvcGrp|86722|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F150745_03301_0|SrvcGrp|84185|2022|PDM|212.00|99|0.00|RESPITE CARE|
20|FH_F41363_0_0|SrvcGrp|64758|2022|PCT|0.80|99|0.00|HCPCS|
20|FH_F35737_34741_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117762_0_0|SrvcGrp|77021|2022|PDM|4992.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F122377_91007_0|SrvcGrp|10393|2022|PDM|6796.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F124441_0_0|SrvcGrp|89860|2022|PDM|5700.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F112805_46011_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141156_04401_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F37444_0_0|SrvcGrp|16617|2022|PCT|0.72|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F35557_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1414794 AM HOME PAT DME MOD NU|
20|FH_F138017_73129_0|SrvcGrp|97475|2022|PDM|6883.00|99|0.00|REPAIR SHOULDER CAPSULE|
20|FH_F128927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.00|99|0.00|AEG 4 (NO REV)|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F42142_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138271_75040_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F50078_0_0|SrvcGrp|38327|2022|PCT|1.00|99|0.00|HILLCREST IV THERAPY DRUGS|
20|FH_F112045_90301_0|SrvcGrp|103696|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F36485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% 2007 MEDICARE TN DME  MOD 53|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F124714_64081_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F116583_0_0|SrvcGrp|103903|2022|PDM|150.00|99|0.00|HOSPICE IN SNF|
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1458.00|99|0.00|AEG 6 (NO REV)|
20|FH_F31087_0_0|SrvcGrp|10623|2022|PDM|110.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F117799_0_0|SrvcGrp|84939|2022|PDM|11935.00|99|0.00|SHOULDER JOINT|
20|FH_F137288_0_0|SrvcGrp|113070|2022|PDM|1050.00|99|0.00|IP DAY HOSPITAL|
20|FH_F147237_40006_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 8 (NO REV)|
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F132160_0_0|SrvcGrp|95107|2022|PDM|5738.00|99|0.00|INTRAOCULAR LENS PROSTHESIS|
20|FH_F150359_30106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36720_0_0|SrvcGrp|10927|2022|PDM|550.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F138217_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F56232_0_0|CSTM-ALL|CSTM-00|2020|PDM|1683.76|99|0.00|ASPG VIII|
20|FH_F98022_89015_0|SrvcGrp|88978|2022|PDM|5833.00|99|0.00|VAGINAL DELIVERY|
20|FH_F143668_0_0|SrvcGrp|114065|2022|PDM|22.00|99|0.00|SEGMENTAL PNEUMATIC (MOD RR)|
20|FH_F85437_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138017_73129_0|SrvcGrp|97478|2022|PDM|6539.00|99|0.00|RELIEVE BLADDER CONTRACTURE|
20|FH_F149402_03301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117799_0_0|SrvcGrp|104856|2022|PDM|5570.00|99|0.00|PERCUTANEIOUS VERTEBROPLASY|
20|FH_F139877_32615_0|SrvcGrp|113586|2022|PDM|73.49|99|0.00|COVID-19 SARSCOV & INF VIR A&B AG IA (HCFA)|
20|FH_F131331_0_0|SrvcGrp|104230|2022|PDM|165.42|99|0.00|RESPITE CARE (HCFA)|
20|FH_F39443_0_0|SrvcGrp|30317|2022|PDM|570.00|99|0.00|HAPA WPA ASC 201|
20|FH_F100663_56537_0|SrvcGrp|73485|2022|PDM|3032.00|99|0.00|AETNA REHAB|
20|FH_F92278_01440_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PDM|1194.00|99|0.00|ASPG V|
20|FH_F117714_94301_0|SrvcGrp|89149|2022|PDM|395.00|99|0.00|OP INTENSIVE|
20|FH_F47902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER QW|
20|FH_F98940_70506_0|SrvcGrp|73601|2022|PDM|4513.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F148859_0_0|SrvcGrp|115528|2022|PDM|69.71|99|0.00|BLADDER IRRIGATION|
20|FH_F148667_0_0|SrvcGrp|41335|2022|PDM|11000.00|99|0.00|TOTAL HIP|
20|FH_F40527_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F124976_0_0|SrvcGrp|73841|2022|PDM|531.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F33632_52349_0|SrvcGrp|89265|2022|PDM|305.22|99|0.00|AMBULATORY DETOX - ALCOHOL AND DRUG REHAB|
20|FH_F140295_0_0|SrvcGrp|74039|2022|PDM|7638.00|99|0.00|LAMINECTOMY|
20|FH_F149480_0_0|SrvcGrp|83235|2022|PCT|0.85|99|0.00|AMBULATORY SURGERY|
20|FH_F35987_0_0|SrvcGrp|361|2022|PDM|2063.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F98020_50138_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F114571_34613_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132137_67218_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|200.00|99|0.00|ASPG 10 PIEDMONT OUTPATIENT SURGERY CENTER|
20|FH_F100661_63640_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F150911_75979_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39844_0_0|SrvcGrp|24703|2022|PDM|318.00|99|0.00|NEWBORN NURSERY|
20|FH_F117995_60126_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F149781_37404_0|SrvcGrp|26275|2022|PDM|3146.00|99|0.00|CPT 29826|
20|FH_F45977_0_0|SrvcGrp|40411|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD RR KE|
20|FH_F120437_85202_0|SrvcGrp|29075|2022|PDM|106.93|99|0.00|HYDRATION THERAPY|
20|FH_F146361_66215_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150905_01608_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F142759_15074_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 3 (NO REV)|
20|FH_F117647_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|PDM|630.00|99|0.00|AEG 2 (NO REV)|
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|CD INTENSIVE OUTPATIENT SVCS|
20|FH_F46914_0_0|SrvcGrp|9828|2022|PDM|63.00|99|0.00|HOME HEALTH AIDE|
20|FH_F144318_32696_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128390_0_0|SrvcGrp|65720|2022|PDM|115.00|99|0.00|RESPITE CARE|
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|AEG 6 (NO REV)|
20|FH_F49637_0_0|CSTM-ALL|CSTM-00|2020|PDM|3465.00|99|0.00|OK SURGICAL HOSPITAL CVTY ENHANCED GROUPER 4|
20|FH_F46372_0_0|SrvcGrp|3066|2022|PCT|0.65|99|0.00|HIGH-COST DRUGS|
20|FH_F83031_0_0|SrvcGrp|44708|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE|
20|FH_F147995_67037_0|SrvcGrp|103913|2022|PCT|1.00|99|0.00|OP DIALYSIS|
20|FH_F67683_0_0|SrvcGrp|38223|2022|PDM|652.00|99|0.00|ADULT DETOX|
20|FH_F143147_80124_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: BREAKOUT|
20|FH_F37567_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|PDM|461.00|99|0.00|HAPA EPA ASC 52|
20|FH_F148867_20191_0|SrvcGrp|88621|2022|PDM|124.00|99|0.00|SKILLED NURSING LPN|
20|FH_F121936_17543_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_F34963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37823_0_0|SrvcGrp|27445|2022|PCT|0.80|99|0.00|ER PROF FEE|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.43|99|0.00|DELAWARE VALLEY- ASC 304|
20|FH_F91873_12723_0|SrvcGrp|85145|2022|PDM|127.00|99|0.00|PT/OT/ST|
20|FH_F97740_01605_0|SrvcGrp|88978|2022|PDM|11468.00|99|0.00|VAGINAL DELIVERY|
20|FH_F86911_0_0|SrvcGrp|27767|2022|PDM|45.00|99|0.00|SKILLED IV NURSING HOURLY|
20|FH_F87054_0_0|SrvcGrp|84935|2022|PDM|1260.00|99|0.00|REPAIR IRIS AND CILIARY BODY|
20|FH_F87197_0_0|SrvcGrp|92606|2022|PDM|519.00|99|0.00|SUB-ACUTE CARE LEVEL III|
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SERVICES|
20|FH_F113903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114063_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|GEORGIA AWP|
20|FH_F115208_0_0|SrvcGrp|97468|2022|PDM|2652.00|99|0.00|PARTIAL EXCISION THYROID|
20|FH_F105481_80120_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F105623_77901_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|GENERAL ACUTE CARE|
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|AEG 7 (NO REV)|
20|FH_F116485_17033_0|SrvcGrp|110058|2022|PDM|21.22|99|0.00|BEHAVIOR ASSESSMENT 15 MINS|
20|FH_F94786_07974_0|SrvcGrp|24754|2022|PDM|15.75|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F133002_0_0|SrvcGrp|72994|2022|PDM|647.00|99|0.00|AEG 3|
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.55|99|0.00|ASPG V|
20|FH_F93252_0_0|SrvcGrp|93013|2022|PDM|1500.00|99|0.00|COLORECTAL CANCER SCREENING|
20|FH_F114389_50131_0|SrvcGrp|22592|2022|PDM|130.65|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F114389_50131_0|SrvcGrp|98961|2022|PDM|102.25|99|0.00|HIT CONT ANTIMETIC (HCFA)|
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 9 (NO REV)|
20|FH_F115971_0_0|SrvcGrp|73008|2022|PDM|585.00|99|0.00|AEG 10|
20|FH_F146903_72901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38233_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|S CODES|
20|FH_F38983_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|ACUTE PSYCH|
20|FH_F98380_43055_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F124636_85008_0|SrvcGrp|46903|2022|PDM|900.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F116097_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F67882_0_0|SrvcGrp|9838|2022|PDM|2530.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F136662_45345_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114638_25309_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114666_30342_0|SrvcGrp|104008|2022|PDM|3500.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS|
20|FH_F114764_78214_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122610_73139_0|SrvcGrp|72996|2022|PDM|6139.00|99|0.00|AEG 4|
20|FH_F122635_06410_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F43412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F43421_0_0|CSTM-ALL|CSTM-00|2020|PDM|489.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135715_32073_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F116345_78626_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F147519_52627_0|SrvcGrp|73496|2022|PDM|2352.52|99|0.00|AETNA ER LEVEL V|
20|FH_F147701_31093_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F147702_75240_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F42708_0_0|CSTM-ALL|CSTM-00|2020|PDM|684.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102641_0_0|SrvcGrp|98779|2022|PDM|3096.00|99|0.00|INCISION OF TENDON SHEATH|
20|FH_F117199_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134087_0_0|SrvcGrp|88491|2022|PDM|6011.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F98361_12065_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F130919_33314_0|SrvcGrp|89417|2022|PDM|467.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F138452_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|SUBACUTE CARE|
20|FH_F39443_0_0|SrvcGrp|13991|2022|PDM|6350.00|99|0.00|PTCA W/ STENT|
20|FH_F97260_06111_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F67381_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45798_0_0|SrvcGrp|3288|2022|PDM|56600.00|99|0.00|DRG 496 COMB ANTI/POST SPINAL FUSION|
20|FH_F111246_80027_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F110783_93013_0|SrvcGrp|86844|2022|PDM|35.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|41.00|99|0.00|HAPA EPA ASC 10|
20|FH_F136806_0_0|SrvcGrp|104448|2022|PDM|3713.00|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE|
20|FH_F38475_0_0|SrvcGrp|27968|2022|PDM|41.00|99|0.00|SKILLED NURSING LPN|
20|FH_F97880_63501_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F120144_77031_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F94621_07728_0|SrvcGrp|87909|2022|PCT|1.00|99|0.00|PENTAMID ISETHION 300MG/1 MX|
20|FH_F74670_0_0|SrvcGrp|72380|2022|PDM|86.00|99|0.00|PHYSICAL AND OCCUPATIONAL THERAPY|
20|FH_F149023_44122_0|SrvcGrp|88155|2022|PDM|12499.00|99|0.00|REVISE KNEECAP WITH IMPLANT|
20|FH_F134397_27513_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F150459_08021_0|SrvcGrp|48398|2022|PDM|116.00|99|0.00|PT SERVICES|
20|FH_F42979_0_0|SrvcGrp|3403|2022|PDM|96.00|99|0.00|CPT 99203|
20|FH_F130581_40356_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116806_0_0|SrvcGrp|107137|2022|PDM|807.12|99|0.00|PREPARE FACE/ORAL PROSTHESIS|
20|FH_F150520_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F84872_18510_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F143536_47546_0|SrvcGrp|100264|2022|PCT|1.00|99|0.00|REMOVE IMPACTED EAR WAX|
20|FH_F102224_0_0|SrvcGrp|40003|2022|PDM|11000.00|99|0.00|TOTAL KNEE|
20|FH_F130925_34652_0|SrvcGrp|73842|2022|PDM|189.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131173_17043_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F151761_20019_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|PDM|257.00|99|0.00|GA RETINA SURG CTR ASC 8|
20|FH_F47792_0_0|SrvcGrp|45284|2022|PDM|95.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F49329_0_0|SrvcGrp|44987|2022|PDM|45.00|99|0.00|SKILLED NURSING (ADDITIONAL HOURS)|
20|FH_F132387_60465_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132417_38119_0|SrvcGrp|73605|2022|PDM|1100.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F132418_84042_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.00|99|0.00|AEG 2 (NO REV)|
20|FH_F119843_14103_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118874_29926_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F36439_0_0|SrvcGrp|23015|2022|PDM|800.00|99|0.00|V5244|
20|FH_F59732_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|HOME INFUSION NURSING SERVICES MOD SD|
20|FH_F61292_0_0|SrvcGrp|12591|2022|PDM|523.00|99|0.00|CD FULL DAY|
20|FH_F31826_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F87254_0_0|SrvcGrp|73006|2022|PDM|2800.00|99|0.00|AEG 9|
20|FH_F128190_45342_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F116697_11703_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F48998_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125210_32901_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC|
20|FH_F128358_46072_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F67699_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS|
20|FH_F110363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49653_0_0|CSTM-ALL|CSTM-00|2020|PDM|1760.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123953_84003_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F139293_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F129231_30060_0|CSTM-ALL|CSTM-00|2020|PDM|924.00|99|0.00|AEG 5  (NO REV)|
20|FH_F129334_43016_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F149862_76051_0|SrvcGrp|108484|2022|PDM|483.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F89734_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F143528_0_0|SrvcGrp|82113|2022|PDM|2625.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F37292_0_0|SrvcGrp|3259|2022|PDM|1629.00|99|0.00|ACUTE REHABILITATION|
20|FH_F149479_0_0|SrvcGrp|109036|2022|PDM|700.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F148486_03110_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121535_60018_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHYSICIAN CLINIC VISIT NATL F/S (MOD NU)|
20|FH_F130682_0_0|SrvcGrp|97480|2022|PDM|3110.00|99|0.00|BASAL/SINUS ENDOSCOPY|
20|FH_F123505_64468_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F88254_33411_0|SrvcGrp|14947|2022|PDM|30.00|99|0.00|HOME INFUSION|
20|FH_F109240_21201_0|SrvcGrp|102985|2022|PDM|11361.00|99|0.00|RADIOTHERAPY DOSE PLAN, IMRT|
20|FH_F150982_0_0|SrvcGrp|27347|2022|PDM|3303.00|99|0.00|CPT 58558|
20|FH_F116108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143928_21061_0|SrvcGrp|48394|2022|PDM|53.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F72546_0_0|SrvcGrp|14096|2022|PCT|0.63|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F62719_0_0|SrvcGrp|12264|2022|PDM|91.80|99|0.00|DIETICIAN OR LPN SERVICES|
20|FH_F151780_0_0|SrvcGrp|82981|2022|PDM|140.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F135771_0_0|SrvcGrp|94780|2022|PDM|169.46|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F148265_06067_0|SrvcGrp|106680|2022|PDM|6530.00|99|0.00|REVISION OF ANKLE JOINT|
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|1522.00|99|0.00|AEG 4 (NO REV)|
20|FH_F150939_0_0|SrvcGrp|96499|2022|PDM|10.00|99|0.00|ADMIN OF PNEUMOCOCCAL VACCINE|
20|FH_F79429_0_0|SrvcGrp|59426|2022|PDM|75.00|99|0.00|PT|
20|FH_F113585_20155_0|SrvcGrp|46605|2022|PDM|125.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F138681_39301_0|SrvcGrp|72602|2022|PDM|733.00|99|0.00|ECT|
20|FH_F138936_01040_0|SrvcGrp|73497|2022|PDM|927.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F88893_0_0|SrvcGrp|87842|2022|PDM|11897.00|99|0.00|LAPAROSCOPY - GASTRIC|
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_F117715_0_0|SrvcGrp|75495|2022|PDM|1957.00|99|0.00|AEG 9|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 11 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|89.55|99|0.00|HAPA WPA-NWPA 2012-13 ASC 317 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.11|99|0.00|HAPA WPA-NWPA 2012-13 ASC 247 W/O REV|
20|FH_F151501_30265_0|SrvcGrp|89988|2022|PDM|2090.00|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F151503_30067_0|SrvcGrp|99172|2022|PDM|6913.00|99|0.00|CPT 28740|
20|FH_F135427_19610_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F135453_70726_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136022_64759_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F100848_17202_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131228_01826_0|SrvcGrp|86700|2022|PDM|202.50|99|0.00|ECHO TRANSESOPHAGEAL 2|
20|FH_F131463_19096_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F130620_18940_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F101661_08879_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128201_33334_0|SrvcGrp|89149|2022|PDM|120.00|99|0.00|OP INTENSIVE|
20|FH_F129967_18915_0|SrvcGrp|73842|2022|PDM|194.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111292_33136_0|SrvcGrp|82744|2022|PDM|72.00|99|0.00|URINE CULTURE COLONY COUNT|
20|FH_F111363_33169_0|SrvcGrp|72998|2022|PDM|2185.00|99|0.00|AEG 5|
20|FH_F134260_02155_0|SrvcGrp|73842|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F134260_02155_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
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|SrvcGrp|93433|2022|PDM|4000.00|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F141651_0_0|SrvcGrp|65403|2022|PDM|2200.00|99|0.00|CPT 42830|
20|FH_F148243_0_0|SrvcGrp|98466|2022|PDM|1450.00|99|0.00|PARTIAL REMOVAL OF FOOT BONE|
20|FH_F131000_0_0|SrvcGrp|93059|2022|PDM|4457.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F132328_0_0|SrvcGrp|79594|2022|PDM|1800.00|99|0.00|CPT 45380|
20|FH_F40260_0_0|SrvcGrp|360|2022|PDM|1600.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F87557_33309_0|SrvcGrp|24745|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F96340_23704_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141035_0_0|SrvcGrp|113719|2022|PDM|7396.00|99|0.00|REPAIR MUSCLES OF HAND|
20|FH_F102862_30606_0|SrvcGrp|21071|2022|PDM|40480.00|99|0.00|MS DRG 028 ONLY|
20|FH_F129240_10028_0|SrvcGrp|16750|2022|PDM|110.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129220_18445_0|CSTM-ALL|CSTM-00|2020|PDM|223.00|99|0.00|CONSULTATION WITH FAMILY (AUTISM) HCFA|
20|FH_F101620_47401_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F143542_0_0|SrvcGrp|109769|2022|PDM|2433.00|99|0.00|COVER EYE W/ MEMBRANE SUTURE INCIDENTAL CODES|
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|1218.00|99|0.00|AEG 8 (NO REV)|
20|FH_F142087_0_0|SrvcGrp|108094|2022|PDM|15500.00|99|0.00|REVISE KNEE|
20|FH_F150663_0_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F87474_0_0|SrvcGrp|9829|2022|PDM|50.00|99|0.00|PT 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_F69944_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F35308_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD KM) - BDSS|
20|FH_F132810_0_0|SrvcGrp|112059|2022|PCT|1.29|99|0.00|RENFLEXIS|
20|FH_F117465_0_0|SrvcGrp|64761|2022|PDM|4000.00|99|0.00|DISCECTOMY|
20|FH_F136386_30901_0|SrvcGrp|113008|2022|PDM|1100.00|99|0.00|AETNA PET SCAN W/ER|
20|FH_F118186_97070_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC|
20|FH_F137147_75006_0|SrvcGrp|104363|2022|PCT|0.00|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F114092_83350_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F114264_51449_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F142491_06033_0|SrvcGrp|84185|2022|PDM|160.00|99|0.00|RESPITE CARE|
20|FH_F142307_74066_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F142691_30328_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F142741_03264_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F138627_82901_0|SrvcGrp|98082|2022|PDM|125.00|99|0.00|HIT ANTIBIOTIC Q3H DIEM (HCFA)|
20|FH_F78404_16646_0|SrvcGrp|31074|2022|PDM|1072.00|99|0.00|MS DRG 795 ONLY|
20|FH_F79724_32501_0|SrvcGrp|471|2022|PDM|472.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F119130_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F126853_19053_0|SrvcGrp|88620|2022|PDM|75.00|99|0.00|SKILLED NURSING RN|
20|FH_F38332_0_0|SrvcGrp|18175|2022|PDM|12064.00|99|0.00|MS DRG 257|
20|FH_F129838_17555_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F109886_36303_0|SrvcGrp|46903|2022|PDM|637.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F117270_32073_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F147725_06002_0|SrvcGrp|102479|2022|PDM|4160.00|99|0.00|AETNA CPT 29895|
20|FH_F147879_93309_0|SrvcGrp|48396|2022|PDM|165.00|99|0.00|OT SERVICES|
20|FH_F147932_78613_0|SrvcGrp|74668|2022|PDM|185.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129474_92701_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F129507_70002_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F117126_12801_0|SrvcGrp|131|2022|PCT|0.50|99|0.00|PACEMAKER DEVICE|
20|FH_F39352_0_0|SrvcGrp|9488|2022|PDM|5000.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|1024.00|99|0.00|AEG 7 (NO REV)|
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39101_0_0|CSTM-ALL|CSTM-00|2020|PDM|38800.00|99|0.00|MSDRG 233-234 CORONARY BYPASS|
20|FH_F131236_84041_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F115057_15601_0|SrvcGrp|74668|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F150982_0_0|SrvcGrp|103542|2022|PDM|6056.00|99|0.00|ANKLE ARTHROSCOPY/SURGERY|
20|FH_F37679_0_0|SrvcGrp|27077|2022|PDM|20.00|99|0.00|HOME INFUSION (MOD SJ)|
20|FH_F76171_0_0|SrvcGrp|52803|2022|PDM|172.00|99|0.00|OT SVCS INITIAL EVAL 97003 VISIT LEVEL|
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|ASPG VII|
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|AEG 10 (NO REV)|
20|FH_F100660_56303_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F31798_0_0|SrvcGrp|941|2022|PCT|0.85|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F72051_0_0|SrvcGrp|66480|2022|PDM|75.00|99|0.00|RN VISIT|
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|940.00|99|0.00|AEG 5  (NO REV)|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC|
20|FH_F125048_94583_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F54793_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F132051_74464_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F93538_87124_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147164_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F120306_16424_0|SrvcGrp|46903|2022|PDM|450.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F72765_0_0|SrvcGrp|21975|2022|PDM|1575.00|99|0.00|INPATIENT SERVICES|
20|FH_F124048_47304_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124048_47304_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F88114_32205_0|SrvcGrp|86872|2022|PCT|1.05|99|0.00|PHYSICIAN E&M CODES|
20|FH_F116747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145588_75081_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD NU/KC) - CPD 1963706|
20|FH_F130747_0_0|SrvcGrp|82109|2022|PDM|2809.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F56678_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34550_0_0|SrvcGrp|3409|2022|PDM|386.00|99|0.00|NEWBORN NURSERY|
20|FH_F131228_01826_0|SrvcGrp|39870|2022|PDM|31766.80|99|0.00|MS DRG 619-621 ONLY|
20|FH_F97540_32114_0|SrvcGrp|73485|2022|PDM|2965.00|99|0.00|AETNA REHAB|
20|FH_F137067_0_0|SrvcGrp|98498|2022|PDM|5250.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC|
20|FH_F136510_0_0|SrvcGrp|112181|2022|PDM|2142.00|99|0.00|DRAINAGE OF EYE|
20|FH_F39479_0_0|SrvcGrp|30553|2022|PDM|85.00|99|0.00|EARLY INTERVENTION SPEECH THERAPY|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1005.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 3 W/O REV|
20|FH_F38411_0_0|SrvcGrp|19468|2022|PCT|0.80|99|0.00|MS DRG 581|
20|FH_F130678_50220_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130711_06716_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F85353_16407_0|SrvcGrp|63757|2022|PDM|2234.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1401|
20|FH_F133585_0_0|SrvcGrp|109468|2022|PDM|342.00|99|0.00|INS CATH ABD/L-EXT ART 2ND|
20|FH_F130123_24171_0|SrvcGrp|29347|2022|PDM|23.00|99|0.00|HOME HEALTH AIDE|
20|FH_F92598_21236_0|SrvcGrp|73701|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F133207_0_0|SrvcGrp|84180|2022|PDM|3809.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS|
20|FH_F110420_60649_0|SrvcGrp|79099|2022|PDM|1558.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F145791_67205_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F31714_0_0|SrvcGrp|11207|2022|PDM|12000.00|99|0.00|DRG 545 REVISION OF HIP OR KNEE REPLACEMENT|
20|FH_F145880_80303_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F100782_0_0|SrvcGrp|97575|2022|PDM|958.97|99|0.00|WINDBER MEDICAL CNTR ASC 202|
20|FH_F143567_62207_0|SrvcGrp|43569|2022|PDM|116.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F131630_0_0|SrvcGrp|88596|2022|PDM|2549.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE|
20|FH_F145604_14850_0|SrvcGrp|86825|2022|PDM|80.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F96160_32207_0|SrvcGrp|22592|2022|PDM|68.65|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F73864_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|1328.00|99|0.00|AEG 9 (NO REV)|
20|FH_F77943_0_0|SrvcGrp|62331|2022|PDM|39769.80|99|0.00|RADIOSURGERY|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|323.98|99|0.00|HAPA WPA-NWPA 2012-13 ASC 233 W/O REV|
20|FH_F114851_15301_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F85213_02840_0|SrvcGrp|105809|2022|PCT|1.03|99|0.00|PT OT ST|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|ACUTE PSYCH|
20|FH_F109264_33431_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139873_0_0|SrvcGrp|26278|2022|PDM|2215.00|99|0.00|CPT 29881|
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2133.00|99|0.00|AEG 4 (NO REV)|
20|FH_F147962_85008_0|SrvcGrp|113608|2022|PCT|1.20|99|0.00|LABORATORY SERVICES|
20|FH_F123851_03235_0|SrvcGrp|73742|2022|PDM|8.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F123157_0_0|SrvcGrp|75489|2022|PDM|794.00|99|0.00|AEG 6|
20|FH_F85652_98034_0|SrvcGrp|73480|2022|PDM|7933.00|99|0.00|VAGINAL COMPLEX DELIVERY MSDRG 774-775 ONLY|
20|FH_F150219_38578_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F114444_19602_0|SrvcGrp|91394|2022|PDM|85.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD HO)|
20|FH_F110509_71351_0|SrvcGrp|72998|2022|PDM|3500.00|99|0.00|AEG 5|
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG V|
20|FH_F123623_03246_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F120484_31419_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F149048_77090_0|SrvcGrp|90388|2022|PDM|960.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F95623_84015_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F120720_24541_0|SrvcGrp|53987|2022|PDM|25.00|99|0.00|PHOTOTHERAPY|
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_F123646_91350_0|SrvcGrp|105350|2022|PDM|495.00|99|0.00|AETNA PARTIAL HOSPITALIZATION|
20|FH_F88744_71103_0|CSTM-ALL|CSTM-00|2020|PDM|1513.00|99|0.00|AEG 3 (NO REV)|
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|391.00|99|0.00|AEG 1 (NO REV)|
20|FH_F38069_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|GENERAL ACUTE CARE|
20|FH_F142894_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F85118_40403_0|SrvcGrp|83519|2022|PDM|105.00|99|0.00|HOSPICE CARE (ALL OTHER)|
20|FH_F143560_03079_0|SrvcGrp|115128|2022|PDM|323.07|99|0.00|CT W/O CONTRAST|
20|FH_F120603_66112_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F127071_82435_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F149079_70809_0|SrvcGrp|73659|2022|PDM|1471.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F141167_0_0|SrvcGrp|108042|2022|PDM|500.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F77943_0_0|SrvcGrp|11000|2022|PCT|0.55|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F52713_0_0|SrvcGrp|20252|2022|PDM|73969.00|99|0.00|MS DRG 224-225 ONLY|
20|FH_F135451_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.20|99|0.00|GENERAL ACUTE CARE|
20|FH_F121628_19533_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134928_0_0|SrvcGrp|73601|2022|PDM|2300.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F81861_0_0|SrvcGrp|64108|2022|PDM|1100.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 11|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|518.70|99|0.00|CPT 95810 (W/MOD TC)|
20|FH_F48092_0_0|SrvcGrp|14997|2022|PDM|4000.00|99|0.00|DRUGS|
20|FH_F100782_0_0|SrvcGrp|105170|2022|PDM|2441.55|99|0.00|WINDBER MEDICAL CNTR ASC 910|
20|FH_F109273_77339_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F85133_85251_0|SrvcGrp|83520|2022|PCT|0.00|99|0.00|HOME VISIT PRENATAL/POSTNATAL & NEWBORN CARE|
20|FH_F119379_0_0|SrvcGrp|33986|2022|PDM|672.00|99|0.00|CPT 26055|
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.01|99|0.00|AEG 5  (NO REV)|
20|FH_F88744_71103_0|SrvcGrp|11152|2022|PCT|0.75|99|0.00|TRAUMA|
20|FH_F145641_06902_0|SrvcGrp|100010|2022|PDM|4664.00|99|0.00|KNEE RECONSTRUCTION|
20|FH_F145702_22192_0|SrvcGrp|46605|2022|PDM|84.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F37910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F85353_16407_0|SrvcGrp|63795|2022|PDM|989.54|99|0.00|HAPA WPA-NWPA 2012-13 ASC 503|
20|FH_F116849_0_0|SrvcGrp|13928|2022|PDM|300.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F130017_02302_0|SrvcGrp|73498|2022|PDM|1190.76|99|0.00|AETNA ER LEVEL III|
20|FH_F132863_65240_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD RR KC"|
20|FH_F132606_0_0|SrvcGrp|74039|2022|PDM|2809.00|99|0.00|LAMINECTOMY|
20|FH_F88698_18951_0|SrvcGrp|89149|2022|PDM|152.00|99|0.00|OP INTENSIVE|
20|FH_F136353_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F54592_0_0|SrvcGrp|47662|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY|
20|FH_F69606_0_0|SrvcGrp|64101|2022|PDM|1222.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 8|
20|FH_F128955_70071_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F85393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F98780_35022_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F115877_63556_0|SrvcGrp|73806|2022|PDM|2800.00|99|0.00|AETNA ER|
20|FH_F115909_38133_0|SrvcGrp|94880|2022|PDM|143.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F80513_0_0|SrvcGrp|31017|2022|PDM|18603.00|99|0.00|MS DRG 468 ONLY|
20|FH_F146881_83661_0|SrvcGrp|80918|2022|PDM|140.00|99|0.00|RESPITE CARE|
20|FH_F120528_60559_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F120795_27514_0|SrvcGrp|115534|2022|PCT|3.04|99|0.00|LABORATORY SERVICES|
20|FH_F139289_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 6 (NO REV)|
20|FH_F39895_0_0|SrvcGrp|16|2022|PDM|811.00|99|0.00|ACUTE REHABILITATION|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|170.84|99|0.00|DELAWARE VALLEY- ASC 113|
20|FH_F113741_63303_0|SrvcGrp|88621|2022|PDM|66.30|99|0.00|SKILLED NURSING LPN|
20|FH_F109462_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77923_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F72939_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F77067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F87054_0_0|SrvcGrp|11663|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F103780_64804_0|SrvcGrp|113925|2022|PCT|0.68|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F103961_63017_0|SrvcGrp|80317|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F42512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43860_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F135491_0_0|SrvcGrp|112755|2022|PDM|1980.00|99|0.00|CORNEAL TRANSPLANT ENDOTHELIAL|
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|1146.00|99|0.00|AETNA AEG 8 WITHOUT 66982-66984|
20|FH_F138929_0_0|SrvcGrp|80617|2022|PDM|14750.00|99|0.00|ARTHOPLASTY|
20|FH_F133002_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|880.00|99|0.00|AEG 10 (NO REV)|
20|FH_F141047_23661_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
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_F71065_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS|
20|FH_F77944_0_0|SrvcGrp|31020|2022|PDM|42203.00|99|0.00|MS DRG 470 ONLY|
20|FH_F132348_16214_0|SrvcGrp|89783|2022|PDM|95.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F132348_16214_0|SrvcGrp|43569|2022|PDM|110.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F146674_70778_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F36318_0_0|SrvcGrp|22799|2022|PCT|0.85|99|0.00|PTCA ANGIOPLASTY|
20|FH_F41885_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY|
20|FH_F109652_0_0|SrvcGrp|78784|2022|PDM|12204.00|99|0.00|PTCA|
20|FH_F109652_0_0|SrvcGrp|78840|2022|PDM|5892.00|99|0.00|STEREOTACTIC BODY RADIATION THERAPY|
20|FH_F110342_0_0|SrvcGrp|72996|2022|PDM|1500.00|99|0.00|AEG 4|
20|FH_F90880_15108_0|SrvcGrp|85963|2022|PCT|1.00|99|0.00|SELF CARE MANGEMENT TRAINING|
20|FH_F90880_15108_0|SrvcGrp|89500|2022|PCT|1.00|99|0.00|SPEECH SOUND LANGUAGE|
20|FH_F124801_67110_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129892_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES|
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|CSTM-ALL|CSTM-00|2020|PDM|682.00|99|0.00|AEG 10 (NO REV)|
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|1614.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F130656_04401_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F130841_49315_0|SrvcGrp|97507|2022|PDM|130.00|99|0.00|AETNA HOSPICE|
20|FH_F119706_63021_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133928_19713_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130017_02302_0|SrvcGrp|114014|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.29|99|0.00|ASPG III|
20|FH_F145604_14850_0|SrvcGrp|73701|2022|PDM|24.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F84552_0_0|SrvcGrp|75545|2022|PDM|347.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F83995_16748_0|SrvcGrp|18024|2022|PDM|65.00|99|0.00|NUTRITNAL CNSLNG/DIABETES EDU|
20|FH_F120555_68405_0|SrvcGrp|76501|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F145930_45236_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146207_73139_0|SrvcGrp|104230|2022|PDM|134.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F109577_0_0|SrvcGrp|53145|2022|PDM|133.00|99|0.00|SOCIAL WORKER|
20|FH_F127071_82435_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F100680_43130_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F141347_52807_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149150_75407_0|SrvcGrp|46903|2022|PDM|750.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F134667_19110_0|SrvcGrp|89417|2022|PDM|430.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F138302_15701_0|SrvcGrp|88620|2022|PDM|65.00|99|0.00|SKILLED NURSING RN|
20|FH_F143628_32810_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1261.54|99|0.00|HAPA WPA-NWPA 2012-13 ASC 6 W/O REV|
20|FH_F126003_79403_0|SrvcGrp|108484|2022|PDM|696.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F143739_33440_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142376_0_0|SrvcGrp|113967|2022|PDM|5666.00|99|0.00|PERQ LAMOT/LAM LUMBAR|
20|FH_F134608_18017_0|SrvcGrp|24541|2022|PDM|110.00|99|0.00|CPT 56605|
20|FH_F124173_66215_0|SrvcGrp|17013|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36552_0_0|SrvcGrp|18107|2022|PDM|20890.00|99|0.00|MS DRG 236|
20|FH_F126341_27284_0|SrvcGrp|16750|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F149345_45044_0|SrvcGrp|87537|2022|PDM|1100.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F112060_07514_0|SrvcGrp|42622|2022|PCT|0.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F146207_73139_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134611_04103_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F42446_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F136359_0_0|SrvcGrp|112859|2022|PDM|15250.00|99|0.00|TOTAL SHOULDER HIP AND KNEES|
20|FH_F128828_44122_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F138507_62208_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130763_0_0|SrvcGrp|65403|2022|PDM|3882.00|99|0.00|CPT 42830|
20|FH_F120670_0_0|SrvcGrp|11663|2022|PCT|0.69|99|0.00|IMPLANTS|
20|FH_F49552_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ST CHARLES PARISH NON-TIME ANES CODES|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|ASPG III- MOD 50|
20|FH_F120555_68405_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F150311_18106_0|SrvcGrp|87077|2022|PDM|153.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F134608_18017_0|SrvcGrp|112607|2022|PDM|160.00|99|0.00|ANESTHESIA FOR INDUCED ABORT|
20|FH_F49552_0_0|SrvcGrp|17065|2022|PDM|449.82|99|0.00|ASPG I|
20|FH_F124173_66215_0|SrvcGrp|22593|2022|PDM|25.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133887_17013_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F143573_01610_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135670_01749_0|SrvcGrp|86838|2022|PDM|12.50|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F120719_27540_0|SrvcGrp|31655|2022|PCT|0.76|99|0.00|TRACHEOSTOMY (MS DRG)|
20|FH_F150239_75569_0|SrvcGrp|26868|2022|PCT|1.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F126225_23413_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120735_40012_0|SrvcGrp|108484|2022|PDM|496.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F130017_02302_0|SrvcGrp|12659|2022|PDM|832.91|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F98021_07012_0|SrvcGrp|73605|2022|PDM|3070.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F112082_30720_0|SrvcGrp|17016|2022|PDM|94.42|99|0.00|HOME INFUSION THERAPY|
20|FH_F133774_06062_0|SrvcGrp|75545|2022|PDM|495.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F36753_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD 53|
20|FH_F42467_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY|
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)|
20|FH_F110344_37421_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150165_06032_0|SrvcGrp|99073|2022|PCT|1.25|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F134172_33126_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132864_71101_0|CSTM-ALL|CSTM-00|2020|PDM|1443.00|99|0.00|AEG 2 (NO REV)|
20|FH_F124613_64735_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|PDM|3700.00|99|0.00|AEG 5  (NO REV)|
20|FH_F133694_89117_0|SrvcGrp|115508|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F100787_69162_0|SrvcGrp|73559|2022|PDM|6799.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F136708_06443_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F136734_46410_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F114638_25309_0|SrvcGrp|16069|2022|PDM|221.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F114645_34952_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114645_34952_0|SrvcGrp|89417|2022|PDM|390.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F114666_30342_0|SrvcGrp|84307|2022|PDM|2140.00|99|0.00|TENDON REPAIR|
20|FH_F138527_64506_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F139655_17078_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138310_60461_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F122608_84123_0|SrvcGrp|88620|2022|PDM|103.00|99|0.00|SKILLED NURSING RN|
20|FH_F43653_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|ACUTE PSYCH|
20|FH_F117085_40207_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F136828_32405_0|SrvcGrp|89417|2022|PDM|403.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F112411_28207_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F45573_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F115567_91711_0|SrvcGrp|86747|2022|PCT|1.25|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F147519_52627_0|CSTM-ALL|CSTM-00|2020|PDM|5266.16|99|0.00|AEG 7 (NO REV)|
20|FH_F147539_68359_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F147599_76240_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F51197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PDM|42.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 10 W/O REV|
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PDM|1573.00|99|0.00|AEG 3 (NO REV)|
20|FH_F35381_0_0|SrvcGrp|14179|2022|PCT|1.00|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F35404_0_0|SrvcGrp|6|2022|PCT|0.55|99|0.00|OP SURGERY|
20|FH_F82357_0_0|SrvcGrp|12403|2022|PDM|770.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F41013_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F138684_44484_0|SrvcGrp|58509|2022|PDM|400.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F138876_25302_0|SrvcGrp|86849|2022|PDM|40.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F86294_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|PDM|2016.30|99|0.00|AEG 8 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|152.94|99|0.00|HAPA WPA-NWPA 2012-13 ASC 134 W/O REV|
20|FH_F151427_04106_0|SrvcGrp|104484|2022|PDM|81.65|99|0.00|THER/PROPH/DIAG IV INF ADDON|
20|FH_F122103_62548_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F144928_02703_0|SrvcGrp|108484|2022|PDM|473.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F135447_53226_0|SrvcGrp|78420|2022|PDM|1750.00|99|0.00|INTERIM LABOR|
20|FH_F135583_17331_0|SrvcGrp|29817|2022|PDM|8884.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F91735_92653_0|SrvcGrp|29347|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F135972_18509_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136041_87107_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F100765_73735_0|SrvcGrp|73559|2022|PDM|6869.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F100880_67735_0|SrvcGrp|88794|2022|PDM|83588.00|99|0.00|AICD|
20|FH_F131228_01826_0|SrvcGrp|74441|2022|PDM|671.95|99|0.00|CARDIAC TESTING|
20|FH_F130756_04901_0|SrvcGrp|81779|2022|PCT|4.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F116463_76501_0|SrvcGrp|89149|2022|PDM|192.00|99|0.00|OP INTENSIVE|
20|FH_F116464_13088_0|SrvcGrp|89149|2022|PDM|135.00|99|0.00|OP INTENSIVE|
20|FH_F140629_0_0|SrvcGrp|82720|2022|PDM|2497.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F121464_15701_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121740_98119_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F121824_92675_0|SrvcGrp|89337|2022|PDM|970.00|99|0.00|DETOXIFICATION|
20|FH_F42098_0_0|SrvcGrp|27768|2022|PDM|40.00|99|0.00|SKILLED LPN VISIT|
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_F111292_33136_0|SrvcGrp|105465|2022|PDM|152.00|99|0.00|AETNA THERAPIES|
20|FH_F111301_33122_0|SrvcGrp|82760|2022|PDM|78.00|99|0.00|ASSAY OF SERUM AMYLASE|
20|FH_F111301_33122_0|SrvcGrp|81402|2022|PDM|105.00|99|0.00|METABOLIC PANEL|
20|FH_F111880_50003_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F111880_50003_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F33390_0_0|SrvcGrp|9774|2022|PDM|1798.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F132915_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F112146_87102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112187_98272_0|CSTM-ALL|CSTM-00|2020|PDM|11579.00|99|0.00|AEG 6 (NO REV)|
20|FH_F98626_29118_0|SrvcGrp|73656|2022|PDM|316.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F102325_62691_0|SrvcGrp|22593|2022|PDM|65.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F98300_30236_0|SrvcGrp|75442|2022|PDM|1094.00|99|0.00|OBSERVATION - REV 762|
20|FH_F38831_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GOOD SHEPHERD LABS|
20|FH_F38980_0_0|SrvcGrp|9541|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F42177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F102947_44084_0|SrvcGrp|89149|2022|PDM|168.00|99|0.00|OP INTENSIVE|
20|FH_F40634_0_0|SrvcGrp|38|2022|PDM|2122.00|99|0.00|NORMAL DELIVERY|
20|FH_F48132_33308_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F92516_0_0|SrvcGrp|89978|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F102844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125133_20601_0|SrvcGrp|46605|2022|PDM|186.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F120555_68405_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124146_46321_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138050_52301_0|SrvcGrp|78377|2022|PDM|918.00|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F110506_98901_0|SrvcGrp|73842|2022|PDM|186.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F127071_82435_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F39776_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134495_84321_0|SrvcGrp|88621|2022|PDM|60.75|99|0.00|SKILLED NURSING LPN|
20|FH_F85911_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.50|99|0.00|ACUTE REHAB II|
20|FH_F84712_0_0|SrvcGrp|73605|2022|PDM|695.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F84712_0_0|SrvcGrp|79300|2022|PDM|59.00|99|0.00|AETNA SCREENING MAMMOGRAPHY|
20|FH_F71829_0_0|SrvcGrp|26001|2022|PDM|160.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F98800_85021_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F102200_06416_0|SrvcGrp|86829|2022|PDM|50.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F66782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F115979_46107_0|SrvcGrp|73700|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F131904_18915_0|SrvcGrp|43567|2022|PDM|112.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F132213_17543_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F133478_40165_0|SrvcGrp|105601|2022|PCT|0.00|99|0.00|IP IMAGING ENHANCING SUBSTANCE|
20|FH_F132008_85226_0|SrvcGrp|111914|2022|PCT|0.80|99|0.00|22NF SEALED LEADACID BATTERY|
20|FH_F146859_0_0|SrvcGrp|108298|2022|PDM|1443.00|99|0.00|AETNA REPAIR CLAVICLE DISLOCATION|
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|957.00|99|0.00|AEG 8 (NO REV)|
20|FH_F151699_01752_0|SrvcGrp|27615|2022|PDM|65.82|99|0.00|AETNA DRUGS|
20|FH_F41802_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|ALTERNACARE INF THERAPY-  MOD SH|
20|FH_F99380_90503_0|SrvcGrp|62017|2022|PCT|0.85|99|0.00|RADIOLOGY SERVICES|
20|FH_F136806_0_0|SrvcGrp|14614|2022|PDM|3787.00|99|0.00|LITHOTRIPSY|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PDM|3087.00|99|0.00|ASPG VIII|
20|FH_F141267_0_0|SrvcGrp|80918|2022|PDM|939.00|99|0.00|RESPITE CARE|
20|FH_F110193_70444_0|SrvcGrp|89337|2022|PDM|898.00|99|0.00|DETOXIFICATION|
20|FH_F122392_78207_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F97640_37043_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|AEG 8 (NO REV)|
20|FH_F122271_79416_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131261_19111_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F64879_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN|
20|FH_F147237_40006_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F31087_0_0|SrvcGrp|10519|2022|PDM|140.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F86714_0_0|SrvcGrp|87246|2022|PCT|0.00|99|0.00|HOME CALL DENIAL SERVICES|
20|FH_F117762_0_0|SrvcGrp|97741|2022|PDM|14560.00|99|0.00|REVISE KNEE|
20|FH_F42979_0_0|SrvcGrp|3390|2022|PDM|132.00|99|0.00|CPT 90801|
20|FH_F69249_0_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F39889_0_0|CSTM-ALL|CSTM-00|2020|PDM|998.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136592_0_0|SrvcGrp|107792|2022|PDM|5870.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F92413_07631_0|SrvcGrp|48398|2022|PDM|112.00|99|0.00|PT SERVICES|
20|FH_F90182_80443_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131383_85006_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F147224_48026_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146266_0_0|SrvcGrp|93057|2022|PDM|5527.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F124381_27610_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F137986_0_0|SrvcGrp|95819|2022|PDM|2050.00|99|0.00|GONIOTOMY|
20|FH_F35174_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER NUKF|
20|FH_F39443_0_0|SrvcGrp|30299|2022|PDM|248.00|99|0.00|HAPA WPA ASC 111|
20|FH_F109843_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F141278_80218_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|J-CODE AND IMMUNIZATIONS|
20|FH_F109762_0_0|SrvcGrp|72994|2022|PDM|510.00|99|0.00|AEG 3|
20|FH_F114825_32789_0|SrvcGrp|58509|2022|PDM|296.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F120154_77498_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F36715_0_0|SrvcGrp|115|2022|PDM|646.00|99|0.00|SKILLED NURSING CARE|
20|FH_F112045_90301_0|SrvcGrp|31931|2022|PDM|1708.00|99|0.00|SKILLED NURSING CARE|
20|FH_F99920_63141_0|SrvcGrp|63297|2022|PDM|110.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F122390_29550_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|649.00|99|0.00|AEG 2 (NO REV)|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F37304_0_0|SrvcGrp|10508|2022|PDM|150.00|99|0.00|CPT CODE 90935|
20|FH_F124322_64131_0|SrvcGrp|73700|2022|PDM|42.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F49300_0_0|SrvcGrp|36066|2022|PDM|26.00|99|0.00|NURSING CARE|
20|FH_F114294_18235_0|CSTM-ALL|CSTM-00|2020|PCT|1.59|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F122392_78207_0|SrvcGrp|89337|2022|PDM|828.00|99|0.00|DETOXIFICATION|
20|FH_F114585_11501_0|SrvcGrp|58509|2022|PDM|400.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F116332_0_0|SrvcGrp|106680|2022|PDM|8689.00|99|0.00|REVISION OF ANKLE JOINT|
20|FH_F138987_0_0|SrvcGrp|83522|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F146266_0_0|SrvcGrp|88163|2022|PDM|20512.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F75944_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F132254_40207_0|SrvcGrp|86834|2022|PDM|15.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F132235_0_0|SrvcGrp|30609|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F113869_40215_0|SrvcGrp|86723|2022|PDM|355.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|1281.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F88639_80204_0|SrvcGrp|114020|2022|PCT|1.82|99|0.00|LABORATORY SERVICES|
20|FH_F34040_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS|
20|FH_F149179_0_0|SrvcGrp|115610|2022|PDM|4578.00|99|0.00|VENTRAL HERN INIT REPAIR|
20|FH_F46832_0_0|SrvcGrp|19742|2022|PDM|125.00|99|0.00|MID-LINE INSERTION|
20|FH_F46832_0_0|SrvcGrp|24934|2022|PDM|75.00|99|0.00|NUTRITIONAL ASSESSMENT (INITIAL)|
20|FH_F117465_0_0|SrvcGrp|75497|2022|PDM|550.00|99|0.00|AEG 10|
20|FH_F117465_0_0|SrvcGrp|107387|2022|PDM|3000.00|99|0.00|AETNA UNLISTED PROC SPINE|
20|FH_F136542_02446_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F120456_67117_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F93180_73772_0|SrvcGrp|79699|2022|PCT|0.83|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F93180_73772_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F137147_75006_0|SrvcGrp|27347|2022|PDM|14280.00|99|0.00|CPT 58558|
20|FH_F137147_75006_0|SrvcGrp|82110|2022|PDM|5828.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC|
20|FH_F142530_60148_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F53732_0_0|SrvcGrp|12403|2022|PDM|640.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F62683_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F138584_30912_0|SrvcGrp|113418|2022|PDM|440.00|99|0.00|REMOVAL OF FACE BONE LESION|
20|FH_F140572_46526_0|CSTM-ALL|CSTM-00|2020|PCT|0.81|99|0.00|OP SVCS|
20|FH_F140652_92626_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F80284_16354_0|SrvcGrp|111930|2022|PDM|35.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DEVICE INSERTION|
20|FH_F120152_0_0|SrvcGrp|41334|2022|PDM|24750.00|99|0.00|TOTAL KNEE|
20|FH_F149586_77535_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118943_64506_0|SrvcGrp|29076|2022|PDM|25.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F147801_90703_0|SrvcGrp|111120|2022|PDM|427.00|99|0.00|PARTIAL HOSP (18-64 YRS)|
20|FH_F129427_92262_0|SrvcGrp|75419|2022|PDM|550.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F117098_20186_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117153_34113_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F109907_0_0|SrvcGrp|46605|2022|PDM|92.60|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F91472_96001_0|SrvcGrp|16|2022|PDM|5614.00|99|0.00|ACUTE REHABILITATION|
20|FH_F110160_0_0|SrvcGrp|72998|2022|PDM|960.00|99|0.00|AEG 5|
20|FH_F77462_0_0|SrvcGrp|42973|2022|PDM|110.00|99|0.00|SPEECH  THERAPIST|
20|FH_F148432_01585_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F148432_01585_0|SrvcGrp|115386|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F148544_60439_0|SrvcGrp|108484|2022|PDM|1020.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F56793_0_0|SrvcGrp|15402|2022|PDM|40.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|72.00|99|0.00|FAMILY PSYTX W PT 50 MINS|
20|FH_F43953_0_0|SrvcGrp|9889|2022|PDM|782.00|99|0.00|NICU LEVEL I & II|
20|FH_F55375_0_0|SrvcGrp|10903|2022|PDM|950.00|99|0.00|EMERGENCY ROOM LEVEL I|
20|FH_F114974_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F87334_16507_0|SrvcGrp|79720|2022|PDM|1231.00|99|0.00|ACUTE REHAB II|
20|FH_F32927_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F133467_03301_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F133021_00910_0|SrvcGrp|16426|2022|PDM|100.00|99|0.00|ER PHYSICIAN SVCS|
20|FH_F50440_0_0|SrvcGrp|43785|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F44312_0_0|SrvcGrp|109|2022|PDM|550.00|99|0.00|CD - DETOX|
20|FH_F111415_33180_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134434_30607_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F119400_0_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F79902_0_0|SrvcGrp|73202|2022|PCT|1.00|99|0.00|NORTH PHIL RADIOLOGY OCN F/S PRICING|
20|FH_F149781_37404_0|SrvcGrp|88162|2022|PDM|4600.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F150559_60018_0|SrvcGrp|46605|2022|PDM|155.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F132785_17961_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F148881_33018_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_F149781_37404_0|SrvcGrp|89860|2022|PDM|4000.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F92676_15063_0|CSTM-ALL|CSTM-00|2020|PCT|2.43|99|0.00|MON VALLEY RAD 2013|
20|FH_F97581_60141_0|SrvcGrp|73659|2022|PDM|9063.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F148556_13206_0|SrvcGrp|29076|2022|PDM|35.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F67285_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102561_75146_0|SrvcGrp|131|2022|PCT|1.15|99|0.00|PACEMAKER DEVICE|
20|FH_F82973_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F151519_35758_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126867_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS APC GROUPED|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|654.67|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1202 W/O REV|
20|FH_F51129_0_0|SrvcGrp|38704|2022|PCT|0.85|99|0.00|PTE EVALUATION|
20|FH_F150000_30152_0|SrvcGrp|115724|2022|PCT|1.00|99|0.00|COVID VACCINE ADMINISTRATION|
20|FH_F147996_21014_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F120763_60957_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F111546_84010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD 26|
20|FH_F150949_0_0|SrvcGrp|93063|2022|PDM|10500.00|99|0.00|LUMBAR ARTIF DISKECTOMY|
20|FH_F144011_60616_0|SrvcGrp|105465|2022|PDM|193.00|99|0.00|AETNA THERAPIES|
20|FH_F38700_0_0|SrvcGrp|18811|2022|PCT|0.80|99|0.00|MS DRG 220|
20|FH_F110841_53012_0|SrvcGrp|34168|2022|PCT|0.85|99|0.00|BURN SERVICES MS DRG|
20|FH_F122649_0_0|SrvcGrp|80920|2022|PDM|112.00|99|0.00|HOSPICE SERVICES|
20|FH_F34918_0_0|SrvcGrp|65|2022|PDM|2188.00|99|0.00|OBSTETRICAL CARE|
20|FH_F52092_0_0|SrvcGrp|9832|2022|PDM|58.00|99|0.00|ST SVCS|
20|FH_F150982_0_0|SrvcGrp|90369|2022|PDM|1382.00|99|0.00|PROBE NASOLACRIMAL DUCT|
20|FH_F150952_85008_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F148961_33403_0|SrvcGrp|74668|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137788_72632_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F97101_98003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F97280_20018_0|SrvcGrp|73559|2022|PDM|8841.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F140295_0_0|SrvcGrp|89980|2022|PDM|4982.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F127258_79912_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F97623_38008_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F150912_19344_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F31087_0_0|SrvcGrp|10931|2022|PCT|0.97|99|0.00|DME/ORTHOTICS/PROSTHETICS|
20|FH_F35730_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145543_0_0|SrvcGrp|104721|2022|PDM|770.00|99|0.00|REVISE EYELID W/ EXCESS SKIN|
20|FH_F74845_0_0|SrvcGrp|13294|2022|PDM|473.00|99|0.00|MRI|
20|FH_F147140_89103_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F97084_91911_0|SrvcGrp|73605|2022|PDM|3665.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F140097_19145_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F143529_84737_0|SrvcGrp|89781|2022|PDM|93.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F143529_84737_0|SrvcGrp|48385|2022|PDM|84.50|99|0.00|SPEECH THERAPY|
20|FH_F143533_30013_0|SrvcGrp|88785|2022|PDM|59.00|99|0.00|AETNA TOMOSYNTHESIS|
20|FH_F32523_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 1 (NO REV)|
20|FH_F131107_43140_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F131173_17043_0|SrvcGrp|90707|2022|PDM|130.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|ASPG II|
20|FH_F120205_53545_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132491_34287_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112679_85711_0|SrvcGrp|48398|2022|PDM|117.00|99|0.00|PT SERVICES|
20|FH_F112687_30474_0|SrvcGrp|73700|2022|PDM|81.40|99|0.00|AETNA - SKILLED NURSING|
20|FH_F116698_07470_0|SrvcGrp|19742|2022|PDM|78.75|99|0.00|MID-LINE INSERTION|
20|FH_F116915_30308_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F125287_92374_0|SrvcGrp|74668|2022|PDM|280.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F113595_29527_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F118882_30012_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F130152_48025_0|SrvcGrp|103608|2022|PCT|1.00|99|0.00|SKILLED NURSING|
20|FH_F36372_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BROOKVIEW NURSING RADIOLOGY CPT|
20|FH_F39272_0_0|SrvcGrp|16746|2022|PDM|65.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F39996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F40855_0_0|SrvcGrp|13551|2022|PDM|322.00|99|0.00|NEWBORN NURSERY|
20|FH_F33381_0_0|SrvcGrp|18145|2022|PDM|17909.00|99|0.00|MS DRG 248|
20|FH_F36704_0_0|SrvcGrp|3275|2022|PDM|1775.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|655.00|99|0.00|AEG 4 (NO REV)|
20|FH_F48132_33308_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1.06|99|0.00|AEG 9 (NO REV)|
20|FH_F46732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F70493_0_0|SrvcGrp|17753|2022|PDM|157.00|99|0.00|NEGATIVE  PRESSURE WOUND THERAPY ELEC PUMP|
20|FH_F46258_0_0|CSTM-ALL|CSTM-00|2020|PDM|78.20|99|0.00|CPAP (MOD RR) - HCFA|
20|FH_F46258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|INJECTIONS/DRUGS -  AWP W/ MOD SS|
20|FH_F61292_0_0|SrvcGrp|360|2022|PDM|1540.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F113410_0_0|SrvcGrp|84972|2022|PDM|709.00|99|0.00|CPT 43247|
20|FH_F115103_31405_0|SrvcGrp|42782|2022|PDM|129.80|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F36366_0_0|CSTM-ALL|CSTM-00|2020|PDM|798.00|99|0.00|CPT 95810 (W/MOD TC)|
20|FH_F35202_0_0|SrvcGrp|10410|2022|PDM|42.00|99|0.00|SKILLED NURSING CARE|
20|FH_F88254_33411_0|SrvcGrp|26869|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F143928_21061_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F135264_40272_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F62892_0_0|SrvcGrp|10534|2022|PDM|90.00|99|0.00|NURSING CARE|
20|FH_F97540_32114_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|2112.00|99|0.00|LAP AND ARTH CARVE OUTS|
20|FH_F52854_0_0|CSTM-ALL|CSTM-00|2020|PDM|61.00|99|0.00|HOME HEALTH AIDE|
20|FH_F98920_46526_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148320_02130_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F50218_0_0|SrvcGrp|28992|2022|PDM|120.00|99|0.00|RN HI-TECH VISIT|
20|FH_F148265_06067_0|SrvcGrp|99169|2022|PDM|5137.00|99|0.00|CPT 28200|
20|FH_F38798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|KIDS HOME INFUSION THERAPY MOD SJ|
20|FH_F135299_61021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125028_19061_0|SrvcGrp|43568|2022|PDM|78.75|99|0.00|SKILLED NURSING - RN|
20|FH_F93920_0_0|SrvcGrp|74403|2022|PCT|0.80|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F109645_0_0|SrvcGrp|46118|2022|PDM|65.00|99|0.00|NUTRITNAL CNSLNG/DIABETES EDU|
20|FH_F128125_68601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113410_0_0|SrvcGrp|63471|2022|PDM|3677.00|99|0.00|CPT 64590|
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|2019.49|99|0.00|AEG 6 (NO REV)|
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_F124903_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F72973_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS|
20|FH_F143809_62401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 8 (NO REV)|
20|FH_F140427_0_0|SrvcGrp|108518|2022|PDM|900.00|99|0.00|IMPLANT PAT ACTIVE HT RECORD|
20|FH_F87254_0_0|SrvcGrp|104615|2022|PDM|1000.00|99|0.00|EXC RECT TUM TRANSANAL PART|
20|FH_F141169_0_0|SrvcGrp|113727|2022|PDM|72.00|99|0.00|ULTRASOUND|
20|FH_F87254_0_0|SrvcGrp|63462|2022|PDM|1000.00|99|0.00|CPT 64595|
20|FH_F42999_0_0|SrvcGrp|36669|2022|PCT|1.00|99|0.00|IMMUNIZATION ADMIN|
20|FH_F33712_0_0|SrvcGrp|15351|2022|PDM|6500.00|99|0.00|PTCA ANGIOPLASTY|
20|FH_F63514_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135207_76053_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129603_34769_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F126678_44870_0|SrvcGrp|63297|2022|PDM|130.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F75382_0_0|SrvcGrp|29817|2022|PDM|3681.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F31056_0_0|SrvcGrp|3271|2022|PDM|3195.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F129656_15005_0|SrvcGrp|43568|2022|PDM|60.00|99|0.00|SKILLED NURSING - RN|
20|FH_F38034_0_0|SrvcGrp|26793|2022|PDM|852.00|99|0.00|NEWBORN NURSERY|
20|FH_F104520_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87031_0_0|SrvcGrp|73008|2022|PDM|983.00|99|0.00|AEG 10|
20|FH_F137387_32605_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F98801_93274_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|2744.00|99|0.00|AEG 8 (NO REV)|
20|FH_F114976_78539_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F110263_0_0|SrvcGrp|115585|2022|PDM|20785.00|99|0.00|NEUROSTIMU INSERTION/REPLACE (HCFA)|
20|FH_F141001_24739_0|SrvcGrp|113703|2022|PCT|1.00|99|0.00|NEW PT OFFICE VISIT (MOD GT)|
20|FH_F92276_32308_0|SrvcGrp|29755|2022|PDM|49245.00|99|0.00|MS DRG 245 ONLY|
20|FH_F148549_60523_0|SrvcGrp|48385|2022|PDM|120.00|99|0.00|SPEECH THERAPY|
20|FH_F43118_0_0|SrvcGrp|14541|2022|PDM|3400.00|99|0.00|OP SURG|
20|FH_F141587_40242_0|SrvcGrp|16069|2022|PDM|630.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F114918_78748_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F73985_0_0|SrvcGrp|361|2022|PDM|1519.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F113253_72206_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F79746_0_0|SrvcGrp|10517|2022|PDM|55.97|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F149839_80002_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F122687_0_0|SrvcGrp|38364|2022|PDM|8742.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F137487_74447_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS APC GROUPED|
20|FH_F111263_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F120337_85004_0|SrvcGrp|112961|2022|PCT|1.00|99|0.00|AMFS CARVE-OUT BILLED W/ HCPC S9083|
20|FH_F118271_46052_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130013_16509_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F56136_0_0|SrvcGrp|63|2022|PDM|803.00|99|0.00|SUBACUTE CARE|
20|FH_F148265_06067_0|SrvcGrp|102481|2022|PDM|3891.00|99|0.00|CPT 29898|
20|FH_F132092_0_0|SrvcGrp|95661|2022|PDM|169.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F148265_06067_0|SrvcGrp|93433|2022|PDM|19340.00|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 10 (NO REV)|
20|FH_F121492_87111_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F89563_29407_0|SrvcGrp|94735|2022|PCT|1.00|99|0.00|AFLURIA VACC IM (>=3 YRS)|
20|FH_F137462_03062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121539_27511_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F78922_0_0|SrvcGrp|42869|2022|PDM|95.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F123302_33407_0|SrvcGrp|89149|2022|PDM|199.00|99|0.00|OP INTENSIVE|
20|FH_F39760_0_0|SrvcGrp|27300|2022|PDM|46.00|99|0.00|CPT 92557|
20|FH_F130013_16509_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F137946_0_0|SrvcGrp|113247|2022|PDM|45.23|99|0.00|COVID19 SARSCOV CORONAVIRUS AG IA (HCFA)|
20|FH_F141527_36830_0|SrvcGrp|86833|2022|PDM|10.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F149866_07401_0|SrvcGrp|104328|2022|PCT|0.85|99|0.00|PRESCRIPTION DRUG|
20|FH_F32413_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137617_84112_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F98920_46526_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F39920_0_0|SrvcGrp|439|2022|PDM|1467.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F115120_19083_0|SrvcGrp|89149|2022|PDM|150.00|99|0.00|OP INTENSIVE|
20|FH_F136790_0_0|SrvcGrp|3405|2022|PDM|154.00|99|0.00|CPT 99212|
20|FH_F147941_06023_0|SrvcGrp|10365|2022|PDM|2342.00|99|0.00|CPT CODE 99285|
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125028_19061_0|SrvcGrp|86837|2022|PDM|210.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F38377_0_0|SrvcGrp|28978|2022|PDM|52.50|99|0.00|SKILLED NURSING NON IV RELATED- MOD TD|
20|FH_F140931_24014_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F43250_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F55212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2096.00|99|0.00|AEG 3 (NO REV)|
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|797.11|99|0.00|2005 ASPG GROUPER III|
20|FH_F87297_17044_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147982_65706_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F111813_08080_0|SrvcGrp|96402|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA|
20|FH_F67205_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F83053_0_0|SrvcGrp|72998|2022|PDM|5047.00|99|0.00|AEG 5|
20|FH_F112632_66207_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111809_93003_0|SrvcGrp|113624|2022|PDM|12665.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F133018_84037_0|SrvcGrp|24744|2022|PDM|50.00|99|0.00|PICC LINE INSERTION|
20|FH_F150021_02725_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94165_0_0|SrvcGrp|73603|2022|PCT|0.85|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F117885_81506_0|SrvcGrp|88621|2022|PDM|105.00|99|0.00|SKILLED NURSING LPN|
20|FH_F100700_20110_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F126762_91311_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F140583_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F97562_29803_0|SrvcGrp|73605|2022|PDM|3449.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F80952_45669_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F41392_0_0|CSTM-ALL|CSTM-00|2020|PDM|1181.00|99|0.00|ASPG VII|
20|FH_F150023_75002_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150539_48374_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F120837_33309_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F132737_0_0|SrvcGrp|107733|2022|PDM|5953.00|99|0.00|CESAREAN SECTION|
20|FH_F144588_60090_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151157_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|AEG 10 (NO REV)|
20|FH_F119079_41018_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F132837_64118_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F101923_98104_0|SrvcGrp|82686|2022|PCT|3.17|99|0.00|AETNA CT SCAN|
20|FH_F92676_15063_0|SrvcGrp|79006|2022|PDM|1047.91|99|0.00|MON VALLEY ASC 219|
20|FH_F108700_63857_0|SrvcGrp|74546|2022|PDM|500.00|99|0.00|HOSPICE SERVICES|
20|FH_F87592_85614_0|SrvcGrp|79786|2022|PCT|1.00|99|0.00|SLEEP STUDIES|
20|FH_F87171_32578_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F42807_0_0|SrvcGrp|12491|2022|PCT|0.75|99|0.00|PACEMAKER|
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115383_80734_0|SrvcGrp|104329|2022|PCT|1.00|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F123091_92627_0|SrvcGrp|87131|2022|PDM|900.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F85753_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|122.22|99|0.00|ASPG 311|
20|FH_F111415_33180_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40765_0_0|CSTM-ALL|CSTM-00|2020|PDM|613.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103360_68845_0|SrvcGrp|82369|2022|PCT|7.50|99|0.00|AETNA LABORATORY|
20|FH_F37491_0_0|SrvcGrp|12682|2022|PDM|75.00|99|0.00|GROUP THERAPY|
20|FH_F49637_0_0|SrvcGrp|45883|2022|PDM|72.00|99|0.00|OT|
20|FH_F142990_06488_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F44016_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|LABS|
20|FH_F83031_0_0|SrvcGrp|44711|2022|PDM|105.00|99|0.00|PT SVCS|
20|FH_F101104_0_0|SrvcGrp|95762|2022|PDM|142.50|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F129535_0_0|SrvcGrp|75497|2022|PDM|700.00|99|0.00|AEG 10|
20|FH_F102721_38118_0|SrvcGrp|14165|2022|PDM|360.00|99|0.00|PARTIAL HOSP PSYCH/CD|
20|FH_F110400_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97563_83201_0|SrvcGrp|73559|2022|PDM|18202.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F118674_29036_0|SrvcGrp|114012|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F102822_84065_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F145862_66209_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F101840_76054_0|SrvcGrp|93751|2022|PDM|1321.00|99|0.00|ERCP STENT EXCHANGE W/DILATE|
20|FH_F39844_0_0|SrvcGrp|58|2022|PDM|3978.00|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F133535_32110_0|SrvcGrp|89149|2022|PDM|189.00|99|0.00|OP INTENSIVE|
20|FH_F68124_0_0|CSTM-ALL|CSTM-00|2020|PDM|920.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123144_0_0|SrvcGrp|72992|2022|PDM|463.00|99|0.00|AEG 2|
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 7 (NO REV)|
20|FH_F44194_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F119220_75068_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F101840_76054_0|SrvcGrp|73501|2022|PDM|76.51|99|0.00|AETNA OBSERVATION|
20|FH_F41441_0_0|SrvcGrp|38|2022|PDM|1273.00|99|0.00|NORMAL DELIVERY|
20|FH_F70606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100788_01420_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F31928_0_0|SrvcGrp|3719|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F123545_44512_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F49027_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F127217_29650_0|SrvcGrp|12659|2022|PDM|691.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F125009_17042_0|SrvcGrp|73842|2022|PDM|206.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F31824_0_0|SrvcGrp|877|2022|PDM|275.00|99|0.00|BOARDER BABY SVCS|
20|FH_F97042_64804_0|SrvcGrp|73605|2022|PDM|1773.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KL|
20|FH_F132528_64014_0|SrvcGrp|48394|2022|PDM|62.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F99720_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F129965_0_0|SrvcGrp|111411|2022|PCT|1.10|99|0.00|PHYSICAL MEDICINE|
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|1099.00|99|0.00|AEG 8 (NO REV)|
20|FH_F142970_43055_0|SrvcGrp|13681|2022|PDM|280.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F120437_85202_0|SrvcGrp|21920|2022|PDM|84.42|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F111789_25301_0|SrvcGrp|220|2022|PCT|0.65|99|0.00|INTRAOCULAR LENSES|
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_F150949_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.43|99|0.00|HSS ASC|
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2434.00|99|0.00|AEG 7 (NO REV)|
20|FH_F128508_37210_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|77.46|99|0.00|AETNA SLEEP STUDY CPT 95801|
20|FH_F123085_21921_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F72750_0_0|SrvcGrp|31981|2022|PCT|0.40|99|0.00|HIGH COST DRUGS|
20|FH_F146132_76801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145288_45345_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F121009_76180_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F148701_32708_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F151059_60435_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F151152_19150_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F72662_0_0|SrvcGrp|11258|2022|PCT|0.35|99|0.00|DRUGS|
20|FH_F98041_10027_0|SrvcGrp|73602|2022|PDM|3214.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F116323_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|556.00|99|0.00|AEG 1 (NO REV)|
20|FH_F115204_0_0|SrvcGrp|75545|2022|PDM|615.96|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F89037_0_0|SrvcGrp|72992|2022|PDM|537.57|99|0.00|AEG 2|
20|FH_F142334_33186_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F142344_16693_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F114063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F104840_32565_0|SrvcGrp|75493|2022|PCT|0.69|99|0.00|AEG 8|
20|FH_F52516_0_0|SrvcGrp|1168|2022|PDM|788.55|99|0.00|CONTINUOUS HOMECARE|
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F95341_08701_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132988_0_0|SrvcGrp|67065|2022|PDM|12555.41|99|0.00|CERVICAL SURGERY|
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137067_0_0|SrvcGrp|88157|2022|PDM|19425.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F130297_41042_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141131_20850_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124059_64055_0|SrvcGrp|29076|2022|PDM|25.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F124059_64055_0|SrvcGrp|47183|2022|PDM|83.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F146985_12205_0|SrvcGrp|48398|2022|PDM|89.00|99|0.00|PT SERVICES|
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|47250|2022|PDM|2855.00|99|0.00|MS DRG 876, 880-887 ONLY|
20|FH_F91998_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100703_0_0|SrvcGrp|80139|2022|PDM|7876.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F98380_43055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124183_01109_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121078_0_0|CSTM-ALL|CSTM-00|2020|PDM|551.00|99|0.00|AEG 1 (NO REV)|
20|FH_F71443_0_0|SrvcGrp|10517|2022|PDM|7.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F133697_63129_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F138052_19462_0|SrvcGrp|112868|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F144039_0_0|SrvcGrp|92549|2022|PDM|5378.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|1701.80|99|0.00|2005 ASPG GROUPER VIII|
20|FH_F42917_0_0|SrvcGrp|36727|2022|PDM|400.00|99|0.00|PSYCH- PARTIAL HOSP|
20|FH_F117069_15236_0|SrvcGrp|88620|2022|PDM|91.00|99|0.00|SKILLED NURSING RN|
20|FH_F134817_30339_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F136778_62034_0|SrvcGrp|101504|2022|PDM|143.00|99|0.00|IMAGE SERVICE|
20|FH_F136796_24016_0|CSTM-ALL|CSTM-00|2020|PDM|2048.69|99|0.00|AEG 6 (NO REV)|
20|FH_F136930_73114_0|SrvcGrp|109153|2022|PDM|118.00|99|0.00|PT/ST/OT - SPECIFIC REVENUE CODES|
20|FH_F113713_17013_0|SrvcGrp|104418|2022|PDM|85.00|99|0.00|OFFICE/OUTPATIENT VISIT EST (HCFA)(MOD AF)|
20|FH_F113713_17013_0|SrvcGrp|86647|2022|PDM|62.00|99|0.00|AETNA OFFICE OP VISIT EST (MOD TD)|
20|FH_F132611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141170_0_0|SrvcGrp|103585|2022|PDM|2998.00|99|0.00|REMOVE SPINE ELTRD PLATE|
20|FH_F115145_83201_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115210_21043_0|SrvcGrp|26273|2022|PDM|2122.00|99|0.00|CPT 29880|
20|FH_F116393_07002_0|SrvcGrp|15789|2022|PDM|230.00|99|0.00|SPEECH THERAPY|
20|FH_F42153_0_0|SrvcGrp|34557|2022|PDM|867.00|99|0.00|MS DRG 894-897 ONLY CHEM DEP|
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_F42654_0_0|SrvcGrp|29744|2022|PDM|50.00|99|0.00|SKILLED NURSING CARE - MOD TD|
20|FH_F131702_17022_0|SrvcGrp|53987|2022|PCT|1.05|99|0.00|PHOTOTHERAPY|
20|FH_F111580_77004_0|SrvcGrp|104270|2022|PCT|1.50|99|0.00|CHEMOTHERAPY & ALL OTHER DRUGS|
20|FH_F111604_16505_0|SrvcGrp|90854|2022|PDM|634.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F34477_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS|
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG I|
20|FH_F86660_0_0|SrvcGrp|11663|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F133536_0_0|SrvcGrp|96539|2022|PDM|1149.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F98361_12065_0|CSTM-ALL|CSTM-00|2020|PCT|0.42|99|0.00|OP SVCS|
20|FH_F42095_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|SPECTRUM INFUSION S CODES W/MODIFIER SJ & SH|
20|FH_F138907_01040_0|SrvcGrp|89783|2022|PDM|170.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F83792_0_0|SrvcGrp|78443|2022|PDM|2730.00|99|0.00|AETNA MATERNITY CARE (NORMAL DELIVERY)|
20|FH_F139750_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F125206_0_0|SrvcGrp|12491|2022|PCT|0.55|99|0.00|PACEMAKER|
20|FH_F151321_92626_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F122085_70360_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F144928_02703_0|SrvcGrp|88819|2022|PDM|504.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F144928_02703_0|SrvcGrp|91070|2022|PDM|284.00|99|0.00|AETNA MH CRISIS INTERVENTION (HCFA)|
20|FH_F135389_43123_0|SrvcGrp|46903|2022|PDM|677.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F135583_17331_0|SrvcGrp|101141|2022|PDM|3162.00|99|0.00|MRI/MRA W/ER|
20|FH_F135607_21613_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F97142_94535_0|SrvcGrp|73659|2022|PDM|11755.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F97142_94535_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F91766_25401_0|SrvcGrp|46104|2022|PDM|78.75|99|0.00|HOME VISIT - PRENATAL|
20|FH_F119892_47586_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F131285_47150_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131132_44077_0|CSTM-ALL|CSTM-00|2020|PDM|1873.00|99|0.00|AEG 1 (NO REV)|
20|FH_F131361_18235_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F94103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|998.00|99|0.00|AEG 8 (NO REV)|
20|FH_F140629_0_0|SrvcGrp|11663|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F55574_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|OP SVCS|
20|FH_F111291_52501_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134264_67226_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F42272_0_0|SrvcGrp|28818|2022|PCT|0.45|99|0.00|SUPPLIES AND DEVICES|
20|FH_F111853_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F112082_30720_0|SrvcGrp|46605|2022|PDM|213.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F87534_19464_0|SrvcGrp|48396|2022|PDM|104.00|99|0.00|OT SERVICES|
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PDM|1875.00|99|0.00|AEG 9 (NO REV)|
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|2343.00|99|0.00|ASPG VII|
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2418.00|99|0.00|AEG 6 (NO REV)|
20|FH_F69968_0_0|SrvcGrp|79977|2022|PCT|0.51|99|0.00|RADIOPHARMACEUTICALS|
20|FH_F136387_61244_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136542_02446_0|SrvcGrp|109613|2022|PDM|354.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION (>=18 YRS)|
20|FH_F118152_20151_0|SrvcGrp|26869|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F120418_43015_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F93178_73448_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F134008_11221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134011_84102_0|SrvcGrp|86833|2022|PDM|10.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F134126_11554_0|SrvcGrp|13681|2022|PDM|360.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F137054_22041_0|SrvcGrp|22596|2022|PDM|176.00|99|0.00|HOSPICE CARE|
20|FH_F137147_75006_0|SrvcGrp|64517|2022|PDM|11424.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F142273_51012_0|SrvcGrp|75505|2022|PCT|0.84|99|0.00|CARDIAC STUDIES|
20|FH_F142547_70002_0|SrvcGrp|86834|2022|PDM|10.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F138584_30912_0|SrvcGrp|113397|2022|PDM|1050.00|99|0.00|TEMPOROMANDIBULAR DISLOCATION TREATMENT|
20|FH_F138627_82901_0|SrvcGrp|113366|2022|PCT|1.00|99|0.00|ALL DRUGS/AGENTS/INJECTION DRUGS|
20|FH_F132733_0_0|SrvcGrp|112088|2022|PCT|0.65|99|0.00|CARDIAC ABLATION|
20|FH_F140844_48083_0|SrvcGrp|27968|2022|PDM|49.00|99|0.00|SKILLED NURSING LPN|
20|FH_F149647_92651_0|SrvcGrp|108484|2022|PDM|725.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F151603_27609_0|CSTM-ALL|CSTM-00|2020|PDM|1225.00|99|0.00|AEG 1 (NO REV)|
20|FH_F119023_91406_0|SrvcGrp|24754|2022|PDM|12.50|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F76144_0_0|SrvcGrp|46905|2022|PDM|1390.36|99|0.00|OBSERVATION SVCS|
20|FH_F92852_0_0|SrvcGrp|46906|2022|PDM|2200.00|99|0.00|CORNEAL TISSUE|
20|FH_F147801_90703_0|SrvcGrp|90854|2022|PDM|1173.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F147882_44056_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F129467_45449_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F129514_79605_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F137905_91364_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F104720_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F112452_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109513_0_0|SrvcGrp|72998|2022|PDM|1071.00|99|0.00|AEG 5|
20|FH_F60836_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F58615_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F62579_0_0|SrvcGrp|27968|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F97840_54729_0|SrvcGrp|73659|2022|PDM|7457.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F135622_34471_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F93076_85016_0|SrvcGrp|16349|2022|PDM|649.37|99|0.00|ACUTE IP MED SVCS|
20|FH_F143687_70461_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145641_06902_0|SrvcGrp|53066|2022|PDM|2163.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL|
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|412.08|99|0.00|HAPA WPA-NWPA 2012-13 ASC 114 W/O REV|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|337.55|99|0.00|HAPA WPA-NWPA 2012-13 ASC 223 W/O REV|
20|FH_F110346_38501_0|SrvcGrp|86748|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F67887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134587_64114_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F88357_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F146049_60462_0|CSTM-ALL|CSTM-00|2020|PCT|0.20|99|0.00|OP SVCS|
20|FH_F123851_03235_0|SrvcGrp|23683|2022|PDM|78.54|99|0.00|SKILLED NURSING RN|
20|FH_F125549_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F133815_46526_0|SrvcGrp|112483|2022|PDM|250.00|99|0.00|OBSERV/HOSP SAME DATE|
20|FH_F130017_02302_0|CSTM-ALL|CSTM-00|2020|PDM|4893.88|99|0.00|AEG 8 (NO REV)|
20|FH_F110302_15931_0|SrvcGrp|88780|2022|PDM|11.26|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F59652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F118147_33801_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F88698_18951_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F100782_0_0|SrvcGrp|105140|2022|PDM|161.10|99|0.00|WINDBER MEDICAL CNTR ASC 246|
20|FH_F111986_0_0|SrvcGrp|104122|2022|PDM|1442.00|99|0.00|BIOPSY/REMOVAL, LYMPH NODE(S)|
20|FH_F121628_19533_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F109577_0_0|SrvcGrp|22384|2022|PDM|135.00|99|0.00|HOME VISIT PRENATAL|
20|FH_F119379_0_0|SrvcGrp|107849|2022|PDM|672.00|99|0.00|SKIN FULL GRAFT PROCEDURE|
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 3 (NO REV)|
20|FH_F125259_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F139380_33062_0|SrvcGrp|89417|2022|PDM|484.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F144228_0_0|SrvcGrp|57864|2022|PDM|3247.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F90334_23323_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F150165_06032_0|SrvcGrp|113889|2022|PDM|1650.00|99|0.00|LYSIS OF LABIAL LESION|
20|FH_F149021_44514_0|CSTM-ALL|CSTM-00|2020|PDM|1033.00|99|0.00|AEG 7 (NO REV)|
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|1096.51|99|0.00|AEG 8 (NO REV)|
20|FH_F133749_84604_0|SrvcGrp|112470|2022|PDM|50.00|99|0.00|TPN (HCFA)|
20|FH_F100782_0_0|SrvcGrp|30623|2022|PDM|5632.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F110580_71106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F96160_32207_0|SrvcGrp|86834|2022|PDM|25.89|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F133749_84604_0|SrvcGrp|112443|2022|PDM|10.00|99|0.00|HOME TRANSFUSION (HCFA)|
20|FH_F133877_84117_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113457_17011_0|SrvcGrp|88620|2022|PDM|88.00|99|0.00|SKILLED NURSING RN|
20|FH_F85353_16407_0|SrvcGrp|63911|2022|PDM|125.92|99|0.00|HAPA WPA-NWPA 2012-13 ASC 142|
20|FH_F109387_35630_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149120_0_0|SrvcGrp|82981|2022|PDM|145.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F150165_06032_0|SrvcGrp|33980|2022|PDM|3475.00|99|0.00|CPT 28298|
20|FH_F136359_0_0|SrvcGrp|88494|2022|PDM|9680.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F117208_0_0|SrvcGrp|106916|2022|PDM|3410.00|99|0.00|NASAL/SINUS ENDOSCPOY - W/ARTERY LIGAMENT|
20|FH_F150165_06032_0|SrvcGrp|109749|2022|PDM|2204.00|99|0.00|REMOVAL OF TESTIS|
20|FH_F148541_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.60|99|0.00|HSS ASC INVOICE|
20|FH_F81698_10457_0|SrvcGrp|86846|2022|PDM|31.50|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F141337_60077_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F118803_0_0|SrvcGrp|107885|2022|PDM|2151.79|99|0.00|TRLUML BALO ANGIOP 1ST VEIN|
20|FH_F127090_45601_0|SrvcGrp|48394|2022|PDM|36.89|99|0.00|SKILLED NURSING SERVICES|
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|1293.50|99|0.00|2005 ASPG GROUPER VII|
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|836.00|99|0.00|AEG 4 (NO REV)|
20|FH_F121303_15501_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|COVID-19 INFUSION ADMIN - ELI LILLY|
20|FH_F112791_0_0|SrvcGrp|73000|2022|PDM|945.00|99|0.00|AEG 6|
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PDM|10593.00|99|0.00|2007 MEDICARE ASPG VIII|
20|FH_F116506_0_0|SrvcGrp|75491|2022|PDM|1020.00|99|0.00|AEG 7|
20|FH_F149279_17022_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|AEG 2 (NO REV)|
20|FH_F114510_33445_0|SrvcGrp|89417|2022|PDM|364.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F141210_0_0|SrvcGrp|113115|2022|PDM|4751.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F73084_0_0|SrvcGrp|68987|2022|PDM|72.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F134431_92647_0|SrvcGrp|74668|2022|PDM|500.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F134537_03060_0|SrvcGrp|86722|2022|PDM|196.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F63281_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
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|11663|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|213.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 125 W/O REV|
20|FH_F78705_0_0|CSTM-ALL|CSTM-00|2020|PDM|2201.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85211_0_0|SrvcGrp|72990|2022|PDM|456.50|99|0.00|AEG 1|
20|FH_F105143_26062_0|SrvcGrp|73002|2022|PDM|9959.00|99|0.00|AEG 7|
20|FH_F115907_12206_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F63625_0_0|SrvcGrp|9911|2022|PCT|0.80|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F146459_48154_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146671_72205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146466_21620_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146501_68025_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146782_19034_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|HSS ASC|
20|FH_F146846_73139_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116023_10027_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F116063_43220_0|SrvcGrp|86722|2022|PDM|147.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F131737_15025_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F131964_89120_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133269_78624_0|SrvcGrp|108484|2022|PDM|575.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139707_84010_0|CSTM-ALL|CSTM-00|2020|PDM|1914.00|99|0.00|AEG 3 (NO REV) W/O BUNION CORRECTION|
20|FH_F111857_68005_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F36594_0_0|SrvcGrp|12856|2022|PDM|53.00|99|0.00|NURSING CARE|
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|1144.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132595_0_0|SrvcGrp|115|2022|PDM|1021.00|99|0.00|SKILLED NURSING CARE|
20|FH_F47037_0_0|SrvcGrp|10540|2022|PDM|37.00|99|0.00|HOME HEALTH AIDE|
20|FH_F34853_0_0|SrvcGrp|12179|2022|PCT|2.00|99|0.00|CPT CODES 70000-79999 (RAD)|
20|FH_F98900_42001_0|SrvcGrp|73601|2022|PDM|5290.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F128506_77304_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124420_33442_0|SrvcGrp|58716|2022|PDM|257.00|99|0.00|CPT CODE 99183|
20|FH_F138995_0_0|SrvcGrp|86505|2022|PDM|1300.00|99|0.00|DENTAL SURGERY|
20|FH_F144029_0_0|SrvcGrp|107749|2022|PDM|214.00|99|0.00|CAPD/CCPD|
20|FH_F144831_0_0|SrvcGrp|104841|2022|PDM|686.00|99|0.00|HOSPICE CARE PROVIDED IP HOSPICE FAC|
20|FH_F83920_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|262.00|99|0.00|HAPA EPA ASC 34|
20|FH_F39162_0_0|SrvcGrp|17379|2022|PDM|135.00|99|0.00|CCPD TRAINING|
20|FH_F138478_0_0|SrvcGrp|113284|2022|PDM|1193.56|99|0.00|LIGATION/BANDING A-V|
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|3809.00|99|0.00|AEG 7 (NO REV)|
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F128392_01026_0|SrvcGrp|74668|2022|PDM|450.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F98940_70506_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F35056_0_0|SrvcGrp|63|2022|PDM|320.00|99|0.00|SUBACUTE CARE|
20|FH_F33649_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F98000_59102_0|SrvcGrp|73559|2022|PDM|10770.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F147181_27514_0|SrvcGrp|112762|2022|PCT|1.00|99|0.00|INFECTIOUS AGENT ANTIGEN DETECTION|
20|FH_F108680_0_0|SrvcGrp|12664|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F139877_32615_0|SrvcGrp|113249|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2 & INF A&B AMP PRB (HCFA)|
20|FH_F123570_0_0|SrvcGrp|41333|2022|PDM|4326.00|99|0.00|LITHO MOD 51|
20|FH_F128375_03909_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97300_47501_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F44255_0_0|SrvcGrp|109|2022|PDM|583.00|99|0.00|CD - DETOX|
20|FH_F97880_63501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117574_49022_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124976_0_0|SrvcGrp|12659|2022|PDM|651.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F150442_28451_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 8 (NO REV)|
20|FH_F148667_0_0|SrvcGrp|92009|2022|PDM|2856.00|99|0.00|CARPAL SCAPHOID FRACTURE|
20|FH_F129307_54174_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132033_60134_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116806_0_0|SrvcGrp|35667|2022|PDM|973.15|99|0.00|CPT 20680|
20|FH_F146266_0_0|SrvcGrp|97730|2022|PDM|8501.00|99|0.00|REVERSE HIP JOINT|
20|FH_F150982_0_0|SrvcGrp|26274|2022|PDM|2202.00|99|0.00|CPT 29877|
20|FH_F149651_90046_0|SrvcGrp|46903|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F111044_0_0|SrvcGrp|35672|2022|PDM|2987.00|99|0.00|CPT 23412|
20|FH_F124760_34997_0|SrvcGrp|90854|2022|PDM|902.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F35730_0_0|SrvcGrp|11331|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F108680_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|1250.00|99|0.00|AEG 8 (NO REV)|
20|FH_F137797_70123_0|SrvcGrp|48396|2022|PDM|124.00|99|0.00|OT SERVICES|
20|FH_F148347_0_0|SrvcGrp|33967|2022|PDM|4676.65|99|0.00|CPT 47562|
20|FH_F124291_44122_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|AEG 7 (NO REV)|
20|FH_F130202_68003_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|3978.00|99|0.00|AEG 7 (NO REV)|
20|FH_F131270_38133_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F108680_0_0|SrvcGrp|87677|2022|PDM|1595.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F35452_0_0|CSTM-ALL|CSTM-00|2020|PDM|3800.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F100540_0_0|SrvcGrp|13187|2022|PCT|1.05|99|0.00|INTRAOCULAR LENSES|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F124316_28112_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F69123_0_0|SrvcGrp|42971|2022|PDM|80.00|99|0.00|SKN RN|
20|FH_F40607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119442_72205_0|SrvcGrp|10393|2022|PDM|1541.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F112794_01040_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F124739_64429_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F149083_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|DRUGS|
20|FH_F140137_15235_0|SrvcGrp|22954|2022|PDM|118.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F139950_76240_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F143207_72301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143347_16001_0|SrvcGrp|79863|2022|PDM|12371.00|99|0.00|ARTHERECTOMY|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD KL)|
20|FH_F116698_07470_0|SrvcGrp|86839|2022|PDM|39.90|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F119924_14070_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120977_50510_0|SrvcGrp|107288|2022|PCT|1.00|99|0.00|INJ INTERFERON BETA|
20|FH_F125479_17501_0|SrvcGrp|108484|2022|PDM|680.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F118917_33317_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F46158_0_0|SrvcGrp|17067|2022|PCT|0.65|99|0.00|ASPG II|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|22990.00|99|0.00|MSDRG 219-221 CARDIAC VLV PX+OTR MJR CARDIOTHORACIC PX W/CC|
20|FH_F36132_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP MAFS  MOD KM|
20|FH_F98621_41042_0|SrvcGrp|73602|2022|PDM|4306.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F38808_0_0|SrvcGrp|17073|2022|PDM|789.00|99|0.00|ASPG V|
20|FH_F51193_30901_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F36155_0_0|SrvcGrp|1171|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F45332_0_0|SrvcGrp|37905|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F57093_0_0|SrvcGrp|3087|2022|PDM|652.00|99|0.00|CD - DETOX|
20|FH_F59732_0_0|SrvcGrp|40824|2022|PDM|90.00|99|0.00|DELIVERY/SERVICE (HIGH RISK)|
20|FH_F63095_0_0|SrvcGrp|35419|2022|PCT|1.00|99|0.00|AIR AMBULANCE SVCS|
20|FH_F46612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F130747_0_0|SrvcGrp|101800|2022|PDM|5202.00|99|0.00|SKELETAL FIXATION|
20|FH_F128883_89521_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F104520_0_0|SrvcGrp|95441|2022|PDM|90.00|99|0.00|HOSPICE OR HOME CARE|
20|FH_F90958_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F88212_20151_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F35259_0_0|SrvcGrp|361|2022|PDM|5624.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F135219_68506_0|SrvcGrp|79786|2022|PCT|0.00|99|0.00|SLEEP STUDIES|
20|FH_F129354_19152_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F91321_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|ASPG VI|
20|FH_F115109_20032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121547_46805_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F151540_17055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118056_29464_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F143528_0_0|SrvcGrp|89979|2022|PDM|17575.95|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F135178_84049_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F143297_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|ADULT PARTIAL HOSPITALIZATION|
20|FH_F125899_07645_0|SrvcGrp|72998|2022|PDM|6174.00|99|0.00|AEG 5|
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|639.00|99|0.00|AEG 1 (NO REV)|
20|FH_F72546_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: ALL (HCFA) OUTPATIENT|
20|FH_F121467_75165_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F82173_72712_0|SrvcGrp|11594|2022|PDM|5469.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F149980_0_0|SrvcGrp|104719|2022|PDM|1921.00|99|0.00|RELIEVE INNER EYE PRESSURE|
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 9 (NO REV)|
20|FH_F65681_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F77862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148165_29169_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|GENERAL ACUTE CARE|
20|FH_F137067_0_0|SrvcGrp|93807|2022|PDM|4200.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F143528_0_0|SrvcGrp|11673|2022|PDM|6022.80|99|0.00|CPT 29888|
20|FH_F126585_45039_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141802_17042_0|SrvcGrp|46683|2022|PDM|2996.00|99|0.00|MS DRG 789-795 (NEONATAL)|
20|FH_F68160_0_0|CSTM-ALL|CSTM-00|2020|PDM|340.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127281_68516_0|SrvcGrp|86723|2022|PDM|424.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F66465_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP|
20|FH_F148265_06067_0|SrvcGrp|112959|2022|PDM|21373.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F34550_0_0|SrvcGrp|16|2022|PDM|738.00|99|0.00|ACUTE REHABILITATION|
20|FH_F63464_0_0|SrvcGrp|28847|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F121492_87111_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F148324_93101_0|SrvcGrp|108484|2022|PDM|775.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F37443_0_0|SrvcGrp|9774|2022|PDM|2100.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126900_61924_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121525_78613_0|SrvcGrp|89337|2022|PDM|1200.00|99|0.00|DETOXIFICATION|
20|FH_F110925_01104_0|SrvcGrp|41453|2022|PDM|3.16|99|0.00|ENTERAL FORMULA - INHERITED METABOLIC DISEASE|
20|FH_F110102_0_0|SrvcGrp|103846|2022|PDM|650.00|99|0.00|HOSPICE CARE|
20|FH_F41202_0_0|SrvcGrp|32108|2022|PDM|450.00|99|0.00|NEWBORN NURSERY|
20|FH_F102800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113410_0_0|SrvcGrp|79588|2022|PDM|630.00|99|0.00|CPT 43235|
20|FH_F117082_66216_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F50184_0_0|SrvcGrp|33165|2022|PDM|405.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F143970_92656_0|SrvcGrp|108484|2022|PDM|725.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F115667_16101_0|SrvcGrp|75545|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F134994_33162_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|1030.00|99|0.00|AEG 4 (NO REV)|
20|FH_F34496_0_0|SrvcGrp|10097|2022|PDM|5292.00|99|0.00|DRG 371 ONLY CESAREAN SECTION W/O CC|
20|FH_F131254_92211_0|SrvcGrp|65621|2022|PDM|45.00|99|0.00|RN NURSING|
20|FH_F120296_97223_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD KF) - PMRS|
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_F35405_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F128276_66441_0|SrvcGrp|46903|2022|PDM|250.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F54614_0_0|SrvcGrp|50905|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY|
20|FH_F118249_0_0|SrvcGrp|108065|2022|PDM|21000.00|99|0.00|IMPLANT NEUROELECTRODES 23|
20|FH_F139515_0_0|SrvcGrp|14614|2022|PDM|4179.00|99|0.00|LITHOTRIPSY|
20|FH_F133099_66801_0|SrvcGrp|109057|2022|PCT|0.80|99|0.00|CARDIAC STUDIES|
20|FH_F145797_46250_0|SrvcGrp|87077|2022|PDM|250.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|872.67|99|0.00|AEG 6 (NO REV)|
20|FH_F130747_0_0|SrvcGrp|99162|2022|PDM|6242.00|99|0.00|CPT 24366|
20|FH_F116021_60714_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F145758_20745_0|CSTM-ALL|CSTM-00|2020|PDM|9460.50|99|0.00|INTRAOSSEOUS DES LUMB/SACRUM|
20|FH_F125118_99201_0|SrvcGrp|74668|2022|PDM|1000.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PDM|937.00|99|0.00|ACUTE PSYCH|
20|FH_F129653_0_0|SrvcGrp|73000|2022|PDM|2015.00|99|0.00|AEG 6|
20|FH_F123953_84003_0|SrvcGrp|87131|2022|PDM|509.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F90362_0_0|SrvcGrp|10986|2022|PDM|1667.00|99|0.00|ARTHROSCOPIC KNEE REPAIR|
20|FH_F91994_0_0|SrvcGrp|13990|2022|PCT|1.15|99|0.00|PACEMAKER|
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|1738.00|99|0.00|AEG 10 (NO REV)|
20|FH_F118555_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F69347_0_0|SrvcGrp|73080|2022|PDM|8025.00|99|0.00|PORTLAND ADVENTIST UNGROUPED|
20|FH_F140035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148431_60523_0|SrvcGrp|104230|2022|PDM|105.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F148554_85016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44334_0_0|SrvcGrp|13626|2022|PDM|476.66|99|0.00|SLEEP STUDIES|
20|FH_F117368_68114_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F44607_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F125348_84660_0|SrvcGrp|108061|2022|PDM|120.00|99|0.00|OP THERAPY SERVICES|
20|FH_F126930_0_0|SrvcGrp|110598|2022|PDM|228.00|99|0.00|ALCOHOL & DRUG SERVICE|
20|FH_F127204_44420_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F119206_35007_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PDM|865.00|99|0.00|ASPG II|
20|FH_F91255_19401_0|SrvcGrp|73485|2022|PDM|2247.00|99|0.00|AETNA REHAB|
20|FH_F142027_37217_0|SrvcGrp|45924|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE|
20|FH_F117340_68144_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F45199_0_0|CSTM-ALL|CSTM-00|2020|PDM|1118.00|99|0.00|ASPG VII|
20|FH_F103360_68845_0|SrvcGrp|67064|2022|PDM|10272.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F130258_54304_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|AEG 5  (NO REV)|
20|FH_F38394_0_0|SrvcGrp|17079|2022|PDM|1548.54|99|0.00|ASPG VIII|
20|FH_F148555_0_0|SrvcGrp|115436|2022|PDM|3090.00|99|0.00|INSERT HEART PM VENTRICULAR|
20|FH_F126808_15005_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F44312_0_0|SrvcGrp|110|2022|PDM|490.00|99|0.00|CD - REHABILITATION|
20|FH_F146217_0_0|SrvcGrp|104229|2022|PDM|141.22|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F39859_0_0|SrvcGrp|37256|2022|PDM|1400.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F141896_61462_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151157_0_0|CSTM-ALL|CSTM-00|2020|PDM|665.00|99|0.00|AEG 1 (NO REV) W/ GASTROESOPHOGEAL|
20|FH_F128605_20910_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F39995_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F115313_11216_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F57592_0_0|SrvcGrp|31020|2022|PDM|18000.00|99|0.00|MS DRG 470 ONLY|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|412.50|99|0.00|HAPA WPA-NWPA 2012-13 ASC 103 W/O REV|
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|472.50|99|0.00|AEG 1 (NO REV)|
20|FH_F81373_64064_0|SrvcGrp|13292|2022|PCT|0.25|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F125672_92663_0|SrvcGrp|52953|2022|PDM|400.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F139825_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F116825_0_0|SrvcGrp|472|2022|PDM|1113.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F39844_0_0|CSTM-ALL|CSTM-00|2020|PDM|690.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F59274_0_0|SrvcGrp|48393|2022|PDM|18.00|99|0.00|SKILLED NURSING SERVICES (PER HOUR)|
20|FH_F133167_82930_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F42332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F98600_91730_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71723_16502_0|SrvcGrp|10431|2022|PDM|47.00|99|0.00|SPEECH THERAPY|
20|FH_F67639_0_0|CSTM-ALL|CSTM-00|2020|PDM|802.00|99|0.00|ASPG VI|
20|FH_F133287_40215_0|SrvcGrp|10391|2022|PDM|2066.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F117794_06473_0|SrvcGrp|76501|2022|PDM|445.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F146211_68144_0|CSTM-ALL|CSTM-00|2020|PDM|5584.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132722_71373_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F133493_90255_0|SrvcGrp|103913|2022|PCT|0.00|99|0.00|OP DIALYSIS|
20|FH_F142900_32792_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|982.14|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F143684_0_0|SrvcGrp|58638|2022|PDM|2563.00|99|0.00|CPT 63688|
20|FH_F145288_45345_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119437_0_0|SrvcGrp|99167|2022|PDM|4750.00|99|0.00|CPT 63057|
20|FH_F148060_01001_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F39627_0_0|SrvcGrp|10111|2022|PCT|0.85|99|0.00|IMPLANTS|
20|FH_F112165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123872_75006_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F101840_76054_0|SrvcGrp|47038|2022|PDM|8151.00|99|0.00|MS DRG 748 ONLY|
20|FH_F84676_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F74084_15206_0|SrvcGrp|10431|2022|PDM|52.00|99|0.00|SPEECH THERAPY|
20|FH_F97565_83301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F112853_22408_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|WV HH  S CODES MOD 53|
20|FH_F49637_0_0|SrvcGrp|58587|2022|PCT|1.00|99|0.00|RADIOLOGY|
20|FH_F132338_18901_0|SrvcGrp|58509|2022|PDM|332.51|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F132886_0_0|SrvcGrp|106314|2022|PDM|412.00|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F75342_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|794.00|99|0.00|AEG 6 (NO REV)|
20|FH_F111444_33401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69242_0_0|SrvcGrp|42973|2022|PDM|95.00|99|0.00|SPEECH  THERAPIST|
20|FH_F128325_19904_0|SrvcGrp|87537|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F92677_08003_0|SrvcGrp|92188|2022|PDM|320.25|99|0.00|CPT 95805  (HCFA)|
20|FH_F100785_54660_0|SrvcGrp|90854|2022|PDM|2829.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F142931_60644_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132224_89119_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|444.79|99|0.00|HAPA WPA-NWPA 2012-13 ASC 213 W/O REV|
20|FH_F96120_67207_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F80952_45669_0|CSTM-ALL|CSTM-00|2020|PDM|568.22|99|0.00|CT SCAN|
20|FH_F107120_22560_0|SrvcGrp|57968|2022|PDM|33.30|99|0.00|CONTINUOUS HOMECARE|
20|FH_F119128_93619_0|SrvcGrp|73841|2022|PDM|575.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F38865_0_0|SrvcGrp|97|2022|PDM|4050.00|99|0.00|C-SECTION|
20|FH_F126666_44053_0|SrvcGrp|91399|2022|PDM|68.00|99|0.00|AETNA PSYCH PT & FAMILY 45MINS (MOD AJ)|
20|FH_F148019_54311_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149652_37212_0|SrvcGrp|110811|2022|PDM|245.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F150602_59718_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F120437_85202_0|SrvcGrp|13929|2022|PDM|33.77|99|0.00|GROWTH HORMONE|
20|FH_F134490_62801_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F88512_0_0|SrvcGrp|46531|2022|PDM|612.83|99|0.00|EMERGENCY ROOM LEVEL 2|
20|FH_F151062_17584_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F31525_0_0|SrvcGrp|701|2022|PDM|1745.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F66688_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F106822_0_0|SrvcGrp|82745|2022|PDM|10.22|99|0.00|CULT BACT NO URINE/BLD/STOOL|
20|FH_F111001_0_0|CSTM-ALL|CSTM-00|2020|PDM|15.00|99|0.00|RN HOURLY|
20|FH_F39704_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F71365_0_0|SrvcGrp|66480|2022|PDM|75.00|99|0.00|RN VISIT|
20|FH_F80711_0_0|SrvcGrp|42828|2022|PDM|60.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F85039_0_0|SrvcGrp|75487|2022|PDM|788.00|99|0.00|AEG 5|
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC STUDIES|
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1915.10|99|0.00|AEG 9 (NO REV)|
20|FH_F142312_62301_0|SrvcGrp|108484|2022|PDM|425.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|977.00|99|0.00|AEG 4 (NO REV)|
20|FH_F112967_0_0|SrvcGrp|89783|2022|PDM|115.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F104840_32565_0|SrvcGrp|76522|2022|PCT|0.69|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F105623_77901_0|SrvcGrp|88778|2022|PDM|115.00|99|0.00|PHYSICAL THERAPY|
20|FH_F130460_33166_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113541_0_0|SrvcGrp|84182|2022|PDM|2580.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE|
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|AEG 3 (NO REV)|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PDM|730.00|99|0.00|ASPG X|
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|1596.00|99|0.00|AEG 8 (NO REV)|
20|FH_F130297_41042_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91039_0_0|SrvcGrp|86863|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F119214_0_0|SrvcGrp|75487|2022|PDM|1300.00|99|0.00|AEG 5|
20|FH_F69504_0_0|SrvcGrp|46424|2022|PDM|27.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F132348_16214_0|SrvcGrp|43567|2022|PDM|110.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F124059_64055_0|SrvcGrp|24761|2022|PDM|37.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F146674_70778_0|SrvcGrp|74668|2022|PDM|235.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F146844_78582_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37603_0_0|SrvcGrp|21791|2022|PDM|60.00|99|0.00|PT/OT/ST|
20|FH_F91998_0_0|SrvcGrp|73006|2022|PDM|1449.00|99|0.00|AEG 9|
20|FH_F92493_0_0|SrvcGrp|35667|2022|PDM|1689.77|99|0.00|CPT 20680|
20|FH_F128613_68111_0|SrvcGrp|73842|2022|PDM|196.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F127995_84010_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F133694_89117_0|SrvcGrp|27968|2022|PDM|55.00|99|0.00|SKILLED NURSING LPN|
20|FH_F136681_60004_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F114666_30342_0|SrvcGrp|85778|2022|PDM|3000.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F114666_30342_0|SrvcGrp|92369|2022|PDM|2800.00|99|0.00|REPAIR OF ANKLE LIGAMENTS|
20|FH_F113791_32055_0|CSTM-ALL|CSTM-00|2020|PDM|512.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F138716_20151_0|SrvcGrp|55677|2022|PDM|2500.00|99|0.00|VAGINAL DELIVERY ONLY|
20|FH_F114985_32073_0|SrvcGrp|104803|2022|PDM|156.00|99|0.00|SPINAL FLUID TAP DIAGNO 5|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122635_06410_0|SrvcGrp|48385|2022|PDM|118.00|99|0.00|SPEECH THERAPY|
20|FH_F43000_0_0|SrvcGrp|36746|2022|PDM|75.00|99|0.00|SOCIAL WORKER|
20|FH_F43444_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS APC GROUPED|
20|FH_F134693_92270_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F134764_73568_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134791_98034_0|SrvcGrp|48398|2022|PDM|283.00|99|0.00|PT SERVICES|
20|FH_F136778_62034_0|CSTM-ALL|CSTM-00|2020|PDM|4790.00|99|0.00|AEG 6 (NO REV)|
20|FH_F136796_24016_0|SrvcGrp|71666|2022|PDM|7788.11|99|0.00|CPT 63655|
20|FH_F136913_68803_0|SrvcGrp|73488|2022|PCT|0.70|99|0.00|AETNA HOSPITAL OP DIALYSIS|
20|FH_F69623_0_0|SrvcGrp|10431|2022|PDM|47.00|99|0.00|SPEECH THERAPY|
20|FH_F115144_71373_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA OP PT/OT/ST (PHYTHY)|
20|FH_F115608_24171_0|SrvcGrp|80244|2022|PCT|0.00|99|0.00|AETNA ICU|
20|FH_F115631_65201_0|SrvcGrp|98943|2022|PDM|7575.00|99|0.00|CPT 43255|
20|FH_F116233_33612_0|SrvcGrp|73841|2022|PDM|312.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F80859_65616_0|SrvcGrp|88980|2022|PDM|802.00|99|0.00|NURSERY NEWBORN|
20|FH_F127432_18015_0|SrvcGrp|75506|2022|PCT|0.38|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F133530_11237_0|SrvcGrp|74584|2022|PDM|2342.00|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F68121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F38394_0_0|SrvcGrp|17067|2022|PDM|709.12|99|0.00|ASPG II|
20|FH_F149940_02645_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F91155_16105_0|SrvcGrp|73559|2022|PDM|2151.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F120437_85202_0|SrvcGrp|22592|2022|PDM|78.79|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F57592_0_0|SrvcGrp|8968|2022|PDM|4000.00|99|0.00|NICU LEVEL III & IV|
20|FH_F92677_08003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F123158_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F97542_32960_0|SrvcGrp|73656|2022|PDM|1385.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F134267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136751_0_0|SrvcGrp|92364|2022|PDM|16000.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F122648_0_0|SrvcGrp|91759|2022|PCT|1.00|99|0.00|OCULAR IMPLANT|
20|FH_F38089_0_0|SrvcGrp|361|2022|PDM|1985.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F40786_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F37641_0_0|SrvcGrp|21342|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F141870_85224_0|SrvcGrp|86843|2022|PDM|35.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1543.00|99|0.00|AEG 5  (NO REV)|
20|FH_F72859_0_0|SrvcGrp|11796|2022|PDM|75.00|99|0.00|DIETICIAN|
20|FH_F39558_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146211_68144_0|SrvcGrp|84939|2022|PDM|14212.00|99|0.00|SHOULDER JOINT|
20|FH_F42494_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY|
20|FH_F37751_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F133333_74132_0|SrvcGrp|82137|2022|PCT|0.62|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F41396_0_0|SrvcGrp|471|2022|PDM|440.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F72859_0_0|SrvcGrp|15504|2022|PDM|236.86|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F40622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F101760_63851_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36756_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F42992_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F67148_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|OP SVCS|
20|FH_F67192_0_0|SrvcGrp|16684|2022|PCT|0.52|99|0.00|DRUGS|
20|FH_F44135_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F97561_30030_0|SrvcGrp|90854|2022|PDM|2955.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F33106_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F128312_45230_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F151063_44094_0|SrvcGrp|73842|2022|PDM|220.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151099_86429_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F151122_10462_0|SrvcGrp|48385|2022|PDM|121.00|99|0.00|SPEECH THERAPY|
20|FH_F151155_26508_0|SrvcGrp|113336|2022|PDM|221.00|99|0.00|INTAKE ACT W/MED EXAM|
20|FH_F139441_91324_0|SrvcGrp|87317|2022|PDM|2835.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F139649_40108_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139707_84010_0|CSTM-ALL|CSTM-00|2020|PDM|2752.00|99|0.00|AEG 8 (NO REV)|
20|FH_F150745_03301_0|SrvcGrp|80920|2022|PDM|837.00|99|0.00|HOSPICE SERVICES|
20|FH_F150882_84041_0|SrvcGrp|86847|2022|PDM|61.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F92280_15090_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F31087_0_0|SrvcGrp|473|2022|PDM|324.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F124759_34108_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138710_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110732_31513_0|SrvcGrp|12491|2022|PCT|0.60|99|0.00|PACEMAKER|
20|FH_F131028_49735_0|SrvcGrp|89781|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F42165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F147332_19406_0|SrvcGrp|113773|2022|PCT|1.01|99|0.00|TELEMEDICINE (MOD 95, GT)|
20|FH_F107980_08005_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133569_17202_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F131385_76457_0|SrvcGrp|73841|2022|PDM|425.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138018_17313_0|SrvcGrp|41460|2022|PDM|24.66|99|0.00|ENTERAL THERAPY - UNSPECIFIED|
20|FH_F103180_85283_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F125656_92868_0|SrvcGrp|86851|2022|PDM|35.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F109762_0_0|SrvcGrp|72996|2022|PDM|630.00|99|0.00|AEG 4|
20|FH_F37487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151660_77074_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76124_0_0|SrvcGrp|33166|2022|PDM|377.00|99|0.00|SKILLED NURSING - LEVEL III|
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_F91938_70121_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F36133_70072_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE|
20|FH_F109251_62269_0|SrvcGrp|103220|2022|PDM|15.61|99|0.00|HIGH COMPRES BAND W>=3<5YD|
20|FH_F132254_40207_0|SrvcGrp|86847|2022|PDM|50.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F131605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148964_30101_0|SrvcGrp|89024|2022|PDM|70.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|HAPA EPA ASC 17|
20|FH_F37244_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42944_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F141250_95062_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F67419_0_0|SrvcGrp|58602|2022|PCT|1.00|99|0.00|DRUGS - J-CODES AND Q-CODES|
20|FH_F149049_28401_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 3 (NO REV)|
20|FH_F130044_0_0|SrvcGrp|35982|2022|PDM|37.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F147389_81632_0|SrvcGrp|104079|2022|PCT|1.25|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F147620_67119_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F41463_0_0|SrvcGrp|34387|2022|PDM|93.45|99|0.00|NURSING CARE|
20|FH_F42024_0_0|SrvcGrp|72265|2022|PCT|0.75|99|0.00|RADIOLOGY|
20|FH_F42654_0_0|SrvcGrp|29345|2022|PDM|35.00|99|0.00|SKILLED NURSING - LPN - MOD TE|
20|FH_F39346_0_0|SrvcGrp|20744|2022|PDM|18945.00|99|0.00|MS DRG 242 ONLY|
20|FH_F81152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F102641_0_0|SrvcGrp|73002|2022|PDM|1679.00|99|0.00|AEG 7|
20|FH_F137906_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F51674_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F134087_0_0|SrvcGrp|89848|2022|PDM|9017.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F33512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F113154_70359_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 9 (NO REV)|
20|FH_F133536_0_0|SrvcGrp|33724|2022|PDM|3215.00|99|0.00|ARTHROSCOPY|
20|FH_F120612_23314_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150939_0_0|SrvcGrp|100266|2022|PDM|4.30|99|0.00|TB INTRADERMAL TEST|
20|FH_F39098_0_0|SrvcGrp|28098|2022|PCT|0.75|99|0.00|OP ANGIOPLASTY|
20|FH_F39633_0_0|SrvcGrp|17075|2022|PDM|1524.00|99|0.00|ASPG VI|
20|FH_F48295_0_0|SrvcGrp|36066|2022|PDM|26.00|99|0.00|NURSING CARE|
20|FH_F48836_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F138684_44484_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F138876_25302_0|SrvcGrp|29077|2022|PDM|150.00|99|0.00|HOME TRANSFUSION|
20|FH_F138876_25302_0|SrvcGrp|17015|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138907_01040_0|SrvcGrp|82223|2022|PDM|170.00|99|0.00|HOSPICE CARE|
20|FH_F122035_84020_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F144968_18702_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144989_07701_0|SrvcGrp|26160|2022|PCT|1.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F145468_60615_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F36555_0_0|SrvcGrp|474|2022|PDM|390.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F135495_33145_0|SrvcGrp|73842|2022|PDM|196.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F135507_02859_0|SrvcGrp|472|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F136170_76132_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F100765_73735_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F100880_67735_0|SrvcGrp|36991|2022|PCT|0.49|99|0.00|IMPLANTS|
20|FH_F130766_04967_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F101581_16371_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33785_0_0|SrvcGrp|588|2022|PDM|1800.00|99|0.00|CORONARY CARE UNIT|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPTION CARE OF MUNCY FH MOD-TC|
20|FH_F111291_52501_0|SrvcGrp|75545|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F111292_33136_0|SrvcGrp|72990|2022|PDM|2653.00|99|0.00|AEG 1|
20|FH_F111301_33122_0|SrvcGrp|83059|2022|PDM|5463.00|99|0.00|TRAUMA / BURNS (MSDRG ONLY)|
20|FH_F149239_0_0|SrvcGrp|92502|2022|PDM|683.95|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F31375_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 7 (NO REV)|
20|FH_F87496_17055_0|SrvcGrp|46424|2022|PDM|104.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F87557_33309_0|SrvcGrp|14893|2022|PDM|25.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F128549_44224_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F101620_47401_0|SrvcGrp|43525|2022|PDM|308.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC|
20|FH_F102940_35034_0|SrvcGrp|48385|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F148100_22406_0|SrvcGrp|48398|2022|PDM|84.00|99|0.00|PT SERVICES|
20|FH_F141471_0_0|SrvcGrp|113284|2022|PDM|1551.00|99|0.00|LIGATION/BANDING A-V|
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136467_0_0|SrvcGrp|36864|2022|PDM|3152.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F137057_0_0|SrvcGrp|14494|2022|PDM|56.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F149179_0_0|SrvcGrp|115608|2022|PDM|5202.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F123601_30680_0|SrvcGrp|78067|2022|PDM|425.00|99|0.00|SUBACUTE CARE|
20|FH_F123784_03264_0|SrvcGrp|48385|2022|PDM|166.00|99|0.00|SPEECH THERAPY|
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|857.00|99|0.00|AEG 2 (NO REV)|
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.00|99|0.00|AEG 1 (NO REV)|
20|FH_F40347_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION|
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|676.00|99|0.00|AEG 1 (NO REV)|
20|FH_F136347_30328_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F136386_30901_0|SrvcGrp|112128|2022|PDM|600.00|99|0.00|CAT SCAN|
20|FH_F134126_11554_0|CSTM-ALL|CSTM-00|2020|PDM|3387.00|99|0.00|AEG 7 (NO REV)|
20|FH_F137236_17603_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F142491_06033_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F83831_0_0|SrvcGrp|9832|2022|PDM|88.00|99|0.00|ST SVCS|
20|FH_F97601_67218_0|SrvcGrp|88978|2022|PDM|7023.00|99|0.00|VAGINAL DELIVERY|
20|FH_F138607_02760_0|SrvcGrp|105615|2022|PDM|170.00|99|0.00|ELECTRIC BREAST PUMP (MOD NU)|
20|FH_F77782_66061_0|SrvcGrp|177|2022|PDM|2408.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F140496_38627_0|SrvcGrp|89149|2022|PDM|207.00|99|0.00|OP INTENSIVE|
20|FH_F140867_56345_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F140890_30906_0|SrvcGrp|73842|2022|PDM|221.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148679_57328_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118943_64506_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F36217_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F109882_36695_0|SrvcGrp|86749|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F37960_0_0|SrvcGrp|14990|2022|PCT|0.80|99|0.00|OBSERVATION SVCS (23 HOURS)|
20|FH_F39772_0_0|SrvcGrp|12342|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F39772_0_0|SrvcGrp|58|2022|PDM|6365.00|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F136779_0_0|SrvcGrp|112926|2022|PDM|2218.00|99|0.00|KNEE ARTHROSCOPY PROCEDURES|
20|FH_F141267_0_0|SrvcGrp|113619|2022|PDM|550.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F75243_0_0|SrvcGrp|10951|2022|PDM|273.00|99|0.00|PARTIAL HOSPITALIZATION PSYCH/CD|
20|FH_F34914_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35416_0_0|SrvcGrp|10927|2022|PDM|1140.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F110783_93013_0|SrvcGrp|24752|2022|PDM|12.50|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F128197_84123_0|SrvcGrp|89783|2022|PDM|112.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F67419_0_0|SrvcGrp|45306|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE - MOD TF|
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_F126398_77090_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F90223_0_0|SrvcGrp|88829|2022|PDM|13.75|99|0.00|HOME PHARMACY SERVICES (MOD SJ) (HCFA)|
20|FH_F126717_66103_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128764_57501_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42979_0_0|SrvcGrp|3378|2022|PDM|372.00|99|0.00|OBSERVATION SVCS|
20|FH_F111266_30339_0|SrvcGrp|86842|2022|PDM|25.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F35527_0_0|SrvcGrp|16494|2022|PDM|425.00|99|0.00|MULTIPLE SLEEP LATENCY|
20|FH_F98880_50158_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120848_20912_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 5  (NO REV)|
20|FH_F36435_0_0|SrvcGrp|16071|2022|PDM|372.00|99|0.00|AMBULANCE - ALS|
20|FH_F33719_0_0|SrvcGrp|512|2022|PCT|0.70|99|0.00|PANCREAS TRANSPLANT|
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1836.00|99|0.00|AEG 2 (NO REV)|
20|FH_F147159_62615_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147218_48026_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138018_17313_0|SrvcGrp|80700|2022|PCT|1.28|99|0.00|AETNA DME|
20|FH_F135093_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126272_70403_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AEG 3 (NO REV)|
20|FH_F131449_19073_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F35726_33324_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F131113_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F35557_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1414794 AM HOME PAT DME MOD KF|
20|FH_F115483_62002_0|SrvcGrp|105806|2022|PDM|9654.00|99|0.00|VASCULAR ANGIOPLASTY|
20|FH_F101441_0_0|SrvcGrp|97179|2022|PDM|7946.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON|
20|FH_F127418_0_0|SrvcGrp|67064|2022|PDM|7137.38|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F143488_84770_0|SrvcGrp|109760|2022|PDM|1688.00|99|0.00|TRANSLUM DIL EYE CANAL|
20|FH_F143536_47546_0|SrvcGrp|100267|2022|PCT|1.00|99|0.00|URINE BACTERIA CULTURE|
20|FH_F84631_0_0|SrvcGrp|17000|2022|PCT|0.83|99|0.00|OUTPATIENT SURGERY|
20|FH_F130925_34652_0|SrvcGrp|46903|2022|PDM|609.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F130937_98002_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F131067_57105_0|SrvcGrp|75505|2022|PCT|1.70|99|0.00|CARDIAC STUDIES|
20|FH_F131173_17043_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F151755_03303_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120208_20109_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132431_79606_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112687_30474_0|SrvcGrp|92518|2022|PDM|158.40|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F116609_35801_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F116907_75093_0|SrvcGrp|105819|2022|PDM|1250.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F120866_51652_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F120856_78247_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F126438_50029_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F126438_50029_0|SrvcGrp|46903|2022|PDM|650.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F118917_33317_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F84611_30281_0|SrvcGrp|31782|2022|PDM|2940.00|99|0.00|MSDRG 258-262 ONLY PACEMAKER REVISION OR REPLACEMENT|
20|FH_F33925_0_0|SrvcGrp|18140|2022|PDM|9500.00|99|0.00|MS DRG 246|
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|990.00|99|0.00|AEG 2 (NO REV)|
20|FH_F40755_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MRI/CT MOD 26|
20|FH_F42012_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OP SVCS|
20|FH_F63117_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|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_F125028_19061_0|SrvcGrp|86832|2022|PDM|3.15|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F129656_15005_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F93881_15009_0|SrvcGrp|100660|2022|PDM|1058.00|99|0.00|AETNA SURGERY|
20|FH_F121111_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F119578_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F149863_68127_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F92034_0_0|SrvcGrp|73008|2022|PDM|831.00|99|0.00|AEG 10|
20|FH_F145588_75081_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F137427_89146_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F110925_01104_0|SrvcGrp|86121|2022|PDM|42.58|99|0.00|AETNA GAMUNEX-C|
20|FH_F132002_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F72183_0_0|SrvcGrp|9263|2022|PDM|600.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F117371_77059_0|SrvcGrp|93919|2022|PDM|475.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F129514_79605_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F117098_20186_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F117098_20186_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117221_23434_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117240_37334_0|SrvcGrp|75497|2022|PDM|2500.00|99|0.00|AEG 10|
20|FH_F137333_51012_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F124757_45750_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F129941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F130035_0_0|SrvcGrp|111472|2022|PDM|15.45|99|0.00|FLUZONE VACCINE|
20|FH_F149029_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62579_0_0|SrvcGrp|17014|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
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_F38560_0_0|SrvcGrp|13551|2022|PDM|350.00|99|0.00|NEWBORN NURSERY|
20|FH_F130656_04401_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AETNA OP CT SCANS (CTSCAN) - HCFA|
20|FH_F130659_44410_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130755_04401_0|SrvcGrp|75506|2022|PCT|0.93|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F118123_67226_0|SrvcGrp|24744|2022|PDM|83.00|99|0.00|PICC LINE INSERTION|
20|FH_F125133_20601_0|SrvcGrp|48398|2022|PDM|180.00|99|0.00|PT SERVICES|
20|FH_F120408_0_0|SrvcGrp|23587|2022|PDM|731.50|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F121601_47446_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148644_06890_0|SrvcGrp|98524|2022|PDM|2710.00|99|0.00|EXCISION OF BONE CYST|
20|FH_F133972_27103_0|SrvcGrp|14949|2022|PDM|70.00|99|0.00|HOME INFUSION|
20|FH_F113424_60626_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149320_82609_0|SrvcGrp|92760|2022|PCT|1.20|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133972_27103_0|SrvcGrp|22589|2022|PDM|35.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F77044_0_0|SrvcGrp|74147|2022|PCT|1.00|99|0.00|INFUSION S-CODE PER MONTH|
20|FH_F137362_0_0|SrvcGrp|113091|2022|PDM|214.00|99|0.00|ACUTE KIDNEY INJURY|
20|FH_F133815_46526_0|SrvcGrp|78420|2022|PDM|1100.00|99|0.00|INTERIM LABOR|
20|FH_F125133_20601_0|SrvcGrp|110072|2022|PDM|63.65|99|0.00|WOUND FILLER GEL/PASTE /OZ|
20|FH_F143677_62301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 3 (NO REV)|
20|FH_F131100_0_0|SrvcGrp|111740|2022|PDM|2300.00|99|0.00|ARTHROSCOPY|
20|FH_F120720_24541_0|SrvcGrp|48385|2022|PDM|70.00|99|0.00|SPEECH THERAPY|
20|FH_F138302_15701_0|SrvcGrp|29023|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134188_83201_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116806_0_0|SrvcGrp|107061|2022|PDM|1923.16|99|0.00|RECONSTRUCT CLEFT PALATE|
20|FH_F127157_43614_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F124159_92506_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F139443_37705_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F49552_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ST CHARLES RAD|
20|FH_F147962_85008_0|SrvcGrp|4003|2022|PDM|5000.00|99|0.00|CPT CODE 99291- CRITICAL CARE|
20|FH_F149246_95603_0|SrvcGrp|89337|2022|PDM|1149.53|99|0.00|DETOXIFICATION|
20|FH_F149199_73005_0|SrvcGrp|15480|2022|PDM|72.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F133957_84121_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134655_14221_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F113345_25301_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F143624_73069_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F121225_98902_0|SrvcGrp|82137|2022|PCT|0.85|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F112004_15401_0|SrvcGrp|46605|2022|PDM|200.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F134328_13088_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146543_89511_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F124173_66215_0|SrvcGrp|24752|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F110344_37421_0|SrvcGrp|89417|2022|PDM|542.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F115616_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F79623_0_0|SrvcGrp|73000|2022|PDM|5803.00|99|0.00|AEG 6|
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|521.00|99|0.00|ASPG II|
20|FH_F125328_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149139_07522_0|SrvcGrp|113230|2022|PDM|42.13|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 SCR|
20|FH_F50657_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F32116_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149270_98004_0|SrvcGrp|75419|2022|PDM|438.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F95623_84015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78584_0_0|SrvcGrp|75646|2022|PCT|0.50|99|0.00|HIGH COST DRUGS|
20|FH_F58713_0_0|SrvcGrp|15472|2022|PDM|544.00|99|0.00|CPT CODE 62284|
20|FH_F146543_89511_0|SrvcGrp|104187|2022|PDM|10.00|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F125259_0_0|SrvcGrp|108114|2022|PDM|2500.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|2026.41|99|0.00|HAPA WPA-NWPA 2012-13 ASC 4 W/O REV|
20|FH_F146103_63851_0|SrvcGrp|109057|2022|PCT|0.75|99|0.00|CARDIAC STUDIES|
20|FH_F146540_78013_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|5500.00|99|0.00|AEG 6 (NO REV)|
20|FH_F150239_75569_0|SrvcGrp|14893|2022|PCT|1.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|373.88|99|0.00|AEG 1 (NO REV)|
20|FH_F125657_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F31714_0_0|SrvcGrp|3420|2022|PDM|5500.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F39619_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136790_0_0|SrvcGrp|3403|2022|PDM|154.00|99|0.00|CPT 99203|
20|FH_F147941_06023_0|SrvcGrp|94882|2022|PCT|1.26|99|0.00|FLU VIRUS VACC-SPLIT 3 YRS & ABOVE|
20|FH_F49042_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING|
20|FH_F130747_0_0|SrvcGrp|71666|2022|PDM|17167.00|99|0.00|CPT 63655|
20|FH_F116291_11570_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F44198_0_0|SrvcGrp|18539|2022|PDM|1.50|99|0.00|ADDITIONAL MILEAGE - WHEELCHAIR VAN|
20|FH_F148239_74012_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F47963_0_0|SrvcGrp|25665|2022|PCT|0.60|99|0.00|PHARMACY|
20|FH_F35476_0_0|SrvcGrp|183|2022|PCT|0.95|99|0.00|TRAUMA EMERGENCY ROOM SVCS|
20|FH_F135172_33157_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F126153_44663_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F148221_06477_0|SrvcGrp|88621|2022|PDM|105.00|99|0.00|SKILLED NURSING LPN|
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_F137527_31322_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F38798_0_0|SrvcGrp|10543|2022|PDM|100.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F38798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|DME - MOD NU|
20|FH_F126439_92627_0|SrvcGrp|104079|2022|PCT|0.60|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F132768_0_0|SrvcGrp|472|2022|PDM|1150.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F128887_57225_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89453_75069_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F120973_34653_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S - PMRS|
20|FH_F127988_85258_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F67121_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F123885_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149060_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|1219.00|99|0.00|AEG 8 (NO REV)|
20|FH_F110263_0_0|SrvcGrp|115582|2022|PDM|7354.00|99|0.00|CYSTO/URETERO LITHOTRIPSY (HCFA)|
20|FH_F37659_0_0|SrvcGrp|89|2022|PDM|131763.00|99|0.00|LIVER TRANSPLANT|
20|FH_F128881_70601_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F110925_01104_0|SrvcGrp|27615|2022|PDM|86.93|99|0.00|AETNA DRUGS|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|1550.00|99|0.00|ASPG III|
20|FH_F149839_80002_0|SrvcGrp|89783|2022|PDM|144.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F120337_85004_0|SrvcGrp|82981|2022|PDM|143.50|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F117784_0_0|SrvcGrp|106317|2022|PDM|488.38|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F135013_46321_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124388_0_0|SrvcGrp|87054|2022|PDM|1254.00|99|0.00|CYSTOSCOPY CHEMODENERVATION|
20|FH_F93563_98499_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F138010_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F119760_0_0|SrvcGrp|89781|2022|PDM|107.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F131267_48846_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148543_71103_0|SrvcGrp|79804|2022|PDM|1428.00|99|0.00|AETNA MEDICAL/SURGICAL|
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1669.08|99|0.00|ASPG IX|
20|FH_F115112_48035_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F116341_12180_0|SrvcGrp|89149|2022|PDM|135.00|99|0.00|OP INTENSIVE|
20|FH_F37651_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD AV|
20|FH_F135267_19002_0|SrvcGrp|106048|2022|PDM|1123.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F93136_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F73985_0_0|SrvcGrp|17071|2022|PDM|2232.00|99|0.00|ASPG IV|
20|FH_F116203_63901_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F145758_20745_0|SrvcGrp|99073|2022|PCT|1.11|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F118057_47906_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150314_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|891.00|99|0.00|AEG 6 (NO REV)|
20|FH_F35476_0_0|CSTM-ALL|CSTM-00|2020|PDM|3737.00|99|0.00|MS DRG 775|
20|FH_F135259_21090_0|SrvcGrp|75419|2022|PDM|350.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F72784_0_0|SrvcGrp|11258|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F143528_0_0|SrvcGrp|90430|2022|PDM|4861.50|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F130747_0_0|SrvcGrp|82108|2022|PDM|5202.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F143785_19713_0|SrvcGrp|74668|2022|PDM|287.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F60019_0_0|SrvcGrp|14497|2022|PCT|0.75|99|0.00|COGNITIVE REMEDIATION PROGRAM|
20|FH_F148486_03110_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F123533_63825_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123895_52722_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F40043_0_0|SrvcGrp|18237|2022|PDM|5990.00|99|0.00|MS DRG 284|
20|FH_F109180_18015_0|SrvcGrp|93919|2022|PDM|533.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PDM|1728.00|99|0.00|AEG 8 (NO REV)|
20|FH_F83451_0_0|SrvcGrp|81563|2022|PDM|3500.00|99|0.00|ABLATION ONE OR MORE|
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PDM|957.00|99|0.00|AEG 3 (NO REV)|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|137.03|99|0.00|CPT 95810 (W/MOD 26)|
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|876.00|99|0.00|AEG 3 (NO REV)|
20|FH_F122705_33351_0|SrvcGrp|73841|2022|PDM|350.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F122911_92240_0|SrvcGrp|46903|2022|PDM|900.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F122911_92240_0|SrvcGrp|73605|2022|PDM|1100.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F37478_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F130656_04401_0|SrvcGrp|105465|2022|PCT|0.89|99|0.00|AETNA THERAPIES|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|138.08|99|0.00|HAPA WPA-NWPA 2012-13 ASC 142 W/O REV|
20|FH_F111903_26241_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F133727_33511_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F133207_0_0|SrvcGrp|44067|2022|PDM|3809.00|99|0.00|CPT 52240|
20|FH_F80172_0_0|SrvcGrp|13929|2022|PCT|0.00|99|0.00|GROWTH HORMONE|
20|FH_F114444_19602_0|SrvcGrp|73842|2022|PDM|120.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111882_51560_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F120583_43219_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F127914_28602_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69606_0_0|SrvcGrp|64113|2022|PDM|45.50|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 10|
20|FH_F134489_90305_0|SrvcGrp|73841|2022|PDM|450.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F122526_22203_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F39832_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87053_0_0|SrvcGrp|73006|2022|PDM|2152.00|99|0.00|AEG 9|
20|FH_F79624_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F115788_02904_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
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|9774|2022|PDM|5789.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F75842_0_0|SrvcGrp|17079|2022|PDM|3583.57|99|0.00|ASPG VIII|
20|FH_F80513_0_0|CSTM-ALL|CSTM-00|2020|PDM|6678.00|99|0.00|MS DRG 491 ONLY|
20|FH_F146855_60069_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125440_04043_0|SrvcGrp|54142|2022|PDM|268.00|99|0.00|OP INTENSIVE SERVICES|
20|FH_F131697_33444_0|SrvcGrp|92761|2022|PCT|1.10|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131989_66030_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132250_12550_0|SrvcGrp|86866|2022|PDM|131.88|99|0.00|AETNA PSYCH DIAG EVAL W/MED SRVC (MOD TD)(HCFA)|
20|FH_F133478_40165_0|SrvcGrp|28167|2022|PDM|64787.00|99|0.00|MS DRG 231 ONLY|
20|FH_F133478_40165_0|SrvcGrp|112338|2022|PCT|0.54|99|0.00|THUMB REPLANTATION|
20|FH_F138487_85297_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F139172_40207_0|SrvcGrp|87441|2022|PDM|630.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F150745_03301_0|SrvcGrp|88620|2022|PDM|167.00|99|0.00|SKILLED NURSING RN|
20|FH_F150839_03833_0|SrvcGrp|104228|2022|PDM|208.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F134432_85053_0|SrvcGrp|73063|2022|PDM|883.00|99|0.00|OBSERVATION SERVICES|
20|FH_F138647_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109470_15370_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120207_0_0|SrvcGrp|33967|2022|PDM|3099.00|99|0.00|CPT 47562|
20|FH_F150982_0_0|SrvcGrp|33724|2022|PDM|2202.00|99|0.00|ARTHROSCOPY|
20|FH_F125182_0_0|SrvcGrp|72996|2022|PDM|680.00|99|0.00|AEG 4|
20|FH_F113869_40215_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F149045_45679_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F140295_0_0|SrvcGrp|93807|2022|PDM|2880.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F136843_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F35416_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F50415_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132039_92008_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F33566_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|ACUTE PSYCH|
20|FH_F98001_27603_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 2 (NO REV)|
20|FH_F117603_92210_0|SrvcGrp|89337|2022|PDM|1150.00|99|0.00|DETOXIFICATION|
20|FH_F138017_73129_0|SrvcGrp|97473|2022|PDM|8122.00|99|0.00|EXPLORE PARATHYROID GLANDS|
20|FH_F102525_73134_0|SrvcGrp|26686|2022|PDM|43000.00|99|0.00|MS DRG 455 ONLY|
20|FH_F150382_80821_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F113957_73554_0|SrvcGrp|73000|2022|PDM|2415.00|99|0.00|AEG 6|
20|FH_F50078_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HILLCREST IV THERAPY - MOD SH|
20|FH_F116753_0_0|SrvcGrp|106776|2022|PDM|7465.00|99|0.00|ARTHROSCOPY FRACTURE|
20|FH_F92299_62016_0|SrvcGrp|73000|2022|PCT|0.75|99|0.00|AEG 6|
20|FH_F139576_0_0|SrvcGrp|97019|2022|PDM|2497.00|99|0.00|ARTHROSCOPY BICEPS TENODESIS|
20|FH_F98940_70506_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F149651_90046_0|SrvcGrp|114008|2022|PDM|525.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F94643_90501_0|SrvcGrp|86845|2022|PDM|60.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F35410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150952_85008_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134394_92101_0|SrvcGrp|112562|2022|PDM|604.00|99|0.00|PARTIAL HOSP (12-17 YRS) (HCFA)|
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|755.00|99|0.00|AEG 2 (NO REV)|
20|FH_F151003_33162_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92498_07442_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89640_98133_0|CSTM-ALL|CSTM-00|2020|PCT|1.11|99|0.00|AETNA - APC GROUPER M|
20|FH_F32825_0_0|CSTM-ALL|CSTM-00|2020|PDM|10058.00|99|0.00|MSDRG 250-251 PERCUTANEOUS CARDIO PROC|
20|FH_F123745_0_0|SrvcGrp|82109|2022|PDM|2200.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F127636_06030_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133569_17202_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|CARECENTRIX AWP - 10% (MANUAL REVIEW)|
20|FH_F34777_0_0|SrvcGrp|17353|2022|PDM|4515.00|99|0.00|LAPAROSCOPIC SURGERY|
20|FH_F35678_0_0|SrvcGrp|18211|2022|PDM|8476.00|99|0.00|MS DRG 028|
20|FH_F130721_04769_0|SrvcGrp|73063|2022|PCT|0.89|99|0.00|OBSERVATION SERVICES|
20|FH_F130914_51103_0|SrvcGrp|46903|2022|PDM|630.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F83380_0_0|SrvcGrp|11157|2022|PDM|55.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F121225_98902_0|SrvcGrp|108700|2022|PDM|103.95|99|0.00|HOME HEALTH AIDE|
20|FH_F83978_66739_0|SrvcGrp|72990|2022|PDM|461.00|99|0.00|AEG 1|
20|FH_F43865_0_0|SrvcGrp|37405|2022|PDM|90.00|99|0.00|OT SVCS|
20|FH_F100782_0_0|SrvcGrp|105069|2022|PDM|668.48|99|0.00|WINDBER MEDICAL CNTR ASC 114|
20|FH_F111027_32817_0|SrvcGrp|86723|2022|PDM|484.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F100782_0_0|SrvcGrp|105167|2022|PDM|1437.80|99|0.00|WINDBER MEDICAL CNTR ASC 602|
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|1362.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F120670_0_0|SrvcGrp|88065|2022|PDM|16000.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F134608_18017_0|SrvcGrp|112611|2022|PDM|150.00|99|0.00|ENDOCERVICAL CURETTAGE|
20|FH_F132899_01002_0|SrvcGrp|90346|2022|PDM|1056.00|99|0.00|AETNA RESIDENTIAL EATING DISORDERS <=17 YRS|
20|FH_F123623_03246_0|SrvcGrp|109291|2022|PCT|1.00|99|0.00|ADMIN INFLUENZA VIRUS VAC|
20|FH_F133887_17013_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F93122_01854_0|SrvcGrp|86639|2022|PDM|945.00|99|0.00|AETNA IP PSYCHIATRIC (<18 YRS)|
20|FH_F145641_06902_0|SrvcGrp|27330|2022|PDM|2178.00|99|0.00|CPT 27096|
20|FH_F126555_44906_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F73864_0_0|SrvcGrp|48398|2022|PDM|12.00|99|0.00|PT SERVICES|
20|FH_F125133_20601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39418_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63836|2022|PDM|477.28|99|0.00|HAPA WPA-NWPA 2012-13 ASC 218|
20|FH_F124161_95932_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132883_31602_0|SrvcGrp|86842|2022|PDM|20.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F81698_10457_0|SrvcGrp|86853|2022|PDM|31.50|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F89219_0_0|SrvcGrp|20902|2022|PDM|29452.00|99|0.00|MS DRG 249 ONLY|
20|FH_F109400_80026_0|SrvcGrp|46605|2022|PDM|98.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F124161_95932_0|SrvcGrp|72998|2022|PDM|4182.00|99|0.00|AEG 5|
20|FH_F134608_18017_0|SrvcGrp|108145|2022|PDM|550.00|99|0.00|INDUCED ABORTION BY ORAL INGESTION OF MEDICATION (HCFA)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|532.59|99|0.00|HAPA WPA-NWPA 2012-13 ASC 307 W/O REV|
20|FH_F31998_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F110309_63301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150165_06032_0|SrvcGrp|86463|2022|PDM|2649.00|99|0.00|FRACTURE NASAL INFERIOR|
20|FH_F149246_95603_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F77943_0_0|SrvcGrp|12886|2022|PCT|0.70|99|0.00|HOSPICE SVCS (HOME CARE)|
20|FH_F132690_87571_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F114404_73044_0|SrvcGrp|99600|2022|PCT|1.05|99|0.00|PT/OT/ST|
20|FH_F112082_30720_0|SrvcGrp|24745|2022|PDM|91.67|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F130763_0_0|SrvcGrp|106265|2022|PDM|6043.00|99|0.00|NSL/SINS NDSC TOTAL|
20|FH_F112791_0_0|SrvcGrp|81859|2022|PDM|535.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F132883_31602_0|SrvcGrp|86849|2022|PDM|20.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F33335_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43861_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F109242_18466_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F135670_01749_0|SrvcGrp|10578|2022|PDM|31.00|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F115616_0_0|SrvcGrp|98494|2022|PDM|4474.00|99|0.00|ARTHRODESIS PRE-SACRAL|
20|FH_F116959_0_0|SrvcGrp|16669|2022|PDM|3000.00|99|0.00|ACROMINOPLASTY OF SHOULDER|
20|FH_F132840_65201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110423_33401_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F149121_01520_0|SrvcGrp|115394|2022|PCT|1.00|99|0.00|DRUGS|
20|FH_F85652_98034_0|SrvcGrp|13228|2022|PDM|1316.00|99|0.00|CPT CODE 99284|
20|FH_F109242_18466_0|SrvcGrp|91394|2022|PDM|123.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD HO)|
20|FH_F149051_01605_0|SrvcGrp|92760|2022|PCT|1.05|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F80172_0_0|SrvcGrp|24752|2022|PCT|0.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F103220_0_0|SrvcGrp|116259|2022|PDM|4510.00|99|0.00|HERNIA|
20|FH_F83995_16748_0|CSTM-ALL|CSTM-00|2020|PDM|686.00|99|0.00|SWING BED|
20|FH_F79743_0_0|CSTM-ALL|CSTM-00|2020|PDM|3511.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F87333_0_0|SrvcGrp|72990|2022|PDM|560.71|99|0.00|AEG 1|
20|FH_F112791_0_0|SrvcGrp|72998|2022|PDM|752.00|99|0.00|AEG 5|
20|FH_F86101_76063_0|SrvcGrp|29347|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE|
20|FH_F111702_07652_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134601_94010_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139512_77550_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F116727_0_0|SrvcGrp|35670|2022|PDM|6500.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 2 (NO REV)|
20|FH_F62995_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100782_0_0|SrvcGrp|69924|2022|PDM|4429.00|99|0.00|PTCA W/O STENT|
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_F50703_0_0|SrvcGrp|46964|2022|PDM|75.00|99|0.00|CHEMO (CPT 96413)|
20|FH_F138127_44857_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F128816_43537_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F54592_0_0|SrvcGrp|27044|2022|PDM|30.50|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS (MOD SH)|
20|FH_F79587_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F75963_0_0|SrvcGrp|48394|2022|PDM|8.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F101100_50314_0|SrvcGrp|97911|2022|PDM|13704.00|99|0.00|LAPAROSCOPY PARTIAL COLECTOMY|
20|FH_F102200_06416_0|SrvcGrp|112058|2022|PDM|45.00|99|0.00|INFLECTRA|
20|FH_F115877_63556_0|SrvcGrp|104100|2022|PDM|2800.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|1002.00|99|0.00|AEG 8 (NO REV)|
20|FH_F130328_0_0|SrvcGrp|95660|2022|PDM|692.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F40567_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F101083_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147224_48026_0|SrvcGrp|108622|2022|PDM|453.00|99|0.00|SUB ACUTE CARE LEVEL II|
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|8150.00|99|0.00|MS DRG 491|
20|FH_F92032_32308_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F35990_0_0|SrvcGrp|701|2022|PDM|3008.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|2046.00|99|0.00|AEG 7 (NO REV)|
20|FH_F130661_04441_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AETNA OP CT SCANS (CTSCAN) - HCFA|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.65|99|0.00|SALLY BALIN,999182,ASC 223|
20|FH_F137767_01841_0|SrvcGrp|22378|2022|PDM|150.00|99|0.00|CPT CODE 93000|
20|FH_F119376_0_0|SrvcGrp|73002|2022|PDM|1194.00|99|0.00|AEG 7|
20|FH_F114571_34613_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F37864_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F82452_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124975_63366_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F126933_33174_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125656_92868_0|SrvcGrp|86854|2022|PDM|50.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F65100_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|HAPA EPA ASC 30|
20|FH_F128988_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F124441_0_0|SrvcGrp|92410|2022|PDM|9025.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F97084_91911_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F92431_80033_0|SrvcGrp|42972|2022|PDM|72.00|99|0.00|HOME HEALTH AIDE|
20|FH_F97184_26101_0|SrvcGrp|73656|2022|PDM|367.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F114206_37203_0|SrvcGrp|75323|2022|PCT|1.00|99|0.00|DME|
20|FH_F35384_0_0|SrvcGrp|11086|2022|PDM|1178.00|99|0.00|CSECT (MOTHER ONLY)|
20|FH_F127292_85705_0|SrvcGrp|87131|2022|PDM|300.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F150442_28451_0|SrvcGrp|92007|2022|PDM|7750.00|99|0.00|PROXIMAL HUMERAL|
20|FH_F122393_76020_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F124325_37643_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|622.96|99|0.00|AEG 1 (NO REV)|
20|FH_F74670_0_0|SrvcGrp|15477|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS INITIAL EVAL|
20|FH_F74845_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F97183_25304_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F35097_16508_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE 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_F122649_0_0|SrvcGrp|97507|2022|PDM|112.00|99|0.00|AETNA HOSPICE|
20|FH_F90455_0_0|SrvcGrp|90065|2022|PDM|6.50|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|980.00|99|0.00|AEG 1 (NO REV)|
20|FH_F131187_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F102620_0_0|SrvcGrp|33813|2022|PDM|646.88|99|0.00|CD - DETOX|
20|FH_F140176_51445_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|GENERAL ACUTE CARE|
20|FH_F101700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F102341_0_0|SrvcGrp|79720|2022|PDM|1379.00|99|0.00|ACUTE REHAB II|
20|FH_F102920_0_0|SrvcGrp|77021|2022|PDM|3602.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD UE KE|
20|FH_F48224_0_0|SrvcGrp|73002|2022|PDM|1177.00|99|0.00|AEG 7|
20|FH_F120191_91360_0|SrvcGrp|89337|2022|PDM|1000.00|99|0.00|DETOXIFICATION|
20|FH_F132426_33844_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132446_19063_0|SrvcGrp|87399|2022|PDM|76.00|99|0.00|CPT 99502 (HCFA)|
20|FH_F112712_63005_0|SrvcGrp|29076|2022|PCT|1.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F116609_35801_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F119998_39823_0|SrvcGrp|75545|2022|PDM|605.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F119998_39823_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35685_0_0|SrvcGrp|3581|2022|PDM|15435.00|99|0.00|DRG 111 MAJOR CV PROC W/O CC|
20|FH_F40855_0_0|CSTM-ALL|CSTM-00|2020|PDM|1066.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98621_41042_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F67739_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F37174_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F49895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD TC|
20|FH_F66961_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO|
20|FH_F61292_0_0|SrvcGrp|20297|2022|PDM|34795.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VALVE PROC|
20|FH_F35202_0_0|SrvcGrp|3327|2022|PDM|94.50|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F135236_02840_0|SrvcGrp|112676|2022|PDM|238.30|99|0.00|COVID-19 SARS-COV-2 ANTIBODY|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/GLOBAL (TN)|
20|FH_F137067_0_0|SrvcGrp|92408|2022|PDM|6300.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F148200_26554_0|SrvcGrp|76744|2022|PCT|0.75|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F141802_17042_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F126242_32796_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148354_44471_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F46612_0_0|CSTM-ALL|CSTM-00|2020|PDM|166.00|99|0.00|SKILLED NURSING CARE|
20|FH_F73202_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F118056_29464_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148169_33138_0|SrvcGrp|105323|2022|PCT|1.00|99|0.00|ESTABLISH PATIENT OFF/OP VST|
20|FH_F39479_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F142073_0_0|SrvcGrp|67065|2022|PDM|11900.00|99|0.00|CERVICAL SURGERY|
20|FH_F148221_06477_0|SrvcGrp|95220|2022|PDM|893.00|99|0.00|HOSPICE CARE PROVIDED IN HOSPICE FACILITY (HCFA)|
20|FH_F89453_75069_0|SrvcGrp|48645|2022|PDM|95.00|99|0.00|OP SKILLED NURSING|
20|FH_F130747_0_0|SrvcGrp|103328|2022|PDM|6242.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN|
20|FH_F148323_84070_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F102184_0_0|SrvcGrp|27261|2022|PDM|8661.00|99|0.00|CPT 27446|
20|FH_F86412_32258_0|SrvcGrp|471|2022|PDM|577.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149859_60005_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116237_43235_0|SrvcGrp|46903|2022|PDM|494.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F44218_0_0|SrvcGrp|23587|2022|PDM|620.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F143528_0_0|SrvcGrp|99167|2022|PDM|5250.00|99|0.00|CPT 63057|
20|FH_F130716_76013_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F78165_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F137946_0_0|SrvcGrp|113226|2022|PDM|42.28|99|0.00|COVID-19 SVNT SARSCOV2 ELISA PLSM SRM|
20|FH_F115050_77995_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F38810_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F149523_0_0|SrvcGrp|98565|2022|PDM|15000.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F143790_83440_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120352_52556_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F123466_93420_0|SrvcGrp|90040|2022|PDM|457.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F130977_0_0|SrvcGrp|11606|2022|PDM|1450.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)|
20|FH_F37590_0_0|SrvcGrp|9832|2022|PDM|84.00|99|0.00|ST SVCS|
20|FH_F129653_0_0|SrvcGrp|88163|2022|PDM|4000.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F131176_28712_0|SrvcGrp|113276|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|2378.41|99|0.00|AEG 8 (NO REV)|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140427_0_0|SrvcGrp|92407|2022|PDM|2500.00|99|0.00|REMOVAL & REPLACE PULSE GEN 2 LEAD|
20|FH_F125011_74467_0|SrvcGrp|73806|2022|PDM|1200.00|99|0.00|AETNA ER|
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|AEG 1 (NO REV)|
20|FH_F72589_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F35388_0_0|SrvcGrp|10639|2022|PDM|1000.00|99|0.00|CT SCAN|
20|FH_F50673_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F88199_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F113546_0_0|SrvcGrp|48385|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F31594_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F111288_0_0|SrvcGrp|99067|2022|PDM|2527.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F118056_29464_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
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_F110132_23451_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F127998_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129334_43016_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F137462_03062_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F82696_16335_0|CSTM-ALL|CSTM-00|2020|PDM|1294.00|99|0.00|SKILLED NURSING|
20|FH_F73985_0_0|SrvcGrp|71265|2022|PDM|9681.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F121539_27511_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151543_95630_0|SrvcGrp|72602|2022|PDM|1146.00|99|0.00|ECT|
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|3375.00|99|0.00|AEG 9 (NO REV)|
20|FH_F83352_06114_0|SrvcGrp|77042|2022|PDM|98.95|99|0.00|AETNA SKILLED NURSE IN HOME|
20|FH_F131228_01826_0|SrvcGrp|73603|2022|PDM|3864.86|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F40332_0_0|SrvcGrp|12791|2022|PCT|0.65|99|0.00|PROSTHETICS/IMPLANTS/DEVICES|
20|FH_F137616_48823_0|SrvcGrp|22529|2022|PDM|400.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F129768_0_0|SrvcGrp|64758|2022|PCT|1.00|99|0.00|HCPCS|
20|FH_F72830_0_0|SrvcGrp|15323|2022|PDM|150.00|99|0.00|ER LEVEL I|
20|FH_F69766_0_0|SrvcGrp|13985|2022|PDM|47.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F131420_29693_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F83493_21220_0|SrvcGrp|473|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F55552_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F77042_0_0|SrvcGrp|74381|2022|PDM|18.00|99|0.00|PHYSICAL THERAPY|
20|FH_F125983_82301_0|SrvcGrp|9866|2022|PCT|0.85|99|0.00|IP OBSERVATION SVCS|
20|FH_F129011_15857_0|SrvcGrp|111060|2022|PCT|1.00|99|0.00|TOXOIDS VACCINES|
20|FH_F34100_0_0|SrvcGrp|3259|2022|PDM|700.00|99|0.00|ACUTE REHABILITATION|
20|FH_F93880_95476_0|SrvcGrp|72992|2022|PDM|4273.00|99|0.00|AEG 2|
20|FH_F38380_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147212_0_0|SrvcGrp|13720|2022|PDM|180.00|99|0.00|RESIDENTIAL HOSPICE SVCS|
20|FH_F135219_68506_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F126242_32796_0|SrvcGrp|89417|2022|PDM|477.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F39819_0_0|SrvcGrp|31244|2022|PDM|4706.00|99|0.00|NY DRG 426 ONLY|
20|FH_F78446_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F82753_18840_0|SrvcGrp|220|2022|PCT|0.39|99|0.00|INTRAOCULAR LENSES|
20|FH_F79212_0_0|SrvcGrp|26001|2022|PDM|160.99|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F129231_30060_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|AEG 3 (NO REV)|
20|FH_F150699_0_0|SrvcGrp|104638|2022|PDM|12055.00|99|0.00|INSERT HEART PM ATRIAL|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF|
20|FH_F93881_15009_0|SrvcGrp|87101|2022|PDM|134.00|99|0.00|X-RAY EXAM OF SINUSES|
20|FH_F122725_32216_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128496_46936_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86872_15215_0|SrvcGrp|86852|2022|PDM|60.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F119417_78212_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137951_0_0|SrvcGrp|82109|2022|PDM|890.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F148379_89129_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F148554_85016_0|SrvcGrp|108175|2022|PDM|5130.00|99|0.00|TIB/PER REVASC W/TLA|
20|FH_F148554_85016_0|SrvcGrp|115447|2022|PDM|1122.00|99|0.00|REPOSITION LEFT VENTRIC LEAD|
20|FH_F148644_06890_0|SrvcGrp|46890|2022|PDM|6157.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F124966_60559_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36137_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F141930_72032_0|CSTM-ALL|CSTM-00|2020|PDM|894.00|99|0.00|AEG 4 (NO REV)|
20|FH_F142081_54929_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F133535_32110_0|SrvcGrp|73842|2022|PDM|189.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F34303_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126889_57030_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141612_19605_0|SrvcGrp|3178|2022|PDM|1365.00|99|0.00|ACUTE PSYCH|
20|FH_F125255_34769_0|SrvcGrp|87317|2022|PDM|788.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F146135_87112_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F133003_49012_0|SrvcGrp|89417|2022|PDM|360.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F131699_08210_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F125103_0_0|SrvcGrp|26471|2022|PDM|215.00|99|0.00|CPT CODE 90945|
20|FH_F146224_84321_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F106740_02886_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148639_0_0|SrvcGrp|70749|2022|PDM|1800.00|99|0.00|CPT 29823|
20|FH_F137639_0_0|SrvcGrp|13127|2022|PDM|385.00|99|0.00|DIALYSIS|
20|FH_F82813_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F41814_0_0|SrvcGrp|6|2022|PDM|2392.00|99|0.00|OP SURGERY|
20|FH_F43018_0_0|SrvcGrp|16033|2022|PCT|0.60|99|0.00|HIGH COST DRUGS|
20|FH_F125540_19462_0|SrvcGrp|89023|2022|PDM|81.60|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F97882_32407_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148556_13206_0|SrvcGrp|29023|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F150123_60515_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126815_02118_0|CSTM-ALL|CSTM-00|2020|PDM|2231.07|99|0.00|AEG 10 (NO REV)|
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|1304.00|99|0.00|AEG 7 (NO REV)|
20|FH_F92676_15063_0|SrvcGrp|78966|2022|PDM|4174.09|99|0.00|MON VALLEY ASC 4|
20|FH_F118845_71111_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F128316_22192_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F134490_62801_0|SrvcGrp|109910|2022|PDM|2715.00|99|0.00|HYSTEROSCOPY BIOPSY|
20|FH_F43774_0_0|SrvcGrp|22022|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE|
20|FH_F150526_16335_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F67379_0_0|SrvcGrp|11336|2022|PCT|0.74|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F120437_85202_0|SrvcGrp|86837|2022|PDM|45.02|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F100788_01420_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|OP SVCS|
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.00|99|0.00|ASPG V|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|460.94|99|0.00|HAPA WPA-NWPA 2012-13 ASC 208 W/O REV|
20|FH_F38016_0_0|SrvcGrp|38|2022|PDM|2380.00|99|0.00|NORMAL DELIVERY|
20|FH_F112832_06776_0|SrvcGrp|473|2022|PDM|502.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120437_85202_0|SrvcGrp|29077|2022|PDM|45.02|99|0.00|HOME TRANSFUSION|
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F103281_32086_0|SrvcGrp|73496|2022|PDM|1200.00|99|0.00|AETNA ER LEVEL V|
20|FH_F97581_60141_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F142011_02859_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 2 (NO REV)|
20|FH_F34706_0_0|CSTM-ALL|CSTM-00|2020|PDM|1453.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F43953_0_0|CSTM-ALL|CSTM-00|2020|PDM|4548.00|99|0.00|IP SURGICAL SERVICES|
20|FH_F89932_10940_0|SrvcGrp|89345|2022|PDM|180.00|99|0.00|ACTIVE WOUND CARE MANAGEMENT|
20|FH_F42902_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128512_37087_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F38953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111809_93003_0|SrvcGrp|114117|2022|PDM|100.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT|
20|FH_F102561_75146_0|SrvcGrp|98101|2022|PDM|1500.00|99|0.00|SLEEP STUDY, ATTENDED|
20|FH_F133021_00910_0|CSTM-ALL|CSTM-00|2020|PDM|16000.00|99|0.00|AORTA SURGERY|
20|FH_F68947_0_0|SrvcGrp|79758|2022|PDM|900.00|99|0.00|ANESTHESIA|
20|FH_F44992_0_0|SrvcGrp|13217|2022|PCT|1.10|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F116440_0_0|SrvcGrp|73606|2022|PDM|500.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F117559_08619_0|SrvcGrp|111061|2022|PDM|45.00|99|0.00|TOXOIDS VACCINES|
20|FH_F48929_0_0|SrvcGrp|42785|2022|PDM|60.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F91155_16105_0|SrvcGrp|48385|2022|PDM|102.00|99|0.00|SPEECH THERAPY|
20|FH_F112165_0_0|SrvcGrp|73000|2022|PDM|2415.00|99|0.00|AEG 6|
20|FH_F31049_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133131_30253_0|SrvcGrp|92760|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F50615_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F115909_38133_0|SrvcGrp|94879|2022|PDM|143.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F63625_0_0|SrvcGrp|23477|2022|PDM|11576.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F146419_68504_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146668_30189_0|SrvcGrp|104008|2022|PDM|8500.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS|
20|FH_F146812_50401_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F146812_50401_0|CSTM-ALL|CSTM-00|2020|PDM|1693.20|99|0.00|AEG 3 (NO REV)|
20|FH_F120522_53549_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120805_92672_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F131943_62243_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133415_90066_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F133478_40165_0|SrvcGrp|28164|2022|PDM|72848.00|99|0.00|MS DRG 224 ONLY|
20|FH_F133688_44504_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133402_10007_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111566_75093_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F121404_32216_0|SrvcGrp|108783|2022|PDM|516.00|99|0.00|CONTINUOUS AIRWAY PRESSURE (MOD NU) (HCFA)|
20|FH_F113926_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F37333_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|PDM|157.55|99|0.00|DELAWARE VALLEY- ASC 217|
20|FH_F65761_0_0|SrvcGrp|43428|2022|PDM|84.87|99|0.00|RN HOURLY|
20|FH_F97740_01605_0|SrvcGrp|73601|2022|PDM|15133.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F117001_0_0|SrvcGrp|106594|2022|PDM|400.00|99|0.00|HEARING AID, BINAURAL, CIC|
20|FH_F87197_0_0|SrvcGrp|31854|2022|PDM|1207.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1391.50|99|0.00|AEG 8 (NO REV)|
20|FH_F116043_0_0|SrvcGrp|90477|2022|PDM|100.00|99|0.00|HOSPICE|
20|FH_F112967_0_0|SrvcGrp|29353|2022|PDM|115.00|99|0.00|HOSPICE SVCS|
20|FH_F103780_64804_0|SrvcGrp|113988|2022|PCT|0.68|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F104840_32565_0|SrvcGrp|73605|2022|PCT|0.69|99|0.00|AETNA ACUTE PSYCH|
20|FH_F105591_17601_0|SrvcGrp|72996|2022|PDM|1188.00|99|0.00|AEG 4|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER AV|
20|FH_F94786_07974_0|SrvcGrp|29023|2022|PDM|52.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|2266.00|99|0.00|AEG 4 (NO REV)|
20|FH_F114389_50131_0|SrvcGrp|14944|2022|PDM|12.31|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F114389_50131_0|SrvcGrp|98994|2022|PDM|120.72|99|0.00|HYDRATION THERAPY 2 LITER (HCFA)|
20|FH_F149719_0_0|SrvcGrp|108546|2022|PDM|236.00|99|0.00|PERITONEAL TREATMENTS W/ PATIENT TRAINING|
20|FH_F146993_66020_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38233_0_0|SrvcGrp|27830|2022|PDM|46.00|99|0.00|THERAPY|
20|FH_F49943_0_0|SrvcGrp|42973|2022|PDM|140.00|99|0.00|SPEECH  THERAPIST|
20|FH_F91998_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|1514.21|99|0.00|AEG 3 (NO REV)|
20|FH_F124237_95023_0|SrvcGrp|46903|2022|PDM|1200.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F147899_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|AEG 2 (NO REV)|
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|AEG 3 (NO REV)|
20|FH_F121078_0_0|CSTM-ALL|CSTM-00|2020|PDM|731.00|99|0.00|AEG 2 (NO REV)|
20|FH_F150535_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|OP SVCS|
20|FH_F137248_0_0|SrvcGrp|113067|2022|PDM|1561.00|99|0.00|SKIN TISSUE REARRANGE ADD-ON|
20|FH_F32740_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136607_68632_0|SrvcGrp|79699|2022|PCT|0.97|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F136647_43506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136671_73110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114666_30342_0|SrvcGrp|93432|2022|PDM|22500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F114666_30342_0|SrvcGrp|78096|2022|PDM|3000.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F114705_77018_0|SrvcGrp|89417|2022|PDM|325.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F113937_15301_0|SrvcGrp|46605|2022|PDM|122.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F81832_13827_0|SrvcGrp|53987|2022|PDM|40.00|99|0.00|PHOTOTHERAPY|
20|FH_F144039_0_0|SrvcGrp|109762|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESION(S)|
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1916.00|99|0.00|AEG 6 (NO REV)|
20|FH_F148553_85016_0|SrvcGrp|115444|2022|PDM|1343.00|99|0.00|INSERT PULSE GEN MULT LEADS|
20|FH_F127448_0_0|SrvcGrp|36991|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F122674_94904_0|CSTM-ALL|CSTM-00|2020|PCT|3.50|99|0.00|HSS ASC|
20|FH_F42837_0_0|SrvcGrp|13620|2022|PDM|975.00|99|0.00|SLEEP STUDIES|
20|FH_F43913_0_0|SrvcGrp|32550|2022|PDM|350.00|99|0.00|NEWBORN NURSERY|
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|713.00|99|0.00|AEG 4 (NO REV)|
20|FH_F141170_0_0|SrvcGrp|88164|2022|PDM|18000.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F38826_0_0|SrvcGrp|29736|2022|PCT|0.80|99|0.00|BURN SVCS|
20|FH_F115625_63110_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F147660_75110_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F42379_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114853_0_0|SrvcGrp|54943|2022|PDM|2887.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F42244_0_0|SrvcGrp|38|2022|PDM|1951.00|99|0.00|NORMAL DELIVERY|
20|FH_F48693_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F151501_30265_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 5  (NO REV)|
20|FH_F151507_32327_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122024_75751_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F135465_80023_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136107_63801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136186_46307_0|SrvcGrp|112744|2022|PCT|0.00|99|0.00|HOME HEALTH PROSPECTIVE PAYMENT SYSTEM (HHRG)|
20|FH_F100880_67735_0|SrvcGrp|88793|2022|PDM|37851.00|99|0.00|CARDIAC PACEMAKER INSERTS|
20|FH_F133029_61264_0|SrvcGrp|89149|2022|PDM|246.00|99|0.00|OP INTENSIVE|
20|FH_F91198_46714_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F119437_0_0|SrvcGrp|77021|2022|PDM|4750.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F120605_0_0|SrvcGrp|72996|2022|PDM|1006.00|99|0.00|AEG 4|
20|FH_F102822_84065_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|AEG 10 (NO REV)|
20|FH_F150951_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87155_04105_0|SrvcGrp|14944|2022|PDM|12.61|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F134267_0_0|SrvcGrp|87077|2022|PDM|128.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F39180_0_0|SrvcGrp|15357|2022|PCT|0.70|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F39721_0_0|SrvcGrp|16703|2022|PDM|355.00|99|0.00|HEMO/HOME DIALYSIS SVCS|
20|FH_F115889_0_0|SrvcGrp|72994|2022|PDM|819.00|99|0.00|AEG 3|
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|710.00|99|0.00|AEG 2 (NO REV)|
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|2241.00|99|0.00|ASPG VIII - IOWA|
20|FH_F38410_0_0|SrvcGrp|27968|2022|PDM|41.00|99|0.00|SKILLED NURSING LPN|
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 2 (NO REV)|
20|FH_F92792_0_0|SrvcGrp|38909|2022|PDM|1320.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F89015_74017_0|SrvcGrp|73523|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F97564_52246_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F136393_0_0|SrvcGrp|109502|2022|PDM|3200.00|99|0.00|INSERT PULSE GEN MULT LEADS|
20|FH_F117132_0_0|SrvcGrp|87387|2022|PDM|2000.00|99|0.00|REMOVE EYE IMPLANT MATERIAL|
20|FH_F103360_68845_0|CSTM-ALL|CSTM-00|2020|PCT|0.58|99|0.00|OP SVCS|
20|FH_F89851_83854_0|SrvcGrp|88777|2022|PCT|1.40|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F35176_0_0|SrvcGrp|12263|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F79927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143848_0_0|SrvcGrp|73485|2022|PDM|2776.00|99|0.00|AETNA REHAB|
20|FH_F133397_23233_0|SrvcGrp|112320|2022|PDM|1103.00|99|0.00|MRI/MRA|
20|FH_F147992_63452_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F92648_90248_0|SrvcGrp|48398|2022|PDM|89.25|99|0.00|PT SERVICES|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|186.20|99|0.00|ASPG 116|
20|FH_F55375_0_0|SrvcGrp|12126|2022|PDM|2400.00|99|0.00|OP PET SCAN|
20|FH_F71882_15228_0|SrvcGrp|13985|2022|PDM|55.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F151157_0_0|CSTM-ALL|CSTM-00|2020|PDM|961.00|99|0.00|AEG 2 (NO REV)|
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|266.00|99|0.00|AEG 1 (NO REV)|
20|FH_F148880_26807_0|SrvcGrp|48396|2022|PDM|160.00|99|0.00|OT SERVICES|
20|FH_F151053_17602_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151204_24073_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151223_73077_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F121960_75503_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39895_0_0|SrvcGrp|14093|2022|PDM|1298.00|99|0.00|AMBULATORY SURGERY|
20|FH_F113741_63303_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F82933_0_0|CSTM-ALL|CSTM-00|2020|PDM|9117.38|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F82933_0_0|SrvcGrp|12343|2022|PDM|7735.96|99|0.00|PET SCAN|
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|476.30|99|0.00|AEG 1 (NO REV)|
20|FH_F116143_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F142344_16693_0|SrvcGrp|46903|2022|PDM|557.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F113794_0_0|SrvcGrp|44042|2022|PDM|80.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F115208_0_0|SrvcGrp|98363|2022|PDM|2016.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F105623_77901_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F43860_0_0|SrvcGrp|37406|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F94786_07974_0|SrvcGrp|17014|2022|PDM|36.75|99|0.00|HOME INFUSION THERAPY|
20|FH_F131047_0_0|SrvcGrp|29817|2022|PDM|8002.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|578.00|99|0.00|AEG 2 (NO REV)|
20|FH_F136832_0_0|SrvcGrp|110579|2022|PCT|0.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F114386_07090_0|SrvcGrp|48398|2022|PDM|76.07|99|0.00|PT SERVICES|
20|FH_F114389_50131_0|SrvcGrp|22954|2022|PDM|269.83|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F131505_0_0|SrvcGrp|101820|2022|PDM|578.00|99|0.00|HYSTEROSCOPY RESECT SEPTUM|
20|FH_F124059_64055_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F146985_12205_0|SrvcGrp|46605|2022|PDM|89.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F38983_0_0|SrvcGrp|3418|2022|PDM|680.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F39753_0_0|SrvcGrp|38|2022|PDM|2797.00|99|0.00|NORMAL DELIVERY|
20|FH_F91898_0_0|SrvcGrp|14727|2022|PCT|0.95|99|0.00|TRAUMA CARE|
20|FH_F124653_64062_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124671_64844_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F97083_90670_0|SrvcGrp|73559|2022|PDM|18127.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F133694_89117_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F64779_0_0|SrvcGrp|42825|2022|PDM|82.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F136569_16506_0|SrvcGrp|43924|2022|PDM|382.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F136665_80004_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F136689_45044_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114645_34952_0|SrvcGrp|73841|2022|PDM|390.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F114666_30342_0|SrvcGrp|26273|2022|PDM|1485.00|99|0.00|CPT 29880|
20|FH_F113809_47302_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F113845_32746_0|CSTM-ALL|CSTM-00|2020|PDM|37.99|99|0.00|AETNA ADAPTIVE BEHAVIOR TREATMNT MODIFIED 30 MINS|
20|FH_F138055_16146_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F138716_20151_0|SrvcGrp|79238|2022|PDM|1000.00|99|0.00|TRANSFER|
20|FH_F81832_13827_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130996_34110_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F131374_08009_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F131132_44077_0|CSTM-ALL|CSTM-00|2020|PDM|3607.00|99|0.00|AEG 5  (NO REV)|
20|FH_F131132_44077_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS|
20|FH_F116527_70443_0|SrvcGrp|75506|2022|PCT|1.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F121823_46234_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F33785_0_0|SrvcGrp|290|2022|PDM|5000.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F131407_07607_0|SrvcGrp|86828|2022|PDM|45.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F132689_18436_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F111363_33169_0|SrvcGrp|10944|2022|PDM|1060.00|99|0.00|EMERGENCY ROOM|
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 6 (NO REV)|
20|FH_F65882_0_0|SrvcGrp|26001|2022|PDM|146.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F145587_0_0|SrvcGrp|26277|2022|PDM|1262.70|99|0.00|CPT 29874|
20|FH_F131000_0_0|SrvcGrp|88160|2022|PDM|6450.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F87534_19464_0|SrvcGrp|73485|2022|PDM|1231.00|99|0.00|AETNA REHAB|
20|FH_F96340_23704_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F102325_62691_0|SrvcGrp|90339|2022|PDM|60.00|99|0.00|SKILLED NURSING RN|
20|FH_F102325_62691_0|SrvcGrp|22389|2022|PDM|19.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F102325_62691_0|SrvcGrp|14948|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F102902_33764_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F101320_26062_0|SrvcGrp|22592|2022|PDM|66.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F101320_26062_0|SrvcGrp|48385|2022|PDM|108.00|99|0.00|SPEECH THERAPY|
20|FH_F143542_0_0|SrvcGrp|109761|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESIONS|
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36372_0_0|SrvcGrp|19984|2022|PDM|42.00|99|0.00|THERAPY|
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F103004_75840_0|SrvcGrp|3066|2022|PCT|0.88|99|0.00|HIGH-COST DRUGS|
20|FH_F103004_75840_0|SrvcGrp|73603|2022|PDM|637.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F86851_0_0|SrvcGrp|79581|2022|PDM|451.00|99|0.00|CPT 44382|
20|FH_F88491_71301_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F35308_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD UE) - BDSS|
20|FH_F123783_03860_0|SrvcGrp|53987|2022|PDM|75.00|99|0.00|PHOTOTHERAPY|
20|FH_F123741_20850_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121250_47401_0|SrvcGrp|90854|2022|PDM|984.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F63316_0_0|SrvcGrp|47183|2022|PDM|67.10|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F63316_0_0|SrvcGrp|47185|2022|PDM|59.13|99|0.00|HOME HEALTH AIDE|
20|FH_F69968_0_0|SrvcGrp|17079|2022|PDM|2546.77|99|0.00|ASPG VIII|
20|FH_F136300_67206_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F136404_06410_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120473_98055_0|CSTM-ALL|CSTM-00|2020|PCT|2.81|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F120490_64133_0|SrvcGrp|43569|2022|PDM|42.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F134011_84102_0|SrvcGrp|95661|2022|PDM|112.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F137209_60515_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137232_28210_0|SrvcGrp|10393|2022|PDM|1200.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F137242_52722_0|SrvcGrp|16069|2022|PDM|927.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F142430_38863_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142267_78240_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F142511_78597_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F138471_84663_0|SrvcGrp|73701|2022|PDM|26.75|99|0.00|AETNA - SKILLED NURSING|
20|FH_F138627_82901_0|SrvcGrp|21917|2022|PDM|45.00|99|0.00|NASOGASTRIC TUBING|
20|FH_F78267_18702_0|CSTM-ALL|CSTM-00|2020|PDM|86.63|99|0.00|SECOND THERAPY|
20|FH_F78403_15552_0|SrvcGrp|11258|2022|PCT|0.62|99|0.00|DRUGS|
20|FH_F139267_30253_0|SrvcGrp|113178|2022|PDM|31.23|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - ASTRAZENECA|
20|FH_F140407_63841_0|SrvcGrp|113298|2022|PDM|28.39|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - PFIZER|
20|FH_F140488_07039_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F140747_34461_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140753_75038_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1268.00|99|0.00|AEG 8 (NO REV)|
20|FH_F128270_0_0|SrvcGrp|42782|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F149663_45219_0|SrvcGrp|103972|2022|PDM|6323.00|99|0.00|AETNA NECK & SPINE SURGERY INCLUDING|
20|FH_F151601_89118_0|SrvcGrp|66264|2022|PDM|80.75|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F151606_64772_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F119023_91406_0|SrvcGrp|17013|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118818_19808_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F118943_64506_0|SrvcGrp|24744|2022|PDM|83.00|99|0.00|PICC LINE INSERTION|
20|FH_F118943_64506_0|SrvcGrp|14944|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F94581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117255_68520_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147799_18052_0|SrvcGrp|48385|2022|PDM|116.42|99|0.00|SPEECH THERAPY|
20|FH_F147726_18017_0|CSTM-ALL|CSTM-00|2020|PDM|1606.00|99|0.00|AEG 9 (NO REV)|
20|FH_F147941_06023_0|SrvcGrp|106298|2022|PDM|748.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT|
20|FH_F129483_77030_0|SrvcGrp|86843|2022|PDM|35.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F117098_20186_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F117153_34113_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F137334_90405_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137982_68510_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|HSS ASC|
20|FH_F122588_53073_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F122591_84010_0|SrvcGrp|75545|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F43249_0_0|SrvcGrp|13248|2022|PCT|0.54|99|0.00|OP SURGERY|
20|FH_F43696_0_0|SrvcGrp|13811|2022|PDM|512.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F134770_14420_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F134791_98034_0|SrvcGrp|46605|2022|PDM|312.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F136775_64701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136778_62034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F132611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS|
20|FH_F149248_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 10 (NO REV)|
20|FH_F115152_77058_0|SrvcGrp|46903|2022|PDM|538.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F115631_65201_0|SrvcGrp|41334|2022|PDM|13526.00|99|0.00|TOTAL KNEE|
20|FH_F115631_65201_0|SrvcGrp|106255|2022|PDM|1141.00|99|0.00|UNLISTED PROCEDURE, LEG OR ANKLE|
20|FH_F41463_0_0|SrvcGrp|17006|2022|PDM|80.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS|
20|FH_F42024_0_0|CSTM-ALL|CSTM-00|2020|PDM|17500.00|99|0.00|MS DRG 619-621|
20|FH_F42433_0_0|SrvcGrp|472|2022|PDM|380.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD NU KE RATE|
20|FH_F133219_89119_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F133408_01095_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F111604_16505_0|SrvcGrp|73842|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111605_80524_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INJECTION, PEGFILGRASTIM 6MG|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|TRC VACV 28 FS %  MOD 26|
20|FH_F35404_0_0|SrvcGrp|9774|2022|PDM|3000.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F135351_0_0|SrvcGrp|36591|2022|PDM|58652.00|99|0.00|CPT 63685|
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|2788.00|99|0.00|AEG 8 (NO REV)|
20|FH_F40535_0_0|SrvcGrp|6|2022|PCT|0.85|99|0.00|OP SURGERY|
20|FH_F42244_0_0|SrvcGrp|115|2022|PDM|468.00|99|0.00|SKILLED NURSING CARE|
20|FH_F50459_0_0|SrvcGrp|44131|2022|PDM|110.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F54552_0_0|SrvcGrp|22954|2022|PDM|150.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F113585_20155_0|SrvcGrp|86844|2022|PDM|60.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F138876_25302_0|SrvcGrp|29076|2022|PDM|40.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|789.00|99|0.00|AEG 5  (NO REV)|
20|FH_F109949_0_0|CSTM-ALL|CSTM-00|2020|PDM|690.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F114326_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118986_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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151461_38063_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F151511_14094_0|SrvcGrp|101407|2022|PCT|0.00|99|0.00|URGENT CARE|
20|FH_F151511_14094_0|CSTM-ALL|CSTM-00|2020|PCT|0.20|99|0.00|OP SVCS|
20|FH_F132258_45404_0|SrvcGrp|24750|2022|PDM|34.98|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F122027_61847_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123184_20906_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F135350_60014_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F135432_16335_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F135489_70508_0|SrvcGrp|82037|2022|PDM|1627.50|99|0.00|AETNA ICU|
20|FH_F100852_61068_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F131132_44077_0|SrvcGrp|4003|2022|PDM|3036.00|99|0.00|CPT CODE 99291- CRITICAL CARE|
20|FH_F116485_17033_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F128104_57702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127399_0_0|SrvcGrp|73004|2022|PDM|1769.00|99|0.00|AEG 8|
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1302.00|99|0.00|REPAIR EPIGASTRIC HERNIA REDUCED|
20|FH_F121428_40202_0|SrvcGrp|73603|2022|PDM|2036.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F121444_47720_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121824_92675_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F101182_07863_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111363_33169_0|SrvcGrp|88978|2022|PDM|4119.00|99|0.00|VAGINAL DELIVERY|
20|FH_F134315_89106_0|SrvcGrp|24754|2022|PCT|1.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F141651_0_0|SrvcGrp|78097|2022|PDM|2310.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F65882_0_0|SrvcGrp|3809|2022|PDM|653.00|99|0.00|HOSPICE CARE|
20|FH_F43137_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SIGNATURE ENTERAL RATES|
20|FH_F150619_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F132073_0_0|SrvcGrp|57967|2022|PDM|143.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F132328_0_0|SrvcGrp|103543|2022|PDM|1425.00|99|0.00|REMOVE SPINAL CANAL CATHE|
20|FH_F87557_33309_0|SrvcGrp|26868|2022|PDM|30.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F129141_21221_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F102228_08846_0|SrvcGrp|86648|2022|PCT|1.05|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F102228_08846_0|SrvcGrp|73849|2022|PDM|321.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F129326_02026_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F98300_30236_0|SrvcGrp|75485|2022|PDM|3690.00|99|0.00|AEG 4|
20|FH_F98300_30236_0|SrvcGrp|82369|2022|PCT|0.60|99|0.00|AETNA LABORATORY|
20|FH_F101320_26062_0|SrvcGrp|14948|2022|PDM|162.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132877_06105_0|SrvcGrp|472|2022|PDM|495.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|448.00|99|0.00|AEG 2 (NO REV)|
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|564.00|99|0.00|AEG 10 (NO REV)|
20|FH_F35898_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG III|
20|FH_F46832_0_0|SrvcGrp|22389|2022|PDM|25.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F109632_0_0|SrvcGrp|74383|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F91472_96001_0|SrvcGrp|103703|2022|PCT|0.40|99|0.00|CARDIAC VALVE REPLACEMENT|
20|FH_F148720_0_0|SrvcGrp|115637|2022|PDM|325.00|99|0.00|HEMODIALYSIS SVCS (HCFA)|
20|FH_F146012_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F56274_0_0|SrvcGrp|34388|2022|PDM|155.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F132212_0_0|SrvcGrp|94780|2022|PDM|90.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F119413_95123_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137951_0_0|SrvcGrp|113170|2022|PDM|1458.00|99|0.00|UPPER GI OPTIC ENDOMICROSCOPY|
20|FH_F148552_68114_0|CSTM-ALL|CSTM-00|2020|PDM|1389.97|99|0.00|AEG 4 (NO REV)|
20|FH_F147993_65622_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F97566_79902_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F74084_15206_0|SrvcGrp|29611|2022|PDM|125.00|99|0.00|VENTILATOR SUPPORT|
20|FH_F126806_44125_0|SrvcGrp|94781|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F97565_83301_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F75251_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.37|99|0.00|COVENTRY ENHANCED DEFAULT 10021-69990|
20|FH_F118456_30012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F89851_83854_0|CSTM-ALL|CSTM-00|2020|PDM|6453.00|99|0.00|AEG 7 (NO REV)|
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|517.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 1|
20|FH_F89932_10940_0|SrvcGrp|89145|2022|PDM|9740.00|99|0.00|BARIATRIC SURGERY|
20|FH_F36542_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143027_16504_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F121416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148886_60621_0|SrvcGrp|115534|2022|PCT|1.35|99|0.00|LABORATORY SERVICES|
20|FH_F131433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F57592_0_0|SrvcGrp|9793|2022|PDM|800.00|99|0.00|NEWBORN NURSERY|
20|FH_F100785_54660_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F150949_0_0|SrvcGrp|80617|2022|PDM|10500.00|99|0.00|ARTHOPLASTY|
20|FH_F90921_77702_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA - ANCD ( HOME HEALTH)|
20|FH_F125471_34471_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F40797_0_0|SrvcGrp|109|2022|PDM|650.00|99|0.00|CD - DETOX|
20|FH_F91198_46714_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F106420_18510_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150540_63401_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F148881_33018_0|SrvcGrp|99459|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY EVALUATION|
20|FH_F78682_0_0|SrvcGrp|75659|2022|PDM|4200.00|99|0.00|ARTHRODESIS|
20|FH_F43443_0_0|CSTM-ALL|CSTM-00|2020|PDM|357.00|99|0.00|RESIDENTIAL TREATMENT SVCS|
20|FH_F128130_10027_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F92677_08003_0|SrvcGrp|92186|2022|PDM|210.00|99|0.00|CPT 94772  (HCFA)|
20|FH_F128325_19904_0|SrvcGrp|73485|2022|PDM|950.00|99|0.00|AETNA REHAB|
20|FH_F38089_0_0|SrvcGrp|97|2022|PDM|4962.00|99|0.00|C-SECTION|
20|FH_F145854_37015_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97182_21502_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F133412_84129_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|ASPG IV|
20|FH_F145988_06105_0|SrvcGrp|75499|2022|PDM|3939.00|99|0.00|CRITICAL CARE|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|OP SVCS|
20|FH_F91155_16105_0|SrvcGrp|76619|2022|PCT|1.00|99|0.00|THERAPY|
20|FH_F91194_33511_0|SrvcGrp|86729|2022|PCT|1.00|99|0.00|COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE|
20|FH_F36973_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REFERENCE LABS|
20|FH_F55375_0_0|SrvcGrp|1168|2022|PDM|794.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F128349_43082_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F87155_04105_0|SrvcGrp|21920|2022|PDM|57.78|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F101925_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|OP SVCS|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|530.15|99|0.00|ASPG 206|
20|FH_F43837_0_0|SrvcGrp|16116|2022|PDM|120.00|99|0.00|PT/OT/ST|
20|FH_F127994_19301_0|SrvcGrp|105047|2022|PDM|175.00|99|0.00|AETNA PSYCH DIAG EVAL W/ MED SVCS (HCFA)|
20|FH_F71929_15090_0|SrvcGrp|13985|2022|PDM|47.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F127325_0_0|SrvcGrp|73006|2022|PDM|1081.00|99|0.00|AEG 9|
20|FH_F100682_97401_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F44134_0_0|SrvcGrp|60816|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 8 (NO REV)|
20|FH_F134447_12883_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128615_78520_0|SrvcGrp|89149|2022|PDM|215.00|99|0.00|OP INTENSIVE|
20|FH_F102325_62691_0|SrvcGrp|60856|2022|PDM|126.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE|
20|FH_F46196_0_0|SrvcGrp|31190|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC (DME)|
20|FH_F126676_43537_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F148556_13206_0|SrvcGrp|10580|2022|PDM|35.00|99|0.00|HYDRATION THERAPY - 3 LITERS|
20|FH_F37600_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F78385_0_0|SrvcGrp|75502|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F95360_08720_0|SrvcGrp|94043|2022|PCT|1.00|99|0.00|GANCICLOVIR IMPLANT/1UNIT MAX|
20|FH_F88512_0_0|SrvcGrp|79977|2022|PCT|0.49|99|0.00|RADIOPHARMACEUTICALS|
20|FH_F51123_0_0|SrvcGrp|29406|2022|PDM|124.00|99|0.00|PHYSICAL THERAPY|
20|FH_F97541_33021_0|CSTM-ALL|CSTM-00|2020|PCT|0.29|99|0.00|OP SVCS|
20|FH_F97542_32960_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|984.64|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F116324_0_0|SrvcGrp|75491|2022|PDM|550.00|99|0.00|AEG 7|
20|FH_F123809_26155_0|SrvcGrp|75506|2022|PCT|0.72|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F132810_0_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F126770_43050_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F67901_0_0|SrvcGrp|43572|2022|PDM|80.00|99|0.00|PICC-LINE INSERTION|
20|FH_F69968_0_0|CSTM-ALL|CSTM-00|2020|PDM|2110.35|99|0.00|MS DRG BAPTIST MEM HOSP MEDICAL|
20|FH_F136411_67031_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118232_24970_0|SrvcGrp|79699|2022|PCT|0.79|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F120489_63552_0|SrvcGrp|88978|2022|PDM|2913.00|99|0.00|VAGINAL DELIVERY|
20|FH_F120489_63552_0|SrvcGrp|73498|2022|PDM|571.00|99|0.00|AETNA ER LEVEL III|
20|FH_F93358_63084_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F137147_75006_0|SrvcGrp|79593|2022|PDM|3360.00|99|0.00|CPT 45378|
20|FH_F137227_64133_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F53732_0_0|SrvcGrp|16559|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F53732_0_0|SrvcGrp|31973|2022|PDM|19.00|99|0.00|HOME THERAPY|
20|FH_F66765_0_0|SrvcGrp|62538|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY|
20|FH_F138545_39503_0|SrvcGrp|88819|2022|PDM|694.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F138627_82901_0|SrvcGrp|99003|2022|PDM|85.00|99|0.00|INFUSION THERAPY (HCFA)|
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)|
20|FH_F140343_89052_0|SrvcGrp|86825|2022|PDM|55.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F140407_63841_0|SrvcGrp|3208|2022|PDM|715.00|99|0.00|SUBACUTE CARE|
20|FH_F140765_30315_0|SrvcGrp|113298|2022|PDM|40.00|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - PFIZER|
20|FH_F149650_96819_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F119004_06850_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F130800_06078_0|SrvcGrp|471|2022|PDM|585.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F109886_36303_0|SrvcGrp|93919|2022|PDM|637.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F109982_33592_0|SrvcGrp|89412|2022|PDM|246.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F76144_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117261_43543_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147741_80012_0|SrvcGrp|92760|2022|PCT|2.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129448_43235_0|SrvcGrp|46605|2022|PDM|113.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F94061_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|OP SVCS|
20|FH_F117131_45209_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F117154_43017_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F117126_12801_0|SrvcGrp|106164|2022|PCT|1.15|99|0.00|AETNA ALL DRUGS OR DRUG AGENTS|
20|FH_F137938_29036_0|SrvcGrp|113184|2022|PCT|0.53|99|0.00|OUTPATIENT PRO FEES|
20|FH_F109652_0_0|SrvcGrp|103689|2022|PCT|0.26|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F109652_0_0|SrvcGrp|87996|2022|PDM|878.00|99|0.00|AETNA OP RADIATION THERAPY|
20|FH_F90876_18447_0|SrvcGrp|53144|2022|PDM|118.65|99|0.00|SPEECH THERAPY|
20|FH_F90876_18447_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F112817_37027_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135653_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F63129_0_0|SrvcGrp|46350|2022|PDM|25.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F135840_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F130711_06716_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130752_43701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130755_04401_0|SrvcGrp|105465|2022|PCT|0.93|99|0.00|AETNA THERAPIES|
20|FH_F126043_30339_0|SrvcGrp|89149|2022|PDM|301.00|99|0.00|OP INTENSIVE|
20|FH_F150160_01301_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F129509_0_0|SrvcGrp|73006|2022|PDM|1685.00|99|0.00|AEG 9|
20|FH_F85213_02840_0|SrvcGrp|79699|2022|PCT|1.03|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F150239_75569_0|SrvcGrp|10577|2022|PCT|1.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F145921_73139_0|SrvcGrp|48385|2022|PDM|97.85|99|0.00|SPEECH THERAPY|
20|FH_F147962_85008_0|SrvcGrp|115650|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F133748_77081_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F133788_74006_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F110346_38501_0|SrvcGrp|73841|2022|PDM|542.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F81698_10457_0|SrvcGrp|13929|2022|PDM|10.50|99|0.00|GROWTH HORMONE|
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|2831.00|99|0.00|AEG 9 (NO REV)|
20|FH_F138259_36606_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F121225_98902_0|SrvcGrp|108699|2022|PDM|201.60|99|0.00|RN VISIT|
20|FH_F83995_16748_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F138951_41101_0|SrvcGrp|14893|2022|PDM|32.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F75087_0_0|SrvcGrp|63459|2022|PDM|2350.00|99|0.00|CPT 52601|
20|FH_F110509_71351_0|SrvcGrp|73000|2022|PDM|3775.00|99|0.00|AEG 6|
20|FH_F127157_43614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134619_14304_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88935_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F85340_98195_0|SrvcGrp|15386|2022|PDM|121.00|99|0.00|CLINIC VISIT|
20|FH_F150239_75569_0|SrvcGrp|13929|2022|PCT|1.00|99|0.00|GROWTH HORMONE|
20|FH_F151300_0_0|CSTM-ALL|CSTM-00|2020|PDM|408.00|99|0.00|AEG 2 (NO REV)|
20|FH_F85097_0_0|SrvcGrp|4109|2022|PDM|1509.00|99|0.00|ACUTE PSYCH|
20|FH_F117208_0_0|SrvcGrp|106267|2022|PDM|4015.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL|
20|FH_F69708_0_0|SrvcGrp|14948|2022|PDM|441.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F110420_60649_0|SrvcGrp|67621|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F136591_0_0|SrvcGrp|11606|2022|PDM|1345.15|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|ASPG V|
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|AEG 2 (NO REV)|
20|FH_F101840_76054_0|SrvcGrp|58419|2022|PDM|16398.00|99|0.00|MS DRG 737 ONLY|
20|FH_F146211_68144_0|SrvcGrp|10363|2022|PDM|694.00|99|0.00|CPT CODE 99283|
20|FH_F93375_0_0|SrvcGrp|72994|2022|PDM|535.00|99|0.00|AEG 3|
20|FH_F132528_64014_0|SrvcGrp|73700|2022|PDM|46.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F38508_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.06|99|0.00|100% OF ASP DRUGS/IMMUN|
20|FH_F68888_0_0|SrvcGrp|44106|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F130108_0_0|SrvcGrp|9937|2022|PCT|0.75|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F148644_06890_0|SrvcGrp|33984|2022|PDM|3794.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F151050_17015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151060_02493_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F139188_29169_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139487_60076_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139673_63011_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F136947_0_0|SrvcGrp|13597|2022|PDM|350.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F117737_75001_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F148966_37865_0|SrvcGrp|74668|2022|PDM|208.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139576_0_0|SrvcGrp|17955|2022|PDM|2393.00|99|0.00|HYSTEROSCOPY|
20|FH_F117711_73080_0|SrvcGrp|106257|2022|PCT|1.05|99|0.00|LABORATORY SERVICES|
20|FH_F147332_19406_0|SrvcGrp|82981|2022|PDM|207.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F147372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|564.00|99|0.00|AEG 10 (NO REV)|
20|FH_F123745_0_0|SrvcGrp|90417|2022|PDM|7500.00|99|0.00|TREATMENT OF JOINT|
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|3410.00|99|0.00|AEG 6 (NO REV)|
20|FH_F120848_20912_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F38246_66606_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F117762_0_0|SrvcGrp|99167|2022|PDM|4992.00|99|0.00|CPT 63057|
20|FH_F35446_0_0|SrvcGrp|361|2022|PDM|2076.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F63759_0_0|SrvcGrp|3205|2022|PDM|1225.00|99|0.00|ACUTE REHAB|
20|FH_F36743_0_0|SrvcGrp|10013|2022|PDM|619.00|99|0.00|NEWBORN NURSERY|
20|FH_F140295_0_0|SrvcGrp|99073|2022|PDM|1.56|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F127324_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F137729_19703_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F125656_92868_0|SrvcGrp|86832|2022|PDM|7.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|AEG 10 (NO REV)|
20|FH_F101083_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128543_44413_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F115483_62002_0|SrvcGrp|105808|2022|PDM|9230.00|99|0.00|STEREOTACTIC RADIOSURGERY|
20|FH_F132095_67042_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F36715_0_0|CSTM-ALL|CSTM-00|2020|PDM|1489.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F91111_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F150922_02452_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F139442_60143_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F117714_94301_0|SrvcGrp|46903|2022|PDM|675.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F149402_03301_0|SrvcGrp|79720|2022|PDM|1296.00|99|0.00|ACUTE REHAB II|
20|FH_F134819_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS|
20|FH_F129970_34986_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F116346_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F35557_0_0|SrvcGrp|15517|2022|PDM|54.00|99|0.00|HYDRATION THERAPY|
20|FH_F124487_89502_0|SrvcGrp|48396|2022|PDM|120.00|99|0.00|OT SERVICES|
20|FH_F136668_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|117.00|99|0.00|HAPA EPA ASC 20|
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|380.00|99|0.00|AEG 2 (NO REV)|
20|FH_F150982_0_0|SrvcGrp|3378|2022|PDM|1652.00|99|0.00|OBSERVATION SVCS|
20|FH_F145543_0_0|SrvcGrp|85563|2022|PDM|931.00|99|0.00|INCISION OF EYE|
20|FH_F116575_0_0|SrvcGrp|84910|2022|PDM|1800.00|99|0.00|ENDOSCOPY|
20|FH_F98820_81401_0|SrvcGrp|73601|2022|PDM|5756.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F41377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F138410_19130_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F90196_10467_0|SrvcGrp|43523|2022|PDM|125.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F137790_62568_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|4545.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132254_40207_0|SrvcGrp|86833|2022|PDM|25.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F42746_0_0|SrvcGrp|30934|2022|PDM|50.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F139814_24333_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F39162_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35280_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|CARDIAC EVENT MONITORING (MOD QW) F/S - TMSS|
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F137728_47203_0|SrvcGrp|46903|2022|PDM|721.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F36429_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|AEG 10 (NO REV)|
20|FH_F136668_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)|
20|FH_F71786_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F151699_01752_0|SrvcGrp|86828|2022|PDM|120.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F132096_89118_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F125656_92868_0|SrvcGrp|86839|2022|PDM|30.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F124492_30040_0|SrvcGrp|112224|2022|PDM|82.50|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F118957_0_0|SrvcGrp|83838|2022|PDM|3300.00|99|0.00|SUSPENSION OF BREAST|
20|FH_F40780_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145601_32159_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130923_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|ASPG IX|
20|FH_F125328_0_0|SrvcGrp|67989|2022|PDM|2370.00|99|0.00|CPT 49320|
20|FH_F121628_19533_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F87012_0_0|SrvcGrp|73006|2022|PDM|2283.46|99|0.00|AEG 9|
20|FH_F112827_26452_0|SrvcGrp|73700|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1145.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F143669_78577_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F61072_0_0|SrvcGrp|42828|2022|PDM|100.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F79824_0_0|SrvcGrp|17081|2022|PDM|3911.00|99|0.00|ASPG IX|
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 7 (NO REV)|
20|FH_F110223_31750_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128825_45211_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F149139_07522_0|SrvcGrp|111926|2022|PDM|35.92|99|0.00|COVID-19 LAB TESTING|
20|FH_F133972_27103_0|SrvcGrp|14944|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F120697_68526_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F107702_01053_0|SrvcGrp|75545|2022|PDM|385.20|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD KL"|
20|FH_F88744_71103_0|SrvcGrp|131|2022|PCT|0.65|99|0.00|PACEMAKER DEVICE|
20|FH_F150309_33323_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F38227_0_0|SrvcGrp|44819|2022|PDM|70.00|99|0.00|SPEECH THERAPY|
20|FH_F100782_0_0|SrvcGrp|105099|2022|PDM|232.13|99|0.00|WINDBER MEDICAL CNTR ASC 144|
20|FH_F134168_70526_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139716_50208_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134655_14221_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130763_0_0|SrvcGrp|87054|2022|PDM|4714.00|99|0.00|CYSTOSCOPY CHEMODENERVATION|
20|FH_F120719_27540_0|SrvcGrp|115926|2022|PCT|3.05|99|0.00|RADIOLOGY SERVICES|
20|FH_F127090_45601_0|SrvcGrp|22593|2022|PDM|69.36|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F142376_0_0|SrvcGrp|87119|2022|PDM|7851.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F90501_71101_0|SrvcGrp|85537|2022|PCT|0.00|99|0.00|ALL DRUGS|
20|FH_F138447_22041_0|SrvcGrp|27968|2022|PDM|55.00|99|0.00|SKILLED NURSING LPN|
20|FH_F130763_0_0|SrvcGrp|74039|2022|PDM|7319.00|99|0.00|LAMINECTOMY|
20|FH_F133957_84121_0|SrvcGrp|48396|2022|PDM|85.50|99|0.00|OT SERVICES|
20|FH_F100782_0_0|SrvcGrp|97670|2022|PDM|1273.32|99|0.00|WINDBER MEDICAL CNTR ASC 507|
20|FH_F38790_0_0|SrvcGrp|69560|2022|PCT|0.77|99|0.00|MS DRG 216-232,237- 238 ONLY CARDIOVASCULAR|
20|FH_F37910_0_0|SrvcGrp|15143|2022|PCT|0.85|99|0.00|ACUTE IP MEDICAL SERVICES|
20|FH_F90496_13159_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F125124_0_0|SrvcGrp|79588|2022|PDM|1783.50|99|0.00|CPT 43235|
20|FH_F130763_0_0|SrvcGrp|34606|2022|PDM|4705.00|99|0.00|CPT 29827|
20|FH_F133887_17013_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|733.00|99|0.00|AEG 5  (NO REV)|
20|FH_F136359_0_0|SrvcGrp|92364|2022|PDM|20750.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1655.00|99|0.00|AEG 9 (NO REV)|
20|FH_F133868_40202_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|OP SVCS|
20|FH_F130337_62948_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142376_0_0|SrvcGrp|96349|2022|PDM|17545.00|99|0.00|NECK SPINE FUSE|
20|FH_F88744_71103_0|SrvcGrp|3066|2022|PCT|0.65|99|0.00|HIGH-COST DRUGS|
20|FH_F54592_0_0|SrvcGrp|26867|2022|PDM|80.00|99|0.00|ANTI-EMETICS INFUSION THERAPY|
20|FH_F54592_0_0|SrvcGrp|14949|2022|PDM|80.00|99|0.00|HOME INFUSION|
20|FH_F42138_0_0|SrvcGrp|13722|2022|PDM|116.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE|
20|FH_F134508_14072_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134536_48080_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F86103_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F84712_0_0|SrvcGrp|82754|2022|PDM|33.00|99|0.00|ASSAY THYROID STIM HORMONE|
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F85553_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|SKILLED NURSING|
20|FH_F98800_85021_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F75842_0_0|SrvcGrp|31769|2022|PDM|21379.24|99|0.00|CARDIAC ABLATION|
20|FH_F146763_76109_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120795_27514_0|SrvcGrp|103913|2022|PCT|0.71|99|0.00|OP DIALYSIS|
20|FH_F139887_0_0|SrvcGrp|113591|2022|PDM|1007.00|99|0.00|REMOVAL OF TOE LESIONS|
20|FH_F138487_85297_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F139391_30127_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139560_78216_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150760_44833_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150839_03833_0|SrvcGrp|27969|2022|PDM|34.68|99|0.00|HOME HEALTH AIDE|
20|FH_F150882_84041_0|SrvcGrp|104229|2022|PDM|100.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F139877_32615_0|SrvcGrp|113248|2022|PDM|51.31|99|0.00|COVID-19 SARS-COV-2 AMP PRB (HCFA)|
20|FH_F126116_0_0|SrvcGrp|109504|2022|PDM|9084.00|99|0.00|REMV & REPLC PM GEN DUAL LEAD|
20|FH_F149419_33966_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131498_0_0|SrvcGrp|24739|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F111266_30339_0|SrvcGrp|86851|2022|PDM|30.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F148020_0_0|SrvcGrp|75545|2022|PDM|472.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F110732_31513_0|SrvcGrp|73008|2022|PDM|1322.00|99|0.00|AEG 10|
20|FH_F138478_0_0|SrvcGrp|92407|2022|PDM|17599.99|99|0.00|REMOVAL & REPLACE PULSE GEN 2 LEAD|
20|FH_F140143_24874_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116332_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F90151_24382_0|SrvcGrp|76501|2022|PDM|278.25|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F141287_14830_0|SrvcGrp|13187|2022|PCT|0.39|99|0.00|INTRAOCULAR LENSES|
20|FH_F122396_90024_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132153_06450_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119442_72205_0|SrvcGrp|10391|2022|PDM|1300.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F109762_0_0|SrvcGrp|73004|2022|PDM|973.00|99|0.00|AEG 8|
20|FH_F123570_0_0|SrvcGrp|72996|2022|PDM|891.11|99|0.00|AEG 4|
20|FH_F149273_0_0|SrvcGrp|36591|2022|PDM|3900.00|99|0.00|CPT 63685|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|341.00|99|0.00|HAPA EPA ASC 41|
20|FH_F149030_37919_0|SrvcGrp|84181|2022|PDM|1500.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD NU|
20|FH_F128741_92879_0|SrvcGrp|88621|2022|PDM|186.39|99|0.00|SKILLED NURSING LPN|
20|FH_F137363_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F114951_20002_0|SrvcGrp|30089|2022|PDM|455.27|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1575124_HCPCS_  MOD KF|
20|FH_F128698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F37493_0_0|SrvcGrp|12492|2022|PCT|0.50|99|0.00|PROSTHETICS|
20|FH_F151008_92625_0|SrvcGrp|75419|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F110783_93013_0|SrvcGrp|112058|2022|PDM|45.00|99|0.00|INFLECTRA|
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|2618.00|99|0.00|DEVICE INSERTION|
20|FH_F103109_33462_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|3034.00|99|0.00|AEG 7 (NO REV)|
20|FH_F63033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F125214_12428_0|SrvcGrp|109057|2022|PCT|0.65|99|0.00|CARDIAC STUDIES|
20|FH_F102525_73134_0|SrvcGrp|73002|2022|PDM|2270.00|99|0.00|AEG 7|
20|FH_F35884_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112754_98057_0|SrvcGrp|104881|2022|PDM|180.71|99|0.00|HOME HEALTH AIDE IN HOME|
20|FH_F141156_04401_0|SrvcGrp|84121|2022|PCT|1.00|99|0.00|OCULAR IMPLANTS|
20|FH_F126914_44136_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F134869_08854_0|SrvcGrp|102981|2022|PDM|185.00|99|0.00|PSYTX WPT W E/M 45 MIN|
20|FH_F134933_73505_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|HERNIA REPAIR W/ MESH|
20|FH_F36903_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KEITH RATHBOON PT HCPC MOD RR|
20|FH_F130723_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F38123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE|
20|FH_F116806_0_0|SrvcGrp|107096|2022|PDM|949.60|99|0.00|BIOPSY/REMOVAL LYMPH NODE(S)|
20|FH_F50100_0_0|SrvcGrp|46183|2022|PCT|0.82|99|0.00|WOUND CARE / MEDICAL SUPPLIES|
20|FH_F32911_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS|
20|FH_F98360_11554_0|SrvcGrp|73656|2022|PDM|1239.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F116753_0_0|SrvcGrp|88977|2022|PDM|2187.00|99|0.00|C-SECTION DELIVERY|
20|FH_F124722_66067_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137363_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F111266_30339_0|SrvcGrp|26869|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F80102_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122377_91007_0|SrvcGrp|941|2022|PDM|6320.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F117799_0_0|SrvcGrp|67066|2022|PDM|9018.00|99|0.00|CERVICAL SURGERY|
20|FH_F124691_78003_0|SrvcGrp|75419|2022|PDM|900.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F42449_0_0|CSTM-ALL|CSTM-00|2020|PDM|775.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138018_17313_0|SrvcGrp|17013|2022|PDM|105.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F47902_0_0|SrvcGrp|43843|2022|PCT|1.00|99|0.00|DME MOD RRKF|
20|FH_F129970_34986_0|SrvcGrp|86722|2022|PDM|231.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F40644_0_0|SrvcGrp|16|2022|PDM|1035.00|99|0.00|ACUTE REHABILITATION|
20|FH_F124976_0_0|SrvcGrp|73842|2022|PDM|247.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138016_19808_0|SrvcGrp|73842|2022|PDM|127.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F145599_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|CARDIAC CATH LAB SVCS|
20|FH_F40607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97623_38008_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F148347_0_0|SrvcGrp|87844|2022|PDM|12778.00|99|0.00|LAPARASCOPY - GASTRIC|
20|FH_F149240_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147306_70115_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31547_0_0|SrvcGrp|12686|2022|PDM|49.14|99|0.00|UROKINASE (ABBOKINASE)|
20|FH_F43865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F151029_52241_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F34853_0_0|SrvcGrp|9911|2022|PDM|875.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F132143_66111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F136806_0_0|SrvcGrp|112947|2022|PDM|11817.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F76124_0_0|SrvcGrp|3259|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION|
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|912.00|99|0.00|AEG 1 (NO REV)|
20|FH_F92498_07442_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F149515_66002_0|SrvcGrp|108484|2022|PDM|483.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F76826_0_0|SrvcGrp|76009|2022|PDM|414.00|99|0.00|EMERGENCY ROOM SVCS LEVEL II|
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 3 (NO REV)|
20|FH_F137363_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|1461.94|99|0.00|SALLY BALIN,999182,ASC 902|
20|FH_F36943_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS NO MOD|
20|FH_F111266_30339_0|SrvcGrp|65621|2022|PDM|25.00|99|0.00|RN NURSING|
20|FH_F150982_0_0|SrvcGrp|82113|2022|PDM|2202.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F129111_43084_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35056_0_0|SrvcGrp|11108|2022|PDM|450.00|99|0.00|NEWBORN NURSERY|
20|FH_F125656_92868_0|SrvcGrp|86836|2022|PDM|12.50|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD RR - CARECENTRIX|
20|FH_F124749_90211_0|SrvcGrp|54142|2022|PDM|363.00|99|0.00|OP INTENSIVE SERVICES|
20|FH_F147219_48207_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147260_53227_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS ASC|
20|FH_F52092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F117576_21207_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147221_49442_0|SrvcGrp|108622|2022|PDM|453.00|99|0.00|SUB ACUTE CARE LEVEL II|
20|FH_F140137_15235_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F143347_16001_0|SrvcGrp|112813|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER|
20|FH_F143347_16001_0|SrvcGrp|103913|2022|PCT|0.65|99|0.00|OP DIALYSIS|
20|FH_F143348_16214_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143348_16214_0|SrvcGrp|79699|2022|PCT|0.89|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 8 (NO REV)|
20|FH_F93740_0_0|SrvcGrp|91580|2022|PDM|2500.00|99|0.00|EVAT|
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|615.00|99|0.00|AEG 3 (NO REV)|
20|FH_F103060_0_0|SrvcGrp|41334|2022|PDM|7803.00|99|0.00|TOTAL KNEE|
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|1445.00|99|0.00|AEG 8 (NO REV)|
20|FH_F116609_35801_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F126438_50029_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F126243_32132_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113595_29527_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118917_33317_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F118792_63379_0|SrvcGrp|104363|2022|PCT|0.74|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F36472_0_0|SrvcGrp|12116|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F102947_44084_0|SrvcGrp|89412|2022|PDM|431.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F39939_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F138350_0_0|SrvcGrp|27310|2022|PDM|2122.00|99|0.00|ENDOSCOPIC PLANTAR FASCIOTOMY|
20|FH_F50516_15014_0|CSTM-ALL|CSTM-00|2020|PDM|340.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|HSS ASC|
20|FH_F147211_0_0|SrvcGrp|14048|2022|PCT|0.60|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN|
20|FH_F150200_0_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F61292_0_0|SrvcGrp|57402|2022|PCT|0.49|99|0.00|LABORATORY|
20|FH_F39617_0_0|SrvcGrp|97|2022|PDM|4031.00|99|0.00|C-SECTION|
20|FH_F94862_0_0|SrvcGrp|72992|2022|PDM|575.00|99|0.00|AEG 2|
20|FH_F148543_71103_0|SrvcGrp|30089|2022|PDM|450.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F131254_92211_0|SrvcGrp|14947|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.79|99|0.00|AEG 1 (NO REV)|
20|FH_F123953_84003_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F148255_72703_0|SrvcGrp|86832|2022|PDM|3.15|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F122687_0_0|SrvcGrp|89883|2022|PDM|3825.00|99|0.00|AETNA TREAT HUMERUS FRACTURE|
20|FH_F125938_0_0|SrvcGrp|79720|2022|PCT|0.75|99|0.00|ACUTE REHAB II|
20|FH_F129255_34952_0|SrvcGrp|3178|2022|PDM|796.00|99|0.00|ACUTE PSYCH|
20|FH_F92276_32308_0|CSTM-ALL|CSTM-00|2020|PDM|10805.00|99|0.00|AEG 4 (NO REV)|
20|FH_F91876_0_0|SrvcGrp|73000|2022|PDM|2217.00|99|0.00|AEG 6|
20|FH_F109180_18015_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F130747_0_0|SrvcGrp|82720|2022|PDM|5202.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F39339_0_0|SrvcGrp|1259|2022|PDM|2700.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F141427_22003_0|SrvcGrp|48398|2022|PDM|84.00|99|0.00|PT SERVICES|
20|FH_F31921_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124026_53188_0|SrvcGrp|108484|2022|PDM|756.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F33233_0_0|SrvcGrp|14826|2022|PDM|543.38|99|0.00|DAY TREATMENT|
20|FH_F125693_92660_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F76171_0_0|SrvcGrp|26160|2022|PDM|60.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F90654_0_0|SrvcGrp|25697|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F90714_0_0|SrvcGrp|72998|2022|PDM|820.00|99|0.00|AEG 5|
20|FH_F125028_19061_0|SrvcGrp|29023|2022|PDM|105.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F128272_60640_0|SrvcGrp|19742|2022|PDM|80.00|99|0.00|MID-LINE INSERTION|
20|FH_F127036_43724_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F37359_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|MS DRG UNGROUPABLE INPATIENT|
20|FH_F109040_0_0|SrvcGrp|26470|2022|PDM|180.00|99|0.00|SELF DIALYSIS TRAINING CAPD|
20|FH_F93880_95476_0|SrvcGrp|88428|2022|PDM|9620.00|99|0.00|AETNA IP SPINAL SURGERY|
20|FH_F52854_0_0|SrvcGrp|12599|2022|PDM|105.00|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F130889_68818_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F141387_63108_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145536_90265_0|SrvcGrp|73605|2022|PDM|2835.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F143773_30350_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|1012.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|1474.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93880_95476_0|SrvcGrp|89317|2022|PCT|1.10|99|0.00|AETNA SLEEP STUDIES|
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 3 (NO REV)|
20|FH_F77925_0_0|SrvcGrp|17987|2022|PCT|0.80|99|0.00|CARDIAC CATH|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|102.27|99|0.00|AETNA SLEEP STUDIES|
20|FH_F62915_0_0|SrvcGrp|42871|2022|PDM|208.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F133099_66801_0|SrvcGrp|11108|2022|PCT|0.80|99|0.00|NEWBORN NURSERY|
20|FH_F135178_84049_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F93114_85016_0|SrvcGrp|27968|2022|PDM|52.00|99|0.00|SKILLED NURSING LPN|
20|FH_F137630_24266_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F128883_89521_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F40709_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|ASPG VII|
20|FH_F142073_0_0|SrvcGrp|84939|2022|PDM|11900.00|99|0.00|SHOULDER JOINT|
20|FH_F90853_0_0|SrvcGrp|75545|2022|PDM|551.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F76171_0_0|CSTM-ALL|CSTM-00|2020|PDM|11.00|99|0.00|LVN HIGH TECH HOURLY|
20|FH_F35513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|GENERAL ACUTE CARE|
20|FH_F148160_29732_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135267_19002_0|SrvcGrp|109330|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F145815_30540_0|SrvcGrp|113297|2022|PDM|16.94|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - PFIZER|
20|FH_F129536_0_0|SrvcGrp|82570|2022|PDM|797.00|99|0.00|REVISION EYELID/EXCESS SKIN|
20|FH_F32327_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133534_33483_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F66501_0_0|SrvcGrp|12403|2022|PDM|28.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F128272_60640_0|SrvcGrp|86838|2022|PDM|25.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F79704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F120973_34653_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
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_F130936_06107_0|SrvcGrp|472|2022|PDM|578.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F106020_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|1505.00|99|0.00|AEG 8 (NO REV)|
20|FH_F116059_62959_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148221_06477_0|SrvcGrp|63297|2022|PDM|168.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F88254_33411_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F114970_28403_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 1 (NO REV)|
20|FH_F137633_85202_0|SrvcGrp|113127|2022|PDM|84.42|99|0.00|BILIRUBIN LIGHT WITH PHOTOMETER (MOD RR)|
20|FH_F34513_0_0|SrvcGrp|13890|2022|PCT|1.00|99|0.00|PHYSICIAN CLINIC VISIT NATL F/S (GLOBAL)|
20|FH_F97104_53545_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F63182_0_0|CSTM-ALL|CSTM-00|2020|PDM|156.00|99|0.00|OP SVCS|
20|FH_F39920_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F37945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1191.00|99|0.00|ASPG IV|
20|FH_F130025_0_0|SrvcGrp|82037|2022|PDM|1623.00|99|0.00|AETNA ICU|
20|FH_F110925_01104_0|SrvcGrp|48398|2022|PDM|94.56|99|0.00|PT SERVICES|
20|FH_F71069_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128272_60640_0|SrvcGrp|86835|2022|PDM|25.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F93881_15009_0|SrvcGrp|91117|2022|PDM|2926.00|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F123466_93420_0|SrvcGrp|73841|2022|PDM|550.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F118050_77565_0|SrvcGrp|93919|2022|PDM|475.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F83451_0_0|SrvcGrp|99073|2022|PDM|1.28|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F129182_24171_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F101201_0_0|SrvcGrp|93919|2022|PDM|412.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F38085_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F141012_22901_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125074_18104_0|SrvcGrp|22596|2022|PDM|144.90|99|0.00|HOSPICE CARE|
20|FH_F93114_85016_0|SrvcGrp|48396|2022|PDM|151.00|99|0.00|OT SERVICES|
20|FH_F141801_80534_0|SrvcGrp|90854|2022|PDM|1200.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F128580_0_0|SrvcGrp|107794|2022|PDM|4058.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F65159_0_0|SrvcGrp|38103|2022|PDM|1605.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F70303_0_0|SrvcGrp|15873|2022|PDM|53.00|99|0.00|HOSPICE SERVICE - CONTINUOUS HOME CARE|
20|FH_F122705_33351_0|SrvcGrp|89417|2022|PDM|350.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F86696_16063_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD HCPC AT HOME NURSING|
20|FH_F90136_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F88545_78734_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F69347_0_0|SrvcGrp|44766|2022|PDM|8560.00|99|0.00|PORTLAND ADVENTIST ASPG V|
20|FH_F69347_0_0|SrvcGrp|10944|2022|PCT|0.80|99|0.00|EMERGENCY ROOM|
20|FH_F132544_0_0|SrvcGrp|12309|2022|PDM|7850.00|99|0.00|MICRODISKETOMY|
20|FH_F132544_0_0|SrvcGrp|97299|2022|PDM|7850.00|99|0.00|REMOVE SPINE ELTRD PLATE|
20|FH_F119256_63031_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148498_75028_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148545_84047_0|SrvcGrp|88621|2022|PDM|60.75|99|0.00|SKILLED NURSING LPN|
20|FH_F148548_37909_0|CSTM-ALL|CSTM-00|2020|PDM|410.00|99|0.00|AEG 1 (NO REV)|
20|FH_F133068_75965_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F67763_0_0|SrvcGrp|44248|2022|PDM|150.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F142041_44846_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41988_0_0|CSTM-ALL|CSTM-00|2020|PDM|442.00|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_F117087_0_0|SrvcGrp|89882|2022|PDM|2494.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F143057_15767_0|SrvcGrp|98041|2022|PDM|10.08|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F111461_32607_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1189.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132080_0_0|SrvcGrp|89781|2022|PDM|169.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F146131_37160_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 8 (NO REV)|
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|730.00|99|0.00|ACUTE PSYCH|
20|FH_F123538_21206_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F99720_0_0|SrvcGrp|104735|2022|PDM|2048.00|99|0.00|NERVE REPAIR WITH SYNTHETIC|
20|FH_F125368_24153_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F101922_98055_0|SrvcGrp|82369|2022|PCT|2.79|99|0.00|AETNA LABORATORY|
20|FH_F119825_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37567_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|ASPG III|
20|FH_F133005_32726_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|8910.00|99|0.00|AEG 9 (NO REV)|
20|FH_F148001_15601_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F103360_68845_0|SrvcGrp|98240|2022|PDM|10272.00|99|0.00|URINARY SYSTEM|
20|FH_F128316_22192_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F125043_53545_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F40890_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91255_19401_0|CSTM-ALL|CSTM-00|2020|PDM|2490.00|99|0.00|AEG 10 (NO REV)|
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|2314.00|99|0.00|ASPG VI|
20|FH_F117380_60020_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F133473_21702_0|SrvcGrp|93734|2022|PCT|1.40|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F38425_0_0|SrvcGrp|10541|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F89932_10940_0|SrvcGrp|75506|2022|PCT|2.92|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F150022_32539_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F111809_93003_0|SrvcGrp|105465|2022|PCT|8.30|99|0.00|AETNA THERAPIES|
20|FH_F34685_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141867_62258_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F69242_0_0|SrvcGrp|43957|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F144049_45242_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F40765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F51438_0_0|CSTM-ALL|CSTM-00|2020|PDM|3350.00|99|0.00|ASPG IX|
20|FH_F89932_10940_0|SrvcGrp|1135|2022|PDM|340.00|99|0.00|CLINIC VISIT|
20|FH_F111784_32901_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F38039_0_0|SrvcGrp|8962|2022|PDM|82.50|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F44795_0_0|SrvcGrp|27767|2022|PDM|40.00|99|0.00|SKILLED IV NURSING HOURLY|
20|FH_F92676_15063_0|SrvcGrp|78993|2022|PDM|1186.68|99|0.00|MON VALLEY ASC 305|
20|FH_F100665_07939_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133477_90247_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F128657_19008_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F44607_0_0|SrvcGrp|38810|2022|PDM|2000.00|99|0.00|CARPAL TUNNEL RELEASE/TENDON SHEATH|
20|FH_F133287_40215_0|CSTM-ALL|CSTM-00|2020|PDM|2021.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 4 (NO REV)|
20|FH_F146320_27610_0|SrvcGrp|109477|2022|PDM|9533.00|99|0.00|PERCUTANEOUS TRANSLUMINAL|
20|FH_F120437_85202_0|SrvcGrp|17001|2022|PDM|185.71|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F134497_47126_0|SrvcGrp|46903|2022|PDM|575.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|774.00|99|0.00|AEG 6 (NO REV)|
20|FH_F38702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|GENERAL ACUTE CARE|
20|FH_F43837_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139825_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F31466_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|ADULT PSYCH PARTIAL HOSP|
20|FH_F69123_0_0|SrvcGrp|47411|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1382.00|99|0.00|AEG 4 (NO REV)|
20|FH_F115289_90057_0|SrvcGrp|89417|2022|PDM|400.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F44048_0_0|CSTM-ALL|CSTM-00|2020|PDM|260.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F96261_0_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
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_F133167_82930_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F38394_0_0|SrvcGrp|17069|2022|PDM|810.72|99|0.00|ASPG III|
20|FH_F141772_80124_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F69071_0_0|SrvcGrp|13595|2022|PDM|598.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F115330_34113_0|SrvcGrp|46903|2022|PDM|500.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F117340_68144_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F141728_71203_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F92677_08003_0|SrvcGrp|92184|2022|PDM|36.75|99|0.00|HCPCS S9340 (HCFA)|
20|FH_F151044_19606_0|SrvcGrp|75419|2022|PDM|370.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F151144_35801_0|SrvcGrp|115970|2022|PDM|1984.57|99|0.00|EYE VITREOUS PROCEDURES|
20|FH_F121985_46256_0|SrvcGrp|116006|2022|PCT|1.00|99|0.00|DRUG TESTS|
20|FH_F113866_0_0|SrvcGrp|90477|2022|PDM|100.00|99|0.00|HOSPICE|
20|FH_F113906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129130_92562_0|SrvcGrp|91177|2022|PDM|3627.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F33744_0_0|SrvcGrp|361|2022|PCT|0.75|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|1903.00|99|0.00|ASPG X|
20|FH_F77923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F91873_12723_0|SrvcGrp|84186|2022|PCT|0.00|99|0.00|LITHOTRIPSY ESWL|
20|FH_F97780_43614_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|1874.00|99|0.00|AEG 7 (NO REV)|
20|FH_F87197_0_0|SrvcGrp|92607|2022|PDM|698.00|99|0.00|SUB-ACUTE CARE LEVEL IV|
20|FH_F116043_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F88456_0_0|SrvcGrp|56462|2022|PDM|2440.00|99|0.00|CPT 53850|
20|FH_F114916_30309_0|SrvcGrp|80617|2022|PDM|22500.00|99|0.00|ARTHOPLASTY|
20|FH_F114916_30309_0|SrvcGrp|67068|2022|PDM|13000.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F142448_15701_0|SrvcGrp|73742|2022|PDM|4.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F104840_32565_0|SrvcGrp|76340|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F138929_0_0|SrvcGrp|88487|2022|PDM|4290.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F141207_0_0|SrvcGrp|65720|2022|PDM|485.00|99|0.00|RESPITE CARE|
20|FH_F95341_08701_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F144828_0_0|SrvcGrp|114194|2022|PDM|2200.00|99|0.00|SKIN FULL GRAFT PROCEDURE|
20|FH_F114389_50131_0|CSTM-ALL|CSTM-00|2020|PDM|291.34|99|0.00|DURABLE MEDICAL EQUIPMENT (DME) (MOD NU)|
20|FH_F114389_50131_0|SrvcGrp|86847|2022|PDM|130.65|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F114389_50131_0|SrvcGrp|86833|2022|PDM|30.30|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F114389_50131_0|SrvcGrp|16559|2022|PDM|48.28|99|0.00|HOME INFUSION THERAPY|
20|FH_F124180_0_0|SrvcGrp|72992|2022|PDM|1125.00|99|0.00|AEG 2|
20|FH_F77944_0_0|CSTM-ALL|CSTM-00|2020|PDM|3863.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F124058_61081_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F146797_44906_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146991_80918_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F36318_0_0|SrvcGrp|22800|2022|PCT|0.85|99|0.00|PACEMAKER|
20|FH_F37703_0_0|SrvcGrp|3810|2022|PDM|135.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F92493_0_0|SrvcGrp|99161|2022|PDM|16193.10|99|0.00|CPT 27138|
20|FH_F124222_92625_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125134_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
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_F128974_70130_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136689_45044_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F113787_31909_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F138716_20151_0|SrvcGrp|78419|2022|PDM|2500.00|99|0.00|VBAC DELIVERY|
20|FH_F139708_54880_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148553_85016_0|SrvcGrp|115438|2022|PDM|2505.00|99|0.00|INSERTION OF HEART ELECTRODE|
20|FH_F148553_85016_0|SrvcGrp|115457|2022|PDM|1561.00|99|0.00|REMOVE ELECTRODE TRANSVENOUSLY|
20|FH_F34498_0_0|SrvcGrp|16704|2022|PDM|1364.00|99|0.00|HOME HEMO TRAINING|
20|FH_F147305_90755_0|SrvcGrp|46605|2022|PDM|134.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F147586_44124_0|SrvcGrp|11663|2022|PCT|0.44|99|0.00|IMPLANTS|
20|FH_F42837_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133471_47901_0|SrvcGrp|93337|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F111561_10002_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F111605_80524_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37772_0_0|SrvcGrp|27300|2022|PDM|46.00|99|0.00|CPT 92557|
20|FH_F134087_0_0|SrvcGrp|92415|2022|PDM|5410.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F35404_0_0|SrvcGrp|66240|2022|PDM|6982.00|99|0.00|PTCA|
20|FH_F100101_24018_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F120630_33161_0|SrvcGrp|89149|2022|PDM|191.00|99|0.00|OP INTENSIVE|
20|FH_F39839_0_0|SrvcGrp|701|2022|PDM|1390.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F41013_0_0|SrvcGrp|31188|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC (DME)|
20|FH_F113585_20155_0|SrvcGrp|29075|2022|PDM|55.00|99|0.00|HYDRATION THERAPY|
20|FH_F138774_74133_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138876_25302_0|SrvcGrp|86852|2022|PDM|40.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F138936_01040_0|SrvcGrp|13990|2022|PCT|0.47|99|0.00|PACEMAKER|
20|FH_F118986_0_0|SrvcGrp|75491|2022|PDM|1409.23|99|0.00|AEG 7|
20|FH_F119888_0_0|SrvcGrp|13422|2022|PDM|264.36|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
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_F113527_31023_0|SrvcGrp|75491|2022|PCT|0.80|99|0.00|AEG 7|
20|FH_F151461_38063_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132248_44060_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F132258_45404_0|SrvcGrp|24761|2022|PDM|34.98|99|0.00|HOME INFUSION THERAPY|
20|FH_F123184_20906_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F123191_15012_0|SrvcGrp|48396|2022|PDM|91.00|99|0.00|OT SERVICES|
20|FH_F91764_93710_0|SrvcGrp|114925|2022|PDM|6127.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F91766_25401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135976_67401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136194_80909_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130620_18940_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F116404_20191_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F116431_76104_0|CSTM-ALL|CSTM-00|2020|PDM|437.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F116464_13088_0|SrvcGrp|104077|2022|PCT|1.05|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1302.00|99|0.00|AREOLA RECONSTRUCTION|
20|FH_F67986_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F36341_0_0|SrvcGrp|16|2022|PDM|893.00|99|0.00|ACUTE REHABILITATION|
20|FH_F42098_0_0|SrvcGrp|11089|2022|PDM|40.00|99|0.00|NURSING CARE|
20|FH_F44754_0_0|SrvcGrp|10545|2022|PDM|72.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F111301_33122_0|SrvcGrp|109707|2022|PDM|5256.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F134263_15628_0|SrvcGrp|90631|2022|PDM|145.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F134288_33919_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC|
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG I|
20|FH_F145587_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F148243_0_0|SrvcGrp|70746|2022|PDM|1450.00|99|0.00|CPT 28292|
20|FH_F101442_0_0|SrvcGrp|98466|2022|PDM|1253.58|99|0.00|PARTIAL REMOVAL OF FOOT BONE|
20|FH_F131000_0_0|SrvcGrp|63463|2022|PDM|3608.00|99|0.00|CPT 52204|
20|FH_F40598_0_0|SrvcGrp|3029|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F124981_32539_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F101320_26062_0|SrvcGrp|47183|2022|PDM|108.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F102940_35034_0|SrvcGrp|46424|2022|PDM|120.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F143542_0_0|SrvcGrp|106235|2022|PDM|6885.00|99|0.00|CYPASS|
20|FH_F143542_0_0|SrvcGrp|46886|2022|PDM|4590.00|99|0.00|REMOVAL OF EYELID LESION|
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|1008.00|99|0.00|AEG 6 (NO REV)|
20|FH_F102881_0_0|SrvcGrp|98720|2022|PCT|0.90|99|0.00|AETNA IMPLANTS|
20|FH_F87222_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88115_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139690_0_0|SrvcGrp|113580|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F136308_34481_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136373_17055_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F136474_95742_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118152_20151_0|SrvcGrp|86843|2022|PDM|50.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F120490_64133_0|SrvcGrp|86829|2022|PDM|37.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F93132_73134_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F134066_33881_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137238_70056_0|SrvcGrp|86723|2022|PDM|409.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F114092_83350_0|SrvcGrp|75943|2022|PDM|8238.00|99|0.00|AETNA INPATIENT SURGICAL CARE|
20|FH_F142400_75090_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142314_19102_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142547_70002_0|SrvcGrp|24745|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F142547_70002_0|SrvcGrp|86845|2022|PDM|25.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F97602_40121_0|SrvcGrp|90854|2022|PDM|1738.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F138584_30912_0|SrvcGrp|113384|2022|PDM|1300.00|99|0.00|TEMPOROMANDIBULAR DISLOCATION TREATMENT|
20|FH_F138627_82901_0|SrvcGrp|111528|2022|PDM|70.00|99|0.00|PICC LINE INSERTION (HCFA)|
20|FH_F130363_0_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F77782_66061_0|SrvcGrp|35010|2022|PCT|0.80|99|0.00|MS DRG 242-251 ONLY|
20|FH_F77782_66061_0|SrvcGrp|35164|2022|PDM|4277.00|99|0.00|NICU LEVEL II OR III|
20|FH_F140688_98405_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F140733_45005_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (BREAKOUT)|
20|FH_F140890_30906_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F80062_27612_0|SrvcGrp|76501|2022|PDM|278.25|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F120152_0_0|SrvcGrp|90063|2022|PDM|3300.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|2090.00|99|0.00|AEG 5  (NO REV)|
20|FH_F118789_92211_0|SrvcGrp|73605|2022|PDM|1000.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F119004_06850_0|CSTM-ALL|CSTM-00|2020|PDM|852.00|99|0.00|AEG 3 (NO REV)|
20|FH_F118932_07652_0|SrvcGrp|73806|2022|PDM|1591.00|99|0.00|AETNA ER|
20|FH_F41481_0_0|SrvcGrp|17071|2022|PDM|692.00|99|0.00|ASPG IV|
20|FH_F115452_15235_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F117371_77059_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F147799_18052_0|SrvcGrp|46605|2022|PDM|116.42|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F129483_77030_0|SrvcGrp|29023|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129504_02871_0|SrvcGrp|94780|2022|PDM|170.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F117108_37841_0|SrvcGrp|106811|2022|PCT|0.00|99|0.00|IP DETOXIFICATION|
20|FH_F137938_29036_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|GENERAL ACUTE CARE|
20|FH_F46273_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F38699_0_0|SrvcGrp|17073|2022|PDM|851.00|99|0.00|ASPG V|
20|FH_F110308_0_0|SrvcGrp|72998|2022|PDM|700.00|99|0.00|AEG 5|
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.00|99|0.00|AEG 2 (NO REV)|
20|FH_F90613_05001_0|SrvcGrp|86639|2022|PDM|1179.00|99|0.00|AETNA IP PSYCHIATRIC (<18 YRS)|
20|FH_F109513_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F60232_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F62974_0_0|SrvcGrp|17140|2022|PDM|98.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F130725_33020_0|SrvcGrp|108484|2022|PDM|854.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F130914_51103_0|SrvcGrp|73063|2022|PDM|800.00|99|0.00|OBSERVATION SERVICES|
20|FH_F100782_0_0|SrvcGrp|105182|2022|PDM|350.00|99|0.00|WINDBER MEDICAL CNTR ASC 1602|
20|FH_F143571_0_0|SrvcGrp|63297|2022|PDM|153.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F79863_0_0|SrvcGrp|14893|2022|PDM|75.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F144248_0_0|SrvcGrp|82570|2022|PDM|4590.00|99|0.00|REVISION EYELID/EXCESS SKIN|
20|FH_F145714_44135_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F85652_98034_0|SrvcGrp|44007|2022|PDM|2512.00|99|0.00|EMERGENCY ROOM (CPT CODE 99285)|
20|FH_F150140_28714_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133957_84121_0|SrvcGrp|80918|2022|PDM|94.50|99|0.00|RESPITE CARE|
20|FH_F121628_19533_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F111912_30720_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|OP SVCS|
20|FH_F134223_83617_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121476_0_0|SrvcGrp|108834|2022|PDM|31575.00|99|0.00|IMPLT NROSTM PLS GEN SNG REC|
20|FH_F126560_43606_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134608_18017_0|SrvcGrp|89673|2022|PDM|105.00|99|0.00|US EXAM PG UTERUS LIMIT|
20|FH_F85353_16407_0|SrvcGrp|76021|2022|PDM|439.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F145940_71730_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145597_78644_0|SrvcGrp|46903|2022|PDM|670.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1395.00|99|0.00|ASPG VIII - FH SW CUSTOM GROUPERS|
20|FH_F51121_0_0|SrvcGrp|3809|2022|PDM|657.00|99|0.00|HOSPICE CARE|
20|FH_F44278_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|PEDIATRIC IP SVCS|
20|FH_F114851_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F83754_0_0|SrvcGrp|3418|2022|PDM|6568.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F135627_77070_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F130017_02302_0|SrvcGrp|98542|2022|PDM|692.01|99|0.00|BEHAVIORAL OBSERVATION IP|
20|FH_F110604_0_0|SrvcGrp|53066|2022|PDM|1100.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL|
20|FH_F109242_18466_0|SrvcGrp|89269|2022|PDM|108.00|99|0.00|PSYTX PT/FAMILY 45 MINUTES|
20|FH_F133749_84604_0|SrvcGrp|112417|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC (HCFA)|
20|FH_F127933_62863_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F69787_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79863_0_0|SrvcGrp|77241|2022|PDM|55.00|99|0.00|AETNA HOME INFUSION S5517|
20|FH_F141337_60077_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|2789.00|99|0.00|AEG 8 (NO REV)|
20|FH_F149103_32803_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F134613_08852_0|SrvcGrp|89337|2022|PDM|2474.50|99|0.00|DETOXIFICATION|
20|FH_F110425_01752_0|SrvcGrp|88620|2022|PDM|170.00|99|0.00|SKILLED NURSING RN|
20|FH_F49552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F145642_15108_0|SrvcGrp|86836|2022|PDM|10.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAMPTON ROADS GAST GLOBAL|
20|FH_F134593_60007_0|SrvcGrp|115522|2022|PCT|0.85|99|0.00|VILTEPSO/VILTOLARSEN INJECTION|
20|FH_F133827_98663_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123623_03246_0|SrvcGrp|108153|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F148600_30328_0|SrvcGrp|88599|2022|PDM|3520.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F36552_0_0|SrvcGrp|18855|2022|PDM|29840.00|99|0.00|MS DRG 229|
20|FH_F117208_0_0|SrvcGrp|59841|2022|PDM|1980.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F148668_33177_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146626_60612_0|SrvcGrp|114333|2022|PCT|1.00|99|0.00|COVID-19 SPECIMEN HANDLING OFFICE LAB|
20|FH_F118123_67226_0|SrvcGrp|22593|2022|PDM|25.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F85212_71075_0|SrvcGrp|73004|2022|PDM|1458.00|99|0.00|AEG 8|
20|FH_F150161_63361_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F81838_0_0|SrvcGrp|9829|2022|PDM|77.00|99|0.00|PT SVCS|
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_F69845_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133947_93950_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F126341_27284_0|SrvcGrp|27615|2022|PCT|1.07|99|0.00|AETNA DRUGS|
20|FH_F149099_23901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130763_0_0|SrvcGrp|27402|2022|PDM|4714.00|99|0.00|LASER PROCEDURES|
20|FH_F92641_34994_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143708_19031_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87012_0_0|SrvcGrp|72998|2022|PDM|1221.96|99|0.00|AEG 5|
20|FH_F38567_0_0|SrvcGrp|16|2022|PDM|670.00|99|0.00|ACUTE REHABILITATION|
20|FH_F95623_84015_0|SrvcGrp|47411|2022|PDM|90.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F85353_16407_0|SrvcGrp|63900|2022|PDM|165.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 136|
20|FH_F126188_59404_0|SrvcGrp|110365|2022|PCT|0.00|99|0.00|REFRACTIVE PROCEDURES|
20|FH_F77943_0_0|SrvcGrp|58521|2022|PCT|0.70|99|0.00|CARDIAC CATH|
20|FH_F95440_0_0|SrvcGrp|93722|2022|PDM|3605.00|99|0.00|LAMINECTOMIES|
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|3438.00|99|0.00|AEG 6 (NO REV)|
20|FH_F150179_23124_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149343_44134_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F85353_16407_0|SrvcGrp|63898|2022|PDM|165.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 314|
20|FH_F135656_74820_0|SrvcGrp|73605|2022|PDM|786.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F85652_98034_0|SrvcGrp|73479|2022|PDM|13934.00|99|0.00|C-SECTION DELIVERY MSDRG 765-766 REPLACEMENT 783-788|
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|AEG 9 (NO REV)|
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145641_06902_0|SrvcGrp|112584|2022|PDM|3709.00|99|0.00|PARTIAL TOE REMOVAL|
20|FH_F134496_66062_0|SrvcGrp|74668|2022|PDM|178.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F122551_75605_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F122553_92705_0|SrvcGrp|100859|2022|PDM|259.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F85911_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F85012_0_0|SrvcGrp|79720|2022|PDM|1155.00|99|0.00|ACUTE REHAB II|
20|FH_F71829_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F76063_0_0|SrvcGrp|73284|2022|PCT|0.55|99|0.00|AMBULATORY SURGERY|
20|FH_F101100_50314_0|SrvcGrp|86233|2022|PDM|18861.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F101100_50314_0|SrvcGrp|97905|2022|PDM|20701.00|99|0.00|REMOVAL OF SMALL INTESTINE|
20|FH_F105361_80104_0|SrvcGrp|67944|2022|PDM|287.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F146796_43334_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120778_43351_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F116088_46410_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133652_50310_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132167_06040_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139673_63011_0|SrvcGrp|66265|2022|PDM|80.75|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F133519_0_0|SrvcGrp|67994|2022|PDM|1255.00|99|0.00|CPT 58120|
20|FH_F138662_78624_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F147209_60202_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F91259_0_0|CSTM-ALL|CSTM-00|2020|PDM|909.00|99|0.00|AEG 1 (NO REV)|
20|FH_F151026_63129_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS|
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PDM|1770.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F128375_03909_0|SrvcGrp|100499|2022|PDM|857.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F134797_0_0|SrvcGrp|72998|2022|PDM|1332.00|99|0.00|AEG 5|
20|FH_F131498_0_0|SrvcGrp|73656|2022|PDM|475.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F67419_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131175_06757_0|SrvcGrp|111762|2022|PDM|1950.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F90455_0_0|SrvcGrp|16304|2022|PDM|685.00|99|0.00|HOSPICE CARE|
20|FH_F32825_0_0|CSTM-ALL|CSTM-00|2020|PDM|1146.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F35140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F147183_17701_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124714_64081_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149045_45679_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149399_17013_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148859_0_0|SrvcGrp|115527|2022|PDM|73.87|99|0.00|INJECTION|
20|FH_F133223_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F39443_0_0|SrvcGrp|30367|2022|PDM|49.00|99|0.00|HAPA WPA ASC 10|
20|FH_F151619_73505_0|SrvcGrp|75487|2022|PDM|828.00|99|0.00|AEG 5|
20|FH_F147260_53227_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F137627_78382_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F35416_0_0|SrvcGrp|15977|2022|PCT|0.80|99|0.00|PALLIDOTOMY|
20|FH_F76382_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116332_0_0|SrvcGrp|83824|2022|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES|
20|FH_F146859_0_0|SrvcGrp|106167|2022|PDM|1765.00|99|0.00|REMOVE TENDON SHEATH LESION|
20|FH_F56232_0_0|CSTM-ALL|CSTM-00|2020|PDM|1683.76|99|0.00|ASPG X|
20|FH_F131383_85006_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F36903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F125656_92868_0|SrvcGrp|24744|2022|PDM|75.00|99|0.00|PICC LINE INSERTION|
20|FH_F98801_93274_0|SrvcGrp|73601|2022|PDM|7915.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F41317_0_0|CSTM-ALL|CSTM-00|2020|PDM|935.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F74845_0_0|CSTM-ALL|CSTM-00|2020|PDM|524.00|99|0.00|MULTIPLE BIRTHS|
20|FH_F130997_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35280_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|CARDIAC EVENT MONITORING (MOD TC) F/S - TMSS|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|11041.00|99|0.00|MSDRG 250-251 PERCUTANEOUS CARDIO PROC|
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|726.00|99|0.00|AEG 1 (NO REV)|
20|FH_F90213_30084_0|SrvcGrp|80285|2022|PDM|156.23|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F37385_0_0|SrvcGrp|15387|2022|PDM|125.00|99|0.00|RN VISIT|
20|FH_F80974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90223_0_0|SrvcGrp|88830|2022|PDM|10.00|99|0.00|HOME PHARMACY SERVICES (MOD SH) (HCFA)|
20|FH_F32902_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132160_0_0|SrvcGrp|46906|2022|PDM|9754.00|99|0.00|CORNEAL TISSUE|
20|FH_F138271_75040_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F101083_0_0|SrvcGrp|73004|2022|PDM|1522.00|99|0.00|AEG 8|
20|FH_F98801_93274_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|10400.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F91799_15010_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97620_75904_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F39772_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (HCFA)|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137747_62278_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97082_90012_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F131175_06757_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F131111_33304_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F124514_21215_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F40644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F148702_32606_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F138018_17313_0|SrvcGrp|26617|2022|PDM|8.34|99|0.00|HOME INFUSION THERAPY|
20|FH_F39443_0_0|SrvcGrp|30325|2022|PDM|452.00|99|0.00|HAPA WPA ASC 209|
20|FH_F147339_08837_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140090_37221_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140296_32068_0|SrvcGrp|87077|2022|PDM|220.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F143533_30013_0|SrvcGrp|86714|2022|PDM|124.00|99|0.00|NON INVASIVE VASCULAR STUDY|
20|FH_F37100_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|616.38|99|0.00|AEG 2 (NO REV)|
20|FH_F151764_03801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120171_33770_0|SrvcGrp|73842|2022|PDM|207.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136296_73170_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F112712_63005_0|SrvcGrp|24750|2022|PCT|1.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F31600_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|OP SVCS|
20|FH_F116579_45822_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F116698_07470_0|SrvcGrp|86838|2022|PDM|21.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F116802_41224_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116869_15146_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F125287_92374_0|SrvcGrp|75419|2022|PDM|405.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F113649_01752_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F84611_30281_0|SrvcGrp|73006|2022|PDM|4643.00|99|0.00|AEG 9|
20|FH_F51276_0_0|SrvcGrp|17004|2022|PDM|54.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS|
20|FH_F100780_24153_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F102948_43606_0|SrvcGrp|46903|2022|PDM|434.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F39939_0_0|SrvcGrp|10111|2022|PCT|0.83|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_F50137_0_0|SrvcGrp|10519|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F61292_0_0|SrvcGrp|48085|2022|PDM|105.00|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F132779_0_0|SrvcGrp|3493|2022|PCT|0.59|99|0.00|PHARMACY SVCS|
20|FH_F145537_02061_0|SrvcGrp|108484|2022|PDM|473.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F148341_21222_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F143743_26501_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|2992.00|99|0.00|AEG 3 (NO REV)|
20|FH_F121090_07848_0|SrvcGrp|86722|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F76171_0_0|CSTM-ALL|CSTM-00|2020|PDM|10.00|99|0.00|LVN HOURLY|
20|FH_F35166_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)|
20|FH_F83198_44125_0|SrvcGrp|28787|2022|PDM|21.00|99|0.00|CPT CODE 90993|
20|FH_F40834_0_0|SrvcGrp|33313|2022|PDM|393.00|99|0.00|MULTIPLE BIRTH|
20|FH_F89779_0_0|SrvcGrp|41334|2022|PDM|20500.00|99|0.00|TOTAL KNEE|
20|FH_F131577_89148_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F113253_72206_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F78165_0_0|SrvcGrp|35964|2022|PDM|45.00|99|0.00|SPEECH THERAPY|
20|FH_F72183_0_0|SrvcGrp|36991|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F139173_0_0|SrvcGrp|97506|2022|PDM|172.09|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F56276_0_0|SrvcGrp|52946|2022|PDM|118.00|99|0.00|PSYCHIATRIC CPT 90807|
20|FH_F137347_26003_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147941_06023_0|SrvcGrp|91257|2022|PDM|485.00|99|0.00|OUTPATIENT SERVICES W/URGENT CARE|
20|FH_F125986_62656_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 7 (NO REV)|
20|FH_F41887_0_0|SrvcGrp|13631|2022|PDM|110.00|99|0.00|CPT 99213|
20|FH_F63556_0_0|SrvcGrp|16|2022|PDM|2000.00|99|0.00|ACUTE REHABILITATION|
20|FH_F34979_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34735_0_0|SrvcGrp|17307|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|3098.00|99|0.00|AEG 9 (NO REV)|
20|FH_F135056_06401_0|SrvcGrp|44007|2022|PDM|180.25|99|0.00|EMERGENCY ROOM (CPT CODE 99285)|
20|FH_F72183_0_0|SrvcGrp|47260|2022|PCT|0.70|99|0.00|IMPLANTS 274-276, 278  LINE LEVEL|
20|FH_F85291_0_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F115121_32250_0|SrvcGrp|89149|2022|PDM|308.00|99|0.00|OP INTENSIVE|
20|FH_F125710_02860_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147941_06023_0|SrvcGrp|115245|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F128272_60640_0|SrvcGrp|24750|2022|PDM|40.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F127068_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38798_0_0|SrvcGrp|27579|2022|PDM|100.00|99|0.00|RESPIRATORY THERAPY INITIAL VISIT|
20|FH_F55054_0_0|SrvcGrp|9939|2022|PDM|1430.00|99|0.00|ACUTE MEDICAL SVCS|
20|FH_F128272_60640_0|SrvcGrp|10577|2022|PDM|50.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F148343_70810_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F34100_0_0|SrvcGrp|12512|2022|PDM|950.00|99|0.00|ACUTE REHABILITATION|
20|FH_F130523_04605_0|SrvcGrp|75506|2022|PCT|0.84|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F93880_95476_0|SrvcGrp|73606|2022|PDM|1036.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F120279_98005_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F39992_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1001.00|99|0.00|AEG 8 (NO REV)|
20|FH_F124388_0_0|SrvcGrp|98526|2022|PDM|1254.00|99|0.00|CYSTOURETHROSCOPY|
20|FH_F141527_36830_0|SrvcGrp|86828|2022|PDM|11.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F126939_32405_0|SrvcGrp|89417|2022|PDM|360.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F126523_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F148549_60523_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F40332_0_0|SrvcGrp|12235|2022|PDM|1100.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F135771_0_0|SrvcGrp|92501|2022|PDM|151.98|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F131560_62946_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132779_0_0|SrvcGrp|99068|2022|PDM|39419.00|99|0.00|MS DRG 228-229 ONLY OTHER CARDIOTHORACIC PROC|
20|FH_F115127_0_0|SrvcGrp|105357|2022|PDM|580.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|1353.00|99|0.00|AEG 2 (NO REV)|
20|FH_F89799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F121149_76021_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F31815_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F143528_0_0|SrvcGrp|78096|2022|PDM|5250.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F93332_0_0|SrvcGrp|58993|2022|PDM|7416.00|99|0.00|DISKECTOMY|
20|FH_F97540_32114_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F42464_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|BURN OUTPATIENT SERVICES|
20|FH_F135021_37160_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141794_50548_0|SrvcGrp|109057|2022|PCT|0.75|99|0.00|CARDIAC STUDIES|
20|FH_F130716_76013_0|SrvcGrp|29347|2022|PDM|105.00|99|0.00|HOME HEALTH AIDE|
20|FH_F145797_46250_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F65159_0_0|SrvcGrp|941|2022|PDM|4961.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F122893_29135_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F86872_15215_0|SrvcGrp|29077|2022|PDM|225.00|99|0.00|HOME TRANSFUSION|
20|FH_F43250_0_0|SrvcGrp|37018|2022|PDM|250.00|99|0.00|BOARDER BABY|
20|FH_F55212_0_0|SrvcGrp|3392|2022|PDM|87.00|99|0.00|CPT 90806|
20|FH_F148345_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F88096_0_0|SrvcGrp|86577|2022|PDM|1200.00|99|0.00|NEUROSTIMULATOR PROCEDURES|
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PDM|730.00|99|0.00|AEG 3 (NO REV)|
20|FH_F89495_0_0|SrvcGrp|29985|2022|PCT|0.45|99|0.00|SUPPLIES|
20|FH_F46492_0_0|SrvcGrp|3448|2022|PDM|1177.00|99|0.00|MRI|
20|FH_F39627_0_0|SrvcGrp|177|2022|PDM|1500.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F133517_49221_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F31928_0_0|CSTM-ALL|CSTM-00|2020|PDM|790.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111467_33761_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132601_92677_0|SrvcGrp|58509|2022|PDM|411.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F33660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127422_0_0|SrvcGrp|73004|2022|PDM|973.00|99|0.00|AEG 8|
20|FH_F101923_98104_0|SrvcGrp|29532|2022|PCT|3.17|99|0.00|LABORATORY|
20|FH_F111809_93003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F141870_85224_0|SrvcGrp|86849|2022|PDM|40.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F132571_24739_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F127217_29650_0|SrvcGrp|89337|2022|PDM|1018.00|99|0.00|DETOXIFICATION|
20|FH_F48052_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F97140_91730_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS|
20|FH_F77663_0_0|SrvcGrp|555|2022|PDM|350.00|99|0.00|INTENSIVE OP SVCS|
20|FH_F123091_92627_0|SrvcGrp|74668|2022|PDM|700.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F101840_76054_0|SrvcGrp|77582|2022|PDM|6260.00|99|0.00|CPT 31255|
20|FH_F40203_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|BRAIN INJURY REHAB|
20|FH_F132722_71373_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|830.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132503_73086_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133009_19038_0|SrvcGrp|43567|2022|PDM|107.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F134447_12883_0|SrvcGrp|471|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PDM|3960.00|99|0.00|AEG 4 (NO REV)|
20|FH_F92833_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F123317_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F150002_28761_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100785_54660_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F85753_0_0|SrvcGrp|80285|2022|PDM|131.17|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F45199_0_0|CSTM-ALL|CSTM-00|2020|PDM|501.00|99|0.00|ASPG II|
20|FH_F127325_0_0|SrvcGrp|73008|2022|PDM|512.00|99|0.00|AEG 10|
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133129_45863_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F141987_02859_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132991_84790_0|SrvcGrp|48398|2022|PDM|85.50|99|0.00|PT SERVICES|
20|FH_F146380_85203_0|SrvcGrp|74668|2022|PDM|149.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F35408_0_0|SrvcGrp|19607|2022|PDM|550.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F41405_0_0|CSTM-ALL|CSTM-00|2020|PDM|65.00|99|0.00|OP SVCS|
20|FH_F97541_33021_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F102561_75146_0|SrvcGrp|98006|2022|PDM|4850.00|99|0.00|PHALANGEAL SHAFT FRACTURE|
20|FH_F90921_77702_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F108700_63857_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F141612_19605_0|SrvcGrp|105439|2022|PDM|433.00|99|0.00|AETNA TERANIAL MAGN STIM TX DELI|
20|FH_F74947_0_0|SrvcGrp|33164|2022|PDM|400.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F141627_43725_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101811_64116_0|SrvcGrp|99436|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F119076_41001_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F46492_0_0|SrvcGrp|11151|2022|PDM|2771.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F141648_60050_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109846_16502_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36350_0_0|SrvcGrp|701|2022|PDM|1618.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F31184_0_0|SrvcGrp|9774|2022|PDM|2700.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD KN|
20|FH_F97560_23249_0|SrvcGrp|73656|2022|PDM|577.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F88355_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F144448_04901_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
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_F68947_0_0|SrvcGrp|65402|2022|PDM|4865.08|99|0.00|CPT 42145|
20|FH_F150579_16652_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145907_03867_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111401_29425_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F127204_44420_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F54552_0_0|SrvcGrp|42322|2022|PDM|60.00|99|0.00|HOME THERAPY|
20|FH_F118819_76226_0|SrvcGrp|93919|2022|PDM|796.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F43433_0_0|SrvcGrp|15325|2022|PCT|1.00|99|0.00|ER LEVEL III|
20|FH_F150660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F123545_44512_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F150899_17243_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67639_0_0|SrvcGrp|63464|2022|PDM|925.00|99|0.00|CPT 52276|
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 4 (NO REV)|
20|FH_F128707_72601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F31184_0_0|SrvcGrp|18817|2022|PDM|41600.00|99|0.00|MS DRG 222|
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|909.00|99|0.00|AEG 6 (NO REV)|
20|FH_F128605_20910_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F44607_0_0|SrvcGrp|2738|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F148863_33021_0|SrvcGrp|46903|2022|PDM|1121.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F121347_29401_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F121976_44505_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F113906_0_0|SrvcGrp|72990|2022|PDM|545.00|99|0.00|AEG 1|
20|FH_F91873_12723_0|SrvcGrp|72994|2022|PDM|2236.00|99|0.00|AEG 3|
20|FH_F97660_29401_0|SrvcGrp|73485|2022|PDM|1925.00|99|0.00|AETNA REHAB|
20|FH_F116323_0_0|SrvcGrp|99073|2022|PDM|404.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F69785_0_0|SrvcGrp|42974|2022|PDM|83.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F86911_0_0|SrvcGrp|85650|2022|PDM|130.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 2 (NO REV)|
20|FH_F114916_30309_0|SrvcGrp|89404|2022|PDM|16500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F117623_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F129597_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1262.00|99|0.00|AEG 8 (NO REV)|
20|FH_F134317_0_0|SrvcGrp|87537|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F132988_0_0|SrvcGrp|100039|2022|PDM|6151.60|99|0.00|REPAIR OF HEEL FRACTURE|
20|FH_F132988_0_0|SrvcGrp|100065|2022|PDM|4493.01|99|0.00|DEEP ANT OR POSTER TIBIAL|
20|FH_F137067_0_0|SrvcGrp|89848|2022|PDM|21000.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F128027_0_0|SrvcGrp|64725|2022|PDM|1085.00|99|0.00|CPT 45378|
20|FH_F42161_0_0|SrvcGrp|22461|2022|PCT|0.88|99|0.00|INPATIENT HOSPICE SVCS|
20|FH_F118786_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118909_0_0|SrvcGrp|65720|2022|PDM|123.60|99|0.00|RESPITE CARE|
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1405.95|99|0.00|AEG 9 (NO REV)|
20|FH_F82432_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F114389_50131_0|SrvcGrp|92104|2022|PDM|316.91|99|0.00|AETNA OXYGEN CONCENTRATOR 1 PORT|
20|FH_F114389_50131_0|SrvcGrp|82846|2022|PCT|1.61|99|0.00|AETNA DME|
20|FH_F49487_0_0|SrvcGrp|17003|2022|PDM|214.00|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS|
20|FH_F83115_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F121426_0_0|SrvcGrp|3388|2022|PDM|969.00|99|0.00|SUBACUTE CARE|
20|FH_F124180_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|546.00|99|0.00|AEG 3 (NO REV)|
20|FH_F146985_12205_0|SrvcGrp|48385|2022|PDM|89.00|99|0.00|SPEECH THERAPY|
20|FH_F146937_27609_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48752_0_0|SrvcGrp|33165|2022|PDM|325.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F64819_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HAPA WPA/NWPA 2013 LABS 100%|
20|FH_F36318_0_0|SrvcGrp|941|2022|PDM|3730.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F41035_0_0|SrvcGrp|72992|2022|PDM|500.00|99|0.00|AEG 2|
20|FH_F43800_0_0|CSTM-ALL|CSTM-00|2020|PDM|847.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F55453_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F146239_0_0|SrvcGrp|87077|2022|PDM|250.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|AEG 7 (NO REV)|
20|FH_F150910_0_0|SrvcGrp|88164|2022|PDM|10500.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F114666_30342_0|SrvcGrp|85792|2022|PDM|4500.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F138984_06896_0|SrvcGrp|471|2022|PDM|655.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PDM|30.75|99|0.00|PSYCHOLOGICAL TESTING|
20|FH_F122608_84123_0|SrvcGrp|48396|2022|PDM|103.00|99|0.00|OT SERVICES|
20|FH_F122641_72365_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136913_68803_0|SrvcGrp|112834|2022|PCT|7.50|99|0.00|RADIOLOGY SERVICES|
20|FH_F136914_64081_0|SrvcGrp|76531|2022|PDM|146.00|99|0.00|HOSPICE IN HOME|
20|FH_F72222_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F147389_81632_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F147520_61614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41463_0_0|SrvcGrp|35432|2022|PCT|0.60|99|0.00|SUPPLIES - MISCELLANEOUS|
20|FH_F41463_0_0|SrvcGrp|34171|2022|PDM|48.30|99|0.00|HOME HEALTH AIDE|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD AV RATE|
20|FH_F133494_90023_0|CSTM-ALL|CSTM-00|2020|PDM|5555.00|99|0.00|AEG 8 (NO REV)|
20|FH_F131212_63017_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F134828_30531_0|SrvcGrp|112650|2022|PDM|35.00|99|0.00|XRAY EXAM CHEST TWO VIEWS|
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|369.00|99|0.00|AEG 1 (NO REV)|
20|FH_F102641_0_0|SrvcGrp|74039|2022|PDM|3602.00|99|0.00|LAMINECTOMY|
20|FH_F116956_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F46433_0_0|SrvcGrp|26617|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F46433_0_0|SrvcGrp|40828|2022|PDM|70.00|99|0.00|CONTINUOUS INSULIN INFUSION THERAPY|
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 10 (NO REV)|
20|FH_F38183_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AMBULANCE SVCS|
20|FH_F91594_0_0|SrvcGrp|75399|2022|PDM|0.10|99|0.00|MED RECORD COPY|
20|FH_F42985_0_0|SrvcGrp|109|2022|PDM|400.00|99|0.00|CD - DETOX|
20|FH_F138936_01040_0|SrvcGrp|111926|2022|PCT|1.00|99|0.00|COVID-19 LAB TESTING|
20|FH_F138963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|423.25|99|0.00|HAPA WPA-NWPA 2012-13 ASC 307 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.59|99|0.00|HAPA WPA-NWPA 2012-13 ASC 127 W/O REV|
20|FH_F113527_31023_0|SrvcGrp|75483|2022|PCT|0.80|99|0.00|AEG 3|
20|FH_F135431_33414_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F135924_02906_0|SrvcGrp|73496|2022|PDM|1446.80|99|0.00|AETNA ER LEVEL V|
20|FH_F100880_67735_0|SrvcGrp|73602|2022|PDM|1596.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F116455_26003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140629_0_0|SrvcGrp|78282|2022|PDM|2497.00|99|0.00|CPT 47563|
20|FH_F121771_91405_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F121824_92675_0|SrvcGrp|87317|2022|PDM|970.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F38013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|SAOF OP SERVICES MOD RR|
20|FH_F131407_07607_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F132689_18436_0|SrvcGrp|86722|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F129967_18915_0|SrvcGrp|104420|2022|PDM|74.80|99|0.00|OFFICE/OUTPATIENT VISIT EST (HCFA)(MOD AF)|
20|FH_F47906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F115943_0_0|SrvcGrp|106488|2022|PDM|977.00|99|0.00|ANESTHESIA SERVICES (HCFA)|
20|FH_F148243_0_0|SrvcGrp|42550|2022|PDM|1570.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F132328_0_0|SrvcGrp|28550|2022|PDM|4110.00|99|0.00|VITRECTOMY|
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_F87557_33309_0|SrvcGrp|14948|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142655_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F102228_08846_0|SrvcGrp|90643|2022|PDM|140.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.85|99|0.00|AEG 2 (NO REV)|
20|FH_F70844_15317_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139236_0_0|SrvcGrp|12664|2022|PCT|0.75|99|0.00|IMPLANTS|
20|FH_F128341_41139_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F128341_41139_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F100906_0_0|SrvcGrp|14614|2022|PDM|2500.00|99|0.00|LITHOTRIPSY|
20|FH_F110604_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F88639_80204_0|SrvcGrp|32011|2022|PDM|29467.47|99|0.00|TRAUMA CARE|
20|FH_F32211_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123792_90803_0|SrvcGrp|100499|2022|PDM|1011.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F123661_30060_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121250_47401_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F69968_0_0|SrvcGrp|46522|2022|PDM|15193.82|99|0.00|TOTAL KNEE|
20|FH_F136386_30901_0|SrvcGrp|73462|2022|PDM|3700.00|99|0.00|AETNA NICU III|
20|FH_F120490_64133_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134011_84102_0|SrvcGrp|106662|2022|PDM|29.00|99|0.00|CONTINUOUS HOSPICE CARE (HCFA)|
20|FH_F138545_39503_0|SrvcGrp|87441|2022|PDM|694.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F139456_47501_0|SrvcGrp|72984|2022|PCT|1.35|99|0.00|CHEMOTHERAPY|
20|FH_F139456_47501_0|SrvcGrp|75506|2022|PCT|0.80|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F140447_84106_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F140668_68745_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149600_18901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149663_45219_0|SrvcGrp|89404|2022|PDM|17156.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F149639_96822_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119090_91502_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F118932_07652_0|SrvcGrp|72996|2022|PDM|2440.00|99|0.00|AEG 4|
20|FH_F109885_35473_0|SrvcGrp|89337|2022|PDM|881.00|99|0.00|DETOXIFICATION|
20|FH_F109925_81301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F109953_75234_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F91913_0_0|SrvcGrp|73008|2022|PDM|630.00|99|0.00|AEG 10|
20|FH_F147726_18017_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F129441_19134_0|SrvcGrp|46903|2022|PDM|540.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F129474_92701_0|SrvcGrp|75419|2022|PDM|900.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F117126_12801_0|SrvcGrp|79099|2022|PDM|2260.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F117123_68025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F117240_37334_0|SrvcGrp|105465|2022|PCT|1.45|99|0.00|AETNA THERAPIES|
20|FH_F137934_51054_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F110900_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F90791_79106_0|SrvcGrp|23683|2022|PDM|35.00|99|0.00|SKILLED NURSING RN|
20|FH_F138543_60130_0|SrvcGrp|46903|2022|PDM|561.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F138732_60016_0|SrvcGrp|86722|2022|PDM|214.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|AEG 1 (NO REV)|
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|1523.00|99|0.00|AEG 9 (NO REV)|
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|TRAUMA CARE|
20|FH_F124369_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1565.69|99|0.00|HAPA WPA-NWPA 2012-13 ASC 7 W/O REV|
20|FH_F135670_01749_0|SrvcGrp|24754|2022|PDM|12.50|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F124792_44515_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|326.73|99|0.00|HAPA WPA-NWPA 2012-13 ASC 224 W/O REV|
20|FH_F109577_0_0|SrvcGrp|103615|2022|PDM|123.00|99|0.00|DIABETIC MANAGEMENT TRN PER INDIVIDUAL|
20|FH_F143624_73069_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F120425_11106_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133207_0_0|SrvcGrp|90795|2022|PDM|2941.00|99|0.00|EXCISION INFERIOR TURBINATE|
20|FH_F145604_14850_0|SrvcGrp|86831|2022|PDM|25.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F134208_21502_0|SrvcGrp|99073|2022|PCT|1.11|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F91412_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F126341_27284_0|SrvcGrp|86844|2022|PDM|30.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F83995_16748_0|SrvcGrp|10543|2022|PDM|91.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|25.33|99|0.00|NON INVASIVE EAR/PULSE OVERNIGHT (MOD TC)|
20|FH_F110346_38501_0|SrvcGrp|86746|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F147987_65674_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120123_0_0|SrvcGrp|79720|2022|PDM|1275.00|99|0.00|ACUTE REHAB II|
20|FH_F145667_01905_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110506_98901_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F81861_0_0|SrvcGrp|64110|2022|PDM|798.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 1|
20|FH_F134249_05060_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125328_0_0|SrvcGrp|73006|2022|PDM|1547.00|99|0.00|AEG 9|
20|FH_F133778_38119_0|SrvcGrp|57968|2022|PDM|24.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD KF"|
20|FH_F127486_06776_0|SrvcGrp|94781|2022|PDM|161.70|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F130364_01331_0|SrvcGrp|81779|2022|PCT|4.25|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F146586_71602_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135670_01749_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F85652_98034_0|CSTM-ALL|CSTM-00|2020|PCT|2.47|99|0.00|AETNA - APC GROUPER A|
20|FH_F149299_43351_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F51519_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124371_0_0|SrvcGrp|106291|2022|PDM|217.36|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F102726_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37877_0_0|CSTM-ALL|CSTM-00|2020|PDM|351.00|99|0.00|ASPG I|
20|FH_F150165_06032_0|SrvcGrp|89989|2022|PDM|4069.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F133727_33511_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F34154_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130123_24171_0|SrvcGrp|95220|2022|PDM|500.00|99|0.00|HOSPICE CARE PROVIDED IN HOSPICE FACILITY (HCFA)|
20|FH_F130763_0_0|SrvcGrp|90795|2022|PDM|3639.00|99|0.00|EXCISION INFERIOR TURBINATE|
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|1043.00|99|0.00|AEG 8 (NO REV)|
20|FH_F85353_16407_0|SrvcGrp|63894|2022|PDM|191.84|99|0.00|HAPA WPA-NWPA 2012-13 ASC 237|
20|FH_F129509_0_0|SrvcGrp|92408|2022|PDM|2846.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F148922_32073_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F138951_41101_0|SrvcGrp|86847|2022|PDM|45.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F148668_33177_0|SrvcGrp|99460|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY EVALUATION|
20|FH_F149319_07670_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F139512_77550_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F49552_0_0|SrvcGrp|16900|2022|PDM|348.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F120720_24541_0|SrvcGrp|43567|2022|PDM|120.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F81861_0_0|SrvcGrp|64111|2022|PDM|500.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 16|
20|FH_F120930_0_0|SrvcGrp|96561|2022|PDM|3000.00|99|0.00|VAGINAL HYSTERCTOMY|
20|FH_F110589_70809_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F140827_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115347_0_0|SrvcGrp|38364|2022|PDM|3000.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F112631_0_0|SrvcGrp|73004|2022|PDM|1114.00|99|0.00|AEG 8|
20|FH_F119227_01752_0|SrvcGrp|24752|2022|PDM|18.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F145555_72204_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F54592_0_0|SrvcGrp|17001|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F67741_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84712_0_0|SrvcGrp|87040|2022|PDM|5109.00|99|0.00|AETNA MATERNITY CARE (C-SECTION)|
20|FH_F85055_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|32.76|99|0.00|HAPA WPA-NWPA 2012-13 ASC 147 W/O REV|
20|FH_F71964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71964_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F84175_0_0|SrvcGrp|75545|2022|PDM|703.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F105340_13502_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115890_75067_0|SrvcGrp|58509|2022|PDM|350.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F80064_0_0|SrvcGrp|29930|2022|PDM|400.00|99|0.00|DIALYSIS|
20|FH_F146839_17601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120522_53549_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F120805_92672_0|SrvcGrp|89337|2022|PDM|1250.00|99|0.00|DETOXIFICATION|
20|FH_F125014_67301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131665_50129_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139388_33407_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150801_19380_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150881_52722_0|SrvcGrp|46903|2022|PDM|730.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|AEG 2 (NO REV)|
20|FH_F138478_0_0|SrvcGrp|108087|2022|PDM|516.06|99|0.00|INSERT NON-TUNNL CNTRL CVC|
20|FH_F131356_19131_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F146266_0_0|SrvcGrp|88740|2022|PDM|5719.00|99|0.00|SP BONE ALGRFT|
20|FH_F147216_48307_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IP MULTI ROOM COMPARISON|
20|FH_F34882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MS DRG 001-002 HEART TRANSPLANT|
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_F120679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.42|99|0.00|OP SVCS|
20|FH_F134847_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F120119_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F110722_19966_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129682_07034_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F91772_0_0|SrvcGrp|72992|2022|PDM|641.00|99|0.00|AEG 2|
20|FH_F148980_18603_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F36403_0_0|SrvcGrp|474|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F33334_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F114207_35243_0|SrvcGrp|29023|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F101861_19567_0|SrvcGrp|83801|2022|PDM|2000.00|99|0.00|INTERIM LABOR FACILITY GLOBA|
20|FH_F141156_04401_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F78009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F98860_96706_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F90232_15126_0|SrvcGrp|17013|2022|PDM|56.70|99|0.00|HOME INFUSION THERAPY|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|100% 2007 MEDICARE DME  TN MOD KN|
20|FH_F116806_0_0|SrvcGrp|107087|2022|PDM|1277.00|99|0.00|SPLIT-THICKNESS AUTOGRAFT|
20|FH_F134887_33409_0|SrvcGrp|35249|2022|PDM|53.00|99|0.00|A5500|
20|FH_F36107_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92151_74104_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|100% 2007 MEDICARETN  DME  MOD RR|
20|FH_F134869_08854_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F31904_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90213_30084_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|52412.00|99|0.00|MSDRG 224-225 CARDIAC DEFIB W/O AMI/HF SHOCK|
20|FH_F90223_0_0|SrvcGrp|88806|2022|PDM|140.00|99|0.00|TOTAL PARENTERAL NUTRITION; < 3 LITERS (HCFA)|
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PDM|494.00|99|0.00|AEG 10 (NO REV)|
20|FH_F149559_60012_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110732_31513_0|SrvcGrp|91077|2022|PDM|1442.00|99|0.00|AETNA INPATIENT SURGICAL CARE|
20|FH_F38584_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150953_74953_0|SrvcGrp|3069|2022|PCT|0.77|99|0.00|IMPLANTS|
20|FH_F151661_78526_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117023_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149648_89148_0|SrvcGrp|46605|2022|PDM|135.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F128375_03909_0|SrvcGrp|108484|2022|PDM|651.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F112128_63017_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F112045_90301_0|SrvcGrp|82369|2022|PCT|2.26|99|0.00|AETNA LABORATORY|
20|FH_F147422_84121_0|SrvcGrp|87317|2022|PDM|957.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F75606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F36743_0_0|SrvcGrp|97|2022|PDM|2100.00|99|0.00|C-SECTION|
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 7 (NO REV)|
20|FH_F120119_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F35255_98310_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F35729_34667_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F90817_0_0|SrvcGrp|91020|2022|PDM|1151.00|99|0.00|REMOVAL OF TEAR SAC (HCFA)|
20|FH_F141267_0_0|SrvcGrp|95661|2022|PDM|939.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|42.50|99|0.00|OTHER UNLISTED THERAPY (MOD KP/SC/SH)|
20|FH_F130919_33314_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F33632_52349_0|SrvcGrp|3178|2022|PDM|804.85|99|0.00|ACUTE PSYCH|
20|FH_F40346_0_0|SrvcGrp|32582|2022|PDM|1450.00|99|0.00|ACUTE MEDICAL/SURGICAL SVCS|
20|FH_F149699_0_0|SrvcGrp|13722|2022|PDM|203.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE|
20|FH_F60296_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|TRACHEOSTOMY|
20|FH_F134738_0_0|SrvcGrp|65403|2022|PDM|2475.00|99|0.00|CPT 42830|
20|FH_F97420_75052_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F151007_90048_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F35567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F131270_38133_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_F35716_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124703_65711_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F147343_17011_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F36992_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD UE|
20|FH_F114568_08097_0|SrvcGrp|86753|2022|PCT|1.05|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F36715_0_0|SrvcGrp|43|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125656_92868_0|SrvcGrp|29023|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F131292_37650_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143347_16001_0|SrvcGrp|113624|2022|PDM|6599.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F143536_47546_0|SrvcGrp|22380|2022|PCT|1.00|99|0.00|CPT CODE 94060|
20|FH_F132418_84042_0|SrvcGrp|87317|2022|PDM|460.43|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F112711_80909_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F120871_14068_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F84611_30281_0|SrvcGrp|79300|2022|PDM|136.00|99|0.00|AETNA SCREENING MAMMOGRAPHY|
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PDM|13500.00|99|0.00|MS DRG 237|
20|FH_F39272_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F40560_0_0|SrvcGrp|439|2022|PDM|1000.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F100780_24153_0|SrvcGrp|73485|2022|PDM|3588.00|99|0.00|AETNA REHAB|
20|FH_F100780_24153_0|SrvcGrp|73659|2022|PDM|5933.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F111186_15213_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F47693_16148_0|SrvcGrp|10431|2022|PDM|47.00|99|0.00|SPEECH THERAPY|
20|FH_F38431_0_0|SrvcGrp|23018|2022|PDM|400.00|99|0.00|HEARING AIDS|
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F139551_0_0|SrvcGrp|110765|2022|PDM|1725.00|99|0.00|2ND LEVEL INJ PARAVERT F JNT C/T|
20|FH_F93791_0_0|SrvcGrp|93605|2022|PDM|1050.00|99|0.00|CERVICAL SURGERY(HCFA)|
20|FH_F149859_60005_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F94403_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F143528_0_0|SrvcGrp|71666|2022|PDM|15750.00|99|0.00|CPT 63655|
20|FH_F122433_0_0|SrvcGrp|73002|2022|PDM|995.00|99|0.00|AEG 7|
20|FH_F145815_30540_0|SrvcGrp|113300|2022|PDM|28.39|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - MODERNA|
20|FH_F34735_0_0|SrvcGrp|941|2022|PDM|2200.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F93563_98499_0|SrvcGrp|43524|2022|PDM|105.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F123950_19111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F140651_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F123895_52722_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F34691_0_0|SrvcGrp|14886|2022|PCT|0.75|99|0.00|TRANSPORTATION|
20|FH_F100762_51104_0|SrvcGrp|73659|2022|PDM|4735.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F85115_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F136684_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F140893_19720_0|SrvcGrp|43567|2022|PDM|167.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F132051_74464_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F116024_13203_0|SrvcGrp|90644|2022|PDM|20.60|99|0.00|AETNA MEDICATION ASSISTED TRTMT MAINTENANCE INJECTION (HCFA)|
20|FH_F115043_77954_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F137366_87505_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F129792_80309_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F130204_40807_0|SrvcGrp|86723|2022|PDM|381.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F128881_70601_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|637.00|99|0.00|ACUTE PSYCH|
20|FH_F139241_0_0|SrvcGrp|77583|2022|PDM|1202.00|99|0.00|REMOVE TONSILS AND ADENOIDS|
20|FH_F121113_33613_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125899_07645_0|SrvcGrp|11258|2022|PCT|0.63|99|0.00|DRUGS|
20|FH_F86332_75081_0|SrvcGrp|10576|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F112377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148666_34205_0|SrvcGrp|74668|2022|PDM|240.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130747_0_0|SrvcGrp|97741|2022|PDM|26010.00|99|0.00|REVISE KNEE|
20|FH_F129656_15005_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109645_0_0|SrvcGrp|103684|2022|PDM|88.00|99|0.00|OCCUPATION THERAPY (HCFA)|
20|FH_F119384_0_0|SrvcGrp|107749|2022|PDM|280.00|99|0.00|CAPD/CCPD|
20|FH_F135982_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F116311_02657_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F118194_50841_0|SrvcGrp|86844|2022|PDM|240.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F135771_0_0|SrvcGrp|22596|2022|PDM|169.46|99|0.00|HOSPICE CARE|
20|FH_F129228_72432_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125011_74467_0|SrvcGrp|3724|2022|PDM|2420.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F143873_33407_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F126033_15301_0|SrvcGrp|27968|2022|PDM|37.69|99|0.00|SKILLED NURSING LPN|
20|FH_F141012_22901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41021_0_0|SrvcGrp|17081|2022|PDM|6589.00|99|0.00|ASPG IX|
20|FH_F90840_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F131254_92211_0|SrvcGrp|86831|2022|PDM|7.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F150982_0_0|SrvcGrp|67065|2022|PDM|13213.00|99|0.00|CERVICAL SURGERY|
20|FH_F123276_20737_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F45632_0_0|SrvcGrp|12403|2022|PDM|867.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F66687_0_0|SrvcGrp|69923|2022|PDM|51051.00|99|0.00|PTCA W/ STENT|
20|FH_F149479_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2007 DME (TN) DBL MODIFIERS - NU/KF|
20|FH_F82114_0_0|SrvcGrp|75327|2022|PDM|179.56|99|0.00|SLEEP STUDY CPT 95806|
20|FH_F125011_74467_0|CSTM-ALL|CSTM-00|2020|PDM|1170.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|419.00|99|0.00|AEG 2 (NO REV)|
20|FH_F115018_78410_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|1138.00|99|0.00|AEG 10 (NO REV)|
20|FH_F129181_28164_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102302_0_0|SrvcGrp|96355|2022|PDM|29900.00|99|0.00|SPINE FIXATION|
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 3 (NO REV)|
20|FH_F127882_62812_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40525_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER SU|
20|FH_F40272_0_0|SrvcGrp|38|2022|PDM|2900.00|99|0.00|NORMAL DELIVERY|
20|FH_F148279_15009_0|SrvcGrp|73559|2022|PDM|2000.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F125973_63830_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F113410_0_0|SrvcGrp|64517|2022|PDM|3257.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F110263_0_0|SrvcGrp|63472|2022|PDM|8659.00|99|0.00|CPT 64581|
20|FH_F93881_15009_0|SrvcGrp|87099|2022|PDM|321.00|99|0.00|CARDIOVASCULAR STRESS TEST|
20|FH_F122911_92240_0|SrvcGrp|74668|2022|PDM|550.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F86851_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119289_43040_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F119500_01570_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119538_60959_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148425_01507_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F148425_01507_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148495_03038_0|SrvcGrp|471|2022|PDM|652.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148548_37909_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 3 (NO REV)|
20|FH_F133112_70433_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F89112_16509_0|SrvcGrp|64100|2022|PDM|2706.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 7|
20|FH_F36917_0_0|SrvcGrp|3259|2022|PDM|725.00|99|0.00|ACUTE REHABILITATION|
20|FH_F68842_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F32509_0_0|SrvcGrp|9511|2022|PDM|5350.00|99|0.00|OBSERVATION SVCS|
20|FH_F114519_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132601_92677_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F144388_19904_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149605_0_0|SrvcGrp|80317|2022|PDM|153.00|99|0.00|RESPITE CARE|
20|FH_F44606_0_0|SrvcGrp|38824|2022|PDM|350.00|99|0.00|HOME SLEEP TEST (TYPE IV)|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD RR|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|431.00|99|0.00|HAPA EPA ASC 48|
20|FH_F108940_15642_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F120437_85202_0|SrvcGrp|88621|2022|PDM|181.20|99|0.00|SKILLED NURSING LPN|
20|FH_F122970_97222_0|SrvcGrp|75419|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F39844_0_0|SrvcGrp|16|2022|PDM|690.00|99|0.00|ACUTE REHABILITATION|
20|FH_F35454_0_0|SrvcGrp|16857|2022|PDM|5.00|99|0.00|BLOOD SUGAR|
20|FH_F38352_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F144748_19707_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127217_29650_0|SrvcGrp|88819|2022|PDM|691.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F103400_33426_0|SrvcGrp|73849|2022|PDM|409.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F115505_21014_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131699_08210_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122245_0_0|SrvcGrp|87054|2022|PDM|1899.70|99|0.00|CYSTOSCOPY CHEMODENERVATION|
20|FH_F117900_19118_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F91262_77036_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117733_91362_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F144528_48081_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F115315_43011_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|311.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 114 W/O REV|
20|FH_F150479_53223_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F64943_0_0|SrvcGrp|61040|2022|PDM|783.00|99|0.00|ADOLESCENT ACUTE RESIDENTIAL|
20|FH_F141804_70503_0|SrvcGrp|92501|2022|PDM|133.35|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F144368_48315_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145884_72113_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F68124_0_0|SrvcGrp|34923|2022|PDM|920.00|99|0.00|ACUTE PSYCH|
20|FH_F51129_0_0|SrvcGrp|3178|2022|PDM|1100.00|99|0.00|ACUTE PSYCH|
20|FH_F102561_75146_0|SrvcGrp|90365|2022|PDM|10038.00|99|0.00|REPAIR METACARPAL FRACTURE|
20|FH_F50618_0_0|SrvcGrp|46923|2022|PCT|1.15|99|0.00|IMPLANTS|
20|FH_F142051_06604_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F81485_0_0|SrvcGrp|16|2022|PDM|1088.00|99|0.00|ACUTE REHABILITATION|
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109566_28601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F141870_85224_0|SrvcGrp|86831|2022|PDM|5.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F79902_0_0|SrvcGrp|13361|2022|PDM|319.00|99|0.00|EMERGENCY ROOM SVCS LEVEL III|
20|FH_F71323_68114_0|SrvcGrp|35208|2022|PDM|2795.00|99|0.00|MS DRG 203 ONLY|
20|FH_F142067_45211_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36756_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130563_85122_0|CSTM-ALL|CSTM-00|2020|PDM|143.50|99|0.00|OP SVCS|
20|FH_F87313_62301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F150121_29072_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39859_0_0|SrvcGrp|10364|2022|PDM|1741.00|99|0.00|CPT CODE 99284|
20|FH_F41661_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1278.00|99|0.00|AEG 5  (NO REV)|
20|FH_F38700_0_0|SrvcGrp|18815|2022|PCT|0.80|99|0.00|MS DRG 221|
20|FH_F141910_70809_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44016_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F79944_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|OP SVCS|
20|FH_F148060_01001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91262_77036_0|SrvcGrp|82773|2022|PDM|105.00|99|0.00|POST NATAL ASSESSMENT W/ NEWBORN|
20|FH_F128468_37087_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD KM|
20|FH_F150949_0_0|SrvcGrp|93431|2022|PDM|10500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F118964_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F39558_0_0|SrvcGrp|17065|2022|PDM|389.00|99|0.00|ASPG I|
20|FH_F43433_0_0|SrvcGrp|15324|2022|PCT|1.00|99|0.00|ER LEVEL II|
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|ASPG VI|
20|FH_F113315_72205_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F117950_37110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F51541_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1427.00|99|0.00|AEG 4 (NO REV)|
20|FH_F43164_0_0|CSTM-ALL|CSTM-00|2020|PDM|773.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|687.50|99|0.00|AEG 10 (NO REV)|
20|FH_F88280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1620.00|99|0.00|GENERAL ACUTE CARE|
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_F54372_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63301_0_0|SrvcGrp|42824|2022|PDM|125.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F134434_30607_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F44016_0_0|SrvcGrp|9521|2022|PDM|3646.00|99|0.00|LITHOTRIPSY|
20|FH_F34759_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F148864_81303_0|SrvcGrp|41563|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F151155_26508_0|SrvcGrp|113323|2022|PDM|329.00|99|0.00|MED ASSIST TX BUPRE ORAL (HCFA)|
20|FH_F151204_24073_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F151259_16505_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151284_72703_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 2 (NO REV)|
20|FH_F112844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129130_92562_0|SrvcGrp|73605|2022|PDM|1744.31|99|0.00|AETNA ACUTE PSYCH|
20|FH_F113738_27006_0|SrvcGrp|48396|2022|PDM|130.00|99|0.00|OT SERVICES|
20|FH_F91873_12723_0|SrvcGrp|75505|2022|PCT|2.92|99|0.00|CARDIAC STUDIES|
20|FH_F71365_0_0|SrvcGrp|59427|2022|PDM|90.00|99|0.00|OT|
20|FH_F87197_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F114566_46224_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F114864_78155_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F115208_0_0|SrvcGrp|106177|2022|PDM|2546.00|99|0.00|EXCISE PAROTID GLAND/LESION|
20|FH_F105623_77901_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
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_F40783_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|BRAIN INJURY REHAB|
20|FH_F130928_0_0|CSTM-ALL|CSTM-00|2020|PDM|2278.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131412_0_0|SrvcGrp|29155|2022|PDM|165.42|99|0.00|HOSPICE SVCS|
20|FH_F135491_0_0|SrvcGrp|62740|2022|PDM|1084.00|99|0.00|SURGERY CARVE OUTS|
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|605.00|99|0.00|AEG 10 (NO REV)|
20|FH_F47694_0_0|SrvcGrp|14210|2022|PDM|320.00|99|0.00|PSYCH INTENSIVE OUTPATIENT|
20|FH_F72162_0_0|SrvcGrp|42972|2022|PDM|56.00|99|0.00|HOME HEALTH AIDE|
20|FH_F141134_84720_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F68950_0_0|SrvcGrp|40944|2022|PDM|2662.54|99|0.00|BIOPSY OF BREAST|
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_F114389_50131_0|SrvcGrp|105612|2022|PDM|185.25|99|0.00|NASAL INTERFACE-MASK/CANNULA (MOD NU)|
20|FH_F114389_50131_0|SrvcGrp|105620|2022|PDM|62.69|99|0.00|PORTABLE OXYGEN CONCENTRATOR (MOD RR)|
20|FH_F114389_50131_0|SrvcGrp|29347|2022|PDM|52.07|99|0.00|HOME HEALTH AIDE|
20|FH_F124059_64055_0|SrvcGrp|17013|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F146906_60445_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124235_92840_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F124237_95023_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124637_77080_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F130929_60438_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97083_90670_0|SrvcGrp|90854|2022|PDM|2162.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F132592_68305_0|SrvcGrp|79099|2022|PCT|0.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|2081.00|99|0.00|AEG 3 (NO REV)|
20|FH_F42954_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F43421_0_0|SrvcGrp|12290|2022|PDM|524.00|99|0.00|DETOXIFICATION|
20|FH_F43696_0_0|SrvcGrp|3066|2022|PCT|0.50|99|0.00|HIGH-COST DRUGS|
20|FH_F134727_30650_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136778_62034_0|SrvcGrp|10362|2022|PDM|746.00|99|0.00|CPT CODE 99282|
20|FH_F112268_19087_0|SrvcGrp|48398|2022|PDM|84.00|99|0.00|PT SERVICES|
20|FH_F113713_17013_0|SrvcGrp|105557|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F32783_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115728_78404_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116233_33612_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147311_37421_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS|
20|FH_F42024_0_0|SrvcGrp|29314|2022|PCT|0.75|99|0.00|CPT CODES 80000-89999 - (LAB)|
20|FH_F42153_0_0|SrvcGrp|360|2022|PDM|1387.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F133219_89119_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F111662_80601_0|SrvcGrp|471|2022|PDM|541.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134828_30531_0|SrvcGrp|112669|2022|PDM|35.00|99|0.00|XRAY EXAM OF KNEE (HCFA)|
20|FH_F134087_0_0|SrvcGrp|112557|2022|PDM|1945.00|99|0.00|REPAIR OF TIBIA FRACTURE|
20|FH_F133536_0_0|SrvcGrp|82113|2022|PDM|3215.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|1749.00|99|0.00|DEVICE INSERTION|
20|FH_F91594_0_0|SrvcGrp|74694|2022|PCT|0.85|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F91594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F36854_0_0|SrvcGrp|72|2022|PDM|570.00|99|0.00|NEWBORN NURSERY|
20|FH_F79429_0_0|SrvcGrp|59427|2022|PDM|75.00|99|0.00|OT|
20|FH_F40088_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F86052_15063_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F126904_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F146100_17403_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F38349_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F77184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50657_0_0|SrvcGrp|28847|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY|
20|FH_F133749_84604_0|SrvcGrp|112448|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F132883_31602_0|SrvcGrp|24750|2022|PDM|20.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F58713_0_0|SrvcGrp|14320|2022|PCT|1.10|99|0.00|OP IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|3300.00|99|0.00|AEG 4 (NO REV)|
20|FH_F126360_22485_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127091_62016_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F145641_06902_0|SrvcGrp|89980|2022|PDM|3024.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F146657_01105_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F146657_01105_0|SrvcGrp|114669|2022|PDM|20.33|99|0.00|HLTH BHV IVNTJ GRP (MOD U2)|
20|FH_F111704_30044_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F124161_95932_0|SrvcGrp|73008|2022|PDM|8011.00|99|0.00|AEG 10|
20|FH_F143631_52248_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133715_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F150227_63301_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|2000.00|99|0.00|AEG 9 (NO REV)|
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|1117.13|99|0.00|AEG 7 (NO REV)|
20|FH_F127526_62917_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 10 (NO REV)|
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AEG 10 (NO REV)|
20|FH_F120207_0_0|SrvcGrp|108935|2022|PCT|0.40|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F134620_73112_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134667_19110_0|SrvcGrp|89149|2022|PDM|230.00|99|0.00|OP INTENSIVE|
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG IV|
20|FH_F134988_61834_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110345_37919_0|SrvcGrp|73841|2022|PDM|542.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F100680_43130_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F134593_60007_0|SrvcGrp|115766|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ. DRUG|
20|FH_F31595_0_0|SrvcGrp|9829|2022|PDM|85.00|99|0.00|PT SVCS|
20|FH_F138302_15701_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F145604_14850_0|SrvcGrp|22589|2022|PDM|85.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F145645_77089_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F87541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120930_0_0|SrvcGrp|96566|2022|PDM|3000.00|99|0.00|EXTENSIVE HYSTERCTOMY|
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|369.00|99|0.00|AEG 1 (NO REV)|
20|FH_F76022_0_0|SrvcGrp|73381|2022|PCT|0.85|99|0.00|GAMMA KNIFE|
20|FH_F133585_0_0|SrvcGrp|103646|2022|PDM|14182.00|99|0.00|AETNA TIB/ PER REVASE STENT & ATHER|
20|FH_F133749_84604_0|SrvcGrp|112411|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F86112_63501_0|SrvcGrp|79699|2022|PCT|0.47|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F49913_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F134947_14227_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F85118_40403_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 2 (NO REV)|
20|FH_F110604_0_0|SrvcGrp|88739|2022|PDM|6050.00|99|0.00|IMPLANT SPINAL CANAL|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|34.32|99|0.00|HAPA WPA-NWPA 2012-13 ASC 147 W/O REV|
20|FH_F114606_0_0|SrvcGrp|65720|2022|PDM|131.76|99|0.00|RESPITE CARE|
20|FH_F119864_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120930_0_0|SrvcGrp|54943|2022|PDM|2000.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F150227_63301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F149079_70809_0|SrvcGrp|103958|2022|PDM|125.00|99|0.00|AETNA FAMILY THERAPY|
20|FH_F99161_0_0|SrvcGrp|75489|2022|PDM|1619.09|99|0.00|AEG 6|
20|FH_F119999_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_F87812_33919_0|SrvcGrp|86635|2022|PCT|1.10|99|0.00|DME|
20|FH_F44299_0_0|SrvcGrp|10545|2022|PDM|65.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F122552_03103_0|SrvcGrp|73841|2022|PDM|325.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F122553_92705_0|SrvcGrp|3178|2022|PDM|778.00|99|0.00|ACUTE PSYCH|
20|FH_F41773_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84755_0_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F87053_0_0|SrvcGrp|73002|2022|PDM|1452.00|99|0.00|AEG 7|
20|FH_F71829_0_0|SrvcGrp|12403|2022|PDM|39.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F72963_0_0|SrvcGrp|17071|2022|PDM|4046.00|99|0.00|ASPG IV|
20|FH_F105143_26062_0|SrvcGrp|79786|2022|PCT|0.70|99|0.00|SLEEP STUDIES|
20|FH_F105361_80104_0|SrvcGrp|41334|2022|PDM|33000.00|99|0.00|TOTAL KNEE|
20|FH_F105361_80104_0|SrvcGrp|27938|2022|PDM|165.00|99|0.00|MAMMOGRAPHY|
20|FH_F115877_63556_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F115907_12206_0|SrvcGrp|89024|2022|PDM|78.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F120805_92672_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F127504_22556_0|SrvcGrp|82981|2022|PDM|156.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F133652_50310_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150060_0_0|SrvcGrp|108484|2022|PDM|800.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130269_74107_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140102_0_0|SrvcGrp|104229|2022|PDM|105.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F148884_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102282_06795_0|SrvcGrp|48398|2022|PDM|103.74|99|0.00|PT SERVICES|
20|FH_F129240_10028_0|SrvcGrp|86854|2022|PDM|50.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|TRAUMA CARE|
20|FH_F39996_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F98621_41042_0|SrvcGrp|73659|2022|PDM|12718.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F136987_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100681_73104_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F69245_84047_0|SrvcGrp|106247|2022|PDM|682.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F76286_16038_0|SrvcGrp|81878|2022|PCT|1.00|99|0.00|RADIOLOGY W/ REV/HCPC|
20|FH_F89372_0_0|SrvcGrp|88428|2022|PDM|14106.00|99|0.00|AETNA IP SPINAL SURGERY|
20|FH_F42896_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F123741_20850_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F136314_19013_0|SrvcGrp|86723|2022|PDM|306.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F136542_02446_0|SrvcGrp|90854|2022|PDM|896.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F118152_20151_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118178_37909_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F118232_24970_0|SrvcGrp|103717|2022|PCT|0.79|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F93177_73044_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134008_11221_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F134126_11554_0|SrvcGrp|107734|2022|PDM|8484.00|99|0.00|VAGINAL DELIVERY|
20|FH_F137048_60714_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F137235_66061_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F114264_51449_0|SrvcGrp|103913|2022|PCT|0.83|99|0.00|OP DIALYSIS|
20|FH_F142377_14626_0|SrvcGrp|89024|2022|PDM|80.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F142273_51012_0|SrvcGrp|103717|2022|PCT|0.84|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F142330_43701_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142547_70002_0|SrvcGrp|17013|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F53732_0_0|SrvcGrp|10577|2022|PDM|80.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F138584_30912_0|SrvcGrp|113392|2022|PDM|1050.00|99|0.00|LOWER JAW BONE GRAFT|
20|FH_F132733_0_0|SrvcGrp|47427|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F140730_84106_0|SrvcGrp|104843|2022|PDM|26.00|99|0.00|CONTINUOUS HOSPICE CARE (HCFA)|
20|FH_F140837_34947_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F140889_33071_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC|
20|FH_F151600_17866_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F39466_0_0|SrvcGrp|1306|2022|PDM|315.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F109885_35473_0|SrvcGrp|86748|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F147939_61611_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129434_98271_0|SrvcGrp|109798|2022|PCT|1.10|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F137331_33165_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137829_62948_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137832_89118_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F34371_0_0|SrvcGrp|10541|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F37878_0_0|SrvcGrp|10541|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F109652_0_0|SrvcGrp|89001|2022|PDM|49803.00|99|0.00|MSDRG 268-269, 270-272 MAJ REEN VASC PROC|
20|FH_F124834_75246_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36500_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F72003_0_0|SrvcGrp|68440|2022|PCT|0.90|99|0.00|DRUGS AND IMMUNIZATIONS|
20|FH_F78003_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|1120.64|99|0.00|2005 ASPG GROUPER V|
20|FH_F119413_95123_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F148459_15241_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40465_0_0|SrvcGrp|2116|2022|PCT|0.75|99|0.00|DRG 121 CIRCULATORY DISORDERS|
20|FH_F112848_06032_0|SrvcGrp|471|2022|PDM|723.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F95641_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F142782_16201_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133477_90247_0|SrvcGrp|106251|2022|PCT|1.40|99|0.00|LABORATORY SERVICES|
20|FH_F37640_0_0|CSTM-ALL|CSTM-00|2020|PDM|814.00|99|0.00|ASPG V|
20|FH_F46352_0_0|SrvcGrp|10410|2022|PDM|79.00|99|0.00|SKILLED NURSING CARE|
20|FH_F125146_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133390_07626_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90032_15234_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132785_17961_0|CSTM-ALL|CSTM-00|2020|PCT|0.38|99|0.00|OP SVCS|
20|FH_F117512_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F39640_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AAA MEDICAL FABRICATORS DME - AWP|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|164.00|99|0.00|HAPA EPA ASC 27|
20|FH_F67379_0_0|SrvcGrp|1943|2022|PDM|1412.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F64943_0_0|SrvcGrp|35966|2022|PDM|783.00|99|0.00|ECT|
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132991_84790_0|SrvcGrp|23683|2022|PDM|42.25|99|0.00|SKILLED NURSING RN|
20|FH_F128000_30121_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102721_38118_0|SrvcGrp|78680|2022|PCT|0.40|99|0.00|AETNA CARDIAC CATH|
20|FH_F140134_52732_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140233_35216_0|SrvcGrp|12664|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F143347_16001_0|SrvcGrp|79786|2022|PCT|1.80|99|0.00|SLEEP STUDIES|
20|FH_F143348_16214_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|OP SVCS|
20|FH_F101700_0_0|SrvcGrp|80137|2022|PDM|1300.00|99|0.00|IMPLANT SPINAL INFUSION|
20|FH_F47600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F48261_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F49054_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F120187_76522_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132401_32796_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F112687_30474_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116546_78723_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F116633_37217_0|SrvcGrp|48396|2022|PDM|125.00|99|0.00|OT SERVICES|
20|FH_F120888_63823_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F120961_66615_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120974_27607_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F125479_17501_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F113595_29527_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F84394_17402_0|SrvcGrp|34606|2022|PDM|7240.00|99|0.00|CPT 29827|
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|592.00|99|0.00|AEG 3 (NO REV)|
20|FH_F143467_0_0|SrvcGrp|92368|2022|PDM|1424.00|99|0.00|REPAIR OF LEG TENDON|
20|FH_F59732_0_0|SrvcGrp|17013|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F61292_0_0|SrvcGrp|20744|2022|PDM|21578.00|99|0.00|MS DRG 242 ONLY|
20|FH_F44198_0_0|SrvcGrp|16983|2022|PDM|5.00|99|0.00|ADDITIONAL MILEAGE|
20|FH_F35388_0_0|SrvcGrp|9793|2022|PDM|400.00|99|0.00|NEWBORN NURSERY|
20|FH_F82753_18840_0|SrvcGrp|109057|2022|PCT|0.87|99|0.00|CARDIAC STUDIES|
20|FH_F63433_0_0|SrvcGrp|17081|2022|PDM|1766.11|99|0.00|ASPG IX|
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.00|99|0.00|ASPG VIII|
20|FH_F39339_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: BREAKOUT|
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_F38967_0_0|SrvcGrp|29971|2022|PDM|700.00|99|0.00|DIALYSIS|
20|FH_F93881_15009_0|SrvcGrp|87112|2022|PDM|237.00|99|0.00|US EXAM PG UTERUS LIMIT|
20|FH_F113410_0_0|SrvcGrp|97922|2022|PDM|3362.00|99|0.00|PARTIAL HYSTERECTOMY|
20|FH_F37647_0_0|SrvcGrp|3327|2022|PDM|180.00|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F100790_10512_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F135151_61874_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F36679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109645_0_0|SrvcGrp|34388|2022|PDM|88.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F41776_0_0|SrvcGrp|12154|2022|PDM|5513.00|99|0.00|LITHOTRIPSY|
20|FH_F128136_48025_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F130810_54728_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125011_74467_0|SrvcGrp|107637|2022|PCT|1.00|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F139515_0_0|SrvcGrp|90343|2022|PDM|8549.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL|
20|FH_F95200_16201_0|SrvcGrp|3178|2022|PDM|1360.00|99|0.00|ACUTE PSYCH|
20|FH_F149888_68506_0|SrvcGrp|114086|2022|PDM|2355.00|99|0.00|CORRECTION HALLUX VALGUS|
20|FH_F130716_76013_0|SrvcGrp|48396|2022|PDM|105.00|99|0.00|OT SERVICES|
20|FH_F127209_45365_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89111_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD_KM|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F128333_71001_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118057_47906_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F100790_10512_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F130214_30144_0|SrvcGrp|74668|2022|PDM|220.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F125249_0_0|SrvcGrp|108255|2022|PDM|1400.00|99|0.00|AETNA REPAIR CLAVICLE DISLOCATION|
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2018.00|99|0.00|AEG 9 (NO REV)|
20|FH_F130747_0_0|SrvcGrp|58638|2022|PDM|6763.00|99|0.00|CPT 63688|
20|FH_F135897_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F78922_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111288_0_0|SrvcGrp|41334|2022|PDM|25908.00|99|0.00|TOTAL KNEE|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F42105_0_0|SrvcGrp|701|2022|PDM|1450.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F130452_48801_0|SrvcGrp|104301|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F102500_0_0|SrvcGrp|72994|2022|PDM|794.00|99|0.00|AEG 3|
20|FH_F40066_0_0|SrvcGrp|65|2022|PDM|2016.00|99|0.00|OBSTETRICAL CARE|
20|FH_F117902_0_0|SrvcGrp|107657|2022|PDM|1625.00|99|0.00|AETNA CARVE OUT CODES SERIES B|
20|FH_F145756_03801_0|SrvcGrp|473|2022|PDM|391.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120693_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|CARDIAC CATH LAB SVCS|
20|FH_F56136_0_0|SrvcGrp|22819|2022|PCT|0.92|99|0.00|PTCA|
20|FH_F65559_0_0|SrvcGrp|59291|2022|PDM|1296.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F32877_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125660_46706_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F107600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F72183_0_0|SrvcGrp|29558|2022|PDM|1400.00|99|0.00|ARTHROSCOPY|
20|FH_F35388_0_0|CSTM-ALL|CSTM-00|2020|PDM|4200.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F80952_45669_0|CSTM-ALL|CSTM-00|2020|PDM|1618.33|99|0.00|AEG 8 (NO REV)|
20|FH_F117816_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F139594_0_0|SrvcGrp|63469|2022|PDM|1000.00|99|0.00|CPT 55700|
20|FH_F45435_0_0|SrvcGrp|13703|2022|PDM|35.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F128312_45230_0|SrvcGrp|104874|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147995_67037_0|CSTM-ALL|CSTM-00|2020|PDM|2742.00|99|0.00|AEG 4 (NO REV)|
20|FH_F91152_60061_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149820_75040_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133052_33462_0|SrvcGrp|73841|2022|PDM|470.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F119825_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F31446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F51438_0_0|SrvcGrp|44564|2022|PDM|350.00|99|0.00|NEWBORN NURSERY|
20|FH_F146227_66210_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124928_04210_0|SrvcGrp|53144|2022|PDM|151.01|99|0.00|SPEECH THERAPY|
20|FH_F111409_33761_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F88816_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F40895_0_0|SrvcGrp|33502|2022|PDM|87.50|99|0.00|NEW TECH INTRAOCULAR LENS|
20|FH_F125342_78754_0|SrvcGrp|89337|2022|PDM|875.00|99|0.00|DETOXIFICATION|
20|FH_F118544_21550_0|SrvcGrp|472|2022|PDM|549.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F128678_68048_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89011_75006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35176_0_0|SrvcGrp|3809|2022|PDM|483.00|99|0.00|HOSPICE CARE|
20|FH_F68944_0_0|SrvcGrp|12258|2022|PCT|0.70|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F120838_01603_0|SrvcGrp|73841|2022|PDM|302.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F122648_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F46473_0_0|SrvcGrp|3448|2022|PDM|1177.00|99|0.00|MRI|
20|FH_F42779_0_0|SrvcGrp|3165|2022|PDM|522.00|99|0.00|EMERGENCY ROOM|
20|FH_F73705_0_0|SrvcGrp|16|2022|PDM|1100.00|99|0.00|ACUTE REHABILITATION|
20|FH_F128601_29340_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F103360_68845_0|SrvcGrp|98242|2022|PDM|9134.00|99|0.00|RELEASE OF SHOULDER|
20|FH_F39604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147995_67037_0|SrvcGrp|114917|2022|PCT|0.00|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F144308_44512_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F31381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F71984_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.81|99|0.00|OP SVCS|
20|FH_F101853_77840_0|SrvcGrp|89417|2022|PDM|465.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F44435_0_0|SrvcGrp|38587|2022|PDM|4100.00|99|0.00|OP SURGERY (CPT 58541-58542, 58552)|
20|FH_F119775_0_0|SrvcGrp|103503|2022|PDM|1517.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F142973_62448_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141802_17042_0|SrvcGrp|112833|2022|PCT|3.24|99|0.00|LABORATORY SERVICES|
20|FH_F120437_85202_0|SrvcGrp|86831|2022|PDM|11.26|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F83031_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|INTERIM INFUSION REV CODE 640 W/MOD SH|
20|FH_F131315_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144191_0_0|SrvcGrp|27261|2022|PDM|9875.00|99|0.00|CPT 27446|
20|FH_F80955_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F37641_0_0|SrvcGrp|11033|2022|PCT|1.00|99|0.00|OP REFERENCE LAB|
20|FH_F126666_44053_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F91194_33511_0|SrvcGrp|83802|2022|PDM|73.00|99|0.00|LACTATION CLASS|
20|FH_F111467_33761_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F87615_80033_0|SrvcGrp|73605|2022|PDM|2100.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F68479_0_0|SrvcGrp|32407|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (RADIOLOGY)|
20|FH_F123154_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69104_0_0|SrvcGrp|17079|2022|PDM|1966.27|99|0.00|ASPG VIII|
20|FH_F49637_0_0|SrvcGrp|31931|2022|PDM|400.00|99|0.00|SKILLED NURSING CARE|
20|FH_F33385_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139368_57043_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139447_40336_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139667_84078_0|SrvcGrp|88621|2022|PDM|42.25|99|0.00|SKILLED NURSING LPN|
20|FH_F150760_44833_0|SrvcGrp|48396|2022|PDM|150.00|99|0.00|OT SERVICES|
20|FH_F150764_33919_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40899_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F117615_30525_0|SrvcGrp|73560|2022|PCT|0.85|99|0.00|AETNA SLEEP STUDIES|
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 3 (NO REV)|
20|FH_F116753_0_0|SrvcGrp|92188|2022|PDM|1268.00|99|0.00|CPT 95805  (HCFA)|
20|FH_F147237_40006_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F139755_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F109515_15301_0|SrvcGrp|26001|2022|PDM|202.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F140295_0_0|SrvcGrp|88157|2022|PDM|14322.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F149619_81008_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148963_56301_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F119376_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F126116_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F128543_44413_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F146266_0_0|SrvcGrp|88065|2022|PDM|10930.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F148667_0_0|SrvcGrp|92007|2022|PDM|2856.00|99|0.00|PROXIMAL HUMERAL|
20|FH_F145543_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F90172_81301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F134396_80045_0|SrvcGrp|89149|2022|PDM|316.00|99|0.00|OP INTENSIVE|
20|FH_F133667_83642_0|SrvcGrp|12659|2022|PDM|1000.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F111584_07002_0|SrvcGrp|89022|2022|PDM|51.38|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F151087_60548_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151144_35801_0|SrvcGrp|84123|2022|PDM|2589.70|99|0.00|INSERT ANT SEGMENT DRAIN EXT|
20|FH_F114931_0_0|SrvcGrp|105759|2022|PDM|1850.00|99|0.00|EXCISE ANAL EXT TAG/PAPILLA|
20|FH_F113866_0_0|SrvcGrp|29353|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|377.44|99|0.00|DELAWARE VALLEY- ASC 1|
20|FH_F72662_0_0|SrvcGrp|29978|2022|PDM|157.00|99|0.00|WOUND THERAPY ELEC PUMP|
20|FH_F72049_0_0|SrvcGrp|3810|2022|PDM|156.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F87197_0_0|SrvcGrp|79720|2022|PDM|809.00|99|0.00|ACUTE REHAB II|
20|FH_F43196_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OP SVCS|
20|FH_F136132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F138929_0_0|SrvcGrp|89842|2022|PDM|13750.00|99|0.00|LUMBAR|
20|FH_F131047_0_0|CSTM-ALL|CSTM-00|2020|PDM|4842.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F131087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129713_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F32769_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F141053_17201_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F50415_0_0|SrvcGrp|44713|2022|PDM|80.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|966.14|99|0.00|ASPG VII|
20|FH_F136735_0_0|SrvcGrp|104719|2022|PDM|1495.66|99|0.00|RELIEVE INNER EYE PRESSURE|
20|FH_F124129_33603_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F146972_17931_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146914_75032_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132864_71101_0|SrvcGrp|3378|2022|PDM|1802.00|99|0.00|OBSERVATION SVCS|
20|FH_F98380_43055_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F124173_66215_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F124225_92506_0|SrvcGrp|89337|2022|PDM|1200.00|99|0.00|DETOXIFICATION|
20|FH_F124653_64062_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F66439_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|IMPLANTS|
20|FH_F123620_0_0|SrvcGrp|13683|2022|PDM|624.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F130039_80228_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F98042_10468_0|SrvcGrp|73605|2022|PDM|3108.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F114666_30342_0|SrvcGrp|95559|2022|PDM|18000.00|99|0.00|HIP JOINT|
20|FH_F81832_13827_0|SrvcGrp|26001|2022|PDM|353.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F148553_85016_0|SrvcGrp|115475|2022|PDM|4320.00|99|0.00|PERC D-E COR STENT ATHER S|
20|FH_F148553_85016_0|SrvcGrp|115441|2022|PDM|3121.00|99|0.00|INSERT 1 ELECTRODE PM DEFIB|
20|FH_F122608_84123_0|SrvcGrp|42046|2022|PDM|112.00|99|0.00|HOSPICE CARE|
20|FH_F122832_61938_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F122689_92009_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F43444_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F43859_0_0|SrvcGrp|30958|2022|PDM|65.00|99|0.00|SKILLED LPN VISIT|
20|FH_F135719_45502_0|SrvcGrp|112748|2022|PDM|21608.37|99|0.00|MSDRG 522 ONLY|
20|FH_F136778_62034_0|SrvcGrp|705|2022|PCT|0.25|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F49016_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41801_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|ADULT RESIDENTIAL TREATMENT|
20|FH_F41832_0_0|SrvcGrp|29677|2022|PDM|125.00|99|0.00|HOME INFUSION NURSING SVCS MOD SD|
20|FH_F47999_0_0|SrvcGrp|42828|2022|PDM|104.50|99|0.00|SPEECH THERAPY VISIT|
20|FH_F42427_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38955_0_0|SrvcGrp|38|2022|PDM|2397.33|99|0.00|NORMAL DELIVERY|
20|FH_F54552_0_0|SrvcGrp|14948|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138867_77021_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138876_25302_0|SrvcGrp|86851|2022|PDM|40.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F72606_0_0|CSTM-ALL|CSTM-00|2020|PDM|4300.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151501_30265_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 6 (NO REV)|
20|FH_F144928_02703_0|SrvcGrp|88905|2022|PDM|1167.00|99|0.00|PSYCHIATRIC CARE (AGE 0-17)|
20|FH_F144968_18702_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40073_0_0|SrvcGrp|17079|2022|PCT|0.70|99|0.00|ASPG VIII|
20|FH_F135350_60014_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135583_17331_0|SrvcGrp|116106|2022|PCT|0.91|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F97143_80012_0|SrvcGrp|73659|2022|PDM|7000.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F91764_93710_0|SrvcGrp|84957|2022|PDM|12883.00|99|0.00|MS DRG 518 - 520|
20|FH_F135763_20678_0|SrvcGrp|112323|2022|PDM|400.00|99|0.00|LABORATORY|
20|FH_F135792_60143_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119892_47586_0|SrvcGrp|43569|2022|PDM|40.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F100880_67735_0|SrvcGrp|90238|2022|PDM|4698.00|99|0.00|ROBOTIC ASSISTED SURGERY|
20|FH_F116431_76104_0|SrvcGrp|80679|2022|PCT|1.50|99|0.00|AETNA RADIOLOGY|
20|FH_F121763_07202_0|SrvcGrp|69075|2022|PDM|60.00|99|0.00|CPT 99213|
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|706.00|99|0.00|ASPG I|
20|FH_F42098_0_0|SrvcGrp|11069|2022|PDM|50.00|99|0.00|OT SVCS|
20|FH_F46918_0_0|SrvcGrp|27968|2022|PDM|41.00|99|0.00|SKILLED NURSING LPN|
20|FH_F72586_0_0|SrvcGrp|13985|2022|PDM|47.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F111301_33122_0|SrvcGrp|73604|2022|PDM|1020.00|99|0.00|AETNA DETOXIFICATION|
20|FH_F111341_80501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111363_33169_0|SrvcGrp|72990|2022|PDM|1048.00|99|0.00|AEG 1|
20|FH_F148243_0_0|SrvcGrp|84972|2022|PDM|550.00|99|0.00|CPT 43247|
20|FH_F149239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131000_0_0|SrvcGrp|100044|2022|PDM|2971.00|99|0.00|INCISION OF HEEL BONE|
20|FH_F113585_20155_0|SrvcGrp|26868|2022|PDM|45.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F138807_32207_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F138857_90025_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138876_25302_0|SrvcGrp|86828|2022|PDM|55.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F138880_92392_0|SrvcGrp|111348|2022|PCT|1.30|99|0.00|OP THERAPY SERVICES|
20|FH_F118986_0_0|SrvcGrp|75493|2022|PDM|1419.37|99|0.00|AEG 8|
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|397.68|99|0.00|AEG 1 (NO REV)|
20|FH_F151501_30265_0|SrvcGrp|85778|2022|PDM|6152.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F122103_62548_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122116_60942_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F122148_62664_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135453_70726_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F135572_89106_0|SrvcGrp|21920|2022|PCT|1.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F135572_89106_0|SrvcGrp|22389|2022|PCT|1.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F135583_17331_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F91764_93710_0|SrvcGrp|50645|2022|PDM|9099.00|99|0.00|MS DRG 488 - 489 ONLY|
20|FH_F135916_33614_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135924_02906_0|SrvcGrp|73841|2022|PDM|1061.10|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F135972_18509_0|SrvcGrp|471|2022|PDM|604.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F135979_66451_0|SrvcGrp|23683|2022|PDM|55.00|99|0.00|SKILLED NURSING RN|
20|FH_F136042_90066_0|SrvcGrp|87317|2022|PDM|1100.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F131228_01826_0|SrvcGrp|111782|2022|PCT|0.00|99|0.00|GLOBAL STRESS THALLIUM TESTING DENIAL|
20|FH_F130756_04901_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 6 (NO REV)|
20|FH_F116397_33404_0|SrvcGrp|24761|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116431_76104_0|SrvcGrp|16277|2022|PCT|0.85|99|0.00|HIGH COST DRUGS|
20|FH_F121464_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121763_07202_0|SrvcGrp|73000|2022|PDM|2838.00|99|0.00|AEG 6|
20|FH_F121763_07202_0|SrvcGrp|72996|2022|PDM|1800.00|99|0.00|AEG 4|
20|FH_F121771_91405_0|SrvcGrp|46903|2022|PDM|1200.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|1218.00|99|0.00|AEG 4 (NO REV)|
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67425_0_0|SrvcGrp|20752|2022|PDM|16200.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F128353_22191_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F111385_33308_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F94340_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132720_0_0|SrvcGrp|58|2022|PDM|9667.00|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F41780_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|567.00|99|0.00|ASPG IV|
20|FH_F132073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132328_0_0|SrvcGrp|88160|2022|PDM|6097.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F96280_06340_0|SrvcGrp|90854|2022|PDM|761.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F128695_50049_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F123036_0_0|SrvcGrp|11306|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F129419_27407_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129220_18445_0|SrvcGrp|105425|2022|PDM|32.52|99|0.00|AETNA EXPOSURE ADAPTIVE BH TREATMENT 60 MINS|
20|FH_F129220_18445_0|CSTM-ALL|CSTM-00|2020|PDM|106.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION MOD HO (HCFA)|
20|FH_F98300_30236_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F102960_50613_0|SrvcGrp|3044|2022|PDM|974.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F102960_50613_0|SrvcGrp|72984|2022|PCT|0.62|99|0.00|CHEMOTHERAPY|
20|FH_F101320_26062_0|SrvcGrp|46104|2022|PDM|60.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F142087_0_0|SrvcGrp|113852|2022|PDM|1250.00|99|0.00|STENT PACEMT ANTE COROTID|
20|FH_F150663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97261_06098_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F97261_06098_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F100906_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F32995_0_0|SrvcGrp|10922|2022|PDM|5345.00|99|0.00|PTCA W/NON DRUG ELUTING STENT|
20|FH_F123809_26155_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F123848_03257_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132810_0_0|SrvcGrp|86835|2022|PDM|25.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F136347_30328_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136373_17055_0|SrvcGrp|48385|2022|PDM|120.00|99|0.00|SPEECH THERAPY|
20|FH_F137147_75006_0|SrvcGrp|47004|2022|PDM|17854.00|99|0.00|MS DRG 626 ONLY|
20|FH_F137147_75006_0|SrvcGrp|74403|2022|PDM|2625.00|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F137187_64015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137231_25550_0|SrvcGrp|48396|2022|PDM|92.00|99|0.00|OT SERVICES|
20|FH_F142387_70454_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F53732_0_0|SrvcGrp|24934|2022|PDM|75.00|99|0.00|NUTRITIONAL ASSESSMENT (INITIAL)|
20|FH_F66765_0_0|SrvcGrp|60057|2022|PDM|125.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F97600_46151_0|SrvcGrp|73656|2022|PDM|1364.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F138627_82901_0|SrvcGrp|41423|2022|PDM|2.50|99|0.00|ENTERAL FORMULA - ADDITIVE|
20|FH_F138627_82901_0|SrvcGrp|86834|2022|PDM|10.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F80284_16354_0|SrvcGrp|11108|2022|PDM|512.00|99|0.00|NEWBORN NURSERY|
20|FH_F149607_76548_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151603_27609_0|CSTM-ALL|CSTM-00|2020|PDM|2857.14|99|0.00|AEG 3 (NO REV)|
20|FH_F151605_78209_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118943_64506_0|SrvcGrp|43569|2022|PDM|42.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F67239_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SURGERY|
20|FH_F70665_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AT HOMEHEALTH INFUSION THERAPY|
20|FH_F94581_0_0|SrvcGrp|473|2022|PDM|405.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F117286_17202_0|SrvcGrp|471|2022|PDM|437.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117301_01887_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147941_06023_0|SrvcGrp|80246|2022|PCT|0.00|99|0.00|AETNA NURSERY|
20|FH_F129483_77030_0|SrvcGrp|86848|2022|PDM|35.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F117131_45209_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117126_12801_0|CSTM-ALL|CSTM-00|2020|PDM|7800.00|99|0.00|AEG 9 (NO REV)|
20|FH_F95900_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F137898_46540_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F109652_0_0|SrvcGrp|39522|2022|PDM|57279.00|99|0.00|MS DRG 216-218 ONLY|
20|FH_F109652_0_0|SrvcGrp|40631|2022|PDM|28834.00|99|0.00|GAMMA KNIFE|
20|FH_F109907_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128804_0_0|SrvcGrp|106267|2022|PDM|4263.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL|
20|FH_F130035_0_0|SrvcGrp|111470|2022|PDM|120.75|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F37734_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146012_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F138873_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F31783_0_0|SrvcGrp|18127|2022|PDM|18270.00|99|0.00|MS DRG 242|
20|FH_F62974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F38560_0_0|SrvcGrp|38|2022|PDM|1750.00|99|0.00|NORMAL DELIVERY|
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130821_85712_0|SrvcGrp|472|2022|PDM|403.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F128235_62626_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F31032_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121476_0_0|SrvcGrp|108866|2022|PDM|995.99|99|0.00|LEAD PACEMAKER|
20|FH_F145641_06902_0|SrvcGrp|114240|2022|PDM|4475.00|99|0.00|PARTIAL REMOVAL OF TOE|
20|FH_F70208_0_0|CSTM-ALL|CSTM-00|2020|PDM|985.00|99|0.00|ASPG X|
20|FH_F51015_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128148_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F113435_19027_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1542.00|99|0.00|AEG 8 (NO REV)|
20|FH_F100782_0_0|SrvcGrp|105081|2022|PDM|522.62|99|0.00|WINDBER MEDICAL CNTR ASC 126|
20|FH_F109264_33431_0|SrvcGrp|90854|2022|PDM|828.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F134234_49525_0|SrvcGrp|73842|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F145604_14850_0|SrvcGrp|46104|2022|PDM|95.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F119379_0_0|SrvcGrp|107008|2022|PDM|1428.00|99|0.00|REMOVAL OF BONE FOR GRAFT|
20|FH_F111986_0_0|SrvcGrp|88824|2022|PDM|2472.00|99|0.00|CPT 69631|
20|FH_F111702_07652_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F85353_16407_0|SrvcGrp|63913|2022|PDM|120.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 242|
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|377.00|99|0.00|AEG 1 (NO REV)|
20|FH_F143624_73069_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F112827_26452_0|SrvcGrp|48394|2022|PDM|15.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F135610_06451_0|SrvcGrp|104228|2022|PDM|89.12|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F145641_06902_0|SrvcGrp|33984|2022|PDM|4228.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F134593_60007_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP WITHOUT CPT 99601|
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|1628.00|99|0.00|AEG 2 (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_F113457_17011_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F118957_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
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_F93219_26354_0|SrvcGrp|73701|2022|PDM|71.50|99|0.00|AETNA - SKILLED NURSING|
20|FH_F146100_17403_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149219_01966_0|SrvcGrp|113171|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F113322_38119_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F145675_33761_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|2336.00|99|0.00|AEG 5  (NO REV)|
20|FH_F136359_0_0|SrvcGrp|107515|2022|PDM|6450.00|99|0.00|ENT1 PROCEDURES|
20|FH_F81698_10457_0|SrvcGrp|24754|2022|PDM|10.50|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F126354_91321_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F89760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F110345_37919_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F102726_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AETNA MRI/MRA|
20|FH_F41594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122930_0_0|SrvcGrp|73004|2022|PDM|3274.00|99|0.00|AEG 8|
20|FH_F110237_94501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|1319.00|99|0.00|AEG 7 (NO REV)|
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|1815.00|99|0.00|AEG 6 (NO REV)|
20|FH_F109273_77339_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F123609_28451_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F83995_16748_0|SrvcGrp|12403|2022|PDM|24.50|99|0.00|CONTINUOUS HOMECARE|
20|FH_F136359_0_0|SrvcGrp|112855|2022|PDM|3700.00|99|0.00|FOOT AND TOE PROCEDURES|
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|1294.00|99|0.00|AEG 7 (NO REV)|
20|FH_F149139_07522_0|SrvcGrp|113222|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS 22 TRGT SARS-COV-2|
20|FH_F145641_06902_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146461_75428_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F50703_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PRECISION HLTH - S CODES + ASP|
20|FH_F130017_02302_0|SrvcGrp|73606|2022|PDM|1797.02|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F150299_22046_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F123157_0_0|SrvcGrp|75479|2022|PDM|317.00|99|0.00|AEG 1|
20|FH_F85315_15217_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F133775_83401_0|SrvcGrp|48396|2022|PDM|140.00|99|0.00|OT SERVICES|
20|FH_F95440_0_0|SrvcGrp|73008|2022|PDM|2781.00|99|0.00|AEG 10|
20|FH_F150259_15668_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134492_85201_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130126_33413_0|SrvcGrp|46903|2022|PDM|1040.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F86733_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|OP SVCS|
20|FH_F84712_0_0|SrvcGrp|81406|2022|PDM|7.00|99|0.00|URINALYSIS|
20|FH_F85894_0_0|SrvcGrp|45703|2022|PCT|1.00|99|0.00|JERSEY SHORE LAB-GH WITH OBS OR UNGROUPED SURG|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|254.10|99|0.00|HAPA WPA-NWPA 2012-13 ASC 119 W/O REV|
20|FH_F101100_50314_0|CSTM-ALL|CSTM-00|2020|PCT|1.38|99|0.00|AETNA - APC GROUPER Y|
20|FH_F102142_80014_0|SrvcGrp|73701|2022|PDM|25.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F102142_80014_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F105145_75075_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F105145_75075_0|SrvcGrp|89984|2022|PDM|26350.00|99|0.00|LAMINECTOMY W/FACE-LUMBAR|
20|FH_F105361_80104_0|SrvcGrp|12343|2022|PDM|3142.00|99|0.00|PET SCAN|
20|FH_F115890_75067_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F146798_44011_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120795_27514_0|SrvcGrp|3178|2022|PCT|0.68|99|0.00|ACUTE PSYCH|
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|595.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116040_24637_0|SrvcGrp|86854|2022|PDM|30.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F116114_37033_0|SrvcGrp|93919|2022|PDM|663.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F131943_62243_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133581_84790_0|CSTM-ALL|CSTM-00|2020|PDM|1365.93|99|0.00|AEG 7 (NO REV)|
20|FH_F139887_0_0|SrvcGrp|98523|2022|PDM|1848.00|99|0.00|CAPSULOTOMY|
20|FH_F145543_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F36903_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KEITH RATHBOON PT HCPC MOD AW|
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PDM|5962.00|99|0.00|AEG 4 (NO REV)|
20|FH_F146859_0_0|SrvcGrp|114858|2022|PDM|1530.00|99|0.00|WRIST ARTHROS|
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|1088.00|99|0.00|AEG 6 (NO REV)|
20|FH_F140140_07722_0|SrvcGrp|22528|2022|PCT|0.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F110969_63084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134847_0_0|SrvcGrp|88158|2022|PDM|5429.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F78185_0_0|SrvcGrp|75980|2022|PCT|1.00|99|0.00|NEBULIZER/CATHETER CARE|
20|FH_F39443_0_0|SrvcGrp|16469|2022|PDM|2310.00|99|0.00|PROSTATE RESECTION|
20|FH_F125656_92868_0|SrvcGrp|86843|2022|PDM|50.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F141228_23181_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146266_0_0|SrvcGrp|88596|2022|PDM|1850.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE|
20|FH_F35678_0_0|SrvcGrp|18247|2022|PDM|6357.00|99|0.00|MS DRG 286|
20|FH_F131356_19131_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|902.00|99|0.00|AEG 10 (NO REV)|
20|FH_F43293_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F122623_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132160_0_0|SrvcGrp|109768|2022|PDM|2433.00|99|0.00|COVER EYE W/ MEMBRANE SUTURE|
20|FH_F138017_73129_0|SrvcGrp|91879|2022|PDM|6539.00|99|0.00|PROSTATE LASER ENUCLEATION|
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PDM|3150.00|99|0.00|AEG 3 (NO REV)|
20|FH_F40501_0_0|CSTM-ALL|CSTM-00|2020|PDM|572.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84532_0_0|SrvcGrp|73002|2022|PDM|2758.00|99|0.00|AEG 7|
20|FH_F97620_75904_0|SrvcGrp|73603|2022|PDM|4944.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F97101_98003_0|SrvcGrp|73485|2022|PDM|3588.00|99|0.00|AETNA REHAB|
20|FH_F134846_06437_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35990_0_0|SrvcGrp|72|2022|PDM|601.00|99|0.00|NEWBORN NURSERY|
20|FH_F147532_0_0|SrvcGrp|63297|2022|PDM|717.20|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F41374_0_0|SrvcGrp|13811|2022|PDM|250.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|402.68|99|0.00|SALLY BALIN,999182,ASC 209|
20|FH_F148859_0_0|SrvcGrp|47545|2022|PDM|18865.00|99|0.00|INSERTION/REPLACEMENT OF PERIPHERAL/GASTRIC NEUROSTIMULATOR|
20|FH_F41273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F56472_0_0|SrvcGrp|29303|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|890.00|99|0.00|AEG 10 (NO REV)|
20|FH_F50461_0_0|SrvcGrp|20151|2022|PDM|53595.00|99|0.00|KIDNEY TRANSPLANT|
20|FH_F128375_03909_0|SrvcGrp|109330|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F76826_0_0|SrvcGrp|10708|2022|PDM|123.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F35387_0_0|SrvcGrp|115|2022|PDM|552.00|99|0.00|SKILLED NURSING CARE|
20|FH_F98360_11554_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F124441_0_0|SrvcGrp|98497|2022|PDM|9025.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F147231_49440_0|SrvcGrp|90340|2022|PDM|38.84|99|0.00|SKILLED NURSING LPN|
20|FH_F125081_15218_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F36343_0_0|SrvcGrp|1168|2022|PDM|28.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F39443_0_0|SrvcGrp|30290|2022|PDM|420.00|99|0.00|HAPA WPA ASC 102|
20|FH_F151619_73505_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39772_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (HCFA)|
20|FH_F39772_0_0|CSTM-ALL|CSTM-00|2020|PDM|655.00|99|0.00|ACUTE PSYCH|
20|FH_F110972_30512_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F137729_19703_0|SrvcGrp|86723|2022|PDM|300.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F138018_17313_0|SrvcGrp|24758|2022|PDM|41.10|99|0.00|HOME INJECTABLE THERAPY|
20|FH_F149160_02180_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F39211_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F97082_90012_0|SrvcGrp|73643|2022|PDM|1296.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F110805_45227_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97480_08204_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F80834_0_0|SrvcGrp|62356|2022|PCT|1.10|99|0.00|LABS W/ OP SURG-OBS-TRAUMA|
20|FH_F36036_0_0|SrvcGrp|22089|2022|PDM|60.00|99|0.00|HCPCS S9001|
20|FH_F123745_0_0|SrvcGrp|89989|2022|PDM|7500.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F137986_0_0|SrvcGrp|27261|2022|PDM|9393.00|99|0.00|CPT 27446|
20|FH_F134427_64014_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97640_37043_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SAINT ALEXIUS FH MOD TC|
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110193_70444_0|SrvcGrp|86753|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F140027_61031_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143249_89801_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F143536_47546_0|SrvcGrp|100275|2022|PCT|1.00|99|0.00|MENINGOCOCCL POLYSACCHRID VA|
20|FH_F37100_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F101540_0_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F115208_0_0|SrvcGrp|106178|2022|PDM|1379.00|99|0.00|REMOVAL TONSILS AND ADENOIDS|
20|FH_F131067_57105_0|CSTM-ALL|CSTM-00|2020|PDM|4338.00|99|0.00|AEG 4 (NO REV)|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD KF)|
20|FH_F136299_75218_0|SrvcGrp|11336|2022|PCT|0.30|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F132373_47130_0|SrvcGrp|92761|2022|PCT|0.75|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F112712_63005_0|SrvcGrp|26869|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F120888_63823_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120974_27607_0|SrvcGrp|82523|2022|PCT|0.46|99|0.00|AETNA NUCLEAR MEDICINE|
20|FH_F33618_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F51276_0_0|SrvcGrp|17001|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F128517_57301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40600_0_0|SrvcGrp|12840|2022|PCT|0.70|99|0.00|PACEMAKER|
20|FH_F42715_0_0|SrvcGrp|471|2022|PDM|618.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F98621_41042_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F128031_0_0|SrvcGrp|73000|2022|PDM|1147.00|99|0.00|AEG 6|
20|FH_F149959_0_0|SrvcGrp|46903|2022|PDM|750.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F39567_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F49895_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F50137_0_0|SrvcGrp|46234|2022|PDM|55.00|99|0.00|SKILLED NURSING|
20|FH_F61292_0_0|SrvcGrp|16|2022|PDM|1271.00|99|0.00|ACUTE REHABILITATION|
20|FH_F39857_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|NUCLEAR MEDICINE / PROSTATE SEED IMPLANTS|
20|FH_F141802_17042_0|SrvcGrp|111928|2022|PDM|95.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2375.00|99|0.00|AEG 8 (NO REV)|
20|FH_F129596_0_0|SrvcGrp|12118|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F72830_0_0|SrvcGrp|3434|2022|PDM|1600.00|99|0.00|OBSERVATION SERVICES|
20|FH_F127032_33573_0|SrvcGrp|82222|2022|PDM|181.40|99|0.00|HOSPICE CARE|
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC STUDIES|
20|FH_F102302_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F135165_15728_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133232_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141407_76226_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147941_06023_0|SrvcGrp|36669|2022|PCT|1.26|99|0.00|IMMUNIZATION ADMIN|
20|FH_F139515_0_0|SrvcGrp|33984|2022|PDM|1391.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F115109_20032_0|SrvcGrp|79458|2022|PDM|0.25|99|0.00|MED RECORD COPY|
20|FH_F66222_0_0|SrvcGrp|62436|2022|PDM|101.27|99|0.00|CONTINUM HOME HEALTH S9338 MOD SD|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD AV|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 949|
20|FH_F136510_0_0|SrvcGrp|110827|2022|PDM|3882.00|99|0.00|REPAIR OF EYE WOUND|
20|FH_F128108_49505_0|SrvcGrp|113502|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45792_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143528_0_0|SrvcGrp|114085|2022|PDM|5250.00|99|0.00|TRANSPEDICULAR|
20|FH_F109645_0_0|SrvcGrp|34146|2022|PDM|88.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|288.96|99|0.00|CPT 95805 (W/MOD TC)|
20|FH_F93114_85016_0|SrvcGrp|23683|2022|PDM|67.00|99|0.00|SKILLED NURSING RN|
20|FH_F83451_0_0|SrvcGrp|81560|2022|PDM|1575.00|99|0.00|STAPECTOMY AND/OR REVISION|
20|FH_F49338_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F149869_03253_0|SrvcGrp|88621|2022|PDM|121.00|99|0.00|SKILLED NURSING LPN|
20|FH_F151543_95630_0|SrvcGrp|16069|2022|PDM|1146.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F124763_61821_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42464_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|1192.00|99|0.00|AEG 2 (NO REV)|
20|FH_F148480_03079_0|SrvcGrp|115405|2022|PDM|4884.00|99|0.00|SPINE PROCEDURES|
20|FH_F121495_92009_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37945_0_0|SrvcGrp|23279|2022|PDM|170.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F137087_0_0|SrvcGrp|84939|2022|PDM|25000.00|99|0.00|SHOULDER JOINT|
20|FH_F129656_15005_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F148265_06067_0|SrvcGrp|82720|2022|PDM|4287.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F137588_33852_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|88162|2022|PDM|8809.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|531.00|99|0.00|AEG 3 (NO REV)|
20|FH_F39428_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130204_40807_0|SrvcGrp|89412|2022|PDM|336.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F148265_06067_0|SrvcGrp|34606|2022|PDM|5654.00|99|0.00|CPT 29827|
20|FH_F82696_16335_0|SrvcGrp|12290|2022|PDM|742.00|99|0.00|DETOXIFICATION|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|1550.00|99|0.00|ASPG III|
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|1158.00|99|0.00|AEG 9 (NO REV)|
20|FH_F125249_0_0|SrvcGrp|75002|2022|PDM|2000.00|99|0.00|ARTHOSCOPY|
20|FH_F93881_15009_0|SrvcGrp|75481|2022|PDM|1407.00|99|0.00|AEG 2|
20|FH_F132130_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F137457_32216_0|SrvcGrp|3178|2022|PDM|1114.00|99|0.00|ACUTE PSYCH|
20|FH_F38034_0_0|SrvcGrp|705|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F116760_68512_0|SrvcGrp|107288|2022|PCT|1.00|99|0.00|INJ INTERFERON BETA|
20|FH_F123895_52722_0|SrvcGrp|91294|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F51672_0_0|SrvcGrp|15402|2022|PDM|40.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F32996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|TRAUMA CARE|
20|FH_F124660_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F120308_07901_0|SrvcGrp|89417|2022|PDM|392.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F36955_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F129666_71901_0|SrvcGrp|48385|2022|PDM|155.00|99|0.00|SPEECH THERAPY|
20|FH_F88114_32205_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F128159_45356_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F124048_47304_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F63458_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131603_53051_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F75307_0_0|SrvcGrp|52782|2022|PDM|46.00|99|0.00|VENIPUNCTURE PER VISIT|
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|3273.44|99|0.00|AEG 9 (NO REV)|
20|FH_F93424_53578_0|SrvcGrp|86753|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F93881_15009_0|SrvcGrp|105604|2022|PCT|0.55|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F110263_0_0|SrvcGrp|111445|2022|PDM|13084.00|99|0.00|RECONSTRUCT ANKLE JOINT (HCFA)|
20|FH_F128580_0_0|SrvcGrp|73610|2022|PCT|0.00|99|0.00|AETNA IMPLANTS|
20|FH_F126489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37882_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F82753_18840_0|SrvcGrp|80525|2022|PDM|26623.00|99|0.00|AETNA PAIN MANAGEMENT|
20|FH_F62892_0_0|SrvcGrp|10541|2022|PDM|95.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1370.02|99|0.00|AEG 3 (NO REV)|
20|FH_F38377_0_0|SrvcGrp|10541|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F109601_0_0|SrvcGrp|75479|2022|PDM|450.00|99|0.00|AEG 1|
20|FH_F116237_43235_0|SrvcGrp|93919|2022|PDM|494.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F93881_15009_0|SrvcGrp|87115|2022|PDM|1033.00|99|0.00|BIOPSY OF BREAST|
20|FH_F123278_20850_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F56137_0_0|SrvcGrp|48085|2022|PDM|95.00|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F130157_84049_0|SrvcGrp|74668|2022|PDM|900.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F40058_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F116327_75701_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F145757_65101_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 5  (NO REV)|
20|FH_F88639_80204_0|SrvcGrp|131|2022|PCT|0.70|99|0.00|PACEMAKER DEVICE|
20|FH_F72544_0_0|SrvcGrp|30623|2022|PDM|4324.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F111594_0_0|SrvcGrp|98494|2022|PDM|7699.00|99|0.00|ARTHRODESIS PRE-SACRAL|
20|FH_F137951_0_0|SrvcGrp|82114|2022|PDM|1478.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F140035_0_0|SrvcGrp|48398|2022|PDM|197.00|99|0.00|PT SERVICES|
20|FH_F148379_89129_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F148545_84047_0|SrvcGrp|29347|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE|
20|FH_F144318_32696_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F92977_64067_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F42779_0_0|SrvcGrp|472|2022|PDM|1399.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F35857_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142994_54313_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F113324_17055_0|SrvcGrp|105263|2022|PDM|765.00|99|0.00|HEMODIALYSIS|
20|FH_F97041_71603_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F145881_46011_0|SrvcGrp|90854|2022|PDM|983.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F40980_0_0|SrvcGrp|18145|2022|PDM|20625.00|99|0.00|MS DRG 248|
20|FH_F119007_0_0|SrvcGrp|103329|2022|PDM|11876.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN|
20|FH_F134430_86301_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F94165_0_0|SrvcGrp|74616|2022|PCT|0.85|99|0.00|AETNA LABORATORY|
20|FH_F35368_0_0|SrvcGrp|474|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F115889_0_0|SrvcGrp|73004|2022|PDM|1640.00|99|0.00|AEG 8|
20|FH_F38700_0_0|SrvcGrp|18822|2022|PCT|0.80|99|0.00|MS DRG 223|
20|FH_F108780_54235_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.00|99|0.00|OP PARTIAL HOSPITALIZATION (4-7 HOURS)|
20|FH_F100785_54660_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F132328_0_0|SrvcGrp|88600|2022|PDM|2383.00|99|0.00|WRIST ARTHROS DIAG W/WO BIO|
20|FH_F102222_19720_0|SrvcGrp|86839|2022|PDM|31.50|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F96960_35404_0|SrvcGrp|88978|2022|PDM|7023.00|99|0.00|VAGINAL DELIVERY|
20|FH_F102960_50613_0|SrvcGrp|87958|2022|PDM|657.00|99|0.00|AETNA OP AMBULANCE - BLS|
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|1685.25|99|0.00|AEG 9 (NO REV)|
20|FH_F148101_33462_0|SrvcGrp|89412|2022|PDM|850.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F68826_0_0|SrvcGrp|81058|2022|PDM|65.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN|
20|FH_F69968_0_0|SrvcGrp|29570|2022|PDM|6685.29|99|0.00|KYPHOPLASTY|
20|FH_F71628_0_0|SrvcGrp|42971|2022|PDM|120.00|99|0.00|SKN RN|
20|FH_F107200_0_0|SrvcGrp|27346|2022|PDM|4162.00|99|0.00|REPAIR BLADDER DEFECT|
20|FH_F136315_98144_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136358_06070_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120489_63552_0|SrvcGrp|3178|2022|PDM|1540.00|99|0.00|ACUTE PSYCH|
20|FH_F120489_63552_0|SrvcGrp|16|2022|PDM|712.00|99|0.00|ACUTE REHABILITATION|
20|FH_F134011_84102_0|SrvcGrp|100663|2022|PDM|632.50|99|0.00|HOSPICE IP CARE|
20|FH_F134029_06517_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137246_66064_0|SrvcGrp|89417|2022|PDM|470.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F121472_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F140447_84106_0|SrvcGrp|29346|2022|PDM|26.75|99|0.00|SKILLED NURSING- LPN|
20|FH_F140846_48207_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119021_03060_0|SrvcGrp|86723|2022|PDM|350.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F117371_77059_0|SrvcGrp|76061|2022|PDM|795.00|99|0.00|AETNA IP ELECTRO SHOCK|
20|FH_F129483_77030_0|SrvcGrp|13929|2022|PDM|25.00|99|0.00|GROWTH HORMONE|
20|FH_F137307_65233_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110308_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36045_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|604.00|99|0.00|AEG 2 (NO REV)|
20|FH_F39085_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 10 (NO REV)|
20|FH_F36372_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F40855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|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_F98621_41042_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F102948_43606_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F111190_30512_0|SrvcGrp|75545|2022|PDM|453.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|531.00|99|0.00|AEG 3 (NO REV)|
20|FH_F131609_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F71183_29601_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS|
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 10 (NO REV)|
20|FH_F117485_0_0|SrvcGrp|29369|2022|PDM|5515.00|99|0.00|CPT 28890|
20|FH_F134797_0_0|SrvcGrp|112581|2022|PDM|10000.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F119315_70663_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149861_85225_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137240_0_0|SrvcGrp|16815|2022|PDM|8403.00|99|0.00|ICU|
20|FH_F150948_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F89112_16509_0|SrvcGrp|3388|2022|PDM|1098.00|99|0.00|SUBACUTE CARE|
20|FH_F128390_0_0|SrvcGrp|93098|2022|PDM|115.00|99|0.00|HOSPICE CARE|
20|FH_F89932_10940_0|SrvcGrp|74581|2022|PCT|0.45|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F118027_28801_0|SrvcGrp|89149|2022|PDM|231.00|99|0.00|OP INTENSIVE|
20|FH_F89932_10940_0|SrvcGrp|89412|2022|PDM|340.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F150949_0_0|SrvcGrp|113854|2022|PDM|4740.00|99|0.00|REMOVE/REINSER SPINE FIXATION DEVICE|
20|FH_F90935_29073_0|SrvcGrp|87317|2022|PDM|400.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F34984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120746_29621_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F143187_52565_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134497_47126_0|SrvcGrp|86722|2022|PDM|170.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F50237_0_0|SrvcGrp|13711|2022|PDM|1400.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F92677_08003_0|SrvcGrp|14945|2022|PDM|12.60|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F132999_19901_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151518_60506_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F44350_0_0|SrvcGrp|1306|2022|PDM|300.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F88512_0_0|SrvcGrp|46516|2022|PDM|10889.63|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F118819_76226_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F120841_16201_0|SrvcGrp|89417|2022|PDM|180.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F106540_26330_0|SrvcGrp|14886|2022|PCT|0.98|99|0.00|TRANSPORTATION|
20|FH_F72226_65804_0|SrvcGrp|114015|2022|PCT|0.56|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F133631_0_0|SrvcGrp|3499|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F128279_77043_0|SrvcGrp|73841|2022|PDM|370.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F119070_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F97565_83301_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F33832_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111403_37167_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F40286_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127325_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133015_36305_0|SrvcGrp|92760|2022|PCT|0.80|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144348_22601_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97622_75051_0|SrvcGrp|73485|2022|PDM|4264.00|99|0.00|AETNA REHAB|
20|FH_F89851_83854_0|SrvcGrp|47036|2022|PDM|10050.00|99|0.00|MS DRG 743 ONLY|
20|FH_F73542_0_0|SrvcGrp|71000|2022|PDM|150.00|99|0.00|AMBULANCE - NEONATAL TRANSPORT|
20|FH_F77787_0_0|SrvcGrp|61578|2022|PCT|0.90|99|0.00|TENECTEPLASE W/636 & J3101|
20|FH_F121011_68510_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120757_83843_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F38700_0_0|SrvcGrp|18335|2022|PCT|0.80|99|0.00|MS DRG 470|
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|408.00|99|0.00|AEG 1 (NO REV)|
20|FH_F148900_0_0|SrvcGrp|35669|2022|PDM|7183.00|99|0.00|CPT 63650|
20|FH_F148555_0_0|SrvcGrp|28400|2022|PDM|3090.00|99|0.00|CPT CODE 93621|
20|FH_F139176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OCN F/S PRICING: ALL|
20|FH_F97562_29803_0|SrvcGrp|73601|2022|PDM|10516.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F38663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|BURMANS APOTHECARY IV THERAPY MOD SJ|
20|FH_F37553_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69242_0_0|SrvcGrp|42976|2022|PDM|95.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F127204_44420_0|SrvcGrp|27968|2022|PDM|32.00|99|0.00|SKILLED NURSING LPN|
20|FH_F117911_86403_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F89932_10940_0|SrvcGrp|89106|2022|PCT|0.45|99|0.00|GRAFTING MATERIALS|
20|FH_F142814_16511_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124928_04210_0|SrvcGrp|87393|2022|PDM|154.22|99|0.00|HCPCS G0151 (HCFA)|
20|FH_F124928_04210_0|SrvcGrp|87395|2022|PDM|151.01|99|0.00|HCPCS G0153 (HCFA)|
20|FH_F144048_91324_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F91155_16105_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F118645_19103_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38865_0_0|SrvcGrp|109|2022|PDM|700.00|99|0.00|CD - DETOX|
20|FH_F130652_51101_0|SrvcGrp|471|2022|PDM|560.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F118391_77040_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F133018_84037_0|SrvcGrp|14949|2022|PDM|10.00|99|0.00|HOME INFUSION|
20|FH_F47679_0_0|SrvcGrp|42784|2022|PDM|40.12|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|3530.00|99|0.00|AEG 5  (NO REV)|
20|FH_F31466_0_0|SrvcGrp|14210|2022|PDM|265.00|99|0.00|PSYCH INTENSIVE OUTPATIENT|
20|FH_F34706_0_0|SrvcGrp|14622|2022|PDM|7602.00|99|0.00|DRG 180 ONLY - GI OBSTRUCTION W/CC|
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F44314_0_0|SrvcGrp|26205|2022|PDM|46.00|99|0.00|ST|
20|FH_F130636_78572_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38700_0_0|SrvcGrp|18843|2022|PCT|0.80|99|0.00|MS DRG 227|
20|FH_F128657_19008_0|SrvcGrp|472|2022|PDM|497.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F45977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|HOME INF- REV 640 MOD SH|
20|FH_F90955_06053_0|SrvcGrp|46605|2022|PDM|84.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F97201_15068_0|SrvcGrp|48385|2022|PDM|82.50|99|0.00|SPEECH THERAPY|
20|FH_F134493_48708_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|AETNA IP MCARE2 OCN F/S PRICING|
20|FH_F35454_0_0|SrvcGrp|16853|2022|PDM|24.00|99|0.00|SPLINT - TOES|
20|FH_F145988_06105_0|SrvcGrp|31074|2022|PDM|1530.00|99|0.00|MS DRG 795 ONLY|
20|FH_F143087_97411_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F100785_54660_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F112836_06040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124505_0_0|SrvcGrp|80538|2022|PDM|434.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 2|
20|FH_F134497_47126_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F97560_23249_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F120406_84047_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134544_03874_0|SrvcGrp|86722|2022|PDM|169.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F117875_70601_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F41785_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F112852_73112_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION|
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|1530.00|99|0.00|AEG 9 (NO REV)|
20|FH_F142991_43920_0|SrvcGrp|13422|2022|PDM|314.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F38953_0_0|SrvcGrp|35054|2022|PDM|1300.00|99|0.00|SKILLED NURSING - LEVEL 2|
20|FH_F101923_98104_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|BURN SERVICES|
20|FH_F133397_23233_0|SrvcGrp|74581|2022|PCT|0.50|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F150464_15746_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146211_68144_0|CSTM-ALL|CSTM-00|2020|PDM|1913.00|99|0.00|AEG 10 (NO REV)|
20|FH_F128246_0_0|SrvcGrp|111043|2022|PDM|841.00|99|0.00|EXCISION OF LESION OF EYELID|
20|FH_F148556_13206_0|SrvcGrp|22389|2022|PDM|12.50|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F97562_29803_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111409_33761_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F87577_80016_0|SrvcGrp|16429|2022|PDM|10062.00|99|0.00|OBSERVATION SVCS|
20|FH_F78167_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148644_06890_0|SrvcGrp|26432|2022|PDM|3712.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F151059_60435_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F151061_02720_0|SrvcGrp|115840|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUG|
20|FH_F151144_35801_0|CSTM-ALL|CSTM-00|2020|PDM|970.00|99|0.00|AEG 5  (NO REV)|
20|FH_F121385_89102_0|SrvcGrp|75506|2022|PCT|2.07|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F121930_60714_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F71465_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38607_0_0|SrvcGrp|35054|2022|PDM|1200.00|99|0.00|SKILLED NURSING - LEVEL 2|
20|FH_F31547_0_0|SrvcGrp|26951|2022|PDM|52.09|99|0.00|PHYSICAL THERAPY|
20|FH_F122392_78207_0|SrvcGrp|73841|2022|PDM|424.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F97880_63501_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146266_0_0|SrvcGrp|35668|2022|PDM|3300.00|99|0.00|CPT 29824|
20|FH_F130997_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143564_0_0|SrvcGrp|105753|2022|PDM|2002.00|99|0.00|GASTRIC RESTRICTIVE PROCEDURE|
20|FH_F37342_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F150938_02062_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F100965_25276_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|737.00|99|0.00|AEG 5  (NO REV)|
20|FH_F119795_0_0|SrvcGrp|105401|2022|PDM|21590.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F35567_0_0|SrvcGrp|21046|2022|PDM|450.00|99|0.00|CT SERVICES|
20|FH_F149023_44122_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F112045_90301_0|SrvcGrp|10391|2022|PDM|6042.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F149273_0_0|SrvcGrp|107793|2022|PDM|9364.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F144029_0_0|SrvcGrp|107750|2022|PDM|25.00|99|0.00|TRAINING INCL A TREATMENT|
20|FH_F42655_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F50220_0_0|SrvcGrp|33165|2022|PDM|405.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F128583_45154_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 8 (NO REV)|
20|FH_F138017_73129_0|SrvcGrp|81571|2022|PDM|6883.00|99|0.00|NASAL ENDOSCOPY W/ SINUS OSTIA DILATION|
20|FH_F128029_48154_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F117645_90034_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F137458_08857_0|SrvcGrp|89149|2022|PDM|196.00|99|0.00|OP INTENSIVE|
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98360_11554_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F98020_50138_0|SrvcGrp|73659|2022|PDM|7486.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F125656_92868_0|SrvcGrp|29077|2022|PDM|12.50|99|0.00|HOME TRANSFUSION|
20|FH_F149419_33966_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101844_0_0|SrvcGrp|85022|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_F101441_0_0|SrvcGrp|97119|2022|PDM|8105.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F40104_0_0|SrvcGrp|12401|2022|PDM|121.29|99|0.00|RN VISIT|
20|FH_F116575_0_0|SrvcGrp|106267|2022|PDM|3132.05|99|0.00|NSL/SINS NDSC SPHN TISS RMVL|
20|FH_F42944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F38123_0_0|SrvcGrp|31188|2022|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER RRKC (DME)|
20|FH_F112794_01040_0|SrvcGrp|94741|2022|PCT|1.00|99|0.00|FLULAVAL VACC IM (>=3 YRS)|
20|FH_F132039_92008_0|SrvcGrp|75419|2022|PDM|1300.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F31547_0_0|SrvcGrp|8962|2022|PDM|90.29|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F40495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F139309_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36462_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128753_32501_0|SrvcGrp|73601|2022|PCT|0.64|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F110609_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148965_62025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124435_03882_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139951_92870_0|SrvcGrp|108484|2022|PDM|950.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F143529_84737_0|SrvcGrp|73700|2022|PDM|42.25|99|0.00|AETNA - SKILLED NURSING|
20|FH_F143529_84737_0|SrvcGrp|48396|2022|PDM|85.50|99|0.00|OT SERVICES|
20|FH_F101709_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F151764_03801_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.00|99|0.00|ASPG IV- MOD 50|
20|FH_F49054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F49329_0_0|SrvcGrp|45335|2022|PDM|140.00|99|0.00|DIETICIAN VISIT - OP|
20|FH_F136250_73026_0|SrvcGrp|73841|2022|PDM|500.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F132472_32547_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116546_78723_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F116662_15801_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120974_27607_0|SrvcGrp|107733|2022|PDM|4682.00|99|0.00|CESAREAN SECTION|
20|FH_F120974_27607_0|SrvcGrp|116117|2022|PCT|2.81|99|0.00|COVID-19 TESTING|
20|FH_F126243_32132_0|SrvcGrp|108484|2022|PDM|683.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F126884_28379_0|SrvcGrp|73842|2022|PDM|140.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F113649_01752_0|SrvcGrp|86852|2022|PDM|60.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F113649_01752_0|SrvcGrp|21920|2022|PDM|67.50|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F118874_29926_0|SrvcGrp|75419|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F118792_63379_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F51276_0_0|SrvcGrp|14945|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F36439_0_0|SrvcGrp|23014|2022|PDM|650.00|99|0.00|V5245|
20|FH_F42367_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|EMERGENCY ROOM|
20|FH_F49895_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F49895_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F67339_0_0|SrvcGrp|474|2022|PDM|1100.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F38377_0_0|SrvcGrp|15070|2022|PDM|115.00|99|0.00|HOME HEALTH (NEWBORN CARE)|
20|FH_F35202_0_0|SrvcGrp|1168|2022|PDM|26.25|99|0.00|CONTINUOUS HOMECARE|
20|FH_F91617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139515_0_0|SrvcGrp|109960|2022|PDM|5252.00|99|0.00|IMPLNT SPINAL CANAL CATHETER|
20|FH_F38807_0_0|SrvcGrp|17065|2022|PDM|333.00|99|0.00|ASPG I|
20|FH_F66408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F98041_10027_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F109951_0_0|SrvcGrp|705|2022|PCT|0.45|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F97660_29401_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F97740_01605_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97761_04072_0|SrvcGrp|90854|2022|PDM|928.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F97780_43614_0|SrvcGrp|73605|2022|PDM|1954.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F97780_43614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F106822_0_0|SrvcGrp|96499|2022|PDM|7.95|99|0.00|ADMIN OF PNEUMOCOCCAL VACCINE|
20|FH_F109627_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111001_0_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F116019_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F43139_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|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_F116143_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DEVICE INSERTION|
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|1569.00|99|0.00|AEG 7 (NO REV)|
20|FH_F114864_78155_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F115895_0_0|SrvcGrp|74670|2022|PCT|1.00|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F103780_64804_0|SrvcGrp|114015|2022|PCT|0.68|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F41539_0_0|SrvcGrp|33829|2022|PDM|941.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 7|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F47773_0_0|CSTM-ALL|CSTM-00|2020|PDM|112.00|99|0.00|OP SVCS|
20|FH_F133178_0_0|SrvcGrp|112205|2022|PDM|586.00|99|0.00|BIOPSY OF PENIS|
20|FH_F133178_0_0|SrvcGrp|112206|2022|PDM|106.00|99|0.00|DESTROY VULVA LESIONS|
20|FH_F141047_23661_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114389_50131_0|SrvcGrp|99031|2022|PDM|133.31|99|0.00|ANTIBIOTIC Q12H (HCFA)|
20|FH_F43665_0_0|CSTM-ALL|CSTM-00|2020|PDM|892.00|99|0.00|SPINAL CORD REHABILITATION|
20|FH_F69504_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|1334.00|99|0.00|AEG 9 (NO REV)|
20|FH_F77944_0_0|CSTM-ALL|CSTM-00|2020|PDM|4445.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F124058_61081_0|SrvcGrp|79699|2022|PCT|0.65|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|1275.00|99|0.00|ASPG VI|
20|FH_F74102_0_0|SrvcGrp|12403|2022|PDM|39.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F93232_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F32731_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F124593_07033_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|AETNA IP LABORATORY|
20|FH_F124593_07033_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132439_0_0|SrvcGrp|90707|2022|PDM|178.17|99|0.00|AETNA HOSPICE CARE|
20|FH_F67888_0_0|SrvcGrp|3809|2022|PDM|615.30|99|0.00|HOSPICE CARE|
20|FH_F89273_0_0|SrvcGrp|88264|2022|PDM|4300.00|99|0.00|CORNEAL TISSUE SVCS (HCFA)|
20|FH_F114666_30342_0|SrvcGrp|89842|2022|PDM|8000.00|99|0.00|LUMBAR|
20|FH_F113845_32746_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F113910_16508_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F144039_0_0|SrvcGrp|109765|2022|PDM|1721.00|99|0.00|CLOSURE OF LACRIMAL PUNCTUM|
20|FH_F122610_73139_0|SrvcGrp|109185|2022|PDM|376.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F122872_67208_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F122689_92009_0|SrvcGrp|86308|2022|PDM|115.00|99|0.00|DEMONSTRATION PRIOR TO INITIATION OF HOME INR MONITORING|
20|FH_F43447_0_0|SrvcGrp|40820|2022|PDM|1944.00|99|0.00|ICU/CCU|
20|FH_F43779_0_0|SrvcGrp|97|2022|PDM|6537.00|99|0.00|C-SECTION|
20|FH_F134727_30650_0|SrvcGrp|12837|2022|PCT|0.60|99|0.00|INTRAOCULAR LENSES|
20|FH_F134727_30650_0|SrvcGrp|74584|2022|PDM|1306.00|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F134817_30339_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136914_64081_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F112505_51503_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F141170_0_0|SrvcGrp|67069|2022|PDM|8000.00|99|0.00|CPT 22634|
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1370.00|99|0.00|AEG 6 (NO REV)|
20|FH_F149543_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38826_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F39622_0_0|SrvcGrp|675|2022|PDM|1770.00|99|0.00|PEDIATRIC INPATIENT SVCS|
20|FH_F116393_07002_0|SrvcGrp|111270|2022|PDM|43.71|99|0.00|X-RAY EXAM OF COLLARBONE|
20|FH_F41463_0_0|SrvcGrp|29077|2022|PDM|120.00|99|0.00|HOME TRANSFUSION|
20|FH_F41678_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F42551_0_0|CSTM-ALL|CSTM-00|2020|PDM|205.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133050_78216_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F131596_60433_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111604_16505_0|SrvcGrp|89149|2022|PDM|161.00|99|0.00|OP INTENSIVE|
20|FH_F35216_0_0|SrvcGrp|18043|2022|PCT|0.75|99|0.00|PT/OT|
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|1135.34|99|0.00|2005 ASPG GROUPER VII|
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117820_0_0|SrvcGrp|90477|2022|PDM|105.00|99|0.00|HOSPICE|
20|FH_F98361_12065_0|SrvcGrp|73602|2022|PDM|6510.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F138907_01040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F96321_0_0|SrvcGrp|24095|2022|PDM|729.94|99|0.00|EGD W/BALLOON DIALATION CPT 43249|
20|FH_F148601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84139_0_0|SrvcGrp|3577|2022|PDM|140.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F151379_21045_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132268_07060_0|SrvcGrp|98008|2022|PDM|97.20|99|0.00|DEBRIDEMENT OPEN WOUND|
20|FH_F132268_07060_0|SrvcGrp|90489|2022|PDM|58.94|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F122107_11229_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F135609_37027_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F97143_80012_0|SrvcGrp|73485|2022|PDM|4855.00|99|0.00|AETNA REHAB|
20|FH_F91764_93710_0|SrvcGrp|113235|2022|PCT|2.19|99|0.00|COVID-19 SARSCOV2&INF A&B&RSV AMP PRB|
20|FH_F91764_93710_0|SrvcGrp|113236|2022|PCT|2.12|99|0.00|COVID-19 SARS-COV-2 W/ OPTIC|
20|FH_F135867_60625_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136174_89146_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F130564_74834_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131132_44077_0|SrvcGrp|64478|2022|PDM|2281.00|99|0.00|CPT CODE 74178|
20|FH_F131407_07607_0|SrvcGrp|86844|2022|PDM|30.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F116431_76104_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116488_79925_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F147163_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|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_F121740_98119_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F33785_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F44113_0_0|SrvcGrp|12146|2022|PDM|1800.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F55574_0_0|SrvcGrp|12834|2022|PCT|0.86|99|0.00|EMERGENCY ROOM|
20|FH_F127992_34952_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133668_63128_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F111292_33136_0|SrvcGrp|14614|2022|PDM|6396.00|99|0.00|LITHOTRIPSY|
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|3750.00|99|0.00|AEG 5  (NO REV)|
20|FH_F39796_0_0|SrvcGrp|3142|2022|PDM|1700.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F42026_0_0|CSTM-ALL|CSTM-00|2020|PDM|183.00|99|0.00|CD DAY TREATMENT|
20|FH_F131000_0_0|SrvcGrp|11673|2022|PDM|5836.00|99|0.00|CPT 29888|
20|FH_F131000_0_0|SrvcGrp|27344|2022|PDM|2494.00|99|0.00|OP SURGERY (CPT 42821)|
20|FH_F132328_0_0|SrvcGrp|77448|2022|PDM|2425.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F132328_0_0|SrvcGrp|109973|2022|PDM|2383.00|99|0.00|ARTHROSCOPY / SURGERY|
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.37|99|0.00|AEG 1 (NO REV)|
20|FH_F112129_62220_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F112135_80910_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102228_08846_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
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|84278|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F138197_0_0|SrvcGrp|44461|2022|PDM|3689.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F100789_0_0|SrvcGrp|11306|2022|PCT|0.74|99|0.00|IMPLANTS|
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|137.37|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F87474_0_0|SrvcGrp|14371|2022|PDM|13.00|99|0.00|DISPOSABLE DRUG DELIVERY|
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149179_0_0|SrvcGrp|93641|2022|PDM|3589.00|99|0.00|KNEE ARTHROSCOPIC SURGERY|
20|FH_F151559_0_0|SrvcGrp|55677|2022|PDM|2000.00|99|0.00|VAGINAL DELIVERY ONLY|
20|FH_F117465_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F117465_0_0|SrvcGrp|84442|2022|PDM|9000.00|99|0.00|REVISION KNEE|
20|FH_F136487_71269_0|SrvcGrp|73842|2022|PDM|240.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136542_02446_0|SrvcGrp|90388|2022|PDM|504.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F120473_98055_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120490_64133_0|SrvcGrp|86850|2022|PDM|25.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F120490_64133_0|SrvcGrp|86827|2022|PDM|83.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F134011_84102_0|SrvcGrp|46104|2022|PDM|50.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F134011_84102_0|SrvcGrp|48398|2022|PDM|103.00|99|0.00|PT SERVICES|
20|FH_F134126_11554_0|SrvcGrp|12491|2022|PCT|0.45|99|0.00|PACEMAKER|
20|FH_F134159_80228_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137127_72761_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F137246_66064_0|SrvcGrp|46903|2022|PDM|650.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F139110_33912_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114092_83350_0|CSTM-ALL|CSTM-00|2020|PDM|7761.00|99|0.00|AEG 3 W/O SURG CARVEOUT (NO REV)|
20|FH_F142406_78840_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142267_78240_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F142690_31774_0|SrvcGrp|26868|2022|PDM|75.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|AEG 3 (NO REV)|
20|FH_F73403_0_0|SrvcGrp|45965|2022|PDM|120.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F83831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F138558_60107_0|SrvcGrp|86722|2022|PDM|234.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F138627_82901_0|SrvcGrp|37385|2022|PDM|0.92|99|0.00|AMINO ACIDS|
20|FH_F78267_18702_0|SrvcGrp|103959|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140343_89052_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F149511_62626_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149653_19702_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F119067_94080_0|SrvcGrp|73700|2022|PDM|60.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F66835_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76144_0_0|SrvcGrp|29021|2022|PCT|1.00|99|0.00|DME AND SUPPLIES|
20|FH_F115452_15235_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F147725_06002_0|SrvcGrp|78093|2022|PDM|4516.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F147941_06023_0|SrvcGrp|106307|2022|PDM|843.00|99|0.00|AMBULANCE SERVICE NO TRANSPORT|
20|FH_F129474_92701_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F117211_15143_0|SrvcGrp|46605|2022|PDM|118.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F109652_0_0|SrvcGrp|21358|2022|PDM|17704.00|99|0.00|MS DRG 258-259 ONLY|
20|FH_F110160_0_0|SrvcGrp|103300|2022|PDM|1350.00|99|0.00|OPHTHALMOLOGY|
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1387.82|99|0.00|ASPG VII|
20|FH_F63049_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F45052_0_0|SrvcGrp|9832|2022|PDM|133.00|99|0.00|ST SVCS|
20|FH_F31029_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F131100_0_0|SrvcGrp|105000|2022|PDM|3260.00|99|0.00|REPAIR OF KNEECAP FRACTURE|
20|FH_F138047_77027_0|SrvcGrp|48398|2022|PDM|105.00|99|0.00|PT SERVICES|
20|FH_F148547_01908_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134613_08852_0|SrvcGrp|74668|2022|PDM|1046.50|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130017_02302_0|SrvcGrp|73605|2022|PDM|1780.60|99|0.00|AETNA ACUTE PSYCH|
20|FH_F145641_06902_0|CSTM-ALL|CSTM-00|2020|PDM|824.00|99|0.00|AEG 2 (NO REV)|
20|FH_F146470_68025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123623_03246_0|SrvcGrp|109275|2022|PCT|1.00|99|0.00|IIV4 VACC NO PRSV 0.25 ML IM|
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2336.00|99|0.00|AEG 5  (NO REV)|
20|FH_F139565_0_0|SrvcGrp|95819|2022|PDM|6885.00|99|0.00|GONIOTOMY|
20|FH_F124369_0_0|SrvcGrp|98465|2022|PDM|11220.00|99|0.00|OPEN TXMT METATARSOPHALANGEAL|
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120670_0_0|SrvcGrp|89848|2022|PDM|16000.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F126003_79403_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2096.00|99|0.00|AEG 3 (NO REV)|
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1255.80|99|0.00|AEG 4 (NO REV)|
20|FH_F123850_0_0|SrvcGrp|80920|2022|PDM|706.00|99|0.00|HOSPICE SERVICES|
20|FH_F37146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F111908_07677_0|SrvcGrp|96401|2022|PCT|1.00|99|0.00|ACYELOVIR INJECTION|
20|FH_F119646_65804_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F88698_18951_0|SrvcGrp|89417|2022|PDM|247.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F114409_18447_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134667_19110_0|SrvcGrp|86722|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F85651_33549_0|SrvcGrp|83800|2022|PDM|5225.00|99|0.00|VBAC DELIVERY|
20|FH_F133912_20852_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134619_14304_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F133749_84604_0|SrvcGrp|112419|2022|PDM|25.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY (HCFA)|
20|FH_F133920_64057_0|SrvcGrp|23683|2022|PDM|44.00|99|0.00|SKILLED NURSING RN|
20|FH_F114510_33445_0|SrvcGrp|73841|2022|PDM|364.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F134568_12946_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F110542_10035_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F81838_0_0|SrvcGrp|26001|2022|PDM|138.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F130364_01331_0|SrvcGrp|10361|2022|PDM|219.00|99|0.00|CPT CODE 99281|
20|FH_F77184_0_0|SrvcGrp|48385|2022|PDM|18.00|99|0.00|SPEECH THERAPY|
20|FH_F120291_0_0|SrvcGrp|30609|2022|PDM|60.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F87812_33919_0|SrvcGrp|66562|2022|PCT|1.10|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F121639_06830_0|SrvcGrp|471|2022|PDM|1030.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133585_0_0|SrvcGrp|112391|2022|PDM|121.00|99|0.00|ACTIVASE (HCFA)|
20|FH_F31714_0_0|SrvcGrp|10906|2022|PDM|424.00|99|0.00|EMERGENCY ROOM LEVEL IV|
20|FH_F150146_95401_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F100782_0_0|SrvcGrp|105059|2022|PDM|770.00|99|0.00|WINDBER MEDICAL CNTR ASC 11|
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_F143628_32810_0|SrvcGrp|114048|2022|PDM|70.00|99|0.00|MISC SUPPLY ACCESSORY IMP VAD (MOD NU)|
20|FH_F150305_18848_0|SrvcGrp|13226|2022|PDM|61.19|99|0.00|CPT CODE 99282|
20|FH_F102842_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129548_44130_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F150165_06032_0|SrvcGrp|102480|2022|PDM|2225.00|99|0.00|CPT 29897|
20|FH_F145619_17603_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138147_18018_0|CSTM-ALL|CSTM-00|2020|PDM|239.00|99|0.00|LEVEL AUTISM DX INTERVIEW (MOD AH) (HCFA)|
20|FH_F92641_34994_0|SrvcGrp|92760|2022|PCT|1.05|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143711_78405_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144228_0_0|SrvcGrp|114143|2022|PDM|6626.00|99|0.00|DRILL FOR OSTEOCH/BONE GRFT|
20|FH_F130123_24171_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F113453_80020_0|SrvcGrp|104329|2022|PCT|1.00|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F79923_0_0|SrvcGrp|46632|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F70883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: ALL|
20|FH_F149343_44134_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145604_14850_0|SrvcGrp|24761|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142376_0_0|SrvcGrp|113973|2022|PDM|462.00|99|0.00|TREAT LUMBAR SPINE LESIO 8|
20|FH_F120930_0_0|SrvcGrp|80617|2022|PDM|5000.00|99|0.00|ARTHOPLASTY|
20|FH_F120719_27540_0|CSTM-ALL|CSTM-00|2020|PDM|3895.00|99|0.00|AEG 2 (NO REV)|
20|FH_F134328_13088_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F138348_04096_0|SrvcGrp|75419|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F130329_64114_0|SrvcGrp|53987|2022|PDM|50.00|99|0.00|PHOTOTHERAPY|
20|FH_F146103_63851_0|SrvcGrp|110581|2022|PCT|0.00|99|0.00|INPATIENT DETOXIFICATION SERVICES|
20|FH_F149244_85201_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F145641_06902_0|SrvcGrp|112148|2022|PDM|2614.00|99|0.00|REPAIR OF DIGIT NERVE|
20|FH_F145642_15108_0|SrvcGrp|47183|2022|PDM|60.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F69647_0_0|SrvcGrp|17069|2022|PDM|900.00|99|0.00|ASPG III|
20|FH_F63318_0_0|SrvcGrp|472|2022|PDM|480.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F41739_0_0|SrvcGrp|10043|2022|PDM|35310.00|99|0.00|DRG 107 ONLY CRNRY BYPASS (DRG 547-548)|
20|FH_F121168_0_0|SrvcGrp|97703|2022|PDM|100.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F123158_0_0|SrvcGrp|87054|2022|PDM|850.00|99|0.00|CYSTOSCOPY CHEMODENERVATION|
20|FH_F126868_60451_0|SrvcGrp|73842|2022|PDM|208.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F113131_19013_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148555_0_0|SrvcGrp|115455|2022|PDM|3337.00|99|0.00|REMOVE PACEMAKER ELECTRODE|
20|FH_F130108_0_0|SrvcGrp|9938|2022|PCT|0.75|99|0.00|SPEECH THERAPY|
20|FH_F128130_10027_0|SrvcGrp|80679|2022|PCT|6.20|99|0.00|AETNA RADIOLOGY|
20|FH_F105760_98104_0|SrvcGrp|85017|2022|PCT|3.01|99|0.00|DME|
20|FH_F92677_08003_0|SrvcGrp|24751|2022|PDM|21.00|99|0.00|INTERMITTENT ANTICOAGULANT THERAPY|
20|FH_F144388_19904_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F138611_0_0|SrvcGrp|93432|2022|PDM|14894.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F88512_0_0|SrvcGrp|36504|2022|PCT|0.49|99|0.00|MS DRG 286 287 INPATIENT CARDIAC CATH OTLR|
20|FH_F92676_15063_0|SrvcGrp|78970|2022|PDM|1937.52|99|0.00|MON VALLEY ASC 1201|
20|FH_F141807_33020_0|SrvcGrp|75419|2022|PDM|484.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F102561_75146_0|SrvcGrp|75505|2022|PCT|2.00|99|0.00|CARDIAC STUDIES|
20|FH_F144048_91324_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.92|99|0.00|HAPA WPA-NWPA 2012-13 ASC 502 W/O REV|
20|FH_F113426_0_0|SrvcGrp|105282|2022|PCT|1.10|99|0.00|PROSTHETICS/IMPLANTS|
20|FH_F51123_0_0|CSTM-ALL|CSTM-00|2020|PDM|146.00|99|0.00|HI TECH NURSING|
20|FH_F88956_0_0|SrvcGrp|75493|2022|PDM|3133.00|99|0.00|AEG 8|
20|FH_F97141_93933_0|SrvcGrp|73601|2022|PDM|13852.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F128316_22192_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F111784_32901_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F134487_14843_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F52733_0_0|SrvcGrp|46104|2022|PDM|85.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F67861_0_0|SrvcGrp|9939|2022|PDM|2200.00|99|0.00|ACUTE MEDICAL SVCS|
20|FH_F71723_16502_0|CSTM-ALL|CSTM-00|2020|PDM|340.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40350_0_0|SrvcGrp|3029|2022|PDM|350.00|99|0.00|NEWBORN NURSERY|
20|FH_F88355_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F44079_0_0|SrvcGrp|11798|2022|PDM|95.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F116988_0_0|SrvcGrp|75495|2022|PDM|1785.00|99|0.00|AEG 9|
20|FH_F111815_35904_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F33331_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS|
20|FH_F118496_92627_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD RR/KF)|
20|FH_F141870_85224_0|SrvcGrp|84260|2022|PCT|1.00|99|0.00|AETNA ALL DRUGS|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|GENERAL ACUTE CARE|
20|FH_F36917_0_0|SrvcGrp|9811|2022|PDM|325.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F92673_44041_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F117733_91362_0|SrvcGrp|73701|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F121068_18036_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F148023_34471_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F45932_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F60101_0_0|SrvcGrp|42828|2022|PDM|68.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F139248_78070_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139707_84010_0|CSTM-ALL|CSTM-00|2020|PDM|1641.00|99|0.00|AEG 2 (NO REV)|
20|FH_F150882_84041_0|SrvcGrp|86843|2022|PDM|61.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F110805_45227_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F110821_31513_0|SrvcGrp|75545|2022|PDM|550.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F114207_35243_0|SrvcGrp|86851|2022|PDM|35.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F74902_0_0|SrvcGrp|66480|2022|PDM|75.00|99|0.00|RN VISIT|
20|FH_F75764_0_0|CSTM-ALL|CSTM-00|2020|PDM|105.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120848_20912_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F90213_30084_0|SrvcGrp|80098|2022|PDM|32.92|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE|
20|FH_F117576_21207_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F132109_66762_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149642_95678_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F125656_92868_0|SrvcGrp|98969|2022|PDM|35.00|99|0.00|HIT ANTI TNF (HCFA)|
20|FH_F38123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F151042_60659_0|SrvcGrp|66264|2022|PDM|98.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F124896_43220_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149522_83221_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F117762_0_0|SrvcGrp|89981|2022|PDM|3620.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY|
20|FH_F124467_27529_0|SrvcGrp|89149|2022|PDM|222.00|99|0.00|OP INTENSIVE|
20|FH_F144651_0_0|SrvcGrp|114175|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES|
20|FH_F149030_37919_0|CSTM-ALL|CSTM-00|2020|PDM|2317.50|99|0.00|AEG 10 (NO REV)|
20|FH_F131068_43055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148859_0_0|SrvcGrp|80524|2022|PDM|13525.00|99|0.00|INFLATABLE PENILE PROSTHESIS|
20|FH_F149023_44122_0|SrvcGrp|76603|2022|PDM|2043.00|99|0.00|CPT 25111|
20|FH_F131449_19073_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F40917_0_0|CSTM-ALL|CSTM-00|2020|PDM|1015.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|814.00|99|0.00|AEG 6 (NO REV)|
20|FH_F115982_0_0|SrvcGrp|73000|2022|PDM|992.00|99|0.00|AEG 6|
20|FH_F77082_0_0|SrvcGrp|19613|2022|PDM|6610.00|99|0.00|MS DRG CONTRACT|
20|FH_F35221_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|OP SVCS|
20|FH_F100782_0_0|SrvcGrp|105125|2022|PDM|532.77|99|0.00|WINDBER MEDICAL CNTR ASC 230|
20|FH_F127545_45227_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F85353_16407_0|SrvcGrp|63880|2022|PDM|273.35|99|0.00|HAPA WPA-NWPA 2012-13 ASC 15|
20|FH_F127934_62274_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F81698_10457_0|SrvcGrp|86850|2022|PDM|31.50|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F130364_01331_0|SrvcGrp|75506|2022|PCT|1.75|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F134608_18017_0|SrvcGrp|112602|2022|PDM|150.00|99|0.00|BIOPSY OF VAGINA|
20|FH_F52672_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|FS 5121 LAB GLOBAL|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|533.50|99|0.00|HAPA WPA-NWPA 2012-13 ASC 302 W/O REV|
20|FH_F69606_0_0|SrvcGrp|64110|2022|PDM|414.70|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 1|
20|FH_F122463_17109_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F122526_22203_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F72963_0_0|SrvcGrp|12787|2022|PCT|0.44|99|0.00|IMPLANTS|
20|FH_F98800_85021_0|SrvcGrp|73605|2022|PDM|2378.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|AEG 6 (NO REV)|
20|FH_F66427_0_0|SrvcGrp|30502|2022|PCT|0.75|99|0.00|PT/OT/ST|
20|FH_F146654_80524_0|SrvcGrp|104079|2022|PCT|1.25|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F146582_75146_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146773_78414_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131675_71753_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131677_50009_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132270_33414_0|CSTM-ALL|CSTM-00|2020|PCT|0.43|99|0.00|GENERAL ACUTE CARE|
20|FH_F86714_0_0|SrvcGrp|45536|2022|PDM|191.60|99|0.00|SKILLED NURSING|
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|AEG 2 (NO REV)|
20|FH_F149023_44122_0|SrvcGrp|115575|2022|PDM|4501.00|99|0.00|SURGICAL SERVICES|
20|FH_F141278_80218_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143850_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149539_06032_0|SrvcGrp|42972|2022|PDM|68.00|99|0.00|HOME HEALTH AIDE|
20|FH_F114207_35243_0|SrvcGrp|86854|2022|PDM|45.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F36094_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|2219.00|99|0.00|AEG 9 (NO REV)|
20|FH_F98860_96706_0|SrvcGrp|73601|2022|PDM|8584.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F36634_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138216_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150920_19490_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151004_87121_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151029_52241_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F89851_83854_0|SrvcGrp|20968|2022|PDM|27267.00|99|0.00|MS DRG 480 ONLY|
20|FH_F137986_0_0|SrvcGrp|26278|2022|PDM|1436.00|99|0.00|CPT 29881|
20|FH_F32150_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F137748_95231_0|CSTM-ALL|CSTM-00|2020|PDM|2174.00|99|0.00|AEG 2 (NO REV)|
20|FH_F134869_08854_0|SrvcGrp|86648|2022|PCT|1.15|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F148891_44432_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131532_46952_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F101640_32218_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|952.00|99|0.00|AEG 6 (NO REV)|
20|FH_F35904_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113957_73554_0|SrvcGrp|100765|2022|PCT|1.05|99|0.00|PT/OT/ST|
20|FH_F111857_68005_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122263_37072_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F84532_0_0|SrvcGrp|72994|2022|PDM|1412.00|99|0.00|AEG 3|
20|FH_F136493_0_0|SrvcGrp|90707|2022|PDM|56.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F98840_31021_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F36903_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KEITH RATHBOON PT HCPC MOD UE|
20|FH_F112128_63017_0|SrvcGrp|90573|2022|PDM|238.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PDM|1387.50|99|0.00|ASPG VI|
20|FH_F139947_43209_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 3 (NO REV)|
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|4100.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F116806_0_0|SrvcGrp|33972|2022|PDM|1923.16|99|0.00|CPT 21048|
20|FH_F147080_02446_0|SrvcGrp|87441|2022|PDM|504.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F32384_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.50|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_F34918_0_0|SrvcGrp|360|2022|PDM|1547.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F41602_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F111044_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F128197_84123_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F126116_0_0|SrvcGrp|83817|2022|PDM|1125.00|99|0.00|LAPAROSCOPY LYSIS ADHESIONS|
20|FH_F116332_0_0|SrvcGrp|41334|2022|PDM|16646.00|99|0.00|TOTAL KNEE|
20|FH_F126189_89129_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F117574_49022_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F117583_21208_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124714_64081_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F144651_0_0|SrvcGrp|98564|2022|PDM|15000.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F42775_0_0|SrvcGrp|24727|2022|PDM|500.00|99|0.00|ANESTHESIA SERVICES - OBSTETRIC|
20|FH_F150961_89169_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F126781_92630_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F131571_63301_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|PDM|1178.00|99|0.00|AEG 4 (NO REV)|
20|FH_F111266_30339_0|SrvcGrp|14949|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F43076_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F136376_0_0|SrvcGrp|89417|2022|PDM|447.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F150982_0_0|SrvcGrp|104248|2022|PDM|1382.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F142694_0_0|SrvcGrp|87077|2022|PDM|250.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F113545_11201_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|581.00|99|0.00|ASPG 3 SURGICAL EYE CENTER|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|1109.68|99|0.00|AEG 10 (NO REV)|
20|FH_F101441_0_0|SrvcGrp|38015|2022|PDM|7946.00|99|0.00|ARTHRODESIS|
20|FH_F127467_44202_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|79.00|99|0.00|HAPA EPA ASC 14|
20|FH_F124714_64081_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F35280_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|CARDIAC EVENT MONITORING (MOD 53) F/S - TMSS|
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 2 (NO REV)|
20|FH_F98840_31021_0|CSTM-ALL|CSTM-00|2020|PCT|0.37|99|0.00|OP SVCS|
20|FH_F137721_80737_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|971.25|99|0.00|AEG 6 (NO REV)|
20|FH_F149085_0_0|SrvcGrp|22528|2022|PCT|0.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F98820_81401_0|SrvcGrp|73643|2022|PDM|2603.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F141249_17103_0|SrvcGrp|73842|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149399_17013_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146266_0_0|SrvcGrp|71666|2022|PDM|7349.00|99|0.00|CPT 63655|
20|FH_F97184_26101_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F37361_0_0|SrvcGrp|9829|2022|PDM|88.00|99|0.00|PT SVCS|
20|FH_F125081_15218_0|SrvcGrp|47411|2022|PDM|130.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F124322_64131_0|SrvcGrp|29347|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F117737_75001_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F147229_60523_0|SrvcGrp|92501|2022|PDM|183.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F101441_0_0|SrvcGrp|112025|2022|PDM|8105.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F42538_0_0|SrvcGrp|12403|2022|PDM|36.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F39772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F63759_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F38172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112045_90301_0|SrvcGrp|91437|2022|PDM|497.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150442_28451_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 2 (NO REV)|
20|FH_F39211_0_0|SrvcGrp|16746|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F122649_0_0|SrvcGrp|94780|2022|PDM|112.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F124470_90025_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150914_17350_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F34853_0_0|SrvcGrp|88|2022|PDM|6998.00|99|0.00|OP LITHOTRIPSY|
20|FH_F119897_78229_0|SrvcGrp|472|2022|PDM|435.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F122649_0_0|SrvcGrp|97702|2022|PDM|112.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F131471_67203_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146266_0_0|SrvcGrp|92415|2022|PDM|7168.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F35369_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|CV SURGERY|
20|FH_F124420_33442_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117711_73080_0|SrvcGrp|72996|2022|PDM|1575.00|99|0.00|AEG 4|
20|FH_F112754_98057_0|SrvcGrp|23681|2022|PDM|263.87|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F120767_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117762_0_0|SrvcGrp|67064|2022|PDM|4836.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F147339_08837_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 1 (NO REV)|
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 7 (NO REV)|
20|FH_F147226_48154_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143207_72301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143348_16214_0|SrvcGrp|98375|2022|PCT|0.89|99|0.00|AETNA SUBACUTE CARE GENERAL|
20|FH_F143529_84737_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1424.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F84631_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.46|99|0.00|HAPA WPA/NWPA 2016 LAB 100%|
20|FH_F115208_0_0|SrvcGrp|64720|2022|PDM|716.00|99|0.00|CPT 45385|
20|FH_F130937_98002_0|SrvcGrp|86723|2022|PDM|403.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F47952_0_0|SrvcGrp|43958|2022|PDM|73.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F48476_0_0|SrvcGrp|10527|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|1518.00|99|0.00|ASPG VIII|
20|FH_F49054_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD AW)|
20|FH_F136249_01913_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F120747_19129_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F113649_01752_0|SrvcGrp|13929|2022|PCT|1.00|99|0.00|GROWTH HORMONE|
20|FH_F84611_30281_0|SrvcGrp|82721|2022|PDM|7637.00|99|0.00|LITHOTRIPSY ESWL|
20|FH_F84394_17402_0|SrvcGrp|114226|2022|PDM|18888.00|99|0.00|JOINT REPLACEMENT-UPPER EXTREMITY|
20|FH_F84394_17402_0|CSTM-ALL|CSTM-00|2020|PDM|3373.00|99|0.00|AEG 3 (NO REV)|
20|FH_F51276_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|LIPIDS|
20|FH_F66420_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F112794_01040_0|SrvcGrp|94739|2022|PCT|1.00|99|0.00|NOS FLU VACC IM (>=3 YRS)|
20|FH_F112794_01040_0|SrvcGrp|90489|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F37095_17543_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F139951_92870_0|SrvcGrp|46903|2022|PDM|950.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F143347_16001_0|SrvcGrp|3378|2022|PCT|0.54|99|0.00|OBSERVATION SVCS|
20|FH_F143451_50635_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143529_84737_0|SrvcGrp|88621|2022|PDM|60.75|99|0.00|SKILLED NURSING LPN|
20|FH_F71747_0_0|SrvcGrp|42782|2022|PDM|60.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F102920_0_0|SrvcGrp|11306|2022|PCT|0.53|99|0.00|IMPLANTS|
20|FH_F131173_17043_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F151720_03301_0|SrvcGrp|105819|2022|PDM|999.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F151745_27312_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132491_34287_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112670_47150_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP|
20|FH_F112679_85711_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F116609_35801_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113563_70560_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 4 (NO REV)|
20|FH_F84442_79606_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|GENERAL ACUTE CARE|
20|FH_F84611_30281_0|SrvcGrp|82632|2022|PDM|10597.00|99|0.00|ARTHRODESIS|
20|FH_F44438_0_0|SrvcGrp|3077|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F98622_45005_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F33381_0_0|SrvcGrp|18107|2022|PDM|37565.00|99|0.00|MS DRG 236|
20|FH_F133100_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F122953_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F50516_15014_0|SrvcGrp|33414|2022|PDM|125.00|99|0.00|SNF VENTILATOR SUPPORT|
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_F36439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40091_0_0|SrvcGrp|17069|2022|PCT|0.70|99|0.00|ASPG III|
20|FH_F139292_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49954_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F61292_0_0|SrvcGrp|92622|2022|PDM|23775.00|99|0.00|AORTIC & HEART ASSIST PRECEDURE|
20|FH_F143528_0_0|SrvcGrp|88823|2022|PDM|1914.15|99|0.00|REPAIR OF EARDRUM|
20|FH_F75804_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PROFESSIONAL FEES ON UB04|
20|FH_F52854_0_0|SrvcGrp|31575|2022|PDM|10984.00|99|0.00|BRACHYTHERAPY SVCS|
20|FH_F148265_06067_0|SrvcGrp|36591|2022|PDM|8668.00|99|0.00|CPT 63685|
20|FH_F37679_0_0|SrvcGrp|26846|2022|PDM|15.25|99|0.00|IMMUNOTHERAPY (MOD SJ)|
20|FH_F148489_0_0|SrvcGrp|89337|2022|PDM|1040.00|99|0.00|DETOXIFICATION|
20|FH_F145590_45242_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135219_68506_0|SrvcGrp|89404|2022|PDM|22295.52|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F93881_15009_0|SrvcGrp|75485|2022|PDM|1983.00|99|0.00|AEG 4|
20|FH_F32885_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112568_0_0|SrvcGrp|80918|2022|PDM|240.60|99|0.00|RESPITE CARE|
20|FH_F139515_0_0|SrvcGrp|88740|2022|PDM|2122.00|99|0.00|SP BONE ALGRFT|
20|FH_F71002_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F55054_0_0|SrvcGrp|51265|2022|PDM|650.00|99|0.00|CD UNIT REHAB|
20|FH_F124388_0_0|SrvcGrp|77445|2022|PDM|2303.40|99|0.00|REMOVAL OF HYDROCELE|
20|FH_F38357_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|1337.00|99|0.00|AEG 3 (NO REV)|
20|FH_F103100_47150_0|SrvcGrp|72994|2022|PDM|1075.00|99|0.00|AEG 3|
20|FH_F119660_0_0|SrvcGrp|84185|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F125011_74467_0|SrvcGrp|68054|2022|PDM|2730.00|99|0.00|CPT 52332|
20|FH_F135013_46321_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F82695_15014_0|SrvcGrp|471|2022|PDM|462.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148255_72703_0|SrvcGrp|86841|2022|PDM|84.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F39821_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|NEWBORN NURSERY|
20|FH_F82173_72712_0|SrvcGrp|32011|2022|PDM|1777.00|99|0.00|TRAUMA CARE|
20|FH_F149863_68127_0|SrvcGrp|46903|2022|PDM|483.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F38320_0_0|SrvcGrp|474|2022|PDM|285.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE|
20|FH_F138450_0_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F118194_50841_0|SrvcGrp|24752|2022|PDM|35.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F115063_78550_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F126926_32250_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117484_15601_0|SrvcGrp|473|2022|PDM|445.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F137847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|427.00|99|0.00|AEG 1 (NO REV)|
20|FH_F47137_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F37756_0_0|SrvcGrp|19508|2022|PDM|1599.00|99|0.00|MS DRG 792|
20|FH_F42999_0_0|SrvcGrp|10543|2022|PDM|70.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F36366_0_0|CSTM-ALL|CSTM-00|2020|PDM|684.00|99|0.00|CPT 95805 (W/MOD TC)|
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
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_F135235_01830_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F83257_32404_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118249_0_0|SrvcGrp|96104|2022|PCT|1.10|99|0.00|IMPLANTABLE NEUROSTIMULATOR|
20|FH_F148182_23324_0|SrvcGrp|23683|2022|PDM|42.00|99|0.00|SKILLED NURSING RN|
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|1495.00|99|0.00|AEG 7 (NO REV)|
20|FH_F40046_0_0|SrvcGrp|10540|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE|
20|FH_F123945_19111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F81033_0_0|SrvcGrp|78660|2022|PDM|892.50|99|0.00|AETNA PARTIAL REMOVAL OF HYMEN|
20|FH_F86518_20721_0|SrvcGrp|471|2022|PDM|446.25|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|1669.94|99|0.00|2005 ASPG GROUPER IX|
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|2780.00|99|0.00|AEG 7 (NO REV)|
20|FH_F94862_0_0|SrvcGrp|73006|2022|PDM|1000.00|99|0.00|AEG 9|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD UE) - CPD 1963706|
20|FH_F142252_0_0|SrvcGrp|82981|2022|PDM|255.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F113410_0_0|SrvcGrp|84181|2022|PDM|2837.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS|
20|FH_F109645_0_0|SrvcGrp|103386|2022|PDM|42.00|99|0.00|ROUTINE VENIPUNCTURE FINGER/HEEL/EAR (HCFA)|
20|FH_F125516_50574_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F71945_0_0|SrvcGrp|180|2022|PDM|2377.00|99|0.00|INTENSIVE CARE SERVICES|
20|FH_F42019_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY|
20|FH_F32780_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91663_19901_0|SrvcGrp|88621|2022|PDM|120.00|99|0.00|SKILLED NURSING LPN|
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|2369.52|99|0.00|AEG 8 (NO REV)|
20|FH_F37679_0_0|SrvcGrp|32707|2022|PDM|7.50|99|0.00|HOME INFUSION THERAPY  (MOD SJ)|
20|FH_F132779_0_0|SrvcGrp|941|2022|PDM|2758.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F129656_15005_0|SrvcGrp|29023|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F113386_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139515_0_0|SrvcGrp|109957|2022|PDM|15862.00|99|0.00|REVISE CERV ARTIFIC DISC|
20|FH_F82696_16335_0|SrvcGrp|76009|2022|PDM|937.00|99|0.00|EMERGENCY ROOM SVCS LEVEL II|
20|FH_F46094_0_0|SrvcGrp|11073|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F128401_44615_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F125074_18104_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F111826_0_0|SrvcGrp|35669|2022|PDM|6000.00|99|0.00|CPT 63650|
20|FH_F131168_33912_0|CSTM-ALL|CSTM-00|2020|PCT|1.09|99|0.00|HSS ASC|
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|AEG 5  (NO REV)|
20|FH_F36154_0_0|SrvcGrp|38|2022|PDM|2500.00|99|0.00|NORMAL DELIVERY|
20|FH_F128237_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F44177_0_0|SrvcGrp|43|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F118194_50841_0|SrvcGrp|86852|2022|PDM|145.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F119593_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143928_21061_0|SrvcGrp|88621|2022|PDM|126.00|99|0.00|SKILLED NURSING LPN|
20|FH_F122687_0_0|SrvcGrp|88164|2022|PDM|12566.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F90714_0_0|SrvcGrp|73004|2022|PDM|1079.00|99|0.00|AEG 8|
20|FH_F37679_0_0|SrvcGrp|27056|2022|PDM|17.50|99|0.00|HYDRATION THERAPY - 2 LITERS (MOD SH)|
20|FH_F137531_62959_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130013_16509_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F91622_0_0|SrvcGrp|941|2022|PDM|2626.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F112568_0_0|SrvcGrp|95661|2022|PDM|240.60|99|0.00|RESPITE CARE (HCFA)|
20|FH_F126687_72560_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F113410_0_0|SrvcGrp|84307|2022|PDM|2837.00|99|0.00|TENDON REPAIR|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|ASPG VI|
20|FH_F49042_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F137573_33764_0|SrvcGrp|16069|2022|PDM|723.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F71282_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148265_06067_0|SrvcGrp|88491|2022|PDM|7361.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F74342_0_0|SrvcGrp|71619|2022|PCT|1.00|99|0.00|DME|
20|FH_F38088_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F124026_53188_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F149980_0_0|SrvcGrp|115793|2022|PDM|1280.00|99|0.00|REVISE EYE MUSCLE|
20|FH_F110263_0_0|SrvcGrp|36591|2022|PDM|28546.00|99|0.00|CPT 63685|
20|FH_F145550_62034_0|SrvcGrp|95661|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F148255_72703_0|SrvcGrp|86848|2022|PDM|31.50|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F112272_0_0|SrvcGrp|73483|2022|PDM|832.00|99|0.00|AETNA SUBACUTE III|
20|FH_F148221_06477_0|SrvcGrp|66265|2022|PDM|89.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F33002_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89779_0_0|SrvcGrp|11673|2022|PDM|4000.00|99|0.00|CPT 29888|
20|FH_F126784_80809_0|SrvcGrp|46903|2022|PDM|1595.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F148320_02130_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123481_90049_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F91900_0_0|SrvcGrp|82957|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F93534_45690_0|SrvcGrp|3809|2022|PDM|578.00|99|0.00|HOSPICE CARE|
20|FH_F72704_0_0|SrvcGrp|33165|2022|PDM|375.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F126784_80809_0|SrvcGrp|108484|2022|PDM|1595.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F145550_62034_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F130157_84049_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F39857_0_0|SrvcGrp|11336|2022|PCT|0.75|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 9 (NO REV)|
20|FH_F93593_33414_0|SrvcGrp|86722|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F99960_0_0|SrvcGrp|73006|2022|PDM|2097.00|99|0.00|AEG 9|
20|FH_F142073_0_0|SrvcGrp|88162|2022|PDM|5980.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F51358_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F123372_0_0|SrvcGrp|15363|2022|PCT|0.52|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F130681_15701_0|CSTM-ALL|CSTM-00|2020|PCT|3.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|1995.00|99|0.00|AEG 10 (NO REV)|
20|FH_F120906_65542_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148162_29412_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130424_41102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125893_78245_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110925_01104_0|SrvcGrp|46104|2022|PDM|94.56|99|0.00|HOME VISIT - PRENATAL|
20|FH_F107800_34609_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD NU|
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_F128272_60640_0|SrvcGrp|29076|2022|PDM|50.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F128125_68601_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F104520_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F93132_73134_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F86319_16365_0|SrvcGrp|79699|2022|PCT|0.63|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F102302_0_0|SrvcGrp|98584|2022|PDM|25500.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F112755_43215_0|SrvcGrp|104306|2022|PCT|0.15|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F129387_33991_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134876_0_0|SrvcGrp|92502|2022|PDM|1308.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F130850_67401_0|SrvcGrp|29347|2022|PDM|16.00|99|0.00|HOME HEALTH AIDE|
20|FH_F149980_0_0|SrvcGrp|115791|2022|PDM|2954.00|99|0.00|REPAIR RETINAL DETACHMENT|
20|FH_F94261_0_0|SrvcGrp|27968|2022|PDM|26.25|99|0.00|SKILLED NURSING LPN|
20|FH_F111826_0_0|SrvcGrp|73006|2022|PDM|1870.00|99|0.00|AEG 9|
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|784.00|99|0.00|AEG 2 (NO REV)|
20|FH_F125249_0_0|SrvcGrp|89980|2022|PDM|2000.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F143902_41018_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F40026_0_0|SrvcGrp|31756|2022|PDM|975.00|99|0.00|BRAIN INJURY SERVICES|
20|FH_F147941_06023_0|SrvcGrp|14079|2022|PCT|0.94|99|0.00|RADIOACTIVE SEED|
20|FH_F117078_01420_0|SrvcGrp|75545|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|1461.00|99|0.00|AEG 4 (NO REV)|
20|FH_F150699_0_0|SrvcGrp|92407|2022|PDM|28330.00|99|0.00|REMOVAL & REPLACE PULSE GEN 2 LEAD|
20|FH_F140907_28601_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123910_19125_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F44114_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F109180_18015_0|SrvcGrp|73842|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F35344_0_0|SrvcGrp|1259|2022|PDM|1785.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F77903_0_0|SrvcGrp|31074|2022|PDM|319.00|99|0.00|MS DRG 795 ONLY|
20|FH_F135252_21911_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 6 (NO REV)|
20|FH_F148259_99163_0|SrvcGrp|115337|2022|PDM|1300.00|99|0.00|VAGINAL DELIVERY|
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_F33642_0_0|SrvcGrp|13692|2022|PDM|6000.00|99|0.00|OP CARDIAC CATH|
20|FH_F110925_01104_0|SrvcGrp|86151|2022|PDM|4.23|99|0.00|AETNA GLASSIA INJ|
20|FH_F65159_0_0|CSTM-ALL|CSTM-00|2020|PDM|3648.00|99|0.00|ASPG V|
20|FH_F65159_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TEMPLE LABS GLOBAL|
20|FH_F122725_32216_0|SrvcGrp|90490|2022|PDM|104.00|99|0.00|EVALUATION OF SPEECH FLUENCY|
20|FH_F130156_98198_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F86917_61108_0|SrvcGrp|76531|2022|PDM|115.50|99|0.00|HOSPICE IN HOME|
20|FH_F55212_0_0|SrvcGrp|26350|2022|PDM|138.00|99|0.00|CPT 90802|
20|FH_F89372_0_0|SrvcGrp|113456|2022|PDM|15750.00|99|0.00|JOINT REPLACEMENT|
20|FH_F88639_80204_0|SrvcGrp|42625|2022|PCT|0.00|99|0.00|BEHAVIORAL HEALTH GENERAL|
20|FH_F72544_0_0|SrvcGrp|15|2022|PDM|5364.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|2029.00|99|0.00|AEG 3 (NO REV)|
20|FH_F148379_89129_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F148548_37909_0|CSTM-ALL|CSTM-00|2020|PDM|2938.00|99|0.00|AEG 8 (NO REV)|
20|FH_F148554_85016_0|SrvcGrp|108177|2022|PDM|2139.00|99|0.00|TRLUML BALO ANGIOP 1ST VEIN|
20|FH_F144109_63376_0|SrvcGrp|13595|2022|PCT|1.68|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F37567_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|ASPG X|
20|FH_F117072_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS|
20|FH_F128246_0_0|SrvcGrp|92548|2022|PDM|673.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F33788_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F127412_15301_0|SrvcGrp|110735|2022|PDM|1640.00|99|0.00|CORNEAL OR VITREOUS PROCEDURES|
20|FH_F49637_0_0|CSTM-ALL|CSTM-00|2020|PDM|3696.00|99|0.00|OK SURGICAL HOSPITAL CVTY ENHANCED GROUPER 5|
20|FH_F36993_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD 26|
20|FH_F36350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|FALSE LABOR|
20|FH_F55113_0_0|SrvcGrp|23477|2022|PDM|4635.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F37562_0_0|SrvcGrp|14404|2022|PCT|0.60|99|0.00|HOME HEALTH CARE MEDICAL SUPPLIES|
20|FH_F49637_0_0|SrvcGrp|12197|2022|PDM|725.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F115889_0_0|SrvcGrp|72996|2022|PDM|1066.00|99|0.00|AEG 4|
20|FH_F141887_65605_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142897_07018_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120437_85202_0|SrvcGrp|86829|2022|PDM|90.04|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F140790_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F125528_81147_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F135714_01922_0|SrvcGrp|80920|2022|PDM|650.00|99|0.00|HOSPICE SERVICES|
20|FH_F45513_0_0|SrvcGrp|41334|2022|PDM|3400.00|99|0.00|TOTAL KNEE|
20|FH_F132547_39180_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132543_79549_0|SrvcGrp|81779|2022|PCT|1.10|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|2678.00|99|0.00|AEG 9 (NO REV)|
20|FH_F40980_0_0|SrvcGrp|8|2022|PDM|6898.00|99|0.00|BURN INTENSIVE CARE|
20|FH_F144011_60616_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F46192_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F40980_0_0|SrvcGrp|18140|2022|PDM|20625.00|99|0.00|MS DRG 246|
20|FH_F39640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|DME - MOD UE|
20|FH_F97181_33143_0|SrvcGrp|43525|2022|PDM|1000.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC|
20|FH_F81373_64064_0|SrvcGrp|941|2022|PDM|11281.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F110606_0_0|SrvcGrp|82981|2022|PDM|165.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F42992_0_0|SrvcGrp|31134|2022|PDM|950.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F143487_0_0|CSTM-ALL|CSTM-00|2020|PDM|896.00|99|0.00|AEG SURGERY DEFAULT W/O AEG 1|
20|FH_F49637_0_0|SrvcGrp|28623|2022|PCT|0.50|99|0.00|HIGH COST DRUGS|
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_F35498_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|507.92|99|0.00|HAPA WPA-NWPA 2012-13 ASC 303 W/O REV|
20|FH_F118303_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F145964_10993_0|SrvcGrp|87536|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F33866_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|CLINIC VISIT|
20|FH_F39723_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (HCFA)|
20|FH_F111520_81601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INJECTION, PEGFILGRASTIM 6MG|
20|FH_F132737_0_0|CSTM-ALL|CSTM-00|2020|PDM|1957.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133021_00910_0|SrvcGrp|112257|2022|PDM|13000.00|99|0.00|CORONARY ARTERY BYPASS|
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_F117838_12901_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F34361_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144709_48076_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F128325_19904_0|SrvcGrp|87536|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F144011_60616_0|CSTM-ALL|CSTM-00|2020|PDM|1207.00|99|0.00|AEG 10 (NO REV)|
20|FH_F40008_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144728_33541_0|SrvcGrp|22596|2022|PDM|168.45|99|0.00|HOSPICE CARE|
20|FH_F87559_0_0|SrvcGrp|42722|2022|PDM|56.28|99|0.00|SLEEP STUDIES CPT 95806 W/MODIFIER 26|
20|FH_F109562_32827_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117895_28170_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|INTRAOCULAR LENS|
20|FH_F128316_22192_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42117_0_0|SrvcGrp|38007|2022|PDM|700.00|99|0.00|CPT CODE 59425|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU KL"|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKE|
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F128130_10027_0|SrvcGrp|11258|2022|PCT|0.63|99|0.00|DRUGS|
20|FH_F90921_77702_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119076_41001_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F118486_95060_0|SrvcGrp|86748|2022|PCT|1.15|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F117872_33462_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F91255_19401_0|SrvcGrp|90389|2022|PDM|1108.00|99|0.00|ACUTE PSYCH 0-64 YRS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|514.80|99|0.00|HAPA WPA-NWPA 2012-13 ASC 202 W/O REV|
20|FH_F32033_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44019_0_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F123012_27703_0|SrvcGrp|73605|2022|PDM|1650.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123158_0_0|SrvcGrp|87026|2022|PDM|475.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F117289_01028_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F38016_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F110240_0_0|SrvcGrp|91468|2022|PDM|743.00|99|0.00|DIAGNOSTIC COLONOSCOPY (HCFA)|
20|FH_F133477_90247_0|SrvcGrp|111928|2022|PDM|100.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F151049_18702_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|157.55|99|0.00|DELAWARE VALLEY- ASC 115|
20|FH_F72090_0_0|SrvcGrp|17139|2022|PDM|704.00|99|0.00|HOSPICE CARE|
20|FH_F82933_0_0|CSTM-ALL|CSTM-00|2020|PDM|6409.21|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F130844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.37|99|0.00|OP SVCS|
20|FH_F97720_70084_0|SrvcGrp|73643|2022|PDM|1382.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F106822_0_0|SrvcGrp|100263|2022|PDM|57.00|99|0.00|DESTRUCT LESION, 15 OR MORE|
20|FH_F73231_0_0|CSTM-ALL|CSTM-00|2020|PDM|52.73|99|0.00|HOME HEALTH MOD TD|
20|FH_F76583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88456_0_0|SrvcGrp|93186|2022|PDM|629.00|99|0.00|AETNA CYSTOURETHROSCOPY PROCEDURES|
20|FH_F114916_30309_0|SrvcGrp|35668|2022|PDM|2000.00|99|0.00|CPT 29824|
20|FH_F142427_36607_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F104840_32565_0|SrvcGrp|73806|2022|PCT|0.69|99|0.00|AETNA ER|
20|FH_F105591_17601_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|541.00|99|0.00|EXTENDED RECOVERY/OBSERVATION (5-7 HRS)|
20|FH_F119581_0_0|SrvcGrp|108195|2022|PDM|1910.00|99|0.00|LAP INSERT TUNNEL IP CATH|
20|FH_F132627_0_0|SrvcGrp|16750|2022|PDM|220.00|99|0.00|HOME INFUSION THERAPY|
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|SrvcGrp|35669|2022|PDM|7285.50|99|0.00|CPT 63650|
20|FH_F132988_0_0|SrvcGrp|105658|2022|PDM|5954.10|99|0.00|REPAIR FRACTURE OF RADIUS|
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
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|CSTM-ALL|CSTM-00|2020|PDM|558.00|99|0.00|AEG 1 (NO REV)|
20|FH_F50415_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 640|
20|FH_F114002_0_0|SrvcGrp|42974|2022|PDM|65.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F43536_0_0|SrvcGrp|13551|2022|PDM|436.00|99|0.00|NEWBORN NURSERY|
20|FH_F115971_0_0|SrvcGrp|705|2022|PCT|0.33|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F147039_06374_0|SrvcGrp|472|2022|PDM|495.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F62624_0_0|SrvcGrp|33751|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F64819_0_0|SrvcGrp|74542|2022|PCT|1.75|99|0.00|HAPA-NWPA RAD W/SURG|
20|FH_F98380_43055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F135450_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F150226_0_0|SrvcGrp|13681|2022|PDM|172.33|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F55694_0_0|SrvcGrp|3178|2022|PDM|844.00|99|0.00|ACUTE PSYCH|
20|FH_F75662_0_0|CSTM-ALL|CSTM-00|2020|PDM|340.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89273_0_0|SrvcGrp|84121|2022|PDM|275.00|99|0.00|OCULAR IMPLANTS|
20|FH_F124112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F123620_0_0|SrvcGrp|13262|2022|PDM|5.00|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F137248_0_0|SrvcGrp|11043|2022|PDM|1977.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F130039_80228_0|SrvcGrp|89417|2022|PDM|425.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F136667_23603_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136674_16335_0|SrvcGrp|16|2022|PDM|1935.00|99|0.00|ACUTE REHABILITATION|
20|FH_F136708_06443_0|SrvcGrp|73605|2022|PDM|1289.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F138779_62703_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F115048_78520_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F43000_0_0|SrvcGrp|17127|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F43169_0_0|SrvcGrp|12403|2022|PDM|580.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F134687_14226_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136189_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136829_29615_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F136914_64081_0|SrvcGrp|105353|2022|PDM|115.00|99|0.00|AETNA PT/OT|
20|FH_F116393_07002_0|SrvcGrp|111265|2022|PDM|69.93|99|0.00|VIT D 1, 25-DIHYDROXY|
20|FH_F116393_07002_0|SrvcGrp|21978|2022|PDM|52.45|99|0.00|CPT 77003|
20|FH_F147389_81632_0|SrvcGrp|74668|2022|PDM|1750.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147416_19095_0|SrvcGrp|112214|2022|PCT|1.00|99|0.00|OFFICE VISIT (MOD GT/95)|
20|FH_F147519_52627_0|CSTM-ALL|CSTM-00|2020|PDM|2994.12|99|0.00|AEG 2 (NO REV)|
20|FH_F41463_0_0|SrvcGrp|17002|2022|PDM|152.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS|
20|FH_F41489_0_0|SrvcGrp|97|2022|PDM|2800.00|99|0.00|C-SECTION|
20|FH_F41801_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F133494_90023_0|CSTM-ALL|CSTM-00|2020|PDM|2335.00|99|0.00|AEG 3 (NO REV)|
20|FH_F130657_04614_0|SrvcGrp|81779|2022|PCT|4.24|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F132234_97703_0|CSTM-ALL|CSTM-00|2020|PCT|1.37|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F131702_17022_0|SrvcGrp|46104|2022|PDM|117.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F111561_10002_0|SrvcGrp|90644|2022|PDM|22.00|99|0.00|AETNA MEDICATION ASSISTED TRTMT MAINTENANCE INJECTION (HCFA)|
20|FH_F111581_77401_0|SrvcGrp|10107|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F111603_19529_0|SrvcGrp|89417|2022|PDM|330.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F111823_32539_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F111847_70301_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|775.50|99|0.00|AEG 2 (NO REV)|
20|FH_F68823_0_0|SrvcGrp|44303|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN|
20|FH_F71502_0_0|SrvcGrp|474|2022|PDM|300.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F134087_0_0|SrvcGrp|67069|2022|PDM|6011.00|99|0.00|CPT 22634|
20|FH_F72445_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|106% OF ASP DRUGS/IMMUN UPDATE QUARTERLY|
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 6 (NO REV)|
20|FH_F47462_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89580_0_0|SrvcGrp|88478|2022|PCT|0.47|99|0.00|OP HIGH COST DRUGS|
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139750_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122032_32413_0|SrvcGrp|89149|2022|PDM|186.00|99|0.00|OP INTENSIVE|
20|FH_F123191_15012_0|SrvcGrp|73700|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F135572_89106_0|SrvcGrp|24754|2022|PCT|1.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F135979_66451_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F136022_64759_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136110_83330_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F119886_25504_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F100765_73735_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F131228_01826_0|SrvcGrp|10365|2022|PDM|1111.47|99|0.00|CPT CODE 99285|
20|FH_F131374_08009_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131407_07607_0|SrvcGrp|24752|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F116397_33404_0|SrvcGrp|26868|2022|PDM|40.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F41196_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|OP SVCS|
20|FH_F101556_81004_0|SrvcGrp|89498|2022|PCT|1.00|99|0.00|AIR AND GROUND AMBULANCE|
20|FH_F88254_33411_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F128232_70374_0|SrvcGrp|73339|2022|PCT|0.90|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F128883_89521_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F128151_62568_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89563_29407_0|SrvcGrp|85963|2022|PCT|1.00|99|0.00|SELF CARE MANGEMENT TRAINING|
20|FH_F63419_0_0|SrvcGrp|59714|2022|PDM|415.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F65159_0_0|SrvcGrp|10425|2022|PDM|1167.00|99|0.00|NEWBORN NURSERY|
20|FH_F65159_0_0|SrvcGrp|12290|2022|PDM|1364.00|99|0.00|DETOXIFICATION|
20|FH_F65159_0_0|SrvcGrp|53422|2022|PDM|5544.00|99|0.00|CARDIAC CATH|
20|FH_F122725_32216_0|SrvcGrp|102980|2022|PDM|63.00|99|0.00|PSYTX WPT W E/M 30 MIN|
20|FH_F122911_92240_0|SrvcGrp|75419|2022|PDM|725.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F86872_15215_0|SrvcGrp|14944|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F50635_0_0|CSTM-ALL|CSTM-00|2020|PDM|365.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145508_0_0|SrvcGrp|80918|2022|PDM|448.40|99|0.00|RESPITE CARE|
20|FH_F86851_0_0|SrvcGrp|84972|2022|PDM|520.00|99|0.00|CPT 43247|
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|1275.00|99|0.00|AEG 3 (NO REV)|
20|FH_F88639_80204_0|SrvcGrp|114189|2022|PCT|1.70|99|0.00|RADIOLOGY SERVICES|
20|FH_F35308_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S - BDSS|
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62579_0_0|SrvcGrp|10577|2022|PDM|80.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F62974_0_0|SrvcGrp|1168|2022|PDM|32.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F38411_0_0|SrvcGrp|941|2022|PDM|3450.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F130656_04401_0|SrvcGrp|92958|2022|PCT|0.89|99|0.00|SLEEP STUDIES|
20|FH_F149048_77090_0|SrvcGrp|88819|2022|PDM|960.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F131630_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F138289_76273_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40780_0_0|SrvcGrp|170|2022|PDM|530.00|99|0.00|CD (ADOLESCENT) - REHAB|
20|FH_F129509_0_0|SrvcGrp|88162|2022|PDM|3767.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F145604_14850_0|SrvcGrp|86838|2022|PDM|35.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F39378_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F114409_18447_0|SrvcGrp|88621|2022|PDM|108.15|99|0.00|SKILLED NURSING LPN|
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_F134615_38478_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F124369_0_0|SrvcGrp|33982|2022|PDM|7480.00|99|0.00|CPT 28296|
20|FH_F114683_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|1488.00|99|0.00|AEG 5  (NO REV)|
20|FH_F63375_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84552_0_0|SrvcGrp|472|2022|PDM|368.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F145959_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F134167_10032_0|SrvcGrp|46605|2022|PDM|109.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F50657_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F133827_98663_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85995_64111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143289_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F127090_45601_0|SrvcGrp|74802|2022|PCT|1.00|99|0.00|AETNA CPT 36415|
20|FH_F132606_0_0|SrvcGrp|11673|2022|PDM|2500.00|99|0.00|CPT 29888|
20|FH_F40635_0_0|SrvcGrp|97|2022|PDM|3715.00|99|0.00|C-SECTION|
20|FH_F138191_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134169_08831_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F134365_60084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70964_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F125244_0_0|SrvcGrp|110096|2022|PDM|5500.00|99|0.00|LAPAROSCOPY SURGICAL COLPOPE|
20|FH_F129440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OFFICE VISIT W/MOD 25 AND PREV MED (EO25, HPVM)|
20|FH_F83380_0_0|SrvcGrp|44709|2022|PDM|120.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F45212_0_0|SrvcGrp|39622|2022|PDM|35.00|99|0.00|PHYSICIANS SERVICES|
20|FH_F121225_98902_0|SrvcGrp|108698|2022|PDM|400.00|99|0.00|HOSPICE SERVICES|
20|FH_F114941_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|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118469_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F133869_19947_0|SrvcGrp|75419|2022|PDM|412.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F120719_27540_0|SrvcGrp|75943|2022|PDM|6087.00|99|0.00|AETNA INPATIENT SURGICAL CARE|
20|FH_F112082_30720_0|SrvcGrp|21920|2022|PDM|89.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F117206_0_0|SrvcGrp|90600|2022|PDM|1485.00|99|0.00|REMOVAL OF LENS LESION|
20|FH_F112082_30720_0|SrvcGrp|78403|2022|PDM|0.15|99|0.00|AETNA MED RECORD|
20|FH_F87812_33919_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|OCN F/S PRICING: ALL|
20|FH_F130763_0_0|SrvcGrp|90157|2022|PDM|3258.00|99|0.00|AETNA REMOVAL OF TONSILS|
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_F81861_0_0|SrvcGrp|64100|2022|PDM|2388.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 7|
20|FH_F82631_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F127343_0_0|SrvcGrp|103538|2022|PDM|3105.00|99|0.00|ARTHROSCOPY HIP W/ FEMOROPLASTY|
20|FH_F134669_17403_0|SrvcGrp|89417|2022|PDM|370.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F90501_71101_0|SrvcGrp|79099|2022|PDM|550.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F134191_75025_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|TELEMEDICINE SERVICES|
20|FH_F126308_44515_0|SrvcGrp|66265|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F145604_14850_0|SrvcGrp|86851|2022|PDM|70.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F101741_16823_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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_F111341_80501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141651_0_0|SrvcGrp|105245|2022|PDM|186.00|99|0.00|CREATE EARDRUM OPENING|
20|FH_F145587_0_0|SrvcGrp|82113|2022|PDM|1262.70|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F132073_0_0|SrvcGrp|57968|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F87496_17055_0|SrvcGrp|85602|2022|PCT|1.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F128695_50049_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F102960_50613_0|SrvcGrp|12920|2022|PDM|1117.00|99|0.00|EMERGENCY CRITICAL CARE|
20|FH_F101320_26062_0|SrvcGrp|73701|2022|PDM|78.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F148100_22406_0|SrvcGrp|88621|2022|PDM|84.00|99|0.00|SKILLED NURSING LPN|
20|FH_F148079_06512_0|SrvcGrp|29347|2022|PDM|28.84|99|0.00|HOME HEALTH AIDE|
20|FH_F97261_06098_0|SrvcGrp|73602|2022|PDM|3756.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F98161_0_0|SrvcGrp|73002|2022|PDM|1144.00|99|0.00|AEG 7|
20|FH_F32995_0_0|SrvcGrp|9937|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F46832_0_0|SrvcGrp|14371|2022|PDM|20.00|99|0.00|DISPOSABLE DRUG DELIVERY|
20|FH_F123785_62298_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123661_30060_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F58856_0_0|SrvcGrp|21102|2022|PDM|36875.00|99|0.00|MS DRG 219 ONLY|
20|FH_F102623_0_0|SrvcGrp|78065|2022|PDM|180.00|99|0.00|DIALYSIS W/O HEMODIALYSIS W/1 DOC EVAL|
20|FH_F136532_54874_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118152_20151_0|SrvcGrp|86853|2022|PDM|40.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F118169_27514_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F118244_30040_0|SrvcGrp|105361|2022|PCT|1.00|99|0.00|HOSPICE/PHYSICIAN|
20|FH_F120418_43015_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134062_32308_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114092_83350_0|CSTM-ALL|CSTM-00|2020|PDM|4805.00|99|0.00|AEG 8 W/O CATHETER SVCS (NO REV)|
20|FH_F139382_49202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142330_43701_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F142690_31774_0|SrvcGrp|17013|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F139267_30253_0|SrvcGrp|73601|2022|PDM|1925.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F140343_89052_0|SrvcGrp|47183|2022|PDM|80.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F140844_48083_0|SrvcGrp|90340|2022|PDM|96.00|99|0.00|SKILLED NURSING LPN|
20|FH_F140888_75119_0|SrvcGrp|73841|2022|PDM|391.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|2860.00|99|0.00|AEG 8 (NO REV)|
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|1325.00|99|0.00|AEG 6 (NO REV)|
20|FH_F118818_19808_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F92475_15931_0|SrvcGrp|472|2022|PDM|507.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117255_68520_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F129467_45449_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F129477_70403_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F129491_90245_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F117126_12801_0|SrvcGrp|107238|2022|PDM|295.00|99|0.00|PSYCH DIAGNOSTIC EVALUATION|
20|FH_F137815_15501_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|593.00|99|0.00|AEG 3 (NO REV)|
20|FH_F107480_0_0|SrvcGrp|75481|2022|PDM|600.00|99|0.00|AEG 2|
20|FH_F90880_15108_0|SrvcGrp|90479|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F114630_48205_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F132736_0_0|SrvcGrp|40820|2022|PDM|3088.00|99|0.00|ICU/CCU|
20|FH_F51016_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F38411_0_0|SrvcGrp|19458|2022|PCT|0.80|99|0.00|MS DRG 918|
20|FH_F38560_0_0|SrvcGrp|29520|2022|PDM|3750.00|99|0.00|ADULT ANGIO W/CARDIAC CATH|
20|FH_F130721_04769_0|SrvcGrp|73806|2022|PCT|0.89|99|0.00|AETNA ER|
20|FH_F149048_77090_0|SrvcGrp|72602|2022|PDM|960.00|99|0.00|ECT|
20|FH_F134326_14094_0|SrvcGrp|471|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F120670_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F124743_0_0|SrvcGrp|29155|2022|PDM|125.00|99|0.00|HOSPICE SVCS|
20|FH_F133207_0_0|SrvcGrp|54943|2022|PDM|3809.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|1119.00|99|0.00|AEG 8 (NO REV)|
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)|
20|FH_F100782_0_0|SrvcGrp|97678|2022|PDM|1855.79|99|0.00|WINDBER MEDICAL CNTR ASC 707|
20|FH_F118253_89052_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F106964_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|764.00|99|0.00|AEG 10 (NO REV)|
20|FH_F145642_15108_0|SrvcGrp|24750|2022|PDM|30.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F133207_0_0|SrvcGrp|35668|2022|PDM|3527.00|99|0.00|CPT 29824|
20|FH_F110442_98003_0|SrvcGrp|89149|2022|PDM|125.00|99|0.00|OP INTENSIVE|
20|FH_F134249_05060_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F92893_75110_0|SrvcGrp|10527|2022|PDM|55.00|99|0.00|HOSPICE SVCS|
20|FH_F138302_15701_0|SrvcGrp|16750|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F137610_0_0|SrvcGrp|73841|2022|PDM|381.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F79863_0_0|SrvcGrp|77230|2022|PDM|90.00|99|0.00|AETNA HOME INFUSION S9348|
20|FH_F59872_0_0|SrvcGrp|13292|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F146586_71602_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119646_65804_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146124_06112_0|CSTM-ALL|CSTM-00|2020|PDM|9871.00|99|0.00|AEG 7 (NO REV)|
20|FH_F114526_33401_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F145641_06902_0|SrvcGrp|67072|2022|PDM|7880.00|99|0.00|CPT 22845|
20|FH_F141340_66208_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F70883_0_0|SrvcGrp|9874|2022|PDM|47.00|99|0.00|DIETICIAN|
20|FH_F134208_21502_0|SrvcGrp|58636|2022|PDM|3500.00|99|0.00|CPT 62362|
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1230.00|99|0.00|AEG 9 (NO REV)|
20|FH_F125870_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F150165_06032_0|SrvcGrp|115165|2022|PDM|4774.00|99|0.00|MIDDLE EAR PROCEDURES|
20|FH_F134608_18017_0|SrvcGrp|112598|2022|PDM|11.00|99|0.00|HEMATOLOGY ANDCOAGULATION|
20|FH_F119227_01752_0|SrvcGrp|24744|2022|PDM|65.00|99|0.00|PICC LINE INSERTION|
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|1362.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F147962_85008_0|CSTM-ALL|CSTM-00|2020|PDM|530.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F145641_06902_0|SrvcGrp|26278|2022|PDM|5484.00|99|0.00|CPT 29881|
20|FH_F138447_22041_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F85995_64111_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126354_91321_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F50334_0_0|SrvcGrp|45783|2022|PDM|115.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F146039_89511_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F121225_98902_0|SrvcGrp|73601|2022|PDM|6190.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F116653_0_0|SrvcGrp|29428|2022|PDM|424.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT|
20|FH_F132606_0_0|SrvcGrp|77021|2022|PDM|3075.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F132958_79903_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F119864_63141_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ACUTE PSYCH|
20|FH_F83978_66739_0|SrvcGrp|105438|2022|PCT|0.00|99|0.00|CONTRAST AGENT|
20|FH_F49598_0_0|SrvcGrp|16|2022|PDM|796.00|99|0.00|ACUTE REHABILITATION|
20|FH_F133972_27103_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119379_0_0|SrvcGrp|92822|2022|PDM|1428.00|99|0.00|REPAIR OF RUPTURED TENDON|
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 9 (NO REV)|
20|FH_F138024_40509_0|SrvcGrp|90388|2022|PDM|739.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F117300_0_0|SrvcGrp|98496|2022|PDM|7853.00|99|0.00|ARTHRODESIS POSTERIOR ATLAS|
20|FH_F85340_98195_0|CSTM-ALL|CSTM-00|2020|PCT|1.88|99|0.00|AETNA - APC GROUPER E|
20|FH_F114844_17061_0|SrvcGrp|472|2022|PDM|364.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1802.20|99|0.00|AEG 9 (NO REV)|
20|FH_F81656_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F34182_0_0|SrvcGrp|18143|2022|PDM|2729.00|99|0.00|MS DRG 247|
20|FH_F129509_0_0|SrvcGrp|67072|2022|PDM|7175.00|99|0.00|CPT 22845|
20|FH_F118123_67226_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|AEG 3 (NO REV)|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F110507_33462_0|SrvcGrp|87317|2022|PDM|760.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F36753_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS NO MOD|
20|FH_F34182_0_0|SrvcGrp|16137|2022|PCT|0.78|99|0.00|PHARMACY SVCS|
20|FH_F147984_63664_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|338.61|99|0.00|HAPA WPA-NWPA 2012-13 ASC 232 W/O REV|
20|FH_F116806_0_0|SrvcGrp|107073|2022|PDM|1923.16|99|0.00|REPAIR CLEFT LIP|
20|FH_F134610_33426_0|SrvcGrp|75419|2022|PDM|1575.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F132969_84003_0|SrvcGrp|86842|2022|PDM|25.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F96700_02135_0|CSTM-ALL|CSTM-00|2020|PDM|1777.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145641_06902_0|SrvcGrp|93431|2022|PDM|17180.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F114444_19602_0|SrvcGrp|91397|2022|PDM|75.00|99|0.00|AETNA PSYCH PT & FAMILY 45MINS (MOD HO)|
20|FH_F142376_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F85371_63141_0|SrvcGrp|78448|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F107702_01053_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132889_63740_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112827_26452_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109400_80026_0|SrvcGrp|48385|2022|PDM|98.00|99|0.00|SPEECH THERAPY|
20|FH_F122553_92705_0|SrvcGrp|108484|2022|PDM|522.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F85055_0_0|SrvcGrp|73004|2022|PDM|1050.00|99|0.00|AEG 8|
20|FH_F85393_0_0|SrvcGrp|42976|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F105145_75075_0|SrvcGrp|37317|2022|PDM|11434.00|99|0.00|LITHOTRIPSY|
20|FH_F115784_06831_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F80513_0_0|SrvcGrp|22106|2022|PDM|710.00|99|0.00|CAT SCAN|
20|FH_F146702_70508_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131737_15025_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F139248_78070_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F74646_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148926_28803_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117615_30525_0|SrvcGrp|81779|2022|PCT|0.75|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F110805_45227_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|2423.00|99|0.00|AEG 9 (NO REV)|
20|FH_F81312_0_0|CSTM-ALL|CSTM-00|2020|PDM|5883.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F75243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37267_0_0|SrvcGrp|12403|2022|PDM|26.25|99|0.00|CONTINUOUS HOMECARE|
20|FH_F97623_38008_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F138932_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148519_83201_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F117799_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F137902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD TW - CARECENTRIX|
20|FH_F92280_15090_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F151003_33162_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132849_0_0|SrvcGrp|32538|2022|PDM|39864.00|99|0.00|MS DRG 216-221 ONLY|
20|FH_F139167_42240_0|CSTM-ALL|CSTM-00|2020|PDM|804.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F36906_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101441_0_0|SrvcGrp|19991|2022|PDM|8105.00|99|0.00|NERVOUS SYSTEM SERVICES|
20|FH_F113545_11201_0|SrvcGrp|86753|2022|PCT|1.02|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 7 (NO REV)|
20|FH_F138017_73129_0|SrvcGrp|97490|2022|PDM|6196.00|99|0.00|ENDO CHOLANGIOPANCREATOGRAPH|
20|FH_F111035_30535_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F35750_0_0|SrvcGrp|18124|2022|PCT|0.65|99|0.00|MS DRG 004|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F112794_01040_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.44|99|0.00|SALLY BALIN,999182,ASC 402|
20|FH_F120057_0_0|SrvcGrp|35664|2022|PDM|1500.00|99|0.00|VNUS CLOSURE|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|427.00|99|0.00|HAPA EPA ASC 47|
20|FH_F132160_0_0|SrvcGrp|109759|2022|PDM|5738.00|99|0.00|REMOVAL CORNEAL EPITHELIUM|
20|FH_F111266_30339_0|SrvcGrp|86844|2022|PDM|30.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F40346_0_0|SrvcGrp|3950|2022|PCT|0.75|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F104640_21204_0|SrvcGrp|75545|2022|PDM|475.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F147422_84121_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F101280_63111_0|SrvcGrp|43524|2022|PDM|170.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F116753_0_0|SrvcGrp|11306|2022|PCT|0.46|99|0.00|IMPLANTS|
20|FH_F97082_90012_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F47902_0_0|SrvcGrp|29959|2022|PCT|1.00|99|0.00|DME MOD KM|
20|FH_F91940_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F115483_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F74465_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
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_F110821_31513_0|SrvcGrp|42782|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F92431_80033_0|SrvcGrp|48398|2022|PDM|146.00|99|0.00|PT SERVICES|
20|FH_F138452_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F113545_11201_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F117617_80439_0|SrvcGrp|73700|2022|PDM|75.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F122377_91007_0|SrvcGrp|10391|2022|PDM|5185.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F117426_0_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.00|99|0.00|AEG 3 (NO REV)|
20|FH_F36202_0_0|SrvcGrp|72|2022|PDM|1177.00|99|0.00|NEWBORN NURSERY|
20|FH_F119897_78229_0|SrvcGrp|471|2022|PDM|552.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F98880_50158_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112754_98057_0|SrvcGrp|90339|2022|PDM|263.87|99|0.00|SKILLED NURSING RN|
20|FH_F133519_0_0|SrvcGrp|112207|2022|PDM|832.00|99|0.00|DESTROY VULVA LESIONS|
20|FH_F74902_0_0|SrvcGrp|59426|2022|PDM|75.00|99|0.00|PT|
20|FH_F112805_46011_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146859_0_0|SrvcGrp|101108|2022|PDM|1465.00|99|0.00|REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|VERTICAL PLUS MRI MOD UE|
20|FH_F151699_01752_0|SrvcGrp|24747|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F94621_07728_0|SrvcGrp|93280|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA NON-ESRD|
20|FH_F37094_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F74670_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138017_73129_0|SrvcGrp|97492|2022|PDM|6196.00|99|0.00|EGD ENDOSCOPIC STENT PLACE|
20|FH_F147140_89103_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F34882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F90817_0_0|SrvcGrp|33981|2022|PDM|1443.00|99|0.00|CPT 49505, 49585|
20|FH_F115982_0_0|SrvcGrp|92366|2022|PDM|1200.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F82452_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F141270_89103_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F143347_16001_0|SrvcGrp|114040|2022|PDM|100.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT|
20|FH_F93740_0_0|SrvcGrp|91589|2022|PDM|7500.00|99|0.00|INSERTION NEEDLE OR INTRACATHETER ARTERIAL|
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|690.00|99|0.00|AEG 2 (NO REV)|
20|FH_F131093_49690_0|SrvcGrp|33722|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F151755_03303_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F136299_75218_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132431_79606_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F116739_78501_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F113649_01752_0|SrvcGrp|86851|2022|PDM|45.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F98625_08103_0|SrvcGrp|73659|2022|PDM|7006.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F100783_03431_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F100783_03431_0|SrvcGrp|73659|2022|PDM|4796.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PDM|2151.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38476_0_0|SrvcGrp|10542|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F40634_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F54612_07631_0|SrvcGrp|9832|2022|PDM|109.50|99|0.00|ST SVCS|
20|FH_F69245_84047_0|SrvcGrp|73841|2022|PDM|469.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F149959_0_0|SrvcGrp|108484|2022|PDM|750.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F126003_79403_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F96700_02135_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F81698_10457_0|SrvcGrp|16750|2022|PDM|84.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F145593_92660_0|SrvcGrp|74668|2022|PDM|700.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F33175_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F36552_0_0|SrvcGrp|18186|2022|PDM|6685.00|99|0.00|MS DRG 260|
20|FH_F112082_30720_0|SrvcGrp|22389|2022|PDM|23.49|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F130329_64114_0|SrvcGrp|106904|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F72262_0_0|SrvcGrp|10393|2022|PDM|2000.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F84712_0_0|SrvcGrp|82746|2022|PDM|87.00|99|0.00|CULT BACT BLD AEROIC ISOLA|
20|FH_F72768_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|P.R. HORTON IV THERAPY SERVICES|
20|FH_F79624_0_0|SrvcGrp|76321|2022|PCT|0.61|99|0.00|AETNA ALL INPATIENT SERVICES|
20|FH_F85211_0_0|SrvcGrp|83624|2022|PDM|3300.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F101100_50314_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA - APC GROUPER F|
20|FH_F115909_38133_0|SrvcGrp|86753|2022|PCT|1.05|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F73967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146582_75146_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146812_50401_0|SrvcGrp|114807|2022|PDM|7500.00|99|0.00|LENGTHENING OF FEMUR|
20|FH_F127504_22556_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F116055_59804_0|SrvcGrp|106441|2022|PCT|1.80|99|0.00|LABORATORY SERVICES|
20|FH_F131858_38732_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133700_92808_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F111836_12901_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F129130_92562_0|SrvcGrp|20677|2022|PDM|1759.00|99|0.00|HYPERBARIC OXYGEN|
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|1547.00|99|0.00|ASPG IX|
20|FH_F66688_0_0|SrvcGrp|46283|2022|PDM|128.00|99|0.00|URGENT CARE|
20|FH_F109648_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F97721_01053_0|SrvcGrp|73605|2022|PDM|2103.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F97740_01605_0|SrvcGrp|73603|2022|PDM|16711.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F117399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F69785_0_0|SrvcGrp|42973|2022|PDM|83.00|99|0.00|SPEECH  THERAPIST|
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|145.77|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)|
20|FH_F87201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|INFUSION- IV SERVICES (MOD SJ)|
20|FH_F111925_0_0|SrvcGrp|38909|2022|PDM|1602.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1955.00|99|0.00|MASTECTOMY, SUBCUTANEOUS|
20|FH_F119435_0_0|SrvcGrp|77290|2022|PDM|543.00|99|0.00|AETNA REMV TUNNLD CVC W/O SUBQ PORT|
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|601.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132988_0_0|SrvcGrp|38364|2022|PDM|7510.24|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F132988_0_0|SrvcGrp|112148|2022|PDM|3144.78|99|0.00|REPAIR OF DIGIT NERVE|
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_F49487_0_0|SrvcGrp|10518|2022|PDM|35.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT|
20|FH_F55812_0_0|SrvcGrp|10540|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132348_16214_0|SrvcGrp|80920|2022|PDM|446.00|99|0.00|HOSPICE SERVICES|
20|FH_F122194_66104_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146989_80204_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F49943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F124687_64024_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F97083_90670_0|SrvcGrp|73461|2022|PDM|9773.00|99|0.00|AETNA NICU IV|
20|FH_F136671_73110_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F148424_01440_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|COVID-19 INFUSION ADMIN - ELI LILLY|
20|FH_F148424_01440_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136775_64701_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136778_62034_0|SrvcGrp|79797|2022|PDM|15991.00|99|0.00|AETNA PTCA|
20|FH_F136778_62034_0|CSTM-ALL|CSTM-00|2020|PDM|3952.00|99|0.00|AEG 5  (NO REV)|
20|FH_F136796_24016_0|SrvcGrp|59705|2022|PDM|2907.56|99|0.00|SEPTOPLASTY|
20|FH_F112411_28207_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|387.00|99|0.00|WELLPATH PROPIETARY ASC I|
20|FH_F116199_75042_0|SrvcGrp|90388|2022|PDM|796.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F147439_84003_0|SrvcGrp|473|2022|PDM|318.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F147528_72114_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F137906_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F113154_70359_0|SrvcGrp|19991|2022|PDM|6500.00|99|0.00|NERVOUS SYSTEM SERVICES|
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 3 (NO REV)|
20|FH_F48836_0_0|SrvcGrp|29021|2022|PCT|1.00|99|0.00|DME AND SUPPLIES|
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|WILLS COMM SURG SVC ASC 8|
20|FH_F54552_0_0|SrvcGrp|22592|2022|PDM|80.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F138936_01040_0|SrvcGrp|112225|2022|PCT|1.00|99|0.00|COVID-19 SPECIMEN COLLECTION|
20|FH_F91641_0_0|SrvcGrp|111992|2022|PDM|1560.60|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F149242_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|72.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 146 W/O REV|
20|FH_F132163_17601_0|SrvcGrp|91392|2022|PDM|210.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AF)|
20|FH_F133119_46545_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AETNA OP LABORATORY|
20|FH_F97501_31501_0|SrvcGrp|73461|2022|PDM|10199.00|99|0.00|AETNA NICU IV|
20|FH_F36492_0_0|SrvcGrp|72998|2022|PDM|1229.00|99|0.00|AEG 5|
20|FH_F33498_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE|
20|FH_F49895_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F49029_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|1480.00|99|0.00|ASPG VIII|
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.21|99|0.00|ASPG I|
20|FH_F125138_63663_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES|
20|FH_F31579_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125118_99201_0|SrvcGrp|87131|2022|PDM|457.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F34496_0_0|SrvcGrp|10101|2022|PDM|3580.50|99|0.00|DRG 373 ONLY VAGINAL DELIVER W/O COMP DX|
20|FH_F31433_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148265_06067_0|SrvcGrp|76604|2022|PDM|5448.00|99|0.00|CPT 25447|
20|FH_F39278_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41776_0_0|CSTM-ALL|CSTM-00|2020|PDM|3859.00|99|0.00|ASPG VII|
20|FH_F120285_32960_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140910_53005_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F63276_0_0|SrvcGrp|42828|2022|PDM|140.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F72850_0_0|SrvcGrp|3029|2022|PDM|789.00|99|0.00|NEWBORN NURSERY|
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|1830.00|99|0.00|AEG 9 (NO REV)|
20|FH_F127550_43026_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F98920_46526_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F131577_89148_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135016_37203_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F39270_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|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_F126523_0_0|SrvcGrp|108935|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44774_0_0|SrvcGrp|32405|2022|PCT|1.20|99|0.00|OCN F/S PRICING: MODIFIER 26 (RADIOLOGY)|
20|FH_F131190_21042_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120001_0_0|SrvcGrp|87537|2022|PDM|408.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F131577_89148_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 8 (NO REV)|
20|FH_F123957_84321_0|SrvcGrp|108484|2022|PDM|500.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F115109_20032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F94662_0_0|SrvcGrp|29353|2022|PDM|199.00|99|0.00|HOSPICE SVCS|
20|FH_F125025_67401_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F39945_0_0|SrvcGrp|439|2022|PDM|1700.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|1543.00|99|0.00|AEG 5  (NO REV)|
20|FH_F141607_27021_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F106020_0_0|SrvcGrp|16732|2022|PDM|2521.00|99|0.00|HYSTEROSCOPY ABLATION|
20|FH_F141410_13045_0|SrvcGrp|73500|2022|PDM|623.00|99|0.00|AETNA ER LEVEL I|
20|FH_F124763_61821_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125074_18104_0|SrvcGrp|73701|2022|PDM|27.31|99|0.00|AETNA - SKILLED NURSING|
20|FH_F40026_0_0|SrvcGrp|31753|2022|PDM|975.00|99|0.00|SPINAL CORD CARE|
20|FH_F139515_0_0|SrvcGrp|64517|2022|PDM|2724.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F139515_0_0|SrvcGrp|102899|2022|PDM|1648.00|99|0.00|PARTIAL REMOVAL OF VULVA|
20|FH_F120352_52556_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F129669_57701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F93384_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F145748_30084_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40358_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F132125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130747_0_0|SrvcGrp|74039|2022|PDM|8843.00|99|0.00|LAMINECTOMY|
20|FH_F131236_84041_0|SrvcGrp|94781|2022|PDM|93.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F66220_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F123915_0_0|SrvcGrp|63297|2022|PDM|198.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F102500_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F38473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72183_0_0|SrvcGrp|30623|2022|PDM|3400.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F132768_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121523_33406_0|SrvcGrp|73605|2022|PDM|1248.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F120322_60016_0|SrvcGrp|471|2022|PDM|993.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F112374_0_0|SrvcGrp|10391|2022|PDM|1456.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F39740_0_0|SrvcGrp|20902|2022|PDM|10964.00|99|0.00|MS DRG 249 ONLY|
20|FH_F125625_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F39476_0_0|CSTM-ALL|CSTM-00|2020|PDM|1361.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F128191_28642_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F86456_79761_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F85295_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F124018_75067_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F148221_06477_0|SrvcGrp|95221|2022|PDM|168.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F89475_71202_0|SrvcGrp|19961|2022|PDM|41564.00|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA|
20|FH_F87254_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40304_0_0|SrvcGrp|19615|2022|PDM|375.00|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)|
20|FH_F110142_39056_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136756_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83451_0_0|SrvcGrp|81567|2022|PDM|1625.00|99|0.00|SINUS ENDOSCOPY|
20|FH_F135350_60014_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F135432_16335_0|SrvcGrp|23683|2022|PDM|30.00|99|0.00|SKILLED NURSING RN|
20|FH_F135493_07514_0|SrvcGrp|73842|2022|PDM|186.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F135608_19348_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F129802_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F91766_25401_0|SrvcGrp|48385|2022|PDM|120.75|99|0.00|SPEECH THERAPY|
20|FH_F135972_18509_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116431_76104_0|SrvcGrp|90726|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F116431_76104_0|SrvcGrp|15386|2022|PDM|43.71|99|0.00|CLINIC VISIT|
20|FH_F121763_07202_0|SrvcGrp|79786|2022|PDM|5425.00|99|0.00|SLEEP STUDIES|
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|1487.00|99|0.00|AEG 8 (NO REV)|
20|FH_F69202_0_0|SrvcGrp|31782|2022|PDM|9300.00|99|0.00|MSDRG 258-262 ONLY PACEMAKER REVISION OR REPLACEMENT|
20|FH_F87557_33309_0|SrvcGrp|86849|2022|PDM|30.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F87557_33309_0|SrvcGrp|16750|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129485_34741_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F102228_08846_0|SrvcGrp|89417|2022|PDM|321.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F101852_78758_0|SrvcGrp|89337|2022|PDM|923.00|99|0.00|DETOXIFICATION|
20|FH_F148100_22406_0|SrvcGrp|46605|2022|PDM|84.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F148079_06512_0|SrvcGrp|48385|2022|PDM|103.00|99|0.00|SPEECH THERAPY|
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2115.00|99|0.00|AEG 5  (NO REV)|
20|FH_F102623_0_0|SrvcGrp|94501|2022|PDM|180.00|99|0.00|PERITONEAL/CAPD/CCPD|
20|FH_F136314_19013_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F136372_19046_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F93178_73448_0|SrvcGrp|79699|2022|PCT|0.71|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F134011_84102_0|SrvcGrp|86834|2022|PDM|10.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F134126_11554_0|SrvcGrp|31704|2022|PDM|3960.00|99|0.00|MS DRG 790 ONLY|
20|FH_F134150_01801_0|SrvcGrp|109613|2022|PDM|345.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION (>=18 YRS)|
20|FH_F137036_60504_0|SrvcGrp|88621|2022|PDM|75.00|99|0.00|SKILLED NURSING LPN|
20|FH_F137147_75006_0|SrvcGrp|73804|2022|PDM|18805.00|99|0.00|AETNA MSDRG 620 ONLY|
20|FH_F142473_07663_0|SrvcGrp|29346|2022|PDM|43.86|99|0.00|SKILLED NURSING- LPN|
20|FH_F142333_28387_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142330_43701_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F142608_02842_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67306_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F138571_65807_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138584_30912_0|SrvcGrp|113393|2022|PDM|1050.00|99|0.00|FACE BONE GRAFT|
20|FH_F125053_0_0|SrvcGrp|72990|2022|PDM|360.00|99|0.00|AEG 1|
20|FH_F137310_0_0|SrvcGrp|113310|2022|PDM|165.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F140727_16046_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140833_19454_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F80284_16354_0|SrvcGrp|64101|2022|PDM|1213.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 8|
20|FH_F149524_28806_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149600_18901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119023_91406_0|SrvcGrp|86829|2022|PDM|35.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F118932_07652_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F38332_0_0|SrvcGrp|18172|2022|PDM|12064.00|99|0.00|MS DRG 256|
20|FH_F41481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117270_32073_0|SrvcGrp|89269|2022|PCT|1.08|99|0.00|PSYTX PT/FAMILY 45 MINUTES|
20|FH_F147922_10031_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129448_43235_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F129524_48104_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|IP/OP MBPR SERVICES|
20|FH_F137270_82901_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F137333_51012_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F101161_0_0|SrvcGrp|98000|2022|PDM|190.00|99|0.00|HOSPITAL OBSERVATION|
20|FH_F137905_91364_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F137937_20032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F107926_0_0|SrvcGrp|54086|2022|PDM|1875.00|99|0.00|VITRECTOMY, MECHANICAL, PARS PLANA APPROACH|
20|FH_F111593_0_0|SrvcGrp|87054|2022|PDM|3025.00|99|0.00|CYSTOSCOPY CHEMODENERVATION|
20|FH_F112526_0_0|SrvcGrp|90707|2022|PDM|105.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F90876_18447_0|SrvcGrp|89781|2022|PDM|110.25|99|0.00|RESPITE CARE (HCFA)|
20|FH_F124893_40311_0|SrvcGrp|23683|2022|PDM|44.00|99|0.00|SKILLED NURSING RN|
20|FH_F42952_0_0|SrvcGrp|31931|2022|PDM|1156.00|99|0.00|SKILLED NURSING CARE|
20|FH_F95880_02726_0|SrvcGrp|94741|2022|PDM|56.65|99|0.00|FLULAVAL VACC IM (>=3 YRS)|
20|FH_F98624_15701_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F100780_24153_0|SrvcGrp|73559|2022|PDM|7987.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F100681_73104_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F48772_66044_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F106980_0_0|SrvcGrp|72994|2022|PDM|800.00|99|0.00|AEG 3|
20|FH_F72544_0_0|SrvcGrp|11336|2022|PCT|0.70|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F117485_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F132544_0_0|SrvcGrp|96350|2022|PDM|7850.00|99|0.00|SHOULDER JOINT|
20|FH_F119491_19904_0|SrvcGrp|88620|2022|PDM|84.00|99|0.00|SKILLED NURSING RN|
20|FH_F148542_43517_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148554_85016_0|SrvcGrp|115456|2022|PDM|1250.00|99|0.00|REMOVE PULSE GENERATOR|
20|FH_F37640_0_0|CSTM-ALL|CSTM-00|2020|PDM|395.00|99|0.00|ASPG I|
20|FH_F112905_62088_0|SrvcGrp|90356|2022|PCT|0.81|99|0.00|OP DIALYSIS|
20|FH_F149980_0_0|SrvcGrp|115792|2022|PDM|1921.00|99|0.00|INCISION OF EYE|
20|FH_F38377_0_0|SrvcGrp|15075|2022|PDM|80.00|99|0.00|PICC LINE INSERTION NURSING|
20|FH_F120349_38774_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F139515_0_0|SrvcGrp|67068|2022|PDM|16995.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F91663_19901_0|SrvcGrp|73742|2022|PCT|1.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F130747_0_0|SrvcGrp|88487|2022|PDM|4162.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F130247_35045_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F56276_0_0|SrvcGrp|52951|2022|PDM|106.00|99|0.00|PSYCHIATRIC CPT 90846|
20|FH_F92618_0_0|SrvcGrp|76094|2022|PDM|136.51|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F115739_78722_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F145537_02061_0|SrvcGrp|114167|2022|PDM|398.00|99|0.00|PARTIAL HOSPITAL (0-17 YRS)|
20|FH_F129969_33908_0|SrvcGrp|86723|2022|PDM|320.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|586.00|99|0.00|ASPG I|
20|FH_F148265_06067_0|SrvcGrp|83642|2022|PDM|3324.00|99|0.00|CPT 29883|
20|FH_F130204_40807_0|SrvcGrp|86722|2022|PDM|184.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F129115_85716_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F142227_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.40|99|0.00|OP SVCS|
20|FH_F39740_0_0|SrvcGrp|21359|2022|PDM|13014.00|99|0.00|MS DRG 460 ONLY|
20|FH_F56136_0_0|SrvcGrp|31101|2022|PDM|635.00|99|0.00|NORMAL NEWBORN VIA NORMAL DELIVERY|
20|FH_F141527_36830_0|SrvcGrp|22592|2022|PDM|23.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F38961_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90362_0_0|SrvcGrp|73006|2022|PDM|1515.00|99|0.00|AEG 9|
20|FH_F41776_0_0|CSTM-ALL|CSTM-00|2020|PDM|2012.00|99|0.00|ASPG III|
20|FH_F125249_0_0|SrvcGrp|105253|2022|PDM|1400.00|99|0.00|REMOVAL/TRANSPLANT TENDON|
20|FH_F125249_0_0|SrvcGrp|98003|2022|PDM|1200.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|143.85|99|0.00|SLEEP STUDY CPT 95800|
20|FH_F46612_0_0|SrvcGrp|40582|2022|PCT|0.80|99|0.00|HOSPICE SVCS|
20|FH_F82753_18840_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|920.00|99|0.00|WELLPATH ASC III|
20|FH_F82955_34266_0|SrvcGrp|72980|2022|PCT|0.66|99|0.00|AETNA LABORATORY|
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|105658|2022|PDM|5284.00|99|0.00|REPAIR FRACTURE OF RADIUS|
20|FH_F135771_0_0|SrvcGrp|14494|2022|PDM|37.74|99|0.00|CONTINUOUS HOMECARE|
20|FH_F135764_0_0|SrvcGrp|93924|2022|PDM|1262.00|99|0.00|AETNA MEDICAL SERVICES|
20|FH_F137067_0_0|SrvcGrp|88491|2022|PDM|5250.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F39479_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F129653_0_0|SrvcGrp|73008|2022|PDM|2047.00|99|0.00|AEG 10|
20|FH_F141592_80233_0|SrvcGrp|23279|2022|PDM|515.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F93880_95476_0|SrvcGrp|72994|2022|PDM|4578.00|99|0.00|AEG 3|
20|FH_F116291_11570_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F120352_52556_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F50873_0_0|SrvcGrp|42830|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F109581_0_0|SrvcGrp|75487|2022|PDM|822.00|99|0.00|AEG 5|
20|FH_F39917_0_0|SrvcGrp|13640|2022|PDM|120.00|99|0.00|CPT 99202|
20|FH_F125249_0_0|SrvcGrp|100066|2022|PDM|1400.00|99|0.00|REPAIR RADIUS FRACTURE|
20|FH_F135236_02840_0|CSTM-ALL|CSTM-00|2020|PDM|2731.50|99|0.00|INPATIENT PSYCHIATRIC CARE <18 YRS|
20|FH_F72784_0_0|SrvcGrp|70134|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F148266_45419_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F93136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|84939|2022|PDM|26425.00|99|0.00|SHOULDER JOINT|
20|FH_F93332_0_0|SrvcGrp|93063|2022|PDM|7416.00|99|0.00|LUMBAR ARTIF DISKECTOMY|
20|FH_F78343_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F115121_32250_0|SrvcGrp|73842|2022|PDM|308.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124738_0_0|SrvcGrp|73002|2022|PDM|980.00|99|0.00|AEG 7|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|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_F122687_0_0|SrvcGrp|35667|2022|PDM|1351.00|99|0.00|CPT 20680|
20|FH_F131517_19152_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130452_48801_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120349_38774_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F123282_03222_0|SrvcGrp|48398|2022|PDM|144.00|99|0.00|PT SERVICES|
20|FH_F114916_30309_0|SrvcGrp|26002|2022|PDM|240.00|99|0.00|C-ARM AND LASER|
20|FH_F89563_29407_0|SrvcGrp|94744|2022|PCT|1.00|99|0.00|NOS FLU VACC IM (>=3 YRS)|
20|FH_F140762_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|GENERAL ACUTE CARE|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F119760_0_0|SrvcGrp|97506|2022|PDM|105.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F145758_20745_0|SrvcGrp|88739|2022|PDM|2040.00|99|0.00|IMPLANT SPINAL CANAL|
20|FH_F50873_0_0|SrvcGrp|42827|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F140995_33040_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139515_0_0|SrvcGrp|92409|2022|PDM|4917.00|99|0.00|PERQ CERVICOTHORACIC INJECT|
20|FH_F82931_18847_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS|
20|FH_F128136_48025_0|SrvcGrp|83857|2022|PDM|550.00|99|0.00|IP HOSPICE SVCS|
20|FH_F64140_0_0|SrvcGrp|62476|2022|PCT|1.10|99|0.00|CARVE OUT CVTY CORP CODES|
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_F62917_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62579_0_0|SrvcGrp|50162|2022|PDM|61.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 12 HRS|
20|FH_F62579_0_0|SrvcGrp|17016|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F78682_0_0|CSTM-ALL|CSTM-00|2020|PDM|48.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F102822_84065_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39180_0_0|SrvcGrp|30626|2022|PCT|0.70|99|0.00|DME|
20|FH_F43018_0_0|SrvcGrp|13709|2022|PDM|3010.00|99|0.00|ACUTE IP MEDICAL SVCS|
20|FH_F127432_18015_0|SrvcGrp|109029|2022|PCT|0.38|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F146229_60031_0|SrvcGrp|109330|2022|PCT|1.10|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F119100_66086_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F117559_08619_0|SrvcGrp|114533|2022|PDM|40.00|99|0.00|ADM SARS COV2 100MCG/0.5 ML (3RD)|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|WV HH S CODES MOD SH|
20|FH_F125050_33765_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|3950|2022|PDM|5621.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F87577_80016_0|SrvcGrp|73806|2022|PDM|16936.00|99|0.00|AETNA ER|
20|FH_F145941_64119_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F92833_0_0|SrvcGrp|26278|2022|PDM|2215.00|99|0.00|CPT 29881|
20|FH_F128438_87410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117009_0_0|SrvcGrp|56453|2022|PDM|2348.00|99|0.00|VITRECTOMY|
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145988_06105_0|SrvcGrp|114152|2022|PDM|25891.00|99|0.00|OSSEOINTEGRATED IMPLANT|
20|FH_F87334_16507_0|SrvcGrp|48385|2022|PDM|104.00|99|0.00|SPEECH THERAPY|
20|FH_F69063_0_0|SrvcGrp|43958|2022|PDM|73.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F131282_0_0|SrvcGrp|91759|2022|PCT|1.00|99|0.00|OCULAR IMPLANT|
20|FH_F118468_21502_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F87295_40351_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F149781_37404_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124854_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F117385_48091_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|AETNA ADAPTIVE BEHAVIOR TREATMNT MODIFIED 30 MINS|
20|FH_F101840_76054_0|SrvcGrp|97459|2022|PCT|1.50|99|0.00|DRUGS/NON-PRESCRIPTION|
20|FH_F145988_06105_0|SrvcGrp|114478|2022|PDM|12318.00|99|0.00|CONDITION OF PREGNANCY|
20|FH_F111551_32825_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40728_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|ASPG X|
20|FH_F133490_90650_0|CSTM-ALL|CSTM-00|2020|PDM|6439.00|99|0.00|AEG 9 (NO REV)|
20|FH_F125255_34769_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F44135_0_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150023_75002_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132591_75146_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F141830_92592_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113792_0_0|SrvcGrp|88621|2022|PDM|70.00|99|0.00|SKILLED NURSING LPN|
20|FH_F142775_72801_0|SrvcGrp|74694|2022|PDM|626.00|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F118542_60188_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F37569_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F107140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F34706_0_0|SrvcGrp|2975|2022|PDM|6978.00|99|0.00|DRG 500 BACK & NECK PROCEDURE EXCEPT SPINAL FUSION W/O CC|
20|FH_F146211_68144_0|SrvcGrp|111588|2022|PDM|6480.00|99|0.00|REPAIR OF THIGH MUSCLE|
20|FH_F142994_54313_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 10 (NO REV)|
20|FH_F132991_84790_0|SrvcGrp|88620|2022|PDM|85.50|99|0.00|SKILLED NURSING RN|
20|FH_F118373_21205_0|SrvcGrp|3477|2022|PCT|0.49|99|0.00|CLINIC VISIT|
20|FH_F67639_0_0|SrvcGrp|56463|2022|PDM|1735.00|99|0.00|CPT 53852|
20|FH_F148599_98034_0|SrvcGrp|31707|2022|PDM|4046.00|99|0.00|MS DRG 793 ONLY|
20|FH_F134493_48708_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|280.61|99|0.00|ASPG 111|
20|FH_F36756_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD 53|
20|FH_F51438_0_0|SrvcGrp|42824|2022|PDM|120.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|5500.00|99|0.00|AEG 7 (NO REV)|
20|FH_F43330_0_0|SrvcGrp|26694|2022|PDM|80.00|99|0.00|INITIAL SPECIALTY NURSING S9123 MOD TG|
20|FH_F145988_06105_0|SrvcGrp|114018|2022|PCT|1.47|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F136751_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F99720_0_0|SrvcGrp|33984|2022|PDM|1638.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F38508_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F125541_07825_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F146211_68144_0|SrvcGrp|89404|2022|PDM|14687.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F146227_66210_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122245_0_0|SrvcGrp|73000|2022|PDM|975.00|99|0.00|AEG 6|
20|FH_F42168_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|GENERAL ACUTE CARE|
20|FH_F35173_0_0|SrvcGrp|43|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F36576_0_0|SrvcGrp|22912|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F100665_07939_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F150531_16148_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F107140_0_0|SrvcGrp|72079|2022|PCT|1.00|99|0.00|VACCINES AND ADMINISTRATION|
20|FH_F120437_85202_0|SrvcGrp|48385|2022|PDM|182.34|99|0.00|SPEECH THERAPY|
20|FH_F34831_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120032_0_0|SrvcGrp|85000|2022|PDM|580.00|99|0.00|CPT 45384|
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|1016.00|99|0.00|AEG 5  (NO REV)|
20|FH_F62799_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89112_16509_0|SrvcGrp|64103|2022|PDM|2300.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 6|
20|FH_F119530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F103821_0_0|SrvcGrp|472|2022|PDM|703.31|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130656_04401_0|SrvcGrp|112064|2022|PCT|0.89|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F130841_49315_0|SrvcGrp|93098|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F31032_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F31064_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|OP SVCS|
20|FH_F125115_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F121687_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146540_78013_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138951_41101_0|SrvcGrp|86851|2022|PDM|40.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F133753_84015_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133769_20783_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133912_20852_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132889_63740_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F52713_0_0|SrvcGrp|31038|2022|PDM|58494.00|99|0.00|MS DRG 233-234 ONLY|
20|FH_F150165_06032_0|SrvcGrp|112205|2022|PDM|1178.00|99|0.00|BIOPSY OF PENIS|
20|FH_F145641_06902_0|SrvcGrp|67074|2022|PDM|5814.00|99|0.00|AC SURGERY|
20|FH_F71843_0_0|SrvcGrp|59159|2022|PCT|0.50|99|0.00|OP SURGERY|
20|FH_F145642_15108_0|SrvcGrp|86830|2022|PDM|30.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F77082_0_0|SrvcGrp|3165|2022|PCT|0.75|99|0.00|EMERGENCY ROOM|
20|FH_F109266_33319_0|SrvcGrp|86648|2022|PCT|1.25|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F80172_0_0|SrvcGrp|22389|2022|PCT|0.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F125870_0_0|SrvcGrp|95819|2022|PDM|2445.00|99|0.00|GONIOTOMY|
20|FH_F125870_0_0|SrvcGrp|73000|2022|PDM|1295.00|99|0.00|AEG 6|
20|FH_F66900_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|1850.00|99|0.00|AEG 8 (NO REV)|
20|FH_F134972_84117_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125244_0_0|SrvcGrp|110095|2022|PDM|2500.00|99|0.00|REPAIR PARAVAG DEFECT|
20|FH_F149279_17022_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149121_01520_0|SrvcGrp|115386|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F109577_0_0|SrvcGrp|95661|2022|PDM|195.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F83978_66739_0|SrvcGrp|75506|2022|PCT|1.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F114527_39047_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
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_F110506_98901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150124_44107_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125513_40071_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37698_0_0|SrvcGrp|27169|2022|PCT|0.90|99|0.00|IMPLANTS/PROSHETICS/ORTHOTICS|
20|FH_F135670_01749_0|SrvcGrp|86835|2022|PDM|12.50|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F150165_06032_0|SrvcGrp|77582|2022|PDM|4017.00|99|0.00|CPT 31255|
20|FH_F150199_62226_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F142376_0_0|SrvcGrp|107374|2022|PDM|9383.00|99|0.00|AETNA ARTHRODESIS INTERSPC|
20|FH_F117300_0_0|SrvcGrp|98495|2022|PDM|7853.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F146103_63851_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129509_0_0|SrvcGrp|92415|2022|PDM|3767.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F143560_03079_0|SrvcGrp|115126|2022|PDM|484.60|99|0.00|CT SCAN WITH AND  W/O CONTRAST|
20|FH_F133585_0_0|SrvcGrp|107881|2022|PDM|298.00|99|0.00|STENT PLMT CTR DIALYSIS SEG|
20|FH_F113453_80020_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150309_33323_0|SrvcGrp|74668|2022|PDM|281.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 6 (NO REV)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|589.35|99|0.00|HAPA WPA-NWPA 2012-13 ASC 213 W/O REV|
20|FH_F146590_77449_0|SrvcGrp|114262|2022|PDM|110.00|99|0.00|HHC RN E&M PLAN SVS|
20|FH_F120930_0_0|SrvcGrp|96559|2022|PDM|3000.00|99|0.00|TOTAL HYSTERCECTOMY|
20|FH_F135670_01749_0|SrvcGrp|86839|2022|PDM|30.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F118265_46268_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F42646_0_0|SrvcGrp|3029|2022|PDM|220.00|99|0.00|NEWBORN NURSERY|
20|FH_F121225_98902_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131100_0_0|SrvcGrp|111738|2022|PDM|1500.00|99|0.00|REMOVE FEMUR LESION/BURSA|
20|FH_F146461_75428_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F34154_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F133935_19958_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130329_64114_0|SrvcGrp|65621|2022|PDM|42.00|99|0.00|RN NURSING|
20|FH_F123850_0_0|SrvcGrp|80918|2022|PDM|706.00|99|0.00|RESPITE CARE|
20|FH_F127908_60640_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F88744_71103_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111732_33771_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F120930_0_0|SrvcGrp|94883|2022|PDM|2200.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|334.46|99|0.00|HAPA WPA-NWPA 2012-13 ASC 16 W/O REV|
20|FH_F126484_30078_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F31714_0_0|SrvcGrp|11612|2022|PDM|25200.00|99|0.00|DRG 546 SPINAL FUSIONS EXPT CERV W/CVTR SPINE OR MLGNCY|
20|FH_F112082_30720_0|SrvcGrp|65621|2022|PDM|91.67|99|0.00|RN NURSING|
20|FH_F149340_19136_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F85894_0_0|SrvcGrp|17079|2022|PDM|2443.00|99|0.00|ASPG VIII|
20|FH_F86375_0_0|SrvcGrp|65720|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F105143_26062_0|SrvcGrp|75505|2022|PCT|0.70|99|0.00|CARDIAC STUDIES|
20|FH_F115893_08002_0|SrvcGrp|73605|2022|PDM|1400.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F66427_0_0|SrvcGrp|45683|2022|PCT|0.80|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F75842_0_0|SrvcGrp|46505|2022|PCT|0.49|99|0.00|MS DRG 215-241,245, 250-265 CARDIAC /CCU SURG OTLR|
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|1269.00|99|0.00|AEG 8 (NO REV)|
20|FH_F78603_0_0|SrvcGrp|20914|2022|PDM|69894.10|99|0.00|MS DRG 233 ONLY|
20|FH_F130681_15701_0|CSTM-ALL|CSTM-00|2020|PCT|3.00|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F38320_0_0|SrvcGrp|28552|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F123473_65109_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35476_0_0|SrvcGrp|18253|2022|PDM|11000.00|99|0.00|MS DRG 287|
20|FH_F130061_84097_0|SrvcGrp|87317|2022|PDM|1100.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F118050_77565_0|SrvcGrp|86722|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F110263_0_0|SrvcGrp|115580|2022|PDM|7354.00|99|0.00|LITHOTRIPSY ESWL (HCFA)|
20|FH_F109980_0_0|SrvcGrp|30089|2022|PDM|375.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F83352_06114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F60112_0_0|SrvcGrp|43431|2022|PDM|26.75|99|0.00|LPN|
20|FH_F62333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F38560_0_0|SrvcGrp|413|2022|PCT|0.70|99|0.00|TRANSPLANT SVCS|
20|FH_F50462_0_0|SrvcGrp|45948|2022|PDM|140.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F130908_32708_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F112726_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS|
20|FH_F31164_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F134988_61834_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144808_0_0|SrvcGrp|67279|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY|
20|FH_F138050_52301_0|SrvcGrp|73500|2022|PDM|507.00|99|0.00|AETNA ER LEVEL I|
20|FH_F118123_67226_0|SrvcGrp|26869|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.00|99|0.00|ASPG IV|
20|FH_F150304_16146_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133753_84015_0|SrvcGrp|472|2022|PDM|377.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F113465_28204_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121225_98902_0|SrvcGrp|57966|2022|PDM|997.50|99|0.00|HOSPICE CARE|
20|FH_F121225_98902_0|SrvcGrp|72984|2022|PCT|0.85|99|0.00|CHEMOTHERAPY|
20|FH_F146421_72758_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F96160_32207_0|SrvcGrp|17016|2022|PDM|68.65|99|0.00|HOME INFUSION THERAPY|
20|FH_F145641_06902_0|SrvcGrp|92819|2022|PDM|5509.00|99|0.00|HIP ARTHOSCOPY|
20|FH_F111986_0_0|SrvcGrp|88594|2022|PDM|1854.00|99|0.00|OPERATIVE LARYNGOSCOPY|
20|FH_F117300_0_0|SrvcGrp|77021|2022|PDM|7360.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F139512_77550_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120555_68405_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|1815.00|99|0.00|AEG 2 (NO REV)|
20|FH_F149150_75407_0|SrvcGrp|74668|2022|PDM|365.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119072_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F150165_06032_0|SrvcGrp|16732|2022|PDM|4500.00|99|0.00|HYSTEROSCOPY ABLATION|
20|FH_F149319_07670_0|SrvcGrp|471|2022|PDM|535.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F85213_02840_0|SrvcGrp|82137|2022|PCT|1.03|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F148799_50125_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F107580_77018_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F96160_32207_0|SrvcGrp|24761|2022|PDM|30.38|99|0.00|HOME INFUSION THERAPY|
20|FH_F138050_52301_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F148643_71343_0|SrvcGrp|113911|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|3928.00|99|0.00|AEG 9 (NO REV)|
20|FH_F81861_0_0|SrvcGrp|537|2022|PCT|0.45|99|0.00|OBSERVATION SERVICES|
20|FH_F126341_27284_0|SrvcGrp|86132|2022|PDM|1.00|99|0.00|FACTOR IX NON RECOMBINANT|
20|FH_F134607_80222_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F134208_21502_0|CSTM-ALL|CSTM-00|2020|PDM|991.00|99|0.00|AEG 6 (NO REV)|
20|FH_F145642_15108_0|SrvcGrp|114252|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F148600_30328_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F135670_01749_0|SrvcGrp|24745|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F149517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F34280_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145930_45236_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130327_03867_0|SrvcGrp|88620|2022|PDM|160.00|99|0.00|SKILLED NURSING RN|
20|FH_F125870_0_0|SrvcGrp|73008|2022|PDM|746.00|99|0.00|AEG 10|
20|FH_F119107_22601_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F146520_80435_0|SrvcGrp|94843|2022|PDM|550.00|99|0.00|AETNA MEDICARE INTENSIVE OP|
20|FH_F96160_32207_0|SrvcGrp|86851|2022|PDM|68.65|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F150166_91401_0|SrvcGrp|75419|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F85353_16407_0|SrvcGrp|63925|2022|PDM|45.24|99|0.00|HAPA WPA-NWPA 2012-13 ASC 147|
20|FH_F69708_0_0|SrvcGrp|42829|2022|PDM|117.00|99|0.00|RESPIRATORY THERAPY VISIT|
20|FH_F73228_0_0|SrvcGrp|17079|2022|PDM|8384.00|99|0.00|ASPG VIII|
20|FH_F111986_0_0|SrvcGrp|87679|2022|PDM|721.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F125870_0_0|SrvcGrp|88154|2022|PDM|2445.00|99|0.00|LASER TREATMENT OLD RETINA|
20|FH_F150159_06511_0|SrvcGrp|109036|2022|PDM|710.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F118803_0_0|SrvcGrp|107874|2022|PDM|349.70|99|0.00|SELECTIVE CATHETER PLACEMENT|
20|FH_F143581_02130_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F83978_66739_0|SrvcGrp|3066|2022|PCT|0.42|99|0.00|HIGH-COST DRUGS|
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|4093.00|99|0.00|AEG 7 (NO REV)|
20|FH_F119706_63021_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130763_0_0|SrvcGrp|90822|2022|PDM|4367.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY|
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|AEG 10 (NO REV)|
20|FH_F51115_0_0|SrvcGrp|22954|2022|PDM|133.87|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F142376_0_0|SrvcGrp|101301|2022|PDM|9873.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F133747_80634_0|SrvcGrp|89417|2022|PDM|330.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F117208_0_0|SrvcGrp|106266|2022|PDM|4015.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT|
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129509_0_0|SrvcGrp|89856|2022|PDM|5125.00|99|0.00|LAMIN EXCIS EXTRADURAL LUMB|
20|FH_F120661_57001_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125139_84096_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|2678.00|99|0.00|ASPG IX|
20|FH_F134509_14075_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F87815_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F70684_0_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F98780_35022_0|SrvcGrp|73643|2022|PDM|2254.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F101100_50314_0|SrvcGrp|31074|2022|PDM|1643.00|99|0.00|MS DRG 795 ONLY|
20|FH_F101100_50314_0|SrvcGrp|97908|2022|PDM|20473.00|99|0.00|PARTIAL REMOVAL OF COLON 2|
20|FH_F105145_75075_0|SrvcGrp|23279|2022|PDM|500.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F146668_30189_0|SrvcGrp|92197|2022|PDM|8500.00|99|0.00|CORRECTION OF BUNION|
20|FH_F55653_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115950_08648_0|SrvcGrp|58509|2022|PDM|550.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F116040_24637_0|SrvcGrp|86847|2022|PDM|30.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F131737_15025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F131757_06320_0|SrvcGrp|75545|2022|PDM|595.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F131860_38834_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131904_18915_0|SrvcGrp|23683|2022|PDM|59.00|99|0.00|SKILLED NURSING RN|
20|FH_F133401_33404_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F133544_78227_0|SrvcGrp|82981|2022|PDM|135.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F133494_90023_0|SrvcGrp|705|2022|PCT|0.25|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F133176_32751_0|SrvcGrp|73842|2022|PDM|232.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111563_02116_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F121329_33015_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122007_30701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F98040_89406_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F114267_0_0|SrvcGrp|88242|2022|PDM|2300.00|99|0.00|LAPAROSCOPY|
20|FH_F117525_0_0|SrvcGrp|73006|2022|PDM|1950.00|99|0.00|AEG 9|
20|FH_F91873_12723_0|SrvcGrp|89147|2022|PDM|5590.00|99|0.00|SPINAL PROCEDURES|
20|FH_F97761_04072_0|SrvcGrp|73603|2022|PDM|7969.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F97780_43614_0|SrvcGrp|73485|2022|PDM|3203.00|99|0.00|AETNA REHAB|
20|FH_F106822_0_0|SrvcGrp|100267|2022|PDM|9.61|99|0.00|URINE BACTERIA CULTURE|
20|FH_F111207_0_0|SrvcGrp|15659|2022|PCT|0.70|99|0.00|CHEMOTHERAPY|
20|FH_F71863_0_0|SrvcGrp|9832|2022|PDM|105.50|99|0.00|ST SVCS|
20|FH_F142318_21218_0|SrvcGrp|89024|2022|PDM|80.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F119581_0_0|SrvcGrp|103642|2022|PDM|7320.00|99|0.00|AETNA FEM/POPL REVASE W/ATHER|
20|FH_F39426_0_0|SrvcGrp|12496|2022|PDM|680.00|99|0.00|ACUTE REHABILITATION|
20|FH_F40397_0_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F43860_0_0|SrvcGrp|35468|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F44195_0_0|CSTM-ALL|CSTM-00|2020|PDM|365.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135491_0_0|SrvcGrp|114443|2022|PDM|5236.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F138929_0_0|SrvcGrp|92364|2022|PDM|15400.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F138929_0_0|SrvcGrp|103236|2022|PDM|13750.00|99|0.00|AETNA INSJ STABLJ DEV|
20|FH_F138929_0_0|SrvcGrp|41325|2022|PDM|4620.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F131047_0_0|CSTM-ALL|CSTM-00|2020|PDM|3421.00|99|0.00|OBSERVATION > 24 HRS|
20|FH_F132627_0_0|SrvcGrp|112083|2022|PDM|1031.00|99|0.00|HOSPICE GENERAL OP CARE|
20|FH_F132988_0_0|SrvcGrp|100009|2022|PDM|4493.01|99|0.00|REPAIR/GRAFT WRIST BONE|
20|FH_F132988_0_0|SrvcGrp|112147|2022|PDM|4493.01|99|0.00|OPTX POST ANKLE FX|
20|FH_F137067_0_0|SrvcGrp|97730|2022|PDM|28875.00|99|0.00|REVERSE HIP JOINT|
20|FH_F141127_62286_0|SrvcGrp|75505|2022|PCT|0.80|99|0.00|CARDIAC STUDIES|
20|FH_F114389_50131_0|SrvcGrp|86854|2022|PDM|160.95|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F114389_50131_0|SrvcGrp|98923|2022|PDM|93.83|99|0.00|HIT CONT PAIN MGMT (HCFA)|
20|FH_F141347_52807_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149719_0_0|SrvcGrp|108180|2022|PDM|550.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F43536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F81731_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F122183_98146_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F124060_76040_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F147017_35976_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F74102_0_0|SrvcGrp|11085|2022|PDM|28.00|99|0.00|HOME HEALTH AIDE|
20|FH_F92493_0_0|SrvcGrp|97741|2022|PDM|16193.10|99|0.00|REVISE KNEE|
20|FH_F92493_0_0|SrvcGrp|92409|2022|PDM|8263.20|99|0.00|PERQ CERVICOTHORACIC INJECT|
20|FH_F132867_83318_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67882_0_0|SrvcGrp|33096|2022|PCT|0.75|99|0.00|INTRAOCULAR LENS|
20|FH_F136546_33176_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136657_70806_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F136745_34772_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138052_19462_0|SrvcGrp|52953|2022|PDM|113.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PDM|21.73|99|0.00|INTERV HLTH/BEHAV FAM W/ PT|
20|FH_F132595_0_0|SrvcGrp|360|2022|PDM|1643.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F122689_92009_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43447_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.43|99|0.00|HSS APC GROUPED|
20|FH_F43693_0_0|SrvcGrp|12682|2022|PDM|340.00|99|0.00|GROUP THERAPY|
20|FH_F43913_0_0|SrvcGrp|37122|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F134670_95628_0|SrvcGrp|73841|2022|PDM|480.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F134672_44060_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F136824_08034_0|SrvcGrp|94880|2022|PDM|239.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F112505_51503_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F141170_0_0|SrvcGrp|89842|2022|PDM|18500.00|99|0.00|LUMBAR|
20|FH_F115206_80923_0|SrvcGrp|3178|2022|PDM|1034.00|99|0.00|ACUTE PSYCH|
20|FH_F115631_65201_0|SrvcGrp|82107|2022|PDM|3177.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F115631_65201_0|CSTM-ALL|CSTM-00|2020|PDM|932.00|99|0.00|AEG 3 (NO REV)|
20|FH_F115733_33012_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F115733_33012_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F116199_75042_0|SrvcGrp|16069|2022|PDM|796.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F116393_07002_0|SrvcGrp|106512|2022|PDM|34.97|99|0.00|ASSAY OF ARSENIC|
20|FH_F147466_18355_0|SrvcGrp|75419|2022|PDM|375.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F147586_44124_0|SrvcGrp|54962|2022|PDM|3601.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)|
20|FH_F42694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151139_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG VII|
20|FH_F42244_0_0|SrvcGrp|97|2022|PDM|3381.00|99|0.00|C-SECTION|
20|FH_F113585_20155_0|SrvcGrp|86848|2022|PDM|45.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F138674_75149_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F139115_32504_0|SrvcGrp|111928|2022|PDM|51.63|99|0.00|COVID-19 BARTONELLA|
20|FH_F83792_0_0|SrvcGrp|73606|2022|PDM|683.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F33316_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63231_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F106500_0_0|SrvcGrp|28221|2022|PDM|455.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.51|99|0.00|HAPA WPA-NWPA 2012-13 ASC 6 W/O REV|
20|FH_F122064_64633_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128115_52001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40073_0_0|SrvcGrp|17000|2022|PCT|0.70|99|0.00|OUTPATIENT SURGERY|
20|FH_F135851_25414_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135952_74501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135972_18509_0|SrvcGrp|112785|2022|PCT|1.00|99|0.00|TELEHEALTH SERVICES|
20|FH_F100763_24202_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F100765_73735_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F131265_84106_0|SrvcGrp|74668|2022|PDM|312.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|AEG 10 (NO REV)|
20|FH_F69205_0_0|SrvcGrp|29303|2022|PDM|172.80|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F111880_50003_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134309_63125_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131000_0_0|SrvcGrp|77021|2022|PDM|6450.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.35|99|0.00|AEG 4 (NO REV)|
20|FH_F118651_0_0|SrvcGrp|93637|2022|PDM|4959.71|99|0.00|LAPAROSCOPY SURGICAL|
20|FH_F112166_72143_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F102222_19720_0|SrvcGrp|86843|2022|PDM|26.25|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F102862_30606_0|SrvcGrp|28213|2022|PDM|19936.40|99|0.00|MS DRG 472 ONLY|
20|FH_F129240_10028_0|SrvcGrp|17015|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129220_18445_0|SrvcGrp|91394|2022|PDM|106.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD HO)|
20|FH_F34400_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F100780_24153_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F140007_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F48772_66044_0|SrvcGrp|104228|2022|PDM|528.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F102844_0_0|CSTM-ALL|CSTM-00|2020|PDM|411.00|99|0.00|AEG 1 (NO REV)|
20|FH_F110604_0_0|SrvcGrp|71666|2022|PDM|23100.00|99|0.00|CPT 63655|
20|FH_F110604_0_0|SrvcGrp|92364|2022|PDM|18150.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F74602_0_0|CSTM-ALL|CSTM-00|2020|PDM|1220.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F86851_0_0|SrvcGrp|84979|2022|PDM|520.00|99|0.00|CPT 44369|
20|FH_F123601_30680_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123752_44502_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F123752_44502_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F123763_80130_0|SrvcGrp|86723|2022|PDM|415.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F123763_80130_0|SrvcGrp|104079|2022|PCT|1.15|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F58252_0_0|SrvcGrp|48397|2022|PDM|31.25|99|0.00|PT SERVICES|
20|FH_F136398_23502_0|SrvcGrp|86723|2022|PDM|375.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F134160_19006_0|SrvcGrp|13422|2022|PDM|271.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F137241_07481_0|SrvcGrp|113050|2022|PCT|1.19|99|0.00|PSYCH TEST EVAL PHYS|
20|FH_F114092_83350_0|CSTM-ALL|CSTM-00|2020|PDM|4500.00|99|0.00|AEG 10 W/O SURG CARVEOUT (NO REV)|
20|FH_F138019_79705_0|SrvcGrp|89417|2022|PDM|466.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F142377_14626_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F140733_45005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F140844_48083_0|SrvcGrp|90339|2022|PDM|96.00|99|0.00|SKILLED NURSING RN|
20|FH_F149586_77535_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119023_91406_0|SrvcGrp|24750|2022|PDM|35.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F119023_91406_0|SrvcGrp|86847|2022|PDM|35.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F118932_07652_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F115452_15235_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F117325_19342_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147725_06002_0|SrvcGrp|28549|2022|PDM|4680.00|99|0.00|VITRECTOMY|
20|FH_F147725_06002_0|SrvcGrp|77582|2022|PDM|3900.00|99|0.00|CPT 31255|
20|FH_F147726_18017_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)|
20|FH_F117098_20186_0|SrvcGrp|33165|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F137818_31602_0|SrvcGrp|3178|2022|PDM|880.00|99|0.00|ACUTE PSYCH|
20|FH_F109652_0_0|SrvcGrp|12290|2022|PDM|1055.00|99|0.00|DETOXIFICATION|
20|FH_F109652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F109907_0_0|SrvcGrp|48385|2022|PDM|92.60|99|0.00|SPEECH THERAPY|
20|FH_F107926_0_0|SrvcGrp|68284|2022|PDM|1875.00|99|0.00|CPT 67113|
20|FH_F109513_0_0|SrvcGrp|65350|2022|PDM|2500.00|99|0.00|KNEE ARTHRO/ANTER|
20|FH_F51016_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F95880_02726_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119449_84032_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119413_95123_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119356_47150_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137951_0_0|SrvcGrp|71666|2022|PDM|3000.00|99|0.00|CPT 63655|
20|FH_F89112_16509_0|SrvcGrp|99620|2022|PDM|39.00|99|0.00|OCCUPATIONAL THERAPY SVCS INITIAL EVAL|
20|FH_F46352_0_0|SrvcGrp|26001|2022|PDM|313.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F117550_0_0|SrvcGrp|17100|2022|PDM|800.00|99|0.00|SKILLED NURSING|
20|FH_F119602_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F125660_46706_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F36993_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F40599_0_0|SrvcGrp|18076|2022|PDM|515.00|99|0.00|MRI|
20|FH_F90811_0_0|SrvcGrp|90427|2022|PDM|6500.00|99|0.00|CERVICAL SPINAL FUSION|
20|FH_F146380_85203_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F57592_0_0|SrvcGrp|21102|2022|PDM|65000.00|99|0.00|MS DRG 219 ONLY|
20|FH_F68968_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134490_62801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F83031_0_0|SrvcGrp|79337|2022|PDM|150.00|99|0.00|HOSPICE CARE|
20|FH_F150602_59718_0|SrvcGrp|80918|2022|PDM|153.00|99|0.00|RESPITE CARE|
20|FH_F117756_75402_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|AEG 1 (NO REV)|
20|FH_F117901_27526_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117380_60020_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F148886_60621_0|CSTM-ALL|CSTM-00|2020|PDM|1982.00|99|0.00|AEG 7 (NO REV)|
20|FH_F124954_17055_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36350_0_0|SrvcGrp|3066|2022|PCT|0.65|99|0.00|HIGH-COST DRUGS|
20|FH_F124505_0_0|SrvcGrp|80544|2022|PDM|956.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 8|
20|FH_F150904_22306_0|SrvcGrp|88620|2022|PDM|139.00|99|0.00|SKILLED NURSING RN|
20|FH_F83031_0_0|SrvcGrp|27767|2022|PDM|52.50|99|0.00|SKILLED IV NURSING HOURLY|
20|FH_F120829_85283_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101853_77840_0|SrvcGrp|43525|2022|PDM|465.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC|
20|FH_F100785_54660_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F42779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1921.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143848_0_0|SrvcGrp|73483|2022|PDM|1963.00|99|0.00|AETNA SUBACUTE III|
20|FH_F150948_0_0|SrvcGrp|93063|2022|PDM|10500.00|99|0.00|LUMBAR ARTIF DISKECTOMY|
20|FH_F118845_71111_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F68944_0_0|SrvcGrp|8968|2022|PDM|3500.00|99|0.00|NICU LEVEL III & IV|
20|FH_F43296_0_0|SrvcGrp|89337|2022|PDM|1045.00|99|0.00|DETOXIFICATION|
20|FH_F89932_10940_0|SrvcGrp|31705|2022|PDM|3310.00|99|0.00|MS DRG 791 ONLY|
20|FH_F146211_68144_0|SrvcGrp|106313|2022|PDM|81.60|99|0.00|PT/OT/ST|
20|FH_F97542_32960_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F150463_50701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F94165_0_0|SrvcGrp|76744|2022|PCT|0.85|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F136751_0_0|SrvcGrp|92819|2022|PDM|9200.00|99|0.00|HIP ARTHOSCOPY|
20|FH_F138611_0_0|SrvcGrp|97741|2022|PDM|14894.00|99|0.00|REVISE KNEE|
20|FH_F108700_63857_0|SrvcGrp|90477|2022|PDM|108.00|99|0.00|HOSPICE|
20|FH_F130553_18640_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F148639_0_0|SrvcGrp|35668|2022|PDM|2412.00|99|0.00|CPT 29824|
20|FH_F39051_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKE|
20|FH_F141910_70809_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130656_04401_0|SrvcGrp|111926|2022|PCT|1.00|99|0.00|COVID-19 LAB TESTING|
20|FH_F117733_91362_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F140790_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F134467_84321_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133467_03301_0|SrvcGrp|112323|2022|PDM|400.00|99|0.00|LABORATORY|
20|FH_F125541_07825_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F149664_33428_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100741_0_0|SrvcGrp|72990|2022|PDM|460.00|99|0.00|AEG 1|
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|958.50|99|0.00|AEG 4 (NO REV)|
20|FH_F129176_48098_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F136751_0_0|SrvcGrp|11673|2022|PDM|9200.00|99|0.00|CPT 29888|
20|FH_F149401_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F64943_0_0|SrvcGrp|51102|2022|PDM|733.00|99|0.00|ADULT EATING DISORDER RESIDENTIAL TREATMENT|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1849.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1401 W/O REV|
20|FH_F39723_0_0|SrvcGrp|14947|2022|PDM|65.00|99|0.00|HOME INFUSION|
20|FH_F127191_44720_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122388_0_0|SrvcGrp|106906|2022|PDM|385.00|99|0.00|AETNA SURGERY DEFAULT W/O GROUPER 1 & 2|
20|FH_F118819_76226_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F140808_0_0|CSTM-ALL|CSTM-00|2020|PDM|541.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132331_89107_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F67861_0_0|SrvcGrp|3066|2022|PCT|0.60|99|0.00|HIGH-COST DRUGS|
20|FH_F125471_34471_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F92676_15063_0|SrvcGrp|79085|2022|PDM|232.11|99|0.00|MON VALLEY ASC 317|
20|FH_F92677_08003_0|SrvcGrp|86853|2022|PDM|52.50|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|143.01|99|0.00|ASPG 120|
20|FH_F122245_0_0|SrvcGrp|72998|2022|PDM|846.00|99|0.00|AEG 5|
20|FH_F133271_72204_0|SrvcGrp|89149|2022|PDM|235.00|99|0.00|OP INTENSIVE|
20|FH_F109404_0_0|SrvcGrp|20483|2022|PCT|1.10|99|0.00|RADIOLOGY SVCS (MOD 26)|
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|ASPG I|
20|FH_F142807_67114_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123545_44512_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F40980_0_0|SrvcGrp|38|2022|PDM|12155.00|99|0.00|NORMAL DELIVERY|
20|FH_F97882_32407_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F142779_64083_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118542_60188_0|SrvcGrp|14949|2022|PDM|74.00|99|0.00|HOME INFUSION|
20|FH_F102721_38118_0|SrvcGrp|91901|2022|PDM|550.00|99|0.00|TCRANIAL MAGN STIM TX PLAN|
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|1503.00|99|0.00|AEG 7 (NO REV)|
20|FH_F145988_06105_0|SrvcGrp|114484|2022|PDM|12422.00|99|0.00|TOTAL HYSTERECTOMY|
20|FH_F128492_49010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148644_06890_0|SrvcGrp|84123|2022|PDM|4477.00|99|0.00|INSERT ANT SEGMENT DRAIN EXT|
20|FH_F148866_84123_0|SrvcGrp|76501|2022|PDM|260.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F148867_20191_0|SrvcGrp|107859|2022|PCT|1.05|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F151062_17584_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD UE KF"|
20|FH_F100540_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F141287_14830_0|SrvcGrp|73498|2022|PDM|992.00|99|0.00|AETNA ER LEVEL III|
20|FH_F149662_85015_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F130939_40353_0|SrvcGrp|89417|2022|PDM|381.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|890.00|99|0.00|AEG 3 (NO REV)|
20|FH_F146859_0_0|SrvcGrp|11043|2022|PDM|1809.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F34777_0_0|SrvcGrp|13217|2022|PCT|0.60|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F90196_10467_0|SrvcGrp|87317|2022|PDM|444.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F129682_07034_0|SrvcGrp|66265|2022|PDM|89.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 8 (NO REV)|
20|FH_F84833_17109_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F151043_71901_0|SrvcGrp|109057|2022|PCT|0.00|99|0.00|CARDIAC STUDIES|
20|FH_F125182_0_0|SrvcGrp|73008|2022|PDM|360.00|99|0.00|AEG 10|
20|FH_F74845_0_0|SrvcGrp|177|2022|PDM|3680.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F90817_0_0|SrvcGrp|91009|2022|PDM|2280.00|99|0.00|JAW ARTHROSCOPY/TMJ SURG (HCFA)|
20|FH_F71468_0_0|CSTM-ALL|CSTM-00|2020|PDM|47.00|99|0.00|HOME INFUSION NURSING SERVICES MOD SD|
20|FH_F41463_0_0|SrvcGrp|35463|2022|PDM|161.00|99|0.00|OXYGEN RENTAL (E1390)|
20|FH_F149023_44122_0|SrvcGrp|115577|2022|PDM|12350.00|99|0.00|LEG SURGERY|
20|FH_F73768_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F134936_01020_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F142327_0_0|SrvcGrp|109794|2022|PDM|2500.00|99|0.00|COLLAGEN CROSSLINKING CORNEA|
20|FH_F147299_02072_0|SrvcGrp|29346|2022|PDM|50.10|99|0.00|SKILLED NURSING- LPN|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD AV RATE|
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|2663.00|99|0.00|AEG 4 (NO REV)|
20|FH_F56232_0_0|CSTM-ALL|CSTM-00|2020|PDM|1683.76|99|0.00|ASPG IX|
20|FH_F122260_98034_0|SrvcGrp|55677|2022|PDM|1100.00|99|0.00|VAGINAL DELIVERY ONLY|
20|FH_F35384_0_0|SrvcGrp|115|2022|PDM|522.00|99|0.00|SKILLED NURSING CARE|
20|FH_F37777_0_0|SrvcGrp|36232|2022|PDM|475.00|99|0.00|TRAUMA, SPINAL CORD & BRAIN DAY TREATMENT|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|JERS RAD RENTAL|
20|FH_F138417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126785_0_0|SrvcGrp|16684|2022|PCT|0.49|99|0.00|DRUGS|
20|FH_F148496_17112_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35387_0_0|SrvcGrp|80|2022|PDM|1000.00|99|0.00|ACUTE PSYCH|
20|FH_F115483_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36943_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD UE|
20|FH_F150982_0_0|SrvcGrp|58671|2022|PDM|1101.00|99|0.00|ASC CARVE OUT 64721|
20|FH_F102525_73134_0|SrvcGrp|73004|2022|PDM|2230.00|99|0.00|AEG 8|
20|FH_F140143_24874_0|SrvcGrp|13681|2022|PDM|293.23|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F125113_0_0|SrvcGrp|19991|2022|PDM|4000.00|99|0.00|NERVOUS SYSTEM SERVICES|
20|FH_F130182_0_0|SrvcGrp|109447|2022|PDM|1457.00|99|0.00|CORONARY ARTERY ANGIO S&I|
20|FH_F110783_93013_0|SrvcGrp|13929|2022|PDM|12.50|99|0.00|GROWTH HORMONE|
20|FH_F117583_21208_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F65103_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO|
20|FH_F140929_67206_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39138_0_0|SrvcGrp|24703|2022|PDM|355.00|99|0.00|NEWBORN NURSERY|
20|FH_F86319_16365_0|SrvcGrp|113275|2022|PDM|100.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT|
20|FH_F83251_32751_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F65159_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|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_F132212_0_0|SrvcGrp|83857|2022|PDM|425.00|99|0.00|IP HOSPICE SVCS|
20|FH_F119447_64081_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F137951_0_0|SrvcGrp|74039|2022|PDM|3000.00|99|0.00|LAMINECTOMY|
20|FH_F148554_85016_0|SrvcGrp|108171|2022|PDM|1787.00|99|0.00|FEM/POPL REVAS W/TLA|
20|FH_F55113_0_0|SrvcGrp|28074|2022|PCT|0.65|99|0.00|HIGH COST PHARMACEUTICALS|
20|FH_F115383_80734_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F148881_33018_0|SrvcGrp|105019|2022|PDM|75.00|99|0.00|THERAPEUTIC ACTIVITIES (HCFA)|
20|FH_F72648_0_0|SrvcGrp|29428|2022|PDM|465.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT|
20|FH_F117829_45227_0|SrvcGrp|73842|2022|PDM|155.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F71926_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME HEALTH AIDE|
20|FH_F110067_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148886_60621_0|SrvcGrp|112223|2022|PCT|1.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F101751_25302_0|SrvcGrp|79237|2022|PDM|2091.13|99|0.00|VBAC DELIVERY|
20|FH_F150602_59718_0|SrvcGrp|66264|2022|PDM|98.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F124608_0_0|SrvcGrp|34606|2022|PDM|4284.00|99|0.00|CPT 29827|
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_F117885_81506_0|SrvcGrp|88620|2022|PDM|115.00|99|0.00|SKILLED NURSING RN|
20|FH_F44607_0_0|SrvcGrp|17083|2022|PCT|0.70|99|0.00|ASPG X|
20|FH_F145988_06105_0|SrvcGrp|114481|2022|PDM|28480.00|99|0.00|PERCUT TRANS COR ANG|
20|FH_F92676_15063_0|SrvcGrp|79021|2022|PDM|954.83|99|0.00|MON VALLEY ASC 112|
20|FH_F103540_24740_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150905_01608_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F117366_33162_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150559_60018_0|SrvcGrp|48396|2022|PDM|155.00|99|0.00|OT SERVICES|
20|FH_F118672_29036_0|CSTM-ALL|CSTM-00|2020|PDM|9037.00|99|0.00|AEG 9 (NO REV)|
20|FH_F119076_41001_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F44016_0_0|SrvcGrp|16132|2022|PDM|5470.00|99|0.00|DRG 372-375 ONLY NORMAL DELIVERY|
20|FH_F40546_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133019_23236_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES|
20|FH_F62799_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|372.23|99|0.00|HAPA WPA-NWPA 2012-13 ASC 222 W/O REV|
20|FH_F119229_90804_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F92676_15063_0|SrvcGrp|78986|2022|PDM|1225.76|99|0.00|MON VALLEY ASC 304|
20|FH_F143198_75219_0|SrvcGrp|74668|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F106540_26330_0|CSTM-ALL|CSTM-00|2020|PDM|4638.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125296_18337_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132737_0_0|SrvcGrp|16|2022|PDM|1532.00|99|0.00|ACUTE REHABILITATION|
20|FH_F36146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PDM|5321.00|99|0.00|AEG 8 (NO REV)|
20|FH_F92676_15063_0|SrvcGrp|79092|2022|PDM|113.40|99|0.00|MON VALLEY ASC 10|
20|FH_F97561_30030_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F44660_0_0|SrvcGrp|10400|2022|PDM|1750.00|99|0.00|IP SURGERY|
20|FH_F88816_0_0|SrvcGrp|472|2022|PDM|385.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU KF"|
20|FH_F37751_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F50618_0_0|SrvcGrp|17065|2022|PDM|439.16|99|0.00|ASPG I|
20|FH_F113324_17055_0|SrvcGrp|105213|2022|PDM|552.00|99|0.00|SKILLED CARE LEVEL 1 AND 2|
20|FH_F115406_79902_0|SrvcGrp|73841|2022|PDM|412.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F117559_08619_0|SrvcGrp|96499|2022|PDM|15.00|99|0.00|ADMIN OF PNEUMOCOCCAL VACCINE|
20|FH_F120058_0_0|CSTM-ALL|CSTM-00|2020|PDM|447.00|99|0.00|AEG 1 (NO REV)|
20|FH_F44607_0_0|SrvcGrp|997|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F40797_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F72859_0_0|SrvcGrp|22018|2022|PDM|25.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F32916_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F150500_85253_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119100_66086_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133018_84037_0|SrvcGrp|22589|2022|PDM|33.60|99|0.00|CHEMOTHERAPY NOC|
20|FH_F143053_89501_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F103281_32086_0|CSTM-ALL|CSTM-00|2020|PDM|2545.00|99|0.00|AEG 3 (NO REV)|
20|FH_F42807_0_0|SrvcGrp|360|2022|PDM|2080.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PDM|2599.00|99|0.00|ASPG IX|
20|FH_F86293_0_0|SrvcGrp|44068|2022|PDM|1995.00|99|0.00|CPT 52332|
20|FH_F141870_85224_0|SrvcGrp|14947|2022|PDM|5.00|99|0.00|HOME INFUSION|
20|FH_F88512_0_0|SrvcGrp|46525|2022|PDM|24749.14|99|0.00|PACEMAKER|
20|FH_F144191_0_0|SrvcGrp|89980|2022|PDM|3700.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F117855_62246_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147992_63452_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F112854_53225_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132543_79549_0|SrvcGrp|105465|2022|PCT|1.10|99|0.00|AETNA THERAPIES|
20|FH_F150062_92501_0|SrvcGrp|74668|2022|PDM|365.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F67205_0_0|SrvcGrp|17652|2022|PDM|1236.00|99|0.00|SKILLED NURSING CARE|
20|FH_F94222_62269_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F98000_59102_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F103180_85283_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F143050_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117762_0_0|SrvcGrp|99159|2022|PDM|2577.00|99|0.00|KNEE ARTHROSCOPY/SURGICAL|
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 4 (NO REV)|
20|FH_F98022_89015_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F138017_73129_0|SrvcGrp|93750|2022|PDM|6196.00|99|0.00|ERCP REMOVE FOREIGN BODY DUCT|
20|FH_F114206_37203_0|SrvcGrp|86849|2022|PDM|35.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F150929_17325_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122425_75082_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F137986_0_0|SrvcGrp|88065|2022|PDM|3000.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F111044_0_0|SrvcGrp|82112|2022|PDM|2266.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|3433.00|99|0.00|LAP VENT/ABD HERN PROC COMP|
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|7150.00|99|0.00|AEG 9 (NO REV)|
20|FH_F47212_0_0|SrvcGrp|24744|2022|PDM|199.00|99|0.00|PICC LINE INSERTION|
20|FH_F50100_0_0|SrvcGrp|46108|2022|PDM|55.32|99|0.00|SKILLED NURSING (ADDITIONAL HOUR)|
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|2265.00|99|0.00|AEG 8 (NO REV)|
20|FH_F76285_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37198_0_0|SrvcGrp|47260|2022|PCT|0.40|99|0.00|IMPLANTS 274-276, 278  LINE LEVEL|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|3979.00|99|0.00|LAP INC HERN RECUR COMP|
20|FH_F138018_17313_0|SrvcGrp|14948|2022|PDM|103.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F38123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F124322_64131_0|SrvcGrp|17013|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F34924_0_0|SrvcGrp|115|2022|PDM|475.00|99|0.00|SKILLED NURSING CARE|
20|FH_F140104_70359_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F139907_42266_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143249_89801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143529_84737_0|SrvcGrp|48398|2022|PDM|85.50|99|0.00|PT SERVICES|
20|FH_F143533_30013_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
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|97279|2022|PDM|1200.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY|
20|FH_F101752_0_0|SrvcGrp|78579|2022|PDM|2618.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
20|FH_F101391_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|GENERAL ACUTE CARE|
20|FH_F47600_0_0|SrvcGrp|32385|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKE (DME)|
20|FH_F49037_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC|
20|FH_F120187_76522_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F132414_30571_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116698_07470_0|SrvcGrp|48385|2022|PDM|52.50|99|0.00|SPEECH THERAPY|
20|FH_F116802_41224_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F32573_0_0|CSTM-ALL|CSTM-00|2020|PCT|43.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84394_17402_0|SrvcGrp|114223|2022|PDM|3836.00|99|0.00|KNEE ARTHROSCOPY/SURGERY|
20|FH_F51276_0_0|SrvcGrp|22954|2022|PDM|150.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F39920_0_0|SrvcGrp|360|2022|PDM|800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F31433_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|ORGAN ACQUISITION|
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_F75483_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38341_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 3 (NO REV)|
20|FH_F107800_34609_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F110263_0_0|SrvcGrp|93600|2022|PDM|12703.00|99|0.00|TOTAL HIP ARTHOPLASTY(HCFA)|
20|FH_F92655_0_0|CSTM-ALL|CSTM-00|2020|PDM|373.00|99|0.00|AEG 1 (NO REV)|
20|FH_F116341_12180_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F149939_91942_0|SrvcGrp|114008|2022|PDM|522.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F84135_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F110925_01104_0|SrvcGrp|31973|2022|PDM|19.50|99|0.00|HOME THERAPY|
20|FH_F124796_37641_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F129367_89117_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F87031_0_0|SrvcGrp|72994|2022|PDM|795.00|99|0.00|AEG 3|
20|FH_F34100_0_0|SrvcGrp|9861|2022|PDM|875.00|99|0.00|ACUTE REHABILITATION|
20|FH_F127281_68516_0|SrvcGrp|89417|2022|PDM|424.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F139551_0_0|SrvcGrp|100919|2022|PDM|4411.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 4 (NO REV)|
20|FH_F102302_0_0|SrvcGrp|98568|2022|PDM|29900.00|99|0.00|EXPLORATION SPINAL FUSION|
20|FH_F63475_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F122687_0_0|SrvcGrp|67279|2022|PDM|11200.00|99|0.00|CERVICAL SURGERY|
20|FH_F133207_0_0|SrvcGrp|89404|2022|PDM|16126.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.00|99|0.00|WELLPATH ASC II|
20|FH_F38798_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|1150.00|99|0.00|AEG 1 (NO REV)|
20|FH_F90691_0_0|SrvcGrp|72996|2022|PDM|699.00|99|0.00|AEG 4|
20|FH_F120249_43215_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F124018_75067_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139515_0_0|SrvcGrp|88157|2022|PDM|10686.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F115763_16433_0|SrvcGrp|75545|2022|PDM|340.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F80513_0_0|SrvcGrp|21360|2022|PDM|11241.00|99|0.00|MS DRG 472-473 ONLY|
20|FH_F146671_72205_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146773_78414_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131451_61455_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148639_0_0|SrvcGrp|72121|2022|PDM|3170.00|99|0.00|ARTHOSCOPY|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|474.34|99|0.00|DELAWARE VALLEY- ASC 402|
20|FH_F62867_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F91873_12723_0|SrvcGrp|91899|2022|PDM|570.00|99|0.00|MINOR SURGERY AETNA ENHANCED GROUPERS|
20|FH_F97720_70084_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F73231_0_0|CSTM-ALL|CSTM-00|2020|PDM|52.73|99|0.00|NURSING CARE MOD TE|
20|FH_F73231_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|HOME INFUSION REV CODE 640/MOD SJ|
20|FH_F74562_0_0|SrvcGrp|110|2022|PDM|352.00|99|0.00|CD - REHABILITATION|
20|FH_F77067_0_0|SrvcGrp|21650|2022|PCT|0.65|99|0.00|MS DRG 003 ONLY|
20|FH_F85039_0_0|SrvcGrp|75495|2022|PDM|1473.00|99|0.00|AEG 9|
20|FH_F87054_0_0|SrvcGrp|83960|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F113143_0_0|SrvcGrp|73000|2022|PDM|945.00|99|0.00|AEG 6|
20|FH_F116043_0_0|SrvcGrp|89822|2022|PDM|100.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1466.00|99|0.00|AEG 8 (NO REV)|
20|FH_F114916_30309_0|SrvcGrp|93069|2022|PDM|3424.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F104840_32565_0|SrvcGrp|75491|2022|PCT|0.69|99|0.00|AEG 7|
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|CSTM-ALL|CSTM-00|2020|PDM|1219.00|99|0.00|EXTENDED RECOVERY/OBSERVATION (8-15 HRS)|
20|FH_F110205_64012_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F94786_07974_0|SrvcGrp|29075|2022|PDM|31.50|99|0.00|HYDRATION THERAPY|
20|FH_F42161_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|PEDIATRIC IP SVCS|
20|FH_F141151_75150_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
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_F141336_16947_0|SrvcGrp|73499|2022|PDM|736.00|99|0.00|AETNA ER LEVEL II|
20|FH_F49487_0_0|SrvcGrp|24744|2022|PDM|140.00|99|0.00|PICC LINE INSERTION|
20|FH_F49487_0_0|SrvcGrp|21711|2022|PDM|159.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PDM|180.00|99|0.00|CD - HALF DAY (4-7 HR)|
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|AEG 9 (NO REV)|
20|FH_F148488_0_0|SrvcGrp|74668|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F81731_0_0|SrvcGrp|92606|2022|PDM|517.00|99|0.00|SUB-ACUTE CARE LEVEL III|
20|FH_F124059_64055_0|SrvcGrp|14944|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F146912_90025_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F74102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36667_0_0|SrvcGrp|17000|2022|PCT|0.65|99|0.00|OUTPATIENT SURGERY|
20|FH_F39561_0_0|SrvcGrp|1168|2022|PDM|29.78|99|0.00|CONTINUOUS HOMECARE|
20|FH_F39753_0_0|SrvcGrp|6|2022|PCT|0.82|99|0.00|OP SURGERY|
20|FH_F124237_95023_0|SrvcGrp|104079|2022|PCT|1.50|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F130929_60438_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100787_69162_0|SrvcGrp|73659|2022|PDM|4741.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F136662_45345_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F148553_85016_0|SrvcGrp|110101|2022|PDM|2182.00|99|0.00|TRLUML BALO ANGIOP 1ST ART|
20|FH_F122610_73139_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F43332_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F43169_0_0|SrvcGrp|26001|2022|PDM|141.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F134675_60134_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136796_24016_0|SrvcGrp|103542|2022|PDM|3634.46|99|0.00|ANKLE ARTHROSCOPY/SURGERY|
20|FH_F112505_51503_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115210_21043_0|SrvcGrp|26277|2022|PDM|2122.00|99|0.00|CPT 29874|
20|FH_F115608_24171_0|SrvcGrp|104231|2022|PCT|0.00|99|0.00|AETNA IP DETOX|
20|FH_F116173_40217_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147540_54871_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|CD SVCS|
20|FH_F42654_0_0|SrvcGrp|14081|2022|PDM|80.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F133401_33404_0|SrvcGrp|82981|2022|PDM|140.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F133700_92808_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F111561_10002_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PDM|1145.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F48692_0_0|SrvcGrp|474|2022|PDM|250.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F129673_0_0|SrvcGrp|92501|2022|PDM|434.41|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F35404_0_0|SrvcGrp|9911|2022|PCT|0.55|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F35404_0_0|SrvcGrp|11301|2022|PDM|1300.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F113154_70359_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 8 (NO REV)|
20|FH_F139530_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F150939_0_0|SrvcGrp|68240|2022|PDM|37.00|99|0.00|DESTRUCTION WARTS - 1ST LESION|
20|FH_F46672_0_0|SrvcGrp|42036|2022|PDM|45.00|99|0.00|SKILLED NURSING (ADDITIONAL HOURS)|
20|FH_F118173_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F129912_0_0|CSTM-ALL|CSTM-00|2020|PDM|530.00|99|0.00|AEG 1 (NO REV)|
20|FH_F131501_0_0|SrvcGrp|73656|2022|PDM|475.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F38949_0_0|SrvcGrp|10111|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F41213_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: PT/OT/ST GLOBAL|
20|FH_F47462_0_0|SrvcGrp|43312|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY|
20|FH_F97566_79902_0|SrvcGrp|73461|2022|PDM|16490.00|99|0.00|AETNA NICU IV|
20|FH_F141849_76053_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149779_0_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F124839_71360_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147988_78759_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128299_44134_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F150662_20901_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F150769_02302_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122364_67203_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137713_50025_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F131418_75215_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F110193_70444_0|SrvcGrp|86748|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU"|
20|FH_F124691_78003_0|SrvcGrp|74668|2022|PDM|600.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F143668_0_0|SrvcGrp|115715|2022|PDM|210.00|99|0.00|SEGMENTAL PNEUMATIC (MOD UE)|
20|FH_F36485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% 2007 MEDICARE TN DME MOD AW|
20|FH_F111246_80027_0|SrvcGrp|104336|2022|PCT|1.00|99|0.00|DENOSUMAB INJECTION|
20|FH_F84433_0_0|SrvcGrp|26160|2022|PDM|16.97|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F36743_0_0|SrvcGrp|2798|2022|PDM|2040.00|99|0.00|POST CARDIAC CARE UNIT|
20|FH_F67924_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147234_19010_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F115982_0_0|SrvcGrp|27315|2022|PDM|2100.00|99|0.00|TENDON REPAIR|
20|FH_F150982_0_0|SrvcGrp|27344|2022|PDM|2753.00|99|0.00|OP SURGERY (CPT 42821)|
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PDM|2273.00|99|0.00|AEG 9 (NO REV)|
20|FH_F140093_33467_0|SrvcGrp|74668|2022|PDM|309.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|26.50|99|0.00|ANCILLARY DRUG THERAPY (MOD KP/SH)|
20|FH_F149023_44122_0|SrvcGrp|58638|2022|PDM|3887.00|99|0.00|CPT 63688|
20|FH_F35097_16508_0|SrvcGrp|10431|2022|PDM|50.00|99|0.00|SPEECH THERAPY|
20|FH_F97080_85122_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F37304_0_0|SrvcGrp|9846|2022|PDM|3470.00|99|0.00|DIAGNOSTIC CARDIAC CATH|
20|FH_F110728_13069_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124288_15701_0|SrvcGrp|82137|2022|PDM|175.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F150224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137769_85234_0|SrvcGrp|92760|2022|PCT|1.60|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F101441_0_0|SrvcGrp|97299|2022|PDM|8105.00|99|0.00|REMOVE SPINE ELTRD PLATE|
20|FH_F111044_0_0|SrvcGrp|77582|2022|PDM|2266.00|99|0.00|CPT 31255|
20|FH_F38742_0_0|SrvcGrp|28930|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MOD NU (A & K CODES)|
20|FH_F114206_37203_0|SrvcGrp|86840|2022|PDM|35.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F98820_81401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F149049_28401_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F138017_73129_0|SrvcGrp|113305|2022|PDM|8122.00|99|0.00|COMPLEX VAGINAL HYSTERECTOMY|
20|FH_F110783_93013_0|SrvcGrp|65621|2022|PDM|45.00|99|0.00|RN NURSING|
20|FH_F117799_0_0|SrvcGrp|89949|2022|PDM|5623.00|99|0.00|HIP ARTHOSCOPY|
20|FH_F101640_32218_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F122282_30080_0|SrvcGrp|89337|2022|PDM|875.00|99|0.00|DETOXIFICATION|
20|FH_F116549_0_0|SrvcGrp|103551|2022|PDM|182.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F131239_54615_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|2062.00|99|0.00|AEG 8 (NO REV)|
20|FH_F149373_0_0|SrvcGrp|114008|2022|PDM|439.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F122394_75979_0|SrvcGrp|89417|2022|PDM|400.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F120040_72703_0|SrvcGrp|87441|2022|PDM|914.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F36620_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2010 B CODES (MOD NU)|
20|FH_F131175_06757_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F102525_73134_0|SrvcGrp|75441|2022|PDM|1050.00|99|0.00|OBSERVATION - REV 760|
20|FH_F147332_19406_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127553_44321_0|SrvcGrp|73700|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F125081_15218_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119316_27104_0|SrvcGrp|73841|2022|PDM|450.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F147231_49440_0|SrvcGrp|53145|2022|PDM|42.46|99|0.00|SOCIAL WORKER|
20|FH_F101861_19567_0|SrvcGrp|86729|2022|PCT|1.00|99|0.00|COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE|
20|FH_F150961_89169_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F151043_71901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124492_30040_0|SrvcGrp|113240|2022|PDM|82.50|99|0.00|COVID-19 TEST NON-CDC HGH THRU (HCFA)|
20|FH_F113545_11201_0|SrvcGrp|90854|2022|PDM|700.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F35780_32073_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F137789_48146_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)|
20|FH_F123570_0_0|SrvcGrp|73006|2022|PDM|1893.97|99|0.00|AEG 9|
20|FH_F35056_0_0|SrvcGrp|15156|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|2557.00|99|0.00|ASPG V|
20|FH_F119352_0_0|SrvcGrp|28787|2022|PDM|60.00|99|0.00|CPT CODE 90993|
20|FH_F143368_33028_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123185_0_0|SrvcGrp|73002|2022|PDM|1144.00|99|0.00|AEG 7|
20|FH_F102920_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78603_0_0|SrvcGrp|20908|2022|PDM|24827.85|99|0.00|MS DRG 247 ONLY|
20|FH_F150982_0_0|SrvcGrp|88157|2022|PDM|24223.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F40416_0_0|SrvcGrp|38|2022|PDM|2822.00|99|0.00|NORMAL DELIVERY|
20|FH_F125048_94583_0|SrvcGrp|107483|2022|PCT|1.10|99|0.00|OP THERAPY SERVICE|
20|FH_F121177_33407_0|SrvcGrp|58509|2022|PDM|280.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F130936_06107_0|SrvcGrp|75545|2022|PDM|477.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F125249_0_0|SrvcGrp|92366|2022|PDM|1200.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F145797_46250_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141550_33619_0|SrvcGrp|86722|2022|PDM|188.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F138010_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1319.00|99|0.00|AEG 7 (NO REV)|
20|FH_F120155_63114_0|SrvcGrp|82846|2022|PCT|0.75|99|0.00|AETNA DME|
20|FH_F120666_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.39|99|0.00|OP SVCS|
20|FH_F113723_10457_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS APC GROUPED|
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_F129268_54220_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F34550_0_0|SrvcGrp|11199|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER|
20|FH_F37659_0_0|SrvcGrp|361|2022|PDM|1654.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F37679_0_0|SrvcGrp|26864|2022|PDM|15.25|99|0.00|MISC INFUSION THERAPY (MOD SJ)|
20|FH_F38526_0_0|SrvcGrp|115|2022|PDM|755.00|99|0.00|SKILLED NURSING CARE|
20|FH_F82955_34266_0|SrvcGrp|78680|2022|PCT|0.66|99|0.00|AETNA CARDIAC CATH|
20|FH_F115112_48035_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F63141_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|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_F123278_20850_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F47733_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% L CODES MOD KN|
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)|
20|FH_F63535_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F129666_71901_0|SrvcGrp|66265|2022|PDM|155.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F148265_06067_0|SrvcGrp|35668|2022|PDM|5395.00|99|0.00|CPT 29824|
20|FH_F79904_0_0|SrvcGrp|12403|2022|PDM|28.73|99|0.00|CONTINUOUS HOMECARE|
20|FH_F135236_02840_0|SrvcGrp|110427|2022|PDM|2119.90|99|0.00|TRAUMA TEAM LEVEL 1|
20|FH_F148201_82716_0|SrvcGrp|41563|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F135267_19002_0|SrvcGrp|86723|2022|PDM|357.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F39531_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|OP SVCS|
20|FH_F147212_0_0|SrvcGrp|11442|2022|PDM|740.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F130504_33756_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F90714_0_0|SrvcGrp|73006|2022|PDM|1040.00|99|0.00|AEG 9|
20|FH_F141367_57104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110925_01104_0|SrvcGrp|24754|2022|PDM|18.91|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F135236_02840_0|SrvcGrp|89417|2022|PDM|1061.10|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F134287_0_0|SrvcGrp|104642|2022|PDM|15000.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F137617_84112_0|SrvcGrp|11152|2022|PCT|0.89|99|0.00|TRAUMA|
20|FH_F110925_01104_0|SrvcGrp|24745|2022|PDM|70.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F64140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67984_0_0|SrvcGrp|64203|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY|
20|FH_F62579_0_0|SrvcGrp|27969|2022|PDM|54.00|99|0.00|HOME HEALTH AIDE|
20|FH_F63229_0_0|SrvcGrp|59396|2022|PDM|290.00|99|0.00|CAPD|
20|FH_F63235_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38560_0_0|SrvcGrp|12523|2022|PDM|11000.00|99|0.00|GAMMA KNIFE|
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PDM|4438.00|99|0.00|2007 MEDICARE ASPG I|
20|FH_F96780_0_0|SrvcGrp|28547|2022|PDM|1761.00|99|0.00|VITRECTOMY|
20|FH_F110470_98335_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F63258_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127090_45601_0|SrvcGrp|29077|2022|PDM|170.00|99|0.00|HOME TRANSFUSION|
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|1466.00|99|0.00|AEG 8 (NO REV)|
20|FH_F121476_0_0|SrvcGrp|107441|2022|PDM|1860.00|99|0.00|AETNA CYSTOSCOPY PROSTATIC IMPLANTS|
20|FH_F69708_0_0|SrvcGrp|14949|2022|PDM|133.00|99|0.00|HOME INFUSION|
20|FH_F145942_72019_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F143561_16001_0|SrvcGrp|88621|2022|PDM|92.00|99|0.00|SKILLED NURSING LPN|
20|FH_F112712_63005_0|SrvcGrp|14947|2022|PCT|1.00|99|0.00|HOME INFUSION|
20|FH_F85732_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F100782_0_0|SrvcGrp|97695|2022|PDM|2110.66|99|0.00|WINDBER MEDICAL CNTR ASC 1403|
20|FH_F120930_0_0|SrvcGrp|96562|2022|PDM|3000.00|99|0.00|VAGINAL HYSTERCTOMY|
20|FH_F50703_0_0|SrvcGrp|46983|2022|PDM|32.71|99|0.00|HOME SUPPLIES (A4221)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|237.90|99|0.00|HAPA WPA-NWPA 2012-13 ASC 122 W/O REV|
20|FH_F127545_45227_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F132958_79903_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134218_20783_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F68251_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F119227_01752_0|SrvcGrp|29076|2022|PDM|38.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F120555_68405_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138024_40509_0|SrvcGrp|86723|2022|PDM|290.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F114823_15701_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F114444_19602_0|SrvcGrp|91398|2022|PDM|85.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AJ)|
20|FH_F133749_84604_0|SrvcGrp|112430|2022|PDM|25.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F110345_37919_0|SrvcGrp|89417|2022|PDM|542.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F47605_0_0|SrvcGrp|43323|2022|PDM|90.00|99|0.00|GROUP THERAPY|
20|FH_F48836_0_0|SrvcGrp|16746|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F138684_44484_0|SrvcGrp|108484|2022|PDM|450.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F109949_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|0.30|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|616.38|99|0.00|AEG 2 (NO REV)|
20|FH_F113390_0_0|SrvcGrp|105239|2022|PDM|1320.00|99|0.00|EXCISION OF TONGUE LESION|
20|FH_F124542_0_0|SrvcGrp|80543|2022|PDM|968.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 7|
20|FH_F151319_64040_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151320_15145_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151421_21244_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F122152_70123_0|SrvcGrp|92501|2022|PDM|155.96|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F135439_33825_0|SrvcGrp|46903|2022|PDM|549.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F91766_25401_0|SrvcGrp|43569|2022|PDM|78.75|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F136009_76051_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136041_87107_0|SrvcGrp|89149|2022|PDM|150.00|99|0.00|OP INTENSIVE|
20|FH_F100763_24202_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F130933_47129_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130996_34110_0|SrvcGrp|88164|2022|PDM|16000.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F130620_18940_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F116397_33404_0|SrvcGrp|86837|2022|PDM|200.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F116397_33404_0|SrvcGrp|29077|2022|PDM|200.00|99|0.00|HOME TRANSFUSION|
20|FH_F116431_76104_0|SrvcGrp|16069|2022|PDM|656.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F121771_91405_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F121771_91405_0|SrvcGrp|75419|2022|PDM|820.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F44356_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F69205_0_0|SrvcGrp|15850|2022|PDM|241.90|99|0.00|HOSPICE SVCS|
20|FH_F128370_76132_0|SrvcGrp|90040|2022|PDM|315.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F111363_33169_0|SrvcGrp|103965|2022|PCT|2.24|99|0.00|IMAGING ENHANCING SUBSTANCE|
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|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG IV|
20|FH_F148243_0_0|SrvcGrp|87679|2022|PDM|957.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F48581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|2122.00|99|0.00|ASPG VIII|
20|FH_F54272_0_0|SrvcGrp|409|2022|PDM|590.00|99|0.00|ER SVCS|
20|FH_F131000_0_0|SrvcGrp|41335|2022|PDM|15086.00|99|0.00|TOTAL HIP|
20|FH_F132328_0_0|SrvcGrp|26279|2022|PDM|2049.00|99|0.00|CPT 29884|
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_F114569_0_0|SrvcGrp|105542|2022|PDM|26.46|99|0.00|AETHA ALCOHOL/SUBS INTERV 15-30 MINS (MOD GT)|
20|FH_F112092_46845_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124981_32539_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F96560_17972_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F101620_47401_0|SrvcGrp|90854|2022|PDM|876.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F98300_30236_0|SrvcGrp|82037|2022|PDM|4002.00|99|0.00|AETNA ICU|
20|FH_F102960_50613_0|SrvcGrp|75505|2022|PCT|0.62|99|0.00|CARDIAC STUDIES|
20|FH_F39996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F60276_0_0|SrvcGrp|56453|2022|PDM|750.00|99|0.00|VITRECTOMY|
20|FH_F114064_0_0|SrvcGrp|72998|2022|PDM|906.00|99|0.00|AEG 5|
20|FH_F89495_0_0|SrvcGrp|72998|2022|PDM|743.00|99|0.00|AEG 5|
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|541.95|99|0.00|AETNA POLYSOMNOGRAPHY|
20|FH_F132810_0_0|SrvcGrp|41460|2022|PDM|8.00|99|0.00|ENTERAL THERAPY - UNSPECIFIED|
20|FH_F58856_0_0|SrvcGrp|31074|2022|PDM|950.00|99|0.00|MS DRG 795 ONLY|
20|FH_F71923_0_0|SrvcGrp|15265|2022|PDM|556.97|99|0.00|HEMODIALYSIS SVCS|
20|FH_F134255_01201_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136400_70360_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F136430_46710_0|SrvcGrp|471|2022|PDM|993.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F136487_71269_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F118198_38119_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F93363_63123_0|SrvcGrp|88620|2022|PDM|75.00|99|0.00|SKILLED NURSING RN|
20|FH_F134057_32570_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134126_11554_0|SrvcGrp|36505|2022|PDM|1895.00|99|0.00|TRAUMA|
20|FH_F139067_66935_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97602_40121_0|SrvcGrp|73601|2022|PDM|8186.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F138471_84663_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F140765_30315_0|SrvcGrp|113230|2022|PDM|42.13|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 SCR|
20|FH_F140791_20678_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F140844_48083_0|SrvcGrp|90341|2022|PDM|96.00|99|0.00|SKILLED NURSING LPN (HCFA)|
20|FH_F80284_16354_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HAPA WPA/NWPA 2014 LABS 100%|
20|FH_F137530_0_0|SrvcGrp|107879|2022|PDM|6507.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F119023_91406_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP WITHOUT CPT 99601|
20|FH_F118932_07652_0|SrvcGrp|103503|2022|PDM|3395.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F76144_0_0|SrvcGrp|37642|2022|PDM|2824.18|99|0.00|LAP HERNIORRHAPY|
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|1054.90|99|0.00|AETNA GLENNVILLE 2016 AEG 4|
20|FH_F129477_70403_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F116753_0_0|SrvcGrp|106782|2022|PDM|7465.00|99|0.00|DRILL FOR OSTEOCH|
20|FH_F130763_0_0|SrvcGrp|100919|2022|PDM|6239.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F120719_27540_0|SrvcGrp|8950|2022|PDM|4495.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F138951_41101_0|SrvcGrp|86849|2022|PDM|40.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F125870_0_0|SrvcGrp|114518|2022|PDM|3095.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123610_60018_0|SrvcGrp|104465|2022|PDM|1250.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F127545_45227_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F117206_0_0|SrvcGrp|90609|2022|PDM|619.00|99|0.00|ESOPHAGUS ENDOSCOPY|
20|FH_F133972_27103_0|SrvcGrp|24744|2022|PDM|60.00|99|0.00|PICC LINE INSERTION|
20|FH_F93122_01854_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134615_38478_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F134650_07921_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F127950_45150_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34182_0_0|SrvcGrp|18165|2022|PCT|0.78|99|0.00|MS DRG 254|
20|FH_F112672_11788_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F89219_0_0|CSTM-ALL|CSTM-00|2020|PDM|8240.00|99|0.00|MT NITTANY SURG MS DRG|
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|AEG 3 (NO REV)|
20|FH_F134669_17403_0|SrvcGrp|73841|2022|PDM|370.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F112863_0_0|SrvcGrp|104253|2022|PDM|1141.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F118252_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F143571_0_0|SrvcGrp|73656|2022|PDM|661.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|363.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 229 W/O REV|
20|FH_F119783_46360_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F59872_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F85353_16407_0|SrvcGrp|63783|2022|PDM|1342.60|99|0.00|HAPA WPA-NWPA 2012-13 ASC 705|
20|FH_F89323_63033_0|SrvcGrp|88246|2022|PDM|40.00|99|0.00|INFLUENZA DNA AMP PROBE|
20|FH_F150239_75569_0|SrvcGrp|26869|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F124162_73127_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132969_84003_0|SrvcGrp|48398|2022|PDM|85.50|99|0.00|PT SERVICES|
20|FH_F112665_0_0|SrvcGrp|89404|2022|PDM|7215.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|AEG 4 (NO REV)|
20|FH_F119509_0_0|SrvcGrp|59159|2022|PCT|0.29|99|0.00|OP SURGERY|
20|FH_F80172_0_0|SrvcGrp|49070|2022|PDM|70.64|99|0.00|IMMUNOMODULATING AGENTS VIG|
20|FH_F81852_0_0|SrvcGrp|12439|2022|PDM|240.00|99|0.00|ER SVCS|
20|FH_F121601_47446_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F125124_0_0|SrvcGrp|72996|2022|PDM|680.00|99|0.00|AEG 4|
20|FH_F147991_65625_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|813.58|99|0.00|AEG 2 (NO REV)|
20|FH_F146207_73139_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137587_0_0|SrvcGrp|107748|2022|PDM|678.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F148267_0_0|SrvcGrp|96699|2022|PDM|155.60|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F89176_0_0|CSTM-ALL|CSTM-00|2020|PDM|1392.00|99|0.00|ASPG V|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149081_63028_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143576_43812_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F130763_0_0|SrvcGrp|86463|2022|PDM|4714.00|99|0.00|FRACTURE NASAL INFERIOR|
20|FH_F127933_62863_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131630_0_0|SrvcGrp|85792|2022|PDM|2081.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F54592_0_0|SrvcGrp|17012|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F54592_0_0|SrvcGrp|22592|2022|PDM|80.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F134509_14075_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F122526_22203_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F31319_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS|
20|FH_F86836_0_0|SrvcGrp|11336|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F79644_0_0|SrvcGrp|14614|2022|PDM|5079.00|99|0.00|LITHOTRIPSY|
20|FH_F98780_35022_0|SrvcGrp|73559|2022|PDM|5852.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F102200_06416_0|SrvcGrp|86842|2022|PDM|40.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F115870_98225_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F66427_0_0|SrvcGrp|58852|2022|PCT|0.80|99|0.00|CYBER GAMMA KNIFE|
20|FH_F68442_0_0|SrvcGrp|33164|2022|PDM|305.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F75842_0_0|SrvcGrp|46523|2022|PDM|21379.24|99|0.00|MASTECTOMY|
20|FH_F146812_50401_0|CSTM-ALL|CSTM-00|2020|PDM|3338.00|99|0.00|AEG 7 (NO REV)|
20|FH_F120795_27514_0|SrvcGrp|108565|2022|PCT|0.71|99|0.00|PT OT ST|
20|FH_F40903_0_0|SrvcGrp|18539|2022|PDM|1.05|99|0.00|ADDITIONAL MILEAGE - WHEELCHAIR VAN|
20|FH_F131747_80108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133583_77074_0|SrvcGrp|86723|2022|PDM|435.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F132937_88201_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F133667_83642_0|SrvcGrp|88819|2022|PDM|1000.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F133153_44113_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F133494_90023_0|SrvcGrp|11663|2022|PCT|0.25|99|0.00|IMPLANTS|
20|FH_F133219_89119_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F130657_04614_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 4 (NO REV)|
20|FH_F111584_07002_0|SrvcGrp|91065|2022|PDM|77.24|99|0.00|PSYCHIATRIC CPT 90853 (HCFA)|
20|FH_F111847_70301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121385_89102_0|SrvcGrp|81779|2022|PCT|2.07|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F121936_17543_0|SrvcGrp|75545|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F35212_0_0|SrvcGrp|12263|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1097.84|99|0.00|DELAWARE VALLEY- ASC 8|
20|FH_F110000_0_0|CSTM-ALL|CSTM-00|2020|PDM|1844.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97740_01605_0|SrvcGrp|73659|2022|PDM|15124.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F117001_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|HEARING AID, BICROS, IN THE|
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|78.56|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F87201_0_0|SrvcGrp|44042|2022|PDM|75.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F142335_60624_0|SrvcGrp|75419|2022|PDM|379.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1366.00|99|0.00|AEG 5  (NO REV)|
20|FH_F115489_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F102041_35010_0|SrvcGrp|46605|2022|PDM|145.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F132275_0_0|SrvcGrp|87077|2022|PDM|158.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F93252_0_0|SrvcGrp|87026|2022|PDM|1200.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F116664_0_0|SrvcGrp|105357|2022|PDM|1265.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F141336_16947_0|SrvcGrp|113740|2022|PCT|3.97|99|0.00|LABORATORY SERVICES|
20|FH_F77944_0_0|SrvcGrp|30623|2022|PDM|10875.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F146886_77378_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38983_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|PSYCHIATRIC FULL DAY TREATMENT|
20|FH_F40643_0_0|SrvcGrp|115|2022|PDM|355.00|99|0.00|SKILLED NURSING CARE|
20|FH_F44341_0_0|CSTM-ALL|CSTM-00|2020|PDM|362.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91998_0_0|SrvcGrp|82107|2022|PDM|1224.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F92493_0_0|SrvcGrp|99073|2022|PDM|1.42|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F132592_68305_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F55694_0_0|CSTM-ALL|CSTM-00|2020|PDM|1827.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F130796_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F136623_01830_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F114629_19131_0|SrvcGrp|12659|2022|PDM|986.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F114666_30342_0|SrvcGrp|92363|2022|PDM|14000.00|99|0.00|OSTEOCHONDRAL ALLOGRAFT KNEE|
20|FH_F114792_48849_0|SrvcGrp|73841|2022|PDM|660.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138855_84067_0|SrvcGrp|46903|2022|PDM|1300.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F81832_13827_0|SrvcGrp|43567|2022|PDM|105.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F144039_0_0|SrvcGrp|42427|2022|PDM|6885.00|99|0.00|OP SURGERY CPT 65420|
20|FH_F122664_07005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F136823_63048_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136913_68803_0|SrvcGrp|73498|2022|PDM|2406.00|99|0.00|AETNA ER LEVEL III|
20|FH_F113713_17013_0|SrvcGrp|102979|2022|PDM|100.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AH)|
20|FH_F141170_0_0|SrvcGrp|67119|2022|PDM|17500.00|99|0.00|ARTHODESIS|
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_F68481_0_0|CSTM-ALL|CSTM-00|2020|PDM|1265.00|99|0.00|ASPG V|
20|FH_F115144_71373_0|SrvcGrp|105737|2022|PDM|1326.00|99|0.00|INPATIENT PSYCHIATRIC|
20|FH_F115154_45069_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147619_72034_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F41463_0_0|SrvcGrp|26871|2022|PDM|80.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3 HRS|
20|FH_F41463_0_0|SrvcGrp|22588|2022|PDM|80.00|99|0.00|CHEMOTHERAPY|
20|FH_F42402_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F102641_0_0|SrvcGrp|11306|2022|PCT|0.53|99|0.00|IMPLANTS|
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|3455.00|99|0.00|AEG 9 (NO REV)|
20|FH_F139238_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F72445_0_0|SrvcGrp|14500|2022|PDM|35.00|99|0.00|STATIONARY/AMBULATORY/DISPOSAL PUMPS|
20|FH_F79429_0_0|SrvcGrp|59428|2022|PDM|75.00|99|0.00|ST|
20|FH_F38955_0_0|SrvcGrp|177|2022|PDM|3423.44|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F41013_0_0|SrvcGrp|31191|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF (DME)|
20|FH_F138992_72703_0|SrvcGrp|112509|2022|PDM|1161.00|99|0.00|MRI/MRA|
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|73806|2022|PDM|735.00|99|0.00|AETNA ER|
20|FH_F91641_0_0|SrvcGrp|91456|2022|PDM|1664.64|99|0.00|LAGOPHTHALMOS CORRECTION|
20|FH_F151401_36607_0|SrvcGrp|80928|2022|PDM|145.00|99|0.00|PT/OT/ST IN HOME HEALTH|
20|FH_F151510_15928_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122027_61847_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F145248_19477_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F144928_02703_0|SrvcGrp|74668|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F135432_16335_0|SrvcGrp|48394|2022|PDM|34.22|99|0.00|SKILLED NURSING SERVICES|
20|FH_F135493_07514_0|SrvcGrp|73841|2022|PDM|318.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F97143_80012_0|CSTM-ALL|CSTM-00|2020|PCT|0.29|99|0.00|OP SVCS|
20|FH_F135924_02906_0|SrvcGrp|116016|2022|PCT|1.21|99|0.00|LABORATORY SERVICES|
20|FH_F119886_25504_0|SrvcGrp|48385|2022|PDM|130.00|99|0.00|SPEECH THERAPY|
20|FH_F119892_47586_0|SrvcGrp|65621|2022|PDM|50.00|99|0.00|RN NURSING|
20|FH_F131463_19096_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F130670_32204_0|SrvcGrp|89149|2022|PDM|208.00|99|0.00|OP INTENSIVE|
20|FH_F131520_19144_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130620_18940_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116467_13031_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133468_74873_0|SrvcGrp|74668|2022|PDM|900.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F48258_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F121796_68355_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F79570_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33791_0_0|SrvcGrp|11108|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F129967_18915_0|SrvcGrp|86647|2022|PDM|63.58|99|0.00|AETNA OFFICE OP VISIT EST (MOD TD)|
20|FH_F111292_33136_0|SrvcGrp|73602|2022|PDM|869.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F134322_98001_0|SrvcGrp|108041|2022|PDM|1100.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F149239_0_0|SrvcGrp|92501|2022|PDM|162.59|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F67150_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F116430_0_0|SrvcGrp|106714|2022|PDM|1114.00|99|0.00|UROLOGY SURGERY|
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141035_0_0|SrvcGrp|113713|2022|PDM|7008.00|99|0.00|REVISE WRIST JOINT|
20|FH_F129240_10028_0|SrvcGrp|86851|2022|PDM|40.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F96960_35404_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|1038.45|99|0.00|AEG 5  (NO REV)|
20|FH_F148100_22406_0|SrvcGrp|48385|2022|PDM|84.00|99|0.00|SPEECH THERAPY|
20|FH_F98621_41042_0|SrvcGrp|73656|2022|PDM|843.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F66880_25301_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F67820_15009_0|SrvcGrp|81878|2022|PCT|1.00|99|0.00|RADIOLOGY W/ REV/HCPC|
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97261_06098_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|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_F36864_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118555_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F74602_0_0|CSTM-ALL|CSTM-00|2020|PDM|1520.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F86851_0_0|SrvcGrp|84986|2022|PDM|788.00|99|0.00|CPT 44392|
20|FH_F87411_0_0|SrvcGrp|85684|2022|PDM|118.02|99|0.00|POLYSOMNOGRAPHY (MOD 26)|
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG III|
20|FH_F58252_0_0|SrvcGrp|48385|2022|PDM|31.25|99|0.00|SPEECH THERAPY|
20|FH_F136386_30901_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F118152_20151_0|SrvcGrp|29075|2022|PDM|40.00|99|0.00|HYDRATION THERAPY|
20|FH_F118193_06241_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F134075_78230_0|SrvcGrp|73742|2022|PCT|1.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F134126_11554_0|SrvcGrp|106301|2022|PDM|360.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT|
20|FH_F134156_32174_0|SrvcGrp|86723|2022|PDM|484.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F137147_75006_0|SrvcGrp|27261|2022|PDM|23370.00|99|0.00|CPT 27446|
20|FH_F142690_31774_0|SrvcGrp|27968|2022|PDM|65.00|99|0.00|SKILLED NURSING LPN|
20|FH_F117552_0_0|SrvcGrp|73008|2022|PDM|825.00|99|0.00|AEG 10|
20|FH_F97602_40121_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138607_02760_0|SrvcGrp|108421|2022|PDM|30.00|99|0.00|REPLACEMENT BREAST PUMP TUBE|
20|FH_F139456_47501_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F140343_89052_0|SrvcGrp|86827|2022|PDM|55.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F149646_71129_0|SrvcGrp|75419|2022|PDM|435.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F151603_27609_0|SrvcGrp|92408|2022|PDM|6243.23|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F151606_64772_0|SrvcGrp|108484|2022|PDM|1138.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F38332_0_0|SrvcGrp|18795|2022|PDM|42216.00|99|0.00|MS DRG 216|
20|FH_F109883_35007_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F76144_0_0|CSTM-ALL|CSTM-00|2020|PDM|1624.57|99|0.00|ASPG IV F/S - BDSS|
20|FH_F117270_32073_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F147725_06002_0|SrvcGrp|115164|2022|PDM|4680.00|99|0.00|MIDDLE EAR PROCEDURES|
20|FH_F129474_92701_0|SrvcGrp|87131|2022|PDM|900.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F129504_02871_0|SrvcGrp|43568|2022|PDM|111.00|99|0.00|SKILLED NURSING - RN|
20|FH_F137813_39232_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F137850_32826_0|SrvcGrp|3178|2022|PDM|844.00|99|0.00|ACUTE PSYCH|
20|FH_F104720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F111593_0_0|SrvcGrp|73002|2022|PDM|2404.60|99|0.00|AEG 7|
20|FH_F124893_40311_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F47452_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F111594_0_0|SrvcGrp|95559|2022|PDM|7215.00|99|0.00|HIP JOINT|
20|FH_F148425_01507_0|SrvcGrp|115401|2022|PCT|1.00|99|0.00|COVID-19 VACCINE COMBINATION - ELI LILLY|
20|FH_F148479_49519_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F51438_0_0|SrvcGrp|45882|2022|PDM|120.00|99|0.00|PT|
20|FH_F148002_78209_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|489.00|99|0.00|AEG 2 (NO REV)|
20|FH_F92677_08003_0|SrvcGrp|24750|2022|PDM|52.50|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F36383_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F88355_0_0|SrvcGrp|78045|2022|PCT|1.00|99|0.00|AETNA AMNIOTIC MEMBRANE|
20|FH_F37568_0_0|SrvcGrp|25939|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F62601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F95641_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F38702_0_0|SrvcGrp|112106|2022|PDM|87.00|99|0.00|COVID-19 AMP PRB (HCFA)|
20|FH_F32382_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|OP SVCS|
20|FH_F125540_19462_0|SrvcGrp|89417|2022|PDM|407.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F129801_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|PSYCHIATRIC RESIDENTIAL TREATMENT|
20|FH_F150951_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F103360_68845_0|SrvcGrp|89939|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F117872_33462_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F116581_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|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_F42343_0_0|SrvcGrp|109|2022|PDM|517.00|99|0.00|CD - DETOX|
20|FH_F64940_0_0|SrvcGrp|3810|2022|PDM|137.50|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F52293_0_0|SrvcGrp|16|2022|PDM|995.00|99|0.00|ACUTE REHABILITATION|
20|FH_F40685_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS|
20|FH_F80855_0_0|SrvcGrp|76096|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|418.03|99|0.00|ASPG 213|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.40|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1301 W/O REV|
20|FH_F31184_0_0|SrvcGrp|18143|2022|PDM|16100.00|99|0.00|MS DRG 247|
20|FH_F47834_0_0|CSTM-ALL|CSTM-00|2020|PDM|3659.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 5  (NO REV)|
20|FH_F121168_0_0|SrvcGrp|97705|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F144569_71055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133257_72088_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133291_33563_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F101840_76054_0|SrvcGrp|31020|2022|PDM|17529.00|99|0.00|MS DRG 470 ONLY|
20|FH_F130553_18640_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F97561_30030_0|CSTM-ALL|CSTM-00|2020|PCT|0.37|99|0.00|OP SVCS|
20|FH_F133287_40215_0|SrvcGrp|49743|2022|PDM|522.00|99|0.00|DIABETIC MANAGEMENT|
20|FH_F97161_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F117911_86403_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150602_59718_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132285_89103_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F81373_64064_0|SrvcGrp|78504|2022|PCT|0.66|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F134533_67801_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F44952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F148599_98034_0|SrvcGrp|16|2022|PDM|3312.00|99|0.00|ACUTE REHABILITATION|
20|FH_F43433_0_0|SrvcGrp|32442|2022|PDM|6180.00|99|0.00|JACKSON MADISON HOSP ASPG 6|
20|FH_F117550_0_0|SrvcGrp|38582|2022|PDM|28.00|99|0.00|THERAPY|
20|FH_F119229_90804_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145865_78130_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97566_79902_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F128421_27016_0|SrvcGrp|73643|2022|PCT|0.80|99|0.00|AETNA SUBACUTE CARE|
20|FH_F142749_15212_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38410_0_0|SrvcGrp|15846|2022|PDM|47.00|99|0.00|HOME VISIT|
20|FH_F83294_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150024_08079_0|SrvcGrp|88065|2022|PDM|4000.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F147997_92620_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F132991_84790_0|SrvcGrp|46605|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F121306_32207_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148599_98034_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F101840_76054_0|SrvcGrp|31925|2022|PDM|21386.00|99|0.00|MS DRG 483 ONLY|
20|FH_F142051_06604_0|SrvcGrp|75545|2022|PDM|450.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F147995_67037_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F49049_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F147992_63452_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132032_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124505_0_0|SrvcGrp|80539|2022|PDM|496.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 3|
20|FH_F146211_68144_0|SrvcGrp|75506|2022|PCT|1.20|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F94300_0_0|SrvcGrp|93600|2022|PDM|4200.00|99|0.00|TOTAL HIP ARTHOPLASTY(HCFA)|
20|FH_F90811_0_0|SrvcGrp|90435|2022|PDM|5300.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F38770_0_0|SrvcGrp|18099|2022|PCT|0.55|99|0.00|OP SURGERY|
20|FH_F32913_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31093_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F125070_64117_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128130_10027_0|SrvcGrp|75505|2022|PCT|4.41|99|0.00|CARDIAC STUDIES|
20|FH_F133155_0_0|SrvcGrp|97507|2022|PDM|100.00|99|0.00|AETNA HOSPICE|
20|FH_F148556_13206_0|SrvcGrp|17001|2022|PDM|90.00|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F103400_33426_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F43296_0_0|SrvcGrp|3178|2022|PDM|1045.00|99|0.00|ACUTE PSYCH|
20|FH_F72859_0_0|SrvcGrp|11802|2022|PDM|160.00|99|0.00|HOME INFUSION|
20|FH_F107082_21015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
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_F115405_06010_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F109625_27330_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125019_67665_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101922_98055_0|SrvcGrp|72984|2022|PCT|1.16|99|0.00|CHEMOTHERAPY|
20|FH_F38725_0_0|CSTM-ALL|CSTM-00|2020|PDM|786.00|99|0.00|ASPG X|
20|FH_F117909_92405_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F138451_0_0|SrvcGrp|111823|2022|PCT|0.90|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F119437_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|2300.00|99|0.00|AEG 6 (NO REV)|
20|FH_F151049_18702_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151120_71901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151141_24014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138347_77701_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F139428_65270_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F139680_76006_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F150760_44833_0|SrvcGrp|88620|2022|PDM|175.00|99|0.00|SKILLED NURSING RN|
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_F47836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|ENT SURG CTR -CVTY ENHANCED GROUP 5|
20|FH_F122377_91007_0|SrvcGrp|75943|2022|PDM|6379.00|99|0.00|AETNA INPATIENT SURGICAL CARE|
20|FH_F150942_66743_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|65403|2022|PDM|2202.00|99|0.00|CPT 42830|
20|FH_F37339_0_0|SrvcGrp|26107|2022|PDM|95.00|99|0.00|URGENT CARE|
20|FH_F137458_08857_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F138995_0_0|SrvcGrp|65403|2022|PDM|1199.00|99|0.00|CPT 42830|
20|FH_F138018_17313_0|SrvcGrp|40828|2022|PDM|105.00|99|0.00|CONTINUOUS INSULIN INFUSION THERAPY|
20|FH_F113524_0_0|SrvcGrp|105219|2022|PDM|11000.00|99|0.00|CERVICAL SPINAL FUSION|
20|FH_F117645_90034_0|SrvcGrp|90854|2022|PDM|1150.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F124452_31322_0|SrvcGrp|48396|2022|PDM|130.00|99|0.00|OT SERVICES|
20|FH_F147210_70633_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|76604|2022|PDM|1976.00|99|0.00|CPT 25447|
20|FH_F137748_95231_0|SrvcGrp|16718|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F129297_97828_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149419_33966_0|SrvcGrp|115602|2022|PCT|1.00|99|0.00|TELEMEDICINE|
20|FH_F105142_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F37580_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|SCHCP MRI MRA 550|
20|FH_F89640_98133_0|CSTM-ALL|CSTM-00|2020|PCT|1.11|99|0.00|AETNA - APC GROUPER G|
20|FH_F142370_0_0|SrvcGrp|113551|2022|PDM|75.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT|
20|FH_F54056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F94330_43220_0|SrvcGrp|22954|2022|PDM|132.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|902.00|99|0.00|AEG 4 (NO REV)|
20|FH_F128753_32501_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|GENERAL ACUTE CARE|
20|FH_F123570_0_0|SrvcGrp|73004|2022|PDM|1388.13|99|0.00|AEG 8|
20|FH_F100663_56537_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F67924_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150946_75783_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F144651_0_0|SrvcGrp|101103|2022|PDM|15000.00|99|0.00|REVIS SHOULDER JOINT|
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|394.00|99|0.00|AEG 1 (NO REV)|
20|FH_F47037_0_0|SrvcGrp|22387|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F138478_0_0|SrvcGrp|88485|2022|PDM|729.67|99|0.00|AETNA REVISE POCKET PACEMAKER|
20|FH_F35678_0_0|SrvcGrp|18219|2022|PDM|8476.00|99|0.00|MS DRG 029|
20|FH_F136947_0_0|SrvcGrp|106291|2022|PDM|400.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F149402_03301_0|SrvcGrp|92760|2022|PCT|1.25|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147321_24523_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PDM|3013.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F131261_19111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42979_0_0|SrvcGrp|3393|2022|PDM|101.00|99|0.00|CPT 90807 IND PSYCHOTHERAPY W/ E&M|
20|FH_F35097_16508_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|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_F136779_0_0|SrvcGrp|101840|2022|PDM|3463.00|99|0.00|REPAIR OF TENDON(S)|
20|FH_F111246_80027_0|SrvcGrp|33166|2022|PDM|525.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)|
20|FH_F110732_31513_0|SrvcGrp|72994|2022|PDM|1082.00|99|0.00|AEG 3|
20|FH_F97480_08204_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F149609_78624_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F127418_0_0|SrvcGrp|67066|2022|PDM|8294.74|99|0.00|CERVICAL SURGERY|
20|FH_F129237_72833_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F37003_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|1025.00|99|0.00|AEG 4 (NO REV)|
20|FH_F122260_98034_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F73262_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F131331_0_0|SrvcGrp|80317|2022|PDM|190.00|99|0.00|RESPITE CARE|
20|FH_F110783_93013_0|SrvcGrp|22389|2022|PDM|12.50|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F139147_0_0|SrvcGrp|15473|2022|PDM|5305.00|99|0.00|CPT CODE 42820|
20|FH_F38007_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F137719_28269_0|SrvcGrp|73605|2022|PDM|1176.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F97183_25304_0|SrvcGrp|73605|2022|PDM|1804.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F149579_95815_0|SrvcGrp|115669|2022|PDM|43.13|99|0.00|THERAPEUTIC MONITORING REM ADDL 20 MINS (HCFA)|
20|FH_F117576_21207_0|SrvcGrp|471|2022|PDM|720.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F124466_32724_0|SrvcGrp|73842|2022|PDM|165.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F109247_73102_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F139823_32250_0|SrvcGrp|73842|2022|PDM|232.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F140176_51445_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|OP SVCS|
20|FH_F139950_76240_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|369.00|99|0.00|AEG 1 (NO REV)|
20|FH_F101752_0_0|SrvcGrp|10393|2022|PDM|5600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F103060_0_0|SrvcGrp|73000|2022|PDM|2497.00|99|0.00|AEG 6|
20|FH_F102522_0_0|SrvcGrp|98694|2022|PDM|464.27|99|0.00|AFO SUPRAMALLEOLAR CUSTOM|
20|FH_F132433_34952_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132479_90290_0|SrvcGrp|75419|2022|PDM|850.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F116579_45822_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F116835_94538_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F119993_71913_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126438_50029_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F125436_60506_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F84394_17402_0|CSTM-ALL|CSTM-00|2020|PDM|5658.00|99|0.00|AEG 8 (NO REV)|
20|FH_F51276_0_0|SrvcGrp|27043|2022|PDM|18.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS (MOD SJ)|
20|FH_F130152_48025_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F143467_0_0|SrvcGrp|105632|2022|PDM|1424.00|99|0.00|AMPUTATION OF TOE|
20|FH_F147211_0_0|SrvcGrp|109459|2022|PDM|375.00|99|0.00|HEMODIALYSIS|
20|FH_F37200_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REGIONAL HEALTH SVCS OF HOWARD-DME-MOD AV|
20|FH_F40589_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS|
20|FH_F100742_00616_0|SrvcGrp|73601|2022|PDM|2564.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F137718_80107_0|SrvcGrp|109330|2022|PCT|1.10|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1213.38|99|0.00|ASPG VIII|
20|FH_F148339_71303_0|SrvcGrp|72602|2022|PDM|600.00|99|0.00|ECT|
20|FH_F101406_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|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_F146885_0_0|SrvcGrp|89337|2022|PDM|980.00|99|0.00|DETOXIFICATION|
20|FH_F100320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125569_71220_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F129415_69361_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HSS ASC|
20|FH_F39022_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F39819_0_0|SrvcGrp|9795|2022|PDM|400.00|99|0.00|SUBACUTE REHAB|
20|FH_F126883_78621_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F131357_17545_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F126595_32308_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F40661_0_0|SrvcGrp|269|2022|PDM|2500.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F86332_75081_0|SrvcGrp|19966|2022|PDM|30.00|99|0.00|HORMONAL THERAPY (LEUPROLIDE/GOSERLINE)|
20|FH_F71848_0_0|SrvcGrp|68779|2022|PDM|183.00|99|0.00|IMMUNOHISTO ANTIBODY STAIN|
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|938.00|99|0.00|ASPG III|
20|FH_F135216_64064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39783_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93720_12303_0|SrvcGrp|90643|2022|PDM|22.75|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F137527_31322_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31940_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
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_F145815_30540_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|ASPG VI|
20|FH_F69423_0_0|SrvcGrp|65625|2022|PDM|1200.00|99|0.00|CPT 30520|
20|FH_F137574_68130_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141527_36830_0|SrvcGrp|86825|2022|PDM|53.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F121539_27511_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145689_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143829_74066_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F90818_0_0|SrvcGrp|15473|2022|PDM|3125.00|99|0.00|CPT CODE 42820|
20|FH_F122536_0_0|CSTM-ALL|CSTM-00|2020|PDM|10329.00|99|0.00|ASPG VI|
20|FH_F93332_0_0|SrvcGrp|89842|2022|PDM|7416.00|99|0.00|LUMBAR|
20|FH_F145550_62034_0|SrvcGrp|48396|2022|PDM|105.00|99|0.00|OT SERVICES|
20|FH_F139719_0_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F82931_18847_0|SrvcGrp|72779|2022|PDM|121.03|99|0.00|RN - VISIT LEVEL|
20|FH_F118249_0_0|SrvcGrp|12664|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F122649_0_0|SrvcGrp|93098|2022|PDM|112.00|99|0.00|HOSPICE CARE|
20|FH_F128992_90808_0|SrvcGrp|86723|2022|PDM|550.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F130032_72034_0|SrvcGrp|105440|2022|PDM|223.00|99|0.00|AETNA TERANIAL MAGN STIM REDETEMINE|
20|FH_F135172_33157_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129782_0_0|SrvcGrp|110860|2022|PCT|1.00|99|0.00|CONJUNCTIVORHINOSTOMY|
20|FH_F51672_0_0|SrvcGrp|104732|2022|PDM|90.00|99|0.00|SPECIAL NURSE VISIT|
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|2450.00|99|0.00|AEG 9 (NO REV)|
20|FH_F33728_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116327_75701_0|SrvcGrp|73842|2022|PDM|192.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F67261_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F139173_0_0|SrvcGrp|94781|2022|PDM|450.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F41201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F125569_71220_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|946.00|99|0.00|AEG 3 (NO REV)|
20|FH_F136684_0_0|SrvcGrp|112917|2022|PCT|1.00|99|0.00|AQUEOUS DRAIN OCULAR IMPLANT|
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_F71686_0_0|SrvcGrp|68662|2022|PCT|0.50|99|0.00|HIGH COST DRUGS|
20|FH_F63276_0_0|SrvcGrp|42824|2022|PDM|140.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F135165_15728_0|SrvcGrp|48398|2022|PDM|93.00|99|0.00|PT SERVICES|
20|FH_F139515_0_0|SrvcGrp|108462|2022|PDM|3348.00|99|0.00|REPAIR LUMBAR HERNIA|
20|FH_F143783_0_0|SrvcGrp|87799|2022|PDM|105.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|ASPG X|
20|FH_F102184_0_0|SrvcGrp|98496|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR ATLAS|
20|FH_F145815_30540_0|SrvcGrp|113301|2022|PDM|16.94|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - ASTRAZENECA|
20|FH_F109260_0_0|SrvcGrp|89404|2022|PDM|23339.80|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F78446_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F84215_0_0|SrvcGrp|79420|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F43171_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37756_0_0|SrvcGrp|9937|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F137943_0_0|SrvcGrp|54162|2022|PDM|1660.00|99|0.00|REVISION OF AQUEOUS SHUNT|
20|FH_F139241_0_0|SrvcGrp|11663|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|699.00|99|0.00|AEG 2 (NO REV)|
20|FH_F34454_0_0|SrvcGrp|22954|2022|PDM|94.50|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F141587_40242_0|SrvcGrp|73842|2022|PDM|213.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139515_0_0|SrvcGrp|88159|2022|PDM|8549.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F100962_0_0|SrvcGrp|73006|2022|PDM|1353.00|99|0.00|AEG 9|
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 4 (NO REV)|
20|FH_F129656_15005_0|SrvcGrp|29075|2022|PDM|30.00|99|0.00|HYDRATION THERAPY|
20|FH_F86332_75081_0|SrvcGrp|19965|2022|PDM|30.00|99|0.00|INTERFERON|
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|2435.00|99|0.00|AEG 3 (NO REV)|
20|FH_F87619_0_0|SrvcGrp|73000|2022|PDM|1043.00|99|0.00|AEG 6|
20|FH_F64440_0_0|SrvcGrp|108695|2022|PDM|1106.00|99|0.00|OP SLEEP STUDIES (MOD TC) (UB)|
20|FH_F43858_0_0|SrvcGrp|37405|2022|PDM|90.00|99|0.00|OT SVCS|
20|FH_F116245_0_0|SrvcGrp|26001|2022|PDM|133.35|99|0.00|HOSPICE RESPITE SVCS|
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_F120338_83226_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122725_32216_0|CSTM-ALL|CSTM-00|2020|PDM|5.20|99|0.00|INTERVENE HLTH/BEHAVE GROUP|
20|FH_F129518_54002_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F60112_0_0|SrvcGrp|42830|2022|PDM|82.50|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PDM|385.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F130721_04769_0|SrvcGrp|114927|2022|PCT|2.25|99|0.00|CHEMOTHERAPY AND ALL OTHER DRUGS|
20|FH_F130775_61701_0|CSTM-ALL|CSTM-00|2020|PDM|464.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F138050_52301_0|SrvcGrp|88819|2022|PDM|1005.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F119110_91773_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F127529_43230_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F81698_10457_0|SrvcGrp|29023|2022|PDM|31.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F119379_0_0|SrvcGrp|107833|2022|PDM|1428.00|99|0.00|FUSION/GRAFT OF FINGER JOINT|
20|FH_F120719_27540_0|SrvcGrp|26690|2022|PCT|0.76|99|0.00|MS DRG 215 ONLY|
20|FH_F85133_85251_0|SrvcGrp|27969|2022|PDM|29.00|99|0.00|HOME HEALTH AIDE|
20|FH_F120670_0_0|SrvcGrp|106684|2022|PDM|17000.00|99|0.00|RECONSTRUCT ANKLE JOINT|
20|FH_F145641_06902_0|SrvcGrp|26275|2022|PDM|6458.00|99|0.00|CPT 29826|
20|FH_F116806_0_0|SrvcGrp|107035|2022|PDM|1923.16|99|0.00|TREATMENT OF FRACTURE|
20|FH_F112631_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125244_0_0|SrvcGrp|107868|2022|PDM|5500.00|99|0.00|AETNA LAPAROSCOPY SURGICAL|
20|FH_F149299_43351_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134191_75025_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F138056_64055_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F89323_63033_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F125124_0_0|SrvcGrp|73002|2022|PDM|1077.00|99|0.00|AEG 7|
20|FH_F119509_0_0|SrvcGrp|72980|2022|PCT|1.25|99|0.00|AETNA LABORATORY|
20|FH_F79743_0_0|SrvcGrp|59656|2022|PCT|0.57|99|0.00|MAMMOGRAPHY|
20|FH_F123616_30117_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F48834_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F93786_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145921_73139_0|SrvcGrp|88621|2022|PDM|87.55|99|0.00|SKILLED NURSING LPN|
20|FH_F149150_75407_0|SrvcGrp|108484|2022|PDM|750.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F96160_32207_0|SrvcGrp|85017|2022|PCT|1.07|99|0.00|DME|
20|FH_F122930_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT|
20|FH_F103220_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F149021_44514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.68|99|0.00|HAPA WPA-NWPA 2012-13 ASC 503 W/O REV|
20|FH_F131630_0_0|SrvcGrp|26275|2022|PDM|2861.00|99|0.00|CPT 29826|
20|FH_F139472_06902_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F109244_19808_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F73583_0_0|CSTM-ALL|CSTM-00|2020|PDM|340.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80172_0_0|SrvcGrp|43572|2022|PDM|85.86|99|0.00|PICC-LINE INSERTION|
20|FH_F49280_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1126.77|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1404 W/O REV|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD RR KF"|
20|FH_F107520_66612_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F127526_62917_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 3247 MOD RR|
20|FH_F92477_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138951_41101_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F95631_33705_0|SrvcGrp|73659|2022|PDM|10670.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F34182_0_0|SrvcGrp|12118|2022|PDM|736.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F51124_0_0|SrvcGrp|12403|2022|PDM|40.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|126.07|99|0.00|HAPA WPA-NWPA 2012-13 ASC 243 W/O REV|
20|FH_F133808_73401_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|3264.00|99|0.00|AEG 7 (NO REV)|
20|FH_F81698_10457_0|SrvcGrp|86834|2022|PDM|10.50|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F134172_33126_0|SrvcGrp|89417|2022|PDM|572.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F137817_17050_0|SrvcGrp|73841|2022|PDM|300.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F101945_0_0|SrvcGrp|98406|2022|PDM|2289.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F101945_0_0|SrvcGrp|83644|2022|PDM|2261.00|99|0.00|CPT 30465|
20|FH_F137934_51054_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F109821_0_0|SrvcGrp|103080|2022|PDM|1122.00|99|0.00|ORAL SURGERY|
20|FH_F90876_18447_0|SrvcGrp|29347|2022|PDM|22.05|99|0.00|HOME HEALTH AIDE|
20|FH_F91472_96001_0|SrvcGrp|103715|2022|PCT|0.40|99|0.00|POSTERIOR LUMBAR INTERBODY FUSION/REFUSION W/ALLOGRAFT|
20|FH_F124834_75246_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F128804_0_0|SrvcGrp|79101|2022|PDM|3520.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|2107.00|99|0.00|AEG 5  (NO REV)|
20|FH_F130035_0_0|SrvcGrp|111469|2022|PDM|56.70|99|0.00|INFLUENZA VACCINE|
20|FH_F112817_37027_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F113503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F147340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119444_72903_0|SrvcGrp|89337|2022|PDM|902.00|99|0.00|DETOXIFICATION|
20|FH_F142897_07018_0|SrvcGrp|113298|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - PFIZER|
20|FH_F146212_57108_0|CSTM-ALL|CSTM-00|2020|PDM|1351.43|99|0.00|AEG 3 (NO REV)|
20|FH_F132571_24739_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|2787.00|99|0.00|AEG 9 (NO REV)|
20|FH_F150123_60515_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F109812_37043_0|SrvcGrp|86747|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F81313_0_0|SrvcGrp|33164|2022|PDM|250.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|201.00|99|0.00|ASPG 220|
20|FH_F65359_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F134448_66203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50440_0_0|SrvcGrp|33164|2022|PDM|315.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F118785_33315_0|SrvcGrp|89149|2022|PDM|450.00|99|0.00|OP INTENSIVE|
20|FH_F146117_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1315.00|99|0.00|ASPG V|
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_F40980_0_0|SrvcGrp|16551|2022|PDM|5151.00|99|0.00|NEUROSCIENCE SVCS|
20|FH_F44135_0_0|SrvcGrp|10544|2022|PDM|70.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F142081_54929_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.23|99|0.00|HAPA WPA-NWPA 2012-13 ASC 708 W/O REV|
20|FH_F143171_18411_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44079_0_0|SrvcGrp|10543|2022|PDM|70.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F111415_33180_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148900_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F90955_06053_0|SrvcGrp|27968|2022|PDM|26.25|99|0.00|SKILLED NURSING LPN|
20|FH_F34706_0_0|SrvcGrp|13465|2022|PDM|10771.00|99|0.00|DRG 493 ONLY - LAP CHOLY W/O COMMON DUCT EXPLORATION W/CC|
20|FH_F37569_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141835_78676_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F119775_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F125013_85251_0|SrvcGrp|107483|2022|PCT|1.10|99|0.00|OP THERAPY SERVICE|
20|FH_F68842_0_0|SrvcGrp|12702|2022|PDM|77.00|99|0.00|RN, INTERMITTENT VISIT|
20|FH_F143171_18411_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120437_85202_0|SrvcGrp|86126|2022|PDM|47.65|99|0.00|AETNA GAMMA GLOBULIN|
20|FH_F133427_48811_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F117954_17961_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F101840_76054_0|SrvcGrp|47034|2022|PDM|9261.00|99|0.00|MS DRG 741 ONLY|
20|FH_F117613_08221_0|SrvcGrp|472|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F113261_38464_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92676_15063_0|SrvcGrp|79074|2022|PDM|323.03|99|0.00|MON VALLEY ASC 315|
20|FH_F141867_62258_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117508_90232_0|SrvcGrp|74614|2022|PDM|550.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F132269_34202_0|CSTM-ALL|CSTM-00|2020|PCT|0.61|99|0.00|GENERAL ACUTE CARE|
20|FH_F38673_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|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_F38630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|100% 2007 MEDICARETN DME MOD QW|
20|FH_F150948_0_0|SrvcGrp|80617|2022|PDM|10500.00|99|0.00|ARTHOPLASTY|
20|FH_F148009_71322_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126679_62401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD TC|
20|FH_F91198_46714_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F126806_44125_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F127204_44420_0|SrvcGrp|46605|2022|PDM|116.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F38630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|100% 2007 MEDICARE TN DME  MOD 53|
20|FH_F117720_23323_0|SrvcGrp|472|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117909_92405_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F51545_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128597_37129_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36993_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD RR|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD RR) - BDSS|
20|FH_F133627_89113_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117009_0_0|SrvcGrp|88154|2022|PDM|2146.00|99|0.00|LASER TREATMENT OLD RETINA|
20|FH_F126191_43616_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132922_91302_0|SrvcGrp|86723|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F114800_68510_0|SrvcGrp|48398|2022|PDM|92.00|99|0.00|PT SERVICES|
20|FH_F120417_63124_0|SrvcGrp|109015|2022|PCT|1.00|99|0.00|EPIFIX OR EPICORD|
20|FH_F132882_63857_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119763_17402_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132958_79903_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F145641_06902_0|CSTM-ALL|CSTM-00|2020|PDM|1143.00|99|0.00|AEG 4 (NO REV)|
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PDM|1112.00|99|0.00|AEG 6 (NO REV)|
20|FH_F86132_27105_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F88744_71103_0|CSTM-ALL|CSTM-00|2020|PDM|2316.00|99|0.00|AEG 5  (NO REV)|
20|FH_F39015_0_0|SrvcGrp|65|2022|PDM|2475.00|99|0.00|OBSTETRICAL CARE|
20|FH_F81656_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.50|99|0.00|OP SVCS|
20|FH_F93122_01854_0|SrvcGrp|88819|2022|PDM|413.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|578.00|99|0.00|AEG 3 (NO REV)|
20|FH_F138418_51201_0|SrvcGrp|83960|2022|PCT|0.90|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F125139_84096_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)|
20|FH_F79743_0_0|SrvcGrp|12342|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F133207_0_0|SrvcGrp|63466|2022|PDM|3809.00|99|0.00|CPT 52005|
20|FH_F69606_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F134509_14075_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F129525_48446_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F68626_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F102200_06416_0|SrvcGrp|14948|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F102200_06416_0|SrvcGrp|19742|2022|PDM|90.00|99|0.00|MID-LINE INSERTION|
20|FH_F105145_75075_0|SrvcGrp|82110|2022|PDM|6950.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC|
20|FH_F115786_57701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F75842_0_0|SrvcGrp|46509|2022|PDM|990.38|99|0.00|MSDRG  880-887 ONLY & REV ACUTE PSYCHIATRIC|
20|FH_F75842_0_0|SrvcGrp|46516|2022|PDM|9406.88|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F80513_0_0|SrvcGrp|29340|2022|PDM|9718.00|99|0.00|MS DRG 262 ONLY|
20|FH_F146668_30189_0|SrvcGrp|41327|2022|PDM|4500.00|99|0.00|OP SURGERY CPT 28308|
20|FH_F146795_44122_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146855_60069_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120778_43351_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120811_53525_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F127656_06068_0|SrvcGrp|110823|2022|PCT|1.00|99|0.00|OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F115952_44484_0|SrvcGrp|86753|2022|PCT|1.05|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F115979_46107_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F116040_24637_0|SrvcGrp|86851|2022|PDM|30.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F131697_33444_0|SrvcGrp|92760|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131737_15025_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F131454_06422_0|SrvcGrp|75545|2022|PDM|349.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F133478_40165_0|SrvcGrp|90003|2022|PDM|29331.00|99|0.00|MS DRG 250, 273 ONLY|
20|FH_F111847_70301_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F121326_60957_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|422.71|99|0.00|DELAWARE VALLEY- ASC 404|
20|FH_F113738_27006_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT HH|
20|FH_F117299_0_0|SrvcGrp|107498|2022|PDM|1144.00|99|0.00|AETNA VASECTOMY, UNILAT OR BILAT|
20|FH_F114916_30309_0|SrvcGrp|72121|2022|PDM|2500.00|99|0.00|ARTHOSCOPY|
20|FH_F142448_15701_0|SrvcGrp|22589|2022|PDM|50.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F112967_0_0|SrvcGrp|74546|2022|PDM|489.00|99|0.00|HOSPICE SERVICES|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|ASPG V|
20|FH_F135491_0_0|SrvcGrp|114442|2022|PDM|5236.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 3 (NO REV)|
20|FH_F138929_0_0|SrvcGrp|87679|2022|PDM|1457.50|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F94786_07974_0|SrvcGrp|24761|2022|PDM|31.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F68950_0_0|SrvcGrp|29718|2022|PCT|0.70|99|0.00|SUPPLIES/DEVICES/IMPLANTABLES|
20|FH_F114389_50131_0|SrvcGrp|105622|2022|PDM|255.89|99|0.00|SEMI-ELECTRIC HOSPITAL BED (MOD RR)|
20|FH_F114389_50131_0|SrvcGrp|88827|2022|PDM|48.28|99|0.00|HOME INFUSION (HCFA)|
20|FH_F136735_0_0|SrvcGrp|108434|2022|PDM|2000.00|99|0.00|INSJ AQUEOUS DRAIN DEV 1ST|
20|FH_F49487_0_0|SrvcGrp|38755|2022|PDM|75.00|99|0.00|ALL SPECIALTY AMINO ACIDS|
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)|
20|FH_F115971_0_0|SrvcGrp|72992|2022|PDM|497.00|99|0.00|AEG 2|
20|FH_F124059_64055_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F146674_70778_0|SrvcGrp|106048|2022|PDM|800.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F43832_0_0|SrvcGrp|13703|2022|PDM|67.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F38233_0_0|SrvcGrp|11798|2022|PDM|54.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F39910_0_0|SrvcGrp|24703|2022|PDM|392.00|99|0.00|NEWBORN NURSERY|
20|FH_F124237_95023_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F127995_84010_0|SrvcGrp|86852|2022|PDM|22.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F127995_84010_0|SrvcGrp|53746|2022|PDM|107.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F67882_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.00|99|0.00|ADULT DAY|
20|FH_F138693_45723_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F148553_85016_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 7 (NO REV)|
20|FH_F122610_73139_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F134747_83404_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136927_45690_0|SrvcGrp|48396|2022|PDM|83.00|99|0.00|OT SERVICES|
20|FH_F113713_17013_0|SrvcGrp|86866|2022|PDM|85.00|99|0.00|AETNA PSYCH DIAG EVAL W/MED SRVC (MOD TD)(HCFA)|
20|FH_F115631_65201_0|SrvcGrp|83640|2022|PDM|3177.00|99|0.00|CPT 29887|
20|FH_F115631_65201_0|SrvcGrp|103542|2022|PDM|3177.00|99|0.00|ANKLE ARTHROSCOPY/SURGERY|
20|FH_F147305_90755_0|SrvcGrp|48385|2022|PDM|134.00|99|0.00|SPEECH THERAPY|
20|FH_F147527_60645_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41675_0_0|SrvcGrp|34668|2022|PDM|650.00|99|0.00|UNCOMPLICATED VENTILATOR SERVICES|
20|FH_F41832_0_0|SrvcGrp|15402|2022|PDM|55.00|99|0.00|HOME INFUSION NURSING SVCS|
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_F42837_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD NU|
20|FH_F38135_0_0|SrvcGrp|28228|2022|PDM|1872.00|99|0.00|PEDIATRIC SURGICAL SERVICES|
20|FH_F38135_0_0|CSTM-ALL|CSTM-00|2020|PDM|1213.00|99|0.00|PEDIATRIC MEDICINE|
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PDM|2090.00|99|0.00|AEG 8 (NO REV)|
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PDM|808.50|99|0.00|AEG 3 (NO REV)|
20|FH_F98361_12065_0|SrvcGrp|73485|2022|PDM|2840.00|99|0.00|AETNA REHAB|
20|FH_F38949_0_0|SrvcGrp|3029|2022|PDM|372.00|99|0.00|NEWBORN NURSERY|
20|FH_F41803_0_0|SrvcGrp|34871|2022|PCT|0.80|99|0.00|CORNEAL TISSUE TRANSPLANT|
20|FH_F113585_20155_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT HOME HEALTH|
20|FH_F138681_39301_0|SrvcGrp|89417|2022|PDM|423.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F138681_39301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F92188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F34999_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F113390_0_0|SrvcGrp|91941|2022|PDM|2750.00|99|0.00|NASAL/SINUS ENDOSCOPY WITH DILATION|
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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|3133.75|99|0.00|AVF USE MAGNETIC/ART/VEN|
20|FH_F83152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F82379_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151304_31520_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 2 (NO REV)|
20|FH_F151425_19111_0|SrvcGrp|116002|2022|PCT|1.00|99|0.00|TELEMEDICINE (MOD GT)|
20|FH_F151515_77901_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151516_63023_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132258_45404_0|SrvcGrp|86779|2022|PDM|43.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F132268_07060_0|SrvcGrp|89502|2022|PDM|38.39|99|0.00|NEUROMUSCULAR REEDUCATION|
20|FH_F123194_97222_0|SrvcGrp|104079|2022|PCT|1.25|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F133119_46545_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36555_0_0|SrvcGrp|472|2022|PDM|468.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F135407_62320_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135590_84066_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135609_37027_0|SrvcGrp|108484|2022|PDM|1012.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F91764_93710_0|SrvcGrp|113228|2022|PCT|2.12|99|0.00|COVID-19 NFCT DS VIR RESP RNA 4 TRGT|
20|FH_F135907_74501_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135924_02906_0|SrvcGrp|111926|2022|PDM|203.10|99|0.00|COVID-19 LAB TESTING|
20|FH_F135978_06851_0|SrvcGrp|109330|2022|PCT|1.20|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136211_74447_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130996_34110_0|SrvcGrp|84318|2022|PDM|6500.00|99|0.00|SPINE INFUSION|
20|FH_F130766_04967_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F140629_0_0|SrvcGrp|33967|2022|PDM|2497.00|99|0.00|CPT 47562|
20|FH_F121823_46234_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F47906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD 26|
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F94280_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1682.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132328_0_0|SrvcGrp|88164|2022|PDM|14566.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F132328_0_0|SrvcGrp|103635|2022|PDM|13005.00|99|0.00|AETNA TRLUML PERIP ATHRC LLIAC ART|
20|FH_F118651_0_0|SrvcGrp|107869|2022|PDM|4349.69|99|0.00|AETNA EXC ABD TUM OVER 10 CM|
20|FH_F98626_29118_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F129220_18445_0|SrvcGrp|91398|2022|PDM|106.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AJ)|
20|FH_F132877_06105_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36034_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41433_0_0|SrvcGrp|12403|2022|PDM|34.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F111186_15213_0|SrvcGrp|46903|2022|PDM|1141.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F48772_66044_0|SrvcGrp|28630|2022|PDM|100.00|99|0.00|HOME INFUSION SKILLED NURSING|
20|FH_F142087_0_0|SrvcGrp|93063|2022|PDM|15000.00|99|0.00|LUMBAR ARTIF DISKECTOMY|
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F86851_0_0|SrvcGrp|84992|2022|PDM|324.00|99|0.00|CPT 45317|
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F89372_0_0|SrvcGrp|106065|2022|PDM|324.00|99|0.00|TRANSCRANIAL MAGNETIC STIMULATION|
20|FH_F88639_80204_0|SrvcGrp|75495|2022|PDM|16043.58|99|0.00|AEG 9|
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|211.56|99|0.00|SLEEP STUDY CPT 95800|
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F69683_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46832_0_0|SrvcGrp|32704|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F123818_43452_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123783_03860_0|SrvcGrp|23683|2022|PDM|77.00|99|0.00|SKILLED NURSING RN|
20|FH_F120444_84037_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F93177_73044_0|SrvcGrp|78504|2022|PCT|0.80|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F134070_20017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134155_07016_0|SrvcGrp|109330|2022|PCT|1.16|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F137147_75006_0|SrvcGrp|26668|2022|PDM|42724.00|99|0.00|MS DRG 461 ONLY|
20|FH_F137227_64133_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137232_28210_0|SrvcGrp|8950|2022|PDM|1200.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F142527_89109_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F53732_0_0|SrvcGrp|41460|2022|PDM|20.00|99|0.00|ENTERAL THERAPY - UNSPECIFIED|
20|FH_F83831_0_0|SrvcGrp|62154|2022|PDM|66.00|99|0.00|PICC LINES|
20|FH_F138627_82901_0|SrvcGrp|41459|2022|PDM|150.00|99|0.00|NOC FOR ENTERAL SUPPLIES|
20|FH_F77782_66061_0|SrvcGrp|46934|2022|PCT|0.80|99|0.00|MS DRG 252-254 ONLY|
20|FH_F139267_30253_0|SrvcGrp|113176|2022|PDM|28.39|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - MODERNA|
20|FH_F118914_43015_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F118932_07652_0|SrvcGrp|72994|2022|PDM|1591.00|99|0.00|AEG 3|
20|FH_F109930_73109_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147799_18052_0|SrvcGrp|29347|2022|PCT|1.00|99|0.00|HOME HEALTH AIDE|
20|FH_F147726_18017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129427_92262_0|SrvcGrp|109798|2022|PCT|1.50|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F129504_02871_0|SrvcGrp|88621|2022|PDM|111.00|99|0.00|SKILLED NURSING LPN|
20|FH_F38438_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117107_33704_0|SrvcGrp|74802|2022|PCT|1.00|99|0.00|AETNA CPT 36415|
20|FH_F111593_0_0|SrvcGrp|87053|2022|PDM|2145.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F90880_15108_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F124754_84403_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114630_48205_0|SrvcGrp|89417|2022|PDM|290.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F72427_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47552_0_0|SrvcGrp|43272|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|646.00|99|0.00|ASPG I|
20|FH_F95880_02726_0|SrvcGrp|94738|2022|PDM|56.65|99|0.00|FLUZONE VACC IM (>=3 YRS)|
20|FH_F111594_0_0|SrvcGrp|72121|2022|PDM|2887.00|99|0.00|ARTHOSCOPY|
20|FH_F119500_01570_0|SrvcGrp|473|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F140035_0_0|SrvcGrp|72941|2022|PDM|263.00|99|0.00|HOSPICE CARE IN HOME|
20|FH_F101840_76054_0|SrvcGrp|20968|2022|PDM|15337.00|99|0.00|MS DRG 480 ONLY|
20|FH_F67302_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F142752_19428_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F106660_26554_0|SrvcGrp|73700|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F72750_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|MS DRG UNGROUPABLE INPATIENT|
20|FH_F113261_38464_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F147993_65622_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1221.00|99|0.00|AEG 6 (NO REV)|
20|FH_F77663_0_0|SrvcGrp|3087|2022|PDM|630.00|99|0.00|CD - DETOX|
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132934_63005_0|SrvcGrp|112081|2022|PDM|145000.00|99|0.00|ECMO|
20|FH_F97581_60141_0|SrvcGrp|88977|2022|PDM|6636.00|99|0.00|C-SECTION DELIVERY|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|507.94|99|0.00|HAPA WPA-NWPA 2012-13 ASC 203 W/O REV|
20|FH_F88956_0_0|SrvcGrp|87988|2022|PDM|15610.00|99|0.00|AETNA GASTROPLASTY|
20|FH_F106880_80528_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F41396_0_0|SrvcGrp|34269|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F86293_0_0|SrvcGrp|54943|2022|PDM|2048.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F46876_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F66648_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F40267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
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_F97561_30030_0|SrvcGrp|73485|2022|PDM|3736.00|99|0.00|AETNA REHAB|
20|FH_F44016_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|RAD|
20|FH_F133118_33143_0|SrvcGrp|87317|2022|PDM|856.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F133021_00910_0|SrvcGrp|112304|2022|PDM|7500.00|99|0.00|EMBOLIZATION|
20|FH_F132934_63005_0|SrvcGrp|12840|2022|PCT|0.50|99|0.00|PACEMAKER|
20|FH_F106600_99202_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128316_22192_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F40980_0_0|SrvcGrp|3277|2022|PDM|2802.00|99|0.00|SKILLED NURSING CARE|
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|AEG 4 (NO REV)|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|243.00|99|0.00|HAPA EPA ASC 32|
20|FH_F89851_83854_0|SrvcGrp|75506|2022|PCT|2.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F151522_72712_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35509_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F115289_90057_0|SrvcGrp|73841|2022|PDM|400.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F149882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F72686_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F95980_20016_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F105921_80014_0|SrvcGrp|73742|2022|PCT|1.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F141411_0_0|SrvcGrp|64517|2022|PDM|20000.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F103360_68845_0|SrvcGrp|98252|2022|PDM|16337.00|99|0.00|CARDIAC CATH PROCEDURES|
20|FH_F97561_30030_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F73684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F87334_16507_0|SrvcGrp|85602|2022|PCT|1.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F148555_0_0|SrvcGrp|115500|2022|PDM|3914.00|99|0.00|ELECTROPHYS MAP, 3D, ADD-ON|
20|FH_F41229_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37491_0_0|SrvcGrp|23992|2022|PDM|37.00|99|0.00|PSYCH PARTIAL HOSP EXTENDED DAY|
20|FH_F126666_44053_0|SrvcGrp|105370|2022|PDM|39.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MINS(HCFA)|
20|FH_F146159_89102_0|SrvcGrp|29346|2022|PDM|40.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F146790_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS|
20|FH_F132601_92677_0|SrvcGrp|73063|2022|PDM|770.00|99|0.00|OBSERVATION SERVICES|
20|FH_F136751_0_0|SrvcGrp|72121|2022|PDM|7500.00|99|0.00|ARTHOSCOPY|
20|FH_F51123_0_0|SrvcGrp|11796|2022|PDM|115.00|99|0.00|DIETICIAN|
20|FH_F120437_85202_0|SrvcGrp|17006|2022|PDM|39.39|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS|
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_F51232_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33866_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F132601_92677_0|SrvcGrp|73605|2022|PDM|970.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F101811_64116_0|SrvcGrp|99438|2022|PDM|80.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|186.20|99|0.00|ASPG 221|
20|FH_F44093_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F149841_73114_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133003_49012_0|SrvcGrp|108484|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F150464_15746_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118708_33455_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F39051_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130626_42345_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132591_75146_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F41461_0_0|SrvcGrp|38|2022|PDM|1800.00|99|0.00|NORMAL DELIVERY|
20|FH_F87297_17044_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|OP SVCS|
20|FH_F101840_76054_0|SrvcGrp|21124|2022|PDM|14607.00|99|0.00|MS DRG 471 ONLY|
20|FH_F111802_22003_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F100788_01420_0|SrvcGrp|73485|2022|PDM|3314.00|99|0.00|AETNA REHAB|
20|FH_F132400_79106_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|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40297_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|ACUTE REHABILITATION|
20|FH_F63250_0_0|SrvcGrp|52782|2022|PDM|46.00|99|0.00|VENIPUNCTURE PER VISIT|
20|FH_F40176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143993_07621_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F98620_43920_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|2063.00|99|0.00|AEG 8 (NO REV)|
20|FH_F72226_65804_0|SrvcGrp|104363|2022|PCT|0.56|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F148701_32708_0|SrvcGrp|74668|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151049_18702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139248_78070_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F150766_33952_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F150767_34741_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F150839_03833_0|SrvcGrp|53987|2022|PDM|87.00|99|0.00|PHOTOTHERAPY|
20|FH_F37864_0_0|CSTM-ALL|CSTM-00|2020|PDM|634.48|99|0.00|ASPG III|
20|FH_F147160_80260_0|SrvcGrp|111555|2022|PDM|150.00|99|0.00|GROUP PSYCHOTHERAPY|
20|FH_F101083_0_0|SrvcGrp|73000|2022|PDM|1123.00|99|0.00|AEG 6|
20|FH_F35280_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|115930|2022|PDM|2600.00|99|0.00|EYELID REVISION|
20|FH_F114585_11501_0|SrvcGrp|104076|2022|PCT|1.03|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F134847_0_0|SrvcGrp|11673|2022|PDM|5926.00|99|0.00|CPT 29888|
20|FH_F131385_76457_0|SrvcGrp|73842|2022|PDM|198.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F36222_0_0|SrvcGrp|115|2022|PDM|412.00|99|0.00|SKILLED NURSING CARE|
20|FH_F136677_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149480_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F52276_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109460_98003_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F137767_01841_0|SrvcGrp|12787|2022|PCT|0.53|99|0.00|IMPLANTS|
20|FH_F45226_0_0|SrvcGrp|11076|2022|PDM|70.00|99|0.00|NURSING CARE|
20|FH_F138995_0_0|SrvcGrp|27344|2022|PDM|1500.00|99|0.00|OP SURGERY (CPT 42821)|
20|FH_F35167_0_0|SrvcGrp|12543|2022|PCT|0.70|99|0.00|LAPAROSCOPIC HYSTERECTOMY|
20|FH_F90817_0_0|SrvcGrp|90372|2022|PDM|1433.00|99|0.00|REP FLX TEND ZONE 2 DIGT SEC|
20|FH_F130661_04441_0|SrvcGrp|537|2022|PCT|0.86|99|0.00|OBSERVATION SERVICES|
20|FH_F116437_0_0|SrvcGrp|77507|2022|PCT|1.10|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F39976_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117615_30525_0|SrvcGrp|107654|2022|PCT|1.46|99|0.00|OP TELEMEDICINE|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|214.05|99|0.00|SALLY BALIN,999182,ASC 112|
20|FH_F138216_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F90817_0_0|SrvcGrp|90365|2022|PDM|1997.00|99|0.00|REPAIR METACARPAL FRACTURE|
20|FH_F49338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F120099_86305_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F116753_0_0|SrvcGrp|73601|2022|PDM|2459.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F47659_0_0|CSTM-ALL|CSTM-00|2020|PDM|6100.00|99|0.00|CV SURGERY|
20|FH_F116753_0_0|SrvcGrp|88978|2022|PDM|2187.00|99|0.00|VAGINAL DELIVERY|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|116.24|99|0.00|SALLY BALIN,999182,ASC 224|
20|FH_F148839_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F137713_50025_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F141287_14830_0|SrvcGrp|111926|2022|PDM|39.51|99|0.00|COVID-19 LAB TESTING|
20|FH_F94643_90501_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F114571_34613_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F147147_50265_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141334_66401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F108180_29526_0|SrvcGrp|93919|2022|PDM|580.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F148940_44077_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117426_0_0|SrvcGrp|96201|2022|PDM|45.00|99|0.00|PT/OT/ST|
20|FH_F93268_0_0|SrvcGrp|76501|2022|PDM|329.68|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F35774_33573_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F134847_0_0|SrvcGrp|88161|2022|PDM|6110.00|99|0.00|LAMINECTOMY W/FACE-THORACIC|
20|FH_F137767_01841_0|SrvcGrp|73483|2022|PDM|969.00|99|0.00|AETNA SUBACUTE III|
20|FH_F98022_89015_0|SrvcGrp|73485|2022|PDM|4028.00|99|0.00|AETNA REHAB|
20|FH_F139227_33162_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149020_78653_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F90817_0_0|SrvcGrp|91008|2022|PDM|2293.00|99|0.00|REPAIR OF ANKLE FRACTURE (HCFA)|
20|FH_F138540_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|2338.00|99|0.00|AEG 7 (NO REV)|
20|FH_F122396_90024_0|SrvcGrp|108061|2022|PCT|1.25|99|0.00|OP THERAPY SERVICES|
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|37963.00|99|0.00|MS DRG 216-218|
20|FH_F40446_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F147160_80260_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F142327_0_0|SrvcGrp|85966|2022|PDM|2500.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F35452_0_0|SrvcGrp|10927|2022|PCT|0.85|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F122393_76020_0|SrvcGrp|75419|2022|PDM|386.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F40446_0_0|SrvcGrp|3418|2022|PDM|1300.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F147231_49440_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37777_0_0|SrvcGrp|36230|2022|PDM|934.00|99|0.00|STROKE, NEURO|
20|FH_F128753_32501_0|SrvcGrp|73606|2022|PCT|0.64|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F35167_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|MULTIPLE BIRTH|
20|FH_F132149_60624_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F147083_46304_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120332_0_0|SrvcGrp|88620|2022|PDM|87.50|99|0.00|SKILLED NURSING RN|
20|FH_F148859_0_0|SrvcGrp|75725|2022|PDM|2185.00|99|0.00|LASER PROCEDURES|
20|FH_F124526_05301_0|SrvcGrp|90160|2022|PDM|1222.00|99|0.00|AETNA INPATIENT DETOX (>= 18 YEARS OF AGE)|
20|FH_F48695_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114308_70601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39443_0_0|SrvcGrp|30360|2022|PDM|966.00|99|0.00|HAPA WPA ASC 5|
20|FH_F35097_16508_0|SrvcGrp|17754|2022|PDM|57.00|99|0.00|DRESSING SET FOR  NEG PRESSURE WOUND THERAPY ELEC PUMP|
20|FH_F66760_0_0|SrvcGrp|63458|2022|PDM|800.00|99|0.00|ANTEPARTUM VISITS 7 OR MORE|
20|FH_F128191_28642_0|SrvcGrp|23683|2022|PDM|46.00|99|0.00|SKILLED NURSING RN|
20|FH_F131292_37650_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117762_0_0|SrvcGrp|36591|2022|PDM|5408.00|99|0.00|CPT 63685|
20|FH_F80834_0_0|SrvcGrp|3418|2022|PDM|6887.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F100663_56537_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F148347_0_0|SrvcGrp|109800|2022|PDM|2378.00|99|0.00|REPAIR ANAL FISTULA|
20|FH_F140097_19145_0|SrvcGrp|73841|2022|PDM|370.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F140104_70359_0|CSTM-ALL|CSTM-00|2020|PCT|1.65|99|0.00|HSS ASC|
20|FH_F143471_02895_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F102224_0_0|SrvcGrp|84442|2022|PDM|9900.00|99|0.00|REVISION KNEE|
20|FH_F102224_0_0|SrvcGrp|58636|2022|PDM|6000.00|99|0.00|CPT 62362|
20|FH_F102224_0_0|SrvcGrp|93807|2022|PDM|6000.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|1120.00|99|0.00|AEG 4 (NO REV)|
20|FH_F151720_03301_0|SrvcGrp|92760|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F47128_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136250_73026_0|SrvcGrp|46903|2022|PDM|1220.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132414_30571_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119591_75034_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F118792_63379_0|SrvcGrp|75506|2022|PCT|0.74|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F84611_30281_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F39028_0_0|SrvcGrp|29958|2022|PCT|1.00|99|0.00|DME MOD KF|
20|FH_F143467_0_0|SrvcGrp|100060|2022|PDM|4157.00|99|0.00|REPAIR MIDFOOT FRACTURE EACH|
20|FH_F147005_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|J CODES & IMMUN FS# 137118|
20|FH_F39567_0_0|SrvcGrp|13551|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1874.25|99|0.00|ASPG IX|
20|FH_F67261_0_0|SrvcGrp|13123|2022|PDM|475.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F123372_0_0|SrvcGrp|63|2022|PDM|1711.00|99|0.00|SUBACUTE CARE|
20|FH_F87254_0_0|SrvcGrp|104616|2022|PDM|1400.00|99|0.00|REPAIR OF RECTOCELE|
20|FH_F65440_0_0|SrvcGrp|27402|2022|PDM|3214.00|99|0.00|LASER PROCEDURES|
20|FH_F42999_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39617_0_0|SrvcGrp|38|2022|PDM|2758.00|99|0.00|NORMAL DELIVERY|
20|FH_F56136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|OP SVCS|
20|FH_F149859_60005_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F124899_45246_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F105680_0_0|SrvcGrp|75483|2022|PDM|1257.00|99|0.00|AEG 3|
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_F129023_15501_0|SrvcGrp|75545|2022|PDM|361.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F122687_0_0|SrvcGrp|109189|2022|PDM|3825.00|99|0.00|TARSAL BONE DISLOCATION TREATMENT|
20|FH_F117440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129221_84325_0|SrvcGrp|104079|2022|PCT|0.75|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 252-254 CV SURGERY|
20|FH_F145534_02155_0|SrvcGrp|74668|2022|PDM|450.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F102185_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F37679_0_0|SrvcGrp|17014|2022|PDM|61.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F130716_76013_0|SrvcGrp|46605|2022|PDM|105.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F116760_68512_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F82114_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F90691_0_0|SrvcGrp|72998|2022|PDM|785.00|99|0.00|AEG 5|
20|FH_F125710_02860_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F49338_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F110925_01104_0|SrvcGrp|86141|2022|PDM|18.85|99|0.00|AETNA NATALIZUMAB|
20|FH_F36433_0_0|CSTM-ALL|CSTM-00|2020|PDM|29741.00|99|0.00|MS DRG 216-221, 228-236|
20|FH_F131176_28712_0|SrvcGrp|114008|2022|PDM|450.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F32154_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F73013_0_0|SrvcGrp|42971|2022|PDM|175.00|99|0.00|SKN RN|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 242-244 PACEMAKER IMPLANT|
20|FH_F149740_33912_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F38341_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F137611_30909_0|SrvcGrp|73842|2022|PDM|176.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131357_17545_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F51358_0_0|SrvcGrp|45944|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE SVCS|
20|FH_F123957_84321_0|SrvcGrp|75419|2022|PDM|409.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F60812_0_0|SrvcGrp|3044|2022|PCT|0.75|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F126033_15301_0|SrvcGrp|48398|2022|PDM|92.72|99|0.00|PT SERVICES|
20|FH_F131311_64804_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87595_0_0|SrvcGrp|36991|2022|PCT|0.49|99|0.00|IMPLANTS|
20|FH_F113410_0_0|SrvcGrp|72121|2022|PDM|2627.00|99|0.00|ARTHOSCOPY|
20|FH_F62892_0_0|SrvcGrp|10543|2022|PDM|95.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F118366_17110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124965_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F115079_62062_0|SrvcGrp|92760|2022|PCT|1.85|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40421_0_0|SrvcGrp|64|2022|PCT|0.75|99|0.00|AMBULATORY SURGERY|
20|FH_F72143_0_0|SrvcGrp|360|2022|PDM|2800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F124026_53188_0|SrvcGrp|73605|2022|PDM|799.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F50218_0_0|SrvcGrp|46244|2022|PDM|120.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F137067_0_0|SrvcGrp|88597|2022|PDM|6300.00|99|0.00|INTERNAL FIX FOR FRACT/INSTA|
20|FH_F135055_63016_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130747_0_0|SrvcGrp|88158|2022|PDM|14566.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F38297_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128333_71001_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F116021_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F98922_40351_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F145545_01602_0|SrvcGrp|90388|2022|PDM|504.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F125703_02907_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F62719_0_0|SrvcGrp|59293|2022|PDM|54.00|99|0.00|NURSING CARE|
20|FH_F113410_0_0|SrvcGrp|27347|2022|PDM|2627.00|99|0.00|CPT 58558|
20|FH_F122433_0_0|SrvcGrp|11663|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F72183_0_0|SrvcGrp|9793|2022|PDM|600.00|99|0.00|NEWBORN NURSERY|
20|FH_F33850_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|1083.00|99|0.00|AEG 6 (NO REV)|
20|FH_F115064_78582_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F74964_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F125883_78748_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F86654_33073_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143783_0_0|SrvcGrp|94781|2022|PDM|105.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|HOME HEALTH AIDE|
20|FH_F89453_75069_0|SrvcGrp|73523|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F93880_95476_0|SrvcGrp|72998|2022|PDM|5595.00|99|0.00|AEG 5|
20|FH_F72742_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F135219_68506_0|SrvcGrp|112054|2022|PCT|1.00|99|0.00|COVID-19 ANTIBODY|
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41021_0_0|SrvcGrp|17079|2022|PDM|6589.00|99|0.00|ASPG VIII|
20|FH_F91994_0_0|SrvcGrp|77449|2022|PDM|1760.00|99|0.00|CPT 52352|
20|FH_F65159_0_0|SrvcGrp|21294|2022|PDM|2333.00|99|0.00|TRANSITIONAL NURSERY|
20|FH_F60292_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F38560_0_0|SrvcGrp|29514|2022|PDM|15000.00|99|0.00|ADULT ABLATION/ELECTROPHYSIOLOGY|
20|FH_F45052_0_0|SrvcGrp|9873|2022|PDM|100.00|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F135840_0_0|SrvcGrp|75487|2022|PDM|753.00|99|0.00|AEG 5|
20|FH_F130665_67202_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130901_68970_0|SrvcGrp|79699|2022|PCT|0.98|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F149050_22844_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135610_06451_0|SrvcGrp|95661|2022|PDM|119.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F93176_73750_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F98021_07012_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120930_0_0|SrvcGrp|99161|2022|PDM|5500.00|99|0.00|CPT 27138|
20|FH_F146124_06112_0|SrvcGrp|44094|2022|PCT|0.00|99|0.00|BURN SERVICES|
20|FH_F109400_80026_0|SrvcGrp|43567|2022|PDM|98.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F112065_20852_0|SrvcGrp|88621|2022|PDM|130.00|99|0.00|SKILLED NURSING LPN|
20|FH_F143650_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|AEG 5  (NO REV)|
20|FH_F90496_13159_0|SrvcGrp|89412|2022|PDM|233.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F133492_0_0|SrvcGrp|86425|2022|PDM|1327.00|99|0.00|EGD LESION ABLATION|
20|FH_F147502_0_0|SrvcGrp|84185|2022|PDM|100.00|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_F134659_83628_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|AEG 1 (NO REV)|
20|FH_F150161_63361_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F85353_16407_0|SrvcGrp|63781|2022|PDM|1373.15|99|0.00|HAPA WPA-NWPA 2012-13 ASC 704|
20|FH_F112023_12866_0|SrvcGrp|104360|2022|PDM|6094.00|99|0.00|COMPLEX MEDICAL EQUIPMENT|
20|FH_F146590_77449_0|SrvcGrp|48394|2022|PDM|41.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F32116_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F77943_0_0|SrvcGrp|9938|2022|PCT|0.70|99|0.00|SPEECH THERAPY|
20|FH_F128828_44122_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F110509_71351_0|SrvcGrp|72984|2022|PCT|1.50|99|0.00|CHEMOTHERAPY|
20|FH_F90438_08873_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F133815_46526_0|SrvcGrp|13238|2022|PCT|0.00|99|0.00|VENIPUNCTURE|
20|FH_F127895_31516_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F79743_0_0|SrvcGrp|14610|2022|PCT|0.57|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F39378_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F90500_32446_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F110345_37919_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149199_73005_0|SrvcGrp|15789|2022|PDM|72.00|99|0.00|SPEECH THERAPY|
20|FH_F80224_0_0|SrvcGrp|4116|2022|PCT|1.00|99|0.00|AMBULANCE SERVICES|
20|FH_F134593_60007_0|SrvcGrp|22593|2022|PDM|42.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|1375.00|99|0.00|AEG 4 (NO REV)|
20|FH_F138240_64114_0|SrvcGrp|48398|2022|PDM|122.00|99|0.00|PT SERVICES|
20|FH_F111986_0_0|SrvcGrp|65625|2022|PDM|1442.00|99|0.00|CPT 30520|
20|FH_F141210_0_0|SrvcGrp|41334|2022|PDM|13648.00|99|0.00|TOTAL KNEE|
20|FH_F145641_06902_0|SrvcGrp|84939|2022|PDM|17020.00|99|0.00|SHOULDER JOINT|
20|FH_F141340_66208_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124161_95932_0|SrvcGrp|10393|2022|PDM|3784.00|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_F112468_0_0|SrvcGrp|72990|2022|PDM|530.00|99|0.00|AEG 1|
20|FH_F138050_52301_0|CSTM-ALL|CSTM-00|2020|PDM|6158.00|99|0.00|AEG 7 (NO REV)|
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 7 (NO REV)|
20|FH_F149044_60463_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130763_0_0|SrvcGrp|35672|2022|PDM|3163.00|99|0.00|CPT 23412|
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.50|99|0.00|AEG 9 (NO REV)|
20|FH_F135663_24401_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F80455_0_0|SrvcGrp|78046|2022|PDM|665.50|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F148644_06890_0|CSTM-ALL|CSTM-00|2020|PDM|2277.00|99|0.00|AEG 3 (NO REV)|
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39015_0_0|CSTM-ALL|CSTM-00|2020|PDM|748.00|99|0.00|ACUTE PSYCH|
20|FH_F146103_63851_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F146039_89511_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PDM|684.00|99|0.00|AEG 2 (NO REV)|
20|FH_F125244_0_0|SrvcGrp|63472|2022|PDM|6900.00|99|0.00|CPT 64581|
20|FH_F116506_0_0|SrvcGrp|75483|2022|PDM|610.00|99|0.00|AEG 3|
20|FH_F119554_16506_0|SrvcGrp|472|2022|PDM|390.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F34182_0_0|SrvcGrp|18886|2022|PDM|2729.00|99|0.00|MS DRG 234|
20|FH_F63312_0_0|SrvcGrp|10545|2022|PDM|90.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F124146_46321_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132883_31602_0|SrvcGrp|86835|2022|PDM|10.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|1517.00|99|0.00|AEG 5  (NO REV)|
20|FH_F88744_71103_0|SrvcGrp|103617|2022|PDM|5792.00|99|0.00|NORMAL DELIVERY (MOM)|
20|FH_F109405_73106_0|SrvcGrp|89412|2022|PDM|285.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F110404_17821_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F36381_0_0|SrvcGrp|11258|2022|PDM|1000.00|99|0.00|DRUGS|
20|FH_F122381_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133749_84604_0|SrvcGrp|112465|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY CATHETER CARE (HCFA)|
20|FH_F141337_60077_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F93743_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F130364_01331_0|SrvcGrp|73842|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111986_0_0|SrvcGrp|104117|2022|PDM|1236.00|99|0.00|REMOVE IN/EX HEM GROUPS = 2|
20|FH_F90501_71101_0|SrvcGrp|75505|2022|PCT|1.00|99|0.00|CARDIAC STUDIES|
20|FH_F150130_70359_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F39776_0_0|SrvcGrp|17000|2022|PDM|658.00|99|0.00|OUTPATIENT SURGERY|
20|FH_F134451_63670_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F47724_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F128955_70071_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F87053_0_0|SrvcGrp|78448|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|326.59|99|0.00|HAPA WPA-NWPA 2012-13 ASC 308 W/O REV|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|86.90|99|0.00|HAPA WPA-NWPA 2012-13 ASC 143 W/O REV|
20|FH_F98800_85021_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F101100_50314_0|SrvcGrp|97919|2022|PDM|8179.00|99|0.00|EXPLORATION OF ABDOMEN|
20|FH_F102142_80014_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F105361_80104_0|SrvcGrp|9438|2022|PCT|0.83|99|0.00|TRAUMA CARE|
20|FH_F115890_75067_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115909_38133_0|SrvcGrp|86746|2022|PCT|1.05|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F63625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F146812_50401_0|CSTM-ALL|CSTM-00|2020|PDM|2742.78|99|0.00|AEG 6 (NO REV)|
20|FH_F120795_27514_0|SrvcGrp|109057|2022|PCT|0.71|99|0.00|CARDIAC STUDIES|
20|FH_F40393_0_0|SrvcGrp|97|2022|PDM|1950.00|99|0.00|C-SECTION|
20|FH_F133007_76010_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F131430_17566_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F111662_80601_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F151279_15301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151280_20740_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F121976_44505_0|SrvcGrp|89149|2022|PDM|215.00|99|0.00|OP INTENSIVE|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|LAPAROSCOPY|
20|FH_F37328_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97740_01605_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F33530_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|BURN INTENSIVE CARE|
20|FH_F114866_77706_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F114916_30309_0|CSTM-ALL|CSTM-00|2020|PDM|1352.00|99|0.00|AEG 6 (NO REV)|
20|FH_F112163_0_0|SrvcGrp|104713|2022|PDM|236.00|99|0.00|HOSPICE RESPITE CARE|
20|FH_F103780_64804_0|SrvcGrp|103913|2022|PCT|0.68|99|0.00|OP DIALYSIS|
20|FH_F103780_64804_0|SrvcGrp|81779|2022|PCT|0.68|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F105581_19053_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F113541_0_0|SrvcGrp|86460|2022|PDM|6662.00|99|0.00|REVISE BREAST RECONSTRUCTION|
20|FH_F120617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.38|99|0.00|OP SVCS|
20|FH_F138929_0_0|SrvcGrp|33986|2022|PDM|1595.00|99|0.00|CPT 26055|
20|FH_F131047_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F141127_62286_0|SrvcGrp|90356|2022|PCT|0.80|99|0.00|OP DIALYSIS|
20|FH_F114389_50131_0|SrvcGrp|88621|2022|PDM|161.90|99|0.00|SKILLED NURSING LPN|
20|FH_F137897_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|OCN F/S PRICING: ALL|
20|FH_F124180_0_0|SrvcGrp|84160|2022|PDM|3000.00|99|0.00|OCCULAR RECONST/AMNIOTIC MEMB|
20|FH_F124059_64055_0|SrvcGrp|24752|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F146993_66020_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40643_0_0|SrvcGrp|12280|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F87822_0_0|SrvcGrp|28787|2022|PDM|22.95|99|0.00|CPT CODE 90993|
20|FH_F92493_0_0|SrvcGrp|97895|2022|PDM|16193.10|99|0.00|REVISE KNEE 2|
20|FH_F92493_0_0|SrvcGrp|92364|2022|PDM|12999.53|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F100703_0_0|SrvcGrp|84442|2022|PDM|9977.00|99|0.00|REVISION KNEE|
20|FH_F129549_01238_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F124173_66215_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F124671_64844_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|3225.00|99|0.00|AEG 9 (NO REV)|
20|FH_F136607_68632_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F136622_60062_0|SrvcGrp|89417|2022|PDM|656.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F136667_23603_0|SrvcGrp|87317|2022|PDM|929.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F136745_34772_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114629_19131_0|CSTM-ALL|CSTM-00|2020|PDM|511.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F81893_23114_0|SrvcGrp|66225|2022|PDM|116.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F144039_0_0|SrvcGrp|109760|2022|PDM|6885.00|99|0.00|TRANSLUM DIL EYE CANAL|
20|FH_F148553_85016_0|SrvcGrp|115454|2022|PDM|1301.00|99|0.00|REMOVE PACEMAKER SYSTEM|
20|FH_F134689_60190_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F134733_19460_0|SrvcGrp|89412|2022|PDM|502.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F136772_89109_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F136772_89109_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F136778_62034_0|SrvcGrp|73606|2022|PDM|710.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F136778_62034_0|SrvcGrp|27877|2022|PDM|213.00|99|0.00|ULTRASOUND|
20|FH_F136778_62034_0|CSTM-ALL|CSTM-00|2020|PDM|1599.00|99|0.00|AETNA OP PET SCANS (PET)|
20|FH_F136778_62034_0|SrvcGrp|113084|2022|PCT|0.00|99|0.00|CARDIAC CATH NOT REIMBURSED|
20|FH_F34604_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F115267_67156_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F147725_06002_0|SrvcGrp|106267|2022|PDM|6490.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL|
20|FH_F42342_0_0|SrvcGrp|13703|2022|PDM|36.75|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F42694_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME STAFF  INFUSION|
20|FH_F42754_0_0|SrvcGrp|109|2022|PDM|400.00|99|0.00|CD - DETOX|
20|FH_F42797_0_0|CSTM-ALL|CSTM-00|2020|PDM|55.00|99|0.00|OP SVCS|
20|FH_F145721_0_0|SrvcGrp|82223|2022|PDM|135.00|99|0.00|HOSPICE CARE|
20|FH_F46433_0_0|SrvcGrp|22396|2022|PDM|60.00|99|0.00|IV IMMUNOGLOBULIN|
20|FH_F46433_0_0|SrvcGrp|24744|2022|PDM|150.00|99|0.00|PICC LINE INSERTION|
20|FH_F83951_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134087_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F35404_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|CV SURGERY|
20|FH_F113291_37055_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F148041_41017_0|SrvcGrp|471|2022|PDM|689.52|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F33659_0_0|SrvcGrp|15390|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F93275_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F130656_04401_0|SrvcGrp|112727|2022|PCT|1.00|99|0.00|COVID-19 IA NFCT AB SARS COV 2|
20|FH_F144572_34203_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97061_85012_0|SrvcGrp|73605|2022|PDM|2274.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F35411_0_0|SrvcGrp|13141|2022|PDM|15189.00|99|0.00|NON-CARDIAC BRACHYTHERAPY|
20|FH_F106540_26330_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL|
20|FH_F148639_0_0|SrvcGrp|82720|2022|PDM|1025.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F103281_32086_0|SrvcGrp|73498|2022|PDM|1200.00|99|0.00|AETNA ER LEVEL III|
20|FH_F133530_11237_0|SrvcGrp|90883|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTALS|
20|FH_F123539_65265_0|SrvcGrp|471|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F118034_60645_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128929_33030_0|SrvcGrp|73841|2022|PDM|412.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F82715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35453_0_0|SrvcGrp|97|2022|PDM|4025.00|99|0.00|C-SECTION|
20|FH_F83031_0_0|SrvcGrp|44703|2022|PDM|105.00|99|0.00|NURSING CARE|
20|FH_F123012_27703_0|SrvcGrp|75419|2022|PDM|850.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F115312_78550_0|SrvcGrp|89337|2022|PDM|953.00|99|0.00|DETOXIFICATION|
20|FH_F36286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F68944_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F148662_01583_0|SrvcGrp|113171|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F122245_0_0|SrvcGrp|106273|2022|PDM|1150.00|99|0.00|REMOVE TONSILS AND ADENOIDS|
20|FH_F46276_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD UE|
20|FH_F133493_90255_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F31530_0_0|SrvcGrp|472|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150533_76051_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F94165_0_0|SrvcGrp|73606|2022|PCT|0.85|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F97882_32407_0|SrvcGrp|73603|2022|PDM|9293.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F142897_07018_0|SrvcGrp|112224|2022|PCT|1.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F139132_36532_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F139447_40336_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150839_03833_0|SrvcGrp|84185|2022|PDM|212.00|99|0.00|RESPITE CARE|
20|FH_F150839_03833_0|SrvcGrp|43567|2022|PDM|164.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F150882_84041_0|SrvcGrp|86827|2022|PDM|71.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F147200_61944_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150952_85008_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F92454_0_0|SrvcGrp|77461|2022|PDM|7800.00|99|0.00|CPT 52356|
20|FH_F110783_93013_0|SrvcGrp|86827|2022|PDM|75.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F127553_44321_0|SrvcGrp|90707|2022|PDM|130.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F64879_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP|
20|FH_F140608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47902_0_0|SrvcGrp|29953|2022|PCT|1.00|99|0.00|DME MOD 26|
20|FH_F40719_0_0|SrvcGrp|32633|2022|PDM|552.00|99|0.00|SKILLED NURSING|
20|FH_F98900_42001_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F147214_48162_0|SrvcGrp|110537|2022|PDM|392.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F124691_78003_0|SrvcGrp|104079|2022|PCT|1.50|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F102069_19034_0|SrvcGrp|94879|2022|PDM|131.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F134732_0_0|SrvcGrp|108076|2022|PDM|2248.00|99|0.00|AV FUSION / FOREARM VEIN|
20|FH_F110725_48047_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F92155_74437_0|SrvcGrp|79699|2022|PCT|0.69|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F149651_90046_0|SrvcGrp|110812|2022|PDM|330.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F149459_06615_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35557_0_0|SrvcGrp|20725|2022|PDM|18.00|99|0.00|HOSPICE PAIN MANAGEMENT KIT|
20|FH_F117762_0_0|SrvcGrp|97895|2022|PDM|14560.00|99|0.00|REVISE KNEE 2|
20|FH_F149402_03301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139565_0_0|SrvcGrp|42551|2022|PDM|1721.00|99|0.00|OP SURGERY|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F108680_0_0|SrvcGrp|71666|2022|PDM|24750.00|99|0.00|CPT 63655|
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|103.00|99|0.00|ASPG 10 SURGICAL EYE CENTER|
20|FH_F124309_24112_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120119_0_0|SrvcGrp|85966|2022|PDM|1057.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F138217_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115982_0_0|SrvcGrp|72992|2022|PDM|563.00|99|0.00|AEG 2|
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 10 (NO REV)|
20|FH_F149049_28401_0|SrvcGrp|104003|2022|PDM|2900.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES|
20|FH_F117629_06514_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119795_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F98001_27603_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120157_93103_0|SrvcGrp|100499|2022|PDM|570.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F151043_71901_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F36036_0_0|SrvcGrp|22091|2022|PDM|23.00|99|0.00|HCPCS A4663|
20|FH_F122336_67042_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41463_0_0|SrvcGrp|34228|2022|PDM|85.00|99|0.00|OTHER INFUSION THERAPY|
20|FH_F113181_72202_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F139573_0_0|SrvcGrp|57968|2022|PDM|1150.63|99|0.00|CONTINUOUS HOMECARE|
20|FH_F150939_0_0|SrvcGrp|82746|2022|PDM|8.00|99|0.00|CULT BACT BLD AEROIC ISOLA|
20|FH_F37850_0_0|SrvcGrp|16|2022|PDM|757.00|99|0.00|ACUTE REHABILITATION|
20|FH_F114853_0_0|SrvcGrp|98493|2022|PDM|7699.00|99|0.00|THORACIC|
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|991.63|99|0.00|2005 ASPG GROUPER V|
20|FH_F39633_0_0|SrvcGrp|15472|2022|PDM|619.00|99|0.00|CPT CODE 62284|
20|FH_F138787_32258_0|SrvcGrp|113175|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - MODERNA|
20|FH_F138870_45176_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117715_0_0|SrvcGrp|80523|2022|PDM|14745.39|99|0.00|PENILE PROSTHESIS IMPLANTATION|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1405 W/O REV|
20|FH_F151509_77076_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144989_07701_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0299-G0300|
20|FH_F36555_0_0|SrvcGrp|44883|2022|PDM|22.00|99|0.00|RT/PT/ST/OT|
20|FH_F135465_80023_0|SrvcGrp|92760|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135489_70508_0|SrvcGrp|26595|2022|PDM|900.00|99|0.00|ACUTE PSYCHIATRIC|
20|FH_F91735_92653_0|SrvcGrp|26160|2022|PDM|52.50|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F91764_93710_0|CSTM-ALL|CSTM-00|2020|PDM|3660.00|99|0.00|AEG 3 (NO REV)|
20|FH_F135795_60016_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135976_67401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135978_06851_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136180_92253_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F119892_47586_0|SrvcGrp|48385|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F119892_47586_0|SrvcGrp|46104|2022|PDM|100.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F131407_07607_0|SrvcGrp|16750|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F127399_0_0|SrvcGrp|110678|2022|PDM|14045.00|99|0.00|DRAINAGE OF HIP JOINT|
20|FH_F140629_0_0|SrvcGrp|113692|2022|PDM|2497.00|99|0.00|ANKLE ARTHROSCOPY|
20|FH_F35093_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42098_0_0|SrvcGrp|24286|2022|PDM|35.00|99|0.00|SKILLED NURSING CARE|
20|FH_F111363_33169_0|SrvcGrp|82757|2022|PDM|16.00|99|0.00|ASSAY BLOOD CREATININE|
20|FH_F134315_89106_0|SrvcGrp|29075|2022|PCT|1.00|99|0.00|HYDRATION THERAPY|
20|FH_F134322_98001_0|SrvcGrp|112569|2022|PCT|1.00|99|0.00|GARAMYCIN/GENTAMICIN INJECTION|
20|FH_F47906_0_0|SrvcGrp|43843|2022|PCT|1.00|99|0.00|DME MOD RRKF|
20|FH_F34532_0_0|SrvcGrp|12890|2022|PCT|0.48|99|0.00|LABORATORY|
20|FH_F33688_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F52992_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42026_0_0|CSTM-ALL|CSTM-00|2020|PDM|273.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F51272_0_0|CSTM-ALL|CSTM-00|2020|PDM|5500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132328_0_0|SrvcGrp|87053|2022|PDM|2123.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F102325_62691_0|SrvcGrp|98666|2022|PCT|1.30|99|0.00|AETNA OP SVCS HH AMFS(H) DEFAULT|
20|FH_F129220_18445_0|CSTM-ALL|CSTM-00|2020|PDM|106.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION MOD AJ (HCFA)|
20|FH_F102960_50613_0|SrvcGrp|16069|2022|PDM|1190.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F103780_64804_0|SrvcGrp|24598|2022|PDM|1177.00|99|0.00|MS DRG 945-946 ONLY|
20|FH_F40600_0_0|SrvcGrp|63|2022|PDM|1402.00|99|0.00|SUBACUTE CARE|
20|FH_F136429_0_0|SrvcGrp|79593|2022|PDM|710.50|99|0.00|CPT 45378|
20|FH_F122953_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PDM|3630.00|99|0.00|AEG 5  (NO REV)|
20|FH_F89372_0_0|SrvcGrp|24006|2022|PCT|0.51|99|0.00|MRI CT SCANS|
20|FH_F129926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F149179_0_0|SrvcGrp|115609|2022|PDM|3519.00|99|0.00|ANKLE FRACTURE REPAIR|
20|FH_F46832_0_0|SrvcGrp|24747|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118152_20151_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F120506_53934_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F93132_73134_0|SrvcGrp|73742|2022|PCT|1.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F134047_32628_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134155_07016_0|SrvcGrp|90572|2022|PDM|276.00|99|0.00|INTENSIVE OP PSYCH (HCFA)|
20|FH_F134160_19006_0|SrvcGrp|13595|2022|PDM|285.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F137147_75006_0|SrvcGrp|53603|2022|PDM|13650.00|99|0.00|MS DRG 494 ONLY|
20|FH_F142508_29108_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F142690_31774_0|SrvcGrp|23683|2022|PDM|71.00|99|0.00|SKILLED NURSING RN|
20|FH_F73403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F83831_0_0|SrvcGrp|9228|2022|PDM|50.00|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F97582_46307_0|SrvcGrp|73656|2022|PDM|540.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F138561_08034_0|SrvcGrp|92760|2022|PCT|1.87|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138584_30912_0|SrvcGrp|113413|2022|PDM|600.00|99|0.00|REPAIR CHEEK BONE FRACTURE|
20|FH_F138627_82901_0|SrvcGrp|86849|2022|PDM|85.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F140329_78570_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149524_28806_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151603_27609_0|SrvcGrp|80617|2022|PDM|12494.80|99|0.00|ARTHOPLASTY|
20|FH_F151608_30236_0|SrvcGrp|98003|2022|PDM|6563.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F118943_64506_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F80366_0_0|SrvcGrp|73006|2022|PCT|0.94|99|0.00|AEG 9|
20|FH_F129483_77030_0|SrvcGrp|86125|2022|PCT|0.83|99|0.00|AETNA FLEBOGAMMA INJ|
20|FH_F117218_32025_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F117218_32025_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F130918_01606_0|SrvcGrp|88905|2022|PDM|1144.00|99|0.00|PSYCHIATRIC CARE (AGE 0-17)|
20|FH_F47792_0_0|SrvcGrp|43562|2022|PDM|95.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F48785_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F132515_19382_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116552_70001_0|SrvcGrp|88620|2022|PDM|97.00|99|0.00|SKILLED NURSING RN|
20|FH_F116698_07470_0|SrvcGrp|17016|2022|PDM|39.90|99|0.00|HOME INFUSION THERAPY|
20|FH_F116915_30308_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120050_92626_0|SrvcGrp|108484|2022|PDM|850.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F120974_27607_0|SrvcGrp|16|2022|PDM|1742.00|99|0.00|ACUTE REHABILITATION|
20|FH_F118917_33317_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118950_33312_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F84394_17402_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F51276_0_0|SrvcGrp|33165|2022|PDM|545.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F51276_0_0|SrvcGrp|10545|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F36676_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|DME|
20|FH_F46732_0_0|SrvcGrp|10544|2022|PDM|144.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F59732_0_0|SrvcGrp|34388|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F61292_0_0|SrvcGrp|21354|2022|PDM|14535.00|99|0.00|MS DRG 250-251 ONLY|
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|3334.00|99|0.00|ASPG VII - FH SW CUSTOM GROUPERS|
20|FH_F110263_0_0|SrvcGrp|115220|2022|PDM|8919.00|99|0.00|IMPLANT NEUROELECTRODES (HCFA)|
20|FH_F83251_32751_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F49338_0_0|SrvcGrp|32385|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKE (DME)|
20|FH_F38732_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F77903_0_0|SrvcGrp|220|2022|PCT|0.60|99|0.00|INTRAOCULAR LENSES|
20|FH_F102302_0_0|SrvcGrp|98565|2022|PDM|39100.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F115018_78410_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F135456_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 2 (NO REV)|
20|FH_F92034_0_0|SrvcGrp|35669|2022|PDM|5200.00|99|0.00|CPT 63650|
20|FH_F66422_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|AEG 4 (NO REV)|
20|FH_F119760_0_0|SrvcGrp|90707|2022|PDM|105.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F135178_84049_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F91739_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102184_0_0|SrvcGrp|74039|2022|PDM|7215.00|99|0.00|LAMINECTOMY|
20|FH_F86654_33073_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141527_36830_0|SrvcGrp|86851|2022|PDM|26.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F129968_98004_0|SrvcGrp|73841|2022|PDM|585.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F32604_0_0|SrvcGrp|10541|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F120280_64701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120349_38774_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129969_33908_0|SrvcGrp|72602|2022|PDM|625.00|99|0.00|ECT|
20|FH_F130051_31707_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130138_02915_0|SrvcGrp|89265|2022|PCT|0.96|99|0.00|AMBULATORY DETOX - ALCOHOL AND DRUG REHAB|
20|FH_F120973_34653_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131995_04730_0|SrvcGrp|48394|2022|PDM|52.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F135165_15728_0|SrvcGrp|48396|2022|PDM|93.00|99|0.00|OT SERVICES|
20|FH_F124388_0_0|SrvcGrp|77449|2022|PDM|2755.50|99|0.00|CPT 52352|
20|FH_F41887_0_0|SrvcGrp|13640|2022|PDM|110.00|99|0.00|CPT 99202|
20|FH_F130523_04605_0|SrvcGrp|114016|2022|PCT|0.84|99|0.00|OBSERVATION W/SURGERY|
20|FH_F135165_15728_0|SrvcGrp|46605|2022|PDM|93.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F59093_0_0|SrvcGrp|42973|2022|PDM|85.00|99|0.00|SPEECH  THERAPIST|
20|FH_F140995_33040_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132374_0_0|SrvcGrp|79561|2022|PDM|2431.80|99|0.00|AETNA CARDIAC CATH|
20|FH_F94942_0_0|SrvcGrp|63471|2022|PDM|3824.39|99|0.00|CPT 64590|
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F123384_72076_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F131321_38135_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F77504_0_0|SrvcGrp|33232|2022|PCT|1.00|99|0.00|TAKE HOME DRUGS|
20|FH_F148266_45419_0|CSTM-ALL|CSTM-00|2020|PDM|983.00|99|0.00|AEG 5  (NO REV)|
20|FH_F141527_36830_0|SrvcGrp|86827|2022|PDM|53.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F93880_95476_0|SrvcGrp|10107|2022|PCT|0.30|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F64440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|OP SVCS|
20|FH_F66481_0_0|SrvcGrp|42975|2022|PDM|100.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F125927_75093_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130807_20721_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F70104_0_0|SrvcGrp|48398|2022|PDM|12.00|99|0.00|PT SERVICES|
20|FH_F35259_0_0|SrvcGrp|360|2022|PDM|3456.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F103902_89118_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F141801_80534_0|SrvcGrp|3178|2022|PDM|1200.00|99|0.00|ACUTE PSYCH|
20|FH_F38900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1240.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123464_63841_0|SrvcGrp|472|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F91663_19901_0|SrvcGrp|53987|2022|PCT|1.00|99|0.00|PHOTOTHERAPY|
20|FH_F118056_29464_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F147941_06023_0|SrvcGrp|18071|2022|PDM|843.00|99|0.00|AMBULANCE RESPONSE/TREATMENT - NO TRANSPORT|
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PDM|608.96|99|0.00|ASPG IV|
20|FH_F68843_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F120175_19606_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101945_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F38948_0_0|SrvcGrp|38|2022|PDM|2743.00|99|0.00|NORMAL DELIVERY|
20|FH_F91472_96001_0|SrvcGrp|103758|2022|PCT|0.40|99|0.00|PACEMAKER LEAD ONLY IMPLANT/REPLACEMENT|
20|FH_F91472_96001_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F112817_37027_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132736_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F40977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F72003_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111594_0_0|SrvcGrp|27261|2022|PDM|8661.00|99|0.00|CPT 27446|
20|FH_F150781_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148425_01507_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F148554_85016_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F44016_0_0|SrvcGrp|16131|2022|PDM|7900.00|99|0.00|DRG 370-371 ONLY C-SECTION|
20|FH_F109574_62859_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F111809_93003_0|SrvcGrp|11663|2022|PCT|0.67|99|0.00|IMPLANTS|
20|FH_F151522_72712_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F150602_59718_0|SrvcGrp|84185|2022|PDM|153.00|99|0.00|RESPITE CARE|
20|FH_F40448_0_0|SrvcGrp|248|2022|PDM|1081.00|99|0.00|PEDIATRIC REHABILITATION|
20|FH_F117793_90405_0|SrvcGrp|87317|2022|PDM|1150.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F126762_91311_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F149119_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122262_0_0|SrvcGrp|12491|2022|PCT|0.50|99|0.00|PACEMAKER|
20|FH_F88223_0_0|SrvcGrp|48385|2022|PDM|88.00|99|0.00|SPEECH THERAPY|
20|FH_F141870_85224_0|SrvcGrp|86854|2022|PDM|60.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F43241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1083.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48475_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|2653.00|99|0.00|AEG 9 W/O SURG CARVEOUT (NO REV)|
20|FH_F63137_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F120757_83843_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127994_19301_0|SrvcGrp|73842|2022|PDM|220.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F72226_65804_0|SrvcGrp|29817|2022|PDM|3445.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F72024_0_0|SrvcGrp|17140|2022|PDM|155.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|74.00|99|0.00|HAPA EPA ASC 13|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD 26|
20|FH_F144368_48315_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F100665_07939_0|SrvcGrp|73601|2022|PDM|6179.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F33225_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F141967_89509_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)|
20|FH_F148361_68779_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35593_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F95641_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F128421_27016_0|SrvcGrp|88977|2022|PCT|0.80|99|0.00|C-SECTION DELIVERY|
20|FH_F96061_63834_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97041_71603_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F37035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F102681_34237_0|SrvcGrp|73004|2022|PDM|1018.00|99|0.00|AEG 8|
20|FH_F97061_85012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|248.74|99|0.00|HAPA WPA-NWPA 2012-13 ASC 124 W/O REV|
20|FH_F46196_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG III|
20|FH_F132737_0_0|SrvcGrp|58|2022|PDM|9184.00|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F141870_85224_0|SrvcGrp|86841|2022|PDM|110.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F123545_44512_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER UEKC|
20|FH_F133477_90247_0|CSTM-ALL|CSTM-00|2020|PDM|4830.00|99|0.00|AEG 7 (NO REV)|
20|FH_F44855_0_0|SrvcGrp|27580|2022|PDM|40.00|99|0.00|RESPIRATORY THERAPY SUBSEQUENT  VISIT|
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 3 (NO REV)|
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|2573.00|99|0.00|DEVICE INSERTION|
20|FH_F37042_0_0|SrvcGrp|37303|2022|PDM|2232.00|99|0.00|ASPG IX|
20|FH_F109815_52241_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_F123085_21921_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F134490_62801_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F38700_0_0|SrvcGrp|18817|2022|PCT|0.80|99|0.00|MS DRG 222|
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|AEG 6 (NO REV)|
20|FH_F100665_07939_0|SrvcGrp|73605|2022|PDM|2744.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F41173_0_0|CSTM-ALL|CSTM-00|2020|PDM|655.00|99|0.00|ACUTE PSYCH|
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|64454.00|99|0.00|MSDRG 228-230|
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127422_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F106540_26330_0|SrvcGrp|101599|2022|PDM|1608.00|99|0.00|MRI/MRA W/ER(SG MRIMRAHCPC)|
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132934_63005_0|SrvcGrp|88819|2022|PDM|734.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F38508_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F103281_32086_0|SrvcGrp|84720|2022|PCT|0.00|99|0.00|AETNA LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F91255_19401_0|SrvcGrp|31931|2022|PDM|925.00|99|0.00|SKILLED NURSING CARE|
20|FH_F118486_95060_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F123012_27703_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130652_51101_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F92676_15063_0|SrvcGrp|106912|2022|PCT|0.85|99|0.00|LAB SERVICES W/ SURGERY|
20|FH_F67763_0_0|SrvcGrp|64298|2022|PDM|280.00|99|0.00|CCPE|
20|FH_F96061_63834_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100682_97401_0|SrvcGrp|90854|2022|PDM|3641.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F109642_80501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F144748_19707_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F130573_02882_0|SrvcGrp|48396|2022|PDM|120.00|99|0.00|OT SERVICES|
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|ASPG II|
20|FH_F45974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129965_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F102561_75146_0|SrvcGrp|82369|2022|PCT|2.00|99|0.00|AETNA LABORATORY|
20|FH_F141907_74021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 7 (NO REV)|
20|FH_F148701_32708_0|SrvcGrp|75419|2022|PDM|330.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F151061_02720_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F151062_17584_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139391_30127_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150769_02302_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127324_0_0|SrvcGrp|87061|2022|PDM|14830.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F36554_0_0|SrvcGrp|68580|2022|PCT|1.00|99|0.00|IMMUNIZATIONS|
20|FH_F132818_24701_0|SrvcGrp|43924|2022|PDM|348.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F36385_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F149602_07109_0|SrvcGrp|114975|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F124309_24112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131498_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|ANTIBIOTIC INTRAMUSCULAR THERAPY (MOD SH)|
20|FH_F124486_0_0|SrvcGrp|109846|2022|PDM|1803.00|99|0.00|RELIEVE INNER EYE PRESSURE (HCFA)|
20|FH_F43865_0_0|SrvcGrp|30955|2022|PDM|115.00|99|0.00|SKILLED RN VISIT|
20|FH_F80834_0_0|SrvcGrp|62357|2022|PCT|1.10|99|0.00|RAD W/ OP SURG-OBS-TRAUMA|
20|FH_F131028_49735_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F35731_33709_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F149579_95815_0|SrvcGrp|115703|2022|PDM|128.25|99|0.00|PSYCHIATRIC COLLABORATIVE CARE MGMT SBSQ (MOD AH)|
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|653.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F131325_48170_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124413_30067_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F147230_49505_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132849_0_0|CSTM-ALL|CSTM-00|2020|PDM|797.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F128536_88240_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119946_36109_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F131389_33169_0|SrvcGrp|109330|2022|PCT|0.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F150942_66743_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F97880_63501_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F132096_89118_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
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_F132132_77040_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F36554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG V|
20|FH_F117762_0_0|SrvcGrp|88158|2022|PDM|4992.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F145567_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F133087_61107_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122263_37072_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132056_32080_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F150312_89103_0|SrvcGrp|73605|2022|PDM|1025.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F94643_90501_0|SrvcGrp|24744|2022|PDM|75.00|99|0.00|PICC LINE INSERTION|
20|FH_F138017_73129_0|CSTM-ALL|CSTM-00|2020|PDM|1790.00|99|0.00|AEG 10 (NO REV) W/O CHEMISTRY|
20|FH_F133223_0_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F130970_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F128091_37129_0|SrvcGrp|46903|2022|PDM|574.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F110724_33064_0|SrvcGrp|75419|2022|PDM|320.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F141287_14830_0|SrvcGrp|111929|2022|PDM|7.70|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F138410_19130_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134797_0_0|SrvcGrp|73008|2022|PDM|1051.00|99|0.00|AEG 10|
20|FH_F98880_50158_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F76522_0_0|SrvcGrp|13990|2022|PCT|0.45|99|0.00|PACEMAKER|
20|FH_F90055_33805_0|SrvcGrp|471|2022|PDM|472.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149601_64111_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)|
20|FH_F128753_32501_0|SrvcGrp|75506|2022|PCT|0.64|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F128392_01026_0|SrvcGrp|87317|2022|PDM|1400.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F137747_62278_0|CSTM-ALL|CSTM-00|2020|PCT|0.26|99|0.00|GENERAL ACUTE CARE|
20|FH_F134407_63801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL|
20|FH_F116549_0_0|SrvcGrp|105357|2022|PDM|425.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F110783_93013_0|SrvcGrp|86838|2022|PDM|12.50|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F129599_17078_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149049_28401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131385_76457_0|SrvcGrp|108484|2022|PDM|585.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F126554_0_0|SrvcGrp|92364|2022|PDM|11000.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PDM|1607.00|99|0.00|ASPG IX|
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PDM|5500.00|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F98022_89015_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|1586.00|99|0.00|AEG 5 W/O LAPAROSCOPY|
20|FH_F97880_63501_0|SrvcGrp|88977|2022|PDM|3344.00|99|0.00|C-SECTION DELIVERY|
20|FH_F111122_63376_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F81456_0_0|SrvcGrp|79237|2022|PDM|3000.00|99|0.00|VBAC DELIVERY|
20|FH_F97101_98003_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F124470_90025_0|SrvcGrp|27968|2022|PDM|50.00|99|0.00|SKILLED NURSING LPN|
20|FH_F43113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40521_0_0|SrvcGrp|24|2022|PDM|4100.00|99|0.00|CARDIAC CATH|
20|FH_F36299_0_0|SrvcGrp|22775|2022|PDM|628.00|99|0.00|SUBACUTE WITH VENTILATOR|
20|FH_F84833_17109_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47212_0_0|SrvcGrp|71160|2022|PDM|75.00|99|0.00|PT/OT/ST|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PDM|1937.69|99|0.00|ASPG IX|
20|FH_F126147_45241_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F92155_74437_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F144831_0_0|SrvcGrp|95779|2022|PDM|175.11|99|0.00|HOSPICE CARE|
20|FH_F38676_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F35770_33511_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F140176_51445_0|SrvcGrp|113608|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F139870_71075_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140036_07702_0|SrvcGrp|46903|2022|PDM|701.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F140036_07702_0|SrvcGrp|73841|2022|PDM|366.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F143227_50312_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143454_94550_0|SrvcGrp|86309|2022|PDM|111.00|99|0.00|PROVISION OF TEST MATERIALS/EQUIPMENT FOR HOME INR MONITORIN|
20|FH_F33287_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F140552_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|PRIMARY CHILDREN'S MED CTR 3%_FIRST CHOICE|
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_F47036_0_0|SrvcGrp|3809|2022|PDM|525.00|99|0.00|HOSPICE CARE|
20|FH_F47600_0_0|SrvcGrp|31188|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC (DME)|
20|FH_F116595_92506_0|SrvcGrp|86749|2022|PCT|1.15|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F116913_77024_0|SrvcGrp|100859|2022|PDM|275.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F120927_28645_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126395_37043_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F84611_30281_0|SrvcGrp|81339|2022|PCT|1.90|99|0.00|AETNA RADIOLOGY|
20|FH_F51276_0_0|SrvcGrp|17302|2022|PDM|55.00|99|0.00|HYDRATION THERAPY - 3+ LITERS|
20|FH_F36439_0_0|SrvcGrp|23012|2022|PDM|650.00|99|0.00|V5247|
20|FH_F40091_0_0|SrvcGrp|17077|2022|PCT|0.70|99|0.00|ASPG VII|
20|FH_F40755_0_0|SrvcGrp|15052|2022|PCT|0.85|99|0.00|RADIOLOGY SVCS|
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.05|99|0.00|ASPG VI|
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|310.00|99|0.00|WELLPATH ASC X|
20|FH_F97500_32025_0|CSTM-ALL|CSTM-00|2020|PCT|0.34|99|0.00|OP SVCS|
20|FH_F148221_06477_0|SrvcGrp|90707|2022|PDM|168.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F133207_0_0|SrvcGrp|84939|2022|PDM|14004.00|99|0.00|SHOULDER JOINT|
20|FH_F38798_0_0|SrvcGrp|23682|2022|PDM|110.00|99|0.00|HIGH TECH/SPECIALTY NURSING/MC PEDS (OB, PEDS, ET, MOM/BABY)|
20|FH_F72842_0_0|CSTM-ALL|CSTM-00|2020|PDM|1541.00|99|0.00|ACUTE PSYCH|
20|FH_F130061_84097_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F88212_20151_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F135267_19002_0|SrvcGrp|73841|2022|PDM|357.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F40252_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|PHYSICIANS SERVICES (CMS 1500)|
20|FH_F58052_0_0|CSTM-ALL|CSTM-00|2020|PDM|162.00|99|0.00|NEBULIZER (DME) (MOD NU)|
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_F92129_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 1 (NO REV)|
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F111222_15701_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|PDM|735.00|99|0.00|ASPG II|
20|FH_F137943_0_0|SrvcGrp|45863|2022|PDM|3000.00|99|0.00|CPT 65730|
20|FH_F63481_0_0|SrvcGrp|26234|2022|PDM|850.00|99|0.00|SLEEP STUDIES|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ASPG I|
20|FH_F52854_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL|
20|FH_F147941_06023_0|SrvcGrp|100243|2022|PCT|0.69|99|0.00|CULTURE SCREEN|
20|FH_F113255_0_0|SrvcGrp|72992|2022|PDM|663.00|99|0.00|AEG 2|
20|FH_F139515_0_0|SrvcGrp|27347|2022|PDM|1957.00|99|0.00|CPT 58558|
20|FH_F125118_99201_0|SrvcGrp|74602|2022|PDM|500.00|99|0.00|AETNA INITIAL PSYCH EVALUATION CPT 90791|
20|FH_F118703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F92091_0_0|SrvcGrp|77580|2022|PDM|1350.00|99|0.00|CPT 28296 - 28299|
20|FH_F66422_0_0|SrvcGrp|44107|2022|PDM|48.00|99|0.00|SPEECH THERAPY|
20|FH_F39273_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F118194_50841_0|SrvcGrp|22592|2022|PDM|145.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F130207_33458_0|SrvcGrp|73842|2022|PDM|233.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114930_71101_0|SrvcGrp|67944|2022|PDM|510.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F131577_89148_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F129656_15005_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F98922_40351_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F125625_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F127567_44070_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F115010_20105_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F66220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133207_0_0|SrvcGrp|27261|2022|PDM|14001.00|99|0.00|CPT 27446|
20|FH_F128307_43219_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F112325_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149819_75067_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F37756_0_0|SrvcGrp|10990|2022|PDM|7718.00|99|0.00|ANGIOPLASTY|
20|FH_F116188_72211_0|SrvcGrp|73841|2022|PDM|468.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.71|99|0.00|ASPG III|
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.00|99|0.00|AEG 2 (NO REV)|
20|FH_F41202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS|
20|FH_F139515_0_0|SrvcGrp|74039|2022|PDM|8196.00|99|0.00|LAMINECTOMY|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131357_17545_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141012_22901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148255_72703_0|SrvcGrp|17013|2022|PDM|31.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F139719_0_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F149869_03253_0|SrvcGrp|48396|2022|PDM|163.00|99|0.00|OT SERVICES|
20|FH_F148265_06067_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F123385_03561_0|SrvcGrp|48385|2022|PDM|163.00|99|0.00|SPEECH THERAPY|
20|FH_F33712_0_0|SrvcGrp|3932|2022|PDM|5250.00|99|0.00|LITHOTRIPSY|
20|FH_F148219_33161_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148263_30830_0|SrvcGrp|25693|2022|PDM|451.14|99|0.00|NEWBORN NURSERY|
20|FH_F36918_0_0|SrvcGrp|3378|2022|PDM|34.00|99|0.00|OBSERVATION SVCS|
20|FH_F63433_0_0|SrvcGrp|17071|2022|PDM|831.05|99|0.00|ASPG IV|
20|FH_F125744_66048_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130747_0_0|SrvcGrp|35669|2022|PDM|3849.00|99|0.00|CPT 63650|
20|FH_F134993_75034_0|SrvcGrp|86722|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F39476_0_0|SrvcGrp|4109|2022|PDM|918.00|99|0.00|ACUTE PSYCH|
20|FH_F137847_0_0|SrvcGrp|89337|2022|PDM|830.00|99|0.00|DETOXIFICATION|
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|2534.35|99|0.00|AEG 7 (NO REV)|
20|FH_F86332_75081_0|SrvcGrp|13159|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F72784_0_0|SrvcGrp|10391|2022|PDM|2249.73|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F126523_0_0|SrvcGrp|73006|2022|PDM|1500.00|99|0.00|AEG 9|
20|FH_F121495_92009_0|SrvcGrp|75419|2022|PDM|725.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F145758_20745_0|CSTM-ALL|CSTM-00|2020|PDM|1216.86|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_F77925_0_0|SrvcGrp|21306|2022|PDM|8600.00|99|0.00|PEDIATRIC INTENSIVE CARE SERVICES|
20|FH_F84994_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143790_83440_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AEG 8 (NO REV)|
20|FH_F135066_02908_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F97104_53545_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115985_0_0|SrvcGrp|17100|2022|PDM|1585.00|99|0.00|SKILLED NURSING|
20|FH_F125913_66762_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F50218_0_0|SrvcGrp|46242|2022|PDM|120.00|99|0.00|HOME VISIT RESPIRATORY THERAPY CARE|
20|FH_F66687_0_0|SrvcGrp|20914|2022|PDM|89142.00|99|0.00|MS DRG 233 ONLY|
20|FH_F63514_0_0|SrvcGrp|3810|2022|PDM|135.89|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F128446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F123400_04605_0|SrvcGrp|109358|2022|PDM|435.00|99|0.00|RESIDENTIAL TREATMENT (>= 18 YRS)|
20|FH_F78603_0_0|SrvcGrp|55194|2022|PDM|28224.05|99|0.00|MS DRG 258 ONLY|
20|FH_F116027_17745_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123385_03561_0|SrvcGrp|43567|2022|PDM|157.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F72183_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|ASPG I - FH SW CUSTOM GROUPERS|
20|FH_F127255_03104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F68343_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89563_29407_0|SrvcGrp|103324|2022|PCT|1.00|99|0.00|OT EVAL LOW COMPLEX 30 MIN|
20|FH_F135235_01830_0|SrvcGrp|74668|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F122694_33334_0|SrvcGrp|90854|2022|PDM|830.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F122905_41018_0|SrvcGrp|75419|2022|PDM|386.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F62697_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F62579_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F38411_0_0|SrvcGrp|18786|2022|PCT|0.80|99|0.00|MS DRG 208|
20|FH_F129440_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117206_0_0|SrvcGrp|42551|2022|PDM|740.00|99|0.00|OP SURGERY|
20|FH_F51115_0_0|SrvcGrp|12403|2022|PDM|32.56|99|0.00|CONTINUOUS HOMECARE|
20|FH_F135610_06451_0|SrvcGrp|48398|2022|PDM|89.12|99|0.00|PT SERVICES|
20|FH_F109367_32751_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124958_49307_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F110260_27546_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F43197_0_0|SrvcGrp|37767|2022|PDM|25.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F71345_0_0|SrvcGrp|9832|2022|PDM|105.37|99|0.00|ST SVCS|
20|FH_F81483_0_0|SrvcGrp|40308|2022|PDM|1706.00|99|0.00|CVTY ENHANCED ASPG 6|
20|FH_F121225_98902_0|SrvcGrp|57965|2022|PDM|997.50|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F125124_0_0|SrvcGrp|78286|2022|PDM|8280.00|99|0.00|CPT 49322|
20|FH_F83196_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AEG 6 (NO REV)|
20|FH_F85340_98195_0|CSTM-ALL|CSTM-00|2020|PCT|2.83|99|0.00|AETNA - APC GROUPER K|
20|FH_F114527_39047_0|SrvcGrp|46903|2022|PDM|663.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F85652_98034_0|CSTM-ALL|CSTM-00|2020|PCT|3.02|99|0.00|AETNA - APC GROUPER L|
20|FH_F145641_06902_0|SrvcGrp|88156|2022|PDM|17180.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F133747_80634_0|SrvcGrp|73841|2022|PDM|330.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F123589_52402_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146544_78705_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|111.87|99|0.00|HAPA WPA-NWPA 2012-13 ASC 145 W/O REV|
20|FH_F127957_89521_0|SrvcGrp|93337|2022|PDM|488.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F146657_01105_0|SrvcGrp|114667|2022|PDM|15.48|99|0.00|HLTH BHV IVNTJ GRP (MOD U1)|
20|FH_F149048_77090_0|SrvcGrp|106048|2022|PDM|880.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F130826_0_0|SrvcGrp|111630|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F133941_70360_0|CSTM-ALL|CSTM-00|2020|PCT|1.60|99|0.00|HSS ASC|
20|FH_F113276_38506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126198_44236_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F89574_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F148927_0_0|SrvcGrp|16301|2022|PDM|6500.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F79863_0_0|SrvcGrp|74081|2022|PDM|215.00|99|0.00|HOME INFUSION|
20|FH_F135670_01749_0|SrvcGrp|16750|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F77943_0_0|SrvcGrp|87307|2022|PDM|73781.47|99|0.00|MSDRG 270 ONLY|
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|1310.00|99|0.00|AEG 1 (NO REV)|
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 3 (NO REV)|
20|FH_F119107_22601_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F90356_63011_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F135670_01749_0|SrvcGrp|86834|2022|PDM|12.50|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)|
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|767.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F76146_0_0|SrvcGrp|68191|2022|PDM|1742.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 7|
20|FH_F110501_07652_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F118123_67226_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F85353_16407_0|SrvcGrp|63910|2022|PDM|139.06|99|0.00|HAPA WPA-NWPA 2012-13 ASC 141|
20|FH_F100782_0_0|SrvcGrp|105101|2022|PDM|218.17|99|0.00|WINDBER MEDICAL CNTR ASC 146|
20|FH_F126391_24651_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150160_01301_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150242_60025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149341_39194_0|SrvcGrp|92502|2022|PDM|980.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F84132_48026_0|SrvcGrp|80263|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F49552_0_0|SrvcGrp|15905|2022|PDM|1.34|99|0.00|EPOGEN|
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|586.60|99|0.00|ASPG II|
20|FH_F119379_0_0|SrvcGrp|27343|2022|PDM|1428.00|99|0.00|OP SURGERY (CPT 25607 - 25609)|
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63884|2022|PDM|253.71|99|0.00|HAPA WPA-NWPA 2012-13 ASC 312|
20|FH_F110470_98335_0|SrvcGrp|90573|2022|PDM|120.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F99161_0_0|SrvcGrp|75479|2022|PDM|700.00|99|0.00|AEG 1|
20|FH_F110580_71106_0|CSTM-ALL|CSTM-00|2020|PDM|1825.00|99|0.00|AEG 9 (NO REV)|
20|FH_F79824_0_0|SrvcGrp|537|2022|PCT|0.57|99|0.00|OBSERVATION SERVICES|
20|FH_F134604_64050_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F36552_0_0|SrvcGrp|18224|2022|PDM|5720.00|99|0.00|MS DRG 282|
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|2090.00|99|0.00|AEG 10 (NO REV)|
20|FH_F79923_0_0|SrvcGrp|46633|2022|PDM|45.00|99|0.00|SPEECH THERAPY|
20|FH_F38790_0_0|SrvcGrp|411|2022|PCT|0.77|99|0.00|OP CARDIAC CATH|
20|FH_F120559_29108_0|SrvcGrp|107861|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F83978_66739_0|SrvcGrp|73008|2022|PDM|1828.00|99|0.00|AEG 10|
20|FH_F96160_32207_0|SrvcGrp|26869|2022|PDM|68.65|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F130017_02302_0|SrvcGrp|73496|2022|PDM|1190.76|99|0.00|AETNA ER LEVEL V|
20|FH_F122941_62702_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F85311_18702_0|SrvcGrp|26001|2022|PDM|110.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F133972_27103_0|SrvcGrp|86851|2022|PDM|35.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F145642_15108_0|SrvcGrp|86840|2022|PDM|30.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F149359_33301_0|SrvcGrp|115643|2022|PCT|0.75|99|0.00|COVID-19 INFECTIOUS AGENT DETECTION|
20|FH_F66406_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F118123_67226_0|SrvcGrp|48396|2022|PDM|83.00|99|0.00|OT SERVICES|
20|FH_F125110_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F85213_02840_0|SrvcGrp|73496|2022|PDM|1446.80|99|0.00|AETNA ER LEVEL V|
20|FH_F150165_06032_0|SrvcGrp|98470|2022|PDM|10397.00|99|0.00|AMPUTATION TOE|
20|FH_F122520_46383_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F84652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F85911_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.50|99|0.00|ACUTE REHABILITATION|
20|FH_F86011_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F72963_0_0|SrvcGrp|17073|2022|PDM|4613.00|99|0.00|ASPG V|
20|FH_F72963_0_0|SrvcGrp|17065|2022|PDM|1530.00|99|0.00|ASPG I|
20|FH_F75963_0_0|SrvcGrp|73141|2022|PDM|18.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F101100_50314_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA - APC GROUPER H|
20|FH_F102200_06416_0|SrvcGrp|86841|2022|PDM|119.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F75842_0_0|SrvcGrp|46515|2022|PDM|9406.88|99|0.00|LAPAROSCOPIC VAGINAL HYSTERECTOMY|
20|FH_F40903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47140_0_0|SrvcGrp|28738|2022|PDM|173.53|99|0.00|SLEEP STUDIES CPT 95811 W/MODIFIER 26|
20|FH_F115979_46107_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F116040_24637_0|SrvcGrp|26868|2022|PDM|30.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F131737_15025_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F133153_44113_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F133471_47901_0|SrvcGrp|100499|2022|PDM|550.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F111584_07002_0|SrvcGrp|104440|2022|PDM|51.38|99|0.00|AETNA DRUG TEST PRSMV DIR OPT OBS|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.00|99|0.00|AEG 5  (NO REV)|
20|FH_F40081_0_0|SrvcGrp|32471|2022|PDM|500.00|99|0.00|PSYCHIATRIC EATING DISORDERS|
20|FH_F82933_0_0|CSTM-ALL|CSTM-00|2020|PDM|3978.78|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F110103_0_0|SrvcGrp|79720|2022|PDM|850.00|99|0.00|ACUTE REHAB II|
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PDM|2957.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F48357_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117299_0_0|SrvcGrp|107497|2022|PDM|976.00|99|0.00|AETNA - CYSTOSCOPY AND TREATMENT|
20|FH_F111925_0_0|SrvcGrp|62737|2022|PDM|1602.00|99|0.00|SURGERY CARVE OUTS|
20|FH_F115895_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F119784_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F36584_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD AU|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F43717_0_0|SrvcGrp|38|2022|PDM|1785.00|99|0.00|NORMAL DELIVERY|
20|FH_F43860_0_0|SrvcGrp|30955|2022|PDM|115.00|99|0.00|SKILLED RN VISIT|
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.57|99|0.00|ASPG II|
20|FH_F135491_0_0|SrvcGrp|92547|2022|PDM|1980.00|99|0.00|SKIN FULL GRAFT PROCEDURE|
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|620.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132627_0_0|SrvcGrp|22389|2022|PDM|43.86|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F136818_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F137067_0_0|SrvcGrp|92364|2022|PDM|22050.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F129189_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|PDM|990.00|99|0.00|AEG 2 (NO REV)|
20|FH_F43612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F141047_23661_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141036_02347_0|SrvcGrp|113725|2022|PCT|1.00|99|0.00|INFLUENZA ASSAY W/ OPTIC|
20|FH_F114389_50131_0|SrvcGrp|105615|2022|PDM|301.31|99|0.00|ELECTRIC BREAST PUMP (MOD NU)|
20|FH_F114389_50131_0|SrvcGrp|86836|2022|PDM|32.19|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F114389_50131_0|SrvcGrp|86635|2022|PCT|1.61|99|0.00|DME|
20|FH_F49487_0_0|SrvcGrp|29303|2022|PDM|32.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F124059_64055_0|SrvcGrp|22589|2022|PDM|34.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F146880_74105_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146993_66020_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F69923_0_0|SrvcGrp|27767|2022|PDM|91.52|99|0.00|SKILLED IV NURSING HOURLY|
20|FH_F92493_0_0|SrvcGrp|86233|2022|PDM|16193.10|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F92493_0_0|SrvcGrp|92358|2022|PDM|15599.43|99|0.00|REMOVAL OF KNEE PROSTHESIS|
20|FH_F93232_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F129549_01238_0|SrvcGrp|43569|2022|PDM|107.62|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F124653_64062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97040_31901_0|SrvcGrp|88978|2022|PDM|7023.00|99|0.00|VAGINAL DELIVERY|
20|FH_F98042_10468_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F100787_69162_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F114792_48849_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F113787_31909_0|SrvcGrp|104762|2022|PCT|1.00|99|0.00|AETNA HIGH COST DRUGS|
20|FH_F138527_64506_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F122610_73139_0|SrvcGrp|72998|2022|PDM|6722.00|99|0.00|AEG 5|
20|FH_F117069_15236_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F135715_32073_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F136796_24016_0|SrvcGrp|90367|2022|PDM|2907.56|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F136828_32405_0|SrvcGrp|89337|2022|PDM|905.00|99|0.00|DETOXIFICATION|
20|FH_F112268_19087_0|SrvcGrp|48394|2022|PDM|31.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F112371_19047_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F138219_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_F37655_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34349_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F63317_0_0|SrvcGrp|29893|2022|PDM|60.00|99|0.00|ST|
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F115631_65201_0|SrvcGrp|34606|2022|PDM|3177.00|99|0.00|CPT 29827|
20|FH_F115631_65201_0|CSTM-ALL|CSTM-00|2020|PDM|1153.00|99|0.00|AEG 4 (NO REV)|
20|FH_F116393_07002_0|SrvcGrp|82762|2022|PDM|7.65|99|0.00|URINALYSIS AUTO W/ SCOPE|
20|FH_F147311_37421_0|SrvcGrp|114093|2022|PDM|390.00|99|0.00|PARTIAL HOSPITAL SUBSTANCE ABUSE|
20|FH_F147541_44805_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149024_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PDM|1170.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F126104_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F35404_0_0|SrvcGrp|3950|2022|PDM|5200.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F113178_44035_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F91937_0_0|SrvcGrp|3809|2022|PDM|566.93|99|0.00|HOSPICE CARE|
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131169_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F131501_0_0|SrvcGrp|63119|2022|PDM|23.00|99|0.00|BASIC HOME HOSPICE CARE|
20|FH_F40088_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|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_F138787_32258_0|SrvcGrp|113176|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - MODERNA|
20|FH_F138847_67156_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138970_62920_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138989_02861_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67359_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 6 (NO REV)|
20|FH_F124542_0_0|SrvcGrp|109899|2022|PDM|311.00|99|0.00|MEDICARE OUTPATIENT GROUPER 9 & 10|
20|FH_F151410_00717_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS APC GROUPED|
20|FH_F151503_30067_0|SrvcGrp|102481|2022|PDM|2090.00|99|0.00|CPT 29898|
20|FH_F132258_45404_0|SrvcGrp|43567|2022|PDM|78.23|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F123193_33431_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F135375_60014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135388_48601_0|SrvcGrp|106294|2022|PDM|598.43|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F91766_25401_0|SrvcGrp|48394|2022|PDM|35.70|99|0.00|SKILLED NURSING SERVICES|
20|FH_F136074_67206_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136188_04005_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F116397_33404_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F34686_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|DRUGS|
20|FH_F146125_0_0|SrvcGrp|34606|2022|PDM|3147.00|99|0.00|CPT 29827|
20|FH_F38013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|SAOF OP SERVICES MOD 53|
20|FH_F46918_0_0|SrvcGrp|10540|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE|
20|FH_F68309_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F69205_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F148243_0_0|SrvcGrp|45063|2022|PDM|400.00|99|0.00|CPT 64493  INJECTION CARVE OUT|
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|794.66|99|0.00|2005 ASPG GROUPER X|
20|FH_F36344_0_0|SrvcGrp|14944|2022|PDM|2.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1062.00|99|0.00|AEG 4 (NO REV)|
20|FH_F132328_0_0|SrvcGrp|77461|2022|PDM|3371.00|99|0.00|CPT 52356|
20|FH_F132328_0_0|SrvcGrp|109960|2022|PDM|2851.00|99|0.00|IMPLNT SPINAL CANAL CATHETER|
20|FH_F132328_0_0|SrvcGrp|107187|2022|PDM|2685.00|99|0.00|REVISE TWO EYE MUSCLES|
20|FH_F132328_0_0|SrvcGrp|26275|2022|PDM|2289.00|99|0.00|CPT 29826|
20|FH_F140102_0_0|SrvcGrp|104224|2022|PDM|105.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY (HCFA)|
20|FH_F129240_10028_0|SrvcGrp|86850|2022|PDM|35.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F103780_64804_0|SrvcGrp|31653|2022|PDM|2890.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III (MS DRG)|
20|FH_F36372_0_0|SrvcGrp|10649|2022|PDM|4.00|99|0.00|HOME INFUSION|
20|FH_F39080_0_0|SrvcGrp|30061|2022|PDM|6480.00|99|0.00|MULTI-BIRTH C-SECTION|
20|FH_F40205_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F103004_75840_0|SrvcGrp|72998|2022|PDM|1004.00|99|0.00|AEG 5|
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 6 (NO REV)|
20|FH_F98161_0_0|SrvcGrp|73008|2022|PDM|587.00|99|0.00|AEG 10|
20|FH_F86872_15215_0|SrvcGrp|86830|2022|PDM|100.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F55212_0_0|SrvcGrp|9433|2022|PDM|104.00|99|0.00|CPT 90847 FAMILY PSYCHOTHERAPY|
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119795_0_0|SrvcGrp|92819|2022|PDM|7263.00|99|0.00|HIP ARTHOSCOPY|
20|FH_F115487_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F74602_0_0|SrvcGrp|3932|2022|PDM|5900.00|99|0.00|LITHOTRIPSY|
20|FH_F88096_0_0|SrvcGrp|36591|2022|PDM|1500.00|99|0.00|CPT 63685|
20|FH_F89340_0_0|SrvcGrp|87769|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F88639_80204_0|SrvcGrp|75479|2022|PDM|3621.95|99|0.00|AEG 1|
20|FH_F117465_0_0|SrvcGrp|75479|2022|PDM|475.00|99|0.00|AEG 1|
20|FH_F69968_0_0|SrvcGrp|46521|2022|PDM|6685.29|99|0.00|SPINAL FUSION|
20|FH_F136299_75218_0|SrvcGrp|537|2022|PDM|4120.00|99|0.00|OBSERVATION SERVICES|
20|FH_F136308_34481_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118169_27514_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F118244_30040_0|SrvcGrp|57968|2022|PDM|32.97|99|0.00|CONTINUOUS HOMECARE|
20|FH_F134126_11554_0|SrvcGrp|112044|2022|PCT|1.15|99|0.00|LABORATORY SERVICES|
20|FH_F114092_83350_0|CSTM-ALL|CSTM-00|2020|PDM|7045.00|99|0.00|AEG 1 W/O SURG CARVEOUT (NO REV)|
20|FH_F142210_61356_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142267_78240_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F142511_78597_0|SrvcGrp|90854|2022|PDM|900.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F142527_89109_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F142590_18336_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142690_31774_0|SrvcGrp|14949|2022|PDM|125.00|99|0.00|HOME INFUSION|
20|FH_F53732_0_0|SrvcGrp|34173|2022|PDM|135.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F138627_82901_0|SrvcGrp|86847|2022|PDM|85.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F140791_20678_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F120152_0_0|SrvcGrp|108349|2022|PDM|2420.00|99|0.00|REMOVAL OF FINGER LESION|
20|FH_F120152_0_0|SrvcGrp|90365|2022|PDM|2420.00|99|0.00|REPAIR METACARPAL FRACTURE|
20|FH_F120152_0_0|SrvcGrp|91567|2022|PDM|2420.00|99|0.00|REPAIR OF KNEECAP TENDON|
20|FH_F151608_30236_0|SrvcGrp|104008|2022|PDM|5709.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS|
20|FH_F151608_30236_0|SrvcGrp|116014|2022|PDM|1988.00|99|0.00|EXE FOOT/TOE TUM SC <1.5 CM|
20|FH_F119065_92029_0|SrvcGrp|75419|2022|PDM|575.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F119018_47802_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F92475_15931_0|SrvcGrp|75399|2022|PDM|0.25|99|0.00|MED RECORD COPY|
20|FH_F109886_36303_0|SrvcGrp|89417|2022|PDM|542.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F117286_17202_0|SrvcGrp|472|2022|PDM|364.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F147801_90703_0|SrvcGrp|111111|2022|PDM|1071.00|99|0.00|INPATIENT PSYCHIATRIC (12-17 YRS)|
20|FH_F129511_44044_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F137812_12118_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137927_52241_0|SrvcGrp|83683|2022|PCT|0.00|99|0.00|ACUTE REHAB II|
20|FH_F109821_0_0|SrvcGrp|55084|2022|PDM|3264.00|99|0.00|CPT 52648|
20|FH_F110342_0_0|SrvcGrp|73000|2022|PDM|1900.00|99|0.00|AEG 6|
20|FH_F124923_23518_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F130035_0_0|SrvcGrp|108546|2022|PDM|203.00|99|0.00|PERITONEAL TREATMENTS W/ PATIENT TRAINING|
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|1011.42|99|0.00|ASPG VII|
20|FH_F78003_0_0|SrvcGrp|30095|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F32324_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F138283_0_0|SrvcGrp|73523|2022|PDM|107.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F148554_85016_0|SrvcGrp|115452|2022|PDM|3641.00|99|0.00|INSERT PULSE GEN W/ MULTI LEADS|
20|FH_F88223_0_0|SrvcGrp|48394|2022|PDM|38.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F73684_0_0|SrvcGrp|9811|2022|PDM|600.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F130108_0_0|SrvcGrp|10906|2022|PCT|0.75|99|0.00|EMERGENCY ROOM LEVEL IV|
20|FH_F101923_98104_0|SrvcGrp|21457|2022|PDM|2955.00|99|0.00|CPT CODE 95811|
20|FH_F51545_0_0|SrvcGrp|42825|2022|PDM|65.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F117745_15801_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133517_49221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136393_0_0|SrvcGrp|95339|2022|PDM|3200.00|99|0.00|INSERT PACING LEAD & CONNECT|
20|FH_F150001_33064_0|SrvcGrp|14945|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|321.49|99|0.00|ASPG 216|
20|FH_F108660_63775_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F71323_68114_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F117816_0_0|SrvcGrp|82222|2022|PDM|148.79|99|0.00|HOSPICE CARE|
20|FH_F118027_28801_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F87313_62301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142770_51546_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133018_84037_0|SrvcGrp|27968|2022|PDM|26.75|99|0.00|SKILLED NURSING LPN|
20|FH_F40980_0_0|SrvcGrp|18253|2022|PDM|10313.00|99|0.00|MS DRG 287|
20|FH_F123538_21206_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F130632_44145_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101851_78024_0|SrvcGrp|87317|2022|PDM|770.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F117891_19034_0|SrvcGrp|46605|2022|PDM|126.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F95284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132127_61053_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120290_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F128299_44134_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133009_19038_0|SrvcGrp|29347|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F44079_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141833_31707_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F44660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|1199.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F145964_10993_0|SrvcGrp|16|2022|PDM|1837.00|99|0.00|ACUTE REHABILITATION|
20|FH_F45977_0_0|SrvcGrp|40404|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K  CODES)- MOD AU|
20|FH_F133291_33563_0|SrvcGrp|73842|2022|PDM|290.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F143199_33403_0|SrvcGrp|75419|2022|PDM|384.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F112953_06066_0|SrvcGrp|473|2022|PDM|502.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F44795_0_0|SrvcGrp|30961|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F36973_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REFERENCE LABS MOD TC|
20|FH_F69104_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|600.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F141753_63334_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44135_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HILLCREST IV THERAPY|
20|FH_F104963_15146_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F144408_21617_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148494_0_0|SrvcGrp|114172|2022|PDM|3000.00|99|0.00|SPINE FIXATION|
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1551.00|99|0.00|AEG 8 (NO REV)|
20|FH_F120837_33309_0|SrvcGrp|89149|2022|PDM|238.00|99|0.00|OP INTENSIVE|
20|FH_F36579_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALLIED MED-MOD TC|
20|FH_F97565_83301_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F35368_0_0|SrvcGrp|12211|2022|PDM|1110.00|99|0.00|ACUTE PHYSICAL REHAB|
20|FH_F141935_76033_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142008_74301_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F73210_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117346_75093_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F118674_29036_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F132999_19901_0|SrvcGrp|27969|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F109561_97216_0|SrvcGrp|55677|2022|PDM|5500.00|99|0.00|VAGINAL DELIVERY ONLY|
20|FH_F148041_41017_0|SrvcGrp|75545|2022|PDM|689.52|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|4820.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119076_41001_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F35080_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136393_0_0|SrvcGrp|112877|2022|PDM|6000.00|99|0.00|INSERT PULSE GEN SNGL LEAD|
20|FH_F117807_86426_0|SrvcGrp|73700|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER UEKF|
20|FH_F95360_08720_0|SrvcGrp|87909|2022|PCT|1.00|99|0.00|PENTAMID ISETHION 300MG/1 MX|
20|FH_F132999_19901_0|SrvcGrp|46605|2022|PDM|89.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F68699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|GENERAL ACUTE CARE|
20|FH_F46914_0_0|SrvcGrp|24639|2022|PDM|147.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F56793_0_0|SrvcGrp|29345|2022|PDM|40.00|99|0.00|SKILLED NURSING - LPN - MOD TE|
20|FH_F117880_91730_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|2855.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F151079_17011_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F151159_46322_0|SrvcGrp|29346|2022|PDM|45.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F138702_43614_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F150659_84604_0|SrvcGrp|46903|2022|PDM|1375.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F150745_03301_0|SrvcGrp|48385|2022|PDM|167.00|99|0.00|SPEECH THERAPY|
20|FH_F111272_74012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137748_95231_0|SrvcGrp|105465|2022|PCT|1.00|99|0.00|AETNA THERAPIES|
20|FH_F37364_0_0|SrvcGrp|26178|2022|PDM|3350.00|99|0.00|BURN-TRAUMA CARE|
20|FH_F144029_0_0|SrvcGrp|113580|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F92154_74023_0|SrvcGrp|79699|2022|PCT|0.71|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F35941_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F43236_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F101844_0_0|SrvcGrp|97895|2022|PDM|8943.00|99|0.00|REVISE KNEE 2|
20|FH_F148839_0_0|SrvcGrp|114442|2022|PDM|3246.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F151699_01752_0|SrvcGrp|22593|2022|PDM|75.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F113957_73554_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|4125.00|99|0.00|ASPG IX|
20|FH_F124441_0_0|SrvcGrp|106267|2022|PDM|3325.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL|
20|FH_F131495_77407_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F50100_0_0|SrvcGrp|46114|2022|PDM|110.64|99|0.00|OT VISIT|
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 4 (NO REV)|
20|FH_F114206_37203_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F130813_85014_0|SrvcGrp|89337|2022|PDM|795.00|99|0.00|DETOXIFICATION|
20|FH_F120057_0_0|SrvcGrp|73006|2022|PDM|1607.00|99|0.00|AEG 9|
20|FH_F126785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS|
20|FH_F149619_81008_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F123377_0_0|CSTM-ALL|CSTM-00|2020|PDM|1904.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|AEG 4 (NO REV)|
20|FH_F134847_0_0|SrvcGrp|101820|2022|PDM|3054.00|99|0.00|HYSTEROSCOPY RESECT SEPTUM|
20|FH_F132818_24701_0|SrvcGrp|104363|2022|PCT|0.88|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F125214_12428_0|SrvcGrp|12840|2022|PCT|0.70|99|0.00|PACEMAKER|
20|FH_F149459_06615_0|SrvcGrp|46605|2022|PDM|116.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|2486.00|99|0.00|AEG 4 (NO REV)|
20|FH_F147082_02359_0|SrvcGrp|46903|2022|PDM|473.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F138478_0_0|SrvcGrp|88482|2022|PDM|1341.77|99|0.00|AETNA REMOVE PULSE GENERATOR|
20|FH_F46433_0_0|SrvcGrp|26871|2022|PDM|90.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3 HRS|
20|FH_F147172_76086_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114825_32789_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F73643_0_0|SrvcGrp|22954|2022|PDM|132.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119946_36109_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148539_33548_0|SrvcGrp|115368|2022|PCT|1.00|99|0.00|COVID-19 VACCINES AND ADMINSTRATION|
20|FH_F122416_72364_0|SrvcGrp|73339|2022|PCT|0.90|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|AEG 9 (NO REV)|
20|FH_F76826_0_0|SrvcGrp|76011|2022|PDM|861.00|99|0.00|EMERGENCY ROOM SVCS LEVEL IV|
20|FH_F149023_44122_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F137767_01841_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F56813_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F132585_0_0|SrvcGrp|112034|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETIC|
20|FH_F32825_0_0|SrvcGrp|10107|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F35475_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F134887_33409_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139167_42240_0|CSTM-ALL|CSTM-00|2020|PDM|596.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F114207_35243_0|SrvcGrp|29077|2022|PDM|15.00|99|0.00|HOME TRANSFUSION|
20|FH_F149003_62208_0|SrvcGrp|48385|2022|PDM|85.49|99|0.00|SPEECH THERAPY|
20|FH_F100663_56537_0|SrvcGrp|73659|2022|PDM|4811.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F144651_0_0|SrvcGrp|40003|2022|PDM|15000.00|99|0.00|TOTAL KNEE|
20|FH_F125081_15218_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F73768_0_0|SrvcGrp|71109|2022|PDM|3.00|99|0.00|HCPCS K0552|
20|FH_F35167_0_0|SrvcGrp|537|2022|PCT|0.66|99|0.00|OBSERVATION SERVICES|
20|FH_F127199_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F125214_12428_0|SrvcGrp|73605|2022|PCT|0.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F124465_84123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F36903_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KEITH RATHBOON PT HCPC MOD 53|
20|FH_F37198_0_0|SrvcGrp|16|2022|PCT|0.75|99|0.00|ACUTE REHABILITATION|
20|FH_F33303_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F140499_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48855_0_0|SrvcGrp|44326|2022|PDM|70.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO|
20|FH_F122425_75082_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F149699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131471_67203_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F127467_44202_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F94643_90501_0|SrvcGrp|24761|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116332_0_0|SrvcGrp|93433|2022|PDM|16726.00|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F37444_0_0|SrvcGrp|997|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F148891_44432_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35174_0_0|CSTM-ALL|CSTM-00|2020|PDM|1209.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F126914_44136_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F75207_0_0|SrvcGrp|59353|2022|PDM|325.00|99|0.00|HEMODIALYSIS - HOME TRAINING|
20|FH_F36554_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130309_17044_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120099_86305_0|SrvcGrp|108484|2022|PDM|1208.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F151041_60647_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35174_0_0|SrvcGrp|20908|2022|PCT|0.75|99|0.00|MS DRG 247 ONLY|
20|FH_F144831_0_0|SrvcGrp|23683|2022|PDM|105.45|99|0.00|SKILLED NURSING RN|
20|FH_F148667_0_0|SrvcGrp|115493|2022|PDM|2052.00|99|0.00|FINGER JOINT FUSION|
20|FH_F132860_0_0|SrvcGrp|701|2022|PDM|2536.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F102525_73134_0|SrvcGrp|76619|2022|PCT|1.00|99|0.00|THERAPY|
20|FH_F111266_30339_0|SrvcGrp|86825|2022|PDM|55.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F143347_16001_0|CSTM-ALL|CSTM-00|2020|PDM|3203.00|99|0.00|AEG 5  (NO REV)|
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|542.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93740_0_0|SrvcGrp|91595|2022|PDM|5900.00|99|0.00|TRANSLUMINAL ANGIOPLASTY OPEN AND PERCUTANEOUS|
20|FH_F102224_0_0|SrvcGrp|88159|2022|PDM|6000.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F130918_01606_0|SrvcGrp|114167|2022|PDM|489.00|99|0.00|PARTIAL HOSPITAL (0-17 YRS)|
20|FH_F130951_15237_0|SrvcGrp|63297|2022|PDM|115.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F131067_57105_0|CSTM-ALL|CSTM-00|2020|PDM|4937.00|99|0.00|AEG 5  (NO REV)|
20|FH_F131093_49690_0|SrvcGrp|97705|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F47969_0_0|SrvcGrp|3809|2022|PDM|460.00|99|0.00|HOSPICE CARE|
20|FH_F48224_0_0|SrvcGrp|62739|2022|PDM|940.00|99|0.00|SURGICAL CARVEOUTS|
20|FH_F49329_0_0|SrvcGrp|44985|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE (ADDITIONAL HOURS)|
20|FH_F132431_79606_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132416_92270_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120747_19129_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120747_19129_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F112712_63005_0|SrvcGrp|17013|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F39028_0_0|SrvcGrp|29666|2022|PCT|1.00|99|0.00|DME MOD RR|
20|FH_F142454_0_0|SrvcGrp|82570|2022|PDM|2800.00|99|0.00|REVISION EYELID/EXCESS SKIN|
20|FH_F88753_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F67505_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F59732_0_0|SrvcGrp|47411|2022|PDM|115.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F60273_0_0|SrvcGrp|44066|2022|PDM|3197.25|99|0.00|CPT 57288|
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|3150.00|99|0.00|AEG 5  (NO REV)|
20|FH_F129000_21017_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F94942_0_0|SrvcGrp|94161|2022|PDM|1854.00|99|0.00|REMOVE TENDON SHEATH LESION|
20|FH_F120952_25303_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 4 (NO REV)|
20|FH_F136756_0_0|SrvcGrp|73002|2022|PDM|1290.30|99|0.00|AEG 7|
20|FH_F90654_0_0|SrvcGrp|25696|2022|PDM|950.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|2921.00|99|0.00|AEG 10 (NO REV)|
20|FH_F143783_0_0|SrvcGrp|83521|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F120876_85250_0|SrvcGrp|108484|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F119760_0_0|SrvcGrp|89783|2022|PDM|105.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F126585_45039_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F72830_0_0|SrvcGrp|11259|2022|PCT|0.40|99|0.00|DRUGS|
20|FH_F149839_80002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F128307_43219_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F109277_0_0|SrvcGrp|60132|2022|PDM|378.00|99|0.00|DIALYSIS - PERITONEAL (NON-CAPD)|
20|FH_F135210_61080_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125028_19061_0|SrvcGrp|86850|2022|PDM|52.50|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F147941_06023_0|SrvcGrp|13681|2022|PDM|748.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OP IMAGING ENHANC. SUBSTANCES (IMAGENHANCE)|
20|FH_F151541_01436_0|SrvcGrp|113171|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F41201_0_0|SrvcGrp|10013|2022|PDM|325.00|99|0.00|NEWBORN NURSERY|
20|FH_F39917_0_0|SrvcGrp|3403|2022|PDM|120.00|99|0.00|CPT 99203|
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|3552.00|99|0.00|AEG 7 (NO REV)|
20|FH_F148266_45419_0|SrvcGrp|114443|2022|PDM|3200.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F110132_23451_0|SrvcGrp|46424|2022|PDM|110.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F147315_33603_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F128543_44413_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F62713_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|1058.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F125249_0_0|SrvcGrp|41334|2022|PDM|15500.00|99|0.00|TOTAL KNEE|
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102943_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F102224_0_0|SrvcGrp|93069|2022|PDM|2300.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|2016.00|99|0.00|AEG 9 (NO REV)|
20|FH_F151741_15090_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151764_03801_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F116552_70001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116629_83467_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F116835_94538_0|SrvcGrp|89417|2022|PDM|727.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F82894_0_0|SrvcGrp|9263|2022|PDM|131.25|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F120948_53188_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125436_60506_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F113563_70560_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113649_01752_0|SrvcGrp|86854|2022|PDM|69.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F118792_63379_0|SrvcGrp|73601|2022|PDM|1331.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F84442_79606_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F84611_30281_0|SrvcGrp|72998|2022|PDM|2557.00|99|0.00|AEG 5|
20|FH_F84394_17402_0|SrvcGrp|82825|2022|PCT|0.50|99|0.00|OSS TRANSFER MS DRG|
20|FH_F51276_0_0|SrvcGrp|24748|2022|PDM|85.00|99|0.00|CORTICOSTEROID THERAPY|
20|FH_F33925_0_0|SrvcGrp|18889|2022|PDM|22990.00|99|0.00|MS DRG 235|
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|2030.00|99|0.00|AEG 5  (NO REV)|
20|FH_F59732_0_0|SrvcGrp|41461|2022|PDM|60.00|99|0.00|ROUTINE SERVICE - INFUSION DEVICE|
20|FH_F91994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121090_07848_0|SrvcGrp|104440|2022|PDM|50.00|99|0.00|AETNA DRUG TEST PRSMV DIR OPT OBS|
20|FH_F49434_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F150079_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.60|99|0.00|OP SVCS|
20|FH_F139515_0_0|SrvcGrp|92410|2022|PDM|16995.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F93538_87124_0|SrvcGrp|93338|2022|PDM|46.28|99|0.00|AETNA MED NUTRITION SEBSEQUENT|
20|FH_F89475_71202_0|SrvcGrp|20914|2022|PDM|33338.00|99|0.00|MS DRG 233 ONLY|
20|FH_F150982_0_0|SrvcGrp|89842|2022|PDM|13213.00|99|0.00|LUMBAR|
20|FH_F123278_20850_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151084_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F149780_00783_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148497_32162_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143783_0_0|SrvcGrp|94780|2022|PDM|105.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F143772_75225_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150462_30458_0|SrvcGrp|17003|2022|PDM|130.00|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS|
20|FH_F124388_0_0|SrvcGrp|84704|2022|PDM|1254.00|99|0.00|CYSTOURETHROSCOPY W/ REMOVAL OF FOREIGN BODY|
20|FH_F55532_0_0|SrvcGrp|473|2022|PDM|725.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F31139_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54513_0_0|SrvcGrp|10528|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F127816_44112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36918_0_0|SrvcGrp|514|2022|PDM|5200.00|99|0.00|EXTRACORPOREAL LITHO (UNILATERAL)|
20|FH_F145756_03801_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110925_01104_0|SrvcGrp|86163|2022|PDM|1.12|99|0.00|AETNA INJ PROGESTERONE|
20|FH_F135268_11231_0|SrvcGrp|89337|2022|PDM|650.00|99|0.00|DETOXIFICATION|
20|FH_F82753_18840_0|SrvcGrp|80526|2022|PDM|20802.00|99|0.00|RADIOLOGY|
20|FH_F97102_83501_0|SrvcGrp|73602|2022|PDM|3772.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F116024_13203_0|SrvcGrp|90017|2022|PDM|78.28|99|0.00|AETNA PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F106822_0_0|SrvcGrp|100249|2022|PDM|14.75|99|0.00|REMOVAL OF SKIN TAGS|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F148121_21734_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F91994_0_0|SrvcGrp|73006|2022|PDM|4712.00|99|0.00|AEG 9|
20|FH_F100962_0_0|SrvcGrp|73002|2022|PDM|1248.00|99|0.00|AEG 7|
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 10 (NO REV)|
20|FH_F37191_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135051_37130_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F77042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F34487_0_0|SrvcGrp|9937|2022|PDM|93.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F117113_0_0|SrvcGrp|471|2022|PDM|367.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F131357_17545_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F123312_54115_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118194_50841_0|SrvcGrp|14947|2022|PDM|50.00|99|0.00|HOME INFUSION|
20|FH_F71945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1716.00|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_F37679_0_0|SrvcGrp|27153|2022|PDM|15.25|99|0.00|HOME INFUSION THERAPY (MOD SJ)|
20|FH_F103100_47150_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F86752_0_0|SrvcGrp|75481|2022|PDM|587.00|99|0.00|AEG 2|
20|FH_F37443_0_0|SrvcGrp|109|2022|PDM|910.00|99|0.00|CD - DETOX|
20|FH_F82753_18840_0|SrvcGrp|80497|2022|PDM|17564.00|99|0.00|PACEMAKER|
20|FH_F33322_0_0|SrvcGrp|3178|2022|PDM|926.00|99|0.00|ACUTE PSYCH|
20|FH_F141592_80233_0|SrvcGrp|10363|2022|PDM|1133.00|99|0.00|CPT CODE 99283|
20|FH_F151225_0_0|SrvcGrp|32189|2022|PDM|204.00|99|0.00|RESPITE CARE|
20|FH_F129011_15857_0|SrvcGrp|92502|2022|PDM|425.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F137972_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F72704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141517_73034_0|SrvcGrp|89417|2022|PDM|398.18|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F93880_95476_0|SrvcGrp|73605|2022|PDM|5939.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F149869_03253_0|SrvcGrp|73701|2022|PDM|52.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F125999_77064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F82173_72712_0|SrvcGrp|111977|2022|PDM|7104.00|99|0.00|CYSTO/URETERO W/ LITHOTRIPSY|
20|FH_F38738_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F141607_27021_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F139551_0_0|SrvcGrp|67064|2022|PDM|4574.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F112568_0_0|SrvcGrp|95660|2022|PDM|1047.73|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F61332_0_0|SrvcGrp|16718|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F93881_15009_0|SrvcGrp|93730|2022|PDM|1058.00|99|0.00|INJ PERIPHERAL NERVE|
20|FH_F132190_0_0|SrvcGrp|101840|2022|PDM|2500.00|99|0.00|REPAIR OF TENDON(S)|
20|FH_F137067_0_0|SrvcGrp|82113|2022|PDM|2625.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F131961_06040_0|SrvcGrp|471|2022|PDM|587.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F131176_28712_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F101711_0_0|SrvcGrp|48396|2022|PDM|75.00|99|0.00|OT SERVICES|
20|FH_F121566_91360_0|SrvcGrp|108484|2022|PDM|1433.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F123957_84321_0|SrvcGrp|75442|2022|PDM|803.00|99|0.00|OBSERVATION - REV 762|
20|FH_F124788_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39857_0_0|CSTM-ALL|CSTM-00|2020|PDM|1664.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F99960_0_0|SrvcGrp|73002|2022|PDM|1558.00|99|0.00|AEG 7|
20|FH_F90564_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F136195_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F72047_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135235_01830_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F121090_07848_0|SrvcGrp|105047|2022|PDM|149.00|99|0.00|AETNA PSYCH DIAG EVAL W/ MED SVCS (HCFA)|
20|FH_F110180_0_0|SrvcGrp|8950|2022|PDM|1730.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F102302_0_0|SrvcGrp|73000|2022|PDM|1537.00|99|0.00|AEG 6|
20|FH_F88212_20151_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F90940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|AEG 1 (NO REV)|
20|FH_F115740_78957_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F82714_18848_0|SrvcGrp|111927|2022|PDM|56.44|99|0.00|COVID-19 NON CDC|
20|FH_F127851_68106_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124660_0_0|SrvcGrp|72996|2022|PDM|744.00|99|0.00|AEG 4|
20|FH_F38377_0_0|SrvcGrp|29088|2022|PDM|105.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F116281_19013_0|SrvcGrp|89673|2022|PDM|90.00|99|0.00|US EXAM PG UTERUS LIMIT|
20|FH_F125883_78748_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122725_32216_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F86872_15215_0|SrvcGrp|16750|2022|PDM|119.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F62579_0_0|SrvcGrp|34389|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F62579_0_0|SrvcGrp|24751|2022|PDM|80.00|99|0.00|INTERMITTENT ANTICOAGULANT THERAPY|
20|FH_F135840_0_0|SrvcGrp|112792|2022|PDM|550.00|99|0.00|BREAST PROCEDURE|
20|FH_F130662_07032_0|SrvcGrp|111553|2022|PDM|265.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F130841_49315_0|SrvcGrp|95661|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|271.73|99|0.00|HAPA WPA-NWPA 2012-13 ASC 309 W/O REV|
20|FH_F125139_84096_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F117896_0_0|SrvcGrp|82222|2022|PDM|140.00|99|0.00|HOSPICE CARE|
20|FH_F149106_07042_0|SrvcGrp|104942|2022|PDM|6564.00|99|0.00|IMMEDIATE BREAST PROSTHESIS|
20|FH_F77943_0_0|SrvcGrp|701|2022|PDM|6736.88|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F80224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS|
20|FH_F127933_62863_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F77943_0_0|SrvcGrp|20752|2022|PDM|27960.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAMPTON ROADS GAST MOD UE|
20|FH_F89219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|MT NITTANY ASC 3|
20|FH_F142376_0_0|SrvcGrp|44461|2022|PDM|34431.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F126099_34237_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F119627_27288_0|SrvcGrp|3378|2022|PCT|0.75|99|0.00|OBSERVATION SVCS|
20|FH_F114483_47905_0|SrvcGrp|73485|2022|PDM|1450.00|99|0.00|AETNA REHAB|
20|FH_F80172_0_0|SrvcGrp|10574|2022|PDM|70.64|99|0.00|HOME INFUSION THERAPY|
20|FH_F113325_80004_0|SrvcGrp|471|2022|PDM|541.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F77943_0_0|SrvcGrp|31782|2022|PDM|29508.64|99|0.00|MSDRG 258-262 ONLY PACEMAKER REVISION OR REPLACEMENT|
20|FH_F133492_0_0|SrvcGrp|71219|2022|PDM|1809.00|99|0.00|COLONOSCOPY CPT 45382|
20|FH_F111986_0_0|SrvcGrp|73004|2022|PDM|1607.00|99|0.00|AEG 8|
20|FH_F85097_0_0|SrvcGrp|14244|2022|PDM|1810.00|99|0.00|EMERGENCY ROOM SVCS LEVEL VI|
20|FH_F145641_06902_0|SrvcGrp|85785|2022|PDM|4783.00|99|0.00|ARTHROSCOPY|
20|FH_F87712_15017_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F148644_06890_0|CSTM-ALL|CSTM-00|2020|PDM|843.00|99|0.00|AEG 1 (NO REV)|
20|FH_F143562_76665_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145642_15108_0|SrvcGrp|86835|2022|PDM|10.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F134608_18017_0|SrvcGrp|112614|2022|PDM|348.00|99|0.00|INDUCED ABORTION 17-24 WKS (HCFA)|
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|1035.00|99|0.00|AEG 4 (NO REV)|
20|FH_F89219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|MT NITTANY ASC 11|
20|FH_F99442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS|
20|FH_F120539_89029_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F147962_85008_0|CSTM-ALL|CSTM-00|2020|PDM|5288.00|99|0.00|AEG 9 (NO REV)|
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|7441.00|99|0.00|AEG 9 (NO REV)|
20|FH_F121687_04401_0|SrvcGrp|108926|2022|PCT|1.00|99|0.00|FERUMOXYTOL, NON-ESRD|
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|2474.00|99|0.00|AEG 7 (NO REV)|
20|FH_F118088_71261_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F93179_73460_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 10 (NO REV)|
20|FH_F130468_0_0|SrvcGrp|97895|2022|PDM|21005.80|99|0.00|REVISE KNEE 2|
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 8 (NO REV)|
20|FH_F145921_73139_0|SrvcGrp|88620|2022|PDM|97.85|99|0.00|SKILLED NURSING RN|
20|FH_F139512_77550_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F134593_60007_0|SrvcGrp|86843|2022|PDM|36.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F135610_06451_0|SrvcGrp|29347|2022|PDM|22.28|99|0.00|HOME HEALTH AIDE|
20|FH_F109577_0_0|SrvcGrp|87394|2022|PDM|133.00|99|0.00|HCPCS G0152 (HCFA)|
20|FH_F135666_37601_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F112791_0_0|SrvcGrp|73002|2022|PDM|1044.00|99|0.00|AEG 7|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|222.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 132 W/O REV|
20|FH_F125133_20601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145675_33761_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|812.00|99|0.00|AEG 2 (NO REV)|
20|FH_F130364_01331_0|SrvcGrp|73605|2022|PDM|1200.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F61034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|GENERAL ACUTE CARE|
20|FH_F133972_27103_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F120484_31419_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150239_75569_0|SrvcGrp|14949|2022|PCT|1.00|99|0.00|HOME INFUSION|
20|FH_F54592_0_0|SrvcGrp|17003|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS|
20|FH_F75184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F75963_0_0|SrvcGrp|66005|2022|PDM|18.00|99|0.00|SKILLED NURSING HCPC|
20|FH_F100907_85206_0|SrvcGrp|44051|2022|PDM|968.00|99|0.00|ACUTE REHAB|
20|FH_F101100_50314_0|SrvcGrp|97736|2022|PDM|8487.00|99|0.00|TREAT THIGH FRACTURE 2|
20|FH_F75842_0_0|SrvcGrp|17069|2022|PDM|1884.61|99|0.00|ASPG III|
20|FH_F146654_80524_0|SrvcGrp|73063|2022|PDM|693.00|99|0.00|OBSERVATION SERVICES|
20|FH_F146808_44641_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120528_60559_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116040_24637_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F131964_89120_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133583_77074_0|SrvcGrp|12659|2022|PDM|933.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F133007_76010_0|SrvcGrp|89023|2022|PDM|80.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F131702_17022_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F132575_38635_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121880_54935_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F115543_0_0|SrvcGrp|103966|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F115884_0_0|SrvcGrp|94781|2022|PDM|111.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F40081_0_0|SrvcGrp|3044|2022|PDM|900.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F97660_29401_0|SrvcGrp|90854|2022|PDM|1636.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F97761_04072_0|SrvcGrp|73659|2022|PDM|11632.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F97780_43614_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PDM|2224.00|99|0.00|AEG 8 (NO REV)|
20|FH_F37875_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130419_72476_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41539_0_0|SrvcGrp|33828|2022|PDM|780.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 6|
20|FH_F52516_0_0|SrvcGrp|11442|2022|PDM|601.02|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F110205_64012_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132988_0_0|SrvcGrp|11673|2022|PDM|6052.21|99|0.00|CPT 29888|
20|FH_F130274_63033_0|SrvcGrp|48398|2022|PDM|70.00|99|0.00|PT SERVICES|
20|FH_F141050_46410_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F81731_0_0|SrvcGrp|73485|2022|PDM|443.00|99|0.00|AETNA REHAB|
20|FH_F146921_43050_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146896_78636_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39398_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49937_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F132864_71101_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124237_95023_0|SrvcGrp|87131|2022|PDM|900.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 2 (NO REV)|
20|FH_F150226_0_0|SrvcGrp|2067|2022|PDM|1118.17|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F137248_0_0|SrvcGrp|98360|2022|PDM|4058.00|99|0.00|AETNA LAMINECTOMY W/FACE-LUMBAR|
20|FH_F133697_63129_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F114666_30342_0|SrvcGrp|100923|2022|PDM|1000.00|99|0.00|DRUGS|
20|FH_F113913_70065_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138779_62703_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132721_0_0|CSTM-ALL|CSTM-00|2020|PDM|2059.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121084_13114_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F121525_78613_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112755_43215_0|SrvcGrp|104305|2022|PCT|0.15|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F129088_68763_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149888_68506_0|CSTM-ALL|CSTM-00|2020|PDM|1708.00|99|0.00|AEG 4 (NO REV)|
20|FH_F148203_60190_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.00|99|0.00|AEG 2 (NO REV)|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PDM|2012.00|99|0.00|ASPG III|
20|FH_F99960_0_0|SrvcGrp|27345|2022|PDM|1760.00|99|0.00|OP SURGERY (CPT 49650)|
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|1881.00|99|0.00|AEG 5  (NO REV)|
20|FH_F143948_44870_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F127072_30458_0|SrvcGrp|74668|2022|PDM|262.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F40198_0_0|SrvcGrp|16|2022|PDM|461.00|99|0.00|ACUTE REHABILITATION|
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)|
20|FH_F41665_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPEN MRI OF NAPLES MRI/CT GLOBAL|
20|FH_F116703_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135267_19002_0|SrvcGrp|3178|2022|PDM|1123.00|99|0.00|ACUTE PSYCH|
20|FH_F107800_34609_0|SrvcGrp|73841|2022|PDM|318.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F149919_85390_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130681_15701_0|CSTM-ALL|CSTM-00|2020|PCT|3.00|99|0.00|HSS APC GROUPED|
20|FH_F140507_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F138020_20016_0|SrvcGrp|44007|2022|PDM|720.30|99|0.00|EMERGENCY ROOM (CPT CODE 99285)|
20|FH_F123511_64076_0|SrvcGrp|75545|2022|PDM|327.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F120876_85250_0|SrvcGrp|73605|2022|PDM|1131.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F52854_0_0|SrvcGrp|17140|2022|PDM|148.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F110263_0_0|SrvcGrp|93980|2022|PDM|9007.00|99|0.00|IMPLANT NEUROELECTRODES 29 (HCFA)|
20|FH_F33126_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F145800_22003_0|SrvcGrp|48385|2022|PDM|84.00|99|0.00|SPEECH THERAPY|
20|FH_F117079_01085_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129627_06037_0|SrvcGrp|93098|2022|PDM|165.00|99|0.00|HOSPICE CARE|
20|FH_F143528_0_0|SrvcGrp|88824|2022|PDM|4076.10|99|0.00|CPT 69631|
20|FH_F116268_19064_0|SrvcGrp|472|2022|PDM|361.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F93563_98499_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118194_50841_0|SrvcGrp|92518|2022|PDM|180.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F89453_75069_0|SrvcGrp|53145|2022|PDM|95.00|99|0.00|SOCIAL WORKER|
20|FH_F102184_0_0|SrvcGrp|24714|2022|PCT|1.00|99|0.00|INTRAOCULAR LENS|
20|FH_F115667_16101_0|SrvcGrp|471|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F127209_45365_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F124017_0_0|SrvcGrp|97159|2022|PDM|5200.00|99|0.00|TRANSPEDICULAR, 1 SEG, LUMBAR|
20|FH_F125943_66071_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130452_48801_0|SrvcGrp|31372|2022|PCT|1.00|99|0.00|PATIENTS CONVENIENCE CHARGES|
20|FH_F130850_67401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F40472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137457_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F141519_51566_0|SrvcGrp|3378|2022|PCT|0.95|99|0.00|OBSERVATION SVCS|
20|FH_F109926_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F130520_43947_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F77883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F135016_37203_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F66687_0_0|SrvcGrp|28163|2022|PCT|0.85|99|0.00|MS DRG 222 ONLY|
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|AEG 1 (NO REV)|
20|FH_F55874_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F135219_68506_0|CSTM-ALL|CSTM-00|2020|PDM|4234.88|99|0.00|AEG 3 (NO REV)|
20|FH_F117113_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|1655.00|99|0.00|AEG 4 (NO REV)|
20|FH_F123272_54901_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128132_69361_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35166_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114963_62062_0|SrvcGrp|43569|2022|PDM|184.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F38473_0_0|SrvcGrp|10541|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F50218_0_0|SrvcGrp|46249|2022|PDM|120.00|99|0.00|HOME VISIT STOMA/COLOSTOMY/CYSTOSTOMY CARE|
20|FH_F128272_60640_0|SrvcGrp|86834|2022|PDM|15.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F70303_0_0|SrvcGrp|17139|2022|PDM|948.00|99|0.00|HOSPICE CARE|
20|FH_F62980_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F128278_21401_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F130468_0_0|SrvcGrp|88156|2022|PDM|12602.50|99|0.00|REVISION OF KNEE JOINT|
20|FH_F146207_73139_0|SrvcGrp|82223|2022|PDM|134.00|99|0.00|HOSPICE CARE|
20|FH_F85353_16407_0|SrvcGrp|63791|2022|PDM|1149.85|99|0.00|HAPA WPA-NWPA 2012-13 ASC 601|
20|FH_F117208_0_0|SrvcGrp|88599|2022|PDM|3410.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F143742_60410_0|SrvcGrp|88978|2022|PDM|3214.00|99|0.00|VAGINAL DELIVERY|
20|FH_F150146_95401_0|SrvcGrp|74668|2022|PDM|339.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139380_33062_0|SrvcGrp|73841|2022|PDM|484.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F120484_31419_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F31714_0_0|SrvcGrp|10925|2022|PDM|8000.00|99|0.00|PACEMAKER IMPLANT W/O ACUTE INFARCTION|
20|FH_F133724_84041_0|SrvcGrp|87799|2022|PDM|93.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F116727_0_0|SrvcGrp|103329|2022|PDM|2500.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN|
20|FH_F148639_0_0|SrvcGrp|54943|2022|PDM|3084.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|78.00|99|0.00|PSYTX W PT 60 MINS|
20|FH_F67205_0_0|SrvcGrp|63|2022|PDM|1531.00|99|0.00|SUBACUTE CARE|
20|FH_F145964_10993_0|SrvcGrp|30625|2022|PCT|1.00|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F128796_57445_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133367_40065_0|SrvcGrp|82037|2022|PDM|3076.00|99|0.00|AETNA ICU|
20|FH_F150949_0_0|SrvcGrp|88164|2022|PDM|10500.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F149840_80002_0|SrvcGrp|90339|2022|PDM|135.00|99|0.00|SKILLED NURSING RN|
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)|
20|FH_F97141_93933_0|SrvcGrp|73643|2022|PDM|785.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F80537_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS|
20|FH_F148880_26807_0|SrvcGrp|46605|2022|PDM|180.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F151122_10462_0|SrvcGrp|88620|2022|PDM|131.00|99|0.00|SKILLED NURSING RN|
20|FH_F151224_85301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F122006_66839_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|2008.00|99|0.00|AEG 9 (NO REV)|
20|FH_F69805_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2504030 MOD TC (HCFA)|
20|FH_F113738_27006_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97721_01053_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F97740_01605_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F106822_0_0|SrvcGrp|100269|2022|PDM|68.25|99|0.00|HEPA VACCINE ADULT IM|
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 7 (NO REV)|
20|FH_F111840_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 1 (NO REV)|
20|FH_F80711_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|(JCODES-IMMUN) OCN F/S PRICING: ALL|
20|FH_F142321_29401_0|SrvcGrp|108484|2022|PDM|731.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F100640_48097_0|SrvcGrp|73485|2022|PDM|2721.00|99|0.00|AETNA REHAB|
20|FH_F105588_15228_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F113541_0_0|SrvcGrp|104953|2022|PDM|2580.00|99|0.00|DESIGN CUSTOM BREAST IMPLANT|
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|2080.00|99|0.00|AEG 7 (NO REV)|
20|FH_F138929_0_0|SrvcGrp|36591|2022|PDM|15400.00|99|0.00|CPT 63685|
20|FH_F94786_07974_0|SrvcGrp|86837|2022|PDM|210.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 2 (NO REV)|
20|FH_F144828_0_0|SrvcGrp|28557|2022|PDM|3850.00|99|0.00|CPT 19318|
20|FH_F120901_0_0|SrvcGrp|86233|2022|PDM|8973.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F54432_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F141014_29732_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|991.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37394_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F133674_30350_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124613_64735_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F124653_64062_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F127995_84010_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F130611_41143_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F67172_0_0|SrvcGrp|359|2022|PDM|1084.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F89273_0_0|SrvcGrp|88265|2022|PDM|595.00|99|0.00|CONNECTIVE TISSUE|
20|FH_F124407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136570_32084_0|SrvcGrp|108484|2022|PDM|625.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F136650_72543_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136729_62704_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114666_30342_0|SrvcGrp|105640|2022|PDM|1000.00|99|0.00|NJX INTERLAMINAR CRV/THRC|
20|FH_F114764_78214_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F138527_64506_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F148424_01440_0|SrvcGrp|115386|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F148553_85016_0|SrvcGrp|22552|2022|PDM|4386.00|99|0.00|REMOVAL PERMANENT PACEMAKER|
20|FH_F43246_0_0|SrvcGrp|31134|2022|PDM|820.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F43321_0_0|SrvcGrp|45723|2022|PCT|0.88|99|0.00|OCN F/S: LAB MOD TC|
20|FH_F43779_0_0|SrvcGrp|411|2022|PCT|0.75|99|0.00|OP CARDIAC CATH|
20|FH_F134672_44060_0|SrvcGrp|89149|2022|PDM|165.00|99|0.00|OP INTENSIVE|
20|FH_F134691_33445_0|SrvcGrp|108061|2022|PCT|1.10|99|0.00|OP THERAPY SERVICES|
20|FH_F134727_30650_0|SrvcGrp|79458|2022|PDM|0.10|99|0.00|MED RECORD COPY|
20|FH_F112410_46112_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115144_71373_0|SrvcGrp|73485|2022|PDM|816.00|99|0.00|AETNA REHAB|
20|FH_F115244_63017_0|SrvcGrp|92760|2022|PCT|1.70|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116365_11417_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147501_52655_0|SrvcGrp|42622|2022|PCT|0.90|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F147541_44805_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41463_0_0|SrvcGrp|23683|2022|PDM|61.95|99|0.00|SKILLED NURSING RN|
20|FH_F42622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F42837_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD RR|
20|FH_F111836_12901_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134839_60942_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|2140.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F132545_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F46433_0_0|SrvcGrp|21920|2022|PDM|70.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F134612_0_0|SrvcGrp|108114|2022|PDM|2300.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F138734_0_0|SrvcGrp|108484|2022|PDM|554.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F48295_0_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F113585_20155_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F138777_43140_0|SrvcGrp|89417|2022|PDM|335.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F138936_01040_0|SrvcGrp|111930|2022|PCT|1.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F138992_72703_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F83792_0_0|SrvcGrp|73605|2022|PDM|683.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|856.03|99|0.00|HAPA WPA-NWPA 2012-13 ASC 503 W/O REV|
20|FH_F124542_0_0|SrvcGrp|80540|2022|PDM|612.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 4|
20|FH_F151420_60654_0|SrvcGrp|82108|2022|PDM|2318.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F151425_19111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151508_60435_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151512_27587_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132248_44060_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F132251_33161_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F127923_69130_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40571_0_0|SrvcGrp|16|2022|PDM|950.00|99|0.00|ACUTE REHABILITATION|
20|FH_F135434_64424_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F91735_92653_0|SrvcGrp|87396|2022|PDM|110.25|99|0.00|HCPCS G0155 (HCFA)|
20|FH_F136003_19380_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136031_62220_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136161_27106_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131334_60062_0|SrvcGrp|14494|2022|PDM|100.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F130996_34110_0|SrvcGrp|67072|2022|PDM|8000.00|99|0.00|CPT 22845|
20|FH_F116397_33404_0|SrvcGrp|86827|2022|PDM|65.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F36479_0_0|SrvcGrp|72|2022|PDM|246.00|99|0.00|NEWBORN NURSERY|
20|FH_F101556_81004_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F121763_07202_0|SrvcGrp|75505|2022|PCT|4.75|99|0.00|CARDIAC STUDIES|
20|FH_F36596_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129967_18915_0|SrvcGrp|86723|2022|PDM|277.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F111291_52501_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F111301_33122_0|SrvcGrp|12280|2022|PCT|0.63|99|0.00|IMPLANTS|
20|FH_F111303_19087_0|SrvcGrp|86746|2022|PCT|1.05|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F36344_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F75806_0_0|SrvcGrp|10540|2022|PDM|143.00|99|0.00|HOME HEALTH AIDE|
20|FH_F131000_0_0|SrvcGrp|87054|2022|PDM|3608.00|99|0.00|CYSTOSCOPY CHEMODENERVATION|
20|FH_F132328_0_0|SrvcGrp|84318|2022|PDM|9270.00|99|0.00|SPINE INFUSION|
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|537.57|99|0.00|AEG 2 (NO REV)|
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1591.35|99|0.00|AEG 3 (NO REV)|
20|FH_F102325_62691_0|SrvcGrp|26869|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F129220_18445_0|SrvcGrp|110060|2022|PDM|16.26|99|0.00|GROUP BH TREATMENT 15 MINS|
20|FH_F148061_11223_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F58856_0_0|SrvcGrp|54966|2022|PCT|0.50|99|0.00|IMPLANTS/PROSTHETICS/HIGH COST DRUGS|
20|FH_F136489_25428_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F118232_24970_0|SrvcGrp|103913|2022|PCT|0.79|99|0.00|OP DIALYSIS|
20|FH_F120444_84037_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120490_64133_0|SrvcGrp|86833|2022|PDM|10.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F93132_73134_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134155_07016_0|SrvcGrp|90573|2022|PDM|276.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F137147_75006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F137147_75006_0|SrvcGrp|98006|2022|PDM|5577.00|99|0.00|PHALANGEAL SHAFT FRACTURE|
20|FH_F142273_51012_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|GENERAL ACUTE CARE|
20|FH_F53732_0_0|SrvcGrp|24748|2022|PDM|85.00|99|0.00|CORTICOSTEROID THERAPY|
20|FH_F138542_40324_0|SrvcGrp|90854|2022|PDM|746.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F138627_82901_0|SrvcGrp|88828|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F138627_82901_0|SrvcGrp|99000|2022|PDM|95.00|99|0.00|HYDRATION THERAPY OVER 3 LITER (HCFA)|
20|FH_F140468_46825_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140572_46526_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140791_20678_0|SrvcGrp|73842|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149530_80014_0|SrvcGrp|89337|2022|PDM|925.00|99|0.00|DETOXIFICATION|
20|FH_F40402_0_0|SrvcGrp|30941|2022|PDM|266.00|99|0.00|NEWBORN NURSERY|
20|FH_F109884_36117_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F109983_98607_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F117371_77059_0|SrvcGrp|90388|2022|PDM|795.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F129524_48104_0|SrvcGrp|71083|2022|PCT|1.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F117108_37841_0|SrvcGrp|537|2022|PCT|0.30|99|0.00|OBSERVATION SERVICES|
20|FH_F117219_77515_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F39538_0_0|SrvcGrp|701|2022|PDM|1676.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F109040_0_0|SrvcGrp|82498|2022|PDM|180.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS|
20|FH_F109652_0_0|SrvcGrp|14187|2022|PDM|1297.00|99|0.00|MRI|
20|FH_F111593_0_0|SrvcGrp|103834|2022|PDM|2145.00|99|0.00|AETNA REMOVE BLADDER STONE|
20|FH_F112080_0_0|SrvcGrp|36591|2022|PDM|26000.00|99|0.00|CPT 63685|
20|FH_F90880_15108_0|SrvcGrp|90485|2022|PCT|1.00|99|0.00|COGNITIVE SKILLS DEVELOPMENT|
20|FH_F129892_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F140207_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F60095_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
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|18381|2022|PCT|0.80|99|0.00|MS DRG 483|
20|FH_F130805_17404_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F89551_0_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146372_28681_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F109266_33319_0|SrvcGrp|73842|2022|PDM|159.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133207_0_0|SrvcGrp|27402|2022|PDM|3809.00|99|0.00|LASER PROCEDURES|
20|FH_F149199_73005_0|SrvcGrp|115250|2022|PCT|1.32|99|0.00|RADIOLOGY SERVICES|
20|FH_F149341_39194_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63833|2022|PDM|485.69|99|0.00|HAPA WPA-NWPA 2012-13 ASC 307|
20|FH_F134972_84117_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F110504_37027_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F81838_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F124743_0_0|SrvcGrp|80918|2022|PDM|125.00|99|0.00|RESPITE CARE|
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PDM|1479.50|99|0.00|AEG 9 (NO REV)|
20|FH_F146120_45040_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134249_05060_0|SrvcGrp|104464|2022|PDM|2492.00|99|0.00|VAGINAL DELIVERY (W/ OR W/O EPISIOTOMY)|
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|842.00|99|0.00|AEG 3 (NO REV)|
20|FH_F90416_73013_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F133815_46526_0|SrvcGrp|112482|2022|PDM|250.00|99|0.00|OBSERV/HOSP SAME DATE|
20|FH_F134668_08003_0|SrvcGrp|73841|2022|PDM|406.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F119575_0_0|SrvcGrp|108180|2022|PDM|435.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 6 (NO REV)|
20|FH_F87775_15106_0|SrvcGrp|22592|2022|PDM|60.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F85097_0_0|CSTM-ALL|CSTM-00|2020|PDM|2717.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138951_41101_0|SrvcGrp|14947|2022|PDM|50.00|99|0.00|HOME INFUSION|
20|FH_F80172_0_0|SrvcGrp|16544|2022|PDM|70.64|99|0.00|TOCOLYTIC THERAPY|
20|FH_F136359_0_0|SrvcGrp|112861|2022|PDM|2375.00|99|0.00|INCISION OF SPINAL NERVE|
20|FH_F85353_16407_0|SrvcGrp|63887|2022|PDM|232.48|99|0.00|HAPA WPA-NWPA 2012-13 ASC 130|
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1041.00|99|0.00|AEG 5  (NO REV)|
20|FH_F85764_33308_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F149059_19702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150239_75569_0|SrvcGrp|17016|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F149321_44691_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F112082_30720_0|SrvcGrp|17013|2022|PDM|89.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|2375.00|99|0.00|AEG 4 (NO REV)|
20|FH_F144808_0_0|SrvcGrp|98494|2022|PDM|7699.00|99|0.00|ARTHRODESIS PRE-SACRAL|
20|FH_F85353_16407_0|SrvcGrp|63874|2022|PDM|308.79|99|0.00|HAPA WPA-NWPA 2012-13 ASC 232|
20|FH_F119227_01752_0|SrvcGrp|16750|2022|PDM|135.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F79824_0_0|SrvcGrp|17069|2022|PDM|1737.00|99|0.00|ASPG III|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER QW|
20|FH_F83995_16748_0|SrvcGrp|72980|2022|PCT|2.25|99|0.00|AETNA LABORATORY|
20|FH_F149199_73005_0|SrvcGrp|97968|2022|PDM|440.00|99|0.00|CT SCAN|
20|FH_F43197_0_0|SrvcGrp|11072|2022|PDM|80.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F83380_0_0|CSTM-ALL|CSTM-00|2020|PDM|52.50|99|0.00|HOME HEALTH MOD TD|
20|FH_F49552_0_0|SrvcGrp|45644|2022|PDM|337.00|99|0.00|DIALYSIS|
20|FH_F114509_10010_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120555_68405_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F110425_01752_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP 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_F81852_0_0|CSTM-ALL|CSTM-00|2020|PDM|442.00|99|0.00|ASPG I|
20|FH_F143581_02130_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F147502_0_0|SrvcGrp|80920|2022|PDM|575.00|99|0.00|HOSPICE SERVICES|
20|FH_F149139_07522_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F119107_22601_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F136207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F31714_0_0|SrvcGrp|11186|2022|PDM|23500.00|99|0.00|DRG 549 CORONARY BYPASS W/O CC W/MAJOR CV DX|
20|FH_F87775_15106_0|SrvcGrp|77224|2022|PDM|120.00|99|0.00|AETNA HOME INFUSION S5521|
20|FH_F145641_06902_0|SrvcGrp|110768|2022|PDM|948.00|99|0.00|3RD LEVEL INJ PARAVERT F JNT L/S|
20|FH_F90496_13159_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F120930_0_0|SrvcGrp|63471|2022|PDM|7000.00|99|0.00|CPT 64590|
20|FH_F71550_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F132822_95125_0|SrvcGrp|23683|2022|PDM|62.50|99|0.00|SKILLED NURSING RN|
20|FH_F93219_26354_0|SrvcGrp|48385|2022|PDM|99.00|99|0.00|SPEECH THERAPY|
20|FH_F113457_17011_0|SrvcGrp|88621|2022|PDM|88.00|99|0.00|SKILLED NURSING LPN|
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|1645.00|99|0.00|AEG 2 (NO REV)|
20|FH_F114606_0_0|SrvcGrp|63297|2022|PDM|120.14|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F116806_0_0|SrvcGrp|107050|2022|PDM|1923.16|99|0.00|REPAIR CLEFT LIP|
20|FH_F110506_98901_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135670_01749_0|SrvcGrp|86829|2022|PDM|35.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F109400_80026_0|SrvcGrp|99066|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|984.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F147980_0_0|SrvcGrp|95661|2022|PDM|95.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F133928_19713_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132883_31602_0|SrvcGrp|24744|2022|PDM|30.00|99|0.00|PICC LINE INSERTION|
20|FH_F63258_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.10|99|0.00|OP SVCS|
20|FH_F139780_75605_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F51039_0_0|SrvcGrp|55983|2022|PDM|100.00|99|0.00|COGNITIVE REMEDIATION PROGRAM|
20|FH_F144848_0_0|SrvcGrp|96349|2022|PDM|11442.00|99|0.00|NECK SPINE FUSE|
20|FH_F146039_89511_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F136359_0_0|SrvcGrp|74039|2022|PDM|6315.00|99|0.00|LAMINECTOMY|
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113368_37752_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F110423_33401_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F52713_0_0|SrvcGrp|9911|2022|PDM|5000.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F132969_84003_0|SrvcGrp|86838|2022|PDM|10.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F147991_65625_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F114409_18447_0|SrvcGrp|48396|2022|PDM|110.25|99|0.00|OT SERVICES|
20|FH_F146650_29690_0|SrvcGrp|3178|2022|PDM|991.00|99|0.00|ACUTE PSYCH|
20|FH_F111031_30252_0|SrvcGrp|57968|2022|PDM|32.48|99|0.00|CONTINUOUS HOMECARE|
20|FH_F117206_0_0|SrvcGrp|73000|2022|PDM|1255.00|99|0.00|AEG 6|
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|513.00|99|0.00|AEG 2 (NO REV)|
20|FH_F150165_06032_0|SrvcGrp|109498|2022|PDM|4626.00|99|0.00|INSERT 1 ELECTRODE PM-DEFIB|
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|2174.00|99|0.00|AEG 8 (NO REV)|
20|FH_F127598_43232_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F127598_43232_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F126089_62420_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134608_18017_0|SrvcGrp|112600|2022|PDM|60.00|99|0.00|RH IG MINIDOSE IM|
20|FH_F89574_0_0|SrvcGrp|87536|2022|PDM|315.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F120719_27540_0|SrvcGrp|60|2022|PDM|3087.00|99|0.00|NEWBORN NURSERY - LEVEL II|
20|FH_F133207_0_0|SrvcGrp|65403|2022|PDM|3136.00|99|0.00|CPT 42830|
20|FH_F127589_45459_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F52713_0_0|SrvcGrp|20299|2022|PDM|61273.00|99|0.00|MS DRG 228-230 ONLY OTHER CARDIOTHORACIC PROC|
20|FH_F133827_98663_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43679_0_0|CSTM-ALL|CSTM-00|2020|PDM|310.00|99|0.00|CD RESIDENTIAL TREATMENT|
20|FH_F138302_15701_0|SrvcGrp|47183|2022|PDM|60.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F85652_98034_0|SrvcGrp|73481|2022|PDM|9367.00|99|0.00|VAGINAL DELIVERY MSDRG 767-768 ONLY|
20|FH_F116806_0_0|SrvcGrp|107016|2022|PDM|1923.16|99|0.00|RECONSTRUCTION MIDFACE, LEFORT 2|
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|516.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F45120_0_0|SrvcGrp|13292|2022|PCT|0.21|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F149321_44691_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139512_77550_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F88094_0_0|SrvcGrp|11000|2022|PCT|0.43|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F110420_60649_0|SrvcGrp|72998|2022|PDM|825.00|99|0.00|AEG 5|
20|FH_F62432_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50474_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100782_0_0|SrvcGrp|105066|2022|PDM|697.67|99|0.00|WINDBER MEDICAL CNTR ASC 111|
20|FH_F132606_0_0|SrvcGrp|67065|2022|PDM|3641.40|99|0.00|CERVICAL SURGERY|
20|FH_F132969_84003_0|SrvcGrp|23683|2022|PDM|42.25|99|0.00|SKILLED NURSING RN|
20|FH_F112024_0_0|SrvcGrp|82138|2022|PDM|1711.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F79763_0_0|SrvcGrp|66480|2022|PDM|110.00|99|0.00|RN VISIT|
20|FH_F138147_18018_0|SrvcGrp|113202|2022|PDM|2.75|99|0.00|SKILLS TRAINING & DEVELOPMENT (HCFA)|
20|FH_F127094_61802_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F93173_73401_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|GENERAL ACUTE CARE|
20|FH_F127806_63044_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88673_71105_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F85353_16407_0|SrvcGrp|63814|2022|PDM|568.50|99|0.00|HAPA WPA-NWPA 2012-13 ASC 207|
20|FH_F143620_81504_0|SrvcGrp|48396|2022|PDM|120.00|99|0.00|OT SERVICES|
20|FH_F111882_51560_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|3118.00|99|0.00|AEG 6 (NO REV)|
20|FH_F130017_02302_0|SrvcGrp|75507|2022|PDM|325.96|99|0.00|CHEMOTHERAPY|
20|FH_F70804_0_0|SrvcGrp|25346|2022|PDM|69.23|99|0.00|PT|
20|FH_F149150_75407_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F100782_0_0|SrvcGrp|97516|2022|PDM|2927.65|99|0.00|WINDBER MEDICAL CNTR ASC 9|
20|FH_F142376_0_0|SrvcGrp|96355|2022|PDM|7405.00|99|0.00|SPINE FIXATION|
20|FH_F127486_06776_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F54592_0_0|SrvcGrp|17006|2022|PDM|61.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS|
20|FH_F113645_0_0|SrvcGrp|103550|2022|PDM|1300.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1741.00|99|0.00|2007 MEDICARE ASPG VII|
20|FH_F71042_0_0|SrvcGrp|68040|2022|PDM|700.00|99|0.00|RESIDENTIAL COMMUNITY RE-ENTRY PROGRAMMING|
20|FH_F79644_0_0|SrvcGrp|9506|2022|PDM|1741.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F105143_26062_0|SrvcGrp|73006|2022|PDM|10022.00|99|0.00|AEG 9|
20|FH_F105145_75075_0|SrvcGrp|12840|2022|PCT|1.15|99|0.00|PACEMAKER|
20|FH_F105361_80104_0|SrvcGrp|72990|2022|PDM|1077.00|99|0.00|AEG 1|
20|FH_F68442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F146881_83661_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125440_04043_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F125014_67301_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F71342_0_0|SrvcGrp|46857|2022|PDM|1223.00|99|0.00|CPT CODE 62284|
20|FH_F48929_0_0|SrvcGrp|44864|2022|PDM|60.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F117300_0_0|SrvcGrp|98497|2022|PDM|7853.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F100782_0_0|SrvcGrp|105174|2022|PDM|954.73|99|0.00|WINDBER MEDICAL CNTR ASC 1202|
20|FH_F125244_0_0|SrvcGrp|103515|2022|PDM|5000.00|99|0.00|VAGINAL HYSTERECTOMY|
20|FH_F117896_0_0|SrvcGrp|92502|2022|PDM|500.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F130763_0_0|SrvcGrp|78282|2022|PDM|3346.00|99|0.00|CPT 47563|
20|FH_F34491_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87053_0_0|SrvcGrp|83542|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|168.35|99|0.00|HAPA WPA-NWPA 2012-13 ASC 130 W/O REV|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|104.69|99|0.00|HAPA WPA-NWPA 2012-13 ASC 315 W/O REV|
20|FH_F70684_0_0|SrvcGrp|47411|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F80185_0_0|SrvcGrp|474|2022|PDM|210.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F105145_75075_0|SrvcGrp|101881|2022|PDM|3840.00|99|0.00|AETNA AEG 3 WITHOUT CARVEOUT SURG|
20|FH_F105340_13502_0|SrvcGrp|87077|2022|PDM|145.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F115870_98225_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F115893_08002_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F120795_27514_0|SrvcGrp|10364|2022|PDM|1977.00|99|0.00|CPT CODE 99284|
20|FH_F120795_27514_0|SrvcGrp|19973|2022|PDM|1073.00|99|0.00|CAT SCAN|
20|FH_F127656_06068_0|SrvcGrp|90707|2022|PDM|161.70|99|0.00|AETNA HOSPICE CARE|
20|FH_F47140_0_0|SrvcGrp|28733|2022|PDM|387.50|99|0.00|SLEEP STUDIES CPT 95807 W/MODIFIER TC|
20|FH_F115956_06516_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132931_57350_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139175_98229_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|26.50|99|0.00|SYNAGIS DISPENSING FEE (MOD KP/SH)|
20|FH_F149160_02180_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F124695_33401_0|SrvcGrp|107709|2022|PDM|734.00|99|0.00|RESIDENTIAL TREATMENT (>=18 YRS)|
20|FH_F127199_0_0|SrvcGrp|65720|2022|PDM|114.00|99|0.00|RESPITE CARE|
20|FH_F134872_32168_0|SrvcGrp|83235|2022|PCT|1.10|99|0.00|AMBULATORY SURGERY|
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110783_93013_0|SrvcGrp|22593|2022|PDM|35.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F126554_0_0|SrvcGrp|88487|2022|PDM|3300.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F35446_0_0|SrvcGrp|72|2022|PDM|574.00|99|0.00|NEWBORN NURSERY|
20|FH_F138018_17313_0|SrvcGrp|17008|2022|PDM|105.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS|
20|FH_F134847_0_0|SrvcGrp|42472|2022|PDM|3258.00|99|0.00|CPT 58670|
20|FH_F122377_91007_0|SrvcGrp|75493|2022|PDM|9105.00|99|0.00|AEG 8|
20|FH_F139990_71418_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F144029_0_0|SrvcGrp|108042|2022|PDM|500.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F149602_07109_0|SrvcGrp|113232|2022|PDM|42.13|99|0.00|COVID-19 SARS-COV-2 ANTB QUANTITATIVE|
20|FH_F140093_33467_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F98840_31021_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F150982_0_0|SrvcGrp|69502|2022|PDM|1382.00|99|0.00|CPT 54150|
20|FH_F98001_27603_0|SrvcGrp|73643|2022|PDM|1045.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F138018_17313_0|SrvcGrp|17002|2022|PDM|208.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS|
20|FH_F102163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137767_01841_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F117023_0_0|SrvcGrp|73006|2022|PDM|2205.00|99|0.00|AEG 9|
20|FH_F49300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151424_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128029_48154_0|SrvcGrp|29155|2022|PDM|130.00|99|0.00|HOSPICE SVCS|
20|FH_F39211_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F39976_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F147215_48105_0|SrvcGrp|110537|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F117574_49022_0|SrvcGrp|73842|2022|PDM|157.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F146859_0_0|SrvcGrp|114838|2022|PDM|2077.00|99|0.00|FOOT BONE PARTIAL REMOVAL|
20|FH_F112045_90301_0|SrvcGrp|8950|2022|PDM|6270.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F122260_98034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123745_0_0|SrvcGrp|34606|2022|PDM|7500.00|99|0.00|CPT 29827|
20|FH_F36343_0_0|SrvcGrp|10543|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|905.00|99|0.00|AEG 6 (NO REV)|
20|FH_F126147_45241_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F127258_79912_0|SrvcGrp|86722|2022|PDM|206.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F130641_40205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F36454_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F115982_0_0|SrvcGrp|73008|2022|PDM|396.00|99|0.00|AEG 10|
20|FH_F124441_0_0|SrvcGrp|88164|2022|PDM|9025.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F37341_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129256_89146_0|SrvcGrp|3178|2022|PDM|1154.00|99|0.00|ACUTE PSYCH|
20|FH_F111042_99159_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F137748_95231_0|SrvcGrp|107908|2022|PDM|6763.00|99|0.00|MATERNITY|
20|FH_F146859_0_0|SrvcGrp|16670|2022|PDM|1802.00|99|0.00|ULNAR NERVE AT ELBOW|
20|FH_F138017_73129_0|SrvcGrp|104752|2022|PDM|6883.00|99|0.00|EXTENSIVE REPAIR OF VAGINA|
20|FH_F119352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F35778_33321_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F39443_0_0|SrvcGrp|30309|2022|PDM|140.00|99|0.00|HAPA WPA ASC 119|
20|FH_F134936_01020_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|1916.00|99|0.00|AEG 6 (NO REV)|
20|FH_F76303_0_0|SrvcGrp|43956|2022|PDM|150.00|99|0.00|NURSING CARE|
20|FH_F91876_0_0|SrvcGrp|34606|2022|PDM|3525.00|99|0.00|CPT 29827|
20|FH_F93881_15009_0|SrvcGrp|105465|2022|PCT|0.55|99|0.00|AETNA THERAPIES|
20|FH_F89475_71202_0|SrvcGrp|20910|2022|PDM|33338.00|99|0.00|MS DRG 234 ONLY|
20|FH_F135013_46321_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39071_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F38377_0_0|SrvcGrp|10543|2022|PDM|105.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F148182_23324_0|SrvcGrp|48396|2022|PDM|84.00|99|0.00|OT SERVICES|
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_F141410_13045_0|SrvcGrp|471|2022|PDM|1133.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F113410_0_0|SrvcGrp|79589|2022|PDM|709.00|99|0.00|UPPER GI|
20|FH_F89563_29407_0|SrvcGrp|103319|2022|PCT|1.50|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F67261_0_0|SrvcGrp|10361|2022|PDM|175.00|99|0.00|CPT CODE 99281|
20|FH_F37733_0_0|SrvcGrp|27214|2022|PDM|250.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F93563_98499_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 2 (NO REV)|
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.50|99|0.00|AEG 10 (NO REV)|
20|FH_F126033_15301_0|SrvcGrp|88621|2022|PDM|105.00|99|0.00|SKILLED NURSING LPN|
20|FH_F56136_0_0|SrvcGrp|21813|2022|PCT|0.92|99|0.00|ARENESP|
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)|
20|FH_F137427_89146_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F124738_0_0|SrvcGrp|73006|2022|PDM|1320.00|99|0.00|AEG 9|
20|FH_F143530_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F127328_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F130716_76013_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F93424_53578_0|SrvcGrp|86648|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F124017_0_0|SrvcGrp|109670|2022|PDM|9500.00|99|0.00|CERV ARTIFIC DISKECTOMY|
20|FH_F133211_0_0|SrvcGrp|111927|2022|PDM|95.00|99|0.00|COVID-19 NON CDC|
20|FH_F89372_0_0|CSTM-ALL|CSTM-00|2020|PDM|5789.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88398_15601_0|SrvcGrp|48385|2022|PDM|83.65|99|0.00|SPEECH THERAPY|
20|FH_F101814_0_0|CSTM-ALL|CSTM-00|2020|PCT|37.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PDM|3550.00|99|0.00|ADULT ANGIO W/O CARDIAC CATH|
20|FH_F130891_41175_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F98002_27103_0|SrvcGrp|90854|2022|PDM|2098.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|3344.00|99|0.00|AEG 6 (NO REV)|
20|FH_F134611_04103_0|SrvcGrp|108484|2022|PDM|2047.50|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU KC"|
20|FH_F143573_01610_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F145641_06902_0|SrvcGrp|76602|2022|PDM|2765.00|99|0.00|CPT 25000|
20|FH_F88274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135663_24401_0|SrvcGrp|48394|2022|PDM|34.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|234.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 232 W/O REV|
20|FH_F124173_66215_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F110420_60649_0|SrvcGrp|79804|2022|PDM|1558.00|99|0.00|AETNA MEDICAL/SURGICAL|
20|FH_F51500_0_0|SrvcGrp|11152|2022|PCT|0.91|99|0.00|TRAUMA|
20|FH_F145641_06902_0|SrvcGrp|27261|2022|PDM|17180.00|99|0.00|CPT 27446|
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F79863_0_0|SrvcGrp|74082|2022|PDM|235.00|99|0.00|HOME INFUSION|
20|FH_F123589_52402_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133922_70563_0|SrvcGrp|112495|2022|PDM|150.93|99|0.00|ACTIGRAPHY TESTING|
20|FH_F34182_0_0|SrvcGrp|9774|2022|PDM|3565.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F39586_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F100782_0_0|SrvcGrp|105164|2022|PDM|625.36|99|0.00|WINDBER MEDICAL CNTR ASC 409|
20|FH_F146520_80435_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130123_24171_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F90232_15126_0|SrvcGrp|22389|2022|PDM|14.18|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F39378_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F110580_71106_0|CSTM-ALL|CSTM-00|2020|PDM|1027.00|99|0.00|AEG 5  (NO REV)|
20|FH_F143677_62301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F114409_18447_0|SrvcGrp|65720|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F111030_05641_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F126343_07018_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F139565_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F124369_0_0|SrvcGrp|96539|2022|PDM|16830.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F130327_03867_0|SrvcGrp|27968|2022|PDM|52.00|99|0.00|SKILLED NURSING LPN|
20|FH_F139747_06241_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F109387_35630_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F137610_0_0|SrvcGrp|89149|2022|PDM|151.00|99|0.00|OP INTENSIVE|
20|FH_F132606_0_0|SrvcGrp|35672|2022|PDM|1873.00|99|0.00|CPT 23412|
20|FH_F113484_43015_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132922_91302_0|SrvcGrp|58509|2022|PDM|500.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F133951_48310_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F52713_0_0|SrvcGrp|70241|2022|PCT|0.32|99|0.00|DIALYSIS|
20|FH_F150139_71667_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126858_43113_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F148760_12953_0|SrvcGrp|88620|2022|PDM|147.00|99|0.00|SKILLED NURSING RN|
20|FH_F151050_17015_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151144_35801_0|SrvcGrp|104562|2022|PDM|1984.57|99|0.00|AETNA ENCIRCLING MATERIAL|
20|FH_F151179_84074_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151279_15301_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F33744_0_0|SrvcGrp|97|2022|PDM|4982.00|99|0.00|C-SECTION|
20|FH_F36386_0_0|SrvcGrp|14412|2022|PDM|460.00|99|0.00|HOSPICE CARE|
20|FH_F116169_0_0|SrvcGrp|29428|2022|PDM|424.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT|
20|FH_F88456_0_0|SrvcGrp|38364|2022|PDM|3291.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F111925_0_0|SrvcGrp|46887|2022|PDM|1602.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|1484.00|99|0.00|AEG 10 (NO REV)|
20|FH_F133376_33414_0|SrvcGrp|108484|2022|PDM|609.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F125910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132800_0_0|SrvcGrp|112479|2022|PDM|65.00|99|0.00|COVID-19 ANTIBODY (HCFA)|
20|FH_F131608_0_0|SrvcGrp|95221|2022|PDM|149.80|99|0.00|RESPITE CARE (HCFA)|
20|FH_F114389_50131_0|SrvcGrp|105734|2022|PCT|1.40|99|0.00|ALL DRUGS, AGENTS, INJECTION DRUGS|
20|FH_F141336_16947_0|SrvcGrp|73500|2022|PDM|623.00|99|0.00|AETNA ER LEVEL I|
20|FH_F49487_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|LIPIDS|
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|332.00|99|0.00|AEG 1 (NO REV)|
20|FH_F49812_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HEARING AIDS|
20|FH_F88733_0_0|SrvcGrp|73483|2022|PDM|630.00|99|0.00|AETNA SUBACUTE III|
20|FH_F122170_60120_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F124059_64055_0|SrvcGrp|24745|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F124115_77546_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124178_01604_0|SrvcGrp|109721|2022|PCT|1.00|99|0.00|LEUPROLIDE ACETATE IMPLANT|
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 10 (NO REV)|
20|FH_F137248_0_0|SrvcGrp|96919|2022|PDM|4058.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F136544_06426_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136674_16335_0|SrvcGrp|110428|2022|PCT|3.00|99|0.00|LABORATORY SERVICES|
20|FH_F136708_06443_0|SrvcGrp|75419|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F136734_46410_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F136745_34772_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114638_25309_0|SrvcGrp|9494|2022|PDM|1544.00|99|0.00|SUBACUTE CARE|
20|FH_F114666_30342_0|SrvcGrp|93071|2022|PDM|3424.00|99|0.00|POSTERIOR SEGMENTAL INSTRU|
20|FH_F138779_62703_0|SrvcGrp|86723|2022|PDM|378.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F100664_03104_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117195_0_0|SrvcGrp|89985|2022|PCT|0.75|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148553_85016_0|SrvcGrp|21781|2022|PDM|4947.00|99|0.00|OP AICD 33249|
20|FH_F122610_73139_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122643_72501_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134733_19460_0|SrvcGrp|104799|2022|PDM|278.00|99|0.00|ELECTROENCEPHALOGRAM|
20|FH_F136778_62034_0|SrvcGrp|75999|2022|PCT|0.00|99|0.00|OP URGENT CARE|
20|FH_F136796_24016_0|SrvcGrp|77021|2022|PDM|5396.49|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F136796_24016_0|SrvcGrp|93432|2022|PDM|2440.83|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F136796_24016_0|SrvcGrp|72121|2022|PDM|2440.83|99|0.00|ARTHOSCOPY|
20|FH_F39622_0_0|SrvcGrp|23958|2022|PCT|0.65|99|0.00|PHARMACY|
20|FH_F49016_0_0|SrvcGrp|10903|2022|PDM|350.00|99|0.00|EMERGENCY ROOM LEVEL I|
20|FH_F147519_52627_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147584_37664_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41695_0_0|SrvcGrp|474|2022|PDM|250.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F42153_0_0|SrvcGrp|65|2022|PDM|2427.00|99|0.00|OBSTETRICAL CARE|
20|FH_F132928_64114_0|SrvcGrp|88620|2022|PDM|157.00|99|0.00|SKILLED NURSING RN|
20|FH_F36541_0_0|CSTM-ALL|CSTM-00|2020|PDM|2222.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F98361_12065_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F120612_23314_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F120657_54220_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
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|100269|2022|PDM|68.25|99|0.00|HEPA VACCINE ADULT IM|
20|FH_F79429_0_0|SrvcGrp|66480|2022|PDM|75.00|99|0.00|RN VISIT|
20|FH_F138670_53045_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138784_32216_0|SrvcGrp|72602|2022|PDM|777.00|99|0.00|ECT|
20|FH_F138787_32258_0|SrvcGrp|113173|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - PFIZER|
20|FH_F139115_32504_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F138387_02886_0|SrvcGrp|113267|2022|PDM|115.00|99|0.00|HOME SOCIAL WORKER|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|295.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1601 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|230.13|99|0.00|HAPA WPA-NWPA 2012-13 ASC 311 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|142.41|99|0.00|HAPA WPA-NWPA 2012-13 ASC 238 W/O REV|
20|FH_F72606_0_0|SrvcGrp|69683|2022|PDM|9525.00|99|0.00|CARDIOVASCULAR SURGERY MS DRG ONLY|
20|FH_F113527_31023_0|SrvcGrp|73605|2022|PDM|1018.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F151339_72758_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F151511_14094_0|SrvcGrp|75999|2022|PCT|0.00|99|0.00|OP URGENT CARE|
20|FH_F132202_67490_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132248_44060_0|SrvcGrp|89149|2022|PDM|163.00|99|0.00|OP INTENSIVE|
20|FH_F122608_84123_0|SrvcGrp|10527|2022|PDM|112.00|99|0.00|HOSPICE SVCS|
20|FH_F117026_17961_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134693_92270_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F134727_30650_0|CSTM-ALL|CSTM-00|2020|PDM|2644.00|99|0.00|AEG 9 (NO REV)|
20|FH_F136778_62034_0|SrvcGrp|105440|2022|PDM|336.00|99|0.00|AETNA TERANIAL MAGN STIM REDETEMINE|
20|FH_F136778_62034_0|SrvcGrp|10361|2022|PDM|693.00|99|0.00|CPT CODE 99281|
20|FH_F136914_64081_0|SrvcGrp|10527|2022|PDM|149.00|99|0.00|HOSPICE SVCS|
20|FH_F131529_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115631_65201_0|SrvcGrp|92821|2022|PDM|2419.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR|
20|FH_F115708_15317_0|SrvcGrp|76501|2022|PDM|321.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F41463_0_0|SrvcGrp|17003|2022|PDM|152.00|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS|
20|FH_F42153_0_0|SrvcGrp|180|2022|PDM|3195.00|99|0.00|INTENSIVE CARE SERVICES|
20|FH_F134612_0_0|SrvcGrp|104098|2022|PDM|6170.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F131169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113585_20155_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F138684_44484_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138907_01040_0|SrvcGrp|104202|2022|PCT|1.00|99|0.00|OP SERVICES AMFS(H) DEFAULT MERCY HH|
20|FH_F57953_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F113390_0_0|SrvcGrp|105237|2022|PDM|1673.10|99|0.00|BIOPSY/REMOVAL LYMPH NODE(S)|
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 7 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1507.61|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1403 W/O REV|
20|FH_F84751_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (HCFA)|
20|FH_F151420_60654_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151420_60654_0|CSTM-ALL|CSTM-00|2020|PDM|1255.00|99|0.00|AEG 10 (NO REV)|
20|FH_F132258_45404_0|SrvcGrp|86851|2022|PDM|34.98|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F132258_45404_0|SrvcGrp|86833|2022|PDM|11.93|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F132268_07060_0|SrvcGrp|90490|2022|PDM|236.00|99|0.00|EVALUATION OF SPEECH FLUENCY|
20|FH_F144928_02703_0|SrvcGrp|17698|2022|PDM|1104.00|99|0.00|ACUTE PSYCH (>=18 YRS)|
20|FH_F145528_76501_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F135352_32225_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135440_32561_0|SrvcGrp|46903|2022|PDM|625.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F91764_93710_0|SrvcGrp|115620|2022|PCT|0.42|99|0.00|NEURORECEIVER 23 IMPLANT|
20|FH_F135805_98225_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135924_02906_0|CSTM-ALL|CSTM-00|2020|PDM|2731.50|99|0.00|INPATIENT DETOX SERVICES <18 YRS|
20|FH_F136211_74447_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F101644_75116_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD HOMEHEALTH|
20|FH_F121731_20164_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F121823_46234_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F44113_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F128201_33334_0|SrvcGrp|73841|2022|PDM|230.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F111301_33122_0|SrvcGrp|12840|2022|PCT|0.63|99|0.00|PACEMAKER|
20|FH_F111301_33122_0|SrvcGrp|82754|2022|PDM|40.00|99|0.00|ASSAY THYROID STIM HORMONE|
20|FH_F141651_0_0|SrvcGrp|65402|2022|PDM|3300.00|99|0.00|CPT 42145|
20|FH_F43137_0_0|SrvcGrp|36971|2022|PDM|50.00|99|0.00|MISC INFUSION THERAPY|
20|FH_F116430_0_0|SrvcGrp|88824|2022|PDM|2864.00|99|0.00|CPT 69631|
20|FH_F141035_0_0|SrvcGrp|91566|2022|PDM|7008.00|99|0.00|REVISE FINGER JOINT|
20|FH_F129240_10028_0|SrvcGrp|26868|2022|PDM|35.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F129240_10028_0|SrvcGrp|22593|2022|PDM|40.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F102960_50613_0|SrvcGrp|99088|2022|PDM|61.22|99|0.00|OP FALSE LABOR|
20|FH_F143648_0_0|SrvcGrp|12491|2022|PCT|0.00|99|0.00|PACEMAKER|
20|FH_F38004_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F39080_0_0|SrvcGrp|30062|2022|PDM|4320.00|99|0.00|MULTIPLE BIRTH NORMAL DELIVERY|
20|FH_F40600_0_0|SrvcGrp|110|2022|PDM|601.00|99|0.00|CD - REHABILITATION|
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_F100783_03431_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F111186_15213_0|SrvcGrp|89417|2022|PDM|575.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F38476_0_0|SrvcGrp|28628|2022|PDM|102.00|99|0.00|SKILLED NURSING|
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|1122.00|99|0.00|AEG 4 (NO REV)|
20|FH_F131235_36049_0|SrvcGrp|73063|2022|PDM|971.00|99|0.00|OBSERVATION SERVICES|
20|FH_F89736_0_0|SrvcGrp|115054|2022|PDM|19542.00|99|0.00|TOTAL JOINT PROCEDURES|
20|FH_F62614_0_0|SrvcGrp|48393|2022|PDM|6.00|99|0.00|SKILLED NURSING SERVICES (PER HOUR)|
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PDM|1181.00|99|0.00|AEG 6 (NO REV)|
20|FH_F89778_0_0|SrvcGrp|88822|2022|PDM|1030.82|99|0.00|CPT 69205|
20|FH_F90136_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F123783_03860_0|SrvcGrp|27969|2022|PDM|28.00|99|0.00|HOME HEALTH AIDE|
20|FH_F58856_0_0|CSTM-ALL|CSTM-00|2020|PDM|2125.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134254_33462_0|SrvcGrp|46903|2022|PDM|749.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F136314_19013_0|SrvcGrp|89337|2022|PDM|673.00|99|0.00|DETOXIFICATION|
20|FH_F136422_29180_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F136489_25428_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F118152_20151_0|SrvcGrp|17015|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118193_06241_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F120490_64133_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F93292_62234_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134011_84102_0|SrvcGrp|29076|2022|PDM|25.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F137048_60714_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F123184_20906_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F135350_60014_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F135434_64424_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F135583_17331_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F135609_37027_0|SrvcGrp|73842|2022|PDM|257.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F135911_32256_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135924_02906_0|SrvcGrp|112678|2022|PDM|132.70|99|0.00|COVID-19 SPECIMEN COLLECT|
20|FH_F135951_34711_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136006_44709_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136165_60637_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129456_30809_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F116397_33404_0|SrvcGrp|86854|2022|PDM|47.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 3 (NO REV)|
20|FH_F101581_16371_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F101741_16823_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F121707_85745_0|SrvcGrp|74668|2022|PDM|450.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121740_98119_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F35357_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE|
20|FH_F42098_0_0|CSTM-ALL|CSTM-00|2020|PDM|26.00|99|0.00|NURSING CARE MOD TE|
20|FH_F63881_0_0|SrvcGrp|59358|2022|PDM|140.00|99|0.00|CCPD TRAINING|
20|FH_F129329_07039_0|SrvcGrp|90397|2022|PDM|325.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F129967_18915_0|SrvcGrp|104418|2022|PDM|112.00|99|0.00|OFFICE/OUTPATIENT VISIT EST (HCFA)(MOD AF)|
20|FH_F111363_33169_0|SrvcGrp|82750|2022|PDM|44.00|99|0.00|CHORIONIC GONADOTROPIN ASSAY|
20|FH_F111363_33169_0|SrvcGrp|72996|2022|PDM|1922.00|99|0.00|AEG 4|
20|FH_F69202_0_0|SrvcGrp|28002|2022|PDM|13200.00|99|0.00|MS DRG 253-254 ONLY|
20|FH_F114166_0_0|SrvcGrp|109732|2022|PDM|198.88|99|0.00|COFINITY  GLOBAL FEE URGENT CARE CENTERS|
20|FH_F116430_0_0|SrvcGrp|27315|2022|PDM|3395.00|99|0.00|TENDON REPAIR|
20|FH_F131000_0_0|SrvcGrp|89980|2022|PDM|3954.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F131000_0_0|SrvcGrp|78097|2022|PDM|3343.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|2006 MEDICARE ASPG V|
20|FH_F128695_50049_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F102222_19720_0|SrvcGrp|86847|2022|PDM|31.50|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F129240_10028_0|SrvcGrp|86843|2022|PDM|35.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F130027_76201_0|SrvcGrp|86723|2022|PDM|344.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F128381_61342_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102960_50613_0|SrvcGrp|10364|2022|PDM|1467.00|99|0.00|CPT CODE 99284|
20|FH_F132090_60915_0|CSTM-ALL|CSTM-00|2020|PDM|2405.55|99|0.00|AEG 8 (NO REV)|
20|FH_F33925_0_0|SrvcGrp|18136|2022|PDM|22990.00|99|0.00|MS DRG 245|
20|FH_F103004_75840_0|SrvcGrp|73004|2022|PDM|1362.00|99|0.00|AEG 8|
20|FH_F131208_0_0|SrvcGrp|106314|2022|PDM|686.40|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F54612_07631_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F98161_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F86712_60173_0|SrvcGrp|76528|2022|PDM|105.00|99|0.00|HOSPICE LTCH|
20|FH_F119795_0_0|SrvcGrp|75002|2022|PDM|7263.00|99|0.00|ARTHOSCOPY|
20|FH_F62614_0_0|SrvcGrp|48398|2022|PDM|30.00|99|0.00|PT SERVICES|
20|FH_F149179_0_0|SrvcGrp|89404|2022|PDM|6800.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F32995_0_0|SrvcGrp|10927|2022|PDM|575.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F40191_0_0|SrvcGrp|13485|2022|PDM|2667.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F46832_0_0|SrvcGrp|22592|2022|PDM|75.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|37.00|99|0.00|AEG 7 (NO REV)|
20|FH_F136371_29720_0|SrvcGrp|87317|2022|PDM|984.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F136487_71269_0|SrvcGrp|108484|2022|PDM|625.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F136542_02446_0|SrvcGrp|87441|2022|PDM|504.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F120489_63552_0|SrvcGrp|75485|2022|PCT|0.75|99|0.00|AEG 4|
20|FH_F137147_75006_0|SrvcGrp|41334|2022|PDM|23370.00|99|0.00|TOTAL KNEE|
20|FH_F137236_17603_0|SrvcGrp|90631|2022|PDM|175.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F137237_33304_0|SrvcGrp|73842|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137238_70056_0|SrvcGrp|73605|2022|PDM|963.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F142403_65201_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142347_75140_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142742_44112_0|SrvcGrp|87131|2022|PDM|500.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 5  (NO REV)|
20|FH_F53732_0_0|SrvcGrp|17016|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F97582_46307_0|SrvcGrp|73603|2022|PDM|9368.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F97601_67218_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F138584_30912_0|SrvcGrp|113382|2022|PDM|1400.00|99|0.00|REPAIR CRANIOFACIAL FRACTURE|
20|FH_F138627_82901_0|SrvcGrp|86844|2022|PDM|85.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1041.40|99|0.00|2006 MEDICARE ASPG V|
20|FH_F140733_45005_0|CSTM-ALL|CSTM-00|2020|PCT|1.75|99|0.00|HSS ASC|
20|FH_F120152_0_0|SrvcGrp|108351|2022|PDM|16500.00|99|0.00|REPAIR RADIUS FRACTURE|
20|FH_F132738_0_0|CSTM-ALL|CSTM-00|2020|PDM|904.00|99|0.00|ACUTE PSYCH|
20|FH_F151611_30032_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119023_91406_0|SrvcGrp|24745|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F119023_91406_0|SrvcGrp|14948|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F120207_0_0|SrvcGrp|83839|2022|PDM|5562.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F145940_71730_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F83754_0_0|SrvcGrp|3224|2022|PCT|0.86|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F133207_0_0|SrvcGrp|90418|2022|PDM|3809.00|99|0.00|ENLARGE BREAST WITH IMPLANT|
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)|
20|FH_F134609_33458_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F85097_0_0|SrvcGrp|12290|2022|PDM|1509.00|99|0.00|DETOXIFICATION|
20|FH_F142376_0_0|SrvcGrp|110443|2022|PDM|1159.00|99|0.00|REMOVE SPINAL CANAL CATHET|
20|FH_F121603_46761_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.00|99|0.00|AEG 6 (NO REV)|
20|FH_F132609_0_0|SrvcGrp|112077|2022|PDM|49727.00|99|0.00|CV SURGERY|
20|FH_F96721_99504_0|SrvcGrp|73601|2022|PDM|13852.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F145641_06902_0|SrvcGrp|87704|2022|PDM|4783.00|99|0.00|AETNA LATERAL RETINACULAR RELEASE|
20|FH_F149660_0_0|SrvcGrp|107193|2022|PDM|6.50|99|0.00|PATIENT ATTENDANT/ESCORT|
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 10 (NO REV)|
20|FH_F118270_30606_0|SrvcGrp|92501|2022|PDM|141.47|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F127282_98004_0|SrvcGrp|93337|2022|PDM|546.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F124369_0_0|SrvcGrp|109788|2022|PDM|4730.00|99|0.00|REVISION OF HAMMERTOE|
20|FH_F85315_15217_0|SrvcGrp|75545|2022|PDM|340.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F77082_0_0|SrvcGrp|361|2022|PDM|5129.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F109242_18466_0|SrvcGrp|52953|2022|PDM|54.10|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F143561_16001_0|SrvcGrp|88620|2022|PDM|90.00|99|0.00|SKILLED NURSING RN|
20|FH_F120930_0_0|SrvcGrp|96539|2022|PDM|2500.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F133875_80027_0|SrvcGrp|3178|2022|PDM|1138.00|99|0.00|ACUTE PSYCH|
20|FH_F126341_27284_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F122551_75605_0|SrvcGrp|3178|2022|PDM|906.00|99|0.00|ACUTE PSYCH|
20|FH_F86733_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|107.86|99|0.00|HAPA WPA-NWPA 2012-13 ASC 138 W/O REV|
20|FH_F72768_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|P.R. HORTON IV THERAPY MOD SH|
20|FH_F105361_80104_0|SrvcGrp|20677|2022|PCT|0.49|99|0.00|HYPERBARIC OXYGEN|
20|FH_F115936_75093_0|SrvcGrp|73841|2022|PDM|475.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F146668_30189_0|SrvcGrp|34605|2022|PDM|7950.00|99|0.00|CPT 28299|
20|FH_F146806_33157_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125440_04043_0|SrvcGrp|67684|2022|PDM|268.00|99|0.00|PSYCH VISIT|
20|FH_F116040_24637_0|SrvcGrp|86833|2022|PDM|10.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F116056_73018_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131697_33444_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132213_17543_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F133170_50501_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F111580_77004_0|SrvcGrp|12280|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F134827_32218_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F151144_35801_0|CSTM-ALL|CSTM-00|2020|PDM|604.00|99|0.00|AEG 2 (NO REV)|
20|FH_F151160_61350_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F121338_37756_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2501000 MOD AW (HCFA)|
20|FH_F91873_12723_0|SrvcGrp|87131|2022|PDM|340.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F115204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F142335_60624_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
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_F116485_17033_0|SrvcGrp|110059|2022|PDM|26.52|99|0.00|ADAPTIVE BH 15 MINS|
20|FH_F94786_07974_0|SrvcGrp|86827|2022|PDM|73.50|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F132627_0_0|SrvcGrp|29075|2022|PDM|64.26|99|0.00|HYDRATION THERAPY|
20|FH_F132627_0_0|SrvcGrp|17003|2022|PDM|220.00|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS|
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|111588|2022|PDM|4493.01|99|0.00|REPAIR OF THIGH MUSCLE|
20|FH_F134027_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 5  (NO REV)|
20|FH_F141014_29732_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136735_0_0|SrvcGrp|91759|2022|PCT|1.00|99|0.00|OCULAR IMPLANT|
20|FH_F77662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F52335_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|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_F122198_20708_0|SrvcGrp|473|2022|PDM|370.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F124058_61081_0|SrvcGrp|73806|2022|PCT|0.65|99|0.00|AETNA ER|
20|FH_F146674_70778_0|SrvcGrp|105410|2022|PDM|30.00|99|0.00|AETNA SUBOXONE ADMIN|
20|FH_F146972_17931_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38688_0_0|SrvcGrp|17075|2022|PDM|1300.00|99|0.00|ASPG VI|
20|FH_F101390_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|GENERAL ACUTE CARE|
20|FH_F124178_01604_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118848_0_0|SrvcGrp|46887|2022|PDM|4800.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F136671_73110_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F113809_47302_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F138779_62703_0|SrvcGrp|89417|2022|PDM|389.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F138052_19462_0|SrvcGrp|90631|2022|PDM|158.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F138855_84067_0|SrvcGrp|108484|2022|PDM|1300.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F138984_06896_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119067_94080_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F119018_47802_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F117371_77059_0|SrvcGrp|86722|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F117295_70006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147726_18017_0|CSTM-ALL|CSTM-00|2020|PDM|991.00|99|0.00|AEG 6 (NO REV)|
20|FH_F117098_20186_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117214_84020_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F137333_51012_0|SrvcGrp|113075|2022|PCT|0.00|99|0.00|BEHAVIORAL HEALTH|
20|FH_F137934_51054_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F35210_0_0|SrvcGrp|3015|2022|PCT|0.50|99|0.00|SUPPLIES|
20|FH_F109652_0_0|SrvcGrp|31038|2022|PDM|49803.00|99|0.00|MS DRG 233-234 ONLY|
20|FH_F111046_0_0|SrvcGrp|13683|2022|PDM|765.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F138732_60016_0|SrvcGrp|73841|2022|PDM|402.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F69364_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ASPG X|
20|FH_F109513_0_0|SrvcGrp|90419|2022|PDM|4000.00|99|0.00|REPAIR HAND DISLOCATION|
20|FH_F110160_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F77462_0_0|SrvcGrp|47764|2022|PDM|141.00|99|0.00|HOSPICE CARE/ IN HOME S9126 VISIT LEVEL|
20|FH_F111594_0_0|SrvcGrp|35670|2022|PDM|7699.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F119417_78212_0|SrvcGrp|90341|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN (HCFA)|
20|FH_F119491_19904_0|SrvcGrp|48385|2022|PDM|84.00|99|0.00|SPEECH THERAPY|
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1007.00|99|0.00|AEG 4 (NO REV)|
20|FH_F81591_70112_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F117372_07442_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F100784_59923_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F97621_75801_0|SrvcGrp|73659|2022|PDM|11035.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F144037_63141_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F67182_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F72226_65804_0|SrvcGrp|30623|2022|PDM|3445.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F40975_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE|
20|FH_F120837_33309_0|SrvcGrp|108484|2022|PDM|623.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F92676_15063_0|SrvcGrp|78944|2022|PDM|3134.28|99|0.00|MON VALLEY ASC 702|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F128445_85704_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F96261_0_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F55375_0_0|SrvcGrp|10905|2022|PDM|1725.00|99|0.00|EMERGENCY ROOM LEVEL III|
20|FH_F42494_0_0|SrvcGrp|18099|2022|PCT|0.85|99|0.00|OP SURGERY|
20|FH_F49637_0_0|SrvcGrp|27375|2022|PDM|4200.00|99|0.00|LITHOTRIPSY- MOD 50|
20|FH_F81373_64064_0|SrvcGrp|10393|2022|PDM|7372.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F111417_33613_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F141772_80124_0|SrvcGrp|108850|2022|PCT|1.00|99|0.00|IMPLANTABLE BREAST PROSTHESIS|
20|FH_F133019_23236_0|SrvcGrp|46605|2022|PDM|90.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 1 (NO REV)|
20|FH_F89851_83854_0|SrvcGrp|31026|2022|PDM|15143.00|99|0.00|MS DRG 488 ONLY|
20|FH_F92676_15063_0|SrvcGrp|79093|2022|PDM|101.09|99|0.00|MON VALLEY ASC 147|
20|FH_F80855_0_0|SrvcGrp|42550|2022|PDM|1250.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F143199_33403_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F118027_28801_0|SrvcGrp|86723|2022|PDM|461.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F133480_85374_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F34706_0_0|SrvcGrp|9645|2022|PDM|11406.00|99|0.00|DRG 149 MAJOR SML & LRG BOWEL PROC|
20|FH_F150529_08037_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92677_08003_0|SrvcGrp|86825|2022|PDM|113.40|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F45977_0_0|SrvcGrp|40409|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD NU KC|
20|FH_F143147_80124_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (BREAKOUT)|
20|FH_F132289_89145_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F97621_75801_0|SrvcGrp|73601|2022|PDM|11414.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F150911_75979_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AETNA OP CHEMOTHERAPY DRUG|
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F38865_0_0|SrvcGrp|24703|2022|PDM|500.00|99|0.00|NEWBORN NURSERY|
20|FH_F124608_0_0|SrvcGrp|109909|2022|PDM|3060.00|99|0.00|LAPAROSCOPY|
20|FH_F142927_52402_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143191_17512_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F49637_0_0|SrvcGrp|14614|2022|PDM|3800.00|99|0.00|LITHOTRIPSY|
20|FH_F117756_75402_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1748.00|99|0.00|AEG 5  (NO REV)|
20|FH_F133478_40165_0|SrvcGrp|107542|2022|PCT|0.54|99|0.00|RADIOLOGY|
20|FH_F31093_0_0|CSTM-ALL|CSTM-00|2020|PDM|1695.00|99|0.00|ASPG V|
20|FH_F125540_19462_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|943.00|99|0.00|AEG 10 (NO REV)|
20|FH_F111540_16823_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F38508_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: POS FACILITY MOD 26|
20|FH_F118496_92627_0|SrvcGrp|86722|2022|PDM|315.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F62601_0_0|SrvcGrp|48397|2022|PDM|30.00|99|0.00|PT SERVICES|
20|FH_F89015_74017_0|SrvcGrp|53145|2022|PDM|110.00|99|0.00|SOCIAL WORKER|
20|FH_F149160_02180_0|SrvcGrp|107288|2022|PCT|1.00|99|0.00|INJ INTERFERON BETA|
20|FH_F110728_13069_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F115483_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|AEG 10 (NO REV)|
20|FH_F130654_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140295_0_0|SrvcGrp|92363|2022|PDM|3607.00|99|0.00|OSTEOCHONDRAL ALLOGRAFT KNEE|
20|FH_F31547_0_0|SrvcGrp|12687|2022|PDM|18.06|99|0.00|VANCOMYCIN|
20|FH_F111044_0_0|SrvcGrp|82114|2022|PDM|2266.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|124.31|99|0.00|SALLY BALIN,999182,ASC 120|
20|FH_F46284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F147330_34761_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F124441_0_0|SrvcGrp|67066|2022|PDM|8550.00|99|0.00|CERVICAL SURGERY|
20|FH_F36047_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F124435_03882_0|SrvcGrp|73842|2022|PDM|182.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F50220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F94643_90501_0|SrvcGrp|86847|2022|PDM|65.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F41377_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY|
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F94643_90501_0|SrvcGrp|26868|2022|PDM|48.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|6055.60|99|0.00|AEG 9 (NO REV)|
20|FH_F115269_0_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F140292_06902_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117645_90034_0|SrvcGrp|93919|2022|PDM|725.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F94303_0_0|SrvcGrp|76243|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|3107.00|99|0.00|ORTHOPEDIC SURGERY|
20|FH_F139823_32250_0|SrvcGrp|89149|2022|PDM|246.00|99|0.00|OP INTENSIVE|
20|FH_F139810_60938_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143412_70503_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F143412_70503_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F143488_84770_0|CSTM-ALL|CSTM-00|2020|PDM|716.00|99|0.00|AEG 2 (NO REV)|
20|FH_F130925_34652_0|SrvcGrp|89417|2022|PDM|389.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F130937_98002_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136250_73026_0|SrvcGrp|108484|2022|PDM|1220.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F120888_63823_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F126395_37043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125287_92374_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F36274_0_0|SrvcGrp|9829|2022|PDM|90.00|99|0.00|PT SVCS|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|22990.00|99|0.00|MS DRG 238|
20|FH_F36132_0_0|SrvcGrp|22351|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F39266_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F150025_0_0|SrvcGrp|30609|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F36439_0_0|SrvcGrp|23008|2022|PDM|1300.00|99|0.00|V5253|
20|FH_F36439_0_0|SrvcGrp|23000|2022|PDM|1300.00|99|0.00|V5261|
20|FH_F37200_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REGIONAL HEALTH SVCS OF HOWARD-DME-MOD AU|
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F59732_0_0|SrvcGrp|16750|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F93791_0_0|SrvcGrp|67066|2022|PDM|1050.00|99|0.00|CERVICAL SURGERY|
20|FH_F125938_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F78603_0_0|SrvcGrp|29607|2022|PDM|43712.36|99|0.00|MS DRG 221 ONLY|
20|FH_F87254_0_0|SrvcGrp|73002|2022|PDM|1870.00|99|0.00|AEG 7|
20|FH_F115121_32250_0|SrvcGrp|108484|2022|PDM|1265.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F149868_0_0|SrvcGrp|90477|2022|PDM|190.00|99|0.00|HOSPICE|
20|FH_F40615_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130207_33458_0|SrvcGrp|89149|2022|PDM|233.00|99|0.00|OP INTENSIVE|
20|FH_F115043_77954_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F37679_0_0|SrvcGrp|27074|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY (MOD SH)|
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|1995.00|99|0.00|AEG 3 (NO REV)|
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121564_35080_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F129019_62650_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F33712_0_0|SrvcGrp|12406|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F92034_0_0|SrvcGrp|107348|2022|PDM|2000.00|99|0.00|EXTERNAL RECHARG SYS INTERN|
20|FH_F146569_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F38798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|DME - MOD UE|
20|FH_F37945_0_0|SrvcGrp|27708|2022|PDM|212.00|99|0.00|DIALYSIS|
20|FH_F118072_38133_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143528_0_0|SrvcGrp|111958|2022|PDM|2625.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F39917_0_0|SrvcGrp|13632|2022|PDM|120.00|99|0.00|CPT 99215|
20|FH_F148260_0_0|SrvcGrp|67994|2022|PDM|4321.00|99|0.00|CPT 58120|
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F116731_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F133215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F38341_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F31253_0_0|SrvcGrp|3259|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION|
20|FH_F130146_0_0|SrvcGrp|107749|2022|PDM|175.00|99|0.00|CAPD/CCPD|
20|FH_F72764_0_0|SrvcGrp|21975|2022|PDM|1575.00|99|0.00|INPATIENT SERVICES|
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_F46874_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ASPG III|
20|FH_F33712_0_0|SrvcGrp|941|2022|PDM|1300.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F37679_0_0|SrvcGrp|26851|2022|PDM|30.50|99|0.00|ANTI-EMETICS INFUSION THERAPY (MOD SH)|
20|FH_F130747_0_0|SrvcGrp|82114|2022|PDM|5202.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F40046_0_0|SrvcGrp|15385|2022|PDM|105.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F100761_02539_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F37945_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.00|99|0.00|ASPG I|
20|FH_F120251_21122_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F128402_80233_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.00|99|0.00|AEG 2 (NO REV)|
20|FH_F89475_71202_0|CSTM-ALL|CSTM-00|2020|PDM|2549.00|99|0.00|AEG 6 (NO REV)|
20|FH_F149888_68506_0|SrvcGrp|26281|2022|PDM|3562.00|99|0.00|CPT 58353|
20|FH_F131228_01826_0|SrvcGrp|20908|2022|PDM|28219.51|99|0.00|MS DRG 247 ONLY|
20|FH_F34496_0_0|SrvcGrp|10099|2022|PDM|4189.50|99|0.00|DRG 372 ONLY VAGINAL DELIVERY W/COMPL DX|
20|FH_F32151_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F55613_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F83255_32025_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F129766_48236_0|SrvcGrp|35982|2022|PDM|50.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F52854_0_0|SrvcGrp|360|2022|PDM|1480.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F116311_02657_0|SrvcGrp|73841|2022|PDM|445.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|2506.00|99|0.00|AEG 5  (NO REV)|
20|FH_F137611_30909_0|SrvcGrp|73605|2022|PDM|1007.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F135171_22601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137614_17602_0|SrvcGrp|89417|2022|PDM|370.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F145552_86301_0|SrvcGrp|3178|2022|PDM|1185.00|99|0.00|ACUTE PSYCH|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39740_0_0|SrvcGrp|28956|2022|PDM|31890.00|99|0.00|MS DRG 222-225 ONLY CV SURGERY|
20|FH_F125028_19061_0|SrvcGrp|19742|2022|PDM|94.50|99|0.00|MID-LINE INSERTION|
20|FH_F145758_20745_0|SrvcGrp|73610|2022|PCT|0.00|99|0.00|AETNA IMPLANTS|
20|FH_F92276_32308_0|SrvcGrp|105465|2022|PDM|273.00|99|0.00|AETNA THERAPIES|
20|FH_F148356_18104_0|SrvcGrp|90854|2022|PDM|950.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F87254_0_0|SrvcGrp|87053|2022|PDM|1100.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F55532_0_0|SrvcGrp|53602|2022|PCT|1.00|99|0.00|DRUGS|
20|FH_F116341_12180_0|SrvcGrp|89024|2022|PDM|83.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F91876_0_0|SrvcGrp|72996|2022|PDM|1691.00|99|0.00|AEG 4|
20|FH_F121547_46805_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F128363_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F89475_71202_0|SrvcGrp|99068|2022|PDM|36221.00|99|0.00|MS DRG 228-229 ONLY OTHER CARDIOTHORACIC PROC|
20|FH_F33855_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|1277.00|99|0.00|AEG 8 (NO REV)|
20|FH_F121090_07848_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F129518_54002_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F86159_15139_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F86159_15139_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F86872_15215_0|SrvcGrp|10577|2022|PDM|50.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)|
20|FH_F36646_0_0|SrvcGrp|474|2022|PDM|275.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|1753.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F86851_0_0|SrvcGrp|79595|2022|PDM|788.00|99|0.00|CPT 45385|
20|FH_F88096_0_0|SrvcGrp|11663|2022|PCT|0.91|99|0.00|IMPLANTS|
20|FH_F148419_01453_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148479_49519_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148482_20136_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F145845_37167_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123872_75006_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F36118_0_0|SrvcGrp|9829|2022|PDM|102.00|99|0.00|PT SVCS|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/MOD AU (TX)|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.00|99|0.00|HAPA EPA ASC 49|
20|FH_F128917_57212_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146159_89102_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F93911_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|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_F43330_0_0|SrvcGrp|11074|2022|PDM|70.00|99|0.00|NURSING CARE|
20|FH_F118542_60188_0|SrvcGrp|14893|2022|PDM|130.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F36973_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REFERENCE LABS MOD 26|
20|FH_F117550_0_0|SrvcGrp|106521|2022|PDM|34.00|99|0.00|PT RE-EVAL|
20|FH_F133473_21702_0|SrvcGrp|48396|2022|PDM|169.74|99|0.00|OT SERVICES|
20|FH_F138611_0_0|SrvcGrp|97895|2022|PDM|14894.00|99|0.00|REVISE KNEE 2|
20|FH_F120837_33309_0|SrvcGrp|73842|2022|PDM|238.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F66403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F119128_93619_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F78385_0_0|SrvcGrp|75501|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY|
20|FH_F132289_89145_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F92676_15063_0|SrvcGrp|79020|2022|PDM|958.62|99|0.00|MON VALLEY ASC 225|
20|FH_F133487_24293_0|SrvcGrp|88621|2022|PDM|125.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133018_84037_0|SrvcGrp|48385|2022|PDM|84.50|99|0.00|SPEECH THERAPY|
20|FH_F137933_0_0|SrvcGrp|113163|2022|PDM|12900.00|99|0.00|REMOVE/REPLACE UR SPHINCTER|
20|FH_F148553_85016_0|SrvcGrp|115474|2022|PDM|2850.00|99|0.00|RIGHT & LEFT HEART ART/VENTRICLE ANGIO|
20|FH_F43249_0_0|SrvcGrp|40820|2022|PDM|2590.00|99|0.00|ICU/CCU|
20|FH_F134693_92270_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F134727_30650_0|SrvcGrp|74581|2022|PCT|0.60|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F136769_37142_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136796_24016_0|SrvcGrp|98347|2022|PDM|3945.98|99|0.00|HIP ARTHROSCOPY / SURGERY|
20|FH_F136914_64081_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113713_17013_0|SrvcGrp|91752|2022|PDM|65.00|99|0.00|AETNA GROUP THERAPY (MOD TD)|
20|FH_F54572_0_0|SrvcGrp|21975|2022|PDM|1575.00|99|0.00|INPATIENT SERVICES|
20|FH_F115266_66736_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F147526_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147563_60160_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|GENERAL ACUTE CARE|
20|FH_F147699_83704_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F147540_54871_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F41463_0_0|SrvcGrp|17008|2022|PDM|80.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS|
20|FH_F41463_0_0|SrvcGrp|35777|2022|PDM|50.00|99|0.00|ENTERAL NUTRITION (B4035)|
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|2739.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F137906_0_0|SrvcGrp|104229|2022|PDM|100.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F133536_0_0|SrvcGrp|82720|2022|PDM|2200.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F133579_0_0|SrvcGrp|38909|2022|PDM|1624.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F141837_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F40715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS|
20|FH_F48295_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE|
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113585_20155_0|SrvcGrp|27969|2022|PDM|23.00|99|0.00|HOME HEALTH AIDE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|221.09|99|0.00|HAPA WPA-NWPA 2012-13 ASC 312 W/O REV|
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_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|1541.00|99|0.00|AEG 8 (NO REV)|
20|FH_F151503_30067_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 7 (NO REV)|
20|FH_F122114_91364_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135350_60014_0|SrvcGrp|27968|2022|PDM|25.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135583_17331_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F136226_28638_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131265_84106_0|SrvcGrp|75419|2022|PDM|583.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F130766_04967_0|SrvcGrp|114018|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F127399_0_0|SrvcGrp|34603|2022|PDM|3121.00|99|0.00|CPT 24341|
20|FH_F140629_0_0|SrvcGrp|107088|2022|PDM|2497.00|99|0.00|JAW ARTHROSCOPY/TMJ SURG|
20|FH_F140629_0_0|SrvcGrp|113481|2022|PDM|2497.00|99|0.00|LAPAROSCOPY|
20|FH_F101741_16823_0|SrvcGrp|75545|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F32803_0_0|SrvcGrp|115|2022|PDM|450.00|99|0.00|SKILLED NURSING CARE|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPTION CARE OF MUNCY FH MOD-SH|
20|FH_F46918_0_0|SrvcGrp|11798|2022|PDM|112.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F75205_0_0|SrvcGrp|43432|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE HOURLY|
20|FH_F129967_18915_0|SrvcGrp|89024|2022|PDM|84.68|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F129967_18915_0|SrvcGrp|109330|2022|PCT|1.09|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F134322_98001_0|SrvcGrp|112545|2022|PCT|1.00|99|0.00|AMPICILLIN INJECTION|
20|FH_F39178_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|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_F38288_0_0|SrvcGrp|28818|2022|PCT|0.45|99|0.00|SUPPLIES AND DEVICES|
20|FH_F41780_0_0|SrvcGrp|31189|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF (DME)|
20|FH_F42026_0_0|SrvcGrp|109|2022|PDM|393.00|99|0.00|CD - DETOX|
20|FH_F87557_33309_0|SrvcGrp|86844|2022|PDM|30.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F88831_84123_0|SrvcGrp|47411|2022|PDM|90.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F140102_0_0|SrvcGrp|83857|2022|PDM|550.00|99|0.00|IP HOSPICE SVCS|
20|FH_F129240_10028_0|SrvcGrp|24745|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F132347_01605_0|SrvcGrp|95220|2022|PDM|450.00|99|0.00|HOSPICE CARE PROVIDED IN HOSPICE FACILITY (HCFA)|
20|FH_F107200_0_0|SrvcGrp|93637|2022|PDM|5722.00|99|0.00|LAPAROSCOPY SURGICAL|
20|FH_F134255_01201_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136367_72210_0|SrvcGrp|73842|2022|PDM|202.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136371_29720_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136373_17055_0|SrvcGrp|60856|2022|PDM|120.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE|
20|FH_F136386_30901_0|SrvcGrp|20914|2022|PDM|94500.00|99|0.00|MS DRG 233 ONLY|
20|FH_F136386_30901_0|SrvcGrp|21359|2022|PDM|52500.00|99|0.00|MS DRG 460 ONLY|
20|FH_F134011_84102_0|SrvcGrp|53746|2022|PDM|112.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F134156_32174_0|SrvcGrp|98319|2022|PDM|739.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY (HCFA)|
20|FH_F137242_52722_0|SrvcGrp|106048|2022|PDM|884.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F142473_07663_0|SrvcGrp|90339|2022|PCT|1.00|99|0.00|SKILLED NURSING RN|
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)|
20|FH_F53732_0_0|SrvcGrp|50164|2022|PDM|74.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 6 HRS|
20|FH_F53732_0_0|SrvcGrp|14945|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F53732_0_0|SrvcGrp|14947|2022|PDM|65.00|99|0.00|HOME INFUSION|
20|FH_F138584_30912_0|SrvcGrp|113380|2022|PDM|1500.00|99|0.00|RECONSTRUCTION MIDFACE LEFORT I|
20|FH_F140615_73013_0|SrvcGrp|3378|2022|PDM|905.00|99|0.00|OBSERVATION SVCS|
20|FH_F136751_0_0|SrvcGrp|74039|2022|PDM|9500.00|99|0.00|LAMINECTOMY|
20|FH_F144011_60616_0|SrvcGrp|705|2022|PCT|0.43|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F35453_0_0|SrvcGrp|38|2022|PDM|1955.00|99|0.00|NORMAL DELIVERY|
20|FH_F109941_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|7283.00|99|0.00|AEG 9 (NO REV)|
20|FH_F115312_78550_0|SrvcGrp|73841|2022|PDM|455.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|194.21|99|0.00|ASPG 115|
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|ASPG VIII|
20|FH_F87615_80033_0|SrvcGrp|113781|2022|PDM|464.00|99|0.00|INTENSIVE OP / CHEMICAL DEPENDENCY|
20|FH_F149940_02645_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F146253_60419_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F97564_52246_0|SrvcGrp|73601|2022|PDM|12053.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F120437_85202_0|SrvcGrp|27968|2022|PDM|60.27|99|0.00|SKILLED NURSING LPN|
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|1614.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F133049_19145_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.76|99|0.00|HAPA WPA-NWPA 2012-13 ASC 204 W/O REV|
20|FH_F44257_0_0|CSTM-ALL|CSTM-00|2020|PDM|1044.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37562_0_0|SrvcGrp|25940|2022|PDM|117.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F133490_90650_0|CSTM-ALL|CSTM-00|2020|PDM|4830.00|99|0.00|AEG 7 (NO REV)|
20|FH_F150900_19104_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143202_32114_0|SrvcGrp|73842|2022|PDM|187.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F50221_0_0|SrvcGrp|33165|2022|PDM|405.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F127284_84403_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F127410_53551_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38089_0_0|SrvcGrp|26893|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS/IMPLANTS|
20|FH_F132934_63005_0|SrvcGrp|12659|2022|PDM|734.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F130108_0_0|SrvcGrp|10964|2022|PDM|1500.00|99|0.00|ACUTE IP MED/SURG SVCS|
20|FH_F70605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F44016_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MRI/CT|
20|FH_F44025_0_0|CSTM-ALL|CSTM-00|2020|PDM|140.00|99|0.00|CD INTENSIVE OUTPATIENT SVCS|
20|FH_F117087_0_0|SrvcGrp|88599|2022|PDM|2093.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F142775_72801_0|SrvcGrp|89417|2022|PDM|424.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F111412_33777_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F144011_60616_0|SrvcGrp|44564|2022|PDM|1035.00|99|0.00|NEWBORN NURSERY|
20|FH_F135179_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132528_64014_0|SrvcGrp|54972|2022|PDM|127.00|99|0.00|ST THERAPY|
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97061_85012_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F149940_02645_0|SrvcGrp|115592|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F126650_68105_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145884_72113_0|SrvcGrp|3178|2022|PDM|849.00|99|0.00|ACUTE PSYCH|
20|FH_F74463_0_0|SrvcGrp|21342|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F87334_16507_0|SrvcGrp|46424|2022|PDM|104.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F41696_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|ACUTE PSYCH|
20|FH_F71271_0_0|SrvcGrp|46605|2022|PDM|12.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133006_48067_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F39640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|DME - NO MOD|
20|FH_F137639_0_0|SrvcGrp|3142|2022|PDM|1900.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F113324_17055_0|SrvcGrp|105215|2022|PDM|980.00|99|0.00|SKILLED CARE LEVEL 4|
20|FH_F92676_15063_0|SrvcGrp|78998|2022|PDM|1113.75|99|0.00|MON VALLEY ASC 103|
20|FH_F42779_0_0|SrvcGrp|10107|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F143168_60563_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|415.99|99|0.00|HAPA WPA-NWPA 2012-13 ASC 102 W/O REV|
20|FH_F92531_0_0|SrvcGrp|92194|2022|PDM|5638.00|99|0.00|SPINE DISK SURGERY REMOVE LAMINA|
20|FH_F112853_22408_0|SrvcGrp|94102|2022|PDM|650.00|99|0.00|HOME VENT NON-INVASIVE INTER|
20|FH_F149028_0_0|SrvcGrp|87077|2022|PDM|161.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F50615_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133261_78041_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F133268_63703_0|SrvcGrp|82981|2022|PDM|106.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F120829_85283_0|SrvcGrp|74668|2022|PDM|500.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148872_45723_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149840_80002_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F87171_32578_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F146229_60031_0|SrvcGrp|52953|2022|PDM|70.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F34759_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151044_19606_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151122_10462_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F112844_0_0|SrvcGrp|89822|2022|PDM|115.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F129130_92562_0|SrvcGrp|115249|2022|PCT|4.64|99|0.00|LABORATORY SERVICES|
20|FH_F37823_0_0|SrvcGrp|3029|2022|PDM|650.00|99|0.00|NEWBORN NURSERY|
20|FH_F37823_0_0|SrvcGrp|27538|2022|PDM|2900.00|99|0.00|NORMAL DELIVERY|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2504030 MOD 26 (HCFA)|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|113.15|99|0.00|DELAWARE VALLEY- ASC 220|
20|FH_F91818_02828_0|SrvcGrp|73842|2022|PDM|171.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114866_77706_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F111925_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F140750_89119_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F140875_63363_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148908_10710_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149514_99701_0|SrvcGrp|74668|2022|PDM|265.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149584_77045_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151562_26003_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151601_89118_0|SrvcGrp|66265|2022|PDM|80.75|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F55893_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F41481_0_0|SrvcGrp|17065|2022|PDM|366.00|99|0.00|ASPG I|
20|FH_F80366_0_0|SrvcGrp|72998|2022|PCT|0.94|99|0.00|AEG 5|
20|FH_F117261_43543_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F147725_06002_0|SrvcGrp|114442|2022|PDM|4651.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F147799_18052_0|SrvcGrp|26160|2022|PCT|1.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F147941_06023_0|SrvcGrp|114475|2022|PCT|1.20|99|0.00|UNLISTED AMBULANCE SERVICE|
20|FH_F129501_67831_0|SrvcGrp|74584|2022|PDM|63.00|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F117093_40041_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117240_37334_0|SrvcGrp|88978|2022|PDM|3200.00|99|0.00|VAGINAL DELIVERY|
20|FH_F38699_0_0|SrvcGrp|68580|2022|PCT|1.00|99|0.00|IMMUNIZATIONS|
20|FH_F39893_0_0|SrvcGrp|38|2022|PDM|1800.00|99|0.00|NORMAL DELIVERY|
20|FH_F124757_45750_0|SrvcGrp|79458|2022|PDM|0.25|99|0.00|MED RECORD COPY|
20|FH_F129053_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F138732_60016_0|SrvcGrp|89417|2022|PDM|402.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F143450_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F85757_0_0|SrvcGrp|82223|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F36372_0_0|SrvcGrp|15516|2022|PDM|54.00|99|0.00|HYDRATION THERAPY|
20|FH_F39266_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F98625_08103_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F128031_0_0|SrvcGrp|96353|2022|PDM|18700.00|99|0.00|RECONSTRUCT ANKLE JOINT|
20|FH_F100681_73104_0|SrvcGrp|73559|2022|PDM|6332.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F139236_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F102881_0_0|SrvcGrp|92825|2022|PCT|0.80|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F101807_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111594_0_0|SrvcGrp|58993|2022|PDM|7215.00|99|0.00|DISKECTOMY|
20|FH_F132544_0_0|SrvcGrp|19920|2022|PDM|3454.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F137951_0_0|SrvcGrp|35672|2022|PDM|3132.00|99|0.00|CPT 23412|
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F81494_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|CT SCAN|
20|FH_F142927_52402_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148039_92629_0|SrvcGrp|90854|2022|PDM|1250.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F118539_44256_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F127412_15301_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|2251.00|99|0.00|AEG 6 (NO REV)|
20|FH_F50974_0_0|CSTM-ALL|CSTM-00|2020|PDM|18.00|99|0.00|ANTIBIOTIC THERAPY Q24 (MOD SH)|
20|FH_F106400_02905_0|SrvcGrp|82369|2022|PCT|2.20|99|0.00|AETNA LABORATORY|
20|FH_F141654_15217_0|SrvcGrp|23681|2022|PDM|103.81|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F40591_0_0|CSTM-ALL|CSTM-00|2020|PDM|928.00|99|0.00|MULTIPLE BIRTH|
20|FH_F91152_60061_0|SrvcGrp|86723|2022|PDM|362.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F95980_20016_0|SrvcGrp|89417|2022|PDM|311.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F103360_68845_0|SrvcGrp|85145|2022|PDM|191.00|99|0.00|PT/OT/ST|
20|FH_F89851_83854_0|CSTM-ALL|CSTM-00|2020|PDM|4130.00|99|0.00|AEG 5  (NO REV)|
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|1987.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F123545_44512_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F40176_0_0|SrvcGrp|32013|2022|PDM|190.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F112886_34109_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129644_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|945.00|99|0.00|AEG 2 (NO REV)|
20|FH_F150464_15746_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F68363_0_0|SrvcGrp|3404|2022|PDM|55.00|99|0.00|CPT 99211|
20|FH_F68947_0_0|SrvcGrp|65403|2022|PDM|4653.17|99|0.00|CPT 42830|
20|FH_F148639_0_0|SrvcGrp|58636|2022|PDM|5000.00|99|0.00|CPT 62362|
20|FH_F40256_0_0|CSTM-ALL|CSTM-00|2020|PDM|490.00|99|0.00|ACUTE PSYCH|
20|FH_F67763_0_0|SrvcGrp|44247|2022|PDM|375.00|99|0.00|CAPD TRAINING|
20|FH_F77787_0_0|SrvcGrp|29893|2022|PDM|114.00|99|0.00|ST|
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1513.00|99|0.00|AEG 7 (NO REV)|
20|FH_F128390_0_0|SrvcGrp|80920|2022|PDM|591.00|99|0.00|HOSPICE SERVICES|
20|FH_F125049_44131_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F141890_64865_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F87559_0_0|SrvcGrp|86474|2022|PDM|43.65|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F106241_93309_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143684_0_0|SrvcGrp|88487|2022|PDM|8323.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F63301_0_0|CSTM-ALL|CSTM-00|2020|PDM|130.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F141668_47978_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40056_0_0|SrvcGrp|30061|2022|PDM|6480.00|99|0.00|MULTI-BIRTH C-SECTION|
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|87.58|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F132722_71373_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F123085_21921_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F141767_62312_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F105440_46383_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER RRKC|
20|FH_F138196_0_0|SrvcGrp|13557|2022|PDM|2500.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F132627_0_0|SrvcGrp|111527|2022|PDM|291.00|99|0.00|HOME INFUSION (HCFA)|
20|FH_F132968_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132988_0_0|SrvcGrp|90420|2022|PDM|6057.71|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F144828_0_0|SrvcGrp|114193|2022|PDM|3014.00|99|0.00|REMOVAL OF TISSUE FOR GRAFT|
20|FH_F141127_62286_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F78447_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1158.00|99|0.00|ASPG IV|
20|FH_F124180_0_0|SrvcGrp|97319|2022|PDM|8808.50|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F131505_0_0|SrvcGrp|111848|2022|PDM|484.00|99|0.00|REVISION OF CERVIX|
20|FH_F52335_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F81731_0_0|SrvcGrp|92604|2022|PDM|298.00|99|0.00|SUB-ACUTE CARE LEVEL I|
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F34652_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|ACUTE PSYCH|
20|FH_F38688_0_0|SrvcGrp|17067|2022|PDM|850.00|99|0.00|ASPG II|
20|FH_F129549_01238_0|SrvcGrp|29347|2022|PDM|36.41|99|0.00|HOME HEALTH AIDE|
20|FH_F124178_01604_0|SrvcGrp|9482|2022|PCT|1.00|99|0.00|ZYVOK/LINEZOLID|
20|FH_F124212_33407_0|SrvcGrp|87317|2022|PDM|675.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F124222_92625_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F124618_32340_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97083_90670_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F55694_0_0|SrvcGrp|25934|2022|PDM|715.00|99|0.00|SKILLED NURSING|
20|FH_F92599_0_0|SrvcGrp|75487|2022|PDM|1031.00|99|0.00|AEG 5|
20|FH_F137248_0_0|SrvcGrp|64761|2022|PDM|4058.00|99|0.00|DISCECTOMY|
20|FH_F100664_03104_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F150763_0_0|SrvcGrp|13807|2022|PDM|511.00|99|0.00|OBSERVATION SVCS|
20|FH_F144039_0_0|SrvcGrp|95107|2022|PDM|5738.00|99|0.00|INTRAOCULAR LENS PROSTHESIS|
20|FH_F148553_85016_0|CSTM-ALL|CSTM-00|2020|PDM|802.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132721_0_0|SrvcGrp|58|2022|PDM|9668.00|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F137447_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F43135_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F43613_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F136796_24016_0|SrvcGrp|93431|2022|PDM|2440.83|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F136807_43220_0|SrvcGrp|48385|2022|PDM|83.00|99|0.00|SPEECH THERAPY|
20|FH_F136913_68803_0|SrvcGrp|24598|2022|PDM|1886.00|99|0.00|MS DRG 945-946 ONLY|
20|FH_F112268_19087_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F116383_63026_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F147621_74338_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147580_75110_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147700_21401_0|CSTM-ALL|CSTM-00|2020|PDM|660.07|99|0.00|AEG 2 (NO REV)|
20|FH_F147725_06002_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F42422_0_0|SrvcGrp|3277|2022|PDM|809.00|99|0.00|SKILLED NURSING CARE|
20|FH_F133494_90023_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F133176_32751_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133700_92808_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F37772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|HEARING AIDS|
20|FH_F102641_0_0|SrvcGrp|76847|2022|PDM|3152.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F35381_0_0|SrvcGrp|16|2022|PDM|1046.00|99|0.00|ACUTE REHABILITATION|
20|FH_F120630_33161_0|SrvcGrp|108484|2022|PDM|640.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F38846_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|NEWBORN NURSERY|
20|FH_F114853_0_0|SrvcGrp|90343|2022|PDM|7215.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL|
20|FH_F138734_0_0|SrvcGrp|46903|2022|PDM|543.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F138992_72703_0|SrvcGrp|3066|2022|PCT|0.26|99|0.00|HIGH-COST DRUGS|
20|FH_F138996_68104_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F63231_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F118986_0_0|SrvcGrp|75483|2022|PDM|731.46|99|0.00|AEG 3|
20|FH_F88893_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|137.50|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1501 W/O REV|
20|FH_F151426_90028_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132258_45404_0|SrvcGrp|29023|2022|PDM|56.18|99|0.00|HOME INFUSION THERAPY|
20|FH_F97501_31501_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F135834_74434_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135877_74403_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135907_74501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135972_18509_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F131334_60062_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130756_04901_0|SrvcGrp|114927|2022|PCT|2.25|99|0.00|CHEMOTHERAPY AND ALL OTHER DRUGS|
20|FH_F94103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F127399_0_0|SrvcGrp|85792|2022|PDM|4162.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F128353_22191_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39796_0_0|SrvcGrp|43284|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F40598_0_0|SrvcGrp|32595|2022|PCT|0.85|99|0.00|IP SURGERY|
20|FH_F112187_98272_0|SrvcGrp|79280|2022|PDM|500.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F87534_19464_0|SrvcGrp|48385|2022|PDM|104.00|99|0.00|SPEECH THERAPY|
20|FH_F141035_0_0|SrvcGrp|112148|2022|PDM|10711.00|99|0.00|REPAIR OF DIGIT NERVE|
20|FH_F141035_0_0|SrvcGrp|76602|2022|PDM|3932.00|99|0.00|CPT 25000|
20|FH_F92676_15063_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F92792_0_0|SrvcGrp|53702|2022|PDM|2200.00|99|0.00|PREP CORNEAL ENDOTHELIAL ALLOGRAFT|
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|ASPG V|
20|FH_F144191_0_0|SrvcGrp|35668|2022|PDM|3183.00|99|0.00|CPT 29824|
20|FH_F40203_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115289_90057_0|SrvcGrp|86748|2022|PCT|1.15|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F144008_11413_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F146061_24502_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132601_92677_0|SrvcGrp|75419|2022|PDM|404.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F138827_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127432_18015_0|SrvcGrp|109221|2022|PCT|2.19|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F42984_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|143.00|99|0.00|HAPA EPA ASC 23|
20|FH_F150528_78644_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97700_0_0|SrvcGrp|75545|2022|PDM|495.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F69648_0_0|CSTM-ALL|CSTM-00|2020|PDM|10.00|99|0.00|SKILLED NURSING HCPC|
20|FH_F45932_0_0|CSTM-ALL|CSTM-00|2020|PDM|605.00|99|0.00|ASPG I|
20|FH_F125540_19462_0|SrvcGrp|105682|2022|PDM|175.00|99|0.00|INTENSIVE OUTPATIENT >=18 YRS|
20|FH_F150001_33064_0|SrvcGrp|24754|2022|PDM|11.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F111520_81601_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128000_30121_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133287_40215_0|CSTM-ALL|CSTM-00|2020|PDM|1421.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 2 (NO REV)|
20|FH_F100740_15206_0|SrvcGrp|90854|2022|PDM|2759.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F150001_33064_0|SrvcGrp|22592|2022|PDM|23.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F132934_63005_0|SrvcGrp|107415|2022|PDM|34348.00|99|0.00|MS DRG 264,291-293 ONLY|
20|FH_F49354_0_0|SrvcGrp|31189|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF (DME)|
20|FH_F142041_44846_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F44342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F41845_0_0|CSTM-ALL|CSTM-00|2020|PDM|378.00|99|0.00|CD DAY TREATMENT|
20|FH_F146212_57108_0|SrvcGrp|12664|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F37042_0_0|SrvcGrp|17071|2022|PDM|1096.00|99|0.00|ASPG IV|
20|FH_F146221_72560_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F106540_26330_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD 26|
20|FH_F102721_38118_0|SrvcGrp|73000|2022|PDM|1300.00|99|0.00|AEG 6|
20|FH_F88512_0_0|SrvcGrp|3378|2022|PDM|149.49|99|0.00|OBSERVATION SVCS|
20|FH_F142752_19428_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145818_77573_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119076_41001_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146360_66502_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38425_0_0|SrvcGrp|22387|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)|
20|FH_F51482_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|OP SVCS|
20|FH_F83294_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143200_91602_0|SrvcGrp|87131|2022|PDM|1740.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F145924_36695_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141217_0_0|SrvcGrp|84939|2022|PDM|9500.00|99|0.00|SHOULDER JOINT|
20|FH_F142769_21204_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146211_68144_0|CSTM-ALL|CSTM-00|2020|PDM|1913.00|99|0.00|AEG 2 (NO REV)|
20|FH_F34706_0_0|CSTM-ALL|CSTM-00|2020|PDM|22308.00|99|0.00|DRG 110 ONLY MAJOR CARDIOVASCULAR PROCEDURE W/CC|
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F148644_06890_0|SrvcGrp|88147|2022|PDM|5000.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA|
20|FH_F139467_46182_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150701_33437_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F147146_06117_0|SrvcGrp|33166|2022|PDM|518.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F149522_83221_0|SrvcGrp|82222|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F134887_33409_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146266_0_0|SrvcGrp|100044|2022|PDM|2850.00|99|0.00|INCISION OF HEEL BONE|
20|FH_F90196_10467_0|SrvcGrp|89023|2022|PDM|77.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F119897_78229_0|SrvcGrp|473|2022|PDM|364.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F92299_62016_0|SrvcGrp|72996|2022|PCT|0.75|99|0.00|AEG 4|
20|FH_F150442_28451_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124281_44286_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F35088_0_0|SrvcGrp|56465|2022|PDM|5302.00|99|0.00|OP PTCA ANGIOPLASTY|
20|FH_F102069_19034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F63033_0_0|SrvcGrp|13928|2022|PDM|450.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F98022_89015_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F150440_35077_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111265_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41363_0_0|CSTM-ALL|CSTM-00|2020|PDM|962.00|99|0.00|ASPG V|
20|FH_F98001_27603_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F147082_02359_0|SrvcGrp|113928|2022|PDM|354.00|99|0.00|PARTIAL HOSPITAL (>=18 YRS)|
20|FH_F35755_34950_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150443_77536_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141287_14830_0|SrvcGrp|705|2022|PCT|0.39|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F128695_50049_0|SrvcGrp|48385|2022|PDM|140.00|99|0.00|SPEECH THERAPY|
20|FH_F102222_19720_0|SrvcGrp|86831|2022|PDM|3.15|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F102862_30606_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F98300_30236_0|SrvcGrp|75493|2022|PDM|2742.00|99|0.00|AEG 8|
20|FH_F143542_0_0|SrvcGrp|95819|2022|PDM|6885.00|99|0.00|GONIOTOMY|
20|FH_F140873_0_0|SrvcGrp|82222|2022|PDM|152.00|99|0.00|HOSPICE CARE|
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_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|566.19|99|0.00|AETNA SLEEP STUDIES W/O MOD 26 & TC|
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|1836.00|99|0.00|AEG 2 (NO REV)|
20|FH_F123604_72104_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132810_0_0|SrvcGrp|98951|2022|PDM|60.00|99|0.00|HIT APLHA I PROTEANS (HCFA)|
20|FH_F58856_0_0|SrvcGrp|20900|2022|PDM|22850.00|99|0.00|MS DRG 248 ONLY|
20|FH_F120456_67117_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F120490_64133_0|SrvcGrp|86834|2022|PDM|10.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F120490_64133_0|SrvcGrp|86825|2022|PDM|83.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F93358_63084_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F134007_27101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134011_84102_0|SrvcGrp|14948|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F137147_75006_0|SrvcGrp|113046|2022|PDM|33668.00|99|0.00|MS DRG 352 ONLY|
20|FH_F138168_63084_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F53732_0_0|SrvcGrp|14944|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F138558_60107_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F138584_30912_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F80205_33161_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F149607_76548_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149663_45219_0|SrvcGrp|89877|2022|PDM|5595.00|99|0.00|HIP ARTHROSCOPY/SURGERY|
20|FH_F118959_44830_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118955_48239_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F117261_43543_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F43201_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117219_77515_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F117126_12801_0|CSTM-ALL|CSTM-00|2020|PDM|5720.00|99|0.00|AEG 7 (NO REV)|
20|FH_F137818_31602_0|SrvcGrp|89337|2022|PDM|911.00|99|0.00|DETOXIFICATION|
20|FH_F137887_33756_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137934_51054_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
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|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)|
20|FH_F111593_0_0|SrvcGrp|11663|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F90613_05001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90613_05001_0|SrvcGrp|70381|2022|PDM|498.00|99|0.00|PSYCH PARTIAL HOSP (FULL & PARTIAL DAY) PER VISIT|
20|FH_F90735_94070_0|SrvcGrp|90293|2022|PDM|375.00|99|0.00|CYSTIC FIBROSIS|
20|FH_F90880_15108_0|SrvcGrp|90489|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F112817_37027_0|SrvcGrp|73700|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F42921_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F60252_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F130721_04769_0|SrvcGrp|111926|2022|PCT|1.00|99|0.00|COVID-19 LAB TESTING|
20|FH_F130911_06001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130017_02302_0|SrvcGrp|21106|2022|PDM|30005.48|99|0.00|MS DRG 250 ONLY|
20|FH_F100680_43130_0|SrvcGrp|73643|2022|PDM|2042.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F47499_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|2680.00|99|0.00|AEG 8 (NO REV)|
20|FH_F120930_0_0|SrvcGrp|88157|2022|PDM|6500.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F133715_63141_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F79863_0_0|SrvcGrp|77227|2022|PDM|90.00|99|0.00|AETNA HOME INFUSION S9363|
20|FH_F120539_89029_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136207_0_0|SrvcGrp|73483|2022|PDM|850.00|99|0.00|AETNA SUBACUTE III|
20|FH_F116753_0_0|SrvcGrp|70074|2022|PDM|7465.00|99|0.00|LAPAROSCOPY CPT 49651|
20|FH_F110311_17078_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F77082_0_0|SrvcGrp|47250|2022|PDM|2160.00|99|0.00|MS DRG 876, 880-887 ONLY|
20|FH_F95631_33705_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F149246_95603_0|SrvcGrp|108484|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F133941_70360_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F150148_71901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134610_33426_0|SrvcGrp|111348|2022|PCT|1.10|99|0.00|OP THERAPY SERVICES|
20|FH_F127418_0_0|SrvcGrp|67068|2022|PDM|38245.92|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|2126.00|99|0.00|AEG 3 (NO REV)|
20|FH_F143742_60410_0|SrvcGrp|11258|2022|PCT|1.03|99|0.00|DRUGS|
20|FH_F118300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127616_17403_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125928_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135657_27612_0|SrvcGrp|89417|2022|PDM|426.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F127598_43232_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F110542_10035_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F122942_89512_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138147_18018_0|SrvcGrp|70642|2022|PDM|20.54|99|0.00|CONSULTANT THERAPIST|
20|FH_F130763_0_0|SrvcGrp|99167|2022|PDM|7319.00|99|0.00|CPT 63057|
20|FH_F145983_45213_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132728_0_0|SrvcGrp|107733|2022|PDM|6266.00|99|0.00|CESAREAN SECTION|
20|FH_F120719_27540_0|SrvcGrp|73659|2022|PDM|5022.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|2393.00|99|0.00|AEG 4 (NO REV)|
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 3 (NO REV)|
20|FH_F70208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.00|99|0.00|ASPG VIII|
20|FH_F133867_84075_0|SrvcGrp|83521|2022|PDM|93.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F86131_28215_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F110471_02215_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F145604_14850_0|SrvcGrp|86827|2022|PDM|80.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F133585_0_0|SrvcGrp|89688|2022|PDM|195.00|99|0.00|CONTRAST X-RAY EXAM OF AORTA|
20|FH_F81698_10457_0|SrvcGrp|22592|2022|PDM|31.50|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F111695_30286_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F120291_0_0|SrvcGrp|53746|2022|PDM|249.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F120425_11106_0|SrvcGrp|89417|2022|PDM|330.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F124146_46321_0|SrvcGrp|26160|2022|PCT|1.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F125328_0_0|SrvcGrp|79588|2022|PDM|1783.50|99|0.00|CPT 43235|
20|FH_F149263_0_0|SrvcGrp|115605|2022|PDM|4998.00|99|0.00|NECK SPINE FUSE|
20|FH_F70964_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120930_0_0|SrvcGrp|34606|2022|PDM|3500.00|99|0.00|CPT 29827|
20|FH_F149660_0_0|SrvcGrp|13422|2022|PDM|189.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|95.52|99|0.00|HAPA WPA-NWPA 2012-13 ASC 142 W/O REV|
20|FH_F132883_31602_0|SrvcGrp|86850|2022|PDM|20.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F79863_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ASANTE AMFS|
20|FH_F132969_84003_0|SrvcGrp|63119|2022|PDM|615.00|99|0.00|BASIC HOME HOSPICE CARE|
20|FH_F81835_0_0|SrvcGrp|75327|2022|PDM|163.33|99|0.00|SLEEP STUDY CPT 95806|
20|FH_F35966_0_0|SrvcGrp|16896|2022|PDM|550.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F138259_36606_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|155.57|99|0.00|HAPA WPA-NWPA 2012-13 ASC 131 W/O REV|
20|FH_F132723_61265_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85652_98034_0|CSTM-ALL|CSTM-00|2020|PDM|251.00|99|0.00|AETNA - APC GROUPER P|
20|FH_F114683_0_0|SrvcGrp|88760|2022|PDM|7800.00|99|0.00|CERVICAL ARTHRODESIS|
20|FH_F149106_07042_0|SrvcGrp|83145|2022|PDM|14661.00|99|0.00|AETNA BREAST RECONSTRUCTION|
20|FH_F130468_0_0|SrvcGrp|11259|2022|PCT|0.75|99|0.00|DRUGS|
20|FH_F133922_70563_0|SrvcGrp|86480|2022|PDM|100.45|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)|
20|FH_F138026_46143_0|SrvcGrp|89149|2022|PDM|201.00|99|0.00|OP INTENSIVE|
20|FH_F70205_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130017_02302_0|SrvcGrp|105465|2022|PCT|1.22|99|0.00|AETNA THERAPIES|
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|838.00|99|0.00|AEG 1 (NO REV)|
20|FH_F115974_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH|
20|FH_F112023_12866_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F149365_77642_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134494_33612_0|SrvcGrp|90854|2022|PDM|919.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F122553_92705_0|SrvcGrp|90854|2022|PDM|654.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F85553_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F75963_0_0|SrvcGrp|66264|2022|PDM|8.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F105145_75075_0|SrvcGrp|98007|2022|PDM|3965.00|99|0.00|FINGER/THUMB AMPUTATION|
20|FH_F105361_80104_0|SrvcGrp|44285|2022|PDM|140.00|99|0.00|THERAPY SERVICES|
20|FH_F115909_38133_0|SrvcGrp|87419|2022|PDM|553.00|99|0.00|ECT|
20|FH_F75842_0_0|SrvcGrp|17067|2022|PDM|1697.31|99|0.00|ASPG II|
20|FH_F146671_72205_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146667_37110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120522_53549_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120811_53525_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F115966_16801_0|SrvcGrp|48396|2022|PDM|125.00|99|0.00|OT SERVICES|
20|FH_F116114_37033_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F150739_44060_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150800_44256_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F148347_0_0|SrvcGrp|109801|2022|PDM|1932.00|99|0.00|ANOSCOPY AND BIOPSY|
20|FH_F124452_31322_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F47424_0_0|SrvcGrp|3809|2022|PDM|730.00|99|0.00|HOSPICE CARE|
20|FH_F139147_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|2753.00|99|0.00|AEG 10 (NO REV)|
20|FH_F117711_73080_0|SrvcGrp|72994|2022|PDM|1260.00|99|0.00|AEG 3|
20|FH_F130182_0_0|SrvcGrp|97741|2022|PDM|8323.00|99|0.00|REVISE KNEE|
20|FH_F124322_64131_0|SrvcGrp|29023|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F124703_65711_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109515_15301_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127418_0_0|SrvcGrp|89860|2022|PDM|10658.38|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F109843_0_0|SrvcGrp|28443|2022|PDM|2640.00|99|0.00|ARTHROSCOPY KNEE|
20|FH_F120207_0_0|SrvcGrp|107878|2022|PDM|3570.32|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F137986_0_0|SrvcGrp|113169|2022|PDM|3130.00|99|0.00|REMOVAL OF KNEECAP|
20|FH_F66545_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115483_62002_0|SrvcGrp|113113|2022|PDM|7214.00|99|0.00|LAPAROSCOPY SERVICES|
20|FH_F101685_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F91155_16105_0|SrvcGrp|83379|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F80535_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97561_30030_0|SrvcGrp|73643|2022|PDM|1709.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|1030.00|99|0.00|AEG 7 (NO REV)|
20|FH_F102561_75146_0|SrvcGrp|73004|2022|PDM|3800.00|99|0.00|AEG 8|
20|FH_F67639_0_0|CSTM-ALL|CSTM-00|2020|PDM|944.29|99|0.00|ASPG VIII|
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|AEG 9 (NO REV)|
20|FH_F128130_10027_0|CSTM-ALL|CSTM-00|2020|PDM|6836.00|99|0.00|AEG 6 (NO REV)|
20|FH_F133287_40215_0|SrvcGrp|105465|2022|PCT|0.53|99|0.00|AETNA THERAPIES|
20|FH_F130108_0_0|SrvcGrp|14614|2022|PDM|5250.00|99|0.00|LITHOTRIPSY|
20|FH_F117559_08619_0|SrvcGrp|113300|2022|PDM|40.00|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - MODERNA|
20|FH_F134430_86301_0|SrvcGrp|108484|2022|PDM|800.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F146320_27610_0|SrvcGrp|103638|2022|PDM|8918.00|99|0.00|AETNA OPEN/PERQ PLACE STENT 1ST|
20|FH_F129965_0_0|SrvcGrp|111414|2022|PCT|1.10|99|0.00|MEDICINE CODES|
20|FH_F92531_0_0|SrvcGrp|92011|2022|PDM|1522.00|99|0.00|REMOVAL OF IMPLANT|
20|FH_F133390_07626_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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_F42779_0_0|SrvcGrp|36588|2022|PCT|0.65|99|0.00|HIGH COST DRUGS|
20|FH_F148886_60621_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD NU|
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 3 (NO REV)|
20|FH_F92648_90248_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F33411_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77025_0_0|SrvcGrp|74120|2022|PDM|2223.00|99|0.00|ARTHROSCOPY|
20|FH_F90935_29073_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F72750_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F40851_0_0|SrvcGrp|34305|2022|PCT|1.00|99|0.00|SURGICAL DAILY CARE|
20|FH_F92935_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F132289_89145_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F141913_65560_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133251_89521_0|SrvcGrp|89417|2022|PDM|477.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F146208_76643_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F105921_80014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133270_77025_0|SrvcGrp|89417|2022|PDM|375.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F39180_0_0|SrvcGrp|12155|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F118400_16701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146104_33410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F49354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F138467_32216_0|SrvcGrp|86723|2022|PDM|876.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F138424_83402_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139666_26175_0|SrvcGrp|10944|2022|PCT|0.94|99|0.00|EMERGENCY ROOM|
20|FH_F150746_31210_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128741_92879_0|SrvcGrp|115768|2022|PCT|1.26|99|0.00|AMFS(H) DEFAULT|
20|FH_F141287_14830_0|CSTM-ALL|CSTM-00|2020|PDM|2096.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F81312_0_0|SrvcGrp|14046|2022|PCT|1.00|99|0.00|DRUGS|
20|FH_F128375_03909_0|SrvcGrp|89149|2022|PDM|213.00|99|0.00|OP INTENSIVE|
20|FH_F151026_63129_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F134732_0_0|SrvcGrp|107792|2022|PDM|6002.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F97100_23462_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS|
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|AEG 5  (NO REV)|
20|FH_F75606_0_0|SrvcGrp|941|2022|PDM|3126.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F114271_08721_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139694_42718_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F147361_19806_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|35667|2022|PDM|1802.00|99|0.00|CPT 20680|
20|FH_F122282_30080_0|SrvcGrp|73605|2022|PDM|875.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F151023_77384_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148882_20814_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138662_78624_0|SrvcGrp|46903|2022|PDM|500.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F150942_66743_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150982_0_0|SrvcGrp|110676|2022|PDM|2527.00|99|0.00|LAPAROSCOPIC TREAT OF ECTOP|
20|FH_F39443_0_0|SrvcGrp|30328|2022|PDM|420.00|99|0.00|HAPA WPA ASC 212|
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130661_04441_0|SrvcGrp|114016|2022|PCT|0.86|99|0.00|OBSERVATION W/SURGERY|
20|FH_F110805_45227_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F116806_0_0|SrvcGrp|89853|2022|PDM|1613.14|99|0.00|NASAL/SINUS ENDOSCOPY-SURG|
20|FH_F149030_37919_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 2 (NO REV)|
20|FH_F150312_89103_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F33719_0_0|SrvcGrp|3803|2022|PCT|0.80|99|0.00|TRAUMA CARE|
20|FH_F125182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47424_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|1000.00|99|0.00|ENT SURG CTR -CVTY ENHANCED GROUP 3|
20|FH_F146288_0_0|CSTM-ALL|CSTM-00|2020|PDM|2617.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146266_0_0|SrvcGrp|89840|2022|PDM|14196.00|99|0.00|THORAX SPINE FUSION|
20|FH_F148959_77375_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F131392_17004_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F131495_77407_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F124322_64131_0|SrvcGrp|24753|2022|PDM|10.00|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F147418_0_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F143050_0_0|SrvcGrp|12868|2022|PDM|31973.00|99|0.00|AIR AMBULANCE|
20|FH_F81456_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131371_0_0|SrvcGrp|101282|2022|PDM|17000.00|99|0.00|REVISE HIP JOINT COMPONENT|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SAINT ALEXIUS FH MOD QW|
20|FH_F116332_0_0|SrvcGrp|13187|2022|PCT|0.80|99|0.00|INTRAOCULAR LENSES|
20|FH_F150943_15537_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130661_04441_0|SrvcGrp|107637|2022|PCT|0.86|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|MRI & CT DIAGNOSTICS CT/CTA|
20|FH_F134472_84624_0|SrvcGrp|472|2022|PDM|377.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F39443_0_0|SrvcGrp|30337|2022|PDM|172.00|99|0.00|HAPA WPA ASC 221|
20|FH_F142826_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40501_0_0|CSTM-ALL|CSTM-00|2020|PDM|263.00|99|0.00|IP PSYCHIATRIC TREATMENT (8-12 HRS)|
20|FH_F134847_0_0|SrvcGrp|28548|2022|PDM|3496.00|99|0.00|VITRECTOMY|
20|FH_F122282_30080_0|SrvcGrp|109036|2022|PDM|520.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F45798_0_0|SrvcGrp|14345|2022|PDM|16900.00|99|0.00|DRG 233 ONLY - OTHR MUSCULOSKEL &  CONN TISS O.R.  PROC W CC|
20|FH_F38742_0_0|SrvcGrp|10541|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F90455_0_0|SrvcGrp|44042|2022|PDM|110.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F97640_37043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130661_04441_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 5  (NO REV)|
20|FH_F137363_0_0|SrvcGrp|108518|2022|PDM|3100.00|99|0.00|IMPLANT PAT ACTIVE HT RECORD|
20|FH_F35416_0_0|SrvcGrp|16089|2022|PCT|0.70|99|0.00|DME/IMPLANTS/PROSTHETICS/PACEMAKERS/CARDIAC DEFIB|
20|FH_F138007_24314_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F129599_17078_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F34130_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F148667_0_0|SrvcGrp|33986|2022|PDM|2856.00|99|0.00|CPT 26055|
20|FH_F125182_0_0|SrvcGrp|72992|2022|PDM|482.00|99|0.00|AEG 2|
20|FH_F39756_0_0|SrvcGrp|31082|2022|PDM|302.50|99|0.00|DENTAL PROCEDURES - CHILD|
20|FH_F41314_0_0|SrvcGrp|65|2022|PDM|1435.00|99|0.00|OBSTETRICAL CARE|
20|FH_F116806_0_0|SrvcGrp|107099|2022|PDM|887.26|99|0.00|TREATMENT OF NOSE FRACTURE|
20|FH_F124380_83406_0|SrvcGrp|89149|2022|PDM|228.00|99|0.00|OP INTENSIVE|
20|FH_F37198_0_0|SrvcGrp|11259|2022|PCT|0.40|99|0.00|DRUGS|
20|FH_F124334_68022_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F127418_0_0|SrvcGrp|89852|2022|PDM|29585.59|99|0.00|OPEN TREATMENT VERTEBRAL FRA|
20|FH_F114294_18235_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F36150_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147237_40006_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PDM|1498.00|99|0.00|ASPG III|
20|FH_F132860_0_0|SrvcGrp|112275|2022|PDM|1268.00|99|0.00|MRI|
20|FH_F37422_0_0|SrvcGrp|473|2022|PDM|300.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F112794_01040_0|SrvcGrp|90479|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F80834_0_0|CSTM-ALL|CSTM-00|2020|PDM|5030.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37580_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
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_F39443_0_0|SrvcGrp|30298|2022|PDM|283.00|99|0.00|HAPA WPA ASC 110|
20|FH_F97084_91911_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124291_44122_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F138018_17313_0|SrvcGrp|22593|2022|PDM|103.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F116583_0_0|SrvcGrp|33722|2022|PDM|40.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F139147_0_0|SrvcGrp|88823|2022|PDM|5305.00|99|0.00|REPAIR OF EARDRUM|
20|FH_F35557_0_0|SrvcGrp|11784|2022|PDM|14.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F140210_60643_0|CSTM-ALL|CSTM-00|2020|PCT|1.45|99|0.00|HSS ASC|
20|FH_F140296_32068_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143249_89801_0|SrvcGrp|14947|2022|PDM|30.00|99|0.00|HOME INFUSION|
20|FH_F143307_72223_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143347_16001_0|SrvcGrp|74442|2022|PCT|2.00|99|0.00|CARDIAC TESTING|
20|FH_F93740_0_0|CSTM-ALL|CSTM-00|2020|PDM|6500.00|99|0.00|AETNA THROMBECTOMY|
20|FH_F102542_0_0|SrvcGrp|75399|2022|PDM|0.10|99|0.00|MED RECORD COPY|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|RPR EPIGASTRIC HERN BLOCKED|
20|FH_F48224_0_0|SrvcGrp|62740|2022|PDM|1225.00|99|0.00|SURGERY CARVE OUTS|
20|FH_F48476_0_0|SrvcGrp|10528|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F49458_0_0|SrvcGrp|45569|2022|PDM|61.97|99|0.00|SOFTEE POST MASTECTOMY|
20|FH_F120187_76522_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F116579_45822_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F116629_83467_0|SrvcGrp|16429|2022|PCT|0.82|99|0.00|OBSERVATION SVCS|
20|FH_F120974_27607_0|SrvcGrp|9539|2022|PDM|537.00|99|0.00|SUBACUTE CARE|
20|FH_F113563_70560_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 9 (NO REV)|
20|FH_F118874_29926_0|SrvcGrp|74668|2022|PDM|335.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|1199.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F36155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F45332_0_0|SrvcGrp|37903|2022|PDM|95.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F129025_57451_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F142992_0_0|SrvcGrp|87077|2022|PDM|250.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F37679_0_0|SrvcGrp|26865|2022|PDM|30.50|99|0.00|CORTICOSTEROID THERAPY (MOD SH)|
20|FH_F129810_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F88114_32205_0|SrvcGrp|26001|2022|PDM|151.01|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F137940_0_0|SrvcGrp|13262|2022|PDM|6.55|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F49394_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F138662_78624_0|SrvcGrp|86723|2022|PDM|350.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F141156_04401_0|CSTM-ALL|CSTM-00|2020|PDM|2581.20|99|0.00|INSERT ANT SEGMENT DRAIN|
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_F114207_35243_0|SrvcGrp|24744|2022|PDM|60.00|99|0.00|PICC LINE INSERTION|
20|FH_F97260_06111_0|SrvcGrp|90854|2022|PDM|3233.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148667_0_0|SrvcGrp|26274|2022|PDM|2856.00|99|0.00|CPT 29877|
20|FH_F149001_37055_0|SrvcGrp|57968|2022|PDM|28.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F133087_61107_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F98000_59102_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F36683_0_0|SrvcGrp|18148|2022|PDM|11149.00|99|0.00|MS DRG 249|
20|FH_F37267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F126116_0_0|SrvcGrp|97921|2022|PDM|2191.00|99|0.00|MYOMECTOMY ABDOM METHOD|
20|FH_F124322_64131_0|SrvcGrp|46104|2022|PDM|50.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F33632_52349_0|SrvcGrp|89939|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F150323_68847_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F47558_0_0|SrvcGrp|40417|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD UE KC|
20|FH_F48855_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|443.00|99|0.00|AEG 2 (NO REV)|
20|FH_F72788_0_0|SrvcGrp|30623|2022|PDM|11790.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F116806_0_0|SrvcGrp|107123|2022|PDM|887.26|99|0.00|DRAINAGE OF SALIVARY GLAND|
20|FH_F111266_30339_0|SrvcGrp|86838|2022|PDM|10.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F151043_71901_0|SrvcGrp|23279|2022|PDM|250.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F114204_53191_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150982_0_0|SrvcGrp|46906|2022|PDM|2392.00|99|0.00|CORNEAL TISSUE|
20|FH_F90817_0_0|SrvcGrp|90357|2022|PDM|2293.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F146859_0_0|SrvcGrp|98200|2022|PDM|1443.00|99|0.00|BUNION CORRECTION|
20|FH_F147216_48307_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|3231.00|99|0.00|AEG 8 (NO REV)|
20|FH_F98940_70506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149023_44122_0|SrvcGrp|27261|2022|PDM|13268.00|99|0.00|CPT 27446|
20|FH_F98900_42001_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F40564_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101824_0_0|SrvcGrp|16|2022|PDM|1050.00|99|0.00|ACUTE REHABILITATION|
20|FH_F119008_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1652.00|99|0.00|AEG 6 (NO REV)|
20|FH_F92413_07631_0|SrvcGrp|48396|2022|PDM|112.00|99|0.00|OT SERVICES|
20|FH_F151619_73505_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|448.00|99|0.00|AEG 2 (NO REV)|
20|FH_F37764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|O2 SOLUTIONS MOD TC|
20|FH_F91076_0_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F133247_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1047.00|99|0.00|AEG 10 (NO REV)|
20|FH_F102522_0_0|SrvcGrp|98693|2022|PDM|72.10|99|0.00|AFO MULTILIG ANK SUP PRE OTS|
20|FH_F131067_57105_0|SrvcGrp|73500|2022|PDM|567.00|99|0.00|AETNA ER LEVEL I|
20|FH_F82375_28601_0|SrvcGrp|27969|2022|PDM|42.00|99|0.00|HOME HEALTH AIDE|
20|FH_F49329_0_0|SrvcGrp|40062|2022|PDM|128.00|99|0.00|PT / OT / ST|
20|FH_F120187_76522_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116633_37217_0|SrvcGrp|23683|2022|PDM|42.00|99|0.00|SKILLED NURSING RN|
20|FH_F116684_30701_0|SrvcGrp|105316|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F127245_43537_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F127245_43537_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113649_01752_0|SrvcGrp|86838|2022|PDM|15.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F84611_30281_0|SrvcGrp|72996|2022|PDM|2209.00|99|0.00|AEG 4|
20|FH_F35685_0_0|SrvcGrp|2953|2022|PDM|18743.00|99|0.00|DRG 471 BILATERAL OR MULTIPLE MAJOR JOINT PX LOWER EXTREMITY|
20|FH_F36704_0_0|SrvcGrp|13749|2022|PDM|550.00|99|0.00|OP MRI|
20|FH_F38431_0_0|SrvcGrp|23007|2022|PDM|800.00|99|0.00|V5254|
20|FH_F59732_0_0|SrvcGrp|50164|2022|PDM|74.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 6 HRS|
20|FH_F102302_0_0|SrvcGrp|98601|2022|PDM|10850.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC|
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
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_F104740_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F149888_68506_0|CSTM-ALL|CSTM-00|2020|PDM|2332.00|99|0.00|AEG 6 (NO REV)|
20|FH_F128151_62568_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148200_26554_0|SrvcGrp|114898|2022|PCT|2.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F89799_0_0|SrvcGrp|82981|2022|PDM|115.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F69322_0_0|SrvcGrp|170|2022|PDM|881.00|99|0.00|CD (ADOLESCENT) - REHAB|
20|FH_F130682_0_0|SrvcGrp|88823|2022|PDM|4980.00|99|0.00|REPAIR OF EARDRUM|
20|FH_F137943_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|DEVICE INSERTION|
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|2620.00|99|0.00|AEG 5  (NO REV)|
20|FH_F95021_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F137347_26003_0|SrvcGrp|10393|2022|PDM|1836.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F98920_46526_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F56136_0_0|SrvcGrp|21354|2022|PCT|0.85|99|0.00|MS DRG 250-251 ONLY|
20|FH_F93332_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F126784_80809_0|SrvcGrp|75419|2022|PDM|1095.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F78603_0_0|SrvcGrp|20900|2022|PDM|27617.58|99|0.00|MS DRG 248 ONLY|
20|FH_F37647_0_0|SrvcGrp|11442|2022|PDM|410.27|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F131952_06002_0|SrvcGrp|471|2022|PDM|568.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F141427_22003_0|SrvcGrp|29346|2022|PDM|32.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F125249_0_0|SrvcGrp|108259|2022|PDM|1200.00|99|0.00|AETNA REPAIR LOWER LEG DISLOCATION|
20|FH_F90872_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132779_0_0|SrvcGrp|92622|2022|PDM|36134.00|99|0.00|AORTIC & HEART ASSIST PRECEDURE|
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|1044.00|99|0.00|AEG 4 (NO REV)|
20|FH_F56152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MS DRG UNGROUPABLE INPATIENT|
20|FH_F31609_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F40358_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151225_0_0|SrvcGrp|76531|2022|PDM|204.00|99|0.00|HOSPICE IN HOME|
20|FH_F92655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140427_0_0|SrvcGrp|76023|2022|PDM|2500.00|99|0.00|OP AICD 33249|
20|FH_F113410_0_0|SrvcGrp|27343|2022|PDM|3677.00|99|0.00|OP SURGERY (CPT 25607 - 25609)|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PDM|1513.84|99|0.00|ASPG IV|
20|FH_F129627_06037_0|SrvcGrp|94781|2022|PDM|165.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F49042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F63276_0_0|SrvcGrp|42830|2022|PDM|150.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F130214_30144_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F112568_0_0|SrvcGrp|84185|2022|PDM|240.60|99|0.00|RESPITE CARE|
20|FH_F115020_67301_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F92276_32308_0|SrvcGrp|90464|2022|PDM|238.00|99|0.00|INTENSIVE OUTPATIENT (18-64 YRS)|
20|FH_F123385_03561_0|SrvcGrp|53987|2022|PDM|75.00|99|0.00|PHOTOTHERAPY|
20|FH_F148265_06067_0|SrvcGrp|100921|2022|PDM|7439.00|99|0.00|SPI  PROSTH DEVICE|
20|FH_F78022_0_0|SrvcGrp|35143|2022|PDM|975.00|99|0.00|LABOR|
20|FH_F72183_0_0|SrvcGrp|30155|2022|PCT|1.80|99|0.00|OTHER DIAGNOSTIC TESTING MOD TC|
20|FH_F130061_84097_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F31433_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|DRUGS|
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_F148160_29732_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F137457_32216_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F91787_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131190_21042_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F129115_85716_0|SrvcGrp|87131|2022|PDM|457.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F121090_07848_0|SrvcGrp|87317|2022|PDM|723.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F93593_33414_0|SrvcGrp|73849|2022|PDM|339.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F123481_90049_0|SrvcGrp|75522|2022|PDM|1350.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD|
20|FH_F131190_21042_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F139515_0_0|SrvcGrp|88160|2022|PDM|8549.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|1753.71|99|0.00|AEG 5  (NO REV)|
20|FH_F38151_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F129011_15857_0|SrvcGrp|24739|2022|PDM|230.00|99|0.00|RESPITE CARE|
20|FH_F130024_78229_0|SrvcGrp|471|2022|PDM|631.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F109260_0_0|SrvcGrp|27261|2022|PDM|22278.90|99|0.00|CPT 27446|
20|FH_F39920_0_0|SrvcGrp|38250|2022|PCT|0.90|99|0.00|OP SURGERY|
20|FH_F43242_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.46|99|0.00|OP SVCS|
20|FH_F124017_0_0|SrvcGrp|40002|2022|PDM|12800.00|99|0.00|TOTAL HIP|
20|FH_F33427_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F125118_99201_0|SrvcGrp|110037|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|2937.00|99|0.00|AEG 8 (NO REV)|
20|FH_F115685_64064_0|SrvcGrp|86825|2022|PDM|80.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F37404_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72746_0_0|SrvcGrp|3809|2022|PDM|698.00|99|0.00|HOSPICE CARE|
20|FH_F135235_01830_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F32478_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F113410_0_0|SrvcGrp|105255|2022|PDM|1996.00|99|0.00|ELBOW REPAIR|
20|FH_F39866_0_0|SrvcGrp|13293|2022|PCT|0.70|99|0.00|HIGH-COST DRUGS|
20|FH_F143530_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F148258_66062_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F129536_0_0|SrvcGrp|108386|2022|PCT|1.00|99|0.00|OCULAR IMPLANT|
20|FH_F131236_84041_0|SrvcGrp|89781|2022|PDM|93.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F38357_0_0|SrvcGrp|28919|2022|PDM|34.00|99|0.00|CPT 97750|
20|FH_F149404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45632_0_0|SrvcGrp|41484|2022|PDM|37.00|99|0.00|LIPIDS|
20|FH_F31056_0_0|CSTM-ALL|CSTM-00|2020|PDM|2063.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77642_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38842_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F139551_0_0|SrvcGrp|84307|2022|PDM|3335.00|99|0.00|TENDON REPAIR|
20|FH_F35476_0_0|SrvcGrp|12393|2022|PCT|0.95|99|0.00|AMBULANCE SVCS|
20|FH_F139515_0_0|SrvcGrp|109959|2022|PDM|10300.00|99|0.00|IMPLANT NEURORECEIVER|
20|FH_F118720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|3890.26|99|0.00|AEG 10 (NO REV)|
20|FH_F55212_0_0|SrvcGrp|3398|2022|PDM|43.00|99|0.00|CPT 90853 GROUP PSYCHOTHERAPY|
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|747.00|99|0.00|AEG 2 (NO REV)|
20|FH_F148379_89129_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148641_92505_0|SrvcGrp|108484|2022|PDM|750.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F43433_0_0|SrvcGrp|15323|2022|PCT|1.00|99|0.00|ER LEVEL I|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|201.00|99|0.00|ASPG 114|
20|FH_F150123_60515_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67500_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F128349_43082_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F132594_78229_0|SrvcGrp|102739|2022|PDM|45.00|99|0.00|PRIVATE DUTY/INDEP NURSE SVC|
20|FH_F123545_44512_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F71594_15644_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|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_F147998_07030_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F74363_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
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_F78205_0_0|SrvcGrp|537|2022|PCT|0.60|99|0.00|OBSERVATION SERVICES|
20|FH_F46352_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|SOCIAL WORKER|
20|FH_F91155_16105_0|SrvcGrp|73002|2022|PDM|1959.00|99|0.00|AEG 7|
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F119291_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F117340_68144_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F121012_29732_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F125540_19462_0|SrvcGrp|105681|2022|PDM|175.00|99|0.00|INTENSIVE OUTPATIENT >=18 YRS (HCFA)|
20|FH_F136330_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39723_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127412_15301_0|SrvcGrp|110738|2022|PDM|740.00|99|0.00|LATE CLOSURE OF SPLIT WOUND|
20|FH_F115448_80031_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F117555_72802_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F123091_92627_0|SrvcGrp|108484|2022|PDM|1200.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F100682_97401_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F132737_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F103281_32086_0|CSTM-ALL|CSTM-00|2020|PDM|1620.00|99|0.00|AEG 1 (NO REV)|
20|FH_F88512_0_0|SrvcGrp|13768|2022|PDM|4255.91|99|0.00|NICU|
20|FH_F47479_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HILLCREST IV THERAPY|
20|FH_F41814_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|GENERAL ACUTE CARE|
20|FH_F31003_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F57592_0_0|SrvcGrp|20912|2022|PDM|34500.00|99|0.00|MS DRG 236 ONLY|
20|FH_F121009_76180_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F93375_0_0|SrvcGrp|72998|2022|PDM|752.00|99|0.00|AEG 5|
20|FH_F72859_0_0|SrvcGrp|471|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F116988_0_0|SrvcGrp|75479|2022|PDM|446.00|99|0.00|AEG 1|
20|FH_F37778_0_0|SrvcGrp|27309|2022|PDM|1884.00|99|0.00|ENDOSCOPY/ARTHOSCOPY|
20|FH_F144348_22601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133530_11237_0|SrvcGrp|92760|2022|PCT|2.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67191_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127560_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_F125216_66755_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F101840_76054_0|SrvcGrp|80303|2022|PDM|14641.00|99|0.00|MS DRG 736 ONLY|
20|FH_F149840_80002_0|SrvcGrp|23683|2022|PDM|65.00|99|0.00|SKILLED NURSING RN|
20|FH_F92676_15063_0|SrvcGrp|79032|2022|PDM|784.08|99|0.00|MON VALLEY ASC 119|
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1652.00|99|0.00|AEG 9 (NO REV)|
20|FH_F102561_75146_0|SrvcGrp|11673|2022|PDM|13483.00|99|0.00|CPT 29888|
20|FH_F117829_45227_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F38770_0_0|SrvcGrp|9518|2022|PCT|0.55|99|0.00|EMERGENCY ROOM|
20|FH_F144048_91324_0|SrvcGrp|89337|2022|PDM|3010.00|99|0.00|DETOXIFICATION|
20|FH_F117087_0_0|SrvcGrp|106264|2022|PDM|4185.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION|
20|FH_F143187_52565_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88818_0_0|SrvcGrp|87821|2022|PDM|1000.00|99|0.00|REPLACE TISSUE EXPANDER|
20|FH_F101840_76054_0|SrvcGrp|72996|2022|PDM|1809.00|99|0.00|AEG 4|
20|FH_F113315_72205_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F135179_0_0|SrvcGrp|108043|2022|PDM|164.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F117289_01028_0|SrvcGrp|75545|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|52.00|99|0.00|HAPA EPA ASC 11|
20|FH_F51548_0_0|SrvcGrp|10540|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F126858_43113_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F34706_0_0|SrvcGrp|12290|2022|PDM|686.00|99|0.00|DETOXIFICATION|
20|FH_F92792_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F130656_04401_0|SrvcGrp|112676|2022|PCT|1.00|99|0.00|COVID-19 SARS-COV-2 ANTIBODY|
20|FH_F67920_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F35411_0_0|SrvcGrp|2138|2022|PDM|1196.00|99|0.00|THERAPEUTIC PLASMAPHERESIS|
20|FH_F150905_01608_0|SrvcGrp|74668|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148919_32806_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F128559_43524_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F132934_63005_0|SrvcGrp|16069|2022|PDM|734.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F35454_0_0|SrvcGrp|16862|2022|PDM|55.00|99|0.00|DESTRUCTION WARTS - 1ST LESION|
20|FH_F45513_0_0|SrvcGrp|10986|2022|PDM|2300.00|99|0.00|ARTHROSCOPIC KNEE REPAIR|
20|FH_F44342_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83053_0_0|SrvcGrp|73006|2022|PDM|7635.00|99|0.00|AEG 9|
20|FH_F100740_15206_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F92677_08003_0|SrvcGrp|37386|2022|PDM|4.20|99|0.00|AMINO ACIDS|
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|865.16|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F141790_85374_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|HSS ASC|
20|FH_F67560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE|
20|FH_F67683_0_0|SrvcGrp|43526|2022|PDM|300.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - SUBSTANCE ABUSE|
20|FH_F55375_0_0|SrvcGrp|36991|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F151050_17015_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151144_35801_0|SrvcGrp|38907|2022|PDM|1273.10|99|0.00|CPT 66170 - FISTULIZATION OF SCLERA FOR GLAUCOMA|
20|FH_F121962_75009_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F130066_84107_0|SrvcGrp|75419|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F98040_89406_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F110381_0_0|SrvcGrp|84939|2022|PDM|15500.00|99|0.00|SHOULDER JOINT|
20|FH_F97761_04072_0|SrvcGrp|88978|2022|PDM|7023.00|99|0.00|VAGINAL DELIVERY|
20|FH_F108800_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.94|99|0.00|AETNA SLEEP STUDY CPT 95811|
20|FH_F142288_44714_0|SrvcGrp|3178|2022|PDM|883.00|99|0.00|ACUTE PSYCH|
20|FH_F100640_48097_0|SrvcGrp|73559|2022|PDM|6747.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F133376_33414_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 10 (NO REV)|
20|FH_F132988_0_0|SrvcGrp|92007|2022|PDM|12347.87|99|0.00|PROXIMAL HUMERAL|
20|FH_F132988_0_0|SrvcGrp|84307|2022|PDM|4493.01|99|0.00|TENDON REPAIR|
20|FH_F126345_0_0|SrvcGrp|33977|2022|PDM|1480.00|99|0.00|CPT 59820|
20|FH_F124927_0_0|SrvcGrp|108935|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F45976_0_0|SrvcGrp|17081|2022|PDM|2019.00|99|0.00|ASPG IX|
20|FH_F118184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|OP SVCS|
20|FH_F38983_0_0|SrvcGrp|38|2022|PDM|2000.00|99|0.00|NORMAL DELIVERY|
20|FH_F41035_0_0|SrvcGrp|73008|2022|PDM|1260.00|99|0.00|AEG 10|
20|FH_F49943_0_0|SrvcGrp|45947|2022|PDM|90.00|99|0.00|LPN NURSING SVCS|
20|FH_F91898_0_0|SrvcGrp|116021|2022|PDM|13050.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F100703_0_0|SrvcGrp|16693|2022|PDM|3535.00|99|0.00|KNEE SCOPE, MENISCECTOMY|
20|FH_F132864_71101_0|SrvcGrp|9866|2022|PDM|2067.00|99|0.00|IP OBSERVATION SVCS|
20|FH_F124178_01604_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F124613_64735_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F129761_43920_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133694_89117_0|SrvcGrp|23683|2022|PDM|65.00|99|0.00|SKILLED NURSING RN|
20|FH_F136674_16335_0|CSTM-ALL|CSTM-00|2020|PCT|3.00|99|0.00|HSS APC GROUPED|
20|FH_F136746_63116_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114666_30342_0|SrvcGrp|100070|2022|PDM|9000.00|99|0.00|REVISION OF UNSTABLE KNEECAP|
20|FH_F144039_0_0|SrvcGrp|114442|2022|PDM|12049.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F119725_0_0|SrvcGrp|13681|2022|PDM|347.56|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F122588_53073_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122739_43558_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43000_0_0|SrvcGrp|36745|2022|PDM|75.00|99|0.00|OT SERVICES|
20|FH_F117026_17961_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.00|99|0.00|ASPG VII|
20|FH_F39622_0_0|SrvcGrp|3069|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F69623_0_0|CSTM-ALL|CSTM-00|2020|PDM|375.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115608_24171_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F115631_65201_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F147440_71334_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F41463_0_0|SrvcGrp|17009|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F133047_74012_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133700_92808_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F111584_07002_0|SrvcGrp|73842|2022|PDM|177.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111584_07002_0|SrvcGrp|69075|2022|PDM|116.00|99|0.00|CPT 99213|
20|FH_F111836_12901_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|1527.85|99|0.00|2005 ASPG GROUPER IX|
20|FH_F46433_0_0|SrvcGrp|10579|2022|PDM|65.00|99|0.00|HYDRATION THERAPY - 2 LITERS|
20|FH_F151399_0_0|SrvcGrp|12869|2022|PDM|128.00|99|0.00|AIR AMBULANCE|
20|FH_F134612_0_0|SrvcGrp|106798|2022|PDM|4500.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F141837_0_0|SrvcGrp|13422|2022|PDM|450.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F77625_0_0|SrvcGrp|42827|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F48295_0_0|SrvcGrp|44430|2022|PDM|100.00|99|0.00|SPEECH THERAPY SVCS (VISIT LVL)|
20|FH_F138681_39301_0|SrvcGrp|3178|2022|PDM|992.00|99|0.00|ACUTE PSYCH|
20|FH_F138880_92392_0|SrvcGrp|108484|2022|PDM|950.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F138992_72703_0|SrvcGrp|75506|2022|PCT|1.48|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F114572_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F92474_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F151307_63127_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151426_90028_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F132163_17601_0|SrvcGrp|91394|2022|PDM|100.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD HO)|
20|FH_F122148_62664_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135572_89106_0|SrvcGrp|29023|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F135792_60143_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136042_90066_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F136161_27106_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100880_67735_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F131228_01826_0|SrvcGrp|92519|2022|PDM|1729.34|99|0.00|GLOBAL STRESS THALLIUM AND MYOCARDIAL IMAGING|
20|FH_F131566_60559_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131407_07607_0|SrvcGrp|86851|2022|PDM|30.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F116468_49660_0|SrvcGrp|46903|2022|PDM|580.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F101661_08879_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F121407_73701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F33785_0_0|SrvcGrp|147|2022|PCT|0.50|99|0.00|HOME HEALTH CARE|
20|FH_F131407_07607_0|SrvcGrp|19742|2022|PDM|55.00|99|0.00|MID-LINE INSERTION|
20|FH_F111292_33136_0|SrvcGrp|81406|2022|PDM|8.00|99|0.00|URINALYSIS|
20|FH_F111301_33122_0|SrvcGrp|73000|2022|PDM|2092.00|99|0.00|AEG 6|
20|FH_F111363_33169_0|SrvcGrp|82747|2022|PDM|64.00|99|0.00|THROMBOPLASTIN TIME PARTIAL|
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_F87153_0_0|SrvcGrp|83881|2022|PDM|44.85|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F40412_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS|
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|SrvcGrp|11340|2022|PDM|7000.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F101442_0_0|SrvcGrp|98470|2022|PDM|1010.93|99|0.00|AMPUTATION TOE|
20|FH_F131000_0_0|SrvcGrp|91880|2022|PDM|7283.00|99|0.00|OSSEOINTEGRATED IMPLANT|
20|FH_F132328_0_0|SrvcGrp|97363|2022|PDM|1821.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F72666_0_0|SrvcGrp|69747|2022|PCT|0.65|99|0.00|HOME HEALTH SERVICES|
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.35|99|0.00|AEG 10 (NO REV)|
20|FH_F101320_26062_0|SrvcGrp|43567|2022|PDM|60.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F143542_0_0|SrvcGrp|42427|2022|PDM|6885.00|99|0.00|OP SURGERY CPT 65420|
20|FH_F143648_0_0|SrvcGrp|113889|2022|PDM|1008.00|99|0.00|LYSIS OF LABIAL LESION|
20|FH_F100906_0_0|SrvcGrp|36591|2022|PDM|4500.00|99|0.00|CPT 63685|
20|FH_F123792_90803_0|SrvcGrp|105819|2022|PDM|1476.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F123847_24012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F63316_0_0|SrvcGrp|17139|2022|PDM|759.44|99|0.00|HOSPICE CARE|
20|FH_F118152_20151_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F120489_63552_0|SrvcGrp|81779|2022|PCT|0.75|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F134011_84102_0|SrvcGrp|86835|2022|PDM|10.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F137033_87108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137147_75006_0|SrvcGrp|10364|2022|PDM|1181.00|99|0.00|CPT CODE 99284|
20|FH_F137147_75006_0|SrvcGrp|112834|2022|PCT|2.10|99|0.00|RADIOLOGY SERVICES|
20|FH_F114092_83350_0|CSTM-ALL|CSTM-00|2020|PDM|4805.00|99|0.00|AEG 9 (NO REV)|
20|FH_F142547_70002_0|SrvcGrp|29023|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142548_66614_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117552_0_0|SrvcGrp|73000|2022|PDM|1000.00|99|0.00|AEG 6|
20|FH_F97602_40121_0|SrvcGrp|73605|2022|PDM|1738.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.45|99|0.00|2006 MEDICARE ASPG II|
20|FH_F134654_0_0|SrvcGrp|110060|2022|PDM|16.63|99|0.00|GROUP BH TREATMENT 15 MINS|
20|FH_F140615_73013_0|SrvcGrp|113188|2022|PCT|1.10|99|0.00|LABORATORY SERVICES|
20|FH_F149540_64083_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119046_74012_0|SrvcGrp|105492|2022|PDM|425.00|99|0.00|MRI/MRA|
20|FH_F117102_39355_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F117123_68025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F101161_0_0|SrvcGrp|75499|2022|PDM|100.00|99|0.00|CRITICAL CARE|
20|FH_F111046_0_0|SrvcGrp|13262|2022|PDM|11.33|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F112080_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90880_15108_0|SrvcGrp|83057|2022|PCT|1.00|99|0.00|AETNA THERAPEUTIC EXERCISES|
20|FH_F109273_77339_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F130763_0_0|SrvcGrp|11673|2022|PDM|6012.00|99|0.00|CPT 29888|
20|FH_F116806_0_0|SrvcGrp|107074|2022|PDM|1923.16|99|0.00|EXCISION OF JAW JOINT|
20|FH_F84132_48026_0|SrvcGrp|72992|2022|PDM|615.00|99|0.00|AEG 2|
20|FH_F98021_07012_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F130329_64114_0|SrvcGrp|86853|2022|PDM|10.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F83380_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INFUSION THERAPIES|
20|FH_F121640_75062_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F89219_0_0|SrvcGrp|107733|2022|PDM|14596.00|99|0.00|CESAREAN SECTION|
20|FH_F128148_0_0|SrvcGrp|12079|2022|PCT|0.70|99|0.00|MED SURG SUPPLIES|
20|FH_F144848_0_0|SrvcGrp|44461|2022|PDM|30900.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F127950_45150_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112712_63005_0|SrvcGrp|105246|2022|PDM|195.00|99|0.00|HOME INFUSION/SPECIALTY DRUG|
20|FH_F125259_0_0|SrvcGrp|110101|2022|PDM|2500.00|99|0.00|TRLUML BALO ANGIOP 1ST ART|
20|FH_F136359_0_0|SrvcGrp|112856|2022|PDM|3475.00|99|0.00|ANKLE / HEEL SERVICES|
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 1 (NO REV)|
20|FH_F50577_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F133749_84604_0|SrvcGrp|112421|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F143650_0_0|SrvcGrp|73006|2022|PDM|4200.00|99|0.00|AEG 9|
20|FH_F122455_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F86112_63501_0|CSTM-ALL|CSTM-00|2020|PCT|0.47|99|0.00|OP SVCS|
20|FH_F139716_50208_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F97861_62223_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F121687_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135666_37601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|1048.00|99|0.00|AEG 6 (NO REV)|
20|FH_F79863_0_0|SrvcGrp|42913|2022|PDM|10.00|99|0.00|CATHETER CARE-DOUBLE LUMEN|
20|FH_F134174_63141_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|CPT 95811 (W/MOD TC) (CMS-1500)|
20|FH_F96160_32207_0|SrvcGrp|24744|2022|PCT|0.00|99|0.00|PICC LINE INSERTION|
20|FH_F117206_0_0|SrvcGrp|90602|2022|PDM|1485.00|99|0.00|EXTRACTION OF LENS|
20|FH_F145714_44135_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F118253_89052_0|SrvcGrp|89417|2022|PDM|390.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F119937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F129440_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANTEPARTUM CARE (HANT)|
20|FH_F87012_0_0|SrvcGrp|72994|2022|PDM|869.25|99|0.00|AEG 3|
20|FH_F100680_43130_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS|
20|FH_F125244_0_0|SrvcGrp|38364|2022|PDM|4900.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|324.17|99|0.00|HAPA WPA-NWPA 2012-13 ASC 112 W/O REV|
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136359_0_0|SrvcGrp|109790|2022|PDM|8600.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F83380_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F63456_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F109267_12202_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F109400_80026_0|SrvcGrp|46104|2022|PDM|98.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F127642_07047_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132606_0_0|SrvcGrp|41334|2022|PDM|3537.36|99|0.00|TOTAL KNEE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|465.61|99|0.00|HAPA WPA-NWPA 2012-13 ASC 203 W/O REV|
20|FH_F146124_06112_0|SrvcGrp|113988|2022|PCT|0.74|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|552.00|99|0.00|ASPG I|
20|FH_F126341_27284_0|SrvcGrp|24761|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F124372_0_0|SrvcGrp|107748|2022|PDM|437.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F132883_31602_0|SrvcGrp|29076|2022|PDM|20.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F85652_98034_0|SrvcGrp|92760|2022|PCT|2.62|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135660_77061_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F31714_0_0|SrvcGrp|2981|2022|PDM|8000.00|99|0.00|DRG 520 CERVICAL SPINAL FUSION W/O CC|
20|FH_F111702_07652_0|SrvcGrp|87910|2022|PCT|1.00|99|0.00|VANCOMYCIN HCL INJECT 500MG|
20|FH_F150143_27320_0|SrvcGrp|74668|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138191_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F31595_0_0|SrvcGrp|3477|2022|PCT|0.93|99|0.00|CLINIC VISIT|
20|FH_F96721_99504_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F54592_0_0|SrvcGrp|24744|2022|PDM|115.00|99|0.00|PICC LINE INSERTION|
20|FH_F134528_63670_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F117344_75062_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F122532_46385_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F122551_75605_0|SrvcGrp|73841|2022|PDM|445.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F129101_27006_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F84712_0_0|SrvcGrp|78807|2022|PDM|27753.00|99|0.00|AETNA CARDIAC VALVE & OTH MAJ CAR|
20|FH_F86836_0_0|SrvcGrp|11259|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F70684_0_0|SrvcGrp|29744|2022|PDM|52.73|99|0.00|SKILLED NURSING CARE - MOD TD|
20|FH_F85314_0_0|SrvcGrp|83898|2022|PDM|640.00|99|0.00|AETNA HIGH RISK IND|
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|AEG 5  (NO REV)|
20|FH_F105145_75075_0|SrvcGrp|72992|2022|PDM|3300.00|99|0.00|AEG 2|
20|FH_F115811_33410_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F115865_78621_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F77665_0_0|SrvcGrp|10518|2022|PDM|15.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT|
20|FH_F146839_17601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F116040_24637_0|SrvcGrp|86825|2022|PDM|55.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F131711_25550_0|SrvcGrp|79699|2022|PCT|0.88|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F131747_80108_0|CSTM-ALL|CSTM-00|2020|PDM|48.00|99|0.00|ANESTHESIA|
20|FH_F132928_64114_0|SrvcGrp|48398|2022|PDM|162.00|99|0.00|PT SERVICES|
20|FH_F133478_40165_0|SrvcGrp|20910|2022|PDM|59321.00|99|0.00|MS DRG 234 ONLY|
20|FH_F139428_65270_0|SrvcGrp|48398|2022|PDM|97.85|99|0.00|PT SERVICES|
20|FH_F139676_76901_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F119946_36109_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F132113_85224_0|SrvcGrp|104330|2022|PDM|1266.00|99|0.00|AETNA ACUTE REHAB II|
20|FH_F146859_0_0|SrvcGrp|107385|2022|PDM|5448.00|99|0.00|REMOVE CERV ARTIF DISC|
20|FH_F99920_63141_0|SrvcGrp|89781|2022|PDM|110.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F124435_03882_0|SrvcGrp|89149|2022|PDM|182.00|99|0.00|OP INTENSIVE|
20|FH_F35744_32177_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS|
20|FH_F37341_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|ASPG X|
20|FH_F136592_0_0|SrvcGrp|107877|2022|PDM|530.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F112754_98057_0|SrvcGrp|22384|2022|PDM|263.87|99|0.00|HOME VISIT PRENATAL|
20|FH_F110727_34994_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F147060_32025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39443_0_0|SrvcGrp|30144|2022|PCT|1.02|99|0.00|JEFFERSON AICD DEVICES|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|947.00|99|0.00|AEG 3 (NO REV)|
20|FH_F151022_17016_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F148967_04254_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F147333_18704_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41033_0_0|SrvcGrp|17079|2022|PDM|1070.00|99|0.00|ASPG VIII|
20|FH_F147422_84121_0|SrvcGrp|73605|2022|PDM|957.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F41033_0_0|SrvcGrp|17077|2022|PDM|1095.00|99|0.00|ASPG VII|
20|FH_F147234_19010_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
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_F117762_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT|
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PDM|418.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F140289_52246_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116753_0_0|SrvcGrp|74793|2022|PDM|1278.00|99|0.00|POLYSOMNOGRAPHY|
20|FH_F128927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F127464_15106_0|SrvcGrp|48394|2022|PDM|46.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F59312_0_0|SrvcGrp|472|2022|PDM|359.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|VERTICAL PLUS MRI OP SERVICES MOD QW|
20|FH_F100540_0_0|SrvcGrp|73002|2022|PDM|2153.25|99|0.00|AEG 7|
20|FH_F110729_15068_0|SrvcGrp|73841|2022|PDM|260.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F122841_0_0|SrvcGrp|28549|2022|PDM|2497.00|99|0.00|VITRECTOMY|
20|FH_F36720_0_0|SrvcGrp|6|2022|PDM|3900.00|99|0.00|OP SURGERY|
20|FH_F90232_15126_0|SrvcGrp|86854|2022|PDM|85.05|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F124325_37643_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109762_0_0|SrvcGrp|86863|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F40644_0_0|CSTM-ALL|CSTM-00|2020|PDM|905.00|99|0.00|ACUTE PSYCH|
20|FH_F112045_90301_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F37058_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113545_11201_0|SrvcGrp|93919|2022|PDM|510.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F73803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1049.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F47212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F147140_89103_0|SrvcGrp|66265|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F151639_90034_0|SrvcGrp|108484|2022|PDM|770.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F148020_0_0|SrvcGrp|472|2022|PDM|528.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134916_16421_0|SrvcGrp|2067|2022|PDM|823.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F132860_0_0|SrvcGrp|112077|2022|PDM|44791.00|99|0.00|CV SURGERY|
20|FH_F73768_0_0|SrvcGrp|71104|2022|PDM|3.00|99|0.00|HCPCS A4232|
20|FH_F149522_83221_0|SrvcGrp|82223|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 10 (NO REV)|
20|FH_F122419_37043_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F143668_0_0|SrvcGrp|114064|2022|PDM|350.00|99|0.00|SEGMENTAL PNEUMATIC CHEST (MOD NU)|
20|FH_F75788_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F122282_30080_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F80102_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F37364_0_0|SrvcGrp|26177|2022|PCT|0.85|99|0.00|BONE MARROW TRANSPLANT|
20|FH_F133677_15601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126914_44136_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F149020_78653_0|SrvcGrp|108484|2022|PDM|675.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F119316_27104_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F35731_33709_0|CSTM-ALL|CSTM-00|2020|PCT|0.43|99|0.00|OP SVCS|
20|FH_F132254_40207_0|SrvcGrp|86121|2022|PCT|0.85|99|0.00|AETNA GAMUNEX-C|
20|FH_F136493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F34777_0_0|CSTM-ALL|CSTM-00|2020|PDM|755.00|99|0.00|ACUTE PSYCH|
20|FH_F36485_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.00|99|0.00|CPT CODE 99284|
20|FH_F149602_07109_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|438.00|99|0.00|AEG 10 (NO REV)|
20|FH_F140032_60550_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84061_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F125249_0_0|SrvcGrp|27261|2022|PDM|11000.00|99|0.00|CPT 27446|
20|FH_F101752_0_0|SrvcGrp|36204|2022|PCT|0.00|99|0.00|ACUTE PSYCH|
20|FH_F102224_0_0|SrvcGrp|92416|2022|PDM|6000.00|99|0.00|CERVICAL LAMINOTOMY|
20|FH_F136249_01913_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F132427_33853_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132399_66801_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F109848_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F120856_78247_0|SrvcGrp|75545|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F120921_75835_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F113649_01752_0|SrvcGrp|24750|2022|PDM|45.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F51276_0_0|SrvcGrp|17003|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS|
20|FH_F33925_0_0|SrvcGrp|63|2022|PDM|575.00|99|0.00|SUBACUTE CARE|
20|FH_F38980_0_0|SrvcGrp|3069|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|997.00|99|0.00|AEG 4 (NO REV)|
20|FH_F39939_0_0|SrvcGrp|8968|2022|PDM|1280.00|99|0.00|NICU LEVEL III & IV|
20|FH_F46972_0_0|SrvcGrp|42046|2022|PDM|595.00|99|0.00|HOSPICE CARE|
20|FH_F141873_0_0|SrvcGrp|46903|2022|PDM|702.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F38431_0_0|SrvcGrp|23003|2022|PDM|1600.00|99|0.00|V5258|
20|FH_F143790_83440_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F139515_0_0|SrvcGrp|27402|2022|PDM|2985.00|99|0.00|LASER PROCEDURES|
20|FH_F33789_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F148167_43950_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F116960_91505_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F109246_10018_0|SrvcGrp|75419|2022|PDM|150.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F123372_0_0|SrvcGrp|3418|2022|PDM|2914.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F109246_10018_0|SrvcGrp|52953|2022|PCT|1.10|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F115043_77954_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F115043_77954_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118338_94952_0|SrvcGrp|89417|2022|PDM|800.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F35476_0_0|CSTM-ALL|CSTM-00|2020|PDM|33926.00|99|0.00|MS DRG 233-234 CORONARY BYPASS|
20|FH_F32778_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F129627_06037_0|SrvcGrp|30609|2022|PDM|17.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F129255_34952_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F69766_0_0|SrvcGrp|10431|2022|PDM|47.00|99|0.00|SPEECH THERAPY|
20|FH_F91078_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143888_32205_0|SrvcGrp|111930|2022|PCT|1.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F130032_72034_0|SrvcGrp|89149|2022|PDM|228.00|99|0.00|OP INTENSIVE|
20|FH_F127571_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F93720_12303_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F151225_0_0|SrvcGrp|74546|2022|PDM|805.00|99|0.00|HOSPICE SERVICES|
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|12601.00|99|0.00|MS DRG 243-244|
20|FH_F116291_11570_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F130157_84049_0|SrvcGrp|87317|2022|PDM|1100.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F143580_0_0|SrvcGrp|13262|2022|PDM|5.25|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F125062_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40418_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F38798_0_0|SrvcGrp|29678|2022|PDM|55.00|99|0.00|HOME INFUSION NURSING SVCS MOD SD|
20|FH_F135165_15728_0|SrvcGrp|48385|2022|PDM|93.00|99|0.00|SPEECH THERAPY|
20|FH_F124017_0_0|SrvcGrp|98563|2022|PDM|5000.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F33233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F38804_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116760_68512_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F131236_84041_0|SrvcGrp|95660|2022|PDM|93.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F151225_0_0|SrvcGrp|76528|2022|PDM|204.00|99|0.00|HOSPICE LTCH|
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|732.16|99|0.00|AEG 3 (NO REV)|
20|FH_F121547_46805_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F38360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F40418_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F139515_0_0|SrvcGrp|67066|2022|PDM|10355.00|99|0.00|CERVICAL SURGERY|
20|FH_F41776_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F130747_0_0|SrvcGrp|83846|2022|PDM|5202.00|99|0.00|RELEASE PALM CONTRACTURE|
20|FH_F38526_0_0|SrvcGrp|360|2022|PDM|2200.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F128272_60640_0|SrvcGrp|14944|2022|PDM|8.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC|
20|FH_F32509_0_0|SrvcGrp|14056|2022|PDM|12840.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F124660_0_0|SrvcGrp|72992|2022|PDM|527.00|99|0.00|AEG 2|
20|FH_F33233_0_0|SrvcGrp|2161|2022|PDM|20.79|99|0.00|THERAPEUTIC|
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|1233.00|99|0.00|AEG 3 (NO REV)|
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|849.00|99|0.00|AEG 6 (NO REV)|
20|FH_F109180_18015_0|SrvcGrp|3178|2022|PDM|872.00|99|0.00|ACUTE PSYCH|
20|FH_F140586_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|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_F91078_0_0|SrvcGrp|43524|2022|PDM|170.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F141001_24739_0|SrvcGrp|112039|2022|PCT|1.00|99|0.00|URGENT CARE TELEMEDICINE ESTABLISHED PATIENT (MOD GT)|
20|FH_F125899_07645_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F143974_28204_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F89211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F114930_71101_0|SrvcGrp|3212|2022|PDM|459.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F77042_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F132190_0_0|SrvcGrp|16693|2022|PDM|2500.00|99|0.00|KNEE SCOPE, MENISCECTOMY|
20|FH_F37679_0_0|SrvcGrp|26862|2022|PDM|15.25|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC (MOD SJ)|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PDM|1414.00|99|0.00|ASPG VIII|
20|FH_F129294_53925_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|100039|2022|PDM|5200.00|99|0.00|REPAIR OF HEEL FRACTURE|
20|FH_F49653_0_0|SrvcGrp|115|2022|PDM|481.00|99|0.00|SKILLED NURSING CARE|
20|FH_F120362_23321_0|SrvcGrp|73700|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F51192_0_0|SrvcGrp|44105|2022|PDM|55.00|99|0.00|PHYSICAL THERAPY|
20|FH_F39138_0_0|SrvcGrp|18886|2022|PDM|28711.00|99|0.00|MS DRG 234|
20|FH_F84215_0_0|SrvcGrp|73004|2022|PDM|1181.00|99|0.00|AEG 8|
20|FH_F126153_44663_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F148480_03079_0|SrvcGrp|27261|2022|PDM|7131.84|99|0.00|CPT 27446|
20|FH_F88254_33411_0|SrvcGrp|65621|2022|PDM|25.00|99|0.00|RN NURSING|
20|FH_F63307_0_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F86696_16063_0|SrvcGrp|23683|2022|PDM|35.00|99|0.00|SKILLED NURSING RN|
20|FH_F86696_16063_0|SrvcGrp|46605|2022|PDM|75.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F87014_65203_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F74602_0_0|SrvcGrp|31377|2022|PDM|1500.00|99|0.00|EMERGENCY ROOM LEVEL V|
20|FH_F88096_0_0|SrvcGrp|78504|2022|PDM|4000.00|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F117485_0_0|SrvcGrp|35921|2022|PDM|7519.00|99|0.00|BARIATRIC SURGERY|
20|FH_F63396_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F119417_78212_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148548_37909_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101840_76054_0|SrvcGrp|81859|2022|PDM|3060.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F35596_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117009_0_0|SrvcGrp|107271|2022|PDM|1097.00|99|0.00|REVISE EYELID DEFECT|
20|FH_F93557_15147_0|SrvcGrp|471|2022|PDM|432.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F129943_77584_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143928_21061_0|SrvcGrp|43567|2022|PDM|131.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91622_0_0|SrvcGrp|86640|2022|PDM|600.00|99|0.00|ELECTROCONVULSIVE THERAPY|
20|FH_F40022_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|OP SVCS|
20|FH_F32118_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F149869_03253_0|SrvcGrp|73700|2022|PDM|80.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F148255_72703_0|SrvcGrp|86850|2022|PDM|31.50|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F34138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|PRO FEES EXCLUDED ON CMS1500|
20|FH_F36366_0_0|SrvcGrp|12045|2022|PDM|791.00|99|0.00|SLEEP STUDIES|
20|FH_F98922_40351_0|CSTM-ALL|CSTM-00|2020|PCT|0.46|99|0.00|OP SVCS|
20|FH_F59333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PDM|2811.00|99|0.00|ASPG V|
20|FH_F149060_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.50|99|0.00|OP SVCS|
20|FH_F82714_18848_0|SrvcGrp|111929|2022|PDM|7.70|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F115010_20105_0|SrvcGrp|79720|2022|PDM|1344.00|99|0.00|ACUTE REHAB II|
20|FH_F90700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137527_31322_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122433_0_0|SrvcGrp|88491|2022|PDM|2000.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F82931_18847_0|SrvcGrp|103675|2022|PDM|2.00|99|0.00|WHEELCHAIR VAN MILEAGE-PER MILE|
20|FH_F37679_0_0|SrvcGrp|13929|2022|PDM|15.00|99|0.00|GROWTH HORMONE|
20|FH_F128906_48423_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39138_0_0|SrvcGrp|18148|2022|PDM|11537.00|99|0.00|MS DRG 249|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S AZ/NV - MOD AW|
20|FH_F117344_75062_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136510_0_0|SrvcGrp|28549|2022|PDM|3882.00|99|0.00|VITRECTOMY|
20|FH_F143928_21061_0|SrvcGrp|48396|2022|PDM|126.00|99|0.00|OT SERVICES|
20|FH_F109581_0_0|SrvcGrp|75495|2022|PDM|1512.00|99|0.00|AEG 9|
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|AEG 10 (NO REV)|
20|FH_F125028_19061_0|SrvcGrp|86838|2022|PDM|15.75|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F89453_75069_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F88199_0_0|SrvcGrp|48394|2022|PDM|38.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F41178_0_0|CSTM-ALL|CSTM-00|2020|PDM|258.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F97500_32025_0|SrvcGrp|73643|2022|PDM|1035.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F150026_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F97104_53545_0|SrvcGrp|73659|2022|PDM|8333.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F123501_64831_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F143528_0_0|SrvcGrp|109016|2022|PDM|1914.15|99|0.00|REMOVAL OF ADENOIDS|
20|FH_F92276_32308_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F135005_06460_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F110263_0_0|SrvcGrp|93601|2022|PDM|8577.00|99|0.00|REVISON OF KNEE JOINT(HCFA)|
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.61|99|0.00|AEG 10 (NO REV)|
20|FH_F148543_71103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F117344_75062_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F110925_01104_0|SrvcGrp|86120|2022|PDM|0.95|99|0.00|AETNA HUMATE|
20|FH_F47656_0_0|SrvcGrp|360|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F127375_28621_0|SrvcGrp|90076|2022|PCT|0.69|99|0.00|CARDIC CATH PROCEDURES|
20|FH_F139580_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F118194_50841_0|CSTM-ALL|CSTM-00|2020|PDM|20.00|99|0.00|DURABLE MEDICAL EQUIPMENT (DME) (MOD RR)|
20|FH_F118194_50841_0|SrvcGrp|86853|2022|PDM|93.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F135294_64093_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F43167_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|411.67|99|0.00|HAPA WPA-NWPA 2012-13 ASC 207 W/O REV|
20|FH_F130524_43701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149839_80002_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F148279_15009_0|SrvcGrp|30089|2022|PDM|425.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F39619_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F131228_01826_0|SrvcGrp|20900|2022|PDM|30090.37|99|0.00|MS DRG 248 ONLY|
20|FH_F102302_0_0|SrvcGrp|93741|2022|PDM|14300.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY|
20|FH_F127375_28621_0|SrvcGrp|76095|2022|PCT|0.69|99|0.00|AETNA OBSERVATION SERVICES W/ER|
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|1280.00|99|0.00|AEG 6 (NO REV)|
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|1751.00|99|0.00|AEG 3 (NO REV)|
20|FH_F73985_0_0|SrvcGrp|9494|2022|PDM|1138.00|99|0.00|SUBACUTE CARE|
20|FH_F121535_60018_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36789_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F82173_72712_0|SrvcGrp|14614|2022|PDM|7104.00|99|0.00|LITHOTRIPSY|
20|FH_F40694_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143873_33407_0|SrvcGrp|110811|2022|PDM|200.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F92034_0_0|SrvcGrp|72992|2022|PDM|588.00|99|0.00|AEG 2|
20|FH_F121488_77478_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F141527_36830_0|SrvcGrp|29023|2022|PDM|26.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F123293_18087_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148161_98198_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38377_0_0|SrvcGrp|11798|2022|PDM|105.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F135650_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F143928_21061_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149980_0_0|SrvcGrp|115790|2022|PDM|3300.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL INSERT LENS|
20|FH_F42807_0_0|SrvcGrp|36602|2022|PCT|0.75|99|0.00|DURABLE MEDICAL EQUIPMENT|
20|FH_F120825_66204_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F100786_24740_0|SrvcGrp|90854|2022|PDM|1902.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F44660_0_0|SrvcGrp|360|2022|PDM|900.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F141927_71901_0|CSTM-ALL|CSTM-00|2020|PDM|1401.00|99|0.00|AEG 8 (NO REV)|
20|FH_F107140_0_0|SrvcGrp|46605|2022|PDM|75.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F55375_0_0|SrvcGrp|36231|2022|PDM|630.00|99|0.00|SUB ACUTE|
20|FH_F49046_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F83113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F142831_08053_0|SrvcGrp|75419|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F111456_33884_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F35262_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141940_50023_0|CSTM-ALL|CSTM-00|2020|PDM|3072.57|99|0.00|AEG 4 (NO REV)|
20|FH_F130108_0_0|SrvcGrp|10905|2022|PCT|0.75|99|0.00|EMERGENCY ROOM LEVEL III|
20|FH_F132446_19063_0|SrvcGrp|48396|2022|PDM|76.00|99|0.00|OT SERVICES|
20|FH_F128296_37167_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F146370_19355_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F128787_60302_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F133490_90650_0|SrvcGrp|12491|2022|PCT|0.25|99|0.00|PACEMAKER|
20|FH_F133455_60110_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F81373_64064_0|SrvcGrp|34170|2022|PCT|0.69|99|0.00|TRAUMA SERVICES MS DRG|
20|FH_F37042_0_0|SrvcGrp|17067|2022|PDM|712.00|99|0.00|ASPG II|
20|FH_F42195_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F123538_21206_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F37562_0_0|SrvcGrp|26017|2022|PDM|117.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F36521_0_0|SrvcGrp|72|2022|PDM|220.00|99|0.00|NEWBORN NURSERY|
20|FH_F72542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F133527_68025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F38702_0_0|SrvcGrp|112479|2022|PDM|65.00|99|0.00|COVID-19 ANTIBODY (HCFA)|
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|915.00|99|0.00|AEG 2 (NO REV)|
20|FH_F38016_0_0|SrvcGrp|20906|2022|PDM|3245.00|99|0.00|MS DRG 243-244 ONLY CARDIAC PACEMAKER|
20|FH_F89011_75006_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F117385_48091_0|CSTM-ALL|CSTM-00|2020|PDM|970.00|99|0.00|AETNA-RESIDENTIAL TREATMENT-EATING DISORDERS|
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F142970_43055_0|SrvcGrp|13422|2022|PCT|0.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F106540_26330_0|SrvcGrp|42782|2022|PDM|119.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F93421_0_0|SrvcGrp|26001|2022|PDM|138.10|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F118517_33316_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F119291_0_0|SrvcGrp|103551|2022|PDM|186.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F127412_15301_0|SrvcGrp|84933|2022|PDM|1800.00|99|0.00|TRANSLUMINAL DILATION OF CANAL|
20|FH_F35454_0_0|SrvcGrp|3406|2022|PDM|65.00|99|0.00|CPT 99214|
20|FH_F86293_0_0|SrvcGrp|27402|2022|PDM|2888.00|99|0.00|LASER PROCEDURES|
20|FH_F148556_13206_0|SrvcGrp|17005|2022|PDM|50.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS|
20|FH_F35176_0_0|SrvcGrp|13703|2022|PDM|26.75|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F67861_0_0|SrvcGrp|24806|2022|PCT|0.60|99|0.00|PHYSICAL THERAPY|
20|FH_F132543_79549_0|SrvcGrp|73559|2022|PDM|1000.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F133474_0_0|SrvcGrp|112727|2022|PDM|45.23|99|0.00|COVID-19 IA NFCT AB SARS COV 2|
20|FH_F117950_37110_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F71667_0_0|SrvcGrp|46903|2022|PDM|480.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F73542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS AMBULANCE TN (10302-35) RURAL|
20|FH_F139789_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F115949_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89851_83854_0|SrvcGrp|90208|2022|PDM|4847.00|99|0.00|CPT 47563|
20|FH_F150121_29072_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133493_90255_0|CSTM-ALL|CSTM-00|2020|PDM|4106.00|99|0.00|AEG 6 (NO REV)|
20|FH_F119007_0_0|SrvcGrp|96819|2022|PDM|393.00|99|0.00|DESTROY L/S FACET JNT ADDL|
20|FH_F130652_51101_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F97566_79902_0|SrvcGrp|73602|2022|PDM|4321.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F97542_32960_0|SrvcGrp|73603|2022|PDM|5789.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F145917_37604_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97565_83301_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F100785_54660_0|SrvcGrp|73605|2022|PDM|2829.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F148430_06278_0|SrvcGrp|114471|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F117728_0_0|SrvcGrp|82498|2022|PDM|175.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS|
20|FH_F133112_70433_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87362_15746_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F132331_89107_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F128299_44134_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F103281_32086_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F148680_33311_0|SrvcGrp|76501|2022|PDM|360.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F148780_70739_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148867_20191_0|SrvcGrp|88620|2022|PDM|128.00|99|0.00|SKILLED NURSING RN|
20|FH_F151061_02720_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F151141_24014_0|CSTM-ALL|CSTM-00|2020|PDM|690.00|99|0.00|AEG 1 (NO REV)|
20|FH_F151155_26508_0|SrvcGrp|100860|2022|PDM|205.00|99|0.00|OFFICE/OUTPATIENT VISIT NEW|
20|FH_F138746_60174_0|SrvcGrp|89149|2022|PDM|228.00|99|0.00|OP INTENSIVE|
20|FH_F117552_0_0|SrvcGrp|107545|2022|PDM|8500.00|99|0.00|PARTIAL OR TOTAL HIP REPLACEMENT|
20|FH_F140447_84106_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES|
20|FH_F140496_38627_0|SrvcGrp|89417|2022|PDM|475.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F140573_46517_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120152_0_0|SrvcGrp|33986|2022|PDM|2420.00|99|0.00|CPT 26055|
20|FH_F151608_30236_0|SrvcGrp|92197|2022|PDM|6737.00|99|0.00|CORRECTION OF BUNION|
20|FH_F119023_91406_0|SrvcGrp|86830|2022|PDM|45.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F119004_06850_0|CSTM-ALL|CSTM-00|2020|PDM|1663.00|99|0.00|AEG 7 (NO REV)|
20|FH_F119067_94080_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F118932_07652_0|SrvcGrp|75506|2022|PCT|1.50|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F117098_20186_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117102_39355_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F137307_65233_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F110308_0_0|SrvcGrp|72990|2022|PDM|150.00|99|0.00|AEG 1|
20|FH_F91472_96001_0|SrvcGrp|14614|2022|PDM|14850.00|99|0.00|LITHOTRIPSY|
20|FH_F139711_16037_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F115495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F69347_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|UNGROUPABLE INPATIENT|
20|FH_F117485_0_0|SrvcGrp|14614|2022|PDM|5515.00|99|0.00|LITHOTRIPSY|
20|FH_F119321_71040_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148545_84047_0|SrvcGrp|73700|2022|PDM|42.25|99|0.00|AETNA - SKILLED NURSING|
20|FH_F148545_84047_0|SrvcGrp|88620|2022|PDM|85.50|99|0.00|SKILLED NURSING RN|
20|FH_F148644_06890_0|SrvcGrp|11673|2022|PDM|6978.00|99|0.00|CPT 29888|
20|FH_F146244_76028_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141835_78676_0|SrvcGrp|108484|2022|PDM|670.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|AEG 4 (NO REV)|
20|FH_F133460_63031_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146211_68144_0|SrvcGrp|114333|2022|PCT|1.00|99|0.00|COVID-19 SPECIMEN HANDLING OFFICE LAB|
20|FH_F40173_28304_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F92792_0_0|SrvcGrp|82570|2022|PDM|1045.00|99|0.00|REVISION EYELID/EXCESS SKIN|
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1184.00|99|0.00|AEG 5  (NO REV)|
20|FH_F134544_03874_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F37600_0_0|SrvcGrp|26819|2022|PDM|170.00|99|0.00|AMBULANCE SVCS|
20|FH_F80952_45669_0|CSTM-ALL|CSTM-00|2020|PDM|1375.74|99|0.00|AEG 6 (NO REV)|
20|FH_F79944_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|NON SURGERY CODES|
20|FH_F101840_76054_0|SrvcGrp|79099|2022|PDM|2957.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F33428_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F126935_33615_0|SrvcGrp|79280|2022|PDM|641.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F37309_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|RS 358 CT CODES|
20|FH_F36579_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109882_36695_0|SrvcGrp|89337|2022|PDM|881.00|99|0.00|DETOXIFICATION|
20|FH_F39417_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GI DX LAB & RAD CARVEOUTS GLOBAL|
20|FH_F43296_0_0|SrvcGrp|43871|2022|PDM|473.00|99|0.00|NEWBORN NURSERY|
20|FH_F34706_0_0|SrvcGrp|14997|2022|PCT|1.00|99|0.00|DRUGS|
20|FH_F117728_0_0|SrvcGrp|107639|2022|PDM|400.00|99|0.00|HEMODIALYSIS|
20|FH_F115327_45320_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD KF|
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_F35411_0_0|CSTM-ALL|CSTM-00|2020|PDM|5299.00|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F128492_49010_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F43018_0_0|SrvcGrp|9793|2022|PDM|575.00|99|0.00|NEWBORN NURSERY|
20|FH_F103281_32086_0|SrvcGrp|91322|2022|PCT|0.00|99|0.00|IMAGING ENHANCING|
20|FH_F37640_0_0|SrvcGrp|64758|2022|PCT|0.80|99|0.00|HCPCS|
20|FH_F97061_85012_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F120437_85202_0|SrvcGrp|26869|2022|PDM|78.78|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F41804_0_0|SrvcGrp|3029|2022|PDM|309.00|99|0.00|NEWBORN NURSERY|
20|FH_F46914_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|SOCIAL WORKER|
20|FH_F117880_91730_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F150119_34205_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F111802_22003_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F100786_24740_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F79902_0_0|SrvcGrp|4109|2022|PDM|1196.00|99|0.00|ACUTE PSYCH|
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_F50472_0_0|SrvcGrp|43785|2022|PDM|65.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F68944_0_0|SrvcGrp|33625|2022|PDM|1175.00|99|0.00|ACUTE PSYCH|
20|FH_F44813_0_0|CSTM-ALL|CSTM-00|2020|PDM|205.00|99|0.00|PSYCH DAY TREATMENT|
20|FH_F117945_78957_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F113271_72205_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F35368_0_0|SrvcGrp|12218|2022|PDM|3300.00|99|0.00|VALVULOPLASTY|
20|FH_F83053_0_0|SrvcGrp|73002|2022|PDM|6127.00|99|0.00|AEG 7|
20|FH_F140790_0_0|SrvcGrp|113615|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F133341_23860_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119100_66086_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F126626_80906_0|SrvcGrp|46903|2022|PDM|765.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F72024_0_0|SrvcGrp|42785|2022|PDM|68.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F133019_23236_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F51438_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ASPG I|
20|FH_F121338_37756_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121385_89102_0|CSTM-ALL|CSTM-00|2020|PDM|8333.00|99|0.00|AEG 9 (NO REV)|
20|FH_F115990_0_0|SrvcGrp|72990|2022|PDM|550.00|99|0.00|AEG 1|
20|FH_F65761_0_0|SrvcGrp|42830|2022|PDM|159.14|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F97660_29401_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F111442_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F80711_0_0|SrvcGrp|3809|2022|PDM|616.00|99|0.00|HOSPICE CARE|
20|FH_F86911_0_0|SrvcGrp|44713|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F114866_77706_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F114916_30309_0|SrvcGrp|85792|2022|PDM|4500.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F142321_29401_0|SrvcGrp|73605|2022|PDM|1176.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F113305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115895_0_0|SrvcGrp|89842|2022|PDM|6365.00|99|0.00|LUMBAR|
20|FH_F115208_0_0|SrvcGrp|106171|2022|PDM|2016.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F100640_48097_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F115808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123774_0_0|SrvcGrp|73004|2022|PDM|1298.00|99|0.00|AEG 8|
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1147.00|99|0.00|AEG 8 (NO REV)|
20|FH_F125910_0_0|SrvcGrp|87077|2022|PDM|113.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F129597_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F133178_0_0|SrvcGrp|67994|2022|PDM|1255.00|99|0.00|CPT 58120|
20|FH_F138196_0_0|SrvcGrp|76243|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F94786_07974_0|SrvcGrp|86836|2022|PDM|15.75|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F137067_0_0|SrvcGrp|89404|2022|PDM|19425.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F72162_0_0|SrvcGrp|15402|2022|PDM|71.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F141050_46410_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F71065_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137897_0_0|SrvcGrp|111642|2022|PDM|1625.00|99|0.00|HOME VENTILATOR (MOD RR) (HCFA)|
20|FH_F92212_0_0|SrvcGrp|90682|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F49026_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F77944_0_0|CSTM-ALL|CSTM-00|2020|PDM|5745.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F124060_76040_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F146674_70778_0|SrvcGrp|89024|2022|PDM|70.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F146901_78006_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F92493_0_0|SrvcGrp|88065|2022|PDM|18504.20|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F100703_0_0|SrvcGrp|96355|2022|PDM|8034.00|99|0.00|SPINE FIXATION|
20|FH_F133674_30350_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F124679_64052_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F127995_84010_0|SrvcGrp|24745|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F97083_90670_0|SrvcGrp|73602|2022|PDM|4034.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F114638_25309_0|SrvcGrp|103913|2022|PCT|0.75|99|0.00|OP DIALYSIS|
20|FH_F113787_31909_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F81832_13827_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|GUTHRIE HOME HEALTH|
20|FH_F117195_0_0|SrvcGrp|14067|2022|PCT|0.75|99|0.00|PROFESSIONAL FEES ON UB04|
20|FH_F122608_84123_0|SrvcGrp|48398|2022|PDM|103.00|99|0.00|PT SERVICES|
20|FH_F122727_64030_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F43779_0_0|CSTM-ALL|CSTM-00|2020|PDM|890.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F136796_24016_0|CSTM-ALL|CSTM-00|2020|PDM|1553.75|99|0.00|AEG 4 (NO REV)|
20|FH_F136914_64081_0|SrvcGrp|80317|2022|PDM|180.00|99|0.00|RESPITE CARE|
20|FH_F112248_53223_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F112268_19087_0|SrvcGrp|88620|2022|PDM|84.00|99|0.00|SKILLED NURSING RN|
20|FH_F112371_19047_0|CSTM-ALL|CSTM-00|2020|PDM|2727.00|99|0.00|AEG 6 (NO REV)|
20|FH_F112505_51503_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115567_91711_0|SrvcGrp|100520|2022|PDM|475.00|99|0.00|INTENSIVE OP EATING DISORDERS|
20|FH_F147311_37421_0|SrvcGrp|108484|2022|PDM|665.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F147701_31093_0|CSTM-ALL|CSTM-00|2020|PDM|4111.00|99|0.00|AEG 4 (NO REV)|
20|FH_F41672_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41798_0_0|SrvcGrp|110|2022|PDM|333.00|99|0.00|CD - REHABILITATION|
20|FH_F42654_0_0|SrvcGrp|10543|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F133007_76010_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133007_76010_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130657_04614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F76824_0_0|SrvcGrp|24028|2022|PDM|40.00|99|0.00|LICENSED PRACTICAL NURSE|
20|FH_F137906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71502_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F60356_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F114853_0_0|SrvcGrp|98496|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR ATLAS|
20|FH_F54552_0_0|SrvcGrp|26871|2022|PDM|95.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3 HRS|
20|FH_F113585_20155_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138700_76802_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138730_22602_0|SrvcGrp|79238|2022|PDM|1000.00|99|0.00|TRANSFER|
20|FH_F138936_01040_0|SrvcGrp|75181|2022|PCT|0.47|99|0.00|AETNA IMPLANTS|
20|FH_F138685_18017_0|SrvcGrp|89149|2022|PDM|177.00|99|0.00|OP INTENSIVE|
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|1420.00|99|0.00|2006 MEDICARE ASPG VIII|
20|FH_F119888_0_0|SrvcGrp|13681|2022|PDM|352.48|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|320.78|99|0.00|HAPA WPA-NWPA 2012-13 ASC 115 W/O REV|
20|FH_F75826_0_0|SrvcGrp|10431|2022|PDM|50.00|99|0.00|SPEECH THERAPY|
20|FH_F151421_21244_0|SrvcGrp|74668|2022|PDM|170.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151501_30265_0|SrvcGrp|109790|2022|PDM|14175.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F132206_67152_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135447_53226_0|SrvcGrp|88337|2022|PCT|1.00|99|0.00|VENIPUNCTURE|
20|FH_F135583_17331_0|SrvcGrp|72984|2022|PCT|0.82|99|0.00|CHEMOTHERAPY|
20|FH_F135587_37334_0|SrvcGrp|76501|2022|PDM|309.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F135590_84066_0|SrvcGrp|472|2022|PDM|446.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F135607_21613_0|SrvcGrp|90397|2022|PDM|1750.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F97142_94535_0|SrvcGrp|73461|2022|PDM|23449.00|99|0.00|AETNA NICU IV|
20|FH_F135924_02906_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135948_60471_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136081_71742_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136147_63901_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136180_92253_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F116527_70443_0|SrvcGrp|36204|2022|PCT|0.00|99|0.00|ACUTE PSYCH|
20|FH_F101681_46123_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F33081_0_0|SrvcGrp|290|2022|PDM|3600.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F36344_0_0|SrvcGrp|10645|2022|PDM|175.00|99|0.00|PICC LINE INSERTION KIT|
20|FH_F54272_0_0|SrvcGrp|9541|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F132328_0_0|SrvcGrp|87386|2022|PDM|3839.00|99|0.00|AMNIOTIC MEMBRANE TRANSPLANTATION|
20|FH_F112082_30720_0|SrvcGrp|48398|2022|PDM|213.00|99|0.00|PT SERVICES|
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112138_80120_0|SrvcGrp|33902|2022|PDM|551.00|99|0.00|DIALYSIS SERVICES|
20|FH_F88831_84123_0|SrvcGrp|87799|2022|PDM|90.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F96560_17972_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141035_0_0|SrvcGrp|113716|2022|PDM|2275.00|99|0.00|NJX AA / STR AXILLARY NERVE|
20|FH_F123036_0_0|SrvcGrp|96350|2022|PDM|13393.00|99|0.00|SHOULDER JOINT|
20|FH_F102228_08846_0|SrvcGrp|75749|2022|PDM|508.00|99|0.00|AMBULATORY DETOX REHAB|
20|FH_F101320_26062_0|SrvcGrp|26869|2022|PDM|42.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F132090_60915_0|SrvcGrp|101102|2022|PDM|9500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F97261_06098_0|SrvcGrp|88978|2022|PDM|8769.00|99|0.00|VAGINAL DELIVERY|
20|FH_F87915_0_0|SrvcGrp|3404|2022|PDM|154.00|99|0.00|CPT 99211|
20|FH_F136467_0_0|SrvcGrp|76604|2022|PDM|1939.00|99|0.00|CPT 25447|
20|FH_F123752_44502_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F123741_20850_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|1505.00|99|0.00|AEG 3 (NO REV)|
20|FH_F126770_43050_0|SrvcGrp|94781|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F118193_06241_0|SrvcGrp|105427|2022|PDM|32.05|99|0.00|AETNA OBSERVATIONS BEHAVIORAL 30 MINS|
20|FH_F120490_64133_0|SrvcGrp|86844|2022|PDM|25.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F134167_10032_0|SrvcGrp|48398|2022|PDM|109.00|99|0.00|PT SERVICES|
20|FH_F136952_78218_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F137130_46168_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142742_44112_0|SrvcGrp|46903|2022|PDM|500.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F117552_0_0|SrvcGrp|103644|2022|PDM|9500.00|99|0.00|AETNA TIB/ PER REVASE W/ ATHER|
20|FH_F53732_0_0|SrvcGrp|9263|2022|PDM|155.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F53732_0_0|SrvcGrp|10578|2022|PDM|40.00|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F73403_0_0|SrvcGrp|43428|2022|PDM|60.00|99|0.00|RN HOURLY|
20|FH_F78402_15905_0|SrvcGrp|31074|2022|PDM|1072.00|99|0.00|MS DRG 795 ONLY|
20|FH_F140343_89052_0|SrvcGrp|13929|2022|PDM|10.00|99|0.00|GROWTH HORMONE|
20|FH_F140447_84106_0|SrvcGrp|46605|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F140496_38627_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F140615_73013_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F140868_63103_0|SrvcGrp|113166|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F120152_0_0|SrvcGrp|100059|2022|PDM|7700.00|99|0.00|REPAIR ULNA FRACTURE|
20|FH_F118955_48239_0|SrvcGrp|89024|2022|PDM|84.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F118943_64506_0|SrvcGrp|73742|2022|PDM|3.50|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F109983_98607_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147725_06002_0|SrvcGrp|85778|2022|PDM|4500.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F147725_06002_0|CSTM-ALL|CSTM-00|2020|PDM|4264.00|99|0.00|AEG 9 (NO REV)|
20|FH_F147799_18052_0|SrvcGrp|88620|2022|PDM|109.57|99|0.00|SKILLED NURSING RN|
20|FH_F117218_32025_0|SrvcGrp|93919|2022|PDM|599.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F117240_37334_0|SrvcGrp|10365|2022|PDM|1615.00|99|0.00|CPT CODE 99285|
20|FH_F137333_51012_0|SrvcGrp|86722|2022|PDM|204.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F101161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F104700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F110720_0_0|SrvcGrp|85198|2022|PDM|4882.00|99|0.00|AETNA KNEE ARTHROSCOPY|
20|FH_F91472_96001_0|SrvcGrp|12290|2022|PDM|2455.00|99|0.00|DETOXIFICATION|
20|FH_F124923_23518_0|SrvcGrp|29347|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE|
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1022.00|99|0.00|AEG 8 (NO REV)|
20|FH_F110160_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|1089.00|99|0.00|AEG 3 (NO REV)|
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|ASPG VI|
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)|
20|FH_F130755_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|AEG 5  (NO REV)|
20|FH_F130775_61701_0|SrvcGrp|108484|2022|PDM|461.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F130898_06405_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|ASPG II- MOD 50|
20|FH_F100782_0_0|SrvcGrp|97639|2022|PDM|958.97|99|0.00|WINDBER MEDICAL CNTR ASC 301|
20|FH_F74024_0_0|SrvcGrp|71420|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY|
20|FH_F112863_0_0|SrvcGrp|104254|2022|PDM|1141.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F51121_0_0|SrvcGrp|22954|2022|PDM|148.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F150239_75569_0|SrvcGrp|24744|2022|PCT|1.00|99|0.00|PICC LINE INSERTION|
20|FH_F79245_0_0|SrvcGrp|59426|2022|PDM|75.00|99|0.00|PT|
20|FH_F86101_76063_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F148885_23226_0|SrvcGrp|57968|2022|PDM|44.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|ASPG II|
20|FH_F145940_71730_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F89358_64735_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F119227_01752_0|SrvcGrp|14944|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130763_0_0|SrvcGrp|70749|2022|PDM|4391.00|99|0.00|CPT 29823|
20|FH_F127579_44321_0|SrvcGrp|29346|2022|PDM|30.00|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_F148499_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F133972_27103_0|SrvcGrp|86835|2022|PDM|30.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F119379_0_0|SrvcGrp|92367|2022|PDM|1280.00|99|0.00|TRANSPLANT HAND TENDON|
20|FH_F138107_15201_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F148862_85390_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F133775_83401_0|SrvcGrp|73700|2022|PDM|54.11|99|0.00|AETNA - SKILLED NURSING|
20|FH_F145819_03431_0|SrvcGrp|472|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150300_23320_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127090_45601_0|SrvcGrp|14945|2022|PDM|4.08|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F149219_01966_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F145702_22192_0|SrvcGrp|23683|2022|PDM|42.00|99|0.00|SKILLED NURSING RN|
20|FH_F86052_15063_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F100782_0_0|SrvcGrp|105067|2022|PDM|695.12|99|0.00|WINDBER MEDICAL CNTR ASC 112|
20|FH_F93359_63084_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120698_75082_0|SrvcGrp|75419|2022|PDM|393.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F126099_34237_0|SrvcGrp|113276|2022|PCT|1.10|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F132883_31602_0|SrvcGrp|65621|2022|PDM|25.00|99|0.00|RN NURSING|
20|FH_F110470_98335_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|AETNA PSYTX W/PT 45 MIN MOD HO (HCFA)|
20|FH_F139565_0_0|SrvcGrp|114442|2022|PDM|12049.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F111731_47802_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F100782_0_0|SrvcGrp|97574|2022|PDM|972.92|99|0.00|WINDBER MEDICAL CNTR ASC 201|
20|FH_F112065_20852_0|SrvcGrp|48385|2022|PDM|130.00|99|0.00|SPEECH THERAPY|
20|FH_F116806_0_0|SrvcGrp|107041|2022|PDM|1923.16|99|0.00|OPEN TREATMENT OF MANDIBULAR FRACTURE W/ EXTERNAL FIXATION|
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_F133724_84041_0|SrvcGrp|48398|2022|PDM|103.00|99|0.00|PT SERVICES|
20|FH_F85133_85251_0|SrvcGrp|46424|2022|PDM|125.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F67581_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F120207_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F149263_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 10 (NO REV)|
20|FH_F126043_30339_0|SrvcGrp|89412|2022|PDM|295.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|502.00|99|0.00|AEG 1 (NO REV)|
20|FH_F86112_63501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133727_33511_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 2 (NO REV)|
20|FH_F112065_20852_0|SrvcGrp|48396|2022|PDM|130.00|99|0.00|OT SERVICES|
20|FH_F133798_20774_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133875_80027_0|SrvcGrp|89149|2022|PDM|271.00|99|0.00|OP INTENSIVE|
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|3745.00|99|0.00|AEG 6 (NO REV)|
20|FH_F149304_64137_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|804.00|99|0.00|AEG 2 (NO REV)|
20|FH_F93122_01854_0|SrvcGrp|90572|2022|PDM|172.00|99|0.00|INTENSIVE OP PSYCH (HCFA)|
20|FH_F34747_0_0|SrvcGrp|17327|2022|PDM|2024.00|99|0.00|HYSTEROSCOPY|
20|FH_F132883_31602_0|SrvcGrp|19742|2022|PDM|30.00|99|0.00|MID-LINE INSERTION|
20|FH_F50703_0_0|SrvcGrp|46988|2022|PDM|20.00|99|0.00|ENTERAL NUTRITION|
20|FH_F31714_0_0|SrvcGrp|11187|2022|PDM|16500.00|99|0.00|DRG 550 CORONARY BYPASS W/O CC W/O|
20|FH_F150304_16146_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150300_23320_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F32374_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134431_92647_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F122532_46385_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F84855_0_0|SrvcGrp|30401|2022|PCT|1.10|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F84935_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F85055_0_0|SrvcGrp|72994|2022|PDM|780.00|99|0.00|AEG 3|
20|FH_F71042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F105145_75075_0|SrvcGrp|101887|2022|PDM|8500.00|99|0.00|AETNA AEG 9 WITHOUT CARVE OUT SURGERY|
20|FH_F105361_80104_0|SrvcGrp|73002|2022|PDM|2709.00|99|0.00|AEG 7|
20|FH_F115814_53235_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97160_77436_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F72859_0_0|SrvcGrp|15495|2022|PDM|20.97|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F44016_0_0|SrvcGrp|16|2022|PDM|1338.00|99|0.00|ACUTE REHABILITATION|
20|FH_F144318_32696_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131282_0_0|SrvcGrp|108434|2022|PDM|2600.00|99|0.00|INSJ AQUEOUS DRAIN DEV 1ST|
20|FH_F118845_71111_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F117911_86403_0|SrvcGrp|48396|2022|PDM|125.00|99|0.00|OT SERVICES|
20|FH_F42779_0_0|CSTM-ALL|CSTM-00|2020|PDM|220.00|99|0.00|CD INTENSIVE OP PROGRAM|
20|FH_F51658_0_0|SrvcGrp|45950|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F118708_33455_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|719.00|99|0.00|AEG 5  (NO REV)|
20|FH_F72940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F34706_0_0|SrvcGrp|12383|2022|PDM|2517.00|99|0.00|DRG 373 NORM DELIVERY MOM ONLY|
20|FH_F75743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F67763_0_0|SrvcGrp|44244|2022|PDM|375.00|99|0.00|HEMODIALYSIS - HOME TRAINING|
20|FH_F112853_22408_0|SrvcGrp|91685|2022|PDM|650.00|99|0.00|HOME VENT|
20|FH_F101104_0_0|SrvcGrp|87394|2022|PDM|148.00|99|0.00|HCPCS G0152 (HCFA)|
20|FH_F142752_19428_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F132279_63775_0|SrvcGrp|109057|2022|PCT|0.50|99|0.00|CARDIAC STUDIES|
20|FH_F133329_40202_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F123545_44512_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F131982_0_0|SrvcGrp|57966|2022|PDM|556.00|99|0.00|HOSPICE CARE|
20|FH_F149665_65689_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|1083.00|99|0.00|AEG 5  (NO REV)|
20|FH_F111316_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139587_0_0|SrvcGrp|82224|2022|PDM|58.52|99|0.00|HOSPICE CONT HOME CARE|
20|FH_F111520_81601_0|SrvcGrp|93291|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA ESRD USE|
20|FH_F97061_85012_0|SrvcGrp|73656|2022|PDM|1015.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|139.00|99|0.00|HAPA EPA ASC 21|
20|FH_F145988_06105_0|SrvcGrp|114477|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F148430_06278_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F134830_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142847_07003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F144049_45242_0|SrvcGrp|74668|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F42340_0_0|SrvcGrp|36482|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY|
20|FH_F126666_44053_0|SrvcGrp|91395|2022|PDM|72.00|99|0.00|AETNA FAMILY PSYTX W/PATIENT (MOD HO)|
20|FH_F36409_0_0|SrvcGrp|3809|2022|PDM|483.00|99|0.00|HOSPICE CARE|
20|FH_F143194_19973_0|SrvcGrp|89024|2022|PDM|80.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F100740_15206_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F139385_37762_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150982_0_0|SrvcGrp|33966|2022|PDM|2202.00|99|0.00|CPT 29866|
20|FH_F147146_06117_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148964_30101_0|SrvcGrp|89412|2022|PDM|360.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F34914_0_0|SrvcGrp|12512|2022|PDM|950.00|99|0.00|ACUTE REHABILITATION|
20|FH_F149662_85015_0|SrvcGrp|115729|2022|PDM|7550.00|99|0.00|INSERT/APPLY/REMOVE SPINE FIXATION DEVICE|
20|FH_F150419_64119_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129297_97828_0|SrvcGrp|109220|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F40644_0_0|SrvcGrp|11283|2022|PCT|0.80|99|0.00|HYPERBARIC CHAMBER|
20|FH_F35410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150945_15904_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F76285_0_0|CSTM-ALL|CSTM-00|2020|PDM|14.00|99|0.00|RN HOURLY|
20|FH_F117762_0_0|SrvcGrp|88740|2022|PDM|4836.00|99|0.00|SP BONE ALGRFT|
20|FH_F127965_32204_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97881_38703_0|SrvcGrp|73601|2022|PDM|9169.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F40590_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F148940_44077_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97223_94028_0|SrvcGrp|471|2022|PDM|640.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|1413.03|99|0.00|ASPG VIII|
20|FH_F146266_0_0|SrvcGrp|99163|2022|PDM|7945.00|99|0.00|CPT 27703|
20|FH_F130328_0_0|SrvcGrp|33722|2022|PDM|43.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F93354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1043.00|99|0.00|ASPG X|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD AW"|
20|FH_F139974_37214_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F46433_0_0|SrvcGrp|17005|2022|PDM|81.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS|
20|FH_F114848_50533_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91996_33805_0|SrvcGrp|69690|2022|PCT|1.00|99|0.00|HOSPICE PHYSICIAN|
20|FH_F130371_0_0|SrvcGrp|74584|2022|PCT|0.92|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F114207_35243_0|SrvcGrp|86829|2022|PDM|4.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F41155_0_0|SrvcGrp|705|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F94502_0_0|SrvcGrp|79720|2022|PDM|975.00|99|0.00|ACUTE REHAB II|
20|FH_F117711_73080_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F134432_85053_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|33982|2022|PDM|1976.00|99|0.00|CPT 28296|
20|FH_F126781_92630_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F76588_0_0|SrvcGrp|26160|2022|PDM|8.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F90232_15126_0|SrvcGrp|86844|2022|PDM|56.70|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F128927_0_0|SrvcGrp|87077|2022|PDM|154.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F40917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F115909_38133_0|SrvcGrp|105442|2022|PDM|500.00|99|0.00|ABH OP TERANIAL MAGN|
20|FH_F115907_12206_0|SrvcGrp|89023|2022|PDM|78.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F80513_0_0|SrvcGrp|28203|2022|PDM|24359.00|99|0.00|MS DRG 260 ONLY|
20|FH_F146848_73072_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F126783_80021_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F40903_0_0|SrvcGrp|17726|2022|PDM|5.83|99|0.00|ADDITIONAL MILEAGE|
20|FH_F47140_0_0|SrvcGrp|13627|2022|PDM|181.17|99|0.00|SLEEP STUDY|
20|FH_F115950_08648_0|SrvcGrp|86748|2022|PCT|1.05|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F116023_10027_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F116040_24637_0|SrvcGrp|86846|2022|PDM|30.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F131698_01862_0|SrvcGrp|23683|2022|PDM|35.00|99|0.00|SKILLED NURSING RN|
20|FH_F133581_84790_0|CSTM-ALL|CSTM-00|2020|PDM|1646.18|99|0.00|AEG 8 (NO REV)|
20|FH_F133658_60053_0|SrvcGrp|48385|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F133478_40165_0|SrvcGrp|10391|2022|PDM|2115.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F150739_44060_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150768_03054_0|SrvcGrp|100982|2022|PCT|1.00|99|0.00|AETNA OP SVCS HH AMFS DEFAULT|
20|FH_F150861_92592_0|SrvcGrp|108484|2022|PDM|750.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F150879_75056_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F126914_44136_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F142587_0_0|SrvcGrp|14494|2022|PDM|1278.30|99|0.00|CONTINUOUS HOMECARE|
20|FH_F117583_21208_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1725.00|99|0.00|AEG 9 (NO REV)|
20|FH_F114206_37203_0|SrvcGrp|17013|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138410_19130_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F131284_76502_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111246_80027_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD NUKF RATE|
20|FH_F125214_12428_0|SrvcGrp|32652|2022|PDM|1040.00|99|0.00|SKILLED NURSING CARE|
20|FH_F38584_0_0|SrvcGrp|17079|2022|PDM|1564.00|99|0.00|ASPG VIII|
20|FH_F90817_0_0|SrvcGrp|90362|2022|PDM|1433.00|99|0.00|RELEASE FOREARM/HAND TENDON|
20|FH_F124514_21215_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
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_F124309_24112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41699_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138017_73129_0|SrvcGrp|97467|2022|PDM|8122.00|99|0.00|PARTIAL EXCISION THYROID|
20|FH_F128987_65737_0|SrvcGrp|106655|2022|PCT|1.00|99|0.00|PARSABIV|
20|FH_F40236_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|85000|2022|PDM|1382.00|99|0.00|CPT 45384|
20|FH_F111080_18103_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F140295_0_0|SrvcGrp|71666|2022|PDM|6668.00|99|0.00|CPT 63655|
20|FH_F113826_51445_0|SrvcGrp|91294|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131545_64057_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 7 (NO REV)|
20|FH_F126914_44136_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F90196_10467_0|SrvcGrp|86722|2022|PDM|125.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F36883_0_0|SrvcGrp|16429|2022|PCT|0.52|99|0.00|OBSERVATION SVCS|
20|FH_F116806_0_0|SrvcGrp|107128|2022|PDM|887.26|99|0.00|EXCISE PHARYNX LESION|
20|FH_F97082_90012_0|SrvcGrp|88978|2022|PDM|8032.00|99|0.00|VAGINAL DELIVERY|
20|FH_F37487_0_0|SrvcGrp|16617|2022|PDM|79.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F119376_0_0|SrvcGrp|72994|2022|PDM|612.00|99|0.00|AEG 3|
20|FH_F129764_48084_0|SrvcGrp|35982|2022|PDM|52.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F34853_0_0|SrvcGrp|9939|2022|PDM|2333.00|99|0.00|ACUTE MEDICAL SVCS|
20|FH_F35387_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.00|99|0.00|ACUTE PSYCH|
20|FH_F122377_91007_0|SrvcGrp|79099|2022|PDM|6379.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F130044_0_0|SrvcGrp|65559|2022|PCT|6.90|99|0.00|E&M CODES|
20|FH_F131449_19073_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F36554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|ASPG VII|
20|FH_F39443_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAPA WPA CARDIO FS 90170 125%|
20|FH_F133569_17202_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F73643_0_0|SrvcGrp|3809|2022|PDM|600.00|99|0.00|HOSPICE CARE|
20|FH_F97184_26101_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F74845_0_0|SrvcGrp|59837|2022|PCT|1.15|99|0.00|RADIOACTIVE SEEDS|
20|FH_F149023_44122_0|CSTM-ALL|CSTM-00|2020|PDM|1170.00|99|0.00|AEG 2 (NO REV)|
20|FH_F93377_0_0|SrvcGrp|29353|2022|PDM|110.00|99|0.00|HOSPICE SVCS|
20|FH_F124322_64131_0|SrvcGrp|43567|2022|PDM|83.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F112754_98057_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147228_49441_0|SrvcGrp|57968|2022|PDM|44.10|99|0.00|CONTINUOUS HOMECARE|
20|FH_F134847_0_0|SrvcGrp|112643|2022|PDM|5071.00|99|0.00|SHOULDER PROCEDURES|
20|FH_F126150_80202_0|SrvcGrp|114620|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|HAPA EPA ASC 26|
20|FH_F116806_0_0|SrvcGrp|107117|2022|PDM|887.26|99|0.00|EXCISE/REPAIR MOUTH LESION|
20|FH_F102525_73134_0|SrvcGrp|72998|2022|PDM|1636.00|99|0.00|AEG 5|
20|FH_F149003_62208_0|SrvcGrp|88620|2022|PDM|99.00|99|0.00|SKILLED NURSING RN|
20|FH_F47902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F128392_01026_0|SrvcGrp|73605|2022|PDM|1400.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F117287_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1156.17|99|0.00|SALLY BALIN,999182,ASC 702|
20|FH_F147231_49440_0|SrvcGrp|23683|2022|PDM|54.32|99|0.00|SKILLED NURSING RN|
20|FH_F33566_0_0|SrvcGrp|21350|2022|PDM|5836.00|99|0.00|MS DRG 287 ONLY|
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|1235.00|99|0.00|AEG 4 (NO REV)|
20|FH_F37095_17543_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F149648_89148_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F98020_50138_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40624_0_0|SrvcGrp|28170|2022|PDM|3173.00|99|0.00|ICU/CCU|
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|1460.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149608_19116_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149400_83301_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F143347_16001_0|SrvcGrp|108935|2022|PCT|0.40|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F143488_84770_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|1450.00|99|0.00|AEG 9 (NO REV) INTERVENTIONAL PAIN CTR|
20|FH_F93740_0_0|SrvcGrp|91586|2022|PDM|9000.00|99|0.00|ATHERECTOMY|
20|FH_F102224_0_0|SrvcGrp|96819|2022|PDM|3000.00|99|0.00|DESTROY L/S FACET JNT ADDL|
20|FH_F114931_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F48785_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F132424_75062_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118950_33312_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F84274_46805_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36274_0_0|SrvcGrp|13703|2022|PDM|35.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F36420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F39919_0_0|SrvcGrp|31513|2022|PDM|1200.00|99|0.00|OP ARTHROSCOPY|
20|FH_F103004_75840_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F140007_0_0|SrvcGrp|96999|2022|PDM|3470.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|1824.00|99|0.00|AEG 2 (NO REV)|
20|FH_F69245_84047_0|SrvcGrp|3178|2022|PDM|852.00|99|0.00|ACUTE PSYCH|
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|490.00|99|0.00|AEG 2 (NO REV)|
20|FH_F36439_0_0|SrvcGrp|23007|2022|PDM|800.00|99|0.00|V5254|
20|FH_F37200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F49895_0_0|SrvcGrp|32386|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKL (DME)|
20|FH_F50137_0_0|SrvcGrp|46247|2022|PDM|120.00|99|0.00|HOME VISIT POSTNATAL CARE|
20|FH_F59732_0_0|SrvcGrp|22590|2022|PDM|80.00|99|0.00|PAIN MANAGAMENT - INTERMITTENT|
20|FH_F116637_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118742_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|AEG 3 (NO REV)|
20|FH_F141587_40242_0|SrvcGrp|89149|2022|PDM|209.00|99|0.00|OP INTENSIVE|
20|FH_F148255_72703_0|SrvcGrp|94093|2022|PCT|1.05|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F109601_0_0|SrvcGrp|75483|2022|PDM|620.00|99|0.00|AEG 3|
20|FH_F149740_33912_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F94261_0_0|SrvcGrp|48398|2022|PDM|84.00|99|0.00|PT SERVICES|
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DEVICE INSERTION|
20|FH_F37330_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F33642_0_0|SrvcGrp|27154|2022|PCT|0.75|99|0.00|TRAUMA ACTIVATION|
20|FH_F123488_65559_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F107800_34609_0|SrvcGrp|89417|2022|PDM|318.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PDM|662.40|99|0.00|ASPG IV|
20|FH_F110002_16901_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F116268_19064_0|SrvcGrp|473|2022|PDM|318.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F89563_29407_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35259_0_0|SrvcGrp|290|2022|PDM|12214.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)|
20|FH_F143783_0_0|SrvcGrp|97702|2022|PDM|105.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F150982_0_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F141591_92630_0|SrvcGrp|108484|2022|PDM|695.25|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F110925_01104_0|SrvcGrp|86135|2022|PDM|42.79|99|0.00|AETNA IMUGLUCERASE|
20|FH_F43171_0_0|CSTM-ALL|CSTM-00|2020|PDM|360.00|99|0.00|ADULT PSYCH DAY TREATMENT|
20|FH_F60812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F139551_0_0|SrvcGrp|88159|2022|PDM|5769.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F100790_10512_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F40059_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PDM|2450.00|99|0.00|AEG 6 (NO REV)|
20|FH_F88254_33411_0|SrvcGrp|16750|2022|PDM|85.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F115109_20032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.00|99|0.00|AEG 8 (NO REV)|
20|FH_F67939_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F72766_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F37679_0_0|SrvcGrp|26847|2022|PDM|30.50|99|0.00|ANTI-HEMOPHILIC (MOD SH)|
20|FH_F141410_13045_0|SrvcGrp|113185|2022|PCT|4.25|99|0.00|RADIOLOGY SERVICES|
20|FH_F148489_0_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F39940_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|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_F34413_0_0|SrvcGrp|9838|2022|PDM|1000.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F128580_0_0|SrvcGrp|108076|2022|PDM|2248.00|99|0.00|AV FUSION / FOREARM VEIN|
20|FH_F132092_0_0|SrvcGrp|97507|2022|PDM|169.00|99|0.00|AETNA HOSPICE|
20|FH_F31871_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F74092_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F128159_45356_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F71185_0_0|SrvcGrp|22106|2022|PDM|1274.00|99|0.00|CAT SCAN|
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|545.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F133099_66801_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37945_0_0|SrvcGrp|361|2022|PDM|1304.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F128906_48423_0|SrvcGrp|84185|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F37539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL FEES ON CMS1500|
20|FH_F63419_0_0|SrvcGrp|3087|2022|PDM|712.00|99|0.00|CD - DETOX|
20|FH_F65159_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TEMPLE RAD CPT|
20|FH_F122898_63011_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F86696_16063_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|482.00|99|0.00|ASPG III|
20|FH_F36532_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88545_78734_0|SrvcGrp|87537|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F87474_0_0|SrvcGrp|62154|2022|PDM|66.00|99|0.00|PICC LINES|
20|FH_F149179_0_0|SrvcGrp|107793|2022|PDM|9364.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F123741_20850_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F130656_04401_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F130858_67026_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146543_89511_0|SrvcGrp|74668|2022|PDM|235.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F135657_27612_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|56.76|99|0.00|HAPA WPA-NWPA 2012-13 ASC 247 W/O REV|
20|FH_F63114_0_0|SrvcGrp|48395|2022|PDM|30.00|99|0.00|OT SERVICES|
20|FH_F147991_65625_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F81861_0_0|SrvcGrp|9522|2022|PDM|4136.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F139565_0_0|SrvcGrp|106235|2022|PDM|6885.00|99|0.00|CYPASS|
20|FH_F85652_98034_0|CSTM-ALL|CSTM-00|2020|PCT|3.13|99|0.00|AETNA - APC GROUPER K|
20|FH_F118147_33801_0|SrvcGrp|112864|2022|PDM|876.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F150165_06032_0|SrvcGrp|88162|2022|PDM|8699.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F145562_70458_0|SrvcGrp|86850|2022|PDM|25.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F130468_0_0|SrvcGrp|88220|2022|PDM|2847.40|99|0.00|SHOULDER ARTHROSCOPY/SURGERY|
20|FH_F51138_0_0|SrvcGrp|3809|2022|PDM|694.00|99|0.00|HOSPICE CARE|
20|FH_F37963_0_0|SrvcGrp|80|2022|PDM|650.00|99|0.00|ACUTE PSYCH|
20|FH_F149199_73005_0|SrvcGrp|114917|2022|PCT|0.00|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F118042_33401_0|SrvcGrp|86722|2022|PDM|375.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F110501_07652_0|SrvcGrp|73841|2022|PDM|621.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F52713_0_0|SrvcGrp|42784|2022|PDM|240.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F112023_12866_0|SrvcGrp|74581|2022|PCT|0.30|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F121303_15501_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F93122_01854_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121225_98902_0|SrvcGrp|108709|2022|PCT|0.00|99|0.00|HOSPICE OP RESPITE CARE|
20|FH_F150165_06032_0|SrvcGrp|113881|2022|PDM|2140.00|99|0.00|PENIS URETHRA REVISE|
20|FH_F149048_77090_0|SrvcGrp|75419|2022|PDM|428.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F150146_95401_0|SrvcGrp|113194|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F144248_0_0|SrvcGrp|106235|2022|PDM|6885.00|99|0.00|CYPASS|
20|FH_F149319_07670_0|SrvcGrp|472|2022|PDM|397.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F132822_95125_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125244_0_0|SrvcGrp|88147|2022|PDM|4000.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA|
20|FH_F45212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F81838_0_0|SrvcGrp|8962|2022|PDM|50.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F85133_85251_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142376_0_0|SrvcGrp|107495|2022|PDM|1459.00|99|0.00|AETNA - ARTHROSCOPY OF JOINT|
20|FH_F116753_0_0|SrvcGrp|101760|2022|PDM|7465.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD UE KF"|
20|FH_F125870_0_0|SrvcGrp|72994|2022|PDM|1195.00|99|0.00|AEG 3|
20|FH_F137350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145839_45244_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|AEG 5  (NO REV)|
20|FH_F87775_15106_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F129440_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANESTHESIOLOGIST/CRNA (HAN2)(HSUR)|
20|FH_F85353_16407_0|SrvcGrp|63832|2022|PDM|493.23|99|0.00|HAPA WPA-NWPA 2012-13 ASC 216|
20|FH_F49598_0_0|SrvcGrp|38017|2022|PDM|4244.00|99|0.00|CARDIAC CATH|
20|FH_F51115_0_0|SrvcGrp|42828|2022|PDM|108.24|99|0.00|SPEECH THERAPY VISIT|
20|FH_F114525_72401_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F138292_60914_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117206_0_0|SrvcGrp|72994|2022|PDM|710.00|99|0.00|AEG 3|
20|FH_F109577_0_0|SrvcGrp|87398|2022|PDM|135.00|99|0.00|CPT 99501 (HCFA)|
20|FH_F100782_0_0|SrvcGrp|105079|2022|PDM|549.26|99|0.00|WINDBER MEDICAL CNTR ASC 124|
20|FH_F132969_84003_0|SrvcGrp|16750|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)|
20|FH_F148499_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC INVOICE|
20|FH_F120719_27540_0|SrvcGrp|361|2022|PDM|3087.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F110344_37421_0|SrvcGrp|86746|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F126341_27284_0|SrvcGrp|22593|2022|PDM|35.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|802.00|99|0.00|ASPG VI|
20|FH_F110245_46016_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F91622_0_0|CSTM-ALL|CSTM-00|2020|PDM|2450.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132190_0_0|SrvcGrp|101110|2022|PDM|2500.00|99|0.00|ARTHROSCOPY|
20|FH_F123481_90049_0|SrvcGrp|73841|2022|PDM|700.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F110925_01104_0|SrvcGrp|37386|2022|PDM|2.42|99|0.00|AMINO ACIDS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.33|99|0.00|HAPA WPA-NWPA 2012-13 ASC 708 W/O REV|
20|FH_F126585_45039_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F137614_17602_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F38982_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.00|99|0.00|ACUTE PSYCH|
20|FH_F78285_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F151408_0_0|CSTM-ALL|CSTM-00|2020|PDM|36.00|99|0.00|AEG 3 (NO REV)|
20|FH_F37404_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SURGERY|
20|FH_F67101_0_0|SrvcGrp|11441|2022|PCT|0.75|99|0.00|PHARMACY SVCS|
20|FH_F148320_02130_0|SrvcGrp|115386|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F129792_80309_0|CSTM-ALL|CSTM-00|2020|PDM|724.00|99|0.00|AETNA MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F109281_0_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 643|
20|FH_F137707_32724_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F123963_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F120939_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135207_76053_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115103_31405_0|SrvcGrp|42785|2022|PDM|129.80|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|336.08|99|0.00|AETNA SLEEP STUDIES|
20|FH_F93920_0_0|SrvcGrp|89239|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F37593_0_0|CSTM-ALL|CSTM-00|2020|PDM|507.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47341_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F130061_84097_0|SrvcGrp|89337|2022|PDM|1000.00|99|0.00|DETOXIFICATION|
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|661.00|99|0.00|AEG 10 (NO REV)|
20|FH_F90798_0_0|SrvcGrp|473|2022|PDM|310.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F70104_0_0|SrvcGrp|46424|2022|PDM|12.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F37884_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD AU|
20|FH_F100962_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F51733_0_0|SrvcGrp|45950|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F141427_22003_0|SrvcGrp|88620|2022|PDM|84.00|99|0.00|SKILLED NURSING RN|
20|FH_F140507_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.50|99|0.00|OP SVCS|
20|FH_F129115_85716_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F129391_17777_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141169_0_0|SrvcGrp|91438|2022|PDM|156.00|99|0.00|ULTRASOUND (HCFA)|
20|FH_F121084_13114_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F116203_63901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|558.04|99|0.00|AEG 6 (NO REV)|
20|FH_F37884_0_0|SrvcGrp|13621|2022|PDM|640.00|99|0.00|SLEEP STUDIES|
20|FH_F120365_30043_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F86159_15139_0|SrvcGrp|75545|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F125485_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|GENERAL ACUTE CARE|
20|FH_F117147_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89778_0_0|SrvcGrp|15473|2022|PDM|1099.69|99|0.00|CPT CODE 42820|
20|FH_F89778_0_0|SrvcGrp|88598|2022|PDM|711.71|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F132544_0_0|SrvcGrp|64761|2022|PDM|8007.00|99|0.00|DISCECTOMY|
20|FH_F132544_0_0|SrvcGrp|97279|2022|PDM|7850.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY|
20|FH_F119507_92627_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F150001_33064_0|SrvcGrp|29075|2022|PDM|26.00|99|0.00|HYDRATION THERAPY|
20|FH_F137638_0_0|SrvcGrp|86723|2022|PDM|484.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F119559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F41785_0_0|SrvcGrp|28919|2022|PDM|34.00|99|0.00|CPT 97750|
20|FH_F150500_85253_0|SrvcGrp|108484|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F133495_70301_0|SrvcGrp|82981|2022|PDM|175.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F148493_38008_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|GENERAL ACUTE CARE|
20|FH_F144008_11413_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F31096_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97140_91730_0|SrvcGrp|88977|2022|PDM|7901.00|99|0.00|C-SECTION DELIVERY|
20|FH_F117335_0_0|SrvcGrp|42550|2022|PDM|1485.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F100785_54660_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F46097_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 4 (NO REV)|
20|FH_F87155_04105_0|SrvcGrp|46104|2022|PDM|94.56|99|0.00|HOME VISIT - PRENATAL|
20|FH_F132785_17961_0|SrvcGrp|103913|2022|PCT|0.38|99|0.00|OP DIALYSIS|
20|FH_F127412_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|79022|2022|PDM|1200.94|99|0.00|MON VALLEY ASC 406|
20|FH_F90811_0_0|SrvcGrp|90431|2022|PDM|2500.00|99|0.00|HAND PROCEDURES|
20|FH_F43652_0_0|SrvcGrp|37503|2022|PDM|4958.13|99|0.00|OBSTETRICAL GLOBAL C SECTION|
20|FH_F101840_76054_0|SrvcGrp|21108|2022|PDM|21569.00|99|0.00|MS DRG 243 ONLY|
20|FH_F149781_37404_0|SrvcGrp|83641|2022|PDM|6561.00|99|0.00|CPT 29889|
20|FH_F73542_0_0|SrvcGrp|71002|2022|PDM|28.00|99|0.00|AMBULANCE - EXTRA ATTENDANT|
20|FH_F150001_33064_0|SrvcGrp|115787|2022|PCT|1.05|99|0.00|ALL DRUGS, AGENTS, INJ DRUG|
20|FH_F129175_0_0|SrvcGrp|100923|2022|PDM|292.50|99|0.00|DRUGS|
20|FH_F125215_78130_0|SrvcGrp|108935|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F126626_80906_0|SrvcGrp|73842|2022|PDM|271.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F110423_33401_0|SrvcGrp|89417|2022|PDM|327.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F125173_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F70804_0_0|SrvcGrp|10649|2022|PDM|11.07|99|0.00|HOME INFUSION|
20|FH_F70883_0_0|SrvcGrp|26253|2022|PDM|41.00|99|0.00|LIPIDS|
20|FH_F119706_63021_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|410.00|99|0.00|CD - ADULT|
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 10 (NO REV)|
20|FH_F134947_14227_0|SrvcGrp|473|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|1319.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F135610_06451_0|SrvcGrp|80920|2022|PDM|515.00|99|0.00|HOSPICE SERVICES|
20|FH_F42138_0_0|SrvcGrp|3810|2022|PDM|116.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F134492_85201_0|SrvcGrp|89417|2022|PDM|504.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F36749_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85416_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.06|99|0.00|GENERAL ACUTE CARE|
20|FH_F85211_0_0|SrvcGrp|73004|2022|PDM|1337.60|99|0.00|AEG 8|
20|FH_F85257_0_0|SrvcGrp|83545|2022|PCT|0.55|99|0.00|NUCLEAR MEDICINE|
20|FH_F98780_35022_0|SrvcGrp|73605|2022|PDM|2180.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F102142_80014_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F105361_80104_0|SrvcGrp|29817|2022|PDM|3750.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F115909_38133_0|SrvcGrp|73841|2022|PDM|436.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F75842_0_0|SrvcGrp|73864|2022|PDM|3583.58|99|0.00|MSDRG 767 W/ REV CODE|
20|FH_F146806_33157_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132150_66083_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133047_74012_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F134826_19067_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F121385_89102_0|CSTM-ALL|CSTM-00|2020|PCT|0.46|99|0.00|AEG 10 (NO REV)|
20|FH_F121960_75503_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F112844_0_0|SrvcGrp|93098|2022|PDM|115.00|99|0.00|HOSPICE CARE|
20|FH_F113926_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2501000 MOD 26 (HCFA)|
20|FH_F36017_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82933_0_0|SrvcGrp|68060|2022|PDM|774.20|99|0.00|NEWBORN BABY|
20|FH_F98040_89406_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F98041_10027_0|SrvcGrp|73603|2022|PDM|6748.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F110000_0_0|SrvcGrp|12047|2022|PCT|1.00|99|0.00|CPT CODES 80000-89999, 36415 (LAB)|
20|FH_F97660_29401_0|SrvcGrp|73559|2022|PDM|14931.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F97720_70084_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F97740_01605_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F97761_04072_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F77067_0_0|SrvcGrp|17548|2022|PCT|0.60|99|0.00|HIGH COST DRUGS|
20|FH_F113784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114864_78155_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F114916_30309_0|SrvcGrp|92363|2022|PDM|14000.00|99|0.00|OSTEOCHONDRAL ALLOGRAFT KNEE|
20|FH_F119435_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F33856_0_0|SrvcGrp|12118|2022|PCT|0.85|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F36584_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE NO MOD|
20|FH_F40783_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|832.00|99|0.00|AEG 5  (NO REV)|
20|FH_F138929_0_0|SrvcGrp|89980|2022|PDM|5005.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132627_0_0|SrvcGrp|47183|2022|PDM|133.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F132988_0_0|SrvcGrp|74039|2022|PDM|4493.01|99|0.00|LAMINECTOMY|
20|FH_F137067_0_0|SrvcGrp|33979|2022|PDM|21000.00|99|0.00|CPT 27440|
20|FH_F130274_63033_0|SrvcGrp|88621|2022|PDM|55.00|99|0.00|SKILLED NURSING LPN|
20|FH_F62252_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114345_27597_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F77944_0_0|SrvcGrp|57607|2022|PCT|2.00|99|0.00|LABORATORY/PATHOLOGY|
20|FH_F132348_16214_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146985_12205_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F101164_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F62767_0_0|SrvcGrp|105465|2022|PCT|1.00|99|0.00|AETNA THERAPIES|
20|FH_F62767_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
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|107784|2022|PDM|919.00|99|0.00|AETNA AEG 6 W/O EYE/OCULAR SURGERY|
20|FH_F91998_0_0|SrvcGrp|35669|2022|PDM|1224.00|99|0.00|CPT 63650|
20|FH_F132864_71101_0|SrvcGrp|19961|2022|PDM|38251.00|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA|
20|FH_F132864_71101_0|CSTM-ALL|CSTM-00|2020|PDM|1082.00|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F124212_33407_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F130929_60438_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130036_43232_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F129143_68739_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131101_45840_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F72416_0_0|SrvcGrp|45882|2022|PDM|80.00|99|0.00|PT|
20|FH_F113791_32055_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138456_33543_0|SrvcGrp|73842|2022|PDM|217.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|7000.00|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_F90223_0_0|SrvcGrp|88805|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; > 3 LITERS (HCFA)|
20|FH_F94643_90501_0|SrvcGrp|86850|2022|PDM|35.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F114173_18901_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|3017.00|99|0.00|AEG 9 (NO REV)|
20|FH_F113826_51445_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F76826_0_0|SrvcGrp|74444|2022|PDM|148.00|99|0.00|CARDIAC TESTING|
20|FH_F102069_19034_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F102069_19034_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F117762_0_0|SrvcGrp|99158|2022|PDM|1872.00|99|0.00|KNEE ARTHROSCOPY/DIAGNOSTIC|
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|2013.00|99|0.00|AEG 3 (NO REV)|
20|FH_F117615_30525_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F138655_63873_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F33632_52349_0|SrvcGrp|75506|2022|PCT|0.88|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149049_28401_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F151041_60647_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38753_0_0|SrvcGrp|17140|2022|PDM|134.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F49300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136376_0_0|SrvcGrp|86723|2022|PDM|447.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F147339_08837_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 4 (NO REV)|
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|449.00|99|0.00|AEG 2 (NO REV)|
20|FH_F134843_83638_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F147147_50265_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F102163_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F37339_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F117626_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F151043_71901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F90201_15650_0|SrvcGrp|75545|2022|PDM|340.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F45226_0_0|SrvcGrp|39996|2022|PDM|25.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146266_0_0|SrvcGrp|93807|2022|PDM|7772.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F139822_30338_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F143347_16001_0|SrvcGrp|73841|2022|PDM|486.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F143347_16001_0|SrvcGrp|105465|2022|PCT|2.00|99|0.00|AETNA THERAPIES|
20|FH_F143529_84737_0|SrvcGrp|95660|2022|PDM|474.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F103060_0_0|SrvcGrp|36591|2022|PDM|8323.00|99|0.00|CPT 63685|
20|FH_F151748_20037_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132496_17512_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120796_33548_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116683_64730_0|SrvcGrp|94738|2022|PCT|1.00|99|0.00|FLUZONE VACC IM (>=3 YRS)|
20|FH_F116913_77024_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120871_14068_0|SrvcGrp|89149|2022|PDM|250.00|99|0.00|OP INTENSIVE|
20|FH_F120856_78247_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F36420_0_0|SrvcGrp|38|2022|PDM|2700.00|99|0.00|NORMAL DELIVERY|
20|FH_F48915_0_0|SrvcGrp|44791|2022|PDM|60.00|99|0.00|PHYSICAL THERAPY|
20|FH_F51276_0_0|SrvcGrp|26869|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F40755_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MRI/CT GLOBAL CVTY|
20|FH_F45332_0_0|SrvcGrp|17139|2022|PDM|480.00|99|0.00|HOSPICE CARE|
20|FH_F129895_50263_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F50137_0_0|SrvcGrp|46241|2022|PDM|120.00|99|0.00|HOME VISIT MECHANICAL VENTILATION CARE|
20|FH_F118057_47906_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F109180_18015_0|SrvcGrp|91390|2022|PDM|214.00|99|0.00|AETNA PSYCH DIAG EVAL W/MED (MOD AF)|
20|FH_F85295_0_0|SrvcGrp|82138|2022|PDM|950.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F99720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143833_63703_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F64519_0_0|SrvcGrp|87536|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F137943_0_0|SrvcGrp|86036|2022|PDM|3000.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F130061_84097_0|SrvcGrp|87131|2022|PDM|611.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F77822_0_0|SrvcGrp|473|2022|PDM|468.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F149888_68506_0|SrvcGrp|115829|2022|PDM|2416.00|99|0.00|SURGERY|
20|FH_F140913_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114916_30309_0|SrvcGrp|82109|2022|PDM|1000.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F123466_93420_0|SrvcGrp|86722|2022|PDM|355.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F90362_0_0|SrvcGrp|89950|2022|PDM|1273.00|99|0.00|PACEMAKER UPGRADE REMOVE REPLACE LEAD|
20|FH_F145815_30540_0|SrvcGrp|114364|2022|PCT|1.00|99|0.00|BAMLANIVIMAB INFUSION|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME,MOD_AU|
20|FH_F143973_28040_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F39479_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F129324_24701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123407_04605_0|SrvcGrp|104085|2022|PDM|435.00|99|0.00|RESIDENTIAL ADULT CD(>= 18 YRS)|
20|FH_F143784_16801_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F100761_02539_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F140247_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|HSS ASC INVOICE|
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.49|99|0.00|ASPG IV|
20|FH_F38865_0_0|SrvcGrp|29763|2022|PCT|0.75|99|0.00|CHEMO DRUGS|
20|FH_F133490_90650_0|CSTM-ALL|CSTM-00|2020|PDM|2335.00|99|0.00|AEG 3 (NO REV)|
20|FH_F38352_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F111456_33884_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128316_22192_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F148662_01583_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|HOME HEALTH MOD TD|
20|FH_F97543_33542_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F120390_91316_0|SrvcGrp|89337|2022|PDM|900.00|99|0.00|DETOXIFICATION|
20|FH_F133271_72204_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130656_04401_0|SrvcGrp|111929|2022|PCT|1.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F67288_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F33010_0_0|CSTM-ALL|CSTM-00|2020|PCT|56.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117559_08619_0|SrvcGrp|113298|2022|PDM|40.00|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - PFIZER|
20|FH_F50618_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F41396_0_0|SrvcGrp|34266|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F146282_08244_0|SrvcGrp|109798|2022|PCT|1.50|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F141860_60610_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
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_F78167_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F129535_0_0|SrvcGrp|79583|2022|PDM|550.00|99|0.00|CPT 45381|
20|FH_F119226_07746_0|SrvcGrp|74668|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F44813_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F149781_37404_0|CSTM-ALL|CSTM-00|2020|PDM|1623.00|99|0.00|AEG 2 (NO REV)|
20|FH_F89112_16509_0|SrvcGrp|64105|2022|PDM|1732.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 4|
20|FH_F90811_0_0|SrvcGrp|90437|2022|PDM|2700.00|99|0.00|ANKLE SURGICAL PROCEDURES|
20|FH_F99720_0_0|SrvcGrp|41327|2022|PDM|1434.00|99|0.00|OP SURGERY CPT 28308|
20|FH_F126858_43113_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|548.32|99|0.00|ASPG 204|
20|FH_F63301_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128312_45230_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F120268_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|OP SVCS|
20|FH_F126849_67337_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F79902_0_0|SrvcGrp|14244|2022|PDM|1434.00|99|0.00|EMERGENCY ROOM SVCS LEVEL VI|
20|FH_F118534_07652_0|SrvcGrp|109330|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|ASPG III|
20|FH_F146211_68144_0|SrvcGrp|53065|2022|PDM|979.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F132420_84660_0|SrvcGrp|89337|2022|PDM|871.58|99|0.00|DETOXIFICATION|
20|FH_F88818_0_0|SrvcGrp|75483|2022|PDM|470.00|99|0.00|AEG 3|
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|AEG 6 (NO REV)|
20|FH_F35408_0_0|SrvcGrp|16898|2022|PDM|252.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F123872_75006_0|SrvcGrp|471|2022|PDM|800.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F147800_0_0|SrvcGrp|96799|2022|PDM|885.00|99|0.00|DESTROY C/TH FACET JNT ADDL|
20|FH_F117340_68144_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F88277_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.20|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_F89851_83854_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|AEG 4 (NO REV)|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|113.00|99|0.00|PSYTX W PT 45 MINS|
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|6041.00|99|0.00|AEG 8 (NO REV)|
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 10 (NO REV)|
20|FH_F80855_0_0|SrvcGrp|33986|2022|PDM|1100.00|99|0.00|CPT 26055|
20|FH_F133018_84037_0|SrvcGrp|14947|2022|PDM|3.00|99|0.00|HOME INFUSION|
20|FH_F36993_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD NU|
20|FH_F133155_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F133028_08021_0|SrvcGrp|89417|2022|PDM|407.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F101840_76054_0|SrvcGrp|28078|2022|PDM|22619.00|99|0.00|MS DRG 029 ONLY|
20|FH_F150523_20877_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F126666_44053_0|SrvcGrp|86722|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F145988_06105_0|SrvcGrp|111936|2022|PCT|1.47|99|0.00|COVID-19 SPECIMEN COLLECTING FROM SNF OR LAB|
20|FH_F116825_0_0|SrvcGrp|44264|2022|PDM|1325.00|99|0.00|ACUTE MEDICAL SERVICES|
20|FH_F116440_0_0|SrvcGrp|73485|2022|PDM|880.00|99|0.00|AETNA REHAB|
20|FH_F143027_16504_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134533_67801_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F127163_74437_0|SrvcGrp|89417|2022|PDM|400.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F126849_67337_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71929_15090_0|SrvcGrp|10431|2022|PDM|47.00|99|0.00|SPEECH THERAPY|
20|FH_F123373_0_0|SrvcGrp|77348|2022|PDM|6557.00|99|0.00|CARDIAC CATH|
20|FH_F148644_06890_0|SrvcGrp|46884|2022|PDM|3131.00|99|0.00|REPAIR EYELID DEFECT|
20|FH_F151085_15905_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151122_10462_0|SrvcGrp|29347|2022|PDM|26.00|99|0.00|HOME HEALTH AIDE|
20|FH_F151154_91761_0|SrvcGrp|48398|2022|PDM|140.00|99|0.00|PT SERVICES|
20|FH_F121930_60714_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114931_0_0|SrvcGrp|105757|2022|PDM|1850.00|99|0.00|INCISION OF RECTAL ABSCESS|
20|FH_F129130_92562_0|SrvcGrp|75506|2022|PCT|4.23|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F116809_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS|
20|FH_F32066_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F40144_0_0|CSTM-ALL|CSTM-00|2020|PDM|919.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69651_0_0|SrvcGrp|10540|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F113305_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|1304.60|99|0.00|AEG 6 (NO REV)|
20|FH_F105362_44601_0|SrvcGrp|89412|2022|PDM|400.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F105623_77901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1625.00|99|0.00|EXTENDED RECOVERY/OBSERVATION (16-23 HRS)(HCFA)|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER RRKF|
20|FH_F41112_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110211_78666_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|16526.00|99|0.00|AEG 9 (NO REV)|
20|FH_F132867_83318_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124225_92506_0|SrvcGrp|75442|2022|PDM|760.00|99|0.00|OBSERVATION - REV 762|
20|FH_F53418_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F67172_0_0|SrvcGrp|361|2022|PDM|2093.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|3679.00|99|0.00|ASPG VI|
20|FH_F143577_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130039_80228_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F136647_43506_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114666_30342_0|SrvcGrp|105658|2022|PDM|3000.00|99|0.00|REPAIR FRACTURE OF RADIUS|
20|FH_F138981_85123_0|SrvcGrp|106048|2022|PDM|923.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F122664_07005_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS APC GROUPED|
20|FH_F122879_39564_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F122689_92009_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F43172_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134687_14226_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134697_32566_0|SrvcGrp|89149|2022|PDM|217.00|99|0.00|OP INTENSIVE|
20|FH_F134733_19460_0|SrvcGrp|104800|2022|PDM|300.00|99|0.00|ELECTROENCEPHALOGRAM|
20|FH_F134770_14420_0|SrvcGrp|473|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F135762_70001_0|SrvcGrp|89337|2022|PDM|1825.00|99|0.00|DETOXIFICATION|
20|FH_F136828_32405_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136914_64081_0|SrvcGrp|2067|2022|PDM|609.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F136930_73114_0|SrvcGrp|109152|2022|PCT|0.50|99|0.00|CARD CATH & INTRACARDIAC PROC - SPEC CODING|
20|FH_F136930_73114_0|SrvcGrp|73008|2022|PDM|5393.00|99|0.00|AEG 10|
20|FH_F112189_81212_0|SrvcGrp|75545|2022|PDM|309.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F141170_0_0|SrvcGrp|92364|2022|PDM|13000.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F65979_0_0|SrvcGrp|61557|2022|PDM|1815.00|99|0.00|MUSCULOSKELETAL SURGERY|
20|FH_F115145_83201_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115631_65201_0|SrvcGrp|88596|2022|PDM|3177.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE|
20|FH_F147319_32763_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F131318_53211_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111584_07002_0|SrvcGrp|90662|2022|PDM|121.00|99|0.00|EVALUATION AND MANAGEMENT CPT 99214|
20|FH_F111602_17102_0|SrvcGrp|93919|2022|PDM|520.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F126104_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F137906_0_0|SrvcGrp|104230|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F133579_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120639_73078_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F138684_44484_0|SrvcGrp|89417|2022|PDM|375.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|266.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 232 W/O REV|
20|FH_F151402_70508_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132258_45404_0|SrvcGrp|86843|2022|PDM|50.88|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F144989_07701_0|SrvcGrp|29346|2022|PDM|55.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F97501_31501_0|SrvcGrp|73659|2022|PDM|8274.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F135432_16335_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F135575_50597_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136042_90066_0|SrvcGrp|73605|2022|PDM|1200.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F136147_63901_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136180_92253_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F130756_04901_0|SrvcGrp|111929|2022|PCT|1.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F116455_26003_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116461_77536_0|SrvcGrp|93919|2022|PDM|431.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F116463_76501_0|SrvcGrp|104078|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F101200_19020_0|SrvcGrp|86747|2022|PCT|1.05|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F101581_16371_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F101665_10027_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F121707_85745_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121771_91405_0|SrvcGrp|73605|2022|PDM|970.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F121813_75701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F42347_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F111303_19087_0|SrvcGrp|86722|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F111363_33169_0|SrvcGrp|104283|2022|PDM|6719.00|99|0.00|GASTRIC SLEEVE WITH HERNIA REPAIR|
20|FH_F126939_32405_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F37756_0_0|SrvcGrp|3934|2022|PDM|303.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS|
20|FH_F143528_0_0|SrvcGrp|93724|2022|PDM|1575.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F42822_0_0|SrvcGrp|196|2022|PDM|567.00|99|0.00|CD (ADOLESCENT) - DETOX|
20|FH_F65444_0_0|SrvcGrp|44326|2022|PDM|75.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO|
20|FH_F93593_33414_0|SrvcGrp|86723|2022|PDM|339.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F148262_17901_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_F90818_0_0|SrvcGrp|54943|2022|PDM|6500.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F121149_76021_0|SrvcGrp|75545|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F111826_0_0|SrvcGrp|73002|2022|PDM|1430.00|99|0.00|AEG 7|
20|FH_F135897_0_0|SrvcGrp|85563|2022|PDM|979.00|99|0.00|INCISION OF EYE|
20|FH_F149523_0_0|SrvcGrp|114174|2022|PDM|6600.00|99|0.00|REMOVE/REINSER SPINE FIXATION DEVICE|
20|FH_F148254_89503_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|NURSING CARE MOD TE|
20|FH_F130523_04605_0|SrvcGrp|94040|2022|PCT|0.84|99|0.00|OBSERVATION SERVICES FOR ER SERVICES|
20|FH_F145689_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F116061_80110_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|1110.00|99|0.00|ASPG IV|
20|FH_F130985_0_0|SrvcGrp|13188|2022|PCT|0.30|99|0.00|DRUGS|
20|FH_F143790_83440_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 7 (NO REV)|
20|FH_F151400_0_0|SrvcGrp|80139|2022|PDM|6900.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F132559_0_0|SrvcGrp|78093|2022|PDM|2800.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F148255_72703_0|SrvcGrp|29023|2022|PDM|31.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F151146_0_0|CSTM-ALL|CSTM-00|2020|PDM|1404.00|99|0.00|AEG 10 (NO REV)|
20|FH_F122433_0_0|SrvcGrp|73000|2022|PDM|826.00|99|0.00|AEG 6|
20|FH_F118194_50841_0|SrvcGrp|86841|2022|PDM|148.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F141354_63556_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145545_01602_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F118742_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F90157_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F114975_78596_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F97000_24201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123943_84041_0|SrvcGrp|94780|2022|PDM|90.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F123945_19111_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE|
20|FH_F86872_15215_0|SrvcGrp|86848|2022|PDM|45.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F86872_15215_0|SrvcGrp|86837|2022|PDM|225.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F62980_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.90|99|0.00|OP SVCS|
20|FH_F135840_0_0|SrvcGrp|79588|2022|PDM|550.00|99|0.00|CPT 43235|
20|FH_F130656_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 2 (NO REV)|
20|FH_F40575_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F149084_33401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132728_0_0|SrvcGrp|361|2022|PDM|3088.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F39378_0_0|SrvcGrp|28847|2022|PDM|120.00|99|0.00|PHYSICAL THERAPY|
20|FH_F150165_06032_0|CSTM-ALL|CSTM-00|2020|PDM|2781.00|99|0.00|AEG 7 (NO REV)|
20|FH_F135610_06451_0|SrvcGrp|46605|2022|PDM|89.12|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F144248_0_0|SrvcGrp|109348|2022|PDM|2869.00|99|0.00|EXCISION OF LESION OF EYELID|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|171.37|99|0.00|HAPA WPA-NWPA 2012-13 ASC 137 W/O REV|
20|FH_F133753_84015_0|SrvcGrp|86659|2022|PDM|71.00|99|0.00|PHYSICAL THERAPY|
20|FH_F114407_19002_0|SrvcGrp|29347|2022|PDM|18.90|99|0.00|HOME HEALTH AIDE|
20|FH_F121628_19533_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F93122_01854_0|SrvcGrp|78377|2022|PDM|748.00|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F126341_27284_0|SrvcGrp|86128|2022|PDM|0.83|99|0.00|AETNA FACTOR VIII PER IU|
20|FH_F145604_14850_0|SrvcGrp|86840|2022|PDM|75.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F145562_70458_0|SrvcGrp|86837|2022|PDM|10.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F126647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124161_95932_0|SrvcGrp|36231|2022|PDM|2066.00|99|0.00|SUB ACUTE|
20|FH_F117531_0_0|SrvcGrp|105357|2022|PDM|525.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F150166_91401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125244_0_0|SrvcGrp|101520|2022|PDM|5500.00|99|0.00|T1H W/T/O (<250G)|
20|FH_F116806_0_0|SrvcGrp|107048|2022|PDM|1923.16|99|0.00|EXCISION OF BONE-FACIAL|
20|FH_F149246_95603_0|SrvcGrp|74668|2022|PDM|330.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F112023_12866_0|SrvcGrp|72996|2022|PDM|4260.00|99|0.00|AEG 4|
20|FH_F89219_0_0|SrvcGrp|21359|2022|PDM|59744.00|99|0.00|MS DRG 460 ONLY|
20|FH_F133972_27103_0|SrvcGrp|26869|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F147962_85008_0|SrvcGrp|39823|2022|PDM|1200.00|99|0.00|ER SERVICES LEVEL 3|
20|FH_F43197_0_0|SrvcGrp|11069|2022|PDM|80.00|99|0.00|OT SVCS|
20|FH_F120425_11106_0|SrvcGrp|89412|2022|PDM|295.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F143771_0_0|SrvcGrp|29155|2022|PDM|133.00|99|0.00|HOSPICE SVCS|
20|FH_F143620_81504_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F130364_01331_0|SrvcGrp|89417|2022|PDM|400.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F134647_35244_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F130017_02302_0|SrvcGrp|88819|2022|PDM|804.74|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F110302_15931_0|SrvcGrp|88779|2022|PDM|11.26|99|0.00|PHYSICAL THERAPY|
20|FH_F127090_45601_0|SrvcGrp|34566|2022|PDM|69.36|99|0.00|HOME INFUSION THERAPY|
20|FH_F124372_0_0|SrvcGrp|108042|2022|PDM|437.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F136276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134727_30650_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|AEG 2 (NO REV)|
20|FH_F135718_33172_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136796_24016_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F136813_06518_0|SrvcGrp|75545|2022|PDM|420.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F136823_63048_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F112187_98272_0|SrvcGrp|113188|2022|PCT|0.81|99|0.00|LABORATORY SERVICES|
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 7 (NO REV)|
20|FH_F115145_83201_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F115631_65201_0|SrvcGrp|83642|2022|PDM|3177.00|99|0.00|CPT 29883|
20|FH_F116233_33612_0|SrvcGrp|73842|2022|PDM|125.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147305_90755_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147586_44124_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F42176_0_0|SrvcGrp|12146|2022|PDM|1700.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139573_0_0|SrvcGrp|57967|2022|PDM|169.47|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F120688_68124_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F112947_47303_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F138992_72703_0|SrvcGrp|112834|2022|PCT|1.64|99|0.00|RADIOLOGY SERVICES|
20|FH_F57953_0_0|SrvcGrp|31188|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC (DME)|
20|FH_F73204_0_0|SrvcGrp|26001|2022|PDM|148.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F83792_0_0|SrvcGrp|73461|2022|PDM|1575.00|99|0.00|AETNA NICU IV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|498.56|99|0.00|HAPA WPA-NWPA 2012-13 ASC 206 W/O REV|
20|FH_F151439_18104_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151503_30067_0|CSTM-ALL|CSTM-00|2020|PDM|2218.00|99|0.00|AEG 9 (NO REV)|
20|FH_F151514_35242_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135440_32561_0|SrvcGrp|89412|2022|PDM|325.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F91735_92653_0|SrvcGrp|91678|2022|PDM|110.25|99|0.00|AETNA SKILLED NURSE IN HOME HEALTH SETTING (HCFA)|
20|FH_F91764_93710_0|SrvcGrp|114253|2022|PCT|2.19|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F135924_02906_0|SrvcGrp|75507|2022|PCT|1.03|99|0.00|CHEMOTHERAPY|
20|FH_F135978_06851_0|SrvcGrp|90574|2022|PDM|280.00|99|0.00|INTENSIVE OP CD (<=18 YRS) (HCFA)|
20|FH_F135979_66451_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F116397_33404_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116404_20191_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F127399_0_0|SrvcGrp|98003|2022|PDM|2913.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121407_73701_0|SrvcGrp|3066|2022|PCT|0.39|99|0.00|HIGH-COST DRUGS|
20|FH_F121407_73701_0|SrvcGrp|16|2022|PDM|1631.00|99|0.00|ACUTE REHABILITATION|
20|FH_F121444_47720_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F121823_46234_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F121824_92675_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F130817_18103_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)|
20|FH_F128353_22191_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F101182_07863_0|SrvcGrp|87902|2022|PCT|1.00|99|0.00|CEFTRIAXON SOD PER 250MG/8MX|
20|FH_F134312_76301_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F69202_0_0|SrvcGrp|31038|2022|PDM|29600.00|99|0.00|MS DRG 233-234 ONLY|
20|FH_F69202_0_0|SrvcGrp|115740|2022|PDM|3500.00|99|0.00|ASPG AMBULATORY SURGERY UNGROUPABLE|
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|ASPG X|
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132328_0_0|SrvcGrp|104170|2022|PDM|2049.00|99|0.00|AETNA ARTHROSCOPY SURGERY|
20|FH_F132328_0_0|SrvcGrp|82110|2022|PDM|2049.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC|
20|FH_F112138_80120_0|SrvcGrp|73485|2022|PDM|1297.00|99|0.00|AETNA REHAB|
20|FH_F102282_06795_0|SrvcGrp|80317|2022|PDM|158.60|99|0.00|RESPITE CARE|
20|FH_F97221_29406_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129220_18445_0|SrvcGrp|98041|2022|PDM|11.05|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F102960_50613_0|CSTM-ALL|CSTM-00|2020|PDM|5152.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132834_63640_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143542_0_0|SrvcGrp|109764|2022|PDM|4590.00|99|0.00|REPAIR EYELID DEFECT|
20|FH_F123733_70714_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132810_0_0|SrvcGrp|86850|2022|PDM|35.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F40702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F61512_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F84134_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F136367_72210_0|SrvcGrp|89417|2022|PDM|408.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F136377_75240_0|SrvcGrp|86723|2022|PDM|420.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F118154_17042_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118201_35126_0|SrvcGrp|92501|2022|PDM|137.86|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F120424_03060_0|SrvcGrp|86648|2022|PCT|1.05|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F134160_19006_0|SrvcGrp|106300|2022|PDM|247.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F114264_51449_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE|
20|FH_F65239_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F97601_67218_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F97602_40121_0|SrvcGrp|73559|2022|PDM|12092.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F74763_63010_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129793_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F77782_66061_0|SrvcGrp|73656|2022|PDM|843.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F139565_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F71685_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F85353_16407_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F70804_0_0|SrvcGrp|26001|2022|PDM|191.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F81698_10457_0|SrvcGrp|86842|2022|PDM|26.50|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F145604_14850_0|SrvcGrp|73700|2022|PDM|48.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F145641_06902_0|SrvcGrp|89946|2022|PDM|5767.00|99|0.00|REPAIR OF KNEE LIGAMENT|
20|FH_F111882_51560_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148600_30328_0|SrvcGrp|106267|2022|PDM|3520.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL|
20|FH_F127725_63017_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118123_67226_0|SrvcGrp|22592|2022|PDM|22.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F136359_0_0|SrvcGrp|100002|2022|PDM|6025.00|99|0.00|REPAIR SHOULDER CAPSULE|
20|FH_F134614_84651_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|249.78|99|0.00|HAPA WPA-NWPA 2012-13 ASC 230 W/O REV|
20|FH_F127199_0_0|SrvcGrp|80918|2022|PDM|114.00|99|0.00|RESPITE CARE|
20|FH_F35966_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90574_22560_0|SrvcGrp|76501|2022|PDM|278.25|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F42438_0_0|SrvcGrp|23585|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F145942_72019_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F150165_06032_0|SrvcGrp|109791|2022|PDM|6047.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F149660_0_0|SrvcGrp|84284|2022|PDM|249.00|99|0.00|AMBULANCE SVC NEONATAL EMERG TRANSPORT|
20|FH_F130763_0_0|SrvcGrp|33984|2022|PDM|3450.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F51138_0_0|SrvcGrp|12403|2022|PDM|39.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F88744_71103_0|SrvcGrp|9866|2022|PDM|2067.00|99|0.00|IP OBSERVATION SVCS|
20|FH_F150599_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|1.00|99|0.00|ANESTHESIOLOGIST/CRNA (HAN2)(HSUR) SAME DOS|
20|FH_F133941_70360_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F132969_84003_0|SrvcGrp|22593|2022|PDM|25.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F146640_54155_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F43861_0_0|SrvcGrp|37406|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F112060_07514_0|SrvcGrp|96399|2022|PCT|1.00|99|0.00|FOUNDAPARINUX SODIUM|
20|FH_F126191_43616_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114409_18447_0|SrvcGrp|29347|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F119554_16506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F128379_0_0|SrvcGrp|67064|2022|PDM|2861.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F63114_0_0|SrvcGrp|48394|2022|PDM|7.50|99|0.00|SKILLED NURSING SERVICES|
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_F150165_06032_0|SrvcGrp|89888|2022|PDM|2652.00|99|0.00|AETNA SUSPENSION OF TESTIS|
20|FH_F130337_62948_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138951_41101_0|SrvcGrp|16750|2022|PDM|70.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|49.61|99|0.00|HAPA WPA-NWPA 2012-13 ASC 147 W/O REV|
20|FH_F96700_02135_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F54592_0_0|SrvcGrp|10580|2022|PDM|55.00|99|0.00|HYDRATION THERAPY - 3 LITERS|
20|FH_F54592_0_0|SrvcGrp|17016|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F122425_75082_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39832_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|36.75|99|0.00|HAPA WPA-NWPA 2012-13 ASC 10 W/O REV|
20|FH_F101100_50314_0|SrvcGrp|97896|2022|PDM|14545.00|99|0.00|TREAT KNEE|
20|FH_F105145_75075_0|SrvcGrp|33724|2022|PDM|16875.00|99|0.00|ARTHROSCOPY|
20|FH_F131711_25550_0|SrvcGrp|110428|2022|PCT|1.50|99|0.00|LABORATORY SERVICES|
20|FH_F133707_73072_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150060_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F132307_06010_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133170_50501_0|SrvcGrp|89417|2022|PDM|260.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F130657_04614_0|SrvcGrp|105465|2022|PCT|0.86|99|0.00|AETNA THERAPIES|
20|FH_F111836_12901_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F134826_19067_0|SrvcGrp|73842|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121404_32216_0|SrvcGrp|108780|2022|PDM|17.28|99|0.00|HUMIDIFIER HEATED USED W PAP (MOD KH, KI, KJ, KX, RR) (HCFA)|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|353.72|99|0.00|DELAWARE VALLEY- ASC 102|
20|FH_F113741_63303_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F72090_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110000_0_0|SrvcGrp|10903|2022|PDM|269.00|99|0.00|EMERGENCY ROOM LEVEL I|
20|FH_F110381_0_0|SrvcGrp|72996|2022|PDM|1272.00|99|0.00|AEG 4|
20|FH_F110381_0_0|SrvcGrp|72992|2022|PDM|901.00|99|0.00|AEG 2|
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_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|2944.00|99|0.00|AEG 9 (NO REV)|
20|FH_F115264_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1498.00|99|0.00|AEG 7 (NO REV)|
20|FH_F114916_30309_0|SrvcGrp|88164|2022|PDM|6500.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|5027.00|99|0.00|AEG 8 (NO REV)|
20|FH_F105581_19053_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115808_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33856_0_0|SrvcGrp|72|2022|PDM|210.00|99|0.00|NEWBORN NURSERY|
20|FH_F94786_07974_0|SrvcGrp|86845|2022|PDM|36.75|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F94786_07974_0|SrvcGrp|86835|2022|PDM|15.75|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F139456_47501_0|SrvcGrp|82137|2022|PCT|0.80|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F140747_34461_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F140890_30906_0|SrvcGrp|89149|2022|PDM|221.00|99|0.00|OP INTENSIVE|
20|FH_F149441_28401_0|SrvcGrp|89337|2022|PDM|1046.00|99|0.00|DETOXIFICATION|
20|FH_F149663_45219_0|SrvcGrp|89942|2022|PDM|11129.00|99|0.00|PERCUTANEOUS INTRADISCAL|
20|FH_F117232_83221_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F147725_06002_0|SrvcGrp|41327|2022|PDM|3850.00|99|0.00|OP SURGERY CPT 28308|
20|FH_F147925_06457_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147726_18017_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|AEG 3 (NO REV)|
20|FH_F129448_43235_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F137901_60089_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F37878_0_0|SrvcGrp|10543|2022|PDM|80.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F38948_0_0|CSTM-ALL|CSTM-00|2020|PDM|1398.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F129892_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)|
20|FH_F80084_0_0|SrvcGrp|76094|2022|PDM|135.76|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F40600_0_0|SrvcGrp|701|2022|PDM|2061.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F98624_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.28|99|0.00|OP SVCS|
20|FH_F102947_44084_0|SrvcGrp|43523|2022|PDM|168.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F140007_0_0|SrvcGrp|97119|2022|PDM|8045.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F40431_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|BRAIN INJURY REHAB|
20|FH_F76286_16038_0|CSTM-ALL|CSTM-00|2020|PDM|340.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76286_16038_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F138197_0_0|SrvcGrp|113271|2022|PDM|830.00|99|0.00|GENICULAR NERVE BLOCK|
20|FH_F95221_0_0|SrvcGrp|73000|2022|PDM|919.00|99|0.00|AEG 6|
20|FH_F132212_0_0|SrvcGrp|95661|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F119315_70663_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148379_89129_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148419_01453_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F132269_34202_0|CSTM-ALL|CSTM-00|2020|PCT|0.61|99|0.00|OP SVCS|
20|FH_F32509_0_0|SrvcGrp|14065|2022|PDM|11486.00|99|0.00|PTCA W/O STENT|
20|FH_F142038_45152_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F113315_72205_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F133257_72088_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132613_84601_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149605_0_0|SrvcGrp|113451|2022|PDM|87.23|99|0.00|HOSPICE CARE|
20|FH_F132080_0_0|SrvcGrp|97506|2022|PDM|169.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F133477_90247_0|CSTM-ALL|CSTM-00|2020|PDM|6439.00|99|0.00|AEG 9 (NO REV)|
20|FH_F40851_0_0|SrvcGrp|186|2022|PDM|3306.00|99|0.00|INTENSIVE & INTERMEDIATE UNIT CARE|
20|FH_F146244_76028_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F97061_85012_0|SrvcGrp|88977|2022|PDM|7225.00|99|0.00|C-SECTION DELIVERY|
20|FH_F128279_77043_0|SrvcGrp|73842|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120605_0_0|SrvcGrp|73004|2022|PDM|1565.00|99|0.00|AEG 8|
20|FH_F72065_0_0|SrvcGrp|17139|2022|PDM|841.00|99|0.00|HOSPICE CARE|
20|FH_F132992_04662_0|SrvcGrp|23683|2022|PDM|42.00|99|0.00|SKILLED NURSING RN|
20|FH_F40943_0_0|SrvcGrp|12496|2022|PDM|753.00|99|0.00|ACUTE REHABILITATION|
20|FH_F130606_41144_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91155_16105_0|SrvcGrp|16|2022|PDM|1003.00|99|0.00|ACUTE REHABILITATION|
20|FH_F100741_0_0|SrvcGrp|72996|2022|PDM|973.00|99|0.00|AEG 4|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER RRBA|
20|FH_F129535_0_0|SrvcGrp|71219|2022|PDM|550.00|99|0.00|COLONOSCOPY CPT 45382|
20|FH_F40895_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MOD 50 ASC- GH|
20|FH_F148040_90631_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138611_0_0|SrvcGrp|80617|2022|PDM|14894.00|99|0.00|ARTHOPLASTY|
20|FH_F124854_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F106700_02906_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F44701_0_0|SrvcGrp|38906|2022|PDM|900.00|99|0.00|CPT 15821 - BLEPHAROPLASTY, LOWER EYELID|
20|FH_F38663_0_0|SrvcGrp|15402|2022|PDM|40.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F148900_0_0|SrvcGrp|92409|2022|PDM|2133.00|99|0.00|PERQ CERVICOTHORACIC INJECT|
20|FH_F46196_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F144037_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F142759_15074_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133155_0_0|SrvcGrp|83522|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F132934_63005_0|SrvcGrp|16319|2022|PDM|5514.00|99|0.00|TRAUMA CARE|
20|FH_F144448_04901_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F94300_0_0|SrvcGrp|89404|2022|PDM|4200.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F100880_67735_0|SrvcGrp|106257|2022|PCT|2.40|99|0.00|LABORATORY SERVICES|
20|FH_F131982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F49637_0_0|CSTM-ALL|CSTM-00|2020|PDM|3696.00|99|0.00|OK SURGICAL HOSPITAL CVTY  ENHANCED GROUPER 7|
20|FH_F126676_43537_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F45752_0_0|SrvcGrp|23936|2022|PCT|1.10|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F107120_22560_0|SrvcGrp|101562|2022|PCT|1.00|99|0.00|HOSPICE/PHYSICIAN|
20|FH_F67424_0_0|SrvcGrp|474|2022|PDM|200.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F40176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133293_49085_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51564_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120817_53051_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132988_0_0|SrvcGrp|112166|2022|PDM|6253.92|99|0.00|RECONSTRUCT WRIST-TRAPEZIUM|
20|FH_F132988_0_0|SrvcGrp|92819|2022|PDM|4493.01|99|0.00|HIP ARTHOSCOPY|
20|FH_F126345_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F137897_0_0|SrvcGrp|107770|2022|PCT|1.00|99|0.00|INJECTABLES (S CODES)|
20|FH_F49487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|S CODES|
20|FH_F124180_0_0|SrvcGrp|93741|2022|PDM|5929.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY|
20|FH_F81731_0_0|SrvcGrp|11258|2022|PCT|1.00|99|0.00|DRUGS|
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91998_0_0|SrvcGrp|73002|2022|PDM|1074.00|99|0.00|AEG 7|
20|FH_F132864_71101_0|CSTM-ALL|CSTM-00|2020|PDM|2442.00|99|0.00|AEG 6 (NO REV)|
20|FH_F124258_53140_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124671_64844_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F101702_0_0|CSTM-ALL|CSTM-00|2020|PDM|3116.00|99|0.00|ONCOTYPE DX COLON|
20|FH_F143577_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122933_0_0|SrvcGrp|106906|2022|PDM|700.00|99|0.00|AETNA SURGERY DEFAULT W/O GROUPER 1 & 2|
20|FH_F136681_60004_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F113809_47302_0|SrvcGrp|89149|2022|PDM|155.00|99|0.00|OP INTENSIVE|
20|FH_F138280_75215_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F122608_84123_0|SrvcGrp|88621|2022|PDM|73.00|99|0.00|SKILLED NURSING LPN|
20|FH_F122689_92009_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|THER CGM SUPPLY ALLOWANCE|
20|FH_F43000_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F43169_0_0|SrvcGrp|22954|2022|PDM|132.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F136778_62034_0|SrvcGrp|107733|2022|PDM|6610.00|99|0.00|CESAREAN SECTION|
20|FH_F136831_78728_0|SrvcGrp|89149|2022|PDM|195.00|99|0.00|OP INTENSIVE|
20|FH_F136927_45690_0|SrvcGrp|88620|2022|PDM|82.00|99|0.00|SKILLED NURSING RN|
20|FH_F136930_73114_0|SrvcGrp|12491|2022|PCT|0.50|99|0.00|PACEMAKER|
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 10 (NO REV)|
20|FH_F39622_0_0|SrvcGrp|38|2022|PDM|2100.00|99|0.00|NORMAL DELIVERY|
20|FH_F115152_77058_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116199_75042_0|SrvcGrp|86722|2022|PDM|172.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F147439_84003_0|SrvcGrp|472|2022|PDM|377.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F147586_44124_0|SrvcGrp|92405|2022|PDM|2000.00|99|0.00|PERQ LUMBOSACRAL INJECTION|
20|FH_F147586_44124_0|SrvcGrp|33987|2022|PDM|1597.00|99|0.00|CPT 57522|
20|FH_F147619_72034_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147701_31093_0|CSTM-ALL|CSTM-00|2020|PDM|7359.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F147404_37863_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147700_21401_0|CSTM-ALL|CSTM-00|2020|PDM|712.00|99|0.00|AEG 3 (NO REV)|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|IVIG THERAPY (MOD SH)|
20|FH_F42522_0_0|SrvcGrp|14187|2022|PDM|937.00|99|0.00|MRI|
20|FH_F113025_0_0|SrvcGrp|75481|2022|PDM|468.00|99|0.00|AEG 2|
20|FH_F116443_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F113178_44035_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 1 (NO REV)|
20|FH_F39988_0_0|CSTM-ALL|CSTM-00|2020|PDM|1330.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138807_32207_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117715_0_0|SrvcGrp|75481|2022|PDM|652.00|99|0.00|AEG 2|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.49|99|0.00|HAPA WPA-NWPA 2012-13 ASC 106 W/O REV|
20|FH_F72606_0_0|SrvcGrp|3259|2022|PDM|4300.00|99|0.00|ACUTE REHABILITATION|
20|FH_F130671_42701_0|SrvcGrp|73842|2022|PDM|187.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F97143_80012_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F40568_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F91764_93710_0|SrvcGrp|112676|2022|PCT|2.19|99|0.00|COVID-19 SARS-COV-2 ANTIBODY|
20|FH_F136040_75080_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F131228_01826_0|SrvcGrp|22378|2022|PDM|99.99|99|0.00|CPT CODE 93000|
20|FH_F116397_33404_0|SrvcGrp|22589|2022|PDM|43.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F116431_76104_0|SrvcGrp|82369|2022|PCT|1.00|99|0.00|AETNA LABORATORY|
20|FH_F116461_77536_0|SrvcGrp|86722|2022|PDM|192.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F116527_70443_0|SrvcGrp|72994|2022|PDM|1100.00|99|0.00|AEG 3|
20|FH_F133468_74873_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F130766_04967_0|SrvcGrp|111275|2022|PDM|100.00|99|0.00|ASSAY, IGA/IGD/IGG/IGM EACH|
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 7 (NO REV)|
20|FH_F127399_0_0|SrvcGrp|26275|2022|PDM|3121.00|99|0.00|CPT 29826|
20|FH_F121407_73701_0|SrvcGrp|941|2022|PDM|2717.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F121763_07202_0|SrvcGrp|89267|2022|PDM|60.00|99|0.00|PSYTX PT/FAMILY 30 MINUTES|
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|1534.00|99|0.00|AEG 7 (NO REV)|
20|FH_F33791_0_0|SrvcGrp|111925|2022|PDM|1200.00|99|0.00|VAGINAL DELIVERY INCLUDES NEWBORN|
20|FH_F131650_50211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129967_18915_0|SrvcGrp|46903|2022|PDM|785.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F101182_07863_0|SrvcGrp|96403|2022|PCT|1.00|99|0.00|CIPROFLOXACIN IV|
20|FH_F111292_33136_0|SrvcGrp|111184|2022|PDM|7236.00|99|0.00|GASTRIC SLEEVE WITH HERNIA REPAIR|
20|FH_F111301_33122_0|SrvcGrp|73463|2022|PDM|2141.00|99|0.00|AETNA NICU II|
20|FH_F111363_33169_0|SrvcGrp|82755|2022|PDM|47.00|99|0.00|ASSAY BLOOD MAGNESIUM|
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 4 (NO REV)|
20|FH_F75806_0_0|SrvcGrp|10543|2022|PDM|249.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141035_0_0|SrvcGrp|92014|2022|PDM|7008.00|99|0.00|PHALANGEAL SHAFT FRACTURE|
20|FH_F98626_29118_0|SrvcGrp|73601|2022|PDM|7720.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F129240_10028_0|SrvcGrp|86846|2022|PDM|35.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F38700_0_0|SrvcGrp|18283|2022|PCT|0.80|99|0.00|MS DRG 461|
20|FH_F142043_45503_0|SrvcGrp|108484|2022|PDM|649.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F127422_0_0|SrvcGrp|72996|2022|PDM|630.00|99|0.00|AEG 4|
20|FH_F49776_0_0|SrvcGrp|42828|2022|PDM|102.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F139825_0_0|SrvcGrp|109763|2022|PDM|2869.00|99|0.00|TREAT EYELID LESION|
20|FH_F126733_83713_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F38352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141833_31707_0|SrvcGrp|13595|2022|PDM|750.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F49776_0_0|SrvcGrp|42825|2022|PDM|42.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F40994_0_0|SrvcGrp|97|2022|PDM|2600.00|99|0.00|C-SECTION|
20|FH_F132594_78229_0|SrvcGrp|23683|2022|PDM|90.00|99|0.00|SKILLED NURSING RN|
20|FH_F113586_0_0|SrvcGrp|75481|2022|PDM|984.00|99|0.00|AEG 2|
20|FH_F36993_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD AW|
20|FH_F112632_66207_0|SrvcGrp|17100|2022|PDM|925.00|99|0.00|SKILLED NURSING|
20|FH_F117945_78957_0|SrvcGrp|58509|2022|PDM|300.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F88956_0_0|SrvcGrp|85083|2022|PCT|0.50|99|0.00|CHEMO DRUGS|
20|FH_F123069_75070_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|2555.50|99|0.00|ASPG IX|
20|FH_F40154_0_0|SrvcGrp|72|2022|PDM|614.00|99|0.00|NEWBORN NURSERY|
20|FH_F32910_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95360_08720_0|SrvcGrp|94045|2022|PCT|1.00|99|0.00|VINCRISTINE SULFATE 1MG/2 MX|
20|FH_F117559_08619_0|SrvcGrp|107748|2022|PDM|599.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F106740_02886_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|ASPG X - IOWA|
20|FH_F149840_80002_0|SrvcGrp|73524|2022|PDM|135.00|99|0.00|PHYSICAL THERAPY|
20|FH_F142927_52402_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37468_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F133391_61032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36993_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118196_0_0|SrvcGrp|82138|2022|PDM|504.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F111522_81067_0|SrvcGrp|91294|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F42355_0_0|SrvcGrp|110|2022|PDM|350.00|99|0.00|CD - REHABILITATION|
20|FH_F71723_16502_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F127191_44720_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F150065_16001_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150526_16335_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147800_0_0|SrvcGrp|115150|2022|PDM|55.00|99|0.00|SINGLE TENDON INJECTIONS|
20|FH_F119437_0_0|SrvcGrp|67068|2022|PDM|4750.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F124928_04210_0|SrvcGrp|27968|2022|PDM|52.50|99|0.00|SKILLED NURSING LPN|
20|FH_F101751_25302_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F89851_83854_0|CSTM-ALL|CSTM-00|2020|PDM|1522.00|99|0.00|AEG 2 (NO REV)|
20|FH_F103360_68845_0|SrvcGrp|79786|2022|PCT|7.50|99|0.00|SLEEP STUDIES|
20|FH_F124928_04210_0|SrvcGrp|47411|2022|PDM|144.58|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F87173_15136_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149999_33150_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F126560_43606_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F88512_0_0|SrvcGrp|73864|2022|PDM|4148.45|99|0.00|MSDRG 767 W/ REV CODE|
20|FH_F128929_33030_0|SrvcGrp|89149|2022|PDM|202.00|99|0.00|OP INTENSIVE|
20|FH_F72823_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F68622_0_0|SrvcGrp|3259|2022|PDM|981.00|99|0.00|ACUTE REHABILITATION|
20|FH_F47834_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|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_F67639_0_0|SrvcGrp|63461|2022|PDM|1025.00|99|0.00|CPT 52235|
20|FH_F139268_36695_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F139553_30084_0|SrvcGrp|75545|2022|PDM|400.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F139584_10281_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147342_08012_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149662_85015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F128506_77304_0|SrvcGrp|83235|2022|PCT|2.25|99|0.00|AMBULATORY SURGERY|
20|FH_F149049_28401_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F138987_0_0|SrvcGrp|80918|2022|PDM|137.00|99|0.00|RESPITE CARE|
20|FH_F150919_17603_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43081_0_0|SrvcGrp|1306|2022|PDM|186.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|674.00|99|0.00|AEG 2 (NO REV)|
20|FH_F147342_08012_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133519_0_0|SrvcGrp|103837|2022|PDM|833.00|99|0.00|AETNA DESTRUCTION PENIS LESION|
20|FH_F138018_17313_0|SrvcGrp|17016|2022|PDM|103.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F125656_92868_0|SrvcGrp|86852|2022|PDM|35.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F35732_32308_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146204_0_0|SrvcGrp|75282|2022|PDM|1500.00|99|0.00|DIAGNOSTIC HYSTEROSCOPY|
20|FH_F120100_98390_0|SrvcGrp|75442|2022|PDM|1350.00|99|0.00|OBSERVATION - REV 762|
20|FH_F134891_45885_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1841.00|99|0.00|ASPG VII|
20|FH_F75606_0_0|CSTM-ALL|CSTM-00|2020|PDM|2460.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97603_77901_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F140295_0_0|SrvcGrp|100000|2022|PDM|18566.00|99|0.00|RECONSTRUCT WRIST DIST ULNA|
20|FH_F117762_0_0|SrvcGrp|99170|2022|PDM|1950.00|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F40205_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|706.00|99|0.00|AEG 2 (NO REV)|
20|FH_F138350_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
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_F148665_65270_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PDM|5041.00|99|0.00|AEG 7 (NO REV)|
20|FH_F100906_0_0|SrvcGrp|34606|2022|PDM|3000.00|99|0.00|CPT 29827|
20|FH_F100906_0_0|SrvcGrp|72994|2022|PDM|793.00|99|0.00|AEG 3|
20|FH_F110604_0_0|SrvcGrp|90797|2022|PDM|19800.00|99|0.00|INSERT SPINAL INFUSION DEV16|
20|FH_F148345_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F86851_0_0|SrvcGrp|79579|2022|PDM|651.00|99|0.00|CPT 43251|
20|FH_F87411_0_0|SrvcGrp|85685|2022|PDM|65.80|99|0.00|SLEEP STUDY (MOD 26)|
20|FH_F40191_0_0|SrvcGrp|3087|2022|PDM|633.00|99|0.00|CD - DETOX|
20|FH_F40191_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F43417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F123735_32708_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA OP LABORATORY|
20|FH_F123752_44502_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F118152_20151_0|SrvcGrp|24744|2022|PDM|60.00|99|0.00|PICC LINE INSERTION|
20|FH_F118193_06241_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118232_24970_0|SrvcGrp|90101|2022|PDM|1.42|99|0.00|AETNA MED RECORD COPY|
20|FH_F134008_11221_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F134126_11554_0|SrvcGrp|42784|2022|PDM|143.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F53732_0_0|SrvcGrp|21711|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|487.00|99|0.00|AEG 1 (NO REV)|
20|FH_F83831_0_0|SrvcGrp|9828|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE|
20|FH_F140615_73013_0|SrvcGrp|113637|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F140753_75038_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F140765_30315_0|SrvcGrp|113236|2022|PDM|41.38|99|0.00|COVID-19 SARS-COV-2 W/ OPTIC|
20|FH_F80205_33161_0|SrvcGrp|471|2022|PDM|472.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F137530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149524_28806_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149663_45219_0|CSTM-ALL|CSTM-00|2020|PDM|1343.00|99|0.00|AEG 4 (NO REV)|
20|FH_F149639_96822_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118789_92211_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F38332_0_0|SrvcGrp|19120|2022|PDM|15759.00|99|0.00|MS DRG 621|
20|FH_F109982_33592_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F49039_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING|
20|FH_F80366_0_0|SrvcGrp|73643|2022|PDM|884.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F117377_71303_0|SrvcGrp|92501|2022|PDM|130.96|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F147799_18052_0|SrvcGrp|29346|2022|PDM|54.79|99|0.00|SKILLED NURSING- LPN|
20|FH_F147929_03820_0|SrvcGrp|74668|2022|PDM|194.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129514_79605_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|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_F109652_0_0|SrvcGrp|20272|2022|PDM|57279.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VLV PROC W/O CA CAT|
20|FH_F107926_0_0|SrvcGrp|104719|2022|PDM|1875.00|99|0.00|RELIEVE INNER EYE PRESSURE|
20|FH_F110900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90880_15108_0|SrvcGrp|90484|2022|PCT|1.00|99|0.00|NOS FLU VACC 3 YRS & > IM|
20|FH_F91472_96001_0|SrvcGrp|76565|2022|PCT|0.00|99|0.00|AETNA LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|596.00|99|0.00|AEG 2 (NO REV)|
20|FH_F143450_0_0|SrvcGrp|114023|2022|PDM|727.00|99|0.00|ESOPH ENDOSCOPY W/US EXAM|
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F109513_0_0|SrvcGrp|95559|2022|PDM|10000.00|99|0.00|HIP JOINT|
20|FH_F119245_19010_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119417_78212_0|SrvcGrp|90339|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F138283_0_0|SrvcGrp|29346|2022|PDM|25.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F148425_01507_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F125050_33765_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126815_02118_0|CSTM-ALL|CSTM-00|2020|PDM|1234.19|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PDM|902.53|99|0.00|ASPG I|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F149344_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128787_60302_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F147988_78759_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72859_0_0|SrvcGrp|15510|2022|PDM|10.07|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.96|99|0.00|HAPA WPA-NWPA 2012-13 ASC 4 W/O REV|
20|FH_F109242_18466_0|SrvcGrp|98041|2022|PDM|8.16|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F128000_30121_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125465_43078_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
20|FH_F115289_90057_0|SrvcGrp|89149|2022|PDM|300.00|99|0.00|OP INTENSIVE|
20|FH_F35740_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|ALBERMARLE GASTRO COLON MOD SU|
20|FH_F117945_78957_0|SrvcGrp|89417|2022|PDM|350.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|1137.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F118496_92627_0|SrvcGrp|86747|2022|PCT|1.20|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|375.00|99|0.00|AEG 1 (NO REV)|
20|FH_F36743_0_0|SrvcGrp|23958|2022|PCT|0.65|99|0.00|PHARMACY|
20|FH_F33632_52349_0|SrvcGrp|103383|2022|PDM|439.21|99|0.00|BEHAVIORAL HEALTH OBSERVATION|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "GLOBAL"|
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|30500.00|99|0.00|MS DRG 237|
20|FH_F150982_0_0|SrvcGrp|63463|2022|PDM|1652.00|99|0.00|CPT 52204|
20|FH_F100540_0_0|SrvcGrp|72994|2022|PDM|1104.75|99|0.00|AEG 3|
20|FH_F40899_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36343_0_0|SrvcGrp|13570|2022|PDM|100.00|99|0.00|HIGH TECH/SPECIALTY NURSING/MC PEDS (OB, PEDS, ET, MOM/BABY)|
20|FH_F97084_91911_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F94502_0_0|SrvcGrp|59290|2022|PDM|200.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F128366_32901_0|SrvcGrp|73841|2022|PDM|371.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128191_28642_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F147532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135613_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139353_67124_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F36594_0_0|SrvcGrp|3810|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F147333_18704_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132105_61554_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35557_0_0|SrvcGrp|16298|2022|PDM|100.00|99|0.00|HOME ADMNSTRTN DRUG THERAPY - AEROSOLIZED|
20|FH_F113957_73554_0|SrvcGrp|104577|2022|PCT|1.00|99|0.00|ALL DRUGS|
20|FH_F131356_19131_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116437_0_0|SrvcGrp|87385|2022|PDM|1757.00|99|0.00|PARTIAL REMOVAL OF EYE FLUID|
20|FH_F36222_0_0|SrvcGrp|72|2022|PDM|232.00|99|0.00|NEWBORN NURSERY|
20|FH_F141156_04401_0|CSTM-ALL|CSTM-00|2020|PDM|644.00|99|0.00|AEG 3 (NO REV)|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F137798_0_0|SrvcGrp|104226|2022|PDM|128.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F56472_0_0|SrvcGrp|46424|2022|PDM|85.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F94303_0_0|SrvcGrp|72990|2022|PDM|1008.00|99|0.00|AEG 1|
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F36883_0_0|SrvcGrp|79699|2022|PCT|0.52|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F138018_17313_0|SrvcGrp|17005|2022|PDM|103.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS|
20|FH_F143348_16214_0|SrvcGrp|104363|2022|PCT|0.89|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F143488_84770_0|SrvcGrp|90369|2022|PDM|991.00|99|0.00|PROBE NASOLACRIMAL DUCT|
20|FH_F143533_30013_0|SrvcGrp|114079|2022|PDM|142.00|99|0.00|MAMMOGRAPHY|
20|FH_F143536_47546_0|SrvcGrp|100244|2022|PCT|0.00|99|0.00|CHYLMD TRACH|
20|FH_F72749_0_0|SrvcGrp|26596|2022|PDM|574.00|99|0.00|PARTIAL HOSP PSYCH/CD (HALF DAY)|
20|FH_F102522_0_0|SrvcGrp|98689|2022|PDM|401.70|99|0.00|AFO POS SOLID ANK PLASTIC MO|
20|FH_F102522_0_0|SrvcGrp|98690|2022|PDM|504.70|99|0.00|AFO PLASTIC MOLDED W/ ANKLE|
20|FH_F131093_49690_0|SrvcGrp|97702|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F151754_71943_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132418_84042_0|SrvcGrp|89337|2022|PDM|871.58|99|0.00|DETOXIFICATION|
20|FH_F116698_07470_0|SrvcGrp|73701|2022|PDM|31.50|99|0.00|AETNA - SKILLED NURSING|
20|FH_F126970_45601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F127033_54501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118950_33312_0|SrvcGrp|89149|2022|PDM|450.00|99|0.00|OP INTENSIVE|
20|FH_F118792_63379_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118792_63379_0|SrvcGrp|11306|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F46158_0_0|SrvcGrp|17075|2022|PCT|0.65|99|0.00|ASPG VI|
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F51276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F51276_0_0|SrvcGrp|13929|2022|PDM|19.00|99|0.00|GROWTH HORMONE|
20|FH_F147211_0_0|SrvcGrp|35058|2022|PDM|750.00|99|0.00|MRI - IP|
20|FH_F36533_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F100742_00616_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F61292_0_0|SrvcGrp|57204|2022|PDM|23802.00|99|0.00|CYBER KNIFE RADIOSURGERY|
20|FH_F61292_0_0|SrvcGrp|17324|2022|PDM|4071.00|99|0.00|ARTHROSCOPIC KNEE REPAIR|
20|FH_F139241_0_0|SrvcGrp|65625|2022|PDM|1530.00|99|0.00|CPT 30520|
20|FH_F132779_0_0|SrvcGrp|87309|2022|PDM|18067.00|99|0.00|MSDRG 272 ONLY|
20|FH_F77544_0_0|SrvcGrp|22954|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F150982_0_0|SrvcGrp|111187|2022|PDM|3178.00|99|0.00|REMOVAL OF OVARIAN CYST(S)|
20|FH_F39786_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|OP SVCS|
20|FH_F151543_95630_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125935_44024_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127415_45822_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F125118_99201_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F93881_15009_0|SrvcGrp|44132|2022|PDM|1058.00|99|0.00|OP SURGERY CPT 64490-64495|
20|FH_F133207_0_0|SrvcGrp|99073|2022|PDM|1.41|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F123302_33407_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F139241_0_0|SrvcGrp|77580|2022|PDM|1420.00|99|0.00|CPT 28296 - 28299|
20|FH_F39920_0_0|SrvcGrp|24703|2022|PDM|450.00|99|0.00|NEWBORN NURSERY|
20|FH_F129231_30060_0|SrvcGrp|108385|2022|PDM|681.00|99|0.00|AQUEOUS SHUNT|
20|FH_F94461_63090_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72704_0_0|SrvcGrp|33164|2022|PDM|305.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F125890_43054_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF|
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_F68363_0_0|SrvcGrp|3406|2022|PDM|190.00|99|0.00|CPT 99214|
20|FH_F98921_64503_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F132737_0_0|SrvcGrp|3409|2022|PDM|570.00|99|0.00|NEWBORN NURSERY|
20|FH_F39723_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (HCFA)|
20|FH_F109812_37043_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F92677_08003_0|SrvcGrp|29077|2022|PDM|210.00|99|0.00|HOME TRANSFUSION|
20|FH_F86293_0_0|SrvcGrp|13990|2022|PCT|0.33|99|0.00|PACEMAKER|
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F102681_34237_0|SrvcGrp|72998|2022|PDM|613.00|99|0.00|AEG 5|
20|FH_F38410_0_0|SrvcGrp|22387|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F133029_61264_0|SrvcGrp|86723|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F142947_76043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|78927|2022|PDM|4173.12|99|0.00|MON VALLEY ASC 902|
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|870.00|99|0.00|ASPG X|
20|FH_F95980_20016_0|SrvcGrp|86748|2022|PCT|1.05|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F95641_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F102561_75146_0|SrvcGrp|3066|2022|PCT|2.00|99|0.00|HIGH-COST DRUGS|
20|FH_F92677_08003_0|SrvcGrp|41460|2022|PDM|36.75|99|0.00|ENTERAL THERAPY - UNSPECIFIED|
20|FH_F148662_01583_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F38663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BURMANS APOTHECARY DME MOD RR|
20|FH_F141927_71901_0|CSTM-ALL|CSTM-00|2020|PDM|894.00|99|0.00|AEG 4 (NO REV)|
20|FH_F117559_08619_0|SrvcGrp|68641|2022|PDM|648.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F132503_73086_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F140472_0_0|SrvcGrp|15789|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F146218_50009_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F141870_85224_0|SrvcGrp|19742|2022|PDM|60.00|99|0.00|MID-LINE INSERTION|
20|FH_F81373_64064_0|SrvcGrp|16|2022|PDM|2183.00|99|0.00|ACUTE REHABILITATION|
20|FH_F136751_0_0|SrvcGrp|26278|2022|PDM|4600.00|99|0.00|CPT 29881|
20|FH_F37035_0_0|SrvcGrp|33825|2022|PDM|645.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 3|
20|FH_F144088_48706_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148009_71322_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F109812_37043_0|SrvcGrp|86648|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F80855_0_0|SrvcGrp|78096|2022|PDM|2200.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F78682_0_0|SrvcGrp|75660|2022|PDM|4200.00|99|0.00|FUSIONS|
20|FH_F47433_0_0|SrvcGrp|9520|2022|PDM|3700.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F41392_0_0|SrvcGrp|64758|2022|PCT|0.80|99|0.00|HCPCS|
20|FH_F101922_98055_0|SrvcGrp|72998|2022|PDM|4000.00|99|0.00|AEG 5|
20|FH_F112905_62088_0|SrvcGrp|75505|2022|PCT|0.81|99|0.00|CARDIAC STUDIES|
20|FH_F43140_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F100741_0_0|SrvcGrp|63469|2022|PDM|904.00|99|0.00|CPT 55700|
20|FH_F37553_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|SOUTH CARE MRI|
20|FH_F102721_38118_0|SrvcGrp|79786|2022|PCT|0.25|99|0.00|SLEEP STUDIES|
20|FH_F126935_33615_0|SrvcGrp|74668|2022|PDM|203.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F90811_0_0|SrvcGrp|10986|2022|PDM|2500.00|99|0.00|ARTHROSCOPIC KNEE REPAIR|
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|ASPG II|
20|FH_F34161_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|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_F39844_0_0|SrvcGrp|361|2022|PDM|1273.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F37640_0_0|CSTM-ALL|CSTM-00|2020|PDM|1520.00|99|0.00|ASPG X|
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F98921_64503_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F57592_0_0|SrvcGrp|53582|2022|PCT|0.68|99|0.00|AMBULATORY SURGICAL PROCEDURES|
20|FH_F102721_38118_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F133470_97068_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133015_36305_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|298.42|99|0.00|ASPG 218|
20|FH_F117733_91362_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F133458_18929_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F91080_67212_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F109642_80501_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F100661_63640_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118539_44256_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F145937_75240_0|SrvcGrp|48396|2022|PDM|105.00|99|0.00|OT SERVICES|
20|FH_F118672_29036_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150902_21713_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40980_0_0|SrvcGrp|18247|2022|PDM|11601.00|99|0.00|MS DRG 286|
20|FH_F117550_0_0|SrvcGrp|73485|2022|PDM|1100.00|99|0.00|AETNA REHAB|
20|FH_F126975_43551_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F88512_0_0|SrvcGrp|17077|2022|PDM|4148.43|99|0.00|ASPG VII|
20|FH_F132900_06074_0|SrvcGrp|112085|2022|PDM|291.00|99|0.00|INTENSIVE OUTPATIENT EATING DISORDERS (>=18 YRS)|
20|FH_F148863_33021_0|SrvcGrp|108484|2022|PDM|1088.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F148880_26807_0|SrvcGrp|94882|2022|PDM|13.70|99|0.00|FLU VIRUS VACC-SPLIT 3 YRS & ABOVE|
20|FH_F151081_85225_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F139707_84010_0|SrvcGrp|109199|2022|PDM|1603.00|99|0.00|GI ENDOSCOPY/COLONOSCOPY|
20|FH_F150765_05001_0|SrvcGrp|53987|2022|PDM|87.00|99|0.00|PHOTOTHERAPY|
20|FH_F122330_75771_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F147941_06023_0|SrvcGrp|13683|2022|PDM|1225.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F62915_0_0|SrvcGrp|42831|2022|PDM|115.00|99|0.00|DIETICIAN VISIT|
20|FH_F102522_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.14|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F37679_0_0|SrvcGrp|27072|2022|PDM|4.25|99|0.00|HOME INFUSION - DOUBLE / TRIPLE LUMEN (MOD SH)|
20|FH_F82114_0_0|SrvcGrp|74664|2022|PDM|696.94|99|0.00|AETNA SLEEP STUDIES|
20|FH_F145803_19061_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120248_77008_0|SrvcGrp|89149|2022|PDM|190.00|99|0.00|OP INTENSIVE|
20|FH_F143968_94520_0|SrvcGrp|46903|2022|PDM|760.00|99|0.00|RESIDENTIAL TREATMENT|
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_F43167_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|CD ADULT REHAB|
20|FH_F89779_0_0|SrvcGrp|77021|2022|PDM|12500.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F121533_26241_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F133099_66801_0|SrvcGrp|36204|2022|PCT|0.00|99|0.00|ACUTE PSYCH|
20|FH_F126523_0_0|SrvcGrp|73002|2022|PDM|1350.00|99|0.00|AEG 7|
20|FH_F141471_0_0|SrvcGrp|107878|2022|PDM|2549.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F42706_0_0|SrvcGrp|9228|2022|PDM|100.00|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F97102_83501_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F150759_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|GENERAL ACUTE CARE|
20|FH_F37443_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|ACUTE PSYCH|
20|FH_F94367_15601_0|SrvcGrp|92760|2022|PCT|1.25|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148162_29412_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116731_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F82931_18847_0|SrvcGrp|72783|2022|PDM|121.03|99|0.00|ST SVCS - VISIT LEVEL|
20|FH_F131254_92211_0|SrvcGrp|22592|2022|PDM|35.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F93332_0_0|SrvcGrp|93060|2022|PDM|2096.00|99|0.00|SPINAL BONE AUTOGRAFT (HCFA)|
20|FH_F125899_07645_0|SrvcGrp|75506|2022|PCT|4.41|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F135260_18655_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F131254_92211_0|SrvcGrp|86841|2022|PDM|100.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F148264_30434_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 6 (NO REV)|
20|FH_F109180_18015_0|SrvcGrp|89269|2022|PDM|108.00|99|0.00|PSYTX PT/FAMILY 45 MINUTES|
20|FH_F94862_0_0|SrvcGrp|72994|2022|PDM|600.00|99|0.00|AEG 3|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1352.40|99|0.00|HAPA WPA-NWPA 2012-13 ASC 902 W/O REV|
20|FH_F129255_34952_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F123488_65559_0|SrvcGrp|471|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F72183_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|ASPG VIII - FH SW CUSTOM GROUPERS|
20|FH_F77762_0_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F115685_64064_0|SrvcGrp|86851|2022|PDM|55.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F124026_53188_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|ASPG I|
20|FH_F115010_20105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148221_06477_0|SrvcGrp|89783|2022|PDM|168.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F148666_34205_0|SrvcGrp|58509|2022|PDM|330.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F48927_0_0|SrvcGrp|12674|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F151560_76012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F107800_34609_0|SrvcGrp|73842|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F72047_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130204_40807_0|SrvcGrp|73841|2022|PDM|381.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F39917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F99960_0_0|SrvcGrp|72992|2022|PDM|675.00|99|0.00|AEG 2|
20|FH_F128272_60640_0|SrvcGrp|86853|2022|PDM|40.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F145545_01602_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F83352_06114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1352.72|99|0.00|HAPA WPA-NWPA 2012-13 ASC 901 W/O REV|
20|FH_F82955_34266_0|SrvcGrp|78720|2022|PDM|1210.00|99|0.00|AETNA PET SCAN|
20|FH_F92276_32308_0|SrvcGrp|113903|2022|PCT|2.98|99|0.00|RADIOLOGY SERVICES|
20|FH_F130032_72034_0|SrvcGrp|89417|2022|PDM|477.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F61332_0_0|SrvcGrp|13268|2022|PCT|0.65|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|1625.00|99|0.00|AEG 8 (NO REV)|
20|FH_F145800_22003_0|SrvcGrp|88620|2022|PDM|84.00|99|0.00|SKILLED NURSING RN|
20|FH_F141587_40242_0|CSTM-ALL|CSTM-00|2020|PDM|596.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F135268_11231_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F137943_0_0|SrvcGrp|23936|2022|PDM|1401.74|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F122705_33351_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F60275_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F62579_0_0|SrvcGrp|10579|2022|PDM|50.00|99|0.00|HYDRATION THERAPY - 2 LITERS|
20|FH_F63249_0_0|SrvcGrp|42976|2022|PDM|95.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F125020_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|OP SVCS|
20|FH_F139472_06902_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|1716.00|99|0.00|AEG 7 (NO REV)|
20|FH_F135316_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139446_87106_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F42577_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F70883_0_0|SrvcGrp|12403|2022|PDM|976.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F110302_15931_0|SrvcGrp|48396|2022|PDM|95.67|99|0.00|OT SERVICES|
20|FH_F35527_0_0|SrvcGrp|16495|2022|PDM|850.00|99|0.00|POLYSOMNOGRAPHY|
20|FH_F128821_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.75|99|0.00|ASPG IV|
20|FH_F128543_44413_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F109251_62269_0|SrvcGrp|48385|2022|PDM|91.56|99|0.00|SPEECH THERAPY|
20|FH_F128392_01026_0|SrvcGrp|89337|2022|PDM|1400.00|99|0.00|DETOXIFICATION|
20|FH_F127396_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.50|99|0.00|NON-ANESTHESIOLOGIST/CRNA (HAN3)|
20|FH_F133223_0_0|SrvcGrp|112223|2022|PDM|95.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.25|99|0.00|ASPG II|
20|FH_F38584_0_0|SrvcGrp|17071|2022|PDM|1012.00|99|0.00|ASPG IV|
20|FH_F35734_32405_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|GENERAL ACUTE CARE|
20|FH_F71468_0_0|SrvcGrp|42404|2022|PDM|29.00|99|0.00|VENIPUNCTURE|
20|FH_F122276_83252_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149582_01534_0|SrvcGrp|115400|2022|PCT|1.00|99|0.00|COVID-19 VACCINE - REGENERON|
20|FH_F37198_0_0|SrvcGrp|11258|2022|PCT|0.40|99|0.00|DRUGS|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PDM|4661.48|99|0.00|MS DRG 767|
20|FH_F147082_02359_0|SrvcGrp|90854|2022|PDM|896.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F147200_61944_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F97223_94028_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149579_95815_0|SrvcGrp|115673|2022|PDM|82.36|99|0.00|COMPLEX CHRONIC CARE 1ST 60 MINS (HCFA)|
20|FH_F92299_62016_0|SrvcGrp|73501|2022|PCT|0.75|99|0.00|AETNA OBSERVATION|
20|FH_F90196_10467_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137767_01841_0|SrvcGrp|31916|2022|PDM|27955.00|99|0.00|MS DRG 473 ONLY|
20|FH_F97623_38008_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F124270_46256_0|SrvcGrp|73701|2022|PDM|25.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F75547_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|MS DRG UNGROUPABLE INPATIENT|
20|FH_F139177_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149023_44122_0|SrvcGrp|106680|2022|PDM|5842.00|99|0.00|REVISION OF ANKLE JOINT|
20|FH_F131495_77407_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F147215_48105_0|SrvcGrp|108622|2022|PDM|444.00|99|0.00|SUB ACUTE CARE LEVEL II|
20|FH_F139668_42701_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F36734_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F149240_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124316_28112_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132254_40207_0|SrvcGrp|24752|2022|PDM|25.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F141334_66401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F97880_63501_0|SrvcGrp|73603|2022|PDM|6853.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F146986_0_0|SrvcGrp|87077|2022|PDM|170.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F122649_0_0|SrvcGrp|95661|2022|PDM|112.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F37192_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|OP SVCS|
20|FH_F117802_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40904_0_0|SrvcGrp|30942|2022|PDM|425.00|99|0.00|SUB-ACUTE SKILLED NURSING CARE|
20|FH_F111044_0_0|SrvcGrp|88597|2022|PDM|1648.00|99|0.00|INTERNAL FIX FOR FRACT/INSTA|
20|FH_F148667_0_0|SrvcGrp|41334|2022|PDM|11000.00|99|0.00|TOTAL KNEE|
20|FH_F37267_0_0|SrvcGrp|12856|2022|PDM|42.25|99|0.00|NURSING CARE|
20|FH_F47902_0_0|SrvcGrp|43839|2022|PCT|1.00|99|0.00|DME MOD NUKF|
20|FH_F149648_89148_0|SrvcGrp|48385|2022|PDM|135.00|99|0.00|SPEECH THERAPY|
20|FH_F148859_0_0|SrvcGrp|89576|2022|PDM|373.00|99|0.00|APPLY INTERSTIT RADIAT COMPLEX|
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|623.00|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_F111857_68005_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147060_32025_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150982_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_F120767_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F35990_0_0|SrvcGrp|360|2022|PDM|1461.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F47659_0_0|SrvcGrp|11336|2022|PCT|0.75|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F140187_61061_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140036_07702_0|SrvcGrp|52953|2022|PDM|92.70|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|542.00|99|0.00|OP SVCS|
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 10 (NO REV)|
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102224_0_0|SrvcGrp|85084|2022|PDM|2300.00|99|0.00|MICROSURGERY ADD-ON CODE|
20|FH_F130951_15237_0|SrvcGrp|83857|2022|PDM|591.00|99|0.00|IP HOSPICE SVCS|
20|FH_F47952_0_0|SrvcGrp|10528|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F120216_68134_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120225_29644_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F120240_37013_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F132418_84042_0|SrvcGrp|108484|2022|PDM|1120.36|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F116739_78501_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F39028_0_0|SrvcGrp|473|2022|PDM|390.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F51276_0_0|SrvcGrp|17006|2022|PDM|61.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS|
20|FH_F51276_0_0|SrvcGrp|22387|2022|PDM|150.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F147211_0_0|SrvcGrp|109118|2022|PDM|1317.00|99|0.00|SUBACUTE REHAB LEVEL 5|
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1.00|99|0.00|AEG 8 (NO REV)|
20|FH_F36439_0_0|SrvcGrp|23010|2022|PDM|1300.00|99|0.00|V5251|
20|FH_F38431_0_0|SrvcGrp|23000|2022|PDM|1300.00|99|0.00|V5261|
20|FH_F122323_60450_0|CSTM-ALL|CSTM-00|2020|PCT|1.85|99|0.00|HSS ASC|
20|FH_F125081_15218_0|SrvcGrp|27969|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F150312_89103_0|SrvcGrp|108484|2022|PDM|725.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F109160_63129_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137767_01841_0|CSTM-ALL|CSTM-00|2020|PDM|3625.00|99|0.00|AEG 9 (NO REV)|
20|FH_F141228_23181_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F147209_60202_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150924_90029_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139147_0_0|SrvcGrp|79589|2022|PDM|1804.00|99|0.00|UPPER GI|
20|FH_F114206_37203_0|SrvcGrp|86839|2022|PDM|35.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F148667_0_0|SrvcGrp|83641|2022|PDM|4400.00|99|0.00|CPT 29889|
20|FH_F150913_70068_0|SrvcGrp|87077|2022|PDM|175.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F127467_44202_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F151158_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F140295_0_0|SrvcGrp|54943|2022|PDM|4164.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F134936_01020_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F35432_0_0|SrvcGrp|3029|2022|PDM|450.00|99|0.00|NEWBORN NURSERY|
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109843_0_0|SrvcGrp|103771|2022|PDM|2640.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY|
20|FH_F36594_0_0|SrvcGrp|12263|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F143668_0_0|SrvcGrp|114067|2022|PDM|28.00|99|0.00|SEGMENTAL PNEUMATIC (MOD RR)|
20|FH_F131028_49735_0|SrvcGrp|83522|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F36594_0_0|SrvcGrp|13703|2022|PDM|40.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F124691_78003_0|SrvcGrp|108484|2022|PDM|1200.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F128753_32501_0|SrvcGrp|73806|2022|PCT|0.64|99|0.00|AETNA ER|
20|FH_F34853_0_0|SrvcGrp|20659|2022|PDM|33126.00|99|0.00|MS DRG 235-236|
20|FH_F129289_54153_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
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_F120057_0_0|SrvcGrp|107792|2022|PDM|4370.06|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F138410_19130_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F97084_91911_0|SrvcGrp|73656|2022|PDM|1218.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F120157_93103_0|SrvcGrp|106248|2022|PDM|475.00|99|0.00|PARTIAL HOSP PSYCH|
20|FH_F114207_35243_0|SrvcGrp|10577|2022|PDM|35.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F120848_20912_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|AEG 3 (NO REV)|
20|FH_F137767_01841_0|SrvcGrp|85099|2022|PDM|360.00|99|0.00|PHYSICIANS SERVICES|
20|FH_F130661_04441_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F116583_0_0|SrvcGrp|106931|2022|PDM|150.00|99|0.00|HOSPICE IN SNF (HCFA)|
20|FH_F109221_15084_0|SrvcGrp|46605|2022|PDM|88.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F37341_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|ASPG III|
20|FH_F148347_0_0|SrvcGrp|82301|2022|PDM|2125.20|99|0.00|HEMORRHOIDECTOMY|
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|2437.00|99|0.00|AEG 10 (NO REV)|
20|FH_F127553_44321_0|SrvcGrp|95660|2022|PDM|550.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F98940_70506_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F148966_37865_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F94426_47403_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F126116_0_0|SrvcGrp|110349|2022|PDM|1125.00|99|0.00|REOPEN FALLOPIAN TUBE|
20|FH_F149030_37919_0|SrvcGrp|115569|2022|PDM|3300.00|99|0.00|LAPARO HERNIA REPAIR INITIAL|
20|FH_F149004_67025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F67924_0_0|SrvcGrp|42828|2022|PDM|125.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F140295_0_0|SrvcGrp|92821|2022|PDM|5974.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR|
20|FH_F47037_0_0|CSTM-ALL|CSTM-00|2020|PDM|10.00|99|0.00|TELEMANAGEMENT SERVICES|
20|FH_F124441_0_0|SrvcGrp|109833|2022|PDM|14250.00|99|0.00|REPLACE ELBOW JOINT|
20|FH_F36683_0_0|SrvcGrp|18145|2022|PDM|11149.00|99|0.00|MS DRG 248|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|3787.00|99|0.00|LAP INC HERN REPAIR COMP|
20|FH_F132849_0_0|SrvcGrp|701|2022|PDM|2233.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F113116_23847_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148891_44432_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128743_57252_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151042_60659_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F117576_21207_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F149083_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F130661_04441_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 9 (NO REV)|
20|FH_F128392_01026_0|SrvcGrp|87131|2022|PDM|450.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF|
20|FH_F132512_0_0|SrvcGrp|86722|2022|PDM|408.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F139928_37228_0|SrvcGrp|89417|2022|PDM|550.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F140167_16101_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93281_0_0|SrvcGrp|92676|2022|PCT|0.00|99|0.00|IMAGING ENHANCED SUBSTANCE|
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)|
20|FH_F151719_02138_0|SrvcGrp|113276|2022|PCT|1.10|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD AV|
20|FH_F120190_92624_0|SrvcGrp|74668|2022|PDM|450.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132467_33825_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132479_90290_0|SrvcGrp|73605|2022|PDM|1800.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F39567_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH|
20|FH_F129895_50263_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F38341_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F91622_0_0|SrvcGrp|16|2022|PDM|1444.00|99|0.00|ACUTE REHABILITATION|
20|FH_F110066_36608_0|SrvcGrp|87077|2022|PDM|145.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F93920_0_0|SrvcGrp|73000|2022|PDM|6400.00|99|0.00|AEG 6|
20|FH_F123945_19111_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124048_47304_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F93880_95476_0|SrvcGrp|72984|2022|PCT|1.10|99|0.00|CHEMOTHERAPY|
20|FH_F88391_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109180_18015_0|SrvcGrp|102979|2022|PDM|193.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AH)|
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_F63276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.00|99|0.00|AEG 1 (NO REV)|
20|FH_F139551_0_0|SrvcGrp|78096|2022|PDM|5500.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
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_F93920_0_0|SrvcGrp|86919|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F120876_85250_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F135236_02840_0|SrvcGrp|73500|2022|PDM|249.50|99|0.00|AETNA ER LEVEL I|
20|FH_F56136_0_0|SrvcGrp|22818|2022|PCT|0.92|99|0.00|ACL|
20|FH_F52854_0_0|SrvcGrp|17077|2022|PDM|2613.00|99|0.00|ASPG VII|
20|FH_F131560_62946_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140762_0_0|SrvcGrp|11663|2022|PCT|0.52|99|0.00|IMPLANTS|
20|FH_F129639_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129653_0_0|SrvcGrp|35669|2022|PDM|4000.00|99|0.00|CPT 63650|
20|FH_F143773_30350_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F130747_0_0|SrvcGrp|85778|2022|PDM|4682.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F116923_85259_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1728.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110925_01104_0|SrvcGrp|104202|2022|PCT|1.00|99|0.00|OP SERVICES AMFS(H) DEFAULT MERCY HH|
20|FH_F86752_0_0|SrvcGrp|75489|2022|PDM|1202.00|99|0.00|AEG 6|
20|FH_F148122_49435_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|2857.55|99|0.00|ASPG IX|
20|FH_F38034_0_0|SrvcGrp|97|2022|PDM|2264.00|99|0.00|C-SECTION|
20|FH_F110925_01104_0|SrvcGrp|58606|2022|PDM|47.28|99|0.00|GASTROSTOMY/JEJUNOSTOMY TUBE|
20|FH_F44582_0_0|SrvcGrp|3420|2022|PCT|0.70|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F44198_0_0|SrvcGrp|13683|2022|PDM|480.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F135299_61021_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 2 (NO REV)|
20|FH_F128136_48025_0|SrvcGrp|82222|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1265.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 906 W/O REV|
20|FH_F114963_62062_0|SrvcGrp|88620|2022|PDM|131.00|99|0.00|SKILLED NURSING RN|
20|FH_F37679_0_0|SrvcGrp|22592|2022|PDM|61.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F145758_20745_0|SrvcGrp|58636|2022|PDM|3570.00|99|0.00|CPT 62362|
20|FH_F137387_32605_0|SrvcGrp|91357|2022|PDM|67.00|99|0.00|ASA CODES & CPT4 CODE|
20|FH_F37679_0_0|SrvcGrp|27062|2022|PDM|30.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F93332_0_0|SrvcGrp|16289|2022|PDM|3090.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F100962_0_0|SrvcGrp|72990|2022|PDM|676.00|99|0.00|AEG 1|
20|FH_F137630_24266_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F73985_0_0|SrvcGrp|592|2022|PDM|1519.00|99|0.00|SUB-ACUTE CARE|
20|FH_F93332_0_0|SrvcGrp|93071|2022|PDM|2295.00|99|0.00|POSTERIOR SEGMENTAL INSTRU|
20|FH_F83451_0_0|SrvcGrp|81598|2022|PDM|1575.00|99|0.00|ARTHOSCOPY KNEE|
20|FH_F82931_18847_0|SrvcGrp|72782|2022|PDM|121.03|99|0.00|OT SVCS - VISIT LEVEL|
20|FH_F40605_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120910_63021_0|SrvcGrp|75419|2022|PDM|695.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F54052_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147212_0_0|SrvcGrp|80098|2022|PDM|41.00|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE|
20|FH_F60072_0_0|CSTM-ALL|CSTM-00|2020|PDM|18407.00|99|0.00|MS DRG 619-621|
20|FH_F123481_90049_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F148201_82716_0|CSTM-ALL|CSTM-00|2020|PCT|2.75|99|0.00|HSS ASC|
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|AEG 10 (NO REV)|
20|FH_F143834_06511_0|SrvcGrp|89024|2022|PDM|80.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F93332_0_0|SrvcGrp|93086|2022|PDM|6386.00|99|0.00|REMOVAL OF SPINAL LAMINA (HCFA)|
20|FH_F129231_30060_0|CSTM-ALL|CSTM-00|2020|PDM|437.00|99|0.00|AEG 1 (NO REV)|
20|FH_F38473_0_0|SrvcGrp|10624|2022|PDM|68.00|99|0.00|CPT CODE 99347|
20|FH_F118194_50841_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125118_99201_0|SrvcGrp|74609|2022|PDM|500.00|99|0.00|AETNA FOLLOW UP VISIT CPT 90834|
20|FH_F54732_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F93880_95476_0|SrvcGrp|93733|2022|PCT|1.10|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F114916_30309_0|SrvcGrp|13807|2022|PDM|1500.00|99|0.00|OBSERVATION SVCS|
20|FH_F129666_71901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F102500_0_0|SrvcGrp|73008|2022|PDM|1250.00|99|0.00|AEG 10|
20|FH_F148342_80621_0|SrvcGrp|89337|2022|PDM|1200.00|99|0.00|DETOXIFICATION|
20|FH_F129231_30060_0|SrvcGrp|68282|2022|PDM|1789.00|99|0.00|CPT 67042|
20|FH_F126523_0_0|SrvcGrp|72990|2022|PDM|565.00|99|0.00|AEG 1|
20|FH_F32720_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93332_0_0|SrvcGrp|93068|2022|PDM|7416.00|99|0.00|SPINE FUSION EXTRA SEGMENT (HCFA)|
20|FH_F116595_92506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116739_78501_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F116802_41224_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_F83292_0_0|SrvcGrp|69529|2022|PCT|5.00|99|0.00|BARNESVILLE RAD @ 100% W/ OP SURG|
20|FH_F119992_67062_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118950_33312_0|SrvcGrp|86723|2022|PDM|650.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F39028_0_0|SrvcGrp|30179|2022|PDM|20.00|99|0.00|ADDITIONAL SKN-REHAB|
20|FH_F51276_0_0|SrvcGrp|3327|2022|PDM|155.61|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F46732_0_0|SrvcGrp|10519|2022|PDM|220.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F100742_00616_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F45832_0_0|SrvcGrp|3029|2022|PDM|580.00|99|0.00|NEWBORN NURSERY|
20|FH_F46258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|B CODES (MOD UE) - WALGREENS|
20|FH_F59732_0_0|SrvcGrp|24745|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F123372_0_0|SrvcGrp|22899|2022|PDM|2914.00|99|0.00|ICU|
20|FH_F141591_92630_0|SrvcGrp|89417|2022|PDM|489.25|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F69423_0_0|SrvcGrp|34069|2022|PDM|2185.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F147941_06023_0|SrvcGrp|12954|2022|PCT|1.38|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F37679_0_0|SrvcGrp|21711|2022|PDM|110.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|947.53|99|0.00|ASPG I|
20|FH_F107600_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F77925_0_0|SrvcGrp|38648|2022|PDM|4968.00|99|0.00|ACUTE MEDICAL/SURGICAL SERVICES|
20|FH_F109180_18015_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F148400_33401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121547_46805_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F123501_64831_0|SrvcGrp|471|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F145537_02061_0|SrvcGrp|87441|2022|PDM|504.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F87254_0_0|SrvcGrp|63471|2022|PDM|3200.00|99|0.00|CPT 64590|
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)|
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)|
20|FH_F37679_0_0|SrvcGrp|27142|2022|PDM|7.50|99|0.00|HOME INFUSION THERAPY (MOD SH)|
20|FH_F121495_92009_0|SrvcGrp|108484|2022|PDM|1250.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F120349_38774_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F123464_63841_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F110925_01104_0|SrvcGrp|82822|2022|PDM|9.25|99|0.00|INJECTION, IMMUNE GLOBULIN (HIZENTRA)|
20|FH_F137427_89146_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F148320_02130_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148279_15009_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
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_F116700_11787_0|SrvcGrp|58509|2022|PDM|275.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F72206_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F93920_0_0|SrvcGrp|90356|2022|PCT|0.75|99|0.00|OP DIALYSIS|
20|FH_F145803_19061_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|1648.00|99|0.00|AEG 7 (NO REV)|
20|FH_F151543_95630_0|SrvcGrp|3178|2022|PDM|1238.00|99|0.00|ACUTE PSYCH|
20|FH_F141801_80534_0|SrvcGrp|12659|2022|PDM|1000.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|731.00|99|0.00|AEG 3 (NO REV)|
20|FH_F100320_0_0|SrvcGrp|75493|2022|PDM|1041.00|99|0.00|AEG 8|
20|FH_F149523_0_0|CSTM-ALL|CSTM-00|2020|PDM|10000.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL|
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F114963_62062_0|SrvcGrp|48396|2022|PDM|131.00|99|0.00|OT SERVICES|
20|FH_F32627_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F143528_0_0|SrvcGrp|12491|2022|PCT|0.00|99|0.00|PACEMAKER|
20|FH_F130807_20721_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F114980_78061_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F70104_0_0|CSTM-ALL|CSTM-00|2020|PDM|12.00|99|0.00|SKILLED NURSING HCPC|
20|FH_F126153_44663_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PDM|1082.00|99|0.00|ASPG V|
20|FH_F125011_74467_0|SrvcGrp|75505|2022|PCT|0.63|99|0.00|CARDIAC STUDIES|
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|487.00|99|0.00|AEG 2 (NO REV)|
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|ASPG 6 HEARTLAND HEALTHCARE|
20|FH_F72143_0_0|SrvcGrp|40820|2022|PDM|2800.00|99|0.00|ICU/CCU|
20|FH_F149839_80002_0|SrvcGrp|48396|2022|PDM|135.00|99|0.00|OT SERVICES|
20|FH_F141507_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F145550_62034_0|SrvcGrp|46605|2022|PDM|105.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F142073_0_0|SrvcGrp|27261|2022|PDM|11900.00|99|0.00|CPT 27446|
20|FH_F33513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|DME F/S (MOD 53) - MHAC|
20|FH_F143834_06511_0|SrvcGrp|108484|2022|PDM|475.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F119384_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38341_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F138488_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S AZ/NV - MOD KN|
20|FH_F143528_0_0|SrvcGrp|114088|2022|PDM|2730.00|99|0.00|HERNIA REPAIR|
20|FH_F75483_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F122687_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F142073_0_0|SrvcGrp|88491|2022|PDM|5980.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F133211_0_0|SrvcGrp|111928|2022|PDM|95.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F136467_0_0|SrvcGrp|11673|2022|PDM|3246.00|99|0.00|CPT 29888|
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|581.00|99|0.00|AEG 4 (NO REV)|
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC STUDIES|
20|FH_F40191_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F60112_0_0|SrvcGrp|43432|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE HOURLY|
20|FH_F63235_0_0|SrvcGrp|15472|2022|PDM|931.00|99|0.00|CPT CODE 62284|
20|FH_F39393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F45052_0_0|SrvcGrp|28536|2022|PCT|0.90|99|0.00|J CODES|
20|FH_F130711_06716_0|SrvcGrp|472|2022|PDM|480.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130721_04769_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F130725_33020_0|SrvcGrp|89337|2022|PDM|1014.00|99|0.00|DETOXIFICATION|
20|FH_F130775_61701_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F38952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|GENERAL ACUTE CARE|
20|FH_F121597_30315_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F149106_07042_0|CSTM-ALL|CSTM-00|2020|PDM|1995.00|99|0.00|AEG 5  (NO REV)|
20|FH_F139780_75605_0|SrvcGrp|46605|2022|PDM|105.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F85097_0_0|SrvcGrp|15366|2022|PDM|3724.00|99|0.00|ICU/CCU|
20|FH_F145641_06902_0|SrvcGrp|78096|2022|PDM|6499.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F51135_0_0|SrvcGrp|26001|2022|PDM|152.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F113368_37752_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F83995_16748_0|SrvcGrp|16302|2022|PDM|42.00|99|0.00|VENIPUNCTURE|
20|FH_F121476_0_0|SrvcGrp|96104|2022|PDM|793.00|99|0.00|IMPLANTABLE NEUROSTIMULATOR|
20|FH_F150165_06032_0|SrvcGrp|67994|2022|PDM|1524.00|99|0.00|CPT 58120|
20|FH_F133943_01606_0|SrvcGrp|109701|2022|PCT|1.00|99|0.00|LEUPROLIDE ACETATE 7.5MG/3MX|
20|FH_F85652_98034_0|SrvcGrp|13222|2022|PDM|416.00|99|0.00|CPT CODE 99281|
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|663.00|99|0.00|2005 ASPG GROUPER III|
20|FH_F134208_21502_0|SrvcGrp|45063|2022|PDM|408.00|99|0.00|CPT 64493  INJECTION CARVE OUT|
20|FH_F127090_45601_0|SrvcGrp|73701|2022|PDM|30.75|99|0.00|AETNA - SKILLED NURSING|
20|FH_F127343_0_0|SrvcGrp|87062|2022|PDM|1725.00|99|0.00|REVISE ULNAR NERVE AT ELBOW|
20|FH_F85353_16407_0|SrvcGrp|63873|2022|PDM|308.79|99|0.00|HAPA WPA-NWPA 2012-13 ASC 310|
20|FH_F130123_24171_0|SrvcGrp|93099|2022|PDM|500.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY|
20|FH_F119383_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1981.86|99|0.00|HAPA WPA-NWPA 2012-13 ASC 904 W/O REV|
20|FH_F145965_50325_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F136327_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F50952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE|
20|FH_F127486_06776_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F89219_0_0|SrvcGrp|33217|2022|PDM|2256.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I & II|
20|FH_F121225_98902_0|SrvcGrp|28630|2022|PDM|155.00|99|0.00|HOME INFUSION SKILLED NURSING|
20|FH_F32926_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134669_17403_0|SrvcGrp|86722|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F77044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.33|99|0.00|INFUSION S-CODE PER MONTH (MOD SJ)|
20|FH_F40780_0_0|SrvcGrp|196|2022|PDM|585.00|99|0.00|CD (ADOLESCENT) - DETOX|
20|FH_F145708_89030_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F126341_27284_0|SrvcGrp|34566|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132824_0_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F146122_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS|
20|FH_F120408_0_0|SrvcGrp|90573|2022|PDM|287.38|99|0.00|INTENSIVE OP PSYCH|
20|FH_F81698_10457_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145604_14850_0|SrvcGrp|86844|2022|PDM|75.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F33175_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133972_27103_0|SrvcGrp|24761|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142376_0_0|SrvcGrp|101279|2022|PDM|7405.00|99|0.00|ADDL NECK SPINE FUSION|
20|FH_F127957_89521_0|SrvcGrp|110811|2022|PDM|390.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F133972_27103_0|SrvcGrp|86827|2022|PDM|60.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F37877_0_0|CSTM-ALL|CSTM-00|2020|PDM|664.00|99|0.00|ASPG X|
20|FH_F110509_71351_0|SrvcGrp|72994|2022|PDM|1850.00|99|0.00|AEG 3|
20|FH_F143742_60410_0|SrvcGrp|79699|2022|PCT|0.64|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F92893_75110_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F133207_0_0|SrvcGrp|70749|2022|PDM|3527.00|99|0.00|CPT 29823|
20|FH_F149365_77642_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142894_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F135670_01749_0|SrvcGrp|26869|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F134507_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138951_41101_0|SrvcGrp|17013|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F83754_0_0|SrvcGrp|23477|2022|PCT|0.81|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F135627_77070_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F90496_13159_0|SrvcGrp|90067|2022|PDM|95.00|99|0.00|AETNA INITIAL HOSPITAL CARE|
20|FH_F136359_0_0|SrvcGrp|46887|2022|PDM|4775.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F130123_24171_0|SrvcGrp|89781|2022|PDM|120.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F149322_19023_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F111702_07652_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F134593_60007_0|SrvcGrp|26868|2022|PDM|48.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 10 (NO REV)|
20|FH_F148905_85390_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F124792_44515_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138302_15701_0|SrvcGrp|17014|2022|PDM|22.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F126550_43085_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F147959_33573_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F112060_07514_0|SrvcGrp|59795|2022|PCT|1.00|99|0.00|TPN|
20|FH_F126555_44906_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F81698_10457_0|SrvcGrp|86829|2022|PDM|31.50|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F132609_0_0|SrvcGrp|11663|2022|PCT|0.67|99|0.00|IMPLANTS|
20|FH_F113276_38506_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121476_0_0|SrvcGrp|83895|2022|PDM|4932.00|99|0.00|IMPLANTABLE MESH|
20|FH_F119227_01752_0|SrvcGrp|86846|2022|PDM|30.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F127199_0_0|SrvcGrp|90707|2022|PDM|114.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F141210_0_0|SrvcGrp|59840|2022|PDM|3713.00|99|0.00|TYMPANOSTOMY|
20|FH_F123646_91350_0|SrvcGrp|79280|2022|PDM|575.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F32204_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|AEG 5  (NO REV)|
20|FH_F150144_39452_0|SrvcGrp|113276|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F150165_06032_0|SrvcGrp|98524|2022|PDM|3090.00|99|0.00|EXCISION OF BONE CYST|
20|FH_F145604_14850_0|SrvcGrp|26869|2022|PDM|70.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F69647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F48302_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95440_0_0|SrvcGrp|63472|2022|PDM|5100.00|99|0.00|CPT 64581|
20|FH_F145641_06902_0|SrvcGrp|92366|2022|PDM|4350.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F144228_0_0|SrvcGrp|103574|2022|PDM|7132.00|99|0.00|ANKLE ARTHROSCOPY|
20|FH_F95440_0_0|SrvcGrp|73002|2022|PDM|2781.00|99|0.00|AEG 7|
20|FH_F85353_16407_0|SrvcGrp|63798|2022|PDM|912.85|99|0.00|HAPA WPA-NWPA 2012-13 ASC 401|
20|FH_F118253_89052_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F119573_95864_0|SrvcGrp|110811|2022|PDM|382.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F145604_14850_0|SrvcGrp|47183|2022|PDM|65.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F117300_0_0|SrvcGrp|89842|2022|PDM|7853.00|99|0.00|LUMBAR|
20|FH_F124146_46321_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F118144_33418_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F85213_02840_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F149199_73005_0|SrvcGrp|74588|2022|PDM|3119.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1553.00|99|0.00|ASPG VII|
20|FH_F134608_18017_0|SrvcGrp|106719|2022|PDM|650.00|99|0.00|INDUCED ABORTION BY DILATION AND EVACUATION|
20|FH_F138302_15701_0|SrvcGrp|14947|2022|PDM|3.00|99|0.00|HOME INFUSION|
20|FH_F116806_0_0|SrvcGrp|107010|2022|PDM|1923.16|99|0.00|REMOVE JAW JOINT CARTILAGE|
20|FH_F139565_0_0|SrvcGrp|42427|2022|PDM|6885.00|99|0.00|OP SURGERY CPT 65420|
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|456.97|99|0.00|AEG 1 (NO REV)|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD AU"|
20|FH_F143562_76665_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130763_0_0|SrvcGrp|90418|2022|PDM|4717.00|99|0.00|ENLARGE BREAST WITH IMPLANT|
20|FH_F52956_0_0|SrvcGrp|12709|2022|PDM|167.68|99|0.00|OP DIALYSIS|
20|FH_F135610_06451_0|SrvcGrp|104226|2022|PDM|89.12|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|325.81|99|0.00|SLEEP EEG (MOD TC)|
20|FH_F110580_71106_0|SrvcGrp|103994|2022|PDM|710.00|99|0.00|TRANSURETHRAL INCISION OF PR|
20|FH_F51124_0_0|SrvcGrp|3809|2022|PDM|675.00|99|0.00|HOSPICE CARE|
20|FH_F134593_60007_0|SrvcGrp|14948|2022|PDM|110.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F112468_0_0|SrvcGrp|72996|2022|PDM|727.00|99|0.00|AEG 4|
20|FH_F119573_95864_0|SrvcGrp|109036|2022|PDM|958.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F72926_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F122672_44089_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F67200_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F84712_0_0|SrvcGrp|82749|2022|PDM|50.00|99|0.00|AUTOMAT HEMOGRAM COMPLET DIF|
20|FH_F84935_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F101100_50314_0|SrvcGrp|97920|2022|PDM|7642.00|99|0.00|REMOVAL OF OMENTUM|
20|FH_F115909_38133_0|SrvcGrp|89337|2022|PDM|1054.00|99|0.00|DETOXIFICATION|
20|FH_F115936_75093_0|SrvcGrp|73842|2022|PDM|231.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F66427_0_0|SrvcGrp|38402|2022|PCT|0.80|99|0.00|MS DRG 001-002, 005-010, 652 ONLY - TRANSPLANT SVCS|
20|FH_F146702_70508_0|SrvcGrp|87537|2022|PDM|567.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F146846_73139_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120774_14070_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116023_10027_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F148760_12953_0|SrvcGrp|48394|2022|PDM|68.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F151144_35801_0|CSTM-ALL|CSTM-00|2020|PDM|1346.00|99|0.00|AEG 7 (NO REV)|
20|FH_F151222_72958_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121910_27104_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121999_67002_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F57854_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|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_F82933_0_0|SrvcGrp|14174|2022|PDM|2762.84|99|0.00|MRI|
20|FH_F77923_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109484_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F115204_0_0|SrvcGrp|79458|2022|PDM|0.25|99|0.00|MED RECORD COPY|
20|FH_F142335_60624_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F137460_42103_0|SrvcGrp|73842|2022|PDM|153.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137716_66204_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F82955_34266_0|SrvcGrp|12280|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F130807_20721_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F35010_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122536_0_0|CSTM-ALL|CSTM-00|2020|PDM|14701.00|99|0.00|ASPG VII|
20|FH_F116998_17701_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141549_33403_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115046_77964_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115119_10003_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|549.00|99|0.00|ASPG I|
20|FH_F129334_43016_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F149888_68506_0|SrvcGrp|67990|2022|PDM|4042.00|99|0.00|CPT 58660 58661 58662|
20|FH_F41776_0_0|SrvcGrp|63|2022|PDM|992.00|99|0.00|SUBACUTE CARE|
20|FH_F115736_77459_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F108762_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F143528_0_0|SrvcGrp|84318|2022|PDM|5250.00|99|0.00|SPINE INFUSION|
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|832.00|99|0.00|AEG 1 (NO REV)|
20|FH_F139515_0_0|SrvcGrp|108461|2022|PDM|2318.00|99|0.00|SLIDING REPAIR ING HERNIA|
20|FH_F49299_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129968_98004_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|905.00|99|0.00|AEG 6 (NO REV)|
20|FH_F128878_11203_0|CSTM-ALL|CSTM-00|2020|PDM|130.00|99|0.00|PSYTX W PT 45 MINS|
20|FH_F131220_08062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F143788_21230_0|SrvcGrp|74668|2022|PDM|281.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F71848_0_0|SrvcGrp|68781|2022|PDM|149.73|99|0.00|SPECIAL STAINS GROUP 1|
20|FH_F130916_33701_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F131002_40977_0|CSTM-ALL|CSTM-00|2020|PCT|0.46|99|0.00|GENERAL ACUTE CARE|
20|FH_F123915_0_0|SrvcGrp|95661|2022|PDM|692.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F103100_47150_0|SrvcGrp|72998|2022|PDM|1425.00|99|0.00|AEG 5|
20|FH_F135236_02840_0|SrvcGrp|112225|2022|PDM|132.70|99|0.00|COVID-19 SPECIMEN COLLECTION|
20|FH_F32177_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F102500_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F127711_0_0|SrvcGrp|12663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F122688_19904_0|SrvcGrp|471|2022|PDM|795.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F86872_15215_0|SrvcGrp|17014|2022|PDM|47.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F62579_0_0|SrvcGrp|29679|2022|PDM|125.00|99|0.00|SKILLED NURSING NON IV RELATED- MOD TJ|
20|FH_F130656_04401_0|SrvcGrp|81779|2022|PCT|4.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F130895_07726_0|SrvcGrp|89149|2022|PDM|182.00|99|0.00|OP INTENSIVE|
20|FH_F133875_80027_0|SrvcGrp|109330|2022|PCT|1.16|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130017_02302_0|CSTM-ALL|CSTM-00|2020|PDM|3150.48|99|0.00|AEG 2 (NO REV)|
20|FH_F100063_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F134188_83201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120930_0_0|SrvcGrp|35668|2022|PDM|3500.00|99|0.00|CPT 29824|
20|FH_F112908_0_0|SrvcGrp|23683|2022|PDM|34.00|99|0.00|SKILLED NURSING RN|
20|FH_F132723_61265_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F127075_64772_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F85353_16407_0|SrvcGrp|63767|2022|PDM|1748.83|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1403|
20|FH_F76146_0_0|SrvcGrp|68187|2022|PDM|893.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 3|
20|FH_F124173_66215_0|SrvcGrp|16750|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F139512_77550_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F134608_18017_0|SrvcGrp|112601|2022|PDM|35.00|99|0.00|GROUP HEALTH EDUCATION|
20|FH_F130468_0_0|SrvcGrp|89404|2022|PDM|11776.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F150311_18106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116753_0_0|CSTM-ALL|CSTM-00|2020|PDM|2163.00|99|0.00|AEG 4 (NO REV)|
20|FH_F123851_03235_0|SrvcGrp|27969|2022|PDM|28.56|99|0.00|HOME HEALTH AIDE|
20|FH_F124371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121597_30315_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147980_0_0|SrvcGrp|104228|2022|PDM|95.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F139169_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_F132728_0_0|SrvcGrp|33793|2022|PDM|13426.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|659.00|99|0.00|AEG 4 (NO REV)|
20|FH_F135670_01749_0|SrvcGrp|98969|2022|PDM|42.00|99|0.00|HIT ANTI TNF (HCFA)|
20|FH_F126427_77082_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146650_29690_0|SrvcGrp|113565|2022|PDM|1125.00|99|0.00|PSYCHIATRIC (AGE 10-21 YRS)|
20|FH_F43199_0_0|SrvcGrp|12401|2022|PDM|105.00|99|0.00|RN VISIT|
20|FH_F145641_06902_0|SrvcGrp|108095|2022|PDM|3709.00|99|0.00|PARTIAL REMOVAL FOOT FASCIA|
20|FH_F111986_0_0|SrvcGrp|35670|2022|PDM|3605.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F84132_48026_0|SrvcGrp|72990|2022|PDM|428.00|99|0.00|AEG 1|
20|FH_F77585_0_0|SrvcGrp|43323|2022|PDM|90.00|99|0.00|GROUP THERAPY|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F150140_28714_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149279_17022_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135666_37601_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F80455_0_0|SrvcGrp|78045|2022|PDM|803.00|99|0.00|AETNA AMNIOTIC MEMBRANE|
20|FH_F81377_0_0|SrvcGrp|70069|2022|PDM|1760.00|99|0.00|CPT 49505|
20|FH_F113484_43015_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.50|99|0.00|AEG 4 (NO REV)|
20|FH_F119784_0_0|SrvcGrp|102419|2022|PDM|2450.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F102041_35010_0|SrvcGrp|48396|2022|PDM|145.00|99|0.00|OT SERVICES|
20|FH_F37294_0_0|SrvcGrp|89|2022|PCT|0.80|99|0.00|LIVER TRANSPLANT|
20|FH_F138929_0_0|SrvcGrp|84939|2022|PDM|17600.00|99|0.00|SHOULDER JOINT|
20|FH_F138929_0_0|SrvcGrp|88065|2022|PDM|13750.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F131047_0_0|SrvcGrp|12126|2022|PCT|0.57|99|0.00|OP PET SCAN|
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|1333.00|99|0.00|AEG 6 (NO REV)|
20|FH_F141070_64093_0|SrvcGrp|88621|2022|PDM|127.00|99|0.00|SKILLED NURSING LPN|
20|FH_F141127_62286_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F137897_0_0|SrvcGrp|92104|2022|PDM|173.80|99|0.00|AETNA OXYGEN CONCENTRATOR 1 PORT|
20|FH_F132351_19342_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124129_33603_0|CSTM-ALL|CSTM-00|2020|PDM|798.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F146921_43050_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146993_66020_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38081_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F38233_0_0|SrvcGrp|10649|2022|PDM|4.00|99|0.00|HOME INFUSION|
20|FH_F39066_0_0|SrvcGrp|8950|2022|PDM|1800.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F92493_0_0|SrvcGrp|92366|2022|PDM|2730.42|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F92493_0_0|SrvcGrp|34609|2022|PDM|1949.64|99|0.00|PODIATRIC PROCEDURE CPT 28080|
20|FH_F124671_64844_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124671_64844_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124679_64052_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F89273_0_0|SrvcGrp|78045|2022|PDM|595.00|99|0.00|AETNA AMNIOTIC MEMBRANE|
20|FH_F113845_32746_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F139708_54880_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|0.70|99|0.00|OP SVCS|
20|FH_F135718_33172_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F112505_51503_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F113713_17013_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|AETNA PSYTX W PT 45 MIN MOD AJ (HCFA)|
20|FH_F39622_0_0|SrvcGrp|13551|2022|PDM|619.00|99|0.00|NEWBORN NURSERY|
20|FH_F49016_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115266_66736_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F147526_32216_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147394_14031_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147520_61614_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|76.00|99|0.00|TPN FOUR LITER (MOD SH)|
20|FH_F111603_19529_0|SrvcGrp|86722|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F35381_0_0|CSTM-ALL|CSTM-00|2020|PDM|707.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F140987_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F41013_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F48693_0_0|SrvcGrp|12045|2022|PDM|686.73|99|0.00|SLEEP STUDIES|
20|FH_F113390_0_0|SrvcGrp|105242|2022|PDM|1320.00|99|0.00|ESOPHAGOSCP RIG TRNSO BIOPSY|
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|1211.00|99|0.00|AEG 9 (NO REV)|
20|FH_F83799_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151285_72956_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151412_71909_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151420_60654_0|CSTM-ALL|CSTM-00|2020|PDM|1531.00|99|0.00|AEG 5  (NO REV)|
20|FH_F151508_60435_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151511_14094_0|SrvcGrp|10361|2022|PDM|282.00|99|0.00|CPT CODE 99281|
20|FH_F122024_75751_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F122032_32413_0|SrvcGrp|89417|2022|PDM|371.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F123191_15012_0|SrvcGrp|88620|2022|PDM|91.00|99|0.00|SKILLED NURSING RN|
20|FH_F132054_30339_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135440_32561_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F110741_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS|
20|FH_F91766_25401_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA - ANCD ( HOME HEALTH)|
20|FH_F130756_04901_0|SrvcGrp|114504|2022|PCT|4.24|99|0.00|LABORATORY SERVICES|
20|FH_F127399_0_0|SrvcGrp|77021|2022|PDM|3849.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F127399_0_0|SrvcGrp|108260|2022|PDM|1248.00|99|0.00|AETNA FIXATION OF KNEE JOINT|
20|FH_F36341_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F42347_0_0|SrvcGrp|31191|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF (DME)|
20|FH_F75205_0_0|SrvcGrp|62537|2022|PDM|130.00|99|0.00|SPEECH THERAPY|
20|FH_F111363_33169_0|SrvcGrp|73008|2022|PDM|2190.00|99|0.00|AEG 10|
20|FH_F47906_0_0|SrvcGrp|29955|2022|PCT|1.00|99|0.00|DME MOD AU|
20|FH_F41780_0_0|SrvcGrp|31191|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF (DME)|
20|FH_F131000_0_0|SrvcGrp|90822|2022|PDM|3343.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY|
20|FH_F40598_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102126_0_0|CSTM-ALL|CSTM-00|2020|PDM|248.00|99|0.00|AEG OUTPATIENT SURGERY|
20|FH_F140102_0_0|SrvcGrp|113619|2022|PDM|105.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F102902_33764_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129240_10028_0|SrvcGrp|86845|2022|PDM|35.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F130027_76201_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F134202_0_0|SrvcGrp|14614|2022|PDM|1780.20|99|0.00|LITHOTRIPSY|
20|FH_F33925_0_0|SrvcGrp|15774|2022|PCT|0.70|99|0.00|TREATMENT ROOM|
20|FH_F39272_0_0|SrvcGrp|29021|2022|PCT|1.00|99|0.00|DME AND SUPPLIES|
20|FH_F39355_0_0|SrvcGrp|13880|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F41934_0_0|SrvcGrp|35261|2022|PDM|1200.00|99|0.00|IOL PROCEDURES|
20|FH_F87571_0_0|SrvcGrp|45884|2022|PDM|85.00|99|0.00|ST|
20|FH_F138418_51201_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133867_84075_0|SrvcGrp|97704|2022|PDM|93.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F70883_0_0|SrvcGrp|8962|2022|PDM|66.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F132822_95125_0|SrvcGrp|48398|2022|PDM|130.00|99|0.00|PT SERVICES|
20|FH_F85213_02840_0|SrvcGrp|116099|2022|PCT|1.03|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F50657_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F148668_33177_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F72543_0_0|SrvcGrp|46117|2022|PDM|40.50|99|0.00|HOME HEALTH AIDE (PER HOUR)|
20|FH_F129525_48446_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F87053_0_0|SrvcGrp|75181|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F68626_0_0|SrvcGrp|11606|2022|PDM|1450.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)|
20|FH_F101100_50314_0|SrvcGrp|41335|2022|PDM|17486.00|99|0.00|TOTAL HIP|
20|FH_F105145_75075_0|SrvcGrp|80617|2022|PDM|8320.00|99|0.00|ARTHOPLASTY|
20|FH_F115903_43560_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F77665_0_0|SrvcGrp|74839|2022|PDM|15.00|99|0.00|SKILLED NURSING|
20|FH_F146881_83661_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F120795_27514_0|SrvcGrp|75943|2022|PDM|5768.00|99|0.00|AETNA INPATIENT SURGICAL CARE|
20|FH_F127656_06068_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131454_06422_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131964_89120_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F133478_40165_0|SrvcGrp|102420|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F132898_06088_0|SrvcGrp|472|2022|PDM|495.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F131430_17566_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111584_07002_0|SrvcGrp|52953|2022|PDM|77.24|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F135891_0_0|SrvcGrp|73485|2022|PDM|900.00|99|0.00|AETNA REHAB|
20|FH_F148780_70739_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F121880_54935_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F113866_0_0|SrvcGrp|74546|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F129130_92562_0|SrvcGrp|47453|2022|PDM|11993.42|99|0.00|LAP BAND|
20|FH_F37823_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F82933_0_0|SrvcGrp|12342|2022|PCT|0.57|99|0.00|IMPLANTS|
20|FH_F98041_10027_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_F117525_0_0|SrvcGrp|72990|2022|PDM|500.00|99|0.00|AEG 1|
20|FH_F142070_0_0|SrvcGrp|107750|2022|PDM|25.00|99|0.00|TRAINING INCL A TREATMENT|
20|FH_F91873_12723_0|SrvcGrp|13187|2022|PCT|0.68|99|0.00|INTRAOCULAR LENSES|
20|FH_F106822_0_0|SrvcGrp|82746|2022|PDM|12.26|99|0.00|CULT BACT BLD AEROIC ISOLA|
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|2543.00|99|0.00|AEG 5  (NO REV)|
20|FH_F117001_0_0|SrvcGrp|49109|2022|PDM|400.00|99|0.00|HEARING AID|
20|FH_F118275_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F86911_0_0|SrvcGrp|44706|2022|PDM|90.00|99|0.00|NURSING CARE|
20|FH_F111885_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|1391.00|99|0.00|AEG 2 (NO REV)|
20|FH_F115208_0_0|SrvcGrp|106185|2022|PDM|2546.00|99|0.00|REVISE MIDDLE EAR & MASTOID|
20|FH_F138196_0_0|SrvcGrp|48380|2022|PDM|530.00|99|0.00|CARVE OUT V2788|
20|FH_F138751_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F132739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132988_0_0|SrvcGrp|92197|2022|PDM|6219.68|99|0.00|CORRECTION OF BUNION|
20|FH_F132988_0_0|SrvcGrp|90063|2022|PDM|4493.01|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62252_0_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F93252_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F114389_50131_0|SrvcGrp|92184|2022|PDM|48.28|99|0.00|HCPCS S9340 (HCFA)|
20|FH_F114389_50131_0|SrvcGrp|17001|2022|PDM|157.40|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F141336_16947_0|SrvcGrp|111928|2022|PDM|56.44|99|0.00|COVID-19 BARTONELLA|
20|FH_F77944_0_0|SrvcGrp|941|2022|PDM|1887.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1107.00|99|0.00|AEG 6 (NO REV)|
20|FH_F124136_75860_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146807_28655_0|SrvcGrp|114616|2022|PCT|0.85|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F39956_0_0|SrvcGrp|10107|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F124613_64735_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F66439_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F97040_31901_0|SrvcGrp|73602|2022|PDM|3772.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F114666_30342_0|SrvcGrp|13807|2022|PDM|1500.00|99|0.00|OBSERVATION SVCS|
20|FH_F144039_0_0|SrvcGrp|106235|2022|PDM|6885.00|99|0.00|CYPASS|
20|FH_F119725_0_0|SrvcGrp|13262|2022|PDM|7.45|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F122610_73139_0|SrvcGrp|11283|2022|PCT|0.63|99|0.00|HYPERBARIC CHAMBER|
20|FH_F117085_40207_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F135762_70001_0|SrvcGrp|46903|2022|PDM|1550.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F112465_28401_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F113713_17013_0|SrvcGrp|86641|2022|PDM|85.00|99|0.00|AETNA PSYCH DIAGNOSITC EVALUATION (MOD TD)|
20|FH_F116365_11417_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F116393_07002_0|SrvcGrp|22528|2022|PCT|0.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F147586_44124_0|SrvcGrp|54943|2022|PDM|3601.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F147500_32720_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147520_61614_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|1164.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F111363_33169_0|SrvcGrp|82754|2022|PDM|40.00|99|0.00|ASSAY THYROID STIM HORMONE|
20|FH_F111363_33169_0|SrvcGrp|82739|2022|PDM|40.00|99|0.00|LIPID PROFILE|
20|FH_F40838_0_0|SrvcGrp|3029|2022|PDM|375.00|99|0.00|NEWBORN NURSERY|
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|466.52|99|0.00|AEG 1 (NO REV)|
20|FH_F44336_0_0|SrvcGrp|196|2022|PDM|411.00|99|0.00|CD (ADOLESCENT) - DETOX|
20|FH_F87557_33309_0|SrvcGrp|86834|2022|PDM|10.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F87557_33309_0|SrvcGrp|24761|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F128185_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PDM|772.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132090_60915_0|CSTM-ALL|CSTM-00|2020|PDM|2019.15|99|0.00|AEG 5  (NO REV)|
20|FH_F148079_06512_0|SrvcGrp|88621|2022|PDM|106.00|99|0.00|SKILLED NURSING LPN|
20|FH_F130302_0_0|SrvcGrp|73008|2022|PDM|1008.00|99|0.00|AEG 10|
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|1761.00|99|0.00|AEG 3 (NO REV)|
20|FH_F128341_41139_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F87474_0_0|SrvcGrp|8962|2022|PDM|50.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F32958_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35308_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD KF) - BDSS|
20|FH_F46832_0_0|SrvcGrp|17002|2022|PDM|180.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS|
20|FH_F123756_45324_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F123848_03257_0|SrvcGrp|88620|2022|PDM|157.00|99|0.00|SKILLED NURSING RN|
20|FH_F132810_0_0|SrvcGrp|29023|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F58856_0_0|CSTM-ALL|CSTM-00|2020|PDM|1725.00|99|0.00|CD SERVICES|
20|FH_F61512_0_0|SrvcGrp|109590|2022|PDM|25.00|99|0.00|CERTIFIED NURSING ASSISTANT|
20|FH_F136386_30901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F118236_25901_0|SrvcGrp|79699|2022|PCT|0.76|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F120490_64133_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F93363_63123_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134011_84102_0|SrvcGrp|103739|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F134156_32174_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F142377_14626_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F142547_70002_0|SrvcGrp|24761|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142690_31774_0|SrvcGrp|43568|2022|PDM|178.00|99|0.00|SKILLED NURSING - RN|
20|FH_F83831_0_0|SrvcGrp|12401|2022|PDM|105.00|99|0.00|RN VISIT|
20|FH_F132733_0_0|SrvcGrp|112077|2022|PDM|49616.00|99|0.00|CV SURGERY|
20|FH_F78267_18702_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139456_47501_0|SrvcGrp|15356|2022|PCT|0.50|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F140447_84106_0|SrvcGrp|88620|2022|PDM|90.00|99|0.00|SKILLED NURSING RN|
20|FH_F140627_68651_0|SrvcGrp|3378|2022|PCT|0.96|99|0.00|OBSERVATION SVCS|
20|FH_F149659_79912_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119023_91406_0|SrvcGrp|14949|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F69862_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F92634_08244_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F109886_36303_0|SrvcGrp|86747|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F49039_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F91913_0_0|SrvcGrp|91759|2022|PCT|1.00|99|0.00|OCULAR IMPLANT|
20|FH_F115452_15235_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F117255_68520_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F147726_18017_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F117098_20186_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F117105_77619_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F137934_51054_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F37878_0_0|SrvcGrp|10540|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F39538_0_0|SrvcGrp|65|2022|PDM|1406.00|99|0.00|OBSTETRICAL CARE|
20|FH_F109652_0_0|SrvcGrp|33879|2022|PDM|5640.00|99|0.00|CYBERKNIFE (ADDITIONAL FRACTIONS)|
20|FH_F90735_94070_0|SrvcGrp|90292|2022|PDM|70.00|99|0.00|FMRL GENE DETECTION|
20|FH_F91472_96001_0|SrvcGrp|103750|2022|PCT|0.40|99|0.00|PARTIAL SHOULDER REPLACEMENT|
20|FH_F114567_43235_0|SrvcGrp|67944|2022|PDM|686.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F132736_0_0|SrvcGrp|33793|2022|PDM|13426.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
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_F148720_0_0|SrvcGrp|104055|2022|PDM|30.00|99|0.00|INFLUENZA VACCINE|
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_F40296_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77462_0_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F119351_95377_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F119507_92627_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AEG 2 (NO REV)|
20|FH_F148548_37909_0|SrvcGrp|35669|2022|PDM|5175.00|99|0.00|CPT 63650|
20|FH_F41396_0_0|SrvcGrp|473|2022|PDM|265.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F38508_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: POS FACILITY MOD TC|
20|FH_F111806_33020_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F87579_33707_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F38848_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F74363_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148555_0_0|SrvcGrp|115499|2022|PDM|3914.00|99|0.00|MAP TACHYCARDIA, ADD-ON|
20|FH_F117559_08619_0|SrvcGrp|90489|2022|PDM|115.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F145842_37172_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F32142_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS|
20|FH_F67136_0_0|SrvcGrp|62721|2022|PDM|8427.00|99|0.00|ICU SERVICES|
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F98624_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F110621_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_F128031_0_0|SrvcGrp|40002|2022|PDM|17600.00|99|0.00|TOTAL HIP|
20|FH_F39939_0_0|SrvcGrp|45469|2022|PDM|4000.00|99|0.00|ROBOTIC PROCEDURES|
20|FH_F48132_33308_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F48348_61605_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|OP SVCS|
20|FH_F48772_66044_0|SrvcGrp|95660|2022|PDM|528.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F69245_84047_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133107_73071_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128341_41139_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F86872_15215_0|SrvcGrp|29076|2022|PCT|1.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F42633_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123847_24012_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F132810_0_0|SrvcGrp|29076|2022|PDM|35.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F150220_0_0|SrvcGrp|115826|2022|PCT|1.00|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F136378_07104_0|SrvcGrp|112868|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136386_30901_0|SrvcGrp|31022|2022|PDM|7875.00|99|0.00|MS DRG 486 ONLY|
20|FH_F93292_62234_0|SrvcGrp|48385|2022|PDM|86.00|99|0.00|SPEECH THERAPY|
20|FH_F134011_84102_0|SrvcGrp|24752|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F137246_66064_0|SrvcGrp|73842|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F56832_0_0|SrvcGrp|43|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F97566_79902_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F138584_30912_0|SrvcGrp|113371|2022|PDM|2000.00|99|0.00|OSTEOPLASTY FACIAL AUGMENT|
20|FH_F138308_50036_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140343_89052_0|SrvcGrp|14949|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F140609_16063_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F140893_19720_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80284_16354_0|SrvcGrp|64107|2022|PDM|631.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 3|
20|FH_F149541_85258_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|1201.20|99|0.00|AETNA GLENNVILLE 2016 AEG 5|
20|FH_F117267_07728_0|SrvcGrp|104363|2022|PCT|5.34|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F117301_01887_0|SrvcGrp|89337|2022|PDM|1000.00|99|0.00|DETOXIFICATION|
20|FH_F147801_90703_0|SrvcGrp|111118|2022|PDM|473.00|99|0.00|PARTIAL HOSP (>=65 YRS)|
20|FH_F137331_33165_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F137814_61820_0|SrvcGrp|90854|2022|PDM|961.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F39893_0_0|SrvcGrp|97|2022|PDM|3200.00|99|0.00|C-SECTION|
20|FH_F109652_0_0|SrvcGrp|30546|2022|PDM|19787.00|99|0.00|MS DRG 246-247 ONLY|
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 1 (NO REV)|
20|FH_F129053_0_0|SrvcGrp|36991|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PDM|1370.00|99|0.00|AEG 4 (NO REV)|
20|FH_F109513_0_0|SrvcGrp|90365|2022|PDM|2700.00|99|0.00|REPAIR METACARPAL FRACTURE|
20|FH_F111594_0_0|SrvcGrp|34606|2022|PDM|2887.00|99|0.00|CPT 29827|
20|FH_F119289_43040_0|SrvcGrp|48168|2022|PDM|280.00|99|0.00|HEMODIALYSIS|
20|FH_F119449_84032_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119500_01570_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41785_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F145818_77573_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145937_75240_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F92677_08003_0|SrvcGrp|22589|2022|PDM|63.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F71723_16502_0|SrvcGrp|29611|2022|PDM|125.00|99|0.00|VENTILATOR SUPPORT|
20|FH_F57396_0_0|SrvcGrp|46591|2022|PDM|100.00|99|0.00|CPT 99213|
20|FH_F113146_15001_0|SrvcGrp|90631|2022|PDM|162.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F117072_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC|
20|FH_F150949_0_0|SrvcGrp|86233|2022|PDM|11960.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F150949_0_0|SrvcGrp|113852|2022|PDM|1125.00|99|0.00|STENT PACEMT ANTE COROTID|
20|FH_F101840_76054_0|SrvcGrp|34475|2022|PDM|15030.00|99|0.00|MS DRG 042 ONLY|
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|668.00|99|0.00|AEG 3 (NO REV)|
20|FH_F92677_08003_0|SrvcGrp|86833|2022|PDM|15.75|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F78682_0_0|SrvcGrp|36591|2022|PDM|3500.00|99|0.00|CPT 63685|
20|FH_F57372_0_0|SrvcGrp|53744|2022|PDM|1275.00|99|0.00|MEDICAL/SURGICAL|
20|FH_F101851_78024_0|SrvcGrp|89149|2022|PDM|185.00|99|0.00|OP INTENSIVE|
20|FH_F42807_0_0|SrvcGrp|38|2022|PDM|4472.00|99|0.00|NORMAL DELIVERY|
20|FH_F120407_84070_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F150528_78644_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F126868_60451_0|SrvcGrp|90854|2022|PDM|853.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F92792_0_0|SrvcGrp|28549|2022|PDM|2200.00|99|0.00|VITRECTOMY|
20|FH_F81373_64064_0|SrvcGrp|75506|2022|PCT|0.66|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F31093_0_0|SrvcGrp|9381|2022|PDM|1694.00|99|0.00|UNGROUPABLE CPT'S|
20|FH_F125541_07825_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128605_20910_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132729_0_0|SrvcGrp|3409|2022|PDM|600.00|99|0.00|NEWBORN NURSERY|
20|FH_F139166_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F97566_79902_0|SrvcGrp|88977|2022|PDM|7699.00|99|0.00|C-SECTION DELIVERY|
20|FH_F52617_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|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_F133395_98801_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|HCFA EXCLUSION MINUS ANESTHESIA|
20|FH_F38089_0_0|SrvcGrp|3055|2022|PDM|1134.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F50297_0_0|SrvcGrp|42972|2022|PDM|26.00|99|0.00|HOME HEALTH AIDE|
20|FH_F41739_0_0|SrvcGrp|14752|2022|PDM|22256.00|99|0.00|DRG 122 ONLY|
20|FH_F126666_44053_0|SrvcGrp|105367|2022|PDM|39.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MINS|
20|FH_F145845_37167_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114024_0_0|SrvcGrp|75483|2022|PDM|573.00|99|0.00|AEG 3|
20|FH_F125256_77365_0|SrvcGrp|73841|2022|PDM|325.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F34005_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F123144_0_0|SrvcGrp|72998|2022|PDM|762.00|99|0.00|AEG 5|
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1228.00|99|0.00|AEG 7 (NO REV)|
20|FH_F123039_44147_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F127325_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F92677_08003_0|SrvcGrp|22389|2022|PDM|15.75|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F115330_34113_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F146211_68144_0|SrvcGrp|96539|2022|PDM|6413.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F150579_16652_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F78385_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F42992_0_0|CSTM-ALL|CSTM-00|2020|PDM|2365.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F134497_47126_0|SrvcGrp|108484|2022|PDM|575.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F117901_27526_0|SrvcGrp|472|2022|PDM|465.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F97562_29803_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
20|FH_F110240_0_0|SrvcGrp|79589|2022|PDM|743.00|99|0.00|UPPER GI|
20|FH_F123538_21206_0|SrvcGrp|76501|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F141935_76033_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2007 DME DBL MODIFIERS - RR/KC|
20|FH_F117880_91730_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F36917_0_0|SrvcGrp|80|2022|PDM|755.00|99|0.00|ACUTE PSYCH|
20|FH_F119076_41001_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F111806_33020_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F48374_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|OP SVCS|
20|FH_F115329_79424_0|SrvcGrp|73841|2022|PDM|400.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1156.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F150000_30152_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127410_53551_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F53592_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31003_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F44079_0_0|SrvcGrp|27579|2022|PDM|70.00|99|0.00|RESPIRATORY THERAPY INITIAL VISIT|
20|FH_F144668_62526_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133095_30024_0|SrvcGrp|82981|2022|PDM|169.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F36993_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD KN|
20|FH_F125146_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F117272_24333_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F117380_60020_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F94300_0_0|SrvcGrp|93431|2022|PDM|4200.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F49354_0_0|SrvcGrp|31190|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC (DME)|
20|FH_F127994_19301_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F97564_52246_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F138487_85297_0|SrvcGrp|12659|2022|PDM|1127.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F139327_62220_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139377_02301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139388_33407_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139666_26175_0|SrvcGrp|112812|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER|
20|FH_F139707_84010_0|CSTM-ALL|CSTM-00|2020|PDM|3104.00|99|0.00|AEG 7 (NO REV)|
20|FH_F52092_0_0|SrvcGrp|9830|2022|PDM|58.00|99|0.00|OT SVCS|
20|FH_F117617_80439_0|SrvcGrp|29347|2022|PDM|37.50|99|0.00|HOME HEALTH AIDE|
20|FH_F148496_17112_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|794.00|99|0.00|AEG 2 (NO REV)|
20|FH_F43324_0_0|SrvcGrp|38022|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F148980_18603_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS|
20|FH_F137798_0_0|SrvcGrp|84185|2022|PDM|140.00|99|0.00|RESPITE CARE|
20|FH_F35416_0_0|SrvcGrp|12906|2022|PDM|6000.00|99|0.00|IP LITHOTRIPSY|
20|FH_F111857_68005_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PDM|3308.00|99|0.00|ASPG VII|
20|FH_F140143_24874_0|SrvcGrp|106294|2022|PDM|348.22|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F40498_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F39211_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F149030_37919_0|SrvcGrp|68543|2022|PDM|1830.05|99|0.00|CPT 36561|
20|FH_F131261_19111_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136592_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F116806_0_0|SrvcGrp|107077|2022|PDM|1923.16|99|0.00|EXCISION OF LESION OR TUMOR W/ COMPLEX REPAIR|
20|FH_F140295_0_0|SrvcGrp|34606|2022|PDM|4482.00|99|0.00|CPT 29827|
20|FH_F100680_43130_0|SrvcGrp|73601|2022|PDM|5789.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F109387_35630_0|SrvcGrp|73841|2022|PDM|542.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F125928_0_0|SrvcGrp|106314|2022|PDM|498.38|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F120603_66112_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132969_84003_0|SrvcGrp|86845|2022|PDM|25.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F116806_0_0|SrvcGrp|59338|2022|PDM|2655.05|99|0.00|GENIOPLASTY ARGUMENTATION|
20|FH_F81838_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: ALL|
20|FH_F145562_70458_0|SrvcGrp|86842|2022|PDM|25.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F146103_63851_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F114444_19602_0|SrvcGrp|105373|2022|PDM|55.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MIN (HCFA)|
20|FH_F81698_10457_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD VITAL CARE|
20|FH_F145686_52591_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F43861_0_0|SrvcGrp|35468|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F112004_15401_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|285.09|99|0.00|HAPA WPA-NWPA 2012-13 ASC 114 W/O REV|
20|FH_F119272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40635_0_0|SrvcGrp|439|2022|PDM|1700.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F125124_0_0|SrvcGrp|79579|2022|PDM|3315.00|99|0.00|CPT 43251|
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|1307.00|99|0.00|AEG 2 (NO REV)|
20|FH_F100782_0_0|SrvcGrp|105130|2022|PDM|461.72|99|0.00|WINDBER MEDICAL CNTR ASC 235|
20|FH_F134587_64114_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149031_80525_0|SrvcGrp|75419|2022|PDM|520.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F51934_0_0|SrvcGrp|46604|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F147990_64701_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125765_83617_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F114526_33401_0|SrvcGrp|89417|2022|PDM|401.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F117245_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F110506_98901_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F109577_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122520_46383_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122552_03103_0|SrvcGrp|46903|2022|PDM|450.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F85911_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.50|99|0.00|OP SVCS|
20|FH_F70684_0_0|SrvcGrp|44042|2022|PDM|105.45|99|0.00|SKILLED NURSING - LPN|
20|FH_F105143_26062_0|SrvcGrp|102344|2022|PDM|1470.00|99|0.00|ER LEVEL V W/ SURGERY|
20|FH_F105361_80104_0|SrvcGrp|72998|2022|PDM|2218.00|99|0.00|AEG 5|
20|FH_F63625_0_0|SrvcGrp|60126|2022|PDM|37946.00|99|0.00|CARDIOVASCULAR SURGERY|
20|FH_F120528_60559_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F120795_27514_0|SrvcGrp|113275|2022|PDM|100.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT|
20|FH_F40903_0_0|SrvcGrp|13681|2022|PDM|278.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F66705_0_0|SrvcGrp|62538|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY|
20|FH_F116040_24637_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F131959_31709_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133272_23834_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133574_91607_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F133574_91607_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F111581_77401_0|SrvcGrp|12280|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F111666_06517_0|SrvcGrp|73842|2022|PDM|207.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121946_43209_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F76172_0_0|SrvcGrp|43785|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F98040_89406_0|SrvcGrp|73601|2022|PDM|8079.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F110000_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F91818_02828_0|SrvcGrp|89417|2022|PDM|288.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F97740_01605_0|SrvcGrp|88977|2022|PDM|8368.00|99|0.00|C-SECTION DELIVERY|
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PDM|1572.00|99|0.00|AEG 5  (NO REV)|
20|FH_F68660_0_0|SrvcGrp|15132|2022|PDM|1500.00|99|0.00|ACUTE IP MEDICAL SVCS|
20|FH_F112153_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F142288_44714_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115895_0_0|SrvcGrp|41334|2022|PDM|10079.00|99|0.00|TOTAL KNEE|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER NUKF|
20|FH_F132988_0_0|SrvcGrp|105000|2022|PDM|4493.01|99|0.00|REPAIR OF KNEECAP FRACTURE|
20|FH_F42948_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F141053_17201_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141036_02347_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F50415_0_0|SrvcGrp|44709|2022|PDM|80.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F114389_50131_0|SrvcGrp|105619|2022|PDM|62.48|99|0.00|PORTABLE GASEOUS OXYGEN SYSTEM (MOD RR)|
20|FH_F114389_50131_0|SrvcGrp|98991|2022|PDM|102.96|99|0.00|HYDRATION THERAPY 1 LITER (HCFA)|
20|FH_F114389_50131_0|SrvcGrp|22591|2022|PDM|93.83|99|0.00|IMPLANTED PUMP|
20|FH_F40333_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION|
20|FH_F43536_0_0|SrvcGrp|177|2022|PDM|2831.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F77944_0_0|SrvcGrp|21948|2022|PCT|2.00|99|0.00|OTHER DIAGNOSTIC TESTING|
20|FH_F115971_0_0|SrvcGrp|72990|2022|PDM|363.00|99|0.00|AEG 1|
20|FH_F146674_70778_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F48552_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43800_0_0|CSTM-ALL|CSTM-00|2020|PDM|961.00|99|0.00|SPINAL CORD REHABILITATION|
20|FH_F100703_0_0|SrvcGrp|96999|2022|PDM|3535.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F102180_0_0|SrvcGrp|75545|2022|PCT|0.84|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F41795_0_0|SrvcGrp|30935|2022|PDM|60.00|99|0.00|PT & OT|
20|FH_F42024_0_0|SrvcGrp|9937|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F42708_0_0|SrvcGrp|110|2022|PDM|528.00|99|0.00|CD - REHABILITATION|
20|FH_F146760_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|2503.00|99|0.00|AEG 6 (NO REV)|
20|FH_F62680_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|2291.00|99|0.00|AEG 8 (NO REV)|
20|FH_F150939_0_0|SrvcGrp|90643|2022|PDM|17.01|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F43867_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F54552_0_0|SrvcGrp|27045|2022|PDM|20.33|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS (MOD SJ)|
20|FH_F54552_0_0|SrvcGrp|24752|2022|PDM|19.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F138627_82901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138687_77477_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F138876_25302_0|SrvcGrp|86845|2022|PDM|40.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F67167_0_0|SrvcGrp|21363|2022|PDM|7223.00|99|0.00|MS DRG 766 ONLY REPLACEMENT CODES 785, 788|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|302.50|99|0.00|HAPA WPA-NWPA 2012-13 ASC 119 W/O REV|
20|FH_F151304_31520_0|CSTM-ALL|CSTM-00|2020|PDM|1765.00|99|0.00|AEG 9 (NO REV)|
20|FH_F151427_04106_0|SrvcGrp|90644|2022|PDM|109.38|99|0.00|AETNA MEDICATION ASSISTED TRTMT MAINTENANCE INJECTION (HCFA)|
20|FH_F151509_77076_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135462_06795_0|SrvcGrp|472|2022|PDM|595.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F135489_70508_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135583_17331_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F97142_94535_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS|
20|FH_F135787_60108_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136220_63638_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136247_28804_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F131132_44077_0|SrvcGrp|36591|2022|PDM|36414.00|99|0.00|CPT 63685|
20|FH_F116463_76501_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F101200_19020_0|SrvcGrp|86753|2022|PCT|1.05|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F101681_46123_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F44113_0_0|SrvcGrp|22461|2022|PCT|0.80|99|0.00|INPATIENT HOSPICE SVCS|
20|FH_F131407_07607_0|SrvcGrp|14947|2022|PDM|30.00|99|0.00|HOME INFUSION|
20|FH_F111363_33169_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|1134.75|99|0.00|AEG 10 (NO REV)|
20|FH_F148243_0_0|SrvcGrp|98326|2022|PDM|7500.00|99|0.00|PERQ LAMOT/LAM LUMBAR|
20|FH_F48215_0_0|SrvcGrp|12403|2022|PDM|26.25|99|0.00|CONTINUOUS HOMECARE|
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|3096.00|99|0.00|AEG 9 (NO REV)|
20|FH_F102126_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112105_24924_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|GENERAL ACUTE CARE|
20|FH_F112187_98272_0|CSTM-ALL|CSTM-00|2020|PDM|11579.00|99|0.00|AEG 4 (NO REV)|
20|FH_F127713_30012_0|SrvcGrp|46605|2022|PDM|155.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F126853_19053_0|SrvcGrp|27969|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F102228_08846_0|SrvcGrp|86753|2022|PCT|1.05|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F102228_08846_0|SrvcGrp|43524|2022|PDM|239.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F129240_10028_0|SrvcGrp|17014|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F98300_30236_0|SrvcGrp|75481|2022|PDM|1686.00|99|0.00|AEG 2|
20|FH_F98300_30236_0|SrvcGrp|76619|2022|PCT|2.50|99|0.00|THERAPY|
20|FH_F96960_35404_0|SrvcGrp|73656|2022|PDM|586.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F102960_50613_0|SrvcGrp|90356|2022|PCT|0.62|99|0.00|OP DIALYSIS|
20|FH_F123784_03264_0|SrvcGrp|27969|2022|PDM|29.13|99|0.00|HOME HEALTH AIDE|
20|FH_F64999_0_0|CSTM-ALL|CSTM-00|2020|PDM|481.00|99|0.00|ASPG I|
20|FH_F69968_0_0|SrvcGrp|30063|2022|PCT|0.51|99|0.00|HIGH COST DRUGS|
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|AEG 4 (NO REV)|
20|FH_F134254_33462_0|SrvcGrp|73842|2022|PDM|246.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F134255_01201_0|SrvcGrp|90854|2022|PDM|287.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F136399_70445_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136426_19006_0|SrvcGrp|106317|2022|PDM|823.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F118195_44039_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120489_63552_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F93175_73438_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F136967_63877_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142511_78597_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138541_54840_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|GENERAL ACUTE CARE|
20|FH_F138584_30912_0|SrvcGrp|113375|2022|PDM|1700.00|99|0.00|RECONSTRUCT OF LOWER JAW BONE|
20|FH_F77782_66061_0|SrvcGrp|3809|2022|PDM|843.00|99|0.00|HOSPICE CARE|
20|FH_F78626_91402_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140338_40475_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F140734_71105_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F149374_38855_0|SrvcGrp|90854|2022|PDM|800.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F149511_62626_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149604_08505_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149610_76543_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F109885_35473_0|SrvcGrp|86746|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AETNA GLENNVILLE 2016 AEG 7|
20|FH_F117371_77059_0|SrvcGrp|87441|2022|PDM|795.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F129504_02871_0|SrvcGrp|30609|2022|PDM|17.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F117126_12801_0|CSTM-ALL|CSTM-00|2020|PDM|4365.00|99|0.00|AEG 5  (NO REV)|
20|FH_F109652_0_0|SrvcGrp|16319|2022|PCT|0.49|99|0.00|TRAUMA CARE|
20|FH_F109632_0_0|SrvcGrp|83683|2022|PCT|0.00|99|0.00|ACUTE REHAB II|
20|FH_F112526_0_0|SrvcGrp|30609|2022|PDM|24.15|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F128804_0_0|SrvcGrp|77582|2022|PDM|4263.00|99|0.00|CPT 31255|
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 1 (NO REV)|
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F42952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F36132_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP MAFS  MOD AW|
20|FH_F39919_0_0|SrvcGrp|31514|2022|PDM|1100.00|99|0.00|LAPAROSCOPIC PROCEDURES|
20|FH_F100780_24153_0|SrvcGrp|73643|2022|PDM|2062.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F100783_03431_0|SrvcGrp|73643|2022|PDM|2696.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F111190_30512_0|SrvcGrp|15480|2022|PDM|79.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F151002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|1151.00|99|0.00|AEG 8 (NO REV)|
20|FH_F72544_0_0|SrvcGrp|16274|2022|PCT|1.00|99|0.00|ORGAN ACQUISITION|
20|FH_F111594_0_0|SrvcGrp|11673|2022|PDM|4812.00|99|0.00|CPT 29888|
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2133.00|99|0.00|AEG 4 (NO REV)|
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|AEG 2 (NO REV)|
20|FH_F140035_0_0|SrvcGrp|84778|2022|PDM|1056.00|99|0.00|HOSPICE SERVICES|
20|FH_F148459_15241_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148548_37909_0|SrvcGrp|36591|2022|PDM|22500.00|99|0.00|CPT 63685|
20|FH_F133251_89521_0|SrvcGrp|89149|2022|PDM|234.00|99|0.00|OP INTENSIVE|
20|FH_F122262_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|PDM|113.00|99|0.00|HAPA EPA ASC 19|
20|FH_F41436_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|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_F68888_0_0|SrvcGrp|44107|2022|PDM|48.00|99|0.00|SPEECH THERAPY|
20|FH_F71644_0_0|SrvcGrp|9826|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F136393_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_F118517_33316_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F136751_0_0|SrvcGrp|89842|2022|PDM|16000.00|99|0.00|LUMBAR|
20|FH_F68622_0_0|SrvcGrp|9861|2022|PDM|1138.00|99|0.00|ACUTE REHABILITATION|
20|FH_F144628_21146_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132991_84790_0|SrvcGrp|48396|2022|PDM|85.50|99|0.00|OT SERVICES|
20|FH_F141987_02859_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134544_03874_0|SrvcGrp|89149|2022|PDM|169.00|99|0.00|OP INTENSIVE|
20|FH_F88956_0_0|SrvcGrp|74586|2022|PCT|0.50|99|0.00|AETNA OP HIGH COST DRUGS|
20|FH_F147745_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F117087_0_0|SrvcGrp|106265|2022|PDM|4185.00|99|0.00|NSL/SINS NDSC TOTAL|
20|FH_F119602_0_0|SrvcGrp|93807|2022|PDM|3500.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F109642_80501_0|SrvcGrp|89498|2022|PCT|1.00|99|0.00|AIR AND GROUND AMBULANCE|
20|FH_F117829_45227_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F86098_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117087_0_0|SrvcGrp|107173|2022|PDM|2494.00|99|0.00|REMOVE EAR CANAL LESIONS|
20|FH_F43141_0_0|SrvcGrp|36976|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F51129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F116433_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F150062_92501_0|SrvcGrp|89412|2022|PDM|530.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F73542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS AMBULANCE MS (00512-00) URBAN|
20|FH_F97541_33021_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F33659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F127181_64155_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F38865_0_0|SrvcGrp|38|2022|PDM|2845.00|99|0.00|NORMAL DELIVERY|
20|FH_F42352_0_0|SrvcGrp|24|2022|PDM|2912.00|99|0.00|CARDIAC CATH|
20|FH_F128325_19904_0|SrvcGrp|106269|2022|PCT|0.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F117829_45227_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F92676_15063_0|SrvcGrp|78994|2022|PDM|1162.58|99|0.00|MON VALLEY ASC 306|
20|FH_F112832_06776_0|SrvcGrp|76501|2022|PDM|368.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F99720_0_0|SrvcGrp|73006|2022|PDM|2608.00|99|0.00|AEG 9|
20|FH_F102062_35447_0|SrvcGrp|99066|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PHOTOTHERAPY - BILIRUBIN|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (GLOBAL)|
20|FH_F126858_43113_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F138611_0_0|SrvcGrp|88155|2022|PDM|14894.00|99|0.00|REVISE KNEECAP WITH IMPLANT|
20|FH_F125103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132934_63005_0|SrvcGrp|72602|2022|PDM|734.00|99|0.00|ECT|
20|FH_F101840_76054_0|SrvcGrp|20744|2022|PDM|30269.00|99|0.00|MS DRG 242 ONLY|
20|FH_F41441_0_0|SrvcGrp|10425|2022|PDM|266.00|99|0.00|NEWBORN NURSERY|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 949|
20|FH_F87362_15746_0|SrvcGrp|471|2022|PDM|467.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F88280_0_0|SrvcGrp|59159|2022|PCT|0.55|99|0.00|OP SURGERY|
20|FH_F37575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100682_97401_0|SrvcGrp|73605|2022|PDM|3641.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F148900_0_0|SrvcGrp|92405|2022|PDM|2133.00|99|0.00|PERQ LUMBOSACRAL INJECTION|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 640|
20|FH_F100740_15206_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F125215_78130_0|CSTM-ALL|CSTM-00|2020|PCT|2.25|99|0.00|HSS ASC|
20|FH_F146370_19355_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F144408_21617_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117340_68144_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F126975_43551_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F133412_84129_0|SrvcGrp|473|2022|PDM|318.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120437_85202_0|SrvcGrp|86125|2022|PDM|44.66|99|0.00|AETNA FLEBOGAMMA INJ|
20|FH_F117891_19034_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F123158_0_0|SrvcGrp|109307|2022|PDM|1200.00|99|0.00|DESTRUCTION ANAL LESION(S)|
20|FH_F63301_0_0|SrvcGrp|1168|2022|PDM|788.55|99|0.00|CONTINUOUS HOMECARE|
20|FH_F138054_0_0|SrvcGrp|46605|2022|PDM|161.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F40176_0_0|SrvcGrp|32015|2022|PDM|45.00|99|0.00|NURSING VISIT|
20|FH_F68301_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F150541_37922_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F92833_0_0|SrvcGrp|33967|2022|PDM|2215.00|99|0.00|CPT 47562|
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|AEG 10 (NO REV)|
20|FH_F50618_0_0|SrvcGrp|17075|2022|PDM|1096.85|99|0.00|ASPG VI|
20|FH_F100784_59923_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F111456_33884_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F113315_72205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92648_90248_0|SrvcGrp|29347|2022|PDM|15.75|99|0.00|HOME HEALTH AIDE|
20|FH_F100740_15206_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F100664_03104_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F133627_89113_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F143487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F45977_0_0|SrvcGrp|15648|2022|PDM|90.00|99|0.00|HOME HEALTH AIDE|
20|FH_F48892_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|PROFESSIONAL FEES ON CMS1500|
20|FH_F149840_80002_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|NON-ANESTHESIOLOGIST/CRNA (HAN3)|
20|FH_F37475_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F91155_16105_0|SrvcGrp|22384|2022|PDM|102.00|99|0.00|HOME VISIT PRENATAL|
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143057_15767_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F106400_02905_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F148903_51101_0|SrvcGrp|73700|2022|PDM|61.80|99|0.00|AETNA - SKILLED NURSING|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD KF) - BDSS|
20|FH_F39546_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F44435_0_0|SrvcGrp|16732|2022|PDM|3900.00|99|0.00|HYSTEROSCOPY ABLATION|
20|FH_F117725_38036_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F150523_20877_0|SrvcGrp|74668|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F44414_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F134447_12883_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148021_80907_0|SrvcGrp|73523|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F94300_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F73502_0_0|SrvcGrp|3809|2022|PDM|425.00|99|0.00|HOSPICE CARE|
20|FH_F83514_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.20|99|0.00|GENERAL ACUTE CARE|
20|FH_F89851_83854_0|SrvcGrp|89959|2022|PDM|6086.00|99|0.00|LAMINOTOMY|
20|FH_F150902_21713_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F72980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128893_0_0|SrvcGrp|80918|2022|PDM|150.00|99|0.00|RESPITE CARE|
20|FH_F119206_35007_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F150463_50701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|77.00|99|0.00|OFFICE / OP VISIT EAST|
20|FH_F148555_0_0|SrvcGrp|115501|2022|PDM|3090.00|99|0.00|STIMULATION, PACING HEART|
20|FH_F101760_63851_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88512_0_0|SrvcGrp|17069|2022|PDM|2181.67|99|0.00|ASPG III|
20|FH_F122648_0_0|SrvcGrp|92545|2022|PDM|758.00|99|0.00|FOLLOW-UP SURGERY OF EYE|
20|FH_F119437_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F146211_68144_0|SrvcGrp|88160|2022|PDM|12473.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F150905_01608_0|SrvcGrp|115863|2022|PDM|61.55|99|0.00|ALCOHOL/DRUG OUTREACH (MOD HT) (0-21 YRS)|
20|FH_F126666_44053_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131282_0_0|SrvcGrp|111801|2022|PDM|400.00|99|0.00|TREATMENT OF RETINAL LESION|
20|FH_F106660_26554_0|SrvcGrp|48385|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F92636_90230_0|SrvcGrp|48398|2022|PDM|89.25|99|0.00|PT SERVICES|
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|779.00|99|0.00|AEG 4 (NO REV)|
20|FH_F117895_28170_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F111456_33884_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F127412_15301_0|SrvcGrp|110736|2022|PDM|925.00|99|0.00|DRAINAGE OF EYE|
20|FH_F130108_0_0|SrvcGrp|10903|2022|PDM|750.00|99|0.00|EMERGENCY ROOM LEVEL I|
20|FH_F128349_43082_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1305.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 6|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|368.23|99|0.00|HAPA WPA-NWPA 2012-13 ASC 223 W/O REV|
20|FH_F141804_70503_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F133028_08021_0|SrvcGrp|108369|2022|PDM|102.00|99|0.00|PSYTX W PT W E/M 30 MINS (HCFA)|
20|FH_F150024_08079_0|CSTM-ALL|CSTM-00|2020|PDM|2726.00|99|0.00|AEG 6 (NO REV)|
20|FH_F37562_0_0|SrvcGrp|10538|2022|PDM|84.50|99|0.00|NURSING CARE|
20|FH_F132864_71101_0|SrvcGrp|13293|2022|PCT|0.65|99|0.00|HIGH-COST DRUGS|
20|FH_F124212_33407_0|SrvcGrp|89337|2022|PDM|830.00|99|0.00|DETOXIFICATION|
20|FH_F97083_90670_0|SrvcGrp|73643|2022|PDM|855.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F66388_0_0|SrvcGrp|44105|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY|
20|FH_F87856_0_0|SrvcGrp|75487|2022|PDM|932.00|99|0.00|AEG 5|
20|FH_F114678_78745_0|SrvcGrp|74668|2022|PDM|234.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138779_62703_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F139372_34698_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114985_32073_0|SrvcGrp|104822|2022|PCT|0.85|99|0.00|OP SERVICES|
20|FH_F100664_03104_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F144039_0_0|SrvcGrp|82570|2022|PDM|4590.00|99|0.00|REVISION EYELID/EXCESS SKIN|
20|FH_F122610_73139_0|SrvcGrp|43924|2022|PDM|376.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F43321_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F134727_30650_0|SrvcGrp|73483|2022|PDM|962.00|99|0.00|AETNA SUBACUTE III|
20|FH_F63256_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112485_61032_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116199_75042_0|SrvcGrp|87441|2022|PDM|796.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F116393_07002_0|CSTM-ALL|CSTM-00|2020|PDM|31.19|99|0.00|MANUAL BODY MUSCLE TESTING|
20|FH_F147701_31093_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147444_32839_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73731_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F37257_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114853_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F138681_39301_0|SrvcGrp|106048|2022|PDM|958.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F138936_01040_0|SrvcGrp|73499|2022|PDM|618.00|99|0.00|AETNA ER LEVEL II|
20|FH_F91641_0_0|SrvcGrp|91457|2022|PDM|1768.68|99|0.00|MINOR SURGERY|
20|FH_F88893_0_0|SrvcGrp|87843|2022|PDM|5940.00|99|0.00|REVISE STOMACH - BOWEL FUSION|
20|FH_F75185_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F75185_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F151512_27587_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132258_45404_0|SrvcGrp|86847|2022|PDM|34.98|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F132268_07060_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F132268_07060_0|SrvcGrp|104967|2022|PCT|0.95|99|0.00|NOC DRUGS|
20|FH_F128181_62690_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F91735_92653_0|SrvcGrp|65720|2022|PDM|94.50|99|0.00|RESPITE CARE|
20|FH_F135874_74403_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100880_67735_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131407_07607_0|SrvcGrp|86853|2022|PDM|30.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F131361_18235_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130766_04967_0|SrvcGrp|75506|2022|PCT|0.88|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F121719_63122_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|787.00|99|0.00|AEG 4 (NO REV)|
20|FH_F69205_0_0|SrvcGrp|35183|2022|PDM|74.04|99|0.00|SKILLED NURSING (ADDITIONAL HOURS)|
20|FH_F72743_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134263_15628_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F141651_0_0|SrvcGrp|113815|2022|PDM|154.00|99|0.00|VENTILATOR TUBE REMOVAL|
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|AEG 7 (NO REV)|
20|FH_F33081_0_0|SrvcGrp|3420|2022|PDM|3600.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F36344_0_0|SrvcGrp|10649|2022|PDM|4.00|99|0.00|HOME INFUSION|
20|FH_F40993_0_0|CSTM-ALL|CSTM-00|2020|PDM|870.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|1188.00|99|0.00|AEG 10 (NO REV)|
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|1925.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132328_0_0|SrvcGrp|67069|2022|PDM|14566.00|99|0.00|CPT 22634|
20|FH_F101320_26062_0|SrvcGrp|24750|2022|PDM|18.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F101320_26062_0|SrvcGrp|14945|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F98624_15701_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
20|FH_F102948_43606_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F33381_0_0|SrvcGrp|9774|2022|PDM|3494.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 10 (NO REV)|
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100681_73104_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F50516_15014_0|SrvcGrp|10431|2022|PDM|47.00|99|0.00|SPEECH THERAPY|
20|FH_F100906_0_0|SrvcGrp|72992|2022|PDM|643.00|99|0.00|AEG 2|
20|FH_F68837_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139689_0_0|SrvcGrp|108043|2022|PDM|232.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F88545_78734_0|SrvcGrp|87539|2022|PCT|1.05|99|0.00|PHYSICAL / OCCUPATIONAL / SPEECH THERAPY|
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|129.45|99|0.00|AETNA SLEEP STUDIES|
20|FH_F123752_44502_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123783_03860_0|SrvcGrp|48396|2022|PDM|163.00|99|0.00|OT SERVICES|
20|FH_F132810_0_0|SrvcGrp|19742|2022|PDM|80.00|99|0.00|MID-LINE INSERTION|
20|FH_F136373_17055_0|SrvcGrp|14494|2022|PDM|26.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F136400_70360_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|GENERAL ACUTE CARE|
20|FH_F120490_64133_0|SrvcGrp|86832|2022|PDM|4.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F134008_11221_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F134011_84102_0|SrvcGrp|88620|2022|PDM|103.00|99|0.00|SKILLED NURSING RN|
20|FH_F134150_01801_0|SrvcGrp|109612|2022|PDM|377.00|99|0.00|PARTIAL HOSPITALIZATION (<=17 YRS)|
20|FH_F142473_07663_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|3520.00|99|0.00|AEG 9 (NO REV)|
20|FH_F102525_73134_0|SrvcGrp|11663|2022|PCT|0.35|99|0.00|IMPLANTS|
20|FH_F73505_0_0|SrvcGrp|17000|2022|PCT|0.60|99|0.00|OUTPATIENT SURGERY|
20|FH_F137748_95231_0|CSTM-ALL|CSTM-00|2020|PDM|5217.00|99|0.00|AEG 7 (NO REV)|
20|FH_F137789_48146_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F140295_0_0|SrvcGrp|41335|2022|PDM|20688.00|99|0.00|TOTAL HIP|
20|FH_F47902_0_0|SrvcGrp|29666|2022|PCT|1.00|99|0.00|DME MOD RR|
20|FH_F148667_0_0|SrvcGrp|99073|2022|PDM|1.66|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F36403_0_0|SrvcGrp|9861|2022|PDM|360.00|99|0.00|ACUTE REHABILITATION|
20|FH_F146204_0_0|SrvcGrp|114177|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F134410_46807_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F47558_0_0|SrvcGrp|43264|2022|PDM|4.00|99|0.00|IMPLANTABLE PORTS CATH CARE|
20|FH_F97084_91911_0|SrvcGrp|73461|2022|PDM|11268.00|99|0.00|AETNA NICU IV|
20|FH_F140295_0_0|SrvcGrp|88491|2022|PDM|7413.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F109221_15084_0|SrvcGrp|48396|2022|PDM|88.00|99|0.00|OT SERVICES|
20|FH_F149619_81008_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139576_0_0|SrvcGrp|19921|2022|PDM|3060.00|99|0.00|ARTHROSCOPICALLY LIGAMENT REPAIR|
20|FH_F80834_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|(LAB) OCN F/S PRICING: ALL|
20|FH_F149023_44122_0|SrvcGrp|112959|2022|PDM|9029.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F36202_0_0|SrvcGrp|16|2022|PDM|1756.00|99|0.00|ACUTE REHABILITATION|
20|FH_F149269_73120_0|SrvcGrp|78504|2022|PCT|0.63|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F149522_83221_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F131418_75215_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F119795_0_0|SrvcGrp|107002|2022|PDM|20453.00|99|0.00|REVISE/RECONSTRUCT SHOULDER JOINT|
20|FH_F148181_0_0|SrvcGrp|87799|2022|PDM|155.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F148667_0_0|SrvcGrp|27261|2022|PDM|11000.00|99|0.00|CPT 27446|
20|FH_F38475_0_0|SrvcGrp|10542|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F97082_90012_0|SrvcGrp|73601|2022|PDM|11030.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F117762_0_0|SrvcGrp|88157|2022|PDM|14560.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F124383_39056_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F97300_47501_0|SrvcGrp|86667|2022|PDM|1250.00|99|0.00|AETNA ER & OBS|
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|373.00|99|0.00|ASPG I - GNADEN HUETTEN|
20|FH_F113545_11201_0|SrvcGrp|86747|2022|PCT|1.02|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F40690_0_0|SrvcGrp|188|2022|PCT|0.80|99|0.00|AZT (ZIDOVUDINE)|
20|FH_F50652_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111266_30339_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F138018_17313_0|SrvcGrp|29076|2022|PDM|103.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F128987_65737_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137789_48146_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F124976_0_0|SrvcGrp|86722|2022|PDM|247.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F47558_0_0|SrvcGrp|43270|2022|PDM|50.00|99|0.00|CATHETER REPAIR|
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F122323_60450_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F110729_15068_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F97101_98003_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F37536_0_0|SrvcGrp|13638|2022|PDM|98.00|99|0.00|CPT 99244|
20|FH_F36435_0_0|SrvcGrp|16070|2022|PDM|232.50|99|0.00|AMBULANCE - BLS|
20|FH_F143668_0_0|SrvcGrp|37161|2022|PDM|330.00|99|0.00|PNEUMATIC COMPRESSOR (MOD RR)|
20|FH_F74902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128977_0_0|SrvcGrp|87077|2022|PDM|265.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F114207_35243_0|SrvcGrp|22592|2022|PDM|35.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F139792_26034_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151745_27312_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151753_03104_0|SrvcGrp|473|2022|PDM|391.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120862_87108_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120966_60707_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F118874_29926_0|SrvcGrp|87317|2022|PDM|1000.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F118917_33317_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
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_F83493_21220_0|SrvcGrp|472|2022|PDM|472.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|443.02|99|0.00|ASPG II|
20|FH_F109240_21201_0|SrvcGrp|89640|2022|PDM|330.00|99|0.00|SET RADIATION THERAPY FIELD|
20|FH_F39760_0_0|SrvcGrp|27301|2022|PDM|20.00|99|0.00|CPT 92567|
20|FH_F151400_0_0|SrvcGrp|87120|2022|PDM|4600.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F130681_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|7416.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL|
20|FH_F132779_0_0|SrvcGrp|87311|2022|PDM|19709.00|99|0.00|MSDRG 274 ONLY|
20|FH_F71185_0_0|SrvcGrp|14174|2022|PDM|2431.00|99|0.00|MRI|
20|FH_F46941_0_0|SrvcGrp|42046|2022|PDM|595.00|99|0.00|HOSPICE CARE|
20|FH_F135237_31015_0|SrvcGrp|88621|2022|PDM|130.00|99|0.00|SKILLED NURSING LPN|
20|FH_F95200_16201_0|SrvcGrp|79458|2022|PDM|0.10|99|0.00|MED RECORD COPY|
20|FH_F116998_17701_0|SrvcGrp|471|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 7 (NO REV)|
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F138471_84663_0|SrvcGrp|106116|2022|PDM|615.00|99|0.00|HOSPICE ROUT HOME CARE-DIEM|
20|FH_F138584_30912_0|SrvcGrp|113381|2022|PDM|1500.00|99|0.00|RECONSTRUCTION MIDFACE LEFORT I|
20|FH_F138584_30912_0|SrvcGrp|113396|2022|PDM|1050.00|99|0.00|NASOMAXILLARY COMPLEX FRACTURE TREATMENT|
20|FH_F140312_77365_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140335_70435_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F119023_91406_0|SrvcGrp|26868|2022|PDM|35.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F109925_81301_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F48292_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F67880_0_0|SrvcGrp|9838|2022|PDM|2530.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F70665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92852_0_0|SrvcGrp|38909|2022|PDM|1320.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F147801_90703_0|SrvcGrp|73842|2022|PDM|329.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129483_77030_0|SrvcGrp|24745|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F117102_39355_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F117105_77619_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F117126_12801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F117240_37334_0|SrvcGrp|23279|2022|PDM|450.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F117240_37334_0|SrvcGrp|16429|2022|PDM|1200.00|99|0.00|OBSERVATION SVCS|
20|FH_F137814_61820_0|SrvcGrp|73842|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137937_20032_0|SrvcGrp|73485|2022|PDM|1545.00|99|0.00|AETNA REHAB|
20|FH_F35210_0_0|SrvcGrp|70252|2022|PCT|0.50|99|0.00|HIGH COST DRUGS|
20|FH_F111593_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F124754_84403_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F129892_0_0|SrvcGrp|88610|2022|PDM|1495.00|99|0.00|NASAL ENDOSCOPY|
20|FH_F139433_37115_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F80084_0_0|SrvcGrp|26001|2022|PDM|140.69|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F69347_0_0|SrvcGrp|44764|2022|PDM|5939.00|99|0.00|PORTLAND ADVENTIST ASPG III|
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PDM|956.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132544_0_0|SrvcGrp|106557|2022|PDM|7850.00|99|0.00|REVISE KNEE 2|
20|FH_F119491_19904_0|SrvcGrp|27968|2022|PDM|26.25|99|0.00|SKILLED NURSING LPN|
20|FH_F43433_0_0|SrvcGrp|32439|2022|PDM|4730.00|99|0.00|JACKSON MADISON HOSP ASPG 3|
20|FH_F97621_75801_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|597.00|99|0.00|AEG 1 (NO REV)|
20|FH_F69063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F141731_92590_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F49617_0_0|SrvcGrp|12965|2022|PDM|992.00|99|0.00|CD - REHAB|
20|FH_F78682_0_0|CSTM-ALL|CSTM-00|2020|PDM|1409.09|99|0.00|ASPG VI|
20|FH_F149665_65689_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127994_19301_0|SrvcGrp|109330|2022|PCT|1.15|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F44607_0_0|SrvcGrp|8|2022|PDM|2750.00|99|0.00|BURN INTENSIVE CARE|
20|FH_F142888_77095_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123069_75070_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F124957_60473_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89932_10940_0|SrvcGrp|73000|2022|PDM|3082.00|99|0.00|AEG 6|
20|FH_F149781_37404_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F97041_71603_0|SrvcGrp|73659|2022|PDM|7063.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150911_75979_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97581_60141_0|SrvcGrp|90854|2022|PDM|3326.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F121011_68510_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F127191_44720_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F150100_39301_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67136_0_0|SrvcGrp|62717|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F135690_20814_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|1564.00|99|0.00|AEG 6 (NO REV)|
20|FH_F38396_0_0|SrvcGrp|12350|2022|PDM|600.00|99|0.00|BOARDER BABY SERVICES|
20|FH_F127422_0_0|SrvcGrp|72994|2022|PDM|510.00|99|0.00|AEG 3|
20|FH_F111417_33613_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148906_79336_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|100% 2007 MEDICARE DME TN  MOD UE|
20|FH_F87579_33707_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F119291_0_0|SrvcGrp|105357|2022|PDM|435.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F79902_0_0|SrvcGrp|1259|2022|PDM|2470.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F118698_32054_0|SrvcGrp|70020|2022|PCT|1.60|99|0.00|PROFESSIONAL RADIOLOGY SERVICES|
20|FH_F150519_92626_0|SrvcGrp|110811|2022|PDM|550.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F78682_0_0|CSTM-ALL|CSTM-00|2020|PDM|870.02|99|0.00|ASPG III|
20|FH_F128893_0_0|SrvcGrp|80920|2022|PDM|600.00|99|0.00|HOSPICE SERVICES|
20|FH_F50237_0_0|SrvcGrp|9774|2022|PDM|1550.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F91155_16105_0|SrvcGrp|73601|2022|PDM|1537.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F92912_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F122245_0_0|SrvcGrp|55084|2022|PDM|8480.00|99|0.00|CPT 52648|
20|FH_F69750_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137240_0_0|SrvcGrp|941|2022|PDM|4678.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F50472_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|PDM|1709.53|99|0.00|ASPG IV|
20|FH_F148900_0_0|SrvcGrp|92364|2022|PDM|16453.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F143528_0_0|SrvcGrp|88164|2022|PDM|10500.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F148892_0_0|SrvcGrp|35669|2022|PDM|7183.00|99|0.00|CPT 63650|
20|FH_F145550_62034_0|SrvcGrp|104841|2022|PDM|660.00|99|0.00|HOSPICE CARE PROVIDED IP HOSPICE FAC|
20|FH_F143528_0_0|SrvcGrp|58638|2022|PDM|2296.35|99|0.00|CPT 63688|
20|FH_F115669_07652_0|SrvcGrp|90573|2022|PDM|265.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F135078_73119_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137717_13901_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F44495_0_0|SrvcGrp|12401|2022|PDM|108.00|99|0.00|RN VISIT|
20|FH_F40270_0_0|SrvcGrp|6|2022|PCT|0.90|99|0.00|OP SURGERY|
20|FH_F93881_15009_0|SrvcGrp|87105|2022|PDM|74.00|99|0.00|X-RAY EXAM OF WRIST|
20|FH_F43294_0_0|SrvcGrp|18932|2022|PDM|2800.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806|
20|FH_F135248_84651_0|SrvcGrp|471|2022|PDM|608.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F94862_0_0|SrvcGrp|73000|2022|PDM|900.00|99|0.00|AEG 6|
20|FH_F134287_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F130317_0_0|SrvcGrp|95664|2022|PDM|2276.20|99|0.00|POST- NEONATAL|
20|FH_F120338_83226_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F123885_60062_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F31861_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62719_0_0|SrvcGrp|30955|2022|PDM|108.00|99|0.00|SKILLED RN VISIT|
20|FH_F66409_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149740_33912_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128580_0_0|SrvcGrp|107793|2022|PDM|9725.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F40519_0_0|SrvcGrp|592|2022|PDM|525.00|99|0.00|SUB-ACUTE CARE|
20|FH_F39286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE|
20|FH_F128580_0_0|SrvcGrp|107792|2022|PDM|6002.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F98920_46526_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|1002.00|99|0.00|AEG 8 (NO REV)|
20|FH_F35287_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F118703_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH|
20|FH_F87619_0_0|SrvcGrp|73006|2022|PDM|1502.00|99|0.00|AEG 9|
20|FH_F116027_17745_0|SrvcGrp|75545|2022|PDM|360.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F38159_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137067_0_0|SrvcGrp|67279|2022|PDM|16800.00|99|0.00|CERVICAL SURGERY|
20|FH_F124660_0_0|SrvcGrp|73004|2022|PDM|1138.00|99|0.00|AEG 8|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.43|99|0.00|HAPA WPA-NWPA 2012-13 ASC 6 W/O REV|
20|FH_F148122_49435_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F40189_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148265_06067_0|SrvcGrp|109833|2022|PDM|16384.00|99|0.00|REPLACE ELBOW JOINT|
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91876_0_0|SrvcGrp|46890|2022|PDM|2200.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|1788.00|99|0.00|AEG 8 (NO REV)|
20|FH_F149869_03253_0|SrvcGrp|29464|2022|PDM|160.00|99|0.00|HOME HEALTH VISIT NEWBORN CARE|
20|FH_F49338_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F39279_0_0|SrvcGrp|9840|2022|PDM|1850.00|99|0.00|ICU UNIT|
20|FH_F112272_0_0|SrvcGrp|30089|2022|PDM|442.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F130154_33607_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F150780_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130681_15701_0|SrvcGrp|111986|2022|PCT|1.45|99|0.00|REMOTE EVALUATION VIDEO/IMAGES|
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|949.00|99|0.00|AEG 3 (NO REV)|
20|FH_F39339_0_0|SrvcGrp|36589|2022|PCT|0.55|99|0.00|HIGH COST DRUGS|
20|FH_F131995_04730_0|SrvcGrp|46605|2022|PDM|90.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F85115_0_0|SrvcGrp|76421|2022|PDM|393.75|99|0.00|HEMODIALYSIS|
20|FH_F54974_0_0|SrvcGrp|51042|2022|PDM|1250.00|99|0.00|INTENSIVE CARE SERVICES|
20|FH_F147941_06023_0|SrvcGrp|103913|2022|PCT|5.00|99|0.00|OP DIALYSIS|
20|FH_F140910_53005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F64519_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48192_0_0|SrvcGrp|472|2022|PDM|480.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F78343_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F143870_19134_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148160_29732_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137366_87505_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F67309_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F110925_01104_0|SrvcGrp|12993|2022|PDM|65.00|99|0.00|ACTIVASE|
20|FH_F93534_45690_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137457_32216_0|SrvcGrp|106048|2022|PDM|1019.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
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_F82114_0_0|SrvcGrp|75325|2022|PDM|180.82|99|0.00|SLEEP STUDY CPT 95800|
20|FH_F87254_0_0|SrvcGrp|98526|2022|PDM|1100.00|99|0.00|CYSTOURETHROSCOPY|
20|FH_F52854_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F93880_95476_0|CSTM-ALL|CSTM-00|2020|PDM|5939.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149869_03253_0|SrvcGrp|48385|2022|PDM|170.00|99|0.00|SPEECH THERAPY|
20|FH_F38090_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.00|99|0.00|ACUTE PSYCH|
20|FH_F34735_0_0|SrvcGrp|9978|2022|PDM|1950.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS|
20|FH_F124017_0_0|SrvcGrp|97099|2022|PDM|5200.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F120059_0_0|SrvcGrp|108116|2022|PDM|1700.00|99|0.00|AV FUSION / UPPER ARM VEIN|
20|FH_F128272_60640_0|SrvcGrp|111026|2022|PCT|0.83|99|0.00|SUPPLIES|
20|FH_F128973_44256_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F142992_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101983_17578_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117909_92405_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F36917_0_0|SrvcGrp|23587|2022|PDM|325.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F141930_72032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F42500_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|SKILLED NURSING CARE|
20|FH_F143187_52565_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147995_67037_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F67560_0_0|SrvcGrp|17071|2022|PCT|0.83|99|0.00|ASPG IV|
20|FH_F47834_0_0|SrvcGrp|30159|2022|PCT|1.10|99|0.00|LABORATORY MOD TC|
20|FH_F134447_12883_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F119220_75068_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125176_20785_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115431_32821_0|SrvcGrp|88819|2022|PDM|688.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F148039_92629_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146211_68144_0|SrvcGrp|92363|2022|PDM|14230.00|99|0.00|OSTEOCHONDRAL ALLOGRAFT KNEE|
20|FH_F46492_0_0|SrvcGrp|10391|2022|PDM|2145.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F101840_76054_0|SrvcGrp|31928|2022|PDM|21180.00|99|0.00|MS DRG 456 ONLY|
20|FH_F40591_0_0|SrvcGrp|9510|2022|PDM|1194.00|99|0.00|SKILLED NURSING CARE|
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F44724_0_0|SrvcGrp|26742|2022|PDM|48.00|99|0.00|PT|
20|FH_F38089_0_0|SrvcGrp|360|2022|PDM|1276.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F133028_08021_0|SrvcGrp|86722|2022|PDM|242.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F141833_31707_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F115315_43011_0|SrvcGrp|106098|2022|PCT|1.00|99|0.00|CEFTAROLINE FOSAMIL INJ|
20|FH_F92833_0_0|SrvcGrp|35668|2022|PDM|2215.00|99|0.00|CPT 29824|
20|FH_F133455_60110_0|SrvcGrp|88621|2022|PDM|100.79|99|0.00|SKILLED NURSING LPN|
20|FH_F144191_0_0|SrvcGrp|90363|2022|PDM|3700.00|99|0.00|REVISE/IMPLANT FINGER JOINT|
20|FH_F103281_32086_0|SrvcGrp|43523|2022|PDM|225.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKE|
20|FH_F88816_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149781_37404_0|CSTM-ALL|CSTM-00|2020|PDM|2454.00|99|0.00|AEG 6 (NO REV)|
20|FH_F110606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141627_43725_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144048_91324_0|SrvcGrp|46903|2022|PDM|2835.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F44354_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ACUTE PSYCH|
20|FH_F100880_67735_0|SrvcGrp|72990|2022|PDM|1077.00|99|0.00|AEG 1|
20|FH_F148644_06890_0|SrvcGrp|67989|2022|PDM|5150.00|99|0.00|CPT 49320|
20|FH_F148863_33021_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151122_10462_0|SrvcGrp|88621|2022|PDM|116.00|99|0.00|SKILLED NURSING LPN|
20|FH_F138487_85297_0|SrvcGrp|89337|2022|PDM|1127.00|99|0.00|DETOXIFICATION|
20|FH_F138742_33125_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150768_03054_0|SrvcGrp|95660|2022|PDM|821.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F150839_03833_0|SrvcGrp|29155|2022|PDM|208.00|99|0.00|HOSPICE SVCS|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|279.45|99|0.00|SALLY BALIN,999182,ASC 108|
20|FH_F141334_66401_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149529_68102_0|SrvcGrp|75419|2022|PDM|402.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148181_0_0|SrvcGrp|90707|2022|PDM|155.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F36992_0_0|CSTM-ALL|CSTM-00|2020|PDM|65.00|99|0.00|DBPT PT-OT-ST|
20|FH_F37304_0_0|SrvcGrp|16813|2022|PDM|1885.00|99|0.00|LITHOTRIPSY|
20|FH_F98623_97006_0|CSTM-ALL|CSTM-00|2020|PCT|0.58|99|0.00|OP SVCS|
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)|
20|FH_F131512_37617_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147532_0_0|SrvcGrp|90477|2022|PDM|144.84|99|0.00|HOSPICE|
20|FH_F120157_93103_0|SrvcGrp|23587|2022|PDM|525.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F98000_59102_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F86717_0_0|CSTM-ALL|CSTM-00|2020|PDM|589.94|99|0.00|AEG 1 (NO REV)|
20|FH_F41363_0_0|CSTM-ALL|CSTM-00|2020|PDM|845.00|99|0.00|ASPG IV|
20|FH_F148519_83201_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F150459_08021_0|SrvcGrp|82224|2022|PDM|30.25|99|0.00|HOSPICE CONT HOME CARE|
20|FH_F103760_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F141278_80218_0|SrvcGrp|110886|2022|PDM|2550.00|99|0.00|INTERM LABOR FACILITY GLOBAL|
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 8 (NO REV)|
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1610.00|99|0.00|AEG 1 (NO REV)|
20|FH_F50461_0_0|SrvcGrp|20154|2022|PDM|210283.00|99|0.00|DOUBLE LUNG TRANSPLANT INCLUDING PHYSICIAN FEES|
20|FH_F114206_37203_0|SrvcGrp|24744|2022|PDM|60.00|99|0.00|PICC LINE INSERTION|
20|FH_F132149_60624_0|SrvcGrp|89149|2022|PDM|235.00|99|0.00|OP INTENSIVE|
20|FH_F116806_0_0|SrvcGrp|105237|2022|PDM|949.60|99|0.00|BIOPSY/REMOVAL LYMPH NODE(S)|
20|FH_F150982_0_0|SrvcGrp|90367|2022|PDM|1927.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 7 (NO REV)|
20|FH_F137767_01841_0|SrvcGrp|21124|2022|PDM|49993.00|99|0.00|MS DRG 471 ONLY|
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.00|99|0.00|AEG 2 (NO REV)|
20|FH_F47212_0_0|SrvcGrp|52782|2022|PDM|30.00|99|0.00|VENIPUNCTURE PER VISIT|
20|FH_F116332_0_0|SrvcGrp|115366|2022|PDM|2947.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F133519_0_0|SrvcGrp|112209|2022|PDM|1255.00|99|0.00|DESTROY VAGINAL LESIONS COMPLEX|
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114568_08097_0|SrvcGrp|86749|2022|PCT|1.05|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F149085_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F56793_0_0|SrvcGrp|43572|2022|PDM|80.00|99|0.00|PICC-LINE INSERTION|
20|FH_F148003_34285_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128485_44667_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139368_57043_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F139677_77087_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F150769_02302_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148539_33548_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F98000_59102_0|SrvcGrp|90854|2022|PDM|2103.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F120144_77031_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F98900_42001_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F100663_56537_0|SrvcGrp|73643|2022|PDM|2637.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F131392_17004_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F94643_90501_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING-OP W/O HOME INFUSION|
20|FH_F128366_32901_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151043_71901_0|SrvcGrp|115926|2022|PCT|1.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F130661_04441_0|SrvcGrp|79699|2022|PCT|0.86|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F148902_40509_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90223_0_0|SrvcGrp|88812|2022|PDM|55.00|99|0.00|HOME PHARMACY SERVICES (HCFA)|
20|FH_F50078_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F137769_85234_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141511_0_0|SrvcGrp|78579|2022|PDM|1400.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
20|FH_F38584_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134397_27513_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F114207_35243_0|SrvcGrp|24752|2022|PDM|15.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F149003_62208_0|SrvcGrp|29347|2022|PDM|14.00|99|0.00|HOME HEALTH AIDE|
20|FH_F36299_0_0|SrvcGrp|16|2022|PDM|1085.00|99|0.00|ACUTE REHABILITATION|
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|1897.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F43236_0_0|SrvcGrp|13643|2022|PDM|1500.00|99|0.00|DRG 372 NORMAL DELIVERY (MOTHER ONLY)|
20|FH_F89851_83854_0|SrvcGrp|28120|2022|PDM|29196.00|99|0.00|MS DRG 467 ONLY|
20|FH_F110725_48047_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149023_44122_0|SrvcGrp|41334|2022|PDM|13451.00|99|0.00|TOTAL KNEE|
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 3 (NO REV)|
20|FH_F93377_0_0|SrvcGrp|74546|2022|PDM|500.00|99|0.00|HOSPICE SERVICES|
20|FH_F36943_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD AU|
20|FH_F97480_08204_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F134869_08854_0|SrvcGrp|90636|2022|PDM|182.00|99|0.00|AETNA PSYTX PT & FAMILY 60 MINUTES (HCFA)|
20|FH_F132008_85226_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F131261_19111_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148959_77375_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F141247_18902_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F100663_56537_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F116575_0_0|SrvcGrp|89882|2022|PDM|2500.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F150982_0_0|SrvcGrp|77448|2022|PDM|2532.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|503.00|99|0.00|AEG 1 (NO REV)|
20|FH_F48617_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F138017_73129_0|SrvcGrp|11663|2022|PCT|0.33|99|0.00|IMPLANTS|
20|FH_F124413_30067_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131525_32159_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97521_30824_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149373_0_0|SrvcGrp|98701|2022|PDM|384.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F39756_0_0|SrvcGrp|31525|2022|PDM|1628.55|99|0.00|CUMBERLAND SURGERY CTR - ASPG IX|
20|FH_F89851_83854_0|SrvcGrp|31017|2022|PDM|23409.00|99|0.00|MS DRG 468 ONLY|
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|11600.00|99|0.00|MS DRG 219-221|
20|FH_F65100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F98020_50138_0|SrvcGrp|73601|2022|PDM|7720.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F148962_08109_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F42746_0_0|SrvcGrp|16746|2022|PDM|55.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F149515_66002_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|CHEMOTHERAPY - CONTINUOUS (MOD SH)|
20|FH_F117762_0_0|SrvcGrp|74039|2022|PDM|4992.00|99|0.00|LAMINECTOMY|
20|FH_F98820_81401_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F149023_44122_0|SrvcGrp|89842|2022|PDM|13975.00|99|0.00|LUMBAR|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|2341.00|99|0.00|AEG 9 (NO REV)|
20|FH_F131261_19111_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|100% 2007 MEDICARE TN DME MOD 26|
20|FH_F42979_0_0|CSTM-ALL|CSTM-00|2020|PDM|74.00|99|0.00|CPT 96100 PSYCHOLOGICAL TESTING|
20|FH_F98000_59102_0|SrvcGrp|73601|2022|PDM|7953.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F131495_77407_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|100% 2007 MEDICARE DME TN|
20|FH_F134797_0_0|SrvcGrp|73004|2022|PDM|1101.00|99|0.00|AEG 8|
20|FH_F39211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36683_0_0|SrvcGrp|18815|2022|PDM|27873.00|99|0.00|MS DRG 221|
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|AEG 2 (NO REV)|
20|FH_F151022_17016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131356_19131_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|43.68|99|0.00|SALLY BALIN,999182,ASC 228|
20|FH_F134874_80120_0|SrvcGrp|104441|2022|PDM|25.00|99|0.00|AETNA DRUG TEST PRSMV DIR OPT OBS (HCFA)|
20|FH_F122330_75771_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|379.00|99|0.00|ASPG 1 SURGICAL EYE CENTER|
20|FH_F147201_48234_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146859_0_0|SrvcGrp|114846|2022|PDM|1415.00|99|0.00|NONUNION CARPAL BONE REPAIR|
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120157_93103_0|SrvcGrp|86648|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F111266_30339_0|SrvcGrp|24745|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F132132_77040_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1112.00|99|0.00|AEG 10 (NO REV)|
20|FH_F147166_03444_0|SrvcGrp|89337|2022|PDM|1825.00|99|0.00|DETOXIFICATION|
20|FH_F139951_92870_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F143367_81003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F84631_0_0|SrvcGrp|62387|2022|PDM|111.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F101709_0_0|SrvcGrp|112025|2022|PDM|8610.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F114931_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F131107_43140_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F136267_73703_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112687_30474_0|SrvcGrp|48398|2022|PDM|169.40|99|0.00|PT SERVICES|
20|FH_F116698_07470_0|SrvcGrp|22589|2022|PDM|52.50|99|0.00|CHEMOTHERAPY NOC|
20|FH_F82894_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119992_67062_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120888_63823_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F113649_01752_0|SrvcGrp|86842|2022|PDM|40.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F113649_01752_0|SrvcGrp|29075|2022|PDM|40.00|99|0.00|HYDRATION THERAPY|
20|FH_F63129_0_0|SrvcGrp|48398|2022|PDM|30.00|99|0.00|PT SERVICES|
20|FH_F63249_0_0|SrvcGrp|27969|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F112024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133207_0_0|SrvcGrp|106264|2022|PDM|5293.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION|
20|FH_F122942_89512_0|SrvcGrp|73063|2022|PDM|900.00|99|0.00|OBSERVATION SERVICES|
20|FH_F124173_66215_0|SrvcGrp|10577|2022|PDM|25.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F130763_0_0|SrvcGrp|89853|2022|PDM|4367.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG|
20|FH_F133749_84604_0|SrvcGrp|112413|2022|PDM|10.00|99|0.00|ANTI-EMETICS INJECTION THERAPY (HCFA)|
20|FH_F77943_0_0|SrvcGrp|33793|2022|PDM|30071.78|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F71445_0_0|SrvcGrp|17139|2022|PDM|350.00|99|0.00|HOSPICE CARE|
20|FH_F119227_01752_0|SrvcGrp|86839|2022|PDM|38.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F127908_60640_0|SrvcGrp|89265|2022|PCT|1.40|99|0.00|AMBULATORY DETOX - ALCOHOL AND DRUG REHAB|
20|FH_F114823_15701_0|SrvcGrp|86723|2022|PDM|250.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1590.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1405 W/O REV|
20|FH_F129440_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REVENUE CODE W/O CPT/HCPCS|
20|FH_F121699_73703_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|1760.00|99|0.00|AEG 3 (NO REV)|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU"|
20|FH_F148484_19462_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F126341_27284_0|SrvcGrp|19742|2022|PCT|1.00|99|0.00|MID-LINE INSERTION|
20|FH_F119379_0_0|SrvcGrp|107830|2022|PDM|1428.00|99|0.00|REPAIR FOREARM TENDON/MUSCLE|
20|FH_F43197_0_0|SrvcGrp|11073|2022|PDM|80.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F130763_0_0|SrvcGrp|41327|2022|PDM|3346.00|99|0.00|OP SURGERY CPT 28308|
20|FH_F148521_0_0|CSTM-ALL|CSTM-00|2020|PDM|318.00|99|0.00|AEG 1 (NO REV)|
20|FH_F116806_0_0|SrvcGrp|107018|2022|PDM|1923.16|99|0.00|OSTEOTOMY|
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_F145584_15010_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|1190.00|99|0.00|AEG 5  (NO REV)|
20|FH_F120930_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F133715_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110509_71351_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F133769_20783_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144808_0_0|SrvcGrp|98497|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AEG 8 (NO REV)|
20|FH_F137567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145619_17603_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138047_77027_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F138507_62208_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F126341_27284_0|SrvcGrp|13929|2022|PCT|1.00|99|0.00|GROWTH HORMONE|
20|FH_F141210_0_0|SrvcGrp|89882|2022|PDM|5305.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F147502_0_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F143771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119567_04072_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F110580_71106_0|SrvcGrp|47530|2022|PDM|630.00|99|0.00|LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS|
20|FH_F125259_0_0|SrvcGrp|106798|2022|PDM|4500.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F134992_34112_0|SrvcGrp|89149|2022|PDM|230.00|99|0.00|OP INTENSIVE|
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_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1059.00|99|0.00|AEG 4 (NO REV)|
20|FH_F67887_0_0|SrvcGrp|42827|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|399.00|99|0.00|AEG 1 (NO REV)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|121.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1501 W/O REV|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC|
20|FH_F123745_0_0|SrvcGrp|93069|2022|PDM|3600.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F110804_11373_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F125214_12428_0|SrvcGrp|73483|2022|PCT|0.00|99|0.00|AETNA SUBACUTE III|
20|FH_F119946_36109_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114207_35243_0|SrvcGrp|86833|2022|PDM|15.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F132907_72949_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34924_0_0|SrvcGrp|72|2022|PDM|460.00|99|0.00|NEWBORN NURSERY|
20|FH_F47902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53|
20|FH_F124441_0_0|SrvcGrp|11673|2022|PDM|3325.00|99|0.00|CPT 29888|
20|FH_F107922_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39443_0_0|SrvcGrp|29804|2022|PDM|665.00|99|0.00|DETOX|
20|FH_F138017_73129_0|SrvcGrp|113309|2022|PDM|5507.00|99|0.00|ARTHROSCOPY|
20|FH_F76124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71468_0_0|SrvcGrp|27579|2022|PDM|70.00|99|0.00|RESPIRATORY THERAPY INITIAL VISIT|
20|FH_F124322_64131_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F85437_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132254_40207_0|SrvcGrp|14893|2022|PDM|85.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F145583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F35458_0_0|SrvcGrp|63|2022|PDM|650.00|99|0.00|SUBACUTE CARE|
20|FH_F93268_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35792_33175_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F109762_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F146568_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138410_19130_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122267_62656_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126116_0_0|SrvcGrp|108193|2022|PDM|6327.00|99|0.00|TIB/PER REVASC W/TLA|
20|FH_F116806_0_0|SrvcGrp|107122|2022|PDM|887.26|99|0.00|EXCISION OF UVULA|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|12933.00|99|0.00|MS DRG 258-259 CARDIAC PACE DEV REPL|
20|FH_F101824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101184_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F98940_70506_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F114206_37203_0|SrvcGrp|86836|2022|PDM|15.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F151025_11230_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F127467_44202_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F131595_58103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112754_98057_0|SrvcGrp|53144|2022|PDM|263.87|99|0.00|SPEECH THERAPY|
20|FH_F35245_0_0|SrvcGrp|9460|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION|
20|FH_F137363_0_0|SrvcGrp|113094|2022|PDM|1854.00|99|0.00|ENDOSCOPIC PROCEDURES|
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|3545.00|99|0.00|AEG 6 (NO REV)|
20|FH_F114332_19973_0|SrvcGrp|84559|2022|PCT|1.05|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|29201.00|99|0.00|MSDRG 235-236 CORONARY BYPASS|
20|FH_F143529_84737_0|SrvcGrp|63119|2022|PDM|26.00|99|0.00|BASIC HOME HOSPICE CARE|
20|FH_F93740_0_0|SrvcGrp|91592|2022|PDM|15300.00|99|0.00|PACING IMPLANTABLE CARDIODEFIBRILLATOR|
20|FH_F151720_03301_0|SrvcGrp|98701|2022|PDM|238.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F151764_03801_0|SrvcGrp|471|2022|PDM|652.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|217.00|99|0.00|GA RETINA SURG CTR ASC 6|
20|FH_F49286_0_0|SrvcGrp|45326|2022|PDM|125.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F120187_76522_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F120888_63823_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F113563_70560_0|SrvcGrp|58755|2022|PDM|6500.00|99|0.00|INJECTION PROC FOR JOINT|
20|FH_F118874_29926_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143467_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F143467_0_0|SrvcGrp|33984|2022|PDM|1424.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F146284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.38|99|0.00|OP SVCS|
20|FH_F38431_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50137_0_0|SrvcGrp|46243|2022|PDM|120.00|99|0.00|HOME VISIT NEWBORN CARE|
20|FH_F52753_0_0|SrvcGrp|46890|2022|PDM|1700.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F143783_0_0|SrvcGrp|63297|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F92276_32308_0|SrvcGrp|3178|2022|PDM|2100.00|99|0.00|ACUTE PSYCH|
20|FH_F118910_0_0|SrvcGrp|97702|2022|PDM|126.18|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F123276_20737_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F115669_07652_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F93384_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F118194_50841_0|SrvcGrp|24761|2022|PDM|93.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F123400_04605_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148255_72703_0|SrvcGrp|86845|2022|PDM|31.50|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F125118_99201_0|SrvcGrp|110036|2022|PDM|300.00|99|0.00|DRUG TESTING|
20|FH_F129408_48034_0|SrvcGrp|29155|2022|PDM|140.00|99|0.00|HOSPICE SVCS|
20|FH_F145550_62034_0|SrvcGrp|104229|2022|PDM|130.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F141590_90049_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|18945.00|99|0.00|MS DRG 242 PERMANENT CARDIAC PACEMAKER|
20|FH_F138450_0_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F33712_0_0|SrvcGrp|12163|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F110263_0_0|SrvcGrp|93596|2022|PDM|13477.00|99|0.00|SHOULDER JOINT(HCFA)|
20|FH_F127988_85258_0|SrvcGrp|93337|2022|PDM|309.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F114823_15701_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F150159_06511_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F127598_43232_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F118253_89052_0|SrvcGrp|73605|2022|PDM|1050.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F150165_06032_0|SrvcGrp|78098|2022|PDM|2811.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|1814.00|99|0.00|AEG 8 (NO REV)|
20|FH_F121640_75062_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F50703_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F78584_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS|
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119227_01752_0|SrvcGrp|14949|2022|PDM|85.00|99|0.00|HOME INFUSION|
20|FH_F125124_0_0|SrvcGrp|73004|2022|PDM|950.00|99|0.00|AEG 8|
20|FH_F117206_0_0|SrvcGrp|107289|2022|PDM|1970.00|99|0.00|KNEE ARTHRO/POSTER C LIG REP|
20|FH_F112791_0_0|SrvcGrp|72994|2022|PDM|535.00|99|0.00|AEG 3|
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|AEG 1 (NO REV)|
20|FH_F119590_29607_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145641_06902_0|SrvcGrp|108348|2022|PDM|3075.00|99|0.00|TREAT FRACTURE RADIUS/ULNA|
20|FH_F54592_0_0|SrvcGrp|17302|2022|PDM|55.00|99|0.00|HYDRATION THERAPY - 3+ LITERS|
20|FH_F146808_44641_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146881_83661_0|SrvcGrp|48398|2022|PDM|150.00|99|0.00|PT SERVICES|
20|FH_F120795_27514_0|SrvcGrp|76884|2022|PCT|0.71|99|0.00|HOSPITAL BASED CLINIC FACILITY FEES|
20|FH_F116063_43220_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132213_17543_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F131430_17566_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F134826_19067_0|SrvcGrp|45752|2022|PDM|108.00|99|0.00|GROUP THERAPY|
20|FH_F67086_0_0|SrvcGrp|1168|2022|PDM|788.55|99|0.00|CONTINUOUS HOMECARE|
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|989.98|99|0.00|ASPG VI|
20|FH_F46433_0_0|SrvcGrp|24751|2022|PDM|60.00|99|0.00|INTERMITTENT ANTICOAGULANT THERAPY|
20|FH_F38135_0_0|SrvcGrp|13551|2022|PDM|392.00|99|0.00|NEWBORN NURSERY|
20|FH_F133536_0_0|SrvcGrp|100011|2022|PDM|3145.00|99|0.00|ANKLE ARTHROSCOPY|
20|FH_F133536_0_0|SrvcGrp|92366|2022|PDM|1682.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F38883_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46354_0_0|SrvcGrp|38367|2022|PDM|3480.00|99|0.00|LITHO MOD 51|
20|FH_F100742_00616_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F40410_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116924_91203_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F143903_06249_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F129627_06037_0|SrvcGrp|29346|2022|PDM|41.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F100660_56303_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F43167_0_0|SrvcGrp|108568|2022|PDM|525.00|99|0.00|CHILD & ADOLESCENT PSYCH|
20|FH_F145537_02061_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F120872_74120_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137574_68130_0|SrvcGrp|53144|2022|PCT|1.00|99|0.00|SPEECH THERAPY|
20|FH_F120215_92064_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F110086_21742_0|CSTM-ALL|CSTM-00|2020|PDM|655.00|99|0.00|AEG 2 (NO REV)|
20|FH_F115049_78539_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F87618_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131190_21042_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92276_32308_0|CSTM-ALL|CSTM-00|2020|PDM|15120.00|99|0.00|AEG 8 (NO REV)|
20|FH_F148343_70810_0|SrvcGrp|13927|2022|PDM|450.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F40525_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD 26|
20|FH_F139515_0_0|SrvcGrp|92416|2022|PDM|8549.00|99|0.00|CERVICAL LAMINOTOMY|
20|FH_F127415_45822_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F110132_23451_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F121488_77478_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F128358_46072_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F34351_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F40066_0_0|SrvcGrp|6|2022|PCT|0.67|99|0.00|OP SURGERY|
20|FH_F116027_17745_0|SrvcGrp|471|2022|PDM|435.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F92276_32308_0|SrvcGrp|3418|2022|PDM|4515.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F32771_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135002_54971_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77722_0_0|SrvcGrp|68846|2022|PDM|700.00|99|0.00|SKILLED NURSING|
20|FH_F40525_0_0|SrvcGrp|25340|2022|PDM|850.00|99|0.00|MRI|
20|FH_F135779_0_0|SrvcGrp|73841|2022|PDM|467.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F151541_01436_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F137490_62226_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120352_52556_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F87716_0_0|SrvcGrp|44564|2022|PDM|647.00|99|0.00|NEWBORN NURSERY|
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 5  (NO REV)|
20|FH_F148420_33437_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34636_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F127152_50636_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121564_35080_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F79542_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|2624.00|99|0.00|AEG 6 (NO REV)|
20|FH_F70984_0_0|SrvcGrp|67990|2022|PDM|1750.00|99|0.00|CPT 58660 58661 58662|
20|FH_F130716_76013_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F40011_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|OP SVCS|
20|FH_F65159_0_0|CSTM-ALL|CSTM-00|2020|PDM|3356.00|99|0.00|ASPG IV|
20|FH_F122725_32216_0|SrvcGrp|83683|2022|PCT|0.00|99|0.00|ACUTE REHAB II|
20|FH_F62373_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130662_07032_0|SrvcGrp|73841|2022|PDM|325.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F121700_60938_0|SrvcGrp|87317|2022|PDM|900.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F97840_54729_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F110905_54452_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F74024_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 5  (NO REV)|
20|FH_F70804_0_0|SrvcGrp|9828|2022|PDM|54.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132827_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126076_75231_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F113322_38119_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F88744_71103_0|SrvcGrp|73605|2022|PDM|828.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F34398_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.81|99|0.00|GENERAL ACUTE CARE|
20|FH_F121687_04401_0|SrvcGrp|108925|2022|PCT|1.38|99|0.00|IRRIGATION OF IMPLANTED VENO|
20|FH_F73228_0_0|SrvcGrp|17083|2022|PCT|0.74|99|0.00|ASPG X|
20|FH_F150139_71667_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F69708_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|VNA OF ROCKFORD IV THERAPY|
20|FH_F134943_17402_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141210_0_0|SrvcGrp|88824|2022|PDM|9548.00|99|0.00|CPT 69631|
20|FH_F71345_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141340_66208_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149263_0_0|SrvcGrp|107793|2022|PDM|9364.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F126341_27284_0|SrvcGrp|86839|2022|PDM|35.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F128795_57469_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F83991_52172_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|OP SVCS|
20|FH_F90501_71101_0|SrvcGrp|75489|2022|PDM|3850.00|99|0.00|AEG 6|
20|FH_F121225_98902_0|SrvcGrp|73700|2022|PDM|201.60|99|0.00|AETNA - SKILLED NURSING|
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|756.00|99|0.00|AEG 5  (NO REV)|
20|FH_F133749_84604_0|SrvcGrp|95660|2022|PDM|483.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F132193_0_0|SrvcGrp|35669|2022|PDM|7500.00|99|0.00|CPT 63650|
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_F38345_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAMPTON ROADS GAST MOD KF|
20|FH_F149021_44514_0|SrvcGrp|94883|2022|PDM|1179.32|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F148905_85390_0|SrvcGrp|87317|2022|PDM|1400.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F80455_0_0|SrvcGrp|77507|2022|PDM|3520.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F111702_07652_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F49572_0_0|SrvcGrp|9774|2022|PDM|1500.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F109405_73106_0|SrvcGrp|90040|2022|PDM|285.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F149081_63028_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133207_0_0|SrvcGrp|44066|2022|PDM|4704.00|99|0.00|CPT 57288|
20|FH_F111702_07652_0|SrvcGrp|87911|2022|PCT|1.00|99|0.00|CYCLOSPORINE ORAL 100MG|
20|FH_F133868_40202_0|CSTM-ALL|CSTM-00|2020|PDM|568.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F122942_89512_0|SrvcGrp|89337|2022|PDM|1200.00|99|0.00|DETOXIFICATION|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|CAREPOINT PARTNERS OF WV S CODES W/MOD SH|
20|FH_F135657_27612_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133749_84604_0|SrvcGrp|112445|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F69647_0_0|SrvcGrp|17079|2022|PDM|1740.00|99|0.00|ASPG VIII|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|222.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 313 W/O REV|
20|FH_F110302_15931_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126341_27284_0|SrvcGrp|14944|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F121225_98902_0|SrvcGrp|73559|2022|PDM|7000.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F145604_14850_0|SrvcGrp|43569|2022|PDM|95.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F84450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F77044_0_0|SrvcGrp|74145|2022|PCT|0.50|99|0.00|INFUSION B-CODES (MOD SH)|
20|FH_F90496_13159_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PDM|533.00|99|0.00|AEG 2 (NO REV)|
20|FH_F121601_47446_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F83617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.61|99|0.00|APC OVERRIDES|
20|FH_F110642_17901_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150160_01301_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F145642_15108_0|SrvcGrp|29023|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134992_34112_0|SrvcGrp|73842|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F51934_0_0|SrvcGrp|48394|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F138050_52301_0|SrvcGrp|73602|2022|PDM|555.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F61034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F116806_0_0|SrvcGrp|107032|2022|PDM|1923.16|99|0.00|TREATMENT OF NOSE FRACTURE|
20|FH_F119590_29607_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F129509_0_0|SrvcGrp|89861|2022|PDM|3767.00|99|0.00|LUMBAR LAMINOTOMY|
20|FH_F125260_0_0|SrvcGrp|27968|2022|PCT|0.00|99|0.00|SKILLED NURSING LPN|
20|FH_F54592_0_0|SrvcGrp|34389|2022|PDM|150.00|99|0.00|SPEECH THERAPY|
20|FH_F72543_0_0|SrvcGrp|68986|2022|PDM|108.00|99|0.00|PT VISIT|
20|FH_F72262_0_0|SrvcGrp|16|2022|PDM|1300.00|99|0.00|ACUTE REHABILITATION|
20|FH_F149442_0_0|SrvcGrp|112225|2022|PDM|23.00|99|0.00|COVID-19 SPECIMEN COLLECTION|
20|FH_F140998_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40454_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|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_F135239_0_0|SrvcGrp|14494|2022|PDM|60.50|99|0.00|CONTINUOUS HOMECARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1012.74|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1406 W/O REV|
20|FH_F102500_0_0|SrvcGrp|98686|2022|PDM|8189.00|99|0.00|OSSEOINTEGRATED IMPLANT|
20|FH_F40427_0_0|SrvcGrp|88|2022|PCT|0.65|99|0.00|OP LITHOTRIPSY|
20|FH_F102704_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|OP SVCS|
20|FH_F131254_92211_0|SrvcGrp|47183|2022|PDM|90.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F129415_69361_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149885_68502_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F100660_56303_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F105680_0_0|SrvcGrp|75481|2022|PDM|1200.00|99|0.00|AEG 2|
20|FH_F137067_0_0|SrvcGrp|111958|2022|PDM|2625.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 6 (NO REV)|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|357.17|99|0.00|HAPA WPA-NWPA 2012-13 ASC 406 W/O REV|
20|FH_F133534_33483_0|SrvcGrp|86722|2022|PDM|189.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F33642_0_0|SrvcGrp|3932|2022|PDM|5250.00|99|0.00|LITHOTRIPSY|
20|FH_F93136_0_0|SrvcGrp|73000|2022|PDM|826.00|99|0.00|AEG 6|
20|FH_F141527_36830_0|SrvcGrp|31973|2022|PDM|11.00|99|0.00|HOME THERAPY|
20|FH_F149888_68506_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F148440_16506_0|CSTM-ALL|CSTM-00|2020|PDM|1330.00|99|0.00|AEG 8 (NO REV)|
20|FH_F41776_0_0|SrvcGrp|1168|2022|PDM|937.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F128333_71001_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F116341_12180_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F141169_0_0|SrvcGrp|63457|2022|PDM|156.00|99|0.00|ULTRASOUND|
20|FH_F121177_33407_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|3116.44|99|0.00|AEG 9 (NO REV)|
20|FH_F149888_68506_0|CSTM-ALL|CSTM-00|2020|PDM|1906.00|99|0.00|AEG 5  (NO REV)|
20|FH_F131254_92211_0|SrvcGrp|86829|2022|PDM|35.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F140651_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F91622_0_0|SrvcGrp|23279|2022|PDM|650.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F92091_0_0|SrvcGrp|72998|2022|PDM|2925.00|99|0.00|AEG 5|
20|FH_F35476_0_0|SrvcGrp|11442|2022|PDM|855.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F102302_0_0|SrvcGrp|72998|2022|PDM|1484.00|99|0.00|AEG 5|
20|FH_F129627_06037_0|SrvcGrp|95660|2022|PDM|720.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F137637_03103_0|SrvcGrp|89149|2022|PDM|187.00|99|0.00|OP INTENSIVE|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER RRKE|
20|FH_F141355_63134_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148866_84123_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121326_60957_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|828.00|99|0.00|ASPG V|
20|FH_F106822_0_0|SrvcGrp|100279|2022|PDM|0.21|99|0.00|ALBUTEROL NON-COMPOUNDED|
20|FH_F39704_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142344_16693_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F113794_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112704_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.30|99|0.00|AEG 3 (NO REV)|
20|FH_F130400_26505_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119784_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|500.00|99|0.00|AEG 5  (NO REV)|
20|FH_F41516_0_0|SrvcGrp|32550|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F136473_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F138929_0_0|SrvcGrp|41335|2022|PDM|17600.00|99|0.00|TOTAL HIP|
20|FH_F141207_0_0|SrvcGrp|94781|2022|PDM|205.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F116525_26003_0|SrvcGrp|104363|2022|PCT|0.62|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F132627_0_0|SrvcGrp|24745|2022|PDM|69.36|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F137067_0_0|SrvcGrp|112960|2022|PDM|21000.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F125946_0_0|SrvcGrp|81599|2022|PDM|552.00|99|0.00|IP HOSPICE SERVICES|
20|FH_F64180_0_0|SrvcGrp|3810|2022|PDM|147.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F122183_98146_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124129_33603_0|SrvcGrp|90631|2022|PDM|180.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F146907_24521_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39066_0_0|SrvcGrp|29780|2022|PDM|7000.00|99|0.00|ANGIOPLASTY|
20|FH_F101390_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS|
20|FH_F132864_71101_0|SrvcGrp|20272|2022|PDM|33469.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VLV PROC W/O CA CAT|
20|FH_F124237_95023_0|SrvcGrp|108061|2022|PDM|300.00|99|0.00|OP THERAPY SERVICES|
20|FH_F124611_64804_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F125134_0_0|SrvcGrp|108041|2022|PDM|360.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F135450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127995_84010_0|SrvcGrp|17016|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F127995_84010_0|SrvcGrp|105751|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJECTION DRUGS|
20|FH_F133399_72211_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F130039_80228_0|SrvcGrp|86723|2022|PDM|425.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F114792_48849_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F34057_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42500_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|ACUTE PSYCH|
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|7900.00|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F142810_77087_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137638_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F128445_85704_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F102561_75146_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F60101_0_0|SrvcGrp|17139|2022|PDM|803.00|99|0.00|HOSPICE CARE|
20|FH_F126666_44053_0|SrvcGrp|105375|2022|PDM|88.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MIN (HCFA)|
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.00|99|0.00|AEG 3 (NO REV)|
20|FH_F77663_0_0|SrvcGrp|12591|2022|PDM|120.00|99|0.00|CD FULL DAY|
20|FH_F126666_44053_0|SrvcGrp|91781|2022|PDM|44.00|99|0.00|AETNA GROUP THERAPY (MOD TD)(HCFA)|
20|FH_F60101_0_0|SrvcGrp|42827|2022|PDM|68.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F148021_80907_0|SrvcGrp|27968|2022|PDM|45.00|99|0.00|SKILLED NURSING LPN|
20|FH_F38700_0_0|SrvcGrp|18798|2022|PCT|0.80|99|0.00|MS DRG 217|
20|FH_F44952_0_0|SrvcGrp|12403|2022|PDM|788.55|99|0.00|CONTINUOUS HOMECARE|
20|FH_F91937_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F142967_65065_0|SrvcGrp|90490|2022|PCT|1.00|99|0.00|EVALUATION OF SPEECH FLUENCY|
20|FH_F92677_08003_0|SrvcGrp|86832|2022|PDM|9.45|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F73244_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F112853_22408_0|SrvcGrp|41422|2022|PDM|4.25|99|0.00|ENTERAL FORMULA - PEDIATRIC|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PDM|2905.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F109404_0_0|SrvcGrp|75746|2022|PCT|0.90|99|0.00|AETNA PT AND CHIRO|
20|FH_F44314_0_0|SrvcGrp|26742|2022|PDM|46.00|99|0.00|PT|
20|FH_F123872_75006_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F115313_11216_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F41438_0_0|SrvcGrp|12403|2022|PDM|34.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F147988_78759_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F44952_0_0|SrvcGrp|26001|2022|PDM|139.76|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F84032_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F92677_08003_0|SrvcGrp|92096|2022|PDM|612.15|99|0.00|AETNA HOME VENT INVASIVE INTERFACE|
20|FH_F33225_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148494_0_0|SrvcGrp|98565|2022|PDM|15000.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F148003_34285_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139441_91324_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139666_26175_0|SrvcGrp|112064|2022|PCT|0.94|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F150662_20901_0|SrvcGrp|48394|2022|PDM|63.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F150882_84041_0|SrvcGrp|86828|2022|PDM|114.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F150945_15904_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F138018_17313_0|SrvcGrp|21711|2022|PDM|208.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|2152.00|99|0.00|AEG 8 (NO REV)|
20|FH_F99142_80233_0|SrvcGrp|472|2022|PDM|485.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F35384_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F35987_0_0|SrvcGrp|115|2022|PDM|908.00|99|0.00|SKILLED NURSING CARE|
20|FH_F97880_63501_0|SrvcGrp|73461|2022|PDM|7187.00|99|0.00|AETNA NICU IV|
20|FH_F50220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F146266_0_0|SrvcGrp|82112|2022|PDM|3555.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F111044_0_0|SrvcGrp|27310|2022|PDM|1648.00|99|0.00|ENDOSCOPIC PLANTAR FASCIOTOMY|
20|FH_F151699_01752_0|SrvcGrp|86825|2022|PDM|90.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F71468_0_0|SrvcGrp|10541|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|610.00|99|0.00|AEG 2 (NO REV)|
20|FH_F148347_0_0|SrvcGrp|35921|2022|PDM|11616.00|99|0.00|BARIATRIC SURGERY|
20|FH_F134847_0_0|SrvcGrp|112645|2022|PDM|4764.00|99|0.00|SINUS PROCEDURES|
20|FH_F117426_0_0|SrvcGrp|472|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F92431_80033_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP AMFS DEFAULT W/OUT S9122|
20|FH_F117802_0_0|SrvcGrp|59368|2022|PDM|188.00|99|0.00|PERITONEAL DIALYSIS|
20|FH_F124467_27529_0|SrvcGrp|108484|2022|PDM|631.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PDM|6598.00|99|0.00|AEG 6 (NO REV)|
20|FH_F113869_40215_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F115483_62002_0|SrvcGrp|14614|2022|PDM|7957.00|99|0.00|LITHOTRIPSY|
20|FH_F146859_0_0|SrvcGrp|114855|2022|PDM|4511.00|99|0.00|NECK SPINE FUSE|
20|FH_F145543_0_0|SrvcGrp|114206|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F137767_01841_0|SrvcGrp|3178|2022|PDM|1475.00|99|0.00|ACUTE PSYCH|
20|FH_F122277_98045_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F37312_0_0|SrvcGrp|25665|2022|PCT|0.60|99|0.00|PHARMACY|
20|FH_F35174_0_0|SrvcGrp|16|2022|PDM|1957.00|99|0.00|ACUTE REHABILITATION|
20|FH_F50398_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F138387_02886_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148926_28803_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F138540_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.00|99|0.00|AEG 2 (NO REV)|
20|FH_F138018_17313_0|SrvcGrp|17007|2022|PDM|103.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS|
20|FH_F99920_63141_0|SrvcGrp|97703|2022|PDM|110.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F147082_02359_0|SrvcGrp|12659|2022|PDM|504.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 6 (NO REV)|
20|FH_F117581_21211_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141334_66401_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F98020_50138_0|SrvcGrp|88977|2022|PDM|6795.00|99|0.00|C-SECTION DELIVERY|
20|FH_F113791_32055_0|CSTM-ALL|CSTM-00|2020|PDM|290.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F113809_47302_0|SrvcGrp|73605|2022|PDM|695.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F138562_46703_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138981_85123_0|SrvcGrp|46903|2022|PDM|500.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F114985_32073_0|SrvcGrp|102980|2022|PDM|63.00|99|0.00|PSYTX WPT W E/M 30 MIN|
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|3144.00|99|0.00|AEG 9 (NO REV)|
20|FH_F122610_73139_0|SrvcGrp|91500|2022|PDM|275.00|99|0.00|ULTRASOUND|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PDM|972.00|99|0.00|ASPG VI|
20|FH_F134687_14226_0|SrvcGrp|76501|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F62864_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136913_68803_0|SrvcGrp|31705|2022|PDM|39017.00|99|0.00|MS DRG 791 ONLY|
20|FH_F113713_17013_0|SrvcGrp|91398|2022|PDM|85.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AJ)|
20|FH_F149248_0_0|CSTM-ALL|CSTM-00|2020|PDM|620.00|99|0.00|AEG 2 (NO REV)|
20|FH_F115664_72758_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115733_33012_0|SrvcGrp|73842|2022|PDM|179.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F116383_63026_0|SrvcGrp|93919|2022|PDM|663.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F42402_0_0|SrvcGrp|31661|2022|PCT|0.90|99|0.00|DURABLE MEDICAL EQUIPMENT|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD RR|
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)|
20|FH_F35929_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F72445_0_0|SrvcGrp|9832|2022|PDM|60.00|99|0.00|ST SVCS|
20|FH_F79429_0_0|CSTM-ALL|CSTM-00|2020|PDM|11.00|99|0.00|VACCINE ADMINISTRATION|
20|FH_F39098_0_0|SrvcGrp|97|2022|PDM|3678.00|99|0.00|C-SECTION|
20|FH_F138787_32258_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F138876_25302_0|SrvcGrp|86836|2022|PDM|15.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F138907_01040_0|SrvcGrp|63297|2022|PDM|170.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F138387_02886_0|SrvcGrp|93359|2022|PDM|115.00|99|0.00|SKILLED NURSING|
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|1286.00|99|0.00|AEG 9 (NO REV)|
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.52|99|0.00|AEG 8 (NO REV)|
20|FH_F151339_72758_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F151340_30040_0|CSTM-ALL|CSTM-00|2020|PDM|1490.00|99|0.00|AEG 8 (NO REV)|
20|FH_F151426_90028_0|SrvcGrp|75419|2022|PDM|530.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F151511_14094_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F135432_16335_0|SrvcGrp|46605|2022|PDM|88.31|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F135470_83201_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F91766_25401_0|SrvcGrp|88620|2022|PDM|131.25|99|0.00|SKILLED NURSING RN|
20|FH_F100765_73735_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F116431_76104_0|SrvcGrp|8950|2022|PDM|1530.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F121428_40202_0|SrvcGrp|12280|2022|PCT|0.27|99|0.00|IMPLANTS|
20|FH_F146125_0_0|SrvcGrp|26278|2022|PDM|3150.00|99|0.00|CPT 29881|
20|FH_F146125_0_0|SrvcGrp|27348|2022|PDM|3150.00|99|0.00|OP SURGERY (CPT 58662)|
20|FH_F44113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
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_F127992_34952_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111880_50003_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F141651_0_0|SrvcGrp|65404|2022|PDM|1540.00|99|0.00|CPT 69421|
20|FH_F145587_0_0|SrvcGrp|82110|2022|PDM|1262.70|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC|
20|FH_F40698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51272_0_0|SrvcGrp|3418|2022|PDM|5500.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1690.00|99|0.00|AEG 4 (NO REV)|
20|FH_F116430_0_0|SrvcGrp|34606|2022|PDM|2705.00|99|0.00|CPT 29827|
20|FH_F131000_0_0|SrvcGrp|106267|2022|PDM|5114.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL|
20|FH_F137243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112187_98272_0|CSTM-ALL|CSTM-00|2020|PDM|12100.00|99|0.00|AEG 7 (NO REV)|
20|FH_F125054_16365_0|SrvcGrp|88621|2022|PDM|53.06|99|0.00|SKILLED NURSING LPN|
20|FH_F102325_62691_0|SrvcGrp|14944|2022|PDM|5.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F102960_50613_0|SrvcGrp|3178|2022|PDM|1984.00|99|0.00|ACUTE PSYCH|
20|FH_F143542_0_0|SrvcGrp|42551|2022|PDM|1721.00|99|0.00|OP SURGERY|
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84394_17402_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F35685_0_0|SrvcGrp|2981|2022|PDM|11025.00|99|0.00|DRG 520 CERVICAL SPINAL FUSION W/O CC|
20|FH_F39266_0_0|SrvcGrp|29021|2022|PCT|1.00|99|0.00|DME AND SUPPLIES|
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|986.58|99|0.00|ASPG VIII|
20|FH_F98621_41042_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F102947_44084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148490_80231_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|1490.00|99|0.00|AEG 9 (NO REV)|
20|FH_F100906_0_0|SrvcGrp|78709|2022|PDM|6000.00|99|0.00|AETNA SPINE SURGERY|
20|FH_F109279_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 2 (NO REV)|
20|FH_F57073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1292.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F119795_0_0|SrvcGrp|82107|2022|PDM|5202.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F139689_0_0|SrvcGrp|107748|2022|PDM|533.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F36397_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86851_0_0|SrvcGrp|84968|2022|PDM|520.00|99|0.00|CPT 43227|
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|597.08|99|0.00|AETNA POLYSOMNOGRAPHY|
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|AEG 2 (NO REV)|
20|FH_F123848_03257_0|SrvcGrp|73742|2022|PDM|8.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2853.00|99|0.00|AEG 8 (NO REV)|
20|FH_F35732_32308_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|GENERAL ACUTE CARE|
20|FH_F35446_0_0|SrvcGrp|12627|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F127396_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.50|99|0.00|ANESTHESIOLOGIST/CRNA (HAN2)(HSUR)|
20|FH_F68460_0_0|SrvcGrp|89337|2022|PDM|813.00|99|0.00|DETOXIFICATION|
20|FH_F122377_91007_0|SrvcGrp|109166|2022|PCT|1.05|99|0.00|CROTALIDAE POLY IMMUNE FAB|
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131449_19073_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F98360_11554_0|SrvcGrp|88978|2022|PDM|8313.00|99|0.00|VAGINAL DELIVERY|
20|FH_F128543_44413_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F35741_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.46|99|0.00|OP SVCS|
20|FH_F94621_07728_0|SrvcGrp|94043|2022|PCT|1.00|99|0.00|GANCICLOVIR IMPLANT/1UNIT MAX|
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PDM|3900.00|99|0.00|CV SURGERY (MS DRG 215-238)|
20|FH_F39443_0_0|SrvcGrp|30356|2022|PDM|626.00|99|0.00|HAPA WPA ASC 401|
20|FH_F128753_32501_0|SrvcGrp|81779|2022|PCT|0.64|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F36534_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F148902_40509_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F127553_44321_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F40627_0_0|SrvcGrp|12359|2022|PDM|3048.00|99|0.00|TELEMETRY SVCS|
20|FH_F92154_74023_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|GENERAL ACUTE CARE|
20|FH_F132254_40207_0|SrvcGrp|84260|2022|PCT|1.00|99|0.00|AETNA ALL DRUGS|
20|FH_F134394_92101_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F113957_73554_0|SrvcGrp|72994|2022|PDM|1365.00|99|0.00|AEG 3|
20|FH_F98840_31021_0|SrvcGrp|73559|2022|PDM|6680.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F150932_15143_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F90817_0_0|SrvcGrp|91045|2022|PDM|1574.00|99|0.00|SHOULDER ARTHROSCOPY (HCFA)|
20|FH_F131028_49735_0|SrvcGrp|87799|2022|PDM|130.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F83871_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F114332_19973_0|SrvcGrp|86635|2022|PCT|1.05|99|0.00|DME|
20|FH_F149582_01534_0|SrvcGrp|115384|2022|PCT|1.00|99|0.00|COVID-19 INFUSION ADMINISTRATION COMBINATION - ELI LILLY|
20|FH_F35432_0_0|SrvcGrp|177|2022|PDM|1575.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|1236.00|99|0.00|AEG 8 (NO REV)|
20|FH_F147372_0_0|SrvcGrp|89337|2022|PDM|1300.00|99|0.00|DETOXIFICATION|
20|FH_F115269_0_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|2145.00|99|0.00|AEG 3 (NO REV)|
20|FH_F146859_0_0|SrvcGrp|113861|2022|PDM|2150.00|99|0.00|REMOVE WRIST TENDON LESION|
20|FH_F141247_18902_0|SrvcGrp|74668|2022|PDM|237.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F141270_89103_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F34882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MS DRG 927  EXTENSIVE BURNS W/SKIN GRFT|
20|FH_F128197_84123_0|SrvcGrp|29347|2022|PDM|21.60|99|0.00|HOME HEALTH AIDE|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146859_0_0|SrvcGrp|114860|2022|PDM|2843.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F148496_17112_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|NURSING CARE MOD TE|
20|FH_F139792_26034_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143536_47546_0|SrvcGrp|100262|2022|PCT|1.00|99|0.00|TREAT DEHISCENCE W/ PACKING|
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102224_0_0|SrvcGrp|67069|2022|PDM|5514.95|99|0.00|CPT 22634|
20|FH_F131107_43140_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F47600_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F112712_63005_0|SrvcGrp|16750|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116915_30308_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F119924_14070_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F84394_17402_0|SrvcGrp|3378|2022|PCT|0.82|99|0.00|OBSERVATION SVCS|
20|FH_F38431_0_0|SrvcGrp|23002|2022|PDM|1300.00|99|0.00|V5259|
20|FH_F45332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46258_0_0|SrvcGrp|14371|2022|PDM|12.00|99|0.00|DISPOSABLE DRUG DELIVERY|
20|FH_F61292_0_0|SrvcGrp|21350|2022|PDM|8746.00|99|0.00|MS DRG 287 ONLY|
20|FH_F143743_26501_0|SrvcGrp|114102|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F148161_98198_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F34155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|1281.00|99|0.00|AEG 8 (NO REV)|
20|FH_F32000_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91994_0_0|SrvcGrp|73002|2022|PDM|2620.00|99|0.00|AEG 7|
20|FH_F81481_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|845.90|99|0.00|AEG 3 (NO REV)|
20|FH_F38798_0_0|SrvcGrp|26732|2022|PDM|850.00|99|0.00|CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE|
20|FH_F131254_92211_0|SrvcGrp|24753|2022|PDM|12.50|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PDM|896.00|99|0.00|AEG 3 (NO REV)|
20|FH_F38526_0_0|SrvcGrp|97|2022|PDM|2100.00|99|0.00|C-SECTION|
20|FH_F135262_02148_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113410_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 2 (NO REV)|
20|FH_F49735_0_0|SrvcGrp|16|2022|PDM|950.00|99|0.00|ACUTE REHABILITATION|
20|FH_F120338_83226_0|SrvcGrp|75442|2022|PDM|894.51|99|0.00|OBSERVATION - REV 762|
20|FH_F89563_29407_0|SrvcGrp|88857|2022|PCT|1.00|99|0.00|THERAPEUTIC ACTIVITIES|
20|FH_F119729_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136347_30328_0|SrvcGrp|108484|2022|PDM|731.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139751_84065_0|SrvcGrp|89337|2022|PDM|1700.00|99|0.00|DETOXIFICATION|
20|FH_F142247_61244_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F78404_16646_0|SrvcGrp|34034|2022|PCT|0.00|99|0.00|BLOOD PRODUCTS|
20|FH_F140750_89119_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F140830_70056_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120152_0_0|SrvcGrp|74039|2022|PDM|11000.00|99|0.00|LAMINECTOMY|
20|FH_F128270_0_0|SrvcGrp|472|2022|PDM|499.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F149530_80014_0|SrvcGrp|109330|2022|PCT|1.03|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F119046_74012_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F119018_47802_0|SrvcGrp|90854|2022|PDM|760.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F118955_48239_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F109884_36117_0|SrvcGrp|86749|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F49039_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F91913_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F92852_0_0|SrvcGrp|28548|2022|PDM|1320.00|99|0.00|VITRECTOMY|
20|FH_F117295_70006_0|SrvcGrp|73700|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F147799_18052_0|SrvcGrp|115510|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F129467_45449_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F114145_0_0|SrvcGrp|114518|2022|PDM|1114.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137818_31602_0|SrvcGrp|106048|2022|PDM|911.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F137850_32826_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F90791_79106_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|990.00|99|0.00|ASPG III|
20|FH_F109513_0_0|SrvcGrp|86460|2022|PDM|2700.00|99|0.00|REVISE BREAST RECONSTRUCTION|
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|4377.00|99|0.00|AEG 9 (NO REV)|
20|FH_F137951_0_0|SrvcGrp|88065|2022|PDM|3000.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F116324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97543_33542_0|SrvcGrp|73485|2022|PDM|3461.00|99|0.00|AETNA REHAB|
20|FH_F115274_15235_0|SrvcGrp|80920|2022|PDM|575.00|99|0.00|HOSPICE SERVICES|
20|FH_F62627_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F97882_32407_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F133473_21702_0|SrvcGrp|48394|2022|PDM|70.02|99|0.00|SKILLED NURSING SERVICES|
20|FH_F111522_81067_0|SrvcGrp|93291|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA ESRD USE|
20|FH_F39180_0_0|SrvcGrp|701|2022|PDM|1783.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F97543_33542_0|SrvcGrp|88977|2022|PDM|7025.00|99|0.00|C-SECTION DELIVERY|
20|FH_F103281_32086_0|SrvcGrp|4003|2022|PDM|1400.00|99|0.00|CPT CODE 99291- CRITICAL CARE|
20|FH_F40542_0_0|SrvcGrp|471|2022|PDM|435.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F109815_52241_0|SrvcGrp|22077|2022|PDM|1624.00|99|0.00|RESIDENTIAL TREATMENT SVCS|
20|FH_F144769_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|CARDIAC CATH|
20|FH_F89932_10940_0|SrvcGrp|79458|2022|PDM|0.50|99|0.00|MED RECORD COPY|
20|FH_F87579_33707_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|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_F92677_08003_0|SrvcGrp|92185|2022|PDM|21.00|99|0.00|HCPCS S9372 (HCFA)|
20|FH_F123872_75006_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F39082_0_0|SrvcGrp|97|2022|PDM|7740.00|99|0.00|C-SECTION|
20|FH_F101923_98104_0|SrvcGrp|93121|2022|PCT|0.73|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F139825_0_0|SrvcGrp|92549|2022|PDM|5738.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F115289_90057_0|SrvcGrp|98319|2022|PDM|500.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY (HCFA)|
20|FH_F133552_77006_0|SrvcGrp|86722|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F35368_0_0|SrvcGrp|12220|2022|PDM|1433.00|99|0.00|PACEMAKER REPLACEMENT PROCEDURE- IP|
20|FH_F132992_04662_0|SrvcGrp|46605|2022|PDM|89.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F149979_15701_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92792_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F150948_0_0|SrvcGrp|41334|2022|PDM|10500.00|99|0.00|TOTAL KNEE|
20|FH_F41661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F81494_0_0|SrvcGrp|27726|2022|PCT|0.68|99|0.00|OP SURGERY|
20|FH_F142814_16511_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F66403_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F117087_0_0|SrvcGrp|107172|2022|PDM|2494.00|99|0.00|EXPLORE PARATHYROID GLANDS|
20|FH_F142991_43920_0|SrvcGrp|13683|2022|PDM|670.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F136393_0_0|SrvcGrp|112878|2022|PDM|3200.00|99|0.00|INSERT 1 ELECTRODE PM DEFIB|
20|FH_F126676_43537_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F148041_41017_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME HEALTH LPN SERVICE|
20|FH_F133155_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F44724_0_0|SrvcGrp|26205|2022|PDM|48.00|99|0.00|ST|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|262.00|99|0.00|HAPA EPA ASC 34|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|373.25|99|0.00|HAPA WPA-NWPA 2012-13 ASC 308 W/O REV|
20|FH_F133009_19038_0|SrvcGrp|48398|2022|PDM|107.00|99|0.00|PT SERVICES|
20|FH_F148886_60621_0|SrvcGrp|39136|2022|PDM|29318.00|99|0.00|MSDRG 226-227 ONLY CARDIAC|
20|FH_F133397_23233_0|SrvcGrp|13127|2022|PDM|624.00|99|0.00|DIALYSIS|
20|FH_F101802_17201_0|SrvcGrp|29464|2022|PDM|134.00|99|0.00|HOME HEALTH VISIT NEWBORN CARE|
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|1252.00|99|0.00|AEG 8 (NO REV)|
20|FH_F149869_03253_0|SrvcGrp|73742|2022|PDM|8.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F137067_0_0|SrvcGrp|100067|2022|PDM|2625.00|99|0.00|ANKLE ARTHROSCOPY SURGERY|
20|FH_F86332_75081_0|SrvcGrp|16300|2022|PDM|30.00|99|0.00|HOME TRANSFUSION|
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 2 (NO REV)|
20|FH_F112272_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F125935_44024_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F137940_0_0|SrvcGrp|106314|2022|PDM|499.11|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F148265_06067_0|SrvcGrp|98496|2022|PDM|11087.00|99|0.00|ARTHRODESIS POSTERIOR ATLAS|
20|FH_F149442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145545_01602_0|SrvcGrp|90854|2022|PDM|896.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F49653_0_0|SrvcGrp|28201|2022|PDM|802.00|99|0.00|NORMAL NEWBORN|
20|FH_F151525_30349_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F121183_75093_0|SrvcGrp|3178|2022|PDM|884.00|99|0.00|ACUTE PSYCH|
20|FH_F93881_15009_0|SrvcGrp|75487|2022|PDM|2257.00|99|0.00|AEG 5|
20|FH_F34816_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40304_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F131254_92211_0|SrvcGrp|24752|2022|PDM|12.50|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F123922_84102_0|SrvcGrp|74668|2022|PDM|325.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132559_0_0|SrvcGrp|90157|2022|PDM|1635.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F124955_98225_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F83451_0_0|SrvcGrp|112112|2022|PDM|6000.00|99|0.00|LUMBAR SPINE CODES|
20|FH_F66501_0_0|SrvcGrp|36068|2022|PDM|47.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F148400_33401_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129768_0_0|SrvcGrp|111422|2022|PCT|5.75|99|0.00|PHYSICAL MEDICINE|
20|FH_F151562_26003_0|SrvcGrp|80920|2022|PDM|520.00|99|0.00|HOSPICE SERVICES|
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F129228_72432_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F48998_0_0|SrvcGrp|43893|2022|PDM|18.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F120249_43215_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F88254_33411_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F115010_20105_0|SrvcGrp|73485|2022|PDM|1148.00|99|0.00|AETNA REHAB|
20|FH_F69965_0_0|SrvcGrp|66482|2022|PDM|25.00|99|0.00|HOME HEALTH AID|
20|FH_F116188_72211_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F70104_0_0|SrvcGrp|10542|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F128190_45342_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143772_75225_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F134994_33162_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F40063_0_0|SrvcGrp|9494|2022|PDM|1044.00|99|0.00|SUBACUTE CARE|
20|FH_F145792_33612_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|HSS ASC|
20|FH_F129683_45255_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F51192_0_0|SrvcGrp|44107|2022|PDM|55.00|99|0.00|SPEECH THERAPY|
20|FH_F118373_21205_0|SrvcGrp|62199|2022|PDM|4769.00|99|0.00|RESIDENTIAL|
20|FH_F130021_77904_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1481.00|99|0.00|AEG 3 (NO REV)|
20|FH_F150982_0_0|SrvcGrp|89404|2022|PDM|24223.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F37679_0_0|SrvcGrp|27126|2022|PDM|7.50|99|0.00|ANTI-EMETICS INJECTION THERAPY (MOD SH)|
20|FH_F69322_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F52854_0_0|SrvcGrp|9838|2022|PDM|2323.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F141548_33410_0|SrvcGrp|74668|2022|PDM|480.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F104520_0_0|SrvcGrp|83519|2022|PDM|90.00|99|0.00|HOSPICE CARE (ALL OTHER)|
20|FH_F135173_06519_0|SrvcGrp|103669|2022|PDM|524.00|99|0.00|AETNA PARTIAL HOSP (HCFA)|
20|FH_F38377_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F122649_0_0|SrvcGrp|24739|2022|PDM|112.00|99|0.00|RESPITE CARE|
20|FH_F110086_21742_0|CSTM-ALL|CSTM-00|2020|PDM|1964.00|99|0.00|AEG 9 (NO REV) WITHOUT CPT 52648|
20|FH_F128580_0_0|SrvcGrp|108077|2022|PDM|2248.00|99|0.00|ARTERIOVENOUS ANASTOMOSIS|
20|FH_F124899_45246_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F38847_0_0|SrvcGrp|13292|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F130846_28304_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141367_57104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139689_0_0|SrvcGrp|107749|2022|PDM|228.00|99|0.00|CAPD/CCPD|
20|FH_F87480_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F42931_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46832_0_0|SrvcGrp|14944|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F38560_0_0|SrvcGrp|29524|2022|PDM|4500.00|99|0.00|ADULT PACEMAKER|
20|FH_F130721_04769_0|SrvcGrp|105465|2022|PCT|0.89|99|0.00|AETNA THERAPIES|
20|FH_F130748_43762_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130821_85712_0|SrvcGrp|471|2022|PDM|477.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130895_07726_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130898_06405_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120930_0_0|SrvcGrp|33967|2022|PDM|3000.00|99|0.00|CPT 47562|
20|FH_F81698_10457_0|SrvcGrp|86838|2022|PDM|10.50|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F149059_19702_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|791.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F139446_87106_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F150001_33064_0|SrvcGrp|86843|2022|PDM|35.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F133530_11237_0|CSTM-ALL|CSTM-00|2020|PDM|2920.00|99|0.00|AEG 3 (NO REV) (W/O ENDOSCOPIC PROCEDURES)|
20|FH_F43027_0_0|SrvcGrp|33165|2022|PDM|325.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F141750_77515_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143057_15767_0|SrvcGrp|113206|2022|PDM|31.28|99|0.00|MULTISYSTEMIC THERAPY|
20|FH_F132503_73086_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F44135_0_0|SrvcGrp|12403|2022|PDM|28.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F111784_32901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141896_61462_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132612_0_0|SrvcGrp|413|2022|PCT|0.70|99|0.00|TRANSPLANT SVCS|
20|FH_F87615_80033_0|SrvcGrp|94064|2022|PCT|0.00|99|0.00|OP BEHAVIORAL OBSERVATION|
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)|
20|FH_F129965_0_0|SrvcGrp|111413|2022|PCT|1.00|99|0.00|OB C-SECTION|
20|FH_F97581_60141_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F34706_0_0|SrvcGrp|10323|2022|PDM|15175.00|99|0.00|DRG 529 VENTRICULAR SHUNT PROC W/CC|
20|FH_F127197_23111_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F133129_45863_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F40728_0_0|CSTM-ALL|CSTM-00|2020|PDM|1438.00|99|0.00|ASPG VII|
20|FH_F49776_0_0|SrvcGrp|43430|2022|PDM|80.00|99|0.00|LPN HOME VISIT|
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F101840_76054_0|SrvcGrp|73498|2022|PDM|927.00|99|0.00|AETNA ER LEVEL III|
20|FH_F97565_83301_0|SrvcGrp|73602|2022|PDM|3772.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F91255_19401_0|SrvcGrp|89317|2022|PDM|1873.00|99|0.00|AETNA SLEEP STUDIES|
20|FH_F118790_98640_0|SrvcGrp|75419|2022|PDM|1137.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F117970_15963_0|SrvcGrp|471|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F108780_54235_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132446_19063_0|SrvcGrp|29464|2022|PDM|76.00|99|0.00|HOME HEALTH VISIT NEWBORN CARE|
20|FH_F118376_46052_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133552_77006_0|SrvcGrp|73841|2022|PDM|435.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F38663_0_0|SrvcGrp|10545|2022|PDM|74.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F139430_63017_0|SrvcGrp|48396|2022|PDM|101.00|99|0.00|OT SERVICES|
20|FH_F150839_03833_0|SrvcGrp|104226|2022|PDM|208.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F37335_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|WINTER PARK RADIOLOGY|
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_F128506_77304_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F147228_49441_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114207_35243_0|SrvcGrp|28630|2022|PCT|1.00|99|0.00|HOME INFUSION SKILLED NURSING|
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|1373.00|99|0.00|AEG 9 (NO REV)|
20|FH_F69123_0_0|SrvcGrp|42975|2022|PDM|90.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F115982_0_0|SrvcGrp|73004|2022|PDM|1165.00|99|0.00|AEG 8|
20|FH_F147418_0_0|SrvcGrp|115023|2022|PDM|13000.00|99|0.00|HIP REVISION|
20|FH_F117615_30525_0|SrvcGrp|83677|2022|PCT|0.85|99|0.00|AETNA CARDIAC CATH|
20|FH_F149399_17013_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137797_70123_0|SrvcGrp|46605|2022|PDM|124.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F131512_37617_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146859_0_0|SrvcGrp|108311|2022|PDM|1443.00|99|0.00|AETNA REPAIR ACHILLES TENDON|
20|FH_F118243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37364_0_0|SrvcGrp|2738|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F123745_0_0|SrvcGrp|67072|2022|PDM|3600.00|99|0.00|CPT 22845|
20|FH_F122394_75979_0|SrvcGrp|89149|2022|PDM|190.00|99|0.00|OP INTENSIVE|
20|FH_F108680_0_0|SrvcGrp|82109|2022|PDM|1650.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 1 (NO REV)|
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 4 (NO REV)|
20|FH_F76382_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F131274_48322_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151010_85007_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F98001_27603_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F33566_0_0|SrvcGrp|20297|2022|PDM|37143.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VALVE PROC|
20|FH_F132254_40207_0|SrvcGrp|22592|2022|PDM|50.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F122248_33441_0|SrvcGrp|75419|2022|PDM|1100.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F147180_19050_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150459_08021_0|SrvcGrp|80918|2022|PDM|137.00|99|0.00|RESPITE CARE|
20|FH_F31547_0_0|SrvcGrp|12708|2022|PCT|0.88|99|0.00|OP SURGERY|
20|FH_F91799_15010_0|SrvcGrp|472|2022|PDM|507.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F113545_11201_0|SrvcGrp|90644|2022|PDM|20.00|99|0.00|AETNA MEDICATION ASSISTED TRTMT MAINTENANCE INJECTION (HCFA)|
20|FH_F90817_0_0|SrvcGrp|83350|2022|PDM|2444.00|99|0.00|AETNA LAPAR HERNIA REPAIR|
20|FH_F119376_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F134819_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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40979_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F124322_64131_0|SrvcGrp|24745|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F114416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113826_51445_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116575_0_0|SrvcGrp|77582|2022|PDM|1800.00|99|0.00|CPT 31255|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PDM|1414.00|99|0.00|ASPG VIII|
20|FH_F148519_83201_0|SrvcGrp|66265|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F120207_0_0|SrvcGrp|84181|2022|PDM|3000.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS|
20|FH_F124287_43160_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111266_30339_0|SrvcGrp|91633|2022|PDM|775.00|99|0.00|HOME VENT (HCFA)|
20|FH_F128392_01026_0|SrvcGrp|75419|2022|PDM|700.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F43244_0_0|SrvcGrp|15150|2022|PCT|0.80|99|0.00|DRUGS|
20|FH_F32825_0_0|SrvcGrp|97|2022|PDM|3447.00|99|0.00|C-SECTION|
20|FH_F124470_90025_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132039_92008_0|SrvcGrp|74668|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131551_68355_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41033_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|GENERAL ACUTE CARE|
20|FH_F114585_11501_0|SrvcGrp|104079|2022|PCT|1.03|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F111122_63376_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132069_63128_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141270_89103_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F36343_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|930741-PHELPS REG-S CODES-AWP|
20|FH_F134936_01020_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124739_64429_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134387_60106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90817_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F132254_40207_0|SrvcGrp|86835|2022|PDM|25.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F47558_0_0|SrvcGrp|40410|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD NU|
20|FH_F94330_43220_0|SrvcGrp|26001|2022|PDM|136.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F131241_54154_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F89674_18640_0|SrvcGrp|27969|2022|PDM|18.90|99|0.00|HOME HEALTH AIDE|
20|FH_F110193_70444_0|SrvcGrp|89149|2022|PDM|233.00|99|0.00|OP INTENSIVE|
20|FH_F151607_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149515_66002_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PDM|20.00|99|0.00|HOME HEALTH AIDE MOD TF|
20|FH_F139913_33407_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143348_16214_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F143367_81003_0|SrvcGrp|96520|2022|PCT|1.00|99|0.00|OP PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143412_70503_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F123185_0_0|SrvcGrp|72990|2022|PDM|340.00|99|0.00|AEG 1|
20|FH_F130937_98002_0|SrvcGrp|89149|2022|PDM|196.00|99|0.00|OP INTENSIVE|
20|FH_F131093_49690_0|SrvcGrp|87799|2022|PDM|130.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F47600_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F48513_0_0|SrvcGrp|44347|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL)|
20|FH_F132436_33144_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120887_78750_0|SrvcGrp|472|2022|PDM|475.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120977_50510_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F126438_50029_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F63232_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|OP SVCS|
20|FH_F130721_04769_0|SrvcGrp|79699|2022|PCT|0.89|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F121303_15501_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F112908_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125259_0_0|SrvcGrp|110102|2022|PDM|1750.00|99|0.00|ARTERY-VEIN GRAFT|
20|FH_F42467_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F112863_0_0|SrvcGrp|104248|2022|PDM|2002.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|2113.00|99|0.00|AEG 3 (NO REV)|
20|FH_F111986_0_0|SrvcGrp|78283|2022|PDM|2060.00|99|0.00|CPT 49505|
20|FH_F133207_0_0|SrvcGrp|34605|2022|PDM|4774.00|99|0.00|CPT 28299|
20|FH_F150160_01301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138026_46143_0|SrvcGrp|73842|2022|PDM|201.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F128791_57201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70863_0_0|SrvcGrp|14948|2022|PDM|74.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F133875_80027_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F109367_32751_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119227_01752_0|SrvcGrp|86836|2022|PDM|18.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F80172_0_0|SrvcGrp|77508|2022|PDM|10.87|99|0.00|AETNA HIT CATH REPAIR KIT|
20|FH_F149082_33406_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39378_0_0|SrvcGrp|29021|2022|PCT|1.00|99|0.00|DME AND SUPPLIES|
20|FH_F85133_85251_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|2241.00|99|0.00|AEG 8 (NO REV)|
20|FH_F97840_54729_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F127090_45601_0|SrvcGrp|17016|2022|PDM|54.06|99|0.00|HOME INFUSION THERAPY|
20|FH_F132740_46250_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|1057.00|99|0.00|AEG 7 (NO REV)|
20|FH_F126341_27284_0|SrvcGrp|86117|2022|PDM|1013.87|99|0.00|AETNA CYTOMEGALOVIRUS IMMUNE GLOBULIN IV|
20|FH_F134613_08852_0|SrvcGrp|75419|2022|PDM|1575.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F111986_0_0|SrvcGrp|78284|2022|PDM|1236.00|99|0.00|CPT 46200|
20|FH_F134353_84123_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143571_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89219_0_0|SrvcGrp|58102|2022|PDM|11679.00|99|0.00|HAPA EPA/SEPA CARDIAC CATH|
20|FH_F149048_77090_0|SrvcGrp|87441|2022|PDM|960.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F150165_06032_0|SrvcGrp|108518|2022|PDM|2318.00|99|0.00|IMPLANT PAT ACTIVE HT RECORD|
20|FH_F119379_0_0|SrvcGrp|33971|2022|PDM|1060.00|99|0.00|CPT 25652|
20|FH_F145604_14850_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134353_84123_0|SrvcGrp|80920|2022|PDM|531.30|99|0.00|HOSPICE SERVICES|
20|FH_F134593_60007_0|SrvcGrp|24752|2022|PDM|12.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F144808_0_0|SrvcGrp|98493|2022|PDM|7699.00|99|0.00|THORACIC|
20|FH_F144248_0_0|SrvcGrp|42429|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 66761|
20|FH_F111702_07652_0|SrvcGrp|96399|2022|PCT|1.00|99|0.00|FOUNDAPARINUX SODIUM|
20|FH_F85353_16407_0|SrvcGrp|42505|2022|PDM|1633.00|99|0.00|RETAVASE/RETEPLASE W/ER|
20|FH_F145562_70458_0|SrvcGrp|86827|2022|PDM|50.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F85097_0_0|SrvcGrp|360|2022|PDM|2717.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F75087_0_0|SrvcGrp|72286|2022|PDM|1500.00|99|0.00|CYSTOURETHROSCOPY|
20|FH_F150146_95401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134191_75025_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F130763_0_0|SrvcGrp|34605|2022|PDM|3137.00|99|0.00|CPT 28299|
20|FH_F110466_06870_0|SrvcGrp|73842|2022|PDM|280.34|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F146113_26719_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138447_22041_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F37877_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 1 (NO REV)|
20|FH_F76146_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F145930_45236_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
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_F149081_63028_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138302_15701_0|SrvcGrp|43569|2022|PDM|50.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F120555_68405_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F125328_0_0|SrvcGrp|110066|2022|PDM|768.00|99|0.00|ANOSCOPY CONTROL BLEEDING|
20|FH_F91633_33907_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F121476_0_0|SrvcGrp|108832|2022|PDM|16198.00|99|0.00|IMPLANTABLE INFUSION PUMP|
20|FH_F49572_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F122930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134208_21502_0|SrvcGrp|88163|2022|PDM|2800.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1008.00|99|0.00|ASPG IV|
20|FH_F38790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1177.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F134655_14221_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F97861_62223_0|SrvcGrp|73602|2022|PDM|3772.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F91412_0_0|SrvcGrp|84912|2022|PDM|3934.70|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F121603_46761_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36552_0_0|SrvcGrp|18848|2022|PDM|29840.00|99|0.00|MS DRG 228|
20|FH_F51115_0_0|SrvcGrp|3809|2022|PDM|594.59|99|0.00|HOSPICE CARE|
20|FH_F121476_0_0|SrvcGrp|108852|2022|PDM|48.00|99|0.00|DERMAGRAFT|
20|FH_F139873_0_0|SrvcGrp|99073|2022|PDM|1.56|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F145642_15108_0|SrvcGrp|86845|2022|PDM|30.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F134358_63068_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133957_84121_0|SrvcGrp|27968|2022|PDM|42.25|99|0.00|SKILLED NURSING LPN|
20|FH_F58396_0_0|SrvcGrp|42824|2022|PDM|84.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F145921_73139_0|SrvcGrp|29346|2022|PDM|30.90|99|0.00|SKILLED NURSING- LPN|
20|FH_F83995_16748_0|SrvcGrp|10545|2022|PDM|128.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F100782_0_0|SrvcGrp|105068|2022|PDM|679.93|99|0.00|WINDBER MEDICAL CNTR ASC 113|
20|FH_F134593_60007_0|SrvcGrp|86849|2022|PDM|48.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F133808_73401_0|SrvcGrp|66264|2022|PDM|81.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F134650_07921_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F135623_53115_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F132193_0_0|SrvcGrp|12664|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F119573_95864_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F149301_44122_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|AEG 4 (NO REV)|
20|FH_F117210_0_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|AEG 2 (NO REV)|
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36552_0_0|SrvcGrp|18253|2022|PDM|5395.00|99|0.00|MS DRG 287|
20|FH_F127091_62016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F85651_33549_0|SrvcGrp|92761|2022|PCT|1.10|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F50334_0_0|SrvcGrp|44131|2022|PDM|123.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F110345_37919_0|SrvcGrp|86747|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F139722_30022_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133947_93950_0|SrvcGrp|89149|2022|PDM|292.00|99|0.00|OP INTENSIVE|
20|FH_F109405_73106_0|SrvcGrp|93919|2022|PDM|400.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F110442_98003_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F134208_21502_0|SrvcGrp|58634|2022|PDM|1300.00|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F114444_19602_0|SrvcGrp|86868|2022|PDM|75.00|99|0.00|AETNA PSYTX PT & FAM 45 MINS (MOD TD)(HCFA)|
20|FH_F54592_0_0|SrvcGrp|34146|2022|PDM|150.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F134494_33612_0|SrvcGrp|108484|2022|PDM|790.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F106942_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85393_0_0|SrvcGrp|42974|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|330.10|99|0.00|HAPA WPA-NWPA 2012-13 ASC 108 W/O REV|
20|FH_F85257_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F121601_47446_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F81852_0_0|CSTM-ALL|CSTM-00|2020|PDM|1303.00|99|0.00|ASPG VIII|
20|FH_F133585_0_0|SrvcGrp|109470|2022|PDM|70.00|99|0.00|INS CATH ABD/L-EXT ART ADDL|
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|1038.00|99|0.00|AEG 6 (NO REV)|
20|FH_F116727_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F147502_0_0|SrvcGrp|23683|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F85311_18702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F85353_16407_0|SrvcGrp|63786|2022|PDM|1282.34|99|0.00|HAPA WPA-NWPA 2012-13 ASC 707|
20|FH_F36753_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD UE|
20|FH_F150165_06032_0|SrvcGrp|88481|2022|PDM|8986.00|99|0.00|AETNA RMVL & RPLCMT DFB GEN MLT LEAD|
20|FH_F150165_06032_0|SrvcGrp|111949|2022|PDM|2140.00|99|0.00|MALE GENITAL PROCEDURES|
20|FH_F138951_41101_0|SrvcGrp|22593|2022|PDM|40.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F132969_84003_0|SrvcGrp|47183|2022|PDM|60.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F146292_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F133585_0_0|SrvcGrp|109467|2022|PDM|342.00|99|0.00|INS CATH ABD/L-EXT ART 1ST|
20|FH_F149359_33301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139299_0_0|SrvcGrp|73842|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F145641_06902_0|SrvcGrp|26274|2022|PDM|5568.00|99|0.00|CPT 29877|
20|FH_F133943_01606_0|SrvcGrp|96399|2022|PCT|1.00|99|0.00|FOUNDAPARINUX SODIUM|
20|FH_F100782_0_0|SrvcGrp|105145|2022|PDM|857.48|99|0.00|WINDBER MEDICAL CNTR ASC 305|
20|FH_F81852_0_0|CSTM-ALL|CSTM-00|2020|PDM|837.00|99|0.00|ASPG IV|
20|FH_F134593_60007_0|SrvcGrp|29076|2022|PDM|48.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F80224_0_0|SrvcGrp|453|2022|PDM|493.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F103220_0_0|SrvcGrp|99145|2022|PDM|2750.00|99|0.00|HEMORRHOIDECTOMY|
20|FH_F144248_0_0|SrvcGrp|109767|2022|PDM|2869.00|99|0.00|COVER EYE W/ MEMBRANE INCIDENTAL CODES|
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|564.00|99|0.00|AEG 2 (NO REV)|
20|FH_F126308_44515_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133887_17013_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F141337_60077_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F139512_77550_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F149079_70809_0|SrvcGrp|45752|2022|PDM|65.00|99|0.00|GROUP THERAPY|
20|FH_F118146_33062_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F38790_0_0|SrvcGrp|361|2022|PCT|0.77|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD AW"|
20|FH_F97861_62223_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F143615_92612_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146590_77449_0|SrvcGrp|29346|2022|PDM|49.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F134619_14304_0|SrvcGrp|471|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F51258_0_0|SrvcGrp|471|2022|PDM|608.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F31319_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|117.19|99|0.00|HAPA WPA-NWPA 2012-13 ASC 239 W/O REV|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.22|99|0.00|HAPA WPA-NWPA 2012-13 ASC 317 W/O REV|
20|FH_F76028_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F80513_0_0|SrvcGrp|22781|2022|PDM|11995.00|99|0.00|MS DRG 244 ONLY|
20|FH_F120775_28805_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F127656_06068_0|SrvcGrp|80920|2022|PDM|706.65|99|0.00|HOSPICE SERVICES|
20|FH_F131853_24017_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133581_84790_0|CSTM-ALL|CSTM-00|2020|PDM|2215.50|99|0.00|AEG 9 (NO REV)|
20|FH_F132213_17543_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F132937_88201_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F132234_97703_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|1604.81|99|0.00|ASPG IX|
20|FH_F46433_0_0|SrvcGrp|14892|2022|PDM|125.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F113226_30025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149959_0_0|SrvcGrp|75419|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F43008_0_0|SrvcGrp|40820|2022|PDM|1280.00|99|0.00|ICU/CCU|
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1249.30|99|0.00|ASPG VIII|
20|FH_F72742_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113410_0_0|SrvcGrp|105249|2022|PDM|2627.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F32486_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F148139_48328_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F34550_0_0|SrvcGrp|97|2022|PDM|3293.00|99|0.00|C-SECTION|
20|FH_F132190_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F129000_21017_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|399.83|99|0.00|HAPA WPA-NWPA 2012-13 ASC 209 W/O REV|
20|FH_F103100_47150_0|SrvcGrp|73006|2022|PDM|2625.00|99|0.00|AEG 9|
20|FH_F82931_18847_0|SrvcGrp|30623|2022|PDM|4140.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F143817_71322_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F42706_0_0|SrvcGrp|36411|2022|PCT|1.00|99|0.00|BLOOD / BLOOD PRODUCTS|
20|FH_F137616_48823_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F82714_18848_0|SrvcGrp|112224|2022|PDM|110.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F93791_0_0|SrvcGrp|93595|2022|PDM|4200.00|99|0.00|ARTHROPLASTY(HCFA)|
20|FH_F114977_78550_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131965_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F140988_22041_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
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_F42105_0_0|SrvcGrp|13551|2022|PDM|350.00|99|0.00|NEWBORN NURSERY|
20|FH_F93332_0_0|SrvcGrp|67119|2022|PDM|7416.00|99|0.00|ARTHODESIS|
20|FH_F39349_0_0|SrvcGrp|701|2022|PDM|2085.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F137616_48823_0|SrvcGrp|22528|2022|PDM|740.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F147941_06023_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|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129547_35476_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147941_06023_0|SrvcGrp|114469|2022|PDM|4570.00|99|0.00|CRITICAL CARE FIRST 30-74 MIN|
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 8 (NO REV)|
20|FH_F41178_0_0|CSTM-ALL|CSTM-00|2020|PDM|421.00|99|0.00|CD RESIDENTIAL TREATMENT|
20|FH_F51120_0_0|SrvcGrp|26001|2022|PDM|160.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F129669_57701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130061_84097_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130747_0_0|SrvcGrp|76604|2022|PDM|6763.00|99|0.00|CPT 25447|
20|FH_F139551_0_0|SrvcGrp|99161|2022|PDM|16500.00|99|0.00|CPT 27138|
20|FH_F131190_21042_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F82173_72712_0|CSTM-ALL|CSTM-00|2020|PDM|1825.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F32781_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F72183_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|ASPG IV - FH SW CUSTOM GROUPERS|
20|FH_F148258_66062_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137087_0_0|SrvcGrp|71666|2022|PDM|10765.00|99|0.00|CPT 63655|
20|FH_F79645_0_0|SrvcGrp|62361|2022|PDM|85.00|99|0.00|SPEECH THERAPY EVAL AND RE-EVAL|
20|FH_F68964_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F52854_0_0|SrvcGrp|361|2022|PDM|2913.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F148892_0_0|SrvcGrp|90974|2022|PDM|668.00|99|0.00|CERVICAL OR THORACIC INJECTION W/ IMAGING GUIDANCE|
20|FH_F136510_0_0|SrvcGrp|104357|2022|PDM|2886.00|99|0.00|DACRYOCYSTORHINOSTOMY|
20|FH_F141549_33403_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F93880_95476_0|SrvcGrp|73601|2022|PDM|6334.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F112325_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F97102_83501_0|SrvcGrp|73659|2022|PDM|11735.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F96902_0_0|SrvcGrp|24739|2022|PDM|165.00|99|0.00|RESPITE CARE|
20|FH_F134999_89106_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F63444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F148220_70578_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125943_66071_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F112568_0_0|SrvcGrp|104842|2022|PDM|1047.73|99|0.00|HOSPICE CARE PROVIDED IP HOSPICE FAC (HCFA)|
20|FH_F47963_0_0|SrvcGrp|14404|2022|PCT|0.60|99|0.00|HOME HEALTH CARE MEDICAL SUPPLIES|
20|FH_F148260_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F129255_34952_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F128272_60640_0|SrvcGrp|86841|2022|PDM|110.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F34735_0_0|SrvcGrp|18386|2022|PCT|0.75|99|0.00|MS DRG 314|
20|FH_F125820_66436_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118194_50841_0|SrvcGrp|46104|2022|PDM|210.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F37679_0_0|SrvcGrp|26843|2022|PDM|30.50|99|0.00|CONTINUOUS ANTICOAGULANT THERAPY (MOD SH)|
20|FH_F76303_0_0|SrvcGrp|26160|2022|PDM|8.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F139551_0_0|SrvcGrp|100921|2022|PDM|4411.00|99|0.00|SPI  PROSTH DEVICE|
20|FH_F132559_0_0|SrvcGrp|59840|2022|PDM|1635.00|99|0.00|TYMPANOSTOMY|
20|FH_F38473_0_0|SrvcGrp|10543|2022|PDM|110.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F40418_0_0|SrvcGrp|97|2022|PDM|1950.00|99|0.00|C-SECTION|
20|FH_F89779_0_0|SrvcGrp|27261|2022|PDM|19500.00|99|0.00|CPT 27446|
20|FH_F50218_0_0|SrvcGrp|46247|2022|PDM|120.00|99|0.00|HOME VISIT POSTNATAL CARE|
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|AEG 10 (NO REV)|
20|FH_F135005_06460_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F44582_0_0|SrvcGrp|16065|2022|PCT|1.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F120059_0_0|SrvcGrp|108117|2022|PDM|1650.00|99|0.00|AV FUSION / FOREARM VEIN|
20|FH_F116161_28112_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|2336.00|99|0.00|AEG 5  (NO REV)|
20|FH_F135236_02840_0|SrvcGrp|88819|2022|PDM|439.50|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F82753_18840_0|SrvcGrp|73499|2022|PDM|758.00|99|0.00|AETNA ER LEVEL II|
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 6 (NO REV)|
20|FH_F66410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F106400_02905_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F141754_21703_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132080_0_0|SrvcGrp|83857|2022|PDM|675.00|99|0.00|IP HOSPICE SVCS|
20|FH_F103360_68845_0|SrvcGrp|98245|2022|PDM|6676.00|99|0.00|RESPIRATORY SYSTEM SURGERY|
20|FH_F148704_66219_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F148867_20191_0|SrvcGrp|48385|2022|PDM|124.00|99|0.00|SPEECH THERAPY|
20|FH_F113866_0_0|SrvcGrp|93099|2022|PDM|475.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY|
20|FH_F38601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69651_0_0|SrvcGrp|10542|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F91873_12723_0|SrvcGrp|89106|2022|PCT|0.68|99|0.00|GRAFTING MATERIALS|
20|FH_F97720_70084_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F42947_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F151423_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1423.40|99|0.00|AEG 7 (NO REV)|
20|FH_F89037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F114916_30309_0|SrvcGrp|93071|2022|PDM|3424.00|99|0.00|POSTERIOR SEGMENTAL INSTRU|
20|FH_F114916_30309_0|SrvcGrp|67072|2022|PDM|3424.00|99|0.00|CPT 22845|
20|FH_F112967_0_0|SrvcGrp|89822|2022|PDM|115.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F115895_0_0|SrvcGrp|84939|2022|PDM|8487.00|99|0.00|SHOULDER JOINT|
20|FH_F103800_70811_0|SrvcGrp|78067|2022|PDM|700.00|99|0.00|SUBACUTE CARE|
20|FH_F40783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F43717_0_0|SrvcGrp|701|2022|PDM|1020.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F133002_0_0|SrvcGrp|84278|2022|PDM|1716.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F129046_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F93252_0_0|SrvcGrp|93011|2022|PDM|1500.00|99|0.00|PAIN MANAGEMENT SURGICAL PROCEDURES|
20|FH_F126345_0_0|SrvcGrp|72998|2022|PDM|979.00|99|0.00|AEG 5|
20|FH_F124180_0_0|SrvcGrp|109735|2022|PDM|3450.00|99|0.00|NSL/SINS NDSC TOTAL|
20|FH_F131505_0_0|SrvcGrp|111630|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F115971_0_0|SrvcGrp|11663|2022|PCT|0.33|99|0.00|IMPLANTS|
20|FH_F124081_64154_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62624_0_0|SrvcGrp|58517|2022|PDM|600.00|99|0.00|OP DIALYSIS|
20|FH_F38233_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAFS FS 100  MOD 26 CPT ONLY|
20|FH_F93232_0_0|SrvcGrp|471|2022|PDM|575.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F150910_0_0|SrvcGrp|113856|2022|PDM|10000.00|99|0.00|SPINE PROCEDURES|
20|FH_F127995_84010_0|SrvcGrp|19742|2022|PDM|50.00|99|0.00|MID-LINE INSERTION|
20|FH_F132973_28054_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F131848_83651_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_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|1682.00|99|0.00|AEG 2 (NO REV)|
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|6000.00|99|0.00|AEG 5  (NO REV)|
20|FH_F127448_0_0|SrvcGrp|73000|2022|PDM|1250.00|99|0.00|AEG 6|
20|FH_F122739_43558_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F43913_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F134689_60190_0|SrvcGrp|112076|2022|PDM|1100.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F134690_46237_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F134727_30650_0|SrvcGrp|105465|2022|PCT|1.10|99|0.00|AETNA THERAPIES|
20|FH_F134733_19460_0|SrvcGrp|74668|2022|PDM|450.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F31878_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F136930_73114_0|SrvcGrp|74670|2022|PCT|0.50|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F112378_60505_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F112410_46112_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|935.00|99|0.00|AEG 6 (NO REV)|
20|FH_F141170_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F46752_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.00|99|0.00|WELLPATH PROPRIETARY ASC IX|
20|FH_F115267_67156_0|SrvcGrp|73842|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147560_30809_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147394_14031_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41540_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F42176_0_0|SrvcGrp|20534|2022|PCT|0.88|99|0.00|SKILLED NURSING|
20|FH_F114853_0_0|SrvcGrp|95559|2022|PDM|7215.00|99|0.00|HIP JOINT|
20|FH_F114853_0_0|SrvcGrp|74039|2022|PDM|7215.00|99|0.00|LAMINECTOMY|
20|FH_F38949_0_0|SrvcGrp|24|2022|PDM|3614.00|99|0.00|CARDIAC CATH|
20|FH_F41213_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F42244_0_0|SrvcGrp|13292|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F138787_32258_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F138807_32207_0|SrvcGrp|66265|2022|PDM|137.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F138936_01040_0|CSTM-ALL|CSTM-00|2020|PDM|2524.00|99|0.00|AEG 4 (NO REV)|
20|FH_F67167_0_0|SrvcGrp|21226|2022|PDM|7750.00|99|0.00|MS DRG 765 ONLY REPLACEMENT 783-784, 786-787|
20|FH_F78265_0_0|SrvcGrp|9828|2022|PDM|86.00|99|0.00|HOME HEALTH AIDE|
20|FH_F117715_0_0|SrvcGrp|75497|2022|PDM|1048.00|99|0.00|AEG 10|
20|FH_F75185_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F84139_0_0|SrvcGrp|10951|2022|PDM|280.00|99|0.00|PARTIAL HOSPITALIZATION PSYCH/CD|
20|FH_F151380_90701_0|SrvcGrp|109036|2022|PDM|642.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F132258_45404_0|SrvcGrp|48394|2022|PDM|40.28|99|0.00|SKILLED NURSING SERVICES|
20|FH_F122032_32413_0|SrvcGrp|73841|2022|PDM|371.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F145168_15601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144989_07701_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F144989_07701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123184_20906_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F97501_31501_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135347_68784_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135493_07514_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135583_17331_0|SrvcGrp|109011|2022|PDM|2313.00|99|0.00|CAT SCAN FOR OP SVCS|
20|FH_F97143_80012_0|SrvcGrp|88977|2022|PDM|8745.00|99|0.00|C-SECTION DELIVERY|
20|FH_F135795_60016_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135924_02906_0|SrvcGrp|112223|2022|PDM|565.70|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F136067_67037_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136183_72756_0|SrvcGrp|111348|2022|PCT|1.30|99|0.00|OP THERAPY SERVICES|
20|FH_F100763_24202_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F131334_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F116404_20191_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F32571_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F121411_33063_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F121761_44130_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F70684_0_0|SrvcGrp|42976|2022|PDM|168.71|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F75842_0_0|SrvcGrp|17077|2022|PDM|3583.57|99|0.00|ASPG VII|
20|FH_F76028_0_0|SrvcGrp|45966|2022|PDM|140.00|99|0.00|SOCIAL WORKER|
20|FH_F146522_74133_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146848_73072_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F131698_01862_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F131976_74571_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F148740_93230_0|SrvcGrp|90040|2022|PDM|501.56|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F129130_92562_0|CSTM-ALL|CSTM-00|2020|PDM|11474.00|99|0.00|AEG 8  W/O CARDIAC CATH PROCEDURES (NO REV)|
20|FH_F129130_92562_0|SrvcGrp|113462|2022|PDM|9343.00|99|0.00|LITHOTRIPSY ESWL|
20|FH_F110000_0_0|SrvcGrp|10904|2022|PDM|269.00|99|0.00|EMERGENCY ROOM LEVEL II|
20|FH_F110103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F73231_0_0|SrvcGrp|44713|2022|PDM|126.53|99|0.00|SPEECH THERAPY SVCS|
20|FH_F87054_0_0|SrvcGrp|84858|2022|PDM|1533.00|99|0.00|AEG 7 W/O 93452-93461|
20|FH_F114916_30309_0|SrvcGrp|36591|2022|PDM|6500.00|99|0.00|CPT 63685|
20|FH_F114916_30309_0|SrvcGrp|105639|2022|PDM|1500.00|99|0.00|INCISION OF ACHILLES TENDON|
20|FH_F37294_0_0|SrvcGrp|299|2022|PDM|28017.00|99|0.00|GAMMA KNIFE|
20|FH_F132988_0_0|SrvcGrp|100042|2022|PDM|11223.07|99|0.00|REPAIR HUMERUS FRACTURE II|
20|FH_F132988_0_0|SrvcGrp|58634|2022|PDM|7439.17|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F132988_0_0|SrvcGrp|98266|2022|PDM|4493.01|99|0.00|REVISE KNEECAP|
20|FH_F114389_50131_0|SrvcGrp|105608|2022|PDM|88.14|99|0.00|TUBING WITH INTEGRATED HEATING ELEMENT (MOD NU)|
20|FH_F114389_50131_0|SrvcGrp|98951|2022|PDM|102.25|99|0.00|HIT APLHA I PROTEANS (HCFA)|
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 1 (NO REV)|
20|FH_F147081_02130_0|SrvcGrp|90854|2022|PDM|896.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F39066_0_0|SrvcGrp|97|2022|PDM|3500.00|99|0.00|C-SECTION|
20|FH_F89582_0_0|SrvcGrp|57968|2022|PDM|31.59|99|0.00|CONTINUOUS HOMECARE|
20|FH_F91898_0_0|SrvcGrp|27251|2022|PDM|338.00|99|0.00|CRISIS INTERVENTION|
20|FH_F91998_0_0|SrvcGrp|89636|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F93232_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F132864_71101_0|SrvcGrp|114975|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F124681_69337_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133701_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|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127995_84010_0|SrvcGrp|86832|2022|PDM|2.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|5947.00|99|0.00|ASPG IX|
20|FH_F52614_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136701_45150_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139556_85006_0|SrvcGrp|38247|2022|PCT|1.89|99|0.00|SLEEP STUDIES|
20|FH_F127448_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F43135_0_0|SrvcGrp|958|2022|PDM|820.00|99|0.00|VENTILATOR SERVICES|
20|FH_F112378_60505_0|SrvcGrp|23683|2022|PDM|52.42|99|0.00|SKILLED NURSING RN|
20|FH_F39622_0_0|SrvcGrp|439|2022|PDM|2400.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F49005_0_0|SrvcGrp|44985|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE (ADDITIONAL HOURS)|
20|FH_F65979_0_0|SrvcGrp|12674|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F74283_0_0|SrvcGrp|44391|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F147519_52627_0|SrvcGrp|93919|2022|PDM|453.09|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F147539_68359_0|SrvcGrp|104363|2022|PCT|0.98|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F41832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F42342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133544_78227_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F133047_74012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133494_90023_0|SrvcGrp|537|2022|PDM|2273.00|99|0.00|OBSERVATION SERVICES|
20|FH_F133170_50501_0|SrvcGrp|108484|2022|PDM|443.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F133170_50501_0|SrvcGrp|73842|2022|PDM|168.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111581_77401_0|SrvcGrp|705|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F111829_32257_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F134839_60942_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F39346_0_0|SrvcGrp|20293|2022|PDM|25602.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY|
20|FH_F46433_0_0|SrvcGrp|10580|2022|PDM|65.00|99|0.00|HYDRATION THERAPY - 3 LITERS|
20|FH_F113154_70359_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 5  (NO REV)|
20|FH_F139573_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150939_0_0|SrvcGrp|100265|2022|PDM|2.00|99|0.00|CHEMISTRY|
20|FH_F72445_0_0|SrvcGrp|3809|2022|PDM|714.00|99|0.00|HOSPICE CARE|
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)|
20|FH_F54552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F138684_44484_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|AEG 1 (NO REV)|
20|FH_F118986_0_0|SrvcGrp|75495|2022|PDM|1848.43|99|0.00|AEG 9|
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|851.00|99|0.00|AEG 6 (NO REV)|
20|FH_F113390_0_0|SrvcGrp|105241|2022|PDM|1320.00|99|0.00|REMOVAL OF SALIVARY STONE|
20|FH_F138963_0_0|SrvcGrp|16|2022|PDM|1031.00|99|0.00|ACUTE REHABILITATION|
20|FH_F151503_30067_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 6 (NO REV)|
20|FH_F122119_62675_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F122137_75633_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135389_43123_0|SrvcGrp|90854|2022|PDM|885.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F135572_89106_0|SrvcGrp|19742|2022|PCT|1.00|99|0.00|MID-LINE INSERTION|
20|FH_F97141_93933_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F121873_54303_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F134256_36117_0|SrvcGrp|57965|2022|PDM|450.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F47906_0_0|SrvcGrp|29953|2022|PCT|1.00|99|0.00|DME MOD 26|
20|FH_F47906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER QW|
20|FH_F148243_0_0|SrvcGrp|96819|2022|PDM|957.00|99|0.00|DESTROY L/S FACET JNT ADDL|
20|FH_F149239_0_0|SrvcGrp|14494|2022|PDM|37.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F134930_0_0|SrvcGrp|13928|2022|PCT|0.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F137243_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F112082_30720_0|SrvcGrp|46104|2022|PDM|148.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F112135_80910_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F102222_19720_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F102325_62691_0|SrvcGrp|24754|2022|PDM|19.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F102862_30606_0|SrvcGrp|30089|2022|PDM|425.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F102960_50613_0|SrvcGrp|110148|2022|PCT|0.00|99|0.00|DRUGS|
20|FH_F102960_50613_0|SrvcGrp|85145|2022|PDM|267.00|99|0.00|PT/OT/ST|
20|FH_F148061_11223_0|SrvcGrp|66265|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F84394_17402_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F46158_0_0|SrvcGrp|17065|2022|PCT|0.65|99|0.00|ASPG I|
20|FH_F33925_0_0|SrvcGrp|18886|2022|PDM|22990.00|99|0.00|MS DRG 234|
20|FH_F34311_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100783_03431_0|SrvcGrp|73559|2022|PDM|6919.00|99|0.00|AETNA INTENSIVE 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_F128031_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F95221_0_0|SrvcGrp|72998|2022|PDM|753.00|99|0.00|AEG 5|
20|FH_F100906_0_0|SrvcGrp|90061|2022|PDM|6000.00|99|0.00|AETNA RECONSTRUCT SHOULDER JOINT|
20|FH_F119795_0_0|SrvcGrp|78096|2022|PDM|5202.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F89372_0_0|SrvcGrp|43|2022|PCT|0.51|99|0.00|IMPLANTS|
20|FH_F89778_0_0|SrvcGrp|16289|2022|PDM|782.06|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F87474_0_0|SrvcGrp|14372|2022|PDM|22.00|99|0.00|AMBULATORY INFUSION PUMP|
20|FH_F123601_30680_0|SrvcGrp|42785|2022|PDM|125.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F123783_03860_0|SrvcGrp|43567|2022|PDM|154.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F132810_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120444_84037_0|SrvcGrp|108484|2022|PDM|750.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F120490_64133_0|SrvcGrp|86840|2022|PDM|22.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F134126_11554_0|SrvcGrp|10107|2022|PCT|0.45|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F137236_17603_0|SrvcGrp|104796|2022|PDM|175.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F142448_15701_0|SrvcGrp|19742|2022|PDM|80.00|99|0.00|MID-LINE INSERTION|
20|FH_F142247_61244_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142547_70002_0|SrvcGrp|17014|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142654_73034_0|SrvcGrp|73842|2022|PDM|262.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F142715_32757_0|CSTM-ALL|CSTM-00|2020|PCT|1.03|99|0.00|HSS ASC|
20|FH_F53732_0_0|SrvcGrp|22590|2022|PDM|80.00|99|0.00|PAIN MANAGAMENT - INTERMITTENT|
20|FH_F97601_67218_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 2 (NO REV)|
20|FH_F140493_67107_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140496_38627_0|SrvcGrp|73841|2022|PDM|475.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F140615_73013_0|CSTM-ALL|CSTM-00|2020|PCT|0.27|99|0.00|OP SVCS|
20|FH_F140633_17901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F140888_75119_0|SrvcGrp|46903|2022|PDM|646.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F80284_16354_0|SrvcGrp|12290|2022|PDM|733.00|99|0.00|DETOXIFICATION|
20|FH_F137530_0_0|SrvcGrp|68546|2022|PDM|3035.00|99|0.00|CPT 36558|
20|FH_F120152_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F118955_48239_0|SrvcGrp|89023|2022|PDM|84.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F92506_07666_0|SrvcGrp|79786|2022|PDM|1538.00|99|0.00|SLEEP STUDIES|
20|FH_F92852_0_0|SrvcGrp|53702|2022|PDM|2200.00|99|0.00|PREP CORNEAL ENDOTHELIAL ALLOGRAFT|
20|FH_F147879_93309_0|SrvcGrp|48385|2022|PDM|165.00|99|0.00|SPEECH THERAPY|
20|FH_F147941_06023_0|SrvcGrp|12290|2022|PDM|8301.00|99|0.00|DETOXIFICATION|
20|FH_F117105_77619_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F117218_32025_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F101945_0_0|SrvcGrp|16289|2022|PDM|1353.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F137818_31602_0|SrvcGrp|86723|2022|PDM|503.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F34371_0_0|SrvcGrp|10538|2022|PDM|26.00|99|0.00|NURSING CARE|
20|FH_F132736_0_0|SrvcGrp|58|2022|PDM|9668.00|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F115495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135653_0_0|SrvcGrp|40002|2022|PDM|14000.00|99|0.00|TOTAL HIP|
20|FH_F132212_0_0|SrvcGrp|92501|2022|PDM|90.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F148379_89129_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F125176_20785_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F146320_27610_0|CSTM-ALL|CSTM-00|2020|PDM|10281.00|99|0.00|PERCUTANEOUS AVF|
20|FH_F146401_76401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92648_90248_0|SrvcGrp|48394|2022|PDM|31.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F67265_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F41396_0_0|SrvcGrp|34277|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF (DME)|
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|772.00|99|0.00|AEG 1 (NO REV)|
20|FH_F128929_33030_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F42803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F136012_60625_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131463_19096_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130670_32204_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F32522_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F121731_20164_0|SrvcGrp|27969|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE|
20|FH_F121763_07202_0|SrvcGrp|52952|2022|PDM|98.00|99|0.00|PSYCHIATRIC CPT 90847|
20|FH_F46918_0_0|SrvcGrp|28631|2022|PDM|73.00|99|0.00|LPN VISIT|
20|FH_F111301_33122_0|SrvcGrp|82762|2022|PDM|24.00|99|0.00|URINALYSIS AUTO W/ SCOPE|
20|FH_F111383_62233_0|SrvcGrp|105650|2022|PCT|1.50|99|0.00|ER CODES|
20|FH_F43137_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134930_0_0|SrvcGrp|13927|2022|PCT|0.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F116430_0_0|SrvcGrp|106710|2022|PDM|3183.00|99|0.00|PAIN STIM SURGERY|
20|FH_F131000_0_0|SrvcGrp|14614|2022|PDM|3608.00|99|0.00|LITHOTRIPSY|
20|FH_F87534_19464_0|SrvcGrp|46424|2022|PDM|104.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|2179.00|99|0.00|AEG 5  (NO REV)|
20|FH_F102325_62691_0|SrvcGrp|29347|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F148101_33462_0|SrvcGrp|102239|2022|PDM|95.00|99|0.00|AETNA METHADONE MAINTENANCE|
20|FH_F36132_0_0|SrvcGrp|22352|2022|PDM|80.00|99|0.00|SPEECH  THERAPY SVCS|
20|FH_F39621_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100780_24153_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F36704_0_0|SrvcGrp|10427|2022|PCT|0.85|99|0.00|TRAUMA CARE|
20|FH_F36704_0_0|SrvcGrp|13123|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F71183_29601_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|GENERAL ACUTE CARE|
20|FH_F130302_0_0|SrvcGrp|73002|2022|PDM|2280.00|99|0.00|AEG 7|
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|465.00|99|0.00|AEG 1 (NO REV)|
20|FH_F122725_32216_0|CSTM-ALL|CSTM-00|2020|PDM|30.00|99|0.00|MANUAL LIMB MUSCLE TESTING|
20|FH_F122725_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122694_33334_0|SrvcGrp|12659|2022|PDM|716.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F119795_0_0|SrvcGrp|98347|2022|PDM|3106.00|99|0.00|HIP ARTHROSCOPY / SURGERY|
20|FH_F36646_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F62614_0_0|SrvcGrp|46604|2022|PDM|30.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|AEG 8 (NO REV)|
20|FH_F46832_0_0|SrvcGrp|14947|2022|PDM|25.00|99|0.00|HOME INFUSION|
20|FH_F123820_91316_0|SrvcGrp|75419|2022|PDM|900.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F47495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F58856_0_0|SrvcGrp|19633|2022|PDM|33750.00|99|0.00|MS DRG 226 ONLY|
20|FH_F136475_89119_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137047_73120_0|SrvcGrp|110585|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION I|
20|FH_F137051_64096_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137147_75006_0|SrvcGrp|98347|2022|PDM|21685.00|99|0.00|HIP ARTHROSCOPY / SURGERY|
20|FH_F142448_15701_0|SrvcGrp|24754|2022|PDM|25.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F142491_06033_0|SrvcGrp|95660|2022|PDM|850.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F142690_31774_0|SrvcGrp|24752|2022|PDM|45.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F83831_0_0|SrvcGrp|10649|2022|PDM|8.00|99|0.00|HOME INFUSION|
20|FH_F138471_84663_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138584_30912_0|SrvcGrp|113386|2022|PDM|1300.00|99|0.00|RECONSTRUCTION OF MANDIBULAR|
20|FH_F138627_82901_0|SrvcGrp|86828|2022|PDM|80.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F140343_89052_0|SrvcGrp|17014|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F140750_89119_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F149530_80014_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F149663_45219_0|SrvcGrp|89981|2022|PDM|2462.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY|
20|FH_F151605_78209_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151611_30032_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F119023_91406_0|SrvcGrp|29076|2022|PDM|35.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F38332_0_0|SrvcGrp|18123|2022|PDM|12064.00|99|0.00|MS DRG 241|
20|FH_F40402_0_0|SrvcGrp|30942|2022|PDM|530.00|99|0.00|SUB-ACUTE SKILLED NURSING CARE|
20|FH_F92506_07666_0|SrvcGrp|11663|2022|PCT|0.42|99|0.00|IMPLANTS|
20|FH_F48292_0_0|SrvcGrp|44249|2022|PDM|192.00|99|0.00|CAPD TRAINING|
20|FH_F117267_07728_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147725_06002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129474_92701_0|SrvcGrp|74668|2022|PDM|700.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129514_79605_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F137814_61820_0|SrvcGrp|73841|2022|PDM|393.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F104700_0_0|SrvcGrp|72996|2022|PDM|1245.00|99|0.00|AEG 4|
20|FH_F109652_0_0|SrvcGrp|43487|2022|PDM|30199.00|99|0.00|MS DRG'S 471-473|
20|FH_F110720_0_0|SrvcGrp|104097|2022|PDM|2759.00|99|0.00|INCISION OF TENDON & MUSCLE|
20|FH_F90838_16146_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F129892_0_0|SrvcGrp|111432|2022|PDM|1715.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F95880_02726_0|SrvcGrp|99460|2022|PDM|91.96|99|0.00|OCCUPATIONAL THERAPY EVALUATION|
20|FH_F111594_0_0|SrvcGrp|98497|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F132544_0_0|SrvcGrp|96999|2022|PDM|3454.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F119289_43040_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F119444_72903_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F119449_84032_0|SrvcGrp|46903|2022|PDM|750.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F119491_19904_0|SrvcGrp|46605|2022|PDM|84.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F148554_85016_0|SrvcGrp|115436|2022|PDM|3121.00|99|0.00|INSERT HEART PM VENTRICULAR|
20|FH_F90811_0_0|SrvcGrp|90426|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY SURGERY|
20|FH_F141940_50023_0|CSTM-ALL|CSTM-00|2020|PDM|2491.55|99|0.00|AEG 3 (NO REV)|
20|FH_F38250_0_0|CSTM-ALL|CSTM-00|2020|PDM|592.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129965_0_0|SrvcGrp|35982|2022|PDM|42.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F46914_0_0|SrvcGrp|26742|2022|PDM|147.00|99|0.00|PT|
20|FH_F39558_0_0|SrvcGrp|17067|2022|PDM|546.00|99|0.00|ASPG II|
20|FH_F112627_26062_0|SrvcGrp|42622|2022|PCT|0.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F125215_78130_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F88512_0_0|SrvcGrp|17075|2022|PDM|3492.23|99|0.00|ASPG VI|
20|FH_F147800_0_0|SrvcGrp|115147|2022|PDM|138.00|99|0.00|DRAIN/INJ JOINT/BURSA W/US|
20|FH_F92677_08003_0|SrvcGrp|17013|2022|PDM|63.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F139594_0_0|SrvcGrp|104448|2022|PDM|6600.00|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE|
20|FH_F103360_68845_0|SrvcGrp|75505|2022|PCT|7.50|99|0.00|CARDIAC STUDIES|
20|FH_F125013_85251_0|SrvcGrp|89149|2022|PDM|450.00|99|0.00|OP INTENSIVE|
20|FH_F121168_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F132555_39466_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133003_49012_0|SrvcGrp|86722|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F93331_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F111461_32607_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130258_54304_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144011_60616_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F88512_0_0|SrvcGrp|40820|2022|PDM|4255.91|99|0.00|ICU/CCU|
20|FH_F118540_32064_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125471_34471_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F145988_06105_0|SrvcGrp|74059|2022|PDM|3939.00|99|0.00|AETNA CC FOR ER SERVICE CPT 99291|
20|FH_F51972_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F97042_64804_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F36207_0_0|SrvcGrp|16896|2022|PDM|550.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F40008_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37751_0_0|SrvcGrp|474|2022|PDM|848.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F146220_72112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD 26|
20|FH_F44079_0_0|SrvcGrp|10541|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F71644_0_0|SrvcGrp|10681|2022|PDM|182.00|99|0.00|INTENSIVE  SVCS|
20|FH_F120437_85202_0|SrvcGrp|86851|2022|PDM|78.78|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F34706_0_0|SrvcGrp|3002|2022|PDM|13574.00|99|0.00|DRG 518 PERCUTANEOUS CARDIO PROC|
20|FH_F142081_54929_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110240_0_0|SrvcGrp|79595|2022|PDM|743.00|99|0.00|CPT 45385|
20|FH_F71271_0_0|SrvcGrp|48394|2022|PDM|7.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F125478_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 8 (NO REV)|
20|FH_F133251_89521_0|SrvcGrp|73841|2022|PDM|477.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F131699_08210_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F95980_20016_0|SrvcGrp|70399|2022|PDM|311.00|99|0.00|PSYCHIATIC/PSYCHOLOGIC SERVICE|
20|FH_F106540_26330_0|SrvcGrp|74469|2022|PCT|0.50|99|0.00|AETNA CHEMOTHERAPY|
20|FH_F148639_0_0|SrvcGrp|109967|2022|PDM|5010.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F39517_0_0|SrvcGrp|11336|2022|PCT|0.75|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F149840_80002_0|SrvcGrp|80918|2022|PDM|142.00|99|0.00|RESPITE CARE|
20|FH_F91155_16105_0|SrvcGrp|73806|2022|PDM|406.00|99|0.00|AETNA ER|
20|FH_F133478_40165_0|SrvcGrp|28787|2022|PDM|41.21|99|0.00|CPT CODE 90993|
20|FH_F120437_85202_0|SrvcGrp|108450|2022|PDM|16.59|99|0.00|INJ CUVITRU, 100 MG|
20|FH_F83031_0_0|SrvcGrp|72960|2022|PDM|105.00|99|0.00|REVENUE 642 AND HCPCS S5522|
20|FH_F118788_91355_0|SrvcGrp|705|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F148925_61531_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150001_33064_0|SrvcGrp|86832|2022|PDM|2.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F40154_0_0|CSTM-ALL|CSTM-00|2020|PDM|698.00|99|0.00|ACUTE PSYCH|
20|FH_F149652_37212_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F128312_45230_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F68944_0_0|SrvcGrp|9511|2022|PCT|0.70|99|0.00|OBSERVATION SVCS|
20|FH_F36118_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F92677_08003_0|SrvcGrp|92808|2022|PDM|7.35|99|0.00|ENTERAL FEEDING SUPPLY KIT BOLUS (HCFA)|
20|FH_F46492_0_0|SrvcGrp|14997|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F128421_27016_0|SrvcGrp|109220|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F37567_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|ASPG IV|
20|FH_F147995_67037_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F149882_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F57396_0_0|SrvcGrp|46593|2022|PDM|160.00|99|0.00|CPT 99215|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/MOD UE (TX)|
20|FH_F144668_62526_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|91312.00|99|0.00|SPINAL FUSION (MS DRG 456-458)|
20|FH_F38673_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F117450_63131_0|SrvcGrp|88620|2022|PDM|115.00|99|0.00|SKILLED NURSING RN|
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|1134.00|99|0.00|AEG 4 (NO REV)|
20|FH_F60101_0_0|SrvcGrp|1168|2022|PDM|1005.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F37640_0_0|SrvcGrp|68580|2022|PCT|1.00|99|0.00|IMMUNIZATIONS|
20|FH_F112853_22408_0|SrvcGrp|41456|2022|PDM|0.70|99|0.00|ENTERAL FORMULA - PEDIATRICS (CALORICALLY DENSE)|
20|FH_F95360_08720_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135649_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123144_0_0|SrvcGrp|72996|2022|PDM|653.00|99|0.00|AEG 4|
20|FH_F139128_49503_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F139667_84078_0|SrvcGrp|46605|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F150700_90028_0|SrvcGrp|108484|2022|PDM|750.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F117576_21207_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97183_25304_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F101685_0_0|SrvcGrp|72990|2022|PDM|384.00|99|0.00|AEG 1|
20|FH_F35387_0_0|SrvcGrp|8968|2022|PDM|1830.00|99|0.00|NICU LEVEL III & IV|
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36485_0_0|SrvcGrp|23235|2022|PCT|0.65|99|0.00|DME (GLOBAL)|
20|FH_F142370_0_0|SrvcGrp|113546|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F111857_68005_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F122264_75972_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97881_38703_0|SrvcGrp|73656|2022|PDM|629.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F98940_70506_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F49300_0_0|SrvcGrp|36068|2022|PDM|45.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F49300_0_0|SrvcGrp|42975|2022|PDM|90.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F144831_0_0|SrvcGrp|104842|2022|PDM|686.00|99|0.00|HOSPICE CARE PROVIDED IP HOSPICE FAC (HCFA)|
20|FH_F128543_44413_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F110729_15068_0|SrvcGrp|108484|2022|PDM|572.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F43236_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110732_31513_0|SrvcGrp|104560|2022|PCT|0.60|99|0.00|CHEMOTHERAPY AND ALL OTHER DRUGS|
20|FH_F125214_12428_0|SrvcGrp|112509|2022|PDM|1704.00|99|0.00|MRI/MRA|
20|FH_F117645_90034_0|SrvcGrp|73842|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F112754_98057_0|SrvcGrp|88781|2022|PDM|232.13|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F137986_0_0|SrvcGrp|35669|2022|PDM|3000.00|99|0.00|CPT 63650|
20|FH_F149542_89169_0|SrvcGrp|74668|2022|PDM|235.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|ST CLAIRS S CODES MOD SH|
20|FH_F39489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F115269_0_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F116753_0_0|SrvcGrp|103864|2022|PCT|1.27|99|0.00|AETNA ALL DRUGS AGENTS|
20|FH_F116554_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147080_02446_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F31087_0_0|SrvcGrp|10522|2022|PDM|218.00|99|0.00|PICC LINE INSERT|
20|FH_F35758_33710_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 3 (NO REV)|
20|FH_F76124_0_0|SrvcGrp|12496|2022|PDM|753.00|99|0.00|ACUTE REHABILITATION|
20|FH_F97881_38703_0|SrvcGrp|73461|2022|PDM|9773.00|99|0.00|AETNA NICU IV|
20|FH_F134916_16421_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149641_87113_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ASPG I|
20|FH_F43113_0_0|SrvcGrp|9828|2022|PDM|38.50|99|0.00|HOME HEALTH AIDE|
20|FH_F116753_0_0|SrvcGrp|73461|2022|PDM|2798.00|99|0.00|AETNA NICU IV|
20|FH_F111266_30339_0|SrvcGrp|86854|2022|PDM|30.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F128672_30274_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131605_0_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F56054_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39443_0_0|SrvcGrp|30315|2022|PDM|64.00|99|0.00|HAPA WPA ASC 124|
20|FH_F138387_02886_0|SrvcGrp|29155|2022|PDM|137.00|99|0.00|HOSPICE SVCS|
20|FH_F124976_0_0|SrvcGrp|72602|2022|PDM|651.00|99|0.00|ECT|
20|FH_F111266_30339_0|SrvcGrp|86833|2022|PDM|10.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F150930_64485_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146204_0_0|SrvcGrp|104753|2022|PDM|1500.00|99|0.00|PELVIC EXAMINATION|
20|FH_F145920_0_0|SrvcGrp|33967|2022|PDM|3433.00|99|0.00|CPT 47562|
20|FH_F149049_28401_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 7 (NO REV)|
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_F120154_77498_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|82114|2022|PDM|2202.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F120100_98390_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|691.00|99|0.00|AEG 2 (NO REV)|
20|FH_F37312_0_0|SrvcGrp|10538|2022|PDM|71.50|99|0.00|NURSING CARE|
20|FH_F101441_0_0|SrvcGrp|93740|2022|PDM|7946.00|99|0.00|REVISE/REMOVE NEURO RECEIVER|
20|FH_F47902_0_0|SrvcGrp|29960|2022|PCT|1.00|99|0.00|DME MOD KN|
20|FH_F39756_0_0|SrvcGrp|31520|2022|PDM|751.30|99|0.00|CUMBERLAND SURGERY CTR - ASPG IV|
20|FH_F101083_0_0|SrvcGrp|73002|2022|PDM|1344.00|99|0.00|AEG 7|
20|FH_F142587_0_0|SrvcGrp|92502|2022|PDM|935.94|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F131942_50833_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F90817_0_0|SrvcGrp|90376|2022|PDM|6580.00|99|0.00|REVISION OF KNEE JOINTLANT|
20|FH_F136541_0_0|SrvcGrp|111934|2022|PDM|51.31|99|0.00|COVID-19 NUCLEIC ACID|
20|FH_F134396_80045_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134936_01020_0|SrvcGrp|66265|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F36903_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD NU|
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_F134891_45885_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F127292_85705_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F89674_18640_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143668_0_0|SrvcGrp|115716|2022|PDM|82.50|99|0.00|SEGMENTAL PNEUMATIC (MOD UE)|
20|FH_F128770_57313_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F36435_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|RAD W/MOD TC - FSHF|
20|FH_F52278_0_0|CSTM-ALL|CSTM-00|2020|PDM|598.00|99|0.00|ASPG I|
20|FH_F31547_0_0|SrvcGrp|12692|2022|PDM|63.67|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|2952.00|99|0.00|AEG 9 (NO REV)|
20|FH_F124739_64429_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F89851_83854_0|SrvcGrp|21359|2022|PDM|28800.00|99|0.00|MS DRG 460 ONLY|
20|FH_F131385_76457_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F138018_17313_0|SrvcGrp|14945|2022|PDM|12.50|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F73768_0_0|SrvcGrp|71107|2022|PDM|570.00|99|0.00|HCPCS A9277|
20|FH_F127418_0_0|SrvcGrp|110767|2022|PDM|5009.38|99|0.00|2ND LEVEL INJ PARAVERT F JNT L/S|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.49|99|0.00|SALLY BALIN,999182,ASC 114|
20|FH_F75944_0_0|SrvcGrp|68192|2022|PDM|1874.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 8|
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|921.85|99|0.00|AEG 6 (NO REV)|
20|FH_F97623_38008_0|SrvcGrp|73659|2022|PDM|4493.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F97184_26101_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F134847_0_0|SrvcGrp|27261|2022|PDM|10026.00|99|0.00|CPT 27446|
20|FH_F35557_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1414794 AM HOME PAT DME MOD AV|
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|2215.30|99|0.00|AEG 3 (NO REV)|
20|FH_F139878_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143249_89801_0|SrvcGrp|26869|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F143249_89801_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F143351_21157_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F143533_30013_0|SrvcGrp|99362|2022|PDM|248.00|99|0.00|DX MAMMO INCL CAD BI|
20|FH_F72749_0_0|SrvcGrp|3499|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F75903_0_0|SrvcGrp|12044|2022|PDM|760.82|99|0.00|SLEEP STUDIES|
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|AEG 5  (NO REV)|
20|FH_F102920_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F103060_0_0|SrvcGrp|89404|2022|PDM|7803.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)|
20|FH_F115443_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 2 (NO REV)|
20|FH_F136286_73120_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116802_41224_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F119918_38201_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F120851_66112_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F62579_0_0|SrvcGrp|29075|2022|PDM|50.00|99|0.00|HYDRATION THERAPY|
20|FH_F135840_0_0|SrvcGrp|75479|2022|PDM|350.00|99|0.00|AEG 1|
20|FH_F130755_04401_0|SrvcGrp|107637|2022|PCT|0.93|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F130805_17404_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)|
20|FH_F130841_49315_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F85777_77030_0|SrvcGrp|73601|2022|PDM|6670.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F79863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36552_0_0|SrvcGrp|16|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION|
20|FH_F70208_0_0|SrvcGrp|941|2022|PDM|2530.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PDM|1097.00|99|0.00|ASPG VIII|
20|FH_F124369_0_0|SrvcGrp|41327|2022|PDM|6545.00|99|0.00|OP SURGERY CPT 28308|
20|FH_F133175_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F72124_0_0|SrvcGrp|29804|2022|PDM|682.00|99|0.00|DETOX|
20|FH_F95440_0_0|SrvcGrp|33967|2022|PDM|3296.00|99|0.00|CPT 47562|
20|FH_F148547_01908_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F93122_01854_0|SrvcGrp|93037|2022|PDM|334.00|99|0.00|PARTIAL HOSPITALIZATION (<18 YRS) (HCFA)|
20|FH_F40635_0_0|SrvcGrp|16|2022|PDM|795.00|99|0.00|ACUTE REHABILITATION|
20|FH_F141337_60077_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F39378_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F149021_44514_0|CSTM-ALL|CSTM-00|2020|PDM|463.00|99|0.00|AEG 2 (NO REV)|
20|FH_F135670_01749_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133972_27103_0|SrvcGrp|108087|2022|PDM|230.00|99|0.00|INSERT NON-TUNNL CNTRL CVC|
20|FH_F130329_64114_0|SrvcGrp|86836|2022|PDM|10.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|1675.00|99|0.00|AEG 2 (NO REV)|
20|FH_F110343_38139_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F145641_06902_0|SrvcGrp|85778|2022|PDM|3588.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F141210_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F98021_07012_0|SrvcGrp|88978|2022|PDM|7363.00|99|0.00|VAGINAL DELIVERY|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|753.30|99|0.00|HAPA WPA-NWPA 2012-13 ASC 502 W/O REV|
20|FH_F134593_60007_0|SrvcGrp|86835|2022|PDM|12.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F125328_0_0|SrvcGrp|72994|2022|PDM|549.00|99|0.00|AEG 3|
20|FH_F111744_32514_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F96721_99504_0|SrvcGrp|73656|2022|PDM|270.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F110580_71106_0|SrvcGrp|104728|2022|PCT|1.00|99|0.00|CHEMOTHERAPY AND ALL OTHER DRUGS|
20|FH_F80594_0_0|SrvcGrp|472|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133943_01606_0|SrvcGrp|87905|2022|PCT|1.00|99|0.00|CILAS SOD;IMIP PR 250MG/32MX|
20|FH_F147962_85008_0|SrvcGrp|104136|2022|PDM|2000.00|99|0.00|PSYCH INTENSIVE CARE UNIT|
20|FH_F70448_0_0|SrvcGrp|64200|2022|PCT|1.00|99|0.00|RAD AND LAB|
20|FH_F37877_0_0|SrvcGrp|70819|2022|PCT|0.80|99|0.00|(HCPCS) OCN F/S PRICING: ALL|
20|FH_F63580_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149021_44514_0|CSTM-ALL|CSTM-00|2020|PDM|1116.00|99|0.00|AEG 8 (NO REV)|
20|FH_F101100_50314_0|SrvcGrp|97924|2022|PDM|3765.00|99|0.00|LIGATE OVIDUCT ADD ON|
20|FH_F105145_75075_0|SrvcGrp|27347|2022|PDM|17000.00|99|0.00|CPT 58558|
20|FH_F105340_13502_0|SrvcGrp|82981|2022|PDM|145.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F115788_02904_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F66782_0_0|SrvcGrp|43567|2022|PDM|80.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F75842_0_0|SrvcGrp|17073|2022|PDM|3157.99|99|0.00|ASPG V|
20|FH_F146881_83661_0|SrvcGrp|104228|2022|PDM|140.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F44638_0_0|SrvcGrp|170|2022|PDM|425.00|99|0.00|CD (ADOLESCENT) - REHAB|
20|FH_F116040_24637_0|SrvcGrp|86850|2022|PDM|30.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F132213_17543_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F132167_06040_0|SrvcGrp|471|2022|PDM|588.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133401_33404_0|SrvcGrp|111928|2022|PDM|70.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F132868_43551_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132028_68776_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F111584_07002_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F134826_19067_0|SrvcGrp|90631|2022|PDM|250.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.00|99|0.00|AEG 10 (NO REV)|
20|FH_F151284_72703_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121329_33015_0|SrvcGrp|473|2022|PDM|390.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F129130_92562_0|SrvcGrp|107637|2022|PCT|2.08|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2501000 MOD TC (HCFA)|
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91873_12723_0|SrvcGrp|31704|2022|PDM|3450.00|99|0.00|MS DRG 790 ONLY|
20|FH_F86911_0_0|SrvcGrp|85656|2022|PDM|14.80|99|0.00|VIA PUMP|
20|FH_F114916_30309_0|SrvcGrp|98497|2022|PDM|6500.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PDM|3348.00|99|0.00|AEG 6 (NO REV)|
20|FH_F113541_0_0|SrvcGrp|83838|2022|PDM|2572.00|99|0.00|SUSPENSION OF BREAST|
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|1775.00|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_F133376_33414_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F39426_0_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133178_0_0|SrvcGrp|106719|2022|PDM|1255.00|99|0.00|INDUCED ABORTION BY DILATION AND EVACUATION|
20|FH_F135491_0_0|SrvcGrp|12994|2022|PCT|1.21|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F94786_07974_0|SrvcGrp|86851|2022|PDM|36.75|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F94786_07974_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA PROMPTCARE ANCD|
20|FH_F95341_08701_0|SrvcGrp|89500|2022|PCT|0.80|99|0.00|SPEECH SOUND LANGUAGE|
20|FH_F131608_0_0|SrvcGrp|89781|2022|PDM|165.42|99|0.00|RESPITE CARE (HCFA)|
20|FH_F132627_0_0|SrvcGrp|44424|2022|PDM|144.00|99|0.00|MEDICAL SOCIAL WORKER (VISIT LVL)|
20|FH_F50415_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 649|
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_F114386_07090_0|SrvcGrp|48396|2022|PDM|76.07|99|0.00|OT SERVICES|
20|FH_F77944_0_0|SrvcGrp|115979|2022|PDM|7849.00|99|0.00|ACUTE MEDICAL/SURGICAL SERVICES|
20|FH_F147059_28806_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F64819_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.75|99|0.00|HAPA WPA/NWPA 2013 RAD 100%|
20|FH_F37603_0_0|SrvcGrp|30170|2022|PCT|0.70|99|0.00|PROSTHETICS|
20|FH_F38688_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92493_0_0|SrvcGrp|67068|2022|PDM|23421.20|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F124235_92840_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125134_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150910_0_0|SrvcGrp|93063|2022|PDM|10500.00|99|0.00|LUMBAR ARTIF DISKECTOMY|
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|4325.00|99|0.00|ASPG VIII|
20|FH_F90653_0_0|SrvcGrp|16778|2022|PCT|0.70|99|0.00|DIALYSIS|
20|FH_F133697_63129_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F100787_69162_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F136567_94578_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136609_72601_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114666_30342_0|SrvcGrp|105632|2022|PDM|1000.00|99|0.00|AMPUTATION OF TOE|
20|FH_F114727_44512_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F139372_34698_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F138267_75087_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 4 (NO REV)|
20|FH_F144039_0_0|SrvcGrp|109758|2022|PDM|11475.00|99|0.00|COLLAGEN CROSSLINKING CORNEA|
20|FH_F122680_53511_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F43295_0_0|SrvcGrp|360|2022|PDM|1499.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F43696_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F134687_14226_0|SrvcGrp|471|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F136813_06518_0|SrvcGrp|472|2022|PDM|430.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F136913_68803_0|SrvcGrp|31072|2022|PDM|12627.00|99|0.00|MS DRG 794 ONLY|
20|FH_F112485_61032_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F116345_78626_0|SrvcGrp|93919|2022|PDM|510.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F147527_60645_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41463_0_0|SrvcGrp|24746|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F41738_0_0|SrvcGrp|21342|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F41795_0_0|SrvcGrp|27736|2022|PDM|60.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F42402_0_0|SrvcGrp|20801|2022|PCT|0.85|99|0.00|HOME HEALTH|
20|FH_F42688_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|TRAUMA CARE|
20|FH_F110344_37421_0|SrvcGrp|86747|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F114444_19602_0|SrvcGrp|86641|2022|PDM|85.00|99|0.00|AETNA PSYCH DIAGNOSITC EVALUATION (MOD TD)|
20|FH_F70804_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|106% OF ASP DRUGS/IMMUN UPDATE QUARTERLY|
20|FH_F73125_0_0|CSTM-ALL|CSTM-00|2020|PDM|12.00|99|0.00|SKILLED NURSING HCPC|
20|FH_F130763_0_0|SrvcGrp|102480|2022|PDM|3258.00|99|0.00|CPT 29897|
20|FH_F63114_0_0|SrvcGrp|48397|2022|PDM|30.00|99|0.00|PT SERVICES|
20|FH_F51039_0_0|SrvcGrp|47603|2022|PCT|0.65|99|0.00|WORK HARDENING|
20|FH_F116473_0_0|SrvcGrp|89404|2022|PDM|15000.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F127090_45601_0|SrvcGrp|110629|2022|PCT|1.06|99|0.00|ALL DRUGS, AGENTS, INJ. DRUGS|
20|FH_F125513_40071_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F89574_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150165_06032_0|SrvcGrp|109492|2022|PDM|8657.00|99|0.00|INSERT HEART PM ATRIAL|
20|FH_F139565_0_0|SrvcGrp|109761|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESIONS|
20|FH_F133887_17013_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|391.08|99|0.00|HAPA WPA-NWPA 2012-13 ASC 101 W/O REV|
20|FH_F93786_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|OP SVCS|
20|FH_F50013_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|2480.00|99|0.00|AEG 2 (NO REV)|
20|FH_F110245_46016_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88698_18951_0|SrvcGrp|70381|2022|PDM|247.00|99|0.00|PSYCH PARTIAL HOSP (FULL & PARTIAL DAY) PER VISIT|
20|FH_F149139_07522_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F85097_0_0|SrvcGrp|13359|2022|PDM|201.00|99|0.00|EMERGENCY ROOM SVCS LEVEL I|
20|FH_F123623_03246_0|SrvcGrp|109298|2022|PCT|1.00|99|0.00|FLU VACCINE, NASAL|
20|FH_F54592_0_0|SrvcGrp|12403|2022|PDM|834.43|99|0.00|CONTINUOUS HOMECARE|
20|FH_F84712_0_0|SrvcGrp|82760|2022|PDM|64.00|99|0.00|ASSAY OF SERUM AMYLASE|
20|FH_F85894_0_0|SrvcGrp|45702|2022|PCT|1.00|99|0.00|JERSEY SHORE RAD-GH WITH OBS OR UNGROUPED SURG|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|217.64|99|0.00|HAPA WPA-NWPA 2012-13 ASC 124 W/O REV|
20|FH_F85211_0_0|SrvcGrp|11663|2022|PCT|1.03|99|0.00|IMPLANTS|
20|FH_F85211_0_0|SrvcGrp|73002|2022|PDM|1366.20|99|0.00|AEG 7|
20|FH_F98780_35022_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F101100_50314_0|SrvcGrp|94064|2022|PDM|517.00|99|0.00|OP BEHAVIORAL OBSERVATION|
20|FH_F77665_0_0|SrvcGrp|29406|2022|PDM|15.00|99|0.00|PHYSICAL THERAPY|
20|FH_F80513_0_0|SrvcGrp|53153|2022|PDM|10849.00|99|0.00|MS DRG 261 ONLY|
20|FH_F120522_53549_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F47140_0_0|SrvcGrp|28739|2022|PDM|615.10|99|0.00|SLEEP STUDIES CPT 95811 W/MODIFIER TC|
20|FH_F116088_46410_0|SrvcGrp|46903|2022|PDM|508.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F133583_77074_0|SrvcGrp|3178|2022|PDM|916.00|99|0.00|ACUTE PSYCH|
20|FH_F133269_78624_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133335_84790_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F133402_10007_0|SrvcGrp|89502|2022|PDM|53.00|99|0.00|NEUROMUSCULAR REEDUCATION|
20|FH_F111566_75093_0|SrvcGrp|12837|2022|PCT|1.10|99|0.00|INTRAOCULAR LENSES|
20|FH_F111584_07002_0|SrvcGrp|90644|2022|PDM|139.00|99|0.00|AETNA MEDICATION ASSISTED TRTMT MAINTENANCE INJECTION (HCFA)|
20|FH_F134828_30531_0|SrvcGrp|112661|2022|PDM|34.00|99|0.00|XRAY EXAM OF ELBOW (HCFA)|
20|FH_F134828_30531_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35216_0_0|SrvcGrp|11000|2022|PCT|0.60|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F46433_0_0|SrvcGrp|16559|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134087_0_0|SrvcGrp|112162|2022|PDM|10455.00|99|0.00|RECONSTRUCT WRIST-LUNATE|
20|FH_F113154_70359_0|SrvcGrp|104557|2022|PCT|1.00|99|0.00|SYNVISC OR SYNVISC-ONE|
20|FH_F149679_0_0|SrvcGrp|2067|2022|PDM|1118.17|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F49029_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|308.00|99|0.00|CD SVCS HALF DAY|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|607.90|99|0.00|CPT 95811 (W/MOD TC)|
20|FH_F41776_0_0|SrvcGrp|10990|2022|PDM|7718.00|99|0.00|ANGIOPLASTY|
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F128906_48423_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1777.00|99|0.00|AEG 9 (NO REV)|
20|FH_F40515_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F140762_0_0|SrvcGrp|113693|2022|PDM|956.42|99|0.00|INCISE INNER EYE ADHESIONS|
20|FH_F139515_0_0|SrvcGrp|35669|2022|PDM|8549.00|99|0.00|CPT 63650|
20|FH_F34636_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F141519_51566_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F142073_0_0|SrvcGrp|26273|2022|PDM|1500.00|99|0.00|CPT 29880|
20|FH_F125011_74467_0|SrvcGrp|110027|2022|PDM|4700.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F111826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38847_0_0|SrvcGrp|72|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.35|99|0.00|ASPG VII|
20|FH_F116923_85259_0|SrvcGrp|89417|2022|PDM|451.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F81033_0_0|SrvcGrp|78658|2022|PDM|892.50|99|0.00|AETNA CYSTOSCOPY AND TREATMENT|
20|FH_F72784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F128272_60640_0|SrvcGrp|14948|2022|PDM|125.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F151400_0_0|SrvcGrp|97299|2022|PDM|3181.00|99|0.00|REMOVE SPINE ELTRD PLATE|
20|FH_F135764_0_0|SrvcGrp|82037|2022|PDM|1350.00|99|0.00|AETNA ICU|
20|FH_F130724_06437_0|SrvcGrp|471|2022|PDM|585.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F34454_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_F148254_89503_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F90714_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F121168_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F97563_83201_0|SrvcGrp|73603|2022|PDM|7629.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F142749_15212_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG III|
20|FH_F147998_07030_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F111789_25301_0|SrvcGrp|2738|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.00|99|0.00|AEG 7 (NO REV)|
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133460_63031_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F101922_98055_0|SrvcGrp|79786|2022|PCT|1.16|99|0.00|SLEEP STUDIES|
20|FH_F133469_33404_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F52795_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F123538_21206_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD UE/KF)|
20|FH_F144049_45242_0|SrvcGrp|90631|2022|PDM|132.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F145842_37172_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120390_91316_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F44795_0_0|SrvcGrp|30956|2022|PDM|80.00|99|0.00|SKILLED IV NURSING VISIT|
20|FH_F34161_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31204_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|EATING DISORDER|
20|FH_F117087_0_0|SrvcGrp|107188|2022|PDM|1153.00|99|0.00|REMOVE NASAL FOREIGN BODY|
20|FH_F42453_0_0|CSTM-ALL|CSTM-00|2020|PDM|827.00|99|0.00|HEAD INJURY REHABILITATION|
20|FH_F132080_0_0|SrvcGrp|83521|2022|PDM|169.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F149840_80002_0|SrvcGrp|109988|2022|PCT|0.70|99|0.00|COFINITY ANESTHESIA NON-TIME CODES|
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.88|99|0.00|AEG 6 (NO REV)|
20|FH_F146282_08244_0|SrvcGrp|87131|2022|PDM|1740.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKL|
20|FH_F141750_77515_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141947_63367_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144569_71055_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 1 (NO REV)|
20|FH_F96102_33884_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F69242_0_0|SrvcGrp|43956|2022|PDM|55.00|99|0.00|NURSING CARE|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120550_91355_0|SrvcGrp|85017|2022|PCT|0.85|99|0.00|DME|
20|FH_F111540_16823_0|SrvcGrp|91390|2022|PDM|210.00|99|0.00|AETNA PSYCH DIAG EVAL W/MED (MOD AF)|
20|FH_F83031_0_0|SrvcGrp|44709|2022|PDM|120.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F96120_67207_0|SrvcGrp|89149|2022|PDM|150.00|99|0.00|OP INTENSIVE|
20|FH_F128279_77043_0|SrvcGrp|89417|2022|PDM|370.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F101754_63141_0|SrvcGrp|97977|2022|PDM|21.95|99|0.00|EVOKED AUDITORY TEST LIMITED|
20|FH_F113271_72205_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F149781_37404_0|SrvcGrp|104008|2022|PDM|5047.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS|
20|FH_F125365_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F79944_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|OP SURGERY|
20|FH_F102561_75146_0|SrvcGrp|73605|2022|PDM|1100.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F40980_0_0|SrvcGrp|13811|2022|PDM|512.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F148904_85255_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F133477_90247_0|SrvcGrp|107595|2022|PCT|1.40|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F145818_77573_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141217_0_0|SrvcGrp|99163|2022|PDM|9500.00|99|0.00|CPT 27703|
20|FH_F87577_80016_0|SrvcGrp|73462|2022|PDM|7544.00|99|0.00|AETNA NICU III|
20|FH_F134497_47126_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F42420_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47795_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F144020_15401_0|SrvcGrp|103913|2022|PCT|0.93|99|0.00|OP DIALYSIS|
20|FH_F132594_78229_0|SrvcGrp|29347|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F119437_0_0|SrvcGrp|108091|2022|PDM|5000.00|99|0.00|DISKECTOMY THORACIC SINGLE|
20|FH_F150001_33064_0|SrvcGrp|14947|2022|PDM|3.00|99|0.00|HOME INFUSION|
20|FH_F150559_60018_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F38352_0_0|SrvcGrp|29090|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY|
20|FH_F96120_67207_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126935_33615_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132934_63005_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F141870_85224_0|SrvcGrp|22389|2022|PDM|25.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F31796_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111412_33777_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148919_32806_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133367_40065_0|SrvcGrp|73601|2022|PDM|2034.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F148599_98034_0|SrvcGrp|112914|2022|PDM|36519.00|99|0.00|MAJOR JOINT REPLACEMENT (MS DRG 470/522)|
20|FH_F148900_0_0|SrvcGrp|53065|2022|PDM|668.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F37611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F106243_92780_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F150602_59718_0|SrvcGrp|82223|2022|PDM|153.00|99|0.00|HOSPICE CARE|
20|FH_F117550_0_0|SrvcGrp|99460|2022|PDM|46.78|99|0.00|OCCUPATIONAL THERAPY EVALUATION|
20|FH_F44394_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD NU|
20|FH_F131228_01826_0|SrvcGrp|113041|2022|PCT|1.01|99|0.00|COVID-19 TESTING|
20|FH_F113546_0_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F123511_64076_0|SrvcGrp|471|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F127571_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90818_0_0|SrvcGrp|89884|2022|PDM|3125.00|99|0.00|AETNA ABLATE TURBINATE SUBMUC|
20|FH_F126489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PDM|1082.00|99|0.00|ASPG V F/S - BDSS|
20|FH_F132243_29571_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)|
20|FH_F82235_0_0|SrvcGrp|72998|2022|PDM|788.70|99|0.00|AEG 5|
20|FH_F41491_0_0|SrvcGrp|115|2022|PDM|477.00|99|0.00|SKILLED NURSING CARE|
20|FH_F115057_15601_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38591_0_0|SrvcGrp|12491|2022|PCT|0.70|99|0.00|PACEMAKER|
20|FH_F93902_04043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109926_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F91640_98166_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|GENERAL ACUTE CARE|
20|FH_F37679_0_0|SrvcGrp|27059|2022|PDM|9.38|99|0.00|HYDRATION THERAPY - 3 LITERS (MOD SJ)|
20|FH_F130810_54728_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115763_16433_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F114963_62062_0|SrvcGrp|73701|2022|PDM|68.29|99|0.00|AETNA - SKILLED NURSING|
20|FH_F44495_0_0|SrvcGrp|42036|2022|PDM|45.00|99|0.00|SKILLED NURSING (ADDITIONAL HOURS)|
20|FH_F37587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37679_0_0|SrvcGrp|22588|2022|PDM|61.00|99|0.00|CHEMOTHERAPY|
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|2640.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|1751.00|99|0.00|AEG 10 (NO REV)|
20|FH_F66687_0_0|SrvcGrp|20912|2022|PDM|60342.00|99|0.00|MS DRG 236 ONLY|
20|FH_F110061_0_0|SrvcGrp|96104|2022|PDM|350.00|99|0.00|IMPLANTABLE NEUROSTIMULATOR|
20|FH_F130747_0_0|SrvcGrp|97895|2022|PDM|26010.00|99|0.00|REVISE KNEE 2|
20|FH_F131128_0_0|SrvcGrp|76604|2022|PDM|1546.00|99|0.00|CPT 25447|
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|1030.15|99|0.00|2005 ASPG GROUPER VI|
20|FH_F130747_0_0|SrvcGrp|82112|2022|PDM|5202.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F36955_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38798_0_0|SrvcGrp|14893|2022|PDM|55.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F123481_90049_0|SrvcGrp|89149|2022|PDM|580.00|99|0.00|OP INTENSIVE|
20|FH_F125817_78613_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139551_0_0|SrvcGrp|87845|2022|PDM|1999.00|99|0.00|GASTRIC RESTRICTIVE PROCEDURE|
20|FH_F143968_94520_0|SrvcGrp|74668|2022|PDM|380.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F37679_0_0|SrvcGrp|26868|2022|PDM|61.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|3178.00|99|0.00|AEG 8 (NO REV)|
20|FH_F127441_45822_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113410_0_0|SrvcGrp|90418|2022|PDM|3257.00|99|0.00|ENLARGE BREAST WITH IMPLANT|
20|FH_F138020_20016_0|SrvcGrp|92760|2022|PCT|2.70|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F82955_34266_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F131254_92211_0|SrvcGrp|86850|2022|PDM|35.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 2 (NO REV)|
20|FH_F145755_08050_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F92129_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 10 (NO REV)|
20|FH_F81033_0_0|SrvcGrp|78665|2022|PDM|892.50|99|0.00|AETNA HYSTEROSCPY, SURGICAL|
20|FH_F115109_20032_0|SrvcGrp|81839|2022|PDM|50.00|99|0.00|AETNA MEDICAL RECORD|
20|FH_F120349_38774_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F88254_33411_0|SrvcGrp|29076|2022|PDM|30.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F121533_26241_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F38473_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|LPN HI TECH - HOURLY|
20|FH_F131207_19947_0|SrvcGrp|89149|2022|PDM|104.00|99|0.00|OP INTENSIVE|
20|FH_F137946_0_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F73013_0_0|SrvcGrp|22954|2022|PDM|282.12|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F137574_68130_0|SrvcGrp|26160|2022|PCT|1.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F109180_18015_0|SrvcGrp|52953|2022|PDM|54.10|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F129305_45614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F38218_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145758_20745_0|SrvcGrp|110762|2022|PDM|2531.64|99|0.00|LUMBAR VERTEBRAL CORPECTOMY|
20|FH_F120952_25303_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F32618_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F40046_0_0|SrvcGrp|10545|2022|PDM|165.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F115109_20032_0|SrvcGrp|10393|2022|PDM|2249.57|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F143973_28040_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F135161_33128_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110925_01104_0|SrvcGrp|86144|2022|PDM|41.50|99|0.00|AETNA BELIMUMAB INJ|
20|FH_F93171_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F98921_64503_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F151087_60548_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151151_76504_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114931_0_0|SrvcGrp|63467|2022|PDM|1850.00|99|0.00|CPT 64585|
20|FH_F69651_0_0|SrvcGrp|10543|2022|PDM|95.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F39346_0_0|SrvcGrp|147|2022|PCT|0.68|99|0.00|HOME HEALTH CARE|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PDM|240.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 16 W/O REV|
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|859.34|99|0.00|ASPG V|
20|FH_F68823_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO|
20|FH_F134612_0_0|SrvcGrp|108115|2022|PDM|3100.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F139530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141837_0_0|SrvcGrp|106300|2022|PDM|600.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F120612_23314_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F120683_80238_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F120683_80238_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F150939_0_0|SrvcGrp|101741|2022|PDM|3.00|99|0.00|IMMUN ADMIN ORAL/NASAL|
20|FH_F41013_0_0|SrvcGrp|17419|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F106500_0_0|SrvcGrp|82037|2022|PDM|1955.00|99|0.00|AETNA ICU|
20|FH_F106500_0_0|SrvcGrp|73601|2022|PDM|1682.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F88893_0_0|SrvcGrp|79589|2022|PDM|660.00|99|0.00|UPPER GI|
20|FH_F113390_0_0|SrvcGrp|105243|2022|PDM|1320.00|99|0.00|PARTIAL REMOVAL EXTERNAL EAR|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.64|99|0.00|HAPA WPA-NWPA 2012-13 ASC 13 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|265.69|99|0.00|HAPA WPA-NWPA 2012-13 ASC 123 W/O REV|
20|FH_F132163_17601_0|SrvcGrp|106248|2022|PDM|527.00|99|0.00|PARTIAL HOSP PSYCH|
20|FH_F132206_67152_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97142_94535_0|SrvcGrp|88977|2022|PDM|16383.00|99|0.00|C-SECTION DELIVERY|
20|FH_F130817_18103_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 9 (NO REV)|
20|FH_F111292_33136_0|SrvcGrp|16301|2022|PDM|9378.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F111301_33122_0|SrvcGrp|81405|2022|PDM|15.00|99|0.00|URINALYSIS W/ MICROSCPY|
20|FH_F111363_33169_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134315_89106_0|SrvcGrp|14893|2022|PDM|47.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F134315_89106_0|SrvcGrp|22593|2022|PCT|1.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F134322_98001_0|SrvcGrp|112548|2022|PCT|1.00|99|0.00|HALOPERIDOL INJECTION|
20|FH_F39796_0_0|SrvcGrp|43283|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY|
20|FH_F132720_0_0|SrvcGrp|112077|2022|PDM|48747.00|99|0.00|CV SURGERY|
20|FH_F44336_0_0|SrvcGrp|166|2022|PDM|411.00|99|0.00|CD (ADULT) - DETOXIFICATION|
20|FH_F54272_0_0|SrvcGrp|11336|2022|PCT|0.45|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F131000_0_0|SrvcGrp|83839|2022|PDM|5098.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F132328_0_0|SrvcGrp|111953|2022|PDM|2425.00|99|0.00|REVISION OF BLADDER NECK|
20|FH_F112082_30720_0|SrvcGrp|43569|2022|PDM|148.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F87501_32055_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F87557_33309_0|SrvcGrp|14947|2022|PDM|30.00|99|0.00|HOME INFUSION|
20|FH_F103109_33462_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F96960_35404_0|SrvcGrp|73602|2022|PDM|3772.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F132347_01605_0|SrvcGrp|88620|2022|PDM|147.00|99|0.00|SKILLED NURSING RN|
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67901_0_0|SrvcGrp|14949|2022|PDM|120.00|99|0.00|HOME INFUSION|
20|FH_F136373_17055_0|SrvcGrp|83198|2022|PDM|495.00|99|0.00|IP HOSPICE CARE|
20|FH_F136430_46710_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118152_20151_0|SrvcGrp|24750|2022|PDM|40.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F118152_20151_0|SrvcGrp|86850|2022|PDM|45.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F93132_73134_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F93292_62234_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS HOME HEALTH|
20|FH_F134088_32209_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F134126_11554_0|SrvcGrp|73493|2022|PDM|9186.00|99|0.00|AETNA LAPAROSCOPY SURGICAL GASTRI|
20|FH_F114092_83350_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F142508_29108_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117552_0_0|SrvcGrp|73006|2022|PDM|1610.00|99|0.00|AEG 9|
20|FH_F53732_0_0|SrvcGrp|22594|2022|PDM|80.00|99|0.00|IMIGLUCERASE|
20|FH_F138778_90066_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F140647_66210_0|SrvcGrp|73842|2022|PDM|520.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F140890_30906_0|SrvcGrp|89417|2022|PDM|455.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F149541_85258_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149646_71129_0|SrvcGrp|46903|2022|PDM|555.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F151611_30032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119018_47802_0|SrvcGrp|73605|2022|PDM|550.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F118932_07652_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118943_64506_0|SrvcGrp|17016|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F35925_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147725_06002_0|SrvcGrp|65625|2022|PDM|2782.00|99|0.00|CPT 30520|
20|FH_F147922_10031_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F147926_19063_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F117108_37841_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F117221_23434_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137307_65233_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137818_31602_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F38699_0_0|SrvcGrp|17081|2022|PDM|1617.00|99|0.00|ASPG IX|
20|FH_F124757_45750_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139350_70056_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|13230.00|99|0.00|MS DRG 253-254 CV SURGERY|
20|FH_F87054_0_0|SrvcGrp|84931|2022|PDM|2132.00|99|0.00|KERATOPLASTY|
20|FH_F88456_0_0|SrvcGrp|56464|2022|PDM|8010.00|99|0.00|CPT 55873|
20|FH_F142448_15701_0|SrvcGrp|53987|2022|PDM|30.00|99|0.00|PHOTOTHERAPY|
20|FH_F103780_64804_0|SrvcGrp|109057|2022|PCT|0.68|99|0.00|CARDIAC STUDIES|
20|FH_F119581_0_0|SrvcGrp|103640|2022|PDM|6578.00|99|0.00|AETNA OPEN/PERQ PLACE STENT SAME|
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F120671_0_0|CSTM-ALL|CSTM-00|2020|PDM|2724.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102041_35010_0|SrvcGrp|73700|2022|PDM|71.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F36584_0_0|SrvcGrp|23387|2022|PDM|65.00|99|0.00|PT/OT/ST|
20|FH_F132988_0_0|SrvcGrp|100020|2022|PDM|11914.06|99|0.00|TREATMENT OF FRACTURE I|
20|FH_F132988_0_0|SrvcGrp|100060|2022|PDM|6047.98|99|0.00|REPAIR MIDFOOT FRACTURE EACH|
20|FH_F132988_0_0|SrvcGrp|103542|2022|PDM|5763.38|99|0.00|ANKLE ARTHROSCOPY/SURGERY|
20|FH_F132988_0_0|SrvcGrp|96539|2022|PDM|4493.01|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F132988_0_0|SrvcGrp|112145|2022|PDM|4493.01|99|0.00|REPAIR/GRAFT OF THIGH MUSCLE|
20|FH_F72204_0_0|SrvcGrp|42973|2022|PDM|80.00|99|0.00|SPEECH  THERAPIST|
20|FH_F114389_50131_0|SrvcGrp|99040|2022|PDM|284.03|99|0.00|ANTIBIOTIC Q4H (HCFA)|
20|FH_F114389_50131_0|SrvcGrp|41460|2022|PDM|48.28|99|0.00|ENTERAL THERAPY - UNSPECIFIED|
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|879.62|99|0.00|AEG 4 (NO REV)|
20|FH_F137897_0_0|SrvcGrp|107865|2022|PCT|1.00|99|0.00|AETNA INJECTABLES (J CODES)|
20|FH_F43665_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69504_0_0|CSTM-ALL|CSTM-00|2020|PDM|27.00|99|0.00|SKILLED NURSING HCPC|
20|FH_F92959_0_0|SrvcGrp|22954|2022|PDM|131.37|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F64819_0_0|SrvcGrp|28963|2022|PDM|15766.00|99|0.00|MS DRG 461-462 ONLY|
20|FH_F134809_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F127995_84010_0|SrvcGrp|80920|2022|PDM|107.00|99|0.00|HOSPICE SERVICES|
20|FH_F67882_0_0|SrvcGrp|9500|2022|PDM|946.00|99|0.00|PSYCH INTENSIVE CARE UNIT|
20|FH_F132890_87544_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F136708_06443_0|SrvcGrp|89337|2022|PDM|748.00|99|0.00|DETOXIFICATION|
20|FH_F113787_31909_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F138055_16146_0|SrvcGrp|73842|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138527_64506_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F138984_06896_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PDM|30.00|99|0.00|MANUAL LIMB MUSCLE TESTING|
20|FH_F137933_0_0|SrvcGrp|113160|2022|PDM|3500.00|99|0.00|KIDNEY ENDOSCOPY|
20|FH_F119725_0_0|SrvcGrp|13683|2022|PDM|597.36|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F122879_39564_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F43418_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F39622_0_0|SrvcGrp|23929|2022|PCT|0.65|99|0.00|HIGH COST DRUGS|
20|FH_F46752_0_0|SrvcGrp|42138|2022|PDM|50.00|99|0.00|HOME INFUSION SKILLED NURSING (ADD'L HOUR)|
20|FH_F49005_0_0|SrvcGrp|45011|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE|
20|FH_F147331_90045_0|SrvcGrp|73700|2022|PDM|84.66|99|0.00|AETNA - SKILLED NURSING|
20|FH_F147380_78520_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41809_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F42522_0_0|SrvcGrp|11258|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F118173_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F40535_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ACUTE PSYCH|
20|FH_F41213_0_0|SrvcGrp|474|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F113585_20155_0|SrvcGrp|17013|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138847_67156_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138880_92392_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F138992_72703_0|CSTM-ALL|CSTM-00|2020|PDM|1257.00|99|0.00|AEG 2 (NO REV)|
20|FH_F110233_0_0|SrvcGrp|75506|2022|PCT|0.94|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F88893_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|1599.80|99|0.00|AEG 9 (NO REV)|
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 6 (NO REV)|
20|FH_F136186_46307_0|SrvcGrp|48398|2022|PDM|120.00|99|0.00|PT SERVICES|
20|FH_F130996_34110_0|SrvcGrp|80617|2022|PDM|17000.00|99|0.00|ARTHOPLASTY|
20|FH_F130620_18940_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116397_33404_0|SrvcGrp|22592|2022|PDM|65.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F36701_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131361_18235_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F140629_0_0|SrvcGrp|88600|2022|PDM|2497.00|99|0.00|WRIST ARTHROS DIAG W/WO BIO|
20|FH_F121763_07202_0|SrvcGrp|69073|2022|PDM|99.00|99|0.00|CPT 99215|
20|FH_F121823_46234_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F31819_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPT CARE OF MUNCY FH -NU|
20|FH_F127926_62832_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111301_33122_0|SrvcGrp|82752|2022|PDM|20.00|99|0.00|ASSAY BUN|
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148243_0_0|SrvcGrp|107986|2022|PDM|800.00|99|0.00|REMOVAL OF FOOT LESION|
20|FH_F72666_0_0|SrvcGrp|12523|2022|PDM|22976.00|99|0.00|GAMMA KNIFE|
20|FH_F118651_0_0|SrvcGrp|97901|2022|PCT|0.00|99|0.00|LIGATION OF ABDOMEN ARTERY|
20|FH_F87557_33309_0|SrvcGrp|86831|2022|PDM|3.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|1363.00|99|0.00|AEG 2 (NO REV)|
20|FH_F101320_26062_0|SrvcGrp|14944|2022|PDM|14.40|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F101320_26062_0|SrvcGrp|17015|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F103780_64804_0|SrvcGrp|73784|2022|PDM|1870.00|99|0.00|MS DRG 880-887, 894-897 ONLY-PSYCH/DETOX BED|
20|FH_F132347_01605_0|SrvcGrp|88621|2022|PDM|147.00|99|0.00|SKILLED NURSING LPN|
20|FH_F40345_0_0|SrvcGrp|16|2022|PDM|725.00|99|0.00|ACUTE REHABILITATION|
20|FH_F40600_0_0|SrvcGrp|13551|2022|PDM|687.00|99|0.00|NEWBORN NURSERY|
20|FH_F41015_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102948_43606_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F136987_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111204_10023_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40972_0_0|SrvcGrp|469|2022|PDM|1300.00|99|0.00|VENTILATOR REHABILITATION|
20|FH_F40972_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|HEAD INJURY REHABILITATION|
20|FH_F120112_0_0|SrvcGrp|80920|2022|PDM|446.25|99|0.00|HOSPICE SERVICES|
20|FH_F138197_0_0|SrvcGrp|87679|2022|PDM|830.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F133107_73071_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F119245_19010_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F148479_49519_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 6 (NO REV)|
20|FH_F31184_0_0|SrvcGrp|3982|2022|PDM|2700.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F52733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F101802_17201_0|SrvcGrp|48396|2022|PDM|134.00|99|0.00|OT SERVICES|
20|FH_F103360_68845_0|SrvcGrp|75506|2022|PCT|7.50|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|912.00|99|0.00|ASPG II|
20|FH_F150602_59718_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F100784_59923_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F121304_61520_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146267_78626_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F36579_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALLIED MED-NO MOD|
20|FH_F107261_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40591_0_0|SrvcGrp|11920|2022|PCT|0.70|99|0.00|PHARMACY SVCS|
20|FH_F148494_0_0|SrvcGrp|101102|2022|PDM|15000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F77025_0_0|SrvcGrp|74119|2022|PDM|2285.00|99|0.00|LAPAROSCOPY|
20|FH_F33581_0_0|CSTM-ALL|CSTM-00|2020|PDM|1944.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F91262_77036_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F118534_07652_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F146375_06751_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F118542_60188_0|SrvcGrp|29023|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F123039_44147_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117855_62246_0|SrvcGrp|23683|2022|PDM|35.00|99|0.00|SKILLED NURSING RN|
20|FH_F117858_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F34971_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117289_01028_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|557.00|99|0.00|HAPA EPA ASC 3|
20|FH_F32301_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69071_0_0|SrvcGrp|13597|2022|PDM|314.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F44016_0_0|SrvcGrp|8968|2022|PDM|2796.00|99|0.00|NICU LEVEL III & IV|
20|FH_F112852_73112_0|SrvcGrp|10391|2022|PDM|1225.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F44093_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|NEWBORN NURSERY|
20|FH_F71162_0_0|SrvcGrp|17753|2022|PDM|160.00|99|0.00|NEGATIVE  PRESSURE WOUND THERAPY ELEC PUMP|
20|FH_F50237_0_0|SrvcGrp|14174|2022|PDM|650.00|99|0.00|MRI|
20|FH_F39844_0_0|SrvcGrp|11336|2022|PCT|0.70|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F83031_0_0|SrvcGrp|47409|2022|PCT|1.00|99|0.00|OCN F/S PRICING:  (A & K CODES ONLY) AND OR REV270|
20|FH_F69648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F42340_0_0|SrvcGrp|28919|2022|PDM|34.00|99|0.00|CPT 97750|
20|FH_F42453_0_0|SrvcGrp|166|2022|PDM|500.00|99|0.00|CD (ADULT) - DETOXIFICATION|
20|FH_F115391_63123_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F133291_33563_0|SrvcGrp|89417|2022|PDM|435.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F132591_75146_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F142775_72801_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|2885.00|99|0.00|AEG 7 (NO REV)|
20|FH_F122970_97222_0|SrvcGrp|108061|2022|PCT|1.25|99|0.00|OP THERAPY SERVICES|
20|FH_F133350_39532_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F117880_91730_0|SrvcGrp|73701|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F112853_22408_0|SrvcGrp|91633|2022|PDM|650.00|99|0.00|HOME VENT (HCFA)|
20|FH_F151157_0_0|SrvcGrp|103861|2022|PDM|2000.00|99|0.00|GASTROESOPHOGEAL STUDY|
20|FH_F118790_98640_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F149243_64114_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111809_93003_0|CSTM-ALL|CSTM-00|2020|PDM|10600.00|99|0.00|AEG 7 (NO REV)|
20|FH_F143057_15767_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F117906_91606_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F91155_16105_0|SrvcGrp|81779|2022|PCT|1.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F132420_84660_0|SrvcGrp|73605|2022|PDM|956.96|99|0.00|AETNA ACUTE PSYCH|
20|FH_F127197_23111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F142822_63437_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_F68831_0_0|SrvcGrp|9828|2022|PDM|49.50|99|0.00|HOME HEALTH AIDE|
20|FH_F117720_23323_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.96|99|0.00|HAPA WPA-NWPA 2012-13 ASC 901 W/O REV|
20|FH_F41392_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|ASPG VI|
20|FH_F117945_78957_0|SrvcGrp|89149|2022|PDM|250.00|99|0.00|OP INTENSIVE|
20|FH_F47433_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CHESTER CTY LABORATORY|
20|FH_F114519_0_0|SrvcGrp|705|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F56793_0_0|SrvcGrp|15850|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F125266_44515_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F150001_33064_0|SrvcGrp|86850|2022|PDM|26.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F150948_0_0|SrvcGrp|86233|2022|PDM|11960.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F128512_37087_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F44023_0_0|SrvcGrp|9875|2022|PDM|2236.00|99|0.00|ACUTE IP MEDICAL SERVICES|
20|FH_F133495_70301_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133416_87402_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97160_77436_0|SrvcGrp|89417|2022|PDM|584.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F120788_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120089_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F133467_03301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F67379_0_0|SrvcGrp|30033|2022|PDM|35315.00|99|0.00|MSDRG 216-238  ONLY CV SURGERY|
20|FH_F92636_90230_0|SrvcGrp|48394|2022|PDM|31.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F144011_60616_0|SrvcGrp|114126|2022|PDM|4809.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|2311.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132571_24739_0|SrvcGrp|76501|2022|PDM|360.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F150701_33437_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F150771_44512_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139147_0_0|SrvcGrp|58671|2022|PDM|4244.00|99|0.00|ASC CARVE OUT 64721|
20|FH_F124759_34108_0|SrvcGrp|93337|2022|PDM|228.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F129966_18017_0|SrvcGrp|73842|2022|PDM|227.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132512_0_0|SrvcGrp|86723|2022|PDM|714.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F134797_0_0|SrvcGrp|73000|2022|PDM|1101.00|99|0.00|AEG 6|
20|FH_F149662_85015_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.49|99|0.00|SALLY BALIN,999182,ASC 220|
20|FH_F151699_01752_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35678_0_0|SrvcGrp|11336|2022|PCT|0.75|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F90213_30084_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F131415_73071_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F120207_0_0|SrvcGrp|108192|2022|PDM|2985.00|99|0.00|FEM/POPL REVAS W/TLA|
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PDM|2490.00|99|0.00|ASPG 7 PIEDMONT OUTPATIENT SURGERY CENTER|
20|FH_F114207_35243_0|SrvcGrp|86828|2022|PDM|70.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F149522_83221_0|SrvcGrp|95661|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F35678_0_0|SrvcGrp|18295|2022|PDM|8476.00|99|0.00|MS DRG 039|
20|FH_F122336_67042_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F140140_07722_0|SrvcGrp|31854|2022|PDM|1336.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F98840_31021_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F90817_0_0|SrvcGrp|90363|2022|PDM|2650.00|99|0.00|REVISE/IMPLANT FINGER JOINT|
20|FH_F101083_0_0|SrvcGrp|73006|2022|PDM|1806.00|99|0.00|AEG 9|
20|FH_F120848_20912_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F76826_0_0|SrvcGrp|29455|2022|PDM|3600.00|99|0.00|PET SCAN|
20|FH_F39443_0_0|SrvcGrp|30321|2022|PDM|533.00|99|0.00|HAPA WPA ASC 205|
20|FH_F119652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F114568_08097_0|SrvcGrp|86748|2022|PCT|1.05|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PDM|481.00|99|0.00|ASPG I|
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1362.00|99|0.00|AEG 5  (NO REV)|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|1292.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132849_0_0|SrvcGrp|71083|2022|PDM|1275.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F100540_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35716_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|18981.00|99|0.00|MS DRG 243-244|
20|FH_F132254_40207_0|SrvcGrp|86839|2022|PDM|40.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F139785_92629_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131371_0_0|SrvcGrp|111811|2022|PDM|5489.00|99|0.00|ADJUST BONE FIXATION DEVICE|
20|FH_F140295_0_0|SrvcGrp|82720|2022|PDM|5103.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F149373_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|PDM|976.00|99|0.00|AEG 5  (NO REV)|
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|1675.00|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_F132235_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F150982_0_0|SrvcGrp|88148|2022|PDM|2527.00|99|0.00|LAPAROSCOPY SALPINGOSTOMY|
20|FH_F147372_0_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F90455_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131274_48322_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F110783_93013_0|SrvcGrp|86854|2022|PDM|56.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F151022_17016_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38475_0_0|SrvcGrp|28631|2022|PDM|73.00|99|0.00|LPN VISIT|
20|FH_F99142_80233_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147260_53227_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118792_63379_0|SrvcGrp|78579|2022|PDM|1331.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
20|FH_F51276_0_0|SrvcGrp|11258|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F33925_0_0|SrvcGrp|18881|2022|PDM|22990.00|99|0.00|MS DRG 233|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|9750.00|99|0.00|MSDRG 250-251 PERCUTANEOUS CARDIO PROC|
20|FH_F36372_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F102948_43606_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F38708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|OP SVCS|
20|FH_F40972_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F47693_16148_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F122694_33334_0|SrvcGrp|72602|2022|PDM|716.00|99|0.00|ECT|
20|FH_F89495_0_0|SrvcGrp|72992|2022|PDM|465.00|99|0.00|AEG 2|
20|FH_F87474_0_0|SrvcGrp|1168|2022|PDM|770.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F139690_0_0|SrvcGrp|107748|2022|PDM|500.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F46832_0_0|SrvcGrp|26871|2022|PDM|90.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3 HRS|
20|FH_F123739_61820_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123752_44502_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F58856_0_0|SrvcGrp|20912|2022|PDM|28750.00|99|0.00|MS DRG 236 ONLY|
20|FH_F62577_0_0|SrvcGrp|58456|2022|PDM|1015.00|99|0.00|ASPG III|
20|FH_F62577_0_0|SrvcGrp|58454|2022|PDM|652.00|99|0.00|ASPG I|
20|FH_F64999_0_0|SrvcGrp|64836|2022|PCT|1.05|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F67901_0_0|SrvcGrp|29826|2022|PCT|1.00|99|0.00|AWP  J & Q CODES|
20|FH_F69968_0_0|SrvcGrp|11970|2022|PDM|91.76|99|0.00|LABOR/DELIVERY CHECK|
20|FH_F117465_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136374_34461_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136386_30901_0|SrvcGrp|113014|2022|PDM|750.00|99|0.00|MRI/MRA W/ER|
20|FH_F120418_43015_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F134159_80228_0|SrvcGrp|46903|2022|PDM|750.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F137209_60515_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F138746_60174_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F97601_67218_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F78404_16646_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|MS DRG UNGROUPABLE INPATIENT|
20|FH_F140733_45005_0|SrvcGrp|41563|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F140760_07003_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F120152_0_0|SrvcGrp|98003|2022|PDM|3850.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F148739_47129_0|SrvcGrp|90397|2022|PDM|1750.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F151608_30236_0|SrvcGrp|99172|2022|PDM|8779.00|99|0.00|CPT 28740|
20|FH_F151608_30236_0|SrvcGrp|116046|2022|PDM|2815.00|99|0.00|FOOT FASCIA REPAIR|
20|FH_F41481_0_0|SrvcGrp|17067|2022|PDM|490.00|99|0.00|ASPG II|
20|FH_F92506_07666_0|SrvcGrp|29464|2022|PDM|209.09|99|0.00|HOME HEALTH VISIT NEWBORN CARE|
20|FH_F48292_0_0|SrvcGrp|44243|2022|PDM|446.00|99|0.00|HOME HEMO TRAINING|
20|FH_F117295_70006_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F129438_08234_0|SrvcGrp|90040|2022|PDM|475.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F129441_19134_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F129474_92701_0|SrvcGrp|104079|2022|PCT|1.50|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F117093_40041_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F117093_40041_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117108_37841_0|SrvcGrp|104363|2022|PCT|0.00|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F117240_37334_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137938_29036_0|SrvcGrp|114020|2022|PCT|0.66|99|0.00|LABORATORY SERVICES|
20|FH_F34371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38948_0_0|SrvcGrp|19594|2022|PCT|0.74|99|0.00|IMPLANTS|
20|FH_F139817_75119_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140347_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95880_02726_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84446_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|OP SVCS|
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132544_0_0|SrvcGrp|19922|2022|PDM|4270.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F148419_01453_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F92677_08003_0|SrvcGrp|86838|2022|PDM|15.75|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F129176_48098_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144049_45242_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F120437_85202_0|SrvcGrp|66265|2022|PDM|157.58|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F67192_0_0|SrvcGrp|537|2022|PCT|0.46|99|0.00|OBSERVATION SERVICES|
20|FH_F101759_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147800_0_0|SrvcGrp|110765|2022|PDM|458.00|99|0.00|2ND LEVEL INJ PARAVERT F JNT C/T|
20|FH_F133287_40215_0|SrvcGrp|112252|2022|PDM|379.00|99|0.00|PULMONARY FUNCTION TESTS|
20|FH_F98600_91730_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F47433_0_0|SrvcGrp|42874|2022|PCT|1.55|99|0.00|CHEMO DRUGS|
20|FH_F66839_0_0|SrvcGrp|33414|2022|PDM|125.00|99|0.00|SNF VENTILATOR SUPPORT|
20|FH_F83053_0_0|SrvcGrp|72994|2022|PDM|3368.00|99|0.00|AEG 3|
20|FH_F127217_29650_0|SrvcGrp|105440|2022|PDM|269.00|99|0.00|AETNA TERANIAL MAGN STIM REDETEMINE|
20|FH_F109882_36695_0|SrvcGrp|89417|2022|PDM|542.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F36383_0_0|SrvcGrp|72|2022|PDM|475.00|99|0.00|NEWBORN NURSERY|
20|FH_F112853_22408_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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_F88956_0_0|SrvcGrp|31038|2022|PDM|43368.00|99|0.00|MS DRG 233-234 ONLY|
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|368.00|99|0.00|AEG 1 (NO REV)|
20|FH_F129966_18017_0|SrvcGrp|104186|2022|PDM|5.00|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F124380_83406_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F122396_90024_0|SrvcGrp|89337|2022|PDM|1428.00|99|0.00|DETOXIFICATION|
20|FH_F147217_33781_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F141330_65075_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134847_0_0|SrvcGrp|38364|2022|PDM|5091.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F138016_19808_0|SrvcGrp|89149|2022|PDM|127.00|99|0.00|OP INTENSIVE|
20|FH_F97101_98003_0|SrvcGrp|73659|2022|PDM|13921.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F130044_0_0|SrvcGrp|111418|2022|PDM|11.50|99|0.00|SURGERY|
20|FH_F109543_63552_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76826_0_0|SrvcGrp|9541|2022|PDM|123.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F148966_37865_0|SrvcGrp|108484|2022|PDM|578.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F37267_0_0|SrvcGrp|9830|2022|PDM|85.50|99|0.00|OT SVCS|
20|FH_F146266_0_0|SrvcGrp|88161|2022|PDM|7892.00|99|0.00|LAMINECTOMY W/FACE-THORACIC|
20|FH_F114207_35243_0|SrvcGrp|86779|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F47837_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151039_16749_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F34024_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS|
20|FH_F140176_51445_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F143210_72211_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143454_94550_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F143533_30013_0|SrvcGrp|114077|2022|PDM|127.00|99|0.00|EXTREMITIES ULTRASOUND|
20|FH_F63234_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63234_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130925_34652_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F151746_20032_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151754_71943_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151764_03801_0|SrvcGrp|472|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F48224_0_0|SrvcGrp|73004|2022|PDM|1153.00|99|0.00|AEG 8|
20|FH_F132534_18407_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132399_66801_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F71585_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116869_15146_0|SrvcGrp|23683|2022|PDM|30.00|99|0.00|SKILLED NURSING RN|
20|FH_F116915_30308_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F120866_51652_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126054_30022_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F118792_63379_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F84394_17402_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F51276_0_0|SrvcGrp|24744|2022|PDM|115.00|99|0.00|PICC LINE INSERTION|
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2221.00|99|0.00|AEG 3 (NO REV)|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MSDRG 219-221 CARDIAC VLV PX+OTR MJR CARDIOTHORAIC W/CC OLR|
20|FH_F36155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F46258_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|WALGREENS S AND B CODES|
20|FH_F48133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F59732_0_0|SrvcGrp|29075|2022|PDM|50.00|99|0.00|HYDRATION THERAPY|
20|FH_F89563_29407_0|SrvcGrp|90487|2022|PCT|1.00|99|0.00|WHEELCHAIR MANAGEMENT|
20|FH_F78603_0_0|SrvcGrp|29606|2022|PDM|54016.77|99|0.00|MS DRG 218 ONLY|
20|FH_F118194_50841_0|SrvcGrp|58588|2022|PDM|136.00|99|0.00|INFUSION|
20|FH_F129262_33813_0|SrvcGrp|105682|2022|PDM|202.00|99|0.00|INTENSIVE OUTPATIENT >=18 YRS|
20|FH_F93920_0_0|SrvcGrp|79099|2022|PCT|0.80|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F123902_19140_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F40661_0_0|SrvcGrp|3029|2022|PDM|314.00|99|0.00|NEWBORN NURSERY|
20|FH_F148220_70578_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140574_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F82696_16335_0|SrvcGrp|87719|2022|PDM|563.00|99|0.00|SUBSTANCE ABUSE REHAB|
20|FH_F125663_66614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144021_0_0|SrvcGrp|111468|2022|PDM|152.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F86332_75081_0|SrvcGrp|77224|2022|PDM|70.00|99|0.00|AETNA HOME INFUSION S5521|
20|FH_F58052_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F148265_06067_0|SrvcGrp|58671|2022|PDM|3061.00|99|0.00|ASC CARVE OUT 64721|
20|FH_F100662_27534_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|OP SVCS|
20|FH_F120294_46322_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F35748_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130025_0_0|SrvcGrp|11283|2022|PDM|580.00|99|0.00|HYPERBARIC CHAMBER|
20|FH_F150982_0_0|SrvcGrp|89869|2022|PDM|2973.00|99|0.00|SPONTANEOUS ABORTION|
20|FH_F131177_44122_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F127072_30458_0|SrvcGrp|87317|2022|PDM|862.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F125138_63663_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F125028_19061_0|SrvcGrp|86847|2022|PDM|63.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F116998_17701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F62719_0_0|SrvcGrp|59288|2022|PDM|56.70|99|0.00|PEDIATRIC RN ROUTING NURSING|
20|FH_F39819_0_0|SrvcGrp|31204|2022|PDM|20941.00|99|0.00|NY DRG 544 ONLY|
20|FH_F129708_54403_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120902_64085_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143819_29485_0|SrvcGrp|108484|2022|PDM|739.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|329.00|99|0.00|AEG 1 (NO REV)|
20|FH_F95360_08720_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F128601_29340_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F88280_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.75|99|0.00|HAPA WPA/NWPA 2018 RAD 100%|
20|FH_F132594_78229_0|SrvcGrp|48396|2022|PDM|105.00|99|0.00|OT SERVICES|
20|FH_F92912_0_0|CSTM-ALL|CSTM-00|2020|PCT|9500.00|99|0.00|TIMELY FILING|
20|FH_F111412_33777_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|WV HH S CODES MOD SH|
20|FH_F117006_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38089_0_0|SrvcGrp|405|2022|PDM|1347.00|99|0.00|ACUTE REHAB - LEVEL II|
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)|
20|FH_F71594_15644_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|1288.00|99|0.00|ASPG IV|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|91.00|99|0.00|FAMILY PSYTX W PT 50 MINS (HCFA)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|26.83|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1001 W/O REV|
20|FH_F139470_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F121168_0_0|SrvcGrp|83521|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F146320_27610_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F89932_10940_0|CSTM-ALL|CSTM-00|2020|PCT|2.92|99|0.00|OCN F/S PRICING: ALL|
20|FH_F71667_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F132543_79549_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F142176_98040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117906_91606_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F83031_0_0|CSTM-ALL|CSTM-00|2020|PDM|38.00|99|0.00|NURSING CARE MOD TE|
20|FH_F34984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38700_0_0|SrvcGrp|18247|2022|PCT|0.80|99|0.00|MS DRG 286|
20|FH_F120954_0_0|SrvcGrp|108541|2022|PCT|0.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|2556.00|99|0.00|AEG 8 (NO REV)|
20|FH_F116324_0_0|SrvcGrp|75485|2022|PDM|550.00|99|0.00|AEG 4|
20|FH_F133478_40165_0|SrvcGrp|103610|2022|PDM|752.00|99|0.00|DIABETIC MGMT PROGRAM - GROUP|
20|FH_F96261_0_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F147800_0_0|SrvcGrp|113271|2022|PDM|1650.00|99|0.00|GENICULAR NERVE BLOCK|
20|FH_F127422_0_0|SrvcGrp|73002|2022|PDM|995.00|99|0.00|AEG 7|
20|FH_F80859_65616_0|SrvcGrp|30698|2022|PCT|0.68|99|0.00|AMBULANCE SVCS|
20|FH_F119437_0_0|SrvcGrp|35670|2022|PDM|4160.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F133470_97068_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F38410_0_0|SrvcGrp|10543|2022|PDM|110.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F33581_0_0|CSTM-ALL|CSTM-00|2020|PDM|1728.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133552_77006_0|SrvcGrp|89337|2022|PDM|750.00|99|0.00|DETOXIFICATION|
20|FH_F143168_60563_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F63301_0_0|CSTM-ALL|CSTM-00|2020|PDM|130.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F148430_06278_0|SrvcGrp|100245|2022|PCT|1.00|99|0.00|INFLUENZA ASSAY W/ OPTIC|
20|FH_F50237_0_0|SrvcGrp|22106|2022|PDM|575.00|99|0.00|CAT SCAN|
20|FH_F111789_25301_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F36973_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|REFERENCE LABS MOD TC%|
20|FH_F111437_33305_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F40980_0_0|SrvcGrp|13482|2022|PDM|5274.00|99|0.00|INTERMEDIATE CARDIAC CARE UNIT|
20|FH_F74463_0_0|SrvcGrp|67073|2022|PDM|1450.00|99|0.00|CPT 22851|
20|FH_F146212_57108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115406_79902_0|SrvcGrp|89417|2022|PDM|412.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F128316_22192_0|SrvcGrp|27969|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE|
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|2036.00|99|0.00|AEG 7 (NO REV)|
20|FH_F149781_37404_0|SrvcGrp|88065|2022|PDM|9803.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F36917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31093_0_0|SrvcGrp|177|2022|PDM|1800.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F148430_06278_0|SrvcGrp|111928|2022|PCT|1.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F149781_37404_0|SrvcGrp|99164|2022|PDM|6200.00|99|0.00|CPT 22846|
20|FH_F111784_32901_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F117900_19118_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F91255_19401_0|SrvcGrp|8950|2022|PDM|2247.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|837.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 5 W/O REV|
20|FH_F54552_0_0|SrvcGrp|15071|2022|PDM|150.00|99|0.00|PHOTOTHERAPY (BILIRUBIN)|
20|FH_F93275_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F118708_33455_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F109562_32827_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE|
20|FH_F33241_0_0|SrvcGrp|9937|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F92677_08003_0|SrvcGrp|85818|2022|PDM|126.00|99|0.00|ENTERAL NUTRITION INFUSION (MOD RR)|
20|FH_F136330_0_0|SrvcGrp|13722|2022|PDM|176.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE|
20|FH_F40895_0_0|SrvcGrp|26058|2022|PCT|1.10|99|0.00|IMPLANTS, PROSTHETICS, OR SUPPLIES|
20|FH_F46357_0_0|SrvcGrp|41334|2022|PDM|3400.00|99|0.00|TOTAL KNEE|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC|
20|FH_F128299_44134_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F102561_75146_0|SrvcGrp|73000|2022|PDM|3000.00|99|0.00|AEG 6|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|534.00|99|0.00|ASPG 205|
20|FH_F100965_25276_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F114171_0_0|SrvcGrp|114518|2022|PDM|1432.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F134732_0_0|SrvcGrp|107794|2022|PDM|4058.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F136806_0_0|SrvcGrp|99073|2022|PDM|1.39|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F37361_0_0|SrvcGrp|9830|2022|PDM|88.00|99|0.00|OT SVCS|
20|FH_F150459_08021_0|SrvcGrp|48394|2022|PDM|44.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F151043_71901_0|CSTM-ALL|CSTM-00|2020|PCT|0.23|99|0.00|OP SVCS|
20|FH_F130140_68845_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147230_49505_0|SrvcGrp|29155|2022|PDM|160.44|99|0.00|HOSPICE SVCS|
20|FH_F59312_0_0|SrvcGrp|12496|2022|PDM|717.00|99|0.00|ACUTE REHABILITATION|
20|FH_F128091_37129_0|SrvcGrp|75754|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F150945_15904_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117581_21211_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|29771.00|99|0.00|MSDRG 235-236 CORONARY BYPASS|
20|FH_F92032_32308_0|SrvcGrp|114052|2022|PCT|1.00|99|0.00|COVID-19 ADMIN|
20|FH_F76588_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90151_24382_0|SrvcGrp|471|2022|PDM|472.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F97100_23462_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 10 (NO REV)|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MS DRG 927  EXTENSIVE BURNS W/SKIN GRFT|
20|FH_F110732_31513_0|SrvcGrp|72992|2022|PDM|922.00|99|0.00|AEG 2|
20|FH_F126781_92630_0|SrvcGrp|75419|2022|PDM|725.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F114207_35243_0|SrvcGrp|14949|2022|PDM|70.00|99|0.00|HOME INFUSION|
20|FH_F90196_10467_0|CSTM-ALL|CSTM-00|2020|PDM|161.00|99|0.00|NEW PATIENT VISIT|
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|572.00|99|0.00|AEG 2 (NO REV)|
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|AEG 4 (NO REV)|
20|FH_F141250_95062_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F38372_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F108680_0_0|SrvcGrp|100921|2022|PDM|4400.00|99|0.00|SPI  PROSTH DEVICE|
20|FH_F92278_01440_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F149662_85015_0|SrvcGrp|109833|2022|PDM|4990.00|99|0.00|REPLACE ELBOW JOINT|
20|FH_F147369_43608_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE|
20|FH_F135093_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F110963_30535_0|SrvcGrp|48385|2022|PDM|170.00|99|0.00|SPEECH THERAPY|
20|FH_F115483_62002_0|SrvcGrp|75999|2022|PDM|220.00|99|0.00|OP URGENT CARE|
20|FH_F40624_0_0|SrvcGrp|31773|2022|PDM|3500.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F128008_27302_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42352_0_0|CSTM-ALL|CSTM-00|2020|PDM|1216.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47037_0_0|SrvcGrp|10545|2022|PDM|90.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F98623_97006_0|SrvcGrp|88978|2022|PDM|8474.00|99|0.00|VAGINAL DELIVERY|
20|FH_F151679_62881_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F111086_29501_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|AEG 3 (NO REV)|
20|FH_F101441_0_0|SrvcGrp|19920|2022|PDM|3567.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|862.00|99|0.00|AEG 6 (NO REV)|
20|FH_F127418_0_0|SrvcGrp|88494|2022|PDM|8125.25|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F90817_0_0|SrvcGrp|91014|2022|PDM|1574.00|99|0.00|KNEE ARTHROSCOPY/SURGERY (HCFA)|
20|FH_F141278_80218_0|SrvcGrp|110896|2022|PDM|7344.00|99|0.00|VBAC DELIVERY|
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)|
20|FH_F117905_0_0|SrvcGrp|103551|2022|PDM|180.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 1 (NO REV)|
20|FH_F135263_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F150982_0_0|SrvcGrp|63460|2022|PDM|2753.00|99|0.00|CPT 55040|
20|FH_F130661_04441_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 8 (NO REV)|
20|FH_F140295_0_0|SrvcGrp|27261|2022|PDM|11219.00|99|0.00|CPT 27446|
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150922_02452_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F132008_85226_0|SrvcGrp|111917|2022|PCT|0.80|99|0.00|MANUAL ADULT WC W TILTINSPAC|
20|FH_F112754_98057_0|SrvcGrp|104882|2022|PDM|312.65|99|0.00|CLINICAL SOCIAL WORKER IN HOME|
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PDM|7698.00|99|0.00|AEG 8 (NO REV)|
20|FH_F120118_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|OP SVCS|
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 1 (NO REV)|
20|FH_F128821_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F35369_0_0|CSTM-ALL|CSTM-00|2020|PDM|1850.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|3499.00|99|0.00|AEG 10 (NO REV)|
20|FH_F36435_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|GENERAL ACUTE CARE|
20|FH_F137627_78382_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F124452_31322_0|SrvcGrp|88621|2022|PDM|130.00|99|0.00|SKILLED NURSING LPN|
20|FH_F36715_0_0|CSTM-ALL|CSTM-00|2020|PDM|758.00|99|0.00|ACUTE PSYCH|
20|FH_F149522_83221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150443_77536_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F42538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113116_23847_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F38742_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|SUNSHINE HHC INFUSION THERAPY MOD SH|
20|FH_F125081_15218_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F131392_17004_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F120207_0_0|SrvcGrp|86460|2022|PDM|3399.00|99|0.00|REVISE BREAST RECONSTRUCTION|
20|FH_F132254_40207_0|SrvcGrp|24744|2022|PDM|100.00|99|0.00|PICC LINE INSERTION|
20|FH_F131387_76001_0|SrvcGrp|73842|2022|PDM|202.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F43324_0_0|SrvcGrp|38021|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY|
20|FH_F34914_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120550_91355_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120437_85202_0|SrvcGrp|98994|2022|PDM|101.29|99|0.00|HYDRATION THERAPY 2 LITER (HCFA)|
20|FH_F50440_0_0|SrvcGrp|33165|2022|PDM|405.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F150120_93619_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F139385_37762_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139707_84010_0|SrvcGrp|116277|2022|PDM|4911.00|99|0.00|LAPAROSCOPY|
20|FH_F150700_90028_0|SrvcGrp|90854|2022|PDM|850.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F150768_03054_0|SrvcGrp|33722|2022|PDM|44.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F101844_0_0|SrvcGrp|41334|2022|PDM|8943.00|99|0.00|TOTAL KNEE|
20|FH_F131389_33169_0|SrvcGrp|108484|2022|PDM|603.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F131471_67203_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F146266_0_0|SrvcGrp|98498|2022|PDM|7168.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC|
20|FH_F94643_90501_0|SrvcGrp|86849|2022|PDM|60.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F125656_92868_0|SrvcGrp|24761|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138995_0_0|SrvcGrp|59705|2022|PDM|1050.00|99|0.00|SEPTOPLASTY|
20|FH_F43236_0_0|SrvcGrp|37018|2022|PDM|225.00|99|0.00|BOARDER BABY|
20|FH_F126116_0_0|SrvcGrp|68000|2022|PDM|1125.00|99|0.00|CPT 58561|
20|FH_F147160_80260_0|SrvcGrp|74668|2022|PDM|364.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F78023_0_0|SrvcGrp|30095|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F138453_74135_0|SrvcGrp|108484|2022|PDM|515.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F123745_0_0|SrvcGrp|67068|2022|PDM|13500.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F148550_48126_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149240_0_0|SrvcGrp|103911|2022|PDM|384.52|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY|
20|FH_F94643_90501_0|SrvcGrp|86829|2022|PDM|35.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F124759_34108_0|SrvcGrp|100499|2022|PDM|600.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F124714_64081_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F40904_0_0|SrvcGrp|701|2022|PDM|1875.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F40564_0_0|SrvcGrp|16|2022|PDM|625.00|99|0.00|ACUTE REHABILITATION|
20|FH_F112794_01040_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F56813_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F131512_37617_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150953_74953_0|SrvcGrp|114504|2022|PCT|5.02|99|0.00|LABORATORY SERVICES|
20|FH_F50100_0_0|SrvcGrp|46111|2022|PDM|103.73|99|0.00|MATERNAL/CHILD HEALTH|
20|FH_F37490_0_0|SrvcGrp|26421|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F151659_17013_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1008.00|99|0.00|AEG 3 (NO REV)|
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|AEG 2 (NO REV)|
20|FH_F137767_01841_0|CSTM-ALL|CSTM-00|2020|PDM|2425.00|99|0.00|AEG 2 (NO REV)|
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_F54056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F98022_89015_0|SrvcGrp|73656|2022|PDM|737.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F151019_14094_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|VERTICAL PLUS MRI MOD RR|
20|FH_F139927_0_0|SrvcGrp|84779|2022|PCT|0.60|99|0.00|ENTERAL AND PARENTERAL THERAPY|
20|FH_F124467_27529_0|SrvcGrp|3178|2022|PDM|928.00|99|0.00|ACUTE PSYCH|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PDM|2481.00|99|0.00|ASPG V|
20|FH_F111080_18103_0|SrvcGrp|93919|2022|PDM|520.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F126554_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F125182_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F136806_0_0|SrvcGrp|105491|2022|PDM|2218.00|99|0.00|KNEE ARTHROCOPY PROCEDURES|
20|FH_F149023_44122_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 10 (NO REV)|
20|FH_F40453_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F130202_68003_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117617_80439_0|SrvcGrp|89783|2022|PDM|165.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|161.85|99|0.00|SALLY BALIN,999182,ASC 116|
20|FH_F148859_0_0|SrvcGrp|68048|2022|PDM|6791.00|99|0.00|CPT 64581|
20|FH_F133519_0_0|SrvcGrp|112206|2022|PDM|106.00|99|0.00|DESTROY VULVA LESIONS|
20|FH_F134847_0_0|SrvcGrp|67065|2022|PDM|17648.00|99|0.00|CERVICAL SURGERY|
20|FH_F124514_21215_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112128_63017_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139785_92629_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F134676_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F34882_0_0|SrvcGrp|18924|2022|PDM|8217.34|99|0.00|MS DRG 768|
20|FH_F116583_0_0|SrvcGrp|95660|2022|PDM|650.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F35557_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1414794 AM HOME PAT DME MOD KN|
20|FH_F99380_90503_0|SrvcGrp|90627|2022|PCT|0.00|99|0.00|FH WEST PROVIDENCE ST JOSEPH OP LAB DRAW (ZERO REIMBURSE)|
20|FH_F140295_0_0|SrvcGrp|90343|2022|PDM|7068.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL|
20|FH_F34764_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F149022_25271_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126554_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F78023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36926_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F31547_0_0|SrvcGrp|12688|2022|PDM|0.56|99|0.00|GENTIMICIN|
20|FH_F71468_0_0|CSTM-ALL|CSTM-00|2020|PDM|95.00|99|0.00|HOME INFUSION NURSING SVCS MOD SD|
20|FH_F130661_04441_0|SrvcGrp|92958|2022|PCT|0.86|99|0.00|SLEEP STUDIES|
20|FH_F97101_98003_0|SrvcGrp|73559|2022|PDM|16827.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F132096_89118_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F146266_0_0|SrvcGrp|82720|2022|PDM|1840.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F114416_0_0|SrvcGrp|65720|2022|PDM|120.00|99|0.00|RESPITE CARE|
20|FH_F140134_52732_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143488_84770_0|SrvcGrp|42550|2022|PDM|1563.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F143536_47546_0|SrvcGrp|100252|2022|PCT|1.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (7.6 - 12.5 CM)|
20|FH_F101709_0_0|SrvcGrp|96354|2022|PDM|8441.00|99|0.00|REMOVAL OF ANKLE JOINT|
20|FH_F114931_0_0|SrvcGrp|63471|2022|PDM|5200.00|99|0.00|CPT 64590|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|199.00|99|0.00|GA RETINA SURG CTR ASC 5|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD KM|
20|FH_F120862_87108_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F126970_45601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F62579_0_0|SrvcGrp|26869|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F146372_28681_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139678_25601_0|SrvcGrp|73842|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F145926_45243_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130364_01331_0|SrvcGrp|103913|2022|PCT|0.00|99|0.00|OP DIALYSIS|
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|2265.00|99|0.00|AEG 8 (NO REV)|
20|FH_F116806_0_0|SrvcGrp|107011|2022|PDM|1923.16|99|0.00|REMOVE CORONOID PROCESS|
20|FH_F96160_32207_0|SrvcGrp|29023|2022|PDM|75.91|99|0.00|HOME INFUSION THERAPY|
20|FH_F125244_0_0|SrvcGrp|110094|2022|PDM|5000.00|99|0.00|APPENDECTOMY ADD-ON|
20|FH_F116806_0_0|SrvcGrp|107029|2022|PDM|1923.16|99|0.00|REVISE EYE SOCKETS|
20|FH_F51258_0_0|SrvcGrp|43284|2022|PDM|81.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F109405_73106_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F118127_30078_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F90232_15126_0|SrvcGrp|29077|2022|PDM|189.00|99|0.00|HOME TRANSFUSION|
20|FH_F143669_78577_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F127908_60640_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F41135_0_0|SrvcGrp|17067|2022|PDM|430.85|99|0.00|ASPG II|
20|FH_F130468_0_0|SrvcGrp|88218|2022|PDM|6500.10|99|0.00|LOW BACK DISK SURGERY|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1432.86|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1301 W/O REV|
20|FH_F133972_27103_0|SrvcGrp|86832|2022|PDM|4.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F70804_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F145604_14850_0|SrvcGrp|17015|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F149517_0_0|SrvcGrp|93098|2022|PDM|190.00|99|0.00|HOSPICE CARE|
20|FH_F150307_84111_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F114527_39047_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F149199_73005_0|SrvcGrp|73606|2022|PDM|385.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PDM|932.00|99|0.00|ASPG VI|
20|FH_F89319_41001_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|GENERAL ACUTE CARE|
20|FH_F146124_06112_0|SrvcGrp|114463|2022|PCT|1.00|99|0.00|NATALIZUMAB INJECTION|
20|FH_F136318_0_0|SrvcGrp|88905|2022|PDM|1208.00|99|0.00|PSYCHIATRIC CARE (AGE 0-17)|
20|FH_F70162_0_0|CSTM-ALL|CSTM-00|2020|PDM|1990.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133749_84604_0|SrvcGrp|112440|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F62432_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F127686_67432_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143571_0_0|SrvcGrp|103846|2022|PDM|87.23|99|0.00|HOSPICE CARE|
20|FH_F145641_06902_0|SrvcGrp|41327|2022|PDM|3697.00|99|0.00|OP SURGERY CPT 28308|
20|FH_F134969_34474_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC INVOICE|
20|FH_F129509_0_0|SrvcGrp|77021|2022|PDM|3767.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F59872_0_0|SrvcGrp|45883|2022|PDM|90.00|99|0.00|OT|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|91.04|99|0.00|HAPA WPA-NWPA 2012-13 ASC 143 W/O REV|
20|FH_F132822_95125_0|SrvcGrp|29347|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F118088_71261_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F142376_0_0|SrvcGrp|112115|2022|PDM|9873.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|HOME HEALTH MOD TD|
20|FH_F149050_22844_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132609_0_0|SrvcGrp|941|2022|PDM|2872.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F86094_16748_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146005_67037_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133805_83401_0|SrvcGrp|63297|2022|PDM|122.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD RR"|
20|FH_F110507_33462_0|SrvcGrp|93919|2022|PDM|635.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|2338.00|99|0.00|AEG 7 (NO REV)|
20|FH_F138418_51201_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F150165_06032_0|SrvcGrp|59705|2022|PDM|2546.00|99|0.00|SEPTOPLASTY|
20|FH_F127090_45601_0|SrvcGrp|29347|2022|PDM|18.45|99|0.00|HOME HEALTH AIDE|
20|FH_F114483_47905_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93122_01854_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F134249_05060_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F145604_14850_0|SrvcGrp|14944|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F118803_0_0|SrvcGrp|107794|2022|PDM|4993.92|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|345.82|99|0.00|HAPA WPA-NWPA 2012-13 ASC 108 W/O REV|
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|2275.00|99|0.00|AEG 5  (NO REV)|
20|FH_F149246_95603_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F72543_0_0|SrvcGrp|22954|2022|PDM|168.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F122526_22203_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F84057_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F84712_0_0|SrvcGrp|73659|2022|PDM|2082.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F84712_0_0|SrvcGrp|82759|2022|PDM|42.00|99|0.00|ASSAY CPK IN BLOOD|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|323.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 109 W/O REV|
20|FH_F102200_06416_0|SrvcGrp|86839|2022|PDM|75.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F105361_80104_0|SrvcGrp|73008|2022|PDM|2465.00|99|0.00|AEG 10|
20|FH_F66782_0_0|SrvcGrp|29826|2022|PCT|1.00|99|0.00|AWP  J & Q CODES|
20|FH_F75842_0_0|SrvcGrp|17083|2022|PDM|3160.05|99|0.00|ASPG X|
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_F146605_72205_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|190.00|99|0.00|CD PARTIAL HOSPITALIZATION - ADOLESCENT|
20|FH_F47140_0_0|SrvcGrp|25038|2022|PDM|788.64|99|0.00|SLEEP STUDIES|
20|FH_F116055_59804_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131860_38834_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133478_40165_0|SrvcGrp|29607|2022|PDM|48973.00|99|0.00|MS DRG 221 ONLY|
20|FH_F133478_40165_0|SrvcGrp|13750|2022|PCT|0.00|99|0.00|DRUGS INCIDENT TO RADIOLOGY|
20|FH_F111605_80524_0|SrvcGrp|471|2022|PDM|541.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134839_60942_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F34626_0_0|SrvcGrp|15846|2022|PDM|50.00|99|0.00|HOME VISIT|
20|FH_F35216_0_0|SrvcGrp|11258|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F39346_0_0|SrvcGrp|20910|2022|PDM|30441.00|99|0.00|MS DRG 234 ONLY|
20|FH_F39346_0_0|SrvcGrp|28002|2022|PDM|17077.00|99|0.00|MS DRG 253-254 ONLY|
20|FH_F134087_0_0|SrvcGrp|107835|2022|PDM|6796.00|99|0.00|NERVE REPAIR|
20|FH_F134087_0_0|SrvcGrp|112555|2022|PDM|3607.00|99|0.00|INTERCALARY ALGRFT COMPL|
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|INTRAOCULAR LENS|
20|FH_F59732_0_0|SrvcGrp|34389|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F141527_36830_0|SrvcGrp|86853|2022|PDM|11.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F120647_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
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_F145550_62034_0|SrvcGrp|30609|2022|PDM|40.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F77883_0_0|SrvcGrp|74932|2022|PDM|818.03|99|0.00|HOSPICE|
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 3 (NO REV)|
20|FH_F83352_06114_0|SrvcGrp|73700|2022|PDM|36.75|99|0.00|AETNA - SKILLED NURSING|
20|FH_F137615_16335_0|SrvcGrp|46903|2022|PDM|557.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F141001_24739_0|SrvcGrp|94299|2022|PCT|1.00|99|0.00|NEW PT OFFICE VISIT|
20|FH_F115020_67301_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F69322_0_0|SrvcGrp|26835|2022|PDM|362.00|99|0.00|CD PARTIAL HOSP ADOLESCENT|
20|FH_F125890_43054_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F98922_40351_0|SrvcGrp|73659|2022|PDM|5175.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F147941_06023_0|SrvcGrp|10361|2022|PDM|224.00|99|0.00|CPT CODE 99281|
20|FH_F136756_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F97102_83501_0|SrvcGrp|88978|2022|PDM|7023.00|99|0.00|VAGINAL DELIVERY|
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)|
20|FH_F128992_90808_0|SrvcGrp|86722|2022|PDM|363.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F149780_00783_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F138578_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89563_29407_0|SrvcGrp|90490|2022|PCT|1.00|99|0.00|EVALUATION OF SPEECH FLUENCY|
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|9954.00|99|0.00|AEG 9 (NO REV)|
20|FH_F123512_64089_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F90492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F127165_32112_0|SrvcGrp|73841|2022|PDM|436.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F93136_0_0|SrvcGrp|78045|2022|PCT|1.00|99|0.00|AETNA AMNIOTIC MEMBRANE|
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 7 (NO REV)|
20|FH_F131234_32207_0|SrvcGrp|3178|2022|PDM|896.00|99|0.00|ACUTE PSYCH|
20|FH_F141802_17042_0|SrvcGrp|113803|2022|PCT|0.68|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F141390_19007_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49042_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F78709_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|OP SVCS|
20|FH_F129328_33311_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|967.50|99|0.00|ASPG VIII|
20|FH_F43118_0_0|SrvcGrp|36840|2022|PDM|17000.00|99|0.00|BARIATRICS|
20|FH_F92276_32308_0|SrvcGrp|27160|2022|PDM|49245.00|99|0.00|MS DRG 242-243 ONLY|
20|FH_F139551_0_0|SrvcGrp|82108|2022|PDM|2788.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F70984_0_0|CSTM-ALL|CSTM-00|2020|PDM|569.00|99|0.00|COVENTRY ENHANCED GROUPERS 1 GA NO CRESCENT|
20|FH_F42706_0_0|SrvcGrp|36415|2022|PDM|140.00|99|0.00|PT/OT/ST (INITIAL EVAL)|
20|FH_F102302_0_0|SrvcGrp|98569|2022|PDM|29900.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F128973_44256_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F149888_68506_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F91622_0_0|SrvcGrp|10393|2022|PDM|3545.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F138934_0_0|SrvcGrp|71221|2022|PDM|675.00|99|0.00|EGD W/BALLOON DIALATION CPT 43249|
20|FH_F125138_63663_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F91622_0_0|SrvcGrp|84186|2022|PCT|0.00|99|0.00|LITHOTRIPSY ESWL|
20|FH_F139515_0_0|SrvcGrp|92413|2022|PDM|8549.00|99|0.00|SPINAL CRD DECOMP->2 THORAC|
20|FH_F37996_0_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F89779_0_0|SrvcGrp|72996|2022|PDM|3000.00|99|0.00|AEG 4|
20|FH_F34546_0_0|SrvcGrp|8950|2022|PDM|1000.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F143930_16101_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F33712_0_0|SrvcGrp|10905|2022|PCT|0.75|99|0.00|EMERGENCY ROOM LEVEL III|
20|FH_F141507_0_0|SrvcGrp|106235|2022|PDM|2400.00|99|0.00|CYPASS|
20|FH_F82714_18848_0|SrvcGrp|997|2022|PCT|0.39|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1352.72|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1 W/O REV|
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|3802.00|99|0.00|AEG 5  (NO REV)|
20|FH_F100761_02539_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F120059_0_0|SrvcGrp|108166|2022|PDM|1800.00|99|0.00|ESTABLISH ACCESS TO AORTA|
20|FH_F43118_0_0|SrvcGrp|38125|2022|PCT|0.50|99|0.00|HIGH COST DRUGS|
20|FH_F129656_15005_0|SrvcGrp|24752|2022|PDM|25.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F131176_28712_0|SrvcGrp|114093|2022|PDM|450.00|99|0.00|PARTIAL HOSPITAL SUBSTANCE ABUSE|
20|FH_F41776_0_0|SrvcGrp|22596|2022|PDM|276.00|99|0.00|HOSPICE CARE|
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F128272_60640_0|SrvcGrp|111025|2022|PCT|0.83|99|0.00|SUPPLIES|
20|FH_F116700_11787_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PDM|801.00|99|0.00|ASPG III F/S - BDSS|
20|FH_F123385_03561_0|SrvcGrp|43569|2022|PDM|154.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F129408_48034_0|SrvcGrp|80918|2022|PDM|140.00|99|0.00|RESPITE CARE|
20|FH_F121177_33407_0|SrvcGrp|86722|2022|PDM|170.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F128151_62568_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|895.00|99|0.00|AEG 5  (NO REV)|
20|FH_F97104_53545_0|SrvcGrp|90854|2022|PDM|2103.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.64|99|0.00|AEG 2 (NO REV)|
20|FH_F132779_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F50218_0_0|SrvcGrp|46234|2022|PDM|60.00|99|0.00|SKILLED NURSING|
20|FH_F128982_44221_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F76303_0_0|SrvcGrp|46248|2022|PDM|72.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F100762_51104_0|SrvcGrp|90854|2022|PDM|2382.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F38377_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F93332_0_0|SrvcGrp|93073|2022|PDM|1906.00|99|0.00|ALLOGRAFT SPINE SURG (HCFA)|
20|FH_F82380_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F34735_0_0|SrvcGrp|18378|2022|PCT|0.75|99|0.00|MS DRG 312|
20|FH_F38297_0_0|SrvcGrp|3810|2022|PDM|103.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F66222_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|S CODES MOD SH|
20|FH_F118338_94952_0|SrvcGrp|46903|2022|PDM|1100.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F100662_27534_0|SrvcGrp|73605|2022|PDM|2196.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F143895_47631_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|2515.00|99|0.00|AEG 9 (NO REV)|
20|FH_F122536_0_0|SrvcGrp|28792|2022|PCT|0.75|99|0.00|UNGROUPED O/P SURGERY|
20|FH_F110263_0_0|SrvcGrp|115584|2022|PDM|8659.00|99|0.00|NEUROELECTRODES IMPLANTS (HCFA)|
20|FH_F122687_0_0|SrvcGrp|92366|2022|PDM|2404.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F117010_10549_0|SrvcGrp|86748|2022|PCT|1.05|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F94862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F38792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|968.00|99|0.00|ASPG V|
20|FH_F49543_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|403.33|99|0.00|HAPA WPA-NWPA 2012-13 ASC 208 W/O REV|
20|FH_F148644_06890_0|SrvcGrp|28548|2022|PDM|5252.00|99|0.00|VITRECTOMY|
20|FH_F151054_06473_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F151140_33134_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151226_33155_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121385_89102_0|SrvcGrp|109057|2022|PCT|2.07|99|0.00|CARDIAC STUDIES|
20|FH_F129130_92562_0|SrvcGrp|111292|2022|PDM|11317.16|99|0.00|ELECTROPHYSIOLOGY EVALUATION|
20|FH_F31525_0_0|CSTM-ALL|CSTM-00|2020|PDM|595.00|99|0.00|ACUTE PSYCH|
20|FH_F38807_0_0|SrvcGrp|17075|2022|PDM|826.00|99|0.00|ASPG VI|
20|FH_F113738_27006_0|SrvcGrp|48394|2022|PDM|46.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F65761_0_0|SrvcGrp|42826|2022|PDM|175.05|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F33624_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97780_43614_0|SrvcGrp|73656|2022|PDM|440.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PDM|968.00|99|0.00|AEG 2 (NO REV)|
20|FH_F85039_0_0|SrvcGrp|75497|2022|PDM|366.00|99|0.00|AEG 10|
20|FH_F88885_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F142321_29401_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F100620_37027_0|SrvcGrp|76501|2022|PDM|330.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F105591_17601_0|SrvcGrp|73006|2022|PDM|2524.00|99|0.00|AEG 9|
20|FH_F130400_26505_0|SrvcGrp|49682|2022|PCT|2.95|99|0.00|HSS DRG GROUPED|
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|911.93|99|0.00|AEG 6 (NO REV)|
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|928.00|99|0.00|AEG 5  (NO REV)|
20|FH_F119838_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F100401_15317_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F138929_0_0|SrvcGrp|90063|2022|PDM|5005.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F116525_26003_0|SrvcGrp|75506|2022|PCT|0.62|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F149879_80045_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151524_84121_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F118373_21205_0|SrvcGrp|16349|2022|PDM|3035.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F40321_0_0|SrvcGrp|97|2022|PDM|4845.00|99|0.00|C-SECTION|
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|691.00|99|0.00|AEG 2 (NO REV)|
20|FH_F141410_13045_0|SrvcGrp|10107|2022|PCT|0.39|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F129657_77479_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97104_53545_0|SrvcGrp|88977|2022|PDM|6795.00|99|0.00|C-SECTION DELIVERY|
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|415.00|99|0.00|AEG 1 (NO REV)|
20|FH_F100762_51104_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F110923_54768_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130598_73601_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120253_44646_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F39515_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123282_03222_0|SrvcGrp|88621|2022|PDM|136.00|99|0.00|SKILLED NURSING LPN|
20|FH_F142710_0_0|SrvcGrp|80918|2022|PDM|125.00|99|0.00|RESPITE CARE|
20|FH_F73985_0_0|SrvcGrp|62376|2022|PDM|14237.00|99|0.00|ATHERECTOMY|
20|FH_F146255_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.90|99|0.00|OP SVCS|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD KF|
20|FH_F88740_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F90798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143528_0_0|SrvcGrp|88596|2022|PDM|2625.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE|
20|FH_F115685_64064_0|SrvcGrp|86852|2022|PDM|75.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F129708_54403_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42999_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139515_0_0|SrvcGrp|88164|2022|PDM|16995.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F131207_19947_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP DIALYSIS|
20|FH_F93880_95476_0|SrvcGrp|73000|2022|PDM|5799.00|99|0.00|AEG 6|
20|FH_F141801_80534_0|SrvcGrp|87441|2022|PDM|1000.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F82714_18848_0|CSTM-ALL|CSTM-00|2020|PDM|621.00|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD QW) - PMRS|
20|FH_F129656_15005_0|SrvcGrp|22389|2022|PDM|25.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F139515_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F137558_36116_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|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_F129596_0_0|SrvcGrp|29930|2022|PDM|400.00|99|0.00|DIALYSIS|
20|FH_F118050_77565_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F56678_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F123385_03561_0|SrvcGrp|46104|2022|PDM|154.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F118720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F118072_38133_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F93920_0_0|SrvcGrp|75506|2022|PCT|0.75|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F82931_18847_0|SrvcGrp|29817|2022|PDM|3029.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F117783_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F135173_06519_0|SrvcGrp|92937|2022|PDM|195.00|99|0.00|INTENSIVE OP PSYCH (HCFA)|
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F58052_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F110109_32901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F123473_65109_0|SrvcGrp|75545|2022|PDM|327.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F113723_10457_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F123400_04605_0|SrvcGrp|109359|2022|PDM|521.00|99|0.00|RESIDENTIAL TREATMENT (<= 17 YRS)|
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_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)|
20|FH_F86851_0_0|SrvcGrp|84962|2022|PDM|520.00|99|0.00|CPT 43204|
20|FH_F89778_0_0|SrvcGrp|79101|2022|PDM|1135.88|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F129926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F123820_91316_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F62797_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|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_F135840_0_0|SrvcGrp|79583|2022|PDM|550.00|99|0.00|CPT 45381|
20|FH_F90232_15126_0|SrvcGrp|86837|2022|PDM|189.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F138026_46143_0|SrvcGrp|46903|2022|PDM|675.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F121225_98902_0|SrvcGrp|34865|2022|PDM|103.95|99|0.00|HOME HEALTH AIDE|
20|FH_F150306_51566_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F121225_98902_0|SrvcGrp|108706|2022|PCT|0.00|99|0.00|MEDICAL SOCIAL WORKER SVCS|
20|FH_F150161_63361_0|SrvcGrp|66264|2022|PDM|98.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F145641_06902_0|SrvcGrp|95559|2022|PDM|20500.00|99|0.00|HIP JOINT|
20|FH_F119379_0_0|SrvcGrp|107844|2022|PDM|885.00|99|0.00|RELEASE WRIST/FOREARM TENDON|
20|FH_F72086_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1499.00|99|0.00|AEG 5  (NO REV)|
20|FH_F134170_33410_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150165_06032_0|SrvcGrp|28549|2022|PDM|3819.00|99|0.00|VITRECTOMY|
20|FH_F145641_06902_0|SrvcGrp|114236|2022|PDM|5814.00|99|0.00|EXCISION OF HIP JOINT/MUSCLE|
20|FH_F130468_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F89219_0_0|SrvcGrp|87310|2022|PDM|44811.00|99|0.00|MSDRG 273 ONLY|
20|FH_F117245_0_0|SrvcGrp|72990|2022|PDM|550.00|99|0.00|AEG 1|
20|FH_F94786_07974_0|SrvcGrp|47183|2022|PDM|84.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1257.00|99|0.00|AEG 8 (NO REV)|
20|FH_F141151_75150_0|SrvcGrp|73339|2022|PCT|0.85|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114389_50131_0|SrvcGrp|105621|2022|PDM|47.43|99|0.00|HEATED HUMIDIFIER (MOD RR)|
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136735_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F91998_0_0|SrvcGrp|88739|2022|PDM|1224.00|99|0.00|IMPLANT SPINAL CANAL|
20|FH_F98380_43055_0|SrvcGrp|73602|2022|PDM|4896.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F124414_92653_0|SrvcGrp|46903|2022|PDM|550.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F124586_14850_0|SrvcGrp|73842|2022|PDM|120.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124611_64804_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124679_64052_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 5  (NO REV)|
20|FH_F133694_89117_0|SrvcGrp|48398|2022|PDM|135.00|99|0.00|PT SERVICES|
20|FH_F63185_0_0|SrvcGrp|46604|2022|PDM|35.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F67882_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136623_01830_0|SrvcGrp|73605|2022|PDM|1065.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F114666_30342_0|SrvcGrp|41334|2022|PDM|16500.00|99|0.00|TOTAL KNEE|
20|FH_F114666_30342_0|SrvcGrp|67069|2022|PDM|3000.00|99|0.00|CPT 22634|
20|FH_F114666_30342_0|SrvcGrp|100067|2022|PDM|2500.00|99|0.00|ANKLE ARTHROSCOPY SURGERY|
20|FH_F113809_47302_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F139652_42211_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138267_75087_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138310_60461_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148553_85016_0|SrvcGrp|115451|2022|PDM|5202.00|99|0.00|INSERT PULSE GEN W/ DUAL LEADS|
20|FH_F122839_37122_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122689_92009_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122641_72365_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F134694_94945_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136778_62034_0|SrvcGrp|17100|2022|PDM|1133.00|99|0.00|SKILLED NURSING|
20|FH_F136778_62034_0|SrvcGrp|87995|2022|PDM|317.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F112378_60505_0|SrvcGrp|27968|2022|PDM|42.00|99|0.00|SKILLED NURSING LPN|
20|FH_F141170_0_0|SrvcGrp|77021|2022|PDM|5010.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F63317_0_0|SrvcGrp|27249|2022|PDM|60.00|99|0.00|PT|
20|FH_F116199_75042_0|SrvcGrp|89337|2022|PDM|804.00|99|0.00|DETOXIFICATION|
20|FH_F147445_76844_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41463_0_0|SrvcGrp|29678|2022|PDM|65.10|99|0.00|HOME INFUSION NURSING SVCS MOD SD|
20|FH_F42399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|KINDRED SNF - PHARMACEUTICALS AWP-15%|
20|FH_F72445_0_0|SrvcGrp|10648|2022|PDM|6.00|99|0.00|HOME INFUSION|
20|FH_F48693_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F54552_0_0|SrvcGrp|17011|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138787_32258_0|SrvcGrp|113174|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - PFIZER|
20|FH_F138973_45036_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78265_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG X|
20|FH_F118986_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F124542_0_0|SrvcGrp|80541|2022|PDM|698.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 5|
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|3088.00|99|0.00|AEG 5  (NO REV)|
20|FH_F82382_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F151501_30265_0|SrvcGrp|84307|2022|PDM|5996.00|99|0.00|TENDON REPAIR|
20|FH_F132163_17601_0|SrvcGrp|102979|2022|PDM|100.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AH)|
20|FH_F132258_45404_0|SrvcGrp|14944|2022|PDM|6.65|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F132258_45404_0|SrvcGrp|88621|2022|PDM|75.26|99|0.00|SKILLED NURSING LPN|
20|FH_F145468_60615_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F127923_69130_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135572_89106_0|SrvcGrp|14948|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F135583_17331_0|SrvcGrp|30623|2022|PDM|13555.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F135587_37334_0|SrvcGrp|92760|2022|PCT|1.02|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F91764_93710_0|SrvcGrp|112223|2022|PCT|2.12|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F135952_74501_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121444_47720_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F121464_15701_0|SrvcGrp|75545|2022|PDM|382.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F121466_84057_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F121871_65401_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146909_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.75|99|0.00|HSS ASC|
20|FH_F33785_0_0|SrvcGrp|16|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION|
20|FH_F67425_0_0|SrvcGrp|9978|2022|PDM|2200.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS|
20|FH_F131407_07607_0|SrvcGrp|14949|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F130817_18103_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F111301_33122_0|CSTM-ALL|CSTM-00|2020|PDM|13768.00|99|0.00|AETNA ANGIOPLASTY|
20|FH_F141651_0_0|SrvcGrp|88599|2022|PDM|2200.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F33081_0_0|SrvcGrp|13742|2022|PCT|1.00|99|0.00|PHYSICIAN/CLINIC VISIT (GLOBAL)|
20|FH_F112129_62220_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F87557_33309_0|SrvcGrp|17016|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F127445_51054_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|1714.00|99|0.00|AEG 3 (NO REV)|
20|FH_F102222_19720_0|SrvcGrp|86852|2022|PDM|31.50|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F102325_62691_0|SrvcGrp|29076|2022|PDM|50.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F129240_10028_0|SrvcGrp|14944|2022|PDM|5.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F98300_30236_0|SrvcGrp|79804|2022|PDM|2814.00|99|0.00|AETNA MEDICAL/SURGICAL|
20|FH_F102960_50613_0|SrvcGrp|75506|2022|PCT|0.62|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F40600_0_0|SrvcGrp|10107|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F100780_24153_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F100783_03431_0|SrvcGrp|73601|2022|PDM|5244.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|465.00|99|0.00|AEG 2 (NO REV)|
20|FH_F133107_73071_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F131235_36049_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F122725_32216_0|SrvcGrp|104795|2022|PDM|15.00|99|0.00|PSYTX COMPLEX INTERACTIVE|
20|FH_F122900_65203_0|SrvcGrp|92760|2022|PCT|1.20|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129518_54002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F86872_15215_0|SrvcGrp|22593|2022|PDM|75.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F86872_15215_0|SrvcGrp|24761|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F86991_15122_0|SrvcGrp|73000|2022|PDM|960.00|99|0.00|AEG 6|
20|FH_F113815_0_0|SrvcGrp|72992|2022|PDM|556.00|99|0.00|AEG 2|
20|FH_F89495_0_0|SrvcGrp|73008|2022|PDM|653.00|99|0.00|AEG 10|
20|FH_F137057_0_0|SrvcGrp|108899|2022|PDM|980.00|99|0.00|HOSPICE INPATIENT RESPITE CARE|
20|FH_F141877_0_0|SrvcGrp|83885|2022|PDM|564.00|99|0.00|CARDIAC CATH|
20|FH_F123847_24012_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132810_0_0|SrvcGrp|86853|2022|PDM|40.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F132810_0_0|SrvcGrp|24747|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F136373_17055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118152_20151_0|SrvcGrp|16750|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F120456_67117_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F137027_63960_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137027_63960_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137068_81147_0|SrvcGrp|111932|2022|PDM|51.31|99|0.00|COVID-19 NON-CDC TESTING LAB|
20|FH_F139751_84065_0|SrvcGrp|74668|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114092_83350_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION|
20|FH_F114264_51449_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142267_78240_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F117552_0_0|SrvcGrp|72990|2022|PDM|400.00|99|0.00|AEG 1|
20|FH_F53732_0_0|SrvcGrp|26869|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F114865_77488_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F140615_73013_0|CSTM-ALL|CSTM-00|2020|PDM|1634.00|99|0.00|AEG 3 (NO REV)|
20|FH_F122067_0_0|SrvcGrp|45583|2022|PDM|1980.00|99|0.00|CPT 65730|
20|FH_F120152_0_0|SrvcGrp|93433|2022|PDM|33000.00|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F149649_80104_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151603_27609_0|CSTM-ALL|CSTM-00|2020|PDM|2342.76|99|0.00|AEG 4 (NO REV)|
20|FH_F119026_36274_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F119004_06850_0|SrvcGrp|84934|2022|PDM|2817.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F38332_0_0|SrvcGrp|18848|2022|PDM|42216.00|99|0.00|MS DRG 228|
20|FH_F94581_0_0|SrvcGrp|76501|2022|PDM|332.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F147925_06457_0|SrvcGrp|115488|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F129474_92701_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129514_79605_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F117219_77515_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F137276_83127_0|SrvcGrp|29347|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE|
20|FH_F137335_08096_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F112080_0_0|SrvcGrp|73000|2022|PDM|1197.00|99|0.00|AEG 6|
20|FH_F91472_96001_0|SrvcGrp|3178|2022|PDM|2455.00|99|0.00|ACUTE PSYCH|
20|FH_F80084_0_0|SrvcGrp|12403|2022|PDM|33.01|99|0.00|CONTINUOUS HOMECARE|
20|FH_F95880_02726_0|SrvcGrp|89500|2022|PDM|226.00|99|0.00|SPEECH SOUND LANGUAGE|
20|FH_F148425_01507_0|SrvcGrp|115400|2022|PCT|1.00|99|0.00|COVID-19 VACCINE - REGENERON|
20|FH_F148501_21550_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F148542_43517_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 4 (NO REV)|
20|FH_F53572_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100741_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F117559_08619_0|SrvcGrp|115657|2022|PDM|20.00|99|0.00|INFLUENZA VACCINE QUADRIVALENT IIV4|
20|FH_F117872_33462_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F111780_38603_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F35368_0_0|SrvcGrp|1014|2022|PDM|6879.00|99|0.00|STENT PLACEMENT|
20|FH_F123096_28210_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F128605_20910_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F128615_78520_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F44435_0_0|SrvcGrp|25518|2022|PDM|3925.00|99|0.00|LAPAROSCOPY SURGICAL CHOLECYSTECTOMY|
20|FH_F122648_0_0|SrvcGrp|109175|2022|PDM|921.00|99|0.00|EYE SERVICES|
20|FH_F39859_0_0|SrvcGrp|10363|2022|PDM|659.00|99|0.00|CPT CODE 99283|
20|FH_F92676_15063_0|SrvcGrp|79033|2022|PDM|765.32|99|0.00|MON VALLEY ASC 1601|
20|FH_F63618_0_0|SrvcGrp|360|2022|PDM|2000.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F69284_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.70|99|0.00|OP SVCS|
20|FH_F143194_19973_0|SrvcGrp|90643|2022|PDM|20.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F128130_10027_0|SrvcGrp|110990|2022|PCT|1.84|99|0.00|DRUGS/DRUG AGENTS|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER NUBA|
20|FH_F125471_34471_0|SrvcGrp|89149|2022|PDM|235.00|99|0.00|OP INTENSIVE|
20|FH_F117993_32054_0|SrvcGrp|107762|2022|PCT|1.10|99|0.00|AETNA HCPC CODE (POS 72)|
20|FH_F126650_68105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133021_00910_0|SrvcGrp|112264|2022|PDM|16000.00|99|0.00|THORACIC ABDOMINAL ANEURYSM SURGERY|
20|FH_F88512_0_0|CSTM-ALL|CSTM-00|2020|PDM|4146.56|99|0.00|MS DRG BAPTIST MEM HOSP SURGICAL|
20|FH_F125212_76301_0|SrvcGrp|73841|2022|PDM|350.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F74163_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F35498_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|63.90|99|0.00|ASPG 126|
20|FH_F133019_23236_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F91216_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49354_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F111421_32216_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113074_0_0|SrvcGrp|103261|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBTANCE|
20|FH_F141790_85374_0|SrvcGrp|113812|2022|PDM|1473.00|99|0.00|WOUND PREP F/N/HF/G|
20|FH_F125176_20785_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F129688_74066_0|SrvcGrp|27969|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE|
20|FH_F144011_60616_0|SrvcGrp|113166|2022|PCT|2.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F132613_84601_0|SrvcGrp|89337|2022|PDM|1200.00|99|0.00|DETOXIFICATION|
20|FH_F148881_33018_0|SrvcGrp|105020|2022|PDM|75.00|99|0.00|SELF CARE MANGEMENT TRAINING (HCFA)|
20|FH_F57396_0_0|SrvcGrp|46587|2022|PDM|80.00|99|0.00|CPT 99211|
20|FH_F124928_04210_0|SrvcGrp|87799|2022|PDM|144.58|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F93375_0_0|SrvcGrp|72992|2022|PDM|468.00|99|0.00|AEG 2|
20|FH_F38508_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53|
20|FH_F150909_70032_0|SrvcGrp|114975|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F133478_40165_0|CSTM-ALL|CSTM-00|2020|PDM|2263.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 6 (NO REV)|
20|FH_F133068_75965_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F126806_44125_0|SrvcGrp|80920|2022|PDM|550.00|99|0.00|HOSPICE SERVICES|
20|FH_F129175_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH|
20|FH_F45199_0_0|CSTM-ALL|CSTM-00|2020|PDM|708.00|99|0.00|ASPG IV|
20|FH_F69242_0_0|SrvcGrp|43958|2022|PDM|73.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F78682_0_0|CSTM-ALL|CSTM-00|2020|PDM|1697.39|99|0.00|ASPG VII|
20|FH_F40906_0_0|SrvcGrp|13683|2022|PDM|455.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F111809_93003_0|SrvcGrp|16301|2022|PDM|15847.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F38663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BURMANS APOTHECARY IV THERAPY|
20|FH_F150538_90056_0|SrvcGrp|75419|2022|PDM|625.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F133478_40165_0|SrvcGrp|49743|2022|PDM|525.00|99|0.00|DIABETIC MANAGEMENT|
20|FH_F52032_0_0|SrvcGrp|13927|2022|PDM|800.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F44772_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|IV SERVICES|
20|FH_F113257_19034_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F73542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS AMBULANCE TN (10302-35) URBAN|
20|FH_F116324_0_0|SrvcGrp|75495|2022|PDM|550.00|99|0.00|AEG 9|
20|FH_F41814_0_0|SrvcGrp|9501|2022|PDM|1196.00|99|0.00|ACUTE IP MED/SURG SVCS|
20|FH_F37568_0_0|SrvcGrp|25938|2022|PDM|90.00|99|0.00|SOCIAL WORKER (MEDICAL)|
20|FH_F63301_0_0|SrvcGrp|14893|2022|PDM|25.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F144508_44107_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131315_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ADULT PSYCH PARTIAL HOSP|
20|FH_F37183_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132224_89119_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F69648_0_0|SrvcGrp|66264|2022|PDM|4.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F132785_17961_0|SrvcGrp|75506|2022|PCT|0.38|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1793.65|99|0.00|ASPG 9|
20|FH_F40622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F72859_0_0|SrvcGrp|15527|2022|PDM|100.00|99|0.00|HYDRATION THERAPY|
20|FH_F141870_85224_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31466_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F95661_27217_0|SrvcGrp|77012|2022|PCT|1.00|99|0.00|PT OT ST|
20|FH_F50618_0_0|SrvcGrp|17071|2022|PDM|831.05|99|0.00|ASPG IV|
20|FH_F92676_15063_0|SrvcGrp|79014|2022|PDM|997.50|99|0.00|MON VALLEY ASC 109|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 643|
20|FH_F35411_0_0|SrvcGrp|11036|2022|PCT|0.65|99|0.00|PHARMACY SVCS|
20|FH_F95360_08720_0|SrvcGrp|87907|2022|PCT|1.00|99|0.00|GANCICLOVIR SODIUM, PER 500MG|
20|FH_F118468_21502_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133287_40215_0|SrvcGrp|29081|2022|PDM|643.00|99|0.00|SLEEP STUDIES|
20|FH_F126769_43701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144668_62526_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115324_78852_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F141648_60050_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117745_15801_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F109845_85207_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146131_37160_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67379_0_0|SrvcGrp|21354|2022|PDM|11300.00|99|0.00|MS DRG 250-251 ONLY|
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|531.00|99|0.00|AEG 1 (NO REV)|
20|FH_F111266_30339_0|SrvcGrp|86830|2022|PDM|30.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|AEG 3 (NO REV)|
20|FH_F137561_43935_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120040_72703_0|SrvcGrp|72602|2022|PDM|914.00|99|0.00|ECT|
20|FH_F146266_0_0|SrvcGrp|93069|2022|PDM|9084.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F36343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146859_0_0|SrvcGrp|87673|2022|PDM|549.00|99|0.00|INJECTION(S) LUMBAR OR SACRAL SINGLE LEVEL|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% OF AWP DRUGS W/ DIRECT RATES|
20|FH_F34882_0_0|SrvcGrp|18791|2022|PCT|0.65|99|0.00|MS DRG 215|
20|FH_F40979_0_0|SrvcGrp|10363|2022|PDM|300.00|99|0.00|CPT CODE 99283|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PDM|801.00|99|0.00|ASPG III|
20|FH_F36720_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2004 NATIONAL LAB F/S|
20|FH_F50220_0_0|SrvcGrp|45148|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F37198_0_0|SrvcGrp|3029|2022|PCT|0.75|99|0.00|NEWBORN NURSERY|
20|FH_F149480_0_0|SrvcGrp|41563|2022|PCT|0.85|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F114207_35243_0|SrvcGrp|14947|2022|PDM|4.00|99|0.00|HOME INFUSION|
20|FH_F143347_16001_0|SrvcGrp|79864|2022|PDM|12371.00|99|0.00|ANGIOPLASTY W/STENT PLACEMENT|
20|FH_F143351_21157_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114931_0_0|SrvcGrp|105752|2022|PDM|5200.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F151744_60914_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48224_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F136299_75218_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132416_92270_0|SrvcGrp|90854|2022|PDM|779.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F120747_19129_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116684_30701_0|SrvcGrp|94736|2022|PCT|1.00|99|0.00|FLULAVAL VACC IM (>=3 YRS)|
20|FH_F82894_0_0|SrvcGrp|80284|2022|PDM|126.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F125287_92374_0|SrvcGrp|87317|2022|PDM|970.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F113563_70560_0|SrvcGrp|105055|2022|PDM|1500.00|99|0.00|DESTRUCTION BY NEUROLYTIC AGENT|
20|FH_F118879_93063_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F84411_32063_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE|
20|FH_F84274_46805_0|SrvcGrp|80619|2022|PCT|1.09|99|0.00|AETNA RADIOLOGY|
20|FH_F41535_0_0|SrvcGrp|3029|2022|PDM|220.00|99|0.00|NEWBORN NURSERY|
20|FH_F51276_0_0|SrvcGrp|17011|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F51276_0_0|SrvcGrp|24754|2022|PDM|19.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F43008_0_0|SrvcGrp|37018|2022|PDM|250.00|99|0.00|BOARDER BABY|
20|FH_F50137_0_0|SrvcGrp|46242|2022|PDM|120.00|99|0.00|HOME VISIT RESPIRATORY THERAPY CARE|
20|FH_F104520_0_0|SrvcGrp|63297|2022|PDM|90.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F94261_0_0|SrvcGrp|48385|2022|PDM|84.00|99|0.00|SPEECH THERAPY|
20|FH_F151400_0_0|SrvcGrp|98603|2022|PDM|4600.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F33120_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F120294_46322_0|SrvcGrp|23683|2022|PDM|42.00|99|0.00|SKILLED NURSING RN|
20|FH_F128190_45342_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F151526_28208_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F31398_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101021_0_0|SrvcGrp|27969|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129011_15857_0|SrvcGrp|88621|2022|PDM|130.00|99|0.00|SKILLED NURSING LPN|
20|FH_F148169_33138_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130681_15701_0|SrvcGrp|111988|2022|PCT|1.45|99|0.00|TELEPHONE SERVICES ESTABLISHED PATIENT|
20|FH_F93424_53578_0|SrvcGrp|86747|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F143834_06511_0|SrvcGrp|46903|2022|PDM|475.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F101021_0_0|SrvcGrp|48385|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F149799_33484_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122687_0_0|SrvcGrp|99171|2022|PDM|3825.00|99|0.00|CPT 28485|
20|FH_F38847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F151526_28208_0|SrvcGrp|108077|2022|PDM|4143.00|99|0.00|ARTERIOVENOUS ANASTOMOSIS|
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F118373_21205_0|SrvcGrp|107761|2022|PDM|2776.00|99|0.00|ALL IP SERVICES|
20|FH_F111826_0_0|SrvcGrp|72990|2022|PDM|880.00|99|0.00|AEG 1|
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_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|1451.18|99|0.00|ASPG III|
20|FH_F125693_92660_0|SrvcGrp|74668|2022|PDM|625.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F39886_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|58634|2022|PDM|8320.00|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F121524_87111_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37945_0_0|SrvcGrp|9984|2022|PDM|111.00|99|0.00|URGENT CARE|
20|FH_F129683_45255_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F131177_44122_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130523_04605_0|SrvcGrp|107637|2022|PCT|0.84|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F33322_0_0|SrvcGrp|14727|2022|PCT|0.90|99|0.00|TRAUMA CARE|
20|FH_F125028_19061_0|SrvcGrp|86833|2022|PDM|15.75|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F128276_66441_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F63556_0_0|SrvcGrp|33793|2022|PDM|4000.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 2 (NO REV)|
20|FH_F33672_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150820_83843_0|SrvcGrp|89981|2022|PDM|3500.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY|
20|FH_F150839_03833_0|SrvcGrp|88621|2022|PDM|135.00|99|0.00|SKILLED NURSING LPN|
20|FH_F111272_74012_0|SrvcGrp|88678|2022|PDM|1082.00|99|0.00|ACUTE REHAB I|
20|FH_F114585_11501_0|SrvcGrp|52953|2022|PDM|70.04|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F90232_15126_0|SrvcGrp|24744|2022|PDM|85.05|99|0.00|PICC LINE INSERTION|
20|FH_F36597_0_0|SrvcGrp|19963|2022|PDM|1950.00|99|0.00|LAP HERNIORRHAPY|
20|FH_F47558_0_0|SrvcGrp|40408|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD NU KE|
20|FH_F147339_08837_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 8 (NO REV)|
20|FH_F124526_05301_0|SrvcGrp|90161|2022|PDM|1252.00|99|0.00|AETNA INPATIENT DETOX (<= 17 YEARS OF AGE)|
20|FH_F44255_0_0|CSTM-ALL|CSTM-00|2020|PDM|583.00|99|0.00|ACUTE PSYCH|
20|FH_F114206_37203_0|SrvcGrp|17014|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F117574_49022_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F115982_0_0|SrvcGrp|72990|2022|PDM|420.00|99|0.00|AEG 1|
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|1794.00|99|0.00|ASPG VII|
20|FH_F134874_80120_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F67419_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F137767_01841_0|CSTM-ALL|CSTM-00|2020|PDM|4110.00|99|0.00|AEG 8 (NO REV)|
20|FH_F149273_0_0|SrvcGrp|115608|2022|PDM|5202.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F73485_0_0|SrvcGrp|48398|2022|PDM|15.00|99|0.00|PT SERVICES|
20|FH_F90817_0_0|SrvcGrp|90383|2022|PDM|7520.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F147082_02359_0|SrvcGrp|91070|2022|PDM|284.00|99|0.00|AETNA MH CRISIS INTERVENTION (HCFA)|
20|FH_F110732_31513_0|SrvcGrp|42784|2022|PDM|109.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F38986_0_0|SrvcGrp|97|2022|PDM|3643.00|99|0.00|C-SECTION|
20|FH_F47037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD KF"|
20|FH_F36485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% 2007 MEDICARE DME TN  MOD TC|
20|FH_F117574_49022_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 5  (NO REV)|
20|FH_F97620_75904_0|SrvcGrp|73485|2022|PDM|2468.00|99|0.00|AETNA REHAB|
20|FH_F124739_64429_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F94643_90501_0|SrvcGrp|95020|2022|PDM|12.50|99|0.00|AETNA HEMATOPOIETIC HORMONE INJECTION THERAPY|
20|FH_F37771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F98360_11554_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|6480.00|99|0.00|ASPG X|
20|FH_F110121_0_0|SrvcGrp|72996|2022|PDM|2415.00|99|0.00|AEG 4|
20|FH_F92454_0_0|SrvcGrp|58636|2022|PDM|7700.00|99|0.00|CPT 62362|
20|FH_F91996_33805_0|SrvcGrp|57968|2022|PDM|32.16|99|0.00|CONTINUOUS HOMECARE|
20|FH_F31087_0_0|SrvcGrp|10520|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F91953_99508_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F130328_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147379_15001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F111266_30339_0|SrvcGrp|21920|2022|PDM|30.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F40561_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F33649_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|CHILD PSYCHIATRIC|
20|FH_F94643_90501_0|SrvcGrp|86846|2022|PDM|48.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F99281_81147_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1849.00|99|0.00|AEG 8 (NO REV)|
20|FH_F90455_0_0|SrvcGrp|48394|2022|PDM|58.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F40979_0_0|SrvcGrp|10362|2022|PDM|150.00|99|0.00|CPT CODE 99282|
20|FH_F116806_0_0|SrvcGrp|107124|2022|PDM|887.26|99|0.00|REMOVAL OF SALIVARY STONE|
20|FH_F84532_0_0|SrvcGrp|82810|2022|PDM|2687.00|99|0.00|SURGICAL CARVEOUTS|
20|FH_F149522_83221_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F98360_11554_0|SrvcGrp|73603|2022|PDM|8385.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F117711_73080_0|SrvcGrp|107600|2022|PCT|1.05|99|0.00|AETNA CHEMOTHERAPY DRUGS|
20|FH_F42746_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133519_0_0|SrvcGrp|112204|2022|PDM|728.00|99|0.00|DESTRUCTION PENIS LESION|
20|FH_F134847_0_0|SrvcGrp|63472|2022|PDM|5091.00|99|0.00|CPT 64581|
20|FH_F151008_92625_0|SrvcGrp|90854|2022|PDM|1265.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)|
20|FH_F37003_0_0|CSTM-ALL|CSTM-00|2020|PDM|42.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F127464_15106_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F147200_61944_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111320_0_0|SrvcGrp|90795|2022|PDM|1200.00|99|0.00|EXCISION INFERIOR TURBINATE|
20|FH_F144831_0_0|SrvcGrp|48396|2022|PDM|14.50|99|0.00|OT SERVICES|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F112956_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F117762_0_0|SrvcGrp|95559|2022|PDM|14560.00|99|0.00|HIP JOINT|
20|FH_F151024_30024_0|SrvcGrp|75419|2022|PDM|411.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F116332_0_0|SrvcGrp|87842|2022|PDM|14551.00|99|0.00|LAPAROSCOPY - GASTRIC|
20|FH_F36683_0_0|SrvcGrp|6|2022|PDM|1968.00|99|0.00|OP SURGERY|
20|FH_F38742_0_0|SrvcGrp|10545|2022|PDM|90.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F146859_0_0|SrvcGrp|114836|2022|PDM|2320.00|99|0.00|ANKLE ARTHROSCOPY|
20|FH_F124441_0_0|SrvcGrp|107035|2022|PDM|2375.00|99|0.00|TREATMENT OF FRACTURE|
20|FH_F90817_0_0|SrvcGrp|90382|2022|PDM|2721.00|99|0.00|ANKLE ARTHROSCOPY SURGERY|
20|FH_F110121_0_0|SrvcGrp|73008|2022|PDM|1050.00|99|0.00|AEG 10|
20|FH_F149579_95815_0|SrvcGrp|115670|2022|PDM|43.13|99|0.00|THERAPEUTIC MONITORING REM ADDL 20 MINS|
20|FH_F108680_0_0|SrvcGrp|67068|2022|PDM|19800.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F36683_0_0|SrvcGrp|18798|2022|PDM|31218.00|99|0.00|MS DRG 217|
20|FH_F143533_30013_0|SrvcGrp|99740|2022|PDM|173.00|99|0.00|ULTRASOUND BREAST(S) (HCFA)|
20|FH_F143533_30013_0|SrvcGrp|76667|2022|PDM|98.00|99|0.00|CPT 76705|
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|AEG 2 (NO REV)|
20|FH_F151719_02138_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F82375_28601_0|SrvcGrp|48385|2022|PDM|135.00|99|0.00|SPEECH THERAPY|
20|FH_F49286_0_0|SrvcGrp|45325|2022|PDM|115.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F136280_54915_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119843_14103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F113563_70560_0|SrvcGrp|104935|2022|PCT|1.00|99|0.00|DRUG ADMIN|
20|FH_F38411_0_0|SrvcGrp|14264|2022|PDM|3250.00|99|0.00|ICU/CCU|
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)|
20|FH_F130659_44410_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F130914_51103_0|SrvcGrp|108484|2022|PDM|630.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F111732_33771_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F127486_06776_0|SrvcGrp|65720|2022|PDM|159.60|99|0.00|RESPITE CARE|
20|FH_F112023_12866_0|SrvcGrp|2738|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F143742_60410_0|SrvcGrp|9866|2022|PDM|2500.00|99|0.00|IP OBSERVATION SVCS|
20|FH_F145641_06902_0|SrvcGrp|96799|2022|PDM|1899.00|99|0.00|DESTROY C/TH FACET JNT ADDL|
20|FH_F130923_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F117300_0_0|SrvcGrp|41334|2022|PDM|7360.00|99|0.00|TOTAL KNEE|
20|FH_F123609_28451_0|SrvcGrp|108484|2022|PDM|631.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F134972_84117_0|SrvcGrp|88621|2022|PDM|60.75|99|0.00|SKILLED NURSING LPN|
20|FH_F85415_27612_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134331_61021_0|SrvcGrp|48398|2022|PDM|150.00|99|0.00|PT SERVICES|
20|FH_F118253_89052_0|SrvcGrp|90854|2022|PDM|1050.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F110509_71351_0|SrvcGrp|75182|2022|PCT|1.05|99|0.00|AETNA IMPLANTS|
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2844.00|99|0.00|AEG 8 (NO REV)|
20|FH_F138127_44857_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|145.53|99|0.00|HAPA WPA-NWPA 2012-13 ASC 133 W/O REV|
20|FH_F87919_01950_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F83754_0_0|SrvcGrp|12290|2022|PDM|2076.00|99|0.00|DETOXIFICATION|
20|FH_F134398_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F125181_0_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F119379_0_0|SrvcGrp|107828|2022|PDM|1428.00|99|0.00|REMOVE WRIST JOINT CARTILAGE|
20|FH_F138507_62208_0|SrvcGrp|88621|2022|PDM|97.85|99|0.00|SKILLED NURSING LPN|
20|FH_F85353_16407_0|SrvcGrp|63808|2022|PDM|615.53|99|0.00|HAPA WPA-NWPA 2012-13 ASC 202|
20|FH_F133585_0_0|SrvcGrp|107884|2022|PDM|2852.00|99|0.00|TRLUML BALO ANGIOP 1ST ART|
20|FH_F146399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71647_0_0|SrvcGrp|473|2022|PDM|335.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F51559_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F125260_0_0|SrvcGrp|26160|2022|PDM|83.69|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F89335_64628_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145641_06902_0|SrvcGrp|11673|2022|PDM|5433.00|99|0.00|CPT 29888|
20|FH_F141347_52807_0|SrvcGrp|73842|2022|PDM|301.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F145641_06902_0|SrvcGrp|114243|2022|PDM|3697.00|99|0.00|SUBTALAR ARTHRO W/DEB|
20|FH_F110309_63301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.55|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1001 W/O REV|
20|FH_F70863_0_0|SrvcGrp|10648|2022|PDM|7.00|99|0.00|HOME INFUSION|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1401.92|99|0.00|HAPA WPA-NWPA 2012-13 ASC 901 W/O REV|
20|FH_F81037_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134611_04103_0|SrvcGrp|89337|2022|PDM|2474.50|99|0.00|DETOXIFICATION|
20|FH_F112631_0_0|SrvcGrp|72996|2022|PDM|727.00|99|0.00|AEG 4|
20|FH_F81861_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.45|99|0.00|RAD - SOUTHWOODS 100%|
20|FH_F133972_27103_0|SrvcGrp|86830|2022|PDM|4.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|AEG 3 (NO REV)|
20|FH_F113435_19027_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F70804_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F127900_63080_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116657_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139722_30022_0|SrvcGrp|92501|2022|PDM|452.08|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F110470_98335_0|SrvcGrp|90572|2022|PDM|120.00|99|0.00|INTENSIVE OP PSYCH (HCFA)|
20|FH_F149265_64429_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F76146_0_0|SrvcGrp|68186|2022|PDM|781.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 2|
20|FH_F122942_89512_0|SrvcGrp|58509|2022|PDM|500.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F132827_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138951_41101_0|SrvcGrp|86852|2022|PDM|40.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F114510_33445_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F124369_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F50703_0_0|SrvcGrp|27601|2022|PDM|943.38|99|0.00|SYNAGIS (50 MG)|
20|FH_F145555_72204_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F145641_06902_0|SrvcGrp|88600|2022|PDM|2698.00|99|0.00|WRIST ARTHROS DIAG W/WO BIO|
20|FH_F146590_77449_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|303.70|99|0.00|HAPA WPA-NWPA 2012-13 ASC 407 W/O REV|
20|FH_F119783_46360_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F121225_98902_0|SrvcGrp|75505|2022|PCT|0.85|99|0.00|CARDIAC STUDIES|
20|FH_F145708_89030_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F150599_0_0|CSTM-ALL|CSTM-00|2020|PDM|676.00|99|0.00|AEG 2 (NO REV)|
20|FH_F85353_16407_0|SrvcGrp|12290|2022|PDM|1302.00|99|0.00|DETOXIFICATION|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|416.15|99|0.00|HAPA WPA-NWPA 2012-13 ASC 404 W/O REV|
20|FH_F149345_45044_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84132_48026_0|SrvcGrp|73006|2022|PDM|1911.00|99|0.00|AEG 9|
20|FH_F89680_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.87|99|0.00|GENERAL ACUTE CARE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|78.80|99|0.00|HAPA WPA-NWPA 2012-13 ASC 144 W/O REV|
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|1171.00|99|0.00|ASPG V|
20|FH_F122551_75605_0|SrvcGrp|89337|2022|PDM|906.00|99|0.00|DETOXIFICATION|
20|FH_F84712_0_0|SrvcGrp|72992|2022|PDM|2177.00|99|0.00|AEG 2|
20|FH_F84712_0_0|SrvcGrp|79298|2022|PDM|59.00|99|0.00|AETNA X-RAY (CPT 77055)|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|140.43|99|0.00|HAPA WPA-NWPA 2012-13 ASC 237 W/O REV|
20|FH_F70684_0_0|SrvcGrp|43567|2022|PDM|105.45|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F71964_0_0|SrvcGrp|68866|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F74583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102200_06416_0|SrvcGrp|26869|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F120811_53525_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F125440_04043_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F115952_44484_0|SrvcGrp|86749|2022|PCT|1.05|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F133494_90023_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F87463_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134087_0_0|SrvcGrp|41335|2022|PDM|10455.00|99|0.00|TOTAL HIP|
20|FH_F33389_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F133536_0_0|SrvcGrp|112379|2022|PDM|1250.00|99|0.00|OP SURGERY|
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|834.00|99|0.00|AEG 5  (NO REV)|
20|FH_F49895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49895_0_0|SrvcGrp|31188|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC (DME)|
20|FH_F126730_84737_0|SrvcGrp|87131|2022|PDM|368.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F131321_38135_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139515_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F74227_0_0|SrvcGrp|3165|2022|PDM|450.00|99|0.00|EMERGENCY ROOM|
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|701.00|99|0.00|AEG 2 (NO REV)|
20|FH_F151400_0_0|SrvcGrp|87119|2022|PDM|4600.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F123627_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F112708_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F128272_60640_0|SrvcGrp|21920|2022|PDM|50.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F72746_0_0|SrvcGrp|22954|2022|PDM|158.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F87538_0_0|SrvcGrp|46390|2022|PDM|108.00|99|0.00|PHYSICAL THERAPY SVCS INITIAL EVAL|
20|FH_F129115_85716_0|SrvcGrp|75442|2022|PDM|803.00|99|0.00|OBSERVATION - REV 762|
20|FH_F141795_89509_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F42736_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F130138_02915_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F40063_0_0|SrvcGrp|15858|2022|PDM|12189.00|99|0.00|KYPHOPLASTY/VERTEBROPLASTY|
20|FH_F60072_0_0|SrvcGrp|3066|2022|PCT|0.60|99|0.00|HIGH-COST DRUGS|
20|FH_F111288_0_0|SrvcGrp|106265|2022|PDM|4199.00|99|0.00|NSL/SINS NDSC TOTAL|
20|FH_F151780_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F83352_06114_0|SrvcGrp|29347|2022|PDM|15.75|99|0.00|HOME HEALTH AIDE|
20|FH_F129768_0_0|SrvcGrp|111418|2022|PDM|160.00|99|0.00|SURGERY|
20|FH_F151525_30349_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90818_0_0|SrvcGrp|33967|2022|PDM|4600.00|99|0.00|CPT 47562|
20|FH_F145544_93536_0|SrvcGrp|108484|2022|PDM|1200.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F129653_0_0|SrvcGrp|103592|2022|PDM|4000.00|99|0.00|VERTEBRAL ART|
20|FH_F143973_28040_0|SrvcGrp|46903|2022|PDM|640.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F70984_0_0|CSTM-ALL|CSTM-00|2020|PDM|1076.00|99|0.00|COVENTRY ENHANCED GROUPER 4 GA NO CRESCENT|
20|FH_F137457_32216_0|SrvcGrp|46903|2022|PDM|793.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|636.46|99|0.00|HAPA WPA-NWPA 2012-13 ASC 402 W/O REV|
20|FH_F122687_0_0|SrvcGrp|82720|2022|PDM|1475.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F125028_19061_0|SrvcGrp|22593|2022|PDM|63.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F125927_75093_0|SrvcGrp|705|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F88451_0_0|SrvcGrp|24029|2022|PDM|35.00|99|0.00|RN HOURLY|
20|FH_F87254_0_0|SrvcGrp|72992|2022|PDM|693.00|99|0.00|AEG 2|
20|FH_F113410_0_0|SrvcGrp|65625|2022|PDM|1891.00|99|0.00|CPT 30520|
20|FH_F148260_0_0|SrvcGrp|41547|2022|PDM|15259.00|99|0.00|OP LAPAROSCOPIC HYSTERECTOMY|
20|FH_F130850_67401_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F148341_21222_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F135221_62691_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141410_13045_0|SrvcGrp|111929|2022|PDM|7.70|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F76303_0_0|SrvcGrp|73523|2022|PDM|18.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F151562_26003_0|SrvcGrp|104228|2022|PDM|103.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F121535_60018_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F143968_94520_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F141791_22572_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143783_0_0|SrvcGrp|89781|2022|PDM|105.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F150982_0_0|SrvcGrp|55071|2022|PDM|3303.00|99|0.00|ARTHROSCOPY SHOULDER|
20|FH_F116093_47327_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F39349_0_0|SrvcGrp|110|2022|PDM|505.00|99|0.00|CD - REHABILITATION|
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|330.77|99|0.00|ASPG I|
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118079_37642_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F123384_72076_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130134_08724_0|SrvcGrp|111490|2022|PDM|500.00|99|0.00|IP DETOXIFICATION SERVICES (18-99 YRS)|
20|FH_F135006_63353_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115047_78526_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F78162_0_0|SrvcGrp|73362|2022|PCT|1.10|99|0.00|VACCINE SERVICES|
20|FH_F143903_06249_0|SrvcGrp|58509|2022|PDM|300.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|2941.00|99|0.00|AEG 10 (NO REV)|
20|FH_F40193_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.30|99|0.00|OP SVCS|
20|FH_F117440_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F110102_0_0|SrvcGrp|104232|2022|PDM|150.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F143894_70001_0|SrvcGrp|113190|2022|PCT|0.00|99|0.00|DIALYSIS (TOB)|
20|FH_F132675_53154_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116327_75701_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F127550_43026_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F66222_0_0|SrvcGrp|42870|2022|PDM|229.36|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F135236_02840_0|SrvcGrp|111475|2022|PDM|2119.90|99|0.00|TRAUMA TEAM LEVEL 1|
20|FH_F149740_33912_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F128139_62650_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72842_0_0|SrvcGrp|30623|2022|PDM|11790.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F150761_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114916_30309_0|SrvcGrp|33986|2022|PDM|900.00|99|0.00|CPT 26055|
20|FH_F72830_0_0|SrvcGrp|13811|2022|PDM|263.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|415.09|99|0.00|ASPG I|
20|FH_F133215_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F38090_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F125210_32901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
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_F149879_80045_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34438_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.00|99|0.00|AEG 2 (NO REV)|
20|FH_F93171_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F72830_0_0|SrvcGrp|4109|2022|PDM|1000.00|99|0.00|ACUTE PSYCH|
20|FH_F38982_0_0|SrvcGrp|16|2022|PDM|881.00|99|0.00|ACUTE REHABILITATION|
20|FH_F90798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135235_01830_0|SrvcGrp|73605|2022|PDM|1199.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F72183_0_0|CSTM-ALL|CSTM-00|2020|PDM|2305.00|99|0.00|ASPG VI - FH SW CUSTOM GROUPERS|
20|FH_F149759_63122_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F128139_62650_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121427_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F88704_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148254_89503_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F125011_74467_0|CSTM-ALL|CSTM-00|2020|PDM|1725.00|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_F122687_0_0|SrvcGrp|98003|2022|PDM|3825.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F148600_30328_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37191_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|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|576.00|99|0.00|AEG 1 (NO REV)|
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)|
20|FH_F130678_50220_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130715_98503_0|SrvcGrp|89337|2022|PDM|1300.00|99|0.00|DETOXIFICATION|
20|FH_F39493_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F146124_06112_0|SrvcGrp|114462|2022|PCT|1.00|99|0.00|CHEMO DRUGS|
20|FH_F96201_01824_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F113345_25301_0|SrvcGrp|75505|2022|PCT|0.70|99|0.00|CARDIAC STUDIES|
20|FH_F125133_20601_0|SrvcGrp|48385|2022|PDM|180.00|99|0.00|SPEECH THERAPY|
20|FH_F127579_44321_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|11669.00|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F63312_0_0|SrvcGrp|14081|2022|PDM|85.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F134607_80222_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133868_40202_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F100782_0_0|SrvcGrp|105094|2022|PDM|276.53|99|0.00|WINDBER MEDICAL CNTR ASC 139|
20|FH_F79623_0_0|SrvcGrp|72996|2022|PDM|4404.00|99|0.00|AEG 4|
20|FH_F90501_71101_0|SrvcGrp|79420|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F101041_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F121476_0_0|SrvcGrp|84121|2022|PDM|3286.00|99|0.00|OCULAR IMPLANTS|
20|FH_F142376_0_0|SrvcGrp|62287|2022|PDM|1159.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F50334_0_0|SrvcGrp|46549|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE|
20|FH_F125515_0_0|SrvcGrp|82981|2022|PDM|135.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F120549_19087_0|SrvcGrp|108522|2022|PCT|1.08|99|0.00|AETNA - FERTILITY PARTNER OF PA SURG CTR LLC|
20|FH_F87775_15106_0|SrvcGrp|29346|2022|PDM|26.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F110589_70809_0|SrvcGrp|89149|2022|PDM|234.00|99|0.00|OP INTENSIVE|
20|FH_F132609_0_0|SrvcGrp|12280|2022|PCT|0.67|99|0.00|IMPLANTS|
20|FH_F89358_64735_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F95631_33705_0|SrvcGrp|73485|2022|PDM|2931.00|99|0.00|AETNA REHAB|
20|FH_F129509_0_0|SrvcGrp|67068|2022|PDM|5125.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F145641_06902_0|SrvcGrp|100009|2022|PDM|2358.00|99|0.00|REPAIR/GRAFT WRIST BONE|
20|FH_F117245_0_0|SrvcGrp|73002|2022|PDM|1642.00|99|0.00|AEG 7|
20|FH_F81483_0_0|SrvcGrp|40305|2022|PDM|1029.00|99|0.00|CVTY ENHANCED ASPG 3|
20|FH_F126194_61111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F75087_0_0|SrvcGrp|27402|2022|PDM|2700.00|99|0.00|LASER PROCEDURES|
20|FH_F142376_0_0|SrvcGrp|113975|2022|PDM|1100.00|99|0.00|NJX INTERLAMINAR LMBR/SAC|
20|FH_F117206_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142376_0_0|SrvcGrp|101281|2022|PDM|7405.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F128833_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149265_64429_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119763_17402_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145781_0_0|SrvcGrp|114307|2022|PDM|1150.00|99|0.00|XCAPSL CTRC REMVL W/O ECP|
20|FH_F83380_0_0|SrvcGrp|44707|2022|PDM|105.00|99|0.00|NURSING CARE|
20|FH_F119379_0_0|SrvcGrp|107834|2022|PDM|1428.00|99|0.00|REPAIR OF HAND OR FOOT NERVE|
20|FH_F92641_34994_0|SrvcGrp|471|2022|PDM|446.25|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130327_03867_0|SrvcGrp|43567|2022|PDM|157.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F149241_30161_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134359_36904_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120719_27540_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|AEG 10 (NO REV)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1371.10|99|0.00|HAPA WPA-NWPA 2012-13 ASC 904 W/O REV|
20|FH_F110346_38501_0|SrvcGrp|86648|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F111030_05641_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133749_84604_0|SrvcGrp|112459|2022|PDM|50.00|99|0.00|MID-LINE INSERTION (HCFA)|
20|FH_F63114_0_0|SrvcGrp|48396|2022|PDM|30.00|99|0.00|OT SERVICES|
20|FH_F125124_0_0|SrvcGrp|72994|2022|PDM|549.00|99|0.00|AEG 3|
20|FH_F73125_0_0|SrvcGrp|48398|2022|PDM|12.00|99|0.00|PT SERVICES|
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 5  (NO REV)|
20|FH_F117206_0_0|SrvcGrp|67066|2022|PDM|4326.00|99|0.00|CERVICAL SURGERY|
20|FH_F117206_0_0|SrvcGrp|104449|2022|PDM|1500.00|99|0.00|CYSTOURETHRO W/ IMPLANT|
20|FH_F132965_60459_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134217_46725_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111027_32817_0|SrvcGrp|73841|2022|PDM|484.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138908_84010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149027_60402_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F38227_0_0|SrvcGrp|47995|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SERVICES VISIT|
20|FH_F145641_06902_0|SrvcGrp|116097|2022|PDM|15000.00|99|0.00|TRML DSTRJ IOS BVN 1ST 2 L/S|
20|FH_F83754_0_0|SrvcGrp|37260|2022|PDM|16588.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F109242_18466_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130166_65065_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F134191_75025_0|SrvcGrp|112536|2022|PDM|51.31|99|0.00|COVID-19 SEVERE ACUTE RESPIRATORY SYNDROME|
20|FH_F134249_05060_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|AETNA IP MCARE2 OCN F/S PRICING|
20|FH_F148862_85390_0|SrvcGrp|75419|2022|PDM|721.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F90356_63011_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126341_27284_0|SrvcGrp|86133|2022|PDM|1.58|99|0.00|AETNA ANTI INHIBITOR|
20|FH_F112023_12866_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145642_15108_0|SrvcGrp|86854|2022|PDM|30.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F121303_15501_0|SrvcGrp|113179|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN - JANSSEN|
20|FH_F138259_36606_0|SrvcGrp|92761|2022|PCT|0.80|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122520_46383_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F80185_0_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F101100_50314_0|SrvcGrp|97910|2022|PDM|6678.00|99|0.00|LAPAROSCOPY ILEOSTOMY OR JEJUNOSTOMY|
20|FH_F102200_06416_0|SrvcGrp|86831|2022|PDM|10.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F105143_26062_0|SrvcGrp|72998|2022|PDM|7133.00|99|0.00|AEG 5|
20|FH_F146522_74133_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131904_18915_0|SrvcGrp|73742|2022|PDM|10.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F133398_43204_0|SrvcGrp|3178|2022|PDM|623.00|99|0.00|ACUTE PSYCH|
20|FH_F133153_44113_0|SrvcGrp|89149|2022|PDM|171.00|99|0.00|OP INTENSIVE|
20|FH_F131702_17022_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111604_16505_0|SrvcGrp|86723|2022|PDM|330.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F134828_30531_0|SrvcGrp|89233|2022|PDM|31.00|99|0.00|X-RAY EXAM OF ANKLE|
20|FH_F134368_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151142_35406_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151222_72958_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121962_75009_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113926_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|1761.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PDM|1289.00|99|0.00|AEG 3 (NO REV)|
20|FH_F88456_0_0|SrvcGrp|37317|2022|PDM|4481.00|99|0.00|LITHOTRIPSY|
20|FH_F142312_62301_0|SrvcGrp|75419|2022|PDM|300.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F115208_0_0|SrvcGrp|106183|2022|PDM|2546.00|99|0.00|REPAIR EARDRUM STRUCTURES|
20|FH_F130400_26505_0|SrvcGrp|111483|2022|PCT|1.50|99|0.00|CHEMOTHERAPY AND ALL OTHER DRUGS|
20|FH_F42744_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F92411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129011_15857_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|HOSPICE GENERAL INPATIENT CARE (HCFA)|
20|FH_F127550_43026_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|369.73|99|0.00|HAPA WPA-NWPA 2012-13 ASC 215 W/O REV|
20|FH_F151524_84121_0|SrvcGrp|108484|2022|PDM|482.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F125011_74467_0|SrvcGrp|110017|2022|PDM|2325.00|99|0.00|RENAL DIALYSIS|
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|AEG 3 (NO REV)|
20|FH_F32283_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F40046_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F66422_0_0|SrvcGrp|44106|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F131190_21042_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F141517_73034_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148184_29527_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|572.84|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1202 W/O REV|
20|FH_F139274_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F88864_29601_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F45632_0_0|SrvcGrp|41495|2022|PDM|57.00|99|0.00|PT SVCS|
20|FH_F129782_0_0|SrvcGrp|114518|2022|PCT|1.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F129656_15005_0|SrvcGrp|22589|2022|PDM|50.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F93881_15009_0|SrvcGrp|13990|2022|PCT|0.40|99|0.00|PACEMAKER|
20|FH_F115685_64064_0|SrvcGrp|86838|2022|PDM|20.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F85291_0_0|SrvcGrp|471|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F140762_0_0|SrvcGrp|12491|2022|PCT|0.52|99|0.00|PACEMAKER|
20|FH_F135236_02840_0|SrvcGrp|82137|2022|PCT|1.01|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F128906_48423_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F97500_32025_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F141367_57104_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123466_93420_0|SrvcGrp|89412|2022|PDM|457.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F148420_33437_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F141587_40242_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F116327_75701_0|SrvcGrp|73841|2022|PDM|324.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F48215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101021_0_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F149862_76051_0|SrvcGrp|74668|2022|PDM|166.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F145550_62034_0|SrvcGrp|104842|2022|PDM|660.00|99|0.00|HOSPICE CARE PROVIDED IP HOSPICE FAC (HCFA)|
20|FH_F148704_66219_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F151224_85301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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_F69651_0_0|SrvcGrp|10538|2022|PDM|27.50|99|0.00|NURSING CARE|
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)|
20|FH_F111840_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F139300_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113130_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103780_64804_0|SrvcGrp|71383|2022|PCT|0.68|99|0.00|ANGIOPLASTY|
20|FH_F119581_0_0|SrvcGrp|108194|2022|PDM|1273.00|99|0.00|INSERT TUN IP CATH PERC|
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1578.00|99|0.00|AEG 9 (NO REV)|
20|FH_F43860_0_0|SrvcGrp|27725|2022|PDM|40.00|99|0.00|SKILLED RN HOURLY|
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PDM|794.66|99|0.00|ASPG X|
20|FH_F143898_0_0|SrvcGrp|57968|2022|PDM|28.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F132275_0_0|SrvcGrp|82981|2022|PDM|158.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F132988_0_0|SrvcGrp|88159|2022|PDM|4493.01|99|0.00|LOW BACK DISK SURGERY|
20|FH_F132988_0_0|SrvcGrp|67074|2022|PDM|4493.01|99|0.00|AC SURGERY|
20|FH_F132988_0_0|SrvcGrp|112161|2022|PDM|1279.81|99|0.00|NERVE DECOMPRESSION|
20|FH_F141353_26452_0|SrvcGrp|73606|2022|PDM|325.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F124180_0_0|SrvcGrp|72998|2022|PDM|2495.00|99|0.00|AEG 5|
20|FH_F122198_20708_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F146882_84532_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F38233_0_0|SrvcGrp|26253|2022|PDM|29.00|99|0.00|LIPIDS|
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_F124624_31792_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127995_84010_0|SrvcGrp|48385|2022|PDM|82.50|99|0.00|SPEECH THERAPY|
20|FH_F114666_30342_0|SrvcGrp|88157|2022|PDM|18000.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F113845_32746_0|SrvcGrp|105425|2022|PDM|56.33|99|0.00|AETNA EXPOSURE ADAPTIVE BH TREATMENT 60 MINS|
20|FH_F139556_85006_0|SrvcGrp|38246|2022|PCT|1.89|99|0.00|SLEEP STUDIES|
20|FH_F139771_54534_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1499.00|99|0.00|AEG 5  (NO REV)|
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_F122641_72365_0|SrvcGrp|73339|2022|PCT|0.90|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134687_14226_0|SrvcGrp|473|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F134694_94945_0|SrvcGrp|87317|2022|PDM|1500.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F135763_20678_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136813_06518_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136824_08034_0|SrvcGrp|87441|2022|PDM|898.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F136830_22003_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F113713_17013_0|SrvcGrp|105562|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F42169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|ASPG VI|
20|FH_F115631_65201_0|SrvcGrp|98347|2022|PDM|3177.00|99|0.00|HIP ARTHROSCOPY / SURGERY|
20|FH_F147440_71334_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147586_44124_0|SrvcGrp|115111|2022|PDM|16500.00|99|0.00|HIP ARTHROPLAST|
20|FH_F117820_0_0|SrvcGrp|90478|2022|PDM|82.34|99|0.00|HOSPICE|
20|FH_F82357_0_0|SrvcGrp|9830|2022|PDM|50.00|99|0.00|OT SVCS|
20|FH_F120683_80238_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F47356_0_0|CSTM-ALL|CSTM-00|2020|PDM|155.00|99|0.00|OP SVCS|
20|FH_F54552_0_0|SrvcGrp|41460|2022|PDM|20.00|99|0.00|ENTERAL THERAPY - UNSPECIFIED|
20|FH_F113585_20155_0|SrvcGrp|88620|2022|PDM|125.00|99|0.00|SKILLED NURSING RN|
20|FH_F138936_01040_0|SrvcGrp|112727|2022|PCT|1.00|99|0.00|COVID-19 IA NFCT AB SARS COV 2|
20|FH_F92474_0_0|SrvcGrp|114519|2022|PDM|1050.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F151420_60654_0|SrvcGrp|42472|2022|PDM|3160.00|99|0.00|CPT 58670|
20|FH_F151501_30265_0|SrvcGrp|12664|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F151501_30265_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 4 (NO REV)|
20|FH_F151503_30067_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F151516_63023_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F132258_45404_0|SrvcGrp|86853|2022|PDM|34.98|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F132258_45404_0|SrvcGrp|29076|2022|PDM|34.98|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F132262_60062_0|SrvcGrp|23587|2022|PDM|785.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F144928_02703_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40073_0_0|SrvcGrp|17071|2022|PCT|0.70|99|0.00|ASPG IV|
20|FH_F135427_19610_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F135438_29030_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135583_17331_0|SrvcGrp|81779|2022|PCT|0.82|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F97141_93933_0|CSTM-ALL|CSTM-00|2020|PCT|0.38|99|0.00|OP SVCS|
20|FH_F136074_67206_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F116431_76104_0|SrvcGrp|1943|2022|PDM|1311.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F126305_0_0|SrvcGrp|87077|2022|PDM|133.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F127399_0_0|SrvcGrp|27261|2022|PDM|14045.00|99|0.00|CPT 27446|
20|FH_F140629_0_0|SrvcGrp|109132|2022|PDM|2497.00|99|0.00|ARTHROSCOPIC FRACTURE TX|
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1712.00|99|0.00|AEG 7 (NO REV)|
20|FH_F101644_75116_0|SrvcGrp|106130|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149271_0_0|SrvcGrp|87077|2022|PDM|240.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F129329_07039_0|SrvcGrp|73841|2022|PDM|345.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F148243_0_0|SrvcGrp|88487|2022|PDM|3000.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F32929_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101442_0_0|SrvcGrp|98465|2022|PDM|1178.85|99|0.00|OPEN TXMT METATARSOPHALANGEAL|
20|FH_F114569_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F128695_50049_0|SrvcGrp|46605|2022|PDM|140.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F129240_10028_0|SrvcGrp|86122|2022|PCT|0.68|99|0.00|AETNA GAMMAGARD LIQUID INJ|
20|FH_F129220_18445_0|SrvcGrp|98040|2022|PDM|18.78|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F101557_81004_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F102960_50613_0|SrvcGrp|10365|2022|PDM|1905.00|99|0.00|CPT CODE 99285|
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_F148120_22903_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148079_06512_0|SrvcGrp|66265|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F118882_30012_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118792_63379_0|SrvcGrp|109057|2022|PCT|0.74|99|0.00|CARDIAC STUDIES|
20|FH_F39028_0_0|SrvcGrp|30132|2022|PCT|1.00|99|0.00|TPN B-CODES|
20|FH_F51276_0_0|SrvcGrp|19742|2022|PDM|115.00|99|0.00|MID-LINE INSERTION|
20|FH_F39266_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39967_0_0|SrvcGrp|12674|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F98625_08103_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F39140_0_0|SrvcGrp|13640|2022|PDM|110.00|99|0.00|CPT 99202|
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|763.00|99|0.00|AEG 10 (NO REV)|
20|FH_F102844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F86851_0_0|SrvcGrp|84971|2022|PDM|520.00|99|0.00|CPT 43245|
20|FH_F88492_70601_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F46832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|HOME INFUSION (TOTAL PARENTERAL NUTRITION)|
20|FH_F123595_70546_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F107200_0_0|SrvcGrp|101524|2022|PDM|1665.00|99|0.00|MISSED ABORTION SECOND TRIMESTER|
20|FH_F136368_62711_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136478_75605_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F134126_11554_0|SrvcGrp|11283|2022|PDM|1377.00|99|0.00|HYPERBARIC CHAMBER|
20|FH_F136952_78218_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136967_63877_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137036_60504_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F142273_51012_0|SrvcGrp|537|2022|PCT|0.84|99|0.00|OBSERVATION SERVICES|
20|FH_F142307_74066_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142548_66614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83831_0_0|SrvcGrp|9829|2022|PDM|99.00|99|0.00|PT SVCS|
20|FH_F97602_40121_0|SrvcGrp|73659|2022|PDM|7919.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F138607_02760_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F140332_19041_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119435_0_0|SrvcGrp|68546|2022|PDM|2212.00|99|0.00|CPT 36558|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER TC|
20|FH_F143898_0_0|SrvcGrp|33722|2022|PDM|36.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F94786_07974_0|SrvcGrp|86838|2022|PDM|15.75|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F132988_0_0|SrvcGrp|34603|2022|PDM|4493.01|99|0.00|CPT 24341|
20|FH_F133002_0_0|SrvcGrp|72996|2022|PDM|792.00|99|0.00|AEG 4|
20|FH_F133529_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F88933_0_0|SrvcGrp|3932|2022|PDM|3377.00|99|0.00|LITHOTRIPSY|
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141336_16947_0|CSTM-ALL|CSTM-00|2020|PDM|1496.00|99|0.00|AEG 4 (NO REV)|
20|FH_F140500_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146937_27609_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41035_0_0|SrvcGrp|73006|2022|PDM|1129.00|99|0.00|AEG 9|
20|FH_F92493_0_0|SrvcGrp|76604|2022|PDM|3119.66|99|0.00|CPT 25447|
20|FH_F98380_43055_0|SrvcGrp|73643|2022|PDM|727.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F127995_84010_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F100787_69162_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F136570_32084_0|SrvcGrp|73841|2022|PDM|325.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138055_16146_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139771_54534_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139771_54534_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122832_61938_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F134791_98034_0|SrvcGrp|53987|2022|PCT|0.00|99|0.00|PHOTOTHERAPY|
20|FH_F136830_22003_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|ASPG VII|
20|FH_F115708_15317_0|SrvcGrp|471|2022|PDM|675.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F115733_33012_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F147389_81632_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F41463_0_0|SrvcGrp|29677|2022|PDM|126.00|99|0.00|HOME INFUSION NURSING SVCS MOD SD|
20|FH_F68322_0_0|SrvcGrp|17065|2022|PDM|585.00|99|0.00|ASPG I|
20|FH_F94101_0_0|CSTM-ALL|CSTM-00|2020|PCT|52.00|99|0.00|OP SVCS|
20|FH_F133536_0_0|SrvcGrp|98404|2022|PDM|3215.00|99|0.00|ARTHROSCOPIC FRACTURE TX|
20|FH_F98361_12065_0|SrvcGrp|73659|2022|PDM|7841.00|99|0.00|AETNA MED & SURG SVCS|
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|95103|2022|PDM|48.00|99|0.00|LASER SURGERY|
20|FH_F37257_0_0|SrvcGrp|147|2022|PCT|0.70|99|0.00|HOME HEALTH CARE|
20|FH_F72445_0_0|SrvcGrp|14372|2022|PDM|27.00|99|0.00|AMBULATORY INFUSION PUMP|
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|2133.00|99|0.00|AEG 4 (NO REV)|
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F42942_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138680_53005_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138787_32258_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F138907_01040_0|SrvcGrp|27968|2022|PDM|47.76|99|0.00|SKILLED NURSING LPN|
20|FH_F57953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53|
20|FH_F101388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|308.79|99|0.00|HAPA WPA-NWPA 2012-13 ASC 227 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.28|99|0.00|HAPA WPA-NWPA 2012-13 ASC 132 W/O REV|
20|FH_F151304_31520_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|AEG 3 (NO REV)|
20|FH_F151321_92626_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F122088_75098_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97501_31501_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F135376_83440_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135507_02859_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136180_92253_0|SrvcGrp|87317|2022|PDM|1500.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F100880_67735_0|SrvcGrp|3208|2022|PDM|1742.00|99|0.00|SUBACUTE CARE|
20|FH_F130620_18940_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116397_33404_0|SrvcGrp|90340|2022|PDM|68.00|99|0.00|SKILLED NURSING LPN|
20|FH_F116397_33404_0|SrvcGrp|106790|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ. DRUGS|
20|FH_F116431_76104_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F116464_13088_0|SrvcGrp|89337|2022|PDM|607.00|99|0.00|DETOXIFICATION|
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 4 (NO REV)|
20|FH_F127399_0_0|SrvcGrp|83835|2022|PDM|2913.00|99|0.00|REPLACE TISSUE EXPANDER|
20|FH_F121761_44130_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121761_44130_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121763_07202_0|SrvcGrp|72984|2022|PCT|8.78|99|0.00|CHEMOTHERAPY|
20|FH_F129329_07039_0|SrvcGrp|89268|2022|PCT|1.20|99|0.00|AETNA INITIAPSYCH DIAGNOSTIC EVALUATION|
20|FH_F111292_33136_0|SrvcGrp|110428|2022|PCT|0.86|99|0.00|LABORATORY SERVICES|
20|FH_F111301_33122_0|SrvcGrp|82765|2022|PDM|59.00|99|0.00|ELECTROLYTE PANEL|
20|FH_F134290_67209_0|SrvcGrp|46903|2022|PDM|568.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F141651_0_0|SrvcGrp|106265|2022|PDM|2200.00|99|0.00|NSL/SINS NDSC TOTAL|
20|FH_F47906_0_0|SrvcGrp|29958|2022|PCT|1.00|99|0.00|DME MOD KF|
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG III|
20|FH_F33688_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|807.00|99|0.00|AEG 1 (NO REV)|
20|FH_F105421_0_0|SrvcGrp|9811|2022|PDM|650.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F96340_23704_0|SrvcGrp|93919|2022|PDM|492.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F102228_08846_0|SrvcGrp|75759|2022|PDM|508.00|99|0.00|AMBULATORY DETOX REHAB|
20|FH_F140844_48083_0|SrvcGrp|53145|2022|PDM|129.00|99|0.00|SOCIAL WORKER|
20|FH_F80284_16354_0|SrvcGrp|64112|2022|PDM|143.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 15|
20|FH_F149530_80014_0|SrvcGrp|108484|2022|PDM|650.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F39466_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F129838_17555_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F109884_36117_0|SrvcGrp|86753|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F147928_11751_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117219_77515_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F137333_51012_0|SrvcGrp|89417|2022|PDM|406.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F137815_15501_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F110308_0_0|SrvcGrp|73006|2022|PDM|900.00|99|0.00|AEG 9|
20|FH_F112452_0_0|CSTM-ALL|CSTM-00|2020|PDM|581.00|99|0.00|AEG 2 (NO REV)|
20|FH_F124893_40311_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F138732_60016_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F95880_02726_0|SrvcGrp|472|2022|PDM|439.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132212_0_0|SrvcGrp|93098|2022|PDM|90.00|99|0.00|HOSPICE CARE|
20|FH_F119495_34711_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F119500_01570_0|SrvcGrp|76501|2022|PDM|317.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F138283_0_0|SrvcGrp|43955|2022|PDM|112.00|99|0.00|NURSING CARE|
20|FH_F148419_01453_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148432_01585_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F148554_85016_0|SrvcGrp|115458|2022|PDM|3641.00|99|0.00|REMOVE & REPLACE PULSE GEN 1 LEAD|
20|FH_F124983_44514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126626_80906_0|SrvcGrp|3178|2022|PDM|1101.00|99|0.00|ACUTE PSYCH|
20|FH_F100784_59923_0|SrvcGrp|90854|2022|PDM|3668.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1511.00|99|0.00|AEG 5  (NO REV)|
20|FH_F118674_29036_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|100% 2007 MEDICARE TN DME MOD 26|
20|FH_F125467_67206_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F62802_0_0|SrvcGrp|13297|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133049_19145_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F43241_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F116324_0_0|SrvcGrp|75481|2022|PDM|550.00|99|0.00|AEG 2|
20|FH_F114310_0_0|SrvcGrp|59841|2022|PDM|1275.00|99|0.00|SUBMUCOUS RESECTION|
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_F114310_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F147800_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F117009_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F40599_0_0|CSTM-ALL|CSTM-00|2020|PDM|1185.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118456_30012_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F145988_06105_0|SrvcGrp|112125|2022|PCT|1.47|99|0.00|COVID-19 SPECIMEN COLLECTING FROM HOSPITAL OP CLINIC|
20|FH_F38352_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F115329_79424_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F118462_21740_0|SrvcGrp|471|2022|PDM|808.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F80362_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114024_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F148556_13206_0|SrvcGrp|22590|2022|PDM|35.00|99|0.00|PAIN MANAGAMENT - INTERMITTENT|
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|4838.00|99|0.00|AEG 6 (NO REV)|
20|FH_F127994_19301_0|SrvcGrp|90644|2022|PDM|25.00|99|0.00|AETNA MEDICATION ASSISTED TRTMT MAINTENANCE INJECTION (HCFA)|
20|FH_F38410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123096_28210_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F117909_92405_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F40297_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115312_78550_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F38700_0_0|SrvcGrp|18143|2022|PCT|0.80|99|0.00|MS DRG 247|
20|FH_F111423_34952_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 3 (NO REV)|
20|FH_F117816_0_0|SrvcGrp|92502|2022|PDM|573.47|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F127284_84403_0|SrvcGrp|75419|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F132900_06074_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F79902_0_0|CSTM-ALL|CSTM-00|2020|PDM|2152.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|UNCLASSIFIED HOME INJECTABLES|
20|FH_F150905_01608_0|SrvcGrp|115855|2022|PDM|21.07|99|0.00|PEER SERVICE (15 MINS) (0-21 YRS)|
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|2399.00|99|0.00|AEG 10 (NO REV)|
20|FH_F148494_0_0|SrvcGrp|96899|2022|PDM|15000.00|99|0.00|LUMBAR ARTIF DISCECTOMY|
20|FH_F126560_43606_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|255.06|99|0.00|HAPA WPA-NWPA 2012-13 ASC 123 W/O REV|
20|FH_F43953_0_0|CSTM-ALL|CSTM-00|2020|PDM|3106.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32869_0_0|SrvcGrp|20303|2022|PDM|17500.00|99|0.00|MS DRG 329-331 BCIR|
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_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 5  (NO REV)|
20|FH_F71268_0_0|SrvcGrp|3499|2022|PCT|0.35|99|0.00|IMPLANTS|
20|FH_F117835_14551_0|SrvcGrp|472|2022|PDM|335.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F101620_47401_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F132810_0_0|SrvcGrp|13929|2022|PDM|25.00|99|0.00|GROWTH HORMONE|
20|FH_F115166_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134155_07016_0|SrvcGrp|90040|2022|PDM|405.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F137054_22041_0|SrvcGrp|92502|2022|PDM|780.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F137147_75006_0|SrvcGrp|31925|2022|PDM|31500.00|99|0.00|MS DRG 483 ONLY|
20|FH_F137147_75006_0|SrvcGrp|83641|2022|PDM|3585.00|99|0.00|CPT 29889|
20|FH_F114178_19083_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142393_33142_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140343_89052_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F140844_48083_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140893_19720_0|SrvcGrp|29346|2022|PDM|39.80|99|0.00|SKILLED NURSING- LPN|
20|FH_F151601_89118_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F92506_07666_0|SrvcGrp|81779|2022|PCT|0.59|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F48292_0_0|SrvcGrp|44246|2022|PDM|192.00|99|0.00|CAPD TRAINING|
20|FH_F76144_0_0|SrvcGrp|34606|2022|PDM|3186.25|99|0.00|CPT 29827|
20|FH_F117295_70006_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F147861_45239_0|SrvcGrp|16069|2022|PDM|900.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F129477_70403_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F114145_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F39538_0_0|CSTM-ALL|CSTM-00|2020|PDM|1243.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110308_0_0|SrvcGrp|72992|2022|PDM|350.00|99|0.00|AEG 2|
20|FH_F91472_96001_0|SrvcGrp|106257|2022|PCT|2.05|99|0.00|LABORATORY SERVICES|
20|FH_F63459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135653_0_0|SrvcGrp|13925|2022|PDM|1665.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F42953_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS APC GROUPED|
20|FH_F98625_08103_0|SrvcGrp|88978|2022|PDM|8330.00|99|0.00|VAGINAL DELIVERY|
20|FH_F131208_0_0|SrvcGrp|106300|2022|PDM|502.70|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F111201_25301_0|SrvcGrp|75399|2022|PDM|0.10|99|0.00|MED RECORD COPY|
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|SrvcGrp|8950|2022|PDM|1450.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F48772_66044_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F69245_84047_0|SrvcGrp|73842|2022|PDM|143.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131235_36049_0|SrvcGrp|89412|2022|PDM|622.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F69347_0_0|SrvcGrp|44770|2022|PDM|9630.00|99|0.00|PORTLAND ADVENTIST ASPG IX|
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PDM|1733.00|99|0.00|AEG 7 (NO REV)|
20|FH_F119507_92627_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F38865_0_0|SrvcGrp|24|2022|PDM|2800.00|99|0.00|CARDIAC CATH|
20|FH_F113326_80014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127138_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F125176_20785_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F57592_0_0|SrvcGrp|20926|2022|PDM|65000.00|99|0.00|MS DRG 235 ONLY|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD AU|
20|FH_F100740_15206_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144088_48706_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F75706_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101840_76054_0|SrvcGrp|31927|2022|PDM|21180.00|99|0.00|MS DRG 457 ONLY|
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|1916.00|99|0.00|AEG 6 (NO REV)|
20|FH_F97562_29803_0|SrvcGrp|88977|2022|PDM|7480.00|99|0.00|C-SECTION DELIVERY|
20|FH_F128605_20910_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148494_0_0|SrvcGrp|96350|2022|PDM|15000.00|99|0.00|SHOULDER JOINT|
20|FH_F141833_31707_0|SrvcGrp|106317|2022|PDM|1275.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F128144_45697_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F133028_08021_0|SrvcGrp|93338|2022|PDM|30.66|99|0.00|AETNA MED NUTRITION SEBSEQUENT|
20|FH_F97161_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F144288_46322_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F44048_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|CHILD PSYCH RESIDENTIAL TREATMENT|
20|FH_F101922_98055_0|SrvcGrp|80737|2022|PCT|0.63|99|0.00|AETNA HOSPITAL OP DIALYSIS|
20|FH_F144011_60616_0|SrvcGrp|75506|2022|PCT|0.45|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F150021_02725_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130330_0_0|SrvcGrp|87077|2022|PDM|114.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F97140_91730_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F42779_0_0|SrvcGrp|473|2022|PDM|1097.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F97103_53295_0|SrvcGrp|90854|2022|PDM|2180.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F128130_10027_0|SrvcGrp|100765|2022|PDM|490.00|99|0.00|PT/OT/ST|
20|FH_F91194_33511_0|SrvcGrp|83801|2022|PDM|2300.00|99|0.00|INTERIM LABOR FACILITY GLOBA|
20|FH_F121016_32607_0|SrvcGrp|63458|2022|PDM|1000.00|99|0.00|ANTEPARTUM VISITS 7 OR MORE|
20|FH_F145884_72113_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F46856_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71644_0_0|SrvcGrp|20151|2022|PDM|53595.00|99|0.00|KIDNEY TRANSPLANT|
20|FH_F97103_53295_0|SrvcGrp|88977|2022|PDM|5192.00|99|0.00|C-SECTION DELIVERY|
20|FH_F70026_0_0|SrvcGrp|1168|2022|PDM|40.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F141927_71901_0|CSTM-ALL|CSTM-00|2020|PDM|894.00|99|0.00|AEG 10 (NO REV)|
20|FH_F128605_20910_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F102561_75146_0|SrvcGrp|98004|2022|PDM|250.00|99|0.00|REMOVAL OF DEVITALIZED TISSUE|
20|FH_F101802_17201_0|SrvcGrp|48394|2022|PDM|134.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F35368_0_0|CSTM-ALL|CSTM-00|2020|PDM|1290.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F119107_22601_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F127545_45227_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F42646_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD RR KC"|
20|FH_F109367_32751_0|SrvcGrp|23587|2022|PDM|715.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F47499_0_0|SrvcGrp|13927|2022|PDM|619.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F114800_68510_0|SrvcGrp|105581|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F133943_01606_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1326.70|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1403 W/O REV|
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1280.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|183.68|99|0.00|HAPA WPA-NWPA 2012-13 ASC 135 W/O REV|
20|FH_F52754_0_0|SrvcGrp|9460|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION|
20|FH_F148668_33177_0|SrvcGrp|72379|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F81861_0_0|SrvcGrp|64112|2022|PDM|275.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 15|
20|FH_F124162_73127_0|SrvcGrp|89417|2022|PDM|367.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F143650_0_0|SrvcGrp|78096|2022|PDM|2800.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F50657_0_0|SrvcGrp|32385|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKE (DME)|
20|FH_F133876_27405_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F89319_41001_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F52713_0_0|SrvcGrp|51643|2022|PDM|4000.00|99|0.00|LABORATORY|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.32|99|0.00|HAPA WPA-NWPA 2012-13 ASC 238 W/O REV|
20|FH_F86052_15063_0|SrvcGrp|471|2022|PDM|440.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F123616_30117_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133207_0_0|SrvcGrp|33985|2022|PDM|2632.00|99|0.00|CPT 19120|
20|FH_F92598_21236_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F127598_43232_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.93|99|0.00|AEG 5  (NO REV)|
20|FH_F132728_0_0|SrvcGrp|16|2022|PDM|1611.00|99|0.00|ACUTE REHABILITATION|
20|FH_F149027_60402_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70863_0_0|SrvcGrp|26253|2022|PDM|35.00|99|0.00|LIPIDS|
20|FH_F134655_14221_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PDM|1496.00|99|0.00|AEG 9 (NO REV)|
20|FH_F143568_85006_0|SrvcGrp|92760|2022|PCT|1.08|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132801_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113484_43015_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125328_0_0|SrvcGrp|83817|2022|PDM|14356.50|99|0.00|LAPAROSCOPY LYSIS ADHESIONS|
20|FH_F133749_84604_0|SrvcGrp|112472|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F134174_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135670_01749_0|SrvcGrp|22593|2022|PDM|30.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F133808_73401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F58396_0_0|SrvcGrp|42829|2022|PDM|68.00|99|0.00|RESPIRATORY THERAPY VISIT|
20|FH_F148924_44003_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123325_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F109242_18466_0|SrvcGrp|89267|2022|PDM|108.00|99|0.00|PSYTX PT/FAMILY 30 MINUTES|
20|FH_F145641_06902_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F112863_0_0|SrvcGrp|104260|2022|PDM|1141.00|99|0.00|SKIN FULL GRAFT PROCEDURE|
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PDM|1799.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F85012_0_0|SrvcGrp|31931|2022|PCT|0.00|99|0.00|SKILLED NURSING CARE|
20|FH_F78344_0_0|SrvcGrp|12403|2022|PDM|40.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F85211_0_0|SrvcGrp|19921|2022|PDM|3465.00|99|0.00|ARTHROSCOPICALLY LIGAMENT REPAIR|
20|FH_F102200_06416_0|SrvcGrp|14947|2022|PDM|100.00|99|0.00|HOME INFUSION|
20|FH_F105361_80104_0|SrvcGrp|79099|2022|PDM|4130.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F115877_63556_0|SrvcGrp|73483|2022|PDM|350.00|99|0.00|AETNA SUBACUTE III|
20|FH_F120528_60559_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F66705_0_0|SrvcGrp|62537|2022|PDM|70.00|99|0.00|SPEECH THERAPY|
20|FH_F115966_16801_0|SrvcGrp|88779|2022|PDM|74.00|99|0.00|PHYSICAL THERAPY|
20|FH_F148867_20191_0|SrvcGrp|73700|2022|PDM|63.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F121404_32216_0|SrvcGrp|108779|2022|PDM|17.28|99|0.00|HUMIDIFIER HEATED USED W PAP (MOD KH, KI, KJ, KX, RR)|
20|FH_F122013_75503_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F113588_0_0|SrvcGrp|3809|2022|PDM|400.05|99|0.00|HOSPICE CARE|
20|FH_F61813_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129130_92562_0|SrvcGrp|111317|2022|PCT|0.35|99|0.00|THROMBOLIC AGENTS|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2501000 MOD RR (HCFA)|
20|FH_F40081_0_0|SrvcGrp|3378|2022|PDM|735.00|99|0.00|OBSERVATION SVCS|
20|FH_F65761_0_0|SrvcGrp|43430|2022|PDM|169.74|99|0.00|LPN HOME VISIT|
20|FH_F97720_70084_0|SrvcGrp|73603|2022|PDM|2881.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F97740_01605_0|SrvcGrp|73559|2022|PDM|23507.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F111207_0_0|SrvcGrp|47260|2022|PCT|0.70|99|0.00|IMPLANTS 274-276, 278  LINE LEVEL|
20|FH_F113784_0_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F142448_15701_0|SrvcGrp|15402|2022|PDM|30.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F115875_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 5  (NO REV)|
20|FH_F100640_48097_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|424.00|99|0.00|AEG 1 (NO REV)|
20|FH_F110211_78666_0|SrvcGrp|108484|2022|PDM|660.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F57592_0_0|SrvcGrp|33789|2022|PDM|2200.00|99|0.00|MS DRG 880-887 ONLY|
20|FH_F106640_78642_0|SrvcGrp|46903|2022|PDM|757.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F43411_0_0|SrvcGrp|15363|2022|PCT|0.60|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F117962_17603_0|SrvcGrp|107112|2022|PDM|2100.00|99|0.00|DENTAL SERVICES UNDER ANESTHESIA|
20|FH_F115274_15235_0|SrvcGrp|97703|2022|PDM|140.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F146360_66502_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F92676_15063_0|SrvcGrp|78985|2022|PDM|1227.25|99|0.00|MON VALLEY ASC 210|
20|FH_F97621_75801_0|SrvcGrp|88978|2022|PDM|9403.00|99|0.00|VAGINAL DELIVERY|
20|FH_F33664_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|OP SVCS|
20|FH_F42557_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120837_33309_0|SrvcGrp|89417|2022|PDM|518.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F148555_0_0|SrvcGrp|115463|2022|PDM|3605.00|99|0.00|INSERT SUBQ CAR RHYTHM MONITOR|
20|FH_F55375_0_0|SrvcGrp|8968|2022|PDM|1583.00|99|0.00|NICU LEVEL III & IV|
20|FH_F141852_78102_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116440_0_0|SrvcGrp|87537|2022|PDM|350.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F130656_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|GENERAL ACUTE CARE|
20|FH_F133478_40165_0|CSTM-ALL|CSTM-00|2020|PDM|2981.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 5 (NO REV)|
20|FH_F39723_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HEARTFIELD OCN F/S PRICING: GLOBAL (HCFA)|
20|FH_F101840_76054_0|SrvcGrp|78377|2022|PDM|603.00|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F38410_0_0|SrvcGrp|11798|2022|PDM|112.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F142047_21853_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F73684_0_0|SrvcGrp|70947|2022|PDM|75.00|99|0.00|ROOM AND BOARD DAY OF DISCHARGE|
20|FH_F128246_0_0|SrvcGrp|111035|2022|PDM|588.00|99|0.00|ECTROPION THERMOCAUTERIZATIN|
20|FH_F51123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F132612_0_0|SrvcGrp|3409|2022|PDM|508.00|99|0.00|NEWBORN NURSERY|
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|CHILD PSYCHIATRIC|
20|FH_F72859_0_0|SrvcGrp|15509|2022|PDM|21.19|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F35411_0_0|SrvcGrp|3226|2022|PDM|8050.00|99|0.00|CARDIAC BRACHYTHERAPY|
20|FH_F71484_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F133021_00910_0|SrvcGrp|112290|2022|PDM|2500.00|99|0.00|LAPAROSCOPY SURGERY|
20|FH_F101922_98055_0|SrvcGrp|74584|2022|PDM|572.00|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|244.51|99|0.00|HAPA WPA-NWPA 2012-13 ASC 125 W/O REV|
20|FH_F32930_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144494_62526_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F74263_0_0|SrvcGrp|66168|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F141827_80003_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F43164_0_0|CSTM-ALL|CSTM-00|2020|PDM|876.00|99|0.00|HEAD INJURY REHAB|
20|FH_F49637_0_0|SrvcGrp|45526|2022|PDM|14700.00|99|0.00|MS DRG 467-468 ONLY|
20|FH_F117829_45227_0|SrvcGrp|89149|2022|PDM|155.00|99|0.00|OP INTENSIVE|
20|FH_F44607_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F93421_0_0|SrvcGrp|76094|2022|PDM|132.57|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F144869_15701_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F83031_0_0|SrvcGrp|11157|2022|PDM|55.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F32215_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F109846_16502_0|SrvcGrp|75545|2022|PDM|364.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F66541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139391_30127_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139597_07009_0|SrvcGrp|472|2022|PDM|575.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150765_05001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150769_02302_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F125782_66763_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126502_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147171_76036_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39151_0_0|SrvcGrp|12350|2022|PDM|600.00|99|0.00|BOARDER BABY SERVICES|
20|FH_F114207_35243_0|SrvcGrp|86827|2022|PDM|60.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F120100_98390_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F97620_75904_0|SrvcGrp|88978|2022|PDM|5662.00|99|0.00|VAGINAL DELIVERY|
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35678_0_0|SrvcGrp|18148|2022|PDM|11300.00|99|0.00|MS DRG 249|
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|343.00|99|0.00|AEG 1 (NO REV)|
20|FH_F130044_0_0|SrvcGrp|111414|2022|PCT|6.90|99|0.00|MEDICINE CODES|
20|FH_F147222_49544_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|930.00|99|0.00|AEG 1 (NO REV)|
20|FH_F36036_0_0|CSTM-ALL|CSTM-00|2020|PDM|205.00|99|0.00|CPT CODE 93012|
20|FH_F120677_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.43|99|0.00|OP SVCS|
20|FH_F35745_33952_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147171_76036_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F37267_0_0|SrvcGrp|22954|2022|PDM|483.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F115483_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|AEG 2 (NO REV)|
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|1516.00|99|0.00|ASPG 9 SURGICAL EYE CENTER|
20|FH_F150932_15143_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136376_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151004_87121_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151007_90048_0|SrvcGrp|74668|2022|PDM|385.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F110824_83221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142847_07003_0|SrvcGrp|105323|2022|PCT|1.00|99|0.00|ESTABLISH PATIENT OFF/OP VST|
20|FH_F87155_04105_0|SrvcGrp|13929|2022|PDM|18.91|99|0.00|GROWTH HORMONE|
20|FH_F77787_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F51438_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|ASPG VIII|
20|FH_F148903_51101_0|SrvcGrp|48385|2022|PDM|128.00|99|0.00|SPEECH THERAPY|
20|FH_F97700_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F87432_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F120829_85283_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F96120_67207_0|SrvcGrp|43523|2022|PDM|150.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F136393_0_0|SrvcGrp|108192|2022|PDM|6400.00|99|0.00|FEM/POPL REVAS W/TLA|
20|FH_F89112_16509_0|SrvcGrp|64110|2022|PDM|914.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 1|
20|FH_F144990_44708_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 10 (NO REV)|
20|FH_F106660_26554_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES|
20|FH_F129644_0_0|SrvcGrp|111216|2022|PDM|400.00|99|0.00|ACUTE KIDNEY INJURY HEMODIALYSIS NO ESRD|
20|FH_F133477_90247_0|SrvcGrp|106261|2022|PDM|3212.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F117372_07442_0|SrvcGrp|90632|2022|PDM|145.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD KN)|
20|FH_F128349_43082_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F142051_06604_0|SrvcGrp|472|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F145884_72113_0|SrvcGrp|74668|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F47433_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CHESTER CTY LABORATORY MOD QW|
20|FH_F130108_0_0|SrvcGrp|18204|2022|PCT|0.75|99|0.00|MS DRG 027|
20|FH_F91216_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F125342_78754_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132331_89107_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F36973_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|REFERENCE LABS %|
20|FH_F121009_76180_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F77025_0_0|SrvcGrp|38352|2022|PDM|2580.00|99|0.00|FOOT MUSCLOSKELETAL PROCEDURE|
20|FH_F120605_0_0|SrvcGrp|72994|2022|PDM|815.00|99|0.00|AEG 3|
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_F43411_0_0|SrvcGrp|11259|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F97581_60141_0|SrvcGrp|88978|2022|PDM|7699.00|99|0.00|VAGINAL DELIVERY|
20|FH_F100741_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F48935_0_0|SrvcGrp|44883|2022|PDM|18.00|99|0.00|RT/PT/ST/OT|
20|FH_F150883_14727_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F145988_06105_0|SrvcGrp|3546|2022|PDM|67317.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PDM|3763.00|99|0.00|AEG 8 (NO REV)|
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1287.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132934_63005_0|SrvcGrp|29817|2022|PDM|8440.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F133477_90247_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F117827_75235_0|SrvcGrp|89412|2022|PDM|247.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F146179_37687_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38352_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F141767_62312_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F81494_0_0|SrvcGrp|22954|2022|PDM|186.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F38700_0_0|SrvcGrp|3029|2022|PDM|578.00|99|0.00|NEWBORN NURSERY|
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|662.00|99|0.00|AEG 5  (NO REV)|
20|FH_F94300_0_0|SrvcGrp|11663|2022|PCT|1.03|99|0.00|IMPLANTS|
20|FH_F111809_93003_0|SrvcGrp|79099|2022|PDM|8406.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F148644_06890_0|SrvcGrp|33977|2022|PDM|3756.00|99|0.00|CPT 59820|
20|FH_F139666_26175_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|GENERAL ACUTE CARE|
20|FH_F150882_84041_0|SrvcGrp|48398|2022|PDM|109.00|99|0.00|PT SERVICES|
20|FH_F136493_0_0|SrvcGrp|83857|2022|PDM|980.00|99|0.00|IP HOSPICE SVCS|
20|FH_F143668_0_0|SrvcGrp|115714|2022|PDM|165.00|99|0.00|SEGMENTAL PNEUMATIC (MOD UE)|
20|FH_F147172_76086_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F32501_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)|
20|FH_F69183_0_0|SrvcGrp|60756|2022|PDM|1200.00|99|0.00|ASPG X - FH SW CUSTOM GROUPERS|
20|FH_F144651_0_0|SrvcGrp|113843|2022|PDM|15500.00|99|0.00|REVISE KNEE|
20|FH_F49338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|1026.00|99|0.00|AEG 8 (NO REV)|
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117762_0_0|SrvcGrp|99171|2022|PDM|1976.00|99|0.00|CPT 28485|
20|FH_F151699_01752_0|SrvcGrp|86829|2022|PDM|50.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F130813_85014_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F72788_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1105.00|99|0.00|AEG 4 (NO REV)|
20|FH_F151661_78526_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131525_32159_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|348.43|99|0.00|SALLY BALIN,999182,ASC 105|
20|FH_F147379_15001_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|HSS ASC|
20|FH_F116753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35752_33470_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F127553_44321_0|SrvcGrp|89783|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F99380_90503_0|SrvcGrp|62395|2022|PCT|0.90|99|0.00|TRAUMA|
20|FH_F107840_07006_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F139867_70816_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PDM|1195.32|99|0.00|ASPG VI|
20|FH_F111266_30339_0|SrvcGrp|86849|2022|PDM|30.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F38742_0_0|SrvcGrp|28630|2022|PDM|90.00|99|0.00|HOME INFUSION SKILLED NURSING|
20|FH_F36343_0_0|SrvcGrp|11796|2022|PDM|90.00|99|0.00|DIETICIAN|
20|FH_F122377_91007_0|SrvcGrp|73497|2022|PDM|2357.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F37198_0_0|SrvcGrp|9501|2022|PCT|0.75|99|0.00|ACUTE IP MED/SURG SVCS|
20|FH_F149403_69210_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F98001_27603_0|SrvcGrp|88978|2022|PDM|4523.00|99|0.00|VAGINAL DELIVERY|
20|FH_F146859_0_0|SrvcGrp|94563|2022|PDM|2789.00|99|0.00|HIP ARTHRO W/ LABRAL REPAIR|
20|FH_F115982_0_0|SrvcGrp|96819|2022|PDM|550.00|99|0.00|DESTROY L/S FACET JNT ADDL|
20|FH_F150941_68124_0|SrvcGrp|3178|2022|PDM|1000.00|99|0.00|ACUTE PSYCH|
20|FH_F110824_83221_0|SrvcGrp|27868|2022|PDM|2618.00|99|0.00|CCU - OTHER CORONARY CARE|
20|FH_F114416_0_0|SrvcGrp|63297|2022|PDM|120.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F112956_0_0|SrvcGrp|75479|2022|PDM|363.00|99|0.00|AEG 1|
20|FH_F84532_0_0|SrvcGrp|705|2022|PCT|0.31|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F140143_24874_0|SrvcGrp|13597|2022|PDM|183.28|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F141267_0_0|SrvcGrp|106927|2022|PDM|172.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F137789_48146_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F130182_0_0|SrvcGrp|88155|2022|PDM|7803.00|99|0.00|REVISE KNEECAP WITH IMPLANT|
20|FH_F92413_07631_0|SrvcGrp|48385|2022|PDM|112.00|99|0.00|SPEECH THERAPY|
20|FH_F137561_43935_0|SrvcGrp|49682|2022|PCT|2.00|99|0.00|HSS DRG GROUPED|
20|FH_F141156_04401_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 10 (NO REV)|
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 5  (NO REV)|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|279.45|99|0.00|SALLY BALIN,999182,ASC 216|
20|FH_F50078_0_0|SrvcGrp|42974|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F125214_12428_0|SrvcGrp|89297|2022|PCT|0.00|99|0.00|INPATIENT DETOXIFICATION SERVICES|
20|FH_F151619_73505_0|SrvcGrp|75491|2022|PDM|1150.00|99|0.00|AEG 7|
20|FH_F50100_0_0|SrvcGrp|46113|2022|PDM|110.64|99|0.00|PT VISIT|
20|FH_F120104_97223_0|SrvcGrp|100499|2022|PDM|750.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)|
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.00|99|0.00|AEG 5  (NO REV)|
20|FH_F102525_73134_0|SrvcGrp|74586|2022|PCT|0.35|99|0.00|AETNA OP HIGH COST DRUGS|
20|FH_F97300_47501_0|SrvcGrp|75443|2022|PDM|900.00|99|0.00|OBSERVATION - REV 769|
20|FH_F124687_64024_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F99142_80233_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148961_33403_0|SrvcGrp|46903|2022|PDM|850.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F131498_0_0|SrvcGrp|80317|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F151000_20707_0|SrvcGrp|115180|2022|PCT|1.00|99|0.00|COVID-19 VACCINES AND ADMINSTRATION|
20|FH_F124435_03882_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F111266_30339_0|SrvcGrp|14945|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|911.00|99|0.00|AEG 6 (NO REV)|
20|FH_F131107_43140_0|SrvcGrp|95661|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F47600_0_0|SrvcGrp|31189|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF (DME)|
20|FH_F132424_75062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132491_34287_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120796_33548_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F112712_63005_0|SrvcGrp|22592|2022|PCT|1.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F116699_46347_0|SrvcGrp|46903|2022|PDM|642.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F120948_53188_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1357.13|99|0.00|ASPG VIII|
20|FH_F63229_0_0|SrvcGrp|43534|2022|PDM|365.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F50462_0_0|SrvcGrp|44428|2022|PDM|140.00|99|0.00|OCCUPATIONAL THERAPY SVCS (VISIT LVL)|
20|FH_F130755_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|AEG 8 (NO REV)|
20|FH_F130755_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|AEG 10 (NO REV)|
20|FH_F130914_51103_0|SrvcGrp|74668|2022|PDM|240.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F110881_63125_0|SrvcGrp|42785|2022|PDM|48.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F114409_18447_0|SrvcGrp|104268|2022|PDM|130.00|99|0.00|HOSPICE HOME CARE|
20|FH_F102726_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F139565_0_0|SrvcGrp|82570|2022|PDM|4590.00|99|0.00|REVISION EYELID/EXCESS SKIN|
20|FH_F109264_33431_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F70208_0_0|SrvcGrp|12670|2022|PCT|0.50|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109364_52349_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F31714_0_0|SrvcGrp|1175|2022|PDM|33400.00|99|0.00|DRG 106 CORONARY BYPASS|
20|FH_F31714_0_0|SrvcGrp|1174|2022|PDM|28600.00|99|0.00|DRG 105 CARDIAC VALVE PX & OTHER MJR CARDIOTHORACIC PX W/CC|
20|FH_F136359_0_0|SrvcGrp|87387|2022|PDM|3325.00|99|0.00|REMOVE EYE IMPLANT MATERIAL|
20|FH_F110420_60649_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F150221_63131_0|CSTM-ALL|CSTM-00|2020|PCT|1.11|99|0.00|HSS ASC|
20|FH_F57453_0_0|SrvcGrp|11259|2022|PCT|1.00|99|0.00|DRUGS|
20|FH_F150146_95401_0|SrvcGrp|75419|2022|PDM|493.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F51115_0_0|SrvcGrp|42763|2022|PDM|120.98|99|0.00|SKILLED NURSING CARE VISIT|
20|FH_F83995_16748_0|SrvcGrp|82625|2022|PDM|862.00|99|0.00|ER SETTING W/ OP SURGERY LEVEL IV|
20|FH_F130654_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F35757_34652_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F149579_95815_0|SrvcGrp|115698|2022|PDM|161.17|99|0.00|PSYCHIATRIC COLLABORATIVE CARE MGMT 1ST (MOD AJ)(HCFA)|
20|FH_F91940_0_0|SrvcGrp|91864|2022|PCT|1.25|99|0.00|IMPLANTS|
20|FH_F123745_0_0|SrvcGrp|10986|2022|PDM|8500.00|99|0.00|ARTHROSCOPIC KNEE REPAIR|
20|FH_F115483_62002_0|SrvcGrp|92769|2022|PDM|2345.00|99|0.00|RADIATION THERAPY|
20|FH_F147170_53051_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|GENERAL ACUTE CARE|
20|FH_F125214_12428_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F127040_63867_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F74845_0_0|SrvcGrp|361|2022|PCT|0.85|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F90213_30084_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40289_0_0|SrvcGrp|3029|2022|PDM|398.00|99|0.00|NEWBORN NURSERY|
20|FH_F130661_04441_0|SrvcGrp|72984|2022|PCT|0.86|99|0.00|CHEMOTHERAPY|
20|FH_F35737_34741_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS|
20|FH_F140608_0_0|SrvcGrp|29346|2022|PDM|122.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F139147_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F120332_0_0|SrvcGrp|48385|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F110783_93013_0|SrvcGrp|86831|2022|PDM|7.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F132155_66209_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147166_03444_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F139147_0_0|SrvcGrp|90157|2022|PDM|5305.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F127291_86426_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116583_0_0|SrvcGrp|103900|2022|PDM|150.00|99|0.00|HOSPICE/HOME HLTH IN ASST LVG|
20|FH_F131356_19131_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134819_0_0|SrvcGrp|22915|2022|PDM|1773.00|99|0.00|CPT CODE 42820|
20|FH_F56572_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37536_0_0|SrvcGrp|23449|2022|PDM|135.00|99|0.00|SUPPLIES|
20|FH_F146266_0_0|SrvcGrp|84939|2022|PDM|12300.00|99|0.00|SHOULDER JOINT|
20|FH_F97100_23462_0|SrvcGrp|73659|2022|PDM|8007.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F150339_75035_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140990_0_0|SrvcGrp|108043|2022|PDM|250.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|12.00|99|0.00|IMPLANTABLE PORTS CATH CARE|
20|FH_F89851_83854_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F90817_0_0|SrvcGrp|91023|2022|PDM|2096.00|99|0.00|REBUILD OUTER EAR CANAL (HCFA)|
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|746.00|99|0.00|AEG 10 (NO REV)|
20|FH_F143564_0_0|SrvcGrp|81904|2022|PDM|3315.00|99|0.00|LAP PARASOPHAG HERNIA REPAIR|
20|FH_F114207_35243_0|SrvcGrp|16750|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116753_0_0|SrvcGrp|38247|2022|PDM|953.00|99|0.00|SLEEP STUDIES|
20|FH_F149376_34239_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F150459_08021_0|SrvcGrp|27968|2022|PDM|33.00|99|0.00|SKILLED NURSING LPN|
20|FH_F129256_89146_0|SrvcGrp|89149|2022|PDM|306.00|99|0.00|OP INTENSIVE|
20|FH_F36202_0_0|SrvcGrp|3066|2022|PCT|0.77|99|0.00|HIGH-COST DRUGS|
20|FH_F97880_63501_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F127086_62246_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1085.00|99|0.00|HAPA EPA ASC 54|
20|FH_F37444_0_0|SrvcGrp|15145|2022|PCT|0.70|99|0.00|DIALYSIS|
20|FH_F143411_78212_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F62713_0_0|SrvcGrp|3809|2022|PDM|601.02|99|0.00|HOSPICE CARE|
20|FH_F75803_0_0|SrvcGrp|11259|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F102224_0_0|SrvcGrp|96799|2022|PDM|3600.00|99|0.00|DESTROY C/TH FACET JNT ADDL|
20|FH_F131107_43140_0|SrvcGrp|95660|2022|PDM|550.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F47245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|1289.00|99|0.00|ASPG VI|
20|FH_F120191_91360_0|SrvcGrp|108484|2022|PDM|875.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F116869_15146_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F83292_0_0|CSTM-ALL|CSTM-00|2020|PCT|4.00|99|0.00|2014 HAPA WPA 4TH QTR INJ|
20|FH_F119918_38201_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120974_27607_0|SrvcGrp|44564|2022|PDM|920.00|99|0.00|NEWBORN NURSERY|
20|FH_F125479_17501_0|SrvcGrp|3044|2022|PDM|680.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F113649_01752_0|SrvcGrp|14948|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142454_0_0|SrvcGrp|109760|2022|PDM|6000.00|99|0.00|TRANSLUM DIL EYE CANAL|
20|FH_F149679_0_0|SrvcGrp|106291|2022|PDM|188.89|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|531.31|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F129895_50263_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F57093_0_0|SrvcGrp|1137|2022|PDM|550.00|99|0.00|ELECTRO CONVULSIVE THERAPY|
20|FH_F71282_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F102009_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F56136_0_0|SrvcGrp|37260|2022|PCT|0.92|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F40499_0_0|SrvcGrp|32641|2022|PCT|1.00|99|0.00|POTOMAC CTR SPECIALITY DME MOD UE|
20|FH_F115737_78660_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F109581_0_0|SrvcGrp|75493|2022|PDM|1087.00|99|0.00|AEG 8|
20|FH_F129367_89117_0|SrvcGrp|73841|2022|PDM|483.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F52854_0_0|SrvcGrp|12446|2022|PDM|587.00|99|0.00|ER SVCS|
20|FH_F56136_0_0|SrvcGrp|22811|2022|PCT|0.92|99|0.00|TRAUMA CARE|
20|FH_F32284_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83352_06114_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AMFS DEFAULT WITHOUT HOMEHEALTH|
20|FH_F138951_41101_0|SrvcGrp|86841|2022|PDM|70.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F121684_74447_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F100782_0_0|SrvcGrp|97586|2022|PDM|837.18|99|0.00|WINDBER MEDICAL CNTR ASC 213|
20|FH_F133815_46526_0|SrvcGrp|106990|2022|PCT|0.00|99|0.00|RHOGAM INJECTION|
20|FH_F112665_0_0|SrvcGrp|98494|2022|PDM|7699.00|99|0.00|ARTHRODESIS PRE-SACRAL|
20|FH_F88744_71103_0|SrvcGrp|73602|2022|PDM|529.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F149219_01966_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F139722_30022_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F48846_0_0|SrvcGrp|26732|2022|PDM|720.00|99|0.00|CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE|
20|FH_F124161_95932_0|SrvcGrp|109220|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F124369_0_0|SrvcGrp|100013|2022|PDM|12100.00|99|0.00|REPAIR/GRAFT ACHILLES TENDON|
20|FH_F141874_0_0|SrvcGrp|92501|2022|PDM|379.05|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F150124_44107_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134327_12853_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F126431_77338_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F73125_0_0|SrvcGrp|48396|2022|PDM|12.00|99|0.00|OT SERVICES|
20|FH_F132922_91302_0|SrvcGrp|108484|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F90453_65203_0|SrvcGrp|79720|2022|PDM|941.00|99|0.00|ACUTE REHAB II|
20|FH_F49979_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|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_F120719_27540_0|CSTM-ALL|CSTM-00|2020|PDM|3762.00|99|0.00|AEG 1 (NO REV)|
20|FH_F119125_0_0|SrvcGrp|9541|2022|PDM|200.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F120539_89029_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F127908_60640_0|SrvcGrp|107758|2022|PCT|1.40|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PDM|374.00|99|0.00|ASPG I|
20|FH_F84191_16001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F40635_0_0|SrvcGrp|38|2022|PDM|2600.00|99|0.00|NORMAL DELIVERY|
20|FH_F48034_0_0|SrvcGrp|9493|2022|PDM|90.00|99|0.00|CPT 90804|
20|FH_F85353_16407_0|SrvcGrp|63801|2022|PDM|860.56|99|0.00|HAPA WPA-NWPA 2012-13 ASC 403|
20|FH_F149120_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63872|2022|PDM|313.59|99|0.00|HAPA WPA-NWPA 2012-13 ASC 122|
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145642_15108_0|SrvcGrp|86844|2022|PDM|30.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F132609_0_0|SrvcGrp|10107|2022|PCT|0.67|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F111942_92647_0|SrvcGrp|48398|2022|PDM|122.00|99|0.00|PT SERVICES|
20|FH_F85777_77030_0|SrvcGrp|73485|2022|PDM|3004.00|99|0.00|AETNA REHAB|
20|FH_F116753_0_0|SrvcGrp|100765|2022|PCT|2.55|99|0.00|PT/OT/ST|
20|FH_F120698_75082_0|SrvcGrp|74668|2022|PDM|184.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119864_63141_0|SrvcGrp|46605|2022|PDM|105.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133747_80634_0|SrvcGrp|73842|2022|PDM|165.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|370.67|99|0.00|HAPA WPA-NWPA 2012-13 ASC 104 W/O REV|
20|FH_F41135_0_0|SrvcGrp|17065|2022|PDM|321.40|99|0.00|ASPG I|
20|FH_F37698_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|NEONATAL INTENSVE CARE LEVEL III|
20|FH_F83380_0_0|SrvcGrp|44713|2022|PDM|105.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F124372_0_0|SrvcGrp|107747|2022|PDM|339.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F85353_16407_0|SrvcGrp|63835|2022|PDM|488.61|99|0.00|HAPA WPA-NWPA 2012-13 ASC 104|
20|FH_F135623_53115_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85212_71075_0|SrvcGrp|78579|2022|PDM|1800.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
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_F150310_07035_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130364_01331_0|SrvcGrp|73559|2022|PDM|3027.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F138302_15701_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F148600_30328_0|SrvcGrp|36864|2022|PDM|43450.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F116207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS|
20|FH_F54592_0_0|SrvcGrp|17008|2022|PDM|88.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS|
20|FH_F73084_0_0|SrvcGrp|46107|2022|PDM|72.00|99|0.00|SKILLED NURSING|
20|FH_F39776_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HANOVER SURGICENTER ASC GH|
20|FH_F122532_46385_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F74583_0_0|SrvcGrp|46424|2022|PDM|14.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F85211_0_0|SrvcGrp|83627|2022|PDM|4042.50|99|0.00|SPINE SURGERY|
20|FH_F102200_06416_0|SrvcGrp|14893|2022|PDM|58.75|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F105145_75075_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F105145_75075_0|SrvcGrp|78282|2022|PDM|19500.00|99|0.00|CPT 47563|
20|FH_F115909_38133_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F80513_0_0|SrvcGrp|27813|2022|PDM|11575.00|99|0.00|MS DRG 280 ONLY|
20|FH_F146782_19034_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120795_27514_0|SrvcGrp|116120|2022|PCT|0.71|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F120795_27514_0|SrvcGrp|10362|2022|PDM|416.00|99|0.00|CPT CODE 99282|
20|FH_F34050_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|595.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F131671_72301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131698_01862_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F131454_06422_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130657_04614_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F111563_02116_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F138929_0_0|SrvcGrp|26278|2022|PDM|3300.00|99|0.00|CPT 29881|
20|FH_F143898_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F131047_0_0|SrvcGrp|105689|2022|PCT|0.57|99|0.00|RADIOLOGY SERVICES|
20|FH_F130274_63033_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F114389_50131_0|SrvcGrp|105605|2022|PDM|30.72|99|0.00|WATER CHAMBER FOR HUMIDIFIER (MOD NU)|
20|FH_F114389_50131_0|SrvcGrp|86828|2022|PDM|215.85|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F141336_16947_0|SrvcGrp|90798|2022|PDM|18202.00|99|0.00|IMPLANT SPINE INFUSION PUMP19|
20|FH_F92600_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|PDM|1393.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F37901_0_0|SrvcGrp|16746|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F38047_0_0|SrvcGrp|177|2022|PDM|2299.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F38688_0_0|SrvcGrp|64758|2022|PCT|0.80|99|0.00|HCPCS|
20|FH_F40302_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F100703_0_0|SrvcGrp|38015|2022|PDM|8034.00|99|0.00|ARTHRODESIS|
20|FH_F124237_95023_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F116097_0_0|SrvcGrp|104745|2022|PDM|148.79|99|0.00|HOSPICE|
20|FH_F150226_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127995_84010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127995_84010_0|SrvcGrp|21920|2022|PDM|25.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F127995_84010_0|SrvcGrp|14949|2022|PDM|10.00|99|0.00|HOME INFUSION|
20|FH_F66388_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F100787_69162_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F136589_72601_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136667_23603_0|SrvcGrp|46903|2022|PDM|652.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F138055_16146_0|SrvcGrp|112868|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F139771_54534_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114985_32073_0|SrvcGrp|102981|2022|PDM|77.00|99|0.00|PSYTX WPT W E/M 45 MIN|
20|FH_F100664_03104_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|8000.00|99|0.00|AEG 8 (NO REV)|
20|FH_F148424_01440_0|SrvcGrp|113171|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
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_F132721_0_0|SrvcGrp|47427|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F122674_94904_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F117026_17961_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134687_14226_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136807_43220_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F136824_08034_0|SrvcGrp|75419|2022|PDM|406.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F112371_19047_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|AEG 10 (NO REV)|
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|ASPG X|
20|FH_F115266_66736_0|SrvcGrp|89149|2022|PDM|160.00|99|0.00|OP INTENSIVE|
20|FH_F115723_78363_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147586_44124_0|SrvcGrp|11673|2022|PDM|4952.00|99|0.00|CPT 29888|
20|FH_F133583_77074_0|SrvcGrp|73841|2022|PDM|435.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71502_0_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F33389_0_0|SrvcGrp|9774|2022|PDM|1712.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F39633_0_0|SrvcGrp|17081|2022|PDM|2484.00|99|0.00|ASPG IX|
20|FH_F138634_33125_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138677_43793_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138857_90025_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F124542_0_0|SrvcGrp|80538|2022|PDM|434.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 2|
20|FH_F151514_35242_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132258_45404_0|SrvcGrp|86834|2022|PDM|11.93|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F104420_52208_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135893_74006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135972_18509_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F135983_22030_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136192_33016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130547_85712_0|SrvcGrp|93267|2022|PDM|0.36|99|0.00|INJECTION|
20|FH_F130756_04901_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 5  (NO REV)|
20|FH_F116431_76104_0|SrvcGrp|12659|2022|PDM|656.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F130766_04967_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|AEG 4 (NO REV)|
20|FH_F140629_0_0|SrvcGrp|78093|2022|PDM|2497.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|1194.00|99|0.00|AEG 7 (NO REV)|
20|FH_F69205_0_0|SrvcGrp|28973|2022|PCT|0.70|99|0.00|HOSPICE MEDICATIONS|
20|FH_F111292_33136_0|SrvcGrp|90854|2022|PDM|1040.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F34864_0_0|CSTM-ALL|CSTM-00|2020|PDM|1284.00|99|0.00|ASPG II|
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|ASPG IX|
20|FH_F71229_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE|
20|FH_F101442_0_0|SrvcGrp|98467|2022|PDM|1218.19|99|0.00|REPAIR BIG TOE FRACTURE|
20|FH_F132328_0_0|SrvcGrp|83646|2022|PDM|5264.00|99|0.00|CPT 31276|
20|FH_F102325_62691_0|SrvcGrp|24744|2022|PDM|60.00|99|0.00|PICC LINE INSERTION|
20|FH_F39266_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F68835_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40345_0_0|SrvcGrp|65|2022|PDM|1339.00|99|0.00|OBSTETRICAL CARE|
20|FH_F41433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F42953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F111143_28659_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F86660_0_0|SrvcGrp|705|2022|PCT|0.55|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F126104_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F113178_44035_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F150025_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F37200_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REGIONAL HEALTH SVCS OF HOWARD-DME-MOD UE|
20|FH_F37578_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|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_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|531.31|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F115763_16433_0|SrvcGrp|472|2022|PDM|340.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F135219_68506_0|CSTM-ALL|CSTM-00|2020|PDM|5088.47|99|0.00|AEG 8 (NO REV)|
20|FH_F120374_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130747_0_0|SrvcGrp|26276|2022|PDM|5202.00|99|0.00|CPT 29819|
20|FH_F124738_0_0|SrvcGrp|73004|2022|PDM|960.00|99|0.00|AEG 8|
20|FH_F118311_35211_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149819_75067_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125743_45640_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F82173_72712_0|CSTM-ALL|CSTM-00|2020|PDM|1153.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F32538_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F128982_44221_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F135239_0_0|SrvcGrp|92501|2022|PDM|495.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F37945_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F91663_19901_0|SrvcGrp|48385|2022|PDM|120.00|99|0.00|SPEECH THERAPY|
20|FH_F40427_0_0|SrvcGrp|97|2022|PDM|3356.00|99|0.00|C-SECTION|
20|FH_F107800_34609_0|SrvcGrp|87317|2022|PDM|637.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 3 (NO REV)|
20|FH_F120251_21122_0|SrvcGrp|73605|2022|PDM|1700.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F121925_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F150982_0_0|SrvcGrp|78285|2022|PDM|4184.00|99|0.00|CPT 58671|
20|FH_F143528_0_0|SrvcGrp|77021|2022|PDM|5250.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F149886_68112_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120279_98005_0|SrvcGrp|87317|2022|PDM|1175.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F51074_0_0|SrvcGrp|13215|2022|PCT|0.55|99|0.00|PHARMACY SVCS|
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 5  (NO REV)|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME,MOD_AV|
20|FH_F124018_75067_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F125899_07645_0|SrvcGrp|110237|2022|PDM|490.00|99|0.00|PT/OT/ST|
20|FH_F145550_62034_0|SrvcGrp|95660|2022|PDM|660.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F141507_0_0|SrvcGrp|95107|2022|PDM|1056.00|99|0.00|INTRAOCULAR LENS PROSTHESIS|
20|FH_F40499_0_0|SrvcGrp|32642|2022|PCT|1.00|99|0.00|POTOMAC CTR SPECIALITY DME GLOBAL|
20|FH_F39170_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CT MRI GLOBAL|
20|FH_F148222_18603_0|SrvcGrp|48385|2022|PDM|98.00|99|0.00|SPEECH THERAPY|
20|FH_F82696_16335_0|SrvcGrp|38246|2022|PCT|1.00|99|0.00|SLEEP STUDIES|
20|FH_F98920_46526_0|SrvcGrp|73659|2022|PDM|4802.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F35287_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110061_0_0|SrvcGrp|75483|2022|PDM|540.00|99|0.00|AEG 3|
20|FH_F36366_0_0|SrvcGrp|22922|2022|PDM|1008.00|99|0.00|CPT 95811|
20|FH_F78903_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141515_50010_0|SrvcGrp|73842|2022|PDM|181.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F86319_16365_0|SrvcGrp|111925|2022|PDM|4376.00|99|0.00|VAGINAL DELIVERY INCLUDES NEWBORN|
20|FH_F101711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129182_24171_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128896_53209_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|DME F/S (MOD KF) - MHAC|
20|FH_F129011_15857_0|SrvcGrp|87799|2022|PDM|210.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F113410_0_0|SrvcGrp|101820|2022|PDM|3152.00|99|0.00|HYSTEROSCOPY RESECT SEPTUM|
20|FH_F148219_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37863_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CRESCENT ANESTHESIA - FH- NON-ANES CODES MOD 26|
20|FH_F125810_67301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F68964_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135010_46342_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149888_68506_0|SrvcGrp|78096|2022|PDM|3548.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F96902_0_0|SrvcGrp|93098|2022|PDM|165.00|99|0.00|HOSPICE CARE|
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130145_98043_0|SrvcGrp|73362|2022|PCT|1.00|99|0.00|VACCINE SERVICES|
20|FH_F111288_0_0|SrvcGrp|35668|2022|PDM|4565.00|99|0.00|CPT 29824|
20|FH_F143814_18062_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F118703_0_0|SrvcGrp|73004|2022|PDM|1134.00|99|0.00|AEG 8|
20|FH_F42473_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32604_0_0|SrvcGrp|14095|2022|PDM|90.00|99|0.00|RN VISIT|
20|FH_F122687_0_0|SrvcGrp|88596|2022|PDM|2732.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE|
20|FH_F38526_0_0|CSTM-ALL|CSTM-00|2020|PDM|5500.00|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F121090_07848_0|SrvcGrp|89149|2022|PDM|225.00|99|0.00|OP INTENSIVE|
20|FH_F143970_92656_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F82955_34266_0|SrvcGrp|76180|2022|PCT|1.38|99|0.00|AETNA CHEMOTHERAPY DRUGS|
20|FH_F39939_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F100681_73104_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F66880_25301_0|SrvcGrp|110585|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION I|
20|FH_F71183_29601_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F100906_0_0|SrvcGrp|98643|2022|PDM|557.00|99|0.00|AETNA AEG 1 WITHOUT LUMBER INJECTION|
20|FH_F104802_0_0|SrvcGrp|12682|2022|PDM|45.00|99|0.00|GROUP THERAPY|
20|FH_F109963_0_0|SrvcGrp|73006|2022|PDM|834.00|99|0.00|AEG 9|
20|FH_F87114_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.30|99|0.00|GENERAL ACUTE CARE|
20|FH_F86851_0_0|SrvcGrp|84970|2022|PDM|520.00|99|0.00|CPT 43243|
20|FH_F114064_0_0|SrvcGrp|73002|2022|PDM|1257.00|99|0.00|AEG 7|
20|FH_F90354_0_0|SrvcGrp|92502|2022|PDM|620.28|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|AEG 4 (NO REV)|
20|FH_F46832_0_0|SrvcGrp|17016|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F123756_45324_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123784_03264_0|SrvcGrp|48396|2022|PDM|163.00|99|0.00|OT SERVICES|
20|FH_F126527_0_0|SrvcGrp|84185|2022|PDM|110.00|99|0.00|RESPITE CARE|
20|FH_F136307_65791_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134011_84102_0|SrvcGrp|43567|2022|PDM|50.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F137147_75006_0|SrvcGrp|28213|2022|PDM|36225.00|99|0.00|MS DRG 472 ONLY|
20|FH_F142247_61244_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142690_31774_0|SrvcGrp|22389|2022|PDM|40.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F53732_0_0|SrvcGrp|50163|2022|PDM|67.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 8 HRS|
20|FH_F97582_46307_0|SrvcGrp|88977|2022|PDM|7288.00|99|0.00|C-SECTION DELIVERY|
20|FH_F138541_54840_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS|
20|FH_F138607_02760_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138627_82901_0|SrvcGrp|86842|2022|PDM|75.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F78267_18702_0|SrvcGrp|74530|2022|PCT|0.65|99|0.00|ENTERAL SUPPLIES|
20|FH_F140343_89052_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING-OP W/O HOME INFUSION|
20|FH_F140407_63841_0|SrvcGrp|113301|2022|PDM|16.94|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - ASTRAZENECA|
20|FH_F140407_63841_0|SrvcGrp|113637|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F140609_16063_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120152_0_0|SrvcGrp|67069|2022|PDM|22000.00|99|0.00|CPT 22634|
20|FH_F149541_85258_0|SrvcGrp|75419|2022|PDM|425.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F118943_64506_0|SrvcGrp|17013|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118943_64506_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|1375.00|99|0.00|AEG 7 (NO REV)|
20|FH_F117232_83221_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117267_07728_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F129483_77030_0|SrvcGrp|86831|2022|PDM|5.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F117240_37334_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
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_F90876_18447_0|SrvcGrp|74546|2022|PDM|432.60|99|0.00|HOSPICE SERVICES|
20|FH_F91472_96001_0|SrvcGrp|88978|2022|PDM|6287.00|99|0.00|VAGINAL DELIVERY|
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F119351_95377_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F119449_84032_0|SrvcGrp|89337|2022|PDM|950.00|99|0.00|DETOXIFICATION|
20|FH_F119449_84032_0|SrvcGrp|87317|2022|PDM|850.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F138283_0_0|SrvcGrp|14494|2022|PDM|24.50|99|0.00|CONTINUOUS HOMECARE|
20|FH_F148359_60191_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F148545_84047_0|SrvcGrp|46605|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F148552_68114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89932_10940_0|SrvcGrp|705|2022|PCT|0.45|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F92676_15063_0|SrvcGrp|67747|2022|PDM|9977.00|99|0.00|MASTECTOMY|
20|FH_F122245_0_0|SrvcGrp|42550|2022|PDM|1700.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F143054_26147_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F33581_0_0|SrvcGrp|14522|2022|PDM|3240.00|99|0.00|INTENSIVE/INTERMEDIATE CARE UNIT|
20|FH_F145988_06105_0|SrvcGrp|111935|2022|PCT|1.47|99|0.00|COVID-19 SPECIMEN COLLECTING ANY SOURCE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.96|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1 W/O REV|
20|FH_F100788_01420_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F42779_0_0|SrvcGrp|8950|2022|PDM|1757.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F111417_33613_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118587_20721_0|SrvcGrp|471|2022|PDM|808.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F40056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F34705_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS|
20|FH_F131699_08210_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F120954_0_0|SrvcGrp|108544|2022|PDM|201.60|99|0.00|SKILLED NURSING|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F88956_0_0|SrvcGrp|82037|2022|PDM|3594.00|99|0.00|AETNA ICU|
20|FH_F133341_23860_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147995_67037_0|SrvcGrp|73496|2022|PDM|1335.00|99|0.00|AETNA ER LEVEL V|
20|FH_F31542_0_0|SrvcGrp|10708|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F136393_0_0|SrvcGrp|110709|2022|PDM|8000.00|99|0.00|TIB/PER REVASC W/ATHER|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|136.72|99|0.00|HAPA WPA-NWPA 2012-13 ASC 238 W/O REV|
20|FH_F68868_0_0|SrvcGrp|12299|2022|PCT|0.68|99|0.00|PROSTHETICS/IMPLANTS/DEVICES|
20|FH_F141871_33024_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F116093_47327_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F115685_64064_0|SrvcGrp|86839|2022|PDM|75.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F120215_92064_0|SrvcGrp|74668|2022|PDM|278.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137573_33764_0|SrvcGrp|12659|2022|PDM|723.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F141590_90049_0|SrvcGrp|87317|2022|PDM|1347.89|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F126730_84737_0|SrvcGrp|73605|2022|PDM|957.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F101021_0_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F35388_0_0|SrvcGrp|11259|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|577.00|99|0.00|AEG 1 (NO REV)|
20|FH_F131228_01826_0|SrvcGrp|10391|2022|PDM|3617.47|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F63307_0_0|SrvcGrp|472|2022|PDM|495.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F67984_0_0|SrvcGrp|59423|2022|PDM|130.00|99|0.00|RN VISIT|
20|FH_F115330_34113_0|SrvcGrp|89417|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F46914_0_0|SrvcGrp|42762|2022|PDM|158.00|99|0.00|NURSING CARE|
20|FH_F151241_15139_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121980_66104_0|SrvcGrp|46903|2022|PDM|450.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F34963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38601_0_0|SrvcGrp|13640|2022|PDM|100.00|99|0.00|CPT 99202|
20|FH_F38607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113741_63303_0|SrvcGrp|48396|2022|PDM|81.60|99|0.00|OT SERVICES|
20|FH_F39907_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F77923_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F87054_0_0|SrvcGrp|73004|2022|PDM|1568.00|99|0.00|AEG 8|
20|FH_F87201_0_0|SrvcGrp|28978|2022|PDM|40.00|99|0.00|SKILLED NURSING NON IV RELATED- MOD TD|
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1174.00|99|0.00|AEG 7 (NO REV)|
20|FH_F36584_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD AV|
20|FH_F94786_07974_0|SrvcGrp|86847|2022|PDM|36.75|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|5202.00|99|0.00|AEG 9 (NO REV)|
20|FH_F114389_50131_0|SrvcGrp|26001|2022|PDM|236.69|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F114389_50131_0|SrvcGrp|105611|2022|PDM|62.58|99|0.00|HEADGEAR (MOD NU)|
20|FH_F114389_50131_0|SrvcGrp|19742|2022|PDM|123.08|99|0.00|MID-LINE INSERTION|
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 3 (NO REV)|
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|210.00|99|0.00|AEG 1 (NO REV)|
20|FH_F146912_90025_0|SrvcGrp|46903|2022|PDM|1226.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F146974_19709_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146914_75032_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F55493_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F69923_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CHOP HOME INFUSION|
20|FH_F36318_0_0|SrvcGrp|675|2022|PDM|1961.00|99|0.00|PEDIATRIC INPATIENT SVCS|
20|FH_F124637_77080_0|SrvcGrp|74668|2022|PDM|750.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132037_66002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133399_72211_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F131101_45840_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|2601.00|99|0.00|AEG 4 (NO REV)|
20|FH_F136708_06443_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113785_35763_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F138055_16146_0|SrvcGrp|73841|2022|PDM|300.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F148487_28210_0|SrvcGrp|75419|2022|PDM|535.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F144039_0_0|SrvcGrp|109764|2022|PDM|4590.00|99|0.00|REPAIR EYELID DEFECT|
20|FH_F132595_0_0|SrvcGrp|16679|2022|PDM|5335.00|99|0.00|LAPAROSCOPIC PROCEDURES|
20|FH_F122606_53818_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F134742_52806_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F134814_62230_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135719_45502_0|SrvcGrp|100765|2022|PCT|0.48|99|0.00|PT/OT/ST|
20|FH_F136778_62034_0|SrvcGrp|103913|2022|PCT|0.00|99|0.00|OP DIALYSIS|
20|FH_F54572_0_0|SrvcGrp|10393|2022|PDM|1900.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F115210_21043_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AEG 4 (NO REV)|
20|FH_F115723_78363_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F116393_07002_0|SrvcGrp|111283|2022|PDM|7.65|99|0.00|SYPHILIS TEST NON-TREP QUAL|
20|FH_F147416_19095_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F147586_44124_0|SrvcGrp|44066|2022|PDM|3103.00|99|0.00|CPT 57288|
20|FH_F147620_67119_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147414_92656_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F147560_30809_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F41013_0_0|SrvcGrp|28847|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY|
20|FH_F41803_0_0|SrvcGrp|34872|2022|PCT|0.80|99|0.00|INTRAOCULAR LENS|
20|FH_F44459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F48836_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F54552_0_0|SrvcGrp|24744|2022|PDM|115.00|99|0.00|PICC LINE INSERTION|
20|FH_F113585_20155_0|SrvcGrp|24745|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F138857_90025_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F138876_25302_0|SrvcGrp|24745|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F57953_0_0|SrvcGrp|32386|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKL (DME)|
20|FH_F113527_31023_0|SrvcGrp|16|2022|PDM|1018.00|99|0.00|ACUTE REHABILITATION|
20|FH_F151401_36607_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151439_18104_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151503_30067_0|SrvcGrp|109790|2022|PDM|14175.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F132258_45404_0|SrvcGrp|86844|2022|PDM|34.98|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F122088_75098_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145251_45107_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97501_31501_0|SrvcGrp|88978|2022|PDM|7987.00|99|0.00|VAGINAL DELIVERY|
20|FH_F135355_73112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135494_10941_0|SrvcGrp|89337|2022|PDM|600.00|99|0.00|DETOXIFICATION|
20|FH_F135781_60643_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135867_60625_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136096_02860_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136170_76132_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131506_18901_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131407_07607_0|SrvcGrp|22589|2022|PDM|25.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F121428_40202_0|SrvcGrp|10107|2022|PCT|0.27|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F121761_44130_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F121763_07202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F38013_0_0|SrvcGrp|13621|2022|PDM|544.00|99|0.00|SLEEP STUDIES|
20|FH_F129967_18915_0|SrvcGrp|90854|2022|PDM|819.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F129967_18915_0|SrvcGrp|73841|2022|PDM|277.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F111303_19087_0|SrvcGrp|86753|2022|PCT|1.05|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F111341_80501_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F47906_0_0|SrvcGrp|43837|2022|PCT|1.00|99|0.00|DME MOD NUKC|
20|FH_F33081_0_0|SrvcGrp|9939|2022|PDM|2200.00|99|0.00|ACUTE MEDICAL SVCS|
20|FH_F36476_0_0|SrvcGrp|997|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F48581_0_0|SrvcGrp|360|2022|PDM|710.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F116430_0_0|SrvcGrp|89989|2022|PDM|2652.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F132328_0_0|SrvcGrp|58636|2022|PDM|5234.00|99|0.00|CPT 62362|
20|FH_F132328_0_0|SrvcGrp|83642|2022|PDM|2049.00|99|0.00|CPT 29883|
20|FH_F112092_46845_0|SrvcGrp|90484|2022|PCT|1.00|99|0.00|NOS FLU VACC 3 YRS & > IM|
20|FH_F87557_33309_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128549_44224_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F130269_74107_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F98626_29118_0|SrvcGrp|90854|2022|PDM|2582.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F97221_29406_0|SrvcGrp|73485|2022|PDM|970.00|99|0.00|AETNA REHAB|
20|FH_F96960_35404_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F102960_50613_0|SrvcGrp|10362|2022|PDM|1000.00|99|0.00|CPT CODE 99282|
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 2 (NO REV)|
20|FH_F148079_06512_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F118815_61021_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F39266_0_0|SrvcGrp|16746|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|338.50|99|0.00|ASPG I|
20|FH_F103004_75840_0|SrvcGrp|997|2022|PCT|0.88|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F124710_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F32127_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F34048_0_0|SrvcGrp|997|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1420.00|99|0.00|AEG 7 (NO REV)|
20|FH_F40972_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|1089.90|99|0.00|AEG 10 (NO REV)|
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|807.00|99|0.00|AEG 3 (NO REV)|
20|FH_F86991_15122_0|SrvcGrp|85485|2022|PDM|1900.00|99|0.00|AQUEOUS SHUNT EYE W/GRAFT|
20|FH_F119795_0_0|SrvcGrp|82720|2022|PDM|3106.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F46832_0_0|SrvcGrp|22396|2022|PDM|60.00|99|0.00|IV IMMUNOGLOBULIN|
20|FH_F62577_0_0|SrvcGrp|58457|2022|PDM|1262.00|99|0.00|ASPG IV|
20|FH_F107200_0_0|SrvcGrp|27347|2022|PDM|1509.00|99|0.00|CPT 58558|
20|FH_F136390_46321_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F136426_19006_0|SrvcGrp|100961|2022|PDM|336.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY|
20|FH_F137147_75006_0|SrvcGrp|98007|2022|PDM|3300.00|99|0.00|FINGER/THUMB AMPUTATION|
20|FH_F137242_52722_0|SrvcGrp|88819|2022|PDM|927.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F142448_15701_0|SrvcGrp|24761|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142448_15701_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F142430_38863_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F142373_78727_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142530_60148_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F138627_82901_0|SrvcGrp|88827|2022|PDM|20.00|99|0.00|HOME INFUSION (HCFA)|
20|FH_F140616_43338_0|SrvcGrp|111927|2022|PCT|1.00|99|0.00|COVID-19 NON CDC|
20|FH_F140730_84106_0|SrvcGrp|104229|2022|PDM|93.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F140765_30315_0|SrvcGrp|113300|2022|PDM|40.00|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - MODERNA|
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PDM|605.00|99|0.00|AEG 2 (NO REV)|
20|FH_F120152_0_0|SrvcGrp|71666|2022|PDM|22000.00|99|0.00|CPT 63655|
20|FH_F148699_19403_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F118959_44830_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F147725_06002_0|SrvcGrp|100045|2022|PDM|4400.00|99|0.00|REVISION OF FOOT TENDON|
20|FH_F147900_48038_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117126_12801_0|SrvcGrp|10364|2022|PDM|1570.00|99|0.00|CPT CODE 99284|
20|FH_F117240_37334_0|SrvcGrp|75495|2022|PDM|4200.00|99|0.00|AEG 9|
20|FH_F137887_33756_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137901_60089_0|SrvcGrp|73842|2022|PDM|222.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F34371_0_0|SrvcGrp|15385|2022|PDM|45.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F38699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111046_0_0|SrvcGrp|78403|2022|PDM|0.25|99|0.00|AETNA MED RECORD|
20|FH_F39085_0_0|SrvcGrp|63|2022|PDM|525.00|99|0.00|SUBACUTE CARE|
20|FH_F95880_02726_0|SrvcGrp|90492|2022|PDM|226.00|99|0.00|BEHAVRAL QUALIT ANALYS VOICE|
20|FH_F44258_0_0|CSTM-ALL|CSTM-00|2020|PDM|320.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F146360_66502_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F49035_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F149664_33428_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F126679_62401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD 26|
20|FH_F117346_75093_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F31093_0_0|CSTM-ALL|CSTM-00|2020|PDM|1488.00|99|0.00|ASPG IV|
20|FH_F89932_10940_0|SrvcGrp|12840|2022|PCT|0.45|99|0.00|PACEMAKER|
20|FH_F72859_0_0|SrvcGrp|10649|2022|PDM|15.00|99|0.00|HOME INFUSION|
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|3276.00|99|0.00|AEG 9 (NO REV)|
20|FH_F67065_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143030_02895_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148599_98034_0|SrvcGrp|92760|2022|PCT|2.62|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142904_50322_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F68363_0_0|SrvcGrp|13631|2022|PDM|137.00|99|0.00|CPT 99213|
20|FH_F33726_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F143198_75219_0|SrvcGrp|75419|2022|PDM|314.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F44795_0_0|SrvcGrp|30958|2022|PDM|70.00|99|0.00|SKILLED LPN VISIT|
20|FH_F73304_0_0|CSTM-ALL|CSTM-00|2020|PDM|791.00|99|0.00|ASPG VI|
20|FH_F148361_68779_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133287_40215_0|SrvcGrp|12670|2022|PCT|0.28|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F68842_0_0|SrvcGrp|11110|2022|PDM|128.00|99|0.00|PT/OT/ST|
20|FH_F95360_08720_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120437_85202_0|SrvcGrp|43568|2022|PDM|171.08|99|0.00|SKILLED NURSING - RN|
20|FH_F135466_0_0|CSTM-ALL|CSTM-00|2020|PDM|1682.00|99|0.00|AEG 2 (NO REV)|
20|FH_F87293_18702_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F133291_33563_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KL|
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.00|99|0.00|ASPG I|
20|FH_F100785_54660_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F141870_85224_0|SrvcGrp|86853|2022|PDM|40.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F81373_64064_0|SrvcGrp|361|2022|PDM|9026.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F134430_86301_0|SrvcGrp|75419|2022|PDM|550.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F119775_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F131982_0_0|SrvcGrp|57967|2022|PDM|143.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F125049_44131_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F37568_0_0|SrvcGrp|11796|2022|PDM|65.00|99|0.00|DIETICIAN|
20|FH_F128296_37167_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141754_21703_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150059_54494_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148039_92629_0|SrvcGrp|108484|2022|PDM|725.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F98640_0_0|SrvcGrp|42550|2022|PDM|2826.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F117368_68114_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
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_F113257_19034_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F35411_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|MULTIPLE BIRTH|
20|FH_F148919_32806_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117807_86426_0|SrvcGrp|48396|2022|PDM|125.00|99|0.00|OT SERVICES|
20|FH_F56792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1707.00|99|0.00|ASPG VI WITH MOD SG|
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_F120430_32177_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127217_29650_0|SrvcGrp|89149|2022|PDM|228.00|99|0.00|OP INTENSIVE|
20|FH_F103360_68845_0|SrvcGrp|31072|2022|PDM|10350.00|99|0.00|MS DRG 794 ONLY|
20|FH_F44296_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F132127_61053_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77663_0_0|SrvcGrp|9811|2022|PDM|300.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F51438_0_0|SrvcGrp|33812|2022|PDM|150.00|99|0.00|IOP / MENTAL HEALTH / SUBSTANCE ABUSE|
20|FH_F36579_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALLIED MED-MOD 26|
20|FH_F97565_83301_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F148900_0_0|SrvcGrp|113271|2022|PDM|1293.00|99|0.00|GENICULAR NERVE BLOCK|
20|FH_F128615_78520_0|SrvcGrp|86722|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F98620_43920_0|SrvcGrp|73603|2022|PDM|9206.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F148361_68779_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37035_0_0|SrvcGrp|33827|2022|PDM|907.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 5|
20|FH_F146211_68144_0|CSTM-ALL|CSTM-00|2020|PDM|7651.00|99|0.00|AEG 9 (NO REV)|
20|FH_F144769_0_0|SrvcGrp|16|2022|PDM|2002.00|99|0.00|ACUTE REHABILITATION|
20|FH_F35278_0_0|SrvcGrp|28417|2022|PDM|70.00|99|0.00|SPEECH THERAPY|
20|FH_F145917_37604_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120550_91355_0|SrvcGrp|84897|2022|PCT|0.85|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F111813_08080_0|SrvcGrp|87910|2022|PCT|1.00|99|0.00|VANCOMYCIN HCL INJECT 500MG|
20|FH_F97561_30030_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F120906_65542_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127441_45822_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F137946_0_0|SrvcGrp|113233|2022|PDM|42.13|99|0.00|COVID-19 SARS-COV-2 ANTB QUANTITATIVE (HFCA)|
20|FH_F135236_02840_0|SrvcGrp|112224|2022|PDM|565.70|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F148222_18603_0|SrvcGrp|46605|2022|PDM|75.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F72047_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SURGERY|
20|FH_F126581_45638_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 4 (NO REV)|
20|FH_F93114_85016_0|SrvcGrp|53987|2022|PCT|1.00|99|0.00|PHOTOTHERAPY|
20|FH_F86319_16365_0|SrvcGrp|73606|2022|PDM|773.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F135249_73114_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150462_30458_0|SrvcGrp|14893|2022|PDM|50.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F148500_50129_0|SrvcGrp|104363|2022|PCT|0.80|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F139173_0_0|SrvcGrp|65720|2022|PDM|172.09|99|0.00|RESPITE CARE|
20|FH_F145758_20745_0|CSTM-ALL|CSTM-00|2020|PDM|1190.34|99|0.00|AEG 8 (NO REV)|
20|FH_F137067_0_0|SrvcGrp|88159|2022|PDM|5250.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F125249_0_0|SrvcGrp|85790|2022|PDM|1400.00|99|0.00|TREATMENT OF FRACTURE|
20|FH_F82714_18848_0|SrvcGrp|80266|2022|PDM|36.17|99|0.00|THERAPEUTIC EXERCISES|
20|FH_F131277_29340_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F87619_0_0|SrvcGrp|73004|2022|PDM|1229.00|99|0.00|AEG 8|
20|FH_F123276_20737_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123922_84102_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140762_0_0|SrvcGrp|94902|2022|PDM|2508.00|99|0.00|INSERT ANT SEGMENT DRAIN EXT|
20|FH_F126687_72560_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135173_06519_0|SrvcGrp|54142|2022|PDM|195.00|99|0.00|OP INTENSIVE SERVICES|
20|FH_F72764_0_0|SrvcGrp|29930|2022|PDM|400.00|99|0.00|DIALYSIS|
20|FH_F148319_37042_0|SrvcGrp|115368|2022|PCT|1.00|99|0.00|COVID-19 VACCINES AND ADMINSTRATION|
20|FH_F137067_0_0|SrvcGrp|89857|2022|PDM|6019.00|99|0.00|REMOVAL OF SPINAL LAMINA|
20|FH_F113253_72206_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98922_40351_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F131228_01826_0|CSTM-ALL|CSTM-00|2020|PDM|5236.35|99|0.00|AEG 7 (NO REV)|
20|FH_F69322_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|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F93881_15009_0|SrvcGrp|75483|2022|PDM|1484.00|99|0.00|AEG 3|
20|FH_F34854_0_0|SrvcGrp|17531|2022|PDM|600.00|99|0.00|ELECTRO CONVULSIVE TREATMENT|
20|FH_F143895_47631_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123533_63825_0|SrvcGrp|472|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F143528_0_0|SrvcGrp|72121|2022|PDM|4359.60|99|0.00|ARTHOSCOPY|
20|FH_F94261_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129964_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|OCN F/S PRICING: GLOBAL|
20|FH_F55673_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PDM|595.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F37679_0_0|SrvcGrp|27140|2022|PDM|7.50|99|0.00|HORMONAL INJECTION THERAPY (MOD SH)|
20|FH_F56276_0_0|SrvcGrp|52245|2022|PDM|160.00|99|0.00|INTENSIVE OUTPATIENT|
20|FH_F39349_0_0|CSTM-ALL|CSTM-00|2020|PDM|632.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F141527_36830_0|SrvcGrp|24754|2022|PDM|11.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F46359_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F122687_0_0|SrvcGrp|33982|2022|PDM|2185.00|99|0.00|CPT 28296|
20|FH_F102185_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F110180_0_0|SrvcGrp|32703|2022|PDM|1900.00|99|0.00|ICU|
20|FH_F140913_63017_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120362_23321_0|SrvcGrp|88620|2022|PDM|93.00|99|0.00|SKILLED NURSING RN|
20|FH_F145590_45242_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150462_30458_0|SrvcGrp|10579|2022|PDM|50.00|99|0.00|HYDRATION THERAPY - 2 LITERS|
20|FH_F116984_28092_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F127415_45822_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F103621_63122_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F39273_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F43118_0_0|SrvcGrp|10944|2022|PCT|0.70|99|0.00|EMERGENCY ROOM|
20|FH_F135175_45121_0|SrvcGrp|90854|2022|PDM|700.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F40418_0_0|SrvcGrp|6|2022|PCT|0.85|99|0.00|OP SURGERY|
20|FH_F130747_0_0|SrvcGrp|77021|2022|PDM|8843.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F136092_0_0|SrvcGrp|83521|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F65440_0_0|SrvcGrp|11663|2022|PCT|0.75|99|0.00|IMPLANTS|
20|FH_F124026_53188_0|SrvcGrp|87131|2022|PDM|303.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F130138_02915_0|SrvcGrp|4109|2022|PCT|0.96|99|0.00|ACUTE PSYCH|
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_F122725_32216_0|SrvcGrp|16|2022|PDM|1898.00|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_F123848_03257_0|SrvcGrp|48396|2022|PDM|169.00|99|0.00|OT SERVICES|
20|FH_F62579_0_0|SrvcGrp|50166|2022|PDM|95.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 3 HRS|
20|FH_F63249_0_0|SrvcGrp|46424|2022|PDM|95.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F128278_21401_0|SrvcGrp|89337|2022|PDM|911.00|99|0.00|DETOXIFICATION|
20|FH_F127090_45601_0|SrvcGrp|22589|2022|PDM|54.06|99|0.00|CHEMOTHERAPY NOC|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1518.00|99|0.00|ASPG VIII- MOD 50|
20|FH_F110562_33409_0|SrvcGrp|86723|2022|PDM|955.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F146400_71860_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F45977_0_0|SrvcGrp|40407|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD NU KF|
20|FH_F46352_0_0|SrvcGrp|40582|2022|PCT|0.85|99|0.00|HOSPICE SVCS|
20|FH_F117733_91362_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F118025_60641_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F141657_85715_0|SrvcGrp|74668|2022|PDM|275.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F62802_0_0|SrvcGrp|58508|2022|PDM|1350.00|99|0.00|UNLISTED CODES OP SURGERY|
20|FH_F120437_85202_0|SrvcGrp|26871|2022|PDM|50.65|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3 HRS|
20|FH_F43164_0_0|CSTM-ALL|CSTM-00|2020|PDM|412.00|99|0.00|SKILLED NURSING CARE|
20|FH_F38249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|TAMPA GENERAL HOSP MSDRG @ 70%|
20|FH_F109562_32827_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F139825_0_0|SrvcGrp|95819|2022|PDM|6885.00|99|0.00|GONIOTOMY|
20|FH_F36118_0_0|SrvcGrp|12264|2022|PDM|80.00|99|0.00|DIETICIAN OR LPN SERVICES|
20|FH_F117911_86403_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116988_0_0|SrvcGrp|75491|2022|PDM|1328.00|99|0.00|AEG 7|
20|FH_F139377_02301_0|SrvcGrp|109330|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F139527_15642_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150746_31210_0|SrvcGrp|92501|2022|PDM|415.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F120144_77031_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F116806_0_0|SrvcGrp|107130|2022|PDM|887.26|99|0.00|EXCISION OF MOUTH LESION|
20|FH_F35416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F120099_86305_0|SrvcGrp|73605|2022|PDM|1221.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|1097.00|99|0.00|AEG 4 (NO REV)|
20|FH_F114173_18901_0|SrvcGrp|472|2022|PDM|477.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F110732_31513_0|SrvcGrp|94843|2022|PDM|169.00|99|0.00|AETNA MEDICARE INTENSIVE OP|
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|2938.00|99|0.00|AEG 8 (NO REV)|
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|741.00|99|0.00|AEG 5  (NO REV)|
20|FH_F122377_91007_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F151043_71901_0|SrvcGrp|10363|2022|PDM|300.00|99|0.00|CPT CODE 99283|
20|FH_F97880_63501_0|SrvcGrp|73559|2022|PDM|14676.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F148939_62650_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F101441_0_0|SrvcGrp|96354|2022|PDM|8105.00|99|0.00|REMOVAL OF ANKLE JOINT|
20|FH_F72788_0_0|SrvcGrp|29817|2022|PDM|5389.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F134410_46807_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F37081_0_0|SrvcGrp|38|2022|PDM|4500.00|99|0.00|NORMAL DELIVERY|
20|FH_F92498_07442_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148550_48126_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134410_46807_0|SrvcGrp|112323|2022|PDM|400.00|99|0.00|LABORATORY|
20|FH_F112794_01040_0|SrvcGrp|94743|2022|PCT|1.00|99|0.00|FLUZONE VACC IM (>=3 YRS)|
20|FH_F73764_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F138017_73129_0|SrvcGrp|23279|2022|PDM|458.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F122649_0_0|SrvcGrp|95660|2022|PDM|112.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F117762_0_0|SrvcGrp|89861|2022|PDM|4992.00|99|0.00|LUMBAR LAMINOTOMY|
20|FH_F148667_0_0|SrvcGrp|26273|2022|PDM|2856.00|99|0.00|CPT 29880|
20|FH_F132849_0_0|SrvcGrp|104879|2022|PDM|1275.00|99|0.00|REHABILIITATION W/O SC/MCC|
20|FH_F138017_73129_0|SrvcGrp|10363|2022|PDM|917.00|99|0.00|CPT CODE 99283|
20|FH_F114825_32789_0|SrvcGrp|73841|2022|PDM|368.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F125214_12428_0|SrvcGrp|73606|2022|PCT|0.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F138452_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 4 (NO REV)|
20|FH_F147086_84751_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F98020_50138_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 6 (NO REV)|
20|FH_F130661_04441_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 6 (NO REV)|
20|FH_F35167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F147181_27514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102620_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F150930_64485_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137986_0_0|SrvcGrp|36591|2022|PDM|3000.00|99|0.00|CPT 63685|
20|FH_F39211_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F122386_70578_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F122394_75979_0|SrvcGrp|90854|2022|PDM|775.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F50078_0_0|SrvcGrp|36068|2022|PDM|47.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F98900_42001_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F67924_0_0|SrvcGrp|24028|2022|PDM|46.00|99|0.00|LICENSED PRACTICAL NURSE|
20|FH_F117762_0_0|SrvcGrp|77582|2022|PDM|3120.00|99|0.00|CPT 31255|
20|FH_F110804_11373_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F149522_83221_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F101083_0_0|SrvcGrp|77486|2022|PDM|2415.00|99|0.00|AETNA REPAIR OF TENDON|
20|FH_F126116_0_0|SrvcGrp|104009|2022|PDM|6726.00|99|0.00|REMOVE AND REPLACE PM GEN SINGL|
20|FH_F131187_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63385_0_0|SrvcGrp|36991|2022|PCT|0.45|99|0.00|IMPLANTS|
20|FH_F117617_80439_0|SrvcGrp|48396|2022|PDM|150.00|99|0.00|OT SERVICES|
20|FH_F114207_35243_0|SrvcGrp|86844|2022|PDM|35.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F74424_0_0|SrvcGrp|48004|2022|PDM|105.00|99|0.00|HOME HEALTH AIDE|
20|FH_F150442_28451_0|SrvcGrp|97895|2022|PDM|12684.00|99|0.00|REVISE KNEE 2|
20|FH_F123545_44512_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|HAPA EPA ASC 26|
20|FH_F126702_33139_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F31542_0_0|SrvcGrp|9937|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F112853_22408_0|SrvcGrp|37385|2022|PDM|0.70|99|0.00|AMINO ACIDS|
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)|
20|FH_F145328_90301_0|SrvcGrp|113322|2022|PDM|275.00|99|0.00|MED ASSIST TX BUPRE ORAL|
20|FH_F110240_0_0|CSTM-ALL|CSTM-00|2020|PDM|716.00|99|0.00|AEG 10 (NO REV)|
20|FH_F39689_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OCCUPATIONAL / ENVIRONMENTAL SVCS|
20|FH_F122928_39563_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119291_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F129535_0_0|SrvcGrp|79593|2022|PDM|550.00|99|0.00|CPT 45378|
20|FH_F132729_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F131982_0_0|SrvcGrp|57965|2022|PDM|131.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F102561_75146_0|SrvcGrp|72996|2022|PDM|2400.00|99|0.00|AEG 4|
20|FH_F133427_48811_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37640_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: ALL|
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2033.00|99|0.00|AEG 6 (NO REV)|
20|FH_F120437_85202_0|SrvcGrp|86825|2022|PDM|114.77|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F144191_0_0|SrvcGrp|34606|2022|PDM|2600.00|99|0.00|CPT 29827|
20|FH_F69104_0_0|SrvcGrp|17067|2022|PDM|902.82|99|0.00|ASPG II|
20|FH_F127217_29650_0|SrvcGrp|16069|2022|PDM|691.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F92676_15063_0|SrvcGrp|78939|2022|PDM|3631.33|99|0.00|MON VALLEY ASC 908|
20|FH_F132285_89103_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F127181_64155_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133129_45863_0|SrvcGrp|3178|2022|PDM|699.00|99|0.00|ACUTE PSYCH|
20|FH_F106540_26330_0|SrvcGrp|27877|2022|PDM|210.00|99|0.00|ULTRASOUND|
20|FH_F125368_24153_0|SrvcGrp|89337|2022|PDM|862.00|99|0.00|DETOXIFICATION|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ASPG I|
20|FH_F132785_17961_0|SrvcGrp|537|2022|PCT|0.38|99|0.00|OBSERVATION SERVICES|
20|FH_F120437_85202_0|SrvcGrp|86853|2022|PDM|85.54|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F150949_0_0|SrvcGrp|41334|2022|PDM|10500.00|99|0.00|TOTAL KNEE|
20|FH_F131433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40797_0_0|SrvcGrp|110|2022|PDM|450.00|99|0.00|CD - REHABILITATION|
20|FH_F88956_0_0|SrvcGrp|78504|2022|PDM|4486.00|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F123181_75057_0|SrvcGrp|75545|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F136751_0_0|SrvcGrp|67068|2022|PDM|16000.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F133287_40215_0|SrvcGrp|73497|2022|PDM|537.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F146224_84321_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F133467_03301_0|SrvcGrp|90397|2022|PDM|1750.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F130195_44143_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124928_04210_0|SrvcGrp|26160|2022|PDM|39.62|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F128246_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39039_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F118542_60188_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F41739_0_0|SrvcGrp|11000|2022|PCT|0.70|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F74947_0_0|SrvcGrp|33166|2022|PDM|650.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|984.64|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F112853_22408_0|SrvcGrp|41455|2022|PDM|0.78|99|0.00|ENTERAL FORMULA - PEDIATRICS (SOY BASED)|
20|FH_F143202_32114_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F141827_80003_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F99720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F101983_17578_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F150948_0_0|SrvcGrp|113855|2022|PDM|3000.00|99|0.00|SPINE FIXATION|
20|FH_F121009_76180_0|SrvcGrp|75545|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F33182_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|ACUTE PSYCH|
20|FH_F141870_85224_0|SrvcGrp|24744|2022|PDM|60.00|99|0.00|PICC LINE INSERTION|
20|FH_F83031_0_0|SrvcGrp|44712|2022|PDM|105.00|99|0.00|OT SVCS|
20|FH_F101840_76054_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F149840_80002_0|SrvcGrp|87394|2022|PDM|135.00|99|0.00|HCPCS G0152 (HCFA)|
20|FH_F31405_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F86434_0_0|SrvcGrp|35670|2022|PDM|7500.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F67192_0_0|SrvcGrp|10667|2022|PDM|657.00|99|0.00|BOARDER BABY SVCS|
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F148555_0_0|SrvcGrp|110820|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F150948_0_0|SrvcGrp|93432|2022|PDM|10500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136507_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP 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_F87173_15136_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F35411_0_0|SrvcGrp|13127|2022|PDM|539.00|99|0.00|DIALYSIS|
20|FH_F133021_00910_0|SrvcGrp|75505|2022|PCT|1.00|99|0.00|CARDIAC STUDIES|
20|FH_F130553_18640_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME THERAPY|
20|FH_F142807_67114_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128717_54449_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP|
20|FH_F118672_29036_0|CSTM-ALL|CSTM-00|2020|PDM|2135.00|99|0.00|AEG 2 (NO REV)|
20|FH_F98020_50138_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|432.00|99|0.00|HAPA EPA ASC 48|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER UEKF|
20|FH_F40446_0_0|SrvcGrp|30941|2022|PDM|350.00|99|0.00|NEWBORN NURSERY|
20|FH_F127487_60169_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F134936_01020_0|SrvcGrp|48394|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F114332_19973_0|SrvcGrp|66562|2022|PCT|1.05|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F122392_78207_0|SrvcGrp|46903|2022|PDM|583.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F99420_91326_0|SrvcGrp|13724|2022|PCT|0.85|99|0.00|PHARMACY SVCS|
20|FH_F134396_80045_0|SrvcGrp|73841|2022|PDM|460.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F120848_20912_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F140689_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150922_02452_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F132818_24701_0|SrvcGrp|109057|2022|PCT|0.88|99|0.00|CARDIAC STUDIES|
20|FH_F149000_07701_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F140248_42420_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143412_70503_0|SrvcGrp|88621|2022|PDM|75.00|99|0.00|SKILLED NURSING LPN|
20|FH_F143488_84770_0|SrvcGrp|104357|2022|PDM|1630.00|99|0.00|DACRYOCYSTORHINOSTOMY|
20|FH_F98480_0_0|CSTM-ALL|CSTM-00|2020|PDM|530.00|99|0.00|AETNA AMBULATORY DEFAULT|
20|FH_F130937_98002_0|SrvcGrp|86722|2022|PDM|196.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F136273_37601_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F82691_0_0|SrvcGrp|79177|2022|PDM|48.00|99|0.00|SPEECH THERAPY|
20|FH_F119918_38201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126054_30022_0|SrvcGrp|104796|2022|PDM|210.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F62765_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F135840_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F135840_0_0|SrvcGrp|112793|2022|PDM|550.00|99|0.00|BREAST PROCEDURE|
20|FH_F134669_17403_0|SrvcGrp|73842|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130763_0_0|SrvcGrp|85778|2022|PDM|4574.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F100782_0_0|SrvcGrp|97528|2022|PDM|734.44|99|0.00|WINDBER MEDICAL CNTR ASC 105|
20|FH_F132883_31602_0|SrvcGrp|24752|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F148186_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119379_0_0|SrvcGrp|92010|2022|PDM|672.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE|
20|FH_F145702_22192_0|SrvcGrp|48385|2022|PDM|84.00|99|0.00|SPEECH THERAPY|
20|FH_F139722_30022_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116753_0_0|CSTM-ALL|CSTM-00|2020|PDM|3489.00|99|0.00|AEG 10 (NO REV)|
20|FH_F146160_52803_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121687_04401_0|SrvcGrp|108922|2022|PCT|1.38|99|0.00|CHEMOTHERAPY ADMINISTRATION|
20|FH_F120720_24541_0|SrvcGrp|104228|2022|PDM|125.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F90438_08873_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F114824_44484_0|SrvcGrp|73842|2022|PDM|135.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111744_32514_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134668_08003_0|SrvcGrp|89149|2022|PDM|230.00|99|0.00|OP INTENSIVE|
20|FH_F136359_0_0|SrvcGrp|67066|2022|PDM|19570.00|99|0.00|CERVICAL SURGERY|
20|FH_F85097_0_0|SrvcGrp|537|2022|PDM|85.00|99|0.00|OBSERVATION SERVICES|
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120417_63124_0|CSTM-ALL|CSTM-00|2020|PDM|932.00|99|0.00|AEG 6 (NO REV)|
20|FH_F127934_62274_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143579_43160_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134171_72301_0|SrvcGrp|3178|2022|PDM|822.00|99|0.00|ACUTE PSYCH|
20|FH_F146100_17403_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145708_89030_0|SrvcGrp|29347|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F110589_70809_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F34182_0_0|SrvcGrp|8950|2022|PDM|2953.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F71345_0_0|SrvcGrp|8962|2022|PDM|105.37|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F133972_27103_0|SrvcGrp|86848|2022|PDM|35.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F120719_27540_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F115616_0_0|SrvcGrp|89404|2022|PDM|6138.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F150223_30720_0|SrvcGrp|87077|2022|PDM|160.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F116806_0_0|SrvcGrp|107068|2022|PDM|1923.16|99|0.00|REPAIR NOSE TO LIP FISTULA|
20|FH_F100060_0_0|SrvcGrp|12491|2022|PCT|0.50|99|0.00|PACEMAKER|
20|FH_F145561_80210_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130364_01331_0|SrvcGrp|73606|2022|PDM|1022.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F145641_06902_0|SrvcGrp|92009|2022|PDM|2527.00|99|0.00|CARPAL SCAPHOID FRACTURE|
20|FH_F126975_43551_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F146372_28681_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 2 (NO REV)|
20|FH_F121476_0_0|SrvcGrp|111250|2022|PDM|1067.00|99|0.00|LEVONORGESTREL|
20|FH_F114824_44484_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F34182_0_0|SrvcGrp|63|2022|PDM|927.00|99|0.00|SUBACUTE CARE|
20|FH_F115430_0_0|SrvcGrp|58755|2022|PDM|5720.00|99|0.00|INJECTION PROC FOR JOINT|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAMPTON ROADS GAST MOD KM|
20|FH_F144228_0_0|SrvcGrp|114147|2022|PDM|1078.00|99|0.00|WINDPIPE INCISION|
20|FH_F127148_63011_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139512_77550_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F31714_0_0|SrvcGrp|3586|2022|PDM|52750.00|99|0.00|DRG 525 OTHER HEART ASSIST SYSTEM IMPLANT|
20|FH_F34852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F134249_05060_0|SrvcGrp|78422|2022|PDM|5280.00|99|0.00|VBAC DELIVERY|
20|FH_F119657_39111_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F76022_0_0|SrvcGrp|11336|2022|PCT|0.85|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F146595_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F50334_0_0|SrvcGrp|12403|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F135670_01749_0|SrvcGrp|47183|2022|PDM|126.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F138024_40509_0|SrvcGrp|88819|2022|PDM|739.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F90501_71101_0|SrvcGrp|23585|2022|PCT|0.37|99|0.00|IMPLANTS|
20|FH_F134972_84117_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F134326_14094_0|SrvcGrp|76501|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F134668_08003_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133943_01606_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F103220_0_0|SrvcGrp|99150|2022|PDM|11000.00|99|0.00|LAP BAND SURGERY|
20|FH_F149517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112672_11788_0|SrvcGrp|74668|2022|PDM|187.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115616_0_0|SrvcGrp|65350|2022|PDM|4474.00|99|0.00|KNEE ARTHRO/ANTER|
20|FH_F126188_59404_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F139169_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F70804_0_0|SrvcGrp|14500|2022|PDM|41.51|99|0.00|STATIONARY/AMBULATORY/DISPOSAL PUMPS|
20|FH_F110507_33462_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F145839_45244_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150145_20124_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133877_84117_0|SrvcGrp|97506|2022|PDM|93.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F97840_54729_0|SrvcGrp|73605|2022|PDM|2103.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F32594_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F136037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F79863_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ASANTE 2010 FIXED MCARE DEFAULT|
20|FH_F70205_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|222.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 235 W/O REV|
20|FH_F109405_73106_0|SrvcGrp|73842|2022|PDM|120.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133749_84604_0|SrvcGrp|112437|2022|PDM|22.00|99|0.00|IV IMMUNOGLOBULIN (HCFA)|
20|FH_F133805_83401_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_F148905_85390_0|SrvcGrp|46903|2022|PDM|1000.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F95623_84015_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F126896_60010_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133207_0_0|SrvcGrp|82108|2022|PDM|3527.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F128379_0_0|SrvcGrp|100919|2022|PDM|3319.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|AEG 3 (NO REV)|
20|FH_F114941_0_0|SrvcGrp|87077|2022|PDM|124.84|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F79824_0_0|SrvcGrp|29109|2022|PDM|12778.00|99|0.00|PACEMAKER|
20|FH_F150306_51566_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130329_64114_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116753_0_0|SrvcGrp|106785|2022|PDM|7465.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F135622_34471_0|SrvcGrp|89149|2022|PDM|225.00|99|0.00|OP INTENSIVE|
20|FH_F145641_06902_0|SrvcGrp|33724|2022|PDM|2847.00|99|0.00|ARTHROSCOPY|
20|FH_F121687_04401_0|SrvcGrp|100266|2022|PCT|1.38|99|0.00|TB INTRADERMAL TEST|
20|FH_F78893_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134608_18017_0|SrvcGrp|112612|2022|PDM|150.00|99|0.00|ENDOCERVICAL CURETTAGE (HCFA)|
20|FH_F92893_75110_0|SrvcGrp|80317|2022|PDM|152.00|99|0.00|RESPITE CARE|
20|FH_F83978_66739_0|SrvcGrp|997|2022|PCT|0.42|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F125115_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149106_07042_0|CSTM-ALL|CSTM-00|2020|PDM|2247.00|99|0.00|AEG 7 (NO REV)|
20|FH_F100782_0_0|SrvcGrp|105159|2022|PDM|1176.31|99|0.00|WINDBER MEDICAL CNTR ASC 403|
20|FH_F126063_43078_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F110881_63125_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31714_0_0|SrvcGrp|13065|2022|PDM|800.00|99|0.00|EMERGENCY ROOM|
20|FH_F72543_0_0|SrvcGrp|68988|2022|PDM|108.00|99|0.00|ST VISIT|
20|FH_F122551_75605_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F105145_75075_0|SrvcGrp|11259|2022|PCT|1.15|99|0.00|DRUGS|
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|PSYCHIATRIC PARTIAL HOSPITALIZATION (IP) - ADOLESCENT|
20|FH_F116023_10027_0|SrvcGrp|89149|2022|PDM|100.00|99|0.00|OP INTENSIVE|
20|FH_F116040_24637_0|SrvcGrp|24753|2022|PDM|10.00|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F116040_24637_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131697_33444_0|SrvcGrp|38006|2022|PDM|1100.00|99|0.00|CPT CODE 59426|
20|FH_F132131_33060_0|SrvcGrp|108484|2022|PDM|250.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F133153_44113_0|SrvcGrp|86722|2022|PDM|176.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F131430_17566_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F131430_17566_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F111605_80524_0|SrvcGrp|104329|2022|PCT|1.00|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F111605_80524_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|6000.00|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F148761_33311_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148761_33311_0|SrvcGrp|105021|2022|PDM|75.00|99|0.00|EVALUATION OF SPEECH (HCFA)|
20|FH_F151059_60435_0|SrvcGrp|66265|2022|PDM|106.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F151061_02720_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F34998_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ACUTE PSYCH|
20|FH_F139172_40207_0|SrvcGrp|3178|2022|PDM|836.00|99|0.00|ACUTE PSYCH|
20|FH_F139377_02301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139673_63011_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150765_05001_0|SrvcGrp|23683|2022|PDM|79.00|99|0.00|SKILLED NURSING RN|
20|FH_F150765_05001_0|SrvcGrp|43567|2022|PDM|164.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F150882_84041_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F124322_64131_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F80974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113826_51445_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147216_48307_0|SrvcGrp|108622|2022|PDM|444.00|99|0.00|SUB ACUTE CARE LEVEL II|
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|3270.00|99|0.00|AEG 5  (NO REV) W/O MUSCULOSKELETAL ENDOSCOPY/ARTHROSCOPY|
20|FH_F97640_37043_0|SrvcGrp|73461|2022|PDM|5147.00|99|0.00|AETNA NICU IV|
20|FH_F108680_0_0|SrvcGrp|67072|2022|PDM|4400.00|99|0.00|CPT 22845|
20|FH_F144651_0_0|SrvcGrp|114176|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES|
20|FH_F149602_07109_0|SrvcGrp|113231|2022|PDM|105.33|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 TITER|
20|FH_F35557_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1414794 AM HOME PAT DME MOD UE|
20|FH_F99420_91326_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F116806_0_0|SrvcGrp|107084|2022|PDM|1923.16|99|0.00|OPEN TREATMENT OF MANDIBULAR CONDYLAR FRACTURE|
20|FH_F47037_0_0|SrvcGrp|3809|2022|PDM|525.00|99|0.00|HOSPICE CARE|
20|FH_F147214_48162_0|SrvcGrp|42622|2022|PDM|638.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F112306_81428_0|SrvcGrp|104336|2022|PCT|1.00|99|0.00|DENOSUMAB INJECTION|
20|FH_F36299_0_0|SrvcGrp|3378|2022|PCT|0.75|99|0.00|OBSERVATION SVCS|
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|1687.00|99|0.00|AEG 8 (NO REV)|
20|FH_F127086_62246_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97184_26101_0|SrvcGrp|73603|2022|PDM|9293.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F94643_90501_0|SrvcGrp|29023|2022|PDM|56.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132096_89118_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138478_0_0|SrvcGrp|107877|2022|PDM|510.32|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F150982_0_0|SrvcGrp|82112|2022|PDM|2202.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F132944_06480_0|SrvcGrp|75545|2022|PDM|460.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F123745_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F125656_92868_0|SrvcGrp|21920|2022|PDM|35.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F117799_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F139442_60143_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|HSS ASC|
20|FH_F40490_0_0|SrvcGrp|17709|2022|PCT|0.58|99|0.00|CT / MRI / MRA|
20|FH_F134870_97015_0|SrvcGrp|62241|2022|PCT|1.15|99|0.00|HIGH COST DRUGS|
20|FH_F134847_0_0|SrvcGrp|35670|2022|PDM|8525.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F120157_93103_0|SrvcGrp|100859|2022|PDM|275.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F37081_0_0|SrvcGrp|409|2022|PCT|0.80|99|0.00|ER SVCS|
20|FH_F139974_37214_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36683_0_0|SrvcGrp|18795|2022|PDM|31218.00|99|0.00|MS DRG 216|
20|FH_F139565_0_0|SrvcGrp|42428|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 65855|
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F148860_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F132160_0_0|SrvcGrp|109767|2022|PCT|0.00|99|0.00|COVER EYE W/ MEMBRANE INCIDENTAL CODES|
20|FH_F137767_01841_0|SrvcGrp|73610|2022|PCT|0.53|99|0.00|AETNA IMPLANTS|
20|FH_F140295_0_0|SrvcGrp|67066|2022|PDM|10609.00|99|0.00|CERVICAL SURGERY|
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1203.00|99|0.00|ASPG IV|
20|FH_F110732_31513_0|SrvcGrp|14187|2022|PDM|1022.00|99|0.00|MRI|
20|FH_F114206_37203_0|SrvcGrp|86829|2022|PDM|4.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F114207_35243_0|SrvcGrp|86848|2022|PDM|35.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F128506_77304_0|SrvcGrp|705|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F143050_0_0|SrvcGrp|47348|2022|PDM|254.00|99|0.00|AIR AMBULANCE SVC PER MILE|
20|FH_F148961_33403_0|SrvcGrp|89337|2022|PDM|710.00|99|0.00|DETOXIFICATION|
20|FH_F101083_0_0|SrvcGrp|72994|2022|PDM|788.00|99|0.00|AEG 3|
20|FH_F137788_72632_0|SrvcGrp|75506|2022|PCT|1.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F149602_07109_0|SrvcGrp|113234|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2 & INF A&B AMP PRB|
20|FH_F140689_0_0|SrvcGrp|87077|2022|PDM|165.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F114171_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F76382_0_0|SrvcGrp|473|2022|PDM|475.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F59312_0_0|SrvcGrp|471|2022|PDM|579.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146204_0_0|SrvcGrp|67991|2022|PDM|2376.00|99|0.00|CPT 59150|
20|FH_F138987_0_0|SrvcGrp|80920|2022|PDM|646.00|99|0.00|HOSPICE SERVICES|
20|FH_F124739_64429_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F35088_0_0|SrvcGrp|115|2022|PDM|1041.00|99|0.00|SKILLED NURSING CARE|
20|FH_F137767_01841_0|SrvcGrp|73606|2022|PDM|969.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F116806_0_0|SrvcGrp|107092|2022|PDM|973.15|99|0.00|RESECT FACE TUM < 2 CM|
20|FH_F99920_63141_0|SrvcGrp|90707|2022|PDM|110.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F34853_0_0|SrvcGrp|3420|2022|PDM|10731.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F136806_0_0|SrvcGrp|105488|2022|PDM|2218.00|99|0.00|SHOULDER ANDOSCOPY PROCEDURES|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|327.00|99|0.00|HAPA EPA ASC 38|
20|FH_F39443_0_0|SrvcGrp|30372|2022|PDM|154.00|99|0.00|HAPA WPA ASC 15|
20|FH_F148550_48126_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F102163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139785_92629_0|SrvcGrp|75419|2022|PDM|2660.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F142376_0_0|SrvcGrp|93741|2022|PDM|6482.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY|
20|FH_F127071_82435_0|SrvcGrp|87317|2022|PDM|785.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F145629_45243_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133585_0_0|SrvcGrp|109428|2022|PDM|131.00|99|0.00|INTRVASC US NONCORONARY|
20|FH_F127651_44124_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F121476_0_0|SrvcGrp|108849|2022|PDM|2641.00|99|0.00|BON VOID FILLER-PUTTY IMPLNT|
20|FH_F90501_71101_0|SrvcGrp|75483|2022|PDM|3100.00|99|0.00|AEG 3|
20|FH_F143611_84065_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F32212_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93122_01854_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F148668_33177_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110562_33409_0|SrvcGrp|46903|2022|PDM|1400.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F133749_84604_0|SrvcGrp|112418|2022|PDM|25.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F145641_06902_0|SrvcGrp|41334|2022|PDM|21013.00|99|0.00|TOTAL KNEE|
20|FH_F110441_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F149059_19702_0|SrvcGrp|87077|2022|PDM|158.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F54592_0_0|CSTM-ALL|CSTM-00|2020|PDM|32.50|99|0.00|INOTROPIC THERAPY (MOD SH)|
20|FH_F54592_0_0|SrvcGrp|24747|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F54592_0_0|SrvcGrp|13929|2022|PDM|19.00|99|0.00|GROWTH HORMONE|
20|FH_F54592_0_0|SrvcGrp|19742|2022|PDM|115.00|99|0.00|MID-LINE INSERTION|
20|FH_F122470_78229_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F122564_53809_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F84712_0_0|SrvcGrp|72996|2022|PDM|3091.00|99|0.00|AEG 4|
20|FH_F84935_0_0|SrvcGrp|74694|2022|PCT|0.90|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F85553_0_0|SrvcGrp|14240|2022|PDM|239.00|99|0.00|EMERGENCY ROOM SVCS LEVEL II|
20|FH_F87053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|141.99|99|0.00|HAPA WPA-NWPA 2012-13 ASC 236 W/O REV|
20|FH_F105145_75075_0|SrvcGrp|67065|2022|PDM|94264.00|99|0.00|CERVICAL SURGERY|
20|FH_F146763_76109_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F51136_0_0|SrvcGrp|11606|2022|PDM|1475.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)|
20|FH_F115979_46107_0|SrvcGrp|73701|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F116055_59804_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F131867_37211_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131927_66043_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139289_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35216_0_0|SrvcGrp|13123|2022|PDM|650.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F114151_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137906_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F150939_0_0|SrvcGrp|100239|2022|PCT|0.00|99|0.00|GLUCOSE|
20|FH_F69982_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F151399_0_0|SrvcGrp|106317|2022|PDM|3945.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|1022.40|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F59732_0_0|SrvcGrp|41464|2022|PDM|60.00|99|0.00|REPAIR OF INFUSION DEVICE|
20|FH_F61292_0_0|SrvcGrp|13724|2022|PCT|0.49|99|0.00|PHARMACY SVCS|
20|FH_F125074_18104_0|SrvcGrp|48394|2022|PDM|55.98|99|0.00|SKILLED NURSING SERVICES|
20|FH_F148265_06067_0|SrvcGrp|88162|2022|PDM|10872.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F110086_21742_0|CSTM-ALL|CSTM-00|2020|PDM|490.00|99|0.00|AEG 1 (NO REV)|
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|741.75|99|0.00|AEG 4 (NO REV)|
20|FH_F49653_0_0|SrvcGrp|35500|2022|PCT|0.55|99|0.00|OP SURGERY|
20|FH_F69322_0_0|SrvcGrp|196|2022|PDM|881.00|99|0.00|CD (ADOLESCENT) - DETOX|
20|FH_F129656_15005_0|SrvcGrp|46104|2022|PDM|60.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F35202_0_0|SrvcGrp|9830|2022|PDM|84.00|99|0.00|OT SVCS|
20|FH_F135237_31015_0|SrvcGrp|48398|2022|PDM|150.00|99|0.00|PT SERVICES|
20|FH_F139515_0_0|SrvcGrp|92365|2022|PDM|14420.00|99|0.00|FUSION OF SACROILIAC JOINT|
20|FH_F91034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110086_21742_0|SrvcGrp|44064|2022|PDM|1800.00|99|0.00|CPT 52351|
20|FH_F128136_48025_0|SrvcGrp|84185|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F62892_0_0|SrvcGrp|53746|2022|PDM|35.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F137946_0_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F90818_0_0|SrvcGrp|26274|2022|PDM|5500.00|99|0.00|CPT 29877|
20|FH_F56276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F35388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 10 (NO REV)|
20|FH_F45873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135237_31015_0|SrvcGrp|88620|2022|PDM|130.00|99|0.00|SKILLED NURSING RN|
20|FH_F103621_63122_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130807_20721_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|8815.00|99|0.00|AEG 10 (NO REV)|
20|FH_F37679_0_0|SrvcGrp|24752|2022|PDM|15.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F123302_33407_0|SrvcGrp|46903|2022|PDM|644.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F37443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F72890_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123466_93420_0|SrvcGrp|73842|2022|PDM|355.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|AEG 3 (NO REV)|
20|FH_F45873_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F110142_39056_0|SrvcGrp|76094|2022|PDM|147.93|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F139296_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|OP SVCS|
20|FH_F143772_75225_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151144_35801_0|SrvcGrp|87385|2022|PDM|1015.97|99|0.00|PARTIAL REMOVAL OF EYE FLUID|
20|FH_F151179_84074_0|SrvcGrp|73002|2022|PDM|1549.00|99|0.00|AEG 7|
20|FH_F151179_84074_0|SrvcGrp|73008|2022|PDM|1365.00|99|0.00|AEG 10|
20|FH_F151226_33155_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F121930_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113139_0_0|SrvcGrp|103503|2022|PDM|2750.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2501000 MOD KN (HCFA)|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.43|99|0.00|DELAWARE VALLEY- ASC 209|
20|FH_F142070_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F106822_0_0|SrvcGrp|101743|2022|PDM|7.95|99|0.00|IM ADMIN 1ST/ONLY COMPONENT|
20|FH_F72845_0_0|CSTM-ALL|CSTM-00|2020|PDM|1541.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F88456_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|950.00|99|0.00|AEG 2 (NO REV)|
20|FH_F115895_0_0|SrvcGrp|58775|2022|PDM|4774.00|99|0.00|CORPECTOMY|
20|FH_F105440_46383_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
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_F119435_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PDM|591.00|99|0.00|ASPG III|
20|FH_F94786_07974_0|SrvcGrp|86853|2022|PDM|36.75|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F132627_0_0|SrvcGrp|16559|2022|PDM|16.32|99|0.00|HOME INFUSION THERAPY|
20|FH_F132988_0_0|SrvcGrp|99172|2022|PDM|6468.75|99|0.00|CPT 28740|
20|FH_F132988_0_0|SrvcGrp|92009|2022|PDM|4493.01|99|0.00|CARPAL SCAPHOID FRACTURE|
20|FH_F137067_0_0|SrvcGrp|88065|2022|PDM|18900.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F128027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120901_0_0|SrvcGrp|41334|2022|PDM|8973.00|99|0.00|TOTAL KNEE|
20|FH_F93252_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114389_50131_0|SrvcGrp|105610|2022|PDM|109.90|99|0.00|REPLACEMENT FULL FACE MASK (MOD NU)|
20|FH_F33635_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147081_02130_0|SrvcGrp|87441|2022|PDM|504.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F69923_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CARVE OUTS MOD NU|
20|FH_F38081_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F39561_0_0|SrvcGrp|3327|2022|PDM|130.53|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F40603_0_0|SrvcGrp|3406|2022|PDM|200.00|99|0.00|CPT 99214|
20|FH_F40643_0_0|SrvcGrp|705|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F45372_0_0|SrvcGrp|269|2022|PDM|4600.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F67172_0_0|SrvcGrp|360|2022|PDM|1083.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F67172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|AEG 2 (NO REV)|
20|FH_F136647_43506_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F114638_25309_0|SrvcGrp|3259|2022|PDM|827.00|99|0.00|ACUTE REHABILITATION|
20|FH_F113845_32746_0|SrvcGrp|105440|2022|PDM|375.00|99|0.00|AETNA TERANIAL MAGN STIM REDETEMINE|
20|FH_F113845_32746_0|SrvcGrp|89149|2022|PDM|145.00|99|0.00|OP INTENSIVE|
20|FH_F139372_34698_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138456_33543_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138855_84067_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F115048_78520_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F42840_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BRA LADY PROSTHETICS|
20|FH_F136913_68803_0|SrvcGrp|73497|2022|PDM|3576.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F113713_17013_0|SrvcGrp|86642|2022|PDM|85.00|99|0.00|AETNA PSYCH DIAG EVAL W/MED SRVC (MOD TD)|
20|FH_F43503_0_0|SrvcGrp|13551|2022|PDM|407.00|99|0.00|NEWBORN NURSERY|
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|WELLPATH PROPRIERARY ASC II|
20|FH_F147348_19406_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F147586_44124_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F147586_44124_0|CSTM-ALL|CSTM-00|2020|PDM|2894.00|99|0.00|AEG 9 (NO REV)|
20|FH_F144988_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PDM|2956.00|99|0.00|AEG 8 (NO REV)|
20|FH_F134087_0_0|SrvcGrp|99162|2022|PDM|10455.00|99|0.00|CPT 24366|
20|FH_F135351_0_0|SrvcGrp|93807|2022|PDM|7221.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F37850_0_0|SrvcGrp|2741|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F72445_0_0|SrvcGrp|13606|2022|PDM|38.00|99|0.00|HOME INFUSION|
20|FH_F41803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F47605_0_0|SrvcGrp|22077|2022|PDM|710.00|99|0.00|RESIDENTIAL TREATMENT SVCS|
20|FH_F48693_0_0|SrvcGrp|44583|2022|PDM|475.00|99|0.00|COLORECTAL CANCER SCREENING - G0121 W/MOD SG|
20|FH_F48693_0_0|SrvcGrp|25038|2022|PDM|831.14|99|0.00|SLEEP STUDIES|
20|FH_F138658_75022_0|SrvcGrp|89149|2022|PDM|190.00|99|0.00|OP INTENSIVE|
20|FH_F138770_75142_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138992_72703_0|SrvcGrp|2738|2022|PCT|0.32|99|0.00|IMPLANTS|
20|FH_F138992_72703_0|CSTM-ALL|CSTM-00|2020|PDM|1584.00|99|0.00|AEG 3 (NO REV)|
20|FH_F57953_0_0|SrvcGrp|32390|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKE (DME)|
20|FH_F119888_0_0|SrvcGrp|106300|2022|PDM|352.48|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|570.00|99|0.00|AEG 3 (NO REV)|
20|FH_F151285_72956_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151440_84095_0|SrvcGrp|74668|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151479_75605_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122032_32413_0|SrvcGrp|46903|2022|PDM|599.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F122152_70123_0|SrvcGrp|101562|2022|PCT|1.00|99|0.00|HOSPICE/PHYSICIAN|
20|FH_F135453_70726_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F135489_70508_0|SrvcGrp|73485|2022|PDM|945.00|99|0.00|AETNA REHAB|
20|FH_F146266_0_0|SrvcGrp|72121|2022|PDM|4100.00|99|0.00|ARTHOSCOPY|
20|FH_F114707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139715_0_0|SrvcGrp|116188|2022|PCT|0.49|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F90817_0_0|SrvcGrp|90997|2022|PDM|2096.00|99|0.00|REPAIR SHOULDER CAPSULE (HCFA)|
20|FH_F143529_84737_0|SrvcGrp|63297|2022|PDM|93.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F143533_30013_0|SrvcGrp|74785|2022|PDM|124.00|99|0.00|BILATERAL STUDY|
20|FH_F143533_30013_0|SrvcGrp|81487|2022|PDM|205.00|99|0.00|NON INVASIVE VASCULAR STUDY|
20|FH_F95629_0_0|SrvcGrp|78878|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD NU KL|
20|FH_F48785_0_0|SrvcGrp|28235|2022|PDM|70.00|99|0.00|PT/OT|
20|FH_F132421_74538_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120799_92651_0|SrvcGrp|75419|2022|PDM|725.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F99520_0_0|CSTM-ALL|CSTM-00|2020|PCT|46.00|99|0.00|OP SVCS|
20|FH_F116579_45822_0|SrvcGrp|89149|2022|PDM|149.88|99|0.00|OP INTENSIVE|
20|FH_F113563_70560_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 8 (NO REV)|
20|FH_F113649_01752_0|SrvcGrp|86853|2022|PDM|45.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F84394_17402_0|CSTM-ALL|CSTM-00|2020|PDM|3948.00|99|0.00|AEG 4 (NO REV)|
20|FH_F51276_0_0|SrvcGrp|27051|2022|PDM|29.33|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS (MOD SJ)|
20|FH_F39567_0_0|SrvcGrp|24|2022|PDM|3000.00|99|0.00|CARDIAC CATH|
20|FH_F39567_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F40091_0_0|SrvcGrp|17071|2022|PCT|0.70|99|0.00|ASPG IV|
20|FH_F59732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
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|39871|2022|PCT|0.59|99|0.00|MS DRG 619-621 ONLY OTLR|
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|9774|2022|PDM|2790.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F123507_63869_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F43663_0_0|SrvcGrp|10951|2022|PDM|293.00|99|0.00|PARTIAL HOSPITALIZATION PSYCH/CD|
20|FH_F33322_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|BURN SERVICES|
20|FH_F101081_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37659_0_0|SrvcGrp|65|2022|PDM|1756.00|99|0.00|OBSTETRICAL CARE|
20|FH_F148254_89503_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F143780_33873_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136684_0_0|SrvcGrp|112919|2022|PDM|70.75|99|0.00|BEVACIZUMAB INJECTION (HCFA)|
20|FH_F127711_0_0|SrvcGrp|77461|2022|PDM|4313.00|99|0.00|CPT 52356|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 252-254 CV SURGERY|
20|FH_F33592_0_0|SrvcGrp|3810|2022|PDM|109.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F73402_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71686_0_0|SrvcGrp|229|2022|PDM|600.00|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)|
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|ASPG 3 HEARTLAND HEALTHCARE|
20|FH_F35344_0_0|SrvcGrp|9488|2022|PDM|6644.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F118366_17110_0|SrvcGrp|80920|2022|PDM|425.00|99|0.00|HOSPICE SERVICES|
20|FH_F40332_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|721.00|99|0.00|AEG 2 (NO REV)|
20|FH_F148266_45419_0|CSTM-ALL|CSTM-00|2020|PDM|1310.00|99|0.00|AEG 8 (NO REV)|
20|FH_F91994_0_0|SrvcGrp|14614|2022|PDM|4712.00|99|0.00|LITHOTRIPSY|
20|FH_F126002_11946_0|SrvcGrp|52953|2022|PDM|60.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F87254_0_0|SrvcGrp|38364|2022|PDM|1200.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94862_0_0|SrvcGrp|72996|2022|PDM|700.00|99|0.00|AEG 4|
20|FH_F39273_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F66222_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|B CODES|
20|FH_F129658_77043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128853_43560_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140913_63017_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128401_44615_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F86332_75081_0|SrvcGrp|43572|2022|PDM|100.00|99|0.00|PICC-LINE INSERTION|
20|FH_F39819_0_0|SrvcGrp|31198|2022|PDM|4315.00|99|0.00|NY DRG 089 ONLY|
20|FH_F40332_0_0|SrvcGrp|16|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION|
20|FH_F128982_44221_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82173_72712_0|CSTM-ALL|CSTM-00|2020|PDM|3753.00|99|0.00|AEG 5  (NO REV)|
20|FH_F41200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130977_0_0|SrvcGrp|33659|2022|PDM|400.00|99|0.00|DIALYSIS SERVICES|
20|FH_F137067_0_0|SrvcGrp|26273|2022|PDM|3491.00|99|0.00|CPT 29880|
20|FH_F109645_0_0|SrvcGrp|23681|2022|PDM|95.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F39176_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BONE MARROW TRANSPLANT|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 291-293 HEART FAILURE & SHOCK|
20|FH_F70104_0_0|SrvcGrp|44427|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY SVCS (VISIT LVL)|
20|FH_F38798_0_0|SrvcGrp|10645|2022|PDM|100.00|99|0.00|PICC LINE INSERTION KIT|
20|FH_F137707_32724_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F56137_0_0|SrvcGrp|45882|2022|PDM|95.00|99|0.00|PT|
20|FH_F34413_0_0|SrvcGrp|15132|2022|PDM|975.00|99|0.00|ACUTE IP MEDICAL SVCS|
20|FH_F132092_0_0|SrvcGrp|97703|2022|PDM|169.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F136092_0_0|SrvcGrp|90707|2022|PDM|105.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F120249_43215_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F102500_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135924_02906_0|SrvcGrp|73500|2022|PDM|249.50|99|0.00|AETNA ER LEVEL I|
20|FH_F131463_19096_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131407_07607_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F116527_70443_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F33725_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|GENERAL ACUTE CARE|
20|FH_F121803_66502_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151143_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111292_33136_0|SrvcGrp|82760|2022|PDM|78.00|99|0.00|ASSAY OF SERUM AMYLASE|
20|FH_F111301_33122_0|SrvcGrp|110234|2022|PCT|0.84|99|0.00|RADIOLOGY SERVICES|
20|FH_F37209_0_0|SrvcGrp|6|2022|PCT|0.90|99|0.00|OP SURGERY|
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|9511|2022|PDM|150.00|99|0.00|OBSERVATION SVCS|
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.97|99|0.00|AEG 4 (NO REV)|
20|FH_F33081_0_0|SrvcGrp|6|2022|PDM|5000.00|99|0.00|OP SURGERY|
20|FH_F72666_0_0|SrvcGrp|43|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F88831_84123_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F141035_0_0|SrvcGrp|83846|2022|PDM|7008.00|99|0.00|RELEASE PALM CONTRACTURE|
20|FH_F102905_85541_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F134202_0_0|SrvcGrp|35669|2022|PDM|4133.98|99|0.00|CPT 63650|
20|FH_F132810_0_0|SrvcGrp|31973|2022|PDM|25.00|99|0.00|HOME THERAPY|
20|FH_F39955_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136347_30328_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F136386_30901_0|SrvcGrp|112999|2022|PCT|1.80|99|0.00|RADIATION ONCOLOGY|
20|FH_F118152_20151_0|SrvcGrp|29023|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F120489_63552_0|SrvcGrp|73497|2022|PDM|571.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F134155_07016_0|SrvcGrp|112507|2022|PDM|437.00|99|0.00|PARTIAL HOSPITALIZATION (0-18 YRS)|
20|FH_F137242_52722_0|SrvcGrp|72602|2022|PDM|927.00|99|0.00|ECT|
20|FH_F138955_43420_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142448_15701_0|SrvcGrp|46605|2022|PDM|88.31|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F142547_70002_0|SrvcGrp|14945|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F138584_30912_0|SrvcGrp|113398|2022|PDM|925.00|99|0.00|REMOVAL OF JAW BONE LESION|
20|FH_F138627_82901_0|SrvcGrp|86838|2022|PDM|50.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F78267_18702_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ENTERAL NUTRIENTS|
20|FH_F140668_68745_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120152_0_0|SrvcGrp|77021|2022|PDM|11000.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F149441_28401_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F118943_64506_0|SrvcGrp|46605|2022|PDM|50.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F38332_0_0|SrvcGrp|72|2022|PDM|363.00|99|0.00|NEWBORN NURSERY|
20|FH_F67880_0_0|SrvcGrp|24714|2022|PCT|0.75|99|0.00|INTRAOCULAR LENS|
20|FH_F147725_06002_0|SrvcGrp|59840|2022|PDM|2250.00|99|0.00|TYMPANOSTOMY|
20|FH_F129434_98271_0|SrvcGrp|73605|2022|PDM|1326.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F117093_40041_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117098_20186_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F117108_37841_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137938_29036_0|SrvcGrp|103913|2022|PCT|0.66|99|0.00|OP DIALYSIS|
20|FH_F45303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F90613_05001_0|SrvcGrp|90163|2022|PDM|1283.00|99|0.00|AETNA IP PSYCH CONSTANT OBS (<= 17 YEARS OF AGE)|
20|FH_F132736_0_0|SrvcGrp|51672|2022|PDM|7161.00|99|0.00|MS DRG 286-287 ONLY|
20|FH_F142007_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F35685_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BUCK LAB|
20|FH_F43156_0_0|SrvcGrp|64|2022|PCT|0.75|99|0.00|AMBULATORY SURGERY|
20|FH_F102947_44084_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F40972_0_0|SrvcGrp|16|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION|
20|FH_F69245_84047_0|SrvcGrp|89337|2022|PDM|704.00|99|0.00|DETOXIFICATION|
20|FH_F70844_15317_0|SrvcGrp|81879|2022|PCT|1.00|99|0.00|LABORATORY W/ REV/HCPC|
20|FH_F142087_0_0|SrvcGrp|89404|2022|PDM|15500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F109279_0_0|SrvcGrp|79593|2022|PDM|600.00|99|0.00|CPT 45378|
20|FH_F77462_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36237_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS|
20|FH_F148425_01507_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F148554_85016_0|SrvcGrp|115443|2022|PDM|1301.00|99|0.00|REPAIR LEAD PACE DEFIB ONE|
20|FH_F120757_83843_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F36409_0_0|SrvcGrp|13722|2022|PDM|94.50|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE|
20|FH_F97140_91730_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118672_29036_0|CSTM-ALL|CSTM-00|2020|PDM|3549.00|99|0.00|AEG 5  (NO REV)|
20|FH_F148886_60621_0|SrvcGrp|73461|2022|PDM|2265.00|99|0.00|AETNA NICU IV|
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|1151.00|99|0.00|AEG 7 (NO REV)|
20|FH_F33800_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.40|99|0.00|OP SVCS|
20|FH_F127422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125049_44131_0|SrvcGrp|73700|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F31944_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F118027_28801_0|SrvcGrp|73841|2022|PDM|461.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F148890_45133_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117756_75402_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F121306_32207_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148900_0_0|SrvcGrp|110571|2022|PDM|668.00|99|0.00|NERVE BLOCK INJECTION 8|
20|FH_F72704_0_0|SrvcGrp|43892|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F73985_0_0|SrvcGrp|3069|2022|PCT|0.54|99|0.00|IMPLANTS|
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_F93332_0_0|SrvcGrp|93089|2022|PDM|7025.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON (HCFA)|
20|FH_F127567_44070_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F41201_0_0|SrvcGrp|65|2022|PCT|0.73|99|0.00|OBSTETRICAL CARE|
20|FH_F97540_32114_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110925_01104_0|SrvcGrp|29023|2022|PDM|82.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.50|99|0.00|ASPG VI|
20|FH_F138020_20016_0|SrvcGrp|75499|2022|PDM|388.50|99|0.00|CRITICAL CARE|
20|FH_F70984_0_0|SrvcGrp|68001|2022|PDM|1000.00|99|0.00|CPT 57460 57461 57522|
20|FH_F49338_0_0|SrvcGrp|31187|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF (DME)|
20|FH_F123895_52722_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F70104_0_0|SrvcGrp|42976|2022|PDM|48.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F31597_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F143821_60559_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F118194_50841_0|SrvcGrp|86837|2022|PDM|545.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F40834_0_0|SrvcGrp|38|2022|PDM|3820.00|99|0.00|NORMAL DELIVERY|
20|FH_F120294_46322_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F143388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145537_02061_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F143820_28405_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F141607_27021_0|SrvcGrp|48396|2022|PDM|135.00|99|0.00|OT SERVICES|
20|FH_F137984_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92276_32308_0|SrvcGrp|20096|2022|PDM|97608.00|99|0.00|MS DRG 222-223 ONLY|
20|FH_F148339_71303_0|SrvcGrp|16069|2022|PDM|600.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F143528_0_0|SrvcGrp|96839|2022|PDM|8400.00|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F39992_0_0|SrvcGrp|25850|2022|PDM|42.25|99|0.00|RN HOURLY HOME CARE|
20|FH_F40186_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F93720_12303_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F100762_51104_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F38377_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CHILDREN'S MERCY IV THERAPY|
20|FH_F93791_0_0|SrvcGrp|705|2022|PCT|1.03|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F110263_0_0|SrvcGrp|27261|2022|PDM|8084.00|99|0.00|CPT 27446|
20|FH_F148222_18603_0|SrvcGrp|88620|2022|PDM|102.00|99|0.00|SKILLED NURSING RN|
20|FH_F116291_11570_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F125249_0_0|SrvcGrp|54962|2022|PDM|2200.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)|
20|FH_F31798_0_0|SrvcGrp|13295|2022|PDM|1890.00|99|0.00|PET SCAN|
20|FH_F116237_43235_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F127036_43724_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F135307_73142_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129088_68763_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83451_0_0|SrvcGrp|14614|2022|PDM|3500.00|99|0.00|LITHOTRIPSY|
20|FH_F143528_0_0|SrvcGrp|27344|2022|PDM|1914.15|99|0.00|OP SURGERY (CPT 42821)|
20|FH_F82714_18848_0|SrvcGrp|73500|2022|PDM|642.00|99|0.00|AETNA ER LEVEL I|
20|FH_F148255_72703_0|SrvcGrp|10577|2022|PDM|31.50|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F93949_02720_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F128970_54729_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128973_44256_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F125519_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.25|99|0.00|GENERAL ACUTE CARE|
20|FH_F38383_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|TRANSPLANT ACQUISITION|
20|FH_F82696_16335_0|SrvcGrp|30312|2022|PCT|0.65|99|0.00|OP SURGERY|
20|FH_F141527_36830_0|SrvcGrp|86830|2022|PDM|3.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F133534_33483_0|SrvcGrp|73842|2022|PDM|189.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131234_32207_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F145758_20745_0|CSTM-ALL|CSTM-00|2020|PDM|1638.12|99|0.00|AEG 9 (NO REV)|
20|FH_F142897_07018_0|SrvcGrp|113297|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - PFIZER|
20|FH_F148760_12953_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148760_12953_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F151154_91761_0|SrvcGrp|66265|2022|PDM|119.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F151201_90020_0|SrvcGrp|90854|2022|PDM|1100.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F121329_33015_0|SrvcGrp|76501|2022|PDM|345.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F121880_54935_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115990_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115990_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129130_92562_0|SrvcGrp|73462|2022|PDM|5813.32|99|0.00|AETNA NICU III|
20|FH_F82933_0_0|CSTM-ALL|CSTM-00|2020|PDM|8564.81|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F117525_0_0|SrvcGrp|72992|2022|PDM|800.00|99|0.00|AEG 2|
20|FH_F91818_02828_0|SrvcGrp|46903|2022|PDM|377.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F97761_04072_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F106822_0_0|SrvcGrp|100286|2022|PDM|3.00|99|0.00|IMMUN ADMIN ORAL/NASAL ADDL (HCFA)|
20|FH_F63414_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|1064.00|99|0.00|AEG 4 (NO REV)|
20|FH_F114916_30309_0|SrvcGrp|100921|2022|PDM|2100.00|99|0.00|SPI  PROSTH DEVICE|
20|FH_F115895_0_0|SrvcGrp|89404|2022|PDM|10079.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F103800_70811_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F105362_44601_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F133534_33483_0|SrvcGrp|89417|2022|PDM|394.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F82714_18848_0|SrvcGrp|113465|2022|PCT|1.10|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F120280_64701_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141515_50010_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F116024_13203_0|SrvcGrp|89337|2022|PDM|491.00|99|0.00|DETOXIFICATION|
20|FH_F124965_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F116731_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143528_0_0|SrvcGrp|107187|2022|PDM|2459.10|99|0.00|REVISE TWO EYE MUSCLES|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD RR/KF) - CPD 1963706|
20|FH_F116327_75701_0|SrvcGrp|104078|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F137067_0_0|SrvcGrp|92415|2022|PDM|7350.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|1257.00|99|0.00|AEG 6 (NO REV)|
20|FH_F121467_75165_0|SrvcGrp|46903|2022|PDM|800.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F129096_77833_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121164_61761_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F76303_0_0|SrvcGrp|73524|2022|PDM|18.00|99|0.00|PHYSICAL THERAPY|
20|FH_F124783_92408_0|SrvcGrp|89337|2022|PDM|1498.00|99|0.00|DETOXIFICATION|
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|415.30|99|0.00|2005 ASPG GROUPER I|
20|FH_F115127_0_0|SrvcGrp|103550|2022|PDM|580.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F91835_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS|
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|827.00|99|0.00|AEG 10 (NO REV)|
20|FH_F72369_0_0|SrvcGrp|25750|2022|PDM|1800.00|99|0.00|SCLERAL COVER SHELL|
20|FH_F122725_32216_0|SrvcGrp|104800|2022|PDM|372.00|99|0.00|ELECTROENCEPHALOGRAM|
20|FH_F63249_0_0|SrvcGrp|43567|2022|PDM|95.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F125069_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130905_60187_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121303_15501_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116126_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149266_38556_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F130364_01331_0|CSTM-ALL|CSTM-00|2020|PDM|3031.00|99|0.00|AEG 8 (NO REV)|
20|FH_F149139_07522_0|SrvcGrp|112762|2022|PDM|45.23|99|0.00|INFECTIOUS AGENT ANTIGEN DETECTION|
20|FH_F130123_24171_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F71345_0_0|SrvcGrp|9828|2022|PDM|46.45|99|0.00|HOME HEALTH AIDE|
20|FH_F109577_0_0|SrvcGrp|53987|2022|PDM|35.00|99|0.00|PHOTOTHERAPY|
20|FH_F138951_41101_0|SrvcGrp|14949|2022|PDM|55.00|99|0.00|HOME INFUSION|
20|FH_F83978_66739_0|SrvcGrp|110875|2022|PDM|1479.00|99|0.00|CARPAL TUNNEL SURGERY|
20|FH_F138418_51201_0|SrvcGrp|75506|2022|PCT|0.90|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F117206_0_0|SrvcGrp|90608|2022|PDM|698.00|99|0.00|PROCTOSIGMOIDOSCOPY DIAGNOSTICS|
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 5  (NO REV)|
20|FH_F127806_63044_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125135_60008_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F112729_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121687_04401_0|SrvcGrp|108927|2022|PCT|1.00|99|0.00|INJ CLINDAMYCIN PHOSP|
20|FH_F146471_63110_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120735_40012_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F118146_33062_0|SrvcGrp|75419|2022|PDM|397.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F133207_0_0|SrvcGrp|26275|2022|PDM|2632.00|99|0.00|CPT 29826|
20|FH_F147959_33573_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 1 (NO REV)|
20|FH_F134928_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F88672_0_0|SrvcGrp|87679|2022|PDM|819.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F138024_40509_0|SrvcGrp|12659|2022|PDM|739.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F130329_64114_0|SrvcGrp|86852|2022|PDM|22.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F132922_91302_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145852_67203_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116806_0_0|SrvcGrp|107022|2022|PDM|1923.16|99|0.00|FACE BONE GRAFT|
20|FH_F120930_0_0|SrvcGrp|79101|2022|PDM|2200.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F125407_68756_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121476_0_0|SrvcGrp|108841|2022|PDM|30208.00|99|0.00|CARDIOVERTER DEFIBRILLATOR|
20|FH_F150165_06032_0|SrvcGrp|92366|2022|PDM|4100.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F132883_31602_0|SrvcGrp|17016|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|AEG 5  (NO REV)|
20|FH_F90334_23323_0|SrvcGrp|471|2022|PDM|472.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|728.00|99|0.00|ASPG II|
20|FH_F149219_01966_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150165_06032_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F125173_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F133867_84075_0|SrvcGrp|46692|2022|PDM|42.25|99|0.00|RN NURSING SERVICES|
20|FH_F133972_27103_0|SrvcGrp|29076|2022|PDM|35.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|971.00|99|0.00|AEG 5  (NO REV)|
20|FH_F96160_32207_0|SrvcGrp|19742|2022|PCT|0.00|99|0.00|MID-LINE INSERTION|
20|FH_F146124_06112_0|SrvcGrp|110586|2022|PCT|0.00|99|0.00|MEDICAL SERVICES|
20|FH_F83978_66739_0|SrvcGrp|110877|2022|PDM|888.00|99|0.00|COLONOSCOPY AND BIOPSY|
20|FH_F142376_0_0|SrvcGrp|98563|2022|PDM|17545.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F133875_80027_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F143771_0_0|SrvcGrp|83857|2022|PDM|657.00|99|0.00|IP HOSPICE SVCS|
20|FH_F105581_19053_0|SrvcGrp|27969|2022|PCT|0.00|99|0.00|HOME HEALTH AIDE|
20|FH_F105623_77901_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
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_F39209_0_0|SrvcGrp|472|2022|PDM|1100.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F41516_0_0|SrvcGrp|34549|2022|PCT|0.95|99|0.00|CAT SCAN|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PDM|1551.00|99|0.00|ASPG IX|
20|FH_F94786_07974_0|SrvcGrp|94102|2022|PDM|787.50|99|0.00|HOME VENT NON-INVASIVE INTER|
20|FH_F94786_07974_0|SrvcGrp|22592|2022|PDM|36.75|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F94786_07974_0|SrvcGrp|22389|2022|PDM|15.75|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F131608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132988_0_0|SrvcGrp|107839|2022|PDM|2057.62|99|0.00|INCISE FLEXOR CARPI RADIALIS|
20|FH_F130274_63033_0|SrvcGrp|48396|2022|PDM|70.00|99|0.00|OT SERVICES|
20|FH_F72204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F119214_0_0|SrvcGrp|83824|2022|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES|
20|FH_F114389_50131_0|SrvcGrp|86834|2022|PDM|30.30|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F55812_0_0|SrvcGrp|53747|2022|PDM|35.00|99|0.00|RESPITE CARE|
20|FH_F81731_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146985_12205_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147014_33612_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F62767_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F38688_0_0|SrvcGrp|17083|2022|PDM|1210.00|99|0.00|ASPG X|
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|11837.00|99|0.00|AEG 5  (NO REV)|
20|FH_F91998_0_0|SrvcGrp|36591|2022|PDM|1836.00|99|0.00|CPT 63685|
20|FH_F92493_0_0|SrvcGrp|35670|2022|PDM|12311.20|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F129549_01238_0|SrvcGrp|95661|2022|PDM|177.45|99|0.00|RESPITE CARE (HCFA)|
20|FH_F124227_01230_0|SrvcGrp|76501|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F150910_0_0|SrvcGrp|113855|2022|PDM|3000.00|99|0.00|SPINE FIXATION|
20|FH_F121799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132592_68305_0|SrvcGrp|112064|2022|PCT|0.94|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F56693_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114666_30342_0|SrvcGrp|90365|2022|PDM|3000.00|99|0.00|REPAIR METACARPAL FRACTURE|
20|FH_F139556_85006_0|SrvcGrp|74792|2022|PCT|1.89|99|0.00|POLYSOMNOGRAPHY|
20|FH_F148424_01440_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122739_43558_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F43919_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136778_62034_0|SrvcGrp|112967|2022|PCT|1.20|99|0.00|LABORATORY SERVICES|
20|FH_F136807_43220_0|SrvcGrp|48398|2022|PDM|83.00|99|0.00|PT SERVICES|
20|FH_F136913_68803_0|SrvcGrp|75505|2022|PCT|7.50|99|0.00|CARDIAC STUDIES|
20|FH_F32783_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F39622_0_0|SrvcGrp|51|2022|PDM|12500.00|99|0.00|KNEE REPLACEMENT|
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ASPG III|
20|FH_F74283_0_0|SrvcGrp|42785|2022|PDM|75.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F115210_21043_0|SrvcGrp|84939|2022|PDM|11000.00|99|0.00|SHOULDER JOINT|
20|FH_F147519_52627_0|SrvcGrp|58509|2022|PDM|303.16|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F147404_37863_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147580_75110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147528_72114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41463_0_0|SrvcGrp|24748|2022|PDM|75.00|99|0.00|CORTICOSTEROID THERAPY|
20|FH_F41540_0_0|SrvcGrp|104295|2022|PDM|1152.00|99|0.00|UNGROUPED|
20|FH_F135351_0_0|SrvcGrp|113710|2022|PDM|2388.00|99|0.00|APPLY/REMOVE FIXATION DEVICE|
20|FH_F117820_0_0|SrvcGrp|94781|2022|PDM|105.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F98361_12065_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F91937_0_0|SrvcGrp|22954|2022|PDM|147.09|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F120639_73078_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F120683_80238_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F72445_0_0|SrvcGrp|20000|2022|PDM|191.00|99|0.00|CATHETER CARE SUPPLIES|
20|FH_F79429_0_0|SrvcGrp|66481|2022|PDM|75.00|99|0.00|SOCIAL WORKER|
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F54552_0_0|SrvcGrp|9543|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F54552_0_0|SrvcGrp|33165|2022|PDM|545.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F54552_0_0|SrvcGrp|17014|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138807_32207_0|SrvcGrp|29347|2022|PDM|26.00|99|0.00|HOME HEALTH AIDE|
20|FH_F57953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD TC|
20|FH_F124542_0_0|SrvcGrp|80542|2022|PDM|813.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 6|
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F151420_60654_0|SrvcGrp|26281|2022|PDM|3160.00|99|0.00|CPT 58353|
20|FH_F122103_62548_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145468_60615_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F123184_20906_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F37809_0_0|SrvcGrp|68079|2022|PDM|2703.00|99|0.00|UNGROUPED SURGERY|
20|FH_F136081_71742_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F136174_89146_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F136186_46307_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F136220_63638_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F119892_47586_0|SrvcGrp|89783|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F100763_24202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131132_44077_0|SrvcGrp|58636|2022|PDM|46818.00|99|0.00|CPT 62362|
20|FH_F116463_76501_0|SrvcGrp|86722|2022|PDM|192.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F116463_76501_0|SrvcGrp|104080|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F140629_0_0|SrvcGrp|113669|2022|PDM|2497.00|99|0.00|LYMPHADENECTOMY LAPAROSCOPY|
20|FH_F140629_0_0|SrvcGrp|44068|2022|PDM|1016.00|99|0.00|CPT 52332|
20|FH_F121761_44130_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121763_07202_0|SrvcGrp|11663|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F32803_0_0|SrvcGrp|13199|2022|PDM|3000.00|99|0.00|TRAUMA CARE|
20|FH_F67425_0_0|SrvcGrp|10425|2022|PDM|550.00|99|0.00|NEWBORN NURSERY|
20|FH_F111301_33122_0|SrvcGrp|81403|2022|PDM|151.00|99|0.00|COMPREHEN METABOLIC PANEL|
20|FH_F33390_0_0|SrvcGrp|11199|2022|PCT|0.75|99|0.00|HYPERBARIC CHAMBER|
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|643.29|99|0.00|2005 ASPG GROUPER III|
20|FH_F132720_0_0|SrvcGrp|112088|2022|PCT|0.65|99|0.00|CARDIAC ABLATION|
20|FH_F140340_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F52992_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F54272_0_0|SrvcGrp|27713|2022|PCT|0.45|99|0.00|PROSTHETICS / ORTHOTICS|
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131000_0_0|SrvcGrp|96539|2022|PDM|4033.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F132328_0_0|SrvcGrp|28548|2022|PDM|4110.00|99|0.00|VITRECTOMY|
20|FH_F132328_0_0|SrvcGrp|82113|2022|PDM|2195.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F125054_16365_0|SrvcGrp|23683|2022|PDM|90.20|99|0.00|SKILLED NURSING RN|
20|FH_F126853_19053_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PDM|1841.00|99|0.00|AEG 5  (NO REV)|
20|FH_F102222_19720_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD HH OP DEF- BIOTEK REMEDYS|
20|FH_F102228_08846_0|SrvcGrp|43525|2022|PDM|321.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC|
20|FH_F98626_29118_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS|
20|FH_F129240_10028_0|SrvcGrp|24752|2022|PDM|25.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F129240_10028_0|SrvcGrp|86827|2022|PDM|60.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F98300_30236_0|SrvcGrp|75506|2022|PCT|2.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F143542_0_0|SrvcGrp|109762|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESION(S)|
20|FH_F118889_17701_0|SrvcGrp|472|2022|PDM|506.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F84611_30281_0|SrvcGrp|82037|2022|PDM|4384.00|99|0.00|AETNA ICU|
20|FH_F41535_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F51276_0_0|SrvcGrp|8961|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39266_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F102947_44084_0|SrvcGrp|73849|2022|PDM|356.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F102948_43606_0|SrvcGrp|43525|2022|PDM|356.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC|
20|FH_F128031_0_0|SrvcGrp|49544|2022|PDM|17600.00|99|0.00|ARTHROPLASTY|
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|1131.00|99|0.00|AEG 5  (NO REV)|
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122725_32216_0|SrvcGrp|90491|2022|PDM|86.00|99|0.00|EVALUATE SPEECH PRODUCTION|
20|FH_F128496_46936_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113815_0_0|SrvcGrp|72998|2022|PDM|233.00|99|0.00|AEG 5|
20|FH_F51538_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|NEWBORN NURSERY - BABY ONLY|
20|FH_F58856_0_0|SrvcGrp|20902|2022|PDM|20625.00|99|0.00|MS DRG 249 ONLY|
20|FH_F117465_0_0|SrvcGrp|40002|2022|PDM|10000.00|99|0.00|TOTAL HIP|
20|FH_F136386_30901_0|SrvcGrp|10107|2022|PCT|0.40|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F120444_84037_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F134011_84102_0|SrvcGrp|100664|2022|PDM|632.50|99|0.00|HOSPICE IP CARE (HCFA)|
20|FH_F134126_11554_0|SrvcGrp|65161|2022|PDM|2489.00|99|0.00|NEWBORN HIGHER LEVEL|
20|FH_F134156_32174_0|SrvcGrp|9811|2022|PDM|739.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F137147_75006_0|SrvcGrp|28121|2022|PDM|44920.00|99|0.00|MS DRG 469 ONLY|
20|FH_F137147_75006_0|SrvcGrp|113047|2022|PDM|33668.00|99|0.00|MS DRG 354 ONLY|
20|FH_F137147_75006_0|SrvcGrp|79099|2022|PDM|4515.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F142491_06033_0|SrvcGrp|104230|2022|PDM|160.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F142449_62220_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F142690_31774_0|SrvcGrp|110782|2022|PDM|20.00|99|0.00|ROUTINE VENIPUNCTURE|
20|FH_F142727_21222_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F53732_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|PEDIATRIC PHYSICAL THERAPY|
20|FH_F53732_0_0|SrvcGrp|26868|2022|PDM|80.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F138607_02760_0|SrvcGrp|108419|2022|PDM|4223.00|99|0.00|EXT AMB INFUSN PUMP INSULIN (MOD NU)|
20|FH_F132733_0_0|SrvcGrp|361|2022|PDM|3147.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F77782_66061_0|SrvcGrp|13131|2022|PCT|0.83|99|0.00|OBSERVATION SVCS|
20|FH_F138778_90066_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F140407_63841_0|CSTM-ALL|CSTM-00|2020|PDM|1346.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140473_30518_0|SrvcGrp|82224|2022|PDM|58.62|99|0.00|HOSPICE CONT HOME CARE|
20|FH_F80205_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122067_0_0|SrvcGrp|108978|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F120152_0_0|SrvcGrp|76604|2022|PDM|2750.00|99|0.00|CPT 25447|
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 1 (NO REV)|
20|FH_F149377_22102_0|SrvcGrp|110811|2022|PDM|350.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F149607_76548_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151579_19802_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F151600_17866_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151603_27609_0|CSTM-ALL|CSTM-00|2020|PDM|3331.94|99|0.00|AEG 5  (NO REV)|
20|FH_F151608_30236_0|CSTM-ALL|CSTM-00|2020|PDM|1020.00|99|0.00|AEG 2 (NO REV)|
20|FH_F119023_91406_0|SrvcGrp|86842|2022|PDM|30.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F120484_31419_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F133775_83401_0|SrvcGrp|48398|2022|PDM|140.00|99|0.00|PT SERVICES|
20|FH_F100782_0_0|SrvcGrp|105134|2022|PDM|304.44|99|0.00|WINDBER MEDICAL CNTR ASC 239|
20|FH_F112649_63764_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145598_23462_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F114606_0_0|SrvcGrp|89822|2022|PDM|120.14|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F120408_0_0|SrvcGrp|93337|2022|PDM|365.75|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F43865_0_0|SrvcGrp|30961|2022|PDM|12.50|99|0.00|HOME HEALTH AIDE|
20|FH_F115616_0_0|SrvcGrp|106228|2022|PDM|4474.00|99|0.00|LUMBAR FUSION|
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|2346.00|99|0.00|AEG 6 (NO REV)|
20|FH_F139727_66035_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111986_0_0|SrvcGrp|104116|2022|PDM|1236.00|99|0.00|EXC RECT TUM TRANSANAL PART|
20|FH_F145965_50325_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F145641_06902_0|SrvcGrp|114232|2022|PDM|6673.00|99|0.00|EX ARM/ELBOW TUM DEEP > 5 CM|
20|FH_F132822_95125_0|SrvcGrp|48396|2022|PDM|130.00|99|0.00|OT SERVICES|
20|FH_F106964_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F49552_0_0|SrvcGrp|17075|2022|PDM|992.40|99|0.00|ASPG VI|
20|FH_F143581_02130_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F135622_34471_0|SrvcGrp|89412|2022|PDM|374.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F132958_79903_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F119613_90035_0|SrvcGrp|74668|2022|PDM|375.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F144248_0_0|SrvcGrp|109765|2022|PDM|1721.00|99|0.00|CLOSURE OF LACRIMAL PUNCTUM|
20|FH_F112408_0_0|SrvcGrp|96201|2022|PDM|45.00|99|0.00|PT/OT/ST|
20|FH_F51393_0_0|SrvcGrp|42829|2022|PDM|64.00|99|0.00|RESPIRATORY THERAPY VISIT|
20|FH_F145942_72019_0|SrvcGrp|87317|2022|PDM|899.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F138951_41101_0|SrvcGrp|13929|2022|PDM|15.00|99|0.00|GROWTH HORMONE|
20|FH_F85212_71075_0|SrvcGrp|75441|2022|PDM|650.00|99|0.00|OBSERVATION - REV 760|
20|FH_F150302_30114_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127199_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F54592_0_0|SrvcGrp|10579|2022|PDM|50.00|99|0.00|HYDRATION THERAPY - 2 LITERS|
20|FH_F47717_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F122470_78229_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F85894_0_0|SrvcGrp|17077|2022|PDM|2459.00|99|0.00|ASPG VII|
20|FH_F98780_35022_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F115788_02904_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F72971_0_0|SrvcGrp|8|2022|PCT|0.85|99|0.00|BURN INTENSIVE CARE|
20|FH_F146668_30189_0|SrvcGrp|89989|2022|PDM|8500.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F120811_53525_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F131943_62243_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123091_92627_0|SrvcGrp|87317|2022|PDM|1200.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F148863_33021_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F151285_72956_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129130_92562_0|SrvcGrp|39871|2022|PCT|0.41|99|0.00|MS DRG 619-621 ONLY OTLR|
20|FH_F129130_92562_0|CSTM-ALL|CSTM-00|2020|PDM|11399.48|99|0.00|AEG 7 (NO REV) W/O SURGERIES|
20|FH_F33744_0_0|SrvcGrp|18127|2022|PDM|7950.00|99|0.00|MS DRG 242|
20|FH_F66711_0_0|SrvcGrp|42763|2022|PDM|85.00|99|0.00|SKILLED NURSING CARE VISIT|
20|FH_F82933_0_0|SrvcGrp|14657|2022|PDM|663.00|99|0.00|MENTAL HEALTH / DETOX|
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97720_70084_0|SrvcGrp|88978|2022|PDM|3309.00|99|0.00|VAGINAL DELIVERY|
20|FH_F73231_0_0|SrvcGrp|44705|2022|PDM|105.45|99|0.00|NURSING CARE|
20|FH_F86911_0_0|SrvcGrp|85618|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F115264_0_0|SrvcGrp|32405|2022|PCT|1.60|99|0.00|OCN F/S PRICING: MODIFIER 26 (RADIOLOGY)|
20|FH_F114916_30309_0|SrvcGrp|92366|2022|PDM|2100.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F142334_33186_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F119435_0_0|SrvcGrp|107885|2022|PDM|4300.00|99|0.00|TRLUML BALO ANGIOP 1ST VEIN|
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132988_0_0|SrvcGrp|98003|2022|PDM|5929.57|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 9 (NO REV)|
20|FH_F43612_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F118909_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120901_0_0|SrvcGrp|35669|2022|PDM|4682.00|99|0.00|CPT 63650|
20|FH_F114365_73162_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F114389_50131_0|SrvcGrp|51585|2022|PDM|1938.27|99|0.00|CONTINUOUS AIRWAY PRESSURE|
20|FH_F114389_50131_0|SrvcGrp|22590|2022|PDM|93.83|99|0.00|PAIN MANAGAMENT - INTERMITTENT|
20|FH_F49487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F124180_0_0|SrvcGrp|73004|2022|PDM|2000.00|99|0.00|AEG 8|
20|FH_F122198_20708_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F100703_0_0|SrvcGrp|97059|2022|PDM|3535.00|99|0.00|MENISCUS REPAIR, MED OR LAT|
20|FH_F124233_92648_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F124679_64052_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F124687_64024_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F131507_64154_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130036_43232_0|SrvcGrp|3178|2022|PDM|918.00|99|0.00|ACUTE PSYCH|
20|FH_F55694_0_0|CSTM-ALL|CSTM-00|2020|PDM|7187.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|4420.00|99|0.00|ASPG VII|
20|FH_F110067_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|OP SVCS|
20|FH_F72226_65804_0|SrvcGrp|74403|2022|PCT|0.56|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F38865_0_0|SrvcGrp|10|2022|PDM|5000.00|99|0.00|ANGIOPLASTY|
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1699.00|99|0.00|AEG 9 (NO REV)|
20|FH_F117829_45227_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F133495_70301_0|SrvcGrp|87077|2022|PDM|175.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F120406_84047_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|1312.00|99|0.00|AEG 5  (NO REV)|
20|FH_F123545_44512_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148921_91356_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F69242_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117275_16936_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|296.44|99|0.00|HAPA WPA-NWPA 2012-13 ASC 227 W/O REV|
20|FH_F37909_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F78385_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 6 (NO REV)|
20|FH_F67191_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS|
20|FH_F135714_01922_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F101923_98104_0|SrvcGrp|89101|2022|PCT|3.17|99|0.00|MAGNETIC IMAGE, NECK SPINE|
20|FH_F138827_0_0|SrvcGrp|87077|2022|PDM|170.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F31184_0_0|SrvcGrp|18843|2022|PDM|29500.00|99|0.00|MS DRG 227|
20|FH_F116825_0_0|SrvcGrp|74382|2022|PDM|33.13|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91155_16105_0|SrvcGrp|29464|2022|PDM|102.00|99|0.00|HOME HEALTH VISIT NEWBORN CARE|
20|FH_F45977_0_0|SrvcGrp|37027|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F142847_07003_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|AEG 10 (NO REV)|
20|FH_F40591_0_0|SrvcGrp|1168|2022|PCT|0.75|99|0.00|CONTINUOUS HOMECARE|
20|FH_F141754_21703_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F38089_0_0|SrvcGrp|177|2022|PDM|1383.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F119226_07746_0|SrvcGrp|75419|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F130652_51101_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F128571_29532_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F67192_0_0|SrvcGrp|177|2022|PDM|2367.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F132080_0_0|SrvcGrp|63297|2022|PDM|169.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F54552_0_0|SrvcGrp|22589|2022|PDM|75.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F91255_19401_0|CSTM-ALL|CSTM-00|2020|PDM|1554.00|99|0.00|AEG 2 (NO REV)|
20|FH_F44646_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F133028_08021_0|SrvcGrp|90632|2022|PDM|175.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F43433_0_0|SrvcGrp|32446|2022|PDM|8514.00|99|0.00|JACKSON MADISON HOSP ASPG 10|
20|FH_F150001_33064_0|SrvcGrp|17015|2022|PDM|11.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F120437_85202_0|SrvcGrp|24745|2022|PDM|159.82|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F97561_30030_0|SrvcGrp|73659|2022|PDM|7458.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F40980_0_0|SrvcGrp|1015|2022|PCT|1.05|99|0.00|MED/SURG SUPPLIES AND DEVICES - OTHER|
20|FH_F57396_0_0|SrvcGrp|36669|2022|PDM|5.00|99|0.00|IMMUNIZATION ADMIN|
20|FH_F91194_33511_0|SrvcGrp|38007|2022|PDM|750.00|99|0.00|CPT CODE 59425|
20|FH_F92792_0_0|SrvcGrp|28551|2022|PDM|2200.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F118542_60188_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|1991.00|99|0.00|AEG 9 (NO REV)|
20|FH_F133019_23236_0|SrvcGrp|48396|2022|PDM|90.00|99|0.00|OT SERVICES|
20|FH_F142755_33916_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F59274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|1464.00|99|0.00|ASPG V|
20|FH_F97042_64804_0|SrvcGrp|88977|2022|PDM|3668.00|99|0.00|C-SECTION DELIVERY|
20|FH_F51438_0_0|SrvcGrp|12179|2022|PCT|1.80|99|0.00|CPT CODES 70000-79999 (RAD)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|406.32|99|0.00|HAPA WPA-NWPA 2012-13 ASC 307 W/O REV|
20|FH_F148599_98034_0|SrvcGrp|112490|2022|PDM|22300.00|99|0.00|BARIATRIC PROCEDURES|
20|FH_F128774_53140_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F56792_0_0|CSTM-ALL|CSTM-00|2020|PDM|52.00|99|0.00|ANESTHESIA F/S - CPD 1896590|
20|FH_F126666_44053_0|SrvcGrp|87317|2022|PDM|678.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F49354_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F72750_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F150021_02725_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111421_32216_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F120437_85202_0|SrvcGrp|66264|2022|PDM|157.58|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 8 (NO REV)|
20|FH_F43837_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F34706_0_0|SrvcGrp|15076|2022|PDM|14069.00|99|0.00|DRG 577 CAROTID ARTERY STENT PROCEDURE|
20|FH_F75643_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41396_0_0|SrvcGrp|34267|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F133018_84037_0|SrvcGrp|31973|2022|PDM|10.00|99|0.00|HOME THERAPY|
20|FH_F119023_91406_0|SrvcGrp|43568|2022|PDM|90.00|99|0.00|SKILLED NURSING - RN|
20|FH_F36915_0_0|SrvcGrp|23587|2022|PDM|325.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F109883_35007_0|SrvcGrp|86648|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F109983_98607_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F147941_06023_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129438_08234_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F117154_43017_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F137814_61820_0|SrvcGrp|86722|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F110342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70005_0_0|SrvcGrp|24714|2022|PCT|0.55|99|0.00|INTRAOCULAR LENS|
20|FH_F111594_0_0|SrvcGrp|98499|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F132544_0_0|SrvcGrp|97059|2022|PDM|3454.00|99|0.00|MENISCUS REPAIR, MED OR LAT|
20|FH_F150001_33064_0|SrvcGrp|86852|2022|PDM|23.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|1526.67|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F132279_63775_0|SrvcGrp|75506|2022|PCT|0.50|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F132571_24739_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F97542_32960_0|SrvcGrp|73643|2022|PDM|998.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F103281_32086_0|SrvcGrp|70380|2022|PDM|337.00|99|0.00|PSYCH PARTIAL HOSP (FULL DAY)|
20|FH_F133052_33462_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F122245_0_0|SrvcGrp|91342|2022|PDM|1750.00|99|0.00|INSERT TANDEM CUFF|
20|FH_F133329_40202_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F73244_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133350_39532_0|SrvcGrp|46903|2022|PDM|1750.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F133350_39532_0|SrvcGrp|108484|2022|PDM|1750.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F133019_23236_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F147997_92620_0|SrvcGrp|87131|2022|PDM|1740.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F31184_0_0|SrvcGrp|9501|2022|PDM|1900.00|99|0.00|ACUTE IP MED/SURG SVCS|
20|FH_F136407_0_0|SrvcGrp|88599|2022|PDM|3960.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F136002_0_0|SrvcGrp|48385|2022|PDM|81.60|99|0.00|SPEECH THERAPY|
20|FH_F118388_34952_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F120605_0_0|SrvcGrp|25518|2022|PDM|2520.00|99|0.00|LAPAROSCOPY SURGICAL CHOLECYSTECTOMY|
20|FH_F97061_85012_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F136407_0_0|SrvcGrp|91880|2022|PDM|12100.00|99|0.00|OSSEOINTEGRATED IMPLANT|
20|FH_F123324_0_0|SrvcGrp|12918|2022|PDM|2367.00|99|0.00|GYNECOLOGICAL MED/SURG|
20|FH_F38914_0_0|SrvcGrp|12184|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F117970_15963_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F74084_15206_0|SrvcGrp|81879|2022|PCT|1.00|99|0.00|LABORATORY W/ REV/HCPC|
20|FH_F134487_14843_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F40448_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|78923|2022|PDM|4992.29|99|0.00|MON VALLEY ASC 1401|
20|FH_F96120_67207_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F148556_13206_0|SrvcGrp|14893|2022|PDM|60.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F101840_76054_0|SrvcGrp|97486|2022|PDM|1321.00|99|0.00|ERCP|
20|FH_F149860_80112_0|SrvcGrp|46903|2022|PDM|483.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F32565_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133550_90630_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F42340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120954_0_0|SrvcGrp|57965|2022|PDM|997.50|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F146212_57108_0|CSTM-ALL|CSTM-00|2020|PDM|2279.00|99|0.00|AEG 7 (NO REV)|
20|FH_F111812_11222_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1447.31|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1403 W/O REV|
20|FH_F32869_0_0|SrvcGrp|14285|2022|PDM|12000.00|99|0.00|BARIATRIC SURGERY|
20|FH_F37575_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F147982_65706_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101840_76054_0|SrvcGrp|47006|2022|PDM|8207.00|99|0.00|MS DRG 627 ONLY|
20|FH_F146104_33410_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F80532_0_0|SrvcGrp|3809|2022|PDM|540.00|99|0.00|HOSPICE CARE|
20|FH_F50615_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING|
20|FH_F87615_80033_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133478_40165_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F118819_76226_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F71162_0_0|SrvcGrp|42826|2022|PDM|57.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F36521_0_0|SrvcGrp|701|2022|PDM|1600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F133028_08021_0|SrvcGrp|93339|2022|PDM|16.00|99|0.00|AETNA MED NUTRITION GROUP|
20|FH_F144211_30012_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F109882_36695_0|SrvcGrp|73841|2022|PDM|542.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F58972_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F142897_07018_0|SrvcGrp|113299|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - MODERNA|
20|FH_F98921_64503_0|SrvcGrp|73659|2022|PDM|4944.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F133397_23233_0|SrvcGrp|112318|2022|PDM|364.00|99|0.00|PERI VASCULAR LAB|
20|FH_F76284_0_0|SrvcGrp|3809|2022|PDM|737.00|99|0.00|HOSPICE CARE|
20|FH_F91255_19401_0|SrvcGrp|73501|2022|PDM|1200.00|99|0.00|AETNA OBSERVATION|
20|FH_F37566_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132613_84601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F144468_45236_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F122200_0_0|SrvcGrp|29428|2022|PDM|670.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT|
20|FH_F136658_50401_0|SrvcGrp|46903|2022|PDM|420.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F114629_19131_0|CSTM-ALL|CSTM-00|2020|PDM|1293.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F114629_19131_0|SrvcGrp|110811|2022|PDM|353.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F114666_30342_0|SrvcGrp|84316|2022|PDM|800.00|99|0.00|ANKLE SURGERY|
20|FH_F138984_06896_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115048_78520_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137933_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F43859_0_0|SrvcGrp|35468|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F134817_30339_0|SrvcGrp|48396|2022|PDM|90.00|99|0.00|OT SERVICES|
20|FH_F135758_98229_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116173_40217_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP|
20|FH_F147420_89032_0|SrvcGrp|74668|2022|PDM|247.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F41749_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|EATING DISORDER PARTIAL DAY - ADULT|
20|FH_F42156_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|ACUTE PSYCH|
20|FH_F133249_33603_0|SrvcGrp|89417|2022|PDM|419.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F133574_91607_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F133700_92808_0|SrvcGrp|89412|2022|PDM|410.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F111584_07002_0|SrvcGrp|58509|2022|PDM|386.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F111836_12901_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F134826_19067_0|SrvcGrp|91065|2022|PDM|45.00|99|0.00|PSYCHIATRIC CPT 90853 (HCFA)|
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_F137906_0_0|SrvcGrp|104226|2022|PDM|100.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F35381_0_0|SrvcGrp|361|2022|PDM|1820.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F38846_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)|
20|FH_F131501_0_0|SrvcGrp|24739|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F41803_0_0|SrvcGrp|34874|2022|PCT|0.50|99|0.00|COCHLEAR IMPLANT|
20|FH_F54552_0_0|SrvcGrp|24754|2022|PDM|19.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F113585_20155_0|SrvcGrp|86851|2022|PDM|50.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F138730_22602_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F138685_18017_0|SrvcGrp|113365|2022|PDM|83.04|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F81823_0_0|SrvcGrp|22954|2022|PDM|130.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F106500_0_0|SrvcGrp|472|2022|PDM|734.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|521.00|99|0.00|AEG 10 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.28|99|0.00|HAPA WPA-NWPA 2012-13 ASC 313 W/O REV|
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F83939_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151342_90272_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F132258_45404_0|SrvcGrp|24744|2022|PDM|71.00|99|0.00|PICC LINE INSERTION|
20|FH_F132268_07060_0|SrvcGrp|99460|2022|PDM|95.68|99|0.00|OCCUPATIONAL THERAPY EVALUATION|
20|FH_F122119_62675_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F135493_07514_0|SrvcGrp|89417|2022|PDM|318.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F135924_02906_0|SrvcGrp|111927|2022|PDM|290.30|99|0.00|COVID-19 NON CDC|
20|FH_F136016_67209_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136040_75080_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F131334_60062_0|SrvcGrp|22596|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F130996_34110_0|CSTM-ALL|CSTM-00|2020|PCT|1.43|99|0.00|HSS ASC|
20|FH_F111301_33122_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F39178_0_0|SrvcGrp|72|2022|PDM|540.00|99|0.00|NEWBORN NURSERY|
20|FH_F69202_0_0|SrvcGrp|26690|2022|PDM|62600.00|99|0.00|MS DRG 215 ONLY|
20|FH_F34864_0_0|CSTM-ALL|CSTM-00|2020|PDM|2408.00|99|0.00|ASPG VI|
20|FH_F43137_0_0|SrvcGrp|36968|2022|PDM|285.00|99|0.00|SKILLED NURSING LEVEL I & II|
20|FH_F54272_0_0|SrvcGrp|8960|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F111853_0_0|SrvcGrp|43739|2022|PDM|975.00|99|0.00|REHABILITATION - PRIVATE/DELUXE|
20|FH_F116430_0_0|SrvcGrp|89888|2022|PDM|2042.00|99|0.00|AETNA SUSPENSION OF TESTIS|
20|FH_F105421_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130206_78209_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F102901_85006_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129326_02026_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130027_76201_0|SrvcGrp|89417|2022|PDM|344.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F102960_50613_0|SrvcGrp|90854|2022|PDM|1984.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F148101_33462_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F33925_0_0|SrvcGrp|15780|2022|PCT|1.00|99|0.00|LAB|
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PDM|28200.00|99|0.00|MSDRG 231-232 CORONARY BYPASS|
20|FH_F39355_0_0|SrvcGrp|109|2022|PDM|475.00|99|0.00|CD - DETOX|
20|FH_F41934_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|ASPG IV - CPD 1281588|
20|FH_F103004_75840_0|SrvcGrp|72994|2022|PDM|714.00|99|0.00|AEG 3|
20|FH_F111143_28659_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|GENERAL ACUTE CARE|
20|FH_F111204_10023_0|SrvcGrp|109036|2022|PDM|618.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F142087_0_0|SrvcGrp|108093|2022|PDM|15500.00|99|0.00|REVISE HIP ARTHROPLASTY|
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|2687.00|99|0.00|AEG 5  (NO REV)|
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|335.00|99|0.00|AEG 1 (NO REV)|
20|FH_F122694_33334_0|SrvcGrp|108484|2022|PDM|563.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F92676_15063_0|SrvcGrp|78955|2022|PDM|2809.70|99|0.00|MON VALLEY ASC 1302|
20|FH_F149979_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141870_85224_0|SrvcGrp|86832|2022|PDM|5.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F115406_79902_0|SrvcGrp|89149|2022|PDM|202.00|99|0.00|OP INTENSIVE|
20|FH_F126858_43113_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F150746_31210_0|SrvcGrp|92502|2022|PDM|901.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F150766_33952_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|HSS ASC|
20|FH_F150771_44512_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150859_14620_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F150882_84041_0|SrvcGrp|86825|2022|PDM|71.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F90223_0_0|SrvcGrp|68247|2022|PDM|3.60|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F139785_92629_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F131551_68355_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112727_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112794_01040_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F73803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1439.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F147237_40006_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134887_33409_0|SrvcGrp|112693|2022|PDM|32.00|99|0.00|MULTI DEN INSERT DIR CARV/CAM|
20|FH_F130309_17044_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F63385_0_0|SrvcGrp|58508|2022|PDM|1060.00|99|0.00|UNLISTED CODES OP SURGERY|
20|FH_F92498_07442_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F147146_06117_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132160_0_0|SrvcGrp|84278|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F124381_27610_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127396_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.50|99|0.00|NON-ANESTHESIOLOGY (HANE) (HSMI) (SAMD)|
20|FH_F150982_0_0|SrvcGrp|38909|2022|PDM|2392.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F122277_98045_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F73803_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F36943_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD AW|
20|FH_F39443_0_0|SrvcGrp|22392|2022|PDM|2510.00|99|0.00|LITHOTRIPSY|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD RR KE RATES|
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 4 (NO REV)|
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PDM|5962.00|99|0.00|AEG 3 (NO REV)|
20|FH_F50078_0_0|SrvcGrp|3810|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F39082_0_0|SrvcGrp|15738|2022|PDM|2147.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F35410_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INFI- S CODES|
20|FH_F124703_65711_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F108500_62702_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F36715_0_0|SrvcGrp|72|2022|PDM|320.00|99|0.00|NEWBORN NURSERY|
20|FH_F117583_21208_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F97080_85122_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F110805_45227_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F138387_02886_0|SrvcGrp|92502|2022|PDM|605.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F117615_30525_0|SrvcGrp|79099|2022|PCT|0.85|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F144831_0_0|SrvcGrp|95660|2022|PDM|926.40|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F40289_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F138478_0_0|SrvcGrp|109493|2022|PDM|6792.89|99|0.00|INSERT HEART PM VENTRICULAR|
20|FH_F141267_0_0|SrvcGrp|84185|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F47902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35776_33063_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SAINT ALEXIUS FH MOD 26|
20|FH_F40593_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124739_64429_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F109221_15084_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F131471_67203_0|SrvcGrp|27968|2022|PDM|35.00|99|0.00|SKILLED NURSING LPN|
20|FH_F124294_66614_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F101441_0_0|SrvcGrp|93741|2022|PDM|8105.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY|
20|FH_F119008_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F98623_97006_0|SrvcGrp|88977|2022|PDM|8512.00|99|0.00|C-SECTION DELIVERY|
20|FH_F98880_50158_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F38246_66606_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F35475_0_0|SrvcGrp|6|2022|PCT|0.60|99|0.00|OP SURGERY|
20|FH_F49984_0_0|SrvcGrp|26732|2022|PDM|720.00|99|0.00|CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE|
20|FH_F128197_84123_0|SrvcGrp|48398|2022|PDM|103.00|99|0.00|PT SERVICES|
20|FH_F148667_0_0|SrvcGrp|26275|2022|PDM|2856.00|99|0.00|CPT 29826|
20|FH_F110972_30512_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F68460_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131356_19131_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F149609_78624_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138254_75446_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F143249_89801_0|SrvcGrp|43567|2022|PDM|120.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F143536_47546_0|SrvcGrp|68240|2022|PCT|1.00|99|0.00|DESTRUCTION WARTS - 1ST LESION|
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1432.00|99|0.00|AEG 8 (NO REV)|
20|FH_F130917_48658_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F131067_57105_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F47600_0_0|SrvcGrp|31187|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF (DME)|
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1391.00|99|0.00|AEG 7 (NO REV)|
20|FH_F103106_04101_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F133019_23236_0|SrvcGrp|88620|2022|PDM|90.00|99|0.00|SKILLED NURSING RN|
20|FH_F92676_15063_0|SrvcGrp|13748|2022|PDM|7871.00|99|0.00|OP LITHOTRIPSY|
20|FH_F148886_60621_0|SrvcGrp|115250|2022|PCT|1.38|99|0.00|RADIOLOGY SERVICES|
20|FH_F139825_0_0|SrvcGrp|84278|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F126815_02118_0|CSTM-ALL|CSTM-00|2020|PDM|2231.07|99|0.00|AEG 4 (NO REV)|
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|2208.00|99|0.00|AEG 7 (NO REV)|
20|FH_F87155_04105_0|SrvcGrp|24745|2022|PDM|68.29|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 10 (NO REV)|
20|FH_F68562_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37573_0_0|SrvcGrp|9858|2022|PDM|407.00|99|0.00|SKILLED NURSING CARE|
20|FH_F42779_0_0|SrvcGrp|97|2022|PDM|5706.00|99|0.00|C-SECTION|
20|FH_F125342_78754_0|SrvcGrp|73605|2022|PDM|875.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F101840_76054_0|SrvcGrp|21106|2022|PDM|24125.00|99|0.00|MS DRG 250 ONLY|
20|FH_F54552_0_0|CSTM-ALL|CSTM-00|2020|PDM|80.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F141867_62258_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F46192_0_0|SrvcGrp|10013|2022|PDM|463.00|99|0.00|NEWBORN NURSERY|
20|FH_F138347_77701_0|SrvcGrp|74668|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139673_63011_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150745_03301_0|SrvcGrp|115510|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F150859_14620_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F90817_0_0|SrvcGrp|90384|2022|PDM|7520.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F129682_07034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F98022_89015_0|CSTM-ALL|CSTM-00|2020|PCT|0.31|99|0.00|OP SVCS|
20|FH_F98020_50138_0|SrvcGrp|73602|2022|PDM|3772.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F128091_37129_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|100% 2007 MEDICARE DME TN  MOD UE|
20|FH_F149579_95815_0|SrvcGrp|115704|2022|PDM|128.25|99|0.00|PSYCHIATRIC COLLABORATIVE CARE MGMT SBSQ (MOD AJ)(HCFA)|
20|FH_F123386_0_0|SrvcGrp|9518|2022|PCT|0.50|99|0.00|EMERGENCY ROOM|
20|FH_F132849_0_0|SrvcGrp|3499|2022|PCT|0.63|99|0.00|IMPLANTS|
20|FH_F151003_33162_0|SrvcGrp|75419|2022|PDM|465.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F116346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138017_73129_0|SrvcGrp|41335|2022|PDM|14341.62|99|0.00|TOTAL HIP|
20|FH_F71468_0_0|SrvcGrp|24289|2022|PDM|70.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F150922_02452_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F146859_0_0|SrvcGrp|114840|2022|PDM|2077.00|99|0.00|FOOT TENDON REPAIR|
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|976.00|99|0.00|AEG 3 (NO REV)|
20|FH_F110732_31513_0|SrvcGrp|72998|2022|PDM|1511.00|99|0.00|AEG 5|
20|FH_F131331_0_0|SrvcGrp|84185|2022|PDM|165.42|99|0.00|RESPITE CARE|
20|FH_F91953_99508_0|SrvcGrp|92324|2022|PDM|2450.00|99|0.00|VBAC DELIVERY|
20|FH_F112306_81428_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INJECTION, PEGFILGRASTIM 6MG|
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1074.00|99|0.00|AEG 3 (NO REV)|
20|FH_F109221_15084_0|SrvcGrp|88834|2022|PDM|88.00|99|0.00|SKILLED NURSING SERVICES (15 MINS)|
20|FH_F132096_89118_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F32825_0_0|SrvcGrp|11259|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F150339_75035_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F92300_37303_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F149662_85015_0|SrvcGrp|41335|2022|PDM|8600.00|99|0.00|TOTAL HIP|
20|FH_F149273_0_0|SrvcGrp|115609|2022|PDM|3589.00|99|0.00|ANKLE FRACTURE REPAIR|
20|FH_F132254_40207_0|SrvcGrp|86829|2022|PDM|15.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F97603_77901_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F97081_21122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101861_19567_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F108500_62702_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|521.00|99|0.00|ASPG II|
20|FH_F124739_64429_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F138018_17313_0|SrvcGrp|86825|2022|PDM|208.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F116583_0_0|SrvcGrp|106927|2022|PDM|150.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F138453_74135_0|SrvcGrp|89417|2022|PDM|424.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F125207_32904_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117023_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|887.00|99|0.00|AEG 3 (NO REV)|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1575124_HCPCS_  MOD 26|
20|FH_F117023_0_0|SrvcGrp|107291|2022|PDM|8000.00|99|0.00|AETNA SPINE PROCEDURES|
20|FH_F39772_0_0|SrvcGrp|15179|2022|PCT|1.05|99|0.00|TISSUE PLASMINOGEN ACTIVATOR|
20|FH_F131495_77407_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F149459_06615_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F113957_73554_0|SrvcGrp|102420|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F122419_37043_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125214_12428_0|SrvcGrp|42782|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F84413_0_0|SrvcGrp|26470|2022|PDM|150.00|99|0.00|SELF DIALYSIS TRAINING CAPD|
20|FH_F40647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER QW|
20|FH_F90213_30084_0|SrvcGrp|14494|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F149582_01534_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F110972_30512_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F110821_31513_0|SrvcGrp|472|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F127132_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F131028_49735_0|SrvcGrp|93098|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F37536_0_0|SrvcGrp|26658|2022|PDM|45.00|99|0.00|MAMMOGRAPHY|
20|FH_F149023_44122_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 10 (NO REV)|
20|FH_F131224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114416_0_0|SrvcGrp|80317|2022|PDM|120.00|99|0.00|RESPITE CARE|
20|FH_F137986_0_0|SrvcGrp|82109|2022|PDM|890.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F42165_0_0|SrvcGrp|31853|2022|PCT|0.85|99|0.00|OP LITHOTRIPSY|
20|FH_F124441_0_0|SrvcGrp|89853|2022|PDM|2375.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG|
20|FH_F109247_73102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F34308_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143249_89801_0|SrvcGrp|24753|2022|PDM|10.00|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F143347_16001_0|SrvcGrp|79866|2022|PDM|12371.00|99|0.00|REVASCULARIZATION W/STENTING|
20|FH_F84631_0_0|SrvcGrp|29347|2022|PDM|49.52|99|0.00|HOME HEALTH AIDE|
20|FH_F112448_0_0|SrvcGrp|14938|2022|PDM|1575.00|99|0.00|PROGRESSIVE TELEMETRY|
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|643.00|99|0.00|AEG 4 (NO REV)|
20|FH_F103060_0_0|SrvcGrp|90343|2022|PDM|7803.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL|
20|FH_F151785_03104_0|SrvcGrp|472|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD NU KF|
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|ASPG III- MOD 50|
20|FH_F49051_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F120171_33770_0|SrvcGrp|89412|2022|PDM|345.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F120187_76522_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132421_74538_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112712_63005_0|SrvcGrp|34566|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116802_41224_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F38411_0_0|SrvcGrp|360|2022|PDM|900.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F45052_0_0|SrvcGrp|8962|2022|PDM|175.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F130765_34113_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F149139_07522_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F137587_0_0|SrvcGrp|108546|2022|PDM|297.00|99|0.00|PERITONEAL TREATMENTS W/ PATIENT TRAINING|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|361.04|99|0.00|HAPA WPA-NWPA 2012-13 ASC 230 W/O REV|
20|FH_F130017_02302_0|CSTM-ALL|CSTM-00|2020|PDM|2118.77|99|0.00|AETNA ENDOSCOPY (ENDO)|
20|FH_F120719_27540_0|CSTM-ALL|CSTM-00|2020|PDM|13581.00|99|0.00|AEG 9 (NO REV)|
20|FH_F111986_0_0|SrvcGrp|104114|2022|PDM|1236.00|99|0.00|INCISION OF FOOT FASCIA|
20|FH_F110562_33409_0|SrvcGrp|108484|2022|PDM|1400.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F35042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|PROFESSIONAL FEES ON CMS1500|
20|FH_F90232_15126_0|SrvcGrp|86839|2022|PDM|56.70|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F145940_71730_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41135_0_0|SrvcGrp|17077|2022|PDM|966.14|99|0.00|ASPG VII|
20|FH_F128825_45211_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135666_37601_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F43863_0_0|SrvcGrp|35468|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F145930_45236_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F83113_0_0|SrvcGrp|9832|2022|PDM|50.00|99|0.00|ST SVCS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|872.30|99|0.00|HAPA WPA-NWPA 2012-13 ASC 601 W/O REV|
20|FH_F133585_0_0|SrvcGrp|108078|2022|PDM|1786.00|99|0.00|ARTERY-VEIN FUSION|
20|FH_F79743_0_0|CSTM-ALL|CSTM-00|2020|PDM|4046.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F121225_98902_0|CSTM-ALL|CSTM-00|2020|PCT|1.13|99|0.00|AETNA DME|
20|FH_F31714_0_0|SrvcGrp|2978|2022|PDM|15500.00|99|0.00|DRG 519 CERVICAL SPINAL FUSION W/CC|
20|FH_F110268_02891_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F120484_31419_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F96780_0_0|SrvcGrp|62737|2022|PDM|1761.00|99|0.00|SURGERY CARVE OUTS|
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_F133748_77081_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F86101_76063_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F83995_16748_0|SrvcGrp|10541|2022|PDM|91.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F31152_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
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_F110345_37919_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133753_84015_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114409_18447_0|SrvcGrp|48398|2022|PDM|110.25|99|0.00|PT SERVICES|
20|FH_F134656_02852_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|161.93|99|0.00|HAPA WPA-NWPA 2012-13 ASC 138 W/O REV|
20|FH_F139747_06241_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132969_84003_0|SrvcGrp|14945|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F131630_0_0|SrvcGrp|70746|2022|PDM|1665.00|99|0.00|CPT 28292|
20|FH_F35042_0_0|CSTM-ALL|CSTM-00|2020|PDM|2163.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142376_0_0|SrvcGrp|97279|2022|PDM|1159.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY|
20|FH_F134230_60098_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145641_06902_0|SrvcGrp|42129|2022|PDM|769.00|99|0.00|SOMATIC NERVE THERAPEUTIC PROCEDURES|
20|FH_F133801_87107_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F150165_06032_0|SrvcGrp|101521|2022|PDM|9856.00|99|0.00|T1H UTERUS (>250G)|
20|FH_F149159_53220_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F119379_0_0|SrvcGrp|35667|2022|PDM|885.00|99|0.00|CPT 20680|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAMPTON ROADS GAST MOD AU|
20|FH_F79623_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F110503_10016_0|SrvcGrp|86722|2022|PDM|339.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114407_19002_0|SrvcGrp|46605|2022|PDM|84.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F111695_30286_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135900_0_0|SrvcGrp|87537|2022|PDM|450.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F118384_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F109577_0_0|SrvcGrp|73700|2022|PDM|65.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F127638_44720_0|SrvcGrp|97703|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F116473_0_0|SrvcGrp|33986|2022|PDM|900.00|99|0.00|CPT 26055|
20|FH_F114525_72401_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F119379_0_0|SrvcGrp|107825|2022|PDM|1800.00|99|0.00|REPAIR DEFECT OF ARM ARTERY|
20|FH_F121303_15501_0|SrvcGrp|113173|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - PFIZER|
20|FH_F112827_26452_0|SrvcGrp|48385|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F134327_12853_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F86101_76063_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F116806_0_0|SrvcGrp|107043|2022|PDM|1923.16|99|0.00|SURGERY ON UPPER JAW|
20|FH_F71647_0_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133801_87107_0|SrvcGrp|29346|2022|PDM|25.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F143571_0_0|SrvcGrp|29353|2022|PDM|153.00|99|0.00|HOSPICE SVCS|
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|862.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F150299_22046_0|SrvcGrp|27969|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F40526_0_0|SrvcGrp|27210|2022|PDM|325.00|99|0.00|SKILLED NURSING LEVEL I|
20|FH_F54592_0_0|SrvcGrp|16750|2022|PDM|135.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134528_63670_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129101_27006_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F70607_0_0|SrvcGrp|15851|2022|PDM|22.00|99|0.00|HOSPICE SVCS|
20|FH_F79624_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F102142_80014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F77665_0_0|SrvcGrp|10538|2022|PDM|60.00|99|0.00|NURSING CARE|
20|FH_F146655_80226_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F63124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F131930_46205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132928_64114_0|SrvcGrp|29347|2022|PDM|32.52|99|0.00|HOME HEALTH AIDE|
20|FH_F133544_78227_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131430_17566_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133176_32751_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F130657_04614_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|GENERAL ACUTE CARE|
20|FH_F133700_92808_0|SrvcGrp|73605|2022|PDM|970.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F134828_30531_0|SrvcGrp|112664|2022|PDM|34.00|99|0.00|XRAY EXAM OF HAND (HCFA)|
20|FH_F43872_0_0|SrvcGrp|12496|2022|PDM|717.00|99|0.00|ACUTE REHABILITATION|
20|FH_F117199_0_0|CSTM-ALL|CSTM-00|2020|PDM|733.22|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F113025_0_0|SrvcGrp|16427|2022|PDM|951.00|99|0.00|OP SURGERY|
20|FH_F33389_0_0|SrvcGrp|11199|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER|
20|FH_F38135_0_0|SrvcGrp|28230|2022|PDM|1686.00|99|0.00|ADULT SURGICAL SERVICES|
20|FH_F133536_0_0|SrvcGrp|69971|2022|PDM|1149.00|99|0.00|CPT 27047|
20|FH_F133579_0_0|SrvcGrp|53702|2022|PDM|2551.00|99|0.00|PREP CORNEAL ENDOTHELIAL ALLOGRAFT|
20|FH_F150025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135187_80229_0|SrvcGrp|92760|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|1563.00|99|0.00|AEG 7 (NO REV)|
20|FH_F136510_0_0|SrvcGrp|84280|2022|PDM|3882.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F148323_84070_0|SrvcGrp|74668|2022|PDM|228.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F82696_16335_0|SrvcGrp|76011|2022|PDM|1305.00|99|0.00|EMERGENCY ROOM SVCS LEVEL IV|
20|FH_F86332_75081_0|SrvcGrp|12073|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F39783_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F48192_0_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|AEG 4 (NO REV)|
20|FH_F88254_33411_0|SrvcGrp|24750|2022|PDM|30.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F40358_0_0|SrvcGrp|9795|2022|PDM|975.00|99|0.00|SUBACUTE REHAB|
20|FH_F72183_0_0|SrvcGrp|66225|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F63627_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37539_0_0|SrvcGrp|1306|2022|PDM|255.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F81183_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F33642_0_0|SrvcGrp|18791|2022|PCT|0.75|99|0.00|MS DRG 215|
20|FH_F123894_60927_0|SrvcGrp|471|2022|PDM|993.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F112755_43215_0|SrvcGrp|81622|2022|PCT|0.15|99|0.00|GENERAL PHARMACY|
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 5  (NO REV)|
20|FH_F137067_0_0|SrvcGrp|88600|2022|PDM|2625.00|99|0.00|WRIST ARTHROS DIAG W/WO BIO|
20|FH_F53932_0_0|CSTM-ALL|CSTM-00|2020|PCT|53.00|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|89848|2022|PDM|9909.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F44582_0_0|SrvcGrp|13881|2022|PCT|1.10|99|0.00|PACEMAKER DEVICE|
20|FH_F31921_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F123278_20850_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F137611_30909_0|SrvcGrp|89417|2022|PDM|418.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F115047_78526_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149888_68506_0|SrvcGrp|78283|2022|PDM|2179.00|99|0.00|CPT 49505|
20|FH_F131228_01826_0|SrvcGrp|11663|2022|PCT|1.11|99|0.00|IMPLANTS|
20|FH_F41494_0_0|SrvcGrp|115|2022|PDM|490.00|99|0.00|SKILLED NURSING CARE|
20|FH_F74653_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120308_07901_0|SrvcGrp|73841|2022|PDM|392.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F42464_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|EMERGENCY ROOM|
20|FH_F37651_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD RR|
20|FH_F40043_0_0|SrvcGrp|33261|2022|PDM|755.00|99|0.00|GA ASPG I|
20|FH_F148220_70578_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131577_89148_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141427_22003_0|SrvcGrp|23683|2022|PDM|42.00|99|0.00|SKILLED NURSING RN|
20|FH_F116341_12180_0|SrvcGrp|104075|2022|PCT|1.05|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130850_67401_0|SrvcGrp|23683|2022|PDM|47.00|99|0.00|SKILLED NURSING RN|
20|FH_F134236_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F125249_0_0|SrvcGrp|90420|2022|PDM|1700.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F137591_33411_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118910_0_0|SrvcGrp|90707|2022|PDM|126.18|99|0.00|AETNA HOSPICE CARE|
20|FH_F132779_0_0|SrvcGrp|89814|2022|PDM|18890.00|99|0.00|MS DRG 499 ONLY|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD AV|
20|FH_F145766_64491_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37376_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100761_02539_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F59093_0_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F94662_0_0|SrvcGrp|89822|2022|PDM|199.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F128272_60640_0|SrvcGrp|86854|2022|PDM|50.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F109581_0_0|SrvcGrp|75481|2022|PDM|886.00|99|0.00|AEG 2|
20|FH_F141791_22572_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151146_0_0|SrvcGrp|81905|2022|PDM|7212.00|99|0.00|LAPAROSCOPY SURGICAL|
20|FH_F31798_0_0|SrvcGrp|24|2022|PCT|0.75|99|0.00|CARDIAC CATH|
20|FH_F92276_32308_0|SrvcGrp|15663|2022|PCT|0.48|99|0.00|TRAUMA CARE|
20|FH_F129943_77584_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141802_17042_0|SrvcGrp|107733|2022|PDM|19066.00|99|0.00|CESAREAN SECTION|
20|FH_F37440_0_0|SrvcGrp|13881|2022|PCT|1.00|99|0.00|PACEMAKER DEVICE|
20|FH_F135219_68506_0|SrvcGrp|112723|2022|PDM|22295.52|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F149839_80002_0|SrvcGrp|63297|2022|PDM|144.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F147941_06023_0|SrvcGrp|73842|2022|PDM|668.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OTHER DIAGNOSTIC - RONL/HSOH|
20|FH_F143783_0_0|SrvcGrp|113454|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F89475_71202_0|SrvcGrp|3378|2022|PCT|0.40|99|0.00|OBSERVATION SVCS|
20|FH_F143819_29485_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120251_21122_0|SrvcGrp|74668|2022|PDM|650.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F38526_0_0|SrvcGrp|997|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F120251_21122_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141591_92630_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F32513_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F145800_22003_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|3303.00|99|0.00|REPAIR VENTRAL HERNIA INI BLOCK|
20|FH_F131228_01826_0|SrvcGrp|73461|2022|PDM|5353.72|99|0.00|AETNA NICU IV|
20|FH_F90691_0_0|SrvcGrp|73002|2022|PDM|1055.00|99|0.00|AEG 7|
20|FH_F88451_0_0|SrvcGrp|56484|2022|PDM|126.00|99|0.00|SKILLED NURSING|
20|FH_F145757_65101_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F65159_0_0|SrvcGrp|526|2022|PDM|4961.00|99|0.00|CARDIAC CARE UNIT|
20|FH_F65159_0_0|CSTM-ALL|CSTM-00|2020|PDM|2626.00|99|0.00|ASPG III|
20|FH_F117559_08619_0|SrvcGrp|104056|2022|PDM|131.00|99|0.00|PNEUMOCOCCAL VACCINE - INTRAMUSCULAR|
20|FH_F55375_0_0|SrvcGrp|10400|2022|PDM|2500.00|99|0.00|IP SURGERY|
20|FH_F77663_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|OP SVCS|
20|FH_F148644_06890_0|SrvcGrp|42472|2022|PDM|5000.00|99|0.00|CPT 58670|
20|FH_F151144_35801_0|SrvcGrp|46884|2022|PDM|915.43|99|0.00|REPAIR EYELID DEFECT|
20|FH_F129130_92562_0|SrvcGrp|88977|2022|PDM|13188.59|99|0.00|C-SECTION DELIVERY|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2501000 MOD AV (HCFA)|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|448.59|99|0.00|DELAWARE VALLEY- ASC 204|
20|FH_F65761_0_0|SrvcGrp|43431|2022|PDM|84.87|99|0.00|LPN|
20|FH_F110000_0_0|SrvcGrp|10910|2022|PCT|0.70|99|0.00|URGENT CARE|
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|1114.00|99|0.00|AEG 8 (NO REV)|
20|FH_F142070_0_0|SrvcGrp|108042|2022|PDM|700.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F71365_0_0|SrvcGrp|59428|2022|PDM|90.00|99|0.00|ST|
20|FH_F112453_0_0|SrvcGrp|61577|2022|PDM|498.75|99|0.00|HOSPICE|
20|FH_F119581_0_0|SrvcGrp|91577|2022|PDM|9866.00|99|0.00|FEM/POPL REVASC STNT & ATHER|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER AW|
20|FH_F129254_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 9 (NO REV)|
20|FH_F94786_07974_0|SrvcGrp|41452|2022|PDM|1.05|99|0.00|ENTERAL FORMULA - SPECIAL METABOLIC NEEDS|
20|FH_F94786_07974_0|SrvcGrp|86839|2022|PDM|36.75|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F137067_0_0|SrvcGrp|99161|2022|PDM|28875.00|99|0.00|CPT 27138|
20|FH_F130267_57248_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F88933_0_0|SrvcGrp|112940|2022|PDM|5065.00|99|0.00|SPINE SURGERY PROCEDURES|
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48473_0_0|SrvcGrp|8962|2022|PDM|93.50|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F116546_78723_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F116869_15146_0|SrvcGrp|27968|2022|PDM|25.00|99|0.00|SKILLED NURSING LPN|
20|FH_F82691_0_0|SrvcGrp|33165|2022|PDM|300.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F125479_17501_0|SrvcGrp|54142|2022|PDM|186.00|99|0.00|OP INTENSIVE SERVICES|
20|FH_F113563_70560_0|CSTM-ALL|CSTM-00|2020|PDM|515.00|99|0.00|AEG 1 (NO REV)|
20|FH_F84611_30281_0|SrvcGrp|73004|2022|PDM|3844.00|99|0.00|AEG 8|
20|FH_F33925_0_0|SrvcGrp|18148|2022|PDM|9750.00|99|0.00|MS DRG 249|
20|FH_F147403_0_0|SrvcGrp|87077|2022|PDM|250.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F38431_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AUDIOLOGIC TESTING|
20|FH_F46373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS|
20|FH_F127375_28621_0|SrvcGrp|74581|2022|PCT|0.70|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F92276_32308_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F92276_32308_0|SrvcGrp|72984|2022|PCT|2.84|99|0.00|CHEMOTHERAPY|
20|FH_F37651_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD 26|
20|FH_F125028_19061_0|SrvcGrp|86844|2022|PDM|63.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F130807_20721_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F132779_0_0|SrvcGrp|57384|2022|PDM|16096.00|99|0.00|MS DRG 469-470 ONLY|
20|FH_F115103_31405_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F125011_74467_0|SrvcGrp|47533|2022|PDM|6300.00|99|0.00|ANTERIOR COLPORRHAPHY|
20|FH_F91622_0_0|SrvcGrp|45751|2022|PDM|98.00|99|0.00|INDIVIDUAL THERAPY|
20|FH_F137427_89146_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148265_06067_0|SrvcGrp|82114|2022|PDM|4682.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F40332_0_0|SrvcGrp|14187|2022|PDM|750.00|99|0.00|MRI|
20|FH_F150462_30458_0|SrvcGrp|22590|2022|PDM|50.00|99|0.00|PAIN MANAGAMENT - INTERMITTENT|
20|FH_F118703_0_0|SrvcGrp|73006|2022|PDM|1513.00|99|0.00|AEG 9|
20|FH_F145756_03801_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93881_15009_0|SrvcGrp|81401|2022|PDM|237.00|99|0.00|GESTATION|
20|FH_F141527_36830_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F86752_0_0|SrvcGrp|75483|2022|PDM|669.00|99|0.00|AEG 3|
20|FH_F129576_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F129262_33813_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F146661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F52854_0_0|SrvcGrp|941|2022|PDM|3936.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F134995_37055_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F72369_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F37155_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F40834_0_0|SrvcGrp|360|2022|PDM|2146.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F130350_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F118742_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119760_0_0|SrvcGrp|95660|2022|PDM|475.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F150982_0_0|SrvcGrp|38709|2022|PDM|3182.00|99|0.00|HYSTEROSCOPY|
20|FH_F123953_84003_0|SrvcGrp|87317|2022|PDM|1079.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F40953_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100762_51104_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F103100_47150_0|SrvcGrp|73000|2022|PDM|1526.00|99|0.00|AEG 6|
20|FH_F67504_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137531_62959_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130747_0_0|SrvcGrp|67065|2022|PDM|20808.00|99|0.00|CERVICAL SURGERY|
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.80|99|0.00|ASPG 6- PROGRESSIVE SURG|
20|FH_F148480_03079_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F91787_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 2 (NO REV)|
20|FH_F93881_15009_0|SrvcGrp|92408|2022|PDM|9930.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F139515_0_0|SrvcGrp|63472|2022|PDM|8549.00|99|0.00|CPT 64581|
20|FH_F150462_30458_0|SrvcGrp|17016|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F102302_0_0|SrvcGrp|87120|2022|PDM|8250.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F118194_50841_0|SrvcGrp|29076|2022|PDM|145.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F54614_0_0|SrvcGrp|90559|2022|PDM|75.00|99|0.00|RN VISIT|
20|FH_F128272_60640_0|SrvcGrp|29075|2022|PDM|45.00|99|0.00|HYDRATION THERAPY|
20|FH_F31798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F38591_0_0|SrvcGrp|361|2022|PDM|2745.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F148892_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F100761_02539_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F124048_47304_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F109343_0_0|SrvcGrp|2047|2022|PDM|2860.00|99|0.00|BIRTHING CENTER|
20|FH_F142252_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145537_02061_0|SrvcGrp|91070|2022|PDM|284.00|99|0.00|AETNA MH CRISIS INTERVENTION (HCFA)|
20|FH_F123505_64468_0|SrvcGrp|471|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F32906_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F34487_0_0|SrvcGrp|12496|2022|PDM|946.00|99|0.00|ACUTE REHABILITATION|
20|FH_F93881_15009_0|SrvcGrp|87109|2022|PDM|595.00|99|0.00|CAT SCAN OF FACE/JAW|
20|FH_F47733_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% L CODES MOD RR|
20|FH_F40661_0_0|CSTM-ALL|CSTM-00|2020|PDM|1164.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72306_0_0|SrvcGrp|21342|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F126923_33612_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139515_0_0|SrvcGrp|106264|2022|PDM|4352.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION|
20|FH_F130317_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F92276_32308_0|SrvcGrp|37423|2022|PDM|49245.00|99|0.00|MSDRG 258-262 ONLY|
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1426.19|99|0.00|ASPG X|
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1021.65|99|0.00|AEG 8 (NO REV)|
20|FH_F114002_0_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F101410_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS|
20|FH_F114389_50131_0|SrvcGrp|17016|2022|PDM|130.65|99|0.00|HOME INFUSION THERAPY|
20|FH_F114389_50131_0|SrvcGrp|22593|2022|PDM|102.25|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|622.72|99|0.00|AEG 2 (NO REV)|
20|FH_F32792_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146990_80206_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ASPG II|
20|FH_F41035_0_0|SrvcGrp|107778|2022|PDM|910.00|99|0.00|ARTHROSCOPIC FRACTURE TX|
20|FH_F92493_0_0|SrvcGrp|92368|2022|PDM|2601.06|99|0.00|REPAIR OF LEG TENDON|
20|FH_F92493_0_0|SrvcGrp|82109|2022|PDM|2340.03|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F129973_48030_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F124663_65608_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F114912_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|OP SVCS|
20|FH_F132592_68305_0|SrvcGrp|75506|2022|PCT|0.94|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F34328_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F130039_80228_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F136686_43551_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114629_19131_0|SrvcGrp|105421|2022|PDM|345.00|99|0.00|AETNA TERANIAL MAGN STIM TX PLAN|
20|FH_F113937_15301_0|SrvcGrp|103343|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134727_30650_0|SrvcGrp|109220|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F134770_14420_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136786_25302_0|SrvcGrp|29346|2022|PDM|40.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F136796_24016_0|SrvcGrp|88739|2022|PDM|6749.71|99|0.00|IMPLANT SPINAL CANAL|
20|FH_F136930_73114_0|SrvcGrp|73000|2022|PDM|7147.00|99|0.00|AEG 6|
20|FH_F46938_0_0|SrvcGrp|10528|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F115631_65201_0|SrvcGrp|89404|2022|PDM|14068.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F115733_33012_0|SrvcGrp|89417|2022|PDM|368.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F116393_07002_0|SrvcGrp|88858|2022|PCT|1.25|99|0.00|EVALUATION OF SPEECH FLUENCY|
20|FH_F147519_52627_0|SrvcGrp|73499|2022|PDM|1041.77|99|0.00|AETNA ER LEVEL II|
20|FH_F147404_37863_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F91937_0_0|SrvcGrp|76531|2022|PDM|147.09|99|0.00|HOSPICE IN HOME|
20|FH_F114853_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F42244_0_0|SrvcGrp|290|2022|PCT|0.70|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|799.00|99|0.00|WILLS COMM SURG SVC ASC 2|
20|FH_F138677_43793_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138876_25302_0|SrvcGrp|86832|2022|PDM|3.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F138936_01040_0|SrvcGrp|73496|2022|PDM|1030.00|99|0.00|AETNA ER LEVEL V|
20|FH_F138996_68104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F83792_0_0|SrvcGrp|78444|2022|PDM|3780.00|99|0.00|AETNA MATERNITY CARE (C-SECTION)|
20|FH_F119888_0_0|SrvcGrp|106297|2022|PDM|220.30|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F117715_0_0|SrvcGrp|38364|2022|PDM|5234.92|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|235.65|99|0.00|HAPA WPA-NWPA 2012-13 ASC 15 W/O REV|
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|1155.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F151304_31520_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122038_34606_0|SrvcGrp|89417|2022|PDM|415.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F145208_63640_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135572_89106_0|SrvcGrp|29076|2022|PCT|1.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F91735_92653_0|SrvcGrp|91677|2022|PDM|110.25|99|0.00|AETNA SKILLED NURSE IN HOME HEALTH SETTING|
20|FH_F91764_93710_0|SrvcGrp|111928|2022|PCT|2.19|99|0.00|COVID-19 BARTONELLA|
20|FH_F91764_93710_0|CSTM-ALL|CSTM-00|2020|PDM|9297.00|99|0.00|AEG 9 (NO REV)|
20|FH_F136130_10029_0|SrvcGrp|84897|2022|PCT|1.05|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F136192_33016_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|HSS ASC|
20|FH_F116460_19464_0|SrvcGrp|75323|2022|PCT|1.00|99|0.00|DME|
20|FH_F127399_0_0|SrvcGrp|54943|2022|PDM|3121.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F140629_0_0|SrvcGrp|83647|2022|PDM|2497.00|99|0.00|CPT 47564|
20|FH_F121743_70005_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121743_70005_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F32803_0_0|SrvcGrp|12901|2022|PCT|0.65|99|0.00|ANGIOPLASTY|
20|FH_F101182_07863_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133668_63128_0|SrvcGrp|73605|2022|PDM|900.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F111301_33122_0|SrvcGrp|82758|2022|PDM|59.00|99|0.00|CHEMISTRY|
20|FH_F111301_33122_0|SrvcGrp|79786|2022|PCT|0.84|99|0.00|SLEEP STUDIES|
20|FH_F111303_19087_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
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_F54272_0_0|SrvcGrp|701|2022|PDM|2069.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F131000_0_0|SrvcGrp|15473|2022|PDM|2494.00|99|0.00|CPT CODE 42820|
20|FH_F132328_0_0|SrvcGrp|89882|2022|PDM|2563.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PDM|895.00|99|0.00|AEG 1 (NO REV)|
20|FH_F102228_08846_0|SrvcGrp|86747|2022|PCT|1.05|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F98300_30236_0|SrvcGrp|75495|2022|PDM|3166.00|99|0.00|AEG 9|
20|FH_F102940_35034_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F132090_60915_0|SrvcGrp|94567|2022|PDM|6085.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F86157_75090_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F57073_0_0|SrvcGrp|3081|2022|PCT|0.75|99|0.00|OBSERVATION SVCS|
20|FH_F119795_0_0|SrvcGrp|26278|2022|PDM|5202.00|99|0.00|CPT 29881|
20|FH_F74602_0_0|SrvcGrp|360|2022|PDM|1370.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F89363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F90354_0_0|SrvcGrp|57967|2022|PDM|160.93|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F87915_0_0|SrvcGrp|13640|2022|PDM|154.00|99|0.00|CPT 99202|
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_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|2658.00|99|0.00|ASPG VIII|
20|FH_F123784_03264_0|SrvcGrp|104874|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|1341.00|99|0.00|AEG 2 (NO REV)|
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|36.00|99|0.00|AEG 6 (NO REV)|
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|1725.00|99|0.00|ACUTE PSYCHIATRIC SERVICES|
20|FH_F136386_30901_0|SrvcGrp|113006|2022|PDM|2100.00|99|0.00|AETNA PET SCAN|
20|FH_F118152_20151_0|SrvcGrp|86829|2022|PDM|4.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F120475_81052_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F134011_84102_0|SrvcGrp|22589|2022|PDM|33.60|99|0.00|CHEMOTHERAPY NOC|
20|FH_F142527_89109_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F142547_70002_0|SrvcGrp|86847|2022|PDM|25.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F142547_70002_0|SrvcGrp|86828|2022|PDM|10.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F62683_0_0|SrvcGrp|472|2022|PDM|475.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F97582_46307_0|SrvcGrp|73461|2022|PDM|18122.00|99|0.00|AETNA NICU IV|
20|FH_F97600_46151_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F140343_89052_0|SrvcGrp|86845|2022|PDM|30.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F140407_63841_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F140570_46996_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128270_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119023_91406_0|SrvcGrp|24744|2022|PDM|75.00|99|0.00|PICC LINE INSERTION|
20|FH_F109883_35007_0|SrvcGrp|89417|2022|PDM|542.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F117267_07728_0|SrvcGrp|537|2022|PCT|0.85|99|0.00|OBSERVATION SERVICES|
20|FH_F129474_92701_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117093_40041_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F117190_84020_0|SrvcGrp|103979|2022|PCT|0.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F117211_15143_0|SrvcGrp|88621|2022|PDM|70.00|99|0.00|SKILLED NURSING LPN|
20|FH_F114145_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F137832_89118_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F137938_29036_0|SrvcGrp|113183|2022|PCT|0.51|99|0.00|INPATIENT PRO FEES|
20|FH_F109821_0_0|SrvcGrp|86236|2022|PDM|2550.00|99|0.00|AETNA SPINAL SURGERY|
20|FH_F110342_0_0|SrvcGrp|72992|2022|PDM|1040.00|99|0.00|AEG 2|
20|FH_F91572_30076_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F129892_0_0|SrvcGrp|89853|2022|PDM|1495.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG|
20|FH_F138543_60130_0|SrvcGrp|73841|2022|PDM|364.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F114630_48205_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F33460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F109513_0_0|SrvcGrp|64517|2022|PDM|2700.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F109513_0_0|SrvcGrp|72996|2022|PDM|958.50|99|0.00|AEG 4|
20|FH_F119289_43040_0|SrvcGrp|107267|2022|PDM|280.00|99|0.00|HEMODIALYSIS|
20|FH_F148554_85016_0|SrvcGrp|115474|2022|PDM|2850.00|99|0.00|RIGHT & LEFT HEART ART/VENTRICLE ANGIO|
20|FH_F133108_98221_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F115289_90057_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F118785_33315_0|SrvcGrp|73842|2022|PDM|450.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|82.15|99|0.00|DELAWARE VALLEY- ASC 123|
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F39517_0_0|SrvcGrp|361|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F32869_0_0|SrvcGrp|12435|2022|PDM|6000.00|99|0.00|PTCA W/ CARDIAC ABLATION|
20|FH_F97541_33021_0|SrvcGrp|73603|2022|PDM|2962.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F120434_34761_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F49044_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC|
20|FH_F95661_27217_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F40851_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132685_63146_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36756_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD AU|
20|FH_F123085_21921_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F128299_44134_0|SrvcGrp|89781|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F149821_21202_0|SrvcGrp|74668|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F82813_0_0|SrvcGrp|72996|2022|PDM|989.00|99|0.00|AEG 4|
20|FH_F118788_91355_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|341.00|99|0.00|HAPA EPA ASC 41|
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 7 (NO REV)|
20|FH_F88512_0_0|SrvcGrp|67265|2022|PDM|24749.14|99|0.00|RECHANNELING OF ARTERY|
20|FH_F82572_0_0|SrvcGrp|47995|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SERVICES VISIT|
20|FH_F97041_71603_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F132338_18901_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F127412_15301_0|SrvcGrp|90599|2022|PDM|905.00|99|0.00|REMOVAL OF LENS LESION|
20|FH_F72859_0_0|SrvcGrp|10564|2022|PDM|170.00|99|0.00|HOME INFUSION|
20|FH_F33070_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS|
20|FH_F134202_0_0|SrvcGrp|112540|2022|PDM|1890.00|99|0.00|ARTHROSCOPY|
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|AEG 3 (NO REV)|
20|FH_F84394_17402_0|SrvcGrp|114224|2022|PDM|14232.00|99|0.00|JOINT REPLACEMENT-UPPER EXTREMITY|
20|FH_F33925_0_0|SrvcGrp|18253|2022|PDM|4730.00|99|0.00|MS DRG 287|
20|FH_F35133_0_0|SrvcGrp|361|2022|PDM|2250.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F56833_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142087_0_0|SrvcGrp|93432|2022|PDM|15000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|2957.00|99|0.00|AEG 8 (NO REV)|
20|FH_F92516_0_0|SrvcGrp|86863|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F86712_60173_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F87092_60101_0|SrvcGrp|85623|2022|PDM|2100.00|99|0.00|INFUSION THERAPY INITIAL|
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 8 (NO REV)|
20|FH_F86851_0_0|SrvcGrp|71221|2022|PDM|520.00|99|0.00|EGD W/BALLOON DIALATION CPT 43249|
20|FH_F88632_33950_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|GENERAL ACUTE CARE|
20|FH_F148346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|1561.00|99|0.00|AEG 10 (NO REV)|
20|FH_F32305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F46832_0_0|SrvcGrp|17008|2022|PDM|90.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS|
20|FH_F117465_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F136358_06070_0|SrvcGrp|75545|2022|PDM|420.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F118152_20151_0|SrvcGrp|86834|2022|PDM|15.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F120441_33065_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134075_78230_0|SrvcGrp|53987|2022|PCT|1.00|99|0.00|PHOTOTHERAPY|
20|FH_F134126_11554_0|SrvcGrp|106289|2022|PDM|5.16|99|0.00|GROUND MILEAGE|
20|FH_F134150_01801_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136952_78218_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F142448_15701_0|SrvcGrp|113941|2022|PCT|1.00|99|0.00|AMFS DEFAULT W/O HOME HEALTH|
20|FH_F142547_70002_0|SrvcGrp|86839|2022|PDM|25.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F124926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F83831_0_0|SrvcGrp|9830|2022|PDM|88.00|99|0.00|OT SVCS|
20|FH_F97582_46307_0|SrvcGrp|73605|2022|PDM|2104.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F138584_30912_0|SrvcGrp|113376|2022|PDM|1700.00|99|0.00|RECONSTRUCTION OF MANDIBULAR|
20|FH_F140569_46975_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F140573_46517_0|SrvcGrp|74615|2022|PDM|100.00|99|0.00|INTENSIVE OUTPATIENT|
20|FH_F140837_34947_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140867_56345_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F140893_19720_0|SrvcGrp|74802|2022|PDM|8.80|99|0.00|AETNA CPT 36415|
20|FH_F149663_45219_0|CSTM-ALL|CSTM-00|2020|PDM|2854.00|99|0.00|AEG 8 (NO REV)|
20|FH_F151608_30236_0|CSTM-ALL|CSTM-00|2020|PDM|1586.00|99|0.00|AEG 10 (NO REV)|
20|FH_F151611_30032_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119004_06850_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F119021_03060_0|SrvcGrp|86753|2022|PCT|1.06|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F92506_07666_0|SrvcGrp|53144|2022|PDM|228.80|99|0.00|SPEECH THERAPY|
20|FH_F147741_80012_0|CSTM-ALL|CSTM-00|2020|PCT|2.02|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F117098_20186_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117153_34113_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F117218_32025_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F111361_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.14|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F91472_96001_0|SrvcGrp|103705|2022|PCT|0.40|99|0.00|DEFIBRILLATOR (AICD) / IMPLANT OR REPLACEMENT|
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143450_0_0|SrvcGrp|91862|2022|PDM|706.00|99|0.00|COLONOSCOPY PROCEDURES 2|
20|FH_F38321_0_0|SrvcGrp|592|2022|PDM|650.00|99|0.00|SUB-ACUTE CARE|
20|FH_F132544_0_0|SrvcGrp|96899|2022|PDM|7850.00|99|0.00|LUMBAR ARTIF DISCECTOMY|
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|AEG 3 (NO REV)|
20|FH_F148544_60439_0|SrvcGrp|104079|2022|PCT|1.50|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F90811_0_0|SrvcGrp|83838|2022|PDM|1850.00|99|0.00|SUSPENSION OF BREAST|
20|FH_F57592_0_0|SrvcGrp|20914|2022|PDM|91500.00|99|0.00|MS DRG 233 ONLY|
20|FH_F88512_0_0|CSTM-ALL|CSTM-00|2020|PDM|3437.54|99|0.00|MS DRG BAPTIST MEM HOSP MEDICAL|
20|FH_F66541_0_0|CSTM-ALL|CSTM-00|2020|PCT|13500.00|99|0.00|DIALYSIS TRAINING|
20|FH_F80859_65616_0|SrvcGrp|29817|2022|PDM|3445.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F42159_0_0|SrvcGrp|177|2022|PDM|925.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F43433_0_0|SrvcGrp|37087|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F35411_0_0|SrvcGrp|16|2022|PDM|1355.00|99|0.00|ACUTE REHABILITATION|
20|FH_F111426_63640_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|109.00|99|0.00|HAPA EPA ASC 18|
20|FH_F148003_34285_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F100786_24740_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F40340_0_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|SPINAL CORD INJURY|
20|FH_F62601_0_0|SrvcGrp|46605|2022|PDM|31.25|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F146320_27610_0|SrvcGrp|107877|2022|PDM|795.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F117550_0_0|SrvcGrp|73606|2022|PDM|800.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F134467_84321_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F117087_0_0|SrvcGrp|106063|2022|PDM|2494.00|99|0.00|REVISE MIDDLE EAR & MASTOID|
20|FH_F74463_0_0|SrvcGrp|71666|2022|PDM|4700.00|99|0.00|CPT 63655|
20|FH_F133307_14580_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F146208_76643_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97543_33542_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F51123_0_0|SrvcGrp|12403|2022|PDM|40.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F150907_17543_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|384.00|99|0.00|HAPA EPA ASC 45|
20|FH_F146285_76109_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|976.00|99|0.00|AEG 2 (NO REV)|
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|1217.00|99|0.00|AEG 3 (NO REV)|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|122.22|99|0.00|ASPG 225|
20|FH_F141807_33020_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F51123_0_0|SrvcGrp|22954|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F35453_0_0|CSTM-ALL|CSTM-00|2020|PDM|1265.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|960.45|99|0.00|ASPG 501|
20|FH_F69648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41229_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F133268_63703_0|SrvcGrp|87077|2022|PDM|106.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F125033_93305_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F42807_0_0|SrvcGrp|12837|2022|PCT|0.75|99|0.00|INTRAOCULAR LENSES|
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|929.00|99|0.00|AEG 2 (NO REV)|
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|922.00|99|0.00|PSYCH FULL DAY|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F70487_0_0|SrvcGrp|29817|2022|PDM|4000.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F44023_0_0|SrvcGrp|38002|2022|PDM|3505.00|99|0.00|SURGICAL DAY CARE|
20|FH_F132528_64014_0|SrvcGrp|48396|2022|PDM|127.00|99|0.00|OT SERVICES|
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|920.00|99|0.00|AEG 4 (NO REV)|
20|FH_F56792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F148920_40207_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67639_0_0|SrvcGrp|63467|2022|PDM|775.00|99|0.00|CPT 64585|
20|FH_F49637_0_0|SrvcGrp|39870|2022|PDM|11550.00|99|0.00|MS DRG 619-621 ONLY|
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|ASPG II|
20|FH_F43296_0_0|CSTM-ALL|CSTM-00|2020|PDM|1675.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F108700_63857_0|SrvcGrp|27969|2022|PDM|10.00|99|0.00|HOME HEALTH AIDE|
20|FH_F150911_75979_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42494_0_0|SrvcGrp|36043|2022|PCT|0.85|99|0.00|OBSERVATION W/SURGERY|
20|FH_F67639_0_0|SrvcGrp|63472|2022|PDM|4750.00|99|0.00|CPT 64581|
20|FH_F44016_0_0|SrvcGrp|16018|2022|PDM|669.00|99|0.00|EMERGENCY ROOM|
20|FH_F131282_0_0|SrvcGrp|104723|2022|PDM|817.00|99|0.00|REPAIR EYELID DEFECT|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|WV HH CATH CARE|
20|FH_F125176_20785_0|SrvcGrp|109459|2022|PDM|280.00|99|0.00|HEMODIALYSIS|
20|FH_F47479_0_0|SrvcGrp|1168|2022|PDM|28.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F47234_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PROFESSIONAL FEES ON CMS1500|
20|FH_F39417_0_0|CSTM-ALL|CSTM-00|2020|PDM|1412.98|99|0.00|ASPG II|
20|FH_F133530_11237_0|SrvcGrp|109949|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F141872_20707_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F72542_0_0|SrvcGrp|12918|2022|PDM|950.00|99|0.00|GYNECOLOGICAL MED/SURG|
20|FH_F38865_0_0|SrvcGrp|361|2022|PDM|1860.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F133530_11237_0|CSTM-ALL|CSTM-00|2020|PDM|2920.00|99|0.00|AEG 7 (NO REV)|
20|FH_F128762_78231_0|CSTM-ALL|CSTM-00|2020|PCT|1.60|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|37450.00|99|0.00|DRG 120 ONLY|
20|FH_F145884_72113_0|SrvcGrp|89337|2022|PDM|824.00|99|0.00|DETOXIFICATION|
20|FH_F71323_68114_0|SrvcGrp|27965|2022|PDM|2999.00|99|0.00|MS DRG 075-076 ONLY|
20|FH_F150519_92626_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|1910.00|99|0.00|AEG 7 (NO REV)|
20|FH_F144494_62526_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71594_15644_0|SrvcGrp|10503|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F139172_40207_0|SrvcGrp|90388|2022|PDM|630.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F139677_77087_0|SrvcGrp|86722|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F150862_75082_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F98820_81401_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F124383_39056_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138017_73129_0|CSTM-ALL|CSTM-00|2020|PDM|2893.00|99|0.00|AEG 7 (NO REV)|
20|FH_F138018_17313_0|SrvcGrp|10577|2022|PDM|103.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1017.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F36743_0_0|SrvcGrp|91|2022|PCT|0.90|99|0.00|KIDNEY TRANSPLANT|
20|FH_F120057_0_0|SrvcGrp|72998|2022|PDM|860.00|99|0.00|AEG 5|
20|FH_F35164_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137748_95231_0|SrvcGrp|23279|2022|PDM|649.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F124435_03882_0|SrvcGrp|86723|2022|PDM|313.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F149608_19116_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97260_06111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119376_0_0|SrvcGrp|104098|2022|PDM|4370.06|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F117615_30525_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117615_30525_0|SrvcGrp|75497|2022|PCT|0.85|99|0.00|AEG 10|
20|FH_F40904_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131270_38133_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127464_15106_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F147222_49544_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IP MULTI ROOM COMPARISON|
20|FH_F134676_0_0|SrvcGrp|107749|2022|PDM|164.00|99|0.00|CAPD/CCPD|
20|FH_F131974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149880_33150_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F46352_0_0|SrvcGrp|3809|2022|PDM|1325.00|99|0.00|HOSPICE CARE|
20|FH_F109242_18466_0|SrvcGrp|70642|2022|PDM|14.02|99|0.00|CONSULTANT THERAPIST|
20|FH_F127325_0_0|SrvcGrp|73002|2022|PDM|953.00|99|0.00|AEG 7|
20|FH_F150948_0_0|SrvcGrp|93431|2022|PDM|10500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F150500_85253_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|821.78|99|0.00|HAPA WPA-NWPA 2012-13 ASC 503 W/O REV|
20|FH_F97621_75801_0|SrvcGrp|73559|2022|PDM|15644.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F111540_16823_0|SrvcGrp|98041|2022|PDM|7.70|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F111540_16823_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F126560_43606_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132543_79549_0|SrvcGrp|112067|2022|PCT|2.00|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F129535_0_0|SrvcGrp|75483|2022|PDM|485.00|99|0.00|AEG 3|
20|FH_F113146_15001_0|SrvcGrp|89149|2022|PDM|168.00|99|0.00|OP INTENSIVE|
20|FH_F120437_85202_0|SrvcGrp|86844|2022|PDM|84.42|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F132331_89107_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F124505_0_0|SrvcGrp|80542|2022|PDM|813.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 6|
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150059_54494_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F54552_0_0|SrvcGrp|49286|2022|PDM|60.00|99|0.00|REPAIR OF INFUSION DEVICE|
20|FH_F94165_0_0|SrvcGrp|84809|2022|PCT|0.85|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F106540_26330_0|SrvcGrp|62017|2022|PDM|93.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F38700_0_0|SrvcGrp|19112|2022|PCT|0.80|99|0.00|MS DRG 620|
20|FH_F99720_0_0|SrvcGrp|104742|2022|PDM|4301.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F150001_33064_0|SrvcGrp|86853|2022|PDM|11.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F44607_0_0|SrvcGrp|220|2022|PCT|0.50|99|0.00|INTRAOCULAR LENSES|
20|FH_F71926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42260_0_0|SrvcGrp|26058|2022|PCT|1.00|99|0.00|IMPLANTS, PROSTHETICS, OR SUPPLIES|
20|FH_F111802_22003_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117559_08619_0|SrvcGrp|45307|2022|PDM|15.00|99|0.00|ADMIN OF INFLUENZA VIRUS VACCINE|
20|FH_F121016_32607_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|551.00|99|0.00|AEG 2 (NO REV)|
20|FH_F68947_0_0|SrvcGrp|65404|2022|PDM|2991.00|99|0.00|CPT 69421|
20|FH_F148021_80907_0|SrvcGrp|90340|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F87577_80016_0|SrvcGrp|16304|2022|PDM|1251.00|99|0.00|HOSPICE CARE|
20|FH_F87173_15136_0|SrvcGrp|85601|2022|PCT|1.45|99|0.00|PT/OT REHAB SERV|
20|FH_F145988_06105_0|CSTM-ALL|CSTM-00|2020|PDM|6233.00|99|0.00|AEG 4 (NO REV)|
20|FH_F43917_0_0|SrvcGrp|59695|2022|PDM|435.00|99|0.00|SLEEP STUDY  MOD 81|
20|FH_F87171_32578_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F122388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|1115.00|99|0.00|ASPG VI|
20|FH_F67192_0_0|SrvcGrp|14997|2022|PCT|0.52|99|0.00|DRUGS|
20|FH_F69242_0_0|SrvcGrp|42975|2022|PDM|95.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F133268_63703_0|SrvcGrp|94882|2022|PDM|13.20|99|0.00|FLU VIRUS VACC-SPLIT 3 YRS & ABOVE|
20|FH_F125023_45246_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146212_57108_0|CSTM-ALL|CSTM-00|2020|PDM|2120.00|99|0.00|AEG 8 (NO REV)|
20|FH_F83031_0_0|SrvcGrp|29826|2022|PCT|1.00|99|0.00|AWP  J & Q CODES|
20|FH_F150100_39301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100700_20110_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F72859_0_0|SrvcGrp|472|2022|PDM|320.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F81485_0_0|CSTM-ALL|CSTM-00|2020|PDM|1568.00|99|0.00|C-SECTION OR NORMAL DELIVERY|
20|FH_F132992_04662_0|SrvcGrp|88620|2022|PDM|89.00|99|0.00|SKILLED NURSING RN|
20|FH_F92677_08003_0|SrvcGrp|92187|2022|PDM|210.00|99|0.00|CPT 94772|
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 6 (NO REV)|
20|FH_F118388_34952_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123538_21206_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F40056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|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_F139680_76006_0|SrvcGrp|86722|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F150746_31210_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150767_34741_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F131028_49735_0|SrvcGrp|83521|2022|PDM|130.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F97183_25304_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91111_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117762_0_0|SrvcGrp|99172|2022|PDM|5144.00|99|0.00|CPT 28740|
20|FH_F125214_12428_0|SrvcGrp|111925|2022|PCT|0.00|99|0.00|VAGINAL DELIVERY INCLUDES NEWBORN|
20|FH_F117711_73080_0|SrvcGrp|74403|2022|PDM|210.00|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F137748_95231_0|SrvcGrp|12491|2022|PCT|0.50|99|0.00|PACEMAKER|
20|FH_F117581_21211_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F94502_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F45798_0_0|SrvcGrp|63|2022|PDM|1604.00|99|0.00|SUBACUTE CARE|
20|FH_F34918_0_0|SrvcGrp|26036|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F78185_0_0|SrvcGrp|75979|2022|PCT|1.00|99|0.00|IV THERAPY|
20|FH_F138987_0_0|SrvcGrp|83857|2022|PDM|646.00|99|0.00|IP HOSPICE SVCS|
20|FH_F144651_0_0|SrvcGrp|96350|2022|PDM|15000.00|99|0.00|SHOULDER JOINT|
20|FH_F98940_70506_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F94330_43220_0|SrvcGrp|3809|2022|PDM|578.00|99|0.00|HOSPICE CARE|
20|FH_F137767_01841_0|SrvcGrp|113133|2022|PCT|1.40|99|0.00|CHEMOTHERAPY & ALL OTHER DRUGS|
20|FH_F118194_50841_0|SrvcGrp|29075|2022|PDM|90.00|99|0.00|HYDRATION THERAPY|
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 1 (NO REV)|
20|FH_F66879_0_0|SrvcGrp|11258|2022|PCT|0.99|99|0.00|DRUGS|
20|FH_F143388_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F94261_0_0|SrvcGrp|48394|2022|PDM|36.75|99|0.00|SKILLED NURSING SERVICES|
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_F116952_01020_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F66220_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F65182_0_0|SrvcGrp|33164|2022|PDM|315.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F148500_50129_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F93332_0_0|SrvcGrp|82109|2022|PDM|3090.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F126926_32250_0|SrvcGrp|73842|2022|PDM|371.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133714_03570_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128272_60640_0|SrvcGrp|86839|2022|PDM|40.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F121564_35080_0|SrvcGrp|75419|2022|PDM|993.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F129536_0_0|SrvcGrp|111373|2022|PCT|1.00|99|0.00|PHENYLEPHRINE KETOROLAC INJECTION|
20|FH_F39992_0_0|SrvcGrp|9829|2022|PDM|85.50|99|0.00|PT SVCS|
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.30|99|0.00|ASPG IV|
20|FH_F124048_47304_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F40043_0_0|SrvcGrp|33266|2022|PDM|1825.00|99|0.00|GA ASPG VI|
20|FH_F38526_0_0|SrvcGrp|59813|2022|PDM|3500.00|99|0.00|PEDIATRIC ONE DAY STAY|
20|FH_F116268_19064_0|SrvcGrp|471|2022|PDM|411.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F48192_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119760_0_0|SrvcGrp|94781|2022|PDM|105.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F63475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME,MOD_TC|
20|FH_F49942_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136846_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F74602_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F87219_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|774.00|99|0.00|AEG 6 (NO REV)|
20|FH_F42633_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|C-SECTION|
20|FH_F123848_03257_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F60112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F62579_0_0|SrvcGrp|22589|2022|PDM|75.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F128278_21401_0|SrvcGrp|89412|2022|PDM|450.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F134618_14892_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F132776_43614_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|GENERAL ACUTE CARE|
20|FH_F79824_0_0|SrvcGrp|9521|2022|PDM|4343.00|99|0.00|LITHOTRIPSY|
20|FH_F143624_73069_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F150165_06032_0|SrvcGrp|88161|2022|PDM|5768.00|99|0.00|LAMINECTOMY W/FACE-THORACIC|
20|FH_F111986_0_0|SrvcGrp|63469|2022|PDM|721.00|99|0.00|CPT 55700|
20|FH_F134347_60630_0|SrvcGrp|73339|2022|PCT|0.92|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F36381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F112082_30720_0|SrvcGrp|29075|2022|PDM|83.43|99|0.00|HYDRATION THERAPY|
20|FH_F85353_16407_0|SrvcGrp|63805|2022|PDM|639.10|99|0.00|HAPA WPA-NWPA 2012-13 ASC 2|
20|FH_F120720_24541_0|SrvcGrp|95660|2022|PDM|560.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|962.00|99|0.00|AEG 10 (NO REV)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|341.21|99|0.00|HAPA WPA-NWPA 2012-13 ASC 221 W/O REV|
20|FH_F86132_27105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F85353_16407_0|SrvcGrp|63857|2022|PDM|374.97|99|0.00|HAPA WPA-NWPA 2012-13 ASC 226|
20|FH_F135670_01749_0|SrvcGrp|86848|2022|PDM|35.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F124173_66215_0|SrvcGrp|73742|2022|PDM|3.50|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F81698_10457_0|SrvcGrp|86840|2022|PDM|31.50|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F150311_18106_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F130364_01331_0|SrvcGrp|105465|2022|PCT|1.75|99|0.00|AETNA THERAPIES|
20|FH_F145641_06902_0|SrvcGrp|107830|2022|PDM|3173.00|99|0.00|REPAIR FOREARM TENDON/MUSCLE|
20|FH_F114444_19602_0|SrvcGrp|86870|2022|PDM|62.00|99|0.00|AETNA OFFICE OP VISIT EST (MOD TD) (HCFA)|
20|FH_F121597_30315_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F95440_0_0|SrvcGrp|72994|2022|PDM|2523.00|99|0.00|AEG 3|
20|FH_F127486_06776_0|SrvcGrp|48385|2022|PDM|109.20|99|0.00|SPEECH THERAPY|
20|FH_F111732_33771_0|SrvcGrp|104496|2022|PDM|1900.00|99|0.00|VAGINAL DELIVERY ONLY (HCFA)|
20|FH_F139780_75605_0|SrvcGrp|48385|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F123610_60018_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F84593_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149139_07522_0|SrvcGrp|114975|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F112665_0_0|SrvcGrp|89840|2022|PDM|7699.00|99|0.00|THORAX SPINE FUSION|
20|FH_F130329_64114_0|SrvcGrp|86854|2022|PDM|25.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F148905_85390_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F127486_06776_0|SrvcGrp|23683|2022|PDM|52.43|99|0.00|SKILLED NURSING RN|
20|FH_F150299_22046_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F119542_45417_0|SrvcGrp|73605|2022|PDM|1020.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F56512_0_0|SrvcGrp|42869|2022|PDM|60.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F134568_12946_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F63241_0_0|SrvcGrp|59399|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES|
20|FH_F35534_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F130328_0_0|SrvcGrp|104229|2022|PDM|190.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F149240_0_0|SrvcGrp|83857|2022|PDM|622.00|99|0.00|IP HOSPICE SVCS|
20|FH_F127189_49503_0|SrvcGrp|82223|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F119897_78229_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F40653_0_0|SrvcGrp|3499|2022|PCT|0.85|99|0.00|IMPLANTS|
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1943.00|99|0.00|AEG 3 (NO REV)|
20|FH_F38123_0_0|SrvcGrp|31186|2022|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER NUKC (DME)|
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 3 (NO REV)|
20|FH_F90199_24083_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F132113_85224_0|SrvcGrp|92760|2022|PCT|0.95|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35174_0_0|SrvcGrp|97|2022|PDM|6875.00|99|0.00|C-SECTION|
20|FH_F127418_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97620_75904_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F138018_17313_0|SrvcGrp|24750|2022|PDM|41.72|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F130203_29601_0|SrvcGrp|89149|2022|PDM|188.00|99|0.00|OP INTENSIVE|
20|FH_F126914_44136_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120119_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F129111_43084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92413_07631_0|SrvcGrp|23683|2022|PDM|50.75|99|0.00|SKILLED NURSING RN|
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35088_0_0|SrvcGrp|56342|2022|PCT|0.65|99|0.00|PTC ANGIOPLASTY|
20|FH_F35452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1614.00|99|0.00|ASPG VI|
20|FH_F114207_35243_0|SrvcGrp|22589|2022|PDM|35.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F148891_44432_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129764_48084_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F139877_32615_0|SrvcGrp|82981|2022|PDM|110.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F40521_0_0|SrvcGrp|38|2022|PDM|2900.00|99|0.00|NORMAL DELIVERY|
20|FH_F39443_0_0|SrvcGrp|30326|2022|PDM|435.00|99|0.00|HAPA WPA ASC 210|
20|FH_F149160_02180_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38999_0_0|SrvcGrp|675|2022|PDM|1573.00|99|0.00|PEDIATRIC INPATIENT SVCS|
20|FH_F35167_0_0|SrvcGrp|269|2022|PDM|8327.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F136779_0_0|SrvcGrp|112927|2022|PDM|11817.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F101685_0_0|SrvcGrp|72998|2022|PDM|885.00|99|0.00|AEG 5|
20|FH_F38873_66434_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS|
20|FH_F111320_0_0|SrvcGrp|90369|2022|PDM|1000.00|99|0.00|PROBE NASOLACRIMAL DUCT|
20|FH_F39756_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|6300.00|99|0.00|AEG 5  (NO REV)|
20|FH_F114676_91911_0|SrvcGrp|86753|2022|PCT|1.20|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F151699_01752_0|SrvcGrp|86842|2022|PDM|40.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F139970_16142_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F34853_0_0|SrvcGrp|9774|2022|PDM|3383.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F84433_0_0|SrvcGrp|53987|2022|PDM|86.99|99|0.00|PHOTOTHERAPY|
20|FH_F90232_15126_0|SrvcGrp|86825|2022|PDM|85.05|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F124452_31322_0|SrvcGrp|46605|2022|PDM|130.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F124526_05301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ENTERAL - CARECENTRIX|
20|FH_F124466_32724_0|SrvcGrp|108484|2022|PDM|484.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F120767_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F124698_45380_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F47902_0_0|SrvcGrp|29961|2022|PCT|1.00|99|0.00|DME MOD QW|
20|FH_F103060_0_0|SrvcGrp|98500|2022|PDM|7803.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|972.00|99|0.00|GA RETINA SURG CTR ASC 22|
20|FH_F47952_0_0|SrvcGrp|42975|2022|PDM|95.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F132418_84042_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F112679_85711_0|SrvcGrp|88620|2022|PDM|117.00|99|0.00|SKILLED NURSING RN|
20|FH_F116662_15801_0|SrvcGrp|471|2022|PDM|475.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F82691_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83292_0_0|CSTM-ALL|CSTM-00|2020|PCT|4.00|99|0.00|BARNESVILLE  CARDIO DX @ 100%|
20|FH_F125885_78741_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126054_30022_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F118917_33317_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F84611_30281_0|SrvcGrp|51222|2022|PDM|35004.00|99|0.00|IP GAMMA KNIFE|
20|FH_F51276_0_0|SrvcGrp|27050|2022|PDM|44.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS(MOD SH)|
20|FH_F150025_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F50137_0_0|SrvcGrp|46239|2022|PDM|120.00|99|0.00|HOME VISIT CATHETER CARE|
20|FH_F59992_0_0|SrvcGrp|55677|2022|PDM|2500.00|99|0.00|VAGINAL DELIVERY ONLY|
20|FH_F129391_17777_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F38718_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|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_F148265_06067_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35166_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|DRUGS|
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|2544.00|99|0.00|AEG 9 (NO REV)|
20|FH_F111826_0_0|SrvcGrp|101320|2022|PDM|1200.00|99|0.00|PARAVERTEBRAL FACET JOINT NERVE|
20|FH_F39819_0_0|SrvcGrp|31260|2022|PDM|21467.00|99|0.00|NY DRG 209 ONLY|
20|FH_F38341_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F137633_85202_0|SrvcGrp|43602|2022|PCT|1.00|99|0.00|DME|
20|FH_F124486_0_0|SrvcGrp|109848|2022|PDM|1009.00|99|0.00|REINFORCE/GRAFT EYE WALL (HCFA)|
20|FH_F110783_93013_0|SrvcGrp|86835|2022|PDM|12.50|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F124291_44122_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F80834_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|(RAD) OCN F/S PRICING: ALL|
20|FH_F47573_0_0|SrvcGrp|42828|2022|PDM|158.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F123745_0_0|SrvcGrp|76603|2022|PDM|2500.00|99|0.00|CPT 25111|
20|FH_F144651_0_0|SrvcGrp|101114|2022|PDM|15000.00|99|0.00|ARTHOPLASTY|
20|FH_F125182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147174_75231_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134847_0_0|SrvcGrp|107187|2022|PDM|2647.00|99|0.00|REVISE TWO EYE MUSCLES|
20|FH_F116583_0_0|SrvcGrp|106932|2022|PDM|650.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F150981_33140_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|946.00|99|0.00|ASPG X|
20|FH_F34764_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.40|99|0.00|OP SVCS|
20|FH_F35097_16508_0|SrvcGrp|99620|2022|PDM|22.00|99|0.00|OCCUPATIONAL THERAPY SVCS INITIAL EVAL|
20|FH_F125182_0_0|SrvcGrp|79593|2022|PDM|1962.00|99|0.00|CPT 45378|
20|FH_F36883_0_0|SrvcGrp|73653|2022|PDM|260.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119376_0_0|SrvcGrp|73000|2022|PDM|991.00|99|0.00|AEG 6|
20|FH_F150938_02062_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F33366_33952_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ENTERAL MOD RR - CARECENTRIX|
20|FH_F149582_01534_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141511_0_0|SrvcGrp|110579|2022|PDM|1550.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F37181_0_0|SrvcGrp|16|2022|PDM|1025.00|99|0.00|ACUTE REHABILITATION|
20|FH_F149400_83301_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F110732_31513_0|SrvcGrp|42782|2022|PDM|109.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F126717_66103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150919_17603_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151026_63129_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F132099_67487_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F99920_63141_0|SrvcGrp|95661|2022|PDM|110.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F150982_0_0|SrvcGrp|114518|2022|PDM|2808.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F92278_01440_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F117615_30525_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F124316_28112_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F150942_66743_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137748_95231_0|CSTM-ALL|CSTM-00|2020|PDM|6956.00|99|0.00|AEG 9 (NO REV)|
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|1016.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132254_40207_0|SrvcGrp|29023|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F113957_73554_0|SrvcGrp|537|2022|PDM|682.50|99|0.00|OBSERVATION SERVICES|
20|FH_F114207_35243_0|SrvcGrp|29076|2022|PDM|35.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F147379_15001_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F141511_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|2246.40|99|0.00|AEG 9 (NO REV)|
20|FH_F132160_0_0|SrvcGrp|84934|2022|PDM|6885.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F69290_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45798_0_0|SrvcGrp|8|2022|PDM|2933.00|99|0.00|BURN INTENSIVE CARE|
20|FH_F137730_46563_0|SrvcGrp|108484|2022|PDM|670.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F151003_33162_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F40627_0_0|CSTM-ALL|CSTM-00|2020|PDM|5520.00|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F37304_0_0|SrvcGrp|12045|2022|PDM|702.00|99|0.00|SLEEP STUDIES|
20|FH_F149648_89148_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F147086_84751_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F143347_16001_0|SrvcGrp|89149|2022|PDM|281.00|99|0.00|OP INTENSIVE|
20|FH_F143533_30013_0|SrvcGrp|89679|2022|PDM|74.00|99|0.00|US EXAM SCROTUM|
20|FH_F75803_0_0|SrvcGrp|16|2022|PDM|969.00|99|0.00|ACUTE REHABILITATION|
20|FH_F102943_0_0|SrvcGrp|95115|2022|PDM|743.05|99|0.00|BIOPSY OF LIVER|
20|FH_F120171_33770_0|SrvcGrp|90854|2022|PDM|849.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F132416_92270_0|SrvcGrp|106248|2022|PDM|590.00|99|0.00|PARTIAL HOSP PSYCH|
20|FH_F132495_33157_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116595_92506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F116698_07470_0|SrvcGrp|21920|2022|PDM|39.90|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F120948_53188_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120974_27607_0|SrvcGrp|39871|2022|PCT|0.76|99|0.00|MS DRG 619-621 ONLY OTLR|
20|FH_F127820_62626_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS|
20|FH_F113649_01752_0|SrvcGrp|27615|2022|PDM|65.82|99|0.00|AETNA DRUGS|
20|FH_F63229_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37970_0_0|SrvcGrp|472|2022|PDM|1045.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F37970_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F130715_98503_0|SrvcGrp|108484|2022|PDM|1275.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F130715_98503_0|SrvcGrp|73063|2022|PCT|0.40|99|0.00|OBSERVATION SERVICES|
20|FH_F130721_04769_0|SrvcGrp|104363|2022|PCT|0.89|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F98002_27103_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F143560_03079_0|SrvcGrp|115132|2022|PDM|300.00|99|0.00|ULTRASOUND AND DOPPLER STUDIES|
20|FH_F149199_73005_0|SrvcGrp|108188|2022|PDM|4811.00|99|0.00|LAPAROSCOPY SERVICES|
20|FH_F120930_0_0|SrvcGrp|26275|2022|PDM|2000.00|99|0.00|CPT 29826|
20|FH_F124660_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132779_0_0|SrvcGrp|112234|2022|PDM|45988.00|99|0.00|CARDIAC SERVICES|
20|FH_F141707_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F123943_84041_0|SrvcGrp|93098|2022|PDM|90.00|99|0.00|HOSPICE CARE|
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|5250.00|99|0.00|AEG 9 (NO REV)|
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F110263_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F151400_0_0|SrvcGrp|98563|2022|PDM|6439.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F145756_03801_0|SrvcGrp|471|2022|PDM|652.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F77862_0_0|SrvcGrp|57968|2022|PDM|36.70|99|0.00|CONTINUOUS HOMECARE|
20|FH_F90853_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35259_0_0|SrvcGrp|941|2022|PDM|5624.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F120059_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F42473_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F39819_0_0|SrvcGrp|9510|2022|PDM|300.00|99|0.00|SKILLED NURSING CARE|
20|FH_F34148_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38051_0_0|SrvcGrp|109|2022|PDM|350.00|99|0.00|CD - DETOX|
20|FH_F145545_01602_0|SrvcGrp|72602|2022|PDM|504.00|99|0.00|ECT|
20|FH_F39212_0_0|SrvcGrp|9510|2022|PDM|375.00|99|0.00|SKILLED NURSING CARE|
20|FH_F123481_90049_0|SrvcGrp|73842|2022|PDM|580.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115050_77995_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F34513_0_0|SrvcGrp|9937|2022|PDM|94.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F116281_19013_0|SrvcGrp|106724|2022|PDM|90.00|99|0.00|US EXAM PG UTERUS LIMIT (HCFA)|
20|FH_F125890_43054_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F148265_06067_0|SrvcGrp|93063|2022|PDM|10686.00|99|0.00|LUMBAR ARTIF DISKECTOMY|
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F121466_84057_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F130138_02915_0|SrvcGrp|111513|2022|PCT|0.96|99|0.00|PARTIAL HOSPITALIZATION SUBSTANCE ABUSE|
20|FH_F88254_33411_0|SrvcGrp|19742|2022|PDM|60.00|99|0.00|MID-LINE INSERTION|
20|FH_F39894_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32627_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38420_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F125820_66436_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F72051_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PDM|1438.00|99|0.00|ASPG VII F/S - BDSS|
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136571_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|474.00|99|0.00|AEG 2 (NO REV)|
20|FH_F111288_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F46941_0_0|SrvcGrp|10527|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F36998_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F124048_47304_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F32373_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F123957_84321_0|SrvcGrp|87131|2022|PDM|457.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F131176_28712_0|SrvcGrp|74668|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHYSICIAN CLINIC VISIT NATL F/S (MOD RR)|
20|FH_F32996_0_0|SrvcGrp|941|2022|PDM|3240.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F41491_0_0|SrvcGrp|3029|2022|PDM|244.00|99|0.00|NEWBORN NURSERY|
20|FH_F127415_45822_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F92091_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F62915_0_0|SrvcGrp|42869|2022|PDM|208.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F38377_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F120306_16424_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F141367_57104_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143873_33407_0|SrvcGrp|98701|2022|PDM|266.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)|
20|FH_F62695_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F77925_0_0|SrvcGrp|38650|2022|PCT|0.53|99|0.00|DRUGS / INJECTABLES|
20|FH_F127946_32514_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F92034_0_0|SrvcGrp|107347|2022|PDM|6000.00|99|0.00|IMPLT NEUROSTIM RADIOFQ REC|
20|FH_F142073_0_0|SrvcGrp|88159|2022|PDM|5980.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F39479_0_0|SrvcGrp|30552|2022|PDM|85.00|99|0.00|EARLY INTERVENTION OCCUPATIONAL THERAPY|
20|FH_F150462_30458_0|SrvcGrp|24747|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F128878_11203_0|SrvcGrp|105374|2022|PDM|101.65|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MIN|
20|FH_F127036_43724_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F129334_43016_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F38357_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F35748_0_0|SrvcGrp|29352|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY|
20|FH_F129653_0_0|SrvcGrp|88065|2022|PDM|4000.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F72047_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F143817_71322_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F40304_0_0|SrvcGrp|17100|2022|PCT|0.81|99|0.00|SKILLED NURSING|
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_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|711.34|99|0.00|ASPG III|
20|FH_F130911_06001_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145781_0_0|SrvcGrp|114304|2022|PDM|1200.00|99|0.00|REVISE EYE W/ IMPLANT|
20|FH_F146590_77449_0|SrvcGrp|27969|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F136780_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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_F91171_0_0|SrvcGrp|65625|2022|PDM|1202.00|99|0.00|CPT 30520|
20|FH_F116753_0_0|SrvcGrp|75505|2022|PCT|0.63|99|0.00|CARDIAC STUDIES|
20|FH_F134972_84117_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F144248_0_0|SrvcGrp|84278|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F144808_0_0|SrvcGrp|27261|2022|PDM|8662.00|99|0.00|CPT 27446|
20|FH_F81838_0_0|SrvcGrp|22954|2022|PDM|138.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F125244_0_0|SrvcGrp|104750|2022|PDM|4500.00|99|0.00|REPAIR BLADDER & VAGINA|
20|FH_F96160_32207_0|SrvcGrp|86853|2022|PDM|68.65|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F134211_17961_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111986_0_0|SrvcGrp|84180|2022|PDM|3811.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS|
20|FH_F116806_0_0|SrvcGrp|90366|2022|PDM|1923.16|99|0.00|RHINOPLASTY COMPLETE EXT PRT|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|HOME INF- REV 640 MOD SH|
20|FH_F126063_43078_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F113484_43015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F81852_0_0|CSTM-ALL|CSTM-00|2020|PDM|1435.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|371.97|99|0.00|HAPA WPA-NWPA 2012-13 ASC 217 W/O REV|
20|FH_F146113_26719_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146103_63851_0|SrvcGrp|75506|2022|PCT|0.75|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F123644_0_0|SrvcGrp|86648|2022|PCT|0.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F113470_74010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F77597_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AETNA OBSERVATION|
20|FH_F145781_0_0|SrvcGrp|41334|2022|PDM|11000.00|99|0.00|TOTAL KNEE|
20|FH_F92598_21236_0|SrvcGrp|48396|2022|PDM|125.00|99|0.00|OT SERVICES|
20|FH_F110302_15931_0|SrvcGrp|27968|2022|PDM|33.77|99|0.00|SKILLED NURSING LPN|
20|FH_F149319_07670_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133748_77081_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F125513_40071_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F149660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F59872_0_0|SrvcGrp|45882|2022|PDM|90.00|99|0.00|PT|
20|FH_F50657_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F122947_29532_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F32374_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F69606_0_0|SrvcGrp|64106|2022|PDM|777.40|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 12|
20|FH_F72262_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F134537_03060_0|SrvcGrp|73842|2022|PDM|196.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F84712_0_0|SrvcGrp|87963|2022|PDM|8842.00|99|0.00|GASTRIC SLEEVE|
20|FH_F85553_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|JONES MEMORIAL HOSPITAL NY RAD|
20|FH_F74583_0_0|SrvcGrp|48394|2022|PDM|8.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F75963_0_0|CSTM-ALL|CSTM-00|2020|PDM|18.00|99|0.00|SKILLED NURSING HCPC|
20|FH_F79644_0_0|SrvcGrp|89735|2022|PDM|218.00|99|0.00|ER SVCS|
20|FH_F85211_0_0|SrvcGrp|73000|2022|PDM|1136.30|99|0.00|AEG 6|
20|FH_F105143_26062_0|SrvcGrp|87995|2022|PDM|331.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115909_38133_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F115907_12206_0|SrvcGrp|93919|2022|PDM|302.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F80513_0_0|SrvcGrp|21350|2022|PDM|6122.00|99|0.00|MS DRG 287 ONLY|
20|FH_F146855_60069_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120795_27514_0|CSTM-ALL|CSTM-00|2020|PDM|7686.00|99|0.00|AEG 3 (NO REV)|
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|190.00|99|0.00|ADULT CD PARTIAL HOSP|
20|FH_F115950_08648_0|SrvcGrp|89024|2022|PDM|85.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F116040_24637_0|SrvcGrp|16750|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F131668_97526_0|SrvcGrp|92760|2022|PCT|1.13|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133219_89119_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111581_77401_0|SrvcGrp|12837|2022|PCT|1.10|99|0.00|INTRAOCULAR LENSES|
20|FH_F148721_67205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148721_67205_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151120_71901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F121338_37756_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F121949_80246_0|SrvcGrp|75419|2022|PDM|1160.73|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F121960_75503_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F38807_0_0|SrvcGrp|17069|2022|PDM|510.00|99|0.00|ASPG III|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|149.46|99|0.00|DELAWARE VALLEY- ASC 116|
20|FH_F110000_0_0|SrvcGrp|33824|2022|PDM|1092.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 2|
20|FH_F97720_70084_0|SrvcGrp|73605|2022|PDM|2199.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F71863_0_0|SrvcGrp|17139|2022|PDM|687.50|99|0.00|HOSPICE CARE|
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|422.87|99|0.00|AETNA POLYSOMNOGRAPHY|
20|FH_F87197_0_0|SrvcGrp|73485|2022|PDM|443.00|99|0.00|AETNA REHAB|
20|FH_F87201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F115264_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F119581_0_0|SrvcGrp|108192|2022|PDM|2646.00|99|0.00|FEM/POPL REVAS W/TLA|
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|3786.00|99|0.00|AETNA AEG 8 WITHOUT 66982-66984|
20|FH_F129597_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F131412_0_0|SrvcGrp|104227|2022|PDM|149.80|99|0.00|RESPITE CARE (HCFA)|
20|FH_F132988_0_0|SrvcGrp|41327|2022|PDM|2057.62|99|0.00|OP SURGERY CPT 28308|
20|FH_F132988_0_0|SrvcGrp|110994|2022|PDM|1766.05|99|0.00|DEB SKIN BONE AT FX SITE|
20|FH_F93252_0_0|SrvcGrp|93019|2022|PDM|8000.00|99|0.00|TOTAL KNEE REPLACEMENT|
20|FH_F126324_20176_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F71345_0_0|SrvcGrp|9829|2022|PDM|110.03|99|0.00|PT SVCS|
20|FH_F127529_43230_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F145604_14850_0|SrvcGrp|86830|2022|PDM|40.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F133920_64057_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F118144_33418_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F81698_10457_0|SrvcGrp|22589|2022|PDM|26.50|99|0.00|CHEMOTHERAPY NOC|
20|FH_F112082_30720_0|SrvcGrp|24752|2022|PDM|23.49|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F119107_22601_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F85353_16407_0|SrvcGrp|63759|2022|PDM|1847.98|99|0.00|HAPA WPA-NWPA 2012-13 ASC 901|
20|FH_F85097_0_0|SrvcGrp|1259|2022|PDM|3119.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F129509_0_0|SrvcGrp|71666|2022|PDM|3075.00|99|0.00|CPT 63655|
20|FH_F70208_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F124146_46321_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F130763_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F138047_77027_0|SrvcGrp|113201|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES HH AMFS(H) DEFAULT|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|86.46|99|0.00|HAPA WPA-NWPA 2012-13 ASC 244 W/O REV|
20|FH_F125928_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63886|2022|PDM|236.97|99|0.00|HAPA WPA-NWPA 2012-13 ASC 129|
20|FH_F90416_73013_0|SrvcGrp|88621|2022|PDM|50.00|99|0.00|SKILLED NURSING LPN|
20|FH_F96160_32207_0|SrvcGrp|86829|2022|PDM|30.38|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F139678_25601_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F83978_66739_0|SrvcGrp|79593|2022|PDM|676.00|99|0.00|CPT 45378|
20|FH_F127091_62016_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F134208_21502_0|CSTM-ALL|CSTM-00|2020|PDM|1606.00|99|0.00|AEG 9 (NO REV)|
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)|
20|FH_F150239_75569_0|SrvcGrp|29077|2022|PCT|1.00|99|0.00|HOME TRANSFUSION|
20|FH_F99161_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F134662_54853_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121476_0_0|SrvcGrp|77507|2022|PDM|6285.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F51393_0_0|SrvcGrp|42831|2022|PDM|46.00|99|0.00|DIETICIAN VISIT|
20|FH_F80224_0_0|SrvcGrp|177|2022|PDM|3343.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F119783_46360_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F127343_0_0|SrvcGrp|110674|2022|PDM|11480.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F136327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135656_74820_0|SrvcGrp|74668|2022|PDM|233.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F141210_0_0|SrvcGrp|65625|2022|PDM|5150.00|99|0.00|CPT 30520|
20|FH_F120719_27540_0|SrvcGrp|14187|2022|PDM|980.00|99|0.00|MRI|
20|FH_F116849_0_0|SrvcGrp|13927|2022|PDM|106.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F124792_44515_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F111702_07652_0|SrvcGrp|100765|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F100782_0_0|SrvcGrp|105166|2022|PDM|1240.10|99|0.00|WINDBER MEDICAL CNTR ASC 508|
20|FH_F109364_52349_0|SrvcGrp|45924|2022|PDM|77.04|99|0.00|HOME HEALTH AIDE|
20|FH_F49572_0_0|SrvcGrp|360|2022|PDM|710.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F133727_33511_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F144808_0_0|SrvcGrp|11673|2022|PDM|4812.00|99|0.00|CPT 29888|
20|FH_F110223_31750_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F144248_0_0|SrvcGrp|42427|2022|PDM|6885.00|99|0.00|OP SURGERY CPT 65420|
20|FH_F117206_0_0|SrvcGrp|90605|2022|PDM|1485.00|99|0.00|REMOVE CATARACT INSERT LENS|
20|FH_F133585_0_0|SrvcGrp|107877|2022|PDM|764.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F120735_40012_0|SrvcGrp|89417|2022|PDM|369.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F113325_80004_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F95440_0_0|SrvcGrp|72996|2022|PDM|2626.00|99|0.00|AEG 4|
20|FH_F85777_77030_0|SrvcGrp|113616|2022|PCT|0.75|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F116506_0_0|SrvcGrp|75493|2022|PDM|1090.00|99|0.00|AEG 8|
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 4 (NO REV)|
20|FH_F146420_18940_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F90438_08873_0|SrvcGrp|43524|2022|PDM|177.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F144248_0_0|SrvcGrp|46906|2022|PDM|9754.00|99|0.00|CORNEAL TISSUE|
20|FH_F149265_64429_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145642_15108_0|SrvcGrp|86853|2022|PDM|30.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F133916_66090_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128379_0_0|SrvcGrp|88740|2022|PDM|2861.00|99|0.00|SP BONE ALGRFT|
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|1640.00|99|0.00|AEG 7 (NO REV)|
20|FH_F112023_12866_0|SrvcGrp|11108|2022|PDM|1929.00|99|0.00|NEWBORN NURSERY|
20|FH_F84712_0_0|SrvcGrp|73000|2022|PDM|4037.00|99|0.00|AEG 6|
20|FH_F84712_0_0|SrvcGrp|87967|2022|PDM|8842.00|99|0.00|GASTRIC SLEEVE|
20|FH_F84912_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F86836_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F98780_35022_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F98800_85021_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F105143_26062_0|SrvcGrp|76619|2022|PCT|0.70|99|0.00|THERAPY|
20|FH_F146881_83661_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120811_53525_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F116114_37033_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F131671_72301_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133398_43204_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114345_27597_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F114345_27597_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114386_07090_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114389_50131_0|SrvcGrp|92097|2022|PDM|1895.43|99|0.00|AETNA HOME VENT NON-INVASIVE INTERFACE|
20|FH_F141336_16947_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F141353_26452_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F124059_64055_0|SrvcGrp|43569|2022|PDM|42.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F146890_44115_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|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_F39956_0_0|SrvcGrp|38|2022|PDM|1751.00|99|0.00|NORMAL DELIVERY|
20|FH_F132864_71101_0|SrvcGrp|112128|2022|PDM|620.00|99|0.00|CAT SCAN|
20|FH_F129549_01238_0|SrvcGrp|46104|2022|PDM|107.62|99|0.00|HOME VISIT - PRENATAL|
20|FH_F124225_92506_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F124227_01230_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116097_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127995_84010_0|SrvcGrp|22593|2022|PDM|25.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 7 (NO REV)|
20|FH_F101702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114629_19131_0|SrvcGrp|90388|2022|PDM|986.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F114705_77018_0|SrvcGrp|93919|2022|PDM|450.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F114705_77018_0|SrvcGrp|89149|2022|PDM|213.00|99|0.00|OP INTENSIVE|
20|FH_F139087_47586_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F42840_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134697_32566_0|SrvcGrp|89417|2022|PDM|467.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F134727_30650_0|SrvcGrp|79786|2022|PCT|1.10|99|0.00|SLEEP STUDIES|
20|FH_F136824_08034_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F136907_44833_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136914_64081_0|SrvcGrp|13683|2022|PDM|603.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F112187_98272_0|SrvcGrp|73806|2022|PCT|0.81|99|0.00|AETNA ER|
20|FH_F112248_53223_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116345_78626_0|SrvcGrp|73841|2022|PDM|340.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F116173_40217_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F147443_06469_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F42279_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F82234_0_0|SrvcGrp|14412|2022|PDM|653.79|99|0.00|HOSPICE CARE|
20|FH_F36854_0_0|SrvcGrp|453|2022|PDM|500.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F50994_0_0|SrvcGrp|3809|2022|PDM|350.00|99|0.00|HOSPICE CARE|
20|FH_F138681_39301_0|SrvcGrp|90388|2022|PDM|708.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F138907_01040_0|SrvcGrp|104228|2022|PDM|170.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F138992_72703_0|SrvcGrp|112966|2022|PCT|0.75|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PDM|1078.00|99|0.00|ASPG VI|
20|FH_F91641_0_0|SrvcGrp|91454|2022|PDM|988.38|99|0.00|PLACEMENT OF AMNIOTIC MEMBRANE ON OCULAR SURFACE|
20|FH_F110233_0_0|SrvcGrp|73488|2022|PCT|0.94|99|0.00|AETNA HOSPITAL OP DIALYSIS|
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|679.80|99|0.00|AEG 10 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|169.04|99|0.00|HAPA WPA-NWPA 2012-13 ASC 236 W/O REV|
20|FH_F113527_31023_0|SrvcGrp|1943|2022|PDM|637.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F151319_64040_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122168_66214_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F135874_74403_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135925_32548_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F130620_18940_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F131132_44077_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F116469_92543_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F116468_49660_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F116370_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F32938_0_0|SrvcGrp|6|2022|PDM|5800.00|99|0.00|OP SURGERY|
20|FH_F33015_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F101644_75116_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121824_92675_0|SrvcGrp|75419|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG X|
20|FH_F46918_0_0|SrvcGrp|28628|2022|PDM|102.00|99|0.00|SKILLED NURSING|
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|994.00|99|0.00|AEG 6 (NO REV)|
20|FH_F131407_07607_0|SrvcGrp|43568|2022|PDM|60.00|99|0.00|SKILLED NURSING - RN|
20|FH_F111292_33136_0|SrvcGrp|82738|2022|PDM|14.00|99|0.00|NON-AUTOMATED WITHOUT MICRO|
20|FH_F134312_76301_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F65882_0_0|SrvcGrp|42831|2022|PDM|41.00|99|0.00|DIETICIAN VISIT|
20|FH_F50485_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|2041.00|99|0.00|ASPG VII|
20|FH_F112129_62220_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F96340_23704_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F128549_44224_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F136390_46321_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F120473_98055_0|CSTM-ALL|CSTM-00|2020|PCT|2.74|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136952_78218_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F142690_31774_0|SrvcGrp|29023|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F53732_0_0|SrvcGrp|17302|2022|PDM|55.00|99|0.00|HYDRATION THERAPY - 3+ LITERS|
20|FH_F138468_63128_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F140343_89052_0|SrvcGrp|86835|2022|PDM|10.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F140750_89119_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F140846_48207_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F80205_33161_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F149530_80014_0|SrvcGrp|87317|2022|PDM|875.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F149541_85258_0|SrvcGrp|74668|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149646_71129_0|SrvcGrp|108484|2022|PDM|555.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F119011_08701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119023_91406_0|SrvcGrp|86839|2022|PDM|35.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F92506_07666_0|SrvcGrp|89922|2022|PDM|5000.00|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F92506_07666_0|SrvcGrp|91629|2022|PDM|209.09|99|0.00|SKILLED NURSE SERVICES 15 MINS|
20|FH_F115452_15235_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F147725_06002_0|SrvcGrp|96539|2022|PDM|4200.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F129448_43235_0|SrvcGrp|48394|2022|PDM|48.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F129467_45449_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F129483_77030_0|SrvcGrp|17014|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129483_77030_0|SrvcGrp|63156|2022|PCT|0.83|99|0.00|IMMUNE GLOBULIN INTRAVENOUS|
20|FH_F129491_90245_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F117102_39355_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117217_80304_0|SrvcGrp|90854|2022|PDM|1145.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F117126_12801_0|SrvcGrp|16|2022|PDM|2260.00|99|0.00|ACUTE REHABILITATION|
20|FH_F137815_15501_0|SrvcGrp|86723|2022|PDM|350.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F137938_29036_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F45303_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38699_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|OCN F/S PRICING: ALL|
20|FH_F39303_0_0|CSTM-ALL|CSTM-00|2020|PDM|854.00|99|0.00|ACUTE PSYCH|
20|FH_F104700_0_0|SrvcGrp|72992|2022|PDM|1245.00|99|0.00|AEG 2|
20|FH_F109652_0_0|SrvcGrp|16|2022|PDM|994.00|99|0.00|ACUTE REHABILITATION|
20|FH_F109652_0_0|SrvcGrp|80019|2022|PDM|6975.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F124923_23518_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F130619_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|OP SVCS|
20|FH_F91067_0_0|SrvcGrp|64517|2022|PDM|2500.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F56274_0_0|SrvcGrp|1168|2022|PDM|871.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F33925_0_0|SrvcGrp|16|2022|PDM|862.00|99|0.00|ACUTE REHABILITATION|
20|FH_F40855_0_0|CSTM-ALL|CSTM-00|2020|PDM|390.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F98622_45005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F111186_15213_0|SrvcGrp|86723|2022|PDM|575.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F36787_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40474_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F56753_15086_0|SrvcGrp|13985|2022|PDM|53.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|1336.00|99|0.00|AEG 6 (NO REV)|
20|FH_F140873_0_0|SrvcGrp|80920|2022|PDM|735.00|99|0.00|HOSPICE SERVICES|
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97261_06098_0|SrvcGrp|73559|2022|PDM|12352.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F100906_0_0|SrvcGrp|97499|2022|PDM|1020.00|99|0.00|AETNA BIOPSY OR EXCISION|
20|FH_F117485_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F34316_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F119417_78212_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F119444_72903_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119449_84032_0|SrvcGrp|108484|2022|PDM|750.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F137951_0_0|SrvcGrp|75002|2022|PDM|4509.00|99|0.00|ARTHOSCOPY|
20|FH_F148001_15601_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141870_85224_0|SrvcGrp|86827|2022|PDM|60.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F81151_16801_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F119437_0_0|SrvcGrp|92412|2022|PDM|4750.00|99|0.00|SPINAL CRD DECOMP->2 CERVIC|
20|FH_F113261_38464_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|494.00|99|0.00|AEG 3 (NO REV)|
20|FH_F129176_48098_0|SrvcGrp|84185|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F40738_0_0|SrvcGrp|16|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION|
20|FH_F51129_0_0|SrvcGrp|30067|2022|PCT|0.75|99|0.00|LASER BRONCHOSCOPY|
20|FH_F117009_0_0|SrvcGrp|42427|2022|PDM|980.00|99|0.00|OP SURGERY CPT 65420|
20|FH_F87155_04105_0|SrvcGrp|46605|2022|PDM|94.56|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F117909_92405_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F91194_33511_0|SrvcGrp|38006|2022|PDM|1400.00|99|0.00|CPT CODE 59426|
20|FH_F130616_43615_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133478_40165_0|SrvcGrp|82686|2022|PDM|485.00|99|0.00|AETNA CT SCAN|
20|FH_F90921_77702_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F46196_0_0|SrvcGrp|40694|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY MOD 59|
20|FH_F41739_0_0|SrvcGrp|27791|2022|PDM|28569.00|99|0.00|DRG 121 ONLY|
20|FH_F89112_16509_0|SrvcGrp|64109|2022|PDM|1228.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 2|
20|FH_F146159_89102_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F90811_0_0|SrvcGrp|90061|2022|PDM|10000.00|99|0.00|AETNA RECONSTRUCT SHOULDER JOINT|
20|FH_F118496_92627_0|SrvcGrp|86749|2022|PCT|1.20|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F102325_62691_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F102822_84065_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD HOME HEALTH|
20|FH_F132954_32066_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111823_32539_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134828_30531_0|SrvcGrp|76662|2022|PDM|37.00|99|0.00|CPT 73630|
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG X|
20|FH_F39346_0_0|SrvcGrp|13551|2022|PDM|295.00|99|0.00|NEWBORN NURSERY|
20|FH_F146760_0_0|SrvcGrp|107749|2022|PDM|182.00|99|0.00|CAPD/CCPD|
20|FH_F133536_0_0|SrvcGrp|69977|2022|PDM|2068.00|99|0.00|CPT 28322, 28725|
20|FH_F46732_0_0|SrvcGrp|9828|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F70531_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F110086_21742_0|CSTM-ALL|CSTM-00|2020|PDM|1055.00|99|0.00|AEG 5  (NO REV)|
20|FH_F69322_0_0|CSTM-ALL|CSTM-00|2020|PDM|962.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F90874_0_0|SrvcGrp|105502|2022|PDM|1476.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1569.00|99|0.00|AEG 6 (NO REV)|
20|FH_F126730_84737_0|SrvcGrp|74668|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F33486_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)|
20|FH_F37679_0_0|SrvcGrp|27076|2022|PDM|40.00|99|0.00|HOME INFUSION (MOD SH)|
20|FH_F121490_86314_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F102185_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F91663_19901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118194_50841_0|SrvcGrp|73701|2022|PDM|90.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|1758.00|99|0.00|AEG 4 (NO REV)|
20|FH_F142710_0_0|SrvcGrp|29155|2022|PDM|105.00|99|0.00|HOSPICE SVCS|
20|FH_F87254_0_0|SrvcGrp|104619|2022|PDM|1445.00|99|0.00|REPAIR OF VAGINA|
20|FH_F84215_0_0|SrvcGrp|73006|2022|PDM|1623.00|99|0.00|AEG 9|
20|FH_F135236_02840_0|SrvcGrp|3378|2022|PCT|1.01|99|0.00|OBSERVATION SVCS|
20|FH_F145542_70503_0|SrvcGrp|88621|2022|PDM|75.00|99|0.00|SKILLED NURSING LPN|
20|FH_F47963_0_0|SrvcGrp|25938|2022|PDM|99.00|99|0.00|SOCIAL WORKER (MEDICAL)|
20|FH_F86319_16365_0|SrvcGrp|103913|2022|PCT|0.63|99|0.00|OP DIALYSIS|
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F125986_62656_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F84778_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F90362_0_0|SrvcGrp|72994|2022|PDM|585.00|99|0.00|AEG 3|
20|FH_F151526_28208_0|SrvcGrp|109488|2022|PDM|11112.00|99|0.00|VASC EMBOLIZE/OCCLUDE ARTERY|
20|FH_F110925_01104_0|SrvcGrp|22593|2022|PDM|59.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F74653_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|OP SVCS|
20|FH_F129782_0_0|SrvcGrp|64776|2022|PCT|1.00|99|0.00|CORNEAL TISSUE IMPLANTS/PROSTHETICS/ORTHO|
20|FH_F34112_0_0|SrvcGrp|63|2022|PDM|825.00|99|0.00|SUBACUTE CARE|
20|FH_F78603_0_0|SrvcGrp|28167|2022|PDM|76163.07|99|0.00|MS DRG 231 ONLY|
20|FH_F149839_80002_0|SrvcGrp|88620|2022|PDM|135.00|99|0.00|SKILLED NURSING RN|
20|FH_F149863_68127_0|SrvcGrp|74668|2022|PDM|166.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F93282_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS SNF PPS|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|ASPG II F/S - BDSS|
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|542.00|99|0.00|AEG 3 (NO REV)|
20|FH_F148348_16803_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F73126_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130681_15701_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148221_06477_0|SrvcGrp|43567|2022|PDM|105.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F135219_68506_0|SrvcGrp|112053|2022|PCT|1.00|99|0.00|COVID-19 IMMUNOASSAY|
20|FH_F40043_0_0|SrvcGrp|360|2022|PDM|1920.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.00|99|0.00|AEG 2 (NO REV)|
20|FH_F137547_32750_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F95962_0_0|SrvcGrp|94886|2022|PDM|1972.00|99|0.00|MEDICAL SVERVICES|
20|FH_F90874_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F126002_11946_0|SrvcGrp|89337|2022|PDM|662.00|99|0.00|DETOXIFICATION|
20|FH_F77925_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F125249_0_0|SrvcGrp|100040|2022|PDM|1800.00|99|0.00|REPAIR HUMERUS FRACTURE|
20|FH_F151400_0_0|SrvcGrp|99073|2022|PCT|0.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F148255_72703_0|SrvcGrp|86851|2022|PDM|31.50|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F82714_18848_0|SrvcGrp|73497|2022|PDM|1162.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F116955_16801_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES|
20|FH_F125867_78748_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148254_89503_0|SrvcGrp|66265|2022|PDM|80.75|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F37539_0_0|SrvcGrp|9795|2022|PDM|605.00|99|0.00|SUBACUTE REHAB|
20|FH_F83520_18704_0|SrvcGrp|76501|2022|PDM|334.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F128079_67456_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F93114_85016_0|SrvcGrp|88621|2022|PDM|145.00|99|0.00|SKILLED NURSING LPN|
20|FH_F38798_0_0|SrvcGrp|27968|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F118057_47906_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F94145_34994_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77066_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F111288_0_0|SrvcGrp|67119|2022|PDM|2067.00|99|0.00|ARTHODESIS|
20|FH_F115669_07652_0|SrvcGrp|100859|2022|PDM|265.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F91994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F93538_87124_0|SrvcGrp|93337|2022|PDM|340.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F110923_54768_0|SrvcGrp|75859|2022|PCT|0.85|99|0.00|MS DRG 541-542 ONLY|
20|FH_F137557_33437_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|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_F98922_40351_0|SrvcGrp|73601|2022|PDM|5625.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F137067_0_0|SrvcGrp|35669|2022|PDM|6825.00|99|0.00|CPT 63650|
20|FH_F93332_0_0|SrvcGrp|93092|2022|PDM|7416.00|99|0.00|DISKECTOMY (HCFA)|
20|FH_F132779_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|ACUTE PSYCH|
20|FH_F124660_0_0|SrvcGrp|72994|2022|PDM|603.00|99|0.00|AEG 3|
20|FH_F83812_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F92659_0_0|SrvcGrp|54086|2022|PDM|1500.00|99|0.00|VITRECTOMY, MECHANICAL, PARS PLANA APPROACH|
20|FH_F147941_06023_0|SrvcGrp|10362|2022|PDM|330.00|99|0.00|CPT CODE 99282|
20|FH_F125813_66030_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148430_06278_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134434_30607_0|SrvcGrp|58509|2022|PDM|410.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F151081_85225_0|SrvcGrp|74668|2022|PDM|226.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151140_33134_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F151155_26508_0|SrvcGrp|113346|2022|PDM|610.00|99|0.00|OFF BASE OPIOID TX 70 MIN|
20|FH_F121887_53144_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F110000_0_0|SrvcGrp|40483|2022|PCT|1.00|99|0.00|OP CARDIOLOGY MOD 26|
20|FH_F116323_0_0|SrvcGrp|106666|2022|PDM|28954.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F69751_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F80711_0_0|SrvcGrp|26001|2022|PDM|138.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F113541_0_0|SrvcGrp|23585|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F123774_0_0|SrvcGrp|73000|2022|PDM|1118.00|99|0.00|AEG 6|
20|FH_F131494_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F129758_54405_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F36584_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD UE|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC|
20|FH_F138929_0_0|SrvcGrp|26274|2022|PDM|3300.00|99|0.00|CPT 29877|
20|FH_F94786_07974_0|SrvcGrp|94103|2022|PDM|34.02|99|0.00|TRACH/LARYN TUBE NON-CUFFED|
20|FH_F95341_08701_0|SrvcGrp|94762|2022|PCT|1.00|99|0.00|FLUVIRIN VACC IM (>=3 YRS)|
20|FH_F132627_0_0|SrvcGrp|24761|2022|PDM|18.36|99|0.00|HOME INFUSION THERAPY|
20|FH_F141131_20850_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141036_02347_0|SrvcGrp|111932|2022|PCT|1.00|99|0.00|COVID-19 NON-CDC TESTING LAB|
20|FH_F114002_0_0|SrvcGrp|42972|2022|PDM|65.00|99|0.00|HOME HEALTH AIDE|
20|FH_F126345_0_0|SrvcGrp|73000|2022|PDM|1136.00|99|0.00|AEG 6|
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 10 (NO REV)|
20|FH_F115971_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F146991_80918_0|SrvcGrp|108484|2022|PDM|535.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|ASPG III|
20|FH_F100703_0_0|SrvcGrp|12309|2022|PDM|7876.00|99|0.00|MICRODISKETOMY|
20|FH_F124679_64052_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F127995_84010_0|SrvcGrp|86830|2022|PDM|3.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F127995_84010_0|SrvcGrp|90707|2022|PDM|107.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F131101_45840_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F63185_0_0|SrvcGrp|48399|2022|PDM|30.00|99|0.00|SPEECH THERAPY|
20|FH_F75662_0_0|SrvcGrp|10431|2022|PDM|49.00|99|0.00|SPEECH THERAPY|
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 5  (NO REV)|
20|FH_F92599_0_0|SrvcGrp|75491|2022|PDM|1432.00|99|0.00|AEG 7|
20|FH_F136570_32084_0|SrvcGrp|90854|2022|PDM|675.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F114726_45213_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F139556_85006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134770_14420_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136824_08034_0|SrvcGrp|72602|2022|PDM|898.00|99|0.00|ECT|
20|FH_F113713_17013_0|SrvcGrp|105375|2022|PDM|95.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MIN (HCFA)|
20|FH_F43503_0_0|SrvcGrp|97|2022|PDM|2369.00|99|0.00|C-SECTION|
20|FH_F77234_0_0|SrvcGrp|17083|2022|PDM|2379.00|99|0.00|ASPG X|
20|FH_F115567_91711_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147331_90045_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147586_44124_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|AEG 2 (NO REV)|
20|FH_F147619_72034_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F42402_0_0|SrvcGrp|36005|2022|PCT|0.90|99|0.00|ENDOSCOPY|
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1332.00|99|0.00|AEG 7 (NO REV)|
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PDM|997.70|99|0.00|AEG 4 (NO REV)|
20|FH_F100260_97116_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
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_F36854_0_0|SrvcGrp|16|2022|PDM|1100.00|99|0.00|ACUTE REHABILITATION|
20|FH_F37257_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F114853_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|616.83|99|0.00|2005 ASPG GROUPER II|
20|FH_F138970_62920_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1264.09|99|0.00|AEG 3 (NO REV)|
20|FH_F32984_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.40|99|0.00|OP SVCS|
20|FH_F119888_0_0|SrvcGrp|13597|2022|PDM|220.30|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1157.41|99|0.00|HAPA WPA-NWPA 2012-13 ASC 705 W/O REV|
20|FH_F151511_14094_0|CSTM-ALL|CSTM-00|2020|PDM|1012.60|99|0.00|AEG 1 (NO REV)|
20|FH_F122035_84020_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F122087_62684_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135485_20171_0|SrvcGrp|48394|2022|PDM|37.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F129802_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|465.00|99|0.00|CD RESIDENTIAL TREATMENT|
20|FH_F52112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F117717_68410_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 10 (NO REV)|
20|FH_F51548_0_0|SrvcGrp|10534|2022|PDM|125.00|99|0.00|NURSING CARE|
20|FH_F49354_0_0|SrvcGrp|31191|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF (DME)|
20|FH_F125266_44515_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F146212_57108_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F91255_19401_0|SrvcGrp|74585|2022|PCT|1.00|99|0.00|AETNA OP IMPLANTS|
20|FH_F101840_76054_0|SrvcGrp|29755|2022|PDM|37967.00|99|0.00|MS DRG 245 ONLY|
20|FH_F126676_43537_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F120725_0_0|CSTM-ALL|CSTM-00|2020|PDM|2617.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117559_08619_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F89932_10940_0|SrvcGrp|84720|2022|PCT|0.00|99|0.00|AETNA LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F73542_0_0|SrvcGrp|70941|2022|PCT|1.00|99|0.00|CMS AMBULANCE TN (10302-35) RURAL GROUND MILEAGE|
20|FH_F117559_08619_0|SrvcGrp|107482|2022|PDM|115.00|99|0.00|HEPATITIS B VACCINE (3 DOSE IMMUNSUP IM)|
20|FH_F38630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|100% 2007 MEDICARE TN DME MOD AW|
20|FH_F111526_32226_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132285_89103_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F89932_10940_0|SrvcGrp|78377|2022|PDM|1495.00|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F91198_46714_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F145937_75240_0|SrvcGrp|48398|2022|PDM|105.00|99|0.00|PT SERVICES|
20|FH_F80532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125212_76301_0|SrvcGrp|73842|2022|PDM|181.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119775_0_0|SrvcGrp|72998|2022|PDM|872.00|99|0.00|AEG 5|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PDM|481.00|99|0.00|ASPG I|
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|TRAUMA CARE|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2007 TX DME HCPCS - MOD KM|
20|FH_F80855_0_0|SrvcGrp|72994|2022|PDM|850.00|99|0.00|AEG 3|
20|FH_F133490_90650_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F121304_61520_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F83113_0_0|SrvcGrp|26253|2022|PDM|33.00|99|0.00|LIPIDS|
20|FH_F92677_08003_0|SrvcGrp|92103|2022|PDM|472.50|99|0.00|AETNA APNEA MONITOR W/RECORDER|
20|FH_F132785_17961_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150904_22306_0|SrvcGrp|48385|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F144020_15401_0|SrvcGrp|3378|2022|PCT|0.93|99|0.00|OBSERVATION SVCS|
20|FH_F89851_83854_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS|
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_F149940_02645_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F141833_31707_0|SrvcGrp|13597|2022|PDM|300.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F116428_0_0|SrvcGrp|92501|2022|PDM|133.35|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F38630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|100% 2007 MEDICARE DMETN  MOD KM|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F118517_33316_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F126560_43606_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F111806_33020_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F100786_24740_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F115405_06010_0|SrvcGrp|73842|2022|PDM|165.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148886_60621_0|SrvcGrp|82037|2022|PDM|2265.00|99|0.00|AETNA ICU|
20|FH_F102721_38118_0|SrvcGrp|73004|2022|PDM|1600.00|99|0.00|AEG 8|
20|FH_F42340_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F89932_10940_0|SrvcGrp|74403|2022|PDM|5040.00|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F133516_44004_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F33241_0_0|SrvcGrp|9511|2022|PDM|42.00|99|0.00|OBSERVATION SVCS|
20|FH_F148556_13206_0|SrvcGrp|17302|2022|PDM|35.00|99|0.00|HYDRATION THERAPY - 3+ LITERS|
20|FH_F133052_33462_0|SrvcGrp|89417|2022|PDM|470.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F115327_45320_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F144068_17901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143168_60563_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|3745.00|99|0.00|AEG 6 (NO REV)|
20|FH_F97103_53295_0|SrvcGrp|73659|2022|PDM|12312.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F147800_0_0|SrvcGrp|58638|2022|PDM|4675.00|99|0.00|CPT 63688|
20|FH_F45915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38508_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F139673_63011_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PDM|132.00|99|0.00|CPT CODE 99282|
20|FH_F36036_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122260_98034_0|SrvcGrp|78419|2022|PDM|1100.00|99|0.00|VBAC DELIVERY|
20|FH_F139814_24333_0|SrvcGrp|73841|2022|PDM|361.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F124719_64093_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122377_91007_0|SrvcGrp|75495|2022|PDM|9575.00|99|0.00|AEG 9|
20|FH_F131028_49735_0|SrvcGrp|97506|2022|PDM|130.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F134887_33409_0|SrvcGrp|84897|2022|PCT|1.05|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F151029_52241_0|SrvcGrp|87537|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F110726_19720_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F100880_67735_0|SrvcGrp|10393|2022|PDM|6048.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F130756_04901_0|SrvcGrp|111927|2022|PCT|1.00|99|0.00|COVID-19 NON CDC|
20|FH_F116397_33404_0|SrvcGrp|86834|2022|PDM|15.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F116527_70443_0|SrvcGrp|105415|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F34686_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131682_50109_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140629_0_0|SrvcGrp|113680|2022|PDM|2497.00|99|0.00|UNLISTED URETER LAPAROSCOPY|
20|FH_F38843_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117266_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F121407_73701_0|SrvcGrp|29817|2022|PDM|9781.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F121704_90405_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F121763_07202_0|SrvcGrp|72990|2022|PDM|1800.00|99|0.00|AEG 1|
20|FH_F121823_46234_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132097_66845_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112152_34994_0|SrvcGrp|46903|2022|PDM|636.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F98626_29118_0|SrvcGrp|73485|2022|PDM|3463.00|99|0.00|AETNA REHAB|
20|FH_F102325_62691_0|SrvcGrp|13929|2022|PDM|19.00|99|0.00|GROWTH HORMONE|
20|FH_F129240_10028_0|SrvcGrp|14949|2022|PDM|70.00|99|0.00|HOME INFUSION|
20|FH_F98300_30236_0|SrvcGrp|3932|2022|PDM|7595.00|99|0.00|LITHOTRIPSY|
20|FH_F101852_78758_0|SrvcGrp|87317|2022|PDM|770.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F102940_35034_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F132090_60915_0|CSTM-ALL|CSTM-00|2020|PDM|1773.45|99|0.00|AEG 4 (NO REV)|
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|644.70|99|0.00|AEG 10 (NO REV)|
20|FH_F72085_0_0|SrvcGrp|44245|2022|PDM|168.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F113649_01752_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F100783_03431_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F103004_75840_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F111186_15213_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F111190_30512_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F46972_0_0|SrvcGrp|10527|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F130302_0_0|SrvcGrp|72992|2022|PDM|1154.00|99|0.00|AEG 2|
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|3098.00|99|0.00|AEG 9 (NO REV)|
20|FH_F97261_06098_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F95101_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F95221_0_0|SrvcGrp|73008|2022|PDM|499.00|99|0.00|AEG 10|
20|FH_F36864_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F62614_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F86851_0_0|SrvcGrp|84990|2022|PDM|324.00|99|0.00|CPT 45308|
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 6 (NO REV)|
20|FH_F88639_80204_0|SrvcGrp|75999|2022|PCT|0.00|99|0.00|OP URGENT CARE|
20|FH_F69846_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46832_0_0|SrvcGrp|10578|2022|PDM|57.00|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F123601_30680_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117465_0_0|SrvcGrp|107472|2022|PDM|6000.00|99|0.00|AETNA CERV ARTIFIC DISKECTOMY|
20|FH_F136374_34461_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136404_06410_0|SrvcGrp|75545|2022|PDM|460.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F134007_27101_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134011_84102_0|SrvcGrp|86847|2022|PDM|25.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F134126_11554_0|CSTM-ALL|CSTM-00|2020|PDM|1321.00|99|0.00|AEG 1 (NO REV)|
20|FH_F134126_11554_0|SrvcGrp|79802|2022|PDM|747.00|99|0.00|AETNA CHEMOTHERAPY|
20|FH_F142547_70002_0|SrvcGrp|14893|2022|PDM|30.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F142547_70002_0|SrvcGrp|22592|2022|PDM|22.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F142691_30328_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F67306_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F97600_46151_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F75549_96101_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F140343_89052_0|SrvcGrp|22592|2022|PDM|30.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F140615_73013_0|CSTM-ALL|CSTM-00|2020|PDM|1634.00|99|0.00|AEG 10 (NO REV)|
20|FH_F118943_64506_0|SrvcGrp|24752|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F92506_07666_0|SrvcGrp|82138|2022|PDM|3966.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F109886_36303_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117261_43543_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117377_71303_0|SrvcGrp|101562|2022|PCT|1.00|99|0.00|HOSPICE/PHYSICIAN|
20|FH_F147725_06002_0|CSTM-ALL|CSTM-00|2020|PDM|2542.00|99|0.00|AEG 4 (NO REV)|
20|FH_F129483_77030_0|SrvcGrp|17015|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F117221_23434_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F101945_0_0|SrvcGrp|98407|2022|PDM|2185.00|99|0.00|CORRECTION OF BUNION|
20|FH_F37878_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90735_94070_0|SrvcGrp|90296|2022|PCT|1.00|99|0.00|CYTOGEN MICRARRAY|
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|3928.00|99|0.00|AEG 9 (NO REV)|
20|FH_F129892_0_0|SrvcGrp|26275|2022|PDM|1495.00|99|0.00|CPT 29826|
20|FH_F137359_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
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_F101807_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119495_34711_0|SrvcGrp|113911|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F138283_0_0|SrvcGrp|46104|2022|PDM|112.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F123144_0_0|SrvcGrp|109383|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F93592_0_0|SrvcGrp|82110|2022|PDM|1278.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC|
20|FH_F71162_0_0|SrvcGrp|73359|2022|PCT|1.10|99|0.00|VACCINE SERVICES|
20|FH_F144769_0_0|SrvcGrp|941|2022|PDM|3390.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F133021_00910_0|SrvcGrp|112301|2022|PDM|550.00|99|0.00|LOCALIZATION DEVICE|
20|FH_F38865_0_0|SrvcGrp|29762|2022|PCT|0.75|99|0.00|AZT (ZIDOVUDINE)|
20|FH_F91155_16105_0|SrvcGrp|72998|2022|PDM|1384.00|99|0.00|AEG 5|
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_F55113_0_0|SrvcGrp|16|2022|PDM|1230.00|99|0.00|ACUTE REHABILITATION|
20|FH_F39121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F132729_0_0|SrvcGrp|47427|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F148872_45723_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F40465_0_0|SrvcGrp|10067|2022|PDM|12000.00|99|0.00|DRG 517 ONLY|
20|FH_F87615_80033_0|SrvcGrp|78180|2022|PDM|1094.00|99|0.00|AETNA RESIDENTIAL TREATMENT|
20|FH_F100785_54660_0|SrvcGrp|73659|2022|PDM|5294.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F33241_0_0|SrvcGrp|14174|2022|PDM|750.00|99|0.00|MRI|
20|FH_F126819_43701_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111802_22003_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F97882_32407_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F142047_21853_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144324_67467_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F102721_38118_0|SrvcGrp|96579|2022|PCT|0.40|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F147995_67037_0|SrvcGrp|109057|2022|PCT|1.00|99|0.00|CARDIAC STUDIES|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F148886_60621_0|SrvcGrp|23198|2022|PDM|11319.00|99|0.00|CARDIAC PACEMAKER (MS DRG ONLY)|
20|FH_F100784_59923_0|SrvcGrp|73643|2022|PDM|2488.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F141802_17042_0|SrvcGrp|38823|2022|PDM|637.00|99|0.00|HOME SLEEP TEST (TYPE III)|
20|FH_F123012_27703_0|SrvcGrp|108061|2022|PCT|1.15|99|0.00|OP THERAPY SERVICES|
20|FH_F148556_13206_0|SrvcGrp|112764|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJECTION DRUGS|
20|FH_F98620_43920_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F132601_92677_0|SrvcGrp|46903|2022|PDM|1675.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F133403_0_0|SrvcGrp|87077|2022|PDM|156.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F118462_21740_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113074_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F113315_72205_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F149820_75040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F92676_15063_0|SrvcGrp|78953|2022|PDM|2919.79|99|0.00|MON VALLEY ASC 1301|
20|FH_F144448_04901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125471_34471_0|SrvcGrp|90854|2022|PDM|941.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F120437_85202_0|SrvcGrp|17302|2022|PDM|106.93|99|0.00|HYDRATION THERAPY - 3+ LITERS|
20|FH_F106540_26330_0|SrvcGrp|11259|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F69648_0_0|SrvcGrp|44042|2022|PDM|45.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F146229_60031_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F133527_68025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F100666_81301_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F141731_92590_0|SrvcGrp|58509|2022|PDM|463.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F136417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F57396_0_0|CSTM-ALL|CSTM-00|2020|PDM|80.00|99|0.00|CPT 99201|
20|FH_F95980_20016_0|SrvcGrp|89149|2022|PDM|170.00|99|0.00|OP INTENSIVE|
20|FH_F49637_0_0|SrvcGrp|21360|2022|PDM|9975.00|99|0.00|MS DRG 472-473 ONLY|
20|FH_F128246_0_0|SrvcGrp|111038|2022|PDM|726.00|99|0.00|REPAIR ENTROPION|
20|FH_F133517_49221_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F133540_72687_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142897_07018_0|SrvcGrp|113994|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F125266_44515_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F149664_33428_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117555_72802_0|SrvcGrp|89149|2022|PDM|198.00|99|0.00|OP INTENSIVE|
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 3 (NO REV)|
20|FH_F142970_43055_0|SrvcGrp|106294|2022|PDM|380.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|686.00|99|0.00|AEG 4 (NO REV)|
20|FH_F72859_0_0|SrvcGrp|15477|2022|PDM|123.22|99|0.00|PHYSICAL THERAPY SVCS INITIAL EVAL|
20|FH_F45324_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F115329_79424_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F129535_0_0|SrvcGrp|79595|2022|PDM|550.00|99|0.00|CPT 45385|
20|FH_F39268_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F37641_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|ASPG IV|
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.00|99|0.00|ASPG V|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|514.93|99|0.00|HAPA WPA-NWPA 2012-13 ASC 201 W/O REV|
20|FH_F34221_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F32869_0_0|SrvcGrp|361|2022|PDM|500.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F144109_63376_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F44952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F69063_0_0|SrvcGrp|24739|2022|PDM|35.00|99|0.00|RESPITE CARE|
20|FH_F68363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121223_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97621_75801_0|SrvcGrp|90854|2022|PDM|2796.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F98921_64503_0|SrvcGrp|73605|2022|PDM|2229.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F56793_0_0|SrvcGrp|43571|2022|PDM|80.00|99|0.00|MID-LINE INSERTION|
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|2755.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F147800_0_0|SrvcGrp|35669|2022|PDM|7700.00|99|0.00|CPT 63650|
20|FH_F148900_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F38407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|NO MOD (BASE)|
20|FH_F63417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F44225_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F136751_0_0|SrvcGrp|89404|2022|PDM|20500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F39721_0_0|SrvcGrp|17378|2022|PDM|210.00|99|0.00|CAPD TRAINING|
20|FH_F119825_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F141967_89509_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|1124.00|99|0.00|AEG 6 (NO REV)|
20|FH_F134447_12883_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149840_80002_0|SrvcGrp|90340|2022|PDM|125.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133455_60110_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F139176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|GENERAL ACUTE CARE|
20|FH_F130556_33764_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97882_32407_0|SrvcGrp|73659|2022|PDM|7565.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F44042_0_0|SrvcGrp|10425|2022|PDM|225.00|99|0.00|NEWBORN NURSERY|
20|FH_F80859_65616_0|SrvcGrp|75505|2022|PCT|0.56|99|0.00|CARDIAC STUDIES|
20|FH_F80952_45669_0|CSTM-ALL|CSTM-00|2020|PDM|874.18|99|0.00|AEG 10 (NO REV)|
20|FH_F146257_83713_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F40784_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F128144_45697_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F144211_30012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125103_0_0|SrvcGrp|103621|2022|PDM|215.00|99|0.00|AETNA DIALYSIS|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 642|
20|FH_F86173_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.77|99|0.00|GENERAL ACUTE CARE|
20|FH_F96120_67207_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F101840_76054_0|SrvcGrp|73805|2022|PDM|19719.00|99|0.00|AETNA MSDRG 621 ONLY|
20|FH_F117855_62246_0|SrvcGrp|46605|2022|PDM|70.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F146159_89102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F68782_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.40|99|0.00|OP SVCS|
20|FH_F47834_0_0|SrvcGrp|12179|2022|PCT|1.10|99|0.00|CPT CODES 70000-79999 (RAD)|
20|FH_F138467_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139707_84010_0|CSTM-ALL|CSTM-00|2020|PCT|0.22|99|0.00|OP SVCS|
20|FH_F150882_84041_0|SrvcGrp|86850|2022|PDM|47.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F141034_0_0|SrvcGrp|109079|2022|PDM|150.00|99|0.00|SELF DIALYSIS TRAINING CAPD|
20|FH_F139814_24333_0|SrvcGrp|108484|2022|PDM|649.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F146859_0_0|SrvcGrp|114856|2022|PDM|3000.00|99|0.00|SP BONE ALGRFT MORSEL|
20|FH_F39443_0_0|SrvcGrp|30145|2022|PCT|1.00|99|0.00|JEFFERSON BRACHYTHERAPY SEEDS|
20|FH_F98020_50138_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F128392_01026_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F97101_98003_0|SrvcGrp|73656|2022|PDM|684.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|2856.00|99|0.00|AHC J CODES %BC|
20|FH_F110783_93013_0|SrvcGrp|17015|2022|PDM|12.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F90232_15126_0|SrvcGrp|17016|2022|PDM|56.70|99|0.00|HOME INFUSION THERAPY|
20|FH_F134738_0_0|SrvcGrp|90157|2022|PDM|2475.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F75724_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131111_33304_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134869_08854_0|SrvcGrp|86723|2022|PDM|477.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F40399_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|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_F90223_0_0|SrvcGrp|89823|2022|PDM|5.00|99|0.00|HOME PHARMACY SERVICES (MOD SJ) (HCFA)|
20|FH_F42165_0_0|SrvcGrp|20534|2022|PCT|0.85|99|0.00|SKILLED NURSING|
20|FH_F73803_0_0|SrvcGrp|69399|2022|PCT|1.00|99|0.00|PREVENTATIVE CODES|
20|FH_F131028_49735_0|SrvcGrp|65720|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F35734_32405_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F37230_0_0|SrvcGrp|15392|2022|PDM|117.00|99|0.00|PHYSICAL THERAPY|
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 4 (NO REV)|
20|FH_F36485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% 2007 MEDICARE TN DME  MOD NU|
20|FH_F84532_0_0|SrvcGrp|73008|2022|PCT|0.68|99|0.00|AEG 10|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|330.00|99|0.00|HAPA EPA ASC 39|
20|FH_F33650_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138995_0_0|SrvcGrp|35670|2022|PDM|3600.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F149419_33966_0|SrvcGrp|87077|2022|PDM|115.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|499.00|99|0.00|ASPG II - GNADEN HUETTEN|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1462.00|99|0.00|HAPA EPA ASC 9|
20|FH_F130919_33314_0|SrvcGrp|89149|2022|PDM|228.00|99|0.00|OP INTENSIVE|
20|FH_F146266_0_0|SrvcGrp|82107|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F39008_34452_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F37304_0_0|SrvcGrp|12044|2022|PDM|1436.00|99|0.00|SLEEP STUDIES|
20|FH_F130941_0_0|CSTM-ALL|CSTM-00|2020|PDM|2113.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89851_83854_0|SrvcGrp|28078|2022|PDM|26289.00|99|0.00|MS DRG 029 ONLY|
20|FH_F147217_33781_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC|
20|FH_F150442_28451_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115483_62002_0|SrvcGrp|997|2022|PCT|0.47|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F120207_0_0|SrvcGrp|64517|2022|PDM|3399.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F131371_0_0|SrvcGrp|40002|2022|PDM|17000.00|99|0.00|TOTAL HIP|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD UE"|
20|FH_F124322_64131_0|SrvcGrp|24744|2022|PDM|83.00|99|0.00|PICC LINE INSERTION|
20|FH_F131512_37617_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40490_0_0|SrvcGrp|17420|2022|PDM|2883.00|99|0.00|INPATIENT SURGICAL|
20|FH_F74507_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149539_06032_0|SrvcGrp|48385|2022|PDM|180.00|99|0.00|SPEECH THERAPY|
20|FH_F43113_0_0|SrvcGrp|8962|2022|PDM|77.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F126781_92630_0|SrvcGrp|74668|2022|PDM|450.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F36053_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F36903_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD KF|
20|FH_F147214_48162_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|% FEE SCHEDULE (EMI)|
20|FH_F39772_0_0|SrvcGrp|38|2022|PDM|1530.00|99|0.00|NORMAL DELIVERY|
20|FH_F124465_84123_0|SrvcGrp|89149|2022|PDM|160.00|99|0.00|OP INTENSIVE|
20|FH_F150399_53045_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115483_62002_0|SrvcGrp|113109|2022|PDM|7957.00|99|0.00|LITHOTRIPSY ESWL|
20|FH_F40490_0_0|SrvcGrp|411|2022|PCT|0.58|99|0.00|OP CARDIAC CATH|
20|FH_F148960_13045_0|SrvcGrp|90643|2022|PDM|20.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F36903_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS NO MOD|
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4750.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F117583_21208_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F132123_91360_0|SrvcGrp|74668|2022|PDM|460.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F37304_0_0|SrvcGrp|15177|2022|PDM|1025.00|99|0.00|OBSTETRICAL SVCS - MOTHER ONLY|
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_F147223_49444_0|SrvcGrp|42623|2022|PDM|539.00|99|0.00|SUBACUTE - LEVEL III|
20|FH_F90817_0_0|SrvcGrp|90373|2022|PDM|2280.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY|
20|FH_F122841_0_0|SrvcGrp|90604|2022|PDM|1349.00|99|0.00|EXTRACTION OF LENS|
20|FH_F35768_32827_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F150913_70068_0|SrvcGrp|113911|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F101844_0_0|SrvcGrp|98328|2022|PDM|8943.00|99|0.00|LAMIN BIO/EXC INTRA/EXT LUMB|
20|FH_F98900_42001_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F61312_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147339_08837_0|SrvcGrp|89842|2022|PDM|2200.00|99|0.00|LUMBAR|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|168.81|99|0.00|SALLY BALIN,999182,ASC 115|
20|FH_F134847_0_0|SrvcGrp|71666|2022|PDM|5429.00|99|0.00|CPT 63655|
20|FH_F110725_48047_0|SrvcGrp|90854|2022|PDM|770.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F31912_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS|
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.50|99|0.00|AEG 4 (NO REV)|
20|FH_F42165_0_0|SrvcGrp|3138|2022|PCT|0.85|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F98820_81401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117629_06514_0|SrvcGrp|76501|2022|PDM|368.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F151202_0_0|SrvcGrp|75419|2022|PDM|350.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F149542_89169_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 4 (NO REV)|
20|FH_F139814_24333_0|SrvcGrp|89417|2022|PDM|372.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F36634_0_0|CSTM-ALL|CSTM-00|2020|PDM|3748.00|99|0.00|CV SURGERY|
20|FH_F45798_0_0|SrvcGrp|16173|2022|PDM|603.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.40|99|0.00|SALLY BALIN,999182,ASC 218|
20|FH_F33719_0_0|SrvcGrp|16|2022|PDM|1178.00|99|0.00|ACUTE REHABILITATION|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PDM|665.25|99|0.00|ASPG I|
20|FH_F125214_12428_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F38007_0_0|SrvcGrp|3944|2022|PDM|3385.00|99|0.00|CORONARY CARE UNIT|
20|FH_F119376_0_0|SrvcGrp|72998|2022|PDM|860.00|99|0.00|AEG 5|
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 10 (NO REV)|
20|FH_F114090_19023_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F47037_0_0|SrvcGrp|26001|2022|PDM|110.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F118907_0_0|SrvcGrp|92837|2022|PDM|81.97|99|0.00|SLEEP STUDY|
20|FH_F116332_0_0|SrvcGrp|11663|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F85014_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F84535_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|99|0.00|OP SVCS|
20|FH_F120057_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F140296_32068_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143249_89801_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F84631_0_0|SrvcGrp|17288|2022|PCT|1.00|99|0.00|PROFESSIONAL FEES|
20|FH_F101700_0_0|SrvcGrp|45063|2022|PDM|509.00|99|0.00|CPT 64493  INJECTION CARVE OUT|
20|FH_F101566_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|99|0.00|OP SVCS|
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|851.00|99|0.00|AEG 6 (NO REV)|
20|FH_F151740_77504_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151740_77504_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120190_92624_0|SrvcGrp|87317|2022|PDM|950.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F132479_90290_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116629_83467_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125287_92374_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F118882_30012_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F149959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F46732_0_0|SrvcGrp|22954|2022|PDM|140.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F71005_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F70208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1115.00|99|0.00|ASPG VI|
20|FH_F120608_19901_0|SrvcGrp|88621|2022|PDM|127.05|99|0.00|SKILLED NURSING LPN|
20|FH_F145817_88101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130923_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F148885_23226_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133867_84075_0|SrvcGrp|80920|2022|PDM|474.00|99|0.00|HOSPICE SERVICES|
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_F129509_0_0|SrvcGrp|72992|2022|PDM|675.00|99|0.00|AEG 2|
20|FH_F42626_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133585_0_0|SrvcGrp|109462|2022|PDM|201.00|99|0.00|PLACE CATHETER IN AORTA|
20|FH_F69647_0_0|SrvcGrp|17073|2022|PDM|1265.00|99|0.00|ASPG V|
20|FH_F119542_45417_0|SrvcGrp|89149|2022|PDM|238.00|99|0.00|OP INTENSIVE|
20|FH_F139565_0_0|SrvcGrp|85966|2022|PDM|7459.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F112672_11788_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130329_64114_0|SrvcGrp|86844|2022|PDM|25.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F100680_43130_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|202.51|99|0.00|HAPA WPA-NWPA 2012-13 ASC 311 W/O REV|
20|FH_F145708_89030_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F113457_17011_0|SrvcGrp|48396|2022|PDM|88.00|99|0.00|OT SERVICES|
20|FH_F127957_89521_0|SrvcGrp|106248|2022|PDM|551.00|99|0.00|PARTIAL HOSP PSYCH|
20|FH_F49552_0_0|SrvcGrp|15449|2022|PDM|65.00|99|0.00|DIABETES PROGRAM|
20|FH_F66991_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.90|99|0.00|OP SVCS|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F43197_0_0|SrvcGrp|15648|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132969_84003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134208_21502_0|CSTM-ALL|CSTM-00|2020|PDM|535.00|99|0.00|AEG 10 (NO REV)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|953.43|99|0.00|HAPA WPA-NWPA 2012-13 ASC 402 W/O REV|
20|FH_F93909_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS|
20|FH_F109577_0_0|SrvcGrp|93147|2022|PDM|123.00|99|0.00|DIABETIC MANAGEMENT PROGRAM (HCFA)|
20|FH_F122941_62702_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143568_85006_0|SrvcGrp|74793|2022|PCT|2.23|99|0.00|POLYSOMNOGRAPHY|
20|FH_F141167_0_0|SrvcGrp|107747|2022|PDM|400.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F139565_0_0|SrvcGrp|62740|2022|PDM|5738.00|99|0.00|SURGERY CARVE OUTS|
20|FH_F110311_17078_0|SrvcGrp|103937|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)|
20|FH_F48034_0_0|SrvcGrp|44004|2022|PDM|150.00|99|0.00|SUBSTANCE ABUSE INTENSIVE OUTPATIENT - ADULT/ADOLESCENT|
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|1819.00|99|0.00|AEG 4 (NO REV)|
20|FH_F138050_52301_0|SrvcGrp|109057|2022|PCT|1.36|99|0.00|CARDIAC STUDIES|
20|FH_F103220_0_0|SrvcGrp|99151|2022|PDM|12100.00|99|0.00|LAPS ESOPHGL SPHNCTR AGMNT|
20|FH_F51138_0_0|SrvcGrp|26001|2022|PDM|160.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|3410.00|99|0.00|AEG 9 (NO REV)|
20|FH_F145722_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F111986_0_0|SrvcGrp|104121|2022|PDM|3605.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|543.00|99|0.00|AEG 10 (NO REV)|
20|FH_F145642_15108_0|SrvcGrp|14948|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F85652_98034_0|SrvcGrp|21359|2022|PDM|57321.00|99|0.00|MS DRG 460 ONLY|
20|FH_F134972_84117_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F39532_0_0|SrvcGrp|110|2022|PDM|340.00|99|0.00|CD - REHABILITATION|
20|FH_F146626_60612_0|SrvcGrp|111928|2022|PCT|1.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F133943_01606_0|SrvcGrp|471|2022|PDM|624.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|512.00|99|0.00|AEG 10 (NO REV)|
20|FH_F125133_20601_0|SrvcGrp|27969|2022|PDM|53.05|99|0.00|HOME HEALTH AIDE|
20|FH_F143681_61938_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F112060_07514_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F146559_71901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113453_80020_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INJECTION, PEGFILGRASTIM 6MG|
20|FH_F133207_0_0|SrvcGrp|85778|2022|PDM|3696.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F134169_08831_0|SrvcGrp|74668|2022|PDM|216.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F93333_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F90574_22560_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120720_24541_0|SrvcGrp|46104|2022|PDM|80.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F120555_68405_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|1615.00|99|0.00|AEG 8 (NO REV)|
20|FH_F134972_84117_0|SrvcGrp|29347|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE|
20|FH_F35128_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122425_75082_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122470_78229_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F33068_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85055_0_0|SrvcGrp|72996|2022|PDM|850.00|99|0.00|AEG 4|
20|FH_F86836_0_0|SrvcGrp|184|2022|PDM|6650.00|99|0.00|MEDICAL INTENSIVE CARE|
20|FH_F75963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118699_0_0|SrvcGrp|103503|2022|PDM|433.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F101100_50314_0|SrvcGrp|12659|2022|PDM|804.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F101100_50314_0|SrvcGrp|97897|2022|PDM|12127.00|99|0.00|AMPUTATION FOLLOW-UP|
20|FH_F115877_63556_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F115936_75093_0|SrvcGrp|108484|2022|PDM|633.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F127467_44202_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F129970_34986_0|SrvcGrp|108484|2022|PDM|588.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F92092_74055_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F35987_0_0|CSTM-ALL|CSTM-00|2020|PDM|1718.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F37152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113957_73554_0|SrvcGrp|72998|2022|PDM|2100.00|99|0.00|AEG 5|
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|AEG 3 (NO REV)|
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_F111080_18103_0|SrvcGrp|46903|2022|PDM|520.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 1 (NO REV)|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ST CLAIRS AWP|
20|FH_F37364_0_0|SrvcGrp|38|2022|PDM|3800.00|99|0.00|NORMAL DELIVERY|
20|FH_F74902_0_0|SrvcGrp|66482|2022|PDM|35.00|99|0.00|HOME HEALTH AID|
20|FH_F47818_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136806_0_0|SrvcGrp|112948|2022|PDM|9076.00|99|0.00|NECK AND SPINE FUSION|
20|FH_F100663_56537_0|SrvcGrp|73605|2022|PDM|2264.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F76285_0_0|SrvcGrp|53145|2022|PDM|80.00|99|0.00|SOCIAL WORKER|
20|FH_F35987_0_0|SrvcGrp|16|2022|PDM|1265.00|99|0.00|ACUTE REHABILITATION|
20|FH_F127418_0_0|SrvcGrp|88340|2022|PDM|16719.02|99|0.00|SPINAL FUSION|
20|FH_F97084_91911_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS|
20|FH_F141247_18902_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F73803_0_0|SrvcGrp|68580|2022|PCT|1.00|99|0.00|IMMUNIZATIONS|
20|FH_F97184_26101_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134867_32068_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F143201_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F114568_08097_0|SrvcGrp|105683|2022|PDM|175.00|99|0.00|INTENSIVE OUTPATIENT 13-17 YRS (HCFA)|
20|FH_F110963_30535_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40624_0_0|SrvcGrp|941|2022|PDM|2800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F97280_20018_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F97300_47501_0|SrvcGrp|75442|2022|PDM|900.00|99|0.00|OBSERVATION - REV 762|
20|FH_F120057_0_0|SrvcGrp|107794|2022|PDM|4300.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F140170_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F84631_0_0|SrvcGrp|10519|2022|PDM|111.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
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_F103060_0_0|SrvcGrp|98499|2022|PDM|7803.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F102224_0_0|SrvcGrp|88492|2022|PDM|2300.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F132414_30571_0|SrvcGrp|90854|2022|PDM|1000.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F120839_19380_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112712_63005_0|SrvcGrp|17016|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116609_35801_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F82771_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F113649_01752_0|SrvcGrp|14947|2022|PDM|100.00|99|0.00|HOME INFUSION|
20|FH_F117300_0_0|SrvcGrp|88164|2022|PDM|7853.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F85353_16407_0|SrvcGrp|63856|2022|PDM|375.80|99|0.00|HAPA WPA-NWPA 2012-13 ASC 114|
20|FH_F126550_43085_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F71345_0_0|SrvcGrp|12401|2022|PDM|105.37|99|0.00|RN VISIT|
20|FH_F146289_0_0|CSTM-ALL|CSTM-00|2020|PDM|2617.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142376_0_0|SrvcGrp|87120|2022|PDM|7822.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F134568_12946_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F145694_84770_0|SrvcGrp|73605|2022|PDM|1900.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F39015_0_0|SrvcGrp|13811|2022|PDM|350.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F33047_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F74024_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F116753_0_0|SrvcGrp|103573|2022|PDM|7465.00|99|0.00|KNEE ARTHO W/ LYSIS OF ADHES|
20|FH_F149139_07522_0|SrvcGrp|113234|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2 & INF A&B AMP PRB|
20|FH_F117300_0_0|SrvcGrp|11673|2022|PDM|4909.00|99|0.00|CPT 29888|
20|FH_F133887_17013_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1018.52|99|0.00|HAPA WPA-NWPA 2012-13 ASC 705 W/O REV|
20|FH_F127589_45459_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F149079_70809_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F142894_0_0|SrvcGrp|113620|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F124161_95932_0|SrvcGrp|73000|2022|PDM|4630.00|99|0.00|AEG 6|
20|FH_F149139_07522_0|SrvcGrp|113220|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS 22 TRGT SARS-COV-2|
20|FH_F120715_83440_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F90334_23323_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F81838_0_0|SrvcGrp|12403|2022|PDM|770.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F123157_0_0|SrvcGrp|75491|2022|PDM|949.00|99|0.00|AEG 7|
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119613_90035_0|SrvcGrp|108484|2022|PDM|1050.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F120720_24541_0|SrvcGrp|29347|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F143576_43812_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114525_72401_0|SrvcGrp|93919|2022|PDM|500.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F48034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F125259_0_0|SrvcGrp|110099|2022|PDM|1750.00|99|0.00|AV FISTULA REVISION|
20|FH_F116753_0_0|SrvcGrp|106778|2022|PDM|7465.00|99|0.00|LAPARO CHOLECYSTOENTEROSTOMY|
20|FH_F118123_67226_0|SrvcGrp|14948|2022|PDM|125.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F75842_0_0|CSTM-ALL|CSTM-00|2020|PDM|2969.48|99|0.00|MS DRG BAPTIST MEM HOSP MEDICAL|
20|FH_F77665_0_0|SrvcGrp|15478|2022|PDM|65.00|99|0.00|OCCUPATIONAL THERAPY SVCS INITIAL EVAL|
20|FH_F146808_44641_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120795_27514_0|SrvcGrp|116117|2022|PCT|3.04|99|0.00|COVID-19 TESTING|
20|FH_F47140_0_0|SrvcGrp|12045|2022|PDM|564.97|99|0.00|SLEEP STUDIES|
20|FH_F116114_37033_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F131698_01862_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F131964_89120_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F149028_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151121_60455_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151142_35406_0|CSTM-ALL|CSTM-00|2020|PDM|1398.00|99|0.00|AEG 6 (NO REV)|
20|FH_F151159_46322_0|SrvcGrp|29347|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F151159_46322_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F113139_0_0|SrvcGrp|104924|2022|PCT|1.00|99|0.00|GUIDE WIRE|
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|920.00|99|0.00|AEG 4 (NO REV)|
20|FH_F38807_0_0|SrvcGrp|17073|2022|PDM|717.00|99|0.00|ASPG V|
20|FH_F113741_63303_0|SrvcGrp|48385|2022|PDM|81.60|99|0.00|SPEECH THERAPY|
20|FH_F143828_0_0|CSTM-ALL|CSTM-00|2020|PDM|1194.00|99|0.00|AEG 2 (NO REV)|
20|FH_F91873_12723_0|SrvcGrp|91219|2022|PDM|180.00|99|0.00|ACTIVE WOUND CARE MANAGEMENT|
20|FH_F106822_0_0|SrvcGrp|101741|2022|PDM|3.00|99|0.00|IMMUN ADMIN ORAL/NASAL|
20|FH_F80711_0_0|SrvcGrp|42830|2022|PDM|50.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F116169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F88456_0_0|SrvcGrp|55084|2022|PDM|4953.00|99|0.00|CPT 52648|
20|FH_F114916_30309_0|SrvcGrp|84939|2022|PDM|22500.00|99|0.00|SHOULDER JOINT|
20|FH_F105362_44601_0|SrvcGrp|90854|2022|PDM|500.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F119435_0_0|SrvcGrp|107794|2022|PDM|7630.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F55694_0_0|SrvcGrp|20900|2022|PDM|20847.00|99|0.00|MS DRG 248 ONLY|
20|FH_F132988_0_0|SrvcGrp|90360|2022|PDM|4493.01|99|0.00|REPAIR FRACTURE OF ULNA|
20|FH_F133002_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|608.96|99|0.00|ASPG IV|
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|349.00|99|0.00|AEG 1 (NO REV)|
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126345_0_0|SrvcGrp|17327|2022|PDM|2428.00|99|0.00|HYSTEROSCOPY|
20|FH_F149899_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124059_64055_0|SrvcGrp|10577|2022|PDM|25.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F124060_76040_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F146894_73505_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33896_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36318_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|CHEMOTHERAPY|
20|FH_F92493_0_0|SrvcGrp|67065|2022|PDM|20241.10|99|0.00|CERVICAL SURGERY|
20|FH_F124575_33351_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F53418_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127995_84010_0|SrvcGrp|86825|2022|PDM|50.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F32740_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F100787_69162_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F136569_16506_0|SrvcGrp|108484|2022|PDM|557.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F136667_23603_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F113785_35763_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113845_32746_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F144039_0_0|SrvcGrp|46906|2022|PDM|9754.00|99|0.00|CORNEAL TISSUE|
20|FH_F122664_07005_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F122675_07055_0|SrvcGrp|49682|2022|PCT|1.70|99|0.00|HSS DRG GROUPED|
20|FH_F43120_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|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_F43412_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43447_0_0|SrvcGrp|18932|2022|PDM|1500.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806|
20|FH_F117069_15236_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES|
20|FH_F134733_19460_0|SrvcGrp|75419|2022|PDM|650.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F134791_98034_0|SrvcGrp|22384|2022|PCT|0.00|99|0.00|HOME VISIT PRENATAL|
20|FH_F136829_29615_0|SrvcGrp|109330|2022|PCT|1.15|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F74283_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116393_07002_0|SrvcGrp|111273|2022|PDM|22.95|99|0.00|ANTIBODY|
20|FH_F147400_77707_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147416_19095_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F147585_60402_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|GENERAL ACUTE CARE|
20|FH_F147586_44124_0|CSTM-ALL|CSTM-00|2020|PDM|2458.00|99|0.00|AEG 6 (NO REV)|
20|FH_F147586_44124_0|SrvcGrp|70749|2022|PDM|1634.00|99|0.00|CPT 29823|
20|FH_F147468_20877_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F41798_0_0|CSTM-ALL|CSTM-00|2020|PDM|192.00|99|0.00|CD PARTIAL HOSP - DAY TREATMENT|
20|FH_F42176_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|PEDIATRIC IP SVCS|
20|FH_F132307_06010_0|SrvcGrp|75545|2022|PDM|550.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F133478_40165_0|SrvcGrp|20926|2022|PDM|47874.00|99|0.00|MS DRG 235 ONLY|
20|FH_F133153_44113_0|SrvcGrp|73841|2022|PDM|371.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F133170_50501_0|SrvcGrp|90854|2022|PDM|583.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F131702_17022_0|SrvcGrp|29347|2022|PDM|23.00|99|0.00|HOME HEALTH AIDE|
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|579.00|99|0.00|AEG 2 (NO REV)|
20|FH_F120639_73078_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F102267_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F118373_21205_0|SrvcGrp|12514|2022|PDM|2524.00|99|0.00|TRANSITIONAL LIVING CENTER|
20|FH_F110086_21742_0|SrvcGrp|103835|2022|PDM|2100.00|99|0.00|AETNA REMOVE BLADDER STONE|
20|FH_F125028_19061_0|SrvcGrp|22592|2022|PDM|63.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F117484_15601_0|SrvcGrp|472|2022|PDM|475.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F145550_62034_0|SrvcGrp|104230|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F41178_0_0|SrvcGrp|109|2022|PDM|710.00|99|0.00|CD - DETOX|
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148262_17901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F49920_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113410_0_0|SrvcGrp|105247|2022|PDM|5253.00|99|0.00|LAPAROSCOPY|
20|FH_F125890_43054_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F111222_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F52854_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F129011_15857_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129653_0_0|SrvcGrp|67066|2022|PDM|4000.00|99|0.00|CERVICAL SURGERY|
20|FH_F129656_15005_0|SrvcGrp|22593|2022|PDM|35.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F50218_0_0|SrvcGrp|45944|2022|PDM|32.00|99|0.00|HOME HEALTH AIDE SVCS|
20|FH_F39857_0_0|SrvcGrp|109|2022|PDM|780.00|99|0.00|CD - DETOX|
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|463.61|99|0.00|AEG 1 (NO REV)|
20|FH_F127375_28621_0|SrvcGrp|11663|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F131961_06040_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F93332_0_0|SrvcGrp|93091|2022|PDM|7416.00|99|0.00|AETNA TRANSPEDICULAR 1 SEGLUMBAR (HCFA)|
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.71|99|0.00|2005 ASPG GROUPER X|
20|FH_F131517_19152_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97500_32025_0|SrvcGrp|73602|2022|PDM|5945.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F37639_0_0|SrvcGrp|13297|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F128358_46072_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F34854_0_0|SrvcGrp|555|2022|PDM|175.00|99|0.00|INTENSIVE OP SVCS|
20|FH_F109926_0_0|SrvcGrp|78047|2022|PCT|1.00|99|0.00|AETNA VISION SERVICES|
20|FH_F90700_0_0|SrvcGrp|22954|2022|PDM|208.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F128190_45342_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F127165_32112_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F125138_63663_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72407_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F31798_0_0|SrvcGrp|16|2022|PDM|1234.00|99|0.00|ACUTE REHABILITATION|
20|FH_F77504_0_0|SrvcGrp|33235|2022|PCT|1.00|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F122240_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97500_32025_0|SrvcGrp|88978|2022|PDM|7815.00|99|0.00|VAGINAL DELIVERY|
20|FH_F77925_0_0|SrvcGrp|13217|2022|PCT|0.53|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F131992_62832_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102302_0_0|SrvcGrp|98594|2022|PDM|10850.00|99|0.00|SPINAL CRD DECOMP->2 CERVIC|
20|FH_F115103_31405_0|SrvcGrp|73485|2022|PDM|1050.50|99|0.00|AETNA REHAB|
20|FH_F148892_0_0|SrvcGrp|113271|2022|PDM|1293.00|99|0.00|GENICULAR NERVE BLOCK|
20|FH_F52653_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141410_13045_0|SrvcGrp|105465|2022|PCT|0.87|99|0.00|AETNA THERAPIES|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 9 (NO REV)|
20|FH_F129334_43016_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F141012_22901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135171_22601_0|SrvcGrp|73841|2022|PDM|400.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138654_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F111222_15701_0|SrvcGrp|76501|2022|PDM|293.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F40912_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135259_21090_0|SrvcGrp|89337|2022|PDM|1199.00|99|0.00|DETOXIFICATION|
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PDM|1274.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72830_0_0|SrvcGrp|70080|2022|PCT|0.40|99|0.00|RADIOLOGY WITH REV CODE 320, 339|
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|3750.00|99|0.00|AEG 9 (NO REV)|
20|FH_F116760_68512_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F93920_0_0|SrvcGrp|74800|2022|PCT|0.75|99|0.00|AETNA CHEMOTHERAPY AND ALL OTHER DRUGS|
20|FH_F128580_0_0|SrvcGrp|109136|2022|PDM|2248.00|99|0.00|AV FISTULA REVISION|
20|FH_F132092_0_0|SrvcGrp|89781|2022|PDM|169.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F128272_60640_0|SrvcGrp|14945|2022|PDM|9.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F67261_0_0|SrvcGrp|10363|2022|PDM|353.00|99|0.00|CPT CODE 99283|
20|FH_F90714_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40834_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ACUTE PSYCH|
20|FH_F123466_93420_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F35344_0_0|SrvcGrp|944|2022|PDM|12320.00|99|0.00|BARIATRIC SVCS|
20|FH_F131763_06002_0|SrvcGrp|472|2022|PDM|494.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F122688_19904_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87014_65203_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F133211_0_0|SrvcGrp|112225|2022|PDM|23.00|99|0.00|COVID-19 SPECIMEN COLLECTION|
20|FH_F145508_0_0|SrvcGrp|82222|2022|PDM|181.21|99|0.00|HOSPICE CARE|
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|2518.00|99|0.00|AEG 7 (NO REV)|
20|FH_F89495_0_0|SrvcGrp|73006|2022|PDM|1342.00|99|0.00|AEG 9|
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|ASPG I|
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.85|99|0.00|ASPG II|
20|FH_F88744_71103_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F71345_0_0|SrvcGrp|3809|2022|PDM|641.85|99|0.00|HOSPICE CARE|
20|FH_F123623_03246_0|SrvcGrp|109281|2022|PCT|1.00|99|0.00|COMP TST,EA.UN,SPIN TECH|
20|FH_F150242_60025_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116657_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F143617_49412_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F109267_12202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F110465_30328_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149139_07522_0|SrvcGrp|113223|2022|PDM|42.13|99|0.00|COVID-19 ANTIBODY SARS-COV-2 TITER(S)|
20|FH_F133868_40202_0|SrvcGrp|89149|2022|PDM|129.00|99|0.00|OP INTENSIVE|
20|FH_F81838_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|106% OF ASP DRUGS/IMMUN UPDATE QUARTERLY|
20|FH_F121225_98902_0|SrvcGrp|108711|2022|PCT|0.00|99|0.00|HOME HEALTH AIDE|
20|FH_F149145_33460_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111023_13905_0|SrvcGrp|76501|2022|PDM|220.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|1811.50|99|0.00|AEG 7 (NO REV)|
20|FH_F145597_78644_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F139565_0_0|SrvcGrp|84278|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|1452.00|99|0.00|AEG 6 (NO REV)|
20|FH_F135670_01749_0|SrvcGrp|24744|2022|PDM|75.00|99|0.00|PICC LINE INSERTION|
20|FH_F115616_0_0|SrvcGrp|93641|2022|PDM|3121.00|99|0.00|KNEE ARTHROSCOPIC SURGERY|
20|FH_F148661_45429_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125124_0_0|SrvcGrp|79593|2022|PDM|1962.00|99|0.00|CPT 45378|
20|FH_F132883_31602_0|SrvcGrp|86779|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F43863_0_0|SrvcGrp|37404|2022|PDM|90.00|99|0.00|PT SVCS|
20|FH_F110541_99336_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 7 (NO REV)|
20|FH_F147980_0_0|SrvcGrp|84185|2022|PDM|95.00|99|0.00|RESPITE CARE|
20|FH_F135610_06451_0|SrvcGrp|48396|2022|PDM|89.12|99|0.00|OT SERVICES|
20|FH_F112827_26452_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.32|99|0.00|HAPA WPA-NWPA 2012-13 ASC 136 W/O REV|
20|FH_F114683_0_0|SrvcGrp|73004|2022|PDM|1655.00|99|0.00|AEG 8|
20|FH_F87775_15106_0|SrvcGrp|48645|2022|PDM|85.00|99|0.00|OP SKILLED NURSING|
20|FH_F145641_06902_0|SrvcGrp|35668|2022|PDM|6619.00|99|0.00|CPT 29824|
20|FH_F111695_30286_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F68909_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F130364_01331_0|CSTM-ALL|CSTM-00|2020|PDM|2516.00|99|0.00|AEG 4 (NO REV)|
20|FH_F126525_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F80172_0_0|SrvcGrp|10649|2022|PDM|4.35|99|0.00|HOME INFUSION|
20|FH_F134495_84321_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.38|99|0.00|HAPA WPA-NWPA 2012-13 ASC 309 W/O REV|
20|FH_F102200_06416_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F105145_75075_0|SrvcGrp|12104|2022|PCT|1.15|99|0.00|DRUGS|
20|FH_F105145_75075_0|SrvcGrp|27402|2022|PDM|11434.00|99|0.00|LASER PROCEDURES|
20|FH_F115865_78621_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F75842_0_0|SrvcGrp|46521|2022|PDM|9406.88|99|0.00|SPINAL FUSION|
20|FH_F146419_68504_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146881_83661_0|SrvcGrp|88621|2022|PDM|130.00|99|0.00|SKILLED NURSING LPN|
20|FH_F120775_28805_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F132845_63841_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133401_33404_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133478_40165_0|SrvcGrp|8950|2022|PDM|2893.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F133153_44113_0|SrvcGrp|86723|2022|PDM|382.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F131490_29909_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111580_77004_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F111602_17102_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F111604_16505_0|SrvcGrp|89417|2022|PDM|330.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F111666_06517_0|SrvcGrp|89149|2022|PDM|207.00|99|0.00|OP INTENSIVE|
20|FH_F142454_0_0|SrvcGrp|42429|2022|PDM|635.00|99|0.00|OP SURGERY CPT 66761|
20|FH_F93720_12303_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127255_03104_0|SrvcGrp|104187|2022|PDM|10.00|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PDM|2450.00|99|0.00|AEG 4 (NO REV)|
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|AEG 1 (NO REV)|
20|FH_F37590_0_0|SrvcGrp|8962|2022|PDM|84.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F132092_0_0|SrvcGrp|90707|2022|PDM|169.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F130716_76013_0|SrvcGrp|48398|2022|PDM|105.00|99|0.00|PT SERVICES|
20|FH_F38591_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F110925_01104_0|SrvcGrp|86143|2022|PDM|4.10|99|0.00|AETNA TOCILIZUMAB|
20|FH_F88254_33411_0|SrvcGrp|22592|2022|PDM|30.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F123953_84003_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 5  (NO REV)|
20|FH_F40332_0_0|SrvcGrp|11258|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|1527.00|99|0.00|AEG 7 (NO REV)|
20|FH_F125028_19061_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125249_0_0|SrvcGrp|92006|2022|PDM|1700.00|99|0.00|SCAPULAR FRACTURE|
20|FH_F131176_28712_0|SrvcGrp|93338|2022|PDM|20.00|99|0.00|AETNA MED NUTRITION SEBSEQUENT|
20|FH_F139719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92659_0_0|SrvcGrp|68280|2022|PDM|1485.00|99|0.00|CPT 67040|
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|3069.00|99|0.00|AEG 4 (NO REV)|
20|FH_F66569_0_0|SrvcGrp|62260|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 10 (NO REV)|
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|2096.00|99|0.00|AEG 3 (NO REV)|
20|FH_F41013_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F41213_0_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 10 (NO REV)|
20|FH_F78265_0_0|CSTM-ALL|CSTM-00|2020|PDM|1114.00|99|0.00|ASPG I|
20|FH_F83792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1837.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1464.38|99|0.00|HAPA WPA-NWPA 2012-13 ASC 907 W/O REV|
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|383.00|99|0.00|AEG 1 (NO REV)|
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|4838.00|99|0.00|AEG 6 (NO REV)|
20|FH_F84297_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132258_45404_0|SrvcGrp|86850|2022|PDM|34.98|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|3286.00|99|0.00|ASPG VIII|
20|FH_F135440_32561_0|SrvcGrp|86723|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F135609_37027_0|SrvcGrp|104187|2022|PDM|5.00|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F97141_93933_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F97143_80012_0|SrvcGrp|73601|2022|PDM|7187.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F91764_93710_0|SrvcGrp|112914|2022|PDM|30605.00|99|0.00|MAJOR JOINT REPLACEMENT (MS DRG 470/522)|
20|FH_F135923_60453_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136042_90066_0|SrvcGrp|23587|2022|PDM|1600.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F136216_27526_0|SrvcGrp|93483|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F100880_67735_0|SrvcGrp|73000|2022|PDM|2465.00|99|0.00|AEG 6|
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|873.00|99|0.00|AEG 2 (NO REV)|
20|FH_F101200_19020_0|SrvcGrp|86748|2022|PCT|1.05|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F121444_47720_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F121761_44130_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F67923_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|BURN INTENSIVE CARE|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131407_07607_0|SrvcGrp|86831|2022|PDM|3.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F111292_33136_0|SrvcGrp|72992|2022|PDM|3536.00|99|0.00|AEG 2|
20|FH_F111292_33136_0|SrvcGrp|82761|2022|PDM|39.00|99|0.00|AUTOMATED WITHOUT MICRO|
20|FH_F134315_89106_0|SrvcGrp|29023|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F40174_0_0|SrvcGrp|30934|2022|PDM|60.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F148243_0_0|SrvcGrp|79583|2022|PDM|770.00|99|0.00|CPT 45381|
20|FH_F132720_0_0|SrvcGrp|107734|2022|PDM|4476.00|99|0.00|VAGINAL DELIVERY|
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|ASPG VI|
20|FH_F54272_0_0|SrvcGrp|18124|2022|PDM|108000.00|99|0.00|MS DRG 004|
20|FH_F131000_0_0|SrvcGrp|36864|2022|PDM|13005.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F89732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F87557_33309_0|SrvcGrp|10577|2022|PDM|30.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F87557_33309_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F88831_84123_0|SrvcGrp|73700|2022|PDM|35.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F96560_17972_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F143542_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F51276_0_0|SrvcGrp|15071|2022|PDM|150.00|99|0.00|PHOTOTHERAPY (BILIRUBIN)|
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ACUTE PSYCH|
20|FH_F38831_0_0|CSTM-ALL|CSTM-00|2020|PDM|32.00|99|0.00|GOOD SHEPHERD PTOTST|
20|FH_F98622_45005_0|SrvcGrp|73603|2022|PDM|7629.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F102947_44084_0|SrvcGrp|89417|2022|PDM|356.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F103004_75840_0|SrvcGrp|73006|2022|PDM|1875.00|99|0.00|AEG 9|
20|FH_F111204_10023_0|CSTM-ALL|CSTM-00|2020|PDM|1308.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS|
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|PTCA ANGIOPLASTY|
20|FH_F48772_66044_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|1683.15|99|0.00|AEG 8 (NO REV)|
20|FH_F97261_06098_0|SrvcGrp|73603|2022|PDM|4470.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F145508_0_0|SrvcGrp|95661|2022|PDM|448.40|99|0.00|RESPITE CARE (HCFA)|
20|FH_F124443_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F117147_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F82381_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F48292_0_0|SrvcGrp|44245|2022|PDM|165.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F126770_43050_0|SrvcGrp|89781|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F32736_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69968_0_0|SrvcGrp|3378|2022|PDM|91.76|99|0.00|OBSERVATION SVCS|
20|FH_F136299_75218_0|SrvcGrp|79786|2022|PCT|2.20|99|0.00|SLEEP STUDIES|
20|FH_F118169_27514_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120424_03060_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120490_64133_0|SrvcGrp|107697|2022|PCT|1.00|99|0.00|AETNA ALL DRUGS AGENTS INJ|
20|FH_F137051_64096_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137209_60515_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1935.00|99|0.00|AEG 7 (NO REV)|
20|FH_F139267_30253_0|SrvcGrp|113542|2022|PDM|156.89|99|0.00|COVID-19 SARSCOV2 & INF A&B AMP PRB|
20|FH_F139456_47501_0|SrvcGrp|113567|2022|PCT|1.35|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F140447_84106_0|SrvcGrp|88621|2022|PDM|60.75|99|0.00|SKILLED NURSING LPN|
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 9 (NO REV)|
20|FH_F149650_96819_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151608_30236_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 5  (NO REV)|
20|FH_F116093_47327_0|SrvcGrp|46903|2022|PDM|508.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F129011_15857_0|SrvcGrp|104054|2022|PCT|1.00|99|0.00|INFLUENZA VACCINE - PRESERVATIVE FREE|
20|FH_F122433_0_0|SrvcGrp|87054|2022|PDM|700.00|99|0.00|CYSTOSCOPY CHEMODENERVATION|
20|FH_F129768_0_0|SrvcGrp|65559|2022|PCT|6.50|99|0.00|E&M CODES|
20|FH_F135228_98003_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHYSICIAN CLINIC VISIT NATL F/S (MOD TC)|
20|FH_F32772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F102184_0_0|SrvcGrp|88157|2022|PDM|7215.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F118028_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|1554.00|99|0.00|AEG 6 (NO REV)|
20|FH_F127209_45365_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F130681_15701_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F125421_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F137943_0_0|SrvcGrp|16427|2022|PDM|610.00|99|0.00|OP SURGERY|
20|FH_F106822_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39479_0_0|SrvcGrp|30554|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F116024_13203_0|SrvcGrp|89412|2022|PDM|290.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|724.34|99|0.00|HAPA WPA-NWPA 2012-13 ASC 501 W/O REV|
20|FH_F37937_0_0|SrvcGrp|27725|2022|PDM|45.00|99|0.00|SKILLED RN HOURLY|
20|FH_F148221_06477_0|SrvcGrp|93099|2022|PDM|893.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY|
20|FH_F149866_07401_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F137614_17602_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F151400_0_0|SrvcGrp|93741|2022|PDM|3181.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY|
20|FH_F127710_44139_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F39138_0_0|SrvcGrp|313|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F116747_0_0|SrvcGrp|88620|2022|PDM|91.00|99|0.00|SKILLED NURSING RN|
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 3 (NO REV)|
20|FH_F120352_52556_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148222_18603_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F31594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128878_11203_0|SrvcGrp|111179|2022|PDM|106.00|99|0.00|PSYTX W PT W E/M 30 MINS  (MOD AF) (HCFA)|
20|FH_F39349_0_0|SrvcGrp|115|2022|PDM|568.00|99|0.00|SKILLED NURSING CARE|
20|FH_F126687_72560_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F109277_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F141795_89509_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F43294_0_0|SrvcGrp|3029|2022|PDM|440.00|99|0.00|NEWBORN NURSERY|
20|FH_F115685_64064_0|SrvcGrp|88805|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; > 3 LITERS (HCFA)|
20|FH_F70984_0_0|SrvcGrp|36875|2022|PDM|2000.00|99|0.00|TEGRESS URETHERAL INJECTION|
20|FH_F140910_53005_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F70104_0_0|SrvcGrp|66265|2022|PDM|4.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F143834_06511_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F39992_0_0|SrvcGrp|3809|2022|PDM|474.00|99|0.00|HOSPICE CARE|
20|FH_F72051_0_0|SrvcGrp|59428|2022|PDM|75.00|99|0.00|ST|
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|AEG 2 (NO REV)|
20|FH_F115064_78582_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F111826_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F38961_0_0|SrvcGrp|474|2022|PDM|250.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F131577_89148_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F151408_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|AEG 4 (NO REV)|
20|FH_F72830_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F137574_68130_0|SrvcGrp|73523|2022|PCT|1.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F116108_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F139551_0_0|SrvcGrp|75002|2022|PDM|5000.00|99|0.00|ARTHOSCOPY|
20|FH_F130214_30144_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F93791_0_0|SrvcGrp|93433|2022|PDM|4200.00|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|1305.00|99|0.00|AEG 6 (NO REV)|
20|FH_F135260_18655_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F124965_0_0|SrvcGrp|73002|2022|PDM|1500.00|99|0.00|AEG 7|
20|FH_F39476_0_0|SrvcGrp|16|2022|PDM|961.00|99|0.00|ACUTE REHABILITATION|
20|FH_F94261_0_0|SrvcGrp|48396|2022|PDM|84.00|99|0.00|OT SERVICES|
20|FH_F93881_15009_0|SrvcGrp|107908|2022|PDM|3051.00|99|0.00|MATERNITY|
20|FH_F130523_04605_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F87620_80014_0|SrvcGrp|110200|2022|PDM|300.00|99|0.00|ULTRASOUND|
20|FH_F141668_47978_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148644_06890_0|SrvcGrp|92013|2022|PDM|4830.00|99|0.00|REPAIR OF COLLATERAL LIGAMENT|
20|FH_F151144_35801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121880_54935_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121954_60706_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|597.00|99|0.00|AEG 2 (NO REV)|
20|FH_F115990_0_0|SrvcGrp|72996|2022|PDM|1055.00|99|0.00|AEG 4|
20|FH_F37625_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F40144_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)|
20|FH_F110000_0_0|SrvcGrp|33828|2022|PDM|2023.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 6|
20|FH_F117525_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117525_0_0|SrvcGrp|72994|2022|PDM|1900.00|99|0.00|AEG 3|
20|FH_F97761_04072_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F111001_0_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 9 (NO REV)|
20|FH_F68660_0_0|SrvcGrp|3378|2022|PCT|0.65|99|0.00|OBSERVATION SVCS|
20|FH_F87054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F115264_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|PATHOLOGY|
20|FH_F114916_30309_0|SrvcGrp|105637|2022|PDM|9000.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F104840_32565_0|SrvcGrp|75479|2022|PCT|0.69|99|0.00|AEG 1|
20|FH_F105588_15228_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1018.00|99|0.00|AEG 3 (NO REV)|
20|FH_F117623_0_0|CSTM-ALL|CSTM-00|2020|PDM|27.00|99|0.00|GROUP BEHAV TREATMENT ADDL|
20|FH_F119581_0_0|SrvcGrp|108191|2022|PDM|2646.00|99|0.00|ILIAC REVASC|
20|FH_F116525_26003_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F144828_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F141148_63043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1877.67|99|0.00|ASPG VI|
20|FH_F78447_0_0|SrvcGrp|75502|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F119214_0_0|SrvcGrp|75497|2022|PDM|1600.00|99|0.00|AEG 10|
20|FH_F114389_50131_0|SrvcGrp|105609|2022|PDM|63.80|99|0.00|CUSHION FOR USE ON NASAL MASK (MOD NU)|
20|FH_F45312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F132348_16214_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F124059_64055_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F146922_68108_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146907_24521_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146990_80206_0|SrvcGrp|74668|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F34838_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F74102_0_0|SrvcGrp|22954|2022|PDM|164.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F38688_0_0|SrvcGrp|17073|2022|PDM|1250.00|99|0.00|ASPG V|
20|FH_F91998_0_0|SrvcGrp|91888|2022|PDM|1800.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F100703_0_0|SrvcGrp|96899|2022|PDM|7876.00|99|0.00|LUMBAR ARTIF DISCECTOMY|
20|FH_F124235_92840_0|SrvcGrp|75419|2022|PDM|900.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F124653_64062_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F127995_84010_0|SrvcGrp|86843|2022|PDM|33.60|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F127995_84010_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F97040_31901_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F132890_87544_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F114666_30342_0|SrvcGrp|89980|2022|PDM|4500.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F138693_45723_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100664_03104_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F144039_0_0|SrvcGrp|85966|2022|PDM|7459.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F148553_85016_0|SrvcGrp|115471|2022|PDM|2907.00|99|0.00|RIGHT HEART ART/GRFT ANGIO|
20|FH_F42923_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.30|99|0.00|GENERAL ACUTE CARE|
20|FH_F43444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136807_43220_0|SrvcGrp|29346|2022|PDM|28.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F112444_07102_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS APC GROUPED|
20|FH_F115157_06851_0|SrvcGrp|109330|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F115723_78363_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F147305_90755_0|SrvcGrp|88621|2022|PDM|134.00|99|0.00|SKILLED NURSING LPN|
20|FH_F41692_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|OP SVCS|
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|957.00|99|0.00|AEG 1 (NO REV)|
20|FH_F141837_0_0|SrvcGrp|13681|2022|PDM|600.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F82357_0_0|SrvcGrp|9874|2022|PDM|39.00|99|0.00|DIETICIAN|
20|FH_F39887_0_0|SrvcGrp|30225|2022|PDM|336.00|99|0.00|NEWBORN NURSERY|
20|FH_F39098_0_0|SrvcGrp|360|2022|PDM|578.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F41013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42244_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|CV SERVICES|
20|FH_F54552_0_0|SrvcGrp|26869|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F138687_77477_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F138876_25302_0|SrvcGrp|86850|2022|PDM|40.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F138879_17837_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS|
20|FH_F78265_0_0|SrvcGrp|69070|2022|PDM|86.00|99|0.00|PT/OT/ST|
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|2006 MEDICARE ASPG III|
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 2 W/O REV|
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|1055.00|99|0.00|AEG 7 (NO REV)|
20|FH_F151501_30265_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F122137_75633_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F135440_32561_0|SrvcGrp|108484|2022|PDM|625.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F135483_53226_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135572_89106_0|SrvcGrp|14947|2022|PCT|1.00|99|0.00|HOME INFUSION|
20|FH_F135763_20678_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F135924_02906_0|SrvcGrp|115762|2022|PCT|1.03|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F136042_90066_0|SrvcGrp|110812|2022|PDM|450.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F119886_25504_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100763_24202_0|SrvcGrp|73605|2022|PDM|2072.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F130756_04901_0|SrvcGrp|112064|2022|PCT|0.89|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F130756_04901_0|SrvcGrp|114917|2022|PCT|0.89|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F116397_33404_0|SrvcGrp|14947|2022|PDM|3.00|99|0.00|HOME INFUSION|
20|FH_F130766_04967_0|SrvcGrp|109057|2022|PCT|0.88|99|0.00|CARDIAC STUDIES|
20|FH_F126305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140629_0_0|SrvcGrp|99155|2022|PDM|2497.00|99|0.00|WRST ARTHROS SURG|
20|FH_F140629_0_0|SrvcGrp|83350|2022|PDM|2497.00|99|0.00|AETNA LAPAR HERNIA REPAIR|
20|FH_F65959_0_0|SrvcGrp|45882|2022|PDM|110.00|99|0.00|PT|
20|FH_F111291_52501_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F111291_52501_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F111292_33136_0|SrvcGrp|109057|2022|PCT|0.86|99|0.00|CARDIAC STUDIES|
20|FH_F111292_33136_0|SrvcGrp|82752|2022|PDM|20.00|99|0.00|ASSAY BUN|
20|FH_F111301_33122_0|SrvcGrp|82753|2022|PDM|71.00|99|0.00|TROPONIN QUANT|
20|FH_F111341_80501_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F111880_50003_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134264_67226_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132328_0_0|SrvcGrp|88740|2022|PDM|5202.00|99|0.00|SP BONE ALGRFT|
20|FH_F132328_0_0|SrvcGrp|42550|2022|PDM|2653.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F91619_32091_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F102282_06795_0|SrvcGrp|90707|2022|PDM|153.62|99|0.00|AETNA HOSPICE CARE|
20|FH_F101620_47401_0|SrvcGrp|73849|2022|PDM|308.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F101852_78758_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148101_33462_0|SrvcGrp|75419|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148101_33462_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F46158_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|2742.00|99|0.00|ASPG VIII|
20|FH_F36132_0_0|SrvcGrp|9861|2022|PDM|710.00|99|0.00|ACUTE REHABILITATION|
20|FH_F120112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F86712_60173_0|SrvcGrp|76531|2022|PDM|105.00|99|0.00|HOSPICE IN HOME|
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|1448.00|99|0.00|AEG 5  (NO REV)|
20|FH_F68365_0_0|SrvcGrp|65627|2022|PCT|1.00|99|0.00|HCPC IMPLANTS (L8600 - L8690)|
20|FH_F74602_0_0|SrvcGrp|31702|2022|PDM|280.00|99|0.00|INTENSIVE OUTPATIENT|
20|FH_F89778_0_0|SrvcGrp|82107|2022|PDM|1215.74|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F88639_80204_0|SrvcGrp|75489|2022|PDM|10074.05|99|0.00|AEG 6|
20|FH_F87474_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F123739_61820_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F136347_30328_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136386_30901_0|CSTM-ALL|CSTM-00|2020|PCT|1.80|99|0.00|CHEMOTHERAPY AND OTHER DRUGS|
20|FH_F120489_63552_0|SrvcGrp|1943|2022|PDM|471.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F120475_81052_0|SrvcGrp|471|2022|PDM|557.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134011_84102_0|SrvcGrp|80920|2022|PDM|112.00|99|0.00|HOSPICE SERVICES|
20|FH_F134126_11554_0|CSTM-ALL|CSTM-00|2020|PDM|3043.00|99|0.00|AEG 6 (NO REV)|
20|FH_F137047_73120_0|SrvcGrp|30089|2022|PDM|450.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F137147_75006_0|SrvcGrp|14614|2022|PDM|9604.00|99|0.00|LITHOTRIPSY|
20|FH_F138188_54901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F142273_51012_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142373_78727_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142690_31774_0|SrvcGrp|14947|2022|PDM|100.00|99|0.00|HOME INFUSION|
20|FH_F142691_30328_0|SrvcGrp|46903|2022|PDM|1244.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F142742_44112_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F53732_0_0|SrvcGrp|17014|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138571_65807_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138584_30912_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 9 (NO REV)|
20|FH_F138627_82901_0|SrvcGrp|86850|2022|PDM|85.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F140553_37205_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140750_89119_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F149701_0_0|SrvcGrp|79720|2022|PDM|972.00|99|0.00|ACUTE REHAB II|
20|FH_F149530_80014_0|SrvcGrp|75419|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F149653_19702_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F151608_30236_0|SrvcGrp|89989|2022|PDM|6666.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F118914_43015_0|SrvcGrp|107966|2022|PDM|280.00|99|0.00|HEMODIALYSIS|
20|FH_F118943_64506_0|SrvcGrp|22592|2022|PDM|22.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F118943_64506_0|SrvcGrp|14949|2022|PDM|125.00|99|0.00|HOME INFUSION|
20|FH_F109982_33592_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147861_45239_0|SrvcGrp|87441|2022|PDM|900.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F117102_39355_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117153_34113_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117126_12801_0|SrvcGrp|997|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F117126_12801_0|CSTM-ALL|CSTM-00|2020|PDM|3430.00|99|0.00|AEG 3 (NO REV)|
20|FH_F137927_52241_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F107480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111593_0_0|SrvcGrp|77461|2022|PDM|4372.50|99|0.00|CPT 52356|
20|FH_F124893_40311_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|3410.00|99|0.00|AEG 8 (NO REV)|
20|FH_F138051_75069_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2409.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132544_0_0|SrvcGrp|38015|2022|PDM|8007.00|99|0.00|ARTHRODESIS|
20|FH_F140035_0_0|SrvcGrp|44042|2022|PDM|180.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F148554_85016_0|SrvcGrp|21781|2022|PDM|5046.00|99|0.00|OP AICD 33249|
20|FH_F148554_85016_0|SrvcGrp|115470|2022|PDM|2965.00|99|0.00|RIGHT HEART CORONARY ARTERY ANGIO|
20|FH_F148644_06890_0|SrvcGrp|64517|2022|PDM|6518.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F108700_63857_0|SrvcGrp|63297|2022|PDM|108.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|603.00|99|0.00|AEG 1 (NO REV)|
20|FH_F106540_26330_0|SrvcGrp|97968|2022|PDM|410.00|99|0.00|CT SCAN|
20|FH_F148494_0_0|SrvcGrp|114175|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES|
20|FH_F56793_0_0|SrvcGrp|42971|2022|PDM|110.00|99|0.00|SKN RN|
20|FH_F146135_87112_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F71947_15227_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F133397_23233_0|SrvcGrp|112319|2022|PDM|749.00|99|0.00|CHEMOTHERAPY ADMINISTRATION|
20|FH_F142847_07003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144569_71055_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F71271_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F68868_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|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_F88277_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.20|99|0.00|GENERAL ACUTE CARE|
20|FH_F35278_0_0|SrvcGrp|28418|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY|
20|FH_F130593_48103_0|SrvcGrp|82222|2022|PDM|140.00|99|0.00|HOSPICE CARE|
20|FH_F113315_72205_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120838_01603_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F118845_71111_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F139825_0_0|SrvcGrp|42427|2022|PDM|6885.00|99|0.00|OP SURGERY CPT 65420|
20|FH_F92677_08003_0|SrvcGrp|17014|2022|PDM|63.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F68121_0_0|SrvcGrp|3259|2022|PDM|1100.00|99|0.00|ACUTE REHABILITATION|
20|FH_F116324_0_0|SrvcGrp|75483|2022|PDM|550.00|99|0.00|AEG 3|
20|FH_F97542_32960_0|SrvcGrp|90854|2022|PDM|1969.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124608_0_0|SrvcGrp|86233|2022|PDM|9149.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F116825_0_0|SrvcGrp|23130|2022|PDM|26.50|99|0.00|1:1 SUPERVISION|
20|FH_F40980_0_0|SrvcGrp|16260|2022|PDM|22249.00|99|0.00|ROBOTIC PROCEDURES|
20|FH_F144011_60616_0|SrvcGrp|16|2022|PDM|1610.00|99|0.00|ACUTE REHABILITATION|
20|FH_F40549_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F130573_02882_0|SrvcGrp|23683|2022|PCT|1.00|99|0.00|SKILLED NURSING RN|
20|FH_F150531_16148_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F113257_19034_0|SrvcGrp|472|2022|PDM|477.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F93592_0_0|SrvcGrp|93217|2022|PDM|2372.00|99|0.00|AETNA SHOULDER ARTHROSCOPY|
20|FH_F144191_0_0|SrvcGrp|92823|2022|PDM|3700.00|99|0.00|REVISE KNUCKLE WITH IMPLANT|
20|FH_F49776_0_0|SrvcGrp|10410|2022|PDM|47.00|99|0.00|SKILLED NURSING CARE|
20|FH_F41166_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132591_75146_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127204_44420_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120407_84070_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F36756_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD KN|
20|FH_F133029_61264_0|SrvcGrp|86722|2022|PDM|246.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F126676_43537_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F133493_90255_0|SrvcGrp|72984|2022|PCT|1.40|99|0.00|CHEMOTHERAPY|
20|FH_F42992_0_0|SrvcGrp|31931|2022|PDM|1336.00|99|0.00|SKILLED NURSING CARE|
20|FH_F150021_02725_0|SrvcGrp|115592|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F50974_0_0|SrvcGrp|12403|2022|PDM|28.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F69123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|INFUSION- IV SERVICES (MOD SJ)|
20|FH_F120089_0_0|SrvcGrp|75493|2022|PDM|985.00|99|0.00|AEG 8|
20|FH_F138054_0_0|SrvcGrp|11442|2022|PDM|881.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F125256_77365_0|SrvcGrp|73842|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F88818_0_0|SrvcGrp|87820|2022|PDM|1000.00|99|0.00|REMOVAL OF PRESSURE SORE|
20|FH_F68363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F75202_0_0|SrvcGrp|63|2022|PDM|530.00|99|0.00|SUBACUTE CARE|
20|FH_F139779_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F92676_15063_0|SrvcGrp|79066|2022|PDM|374.28|99|0.00|MON VALLEY ASC 135|
20|FH_F148861_18706_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F126858_43113_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F132999_19901_0|SrvcGrp|27968|2022|PDM|32.00|99|0.00|SKILLED NURSING LPN|
20|FH_F65899_0_0|SrvcGrp|3409|2022|PDM|650.00|99|0.00|NEWBORN NURSERY|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|827.82|99|0.00|HAPA WPA-NWPA 2012-13 ASC 501 W/O REV|
20|FH_F142789_34104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F120437_85202_0|SrvcGrp|98991|2022|PDM|95.67|99|0.00|HYDRATION THERAPY 1 LITER (HCFA)|
20|FH_F149581_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F87577_80016_0|SrvcGrp|73602|2022|PDM|1828.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F142769_21204_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F80859_65616_0|SrvcGrp|30623|2022|PDM|3445.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F97564_52246_0|SrvcGrp|73602|2022|PDM|3772.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F87155_04105_0|SrvcGrp|43569|2022|PDM|94.56|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F150500_85253_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F150948_0_0|SrvcGrp|108094|2022|PDM|10950.00|99|0.00|REVISE KNEE|
20|FH_F146257_83713_0|SrvcGrp|114499|2022|PDM|3.29|99|0.00|NALTREXONE DEPOT FORM|
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_F141870_85224_0|SrvcGrp|14949|2022|PDM|70.00|99|0.00|HOME INFUSION|
20|FH_F86293_0_0|SrvcGrp|77449|2022|PDM|1995.00|99|0.00|CPT 52352|
20|FH_F95980_20016_0|SrvcGrp|43524|2022|PDM|170.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F128657_19008_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 2 (NO REV)|
20|FH_F101104_0_0|SrvcGrp|73524|2022|PDM|147.00|99|0.00|PHYSICAL THERAPY|
20|FH_F133167_82930_0|SrvcGrp|76501|2022|PDM|380.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F138487_85297_0|SrvcGrp|72602|2022|PDM|1127.00|99|0.00|ECT|
20|FH_F139129_70508_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F150768_03054_0|SrvcGrp|27968|2022|PDM|54.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150882_84041_0|SrvcGrp|86846|2022|PDM|61.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F128753_32501_0|SrvcGrp|73461|2022|PCT|0.64|99|0.00|AETNA NICU IV|
20|FH_F41802_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149699_0_0|SrvcGrp|11442|2022|PDM|1100.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F110783_93013_0|SrvcGrp|86850|2022|PDM|35.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F131555_66213_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97101_98003_0|SrvcGrp|90854|2022|PDM|3263.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F83871_0_0|CSTM-ALL|CSTM-00|2020|PDM|555.00|99|0.00|AEG 2 (NO REV)|
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F115483_62002_0|SrvcGrp|131|2022|PCT|0.47|99|0.00|PACEMAKER DEVICE|
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|1666.00|99|0.00|AEG 5  (NO REV)|
20|FH_F137748_95231_0|SrvcGrp|112978|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F35387_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F99920_63141_0|SrvcGrp|80918|2022|PDM|110.00|99|0.00|RESPITE CARE|
20|FH_F80024_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97082_90012_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F138017_73129_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F41602_0_0|SrvcGrp|3577|2022|PDM|334.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|2705.00|99|0.00|AEG 5  (NO REV)|
20|FH_F151659_17013_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109160_63129_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F126189_89129_0|SrvcGrp|73841|2022|PDM|441.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F114206_37203_0|SrvcGrp|86827|2022|PDM|60.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F38742_0_0|SrvcGrp|28978|2022|PDM|50.00|99|0.00|SKILLED NURSING NON IV RELATED- MOD TD|
20|FH_F147082_02359_0|SrvcGrp|90388|2022|PDM|504.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F149582_01534_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F98000_59102_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
20|FH_F122623_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS|
20|FH_F124364_38611_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F99920_63141_0|SrvcGrp|94780|2022|PDM|110.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F139247_77657_0|SrvcGrp|11259|2022|PCT|0.62|99|0.00|DRUGS|
20|FH_F40624_0_0|CSTM-ALL|CSTM-00|2020|PDM|6519.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F123386_0_0|SrvcGrp|15363|2022|PCT|0.50|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F35750_0_0|SrvcGrp|360|2022|PDM|1599.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F120767_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F124695_33401_0|SrvcGrp|104186|2022|PDM|11.00|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F38742_0_0|SrvcGrp|28934|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MOD AU (A & K CODES)|
20|FH_F37078_0_0|SrvcGrp|471|2022|PDM|546.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F114568_08097_0|SrvcGrp|105684|2022|PDM|175.00|99|0.00|INTENSIVE OUTPATIENT 13-17 YRS|
20|FH_F124441_0_0|SrvcGrp|108094|2022|PDM|12825.00|99|0.00|REVISE KNEE|
20|FH_F74507_0_0|SrvcGrp|72161|2022|PDM|1790.00|99|0.00|SKILLED NURSING LEVEL 2 REV CODE 206|
20|FH_F133519_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F94585_19040_0|SrvcGrp|76501|2022|PDM|284.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F138228_76208_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F148351_33012_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F110732_31513_0|SrvcGrp|12659|2022|PDM|250.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F116332_0_0|SrvcGrp|36591|2022|PDM|4512.00|99|0.00|CPT 63685|
20|FH_F124703_65711_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F80834_0_0|SrvcGrp|30571|2022|PDM|2728.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F75944_0_0|SrvcGrp|68190|2022|PDM|1591.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 6|
20|FH_F90232_15126_0|SrvcGrp|86852|2022|PDM|56.70|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F36663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S MOD KM (CPD 1364768)|
20|FH_F40653_0_0|SrvcGrp|8942|2022|PCT|0.90|99|0.00|BRACHYTHERAPY SVCS|
20|FH_F151699_01752_0|SrvcGrp|26869|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F143249_89801_0|SrvcGrp|47183|2022|PDM|120.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F71747_0_0|SrvcGrp|42785|2022|PDM|60.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F101700_0_0|SrvcGrp|98103|2022|PDM|38.85|99|0.00|INJECTION TRIGGER POINTS >3|
20|FH_F101709_0_0|SrvcGrp|72990|2022|PDM|1236.00|99|0.00|AEG 1|
20|FH_F101540_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|954.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F120187_76522_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F120205_53545_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132417_38119_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132426_33844_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116633_37217_0|SrvcGrp|48398|2022|PDM|125.00|99|0.00|PT SERVICES|
20|FH_F120974_27607_0|SrvcGrp|26690|2022|PCT|0.76|99|0.00|MS DRG 215 ONLY|
20|FH_F120974_27607_0|SrvcGrp|10362|2022|PDM|424.00|99|0.00|CPT CODE 99282|
20|FH_F120977_50510_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126435_77459_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|2660.00|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_F32411_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F130656_04401_0|SrvcGrp|114917|2022|PCT|0.89|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F130662_07032_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F130914_51103_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F134895_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F95340_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138951_41101_0|SrvcGrp|86850|2022|PDM|40.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|912.00|99|0.00|AEG 4 (NO REV)|
20|FH_F110305_70403_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1318.11|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1303 W/O REV|
20|FH_F124789_44514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113465_28204_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143674_34208_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150239_75569_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD AW"|
20|FH_F149199_73005_0|SrvcGrp|79797|2022|PDM|4180.00|99|0.00|AETNA PTCA|
20|FH_F149159_53220_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|374.18|99|0.00|HAPA WPA-NWPA 2012-13 ASC 216 W/O REV|
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.60|99|0.00|AEG 7 (NO REV)|
20|FH_F90160_0_0|CSTM-ALL|CSTM-00|2020|PCT|44.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F118088_71261_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F121685_75093_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|1144.00|99|0.00|AEG 7 (NO REV)|
20|FH_F110589_70809_0|SrvcGrp|73842|2022|PDM|234.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F80776_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112962_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F150165_06032_0|SrvcGrp|92364|2022|PDM|5480.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F114509_10010_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148499_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111986_0_0|SrvcGrp|33966|2022|PDM|3605.00|99|0.00|CPT 29866|
20|FH_F83380_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INTERIM INFUSION REV CODE 949|
20|FH_F96160_32207_0|SrvcGrp|10577|2022|PDM|68.65|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F133916_66090_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132883_31602_0|SrvcGrp|86836|2022|PDM|10.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PDM|1268.00|99|0.00|AEG 8 (NO REV)|
20|FH_F130763_0_0|SrvcGrp|106266|2022|PDM|6043.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT|
20|FH_F149266_38556_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145604_14850_0|SrvcGrp|86832|2022|PDM|15.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F49552_0_0|SrvcGrp|17081|2022|PDM|747.47|99|0.00|ASPG IX|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|181.15|99|0.00|HAPA WPA-NWPA 2012-13 ASC 238 W/O REV|
20|FH_F85311_18702_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F85353_16407_0|SrvcGrp|63813|2022|PDM|577.56|99|0.00|HAPA WPA-NWPA 2012-13 ASC 206|
20|FH_F138286_50014_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F83754_0_0|CSTM-ALL|CSTM-00|2020|PDM|4286.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71748_0_0|SrvcGrp|17139|2022|PDM|746.29|99|0.00|HOSPICE CARE|
20|FH_F130337_62948_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100680_43130_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F50583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133815_46526_0|SrvcGrp|79238|2022|PDM|1100.00|99|0.00|TRANSFER|
20|FH_F69647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1325.51|99|0.00|HAPA WPA-NWPA 2012-13 ASC 906 W/O REV|
20|FH_F126324_20176_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138050_52301_0|CSTM-ALL|CSTM-00|2020|PDM|3898.00|99|0.00|AEG 4 (NO REV)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.03|99|0.00|HAPA WPA-NWPA 2012-13 ASC 228 W/O REV|
20|FH_F150165_06032_0|SrvcGrp|100017|2022|PDM|10094.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F100782_0_0|SrvcGrp|105104|2022|PDM|163.63|99|0.00|WINDBER MEDICAL CNTR ASC 149|
20|FH_F113465_28204_0|SrvcGrp|76094|2022|PDM|151.65|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F83380_0_0|SrvcGrp|44708|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE|
20|FH_F120930_0_0|SrvcGrp|27347|2022|PDM|3000.00|99|0.00|CPT 58558|
20|FH_F66900_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138302_15701_0|SrvcGrp|46605|2022|PDM|70.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F119937_0_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F91633_33907_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F89219_0_0|CSTM-ALL|CSTM-00|2020|PDM|6836.00|99|0.00|MT NITTANY MED MS DRGS|
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|1792.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132776_43614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F150165_06032_0|SrvcGrp|90417|2022|PDM|4120.00|99|0.00|TREATMENT OF JOINT|
20|FH_F145642_15108_0|SrvcGrp|86829|2022|PDM|30.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F114683_0_0|SrvcGrp|88158|2022|PDM|5000.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F81483_0_0|SrvcGrp|40311|2022|PDM|2244.00|99|0.00|CVTY ENHANCED ASPG 9|
20|FH_F147987_65674_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F54592_0_0|SrvcGrp|29023|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F113645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F85553_0_0|SrvcGrp|537|2022|PCT|0.75|99|0.00|OBSERVATION SERVICES|
20|FH_F62333_0_0|SrvcGrp|17140|2022|PDM|160.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F62579_0_0|SrvcGrp|24758|2022|PDM|19.00|99|0.00|HOME INJECTABLE THERAPY|
20|FH_F130678_50220_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130901_68970_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F40850_0_0|SrvcGrp|32550|2022|PDM|104.00|99|0.00|NEWBORN NURSERY|
20|FH_F134327_12853_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134593_60007_0|SrvcGrp|115524|2022|PCT|0.84|99|0.00|ZOLGENSMA/ONASE ABEPAR-XIOI TREAT INJECTION|
20|FH_F71669_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F150165_06032_0|SrvcGrp|33965|2022|PDM|9290.00|99|0.00|CPT 58552|
20|FH_F70804_0_0|SrvcGrp|12073|2022|PDM|63.67|99|0.00|HOME INFUSION THERAPY|
20|FH_F149270_98004_0|SrvcGrp|74668|2022|PDM|240.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F73228_0_0|SrvcGrp|17081|2022|PDM|8384.00|99|0.00|ASPG IX|
20|FH_F138056_64055_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|977.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115974_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F110305_70403_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143568_85006_0|SrvcGrp|38246|2022|PCT|2.23|99|0.00|SLEEP STUDIES|
20|FH_F133880_06488_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141337_60077_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F146200_70815_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131127_0_0|SrvcGrp|82720|2022|PDM|2732.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F120539_89029_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F150223_30720_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113368_37752_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123644_0_0|SrvcGrp|86722|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F110268_02891_0|SrvcGrp|102239|2022|PDM|20.00|99|0.00|AETNA METHADONE MAINTENANCE|
20|FH_F147962_85008_0|SrvcGrp|105465|2022|PCT|1.20|99|0.00|AETNA THERAPIES|
20|FH_F80224_0_0|CSTM-ALL|CSTM-00|2020|PDM|1403.00|99|0.00|ACUTE PSYCH|
20|FH_F146399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150222_98026_0|SrvcGrp|75419|2022|PDM|466.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|383.00|99|0.00|AEG 1 (NO REV)|
20|FH_F129509_0_0|SrvcGrp|67119|2022|PDM|5125.00|99|0.00|ARTHODESIS|
20|FH_F132776_43614_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143620_81504_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F134593_60007_0|SrvcGrp|86832|2022|PDM|3.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|113.91|99|0.00|HAPA WPA-NWPA 2012-13 ASC 144 W/O REV|
20|FH_F127199_0_0|SrvcGrp|89783|2022|PDM|114.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 4 (NO REV)|
20|FH_F50703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110466_06870_0|SrvcGrp|86722|2022|PDM|280.34|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F130763_0_0|SrvcGrp|93057|2022|PDM|5823.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 5  (NO REV)|
20|FH_F76146_0_0|SrvcGrp|34342|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F85353_16407_0|SrvcGrp|3178|2022|PDM|1302.00|99|0.00|ACUTE PSYCH|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|598.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 210 W/O REV|
20|FH_F114683_0_0|SrvcGrp|67279|2022|PDM|7000.00|99|0.00|CERVICAL SURGERY|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|337.80|99|0.00|HAPA WPA-NWPA 2012-13 ASC 110 W/O REV|
20|FH_F149031_80525_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F120670_0_0|SrvcGrp|41334|2022|PDM|15000.00|99|0.00|TOTAL KNEE|
20|FH_F133724_84041_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117437_0_0|SrvcGrp|80918|2022|PDM|180.00|99|0.00|RESPITE CARE|
20|FH_F150308_48180_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PDM|7737.00|99|0.00|2007 MEDICARE ASPG IV|
20|FH_F133867_84075_0|SrvcGrp|92139|2022|PDM|60.75|99|0.00|SKILLED NURSING LPN|
20|FH_F119509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.33|99|0.00|OP SVCS|
20|FH_F134488_14086_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F71964_0_0|SrvcGrp|68865|2022|PDM|75.00|99|0.00|SOCIAL WORKER|
20|FH_F115890_75067_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F146812_50401_0|SrvcGrp|73610|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F146812_50401_0|CSTM-ALL|CSTM-00|2020|PDM|4536.00|99|0.00|AEG 9 (NO REV)|
20|FH_F115952_44484_0|SrvcGrp|86748|2022|PCT|1.05|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F116063_43220_0|SrvcGrp|73842|2022|PDM|147.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131697_33444_0|SrvcGrp|83801|2022|PDM|1800.00|99|0.00|INTERIM LABOR FACILITY GLOBA|
20|FH_F131943_62243_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133408_01095_0|SrvcGrp|113236|2022|PCT|1.00|99|0.00|COVID-19 SARS-COV-2 W/ OPTIC|
20|FH_F133491_74012_0|SrvcGrp|97703|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F43872_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_F31872_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134087_0_0|SrvcGrp|89861|2022|PDM|5771.00|99|0.00|LUMBAR LAMINOTOMY|
20|FH_F45332_0_0|SrvcGrp|55786|2022|PDM|90.00|99|0.00|PT / OT / ST|
20|FH_F67339_0_0|SrvcGrp|9936|2022|PDM|65.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F70493_0_0|SrvcGrp|17754|2022|PDM|63.00|99|0.00|DRESSING SET FOR  NEG PRESSURE WOUND THERAPY ELEC PUMP|
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F59732_0_0|SrvcGrp|34146|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F72183_0_0|SrvcGrp|10927|2022|PDM|650.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F141169_0_0|SrvcGrp|19923|2022|PDM|1994.00|99|0.00|HYSTEROSCOPY|
20|FH_F118959_44830_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F119026_36274_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118955_48239_0|SrvcGrp|89149|2022|PDM|150.00|99|0.00|OP INTENSIVE|
20|FH_F109883_35007_0|SrvcGrp|93919|2022|PDM|637.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F66835_0_0|SrvcGrp|12682|2022|PDM|150.00|99|0.00|GROUP THERAPY|
20|FH_F147801_90703_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|OBSERVATION SERVICES (18-64 YRS)|
20|FH_F115868_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35210_0_0|SrvcGrp|537|2022|PCT|0.68|99|0.00|OBSERVATION SERVICES|
20|FH_F39893_0_0|SrvcGrp|439|2022|PDM|1500.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F104720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109652_0_0|SrvcGrp|43485|2022|PDM|30199.00|99|0.00|MS DRG'S 453-455|
20|FH_F90880_15108_0|SrvcGrp|90495|2022|PCT|1.00|99|0.00|FLULAVAL VACC 3 YRS & > IM|
20|FH_F139711_16037_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F36732_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F119285_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F109513_0_0|SrvcGrp|72994|2022|PDM|765.00|99|0.00|AEG 3|
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|1990.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132544_0_0|SrvcGrp|97119|2022|PDM|8007.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F119448_07083_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F148379_89129_0|SrvcGrp|66265|2022|PDM|80.75|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F148432_01585_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F148495_03038_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145988_06105_0|SrvcGrp|18089|2022|PCT|0.69|99|0.00|CLINIC VISITS|
20|FH_F35176_0_0|SrvcGrp|22954|2022|PDM|94.50|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F80952_45669_0|CSTM-ALL|CSTM-00|2020|PDM|739.78|99|0.00|AEG 2 (NO REV)|
20|FH_F133341_23860_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39558_0_0|SrvcGrp|17077|2022|PDM|1162.00|99|0.00|ASPG VII|
20|FH_F88816_0_0|SrvcGrp|75545|2022|PDM|352.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F119825_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F111502_33331_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133493_90255_0|CSTM-ALL|CSTM-00|2020|PDM|4092.00|99|0.00|AEG 10 (NO REV)|
20|FH_F44354_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148493_38008_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F144008_11413_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|505.00|99|0.00|AEG 2 (NO REV)|
20|FH_F123538_21206_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F118785_33315_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F121012_29732_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS|
20|FH_F144308_44512_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F38016_0_0|SrvcGrp|72|2022|PDM|324.00|99|0.00|NEWBORN NURSERY|
20|FH_F100700_20110_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40851_0_0|SrvcGrp|15052|2022|PCT|1.75|99|0.00|RADIOLOGY SVCS|
20|FH_F136812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
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_F41181_0_0|SrvcGrp|12280|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F150948_0_0|SrvcGrp|89404|2022|PDM|10950.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F47857_0_0|SrvcGrp|167|2022|PDM|275.00|99|0.00|CD (ADULT) - REHABILITATION|
20|FH_F128445_85704_0|SrvcGrp|89337|2022|PDM|1048.00|99|0.00|DETOXIFICATION|
20|FH_F68544_0_0|CSTM-ALL|CSTM-00|2020|PDM|140.00|99|0.00|OP SVCS|
20|FH_F31542_0_0|SrvcGrp|9938|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F92531_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F71882_15228_0|SrvcGrp|10431|2022|PDM|55.00|99|0.00|SPEECH THERAPY|
20|FH_F137896_0_0|SrvcGrp|111642|2022|PDM|1625.00|99|0.00|HOME VENTILATOR (MOD RR) (HCFA)|
20|FH_F102188_0_0|SrvcGrp|57968|2022|PDM|29.47|99|0.00|CONTINUOUS HOMECARE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|85.16|99|0.00|HAPA WPA-NWPA 2012-13 ASC 245 W/O REV|
20|FH_F33039_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146374_84102_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118309_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F98921_64503_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F76624_0_0|SrvcGrp|14006|2022|PCT|0.38|99|0.00|IMPLANTS|
20|FH_F87155_04105_0|SrvcGrp|46424|2022|PDM|94.56|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F51438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|ASPG X|
20|FH_F128919_48075_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F132400_79106_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|HSS ASC|
20|FH_F102561_75146_0|SrvcGrp|72984|2022|PDM|2000.00|99|0.00|CHEMOTHERAPY|
20|FH_F68842_0_0|SrvcGrp|3810|2022|PDM|145.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F146229_60031_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F91255_19401_0|CSTM-ALL|CSTM-00|2020|PDM|4489.00|99|0.00|AEG 8 (NO REV)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|712.19|99|0.00|HAPA WPA-NWPA 2012-13 ASC 403 W/O REV|
20|FH_F42640_0_0|SrvcGrp|28146|2022|PDM|340.00|99|0.00|SKILLED NURSING|
20|FH_F132289_89145_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F115273_15132_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92676_15063_0|SrvcGrp|537|2022|PDM|3990.00|99|0.00|OBSERVATION SERVICES|
20|FH_F149860_80112_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F88512_0_0|SrvcGrp|17775|2022|PDM|326.48|99|0.00|ULTRASOUND|
20|FH_F119095_08536_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133270_77025_0|SrvcGrp|73841|2022|PDM|375.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F145924_36695_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F44016_0_0|SrvcGrp|537|2022|PDM|91.00|99|0.00|OBSERVATION SERVICES|
20|FH_F118541_15222_0|SrvcGrp|78420|2022|PDM|2026.00|99|0.00|INTERIM LABOR|
20|FH_F150949_0_0|CSTM-ALL|CSTM-00|2020|PDM|9000.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL|
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|832.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F108780_54235_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F102561_75146_0|SrvcGrp|98724|2022|PDM|5750.00|99|0.00|TRANSURETH RESECT OF PROSTAT|
20|FH_F37909_0_0|SrvcGrp|15478|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SVCS INITIAL EVAL|
20|FH_F72750_0_0|SrvcGrp|10927|2022|PDM|550.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F33581_0_0|SrvcGrp|8950|2022|PDM|2700.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F111551_32825_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F78205_0_0|SrvcGrp|13168|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F136002_0_0|SrvcGrp|88621|2022|PDM|86.70|99|0.00|SKILLED NURSING LPN|
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|2242.90|99|0.00|AEG 9 (NO REV)|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/MOD AW (CO)|
20|FH_F146377_85007_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|81765|2022|PCT|2.43|99|0.00|AETNA OP RADIOLOGY (RAD)|
20|FH_F132446_19063_0|SrvcGrp|88620|2022|PDM|76.00|99|0.00|SKILLED NURSING RN|
20|FH_F118486_95060_0|SrvcGrp|86749|2022|PCT|1.15|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F120605_0_0|SrvcGrp|12663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F101983_17578_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41392_0_0|CSTM-ALL|CSTM-00|2020|PDM|774.00|99|0.00|ASPG X|
20|FH_F72859_0_0|SrvcGrp|11442|2022|PDM|509.86|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F38249_0_0|SrvcGrp|4109|2022|PDM|500.00|99|0.00|ACUTE PSYCH|
20|FH_F118704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38352_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F45392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133530_11237_0|SrvcGrp|79099|2022|PDM|2888.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F117471_19111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128545_29569_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146257_83713_0|SrvcGrp|75419|2022|PDM|475.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F34706_0_0|SrvcGrp|11205|2022|PDM|17773.00|99|0.00|DRG 544 MAJOR JOINT REPLACEMENT/REATTACHMENT OF LWR EXTRMTY|
20|FH_F76662_0_0|SrvcGrp|66480|2022|PDM|85.00|99|0.00|RN VISIT|
20|FH_F103180_85283_0|SrvcGrp|23683|2022|PDM|35.00|99|0.00|SKILLED NURSING RN|
20|FH_F36328_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PDM|1082.00|99|0.00|ASPG V|
20|FH_F150982_0_0|SrvcGrp|106266|2022|PDM|2753.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT|
20|FH_F150928_62521_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37864_0_0|CSTM-ALL|CSTM-00|2020|PDM|783.83|99|0.00|ASPG IV|
20|FH_F32364_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138453_74135_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F41600_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|68543|2022|PDM|2202.00|99|0.00|CPT 36561|
20|FH_F150442_28451_0|SrvcGrp|77021|2022|PDM|12000.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|407.00|99|0.00|HAPA EPA ASC 46|
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_F130939_40353_0|SrvcGrp|90040|2022|PDM|336.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F124749_90211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F122393_76020_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F35768_32827_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|GENERAL ACUTE CARE|
20|FH_F139147_0_0|SrvcGrp|89882|2022|PDM|5305.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F132849_0_0|SrvcGrp|33793|2022|PDM|10843.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 5  (NO REV)|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU KE"|
20|FH_F115483_62002_0|SrvcGrp|113112|2022|PDM|9283.00|99|0.00|CARDIAC DEFIBRILLATOR|
20|FH_F149582_01534_0|SrvcGrp|107288|2022|PCT|1.00|99|0.00|INJ INTERFERON BETA|
20|FH_F146266_0_0|SrvcGrp|89860|2022|PDM|7231.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PDM|22600.00|99|0.00|DRG 519 ONLY|
20|FH_F150914_17350_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F137986_0_0|SrvcGrp|33984|2022|PDM|1479.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F46433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|100% AWP HCPC|
20|FH_F76826_0_0|SrvcGrp|76013|2022|PDM|1968.00|99|0.00|EMERGENCY ROOM SVCS LEVEL VI|
20|FH_F140295_0_0|SrvcGrp|35669|2022|PDM|6668.00|99|0.00|CPT 63650|
20|FH_F146283_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.37|99|0.00|OP SVCS|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ENTERAL MOD NU - CARECENTRIX|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F111038_62960_0|SrvcGrp|103913|2022|PCT|0.84|99|0.00|OP DIALYSIS|
20|FH_F81456_0_0|SrvcGrp|55677|2022|PDM|3000.00|99|0.00|VAGINAL DELIVERY ONLY|
20|FH_F137627_78382_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F35174_0_0|SrvcGrp|360|2022|PDM|3893.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F117576_21207_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F130641_40205_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117605_85260_0|SrvcGrp|705|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F141519_51566_0|SrvcGrp|79699|2022|PCT|0.95|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F62750_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F33120_0_0|SrvcGrp|409|2022|PCT|0.80|99|0.00|ER SVCS|
20|FH_F128682_57701_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F37539_0_0|SrvcGrp|13811|2022|PDM|255.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 1 (NO REV)|
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F40661_0_0|CSTM-ALL|CSTM-00|2020|PDM|569.00|99|0.00|CHILD PSYCHIATRIC|
20|FH_F40063_0_0|CSTM-ALL|CSTM-00|2020|PDM|7296.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F117044_37352_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124972_64644_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F57032_0_0|SrvcGrp|53483|2022|PDM|34.00|99|0.00|TEST STRIPS|
20|FH_F125890_43054_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F86319_16365_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 7 (NO REV)|
20|FH_F39176_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F38847_0_0|SrvcGrp|439|2022|PDM|1450.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1033.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 7 W/O REV|
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1431.00|99|0.00|AEG 6 (NO REV)|
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|893.55|99|0.00|AEG 1 (NO REV)|
20|FH_F102302_0_0|SrvcGrp|98564|2022|PDM|39100.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F114930_71101_0|SrvcGrp|79804|2022|PDM|1428.00|99|0.00|AETNA MEDICAL/SURGICAL|
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|741.00|99|0.00|AEG 2 (NO REV)|
20|FH_F119824_0_0|SrvcGrp|82498|2022|PDM|164.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS|
20|FH_F148201_82716_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F143821_60559_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PDM|3197.00|99|0.00|ASPG VI|
20|FH_F129656_15005_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F58052_0_0|SrvcGrp|24289|2022|PDM|40.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F113723_10457_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47656_0_0|SrvcGrp|361|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1921.36|99|0.00|AEG 5  (NO REV)|
20|FH_F35513_0_0|SrvcGrp|11325|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F91622_0_0|SrvcGrp|1943|2022|PDM|1772.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F131763_06002_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38090_0_0|SrvcGrp|24703|2022|PDM|562.00|99|0.00|NEWBORN NURSERY|
20|FH_F123466_93420_0|SrvcGrp|89337|2022|PDM|1200.00|99|0.00|DETOXIFICATION|
20|FH_F150462_30458_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102020_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119635_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F123400_04605_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F77903_0_0|SrvcGrp|14651|2022|PDM|6500.00|99|0.00|LITHOTRIPSY SVCS|
20|FH_F121090_07848_0|SrvcGrp|86723|2022|PDM|429.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F35513_0_0|SrvcGrp|11331|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F38569_0_0|SrvcGrp|22563|2022|PDM|82.00|99|0.00|PT|
20|FH_F116024_13203_0|SrvcGrp|89024|2022|PDM|78.28|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F116281_19013_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|355.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F69766_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F113255_0_0|SrvcGrp|86425|2022|PDM|737.00|99|0.00|EGD LESION ABLATION|
20|FH_F151539_64014_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F93881_15009_0|SrvcGrp|87677|2022|PDM|2308.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F111288_0_0|SrvcGrp|88599|2022|PDM|4069.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F116924_91203_0|CSTM-ALL|CSTM-00|2020|PCT|3.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F31982_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137946_0_0|SrvcGrp|112762|2022|PDM|45.23|99|0.00|INFECTIOUS AGENT ANTIGEN DETECTION|
20|FH_F39945_0_0|SrvcGrp|38|2022|PDM|2000.00|99|0.00|NORMAL DELIVERY|
20|FH_F125899_07645_0|SrvcGrp|110281|2022|PDM|2923.00|99|0.00|AETNA OP MRI/MRA (MRIMRA)|
20|FH_F122687_0_0|SrvcGrp|89842|2022|PDM|11200.00|99|0.00|LUMBAR|
20|FH_F141801_80534_0|SrvcGrp|90388|2022|PDM|1000.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F91622_0_0|SrvcGrp|3066|2022|PCT|0.54|99|0.00|HIGH-COST DRUGS|
20|FH_F131254_92211_0|SrvcGrp|86834|2022|PDM|12.50|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F120306_16424_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F87619_0_0|SrvcGrp|72994|2022|PDM|640.00|99|0.00|AEG 3|
20|FH_F111288_0_0|SrvcGrp|33967|2022|PDM|8670.00|99|0.00|CPT 47562|
20|FH_F31253_0_0|SrvcGrp|11606|2022|PDM|1125.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)|
20|FH_F130935_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F129334_43016_0|SrvcGrp|48398|2022|PDM|123.00|99|0.00|PT SERVICES|
20|FH_F139551_0_0|SrvcGrp|36591|2022|PDM|6000.00|99|0.00|CPT 63685|
20|FH_F32366_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F40063_0_0|SrvcGrp|32169|2022|PDM|15384.00|99|0.00|CARDIAC ABLATION W/PVI|
20|FH_F148265_06067_0|SrvcGrp|83643|2022|PDM|3203.00|99|0.00|CPT 29885|
20|FH_F141527_36830_0|SrvcGrp|24744|2022|PDM|53.00|99|0.00|PICC LINE INSERTION|
20|FH_F109601_0_0|SrvcGrp|75493|2022|PDM|1077.00|99|0.00|AEG 8|
20|FH_F77762_0_0|SrvcGrp|43957|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE|
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.18|99|0.00|AEG 1 (NO REV)|
20|FH_F137574_68130_0|SrvcGrp|23681|2022|PCT|1.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F60072_0_0|SrvcGrp|9438|2022|PCT|0.70|99|0.00|TRAUMA CARE|
20|FH_F125249_0_0|SrvcGrp|100921|2022|PDM|3000.00|99|0.00|SPI  PROSTH DEVICE|
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|2384.00|99|0.00|AEG 5  (NO REV)|
20|FH_F123302_33407_0|SrvcGrp|73842|2022|PDM|199.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130204_40807_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138020_20016_0|SrvcGrp|13222|2022|PDM|84.00|99|0.00|CPT CODE 99281|
20|FH_F55552_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98920_46526_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F117082_66216_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F125899_07645_0|SrvcGrp|80679|2022|PCT|6.20|99|0.00|AETNA RADIOLOGY|
20|FH_F102020_0_0|SrvcGrp|9829|2022|PDM|143.00|99|0.00|PT SVCS|
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|1008.00|99|0.00|AEG 8 (NO REV)|
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|1330.00|99|0.00|AEG 8 (NO REV)|
20|FH_F114916_30309_0|SrvcGrp|100923|2022|PDM|1000.00|99|0.00|DRUGS|
20|FH_F121525_78613_0|SrvcGrp|46903|2022|PDM|1000.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F33513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|DME F/S (MOD AW) - MHAC|
20|FH_F148879_33018_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F151050_17015_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151056_17821_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121897_28144_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F38607_0_0|SrvcGrp|25697|2022|PDM|1100.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2504030 MOD UE (HCFA)|
20|FH_F113741_63303_0|SrvcGrp|45924|2022|PDM|25.50|99|0.00|HOME HEALTH AIDE|
20|FH_F77448_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110000_0_0|SrvcGrp|11152|2022|PDM|5272.00|99|0.00|TRAUMA|
20|FH_F91873_12723_0|SrvcGrp|90364|2022|PDM|1055.00|99|0.00|AETNA MRI/MRA|
20|FH_F116323_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F142447_72758_0|SrvcGrp|113950|2022|PCT|1.22|99|0.00|PT/OT/ST|
20|FH_F105381_66845_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130439_85014_0|SrvcGrp|46903|2022|PDM|557.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F119435_0_0|SrvcGrp|108087|2022|PDM|875.00|99|0.00|INSERT NON-TUNNL CNTRL CVC|
20|FH_F133178_0_0|SrvcGrp|103513|2022|PDM|74.00|99|0.00|VAGINA EXAMINATION & BIOPSY|
20|FH_F138929_0_0|SrvcGrp|34606|2022|PDM|4620.00|99|0.00|CPT 29827|
20|FH_F132627_0_0|SrvcGrp|53143|2022|PDM|52.02|99|0.00|RN|
20|FH_F132988_0_0|SrvcGrp|84314|2022|PDM|2057.62|99|0.00|MINOR SURGERY|
20|FH_F72162_0_0|SrvcGrp|44042|2022|PDM|85.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F51555_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72204_0_0|SrvcGrp|26253|2022|PDM|4.95|99|0.00|LIPIDS|
20|FH_F114365_73162_0|SrvcGrp|99600|2022|PCT|1.05|99|0.00|PT/OT/ST|
20|FH_F49487_0_0|SrvcGrp|23675|2022|PDM|400.00|99|0.00|REMICAIDE INFUSION (DURING BUSINESS HOURS)|
20|FH_F124059_64055_0|SrvcGrp|73742|2022|PDM|3.50|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F146921_43050_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39956_0_0|SrvcGrp|115|2022|PDM|489.00|99|0.00|SKILLED NURSING CARE|
20|FH_F40643_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F92493_0_0|SrvcGrp|92408|2022|PDM|9539.20|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F100703_0_0|SrvcGrp|97159|2022|PDM|8034.00|99|0.00|TRANSPEDICULAR, 1 SEG, LUMBAR|
20|FH_F100000_45417_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134809_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F97083_90670_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F89273_0_0|SrvcGrp|88263|2022|PDM|595.00|99|0.00|AETNA AMNIOTIC MEMBRANE (HCFA)|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BIENVILLE MED CTR ALL OTHER OP|
20|FH_F134674_06473_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134691_33445_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F136769_37142_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136907_44833_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136913_68803_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112189_81212_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F49016_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION|
20|FH_F49016_0_0|SrvcGrp|10400|2022|PDM|1450.00|99|0.00|IP SURGERY|
20|FH_F65979_0_0|SrvcGrp|61559|2022|PDM|1200.00|99|0.00|MUSCULOSKELETAL SURGERY|
20|FH_F115567_91711_0|SrvcGrp|86749|2022|PCT|1.25|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F115631_65201_0|CSTM-ALL|CSTM-00|2020|PDM|1310.00|99|0.00|AEG 5  (NO REV)|
20|FH_F116393_07002_0|SrvcGrp|111269|2022|PDM|44.80|99|0.00|X-RAY EXAM SACROILIAC JOINTS|
20|FH_F116393_07002_0|SrvcGrp|111277|2022|PDM|15.30|99|0.00|MICROBE SUSCEPTIBLE, MIC|
20|FH_F147389_81632_0|SrvcGrp|73605|2022|PDM|1950.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F147586_44124_0|SrvcGrp|80617|2022|PDM|15000.00|99|0.00|ARTHOPLASTY|
20|FH_F147621_74338_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F147444_32839_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F41254_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F42522_0_0|SrvcGrp|22106|2022|PDM|717.00|99|0.00|CAT SCAN|
20|FH_F144548_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120683_80238_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F115185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41611_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48295_0_0|SrvcGrp|33722|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F138684_44484_0|SrvcGrp|90854|2022|PDM|675.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F138936_01040_0|SrvcGrp|73500|2022|PDM|515.00|99|0.00|AETNA ER LEVEL I|
20|FH_F138989_02861_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F96321_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
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_F117715_0_0|SrvcGrp|75485|2022|PDM|921.00|99|0.00|AEG 4|
20|FH_F91933_0_0|SrvcGrp|73483|2022|PDM|500.00|99|0.00|AETNA SUBACUTE III|
20|FH_F151341_75904_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122088_75098_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135453_70726_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135507_02859_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F135772_61364_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135972_18509_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F119892_47586_0|SrvcGrp|89781|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F131228_01826_0|SrvcGrp|113576|2022|PCT|1.28|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F131374_08009_0|SrvcGrp|109330|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F116488_79925_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F34709_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140629_0_0|SrvcGrp|113679|2022|PDM|2497.00|99|0.00|LAPARO DRAIN LYMPHOCELE|
20|FH_F140629_0_0|SrvcGrp|113685|2022|PDM|1016.00|99|0.00|CYSTOURETHROSCOPY W/ URETER|
20|FH_F42347_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F63881_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131650_50211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128353_22191_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F111363_33169_0|SrvcGrp|104285|2022|PDM|62.00|99|0.00|DRUG SCREEN|
20|FH_F47906_0_0|SrvcGrp|29957|2022|PCT|1.00|99|0.00|DME MOD AW|
20|FH_F65882_0_0|SrvcGrp|22954|2022|PDM|146.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F69202_0_0|SrvcGrp|16|2022|PDM|1800.00|99|0.00|ACUTE REHABILITATION|
20|FH_F89360_0_0|SrvcGrp|88430|2022|PDM|2480.00|99|0.00|NORMAL DELIVERY|
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 5  (NO REV)|
20|FH_F112129_62220_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112187_98272_0|CSTM-ALL|CSTM-00|2020|PDM|10202.00|99|0.00|AEG 3 (NO REV)|
20|FH_F148120_22903_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148061_11223_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F113649_01752_0|SrvcGrp|29076|2022|PCT|1.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F113649_01752_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118792_63379_0|SrvcGrp|94040|2022|PCT|0.74|99|0.00|OBSERVATION SERVICES FOR ER SERVICES|
20|FH_F84411_32063_0|SrvcGrp|2738|2022|PCT|0.69|99|0.00|IMPLANTS|
20|FH_F84611_30281_0|SrvcGrp|73659|2022|PDM|2839.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F84611_30281_0|SrvcGrp|82081|2022|PDM|12669.00|99|0.00|EP ABLATION|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|2126.00|99|0.00|ASPG V|
20|FH_F38980_0_0|SrvcGrp|10708|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F39996_0_0|SrvcGrp|12184|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F102984_80026_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F103004_75840_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F103004_75840_0|SrvcGrp|537|2022|PCT|0.80|99|0.00|OBSERVATION SERVICES|
20|FH_F38476_0_0|SrvcGrp|28631|2022|PDM|73.00|99|0.00|LPN VISIT|
20|FH_F123445_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120112_0_0|SrvcGrp|65720|2022|PDM|94.50|99|0.00|RESPITE CARE|
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|1131.00|99|0.00|AEG 10 (NO REV)|
20|FH_F92516_0_0|SrvcGrp|73008|2022|PDM|693.00|99|0.00|AEG 10|
20|FH_F86712_60173_0|SrvcGrp|22933|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|678.00|99|0.00|ASPG V|
20|FH_F136846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F128378_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123752_44502_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F126770_43050_0|SrvcGrp|87799|2022|PDM|130.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F47495_0_0|SrvcGrp|42783|2022|PCT|0.50|99|0.00|HIGH COST DRUGS|
20|FH_F63316_0_0|SrvcGrp|47188|2022|PDM|138.86|99|0.00|PHYSICAL THERPY|
20|FH_F69968_0_0|CSTM-ALL|CSTM-00|2020|PDM|7370.60|99|0.00|MS DRG 691-692 408-416 LITHOTRISPY/LAP CHOLE|
20|FH_F107200_0_0|SrvcGrp|73610|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F136426_19006_0|SrvcGrp|13422|2022|PDM|271.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F136488_16828_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F120489_63552_0|SrvcGrp|73499|2022|PDM|571.00|99|0.00|AETNA ER LEVEL II|
20|FH_F120489_63552_0|SrvcGrp|103913|2022|PCT|0.75|99|0.00|OP DIALYSIS|
20|FH_F138019_79705_0|SrvcGrp|89149|2022|PDM|239.00|99|0.00|OP INTENSIVE|
20|FH_F142491_06033_0|SrvcGrp|82223|2022|PDM|160.00|99|0.00|HOSPICE CARE|
20|FH_F117552_0_0|SrvcGrp|63471|2022|PDM|15400.00|99|0.00|CPT 64590|
20|FH_F137951_0_0|SrvcGrp|41335|2022|PDM|10500.00|99|0.00|TOTAL HIP|
20|FH_F77782_66061_0|SrvcGrp|23972|2022|PCT|0.83|99|0.00|ARTHROSCOPIC & LASER SURGERIES|
20|FH_F140407_63841_0|SrvcGrp|113299|2022|PDM|16.94|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - MODERNA|
20|FH_F149441_28401_0|SrvcGrp|87317|2022|PDM|837.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F149514_99701_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F149663_45219_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F109930_73109_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F109953_75234_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F80366_0_0|SrvcGrp|74616|2022|PCT|0.77|99|0.00|AETNA LABORATORY|
20|FH_F129483_77030_0|SrvcGrp|86121|2022|PCT|0.83|99|0.00|AETNA GAMUNEX-C|
20|FH_F117093_40041_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F137333_51012_0|SrvcGrp|113079|2022|PDM|608.00|99|0.00|RESIDENTIAL TREATMENT PSYCH & CD (12-18 YRS)|
20|FH_F137850_32826_0|SrvcGrp|89417|2022|PDM|296.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F98780_35022_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F115936_75093_0|SrvcGrp|86722|2022|PDM|231.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F115952_44484_0|SrvcGrp|89149|2022|PDM|138.00|99|0.00|OP INTENSIVE|
20|FH_F115966_16801_0|SrvcGrp|44042|2022|PDM|100.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F116114_37033_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F131711_25550_0|SrvcGrp|104363|2022|PCT|0.88|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F132213_17543_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134826_19067_0|SrvcGrp|90641|2022|PDM|150.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE OVER 30 MINS|
20|FH_F134828_30531_0|SrvcGrp|112652|2022|PDM|46.00|99|0.00|XRAY EXAM OF RIBS|
20|FH_F134368_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145188_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F145721_0_0|SrvcGrp|29155|2022|PDM|135.00|99|0.00|HOSPICE SVCS|
20|FH_F34477_0_0|SrvcGrp|22954|2022|PDM|109.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F151059_60435_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F151154_91761_0|SrvcGrp|23683|2022|PDM|65.00|99|0.00|SKILLED NURSING RN|
20|FH_F121970_92653_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F129130_92562_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116809_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F31525_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|1517.70|99|0.00|DELAWARE VALLEY- ASC 9|
20|FH_F91873_12723_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F113143_0_0|SrvcGrp|73006|2022|PDM|1406.00|99|0.00|AEG 9|
20|FH_F114864_78155_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112163_0_0|SrvcGrp|104745|2022|PDM|236.00|99|0.00|HOSPICE|
20|FH_F117623_0_0|CSTM-ALL|CSTM-00|2020|PDM|27.00|99|0.00|OBSERV BEHAV ASSESS ADDL|
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|2010.00|99|0.00|AEG 3 (NO REV)|
20|FH_F124926_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F95341_08701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114389_50131_0|SrvcGrp|14948|2022|PDM|215.86|99|0.00|HOME INFUSION THERAPY|
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|1753.00|99|0.00|AEG 8 (NO REV)|
20|FH_F49487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 DMEPOS TX (GLOBAL)|
20|FH_F45976_0_0|SrvcGrp|17065|2022|PDM|481.00|99|0.00|ASPG I|
20|FH_F132348_16214_0|SrvcGrp|94780|2022|PDM|95.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F124060_76040_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F124082_78526_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F146985_12205_0|SrvcGrp|29347|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F100703_0_0|SrvcGrp|97039|2022|PDM|3535.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F132864_71101_0|SrvcGrp|73483|2022|PDM|877.00|99|0.00|AETNA SUBACUTE III|
20|FH_F132864_71101_0|CSTM-ALL|CSTM-00|2020|PDM|2874.00|99|0.00|AEG 8 (NO REV)|
20|FH_F100000_45417_0|SrvcGrp|79720|2022|PDM|860.00|99|0.00|ACUTE REHAB II|
20|FH_F124679_64052_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F127995_84010_0|SrvcGrp|43567|2022|PDM|50.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F127995_84010_0|SrvcGrp|48396|2022|PDM|85.50|99|0.00|OT SERVICES|
20|FH_F132592_68305_0|SrvcGrp|537|2022|PCT|0.94|99|0.00|OBSERVATION SERVICES|
20|FH_F98042_10468_0|SrvcGrp|73603|2022|PDM|7969.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F100787_69162_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114684_80547_0|SrvcGrp|105322|2022|PDM|102.00|99|0.00|OFFICE/OUTPATIENT VISIT NEW|
20|FH_F113937_15301_0|SrvcGrp|73701|2022|PDM|26.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F43000_0_0|SrvcGrp|36747|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F134746_83318_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136814_70605_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112371_19047_0|CSTM-ALL|CSTM-00|2020|PDM|3195.00|99|0.00|AEG 9 (NO REV)|
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_F69623_0_0|SrvcGrp|33414|2022|PDM|125.00|99|0.00|SNF VENTILATOR SUPPORT|
20|FH_F116393_07002_0|CSTM-ALL|CSTM-00|2020|PDM|22.28|99|0.00|MANUAL HAND MUSCLE TESTING|
20|FH_F147519_52627_0|SrvcGrp|15789|2022|PDM|93.70|99|0.00|SPEECH THERAPY|
20|FH_F147586_44124_0|SrvcGrp|88487|2022|PDM|3900.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
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|750.00|99|0.00|ACUTE PSYCH|
20|FH_F41832_0_0|SrvcGrp|29898|2022|PDM|108.00|99|0.00|RN VISIT|
20|FH_F42522_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG II|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.60|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 12 W/O REV|
20|FH_F46433_0_0|SrvcGrp|17003|2022|PDM|200.00|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS|
20|FH_F129673_0_0|SrvcGrp|110638|2022|PDM|974.11|99|0.00|HOSPICE GENERAL INPATIENT CARE|
20|FH_F135351_0_0|SrvcGrp|16289|2022|PDM|2655.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F100101_24018_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F120695_15017_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F34269_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F117509_0_0|SrvcGrp|92502|2022|PDM|573.47|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F38949_0_0|SrvcGrp|705|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F39098_0_0|SrvcGrp|701|2022|PDM|1576.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F113585_20155_0|SrvcGrp|48396|2022|PDM|125.00|99|0.00|OT SERVICES|
20|FH_F150982_0_0|SrvcGrp|67994|2022|PDM|2202.00|99|0.00|CPT 58120|
20|FH_F137769_85234_0|SrvcGrp|113127|2022|PDM|79.57|99|0.00|BILIRUBIN LIGHT WITH PHOTOMETER (MOD RR)|
20|FH_F134394_92101_0|SrvcGrp|112559|2022|PDM|604.00|99|0.00|PARTIAL HOSP (12-17 YRS)|
20|FH_F35097_16508_0|SrvcGrp|17753|2022|PDM|143.00|99|0.00|NEGATIVE  PRESSURE WOUND THERAPY ELEC PUMP|
20|FH_F148347_0_0|SrvcGrp|109707|2022|PDM|1980.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F138995_0_0|SrvcGrp|87679|2022|PDM|800.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F141156_04401_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|AEG 9 (NO REV)|
20|FH_F130182_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F118907_0_0|SrvcGrp|107898|2022|PDM|603.56|99|0.00|SLEEP STUDIES (HCFA)|
20|FH_F112956_0_0|SrvcGrp|75493|2022|PDM|1072.00|99|0.00|AEG 8|
20|FH_F101844_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F141247_18902_0|SrvcGrp|89417|2022|PDM|400.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F147418_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F126977_34990_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|MS DRG UNGROUPABLE INPATIENT|
20|FH_F147360_06415_0|SrvcGrp|112678|2022|PCT|1.00|99|0.00|COVID-19 SPECIMEN COLLECT|
20|FH_F148347_0_0|SrvcGrp|110820|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F119008_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F108460_32746_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F90199_24083_0|SrvcGrp|471|2022|PDM|472.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132732_0_0|SrvcGrp|16|2022|PDM|1788.00|99|0.00|ACUTE REHABILITATION|
20|FH_F33504_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|BURN SERVICES|
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|ENT SURGERY CENTER CARVEOUT|
20|FH_F97623_38008_0|SrvcGrp|73656|2022|PDM|482.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F138017_73129_0|SrvcGrp|112967|2022|PCT|1.57|99|0.00|LABORATORY SERVICES|
20|FH_F116100_0_0|SrvcGrp|3809|2022|PDM|573.47|99|0.00|HOSPICE CARE|
20|FH_F131239_54615_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128764_57501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F138410_19130_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F90455_0_0|SrvcGrp|88834|2022|PDM|128.00|99|0.00|SKILLED NURSING SERVICES (15 MINS)|
20|FH_F128392_01026_0|SrvcGrp|46903|2022|PDM|1400.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F139907_42266_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F102920_0_0|SrvcGrp|16289|2022|PDM|1182.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F102522_0_0|SrvcGrp|72379|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F114931_0_0|SrvcGrp|105753|2022|PDM|3200.00|99|0.00|GASTRIC RESTRICTIVE PROCEDURE|
20|FH_F131093_49690_0|SrvcGrp|83521|2022|PDM|130.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F120187_76522_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F120190_92624_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120190_92624_0|SrvcGrp|73605|2022|PDM|950.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F132534_18407_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132496_17512_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116546_78723_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F116835_94538_0|SrvcGrp|73841|2022|PDM|727.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F116835_94538_0|SrvcGrp|73842|2022|PDM|401.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120856_78247_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120888_63823_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126243_32132_0|SrvcGrp|46903|2022|PDM|683.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F113649_01752_0|SrvcGrp|17013|2022|PDM|55.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118792_63379_0|SrvcGrp|78534|2022|PDM|0.35|99|0.00|AETNA MED RECORD|
20|FH_F49895_0_0|SrvcGrp|31190|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC (DME)|
20|FH_F49895_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F50137_0_0|SrvcGrp|15070|2022|PDM|120.00|99|0.00|HOME HEALTH (NEWBORN CARE)|
20|FH_F65440_0_0|SrvcGrp|29830|2022|PDM|2571.00|99|0.00|PERCUT NEEDLE INSERTION|
20|FH_F123466_93420_0|SrvcGrp|107483|2022|PCT|1.10|99|0.00|OP THERAPY SERVICE|
20|FH_F39694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F84135_0_0|SrvcGrp|108082|2022|PDM|952.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F128307_43219_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F128108_49505_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|1287.78|99|0.00|AEG 3 (NO REV)|
20|FH_F73985_0_0|SrvcGrp|90626|2022|PDM|10441.00|99|0.00|PACEMAKER|
20|FH_F130523_04605_0|SrvcGrp|537|2022|PCT|0.84|99|0.00|OBSERVATION SERVICES|
20|FH_F136790_0_0|SrvcGrp|13640|2022|PDM|154.00|99|0.00|CPT 99202|
20|FH_F89779_0_0|SrvcGrp|88065|2022|PDM|12000.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F151526_28208_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AEG 3 (NO REV)|
20|FH_F93791_0_0|SrvcGrp|93598|2022|PDM|4200.00|99|0.00|REVISE RECONSTRUCT SHOULDER JOINT(HCFA)|
20|FH_F120059_0_0|SrvcGrp|108118|2022|PDM|1600.00|99|0.00|ARTERIOVENOUS ANASTOMOSIS|
20|FH_F93741_85006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129767_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148222_18603_0|SrvcGrp|48396|2022|PDM|102.00|99|0.00|OT SERVICES|
20|FH_F90362_0_0|SrvcGrp|69964|2022|PDM|1697.00|99|0.00|CPT 23120|
20|FH_F90714_0_0|SrvcGrp|72992|2022|PDM|490.00|99|0.00|AEG 2|
20|FH_F82753_18840_0|SrvcGrp|80518|2022|PDM|8060.00|99|0.00|TRANSCATHETER STENT ADD ON|
20|FH_F123331_45373_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148203_60190_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F112526_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90613_05001_0|SrvcGrp|90161|2022|PDM|1179.00|99|0.00|AETNA INPATIENT DETOX (<= 17 YEARS OF AGE)|
20|FH_F124837_65625_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|1847.00|99|0.00|AEG 4 (NO REV)|
20|FH_F129892_0_0|SrvcGrp|34606|2022|PDM|1715.00|99|0.00|CPT 29827|
20|FH_F50446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137951_0_0|SrvcGrp|90420|2022|PDM|4296.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F137951_0_0|SrvcGrp|88491|2022|PDM|3000.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F148544_60439_0|SrvcGrp|108061|2022|PCT|1.50|99|0.00|OP THERAPY SERVICES|
20|FH_F148554_85016_0|SrvcGrp|115448|2022|PDM|2500.00|99|0.00|REMOVE & REPLACE PM GEN SINGLE|
20|FH_F36363_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46196_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F74163_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F135711_61401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F122646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS APC GROUPED|
20|FH_F123144_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148886_60621_0|SrvcGrp|16141|2022|PCT|0.56|99|0.00|PACEMAKER|
20|FH_F117909_92405_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F112862_46176_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F79902_0_0|SrvcGrp|73201|2022|PCT|1.00|99|0.00|NORTH PHIL CT & MRI OCN F/S PRICING|
20|FH_F39171_61362_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F133261_78041_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F111809_93003_0|SrvcGrp|12491|2022|PCT|0.67|99|0.00|PACEMAKER|
20|FH_F149861_85225_0|SrvcGrp|90854|2022|PDM|567.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F117272_24333_0|SrvcGrp|29347|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F148886_60621_0|SrvcGrp|111927|2022|PCT|1.00|99|0.00|COVID-19 NON CDC|
20|FH_F126868_60451_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F35857_0_0|SrvcGrp|30401|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F146229_60031_0|SrvcGrp|46903|2022|PDM|660.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F141940_50023_0|CSTM-ALL|CSTM-00|2020|PDM|2178.62|99|0.00|AEG 2 (NO REV)|
20|FH_F97543_33542_0|SrvcGrp|73602|2022|PDM|1341.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F38161_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MOD 26|
20|FH_F149867_62901_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F89932_10940_0|SrvcGrp|89414|2022|PDM|1590.00|99|0.00|SLEEP STUDIES|
20|FH_F47433_0_0|SrvcGrp|9518|2022|PDM|900.00|99|0.00|EMERGENCY ROOM|
20|FH_F48052_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141750_77515_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F92676_15063_0|SrvcGrp|67749|2022|PDM|3990.00|99|0.00|KYPHOPLASTY|
20|FH_F100666_81301_0|SrvcGrp|73559|2022|PDM|8161.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F98921_64503_0|SrvcGrp|73601|2022|PDM|5394.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F97061_85012_0|SrvcGrp|90854|2022|PDM|2274.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F56793_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|BARTON COUNTY IV SERVICES MOD SH|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PHENYLKEOTONURIA|
20|FH_F41999_0_0|SrvcGrp|35142|2022|PDM|1825.00|99|0.00|DELIVERY|
20|FH_F102681_34237_0|SrvcGrp|72996|2022|PDM|538.00|99|0.00|AEG 4|
20|FH_F127422_0_0|SrvcGrp|72998|2022|PDM|717.00|99|0.00|AEG 5|
20|FH_F49776_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F146320_27610_0|CSTM-ALL|CSTM-00|2020|PDM|1552.20|99|0.00|AEG 7 (NO REV)|
20|FH_F91275_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F44257_0_0|CSTM-ALL|CSTM-00|2020|PDM|579.00|99|0.00|ACUTE PSYCH|
20|FH_F49776_0_0|SrvcGrp|26001|2022|PDM|90.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F128559_43524_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111812_11222_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F32833_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F150463_50701_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 1 (NO REV)|
20|FH_F146105_76016_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|446.07|99|0.00|ASPG 101|
20|FH_F117508_90232_0|SrvcGrp|89337|2022|PDM|1150.00|99|0.00|DETOXIFICATION|
20|FH_F37035_0_0|SrvcGrp|33823|2022|PDM|421.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG I|
20|FH_F126762_91311_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F133327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD UE/KC)|
20|FH_F125528_81147_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F31446_0_0|SrvcGrp|52|2022|PDM|50.00|99|0.00|RESIDENTIAL TREATMENT SVCS|
20|FH_F118400_16701_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F53032_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111784_32901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100788_01420_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118845_71111_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F38770_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALTOONA REG MED CTR GH LABS|
20|FH_F105842_70433_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F123085_21921_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118667_95131_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F101754_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133005_32726_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F34706_0_0|SrvcGrp|10375|2022|PDM|36356.00|99|0.00|DRG 543 CRAN W/IMPL OF CHEMO AGENT|
20|FH_F139016_47460_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F91641_0_0|SrvcGrp|111993|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|985.71|99|0.00|AEG 6 (NO REV)|
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|730.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F151342_90272_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132262_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F122087_62684_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F144991_43607_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F123184_20906_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F128244_62254_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91764_93710_0|SrvcGrp|113230|2022|PCT|2.12|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 SCR|
20|FH_F136038_33018_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136096_02860_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100763_24202_0|SrvcGrp|73643|2022|PDM|2118.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F130756_04901_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 8 (NO REV)|
20|FH_F116431_76104_0|SrvcGrp|73489|2022|PCT|0.90|99|0.00|AETNA TRAUMA|
20|FH_F130766_04967_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F140629_0_0|SrvcGrp|87841|2022|PDM|2497.00|99|0.00|LAPAROSCOPE PROCEDURE - STOMACH|
20|FH_F36479_0_0|SrvcGrp|97|2022|PDM|1476.00|99|0.00|C-SECTION|
20|FH_F85135_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|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_F67425_0_0|SrvcGrp|43|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F111291_52501_0|SrvcGrp|104302|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F141651_0_0|SrvcGrp|91941|2022|PDM|3850.00|99|0.00|NASAL/SINUS ENDOSCOPY WITH DILATION|
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|1227.30|99|0.00|2005 ASPG GROUPER VIII|
20|FH_F71229_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F116430_0_0|SrvcGrp|27316|2022|PDM|2864.00|99|0.00|TONSILS & ADENOIDS (42820)|
20|FH_F89732_0_0|SrvcGrp|88427|2022|PDM|2882.00|99|0.00|AETNA IP SERVICES|
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.90|99|0.00|AEG 4 (NO REV)|
20|FH_F112086_33713_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F87557_33309_0|SrvcGrp|86840|2022|PDM|30.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F98300_30236_0|SrvcGrp|75479|2022|PDM|1487.00|99|0.00|AEG 1|
20|FH_F134202_0_0|SrvcGrp|38364|2022|PDM|4260.90|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F123741_20850_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F58856_0_0|SrvcGrp|20908|2022|PDM|17800.00|99|0.00|MS DRG 247 ONLY|
20|FH_F136348_32092_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136371_29720_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136386_30901_0|SrvcGrp|27815|2022|PDM|11550.00|99|0.00|MS DRG 281 ONLY|
20|FH_F120489_63552_0|SrvcGrp|106257|2022|PCT|0.75|99|0.00|LABORATORY SERVICES|
20|FH_F134011_84102_0|SrvcGrp|86848|2022|PDM|25.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F134159_80228_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F142448_15701_0|SrvcGrp|43567|2022|PDM|60.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F104340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138627_82901_0|SrvcGrp|86837|2022|PDM|10.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F140343_89052_0|SrvcGrp|22589|2022|PDM|25.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F140627_68651_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F140652_92626_0|SrvcGrp|108484|2022|PDM|725.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F149540_64083_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149607_76548_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119003_78070_0|SrvcGrp|78180|2022|PDM|600.00|99|0.00|AETNA RESIDENTIAL TREATMENT|
20|FH_F118818_19808_0|SrvcGrp|73842|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F118943_64506_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F70665_0_0|SrvcGrp|17140|2022|PDM|180.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F147779_34240_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147925_06457_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129434_98271_0|SrvcGrp|75419|2022|PDM|716.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F129514_79605_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F117214_84020_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F137934_51054_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F137938_29036_0|SrvcGrp|74586|2022|PCT|0.55|99|0.00|AETNA OP HIGH COST DRUGS|
20|FH_F124893_40311_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PDM|1562.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132736_0_0|SrvcGrp|360|2022|PDM|2059.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F39621_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F111101_97123_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111101_97123_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F141471_0_0|SrvcGrp|107879|2022|PDM|2200.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F92516_0_0|SrvcGrp|73004|2022|PDM|989.00|99|0.00|AEG 8|
20|FH_F100906_0_0|SrvcGrp|97461|2022|PDM|6000.00|99|0.00|REVISON OF KNEE JOINT|
20|FH_F78003_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119447_64081_0|SrvcGrp|89149|2022|PDM|188.00|99|0.00|OP INTENSIVE|
20|FH_F137951_0_0|SrvcGrp|27261|2022|PDM|9393.00|99|0.00|CPT 27446|
20|FH_F125013_85251_0|SrvcGrp|89417|2022|PDM|600.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F81313_0_0|SrvcGrp|33165|2022|PDM|310.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|ASPG II|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1332.85|99|0.00|ASPG 7|
20|FH_F101923_98104_0|CSTM-ALL|CSTM-00|2020|PCT|3.17|99|0.00|RITUXAN/RITUXIMAB|
20|FH_F112862_46176_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F111409_33761_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118819_76226_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148886_60621_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 3 (NO REV)|
20|FH_F90811_0_0|SrvcGrp|64517|2022|PDM|2700.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F32869_0_0|SrvcGrp|12032|2022|PDM|3000.00|99|0.00|TRANSURETHRAL MICROWAVE THERAPY|
20|FH_F72909_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F103281_32086_0|SrvcGrp|79099|2022|PDM|4500.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F109812_37043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145907_03867_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F45653_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150904_22306_0|SrvcGrp|48398|2022|PDM|139.00|99|0.00|PT SERVICES|
20|FH_F102721_38118_0|SrvcGrp|72992|2022|PDM|750.00|99|0.00|AEG 2|
20|FH_F31824_0_0|SrvcGrp|13213|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F37909_0_0|SrvcGrp|27170|2022|PDM|60.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F120745_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|1633.00|99|0.00|AEG 5  (NO REV)|
20|FH_F139553_30084_0|SrvcGrp|42785|2022|PDM|125.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F139707_84010_0|SrvcGrp|99073|2022|PCT|1.16|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F35750_0_0|SrvcGrp|18932|2022|PDM|4055.96|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806|
20|FH_F149030_37919_0|CSTM-ALL|CSTM-00|2020|PDM|2493.12|99|0.00|AEG 6 (NO REV)|
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|ASPG V|
20|FH_F74646_0_0|SrvcGrp|25346|2022|PDM|55.00|99|0.00|PT|
20|FH_F122277_98045_0|SrvcGrp|472|2022|PDM|428.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|VERTICAL PLUS MRI OP SERVICES MOD 26|
20|FH_F90223_0_0|SrvcGrp|88828|2022|PDM|8.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F81272_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|2268.00|99|0.00|AEG 6 (NO REV)|
20|FH_F117615_30525_0|SrvcGrp|3273|2022|PCT|1.12|99|0.00|IMPLANTS|
20|FH_F148326_0_0|SrvcGrp|90376|2022|PDM|8160.00|99|0.00|REVISION OF KNEE JOINTLANT|
20|FH_F125214_12428_0|CSTM-ALL|CSTM-00|2020|PDM|1821.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F148351_33012_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149662_85015_0|SrvcGrp|27100|2022|PCT|0.00|99|0.00|EMERGENCY ROOM|
20|FH_F127487_60169_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F39162_0_0|SrvcGrp|17378|2022|PDM|135.00|99|0.00|CAPD TRAINING|
20|FH_F137767_01841_0|CSTM-ALL|CSTM-00|2020|PDM|3325.00|99|0.00|AEG 6 (NO REV)|
20|FH_F91940_0_0|SrvcGrp|81859|2022|PDM|1890.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F147174_75231_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132849_0_0|SrvcGrp|51672|2022|PDM|4783.00|99|0.00|MS DRG 286-287 ONLY|
20|FH_F147147_50265_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F46284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F124548_12414_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F120154_77498_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F98022_89015_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F36826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F47558_0_0|SrvcGrp|43268|2022|PDM|120.00|99|0.00|PICC LINE CATH CARE|
20|FH_F97280_20018_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F124749_90211_0|SrvcGrp|106249|2022|PDM|384.00|99|0.00|PARTIAL HOSP SUBSTANCE ABUSE|
20|FH_F112045_90301_0|SrvcGrp|103617|2022|PDM|3200.00|99|0.00|NORMAL DELIVERY (MOM)|
20|FH_F40527_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|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_F117574_49022_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F148667_0_0|SrvcGrp|82114|2022|PDM|2856.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F149648_89148_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128583_45154_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125214_12428_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F114207_35243_0|SrvcGrp|22593|2022|PDM|35.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F100663_56537_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F97420_75052_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SAINT ALEXIUS FH MOD 53|
20|FH_F127396_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F127467_44202_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F117762_0_0|SrvcGrp|89848|2022|PDM|7280.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F92153_74017_0|CSTM-ALL|CSTM-00|2020|PCT|0.58|99|0.00|GENERAL ACUTE CARE|
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.00|99|0.00|AEG 4 (NO REV)|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|31545.00|99|0.00|MSDRG 231-232 CORONARY BYPASS|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC|
20|FH_F84833_17109_0|SrvcGrp|73701|2022|PDM|35.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F133569_17202_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 10 (NO REV)|
20|FH_F37364_0_0|SrvcGrp|11258|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F122377_91007_0|SrvcGrp|109116|2022|PDM|65897.00|99|0.00|PACEMAKER IMPLANT/REPLACEMENT|
20|FH_F120099_86305_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F35088_0_0|SrvcGrp|11200|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F38425_0_0|SrvcGrp|11798|2022|PDM|112.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F42117_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118667_95131_0|SrvcGrp|88621|2022|PDM|120.00|99|0.00|SKILLED NURSING LPN|
20|FH_F140808_0_0|CSTM-ALL|CSTM-00|2020|PDM|37.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F150602_59718_0|SrvcGrp|80920|2022|PDM|543.00|99|0.00|HOSPICE SERVICES|
20|FH_F36101_0_0|SrvcGrp|3810|2022|PDM|105.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F146250_67601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123538_21206_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F71145_0_0|SrvcGrp|44248|2022|PDM|145.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F148639_0_0|SrvcGrp|36591|2022|PDM|5284.00|99|0.00|CPT 63685|
20|FH_F125541_07825_0|SrvcGrp|89149|2022|PDM|205.00|99|0.00|OP INTENSIVE|
20|FH_F141907_74021_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147800_0_0|SrvcGrp|115841|2022|PDM|11000.00|99|0.00|PERQ NJX ALGC CT LMBR 1ST|
20|FH_F31204_0_0|SrvcGrp|110|2022|PDM|635.00|99|0.00|CD - REHABILITATION|
20|FH_F101840_76054_0|SrvcGrp|31017|2022|PDM|17529.00|99|0.00|MS DRG 468 ONLY|
20|FH_F144011_60616_0|SrvcGrp|81779|2022|PCT|1.31|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F126815_02118_0|SrvcGrp|16429|2022|PDM|1179.20|99|0.00|OBSERVATION SVCS|
20|FH_F120430_32177_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F42494_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F150538_90056_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F44755_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.60|99|0.00|OP SVCS|
20|FH_F42779_0_0|SrvcGrp|13805|2022|PDM|3621.00|99|0.00|CARDIAC CATH LAB IP SVCS|
20|FH_F37778_0_0|SrvcGrp|27310|2022|PDM|2350.00|99|0.00|ENDOSCOPIC PLANTAR FASCIOTOMY|
20|FH_F92676_15063_0|SrvcGrp|79070|2022|PDM|356.40|99|0.00|MON VALLEY ASC 1501|
20|FH_F132737_0_0|SrvcGrp|3078|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F148556_13206_0|SrvcGrp|14948|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F43953_0_0|SrvcGrp|13488|2022|PCT|0.70|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F73304_0_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|ASPG II|
20|FH_F59274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F126815_02118_0|SrvcGrp|78403|2022|PDM|0.25|99|0.00|AETNA MED RECORD|
20|FH_F148021_80907_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39723_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HEALTHFIELD HOME HEALTH HCPCS|
20|FH_F40994_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY|
20|FH_F31796_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F44342_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|CHILD PSYCHIATRIC|
20|FH_F31093_0_0|SrvcGrp|10980|2022|PDM|650.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F117816_0_0|SrvcGrp|57967|2022|PDM|148.79|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F119229_90804_0|SrvcGrp|73700|2022|PDM|55.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F43296_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|CD SVCS (ADULT)|
20|FH_F112832_06776_0|SrvcGrp|471|2022|PDM|725.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F118027_28801_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F137639_0_0|SrvcGrp|1259|2022|PDM|1700.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F92676_15063_0|SrvcGrp|79061|2022|PDM|438.15|99|0.00|MON VALLEY ASC 236|
20|FH_F132118_92240_0|SrvcGrp|86723|2022|PDM|520.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F133287_40215_0|SrvcGrp|73606|2022|PDM|907.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F132420_84660_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F148925_61531_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F46357_0_0|SrvcGrp|41547|2022|PDM|3000.00|99|0.00|OP LAPAROSCOPIC HYSTERECTOMY|
20|FH_F146241_91326_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F49035_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F135690_20814_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F142027_37217_0|SrvcGrp|65645|2022|PDM|125.00|99|0.00|NURSING CARE IN HOME - S9123|
20|FH_F148556_13206_0|SrvcGrp|21920|2022|PDM|35.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F128246_0_0|SrvcGrp|111047|2022|PDM|673.00|99|0.00|REVISION OF EYELID|
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|281.00|99|0.00|CD - ADOLESCENT FULL DAY|
20|FH_F97565_83301_0|SrvcGrp|73559|2022|PDM|11197.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.37|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|951.00|99|0.00|AEG 4 (NO REV)|
20|FH_F95661_27217_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139825_0_0|SrvcGrp|45583|2022|PDM|9754.00|99|0.00|CPT 65730|
20|FH_F129364_0_0|SrvcGrp|111218|2022|PDM|182.00|99|0.00|CAPD/CCPD|
20|FH_F125540_19462_0|SrvcGrp|73841|2022|PDM|407.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F149840_80002_0|SrvcGrp|87395|2022|PDM|135.00|99|0.00|HCPCS G0153 (HCFA)|
20|FH_F120954_0_0|SrvcGrp|57967|2022|PDM|236.25|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F150900_19104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F123539_65265_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F148579_17057_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F101802_17201_0|SrvcGrp|27968|2022|PDM|27.31|99|0.00|SKILLED NURSING LPN|
20|FH_F81853_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F80855_0_0|SrvcGrp|27347|2022|PDM|2650.00|99|0.00|CPT 58558|
20|FH_F45977_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|HOME HEALTH AIDE MOD TF|
20|FH_F38845_0_0|SrvcGrp|11301|2022|PDM|900.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F132601_92677_0|SrvcGrp|108484|2022|PDM|1675.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F111813_08080_0|SrvcGrp|100765|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F91255_19401_0|CSTM-ALL|CSTM-00|2020|PDM|2924.00|99|0.00|AEG 5  (NO REV)|
20|FH_F116049_0_0|SrvcGrp|3809|2022|PDM|573.47|99|0.00|HOSPICE CARE|
20|FH_F97242_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F139515_0_0|SrvcGrp|54962|2022|PDM|1910.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)|
20|FH_F126678_44870_0|SrvcGrp|65720|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F39920_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F138416_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F39866_0_0|SrvcGrp|12342|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F148663_48601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39022_0_0|SrvcGrp|38|2022|PDM|4200.00|99|0.00|NORMAL DELIVERY|
20|FH_F37679_0_0|SrvcGrp|27079|2022|PDM|25.00|99|0.00|PICC LINE INSERT|
20|FH_F116281_19013_0|SrvcGrp|106719|2022|PDM|630.00|99|0.00|INDUCED ABORTION BY DILATION AND EVACUATION|
20|FH_F41519_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F114511_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F72947_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|GENERAL ACUTE CARE|
20|FH_F51733_0_0|SrvcGrp|46248|2022|PDM|90.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F125899_07645_0|SrvcGrp|72996|2022|PDM|5733.00|99|0.00|AEG 4|
20|FH_F110263_0_0|SrvcGrp|93602|2022|PDM|13477.00|99|0.00|TOTAL KNEE(HCFA)|
20|FH_F40149_0_0|SrvcGrp|38|2022|PDM|2530.00|99|0.00|NORMAL DELIVERY|
20|FH_F66687_0_0|SrvcGrp|29607|2022|PDM|86529.00|99|0.00|MS DRG 221 ONLY|
20|FH_F32000_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|ASPG IV|
20|FH_F129294_53925_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133207_0_0|SrvcGrp|92197|2022|PDM|6684.00|99|0.00|CORRECTION OF BUNION|
20|FH_F124388_0_0|SrvcGrp|87053|2022|PDM|1870.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F120672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|GENERAL ACUTE CARE|
20|FH_F120349_38774_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|2061.00|99|0.00|AEG 9 (NO REV)|
20|FH_F125546_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AEG 8 (NO REV)|
20|FH_F92993_0_0|SrvcGrp|86474|2022|PDM|39.63|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F129792_80309_0|SrvcGrp|111426|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
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_F40149_0_0|SrvcGrp|3277|2022|PDM|506.00|99|0.00|SKILLED NURSING CARE|
20|FH_F149939_91942_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136790_0_0|SrvcGrp|13630|2022|PDM|647.00|99|0.00|CPT 99204|
20|FH_F33513_0_0|SrvcGrp|29898|2022|PCT|0.77|99|0.00|RN VISIT|
20|FH_F123918_76012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F132190_0_0|SrvcGrp|97039|2022|PDM|2500.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F110086_21742_0|SrvcGrp|55084|2022|PDM|1750.00|99|0.00|CPT 52648|
20|FH_F33002_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F44495_0_0|SrvcGrp|42037|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE (ADDITIONAL HOURS)|
20|FH_F88199_0_0|SrvcGrp|46424|2022|PDM|82.50|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F125817_78613_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F81033_0_0|SrvcGrp|78666|2022|PDM|892.50|99|0.00|AETNA MISSED ABORTION, ANY TRIMEST|
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|1671.00|99|0.00|AEG 9 CENTER ONE|
20|FH_F125652_66743_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121547_46805_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F141410_13045_0|SrvcGrp|109057|2022|PCT|0.87|99|0.00|CARDIAC STUDIES|
20|FH_F72746_0_0|SrvcGrp|26001|2022|PDM|159.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F149759_63122_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F81033_0_0|SrvcGrp|78662|2022|PDM|892.50|99|0.00|AETNA ENDOMETRIAL THERMAL ABLTN|
20|FH_F32156_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F151525_30349_0|SrvcGrp|116059|2022|PCT|1.00|99|0.00|LABORATORY AND PATHOLOGY|
20|FH_F63276_0_0|SrvcGrp|42827|2022|PDM|140.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F93920_0_0|SrvcGrp|81779|2022|PCT|0.75|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F125254_30306_0|SrvcGrp|89417|2022|PDM|476.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F145815_30540_0|SrvcGrp|113298|2022|PDM|28.39|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - PFIZER|
20|FH_F63422_0_0|SrvcGrp|33812|2022|PDM|300.00|99|0.00|IOP / MENTAL HEALTH / SUBSTANCE ABUSE|
20|FH_F39170_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|RAD MOD TC|
20|FH_F121090_07848_0|SrvcGrp|108727|2022|PDM|50.00|99|0.00|DRUG TEST PRSMV INSTRUMENT HCFA|
20|FH_F63095_0_0|SrvcGrp|13368|2022|PCT|0.65|99|0.00|OP SURGERY|
20|FH_F60112_0_0|SrvcGrp|42825|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F38411_0_0|SrvcGrp|361|2022|PDM|1500.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F146640_54155_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35009_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F88673_71105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F150165_06032_0|SrvcGrp|112208|2022|PDM|1700.00|99|0.00|DESTROY VAGINAL LESIONS SIMPLE|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% OF AWP DRUGS W/ DIRECT RATES|
20|FH_F32073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1103.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118088_71261_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145579_67226_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112023_12866_0|SrvcGrp|73000|2022|PDM|5209.00|99|0.00|AEG 6|
20|FH_F81698_10457_0|SrvcGrp|86845|2022|PDM|31.50|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F149051_01605_0|SrvcGrp|84559|2022|PCT|1.07|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F32073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1295.00|99|0.00|STROKE REHAB|
20|FH_F85213_02840_0|SrvcGrp|88819|2022|PDM|439.50|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F138018_17313_0|SrvcGrp|22594|2022|PDM|105.00|99|0.00|IMIGLUCERASE|
20|FH_F122282_30080_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110824_83221_0|SrvcGrp|79099|2022|PDM|2618.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F125656_92868_0|SrvcGrp|86830|2022|PDM|45.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F97640_37043_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F35167_0_0|CSTM-ALL|CSTM-00|2020|PDM|3406.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92032_32308_0|SrvcGrp|114102|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F84413_0_0|SrvcGrp|16526|2022|PDM|180.00|99|0.00|DIALYSIS|
20|FH_F137748_95231_0|SrvcGrp|112967|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 9 (NO REV)|
20|FH_F138016_19808_0|CSTM-ALL|CSTM-00|2020|PDM|583.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F133087_61107_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138018_17313_0|SrvcGrp|20480|2022|PDM|103.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F112045_90301_0|SrvcGrp|91198|2022|PDM|51818.00|99|0.00|NEUROSURGERY|
20|FH_F45798_0_0|SrvcGrp|9879|2022|PDM|964.00|99|0.00|SKILLED NURSING CARE- IP|
20|FH_F139870_71075_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140233_35216_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143210_72211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143407_75021_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143536_47546_0|SrvcGrp|100253|2022|PCT|1.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (12.6 - 20.0 CM)|
20|FH_F101700_0_0|SrvcGrp|93741|2022|PDM|1476.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY|
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|1612.00|99|0.00|AEG 7 (NO REV)|
20|FH_F130917_48658_0|SrvcGrp|82223|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F151752_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82375_28601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|1553.00|99|0.00|ASPG VII- MOD 50|
20|FH_F120796_33548_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116683_64730_0|SrvcGrp|94739|2022|PCT|1.00|99|0.00|NOS FLU VACC IM (>=3 YRS)|
20|FH_F62579_0_0|SrvcGrp|19742|2022|PDM|115.00|99|0.00|MID-LINE INSERTION|
20|FH_F62579_0_0|SrvcGrp|17011|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F130656_04401_0|SrvcGrp|73806|2022|PCT|0.89|99|0.00|AETNA ER|
20|FH_F130662_07032_0|SrvcGrp|52953|2022|PDM|80.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F130721_04769_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 6 (NO REV)|
20|FH_F139727_66035_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100782_0_0|SrvcGrp|105072|2022|PDM|606.60|99|0.00|WINDBER MEDICAL CNTR ASC 117|
20|FH_F121225_98902_0|SrvcGrp|80988|2022|PDM|8000.00|99|0.00|AETNA MATERNITY DELIVERY|
20|FH_F149141_27262_0|SrvcGrp|75419|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F96780_0_0|SrvcGrp|28551|2022|PDM|1761.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F127556_66725_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F85353_16407_0|SrvcGrp|63909|2022|PDM|139.06|99|0.00|HAPA WPA-NWPA 2012-13 ASC 241|
20|FH_F126341_27284_0|SrvcGrp|86130|2022|PDM|1.45|99|0.00|AETNA FACTOR VIIA|
20|FH_F138908_84010_0|SrvcGrp|471|2022|PDM|630.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149021_44514_0|SrvcGrp|46890|2022|PDM|2291.08|99|0.00|IMPLANT EYE SHUNT|
20|FH_F132728_0_0|SrvcGrp|107734|2022|PDM|4476.00|99|0.00|VAGINAL DELIVERY|
20|FH_F134593_60007_0|SrvcGrp|86840|2022|PDM|36.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F143571_0_0|SrvcGrp|80317|2022|PDM|153.00|99|0.00|RESPITE CARE|
20|FH_F112065_20852_0|SrvcGrp|88620|2022|PDM|130.00|99|0.00|SKILLED NURSING RN|
20|FH_F87333_0_0|SrvcGrp|72996|2022|PDM|1321.92|99|0.00|AEG 4|
20|FH_F120709_64116_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F114444_19602_0|SrvcGrp|105368|2022|PDM|45.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MINS(HCFA)|
20|FH_F130763_0_0|SrvcGrp|76604|2022|PDM|3895.00|99|0.00|CPT 25447|
20|FH_F139658_02893_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 4 (NO REV)|
20|FH_F110420_60649_0|SrvcGrp|73004|2022|PDM|1119.00|99|0.00|AEG 8|
20|FH_F143545_78723_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143650_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119227_01752_0|SrvcGrp|24753|2022|PDM|18.00|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F145697_52302_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F68251_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F85353_16407_0|SrvcGrp|63869|2022|PDM|331.22|99|0.00|HAPA WPA-NWPA 2012-13 ASC 121|
20|FH_F96160_32207_0|SrvcGrp|24754|2022|PDM|25.89|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F118123_67226_0|SrvcGrp|103739|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F85371_63141_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F127282_98004_0|SrvcGrp|90573|2022|PDM|328.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F85097_0_0|SrvcGrp|13361|2022|PDM|402.00|99|0.00|EMERGENCY ROOM SVCS LEVEL III|
20|FH_F125513_40071_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F150165_06032_0|SrvcGrp|102479|2022|PDM|4000.00|99|0.00|AETNA CPT 29895|
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|740.00|99|0.00|AEG 2 (NO REV)|
20|FH_F149149_32937_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70863_0_0|SrvcGrp|8962|2022|PDM|236.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F100782_0_0|SrvcGrp|105122|2022|PDM|671.02|99|0.00|WINDBER MEDICAL CNTR ASC 227|
20|FH_F121476_0_0|SrvcGrp|108835|2022|PDM|55.00|99|0.00|LEAD NEUROSTIMULATOR|
20|FH_F148429_0_0|SrvcGrp|79720|2022|PDM|1372.00|99|0.00|ACUTE REHAB II|
20|FH_F134608_18017_0|SrvcGrp|112613|2022|PDM|348.00|99|0.00|INDUCED ABORTION 17-24 WKS|
20|FH_F85097_0_0|SrvcGrp|33011|2022|PCT|1.00|99|0.00|HIGH COST DRUGS/PHARMACEUTICALS|
20|FH_F135660_77061_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150165_06032_0|SrvcGrp|88158|2022|PDM|5835.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F121476_0_0|SrvcGrp|105319|2022|PDM|30331.00|99|0.00|IMPLT NROSTM PLS GEN DUA REC|
20|FH_F139443_37705_0|SrvcGrp|46903|2022|PDM|800.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F83754_0_0|SrvcGrp|21813|2022|PCT|0.86|99|0.00|ARENESP|
20|FH_F92893_75110_0|SrvcGrp|76528|2022|PDM|35.00|99|0.00|HOSPICE LTCH|
20|FH_F128828_44122_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F126341_27284_0|SrvcGrp|10577|2022|PCT|1.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F147981_60035_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150299_22046_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123850_0_0|SrvcGrp|94781|2022|PDM|198.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F110425_01752_0|SrvcGrp|73701|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F83754_0_0|SrvcGrp|22812|2022|PCT|0.86|99|0.00|ENDOSCOPY|
20|FH_F132883_31602_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F126975_43551_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F70804_0_0|SrvcGrp|26253|2022|PDM|45.67|99|0.00|LIPIDS|
20|FH_F150165_06032_0|SrvcGrp|76023|2022|PDM|9092.00|99|0.00|OP AICD 33249|
20|FH_F134172_33126_0|SrvcGrp|109330|2022|PCT|1.03|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F74024_0_0|SrvcGrp|16746|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F138348_04096_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F109387_35630_0|SrvcGrp|86753|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F150279_91767_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F114444_19602_0|SrvcGrp|91751|2022|PDM|65.00|99|0.00|AETNA GROUP THERAPY (MOD AJ)|
20|FH_F44299_0_0|SrvcGrp|10541|2022|PDM|65.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F86011_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.50|99|0.00|OP SVCS|
20|FH_F84712_0_0|SrvcGrp|82753|2022|PDM|58.00|99|0.00|TROPONIN QUANT|
20|FH_F105145_75075_0|SrvcGrp|98347|2022|PDM|23138.00|99|0.00|HIP ARTHROSCOPY / SURGERY|
20|FH_F115936_75093_0|SrvcGrp|89149|2022|PDM|231.00|99|0.00|OP INTENSIVE|
20|FH_F66427_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|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_F75842_0_0|SrvcGrp|17081|2022|PDM|6127.92|99|0.00|ASPG IX|
20|FH_F146881_83661_0|SrvcGrp|95661|2022|PDM|140.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F146881_83661_0|SrvcGrp|48396|2022|PDM|150.00|99|0.00|OT SERVICES|
20|FH_F120795_27514_0|CSTM-ALL|CSTM-00|2020|PDM|7949.00|99|0.00|AEG 9 (NO REV)|
20|FH_F116114_37033_0|SrvcGrp|100859|2022|PDM|239.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F131964_89120_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F139887_0_0|SrvcGrp|113588|2022|PDM|826.00|99|0.00|REMOVAL OF FOOT FOREIGN BODY|
20|FH_F133478_40165_0|SrvcGrp|28161|2022|PDM|73785.00|99|0.00|MS DRG 216 ONLY|
20|FH_F133047_74012_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133494_90023_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 1 (NO REV)|
20|FH_F131212_63017_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F130657_04614_0|SrvcGrp|79699|2022|PCT|0.86|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F134826_19067_0|SrvcGrp|108727|2022|PDM|50.00|99|0.00|DRUG TEST PRSMV INSTRUMENT HCFA|
20|FH_F102641_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132545_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|1572.00|99|0.00|AEG 6 (NO REV)|
20|FH_F113025_0_0|SrvcGrp|104962|2022|PDM|661.00|99|0.00|AEG 4 W/O CPT 67903-67904|
20|FH_F113154_70359_0|CSTM-ALL|CSTM-00|2020|PDM|515.00|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|88065|2022|PDM|9500.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 1 (NO REV)|
20|FH_F150200_0_0|SrvcGrp|14614|2022|PDM|4590.00|99|0.00|LITHOTRIPSY|
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_F49895_0_0|SrvcGrp|32383|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KL (DME)|
20|FH_F63095_0_0|SrvcGrp|16|2022|PDM|2441.00|99|0.00|ACUTE REHABILITATION|
20|FH_F78446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39138_0_0|SrvcGrp|1259|2022|PDM|1639.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F94942_0_0|SrvcGrp|72994|2022|PDM|846.66|99|0.00|AEG 3|
20|FH_F93881_15009_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PDM|2137.86|99|0.00|ASPG VII|
20|FH_F126523_0_0|SrvcGrp|72994|2022|PDM|810.00|99|0.00|AEG 3|
20|FH_F121535_60018_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149523_0_0|SrvcGrp|114175|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES|
20|FH_F141549_33403_0|SrvcGrp|74668|2022|PDM|480.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F123385_03561_0|SrvcGrp|23683|2022|PDM|77.00|99|0.00|SKILLED NURSING RN|
20|FH_F110925_01104_0|SrvcGrp|21919|2022|PDM|8.09|99|0.00|NASOGASTRIC TUBING|
20|FH_F130807_20721_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F97440_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F148265_06067_0|SrvcGrp|102480|2022|PDM|2801.00|99|0.00|CPT 29897|
20|FH_F121492_87111_0|SrvcGrp|89337|2022|PDM|1100.00|99|0.00|DETOXIFICATION|
20|FH_F145552_86301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97000_24201_0|SrvcGrp|79720|2022|PDM|1103.00|99|0.00|ACUTE REHAB II|
20|FH_F123276_20737_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F118338_94952_0|SrvcGrp|89149|2022|PDM|500.00|99|0.00|OP INTENSIVE|
20|FH_F113253_72206_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151541_01436_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F40834_0_0|SrvcGrp|8950|2022|PDM|1910.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F116115_14437_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F135231_90265_0|SrvcGrp|73841|2022|PDM|1000.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F130850_67401_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F148255_72703_0|SrvcGrp|29077|2022|PDM|10.50|99|0.00|HOME TRANSFUSION|
20|FH_F130146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F131517_19152_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143528_0_0|SrvcGrp|114087|2022|PDM|5250.00|99|0.00|SPINAL CRD DECOMP|
20|FH_F92411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F57553_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F100662_27534_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F42105_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION|
20|FH_F131228_01826_0|SrvcGrp|73063|2022|PCT|0.87|99|0.00|OBSERVATION SERVICES|
20|FH_F110925_01104_0|SrvcGrp|22589|2022|PDM|59.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP DIALYSIS|
20|FH_F43858_0_0|SrvcGrp|37404|2022|PDM|90.00|99|0.00|PT SVCS|
20|FH_F149868_0_0|SrvcGrp|93100|2022|PDM|705.00|99|0.00|RESPITE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1356.41|99|0.00|HAPA WPA-NWPA 2012-13 ASC 9 W/O REV|
20|FH_F79645_0_0|SrvcGrp|471|2022|PDM|570.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F91876_0_0|SrvcGrp|91322|2022|PCT|0.00|99|0.00|IMAGING ENHANCING|
20|FH_F38526_0_0|SrvcGrp|3037|2022|PDM|6115.00|99|0.00|LITHOTRIPSY|
20|FH_F93881_15009_0|SrvcGrp|87127|2022|PCT|0.00|99|0.00|GLOBAL ELECTROMYOPATHY|
20|FH_F123282_03222_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139515_0_0|SrvcGrp|92412|2022|PDM|8549.00|99|0.00|SPINAL CRD DECOMP->2 CERVIC|
20|FH_F39041_0_0|SrvcGrp|941|2022|PDM|2054.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F130889_68818_0|CSTM-ALL|CSTM-00|2020|PCT|0.96|99|0.00|OP SVCS|
20|FH_F130127_77071_0|SrvcGrp|89337|2022|PDM|1353.00|99|0.00|DETOXIFICATION|
20|FH_F39866_0_0|SrvcGrp|88|2022|PCT|0.75|99|0.00|OP LITHOTRIPSY|
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.00|99|0.00|AEG 10 (NO REV)|
20|FH_F139515_0_0|SrvcGrp|89404|2022|PDM|10686.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F52393_0_0|SrvcGrp|24405|2022|PDM|950.00|99|0.00|HEARING AIDE|
20|FH_F126523_0_0|SrvcGrp|72992|2022|PDM|680.00|99|0.00|AEG 2|
20|FH_F120175_19606_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F129115_85716_0|SrvcGrp|108484|2022|PDM|500.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F149888_68506_0|SrvcGrp|84910|2022|PDM|5416.00|99|0.00|ENDOSCOPY|
20|FH_F82714_18848_0|SrvcGrp|112223|2022|PDM|110.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F127205_44125_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F43663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC|
20|FH_F79904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F33900_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1291.00|99|0.00|ASPG V|
20|FH_F39943_0_0|SrvcGrp|16|2022|PDM|898.00|99|0.00|ACUTE REHABILITATION|
20|FH_F39022_0_0|SrvcGrp|23|2022|PCT|0.87|99|0.00|BONE MARROW TRANSPLANT|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F37659_0_0|SrvcGrp|26985|2022|PDM|79058.00|99|0.00|BMT RELATED ALLOGENEIC|
20|FH_F130452_48801_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F143900_63303_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F123468_63384_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F129828_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89475_71202_0|SrvcGrp|81775|2022|PCT|1.98|99|0.00|AETNA RADIOLOGY (RADHCPC)|
20|FH_F129767_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F86319_16365_0|SrvcGrp|3719|2022|PDM|845.00|99|0.00|NEWBORN NURSERY|
20|FH_F123466_93420_0|SrvcGrp|89149|2022|PDM|355.00|99|0.00|OP INTENSIVE|
20|FH_F130747_0_0|SrvcGrp|93063|2022|PDM|24970.00|99|0.00|LUMBAR ARTIF DISKECTOMY|
20|FH_F141169_0_0|SrvcGrp|85980|2022|PDM|2468.00|99|0.00|CPT 58670|
20|FH_F129011_15857_0|SrvcGrp|111061|2022|PCT|1.00|99|0.00|TOXOIDS VACCINES|
20|FH_F131653_50314_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82753_18840_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148264_30434_0|CSTM-ALL|CSTM-00|2020|PDM|1288.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100790_10512_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F141517_73034_0|SrvcGrp|73842|2022|PDM|181.38|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD NU|
20|FH_F39531_0_0|SrvcGrp|6|2022|PCT|0.85|99|0.00|OP SURGERY|
20|FH_F117784_0_0|SrvcGrp|106314|2022|PDM|370.45|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F129968_98004_0|SrvcGrp|73842|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F94402_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129115_85716_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141407_76226_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F145534_02155_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F125746_45331_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F62601_0_0|SrvcGrp|48385|2022|PDM|30.00|99|0.00|SPEECH THERAPY|
20|FH_F134434_30607_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F151155_26508_0|SrvcGrp|113347|2022|PDM|592.00|99|0.00|OFF BASE OPIOID TX 70 MIN (HCFA)|
20|FH_F121385_89102_0|CSTM-ALL|CSTM-00|2020|PDM|7299.00|99|0.00|AEG 8 (NO REV)|
20|FH_F121887_53144_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130066_84107_0|SrvcGrp|90070|2022|PDM|90.00|99|0.00|GROUP RX|
20|FH_F77923_0_0|SrvcGrp|46632|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F121225_98902_0|SrvcGrp|108755|2022|PCT|0.00|99|0.00|SPEECH THERAPY|
20|FH_F134218_20783_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122947_29532_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F81852_0_0|CSTM-ALL|CSTM-00|2020|PDM|1109.00|99|0.00|ASPG VI|
20|FH_F62352_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|2031.00|99|0.00|AEG 5  (NO REV)|
20|FH_F120484_31419_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F31714_0_0|SrvcGrp|11212|2022|PDM|9100.00|99|0.00|DRG 556 PERCUTANEUS CV PX W/NON DRUG ELUTING STENT W/O MC DX|
20|FH_F109400_80026_0|SrvcGrp|27969|2022|PDM|28.14|99|0.00|HOME HEALTH AIDE|
20|FH_F84132_48026_0|SrvcGrp|73008|2022|PDM|700.00|99|0.00|AEG 10|
20|FH_F126341_27284_0|SrvcGrp|82822|2022|PDM|10.00|99|0.00|INJECTION, IMMUNE GLOBULIN (HIZENTRA)|
20|FH_F149246_95603_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F133749_84604_0|SrvcGrp|112451|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY (HCFA)|
20|FH_F67581_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115616_0_0|SrvcGrp|88030|2022|PDM|5930.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F83995_16748_0|SrvcGrp|3388|2022|PDM|686.00|99|0.00|SUBACUTE CARE|
20|FH_F120555_68405_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F100782_0_0|SrvcGrp|97672|2022|PDM|2227.46|99|0.00|WINDBER MEDICAL CNTR ASC 701|
20|FH_F41594_0_0|SrvcGrp|10431|2022|PDM|78.00|99|0.00|SPEECH THERAPY|
20|FH_F139658_02893_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F93122_01854_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AETNA ABH IP OBSERVATION (<18 YRS)|
20|FH_F127282_98004_0|SrvcGrp|100159|2022|PDM|1311.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F138107_15201_0|SrvcGrp|89149|2022|PDM|210.00|99|0.00|OP INTENSIVE|
20|FH_F83995_16748_0|SrvcGrp|3178|2022|PDM|827.00|99|0.00|ACUTE PSYCH|
20|FH_F111031_30252_0|SrvcGrp|3809|2022|PDM|595.95|99|0.00|HOSPICE CARE|
20|FH_F128379_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F79743_0_0|SrvcGrp|19973|2022|PCT|0.57|99|0.00|CAT SCAN|
20|FH_F132883_31602_0|SrvcGrp|10577|2022|PDM|20.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F127071_82435_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F149320_82609_0|SrvcGrp|82981|2022|PDM|170.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F146005_67037_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132969_84003_0|SrvcGrp|14947|2022|PDM|3.00|99|0.00|HOME INFUSION|
20|FH_F118042_33401_0|SrvcGrp|107574|2022|PCT|1.10|99|0.00|AETNA OUTPATIENT THERAPY|
20|FH_F50013_0_0|SrvcGrp|16|2022|PDM|1212.00|99|0.00|ACUTE REHABILITATION|
20|FH_F138302_15701_0|SrvcGrp|26869|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F112023_12866_0|SrvcGrp|75505|2022|PCT|0.62|99|0.00|CARDIAC STUDIES|
20|FH_F80172_0_0|SrvcGrp|77511|2022|PDM|67.93|99|0.00|HOME INFUSION THERAPY|
20|FH_F146064_17331_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F124369_0_0|SrvcGrp|109792|2022|PDM|9350.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F122941_62702_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124173_66215_0|SrvcGrp|27968|2022|PDM|37.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133887_17013_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146124_06112_0|SrvcGrp|114465|2022|PDM|236.39|99|0.00|PT/OT/ST|
20|FH_F49552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1202.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F109266_33319_0|SrvcGrp|86749|2022|PCT|1.25|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F120603_66112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119379_0_0|SrvcGrp|69981|2022|PDM|1428.00|99|0.00|CPT 24358|
20|FH_F133869_19947_0|SrvcGrp|112138|2022|PCT|1.03|99|0.00|TELEMEDICINE SERVICES|
20|FH_F121225_98902_0|SrvcGrp|29075|2022|PDM|105.00|99|0.00|HYDRATION THERAPY|
20|FH_F119575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134608_18017_0|SrvcGrp|103516|2022|PDM|100.00|99|0.00|INSERT INTRAUTERINE DEVICE|
20|FH_F133749_84604_0|SrvcGrp|112468|2022|PDM|630.00|99|0.00|HOSPICE ROUT HOME CARE-DIEM|
20|FH_F37667_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F100782_0_0|SrvcGrp|105168|2022|PDM|2500.15|99|0.00|WINDBER MEDICAL CNTR ASC 908|
20|FH_F72543_0_0|SrvcGrp|26001|2022|PDM|150.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F84672_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.70|99|0.00|HAPA WPA-NWPA 2012-13 ASC 222 W/O REV|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 111 W/O REV|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|82.53|99|0.00|HAPA WPA-NWPA 2012-13 ASC 244 W/O REV|
20|FH_F98800_85021_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F101100_50314_0|SrvcGrp|97921|2022|PDM|3331.00|99|0.00|MYOMECTOMY ABDOM METHOD|
20|FH_F105145_75075_0|SrvcGrp|74581|2022|PCT|1.15|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F105361_80104_0|SrvcGrp|43924|2022|PDM|391.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F77665_0_0|SrvcGrp|10623|2022|PDM|15.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F80513_0_0|SrvcGrp|29294|2022|PDM|947.00|99|0.00|ACUTE REHAB|
20|FH_F146479_20782_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146466_21620_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120522_53549_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F127656_06068_0|SrvcGrp|46104|2022|PDM|115.50|99|0.00|HOME VISIT - PRENATAL|
20|FH_F131628_26505_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F131976_74571_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133583_77074_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F148866_84123_0|SrvcGrp|472|2022|PDM|377.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F151062_17584_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151154_91761_0|SrvcGrp|29346|2022|PDM|55.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F97740_01605_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F106822_0_0|SrvcGrp|100288|2022|PDM|45.00|99|0.00|NEW PATIENT OFF/OP VISIT (HCFA)|
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|SrvcGrp|72996|2022|PDM|630.00|99|0.00|AEG 4|
20|FH_F111840_0_0|SrvcGrp|75479|2022|PDM|333.00|99|0.00|AEG 1|
20|FH_F73231_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|HOME INFUSION REV CODE 640/MOD SH|
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|768.00|99|0.00|AEG 10 (NO REV)|
20|FH_F142448_15701_0|SrvcGrp|73700|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F115489_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|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_F112967_0_0|SrvcGrp|93098|2022|PDM|115.00|99|0.00|HOSPICE CARE|
20|FH_F117623_0_0|CSTM-ALL|CSTM-00|2020|PDM|27.00|99|0.00|OBSERV BEHAVIORAL ASSESSMENT 1ST 30 MINS (HCFA)|
20|FH_F119784_0_0|SrvcGrp|102420|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F141207_0_0|SrvcGrp|93098|2022|PDM|205.00|99|0.00|HOSPICE CARE|
20|FH_F116485_17033_0|SrvcGrp|110057|2022|PDM|30.55|99|0.00|BEHAVIOR ID ASSESSMENT 15 MINS|
20|FH_F131047_0_0|CSTM-ALL|CSTM-00|2020|PDM|5699.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F132988_0_0|SrvcGrp|92359|2022|PDM|2057.62|99|0.00|REMOVAL OF TAIL BONE|
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|1024.00|99|0.00|AEG 4 (NO REV)|
20|FH_F47694_0_0|SrvcGrp|23587|2022|PDM|1295.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F50415_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 949|
20|FH_F40333_0_0|SrvcGrp|12235|2022|PDM|1450.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PDM|1362.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F124188_29621_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|GENERAL ACUTE CARE|
20|FH_F124212_33407_0|SrvcGrp|75419|2022|PDM|420.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F124613_64735_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F124687_64024_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F127995_84010_0|SrvcGrp|110927|2022|PDM|545.00|99|0.00|IP HOSPICE RESPITE CARE (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_F132890_87544_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100787_69162_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F114666_30342_0|SrvcGrp|26277|2022|PDM|1500.00|99|0.00|CPT 29874|
20|FH_F113845_32746_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F138310_60461_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F114985_32073_0|SrvcGrp|104795|2022|PDM|15.00|99|0.00|PSYTX COMPLEX INTERACTIVE|
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148424_01440_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F122610_73139_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122727_64030_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F43249_0_0|SrvcGrp|3069|2022|PCT|0.54|99|0.00|IMPLANTS|
20|FH_F134770_14420_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F136778_62034_0|SrvcGrp|73462|2022|PDM|1933.00|99|0.00|AETNA NICU III|
20|FH_F136831_78728_0|SrvcGrp|73841|2022|PDM|420.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F136831_78728_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136914_64081_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F112371_19047_0|CSTM-ALL|CSTM-00|2020|PDM|1552.00|99|0.00|AEG 3 (NO REV)|
20|FH_F112378_60505_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F112505_51503_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F113713_17013_0|SrvcGrp|105376|2022|PDM|7.06|99|0.00|SKILLS TRAINING DEVELOPMENT - 15 MIN|
20|FH_F42169_0_0|SrvcGrp|177|2022|PDM|1100.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F62922_0_0|SrvcGrp|13778|2022|PDM|850.00|99|0.00|PSYCH/CD|
20|FH_F115206_80923_0|SrvcGrp|86723|2022|PDM|463.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F115263_47129_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116233_33612_0|SrvcGrp|58509|2022|PDM|364.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F147701_31093_0|CSTM-ALL|CSTM-00|2020|PDM|4761.00|99|0.00|AEG 5  (NO REV)|
20|FH_F147541_44805_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41463_0_0|SrvcGrp|34358|2022|PDM|126.00|99|0.00|NURSING CARE MOD TG|
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_F42342_0_0|SrvcGrp|12401|2022|PDM|105.00|99|0.00|RN VISIT|
20|FH_F100161_17325_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F54552_0_0|SrvcGrp|21920|2022|PDM|70.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F113585_20155_0|SrvcGrp|23681|2022|PCT|1.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F138907_01040_0|SrvcGrp|23683|2022|PDM|52.93|99|0.00|SKILLED NURSING RN|
20|FH_F138992_72703_0|CSTM-ALL|CSTM-00|2020|PDM|2295.00|99|0.00|AEG 5  (NO REV)|
20|FH_F113390_0_0|SrvcGrp|105236|2022|PDM|1673.10|99|0.00|LARYNGOSCOPY|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|392.98|99|0.00|HAPA WPA-NWPA 2012-13 ASC 108 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|124.63|99|0.00|HAPA WPA-NWPA 2012-13 ASC 140 W/O REV|
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151427_04106_0|SrvcGrp|100865|2022|PDM|139.03|99|0.00|CHEMOTHERAPY ADMINISTRATION|
20|FH_F132258_45404_0|SrvcGrp|86852|2022|PDM|34.98|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F145408_43920_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135453_70726_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135583_17331_0|SrvcGrp|86729|2022|PDM|19.38|99|0.00|COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE|
20|FH_F91764_93710_0|SrvcGrp|115618|2022|PCT|0.42|99|0.00|NEURORECEIVER 23 IMPLANT|
20|FH_F136174_89146_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F130620_18940_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F118647_21811_0|SrvcGrp|472|2022|PDM|549.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F103400_33426_0|SrvcGrp|46903|2022|PDM|737.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132785_17961_0|SrvcGrp|12491|2022|PCT|0.11|99|0.00|PACEMAKER|
20|FH_F57592_0_0|SrvcGrp|28623|2022|PCT|0.50|99|0.00|HIGH COST DRUGS|
20|FH_F150906_0_0|SrvcGrp|115868|2022|PDM|50.00|99|0.00|HOSPICE  HOME CARE|
20|FH_F125352_90034_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F35454_0_0|SrvcGrp|65739|2022|PDM|65.00|99|0.00|E&M SERVICES|
20|FH_F48475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71145_0_0|SrvcGrp|44242|2022|PDM|375.00|99|0.00|HEMO/HOME DIALYSIS SVCS|
20|FH_F101754_63141_0|SrvcGrp|97973|2022|PDM|20.82|99|0.00|TYMPANOMETRY & REFLEX THRESH|
20|FH_F133530_11237_0|CSTM-ALL|CSTM-00|2020|PDM|2920.00|99|0.00|AEG 9 (NO REV)|
20|FH_F143168_60563_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148644_06890_0|SrvcGrp|68000|2022|PDM|4635.00|99|0.00|CPT 58561|
20|FH_F139707_84010_0|SrvcGrp|63667|2022|PCT|0.45|99|0.00|OP ORPHAN DRUGS|
20|FH_F139707_84010_0|SrvcGrp|116278|2022|PDM|8058.00|99|0.00|NEUROSTIMULATOR|
20|FH_F150760_44833_0|SrvcGrp|46605|2022|PDM|150.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F143668_0_0|SrvcGrp|114070|2022|PDM|110.00|99|0.00|SEGMENTAL PNEUMATIC (MOD NU)|
20|FH_F150982_0_0|SrvcGrp|63466|2022|PDM|1652.00|99|0.00|CPT 52005|
20|FH_F147418_0_0|SrvcGrp|115019|2022|PDM|5500.00|99|0.00|PERQ NJX ALGC FLUOR LMBR 1ST|
20|FH_F39756_0_0|SrvcGrp|31079|2022|PDM|220.00|99|0.00|DENTAL PROCEDURES - CHILD|
20|FH_F98360_11554_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F76222_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F97100_23462_0|SrvcGrp|73605|2022|PDM|1711.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F120332_0_0|SrvcGrp|48396|2022|PDM|75.00|99|0.00|OT SERVICES|
20|FH_F138410_19130_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F34777_0_0|SrvcGrp|2045|2022|PDM|17500.00|99|0.00|ANEURYSM REPAIR|
20|FH_F117711_73080_0|SrvcGrp|73006|2022|PDM|2310.00|99|0.00|AEG 9|
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84433_0_0|SrvcGrp|52803|2022|PDM|93.36|99|0.00|OT SVCS INITIAL EVAL 97003 VISIT LEVEL|
20|FH_F97100_23462_0|SrvcGrp|73656|2022|PDM|404.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F110729_15068_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F47212_0_0|SrvcGrp|71161|2022|PDM|45.00|99|0.00|HOME CARE|
20|FH_F99523_80016_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F97183_25304_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F134919_02155_0|SrvcGrp|48396|2022|PDM|102.50|99|0.00|OT SERVICES|
20|FH_F119376_0_0|SrvcGrp|108117|2022|PDM|1698.78|99|0.00|AV FUSION / FOREARM VEIN|
20|FH_F147418_0_0|SrvcGrp|115020|2022|PDM|7000.00|99|0.00|ORTHO|
20|FH_F71468_0_0|SrvcGrp|10542|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F98001_27603_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F109221_15084_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100663_56537_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F112128_63017_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F69123_0_0|SrvcGrp|42976|2022|PDM|80.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F97623_38008_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F142370_0_0|SrvcGrp|73659|2022|PDM|1265.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PDM|1036.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F36554_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|ASPG III|
20|FH_F37487_0_0|SrvcGrp|3259|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION|
20|FH_F114207_35243_0|SrvcGrp|24761|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY|
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_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|634.00|99|0.00|AEG 10 (NO REV)|
20|FH_F137797_70123_0|SrvcGrp|66265|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F137730_46563_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F97420_75052_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.40|99|0.00|SALLY BALIN,999182,ASC 110|
20|FH_F110193_70444_0|SrvcGrp|89417|2022|PDM|379.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F146266_0_0|SrvcGrp|90343|2022|PDM|9720.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL|
20|FH_F132254_40207_0|SrvcGrp|29075|2022|PDM|45.00|99|0.00|HYDRATION THERAPY|
20|FH_F151029_52241_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F37364_0_0|SrvcGrp|941|2022|PDM|2700.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F133677_15601_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F41808_0_0|SrvcGrp|26001|2022|PDM|139.76|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F138410_19130_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110727_34994_0|SrvcGrp|89149|2022|PDM|217.00|99|0.00|OP INTENSIVE|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|464.86|99|0.00|SALLY BALIN,999182,ASC 205|
20|FH_F141267_0_0|SrvcGrp|103899|2022|PDM|172.00|99|0.00|HOSPICE OR HOME HLTH IN HOME|
20|FH_F139824_24801_0|SrvcGrp|112064|2022|PCT|0.95|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F132033_60134_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F38475_0_0|SrvcGrp|11798|2022|PDM|112.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F99380_90503_0|SrvcGrp|12834|2022|PCT|0.76|99|0.00|EMERGENCY ROOM|
20|FH_F148859_0_0|SrvcGrp|115536|2022|PDM|6462.00|99|0.00|BLADDER PROCEDURES|
20|FH_F132732_0_0|SrvcGrp|107733|2022|PDM|6648.00|99|0.00|CESAREAN SECTION|
20|FH_F137788_72632_0|SrvcGrp|109057|2022|PCT|0.90|99|0.00|CARDIAC STUDIES|
20|FH_F137767_01841_0|SrvcGrp|82037|2022|PDM|4410.00|99|0.00|AETNA ICU|
20|FH_F36743_0_0|SrvcGrp|3037|2022|PDM|6115.00|99|0.00|LITHOTRIPSY|
20|FH_F149459_06615_0|SrvcGrp|66265|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F124322_64131_0|SrvcGrp|53987|2022|PDM|50.00|99|0.00|PHOTOTHERAPY|
20|FH_F116404_20191_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F130766_04967_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F121407_73701_0|SrvcGrp|73602|2022|PDM|869.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F35357_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|416.00|99|0.00|AEG 1 (NO REV)|
20|FH_F72586_0_0|SrvcGrp|10431|2022|PDM|47.00|99|0.00|SPEECH THERAPY|
20|FH_F111292_33136_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111292_33136_0|SrvcGrp|78687|2022|PDM|205.00|99|0.00|AETNA DUAL ENERGY X-RAY ABSORBTION|
20|FH_F111301_33122_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F141651_0_0|SrvcGrp|78098|2022|PDM|2420.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F89360_0_0|SrvcGrp|78523|2022|PCT|1.20|99|0.00|LAB|
20|FH_F145587_0_0|SrvcGrp|26432|2022|PDM|1262.70|99|0.00|OP SURGICAL SERVICES|
20|FH_F33390_0_0|SrvcGrp|16|2022|PDM|1064.00|99|0.00|ACUTE REHABILITATION|
20|FH_F150619_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|459.00|99|0.00|ASPG X|
20|FH_F87501_32055_0|SrvcGrp|3327|2022|PDM|153.80|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F96280_06340_0|SrvcGrp|89149|2022|PDM|220.00|99|0.00|OP INTENSIVE|
20|FH_F129220_18445_0|SrvcGrp|110057|2022|PDM|16.26|99|0.00|BEHAVIOR ID ASSESSMENT 15 MINS|
20|FH_F98300_30236_0|SrvcGrp|86582|2022|PDM|4535.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F118845_71111_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38289_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39266_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F43156_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F140007_0_0|SrvcGrp|96353|2022|PDM|8045.00|99|0.00|RECONSTRUCT ANKLE JOINT|
20|FH_F118446_0_0|SrvcGrp|29155|2022|PDM|150.00|99|0.00|HOSPICE SVCS|
20|FH_F106980_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F122642_72212_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|850.00|99|0.00|AEG 10 (NO REV)|
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 4 (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_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|662.00|99|0.00|AEG 5  (NO REV)|
20|FH_F115488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46832_0_0|SrvcGrp|29077|2022|PDM|150.00|99|0.00|HOME TRANSFUSION|
20|FH_F123783_03860_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123661_30060_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F58856_0_0|SrvcGrp|28163|2022|PDM|45000.00|99|0.00|MS DRG 222 ONLY|
20|FH_F136347_30328_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F118178_37909_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F118244_30040_0|SrvcGrp|92501|2022|PDM|141.47|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F93292_62234_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137147_75006_0|CSTM-ALL|CSTM-00|2020|PDM|4515.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137147_75006_0|SrvcGrp|98265|2022|PDM|10710.00|99|0.00|SURGICAL PREPARATION OR CREA|
20|FH_F142320_07747_0|SrvcGrp|74668|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F142530_60148_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F142690_31774_0|SrvcGrp|53987|2022|PDM|60.00|99|0.00|PHOTOTHERAPY|
20|FH_F53732_0_0|SrvcGrp|24747|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F97601_67218_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F137951_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F119023_91406_0|SrvcGrp|86835|2022|PDM|12.50|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F119067_94080_0|SrvcGrp|48396|2022|PDM|120.00|99|0.00|OT SERVICES|
20|FH_F119067_94080_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F117371_77059_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F117301_01887_0|SrvcGrp|17574|2022|PDM|300.00|99|0.00|BEHAVIORAL HEALTH INTENSIVE OUTPT|
20|FH_F147941_06023_0|SrvcGrp|106289|2022|PDM|18.36|99|0.00|GROUND MILEAGE|
20|FH_F129483_77030_0|SrvcGrp|43568|2022|PDM|70.00|99|0.00|SKILLED NURSING - RN|
20|FH_F137850_32826_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124754_84403_0|SrvcGrp|87317|2022|PDM|1028.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F56274_0_0|SrvcGrp|14892|2022|PDM|155.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F77462_0_0|SrvcGrp|43955|2022|PDM|100.00|99|0.00|NURSING CARE|
20|FH_F111594_0_0|SrvcGrp|77021|2022|PDM|7215.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2346.00|99|0.00|AEG 6 (NO REV)|
20|FH_F119245_19010_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F148554_85016_0|SrvcGrp|115445|2022|PDM|1317.00|99|0.00|INSERT PACING LEAD & CONNECT|
20|FH_F44350_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F97140_91730_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F113131_19013_0|SrvcGrp|86722|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F67683_0_0|SrvcGrp|14165|2022|PDM|300.00|99|0.00|PARTIAL HOSP PSYCH/CD|
20|FH_F91634_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F123373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1711.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117087_0_0|SrvcGrp|107187|2022|PDM|1596.00|99|0.00|REVISE TWO EYE MUSCLES|
20|FH_F71145_0_0|SrvcGrp|44245|2022|PDM|145.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F133009_19038_0|SrvcGrp|88621|2022|PDM|107.00|99|0.00|SKILLED NURSING LPN|
20|FH_F139825_0_0|SrvcGrp|106235|2022|PDM|6885.00|99|0.00|CYPASS|
20|FH_F128657_19008_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F50974_0_0|SrvcGrp|22954|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F135714_01922_0|SrvcGrp|104226|2022|PDM|145.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F132289_89145_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F69123_0_0|SrvcGrp|29345|2022|PDM|35.00|99|0.00|SKILLED NURSING - LPN - MOD TE|
20|FH_F38394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F142994_54313_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F141411_0_0|SrvcGrp|104950|2022|PDM|12500.00|99|0.00|REMOVAL OF IMPLANT MATERIAL|
20|FH_F101840_76054_0|SrvcGrp|97475|2022|PDM|6956.00|99|0.00|REPAIR SHOULDER CAPSULE|
20|FH_F145988_06105_0|SrvcGrp|10363|2022|PDM|3252.00|99|0.00|CPT CODE 99283|
20|FH_F133287_40215_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 1 (NO REV)|
20|FH_F118819_76226_0|SrvcGrp|89417|2022|PDM|530.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F117807_86426_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F93275_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F126819_43701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133380_46254_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F114519_0_0|SrvcGrp|72994|2022|PDM|1241.00|99|0.00|AEG 3|
20|FH_F100784_59923_0|SrvcGrp|73659|2022|PDM|7457.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F141870_85224_0|SrvcGrp|86844|2022|PDM|50.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 2 (NO REV)|
20|FH_F101840_76054_0|SrvcGrp|97492|2022|PDM|1321.00|99|0.00|EGD ENDOSCOPIC STENT PLACE|
20|FH_F132543_79549_0|SrvcGrp|103913|2022|PCT|1.25|99|0.00|OP DIALYSIS|
20|FH_F101840_76054_0|SrvcGrp|72992|2022|PDM|1280.00|99|0.00|AEG 2|
20|FH_F117901_27526_0|SrvcGrp|76501|2022|PDM|365.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F36207_0_0|SrvcGrp|20870|2022|PDM|275.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) PARAMEDIC INTERCEPT|
20|FH_F45977_0_0|SrvcGrp|41104|2022|PDM|40.00|99|0.00|NURSING CARE|
20|FH_F133018_84037_0|SrvcGrp|88620|2022|PDM|85.50|99|0.00|SKILLED NURSING RN|
20|FH_F80592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F92677_08003_0|SrvcGrp|86835|2022|PDM|15.75|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F128316_22192_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F117821_90049_0|SrvcGrp|105819|2022|PDM|1300.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F146257_83713_0|SrvcGrp|114559|2022|PDM|3.29|99|0.00|NALTREXONE DEPOT FORM|
20|FH_F128421_27016_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149781_37404_0|CSTM-ALL|CSTM-00|2020|PDM|4235.00|99|0.00|AEG 9 (NO REV)|
20|FH_F142011_02859_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F83031_0_0|CSTM-ALL|CSTM-00|2020|PDM|52.50|99|0.00|HOME HEALTH MOD TD|
20|FH_F133367_40065_0|SrvcGrp|73659|2022|PDM|1843.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F41275_0_0|SrvcGrp|913|2022|PDM|325.00|99|0.00|ELECTROSHOCK TREATMENT|
20|FH_F80855_0_0|SrvcGrp|79101|2022|PDM|1660.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F97542_32960_0|SrvcGrp|73605|2022|PDM|1969.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F149880_33150_0|SrvcGrp|75419|2022|PDM|535.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F146217_0_0|SrvcGrp|104228|2022|PDM|178.66|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F127217_29650_0|SrvcGrp|89417|2022|PDM|440.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F88512_0_0|SrvcGrp|17081|2022|PDM|7093.84|99|0.00|ASPG IX|
20|FH_F119599_0_0|SrvcGrp|82981|2022|PDM|135.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F121016_32607_0|SrvcGrp|90860|2022|PDM|630.00|99|0.00|MATERNITY TRANSFER (MOD 53)|
20|FH_F149883_43920_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146218_50009_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115289_90057_0|SrvcGrp|86723|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F128438_87410_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47433_0_0|SrvcGrp|24006|2022|PCT|1.00|99|0.00|MRI CT SCANS|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER QW|
20|FH_F130108_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION|
20|FH_F130108_0_0|SrvcGrp|15353|2022|PCT|0.60|99|0.00|OP TRAUMA ACTIVATION|
20|FH_F128120_76513_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F115330_34113_0|SrvcGrp|89337|2022|PDM|625.00|99|0.00|DETOXIFICATION|
20|FH_F97543_33542_0|SrvcGrp|73659|2022|PDM|10174.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F115274_15235_0|SrvcGrp|90707|2022|PDM|135.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F40599_0_0|SrvcGrp|58|2022|PDM|5150.00|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F147995_67037_0|SrvcGrp|105465|2022|PCT|1.00|99|0.00|AETNA THERAPIES|
20|FH_F123373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F146110_48433_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F67136_0_0|SrvcGrp|44564|2022|PDM|3371.00|99|0.00|NEWBORN NURSERY|
20|FH_F133142_19076_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|168.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 313 W/O REV|
20|FH_F144508_44107_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PDM|984.28|99|0.00|AEG 6 (NO REV)|
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|1243.00|99|0.00|AEG 3 (NO REV)|
20|FH_F138467_32216_0|SrvcGrp|108484|2022|PDM|1231.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139428_65270_0|SrvcGrp|48394|2022|PDM|30.90|99|0.00|SKILLED NURSING SERVICES|
20|FH_F139677_77087_0|SrvcGrp|90854|2022|PDM|650.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F139707_84010_0|CSTM-ALL|CSTM-00|2020|PDM|6796.00|99|0.00|AEG 6 (NO REV)|
20|FH_F139707_84010_0|SrvcGrp|114705|2022|PDM|3419.00|99|0.00|NEUROSTIMULATOR|
20|FH_F150739_44060_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150882_84041_0|SrvcGrp|86836|2022|PDM|17.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F37230_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F42426_0_0|SrvcGrp|109|2022|PDM|450.00|99|0.00|CD - DETOX|
20|FH_F66760_0_0|SrvcGrp|63456|2022|PDM|2000.00|99|0.00|GLOBAL FEE FACILITY FEE (EXCLUDING DELIVERY)|
20|FH_F36720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F39443_0_0|SrvcGrp|30324|2022|PDM|466.00|99|0.00|HAPA WPA ASC 208|
20|FH_F37493_0_0|SrvcGrp|413|2022|PCT|0.75|99|0.00|TRANSPLANT SVCS|
20|FH_F110732_31513_0|SrvcGrp|75505|2022|PCT|0.60|99|0.00|CARDIAC STUDIES|
20|FH_F117799_0_0|SrvcGrp|104852|2022|PDM|5305.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F137772_27320_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
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_F124316_28112_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F43081_0_0|CSTM-ALL|CSTM-00|2020|PDM|144.00|99|0.00|OP SVCS|
20|FH_F94643_90501_0|SrvcGrp|86843|2022|PDM|60.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F124322_64131_0|SrvcGrp|19742|2022|PDM|83.00|99|0.00|MID-LINE INSERTION|
20|FH_F124976_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F35750_0_0|SrvcGrp|11306|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F125081_15218_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 8 (NO REV)|
20|FH_F127418_0_0|SrvcGrp|98497|2022|PDM|26571.83|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F147181_27514_0|SrvcGrp|111928|2022|PCT|1.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F116806_0_0|SrvcGrp|107139|2022|PDM|776.99|99|0.00|PREPARE FACE/ORAL PROSTHESIS|
20|FH_F42941_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F132254_40207_0|SrvcGrp|86851|2022|PDM|50.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F126150_80202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|28800.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F117711_73080_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149648_89148_0|SrvcGrp|88621|2022|PDM|105.00|99|0.00|SKILLED NURSING LPN|
20|FH_F151029_52241_0|SrvcGrp|73485|2022|PDM|1575.00|99|0.00|AETNA REHAB|
20|FH_F139974_37214_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F43934_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F125656_92868_0|SrvcGrp|86840|2022|PDM|35.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F134396_80045_0|SrvcGrp|92760|2022|PCT|1.25|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113806_53083_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD RR KC"|
20|FH_F92154_74023_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148347_0_0|SrvcGrp|115376|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F124698_45380_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|736.00|99|0.00|ASPG IV|
20|FH_F37304_0_0|SrvcGrp|360|2022|PDM|1246.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|ASPG IV|
20|FH_F151202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148960_13045_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149376_34239_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|612.85|99|0.00|AEG 3 (NO REV)|
20|FH_F97101_98003_0|SrvcGrp|88977|2022|PDM|8408.00|99|0.00|C-SECTION DELIVERY|
20|FH_F111080_18103_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F139048_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F117615_30525_0|SrvcGrp|83824|2022|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES|
20|FH_F147316_70433_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F114585_11501_0|SrvcGrp|104077|2022|PCT|1.03|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F139576_0_0|SrvcGrp|73616|2022|PDM|2497.00|99|0.00|AETNA WRIST ENDOSCOPY|
20|FH_F39756_0_0|SrvcGrp|31085|2022|PDM|770.00|99|0.00|DENTAL PROCEDURES - CHILD|
20|FH_F131187_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F138540_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124492_30040_0|SrvcGrp|111926|2022|PDM|39.51|99|0.00|COVID-19 LAB TESTING|
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|1137.00|99|0.00|ASPG VIII|
20|FH_F137767_01841_0|SrvcGrp|73604|2022|PDM|1350.00|99|0.00|AETNA DETOXIFICATION|
20|FH_F97623_38008_0|SrvcGrp|73643|2022|PDM|2282.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F134847_0_0|SrvcGrp|92409|2022|PDM|4345.00|99|0.00|PERQ CERVICOTHORACIC INJECT|
20|FH_F137798_0_0|SrvcGrp|104229|2022|PDM|743.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F117645_90034_0|SrvcGrp|89417|2022|PDM|550.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F92454_0_0|SrvcGrp|79561|2022|PDM|1716.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F34319_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|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_F110783_93013_0|SrvcGrp|26868|2022|PDM|35.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F149648_89148_0|SrvcGrp|66265|2022|PDM|120.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F98860_96706_0|SrvcGrp|73559|2022|PDM|8964.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F148667_0_0|SrvcGrp|11673|2022|PDM|3115.00|99|0.00|CPT 29888|
20|FH_F150914_17350_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129237_72833_0|SrvcGrp|109057|2022|PCT|1.00|99|0.00|CARDIAC STUDIES|
20|FH_F109762_0_0|SrvcGrp|73006|2022|PDM|1339.00|99|0.00|AEG 9|
20|FH_F143850_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 6 (NO REV)|
20|FH_F140147_34785_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143488_84770_0|SrvcGrp|46906|2022|PDM|1886.00|99|0.00|CORNEAL TISSUE|
20|FH_F143529_84737_0|SrvcGrp|29347|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE|
20|FH_F114931_0_0|SrvcGrp|105754|2022|PDM|3200.00|99|0.00|RPR I/HERN INIT BLOCK >5 YR|
20|FH_F46893_0_0|SrvcGrp|31267|2022|PCT|0.65|99|0.00|LABORATORY|
20|FH_F132371_19083_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F97881_38703_0|SrvcGrp|73605|2022|PDM|1476.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F127636_06030_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F34918_0_0|CSTM-ALL|CSTM-00|2020|PDM|1547.00|99|0.00|ACUTE PSYCH|
20|FH_F129237_72833_0|SrvcGrp|103913|2022|PCT|1.00|99|0.00|OP DIALYSIS|
20|FH_F73803_0_0|CSTM-ALL|CSTM-00|2020|PDM|891.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F114825_32789_0|SrvcGrp|89417|2022|PDM|368.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F87711_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149582_01534_0|SrvcGrp|115592|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F140097_19145_0|SrvcGrp|86723|2022|PDM|370.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F140036_07702_0|SrvcGrp|90854|2022|PDM|888.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F143412_70503_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F143536_47546_0|SrvcGrp|100272|2022|PCT|1.00|99|0.00|IIV3 VACCINE SPLT 0.25 ML IM|
20|FH_F93740_0_0|SrvcGrp|91591|2022|PDM|6400.00|99|0.00|AORTOGRAPHY/ANGIOGRAPHY|
20|FH_F101806_0_0|SrvcGrp|24714|2022|PCT|1.05|99|0.00|INTRAOCULAR LENS|
20|FH_F115208_0_0|SrvcGrp|64725|2022|PDM|716.00|99|0.00|CPT 45378|
20|FH_F131173_17043_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F151752_63017_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120171_33770_0|SrvcGrp|58509|2022|PDM|345.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F136299_75218_0|SrvcGrp|73497|2022|PDM|2350.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F116684_30701_0|SrvcGrp|90479|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F116698_07470_0|SrvcGrp|86830|2022|PDM|57.75|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F116698_07470_0|SrvcGrp|14947|2022|PDM|57.75|99|0.00|HOME INFUSION|
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F83292_0_0|CSTM-ALL|CSTM-00|2020|PDM|1520.00|99|0.00|SKILLED NURSING|
20|FH_F120974_27607_0|CSTM-ALL|CSTM-00|2020|PDM|8977.00|99|0.00|AEG 5  (NO REV)|
20|FH_F118879_93063_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F143467_0_0|SrvcGrp|98469|2022|PDM|1424.00|99|0.00|AMPUTATION METATARSAL|
20|FH_F150200_0_0|SrvcGrp|88160|2022|PDM|4500.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F46354_0_0|SrvcGrp|3932|2022|PDM|3150.00|99|0.00|LITHOTRIPSY|
20|FH_F59732_0_0|SrvcGrp|17014|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F61292_0_0|SrvcGrp|20252|2022|PDM|37486.00|99|0.00|MS DRG 224-225 ONLY|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|ASPG IV|
20|FH_F148356_18104_0|SrvcGrp|46903|2022|PDM|650.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F129657_77479_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F105221_01757_0|SrvcGrp|48394|2022|PDM|36.75|99|0.00|SKILLED NURSING SERVICES|
20|FH_F35476_0_0|SrvcGrp|18127|2022|PDM|21714.00|99|0.00|MS DRG 242|
20|FH_F63535_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128992_90808_0|SrvcGrp|108484|2022|PDM|832.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F149888_68506_0|SrvcGrp|75282|2022|PDM|2008.00|99|0.00|DIAGNOSTIC HYSTEROSCOPY|
20|FH_F82753_18840_0|SrvcGrp|80521|2022|PDM|51274.00|99|0.00|RADIOLOGY|
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|1841.00|99|0.00|AEG 6 (NO REV)|
20|FH_F93881_15009_0|SrvcGrp|105480|2022|PCT|1.97|99|0.00|RADIOLOGY SERVICES|
20|FH_F123385_03561_0|SrvcGrp|88621|2022|PDM|121.00|99|0.00|SKILLED NURSING LPN|
20|FH_F122687_0_0|SrvcGrp|83641|2022|PDM|4371.00|99|0.00|CPT 29889|
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|633.00|99|0.00|AEG 1 (NO REV)|
20|FH_F105680_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F51120_0_0|SrvcGrp|22954|2022|PDM|157.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F77504_0_0|SrvcGrp|97|2022|PDM|3900.00|99|0.00|C-SECTION|
20|FH_F100660_56303_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_F38090_0_0|SrvcGrp|3066|2022|PCT|0.50|99|0.00|HIGH-COST DRUGS|
20|FH_F126678_44870_0|SrvcGrp|94780|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F32675_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91284_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F63182_0_0|SrvcGrp|12682|2022|PDM|448.00|99|0.00|GROUP THERAPY|
20|FH_F118194_50841_0|SrvcGrp|43568|2022|PDM|180.00|99|0.00|SKILLED NURSING - RN|
20|FH_F122687_0_0|SrvcGrp|58773|2022|PDM|2732.00|99|0.00|ARTHROSCOPY KNEE|
20|FH_F31798_0_0|SrvcGrp|115|2022|PCT|0.85|99|0.00|SKILLED NURSING CARE|
20|FH_F72664_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141802_17042_0|SrvcGrp|73806|2022|PCT|0.68|99|0.00|AETNA ER|
20|FH_F49653_0_0|SrvcGrp|35329|2022|PCT|0.54|99|0.00|RADIOLOGY|
20|FH_F83451_0_0|SrvcGrp|81561|2022|PDM|1250.00|99|0.00|REPAIR PARAVAGINAL DEFECT|
20|FH_F34735_0_0|SrvcGrp|11199|2022|PCT|0.75|99|0.00|HYPERBARIC CHAMBER|
20|FH_F127584_45219_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F111222_15701_0|SrvcGrp|471|2022|PDM|591.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F42312_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F32154_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151525_30349_0|SrvcGrp|113911|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F132779_0_0|SrvcGrp|29067|2022|PDM|2415.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F46359_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|SKILLED NURSING CARE|
20|FH_F118311_35211_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F109040_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122687_0_0|SrvcGrp|71666|2022|PDM|6753.00|99|0.00|CPT 63655|
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 5  (NO REV)|
20|FH_F38360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F148352_74637_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F130051_31707_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|649.00|99|0.00|AEG 4 (NO REV)|
20|FH_F41200_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ACUTE PSYCH|
20|FH_F116683_64730_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F116766_06460_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|2048.00|99|0.00|AEG 6 (NO REV)|
20|FH_F119921_83213_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119992_67062_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120895_19460_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120974_27607_0|CSTM-ALL|CSTM-00|2020|PDM|7514.00|99|0.00|AEG 4 (NO REV)|
20|FH_F120977_50510_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F50462_0_0|SrvcGrp|46692|2022|PDM|105.00|99|0.00|RN NURSING SERVICES|
20|FH_F130658_44484_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130895_07726_0|SrvcGrp|104186|2022|PDM|12.00|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F128278_21401_0|SrvcGrp|73841|2022|PDM|528.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F72102_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F85214_70360_0|SrvcGrp|73485|2022|PDM|945.00|99|0.00|AETNA REHAB|
20|FH_F114527_39047_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F130364_01331_0|SrvcGrp|107150|2022|PCT|2.00|99|0.00|CHEMOTHERAPY & ALL OTH DRG|
20|FH_F139446_87106_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119810_31525_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130017_02302_0|SrvcGrp|111447|2022|PDM|1169.78|99|0.00|CONDITION OF PREGNANCY|
20|FH_F85652_98034_0|SrvcGrp|13226|2022|PDM|741.00|99|0.00|CPT CODE 99282|
20|FH_F128825_45211_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F110425_01752_0|SrvcGrp|88621|2022|PDM|170.00|99|0.00|SKILLED NURSING LPN|
20|FH_F149219_01966_0|SrvcGrp|115401|2022|PCT|1.00|99|0.00|COVID-19 VACCINE COMBINATION - ELI LILLY|
20|FH_F149044_60463_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134593_60007_0|SrvcGrp|13929|2022|PDM|12.00|99|0.00|GROWTH HORMONE|
20|FH_F63241_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|OP SVCS|
20|FH_F120583_43219_0|SrvcGrp|53987|2022|PCT|1.00|99|0.00|PHOTOTHERAPY|
20|FH_F86101_76063_0|SrvcGrp|73700|2022|PDM|35.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F83754_0_0|SrvcGrp|13472|2022|PDM|6912.00|99|0.00|ICU/CCU|
20|FH_F127908_60640_0|SrvcGrp|108061|2022|PCT|1.40|99|0.00|OP THERAPY SERVICES|
20|FH_F127957_89521_0|SrvcGrp|23587|2022|PDM|650.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F144228_0_0|SrvcGrp|85198|2022|PDM|8072.00|99|0.00|AETNA KNEE ARTHROSCOPY|
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|2833.00|99|0.00|AEG 9 (NO REV)|
20|FH_F130763_0_0|SrvcGrp|82112|2022|PDM|3450.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F79863_0_0|SrvcGrp|77237|2022|PDM|90.00|99|0.00|AETNA HOME INFUSION S9345|
20|FH_F139512_77550_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134347_60630_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111349_0_0|SrvcGrp|471|2022|PDM|605.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146640_54155_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93190_26456_0|SrvcGrp|48396|2022|PDM|90.00|99|0.00|OT SERVICES|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|374.18|99|0.00|HAPA WPA-NWPA 2012-13 ASC 406 W/O REV|
20|FH_F145675_33761_0|SrvcGrp|88620|2022|PDM|90.00|99|0.00|SKILLED NURSING RN|
20|FH_F111681_62702_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F96721_99504_0|SrvcGrp|73605|2022|PDM|2103.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F119613_90035_0|SrvcGrp|87317|2022|PDM|970.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F150124_44107_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132147_33183_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F81698_10457_0|SrvcGrp|24761|2022|PDM|31.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F143573_01610_0|SrvcGrp|75545|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F127157_43614_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F90416_73013_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F146480_75042_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112631_0_0|SrvcGrp|72998|2022|PDM|817.00|99|0.00|AEG 5|
20|FH_F77943_0_0|SrvcGrp|26165|2022|PCT|0.70|99|0.00|HOME HEALTH SERVICES|
20|FH_F63398_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F138951_41101_0|SrvcGrp|26868|2022|PDM|40.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F42646_0_0|SrvcGrp|3418|2022|PDM|1000.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F139569_15063_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)|
20|FH_F111908_07677_0|SrvcGrp|75545|2022|PDM|390.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F110343_38139_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134174_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121700_60938_0|SrvcGrp|46903|2022|PDM|875.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F135626_20176_0|SrvcGrp|46903|2022|PDM|780.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F130017_02302_0|CSTM-ALL|CSTM-00|2020|PDM|3705.37|99|0.00|AEG 4 (NO REV)|
20|FH_F133788_74006_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124161_95932_0|SrvcGrp|103913|2022|PCT|1.56|99|0.00|OP DIALYSIS|
20|FH_F118088_71261_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145667_01905_0|SrvcGrp|82981|2022|PDM|148.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|77.40|99|0.00|HAPA WPA-NWPA 2012-13 ASC 145 W/O REV|
20|FH_F129509_0_0|SrvcGrp|73004|2022|PDM|1427.00|99|0.00|AEG 8|
20|FH_F134655_14221_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F52801_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119213_66209_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F87775_15106_0|SrvcGrp|14893|2022|PDM|35.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F149150_75407_0|SrvcGrp|58509|2022|PDM|411.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F150259_15668_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149159_53220_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145641_06902_0|SrvcGrp|107988|2022|PDM|3588.00|99|0.00|PARTIAL REMOVAL OF TOE|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|42.50|99|0.00|AETNA SLEEP STUDIES (MOD TC)|
20|FH_F132969_84003_0|SrvcGrp|86836|2022|PDM|10.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F114851_15301_0|SrvcGrp|42782|2022|PDM|54.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F139512_77550_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F113453_80020_0|SrvcGrp|75545|2022|PDM|309.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F132802_68022_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F148600_30328_0|SrvcGrp|78093|2022|PDM|3520.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F83754_0_0|SrvcGrp|8950|2022|PDM|5809.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)|
20|FH_F120583_43219_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145579_67226_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F112712_63005_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F32073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1516.00|99|0.00|TRAUMATIC BRAIN INJURY|
20|FH_F134431_92647_0|SrvcGrp|75419|2022|PDM|800.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F84712_0_0|SrvcGrp|81402|2022|PDM|86.00|99|0.00|METABOLIC PANEL|
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86836_0_0|SrvcGrp|105888|2022|PCT|0.65|99|0.00|WOUND CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|339.60|99|0.00|HAPA WPA-NWPA 2012-13 ASC 219 W/O REV|
20|FH_F70607_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F72768_0_0|SrvcGrp|43568|2022|PDM|75.00|99|0.00|SKILLED NURSING - RN|
20|FH_F79644_0_0|SrvcGrp|89732|2022|PDM|1235.00|99|0.00|ER SVCS|
20|FH_F105361_80104_0|SrvcGrp|14096|2022|PCT|0.78|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F80513_0_0|SrvcGrp|87306|2022|PDM|21718.00|99|0.00|MSDRG 269 ONLY|
20|FH_F127656_06068_0|SrvcGrp|63119|2022|PDM|15.72|99|0.00|BASIC HOME HOSPICE CARE|
20|FH_F40903_0_0|SrvcGrp|13595|2022|PDM|330.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F131675_71753_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131697_33444_0|SrvcGrp|86728|2022|PCT|1.20|99|0.00|RHOGAM INJECTION|
20|FH_F139289_0_0|SrvcGrp|82224|2022|PDM|58.52|99|0.00|HOSPICE CONT HOME CARE|
20|FH_F133478_40165_0|SrvcGrp|21104|2022|PDM|53468.00|99|0.00|MS DRG 220 ONLY|
20|FH_F133170_50501_0|SrvcGrp|86723|2022|PDM|260.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F111604_16505_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F47097_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F113154_70359_0|CSTM-ALL|CSTM-00|2020|PDM|895.00|99|0.00|AEG 3 (NO REV)|
20|FH_F113181_72202_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133579_0_0|SrvcGrp|88154|2022|PDM|2205.00|99|0.00|LASER TREATMENT OLD RETINA|
20|FH_F149679_0_0|SrvcGrp|84284|2022|PDM|248.94|99|0.00|AMBULANCE SVC NEONATAL EMERG TRANSPORT|
20|FH_F73768_0_0|SrvcGrp|71103|2022|PDM|6.00|99|0.00|HCPCS A4231|
20|FH_F100742_00616_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48133_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|SKILLED NURSING|
20|FH_F50672_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (HCFA)|
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|4489.00|99|0.00|ASPG IX - FH SW CUSTOM GROUPERS|
20|FH_F130479_67526_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F113410_0_0|SrvcGrp|105257|2022|PDM|1786.00|99|0.00|CORRECTION HALLUX VALGUS|
20|FH_F38526_0_0|SrvcGrp|1259|2022|PDM|2040.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F117010_10549_0|SrvcGrp|86749|2022|PCT|1.05|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F84911_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F136510_0_0|SrvcGrp|84123|2022|PDM|5480.00|99|0.00|INSERT ANT SEGMENT DRAIN EXT|
20|FH_F117784_0_0|SrvcGrp|13681|2022|PDM|134.93|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F73209_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F120349_38774_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F145800_22003_0|SrvcGrp|88621|2022|PDM|84.00|99|0.00|SKILLED NURSING LPN|
20|FH_F141591_92630_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112568_0_0|SrvcGrp|104837|2022|PDM|240.60|99|0.00|HOSPICE CARE|
20|FH_F127375_28621_0|SrvcGrp|74586|2022|PCT|0.70|99|0.00|AETNA OP HIGH COST DRUGS|
20|FH_F37937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109346_0_0|SrvcGrp|103605|2022|PCT|0.00|99|0.00|BIRTHING CENTER|
20|FH_F71070_0_0|SrvcGrp|68056|2022|PDM|1000.00|99|0.00|CPT 55700|
20|FH_F128902_53105_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F148265_06067_0|SrvcGrp|67072|2022|PDM|8311.00|99|0.00|CPT 22845|
20|FH_F63433_0_0|SrvcGrp|17079|2022|PDM|1290.17|99|0.00|ASPG VIII|
20|FH_F141468_75160_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145766_64491_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97540_32114_0|SrvcGrp|88977|2022|PDM|8013.00|99|0.00|C-SECTION DELIVERY|
20|FH_F123320_43558_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F148342_80621_0|SrvcGrp|109330|2022|PCT|1.03|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F143528_0_0|SrvcGrp|88597|2022|PDM|5250.00|99|0.00|INTERNAL FIX FOR FRACT/INSTA|
20|FH_F102302_0_0|SrvcGrp|73004|2022|PDM|1775.00|99|0.00|AEG 8|
20|FH_F129782_0_0|CSTM-ALL|CSTM-00|2020|PDM|455.00|99|0.00|AEG 1 (NO REV)|
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|976.00|99|0.00|AEG 7 (NO REV)|
20|FH_F78922_0_0|SrvcGrp|11853|2022|PCT|0.20|99|0.00|DRUGS|
20|FH_F139164_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 10 (NO REV)|
20|FH_F39992_0_0|SrvcGrp|12403|2022|PDM|26.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F130551_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143970_92656_0|SrvcGrp|75419|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F91876_0_0|SrvcGrp|65403|2022|PDM|2645.00|99|0.00|CPT 42830|
20|FH_F139515_0_0|SrvcGrp|96839|2022|PDM|14072.00|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F126900_61924_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120248_77008_0|SrvcGrp|89417|2022|PDM|375.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F88212_20151_0|SrvcGrp|48385|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F149866_07401_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116281_19013_0|SrvcGrp|106718|2022|PDM|515.00|99|0.00|INDUCED ABORTION BY DILATION AND CURETTAGE|
20|FH_F143814_18062_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F115050_77995_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F128012_64628_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F115669_07652_0|SrvcGrp|100499|2022|PDM|750.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F114916_30309_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|AEG 2 (NO REV)|
20|FH_F122536_0_0|SrvcGrp|14320|2022|PCT|0.80|99|0.00|OP IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F42999_0_0|SrvcGrp|36668|2022|PDM|170.00|99|0.00|ZOSTER (SHINGLES VACCINE)|
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG III|
20|FH_F135055_63016_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|PDM|1250.00|99|0.00|AEG 6 (NO REV)|
20|FH_F51358_0_0|SrvcGrp|44428|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY SVCS (VISIT LVL)|
20|FH_F113723_10457_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F78446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F40058_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139515_0_0|SrvcGrp|88494|2022|PDM|4917.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F130747_0_0|SrvcGrp|35670|2022|PDM|36414.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F39740_0_0|SrvcGrp|31038|2022|PDM|27096.00|99|0.00|MS DRG 233-234 ONLY|
20|FH_F97500_32025_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 1 (NO REV)|
20|FH_F93119_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_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|979.00|99|0.00|AEG 4 (NO REV)|
20|FH_F97104_53545_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F63182_0_0|CSTM-ALL|CSTM-00|2020|PDM|1038.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F130523_04605_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F144021_0_0|SrvcGrp|108043|2022|PDM|207.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F35344_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F94261_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|2016 BETTER HOME CARE AGENCY|
20|FH_F37077_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F118057_47906_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F40295_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|PHYSICIANS SERVICES (CMS 1500)|
20|FH_F93880_95476_0|SrvcGrp|73806|2022|PDM|1285.00|99|0.00|AETNA ER|
20|FH_F145537_02061_0|SrvcGrp|113928|2022|PDM|354.00|99|0.00|PARTIAL HOSPITAL (>=18 YRS)|
20|FH_F139551_0_0|SrvcGrp|72121|2022|PDM|3921.00|99|0.00|ARTHOSCOPY|
20|FH_F79645_0_0|SrvcGrp|47225|2022|PDM|85.00|99|0.00|OT RC434, CPT97003-97004|
20|FH_F40043_0_0|SrvcGrp|46385|2022|PCT|0.76|99|0.00|LAPAROSCOPY F/S|
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AEG 9 (NO REV)|
20|FH_F139515_0_0|SrvcGrp|58776|2022|PDM|8549.00|99|0.00|DISKECTOMY|
20|FH_F86752_0_0|SrvcGrp|75479|2022|PDM|443.00|99|0.00|AEG 1|
20|FH_F130157_84049_0|SrvcGrp|46903|2022|PDM|1300.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F120973_34653_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F31464_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F118249_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F112325_0_0|SrvcGrp|73656|2022|PDM|475.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F130138_02915_0|SrvcGrp|3142|2022|PDM|2812.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F89563_29407_0|SrvcGrp|89502|2022|PCT|1.00|99|0.00|NEUROMUSCULAR REEDUCATION|
20|FH_F131236_84041_0|SrvcGrp|93098|2022|PDM|93.00|99|0.00|HOSPICE CARE|
20|FH_F100761_02539_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F67101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F95021_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F118194_50841_0|SrvcGrp|22596|2022|PDM|285.00|99|0.00|HOSPICE CARE|
20|FH_F118194_50841_0|SrvcGrp|24745|2022|PDM|145.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F123282_03222_0|SrvcGrp|48396|2022|PDM|144.00|99|0.00|OT SERVICES|
20|FH_F151204_24073_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F121385_89102_0|SrvcGrp|111768|2022|PCT|2.07|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F114931_0_0|SrvcGrp|104115|2022|PDM|1850.00|99|0.00|DESTRUCTION, ANAL LESION(S)|
20|FH_F129130_92562_0|SrvcGrp|10365|2022|PDM|2841.53|99|0.00|CPT CODE 99285|
20|FH_F98040_89406_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F77983_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|ZERO ALLOWABLE - OUTPATIENT SERVICES|
20|FH_F97721_01053_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|1232.00|99|0.00|AEG 5  (NO REV)|
20|FH_F114916_30309_0|SrvcGrp|26430|2022|PDM|3750.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F113541_0_0|SrvcGrp|83839|2022|PDM|6662.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|889.00|99|0.00|AEG 2 (NO REV)|
20|FH_F129758_54405_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F138929_0_0|SrvcGrp|67066|2022|PDM|11000.00|99|0.00|CERVICAL SURGERY|
20|FH_F132627_0_0|SrvcGrp|24754|2022|PDM|43.86|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 4 (NO REV)|
20|FH_F141036_02347_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|COVID-19 INFUSION ADMINISTRATION - ELI LILLY (HCFA)|
20|FH_F77662_0_0|SrvcGrp|42869|2022|PDM|65.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F92212_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F124180_0_0|SrvcGrp|109742|2022|PDM|1900.00|99|0.00|LARYNGOSCOPY|
20|FH_F146882_84532_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F62624_0_0|SrvcGrp|43871|2022|PDM|650.00|99|0.00|NEWBORN NURSERY|
20|FH_F62624_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F129549_01238_0|SrvcGrp|94781|2022|PDM|177.45|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F124417_85364_0|SrvcGrp|109835|2022|PCT|0.50|99|0.00|AMBULATORY SURGERY SERVICES|
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 1 (NO REV)|
20|FH_F55694_0_0|SrvcGrp|16|2022|PDM|1064.00|99|0.00|ACUTE REHABILITATION|
20|FH_F71443_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|338.00|99|0.00|AEG 2 W/O FEMALE GENITAL SERVICE (NO REV)|
20|FH_F114666_30342_0|CSTM-ALL|CSTM-00|2020|PDM|1541.00|99|0.00|AEG 8 (NO REV)|
20|FH_F113785_35763_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138562_46703_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139027_18407_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F114985_32073_0|SrvcGrp|89269|2022|PDM|79.00|99|0.00|PSYTX PT/FAMILY 45 MINUTES|
20|FH_F114985_32073_0|SrvcGrp|104800|2022|PDM|372.00|99|0.00|ELECTROENCEPHALOGRAM|
20|FH_F148553_85016_0|SrvcGrp|108172|2022|PDM|2745.00|99|0.00|AETNA FEM/POPL REVASE W/ATHER|
20|FH_F122610_73139_0|SrvcGrp|73006|2022|PDM|11295.00|99|0.00|AEG 9|
20|FH_F42940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F43169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|MRI|
20|FH_F117026_17961_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136807_43220_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136927_45690_0|SrvcGrp|27968|2022|PDM|28.00|99|0.00|SKILLED NURSING LPN|
20|FH_F113713_17013_0|SrvcGrp|105371|2022|PDM|100.00|99|0.00|PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F38826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ACUTE PSYCH|
20|FH_F77234_0_0|SrvcGrp|17065|2022|PDM|1383.00|99|0.00|ASPG I|
20|FH_F115210_21043_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F115631_65201_0|CSTM-ALL|CSTM-00|2020|PDM|1153.00|99|0.00|AEG 10 (NO REV)|
20|FH_F116393_07002_0|SrvcGrp|89190|2022|PDM|44.80|99|0.00|X-RAY EXAM SACROILIAC JOINTS|
20|FH_F147348_19406_0|SrvcGrp|75419|2022|PDM|370.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F147539_68359_0|SrvcGrp|109057|2022|PCT|0.98|99|0.00|CARDIAC STUDIES|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|CHEMOTHERAPY - BOLUS (MOD SH)|
20|FH_F139916_0_0|SrvcGrp|46903|2022|PDM|649.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F98361_12065_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F114853_0_0|SrvcGrp|58993|2022|PDM|7215.00|99|0.00|DISKECTOMY|
20|FH_F39633_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138680_53005_0|SrvcGrp|89149|2022|PDM|205.00|99|0.00|OP INTENSIVE|
20|FH_F138681_39301_0|SrvcGrp|73841|2022|PDM|409.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138684_44484_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138876_25302_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F77933_0_0|SrvcGrp|21594|2022|PDM|374.00|99|0.00|SKILLED NURSING|
20|FH_F33067_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F91933_0_0|SrvcGrp|10391|2022|PDM|1300.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F113527_31023_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F151303_50703_0|CSTM-ALL|CSTM-00|2020|PDM|465.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F151501_30265_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132258_45404_0|SrvcGrp|86841|2022|PDM|80.56|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F122069_75935_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F135434_64424_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91735_92653_0|SrvcGrp|87394|2022|PDM|110.25|99|0.00|HCPCS G0152 (HCFA)|
20|FH_F136040_75080_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F136226_28638_0|SrvcGrp|57968|2022|PDM|41.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F119892_47586_0|SrvcGrp|46605|2022|PDM|90.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F130670_32204_0|SrvcGrp|90854|2022|PDM|624.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F130670_32204_0|SrvcGrp|89417|2022|PDM|364.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F131132_44077_0|SrvcGrp|64476|2022|PDM|2281.00|99|0.00|CPT CODE 74176|
20|FH_F127399_0_0|SrvcGrp|72992|2022|PDM|1873.00|99|0.00|AEG 2|
20|FH_F140629_0_0|SrvcGrp|103834|2022|PDM|1016.00|99|0.00|AETNA REMOVE BLADDER STONE|
20|FH_F121704_90405_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F146125_0_0|SrvcGrp|11673|2022|PDM|3150.00|99|0.00|CPT 29888|
20|FH_F32803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1461.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|SAOF OP SERVICES|
20|FH_F44113_0_0|SrvcGrp|12299|2022|PCT|0.60|99|0.00|PROSTHETICS/IMPLANTS/DEVICES|
20|FH_F65959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|OP SVCS|
20|FH_F134309_63125_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134322_98001_0|SrvcGrp|91737|2022|PCT|1.00|99|0.00|CEFOXITIN SODIUM 1G/12MX|
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|782.00|99|0.00|AEG 3 (NO REV)|
20|FH_F101442_0_0|SrvcGrp|98469|2022|PDM|1106.52|99|0.00|AMPUTATION METATARSAL|
20|FH_F118651_0_0|SrvcGrp|101525|2022|PDM|4959.71|99|0.00|MYOMECTOMY|
20|FH_F112082_30720_0|SrvcGrp|48396|2022|PDM|207.00|99|0.00|OT SERVICES|
20|FH_F88831_84123_0|SrvcGrp|83519|2022|PDM|90.00|99|0.00|HOSPICE CARE (ALL OTHER)|
20|FH_F130269_74107_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F101557_81004_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F143542_0_0|SrvcGrp|109763|2022|PDM|2869.00|99|0.00|TREAT EYELID LESION|
20|FH_F148079_06512_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151155_26508_0|SrvcGrp|113320|2022|PDM|271.00|99|0.00|MED ASSIST TX METH WK|
20|FH_F112844_0_0|SrvcGrp|65720|2022|PDM|115.00|99|0.00|RESPITE CARE|
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|344.00|99|0.00|AEG 1 (NO REV)|
20|FH_F37190_0_0|CSTM-ALL|CSTM-00|2020|PDM|54.00|99|0.00|OP SVCS|
20|FH_F37625_0_0|SrvcGrp|26886|2022|PDM|150.00|99|0.00|BLOOD TRANSFUSION SERVICES|
20|FH_F113726_61520_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116323_0_0|SrvcGrp|71666|2022|PDM|26766.00|99|0.00|CPT 63655|
20|FH_F72923_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112943_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F113143_0_0|SrvcGrp|72998|2022|PDM|753.00|99|0.00|AEG 5|
20|FH_F114916_30309_0|SrvcGrp|54943|2022|PDM|2500.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PDM|1535.00|99|0.00|AEG 8 (NO REV)|
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|4098.00|99|0.00|AEG 6 (NO REV)|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER 26|
20|FH_F135491_0_0|SrvcGrp|45583|2022|PDM|1980.00|99|0.00|CPT 65730|
20|FH_F138929_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F133002_0_0|SrvcGrp|46887|2022|PDM|1716.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F141070_64093_0|SrvcGrp|48394|2022|PDM|62.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F114389_50131_0|SrvcGrp|74147|2022|PDM|47.34|99|0.00|INFUSION S-CODE PER MONTH|
20|FH_F77944_0_0|SrvcGrp|34557|2022|PDM|1581.00|99|0.00|MS DRG 894-897 ONLY CHEM DEP|
20|FH_F109248_0_0|SrvcGrp|35669|2022|PDM|1791.00|99|0.00|CPT 63650|
20|FH_F50622_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|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_F122183_98146_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F122183_98146_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124059_64055_0|SrvcGrp|22593|2022|PDM|25.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F124059_64055_0|SrvcGrp|48396|2022|PDM|83.00|99|0.00|OT SERVICES|
20|FH_F146906_60445_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129549_01238_0|SrvcGrp|95660|2022|PDM|741.30|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F124593_07033_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|AETNA OP LABORATORY|
20|FH_F124671_64844_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F97083_90670_0|SrvcGrp|88977|2022|PDM|10460.00|99|0.00|C-SECTION DELIVERY|
20|FH_F64779_0_0|SrvcGrp|42828|2022|PDM|163.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F123620_0_0|SrvcGrp|106314|2022|PDM|624.00|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F128188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136568_92562_0|SrvcGrp|90854|2022|PDM|1250.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F136734_46410_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F114666_30342_0|SrvcGrp|67064|2022|PDM|2500.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F139306_08854_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138052_19462_0|SrvcGrp|89149|2022|PDM|221.00|99|0.00|OP INTENSIVE|
20|FH_F122610_73139_0|SrvcGrp|109152|2022|PCT|0.50|99|0.00|CARD CATH & INTRACARDIAC PROC - SPEC CODING|
20|FH_F43123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|CD SVCS (ADULT)|
20|FH_F136824_08034_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136930_73114_0|SrvcGrp|82523|2022|PCT|0.50|99|0.00|AETNA NUCLEAR MEDICINE|
20|FH_F136930_73114_0|SrvcGrp|91500|2022|PDM|275.00|99|0.00|ULTRASOUND|
20|FH_F116199_75042_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F147445_76844_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41749_0_0|SrvcGrp|3390|2022|PDM|275.00|99|0.00|CPT 90801|
20|FH_F42153_0_0|CSTM-ALL|CSTM-00|2020|PDM|1849.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133710_21811_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111603_19529_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F111604_16505_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F111604_16505_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F134828_30531_0|SrvcGrp|112657|2022|PDM|41.00|99|0.00|XRAY EXAM OF THORAX SPINE|
20|FH_F98361_12065_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82357_0_0|SrvcGrp|9228|2022|PDM|50.00|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F120612_23314_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F138992_72703_0|SrvcGrp|131|2022|PCT|0.41|99|0.00|PACEMAKER DEVICE|
20|FH_F88893_0_0|SrvcGrp|113481|2022|PDM|1210.00|99|0.00|LAPAROSCOPY|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|369.84|99|0.00|HAPA WPA-NWPA 2012-13 ASC 225 W/O REV|
20|FH_F91933_0_0|SrvcGrp|73559|2022|PDM|1500.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F151303_50703_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F151339_72758_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F151421_21244_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F151511_14094_0|SrvcGrp|81765|2022|PCT|1.00|99|0.00|AETNA OP RADIOLOGY (RAD)|
20|FH_F132258_45404_0|SrvcGrp|86854|2022|PDM|56.18|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F132258_45404_0|SrvcGrp|29077|2022|PDM|11.93|99|0.00|HOME TRANSFUSION|
20|FH_F132268_07060_0|SrvcGrp|104329|2022|PCT|0.95|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F122106_60035_0|SrvcGrp|86722|2022|PDM|201.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F135384_28714_0|SrvcGrp|92502|2022|PDM|699.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F119892_47586_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F116431_76104_0|SrvcGrp|72602|2022|PDM|656.00|99|0.00|ECT|
20|FH_F32522_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140629_0_0|SrvcGrp|113668|2022|PDM|2497.00|99|0.00|LYMPHATIC LAPAROSCOPY|
20|FH_F121823_46234_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F121824_92675_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F70104_0_0|SrvcGrp|10517|2022|PDM|7.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F135231_90265_0|SrvcGrp|73842|2022|PDM|625.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137347_26003_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F116327_75701_0|SrvcGrp|89417|2022|PDM|324.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F71633_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD AW|
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|INTENSIVE PSYCH SVCS|
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1724.00|99|0.00|AEG 7 (NO REV)|
20|FH_F97242_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|47.12|99|0.00|CPT 95805 (W/MOD 26)|
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121547_46805_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F129168_43050_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_F93119_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112708_0_0|SrvcGrp|76847|2022|PDM|2223.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F145538_34997_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.00|99|0.00|AEG 9 (NO REV)|
20|FH_F102302_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F120872_74120_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148892_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|S CODES MOD 53|
20|FH_F86518_20721_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F38677_0_0|SrvcGrp|29497|2022|PDM|300.00|99|0.00|ULTRAFILTRATION|
20|FH_F118086_66604_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F93880_95476_0|SrvcGrp|89939|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|5300.00|99|0.00|AEG 8 (NO REV)|
20|FH_F90874_0_0|SrvcGrp|106655|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F119660_0_0|SrvcGrp|80918|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F125323_43213_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F41776_0_0|SrvcGrp|9938|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F92276_32308_0|SrvcGrp|105571|2022|PDM|2478.00|99|0.00|PET SCAN|
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 4 (NO REV)|
20|FH_F127255_03104_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|102481|2022|PDM|3854.00|99|0.00|CPT 29898|
20|FH_F150982_0_0|SrvcGrp|88494|2022|PDM|4886.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F145544_93536_0|SrvcGrp|75419|2022|PDM|750.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F86712_60173_0|SrvcGrp|15850|2022|PDM|105.00|99|0.00|HOSPICE SVCS|
20|FH_F86872_15215_0|SrvcGrp|24752|2022|PDM|15.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F86872_15215_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F86872_15215_0|SrvcGrp|86833|2022|PDM|15.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F86917_61108_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89778_0_0|SrvcGrp|76604|2022|PDM|1900.99|99|0.00|CPT 25447|
20|FH_F88398_15601_0|SrvcGrp|27969|2022|PDM|17.98|99|0.00|HOME HEALTH AIDE|
20|FH_F88639_80204_0|SrvcGrp|73605|2022|PDM|1487.30|99|0.00|AETNA ACUTE PSYCH|
20|FH_F88115_0_0|SrvcGrp|22529|2022|PDM|199.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F32995_0_0|SrvcGrp|12212|2022|PDM|750.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)|
20|FH_F60252_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62579_0_0|SrvcGrp|26868|2022|PDM|80.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F130721_04769_0|SrvcGrp|109057|2022|PCT|0.89|99|0.00|CARDIAC STUDIES|
20|FH_F130765_34113_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F130901_68970_0|SrvcGrp|109029|2022|PCT|0.98|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F120930_0_0|SrvcGrp|96542|2022|PDM|2500.00|99|0.00|REPAIR OF LEG TENDON|
20|FH_F133749_84604_0|SrvcGrp|112424|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU KF"|
20|FH_F117300_0_0|SrvcGrp|88491|2022|PDM|7360.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|1186.00|99|0.00|AEG 8 (NO REV)|
20|FH_F133938_53143_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F85353_16407_0|SrvcGrp|63778|2022|PDM|1398.54|99|0.00|HAPA WPA-NWPA 2012-13 ASC 13|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|152.48|99|0.00|HAPA WPA-NWPA 2012-13 ASC 141 W/O REV|
20|FH_F119763_17402_0|SrvcGrp|471|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146039_89511_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F150199_62226_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F149148_15330_0|SrvcGrp|46605|2022|PDM|91.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|1721.30|99|0.00|AEG 2 (NO REV)|
20|FH_F117382_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F128379_0_0|SrvcGrp|67072|2022|PDM|7553.00|99|0.00|CPT 22845|
20|FH_F146579_99202_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F35966_0_0|SrvcGrp|16900|2022|PDM|325.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F149199_73005_0|CSTM-ALL|CSTM-00|2020|PDM|1714.00|99|0.00|AEG 6 (NO REV)|
20|FH_F119107_22601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F82591_0_0|SrvcGrp|75481|2022|PDM|1102.50|99|0.00|AEG 2|
20|FH_F125765_83617_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|GENERAL ACUTE CARE|
20|FH_F31595_0_0|SrvcGrp|10432|2022|PCT|0.93|99|0.00|TREATMENT ROOM|
20|FH_F36835_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F143650_0_0|SrvcGrp|42472|2022|PDM|2600.00|99|0.00|CPT 58670|
20|FH_F116806_0_0|SrvcGrp|107052|2022|PDM|1923.16|99|0.00|REPAIR CLEFT LIP|
20|FH_F117300_0_0|SrvcGrp|90343|2022|PDM|7360.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL|
20|FH_F118792_63379_0|SrvcGrp|73483|2022|PDM|514.00|99|0.00|AETNA SUBACUTE III|
20|FH_F118792_63379_0|SrvcGrp|112040|2022|PCT|0.00|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F35685_0_0|CSTM-ALL|CSTM-00|2020|PDM|7166.00|99|0.00|C-SECTION|
20|FH_F38476_0_0|SrvcGrp|22387|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F136429_0_0|SrvcGrp|82307|2022|PDM|700.00|99|0.00|COLORECTAL CANCER SCREENING|
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 5  (NO REV)|
20|FH_F100681_73104_0|SrvcGrp|73601|2022|PDM|5318.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F54612_07631_0|SrvcGrp|20162|2022|PDM|17871.00|99|0.00|BARIATRIC SERVICES|
20|FH_F70844_15317_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.40|99|0.00|AEG 1 (NO REV)|
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PDM|2896.00|99|0.00|AEG 7 (NO REV)|
20|FH_F86696_16063_0|SrvcGrp|92518|2022|PDM|75.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F86917_61108_0|SrvcGrp|9529|2022|PDM|525.00|99|0.00|HOSPICE SVCS|
20|FH_F43250_0_0|SrvcGrp|18932|2022|PDM|2100.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806|
20|FH_F88632_33950_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|OP SVCS|
20|FH_F139690_0_0|SrvcGrp|108153|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F105301_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F71923_0_0|SrvcGrp|12041|2022|PDM|212.18|99|0.00|DIALYSIS|
20|FH_F134150_01801_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F134156_32174_0|SrvcGrp|105442|2022|PCT|1.00|99|0.00|ABH OP TERANIAL MAGN|
20|FH_F137147_75006_0|SrvcGrp|80837|2022|PDM|36750.00|99|0.00|MSDRG 518 ONLY|
20|FH_F137246_66064_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F142654_73034_0|SrvcGrp|89417|2022|PDM|430.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F142737_77703_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F142741_03264_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F53732_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|PARENTERAL NUTRITION|
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|ASPG I|
20|FH_F104340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97600_46151_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138512_62236_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138542_40324_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138584_30912_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 5  (NO REV) W/O MANDIBULAR FRACTURE|
20|FH_F125053_0_0|SrvcGrp|79589|2022|PDM|1923.00|99|0.00|UPPER GI|
20|FH_F139267_30253_0|SrvcGrp|73559|2022|PDM|2200.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F140343_89052_0|SrvcGrp|86832|2022|PDM|3.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F140553_37205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140573_46517_0|SrvcGrp|74614|2022|PDM|160.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F140830_70056_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140844_48083_0|SrvcGrp|27969|2022|PDM|29.00|99|0.00|HOME HEALTH AIDE|
20|FH_F128270_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148908_10710_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F119090_91502_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F119018_47802_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F92634_08244_0|SrvcGrp|72984|2022|PCT|0.70|99|0.00|CHEMOTHERAPY|
20|FH_F109983_98607_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F52832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F147725_06002_0|SrvcGrp|27316|2022|PDM|2912.00|99|0.00|TONSILS & ADENOIDS (42820)|
20|FH_F129483_77030_0|SrvcGrp|86839|2022|PDM|40.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F137813_39232_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101945_0_0|SrvcGrp|98401|2022|PDM|2261.00|99|0.00|RIB CARTILAGE GRAFT|
20|FH_F137850_32826_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F104700_0_0|SrvcGrp|72998|2022|PDM|1245.00|99|0.00|AEG 5|
20|FH_F112526_0_0|SrvcGrp|89822|2022|PDM|105.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F51016_0_0|SrvcGrp|44131|2022|PDM|110.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F82199_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F111594_0_0|SrvcGrp|98496|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR ATLAS|
20|FH_F125176_20785_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F89851_83854_0|SrvcGrp|90356|2022|PCT|1.00|99|0.00|OP DIALYSIS|
20|FH_F142229_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.10|99|0.00|GENERAL ACUTE CARE|
20|FH_F86434_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F44607_0_0|SrvcGrp|38811|2022|PDM|3800.00|99|0.00|OP ARTHROSCOPY/LAMINATOMY|
20|FH_F117855_62246_0|SrvcGrp|48398|2022|PDM|61.00|99|0.00|PT SERVICES|
20|FH_F109882_36695_0|SrvcGrp|86746|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|103.42|99|0.00|DELAWARE VALLEY- ASC 221|
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_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|142.66|99|0.00|AETNA SLEEP STUDY|
20|FH_F63301_0_0|CSTM-ALL|CSTM-00|2020|PDM|135.00|99|0.00|PEDS ST SVCS (MOD TJ)|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2007 DME DBL MODIFIERS - UE/KC|
20|FH_F97061_85012_0|SrvcGrp|73659|2022|PDM|8032.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|1595.00|99|0.00|ASPG VII|
20|FH_F127325_0_0|SrvcGrp|72996|2022|PDM|602.00|99|0.00|AEG 4|
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_F149840_80002_0|SrvcGrp|94781|2022|PDM|144.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F150527_33844_0|SrvcGrp|115830|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F37641_0_0|SrvcGrp|64758|2022|PCT|0.80|99|0.00|HCPCS|
20|FH_F91262_77036_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F85353_16407_0|SrvcGrp|63885|2022|PDM|253.71|99|0.00|HAPA WPA-NWPA 2012-13 ASC 128|
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|707.47|99|0.00|AEG 3 (NO REV)|
20|FH_F133818_01027_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149319_07670_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F119227_01752_0|SrvcGrp|29023|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F85213_02840_0|SrvcGrp|103913|2022|PCT|1.03|99|0.00|OP DIALYSIS|
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AEG 9 (NO REV)|
20|FH_F133747_80634_0|SrvcGrp|89149|2022|PDM|165.00|99|0.00|OP INTENSIVE|
20|FH_F79743_0_0|SrvcGrp|63|2022|PDM|1429.00|99|0.00|SUBACUTE CARE|
20|FH_F145921_73139_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F109577_0_0|SrvcGrp|63297|2022|PDM|195.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F69604_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|OP SVCS|
20|FH_F93946_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F150165_06032_0|SrvcGrp|34606|2022|PDM|2854.00|99|0.00|CPT 29827|
20|FH_F150165_06032_0|SrvcGrp|27346|2022|PDM|2460.00|99|0.00|REPAIR BLADDER DEFECT|
20|FH_F150165_06032_0|CSTM-ALL|CSTM-00|2020|PDM|2254.00|99|0.00|AEG 4 (NO REV)|
20|FH_F143650_0_0|SrvcGrp|78285|2022|PDM|2600.00|99|0.00|CPT 58671|
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1042.00|99|0.00|AEG 8 (NO REV)|
20|FH_F84552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)|
20|FH_F79863_0_0|SrvcGrp|77245|2022|PDM|13.00|99|0.00|AETNA HIT ENTERAL BOLUS NURS|
20|FH_F85315_15217_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F149021_44514_0|CSTM-ALL|CSTM-00|2020|PDM|687.00|99|0.00|AEG 4 (NO REV)|
20|FH_F45212_0_0|CSTM-ALL|CSTM-00|2020|PDM|1727.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63114_0_0|SrvcGrp|48399|2022|PDM|30.00|99|0.00|SPEECH THERAPY|
20|FH_F87775_15106_0|SrvcGrp|86610|2022|PDM|6.00|99|0.00|ROUTINE VENIPUNCTURE|
20|FH_F132606_0_0|SrvcGrp|26278|2022|PDM|1305.00|99|0.00|CPT 29881|
20|FH_F93190_26456_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124369_0_0|SrvcGrp|102481|2022|PDM|12155.00|99|0.00|CPT 29898|
20|FH_F71550_0_0|SrvcGrp|17139|2022|PDM|573.00|99|0.00|HOSPICE CARE|
20|FH_F132883_31602_0|SrvcGrp|86830|2022|PDM|30.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F146461_75428_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111882_51560_0|SrvcGrp|91294|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F111942_92647_0|SrvcGrp|46605|2022|PDM|122.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F58396_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F133880_06488_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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143650_0_0|SrvcGrp|70749|2022|PDM|1800.00|99|0.00|CPT 29823|
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PDM|506.00|99|0.00|AEG 2 (NO REV)|
20|FH_F74024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135666_37601_0|SrvcGrp|48394|2022|PDM|34.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F130364_01331_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F91171_0_0|SrvcGrp|78093|2022|PDM|783.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F148600_30328_0|SrvcGrp|83646|2022|PDM|3520.00|99|0.00|CPT 31276|
20|FH_F83978_66739_0|SrvcGrp|79786|2022|PCT|1.00|99|0.00|SLEEP STUDIES|
20|FH_F119227_01752_0|SrvcGrp|86827|2022|PDM|65.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F83754_0_0|SrvcGrp|3029|2022|PDM|1247.00|99|0.00|NEWBORN NURSERY|
20|FH_F89219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|MT NITTANY ASC 10|
20|FH_F85353_16407_0|SrvcGrp|63871|2022|PDM|313.59|99|0.00|HAPA WPA-NWPA 2012-13 ASC 231|
20|FH_F132883_31602_0|SrvcGrp|26869|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F120930_0_0|SrvcGrp|82108|2022|PDM|2000.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F130763_0_0|SrvcGrp|77021|2022|PDM|7319.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F139169_0_0|SrvcGrp|35669|2022|PDM|5500.00|99|0.00|CPT 63650|
20|FH_F134650_07921_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F71103_0_0|SrvcGrp|42785|2022|PDM|90.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F122532_46385_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F129101_27006_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F129101_27006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F84712_0_0|SrvcGrp|82738|2022|PDM|13.00|99|0.00|NON-AUTOMATED WITHOUT MICRO|
20|FH_F84912_0_0|SrvcGrp|3405|2022|PDM|39.92|99|0.00|CPT 99212|
20|FH_F105143_26062_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F105143_26062_0|SrvcGrp|73605|2022|PDM|1216.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F105143_26062_0|SrvcGrp|72984|2022|PCT|2.50|99|0.00|CHEMOTHERAPY|
20|FH_F115893_08002_0|SrvcGrp|78180|2022|PDM|1000.00|99|0.00|AETNA RESIDENTIAL TREATMENT|
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1172.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F73967_0_0|SrvcGrp|42784|2022|PDM|68.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F146668_30189_0|SrvcGrp|70746|2022|PDM|4850.00|99|0.00|CPT 28292|
20|FH_F146668_30189_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 5  (NO REV)|
20|FH_F146716_46733_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F146782_19034_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F63124_0_0|SrvcGrp|45949|2022|PDM|145.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F66705_0_0|SrvcGrp|62539|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F133583_77074_0|SrvcGrp|94879|2022|PDM|152.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F133589_54722_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133667_83642_0|SrvcGrp|72602|2022|PDM|1000.00|99|0.00|ECT|
20|FH_F133219_89119_0|SrvcGrp|66265|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F131212_63017_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F131318_53211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F68944_0_0|SrvcGrp|60|2022|PDM|2870.00|99|0.00|NEWBORN NURSERY - LEVEL II|
20|FH_F111403_37167_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F92673_44041_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F133380_46254_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F100741_0_0|SrvcGrp|73000|2022|PDM|1149.00|99|0.00|AEG 6|
20|FH_F119602_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F49637_0_0|SrvcGrp|21948|2022|PCT|1.00|99|0.00|OTHER DIAGNOSTIC TESTING|
20|FH_F91194_33511_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F146282_08244_0|SrvcGrp|75419|2022|PDM|2100.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|523.70|99|0.00|ASPG 207|
20|FH_F127422_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|IMPLANTS|
20|FH_F38249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130636_78572_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F57592_0_0|SrvcGrp|39870|2022|PDM|23500.00|99|0.00|MS DRG 619-621 ONLY|
20|FH_F32833_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34706_0_0|SrvcGrp|11376|2022|PDM|5068.00|99|0.00|DRG 181 GI OBSTRUCTION WO/CC|
20|FH_F49354_0_0|SrvcGrp|33643|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F107120_22560_0|SrvcGrp|80284|2022|PDM|157.89|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F148903_51101_0|SrvcGrp|29347|2022|PDM|25.75|99|0.00|HOME HEALTH AIDE|
20|FH_F69071_0_0|SrvcGrp|18071|2022|PDM|82.70|99|0.00|AMBULANCE RESPONSE/TREATMENT - NO TRANSPORT|
20|FH_F118476_17815_0|SrvcGrp|75545|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F91044_74010_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|912.15|99|0.00|AEG 6 (NO REV)|
20|FH_F124983_44514_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151751_0_0|SrvcGrp|116019|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F111809_93003_0|SrvcGrp|13187|2022|PCT|0.65|99|0.00|INTRAOCULAR LENSES|
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|1326.00|99|0.00|AEG 7 (NO REV)|
20|FH_F41173_0_0|CSTM-ALL|CSTM-00|2020|PDM|364.00|99|0.00|CHILD PSYCH RESIDENTIAL TREAT|
20|FH_F87596_33609_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD NU) - BDSS|
20|FH_F132285_89103_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F68479_0_0|SrvcGrp|64640|2022|PDM|60.00|99|0.00|PT AND OT|
20|FH_F125176_20785_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F111417_33613_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F150527_33844_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F127412_15301_0|SrvcGrp|110732|2022|PCT|1.00|99|0.00|AQUEOUS SHUNT|
20|FH_F102721_38118_0|SrvcGrp|73006|2022|PDM|1800.00|99|0.00|AEG 9|
20|FH_F133458_18929_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F109812_37043_0|SrvcGrp|86746|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F132613_84601_0|SrvcGrp|108484|2022|PDM|800.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F44334_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141867_62258_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37553_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F72859_0_0|SrvcGrp|11787|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F126666_44053_0|SrvcGrp|89337|2022|PDM|775.00|99|0.00|DETOXIFICATION|
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|602.00|99|0.00|ASPG II|
20|FH_F97543_33542_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128279_77043_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|1051.00|99|0.00|ASPG III - IOWA|
20|FH_F52293_0_0|SrvcGrp|14510|2022|PDM|645.00|99|0.00|SKILLED NURSING|
20|FH_F133112_70433_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F89015_74017_0|SrvcGrp|73700|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F143190_46168_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F126806_44125_0|SrvcGrp|95660|2022|PDM|550.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F45977_0_0|SrvcGrp|40413|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD RR KF|
20|FH_F139128_49503_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139377_02301_0|SrvcGrp|108484|2022|PDM|347.39|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139677_77087_0|SrvcGrp|108484|2022|PDM|590.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F150882_84041_0|SrvcGrp|86838|2022|PDM|19.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|981.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F35174_0_0|SrvcGrp|38|2022|PDM|4864.00|99|0.00|NORMAL DELIVERY|
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F120057_0_0|SrvcGrp|108075|2022|PDM|1698.78|99|0.00|AV FUSION / UPPER ARM VEIN|
20|FH_F46433_0_0|SrvcGrp|24762|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F98900_42001_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F124719_64093_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F132849_0_0|SrvcGrp|177|2022|PDM|1556.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F112045_90301_0|SrvcGrp|83417|2022|PDM|93713.00|99|0.00|OPEN HEART SURGERY|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F132096_89118_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F136376_0_0|SrvcGrp|86722|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F137789_48146_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F131327_0_0|SrvcGrp|111630|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F141270_89103_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F149240_0_0|SrvcGrp|84185|2022|PDM|144.84|99|0.00|RESPITE CARE|
20|FH_F32803_0_0|SrvcGrp|12350|2022|PDM|458.00|99|0.00|BOARDER BABY SERVICES|
20|FH_F111301_33122_0|SrvcGrp|73008|2022|PDM|2190.00|99|0.00|AEG 10|
20|FH_F65882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
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|23477|2022|PDM|8100.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F148243_0_0|SrvcGrp|87677|2022|PDM|957.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F33081_0_0|SrvcGrp|14609|2022|PCT|0.70|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F51272_0_0|SrvcGrp|47591|2022|PDM|6000.00|99|0.00|OBSTETRICAL CARE VAGINAL DELIVERY|
20|FH_F56573_0_0|SrvcGrp|8960|2022|PDM|60.00|99|0.00|SPEECH THERAPY|
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F87557_33309_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88831_84123_0|SrvcGrp|80318|2022|PDM|90.00|99|0.00|HOSPICE CARE (ALL OTHER)|
20|FH_F125054_16365_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125745_66025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91619_32091_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|GENERAL ACUTE CARE|
20|FH_F102960_50613_0|SrvcGrp|99599|2022|PDM|492.00|99|0.00|CARDIAC REHAB|
20|FH_F100783_03431_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F140007_0_0|SrvcGrp|19921|2022|PDM|4733.00|99|0.00|ARTHROSCOPICALLY LIGAMENT REPAIR|
20|FH_F128031_0_0|SrvcGrp|72990|2022|PDM|460.00|99|0.00|AEG 1|
20|FH_F131324_0_0|CSTM-ALL|CSTM-00|2020|PDM|542.00|99|0.00|AEG 1 (NO REV)|
20|FH_F118446_0_0|SrvcGrp|83857|2022|PDM|610.00|99|0.00|IP HOSPICE SVCS|
20|FH_F131235_36049_0|SrvcGrp|89337|2022|PDM|1072.00|99|0.00|DETOXIFICATION|
20|FH_F95101_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F119795_0_0|SrvcGrp|71666|2022|PDM|5202.00|99|0.00|CPT 63655|
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|897.00|99|0.00|AEG 1 (NO REV)|
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F35942_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F86851_0_0|SrvcGrp|84961|2022|PDM|520.00|99|0.00|CPT 43201|
20|FH_F86851_0_0|SrvcGrp|79586|2022|PDM|460.00|99|0.00|CPT 43200|
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|1261.32|99|0.00|AEG 6 (NO REV)|
20|FH_F149179_0_0|SrvcGrp|88030|2022|PDM|6763.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F123848_03257_0|SrvcGrp|46104|2022|PDM|154.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F123820_91316_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F132810_0_0|SrvcGrp|22389|2022|PDM|25.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F47495_0_0|SrvcGrp|15488|2022|PCT|0.50|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)|
20|FH_F67901_0_0|SrvcGrp|42322|2022|PDM|60.00|99|0.00|HOME THERAPY|
20|FH_F90314_0_0|SrvcGrp|12280|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F136386_30901_0|SrvcGrp|112998|2022|PDM|21000.00|99|0.00|MS DRG 803 ONLY|
20|FH_F136414_54548_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134126_11554_0|SrvcGrp|31074|2022|PDM|1357.00|99|0.00|MS DRG 795 ONLY|
20|FH_F137130_46168_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138019_79705_0|SrvcGrp|73842|2022|PDM|231.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F62683_0_0|SrvcGrp|9539|2022|PDM|330.00|99|0.00|SUBACUTE CARE|
20|FH_F97600_46151_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F129793_0_0|SrvcGrp|111415|2022|PCT|1.00|99|0.00|SURGICAL SERVICES|
20|FH_F140473_30518_0|SrvcGrp|98062|2022|PDM|452.08|99|0.00|HOSPICE INPATIENT RESPITE CARE PER DIEM|
20|FH_F140727_16046_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140888_75119_0|SrvcGrp|89149|2022|PDM|194.00|99|0.00|OP INTENSIVE|
20|FH_F120152_0_0|SrvcGrp|35672|2022|PDM|4400.00|99|0.00|CPT 23412|
20|FH_F128270_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F118818_19808_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F92506_07666_0|SrvcGrp|23681|2022|PDM|209.09|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F130800_06078_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F109885_35473_0|SrvcGrp|86749|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F147901_95008_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F129467_45449_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117093_40041_0|SrvcGrp|105265|2022|PDM|280.00|99|0.00|HEMODIALYSIS|
20|FH_F117126_12801_0|SrvcGrp|106257|2022|PCT|2.12|99|0.00|LABORATORY SERVICES|
20|FH_F137818_31602_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F111361_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124923_23518_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F36500_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72003_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F111594_0_0|SrvcGrp|54943|2022|PDM|2887.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F140035_0_0|SrvcGrp|48396|2022|PDM|192.00|99|0.00|OT SERVICES|
20|FH_F140373_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F32420_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42557_0_0|SrvcGrp|15456|2022|PDM|430.00|99|0.00|ACUTE REHABILITATION|
20|FH_F112865_46135_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87615_80033_0|SrvcGrp|52952|2022|PDM|148.00|99|0.00|PSYCHIATRIC CPT 90847|
20|FH_F31466_0_0|CSTM-ALL|CSTM-00|2020|PDM|694.00|99|0.00|ACUTE PSYCH|
20|FH_F80855_0_0|SrvcGrp|59840|2022|PDM|1135.00|99|0.00|TYMPANOSTOMY|
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_F137240_0_0|SrvcGrp|16634|2022|PDM|25783.00|99|0.00|CRYOBLATION|
20|FH_F34353_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F119775_0_0|SrvcGrp|72994|2022|PDM|564.00|99|0.00|AEG 3|
20|FH_F117827_75235_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F117087_0_0|SrvcGrp|83646|2022|PDM|2093.00|99|0.00|CPT 31276|
20|FH_F36036_0_0|SrvcGrp|16544|2022|PDM|200.00|99|0.00|TOCOLYTIC THERAPY|
20|FH_F114676_91911_0|SrvcGrp|86746|2022|PCT|1.20|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F150925_33936_0|SrvcGrp|15557|2022|PDM|300.00|99|0.00|VENTILATOR|
20|FH_F132096_89118_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F130371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120057_0_0|SrvcGrp|107878|2022|PDM|2500.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F98360_11554_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F126914_44136_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F98840_31021_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F124435_03882_0|SrvcGrp|73841|2022|PDM|313.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F120057_0_0|SrvcGrp|73000|2022|PDM|991.00|99|0.00|AEG 6|
20|FH_F130578_43950_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124484_83837_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F123745_0_0|SrvcGrp|36591|2022|PDM|22000.00|99|0.00|CPT 63685|
20|FH_F100663_56537_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F149651_90046_0|SrvcGrp|98701|2022|PDM|525.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F37864_0_0|CSTM-ALL|CSTM-00|2020|PDM|1665.51|99|0.00|ASPG X|
20|FH_F137363_0_0|SrvcGrp|110618|2022|PDM|1854.00|99|0.00|LAPAROSCOPY SERVICES|
20|FH_F94621_07728_0|SrvcGrp|94046|2022|PCT|1.00|99|0.00|TOBRAMYCIN COMP UNIT|
20|FH_F127324_0_0|SrvcGrp|87060|2022|PDM|3105.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY|
20|FH_F98623_97006_0|SrvcGrp|73656|2022|PDM|710.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F128583_45154_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F140295_0_0|SrvcGrp|90363|2022|PDM|6896.00|99|0.00|REVISE/IMPLANT FINGER JOINT|
20|FH_F98000_59102_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F127418_0_0|SrvcGrp|110766|2022|PDM|5481.88|99|0.00|3RD LEVEL INJ PARAVERT F JNT C/T|
20|FH_F128821_0_0|SrvcGrp|111218|2022|PDM|182.00|99|0.00|CAPD/CCPD|
20|FH_F138987_0_0|SrvcGrp|93098|2022|PDM|685.00|99|0.00|HOSPICE CARE|
20|FH_F150440_35077_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100965_25276_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F125656_92868_0|SrvcGrp|86849|2022|PDM|35.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F101685_0_0|SrvcGrp|73006|2022|PDM|1268.00|99|0.00|AEG 9|
20|FH_F90817_0_0|SrvcGrp|91002|2022|PDM|1433.00|99|0.00|RELEASE FOREARM/HAND TENDON (HCFA)|
20|FH_F114271_08721_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|3700.00|99|0.00|AEG 9 (NO REV)|
20|FH_F125081_15218_0|SrvcGrp|94781|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F131392_17004_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F91938_70121_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 3 (NO REV)|
20|FH_F41802_0_0|SrvcGrp|11798|2022|PDM|80.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|ANTIBIOTIC THERAPY Q8 (MOD SH)|
20|FH_F147418_0_0|SrvcGrp|115021|2022|PDM|7000.00|99|0.00|SPINE|
20|FH_F141267_0_0|SrvcGrp|104224|2022|PDM|939.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY (HCFA)|
20|FH_F97620_75904_0|SrvcGrp|73559|2022|PDM|9744.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F149049_28401_0|CSTM-ALL|CSTM-00|2020|PDM|1390.00|99|0.00|AEG 8 (NO REV)|
20|FH_F43865_0_0|SrvcGrp|27725|2022|PDM|40.00|99|0.00|SKILLED RN HOURLY|
20|FH_F92278_01440_0|SrvcGrp|43523|2022|PDM|140.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F97620_75904_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F150953_74953_0|SrvcGrp|23279|2022|PDM|275.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F139576_0_0|SrvcGrp|16693|2022|PDM|2868.00|99|0.00|KNEE SCOPE, MENISCECTOMY|
20|FH_F36720_0_0|SrvcGrp|9911|2022|PDM|600.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|VERTICAL PLUS MRI MOD KN|
20|FH_F117762_0_0|SrvcGrp|93069|2022|PDM|7280.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126272_70403_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116437_0_0|SrvcGrp|38908|2022|PDM|1757.00|99|0.00|CPT 67025 - INJECTION OF VITREOUS SUBSTITUTE|
20|FH_F150919_17603_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139824_24801_0|SrvcGrp|75506|2022|PCT|0.95|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F137363_0_0|SrvcGrp|104638|2022|PDM|3100.00|99|0.00|INSERT HEART PM ATRIAL|
20|FH_F139950_76240_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F143249_89801_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F143347_16001_0|SrvcGrp|3208|2022|PDM|1300.00|99|0.00|SUBACUTE CARE|
20|FH_F143347_16001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F143407_75021_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143533_30013_0|SrvcGrp|84937|2022|PDM|210.00|99|0.00|NON-INVASIVE VASCULAR STUDY|
20|FH_F143536_47546_0|SrvcGrp|85260|2022|PCT|0.00|99|0.00|INITIAL EVALUATION|
20|FH_F62713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F93740_0_0|CSTM-ALL|CSTM-00|2020|PDM|5200.00|99|0.00|IMPLANT PAT-ACTIVE HT RECORD|
20|FH_F102224_0_0|SrvcGrp|96780|2022|PDM|2300.00|99|0.00|REVISE EXTRA SPINE SEGMENT|
20|FH_F102224_0_0|SrvcGrp|96781|2022|PDM|1800.00|99|0.00|INJECTION FOR NERVE BLOCK 5|
20|FH_F102522_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115208_0_0|SrvcGrp|106179|2022|PDM|716.00|99|0.00|EGD CAUTERY TUMORE POLYP|
20|FH_F151753_03104_0|SrvcGrp|472|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F82375_28601_0|SrvcGrp|48398|2022|PDM|135.00|99|0.00|PT SERVICES|
20|FH_F120225_29644_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132371_19083_0|SrvcGrp|43569|2022|PDM|99.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F132421_74538_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116869_15146_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119992_67062_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|ASPG VII|
20|FH_F130901_68970_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|21510.00|99|0.00|MS DRG 237|
20|FH_F126431_77338_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145584_15010_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F121628_19533_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F85353_16407_0|SrvcGrp|63914|2022|PDM|120.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 143|
20|FH_F95440_0_0|SrvcGrp|93723|2022|PDM|2575.00|99|0.00|LAP HERNIA|
20|FH_F96721_99504_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F138739_21157_0|SrvcGrp|86722|2022|PDM|174.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F127486_06776_0|SrvcGrp|29347|2022|PDM|34.28|99|0.00|HOME HEALTH AIDE|
20|FH_F150306_51566_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|819.00|99|0.00|2005 ASPG GROUPER X|
20|FH_F119227_01752_0|SrvcGrp|86831|2022|PDM|25.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F32482_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133749_84604_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F85212_71075_0|SrvcGrp|73806|2022|PDM|500.00|99|0.00|AETNA ER|
20|FH_F31714_0_0|SrvcGrp|941|2022|PDM|1660.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F125115_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146590_77449_0|SrvcGrp|88621|2022|PDM|101.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150165_06032_0|SrvcGrp|46887|2022|PDM|4244.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F100680_43130_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F85777_77030_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F63312_0_0|SrvcGrp|14080|2022|PDM|85.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F149199_73005_0|CSTM-ALL|CSTM-00|2020|PDM|2764.00|99|0.00|AEG 9 (NO REV)|
20|FH_F123157_0_0|SrvcGrp|75493|2022|PDM|900.00|99|0.00|AEG 8|
20|FH_F85353_16407_0|SrvcGrp|63793|2022|PDM|996.77|99|0.00|HAPA WPA-NWPA 2012-13 ASC 501|
20|FH_F36753_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD KF|
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|AEG 1 (NO REV)|
20|FH_F110604_0_0|SrvcGrp|98268|2022|PDM|6050.00|99|0.00|HIP ARTHROSCOPY DX|
20|FH_F110470_98335_0|SrvcGrp|93919|2022|PDM|300.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F74024_0_0|SrvcGrp|28919|2022|PDM|34.00|99|0.00|CPT 97750|
20|FH_F133749_84604_0|SrvcGrp|112420|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132969_84003_0|SrvcGrp|21920|2022|PDM|25.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F62853_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112023_12866_0|SrvcGrp|72992|2022|PDM|2663.00|99|0.00|AEG 2|
20|FH_F146480_75042_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118957_0_0|SrvcGrp|110784|2022|PDM|3300.00|99|0.00|HAND OR FOOT NERVE GRAFT|
20|FH_F134331_61021_0|SrvcGrp|48385|2022|PDM|150.00|99|0.00|SPEECH THERAPY|
20|FH_F120720_24541_0|SrvcGrp|48398|2022|PDM|70.00|99|0.00|PT SERVICES|
20|FH_F143624_73069_0|SrvcGrp|88621|2022|PDM|105.00|99|0.00|SKILLED NURSING LPN|
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1935.00|99|0.00|AEG 10 (NO REV)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|582.35|99|0.00|HAPA WPA-NWPA 2012-13 ASC 305 W/O REV|
20|FH_F87333_0_0|SrvcGrp|86088|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F110521_98034_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F145619_17603_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111704_30044_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F116753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F114683_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F85353_16407_0|SrvcGrp|63908|2022|PDM|143.01|99|0.00|HAPA WPA-NWPA 2012-13 ASC 140|
20|FH_F133943_01606_0|SrvcGrp|109705|2022|PCT|1.00|99|0.00|DALTEPARIN SODIUM PER 2500IU|
20|FH_F120417_63124_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F85213_02840_0|SrvcGrp|112678|2022|PDM|132.70|99|0.00|COVID-19 SPECIMEN COLLECT|
20|FH_F52672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F83754_0_0|SrvcGrp|24600|2022|PCT|0.86|99|0.00|CAPD TRAINING|
20|FH_F133207_0_0|SrvcGrp|79101|2022|PDM|3529.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F118138_60532_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F110311_17078_0|SrvcGrp|103938|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F117206_0_0|SrvcGrp|90607|2022|PDM|619.00|99|0.00|SMALL BOWEL ENDOSCOPY|
20|FH_F85118_40403_0|SrvcGrp|80918|2022|PDM|131.25|99|0.00|RESPITE CARE|
20|FH_F138507_62208_0|SrvcGrp|48396|2022|PDM|117.00|99|0.00|OT SERVICES|
20|FH_F137799_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F89176_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|ASPG I|
20|FH_F145604_14850_0|SrvcGrp|86850|2022|PDM|70.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F85415_27612_0|SrvcGrp|46605|2022|PDM|78.75|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F72584_0_0|SrvcGrp|12263|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F95440_0_0|SrvcGrp|58638|2022|PDM|4900.00|99|0.00|CPT 63688|
20|FH_F95631_33705_0|SrvcGrp|88977|2022|PDM|7325.00|99|0.00|C-SECTION DELIVERY|
20|FH_F113453_80020_0|SrvcGrp|91294|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F138056_64055_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133808_73401_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F125870_0_0|SrvcGrp|90601|2022|PDM|2445.00|99|0.00|REMOVAL OF LENS MATERIAL|
20|FH_F34852_0_0|SrvcGrp|12596|2022|PCT|0.70|99|0.00|OP RADIOLOGY|
20|FH_F110541_99336_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F150160_01301_0|SrvcGrp|113171|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F110470_98335_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F126896_60010_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F81861_0_0|SrvcGrp|64109|2022|PDM|1070.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 2|
20|FH_F145604_14850_0|SrvcGrp|24750|2022|PDM|70.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F83380_0_0|SrvcGrp|44703|2022|PDM|105.00|99|0.00|NURSING CARE|
20|FH_F114509_10010_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F119227_01752_0|SrvcGrp|86828|2022|PDM|85.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F87796_63376_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145604_14850_0|SrvcGrp|86852|2022|PDM|70.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|673.02|99|0.00|HAPA WPA-NWPA 2012-13 ASC 203 W/O REV|
20|FH_F145641_06902_0|SrvcGrp|87679|2022|PDM|1844.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F111744_32514_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121684_74447_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|AEG 1 (NO REV)|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD RR"|
20|FH_F120408_0_0|SrvcGrp|106248|2022|PDM|481.00|99|0.00|PARTIAL HOSP PSYCH|
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.80|99|0.00|ASPG I|
20|FH_F116806_0_0|SrvcGrp|107066|2022|PDM|1923.16|99|0.00|LENGTHENING OF PALATE|
20|FH_F133749_84604_0|SrvcGrp|112447|2022|PDM|10.00|99|0.00|GROWTH HORMONE INJECTION THERAPY (HCFA)|
20|FH_F134496_66062_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F84712_0_0|SrvcGrp|78448|2022|PCT|0.74|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F86836_0_0|SrvcGrp|3095|2022|PDM|2850.00|99|0.00|ROOM AND BOARD PRIVATE|
20|FH_F101100_50314_0|SrvcGrp|97730|2022|PDM|30114.00|99|0.00|REVERSE HIP JOINT|
20|FH_F133478_40165_0|SrvcGrp|12659|2022|PDM|585.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F133471_47901_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F131318_53211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134828_30531_0|SrvcGrp|112656|2022|PDM|41.00|99|0.00|XRAY EXAM OF THORAX SPINE (HCFA)|
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|3157.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F114151_0_0|SrvcGrp|73656|2022|PDM|450.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F114151_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|1373.00|99|0.00|AEG 4 (NO REV)|
20|FH_F36439_0_0|SrvcGrp|24405|2022|PDM|500.00|99|0.00|HEARING AIDE|
20|FH_F45332_0_0|SrvcGrp|1168|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F59732_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|PARENTERAL NUTRITION|
20|FH_F138649_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133099_66801_0|SrvcGrp|16|2022|PCT|0.80|99|0.00|ACUTE REHABILITATION|
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F120910_63021_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114930_71101_0|SrvcGrp|103958|2022|PDM|128.00|99|0.00|AETNA FAMILY THERAPY|
20|FH_F90362_0_0|SrvcGrp|89945|2022|PDM|2122.00|99|0.00|REPAIR OF TENDON(S)|
20|FH_F101021_0_0|SrvcGrp|46605|2022|PDM|105.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F151526_28208_0|SrvcGrp|107794|2022|PDM|7455.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F132138_0_0|SrvcGrp|82981|2022|PDM|154.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F72183_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|ASPG III - FH SW CUSTOM GROUPERS|
20|FH_F120251_21122_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F100320_0_0|SrvcGrp|75487|2022|PDM|767.00|99|0.00|AEG 5|
20|FH_F127205_44125_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F124783_92408_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F117783_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F38151_0_0|SrvcGrp|28279|2022|PCT|0.85|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F145544_93536_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F39866_0_0|SrvcGrp|3081|2022|PCT|0.75|99|0.00|OBSERVATION SVCS|
20|FH_F100660_56303_0|SrvcGrp|73485|2022|PDM|2997.00|99|0.00|AETNA REHAB|
20|FH_F128272_60640_0|SrvcGrp|86830|2022|PDM|13.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F145797_46250_0|SrvcGrp|114018|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F125890_43054_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|2319.00|99|0.00|AEG 9 (NO REV)|
20|FH_F120872_74120_0|SrvcGrp|90854|2022|PDM|745.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F109645_0_0|SrvcGrp|34173|2022|PDM|118.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F37679_0_0|SrvcGrp|27071|2022|PDM|1.63|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN (MOD SJ)|
20|FH_F63153_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116341_12180_0|SrvcGrp|87317|2022|PDM|478.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F125011_74467_0|SrvcGrp|72998|2022|PDM|2275.00|99|0.00|AEG 5|
20|FH_F71185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|MS DRG UNGROUPABLE INPATIENT|
20|FH_F132675_53154_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F51074_0_0|CSTM-ALL|CSTM-00|2020|PDM|1257.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91632_46360_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F141801_80534_0|SrvcGrp|89417|2022|PDM|525.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F123926_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F147941_06023_0|SrvcGrp|113560|2022|PDM|1410.00|99|0.00|OBSERVATION W/ ER|
20|FH_F115020_67301_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F137940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F37884_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD UE|
20|FH_F86319_16365_0|SrvcGrp|109057|2022|PCT|0.63|99|0.00|CARDIAC STUDIES|
20|FH_F90872_0_0|SrvcGrp|105502|2022|PDM|1460.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F111581_77401_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F111602_17102_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F134828_30531_0|SrvcGrp|112670|2022|PDM|36.00|99|0.00|XRAY EXAM OF LOWER LEG (HCFA)|
20|FH_F34477_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DURABLE MEDICAL EQUIPMENT (DME) W/MOD AW - WINN|
20|FH_F35216_0_0|SrvcGrp|18161|2022|PDM|11750.00|99|0.00|MS DRG 253|
20|FH_F148879_33018_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F151056_17821_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151059_60435_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151085_15905_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151159_46322_0|SrvcGrp|23683|2022|PDM|55.00|99|0.00|SKILLED NURSING RN|
20|FH_F114931_0_0|SrvcGrp|86426|2022|PDM|1850.00|99|0.00|REMOVE INT/EXT HEM GROUP 2|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.43|99|0.00|DELAWARE VALLEY- ASC 101|
20|FH_F148901_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.70|99|0.00|OP SVCS|
20|FH_F82933_0_0|SrvcGrp|13250|2022|PDM|2321.08|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F91832_06106_0|SrvcGrp|48394|2022|PDM|36.75|99|0.00|SKILLED NURSING SERVICES|
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115264_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|OLD MOULTRIE SURGERY GROUPER 2|
20|FH_F142318_21218_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F113305_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F104840_32565_0|SrvcGrp|75497|2022|PCT|0.69|99|0.00|AEG 10|
20|FH_F113541_0_0|SrvcGrp|64517|2022|PDM|3295.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F43717_0_0|SrvcGrp|30941|2022|PDM|280.00|99|0.00|NEWBORN NURSERY|
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 4 (NO REV)|
20|FH_F132627_0_0|SrvcGrp|22596|2022|PDM|185.00|99|0.00|HOSPICE CARE|
20|FH_F58932_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78447_0_0|SrvcGrp|75503|2022|PDM|45.00|99|0.00|SPEECH THERAPY|
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1022.00|99|0.00|AEG 8 (NO REV)|
20|FH_F126345_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F149719_0_0|SrvcGrp|107748|2022|PDM|550.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F92212_0_0|SrvcGrp|92085|2022|PDM|1737.00|99|0.00|RETINA PROCEDURES|
20|FH_F146800_74128_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146674_70778_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F146994_74462_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F74102_0_0|SrvcGrp|11069|2022|PDM|105.00|99|0.00|OT SVCS|
20|FH_F34652_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F37603_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F92493_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F92493_0_0|SrvcGrp|97730|2022|PDM|16193.10|99|0.00|REVERSE HIP JOINT|
20|FH_F129973_48030_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|(JCODES-IMMUN) OCN F/S PRICING: ALL|
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 4 (NO REV)|
20|FH_F137248_0_0|SrvcGrp|98206|2022|PDM|4058.00|99|0.00|CORRECTION OF BUNION|
20|FH_F100787_69162_0|SrvcGrp|73605|2022|PDM|2257.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F136569_16506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F114764_78214_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F139027_18407_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127448_0_0|SrvcGrp|107794|2022|PDM|3900.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F132595_0_0|SrvcGrp|33793|2022|PDM|6847.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F43696_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F134770_14420_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134791_98034_0|SrvcGrp|87401|2022|PDM|119.00|99|0.00|HCPCS G0156 (HCFA)|
20|FH_F135719_45502_0|SrvcGrp|112738|2022|PDM|32781.81|99|0.00|MSDRG 521 ONLY|
20|FH_F37847_0_0|SrvcGrp|12401|2022|PDM|93.50|99|0.00|RN VISIT|
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|491.00|99|0.00|ASPG II|
20|FH_F38826_0_0|SrvcGrp|20012|2022|PCT|0.85|99|0.00|KIDNEY TRANSPLANT|
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_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.00|99|0.00|WELLPATH PROPIETARY ASC V|
20|FH_F115206_80923_0|SrvcGrp|89337|2022|PDM|1034.00|99|0.00|DETOXIFICATION|
20|FH_F115631_65201_0|SrvcGrp|67065|2022|PDM|7575.00|99|0.00|CERVICAL SURGERY|
20|FH_F115733_33012_0|SrvcGrp|86722|2022|PDM|179.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F147331_90045_0|SrvcGrp|48396|2022|PDM|171.00|99|0.00|OT SERVICES|
20|FH_F147440_71334_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F147530_49441_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41678_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F42694_0_0|SrvcGrp|8962|2022|PDM|80.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39346_0_0|SrvcGrp|19846|2022|PDM|12105.00|99|0.00|MS DRG 249 ONLY|
20|FH_F51938_0_0|SrvcGrp|33164|2022|PDM|305.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|399.11|99|0.00|ASPG I|
20|FH_F116956_0_0|SrvcGrp|3932|2022|PDM|3000.00|99|0.00|LITHOTRIPSY|
20|FH_F87152_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F46433_0_0|SrvcGrp|22592|2022|PDM|75.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F62680_0_0|SrvcGrp|11112|2022|PDM|25.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F129673_0_0|SrvcGrp|111404|2022|PDM|69.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133536_0_0|SrvcGrp|99158|2022|PDM|3215.00|99|0.00|KNEE ARTHROSCOPY/DIAGNOSTIC|
20|FH_F133579_0_0|SrvcGrp|103585|2022|PDM|3248.00|99|0.00|REMOVE SPINE ELTRD PLATE|
20|FH_F139916_0_0|SrvcGrp|90854|2022|PDM|881.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F82357_0_0|SrvcGrp|12073|2022|PDM|46.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F120635_22903_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F45932_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|ASPG II|
20|FH_F97061_85012_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F141833_31707_0|SrvcGrp|106300|2022|PDM|600.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F35408_0_0|SrvcGrp|16897|2022|PDM|240.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F123545_44512_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F144572_34203_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117471_19111_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F71268_0_0|SrvcGrp|68287|2022|PCT|0.80|99|0.00|TRAUMA|
20|FH_F40728_0_0|SrvcGrp|3378|2022|PDM|34.00|99|0.00|OBSERVATION SVCS|
20|FH_F127105_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1043.00|99|0.00|AEG 4 (NO REV)|
20|FH_F133261_78041_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F106700_02906_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F79944_0_0|SrvcGrp|11000|2022|PCT|0.55|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F87155_04105_0|SrvcGrp|77223|2022|PDM|57.78|99|0.00|AETNA HOME INFUSION - S5520|
20|FH_F102561_75146_0|SrvcGrp|88147|2022|PDM|9445.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA|
20|FH_F34706_0_0|SrvcGrp|12792|2022|PDM|2746.00|99|0.00|PET SCAN|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD KF)|
20|FH_F93561_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F141893_65655_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141927_71901_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132528_64014_0|SrvcGrp|48385|2022|PDM|127.00|99|0.00|SPEECH THERAPY|
20|FH_F55375_0_0|SrvcGrp|10906|2022|PDM|2100.00|99|0.00|EMERGENCY ROOM LEVEL IV|
20|FH_F148599_98034_0|CSTM-ALL|CSTM-00|2020|PCT|3.13|99|0.00|HSS APC K PROCEDURE NOT ON FS OR W/O WEIGHT|
20|FH_F145328_90301_0|SrvcGrp|113338|2022|PDM|120.00|99|0.00|PERIODIC ASSESSMENT|
20|FH_F150905_01608_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43719_0_0|CSTM-ALL|CSTM-00|2020|PDM|240.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F73210_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|1753.00|99|0.00|AEG 9 (NO REV)|
20|FH_F123181_75057_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F91152_60061_0|SrvcGrp|73849|2022|PDM|362.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F142673_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F141411_0_0|SrvcGrp|83835|2022|PDM|15000.00|99|0.00|REPLACE TISSUE EXPANDER|
20|FH_F133490_90650_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F144011_60616_0|SrvcGrp|103913|2022|PDM|836.00|99|0.00|OP DIALYSIS|
20|FH_F72823_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F40203_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|SPINAL CORD REHAB|
20|FH_F37408_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.89|99|0.00|OP SVCS|
20|FH_F50440_0_0|SrvcGrp|28074|2022|PCT|0.90|99|0.00|HIGH COST PHARMACEUTICALS|
20|FH_F150602_59718_0|SrvcGrp|27968|2022|PDM|45.00|99|0.00|SKILLED NURSING LPN|
20|FH_F142776_65338_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F92677_08003_0|SrvcGrp|92218|2022|PDM|147.00|99|0.00|HCPCS E0570 MOD RR (HCFA)|
20|FH_F100666_81301_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_F46352_0_0|SrvcGrp|9937|2022|PDM|147.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F142990_06488_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38953_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|912.00|99|0.00|AEG 6 (NO REV)|
20|FH_F97563_83201_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F133397_23233_0|SrvcGrp|27775|2022|PDM|603.00|99|0.00|RADIATION THERAPY SVCS (GAMMA KNIFE)|
20|FH_F40599_0_0|SrvcGrp|528|2022|PDM|1391.00|99|0.00|TELEMETRY UNIT|
20|FH_F142822_63437_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F83031_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INTERIM INFUSION REV CODE 649|
20|FH_F128648_44256_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F111540_16823_0|SrvcGrp|104420|2022|PDM|90.35|99|0.00|OFFICE/OUTPATIENT VISIT EST (HCFA)(MOD AF)|
20|FH_F49354_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUBA|
20|FH_F120437_85202_0|SrvcGrp|86779|2022|PDM|183.46|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F120773_77706_0|SrvcGrp|75419|2022|PDM|398.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F139441_91324_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F139444_32966_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F139627_80537_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150768_03054_0|SrvcGrp|53987|2022|PDM|90.51|99|0.00|PHOTOTHERAPY|
20|FH_F139150_75206_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F143668_0_0|SrvcGrp|115717|2022|PDM|1687.50|99|0.00|PNEUMATIC COMPRESSION DEVICE (MOD UE)|
20|FH_F35458_0_0|SrvcGrp|15143|2022|PDM|1460.00|99|0.00|ACUTE IP MEDICAL SERVICES|
20|FH_F128753_32501_0|SrvcGrp|75497|2022|PCT|0.64|99|0.00|AEG 10|
20|FH_F128375_03909_0|SrvcGrp|46903|2022|PDM|651.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F119376_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F134603_0_0|SrvcGrp|11663|2022|PCT|0.44|99|0.00|IMPLANTS|
20|FH_F138017_73129_0|SrvcGrp|112734|2022|PCT|1.57|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F38123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F94643_90501_0|SrvcGrp|93899|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F97881_38703_0|SrvcGrp|73659|2022|PDM|9010.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F97082_90012_0|SrvcGrp|73461|2022|PDM|17891.00|99|0.00|AETNA NICU IV|
20|FH_F136668_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 8 (NO REV)|
20|FH_F147332_19406_0|SrvcGrp|114975|2022|PCT|1.01|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F141510_95123_0|SrvcGrp|89149|2022|PDM|325.00|99|0.00|OP INTENSIVE|
20|FH_F116092_83254_0|SrvcGrp|103503|2022|PCT|0.92|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F118194_50841_0|SrvcGrp|86849|2022|PDM|240.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F116024_13203_0|SrvcGrp|73842|2022|PDM|148.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F35276_0_0|SrvcGrp|10402|2022|PDM|52.00|99|0.00|CPT CODES 00100-01999|
20|FH_F92618_0_0|SrvcGrp|57968|2022|PDM|33.20|99|0.00|CONTINUOUS HOMECARE|
20|FH_F137718_80107_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127816_44112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91663_19901_0|SrvcGrp|43569|2022|PDM|125.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F73013_0_0|SrvcGrp|10522|2022|PDM|519.82|99|0.00|PICC LINE INSERT|
20|FH_F122926_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F85115_0_0|SrvcGrp|16526|2022|PDM|169.05|99|0.00|DIALYSIS|
20|FH_F110232_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|OP SVCS|
20|FH_F82714_18848_0|CSTM-ALL|CSTM-00|2020|PDM|2016.00|99|0.00|AEG 6 (NO REV)|
20|FH_F110925_01104_0|SrvcGrp|41455|2022|PDM|1.16|99|0.00|ENTERAL FORMULA - PEDIATRICS (SOY BASED)|
20|FH_F68160_0_0|SrvcGrp|13985|2022|PDM|47.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F135005_06460_0|SrvcGrp|27968|2022|PDM|32.00|99|0.00|SKILLED NURSING LPN|
20|FH_F75804_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148265_06067_0|SrvcGrp|84939|2022|PDM|19500.00|99|0.00|SHOULDER JOINT|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2007 DME DBL MODIFIERS - RR/KC|
20|FH_F93881_15009_0|SrvcGrp|75495|2022|PDM|3093.00|99|0.00|AEG 9|
20|FH_F77484_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|OP SVCS|
20|FH_F56136_0_0|SrvcGrp|22812|2022|PCT|0.92|99|0.00|ENDOSCOPY|
20|FH_F94942_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129928_80033_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F77504_0_0|SrvcGrp|33230|2022|PDM|1275.00|99|0.00|AIDS UNIT|
20|FH_F148486_03110_0|SrvcGrp|473|2022|PDM|391.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F142992_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42360_0_0|SrvcGrp|471|2022|PDM|435.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F116269_92627_0|SrvcGrp|93919|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F123943_84041_0|SrvcGrp|97507|2022|PDM|90.00|99|0.00|AETNA HOSPICE|
20|FH_F125899_07645_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F79800_0_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149839_80002_0|SrvcGrp|90707|2022|PDM|144.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F137507_62901_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F49653_0_0|CSTM-ALL|CSTM-00|2020|PDM|919.00|99|0.00|MS DRG 789-795|
20|FH_F117082_66216_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129415_69361_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1236.00|99|0.00|AEG 6 (NO REV)|
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_F145593_92660_0|SrvcGrp|108484|2022|PDM|1300.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S NV - GLOBAL|
20|FH_F43436_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|AMBULANCE SVCS|
20|FH_F63433_0_0|SrvcGrp|17069|2022|PDM|672.40|99|0.00|ASPG III|
20|FH_F131228_01826_0|SrvcGrp|705|2022|PCT|1.11|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.58|99|0.00|AEG 6 (NO REV)|
20|FH_F113410_0_0|SrvcGrp|105251|2022|PDM|2311.00|99|0.00|RPR I/HERNIA INIT REDUCTION|
20|FH_F110142_39056_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|413.06|99|0.00|AETNA POLYSOMNOGRAPHY|
20|FH_F100660_56303_0|SrvcGrp|73643|2022|PDM|2543.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F142073_0_0|SrvcGrp|74039|2022|PDM|5980.00|99|0.00|LAMINECTOMY|
20|FH_F129627_06037_0|SrvcGrp|80920|2022|PDM|720.00|99|0.00|HOSPICE SERVICES|
20|FH_F132190_0_0|SrvcGrp|96959|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F137946_0_0|SrvcGrp|113248|2022|PDM|51.31|99|0.00|COVID-19 SARS-COV-2 AMP PRB (HCFA)|
20|FH_F135236_02840_0|SrvcGrp|109057|2022|PCT|1.01|99|0.00|CARDIAC STUDIES|
20|FH_F143528_0_0|SrvcGrp|89882|2022|PDM|4076.10|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F56136_0_0|SrvcGrp|12393|2022|PCT|0.92|99|0.00|AMBULANCE SVCS|
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131357_17545_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F112545_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 4 (NO REV)|
20|FH_F37568_0_0|SrvcGrp|25665|2022|PCT|0.60|99|0.00|PHARMACY|
20|FH_F135649_0_0|CSTM-ALL|CSTM-00|2020|PDM|507.00|99|0.00|AEG 1 (NO REV)|
20|FH_F148740_93230_0|SrvcGrp|89337|2022|PDM|1100.00|99|0.00|DETOXIFICATION|
20|FH_F151050_17015_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151081_85225_0|SrvcGrp|89337|2022|PDM|1041.00|99|0.00|DETOXIFICATION|
20|FH_F121930_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F115884_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F61493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42947_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117299_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F76085_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F80711_0_0|SrvcGrp|12403|2022|PDM|770.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F151423_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F111925_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F111925_0_0|SrvcGrp|28549|2022|PDM|1602.00|99|0.00|VITRECTOMY|
20|FH_F103780_64804_0|SrvcGrp|114020|2022|PCT|0.68|99|0.00|LABORATORY SERVICES|
20|FH_F114571_34613_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F136493_0_0|SrvcGrp|63297|2022|PDM|166.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F35987_0_0|SrvcGrp|3029|2022|PDM|601.00|99|0.00|NEWBORN NURSERY|
20|FH_F38742_0_0|SrvcGrp|10543|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F91953_99508_0|SrvcGrp|91993|2022|PDM|2200.00|99|0.00|VAGINAL DELIVERY ONLY|
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 3 (NO REV)|
20|FH_F123745_0_0|SrvcGrp|109525|2022|PDM|6800.00|99|0.00|TREAT WRIST BONE FRACTURE|
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|5000.00|99|0.00|AEG 9 (NO REV)|
20|FH_F131591_67203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (CPD 1364768)|
20|FH_F37003_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F147316_70433_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F100663_56537_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F71468_0_0|SrvcGrp|12403|2022|PDM|28.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F146765_0_0|SrvcGrp|113620|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F119376_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F32963_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110841_53012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F125656_92868_0|SrvcGrp|86850|2022|PDM|35.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F142370_0_0|SrvcGrp|113178|2022|PDM|28.39|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - ASTRAZENECA|
20|FH_F147422_84121_0|SrvcGrp|89412|2022|PDM|457.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F140295_0_0|SrvcGrp|97741|2022|PDM|10378.00|99|0.00|REVISE KNEE|
20|FH_F151003_33162_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F35802_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F134396_80045_0|SrvcGrp|86722|2022|PDM|316.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F151699_01752_0|SrvcGrp|86832|2022|PDM|10.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|3875.00|99|0.00|ASPG VII|
20|FH_F122277_98045_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134410_46807_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F38742_0_0|SrvcGrp|29346|2022|PDM|80.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F147223_49444_0|SrvcGrp|110537|2022|PDM|392.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F84655_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F149269_73120_0|SrvcGrp|79699|2022|PCT|0.63|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|523.00|99|0.00|AEG 10 (NO REV)|
20|FH_F35475_0_0|SrvcGrp|9511|2022|PCT|0.50|99|0.00|OBSERVATION SVCS|
20|FH_F38007_0_0|SrvcGrp|13135|2022|PDM|3365.00|99|0.00|ONCOLOGY CARE UNIT|
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|610.00|99|0.00|AEG 1 (NO REV)|
20|FH_F138018_17313_0|SrvcGrp|111528|2022|PDM|205.00|99|0.00|PICC LINE INSERTION (HCFA)|
20|FH_F131069_54724_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119316_27104_0|SrvcGrp|89337|2022|PDM|1006.00|99|0.00|DETOXIFICATION|
20|FH_F140295_0_0|SrvcGrp|26274|2022|PDM|3586.00|99|0.00|CPT 29877|
20|FH_F117762_0_0|SrvcGrp|79101|2022|PDM|2288.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F37364_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ACUTE PSYCH|
20|FH_F149579_95815_0|SrvcGrp|115666|2022|PDM|5.83|99|0.00|BRIEF EMOTIONAL BH|
20|FH_F151025_11230_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148702_32606_0|SrvcGrp|108484|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F124441_0_0|SrvcGrp|67119|2022|PDM|9975.00|99|0.00|ARTHODESIS|
20|FH_F137790_62568_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97280_20018_0|SrvcGrp|73605|2022|PDM|3236.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F140087_62864_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143347_16001_0|SrvcGrp|75506|2022|PCT|0.65|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F143347_16001_0|SrvcGrp|79850|2022|PCT|2.00|99|0.00|NON-INVASIVE VASCULAR STUDY|
20|FH_F143410_77845_0|SrvcGrp|74668|2022|PDM|220.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F143529_84737_0|SrvcGrp|88620|2022|PDM|85.50|99|0.00|SKILLED NURSING RN|
20|FH_F143533_30013_0|SrvcGrp|114078|2022|PDM|39.00|99|0.00|EXTREMITIES ULTRASOUND|
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F84631_0_0|SrvcGrp|21342|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F62172_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F120225_29644_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136299_75218_0|CSTM-ALL|CSTM-00|2020|PDM|8755.00|99|0.00|AEG 7 (NO REV)|
20|FH_F120747_19129_0|SrvcGrp|471|2022|PDM|980.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F112679_85711_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F116904_17543_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119924_14070_0|SrvcGrp|76501|2022|PDM|250.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F119918_38201_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F120977_50510_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F32739_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F113649_01752_0|SrvcGrp|22389|2022|PDM|15.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F147211_0_0|SrvcGrp|11852|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F93805_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F150699_0_0|SrvcGrp|112878|2022|PDM|9639.00|99|0.00|INSERT 1 ELECTRODE PM DEFIB|
20|FH_F131995_04730_0|SrvcGrp|29347|2022|PDM|29.00|99|0.00|HOME HEALTH AIDE|
20|FH_F39339_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ACUTE PSYCH|
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|1240.92|99|0.00|2005 ASPG GROUPER VII|
20|FH_F126523_0_0|SrvcGrp|72998|2022|PDM|1050.00|99|0.00|AEG 5|
20|FH_F129792_80309_0|SrvcGrp|107861|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F129338_19114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67261_0_0|CSTM-ALL|CSTM-00|2020|PDM|1953.00|99|0.00|ASPG IV - FH SW CUSTOM GROUPERS|
20|FH_F104840_32565_0|SrvcGrp|83678|2022|PCT|0.69|99|0.00|AETNA THERAPY|
20|FH_F41112_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|SUB-ACUTE PHYSICAL REHAB|
20|FH_F43860_0_0|SrvcGrp|37404|2022|PDM|90.00|99|0.00|PT SVCS|
20|FH_F44358_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|2250.00|99|0.00|AEG 5  (NO REV)|
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|2075.00|99|0.00|AEG 10 (NO REV)|
20|FH_F114365_73162_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114389_50131_0|SrvcGrp|88620|2022|PDM|161.90|99|0.00|SKILLED NURSING RN|
20|FH_F83115_0_0|SrvcGrp|473|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|375.00|99|0.00|AEG 1 (NO REV)|
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.00|99|0.00|AEG 9 (NO REV)|
20|FH_F124059_64055_0|SrvcGrp|14947|2022|PDM|5.00|99|0.00|HOME INFUSION|
20|FH_F146715_34240_0|SrvcGrp|73601|2022|PDM|1990.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F38081_0_0|SrvcGrp|474|2022|PDM|300.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F100703_0_0|SrvcGrp|97179|2022|PDM|7876.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON|
20|FH_F124173_66215_0|SrvcGrp|14944|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F124584_28204_0|SrvcGrp|58509|2022|PDM|424.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F124637_77080_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97083_90670_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F55694_0_0|SrvcGrp|12290|2022|PDM|1827.00|99|0.00|DETOXIFICATION|
20|FH_F113809_47302_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F113845_32746_0|SrvcGrp|105420|2022|PDM|700.00|99|0.00|AETNA IP HOSP ROUNDING|
20|FH_F113937_15301_0|SrvcGrp|73700|2022|PDM|31.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F43295_0_0|SrvcGrp|37018|2022|PDM|432.00|99|0.00|BOARDER BABY|
20|FH_F43352_0_0|CSTM-ALL|CSTM-00|2020|PDM|1146.00|99|0.00|WELLPATH PROPIETARY ASC V|
20|FH_F43447_0_0|SrvcGrp|64132|2022|PDM|1242.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F43779_0_0|SrvcGrp|13292|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BIENVILLE MED CTR ALL OTHER OP MOD TC|
20|FH_F136775_64701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|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_F113713_17013_0|SrvcGrp|98040|2022|PDM|12.08|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F115267_67156_0|SrvcGrp|89149|2022|PDM|160.00|99|0.00|OP INTENSIVE|
20|FH_F115267_67156_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F147400_77707_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147585_60402_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117820_0_0|SrvcGrp|89822|2022|PDM|105.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F98361_12065_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F150939_0_0|SrvcGrp|115658|2022|PDM|66.43|99|0.00|INFLUENZA VACCINE AIIV4|
20|FH_F36854_0_0|SrvcGrp|361|2022|PDM|2225.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F37257_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F37850_0_0|CSTM-ALL|CSTM-00|2020|PDM|757.00|99|0.00|ACUTE PSYCH|
20|FH_F131169_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F38949_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F54552_0_0|SrvcGrp|14412|2022|PDM|635.74|99|0.00|HOSPICE CARE|
20|FH_F111951_80111_0|SrvcGrp|472|2022|PDM|446.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F138876_25302_0|SrvcGrp|17013|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F67167_0_0|SrvcGrp|16|2022|PDM|1533.00|99|0.00|ACUTE REHABILITATION|
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_F151412_71909_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151511_14094_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151514_35242_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132268_07060_0|SrvcGrp|472|2022|PDM|439.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F123193_33431_0|SrvcGrp|104079|2022|PCT|1.25|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F135583_17331_0|SrvcGrp|16111|2022|PCT|0.85|99|0.00|HIGH COST DRUGS|
20|FH_F136223_60954_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F116460_19464_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116463_76501_0|SrvcGrp|104076|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F121713_84747_0|SrvcGrp|75419|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F121731_20164_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F146125_0_0|SrvcGrp|65625|2022|PDM|2164.00|99|0.00|CPT 30520|
20|FH_F75205_0_0|SrvcGrp|62538|2022|PDM|130.00|99|0.00|PHYSICAL THERAPY|
20|FH_F133565_32570_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111880_50003_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
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|CSTM-ALL|CSTM-00|2020|PDM|1763.00|99|0.00|AEG 9 (NO REV)|
20|FH_F89360_0_0|SrvcGrp|88099|2022|PCT|1.20|99|0.00|DRUGS|
20|FH_F145587_0_0|SrvcGrp|83640|2022|PDM|2784.62|99|0.00|CPT 29887|
20|FH_F145587_0_0|SrvcGrp|33724|2022|PDM|1262.70|99|0.00|ARTHROSCOPY|
20|FH_F132328_0_0|SrvcGrp|67066|2022|PDM|14566.00|99|0.00|CERVICAL SURGERY|
20|FH_F132328_0_0|SrvcGrp|103834|2022|PDM|1259.00|99|0.00|AETNA REMOVE BLADDER STONE|
20|FH_F112082_30720_0|SrvcGrp|47183|2022|PDM|157.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F87557_33309_0|SrvcGrp|22589|2022|PDM|25.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F128695_50049_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F102325_62691_0|SrvcGrp|24745|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F129240_10028_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F84611_30281_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (HCFA)|
20|FH_F84611_30281_0|SrvcGrp|16033|2022|PCT|0.74|99|0.00|HIGH COST DRUGS|
20|FH_F120695_15017_0|SrvcGrp|73605|2022|PDM|1108.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F110940_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F39839_0_0|SrvcGrp|65|2022|PDM|1635.00|99|0.00|OBSTETRICAL CARE|
20|FH_F138936_01040_0|CSTM-ALL|CSTM-00|2020|PDM|3693.00|99|0.00|AEG 10 (NO REV)|
20|FH_F106500_0_0|CSTM-ALL|CSTM-00|2020|PDM|336.00|99|0.00|CPT 95805 (W/MOD TC)|
20|FH_F143832_0_0|SrvcGrp|113987|2022|PDM|2232.73|99|0.00|VASC EMBOLIZE/OCCLUDE VENOUS|
20|FH_F143832_0_0|SrvcGrp|108115|2022|PDM|1908.90|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F132258_45404_0|SrvcGrp|14945|2022|PDM|6.65|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F132258_45404_0|SrvcGrp|86830|2022|PDM|45.58|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F122085_70360_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F145531_61614_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135355_73112_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135978_06851_0|SrvcGrp|112780|2022|PDM|254.00|99|0.00|INTENSIVE OP (>=19 YRS) (HCFA)|
20|FH_F136164_63965_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100880_67735_0|SrvcGrp|29816|2022|PCT|0.49|99|0.00|IMPLANTS/PROSTHETICS/DRUGS|
20|FH_F116397_33404_0|SrvcGrp|86844|2022|PDM|40.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F116397_33404_0|SrvcGrp|90341|2022|PDM|68.00|99|0.00|SKILLED NURSING LPN (HCFA)|
20|FH_F121808_70390_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148243_0_0|SrvcGrp|93807|2022|PDM|5000.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F36344_0_0|SrvcGrp|11802|2022|PDM|120.00|99|0.00|HOME INFUSION|
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|896.00|99|0.00|ASPG VII|
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1769.00|99|0.00|AEG 6 (NO REV)|
20|FH_F132073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132328_0_0|SrvcGrp|83351|2022|PDM|3891.00|99|0.00|AETNA LAPAR ORCHIOPEXY|
20|FH_F112092_46845_0|SrvcGrp|90489|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)|
20|FH_F87557_33309_0|SrvcGrp|86779|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F88831_84123_0|SrvcGrp|27969|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F125054_16365_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102325_62691_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129240_10028_0|SrvcGrp|86829|2022|PDM|5.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F130027_76201_0|SrvcGrp|3178|2022|PDM|834.00|99|0.00|ACUTE PSYCH|
20|FH_F47495_0_0|SrvcGrp|28145|2022|PDM|1550.00|99|0.00|SKILLED NURSING|
20|FH_F58856_0_0|CSTM-ALL|CSTM-00|2020|PDM|30625.00|99|0.00|MS DRG 238 ONLY|
20|FH_F62577_0_0|SrvcGrp|58459|2022|PDM|1641.00|99|0.00|ASPG VI|
20|FH_F136368_62711_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136481_61350_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118152_20151_0|SrvcGrp|86848|2022|PDM|40.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F120456_67117_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120490_64133_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120520_54401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F137047_73120_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F137054_22041_0|SrvcGrp|101403|2022|PCT|1.00|99|0.00|HOSPICE/PHYSICIAN OP|
20|FH_F137147_75006_0|SrvcGrp|34609|2022|PDM|13608.00|99|0.00|PODIATRIC PROCEDURE CPT 28080|
20|FH_F137147_75006_0|CSTM-ALL|CSTM-00|2020|PDM|4725.00|99|0.00|AEG 4 (NO REV)|
20|FH_F114092_83350_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F142267_78240_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F142530_60148_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138558_60107_0|SrvcGrp|73842|2022|PDM|243.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138584_30912_0|SrvcGrp|113370|2022|PDM|2000.00|99|0.00|RECONSTRUCT MIDFACE LEFORT 3|
20|FH_F138584_30912_0|SrvcGrp|113407|2022|PDM|750.00|99|0.00|REPAIR CRANIOFACIAL FRACTURE|
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|466.99|99|0.00|2006 MEDICARE ASPG I|
20|FH_F140387_72202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140496_38627_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F140615_73013_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F140756_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149375_26101_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F119003_78070_0|SrvcGrp|89337|2022|PDM|800.00|99|0.00|DETOXIFICATION|
20|FH_F119003_78070_0|SrvcGrp|89412|2022|PDM|411.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F80366_0_0|SrvcGrp|72992|2022|PCT|0.94|99|0.00|AEG 2|
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115452_15235_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147725_06002_0|SrvcGrp|34605|2022|PDM|5408.00|99|0.00|CPT 28299|
20|FH_F147725_06002_0|SrvcGrp|115163|2022|PDM|4680.00|99|0.00|NOSE REPAIR|
20|FH_F147900_48038_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117240_37334_0|SrvcGrp|10393|2022|PDM|2100.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F78894_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109652_0_0|SrvcGrp|20252|2022|PDM|62484.00|99|0.00|MS DRG 224-225 ONLY|
20|FH_F90735_94070_0|SrvcGrp|90283|2022|PDM|32.50|99|0.00|GAUCHER DISEASE|
20|FH_F124834_75246_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F102760_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|DME|
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85757_0_0|SrvcGrp|80918|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F85757_0_0|SrvcGrp|29155|2022|PDM|105.00|99|0.00|HOSPICE SVCS|
20|FH_F39749_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F41015_0_0|SrvcGrp|474|2022|PDM|200.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F41433_0_0|SrvcGrp|22954|2022|PDM|140.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F31884_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|1394.00|99|0.00|AEG 1 (NO REV)|
20|FH_F100681_73104_0|SrvcGrp|73643|2022|PDM|1585.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F150663_0_0|SrvcGrp|108484|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71323_68114_0|SrvcGrp|35214|2022|PDM|2454.00|99|0.00|MS DRG 392 ONLY|
20|FH_F140472_0_0|SrvcGrp|17100|2022|PDM|600.00|99|0.00|SKILLED NURSING|
20|FH_F118027_28801_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F142775_72801_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.00|99|0.00|IP PARTIAL HOSPITALIZATION (4-7 HOURS)|
20|FH_F112587_37058_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127960_85205_0|SrvcGrp|89149|2022|PDM|186.00|99|0.00|OP INTENSIVE|
20|FH_F113271_72205_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.81|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F107140_0_0|SrvcGrp|42971|2022|PDM|75.00|99|0.00|SKN RN|
20|FH_F67560_0_0|SrvcGrp|17075|2022|PCT|0.83|99|0.00|ASPG VI|
20|FH_F71882_15228_0|SrvcGrp|10503|2022|PDM|55.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F144191_0_0|SrvcGrp|41334|2022|PDM|9875.00|99|0.00|TOTAL KNEE|
20|FH_F127197_23111_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133021_00910_0|SrvcGrp|112298|2022|PDM|2000.00|99|0.00|IVC FILTER|
20|FH_F31928_0_0|SrvcGrp|10419|2022|PDM|790.00|99|0.00|SKILLED NURSING CARE|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|ASPG X|
20|FH_F36384_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.30|99|0.00|OP SVCS|
20|FH_F133470_97068_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F100666_81301_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|AEG 5  (NO REV)|
20|FH_F87155_04105_0|SrvcGrp|48385|2022|PDM|94.56|99|0.00|SPEECH THERAPY|
20|FH_F117885_81506_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F144769_0_0|SrvcGrp|104457|2022|PDM|7386.00|99|0.00|MATERNITY CARE (C-SECTION)|
20|FH_F36207_0_0|SrvcGrp|16900|2022|PDM|325.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F50420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F71947_15227_0|SrvcGrp|13985|2022|PDM|47.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F101840_76054_0|SrvcGrp|86425|2022|PDM|1321.00|99|0.00|EGD LESION ABLATION|
20|FH_F126815_02118_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F89112_16509_0|SrvcGrp|10364|2022|PDM|733.00|99|0.00|CPT CODE 99284|
20|FH_F142749_15212_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F104180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F91262_77036_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88956_0_0|SrvcGrp|84438|2022|PDM|6335.00|99|0.00|AETNA MATERNITY CARE (C-SECTION)|
20|FH_F111421_32216_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F33346_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS|
20|FH_F146135_87112_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F43296_0_0|SrvcGrp|40820|2022|PDM|2515.00|99|0.00|ICU/CCU|
20|FH_F37778_0_0|SrvcGrp|27307|2022|PDM|895.00|99|0.00|BUNION CORRECTION|
20|FH_F89233_0_0|SrvcGrp|88138|2022|PCT|0.75|99|0.00|OR PROCEDURE FOR OBESITY|
20|FH_F133470_97068_0|SrvcGrp|112076|2022|PDM|1100.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F68831_0_0|SrvcGrp|9827|2022|PDM|104.50|99|0.00|RN INTERMITTENT VISIT|
20|FH_F97564_52246_0|SrvcGrp|73603|2022|PDM|9293.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F111456_33884_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149243_64114_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97543_33542_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F73542_0_0|SrvcGrp|60145|2022|PCT|0.50|99|0.00|CMS AMBULANCE - HCPCS A0999|
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 8 (NO REV)|
20|FH_F130108_0_0|SrvcGrp|15355|2022|PCT|0.60|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)|
20|FH_F148579_17057_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F144588_60090_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39082_0_0|SrvcGrp|38|2022|PDM|4300.00|99|0.00|NORMAL DELIVERY|
20|FH_F117335_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133008_78382_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146377_85007_0|SrvcGrp|75419|2022|PDM|326.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F117559_08619_0|SrvcGrp|100277|2022|PDM|45.00|99|0.00|HEPB VACCINE ADULT|
20|FH_F113074_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F117550_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F35411_0_0|SrvcGrp|3069|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F67861_0_0|SrvcGrp|11577|2022|PDM|850.00|99|0.00|DIALYSIS|
20|FH_F38425_0_0|SrvcGrp|10615|2022|PDM|120.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132693_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|ASPG IX|
20|FH_F40060_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS|
20|FH_F42500_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F118534_07652_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHENYLEPHRINE KETOROLAC|
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F141896_61462_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|310.32|99|0.00|HAPA WPA-NWPA 2012-13 ASC 226 W/O REV|
20|FH_F68865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35685_0_0|SrvcGrp|9795|2022|PDM|882.00|99|0.00|SUBACUTE REHAB|
20|FH_F39266_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|837.16|99|0.00|ASPG VI|
20|FH_F41158_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98625_08103_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F111190_30512_0|SrvcGrp|471|2022|PDM|736.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136429_0_0|SrvcGrp|79591|2022|PDM|490.00|99|0.00|CPT 43450|
20|FH_F100681_73104_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F54612_07631_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE|
20|FH_F36895_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F74602_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F32995_0_0|SrvcGrp|9911|2022|PCT|0.65|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F123752_44502_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|36.00|99|0.00|AEG 9 (NO REV)|
20|FH_F58856_0_0|SrvcGrp|360|2022|PDM|1800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F136542_02446_0|SrvcGrp|90397|2022|PDM|284.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F118156_19446_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F118170_18901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120418_43015_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F93292_62234_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F134029_06517_0|SrvcGrp|75545|2022|PDM|395.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F134057_32570_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F134126_11554_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F137147_75006_0|SrvcGrp|82720|2022|PDM|5874.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F142491_06033_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142267_78240_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F142547_70002_0|SrvcGrp|86842|2022|PDM|25.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F138627_82901_0|SrvcGrp|41456|2022|PDM|0.65|99|0.00|ENTERAL FORMULA - PEDIATRICS (CALORICALLY DENSE)|
20|FH_F74264_15301_0|SrvcGrp|81878|2022|PCT|1.00|99|0.00|RADIOLOGY W/ REV/HCPC|
20|FH_F140343_89052_0|SrvcGrp|86844|2022|PDM|30.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F140648_75070_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F140787_66427_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120152_0_0|SrvcGrp|93069|2022|PDM|8800.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F149527_62859_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118943_64506_0|SrvcGrp|19742|2022|PDM|83.00|99|0.00|MID-LINE INSERTION|
20|FH_F109884_36117_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109885_35473_0|SrvcGrp|86753|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F52832_0_0|SrvcGrp|42784|2022|PDM|175.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F147725_06002_0|SrvcGrp|28547|2022|PDM|4004.00|99|0.00|VITRECTOMY|
20|FH_F147922_10031_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F117091_28144_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117214_84020_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117240_37334_0|SrvcGrp|75485|2022|PDM|1700.00|99|0.00|AEG 4|
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1353.00|99|0.00|AEG 8 (NO REV)|
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)|
20|FH_F90880_15108_0|SrvcGrp|91066|2022|PCT|1.50|99|0.00|AETNA EPOETIN ALFA (MOD TC)|
20|FH_F91472_96001_0|SrvcGrp|11852|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F124890_76119_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129500_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F138543_60130_0|SrvcGrp|86722|2022|PDM|243.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|902.00|99|0.00|AEG 5  (NO REV)|
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|AEG 3 (NO REV)|
20|FH_F95880_02726_0|SrvcGrp|83057|2022|PDM|37.20|99|0.00|AETNA THERAPEUTIC EXERCISES|
20|FH_F137951_0_0|SrvcGrp|97484|2022|PDM|1458.00|99|0.00|ENDO CHOLANGIOPANCREATOGRAPH|
20|FH_F148545_84047_0|SrvcGrp|48396|2022|PDM|85.50|99|0.00|OT SERVICES|
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|5500.00|99|0.00|AEG 7 (NO REV)|
20|FH_F128919_48075_0|SrvcGrp|82223|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F144769_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|DRG 124-125 CARDIAC CATH|
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1086.00|99|0.00|AEG 5  (NO REV)|
20|FH_F149781_37404_0|SrvcGrp|26432|2022|PDM|3146.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F92677_08003_0|SrvcGrp|86829|2022|PDM|52.50|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F35727_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F106600_99202_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F83053_0_0|SrvcGrp|73000|2022|PDM|5566.00|99|0.00|AEG 6|
20|FH_F138054_0_0|SrvcGrp|88621|2022|PDM|159.00|99|0.00|SKILLED NURSING LPN|
20|FH_F39640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F57592_0_0|SrvcGrp|50942|2022|PDM|1350.00|99|0.00|MRI|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|379.58|99|0.00|HAPA WPA-NWPA 2012-13 ASC 220 W/O REV|
20|FH_F128605_20910_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F150523_20877_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F91152_60061_0|SrvcGrp|86722|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F102681_34237_0|SrvcGrp|73002|2022|PDM|851.00|99|0.00|AEG 7|
20|FH_F47795_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32933_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120089_0_0|SrvcGrp|75481|2022|PDM|444.00|99|0.00|AEG 2|
20|FH_F89015_74017_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150949_0_0|SrvcGrp|113855|2022|PDM|3000.00|99|0.00|SPINE FIXATION|
20|FH_F98640_0_0|SrvcGrp|65404|2022|PDM|1818.00|99|0.00|CPT 69421|
20|FH_F71162_0_0|SrvcGrp|29977|2022|PDM|53.00|99|0.00|WOUND CARE CANISTER SET|
20|FH_F132224_89119_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111437_33305_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F52032_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F127204_44420_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F102062_35447_0|SrvcGrp|48385|2022|PDM|145.00|99|0.00|SPEECH THERAPY|
20|FH_F86394_0_0|SrvcGrp|46482|2022|PDM|140.00|99|0.00|S9083 PER VISIT|
20|FH_F133021_00910_0|SrvcGrp|112307|2022|PDM|3000.00|99|0.00|PTA INTRAVASCULAR STENT|
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F146141_77598_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F96261_0_0|SrvcGrp|27969|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133268_63703_0|SrvcGrp|112230|2022|PDM|13.20|99|0.00|CCIIV4 VACCINE IM CULT PRSV FREE 0.5 ML|
20|FH_F151157_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F112165_0_0|SrvcGrp|72992|2022|PDM|2500.00|99|0.00|AEG 2|
20|FH_F97103_53295_0|SrvcGrp|73485|2022|PDM|3606.00|99|0.00|AETNA REHAB|
20|FH_F144191_0_0|SrvcGrp|80617|2022|PDM|9875.00|99|0.00|ARTHOPLASTY|
20|FH_F40851_0_0|SrvcGrp|38421|2022|PCT|0.50|99|0.00|INTERLUKEN II & DRUGS (IP)|
20|FH_F37309_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109561_97216_0|SrvcGrp|98331|2022|PCT|0.00|99|0.00|INTERIM LABOR FACILITY GLOBAL|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.13|99|0.00|5780852_USTN_XR_MODTC|
20|FH_F142043_45503_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128325_19904_0|SrvcGrp|79720|2022|PDM|1195.00|99|0.00|ACUTE REHAB II|
20|FH_F146373_66092_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132601_92677_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F118541_15222_0|SrvcGrp|79238|2022|PDM|2026.00|99|0.00|TRANSFER|
20|FH_F117909_92405_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F127960_85205_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F50237_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION|
20|FH_F133021_00910_0|SrvcGrp|112291|2022|PDM|10000.00|99|0.00|DEFIBRILLATOR|
20|FH_F133049_19145_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F113264_71860_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F132900_06074_0|SrvcGrp|112087|2022|PDM|524.00|99|0.00|PARTIAL HOSP EATING DISORDERS (>=18 YRS)|
20|FH_F121223_0_0|SrvcGrp|108081|2022|PDM|186.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F144588_60090_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F141657_85715_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F41396_0_0|SrvcGrp|472|2022|PDM|340.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117717_68410_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150602_59718_0|SrvcGrp|29155|2022|PDM|153.00|99|0.00|HOSPICE SVCS|
20|FH_F97160_77436_0|SrvcGrp|90854|2022|PDM|955.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F141654_15217_0|SrvcGrp|29346|2022|PDM|31.83|99|0.00|SKILLED NURSING- LPN|
20|FH_F33246_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F44795_0_0|SrvcGrp|11113|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME|
20|FH_F141849_76053_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F127327_27401_0|SrvcGrp|73559|2022|PDM|2233.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F112853_22408_0|SrvcGrp|22384|2022|PDM|100.00|99|0.00|HOME VISIT PRENATAL|
20|FH_F144468_45236_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40465_0_0|SrvcGrp|10063|2022|PDM|27000.00|99|0.00|DRG 515 ONLY CARDIAC DEF IMP W/O CARD CATH|
20|FH_F142782_16201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118645_19103_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F107400_0_0|SrvcGrp|88620|2022|PDM|127.00|99|0.00|SKILLED NURSING RN|
20|FH_F141967_89509_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F142847_07003_0|SrvcGrp|113995|2022|PCT|1.00|99|0.00|IMMUNIZATION ADMINISTRATION|
20|FH_F105921_80014_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F133018_84037_0|SrvcGrp|19742|2022|PDM|50.00|99|0.00|MID-LINE INSERTION|
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|594.00|99|0.00|ASPG III|
20|FH_F144211_30012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31542_0_0|SrvcGrp|88|2022|PDM|4500.00|99|0.00|OP LITHOTRIPSY|
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117272_24333_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F120437_85202_0|SrvcGrp|19742|2022|PDM|114.77|99|0.00|MID-LINE INSERTION|
20|FH_F133005_32726_0|SrvcGrp|83800|2022|PDM|5000.00|99|0.00|VBAC DELIVERY|
20|FH_F150022_32539_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F146244_76028_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F113326_80014_0|SrvcGrp|75545|2022|PDM|309.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|105.35|99|0.00|HAPA WPA-NWPA 2012-13 ASC 142 W/O REV|
20|FH_F71268_0_0|SrvcGrp|14366|2022|PDM|4100.00|99|0.00|ICU/PICU/CCU|
20|FH_F150003_22630_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117512_0_0|SrvcGrp|75189|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F115327_45320_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F38394_0_0|SrvcGrp|17077|2022|PDM|1582.02|99|0.00|ASPG VII|
20|FH_F69284_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F125475_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F71162_0_0|SrvcGrp|42827|2022|PDM|57.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F72934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS|
20|FH_F59274_0_0|SrvcGrp|17139|2022|PDM|600.00|99|0.00|HOSPICE CARE|
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 2 (NO REV)|
20|FH_F139467_46182_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139487_60076_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F139707_84010_0|SrvcGrp|116274|2022|PDM|7127.00|99|0.00|BONE ANCHORED HEARING AID|
20|FH_F150662_20901_0|SrvcGrp|73701|2022|PDM|65.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F150765_05001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146266_0_0|SrvcGrp|98347|2022|PDM|5481.00|99|0.00|HIP ARTHROSCOPY / SURGERY|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97082_90012_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124435_03882_0|SrvcGrp|46903|2022|PDM|433.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|582.00|99|0.00|AEG 3 (NO REV)|
20|FH_F107840_07006_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F116806_0_0|SrvcGrp|107097|2022|PDM|887.26|99|0.00|DRAINAGE OF MOUTH LESION|
20|FH_F124322_64131_0|SrvcGrp|24752|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F116346_0_0|SrvcGrp|105357|2022|PDM|435.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F43324_0_0|SrvcGrp|30552|2022|PDM|115.00|99|0.00|EARLY INTERVENTION OCCUPATIONAL THERAPY|
20|FH_F146266_0_0|SrvcGrp|34606|2022|PDM|5000.00|99|0.00|CPT 29827|
20|FH_F150313_78666_0|SrvcGrp|90854|2022|PDM|925.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F72590_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122271_79416_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|634.00|99|0.00|AEG 4 (NO REV)|
20|FH_F127143_68716_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35069_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|GENERAL ACUTE CARE|
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|1220.00|99|0.00|AEG 2 (NO REV)|
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PDM|3206.25|99|0.00|AEG 7 (NO REV)|
20|FH_F127418_0_0|SrvcGrp|107361|2022|PDM|22312.11|99|0.00|SECOND LEVEL CER DISKECTOMY|
20|FH_F129765_43015_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F35987_0_0|SrvcGrp|3015|2022|PCT|0.60|99|0.00|SUPPLIES|
20|FH_F40624_0_0|SrvcGrp|19846|2022|PDM|18909.00|99|0.00|MS DRG 249 ONLY|
20|FH_F124976_0_0|SrvcGrp|3178|2022|PDM|1213.00|99|0.00|ACUTE PSYCH|
20|FH_F140295_0_0|SrvcGrp|82113|2022|PDM|3543.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|1649.00|99|0.00|AEG 7 (NO REV)|
20|FH_F147339_08837_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130309_17044_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F110726_19720_0|SrvcGrp|89417|2022|PDM|383.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F149023_44122_0|SrvcGrp|71666|2022|PDM|25718.00|99|0.00|CPT 63655|
20|FH_F149512_62550_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134394_92101_0|SrvcGrp|105682|2022|PDM|360.00|99|0.00|INTENSIVE OUTPATIENT >=18 YRS|
20|FH_F43244_0_0|SrvcGrp|31134|2022|PDM|1100.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F131152_33403_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F36594_0_0|SrvcGrp|9832|2022|PDM|102.00|99|0.00|ST SVCS|
20|FH_F146266_0_0|SrvcGrp|89861|2022|PDM|6188.00|99|0.00|LUMBAR LAMINOTOMY|
20|FH_F94643_90501_0|SrvcGrp|24750|2022|PDM|33.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F128091_37129_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1575124_HCPCS_  MOD 53|
20|FH_F38742_0_0|SrvcGrp|28933|2022|PCT|1.00|99|0.00|OCN F/S PRICING:  (A & K CODES ONLY)|
20|FH_F90817_0_0|SrvcGrp|91043|2022|PDM|1574.00|99|0.00|ARTHROSCOPY/SURGERY (HCFA)|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PDM|1438.00|99|0.00|ASPG VII|
20|FH_F37490_0_0|SrvcGrp|26475|2022|PDM|1750.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F119376_0_0|SrvcGrp|72992|2022|PDM|535.00|99|0.00|AEG 2|
20|FH_F41363_0_0|SrvcGrp|68580|2022|PCT|1.00|99|0.00|IMMUNIZATIONS|
20|FH_F124044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134396_80045_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 3 (NO REV)|
20|FH_F128392_01026_0|SrvcGrp|104079|2022|PCT|1.30|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F147360_06415_0|SrvcGrp|88246|2022|PCT|1.00|99|0.00|INFLUENZA DNA AMP PROBE|
20|FH_F41463_0_0|SrvcGrp|34137|2022|PDM|53.00|99|0.00|OTHER SQ/IM INJECTABLE|
20|FH_F90232_15126_0|SrvcGrp|86843|2022|PDM|61.95|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F37764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|O2 SOLUTIONS MOD 26|
20|FH_F124325_37643_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40624_0_0|SrvcGrp|31038|2022|PDM|36409.00|99|0.00|MS DRG 233-234 ONLY|
20|FH_F132849_0_0|SrvcGrp|537|2022|PCT|0.61|99|0.00|OBSERVATION SERVICES|
20|FH_F150952_85008_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132056_32080_0|SrvcGrp|90854|2022|PDM|832.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F122841_0_0|SrvcGrp|38909|2022|PDM|2287.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F147166_03444_0|SrvcGrp|75419|2022|PDM|1250.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F37490_0_0|SrvcGrp|26432|2022|PDM|741.17|99|0.00|OP SURGICAL SERVICES|
20|FH_F150926_17404_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F75724_0_0|SrvcGrp|73041|2022|PCT|1.00|99|0.00|TPN|
20|FH_F146859_0_0|SrvcGrp|114837|2022|PDM|1096.00|99|0.00|FOOT/TOES PROCEDURES|
20|FH_F46284_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|SOCIAL WORKER|
20|FH_F37078_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F124316_28112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F128386_60124_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_F32666_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|OP SVCS|
20|FH_F115483_62002_0|SrvcGrp|30623|2022|PDM|7320.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F85772_0_0|SrvcGrp|84182|2022|PDM|1639.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE|
20|FH_F131954_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F110824_83221_0|SrvcGrp|75505|2022|PCT|0.85|99|0.00|CARDIAC STUDIES|
20|FH_F35369_0_0|SrvcGrp|12713|2022|PDM|13000.00|99|0.00|BRACHIOTHERAPY|
20|FH_F74845_0_0|SrvcGrp|59839|2022|PCT|1.15|99|0.00|TPA|
20|FH_F149399_17013_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147310_77036_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F42979_0_0|SrvcGrp|3400|2022|PDM|133.00|99|0.00|CPT 90885 PSYCHIATRIC EVALUATION|
20|FH_F123745_0_0|SrvcGrp|84939|2022|PDM|16000.00|99|0.00|SHOULDER JOINT|
20|FH_F139785_92629_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F100663_56537_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC|
20|FH_F150982_0_0|SrvcGrp|90822|2022|PDM|2753.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY|
20|FH_F112956_0_0|SrvcGrp|75483|2022|PDM|612.00|99|0.00|AEG 3|
20|FH_F127830_63703_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140233_35216_0|SrvcGrp|90436|2022|PDM|10500.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F143368_33028_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F143536_47546_0|SrvcGrp|95103|2022|PCT|1.00|99|0.00|LASER SURGERY|
20|FH_F93740_0_0|SrvcGrp|79867|2022|PDM|2700.00|99|0.00|VENA CAVA FILTER INSERTION/ADJUSTMENT|
20|FH_F101709_0_0|SrvcGrp|82113|2022|PDM|3045.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F131067_57105_0|SrvcGrp|103864|2022|PCT|2.00|99|0.00|AETNA ALL DRUGS AGENTS|
20|FH_F49051_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F132371_19083_0|SrvcGrp|88621|2022|PDM|102.00|99|0.00|SKILLED NURSING LPN|
20|FH_F116698_07470_0|SrvcGrp|86844|2022|PDM|39.90|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F83292_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.25|99|0.00|BARNESVILLE  OP REHAB @ 100%|
20|FH_F34797_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113649_01752_0|SrvcGrp|86825|2022|PDM|90.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F62373_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F62579_0_0|SrvcGrp|50164|2022|PDM|74.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 6 HRS|
20|FH_F105593_0_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F135840_0_0|SrvcGrp|75489|2022|PDM|867.00|99|0.00|AEG 6|
20|FH_F130755_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|GENERAL ACUTE CARE|
20|FH_F130898_06405_0|SrvcGrp|75545|2022|PDM|440.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F130908_32708_0|SrvcGrp|89417|2022|PDM|415.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F73864_0_0|SrvcGrp|48385|2022|PDM|12.00|99|0.00|SPEECH THERAPY|
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84593_0_0|SrvcGrp|471|2022|PDM|446.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133749_84604_0|SrvcGrp|112456|2022|PDM|50.00|99|0.00|PICC LINE INSERTION|
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 2 (NO REV)|
20|FH_F123609_28451_0|SrvcGrp|46903|2022|PDM|631.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F127529_43230_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F125181_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133749_84604_0|SrvcGrp|112462|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY DOUBLE/TRIPLE LUMEN|
20|FH_F127642_07047_0|SrvcGrp|72994|2022|PDM|1597.00|99|0.00|AEG 3|
20|FH_F121476_0_0|SrvcGrp|108840|2022|PDM|6695.00|99|0.00|LEAD CARDIOVERTER DEFIBRILLATOR|
20|FH_F127814_63103_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109244_19808_0|SrvcGrp|52953|2022|PDM|60.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F138951_41101_0|SrvcGrp|24750|2022|PDM|15.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F127651_44124_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F126341_27284_0|SrvcGrp|14947|2022|PCT|1.00|99|0.00|HOME INFUSION|
20|FH_F126341_27284_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP WITHOUT CPT 99601|
20|FH_F112060_07514_0|SrvcGrp|93268|2022|PCT|1.00|99|0.00|LOVENOX/ENOXAPARIN|
20|FH_F85651_33549_0|SrvcGrp|83801|2022|PDM|2530.00|99|0.00|INTERIM LABOR FACILITY GLOBA|
20|FH_F110247_08865_0|CSTM-ALL|CSTM-00|2020|PCT|2.60|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F87775_15106_0|SrvcGrp|29075|2022|PDM|55.00|99|0.00|HYDRATION THERAPY|
20|FH_F144248_0_0|SrvcGrp|42551|2022|PDM|1721.00|99|0.00|OP SURGERY|
20|FH_F124173_66215_0|SrvcGrp|24750|2022|PDM|10.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F111695_30286_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F126308_44515_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F127651_44124_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F40850_0_0|CSTM-ALL|CSTM-00|2020|PDM|828.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133808_73401_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F145642_15108_0|SrvcGrp|29076|2022|PDM|30.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F116806_0_0|SrvcGrp|107026|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MANDIBLE/MAXILLA-PARTIAL SUBPERIOSTEAL IMP|
20|FH_F136359_0_0|SrvcGrp|65625|2022|PDM|2875.00|99|0.00|CPT 30520|
20|FH_F138050_52301_0|SrvcGrp|109286|2022|PDM|13017.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F148600_30328_0|CSTM-ALL|CSTM-00|2020|PDM|998.00|99|0.00|AEG 5  (NO REV)|
20|FH_F85118_40403_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150160_01301_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F134993_75034_0|SrvcGrp|73841|2022|PDM|380.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F132922_91302_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F143054_26147_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F100784_59923_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F88956_0_0|SrvcGrp|75489|2022|PDM|2662.00|99|0.00|AEG 6|
20|FH_F85753_0_0|SrvcGrp|80284|2022|PDM|131.17|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F41396_0_0|SrvcGrp|34268|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F150001_33064_0|SrvcGrp|65621|2022|PDM|32.00|99|0.00|RN NURSING|
20|FH_F97182_21502_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F33517_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|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_F133155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F141411_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F97562_29803_0|SrvcGrp|73485|2022|PDM|4236.00|99|0.00|AETNA REHAB|
20|FH_F71268_0_0|SrvcGrp|3409|2022|PDM|800.00|99|0.00|NEWBORN NURSERY|
20|FH_F149840_80002_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100661_63640_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F138611_0_0|SrvcGrp|95559|2022|PDM|14894.00|99|0.00|HIP JOINT|
20|FH_F92677_08003_0|SrvcGrp|86842|2022|PDM|63.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F51129_0_0|CSTM-ALL|CSTM-00|2020|PDM|3657.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F79902_0_0|SrvcGrp|32585|2022|PDM|399.00|99|0.00|DIALYSIS|
20|FH_F139175_98229_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F139268_36695_0|SrvcGrp|113502|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F150739_44060_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150745_03301_0|SrvcGrp|104228|2022|PDM|212.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F150767_34741_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|HSS ASC|
20|FH_F150820_83843_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F150882_84041_0|SrvcGrp|95661|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F150882_84041_0|SrvcGrp|48743|2022|PDM|210.00|99|0.00|RN HOME VISIT (99600)|
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1322.00|99|0.00|AEG 4 (NO REV)|
20|FH_F39756_0_0|SrvcGrp|31081|2022|PDM|275.00|99|0.00|DENTAL PROCEDURES - CHILD|
20|FH_F90232_15126_0|SrvcGrp|86850|2022|PDM|47.25|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F110732_31513_0|SrvcGrp|73560|2022|PCT|0.60|99|0.00|AETNA SLEEP STUDIES|
20|FH_F35758_33710_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|1407.12|99|0.00|AEG 6 (NO REV)|
20|FH_F146266_0_0|SrvcGrp|88159|2022|PDM|6678.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F110783_93013_0|SrvcGrp|86834|2022|PDM|12.50|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F75944_0_0|SrvcGrp|34342|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F74825_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|956.62|99|0.00|SALLY BALIN,999182,ASC 601|
20|FH_F146266_0_0|SrvcGrp|98496|2022|PDM|14196.00|99|0.00|ARTHRODESIS POSTERIOR ATLAS|
20|FH_F146266_0_0|SrvcGrp|99172|2022|PDM|7658.00|99|0.00|CPT 28740|
20|FH_F74845_0_0|SrvcGrp|12184|2022|PCT|1.15|99|0.00|IMPLANTS|
20|FH_F124322_64131_0|SrvcGrp|24761|2022|PDM|37.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F113806_53083_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130044_0_0|SrvcGrp|111481|2022|PCT|1.00|99|0.00|VISION SERVICES|
20|FH_F36343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F117617_80439_0|SrvcGrp|73701|2022|PDM|75.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F147231_49440_0|SrvcGrp|27968|2022|PDM|36.71|99|0.00|SKILLED NURSING LPN|
20|FH_F34951_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147213_48609_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F114207_35243_0|SrvcGrp|86853|2022|PDM|35.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F127553_44321_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|2012.00|99|0.00|AEG 8 (NO REV)|
20|FH_F90232_15126_0|SrvcGrp|88620|2022|PDM|99.75|99|0.00|SKILLED NURSING RN|
20|FH_F117762_0_0|SrvcGrp|85778|2022|PDM|3640.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F116753_0_0|SrvcGrp|73602|2022|PDM|878.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F140295_0_0|SrvcGrp|76604|2022|PDM|3681.00|99|0.00|CPT 25447|
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124044_0_0|SrvcGrp|82137|2022|PCT|0.82|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F40564_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F97223_94028_0|SrvcGrp|76501|2022|PDM|490.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F94621_07728_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F113957_73554_0|SrvcGrp|73004|2022|PDM|2940.00|99|0.00|AEG 8|
20|FH_F112956_0_0|SrvcGrp|75495|2022|PDM|1493.00|99|0.00|AEG 9|
20|FH_F35728_34209_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113869_40215_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F146266_0_0|SrvcGrp|77021|2022|PDM|5672.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F44255_0_0|SrvcGrp|13811|2022|PDM|265.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F138016_19808_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F144029_0_0|SrvcGrp|108043|2022|PDM|214.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F114171_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F132096_89118_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F141287_14830_0|SrvcGrp|111930|2022|PDM|14.30|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F45798_0_0|SrvcGrp|9518|2022|PDM|1090.00|99|0.00|EMERGENCY ROOM|
20|FH_F32364_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS|
20|FH_F150979_44060_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F110727_34994_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114204_53191_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125407_68756_0|SrvcGrp|537|2022|PCT|0.98|99|0.00|OBSERVATION SERVICES|
20|FH_F134331_61021_0|SrvcGrp|88621|2022|PDM|150.00|99|0.00|SKILLED NURSING LPN|
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_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|970.00|99|0.00|AEG 8 (NO REV)|
20|FH_F135666_37601_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F122941_62702_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149263_0_0|SrvcGrp|115613|2022|PDM|4578.00|99|0.00|ARTHROS, SYNOVECT, SURG|
20|FH_F143742_60410_0|SrvcGrp|73610|2022|PCT|0.34|99|0.00|AETNA IMPLANTS|
20|FH_F145562_70458_0|SrvcGrp|86848|2022|PDM|25.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F117627_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F133892_60076_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110604_0_0|SrvcGrp|90977|2022|PDM|1100.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT|
20|FH_F143545_78723_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117382_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F50654_0_0|SrvcGrp|46891|2022|PCT|1.00|99|0.00|DRAINAGE OF EYE|
20|FH_F132883_31602_0|SrvcGrp|86846|2022|PDM|20.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F32534_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121225_98902_0|SrvcGrp|108704|2022|PCT|0.00|99|0.00|HOME HEALTH AIDE|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2005 Q4 AWP DRUGS/INJECTABLES NATL F/S|
20|FH_F133867_84075_0|SrvcGrp|95660|2022|PDM|474.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F63114_0_0|SrvcGrp|46350|2022|PDM|25.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F150302_30114_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 7 (NO REV)|
20|FH_F110453_0_0|SrvcGrp|72996|2022|PDM|677.00|99|0.00|AEG 4|
20|FH_F129638_0_0|SrvcGrp|15325|2022|PDM|600.00|99|0.00|ER LEVEL III|
20|FH_F50053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F88744_71103_0|CSTM-ALL|CSTM-00|2020|PDM|1443.00|99|0.00|AEG 2 (NO REV)|
20|FH_F130327_03867_0|SrvcGrp|48394|2022|PDM|57.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F83754_0_0|SrvcGrp|13131|2022|PCT|0.86|99|0.00|OBSERVATION SVCS|
20|FH_F149301_44122_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138050_52301_0|SrvcGrp|89412|2022|PDM|398.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F84712_0_0|SrvcGrp|73381|2022|PDM|13876.00|99|0.00|GAMMA KNIFE|
20|FH_F85894_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F72963_0_0|SrvcGrp|17067|2022|PDM|1556.00|99|0.00|ASPG II|
20|FH_F98800_85021_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F101100_50314_0|SrvcGrp|97912|2022|PDM|13875.00|99|0.00|ILEOSTOMY OR JEJUNOSTOMY|
20|FH_F102200_06416_0|SrvcGrp|86847|2022|PDM|45.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F102200_06416_0|SrvcGrp|17014|2022|PDM|47.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F71027_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127656_06068_0|SrvcGrp|46605|2022|PDM|109.20|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F116088_46410_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F132250_12550_0|CSTM-ALL|CSTM-00|2020|PDM|109.14|99|0.00|FAMILY PSYTX W PT 50 MINS|
20|FH_F133688_44504_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43872_0_0|SrvcGrp|473|2022|PDM|303.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F35381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|BURN SERVICES|
20|FH_F35404_0_0|SrvcGrp|43439|2022|PCT|0.75|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2402.00|99|0.00|AEG 5  (NO REV)|
20|FH_F33183_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F37200_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MIDWEST RADIOLOGICAL MODKN HCP|
20|FH_F40091_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F49895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL|
20|FH_F67339_0_0|SrvcGrp|9938|2022|PDM|65.00|99|0.00|SPEECH THERAPY|
20|FH_F82173_72712_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|AEG 10 (NO REV)|
20|FH_F72183_0_0|SrvcGrp|36815|2022|PDM|3000.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F148666_34205_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136092_0_0|SrvcGrp|80918|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F37679_0_0|SrvcGrp|27078|2022|PDM|50.00|99|0.00|PICC LINE INSERT|
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|930.00|99|0.00|ASPG V|
20|FH_F116061_80110_0|SrvcGrp|104076|2022|PCT|1.40|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F127375_28621_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F143834_06511_0|SrvcGrp|91398|2022|PDM|130.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AJ)|
20|FH_F135069_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F83253_33511_0|SrvcGrp|75545|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F99142_80233_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38875_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GLOABAL RAD|
20|FH_F37679_0_0|SrvcGrp|27132|2022|PDM|7.50|99|0.00|GROWTH HORMONE (MOD SH)|
20|FH_F116115_14437_0|SrvcGrp|90643|2022|PDM|20.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F143788_21230_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F128333_71001_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG VI F/S - BDSS|
20|FH_F77822_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F93791_0_0|SrvcGrp|27261|2022|PDM|4200.00|99|0.00|CPT 27446|
20|FH_F41350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1127.00|99|0.00|ASPG V|
20|FH_F89475_71202_0|SrvcGrp|104363|2022|PCT|2.05|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F62915_0_0|SrvcGrp|42825|2022|PDM|115.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F124788_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH|
20|FH_F126439_92627_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F38377_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F37267_0_0|SrvcGrp|8962|2022|PDM|82.50|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F113826_51445_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117583_21208_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137767_01841_0|SrvcGrp|58623|2022|PCT|0.79|99|0.00|C T SCANS|
20|FH_F112746_33844_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97183_25304_0|SrvcGrp|73559|2022|PDM|14683.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F147171_76036_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139167_42240_0|SrvcGrp|108484|2022|PDM|596.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F119897_78229_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F90455_0_0|SrvcGrp|14494|2022|PDM|31.81|99|0.00|CONTINUOUS HOMECARE|
20|FH_F125762_66701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149023_44122_0|SrvcGrp|96839|2022|PDM|13924.00|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F132008_85226_0|SrvcGrp|107226|2022|PCT|0.80|99|0.00|POWER WHEELCHAIR GROUP 2|
20|FH_F134869_08854_0|SrvcGrp|90631|2022|PDM|239.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F47902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37341_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38976_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F114206_37203_0|SrvcGrp|86846|2022|PDM|30.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F140032_60550_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140036_07702_0|SrvcGrp|113276|2022|PCT|1.15|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F143207_72301_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F102341_0_0|SrvcGrp|73483|2022|PDM|831.00|99|0.00|AETNA SUBACUTE III|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|GA RETINA SURG CTR ASC 18|
20|FH_F120216_68134_0|SrvcGrp|89149|2022|PDM|199.00|99|0.00|OP INTENSIVE|
20|FH_F136289_73099_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132371_19083_0|SrvcGrp|46609|2022|PDM|99.00|99|0.00|RESPIRATORY THERAPY CARE HOME VISIT|
20|FH_F132427_33853_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112712_63005_0|SrvcGrp|21920|2022|PCT|1.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F116766_06460_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F116835_94538_0|SrvcGrp|114315|2022|PDM|120.00|99|0.00|PSYCH TEST EVALUATION 1ST HOUR|
20|FH_F116915_30308_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F119929_70364_0|CSTM-ALL|CSTM-00|2020|PDM|141.40|99|0.00|HOSPICE ROUTINE HOME CARE (DAYS 0-60)|
20|FH_F120974_27607_0|SrvcGrp|10365|2022|PDM|2289.00|99|0.00|CPT CODE 99285|
20|FH_F126884_28379_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F34020_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49895_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F59732_0_0|SrvcGrp|17001|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F143528_0_0|SrvcGrp|67066|2022|PDM|10500.00|99|0.00|CERVICAL SURGERY|
20|FH_F101564_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126939_32405_0|SrvcGrp|73842|2022|PDM|195.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130138_02915_0|SrvcGrp|110147|2022|PCT|0.96|99|0.00|OP BEHAVIORAL OBSERVATION|
20|FH_F126523_0_0|SrvcGrp|73004|2022|PDM|1425.00|99|0.00|AEG 8|
20|FH_F83255_32025_0|SrvcGrp|33166|2022|PDM|420.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F121427_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F125028_19061_0|SrvcGrp|106790|2022|PCT|1.05|99|0.00|ALL DRUGS, AGENTS, INJ. DRUGS|
20|FH_F110925_01104_0|SrvcGrp|10577|2022|PDM|59.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F135165_15728_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151560_76012_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148166_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33712_0_0|SrvcGrp|18791|2022|PCT|0.75|99|0.00|MS DRG 215|
20|FH_F125652_66743_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41202_0_0|SrvcGrp|350|2022|PDM|1800.00|99|0.00|SURGICAL CARE|
20|FH_F38151_0_0|SrvcGrp|38|2022|PDM|2704.00|99|0.00|NORMAL DELIVERY|
20|FH_F97500_32025_0|SrvcGrp|73659|2022|PDM|6966.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F129656_15005_0|SrvcGrp|14893|2022|PDM|30.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F79625_0_0|SrvcGrp|471|2022|PDM|815.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|2133.00|99|0.00|AEG 4 (NO REV)|
20|FH_F120899_72758_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F143790_83440_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 5  (NO REV)|
20|FH_F37679_0_0|SrvcGrp|27080|2022|PDM|50.00|99|0.00|PICC LINE INSERTION (MID-LINE) (MOD SH)|
20|FH_F39857_0_0|SrvcGrp|31474|2022|PCT|0.75|99|0.00|DURABLE MEDICAL EQUIPMENT|
20|FH_F148262_17901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F94942_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38051_0_0|SrvcGrp|110|2022|PDM|300.00|99|0.00|CD - REHABILITATION|
20|FH_F37679_0_0|SrvcGrp|32706|2022|PDM|3.75|99|0.00|HOME INFUSION THERAPY MOD ( SH )|
20|FH_F131254_92211_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F141515_50010_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F123466_93420_0|SrvcGrp|73063|2022|PDM|855.00|99|0.00|OBSERVATION SERVICES|
20|FH_F122433_0_0|SrvcGrp|109082|2022|PDM|2000.00|99|0.00|SPINE FUSION|
20|FH_F110923_54768_0|SrvcGrp|104173|2022|PCT|2.00|99|0.00|IMMUNIZATIONS AND INJECTIONS|
20|FH_F149869_03253_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130747_0_0|SrvcGrp|109526|2022|PDM|2601.00|99|0.00|TREATMENT OF ANKLE FRACTURE|
20|FH_F148322_93060_0|SrvcGrp|89337|2022|PDM|1100.00|99|0.00|DETOXIFICATION|
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|1753.00|99|0.00|AEG 9 (NO REV)|
20|FH_F40043_0_0|SrvcGrp|14654|2022|PCT|0.76|99|0.00|HIP REVISION|
20|FH_F87412_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS SNF PPS|
20|FH_F130145_98043_0|SrvcGrp|90496|2022|PCT|1.00|99|0.00|FLUVIRIN VACC 3 YRS & > IM|
20|FH_F141802_17042_0|SrvcGrp|113085|2022|PDM|5162.00|99|0.00|CARDIAC CATH|
20|FH_F78603_0_0|SrvcGrp|29609|2022|PDM|55094.20|99|0.00|MS DRG 232 ONLY|
20|FH_F31433_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|HEMOPHILIA FACTOR|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 417-419|
20|FH_F110043_33308_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F87254_0_0|SrvcGrp|84184|2022|PDM|1642.00|99|0.00|AETNA REMOVAL OF BREAST IMPLANT|
20|FH_F35806_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 4 (NO REV)|
20|FH_F141588_60062_0|SrvcGrp|108484|2022|PDM|989.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F135052_18702_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40066_0_0|SrvcGrp|411|2022|PDM|4500.00|99|0.00|OP CARDIAC CATH|
20|FH_F129656_15005_0|SrvcGrp|24754|2022|PDM|25.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F142073_0_0|SrvcGrp|84318|2022|PDM|5980.00|99|0.00|SPINE INFUSION|
20|FH_F40418_0_0|SrvcGrp|38|2022|PDM|1230.00|99|0.00|NORMAL DELIVERY|
20|FH_F124899_45246_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F70163_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116161_28112_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F141527_36830_0|SrvcGrp|26869|2022|PDM|26.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F37443_0_0|SrvcGrp|1317|2022|PCT|0.45|99|0.00|CARDIAC CATH LAB SVCS|
20|FH_F84215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129536_0_0|SrvcGrp|92552|2022|PCT|1.00|99|0.00|AMNIOTIC MEMBRANE|
20|FH_F92276_32308_0|SrvcGrp|88977|2022|PDM|2940.00|99|0.00|C-SECTION DELIVERY|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|389.19|99|0.00|HAPA WPA-NWPA 2012-13 ASC 213 W/O REV|
20|FH_F101021_0_0|SrvcGrp|63297|2022|PDM|144.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F120175_19606_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F149666_33460_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F46094_0_0|SrvcGrp|11089|2022|PDM|50.00|99|0.00|NURSING CARE|
20|FH_F66410_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F122725_32216_0|SrvcGrp|29080|2022|PDM|328.00|99|0.00|SLEEP STUDIES|
20|FH_F86851_0_0|SrvcGrp|84978|2022|PDM|520.00|99|0.00|CPT 44366|
20|FH_F89778_0_0|SrvcGrp|35667|2022|PDM|1030.82|99|0.00|CPT 20680|
20|FH_F87480_0_0|SrvcGrp|86236|2022|PDM|2500.00|99|0.00|AETNA SPINAL SURGERY|
20|FH_F69683_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|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_F46832_0_0|SrvcGrp|22590|2022|PDM|80.00|99|0.00|PAIN MANAGAMENT - INTERMITTENT|
20|FH_F123735_32708_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131612_0_0|SrvcGrp|91627|2022|PDM|105.45|99|0.00|SKILLED NURSE SERVICES 15 MINS (HCFA)|
20|FH_F130721_04769_0|SrvcGrp|113275|2022|PCT|1.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT|
20|FH_F50654_0_0|SrvcGrp|46885|2022|PCT|1.00|99|0.00|REPAIR BROW DEFECT|
20|FH_F132606_0_0|SrvcGrp|34606|2022|PDM|1305.00|99|0.00|CPT 29827|
20|FH_F150239_75569_0|SrvcGrp|24752|2022|PCT|1.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F137362_0_0|SrvcGrp|81023|2022|PDM|214.00|99|0.00|AETNA CAPD CCPD IPD DIALYSIS PROC|
20|FH_F128825_45211_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F120720_24541_0|SrvcGrp|88621|2022|PDM|70.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150299_22046_0|SrvcGrp|27968|2022|PDM|32.00|99|0.00|SKILLED NURSING LPN|
20|FH_F35966_0_0|SrvcGrp|20870|2022|PDM|275.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) PARAMEDIC INTERCEPT|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|407.73|99|0.00|HAPA WPA-NWPA 2012-13 ASC 405 W/O REV|
20|FH_F114683_0_0|SrvcGrp|72996|2022|PDM|1655.00|99|0.00|AEG 4|
20|FH_F132883_31602_0|SrvcGrp|86847|2022|PDM|20.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F136318_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F93946_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85995_64111_0|SrvcGrp|62096|2022|PDM|181.00|99|0.00|CPT CODE 99350 VISIT LEVEL|
20|FH_F130763_0_0|SrvcGrp|79101|2022|PDM|4367.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F118265_46268_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F31714_0_0|SrvcGrp|361|2022|PDM|1325.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F136359_0_0|SrvcGrp|99073|2022|PDM|1.75|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F85353_16407_0|SrvcGrp|63806|2022|PDM|638.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 11|
20|FH_F138152_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120661_57001_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147987_65674_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144808_0_0|SrvcGrp|77021|2022|PDM|7215.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F129548_44130_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F125260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F134331_61021_0|SrvcGrp|48394|2022|PCT|1.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F114683_0_0|SrvcGrp|73006|2022|PDM|2688.00|99|0.00|AEG 9|
20|FH_F43863_0_0|SrvcGrp|27769|2022|PDM|25.00|99|0.00|SKILLED LPN HOURLY|
20|FH_F149362_19446_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35534_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F81377_0_0|SrvcGrp|11663|2022|PCT|1.13|99|0.00|IMPLANTS|
20|FH_F130364_01331_0|SrvcGrp|10363|2022|PDM|586.00|99|0.00|CPT CODE 99283|
20|FH_F135670_01749_0|SrvcGrp|86833|2022|PDM|12.50|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F133207_0_0|SrvcGrp|63463|2022|PDM|3809.00|99|0.00|CPT 52204|
20|FH_F118135_38109_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149139_07522_0|SrvcGrp|113235|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2&INF A&B&RSV AMP PRB|
20|FH_F100782_0_0|SrvcGrp|105076|2022|PDM|575.12|99|0.00|WINDBER MEDICAL CNTR ASC 121|
20|FH_F100782_0_0|SrvcGrp|105133|2022|PDM|305.71|99|0.00|WINDBER MEDICAL CNTR ASC 238|
20|FH_F132802_68022_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F127589_45459_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F83380_0_0|SrvcGrp|44705|2022|PDM|75.00|99|0.00|NURSING CARE|
20|FH_F85353_16407_0|SrvcGrp|63918|2022|PDM|103.88|99|0.00|HAPA WPA-NWPA 2012-13 ASC 144|
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.00|99|0.00|MSDRG 250-251 PERCUTANEOUS CARDIO PROC|
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|544.00|99|0.00|ASPG I|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "GLOBAL"|
20|FH_F145562_70458_0|SrvcGrp|86845|2022|PDM|25.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAMPTON ROADS GAST MOD RR|
20|FH_F127598_43232_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F126493_31501_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143620_81504_0|SrvcGrp|23683|2022|PDM|57.00|99|0.00|SKILLED NURSING RN|
20|FH_F85340_98195_0|CSTM-ALL|CSTM-00|2020|PCT|2.83|99|0.00|AETNA - APC GROUPER F|
20|FH_F82631_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.60|99|0.00|OCN F/S PRICING: ALL|
20|FH_F83754_0_0|SrvcGrp|4109|2022|PDM|2076.00|99|0.00|ACUTE PSYCH|
20|FH_F36552_0_0|SrvcGrp|18798|2022|PDM|37410.00|99|0.00|MS DRG 217|
20|FH_F128379_0_0|SrvcGrp|67066|2022|PDM|7553.00|99|0.00|CERVICAL SURGERY|
20|FH_F149319_07670_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F150239_75569_0|SrvcGrp|22589|2022|PCT|1.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F133778_38119_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149219_01966_0|SrvcGrp|115592|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1406.15|99|0.00|HAPA WPA-NWPA 2012-13 ASC 707 W/O REV|
20|FH_F141829_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149339_44147_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144808_0_0|SrvcGrp|74039|2022|PDM|7215.00|99|0.00|LAMINECTOMY|
20|FH_F120661_57001_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F79587_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F105361_80104_0|SrvcGrp|81779|2022|PDM|90.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F73967_0_0|SrvcGrp|42782|2022|PDM|68.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F146459_48154_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126359_24228_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116040_24637_0|SrvcGrp|22592|2022|PDM|30.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F131904_18915_0|SrvcGrp|88621|2022|PDM|112.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133658_60053_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F111561_10002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148880_26807_0|SrvcGrp|45307|2022|PDM|10.00|99|0.00|ADMIN OF INFLUENZA VIRUS VACCINE|
20|FH_F151059_60435_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F151144_35801_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 4 (NO REV) W/O EYE PROCEDURES|
20|FH_F151151_76504_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151154_91761_0|SrvcGrp|48385|2022|PDM|140.00|99|0.00|SPEECH THERAPY|
20|FH_F151221_71857_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121999_67002_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|854.00|99|0.00|AEG 6 (NO REV)|
20|FH_F35212_0_0|SrvcGrp|26001|2022|PDM|94.50|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F113738_27006_0|SrvcGrp|73700|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F69582_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS SNF PART B SERVICES|
20|FH_F82933_0_0|SrvcGrp|63|2022|PDM|707.71|99|0.00|SUBACUTE CARE|
20|FH_F98041_10027_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F91873_12723_0|SrvcGrp|10107|2022|PCT|0.68|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F91873_12723_0|SrvcGrp|85638|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F97740_01605_0|SrvcGrp|73605|2022|PDM|2536.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F85039_0_0|SrvcGrp|75485|2022|PDM|693.00|99|0.00|AEG 4|
20|FH_F111885_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F100640_48097_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F105700_08865_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F43717_0_0|SrvcGrp|97|2022|PDM|3010.00|99|0.00|C-SECTION|
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|620.00|99|0.00|AEG 10 (NO REV)|
20|FH_F137067_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F141147_02571_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F68950_0_0|SrvcGrp|40945|2022|PDM|4051.69|99|0.00|LITHOTRIPSY|
20|FH_F93252_0_0|SrvcGrp|93006|2022|PDM|1500.00|99|0.00|PAIN MANAGEMENT SURGICAL PROCEDURES|
20|FH_F122183_98146_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F62767_0_0|SrvcGrp|110428|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F37603_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F38047_0_0|SrvcGrp|16|2022|PDM|679.00|99|0.00|ACUTE REHABILITATION|
20|FH_F39066_0_0|SrvcGrp|3132|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F91898_0_0|SrvcGrp|3987|2022|PCT|0.95|99|0.00|TRAUMA CARE|
20|FH_F100703_0_0|SrvcGrp|96352|2022|PDM|6024.00|99|0.00|ANKLE JOINT|
20|FH_F124225_92506_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F127995_84010_0|SrvcGrp|73700|2022|PDM|42.25|99|0.00|AETNA - SKILLED NURSING|
20|FH_F55694_0_0|SrvcGrp|81722|2022|PDM|3859.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F67882_0_0|SrvcGrp|13292|2022|PCT|0.75|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F90653_0_0|SrvcGrp|15659|2022|PCT|0.70|99|0.00|CHEMOTHERAPY|
20|FH_F130039_80228_0|SrvcGrp|89149|2022|PDM|220.00|99|0.00|OP INTENSIVE|
20|FH_F136665_80004_0|SrvcGrp|113773|2022|PDM|185.00|99|0.00|TELEMEDICINE (MOD 95, GT)|
20|FH_F114666_30342_0|CSTM-ALL|CSTM-00|2020|PDM|1352.00|99|0.00|AEG 6 (NO REV)|
20|FH_F114678_78745_0|SrvcGrp|75419|2022|PDM|433.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F122832_61938_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134727_30650_0|SrvcGrp|109707|2022|PDM|1923.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F134796_70001_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F135719_45502_0|SrvcGrp|31916|2022|PDM|22947.37|99|0.00|MS DRG 473 ONLY|
20|FH_F136772_89109_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136913_68803_0|SrvcGrp|112973|2022|PDM|15108.00|99|0.00|C-SECTION W/ STERILIZATION W/ MCC|
20|FH_F131529_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F115244_63017_0|SrvcGrp|92761|2022|PCT|1.70|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115267_67156_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116393_07002_0|SrvcGrp|12526|2022|PDM|46.99|99|0.00|RADIOLOGY SVCS|
20|FH_F147586_44124_0|CSTM-ALL|CSTM-00|2020|PDM|1104.00|99|0.00|AEG 3 (NO REV) W/O ADJACENT TISSUE TRANSFER|
20|FH_F41540_0_0|SrvcGrp|33829|2022|PDM|1776.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 7|
20|FH_F41663_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|596.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F42402_0_0|SrvcGrp|12117|2022|PCT|0.90|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F42402_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42654_0_0|SrvcGrp|27968|2022|PDM|70.00|99|0.00|SKILLED NURSING LPN|
20|FH_F137906_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F35381_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|ADOLESCENT PSYCHIATRIC|
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|26432|2022|PDM|3000.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)|
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_F79429_0_0|SrvcGrp|12403|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F114853_0_0|SrvcGrp|98500|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F138777_43140_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138784_32216_0|SrvcGrp|88819|2022|PDM|777.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F138685_18017_0|SrvcGrp|89417|2022|PDM|291.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F67167_0_0|SrvcGrp|21459|2022|PDM|5716.00|99|0.00|MS DRG 774 ONLY REPLACEMENT MS DRG 805-806|
20|FH_F78265_0_0|CSTM-ALL|CSTM-00|2020|PDM|1486.00|99|0.00|ASPG II|
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|87.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 145 W/O REV|
20|FH_F151379_21045_0|SrvcGrp|72992|2022|PDM|589.00|99|0.00|AEG 2|
20|FH_F132163_17601_0|SrvcGrp|86641|2022|PDM|100.00|99|0.00|AETNA PSYCH DIAGNOSITC EVALUATION (MOD TD)|
20|FH_F145168_15601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F123194_97222_0|SrvcGrp|108061|2022|PCT|1.25|99|0.00|OP THERAPY SERVICES|
20|FH_F135388_48601_0|SrvcGrp|13422|2022|PDM|416.38|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F97142_94535_0|SrvcGrp|73559|2022|PDM|16356.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F97143_80012_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F91735_92653_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F135924_02906_0|SrvcGrp|3378|2022|PCT|1.03|99|0.00|OBSERVATION SVCS|
20|FH_F135924_02906_0|SrvcGrp|75506|2022|PCT|1.03|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F116431_76104_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F131361_18235_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130766_04967_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|AEG 7 (NO REV)|
20|FH_F69583_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121731_20164_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|LUZERNE HOME INFUSION AWP MOD KD|
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|AEG 5  (NO REV)|
20|FH_F131407_07607_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133668_63128_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111301_33122_0|SrvcGrp|104284|2022|PDM|11518.00|99|0.00|GASTRIC SLEEVE|
20|FH_F117486_0_0|SrvcGrp|103551|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F34864_0_0|SrvcGrp|9911|2022|PCT|0.70|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F40993_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS|
20|FH_F44336_0_0|SrvcGrp|167|2022|PDM|354.00|99|0.00|CD (ADULT) - REHABILITATION|
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1482.00|99|0.00|AEG 3 (NO REV)|
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|1370.00|99|0.00|AEG 6 (NO REV)|
20|FH_F112129_62220_0|SrvcGrp|93337|2022|PDM|288.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F112152_34994_0|SrvcGrp|89337|2022|PDM|796.00|99|0.00|DETOXIFICATION|
20|FH_F141035_0_0|SrvcGrp|113715|2022|PDM|7008.00|99|0.00|AMPUTATION OF FINGER / THUMB|
20|FH_F142655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102222_19720_0|SrvcGrp|86779|2022|PDM|47.25|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F102222_19720_0|SrvcGrp|86836|2022|PDM|10.50|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F129220_18445_0|SrvcGrp|108484|2022|PDM|565.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|2338.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132810_0_0|SrvcGrp|47183|2022|PDM|100.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F126770_43050_0|SrvcGrp|95660|2022|PDM|550.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F67901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F136347_30328_0|SrvcGrp|73063|2022|PDM|751.00|99|0.00|OBSERVATION SERVICES|
20|FH_F136398_23502_0|SrvcGrp|73841|2022|PDM|375.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F130512_40205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125249_0_0|SrvcGrp|89946|2022|PDM|1200.00|99|0.00|REPAIR OF KNEE LIGAMENT|
20|FH_F129231_30060_0|SrvcGrp|13557|2022|PCT|1.05|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F40258_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|70749|2022|PDM|3303.00|99|0.00|CPT 29823|
20|FH_F76303_0_0|SrvcGrp|42974|2022|PDM|150.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F140575_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F33486_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37679_0_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F128307_43219_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F130523_04605_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|AEG 8 (NO REV)|
20|FH_F121164_61761_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F124026_53188_0|SrvcGrp|89337|2022|PDM|700.00|99|0.00|DETOXIFICATION|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CATHETER CARE|
20|FH_F37590_0_0|SrvcGrp|9828|2022|PDM|35.70|99|0.00|HOME HEALTH AIDE|
20|FH_F123464_63841_0|SrvcGrp|75545|2022|PDM|327.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F128272_60640_0|SrvcGrp|86828|2022|PDM|110.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F124783_92408_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130032_72034_0|SrvcGrp|105439|2022|PDM|244.00|99|0.00|AETNA TERANIAL MAGN STIM TX DELI|
20|FH_F137352_43912_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC|
20|FH_F38984_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F93332_0_0|SrvcGrp|58775|2022|PDM|7025.00|99|0.00|CORPECTOMY|
20|FH_F123957_84321_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F122687_0_0|SrvcGrp|88025|2022|PDM|14632.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F129928_80033_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F31594_0_0|SrvcGrp|24|2022|PDM|1400.00|99|0.00|CARDIAC CATH|
20|FH_F125249_0_0|SrvcGrp|95560|2022|PDM|1400.00|99|0.00|REMOVAL OF SHOULDER BONE|
20|FH_F66687_0_0|SrvcGrp|69925|2022|PDM|22871.00|99|0.00|PTCA W/ CARDIAC ABLATION|
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG VIII|
20|FH_F125249_0_0|SrvcGrp|41327|2022|PDM|1200.00|99|0.00|OP SURGERY CPT 28308|
20|FH_F93534_45690_0|SrvcGrp|22954|2022|PDM|132.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F141468_75160_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117784_0_0|SrvcGrp|106300|2022|PDM|134.93|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F82173_72712_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F66481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PDM|2536.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F148489_0_0|SrvcGrp|75419|2022|PDM|440.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F135236_02840_0|SrvcGrp|113560|2022|PCT|1.01|99|0.00|OBSERVATION W/ ER|
20|FH_F139515_0_0|SrvcGrp|16732|2022|PDM|2150.00|99|0.00|HYSTEROSCOPY ABLATION|
20|FH_F56952_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F88114_32205_0|SrvcGrp|57968|2022|PDM|35.24|99|0.00|CONTINUOUS HOMECARE|
20|FH_F40709_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CTR ORTHO SURGERY CARVE OUTS|
20|FH_F130025_0_0|SrvcGrp|17100|2022|PDM|1102.00|99|0.00|SKILLED NURSING|
20|FH_F31798_0_0|SrvcGrp|58|2022|PCT|0.85|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F132779_0_0|SrvcGrp|8950|2022|PDM|1806.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F118271_46052_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125512_85295_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151408_0_0|CSTM-ALL|CSTM-00|2020|PDM|37.00|99|0.00|AEG 7 (NO REV)|
20|FH_F72183_0_0|SrvcGrp|12035|2022|PDM|4500.00|99|0.00|PTCA W/O STENT|
20|FH_F33513_0_0|SrvcGrp|15211|2022|PCT|0.60|99|0.00|HOME HEALTH CARE|
20|FH_F41021_0_0|SrvcGrp|17073|2022|PDM|3884.00|99|0.00|ASPG V|
20|FH_F111409_33761_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151081_85225_0|SrvcGrp|46903|2022|PDM|437.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F129130_92562_0|SrvcGrp|131|2022|PCT|0.46|99|0.00|PACEMAKER DEVICE|
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|1385.00|99|0.00|AEG 9 (NO REV)|
20|FH_F41281_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77923_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F97740_01605_0|SrvcGrp|73602|2022|PDM|3871.00|99|0.00|AETNA NEWBORN NURSERY I|
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|48396|2022|PDM|30.00|99|0.00|OT SERVICES|
20|FH_F113784_0_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F125910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93252_0_0|SrvcGrp|58636|2022|PDM|2500.00|99|0.00|CPT 62362|
20|FH_F137897_0_0|SrvcGrp|107863|2022|PCT|1.00|99|0.00|AETNA IMMUNIZATIONS|
20|FH_F40333_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F77944_0_0|SrvcGrp|8950|2022|PDM|7228.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F124060_76040_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F146993_66020_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43832_0_0|SrvcGrp|12263|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F37703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91998_0_0|SrvcGrp|91887|2022|PDM|1000.00|99|0.00|SKELETAL FIXATION|
20|FH_F129549_01238_0|SrvcGrp|29346|2022|PDM|49.89|99|0.00|SKILLED NURSING- LPN|
20|FH_F124414_92653_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F127995_84010_0|SrvcGrp|86850|2022|PDM|25.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F97040_31901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97040_31901_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F132037_66002_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F87856_0_0|SrvcGrp|75483|2022|PDM|663.00|99|0.00|AEG 3|
20|FH_F139758_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114666_30342_0|SrvcGrp|33982|2022|PDM|1760.00|99|0.00|CPT 28296|
20|FH_F114684_80547_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113937_15301_0|SrvcGrp|48398|2022|PDM|91.00|99|0.00|PT SERVICES|
20|FH_F138562_46703_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F114985_32073_0|SrvcGrp|104807|2022|PDM|34.00|99|0.00|BIOFEEDBACK ANY METHOD|
20|FH_F150763_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146040_0_0|SrvcGrp|87077|2022|PDM|182.35|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F122680_53511_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F134674_06473_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F134687_14226_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F134691_33445_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F134697_32566_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F134791_98034_0|SrvcGrp|23683|2022|PCT|0.00|99|0.00|SKILLED NURSING RN|
20|FH_F134796_70001_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F135719_45502_0|SrvcGrp|80679|2022|PCT|1.70|99|0.00|AETNA RADIOLOGY|
20|FH_F136829_29615_0|SrvcGrp|73842|2022|PDM|406.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F113713_17013_0|SrvcGrp|91393|2022|PDM|75.00|99|0.00|AETNA OFFICE OPT VISIT EST (MOD AF)|
20|FH_F69623_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAPA WPA/NWPA 2012 LABS 100%|
20|FH_F115210_21043_0|CSTM-ALL|CSTM-00|2020|PDM|769.00|99|0.00|AEG 3 (NO REV)|
20|FH_F115266_66736_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F147380_78520_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147519_52627_0|SrvcGrp|73842|2022|PDM|172.06|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147563_60160_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F147586_44124_0|SrvcGrp|89988|2022|PDM|1634.00|99|0.00|REPAIR HALLUX RIGIDUS|
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_F120612_23314_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F37850_0_0|SrvcGrp|24|2022|PCT|0.68|99|0.00|CARDIAC CATH|
20|FH_F42095_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SPECTRUM INFUSION S CODES|
20|FH_F39988_0_0|CSTM-ALL|CSTM-00|2020|PDM|274.00|99|0.00|PSYCHIATRIC FULL DAY TREATMENT|
20|FH_F42942_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F48836_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F50459_0_0|SrvcGrp|33166|2022|PDM|550.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F138730_22602_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138876_25302_0|SrvcGrp|86854|2022|PDM|50.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F138907_01040_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F57953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F151401_36607_0|SrvcGrp|3810|2022|PDM|190.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F132268_07060_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123184_20906_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F97142_94535_0|SrvcGrp|73605|2022|PDM|2335.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F97142_94535_0|SrvcGrp|73643|2022|PDM|1462.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F91735_92653_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135781_60643_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136081_71742_0|SrvcGrp|81919|2022|PCT|0.60|99|0.00|AETNA CARDIAC CATH|
20|FH_F119886_25504_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F100765_73735_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F100880_67735_0|SrvcGrp|16|2022|PDM|2831.00|99|0.00|ACUTE REHABILITATION|
20|FH_F131228_01826_0|SrvcGrp|79999|2022|PDM|471.74|99|0.00|AETNA ECHO EXAM|
20|FH_F131407_07607_0|SrvcGrp|17013|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F131407_07607_0|SrvcGrp|26868|2022|PDM|30.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F116463_76501_0|SrvcGrp|73841|2022|PDM|324.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F116469_92543_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F104800_0_0|SrvcGrp|23585|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F140629_0_0|SrvcGrp|33985|2022|PDM|1016.00|99|0.00|CPT 19120|
20|FH_F36479_0_0|SrvcGrp|115|2022|PDM|519.00|99|0.00|SKILLED NURSING CARE|
20|FH_F32803_0_0|SrvcGrp|3259|2022|PDM|944.00|99|0.00|ACUTE REHABILITATION|
20|FH_F65882_0_0|SrvcGrp|42824|2022|PDM|70.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|ASPG I|
20|FH_F72889_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|GENERAL ACUTE CARE|
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1257.00|99|0.00|AEG 2 (NO REV)|
20|FH_F101442_0_0|SrvcGrp|98471|2022|PDM|711.90|99|0.00|CLOSED TXMT TALOTARSAL JOINT|
20|FH_F40260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F112082_30720_0|SrvcGrp|92518|2022|PDM|178.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F101904_17057_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129240_10028_0|SrvcGrp|86842|2022|PDM|35.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F132347_01605_0|SrvcGrp|90707|2022|PDM|110.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F132347_01605_0|SrvcGrp|93098|2022|PDM|110.00|99|0.00|HOSPICE CARE|
20|FH_F132347_01605_0|SrvcGrp|48396|2022|PDM|147.00|99|0.00|OT SERVICES|
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|892.50|99|0.00|AEG 4 (NO REV)|
20|FH_F46158_0_0|SrvcGrp|17077|2022|PCT|0.65|99|0.00|ASPG VII|
20|FH_F33925_0_0|SrvcGrp|20287|2022|PDM|3350.00|99|0.00|C-SECTION|
20|FH_F98624_15701_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F102948_43606_0|SrvcGrp|43524|2022|PDM|168.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F70762_90805_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|ADULT INTENSIVE OP PSYCH|
20|FH_F92516_0_0|SrvcGrp|72998|2022|PDM|725.00|99|0.00|AEG 5|
20|FH_F95221_0_0|SrvcGrp|72990|2022|PDM|349.00|99|0.00|AEG 1|
20|FH_F100906_0_0|SrvcGrp|63459|2022|PDM|1800.00|99|0.00|CPT 52601|
20|FH_F67984_0_0|SrvcGrp|59424|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F122642_72212_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122911_92240_0|SrvcGrp|108484|2022|PDM|900.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F86696_16063_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS DEFAULT AT HOME NURSING|
20|FH_F86872_15215_0|SrvcGrp|86828|2022|PDM|120.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F136467_0_0|SrvcGrp|58671|2022|PDM|866.00|99|0.00|ASC CARVE OUT 64721|
20|FH_F43417_0_0|SrvcGrp|18932|2022|PDM|1500.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806|
20|FH_F117611_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_F134253_48879_0|SrvcGrp|3178|2022|PDM|1000.00|99|0.00|ACUTE PSYCH|
20|FH_F136475_89119_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F118152_20151_0|SrvcGrp|22592|2022|PDM|35.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F118198_38119_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F93360_64730_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F134167_10032_0|SrvcGrp|88620|2022|PDM|109.00|99|0.00|SKILLED NURSING RN|
20|FH_F137048_60714_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F137147_75006_0|SrvcGrp|33197|2022|PDM|28758.00|99|0.00|MS DRG 331 ONLY|
20|FH_F137147_75006_0|SrvcGrp|110281|2022|PDM|1890.00|99|0.00|AETNA OP MRI/MRA (MRIMRA)|
20|FH_F142390_20866_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F53732_0_0|SrvcGrp|14948|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1199.72|99|0.00|2006 MEDICARE ASPG VI|
20|FH_F114865_77488_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F140343_89052_0|SrvcGrp|86853|2022|PDM|30.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F140647_66210_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F149441_28401_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149531_80237_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F151604_44266_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F118943_64506_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F109886_36303_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F48292_0_0|SrvcGrp|44244|2022|PDM|446.00|99|0.00|HEMODIALYSIS - HOME TRAINING|
20|FH_F50519_0_0|SrvcGrp|46766|2022|PDM|45.00|99|0.00|CPT CODE 90804 PER VISIT|
20|FH_F147725_06002_0|SrvcGrp|33980|2022|PDM|3475.00|99|0.00|CPT 28298|
20|FH_F147801_90703_0|SrvcGrp|88819|2022|PDM|1454.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F147929_03820_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F101945_0_0|SrvcGrp|98403|2022|PDM|2261.00|99|0.00|RHINOPLASTY MAJOR REVISION|
20|FH_F109652_0_0|SrvcGrp|43486|2022|PDM|30199.00|99|0.00|MS DRG'S 459-460|
20|FH_F90613_05001_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F90735_94070_0|SrvcGrp|90280|2022|PDM|749.00|99|0.00|NON-INVASIVE PRENATAL|
20|FH_F129892_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F47552_0_0|SrvcGrp|43240|2022|PDM|646.00|99|0.00|OP SURGERY CARVE OUTS|
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|867.00|99|0.00|AEG 6 (NO REV)|
20|FH_F95880_02726_0|SrvcGrp|90493|2022|PDM|13.73|99|0.00|ELEC STIM OTHER THAN WOUND|
20|FH_F73626_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|986.00|99|0.00|AEG 10 (NO REV)|
20|FH_F39627_0_0|SrvcGrp|12214|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F86293_0_0|SrvcGrp|26275|2022|PDM|2794.00|99|0.00|CPT 29826|
20|FH_F97201_15068_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120437_85202_0|SrvcGrp|21711|2022|PDM|185.71|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F120437_85202_0|SrvcGrp|93338|2022|PDM|181.20|99|0.00|AETNA MED NUTRITION SEBSEQUENT|
20|FH_F124928_04210_0|SrvcGrp|90339|2022|PDM|132.30|99|0.00|SKILLED NURSING RN|
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.16|99|0.00|ASPG VI|
20|FH_F49669_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111551_32825_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133129_45863_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F89112_16509_0|SrvcGrp|3178|2022|PDM|1192.00|99|0.00|ACUTE PSYCH|
20|FH_F87155_04105_0|SrvcGrp|24761|2022|PDM|37.82|99|0.00|HOME INFUSION THERAPY|
20|FH_F103281_32086_0|SrvcGrp|76257|2022|PDM|2083.00|99|0.00|CARDIAC STUDIES|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD 53) - BDSS|
20|FH_F65899_0_0|SrvcGrp|21650|2022|PCT|0.65|99|0.00|MS DRG 003 ONLY|
20|FH_F128912_44313_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F101104_0_0|SrvcGrp|86828|2022|PDM|200.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F101851_78024_0|SrvcGrp|43524|2022|PDM|185.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F113257_19034_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120753_61701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F35411_0_0|SrvcGrp|9947|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F105760_98104_0|SrvcGrp|82846|2022|PCT|3.01|99|0.00|AETNA DME|
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|1515.00|99|0.00|AEG 9 (NO REV)|
20|FH_F133029_61264_0|SrvcGrp|89417|2022|PDM|500.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F112865_46135_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115312_78550_0|SrvcGrp|86722|2022|PDM|227.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F88512_0_0|SrvcGrp|46517|2022|PDM|10889.63|99|0.00|LAMINECTOMIES|
20|FH_F120954_0_0|SrvcGrp|108697|2022|PCT|0.00|99|0.00|HOSPICE IP/OP RESPITE CARE|
20|FH_F139825_0_0|SrvcGrp|109346|2022|PDM|4590.00|99|0.00|EXCISION OF CHALAZION DIFFERENT LIDS|
20|FH_F136330_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128893_0_0|SrvcGrp|94781|2022|PDM|160.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F136399_70445_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118152_20151_0|SrvcGrp|13929|2022|PDM|15.00|99|0.00|GROWTH HORMONE|
20|FH_F118244_30040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120490_64133_0|SrvcGrp|86848|2022|PDM|25.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F134011_84102_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F134011_84102_0|SrvcGrp|21920|2022|PDM|25.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F134151_17509_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139382_49202_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F142473_07663_0|SrvcGrp|73523|2022|PCT|1.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F117552_0_0|SrvcGrp|88030|2022|PDM|8500.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F53732_0_0|SrvcGrp|24750|2022|PDM|80.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F53732_0_0|SrvcGrp|21920|2022|PDM|70.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F138627_82901_0|SrvcGrp|111529|2022|PDM|70.00|99|0.00|MID-LINE INSERTION (HCFA)|
20|FH_F140867_56345_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP|
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|2475.00|99|0.00|AEG 7 (NO REV)|
20|FH_F149600_18901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151608_30236_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F92506_07666_0|SrvcGrp|74586|2022|PCT|0.34|99|0.00|AETNA OP HIGH COST DRUGS|
20|FH_F92634_08244_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F35928_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F117190_84020_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION|
20|FH_F117190_84020_0|SrvcGrp|74615|2022|PDM|450.00|99|0.00|INTENSIVE OUTPATIENT|
20|FH_F117126_12801_0|SrvcGrp|10365|2022|PDM|2080.00|99|0.00|CPT CODE 99285|
20|FH_F137818_31602_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137905_91364_0|SrvcGrp|87317|2022|PDM|1000.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F137938_29036_0|SrvcGrp|65163|2022|PDM|1785.00|99|0.00|NEWBORN LOWER LEVEL|
20|FH_F137938_29036_0|SrvcGrp|111322|2022|PCT|0.68|99|0.00|OBSERVATION SERVICES|
20|FH_F110720_0_0|SrvcGrp|72998|2022|PDM|2961.00|99|0.00|AEG 5|
20|FH_F124891_29935_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91067_0_0|SrvcGrp|73008|2022|PDM|884.00|99|0.00|AEG 10|
20|FH_F148720_0_0|SrvcGrp|114156|2022|PDM|450.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F129487_0_0|SrvcGrp|99073|2022|PDM|1.36|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F56274_0_0|CSTM-ALL|CSTM-00|2020|PDM|155.00|99|0.00|PEDIATRIC PHYSICAL THERAPY|
20|FH_F56274_0_0|SrvcGrp|34146|2022|PDM|155.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F98624_15701_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F102947_44084_0|CSTM-ALL|CSTM-00|2020|PDM|434.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|AEG 3 (NO REV)|
20|FH_F140007_0_0|SrvcGrp|96939|2022|PDM|4290.00|99|0.00|SHOULDER ARTHROSCOPY|
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_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|2285.00|99|0.00|AEG 4 (NO REV)|
20|FH_F72544_0_0|SrvcGrp|12290|2022|PDM|1685.00|99|0.00|DETOXIFICATION|
20|FH_F111594_0_0|SrvcGrp|88160|2022|PDM|7215.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F148419_01453_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F34706_0_0|SrvcGrp|11196|2022|PDM|37456.00|99|0.00|DRG 548 CORONARY BYPASS W/ CARDIAC CATH W/O MAJOR CV DX|
20|FH_F146253_60419_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32850_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F151157_0_0|CSTM-ALL|CSTM-00|2020|PDM|665.00|99|0.00|AEG 1 (NO REV)|
20|FH_F126030_29835_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F40645_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|ACUTE PSYCH|
20|FH_F127412_15301_0|SrvcGrp|111136|2022|PCT|1.00|99|0.00|PHENYLEPHRINE KETOROLAC INJECTION|
20|FH_F103281_32086_0|SrvcGrp|76744|2022|PDM|2083.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F144869_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142789_34104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F130553_18640_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F84032_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|1290.00|99|0.00|ASPG IV - IOWA|
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|ASPG VI|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|324.30|99|0.00|HAPA WPA-NWPA 2012-13 ASC 113 W/O REV|
20|FH_F128929_33030_0|SrvcGrp|73842|2022|PDM|202.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F134447_12883_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F146061_24502_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F88512_0_0|SrvcGrp|17083|2022|PDM|3658.15|99|0.00|ASPG X|
20|FH_F100784_59923_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F120437_85202_0|SrvcGrp|24752|2022|PDM|33.77|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F44023_0_0|SrvcGrp|38421|2022|PCT|0.69|99|0.00|INTERLUKEN II & DRUGS (IP)|
20|FH_F31824_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|OBSTETRICAL CARE (MOTHER & BABY)|
20|FH_F49776_0_0|SrvcGrp|12403|2022|PDM|25.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F100682_97401_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F146258_90004_0|SrvcGrp|110811|2022|PCT|0.60|99|0.00|INTENSIVE OP PSYCH|
20|FH_F92676_15063_0|SrvcGrp|70121|2022|PDM|8993.00|99|0.00|HAPA WPA:PTCA W/O STENT|
20|FH_F117289_01028_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F71271_0_0|SrvcGrp|68259|2022|PDM|15.00|99|0.00|SKILLED NURSING|
20|FH_F117346_75093_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F117380_60020_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F132080_0_0|SrvcGrp|87799|2022|PDM|169.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F60101_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INFUSION SERVICE|
20|FH_F101840_76054_0|SrvcGrp|26668|2022|PDM|19719.00|99|0.00|MS DRG 461 ONLY|
20|FH_F40645_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F147995_67037_0|CSTM-ALL|CSTM-00|2020|PDM|1765.00|99|0.00|AEG 2 (NO REV)|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|BILIRUBIN DIRECT|
20|FH_F35982_0_0|SrvcGrp|3932|2022|PDM|4500.00|99|0.00|LITHOTRIPSY|
20|FH_F141930_72032_0|CSTM-ALL|CSTM-00|2020|PDM|471.00|99|0.00|AEG 1 (NO REV)|
20|FH_F88956_0_0|SrvcGrp|73483|2022|PDM|1560.00|99|0.00|AETNA SUBACUTE III|
20|FH_F142831_08053_0|SrvcGrp|74668|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F106241_93309_0|SrvcGrp|16|2022|PDM|969.00|99|0.00|ACUTE REHABILITATION|
20|FH_F112632_66207_0|SrvcGrp|79720|2022|PDM|980.00|99|0.00|ACUTE REHAB II|
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1622.00|99|0.00|AEG 6 (NO REV)|
20|FH_F134533_67801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125176_20785_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F40256_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|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_F117346_75093_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|730.00|99|0.00|AEG 2 (NO REV)|
20|FH_F97561_30030_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F147800_0_0|SrvcGrp|115148|2022|PDM|138.00|99|0.00|CHEMODENERV TRUNK MUSC 6|
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|2573.00|99|0.00|IMPLANTS|
20|FH_F148662_01583_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126626_80906_0|SrvcGrp|73841|2022|PDM|484.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F97061_85012_0|SrvcGrp|73461|2022|PDM|10527.00|99|0.00|AETNA NICU IV|
20|FH_F48230_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|OP SVCS|
20|FH_F139470_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F132528_64014_0|SrvcGrp|48398|2022|PDM|127.00|99|0.00|PT SERVICES|
20|FH_F148556_13206_0|SrvcGrp|26871|2022|PDM|50.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3 HRS|
20|FH_F146211_68144_0|SrvcGrp|89989|2022|PDM|6473.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F120829_85283_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128703_68638_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120437_85202_0|SrvcGrp|86838|2022|PDM|33.77|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F141654_15217_0|SrvcGrp|48398|2022|PDM|95.68|99|0.00|PT SERVICES|
20|FH_F44334_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121009_76180_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124954_17055_0|SrvcGrp|107353|2022|PDM|305.91|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)|
20|FH_F81313_0_0|SrvcGrp|78537|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F127217_29650_0|SrvcGrp|3178|2022|PDM|1018.00|99|0.00|ACUTE PSYCH|
20|FH_F80855_0_0|SrvcGrp|72992|2022|PDM|700.00|99|0.00|AEG 2|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|DIURETIC THERAPY|
20|FH_F36973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101104_0_0|SrvcGrp|88809|2022|PDM|61.00|99|0.00|HOME HEALTH AIDE (HCFA)|
20|FH_F149840_80002_0|SrvcGrp|88781|2022|PDM|115.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F89015_74017_0|SrvcGrp|87393|2022|PDM|110.00|99|0.00|HCPCS G0151 (HCFA)|
20|FH_F55113_0_0|SrvcGrp|51263|2022|PDM|4770.00|99|0.00|ANGIOPLASTY|
20|FH_F103360_68845_0|SrvcGrp|93121|2022|PCT|2.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F102681_34237_0|SrvcGrp|14614|2022|PDM|3000.00|99|0.00|LITHOTRIPSY|
20|FH_F133470_97068_0|SrvcGrp|74668|2022|PDM|700.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120837_33309_0|SrvcGrp|86723|2022|PDM|518.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F133003_49012_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F101923_98104_0|SrvcGrp|89772|2022|PCT|3.17|99|0.00|MRI ANY LOWER EXTREMITY JNT|
20|FH_F42117_0_0|SrvcGrp|38008|2022|PDM|160.00|99|0.00|SONOGRAM|
20|FH_F150602_59718_0|SrvcGrp|88621|2022|PDM|98.00|99|0.00|SKILLED NURSING LPN|
20|FH_F67920_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117368_68114_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148361_68779_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F147995_67037_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F46197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72226_65804_0|SrvcGrp|83960|2022|PCT|0.56|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F35176_0_0|SrvcGrp|9830|2022|PDM|85.50|99|0.00|OT SVCS|
20|FH_F142014_33170_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F123872_75006_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F42168_0_0|SrvcGrp|12118|2022|PDM|600.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F133477_90247_0|SrvcGrp|72984|2022|PCT|1.40|99|0.00|CHEMOTHERAPY|
20|FH_F139248_78070_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139666_26175_0|SrvcGrp|111932|2022|PDM|51.91|99|0.00|COVID-19 NON-CDC TESTING LAB|
20|FH_F139680_76006_0|SrvcGrp|89149|2022|PDM|250.00|99|0.00|OP INTENSIVE|
20|FH_F150765_05001_0|SrvcGrp|80928|2022|PDM|167.00|99|0.00|PT/OT/ST IN HOME HEALTH|
20|FH_F116806_0_0|SrvcGrp|107075|2022|PDM|1923.16|99|0.00|REMOVAL OF JAW BONE LESION|
20|FH_F36903_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD TC|
20|FH_F127418_0_0|SrvcGrp|88492|2022|PDM|2327.65|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F40653_0_0|SrvcGrp|3066|2022|PCT|0.85|99|0.00|HIGH-COST DRUGS|
20|FH_F75547_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F35742_33407_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F110666_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139847_66205_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F69183_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|ASPG VI - FH SW CUSTOM GROUPERS|
20|FH_F117762_0_0|SrvcGrp|58776|2022|PDM|5928.00|99|0.00|DISKECTOMY|
20|FH_F131331_0_0|SrvcGrp|73656|2022|PDM|980.13|99|0.00|AETNA HOSPICE SVCS|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|2162.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F151517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F130309_17044_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 3 (NO REV)|
20|FH_F147225_48093_0|SrvcGrp|108622|2022|PDM|453.00|99|0.00|SUB ACUTE CARE LEVEL II|
20|FH_F34918_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
20|FH_F127553_44321_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F116437_0_0|SrvcGrp|88150|2022|PDM|1757.00|99|0.00|IMPLANT EYE DRUG SYSTEM|
20|FH_F132907_72949_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|ANTIBIOTIC THERAPY Q6 (MOD SH)|
20|FH_F113957_73554_0|SrvcGrp|73806|2022|PDM|682.50|99|0.00|AETNA ER|
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1732.00|99|0.00|AEG 7 (NO REV)|
20|FH_F102525_73134_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137719_28269_0|SrvcGrp|108484|2022|PDM|731.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F147303_70508_0|SrvcGrp|23683|2022|PDM|42.00|99|0.00|SKILLED NURSING RN|
20|FH_F113765_0_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F35776_33063_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- NO MODIFIERS|
20|FH_F115982_0_0|SrvcGrp|70749|2022|PDM|1200.00|99|0.00|CPT 29823|
20|FH_F140292_06902_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38742_0_0|SrvcGrp|29345|2022|PDM|40.00|99|0.00|SKILLED NURSING - LPN - MOD TE|
20|FH_F143668_0_0|SrvcGrp|114060|2022|PDM|3300.00|99|0.00|PNEUMATIC COMPRESSOR (MOD NU)|
20|FH_F74670_0_0|SrvcGrp|3044|2022|PDM|1150.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F149083_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SVCS|
20|FH_F37444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149655_78539_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F113869_40215_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F37493_0_0|SrvcGrp|453|2022|PDM|570.00|99|0.00|PSYCH PARTIAL HOSP|
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_F45798_0_0|SrvcGrp|537|2022|PDM|2650.00|99|0.00|OBSERVATION SERVICES|
20|FH_F49338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER QW|
20|FH_F90817_0_0|SrvcGrp|91047|2022|PDM|1217.00|99|0.00|REVISE MEDIAN NERVE AT WRIST (HCFA)|
20|FH_F35726_33324_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F39889_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|2705.04|99|0.00|LAPAROSCOPY|
20|FH_F35416_0_0|CSTM-ALL|CSTM-00|2020|PDM|3420.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91953_99508_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147213_48609_0|SrvcGrp|108622|2022|PDM|444.00|99|0.00|SUB ACUTE CARE LEVEL II|
20|FH_F112754_98057_0|SrvcGrp|73701|2022|PDM|102.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)|
20|FH_F111266_30339_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F141287_14830_0|SrvcGrp|73497|2022|PDM|1197.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F116437_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|1350.00|99|0.00|AEG 6 (NO REV)|
20|FH_F116332_0_0|SrvcGrp|115365|2022|PDM|2889.00|99|0.00|SHOULDER SURGERY|
20|FH_F39211_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F147082_02359_0|SrvcGrp|17698|2022|PDM|1104.00|99|0.00|ACUTE PSYCH (>=18 YRS)|
20|FH_F45226_0_0|SrvcGrp|15649|2022|PDM|4.95|99|0.00|HOME INFUSION THERAPY|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD RR KC RATES|
20|FH_F140143_24874_0|SrvcGrp|106317|2022|PDM|595.64|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F78009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F37189_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|OP SVCS|
20|FH_F151699_01752_0|SrvcGrp|17015|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F37897_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147304_75965_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125214_12428_0|SrvcGrp|75506|2022|PCT|0.65|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F112805_46011_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F97480_08204_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122282_30080_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F40501_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|PSYCHIATRIC RESIDENTIAL TREATMENT|
20|FH_F110726_19720_0|SrvcGrp|73841|2022|PDM|395.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F112045_90301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F140036_07702_0|SrvcGrp|108484|2022|PDM|701.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139907_42266_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143249_89801_0|SrvcGrp|14948|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F143447_53204_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143536_47546_0|SrvcGrp|36669|2022|PCT|1.00|99|0.00|IMMUNIZATION ADMIN|
20|FH_F32125_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101700_0_0|SrvcGrp|110443|2022|PDM|1476.00|99|0.00|REMOVE SPINAL CANAL CATHET|
20|FH_F101709_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F102224_0_0|SrvcGrp|93057|2022|PDM|2300.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F130951_15237_0|SrvcGrp|80918|2022|PDM|125.00|99|0.00|RESPITE CARE|
20|FH_F131067_57105_0|CSTM-ALL|CSTM-00|2020|PDM|8042.00|99|0.00|AEG 9 (NO REV)|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD RR KF|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD UE/KF)|
20|FH_F120190_92624_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F132390_60018_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120796_33548_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F116802_41224_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F116915_30308_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F126395_37043_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F125350_81050_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F103821_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110441_60062_0|SrvcGrp|73842|2022|PDM|280.88|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F63114_0_0|SrvcGrp|48385|2022|PDM|30.00|99|0.00|SPEECH THERAPY|
20|FH_F145641_06902_0|SrvcGrp|111738|2022|PDM|5607.00|99|0.00|REMOVE FEMUR LESION/BURSA|
20|FH_F110589_70809_0|SrvcGrp|89417|2022|PDM|452.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|503.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 107 W/O REV|
20|FH_F136318_0_0|SrvcGrp|87317|2022|PDM|1103.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F134943_17402_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F85212_71075_0|SrvcGrp|83824|2022|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES|
20|FH_F150165_06032_0|SrvcGrp|26278|2022|PDM|2387.00|99|0.00|CPT 29881|
20|FH_F109577_0_0|SrvcGrp|89783|2022|PDM|195.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F145593_92660_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F87333_0_0|SrvcGrp|86312|2022|PCT|0.00|99|0.00|CARDIAC CATH|
20|FH_F112024_0_0|SrvcGrp|72990|2022|PDM|1661.00|99|0.00|AEG 1|
20|FH_F120720_24541_0|SrvcGrp|87799|2022|PDM|95.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F117896_0_0|SrvcGrp|57968|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F146420_18940_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63842|2022|PDM|455.85|99|0.00|HAPA WPA-NWPA 2012-13 ASC 108|
20|FH_F145641_06902_0|SrvcGrp|88160|2022|PDM|11173.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F83196_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F81698_10457_0|SrvcGrp|22389|2022|PDM|10.50|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F121303_15501_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F83754_0_0|SrvcGrp|3069|2022|PCT|0.63|99|0.00|IMPLANTS|
20|FH_F109242_18466_0|SrvcGrp|102979|2022|PDM|193.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AH)|
20|FH_F133847_21702_0|SrvcGrp|83801|2022|PDM|1800.00|99|0.00|INTERIM LABOR FACILITY GLOBA|
20|FH_F146124_06112_0|SrvcGrp|106269|2022|PCT|0.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F109577_0_0|SrvcGrp|90340|2022|PDM|135.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133887_17013_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F110268_02891_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|1503.35|99|0.00|AEG 9 (NO REV)|
20|FH_F120709_64116_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114525_72401_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F127073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150305_18848_0|SrvcGrp|13228|2022|PDM|206.80|99|0.00|CPT CODE 99284|
20|FH_F111986_0_0|SrvcGrp|73006|2022|PDM|2015.00|99|0.00|AEG 9|
20|FH_F133715_63141_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|669.00|99|0.00|AEG 4 (NO REV)|
20|FH_F149106_07042_0|SrvcGrp|101842|2022|PDM|6728.00|99|0.00|REVISE BREAST RECONSTRUCTION|
20|FH_F150165_06032_0|SrvcGrp|77461|2022|PDM|2850.00|99|0.00|CPT 52356|
20|FH_F121476_0_0|SrvcGrp|104924|2022|PDM|150.00|99|0.00|GUIDE WIRE|
20|FH_F119542_45417_0|SrvcGrp|73842|2022|PDM|232.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
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_F133935_19958_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100782_0_0|SrvcGrp|97511|2022|PDM|1428.30|99|0.00|WINDBER MEDICAL CNTR ASC 4|
20|FH_F133951_48310_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129526_0_0|SrvcGrp|111372|2022|PCT|1.05|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F144228_0_0|SrvcGrp|114151|2022|PDM|7161.00|99|0.00|REBUILD OUTER EAR CANAL|
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F91412_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F31714_0_0|SrvcGrp|3480|2022|PDM|5600.00|99|0.00|DRG 125 CIRCULATORY DISORDER W/ CC W/O COMP DX|
20|FH_F77184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114683_0_0|SrvcGrp|41335|2022|PDM|8500.00|99|0.00|TOTAL HIP|
20|FH_F35042_0_0|SrvcGrp|43|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|ASPG II - FH SW CUSTOM GROUPERS|
20|FH_F100782_0_0|SrvcGrp|97681|2022|PDM|2824.90|99|0.00|WINDBER MEDICAL CNTR ASC 903|
20|FH_F127090_45601_0|SrvcGrp|105293|2022|PCT|1.25|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F54592_0_0|SrvcGrp|17013|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F54592_0_0|SrvcGrp|26863|2022|PDM|35.00|99|0.00|MISC INFUSION THERAPY (MOD SH)|
20|FH_F54592_0_0|SrvcGrp|42322|2022|PDM|60.00|99|0.00|HOME THERAPY|
20|FH_F42138_0_0|SrvcGrp|14494|2022|PDM|28.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F79644_0_0|SrvcGrp|16301|2022|PDM|4352.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F102200_06416_0|SrvcGrp|27615|2022|PDM|65.82|99|0.00|AETNA DRUGS|
20|FH_F105143_26062_0|SrvcGrp|73499|2022|PDM|744.00|99|0.00|AETNA ER LEVEL II|
20|FH_F66404_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F120795_27514_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|2444.00|99|0.00|AEG 8 (NO REV)|
20|FH_F131282_0_0|SrvcGrp|78045|2022|PCT|1.00|99|0.00|AETNA AMNIOTIC MEMBRANE|
20|FH_F37537_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|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_F129175_0_0|SrvcGrp|90976|2022|PDM|300.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT|
20|FH_F59274_0_0|SrvcGrp|48395|2022|PDM|32.00|99|0.00|OT SERVICES|
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|ASPG I|
20|FH_F40980_0_0|SrvcGrp|18886|2022|PDM|59298.00|99|0.00|MS DRG 234|
20|FH_F39844_0_0|SrvcGrp|115|2022|PDM|557.00|99|0.00|SKILLED NURSING CARE|
20|FH_F49637_0_0|CSTM-ALL|CSTM-00|2020|PDM|3696.00|99|0.00|OK SURGICAL HOSPITAL CVTY ENHANCED GROUPER 8|
20|FH_F117872_33462_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F89112_16509_0|SrvcGrp|39772|2022|PCT|0.55|99|0.00|MILLCREEK ASPG UNGROUPED|
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|1599.00|99|0.00|AEG 5  (NO REV)|
20|FH_F92833_0_0|SrvcGrp|45583|2022|PDM|2992.00|99|0.00|CPT 65730|
20|FH_F133018_84037_0|SrvcGrp|17013|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F101802_17201_0|SrvcGrp|88620|2022|PDM|134.00|99|0.00|SKILLED NURSING RN|
20|FH_F144020_15401_0|SrvcGrp|83960|2022|PCT|0.93|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F146208_76643_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97180_14604_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F132934_63005_0|SrvcGrp|107403|2022|PDM|2184.00|99|0.00|PARTIAL HOSPITALIZATION REHABILITATIVE SERVICES|
20|FH_F117793_90405_0|SrvcGrp|75522|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD|
20|FH_F109404_0_0|SrvcGrp|45005|2022|PCT|1.10|99|0.00|LABORATORY|
20|FH_F138827_0_0|SrvcGrp|113445|2022|PDM|100.00|99|0.00|TELEMEDICINE SERVICES (MOD GT) (HCFA)|
20|FH_F146282_08244_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F128099_70403_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F117954_17961_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|68.00|99|0.00|AETNA PSYTX W PT 45 MIN MOD AJ (HCFA)|
20|FH_F133490_90650_0|SrvcGrp|73841|2022|PDM|410.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F41142_0_0|SrvcGrp|166|2022|PDM|535.00|99|0.00|CD (ADULT) - DETOXIFICATION|
20|FH_F118612_21502_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118785_33315_0|SrvcGrp|73605|2022|PDM|1275.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F126666_44053_0|SrvcGrp|91782|2022|PDM|44.00|99|0.00|AETNA GROUP THERAPY (MOD HO)(HCFA)|
20|FH_F144188_76502_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112832_06776_0|SrvcGrp|472|2022|PDM|691.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F125348_84660_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F132543_79549_0|SrvcGrp|75506|2022|PCT|1.30|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F125009_17042_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120753_61701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F117275_16936_0|SrvcGrp|90854|2022|PDM|590.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F109882_36695_0|SrvcGrp|86748|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F120763_60957_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133287_40215_0|SrvcGrp|112287|2022|PCT|0.53|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F146370_19355_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148903_51101_0|SrvcGrp|46605|2022|PDM|124.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F121009_76180_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F78205_0_0|SrvcGrp|17069|2022|PDM|1382.98|99|0.00|ASPG III|
20|FH_F133490_90650_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|CHEMOTHERAPHY DRUGS|
20|FH_F142759_15074_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F102900_44883_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F120437_85202_0|SrvcGrp|14948|2022|PDM|183.46|99|0.00|HOME INFUSION THERAPY|
20|FH_F75202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F75706_0_0|SrvcGrp|42827|2022|PDM|50.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F67379_0_0|CSTM-ALL|CSTM-00|2020|PDM|8476.00|99|0.00|MS DRG 037-039|
20|FH_F51545_0_0|SrvcGrp|45784|2022|PDM|160.00|99|0.00|NUTRITIONAL SERVICES (RD)|
20|FH_F142818_34209_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138424_83402_0|SrvcGrp|74615|2022|PDM|220.00|99|0.00|INTENSIVE OUTPATIENT|
20|FH_F139148_70006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139467_46182_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F150799_44041_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150801_19380_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131331_0_0|SrvcGrp|29155|2022|PDM|165.42|99|0.00|HOSPICE SVCS|
20|FH_F34983_0_0|SrvcGrp|72|2022|PDM|408.00|99|0.00|NEWBORN NURSERY|
20|FH_F139147_0_0|SrvcGrp|88824|2022|PDM|9548.00|99|0.00|CPT 69631|
20|FH_F90182_80443_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (HCFA)|
20|FH_F147230_49505_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97480_08204_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146859_0_0|SrvcGrp|108316|2022|PDM|557.00|99|0.00|AETNA FIXATION OF KNEE JOINT|
20|FH_F146256_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F150944_18052_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F46433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2010 B CODES (GLOBAL)|
20|FH_F40607_0_0|SrvcGrp|27171|2022|PDM|45.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F92300_37303_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F130182_0_0|SrvcGrp|109453|2022|PDM|1457.00|99|0.00|R&L HRT ART/VENTRICLE ANGIO|
20|FH_F150440_35077_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F101844_0_0|SrvcGrp|93433|2022|PDM|8943.00|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F114963_62062_0|SrvcGrp|53987|2022|PCT|1.45|99|0.00|PHOTOTHERAPY|
20|FH_F69423_0_0|SrvcGrp|10989|2022|PDM|1561.00|99|0.00|ENDOSCOPIC LIGATION|
20|FH_F47733_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% L CODES|
20|FH_F125138_63663_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111288_0_0|SrvcGrp|67065|2022|PDM|19003.00|99|0.00|CERVICAL SURGERY|
20|FH_F93742_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F141169_0_0|SrvcGrp|74670|2022|PCT|0.00|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F41776_0_0|SrvcGrp|9936|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F37433_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F116269_92627_0|SrvcGrp|86746|2022|PCT|1.15|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F109601_0_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F115081_37185_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE|
20|FH_F120945_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F87254_0_0|SrvcGrp|68000|2022|PDM|1600.00|99|0.00|CPT 58561|
20|FH_F102302_0_0|SrvcGrp|16470|2022|PDM|16000.00|99|0.00|ASPIRATION|
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PDM|652.00|99|0.00|AEG 1 (NO REV)|
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)|
20|FH_F91622_0_0|SrvcGrp|10363|2022|PDM|925.00|99|0.00|CPT CODE 99283|
20|FH_F139173_0_0|SrvcGrp|73700|2022|PDM|176.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F34735_0_0|SrvcGrp|18362|2022|PCT|0.75|99|0.00|MS DRG 308|
20|FH_F41519_0_0|SrvcGrp|38|2022|PDM|2200.00|99|0.00|NORMAL DELIVERY|
20|FH_F141527_36830_0|SrvcGrp|24761|2022|PDM|21.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F39819_0_0|SrvcGrp|31206|2022|PDM|6566.00|99|0.00|NY DRG 296 ONLY|
20|FH_F117387_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|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_F131128_0_0|SrvcGrp|108348|2022|PDM|1273.00|99|0.00|TREAT FRACTURE RADIUS/ULNA|
20|FH_F60812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F67699_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127375_28621_0|SrvcGrp|108935|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F137943_0_0|SrvcGrp|54084|2022|PDM|4029.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F114970_28403_0|SrvcGrp|100859|2022|PDM|176.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F42945_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125983_82301_0|SrvcGrp|89337|2022|PDM|1000.00|99|0.00|DETOXIFICATION|
20|FH_F34691_0_0|SrvcGrp|13127|2022|PCT|0.70|99|0.00|DIALYSIS|
20|FH_F40066_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PDM|48.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128878_11203_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 235-236 CORONARY BYPASS|
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SERVICES|
20|FH_F149980_0_0|SrvcGrp|114519|2022|PDM|1921.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F93980_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS SNF PART B DRUGS|
20|FH_F150982_0_0|SrvcGrp|41334|2022|PDM|22021.00|99|0.00|TOTAL KNEE|
20|FH_F78162_0_0|SrvcGrp|11258|2022|PCT|0.35|99|0.00|DRUGS|
20|FH_F148265_06067_0|SrvcGrp|33986|2022|PDM|3336.00|99|0.00|CPT 26055|
20|FH_F127165_32112_0|SrvcGrp|90854|2022|PDM|736.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F86332_75081_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F32718_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34496_0_0|SrvcGrp|12981|2022|PDM|5160.75|99|0.00|ICU|
20|FH_F62915_0_0|SrvcGrp|34203|2022|PDM|72.00|99|0.00|OCN F/S: ANESTHESIA (HCFA)|
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|1441.00|99|0.00|ASPG 5 HEARTLAND HEALTHCARE|
20|FH_F58514_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO|
20|FH_F77903_0_0|SrvcGrp|3066|2022|PCT|0.60|99|0.00|HIGH-COST DRUGS|
20|FH_F126678_44870_0|SrvcGrp|95661|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F93881_15009_0|SrvcGrp|79786|2022|PCT|0.50|99|0.00|SLEEP STUDIES|
20|FH_F118194_50841_0|SrvcGrp|17014|2022|PDM|252.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F94403_0_0|SrvcGrp|58755|2022|PDM|5200.00|99|0.00|INJECTION PROC FOR JOINT|
20|FH_F80245_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|PEORIA DAY IMPLANTS|
20|FH_F128401_44615_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F130747_0_0|SrvcGrp|11669|2022|PDM|5202.00|99|0.00|OP SURG|
20|FH_F37863_0_0|SrvcGrp|24727|2022|PDM|400.00|99|0.00|ANESTHESIA SERVICES - OBSTETRIC|
20|FH_F120899_72758_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135219_68506_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149140_07522_0|SrvcGrp|114975|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F42822_0_0|SrvcGrp|33251|2022|PDM|350.00|99|0.00|CD (CHILD) - REHAB|
20|FH_F39892_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F77903_0_0|SrvcGrp|10944|2022|PCT|0.85|99|0.00|EMERGENCY ROOM|
20|FH_F135299_61021_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F39479_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F93881_15009_0|SrvcGrp|88487|2022|PDM|9930.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F110925_01104_0|SrvcGrp|42384|2022|PDM|47.28|99|0.00|ENTERAL ADDITIVE (B4088)|
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|517.00|99|0.00|ASPG II|
20|FH_F130479_67526_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126784_80809_0|SrvcGrp|104079|2022|PCT|0.70|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F93791_0_0|SrvcGrp|89404|2022|PDM|4200.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F150982_0_0|SrvcGrp|104008|2022|PDM|4992.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS|
20|FH_F66630_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|PARTIAL EATING DISORDERS|
20|FH_F150982_0_0|SrvcGrp|105235|2022|PDM|4955.00|99|0.00|PARTIAL REMOVAL OF THYROID|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PDM|6450.83|99|0.00|MS DRG 765|
20|FH_F151042_60659_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F101441_0_0|SrvcGrp|96919|2022|PDM|4323.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F138662_78624_0|SrvcGrp|90854|2022|PDM|675.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F124441_0_0|SrvcGrp|89980|2022|PDM|5700.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F112794_01040_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F126147_45241_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F141034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90817_0_0|SrvcGrp|90375|2022|PDM|1574.00|99|0.00|KNEE ARTHROSCOPY/SURGERY|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|84.39|99|0.00|SALLY BALIN,999182,ASC 124|
20|FH_F76285_0_0|CSTM-ALL|CSTM-00|2020|PDM|16.00|99|0.00|RN HIGH TECH HOURLY|
20|FH_F131532_46952_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110824_83221_0|SrvcGrp|74403|2022|PCT|0.85|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|13000.00|99|0.00|MS DRG 472-473|
20|FH_F117023_0_0|SrvcGrp|102261|2022|PDM|3500.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F93961_0_0|SrvcGrp|79757|2022|PDM|926.00|99|0.00|ESOPHAGUS ENDOSCOPY REPAIR|
20|FH_F124514_21215_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122394_75979_0|SrvcGrp|108484|2022|PDM|530.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F99920_63141_0|SrvcGrp|73656|2022|PDM|475.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F38475_0_0|SrvcGrp|10624|2022|PDM|68.00|99|0.00|CPT CODE 99347|
20|FH_F147304_75965_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)|
20|FH_F124470_90025_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F150927_64836_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141034_0_0|SrvcGrp|108443|2022|PDM|400.00|99|0.00|HEMODIALYSIS W/ TRAINING|
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|ASPG 7 SURGICAL EYE CENTER|
20|FH_F116806_0_0|SrvcGrp|107085|2022|PDM|1923.16|99|0.00|REPAIR UPPER JAW FISTULA|
20|FH_F132126_08037_0|SrvcGrp|90854|2022|PDM|815.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F110729_15068_0|SrvcGrp|89337|2022|PDM|572.00|99|0.00|DETOXIFICATION|
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F110725_48047_0|SrvcGrp|86723|2022|PDM|350.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
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_F32825_0_0|SrvcGrp|11258|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F147347_70806_0|SrvcGrp|46903|2022|PDM|540.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F32986_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F150961_89169_0|SrvcGrp|29347|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F149579_95815_0|SrvcGrp|115691|2022|PDM|41.84|99|0.00|PHYSIOLOGIC MONITORING REM ADDL 20 MINS|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|688.00|99|0.00|HAPA EPA ASC 4|
20|FH_F138017_73129_0|SrvcGrp|108935|2022|PCT|0.33|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F150952_85008_0|SrvcGrp|75419|2022|PDM|425.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F151000_20707_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F119940_60126_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97183_25304_0|SrvcGrp|88977|2022|PDM|8151.00|99|0.00|C-SECTION DELIVERY|
20|FH_F151699_01752_0|SrvcGrp|86841|2022|PDM|119.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F129174_20910_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150459_08021_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F35678_0_0|SrvcGrp|18316|2022|PDM|16952.00|99|0.00|MS DRG 042|
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117762_0_0|SrvcGrp|93071|2022|PDM|7280.00|99|0.00|POSTERIOR SEGMENTAL INSTRU|
20|FH_F113116_23847_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F89674_18640_0|SrvcGrp|13238|2022|PDM|5.25|99|0.00|VENIPUNCTURE|
20|FH_F108260_63141_0|SrvcGrp|48396|2022|PDM|83.00|99|0.00|OT SERVICES|
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 3 (NO REV)|
20|FH_F89851_83854_0|SrvcGrp|80123|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F140295_0_0|SrvcGrp|67064|2022|PDM|1650.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|748.00|99|0.00|AEG 3 (NO REV)|
20|FH_F117615_30525_0|CSTM-ALL|CSTM-00|2020|PDM|844.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F140292_06902_0|SrvcGrp|471|2022|PDM|575.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F102525_73134_0|SrvcGrp|31927|2022|PDM|44000.00|99|0.00|MS DRG 457 ONLY|
20|FH_F131418_75215_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F74845_0_0|SrvcGrp|903|2022|PCT|0.75|99|0.00|PTC ANGIOPLASTY|
20|FH_F90817_0_0|SrvcGrp|91025|2022|PDM|2914.00|99|0.00|OPEN TREATMENT OF DISTAL (HCFA)|
20|FH_F139951_92870_0|SrvcGrp|109798|2022|PCT|1.30|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F143533_30013_0|SrvcGrp|74782|2022|PDM|131.00|99|0.00|ULTRASOUND|
20|FH_F101380_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.00|99|0.00|AEG 1 (NO REV)|
20|FH_F130937_98002_0|SrvcGrp|89337|2022|PDM|796.00|99|0.00|DETOXIFICATION|
20|FH_F47952_0_0|SrvcGrp|44284|2022|PDM|125.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F49329_0_0|SrvcGrp|45552|2022|PDM|45.00|99|0.00|SKILLED NURSING (ADDITIONAL HOURS)|
20|FH_F132371_19083_0|SrvcGrp|29346|2022|PDM|38.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F132479_90290_0|SrvcGrp|87317|2022|PDM|1800.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F116684_30701_0|SrvcGrp|94738|2022|PCT|1.00|99|0.00|FLUZONE VACC IM (>=3 YRS)|
20|FH_F116698_07470_0|SrvcGrp|86853|2022|PDM|39.90|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F116835_94538_0|SrvcGrp|109215|2022|PDM|126.00|99|0.00|PSYCH TEST EVALUATION 1ST HOUR|
20|FH_F145815_30540_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128358_46072_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F63432_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS|
20|FH_F118910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143968_94520_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F126489_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F38357_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F130755_04401_0|SrvcGrp|72984|2022|PCT|0.93|99|0.00|CHEMOTHERAPY|
20|FH_F39902_0_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133749_84604_0|SrvcGrp|112449|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY (HCFA)|
20|FH_F119227_01752_0|SrvcGrp|24754|2022|PDM|18.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F146640_54155_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F87333_0_0|SrvcGrp|75182|2022|PCT|0.84|99|0.00|AETNA IMPLANTS|
20|FH_F149528_0_0|SrvcGrp|46903|2022|PDM|730.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F133972_27103_0|SrvcGrp|86837|2022|PDM|45.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F110881_63125_0|SrvcGrp|42782|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F130017_02302_0|SrvcGrp|13881|2022|PCT|0.67|99|0.00|PACEMAKER DEVICE|
20|FH_F143567_62207_0|SrvcGrp|46963|2022|PDM|71.00|99|0.00|RN SERVICES (CPT 99602)|
20|FH_F133775_83401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|481.00|99|0.00|AEG 1 (NO REV)|
20|FH_F39532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.01|99|0.00|OP SVCS|
20|FH_F79743_0_0|SrvcGrp|14609|2022|PCT|0.57|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F58396_0_0|SrvcGrp|17140|2022|PDM|180.00|99|0.00|HOSPICE RESPITE SVCS|
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_F112065_20852_0|SrvcGrp|73701|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F148484_19462_0|SrvcGrp|75419|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F133877_84117_0|SrvcGrp|95440|2022|PDM|26.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F133922_70563_0|SrvcGrp|86603|2022|PDM|430.42|99|0.00|SLEEP STUDIES (MOD TC)|
20|FH_F36552_0_0|SrvcGrp|18795|2022|PDM|37410.00|99|0.00|MS DRG 216|
20|FH_F110453_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85133_85251_0|SrvcGrp|27968|2022|PDM|43.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133767_61254_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133947_93950_0|SrvcGrp|73841|2022|PDM|334.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F120583_43219_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES|
20|FH_F143617_49412_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F77943_0_0|SrvcGrp|9936|2022|PCT|0.70|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F52713_0_0|SrvcGrp|3029|2022|PDM|1025.00|99|0.00|NEWBORN NURSERY|
20|FH_F129509_0_0|SrvcGrp|92409|2022|PDM|5139.00|99|0.00|PERQ CERVICOTHORACIC INJECT|
20|FH_F113325_80004_0|SrvcGrp|93291|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA ESRD USE|
20|FH_F144228_0_0|SrvcGrp|22915|2022|PDM|2647.00|99|0.00|CPT CODE 42820|
20|FH_F120425_11106_0|SrvcGrp|73842|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F108160_0_0|SrvcGrp|29428|2022|PDM|500.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT|
20|FH_F119379_0_0|SrvcGrp|107846|2022|PDM|672.00|99|0.00|REPAIR FINGER TENDON|
20|FH_F139569_15063_0|CSTM-ALL|CSTM-00|2020|PDM|1610.00|99|0.00|AEG 9 (NO REV)|
20|FH_F134331_61021_0|SrvcGrp|29346|2022|PDM|25.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F43679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F36753_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD AW|
20|FH_F130763_0_0|SrvcGrp|33967|2022|PDM|3346.00|99|0.00|CPT 47562|
20|FH_F120719_27540_0|SrvcGrp|116131|2022|PCT|0.71|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F125133_20601_0|SrvcGrp|23683|2022|PDM|68.96|99|0.00|SKILLED NURSING RN|
20|FH_F121601_47446_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F121603_46761_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F149059_19702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F69766_0_0|CSTM-ALL|CSTM-00|2020|PDM|340.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F81861_0_0|SrvcGrp|11000|2022|PCT|0.45|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F93179_73460_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F136327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135663_24401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132938_33710_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133207_0_0|SrvcGrp|39909|2022|PDM|2632.00|99|0.00|PARTIAL MASTECTOMY|
20|FH_F150299_22046_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F130327_03867_0|SrvcGrp|73742|2022|PDM|8.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F39898_0_0|SrvcGrp|22954|2022|PDM|170.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F112468_0_0|SrvcGrp|72998|2022|PDM|817.00|99|0.00|AEG 5|
20|FH_F43679_0_0|CSTM-ALL|CSTM-00|2020|PDM|210.00|99|0.00|CD DAY TREATMENT|
20|FH_F110466_06870_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F126341_27284_0|SrvcGrp|24750|2022|PCT|1.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F100680_43130_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F88274_0_0|SrvcGrp|75481|2022|PDM|700.00|99|0.00|AEG 2|
20|FH_F147962_85008_0|CSTM-ALL|CSTM-00|2020|PDM|3793.00|99|0.00|AEG 5  (NO REV)|
20|FH_F123851_03235_0|SrvcGrp|46605|2022|PDM|163.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F149121_01520_0|SrvcGrp|473|2022|PDM|435.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F133950_06029_0|SrvcGrp|109945|2022|PCT|1.00|99|0.00|VACCINE|
20|FH_F77943_0_0|SrvcGrp|26690|2022|PDM|120903.24|99|0.00|MS DRG 215 ONLY|
20|FH_F149319_07670_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F135656_74820_0|SrvcGrp|75419|2022|PDM|424.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F143715_33161_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 7 (NO REV)|
20|FH_F84611_30281_0|SrvcGrp|82636|2022|PDM|2892.00|99|0.00|INSERT HEART PM ATRIAL|
20|FH_F51276_0_0|SrvcGrp|10538|2022|PDM|90.00|99|0.00|NURSING CARE|
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 3 (NO REV)|
20|FH_F43698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F63117_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F100742_00616_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F72907_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|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_F137946_0_0|SrvcGrp|113235|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2&INF A&B&RSV AMP PRB|
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|2029.00|99|0.00|AEG 10 (NO REV)|
20|FH_F129658_77043_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F146642_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.18|99|0.00|HSS ASC|
20|FH_F117082_66216_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F151541_01436_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F102184_0_0|SrvcGrp|98498|2022|PDM|7215.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC|
20|FH_F120910_63021_0|SrvcGrp|74668|2022|PDM|343.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F73013_0_0|SrvcGrp|16552|2022|PDM|60.07|99|0.00|LIPIDS|
20|FH_F150699_0_0|SrvcGrp|109508|2022|PDM|9450.00|99|0.00|REMOVAL OF PM GENERATOR|
20|FH_F128276_66441_0|SrvcGrp|89149|2022|PDM|132.00|99|0.00|OP INTENSIVE|
20|FH_F123468_63384_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F123943_84041_0|SrvcGrp|95660|2022|PDM|605.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F40840_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136571_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121427_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109240_21201_0|SrvcGrp|89644|2022|PDM|56.00|99|0.00|RADIATION THERAPY DOSE PLAN|
20|FH_F148480_03079_0|CSTM-ALL|CSTM-00|2020|PDM|1758.75|99|0.00|AEG 3 (NO REV)|
20|FH_F130724_06437_0|SrvcGrp|472|2022|PDM|585.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120215_92064_0|SrvcGrp|108484|2022|PDM|556.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F137067_0_0|SrvcGrp|92413|2022|PDM|5250.00|99|0.00|SPINAL CRD DECOMP->2 THORAC|
20|FH_F56136_0_0|SrvcGrp|17379|2022|PCT|0.92|99|0.00|CCPD TRAINING|
20|FH_F110180_0_0|SrvcGrp|29930|2022|PDM|400.00|99|0.00|DIALYSIS|
20|FH_F137239_0_0|SrvcGrp|86723|2022|PDM|451.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F80283_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140929_67206_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73013_0_0|SrvcGrp|63219|2022|PDM|78.36|99|0.00|VENIPUNCTURE PER VISIT|
20|FH_F103100_47150_0|SrvcGrp|72996|2022|PDM|1300.00|99|0.00|AEG 4|
20|FH_F119511_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F131254_92211_0|SrvcGrp|14948|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F148324_93101_0|SrvcGrp|74668|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129656_15005_0|SrvcGrp|46605|2022|PDM|88.31|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F102302_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39857_0_0|SrvcGrp|97|2022|PDM|5616.00|99|0.00|C-SECTION|
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|968.00|99|0.00|AEG 10 (NO REV)|
20|FH_F92091_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124017_0_0|SrvcGrp|101303|2022|PDM|3500.00|99|0.00|KNEE ARTHROSCOPY / SURGERY|
20|FH_F143971_34986_0|SrvcGrp|46903|2022|PDM|650.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F143974_28204_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F118194_50841_0|SrvcGrp|86846|2022|PDM|145.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F130889_68818_0|SrvcGrp|109057|2022|PCT|0.96|99|0.00|CARDIAC STUDIES|
20|FH_F31433_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|AIR AMBULANCE SVCS|
20|FH_F123372_0_0|SrvcGrp|3178|2022|PDM|837.00|99|0.00|ACUTE PSYCH|
20|FH_F130747_0_0|SrvcGrp|89861|2022|PDM|8843.00|99|0.00|LUMBAR LAMINOTOMY|
20|FH_F66501_0_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F122687_0_0|SrvcGrp|10985|2022|PDM|2732.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F41442_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123953_84003_0|SrvcGrp|74668|2022|PDM|273.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F140762_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F77066_0_0|SrvcGrp|115|2022|PDM|400.00|99|0.00|SKILLED NURSING CARE|
20|FH_F129262_33813_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F143580_0_0|SrvcGrp|2067|2022|PDM|1200.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F141588_60062_0|SrvcGrp|89149|2022|PDM|377.00|99|0.00|OP INTENSIVE|
20|FH_F134994_33162_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F92993_0_0|SrvcGrp|92839|2022|PDM|63.00|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F40834_0_0|SrvcGrp|12969|2022|PDM|393.00|99|0.00|NEWBORN NURSERY|
20|FH_F120195_28403_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F149980_0_0|SrvcGrp|113195|2022|PDM|1280.00|99|0.00|REINFORCE/GRAFT EYE WALL|
20|FH_F148480_03079_0|CSTM-ALL|CSTM-00|2020|PDM|2940.00|99|0.00|AEG 7 (NO REV)|
20|FH_F123473_65109_0|SrvcGrp|471|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F125028_19061_0|SrvcGrp|86836|2022|PDM|15.75|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F127567_44070_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F112568_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F113410_0_0|SrvcGrp|105254|2022|PDM|1996.00|99|0.00|EXPLORE/TREAT ELBOW JOINT|
20|FH_F131998_67401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123943_84041_0|SrvcGrp|63297|2022|PDM|125.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F123957_84321_0|SrvcGrp|87317|2022|PDM|957.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F40252_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114976_78539_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141527_36830_0|SrvcGrp|86850|2022|PDM|26.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1286.00|99|0.00|AEG 9 (NO REV)|
20|FH_F36277_0_0|SrvcGrp|27210|2022|PDM|439.00|99|0.00|SKILLED NURSING LEVEL I|
20|FH_F38798_0_0|SrvcGrp|27246|2022|PDM|100.00|99|0.00|RESPIRATORY THERAPY VISIT|
20|FH_F145755_08050_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F127209_45365_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F92964_0_0|SrvcGrp|79720|2022|PDM|1375.00|99|0.00|ACUTE REHAB II|
20|FH_F82380_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130156_98198_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86696_16063_0|SrvcGrp|48396|2022|PDM|75.00|99|0.00|OT SERVICES|
20|FH_F138713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 5  (NO REV)|
20|FH_F88545_78734_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F130755_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F31101_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F95623_84015_0|SrvcGrp|65720|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114506_15946_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F143650_0_0|SrvcGrp|72998|2022|PDM|2500.00|99|0.00|AEG 5|
20|FH_F110237_94501_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130329_64114_0|SrvcGrp|88620|2022|PDM|87.00|99|0.00|SKILLED NURSING RN|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.69|99|0.00|HAPA WPA-NWPA 2012-13 ASC 246 W/O REV|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU KE"|
20|FH_F114432_75035_0|SrvcGrp|471|2022|PDM|552.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F85353_16407_0|SrvcGrp|63917|2022|PDM|103.88|99|0.00|HAPA WPA-NWPA 2012-13 ASC 317|
20|FH_F132802_68022_0|SrvcGrp|27968|2022|PDM|35.00|99|0.00|SKILLED NURSING LPN|
20|FH_F127071_82435_0|SrvcGrp|75442|2022|PDM|720.00|99|0.00|OBSERVATION - REV 762|
20|FH_F87775_15106_0|SrvcGrp|13929|2022|PDM|15.00|99|0.00|GROWTH HORMONE|
20|FH_F129548_44130_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|1375.00|99|0.00|AEG 10 (NO REV)|
20|FH_F132790_38901_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114606_0_0|SrvcGrp|90707|2022|PDM|120.14|99|0.00|AETNA HOSPICE CARE|
20|FH_F150281_76309_0|SrvcGrp|89337|2022|PDM|738.00|99|0.00|DETOXIFICATION|
20|FH_F145641_06902_0|SrvcGrp|54943|2022|PDM|6458.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F92893_75110_0|SrvcGrp|32189|2022|PDM|55.00|99|0.00|RESPITE CARE|
20|FH_F146369_0_0|SrvcGrp|75419|2022|PDM|515.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F110604_0_0|SrvcGrp|35669|2022|PDM|9176.20|99|0.00|CPT 63650|
20|FH_F85133_85251_0|SrvcGrp|46605|2022|PDM|126.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F38790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1177.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F122243_30655_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F111986_0_0|SrvcGrp|72994|2022|PDM|1030.00|99|0.00|AEG 3|
20|FH_F139780_75605_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F127895_31516_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|1551.00|99|0.00|AEG 9 (NO REV)|
20|FH_F109273_77339_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F134235_70403_0|SrvcGrp|83235|2022|PCT|1.60|99|0.00|AMBULATORY SURGERY|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|192.44|99|0.00|HAPA WPA-NWPA 2012-13 ASC 134 W/O REV|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|133.13|99|0.00|HAPA WPA-NWPA 2012-13 ASC 134 W/O REV|
20|FH_F84973_46733_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143742_60410_0|SrvcGrp|112722|2022|PCT|0.69|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|533.00|99|0.00|AEG 2 (NO REV)|
20|FH_F79743_0_0|SrvcGrp|24598|2022|PDM|1843.00|99|0.00|MS DRG 945-946 ONLY|
20|FH_F127957_89521_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F109273_77339_0|SrvcGrp|3178|2022|PDM|862.00|99|0.00|ACUTE PSYCH|
20|FH_F145561_80210_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F114483_47905_0|SrvcGrp|79720|2022|PDM|1450.00|99|0.00|ACUTE REHAB II|
20|FH_F135670_01749_0|SrvcGrp|21920|2022|PDM|42.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F130017_02302_0|SrvcGrp|109057|2022|PCT|1.11|99|0.00|CARDIAC STUDIES|
20|FH_F111500_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|440.00|99|0.00|AEG 2 (NO REV)|
20|FH_F38790_0_0|SrvcGrp|1942|2022|PDM|1177.00|99|0.00|CORONARY & INTERMEDIATE UNIT CARE|
20|FH_F139873_0_0|SrvcGrp|84279|2022|PDM|2992.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F109577_0_0|SrvcGrp|87397|2022|PDM|135.00|99|0.00|CPT 99500 (HCFA)|
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.00|99|0.00|ASPG I - FH SW CUSTOM GROUPERS|
20|FH_F145880_80303_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F119864_63141_0|SrvcGrp|66264|2022|PDM|89.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F90496_13159_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F123850_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112631_0_0|SrvcGrp|73002|2022|PDM|1114.00|99|0.00|AEG 7|
20|FH_F129316_65066_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116753_0_0|SrvcGrp|103503|2022|PDM|5599.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F145781_0_0|SrvcGrp|10986|2022|PDM|3100.00|99|0.00|ARTHROSCOPIC KNEE REPAIR|
20|FH_F143650_0_0|SrvcGrp|82110|2022|PDM|1800.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC|
20|FH_F79863_0_0|SrvcGrp|47183|2022|PDM|150.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F100782_0_0|SrvcGrp|105071|2022|PDM|612.68|99|0.00|WINDBER MEDICAL CNTR ASC 116|
20|FH_F115616_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F143771_0_0|SrvcGrp|84185|2022|PDM|133.00|99|0.00|RESPITE CARE|
20|FH_F148186_0_0|SrvcGrp|13597|2022|PDM|250.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F93176_73750_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F93359_63084_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F147987_65674_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145641_06902_0|SrvcGrp|100068|2022|PDM|4902.00|99|0.00|REPAIR DEGENERATED KNEECAP|
20|FH_F134229_0_0|SrvcGrp|112539|2022|PDM|15000.00|99|0.00|HIP REPLACEMENT|
20|FH_F138507_62208_0|SrvcGrp|48398|2022|PDM|117.00|99|0.00|PT SERVICES|
20|FH_F83113_0_0|SrvcGrp|20000|2022|PDM|165.00|99|0.00|CATHETER CARE SUPPLIES|
20|FH_F90438_08873_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F145921_73139_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146657_01105_0|SrvcGrp|114676|2022|PDM|22.91|99|0.00|THERAPEUTIC BEHAV SERV (MOD HN)|
20|FH_F81852_0_0|SrvcGrp|10503|2022|PDM|50.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F143631_52248_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145562_70458_0|SrvcGrp|86779|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F150165_06032_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|AEG 1 (NO REV)|
20|FH_F70208_0_0|SrvcGrp|29817|2022|PDM|2277.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F49914_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING|
20|FH_F149305_76036_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F54592_0_0|SrvcGrp|22588|2022|PDM|75.00|99|0.00|CHEMOTHERAPY|
20|FH_F134536_48080_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122425_75082_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F72963_0_0|SrvcGrp|11306|2022|PCT|0.44|99|0.00|IMPLANTS|
20|FH_F102200_06416_0|SrvcGrp|86850|2022|PDM|50.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F105145_75075_0|SrvcGrp|98272|2022|PDM|5330.00|99|0.00|LAPAROSCOPY SERVICES|
20|FH_F146812_50401_0|SrvcGrp|114015|2022|PDM|4536.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F125440_04043_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AETNA-RESIDENTIAL TREATMENT-EATING DISORDERS|
20|FH_F63124_0_0|SrvcGrp|45948|2022|PDM|145.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F116023_10027_0|SrvcGrp|46903|2022|PDM|210.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F131964_89120_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F87596_33609_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F148761_33311_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F148866_84123_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F151044_19606_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F151200_10001_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F121385_89102_0|CSTM-ALL|CSTM-00|2020|PDM|4951.00|99|0.00|AEG 5  (NO REV)|
20|FH_F113738_27006_0|SrvcGrp|73701|2022|PDM|35.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F65761_0_0|SrvcGrp|42824|2022|PDM|169.74|99|0.00|SKILLED NURSING VISIT|
20|FH_F111001_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F80711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|533.51|99|0.00|AETNA SLEEP STUDY CPT 95808|
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1418.00|99|0.00|AEG 8 (NO REV)|
20|FH_F133178_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F135491_0_0|SrvcGrp|84280|2022|PDM|1980.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F143457_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F132988_0_0|SrvcGrp|107091|2022|PDM|1766.05|99|0.00|BONE BIOPSY OPEN SUPERFICIAL|
20|FH_F133529_0_0|SrvcGrp|82138|2022|PDM|3786.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|AEG 3 (NO REV)|
20|FH_F114386_07090_0|SrvcGrp|46605|2022|PDM|76.07|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F114389_50131_0|SrvcGrp|73742|2022|PDM|4.73|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F114389_50131_0|SrvcGrp|26869|2022|PDM|130.65|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F64180_0_0|SrvcGrp|37016|2022|PDM|68.00|99|0.00|PT/OT/ST|
20|FH_F77662_0_0|SrvcGrp|471|2022|PDM|560.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F124180_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F124180_0_0|SrvcGrp|73008|2022|PDM|1000.00|99|0.00|AEG 10|
20|FH_F54752_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|0.00|99|0.00|OP SVCS|
20|FH_F89582_0_0|SrvcGrp|11442|2022|PDM|577.85|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F91998_0_0|SrvcGrp|73000|2022|PDM|896.00|99|0.00|AEG 6|
20|FH_F128360_0_0|SrvcGrp|93807|2022|PDM|3500.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F97083_90670_0|SrvcGrp|73659|2022|PDM|13333.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F129529_45229_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136624_15025_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|OP SVCS|
20|FH_F136665_80004_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F136708_06443_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138875_78041_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F148424_01440_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F43447_0_0|CSTM-ALL|CSTM-00|2020|PDM|918.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43913_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117085_40207_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134727_30650_0|CSTM-ALL|CSTM-00|2020|PDM|1517.00|99|0.00|AEG 6 (NO REV)|
20|FH_F135763_20678_0|SrvcGrp|46903|2022|PDM|1550.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F136783_40069_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F38826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ANGIOPLASTY|
20|FH_F147466_18355_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F147586_44124_0|CSTM-ALL|CSTM-00|2020|PDM|1409.00|99|0.00|AEG 7 (NO REV)|
20|FH_F147445_76844_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132928_64114_0|SrvcGrp|24934|2022|PDM|147.60|99|0.00|NUTRITIONAL ASSESSMENT (INITIAL)|
20|FH_F111602_17102_0|SrvcGrp|89417|2022|PDM|330.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F89219_0_0|SrvcGrp|21122|2022|PDM|61253.00|99|0.00|MS DRG 459 ONLY|
20|FH_F130763_0_0|SrvcGrp|39909|2022|PDM|3345.00|99|0.00|PARTIAL MASTECTOMY|
20|FH_F118252_32216_0|SrvcGrp|89417|2022|PDM|600.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F138149_24112_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F72584_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124161_95932_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67887_0_0|SrvcGrp|42826|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2788.00|99|0.00|AEG 8 (NO REV)|
20|FH_F145561_80210_0|SrvcGrp|75419|2022|PDM|1575.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F150165_06032_0|SrvcGrp|84939|2022|PDM|12731.00|99|0.00|SHOULDER JOINT|
20|FH_F114683_0_0|SrvcGrp|84939|2022|PDM|5900.00|99|0.00|SHOULDER JOINT|
20|FH_F132958_79903_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F109266_33319_0|SrvcGrp|89149|2022|PDM|159.00|99|0.00|OP INTENSIVE|
20|FH_F83754_0_0|SrvcGrp|29817|2022|PDM|3935.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F138050_52301_0|CSTM-ALL|CSTM-00|2020|PDM|4437.00|99|0.00|AEG 5  (NO REV)|
20|FH_F126308_44515_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 3 (NO REV)|
20|FH_F148600_30328_0|SrvcGrp|106265|2022|PDM|3520.00|99|0.00|NSL/SINS NDSC TOTAL|
20|FH_F145817_88101_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA IP MCARE2 OCN F/S PRICING|
20|FH_F146124_06112_0|SrvcGrp|110650|2022|PCT|0.00|99|0.00|ACUTE PSYCH|
20|FH_F150159_06511_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F54592_0_0|SrvcGrp|27047|2022|PDM|22.33|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS (MOD SJ)|
20|FH_F122520_46383_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F128955_70071_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F84755_0_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PDM|1527.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F84912_0_0|SrvcGrp|13631|2022|PDM|67.67|99|0.00|CPT 99213|
20|FH_F85894_0_0|SrvcGrp|10364|2022|PDM|1128.00|99|0.00|CPT CODE 99284|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 224 W/O REV|
20|FH_F66782_0_0|SrvcGrp|42973|2022|PDM|80.00|99|0.00|SPEECH  THERAPIST|
20|FH_F80513_0_0|SrvcGrp|87305|2022|PDM|21718.00|99|0.00|MSDRG 268 ONLY|
20|FH_F116040_24637_0|SrvcGrp|86831|2022|PDM|3.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F116114_37033_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F132678_19090_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111561_10002_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F111666_06517_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134828_30531_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F151047_20860_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151082_18020_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151120_71901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151122_10462_0|SrvcGrp|66264|2022|PDM|121.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F151141_24014_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F130066_84107_0|SrvcGrp|89412|2022|PDM|410.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F129130_92562_0|CSTM-ALL|CSTM-00|2020|PDM|6373.00|99|0.00|AEG 3 (NO REV)|
20|FH_F113715_45005_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F117525_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F97720_70084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97720_70084_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F32093_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F113784_0_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F114916_30309_0|SrvcGrp|26273|2022|PDM|1485.00|99|0.00|CPT 29880|
20|FH_F142319_19403_0|SrvcGrp|90854|2022|PDM|749.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F105700_08865_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130419_72476_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119535_0_0|SrvcGrp|3142|2022|PDM|1550.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1185.00|99|0.00|AEG 5  (NO REV)|
20|FH_F95341_08701_0|SrvcGrp|94760|2022|PCT|1.00|99|0.00|AFLURIA VACC IM (>=3 YRS)|
20|FH_F141018_70125_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141127_62286_0|SrvcGrp|79699|2022|PCT|0.80|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F141336_16947_0|SrvcGrp|12280|2022|PCT|0.39|99|0.00|IMPLANTS|
20|FH_F131505_0_0|SrvcGrp|68000|2022|PDM|814.00|99|0.00|CPT 58561|
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132348_16214_0|SrvcGrp|89781|2022|PDM|95.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F124115_77546_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F49943_0_0|SrvcGrp|45950|2022|PDM|140.00|99|0.00|SPEECH THERAPY|
20|FH_F124212_33407_0|SrvcGrp|73605|2022|PDM|675.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F124575_33351_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F130036_43232_0|SrvcGrp|16069|2022|PDM|867.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F114666_30342_0|SrvcGrp|88160|2022|PDM|5000.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F114666_30342_0|SrvcGrp|84314|2022|PDM|1200.00|99|0.00|MINOR SURGERY|
20|FH_F138207_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138875_78041_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122591_84010_0|SrvcGrp|471|2022|PDM|582.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F42917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F136807_43220_0|SrvcGrp|88620|2022|PDM|82.00|99|0.00|SKILLED NURSING RN|
20|FH_F131529_0_0|SrvcGrp|24739|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F115631_65201_0|SrvcGrp|89842|2022|PDM|7575.00|99|0.00|LUMBAR|
20|FH_F147522_64114_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|330.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F42024_0_0|SrvcGrp|15354|2022|PCT|0.75|99|0.00|OTHER DIAGNOSTIC TESTING|
20|FH_F35216_0_0|SrvcGrp|18623|2022|PDM|7000.00|99|0.00|MS DRG 495|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TRC VACV 28 FS MOD AW|
20|FH_F102641_0_0|SrvcGrp|77021|2022|PDM|3602.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F35381_0_0|SrvcGrp|13666|2022|PCT|0.75|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F120612_23314_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F72445_0_0|SrvcGrp|8962|2022|PDM|60.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F41013_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F43867_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F48693_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHMC CT/MRI|
20|FH_F78265_0_0|CSTM-ALL|CSTM-00|2020|PDM|1674.00|99|0.00|ASPG III|
20|FH_F83792_0_0|SrvcGrp|73602|2022|PDM|630.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 10 (NO REV)|
20|FH_F37738_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1228.36|99|0.00|HAPA WPA-NWPA 2012-13 ASC 701 W/O REV|
20|FH_F72606_0_0|SrvcGrp|3069|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F151319_64040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151401_36607_0|SrvcGrp|26001|2022|PDM|432.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F144928_02703_0|CSTM-ALL|CSTM-00|2020|PDM|473.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F145408_43920_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135485_20171_0|SrvcGrp|107859|2022|PCT|1.05|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F135587_37334_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97143_80012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136161_27106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100880_67735_0|SrvcGrp|78377|2022|PDM|3472.00|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F131228_01826_0|SrvcGrp|86698|2022|PDM|419.96|99|0.00|CARDIOVASCULAR STRESS TEST|
20|FH_F131285_47150_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F130557_66012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116397_33404_0|SrvcGrp|86841|2022|PDM|80.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F116397_33404_0|SrvcGrp|86831|2022|PDM|4.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F116431_76104_0|SrvcGrp|10944|2022|PCT|0.80|99|0.00|EMERGENCY ROOM|
20|FH_F116463_76501_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F116464_13088_0|SrvcGrp|104079|2022|PCT|1.05|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F127399_0_0|SrvcGrp|90063|2022|PDM|3121.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F43237_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F99101_24614_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F111301_33122_0|SrvcGrp|105604|2022|PCT|2.24|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F111363_33169_0|SrvcGrp|82760|2022|PDM|78.00|99|0.00|ASSAY OF SERUM AMYLASE|
20|FH_F141651_0_0|SrvcGrp|88823|2022|PDM|1540.00|99|0.00|REPAIR OF EARDRUM|
20|FH_F47906_0_0|SrvcGrp|43839|2022|PCT|1.00|99|0.00|DME MOD NUKF|
20|FH_F145587_0_0|SrvcGrp|98523|2022|PDM|1262.70|99|0.00|CAPSULOTOMY|
20|FH_F50485_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|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_F131000_0_0|SrvcGrp|84180|2022|PDM|3608.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS|
20|FH_F96280_06340_0|SrvcGrp|73842|2022|PDM|220.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148120_22903_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F148120_22903_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F68826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136315_98144_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136368_62711_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136424_34470_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136426_19006_0|SrvcGrp|106294|2022|PDM|285.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F136478_75605_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118193_06241_0|CSTM-ALL|CSTM-00|2020|PDM|129.71|99|0.00|AETNA BEHAVIORAL ID ASSESSMENT|
20|FH_F93358_63084_0|SrvcGrp|92807|2022|PDM|430.00|99|0.00|AETNA RESIDENTIAL TREATMENT PYCH & CD (AGE 13-17)|
20|FH_F134011_84102_0|SrvcGrp|47411|2022|PDM|112.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F137130_46168_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142387_70454_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F53732_0_0|SrvcGrp|24751|2022|PDM|80.00|99|0.00|INTERMITTENT ANTICOAGULANT THERAPY|
20|FH_F138627_82901_0|SrvcGrp|98969|2022|PDM|85.00|99|0.00|HIT ANTI TNF (HCFA)|
20|FH_F77782_66061_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F77782_66061_0|SrvcGrp|11336|2022|PCT|0.80|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F140407_63841_0|SrvcGrp|112676|2022|PDM|42.13|99|0.00|COVID-19 SARS-COV-2 ANTIBODY|
20|FH_F140473_30518_0|SrvcGrp|113492|2022|PDM|195.36|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F140615_73013_0|SrvcGrp|81779|2022|PCT|1.35|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F140616_43338_0|SrvcGrp|112967|2022|PCT|2.00|99|0.00|LABORATORY SERVICES|
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 6 (NO REV)|
20|FH_F151608_30236_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 6 (NO REV)|
20|FH_F118789_92211_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F118932_07652_0|SrvcGrp|473|2022|PDM|849.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F40402_0_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92506_07666_0|SrvcGrp|22384|2022|PDM|209.09|99|0.00|HOME VISIT PRENATAL|
20|FH_F147725_06002_0|SrvcGrp|92366|2022|PDM|4100.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F137817_17050_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F109652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112263_0_0|SrvcGrp|35669|2022|PDM|5720.00|99|0.00|CPT 63650|
20|FH_F124754_84403_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|417.00|99|0.00|AEG 1 (NO REV)|
20|FH_F72945_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80084_0_0|SrvcGrp|3809|2022|PDM|604.30|99|0.00|HOSPICE CARE|
20|FH_F38476_0_0|SrvcGrp|27968|2022|PDM|41.00|99|0.00|SKILLED NURSING LPN|
20|FH_F140007_0_0|SrvcGrp|96979|2022|PDM|3539.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F137951_0_0|SrvcGrp|33984|2022|PDM|1479.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1922.00|99|0.00|AEG 9 (NO REV)|
20|FH_F148432_01585_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148554_85016_0|SrvcGrp|115468|2022|PDM|2965.00|99|0.00|CORONARY ARTERY ANGIO S&I|
20|FH_F133021_00910_0|SrvcGrp|112258|2022|PDM|22000.00|99|0.00|AORTIC VALVE|
20|FH_F144068_17901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149781_37404_0|SrvcGrp|67119|2022|PDM|7200.00|99|0.00|ARTHODESIS|
20|FH_F133487_24293_0|SrvcGrp|27969|2022|PDM|23.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133006_48067_0|SrvcGrp|86723|2022|PDM|360.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F63244_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134430_86301_0|SrvcGrp|46903|2022|PDM|800.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F125033_93305_0|SrvcGrp|89417|2022|PDM|450.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F111812_11222_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F33415_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F102721_38118_0|CSTM-ALL|CSTM-00|2020|PCT|0.47|99|0.00|OP SVCS|
20|FH_F31944_0_0|SrvcGrp|13380|2022|PDM|75.00|99|0.00|RN VISIT|
20|FH_F65899_0_0|SrvcGrp|360|2022|PDM|1796.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F123583_72756_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F51129_0_0|SrvcGrp|30065|2022|PDM|6000.00|99|0.00|IP SURGERY|
20|FH_F115324_78852_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F121168_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F126626_80906_0|SrvcGrp|89417|2022|PDM|484.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F39039_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117450_63131_0|SrvcGrp|66265|2022|PDM|98.94|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F143684_0_0|SrvcGrp|108835|2022|PDM|3000.00|99|0.00|LEAD NEUROSTIMULATOR|
20|FH_F91255_19401_0|SrvcGrp|73559|2022|PDM|2247.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|917.40|99|0.00|ASPG VI|
20|FH_F97562_29803_0|SrvcGrp|73659|2022|PDM|10372.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F50974_0_0|SrvcGrp|27579|2022|PDM|70.00|99|0.00|RESPIRATORY THERAPY INITIAL VISIT|
20|FH_F67560_0_0|SrvcGrp|17081|2022|PCT|0.83|99|0.00|ASPG IX|
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 2 (NO REV)|
20|FH_F133287_40215_0|SrvcGrp|112325|2022|PCT|0.28|99|0.00|HIGH COST DRUGS|
20|FH_F37491_0_0|SrvcGrp|3259|2022|PDM|370.00|99|0.00|ACUTE REHABILITATION|
20|FH_F117346_75093_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121009_76180_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F115312_78550_0|SrvcGrp|106048|2022|PDM|953.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F127191_44720_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F118476_17815_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67639_0_0|SrvcGrp|63463|2022|PDM|925.00|99|0.00|CPT 52204|
20|FH_F148599_98034_0|SrvcGrp|31705|2022|PDM|4044.00|99|0.00|MS DRG 791 ONLY|
20|FH_F32869_0_0|SrvcGrp|411|2022|PDM|4000.00|99|0.00|OP CARDIAC CATH|
20|FH_F67192_0_0|CSTM-ALL|CSTM-00|2020|PDM|1711.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F150001_33064_0|SrvcGrp|86840|2022|PDM|26.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F104180_0_0|SrvcGrp|471|2022|PDM|759.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133533_33901_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117559_08619_0|SrvcGrp|100269|2022|PDM|15.00|99|0.00|HEPA VACCINE ADULT IM|
20|FH_F97542_32960_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F47479_0_0|SrvcGrp|36068|2022|PDM|47.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F121016_32607_0|SrvcGrp|88337|2022|PCT|1.00|99|0.00|VENIPUNCTURE|
20|FH_F148040_90631_0|SrvcGrp|58509|2022|PDM|500.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F87615_80033_0|SrvcGrp|113780|2022|PDM|112.00|99|0.00|TELEHEALTH|
20|FH_F78167_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F133287_40215_0|SrvcGrp|92958|2022|PCT|0.53|99|0.00|SLEEP STUDIES|
20|FH_F133021_00910_0|SrvcGrp|112259|2022|PDM|17595.00|99|0.00|AORTIC VALVE REPLACEMENT|
20|FH_F113324_17055_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115505_21014_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F73542_0_0|SrvcGrp|71001|2022|PDM|0.22|99|0.00|AMBULANCE - NON-EMERG TRANSPORT; PER MILE, CASE WORKER|
20|FH_F43953_0_0|SrvcGrp|37990|2022|PDM|782.00|99|0.00|NEWBORN - WELL BABY|
20|FH_F128912_44313_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F56793_0_0|SrvcGrp|44042|2022|PDM|80.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F98620_43920_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F149940_02645_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F94300_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F118612_21502_0|SrvcGrp|472|2022|PDM|549.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F31093_0_0|CSTM-ALL|CSTM-00|2020|PDM|2320.00|99|0.00|ASPG VIII|
20|FH_F129688_74066_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134826_19067_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F35216_0_0|SrvcGrp|21124|2022|PDM|11000.00|99|0.00|MS DRG 471 ONLY|
20|FH_F144988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113250_71901_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133579_0_0|SrvcGrp|84278|2022|PDM|2551.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F120657_54220_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150939_0_0|SrvcGrp|100247|2022|PDM|24.30|99|0.00|NASAL FLU VACCINE|
20|FH_F114853_0_0|SrvcGrp|89404|2022|PDM|7215.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F41989_0_0|CSTM-ALL|CSTM-00|2020|PDM|179.00|99|0.00|ADOLESCENT PSYCH DAY OP SERVICES|
20|FH_F42244_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F47605_0_0|SrvcGrp|115049|2022|PDM|500.00|99|0.00|DAY PROGRAM|
20|FH_F138784_32216_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138992_72703_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F57953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117715_0_0|SrvcGrp|2784|2022|PDM|7053.99|99|0.00|PROSTATE CRYOABLATION|
20|FH_F91933_0_0|SrvcGrp|73606|2022|PDM|350.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F84139_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F151285_72956_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151341_75904_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151412_71909_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132268_07060_0|SrvcGrp|94736|2022|PDM|56.65|99|0.00|FLULAVAL VACC IM (>=3 YRS)|
20|FH_F145248_19477_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123194_97222_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135572_89106_0|SrvcGrp|16750|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F135583_17331_0|SrvcGrp|103875|2022|PCT|0.82|99|0.00|AETNA OBSERVATION SERVICES W/ER|
20|FH_F110741_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91766_25401_0|SrvcGrp|46605|2022|PDM|120.75|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F135787_60108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119886_25504_0|SrvcGrp|88621|2022|PDM|120.00|99|0.00|SKILLED NURSING LPN|
20|FH_F127399_0_0|SrvcGrp|105701|2022|PDM|4682.00|99|0.00|REPAIR OF VAGINA|
20|FH_F140629_0_0|SrvcGrp|104170|2022|PDM|2497.00|99|0.00|AETNA ARTHROSCOPY SURGERY|
20|FH_F121707_85745_0|SrvcGrp|73605|2022|PDM|1250.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F33785_0_0|SrvcGrp|3069|2022|PCT|0.75|99|0.00|IMPLANTS|
20|FH_F42098_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F44754_0_0|SrvcGrp|15385|2022|PDM|80.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F63881_0_0|SrvcGrp|59357|2022|PDM|140.00|99|0.00|CAPD TRAINING|
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F118482_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F50336_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F58494_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F36344_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|720223_LABS_MOD 26|
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1925.00|99|0.00|AEG 9 (NO REV)|
20|FH_F111853_0_0|SrvcGrp|87537|2022|PDM|420.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F131000_0_0|SrvcGrp|93057|2022|PDM|4457.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F131000_0_0|SrvcGrp|34606|2022|PDM|3608.00|99|0.00|CPT 29827|
20|FH_F132328_0_0|SrvcGrp|98268|2022|PDM|2143.00|99|0.00|HIP ARTHROSCOPY DX|
20|FH_F141035_0_0|SrvcGrp|92010|2022|PDM|3932.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE|
20|FH_F101852_78758_0|SrvcGrp|43525|2022|PDM|465.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC|
20|FH_F132877_06105_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F98622_45005_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F102948_43606_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F102984_80026_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140873_0_0|SrvcGrp|95661|2022|PDM|145.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F98161_0_0|SrvcGrp|72998|2022|PDM|825.00|99|0.00|AEG 5|
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PDM|3893.00|99|0.00|AEG 9 (NO REV)|
20|FH_F106980_0_0|SrvcGrp|74670|2022|PCT|1.05|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F109279_0_0|SrvcGrp|79595|2022|PDM|600.00|99|0.00|CPT 45385|
20|FH_F86851_0_0|SrvcGrp|82300|2022|PDM|451.00|99|0.00|SIGMOIDOSCOPY|
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.55|99|0.00|ASPG V|
20|FH_F46832_0_0|SrvcGrp|27601|2022|PDM|1038.78|99|0.00|SYNAGIS (50 MG)|
20|FH_F134254_33462_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136299_75218_0|SrvcGrp|73500|2022|PDM|750.00|99|0.00|AETNA ER LEVEL I|
20|FH_F136532_54874_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134126_11554_0|SrvcGrp|106305|2022|PDM|824.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F142473_07663_0|SrvcGrp|53145|2022|PCT|1.00|99|0.00|SOCIAL WORKER|
20|FH_F142547_70002_0|SrvcGrp|86853|2022|PDM|10.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F122009_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F65239_0_0|SrvcGrp|61356|2022|PDM|984.00|99|0.00|SURGICAL CARVEOUTS (1)|
20|FH_F97601_67218_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F137287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77782_66061_0|SrvcGrp|21358|2022|PCT|0.80|99|0.00|MS DRG 258-259 ONLY|
20|FH_F140765_30315_0|SrvcGrp|112762|2022|PDM|45.23|99|0.00|INFECTIOUS AGENT ANTIGEN DETECTION|
20|FH_F80205_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151601_89118_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F119023_91406_0|SrvcGrp|86841|2022|PDM|100.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F118914_43015_0|SrvcGrp|107288|2022|PCT|1.00|99|0.00|INJ INTERFERON BETA|
20|FH_F38332_0_0|SrvcGrp|18145|2022|PDM|12064.00|99|0.00|MS DRG 248|
20|FH_F36521_0_0|SrvcGrp|97|2022|PDM|2600.00|99|0.00|C-SECTION|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|418.03|99|0.00|ASPG 103|
20|FH_F98921_64503_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|274.00|99|0.00|HAPA EPA ASC 37|
20|FH_F120954_0_0|SrvcGrp|57966|2022|PDM|997.50|99|0.00|HOSPICE CARE|
20|FH_F117275_16936_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|1140.00|99|0.00|AEG 2 (NO REV)|
20|FH_F150904_22306_0|SrvcGrp|73701|2022|PDM|47.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F36450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97182_21502_0|SrvcGrp|73559|2022|PDM|8045.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F49663_0_0|SrvcGrp|58894|2022|PDM|720.00|99|0.00|CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE|
20|FH_F115431_32821_0|SrvcGrp|72602|2022|PDM|675.00|99|0.00|ECT|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118819_76226_0|SrvcGrp|105819|2022|PDM|902.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F63244_0_0|SrvcGrp|33164|2022|PDM|275.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F42557_0_0|SrvcGrp|14637|2022|PDM|330.00|99|0.00|CD - ADULT PARTIAL HOSPITAL|
20|FH_F111809_93003_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117087_0_0|SrvcGrp|107183|2022|PDM|2494.00|99|0.00|REVISE MIDDLE EAR BONE|
20|FH_F144017_33873_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F41436_0_0|SrvcGrp|47260|2022|PCT|0.90|99|0.00|IMPLANTS 274-276, 278  LINE LEVEL|
20|FH_F117945_78957_0|SrvcGrp|73605|2022|PDM|735.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|76.07|99|0.00|DELAWARE VALLEY- ASC 223|
20|FH_F124608_0_0|SrvcGrp|88157|2022|PDM|7650.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F72065_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139129_70508_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139550_75219_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F150766_33952_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F150882_84041_0|SrvcGrp|110823|2022|PCT|1.00|99|0.00|OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F101861_19567_0|SrvcGrp|83800|2022|PDM|3342.00|99|0.00|VBAC DELIVERY|
20|FH_F139814_24333_0|SrvcGrp|46903|2022|PDM|649.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F47212_0_0|SrvcGrp|42976|2022|PDM|155.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F39443_0_0|SrvcGrp|30355|2022|PDM|848.00|99|0.00|HAPA WPA ASC 4|
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|AEG 1 (NO REV)|
20|FH_F35987_0_0|SrvcGrp|22147|2022|PDM|127.00|99|0.00|PSYCH PARTIAL HOSP (HALF DAY)|
20|FH_F129340_43212_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F125182_0_0|SrvcGrp|78286|2022|PDM|8280.00|99|0.00|CPT 49322|
20|FH_F101685_0_0|SrvcGrp|104021|2022|PDM|2450.00|99|0.00|CYSTOSCOPY PROSTATIC IMP 1-3|
20|FH_F40719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|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_F116437_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.80|99|0.00|AEG 1 (NO REV)|
20|FH_F99420_91326_0|SrvcGrp|62396|2022|PCT|0.85|99|0.00|OP PET/CT/MRI/NUCLEAR MEDICINE|
20|FH_F40644_0_0|SrvcGrp|701|2022|PDM|1552.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F131471_67203_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149522_83221_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F150459_08021_0|SrvcGrp|48396|2022|PDM|116.00|99|0.00|OT SERVICES|
20|FH_F101844_0_0|SrvcGrp|97741|2022|PDM|8943.00|99|0.00|REVISE KNEE|
20|FH_F102525_73134_0|SrvcGrp|89811|2022|PDM|12000.00|99|0.00|MS DRG 496 ONLY|
20|FH_F116753_0_0|SrvcGrp|79099|2022|PDM|2187.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F147347_70806_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F132113_85224_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127324_0_0|SrvcGrp|82694|2022|PDM|1725.00|99|0.00|PODIATRY|
20|FH_F40346_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION|
20|FH_F35990_0_0|SrvcGrp|38|2022|PDM|3608.00|99|0.00|NORMAL DELIVERY|
20|FH_F101280_63111_0|SrvcGrp|43525|2022|PDM|325.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC|
20|FH_F110805_45227_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F35743_34202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
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_F35174_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 216-237 CV SURGERY|
20|FH_F132254_40207_0|SrvcGrp|17013|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F109762_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F131069_54724_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36170_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F139927_0_0|SrvcGrp|10107|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F84433_0_0|SrvcGrp|48385|2022|PDM|146.00|99|0.00|SPEECH THERAPY|
20|FH_F117615_30525_0|SrvcGrp|42782|2022|PDM|141.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F117762_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F120057_0_0|SrvcGrp|107879|2022|PDM|1969.74|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F78009_0_0|SrvcGrp|30094|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY|
20|FH_F117605_85260_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS ASC|
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)|
20|FH_F112128_63017_0|SrvcGrp|73841|2022|PDM|299.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F134871_28205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97101_98003_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F41342_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|ACUTE PSYCH|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F149515_66002_0|SrvcGrp|46903|2022|PDM|483.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F114206_37203_0|SrvcGrp|22389|2022|PDM|15.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F36133_70072_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F44255_0_0|SrvcGrp|110|2022|PDM|530.00|99|0.00|CD - REHABILITATION|
20|FH_F97080_85122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146859_0_0|SrvcGrp|87125|2022|PDM|557.00|99|0.00|INJ FOR SACROILIAC JT ANEST|
20|FH_F34882_0_0|SrvcGrp|12787|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F87711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F116575_0_0|SrvcGrp|105235|2022|PDM|2500.00|99|0.00|PARTIAL REMOVAL OF THYROID|
20|FH_F127886_62930_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|0.65|99|0.00|AEG 1 (NO REV)|
20|FH_F138478_0_0|SrvcGrp|88481|2022|PDM|23793.91|99|0.00|AETNA RMVL & RPLCMT DFB GEN MLT LEAD|
20|FH_F146266_0_0|SrvcGrp|67069|2022|PDM|7327.00|99|0.00|CPT 22634|
20|FH_F146986_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113765_0_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F42145_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F131175_06757_0|SrvcGrp|74668|2022|PDM|1135.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|4558.00|99|0.00|AEG 9 (NO REV)|
20|FH_F39443_0_0|SrvcGrp|29803|2022|PDM|665.00|99|0.00|PSYCH|
20|FH_F35475_0_0|SrvcGrp|10526|2022|PDM|700.00|99|0.00|SLEEP STUDIES|
20|FH_F35730_0_0|SrvcGrp|11330|2022|PDM|90.00|99|0.00|SOCIAL WORKER (MEDICAL)|
20|FH_F97881_38703_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F139910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36720_0_0|SrvcGrp|12791|2022|PCT|1.10|99|0.00|PROSTHETICS/IMPLANTS/DEVICES|
20|FH_F149579_95815_0|SrvcGrp|115700|2022|PDM|128.25|99|0.00|PSYCHIATRIC COLLABORATIVE CARE MGMT SBSQ (MOD AF)(HCFA)|
20|FH_F32653_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|1499.00|99|0.00|ASPG VIII|
20|FH_F69183_0_0|SrvcGrp|13123|2022|PCT|0.50|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F147532_0_0|SrvcGrp|113451|2022|PDM|87.23|99|0.00|HOSPICE CARE|
20|FH_F74825_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F140104_70359_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F143533_30013_0|SrvcGrp|114080|2022|PDM|180.00|99|0.00|MAMMOGRAPHY|
20|FH_F101709_0_0|SrvcGrp|72998|2022|PDM|2497.00|99|0.00|AEG 5|
20|FH_F151719_02138_0|SrvcGrp|92760|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151744_60914_0|CSTM-ALL|CSTM-00|2020|PCT|1.80|99|0.00|HSS ASC|
20|FH_F120208_20109_0|SrvcGrp|82981|2022|PDM|156.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F116662_15801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116699_46347_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F116739_78501_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F116869_15146_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F119929_70364_0|CSTM-ALL|CSTM-00|2020|PDM|141.34|99|0.00|HOSPICE ROUTINE HOME CARE (DAYS 0-60)|
20|FH_F120888_63823_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120974_27607_0|SrvcGrp|11000|2022|PCT|0.36|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F126970_45601_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F127820_62626_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F31150_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F59732_0_0|SrvcGrp|29679|2022|PDM|125.00|99|0.00|SKILLED NURSING NON IV RELATED- MOD TJ|
20|FH_F79485_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F130013_16509_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135207_76053_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F130724_06437_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143969_71129_0|SrvcGrp|74668|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147919_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128446_0_0|SrvcGrp|82981|2022|PDM|161.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F87031_0_0|SrvcGrp|73006|2022|PDM|2088.00|99|0.00|AEG 9|
20|FH_F74227_0_0|SrvcGrp|16700|2022|PDM|3000.00|99|0.00|PROFESSIONAL FEES ON UB04|
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|1517.00|99|0.00|AEG 4 (NO REV)|
20|FH_F123957_84321_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F78603_0_0|SrvcGrp|29757|2022|PDM|15978.95|99|0.00|MS DRG 251 ONLY|
20|FH_F34795_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS|
20|FH_F143834_06511_0|SrvcGrp|91394|2022|PDM|130.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD HO)|
20|FH_F110925_01104_0|SrvcGrp|86117|2022|PDM|1120.00|99|0.00|AETNA CYTOMEGALOVIRUS IMMUNE GLOBULIN IV|
20|FH_F82114_0_0|SrvcGrp|74661|2022|PDM|350.58|99|0.00|AETNA SLEEP STUDIES|
20|FH_F99100_0_0|SrvcGrp|90973|2022|PDM|679.80|99|0.00|CERVICAL OR THORACIC INJECTION|
20|FH_F131254_92211_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING-OP W/O HOME INFUSION|
20|FH_F118086_66604_0|SrvcGrp|73605|2022|PDM|857.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F99320_0_0|CSTM-ALL|CSTM-00|2020|PCT|46.00|99|0.00|OP SVCS|
20|FH_F38526_0_0|SrvcGrp|359|2022|PDM|2100.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F40304_0_0|SrvcGrp|115|2022|PDM|636.00|99|0.00|SKILLED NURSING CARE|
20|FH_F129115_85716_0|SrvcGrp|89337|2022|PDM|996.00|99|0.00|DETOXIFICATION|
20|FH_F137457_32216_0|SrvcGrp|89337|2022|PDM|1055.00|99|0.00|DETOXIFICATION|
20|FH_F32996_0_0|SrvcGrp|24|2022|PCT|0.75|99|0.00|CARDIAC CATH|
20|FH_F125323_43213_0|SrvcGrp|27969|2022|PDM|16.00|99|0.00|HOME HEALTH AIDE|
20|FH_F151526_28208_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AEG 10 (NO REV)|
20|FH_F116093_47327_0|SrvcGrp|89149|2022|PDM|161.00|99|0.00|OP INTENSIVE|
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111826_0_0|SrvcGrp|73000|2022|PDM|1320.00|99|0.00|AEG 6|
20|FH_F92276_32308_0|SrvcGrp|19961|2022|PDM|77506.00|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA|
20|FH_F110102_0_0|SrvcGrp|104268|2022|PDM|150.00|99|0.00|HOSPICE HOME CARE|
20|FH_F31609_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131948_23226_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134994_33162_0|SrvcGrp|89149|2022|PDM|224.00|99|0.00|OP INTENSIVE|
20|FH_F114916_30309_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97500_32025_0|SrvcGrp|73461|2022|PDM|9773.00|99|0.00|AETNA NICU IV|
20|FH_F77862_0_0|SrvcGrp|22954|2022|PDM|151.22|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F55054_0_0|SrvcGrp|3069|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F128159_45356_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F37650_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125760_67039_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125927_75093_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS ASC|
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151523_86333_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120172_92653_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138214_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|7500.00|99|0.00|PERCUTANEOUS AVF|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD AW|
20|FH_F141517_73034_0|SrvcGrp|86722|2022|PDM|181.38|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F129367_89117_0|SrvcGrp|89337|2022|PDM|1047.00|99|0.00|DETOXIFICATION|
20|FH_F38377_0_0|SrvcGrp|29087|2022|PDM|52.50|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S AZ/NV - MOD AV|
20|FH_F142073_0_0|SrvcGrp|76602|2022|PDM|990.00|99|0.00|CPT 25000|
20|FH_F38159_0_0|SrvcGrp|28262|2022|PDM|71.50|99|0.00|NOMINAL FEE CODES/OFC BASED PROC|
20|FH_F39170_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CT MRI MOD TC|
20|FH_F131577_89148_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F148121_21734_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|3600.00|99|0.00|AEG 9 (NO REV)|
20|FH_F140893_19720_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40499_0_0|SrvcGrp|32638|2022|PCT|0.65|99|0.00|POTOMAC CTR SPECIALITY DME|
20|FH_F66687_0_0|SrvcGrp|39136|2022|PCT|0.85|99|0.00|MSDRG 226-227 ONLY CARDIAC|
20|FH_F149886_68112_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145758_20745_0|SrvcGrp|63471|2022|PDM|3060.00|99|0.00|CPT 64590|
20|FH_F129653_0_0|SrvcGrp|77021|2022|PDM|4000.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F78446_0_0|SrvcGrp|75502|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F145593_92660_0|SrvcGrp|73605|2022|PDM|975.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F39479_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F39992_0_0|SrvcGrp|22954|2022|PDM|93.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F40186_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|CAROLINA DIGESTIVE ENDOSCOPY FH RATES|
20|FH_F56136_0_0|SrvcGrp|13131|2022|PDM|2073.00|99|0.00|OBSERVATION SVCS|
20|FH_F129587_27360_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132190_0_0|SrvcGrp|103572|2022|PDM|2500.00|99|0.00|KNEE ARTHOROSCOPY|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD 53) - PMRS|
20|FH_F65159_0_0|SrvcGrp|16132|2022|PDM|6858.00|99|0.00|DRG 372-375 ONLY NORMAL DELIVERY|
20|FH_F65159_0_0|CSTM-ALL|CSTM-00|2020|PDM|3940.00|99|0.00|ASPG VI|
20|FH_F109501_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|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_F89363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|OP SVCS|
20|FH_F89372_0_0|SrvcGrp|14514|2022|PDM|30240.00|99|0.00|LAP BANDS|
20|FH_F89778_0_0|SrvcGrp|77450|2022|PDM|663.96|99|0.00|CPT 54161|
20|FH_F88398_15601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F87915_0_0|CSTM-ALL|CSTM-00|2020|PDM|154.00|99|0.00|CPT 99201|
20|FH_F46832_0_0|SrvcGrp|40827|2022|PDM|1.79|99|0.00|STERILE WATER SALINE|
20|FH_F123763_80130_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F63186_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F62333_0_0|SrvcGrp|1168|2022|PDM|925.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F62579_0_0|SrvcGrp|34173|2022|PDM|135.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F131612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37970_0_0|SrvcGrp|473|2022|PDM|946.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F105593_0_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F135840_0_0|SrvcGrp|79595|2022|PDM|550.00|99|0.00|CPT 45385|
20|FH_F130715_98503_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120417_63124_0|CSTM-ALL|CSTM-00|2020|PDM|1120.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132969_84003_0|SrvcGrp|86846|2022|PDM|25.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F99021_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH|
20|FH_F149341_39194_0|SrvcGrp|106792|2022|PDM|190.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F113764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F97861_62223_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|AEG 2 (NO REV)|
20|FH_F114444_19602_0|SrvcGrp|106469|2022|PDM|72.00|99|0.00|AETNA OFFICE OUTPATIENT VISIT EST (MOD TD) (HCFA)|
20|FH_F133207_0_0|SrvcGrp|82113|2022|PDM|3529.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F88640_32935_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|GENERAL ACUTE CARE|
20|FH_F146657_01105_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F112665_0_0|SrvcGrp|77021|2022|PDM|7215.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F120930_0_0|SrvcGrp|41334|2022|PDM|6500.00|99|0.00|TOTAL KNEE|
20|FH_F118146_33062_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111942_92647_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100782_0_0|SrvcGrp|105163|2022|PDM|769.95|99|0.00|WINDBER MEDICAL CNTR ASC 408|
20|FH_F145667_01905_0|SrvcGrp|87077|2022|PDM|148.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F110589_70809_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F36552_0_0|SrvcGrp|18811|2022|PDM|29295.00|99|0.00|MS DRG 220|
20|FH_F83380_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F133867_84075_0|SrvcGrp|83522|2022|PDM|93.00|99|0.00|RESPITE CARE|
20|FH_F110423_33401_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F83995_16748_0|SrvcGrp|10518|2022|PDM|98.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT|
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1373.00|99|0.00|AEG 4 (NO REV)|
20|FH_F85213_02840_0|SrvcGrp|75506|2022|PCT|1.03|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F143742_60410_0|SrvcGrp|88977|2022|PDM|4567.00|99|0.00|C-SECTION DELIVERY|
20|FH_F88935_0_0|SrvcGrp|26001|2022|PDM|135.22|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F95631_33705_0|SrvcGrp|73603|2022|PDM|3590.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F121225_98902_0|SrvcGrp|45541|2022|PDM|201.60|99|0.00|SPEECH THERAPY|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|414.37|99|0.00|HAPA WPA-NWPA 2012-13 ASC 210 W/O REV|
20|FH_F110247_08865_0|CSTM-ALL|CSTM-00|2020|PCT|0.05|99|0.00|OP SVCS|
20|FH_F97861_62223_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F126550_43085_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F124173_66215_0|SrvcGrp|17014|2022|PDM|22.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F133972_27103_0|SrvcGrp|22592|2022|PDM|35.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F80224_0_0|SrvcGrp|30595|2022|PCT|0.79|99|0.00|MS DRG 010 ONLY|
20|FH_F129548_44130_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110346_38501_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117206_0_0|SrvcGrp|73004|2022|PDM|1364.00|99|0.00|AEG 8|
20|FH_F133972_27103_0|SrvcGrp|31973|2022|PDM|30.00|99|0.00|HOME THERAPY|
20|FH_F125513_40071_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F145942_72019_0|SrvcGrp|3178|2022|PDM|873.00|99|0.00|ACUTE PSYCH|
20|FH_F133876_27405_0|SrvcGrp|46903|2022|PDM|632.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F79743_0_0|CSTM-ALL|CSTM-00|2020|PDM|2859.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124161_95932_0|SrvcGrp|10944|2022|PCT|0.70|99|0.00|EMERGENCY ROOM|
20|FH_F144808_0_0|SrvcGrp|98495|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F100782_0_0|SrvcGrp|97526|2022|PDM|763.62|99|0.00|WINDBER MEDICAL CNTR ASC 103|
20|FH_F113424_60626_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F127579_44321_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F118135_38109_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148439_0_0|SrvcGrp|87536|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F93122_01854_0|CSTM-ALL|CSTM-00|2020|PDM|896.00|99|0.00|AETNA ABH IP OBSERVATION (>=18 YRS)|
20|FH_F81483_0_0|SrvcGrp|40312|2022|PCT|0.50|99|0.00|CVTY ENHANCED ASPG 10|
20|FH_F31714_0_0|SrvcGrp|9793|2022|PDM|320.00|99|0.00|NEWBORN NURSERY|
20|FH_F83978_66739_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F118469_0_0|SrvcGrp|107794|2022|PDM|4100.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F126341_27284_0|SrvcGrp|86126|2022|PDM|25.18|99|0.00|AETNA GAMMA GLOBULIN|
20|FH_F139780_75605_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F83113_0_0|SrvcGrp|9829|2022|PDM|50.00|99|0.00|PT SVCS|
20|FH_F117206_0_0|SrvcGrp|36591|2022|PDM|1500.00|99|0.00|CPT 63685|
20|FH_F71445_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F95340_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F100680_43130_0|SrvcGrp|90854|2022|PDM|2397.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F139565_0_0|SrvcGrp|92549|2022|PDM|5738.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F132969_84003_0|SrvcGrp|86827|2022|PDM|50.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F90496_13159_0|SrvcGrp|75749|2022|PDM|233.00|99|0.00|AMBULATORY DETOX REHAB|
20|FH_F135670_01749_0|SrvcGrp|86851|2022|PDM|35.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F126493_31501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125260_0_0|SrvcGrp|48396|2022|PDM|202.86|99|0.00|OT SERVICES|
20|FH_F32534_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F134326_14094_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F121628_19533_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143568_85006_0|SrvcGrp|93607|2022|PCT|2.23|99|0.00|HOME SLEEP TEST TYPE IV|
20|FH_F107702_01053_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F130017_02302_0|SrvcGrp|104363|2022|PCT|0.69|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F73024_0_0|SrvcGrp|48396|2022|PDM|30.00|99|0.00|OT SERVICES|
20|FH_F134495_84321_0|SrvcGrp|48385|2022|PDM|85.50|99|0.00|SPEECH THERAPY|
20|FH_F32427_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129101_27006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101100_50314_0|SrvcGrp|97906|2022|PDM|14359.00|99|0.00|MOBILIZATION OF COLON|
20|FH_F102200_06416_0|SrvcGrp|29023|2022|PDM|69.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F115786_57701_0|SrvcGrp|88621|2022|PDM|93.00|99|0.00|SKILLED NURSING LPN|
20|FH_F115907_12206_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F75842_0_0|SrvcGrp|46531|2022|PDM|529.39|99|0.00|EMERGENCY ROOM LEVEL 2|
20|FH_F80513_0_0|SrvcGrp|941|2022|PDM|2337.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F146773_78414_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146855_60069_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120528_60559_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120795_27514_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115956_06516_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F116114_37033_0|SrvcGrp|67684|2022|PDM|239.00|99|0.00|PSYCH VISIT|
20|FH_F131904_18915_0|SrvcGrp|46605|2022|PDM|149.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133583_77074_0|SrvcGrp|87441|2022|PDM|933.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F133249_33603_0|SrvcGrp|3178|2022|PDM|796.00|99|0.00|ACUTE PSYCH|
20|FH_F132088_34981_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130657_04614_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F134828_30531_0|SrvcGrp|113098|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME) (HCFA)|
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|1423.40|99|0.00|AEG 6 (NO REV)|
20|FH_F148863_33021_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F151087_60548_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151144_35801_0|SrvcGrp|92547|2022|PDM|1015.97|99|0.00|SKIN FULL GRAFT PROCEDURE|
20|FH_F121971_33021_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F122007_30701_0|CSTM-ALL|CSTM-00|2020|PDM|165.42|99|0.00|HOSPICE ROUTINE HOME CARE (DAYS 0-60)|
20|FH_F115990_0_0|SrvcGrp|73008|2022|PDM|1300.00|99|0.00|AEG 10|
20|FH_F35212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F65761_0_0|SrvcGrp|22954|2022|PDM|153.83|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F98040_89406_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F130844_0_0|CSTM-ALL|CSTM-00|2020|PDM|2617.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F105588_15228_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F119535_0_0|SrvcGrp|11606|2022|PDM|1275.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)|
20|FH_F39209_0_0|SrvcGrp|473|2022|PDM|1000.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F116485_17033_0|SrvcGrp|114753|2022|PDM|336.81|99|0.00|EDUCATIONALLY BEHAVIORAL SUPPORTS LEVEL 2|
20|FH_F132988_0_0|SrvcGrp|41325|2022|PDM|4493.01|99|0.00|OP SURGERY CPT 24342|
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 3 (NO REV)|
20|FH_F134270_0_0|SrvcGrp|84939|2022|PDM|23000.00|99|0.00|SHOULDER JOINT|
20|FH_F78447_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141336_16947_0|SrvcGrp|79786|2022|PCT|0.55|99|0.00|SLEEP STUDIES|
20|FH_F141353_26452_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F50163_0_0|SrvcGrp|15634|2022|PDM|180.00|99|0.00|OP PARTIAL PSYCH|
20|FH_F132348_16214_0|SrvcGrp|93098|2022|PDM|95.00|99|0.00|HOSPICE CARE|
20|FH_F48752_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|1339.00|99|0.00|ASPG IX|
20|FH_F40603_0_0|CSTM-ALL|CSTM-00|2020|PDM|65.00|99|0.00|NEW PATIENT - SHORT VISIT|
20|FH_F91998_0_0|SrvcGrp|35672|2022|PDM|1530.00|99|0.00|CPT 23412|
20|FH_F129549_01238_0|SrvcGrp|88620|2022|PDM|107.62|99|0.00|SKILLED NURSING RN|
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1282.00|99|0.00|AEG 8 (NO REV)|
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_F131494_0_0|SrvcGrp|101523|2022|PDM|252.00|99|0.00|CERCLAGE OF CERVIX|
20|FH_F123620_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132890_87544_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F114638_25309_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F114684_80547_0|SrvcGrp|100860|2022|PDM|187.00|99|0.00|OFFICE/OUTPATIENT VISIT NEW|
20|FH_F81832_13827_0|SrvcGrp|46605|2022|PDM|268.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F137933_0_0|SrvcGrp|111530|2022|PDM|13200.00|99|0.00|INSERT PENILE PROSTH-INFLAT|
20|FH_F144039_0_0|SrvcGrp|109761|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESIONS|
20|FH_F122885_39571_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F43779_0_0|SrvcGrp|38|2022|PDM|4506.00|99|0.00|NORMAL DELIVERY|
20|FH_F43859_0_0|SrvcGrp|37405|2022|PDM|90.00|99|0.00|OT SVCS|
20|FH_F43862_0_0|SrvcGrp|37404|2022|PDM|90.00|99|0.00|PT SVCS|
20|FH_F43862_0_0|SrvcGrp|35468|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F134697_32566_0|SrvcGrp|73841|2022|PDM|467.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F134697_32566_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135762_70001_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F113713_17013_0|SrvcGrp|86722|2022|PDM|120.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F49016_0_0|SrvcGrp|10904|2022|PDM|550.00|99|0.00|EMERGENCY ROOM LEVEL II|
20|FH_F49016_0_0|SrvcGrp|44999|2022|PCT|0.60|99|0.00|MEDICAL SUPPLIES|
20|FH_F77234_0_0|SrvcGrp|17075|2022|PDM|2379.00|99|0.00|ASPG VI|
20|FH_F115664_72758_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115723_78363_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147700_21401_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PDM|3126.00|99|0.00|AEG 7 (NO REV)|
20|FH_F151399_0_0|SrvcGrp|100959|2022|PDM|11724.00|99|0.00|AMB SRVC CONVNTION AIR TRANSPORT 1 WAY|
20|FH_F38135_0_0|SrvcGrp|14394|2022|PCT|0.75|99|0.00|DIAGNOSTIC CARDIAC CATH|
20|FH_F150939_0_0|SrvcGrp|100279|2022|PDM|0.17|99|0.00|ALBUTEROL NON-COMPOUNDED|
20|FH_F117509_0_0|SrvcGrp|82222|2022|PDM|148.79|99|0.00|HOSPICE CARE|
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)|
20|FH_F136410_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AEG 1 (NO REV)|
20|FH_F38955_0_0|SrvcGrp|97|2022|PDM|3423.44|99|0.00|C-SECTION|
20|FH_F48295_0_0|SrvcGrp|44424|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER (VISIT LVL)|
20|FH_F138936_01040_0|SrvcGrp|111928|2022|PCT|1.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F57953_0_0|SrvcGrp|31191|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF (DME)|
20|FH_F89580_0_0|SrvcGrp|10944|2022|PCT|0.66|99|0.00|EMERGENCY ROOM|
20|FH_F113885_0_0|SrvcGrp|26001|2022|PDM|154.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F151380_90701_0|SrvcGrp|114008|2022|PDM|549.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F151425_19111_0|SrvcGrp|87077|2022|PDM|145.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F151513_44718_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC|
20|FH_F122140_66064_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F131668_97526_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132307_06010_0|SrvcGrp|472|2022|PDM|700.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133478_40165_0|SrvcGrp|12840|2022|PCT|0.28|99|0.00|PACEMAKER|
20|FH_F31970_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F50655_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50655_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS|
20|FH_F133536_0_0|SrvcGrp|90376|2022|PDM|23760.00|99|0.00|REVISION OF KNEE JOINTLANT|
20|FH_F32360_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F52753_0_0|SrvcGrp|13557|2022|PCT|1.10|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F59732_0_0|SrvcGrp|41460|2022|PDM|20.00|99|0.00|ENTERAL THERAPY - UNSPECIFIED|
20|FH_F61292_0_0|SrvcGrp|12683|2022|PDM|308.00|99|0.00|OP PSYCH PARTIAL HOSP - HALF DAY|
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|1723.00|99|0.00|AEG 7 (NO REV)|
20|FH_F130840_21738_0|SrvcGrp|74668|2022|PDM|700.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|AEG 5  (NO REV)|
20|FH_F130051_31707_0|SrvcGrp|15052|2022|PCT|1.65|99|0.00|RADIOLOGY SVCS|
20|FH_F148265_06067_0|CSTM-ALL|CSTM-00|2020|PDM|2710.00|99|0.00|AEG 9 (NO REV)|
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|AEG 8 (NO REV)|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PDM|481.00|99|0.00|ASPG I|
20|FH_F151541_01436_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F114970_28403_0|SrvcGrp|93338|2022|PDM|20.00|99|0.00|AETNA MED NUTRITION SEBSEQUENT|
20|FH_F97102_83501_0|SrvcGrp|73603|2022|PDM|9293.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F124048_47304_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F143785_19713_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F135231_90265_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F148169_33138_0|SrvcGrp|114112|2022|PDM|23.46|99|0.00|COVID-19 SPECIMEN COLLECT|
20|FH_F83938_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102184_0_0|SrvcGrp|98499|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|ASPG VI|
20|FH_F109538_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F120338_83226_0|SrvcGrp|108484|2022|PDM|1755.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F137239_0_0|SrvcGrp|89149|2022|PDM|235.00|99|0.00|OP INTENSIVE|
20|FH_F135173_06519_0|SrvcGrp|90572|2022|PDM|223.00|99|0.00|INTENSIVE OP PSYCH (HCFA)|
20|FH_F67261_0_0|SrvcGrp|63056|2022|PDM|4795.00|99|0.00|SPINE SURGERY|
20|FH_F128580_0_0|SrvcGrp|108078|2022|PDM|1306.00|99|0.00|ARTERY-VEIN FUSION|
20|FH_F143900_63303_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147941_06023_0|SrvcGrp|73523|2022|PDM|247.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME|
20|FH_F41665_0_0|SrvcGrp|32404|2022|PCT|0.65|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL (RADIOLOGY)|
20|FH_F148260_0_0|SrvcGrp|87026|2022|PDM|1420.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F93880_95476_0|SrvcGrp|88978|2022|PDM|10860.00|99|0.00|VAGINAL DELIVERY|
20|FH_F118703_0_0|SrvcGrp|72998|2022|PDM|820.00|99|0.00|AEG 5|
20|FH_F93114_85016_0|SrvcGrp|43567|2022|PDM|145.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F102302_0_0|SrvcGrp|98639|2022|PDM|1817.00|99|0.00|REVISION OF ARM NERVE(S)|
20|FH_F114918_78748_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F63438_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137940_0_0|SrvcGrp|106317|2022|PDM|595.64|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F44198_0_0|SrvcGrp|13597|2022|PDM|190.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F149888_68506_0|CSTM-ALL|CSTM-00|2020|PDM|2791.00|99|0.00|AEG 9 (NO REV)|
20|FH_F147941_06023_0|SrvcGrp|13807|2022|PDM|1410.00|99|0.00|OBSERVATION SVCS|
20|FH_F143930_16101_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F37443_0_0|CSTM-ALL|CSTM-00|2020|PDM|7000.00|99|0.00|C-SECTION|
20|FH_F128190_45342_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F125249_0_0|SrvcGrp|82634|2022|PDM|1200.00|99|0.00|REPAIR OF KNEE LIGAMENTS|
20|FH_F130807_20721_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73013_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALEGENT HH - DME RR|
20|FH_F126926_32250_0|SrvcGrp|89149|2022|PDM|371.00|99|0.00|OP INTENSIVE|
20|FH_F131902_46402_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116237_43235_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F110925_01104_0|SrvcGrp|17013|2022|PDM|59.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F89563_29407_0|SrvcGrp|103321|2022|PCT|1.00|99|0.00|PT EVAL LOW COMPLEX 20 MIN|
20|FH_F120902_64085_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F51358_0_0|SrvcGrp|45949|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F135173_06519_0|SrvcGrp|3044|2022|PDM|714.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F141801_80534_0|SrvcGrp|72602|2022|PDM|1000.00|99|0.00|ECT|
20|FH_F38151_0_0|SrvcGrp|131|2022|PCT|0.85|99|0.00|PACEMAKER DEVICE|
20|FH_F102800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40046_0_0|SrvcGrp|10541|2022|PDM|115.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PDM|1023.23|99|0.00|ASPG VIII|
20|FH_F141801_80534_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S AZ/NV - MOD KF|
20|FH_F89475_71202_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F54614_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|510.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F38933_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145792_33612_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F41481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109885_35473_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129483_77030_0|SrvcGrp|14945|2022|PDM|5.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F129501_67831_0|SrvcGrp|109057|2022|PCT|1.00|99|0.00|CARDIAC STUDIES|
20|FH_F117093_40041_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117102_39355_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F117219_77515_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F117126_12801_0|SrvcGrp|75505|2022|PCT|0.75|99|0.00|CARDIAC STUDIES|
20|FH_F117240_37334_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101161_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|817.00|99|0.00|AEG 5  (NO REV)|
20|FH_F111046_0_0|SrvcGrp|84284|2022|PDM|595.00|99|0.00|AMBULANCE SVC NEONATAL EMERG TRANSPORT|
20|FH_F138543_60130_0|SrvcGrp|3178|2022|PDM|539.00|99|0.00|ACUTE PSYCH|
20|FH_F135653_0_0|SrvcGrp|85198|2022|PDM|7000.00|99|0.00|AETNA KNEE ARTHROSCOPY|
20|FH_F132212_0_0|SrvcGrp|92502|2022|PDM|425.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F119449_84032_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F148419_01453_0|SrvcGrp|115384|2022|PCT|1.00|99|0.00|COVID-19 INFUSION ADMINISTRATION COMBINATION - ELI LILLY|
20|FH_F91152_60061_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F132934_63005_0|SrvcGrp|361|2022|PDM|4937.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F110140_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F133458_18929_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150948_0_0|SrvcGrp|84939|2022|PDM|10500.00|99|0.00|SHOULDER JOINT|
20|FH_F51438_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY|
20|FH_F34706_0_0|SrvcGrp|72|2022|PDM|583.00|99|0.00|NEWBORN NURSERY|
20|FH_F111809_93003_0|SrvcGrp|109057|2022|PCT|9.10|99|0.00|CARDIAC STUDIES|
20|FH_F141870_85224_0|SrvcGrp|86837|2022|PDM|25.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F118587_20721_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129688_74066_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F42340_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F92648_90248_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130556_33764_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149664_33428_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150464_15746_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141833_31707_0|SrvcGrp|13681|2022|PDM|600.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F120437_85202_0|SrvcGrp|86123|2022|PDM|49.12|99|0.00|AETNA INJ IVIG PRIVIGEN|
20|FH_F132934_63005_0|SrvcGrp|92578|2022|PDM|3556.00|99|0.00|ADULT MEDICAL CARE (>= 18 YRS)|
20|FH_F132446_19063_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F31093_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|LAB FS - SPCE|
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F67560_0_0|SrvcGrp|17073|2022|PCT|0.83|99|0.00|ASPG V|
20|FH_F117340_68144_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F77663_0_0|SrvcGrp|14210|2022|PDM|120.00|99|0.00|PSYCH INTENSIVE OUTPATIENT|
20|FH_F92977_64067_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F141835_78676_0|SrvcGrp|74668|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F39721_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F149781_37404_0|SrvcGrp|92363|2022|PDM|4635.00|99|0.00|OSTEOCHONDRAL ALLOGRAFT KNEE|
20|FH_F91152_60061_0|SrvcGrp|43524|2022|PDM|205.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|1656.00|99|0.00|AEG 6 (NO REV)|
20|FH_F97565_83301_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F148556_13206_0|SrvcGrp|14947|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F126676_43537_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F78205_0_0|SrvcGrp|17073|2022|PDM|2031.18|99|0.00|ASPG V|
20|FH_F141893_65655_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143147_80124_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F140790_0_0|SrvcGrp|28549|2022|PDM|2750.00|99|0.00|VITRECTOMY|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.63|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1302 W/O REV|
20|FH_F101754_63141_0|SrvcGrp|97985|2022|PDM|64.00|99|0.00|EAR MOLD/INSERT|
20|FH_F90811_0_0|SrvcGrp|90417|2022|PDM|2700.00|99|0.00|TREATMENT OF JOINT|
20|FH_F100788_01420_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F145988_06105_0|CSTM-ALL|CSTM-00|2020|PDM|3555.00|99|0.00|AEG 1 (NO REV)|
20|FH_F111520_81601_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F52032_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F133493_90255_0|SrvcGrp|705|2022|PCT|0.25|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F45199_0_0|CSTM-ALL|CSTM-00|2020|PDM|374.00|99|0.00|ASPG I|
20|FH_F118393_21032_0|SrvcGrp|75545|2022|PDM|343.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F97882_32407_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F112836_06040_0|SrvcGrp|76501|2022|PDM|368.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F98620_43920_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F45977_0_0|SrvcGrp|40408|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD NU KE|
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|1338.00|99|0.00|AEG 10 (NO REV)|
20|FH_F149605_0_0|SrvcGrp|90477|2022|PDM|153.00|99|0.00|HOSPICE|
20|FH_F121068_18036_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133018_84037_0|SrvcGrp|47411|2022|PDM|93.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PDM|596.21|99|0.00|AEG 3 (NO REV)|
20|FH_F144928_02703_0|SrvcGrp|16069|2022|PDM|504.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F123184_20906_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F123193_33431_0|SrvcGrp|108061|2022|PCT|1.25|99|0.00|OP THERAPY SERVICES|
20|FH_F97143_80012_0|SrvcGrp|88978|2022|PDM|6965.00|99|0.00|VAGINAL DELIVERY|
20|FH_F97143_80012_0|SrvcGrp|73605|2022|PDM|3307.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F91700_15601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136174_89146_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136180_92253_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F136223_60954_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130564_74834_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131132_44077_0|SrvcGrp|73500|2022|PDM|362.00|99|0.00|AETNA ER LEVEL I|
20|FH_F116431_76104_0|SrvcGrp|24011|2022|PCT|0.85|99|0.00|IMPLANTS|
20|FH_F116527_70443_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F94103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F36479_0_0|SrvcGrp|413|2022|PCT|0.75|99|0.00|TRANSPLANT SVCS|
20|FH_F101665_10027_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F38013_0_0|SrvcGrp|12044|2022|PDM|693.00|99|0.00|SLEEP STUDIES|
20|FH_F130817_18103_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)|
20|FH_F111292_33136_0|SrvcGrp|99363|2022|PDM|76.00|99|0.00|SCR MAMMO BI INCL CAD|
20|FH_F111292_33136_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|OP SVCS|
20|FH_F39178_0_0|SrvcGrp|439|2022|PDM|2247.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F69202_0_0|SrvcGrp|361|2022|PDM|1100.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F34246_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.10|99|0.00|GENERAL ACUTE CARE|
20|FH_F54272_0_0|SrvcGrp|51786|2022|PCT|0.45|99|0.00|IP BLOOD PRODUCTS|
20|FH_F54272_0_0|SrvcGrp|110|2022|PDM|789.00|99|0.00|CD - REHABILITATION|
20|FH_F54272_0_0|SrvcGrp|12079|2022|PCT|0.45|99|0.00|MED SURG SUPPLIES|
20|FH_F54272_0_0|SrvcGrp|31214|2022|PCT|0.45|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F56573_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F94280_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)|
20|FH_F32826_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114569_0_0|SrvcGrp|105540|2022|PDM|18.38|99|0.00|AETHA BRIEF ALCOHOL MISUSE COUNSEL (MOD GT)|
20|FH_F112092_46845_0|SrvcGrp|90481|2022|PCT|1.00|99|0.00|FLULAVAL VACC 3 YRS & > IM|
20|FH_F112135_80910_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F87532_32110_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F87557_33309_0|SrvcGrp|86824|2022|PDM|60.00|99|0.00|CPT CODE 99601 (HCFA)|
20|FH_F96340_23704_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101904_17057_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F129240_10028_0|SrvcGrp|86831|2022|PDM|5.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F101320_26062_0|SrvcGrp|73742|2022|PDM|7.20|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F132090_60915_0|SrvcGrp|16670|2022|PDM|2000.00|99|0.00|ULNAR NERVE AT ELBOW|
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132810_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F69968_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|OP SVCS|
20|FH_F136372_19046_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136377_75240_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136387_61244_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136478_75605_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136487_71269_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136542_02446_0|SrvcGrp|86722|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F120456_67117_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F120490_64133_0|SrvcGrp|53987|2022|PDM|50.00|99|0.00|PHOTOTHERAPY|
20|FH_F120506_53934_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F134011_84102_0|SrvcGrp|14944|2022|PDM|2.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F134155_07016_0|SrvcGrp|90576|2022|PDM|437.00|99|0.00|AETNA PARTIAL HOSPITALIZATION (<=18 YRS) (HCFA)|
20|FH_F137147_75006_0|SrvcGrp|33979|2022|PDM|23370.00|99|0.00|CPT 27440|
20|FH_F138746_60174_0|SrvcGrp|73842|2022|PDM|228.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138627_82901_0|SrvcGrp|86848|2022|PDM|85.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F77782_66061_0|SrvcGrp|15782|2022|PDM|9264.00|99|0.00|LITHOTRIPSY - BILATERAL (MOD 50)|
20|FH_F140343_89052_0|SrvcGrp|86828|2022|PDM|45.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F140407_63841_0|SrvcGrp|104363|2022|PCT|0.75|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F149374_38855_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F149374_38855_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149524_28806_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151579_19802_0|SrvcGrp|115830|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F118932_07652_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F109885_35473_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F80366_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|OP SVCS|
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 3 (NO REV)|
20|FH_F117102_39355_0|SrvcGrp|33165|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F117126_12801_0|CSTM-ALL|CSTM-00|2020|PDM|2520.00|99|0.00|AEG 10 (NO REV)|
20|FH_F39352_0_0|SrvcGrp|115|2022|PDM|400.00|99|0.00|SKILLED NURSING CARE|
20|FH_F39893_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F109652_0_0|SrvcGrp|78782|2022|PDM|16469.00|99|0.00|INTRACARDIAC CATHETER PROCEDURES|
20|FH_F110720_0_0|SrvcGrp|73000|2022|PDM|3041.00|99|0.00|AEG 6|
20|FH_F90876_18447_0|SrvcGrp|73700|2022|PDM|32.55|99|0.00|AETNA - SKILLED NURSING|
20|FH_F93881_15009_0|SrvcGrp|16719|2022|PCT|0.40|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F33642_0_0|SrvcGrp|14609|2022|PCT|0.75|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F148892_0_0|SrvcGrp|58638|2022|PDM|2940.00|99|0.00|CPT 63688|
20|FH_F82931_18847_0|SrvcGrp|537|2022|PCT|0.74|99|0.00|OBSERVATION SERVICES|
20|FH_F124660_0_0|SrvcGrp|109930|2022|PDM|903.00|99|0.00|DESTROY CERV/THOR FACET JNT|
20|FH_F147162_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F115019_78414_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116188_72211_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F93424_53578_0|SrvcGrp|89149|2022|PDM|239.00|99|0.00|OP INTENSIVE|
20|FH_F115967_60123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135294_64093_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40046_0_0|SrvcGrp|3066|2022|PCT|0.65|99|0.00|HIGH-COST DRUGS|
20|FH_F116061_80110_0|SrvcGrp|104080|2022|PCT|1.40|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F145792_33612_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F32804_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F46094_0_0|SrvcGrp|11074|2022|PDM|100.00|99|0.00|NURSING CARE|
20|FH_F110086_21742_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|AEG 10 (NO REV)|
20|FH_F141510_95123_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F110925_01104_0|SrvcGrp|41452|2022|PDM|1.10|99|0.00|ENTERAL FORMULA - SPECIAL METABOLIC NEEDS|
20|FH_F116161_28112_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F127255_03104_0|SrvcGrp|108484|2022|PDM|675.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F128682_57701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128982_44221_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F137507_62901_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143783_0_0|SrvcGrp|97506|2022|PDM|105.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F145545_01602_0|SrvcGrp|46903|2022|PDM|473.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F115949_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F50237_0_0|SrvcGrp|9978|2022|PDM|1150.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS|
20|FH_F151061_02720_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F151142_35406_0|CSTM-ALL|CSTM-00|2020|PDM|1398.00|99|0.00|AEG 9 (NO REV)|
20|FH_F151226_33155_0|SrvcGrp|115908|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F116809_0_0|SrvcGrp|79593|2022|PDM|536.00|99|0.00|CPT 45378|
20|FH_F116809_0_0|SrvcGrp|79589|2022|PDM|461.00|99|0.00|UPPER GI|
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40144_0_0|SrvcGrp|16|2022|PDM|891.00|99|0.00|ACUTE REHABILITATION|
20|FH_F36017_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|OP SVCS|
20|FH_F108800_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F32227_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F74562_0_0|SrvcGrp|115|2022|PDM|750.00|99|0.00|SKILLED NURSING CARE|
20|FH_F114916_30309_0|SrvcGrp|88163|2022|PDM|6500.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F114916_30309_0|SrvcGrp|67064|2022|PDM|2500.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F142448_15701_0|SrvcGrp|29076|2022|PDM|54.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F104840_32565_0|SrvcGrp|73559|2022|PCT|0.69|99|0.00|AETNA INTENSIVE CARE|
20|FH_F105481_80120_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER UEKF|
20|FH_F138929_0_0|SrvcGrp|90420|2022|PDM|5005.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F95341_08701_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F62252_0_0|SrvcGrp|12496|2022|PDM|680.00|99|0.00|ACUTE REHABILITATION|
20|FH_F120901_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|350.00|99|0.00|AEG 10 (NO REV)|
20|FH_F126345_0_0|SrvcGrp|63472|2022|PDM|2376.00|99|0.00|CPT 64581|
20|FH_F114389_50131_0|SrvcGrp|53987|2022|PDM|18.94|99|0.00|PHOTOTHERAPY|
20|FH_F141336_16947_0|SrvcGrp|98353|2022|PCT|0.66|99|0.00|OP TRAUMA 684|
20|FH_F132348_16214_0|SrvcGrp|46104|2022|PDM|110.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F146674_70778_0|SrvcGrp|75419|2022|PDM|425.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F38688_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F93232_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132864_71101_0|CSTM-ALL|CSTM-00|2020|PDM|937.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F124177_59254_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|GENERAL ACUTE CARE|
20|FH_F124235_92840_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F124246_71655_0|SrvcGrp|74668|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F135450_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F127995_84010_0|SrvcGrp|86846|2022|PDM|25.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F87856_0_0|SrvcGrp|81424|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F143577_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F124112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136741_60523_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F114629_19131_0|SrvcGrp|105704|2022|PDM|449.00|99|0.00|AETNA TERANIAL MAGN STIM TX DELI (HCFA)|
20|FH_F138716_20151_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139087_47586_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F122591_84010_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37847_0_0|SrvcGrp|8962|2022|PDM|93.50|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F115664_72758_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147519_52627_0|SrvcGrp|89149|2022|PDM|172.06|99|0.00|OP INTENSIVE|
20|FH_F135351_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F144648_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F40154_0_0|SrvcGrp|439|2022|PDM|1837.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F134493_48708_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F125222_83211_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F88512_0_0|SrvcGrp|12343|2022|PDM|6330.10|99|0.00|PET SCAN|
20|FH_F97882_32407_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
20|FH_F42355_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128130_10027_0|CSTM-ALL|CSTM-00|2020|PDM|7718.00|99|0.00|AEG 8 (NO REV)|
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|742.00|99|0.00|AEG 2 (NO REV)|
20|FH_F144109_63376_0|SrvcGrp|18071|2022|PDM|500.00|99|0.00|AMBULANCE RESPONSE/TREATMENT - NO TRANSPORT|
20|FH_F67305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)|
20|FH_F132543_79549_0|SrvcGrp|109707|2022|PDM|1500.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F47479_0_0|SrvcGrp|3810|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|2355.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F133291_33563_0|SrvcGrp|108484|2022|PDM|561.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F103360_68845_0|CSTM-ALL|CSTM-00|2020|PDM|8151.00|99|0.00|AEG 7 (NO REV)|
20|FH_F133477_90247_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125070_64117_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86293_0_0|SrvcGrp|34606|2022|PDM|2794.00|99|0.00|CPT 29827|
20|FH_F117855_62246_0|SrvcGrp|48396|2022|PDM|61.00|99|0.00|OT SERVICES|
20|FH_F150499_32405_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F81494_0_0|SrvcGrp|16615|2022|PDM|144.00|99|0.00|RN VISIT|
20|FH_F97581_60141_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F115329_79424_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F139527_15642_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139680_76006_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F132254_40207_0|SrvcGrp|86831|2022|PDM|9.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F149240_0_0|SrvcGrp|82222|2022|PDM|144.84|99|0.00|HOSPICE CARE|
20|FH_F114206_37203_0|SrvcGrp|86854|2022|PDM|45.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F134707_0_0|SrvcGrp|12491|2022|PCT|0.44|99|0.00|PACEMAKER|
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|AEG 8 (NO REV)|
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_F150927_64836_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% 2007 MEDICARETN DME MOD QW|
20|FH_F122277_98045_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F113116_23847_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F117023_0_0|SrvcGrp|75497|2022|PDM|1038.00|99|0.00|AEG 10|
20|FH_F35452_0_0|SrvcGrp|12179|2022|PCT|1.50|99|0.00|CPT CODES 70000-79999 (RAD)|
20|FH_F151042_60659_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F119316_27104_0|SrvcGrp|87317|2022|PDM|1006.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F97480_08204_0|SrvcGrp|73602|2022|PDM|5659.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F149662_85015_0|SrvcGrp|75506|2022|PCT|0.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|311.00|99|0.00|AEG 10 (NO REV)|
20|FH_F143668_0_0|SrvcGrp|114059|2022|PDM|600.00|99|0.00|PNEUMATIC COMPRESSOR (MOD NU)|
20|FH_F75724_0_0|SrvcGrp|471|2022|PDM|480.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F139309_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97183_25304_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132849_0_0|SrvcGrp|361|2022|PDM|2233.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F125182_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|3465.00|99|0.00|ASPG VI|
20|FH_F138932_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.50|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F48254_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO|
20|FH_F99920_63141_0|SrvcGrp|97507|2022|PDM|110.00|99|0.00|AETNA HOSPICE|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|ASPG II|
20|FH_F124976_0_0|SrvcGrp|87441|2022|PDM|651.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37095_17543_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F129765_43015_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|RADIOLOGY W/MOD 26|
20|FH_F35088_0_0|SrvcGrp|537|2022|PCT|0.44|99|0.00|OBSERVATION SERVICES|
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|586.00|99|0.00|AEG 1 (NO REV)|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.65|99|0.00|SALLY BALIN,999182,ASC 121|
20|FH_F38873_66434_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|12933.00|99|0.00|MS DRG 260-262 CARDIAC PACEMAKER REVISION|
20|FH_F151699_01752_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F35557_0_0|SrvcGrp|13606|2022|PDM|4.00|99|0.00|HOME INFUSION|
20|FH_F125182_0_0|SrvcGrp|72998|2022|PDM|889.00|99|0.00|AEG 5|
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PDM|1681.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F119203_0_0|SrvcGrp|108022|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F117799_0_0|SrvcGrp|84357|2022|PDM|11935.00|99|0.00|HIP SURGERY|
20|FH_F151699_01752_0|SrvcGrp|86846|2022|PDM|50.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F101441_0_0|SrvcGrp|16694|2022|PDM|3567.00|99|0.00|KNEE SCOPE, CHONDROPLASTY|
20|FH_F147140_89103_0|SrvcGrp|73701|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F94643_90501_0|SrvcGrp|22592|2022|PDM|48.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F138017_73129_0|SrvcGrp|112978|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F139817_75119_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F72945_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|OP SVCS|
20|FH_F38321_0_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F109513_0_0|SrvcGrp|90430|2022|PDM|2500.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|13545.00|99|0.00|MS DRG 243-244|
20|FH_F31537_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95880_02726_0|SrvcGrp|471|2022|PDM|439.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F33925_0_0|SrvcGrp|9263|2022|PDM|575.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F35685_0_0|SrvcGrp|11196|2022|PDM|37485.00|99|0.00|DRG 548 CORONARY BYPASS W/ CARDIAC CATH W/O MAJOR CV DX|
20|FH_F41015_0_0|SrvcGrp|16624|2022|PCT|1.00|99|0.00|PHARMACY SVCS|
20|FH_F140007_0_0|SrvcGrp|80139|2022|PDM|7887.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F41605_0_0|SrvcGrp|13551|2022|PDM|379.00|99|0.00|NEWBORN NURSERY|
20|FH_F120112_0_0|SrvcGrp|90707|2022|PDM|94.50|99|0.00|AETNA HOSPICE CARE|
20|FH_F140873_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|2920.00|99|0.00|AEG 6 (NO REV)|
20|FH_F100906_0_0|SrvcGrp|37984|2022|PDM|500.00|99|0.00|LUMBAR INJECTIONS PROCEDURE|
20|FH_F138283_0_0|SrvcGrp|26160|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F138283_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140035_0_0|SrvcGrp|46605|2022|PDM|197.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F148419_01453_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41173_0_0|SrvcGrp|110|2022|PDM|598.00|99|0.00|CD - REHABILITATION|
20|FH_F147800_0_0|SrvcGrp|115151|2022|PDM|55.00|99|0.00|NJX AA&/STRD GR OCPL NRV|
20|FH_F117945_78957_0|SrvcGrp|89412|2022|PDM|300.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F133458_18929_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F118393_21032_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F68944_0_0|SrvcGrp|23206|2022|PCT|0.70|99|0.00|PTCA|
20|FH_F40465_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F72859_0_0|SrvcGrp|15517|2022|PDM|90.00|99|0.00|HYDRATION THERAPY|
20|FH_F101802_17201_0|SrvcGrp|94021|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F43719_0_0|CSTM-ALL|CSTM-00|2020|PDM|240.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F141871_33024_0|SrvcGrp|75419|2022|PDM|384.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F150883_14727_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F51129_0_0|SrvcGrp|38705|2022|PCT|0.75|99|0.00|CARDIAC ABLATION|
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1640.00|99|0.00|AEG 8 (NO REV)|
20|FH_F115383_80734_0|SrvcGrp|471|2022|PDM|541.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F40906_0_0|SrvcGrp|13422|2022|PDM|209.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F138236_0_0|SrvcGrp|29155|2022|PDM|105.00|99|0.00|HOSPICE SVCS|
20|FH_F87436_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.65|99|0.00|HAPA WPA/NWPA 2016 LAB 100%|
20|FH_F31093_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.00|99|0.00|ASPG III|
20|FH_F67639_0_0|SrvcGrp|63459|2022|PDM|1500.00|99|0.00|CPT 52601|
20|FH_F132080_0_0|SrvcGrp|83522|2022|PDM|169.00|99|0.00|RESPITE CARE|
20|FH_F40599_0_0|SrvcGrp|12118|2022|PDM|360.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F94300_0_0|SrvcGrp|12491|2022|PCT|1.03|99|0.00|PACEMAKER|
20|FH_F150526_16335_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F73842_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS|
20|FH_F97621_75801_0|SrvcGrp|73643|2022|PDM|1131.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F148881_33018_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F133018_84037_0|SrvcGrp|46605|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F41785_0_0|SrvcGrp|31186|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC (DME)|
20|FH_F68868_0_0|SrvcGrp|3029|2022|PDM|567.00|99|0.00|NEWBORN NURSERY|
20|FH_F39417_0_0|CSTM-ALL|CSTM-00|2020|PDM|1160.45|99|0.00|ASPG I|
20|FH_F72859_0_0|SrvcGrp|15508|2022|PDM|8.06|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F115405_06010_0|SrvcGrp|89149|2022|PDM|165.00|99|0.00|OP INTENSIVE|
20|FH_F128418_88260_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111415_33180_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F42340_0_0|SrvcGrp|31188|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC (DME)|
20|FH_F43953_0_0|SrvcGrp|9875|2022|PDM|3106.00|99|0.00|ACUTE IP MEDICAL SERVICES|
20|FH_F88818_0_0|SrvcGrp|87819|2022|PDM|475.00|99|0.00|REPAIR OF WOUND/LESION|
20|FH_F131699_08210_0|SrvcGrp|29346|2022|PDM|64.85|99|0.00|SKILLED NURSING- LPN|
20|FH_F97562_29803_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131699_08210_0|SrvcGrp|48385|2022|PDM|154.35|99|0.00|SPEECH THERAPY|
20|FH_F81485_0_0|SrvcGrp|9518|2022|PDM|369.00|99|0.00|EMERGENCY ROOM|
20|FH_F88818_0_0|SrvcGrp|75485|2022|PDM|549.00|99|0.00|AEG 4|
20|FH_F133351_84003_0|SrvcGrp|75545|2022|PDM|390.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118542_60188_0|SrvcGrp|29075|2022|PDM|90.00|99|0.00|HYDRATION THERAPY|
20|FH_F128299_44134_0|SrvcGrp|94781|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F52733_0_0|SrvcGrp|42971|2022|PDM|85.00|99|0.00|SKN RN|
20|FH_F146212_57108_0|CSTM-ALL|CSTM-00|2020|PDM|1983.69|99|0.00|AEG 5  (NO REV)|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD QW) - BDSS|
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F41166_0_0|SrvcGrp|207|2022|PDM|303.00|99|0.00|OP REHAB PROGRAM|
20|FH_F34653_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.20|99|0.00|GENERAL ACUTE CARE|
20|FH_F122245_0_0|SrvcGrp|104448|2022|PDM|9902.25|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE|
20|FH_F102681_34237_0|SrvcGrp|72990|2022|PDM|295.00|99|0.00|AEG 1|
20|FH_F151747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F57592_0_0|SrvcGrp|29607|2022|PDM|48000.00|99|0.00|MS DRG 221 ONLY|
20|FH_F150600_44270_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150600_44270_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150939_0_0|SrvcGrp|100272|2022|PDM|9.50|99|0.00|IIV3 VACCINE SPLT 0.25 ML IM|
20|FH_F46672_0_0|SrvcGrp|40062|2022|PDM|105.00|99|0.00|PT / OT / ST|
20|FH_F73204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86377_0_0|SrvcGrp|76094|2022|PDM|118.16|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F92188_0_0|CSTM-ALL|CSTM-00|2020|PDM|726.00|99|0.00|AEG 2 (NO REV)|
20|FH_F36719_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|OP SVCS|
20|FH_F151419_07852_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F151503_30067_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F122148_62664_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F135389_43123_0|SrvcGrp|89149|2022|PDM|227.00|99|0.00|OP INTENSIVE|
20|FH_F135447_53226_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135587_37334_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135924_02906_0|SrvcGrp|115518|2022|PCT|1.03|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F136180_92253_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F116464_13088_0|SrvcGrp|86722|2022|PDM|135.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F140629_0_0|SrvcGrp|113689|2022|PDM|2497.00|99|0.00|VAGUS NERVE LAPAROSCOPY|
20|FH_F101200_19020_0|SrvcGrp|86648|2022|PCT|1.05|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F121466_84057_0|SrvcGrp|46903|2022|PDM|625.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F32803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F33685_0_0|SrvcGrp|63|2022|PDM|650.00|99|0.00|SUBACUTE CARE|
20|FH_F33791_0_0|SrvcGrp|16|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION|
20|FH_F111292_33136_0|SrvcGrp|82739|2022|PDM|40.00|99|0.00|LIPID PROFILE|
20|FH_F114166_0_0|SrvcGrp|111928|2022|PDM|52.85|99|0.00|COVID-19 BARTONELLA|
20|FH_F33390_0_0|SrvcGrp|13390|2022|PCT|0.70|99|0.00|DIALYSIS SVCS|
20|FH_F40698_0_0|SrvcGrp|3403|2022|PDM|100.00|99|0.00|CPT 99203|
20|FH_F132328_0_0|SrvcGrp|111952|2022|PDM|2425.00|99|0.00|CYSTOURETHROSCOPY/URETEROSCO|
20|FH_F87557_33309_0|SrvcGrp|29023|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F87557_33309_0|SrvcGrp|86842|2022|PDM|25.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F102325_62691_0|SrvcGrp|98258|2022|PCT|1.30|99|0.00|ALL DRUGS/AGENTS/ INJ DRUG|
20|FH_F101557_81004_0|SrvcGrp|89498|2022|PCT|1.00|99|0.00|AIR AND GROUND AMBULANCE|
20|FH_F148101_33462_0|SrvcGrp|102279|2022|PDM|95.00|99|0.00|AETNA METHADONE MAINTENANCE (HCFA)|
20|FH_F118792_63379_0|SrvcGrp|81779|2022|PCT|0.74|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F84611_30281_0|SrvcGrp|82082|2022|PDM|11193.00|99|0.00|EPS AND MAPPING STUDIES|
20|FH_F41535_0_0|SrvcGrp|97|2022|PDM|2600.00|99|0.00|C-SECTION|
20|FH_F51276_0_0|SrvcGrp|20480|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F35685_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|RADIOLOGY FS|
20|FH_F38190_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|OP SVCS|
20|FH_F39355_0_0|SrvcGrp|13990|2022|PCT|1.05|99|0.00|PACEMAKER|
20|FH_F98622_45005_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F86872_15215_0|SrvcGrp|26869|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F86991_15122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F74602_0_0|SrvcGrp|71025|2022|PDM|5200.00|99|0.00|PACEMAKER/AICD INSERTION|
20|FH_F86851_0_0|SrvcGrp|84997|2022|PDM|451.00|99|0.00|CPT 45337|
20|FH_F89778_0_0|SrvcGrp|82109|2022|PDM|782.01|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F88634_33952_0|CSTM-ALL|CSTM-00|2020|PCT|0.81|99|0.00|OP SVCS|
20|FH_F40191_0_0|SrvcGrp|3188|2022|PDM|562.00|99|0.00|NEWBORN NURSERY|
20|FH_F40347_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F71923_0_0|SrvcGrp|10510|2022|PDM|318.27|99|0.00|CPT CODE 90945|
20|FH_F107200_0_0|SrvcGrp|27348|2022|PDM|4422.00|99|0.00|OP SURGERY (CPT 58662)|
20|FH_F136378_07104_0|SrvcGrp|89417|2022|PDM|370.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F134011_84102_0|SrvcGrp|97506|2022|PDM|112.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F134126_11554_0|CSTM-ALL|CSTM-00|2020|PDM|3616.00|99|0.00|AEG 8 (NO REV)|
20|FH_F142473_07663_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F142690_31774_0|SrvcGrp|24744|2022|PDM|225.00|99|0.00|PICC LINE INSERTION|
20|FH_F142742_44112_0|SrvcGrp|108484|2022|PDM|500.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F56832_0_0|SrvcGrp|16|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION|
20|FH_F138584_30912_0|SrvcGrp|113394|2022|PDM|1050.00|99|0.00|MANDIBULAR FRACTURE TREATMENT|
20|FH_F74763_63010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F132733_0_0|SrvcGrp|360|2022|PDM|2306.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F77782_66061_0|SrvcGrp|33168|2022|PDM|1533.00|99|0.00|MRI W/O CONTRAST|
20|FH_F140569_46975_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F140668_68745_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151608_30236_0|SrvcGrp|100017|2022|PDM|17923.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F118955_48239_0|SrvcGrp|86722|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F91913_0_0|SrvcGrp|73000|2022|PDM|826.00|99|0.00|AEG 6|
20|FH_F147925_06457_0|SrvcGrp|82981|2022|PDM|163.01|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F117093_40041_0|SrvcGrp|48168|2022|PDM|280.00|99|0.00|HEMODIALYSIS|
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137930_51546_0|SrvcGrp|73701|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F35210_0_0|CSTM-ALL|CSTM-00|2020|PDM|3785.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109652_0_0|SrvcGrp|78579|2022|PDM|3186.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
20|FH_F90876_18447_0|SrvcGrp|26160|2022|PDM|8.40|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F31829_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132736_0_0|SrvcGrp|16|2022|PDM|1611.00|99|0.00|ACUTE REHABILITATION|
20|FH_F84091_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.20|99|0.00|OP SVCS|
20|FH_F39085_0_0|SrvcGrp|72|2022|PDM|400.00|99|0.00|NEWBORN NURSERY|
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.00|99|0.00|AEG 2 (NO REV)|
20|FH_F35103_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148459_15241_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132785_17961_0|SrvcGrp|109221|2022|PCT|2.19|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F71323_68114_0|SrvcGrp|16897|2022|PDM|929.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F37309_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|RS 358 MRI CODES|
20|FH_F90811_0_0|SrvcGrp|90436|2022|PDM|10000.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F138236_0_0|SrvcGrp|104226|2022|PDM|105.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F36576_0_0|SrvcGrp|16|2022|PDM|803.00|99|0.00|ACUTE REHABILITATION|
20|FH_F148703_33853_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F127412_15301_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F117340_68144_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F144327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121223_0_0|SrvcGrp|108041|2022|PDM|435.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F141627_43725_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132613_84601_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F101840_76054_0|SrvcGrp|21071|2022|PDM|43873.00|99|0.00|MS DRG 028 ONLY|
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144494_62526_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F101751_25302_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142027_37217_0|SrvcGrp|44042|2022|PDM|125.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F95360_08720_0|SrvcGrp|93280|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA NON-ESRD|
20|FH_F113074_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F100682_97401_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F69071_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38425_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F120437_85202_0|SrvcGrp|86847|2022|PDM|108.05|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F89932_10940_0|SrvcGrp|74615|2022|PDM|360.00|99|0.00|INTENSIVE OUTPATIENT|
20|FH_F111403_37167_0|SrvcGrp|93919|2022|PDM|912.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|1682.00|99|0.00|ASPG VI|
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.53|99|0.00|ASPG I|
20|FH_F67989_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F119226_07746_0|SrvcGrp|87571|2022|PDM|150.00|99|0.00|CPT 90834 W/REV 914|
20|FH_F133287_40215_0|SrvcGrp|42783|2022|PCT|0.00|99|0.00|HIGH COST DRUGS|
20|FH_F88818_0_0|SrvcGrp|28557|2022|PDM|3700.00|99|0.00|CPT 19318|
20|FH_F145907_03867_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F57592_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148886_60621_0|SrvcGrp|17520|2022|PCT|0.56|99|0.00|IMPLANTS|
20|FH_F148556_13206_0|SrvcGrp|14949|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F125256_77365_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F132541_39120_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125049_44131_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88512_0_0|SrvcGrp|73862|2022|PDM|12005.93|99|0.00|LITHOTRIPSY/CHOLECYSECTOMY|
20|FH_F109840_62832_0|SrvcGrp|89939|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F94300_0_0|SrvcGrp|36591|2022|PDM|1155.00|99|0.00|CPT 63685|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.04|99|0.00|CPT 95810 (W/MOD TC)|
20|FH_F103540_24740_0|SrvcGrp|79720|2022|PDM|975.00|99|0.00|ACUTE REHAB II|
20|FH_F133367_40065_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F34706_0_0|SrvcGrp|11227|2022|PDM|26893.00|99|0.00|DRG 557 PERCUTANEOUS CV PX W/DRUG-ELUTING STENT W/MAJ CV DX|
20|FH_F150533_76051_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F98620_43920_0|SrvcGrp|88977|2022|PDM|4846.00|99|0.00|C-SECTION DELIVERY|
20|FH_F100665_07939_0|CSTM-ALL|CSTM-00|2020|PCT|0.32|99|0.00|OP SVCS|
20|FH_F146211_68144_0|SrvcGrp|91567|2022|PDM|3228.00|99|0.00|REPAIR OF KNEECAP TENDON|
20|FH_F68121_0_0|SrvcGrp|64320|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY EVAL/RE-EVAL|
20|FH_F66906_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F151157_0_0|CSTM-ALL|CSTM-00|2020|PDM|961.00|99|0.00|AEG 2 (NO REV) W/ GASTROESOPHOGEAL|
20|FH_F150020_70601_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41739_0_0|SrvcGrp|10053|2022|PDM|36380.00|99|0.00|DRG 116 ONLY OTH CARDIAC PACEMKR (552)|
20|FH_F46192_0_0|CSTM-ALL|CSTM-00|2020|PDM|3010.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F98600_91730_0|SrvcGrp|46424|2022|PDM|85.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F51548_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F119220_75068_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F133530_11237_0|SrvcGrp|75506|2022|PCT|2.20|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|255.55|99|0.00|HAPA WPA-NWPA 2012-13 ASC 232 W/O REV|
20|FH_F148599_98034_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F117132_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F46196_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F150480_14043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100661_63640_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F38376_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145328_90301_0|SrvcGrp|113328|2022|PDM|465.00|99|0.00|MED TX REMOVE IMPLANT|
20|FH_F87620_80014_0|CSTM-ALL|CSTM-00|2020|PDM|605.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F40154_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|5824.00|99|0.00|AEG 7 (NO REV)|
20|FH_F101104_0_0|SrvcGrp|73700|2022|PDM|125.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|AEG 3 (NO REV)|
20|FH_F125695_52033_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132818_24701_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F35726_33324_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150961_89169_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146204_0_0|SrvcGrp|27347|2022|PDM|1500.00|99|0.00|CPT 58558|
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|22500.00|99|0.00|PT SERVICES|
20|FH_F90232_15126_0|SrvcGrp|26869|2022|PDM|47.25|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F127418_0_0|SrvcGrp|96819|2022|PDM|5958.75|99|0.00|DESTROY L/S FACET JNT ADDL|
20|FH_F146266_0_0|SrvcGrp|67064|2022|PDM|6119.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F150440_35077_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129682_07034_0|SrvcGrp|66264|2022|PDM|89.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F112863_0_0|SrvcGrp|92547|2022|PDM|1141.00|99|0.00|SKIN FULL GRAFT PROCEDURE|
20|FH_F131392_17004_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F32501_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125656_92868_0|SrvcGrp|86841|2022|PDM|80.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F98360_11554_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F146204_0_0|SrvcGrp|113890|2022|PDM|1500.00|99|0.00|REMOVE VAGINA LESION|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F137986_0_0|SrvcGrp|75002|2022|PDM|4509.00|99|0.00|ARTHOSCOPY|
20|FH_F126398_77090_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138016_19808_0|SrvcGrp|86722|2022|PDM|127.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F41167_0_0|SrvcGrp|3418|2022|PDM|1300.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F134916_16421_0|SrvcGrp|107353|2022|PDM|336.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)|
20|FH_F148961_33403_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F128155_62249_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35167_0_0|SrvcGrp|65|2022|PDM|3475.00|99|0.00|OBSTETRICAL CARE|
20|FH_F140036_07702_0|SrvcGrp|86722|2022|PDM|249.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F143410_77845_0|SrvcGrp|108484|2022|PDM|635.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 7 (NO REV)|
20|FH_F101709_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103060_0_0|SrvcGrp|11673|2022|PDM|5202.00|99|0.00|CPT 29888|
20|FH_F48473_0_0|SrvcGrp|9830|2022|PDM|93.50|99|0.00|OT SVCS|
20|FH_F112711_80909_0|SrvcGrp|75545|2022|PDM|309.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F116645_71457_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
20|FH_F116684_30701_0|SrvcGrp|94737|2022|PCT|1.00|99|0.00|FLUVIRIN VACC IM (>=3 YRS)|
20|FH_F120921_75835_0|SrvcGrp|75545|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F126438_50029_0|SrvcGrp|74668|2022|PDM|240.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F51276_0_0|SrvcGrp|27046|2022|PDM|33.50|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS (MOD SH)|
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 1 (NO REV)|
20|FH_F36439_0_0|SrvcGrp|23013|2022|PDM|650.00|99|0.00|V5246|
20|FH_F52753_0_0|SrvcGrp|36991|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F138882_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F141588_60062_0|SrvcGrp|73842|2022|PDM|377.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F51358_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F143528_0_0|SrvcGrp|98497|2022|PDM|10500.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F123280_67002_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110043_33308_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|2620.00|99|0.00|AEG 7 (NO REV)|
20|FH_F129262_33813_0|SrvcGrp|91957|2022|PDM|202.00|99|0.00|INTENSIVE OUTPATIENT (>=18 YRS)|
20|FH_F85295_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F141470_71913_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F116059_62959_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37884_0_0|SrvcGrp|12045|2022|PDM|411.00|99|0.00|SLEEP STUDIES|
20|FH_F120647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40519_0_0|SrvcGrp|32646|2022|PCT|1.50|99|0.00|RADIOLOGY - CPT/MOD TC|
20|FH_F124018_75067_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F140427_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
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_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|809.92|99|0.00|ASPG III|
20|FH_F40198_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F143388_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F130747_0_0|SrvcGrp|67066|2022|PDM|20808.00|99|0.00|CERVICAL SURGERY|
20|FH_F131228_01826_0|CSTM-ALL|CSTM-00|2020|PDM|4914.19|99|0.00|AEG 6 (NO REV)|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 237|
20|FH_F110925_01104_0|SrvcGrp|29075|2022|PDM|59.00|99|0.00|HYDRATION THERAPY|
20|FH_F115685_64064_0|SrvcGrp|86832|2022|PDM|3.60|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F115018_78410_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F94261_0_0|SrvcGrp|88620|2022|PDM|84.00|99|0.00|SKILLED NURSING RN|
20|FH_F137617_84112_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F135239_0_0|SrvcGrp|92502|2022|PDM|1072.50|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F151225_0_0|SrvcGrp|33722|2022|PDM|44.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F76171_0_0|SrvcGrp|47991|2022|PDM|172.00|99|0.00|THERAPY SERVICES VISIT|
20|FH_F138218_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130716_76013_0|SrvcGrp|88781|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F128363_60062_0|SrvcGrp|86723|2022|PDM|438.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F133458_18929_0|SrvcGrp|89337|2022|PDM|1825.00|99|0.00|DETOXIFICATION|
20|FH_F103360_68845_0|CSTM-ALL|CSTM-00|2020|PDM|8409.00|99|0.00|AEG 4 (NO REV)|
20|FH_F120788_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F106540_26330_0|SrvcGrp|102439|2022|PCT|0.50|99|0.00|IMPLANTS W/TRAUMA|
20|FH_F45199_0_0|CSTM-ALL|CSTM-00|2020|PDM|932.00|99|0.00|ASPG VI|
20|FH_F148361_68779_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151081_85225_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F151119_66018_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F121385_89102_0|SrvcGrp|73461|2022|PDM|7299.00|99|0.00|AETNA NICU IV|
20|FH_F139172_40207_0|SrvcGrp|108484|2022|PDM|596.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139667_84078_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F150662_20901_0|SrvcGrp|23683|2022|PDM|65.00|99|0.00|SKILLED NURSING RN|
20|FH_F150802_15401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150841_84757_0|SrvcGrp|74668|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F40624_0_0|SrvcGrp|27726|2022|PCT|0.55|99|0.00|OP SURGERY|
20|FH_F148519_83201_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F73485_0_0|SrvcGrp|48385|2022|PDM|15.00|99|0.00|SPEECH THERAPY|
20|FH_F147230_49505_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F98623_97006_0|SrvcGrp|73605|2022|PDM|2977.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F120144_77031_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125782_66763_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F36323_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110121_0_0|SrvcGrp|73006|2022|PDM|3675.00|99|0.00|AEG 9|
20|FH_F127418_0_0|SrvcGrp|110759|2022|PDM|30935.95|99|0.00|THORACIC OPEN TX OF VERTEBRAL FX|
20|FH_F80834_0_0|SrvcGrp|4003|2022|PCT|0.59|99|0.00|CPT CODE 99291- CRITICAL CARE|
20|FH_F33930_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129297_97828_0|SrvcGrp|109219|2022|PCT|0.95|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F92413_07631_0|SrvcGrp|88620|2022|PDM|107.00|99|0.00|SKILLED NURSING RN|
20|FH_F142370_0_0|SrvcGrp|113545|2022|PDM|7.00|99|0.00|COVID-19 SPECIMEN HANDLING OFFICE-LAB|
20|FH_F129297_97828_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F147532_0_0|SrvcGrp|74546|2022|PDM|384.52|99|0.00|HOSPICE SERVICES|
20|FH_F140295_0_0|SrvcGrp|112035|2022|PDM|3348.00|99|0.00|ANKLE IMPLANT|
20|FH_F34777_0_0|SrvcGrp|177|2022|PDM|3010.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F149579_95815_0|SrvcGrp|98256|2022|PDM|42.71|99|0.00|CHRON CARE MGMT SRVC 20 MIN|
20|FH_F147372_0_0|SrvcGrp|108484|2022|PDM|825.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F113545_11201_0|SrvcGrp|86648|2022|PCT|1.02|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F92413_07631_0|SrvcGrp|88621|2022|PDM|96.43|99|0.00|SKILLED NURSING LPN|
20|FH_F150982_0_0|SrvcGrp|83817|2022|PDM|2527.00|99|0.00|LAPAROSCOPY LYSIS ADHESIONS|
20|FH_F127464_15106_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F146266_0_0|SrvcGrp|82109|2022|PDM|1440.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F136887_0_0|SrvcGrp|97019|2022|PDM|9018.00|99|0.00|ARTHROSCOPY BICEPS TENODESIS|
20|FH_F101441_0_0|SrvcGrp|97319|2022|PDM|7946.00|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F120119_0_0|SrvcGrp|103982|2022|PDM|1074.00|99|0.00|AEG 8 W/O 66982, 66984|
20|FH_F36590_0_0|CSTM-ALL|CSTM-00|2020|PDM|616.00|99|0.00|ACUTE PSYCH|
20|FH_F134936_01020_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F145599_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149085_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F110193_70444_0|SrvcGrp|86747|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F130182_0_0|SrvcGrp|111514|2022|PDM|1457.00|99|0.00|L HRT CATH TRNSPTL PUNCTURE|
20|FH_F98280_31015_0|SrvcGrp|76083|2022|PCT|1.10|99|0.00|AETNA THERAPY|
20|FH_F122267_62656_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151005_17044_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132137_67218_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F34985_0_0|SrvcGrp|17854|2022|PCT|0.77|99|0.00|OBSERVATION SERVICES|
20|FH_F125214_12428_0|SrvcGrp|73601|2022|PCT|0.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F137627_78382_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F47573_0_0|SrvcGrp|12079|2022|PCT|1.00|99|0.00|MED SURG SUPPLIES|
20|FH_F110722_19966_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F151517_0_0|SrvcGrp|75419|2022|PDM|367.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F151699_01752_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP WITHOUT CPT 99601|
20|FH_F101441_0_0|SrvcGrp|12309|2022|PDM|8105.00|99|0.00|MICRODISKETOMY|
20|FH_F112794_01040_0|SrvcGrp|94736|2022|PCT|1.00|99|0.00|FLULAVAL VACC IM (>=3 YRS)|
20|FH_F130331_0_0|SrvcGrp|57966|2022|PDM|550.00|99|0.00|HOSPICE CARE|
20|FH_F134871_28205_0|SrvcGrp|73842|2022|PDM|239.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F110728_13069_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|AEG 8 (NO REV)|
20|FH_F134472_84624_0|SrvcGrp|12496|2022|PDM|753.00|99|0.00|ACUTE REHABILITATION|
20|FH_F119376_0_0|SrvcGrp|106798|2022|PDM|4300.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F147422_84121_0|SrvcGrp|75419|2022|PDM|409.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|AETNA OBSERVATIONS BEHAVIORAL 30 MINS|
20|FH_F101861_19567_0|SrvcGrp|38006|2022|PDM|2500.00|99|0.00|CPT CODE 59426|
20|FH_F37864_0_0|CSTM-ALL|CSTM-00|2020|PDM|891.98|99|0.00|ASPG V|
20|FH_F40885_0_0|SrvcGrp|26427|2022|PDM|850.00|99|0.00|CPT 95811  MOD TC|
20|FH_F42746_0_0|SrvcGrp|30935|2022|PDM|50.00|99|0.00|PT & OT|
20|FH_F64739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138018_17313_0|SrvcGrp|24747|2022|PDM|105.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127830_63703_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F109252_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F97100_23462_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37198_0_0|SrvcGrp|69665|2022|PDM|1400.00|99|0.00|MRI|
20|FH_F74646_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OCN F/S PRICING: GLOBAL (HCFA)|
20|FH_F36299_0_0|SrvcGrp|115|2022|PDM|465.00|99|0.00|SKILLED NURSING CARE|
20|FH_F149651_90046_0|SrvcGrp|108484|2022|PDM|725.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F140104_70359_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139807_33064_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143348_16214_0|SrvcGrp|109057|2022|PCT|0.89|99|0.00|CARDIAC STUDIES|
20|FH_F143488_84770_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F143536_47546_0|SrvcGrp|94423|2022|PCT|1.00|99|0.00|IMMUNIZATIONS|
20|FH_F101700_0_0|SrvcGrp|98104|2022|PDM|33.30|99|0.00|INJ SINGLE/MX TRIGGER POINT1|
20|FH_F102341_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F102920_0_0|SrvcGrp|73006|2022|PDM|2184.00|99|0.00|AEG 9|
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130925_34652_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130937_98002_0|SrvcGrp|106048|2022|PDM|796.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F131067_57105_0|CSTM-ALL|CSTM-00|2020|PDM|6702.00|99|0.00|AEG 8 W/O REPAIR HEART DEFECT (NO REV)|
20|FH_F131107_43140_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F47128_0_0|SrvcGrp|3142|2022|PDM|2121.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F48473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49286_0_0|SrvcGrp|29406|2022|PDM|115.00|99|0.00|PHYSICAL THERAPY|
20|FH_F82894_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119918_38201_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F113649_01752_0|SrvcGrp|10577|2022|PDM|50.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F113649_01752_0|SrvcGrp|29077|2022|PDM|225.00|99|0.00|HOME TRANSFUSION|
20|FH_F51276_0_0|SrvcGrp|24750|2022|PDM|80.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F38190_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98621_41042_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F100783_03431_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.00|99|0.00|AEG 4 (NO REV)|
20|FH_F59732_0_0|SrvcGrp|22588|2022|PDM|75.00|99|0.00|CHEMOTHERAPY|
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|2112.00|99|0.00|ASPG IV - FH SW CUSTOM GROUPERS|
20|FH_F140988_22041_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F99100_0_0|SrvcGrp|96104|2022|PDM|211.87|99|0.00|IMPLANTABLE NEUROSTIMULATOR|
20|FH_F124955_98225_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143895_47631_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40499_0_0|SrvcGrp|32640|2022|PCT|1.00|99|0.00|POTOMAC CTR SPECIALITY DME MOD NU|
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_F120172_92653_0|SrvcGrp|89149|2022|PDM|340.00|99|0.00|OP INTENSIVE|
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_F128853_43560_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141592_80233_0|SrvcGrp|12920|2022|PDM|4635.00|99|0.00|EMERGENCY CRITICAL CARE|
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F37756_0_0|SrvcGrp|9938|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F123894_60927_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148663_48601_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136756_0_0|SrvcGrp|73006|2022|PDM|1423.40|99|0.00|AEG 9|
20|FH_F111826_0_0|SrvcGrp|72996|2022|PDM|1045.00|99|0.00|AEG 4|
20|FH_F32770_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F38151_0_0|CSTM-ALL|CSTM-00|2020|PDM|1315.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123953_84003_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F109240_21201_0|SrvcGrp|89588|2022|PDM|493.00|99|0.00|RADIATION TREATMENT DEVICES|
20|FH_F51733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132779_0_0|SrvcGrp|38|2022|PDM|4837.00|99|0.00|NORMAL DELIVERY|
20|FH_F40043_0_0|SrvcGrp|13692|2022|PDM|4061.00|99|0.00|OP CARDIAC CATH|
20|FH_F128580_0_0|SrvcGrp|107877|2022|PDM|522.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F81033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128992_90808_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148892_0_0|SrvcGrp|110570|2022|PDM|668.00|99|0.00|NERVE BLOCK INJECTION 7|
20|FH_F135764_0_0|SrvcGrp|73485|2022|PDM|1100.00|99|0.00|AETNA REHAB|
20|FH_F110925_01104_0|SrvcGrp|86130|2022|PDM|1.51|99|0.00|AETNA FACTOR VIIA|
20|FH_F129408_48034_0|SrvcGrp|84185|2022|PDM|145.00|99|0.00|RESPITE CARE|
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|1039.00|99|0.00|AEG 5  (NO REV)|
20|FH_F65559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F149720_81212_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128580_0_0|SrvcGrp|107878|2022|PDM|2003.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F126033_15301_0|SrvcGrp|46605|2022|PDM|118.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F126883_78621_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F122433_0_0|SrvcGrp|109085|2022|PDM|1000.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F116923_85259_0|SrvcGrp|46903|2022|PDM|572.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F116960_91505_0|SrvcGrp|114008|2022|PDM|575.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F38090_0_0|SrvcGrp|97|2022|PDM|4636.00|99|0.00|C-SECTION|
20|FH_F97242_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F109277_0_0|SrvcGrp|9460|2022|PDM|1597.00|99|0.00|ACUTE REHABILITATION|
20|FH_F75307_0_0|SrvcGrp|27968|2022|PDM|28.00|99|0.00|SKILLED NURSING LPN|
20|FH_F140995_33040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113546_0_0|SrvcGrp|46605|2022|PDM|90.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F86319_16365_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F94402_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|AEG 2 (NO REV)|
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 1 (NO REV)|
20|FH_F39138_0_0|SrvcGrp|30093|2022|PDM|765.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)|
20|FH_F38120_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141517_73034_0|SrvcGrp|86723|2022|PDM|398.18|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F129011_15857_0|SrvcGrp|48398|2022|PDM|120.00|99|0.00|PT SERVICES|
20|FH_F87272_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F137352_43912_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151540_17055_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134995_37055_0|SrvcGrp|75419|2022|PDM|557.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F99960_0_0|SrvcGrp|72121|2022|PDM|2180.00|99|0.00|ARTHOSCOPY|
20|FH_F40318_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|AEG 5  (NO REV)|
20|FH_F38187_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F92034_0_0|SrvcGrp|103865|2022|PDM|1300.00|99|0.00|PT PRGRM FOR IMPLT NEUROSTIM|
20|FH_F124017_0_0|SrvcGrp|101114|2022|PDM|12800.00|99|0.00|ARTHOPLASTY|
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F100320_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F145537_02061_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F66630_0_0|SrvcGrp|1306|2022|PDM|300.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F124388_0_0|SrvcGrp|14614|2022|PDM|3875.00|99|0.00|LITHOTRIPSY|
20|FH_F129653_0_0|SrvcGrp|67279|2022|PDM|4000.00|99|0.00|CERVICAL SURGERY|
20|FH_F139551_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F129782_0_0|CSTM-ALL|CSTM-00|2020|PDM|865.00|99|0.00|AEG 4 (NO REV)|
20|FH_F141410_13045_0|SrvcGrp|13187|2022|PCT|0.39|99|0.00|INTRAOCULAR LENSES|
20|FH_F40059_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F129221_84325_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F139303_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35468_0_0|SrvcGrp|20448|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F125760_67039_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122905_41018_0|SrvcGrp|74668|2022|PDM|186.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F86712_60173_0|SrvcGrp|80317|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F35942_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86851_0_0|SrvcGrp|84974|2022|PDM|520.00|99|0.00|CPT 43255|
20|FH_F86851_0_0|SrvcGrp|84996|2022|PDM|469.00|99|0.00|CPT 45335|
20|FH_F105301_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F38568_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F46832_0_0|SrvcGrp|42322|2022|PDM|35.00|99|0.00|HOME THERAPY|
20|FH_F36788_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F51124_0_0|SrvcGrp|26160|2022|PDM|38.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F52713_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|ACUTE PSYCH|
20|FH_F146421_72758_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133585_0_0|SrvcGrp|112388|2022|PDM|245.00|99|0.00|ARTERY XRAYS ARMS/LEGS (HCFA)|
20|FH_F80172_0_0|SrvcGrp|77509|2022|PDM|46.74|99|0.00|AETNA CONTINUED PAIN MANAGEMENT INFUSION|
20|FH_F134353_84123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147502_0_0|SrvcGrp|104230|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F149247_02760_0|SrvcGrp|82981|2022|PDM|155.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F93076_85016_0|SrvcGrp|3259|2022|PDM|1622.89|99|0.00|ACUTE REHABILITATION|
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 10 (NO REV)|
20|FH_F112863_0_0|SrvcGrp|104259|2022|PDM|1141.00|99|0.00|SKIN FULL GRAFT PROCEDURE|
20|FH_F146423_28401_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133972_27103_0|SrvcGrp|86850|2022|PDM|35.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F141210_0_0|SrvcGrp|106273|2022|PDM|5150.00|99|0.00|REMOVE TONSILS AND ADENOIDS|
20|FH_F85213_02840_0|SrvcGrp|111928|2022|PDM|290.30|99|0.00|COVID-19 BARTONELLA|
20|FH_F39378_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F125328_0_0|SrvcGrp|78286|2022|PDM|8280.00|99|0.00|CPT 49322|
20|FH_F145959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.20|99|0.00|OP SVCS|
20|FH_F121255_76132_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134218_20783_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136207_0_0|SrvcGrp|73485|2022|PDM|850.00|99|0.00|AETNA REHAB|
20|FH_F149321_44691_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133749_84604_0|SrvcGrp|112431|2022|PDM|25.00|99|0.00|UNCLASSIFIED INFUSION THERAPY (HCFA)|
20|FH_F109400_80026_0|SrvcGrp|88621|2022|PDM|88.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133922_70563_0|SrvcGrp|104800|2022|PDM|446.06|99|0.00|ELECTROENCEPHALOGRAM|
20|FH_F89319_41001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F110506_98901_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F88744_71103_0|CSTM-ALL|CSTM-00|2020|PDM|1851.00|99|0.00|AEG 4 (NO REV)|
20|FH_F116753_0_0|SrvcGrp|106774|2022|PDM|5599.00|99|0.00|TRANSLUMINAL ANGIOPLASTY|
20|FH_F90496_13159_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1917.68|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1403 W/O REV|
20|FH_F120408_0_0|SrvcGrp|105819|2022|PDM|1326.11|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F110589_70809_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F127343_0_0|SrvcGrp|82694|2022|PDM|1725.00|99|0.00|PODIATRY|
20|FH_F117300_0_0|SrvcGrp|58993|2022|PDM|7360.00|99|0.00|DISKECTOMY|
20|FH_F132827_0_0|SrvcGrp|14494|2022|PDM|15.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|2420.00|99|0.00|AEG 3 (NO REV)|
20|FH_F133749_84604_0|SrvcGrp|112466|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY SUPPLIES|
20|FH_F145642_15108_0|SrvcGrp|86850|2022|PDM|30.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F125407_68756_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|OP SVCS|
20|FH_F89219_0_0|SrvcGrp|44007|2022|PDM|1423.00|99|0.00|EMERGENCY ROOM (CPT CODE 99285)|
20|FH_F124711_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F96780_0_0|SrvcGrp|90568|2022|PDM|1761.00|99|0.00|TREATMENT OF RETINA|
20|FH_F130327_03867_0|SrvcGrp|46104|2022|PDM|154.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F139873_0_0|SrvcGrp|35668|2022|PDM|2215.00|99|0.00|CPT 29824|
20|FH_F83995_16748_0|SrvcGrp|10425|2022|PDM|713.00|99|0.00|NEWBORN NURSERY|
20|FH_F149299_43351_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F58396_0_0|SrvcGrp|42830|2022|PDM|68.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|3069.00|99|0.00|AEG 8 (NO REV)|
20|FH_F89760_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149082_33406_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134972_84117_0|SrvcGrp|46605|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133749_84604_0|SrvcGrp|112436|2022|PDM|22.00|99|0.00|IV IMMUNOGLOBULIN|
20|FH_F71866_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128379_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F89176_0_0|SrvcGrp|66168|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F109267_12202_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F110268_02891_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F141874_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112665_0_0|SrvcGrp|89842|2022|PDM|7699.00|99|0.00|LUMBAR|
20|FH_F125259_0_0|SrvcGrp|110100|2022|PDM|1750.00|99|0.00|AV FISTULA REVISION|
20|FH_F70883_0_0|SrvcGrp|62154|2022|PDM|82.00|99|0.00|PICC LINES|
20|FH_F134353_84123_0|SrvcGrp|97702|2022|PDM|94.50|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F127908_60640_0|SrvcGrp|73063|2022|PCT|1.40|99|0.00|OBSERVATION SERVICES|
20|FH_F134595_06226_0|SrvcGrp|471|2022|PDM|690.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130763_0_0|SrvcGrp|92415|2022|PDM|7319.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F117437_0_0|SrvcGrp|95661|2022|PDM|180.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F49459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135627_77070_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F137610_0_0|SrvcGrp|108484|2022|PDM|411.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F134495_84321_0|SrvcGrp|48398|2022|PDM|85.50|99|0.00|PT SERVICES|
20|FH_F122475_37659_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F125677_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|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_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|893.00|99|0.00|2007 MEDICARE ASPG III|
20|FH_F68626_0_0|SrvcGrp|33659|2022|PDM|400.00|99|0.00|DIALYSIS SERVICES|
20|FH_F102200_06416_0|SrvcGrp|86827|2022|PDM|90.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F105361_80104_0|SrvcGrp|41335|2022|PDM|33000.00|99|0.00|TOTAL HIP|
20|FH_F115811_33410_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F80513_0_0|SrvcGrp|20900|2022|PDM|22875.00|99|0.00|MS DRG 248 ONLY|
20|FH_F120795_27514_0|SrvcGrp|10365|2022|PDM|2289.00|99|0.00|CPT CODE 99285|
20|FH_F40903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|190.00|99|0.00|CD PARTIAL HOSPITALIZATION (OP) - ADULT|
20|FH_F132307_06010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F111603_19529_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F121385_89102_0|CSTM-ALL|CSTM-00|2020|PDM|2867.00|99|0.00|AEG 2 (NO REV)|
20|FH_F121985_46256_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F114931_0_0|SrvcGrp|78285|2022|PDM|3200.00|99|0.00|CPT 58671|
20|FH_F110927_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117525_0_0|SrvcGrp|83817|2022|PDM|1900.00|99|0.00|LAPAROSCOPY LYSIS ADHESIONS|
20|FH_F97740_01605_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F97780_43614_0|SrvcGrp|73602|2022|PDM|2670.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F108800_0_0|SrvcGrp|101184|2022|PDM|4000.00|99|0.00|AETNA SPINE|
20|FH_F85674_0_0|SrvcGrp|83881|2022|PDM|46.21|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F115204_0_0|SrvcGrp|81839|2022|PDM|50.00|99|0.00|AETNA MEDICAL RECORD|
20|FH_F114916_30309_0|SrvcGrp|93432|2022|PDM|22500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F142448_15701_0|SrvcGrp|26869|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F113130_0_0|SrvcGrp|105034|2022|PDM|1200.00|99|0.00|GI PEGFILGRASTIM (HCFA)|
20|FH_F104840_32565_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|GENERAL ACUTE CARE|
20|FH_F113541_0_0|SrvcGrp|33985|2022|PDM|1955.00|99|0.00|CPT 19120|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PDM|386.00|99|0.00|ASPG I|
20|FH_F94786_07974_0|SrvcGrp|10577|2022|PDM|36.75|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F130310_66604_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114002_0_0|SrvcGrp|42975|2022|PDM|80.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F125946_0_0|SrvcGrp|22596|2022|PDM|285.00|99|0.00|HOSPICE CARE|
20|FH_F49487_0_0|SrvcGrp|17002|2022|PDM|187.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS|
20|FH_F64180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132351_19342_0|SrvcGrp|84897|2022|PCT|1.05|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F146912_90025_0|SrvcGrp|74668|2022|PDM|642.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F146886_77378_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40302_0_0|CSTM-ALL|CSTM-00|2020|PDM|1409.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47736_0_0|SrvcGrp|26001|2022|PDM|125.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F32190_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|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_F98380_43055_0|SrvcGrp|73461|2022|PDM|4959.00|99|0.00|AETNA NICU IV|
20|FH_F124679_64052_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F131101_45840_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F87856_0_0|SrvcGrp|86458|2022|PDM|791.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F136708_06443_0|SrvcGrp|46903|2022|PDM|554.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F114666_30342_0|SrvcGrp|104112|2022|PDM|3000.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F138055_16146_0|SrvcGrp|89417|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F148553_85016_0|SrvcGrp|115460|2022|PDM|4335.00|99|0.00|REMOVE & REPLACE DEFIB GEN MULTI LEAD|
20|FH_F148553_85016_0|SrvcGrp|115446|2022|PDM|2000.00|99|0.00|LEFT VENTRIC PACING LEAD ADD-ON|
20|FH_F127448_0_0|SrvcGrp|107884|2022|PDM|2150.00|99|0.00|TRLUML BALO ANGIOP 1ST ART|
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_F136831_78728_0|SrvcGrp|86723|2022|PDM|420.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F136930_73114_0|SrvcGrp|72992|2022|PDM|4423.00|99|0.00|AEG 2|
20|FH_F116345_78626_0|SrvcGrp|86723|2022|PDM|340.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F147539_68359_0|SrvcGrp|76321|2022|PCT|0.98|99|0.00|AETNA ALL INPATIENT SERVICES|
20|FH_F147660_75110_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147414_92656_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F31970_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133536_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F120697_68526_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F72445_0_0|SrvcGrp|62154|2022|PDM|76.00|99|0.00|PICC LINES|
20|FH_F80511_0_0|SrvcGrp|78184|2022|PDM|1643.00|99|0.00|AETNA OP MRI|
20|FH_F114853_0_0|SrvcGrp|67065|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY|
20|FH_F114853_0_0|SrvcGrp|11669|2022|PDM|2887.00|99|0.00|OP SURG|
20|FH_F131501_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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113585_20155_0|SrvcGrp|48385|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F138680_53005_0|SrvcGrp|73841|2022|PDM|405.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138777_43140_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PDM|1266.00|99|0.00|ASPG VIII|
20|FH_F90422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113390_0_0|SrvcGrp|105234|2022|PDM|2200.00|99|0.00|EXPLORE DEEP NODE NECK|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.99|99|0.00|HAPA WPA-NWPA 2012-13 ASC 209 W/O REV|
20|FH_F151501_30265_0|SrvcGrp|96542|2022|PDM|4606.00|99|0.00|REPAIR OF LEG TENDON|
20|FH_F145148_60162_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145208_63640_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123184_20906_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135453_70726_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F130933_47129_0|SrvcGrp|73842|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130756_04901_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F131407_07607_0|SrvcGrp|86838|2022|PDM|10.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F131407_07607_0|SrvcGrp|86835|2022|PDM|10.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F140629_0_0|SrvcGrp|90383|2022|PDM|8400.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F101558_80443_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F121731_20164_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F42347_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F111292_33136_0|SrvcGrp|12280|2022|PCT|0.63|99|0.00|IMPLANTS|
20|FH_F134315_89106_0|SrvcGrp|24752|2022|PCT|1.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F47906_0_0|SrvcGrp|43840|2022|PCT|1.00|99|0.00|DME MOD NUKL|
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|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F132720_0_0|SrvcGrp|33793|2022|PDM|13426.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F36344_0_0|SrvcGrp|13606|2022|PDM|35.00|99|0.00|HOME INFUSION|
20|FH_F72889_0_0|SrvcGrp|9438|2022|PCT|0.85|99|0.00|TRAUMA CARE|
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1127.00|99|0.00|AEG 1 (NO REV)|
20|FH_F101442_0_0|SrvcGrp|89988|2022|PDM|1373.81|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F133994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F66469_0_0|SrvcGrp|29718|2022|PCT|0.45|99|0.00|SUPPLIES/DEVICES/IMPLANTABLES|
20|FH_F124892_32535_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130206_78209_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F141035_0_0|SrvcGrp|91886|2022|PDM|7008.00|99|0.00|REPAIR FLEXOR TENDON ZONE 2|
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_F132347_01605_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F50516_15014_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F140873_0_0|SrvcGrp|95660|2022|PDM|735.00|99|0.00|HOSPICE SERVICES (HCFA)|
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_F133660_53225_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67901_0_0|SrvcGrp|43571|2022|PDM|80.00|99|0.00|MID-LINE INSERTION|
20|FH_F69968_0_0|SrvcGrp|59075|2022|PDM|4690.70|99|0.00|MS DRG 060-063 AND REV 110-219 STROKE|
20|FH_F69968_0_0|SrvcGrp|46517|2022|PDM|6685.29|99|0.00|LAMINECTOMIES|
20|FH_F107200_0_0|SrvcGrp|69502|2022|PDM|1665.00|99|0.00|CPT 54150|
20|FH_F118171_00674_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F134011_84102_0|SrvcGrp|86830|2022|PDM|3.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F134126_11554_0|SrvcGrp|106295|2022|PDM|402.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1|
20|FH_F134160_19006_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137147_75006_0|SrvcGrp|37984|2022|PDM|12852.00|99|0.00|LUMBAR INJECTIONS PROCEDURE|
20|FH_F137147_75006_0|SrvcGrp|113044|2022|PDM|11931.00|99|0.00|REVISION OF URINARY TRACT|
20|FH_F142448_15701_0|SrvcGrp|14948|2022|PDM|95.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142449_62220_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142273_51012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F125408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134654_0_0|SrvcGrp|110059|2022|PDM|37.50|99|0.00|ADAPTIVE BH 15 MINS|
20|FH_F119064_01581_0|SrvcGrp|90854|2022|PDM|695.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F117377_71303_0|SrvcGrp|57968|2022|PDM|29.83|99|0.00|CONTINUOUS HOMECARE|
20|FH_F147931_29732_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F129483_77030_0|SrvcGrp|86846|2022|PDM|35.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F129511_44044_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F117107_33704_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117240_37334_0|SrvcGrp|31931|2022|PDM|1000.00|99|0.00|SKILLED NURSING CARE|
20|FH_F137832_89118_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F137927_52241_0|SrvcGrp|87536|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F109652_0_0|SrvcGrp|78789|2022|PDM|12535.00|99|0.00|BARIATRIC|
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_F90735_94070_0|SrvcGrp|90286|2022|PDM|32.50|99|0.00|MUCOLIPIDOSIS-TYPE|
20|FH_F90880_15108_0|SrvcGrp|90497|2022|PCT|1.00|99|0.00|FLUZONE VACC 3 YRS & > IM|
20|FH_F90880_15108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124828_74074_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124893_40311_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F128804_0_0|SrvcGrp|106266|2022|PDM|4263.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT|
20|FH_F130676_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F119374_62263_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F137951_0_0|SrvcGrp|72121|2022|PDM|3131.00|99|0.00|ARTHOSCOPY|
20|FH_F148552_68114_0|SrvcGrp|115419|2022|PDM|1390.26|99|0.00|INTESTINE PROCEDURES|
20|FH_F132685_63146_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F44257_0_0|SrvcGrp|350|2022|PDM|1739.00|99|0.00|SURGICAL CARE|
20|FH_F122245_0_0|SrvcGrp|72996|2022|PDM|802.00|99|0.00|AEG 4|
20|FH_F118468_21502_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121009_76180_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F68944_0_0|SrvcGrp|14366|2022|PDM|3500.00|99|0.00|ICU/PICU/CCU|
20|FH_F44135_0_0|SrvcGrp|27579|2022|PDM|70.00|99|0.00|RESPIRATORY THERAPY INITIAL VISIT|
20|FH_F117725_38036_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F72226_65804_0|SrvcGrp|14886|2022|PCT|0.68|99|0.00|TRANSPORTATION|
20|FH_F117368_68114_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F144191_0_0|SrvcGrp|113939|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|NURSING CARE MOD TE|
20|FH_F149860_80112_0|SrvcGrp|90854|2022|PDM|567.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F41229_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|SPINAL CORD REHABILITATION|
20|FH_F148002_78209_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97562_29803_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F64142_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F52293_0_0|SrvcGrp|44427|2022|PDM|115.00|99|0.00|PHYSICAL THERAPY SVCS (VISIT LVL)|
20|FH_F65899_0_0|CSTM-ALL|CSTM-00|2020|PDM|1115.00|99|0.00|ACUTE PSYCH|
20|FH_F142047_21853_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128615_78520_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F127412_15301_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 7 (NO REV)|
20|FH_F101760_63851_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150001_33064_0|SrvcGrp|86831|2022|PDM|3.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F115327_45320_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F87313_62301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132279_63775_0|SrvcGrp|105465|2022|PCT|0.50|99|0.00|AETNA THERAPIES|
20|FH_F38508_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F40267_0_0|SrvcGrp|17077|2022|PDM|1152.00|99|0.00|ASPG VII|
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|2649.00|99|0.00|DEVICE INSERTION|
20|FH_F37751_0_0|SrvcGrp|27699|2022|PCT|1.00|99|0.00|DME|
20|FH_F102721_38118_0|SrvcGrp|82242|2022|PCT|0.25|99|0.00|AETNA PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY|
20|FH_F38865_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|ACUTE PSYCH|
20|FH_F119079_41018_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97562_29803_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F78167_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F123154_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F144388_19904_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113586_0_0|SrvcGrp|75493|2022|PDM|1158.00|99|0.00|AEG 8|
20|FH_F123539_65265_0|SrvcGrp|472|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F111551_32825_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F100788_01420_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F40549_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|ASPG III|
20|FH_F114519_0_0|SrvcGrp|73002|2022|PDM|1527.00|99|0.00|AEG 7|
20|FH_F125672_92663_0|SrvcGrp|114960|2022|PCT|1.50|99|0.00|OP THERAPY SERVICE|
20|FH_F132992_04662_0|SrvcGrp|29346|2022|PDM|37.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F35857_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.00|99|0.00|AEG 1 (NO REV)|
20|FH_F97564_52246_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F90921_77702_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|405.90|99|0.00|ASPG I|
20|FH_F116433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129596_0_0|SrvcGrp|21975|2022|PDM|1575.00|99|0.00|INPATIENT SERVICES|
20|FH_F149884_68516_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141612_19605_0|SrvcGrp|88819|2022|PDM|955.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F145328_90301_0|SrvcGrp|113340|2022|PDM|36.00|99|0.00|TAKE HOME METHADONE|
20|FH_F42803_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F32970_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127422_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F38700_0_0|SrvcGrp|18613|2022|PCT|0.80|99|0.00|MS DRG 417|
20|FH_F114024_0_0|SrvcGrp|75481|2022|PDM|565.00|99|0.00|AEG 2|
20|FH_F122958_45014_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F102681_34237_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F102681_34237_0|SrvcGrp|48160|2022|PCT|1.00|99|0.00|BOTULINUM TOXIN TYPE A, PER UNIT|
20|FH_F38691_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144011_60616_0|CSTM-ALL|CSTM-00|2020|PDM|2091.00|99|0.00|AETNA OP PET SCANS (PET)|
20|FH_F126735_38018_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F57592_0_0|SrvcGrp|11336|2022|PCT|0.50|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F92673_44041_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F97882_32407_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127994_19301_0|SrvcGrp|104443|2022|PDM|86.00|99|0.00|AETNA OFFICE/OP VISIT EST (HCFA)|
20|FH_F87615_80033_0|SrvcGrp|102982|2022|PDM|274.00|99|0.00|PSYTX WPT W E/M 60 MIN|
20|FH_F83113_0_0|SrvcGrp|3809|2022|PDM|616.00|99|0.00|HOSPICE CARE|
20|FH_F130596_50273_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133527_68025_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|HSS ASC|
20|FH_F41392_0_0|SrvcGrp|11033|2022|PCT|1.00|99|0.00|OP REFERENCE LAB|
20|FH_F122245_0_0|SrvcGrp|76565|2022|PCT|0.00|99|0.00|AETNA LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F150122_75020_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|136.72|99|0.00|HAPA WPA-NWPA 2012-13 ASC 136 W/O REV|
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|968.00|99|0.00|ASPG V|
20|FH_F121009_76180_0|SrvcGrp|471|2022|PDM|555.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F41988_0_0|CSTM-ALL|CSTM-00|2020|PDM|442.00|99|0.00|ACUTE PSYCH|
20|FH_F118785_33315_0|SrvcGrp|75522|2022|PDM|1025.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD|
20|FH_F40685_0_0|SrvcGrp|115|2022|PDM|468.00|99|0.00|SKILLED NURSING CARE|
20|FH_F132279_63775_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80952_45669_0|CSTM-ALL|CSTM-00|2020|PDM|2681.55|99|0.00|AEG 9 (NO REV)|
20|FH_F120089_0_0|SrvcGrp|75483|2022|PDM|505.00|99|0.00|AEG 3|
20|FH_F148644_06890_0|SrvcGrp|89988|2022|PDM|3908.00|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F148780_70739_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148864_81303_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F151061_02720_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F151142_35406_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F139394_07424_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139597_07009_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150771_44512_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132109_66762_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F36883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F132160_0_0|SrvcGrp|109795|2022|PCT|0.00|99|0.00|COLLAGEN CROSSLINKING CORNEA INCIDENTAL CODES|
20|FH_F113545_11201_0|SrvcGrp|89149|2022|PDM|240.00|99|0.00|OP INTENSIVE|
20|FH_F136887_0_0|SrvcGrp|96350|2022|PDM|14057.00|99|0.00|SHOULDER JOINT|
20|FH_F36992_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD KM|
20|FH_F92151_74104_0|CSTM-ALL|CSTM-00|2020|PCT|0.58|99|0.00|GENERAL ACUTE CARE|
20|FH_F124487_89502_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|2250.00|99|0.00|ASPG IV|
20|FH_F140608_0_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F148519_83201_0|SrvcGrp|66264|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 7 (NO REV)|
20|FH_F110732_31513_0|SrvcGrp|8950|2022|PDM|1635.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F101280_63111_0|SrvcGrp|93919|2022|PDM|507.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F114206_37203_0|SrvcGrp|86833|2022|PDM|15.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F125214_12428_0|SrvcGrp|112833|2022|PCT|0.65|99|0.00|LABORATORY SERVICES|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|457.00|99|0.00|HAPA EPA ASC 51|
20|FH_F139694_42718_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150459_08021_0|SrvcGrp|88621|2022|PDM|98.18|99|0.00|SKILLED NURSING LPN|
20|FH_F128743_57252_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|400.00|99|0.00|AEG 1 (NO REV)|
20|FH_F40690_0_0|SrvcGrp|33486|2022|PCT|0.80|99|0.00|ELECTRO CONVULSIVE THERAPY|
20|FH_F97184_26101_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F133223_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|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_F124322_64131_0|SrvcGrp|73701|2022|PDM|37.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F132849_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F90196_10467_0|SrvcGrp|89337|2022|PDM|564.00|99|0.00|DETOXIFICATION|
20|FH_F66545_0_0|SrvcGrp|32978|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU KL"|
20|FH_F89674_18640_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F33566_0_0|SrvcGrp|59856|2022|PDM|9550.00|99|0.00|MS DRG 244 OR 249 ONLY|
20|FH_F122419_37043_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110804_11373_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F114825_32789_0|SrvcGrp|86722|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F146859_0_0|SrvcGrp|105505|2022|PDM|2447.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS|
20|FH_F36683_0_0|SrvcGrp|18811|2022|PDM|27873.00|99|0.00|MS DRG 220|
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 4 (NO REV)|
20|FH_F116583_0_0|SrvcGrp|106928|2022|PDM|150.00|99|0.00|HOSPICE/HH IN ASST LVG (HCFA)|
20|FH_F109251_62269_0|SrvcGrp|103221|2022|PDM|7.80|99|0.00|CONFORM BAND N/S W>=3<5YD|
20|FH_F69290_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F148966_37865_0|SrvcGrp|75419|2022|PDM|445.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F131072_26416_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F128500_37215_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141249_17103_0|SrvcGrp|89149|2022|PDM|210.00|99|0.00|OP INTENSIVE|
20|FH_F119203_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F149046_53022_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137748_95231_0|CSTM-ALL|CSTM-00|2020|PDM|5073.00|99|0.00|AEG 8 (NO REV)|
20|FH_F134919_02155_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F141287_14830_0|SrvcGrp|12840|2022|PCT|0.39|99|0.00|PACEMAKER|
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|1943.00|99|0.00|AEG 3 (NO REV)|
20|FH_F63033_0_0|SrvcGrp|13927|2022|PDM|900.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F114206_37203_0|SrvcGrp|24761|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 5  (NO REV)|
20|FH_F34853_0_0|SrvcGrp|19661|2022|PDM|66487.00|99|0.00|MS DRG 216-218 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH|
20|FH_F126933_33174_0|SrvcGrp|89149|2022|PDM|130.00|99|0.00|OP INTENSIVE|
20|FH_F124380_83406_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F84532_0_0|SrvcGrp|82807|2022|PDM|3694.00|99|0.00|ARTHROSCOPIC CARVEOUTS|
20|FH_F56813_0_0|SrvcGrp|31970|2022|PDM|200.00|99|0.00|OP THERAPY SERVICES (INITIAL EVAL)|
20|FH_F39162_0_0|SrvcGrp|29497|2022|PDM|300.00|99|0.00|ULTRAFILTRATION|
20|FH_F92498_07442_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F131376_66215_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147229_60523_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SUPPLEMENTAL. OCN F/S PRICING: ALL|
20|FH_F48695_0_0|SrvcGrp|471|2022|PDM|1825.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F112794_01040_0|SrvcGrp|94735|2022|PCT|1.00|99|0.00|AFLURIA VACC IM (>=3 YRS)|
20|FH_F132512_0_0|SrvcGrp|73842|2022|PDM|408.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|1990.00|99|0.00|AEG 10 (NO REV)|
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36343_0_0|SrvcGrp|17140|2022|PDM|125.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F147225_48093_0|SrvcGrp|42622|2022|PDM|638.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F40346_0_0|SrvcGrp|14187|2022|PCT|0.75|99|0.00|MRI|
20|FH_F126150_80202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F36165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131371_0_0|SrvcGrp|101102|2022|PDM|17000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F110193_70444_0|SrvcGrp|73842|2022|PDM|233.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F142370_0_0|SrvcGrp|113550|2022|PDM|51.31|99|0.00|COVID-19 LAB TESTING|
20|FH_F146266_0_0|SrvcGrp|78096|2022|PDM|7168.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F141267_0_0|SrvcGrp|113662|2022|PDM|172.00|99|0.00|HOSPICE ROUT HOME CARE-DIEM|
20|FH_F131152_33403_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F41363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F143488_84770_0|SrvcGrp|84934|2022|PDM|1688.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F47969_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F48937_0_0|SrvcGrp|29406|2022|PDM|65.00|99|0.00|PHYSICAL THERAPY|
20|FH_F120216_68134_0|SrvcGrp|73842|2022|PDM|199.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120233_24368_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F136273_37601_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132419_84042_0|SrvcGrp|73063|2022|PDM|802.77|99|0.00|OBSERVATION SERVICES|
20|FH_F112679_85711_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F116546_78723_0|SrvcGrp|86722|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F116552_70001_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F116629_83467_0|SrvcGrp|102419|2022|PCT|0.82|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F116802_41224_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F82691_0_0|SrvcGrp|33164|2022|PDM|225.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F119591_75034_0|SrvcGrp|86722|2022|PDM|209.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F125479_17501_0|SrvcGrp|92937|2022|PDM|186.00|99|0.00|INTENSIVE OP PSYCH (HCFA)|
20|FH_F118792_63379_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F39028_0_0|SrvcGrp|29963|2022|PCT|1.00|99|0.00|DME MOD UE|
20|FH_F41158_0_0|SrvcGrp|110|2022|PDM|428.00|99|0.00|CD - REHABILITATION|
20|FH_F141873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F61292_0_0|SrvcGrp|20096|2022|PDM|46229.00|99|0.00|MS DRG 222-223 ONLY|
20|FH_F149523_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.53|99|0.00|HSS ASC|
20|FH_F140427_0_0|SrvcGrp|92406|2022|PDM|2500.00|99|0.00|REMOVAL & REPLACE PULSE GEN 1 LEAD|
20|FH_F148892_0_0|SrvcGrp|88487|2022|PDM|4704.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F129328_33311_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F150699_0_0|SrvcGrp|91959|2022|PDM|29461.00|99|0.00|INSERT PULSE GENERATOR|
20|FH_F140910_53005_0|SrvcGrp|33722|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F109472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE|
20|FH_F143388_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F130747_0_0|SrvcGrp|67069|2022|PDM|36414.00|99|0.00|CPT 22634|
20|FH_F150982_0_0|SrvcGrp|68000|2022|PDM|4625.00|99|0.00|CPT 58561|
20|FH_F116311_02657_0|SrvcGrp|73842|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F93593_33414_0|SrvcGrp|43524|2022|PDM|212.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F109000_0_0|SrvcGrp|96350|2022|PDM|11110.00|99|0.00|SHOULDER JOINT|
20|FH_F135207_76053_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F135264_40272_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F141012_22901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97540_32114_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F39138_0_0|SrvcGrp|25346|2022|PDM|98.00|99|0.00|PT|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|989.10|99|0.00|HAPA WPA-NWPA 2012-13 ASC 801 W/O REV|
20|FH_F143829_74066_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F76171_0_0|SrvcGrp|44885|2022|PDM|154.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL PER VISIT|
20|FH_F120285_32960_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F148342_80621_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F125249_0_0|SrvcGrp|94904|2022|PDM|1100.00|99|0.00|REPAIR/REVISE WRIST JOINT|
20|FH_F116327_75701_0|SrvcGrp|98319|2022|PDM|431.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY (HCFA)|
20|FH_F118742_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F77544_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F131236_84041_0|SrvcGrp|48394|2022|PDM|39.60|99|0.00|SKILLED NURSING SERVICES|
20|FH_F143908_52233_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F84215_0_0|SrvcGrp|72990|2022|PDM|407.00|99|0.00|AEG 1|
20|FH_F38377_0_0|SrvcGrp|10545|2022|PDM|105.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F148700_0_0|SrvcGrp|74668|2022|PDM|408.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F37292_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F55532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|3685.00|99|0.00|AEG 9 (NO REV)|
20|FH_F151526_28208_0|SrvcGrp|109477|2022|PDM|11440.00|99|0.00|PERCUTANEOUS TRANSLUMINAL|
20|FH_F131560_62946_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|669.00|99|0.00|AEG 4 (NO REV)|
20|FH_F112374_0_0|SrvcGrp|30089|2022|PDM|442.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F117784_0_0|SrvcGrp|13683|2022|PDM|370.45|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F143528_0_0|SrvcGrp|70749|2022|PDM|3150.00|99|0.00|CPT 29823|
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|443.00|99|0.00|AEG 1 (NO REV)|
20|FH_F149869_03253_0|SrvcGrp|43567|2022|PDM|160.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F151400_0_0|SrvcGrp|44461|2022|PDM|5142.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F151541_01436_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|391.43|99|0.00|HAPA WPA-NWPA 2012-13 ASC 212 W/O REV|
20|FH_F115985_0_0|SrvcGrp|79458|2022|PDM|0.10|99|0.00|MED RECORD COPY|
20|FH_F123505_64468_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F65200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F93424_53578_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87254_0_0|SrvcGrp|82301|2022|PDM|610.00|99|0.00|HEMORRHOIDECTOMY|
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|591.00|99|0.00|AEG 4 (NO REV)|
20|FH_F145800_22003_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F120338_83226_0|SrvcGrp|75419|2022|PDM|506.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F149869_03253_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110066_36608_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F116203_63901_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F125965_66720_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109000_0_0|SrvcGrp|19921|2022|PDM|4600.20|99|0.00|ARTHROSCOPICALLY LIGAMENT REPAIR|
20|FH_F130747_0_0|SrvcGrp|67064|2022|PDM|6763.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F149140_07522_0|SrvcGrp|113232|2022|PDM|42.13|99|0.00|COVID-19 SARS-COV-2 ANTB QUANTITATIVE|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|HOME INF- REV 640 MOD SJ|
20|FH_F38798_0_0|SrvcGrp|29345|2022|PDM|45.00|99|0.00|SKILLED NURSING - LPN - MOD TE|
20|FH_F112508_0_0|SrvcGrp|10391|2022|PDM|1456.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F128307_43219_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F127262_68064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125249_0_0|SrvcGrp|108257|2022|PDM|1400.00|99|0.00|AETNA FUSION HAND BONES WITH GRAFT|
20|FH_F77883_0_0|SrvcGrp|74930|2022|PDM|385.33|99|0.00|HOSPICE LEVEL 2|
20|FH_F51358_0_0|SrvcGrp|44430|2022|PDM|125.00|99|0.00|SPEECH THERAPY SVCS (VISIT LVL)|
20|FH_F143528_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F120910_63021_0|SrvcGrp|108484|2022|PDM|1323.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F135236_02840_0|SrvcGrp|79699|2022|PCT|1.01|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F42573_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OP SVCS|
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_F137366_87505_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F136195_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136510_0_0|SrvcGrp|87386|2022|PDM|2866.00|99|0.00|AMNIOTIC MEMBRANE TRANSPLANTATION|
20|FH_F113682_0_0|SrvcGrp|95360|2022|PDM|247.23|99|0.00|SPEECH THERAPY|
20|FH_F126002_11946_0|SrvcGrp|91065|2022|PDM|60.00|99|0.00|PSYCHIATRIC CPT 90853 (HCFA)|
20|FH_F129656_15005_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F37651_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD KN|
20|FH_F82714_18848_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|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_F86914_19605_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F86991_15122_0|SrvcGrp|73008|2022|PDM|792.00|99|0.00|AEG 10|
20|FH_F86851_0_0|SrvcGrp|84965|2022|PDM|520.00|99|0.00|CPT 43217|
20|FH_F88639_80204_0|SrvcGrp|105465|2022|PCT|1.70|99|0.00|AETNA THERAPIES|
20|FH_F46832_0_0|SrvcGrp|17011|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F62579_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F63229_0_0|SrvcGrp|44245|2022|PDM|160.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F50462_0_0|SrvcGrp|45949|2022|PDM|140.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F130656_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 6 (NO REV)|
20|FH_F130715_98503_0|SrvcGrp|46903|2022|PDM|1275.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F145642_15108_0|SrvcGrp|22593|2022|PDM|30.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F100782_0_0|SrvcGrp|105150|2022|PDM|559.39|99|0.00|WINDBER MEDICAL CNTR ASC 310|
20|FH_F70804_0_0|SrvcGrp|26179|2022|PDM|69.23|99|0.00|OT|
20|FH_F110541_99336_0|SrvcGrp|86722|2022|PDM|135.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F103320_0_0|SrvcGrp|72998|2022|PDM|1156.00|99|0.00|AEG 5|
20|FH_F118123_67226_0|SrvcGrp|10577|2022|PDM|25.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F145594_02809_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110522_13501_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134947_14227_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|6930.00|99|0.00|AEG 9 (NO REV)|
20|FH_F133749_84604_0|SrvcGrp|97705|2022|PDM|94.50|99|0.00|RESPITE CARE (HCFA)|
20|FH_F100782_0_0|SrvcGrp|97679|2022|PDM|2918.75|99|0.00|WINDBER MEDICAL CNTR ASC 901|
20|FH_F93122_01854_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F85213_02840_0|SrvcGrp|111929|2022|PDM|48.70|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F81698_10457_0|SrvcGrp|86833|2022|PDM|10.50|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F36753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70804_0_0|SrvcGrp|62154|2022|PDM|91.36|99|0.00|PICC LINES|
20|FH_F149148_15330_0|SrvcGrp|73700|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132740_46250_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F129509_0_0|SrvcGrp|77484|2022|PDM|610.00|99|0.00|AETNA OBSERVATION|
20|FH_F85213_02840_0|SrvcGrp|88678|2022|PDM|3251.40|99|0.00|ACUTE REHAB I|
20|FH_F145558_43950_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F59872_0_0|SrvcGrp|10903|2022|PDM|495.00|99|0.00|EMERGENCY ROOM LEVEL I|
20|FH_F126042_97005_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134928_0_0|SrvcGrp|82037|2022|PDM|2300.00|99|0.00|AETNA ICU|
20|FH_F145681_38301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123157_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F133938_53143_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F113322_38119_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F139873_0_0|SrvcGrp|26273|2022|PDM|2215.00|99|0.00|CPT 29880|
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|1128.00|99|0.00|AEG 7 (NO REV)|
20|FH_F143715_33161_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145641_06902_0|SrvcGrp|90421|2022|PDM|3588.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F121628_19533_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F90574_22560_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F147980_0_0|SrvcGrp|80918|2022|PDM|95.00|99|0.00|RESPITE CARE|
20|FH_F138302_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150165_06032_0|SrvcGrp|88159|2022|PDM|6259.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F129509_0_0|SrvcGrp|88160|2022|PDM|3767.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F126555_44906_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F124161_95932_0|SrvcGrp|109221|2022|PCT|2.00|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F127934_62274_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F109266_33319_0|SrvcGrp|86747|2022|PCT|1.25|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F145641_06902_0|SrvcGrp|82114|2022|PDM|5621.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F145819_03431_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145629_45243_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128816_43537_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F111882_51560_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F148779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42258_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH|
20|FH_F112863_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F113325_80004_0|SrvcGrp|104329|2022|PCT|1.00|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F133207_0_0|SrvcGrp|95819|2022|PDM|3183.00|99|0.00|GONIOTOMY|
20|FH_F85353_16407_0|SrvcGrp|63875|2022|PDM|308.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 123|
20|FH_F85995_64111_0|SrvcGrp|48398|2022|PDM|136.00|99|0.00|PT SERVICES|
20|FH_F118123_67226_0|SrvcGrp|21920|2022|PDM|25.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F133585_0_0|SrvcGrp|112387|2022|PDM|230.00|99|0.00|ARTERY X-RAYS ARM/LEG (HCFA)|
20|FH_F127486_06776_0|SrvcGrp|46605|2022|PDM|109.20|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F113322_38119_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F112908_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35221_0_0|SrvcGrp|6|2022|PDM|3500.00|99|0.00|OP SURGERY|
20|FH_F143771_0_0|SrvcGrp|82223|2022|PDM|136.00|99|0.00|HOSPICE CARE|
20|FH_F81297_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|4958.80|99|0.00|AEG 9 (NO REV)|
20|FH_F136787_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|91.84|99|0.00|HAPA WPA-NWPA 2012-13 ASC 146 W/O REV|
20|FH_F134972_84117_0|SrvcGrp|23683|2022|PDM|47.50|99|0.00|SKILLED NURSING RN|
20|FH_F114444_19602_0|SrvcGrp|91392|2022|PDM|190.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AF)|
20|FH_F134508_14072_0|SrvcGrp|92760|2022|PCT|0.92|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122459_15221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F105145_75075_0|SrvcGrp|33967|2022|PDM|34200.00|99|0.00|CPT 47562|
20|FH_F105145_75075_0|SrvcGrp|82298|2022|PDM|8000.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY|
20|FH_F115786_57701_0|SrvcGrp|48385|2022|PDM|94.00|99|0.00|SPEECH THERAPY|
20|FH_F77665_0_0|SrvcGrp|10534|2022|PDM|120.00|99|0.00|NURSING CARE|
20|FH_F120805_92672_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F126376_23936_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127656_06068_0|SrvcGrp|88621|2022|PDM|109.20|99|0.00|SKILLED NURSING LPN|
20|FH_F133583_77074_0|SrvcGrp|108484|2022|PDM|552.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F133272_23834_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133478_40165_0|CSTM-ALL|CSTM-00|2020|PDM|3084.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 8 (NO REV)|
20|FH_F133007_76010_0|SrvcGrp|102279|2022|PDM|100.00|99|0.00|AETNA METHADONE MAINTENANCE (HCFA)|
20|FH_F131212_63017_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F134826_19067_0|SrvcGrp|90636|2022|PDM|150.00|99|0.00|AETNA PSYTX PT & FAMILY 60 MINUTES (HCFA)|
20|FH_F121949_80246_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129130_92562_0|SrvcGrp|111316|2022|PCT|2.16|99|0.00|THROMBOLIC AGENTS|
20|FH_F129130_92562_0|CSTM-ALL|CSTM-00|2020|PDM|8668.00|99|0.00|AEG 4 (NO REV) W/O SURGERIES|
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|ADOLESCENT PSYCH RESIDENTIAL TREATMENT|
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_F69651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F110000_0_0|SrvcGrp|10947|2022|PDM|5272.00|99|0.00|EMERGENCY ROOM|
20|FH_F91873_12723_0|SrvcGrp|31706|2022|PDM|2560.00|99|0.00|MS DRG 792 ONLY|
20|FH_F97660_29401_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
20|FH_F33530_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111925_0_0|SrvcGrp|74670|2022|PCT|1.00|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F103780_64804_0|CSTM-ALL|CSTM-00|2020|PDM|2191.00|99|0.00|AEG 4 (NO REV)|
20|FH_F123774_0_0|SrvcGrp|73008|2022|PDM|700.00|99|0.00|AEG 10|
20|FH_F39209_0_0|SrvcGrp|13168|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F94786_07974_0|SrvcGrp|14893|2022|PDM|31.50|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F132627_0_0|SrvcGrp|26617|2022|PDM|8.16|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_F114389_50131_0|SrvcGrp|86835|2022|PDM|30.30|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F114389_50131_0|SrvcGrp|17006|2022|PDM|133.31|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS|
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49487_0_0|SrvcGrp|14892|2022|PDM|75.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F77944_0_0|SrvcGrp|57606|2022|PCT|2.00|99|0.00|RADIOLOGY|
20|FH_F119266_0_0|SrvcGrp|103551|2022|PDM|214.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F124082_78526_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F147081_02130_0|SrvcGrp|90397|2022|PDM|284.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F37394_0_0|SrvcGrp|473|2022|PDM|725.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133674_30350_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AETNA OP LABORATORY|
20|FH_F124233_92648_0|SrvcGrp|74668|2022|PDM|700.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124637_77080_0|SrvcGrp|75419|2022|PDM|1100.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F124671_64844_0|SrvcGrp|75545|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F150226_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_F124407_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AMBULATORY SURGERY W/O AEG 1 & 2|
20|FH_F137248_0_0|SrvcGrp|113058|2022|PDM|4058.00|99|0.00|REMOVAL OF PILONIDAL LESION|
20|FH_F122933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136734_46410_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F113809_47302_0|SrvcGrp|46903|2022|PDM|544.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F138456_33543_0|SrvcGrp|73841|2022|PDM|421.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F139556_85006_0|SrvcGrp|21457|2022|PCT|1.89|99|0.00|CPT CODE 95811|
20|FH_F148553_85016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146043_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
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|1570.00|99|0.00|WELLPATH PROPIETARY ASC VIII|
20|FH_F117075_68847_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F141170_0_0|SrvcGrp|93724|2022|PDM|2001.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F37847_0_0|SrvcGrp|9830|2022|PDM|93.50|99|0.00|OT SVCS|
20|FH_F115631_65201_0|SrvcGrp|71666|2022|PDM|3177.00|99|0.00|CPT 63655|
20|FH_F115631_65201_0|SrvcGrp|82463|2022|PDM|1141.00|99|0.00|CPT 64447|
20|FH_F147586_44124_0|SrvcGrp|58634|2022|PDM|5864.00|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F41749_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F42176_0_0|SrvcGrp|12117|2022|PCT|0.88|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|981.00|99|0.00|AEG 1 (NO REV)|
20|FH_F113178_44035_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F113181_72202_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F133536_0_0|SrvcGrp|100661|2022|PDM|3215.00|99|0.00|AETNA OP SURGERY|
20|FH_F120630_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F44459_0_0|SrvcGrp|27173|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F48836_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F138876_25302_0|SrvcGrp|113446|2022|PCT|1.00|99|0.00|ALL DRUGS/AGENTS/INJECTION DRUGS|
20|FH_F57953_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|388.80|99|0.00|HAPA WPA-NWPA 2012-13 ASC 221 W/O REV|
20|FH_F151420_60654_0|SrvcGrp|33982|2022|PDM|2233.00|99|0.00|CPT 28296|
20|FH_F135350_60014_0|SrvcGrp|26160|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F135477_50501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91766_25401_0|SrvcGrp|27969|2022|PDM|17.85|99|0.00|HOME HEALTH AIDE|
20|FH_F130766_04967_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F140629_0_0|SrvcGrp|47142|2022|PDM|2497.00|99|0.00|CPT 49650|
20|FH_F32228_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46815_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F121466_84057_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121763_07202_0|SrvcGrp|73004|2022|PDM|2838.00|99|0.00|AEG 8|
20|FH_F33785_0_0|SrvcGrp|11083|2022|PDM|2400.00|99|0.00|NORMAL DELIVERY (MOTHER ONLY)|
20|FH_F33791_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F111363_33169_0|SrvcGrp|81403|2022|PDM|151.00|99|0.00|COMPREHEN METABOLIC PANEL|
20|FH_F134263_15628_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F134322_98001_0|SrvcGrp|108153|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F34532_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39796_0_0|SrvcGrp|184|2022|PDM|2000.00|99|0.00|MEDICAL INTENSIVE CARE|
20|FH_F48215_0_0|SrvcGrp|26001|2022|PDM|94.50|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F132328_0_0|SrvcGrp|82108|2022|PDM|1821.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F112092_46845_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F96480_15224_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128695_50049_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F98626_29118_0|SrvcGrp|73603|2022|PDM|7634.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F102902_33764_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F102960_50613_0|SrvcGrp|88819|2022|PDM|1190.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F38476_0_0|SrvcGrp|10543|2022|PDM|110.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F140007_0_0|SrvcGrp|16692|2022|PDM|3539.00|99|0.00|KNEE SCOPE|
20|FH_F38808_0_0|SrvcGrp|17067|2022|PDM|491.00|99|0.00|ASPG II|
20|FH_F54055_70006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F123083_0_0|SrvcGrp|28548|2022|PDM|1233.94|99|0.00|VITRECTOMY|
20|FH_F131235_36049_0|SrvcGrp|46903|2022|PDM|715.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F136308_34481_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136542_02446_0|CSTM-ALL|CSTM-00|2020|PDM|473.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F118152_20151_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F118154_17042_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F120490_64133_0|SrvcGrp|43568|2022|PDM|83.00|99|0.00|SKILLED NURSING - RN|
20|FH_F134007_27101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134113_61614_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136952_78218_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F137187_64015_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138892_46341_0|CSTM-ALL|CSTM-00|2020|PDM|698.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F142473_07663_0|SrvcGrp|90340|2022|PCT|1.00|99|0.00|SKILLED NURSING LPN|
20|FH_F142247_61244_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142590_18336_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F51276_0_0|SrvcGrp|24287|2022|PDM|60.00|99|0.00|IV PUMP MAINTENANCE|
20|FH_F51276_0_0|SrvcGrp|49286|2022|PDM|60.00|99|0.00|REPAIR OF INFUSION DEVICE|
20|FH_F73403_0_0|SrvcGrp|43432|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE HOURLY|
20|FH_F97601_67218_0|SrvcGrp|90854|2022|PDM|2103.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F97601_67218_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F138607_02760_0|SrvcGrp|108422|2022|PDM|30.00|99|0.00|REPLACEMENT BREAST PUMP ADPT|
20|FH_F140312_77365_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140496_38627_0|SrvcGrp|86722|2022|PDM|207.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F140627_68651_0|SrvcGrp|109057|2022|PCT|0.96|99|0.00|CARDIAC STUDIES|
20|FH_F140750_89119_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119023_91406_0|SrvcGrp|86827|2022|PDM|75.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F119046_74012_0|SrvcGrp|74581|2022|PCT|1.00|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F92506_07666_0|SrvcGrp|12491|2022|PCT|0.42|99|0.00|PACEMAKER|
20|FH_F91913_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|DEVICE INSERTION|
20|FH_F147801_90703_0|CSTM-ALL|CSTM-00|2020|PDM|1071.00|99|0.00|OBSERVATION SERVICES (>=65 YRS)|
20|FH_F129438_08234_0|SrvcGrp|89149|2022|PDM|215.00|99|0.00|OP INTENSIVE|
20|FH_F129450_17201_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F101161_0_0|SrvcGrp|15326|2022|PDM|1731.00|99|0.00|ER LEVEL IV|
20|FH_F137905_91364_0|SrvcGrp|73605|2022|PDM|970.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F112526_0_0|SrvcGrp|74546|2022|PDM|499.00|99|0.00|HOSPICE SERVICES|
20|FH_F91472_96001_0|SrvcGrp|32703|2022|PDM|11924.00|99|0.00|ICU|
20|FH_F124954_17055_0|SrvcGrp|13262|2022|PDM|7.00|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F148720_0_0|SrvcGrp|107634|2022|PDM|325.00|99|0.00|PERITONEAL TREATMENTS W/ PATIENT TRAINGING|
20|FH_F119090_91502_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F69347_0_0|SrvcGrp|44769|2022|PDM|6955.00|99|0.00|PORTLAND ADVENTIST ASPG VIII|
20|FH_F72544_0_0|SrvcGrp|31477|2022|PCT|1.00|99|0.00|DONOR SEARCH AND PROCUREMENT|
20|FH_F119447_64081_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119449_84032_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F101840_76054_0|SrvcGrp|87310|2022|PDM|24125.00|99|0.00|MSDRG 273 ONLY|
20|FH_F128246_0_0|SrvcGrp|79794|2022|PDM|1176.00|99|0.00|EYE/OCULAR ADNEXA SURGERY|
20|FH_F100665_07939_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F133487_24293_0|SrvcGrp|48394|2022|PDM|46.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F133535_32110_0|SrvcGrp|73841|2022|PDM|389.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F126762_91311_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F89112_16509_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F100788_01420_0|SrvcGrp|73559|2022|PDM|7687.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F148040_90631_0|SrvcGrp|75419|2022|PDM|545.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|1134.00|99|0.00|AEG 10 (NO REV)|
20|FH_F133118_33143_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132594_78229_0|SrvcGrp|29346|2022|PDM|40.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F150903_45805_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111789_25301_0|SrvcGrp|103913|2022|PCT|0.77|99|0.00|OP DIALYSIS|
20|FH_F35368_0_0|SrvcGrp|15179|2022|PCT|1.05|99|0.00|TISSUE PLASMINOGEN ACTIVATOR|
20|FH_F141967_89509_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F128097_68801_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F103540_24740_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88280_0_0|SrvcGrp|108002|2022|PCT|1.75|99|0.00|HAPA-NWPA RAD W/ SURG 2018|
20|FH_F88512_0_0|SrvcGrp|46530|2022|PDM|308.89|99|0.00|EMERGENCY ROOM LEVEL 1|
20|FH_F148881_33018_0|SrvcGrp|85963|2022|PDM|75.00|99|0.00|SELF CARE MANGEMENT TRAINING|
20|FH_F133021_00910_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97182_21502_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F120837_33309_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F86293_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F106540_26330_0|SrvcGrp|75799|2022|PDM|630.00|99|0.00|EMERGENCY ROOM LEVEL I|
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148556_13206_0|SrvcGrp|17016|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F133397_23233_0|SrvcGrp|87537|2022|PDM|520.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F139587_0_0|SrvcGrp|113492|2022|PDM|195.36|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F126762_91311_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F87334_16507_0|SrvcGrp|81950|2022|PCT|1.00|99|0.00|AETNA LABORATORY|
20|FH_F111815_35904_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F136401_0_0|SrvcGrp|82981|2022|PDM|154.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F132528_64014_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F108700_63857_0|SrvcGrp|27968|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F83053_0_0|SrvcGrp|72996|2022|PDM|4224.00|99|0.00|AEG 4|
20|FH_F88956_0_0|SrvcGrp|80679|2022|PCT|1.33|99|0.00|AETNA RADIOLOGY|
20|FH_F148494_0_0|SrvcGrp|98560|2022|PDM|15000.00|99|0.00|LUMBAR|
20|FH_F40591_0_0|CSTM-ALL|CSTM-00|2020|PDM|3770.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F87559_0_0|SrvcGrp|86476|2022|PDM|45.79|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F97543_33542_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F133018_84037_0|SrvcGrp|73742|2022|PDM|4.41|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F51438_0_0|SrvcGrp|37542|2022|PDM|425.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|638.00|99|0.00|AEG 1 (NO REV)|
20|FH_F41461_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120605_0_0|SrvcGrp|72992|2022|PDM|712.00|99|0.00|AEG 2|
20|FH_F35454_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IMMUNIZATION F/S - ICLN|
20|FH_F35454_0_0|SrvcGrp|16852|2022|PDM|24.00|99|0.00|LEG SPLINT|
20|FH_F97882_32407_0|SrvcGrp|73605|2022|PDM|2943.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F97621_75801_0|SrvcGrp|73485|2022|PDM|2468.00|99|0.00|AETNA REHAB|
20|FH_F101754_63141_0|SrvcGrp|97989|2022|PCT|0.75|99|0.00|PROSTHETIC DEVICE REPAIR REP|
20|FH_F40890_0_0|SrvcGrp|30942|2022|PDM|440.00|99|0.00|SUB-ACUTE SKILLED NURSING CARE|
20|FH_F111444_33401_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150602_59718_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F44855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F135179_0_0|SrvcGrp|107749|2022|PDM|164.00|99|0.00|CAPD/CCPD|
20|FH_F129175_0_0|SrvcGrp|96819|2022|PDM|150.13|99|0.00|DESTROY L/S FACET JNT ADDL|
20|FH_F117872_33462_0|SrvcGrp|93919|2022|PDM|711.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F68121_0_0|SrvcGrp|64377|2022|PDM|100.00|99|0.00|SPEECH THERAPY EVAL/RE-EVAL|
20|FH_F117450_63131_0|SrvcGrp|48396|2022|PDM|114.00|99|0.00|OT SERVICES|
20|FH_F41785_0_0|SrvcGrp|31190|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC (DME)|
20|FH_F149840_80002_0|SrvcGrp|71719|2022|PCT|1.00|99|0.00|CPT 99100, 99116, 99135, 99140|
20|FH_F66541_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F142038_45152_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89932_10940_0|SrvcGrp|89144|2022|PDM|1095.00|99|0.00|UPPER GI ENDOSCOPY|
20|FH_F92676_15063_0|SrvcGrp|79067|2022|PDM|369.13|99|0.00|MON VALLEY ASC 238|
20|FH_F67861_0_0|SrvcGrp|8950|2022|PDM|2530.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F139825_0_0|SrvcGrp|42428|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 65855|
20|FH_F65899_0_0|SrvcGrp|361|2022|PDM|2352.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F144572_34203_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F38249_0_0|SrvcGrp|13199|2022|PCT|0.95|99|0.00|TRAUMA CARE|
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|1765.00|99|0.00|AEG 9 (NO REV)|
20|FH_F148761_33311_0|SrvcGrp|105020|2022|PDM|75.00|99|0.00|SELF CARE MANGEMENT TRAINING (HCFA)|
20|FH_F151154_91761_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F121338_37756_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F139454_32839_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F150620_53402_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F34786_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F115483_62002_0|SrvcGrp|105465|2022|PCT|0.60|99|0.00|AETNA THERAPIES|
20|FH_F74670_0_0|SrvcGrp|15478|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY SVCS INITIAL EVAL|
20|FH_F124389_84115_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129297_97828_0|SrvcGrp|73643|2022|PDM|2550.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F111040_30033_0|SrvcGrp|16|2022|PDM|3591.00|99|0.00|ACUTE REHABILITATION|
20|FH_F32825_0_0|SrvcGrp|361|2022|PDM|1638.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F149602_07109_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110783_93013_0|SrvcGrp|29075|2022|PDM|30.00|99|0.00|HYDRATION THERAPY|
20|FH_F147237_40006_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F140990_0_0|SrvcGrp|108082|2022|PDM|150.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F101441_0_0|SrvcGrp|16693|2022|PDM|3567.00|99|0.00|KNEE SCOPE, MENISCECTOMY|
20|FH_F138017_73129_0|SrvcGrp|97465|2022|PDM|6539.00|99|0.00|REMOVE PROSTATE REGROWTH|
20|FH_F111044_0_0|SrvcGrp|69964|2022|PDM|2060.00|99|0.00|CPT 23120|
20|FH_F44132_0_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149049_28401_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 6 (NO REV)|
20|FH_F97184_26101_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F147422_84121_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F35452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1204.00|99|0.00|ASPG IV|
20|FH_F144651_0_0|SrvcGrp|101280|2022|PDM|15500.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F47424_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149003_62208_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F146266_0_0|SrvcGrp|90420|2022|PDM|5500.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F45798_0_0|SrvcGrp|2975|2022|PDM|8200.00|99|0.00|DRG 500 BACK & NECK PROCEDURE EXCEPT SPINAL FUSION W/O CC|
20|FH_F41273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F151019_14094_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F69183_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|ASPG I - FH SW CUSTOM GROUPERS|
20|FH_F131942_50833_0|SrvcGrp|88620|2022|PDM|115.00|99|0.00|SKILLED NURSING RN|
20|FH_F122841_0_0|SrvcGrp|109237|2022|PDM|1349.00|99|0.00|REPAIR OF BLEPHAROPTOSIS|
20|FH_F98280_31015_0|SrvcGrp|472|2022|PDM|495.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F129970_34986_0|SrvcGrp|89417|2022|PDM|473.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F47659_0_0|SrvcGrp|361|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F40490_0_0|SrvcGrp|9511|2022|PCT|0.58|99|0.00|OBSERVATION SVCS|
20|FH_F124760_34997_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F110783_93013_0|SrvcGrp|24744|2022|PDM|75.00|99|0.00|PICC LINE INSERTION|
20|FH_F137747_62278_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F138417_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F147339_08837_0|SrvcGrp|88158|2022|PDM|2775.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F36107_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45798_0_0|SrvcGrp|2953|2022|PDM|27000.00|99|0.00|DRG 471 BILATERAL OR MULTIPLE MAJOR JOINT PX LOWER EXTREMITY|
20|FH_F90223_0_0|SrvcGrp|86830|2022|PDM|4.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F110963_30535_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132160_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F34882_0_0|CSTM-ALL|CSTM-00|2020|PDM|4750.60|99|0.00|MS DRG 767|
20|FH_F48254_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN|
20|FH_F125214_12428_0|SrvcGrp|73659|2022|PDM|4822.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F42165_0_0|SrvcGrp|20801|2022|PCT|0.85|99|0.00|HOME HEALTH|
20|FH_F98000_59102_0|SrvcGrp|88978|2022|PDM|7023.00|99|0.00|VAGINAL DELIVERY|
20|FH_F116554_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 6 (NO REV)|
20|FH_F35738_33180_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149582_01534_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132254_40207_0|SrvcGrp|86830|2022|PDM|13.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F90817_0_0|SrvcGrp|90386|2022|PDM|2256.00|99|0.00|REPAIR EARDRUM STRUCTURES|
20|FH_F149160_02180_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F140140_07722_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124441_0_0|SrvcGrp|90063|2022|PDM|3040.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F131498_0_0|SrvcGrp|63119|2022|PDM|23.00|99|0.00|BASIC HOME HOSPICE CARE|
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|649.00|99|0.00|AEG 4 (NO REV)|
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PDM|2112.00|99|0.00|AEG 6 (NO REV)|
20|FH_F147532_0_0|SrvcGrp|89822|2022|PDM|144.84|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F92413_07631_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F89851_83854_0|SrvcGrp|28121|2022|PDM|23409.00|99|0.00|MS DRG 469 ONLY|
20|FH_F122377_91007_0|SrvcGrp|107674|2022|PCT|4.50|99|0.00|AETNA RADIOLOGY|
20|FH_F98900_42001_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F97100_23462_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F97183_25304_0|SrvcGrp|73602|2022|PDM|3193.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F128672_30274_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F36883_0_0|SrvcGrp|52953|2022|PDM|260.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F149602_07109_0|SrvcGrp|113235|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2&INF A&B&RSV AMP PRB|
20|FH_F94643_90501_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146266_0_0|SrvcGrp|92366|2022|PDM|2835.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F147332_19406_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140231_60540_0|SrvcGrp|87317|2022|PDM|984.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F143536_47546_0|SrvcGrp|100241|2022|PCT|0.00|99|0.00|IMMUNOLOGY|
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F98480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102542_0_0|SrvcGrp|16|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION|
20|FH_F103060_0_0|SrvcGrp|88491|2022|PDM|7803.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F102224_0_0|SrvcGrp|73610|2022|PCT|0.54|99|0.00|AETNA IMPLANTS|
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AEG 6 (NO REV)|
20|FH_F114931_0_0|SrvcGrp|33967|2022|PDM|4494.00|99|0.00|CPT 47562|
20|FH_F131067_57105_0|CSTM-ALL|CSTM-00|2020|PDM|3511.00|99|0.00|AEG 3 (NO REV)|
20|FH_F131093_49690_0|SrvcGrp|89781|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F131153_66203_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F46893_0_0|SrvcGrp|42208|2022|PCT|1.00|99|0.00|AIR AMBULANCE SVCS|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|654.00|99|0.00|GA RETINA SURG CTR ASC 15|
20|FH_F116802_41224_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116924_91203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126054_30022_0|CSTM-ALL|CSTM-00|2020|PDM|1014.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS|
20|FH_F118874_29926_0|SrvcGrp|75442|2022|PDM|770.00|99|0.00|OBSERVATION - REV 762|
20|FH_F84394_17402_0|CSTM-ALL|CSTM-00|2020|PDM|2352.00|99|0.00|AEG 2 (NO REV)|
20|FH_F51276_0_0|SrvcGrp|17009|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F102948_43606_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|366.00|99|0.00|AEG 1 (NO REV)|
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|1036.58|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F59732_0_0|SrvcGrp|10577|2022|PDM|80.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F59732_0_0|SrvcGrp|24762|2022|PDM|150.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F33642_0_0|SrvcGrp|13361|2022|PCT|0.75|99|0.00|EMERGENCY ROOM SVCS LEVEL III|
20|FH_F143530_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1926.04|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1401 W/O REV|
20|FH_F129658_77043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110263_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F130747_0_0|SrvcGrp|90357|2022|PDM|4682.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F39886_0_0|SrvcGrp|72|2022|PDM|265.00|99|0.00|NEWBORN NURSERY|
20|FH_F109246_10018_0|SrvcGrp|113276|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148266_45419_0|CSTM-ALL|CSTM-00|2020|PDM|699.00|99|0.00|AEG 10 (NO REV)|
20|FH_F130127_77071_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F106822_0_0|SrvcGrp|68240|2022|PDM|57.00|99|0.00|DESTRUCTION WARTS - 1ST LESION|
20|FH_F148719_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|OP SVCS|
20|FH_F39917_0_0|SrvcGrp|20070|2022|PDM|120.00|99|0.00|HCPCS S9083|
20|FH_F118194_50841_0|SrvcGrp|108147|2022|PCT|1.00|99|0.00|DME (MOD RR)|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F137718_80107_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F139173_0_0|SrvcGrp|63297|2022|PDM|172.09|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F123957_84321_0|SrvcGrp|74668|2022|PDM|144.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|1057.00|99|0.00|AEG 7 (NO REV)|
20|FH_F39278_0_0|SrvcGrp|72781|2022|PDM|166.00|99|0.00|PT SVCS - VISIT LEVEL|
20|FH_F145758_20745_0|CSTM-ALL|CSTM-00|2020|PDM|426.36|99|0.00|AEG 1 (NO REV)|
20|FH_F97500_32025_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F142073_0_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F37679_0_0|SrvcGrp|14944|2022|PDM|6.50|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F123895_52722_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148103_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F148255_72703_0|SrvcGrp|86828|2022|PDM|47.25|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F31798_0_0|SrvcGrp|3069|2022|PCT|1.15|99|0.00|IMPLANTS|
20|FH_F141407_76226_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F148254_89503_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F129683_45255_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F120899_72758_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135237_31015_0|SrvcGrp|48385|2022|PDM|150.00|99|0.00|SPEECH THERAPY|
20|FH_F130747_0_0|SrvcGrp|89980|2022|PDM|6763.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F34454_0_0|SrvcGrp|10410|2022|PDM|42.25|99|0.00|SKILLED NURSING CARE|
20|FH_F131176_28712_0|SrvcGrp|105819|2022|PDM|1273.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F91876_0_0|SrvcGrp|78282|2022|PDM|2925.00|99|0.00|CPT 47563|
20|FH_F78446_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|570.00|99|0.00|AEG 10 (NO REV)|
20|FH_F139173_0_0|SrvcGrp|48396|2022|PDM|192.00|99|0.00|OT SERVICES|
20|FH_F39819_0_0|SrvcGrp|31246|2022|PDM|34666.00|99|0.00|NY DRG 585 ONLY|
20|FH_F78048_0_0|SrvcGrp|30094|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY|
20|FH_F129969_33908_0|SrvcGrp|106048|2022|PDM|825.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F120952_25303_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|AEG 7 (NO REV)|
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|783.00|99|0.00|AEG 10 (NO REV)|
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F56276_0_0|SrvcGrp|52949|2022|PDM|111.00|99|0.00|PSYCHIATRIC CPT 90812|
20|FH_F137573_33764_0|SrvcGrp|88819|2022|PDM|723.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F137367_89139_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F37679_0_0|SrvcGrp|10578|2022|PDM|33.50|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F136510_0_0|SrvcGrp|88154|2022|PDM|3882.00|99|0.00|LASER TREATMENT OLD RETINA|
20|FH_F120362_23321_0|SrvcGrp|46605|2022|PDM|93.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F70104_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|1063.00|99|0.00|AEG 6 (NO REV)|
20|FH_F82955_34266_0|SrvcGrp|78448|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F92129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143528_0_0|SrvcGrp|114083|2022|PDM|1914.15|99|0.00|EXCISION OF NECK CYST|
20|FH_F139173_0_0|SrvcGrp|89783|2022|PDM|172.09|99|0.00|RESPITE CARE (HCFA)|
20|FH_F151560_76012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F116237_43235_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F84215_0_0|SrvcGrp|82571|2022|PDM|3642.00|99|0.00|PERCUTANEOUS IMPLANT OF NEURO ELECTRODES|
20|FH_F148123_91301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F117783_0_0|SrvcGrp|58659|2022|PCT|1.00|99|0.00|PROSTHETIC IMPLANTS|
20|FH_F130850_67401_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F39138_0_0|SrvcGrp|18881|2022|PDM|28711.00|99|0.00|MS DRG 233|
20|FH_F33513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|DME F/S (GLOBAL) - MHAC|
20|FH_F128401_44615_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F137067_0_0|SrvcGrp|34606|2022|PDM|6825.00|99|0.00|CPT 29827|
20|FH_F139515_0_0|SrvcGrp|92411|2022|PDM|8549.00|99|0.00|RELIEVE SPINAL CORD PRESSURE|
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)|
20|FH_F148549_60523_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F34112_0_0|SrvcGrp|16197|2022|PDM|360.00|99|0.00|NEWBORN NURSERY|
20|FH_F148892_0_0|SrvcGrp|92405|2022|PDM|2133.00|99|0.00|PERQ LUMBOSACRAL INJECTION|
20|FH_F128272_60640_0|SrvcGrp|43568|2022|PDM|140.00|99|0.00|SKILLED NURSING - RN|
20|FH_F121090_07848_0|CSTM-ALL|CSTM-00|2020|PDM|666.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F34454_0_0|SrvcGrp|9830|2022|PDM|85.50|99|0.00|OT SVCS|
20|FH_F130747_0_0|SrvcGrp|84939|2022|PDM|26010.00|99|0.00|SHOULDER JOINT|
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|1718.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F109645_0_0|SrvcGrp|23683|2022|PDM|30.00|99|0.00|SKILLED NURSING RN|
20|FH_F131234_32207_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135056_06401_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F125876_78254_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89495_0_0|SrvcGrp|71666|2022|PDM|1530.00|99|0.00|CPT 63655|
20|FH_F88398_15601_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|177.29|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)|
20|FH_F66406_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F112023_12866_0|SrvcGrp|73008|2022|PDM|2506.00|99|0.00|AEG 10|
20|FH_F116806_0_0|SrvcGrp|107036|2022|PDM|1923.16|99|0.00|REPAIR CHEEK BONE FRACTURE|
20|FH_F60072_0_0|CSTM-ALL|CSTM-00|2020|PDM|2375.00|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_F79863_0_0|SrvcGrp|77233|2022|PDM|90.00|99|0.00|AETNA HOME INFUSION S9329|
20|FH_F49598_0_0|SrvcGrp|3277|2022|PDM|478.00|99|0.00|SKILLED NURSING CARE|
20|FH_F138240_64114_0|SrvcGrp|73700|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F138313_75479_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F80172_0_0|SrvcGrp|10648|2022|PDM|4.35|99|0.00|HOME INFUSION|
20|FH_F150160_01301_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118307_60103_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE|
20|FH_F143568_85006_0|SrvcGrp|21458|2022|PCT|2.23|99|0.00|SLEEP STUDIES|
20|FH_F80172_0_0|SrvcGrp|13154|2022|PDM|69.56|99|0.00|HOME INFUSION THERAPY|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PDM|1504.00|99|0.00|ASPG IX|
20|FH_F149365_77642_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133585_0_0|SrvcGrp|109136|2022|PDM|3092.00|99|0.00|AV FISTULA REVISION|
20|FH_F114683_0_0|SrvcGrp|104007|2022|PDM|4500.00|99|0.00|ENDOSCOPIC DCMPR 1|
20|FH_F147502_0_0|SrvcGrp|104228|2022|PDM|150.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109242_18466_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F81852_0_0|SrvcGrp|15478|2022|PDM|20.00|99|0.00|OCCUPATIONAL THERAPY SVCS INITIAL EVAL|
20|FH_F123850_0_0|SrvcGrp|94780|2022|PDM|194.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F111744_32514_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F51021_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120709_64116_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150161_63361_0|SrvcGrp|73701|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F41962_0_0|SrvcGrp|30682|2022|PCT|0.75|99|0.00|HOME HEALTH CARE|
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 3 (NO REV)|
20|FH_F127686_67432_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138951_41101_0|SrvcGrp|86836|2022|PDM|15.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|AEG 3 (NO REV)|
20|FH_F52754_0_0|SrvcGrp|9861|2022|PDM|1120.00|99|0.00|ACUTE REHABILITATION|
20|FH_F118252_32216_0|SrvcGrp|73842|2022|PDM|423.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F125407_68756_0|SrvcGrp|109029|2022|PCT|0.98|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F114824_44484_0|SrvcGrp|89149|2022|PDM|135.00|99|0.00|OP INTENSIVE|
20|FH_F126417_77338_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147962_85008_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F150165_06032_0|SrvcGrp|77021|2022|PDM|5665.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F83380_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F149021_44514_0|SrvcGrp|115563|2022|PDM|787.16|99|0.00|SURGICAL SERVICES|
20|FH_F90496_13159_0|SrvcGrp|75759|2022|PDM|233.00|99|0.00|AMBULATORY DETOX REHAB|
20|FH_F145641_06902_0|SrvcGrp|31533|2022|PDM|5767.00|99|0.00|HCPCS G0289|
20|FH_F138447_22041_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2945.00|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_F139472_06902_0|SrvcGrp|75545|2022|PDM|420.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F133749_84604_0|SrvcGrp|46606|2022|PDM|50.00|99|0.00|POSTNATAL CARE HOME VISIT|
20|FH_F134229_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.20|99|0.00|OP SVCS|
20|FH_F142376_0_0|SrvcGrp|113974|2022|PDM|1100.00|99|0.00|NJX INTERLAMINAR CRV/THRC|
20|FH_F40566_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F119763_17402_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F110504_37027_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F118253_89052_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F125328_0_0|SrvcGrp|75282|2022|PDM|2305.50|99|0.00|DIAGNOSTIC HYSTEROSCOPY|
20|FH_F149246_95603_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F85353_16407_0|SrvcGrp|63829|2022|PDM|502.66|99|0.00|HAPA WPA-NWPA 2012-13 ASC 102|
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|448.00|99|0.00|AEG 2 (NO REV)|
20|FH_F149021_44514_0|SrvcGrp|114518|2022|PDM|1420.81|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F110245_46016_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F145641_06902_0|CSTM-ALL|CSTM-00|2020|PDM|1702.00|99|0.00|AEG 7 (NO REV)|
20|FH_F49552_0_0|SrvcGrp|28704|2022|PDM|82.00|99|0.00|WOUND CARE|
20|FH_F51138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F126341_27284_0|SrvcGrp|22589|2022|PCT|1.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F130327_03867_0|SrvcGrp|46605|2022|PDM|163.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F134249_05060_0|SrvcGrp|104468|2022|PDM|897.00|99|0.00|ANTEPARTUM CARE ONLY (4-6 VISITS)|
20|FH_F37698_0_0|SrvcGrp|177|2022|PDM|1500.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F69606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F84712_0_0|SrvcGrp|82742|2022|PDM|135.00|99|0.00|X-RAY EXAM CHEST SINGLE VIEW|
20|FH_F84935_0_0|SrvcGrp|3087|2022|PDM|1523.00|99|0.00|CD - DETOX|
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|106.93|99|0.00|HAPA WPA-NWPA 2012-13 ASC 139 W/O REV|
20|FH_F115872_06052_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146668_30189_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146667_37110_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F116088_46410_0|SrvcGrp|89417|2022|PDM|346.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F131668_97526_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131927_66043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133292_75042_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133047_74012_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F133700_92808_0|SrvcGrp|110811|2022|PDM|500.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F111823_32539_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)|
20|FH_F116809_0_0|SrvcGrp|79595|2022|PDM|536.00|99|0.00|CPT 45385|
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|SrvcGrp|115|2022|PDM|663.00|99|0.00|SKILLED NURSING CARE|
20|FH_F37328_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F97720_70084_0|SrvcGrp|73461|2022|PDM|9106.00|99|0.00|AETNA NICU IV|
20|FH_F117399_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F79025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88456_0_0|SrvcGrp|44066|2022|PDM|2465.00|99|0.00|CPT 57288|
20|FH_F142448_15701_0|SrvcGrp|27969|2022|PDM|17.11|99|0.00|HOME HEALTH AIDE|
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PDM|1571.90|99|0.00|AEG 7 (NO REV)|
20|FH_F40397_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.01|99|0.00|OP SVCS|
20|FH_F138929_0_0|SrvcGrp|113271|2022|PDM|1320.00|99|0.00|GENICULAR NERVE BLOCK|
20|FH_F131047_0_0|SrvcGrp|30623|2022|PDM|11697.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F132988_0_0|SrvcGrp|109790|2022|PDM|12889.12|99|0.00|FUSION OF FOOT BONES|
20|FH_F132988_0_0|SrvcGrp|112150|2022|PDM|895.82|99|0.00|DRAINAGE OF FINGER ABSCESS|
20|FH_F141036_02347_0|SrvcGrp|111934|2022|PCT|1.00|99|0.00|COVID-19 NUCLEIC ACID|
20|FH_F50415_0_0|SrvcGrp|44708|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F42300_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126345_0_0|SrvcGrp|68000|2022|PDM|2376.00|99|0.00|CPT 58561|
20|FH_F141336_16947_0|SrvcGrp|13187|2022|PCT|0.39|99|0.00|INTRAOCULAR LENSES|
20|FH_F64180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45976_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F51478_0_0|SrvcGrp|40222|2022|PDM|80.00|99|0.00|OP SVCS|
20|FH_F132348_16214_0|SrvcGrp|27968|2022|PDM|32.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132348_16214_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F122184_65674_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F63196_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91998_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92493_0_0|SrvcGrp|89980|2022|PDM|3119.66|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F100703_0_0|SrvcGrp|112026|2022|PDM|7876.00|99|0.00|TOTAL KNEE ARTHROPLASTY|
20|FH_F124233_92648_0|SrvcGrp|104079|2022|PCT|1.50|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F124235_92840_0|SrvcGrp|108484|2022|PDM|1200.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F124679_64052_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F127995_84010_0|SrvcGrp|29076|2022|PDM|25.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F133399_72211_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F55694_0_0|SrvcGrp|3409|2022|PDM|441.00|99|0.00|NEWBORN NURSERY|
20|FH_F76544_0_0|CSTM-ALL|CSTM-00|2020|PDM|1031.00|99|0.00|REHABILITATION FULL DAY|
20|FH_F98101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|GENERAL ACUTE CARE|
20|FH_F136674_16335_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113809_47302_0|SrvcGrp|89417|2022|PDM|272.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F148553_85016_0|SrvcGrp|69620|2022|PDM|2907.00|99|0.00|CPT 93459 PTCA|
20|FH_F42897_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F134675_60134_0|SrvcGrp|89149|2022|PDM|252.00|99|0.00|OP INTENSIVE|
20|FH_F134727_30650_0|SrvcGrp|111768|2022|PCT|1.10|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F134733_19460_0|SrvcGrp|112634|2022|PDM|650.00|99|0.00|ELECTRODE STIMULATION BRAIN-ADD ON|
20|FH_F113713_17013_0|SrvcGrp|104419|2022|PDM|85.00|99|0.00|OFFICE/OUTPATIENT VISIT EST (MOD AF)|
20|FH_F138219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115181_78602_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F115608_24171_0|SrvcGrp|10391|2022|PDM|1800.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F115631_65201_0|SrvcGrp|70749|2022|PDM|3177.00|99|0.00|CPT 29823|
20|FH_F115728_78404_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F147586_44124_0|SrvcGrp|83646|2022|PDM|2447.00|99|0.00|CPT 31276|
20|FH_F147700_21401_0|CSTM-ALL|CSTM-00|2020|PDM|1389.00|99|0.00|AEG 7 (NO REV)|
20|FH_F42153_0_0|SrvcGrp|11336|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F42130_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F102641_0_0|SrvcGrp|73006|2022|PDM|2184.00|99|0.00|AEG 9|
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|104721|2022|PDM|653.00|99|0.00|REVISE EYELID W/ EXCESS SKIN|
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|2087.19|99|0.00|AEG 3 (NO REV)|
20|FH_F151399_0_0|SrvcGrp|13262|2022|PDM|24.96|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F150939_0_0|SrvcGrp|104054|2022|PDM|65.26|99|0.00|INFLUENZA VACCINE - PRESERVATIVE FREE|
20|FH_F36854_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F39633_0_0|SrvcGrp|17077|2022|PDM|1846.00|99|0.00|ASPG VII|
20|FH_F42244_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.00|99|0.00|ACUTE PSYCH|
20|FH_F138674_75149_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138907_01040_0|SrvcGrp|89781|2022|PDM|170.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F138907_01040_0|SrvcGrp|46605|2022|PDM|103.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F138936_01040_0|SrvcGrp|75182|2022|PCT|0.47|99|0.00|AETNA IMPLANTS|
20|FH_F78265_0_0|SrvcGrp|75559|2022|PDM|6020.00|99|0.00|OP DIAGNOSTIC CARDIAC CATHETERIZATION|
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.64|99|0.00|AEG 10 (NO REV)|
20|FH_F91933_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION|
20|FH_F113527_31023_0|SrvcGrp|75493|2022|PCT|0.80|99|0.00|AEG 8|
20|FH_F151501_30265_0|SrvcGrp|705|2022|PCT|0.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F132258_45404_0|SrvcGrp|86849|2022|PDM|50.88|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F122038_34606_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F122089_68010_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F144991_43607_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97501_31501_0|SrvcGrp|73605|2022|PDM|2467.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F135485_20171_0|SrvcGrp|48396|2022|PDM|84.00|99|0.00|OT SERVICES|
20|FH_F135572_89106_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135583_17331_0|SrvcGrp|112760|2022|PDM|454.00|99|0.00|HOME SLEEP TEST (TYPE III) (POS 12)|
20|FH_F135800_28731_0|SrvcGrp|26001|2022|PDM|195.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F135951_34711_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F130620_18940_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140629_0_0|SrvcGrp|100661|2022|PDM|2497.00|99|0.00|AETNA OP SURGERY|
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1254.00|99|0.00|AEG 5  (NO REV)|
20|FH_F101741_16823_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121713_84747_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F46918_0_0|SrvcGrp|22387|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F111292_33136_0|SrvcGrp|110820|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F111292_33136_0|SrvcGrp|109707|2022|PDM|6472.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F111301_33122_0|SrvcGrp|107506|2022|PDM|231.00|99|0.00|X-RAY EXAM CHEST TWO VIEWS|
20|FH_F111301_33122_0|SrvcGrp|81406|2022|PDM|8.00|99|0.00|URINALYSIS|
20|FH_F111363_33169_0|SrvcGrp|82737|2022|PDM|41.00|99|0.00|URINALYSIS|
20|FH_F111363_33169_0|SrvcGrp|81405|2022|PDM|15.00|99|0.00|URINALYSIS W/ MICROSCPY|
20|FH_F134263_15628_0|SrvcGrp|90854|2022|PDM|743.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F87153_0_0|CSTM-ALL|CSTM-00|2020|PDM|104.45|99|0.00|AETNA SLEEP STUDIES|
20|FH_F148243_0_0|SrvcGrp|92408|2022|PDM|3000.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F148243_0_0|SrvcGrp|33984|2022|PDM|1450.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F72666_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 10 (NO REV)|
20|FH_F112092_46845_0|SrvcGrp|90496|2022|PCT|1.00|99|0.00|FLUVIRIN VACC 3 YRS & > IM|
20|FH_F87557_33309_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F127445_51054_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129240_10028_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98300_30236_0|SrvcGrp|80679|2022|PCT|2.00|99|0.00|AETNA RADIOLOGY|
20|FH_F132090_60915_0|CSTM-ALL|CSTM-00|2020|PDM|979.65|99|0.00|AEG 10 (NO REV)|
20|FH_F143542_0_0|SrvcGrp|82570|2022|PDM|4590.00|99|0.00|REVISION EYELID/EXCESS SKIN|
20|FH_F148490_80231_0|SrvcGrp|74668|2022|PDM|240.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|2106.00|99|0.00|AEG 4 (NO REV)|
20|FH_F98161_0_0|SrvcGrp|73004|2022|PDM|1119.00|99|0.00|AEG 8|
20|FH_F150220_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F63316_0_0|SrvcGrp|47189|2022|PDM|203.43|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F69968_0_0|CSTM-ALL|CSTM-00|2020|PDM|18761.63|99|0.00|MS DRG 619-621 & REV CODES 110-219 OR PROCEDURES FOR OBESITY|
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1561.00|99|0.00|AEG 7 (NO REV)|
20|FH_F136307_65791_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136367_72210_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136404_06410_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136475_89119_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F118152_20151_0|SrvcGrp|29077|2022|PDM|15.00|99|0.00|HOME TRANSFUSION|
20|FH_F118171_00674_0|SrvcGrp|107752|2022|PDM|6000.00|99|0.00|ATHERECTOMY|
20|FH_F120456_67117_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F120506_53934_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F93358_63084_0|SrvcGrp|92799|2022|PDM|418.00|99|0.00|AETNA RESIDENTIAL TREATMENT PYCH & CD (AGE 18-150)|
20|FH_F137235_66061_0|SrvcGrp|108484|2022|PDM|400.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F138108_47130_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142690_31774_0|SrvcGrp|27969|2022|PDM|34.00|99|0.00|HOME HEALTH AIDE|
20|FH_F138545_39503_0|SrvcGrp|86722|2022|PDM|202.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F132733_0_0|SrvcGrp|40820|2022|PDM|3147.00|99|0.00|ICU/CCU|
20|FH_F140407_63841_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F140615_73013_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140633_17901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F140730_84106_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140887_43338_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F80284_16354_0|SrvcGrp|64110|2022|PDM|412.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 1|
20|FH_F80284_16354_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TITUSVILLE INJ 2014|
20|FH_F119023_91406_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118943_64506_0|SrvcGrp|16750|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 10 (NO REV)|
20|FH_F117255_68520_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117102_39355_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117108_37841_0|SrvcGrp|107254|2022|PCT|0.00|99|0.00|MATERNITY DELIVERY|
20|FH_F111593_0_0|SrvcGrp|27402|2022|PDM|3495.50|99|0.00|LASER PROCEDURES|
20|FH_F90838_16146_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132736_0_0|SrvcGrp|112088|2022|PCT|0.65|99|0.00|CARDIAC ABLATION|
20|FH_F95880_02726_0|SrvcGrp|89502|2022|PDM|36.90|99|0.00|NEUROMUSCULAR REEDUCATION|
20|FH_F69347_0_0|SrvcGrp|44234|2022|PDM|1569.00|99|0.00|NURSERY|
20|FH_F119444_72903_0|SrvcGrp|89417|2022|PDM|386.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F148379_89129_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F148554_85016_0|CSTM-ALL|CSTM-00|2020|PDM|923.00|99|0.00|AEG 6 (NO REV)|
20|FH_F126806_44125_0|SrvcGrp|90707|2022|PDM|130.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F88512_0_0|SrvcGrp|48682|2022|PDM|763.50|99|0.00|MS DRG 795 ONLY & REV CODES 170-172 NORMAL NEWBORN|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|447.35|99|0.00|HAPA WPA-NWPA 2012-13 ASC 212 W/O REV|
20|FH_F102822_84065_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F145988_06105_0|SrvcGrp|112813|2022|PDM|18.76|99|0.00|COVID-19 LAB TRANSFER|
20|FH_F146218_50009_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F71723_16502_0|SrvcGrp|13985|2022|PDM|47.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F100682_97401_0|SrvcGrp|73659|2022|PDM|7451.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F73705_0_0|SrvcGrp|42871|2022|PDM|75.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|3300.00|99|0.00|AEG 9 (NO REV)|
20|FH_F144109_63376_0|SrvcGrp|13262|2022|PCT|1.17|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F42340_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F67136_0_0|SrvcGrp|39870|2022|PDM|10112.00|99|0.00|MS DRG 619-621 ONLY|
20|FH_F46372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F113257_19034_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128492_49010_0|SrvcGrp|82223|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F132224_89119_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F126560_43606_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F81494_0_0|SrvcGrp|16620|2022|PDM|136.00|99|0.00|PT SVCS|
20|FH_F133003_49012_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97103_53295_0|SrvcGrp|73605|2022|PDM|2180.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F146217_0_0|SrvcGrp|104226|2022|PDM|178.66|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F136751_0_0|SrvcGrp|67065|2022|PDM|16000.00|99|0.00|CERVICAL SURGERY|
20|FH_F102721_38118_0|SrvcGrp|72984|2022|PCT|0.40|99|0.00|CHEMOTHERAPY|
20|FH_F126815_02118_0|SrvcGrp|94040|2022|PDM|1235.34|99|0.00|OBSERVATION SERVICES FOR ER SERVICES|
20|FH_F144188_76502_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F97581_60141_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS|
20|FH_F117346_75093_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% OF AWP DRUGS W/ DIRECT RATES|
20|FH_F42807_0_0|SrvcGrp|37117|2022|PCT|0.75|99|0.00|DURABLE MEDICAL EQUIPMENT|
20|FH_F144011_60616_0|SrvcGrp|360|2022|PDM|3447.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F146361_66215_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F100741_0_0|SrvcGrp|73004|2022|PDM|1352.00|99|0.00|AEG 8|
20|FH_F74263_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|3192.00|99|0.00|AEG 6 (NO REV)|
20|FH_F145988_06105_0|SrvcGrp|114482|2022|PDM|34953.00|99|0.00|DRUG-ELUTING STENTS, SINGLE|
20|FH_F127217_29650_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133287_40215_0|SrvcGrp|102419|2022|PDM|12254.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F97042_64804_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F140472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73304_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|ASPG III|
20|FH_F38865_0_0|SrvcGrp|4111|2022|PCT|0.75|99|0.00|DRUGS|
20|FH_F91262_77036_0|SrvcGrp|90339|2022|PDM|90.00|99|0.00|SKILLED NURSING RN|
20|FH_F134487_14843_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F37778_0_0|SrvcGrp|27315|2022|PDM|1749.00|99|0.00|TENDON REPAIR|
20|FH_F142752_19428_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F88956_0_0|SrvcGrp|20077|2022|PDM|40692.00|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR|
20|FH_F68441_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|2105.00|99|0.00|AEG 7 (NO REV)|
20|FH_F150949_0_0|SrvcGrp|89842|2022|PDM|10500.00|99|0.00|LUMBAR|
20|FH_F115889_0_0|SrvcGrp|72992|2022|PDM|655.00|99|0.00|AEG 2|
20|FH_F112853_22408_0|SrvcGrp|73523|2022|PCT|1.05|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F118788_91355_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC|
20|FH_F123012_27703_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F144288_46322_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F141940_50023_0|CSTM-ALL|CSTM-00|2020|PDM|4859.57|99|0.00|AEG 7 (NO REV)|
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F65139_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|COLUMBIA EYE SURGE CENTER  CPT|
20|FH_F62816_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128120_76513_0|SrvcGrp|23587|2022|PDM|740.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F36384_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.30|99|0.00|GENERAL ACUTE CARE|
20|FH_F39640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|DME - MOD NU|
20|FH_F125212_76301_0|SrvcGrp|86723|2022|PDM|350.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|716.00|99|0.00|AEG 2 (NO REV)|
20|FH_F59274_0_0|SrvcGrp|46424|2022|PDM|32.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F125009_17042_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F133367_40065_0|SrvcGrp|12840|2022|PCT|0.43|99|0.00|PACEMAKER|
20|FH_F117880_91730_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92676_15063_0|SrvcGrp|78941|2022|PDM|3240.00|99|0.00|MON VALLEY ASC 1405|
20|FH_F132551_39194_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128678_68048_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116828_0_0|SrvcGrp|57967|2022|PDM|148.79|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F133021_00910_0|SrvcGrp|112302|2022|PDM|700.00|99|0.00|STEREOTACTIC BX SECOND LESION|
20|FH_F100661_63640_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F51438_0_0|SrvcGrp|3810|2022|PDM|156.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F88956_0_0|SrvcGrp|12664|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F45435_0_0|SrvcGrp|12401|2022|PDM|105.00|99|0.00|RN VISIT|
20|FH_F136751_0_0|SrvcGrp|97741|2022|PDM|20500.00|99|0.00|REVISE KNEE|
20|FH_F151059_60435_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151086_60649_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139487_60076_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F139667_84078_0|SrvcGrp|104230|2022|PDM|93.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F150745_03301_0|SrvcGrp|82223|2022|PDM|212.00|99|0.00|HOSPICE CARE|
20|FH_F150745_03301_0|SrvcGrp|27969|2022|PDM|34.00|99|0.00|HOME HEALTH AIDE|
20|FH_F150760_44833_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F150882_84041_0|SrvcGrp|86849|2022|PDM|47.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F110728_13069_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F112796_63703_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F39889_0_0|SrvcGrp|12906|2022|PCT|0.85|99|0.00|IP LITHOTRIPSY|
20|FH_F116100_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|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128369_72901_0|SrvcGrp|108484|2022|PDM|371.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F120157_93103_0|SrvcGrp|93337|2022|PDM|330.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F47558_0_0|SrvcGrp|40407|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD NU KF|
20|FH_F124514_21215_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F111266_30339_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|1597.00|99|0.00|AEG 1 (NO REV)|
20|FH_F151024_30024_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F132008_85226_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F45798_0_0|SrvcGrp|13490|2022|PDM|12300.00|99|0.00|DRG 499 ONLY|
20|FH_F125214_12428_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F137730_46563_0|SrvcGrp|89149|2022|PDM|206.00|99|0.00|OP INTENSIVE|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|447.00|99|0.00|HAPA EPA ASC 50|
20|FH_F150979_44060_0|SrvcGrp|74668|2022|PDM|188.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
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_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|949.50|99|0.00|AEG 4 (NO REV)|
20|FH_F111246_80027_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F89674_18640_0|SrvcGrp|48394|2022|PDM|31.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F109251_62269_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|1034.00|99|0.00|AEG 3 (NO REV)|
20|FH_F74902_0_0|SrvcGrp|59428|2022|PDM|75.00|99|0.00|ST|
20|FH_F94303_0_0|SrvcGrp|73008|2022|PDM|1008.00|99|0.00|AEG 10|
20|FH_F36594_0_0|SrvcGrp|1168|2022|PDM|25.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F130578_43950_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147532_0_0|SrvcGrp|80317|2022|PDM|144.84|99|0.00|RESPITE CARE|
20|FH_F138995_0_0|SrvcGrp|89882|2022|PDM|2300.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F146266_0_0|SrvcGrp|41325|2022|PDM|3800.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F120332_0_0|SrvcGrp|29347|2022|PCT|0.00|99|0.00|HOME HEALTH AIDE|
20|FH_F39772_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (HCFA)|
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|782.00|99|0.00|AEG 6 (NO REV)|
20|FH_F150922_02452_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F143668_0_0|SrvcGrp|115712|2022|PDM|277.50|99|0.00|SEGMENTAL PNEUMATIC TRUNK (MOD UE)|
20|FH_F141267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122841_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F131555_66213_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147227_48302_0|SrvcGrp|92502|2022|PDM|804.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F94643_90501_0|SrvcGrp|17015|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116793_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138387_02886_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F150999_20678_0|SrvcGrp|115180|2022|PCT|1.00|99|0.00|COVID-19 VACCINES AND ADMINSTRATION|
20|FH_F127040_63867_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50484_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F35458_0_0|SrvcGrp|17092|2022|PDM|2950.00|99|0.00|ORTHOPEDIC SURGERY|
20|FH_F34924_0_0|SrvcGrp|944|2022|PDM|26250.00|99|0.00|BARIATRIC SVCS|
20|FH_F148667_0_0|SrvcGrp|31112|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CARECENTRIX AWP|
20|FH_F131331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F91996_33805_0|SrvcGrp|76094|2022|PDM|152.62|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F150922_02452_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F47424_0_0|SrvcGrp|12403|2022|PDM|955.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F37490_0_0|SrvcGrp|26433|2022|PDM|647.57|99|0.00|OP SURGICAL SERVICES|
20|FH_F117905_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F148859_0_0|SrvcGrp|47529|2022|PDM|890.00|99|0.00|CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY|
20|FH_F142327_0_0|SrvcGrp|36273|2022|PDM|450.00|99|0.00|INTRAOCULAR LENS|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F142228_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.10|99|0.00|GENERAL ACUTE CARE|
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|1441.00|99|0.00|AEG 3 (NO REV)|
20|FH_F114848_50533_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149648_89148_0|SrvcGrp|88620|2022|PDM|130.00|99|0.00|SKILLED NURSING RN|
20|FH_F148539_33548_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F35987_0_0|SrvcGrp|37389|2022|PDM|5219.00|99|0.00|MS DRG 286-287 ONLY CARDIAC CATH|
20|FH_F114207_35243_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F138387_02886_0|SrvcGrp|113268|2022|PDM|115.00|99|0.00|HOME SPEECH THERAPY|
20|FH_F140131_62870_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F95800_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F102920_0_0|SrvcGrp|72992|2022|PDM|753.00|99|0.00|AEG 2|
20|FH_F49037_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F49054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F116662_15801_0|SrvcGrp|75545|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F116869_15146_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F120888_63823_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120971_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F120974_27607_0|SrvcGrp|82858|2022|PCT|0.44|99|0.00|NUCLEAR MEDICINE|
20|FH_F118792_63379_0|SrvcGrp|75507|2022|PCT|0.74|99|0.00|CHEMOTHERAPY|
20|FH_F38980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98621_41042_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F98625_08103_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F143467_0_0|SrvcGrp|99171|2022|PDM|4231.00|99|0.00|CPT 28485|
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|AEG 10 (NO REV)|
20|FH_F36439_0_0|SrvcGrp|22999|2022|PCT|0.30|99|0.00|V5298|
20|FH_F115050_77995_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F92091_0_0|SrvcGrp|89981|2022|PDM|3600.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY|
20|FH_F126730_84737_0|SrvcGrp|75419|2022|PDM|600.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148700_0_0|CSTM-ALL|CSTM-00|2020|PDM|1428.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS|
20|FH_F119760_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F55532_0_0|SrvcGrp|592|2022|PDM|825.00|99|0.00|SUB-ACUTE CARE|
20|FH_F148265_06067_0|SrvcGrp|95559|2022|PDM|23406.00|99|0.00|HIP JOINT|
20|FH_F125323_43213_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F116647_0_0|SrvcGrp|29428|2022|PDM|445.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT|
20|FH_F135779_0_0|SrvcGrp|86723|2022|PDM|467.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F143388_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F126027_63069_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36822_0_0|CSTM-ALL|CSTM-00|2020|PDM|11814.00|99|0.00|MSDRG 246-251 ANGIOPLASTY|
20|FH_F92129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG IV|
20|FH_F99960_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F52854_0_0|SrvcGrp|3069|2022|PCT|0.67|99|0.00|IMPLANTS|
20|FH_F93332_0_0|SrvcGrp|93069|2022|PDM|2295.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F129639_0_0|SrvcGrp|87077|2022|PDM|154.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F49338_0_0|SrvcGrp|32390|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKE (DME)|
20|FH_F37679_0_0|SrvcGrp|27075|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY (MOD SJ)|
20|FH_F82714_18848_0|SrvcGrp|113739|2022|PCT|1.65|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F116176_0_0|SrvcGrp|80285|2022|PDM|148.79|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F147941_06023_0|SrvcGrp|75506|2022|PCT|5.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F139241_0_0|SrvcGrp|104761|2022|PDM|1420.00|99|0.00|LAPAROSCOPY|
20|FH_F125011_74467_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|3596.77|99|0.00|AEG 9 (NO REV)|
20|FH_F143820_28405_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115063_78550_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116760_68512_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139241_0_0|SrvcGrp|27918|2022|PDM|1858.00|99|0.00|CPT 23410, 23412|
20|FH_F107800_34609_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F93593_33414_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143903_06249_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137347_26003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F62915_0_0|SrvcGrp|58799|2022|PCT|1.64|99|0.00|OCN F/S MEDICAL (HCFA) POS FAC (MOD 26 TC) GLOBAL|
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|905.00|99|0.00|AEG 6 (NO REV)|
20|FH_F88704_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F100460_0_0|SrvcGrp|105319|2022|PCT|0.00|99|0.00|IMPLT NROSTM PLS GEN DUA REC|
20|FH_F130935_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37945_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F131357_17545_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F120308_07901_0|SrvcGrp|94879|2022|PDM|247.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F145766_64491_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93563_98499_0|SrvcGrp|43523|2022|PDM|105.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F150462_30458_0|SrvcGrp|17005|2022|PDM|50.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS|
20|FH_F143833_63703_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F118057_47906_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F43858_0_0|SrvcGrp|27769|2022|PDM|25.00|99|0.00|SKILLED LPN HOURLY|
20|FH_F56276_0_0|SrvcGrp|52244|2022|PDM|200.00|99|0.00|BUPRENORPHINE MAINTENANCE|
20|FH_F149759_63122_0|CSTM-ALL|CSTM-00|2020|PCT|0.35|99|0.00|OP SVCS|
20|FH_F132190_0_0|SrvcGrp|16669|2022|PDM|2500.00|99|0.00|ACROMINOPLASTY OF SHOULDER|
20|FH_F123488_65559_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F130747_0_0|SrvcGrp|90420|2022|PDM|4682.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F41491_0_0|SrvcGrp|38|2022|PDM|2016.00|99|0.00|NORMAL DELIVERY|
20|FH_F145550_62034_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F132092_0_0|SrvcGrp|87799|2022|PDM|169.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F125813_66030_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F84215_0_0|SrvcGrp|72992|2022|PDM|546.00|99|0.00|AEG 2|
20|FH_F45632_0_0|SrvcGrp|41486|2022|PDM|14.00|99|0.00|DISPOSABLE DRUG DELIVERY SYSTEM|
20|FH_F37733_0_0|SrvcGrp|27210|2022|PDM|140.00|99|0.00|SKILLED NURSING LEVEL I|
20|FH_F121488_77478_0|SrvcGrp|89337|2022|PDM|1200.00|99|0.00|DETOXIFICATION|
20|FH_F148700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F130204_40807_0|SrvcGrp|58509|2022|PDM|336.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F149888_68506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143971_34986_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F38433_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F130452_48801_0|SrvcGrp|104762|2022|PCT|1.00|99|0.00|AETNA HIGH COST DRUGS|
20|FH_F40318_0_0|SrvcGrp|32394|2022|PDM|45.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F130747_0_0|SrvcGrp|100046|2022|PDM|2601.00|99|0.00|TREAT METATARSAL FRACTURE|
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115739_78722_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129556_65233_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71962_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.00|99|0.00|OP SVCS|
20|FH_F129011_15857_0|SrvcGrp|47411|2022|PDM|210.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F69971_0_0|SrvcGrp|24952|2022|PDM|371.00|99|0.00|GASTROESOPHOGEAL STUDY|
20|FH_F89778_0_0|SrvcGrp|82881|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBTANCE|
20|FH_F89778_0_0|SrvcGrp|64517|2022|PDM|2345.20|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F88492_70601_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|857.08|99|0.00|POLYSOM W/O MOD 26 & TC|
20|FH_F136467_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F93114_85016_0|SrvcGrp|46605|2022|PDM|151.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F110263_0_0|SrvcGrp|93807|2022|PDM|9277.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F124899_45246_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F129627_06037_0|SrvcGrp|43569|2022|PDM|118.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|2222.00|99|0.00|AEG 9 (NO REV)|
20|FH_F109000_0_0|SrvcGrp|84442|2022|PDM|9592.00|99|0.00|REVISION KNEE|
20|FH_F135897_0_0|SrvcGrp|105033|2022|PDM|2750.00|99|0.00|INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE|
20|FH_F117378_16148_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F135235_01830_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F126678_44870_0|SrvcGrp|80920|2022|PDM|550.00|99|0.00|HOSPICE SERVICES|
20|FH_F125710_02860_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F143903_06249_0|SrvcGrp|89337|2022|PDM|650.00|99|0.00|DETOXIFICATION|
20|FH_F91876_0_0|SrvcGrp|72994|2022|PDM|1369.00|99|0.00|AEG 3|
20|FH_F114975_78596_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F100662_27534_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F120169_83814_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F117378_16148_0|SrvcGrp|29347|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE|
20|FH_F86412_32258_0|SrvcGrp|473|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|AEG 4 (NO REV)|
20|FH_F123533_63825_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F125249_0_0|SrvcGrp|100011|2022|PDM|1800.00|99|0.00|ANKLE ARTHROSCOPY|
20|FH_F135178_84049_0|SrvcGrp|46903|2022|PDM|1300.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F148440_16506_0|CSTM-ALL|CSTM-00|2020|PDM|962.00|99|0.00|AEG 6 (NO REV)|
20|FH_F150699_0_0|SrvcGrp|104009|2022|PDM|9639.00|99|0.00|REMOVE AND REPLACE PM GEN SINGL|
20|FH_F149720_81212_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131002_40977_0|CSTM-ALL|CSTM-00|2020|PCT|0.46|99|0.00|OP SVCS|
20|FH_F112325_0_0|SrvcGrp|24739|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F77862_0_0|SrvcGrp|26001|2022|PDM|156.39|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F60317_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F148255_72703_0|SrvcGrp|86846|2022|PDM|31.50|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F39819_0_0|SrvcGrp|31258|2022|PDM|5774.00|99|0.00|NY DRG 294 ONLY|
20|FH_F86319_16365_0|SrvcGrp|112064|2022|PCT|0.63|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F102302_0_0|SrvcGrp|80877|2022|PDM|14300.00|99|0.00|CRANIAL DEVICE INSERTION/REPLACEMENT|
20|FH_F122536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|ASPG X|
20|FH_F38357_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F117344_75062_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F124026_53188_0|SrvcGrp|75419|2022|PDM|343.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F86332_75081_0|SrvcGrp|81003|2022|PDM|65.00|99|0.00|AETNA HOME INFUSION THERAPY|
20|FH_F72183_0_0|CSTM-ALL|CSTM-00|2020|PDM|1065.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125028_19061_0|SrvcGrp|86825|2022|PDM|94.50|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F129650_49417_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130747_0_0|SrvcGrp|103236|2022|PDM|6242.00|99|0.00|AETNA INSJ STABLJ DEV|
20|FH_F36366_0_0|SrvcGrp|22920|2022|PDM|555.00|99|0.00|CPT 95807|
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1085.70|99|0.00|ASPG 7- PROGRESSIVE SURG|
20|FH_F133671_89102_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36681_0_0|SrvcGrp|15472|2022|PDM|450.00|99|0.00|CPT CODE 62284|
20|FH_F148169_33138_0|SrvcGrp|111930|2022|PCT|1.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F44582_0_0|SrvcGrp|39096|2022|PDM|3800.00|99|0.00|ORTHOPEDIC SHORT STAY|
20|FH_F124048_47304_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F44774_0_0|SrvcGrp|32402|2022|PCT|1.20|99|0.00|OCN F/S PRICING: POS FACILITY MOD 26 (RADIOLOGY)|
20|FH_F39617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 3 (NO REV)|
20|FH_F130523_04605_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|AEG 9 (NO REV)|
20|FH_F111288_0_0|SrvcGrp|84318|2022|PDM|1551.00|99|0.00|SPINE INFUSION|
20|FH_F39855_0_0|SrvcGrp|24703|2022|PDM|424.00|99|0.00|NEWBORN NURSERY|
20|FH_F34899_0_0|SrvcGrp|6|2022|PCT|0.90|99|0.00|OP SURGERY|
20|FH_F110061_0_0|SrvcGrp|93741|2022|PDM|4000.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY|
20|FH_F89475_71202_0|SrvcGrp|73606|2022|PDM|788.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.00|99|0.00|AEG 10 (NO REV)|
20|FH_F123921_89128_0|SrvcGrp|46903|2022|PDM|1300.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F138578_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143821_60559_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F52854_0_0|SrvcGrp|12583|2022|PDM|2031.00|99|0.00|TRAUMA HEAD/SPINE REHAB|
20|FH_F150982_0_0|SrvcGrp|83641|2022|PDM|3854.00|99|0.00|CPT 29889|
20|FH_F63095_0_0|SrvcGrp|12889|2022|PCT|0.65|99|0.00|RADIOLOGY|
20|FH_F122725_32216_0|SrvcGrp|104806|2022|PDM|84.00|99|0.00|PSYCHOANALYSIS|
20|FH_F62579_0_0|SrvcGrp|47411|2022|PDM|115.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F130755_04401_0|SrvcGrp|103717|2022|PCT|0.93|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F98002_27103_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F38952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|OP SVCS|
20|FH_F133867_84075_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F63318_0_0|SrvcGrp|44122|2022|PDM|550.00|99|0.00|SUB-ACUTE REHB - LEVEL  V|
20|FH_F50958_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71647_0_0|SrvcGrp|12163|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|6611.00|99|0.00|MS DRG 691|
20|FH_F117206_0_0|SrvcGrp|88494|2022|PDM|700.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F119383_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F58714_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32995_0_0|SrvcGrp|9774|2022|PDM|1700.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F35308_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD RR) - BDSS|
20|FH_F38411_0_0|SrvcGrp|28990|2022|PCT|0.80|99|0.00|TRAUMA SERVICES|
20|FH_F38560_0_0|SrvcGrp|29545|2022|PDM|1200.00|99|0.00|LITHOTRIPSY|
20|FH_F130721_04769_0|SrvcGrp|112676|2022|PCT|1.00|99|0.00|COVID-19 SARS-COV-2 ANTIBODY|
20|FH_F130805_17404_0|SrvcGrp|111136|2022|PCT|1.00|99|0.00|PHENYLEPHRINE KETOROLAC INJECTION|
20|FH_F100982_75601_0|SrvcGrp|73601|2022|PDM|1660.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F130329_64114_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F119110_91773_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F110509_71351_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F146657_01105_0|SrvcGrp|114662|2022|PDM|26.54|99|0.00|COMP COMM SUPP SVC|
20|FH_F112827_26452_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F125870_0_0|SrvcGrp|73004|2022|PDM|1495.00|99|0.00|AEG 8|
20|FH_F120408_0_0|SrvcGrp|100859|2022|PDM|287.38|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F145601_32159_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137567_0_0|SrvcGrp|82981|2022|PDM|105.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F145619_17603_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F99161_0_0|SrvcGrp|75493|2022|PDM|1823.36|99|0.00|AEG 8|
20|FH_F138951_41101_0|SrvcGrp|22589|2022|PDM|45.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F85353_16407_0|SrvcGrp|63879|2022|PDM|290.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1602|
20|FH_F150279_91767_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F85353_16407_0|SrvcGrp|63922|2022|PDM|83.75|99|0.00|HAPA WPA-NWPA 2012-13 ASC 146|
20|FH_F142930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121601_47446_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F83113_0_0|SrvcGrp|13606|2022|PDM|33.00|99|0.00|HOME INFUSION|
20|FH_F127486_06776_0|SrvcGrp|48398|2022|PDM|109.20|99|0.00|PT SERVICES|
20|FH_F143579_43160_0|SrvcGrp|107595|2022|PCT|2.50|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F112631_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F114444_19602_0|SrvcGrp|86722|2022|PDM|120.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F135610_06451_0|SrvcGrp|48385|2022|PDM|89.12|99|0.00|SPEECH THERAPY|
20|FH_F145641_06902_0|SrvcGrp|26277|2022|PDM|2965.00|99|0.00|CPT 29874|
20|FH_F148862_85390_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F150166_91401_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130327_03867_0|SrvcGrp|104874|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149139_07522_0|SrvcGrp|113227|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 3 TRGT|
20|FH_F70208_0_0|SrvcGrp|66459|2022|PDM|370.00|99|0.00|CT SCAN|
20|FH_F111882_51560_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F142930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133877_84117_0|SrvcGrp|95660|2022|PDM|93.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F31714_0_0|SrvcGrp|10903|2022|PDM|266.00|99|0.00|EMERGENCY ROOM LEVEL I|
20|FH_F149305_76036_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117208_0_0|SrvcGrp|107058|2022|PDM|4015.00|99|0.00|PARTIAL REMOVAL OF TONGUE|
20|FH_F126904_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F81852_0_0|SrvcGrp|30623|2022|PDM|4733.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F139723_30066_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|238.00|99|0.00|OP ADULT PSYCHIATRIC PARTIAL HOSP|
20|FH_F128379_0_0|SrvcGrp|67119|2022|PDM|7553.00|99|0.00|ARTHODESIS|
20|FH_F148644_06890_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119650_0_0|SrvcGrp|40002|2022|PDM|25151.00|99|0.00|TOTAL HIP|
20|FH_F133749_84604_0|SrvcGrp|112464|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY CATHETER CARE|
20|FH_F125928_0_0|SrvcGrp|106294|2022|PDM|344.16|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F130763_0_0|SrvcGrp|63463|2022|PDM|4714.00|99|0.00|CPT 52204|
20|FH_F130763_0_0|SrvcGrp|94989|2022|PDM|4367.00|99|0.00|SINUS ENDO W/ BALLOON DILATION|
20|FH_F130364_01331_0|SrvcGrp|73603|2022|PDM|1805.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F85353_16407_0|SrvcGrp|63890|2022|PDM|203.32|99|0.00|HAPA WPA-NWPA 2012-13 ASC 313|
20|FH_F121476_0_0|SrvcGrp|105318|2022|PDM|1795.00|99|0.00|INTERPHALANGEAL JOINT REPL|
20|FH_F116806_0_0|SrvcGrp|107034|2022|PDM|1923.16|99|0.00|REPAIR NASOETHMOID FRACTURE|
20|FH_F85353_16407_0|SrvcGrp|63839|2022|PDM|459.65|99|0.00|HAPA WPA-NWPA 2012-13 ASC 106|
20|FH_F138024_40509_0|SrvcGrp|72602|2022|PDM|739.00|99|0.00|ECT|
20|FH_F124162_73127_0|SrvcGrp|73841|2022|PDM|367.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138951_41101_0|SrvcGrp|22592|2022|PDM|40.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F133887_17013_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F100782_0_0|SrvcGrp|105148|2022|PDM|767.43|99|0.00|WINDBER MEDICAL CNTR ASC 308|
20|FH_F130017_02302_0|SrvcGrp|29340|2022|PDM|14273.00|99|0.00|MS DRG 262 ONLY|
20|FH_F124785_0_0|SrvcGrp|87077|2022|PDM|80.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F147502_0_0|SrvcGrp|104226|2022|PDM|150.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F48092_0_0|SrvcGrp|184|2022|PDM|1600.00|99|0.00|MEDICAL INTENSIVE CARE|
20|FH_F130017_02302_0|SrvcGrp|73497|2022|PDM|1190.76|99|0.00|AETNA ER LEVEL IV|
20|FH_F110344_37421_0|SrvcGrp|86749|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F148922_32073_0|CSTM-ALL|CSTM-00|2020|PCT|1.19|99|0.00|HSS ASC|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F112650_85016_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F44299_0_0|SrvcGrp|15385|2022|PDM|75.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F69606_0_0|SrvcGrp|64103|2022|PDM|1038.70|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 6|
20|FH_F91313_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS|
20|FH_F85553_0_0|SrvcGrp|59163|2022|PCT|0.70|99|0.00|OP SURGICAL ANCILLARY SERVICES|
20|FH_F102200_06416_0|SrvcGrp|86830|2022|PDM|100.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F146459_48154_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146419_68504_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115956_06516_0|SrvcGrp|472|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116040_24637_0|SrvcGrp|86852|2022|PDM|30.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F116114_37033_0|CSTM-ALL|CSTM-00|2020|PDM|515.00|99|0.00|PARTIAL HOSPITALIZATION PSYCHIATRIC|
20|FH_F139289_0_0|SrvcGrp|98062|2022|PDM|452.08|99|0.00|HOSPICE INPATIENT RESPITE CARE PER DIEM|
20|FH_F139887_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F132197_67437_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133494_90023_0|CSTM-ALL|CSTM-00|2020|PDM|4092.00|99|0.00|AEG 10 (NO REV)|
20|FH_F133050_78216_0|SrvcGrp|93337|2022|PDM|390.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F133170_50501_0|SrvcGrp|73841|2022|PDM|260.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F131808_74525_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131212_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132575_38635_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111603_19529_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121910_27104_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122013_75503_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F51356_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F91873_12723_0|SrvcGrp|11663|2022|PCT|0.68|99|0.00|IMPLANTS|
20|FH_F97660_29401_0|SrvcGrp|73605|2022|PDM|1636.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 5  (NO REV)|
20|FH_F86911_0_0|SrvcGrp|44708|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE|
20|FH_F114916_30309_0|SrvcGrp|100070|2022|PDM|9000.00|99|0.00|REVISION OF UNSTABLE KNEECAP|
20|FH_F115045_0_0|SrvcGrp|98331|2022|PDM|1500.00|99|0.00|INTERIM LABOR FACILITY GLOBAL|
20|FH_F103780_64804_0|CSTM-ALL|CSTM-00|2020|PDM|3399.00|99|0.00|AEG 7 (NO REV)|
20|FH_F105588_15228_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F36584_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD AW|
20|FH_F131047_0_0|CSTM-ALL|CSTM-00|2020|PDM|4201.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
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|44428|2022|PDM|144.00|99|0.00|OCCUPATIONAL THERAPY SVCS (VISIT LVL)|
20|FH_F132988_0_0|SrvcGrp|88065|2022|PDM|18566.99|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F132988_0_0|SrvcGrp|72120|2022|PDM|4493.01|99|0.00|TENOTOMY|
20|FH_F132988_0_0|SrvcGrp|33980|2022|PDM|4493.01|99|0.00|CPT 28298|
20|FH_F43612_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|CHILD PSYCHIATRIC|
20|FH_F63457_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|867.30|99|0.00|AEG 6 (NO REV)|
20|FH_F93252_0_0|SrvcGrp|93014|2022|PDM|2500.00|99|0.00|ACL REPAIR|
20|FH_F126345_0_0|SrvcGrp|16732|2022|PDM|3209.00|99|0.00|HYSTEROSCOPY ABLATION|
20|FH_F114389_50131_0|SrvcGrp|73700|2022|PDM|80.47|99|0.00|AETNA - SKILLED NURSING|
20|FH_F137897_0_0|SrvcGrp|105616|2022|PDM|87.97|99|0.00|CPAP DEVICE (MOD RR)|
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 3 (NO REV)|
20|FH_F77944_0_0|CSTM-ALL|CSTM-00|2020|PDM|4131.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F122183_98146_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124116_79410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146797_44906_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124567_33144_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124613_64735_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F124681_69337_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128360_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F32001_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67888_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F113830_96002_0|SrvcGrp|89149|2022|PDM|250.00|99|0.00|OP INTENSIVE|
20|FH_F138527_64506_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PDM|23.29|99|0.00|ASSESS HLTH/BEHAVE SUBSEQ|
20|FH_F132721_0_0|SrvcGrp|51672|2022|PDM|7161.00|99|0.00|MS DRG 286-287 ONLY|
20|FH_F122608_84123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43653_0_0|SrvcGrp|3409|2022|PDM|175.00|99|0.00|NEWBORN NURSERY|
20|FH_F134764_73568_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F68481_0_0|SrvcGrp|64776|2022|PCT|1.00|99|0.00|CORNEAL TISSUE IMPLANTS/PROSTHETICS/ORTHO|
20|FH_F116345_78626_0|SrvcGrp|89417|2022|PDM|340.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F147331_90045_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F134828_30531_0|SrvcGrp|91631|2022|PDM|167.00|99|0.00|OFFICE VISIT|
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|578.60|99|0.00|AEG 1 (NO REV)|
20|FH_F35381_0_0|SrvcGrp|14495|2022|PCT|0.95|99|0.00|TRAUMA|
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PDM|1139.60|99|0.00|AEG 5  (NO REV)|
20|FH_F72445_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F41803_0_0|SrvcGrp|34875|2022|PCT|0.50|99|0.00|COCHLEAR IMPLANT|
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 4 (NO REV)|
20|FH_F54552_0_0|SrvcGrp|14944|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F113585_20155_0|SrvcGrp|48398|2022|PDM|125.00|99|0.00|PT SERVICES|
20|FH_F138777_43140_0|SrvcGrp|73841|2022|PDM|353.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138936_01040_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F96321_0_0|SrvcGrp|108770|2022|PDM|797.69|99|0.00|OPERATIVE UPPER GI ENDOSCOPY|
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151320_15145_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151461_38063_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F151511_14094_0|SrvcGrp|105465|2022|PCT|1.00|99|0.00|AETNA THERAPIES|
20|FH_F132258_45404_0|SrvcGrp|24752|2022|PDM|11.93|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F135781_60643_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135979_66451_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F116431_76104_0|SrvcGrp|86444|2022|PCT|1.50|99|0.00|CHEMOTHERAPY AND RADIATION|
20|FH_F116467_13031_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F116469_92543_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121428_40202_0|CSTM-ALL|CSTM-00|2020|PCT|0.33|99|0.00|OP SVCS|
20|FH_F121464_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121763_07202_0|SrvcGrp|12491|2022|PCT|0.40|99|0.00|PACEMAKER|
20|FH_F33785_0_0|SrvcGrp|439|2022|PDM|1500.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F131650_50211_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111363_33169_0|SrvcGrp|97968|2022|PDM|1299.00|99|0.00|CT SCAN|
20|FH_F141651_0_0|SrvcGrp|86463|2022|PDM|2310.00|99|0.00|FRACTURE NASAL INFERIOR|
20|FH_F44336_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1212.00|99|0.00|AEG 5  (NO REV)|
20|FH_F131000_0_0|SrvcGrp|88162|2022|PDM|6450.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F132328_0_0|SrvcGrp|71221|2022|PDM|2000.00|99|0.00|EGD W/BALLOON DIALATION CPT 43249|
20|FH_F112092_46845_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F112166_72143_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F96560_17972_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_F102905_85541_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F132854_77379_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140007_0_0|SrvcGrp|96919|2022|PDM|4290.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F142087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.11|99|0.00|OP SVCS|
20|FH_F69968_0_0|CSTM-ALL|CSTM-00|2020|PDM|2546.78|99|0.00|MS DRG 767|
20|FH_F136387_61244_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137147_75006_0|SrvcGrp|11673|2022|PDM|11325.00|99|0.00|CPT 29888|
20|FH_F114264_51449_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F142690_31774_0|SrvcGrp|10577|2022|PDM|55.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F73403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97602_40121_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138468_63128_0|CSTM-ALL|CSTM-00|2020|PCT|1.57|99|0.00|HSS ASC|
20|FH_F138627_82901_0|SrvcGrp|88806|2022|PDM|200.00|99|0.00|TOTAL PARENTERAL NUTRITION; < 3 LITERS (HCFA)|
20|FH_F114865_77488_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140888_75119_0|SrvcGrp|86723|2022|PDM|391.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F148739_47129_0|SrvcGrp|108484|2022|PDM|1550.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F151608_30236_0|SrvcGrp|100044|2022|PDM|8750.00|99|0.00|INCISION OF HEEL BONE|
20|FH_F119090_91502_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F109920_39180_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F63054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76144_0_0|CSTM-ALL|CSTM-00|2020|PDM|2463.57|99|0.00|ASPG VIII F/S - BDSS|
20|FH_F117255_68520_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F147725_06002_0|SrvcGrp|46887|2022|PDM|4326.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F147882_44056_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129448_43235_0|SrvcGrp|48396|2022|PDM|113.00|99|0.00|OT SERVICES|
20|FH_F137270_82901_0|SrvcGrp|48385|2022|PDM|84.50|99|0.00|SPEECH THERAPY|
20|FH_F101945_0_0|SrvcGrp|33984|2022|PDM|1095.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|AEG 3 (NO REV)|
20|FH_F137898_46540_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F137927_52241_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|PDM|440.00|99|0.00|AEG 1 (NO REV)|
20|FH_F90735_94070_0|SrvcGrp|90287|2022|PDM|32.50|99|0.00|NIEMANN-PICK DISEASE|
20|FH_F129892_0_0|SrvcGrp|41334|2022|PDM|3060.00|99|0.00|TOTAL KNEE|
20|FH_F140347_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|1361.10|99|0.00|ASPG IX|
20|FH_F50446_0_0|SrvcGrp|33164|2022|PDM|315.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F132544_0_0|SrvcGrp|96939|2022|PDM|4186.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F119245_19010_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148554_85016_0|SrvcGrp|115441|2022|PDM|3060.00|99|0.00|INSERT 1 ELECTRODE PM DEFIB|
20|FH_F124608_0_0|SrvcGrp|88491|2022|PDM|6452.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F42779_0_0|SrvcGrp|36518|2022|PDM|1426.00|99|0.00|CHEMOTHERAPY - IP|
20|FH_F39535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS|
20|FH_F146221_72560_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133530_11237_0|SrvcGrp|90882|2022|PDM|6115.00|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F109242_18466_0|SrvcGrp|73842|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F98600_91730_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F38079_0_0|SrvcGrp|27940|2022|PDM|100.00|99|0.00|PT/OT/ST|
20|FH_F132420_84660_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F128929_33030_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F39627_0_0|SrvcGrp|439|2022|PDM|2500.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F146211_68144_0|SrvcGrp|100010|2022|PDM|6473.00|99|0.00|KNEE RECONSTRUCTION|
20|FH_F92676_15063_0|SrvcGrp|79019|2022|PDM|972.81|99|0.00|MON VALLEY ASC 224|
20|FH_F132279_63775_0|SrvcGrp|537|2022|PCT|0.75|99|0.00|OBSERVATION SERVICES|
20|FH_F87295_40351_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40542_0_0|SrvcGrp|32648|2022|PCT|1.50|99|0.00|OTHER DIAGNOSTIC TESTING - CPT/MOD 26|
20|FH_F132729_0_0|SrvcGrp|40820|2022|PDM|3088.00|99|0.00|ICU/CCU|
20|FH_F133009_19038_0|SrvcGrp|46104|2022|PDM|107.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F130258_54304_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F67379_0_0|SrvcGrp|31145|2022|PDM|8476.00|99|0.00|MS DRG 281-282 ONLY|
20|FH_F131282_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F62601_0_0|SrvcGrp|48393|2022|PDM|7.00|99|0.00|SKILLED NURSING SERVICES (PER HOUR)|
20|FH_F40728_0_0|CSTM-ALL|CSTM-00|2020|PDM|481.00|99|0.00|ASPG I|
20|FH_F102561_75146_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AEG 10 (NO REV)|
20|FH_F117880_91730_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F49354_0_0|SrvcGrp|36808|2022|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53  (DME)|
20|FH_F97561_30030_0|SrvcGrp|73559|2022|PDM|10166.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F125176_20785_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F46196_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F51545_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F96102_33884_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F106660_26554_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F145845_37167_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F37641_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F71271_0_0|SrvcGrp|68260|2022|PDM|12.00|99|0.00|PHYSICAL THERAPY|
20|FH_F134487_14843_0|SrvcGrp|76501|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F132032_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F102822_84065_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F51564_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F106100_26651_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 691-692 URINARY STONES|
20|FH_F133487_24293_0|SrvcGrp|48398|2022|PDM|125.00|99|0.00|PT SERVICES|
20|FH_F42355_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|CD SVCS|
20|FH_F118496_92627_0|SrvcGrp|86748|2022|PCT|1.20|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F150523_20877_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|684.00|99|0.00|AEG 3 (NO REV)|
20|FH_F101840_76054_0|SrvcGrp|3066|2022|PCT|1.50|99|0.00|HIGH-COST DRUGS|
20|FH_F37641_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.00|99|0.00|ASPG II|
20|FH_F49049_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC|
20|FH_F100786_24740_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F97622_75051_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F97543_33542_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F147995_67037_0|CSTM-ALL|CSTM-00|2020|PDM|4193.00|99|0.00|AEG 7 (NO REV)|
20|FH_F73304_0_0|CSTM-ALL|CSTM-00|2020|PDM|1268.00|99|0.00|ASPG IX|
20|FH_F49617_0_0|SrvcGrp|537|2022|PDM|81.00|99|0.00|OBSERVATION SERVICES|
20|FH_F120746_29621_0|CSTM-ALL|CSTM-00|2020|PDM|143.38|99|0.00|HOSPICE ROUTINE HOME CARE (DAYS 0-60)|
20|FH_F130652_51101_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145964_10993_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149028_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F128564_43235_0|SrvcGrp|95660|2022|PDM|550.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F101840_76054_0|SrvcGrp|98330|2022|PDM|6608.00|99|0.00|AETNA MS DRG 714|
20|FH_F127191_44720_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F109845_85207_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F81737_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|OP SVCS|
20|FH_F101840_76054_0|SrvcGrp|90320|2022|PDM|13911.00|99|0.00|AETNA LAPAROSCOPY SURGICAL|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|506.00|99|0.00|HAPA EPA ASC 53|
20|FH_F142759_15074_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39844_0_0|SrvcGrp|97|2022|PDM|3289.00|99|0.00|C-SECTION|
20|FH_F35596_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F92676_15063_0|SrvcGrp|78925|2022|PDM|4174.09|99|0.00|MON VALLEY ASC 901|
20|FH_F49354_0_0|SrvcGrp|32388|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKE (DME)|
20|FH_F128559_43524_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|778.00|99|0.00|AEG 4 (NO REV)|
20|FH_F151154_91761_0|SrvcGrp|46605|2022|PDM|140.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F151155_26508_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F150768_03054_0|SrvcGrp|27969|2022|PDM|35.37|99|0.00|HOME HEALTH AIDE|
20|FH_F150769_02302_0|SrvcGrp|115840|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUG|
20|FH_F150982_0_0|SrvcGrp|94883|2022|PDM|2753.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F37864_0_0|SrvcGrp|70819|2022|PCT|0.80|99|0.00|(HCPCS) OCN F/S PRICING: ALL|
20|FH_F50490_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F149160_02180_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F113826_51445_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136779_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F131449_19073_0|SrvcGrp|76501|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F45798_0_0|CSTM-ALL|CSTM-00|2020|PDM|2074.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|858.00|99|0.00|AEG 2 (NO REV)|
20|FH_F40627_0_0|SrvcGrp|360|2022|PDM|2760.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F137797_70123_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F131331_0_0|SrvcGrp|104226|2022|PDM|55.66|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120100_98390_0|SrvcGrp|87317|2022|PDM|1221.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F134869_08854_0|SrvcGrp|112683|2022|PDM|153.00|99|0.00|TELEPHONIC CONSULTATION|
20|FH_F43865_0_0|SrvcGrp|27769|2022|PDM|25.00|99|0.00|SKILLED LPN HOURLY|
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|1012.00|99|0.00|AEG 3 (NO REV)|
20|FH_F149642_95678_0|SrvcGrp|75419|2022|PDM|575.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F151000_20707_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|3787.00|99|0.00|LAP INC HERNIA REPAIR RECUR|
20|FH_F149400_83301_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F98022_89015_0|SrvcGrp|73603|2022|PDM|6751.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F124441_0_0|SrvcGrp|84939|2022|PDM|14250.00|99|0.00|SHOULDER JOINT|
20|FH_F60296_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|TRAUMA CARE|
20|FH_F101441_0_0|SrvcGrp|97019|2022|PDM|4323.00|99|0.00|ARTHROSCOPY BICEPS TENODESIS|
20|FH_F116332_0_0|SrvcGrp|11673|2022|PDM|7896.00|99|0.00|CPT 29888|
20|FH_F92299_62016_0|SrvcGrp|73008|2022|PCT|0.75|99|0.00|AEG 10|
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG VII|
20|FH_F128506_77304_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|OP SVCS|
20|FH_F35990_0_0|SrvcGrp|22148|2022|PDM|261.00|99|0.00|PSYCH PARTIAL HOSP (FULL DAY)|
20|FH_F101844_0_0|SrvcGrp|98326|2022|PDM|8943.00|99|0.00|PERQ LAMOT/LAM LUMBAR|
20|FH_F131261_19111_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117617_80439_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SAINT ALEXIUS FH MOD KN|
20|FH_F134847_0_0|SrvcGrp|89860|2022|PDM|8145.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F37487_0_0|SrvcGrp|16619|2022|PDM|80.00|99|0.00|OT SVCS|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1575124_HCPCS_ NO MOD|
20|FH_F110193_70444_0|SrvcGrp|86746|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F37444_0_0|SrvcGrp|16620|2022|PCT|0.72|99|0.00|PT SVCS|
20|FH_F124714_64081_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F149085_0_0|SrvcGrp|73485|2022|PDM|1350.00|99|0.00|AETNA REHAB|
20|FH_F35780_32073_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132137_67218_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|505.00|99|0.00|ASPG I|
20|FH_F116373_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F122377_91007_0|SrvcGrp|92958|2022|PCT|2.89|99|0.00|SLEEP STUDIES|
20|FH_F137767_01841_0|SrvcGrp|79999|2022|PDM|750.00|99|0.00|AETNA ECHO EXAM|
20|FH_F115982_0_0|SrvcGrp|87679|2022|PDM|550.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F114951_20002_0|SrvcGrp|10393|2022|PDM|2249.57|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F36554_0_0|SrvcGrp|11033|2022|PCT|1.00|99|0.00|OP REFERENCE LAB|
20|FH_F124322_64131_0|SrvcGrp|14944|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F134847_0_0|SrvcGrp|28551|2022|PDM|3486.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F124739_64429_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F94502_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F110732_31513_0|SrvcGrp|104702|2022|PCT|0.00|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F36594_0_0|SrvcGrp|3327|2022|PDM|90.00|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F35792_33175_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|GENERAL ACUTE CARE|
20|FH_F35678_0_0|SrvcGrp|8950|2022|PDM|1696.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F139974_37214_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109762_0_0|SrvcGrp|73000|2022|PDM|826.00|99|0.00|AEG 6|
20|FH_F114207_35243_0|SrvcGrp|14948|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F126150_80202_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE|
20|FH_F131239_54615_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F103180_85283_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139867_70816_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F98000_59102_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143249_89801_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F143447_53204_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143471_02895_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F143536_47546_0|SrvcGrp|101742|2022|PCT|1.00|99|0.00|IMMUN ADMIN ORAL/NASAL ADDL|
20|FH_F75903_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHMC CT/MRI|
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|573.00|99|0.00|AEG 3 (NO REV)|
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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151720_03301_0|SrvcGrp|107666|2022|PDM|453.00|99|0.00|AETNA PARTIAL HOSP EATING DIS HALF DAY|
20|FH_F48224_0_0|SrvcGrp|73006|2022|PDM|1584.00|99|0.00|AEG 9|
20|FH_F132480_92054_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120866_51652_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120856_78247_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F120977_50510_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F35685_0_0|SrvcGrp|2077|2022|PDM|38588.00|99|0.00|DRG 515 CV SURG CARDIAC DEFIBRILLATOR|
20|FH_F35685_0_0|SrvcGrp|11188|2022|PDM|14333.00|99|0.00|DRG 552 OTHER PERMANENT CARDIAC PACEMAKER IMP W/O CV DX|
20|FH_F36472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F102948_43606_0|SrvcGrp|75759|2022|PDM|431.00|99|0.00|AMBULATORY DETOX REHAB|
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|732.00|99|0.00|AEG 4 (NO REV)|
20|FH_F37578_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100742_00616_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F78603_0_0|CSTM-ALL|CSTM-00|2020|PDM|2025.92|99|0.00|ACUTE PSYCH|
20|FH_F125249_0_0|SrvcGrp|108258|2022|PDM|1200.00|99|0.00|AETNA PARTIAL REMOVAL OF ELBOW|
20|FH_F133530_11237_0|CSTM-ALL|CSTM-00|2020|PDM|2920.00|99|0.00|AEG 5  (NO REV) (W/O ENDOSCOPIC PROCEDURES)|
20|FH_F133478_40165_0|CSTM-ALL|CSTM-00|2020|PDM|1428.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 1 (NO REV)|
20|FH_F133412_84129_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125342_78754_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|103.42|99|0.00|DELAWARE VALLEY- ASC 309|
20|FH_F68944_0_0|SrvcGrp|44008|2022|PCT|0.70|99|0.00|EMERGENCY ROOM SERVICES|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1393.00|99|0.00|COVENTRY ENHANCED GROUPER 7 MOD 50|
20|FH_F43433_0_0|SrvcGrp|32440|2022|PDM|5687.00|99|0.00|JACKSON MADISON HOSP ASPG 4|
20|FH_F130593_48103_0|SrvcGrp|33722|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F50694_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F150522_95864_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134434_30607_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F139666_26175_0|SrvcGrp|103913|2022|PCT|0.94|99|0.00|OP DIALYSIS|
20|FH_F150719_30012_0|SrvcGrp|57968|2022|PDM|52.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F150764_33919_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F150839_03833_0|SrvcGrp|80920|2022|PDM|805.00|99|0.00|HOSPICE SERVICES|
20|FH_F150862_75082_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F50100_0_0|SrvcGrp|12403|2022|PDM|43.67|99|0.00|CONTINUOUS HOMECARE|
20|FH_F150927_64836_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140576_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F111122_63376_0|SrvcGrp|23683|2022|PDM|30.00|99|0.00|SKILLED NURSING RN|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD UE|
20|FH_F150928_62521_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|3034.00|99|0.00|AEG 7 (NO REV)|
20|FH_F131113_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|1061.00|99|0.00|AEG 1 (NO REV)|
20|FH_F147532_0_0|SrvcGrp|103846|2022|PDM|87.23|99|0.00|HOSPICE CARE|
20|FH_F108180_29526_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F131495_77407_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F149641_87113_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130309_17044_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F85014_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124514_21215_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F140295_0_0|SrvcGrp|11673|2022|PDM|7442.00|99|0.00|CPT 29888|
20|FH_F130182_0_0|SrvcGrp|109452|2022|PDM|1457.00|99|0.00|L HRT ART/GRFT ANGIO|
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F90201_15650_0|SrvcGrp|472|2022|PDM|340.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F97280_20018_0|SrvcGrp|73602|2022|PDM|3772.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.25|99|0.00|ASPG VII|
20|FH_F114294_18235_0|SrvcGrp|92760|2022|PCT|1.59|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147167_75605_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F115982_0_0|SrvcGrp|26274|2022|PDM|1250.00|99|0.00|CPT 29877|
20|FH_F123745_0_0|SrvcGrp|100919|2022|PDM|3500.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F120157_93103_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|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_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|2658.00|99|0.00|LAP INC HERNIA REPAIR|
20|FH_F111723_0_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F47836_0_0|SrvcGrp|44143|2022|PDM|1675.00|99|0.00|CPT  30520, 42820, 69421, 69436|
20|FH_F110732_31513_0|SrvcGrp|23279|2022|PDM|168.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F149539_06032_0|SrvcGrp|22596|2022|PCT|1.00|99|0.00|HOSPICE CARE|
20|FH_F32010_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|OP SVCS|
20|FH_F138662_78624_0|SrvcGrp|73841|2022|PDM|350.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F47558_0_0|SrvcGrp|43262|2022|PDM|3.60|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F113116_23847_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F124316_28112_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F52276_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F117023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76285_0_0|SrvcGrp|73300|2022|PDM|172.00|99|0.00|PHYSICAL THERAPY TREATMENT|
20|FH_F136806_0_0|SrvcGrp|16289|2022|PDM|1174.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F147237_40006_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F97260_06111_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F50461_0_0|SrvcGrp|20149|2022|PDM|131762.00|99|0.00|HEART TRANSPLANT|
20|FH_F86714_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98000_59102_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|363.37|99|0.00|SALLY BALIN,999182,ASC 213|
20|FH_F149542_89169_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F50490_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F71468_0_0|SrvcGrp|33643|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F33930_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F128392_01026_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F139910_0_0|CSTM-ALL|CSTM-00|2020|PDM|530.00|99|0.00|AEG 2 (NO REV)|
20|FH_F150224_0_0|SrvcGrp|57968|2022|PDM|43.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F45798_0_0|SrvcGrp|10201|2022|PDM|11200.00|99|0.00|DRG 234 OTHER MSCLSKLTL &  CON PROC WO CC|
20|FH_F148667_0_0|SrvcGrp|108351|2022|PDM|2856.00|99|0.00|REPAIR RADIUS FRACTURE|
20|FH_F134891_45885_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F137487_74447_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|923.00|99|0.00|AEG 8 (NO REV)|
20|FH_F130207_33458_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F123964_86303_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.86|99|0.00|AEG 7 (NO REV)|
20|FH_F135307_73142_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F119578_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F112374_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137717_13901_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F123372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F39279_0_0|SrvcGrp|17307|2022|PCT|0.55|99|0.00|DRUGS|
20|FH_F148255_72703_0|SrvcGrp|86831|2022|PDM|3.15|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F87254_0_0|SrvcGrp|72990|2022|PDM|489.00|99|0.00|AEG 1|
20|FH_F137574_68130_0|SrvcGrp|22384|2022|PCT|1.00|99|0.00|HOME VISIT PRENATAL|
20|FH_F120647_0_0|SrvcGrp|108180|2022|PDM|400.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F110925_01104_0|SrvcGrp|24750|2022|PDM|59.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F77066_0_0|SrvcGrp|13481|2022|PDM|700.00|99|0.00|SKILLED NURSING W/VENT SVCS|
20|FH_F82173_72712_0|SrvcGrp|115908|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F98922_40351_0|SrvcGrp|73643|2022|PDM|2439.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F147941_06023_0|SrvcGrp|13597|2022|PDM|748.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F130138_02915_0|CSTM-ALL|CSTM-00|2020|PCT|0.96|99|0.00|PARTIAL HOSPITALIZATION PSYCHIATRIC|
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|960.00|99|0.00|AEG 6 (NO REV)|
20|FH_F120001_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.32|99|0.00|OP SVCS|
20|FH_F129231_30060_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|AEG 2 (NO REV)|
20|FH_F32781_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94662_0_0|SrvcGrp|90707|2022|PDM|199.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F125028_19061_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137067_0_0|SrvcGrp|88158|2022|PDM|5250.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F123533_63825_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F50184_0_0|SrvcGrp|33166|2022|PDM|515.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F36433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|OP SVCS|
20|FH_F40063_0_0|SrvcGrp|10425|2022|PDM|1724.00|99|0.00|NEWBORN NURSERY|
20|FH_F137573_33764_0|SrvcGrp|106048|2022|PDM|726.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F149868_0_0|SrvcGrp|80317|2022|PDM|705.00|99|0.00|RESPITE CARE|
20|FH_F147941_06023_0|SrvcGrp|114014|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F36433_0_0|SrvcGrp|65|2022|PDM|3785.00|99|0.00|OBSTETRICAL CARE|
20|FH_F110236_0_0|SrvcGrp|75479|2022|PDM|900.00|99|0.00|AEG 1|
20|FH_F139515_0_0|SrvcGrp|109966|2022|PDM|8549.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON|
20|FH_F83772_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.28|99|0.00|GENERAL ACUTE CARE|
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_F116700_11787_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F141410_13045_0|SrvcGrp|705|2022|PCT|0.39|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F123915_0_0|SrvcGrp|90707|2022|PDM|190.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F141410_13045_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F43294_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F135236_02840_0|SrvcGrp|115926|2022|PCT|1.01|99|0.00|RADIOLOGY SERVICES|
20|FH_F66222_0_0|SrvcGrp|42871|2022|PDM|241.29|99|0.00|SPEECH THERAPY VISIT|
20|FH_F148483_94087_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148265_06067_0|SrvcGrp|92363|2022|PDM|11101.00|99|0.00|OSTEOCHONDRAL ALLOGRAFT KNEE|
20|FH_F93332_0_0|SrvcGrp|93088|2022|PDM|6695.00|99|0.00|LAMINECTOMY (HCFA)|
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136510_0_0|SrvcGrp|46890|2022|PDM|5206.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F143821_60559_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148265_06067_0|SrvcGrp|100001|2022|PDM|14418.00|99|0.00|WRIST REPLACEMNT TOT WRIST|
20|FH_F39819_0_0|SrvcGrp|31227|2022|PDM|5222.00|99|0.00|NY DRG 832 ONLY|
20|FH_F89563_29407_0|SrvcGrp|75545|2022|PDM|433.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F118703_0_0|SrvcGrp|73000|2022|PDM|967.00|99|0.00|AEG 6|
20|FH_F36955_0_0|SrvcGrp|24742|2022|PDM|672.00|99|0.00|CD - RESIDENTIAL TREATMENT|
20|FH_F124738_0_0|SrvcGrp|72990|2022|PDM|330.00|99|0.00|AEG 1|
20|FH_F149888_68506_0|SrvcGrp|26275|2022|PDM|2708.00|99|0.00|CPT 29826|
20|FH_F141802_17042_0|CSTM-ALL|CSTM-00|2020|PDM|19066.00|99|0.00|PATIENT TRANSFER  (<=48 HRS)|
20|FH_F150699_0_0|SrvcGrp|96380|2022|PDM|38826.00|99|0.00|AETNA INS/REP SUBQ DEFIBRILLATOR|
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33782_0_0|SrvcGrp|3810|2022|PDM|109.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F125516_50574_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F91622_0_0|CSTM-ALL|CSTM-00|2020|PDM|1188.00|99|0.00|AEG 1 (NO REV) ANTHONY MED CTR|
20|FH_F56136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|PROCRIT/ERYTHROPOIETIN (EPOETIN)|
20|FH_F130598_73601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72546_0_0|SrvcGrp|16276|2022|PCT|0.35|99|0.00|HIGH COST DRUGS|
20|FH_F150982_0_0|SrvcGrp|100920|2022|PDM|3303.00|99|0.00|SPINE PRO DEVICE|
20|FH_F121564_35080_0|SrvcGrp|74668|2022|PDM|431.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137427_89146_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F136510_0_0|SrvcGrp|28551|2022|PDM|3882.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F122694_33334_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F88398_15601_0|SrvcGrp|43569|2022|PDM|83.65|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F129975_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.60|99|0.00|RADIOLOGY W/MOD 26|
20|FH_F35898_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|3156.00|99|0.00|ASPG IX|
20|FH_F123848_03257_0|SrvcGrp|104874|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ASPG IX|
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 009|
20|FH_F130656_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 8 (NO REV)|
20|FH_F130715_98503_0|SrvcGrp|74668|2022|PDM|428.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130755_04401_0|SrvcGrp|81779|2022|PCT|4.24|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F127579_44321_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F129509_0_0|SrvcGrp|82109|2022|PDM|1128.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F111031_30252_0|SrvcGrp|26001|2022|PDM|139.67|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F122942_89512_0|SrvcGrp|89149|2022|PDM|225.00|99|0.00|OP INTENSIVE|
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132958_79903_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|1832.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F127090_45601_0|SrvcGrp|48385|2022|PDM|92.25|99|0.00|SPEECH THERAPY|
20|FH_F145554_53066_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F73583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|699.60|99|0.00|HAPA WPA-NWPA 2012-13 ASC 11 W/O REV|
20|FH_F114800_68510_0|SrvcGrp|27969|2022|PDM|19.00|99|0.00|HOME HEALTH AIDE|
20|FH_F121225_98902_0|SrvcGrp|108456|2022|PCT|1.13|99|0.00|ALL DRUGS/AGENTS/INJ DRUGS|
20|FH_F120626_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.36|99|0.00|OP SVCS|
20|FH_F93122_01854_0|SrvcGrp|87441|2022|PDM|413.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F54532_0_0|SrvcGrp|24090|2022|PDM|973.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F113424_60626_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|GENERAL ACUTE CARE|
20|FH_F123157_0_0|SrvcGrp|75495|2022|PDM|1300.00|99|0.00|AEG 9|
20|FH_F143669_78577_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|1516.00|99|0.00|AEG 9 (NO REV)|
20|FH_F110943_80026_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F95631_33705_0|SrvcGrp|73602|2022|PDM|1471.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F150219_38578_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112023_12866_0|SrvcGrp|72990|2022|PDM|2084.00|99|0.00|AEG 1|
20|FH_F126975_43551_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F133957_84121_0|SrvcGrp|63297|2022|PDM|94.50|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F118146_33062_0|SrvcGrp|46903|2022|PDM|623.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F110509_71351_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F96160_32207_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126076_75231_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111702_07652_0|SrvcGrp|472|2022|PDM|390.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F85212_71075_0|SrvcGrp|131|2022|PCT|1.00|99|0.00|PACEMAKER DEVICE|
20|FH_F142376_0_0|SrvcGrp|97299|2022|PDM|2640.00|99|0.00|REMOVE SPINE ELTRD PLATE|
20|FH_F130763_0_0|SrvcGrp|14614|2022|PDM|4714.00|99|0.00|LITHOTRIPSY|
20|FH_F138302_15701_0|SrvcGrp|22589|2022|PDM|33.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F92893_75110_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133585_0_0|SrvcGrp|107880|2022|PDM|211.00|99|0.00|BALO ANGIOP CTR DIALYSIS SEG|
20|FH_F127486_06776_0|SrvcGrp|43568|2022|PDM|109.20|99|0.00|SKILLED NURSING - RN|
20|FH_F148905_85390_0|SrvcGrp|89337|2022|PDM|1400.00|99|0.00|DETOXIFICATION|
20|FH_F106964_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_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|348.70|99|0.00|HAPA WPA-NWPA 2012-13 ASC 106 W/O REV|
20|FH_F95631_33705_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F77585_0_0|SrvcGrp|474|2022|PDM|675.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F130763_0_0|SrvcGrp|83639|2022|PDM|3450.00|99|0.00|CPT 29886|
20|FH_F132965_60459_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39015_0_0|SrvcGrp|1306|2022|PDM|350.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F150165_06032_0|SrvcGrp|91880|2022|PDM|10300.00|99|0.00|OSSEOINTEGRATED IMPLANT|
20|FH_F51318_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F116753_0_0|SrvcGrp|106822|2022|PDM|7465.00|99|0.00|MENISCUS REPAIR|
20|FH_F119110_91773_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F134331_61021_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130364_01331_0|SrvcGrp|88977|2022|PDM|5295.00|99|0.00|C-SECTION DELIVERY|
20|FH_F132802_68022_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F122551_75605_0|SrvcGrp|73842|2022|PDM|232.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130126_33413_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F84712_0_0|SrvcGrp|82741|2022|PDM|190.00|99|0.00|XRAY EXAM CHEST TWO VIEWS|
20|FH_F105145_75075_0|SrvcGrp|101885|2022|PDM|5800.00|99|0.00|AETNA AEG 7 WITHOUT 49651, 50542-50543|
20|FH_F115811_33410_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F115784_06831_0|SrvcGrp|473|2022|PDM|502.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F66427_0_0|SrvcGrp|30623|2022|PDM|10671.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F66782_0_0|SrvcGrp|48042|2022|PCT|1.00|99|0.00|OCN F/S PRICING:  (A , E & K CODES ONLY)|
20|FH_F75842_0_0|SrvcGrp|29816|2022|PCT|0.53|99|0.00|IMPLANTS/PROSTHETICS/DRUGS|
20|FH_F146668_30189_0|SrvcGrp|89988|2022|PDM|3500.00|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F146667_37110_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F131697_33444_0|SrvcGrp|86729|2022|PCT|1.00|99|0.00|COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE|
20|FH_F133176_32751_0|SrvcGrp|46903|2022|PDM|743.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F133402_10007_0|SrvcGrp|85963|2022|PDM|53.00|99|0.00|SELF CARE MANGEMENT TRAINING|
20|FH_F111561_10002_0|SrvcGrp|90643|2022|PDM|22.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F121985_46256_0|SrvcGrp|74668|2022|PDM|267.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129130_92562_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|828.00|99|0.00|ASPG X|
20|FH_F40144_0_0|SrvcGrp|3055|2022|PCT|0.73|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F73163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.19|99|0.00|OP SVCS|
20|FH_F97721_01053_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.34|99|0.00|AETNA POLYSOMNOGRAPHY|
20|FH_F89037_0_0|SrvcGrp|16719|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F114916_30309_0|SrvcGrp|35667|2022|PDM|1430.00|99|0.00|CPT 20680|
20|FH_F142447_72758_0|SrvcGrp|16|2022|PDM|1436.00|99|0.00|ACUTE REHABILITATION|
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|814.00|99|0.00|AEG 10 (NO REV)|
20|FH_F113794_0_0|SrvcGrp|45924|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F113537_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PDM|2116.40|99|0.00|AEG 9 (NO REV)|
20|FH_F115895_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F103961_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F105588_15228_0|SrvcGrp|29346|2022|PDM|40.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F112064_0_0|SrvcGrp|84185|2022|PCT|0.00|99|0.00|RESPITE CARE|
20|FH_F117623_0_0|CSTM-ALL|CSTM-00|2020|PDM|27.00|99|0.00|BEHAVIOR TREATMENT ADDL|
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_F119581_0_0|SrvcGrp|108193|2022|PDM|4697.00|99|0.00|TIB/PER REVASC W/TLA|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER KN|
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 6 (NO REV)|
20|FH_F114389_50131_0|SrvcGrp|17013|2022|PDM|130.65|99|0.00|HOME INFUSION THERAPY|
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|1821.00|99|0.00|AEG 5  (NO REV)|
20|FH_F83115_0_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F92212_0_0|SrvcGrp|92084|2022|PDM|1737.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F39549_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F146715_34240_0|SrvcGrp|89344|2022|PCT|1.00|99|0.00|HYPERBARIC OXYGEN|
20|FH_F147081_02130_0|SrvcGrp|46903|2022|PDM|473.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F38047_0_0|SrvcGrp|72|2022|PDM|277.00|99|0.00|NEWBORN NURSERY|
20|FH_F38688_0_0|SrvcGrp|69399|2022|PCT|1.20|99|0.00|PREVENTATIVE CODES|
20|FH_F91998_0_0|SrvcGrp|90428|2022|PDM|4500.00|99|0.00|INSERT SPINE FIXATION DEVICE|
20|FH_F124173_66215_0|SrvcGrp|43567|2022|PDM|83.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F124258_53140_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125134_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F121078_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F89273_0_0|SrvcGrp|13557|2022|PDM|4300.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F126817_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F114638_25309_0|SrvcGrp|3087|2022|PDM|992.00|99|0.00|CD - DETOX|
20|FH_F122588_53073_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122664_07005_0|CSTM-ALL|CSTM-00|2020|PCT|0.22|99|0.00|OP SVCS|
20|FH_F43779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1689.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134727_30650_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136830_22003_0|SrvcGrp|86722|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F136914_64081_0|SrvcGrp|13681|2022|PDM|365.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F32683_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115210_21043_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 10 (NO REV)|
20|FH_F147299_02072_0|SrvcGrp|48394|2022|PDM|82.62|99|0.00|SKILLED NURSING SERVICES|
20|FH_F147539_68359_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|GENERAL ACUTE CARE|
20|FH_F41749_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|ACUTE PSYCH|
20|FH_F34477_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DURABLE MEDICAL EQUIPMENT (DME) W/MOD KM - WINN|
20|FH_F36049_0_0|SrvcGrp|22137|2022|PDM|435.00|99|0.00|MRI|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PDM|132.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 15 W/O REV|
20|FH_F71165_0_0|SrvcGrp|3271|2022|PDM|2300.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F46433_0_0|SrvcGrp|13929|2022|PDM|35.00|99|0.00|GROWTH HORMONE|
20|FH_F35404_0_0|SrvcGrp|12179|2022|PCT|0.55|99|0.00|CPT CODES 70000-79999 (RAD)|
20|FH_F113246_72687_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113250_71901_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F113250_71901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133536_0_0|SrvcGrp|37166|2022|PDM|1000.00|99|0.00|PNEUMATIC COMPRESSION DEVICE, HIGH PRESSURE|
20|FH_F133579_0_0|SrvcGrp|36591|2022|PDM|3770.00|99|0.00|CPT 63685|
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|1102.00|99|0.00|AEG 2 (NO REV)|
20|FH_F138876_25302_0|SrvcGrp|86829|2022|PDM|35.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F81823_0_0|SrvcGrp|59427|2022|PDM|75.00|99|0.00|OT|
20|FH_F88893_0_0|SrvcGrp|82298|2022|PDM|10112.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY|
20|FH_F151439_18104_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151440_84095_0|SrvcGrp|108484|2022|PDM|510.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F132268_07060_0|SrvcGrp|94742|2022|PDM|58.94|99|0.00|FLUVIRIN VACC IM (>=3 YRS)|
20|FH_F122027_61847_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F97143_80012_0|SrvcGrp|90854|2022|PDM|3307.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F97143_80012_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F91764_93710_0|SrvcGrp|43486|2022|PDM|27069.00|99|0.00|MS DRG'S 459-460|
20|FH_F91764_93710_0|SrvcGrp|111929|2022|PCT|2.19|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F136022_64759_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136042_90066_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F136086_63701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136107_63801_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136180_92253_0|SrvcGrp|112394|2022|PDM|700.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F100852_61068_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116460_19464_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F127399_0_0|SrvcGrp|101526|2022|PDM|4786.00|99|0.00|LAPARO-ASST VAG HYSTERECTOMY|
20|FH_F140629_0_0|SrvcGrp|78911|2022|PDM|2497.00|99|0.00|LAPARO HERNIA REPAIR RECUR|
20|FH_F121713_84747_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F121763_07202_0|SrvcGrp|103913|2022|PCT|8.78|99|0.00|OP DIALYSIS|
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_F99101_24614_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128353_22191_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F128353_22191_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F134290_67209_0|SrvcGrp|74668|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F69202_0_0|SrvcGrp|9938|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F150619_0_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F54272_0_0|SrvcGrp|12019|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F56573_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F116430_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F132328_0_0|SrvcGrp|80617|2022|PDM|13245.00|99|0.00|ARTHOPLASTY|
20|FH_F40598_0_0|SrvcGrp|6|2022|PCT|0.85|99|0.00|OP SURGERY|
20|FH_F125054_16365_0|SrvcGrp|48394|2022|PDM|43.29|99|0.00|SKILLED NURSING SERVICES|
20|FH_F141035_0_0|SrvcGrp|110994|2022|PDM|6016.00|99|0.00|DEB SKIN BONE AT FX SITE|
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PDM|1054.00|99|0.00|AEG 10 (NO REV)|
20|FH_F129220_18445_0|CSTM-ALL|CSTM-00|2020|PDM|223.00|99|0.00|CONSULTATION WITH FAMILY (AUTISM)|
20|FH_F140007_0_0|SrvcGrp|96352|2022|PDM|6153.00|99|0.00|ANKLE JOINT|
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PDM|1298.00|99|0.00|AEG 2 (NO REV)|
20|FH_F58856_0_0|SrvcGrp|361|2022|PDM|2000.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F67901_0_0|SrvcGrp|15402|2022|PDM|40.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F96182_0_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1301.00|99|0.00|AEG 10 (NO REV)|
20|FH_F117465_0_0|SrvcGrp|96350|2022|PDM|10000.00|99|0.00|SHOULDER JOINT|
20|FH_F136386_30901_0|SrvcGrp|21104|2022|PDM|65000.00|99|0.00|MS DRG 220 ONLY|
20|FH_F118152_20151_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F118186_97070_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F118171_00674_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F120490_64133_0|SrvcGrp|86854|2022|PDM|50.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F93363_63123_0|SrvcGrp|53144|2022|PCT|0.00|99|0.00|SPEECH THERAPY|
20|FH_F134126_11554_0|SrvcGrp|112406|2022|PDM|5856.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F137241_07481_0|SrvcGrp|74668|2022|PDM|238.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139067_66935_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142448_15701_0|SrvcGrp|22593|2022|PDM|35.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F142491_06033_0|SrvcGrp|104228|2022|PDM|160.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F142547_70002_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F53732_0_0|SrvcGrp|17001|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F138542_40324_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F138545_39503_0|SrvcGrp|86723|2022|PDM|759.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F138627_82901_0|SrvcGrp|98994|2022|PDM|85.00|99|0.00|HYDRATION THERAPY 2 LITER (HCFA)|
20|FH_F134654_0_0|SrvcGrp|110061|2022|PDM|75.00|99|0.00|ADAPTIVE BH TREATMENT 15 MINS|
20|FH_F138967_67208_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F140627_68651_0|SrvcGrp|79699|2022|PCT|0.96|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F140868_63103_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|3300.00|99|0.00|AEG 10 (NO REV)|
20|FH_F132738_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151605_78209_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F109886_36303_0|SrvcGrp|89337|2022|PDM|855.00|99|0.00|DETOXIFICATION|
20|FH_F117261_43543_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F117255_68520_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147801_90703_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147799_18052_0|SrvcGrp|48398|2022|PDM|116.42|99|0.00|PT SERVICES|
20|FH_F129511_44044_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F117107_33704_0|SrvcGrp|78422|2022|PDM|4750.00|99|0.00|VBAC DELIVERY|
20|FH_F137814_61820_0|SrvcGrp|108484|2022|PDM|575.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F111593_0_0|SrvcGrp|86583|2022|PCT|0.00|99|0.00|AETNA LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F90876_18447_0|CSTM-ALL|CSTM-00|2020|PDM|97.65|99|0.00|SKILLED NURSING SERVICES (15 MINS)|
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1331.00|99|0.00|AEG 7 (NO REV)|
20|FH_F138051_75069_0|SrvcGrp|89149|2022|PDM|190.00|99|0.00|OP INTENSIVE|
20|FH_F113503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F56274_0_0|SrvcGrp|34173|2022|PDM|155.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F69347_0_0|CSTM-ALL|CSTM-00|2020|PDM|1823.00|99|0.00|ACUTE PSYCH|
20|FH_F41396_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150602_59718_0|SrvcGrp|23683|2022|PDM|55.00|99|0.00|SKILLED NURSING RN|
20|FH_F145901_45205_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1148.40|99|0.00|HAPA WPA-NWPA 2012-13 ASC 704 W/O REV|
20|FH_F35454_0_0|SrvcGrp|16855|2022|PDM|12.00|99|0.00|CHOLESTEROL SCREEN|
20|FH_F146211_68144_0|CSTM-ALL|CSTM-00|2020|PDM|371.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F33865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F148900_0_0|SrvcGrp|110570|2022|PDM|668.00|99|0.00|NERVE BLOCK INJECTION 7|
20|FH_F141804_70503_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
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_F118587_20721_0|SrvcGrp|75545|2022|PDM|343.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F87577_80016_0|SrvcGrp|32539|2022|PDM|13838.00|99|0.00|MS DRG 222-227 ONLY|
20|FH_F45392_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F49027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F87594_81501_0|SrvcGrp|20752|2022|PDM|24720.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F117006_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86394_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F36146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE|
20|FH_F143054_26147_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F115383_80734_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101923_98104_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F149860_80112_0|SrvcGrp|75419|2022|PDM|392.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148886_60621_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F103281_32086_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146375_06751_0|SrvcGrp|46903|2022|PDM|2123.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F56792_0_0|CSTM-ALL|CSTM-00|2020|PDM|842.00|99|0.00|ASPG I WITH MOD SG|
20|FH_F44225_0_0|SrvcGrp|229|2022|PDM|700.00|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)|
20|FH_F144508_44107_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F96102_33884_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F63250_0_0|SrvcGrp|42976|2022|PDM|105.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F144288_46322_0|SrvcGrp|33722|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F92676_15063_0|SrvcGrp|79011|2022|PDM|1007.77|99|0.00|MON VALLEY ASC 308|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|367.68|99|0.00|AETNA SLEEP STUDIES|
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72387_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F150164_0_0|SrvcGrp|30609|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F78682_0_0|CSTM-ALL|CSTM-00|2020|PDM|1223.14|99|0.00|ASPG V|
20|FH_F109812_37043_0|SrvcGrp|73841|2022|PDM|542.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F146104_33410_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F97564_52246_0|SrvcGrp|73656|2022|PDM|586.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|4815.00|99|0.00|AEG 7 (NO REV)|
20|FH_F151521_45882_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F92677_08003_0|SrvcGrp|86779|2022|PDM|151.20|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F135690_20814_0|SrvcGrp|74668|2022|PDM|314.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F40980_0_0|SrvcGrp|3066|2022|PCT|0.50|99|0.00|HIGH-COST DRUGS|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F123373_0_0|SrvcGrp|3178|2022|PDM|837.00|99|0.00|ACUTE PSYCH|
20|FH_F118486_95060_0|SrvcGrp|86648|2022|PCT|1.15|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F133018_84037_0|SrvcGrp|43567|2022|PDM|50.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F101840_76054_0|SrvcGrp|50169|2022|PDM|44728.00|99|0.00|MSDRG 227 ONLY|
20|FH_F81771_0_0|SrvcGrp|26001|2022|PDM|125.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F149781_37404_0|SrvcGrp|35669|2022|PDM|4120.00|99|0.00|CPT 63650|
20|FH_F40980_0_0|SrvcGrp|18148|2022|PDM|20625.00|99|0.00|MS DRG 249|
20|FH_F68121_0_0|SrvcGrp|64323|2022|PDM|700.00|99|0.00|FUNCTIONAL CAPACITY EVAL|
20|FH_F115383_80734_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F97622_75051_0|SrvcGrp|73602|2022|PDM|3060.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|1479.50|99|0.00|AEG 9 (NO REV)|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD KM|
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|AEG 7 (NO REV)|
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_F146211_68144_0|SrvcGrp|111928|2022|PCT|1.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F92676_15063_0|SrvcGrp|78945|2022|PDM|3125.63|99|0.00|MON VALLEY ASC 8|
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|3270.00|99|0.00|AEG 9 (NO REV)|
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|2211.00|99|0.00|AEG 5  (NO REV)|
20|FH_F92676_15063_0|SrvcGrp|79064|2022|PDM|396.41|99|0.00|MON VALLEY ASC 134|
20|FH_F31093_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|ASPG IX|
20|FH_F125256_77365_0|SrvcGrp|89149|2022|PDM|160.00|99|0.00|OP INTENSIVE|
20|FH_F106241_93309_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126858_43113_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F117872_33462_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F146373_66092_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111812_11222_0|SrvcGrp|113276|2022|PCT|1.03|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F68479_0_0|SrvcGrp|103390|2022|PDM|25.00|99|0.00|OT INITIAL VISIT|
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|474.00|99|0.00|AEG 1 (NO REV)|
20|FH_F135714_01922_0|SrvcGrp|104230|2022|PDM|145.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F115313_11216_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F93237_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117581_21211_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F119376_0_0|SrvcGrp|72990|2022|PDM|400.00|99|0.00|AEG 1|
20|FH_F139576_0_0|SrvcGrp|68054|2022|PDM|2651.00|99|0.00|CPT 52332|
20|FH_F147060_32025_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F37198_0_0|SrvcGrp|31793|2022|PCT|0.75|99|0.00|PACEMAKER IMPLANT|
20|FH_F143347_16001_0|SrvcGrp|34923|2022|PDM|986.00|99|0.00|ACUTE PSYCH|
20|FH_F143351_21157_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F72749_0_0|SrvcGrp|31072|2022|PDM|761.00|99|0.00|MS DRG 794 ONLY|
20|FH_F151745_27312_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47952_0_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F116698_07470_0|SrvcGrp|29075|2022|PDM|31.50|99|0.00|HYDRATION THERAPY|
20|FH_F116698_07470_0|SrvcGrp|86836|2022|PDM|21.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F120851_66112_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F126627_33155_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F125648_67005_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F126054_30022_0|SrvcGrp|105047|2022|PDM|210.00|99|0.00|AETNA PSYCH DIAG EVAL W/ MED SVCS (HCFA)|
20|FH_F125436_60506_0|SrvcGrp|73842|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F118879_93063_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F150280_0_0|SrvcGrp|87537|2022|PDM|809.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F49954_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F50137_0_0|SrvcGrp|10543|2022|PDM|115.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|1708.00|99|0.00|ASPG III - FH SW CUSTOM GROUPERS|
20|FH_F125249_0_0|SrvcGrp|35671|2022|PDM|1100.00|99|0.00|TRANSPLANT FOREARM TENDON|
20|FH_F114930_71101_0|SrvcGrp|105736|2022|PDM|153.00|99|0.00|WOUND CARE|
20|FH_F129656_15005_0|SrvcGrp|111366|2022|PCT|0.90|99|0.00|ALL DRUGS, AGENTS, INJ DRUG|
20|FH_F137573_33764_0|SrvcGrp|89337|2022|PDM|872.00|99|0.00|DETOXIFICATION|
20|FH_F43167_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|ACUTE PSYCH|
20|FH_F37945_0_0|SrvcGrp|9936|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F79645_0_0|SrvcGrp|76927|2022|PCT|0.70|99|0.00|MEDICAL EQUIPMENT|
20|FH_F40415_0_0|SrvcGrp|405|2022|PDM|1034.00|99|0.00|ACUTE REHAB - LEVEL II|
20|FH_F43118_0_0|SrvcGrp|411|2022|PDM|6000.00|99|0.00|OP CARDIAC CATH|
20|FH_F123910_19125_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F47963_0_0|SrvcGrp|25940|2022|PDM|99.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F82173_72712_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131357_17545_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|3975.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|2222.00|99|0.00|AEG 9 (NO REV)|
20|FH_F38798_0_0|SrvcGrp|10545|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F130524_43701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40063_0_0|SrvcGrp|31007|2022|PDM|657.00|99|0.00|MS DRG 795 ONLY & REV CODES 170-171 NORMAL NEWBORN|
20|FH_F121149_76021_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F98801_93274_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F145758_20745_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F70805_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123272_54901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F130523_04605_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AETNA OP CT SCANS (CTSCAN) - HCFA|
20|FH_F137637_03103_0|SrvcGrp|46903|2022|PDM|450.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F34550_0_0|SrvcGrp|11283|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER|
20|FH_F44582_0_0|SrvcGrp|30456|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F93881_15009_0|SrvcGrp|53065|2022|PDM|1058.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F34253_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F119760_0_0|SrvcGrp|97702|2022|PDM|105.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F137573_33764_0|SrvcGrp|89417|2022|PDM|271.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F107782_0_0|SrvcGrp|102521|2022|PDM|2600.00|99|0.00|PENILE PROSTHESIS|
20|FH_F102500_0_0|CSTM-ALL|CSTM-00|2020|PDM|3668.00|99|0.00|OSSEOINTEGRATED IMPLANT REPL|
20|FH_F90157_0_0|SrvcGrp|73485|2022|PDM|1243.00|99|0.00|AETNA REHAB|
20|FH_F37756_0_0|SrvcGrp|27224|2022|PDM|551.00|99|0.00|RESIDENTIAL HOSPICE|
20|FH_F91622_0_0|SrvcGrp|220|2022|PCT|0.59|99|0.00|INTRAOCULAR LENSES|
20|FH_F131965_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F34735_0_0|SrvcGrp|18358|2022|PCT|0.75|99|0.00|MS DRG 307|
20|FH_F129669_57701_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F112568_0_0|SrvcGrp|33722|2022|PDM|59.87|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F143780_33873_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118194_50841_0|SrvcGrp|10577|2022|PDM|334.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F138020_20016_0|SrvcGrp|13228|2022|PDM|478.80|99|0.00|CPT CODE 99284|
20|FH_F128288_57058_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63018_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141794_50548_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F124965_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F123385_03561_0|SrvcGrp|73742|2022|PDM|8.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F37945_0_0|SrvcGrp|13217|2022|PCT|0.50|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F89563_29407_0|SrvcGrp|103323|2022|PCT|1.00|99|0.00|PT EVAL HIGH COMPLEX 45 MIN|
20|FH_F122687_0_0|SrvcGrp|78096|2022|PDM|2732.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F38034_0_0|SrvcGrp|43395|2022|PCT|0.85|99|0.00|LITHOTRIPSY SVCS|
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F124018_75067_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F72226_65804_0|SrvcGrp|3069|2022|PCT|0.73|99|0.00|IMPLANTS|
20|FH_F148494_0_0|SrvcGrp|40003|2022|PDM|15000.00|99|0.00|TOTAL KNEE|
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|734.80|99|0.00|ASPG IV|
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SERVICES|
20|FH_F33788_0_0|SrvcGrp|58|2022|PDM|5200.00|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114519_0_0|SrvcGrp|12491|2022|PCT|0.50|99|0.00|PACEMAKER|
20|FH_F47857_0_0|SrvcGrp|166|2022|PDM|340.00|99|0.00|CD (ADULT) - DETOXIFICATION|
20|FH_F39477_0_0|SrvcGrp|22954|2022|PDM|115.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F69122_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F31542_0_0|SrvcGrp|12676|2022|PCT|0.65|99|0.00|OP LAB SVCS|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD AW|
20|FH_F108960_47403_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133021_00910_0|SrvcGrp|112256|2022|PDM|8000.00|99|0.00|CARDIAC CATH/PTCA|
20|FH_F92677_08003_0|SrvcGrp|86831|2022|PDM|12.60|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F46192_0_0|SrvcGrp|9774|2022|PDM|3120.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F118025_60641_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120437_85202_0|SrvcGrp|24744|2022|PDM|114.77|99|0.00|PICC LINE INSERTION|
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|832.00|99|0.00|ACUTE PSYCH|
20|FH_F141611_43113_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F148644_06890_0|SrvcGrp|45583|2022|PDM|4300.00|99|0.00|CPT 65730|
20|FH_F151048_15122_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151142_35406_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|AEG 2 (NO REV)|
20|FH_F151155_26508_0|SrvcGrp|113321|2022|PDM|271.00|99|0.00|MED ASSIST TX METH WK (HCFA)|
20|FH_F121329_33015_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121385_89102_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F138487_85297_0|SrvcGrp|90388|2022|PDM|1127.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F139128_49503_0|SrvcGrp|98701|2022|PDM|285.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F139215_32218_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139394_07424_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150662_20901_0|SrvcGrp|48396|2022|PDM|153.00|99|0.00|OT SERVICES|
20|FH_F148702_32606_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F42538_0_0|SrvcGrp|26001|2022|PDM|153.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F149085_0_0|SrvcGrp|22529|2022|PCT|0.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F89640_98133_0|SrvcGrp|33789|2022|PDM|1513.00|99|0.00|MS DRG 880-887 ONLY|
20|FH_F128543_44413_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
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_F134847_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F36343_0_0|SrvcGrp|10645|2022|PDM|137.75|99|0.00|PICC LINE INSERTION KIT|
20|FH_F149003_62208_0|SrvcGrp|88781|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F134869_08854_0|SrvcGrp|90648|2022|PDM|159.00|99|0.00|PSYTX PT/FAMILY 45 MINUTES (HCFA)|
20|FH_F149579_95815_0|SrvcGrp|115687|2022|PDM|65.96|99|0.00|PHYSIOLOGIC MONITORING REM PARAM DEV|
20|FH_F138410_19130_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F46433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2010 B CODES (MOD UE)|
20|FH_F127418_0_0|SrvcGrp|93071|2022|PDM|15837.41|99|0.00|POSTERIOR SEGMENTAL INSTRU|
20|FH_F36663_0_0|CSTM-ALL|CSTM-00|2020|PDM|1190.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146859_0_0|SrvcGrp|114845|2022|PDM|1731.00|99|0.00|FINGER TENDON REPAIR|
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|1388.00|99|0.00|AEG 2 (NO REV)|
20|FH_F36620_0_0|SrvcGrp|474|2022|PDM|325.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F100663_56537_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PDM|1647.00|99|0.00|ASPG VIII|
20|FH_F123745_0_0|SrvcGrp|27343|2022|PDM|6800.00|99|0.00|OP SURGERY (CPT 25607 - 25609)|
20|FH_F43293_0_0|SrvcGrp|40820|2022|PDM|1150.00|99|0.00|ICU/CCU|
20|FH_F97084_91911_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F76124_0_0|SrvcGrp|471|2022|PDM|683.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F47037_0_0|SrvcGrp|12401|2022|PDM|92.00|99|0.00|RN VISIT|
20|FH_F110841_53012_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|BURN SERVICES|
20|FH_F141250_95062_0|SrvcGrp|89417|2022|PDM|309.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F149539_06032_0|SrvcGrp|92501|2022|PDM|525.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F80834_0_0|SrvcGrp|21365|2022|PDM|6474.00|99|0.00|MS DRG 768 ONLY|
20|FH_F84833_17109_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F98820_81401_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F35557_0_0|SrvcGrp|10564|2022|PDM|120.00|99|0.00|HOME INFUSION|
20|FH_F134387_60106_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43486_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|OP SVCS|
20|FH_F131261_19111_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136592_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F149022_25271_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|1644.00|99|0.00|AEG 7 (NO REV)|
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114206_37203_0|SrvcGrp|86847|2022|PDM|35.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|1564.00|99|0.00|ASPG IX|
20|FH_F39443_0_0|SrvcGrp|12035|2022|PDM|4045.00|99|0.00|PTCA W/O STENT|
20|FH_F138018_17313_0|SrvcGrp|73700|2022|PDM|123.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F116753_0_0|SrvcGrp|106773|2022|PDM|1278.00|99|0.00|POLYSOMNOGRAPHY (HCFA)|
20|FH_F132160_0_0|SrvcGrp|82570|2022|PDM|4590.00|99|0.00|REVISION EYELID/EXCESS SKIN|
20|FH_F41374_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|CD - ADULT|
20|FH_F149619_81008_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122323_60450_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F122419_37043_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F110732_31513_0|SrvcGrp|16|2022|PDM|1163.00|99|0.00|ACUTE REHABILITATION|
20|FH_F98001_27603_0|SrvcGrp|73485|2022|PDM|2721.00|99|0.00|AETNA REHAB|
20|FH_F128191_28642_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|HAPA EPA ASC 37|
20|FH_F137728_47203_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F90223_0_0|SrvcGrp|88831|2022|PDM|20.00|99|0.00|HOME PHARMACY SERVICES (HCFA)|
20|FH_F100540_0_0|SrvcGrp|73006|2022|PDM|909.00|99|0.00|AEG 9|
20|FH_F110824_83221_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 7 (NO REV)|
20|FH_F151042_60659_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132143_66111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F37335_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F122333_67010_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F149579_95815_0|SrvcGrp|115679|2022|PDM|82.27|99|0.00|CHRONIC CARE MGMT STAFF 1ST 30 MINS|
20|FH_F132160_0_0|SrvcGrp|42428|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 65855|
20|FH_F144651_0_0|SrvcGrp|96353|2022|PDM|16400.00|99|0.00|RECONSTRUCT ANKLE JOINT|
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|775.00|99|0.00|AEG 1 (NO REV)|
20|FH_F134396_80045_0|SrvcGrp|46903|2022|PDM|968.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F143488_84770_0|CSTM-ALL|CSTM-00|2020|PDM|2150.00|99|0.00|AEG 9 (NO REV)|
20|FH_F101700_0_0|SrvcGrp|35669|2022|PDM|4422.13|99|0.00|CPT 63650|
20|FH_F102920_0_0|SrvcGrp|72998|2022|PDM|1250.00|99|0.00|AEG 5|
20|FH_F131067_57105_0|SrvcGrp|73499|2022|PDM|1083.00|99|0.00|AETNA ER LEVEL II|
20|FH_F151748_20037_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151753_03104_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47036_0_0|SrvcGrp|34390|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F112712_63005_0|SrvcGrp|14944|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F116684_30701_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F127245_43537_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125287_92374_0|SrvcGrp|87131|2022|PDM|410.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F118917_33317_0|SrvcGrp|86722|2022|PDM|186.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F36274_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_F41015_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F41433_0_0|SrvcGrp|9263|2022|PDM|145.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F103241_06002_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F59732_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|PEDIATRIC PHYSICAL THERAPY|
20|FH_F60273_0_0|SrvcGrp|29830|2022|PDM|7276.50|99|0.00|PERCUT NEEDLE INSERTION|
20|FH_F61292_0_0|SrvcGrp|12580|2022|PDM|2908.00|99|0.00|OP LAPAROSCOPIC PROCEDURE|
20|FH_F113253_72206_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F110363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119660_0_0|SrvcGrp|29155|2022|PDM|90.00|99|0.00|HOSPICE SVCS|
20|FH_F148220_70578_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F128402_80233_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F89475_71202_0|SrvcGrp|73601|2022|PDM|2250.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F140578_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MOD TC (100%)|
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|1513.00|99|0.00|AEG 7 (NO REV)|
20|FH_F141527_36830_0|SrvcGrp|14893|2022|PDM|32.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F78165_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F80269_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129387_33991_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148169_33138_0|SrvcGrp|114012|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F129231_30060_0|CSTM-ALL|CSTM-00|2020|PDM|1728.00|99|0.00|AEG 9 (NO REV)|
20|FH_F73985_0_0|SrvcGrp|26219|2022|PDM|9397.00|99|0.00|LITHOTRIPSY|
20|FH_F148343_70810_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139551_0_0|SrvcGrp|88160|2022|PDM|5769.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F112568_0_0|SrvcGrp|104229|2022|PDM|240.60|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F129408_48034_0|SrvcGrp|82223|2022|PDM|140.00|99|0.00|HOSPICE CARE|
20|FH_F149140_07522_0|SrvcGrp|113230|2022|PDM|42.13|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 SCR|
20|FH_F121467_75165_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F141367_57104_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130025_0_0|SrvcGrp|93924|2022|PDM|1391.00|99|0.00|AETNA MEDICAL SERVICES|
20|FH_F148255_72703_0|SrvcGrp|86837|2022|PDM|10.50|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F120322_60016_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F102500_0_0|SrvcGrp|73002|2022|PDM|1551.00|99|0.00|AEG 7|
20|FH_F118194_50841_0|SrvcGrp|46605|2022|PDM|225.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F114963_62062_0|SrvcGrp|73742|2022|PDM|14.71|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F128869_45458_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39476_0_0|SrvcGrp|41406|2022|PDM|1728.00|99|0.00|CARDIAC CATH W/ICD 9|
20|FH_F33845_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89475_71202_0|SrvcGrp|114975|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F86456_79761_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|GENERAL ACUTE CARE|
20|FH_F141169_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F100761_02539_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F38360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F99960_0_0|SrvcGrp|72998|2022|PDM|1124.00|99|0.00|AEG 5|
20|FH_F125938_0_0|SrvcGrp|13927|2022|PCT|0.75|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F129969_33908_0|SrvcGrp|86722|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|AEG 2 (NO REV)|
20|FH_F120251_21122_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F123272_54901_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F128288_57058_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120215_92064_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F43243_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F107800_34609_0|SrvcGrp|89337|2022|PDM|637.00|99|0.00|DETOXIFICATION|
20|FH_F40295_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F150699_0_0|SrvcGrp|109500|2022|PDM|4068.00|99|0.00|REPAIR LEAD PACE-DEFIB ONE|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F78922_0_0|SrvcGrp|42870|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F66501_0_0|SrvcGrp|22954|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F117378_16148_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F148258_66062_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F56136_0_0|SrvcGrp|3418|2022|PDM|3177.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F33712_0_0|SrvcGrp|73420|2022|PDM|3500.00|99|0.00|UNGROUPABLE ASPG + REV CODES|
20|FH_F129657_77479_0|SrvcGrp|81779|2022|PCT|1.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F41494_0_0|SrvcGrp|97|2022|PDM|4685.00|99|0.00|C-SECTION|
20|FH_F66220_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F92618_0_0|SrvcGrp|3809|2022|PDM|609.83|99|0.00|HOSPICE CARE|
20|FH_F129968_98004_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F139241_0_0|SrvcGrp|77582|2022|PDM|1639.00|99|0.00|CPT 31255|
20|FH_F128384_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71945_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|(LAB) OCN F/S PRICING: ALL|
20|FH_F87254_0_0|SrvcGrp|77461|2022|PDM|1800.00|99|0.00|CPT 52356|
20|FH_F113410_0_0|SrvcGrp|105252|2022|PDM|1996.00|99|0.00|COLLARBONE REMOVAL|
20|FH_F115740_78957_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F132779_0_0|SrvcGrp|87310|2022|PDM|21351.00|99|0.00|MSDRG 273 ONLY|
20|FH_F110061_0_0|SrvcGrp|75489|2022|PDM|879.00|99|0.00|AEG 6|
20|FH_F40661_0_0|CSTM-ALL|CSTM-00|2020|PDM|569.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F52854_0_0|SrvcGrp|15|2022|PDM|3307.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F131517_19152_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129305_45614_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F120973_34653_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F98922_40351_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F120195_28403_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|661.03|99|0.00|HAPA WPA-NWPA 2012-13 ASC 401 W/O REV|
20|FH_F139551_0_0|SrvcGrp|82107|2022|PDM|2982.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F102267_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F95200_16201_0|SrvcGrp|16|2022|PDM|1633.00|99|0.00|ACUTE REHABILITATION|
20|FH_F122687_0_0|SrvcGrp|11673|2022|PDM|3825.00|99|0.00|CPT 29888|
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F60812_0_0|SrvcGrp|11853|2022|PCT|0.45|99|0.00|DRUGS|
20|FH_F143528_0_0|SrvcGrp|114090|2022|PDM|4861.50|99|0.00|ARTHROSCOPIC SERVICES|
20|FH_F82714_18848_0|SrvcGrp|36093|2022|PDM|1360.00|99|0.00|ACUTE REHABILITATION|
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_F148165_29169_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F44495_0_0|SrvcGrp|40062|2022|PDM|128.00|99|0.00|PT / OT / ST|
20|FH_F128272_60640_0|SrvcGrp|86833|2022|PDM|25.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F133671_89102_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F135056_06401_0|SrvcGrp|89149|2022|PDM|165.00|99|0.00|OP INTENSIVE|
20|FH_F130013_16509_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F91891_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F110166_32757_0|SrvcGrp|12514|2022|PDM|1208.00|99|0.00|TRANSITIONAL LIVING CENTER|
20|FH_F129964_0_0|SrvcGrp|35982|2022|PDM|42.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F123468_63384_0|SrvcGrp|472|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F115020_67301_0|SrvcGrp|89149|2022|PDM|160.00|99|0.00|OP INTENSIVE|
20|FH_F88096_0_0|SrvcGrp|35669|2022|PDM|1325.00|99|0.00|CPT 63650|
20|FH_F89778_0_0|SrvcGrp|77444|2022|PDM|1023.96|99|0.00|VASECTOMY|
20|FH_F125816_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|321.40|99|0.00|ASPG I|
20|FH_F63229_0_0|SrvcGrp|44244|2022|PDM|385.00|99|0.00|HEMODIALYSIS - HOME TRAINING|
20|FH_F63249_0_0|SrvcGrp|46104|2022|PDM|90.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F38411_0_0|SrvcGrp|3029|2022|PDM|460.00|99|0.00|NEWBORN NURSERY|
20|FH_F45052_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|GENERAL ACUTE CARE|
20|FH_F130658_44484_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130715_98503_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F130775_61701_0|SrvcGrp|86723|2022|PDM|346.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F83754_0_0|SrvcGrp|20077|2022|PCT|0.81|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR|
20|FH_F138256_68803_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F96780_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F145641_06902_0|SrvcGrp|114242|2022|PDM|3697.00|99|0.00|REVISION OF BIG TOE|
20|FH_F71273_0_0|SrvcGrp|46683|2022|PDM|1394.00|99|0.00|MS DRG 789-795 (NEONATAL)|
20|FH_F129638_0_0|SrvcGrp|15323|2022|PDM|200.00|99|0.00|ER LEVEL I|
20|FH_F124173_66215_0|SrvcGrp|27969|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F148668_33177_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F81377_0_0|SrvcGrp|19891|2022|PDM|2604.00|99|0.00|LAPAROSCOPY SURGICAL CHOLECYSTECTOMY|
20|FH_F83995_16748_0|SrvcGrp|16429|2022|PCT|1.00|99|0.00|OBSERVATION SVCS|
20|FH_F130329_64114_0|SrvcGrp|86837|2022|PDM|10.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F111023_13905_0|SrvcGrp|473|2022|PDM|270.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F138313_75479_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F97861_62223_0|CSTM-ALL|CSTM-00|2020|PCT|0.38|99|0.00|OP SVCS|
20|FH_F116753_0_0|SrvcGrp|73501|2022|PCT|0.53|99|0.00|AETNA OBSERVATION|
20|FH_F121476_0_0|SrvcGrp|91759|2022|PDM|2342.00|99|0.00|OCULAR IMPLANT|
20|FH_F70205_0_0|SrvcGrp|44883|2022|PDM|18.00|99|0.00|RT/PT/ST/OT|
20|FH_F138507_62208_0|SrvcGrp|46605|2022|PDM|113.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F145702_22192_0|SrvcGrp|27969|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F149148_15330_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD UE KE"|
20|FH_F138302_15701_0|SrvcGrp|29076|2022|PDM|25.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F110943_80026_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31714_0_0|SrvcGrp|10924|2022|PDM|8000.00|99|0.00|PTCA W/O STENT|
20|FH_F131996_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F138447_22041_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F95623_84015_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|AEG 6 (NO REV)|
20|FH_F68844_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F134610_33426_0|SrvcGrp|108484|2022|PDM|2047.50|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F85415_27612_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F150179_23124_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F139578_70433_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F134992_34112_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F119379_0_0|SrvcGrp|107835|2022|PDM|1350.00|99|0.00|NERVE REPAIR|
20|FH_F130763_0_0|SrvcGrp|59840|2022|PDM|2773.00|99|0.00|TYMPANOSTOMY|
20|FH_F52754_0_0|SrvcGrp|47132|2022|PDM|95.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F90416_73013_0|SrvcGrp|48396|2022|PDM|105.00|99|0.00|OT SERVICES|
20|FH_F81698_10457_0|SrvcGrp|14949|2022|PDM|47.25|99|0.00|HOME INFUSION|
20|FH_F141337_60077_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F116806_0_0|SrvcGrp|107072|2022|PDM|1923.16|99|0.00|DRAINAGE OF THROAT ABSCESS|
20|FH_F125259_0_0|SrvcGrp|104098|2022|PDM|4000.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F49598_0_0|SrvcGrp|23477|2022|PDM|6365.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F81835_0_0|SrvcGrp|75325|2022|PDM|142.66|99|0.00|SLEEP STUDY CPT 95800|
20|FH_F150165_06032_0|SrvcGrp|89853|2022|PDM|3925.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG|
20|FH_F150305_18848_0|SrvcGrp|13227|2022|PDM|134.20|99|0.00|CPT CODE 99283|
20|FH_F134608_18017_0|SrvcGrp|112604|2022|PDM|130.00|99|0.00|BIOPSY OF CERVIX|
20|FH_F132728_0_0|SrvcGrp|360|2022|PDM|2059.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F149147_66221_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F83995_16748_0|CSTM-ALL|CSTM-00|2020|PDM|174.00|99|0.00|RURAL HEALTH CLINIC|
20|FH_F125328_0_0|SrvcGrp|79579|2022|PDM|3315.00|99|0.00|CPT 43251|
20|FH_F96160_32207_0|SrvcGrp|86831|2022|PDM|6.76|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F144228_0_0|SrvcGrp|106175|2022|PDM|2374.00|99|0.00|EXCISE PAROTID GLAND/LESION|
20|FH_F116753_0_0|SrvcGrp|106786|2022|PDM|7465.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F85353_16407_0|SrvcGrp|63787|2022|PDM|1257.43|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1302|
20|FH_F126063_43078_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F69647_0_0|SrvcGrp|17065|2022|PDM|585.00|99|0.00|ASPG I|
20|FH_F39015_0_0|SrvcGrp|13551|2022|PDM|442.00|99|0.00|NEWBORN NURSERY|
20|FH_F123623_03246_0|SrvcGrp|107748|2022|PDM|1100.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F90496_13159_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F126324_20176_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F100680_43130_0|SrvcGrp|73559|2022|PDM|6735.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.00|99|0.00|AEG 5  (NO REV)|
20|FH_F134207_19116_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139727_66035_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F134608_18017_0|SrvcGrp|112603|2022|PDM|65.00|99|0.00|FITTING OF DIAPHRAGM|
20|FH_F81838_0_0|SrvcGrp|10648|2022|PDM|6.00|99|0.00|HOME INFUSION|
20|FH_F81852_0_0|CSTM-ALL|CSTM-00|2020|PDM|1322.00|99|0.00|ASPG VII|
20|FH_F63102_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F40635_0_0|SrvcGrp|3029|2022|PDM|345.00|99|0.00|NEWBORN NURSERY|
20|FH_F126043_30339_0|SrvcGrp|73842|2022|PDM|301.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132969_84003_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F111023_13905_0|SrvcGrp|472|2022|PDM|345.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|1094.00|99|0.00|AEG 6 (NO REV)|
20|FH_F125682_46825_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40526_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F54592_0_0|SrvcGrp|24934|2022|PDM|75.00|99|0.00|NUTRITIONAL ASSESSMENT (INITIAL)|
20|FH_F63297_0_0|SrvcGrp|59425|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F122968_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F42138_0_0|SrvcGrp|16016|2022|PDM|28.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F71103_0_0|SrvcGrp|44391|2022|PDM|110.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|74.52|99|0.00|HAPA WPA-NWPA 2012-13 ASC 245 W/O REV|
20|FH_F63625_0_0|SrvcGrp|39871|2022|PCT|0.80|99|0.00|MS DRG 619-621 ONLY OTLR|
20|FH_F66404_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F146422_80210_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146654_80524_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146716_46733_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F120774_14070_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F131698_01862_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130657_04614_0|SrvcGrp|114016|2022|PCT|0.86|99|0.00|OBSERVATION W/SURGERY|
20|FH_F133574_91607_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111584_07002_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F111841_85212_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F134826_19067_0|SrvcGrp|108728|2022|PDM|50.00|99|0.00|DRUG TEST PRSMV INSTRUMENT|
20|FH_F39540_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.81|99|0.00|GENERAL ACUTE CARE|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2501000 MOD AU (HCFA)|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|443.13|99|0.00|DELAWARE VALLEY- ASC 205|
20|FH_F113738_27006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69651_0_0|SrvcGrp|15850|2022|PDM|120.00|99|0.00|HOSPICE SVCS|
20|FH_F98041_10027_0|SrvcGrp|73559|2022|PDM|6587.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F110000_0_0|SrvcGrp|29817|2022|PDM|3518.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|397.00|99|0.00|AEG 1 (NO REV)|
20|FH_F91873_12723_0|SrvcGrp|72990|2022|PDM|1591.00|99|0.00|AEG 1|
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|1544.00|99|0.00|AEG 2 (NO REV)|
20|FH_F39727_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F86911_0_0|SrvcGrp|42762|2022|PDM|90.00|99|0.00|NURSING CARE|
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.20|99|0.00|AEG 5  (NO REV)|
20|FH_F113784_0_0|SrvcGrp|88621|2022|PDM|60.00|99|0.00|SKILLED NURSING LPN|
20|FH_F114916_30309_0|SrvcGrp|100920|2022|PDM|2100.00|99|0.00|SPINE PRO DEVICE|
20|FH_F114916_30309_0|SrvcGrp|11673|2022|PDM|1760.00|99|0.00|CPT 29888|
20|FH_F105440_46383_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F112453_0_0|SrvcGrp|90707|2022|PDM|105.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 2 (NO REV)|
20|FH_F102041_35010_0|SrvcGrp|73701|2022|PDM|65.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F39426_0_0|SrvcGrp|474|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F43694_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|ACUTE PSYCH|
20|FH_F125163_0_0|SrvcGrp|108082|2022|PDM|1325.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F120901_0_0|SrvcGrp|89980|2022|PDM|4682.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F141147_02571_0|SrvcGrp|20752|2022|PDM|18000.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F42933_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F126345_0_0|SrvcGrp|75282|2022|PDM|1503.00|99|0.00|DIAGNOSTIC HYSTEROSCOPY|
20|FH_F126345_0_0|SrvcGrp|72990|2022|PDM|453.00|99|0.00|AEG 1|
20|FH_F114389_50131_0|SrvcGrp|12403|2022|PDM|961.47|99|0.00|CONTINUOUS HOMECARE|
20|FH_F114389_50131_0|SrvcGrp|86845|2022|PDM|130.65|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|1457.00|99|0.00|AEG 3 (NO REV)|
20|FH_F46333_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|IMPLANTS|
20|FH_F76782_0_0|SrvcGrp|12403|2022|PDM|40.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F77944_0_0|SrvcGrp|11301|2022|PDM|1436.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F124140_15214_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146800_74128_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147081_02130_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F64819_0_0|SrvcGrp|22781|2022|PDM|11487.00|99|0.00|MS DRG 244 ONLY|
20|FH_F74102_0_0|SrvcGrp|11080|2022|PDM|105.00|99|0.00|NURSING CARE|
20|FH_F34652_0_0|SrvcGrp|97|2022|PDM|5440.00|99|0.00|C-SECTION|
20|FH_F45372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F92493_0_0|SrvcGrp|70749|2022|PDM|3250.17|99|0.00|CPT 29823|
20|FH_F92493_0_0|SrvcGrp|92370|2022|PDM|2079.00|99|0.00|FUSION OF KNUCKLE JOINT|
20|FH_F132864_71101_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F124178_01604_0|SrvcGrp|87282|2022|PCT|1.00|99|0.00|EPOETIN ALFA|
20|FH_F124235_92840_0|SrvcGrp|46903|2022|PDM|1200.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F124679_64052_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F118848_0_0|SrvcGrp|28548|2022|PDM|4800.00|99|0.00|VITRECTOMY|
20|FH_F128974_70130_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F136657_70806_0|SrvcGrp|73605|2022|PDM|933.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F113787_31909_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F113791_32055_0|SrvcGrp|81779|2022|PCT|1.33|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F138527_64506_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F138284_98052_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F138310_60461_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|2341.94|99|0.00|2005 ASPG GROUPER IX|
20|FH_F122879_39564_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F43352_0_0|CSTM-ALL|CSTM-00|2020|PDM|1335.00|99|0.00|WELLPATH PROPIETARY ASC VI|
20|FH_F134690_46237_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F136769_37142_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136824_08034_0|SrvcGrp|88819|2022|PDM|898.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F112268_19087_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132809_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77234_0_0|SrvcGrp|17077|2022|PDM|2882.00|99|0.00|ASPG VII|
20|FH_F66501_0_0|SrvcGrp|11798|2022|PDM|95.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F137462_03062_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 5  (NO REV)|
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_F97540_32114_0|SrvcGrp|73603|2022|PDM|3055.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F136485_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|22000.00|99|0.00|MSDRG 228-230|
20|FH_F148200_26554_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F148165_29169_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)|
20|FH_F133099_66801_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F135173_06519_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F46612_0_0|SrvcGrp|11080|2022|PDM|166.00|99|0.00|NURSING CARE|
20|FH_F90818_0_0|SrvcGrp|57596|2022|PDM|3200.00|99|0.00|CIRCUMCISION|
20|FH_F138934_0_0|SrvcGrp|79579|2022|PDM|675.00|99|0.00|CPT 43251|
20|FH_F150982_0_0|SrvcGrp|112583|2022|PDM|3664.00|99|0.00|LAPAROSCOPY|
20|FH_F71927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F64160_0_0|SrvcGrp|60461|2022|PDM|179.96|99|0.00|RESIDENTIAL HOSPICE|
20|FH_F122725_32216_0|SrvcGrp|84961|2022|PDM|216.00|99|0.00|CPT 43201|
20|FH_F89778_0_0|SrvcGrp|87055|2022|PDM|1178.04|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION|
20|FH_F89778_0_0|SrvcGrp|67994|2022|PDM|1043.18|99|0.00|CPT 58120|
20|FH_F88545_78734_0|SrvcGrp|73485|2022|PDM|923.00|99|0.00|AETNA REHAB|
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_F72941_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F100240_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123647_66441_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F123756_45324_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123848_03257_0|SrvcGrp|27969|2022|PDM|28.00|99|0.00|HOME HEALTH AIDE|
20|FH_F123763_80130_0|SrvcGrp|73841|2022|PDM|415.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F125020_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F119783_46360_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150143_27320_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F39898_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134353_84123_0|SrvcGrp|83521|2022|PDM|103.95|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|835.00|99|0.00|AEG 6 (NO REV)|
20|FH_F146005_67037_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112065_20852_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F83754_0_0|SrvcGrp|38980|2022|PCT|0.81|99|0.00|MSDRG 246-249 ONLY|
20|FH_F124219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93219_26354_0|SrvcGrp|88621|2022|PDM|99.00|99|0.00|SKILLED NURSING LPN|
20|FH_F143681_61938_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145579_67226_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116753_0_0|SrvcGrp|85198|2022|PDM|7465.00|99|0.00|AETNA KNEE ARTHROSCOPY|
20|FH_F100782_0_0|SrvcGrp|97665|2022|PDM|1556.43|99|0.00|WINDBER MEDICAL CNTR ASC 502|
20|FH_F112468_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH|
20|FH_F149051_01605_0|SrvcGrp|82846|2022|PCT|1.07|99|0.00|AETNA DME|
20|FH_F134650_07921_0|SrvcGrp|87077|2022|PDM|155.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F141829_0_0|SrvcGrp|106314|2022|PDM|659.39|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F138457_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.00|99|0.00|AEG 2 (NO REV)|
20|FH_F135670_01749_0|SrvcGrp|17015|2022|PDM|12.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F123610_60018_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F121476_0_0|SrvcGrp|108827|2022|PDM|1443.00|99|0.00|REPLACEMENT IMPL PUMP CATHET|
20|FH_F146103_63851_0|SrvcGrp|82037|2022|PDM|1139.00|99|0.00|AETNA ICU|
20|FH_F139767_15217_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F63387_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149199_73005_0|SrvcGrp|115534|2022|PCT|1.32|99|0.00|LABORATORY SERVICES|
20|FH_F49552_0_0|SrvcGrp|17077|2022|PDM|1182.54|99|0.00|ASPG VII|
20|FH_F138302_15701_0|SrvcGrp|48385|2022|PDM|65.00|99|0.00|SPEECH THERAPY|
20|FH_F132609_0_0|SrvcGrp|3409|2022|PDM|508.00|99|0.00|NEWBORN NURSERY|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|HOME INF- REV 640 MOD SJ|
20|FH_F117300_0_0|SrvcGrp|88159|2022|PDM|7360.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F150165_06032_0|SrvcGrp|36864|2022|PDM|13390.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F128825_45211_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F128148_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|NON-ANESTHESIOLOGY (HANE) (HSMI) (SAMD)|
20|FH_F119227_01752_0|SrvcGrp|24750|2022|PDM|38.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|2403.00|99|0.00|AEG 9 (NO REV)|
20|FH_F114683_0_0|SrvcGrp|11306|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F118803_0_0|SrvcGrp|107872|2022|PDM|349.70|99|0.00|INJECTION EXT VENOGRAPHY|
20|FH_F85995_64111_0|SrvcGrp|46104|2022|PDM|136.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F145641_06902_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133207_0_0|SrvcGrp|102480|2022|PDM|2632.00|99|0.00|CPT 29897|
20|FH_F148186_0_0|SrvcGrp|106291|2022|PDM|285.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F123638_0_0|SrvcGrp|109020|2022|PCT|0.90|99|0.00|PARSABIV INJECTION ETELCALCETIDE 0.1 MG|
20|FH_F145852_67203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109364_52349_0|SrvcGrp|44042|2022|PDM|166.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F123851_03235_0|SrvcGrp|48398|2022|PDM|169.00|99|0.00|PT SERVICES|
20|FH_F133972_27103_0|SrvcGrp|14948|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F85213_02840_0|SrvcGrp|115518|2022|PCT|1.03|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F115608_24171_0|SrvcGrp|36204|2022|PCT|0.00|99|0.00|ACUTE PSYCH|
20|FH_F115631_65201_0|CSTM-ALL|CSTM-00|2020|PDM|2443.00|99|0.00|AEG 9 (NO REV)|
20|FH_F115723_78363_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F147362_33137_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147522_64114_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147586_44124_0|SrvcGrp|27310|2022|PDM|1634.00|99|0.00|ENDOSCOPIC PLANTAR FASCIOTOMY|
20|FH_F147621_74338_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41675_0_0|SrvcGrp|14651|2022|PDM|1575.00|99|0.00|LITHOTRIPSY SVCS|
20|FH_F35404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F113246_72687_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F133536_0_0|SrvcGrp|102481|2022|PDM|3215.00|99|0.00|CPT 29898|
20|FH_F82357_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: ALL|
20|FH_F120639_73078_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150939_0_0|SrvcGrp|101742|2022|PDM|3.00|99|0.00|IMMUN ADMIN ORAL/NASAL ADDL|
20|FH_F37850_0_0|SrvcGrp|2738|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F115185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F48693_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F51492_0_0|SrvcGrp|43892|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F113585_20155_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138687_77477_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F138687_77477_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F138876_25302_0|SrvcGrp|86841|2022|PDM|70.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F138876_25302_0|SrvcGrp|22593|2022|PDM|40.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F83792_0_0|SrvcGrp|73603|2022|PDM|1575.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|856.55|99|0.00|AEG 5  (NO REV)|
20|FH_F113390_0_0|SrvcGrp|89882|2022|PDM|2200.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F151426_90028_0|SrvcGrp|74668|2022|PDM|365.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151509_77076_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132268_07060_0|SrvcGrp|104966|2022|PCT|0.95|99|0.00|NOC DRUGS|
20|FH_F122152_70123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132054_30339_0|SrvcGrp|93098|2022|PDM|128.00|99|0.00|HOSPICE CARE|
20|FH_F135375_60014_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135427_19610_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F135470_83201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135493_07514_0|SrvcGrp|46903|2022|PDM|424.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F135795_60016_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135877_74403_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136216_27526_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F116397_33404_0|SrvcGrp|86825|2022|PDM|65.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F116467_13031_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F131682_50109_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117266_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111292_33136_0|SrvcGrp|107505|2022|PDM|164.00|99|0.00|X-RAY EXAM CHEST SINGLE VIEW|
20|FH_F111301_33122_0|SrvcGrp|11258|2022|PCT|0.33|99|0.00|DRUGS|
20|FH_F40423_0_0|SrvcGrp|6|2022|PCT|0.85|99|0.00|OP SURGERY|
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|2081.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F87534_19464_0|SrvcGrp|85602|2022|PCT|1.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F141035_0_0|SrvcGrp|107826|2022|PDM|7008.00|99|0.00|REMOVAL OF WRIST BONE|
20|FH_F128695_50049_0|SrvcGrp|27968|2022|PDM|50.00|99|0.00|SKILLED NURSING LPN|
20|FH_F129234_78245_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F102940_35034_0|SrvcGrp|48398|2022|PDM|125.00|99|0.00|PT SERVICES|
20|FH_F134202_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F33381_0_0|SrvcGrp|15054|2022|PCT|0.68|99|0.00|CARDIAC CATH|
20|FH_F128031_0_0|SrvcGrp|73006|2022|PDM|1803.00|99|0.00|AEG 9|
20|FH_F36787_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F51193_30901_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F66922_66211_0|SrvcGrp|91257|2022|PCT|0.00|99|0.00|OUTPATIENT SERVICES W/URGENT CARE|
20|FH_F100906_0_0|SrvcGrp|69964|2022|PDM|1750.00|99|0.00|CPT 23120|
20|FH_F100906_0_0|SrvcGrp|73000|2022|PDM|1316.00|99|0.00|AEG 6|
20|FH_F121250_47401_0|SrvcGrp|73841|2022|PDM|340.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F136367_72210_0|SrvcGrp|46903|2022|PDM|621.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F136386_30901_0|SrvcGrp|19671|2022|PDM|26250.00|99|0.00|MS DRG 286 ONLY CIRCULATORY DISORDERS W/CARD CATH COMPLEX DX|
20|FH_F134011_84102_0|SrvcGrp|29023|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F137040_76011_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114178_19083_0|SrvcGrp|471|2022|PDM|536.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F114092_83350_0|SrvcGrp|112044|2022|PCT|2.60|99|0.00|LABORATORY SERVICES|
20|FH_F142690_31774_0|SrvcGrp|90340|2022|PDM|125.00|99|0.00|SKILLED NURSING LPN|
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F83831_0_0|SrvcGrp|3809|2022|PDM|616.00|99|0.00|HOSPICE CARE|
20|FH_F138584_30912_0|SrvcGrp|113378|2022|PDM|1600.00|99|0.00|RECONSTRUCTION MIDFACE LEFORT I|
20|FH_F78267_18702_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F140473_30518_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F140652_92626_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F140867_56345_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F151609_17601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118926_30135_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F85713_0_0|SrvcGrp|81023|2022|PDM|180.00|99|0.00|AETNA CAPD CCPD IPD DIALYSIS PROC|
20|FH_F117377_71303_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F147725_06002_0|SrvcGrp|91941|2022|PDM|4759.00|99|0.00|NASAL/SINUS ENDOSCOPY WITH DILATION|
20|FH_F147801_90703_0|SrvcGrp|12659|2022|PDM|1454.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F147879_93309_0|SrvcGrp|48398|2022|PDM|165.00|99|0.00|PT SERVICES|
20|FH_F147925_06457_0|SrvcGrp|112678|2022|PCT|1.00|99|0.00|COVID-19 SPECIMEN COLLECT|
20|FH_F147941_06023_0|SrvcGrp|111924|2022|PDM|17500.00|99|0.00|C-SECTION DELIVERY INCLUDES NEWBORN|
20|FH_F117240_37334_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F137331_33165_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137814_61820_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F35210_0_0|SrvcGrp|268|2022|PCT|0.65|99|0.00|HYPERBARIC CHAMBER|
20|FH_F110308_0_0|SrvcGrp|73000|2022|PDM|700.00|99|0.00|AEG 6|
20|FH_F109632_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_F110720_0_0|SrvcGrp|72996|2022|PDM|2584.00|99|0.00|AEG 4|
20|FH_F91472_96001_0|SrvcGrp|103751|2022|PCT|0.40|99|0.00|PARTIAL KNEE REPLACEMENT|
20|FH_F124891_29935_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91067_0_0|SrvcGrp|72990|2022|PDM|410.00|99|0.00|AEG 1|
20|FH_F149029_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F69364_0_0|SrvcGrp|14502|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F95880_02726_0|SrvcGrp|89503|2022|PDM|30.38|99|0.00|GAIT TRAINING THERAPY|
20|FH_F119351_95377_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F119448_07083_0|SrvcGrp|86722|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F138283_0_0|SrvcGrp|23683|2022|PDM|30.00|99|0.00|SKILLED NURSING RN|
20|FH_F148419_01453_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F119076_41001_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F97564_52246_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F44257_0_0|SrvcGrp|3029|2022|PDM|249.00|99|0.00|NEWBORN NURSERY|
20|FH_F42984_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 5  (NO REV)|
20|FH_F92677_08003_0|SrvcGrp|92219|2022|PDM|3.15|99|0.00|HCPCS A7003 MOD NU (HCFA)|
20|FH_F35368_0_0|SrvcGrp|24|2022|PDM|6416.00|99|0.00|CARDIAC CATH|
20|FH_F150530_63031_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150602_59718_0|SrvcGrp|82222|2022|PDM|153.00|99|0.00|HOSPICE CARE|
20|FH_F111582_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F49354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F115391_63123_0|SrvcGrp|106154|2022|PCT|1.00|99|0.00|AMFS DEFAULT W/O CPT 92507|
20|FH_F87334_16507_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.05|99|0.00|ASPG 102|
20|FH_F141654_15217_0|SrvcGrp|42404|2022|PDM|43.26|99|0.00|VENIPUNCTURE|
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1810.00|99|0.00|AEG 10 (NO REV)|
20|FH_F118819_76226_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|118.00|99|0.00|ASPG 123|
20|FH_F143197_34957_0|SrvcGrp|75419|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148861_18706_0|SrvcGrp|108484|2022|PDM|928.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F83113_0_0|SrvcGrp|14371|2022|PDM|17.00|99|0.00|DISPOSABLE DRUG DELIVERY|
20|FH_F149513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133167_82930_0|SrvcGrp|472|2022|PDM|499.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F44660_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F95360_08720_0|SrvcGrp|94042|2022|PCT|1.00|99|0.00|GAMMA GLOBULIN  INTRAM>10 CC|
20|FH_F143190_46168_0|SrvcGrp|74668|2022|PDM|249.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F36521_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F91152_60061_0|SrvcGrp|70381|2022|PDM|362.00|99|0.00|PSYCH PARTIAL HOSP (FULL & PARTIAL DAY) PER VISIT|
20|FH_F43014_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OP SVCS|
20|FH_F36993_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD AV|
20|FH_F150121_29072_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136507_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129659_0_0|SrvcGrp|82981|2022|PDM|170.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F124954_17055_0|SrvcGrp|106317|2022|PDM|631.68|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F119437_0_0|SrvcGrp|75497|2022|PDM|700.00|99|0.00|AEG 10|
20|FH_F101923_98104_0|SrvcGrp|34168|2022|PCT|0.82|99|0.00|BURN SERVICES MS DRG|
20|FH_F44813_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|CHILD PSYCHIATRIC|
20|FH_F150001_33064_0|SrvcGrp|19742|2022|PDM|53.00|99|0.00|MID-LINE INSERTION|
20|FH_F97041_71603_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F133493_90255_0|SrvcGrp|111928|2022|PDM|100.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F35013_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142752_19428_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F143194_19973_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F115330_34113_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F73684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F103360_68845_0|SrvcGrp|88740|2022|PDM|6676.00|99|0.00|SP BONE ALGRFT|
20|FH_F150001_33064_0|SrvcGrp|17014|2022|PDM|26.00|99|0.00|HOME INFUSION THERAPY|
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_F105921_80014_0|SrvcGrp|43567|2022|PDM|90.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F150538_90056_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F115313_11216_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F150902_21713_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F95980_20016_0|SrvcGrp|43523|2022|PDM|170.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F111625_0_0|SrvcGrp|73485|2022|PDM|850.00|99|0.00|AETNA REHAB|
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|664.00|99|0.00|AEG 1 (NO REV)|
20|FH_F40267_0_0|SrvcGrp|17073|2022|PDM|830.00|99|0.00|ASPG V|
20|FH_F105842_70433_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98640_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F45199_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|ASPG V|
20|FH_F91044_74010_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F133293_49085_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F101802_17201_0|SrvcGrp|53987|2022|PDM|33.44|99|0.00|PHOTOTHERAPY|
20|FH_F142169_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F106600_99202_0|SrvcGrp|86748|2022|PCT|1.05|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F39721_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133493_90255_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1602.00|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_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|76.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 246 W/O REV|
20|FH_F51658_0_0|SrvcGrp|44428|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY SVCS (VISIT LVL)|
20|FH_F117275_16936_0|SrvcGrp|73841|2022|PDM|285.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F88512_0_0|SrvcGrp|17073|2022|PDM|3655.76|99|0.00|ASPG V|
20|FH_F96102_33884_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F39417_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|1699.00|99|0.00|AEG 6  W/O BREAKOUT SURG (NO REV)|
20|FH_F35411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F128657_19008_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97041_71603_0|SrvcGrp|88978|2022|PDM|6510.00|99|0.00|VAGINAL DELIVERY|
20|FH_F44992_0_0|SrvcGrp|9525|2022|PDM|425.00|99|0.00|DIALYSIS|
20|FH_F117335_0_0|SrvcGrp|73002|2022|PDM|1135.00|99|0.00|AEG 7|
20|FH_F148599_98034_0|SrvcGrp|74464|2022|PDM|42438.00|99|0.00|AETNA MS DRG 247 ONLY|
20|FH_F117346_75093_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F126666_44053_0|SrvcGrp|86643|2022|PDM|39.00|99|0.00|AETNA PSYTX PT & FAMILY 30 MINS (MOD TD)|
20|FH_F35411_0_0|SrvcGrp|13148|2022|PDM|5299.00|99|0.00|DIAGNOSTIC CARDIAC CATH|
20|FH_F142810_77087_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1792.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F124928_04210_0|SrvcGrp|97506|2022|PDM|144.58|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F39640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|DME - OSTOMY|
20|FH_F133003_49012_0|SrvcGrp|73842|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148644_06890_0|SrvcGrp|89980|2022|PDM|4830.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F148880_26807_0|SrvcGrp|48394|2022|PDM|55.83|99|0.00|SKILLED NURSING SERVICES|
20|FH_F151053_17602_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151159_46322_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F151179_84074_0|SrvcGrp|73610|2022|PCT|0.00|99|0.00|AETNA IMPLANTS|
20|FH_F151222_72958_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138467_32216_0|SrvcGrp|87317|2022|PDM|1246.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F150801_19380_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F37342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131241_54154_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90232_15126_0|SrvcGrp|86851|2022|PDM|47.25|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F136887_0_0|SrvcGrp|112977|2022|PDM|9018.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F37058_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132143_66111_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F107922_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F35557_0_0|SrvcGrp|11797|2022|PDM|54.00|99|0.00|HYDRATION THERAPY - 3+ LITERS|
20|FH_F90817_0_0|SrvcGrp|91018|2022|PDM|1762.00|99|0.00|NASAL ENDOSCOPY SURGICAL (HCFA)|
20|FH_F150938_02062_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F97623_38008_0|SrvcGrp|73461|2022|PDM|3750.00|99|0.00|AETNA NICU IV|
20|FH_F149651_90046_0|SrvcGrp|109036|2022|PDM|650.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F98022_89015_0|SrvcGrp|73461|2022|PDM|11683.00|99|0.00|AETNA NICU IV|
20|FH_F150982_0_0|SrvcGrp|79595|2022|PDM|1382.00|99|0.00|CPT 45385|
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1094.00|99|0.00|AEG 4 (NO REV)|
20|FH_F37312_0_0|SrvcGrp|24286|2022|PDM|27.50|99|0.00|SKILLED NURSING CARE|
20|FH_F38742_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|100% OF AWP DRUGS (HCPCS ONLY)|
20|FH_F35069_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F74670_0_0|SrvcGrp|28919|2022|PDM|31.00|99|0.00|CPT 97750|
20|FH_F128839_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F150943_15537_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32393_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34783_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PDM|4883.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F134919_02155_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F37304_0_0|SrvcGrp|9511|2022|PCT|0.70|99|0.00|OBSERVATION SVCS|
20|FH_F146266_0_0|SrvcGrp|89848|2022|PDM|14196.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F151043_71901_0|SrvcGrp|75506|2022|PCT|0.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F120099_86305_0|SrvcGrp|75442|2022|PDM|1350.00|99|0.00|OBSERVATION - REV 762|
20|FH_F137767_01841_0|SrvcGrp|113137|2022|PDM|8495.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F34983_0_0|SrvcGrp|38|2022|PDM|1377.00|99|0.00|NORMAL DELIVERY|
20|FH_F120057_0_0|SrvcGrp|108219|2022|PDM|4300.00|99|0.00|VASC EMBOLIZE/OCCLUDE ORGAN|
20|FH_F116437_0_0|SrvcGrp|91759|2022|PCT|1.10|99|0.00|OCULAR IMPLANT|
20|FH_F137729_19703_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F127943_68939_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132740_46250_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F45120_0_0|SrvcGrp|30458|2022|PCT|0.21|99|0.00|DRUGS|
20|FH_F119213_66209_0|SrvcGrp|92537|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F50334_0_0|SrvcGrp|43893|2022|PDM|123.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F127651_44124_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136037_0_0|SrvcGrp|86722|2022|PDM|233.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F145561_80210_0|SrvcGrp|74668|2022|PDM|1046.50|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F150165_06032_0|SrvcGrp|83646|2022|PDM|4120.00|99|0.00|CPT 31276|
20|FH_F145642_15108_0|SrvcGrp|24745|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F42467_0_0|SrvcGrp|97|2022|PDM|2600.00|99|0.00|C-SECTION|
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91412_0_0|SrvcGrp|87058|2022|PDM|4435.31|99|0.00|LOW BACK DISK SURGERY|
20|FH_F149139_07522_0|SrvcGrp|113236|2022|PDM|41.38|99|0.00|COVID-19 SARS-COV-2 W/ OPTIC|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU KE"|
20|FH_F138313_75479_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143650_0_0|SrvcGrp|11673|2022|PDM|2900.00|99|0.00|CPT 29888|
20|FH_F145641_06902_0|SrvcGrp|107986|2022|PDM|3802.00|99|0.00|REMOVAL OF FOOT LESION|
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F76146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|INTRAOCULAR LENS|
20|FH_F136359_0_0|SrvcGrp|112857|2022|PDM|5180.00|99|0.00|REPAIR / REVISION / RECONSTRUCTION OF FOOT OR TOES|
20|FH_F112987_46222_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130329_64114_0|SrvcGrp|86830|2022|PDM|5.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F127642_07047_0|SrvcGrp|73002|2022|PDM|2653.00|99|0.00|AEG 7|
20|FH_F150165_06032_0|SrvcGrp|100065|2022|PDM|4161.00|99|0.00|DEEP ANT OR POSTER TIBIAL|
20|FH_F129509_0_0|SrvcGrp|88065|2022|PDM|6319.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F149147_66221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|AEG 5  (NO REV)|
20|FH_F31714_0_0|SrvcGrp|11188|2022|PDM|10500.00|99|0.00|DRG 552 OTHER PERMANENT CARDIAC PACEMAKER IMP W/O CV DX|
20|FH_F143628_32810_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150161_63361_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F77943_0_0|SrvcGrp|9937|2022|PCT|0.70|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F85213_02840_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149340_19136_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139569_15063_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 6 (NO REV)|
20|FH_F93219_26354_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120417_63124_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|154.24|99|0.00|HAPA WPA-NWPA 2012-13 ASC 313 W/O REV|
20|FH_F127486_06776_0|SrvcGrp|29346|2022|PDM|52.43|99|0.00|SKILLED NURSING- LPN|
20|FH_F127071_82435_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|399.79|99|0.00|ASPG I|
20|FH_F112041_19020_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134613_08852_0|SrvcGrp|108484|2022|PDM|2047.50|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F113484_43015_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129548_44130_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124369_0_0|SrvcGrp|34609|2022|PDM|7480.00|99|0.00|PODIATRIC PROCEDURE CPT 28080|
20|FH_F126341_27284_0|SrvcGrp|29077|2022|PCT|1.00|99|0.00|HOME TRANSFUSION|
20|FH_F143545_78723_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129509_0_0|SrvcGrp|92410|2022|PDM|5125.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F114606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145817_88101_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F134234_49525_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F50654_0_0|SrvcGrp|46892|2022|PCT|1.00|99|0.00|REVISION OF UPPER/LOWER EYELID|
20|FH_F138050_52301_0|SrvcGrp|103913|2022|PCT|1.36|99|0.00|OP DIALYSIS|
20|FH_F118127_30078_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134169_08831_0|SrvcGrp|113276|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|1013.00|99|0.00|AEG 1 (NO REV)|
20|FH_F134928_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F87919_01950_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|HERNIA REPAIR W/ MESH|
20|FH_F139565_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|604.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 208 W/O REV|
20|FH_F148600_30328_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 6 (NO REV)|
20|FH_F127486_06776_0|SrvcGrp|43569|2022|PDM|115.50|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F98021_07012_0|SrvcGrp|73603|2022|PDM|6219.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F67887_0_0|SrvcGrp|12702|2022|PDM|55.00|99|0.00|RN, INTERMITTENT VISIT|
20|FH_F150279_91767_0|SrvcGrp|75419|2022|PDM|475.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F73228_0_0|SrvcGrp|17075|2022|PDM|5693.00|99|0.00|ASPG VI|
20|FH_F110466_06870_0|SrvcGrp|89417|2022|PDM|512.53|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F149102_33433_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F119379_0_0|SrvcGrp|107837|2022|PDM|1060.00|99|0.00|REPAIR FINGER/HAND TENDON|
20|FH_F130017_02302_0|SrvcGrp|28203|2022|PDM|14772.56|99|0.00|MS DRG 260 ONLY|
20|FH_F125105_67361_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138017_73129_0|SrvcGrp|104751|2022|PDM|6883.00|99|0.00|REPAIR RECTUM & VAGINA|
20|FH_F35750_0_0|SrvcGrp|17549|2022|PCT|0.60|99|0.00|HIGH COST DRUGS|
20|FH_F75547_0_0|SrvcGrp|11283|2022|PCT|0.75|99|0.00|HYPERBARIC CHAMBER|
20|FH_F132860_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.61|99|0.00|OP SVCS|
20|FH_F97640_37043_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116575_0_0|SrvcGrp|89853|2022|PDM|1250.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG|
20|FH_F148347_0_0|SrvcGrp|86426|2022|PDM|2125.20|99|0.00|REMOVE INT/EXT HEM GROUP 2|
20|FH_F147339_08837_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 7 (NO REV)|
20|FH_F136806_0_0|SrvcGrp|54943|2022|PDM|3463.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F109251_62269_0|SrvcGrp|48394|2022|PDM|46.82|99|0.00|SKILLED NURSING SERVICES|
20|FH_F134394_92101_0|SrvcGrp|112561|2022|PDM|414.00|99|0.00|INTENSIVE OP (12-17 YRS)|
20|FH_F119652_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F40501_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F134397_27513_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134432_85053_0|SrvcGrp|74668|2022|PDM|800.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F39443_0_0|SrvcGrp|30336|2022|PDM|118.00|99|0.00|HAPA WPA ASC 220|
20|FH_F137986_0_0|SrvcGrp|54943|2022|PDM|3131.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F110732_31513_0|SrvcGrp|73004|2022|PDM|2064.00|99|0.00|AEG 8|
20|FH_F73485_0_0|SrvcGrp|48396|2022|PDM|15.00|99|0.00|OT SERVICES|
20|FH_F114206_37203_0|SrvcGrp|10577|2022|PDM|35.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F119442_72205_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION|
20|FH_F131274_48322_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116806_0_0|SrvcGrp|107082|2022|PDM|1923.16|99|0.00|ARTHROPLASTY W/ OR W/O AUTOGRAFT|
20|FH_F50398_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F138017_73129_0|SrvcGrp|537|2022|PDM|1260.00|99|0.00|OBSERVATION SERVICES|
20|FH_F124760_34997_0|SrvcGrp|12659|2022|PDM|695.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F116806_0_0|SrvcGrp|107100|2022|PDM|887.26|99|0.00|REPAIR NASAL SEPTAL FRACTURE|
20|FH_F42979_0_0|SrvcGrp|3398|2022|PDM|42.00|99|0.00|CPT 90853 GROUP PSYCHOTHERAPY|
20|FH_F150982_0_0|SrvcGrp|79594|2022|PDM|1382.00|99|0.00|CPT 45380|
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|2755.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132160_0_0|SrvcGrp|109760|2022|PDM|6885.00|99|0.00|TRANSLUM DIL EYE CANAL|
20|FH_F40346_0_0|SrvcGrp|9774|2022|PDM|2000.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F42746_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119203_0_0|SrvcGrp|108019|2022|PDM|435.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F124441_0_0|SrvcGrp|86505|2022|PDM|1425.00|99|0.00|DENTAL SURGERY|
20|FH_F124413_30067_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F123570_0_0|SrvcGrp|89404|2022|PDM|3502.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F118220_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F40899_0_0|SrvcGrp|16746|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F50621_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97623_38008_0|SrvcGrp|73601|2022|PDM|4847.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F85437_0_0|SrvcGrp|76501|2022|PDM|325.50|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F110828_32757_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147167_75605_0|SrvcGrp|90854|2022|PDM|650.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F75344_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|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_F89674_18640_0|SrvcGrp|48385|2022|PDM|68.25|99|0.00|SPEECH THERAPY|
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1456.00|99|0.00|AEG 6 (NO REV)|
20|FH_F97280_20018_0|SrvcGrp|73643|2022|PDM|2384.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F141334_66401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139822_30338_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F139928_37228_0|SrvcGrp|87441|2022|PDM|794.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F143227_50312_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1401.00|99|0.00|AEG 5  (NO REV)|
20|FH_F102224_0_0|SrvcGrp|106557|2022|PDM|11000.00|99|0.00|REVISE KNEE 2|
20|FH_F48224_0_0|SrvcGrp|72990|2022|PDM|399.00|99|0.00|AEG 1|
20|FH_F112687_30474_0|SrvcGrp|29347|2022|PDM|46.20|99|0.00|HOME HEALTH AIDE|
20|FH_F116699_46347_0|SrvcGrp|93919|2022|PDM|642.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F118792_63379_0|SrvcGrp|105465|2022|PCT|0.74|99|0.00|AETNA THERAPIES|
20|FH_F84611_30281_0|SrvcGrp|79299|2022|PDM|136.00|99|0.00|AETNA X-RAY (CPT 77056)|
20|FH_F39266_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F98624_15701_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 4 (NO REV)|
20|FH_F61292_0_0|SrvcGrp|47260|2022|PCT|0.44|99|0.00|IMPLANTS 274-276, 278  LINE LEVEL|
20|FH_F40255_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F117079_01085_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F131190_21042_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F36669_0_0|SrvcGrp|3810|2022|PDM|131.37|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F39273_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|2653.00|99|0.00|DEVICE INSERTION|
20|FH_F116923_85259_0|SrvcGrp|73841|2022|PDM|451.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F74647_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F116747_0_0|SrvcGrp|23683|2022|PCT|0.00|99|0.00|SKILLED NURSING RN|
20|FH_F128992_90808_0|SrvcGrp|109330|2022|PCT|1.15|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F92276_32308_0|SrvcGrp|114015|2022|PDM|7718.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F143528_0_0|SrvcGrp|109965|2022|PDM|5250.00|99|0.00|THORAX SPINE DISK SURGERY|
20|FH_F69423_0_0|SrvcGrp|36991|2022|PCT|0.84|99|0.00|IMPLANTS|
20|FH_F62915_0_0|SrvcGrp|42829|2022|PDM|115.00|99|0.00|RESPIRATORY THERAPY VISIT|
20|FH_F123943_84041_0|SrvcGrp|92502|2022|PDM|605.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F143768_34785_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118366_17110_0|SrvcGrp|63297|2022|PDM|95.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F137573_33764_0|SrvcGrp|3178|2022|PDM|864.00|99|0.00|ACUTE PSYCH|
20|FH_F130977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F68160_0_0|SrvcGrp|64200|2022|PCT|1.00|99|0.00|RAD AND LAB|
20|FH_F118194_50841_0|SrvcGrp|22593|2022|PDM|114.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F148265_06067_0|SrvcGrp|33979|2022|PDM|15522.00|99|0.00|CPT 27440|
20|FH_F42431_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|26275|2022|PDM|3303.00|99|0.00|CPT 29826|
20|FH_F41201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ACUTE PSYCH|
20|FH_F87254_0_0|SrvcGrp|63467|2022|PDM|1000.00|99|0.00|CPT 64585|
20|FH_F73729_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|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_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 280|
20|FH_F129766_48236_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|IP/OP MBPR SERVICES|
20|FH_F147941_06023_0|SrvcGrp|113988|2022|PCT|0.73|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F41776_0_0|SrvcGrp|27224|2022|PDM|551.00|99|0.00|RESIDENTIAL HOSPICE|
20|FH_F116291_11570_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F35748_0_0|SrvcGrp|28417|2022|PDM|70.00|99|0.00|SPEECH THERAPY|
20|FH_F126939_32405_0|SrvcGrp|108484|2022|PDM|625.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
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_F91663_19901_0|SrvcGrp|73701|2022|PDM|49.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F32293_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120371_63136_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F120349_38774_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F125983_82301_0|SrvcGrp|75442|2022|PDM|803.00|99|0.00|OBSERVATION - REV 762|
20|FH_F110102_0_0|SrvcGrp|95762|2022|PDM|150.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD AW) - CPD 1963706|
20|FH_F35468_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F39819_0_0|SrvcGrp|31248|2022|PDM|6145.00|99|0.00|NY DRG 204 ONLY|
20|FH_F56276_0_0|SrvcGrp|52954|2022|PDM|60.00|99|0.00|MEDICATION MANAGEMENT|
20|FH_F129397_17847_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92120_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F135005_06460_0|SrvcGrp|48398|2022|PDM|89.00|99|0.00|PT SERVICES|
20|FH_F135232_34471_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F49653_0_0|SrvcGrp|13168|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F88391_0_0|SrvcGrp|22954|2022|PDM|135.31|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F65444_0_0|SrvcGrp|44302|2022|PDM|75.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP|
20|FH_F32283_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123507_63869_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F140427_0_0|SrvcGrp|106240|2022|PDM|1400.00|99|0.00|STENT REPLACEMENT|
20|FH_F109601_0_0|SrvcGrp|75487|2022|PDM|800.00|99|0.00|AEG 5|
20|FH_F112568_0_0|SrvcGrp|29155|2022|PDM|240.60|99|0.00|HOSPICE SVCS|
20|FH_F147941_06023_0|CSTM-ALL|CSTM-00|2020|PDM|10375.00|99|0.00|AEG 4 (NO REV)|
20|FH_F78603_0_0|SrvcGrp|360|2022|PDM|2025.92|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F102302_0_0|SrvcGrp|98603|2022|PDM|10800.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 2 (NO REV)|
20|FH_F110161_31329_0|SrvcGrp|103832|2022|PDM|385.00|99|0.00|SUBACUTE LVL I W/TOB 210-28Z|
20|FH_F115020_67301_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F148480_03079_0|SrvcGrp|115404|2022|PDM|11281.00|99|0.00|TOTAL KNEE/HIP/SHOULDER|
20|FH_F45220_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148221_06477_0|SrvcGrp|48398|2022|PDM|105.00|99|0.00|PT SERVICES|
20|FH_F77504_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118194_50841_0|SrvcGrp|27969|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE|
20|FH_F128073_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F118194_50841_0|SrvcGrp|86850|2022|PDM|334.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F71686_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F103902_89118_0|SrvcGrp|23683|2022|PDM|35.00|99|0.00|SKILLED NURSING RN|
20|FH_F143930_16101_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F86157_75090_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F87092_60101_0|SrvcGrp|73000|2022|PDM|3570.00|99|0.00|AEG 6|
20|FH_F33025_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|1423.00|99|0.00|AEG 4 (NO REV)|
20|FH_F136629_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F89372_0_0|SrvcGrp|107734|2022|PDM|5682.00|99|0.00|VAGINAL DELIVERY|
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|2097.00|99|0.00|AEG 9 (NO REV)|
20|FH_F88639_80204_0|SrvcGrp|109057|2022|PCT|1.70|99|0.00|CARDIAC STUDIES|
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|307.00|99|0.00|AEG 1 (NO REV)|
20|FH_F123647_66441_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F62579_0_0|SrvcGrp|16559|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F63235_0_0|SrvcGrp|73006|2022|PDM|3746.00|99|0.00|AEG 9|
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F130821_85712_0|SrvcGrp|93269|2022|PDM|6.93|99|0.00|LINEZOLID INJECTION|
20|FH_F128235_62626_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138050_52301_0|SrvcGrp|42782|2022|PDM|140.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F132883_31602_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING-OP W/O HOME INFUSION|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.12|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1202 W/O REV|
20|FH_F93122_01854_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F145562_70458_0|SrvcGrp|86830|2022|PDM|3.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F133972_27103_0|SrvcGrp|86841|2022|PDM|100.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F125765_83617_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|OP SVCS|
20|FH_F113345_25301_0|SrvcGrp|75506|2022|PCT|0.70|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F113428_19446_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1041.76|99|0.00|HAPA WPA-NWPA 2012-13 ASC 3 W/O REV|
20|FH_F80694_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F150239_75569_0|SrvcGrp|14948|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F93333_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F35042_0_0|SrvcGrp|941|2022|PDM|2506.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F117206_0_0|SrvcGrp|90603|2022|PDM|1485.00|99|0.00|EXTRACTION OF LENS|
20|FH_F133801_87107_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F127091_62016_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|MCARE2 OCN F/S PRICING W/O HOME HEALTH|
20|FH_F114444_19602_0|SrvcGrp|102979|2022|PDM|100.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AH)|
20|FH_F135610_06451_0|SrvcGrp|48394|2022|PDM|39.25|99|0.00|SKILLED NURSING SERVICES|
20|FH_F31714_0_0|SrvcGrp|11196|2022|PDM|24600.00|99|0.00|DRG 548 CORONARY BYPASS W/ CARDIAC CATH W/O MAJOR CV DX|
20|FH_F97840_54729_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F110245_46016_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F126493_31501_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149320_82609_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121601_47446_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F126341_27284_0|SrvcGrp|110411|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUG|
20|FH_F121603_46761_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120670_0_0|SrvcGrp|108912|2022|PDM|7800.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|251.27|99|0.00|HAPA WPA-NWPA 2012-13 ASC 121 W/O REV|
20|FH_F132883_31602_0|SrvcGrp|21920|2022|PDM|20.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F102726_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|DIAGNOSTIC RADIOLOGY SERVICES|
20|FH_F119227_01752_0|SrvcGrp|17013|2022|PDM|38.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F145604_14850_0|SrvcGrp|48394|2022|PDM|44.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F127091_62016_0|SrvcGrp|66264|2022|PDM|98.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F110604_0_0|SrvcGrp|38364|2022|PDM|6050.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F113764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70863_0_0|SrvcGrp|11116|2022|PDM|161.00|99|0.00|PT SVCS|
20|FH_F135656_74820_0|SrvcGrp|46903|2022|PDM|464.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F133788_74006_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F145883_71106_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F127486_06776_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F110247_08865_0|CSTM-ALL|CSTM-00|2020|PCT|1.34|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132969_84003_0|SrvcGrp|86843|2022|PDM|33.60|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F147962_85008_0|CSTM-ALL|CSTM-00|2020|PDM|3393.00|99|0.00|AEG 7 (NO REV)|
20|FH_F133922_70563_0|SrvcGrp|86474|2022|PDM|56.44|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F120719_27540_0|SrvcGrp|3378|2022|PDM|6090.00|99|0.00|OBSERVATION SVCS|
20|FH_F95631_33705_0|SrvcGrp|73656|2022|PDM|1185.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F85212_71075_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|AETNA OP SVCS|
20|FH_F120583_43219_0|SrvcGrp|88620|2022|PDM|90.00|99|0.00|SKILLED NURSING RN|
20|FH_F110402_74361_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F81698_10457_0|SrvcGrp|86835|2022|PDM|10.50|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F134593_60007_0|SrvcGrp|10577|2022|PDM|48.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F120425_11106_0|SrvcGrp|73841|2022|PDM|330.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F110589_70809_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F31714_0_0|SrvcGrp|9774|2022|PDM|2100.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F121225_98902_0|SrvcGrp|17002|2022|PDM|424.11|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS|
20|FH_F138147_18018_0|SrvcGrp|103525|2022|PDM|20.54|99|0.00|AETNA-MB SVC PLAN DEB BY NON-MD (HCFA)|
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_F118252_32216_0|SrvcGrp|109330|2022|PCT|1.09|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F54592_0_0|SrvcGrp|17007|2022|PDM|74.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS|
20|FH_F134508_14072_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134537_03060_0|SrvcGrp|86723|2022|PDM|354.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PDM|976.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1446.00|99|0.00|2007 MEDICARE ASPG VI|
20|FH_F70607_0_0|SrvcGrp|17139|2022|PDM|686.00|99|0.00|HOSPICE CARE|
20|FH_F70607_0_0|SrvcGrp|10411|2022|PDM|115.99|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F72963_0_0|SrvcGrp|17075|2022|PDM|1517.00|99|0.00|ASPG VI|
20|FH_F85211_0_0|SrvcGrp|72992|2022|PDM|611.60|99|0.00|AEG 2|
20|FH_F98800_85021_0|SrvcGrp|73643|2022|PDM|2559.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F98800_85021_0|SrvcGrp|73485|2022|PDM|3516.00|99|0.00|AETNA REHAB|
20|FH_F105145_75075_0|SrvcGrp|82369|2022|PCT|2.00|99|0.00|AETNA LABORATORY|
20|FH_F75842_0_0|SrvcGrp|3378|2022|PDM|129.13|99|0.00|OBSERVATION SVCS|
20|FH_F146806_33157_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120522_53549_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120775_28805_0|SrvcGrp|73841|2022|PDM|372.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F120795_27514_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|AEG 10 (NO REV)|
20|FH_F125440_04043_0|SrvcGrp|79280|2022|PDM|546.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F146160_52803_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133749_84604_0|SrvcGrp|112458|2022|PDM|50.00|99|0.00|MID-LINE INSERTION|
20|FH_F36552_0_0|SrvcGrp|18237|2022|PDM|7845.00|99|0.00|MS DRG 284|
20|FH_F118147_33801_0|SrvcGrp|89149|2022|PDM|198.00|99|0.00|OP INTENSIVE|
20|FH_F145839_45244_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|592.00|99|0.00|AEG 3 (NO REV)|
20|FH_F40780_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|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_F110453_0_0|SrvcGrp|72998|2022|PDM|771.00|99|0.00|AEG 5|
20|FH_F126188_59404_0|SrvcGrp|110366|2022|PDM|600.00|99|0.00|TRABECULOPLASTY|
20|FH_F149199_73005_0|CSTM-ALL|CSTM-00|2020|PDM|2019.00|99|0.00|AEG 8 (NO REV)|
20|FH_F93122_01854_0|CSTM-ALL|CSTM-00|2020|PDM|828.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F96780_0_0|SrvcGrp|28549|2022|PDM|1761.00|99|0.00|VITRECTOMY|
20|FH_F117344_75062_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F84912_0_0|SrvcGrp|83180|2022|PDM|20.64|99|0.00|ORTHOPANTOGRAM|
20|FH_F70607_0_0|SrvcGrp|73671|2022|PCT|0.55|99|0.00|GRADIENT COMPRESSION STOCKING|
20|FH_F70684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|GENERAL ACUTE CARE|
20|FH_F101084_15459_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F105303_15136_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F80087_0_0|SrvcGrp|77419|2022|PCT|1.00|99|0.00|AETNA REFERENCE LABORATORY|
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|1801.00|99|0.00|AEG 5  (NO REV)|
20|FH_F116023_10027_0|SrvcGrp|93919|2022|PDM|210.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F132187_66111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132197_67437_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133153_44113_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F133494_90023_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F151063_44094_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F151063_44094_0|SrvcGrp|86722|2022|PDM|220.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F151141_24014_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 4 (NO REV)|
20|FH_F121338_37756_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F114931_0_0|SrvcGrp|91939|2022|PDM|1850.00|99|0.00|SURGICAL TREATMENT OF ANAL FISTULA|
20|FH_F38564_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F113715_45005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F113738_27006_0|SrvcGrp|48398|2022|PDM|130.00|99|0.00|PT SERVICES|
20|FH_F148901_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F110381_0_0|SrvcGrp|103973|2022|PDM|8734.00|99|0.00|AETNA DISK SURGERY|
20|FH_F97721_01053_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F73025_0_0|SrvcGrp|46424|2022|PDM|30.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F85039_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F114866_77706_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F142321_29401_0|SrvcGrp|89337|2022|PDM|1122.00|99|0.00|DETOXIFICATION|
20|FH_F115895_0_0|SrvcGrp|80617|2022|PDM|9442.00|99|0.00|ARTHOPLASTY|
20|FH_F103800_70811_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103961_63017_0|SrvcGrp|3810|2022|PDM|105.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F112064_0_0|SrvcGrp|29155|2022|PCT|0.00|99|0.00|HOSPICE SVCS|
20|FH_F113392_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|900.00|99|0.00|AEG 4 (NO REV)|
20|FH_F36584_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD NU|
20|FH_F39426_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40471_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|1100.00|99|0.00|AEG 3 (NO REV)|
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|4427.00|99|0.00|AEG 8 (NO REV)|
20|FH_F72204_0_0|SrvcGrp|42975|2022|PDM|80.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F119214_0_0|SrvcGrp|75491|2022|PDM|1366.00|99|0.00|AEG 7|
20|FH_F114389_50131_0|SrvcGrp|47183|2022|PDM|132.55|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F55812_0_0|SrvcGrp|10541|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F32620_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124060_76040_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F124082_78526_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F147081_02130_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F64819_0_0|SrvcGrp|74541|2022|PCT|1.50|99|0.00|HAPA-NWPA LAB W/SURG|
20|FH_F98380_43055_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F124267_29671_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F121799_0_0|SrvcGrp|29155|2022|PDM|103.00|99|0.00|HOSPICE SVCS|
20|FH_F64779_0_0|SrvcGrp|42824|2022|PDM|163.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F98042_10468_0|SrvcGrp|73659|2022|PDM|10464.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F98042_10468_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F114666_30342_0|SrvcGrp|84939|2022|PDM|22500.00|99|0.00|SHOULDER JOINT|
20|FH_F114792_48849_0|SrvcGrp|12659|2022|PDM|695.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 4 (NO REV)|
20|FH_F148553_85016_0|SrvcGrp|15026|2022|PDM|3500.00|99|0.00|CARDIOVERTER DEFIBRILLATOR INSERTION (SINGLE OR DUAL)|
20|FH_F42946_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43321_0_0|SrvcGrp|45725|2022|PCT|0.88|99|0.00|OCN F/S: LAB MOD 26|
20|FH_F117069_15236_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F134687_14226_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136828_32405_0|SrvcGrp|16069|2022|PDM|724.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F136914_64081_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F136930_73114_0|SrvcGrp|62210|2022|PDM|121.00|99|0.00|MAMMOGRAPHY - VISIT LEVEL|
20|FH_F115608_24171_0|SrvcGrp|99189|2022|PCT|0.00|99|0.00|C-SECTION|
20|FH_F116199_75042_0|SrvcGrp|12659|2022|PDM|796.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F41463_0_0|SrvcGrp|24745|2022|PDM|76.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F41795_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42024_0_0|SrvcGrp|35558|2022|PCT|1.10|99|0.00|LITHOTRIPSY - OP|
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|942.50|99|0.00|2005 ASPG GROUPER VI|
20|FH_F46433_0_0|SrvcGrp|17302|2022|PDM|65.00|99|0.00|HYDRATION THERAPY - 3+ LITERS|
20|FH_F69982_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133536_0_0|SrvcGrp|67066|2022|PDM|9500.00|99|0.00|CERVICAL SURGERY|
20|FH_F150939_0_0|SrvcGrp|22380|2022|PDM|41.00|99|0.00|CPT CODE 94060|
20|FH_F48693_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PINEHURST RAD|
20|FH_F113585_20155_0|SrvcGrp|73742|2022|PCT|1.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F138627_82901_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F138992_72703_0|SrvcGrp|104363|2022|PCT|1.41|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F32589_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.64|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1406 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|757.69|99|0.00|HAPA WPA-NWPA 2012-13 ASC 402 W/O REV|
20|FH_F151401_36607_0|SrvcGrp|73700|2022|PCT|0.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F132238_27615_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123184_20906_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F40334_0_0|CSTM-ALL|CSTM-00|2020|PDM|1591.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43239_0_0|SrvcGrp|3178|2022|PDM|850.00|99|0.00|ACUTE PSYCH|
20|FH_F135427_19610_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F135427_19610_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135447_53226_0|SrvcGrp|104469|2022|PDM|5000.00|99|0.00|VBAC DELIVERY|
20|FH_F135447_53226_0|SrvcGrp|79238|2022|PDM|1750.00|99|0.00|TRANSFER|
20|FH_F135924_02906_0|SrvcGrp|82137|2022|PCT|1.03|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F100880_67735_0|SrvcGrp|109112|2022|PDM|41004.00|99|0.00|ESOPHAGEAL RECORDING|
20|FH_F116460_19464_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F127399_0_0|SrvcGrp|72998|2022|PDM|2705.00|99|0.00|AEG 5|
20|FH_F32938_0_0|SrvcGrp|12342|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F121823_46234_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F151143_0_0|SrvcGrp|12868|2022|PDM|24000.00|99|0.00|AIR AMBULANCE|
20|FH_F151143_0_0|SrvcGrp|115962|2022|PDM|4250.00|99|0.00|NON-EMERGENT AIR TRANSPORT 1 WAY (MOD NE)|
20|FH_F32803_0_0|CSTM-ALL|CSTM-00|2020|PDM|30341.00|99|0.00|CV SURGERY|
20|FH_F33785_0_0|SrvcGrp|11086|2022|PDM|3300.00|99|0.00|CSECT (MOTHER ONLY)|
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|AEG 3 (NO REV)|
20|FH_F75205_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128370_76132_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F111301_33122_0|SrvcGrp|103913|2022|PCT|0.84|99|0.00|OP DIALYSIS|
20|FH_F111363_33169_0|SrvcGrp|16301|2022|PDM|6354.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F141651_0_0|SrvcGrp|111209|2022|PDM|1870.00|99|0.00|TONGUE BASE VOL REDUCTION|
20|FH_F65882_0_0|SrvcGrp|12403|2022|PDM|817.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F69202_0_0|SrvcGrp|20096|2022|PDM|42500.00|99|0.00|MS DRG 222-223 ONLY|
20|FH_F145587_0_0|SrvcGrp|89988|2022|PDM|1262.70|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F34864_0_0|SrvcGrp|3069|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F131000_0_0|SrvcGrp|67065|2022|PDM|15494.00|99|0.00|CERVICAL SURGERY|
20|FH_F131000_0_0|SrvcGrp|91941|2022|PDM|3343.00|99|0.00|NASAL/SINUS ENDOSCOPY WITH DILATION|
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|2006 MEDICARE ASPG IX|
20|FH_F87500_16823_0|SrvcGrp|46424|2022|PDM|104.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F128695_50049_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F98626_29118_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F102282_06795_0|SrvcGrp|88621|2022|PDM|103.74|99|0.00|SKILLED NURSING LPN|
20|FH_F129151_43950_0|SrvcGrp|107861|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F96960_35404_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F102960_50613_0|SrvcGrp|75522|2022|PDM|851.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD|
20|FH_F103780_64804_0|SrvcGrp|88980|2022|PDM|775.00|99|0.00|NURSERY NEWBORN|
20|FH_F143542_0_0|SrvcGrp|109765|2022|PDM|1721.00|99|0.00|CLOSURE OF LACRIMAL PUNCTUM|
20|FH_F39955_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F136487_71269_0|SrvcGrp|90854|2022|PDM|900.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F120489_63552_0|SrvcGrp|107637|2022|PCT|0.00|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F137241_07481_0|SrvcGrp|80|2022|PDM|1206.00|99|0.00|ACUTE PSYCH|
20|FH_F114178_19083_0|SrvcGrp|75545|2022|PDM|305.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F114092_83350_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F142527_89109_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F142707_02891_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138584_30912_0|SrvcGrp|113414|2022|PDM|550.00|99|0.00|MANDIBULAR FRACTURE TREATMENT|
20|FH_F132733_0_0|SrvcGrp|107733|2022|PDM|4834.00|99|0.00|CESAREAN SECTION|
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 1 (NO REV)|
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 7 (NO REV)|
20|FH_F119130_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132738_0_0|SrvcGrp|109|2022|PDM|887.00|99|0.00|CD - DETOX|
20|FH_F149610_76543_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149644_91367_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F151610_77304_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118789_92211_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F127656_06068_0|SrvcGrp|95661|2022|PDM|166.95|99|0.00|RESPITE CARE (HCFA)|
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|PSYCHIATRIC PARTIAL HOSPITALIZATION (IP) - ADULT|
20|FH_F139887_0_0|SrvcGrp|41327|2022|PDM|1848.00|99|0.00|OP SURGERY CPT 28308|
20|FH_F133133_32433_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F131430_17566_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F131702_17022_0|SrvcGrp|88620|2022|PDM|128.00|99|0.00|SKILLED NURSING RN|
20|FH_F111584_07002_0|SrvcGrp|89149|2022|PDM|177.00|99|0.00|OP INTENSIVE|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|121.01|99|0.00|DELAWARE VALLEY- ASC 119|
20|FH_F69651_0_0|SrvcGrp|10541|2022|PDM|95.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F97780_43614_0|SrvcGrp|88977|2022|PDM|7687.00|99|0.00|C-SECTION DELIVERY|
20|FH_F109484_0_0|SrvcGrp|73008|2022|PDM|333.00|99|0.00|AEG 10|
20|FH_F111001_0_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F113143_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F115264_0_0|SrvcGrp|82603|2022|PCT|6.00|99|0.00|AETNA HUMAN IG IM|
20|FH_F142315_33701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111141_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F119535_0_0|SrvcGrp|28221|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|526.00|99|0.00|AEG 2 (NO REV)|
20|FH_F138929_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F131047_0_0|SrvcGrp|105688|2022|PCT|0.57|99|0.00|SLEEP STUDIES|
20|FH_F132627_0_0|SrvcGrp|29077|2022|PDM|43.86|99|0.00|HOME TRANSFUSION|
20|FH_F132627_0_0|SrvcGrp|22588|2022|PDM|84.66|99|0.00|CHEMOTHERAPY|
20|FH_F133025_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|AEG 2 (NO REV)|
20|FH_F75542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114389_50131_0|SrvcGrp|86839|2022|PDM|102.25|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F114389_50131_0|SrvcGrp|86779|2022|PDM|215.86|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F124180_0_0|SrvcGrp|57863|2022|PDM|3215.50|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F124067_15425_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F124082_78526_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F62624_0_0|SrvcGrp|9838|2022|PDM|2300.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F39753_0_0|SrvcGrp|997|2022|PCT|0.85|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F39753_0_0|SrvcGrp|13551|2022|PDM|731.00|99|0.00|NEWBORN NURSERY|
20|FH_F100703_0_0|SrvcGrp|16694|2022|PDM|3535.00|99|0.00|KNEE SCOPE, CHONDROPLASTY|
20|FH_F124637_77080_0|SrvcGrp|108061|2022|PDM|300.00|99|0.00|OP THERAPY SERVICES|
20|FH_F118848_0_0|SrvcGrp|33967|2022|PDM|4800.00|99|0.00|CPT 47562|
20|FH_F121078_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F87856_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_F114666_30342_0|SrvcGrp|105000|2022|PDM|3000.00|99|0.00|REPAIR OF KNEECAP FRACTURE|
20|FH_F138456_33543_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F114985_32073_0|SrvcGrp|79586|2022|PDM|201.00|99|0.00|CPT 43200|
20|FH_F119725_0_0|SrvcGrp|106291|2022|PDM|260.67|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F117075_68847_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F134760_32202_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134791_98034_0|SrvcGrp|89268|2022|PDM|296.00|99|0.00|AETNA INITIAPSYCH DIAGNOSTIC EVALUATION|
20|FH_F136778_62034_0|SrvcGrp|16|2022|PDM|1321.00|99|0.00|ACUTE REHABILITATION|
20|FH_F136778_62034_0|CSTM-ALL|CSTM-00|2020|PDM|6484.00|99|0.00|AEG 9 (NO REV)|
20|FH_F136778_62034_0|CSTM-ALL|CSTM-00|2020|PDM|1988.00|99|0.00|AEG 1 (NO REV)|
20|FH_F112187_98272_0|CSTM-ALL|CSTM-00|2020|PDM|2434.00|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F37655_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F43503_0_0|CSTM-ALL|CSTM-00|2020|PDM|1704.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115144_71373_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F116393_07002_0|SrvcGrp|111261|2022|PDM|140.00|99|0.00|CINE/VIDEO X-RAY, THROAT/ESO|
20|FH_F42688_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|BURN INTENSIVE CARE|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD AW RATE|
20|FH_F81152_0_0|SrvcGrp|33166|2022|PDM|472.50|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F62680_0_0|SrvcGrp|17139|2022|PDM|528.00|99|0.00|HOSPICE CARE|
20|FH_F67303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F133536_0_0|SrvcGrp|26273|2022|PDM|3000.00|99|0.00|CPT 29880|
20|FH_F39098_0_0|SrvcGrp|38|2022|PDM|2627.00|99|0.00|NORMAL DELIVERY|
20|FH_F47605_0_0|SrvcGrp|86607|2022|PDM|1200.00|99|0.00|COMPREHENSIVE PAIN EVALUATION|
20|FH_F48836_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F57953_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F67167_0_0|CSTM-ALL|CSTM-00|2020|PDM|2651.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117715_0_0|SrvcGrp|75489|2022|PDM|1048.00|99|0.00|AEG 6|
20|FH_F84751_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS|
20|FH_F151441_98664_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131132_44077_0|CSTM-ALL|CSTM-00|2020|PDM|2913.00|99|0.00|AEG 3 (NO REV)|
20|FH_F121407_73701_0|CSTM-ALL|CSTM-00|2020|PCT|0.42|99|0.00|OP SVCS|
20|FH_F132689_18436_0|SrvcGrp|86723|2022|PDM|479.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F133668_63128_0|SrvcGrp|90854|2022|PDM|900.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F111301_33122_0|SrvcGrp|82759|2022|PDM|46.00|99|0.00|ASSAY CPK IN BLOOD|
20|FH_F141651_0_0|SrvcGrp|91422|2022|PDM|2200.00|99|0.00|REMOVAL OF ADENOIDS|
20|FH_F87153_0_0|CSTM-ALL|CSTM-00|2020|PDM|498.28|99|0.00|AETNA POLYSOMNOGRAPHY|
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|1179.61|99|0.00|AEG 6 (NO REV)|
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 10 (NO REV)|
20|FH_F119023_91406_0|SrvcGrp|86853|2022|PDM|35.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F118932_07652_0|SrvcGrp|73002|2022|PDM|5092.00|99|0.00|AEG 7|
20|FH_F126853_19053_0|SrvcGrp|46605|2022|PDM|75.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F129441_19134_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F129514_79605_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F117105_77619_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F117153_34113_0|SrvcGrp|89149|2022|PDM|171.00|99|0.00|OP INTENSIVE|
20|FH_F117190_84020_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F137898_46540_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F137930_51546_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F35210_0_0|SrvcGrp|65|2022|PDM|3199.00|99|0.00|OBSTETRICAL CARE|
20|FH_F109652_0_0|SrvcGrp|20293|2022|PDM|49803.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY|
20|FH_F90735_94070_0|SrvcGrp|90290|2022|PDM|45.00|99|0.00|MOPATH PROCEDURE LEVEL 1|
20|FH_F138543_60130_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1389.00|99|0.00|ASPG V|
20|FH_F50446_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F33925_0_0|SrvcGrp|13845|2022|PCT|0.70|99|0.00|RADIOLOGY|
20|FH_F140007_0_0|SrvcGrp|97139|2022|PDM|7887.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F40431_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|SPINAL CORD CARE|
20|FH_F136429_0_0|SrvcGrp|79595|2022|PDM|714.00|99|0.00|CPT 45385|
20|FH_F47693_16148_0|SrvcGrp|33414|2022|PDM|125.00|99|0.00|SNF VENTILATOR SUPPORT|
20|FH_F48348_61605_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54612_07631_0|SrvcGrp|12401|2022|PDM|132.20|99|0.00|RN VISIT|
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|1556.00|99|0.00|AEG 7 (NO REV)|
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 2 (NO REV)|
20|FH_F100906_0_0|SrvcGrp|68543|2022|PDM|1020.00|99|0.00|CPT 36561|
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|1555.14|99|0.00|2005 ASPG GROUPER VII|
20|FH_F119444_72903_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F137951_0_0|SrvcGrp|36591|2022|PDM|3000.00|99|0.00|CPT 63685|
20|FH_F148379_89129_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F148548_37909_0|SrvcGrp|115408|2022|PCT|0.00|99|0.00|IMPLANT NEURORECEIVER 23 INCIDENTAL CODES|
20|FH_F130108_0_0|SrvcGrp|10904|2022|PDM|750.00|99|0.00|EMERGENCY ROOM LEVEL II|
20|FH_F135649_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40350_0_0|SrvcGrp|12235|2022|PDM|1450.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|501.00|99|0.00|AEG 1 (NO REV)|
20|FH_F121416_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F144011_60616_0|SrvcGrp|113624|2022|PDM|8364.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F90032_15234_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|2024.00|99|0.00|AEG 9 (NO REV)|
20|FH_F87155_04105_0|SrvcGrp|43572|2022|PDM|68.29|99|0.00|PICC-LINE INSERTION|
20|FH_F145864_65084_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145937_75240_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F108700_63857_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144324_67467_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92792_0_0|SrvcGrp|88154|2022|PDM|2200.00|99|0.00|LASER TREATMENT OLD RETINA|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|418.61|99|0.00|ASPG 212|
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|406.00|99|0.00|AEG 1 (NO REV)|
20|FH_F38250_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F148023_34471_0|SrvcGrp|115269|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|1848.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132729_0_0|SrvcGrp|51672|2022|PDM|7161.00|99|0.00|MS DRG 286-287 ONLY|
20|FH_F148886_60621_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS|
20|FH_F122262_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F36576_0_0|SrvcGrp|147|2022|PCT|0.90|99|0.00|HOME HEALTH CARE|
20|FH_F71145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141870_85224_0|SrvcGrp|111026|2022|PCT|0.83|99|0.00|SUPPLIES|
20|FH_F133530_11237_0|CSTM-ALL|CSTM-00|2020|PDM|2920.00|99|0.00|AEG 8 (NO REV)|
20|FH_F63301_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F87620_80014_0|CSTM-ALL|CSTM-00|2020|PDM|873.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F47479_0_0|SrvcGrp|42974|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F31466_0_0|CSTM-ALL|CSTM-00|2020|PDM|694.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136812_0_0|SrvcGrp|107749|2022|PDM|175.00|99|0.00|CAPD/CCPD|
20|FH_F38949_0_0|SrvcGrp|10107|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.27|99|0.00|DELAWARE VALLEY- ASC 122|
20|FH_F144769_0_0|SrvcGrp|360|2022|PDM|1155.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F144011_60616_0|SrvcGrp|109057|2022|PCT|0.45|99|0.00|CARDIAC STUDIES|
20|FH_F141987_02859_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|163.34|99|0.00|AETNA SLEEP STUDY|
20|FH_F118672_29036_0|CSTM-ALL|CSTM-00|2020|PDM|2871.00|99|0.00|AEG 4 (NO REV)|
20|FH_F109624_15401_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|620.42|99|0.00|ASPG 2|
20|FH_F118728_33409_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F127284_84403_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F133021_00910_0|SrvcGrp|112282|2022|PDM|6000.00|99|0.00|PERCUTANEOUS TRANSCATHETER|
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|67.67|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F81373_64064_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97563_83201_0|SrvcGrp|73659|2022|PDM|12075.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F119530_0_0|SrvcGrp|82137|2022|PDM|450.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F34864_0_0|CSTM-ALL|CSTM-00|2020|PDM|2785.00|99|0.00|ASPG VII|
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 9 (NO REV)|
20|FH_F32285_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114569_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F87501_32055_0|SrvcGrp|80284|2022|PDM|148.30|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F129240_10028_0|SrvcGrp|13929|2022|PDM|25.00|99|0.00|GROWTH HORMONE|
20|FH_F129240_10028_0|SrvcGrp|84260|2022|PCT|1.00|99|0.00|AETNA ALL DRUGS|
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|MSDRG 231-232 CORONARY BYPASS|
20|FH_F128031_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136429_0_0|SrvcGrp|71221|2022|PDM|665.00|99|0.00|EGD W/BALLOON DIALATION CPT 43249|
20|FH_F122953_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F142087_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.53|99|0.00|HSS ASC|
20|FH_F100906_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F62577_0_0|SrvcGrp|58460|2022|PDM|1966.00|99|0.00|ASPG VII|
20|FH_F90314_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F90314_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|HSS APC GROUPED|
20|FH_F136371_29720_0|SrvcGrp|3178|2022|PDM|984.00|99|0.00|ACUTE PSYCH|
20|FH_F120489_63552_0|SrvcGrp|73500|2022|PDM|571.00|99|0.00|AETNA ER LEVEL I|
20|FH_F120490_64133_0|SrvcGrp|86853|2022|PDM|10.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F120506_53934_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120475_81052_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134126_11554_0|SrvcGrp|97968|2022|PDM|976.00|99|0.00|CT SCAN|
20|FH_F134156_32174_0|SrvcGrp|73842|2022|PDM|229.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137147_75006_0|SrvcGrp|98270|2022|PDM|5880.00|99|0.00|INJECT SPINE L/S (CD)|
20|FH_F137147_75006_0|CSTM-ALL|CSTM-00|2020|PCT|0.58|99|0.00|OP SVCS|
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 10 (NO REV)|
20|FH_F97566_79902_0|CSTM-ALL|CSTM-00|2020|PCT|0.32|99|0.00|OP SVCS|
20|FH_F138627_82901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138627_82901_0|SrvcGrp|98936|2022|PDM|95.00|99|0.00|HIT CONT CHEMOTX (HCFA)|
20|FH_F134654_0_0|SrvcGrp|110064|2022|PDM|22.43|99|0.00|GROUP BH TREATMENT 15 MINS|
20|FH_F151603_27609_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F151603_27609_0|SrvcGrp|88160|2022|PDM|6632.65|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F119046_74012_0|SrvcGrp|88678|2022|PCT|0.00|99|0.00|ACUTE REHAB I|
20|FH_F118943_64506_0|SrvcGrp|10577|2022|PDM|25.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F147801_90703_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F117108_37841_0|SrvcGrp|73606|2022|PDM|1600.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F117211_15143_0|SrvcGrp|48385|2022|PDM|88.00|99|0.00|SPEECH THERAPY|
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|578.00|99|0.00|AEG 3 (NO REV)|
20|FH_F109652_0_0|SrvcGrp|15788|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F112080_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90880_15108_0|SrvcGrp|72379|2022|PCT|1.00|99|0.00|SPEECH THERAPY|
20|FH_F38321_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F85757_0_0|SrvcGrp|73656|2022|PDM|480.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F109513_0_0|SrvcGrp|90438|2022|PDM|2500.00|99|0.00|ARM SURGICAL PROCEDURES|
20|FH_F129487_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F39749_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148554_85016_0|SrvcGrp|115459|2022|PDM|3641.00|99|0.00|REMOVE & REPLACE DEFIB GEN 2 LEAD|
20|FH_F148554_85016_0|SrvcGrp|69620|2022|PDM|2850.00|99|0.00|CPT 93459 PTCA|
20|FH_F39640_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|NEBULIZER (DME) (MOD NU)|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|95.00|99|0.00|HAPA EPA ASC 15|
20|FH_F81373_64064_0|SrvcGrp|78377|2022|PDM|702.00|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F118388_34952_0|SrvcGrp|78067|2022|PDM|425.00|99|0.00|SUBACUTE CARE|
20|FH_F101751_25302_0|SrvcGrp|78419|2022|PDM|2091.13|99|0.00|VBAC DELIVERY|
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|2952.00|99|0.00|AEG 9 (NO REV)|
20|FH_F133293_49085_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35411_0_0|SrvcGrp|913|2022|PDM|539.00|99|0.00|ELECTROSHOCK TREATMENT|
20|FH_F123373_0_0|SrvcGrp|62963|2022|PCT|0.52|99|0.00|SURGICAL|
20|FH_F130616_43615_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146377_85007_0|SrvcGrp|74668|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F79902_0_0|SrvcGrp|8968|2022|PDM|2950.00|99|0.00|NICU LEVEL III & IV|
20|FH_F148599_98034_0|SrvcGrp|31072|2022|PDM|2459.00|99|0.00|MS DRG 794 ONLY|
20|FH_F101840_76054_0|SrvcGrp|93750|2022|PDM|1321.00|99|0.00|ERCP REMOVE FOREIGN BODY DUCT|
20|FH_F97140_91730_0|SrvcGrp|73643|2022|PDM|2329.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F117372_07442_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F133124_33837_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126942_39540_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F133477_90247_0|CSTM-ALL|CSTM-00|2020|PDM|5555.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132279_63775_0|SrvcGrp|73806|2022|PCT|0.75|99|0.00|AETNA ER|
20|FH_F141217_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132541_39120_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117835_14551_0|SrvcGrp|33165|2022|PDM|285.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F145988_06105_0|CSTM-ALL|CSTM-00|2020|PDM|4009.00|99|0.00|AEG 2 (NO REV)|
20|FH_F94300_0_0|SrvcGrp|93432|2022|PDM|4200.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F117380_60020_0|SrvcGrp|89149|2022|PDM|214.00|99|0.00|OP INTENSIVE|
20|FH_F37042_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F117717_68410_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F54552_0_0|SrvcGrp|10545|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F96261_0_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F148703_33853_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119602_0_0|SrvcGrp|58638|2022|PDM|3000.00|99|0.00|CPT 63688|
20|FH_F119104_44870_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F36118_0_0|SrvcGrp|9832|2022|PDM|102.00|99|0.00|ST SVCS|
20|FH_F92676_15063_0|SrvcGrp|70120|2022|PDM|8993.00|99|0.00|HAPA WPA:PTCA W/STENT|
20|FH_F132613_84601_0|SrvcGrp|74668|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F92833_0_0|SrvcGrp|26274|2022|PDM|2215.00|99|0.00|CPT 29877|
20|FH_F40645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F117911_86403_0|SrvcGrp|48394|2022|PDM|58.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F49617_0_0|SrvcGrp|997|2022|PCT|0.40|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F151520_44134_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F56792_0_0|CSTM-ALL|CSTM-00|2020|PDM|2141.00|99|0.00|ASPG VIII WITH MOD SG|
20|FH_F117450_63131_0|SrvcGrp|48398|2022|PDM|114.00|99|0.00|PT SERVICES|
20|FH_F146211_68144_0|SrvcGrp|10364|2022|PDM|982.00|99|0.00|CPT CODE 99284|
20|FH_F97182_21502_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F100741_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F134447_12883_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F133287_40215_0|SrvcGrp|102420|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1664.00|99|0.00|AEG 7 (NO REV)|
20|FH_F133251_89521_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F91194_33511_0|SrvcGrp|74500|2022|PDM|150.00|99|0.00|CPT 76805|
20|FH_F61494_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 471-473 CERVICAL FUSION|
20|FH_F131282_0_0|SrvcGrp|104721|2022|PDM|810.00|99|0.00|REVISE EYELID W/ EXCESS SKIN|
20|FH_F100666_81301_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 3 (NO REV)|
20|FH_F66480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109625_27330_0|SrvcGrp|87992|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTIAL|
20|FH_F133052_33462_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125070_64117_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F44795_0_0|SrvcGrp|30959|2022|PDM|80.00|99|0.00|NURSING CARE|
20|FH_F37562_0_0|SrvcGrp|25939|2022|PDM|117.00|99|0.00|SPEECH THERAPY|
20|FH_F121068_18036_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147996_21014_0|SrvcGrp|74668|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F92677_08003_0|SrvcGrp|16750|2022|PDM|147.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F68719_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|1338.00|99|0.00|AEG 4 (NO REV)|
20|FH_F115315_43011_0|SrvcGrp|94744|2022|PCT|1.00|99|0.00|NOS FLU VACC IM (>=3 YRS)|
20|FH_F119079_41018_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F107400_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F38352_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F97543_33542_0|CSTM-ALL|CSTM-00|2020|PCT|0.37|99|0.00|OP SVCS|
20|FH_F97561_30030_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F117816_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F144011_60616_0|SrvcGrp|39823|2022|PDM|732.00|99|0.00|ER SERVICES LEVEL 3|
20|FH_F141913_65560_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132420_84660_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F100740_15206_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F97563_83201_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F133552_77006_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F35100_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128893_0_0|SrvcGrp|90707|2022|PDM|160.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F148890_45133_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117725_38036_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126666_44053_0|SrvcGrp|73841|2022|PDM|300.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F132224_89119_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111540_16823_0|SrvcGrp|104415|2022|PDM|210.00|99|0.00|PSYCH DIAGNOSTIC (HCFA)(MOD AF)|
20|FH_F81373_64064_0|SrvcGrp|18090|2022|PCT|1.00|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F117900_19118_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F145988_06105_0|SrvcGrp|114507|2022|PDM|845.00|99|0.00|HOME SLEEP STUDIES|
20|FH_F92676_15063_0|SrvcGrp|79028|2022|PDM|815.73|99|0.00|MON VALLEY ASC 117|
20|FH_F92677_08003_0|SrvcGrp|92091|2022|PDM|3.15|99|0.00|AETNA OROPHARYNGEAL SUCTION CATH|
20|FH_F132647_60067_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100784_59923_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F35368_0_0|SrvcGrp|12219|2022|PDM|6416.00|99|0.00|PACEMAKER IMPLANT|
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|611.00|99|0.00|ASPG I|
20|FH_F128445_85704_0|SrvcGrp|12659|2022|PDM|1048.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F115329_79424_0|SrvcGrp|86722|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F62601_0_0|SrvcGrp|48395|2022|PDM|30.00|99|0.00|OT SERVICES|
20|FH_F134447_12883_0|SrvcGrp|473|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F132886_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F102681_34237_0|SrvcGrp|73008|2022|PDM|453.00|99|0.00|AEG 10|
20|FH_F117827_75235_0|SrvcGrp|58509|2022|PDM|247.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F132934_63005_0|SrvcGrp|73485|2022|PDM|2046.00|99|0.00|AETNA REHAB|
20|FH_F120406_84047_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43018_0_0|SrvcGrp|35164|2022|PCT|0.75|99|0.00|NICU LEVEL II OR III|
20|FH_F101754_63141_0|SrvcGrp|97974|2022|PDM|29.61|99|0.00|PURE TONE AUDIOMETRY AIR|
20|FH_F67288_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F63301_0_0|CSTM-ALL|CSTM-00|2020|PDM|30.00|99|0.00|HOME INFUSION NURSING SERVICES MOD SD|
20|FH_F97562_29803_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|3126.00|99|0.00|AEG 8 (NO REV)|
20|FH_F81485_0_0|SrvcGrp|79637|2022|PCT|1.20|99|0.00|2014 WMS CHRISTIAN ASSOC LAB W/ OBS OR SURG|
20|FH_F59274_0_0|SrvcGrp|46604|2022|PDM|35.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F97561_30030_0|SrvcGrp|73461|2022|PDM|7175.00|99|0.00|AETNA NICU IV|
20|FH_F133261_78041_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146258_90004_0|SrvcGrp|114093|2022|PCT|0.60|99|0.00|PARTIAL HOSPITAL SUBSTANCE ABUSE|
20|FH_F148886_60621_0|SrvcGrp|111928|2022|PCT|1.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 4 (NO REV)|
20|FH_F49637_0_0|SrvcGrp|45617|2022|PDM|3400.00|99|0.00|TOTAL KNEE (OPEN)|
20|FH_F147995_67037_0|CSTM-ALL|CSTM-00|2020|PDM|2300.00|99|0.00|AEG 3 (NO REV)|
20|FH_F90811_0_0|SrvcGrp|87769|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F146320_27610_0|SrvcGrp|111139|2022|PDM|1989.00|99|0.00|ARTERY-VEIN GRAFT|
20|FH_F41276_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F128508_37210_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88818_0_0|SrvcGrp|75489|2022|PDM|630.00|99|0.00|AEG 6|
20|FH_F123181_75057_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F40203_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F92676_15063_0|SrvcGrp|78972|2022|PDM|1589.84|99|0.00|MON VALLEY ASC 302|
20|FH_F112853_22408_0|SrvcGrp|104917|2022|PDM|650.00|99|0.00|HOME VENT NON-INVASIVE INTER (HCFA)|
20|FH_F49776_0_0|SrvcGrp|13703|2022|PDM|40.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F119206_35007_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117993_32054_0|SrvcGrp|107763|2022|PCT|1.10|99|0.00|AETNA LABORATORY (POS 72)|
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41976_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F101840_76054_0|SrvcGrp|100765|2022|PCT|1.20|99|0.00|PT/OT/ST|
20|FH_F144048_91324_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136330_0_0|SrvcGrp|3327|2022|PDM|159.00|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F132729_0_0|SrvcGrp|3078|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.00|99|0.00|ASPG VIII|
20|FH_F150951_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128316_22192_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F113264_71860_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F98600_91730_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD HOMEHEALTH|
20|FH_F121009_76180_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F139666_26175_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139666_26175_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|OP SVCS|
20|FH_F150769_02302_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F150882_84041_0|SrvcGrp|53987|2022|PDM|239.49|99|0.00|PHOTOTHERAPY|
20|FH_F150882_84041_0|SrvcGrp|86833|2022|PDM|19.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|40883.00|99|0.00|MS DRG 228-230|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|1166.00|99|0.00|ACUTE PSYCH|
20|FH_F40899_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F35731_33709_0|CSTM-ALL|CSTM-00|2020|PCT|0.43|99|0.00|GENERAL ACUTE CARE|
20|FH_F149023_44122_0|SrvcGrp|33979|2022|PDM|12401.00|99|0.00|CPT 27440|
20|FH_F134847_0_0|SrvcGrp|87026|2022|PDM|1182.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F146204_0_0|SrvcGrp|24543|2022|PDM|1500.00|99|0.00|REMOVE VAGINA GLAND LESION|
20|FH_F117799_0_0|SrvcGrp|77585|2022|PDM|3130.00|99|0.00|CPT 58558 - 58563|
20|FH_F39772_0_0|SrvcGrp|15|2022|PDM|2015.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F129966_18017_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|395.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F117605_85260_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F147224_48026_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IP MULTI ROOM COMPARISON|
20|FH_F129966_18017_0|SrvcGrp|89417|2022|PDM|324.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 5  (NO REV)|
20|FH_F117799_0_0|SrvcGrp|16301|2022|PDM|3395.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F44455_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|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_F35088_0_0|SrvcGrp|72|2022|PDM|660.00|99|0.00|NEWBORN NURSERY|
20|FH_F85437_0_0|SrvcGrp|473|2022|PDM|352.80|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F150982_0_0|SrvcGrp|111804|2022|PDM|1377.00|99|0.00|CYSTOSCOPY & REVISE URETHRA|
20|FH_F98940_70506_0|SrvcGrp|73659|2022|PDM|4067.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F39443_0_0|SrvcGrp|30320|2022|PDM|538.00|99|0.00|HAPA WPA ASC 204|
20|FH_F134869_08854_0|SrvcGrp|90040|2022|PDM|480.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F35770_33511_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132254_40207_0|SrvcGrp|86125|2022|PCT|0.85|99|0.00|AETNA FLEBOGAMMA INJ|
20|FH_F129183_24084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100540_0_0|SrvcGrp|73000|2022|PDM|1200.00|99|0.00|AEG 6|
20|FH_F120157_93103_0|SrvcGrp|92937|2022|PDM|275.00|99|0.00|INTENSIVE OP PSYCH (HCFA)|
20|FH_F141156_04401_0|CSTM-ALL|CSTM-00|2020|PDM|405.00|99|0.00|AEG 1 (NO REV)|
20|FH_F51545_0_0|SrvcGrp|42830|2022|PDM|190.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F118476_17815_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F50237_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKE|
20|FH_F139779_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F41229_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|HEAD INJURY REHABILITATION|
20|FH_F151048_15122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151120_71901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121329_33015_0|SrvcGrp|471|2022|PDM|705.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F139666_26175_0|SrvcGrp|112813|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER|
20|FH_F129307_54174_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130182_0_0|SrvcGrp|109451|2022|PDM|1457.00|99|0.00|L HRT ARTERY/VENTRICLE ANGIO|
20|FH_F150953_74953_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F132008_85226_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F127258_79912_0|SrvcGrp|73842|2022|PDM|206.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F32825_0_0|SrvcGrp|16|2022|PDM|776.00|99|0.00|ACUTE REHABILITATION|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|2640.00|99|0.00|REPAIR UMBIL HERNIA|
20|FH_F35086_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114173_18901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F127364_26241_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33632_52349_0|SrvcGrp|75522|2022|PDM|456.25|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD|
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|443.00|99|0.00|AEG 10 (NO REV)|
20|FH_F122263_37072_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F151008_92625_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136493_0_0|SrvcGrp|93098|2022|PDM|56.00|99|0.00|HOSPICE CARE|
20|FH_F128753_32501_0|SrvcGrp|75489|2022|PCT|0.64|99|0.00|AEG 6|
20|FH_F56232_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F147140_89103_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1277.00|99|0.00|REMOVAL OF TISSUE FOR GRAFT|
20|FH_F134936_01020_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F116753_0_0|SrvcGrp|106217|2022|PDM|7465.00|99|0.00|ARTHROSCOPY SHOULDER|
20|FH_F149579_95815_0|SrvcGrp|115677|2022|PDM|42.71|99|0.00|COMPLEX CHRONIC CARE MGMT STAFF 1ST 20 MINS (HCFA)|
20|FH_F40289_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|603.00|99|0.00|AEG 3 (NO REV)|
20|FH_F146266_0_0|SrvcGrp|100001|2022|PDM|6944.00|99|0.00|WRIST REPLACEMNT TOT WRIST|
20|FH_F147369_43608_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114825_32789_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F97080_85122_0|SrvcGrp|73656|2022|PDM|363.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F56813_0_0|SrvcGrp|103730|2022|PDM|171.00|99|0.00|PHYSICAL THERAPY|
20|FH_F147303_70508_0|SrvcGrp|29346|2022|PDM|32.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F124441_0_0|SrvcGrp|41334|2022|PDM|14250.00|99|0.00|TOTAL KNEE|
20|FH_F90223_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|500.00|99|0.00|AEG 2 (NO REV)|
20|FH_F71108_0_0|SrvcGrp|20071|2022|PCT|0.80|99|0.00|MS DRG 945-946|
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_F120057_0_0|SrvcGrp|12664|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F98360_11554_0|SrvcGrp|90854|2022|PDM|3706.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F149651_90046_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40453_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|TRAUMA CARE|
20|FH_F40885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137767_01841_0|SrvcGrp|73601|2022|PDM|4175.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F131028_49735_0|SrvcGrp|63297|2022|PDM|130.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.00|99|0.00|AEG 10 (NO REV)|
20|FH_F35167_0_0|SrvcGrp|903|2022|PCT|0.65|99|0.00|PTC ANGIOPLASTY|
20|FH_F130661_04441_0|SrvcGrp|105465|2022|PCT|0.86|99|0.00|AETNA THERAPIES|
20|FH_F99523_80016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41374_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F74670_0_0|SrvcGrp|72379|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F117615_30525_0|SrvcGrp|73806|2022|PDM|844.00|99|0.00|AETNA ER|
20|FH_F97300_47501_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AETNA OP PET SCANS (PET)|
20|FH_F41161_0_0|CSTM-ALL|CSTM-00|2020|PDM|548.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119316_27104_0|SrvcGrp|73842|2022|PDM|275.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147225_48093_0|SrvcGrp|110537|2022|PDM|392.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F136806_0_0|SrvcGrp|105490|2022|PDM|2218.00|99|0.00|KNEE ARTHROSCOPY PROCEDURES|
20|FH_F150442_28451_0|SrvcGrp|36591|2022|PDM|22000.00|99|0.00|CPT 63685|
20|FH_F110783_93013_0|SrvcGrp|29077|2022|PDM|12.50|99|0.00|HOME TRANSFUSION|
20|FH_F67419_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INFUSION- IV SERVICES|
20|FH_F114825_32789_0|SrvcGrp|90040|2022|PDM|296.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F49300_0_0|SrvcGrp|42974|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F50398_0_0|SrvcGrp|45148|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F132254_40207_0|SrvcGrp|29076|2022|PDM|50.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F34777_0_0|SrvcGrp|1306|2022|PDM|355.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F147321_24523_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116583_0_0|SrvcGrp|29155|2022|PDM|150.00|99|0.00|HOSPICE SVCS|
20|FH_F122377_91007_0|SrvcGrp|83420|2022|PDM|34189.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|514.00|99|0.00|AEG 3 (NO REV)|
20|FH_F128392_01026_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F146204_0_0|SrvcGrp|112207|2022|PDM|900.00|99|0.00|DESTROY VULVA LESIONS|
20|FH_F110725_48047_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F36485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% 2007 MEDICARE DME TN|
20|FH_F149269_73120_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F49300_0_0|SrvcGrp|43957|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|ACUTE IP SVCS ONE DAY STAY|
20|FH_F101083_0_0|SrvcGrp|19923|2022|PDM|2625.00|99|0.00|HYSTEROSCOPY|
20|FH_F114188_15205_0|SrvcGrp|29347|2022|PDM|27.60|99|0.00|HOME HEALTH AIDE|
20|FH_F140187_61061_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F102920_0_0|SrvcGrp|96819|2022|PDM|2026.00|99|0.00|DESTROY L/S FACET JNT ADDL|
20|FH_F131040_47715_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F131067_57105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F151762_17042_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136250_73026_0|SrvcGrp|89417|2022|PDM|500.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F136273_37601_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F120974_27607_0|SrvcGrp|19973|2022|PDM|579.00|99|0.00|CAT SCAN|
20|FH_F84394_17402_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F38289_0_0|SrvcGrp|28707|2022|PDM|316.24|99|0.00|INJECTION PROC FOR JOINT|
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|22990.00|99|0.00|MSDRG 228-230|
20|FH_F35685_0_0|SrvcGrp|21|2022|PDM|36383.00|99|0.00|DRG 108 OTHER CARDIOTHORACIC PROCEDURE|
20|FH_F100780_24153_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F36439_0_0|SrvcGrp|23001|2022|PDM|1300.00|99|0.00|V5260|
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|464.64|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F59732_0_0|SrvcGrp|24744|2022|PDM|115.00|99|0.00|PICC LINE INSERTION|
20|FH_F112568_0_0|SrvcGrp|104838|2022|PDM|240.60|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F115685_64064_0|SrvcGrp|86854|2022|PDM|75.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|902.00|99|0.00|AEG 1 (NO REV)|
20|FH_F77302_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.90|99|0.00|OP SVCS|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD KF) - CPD 1963706|
20|FH_F133215_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F125969_73112_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40063_0_0|CSTM-ALL|CSTM-00|2020|PDM|2194.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F89453_75069_0|SrvcGrp|87394|2022|PDM|95.00|99|0.00|HCPCS G0152 (HCFA)|
20|FH_F84778_0_0|SrvcGrp|78680|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F129567_60616_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116203_63901_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F34496_0_0|SrvcGrp|3069|2022|PCT|0.46|99|0.00|IMPLANTS|
20|FH_F125028_19061_0|SrvcGrp|86853|2022|PDM|36.75|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F128906_48423_0|SrvcGrp|29155|2022|PDM|130.00|99|0.00|HOSPICE SVCS|
20|FH_F37440_0_0|SrvcGrp|14501|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F92276_32308_0|SrvcGrp|90159|2022|PDM|862.00|99|0.00|ECT (AGE 18-64)|
20|FH_F141548_33410_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F123276_20737_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F99720_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F40043_0_0|SrvcGrp|33264|2022|PDM|1221.00|99|0.00|GA ASPG IV|
20|FH_F148892_0_0|SrvcGrp|92364|2022|PDM|16453.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F145536_90265_0|SrvcGrp|89337|2022|PDM|3010.00|99|0.00|DETOXIFICATION|
20|FH_F88254_33411_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132243_29571_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124660_0_0|SrvcGrp|89721|2022|PDM|2500.00|99|0.00|SPINAL NEUROSTIMULATION|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD AU) - CPD 1963706|
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|385.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F70984_0_0|CSTM-ALL|CSTM-00|2020|PDM|1409.00|99|0.00|COVENTRY ENHANCED GROUPER 6 GA NO CRESCENT|
20|FH_F148265_06067_0|SrvcGrp|67065|2022|PDM|16015.00|99|0.00|CERVICAL SURGERY|
20|FH_F129656_15005_0|SrvcGrp|24761|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F149868_0_0|SrvcGrp|83519|2022|PDM|198.00|99|0.00|HOSPICE CARE (ALL OTHER)|
20|FH_F39801_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109980_0_0|SrvcGrp|79804|2022|PDM|1200.00|99|0.00|AETNA MEDICAL/SURGICAL|
20|FH_F143903_06249_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F73013_0_0|SrvcGrp|42975|2022|PDM|182.86|99|0.00|PHYSICAL THERAPIST|
20|FH_F39917_0_0|SrvcGrp|13631|2022|PDM|120.00|99|0.00|CPT 99213|
20|FH_F55532_0_0|SrvcGrp|12030|2022|PDM|1100.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F145758_20745_0|SrvcGrp|63462|2022|PDM|867.00|99|0.00|CPT 64595|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|462.80|99|0.00|HAPA WPA-NWPA 2012-13 ASC 2 W/O REV|
20|FH_F143743_26501_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F37945_0_0|SrvcGrp|3409|2022|PDM|250.00|99|0.00|NEWBORN NURSERY|
20|FH_F139551_0_0|SrvcGrp|67065|2022|PDM|13234.00|99|0.00|CERVICAL SURGERY|
20|FH_F40198_0_0|CSTM-ALL|CSTM-00|2020|PDM|636.00|99|0.00|ACUTE PSYCH|
20|FH_F72143_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92091_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147941_06023_0|SrvcGrp|17808|2022|PDM|1092.00|99|0.00|ELECTRO CONVULSIVE THERAPY|
20|FH_F131995_04730_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F140910_53005_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F130207_33458_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F93791_0_0|SrvcGrp|41334|2022|PDM|4200.00|99|0.00|TOTAL KNEE|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F77404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110102_0_0|SrvcGrp|65720|2022|PDM|150.00|99|0.00|RESPITE CARE|
20|FH_F41474_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F122564_53809_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|147.23|99|0.00|HAPA WPA-NWPA 2012-13 ASC 313 W/O REV|
20|FH_F85314_0_0|SrvcGrp|24954|2022|PDM|409.00|99|0.00|SIGMOIDOSCOPY|
20|FH_F102200_06416_0|SrvcGrp|86828|2022|PDM|120.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F115811_33410_0|SrvcGrp|89412|2022|PDM|343.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F115872_06052_0|SrvcGrp|472|2022|PDM|691.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F115892_83263_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F66782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|MEDICAP 151 INFUSION- IV SERVICES (MOD SJ)|
20|FH_F77665_0_0|SrvcGrp|10540|2022|PDM|32.00|99|0.00|HOME HEALTH AIDE|
20|FH_F146419_68504_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146812_50401_0|SrvcGrp|96353|2022|PDM|11500.00|99|0.00|RECONSTRUCT ANKLE JOINT|
20|FH_F120795_27514_0|SrvcGrp|75506|2022|PCT|0.71|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F115298_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125440_04043_0|SrvcGrp|100499|2022|PDM|820.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F63124_0_0|SrvcGrp|42974|2022|PDM|145.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F116088_46410_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116114_37033_0|SrvcGrp|100499|2022|PDM|631.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F131454_06422_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148761_33311_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148864_81303_0|CSTM-ALL|CSTM-00|2020|PCT|2.50|99|0.00|HSS ASC|
20|FH_F151241_15139_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 3 (NO REV)|
20|FH_F129130_92562_0|SrvcGrp|111295|2022|PDM|11527.00|99|0.00|ANGIOPLASTY|
20|FH_F40081_0_0|SrvcGrp|80|2022|PDM|735.00|99|0.00|ACUTE PSYCH|
20|FH_F110381_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|1537.00|99|0.00|AEG 9 (NO REV)|
20|FH_F68660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F86911_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|AEG 6 (NO REV)|
20|FH_F115264_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|OLD MOULTRIE SURGERY GROUPER 1|
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1253.00|99|0.00|AEG 6 (NO REV)|
20|FH_F112967_0_0|SrvcGrp|90478|2022|PDM|115.00|99|0.00|HOSPICE|
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|2050.00|99|0.00|AEG 8 (NO REV)|
20|FH_F33807_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ST LUKE 1698 CARVE OUT CODES|
20|FH_F129597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F135491_0_0|SrvcGrp|82570|2022|PDM|1980.00|99|0.00|REVISION EYELID/EXCESS SKIN|
20|FH_F143898_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F94786_07974_0|SrvcGrp|86832|2022|PDM|8.40|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PDM|2440.00|99|0.00|AEG 9 (NO REV)|
20|FH_F115491_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124067_15425_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146901_78006_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F47636_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91898_0_0|SrvcGrp|941|2022|PDM|7435.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|2463.00|99|0.00|AEG 10 (NO REV)|
20|FH_F124586_14850_0|SrvcGrp|89149|2022|PDM|120.00|99|0.00|OP INTENSIVE|
20|FH_F127995_84010_0|SrvcGrp|86779|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F127995_84010_0|SrvcGrp|14948|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F100787_69162_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F136568_92562_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F139556_85006_0|SrvcGrp|71951|2022|PCT|1.89|99|0.00|HOME SLEEP TEST|
20|FH_F138981_85123_0|SrvcGrp|73842|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115048_78520_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146040_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148424_01440_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F148553_85016_0|SrvcGrp|115472|2022|PDM|2907.00|99|0.00|LEFT HEART ARTERY/VENTRICLE ANGIO|
20|FH_F127448_0_0|SrvcGrp|107793|2022|PDM|9000.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F43120_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|EMERGENCY MEDICAL SERVICES (EMS)|
20|FH_F43249_0_0|CSTM-ALL|CSTM-00|2020|PDM|2888.00|99|0.00|CV SERVICES (MS DRG)|
20|FH_F43779_0_0|SrvcGrp|958|2022|PDM|2887.00|99|0.00|VENTILATOR SERVICES|
20|FH_F135761_70127_0|SrvcGrp|90397|2022|PDM|1750.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F136824_08034_0|SrvcGrp|12659|2022|PDM|898.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F112371_19047_0|SrvcGrp|12280|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F112505_51503_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F43503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F115608_24171_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147331_90045_0|SrvcGrp|48385|2022|PDM|168.00|99|0.00|SPEECH THERAPY|
20|FH_F147348_19406_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F147559_70433_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F147586_44124_0|SrvcGrp|92408|2022|PDM|3900.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F147701_31093_0|CSTM-ALL|CSTM-00|2020|PDM|2814.00|99|0.00|AEG 2 (NO REV)|
20|FH_F42708_0_0|SrvcGrp|13811|2022|PDM|311.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F132928_64114_0|SrvcGrp|54972|2022|PDM|157.00|99|0.00|ST THERAPY|
20|FH_F132250_12550_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F133574_91607_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F38120_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F141795_89509_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 691-692 URINARY STONES|
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100790_10512_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F132190_0_0|SrvcGrp|19920|2022|PDM|2500.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F145758_20745_0|SrvcGrp|36591|2022|PDM|4080.00|99|0.00|CPT 63685|
20|FH_F125074_18104_0|SrvcGrp|88620|2022|PDM|113.40|99|0.00|SKILLED NURSING RN|
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1056.00|99|0.00|AEG 5  (NO REV)|
20|FH_F77302_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89779_0_0|SrvcGrp|70749|2022|PDM|3200.00|99|0.00|CPT 29823|
20|FH_F92513_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F102500_0_0|SrvcGrp|92084|2022|PDM|1863.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F87254_0_0|SrvcGrp|73000|2022|PDM|1092.00|99|0.00|AEG 6|
20|FH_F119760_0_0|SrvcGrp|65720|2022|PDM|107.00|99|0.00|RESPITE CARE|
20|FH_F92392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72842_0_0|CSTM-ALL|CSTM-00|2020|PDM|1541.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F97500_32025_0|SrvcGrp|73605|2022|PDM|3745.00|99|0.00|AETNA ACUTE PSYCH|
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_F68866_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139515_0_0|SrvcGrp|113570|2022|PDM|1380.00|99|0.00|REMOVAL OF PILONIDAL LESION|
20|FH_F52854_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F83520_18704_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109645_0_0|SrvcGrp|88808|2022|PDM|118.00|99|0.00|MEDICAL SOCIAL WORKER (HCFA)|
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|1605.00|99|0.00|ASPG VIII|
20|FH_F132051_74464_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F127946_32514_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F67261_0_0|SrvcGrp|62201|2022|PDM|5000.00|99|0.00|ARTHROSCOPY|
20|FH_F116311_02657_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141795_89509_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F120672_0_0|SrvcGrp|102419|2022|PCT|0.87|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F68160_0_0|SrvcGrp|29611|2022|PDM|125.00|99|0.00|VENTILATOR SUPPORT|
20|FH_F129643_33176_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130523_04605_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|AEG 6 (NO REV)|
20|FH_F143528_0_0|SrvcGrp|41335|2022|PDM|12600.00|99|0.00|TOTAL HIP|
20|FH_F92091_0_0|SrvcGrp|80617|2022|PDM|6000.00|99|0.00|ARTHOPLASTY|
20|FH_F130747_0_0|SrvcGrp|99161|2022|PDM|26010.00|99|0.00|CPT 27138|
20|FH_F148205_75149_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F148255_72703_0|SrvcGrp|29075|2022|PDM|26.25|99|0.00|HYDRATION THERAPY|
20|FH_F69971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F122688_19904_0|SrvcGrp|473|2022|PDM|495.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F55212_0_0|SrvcGrp|46905|2022|PDM|73.00|99|0.00|OBSERVATION SVCS|
20|FH_F57073_0_0|SrvcGrp|63|2022|PDM|603.00|99|0.00|SUBACUTE CARE|
20|FH_F143539_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F119795_0_0|SrvcGrp|108073|2022|PDM|7231.00|99|0.00|SPINE STIMULATORS|
20|FH_F32995_0_0|SrvcGrp|9936|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY 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_F123785_62298_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F62579_0_0|SrvcGrp|31973|2022|PDM|19.00|99|0.00|HOME THERAPY|
20|FH_F63229_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F45052_0_0|SrvcGrp|34865|2022|PDM|65.00|99|0.00|HOME HEALTH AIDE|
20|FH_F45052_0_0|SrvcGrp|9830|2022|PDM|125.00|99|0.00|OT SVCS|
20|FH_F40134_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130805_17404_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)|
20|FH_F130821_85712_0|SrvcGrp|103319|2022|PDM|7.54|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F98002_27103_0|SrvcGrp|73559|2022|PDM|5835.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F146399_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F118135_38109_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130017_02302_0|SrvcGrp|20898|2022|PDM|38985.10|99|0.00|MS DRG 246 ONLY|
20|FH_F36552_0_0|SrvcGrp|701|2022|PDM|1300.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F125328_0_0|SrvcGrp|73002|2022|PDM|1077.00|99|0.00|AEG 7|
20|FH_F121687_04401_0|SrvcGrp|77290|2022|PCT|1.38|99|0.00|AETNA REMV TUNNLD CVC W/O SUBQ PORT|
20|FH_F149106_07042_0|CSTM-ALL|CSTM-00|2020|PDM|1739.00|99|0.00|AEG 3 (NO REV)|
20|FH_F123644_0_0|SrvcGrp|89149|2022|PDM|215.00|99|0.00|OP INTENSIVE|
20|FH_F149103_32803_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HSS ASC|
20|FH_F100782_0_0|SrvcGrp|108210|2022|PDM|770.00|99|0.00|REVJ TOT DISC|
20|FH_F122930_0_0|SrvcGrp|72992|2022|PDM|1084.00|99|0.00|AEG 2|
20|FH_F127849_43920_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132840_65201_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.80|99|0.00|AEG 2 (NO REV)|
20|FH_F43865_0_0|SrvcGrp|37406|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|375.57|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1601 W/O REV|
20|FH_F89219_0_0|SrvcGrp|57383|2022|PDM|39666.00|99|0.00|MS DRG 466-468 ONLY|
20|FH_F133922_70563_0|SrvcGrp|38246|2022|PDM|501.80|99|0.00|SLEEP STUDIES|
20|FH_F111704_30044_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134614_84651_0|SrvcGrp|108484|2022|PDM|800.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F133724_84041_0|SrvcGrp|88621|2022|PDM|60.75|99|0.00|SKILLED NURSING LPN|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|466.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 202 W/O REV|
20|FH_F129509_0_0|SrvcGrp|88158|2022|PDM|3767.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F111986_0_0|SrvcGrp|77444|2022|PDM|1236.00|99|0.00|VASECTOMY|
20|FH_F96160_32207_0|SrvcGrp|24745|2022|PDM|68.65|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F113435_19027_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F85652_98034_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F133585_0_0|SrvcGrp|107885|2022|PDM|2852.00|99|0.00|TRLUML BALO ANGIOP 1ST VEIN|
20|FH_F51318_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|TRAUMA CARE|
20|FH_F110420_60649_0|SrvcGrp|73000|2022|PDM|950.00|99|0.00|AEG 6|
20|FH_F150179_23124_0|SrvcGrp|23587|2022|PDM|633.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F147502_0_0|SrvcGrp|48394|2022|PDM|45.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F149268_74820_0|SrvcGrp|79699|2022|PCT|0.85|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F137799_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.81|99|0.00|HAPA WPA-NWPA 2012-13 ASC 2 W/O REV|
20|FH_F33496_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123646_91350_0|SrvcGrp|90854|2022|PDM|765.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F131630_0_0|SrvcGrp|11673|2022|PDM|2705.00|99|0.00|CPT 29888|
20|FH_F139565_0_0|SrvcGrp|84280|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F71445_0_0|SrvcGrp|90558|2022|PDM|75.00|99|0.00|RN VISIT|
20|FH_F50053_0_0|SrvcGrp|16276|2022|PCT|1.20|99|0.00|HIGH COST DRUGS|
20|FH_F73787_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F80172_0_0|SrvcGrp|10575|2022|PDM|70.64|99|0.00|HOME INFUSION THERAPY|
20|FH_F130329_64114_0|SrvcGrp|73700|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F110980_53566_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|GENERAL ACUTE CARE|
20|FH_F110604_0_0|SrvcGrp|103329|2022|PDM|8250.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN|
20|FH_F88744_71103_0|SrvcGrp|115057|2022|PCT|2.00|99|0.00|LABORATORY SERVICES|
20|FH_F129509_0_0|SrvcGrp|36591|2022|PDM|5125.00|99|0.00|CPT 63685|
20|FH_F130468_0_0|SrvcGrp|97730|2022|PDM|11776.00|99|0.00|REVERSE HIP JOINT|
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|29840.00|99|0.00|MS DRG 230|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|472.28|99|0.00|HAPA WPA-NWPA 2012-13 ASC 111 W/O REV|
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 7 (NO REV)|
20|FH_F83995_16748_0|SrvcGrp|10542|2022|PDM|91.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F127075_64772_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134208_21502_0|SrvcGrp|87679|2022|PDM|420.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F134655_14221_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F133585_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F136359_0_0|SrvcGrp|36865|2022|PDM|6275.00|99|0.00|NUCLEOPLASTY|
20|FH_F149359_33301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116806_0_0|SrvcGrp|107037|2022|PDM|1923.16|99|0.00|REPAIR CHEEK BONE FRACTURE|
20|FH_F100782_0_0|SrvcGrp|105080|2022|PDM|535.28|99|0.00|WINDBER MEDICAL CNTR ASC 125|
20|FH_F125870_0_0|SrvcGrp|90569|2022|PDM|1295.00|99|0.00|INCISION SECONDARY CATARACT|
20|FH_F121476_0_0|CSTM-ALL|CSTM-00|2020|PDM|2449.00|99|0.00|MOMETASONE SINUS IMPLANT|
20|FH_F45200_0_0|CSTM-ALL|CSTM-00|2020|PDM|643.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130763_0_0|SrvcGrp|89988|2022|PDM|3450.00|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F149199_73005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F54592_0_0|SrvcGrp|29075|2022|PDM|50.00|99|0.00|HYDRATION THERAPY|
20|FH_F54592_0_0|SrvcGrp|14948|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F69606_0_0|SrvcGrp|64100|2022|PDM|1241.50|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 7|
20|FH_F134431_92647_0|SrvcGrp|104079|2022|PCT|1.50|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F31053_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101063_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|OP SVCS|
20|FH_F84712_0_0|SrvcGrp|73485|2022|PDM|1388.00|99|0.00|AETNA REHAB|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|119.63|99|0.00|HAPA WPA-NWPA 2012-13 ASC 238 W/O REV|
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|966.00|99|0.00|AEG 7 (NO REV)|
20|FH_F105145_75075_0|SrvcGrp|98006|2022|PDM|6640.00|99|0.00|PHALANGEAL SHAFT FRACTURE|
20|FH_F105361_80104_0|SrvcGrp|10393|2022|PDM|6048.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F146793_44236_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66705_0_0|SrvcGrp|60057|2022|PDM|90.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F133249_33603_0|SrvcGrp|86722|2022|PDM|239.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F133249_33603_0|SrvcGrp|73842|2022|PDM|239.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132928_64114_0|SrvcGrp|88780|2022|PDM|147.60|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F132307_06010_0|SrvcGrp|471|2022|PDM|805.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133491_74012_0|SrvcGrp|65720|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F113906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113738_27006_0|SrvcGrp|27969|2022|PDM|23.00|99|0.00|HOME HEALTH AIDE|
20|FH_F113738_27006_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F85002_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|OP SVCS|
20|FH_F92496_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F98040_89406_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97721_01053_0|SrvcGrp|88978|2022|PDM|7023.00|99|0.00|VAGINAL DELIVERY|
20|FH_F97721_01053_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F97740_01605_0|SrvcGrp|73485|2022|PDM|1906.00|99|0.00|AETNA REHAB|
20|FH_F72049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F73231_0_0|SrvcGrp|30961|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F85039_0_0|SrvcGrp|75481|2022|PDM|491.00|99|0.00|AEG 2|
20|FH_F86911_0_0|SrvcGrp|43266|2022|PDM|120.00|99|0.00|MIDLINE INSERTION KIT|
20|FH_F116143_0_0|SrvcGrp|73000|2022|PDM|1425.00|99|0.00|AEG 6|
20|FH_F114566_46224_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F115303_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 2 (NO REV)|
20|FH_F113541_0_0|SrvcGrp|104951|2022|PDM|2580.00|99|0.00|BREAST RECON-INVERTED NIPPLE|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1018.00|99|0.00|AEG 10 (NO REV)|
20|FH_F119581_0_0|SrvcGrp|68546|2022|PDM|1361.00|99|0.00|CPT 36558|
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 6 (NO REV)|
20|FH_F132627_0_0|SrvcGrp|86832|2022|PDM|18.36|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F45312_0_0|SrvcGrp|39742|2022|PCT|0.88|99|0.00|BURN INTENSIVE CARE - OUTPATIENT|
20|FH_F77944_0_0|SrvcGrp|12884|2022|PDM|2608.00|99|0.00|ACUTE REHAB|
20|FH_F124060_76040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F32190_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132864_71101_0|SrvcGrp|72984|2022|PCT|2.15|99|0.00|CHEMOTHERAPY|
20|FH_F124258_53140_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124584_28204_0|SrvcGrp|89412|2022|PDM|424.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F127995_84010_0|SrvcGrp|94781|2022|PDM|107.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F131101_45840_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F132592_68305_0|SrvcGrp|79699|2022|PCT|0.94|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F114629_19131_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F114666_30342_0|SrvcGrp|89404|2022|PDM|16500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F114666_30342_0|SrvcGrp|92362|2022|PDM|10000.00|99|0.00|AUTOLOG CHONDROCYTE IMP KNEE|
20|FH_F114666_30342_0|SrvcGrp|67119|2022|PDM|1800.00|99|0.00|ARTHODESIS|
20|FH_F113787_31909_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F113787_31909_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F113809_47302_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F114985_32073_0|SrvcGrp|90631|2022|PDM|124.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F114985_32073_0|SrvcGrp|22528|2022|PDM|705.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F137933_0_0|SrvcGrp|87056|2022|PDM|13100.00|99|0.00|REMOVE/REPLACE PENIS PROSTHETIC|
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 2 (NO REV)|
20|FH_F134694_94945_0|SrvcGrp|46903|2022|PDM|1200.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F134791_98034_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135762_70001_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136786_25302_0|SrvcGrp|48394|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F136830_22003_0|SrvcGrp|89417|2022|PDM|420.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F141170_0_0|SrvcGrp|103593|2022|PDM|6000.00|99|0.00|XTRNL CAROTID|
20|FH_F115152_77058_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115181_78602_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F115631_65201_0|SrvcGrp|100018|2022|PDM|1141.00|99|0.00|UNLISTED PROC FEMUR OR KNEE|
20|FH_F116393_07002_0|SrvcGrp|86710|2022|PDM|180.00|99|0.00|NON INVASIVE VASCULAR STUDY|
20|FH_F147311_37421_0|SrvcGrp|46903|2022|PDM|665.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F147519_52627_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F147586_44124_0|SrvcGrp|99174|2022|PDM|1331.00|99|0.00|CPT 30140|
20|FH_F147580_75110_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41426_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|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_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|2585.00|99|0.00|AEG 7 (NO REV)|
20|FH_F134087_0_0|SrvcGrp|112553|2022|PDM|3607.00|99|0.00|OSTEOART ALGRFT W/ SURF & B1|
20|FH_F139238_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F139573_0_0|SrvcGrp|57966|2022|PDM|842.10|99|0.00|HOSPICE CARE|
20|FH_F138684_44484_0|SrvcGrp|89412|2022|PDM|400.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F138876_25302_0|SrvcGrp|29023|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138992_72703_0|CSTM-ALL|CSTM-00|2020|PDM|1639.00|99|0.00|AEG 10 (NO REV)|
20|FH_F109949_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)|
20|FH_F151340_30040_0|CSTM-ALL|CSTM-00|2020|PDM|2010.00|99|0.00|AEG 9 (NO REV)|
20|FH_F151382_30501_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151404_71655_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151511_14094_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F47212_0_0|SrvcGrp|74960|2022|PDM|24.00|99|0.00|IMMUNIZATIONS|
20|FH_F135590_84066_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135924_02906_0|SrvcGrp|73499|2022|PDM|554.60|99|0.00|AETNA ER LEVEL II|
20|FH_F135924_02906_0|CSTM-ALL|CSTM-00|2020|PCT|1.03|99|0.00|OP SVCS|
20|FH_F135988_75703_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136127_15658_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136130_10029_0|SrvcGrp|92760|2022|PCT|1.05|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131265_84106_0|SrvcGrp|89337|2022|PDM|1013.00|99|0.00|DETOXIFICATION|
20|FH_F127399_0_0|SrvcGrp|89883|2022|PDM|2913.00|99|0.00|AETNA TREAT HUMERUS FRACTURE|
20|FH_F140629_0_0|SrvcGrp|113691|2022|PDM|2497.00|99|0.00|LAPAROSCOPY|
20|FH_F67425_0_0|SrvcGrp|8968|2022|PDM|2730.00|99|0.00|NICU LEVEL III & IV|
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG IX|
20|FH_F59052_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|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_F101442_0_0|SrvcGrp|98456|2022|PDM|1377.38|99|0.00|TREATMENT OF FOOT INFECTION|
20|FH_F132328_0_0|SrvcGrp|54943|2022|PDM|2913.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F105421_0_0|SrvcGrp|100950|2022|PDM|825.00|99|0.00|CHEMICAL DEPENDENCY DETOX|
20|FH_F141035_0_0|SrvcGrp|98005|2022|PDM|7008.00|99|0.00|DISTAL PHALANGEAL FRACTURE|
20|FH_F102325_62691_0|SrvcGrp|21920|2022|PDM|70.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F134202_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F39939_0_0|SrvcGrp|10667|2022|PDM|800.00|99|0.00|BOARDER BABY SVCS|
20|FH_F148859_0_0|SrvcGrp|115525|2022|PDM|1248.00|99|0.00|CYSTOSCOPY|
20|FH_F147418_0_0|SrvcGrp|85740|2022|PDM|13000.00|99|0.00|TOTAL KNEE REPLACEMENT|
20|FH_F117576_21207_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F74844_0_0|SrvcGrp|42871|2022|PDM|60.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F113869_40215_0|SrvcGrp|86722|2022|PDM|169.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F148964_30101_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F148667_0_0|SrvcGrp|107835|2022|PDM|5861.00|99|0.00|NERVE REPAIR|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER UEKC|
20|FH_F124322_64131_0|SrvcGrp|103739|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F94502_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F123570_0_0|SrvcGrp|65350|2022|PDM|2369.00|99|0.00|KNEE ARTHRO/ANTER|
20|FH_F98840_31021_0|SrvcGrp|73601|2022|PDM|5354.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F146859_0_0|SrvcGrp|114861|2022|PDM|4290.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F111266_30339_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F81312_0_0|SrvcGrp|59290|2022|PCT|1.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|1910.00|99|0.00|AEG 10 (NO REV)|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER QW|
20|FH_F126189_89129_0|SrvcGrp|89149|2022|PDM|206.00|99|0.00|OP INTENSIVE|
20|FH_F133677_15601_0|SrvcGrp|29346|2022|PDM|25.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92431_80033_0|SrvcGrp|27968|2022|PDM|59.00|99|0.00|SKILLED NURSING LPN|
20|FH_F131187_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F59312_0_0|SrvcGrp|43284|2022|PDM|74.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F92153_74017_0|SrvcGrp|82137|2022|PCT|0.58|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F92300_37303_0|SrvcGrp|27969|2022|PDM|22.50|99|0.00|HOME HEALTH AIDE|
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|ASPG II|
20|FH_F140090_37221_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123185_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F123185_0_0|SrvcGrp|72994|2022|PDM|581.00|99|0.00|AEG 3|
20|FH_F93740_0_0|SrvcGrp|91596|2022|PDM|6900.00|99|0.00|TRANSCATHETER|
20|FH_F102943_0_0|SrvcGrp|84974|2022|PDM|797.69|99|0.00|CPT 43255|
20|FH_F102920_0_0|SrvcGrp|73004|2022|PDM|1679.00|99|0.00|AEG 8|
20|FH_F102224_0_0|SrvcGrp|35669|2022|PDM|7000.00|99|0.00|CPT 63650|
20|FH_F130937_98002_0|SrvcGrp|89417|2022|PDM|403.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD NU)|
20|FH_F136299_75218_0|SrvcGrp|109220|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F132414_30571_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120799_92651_0|SrvcGrp|89337|2022|PDM|1250.00|99|0.00|DETOXIFICATION|
20|FH_F116629_83467_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F82691_0_0|SrvcGrp|78537|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY|
20|FH_F83292_0_0|SrvcGrp|14096|2022|PDM|632.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F120866_51652_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F44584_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F84611_30281_0|SrvcGrp|79786|2022|PCT|0.73|99|0.00|SLEEP STUDIES|
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 6 (NO REV)|
20|FH_F147005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90853_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|621.50|99|0.00|ASPG 11- PROGRESSIVE SURG- UNGROUPED|
20|FH_F39349_0_0|SrvcGrp|453|2022|PDM|285.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F143902_41018_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F91622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS|
20|FH_F94942_0_0|SrvcGrp|94159|2022|PDM|545.90|99|0.00|PROPHYLAXIS ADULT|
20|FH_F52854_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER QW|
20|FH_F151525_30349_0|SrvcGrp|116058|2022|PCT|1.00|99|0.00|LABORATORY AND PATHOLOGY|
20|FH_F54513_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE|
20|FH_F125249_0_0|SrvcGrp|108256|2022|PDM|1400.00|99|0.00|AETNA TREATMENT OF FRACTURE|
20|FH_F125011_74467_0|SrvcGrp|98571|2022|PDM|9000.00|99|0.00|REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION|
20|FH_F115685_64064_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129556_65233_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F74802_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.30|99|0.00|GENERAL ACUTE CARE|
20|FH_F116024_13203_0|SrvcGrp|110641|2022|PCT|1.06|99|0.00|OP THERAPY SERVICES|
20|FH_F118194_50841_0|SrvcGrp|86838|2022|PDM|35.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F148200_26554_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F41776_0_0|SrvcGrp|9937|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F89475_71202_0|SrvcGrp|20272|2022|PDM|36368.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VLV PROC W/O CA CAT|
20|FH_F75804_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F143790_83440_0|CSTM-ALL|CSTM-00|2020|PDM|1225.00|99|0.00|AEG 6 (NO REV)|
20|FH_F35388_0_0|SrvcGrp|16868|2022|PCT|0.50|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS/DME/DIALYSIS|
20|FH_F92276_32308_0|SrvcGrp|114019|2022|PCT|1.68|99|0.00|CHEMOTHERAPY AND ALL OTHER DRUGS|
20|FH_F143908_52233_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137495_36701_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_F129011_15857_0|SrvcGrp|29346|2022|PDM|130.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F140762_0_0|SrvcGrp|108434|2022|PDM|2677.00|99|0.00|INSJ AQUEOUS DRAIN DEV 1ST|
20|FH_F143528_0_0|SrvcGrp|58993|2022|PDM|5250.00|99|0.00|DISKECTOMY|
20|FH_F76286_16038_0|SrvcGrp|29611|2022|PDM|125.00|99|0.00|VENTILATOR SUPPORT|
20|FH_F97261_06098_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F123820_91316_0|SrvcGrp|104079|2022|PCT|1.50|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F132810_0_0|SrvcGrp|22594|2022|PDM|60.00|99|0.00|IMIGLUCERASE|
20|FH_F136377_75240_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F118193_06241_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F118236_25901_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120490_64133_0|SrvcGrp|86837|2022|PDM|10.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F120490_64133_0|SrvcGrp|86779|2022|PDM|125.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F134011_84102_0|SrvcGrp|86836|2022|PDM|10.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F134011_84102_0|SrvcGrp|43568|2022|PDM|60.00|99|0.00|SKILLED NURSING - RN|
20|FH_F137048_60714_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F137068_81147_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA IP MCARE2 OCN F/S PRICING|
20|FH_F137246_66064_0|SrvcGrp|73841|2022|PDM|470.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F137247_40160_0|SrvcGrp|90854|2022|PDM|588.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F138961_33430_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F139067_66935_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138019_79705_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F142387_70454_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142730_20646_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F53732_0_0|SrvcGrp|42322|2022|PDM|60.00|99|0.00|HOME THERAPY|
20|FH_F104340_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PDM|935.00|99|0.00|AEG 4 (NO REV)|
20|FH_F120152_0_0|SrvcGrp|108353|2022|PDM|6050.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F70665_0_0|SrvcGrp|1168|2022|PDM|1005.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F147927_19083_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F129491_90245_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F39303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F109652_0_0|SrvcGrp|36508|2022|PDM|125.00|99|0.00|ULTRASOUND|
20|FH_F110720_0_0|SrvcGrp|97119|2022|PDM|4882.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F90613_05001_0|SrvcGrp|43524|2022|PDM|268.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F129892_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F131472_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F139287_33544_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138543_60130_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F38321_0_0|SrvcGrp|472|2022|PDM|475.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F109513_0_0|SrvcGrp|73000|2022|PDM|1161.00|99|0.00|AEG 6|
20|FH_F135653_0_0|SrvcGrp|107112|2022|PDM|782.00|99|0.00|DENTAL SERVICES UNDER ANESTHESIA|
20|FH_F72003_0_0|SrvcGrp|46802|2022|PDM|95.00|99|0.00|IV SERVICES|
20|FH_F72003_0_0|SrvcGrp|10407|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F111594_0_0|SrvcGrp|74039|2022|PDM|7215.00|99|0.00|LAMINECTOMY|
20|FH_F33581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|TRAUMA CARE|
20|FH_F46357_0_0|SrvcGrp|38925|2022|PCT|1.10|99|0.00|HCPC IMPLANTS|
20|FH_F117087_0_0|SrvcGrp|27316|2022|PDM|2494.00|99|0.00|TONSILS & ADENOIDS (42820)|
20|FH_F118790_98640_0|SrvcGrp|46903|2022|PDM|1377.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F92676_15063_0|SrvcGrp|79024|2022|PDM|839.71|99|0.00|MON VALLEY ASC 114|
20|FH_F129644_0_0|SrvcGrp|111388|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY - IPD/CAPD/CCPD - NO ESRD|
20|FH_F44350_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42117_0_0|SrvcGrp|38006|2022|PDM|1000.00|99|0.00|CPT CODE 59426|
20|FH_F117446_31322_0|SrvcGrp|92501|2022|PDM|133.76|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F118542_60188_0|SrvcGrp|24744|2022|PDM|77.00|99|0.00|PICC LINE INSERTION|
20|FH_F121016_32607_0|SrvcGrp|104468|2022|PDM|500.00|99|0.00|ANTEPARTUM CARE ONLY (4-6 VISITS)|
20|FH_F80855_0_0|SrvcGrp|72996|2022|PDM|950.00|99|0.00|AEG 4|
20|FH_F51438_0_0|SrvcGrp|10904|2022|PDM|305.00|99|0.00|EMERGENCY ROOM LEVEL II|
20|FH_F34706_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F40895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F80855_0_0|SrvcGrp|58671|2022|PDM|1300.00|99|0.00|ASC CARVE OUT 64721|
20|FH_F130108_0_0|SrvcGrp|15399|2022|PCT|0.60|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F130108_0_0|SrvcGrp|15370|2022|PCT|0.60|99|0.00|OTHER DIAGNOSTIC|
20|FH_F143187_52565_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F71162_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148556_13206_0|SrvcGrp|26869|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F119220_75068_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F133287_40215_0|CSTM-ALL|CSTM-00|2020|PDM|1220.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F45199_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87615_80033_0|SrvcGrp|102981|2022|PDM|148.00|99|0.00|PSYTX WPT W E/M 45 MIN|
20|FH_F141940_50023_0|CSTM-ALL|CSTM-00|2020|PDM|3500.79|99|0.00|AEG 5  (NO REV)|
20|FH_F132446_19063_0|SrvcGrp|112062|2022|PDM|76.00|99|0.00|RESPIRATORY THERAPY VISIT (HCFA)|
20|FH_F71323_68114_0|SrvcGrp|21280|2022|PDM|2800.00|99|0.00|MS DRG 193 ONLY|
20|FH_F146159_89102_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F31093_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|ASPG I|
20|FH_F117995_60126_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146117_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F115329_79424_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133009_19038_0|SrvcGrp|73742|2022|PDM|10.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F41739_0_0|SrvcGrp|11336|2022|PCT|0.70|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F133021_00910_0|SrvcGrp|77484|2022|PDM|1280.00|99|0.00|AETNA OBSERVATION|
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F125540_19462_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F89851_83854_0|CSTM-ALL|CSTM-00|2020|PDM|2710.00|99|0.00|AEG 3 (NO REV)|
20|FH_F145964_10993_0|SrvcGrp|93819|2022|PCT|1.29|99|0.00|IP DRUGS|
20|FH_F134434_30607_0|SrvcGrp|89337|2022|PDM|1000.00|99|0.00|DETOXIFICATION|
20|FH_F109624_15401_0|SrvcGrp|75545|2022|PDM|340.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F41785_0_0|SrvcGrp|31188|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC (DME)|
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|812.00|99|0.00|AEG 1 (NO REV)|
20|FH_F82475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|GENERAL ACUTE CARE|
20|FH_F46914_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|SKILLED NURSING CARE|
20|FH_F102561_75146_0|SrvcGrp|23279|2022|PDM|425.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F125049_44131_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F42992_0_0|SrvcGrp|40820|2022|PDM|1900.00|99|0.00|ICU/CCU|
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PDM|1156.65|99|0.00|AEG 8 (NO REV)|
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_F44607_0_0|SrvcGrp|9511|2022|PCT|0.80|99|0.00|OBSERVATION SVCS|
20|FH_F134544_03874_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133005_32726_0|SrvcGrp|38007|2022|PDM|500.00|99|0.00|CPT CODE 59425|
20|FH_F36993_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE|
20|FH_F38371_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F39180_0_0|SrvcGrp|30627|2022|PCT|0.70|99|0.00|DME|
20|FH_F150533_76051_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142807_67114_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|1367.00|99|0.00|AEG 3 (NO REV)|
20|FH_F92676_15063_0|SrvcGrp|79025|2022|PDM|837.86|99|0.00|MON VALLEY ASC 226|
20|FH_F71271_0_0|SrvcGrp|68261|2022|PDM|12.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F132612_0_0|SrvcGrp|11663|2022|PCT|0.67|99|0.00|IMPLANTS|
20|FH_F136393_0_0|SrvcGrp|112880|2022|PDM|3200.00|99|0.00|REMOVE AND REPLACE PM GEN SINGL|
20|FH_F32953_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133155_0_0|SrvcGrp|97506|2022|PDM|100.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F148861_18706_0|SrvcGrp|74668|2022|PDM|328.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F34706_0_0|SrvcGrp|14964|2022|PDM|22994.00|99|0.00|DRG 570 MJR SM/LG BOWEL PRO W/CC W/O MJR GASTRO DX|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|56.00|99|0.00|AETNA GROUP PSYCHOTHERAPY (MOD AF)(HCFA)|
20|FH_F145937_75240_0|SrvcGrp|48385|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F97563_83201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69104_0_0|SrvcGrp|17069|2022|PDM|1140.99|99|0.00|ASPG III|
20|FH_F150003_22630_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F72859_0_0|SrvcGrp|11800|2022|PDM|46.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F40267_0_0|SrvcGrp|17067|2022|PDM|516.00|99|0.00|ASPG II|
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|948.00|99|0.00|AEG 7 (NO REV)|
20|FH_F46357_0_0|SrvcGrp|14614|2022|PDM|3800.00|99|0.00|LITHOTRIPSY|
20|FH_F130108_0_0|SrvcGrp|15967|2022|PDM|1800.00|99|0.00|ICU|
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119095_08536_0|SrvcGrp|13187|2022|PCT|0.30|99|0.00|INTRAOCULAR LENSES|
20|FH_F133530_11237_0|SrvcGrp|82369|2022|PCT|1.50|99|0.00|AETNA LABORATORY|
20|FH_F44607_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F109882_36695_0|SrvcGrp|87317|2022|PDM|637.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F123872_75006_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD UE/KE)|
20|FH_F63301_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|(JCODES-IMMUN) OCN F/S PRICING: ALL|
20|FH_F128299_44134_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F150904_22306_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F123181_75057_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F150499_32405_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38700_0_0|SrvcGrp|19120|2022|PCT|0.80|99|0.00|MS DRG 621|
20|FH_F133647_32952_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144008_11413_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F130258_54304_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F109845_85207_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35411_0_0|SrvcGrp|360|2022|PDM|2080.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F148761_33311_0|SrvcGrp|472|2022|PDM|505.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F151063_44094_0|SrvcGrp|73841|2022|PDM|401.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F151144_35801_0|SrvcGrp|98684|2022|PDM|915.43|99|0.00|OSSEOINTEGRATED IMPLANT REPL|
20|FH_F121329_33015_0|SrvcGrp|472|2022|PDM|480.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150799_44041_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150799_44041_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150879_75056_0|SrvcGrp|75419|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F150882_84041_0|SrvcGrp|104828|2022|PDM|38.00|99|0.00|NURSING CARE LPN (HCFA)|
20|FH_F139150_75206_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F135613_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F117762_0_0|SrvcGrp|99165|2022|PDM|7280.00|99|0.00|CPT 22848|
20|FH_F137561_43935_0|SrvcGrp|88403|2022|PCT|2.00|99|0.00|CMS SNF PPS|
20|FH_F150938_02062_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F137788_72632_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F114206_37203_0|SrvcGrp|17016|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F36343_0_0|SrvcGrp|10545|2022|PDM|90.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F114206_37203_0|SrvcGrp|86842|2022|PDM|30.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F134828_30531_0|SrvcGrp|112671|2022|PDM|32.00|99|0.00|XRAY EXAM OF ANKLE (HCFA)|
20|FH_F134831_17331_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F81152_0_0|SrvcGrp|471|2022|PDM|577.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113178_44035_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134612_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F37850_0_0|SrvcGrp|115|2022|PDM|650.00|99|0.00|SKILLED NURSING CARE|
20|FH_F54552_0_0|SrvcGrp|19742|2022|PDM|115.00|99|0.00|MID-LINE INSERTION|
20|FH_F113585_20155_0|SrvcGrp|17016|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138747_53158_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F138787_32258_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138893_98903_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67167_0_0|SrvcGrp|3944|2022|PDM|6896.00|99|0.00|CORONARY CARE UNIT|
20|FH_F78265_0_0|CSTM-ALL|CSTM-00|2020|PDM|2083.00|99|0.00|ASPG IV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|323.25|99|0.00|HAPA WPA-NWPA 2012-13 ASC 226 W/O REV|
20|FH_F75185_0_0|SrvcGrp|44883|2022|PDM|18.00|99|0.00|RT/PT/ST/OT|
20|FH_F82196_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151379_21045_0|SrvcGrp|73004|2022|PDM|1119.00|99|0.00|AEG 8|
20|FH_F151419_07852_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F151443_34741_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151510_15928_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145208_63640_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135388_48601_0|SrvcGrp|13595|2022|PDM|598.43|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F135388_48601_0|SrvcGrp|100961|2022|PDM|754.04|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY|
20|FH_F135485_20171_0|SrvcGrp|48385|2022|PDM|84.00|99|0.00|SPEECH THERAPY|
20|FH_F135836_60804_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136042_90066_0|SrvcGrp|87131|2022|PDM|610.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F136174_89146_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F127399_0_0|SrvcGrp|63472|2022|PDM|4162.00|99|0.00|CPT 64581|
20|FH_F101644_75116_0|SrvcGrp|46605|2022|PDM|107.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F121428_40202_0|SrvcGrp|537|2022|PCT|0.33|99|0.00|OBSERVATION SERVICES|
20|FH_F121731_20164_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F111383_62233_0|SrvcGrp|75506|2022|PCT|0.88|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F37209_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F65882_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|106% OF ASP DRUGS/IMMUN UPDATE QUARTERLY|
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.00|99|0.00|ASPG VII|
20|FH_F102862_30606_0|SrvcGrp|26666|2022|PDM|11113.60|99|0.00|MS DRG 482 ONLY|
20|FH_F129240_10028_0|SrvcGrp|86841|2022|PDM|110.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F129220_18445_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F36132_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP MAFS  MOD QW|
20|FH_F36372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F38831_0_0|SrvcGrp|16|2022|PDM|1159.00|99|0.00|ACUTE REHABILITATION|
20|FH_F36464_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F38808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95221_0_0|SrvcGrp|72996|2022|PDM|675.00|99|0.00|AEG 4|
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PDM|2259.00|99|0.00|AEG 2 (NO REV)|
20|FH_F86159_15139_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F86872_15215_0|SrvcGrp|17016|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F74602_0_0|SrvcGrp|29817|2022|PDM|2550.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F89778_0_0|SrvcGrp|69964|2022|PDM|1470.32|99|0.00|CPT 23120|
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1625.00|99|0.00|AEG 10 (NO REV)|
20|FH_F46832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|100% AWP HCPC|
20|FH_F46832_0_0|SrvcGrp|24744|2022|PDM|150.00|99|0.00|PICC LINE INSERTION|
20|FH_F121250_47401_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F47495_0_0|SrvcGrp|23132|2022|PDM|400.00|99|0.00|DIALYSIS/CHEMOTHERAPY/RADIATION|
20|FH_F117465_0_0|SrvcGrp|107494|2022|PDM|3000.00|99|0.00|AETNA SHOULDER ARTHROSCOPY/SURGERY|
20|FH_F136373_17055_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118171_00674_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS APC GROUPED|
20|FH_F93292_62234_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F134011_84102_0|SrvcGrp|86853|2022|PDM|10.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F142527_89109_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F142547_70002_0|SrvcGrp|86854|2022|PDM|25.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F142547_70002_0|SrvcGrp|86844|2022|PDM|25.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F83831_0_0|SrvcGrp|8962|2022|PDM|50.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F138627_82901_0|SrvcGrp|98929|2022|PDM|95.00|99|0.00|HIT PAIN IMP PUMP (HCFA)|
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 5  (NO REV)|
20|FH_F77782_66061_0|SrvcGrp|47442|2022|PCT|0.80|99|0.00|MS DRG 216-238 ONLY|
20|FH_F80284_16354_0|SrvcGrp|64102|2022|PDM|1078.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 13|
20|FH_F119011_08701_0|SrvcGrp|81779|2022|PCT|1.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F119023_91406_0|SrvcGrp|86833|2022|PDM|12.50|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F118943_64506_0|SrvcGrp|21920|2022|PDM|25.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F109883_35007_0|SrvcGrp|86749|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F109953_75234_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F129514_79605_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F56683_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117217_80304_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F137927_52241_0|SrvcGrp|13100|2022|PDM|350.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F93593_33414_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F125935_44024_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141795_89509_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F100660_56303_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F125473_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F87254_0_0|SrvcGrp|104611|2022|PDM|662.00|99|0.00|REMOVAL OF SKIN LESION|
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|1740.00|99|0.00|ASPG 8 HEARTLAND HEALTHCARE|
20|FH_F39273_0_0|SrvcGrp|16746|2022|PDM|65.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F117784_0_0|SrvcGrp|106294|2022|PDM|155.47|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F33789_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE|
20|FH_F141527_36830_0|SrvcGrp|14945|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F123505_64468_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148264_30434_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F81033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F78603_0_0|SrvcGrp|20926|2022|PDM|56509.28|99|0.00|MS DRG 235 ONLY|
20|FH_F118079_37642_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F33712_0_0|SrvcGrp|18200|2022|PCT|0.75|99|0.00|MS DRG 026|
20|FH_F39548_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130846_28304_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F33712_0_0|SrvcGrp|15369|2022|PCT|0.60|99|0.00|LABORATORY|
20|FH_F148239_74012_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|345.00|99|0.00|AEG 1 (NO REV)|
20|FH_F129328_33311_0|SrvcGrp|89417|2022|PDM|385.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F127205_44125_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F141527_36830_0|SrvcGrp|86834|2022|PDM|11.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F33642_0_0|SrvcGrp|3029|2022|PDM|500.00|99|0.00|NEWBORN NURSERY|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/MOD UE  (TN)|
20|FH_F41053_0_0|CSTM-ALL|CSTM-00|2020|PDM|281.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F44218_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129657_77479_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F66501_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F82753_18840_0|SrvcGrp|112223|2022|PDM|110.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F92971_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|OP SVCS|
20|FH_F142073_0_0|SrvcGrp|92412|2022|PDM|5980.00|99|0.00|SPINAL CRD DECOMP->2 CERVIC|
20|FH_F103902_89118_0|SrvcGrp|27969|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F66687_0_0|SrvcGrp|21106|2022|PDM|35205.00|99|0.00|MS DRG 250 ONLY|
20|FH_F128276_66441_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F123407_04605_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F86332_75081_0|SrvcGrp|13155|2022|PDM|130.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F135065_08043_0|SrvcGrp|112625|2022|PDM|103.00|99|0.00|ORAL MEDICATION ADMINISTRATION|
20|FH_F115103_31405_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F76171_0_0|SrvcGrp|53145|2022|PDM|80.00|99|0.00|SOCIAL WORKER|
20|FH_F130317_0_0|SrvcGrp|87537|2022|PDM|660.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F48927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F93920_0_0|SrvcGrp|72996|2022|PDM|4500.00|99|0.00|AEG 4|
20|FH_F129683_45255_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134995_37055_0|SrvcGrp|74668|2022|PDM|331.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132374_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F137347_26003_0|SrvcGrp|10391|2022|PDM|1561.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F143970_92656_0|SrvcGrp|89337|2022|PDM|1265.00|99|0.00|DETOXIFICATION|
20|FH_F114963_62062_0|SrvcGrp|46605|2022|PDM|131.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F129255_34952_0|SrvcGrp|73841|2022|PDM|420.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F130317_0_0|SrvcGrp|69441|2022|PDM|308.42|99|0.00|CLINIC VISIT|
20|FH_F41776_0_0|CSTM-ALL|CSTM-00|2020|PDM|2536.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F38804_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.00|99|0.00|OP SVCS|
20|FH_F128878_11203_0|CSTM-ALL|CSTM-00|2020|PDM|95.00|99|0.00|AETNA PSYTX W PT 45 MIN MOD AJ (HCFA)|
20|FH_F127068_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F31036_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F151524_84121_0|SrvcGrp|46903|2022|PDM|482.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F141588_60062_0|SrvcGrp|89417|2022|PDM|710.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F67984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122725_32216_0|SrvcGrp|104822|2022|PCT|0.85|99|0.00|OP SERVICES|
20|FH_F86917_61108_0|SrvcGrp|32189|2022|PDM|115.50|99|0.00|RESPITE CARE|
20|FH_F139690_0_0|SrvcGrp|107747|2022|PDM|375.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F98002_27103_0|SrvcGrp|73656|2022|PDM|724.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F72124_0_0|SrvcGrp|36231|2022|PDM|751.00|99|0.00|SUB ACUTE|
20|FH_F146663_25311_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F134607_80222_0|SrvcGrp|86722|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F133877_84117_0|SrvcGrp|97705|2022|PDM|93.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F133892_60076_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110302_15931_0|SrvcGrp|46424|2022|PDM|90.04|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F139678_25601_0|SrvcGrp|89337|2022|PDM|875.00|99|0.00|DETOXIFICATION|
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F133909_19805_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51393_0_0|SrvcGrp|42826|2022|PDM|64.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F121476_0_0|SrvcGrp|78743|2022|PDM|925.00|99|0.00|J7300|
20|FH_F96721_99504_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|OP SVCS|
20|FH_F131577_89148_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F105680_0_0|SrvcGrp|75497|2022|PDM|1200.00|99|0.00|AEG 10|
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F72830_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|PSYCH AND ER|
20|FH_F38709_0_0|SrvcGrp|24703|2022|PDM|335.00|99|0.00|NEWBORN NURSERY|
20|FH_F148483_94087_0|SrvcGrp|74668|2022|PDM|335.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120674_0_0|CSTM-ALL|CSTM-00|2020|PDM|2724.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92760_0_0|CSTM-ALL|CSTM-00|2020|PDM|1752.00|99|0.00|OP SVCS|
20|FH_F145537_02061_0|SrvcGrp|12659|2022|PDM|504.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|591.80|99|0.00|ASPG III|
20|FH_F38798_0_0|SrvcGrp|15075|2022|PDM|115.00|99|0.00|PICC LINE INSERTION NURSING|
20|FH_F120362_23321_0|SrvcGrp|48396|2022|PDM|93.00|99|0.00|OT SERVICES|
20|FH_F77822_0_0|SrvcGrp|474|2022|PDM|390.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F40321_0_0|SrvcGrp|38|2022|PDM|3570.00|99|0.00|NORMAL DELIVERY|
20|FH_F115049_78539_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148265_06067_0|SrvcGrp|115355|2022|PDM|12142.00|99|0.00|RECONSTRUCT HEAD OF RADIUS|
20|FH_F35388_0_0|SrvcGrp|9907|2022|PDM|1185.00|99|0.00|ACUTE MEDICAL/SURGICAL SVCS|
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|682.00|99|0.00|AEG 3 (NO REV)|
20|FH_F93534_45690_0|SrvcGrp|26001|2022|PDM|136.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F96902_0_0|SrvcGrp|47411|2022|PDM|165.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F145758_20745_0|SrvcGrp|98326|2022|PDM|4044.30|99|0.00|PERQ LAMOT/LAM LUMBAR|
20|FH_F102302_0_0|SrvcGrp|80135|2022|PDM|14750.00|99|0.00|INSERT SPINAL INFUSION|
20|FH_F119635_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F54513_0_0|SrvcGrp|10527|2022|PDM|110.00|99|0.00|HOSPICE SVCS|
20|FH_F89779_0_0|SrvcGrp|74039|2022|PDM|12500.00|99|0.00|LAMINECTOMY|
20|FH_F125899_07645_0|SrvcGrp|75999|2022|PDM|2426.00|99|0.00|OP URGENT CARE|
20|FH_F125249_0_0|SrvcGrp|108264|2022|PDM|700.00|99|0.00|AETNA DRAINAGE OF PALM BURSA|
20|FH_F102704_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116281_19013_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_F81481_0_0|SrvcGrp|75481|2022|PDM|1050.00|99|0.00|AEG 2|
20|FH_F132190_0_0|SrvcGrp|94565|2022|PDM|2500.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE|
20|FH_F37539_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|462.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 11 W/O REV|
20|FH_F93881_15009_0|SrvcGrp|18008|2022|PDM|6.00|99|0.00|DOPPLER FLOW TESTING|
20|FH_F123922_84102_0|SrvcGrp|46903|2022|PDM|750.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F141794_50548_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130889_68818_0|SrvcGrp|109029|2022|PCT|0.96|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F34454_0_0|SrvcGrp|12403|2022|PDM|26.25|99|0.00|CONTINUOUS HOMECARE|
20|FH_F78162_0_0|SrvcGrp|67285|2022|PDM|57.00|99|0.00|ST SUBSEQUENT VISIT 92507|
20|FH_F54172_0_0|SrvcGrp|15850|2022|PDM|150.00|99|0.00|HOSPICE SVCS|
20|FH_F148666_34205_0|SrvcGrp|75419|2022|PDM|452.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 6 (NO REV)|
20|FH_F125983_82301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125249_0_0|SrvcGrp|67074|2022|PDM|1400.00|99|0.00|AC SURGERY|
20|FH_F35513_0_0|SrvcGrp|11330|2022|PDM|75.00|99|0.00|SOCIAL WORKER (MEDICAL)|
20|FH_F144021_0_0|SrvcGrp|107749|2022|PDM|207.00|99|0.00|CAPD/CCPD|
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 1 (NO REV)|
20|FH_F109645_0_0|SrvcGrp|27969|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F62915_0_0|SrvcGrp|58768|2022|PCT|1.00|99|0.00|OCN F/S PRICING: HCPCS (HCFA)|
20|FH_F149866_07401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F94942_0_0|SrvcGrp|73000|2022|PDM|1122.70|99|0.00|AEG 6|
20|FH_F149868_0_0|SrvcGrp|74546|2022|PDM|705.00|99|0.00|HOSPICE SERVICES|
20|FH_F149140_07522_0|SrvcGrp|113231|2022|PDM|105.33|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 TITER|
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 10 (NO REV)|
20|FH_F128136_48025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124899_45246_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F121183_75093_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F52393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135267_19002_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F148543_71103_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|1442.60|99|0.00|AEG 7 (NO REV)|
20|FH_F143528_0_0|SrvcGrp|89883|2022|PDM|4861.50|99|0.00|AETNA TREAT HUMERUS FRACTURE|
20|FH_F72183_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|ASPG VII - FH SW CUSTOM GROUPERS|
20|FH_F128272_60640_0|SrvcGrp|86851|2022|PDM|50.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F125899_07645_0|SrvcGrp|110238|2022|PDM|1384.00|99|0.00|CAT SCAN|
20|FH_F135294_64093_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120718_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F145542_70503_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F93741_85006_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|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|34606|2022|PDM|3303.00|99|0.00|CPT 29827|
20|FH_F93332_0_0|SrvcGrp|93087|2022|PDM|6386.00|99|0.00|LAMINECTOMY W/FACE-THORACIC (HFCA)|
20|FH_F136510_0_0|SrvcGrp|28547|2022|PDM|3882.00|99|0.00|VITRECTOMY|
20|FH_F58592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F65159_0_0|SrvcGrp|8|2022|PDM|7295.00|99|0.00|BURN INTENSIVE CARE|
20|FH_F122725_32216_0|SrvcGrp|102981|2022|PDM|77.00|99|0.00|PSYTX WPT W E/M 45 MIN|
20|FH_F60112_0_0|SrvcGrp|43429|2022|PDM|42.25|99|0.00|RN HOURLY, HIGH TECH PEDS|
20|FH_F149300_53158_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133947_93950_0|SrvcGrp|90854|2022|PDM|849.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F81861_0_0|SrvcGrp|64107|2022|PDM|1223.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 3|
20|FH_F149345_45044_0|SrvcGrp|83683|2022|PCT|0.00|99|0.00|ACUTE REHAB II|
20|FH_F150165_06032_0|SrvcGrp|88599|2022|PDM|3925.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F149120_0_0|SrvcGrp|87077|2022|PDM|145.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F126249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F133972_27103_0|SrvcGrp|86845|2022|PDM|35.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F83380_0_0|SrvcGrp|43265|2022|PDM|105.00|99|0.00|MID-LINE INSERTION|
20|FH_F118803_0_0|SrvcGrp|107884|2022|PDM|2717.44|99|0.00|TRLUML BALO ANGIOP 1ST ART|
20|FH_F118123_67226_0|SrvcGrp|88621|2022|PDM|73.00|99|0.00|SKILLED NURSING LPN|
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|1597.00|99|0.00|ASPG VIII|
20|FH_F150308_48180_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133724_84041_0|SrvcGrp|48396|2022|PDM|103.00|99|0.00|OT SERVICES|
20|FH_F149199_73005_0|SrvcGrp|33789|2022|PDM|605.00|99|0.00|MS DRG 880-887 ONLY|
20|FH_F83054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE (HCFA)|
20|FH_F132969_84003_0|SrvcGrp|46104|2022|PDM|50.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F145604_14850_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145642_15108_0|SrvcGrp|14945|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F149059_19702_0|SrvcGrp|82981|2022|PDM|158.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F110311_17078_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F120549_19087_0|SrvcGrp|108520|2022|PDM|300.00|99|0.00|MALE AND FEMALE GENITAL SYSTEM|
20|FH_F149319_07670_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F139873_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F36552_0_0|SrvcGrp|18881|2022|PDM|28250.00|99|0.00|MS DRG 233|
20|FH_F143708_19031_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F85415_27612_0|SrvcGrp|48398|2022|PDM|78.75|99|0.00|PT SERVICES|
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|991.68|99|0.00|ASPG VI|
20|FH_F100782_0_0|SrvcGrp|105178|2022|PDM|1792.60|99|0.00|WINDBER MEDICAL CNTR ASC 1404|
20|FH_F126341_27284_0|SrvcGrp|17016|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F121225_98902_0|SrvcGrp|14948|2022|PDM|150.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F83991_52172_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|GENERAL ACUTE CARE|
20|FH_F69942_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127651_44124_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F121255_76132_0|SrvcGrp|75419|2022|PDM|386.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F137799_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F144228_0_0|SrvcGrp|114140|2022|PDM|1027.00|99|0.00|REMOVAL OF SKIN LESION|
20|FH_F133972_27103_0|SrvcGrp|86834|2022|PDM|30.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F134595_06226_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144228_0_0|SrvcGrp|99073|2022|PCT|0.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F88744_71103_0|SrvcGrp|113275|2022|PDM|100.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT|
20|FH_F149270_98004_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135670_01749_0|SrvcGrp|115834|2022|PCT|0.82|99|0.00|J CODES/NDC|
20|FH_F109387_35630_0|SrvcGrp|86748|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F39378_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F69606_0_0|SrvcGrp|64109|2022|PDM|556.40|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 2|
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F78344_0_0|SrvcGrp|72941|2022|PDM|160.00|99|0.00|HOSPICE CARE IN HOME|
20|FH_F80064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.61|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_F116114_37033_0|SrvcGrp|87317|2022|PDM|833.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F131697_33444_0|SrvcGrp|104464|2022|PDM|1500.00|99|0.00|VAGINAL DELIVERY (W/ OR W/O EPISIOTOMY)|
20|FH_F132187_66111_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133153_44113_0|CSTM-ALL|CSTM-00|2020|PDM|452.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F34626_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS|
20|FH_F148760_12953_0|SrvcGrp|23683|2022|PDM|53.00|99|0.00|SKILLED NURSING RN|
20|FH_F151154_91761_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151155_26508_0|SrvcGrp|113338|2022|PDM|136.00|99|0.00|PERIODIC ASSESSMENT|
20|FH_F151199_77511_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)|
20|FH_F129130_92562_0|SrvcGrp|73463|2022|PDM|6046.00|99|0.00|AETNA NICU II|
20|FH_F129130_92562_0|SrvcGrp|114925|2022|PDM|8606.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F129130_92562_0|CSTM-ALL|CSTM-00|2020|PDM|1750.56|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F31525_0_0|SrvcGrp|3029|2022|PDM|562.00|99|0.00|NEWBORN NURSERY|
20|FH_F69651_0_0|SrvcGrp|14254|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F97780_43614_0|SrvcGrp|90854|2022|PDM|1954.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F34463_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.00|99|0.00|OP SVCS|
20|FH_F117442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F74562_0_0|SrvcGrp|38|2022|PDM|2725.00|99|0.00|NORMAL DELIVERY|
20|FH_F142318_21218_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F142335_60624_0|SrvcGrp|90854|2022|PDM|959.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F112163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F105588_15228_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F105591_17601_0|SrvcGrp|72992|2022|PDM|840.00|99|0.00|AEG 2|
20|FH_F105591_17601_0|SrvcGrp|72990|2022|PDM|627.00|99|0.00|AEG 1|
20|FH_F113392_0_0|SrvcGrp|84183|2022|PDM|1177.00|99|0.00|AETNA SURGERY OF BREAST CAPSULE|
20|FH_F34371_0_0|SrvcGrp|10539|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F109652_0_0|SrvcGrp|32560|2022|PCT|0.54|99|0.00|BURN SERVICES (MS DRG)|
20|FH_F130676_0_0|SrvcGrp|73485|2022|PDM|1575.00|99|0.00|AETNA REHAB|
20|FH_F127326_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F120210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F69347_0_0|SrvcGrp|29817|2022|PDM|4040.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F111594_0_0|SrvcGrp|88158|2022|PDM|7215.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F113709_0_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F117485_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F132544_0_0|SrvcGrp|96352|2022|PDM|6124.00|99|0.00|ANKLE JOINT|
20|FH_F138283_0_0|SrvcGrp|73524|2022|PDM|107.00|99|0.00|PHYSICAL THERAPY|
20|FH_F148419_01453_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148554_85016_0|SrvcGrp|115477|2022|PDM|4517.00|99|0.00|PERC D-E COR REVASC CHRO SIN|
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|2510.00|99|0.00|AEG 8 (NO REV)|
20|FH_F92676_15063_0|SrvcGrp|70119|2022|PDM|8993.00|99|0.00|HAPA WPA:PTCA W/DRUG ELUTING STENT|
20|FH_F141893_65655_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F72980_0_0|SrvcGrp|13595|2022|PDM|431.35|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F124505_0_0|SrvcGrp|80540|2022|PDM|612.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 4|
20|FH_F81494_0_0|SrvcGrp|8950|2022|PDM|2514.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F144471_19805_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101754_63141_0|SrvcGrp|89500|2022|PDM|170.58|99|0.00|SPEECH SOUND LANGUAGE|
20|FH_F89932_10940_0|SrvcGrp|10700|2022|PDM|340.00|99|0.00|INTENSIVE SVCS|
20|FH_F117555_72802_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F80855_0_0|SrvcGrp|72998|2022|PDM|1025.00|99|0.00|AEG 5|
20|FH_F105921_80014_0|SrvcGrp|48394|2022|PDM|49.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD NU/KC)|
20|FH_F101754_63141_0|SrvcGrp|72379|2022|PDM|79.45|99|0.00|SPEECH THERAPY|
20|FH_F146285_76109_0|SrvcGrp|74668|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F32509_0_0|SrvcGrp|13052|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F120089_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130599_41472_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127327_27401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F39859_0_0|SrvcGrp|10362|2022|PDM|196.00|99|0.00|CPT CODE 99282|
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 10 (NO REV)|
20|FH_F150024_08079_0|CSTM-ALL|CSTM-00|2020|PDM|2464.00|99|0.00|AEG 4 (NO REV)|
20|FH_F150602_59718_0|SrvcGrp|88620|2022|PDM|115.00|99|0.00|SKILLED NURSING RN|
20|FH_F35411_0_0|CSTM-ALL|CSTM-00|2020|PDM|8050.00|99|0.00|MSDRG 246-251 ANGIOPLASTY|
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 5  (NO REV)|
20|FH_F83113_0_0|SrvcGrp|12403|2022|PDM|770.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F98921_64503_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F40851_0_0|SrvcGrp|33708|2022|PDM|5392.00|99|0.00|OP CARDIAC CATHETERIZATION|
20|FH_F120954_0_0|SrvcGrp|108696|2022|PCT|0.00|99|0.00|HOSPICE IP/OP RESPITE CARE|
20|FH_F150908_38570_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128089_57385_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128648_44256_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F133371_63077_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120773_77706_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F35875_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F63101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|OP SVCS|
20|FH_F133390_07626_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F117446_31322_0|CSTM-ALL|CSTM-00|2020|PDM|145.31|99|0.00|HOSPICE ROUTINE HOME CARE (DAYS 0-60)|
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 4 (NO REV)|
20|FH_F40448_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F141930_72032_0|CSTM-ALL|CSTM-00|2020|PDM|1414.00|99|0.00|AEG 7 (NO REV)|
20|FH_F147800_0_0|SrvcGrp|88487|2022|PDM|4510.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F40906_0_0|SrvcGrp|2067|2022|PDM|538.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F150119_34205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PDM|1604.00|99|0.00|ASPG VI|
20|FH_F149882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116145_0_0|SrvcGrp|26001|2022|PDM|133.35|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F142814_16511_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F102561_75146_0|SrvcGrp|42724|2022|PDM|600.00|99|0.00|SLEEP STUDY|
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1240.00|99|0.00|ASPG V|
20|FH_F108940_15642_0|SrvcGrp|73842|2022|PDM|159.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F141967_89509_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F113792_0_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F125570_66104_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39079_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F142081_54929_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117508_90232_0|SrvcGrp|74615|2022|PDM|350.00|99|0.00|INTENSIVE OUTPATIENT|
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123144_0_0|SrvcGrp|72994|2022|PDM|523.00|99|0.00|AEG 3|
20|FH_F132543_79549_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118788_91355_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128312_45230_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F125013_85251_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F80831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|GENERAL ACUTE CARE|
20|FH_F36663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S MOD NU (CPD 1364768)|
20|FH_F128392_01026_0|SrvcGrp|111100|2022|PCT|1.30|99|0.00|EVALUATION AND MANAGEMENT|
20|FH_F38986_0_0|SrvcGrp|115|2022|PDM|370.00|99|0.00|SKILLED NURSING CARE|
20|FH_F124452_31322_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F131942_50833_0|SrvcGrp|48385|2022|PDM|120.00|99|0.00|SPEECH THERAPY|
20|FH_F134432_85053_0|SrvcGrp|75419|2022|PDM|1050.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F49093_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35750_0_0|SrvcGrp|18924|2022|PDM|8063.18|99|0.00|MS DRG 768|
20|FH_F124329_37874_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149160_02180_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F99380_90503_0|SrvcGrp|38871|2022|PCT|0.90|99|0.00|TRAUMA SERVICES - OP|
20|FH_F117583_21208_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F97080_85122_0|SrvcGrp|73659|2022|PDM|7016.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F31547_0_0|SrvcGrp|109841|2022|PCT|1.00|99|0.00|LAB F/S - STAND ALONE|
20|FH_F110732_31513_0|SrvcGrp|72984|2022|PCT|0.60|99|0.00|CHEMOTHERAPY|
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|2198.00|99|0.00|AEG 7 (NO REV)|
20|FH_F138217_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F114308_70601_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F41802_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F71786_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110783_93013_0|SrvcGrp|21920|2022|PDM|35.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F141247_18902_0|SrvcGrp|89149|2022|PDM|230.00|99|0.00|OP INTENSIVE|
20|FH_F130328_0_0|SrvcGrp|104226|2022|PDM|198.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F138017_73129_0|CSTM-ALL|CSTM-00|2020|PDM|2074.00|99|0.00|AEG 5  (NO REV)|
20|FH_F127324_0_0|SrvcGrp|87062|2022|PDM|1725.00|99|0.00|REVISE ULNAR NERVE AT ELBOW|
20|FH_F39695_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84532_0_0|SrvcGrp|72998|2022|PDM|1986.00|99|0.00|AEG 5|
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1820.00|99|0.00|AEG 8 (NO REV)|
20|FH_F128988_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F147316_70433_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F75944_0_0|SrvcGrp|68186|2022|PDM|860.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 2|
20|FH_F148181_0_0|SrvcGrp|95660|2022|PDM|1000.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F101280_63111_0|SrvcGrp|89417|2022|PDM|325.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F148967_04254_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F35557_0_0|SrvcGrp|15516|2022|PDM|54.00|99|0.00|HYDRATION THERAPY|
20|FH_F127258_79912_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F36766_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F151424_0_0|CSTM-ALL|CSTM-00|2020|PCT|30.00|99|0.00|OP SVCS|
20|FH_F149539_06032_0|SrvcGrp|57968|2022|PDM|69.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F147082_02359_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F117603_92210_0|SrvcGrp|106247|2022|PDM|1150.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F115982_0_0|SrvcGrp|87677|2022|PDM|550.00|99|0.00|CERVICAL OR THORACIC SURGERY|
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_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|24661.00|99|0.00|MS DRG 242-244 PACEMAKER IMPLANT|
20|FH_F116575_0_0|SrvcGrp|15473|2022|PDM|1600.00|99|0.00|CPT CODE 42820|
20|FH_F138987_0_0|SrvcGrp|95660|2022|PDM|646.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F37081_0_0|SrvcGrp|701|2022|PDM|2848.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F132595_0_0|SrvcGrp|16|2022|PDM|1423.00|99|0.00|ACUTE REHABILITATION|
20|FH_F129682_07034_0|SrvcGrp|48398|2022|PDM|105.00|99|0.00|PT SERVICES|
20|FH_F97080_85122_0|SrvcGrp|73602|2022|PDM|3215.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F140187_61061_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143347_16001_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F143536_47546_0|SrvcGrp|100259|2022|PCT|1.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (20.1 - 30.0 CM)|
20|FH_F101700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD RR|
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132446_19063_0|SrvcGrp|87398|2022|PDM|76.00|99|0.00|CPT 99501 (HCFA)|
20|FH_F73011_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F99520_0_0|CSTM-ALL|CSTM-00|2020|PCT|46.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116756_77477_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119918_38201_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120974_27607_0|CSTM-ALL|CSTM-00|2020|PDM|8292.00|99|0.00|AEG 8 (NO REV)|
20|FH_F120974_27607_0|SrvcGrp|75506|2022|PCT|0.71|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F126395_37043_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40207_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP CATARACT SURGERY|
20|FH_F118950_33312_0|SrvcGrp|86722|2022|PDM|450.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F118950_33312_0|SrvcGrp|89417|2022|PDM|650.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F98622_45005_0|SrvcGrp|73559|2022|PDM|18041.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F103004_75840_0|SrvcGrp|73605|2022|PDM|608.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F111190_30512_0|SrvcGrp|33166|2022|PDM|567.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F143036_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143467_0_0|SrvcGrp|96542|2022|PDM|3140.00|99|0.00|REPAIR OF LEG TENDON|
20|FH_F143467_0_0|SrvcGrp|98470|2022|PDM|1424.00|99|0.00|AMPUTATION TOE|
20|FH_F45832_0_0|SrvcGrp|537|2022|PCT|0.72|99|0.00|OBSERVATION SERVICES|
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|651.63|99|0.00|ASPG X|
20|FH_F130747_0_0|SrvcGrp|55071|2022|PDM|5202.00|99|0.00|ARTHROSCOPY SHOULDER|
20|FH_F123282_03222_0|SrvcGrp|46104|2022|PDM|136.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F135165_15728_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F148663_48601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142073_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F130127_77071_0|SrvcGrp|46903|2022|PDM|1040.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F125966_68776_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F74242_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F83451_0_0|SrvcGrp|10986|2022|PDM|2000.00|99|0.00|ARTHROSCOPIC KNEE REPAIR|
20|FH_F135021_37160_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136756_0_0|SrvcGrp|73008|2022|PDM|266.20|99|0.00|AEG 10|
20|FH_F32502_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F137972_0_0|SrvcGrp|95819|2022|PDM|1980.00|99|0.00|GONIOTOMY|
20|FH_F127851_68106_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F63141_0_0|SrvcGrp|80|2022|PDM|1300.00|99|0.00|ACUTE PSYCH|
20|FH_F131234_32207_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
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_F40421_0_0|SrvcGrp|997|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|1024.00|99|0.00|AEG 4 (NO REV)|
20|FH_F120253_44646_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F78162_0_0|SrvcGrp|73359|2022|PCT|1.10|99|0.00|VACCINE SERVICES|
20|FH_F148343_70810_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148205_75149_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40438_0_0|SrvcGrp|350|2022|PDM|1366.00|99|0.00|SURGICAL CARE|
20|FH_F120666_0_0|CSTM-ALL|CSTM-00|2020|PDM|2113.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121149_76021_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F92091_0_0|SrvcGrp|77021|2022|PDM|7800.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F137716_66204_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125938_0_0|SrvcGrp|13928|2022|PCT|0.75|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F125254_30306_0|SrvcGrp|73841|2022|PDM|476.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F109180_18015_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F112755_43215_0|SrvcGrp|104304|2022|PCT|0.15|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F90818_0_0|SrvcGrp|89887|2022|PDM|3750.00|99|0.00|AETNA CYSTOSCOPY AND TREATMENT|
20|FH_F90818_0_0|SrvcGrp|89882|2022|PDM|3125.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F124050_75089_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130145_98043_0|SrvcGrp|108041|2022|PDM|715.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F32784_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38360_0_0|SrvcGrp|28847|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY|
20|FH_F41178_0_0|CSTM-ALL|CSTM-00|2020|PDM|646.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102302_0_0|SrvcGrp|98579|2022|PDM|29900.00|99|0.00|REMOVE VERTEBRAL BODY ADD-ON|
20|FH_F118194_50841_0|SrvcGrp|86847|2022|PDM|240.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F150699_0_0|SrvcGrp|108518|2022|PDM|9450.00|99|0.00|IMPLANT PAT ACTIVE HT RECORD|
20|FH_F141410_13045_0|SrvcGrp|113465|2022|PCT|1.10|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F40427_0_0|SrvcGrp|38|2022|PDM|2127.00|99|0.00|NORMAL DELIVERY|
20|FH_F150314_0_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F135252_21911_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150982_0_0|SrvcGrp|35668|2022|PDM|3303.00|99|0.00|CPT 29824|
20|FH_F38383_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90362_0_0|SrvcGrp|73008|2022|PDM|721.00|99|0.00|AEG 10|
20|FH_F131653_50314_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F92411_0_0|SrvcGrp|3809|2022|PDM|588.89|99|0.00|HOSPICE CARE|
20|FH_F67504_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F148266_45419_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F50214_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120215_92064_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F151524_84121_0|SrvcGrp|74668|2022|PDM|48.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F40063_0_0|SrvcGrp|592|2022|PDM|1669.00|99|0.00|SUB-ACUTE CARE|
20|FH_F76171_0_0|SrvcGrp|73301|2022|PDM|73.00|99|0.00|PHYSICAL THERAPY HOURLY|
20|FH_F141567_80128_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1031.82|99|0.00|HAPA WPA-NWPA 2012-13 ASC 701 W/O REV|
20|FH_F87618_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|OP SVCS|
20|FH_F46094_0_0|SrvcGrp|11068|2022|PDM|100.00|99|0.00|PT SVCS|
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|ASPG VIII|
20|FH_F123280_67002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129656_15005_0|SrvcGrp|17014|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 5  (NO REV)|
20|FH_F94662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67261_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F40043_0_0|SrvcGrp|24613|2022|PDM|6164.00|99|0.00|CARDIAC CATH|
20|FH_F148170_04005_0|SrvcGrp|106317|2022|PDM|1454.61|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F123511_64076_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F148221_06477_0|SrvcGrp|43569|2022|PDM|105.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F149869_03253_0|SrvcGrp|22384|2022|PDM|154.00|99|0.00|HOME VISIT PRENATAL|
20|FH_F40605_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|HEAD INJURY REHABILITATION|
20|FH_F88391_0_0|SrvcGrp|12403|2022|PDM|32.90|99|0.00|CONTINUOUS HOMECARE|
20|FH_F102184_0_0|SrvcGrp|35669|2022|PDM|4812.00|99|0.00|CPT 63650|
20|FH_F143528_0_0|SrvcGrp|88600|2022|PDM|2625.00|99|0.00|WRIST ARTHROS DIAG W/WO BIO|
20|FH_F123844_0_0|SrvcGrp|95661|2022|PDM|678.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F37539_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F51129_0_0|SrvcGrp|14727|2022|PCT|0.92|99|0.00|TRAUMA CARE|
20|FH_F81373_64064_0|SrvcGrp|42750|2022|PCT|0.69|99|0.00|MS DRG 927-929, 933-934 ONLY BURN SVCS|
20|FH_F46473_0_0|SrvcGrp|10391|2022|PDM|2076.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F111316_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F52293_0_0|SrvcGrp|44428|2022|PDM|115.00|99|0.00|OCCUPATIONAL THERAPY SVCS (VISIT LVL)|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|72.00|99|0.00|FAMILY PSYTX W PT 50 MINS (HCFA)|
20|FH_F73705_0_0|SrvcGrp|42870|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F92676_15063_0|SrvcGrp|79056|2022|PDM|469.83|99|0.00|MON VALLEY ASC 234|
20|FH_F132543_79549_0|SrvcGrp|79786|2022|PCT|1.20|99|0.00|SLEEP STUDIES|
20|FH_F96102_33884_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F118541_15222_0|SrvcGrp|55677|2022|PDM|3309.00|99|0.00|VAGINAL DELIVERY ONLY|
20|FH_F102721_38118_0|SrvcGrp|86800|2022|PCT|0.37|99|0.00|AETNA CHEMOTHERAPY|
20|FH_F120954_0_0|SrvcGrp|108543|2022|PDM|103.95|99|0.00|HOME HEALTH AIDE|
20|FH_F150907_17543_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149781_37404_0|SrvcGrp|88164|2022|PDM|7002.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F75706_0_0|SrvcGrp|42826|2022|PDM|50.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F115312_78550_0|SrvcGrp|72602|2022|PDM|845.00|99|0.00|ECT|
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 5  (NO REV)|
20|FH_F126733_83713_0|SrvcGrp|89337|2022|PDM|784.00|99|0.00|DETOXIFICATION|
20|FH_F91155_16105_0|SrvcGrp|72996|2022|PDM|1283.00|99|0.00|AEG 4|
20|FH_F120437_85202_0|SrvcGrp|23683|2022|PDM|77.66|99|0.00|SKILLED NURSING RN|
20|FH_F121016_32607_0|SrvcGrp|78420|2022|PDM|2300.00|99|0.00|INTERIM LABOR|
20|FH_F50440_0_0|SrvcGrp|45148|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F37035_0_0|SrvcGrp|33826|2022|PDM|797.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 4|
20|FH_F117555_72802_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41785_0_0|SrvcGrp|31189|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF (DME)|
20|FH_F143054_26147_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F118388_34952_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|1560.00|99|0.00|AEG 8 (NO REV)|
20|FH_F133350_39532_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
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_F128421_27016_0|SrvcGrp|34923|2022|PCT|0.80|99|0.00|ACUTE PSYCH|
20|FH_F92792_0_0|SrvcGrp|87759|2022|PDM|1320.00|99|0.00|REINFORCE/GRAFT EYE WALL|
20|FH_F62627_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F44257_0_0|SrvcGrp|24585|2022|PDM|451.00|99|0.00|SKILLED NURSING|
20|FH_F142967_65065_0|SrvcGrp|92537|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F111589_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F144211_30012_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132934_63005_0|SrvcGrp|12280|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F145328_90301_0|SrvcGrp|113344|2022|PDM|35.00|99|0.00|ADD 30 MINS COUNSEL|
20|FH_F143684_0_0|SrvcGrp|92364|2022|PDM|18135.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F146104_33410_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (BREAKOUT)|
20|FH_F92676_15063_0|SrvcGrp|78957|2022|PDM|2654.73|99|0.00|MON VALLEY ASC 708|
20|FH_F144449_04619_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F35678_0_0|SrvcGrp|3029|2022|PDM|423.00|99|0.00|NEWBORN NURSERY|
20|FH_F34924_0_0|SrvcGrp|38|2022|PDM|3000.00|99|0.00|NORMAL DELIVERY|
20|FH_F128191_28642_0|SrvcGrp|48396|2022|PDM|90.00|99|0.00|OT SERVICES|
20|FH_F45158_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103180_85283_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F75207_0_0|SrvcGrp|16703|2022|PDM|325.00|99|0.00|HEMO/HOME DIALYSIS SVCS|
20|FH_F139715_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|611.00|99|0.00|AEG 4 (NO REV)|
20|FH_F93392_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F125182_0_0|SrvcGrp|73006|2022|PDM|1547.00|99|0.00|AEG 9|
20|FH_F129966_18017_0|SrvcGrp|89149|2022|PDM|227.00|99|0.00|OP INTENSIVE|
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_F149662_85015_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 2 (NO REV)|
20|FH_F90223_0_0|SrvcGrp|88809|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE (HCFA)|
20|FH_F151001_80501_0|SrvcGrp|74668|2022|PDM|1660.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F116753_0_0|SrvcGrp|21457|2022|PDM|1278.00|99|0.00|CPT CODE 95811|
20|FH_F122841_0_0|SrvcGrp|42551|2022|PDM|603.00|99|0.00|OP SURGERY|
20|FH_F149459_06615_0|SrvcGrp|88621|2022|PDM|84.00|99|0.00|SKILLED NURSING LPN|
20|FH_F138017_73129_0|SrvcGrp|90320|2022|PDM|13768.00|99|0.00|AETNA LAPAROSCOPY SURGICAL|
20|FH_F149000_07701_0|SrvcGrp|74668|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F141327_65566_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F147347_70806_0|SrvcGrp|89024|2022|PDM|75.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F132155_66209_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F126189_89129_0|SrvcGrp|108484|2022|PDM|675.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F126785_0_0|SrvcGrp|14174|2022|PDM|2553.00|99|0.00|MRI|
20|FH_F134870_97015_0|SrvcGrp|79747|2022|PCT|1.20|99|0.00|LABORATORY|
20|FH_F138347_77701_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|AEG 2 (NO REV)|
20|FH_F117603_92210_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F127464_15106_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35557_0_0|SrvcGrp|12071|2022|PDM|28.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F123915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F141410_13045_0|SrvcGrp|113739|2022|PCT|1.65|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F39786_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F128853_43560_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 281-282 CIRCULATORY DISORDER|
20|FH_F123950_19111_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE|
20|FH_F70303_0_0|SrvcGrp|9263|2022|PDM|211.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F122725_32216_0|SrvcGrp|52953|2022|PDM|23.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F122911_92240_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F86872_15215_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34096_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86851_0_0|SrvcGrp|84973|2022|PDM|651.00|99|0.00|CPT 43250|
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 7 (NO REV)|
20|FH_F88639_80204_0|SrvcGrp|75487|2022|PDM|9472.60|99|0.00|AEG 5|
20|FH_F62579_0_0|SrvcGrp|15596|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F125069_0_0|SrvcGrp|72990|2022|PDM|683.00|99|0.00|AEG 1|
20|FH_F142894_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F110507_33462_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1012.31|99|0.00|AEG 8 (NO REV)|
20|FH_F112665_0_0|SrvcGrp|90343|2022|PDM|7215.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL|
20|FH_F127598_43232_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F110580_71106_0|SrvcGrp|103991|2022|PDM|800.00|99|0.00|ENDOSCOPIC INJECTION OF IMPL|
20|FH_F150165_06032_0|SrvcGrp|24542|2022|PDM|1650.00|99|0.00|PARTIAL REMOVAL OF HYMEN|
20|FH_F87541_0_0|SrvcGrp|73008|2022|PDM|864.00|99|0.00|AEG 10|
20|FH_F119999_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F150219_38578_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F78893_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F63114_0_0|SrvcGrp|46424|2022|PDM|25.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F110302_15931_0|SrvcGrp|48394|2022|PDM|45.02|99|0.00|SKILLED NURSING SERVICES|
20|FH_F117206_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F132883_31602_0|SrvcGrp|86833|2022|PDM|10.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PDM|1128.00|99|0.00|AEG 5  (NO REV)|
20|FH_F122942_89512_0|SrvcGrp|86723|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F49552_0_0|SrvcGrp|17069|2022|PDM|605.80|99|0.00|ASPG III|
20|FH_F133207_0_0|SrvcGrp|27316|2022|PDM|2632.00|99|0.00|TONSILS & ADENOIDS (42820)|
20|FH_F146626_60612_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143708_19031_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127090_45601_0|SrvcGrp|24745|2022|PDM|55.08|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F70863_0_0|SrvcGrp|9832|2022|PDM|174.00|99|0.00|ST SVCS|
20|FH_F133749_84604_0|SrvcGrp|112425|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F34378_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|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_F120408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F127090_45601_0|SrvcGrp|31973|2022|PDM|15.30|99|0.00|HOME THERAPY|
20|FH_F95631_33705_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F117245_0_0|SrvcGrp|74585|2022|PCT|0.60|99|0.00|AETNA OP IMPLANTS|
20|FH_F138951_41101_0|SrvcGrp|29077|2022|PDM|150.00|99|0.00|HOME TRANSFUSION|
20|FH_F147962_85008_0|SrvcGrp|75799|2022|PDM|325.00|99|0.00|EMERGENCY ROOM LEVEL I|
20|FH_F112004_15401_0|SrvcGrp|48394|2022|PDM|80.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F147502_0_0|SrvcGrp|29347|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F114509_10010_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F114409_18447_0|SrvcGrp|48394|2022|PDM|52.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F134593_60007_0|SrvcGrp|86137|2022|PCT|0.85|99|0.00|AETNA VELAGLUCERASE|
20|FH_F128816_43537_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121225_98902_0|SrvcGrp|34389|2022|PDM|201.60|99|0.00|SPEECH THERAPY|
20|FH_F113435_19027_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146520_80435_0|SrvcGrp|114583|2022|PCT|1.00|99|0.00|OP THERAPY SERVICE|
20|FH_F85353_16407_0|SrvcGrp|63882|2022|PDM|264.44|99|0.00|HAPA WPA-NWPA 2012-13 ASC 126|
20|FH_F145880_80303_0|SrvcGrp|75419|2022|PDM|489.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F93359_63084_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F143567_62207_0|SrvcGrp|42971|2022|PDM|135.00|99|0.00|SKN RN|
20|FH_F130329_64114_0|SrvcGrp|86833|2022|PDM|10.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F114483_47905_0|SrvcGrp|105569|2022|PDM|1450.00|99|0.00|PRIVATE MED/SURG/GYN|
20|FH_F128148_0_0|SrvcGrp|34868|2022|PDM|185.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F31595_0_0|SrvcGrp|9830|2022|PDM|85.00|99|0.00|OT SVCS|
20|FH_F110509_71351_0|SrvcGrp|79699|2022|PCT|0.55|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F110881_63125_0|SrvcGrp|42784|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F149263_0_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F87541_0_0|SrvcGrp|72992|2022|PDM|538.00|99|0.00|AEG 2|
20|FH_F109387_35630_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.85|99|0.00|HAPA WPA-NWPA 2012-13 ASC 129 W/O REV|
20|FH_F133920_64057_0|SrvcGrp|46605|2022|PDM|125.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F128795_57469_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F85353_16407_0|SrvcGrp|63889|2022|PDM|205.07|99|0.00|HAPA WPA-NWPA 2012-13 ASC 131|
20|FH_F144248_0_0|SrvcGrp|109763|2022|PDM|2869.00|99|0.00|TREAT EYELID LESION|
20|FH_F116653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138951_41101_0|SrvcGrp|29076|2022|PDM|40.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F120715_83440_0|SrvcGrp|75506|2022|PCT|0.96|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F109400_80026_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F143674_34208_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149150_75407_0|SrvcGrp|73605|2022|PDM|1000.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F134593_60007_0|SrvcGrp|115521|2022|PCT|0.85|99|0.00|AMONDYS 45/CASIMERSEN INJECTION|
20|FH_F43199_0_0|SrvcGrp|13703|2022|PDM|36.75|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F136359_0_0|SrvcGrp|28548|2022|PDM|6500.00|99|0.00|VITRECTOMY|
20|FH_F100782_0_0|SrvcGrp|105083|2022|PDM|483.31|99|0.00|WINDBER MEDICAL CNTR ASC 128|
20|FH_F149279_17022_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F37698_0_0|SrvcGrp|11151|2022|PDM|1800.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F80455_0_0|SrvcGrp|78047|2022|PDM|291.50|99|0.00|AETNA VISION SERVICES|
20|FH_F42690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F44299_0_0|SrvcGrp|10542|2022|PDM|65.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F71103_0_0|SrvcGrp|68140|2022|PDM|35.00|99|0.00|HOME HEALTH AID|
20|FH_F134495_84321_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F122564_53809_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F85012_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F85393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87053_0_0|SrvcGrp|72994|2022|PDM|826.00|99|0.00|AEG 3|
20|FH_F101100_50314_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA - APC GROUPER B|
20|FH_F105143_26062_0|SrvcGrp|31931|2022|PDM|937.00|99|0.00|SKILLED NURSING CARE|
20|FH_F73967_0_0|SrvcGrp|12023|2022|PDM|147.00|99|0.00|HOSPICE RESPITE SERVICES|
20|FH_F75842_0_0|SrvcGrp|40820|2022|PDM|3676.42|99|0.00|ICU/CCU|
20|FH_F75842_0_0|SrvcGrp|14174|2022|PDM|1508.37|99|0.00|MRI|
20|FH_F146501_68025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146783_76048_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146798_44011_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120811_53525_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F126783_80021_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115966_16801_0|SrvcGrp|88620|2022|PDM|125.00|99|0.00|SKILLED NURSING RN|
20|FH_F115979_46107_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131711_25550_0|SrvcGrp|3208|2022|PDM|520.00|99|0.00|SUBACUTE CARE|
20|FH_F133133_32433_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133491_74012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132678_19090_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|1123.00|99|0.00|ASPG VIII|
20|FH_F40081_0_0|SrvcGrp|3087|2022|PDM|735.00|99|0.00|CD - DETOX|
20|FH_F113715_45005_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F72662_0_0|SrvcGrp|29977|2022|PDM|59.00|99|0.00|WOUND CARE CANISTER SET|
20|FH_F76172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F110381_0_0|SrvcGrp|89877|2022|PDM|5300.00|99|0.00|HIP ARTHROSCOPY/SURGERY|
20|FH_F97721_01053_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F106822_0_0|SrvcGrp|100270|2022|PDM|16.30|99|0.00|IIV3 VACC NO PRSV 0.25 ML IM|
20|FH_F116323_0_0|SrvcGrp|27261|2022|PDM|28954.00|99|0.00|CPT 27446|
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|180.82|99|0.00|SLEEP STUDY CPT 95800|
20|FH_F115204_0_0|SrvcGrp|472|2022|PDM|696.30|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F114916_30309_0|SrvcGrp|89980|2022|PDM|4500.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F142447_72758_0|SrvcGrp|83683|2022|PCT|0.00|99|0.00|ACUTE REHAB II|
20|FH_F130400_26505_0|SrvcGrp|103913|2022|PCT|0.74|99|0.00|OP DIALYSIS|
20|FH_F112064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F125163_0_0|SrvcGrp|108041|2022|PDM|1300.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|AEG 2 (NO REV)|
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132627_0_0|SrvcGrp|19742|2022|PDM|153.00|99|0.00|MID-LINE INSERTION|
20|FH_F93252_0_0|SrvcGrp|93024|2022|PDM|2500.00|99|0.00|NEURO STIMULATOR|
20|FH_F114389_50131_0|SrvcGrp|99037|2022|PDM|224.99|99|0.00|ANTIBIOTIC Q6H (HCFA)|
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_F121426_0_0|SrvcGrp|12995|2022|PDM|485.00|99|0.00|DIALYSIS|
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1512.00|99|0.00|ASPG VI|
20|FH_F124180_0_0|SrvcGrp|109739|2022|PDM|2724.00|99|0.00|NASAL/SINUS ENDOSCOPY WITH DILATION|
20|FH_F122181_66538_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F124059_64055_0|SrvcGrp|22592|2022|PDM|22.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F124059_64055_0|SrvcGrp|14949|2022|PDM|125.00|99|0.00|HOME INFUSION|
20|FH_F43832_0_0|SrvcGrp|8962|2022|PDM|120.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F74102_0_0|SrvcGrp|3809|2022|PDM|715.00|99|0.00|HOSPICE CARE|
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|1718.20|99|0.00|AEG 5  (NO REV)|
20|FH_F132864_71101_0|CSTM-ALL|CSTM-00|2020|PDM|4324.00|99|0.00|AEG 9 (NO REV)|
20|FH_F98380_43055_0|SrvcGrp|73656|2022|PDM|797.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F124173_66215_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F124676_45503_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127932_32117_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100520_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|AEG 8 (NO REV)|
20|FH_F100787_69162_0|SrvcGrp|90854|2022|PDM|2257.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F123774_0_0|SrvcGrp|105604|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_F55694_0_0|SrvcGrp|30546|2022|PDM|20847.00|99|0.00|MS DRG 246-247 ONLY|
20|FH_F138929_0_0|SrvcGrp|88157|2022|PDM|17600.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F141207_0_0|SrvcGrp|80918|2022|PDM|485.00|99|0.00|RESPITE CARE|
20|FH_F132627_0_0|SrvcGrp|10577|2022|PDM|7.14|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F132627_0_0|SrvcGrp|22594|2022|PDM|80.58|99|0.00|IMIGLUCERASE|
20|FH_F93252_0_0|SrvcGrp|93029|2022|PDM|2000.00|99|0.00|GYN SURGICAL PROCEDURES|
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_F116664_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F114389_50131_0|SrvcGrp|86829|2022|PDM|84.26|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F77944_0_0|CSTM-ALL|CSTM-00|2020|PDM|6642.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F122183_98146_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F122198_20708_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F147017_35976_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38081_0_0|SrvcGrp|13133|2022|PDM|46.00|99|0.00|PT/OT/ST|
20|FH_F91998_0_0|SrvcGrp|27315|2022|PDM|1000.00|99|0.00|TENDON REPAIR|
20|FH_F72863_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130909_33025_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F124178_01604_0|SrvcGrp|10008|2022|PCT|1.00|99|0.00|LUPRON DEPOT/ELIGARD/LEUPROLIDE|
20|FH_F136590_71263_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136622_60062_0|SrvcGrp|73842|2022|PDM|349.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114666_30342_0|SrvcGrp|26002|2022|PDM|240.00|99|0.00|C-ARM AND LASER|
20|FH_F114764_78214_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138310_60461_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F81893_23114_0|SrvcGrp|92760|2022|PCT|1.41|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122885_39571_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F42837_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE HCPCS NO MOD|
20|FH_F134727_30650_0|SrvcGrp|12491|2022|PCT|0.60|99|0.00|PACEMAKER|
20|FH_F62922_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F74283_0_0|SrvcGrp|68139|2022|PDM|75.00|99|0.00|RN VISIT|
20|FH_F115210_21043_0|SrvcGrp|93433|2022|PDM|8200.00|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F115708_15317_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116199_75042_0|SrvcGrp|86723|2022|PDM|355.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F147439_84003_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147519_52627_0|SrvcGrp|73841|2022|PDM|342.71|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F41663_0_0|SrvcGrp|10400|2022|PDM|1750.00|99|0.00|IP SURGERY|
20|FH_F39346_0_0|SrvcGrp|29704|2022|PDM|9044.00|99|0.00|CV SURGERY MS DRG 283-285 ONLY|
20|FH_F102641_0_0|SrvcGrp|87679|2022|PDM|2026.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F46433_0_0|SrvcGrp|17016|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F133536_0_0|SrvcGrp|26278|2022|PDM|3300.00|99|0.00|CPT 29881|
20|FH_F117820_0_0|SrvcGrp|47411|2022|PDM|62.60|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F120683_80238_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F44459_0_0|SrvcGrp|16746|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F48836_0_0|SrvcGrp|31186|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC (DME)|
20|FH_F57953_0_0|SrvcGrp|36807|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER QW (DME)|
20|FH_F57953_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F109949_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 1 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|457.83|99|0.00|HAPA WPA-NWPA 2012-13 ASC 305 W/O REV|
20|FH_F113527_31023_0|SrvcGrp|75481|2022|PCT|0.80|99|0.00|AEG 2|
20|FH_F132163_17601_0|SrvcGrp|100499|2022|PDM|780.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F43239_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS APC GROUPED|
20|FH_F135440_32561_0|SrvcGrp|58509|2022|PDM|325.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F135447_53226_0|SrvcGrp|106977|2022|PCT|1.00|99|0.00|RHOGAM INJECTION|
20|FH_F135583_17331_0|SrvcGrp|115534|2022|PCT|6.46|99|0.00|LABORATORY SERVICES|
20|FH_F91735_92653_0|SrvcGrp|73701|2022|PDM|36.75|99|0.00|AETNA - SKILLED NURSING|
20|FH_F135924_02906_0|SrvcGrp|111928|2022|PDM|290.36|99|0.00|COVID-19 BARTONELLA|
20|FH_F130996_34110_0|SrvcGrp|67065|2022|PDM|14000.00|99|0.00|CERVICAL SURGERY|
20|FH_F116527_70443_0|SrvcGrp|73461|2022|PDM|750.00|99|0.00|AETNA NICU IV|
20|FH_F121428_40202_0|SrvcGrp|82037|2022|PDM|2255.00|99|0.00|AETNA ICU|
20|FH_F121428_40202_0|SrvcGrp|73461|2022|PDM|2436.00|99|0.00|AETNA NICU IV|
20|FH_F34177_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.30|99|0.00|OP SVCS|
20|FH_F121425_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132097_66845_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111292_33136_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F111363_33169_0|SrvcGrp|103913|2022|PCT|0.84|99|0.00|OP DIALYSIS|
20|FH_F47906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F69202_0_0|SrvcGrp|3982|2022|PDM|3100.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F32929_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101442_0_0|SrvcGrp|98468|2022|PDM|1136.00|99|0.00|EXC FOOT/TOE TUM DEEP|
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|87679|2022|PDM|2212.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F124981_32539_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F130120_75862_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129419_27407_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136614_43512_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136741_60523_0|SrvcGrp|73339|2022|PCT|0.92|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114666_30342_0|CSTM-ALL|CSTM-00|2020|PDM|1217.00|99|0.00|AEG 10 (NO REV)|
20|FH_F138716_20151_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138981_85123_0|SrvcGrp|89337|2022|PDM|923.00|99|0.00|DETOXIFICATION|
20|FH_F148487_28210_0|SrvcGrp|46903|2022|PDM|727.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F148424_01440_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F132721_0_0|SrvcGrp|107733|2022|PDM|6266.00|99|0.00|CESAREAN SECTION|
20|FH_F136778_62034_0|SrvcGrp|105439|2022|PDM|392.00|99|0.00|AETNA TERANIAL MAGN STIM TX DELI|
20|FH_F136778_62034_0|SrvcGrp|10365|2022|PDM|1386.00|99|0.00|CPT CODE 99285|
20|FH_F112378_60505_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F112485_61032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49016_0_0|SrvcGrp|9774|2022|PDM|1650.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F115154_45069_0|SrvcGrp|74668|2022|PDM|240.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115206_80923_0|SrvcGrp|89149|2022|PDM|258.00|99|0.00|OP INTENSIVE|
20|FH_F115631_65201_0|SrvcGrp|26275|2022|PDM|3177.00|99|0.00|CPT 29826|
20|FH_F115631_65201_0|SrvcGrp|100080|2022|PDM|1141.00|99|0.00|UNLISTED PROC FOOT OR TOES|
20|FH_F116233_33612_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F147660_75110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41463_0_0|SrvcGrp|34359|2022|PDM|65.10|99|0.00|S9123 WITH TG MOD|
20|FH_F41540_0_0|SrvcGrp|33823|2022|PDM|688.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG I|
20|FH_F42342_0_0|SrvcGrp|9828|2022|PDM|47.25|99|0.00|HOME HEALTH AIDE|
20|FH_F42694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PDM|610.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F81152_0_0|SrvcGrp|473|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F134087_0_0|SrvcGrp|88160|2022|PDM|5410.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F35381_0_0|SrvcGrp|3029|2022|PDM|351.00|99|0.00|NEWBORN NURSERY|
20|FH_F141837_0_0|SrvcGrp|13595|2022|PDM|750.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F120635_22903_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F120639_73078_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F150939_0_0|SrvcGrp|100267|2022|PDM|6.50|99|0.00|URINE BACTERIA CULTURE|
20|FH_F131169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113585_20155_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F113390_0_0|SrvcGrp|89884|2022|PDM|1673.10|99|0.00|AETNA ABLATE TURBINATE SUBMUC|
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|461.84|99|0.00|HAPA WPA-NWPA 2012-13 ASC 214 W/O REV|
20|FH_F151304_31520_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 4 (NO REV)|
20|FH_F151401_36607_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151402_70508_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144928_02703_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F91764_93710_0|CSTM-ALL|CSTM-00|2020|PDM|3035.00|99|0.00|AEG 2 (NO REV)|
20|FH_F135972_18509_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F100765_73735_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F116468_49660_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1148.00|99|0.00|AEG 4 (NO REV)|
20|FH_F67425_0_0|SrvcGrp|30031|2022|PDM|3400.00|99|0.00|PTCA + CATH|
20|FH_F67425_0_0|SrvcGrp|23477|2022|PDM|2733.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F111292_33136_0|SrvcGrp|82759|2022|PDM|51.00|99|0.00|ASSAY CPK IN BLOOD|
20|FH_F111363_33169_0|CSTM-ALL|CSTM-00|2020|PDM|1987.00|99|0.00|AETNA OP PET SCANS (PET)|
20|FH_F47906_0_0|SrvcGrp|43838|2022|PCT|1.00|99|0.00|DME MOD NUKE|
20|FH_F89360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F145587_0_0|SrvcGrp|109788|2022|PDM|1262.70|99|0.00|REVISION OF HAMMERTOE|
20|FH_F139304_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33390_0_0|SrvcGrp|14888|2022|PCT|0.75|99|0.00|NUCLEAR MEDICINE|
20|FH_F34864_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG X|
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|940.00|99|0.00|AEG 7 (NO REV)|
20|FH_F129485_34741_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140102_0_0|SrvcGrp|84185|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F101904_17057_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F102282_06795_0|SrvcGrp|94780|2022|PDM|153.62|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F102325_62691_0|SrvcGrp|17013|2022|PDM|90.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39939_0_0|SrvcGrp|10425|2022|PDM|700.00|99|0.00|NEWBORN NURSERY|
20|FH_F132772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F75787_85137_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|1055.00|99|0.00|AEG 5  (NO REV)|
20|FH_F129850_0_0|SrvcGrp|65559|2022|PCT|5.50|99|0.00|E&M CODES|
20|FH_F104802_0_0|SrvcGrp|100560|2022|PDM|90.00|99|0.00|FAMILY/COUPLES THERAPY|
20|FH_F106980_0_0|SrvcGrp|72990|2022|PDM|600.00|99|0.00|AEG 1|
20|FH_F139703_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F58856_0_0|SrvcGrp|10400|2022|PDM|1900.00|99|0.00|IP SURGERY|
20|FH_F134255_01201_0|SrvcGrp|108484|2022|PDM|210.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F118152_20151_0|SrvcGrp|14948|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118170_18901_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120489_63552_0|SrvcGrp|75493|2022|PCT|0.75|99|0.00|AEG 8|
20|FH_F134011_84102_0|SrvcGrp|17013|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142448_15701_0|SrvcGrp|80920|2022|PDM|944.99|99|0.00|HOSPICE SERVICES|
20|FH_F142473_07663_0|SrvcGrp|26160|2022|PCT|1.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F138584_30912_0|SrvcGrp|113404|2022|PDM|800.00|99|0.00|RECONSTRUCT FACIAL CONTOUR|
20|FH_F138627_82901_0|SrvcGrp|86835|2022|PDM|10.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F138627_82901_0|SrvcGrp|86843|2022|PDM|95.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F140407_63841_0|SrvcGrp|112678|2022|PDM|23.46|99|0.00|COVID-19 SPECIMEN COLLECT|
20|FH_F79724_32501_0|SrvcGrp|472|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F149643_91367_0|SrvcGrp|108484|2022|PDM|725.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F149643_91367_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F149649_80104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F119065_92029_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F35587_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1725.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67880_0_0|SrvcGrp|21801|2022|PDM|2750.00|99|0.00|ICU|
20|FH_F117261_43543_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F147879_93309_0|SrvcGrp|48394|2022|PDM|70.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F129501_67831_0|SrvcGrp|109286|2022|PCT|0.80|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F129504_02871_0|SrvcGrp|29347|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE|
20|FH_F117221_23434_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F38948_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F109632_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F110160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F50446_0_0|SrvcGrp|28074|2022|PCT|0.90|99|0.00|HIGH COST PHARMACEUTICALS|
20|FH_F132212_0_0|SrvcGrp|89781|2022|PDM|90.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F142991_43920_0|SrvcGrp|100961|2022|PDM|250.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY|
20|FH_F44607_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F97103_53295_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F149344_0_0|SrvcGrp|13262|2022|PDM|3.68|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F146208_76643_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|20625.00|99|0.00|MSDRG 250-251 PERCUTANEOUS CARDIO PROC|
20|FH_F34706_0_0|SrvcGrp|3586|2022|PDM|51480.00|99|0.00|DRG 525 OTHER HEART ASSIST SYSTEM IMPLANT|
20|FH_F149781_37404_0|SrvcGrp|88163|2022|PDM|6798.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F68831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141870_85224_0|SrvcGrp|17015|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F32869_0_0|SrvcGrp|9911|2022|PDM|650.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F36137_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1385.61|99|0.00|ASPG III|
20|FH_F72648_0_0|SrvcGrp|68642|2022|PDM|570.00|99|0.00|URGENT PERITONEAL DIALYSIS|
20|FH_F133469_33404_0|SrvcGrp|73063|2022|PDM|883.00|99|0.00|OBSERVATION SERVICES|
20|FH_F97566_79902_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36579_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALLIED MED-MOD KN|
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|2315.00|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_F128699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137896_0_0|SrvcGrp|110173|2022|PCT|1.00|99|0.00|INJECTABLES (Q CODES)|
20|FH_F144011_60616_0|SrvcGrp|11663|2022|PCT|0.43|99|0.00|IMPLANTS|
20|FH_F97182_21502_0|SrvcGrp|73461|2022|PDM|10623.00|99|0.00|AETNA NICU IV|
20|FH_F97041_71603_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F133003_49012_0|SrvcGrp|73841|2022|PDM|360.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F32288_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|2537.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F132503_73086_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AEG 8 (NO REV)|
20|FH_F71667_0_0|SrvcGrp|38797|2022|PDM|342.00|99|0.00|PSYCHIATRIC PARTIAL HOSPITALIZATION - IP|
20|FH_F133627_89113_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F121168_0_0|SrvcGrp|97702|2022|PDM|100.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F103400_33426_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F141870_85224_0|SrvcGrp|86839|2022|PDM|40.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F41456_0_0|SrvcGrp|11442|2022|PDM|623.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F88512_0_0|SrvcGrp|17071|2022|PDM|2619.16|99|0.00|ASPG IV|
20|FH_F33788_0_0|SrvcGrp|10962|2022|PCT|0.70|99|0.00|INPATIENT LAPAROSCOPIC SURGERY|
20|FH_F45977_0_0|SrvcGrp|40415|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD UE KF|
20|FH_F67861_0_0|SrvcGrp|229|2022|PCT|0.60|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)|
20|FH_F43774_0_0|SrvcGrp|12157|2022|PDM|105.00|99|0.00|RN VISIT|
20|FH_F39721_0_0|SrvcGrp|21815|2022|PDM|210.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F118785_33315_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136507_0_0|SrvcGrp|97506|2022|PDM|120.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F34998_0_0|SrvcGrp|6|2022|PCT|0.90|99|0.00|OP SURGERY|
20|FH_F71268_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87436_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.50|99|0.00|HAPA WPA/NWPA 2016 RAD 100%|
20|FH_F128717_54449_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146179_37687_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F44042_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|919.00|99|0.00|AEG 7 (NO REV)|
20|FH_F99720_0_0|SrvcGrp|104734|2022|PDM|1946.00|99|0.00|CORRECTION HALLUX VALGUS|
20|FH_F138054_0_0|SrvcGrp|22954|2022|PDM|236.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F130593_48103_0|SrvcGrp|80918|2022|PDM|140.00|99|0.00|RESPITE CARE|
20|FH_F144327_0_0|SrvcGrp|87077|2022|PDM|138.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F132528_64014_0|SrvcGrp|112070|2022|PDM|127.00|99|0.00|ENTEROSTOMAL THERAPY (HCFA)|
20|FH_F118496_92627_0|SrvcGrp|86753|2022|PCT|1.20|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F148904_85255_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F143087_97411_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F121011_68510_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F49637_0_0|CSTM-ALL|CSTM-00|2020|PDM|7190.00|99|0.00|MS DRG 490 ONLY|
20|FH_F120838_01603_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1158.00|99|0.00|ASPG IV|
20|FH_F111412_33777_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149940_02645_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F68944_0_0|SrvcGrp|44011|2022|PDM|630.00|99|0.00|DIALYSIS|
20|FH_F125216_66755_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102561_75146_0|SrvcGrp|73601|2022|PDM|3300.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F102062_35447_0|SrvcGrp|73700|2022|PDM|71.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F55375_0_0|SrvcGrp|12287|2022|PDM|2400.00|99|0.00|IP PET SCAN|
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1418.00|99|0.00|AEG 4 (NO REV)|
20|FH_F116324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89015_74017_0|SrvcGrp|27969|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F89112_16509_0|SrvcGrp|29817|2022|PDM|4027.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F151119_66018_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151155_26508_0|SrvcGrp|113322|2022|PDM|319.00|99|0.00|MED ASSIST TX BUPRE ORAL|
20|FH_F139172_40207_0|SrvcGrp|12659|2022|PDM|630.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F139666_26175_0|SrvcGrp|3378|2022|PCT|0.94|99|0.00|OBSERVATION SVCS|
20|FH_F150839_03833_0|SrvcGrp|95660|2022|PDM|821.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F73485_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|987.00|99|0.00|AEG 8 (NO REV)|
20|FH_F151029_52241_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92152_74133_0|SrvcGrp|82137|2022|PCT|0.60|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F123386_0_0|SrvcGrp|10667|2022|PDM|450.00|99|0.00|BOARDER BABY SVCS|
20|FH_F134919_02155_0|SrvcGrp|29346|2022|PDM|47.50|99|0.00|SKILLED NURSING- LPN|
20|FH_F73803_0_0|SrvcGrp|64758|2022|PCT|0.80|99|0.00|HCPCS|
20|FH_F93377_0_0|SrvcGrp|90478|2022|PDM|120.00|99|0.00|HOSPICE|
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|180.00|99|0.00|BEHAVIORAL ID ASSESSMENT (HCFA)|
20|FH_F84532_0_0|SrvcGrp|78680|2022|PDM|6550.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F149403_69210_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F35990_0_0|SrvcGrp|33793|2022|PDM|6087.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F148966_37865_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F117615_30525_0|SrvcGrp|3066|2022|PCT|0.85|99|0.00|HIGH-COST DRUGS|
20|FH_F137729_19703_0|SrvcGrp|73841|2022|PDM|300.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F124322_64131_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F98000_59102_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F136947_0_0|SrvcGrp|13683|2022|PDM|700.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F35174_0_0|SrvcGrp|3360|2022|PCT|0.75|99|0.00|HIGH COST DRUGS|
20|FH_F116806_0_0|SrvcGrp|107121|2022|PDM|887.26|99|0.00|RECONSTRUCTION TONGUE FOLD|
20|FH_F147375_32503_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F36554_0_0|SrvcGrp|70820|2022|PCT|1.00|99|0.00|(PREVENTATIVE) OCN F/S PRICING: ALL|
20|FH_F147310_77036_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130203_29601_0|SrvcGrp|73842|2022|PDM|188.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115483_62002_0|SrvcGrp|113119|2022|PCT|0.60|99|0.00|CHEMOTHERAPY ADMINISTRATION|
20|FH_F124441_0_0|SrvcGrp|90420|2022|PDM|3040.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F100540_0_0|SrvcGrp|72992|2022|PDM|969.25|99|0.00|AEG 2|
20|FH_F101083_0_0|SrvcGrp|85540|2022|PDM|525.00|99|0.00|LOWER GI PROCEDURES|
20|FH_F120099_86305_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F149022_25271_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137748_95231_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115982_0_0|SrvcGrp|98003|2022|PDM|1750.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F132069_63128_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F42165_0_0|SrvcGrp|177|2022|PDM|1100.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F126116_0_0|SrvcGrp|103645|2022|PDM|11079.00|99|0.00|AETNA TIB/ PER REVASE W/ STENT|
20|FH_F150459_08021_0|SrvcGrp|104230|2022|PDM|133.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F122393_76020_0|SrvcGrp|108484|2022|PDM|489.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F97880_63501_0|SrvcGrp|88978|2022|PDM|4062.00|99|0.00|VAGINAL DELIVERY|
20|FH_F148902_40509_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PDM|2802.62|99|0.00|MS DRG 775|
20|FH_F131385_76457_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122649_0_0|SrvcGrp|100663|2022|PDM|632.50|99|0.00|HOSPICE IP CARE|
20|FH_F90151_24382_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|AEG 3 (NO REV)|
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|1704.00|99|0.00|AEG 8 (NO REV)|
20|FH_F114188_15205_0|SrvcGrp|48396|2022|PDM|99.34|99|0.00|OT SERVICES|
20|FH_F40627_0_0|CSTM-ALL|CSTM-00|2020|PDM|2460.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F47818_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F94303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47558_0_0|SrvcGrp|40415|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD UE KF|
20|FH_F147306_70115_0|SrvcGrp|113132|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F131356_19131_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F124976_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1575124_CPT_ MOD 53|
20|FH_F126147_45241_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F73803_0_0|CSTM-ALL|CSTM-00|2020|PDM|677.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F91259_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F34308_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP 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_F124441_0_0|SrvcGrp|35669|2022|PDM|4512.50|99|0.00|CPT 63650|
20|FH_F127079_33026_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F42979_0_0|CSTM-ALL|CSTM-00|2020|PDM|557.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F129237_72833_0|SrvcGrp|537|2022|PCT|0.88|99|0.00|OBSERVATION SERVICES|
20|FH_F34853_0_0|SrvcGrp|12846|2022|PCT|0.80|99|0.00|PHARMACY SVCS|
20|FH_F134872_32168_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110729_15068_0|SrvcGrp|73842|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F128770_57313_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137788_72632_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F149579_95815_0|SrvcGrp|115674|2022|PDM|82.36|99|0.00|COMPLEX CHRONIC CARE 1ST 60 MINS|
20|FH_F140167_16101_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143348_16214_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F75903_0_0|SrvcGrp|12045|2022|PDM|686.73|99|0.00|SLEEP STUDIES|
20|FH_F114931_0_0|SrvcGrp|91569|2022|PDM|3200.00|99|0.00|REMOVE HEMMORRHOIDS AND FISSURE|
20|FH_F130951_15237_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|GA RETINA SURG CTR ASC 13|
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112687_30474_0|SrvcGrp|46605|2022|PDM|169.40|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F119918_38201_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F125287_92374_0|SrvcGrp|89337|2022|PDM|970.00|99|0.00|DETOXIFICATION|
20|FH_F113649_01752_0|SrvcGrp|17016|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118917_33317_0|SrvcGrp|73842|2022|PDM|186.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F84611_30281_0|SrvcGrp|82631|2022|PDM|7637.00|99|0.00|HYSTERSCOPE PROCEDURE|
20|FH_F98621_41042_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F46732_0_0|SrvcGrp|12403|2022|PDM|34.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F113410_0_0|SrvcGrp|27316|2022|PDM|1681.00|99|0.00|TONSILS & ADENOIDS (42820)|
20|FH_F66501_0_0|SrvcGrp|62224|2022|PCT|1.00|99|0.00|IV THERAPY DRUGS|
20|FH_F127209_45365_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F31056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ST FRANCIS MS DRGS|
20|FH_F113410_0_0|SrvcGrp|96559|2022|PDM|4833.00|99|0.00|TOTAL HYSTERCECTOMY|
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1301.00|99|0.00|AEG 8 (NO REV)|
20|FH_F45632_0_0|SrvcGrp|9827|2022|PDM|74.00|99|0.00|RN INTERMITTENT VISIT|
20|FH_F90564_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.40|99|0.00|OP SVCS|
20|FH_F89453_75069_0|SrvcGrp|87393|2022|PDM|95.00|99|0.00|HCPCS G0151 (HCFA)|
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141795_89509_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148543_71103_0|SrvcGrp|73559|2022|PDM|1766.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F77762_0_0|SrvcGrp|27968|2022|PDM|55.00|99|0.00|SKILLED NURSING LPN|
20|FH_F125893_78245_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|2583.21|99|0.00|AEG 8 (NO REV)|
20|FH_F87538_0_0|SrvcGrp|59291|2022|PDM|731.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|628.94|99|0.00|AEG 8 (NO REV)|
20|FH_F43858_0_0|SrvcGrp|30955|2022|PDM|115.00|99|0.00|SKILLED RN VISIT|
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 6 (NO REV)|
20|FH_F78887_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
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_F126422_77375_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F102302_0_0|SrvcGrp|98567|2022|PDM|29900.00|99|0.00|ARTHRODESIS ANTERIOR TRANS|
20|FH_F102302_0_0|SrvcGrp|97299|2022|PDM|14300.00|99|0.00|REMOVE SPINE ELTRD PLATE|
20|FH_F137716_66204_0|SrvcGrp|472|2022|PDM|448.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130747_0_0|SrvcGrp|92367|2022|PDM|5202.00|99|0.00|TRANSPLANT HAND TENDON|
20|FH_F38847_0_0|SrvcGrp|411|2022|PCT|0.70|99|0.00|OP CARDIAC CATH|
20|FH_F124738_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37679_0_0|SrvcGrp|19742|2022|PDM|100.00|99|0.00|MID-LINE INSERTION|
20|FH_F135264_40272_0|SrvcGrp|87131|2022|PDM|502.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F148480_03079_0|SrvcGrp|73610|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|1825.00|99|0.00|AEG 10 (NO REV)|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.57|99|0.00|HAPA WPA-NWPA 2012-13 ASC 201 W/O REV|
20|FH_F139551_0_0|SrvcGrp|90063|2022|PDM|4500.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F87254_0_0|SrvcGrp|63465|2022|PDM|1100.00|99|0.00|CPT 52214|
20|FH_F143928_21061_0|SrvcGrp|66264|2022|PDM|126.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F40046_0_0|SrvcGrp|10542|2022|PDM|115.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F129627_06037_0|SrvcGrp|14893|2022|PDM|54.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F93620_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123511_64076_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F148254_89503_0|SrvcGrp|66264|2022|PDM|80.75|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F47573_0_0|SrvcGrp|42826|2022|PDM|158.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|ANTIBIOTIC THERAPY Q12 (MOD SH)|
20|FH_F34777_0_0|SrvcGrp|24|2022|PDM|5557.00|99|0.00|CARDIAC CATH|
20|FH_F90817_0_0|SrvcGrp|88358|2022|PDM|2914.00|99|0.00|ARTHROSCOPIC KNEE REPAIR (HCFA)|
20|FH_F37897_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F130919_33314_0|SrvcGrp|73842|2022|PDM|228.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F118220_0_0|SrvcGrp|60778|2022|PDM|180.00|99|0.00|CPT 93271|
20|FH_F74825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F127418_0_0|SrvcGrp|89857|2022|PDM|24591.46|99|0.00|REMOVAL OF SPINAL LAMINA|
20|FH_F116806_0_0|SrvcGrp|107120|2022|PDM|887.26|99|0.00|TONGUE TO LIP SURGERY|
20|FH_F43113_0_0|SrvcGrp|12401|2022|PDM|71.50|99|0.00|RN VISIT|
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|6300.00|99|0.00|AEG 9 (NO REV)|
20|FH_F36403_0_0|SrvcGrp|12512|2022|PDM|385.00|99|0.00|ACUTE REHABILITATION|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CATHETER CARE|
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 7 (NO REV)|
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110732_31513_0|SrvcGrp|81779|2022|PCT|0.60|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F102525_73134_0|SrvcGrp|72996|2022|PDM|1439.00|99|0.00|AEG 4|
20|FH_F117799_0_0|SrvcGrp|104853|2022|PDM|3713.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F94643_90501_0|SrvcGrp|29076|2022|PDM|60.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F98020_50138_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F116575_0_0|SrvcGrp|78093|2022|PDM|1600.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F35174_0_0|SrvcGrp|537|2022|PCT|0.76|99|0.00|OBSERVATION SERVICES|
20|FH_F130309_17044_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F129682_07034_0|SrvcGrp|48385|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F94222_62269_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122377_91007_0|SrvcGrp|106257|2022|PCT|4.02|99|0.00|LABORATORY SERVICES|
20|FH_F36036_0_0|SrvcGrp|10775|2022|PDM|205.00|99|0.00|CPT CODE 93271|
20|FH_F146859_0_0|SrvcGrp|47526|2022|PDM|2118.00|99|0.00|CORRECTION, HAMMERTOE|
20|FH_F97082_90012_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F129765_43015_0|SrvcGrp|71083|2022|PCT|1.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F110732_31513_0|SrvcGrp|10363|2022|PDM|781.00|99|0.00|CPT CODE 99283|
20|FH_F115483_62002_0|CSTM-ALL|CSTM-00|2020|PDM|1369.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F36743_0_0|SrvcGrp|23928|2022|PDM|5900.00|99|0.00|ABDOMINAL LAPAROSCOPIC PROCEDURES|
20|FH_F134847_0_0|SrvcGrp|27348|2022|PDM|3258.00|99|0.00|OP SURGERY (CPT 58662)|
20|FH_F35990_0_0|SrvcGrp|3078|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F116753_0_0|SrvcGrp|82037|2022|PDM|2798.00|99|0.00|AETNA ICU|
20|FH_F36299_0_0|SrvcGrp|30645|2022|PCT|0.75|99|0.00|OP IV THERAPY SERVICES|
20|FH_F141287_14830_0|SrvcGrp|73496|2022|PDM|1360.00|99|0.00|AETNA ER LEVEL V|
20|FH_F115982_0_0|SrvcGrp|72121|2022|PDM|1200.00|99|0.00|ARTHOSCOPY|
20|FH_F139927_0_0|SrvcGrp|33166|2022|PDM|720.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F90232_15126_0|SrvcGrp|53987|2022|PDM|30.45|99|0.00|PHOTOTHERAPY|
20|FH_F131376_66215_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|450.00|99|0.00|AEG 1 (NO REV)|
20|FH_F128753_32501_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F41808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F117762_0_0|SrvcGrp|41327|2022|PDM|1976.00|99|0.00|OP SURGERY CPT 28308|
20|FH_F124322_64131_0|SrvcGrp|22589|2022|PDM|34.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F110732_31513_0|SrvcGrp|19973|2022|PDM|781.00|99|0.00|CAT SCAN|
20|FH_F37493_0_0|SrvcGrp|97|2022|PDM|7928.00|99|0.00|C-SECTION|
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139822_30338_0|SrvcGrp|104079|2022|PCT|1.15|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F139823_32250_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F140087_62864_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F140233_35216_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 3 (NO REV)|
20|FH_F140036_07702_0|SrvcGrp|105047|2022|PDM|180.00|99|0.00|AETNA PSYCH DIAG EVAL W/ MED SVCS (HCFA)|
20|FH_F143427_30442_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F75305_0_0|SrvcGrp|9911|2022|PCT|0.60|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F103060_0_0|SrvcGrp|72992|2022|PDM|1691.00|99|0.00|AEG 2|
20|FH_F102224_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F151741_15090_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151762_17042_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD NU/KF)|
20|FH_F136286_73120_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132496_17512_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116633_37217_0|SrvcGrp|46963|2022|PDM|60.00|99|0.00|RN SERVICES (CPT 99602)|
20|FH_F119929_70364_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120050_92626_0|SrvcGrp|73605|2022|PDM|970.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F120974_27607_0|SrvcGrp|11336|2022|PCT|0.34|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F126054_30022_0|SrvcGrp|103613|2022|PDM|25.00|99|0.00|MED NUTRITION IND SUBSEQUENT|
20|FH_F127245_43537_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113649_01752_0|SrvcGrp|14893|2022|PDM|58.75|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F36420_0_0|SrvcGrp|23173|2022|PCT|0.80|99|0.00|PENILE IMPLANT|
20|FH_F46258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F119760_0_0|SrvcGrp|80918|2022|PDM|107.00|99|0.00|RESPITE CARE|
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|776.00|99|0.00|AEG 10 (NO REV)|
20|FH_F129181_28164_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F89563_29407_0|SrvcGrp|103326|2022|PCT|1.00|99|0.00|OT EVAL HIGH COMPLEX 60 MIN|
20|FH_F87254_0_0|SrvcGrp|104612|2022|PDM|1000.00|99|0.00|EXC FOOT/TOE TUM SC > 1.5 CM|
20|FH_F38357_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F145537_02061_0|SrvcGrp|72602|2022|PDM|504.00|99|0.00|ECT|
20|FH_F137940_0_0|SrvcGrp|106300|2022|PDM|293.23|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F90362_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130747_0_0|SrvcGrp|54943|2022|PDM|5202.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F123466_93420_0|SrvcGrp|58509|2022|PDM|457.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F70104_0_0|SrvcGrp|46248|2022|PDM|48.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F124026_53188_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F126581_45638_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F54614_0_0|SrvcGrp|50904|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F124017_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F127205_44125_0|SrvcGrp|105267|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F110236_0_0|SrvcGrp|75481|2022|PDM|1200.00|99|0.00|AEG 2|
20|FH_F97104_53545_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.60|99|0.00|ASPG 3- PROGRESSIVE SURG|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD UE/KF) - CPD 1963706|
20|FH_F117082_66216_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F49735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32118_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|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_F97102_83501_0|SrvcGrp|90854|2022|PDM|2103.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F109980_0_0|SrvcGrp|73601|2022|PDM|1450.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F35344_0_0|SrvcGrp|184|2022|PDM|2076.00|99|0.00|MEDICAL INTENSIVE CARE|
20|FH_F129627_06037_0|SrvcGrp|48394|2022|PDM|71.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)|
20|FH_F122433_0_0|SrvcGrp|72994|2022|PDM|580.00|99|0.00|AEG 3|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PDM|4410.00|99|0.00|ASPG VIII|
20|FH_F70984_0_0|SrvcGrp|67998|2022|PDM|3250.00|99|0.00|CPT 58550 58554|
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1649.00|99|0.00|AEG 4 (NO REV)|
20|FH_F122433_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F139173_0_0|SrvcGrp|48398|2022|PDM|192.00|99|0.00|PT SERVICES|
20|FH_F96902_0_0|SrvcGrp|87799|2022|PDM|165.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F116311_02657_0|SrvcGrp|90397|2022|PDM|205.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F39992_0_0|SrvcGrp|9830|2022|PDM|85.50|99|0.00|OT SVCS|
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.00|99|0.00|AEG 2 (NO REV)|
20|FH_F109980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F44582_0_0|SrvcGrp|9518|2022|PCT|0.70|99|0.00|EMERGENCY ROOM|
20|FH_F137067_0_0|SrvcGrp|103585|2022|PDM|3150.00|99|0.00|REMOVE SPINE ELTRD PLATE|
20|FH_F63095_0_0|SrvcGrp|27781|2022|PCT|0.65|99|0.00|CARDIAC CATH|
20|FH_F86872_15215_0|SrvcGrp|86846|2022|PDM|50.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F133211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|GENERAL ACUTE CARE|
20|FH_F88634_33952_0|CSTM-ALL|CSTM-00|2020|PCT|0.81|99|0.00|GENERAL ACUTE CARE|
20|FH_F88639_80204_0|SrvcGrp|75485|2022|PDM|5903.19|99|0.00|AEG 4|
20|FH_F35308_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD AV) - BDSS|
20|FH_F123752_44502_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F123848_03257_0|SrvcGrp|48394|2022|PDM|58.14|99|0.00|SKILLED NURSING SERVICES|
20|FH_F130662_07032_0|SrvcGrp|109330|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130911_06001_0|SrvcGrp|75545|2022|PDM|477.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|665.00|99|0.00|AEG 4 (NO REV)|
20|FH_F142894_0_0|SrvcGrp|80920|2022|PDM|100.00|99|0.00|HOSPICE SERVICES|
20|FH_F80224_0_0|SrvcGrp|762|2022|PCT|1.00|99|0.00|AIR AMBULANCE SVCS|
20|FH_F118267_45005_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36552_0_0|SrvcGrp|18231|2022|PDM|7845.00|99|0.00|MS DRG 283|
20|FH_F87541_0_0|SrvcGrp|73002|2022|PDM|1199.00|99|0.00|AEG 7|
20|FH_F133774_06062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110341_81212_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F110425_01752_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143567_62207_0|SrvcGrp|114262|2022|PDM|135.00|99|0.00|HHC RN E&M PLAN SVS|
20|FH_F146480_75042_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133207_0_0|SrvcGrp|64517|2022|PDM|5600.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F145641_06902_0|SrvcGrp|53065|2022|PDM|2217.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F121601_47446_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F139565_0_0|SrvcGrp|109760|2022|PDM|6885.00|99|0.00|TRANSLUM DIL EYE CANAL|
20|FH_F127579_44321_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F98021_07012_0|SrvcGrp|73602|2022|PDM|4764.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F52713_0_0|SrvcGrp|3499|2022|PCT|0.42|99|0.00|IMPLANTS|
20|FH_F146420_18940_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133749_84604_0|SrvcGrp|112415|2022|PDM|22.00|99|0.00|CONTINUOUS ANTI-COAGULANTS (HCFA)|
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1347.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F134230_60098_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145702_22192_0|SrvcGrp|88621|2022|PDM|79.00|99|0.00|SKILLED NURSING LPN|
20|FH_F111030_05641_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F63318_0_0|SrvcGrp|474|2022|PDM|295.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F112082_30720_0|SrvcGrp|24754|2022|PDM|23.49|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F100782_0_0|SrvcGrp|97522|2022|PDM|329.91|99|0.00|WINDBER MEDICAL CNTR ASC 15|
20|FH_F35388_0_0|CSTM-ALL|CSTM-00|2020|PDM|1185.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F137490_62226_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F147941_06023_0|SrvcGrp|74607|2022|PDM|133.00|99|0.00|AETNA FOLLOW UP VISIT CPT 90832|
20|FH_F74802_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.30|99|0.00|OP SVCS|
20|FH_F149140_07522_0|SrvcGrp|113222|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS 22 TRGT SARS-COV-2|
20|FH_F128881_70601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F34315_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F94942_0_0|SrvcGrp|94164|2022|PDM|3278.49|99|0.00|SHOULDER ARTHROSCOPY/SURGERY|
20|FH_F137614_17602_0|SrvcGrp|86722|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F123385_03561_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143891_19808_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F100662_27534_0|SrvcGrp|90854|2022|PDM|2196.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F139580_0_0|SrvcGrp|107747|2022|PDM|318.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F138533_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 1 (NO REV)|
20|FH_F131254_92211_0|SrvcGrp|24744|2022|PDM|75.00|99|0.00|PICC LINE INSERTION|
20|FH_F67261_0_0|CSTM-ALL|CSTM-00|2020|PDM|1579.00|99|0.00|ASPG III - FH SW CUSTOM GROUPERS|
20|FH_F38730_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149939_91942_0|SrvcGrp|58509|2022|PDM|522.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F118057_47906_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F41776_0_0|SrvcGrp|19508|2022|PDM|1599.00|99|0.00|MS DRG 792|
20|FH_F82173_72712_0|SrvcGrp|30623|2022|PDM|10722.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F65719_0_0|SrvcGrp|35669|2022|PDM|3988.20|99|0.00|CPT 63650|
20|FH_F34112_0_0|SrvcGrp|12342|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F35823_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130452_48801_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118050_77565_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F140967_20735_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F83255_32025_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123921_89128_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37366_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91617_0_0|SrvcGrp|82981|2022|PDM|240.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F135005_06460_0|SrvcGrp|88621|2022|PDM|79.00|99|0.00|SKILLED NURSING LPN|
20|FH_F121183_75093_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F148255_72703_0|SrvcGrp|24761|2022|PDM|31.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F143870_19134_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120300_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F135161_33128_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148666_34205_0|SrvcGrp|89412|2022|PDM|330.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F69965_0_0|SrvcGrp|59428|2022|PDM|110.00|99|0.00|ST|
20|FH_F101201_0_0|SrvcGrp|89417|2022|PDM|275.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F82714_18848_0|CSTM-ALL|CSTM-00|2020|PDM|56.01|99|0.00|HOSPITAL OBSERVATION (0-4 HOURS)|
20|FH_F129627_06037_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F131228_01826_0|CSTM-ALL|CSTM-00|2020|PDM|4146.29|99|0.00|AEG 3 (NO REV)|
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|2945.00|99|0.00|AEG 7 (NO REV)|
20|FH_F111288_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F54513_0_0|SrvcGrp|44423|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE (VISIT LVL)|
20|FH_F51733_0_0|SrvcGrp|45924|2022|PDM|46.00|99|0.00|HOME HEALTH AIDE|
20|FH_F62532_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS|
20|FH_F141468_75160_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F127165_32112_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F69965_0_0|SrvcGrp|66481|2022|PDM|140.00|99|0.00|SOCIAL WORKER|
20|FH_F93741_85006_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F129231_30060_0|SrvcGrp|108434|2022|PDM|2805.00|99|0.00|INSJ AQUEOUS DRAIN DEV 1ST|
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|1257.00|99|0.00|AEG 9 (NO REV)|
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_F31814_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F129387_33991_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F38810_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147161_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F128272_60640_0|SrvcGrp|17016|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F130127_77071_0|SrvcGrp|108484|2022|PDM|1040.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F141519_51566_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F145803_19061_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129391_17777_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129231_30060_0|CSTM-ALL|CSTM-00|2020|PDM|1283.00|99|0.00|AEG 7 (NO REV) W/O KERATOPLASTY|
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|313.00|99|0.00|AEG 1 (NO REV)|
20|FH_F125891_45219_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F142611_0_0|SrvcGrp|82981|2022|PDM|155.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F129653_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130724_06437_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126033_15301_0|SrvcGrp|88620|2022|PDM|102.00|99|0.00|SKILLED NURSING RN|
20|FH_F93881_15009_0|CSTM-ALL|CSTM-00|2020|PDM|633.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F65159_0_0|CSTM-ALL|CSTM-00|2020|PDM|3065.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F63197_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145930_45236_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116506_0_0|SrvcGrp|103503|2022|PDM|1700.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F127545_45227_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F90232_15126_0|SrvcGrp|48385|2022|PDM|89.25|99|0.00|SPEECH THERAPY|
20|FH_F141337_60077_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F117206_0_0|SrvcGrp|85000|2022|PDM|721.00|99|0.00|CPT 45384|
20|FH_F135670_01749_0|SrvcGrp|22592|2022|PDM|42.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F50013_0_0|CSTM-ALL|CSTM-00|2020|PDM|776.00|99|0.00|ACUTE PSYCH|
20|FH_F79863_0_0|SrvcGrp|65647|2022|PDM|22.00|99|0.00|S9560|
20|FH_F128148_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANESTHESIOLOGIST/CRNA (HAN1)|
20|FH_F134595_06226_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143771_0_0|SrvcGrp|80918|2022|PDM|136.00|99|0.00|RESPITE CARE|
20|FH_F111986_0_0|SrvcGrp|72998|2022|PDM|1133.00|99|0.00|AEG 5|
20|FH_F92477_0_0|SrvcGrp|73559|2022|PDM|1627.50|99|0.00|AETNA INTENSIVE CARE|
20|FH_F130763_0_0|SrvcGrp|26432|2022|PDM|3450.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F110604_0_0|SrvcGrp|96819|2022|PDM|1100.00|99|0.00|DESTROY L/S FACET JNT ADDL|
20|FH_F35966_0_0|SrvcGrp|16901|2022|PDM|5.35|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F150301_23236_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F77943_0_0|SrvcGrp|9826|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F149245_78576_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132922_91302_0|SrvcGrp|73841|2022|PDM|500.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F134205_33410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130763_0_0|SrvcGrp|89404|2022|PDM|15683.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F133887_17013_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F139873_0_0|SrvcGrp|33967|2022|PDM|2215.00|99|0.00|CPT 47562|
20|FH_F120670_0_0|SrvcGrp|67072|2022|PDM|6500.00|99|0.00|CPT 22845|
20|FH_F122930_0_0|CSTM-ALL|CSTM-00|2020|PDM|3463.00|99|0.00|DEVICE INSERTION|
20|FH_F95631_33705_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F135670_01749_0|SrvcGrp|24747|2022|PDM|42.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F123610_60018_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F42438_0_0|SrvcGrp|16719|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F149342_72204_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120930_0_0|SrvcGrp|33965|2022|PDM|3000.00|99|0.00|CPT 58552|
20|FH_F127094_61802_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125828_67547_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90496_13159_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F116506_0_0|SrvcGrp|75479|2022|PDM|375.00|99|0.00|AEG 1|
20|FH_F83995_16748_0|SrvcGrp|107733|2022|PDM|6147.00|99|0.00|CESAREAN SECTION|
20|FH_F143650_0_0|SrvcGrp|54943|2022|PDM|2800.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F149079_70809_0|SrvcGrp|73483|2022|PDM|816.00|99|0.00|AETNA SUBACUTE III|
20|FH_F37963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F127091_62016_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F146657_01105_0|SrvcGrp|114678|2022|PDM|37.72|99|0.00|SKILLS TRAINING DEV (MOD HO)|
20|FH_F138951_41101_0|SrvcGrp|86827|2022|PDM|60.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F120719_27540_0|SrvcGrp|10393|2022|PDM|5521.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F90356_63011_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150259_15668_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F132802_68022_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F126391_24651_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87775_15106_0|SrvcGrp|22593|2022|PDM|60.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F149219_01966_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F110420_60649_0|SrvcGrp|85145|2022|PDM|75.00|99|0.00|PT/OT/ST|
20|FH_F122425_75082_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122526_22203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F80185_0_0|SrvcGrp|44105|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY|
20|FH_F98800_85021_0|SrvcGrp|90854|2022|PDM|2378.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F101100_50314_0|SrvcGrp|95559|2022|PDM|24694.00|99|0.00|HIP JOINT|
20|FH_F105143_26062_0|SrvcGrp|73004|2022|PDM|9001.00|99|0.00|AEG 8|
20|FH_F146668_30189_0|SrvcGrp|33984|2022|PDM|4500.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F146763_76109_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120795_27514_0|SrvcGrp|110363|2022|PCT|0.93|99|0.00|BURN SERVICES|
20|FH_F131904_18915_0|SrvcGrp|48385|2022|PDM|133.00|99|0.00|SPEECH THERAPY|
20|FH_F139887_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F139887_0_0|SrvcGrp|34605|2022|PDM|4076.00|99|0.00|CPT 28299|
20|FH_F132898_06088_0|SrvcGrp|471|2022|PDM|588.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133408_01095_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133253_62226_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111581_77401_0|SrvcGrp|12840|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F111841_85212_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F121954_60706_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F118661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F33744_0_0|SrvcGrp|903|2022|PDM|5300.00|99|0.00|PTC ANGIOPLASTY|
20|FH_F66711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F92496_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91832_06106_0|SrvcGrp|73700|2022|PDM|36.75|99|0.00|AETNA - SKILLED NURSING|
20|FH_F114864_78155_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F113541_0_0|SrvcGrp|104950|2022|PDM|2580.00|99|0.00|REMOVAL OF IMPLANT MATERIAL|
20|FH_F40783_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|SPINAL CORD REHABILITATION|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER NUKC|
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138929_0_0|SrvcGrp|33724|2022|PDM|3300.00|99|0.00|ARTHROSCOPY|
20|FH_F131608_0_0|SrvcGrp|89783|2022|PDM|165.42|99|0.00|RESPITE CARE (HCFA)|
20|FH_F133025_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F119214_0_0|SrvcGrp|75479|2022|PDM|552.00|99|0.00|AEG 1|
20|FH_F126345_0_0|SrvcGrp|72992|2022|PDM|610.00|99|0.00|AEG 2|
20|FH_F92959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F124180_0_0|SrvcGrp|106216|2022|PDM|2824.50|99|0.00|CORNEAL TRANSPLANT ENDOTHELIAL|
20|FH_F45312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F132348_16214_0|SrvcGrp|95661|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F146914_75032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69923_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CARVE OUTS MOD RR|
20|FH_F34938_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F40603_0_0|SrvcGrp|13630|2022|PDM|200.00|99|0.00|CPT 99204|
20|FH_F47736_0_0|SrvcGrp|22954|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F124212_33407_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97083_90670_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F67882_0_0|SrvcGrp|13881|2022|PCT|0.75|99|0.00|PACEMAKER DEVICE|
20|FH_F136570_32084_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113809_47302_0|SrvcGrp|105410|2022|PDM|30.00|99|0.00|AETNA SUBOXONE ADMIN|
20|FH_F122674_94904_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F122689_92009_0|SrvcGrp|108904|2022|PDM|250.00|99|0.00|BLD GLUCOSE MONITOR W VOICE|
20|FH_F43919_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F43169_0_0|SrvcGrp|3809|2022|PDM|584.00|99|0.00|HOSPICE CARE|
20|FH_F43779_0_0|SrvcGrp|37945|2022|PCT|1.00|99|0.00|FACTOR IX|
20|FH_F134742_52806_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136814_70605_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F112410_46112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115625_63110_0|SrvcGrp|79720|2022|PDM|1008.00|99|0.00|ACUTE REHAB II|
20|FH_F115631_65201_0|SrvcGrp|33724|2022|PDM|3177.00|99|0.00|ARTHROSCOPY|
20|FH_F116393_07002_0|SrvcGrp|106556|2022|PCT|1.25|99|0.00|MOTION FLUROSCOPIC EVAL|
20|FH_F147699_83704_0|SrvcGrp|3178|2022|PDM|1337.00|99|0.00|ACUTE PSYCH|
20|FH_F147584_37664_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147725_06002_0|SrvcGrp|109790|2022|PDM|9464.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F135891_0_0|SrvcGrp|73606|2022|PDM|500.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F145721_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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|SrvcGrp|12137|2022|PCT|0.75|99|0.00|EMERGENCY ROOM SVCS W/TRAUMA|
20|FH_F39346_0_0|SrvcGrp|21350|2022|PDM|6697.00|99|0.00|MS DRG 287 ONLY|
20|FH_F120612_23314_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150939_0_0|SrvcGrp|85260|2022|PCT|0.00|99|0.00|INITIAL EVALUATION|
20|FH_F37257_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|BURN SVCS|
20|FH_F38955_0_0|CSTM-ALL|CSTM-00|2020|PDM|1221.85|99|0.00|ACUTE PSYCH|
20|FH_F41013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F48295_0_0|SrvcGrp|44427|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS (VISIT LVL)|
20|FH_F112947_47303_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138936_01040_0|SrvcGrp|75506|2022|PCT|1.40|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F78265_0_0|CSTM-ALL|CSTM-00|2020|PDM|3224.00|99|0.00|ASPG VII|
20|FH_F32984_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F143832_0_0|SrvcGrp|108175|2022|PDM|2255.06|99|0.00|TIB/PER REVASC W/TLA|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|39.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 147 W/O REV|
20|FH_F132268_07060_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122064_64633_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F122137_75633_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36492_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F135485_20171_0|SrvcGrp|23683|2022|PDM|37.00|99|0.00|SKILLED NURSING RN|
20|FH_F135960_33141_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F131344_61832_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116461_77536_0|SrvcGrp|46903|2022|PDM|431.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F140629_0_0|SrvcGrp|89853|2022|PDM|1372.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG|
20|FH_F121444_47720_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F121707_85745_0|SrvcGrp|87317|2022|PDM|1250.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F130817_18103_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)|
20|FH_F129967_18915_0|SrvcGrp|104419|2022|PDM|112.00|99|0.00|OFFICE/OUTPATIENT VISIT EST (MOD AF)|
20|FH_F111292_33136_0|SrvcGrp|99361|2022|PDM|82.00|99|0.00|DX MAMMO INCL CAD UNI|
20|FH_F111363_33169_0|SrvcGrp|73004|2022|PDM|2642.00|99|0.00|AEG 8|
20|FH_F98626_29118_0|SrvcGrp|73659|2022|PDM|7611.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F102322_32233_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F102862_30606_0|SrvcGrp|31926|2022|PDM|36432.00|99|0.00|MS DRG 458 ONLY|
20|FH_F132090_60915_0|SrvcGrp|94564|2022|PDM|2500.00|99|0.00|REPAIR METACARPAL FRACTURE|
20|FH_F143542_0_0|SrvcGrp|109767|2022|PDM|2869.00|99|0.00|COVER EYE W/ MEMBRANE INCIDENTAL CODES|
20|FH_F33381_0_0|SrvcGrp|18247|2022|PDM|8299.00|99|0.00|MS DRG 286|
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 7 (NO REV)|
20|FH_F100681_73104_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F63628_30824_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F70844_15317_0|SrvcGrp|29611|2022|PDM|150.00|99|0.00|VENTILATOR SUPPORT|
20|FH_F150663_0_0|SrvcGrp|75419|2022|PDM|464.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F117465_0_0|SrvcGrp|75491|2022|PDM|1300.00|99|0.00|AEG 7|
20|FH_F71923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136378_07104_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F93132_73134_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F93132_73134_0|SrvcGrp|43567|2022|PDM|60.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F134011_84102_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134167_10032_0|SrvcGrp|48394|2022|PDM|52.02|99|0.00|SKILLED NURSING SERVICES|
20|FH_F137147_75006_0|CSTM-ALL|CSTM-00|2020|PDM|8925.00|99|0.00|AEG 9 (NO REV)|
20|FH_F137227_64133_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F137238_70056_0|SrvcGrp|86722|2022|PDM|253.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F114979_77979_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F142449_62220_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F73403_0_0|SrvcGrp|45967|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE|
20|FH_F83831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: ALL|
20|FH_F137310_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139267_30253_0|SrvcGrp|113552|2022|PDM|82.50|99|0.00|COVID-19 TEST NON-CDC HGH THRU|
20|FH_F138583_60644_0|SrvcGrp|3178|2022|PDM|959.00|99|0.00|ACUTE PSYCH|
20|FH_F140367_70510_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F140750_89119_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F149583_98930_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F41481_0_0|SrvcGrp|17075|2022|PDM|914.00|99|0.00|ASPG VI|
20|FH_F92506_07666_0|SrvcGrp|31125|2022|PDM|1381.00|99|0.00|MS DRG 789-794 ONLY SICK BABY|
20|FH_F92506_07666_0|SrvcGrp|88697|2022|PCT|0.34|99|0.00|DRUGS|
20|FH_F92506_07666_0|SrvcGrp|73524|2022|PDM|228.80|99|0.00|PHYSICAL THERAPY|
20|FH_F109920_39180_0|SrvcGrp|73559|2022|PDM|1650.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F109983_98607_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F48292_0_0|SrvcGrp|44248|2022|PDM|165.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F76144_0_0|SrvcGrp|58993|2022|PCT|0.00|99|0.00|DISKECTOMY|
20|FH_F147725_06002_0|SrvcGrp|99172|2022|PDM|4867.00|99|0.00|CPT 28740|
20|FH_F147921_19083_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F147931_29732_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F147939_61611_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147941_06023_0|SrvcGrp|106292|2022|PDM|753.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1|
20|FH_F137815_15501_0|SrvcGrp|89417|2022|PDM|350.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F137934_51054_0|SrvcGrp|73700|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F111046_0_0|SrvcGrp|2067|2022|PDM|906.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F110720_0_0|SrvcGrp|73004|2022|PDM|3327.00|99|0.00|AEG 8|
20|FH_F129892_0_0|SrvcGrp|79101|2022|PDM|1495.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F130035_0_0|SrvcGrp|111468|2022|PDM|222.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F102760_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F147363_0_0|SrvcGrp|79720|2022|PDM|1000.00|99|0.00|ACUTE REHAB II|
20|FH_F69364_0_0|CSTM-ALL|CSTM-00|2020|PDM|1598.00|99|0.00|ASPG V|
20|FH_F85757_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72544_0_0|SrvcGrp|29817|2022|PDM|4324.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F148554_85016_0|CSTM-ALL|CSTM-00|2020|PDM|1122.00|99|0.00|AEG 7 (NO REV)|
20|FH_F148554_85016_0|CSTM-ALL|CSTM-00|2020|PDM|729.00|99|0.00|AEG 4 (NO REV)|
20|FH_F36756_0_0|SrvcGrp|23966|2022|PDM|65.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F40465_0_0|SrvcGrp|10047|2022|PDM|21500.00|99|0.00|DRG 109 ONLY CORONARY BYPASS|
20|FH_F149861_85225_0|SrvcGrp|108484|2022|PDM|483.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F133416_87402_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133052_33462_0|SrvcGrp|108484|2022|PDM|734.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F120825_66204_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132338_18901_0|SrvcGrp|73063|2022|PDM|569.19|99|0.00|OBSERVATION SERVICES|
20|FH_F109242_18466_0|SrvcGrp|89417|2022|PDM|321.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1239.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132555_39466_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45977_0_0|SrvcGrp|27767|2022|PDM|55.00|99|0.00|SKILLED IV NURSING HOURLY|
20|FH_F117827_75235_0|SrvcGrp|89149|2022|PDM|147.00|99|0.00|OP INTENSIVE|
20|FH_F34221_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121223_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|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F133477_90247_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|ASPG VII|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F138236_0_0|SrvcGrp|104229|2022|PDM|105.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F72750_0_0|CSTM-ALL|CSTM-00|2020|PDM|1765.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F91155_16105_0|SrvcGrp|72984|2022|PCT|1.00|99|0.00|CHEMOTHERAPY|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|37.44|99|0.00|HAPA WPA-NWPA 2012-13 ASC 147 W/O REV|
20|FH_F33972_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F111540_16823_0|SrvcGrp|104429|2022|PDM|67.24|99|0.00|AETNA OFFICE OUTPATIENT VISIT EST (MOD AF)|
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_F148556_13206_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F88512_0_0|SrvcGrp|29570|2022|PDM|10889.63|99|0.00|KYPHOPLASTY|
20|FH_F141830_92592_0|SrvcGrp|108484|2022|PDM|725.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F141907_74021_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F106580_33321_0|SrvcGrp|89412|2022|PDM|292.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F87293_18702_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F92676_15063_0|SrvcGrp|79001|2022|PDM|1097.06|99|0.00|MON VALLEY ASC 307|
20|FH_F38845_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F117950_37110_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F126666_44053_0|SrvcGrp|91752|2022|PDM|44.00|99|0.00|AETNA GROUP THERAPY (MOD TD)|
20|FH_F73785_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F128130_10027_0|SrvcGrp|110988|2022|PCT|1.84|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F38249_0_0|SrvcGrp|3029|2022|PDM|175.00|99|0.00|NEWBORN NURSERY|
20|FH_F119226_07746_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F133447_53120_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133516_44004_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F111540_16823_0|SrvcGrp|91393|2022|PDM|90.35|99|0.00|AETNA OFFICE OPT VISIT EST (MOD AF)|
20|FH_F118647_21811_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127284_84403_0|SrvcGrp|74668|2022|PDM|275.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F150121_29072_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128564_43235_0|SrvcGrp|95661|2022|PDM|138.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F115383_80734_0|SrvcGrp|75545|2022|PDM|335.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|113.00|99|0.00|PSYTX W PT 45 MINS (HCFA)|
20|FH_F126702_33139_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F73304_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87155_04105_0|SrvcGrp|77224|2022|PDM|57.78|99|0.00|AETNA HOME INFUSION S5521|
20|FH_F40906_0_0|SrvcGrp|18071|2022|PDM|55.00|99|0.00|AMBULANCE RESPONSE/TREATMENT - NO TRANSPORT|
20|FH_F126666_44053_0|SrvcGrp|91396|2022|PDM|44.00|99|0.00|AETNA GROUP PSYCHOTHERAPY (MOD HO)|
20|FH_F133550_90630_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F36350_0_0|CSTM-ALL|CSTM-00|2020|PDM|424.00|99|0.00|MS DRG 789-794 SICK BABY|
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1420.00|99|0.00|AEG 6 (NO REV)|
20|FH_F112853_22408_0|SrvcGrp|104918|2022|PCT|1.05|99|0.00|AETNA OP AMFS DEFAULT HH W/O G0299-G0300|
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F150949_0_0|SrvcGrp|113857|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES|
20|FH_F92648_90248_0|SrvcGrp|46605|2022|PDM|89.25|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F38425_0_0|SrvcGrp|28631|2022|PDM|73.00|99|0.00|LPN VISIT|
20|FH_F102822_84065_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F41739_0_0|SrvcGrp|8968|2022|PDM|2514.00|99|0.00|NICU LEVEL III & IV|
20|FH_F118667_95131_0|SrvcGrp|23683|2022|PDM|60.00|99|0.00|SKILLED NURSING RN|
20|FH_F150024_08079_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F118544_21550_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128299_44134_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117009_0_0|SrvcGrp|46885|2022|PDM|1393.00|99|0.00|REPAIR BROW DEFECT|
20|FH_F38700_0_0|SrvcGrp|18107|2022|PCT|0.80|99|0.00|MS DRG 236|
20|FH_F142084_82009_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F125009_17042_0|SrvcGrp|73605|2022|PDM|1175.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F117368_68114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117009_0_0|SrvcGrp|95100|2022|PDM|1163.00|99|0.00|INCISE TEAR DUCT OPENING|
20|FH_F118612_21502_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|491.00|99|0.00|ASPG II|
20|FH_F41596_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|79057|2022|PDM|458.23|99|0.00|MON VALLEY ASC 131|
20|FH_F132338_18901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F79902_0_0|SrvcGrp|13297|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F116825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F106740_02886_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F120437_85202_0|SrvcGrp|86124|2022|PDM|41.06|99|0.00|AETNA OCTAGAM INJ|
20|FH_F146211_68144_0|SrvcGrp|92819|2022|PDM|6473.71|99|0.00|HIP ARTHOSCOPY|
20|FH_F109404_0_0|SrvcGrp|12957|2022|PCT|1.10|99|0.00|DME|
20|FH_F148864_81303_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: BREAKOUT|
20|FH_F121385_89102_0|CSTM-ALL|CSTM-00|2020|PDM|6515.00|99|0.00|AEG 7 (NO REV)|
20|FH_F138487_85297_0|SrvcGrp|3178|2022|PDM|1127.00|99|0.00|ACUTE PSYCH|
20|FH_F139156_30060_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139208_30309_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139666_26175_0|SrvcGrp|109057|2022|PCT|0.94|99|0.00|CARDIAC STUDIES|
20|FH_F150662_20901_0|SrvcGrp|27969|2022|PDM|31.00|99|0.00|HOME HEALTH AIDE|
20|FH_F150765_05001_0|SrvcGrp|27968|2022|PDM|54.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150769_02302_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148859_0_0|SrvcGrp|89596|2022|PDM|25.50|99|0.00|SPECIAL RADIATION TREATMENT|
20|FH_F37864_0_0|CSTM-ALL|CSTM-00|2020|PDM|414.06|99|0.00|ASPG I|
20|FH_F147060_32025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134936_01020_0|SrvcGrp|46605|2022|PDM|125.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F97080_85122_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F38475_0_0|SrvcGrp|10541|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F90213_30084_0|SrvcGrp|80284|2022|PDM|148.79|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F128375_03909_0|SrvcGrp|93337|2022|PDM|428.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F149522_83221_0|SrvcGrp|80920|2022|PDM|550.00|99|0.00|HOSPICE SERVICES|
20|FH_F67280_0_0|SrvcGrp|44105|2022|PDM|54.00|99|0.00|PHYSICAL THERAPY|
20|FH_F139847_66205_0|SrvcGrp|92760|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|2108.00|99|0.00|AEG 10 (NO REV)|
20|FH_F132113_85224_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145604_14850_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES|
20|FH_F71590_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F85353_16407_0|SrvcGrp|63878|2022|PDM|295.45|99|0.00|HAPA WPA-NWPA 2012-13 ASC 125|
20|FH_F136359_0_0|SrvcGrp|70749|2022|PDM|4475.00|99|0.00|CPT 29823|
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|745.97|99|0.00|AEG 5  (NO REV)|
20|FH_F146103_63851_0|SrvcGrp|73606|2022|PDM|443.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F85353_16407_0|SrvcGrp|63766|2022|PDM|1770.68|99|0.00|HAPA WPA-NWPA 2012-13 ASC 905|
20|FH_F143560_03079_0|SrvcGrp|81948|2022|PDM|1000.00|99|0.00|ANGIO CT HRT W/ 3D IMAGE|
20|FH_F149339_44147_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135610_06451_0|SrvcGrp|104230|2022|PDM|119.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F120720_24541_0|SrvcGrp|95661|2022|PDM|575.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F113325_80004_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 7 (NO REV)|
20|FH_F83380_0_0|SrvcGrp|79337|2022|PDM|150.00|99|0.00|HOSPICE CARE|
20|FH_F124161_95932_0|SrvcGrp|72992|2022|PDM|2497.00|99|0.00|AEG 2|
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 10 (NO REV)|
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F59872_0_0|CSTM-ALL|CSTM-00|2020|PDM|2675.00|99|0.00|ASPG V|
20|FH_F109273_77339_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F119829_83221_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100782_0_0|SrvcGrp|105123|2022|PDM|587.30|99|0.00|WINDBER MEDICAL CNTR ASC 228|
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 8 (NO REV)|
20|FH_F138507_62208_0|SrvcGrp|88620|2022|PDM|106.00|99|0.00|SKILLED NURSING RN|
20|FH_F125260_0_0|SrvcGrp|23683|2022|PCT|0.00|99|0.00|SKILLED NURSING RN|
20|FH_F127665_44124_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111986_0_0|SrvcGrp|104108|2022|PDM|1545.00|99|0.00|EXCISION OF BREAST LESION ID|
20|FH_F126191_43616_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135657_27612_0|SrvcGrp|73841|2022|PDM|426.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F149247_02760_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148659_28134_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145642_15108_0|SrvcGrp|19742|2022|PDM|55.00|99|0.00|MID-LINE INSERTION|
20|FH_F119650_0_0|SrvcGrp|40003|2022|PDM|25151.00|99|0.00|TOTAL KNEE|
20|FH_F86112_63501_0|SrvcGrp|73501|2022|PCT|0.47|99|0.00|AETNA OBSERVATION|
20|FH_F127638_44720_0|SrvcGrp|89781|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F117206_0_0|SrvcGrp|90599|2022|PDM|1485.00|99|0.00|REMOVAL OF LENS LESION|
20|FH_F145562_70458_0|SrvcGrp|86846|2022|PDM|25.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F149343_44134_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130763_0_0|SrvcGrp|67066|2022|PDM|15683.00|99|0.00|CERVICAL SURGERY|
20|FH_F103320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|872.76|99|0.00|HAPA WPA-NWPA 2012-13 ASC 6 W/O REV|
20|FH_F133492_0_0|SrvcGrp|79584|2022|PDM|1809.00|99|0.00|CPT 45386|
20|FH_F85651_33549_0|SrvcGrp|84198|2022|PDM|6270.00|99|0.00|AETNA MATERNITY TRANSFER|
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)|
20|FH_F138024_40509_0|SrvcGrp|87441|2022|PDM|724.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F118123_67226_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149121_01520_0|SrvcGrp|115412|2022|PCT|0.15|99|0.00|DRUGS|
20|FH_F118146_33062_0|SrvcGrp|90854|2022|PDM|828.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F127814_63103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126063_43078_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114683_0_0|SrvcGrp|72992|2022|PDM|920.00|99|0.00|AEG 2|
20|FH_F52754_0_0|SrvcGrp|47134|2022|PDM|95.00|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F149439_0_0|SrvcGrp|80098|2022|PDM|56.00|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE|
20|FH_F142376_0_0|SrvcGrp|113991|2022|PDM|20.00|99|0.00|ANALYZE SPINE INFUS PUMP|
20|FH_F124369_0_0|SrvcGrp|109789|2022|PDM|11220.00|99|0.00|REPAIR OF FOOT BONES|
20|FH_F76022_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F112023_12866_0|SrvcGrp|104340|2022|PCT|1.30|99|0.00|DRUGS|
20|FH_F134618_14892_0|SrvcGrp|471|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F119227_01752_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F110509_71351_0|SrvcGrp|73002|2022|PDM|4050.00|99|0.00|AEG 7|
20|FH_F85212_71075_0|SrvcGrp|82881|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBTANCE|
20|FH_F150279_91767_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F127080_77520_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F110562_33409_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F110223_31750_0|SrvcGrp|78504|2022|PCT|0.90|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F42646_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F143669_78577_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F134593_60007_0|SrvcGrp|86839|2022|PDM|42.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F143742_60410_0|SrvcGrp|12787|2022|PCT|1.03|99|0.00|IMPLANTS|
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2081.00|99|0.00|AEG 3 (NO REV)|
20|FH_F115616_0_0|SrvcGrp|104015|2022|PDM|4474.00|99|0.00|INSERT STABILIZATION DEVICE|
20|FH_F125328_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F138951_41101_0|SrvcGrp|26869|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F109400_80026_0|SrvcGrp|53987|2022|PCT|1.00|99|0.00|PHOTOTHERAPY|
20|FH_F110471_02215_0|SrvcGrp|109036|2022|PDM|537.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F147962_85008_0|SrvcGrp|113186|2022|PCT|1.00|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F83380_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|HOME INF- REV 640 MOD SJ|
20|FH_F145554_53066_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1378.83|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1302 W/O REV|
20|FH_F36903_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD 26|
20|FH_F117615_30525_0|SrvcGrp|75505|2022|PCT|0.85|99|0.00|CARDIAC STUDIES|
20|FH_F97183_25304_0|SrvcGrp|73643|2022|PDM|1130.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 9 (NO REV)|
20|FH_F113545_11201_0|SrvcGrp|90040|2022|PDM|295.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
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_F147080_02446_0|SrvcGrp|113928|2022|PDM|354.00|99|0.00|PARTIAL HOSPITAL (>=18 YRS)|
20|FH_F146266_0_0|SrvcGrp|89404|2022|PDM|16100.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 6 (NO REV)|
20|FH_F146645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34675_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|56.50|99|0.00|MIDLINE INSTERTION KIT (MOD SD/SH)|
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PDM|5962.00|99|0.00|AEG 5  (NO REV)|
20|FH_F131392_17004_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F39443_0_0|SrvcGrp|30332|2022|PDM|318.00|99|0.00|HAPA WPA ASC 216|
20|FH_F90199_24083_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F94585_19040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|26.50|99|0.00|OTHER SQ/IM INJECTABLE (NOT LISTED) (MOD KP/SH)|
20|FH_F37444_0_0|SrvcGrp|16616|2022|PCT|0.72|99|0.00|HOME HEALTH AIDE|
20|FH_F47902_0_0|SrvcGrp|43844|2022|PCT|1.00|99|0.00|DME MOD UEKC|
20|FH_F127636_06030_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F132878_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F37777_0_0|SrvcGrp|36229|2022|PDM|1050.00|99|0.00|TRAUMA - SPINAL CORD, BRAIN, BURNS, AMPUTEE|
20|FH_F124322_64131_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F98280_31015_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F151699_01752_0|SrvcGrp|112058|2022|PDM|45.00|99|0.00|INFLECTRA|
20|FH_F137986_0_0|SrvcGrp|79578|2022|PDM|1458.00|99|0.00|CPT 43246|
20|FH_F39162_0_0|SrvcGrp|21815|2022|PDM|135.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F117762_0_0|SrvcGrp|84307|2022|PDM|3640.00|99|0.00|TENDON REPAIR|
20|FH_F124514_21215_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F125214_12428_0|SrvcGrp|103913|2022|PCT|0.00|99|0.00|OP DIALYSIS|
20|FH_F130836_53406_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97603_77901_0|SrvcGrp|73601|2022|PDM|5646.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F149655_78539_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143564_0_0|SrvcGrp|87845|2022|PDM|1850.00|99|0.00|GASTRIC RESTRICTIVE PROCEDURE|
20|FH_F150926_17404_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F34806_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F85772_0_0|SrvcGrp|84184|2022|PDM|1719.00|99|0.00|AETNA REMOVAL OF BREAST IMPLANT|
20|FH_F40490_0_0|SrvcGrp|29817|2022|PDM|5126.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F147174_75231_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F41167_0_0|SrvcGrp|3029|2022|PDM|350.00|99|0.00|NEWBORN NURSERY|
20|FH_F117581_21211_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F97280_20018_0|CSTM-ALL|CSTM-00|2020|PCT|0.39|99|0.00|OP SVCS|
20|FH_F110828_32757_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S MOD AW (CPD 1364768)|
20|FH_F35097_16508_0|SrvcGrp|81879|2022|PCT|1.00|99|0.00|LABORATORY W/ REV/HCPC|
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PDM|1535.60|99|0.00|AEG 8 (NO REV)|
20|FH_F150914_17350_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F112794_01040_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 7 (NO REV)|
20|FH_F118907_0_0|SrvcGrp|103928|2022|PDM|81.97|99|0.00|SLEEP STUDY UNATTENDED ANALYSIS(HCFA)|
20|FH_F39008_34452_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|2373.00|99|0.00|AEG 6 (NO REV)|
20|FH_F35446_0_0|SrvcGrp|282|2022|PDM|233.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F143529_84737_0|SrvcGrp|106115|2022|PDM|615.00|99|0.00|HOSPICE ROUT HOME CARE-DIEM (HCFA)|
20|FH_F143533_30013_0|SrvcGrp|76665|2022|PDM|125.00|99|0.00|CPT 76536|
20|FH_F32623_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|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_F151785_03104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47600_0_0|SrvcGrp|36807|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER QW (DME)|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD KL|
20|FH_F120240_37013_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132371_19083_0|SrvcGrp|74802|2022|PDM|7.00|99|0.00|AETNA CPT 36415|
20|FH_F116739_78501_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F120974_27607_0|SrvcGrp|941|2022|PDM|3725.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F126438_50029_0|SrvcGrp|75419|2022|PDM|440.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F113649_01752_0|SrvcGrp|86839|2022|PDM|75.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F84394_17402_0|SrvcGrp|112044|2022|PCT|0.82|99|0.00|LABORATORY SERVICES|
20|FH_F98622_45005_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F100780_24153_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F116279_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129969_33908_0|SrvcGrp|89337|2022|PDM|900.00|99|0.00|DETOXIFICATION|
20|FH_F148265_06067_0|SrvcGrp|71666|2022|PDM|6981.00|99|0.00|CPT 63655|
20|FH_F117783_0_0|SrvcGrp|107611|2022|PCT|1.00|99|0.00|IMPLTJ NTRSTRML CRNL RNG SEGMENTS|
20|FH_F121149_76021_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F110132_23451_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147941_06023_0|CSTM-ALL|CSTM-00|2020|PDM|2192.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|636.00|99|0.00|AEG 3 (NO REV)|
20|FH_F110925_01104_0|SrvcGrp|22389|2022|PDM|18.91|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PDM|52.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F37679_0_0|SrvcGrp|17005|2022|PDM|61.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS|
20|FH_F89779_0_0|SrvcGrp|72990|2022|PDM|1300.00|99|0.00|AEG 1|
20|FH_F141590_90049_0|SrvcGrp|46903|2022|PDM|1700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F92659_0_0|SrvcGrp|92540|2022|PDM|806.00|99|0.00|MUSCLE FLAP|
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.61|99|0.00|ASPG III|
20|FH_F101021_0_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F127890_44857_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130807_20721_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148255_72703_0|SrvcGrp|26868|2022|PDM|31.50|99|0.00|DIURETIC IV THERAPY|
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|AEG 4 (NO REV)|
20|FH_F125983_82301_0|SrvcGrp|74668|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F36154_0_0|SrvcGrp|72|2022|PDM|400.00|99|0.00|NEWBORN NURSERY|
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|490.45|99|0.00|AEG 3 (NO REV)|
20|FH_F143894_70001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F137946_0_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F39731_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS|
20|FH_F109180_18015_0|SrvcGrp|98040|2022|PDM|12.24|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F64440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|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_F31111_0_0|SrvcGrp|112105|2022|PDM|87.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HCFA)|
20|FH_F143820_28405_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120169_83814_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE|
20|FH_F141387_63108_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149980_0_0|SrvcGrp|115797|2022|PDM|2500.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F33120_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F39339_0_0|SrvcGrp|8|2022|PDM|3260.00|99|0.00|BURN INTENSIVE CARE|
20|FH_F108762_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F73733_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121427_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F39819_0_0|SrvcGrp|31196|2022|PDM|4615.00|99|0.00|NY DRG 127 ONLY|
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|387.00|99|0.00|AEG 1 (NO REV)|
20|FH_F102500_0_0|SrvcGrp|83646|2022|PDM|1780.00|99|0.00|CPT 31276|
20|FH_F141587_40242_0|SrvcGrp|87441|2022|PDM|643.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F129168_43050_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|2120.00|99|0.00|AEG 7 (NO REV)|
20|FH_F61332_0_0|SrvcGrp|17520|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F137940_0_0|SrvcGrp|13681|2022|PDM|293.23|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F110086_21742_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F141591_92630_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F110925_01104_0|SrvcGrp|86118|2022|PDM|1.04|99|0.00|AETNA FACTOR VIII RECOMBINANT|
20|FH_F40270_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F130681_15701_0|SrvcGrp|16|2022|PDM|4435.00|99|0.00|ACUTE REHABILITATION|
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)|
20|FH_F39943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1385.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F75425_0_0|SrvcGrp|33164|2022|PDM|400.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F141527_36830_0|SrvcGrp|86779|2022|PDM|26.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|633.00|99|0.00|AEG 2 (NO REV)|
20|FH_F34454_0_0|SrvcGrp|8962|2022|PDM|82.50|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F115685_64064_0|SrvcGrp|86850|2022|PDM|55.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F128371_40207_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F91876_0_0|SrvcGrp|33967|2022|PDM|2925.00|99|0.00|CPT 47562|
20|FH_F143833_63703_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F40615_0_0|SrvcGrp|16|2022|PDM|909.00|99|0.00|ACUTE REHABILITATION|
20|FH_F115127_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115772_26250_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F109320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90654_0_0|SrvcGrp|17990|2022|PCT|0.70|99|0.00|CT / MRI|
20|FH_F115127_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|1957.00|99|0.00|AEG 9 (NO REV)|
20|FH_F45632_0_0|SrvcGrp|41498|2022|PDM|57.00|99|0.00|RT SVCS|
20|FH_F40026_0_0|SrvcGrp|16232|2022|PCT|0.73|99|0.00|DURABLE MEDICAL EQUIPMENT|
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1890.00|99|0.00|AEG 10 (NO REV)|
20|FH_F130724_06437_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141548_33410_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F143974_28204_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|HOME HEALTH MOD TD|
20|FH_F38867_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS|
20|FH_F151562_26003_0|SrvcGrp|82223|2022|PDM|103.00|99|0.00|HOSPICE CARE|
20|FH_F121149_76021_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F86872_15215_0|SrvcGrp|97950|2022|PCT|1.00|99|0.00|AETNA ANCD DEFAULT BIOSCRIP|
20|FH_F88096_0_0|SrvcGrp|83379|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F88096_0_0|SrvcGrp|85540|2022|PDM|600.00|99|0.00|LOWER GI PROCEDURES|
20|FH_F145690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149179_0_0|SrvcGrp|115614|2022|PDM|3978.00|99|0.00|LAMINOTOMY/LAMINECTOMY|
20|FH_F32995_0_0|SrvcGrp|13231|2022|PDM|1275.00|99|0.00|INTERMEDIATE MED/SURG SVCS|
20|FH_F123752_44502_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F62579_0_0|SrvcGrp|17012|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142332_0_0|SrvcGrp|53144|2022|PDM|70.00|99|0.00|SPEECH THERAPY|
20|FH_F142332_0_0|SrvcGrp|88621|2022|PDM|118.00|99|0.00|SKILLED NURSING LPN|
20|FH_F130805_17404_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130841_49315_0|SrvcGrp|83522|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F98002_27103_0|SrvcGrp|73643|2022|PDM|1277.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F133724_84041_0|SrvcGrp|73701|2022|PDM|26.75|99|0.00|AETNA - SKILLED NURSING|
20|FH_F81835_0_0|SrvcGrp|74661|2022|PDM|589.23|99|0.00|AETNA SLEEP STUDIES|
20|FH_F143650_0_0|SrvcGrp|73002|2022|PDM|3400.00|99|0.00|AEG 7|
20|FH_F145604_14850_0|SrvcGrp|29023|2022|PDM|85.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)|
20|FH_F150165_06032_0|SrvcGrp|95462|2022|PDM|4286.00|99|0.00|REPAIR OF ANKLE LIGAMENT|
20|FH_F136591_0_0|SrvcGrp|3157|2022|PDM|1076.34|99|0.00|ACUTE REHABILITATION|
20|FH_F90160_0_0|CSTM-ALL|CSTM-00|2020|PCT|44.90|99|0.00|OP SVCS|
20|FH_F146666_75154_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51613_0_0|SrvcGrp|17608|2022|PDM|901.00|99|0.00|MENTAL HEALTH / DETOX|
20|FH_F132969_84003_0|SrvcGrp|22589|2022|PDM|33.60|99|0.00|CHEMOTHERAPY NOC|
20|FH_F71590_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134324_26354_0|SrvcGrp|112406|2022|PCT|0.84|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F83617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|GENERAL ACUTE CARE|
20|FH_F127090_45601_0|SrvcGrp|24750|2022|PDM|15.30|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F120608_19901_0|SrvcGrp|48398|2022|PDM|136.50|99|0.00|PT SERVICES|
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1193.60|99|0.00|AEG 3 (NO REV)|
20|FH_F99161_0_0|SrvcGrp|74585|2022|PCT|1.00|99|0.00|AETNA OP IMPLANTS|
20|FH_F43199_0_0|SrvcGrp|9828|2022|PDM|47.25|99|0.00|HOME HEALTH AIDE|
20|FH_F83534_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F100782_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HAPA WPA/NWPA 2015 LAB 100%|
20|FH_F132883_31602_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36835_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134655_14221_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F95440_0_0|SrvcGrp|11663|2022|PCT|1.03|99|0.00|IMPLANTS|
20|FH_F148668_33177_0|SrvcGrp|88858|2022|PDM|75.00|99|0.00|EVALUATION OF SPEECH FLUENCY|
20|FH_F145641_06902_0|SrvcGrp|35667|2022|PDM|2837.00|99|0.00|CPT 20680|
20|FH_F110344_37421_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F134358_63068_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 2 (NO REV)|
20|FH_F52754_0_0|SrvcGrp|3259|2022|PDM|970.00|99|0.00|ACUTE REHABILITATION|
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 3 (NO REV)|
20|FH_F147981_60035_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111163_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_F121684_74447_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100782_0_0|SrvcGrp|105090|2022|PDM|362.79|99|0.00|WINDBER MEDICAL CNTR ASC 135|
20|FH_F42467_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F148644_06890_0|SrvcGrp|42550|2022|PDM|2493.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F145659_29646_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F149106_07042_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F110604_0_0|SrvcGrp|63467|2022|PDM|2318.00|99|0.00|CPT 64585|
20|FH_F150225_03051_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134217_46725_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE|
20|FH_F100782_0_0|SrvcGrp|105147|2022|PDM|813.10|99|0.00|WINDBER MEDICAL CNTR ASC 307|
20|FH_F149517_0_0|SrvcGrp|30609|2022|PDM|43.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F110466_06870_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F145641_06902_0|SrvcGrp|102519|2022|PDM|2638.00|99|0.00|AETNA REVISION OF ULNA|
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|943.60|99|0.00|ASPG V|
20|FH_F147981_60035_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149268_74820_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F52805_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132925_84041_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150144_39452_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F150302_30114_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F91777_29577_0|SrvcGrp|27969|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE|
20|FH_F149263_0_0|SrvcGrp|115614|2022|PDM|3900.00|99|0.00|LAMINOTOMY/LAMINECTOMY|
20|FH_F120608_19901_0|SrvcGrp|73700|2022|PDM|61.40|99|0.00|AETNA - SKILLED NURSING|
20|FH_F134618_14892_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134610_33426_0|SrvcGrp|74668|2022|PDM|1046.50|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139569_15063_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F143567_62207_0|SrvcGrp|43567|2022|PDM|116.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F125513_40071_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F149660_0_0|SrvcGrp|115764|2022|PDM|2.79|99|0.00|NON-EMERGENCY TRANSPORTATION STRETCHER VAN|
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|AEG 5  (NO REV)|
20|FH_F118307_60103_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129101_27006_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F84912_0_0|SrvcGrp|13630|2022|PDM|163.72|99|0.00|CPT 99204|
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 10 (NO REV)|
20|FH_F71042_0_0|SrvcGrp|14609|2022|PCT|0.70|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F72963_0_0|SrvcGrp|42136|2022|PCT|0.55|99|0.00|EMERGENCY ROOM|
20|FH_F80185_0_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F100907_85206_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101100_50314_0|SrvcGrp|72602|2022|PDM|804.00|99|0.00|ECT|
20|FH_F102200_06416_0|SrvcGrp|26253|2022|PDM|5.17|99|0.00|LIPIDS|
20|FH_F105145_75075_0|SrvcGrp|84939|2022|PDM|17620.00|99|0.00|SHOULDER JOINT|
20|FH_F105361_80104_0|SrvcGrp|91077|2022|PDM|5157.00|99|0.00|AETNA INPATIENT SURGICAL CARE|
20|FH_F105361_80104_0|SrvcGrp|90246|2022|PDM|588.00|99|0.00|CT W/OTHER SERVICES|
20|FH_F115903_43560_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F66782_0_0|SrvcGrp|26253|2022|PDM|4.95|99|0.00|LIPIDS|
20|FH_F146466_21620_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131858_38732_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37568_0_0|SrvcGrp|25940|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F97542_32960_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F138054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148867_20191_0|SrvcGrp|48394|2022|PDM|34.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F151054_06473_0|SrvcGrp|111927|2022|PCT|1.00|99|0.00|COVID-19 NON CDC|
20|FH_F151061_02720_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151144_35801_0|SrvcGrp|90570|2022|PDM|1273.10|99|0.00|DRAINAGE OF EYE|
20|FH_F151221_71857_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122006_66839_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F72090_0_0|SrvcGrp|1168|2022|PDM|39.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|272.02|99|0.00|AETNA SLEEP STUDIES|
20|FH_F114916_30309_0|SrvcGrp|93431|2022|PDM|22500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F142319_19403_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F103880_85014_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F123774_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41516_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PDM|1126.00|99|0.00|ASPG VIII|
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132627_0_0|SrvcGrp|111528|2022|PDM|153.00|99|0.00|PICC LINE INSERTION (HCFA)|
20|FH_F132988_0_0|SrvcGrp|103568|2022|PDM|2057.62|99|0.00|PARTIAL REMOVAL OF TIBIA|
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|815.00|99|0.00|AEG 10 (NO REV)|
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|3150.00|99|0.00|AEG 6 (NO REV)|
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|752.85|99|0.00|AEG 5  (NO REV)|
20|FH_F112722_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS|
20|FH_F114389_50131_0|SrvcGrp|17012|2022|PDM|48.28|99|0.00|HOME INFUSION THERAPY|
20|FH_F131505_0_0|SrvcGrp|101523|2022|PDM|252.00|99|0.00|CERCLAGE OF CERVIX|
20|FH_F77944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F118184_0_0|SrvcGrp|111934|2022|PDM|51.31|99|0.00|COVID-19 NUCLEIC ACID|
20|FH_F124081_64154_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146882_84532_0|SrvcGrp|112064|2022|PCT|0.93|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F146894_73505_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146990_80206_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F127995_84010_0|SrvcGrp|88621|2022|PDM|60.75|99|0.00|SKILLED NURSING LPN|
20|FH_F67882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F89273_0_0|SrvcGrp|88266|2022|PDM|595.00|99|0.00|CONNECTIVE TISSUE (HCFA)|
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 8 (NO REV)|
20|FH_F137248_0_0|SrvcGrp|113065|2022|PDM|4058.00|99|0.00|REVISION OF FOOT TENDON|
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100787_69162_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F113847_20910_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F113913_70065_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138696_64772_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138052_19462_0|SrvcGrp|73842|2022|PDM|228.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F117195_0_0|SrvcGrp|74403|2022|PCT|0.59|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F136276_0_0|SrvcGrp|82981|2022|PDM|154.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F122635_06410_0|SrvcGrp|29347|2022|PDM|24.40|99|0.00|HOME HEALTH AIDE|
20|FH_F122680_53511_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122879_39564_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F42837_0_0|SrvcGrp|13621|2022|PDM|700.00|99|0.00|SLEEP STUDIES|
20|FH_F134670_95628_0|SrvcGrp|86722|2022|PDM|330.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F115210_21043_0|SrvcGrp|82720|2022|PDM|2122.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F147586_44124_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132971_77063_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F111605_80524_0|SrvcGrp|104336|2022|PCT|1.00|99|0.00|DENOSUMAB INJECTION|
20|FH_F135891_0_0|SrvcGrp|87536|2022|PDM|300.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F34477_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DURABLE MEDICAL EQUIPMENT (DME) W/MOD NU - WINN|
20|FH_F81152_0_0|SrvcGrp|76501|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F116443_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F134087_0_0|SrvcGrp|75002|2022|PDM|5410.00|99|0.00|ARTHOSCOPY|
20|FH_F35404_0_0|SrvcGrp|66239|2022|PDM|5200.00|99|0.00|LITHOTRIPSY|
20|FH_F150141_63103_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F149082_33406_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F95623_84015_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F100680_43130_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F110501_07652_0|SrvcGrp|86722|2022|PDM|339.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F145629_45243_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F113428_19446_0|SrvcGrp|76501|2022|PDM|304.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F87775_15106_0|SrvcGrp|31973|2022|PDM|15.00|99|0.00|HOME THERAPY|
20|FH_F88744_71103_0|CSTM-ALL|CSTM-00|2020|PDM|3931.00|99|0.00|AEG 9 (NO REV)|
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|410.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148661_45429_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F47717_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|OP SVCS|
20|FH_F69606_0_0|SrvcGrp|64112|2022|PDM|143.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 15|
20|FH_F134495_84321_0|SrvcGrp|29347|2022|PDM|1750.00|99|0.00|HOME HEALTH AIDE|
20|FH_F45093_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F84712_0_0|SrvcGrp|72998|2022|PDM|3532.00|99|0.00|AEG 5|
20|FH_F84712_0_0|SrvcGrp|81403|2022|PDM|125.00|99|0.00|COMPREHEN METABOLIC PANEL|
20|FH_F68887_0_0|SrvcGrp|474|2022|PDM|250.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F101100_50314_0|SrvcGrp|88819|2022|PDM|804.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F101100_50314_0|SrvcGrp|78180|2022|PDM|689.00|99|0.00|AETNA RESIDENTIAL TREATMENT|
20|FH_F115907_12206_0|SrvcGrp|90643|2022|PDM|20.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F77665_0_0|SrvcGrp|10537|2022|PDM|120.00|99|0.00|NURSING CARE|
20|FH_F146673_19085_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F146846_73139_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120795_27514_0|CSTM-ALL|CSTM-00|2020|PDM|6519.00|99|0.00|AEG 2 (NO REV)|
20|FH_F116040_24637_0|SrvcGrp|65621|2022|PDM|25.00|99|0.00|RN NURSING|
20|FH_F116114_37033_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F132213_17543_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133491_74012_0|SrvcGrp|63297|2022|PDM|130.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F121404_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F113677_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38807_0_0|SrvcGrp|17077|2022|PDM|995.00|99|0.00|ASPG VII|
20|FH_F72090_0_0|SrvcGrp|17140|2022|PDM|160.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F41281_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F98040_89406_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F114267_0_0|SrvcGrp|105550|2022|PDM|1800.00|99|0.00|AETNA SPINAL SURGERY|
20|FH_F78243_0_0|CSTM-ALL|CSTM-00|2020|PDM|515.00|99|0.00|DIGESTIVE SURGERY|
20|FH_F119595_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.90|99|0.00|AEG 4 (NO REV)|
20|FH_F89037_0_0|SrvcGrp|73004|2022|PDM|1172.78|99|0.00|AEG 8|
20|FH_F142321_29401_0|SrvcGrp|75442|2022|PDM|751.00|99|0.00|OBSERVATION - REV 762|
20|FH_F112704_0_0|SrvcGrp|44132|2022|PDM|733.00|99|0.00|OP SURGERY CPT 64490-64495|
20|FH_F33856_0_0|SrvcGrp|88|2022|PCT|0.85|99|0.00|OP LITHOTRIPSY|
20|FH_F110205_64012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F132800_0_0|SrvcGrp|111934|2022|PDM|87.00|99|0.00|COVID-19 NUCLEIC ACID|
20|FH_F143898_0_0|SrvcGrp|80918|2022|PDM|160.00|99|0.00|RESPITE CARE|
20|FH_F132988_0_0|SrvcGrp|112162|2022|PDM|14776.53|99|0.00|RECONSTRUCT WRIST-LUNATE|
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|AEG 7 (NO REV)|
20|FH_F141336_16947_0|CSTM-ALL|CSTM-00|2020|PDM|1824.00|99|0.00|AEG 6 (NO REV)|
20|FH_F137897_0_0|CSTM-ALL|CSTM-00|2020|PDM|87.97|99|0.00|CPAP (MOD RR) - HCFA|
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 4 (NO REV)|
20|FH_F115971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38233_0_0|SrvcGrp|10645|2022|PDM|175.00|99|0.00|PICC LINE INSERTION KIT|
20|FH_F91998_0_0|SrvcGrp|11673|2022|PDM|1020.00|99|0.00|CPT 29888|
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|4070.00|99|0.00|AEG 7 (NO REV)|
20|FH_F124237_95023_0|SrvcGrp|75442|2022|PDM|900.00|99|0.00|OBSERVATION - REV 762|
20|FH_F121078_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F127932_32117_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136567_94578_0|SrvcGrp|108484|2022|PDM|769.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F136614_43512_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136674_16335_0|SrvcGrp|81655|2022|PDM|1346.00|99|0.00|AETNA SUB ACUTE|
20|FH_F114726_45213_0|SrvcGrp|3178|2022|PDM|857.00|99|0.00|ACUTE PSYCH|
20|FH_F148487_28210_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137447_0_0|SrvcGrp|13597|2022|PDM|226.23|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F122739_43558_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122638_59715_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F134691_33445_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F135752_98290_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F31878_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136914_64081_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F136914_64081_0|SrvcGrp|13597|2022|PDM|220.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F136927_45690_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F113713_17013_0|SrvcGrp|86864|2022|PDM|85.00|99|0.00|AETNA PSYCH DIAGNOSITC EVALUATION (MOD TD)(HCFA)|
20|FH_F149543_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115567_91711_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_F42333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F134827_32218_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PDM|2711.00|99|0.00|AEG 7 (NO REV)|
20|FH_F113180_23507_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
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_F37850_0_0|SrvcGrp|361|2022|PDM|1892.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F39988_0_0|SrvcGrp|16|2022|PDM|933.00|99|0.00|ACUTE REHABILITATION|
20|FH_F48836_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F111951_80111_0|SrvcGrp|104578|2022|PCT|1.00|99|0.00|IP CARVEOUT DRUGS|
20|FH_F138936_01040_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F39018_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|ACUTE PSYCH|
20|FH_F127207_0_0|SrvcGrp|84185|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|383.58|99|0.00|HAPA WPA-NWPA 2012-13 ASC 223 W/O REV|
20|FH_F151304_31520_0|SrvcGrp|114177|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F151405_65109_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151503_30067_0|SrvcGrp|109068|2022|PDM|2090.00|99|0.00|PARTIAL REMOVAL OF FOOT BONE|
20|FH_F122064_64633_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122106_60035_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F145148_60162_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133608_33602_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F42492_0_0|CSTM-ALL|CSTM-00|2020|PDM|2224.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135385_38614_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135925_32548_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136026_66062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130670_32204_0|SrvcGrp|58509|2022|PDM|364.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F130670_32204_0|SrvcGrp|73842|2022|PDM|208.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131132_44077_0|SrvcGrp|95559|2022|PDM|22889.00|99|0.00|HIP JOINT|
20|FH_F116397_33404_0|SrvcGrp|24752|2022|PDM|15.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F121464_15701_0|SrvcGrp|472|2022|PDM|492.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F33785_0_0|SrvcGrp|177|2022|PDM|1200.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F42347_0_0|SrvcGrp|36482|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F130817_18103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111301_33122_0|SrvcGrp|16301|2022|PDM|6354.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F111363_33169_0|SrvcGrp|73601|2022|PDM|2965.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F111363_33169_0|SrvcGrp|109219|2022|PDM|5256.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37804_0_0|SrvcGrp|25155|2022|PDM|50.00|99|0.00|PT/OT/ST|
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|ASPG III|
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132328_0_0|SrvcGrp|77445|2022|PDM|2819.00|99|0.00|REMOVAL OF HYDROCELE|
20|FH_F132328_0_0|SrvcGrp|104002|2022|PDM|2383.00|99|0.00|ELBOW ARTHROSCOPY|
20|FH_F114569_0_0|SrvcGrp|105680|2022|PCT|1.00|99|0.00|AETNA BH TELEMEDICINE/OP THERAPY SVCS (MOD GT/TD)|
20|FH_F129240_10028_0|SrvcGrp|86121|2022|PCT|0.83|99|0.00|AETNA GAMUNEX-C|
20|FH_F129220_18445_0|SrvcGrp|70642|2022|PDM|23.70|99|0.00|CONSULTANT THERAPIST|
20|FH_F129220_18445_0|SrvcGrp|110061|2022|PDM|23.70|99|0.00|ADAPTIVE BH TREATMENT 15 MINS|
20|FH_F96960_35404_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F33381_0_0|SrvcGrp|18140|2022|PDM|21076.00|99|0.00|MS DRG 246|
20|FH_F133107_73071_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PDM|2581.00|99|0.00|AEG 3 (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_F109963_0_0|SrvcGrp|73000|2022|PDM|857.00|99|0.00|AEG 6|
20|FH_F123784_03264_0|SrvcGrp|88621|2022|PDM|121.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132810_0_0|SrvcGrp|111527|2022|PDM|90.00|99|0.00|HOME INFUSION (HCFA)|
20|FH_F126770_43050_0|SrvcGrp|80920|2022|PDM|550.00|99|0.00|HOSPICE SERVICES|
20|FH_F71628_0_0|SrvcGrp|48385|2022|PDM|15.00|99|0.00|SPEECH THERAPY|
20|FH_F136488_16828_0|SrvcGrp|3178|2022|PDM|913.00|99|0.00|ACUTE PSYCH|
20|FH_F118169_27514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118186_97070_0|SrvcGrp|705|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F120424_03060_0|SrvcGrp|89149|2022|PDM|182.00|99|0.00|OP INTENSIVE|
20|FH_F120490_64133_0|SrvcGrp|86830|2022|PDM|5.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F137147_75006_0|CSTM-ALL|CSTM-00|2020|PDM|4032.00|99|0.00|AEG 3 (NO REV)|
20|FH_F137241_07481_0|SrvcGrp|13810|2022|PDM|1309.00|99|0.00|ACUTE PSYCH|
20|FH_F114092_83350_0|SrvcGrp|10944|2022|PDM|7500.00|99|0.00|EMERGENCY ROOM|
20|FH_F138892_46341_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F53732_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|HOME INFUSION NURSING SERVICES MOD SD|
20|FH_F97582_46307_0|SrvcGrp|88978|2022|PDM|8656.00|99|0.00|VAGINAL DELIVERY|
20|FH_F138542_40324_0|SrvcGrp|46903|2022|PDM|495.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F138558_60107_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F138584_30912_0|SrvcGrp|113387|2022|PDM|1250.00|99|0.00|NASOMAXILLARY COMPLEX FRACTURE TREATMENT|
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140615_73013_0|CSTM-ALL|CSTM-00|2020|PDM|1346.00|99|0.00|AEG 6 (NO REV)|
20|FH_F80754_31601_0|CSTM-ALL|CSTM-00|2020|PDM|131.05|99|0.00|AETNA DIGITAL SCREENING MAMMOGRAM UNILATERAL|
20|FH_F122067_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|815.00|99|0.00|AEG 4 (NO REV)|
20|FH_F151600_17866_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36217_0_0|SrvcGrp|13807|2022|PCT|0.70|99|0.00|OBSERVATION SVCS|
20|FH_F38332_0_0|SrvcGrp|18855|2022|PDM|42216.00|99|0.00|MS DRG 229|
20|FH_F109884_36117_0|SrvcGrp|86746|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F80366_0_0|SrvcGrp|72996|2022|PCT|0.94|99|0.00|AEG 4|
20|FH_F117371_77059_0|SrvcGrp|3178|2022|PDM|785.00|99|0.00|ACUTE PSYCH|
20|FH_F117214_84020_0|SrvcGrp|85759|2022|PCT|0.00|99|0.00|DETOXIFICATION|
20|FH_F117240_37334_0|SrvcGrp|17100|2022|PDM|1200.00|99|0.00|SKILLED NURSING|
20|FH_F45303_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F37878_0_0|SrvcGrp|10542|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F109652_0_0|SrvcGrp|20077|2022|PDM|57279.00|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR|
20|FH_F107926_0_0|SrvcGrp|11663|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F110720_0_0|SrvcGrp|72990|2022|PDM|1008.00|99|0.00|AEG 1|
20|FH_F90735_94070_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_F62394_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|775.00|99|0.00|AEG 1 (NO REV)|
20|FH_F148359_60191_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148419_01453_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|352.00|99|0.00|HAPA EPA ASC 42|
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1620.00|99|0.00|ASPG VIII|
20|FH_F148579_17057_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F102561_75146_0|SrvcGrp|98005|2022|PDM|4850.00|99|0.00|DISTAL PHALANGEAL FRACTURE|
20|FH_F39535_0_0|SrvcGrp|65|2022|PDM|3160.00|99|0.00|OBSTETRICAL CARE|
20|FH_F128893_0_0|SrvcGrp|93098|2022|PDM|160.00|99|0.00|HOSPICE CARE|
20|FH_F34706_0_0|SrvcGrp|11207|2022|PDM|22463.00|99|0.00|DRG 545 REVISION OF HIP OR KNEE REPLACEMENT|
20|FH_F63618_0_0|SrvcGrp|675|2022|PDM|3000.00|99|0.00|PEDIATRIC INPATIENT SVCS|
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PDM|3960.00|99|0.00|AEG 5  (NO REV)|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109941_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F36576_0_0|SrvcGrp|72|2022|PDM|321.00|99|0.00|NEWBORN NURSERY|
20|FH_F144022_32118_0|SrvcGrp|113911|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F51232_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F39844_0_0|CSTM-ALL|CSTM-00|2020|PDM|690.00|99|0.00|ACUTE PSYCH|
20|FH_F40542_0_0|SrvcGrp|472|2022|PDM|355.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117795_36272_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117720_23323_0|SrvcGrp|471|2022|PDM|472.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F100788_01420_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F150902_21713_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133287_40215_0|CSTM-ALL|CSTM-00|2020|PDM|716.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143027_16504_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145988_06105_0|SrvcGrp|31125|2022|PDM|3215.00|99|0.00|MS DRG 789-794 ONLY SICK BABY|
20|FH_F109242_18466_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F71162_0_0|SrvcGrp|11258|2022|PCT|0.35|99|0.00|DRUGS|
20|FH_F133005_32726_0|SrvcGrp|38004|2022|PDM|4700.00|99|0.00|CPT CODE 59400|
20|FH_F117911_86403_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F115312_78550_0|SrvcGrp|88819|2022|PDM|845.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F57592_0_0|SrvcGrp|12523|2022|PCT|0.67|99|0.00|GAMMA KNIFE|
20|FH_F140472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87620_80014_0|SrvcGrp|86380|2022|PDM|176.00|99|0.00|BONE DENSITY|
20|FH_F97564_52246_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F117346_75093_0|SrvcGrp|33165|2022|PDM|375.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F148639_0_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F97622_75051_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F127138_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|425.00|99|0.00|AEG 2 (NO REV)|
20|FH_F121011_68510_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F40331_0_0|SrvcGrp|361|2022|PDM|2484.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F97103_53295_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F72934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|GENERAL ACUTE CARE|
20|FH_F117717_68410_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F97564_52246_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F106580_33321_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F103540_24740_0|SrvcGrp|59290|2022|PDM|250.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F100784_59923_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F117087_0_0|SrvcGrp|107180|2022|PDM|2494.00|99|0.00|REBUILD EARDRUM STRUCTURES|
20|FH_F69104_0_0|SrvcGrp|58673|2022|PDM|332.33|99|0.00|ASC CARVE OUTS 64479-64480, 64483-64484|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F63301_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F148662_01583_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F130553_18640_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F118542_60188_0|SrvcGrp|88621|2022|PDM|108.00|99|0.00|SKILLED NURSING LPN|
20|FH_F99720_0_0|SrvcGrp|73000|2022|PDM|2608.00|99|0.00|AEG 6|
20|FH_F34662_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F97541_33021_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F45516_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F83031_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INTERIM INFUSION REV CODE 640|
20|FH_F120838_01603_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F150907_17543_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133018_84037_0|SrvcGrp|43569|2022|PDM|50.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F144048_91324_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F141870_85224_0|SrvcGrp|86845|2022|PDM|35.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F133561_70364_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117962_17603_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37568_0_0|SrvcGrp|22387|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F38410_0_0|SrvcGrp|10624|2022|PDM|68.00|99|0.00|CPT CODE 99347|
20|FH_F146124_06112_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125215_78130_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F36118_0_0|SrvcGrp|14306|2022|PDM|53.00|99|0.00|WELL MOM/WELL BABY VISIT|
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|2255.00|99|0.00|AEG 8 (NO REV)|
20|FH_F141967_89509_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F121016_32607_0|SrvcGrp|104467|2022|PDM|500.00|99|0.00|ANTEPARTUM CARE ONLY (4-6 VISITS)|
20|FH_F115315_43011_0|SrvcGrp|75545|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1884.00|99|0.00|ASPG VIII|
20|FH_F113271_72205_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F150519_92626_0|SrvcGrp|98701|2022|PDM|425.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F80855_0_0|SrvcGrp|26275|2022|PDM|2200.00|99|0.00|CPT 29826|
20|FH_F117559_08619_0|SrvcGrp|113701|2022|PDM|40.00|99|0.00|COVID-19 IMMUN ADMIN - JANSSEN|
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|AEG 1 (NO REV)|
20|FH_F144049_45242_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F151119_66018_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139527_15642_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40501_0_0|CSTM-ALL|CSTM-00|2020|PDM|131.00|99|0.00|IP PSYCHIATRIC TREATMENT (4-7 HRS)|
20|FH_F133519_0_0|SrvcGrp|89869|2022|PDM|1255.00|99|0.00|SPONTANEOUS ABORTION|
20|FH_F47902_0_0|SrvcGrp|43846|2022|PCT|1.00|99|0.00|DME MOD UEKF|
20|FH_F139877_32615_0|SrvcGrp|113359|2022|PDM|73.49|99|0.00|COVID-19 SARSCOV & INF VIR A&B AG IA|
20|FH_F35792_33175_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F149662_85015_0|CSTM-ALL|CSTM-00|2020|PDM|2821.00|99|0.00|AEG 8 (NO REV)|
20|FH_F138018_17313_0|SrvcGrp|17012|2022|PDM|17.09|99|0.00|HOME INFUSION THERAPY|
20|FH_F37764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|O2 SOLUTIONS MOD 53|
20|FH_F34777_0_0|SrvcGrp|65|2022|PDM|3346.00|99|0.00|OBSTETRICAL CARE|
20|FH_F97623_38008_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F150982_0_0|SrvcGrp|53065|2022|PDM|1040.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F124441_0_0|SrvcGrp|88599|2022|PDM|2090.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F37304_0_0|SrvcGrp|9522|2022|PDM|2051.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F140295_0_0|SrvcGrp|33982|2022|PDM|3268.00|99|0.00|CPT 28296|
20|FH_F150443_77536_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150961_89169_0|SrvcGrp|66265|2022|PDM|81.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F127553_44321_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F149579_95815_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F128536_88240_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125656_92868_0|SrvcGrp|86779|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F39211_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F149046_53022_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|1321.00|99|0.00|AEG 9 (NO REV)|
20|FH_F146859_0_0|SrvcGrp|87123|2022|PDM|549.00|99|0.00|DESTROY LUMB/SAC FACET JNT|
20|FH_F142370_0_0|SrvcGrp|113174|2022|PDM|28.39|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - PFIZER|
20|FH_F128753_32501_0|SrvcGrp|75493|2022|PCT|0.64|99|0.00|AEG 8|
20|FH_F124492_30040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110805_45227_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F115269_0_0|SrvcGrp|93919|2022|PDM|520.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F115269_0_0|SrvcGrp|73841|2022|PDM|375.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F127258_79912_0|SrvcGrp|89149|2022|PDM|206.00|99|0.00|OP INTENSIVE|
20|FH_F134869_08854_0|SrvcGrp|104442|2022|PDM|120.00|99|0.00|AETNA OFFICE/OP VISIT EST (HCFA)|
20|FH_F148891_44432_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149602_07109_0|SrvcGrp|113224|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS DNA&RNA 21 SARSCOV2|
20|FH_F34777_0_0|SrvcGrp|360|2022|PDM|1070.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F145563_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134676_0_0|SrvcGrp|108043|2022|PDM|164.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F39443_0_0|SrvcGrp|30303|2022|PDM|188.00|99|0.00|HAPA WPA ASC 115|
20|FH_F90223_0_0|SrvcGrp|88808|2022|PDM|110.00|99|0.00|MEDICAL SOCIAL WORKER (HCFA)|
20|FH_F151024_30024_0|SrvcGrp|74668|2022|PDM|208.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F92454_0_0|SrvcGrp|21978|2022|PDM|75.00|99|0.00|CPT 77003|
20|FH_F97280_20018_0|SrvcGrp|73659|2022|PDM|8247.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|1894.00|99|0.00|AEG 3 (NO REV)|
20|FH_F128839_0_0|SrvcGrp|89417|2022|PDM|304.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F39756_0_0|SrvcGrp|31524|2022|PDM|1170.40|99|0.00|CUMBERLAND SURGERY - ASPG VIII|
20|FH_F73768_0_0|SrvcGrp|73144|2022|PDM|165.00|99|0.00|HCPC E0603|
20|FH_F149579_95815_0|SrvcGrp|115702|2022|PDM|128.25|99|0.00|PSYCHIATRIC COLLABORATIVE CARE MGMT SBSQ (MOD AH)(HCFA)|
20|FH_F128753_32501_0|SrvcGrp|75483|2022|PCT|0.64|99|0.00|AEG 3|
20|FH_F147302_33573_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F132254_40207_0|SrvcGrp|86848|2022|PDM|50.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PDM|1544.00|99|0.00|ASPG II|
20|FH_F33632_52349_0|SrvcGrp|89922|2022|PCT|0.88|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F113181_72202_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F113226_30025_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117820_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120635_22903_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F150939_0_0|SrvcGrp|25383|2022|PCT|0.00|99|0.00|MEDICINE SERVICES|
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_F138787_32258_0|SrvcGrp|78067|2022|PDM|474.00|99|0.00|SUBACUTE CARE|
20|FH_F138907_01040_0|SrvcGrp|104226|2022|PDM|170.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|IMPLANTS CARVE OUT|
20|FH_F75185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F151302_80227_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151304_31520_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F151402_70508_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151419_07852_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F144989_07701_0|SrvcGrp|29347|2022|PCT|1.00|99|0.00|HOME HEALTH AIDE|
20|FH_F36555_0_0|SrvcGrp|473|2022|PDM|429.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|3604.00|99|0.00|ASPG IX|
20|FH_F135427_19610_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F135457_67214_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135494_10941_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97141_93933_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F97143_80012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F91700_15601_0|SrvcGrp|471|2022|PDM|445.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F91764_93710_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F91764_93710_0|CSTM-ALL|CSTM-00|2020|PDM|3983.00|99|0.00|AEG 10 (NO REV)|
20|FH_F135809_50501_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135851_25414_0|SrvcGrp|73842|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119886_25504_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F131506_18901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116397_33404_0|SrvcGrp|86832|2022|PDM|3.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F130766_04967_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F121444_47720_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121763_07202_0|SrvcGrp|106249|2022|PDM|105.00|99|0.00|PARTIAL HOSP SUBSTANCE ABUSE|
20|FH_F55574_0_0|SrvcGrp|9511|2022|PCT|0.86|99|0.00|OBSERVATION SVCS|
20|FH_F67425_0_0|SrvcGrp|9774|2022|PDM|2569.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F111301_33122_0|SrvcGrp|72992|2022|PDM|1353.00|99|0.00|AEG 2|
20|FH_F111363_33169_0|SrvcGrp|11258|2022|PCT|0.33|99|0.00|DRUGS|
20|FH_F141651_0_0|SrvcGrp|89882|2022|PDM|3850.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F87153_0_0|CSTM-ALL|CSTM-00|2020|PDM|541.43|99|0.00|AETNA POLYSOMNOGRAPHY|
20|FH_F145587_0_0|SrvcGrp|82108|2022|PDM|1262.70|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F33081_0_0|SrvcGrp|11301|2022|PDM|1400.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F33390_0_0|SrvcGrp|13188|2022|PCT|0.75|99|0.00|DRUGS|
20|FH_F134930_0_0|SrvcGrp|104330|2022|PDM|1200.00|99|0.00|AETNA ACUTE REHAB II|
20|FH_F96280_06340_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F128549_44224_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F101620_47401_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F132347_01605_0|SrvcGrp|29347|2022|PDM|28.73|99|0.00|HOME HEALTH AIDE|
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F39967_0_0|CSTM-ALL|CSTM-00|2020|PDM|1460.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40600_0_0|SrvcGrp|12214|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F98622_45005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48772_66044_0|SrvcGrp|54972|2022|PDM|110.00|99|0.00|ST THERAPY|
20|FH_F131235_36049_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F98161_0_0|SrvcGrp|73006|2022|PDM|1540.00|99|0.00|AEG 9|
20|FH_F98161_0_0|SrvcGrp|84280|2022|PDM|1365.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F86991_15122_0|SrvcGrp|85481|2022|PCT|1.00|99|0.00|OPTHALMIC MITOMYCIN|
20|FH_F55212_0_0|SrvcGrp|51123|2022|PDM|22.00|99|0.00|COMMUNITY PSYCH SUPPORTIVE TREATMENT|
20|FH_F87480_0_0|SrvcGrp|86233|2022|PDM|7500.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F34418_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F32995_0_0|SrvcGrp|3420|2022|PDM|4500.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F123763_80130_0|SrvcGrp|86722|2022|PDM|240.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2195.00|99|0.00|AEG 10 (NO REV)|
20|FH_F67901_0_0|SrvcGrp|64136|2022|PDM|84.40|99|0.00|IMPLANTABLE INFUSION PUMP REFILL KIT|
20|FH_F117465_0_0|SrvcGrp|107495|2022|PDM|3000.00|99|0.00|AETNA - ARTHROSCOPY OF JOINT|
20|FH_F120418_43015_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134126_11554_0|SrvcGrp|13597|2022|PDM|360.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F134155_07016_0|CSTM-ALL|CSTM-00|2020|PDM|267.00|99|0.00|AETNA INTENSIVE OUTPATIENT CD (<=18 YRS)|
20|FH_F137033_87108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F137235_66061_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F142470_32935_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F142530_60148_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 4 (NO REV)|
20|FH_F138627_82901_0|SrvcGrp|86841|2022|PDM|50.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F125053_0_0|SrvcGrp|73004|2022|PDM|950.00|99|0.00|AEG 8|
20|FH_F140753_75038_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120152_0_0|SrvcGrp|88023|2022|PDM|5500.00|99|0.00|REMOVAL OF ANTERIOR INSTRUMENTATION|
20|FH_F119352_0_0|SrvcGrp|82498|2022|PDM|135.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS|
20|FH_F36743_0_0|SrvcGrp|16|2022|PDM|1125.00|99|0.00|ACUTE REHABILITATION|
20|FH_F35678_0_0|SrvcGrp|9774|2022|PDM|2119.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F149049_28401_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 4 (NO REV)|
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|2456.00|99|0.00|AEG 10 (NO REV)|
20|FH_F122377_91007_0|SrvcGrp|537|2022|PCT|0.46|99|0.00|OBSERVATION SERVICES|
20|FH_F110783_93013_0|SrvcGrp|27615|2022|PDM|41.25|99|0.00|AETNA DRUGS|
20|FH_F132160_0_0|SrvcGrp|92549|2022|PDM|5738.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F35174_0_0|CSTM-ALL|CSTM-00|2020|PDM|1005.00|99|0.00|NEWBORN NURSERY - LEVEL I|
20|FH_F122394_75979_0|SrvcGrp|73842|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F127467_44202_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F91772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102525_73134_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F151517_0_0|SrvcGrp|74668|2022|PDM|214.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149579_95815_0|SrvcGrp|115684|2022|PDM|19.89|99|0.00|PHYSIOLOGIC REM MONITORING SETUP (HCFA)|
20|FH_F98820_81401_0|SrvcGrp|73485|2022|PDM|3568.00|99|0.00|AETNA REHAB|
20|FH_F108080_77081_0|SrvcGrp|75419|2022|PDM|367.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F114332_19973_0|SrvcGrp|85017|2022|PCT|1.05|99|0.00|DME|
20|FH_F146266_0_0|SrvcGrp|85778|2022|PDM|3750.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F149608_19116_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137986_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F149642_95678_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110785_10040_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F127487_60169_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F97640_37043_0|SrvcGrp|73601|2022|PDM|8389.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F90817_0_0|SrvcGrp|91015|2022|PDM|2721.00|99|0.00|ANKLE ARTHROSCOPY SURGERY (HCFA)|
20|FH_F36992_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD AV|
20|FH_F101441_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F98020_50138_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F74902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140231_60540_0|SrvcGrp|74668|2022|PDM|318.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F143214_92506_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HSS ASC|
20|FH_F143249_89801_0|SrvcGrp|23683|2022|PDM|55.00|99|0.00|SKILLED NURSING RN|
20|FH_F143454_94550_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F101700_0_0|SrvcGrp|98604|2022|PDM|1700.00|99|0.00|IMPLANT SPINAL CANAL|
20|FH_F101709_0_0|SrvcGrp|99073|2022|PDM|1.39|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F120190_92624_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F132530_38930_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116756_77477_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F116918_06488_0|SrvcGrp|76501|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F119992_67062_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F126627_33155_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F126884_28379_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F118815_61021_0|SrvcGrp|86748|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F39028_0_0|SrvcGrp|29955|2022|PCT|1.00|99|0.00|DME MOD AU|
20|FH_F130152_48025_0|SrvcGrp|83099|2022|PCT|1.00|99|0.00|HOSPICE SVCS|
20|FH_F36372_0_0|SrvcGrp|10645|2022|PDM|175.00|99|0.00|PICC LINE INSERTION KIT|
20|FH_F40600_0_0|SrvcGrp|97|2022|PDM|5719.00|99|0.00|C-SECTION|
20|FH_F102948_43606_0|SrvcGrp|87317|2022|PDM|677.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F111190_30512_0|SrvcGrp|15789|2022|PDM|79.00|99|0.00|SPEECH THERAPY|
20|FH_F39567_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F66409_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F40011_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82173_72712_0|SrvcGrp|96462|2022|PDM|71.00|99|0.00|HOSPICE CONTINUOUS HOME CARE|
20|FH_F82173_72712_0|SrvcGrp|116077|2022|PCT|2.25|99|0.00|LABORATORY SERVICES|
20|FH_F82235_0_0|SrvcGrp|72994|2022|PDM|560.00|99|0.00|AEG 3|
20|FH_F148266_45419_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F131420_29693_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F128363_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F130452_48801_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F130025_0_0|SrvcGrp|16|2022|PDM|1102.00|99|0.00|ACUTE REHABILITATION|
20|FH_F110263_0_0|SrvcGrp|115583|2022|PDM|9555.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY (HCFA)|
20|FH_F33612_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F90492_0_0|SrvcGrp|89149|2022|PDM|215.00|99|0.00|OP INTENSIVE|
20|FH_F127441_45822_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F138450_0_0|SrvcGrp|112727|2022|PDM|45.23|99|0.00|COVID-19 IA NFCT AB SARS COV 2|
20|FH_F140995_33040_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40605_0_0|SrvcGrp|16|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION|
20|FH_F37945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1670.00|99|0.00|ASPG VIII|
20|FH_F148500_50129_0|SrvcGrp|3378|2022|PCT|0.80|99|0.00|OBSERVATION SVCS|
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_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|1786.00|99|0.00|AEG 8 (NO REV)|
20|FH_F129181_28164_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F51672_0_0|SrvcGrp|98377|2022|PDM|100.00|99|0.00|HIGH TECH SPECIALITY NURSE (MOD TG)|
20|FH_F148320_02130_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F148483_94087_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F102282_06795_0|SrvcGrp|89783|2022|PDM|153.62|99|0.00|RESPITE CARE (HCFA)|
20|FH_F102325_62691_0|SrvcGrp|73701|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F117465_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71923_0_0|SrvcGrp|68900|2022|PDM|583.50|99|0.00|DIALYSIS TRAINING|
20|FH_F136347_30328_0|SrvcGrp|87317|2022|PDM|1176.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F136424_34470_0|SrvcGrp|89149|2022|PDM|198.00|99|0.00|OP INTENSIVE|
20|FH_F120418_43015_0|SrvcGrp|91294|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F120418_43015_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120489_63552_0|SrvcGrp|97968|2022|PCT|1.10|99|0.00|CT SCAN|
20|FH_F137147_75006_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F139559_21001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138188_54901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F117552_0_0|SrvcGrp|72996|2022|PDM|758.00|99|0.00|AEG 4|
20|FH_F117552_0_0|SrvcGrp|72994|2022|PDM|614.00|99|0.00|AEG 3|
20|FH_F139456_47501_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F138583_60644_0|SrvcGrp|90854|2022|PDM|959.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F118789_92211_0|SrvcGrp|75442|2022|PDM|770.00|99|0.00|OBSERVATION - REV 762|
20|FH_F119023_91406_0|SrvcGrp|14945|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F118932_07652_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F118943_64506_0|SrvcGrp|14947|2022|PDM|5.00|99|0.00|HOME INFUSION|
20|FH_F38332_0_0|SrvcGrp|18127|2022|PDM|12064.00|99|0.00|MS DRG 242|
20|FH_F67239_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F67880_0_0|SrvcGrp|33096|2022|PCT|0.75|99|0.00|INTRAOCULAR LENS|
20|FH_F147799_18052_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129511_44044_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129524_48104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL|
20|FH_F117217_80304_0|SrvcGrp|89023|2022|PDM|94.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F137276_83127_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137905_91364_0|SrvcGrp|75419|2022|PDM|700.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F39303_0_0|SrvcGrp|115|2022|PDM|464.00|99|0.00|SKILLED NURSING CARE|
20|FH_F111593_0_0|SrvcGrp|63466|2022|PDM|2090.00|99|0.00|CPT 52005|
20|FH_F124923_23518_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F129487_0_0|SrvcGrp|72996|2022|PDM|1948.00|99|0.00|AEG 4|
20|FH_F98625_08103_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F100780_24153_0|SrvcGrp|73601|2022|PDM|6382.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F100906_0_0|SrvcGrp|84320|2022|PDM|2000.00|99|0.00|SPINE SURGERY|
20|FH_F69347_0_0|SrvcGrp|44771|2022|PDM|8025.00|99|0.00|PORTLAND ADVENTIST ASPG X|
20|FH_F132544_0_0|SrvcGrp|3932|2022|PDM|4484.00|99|0.00|LITHOTRIPSY|
20|FH_F148432_01585_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F38725_0_0|CSTM-ALL|CSTM-00|2020|PDM|605.00|99|0.00|ASPG III|
20|FH_F132785_17961_0|SrvcGrp|79699|2022|PCT|0.38|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F108960_47403_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F40442_0_0|SrvcGrp|97|2022|PDM|3885.00|99|0.00|C-SECTION|
20|FH_F149840_80002_0|SrvcGrp|95661|2022|PDM|142.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F92972_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|GENERAL ACUTE CARE|
20|FH_F67500_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120837_33309_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F111423_34952_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51548_0_0|SrvcGrp|15850|2022|PDM|120.00|99|0.00|HOSPICE SVCS|
20|FH_F89015_74017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126930_0_0|SrvcGrp|110599|2022|PDM|270.00|99|0.00|ORAL MEDICATION ADMIN|
20|FH_F47433_0_0|CSTM-ALL|CSTM-00|2020|PDM|1622.00|99|0.00|OP SVCS|
20|FH_F133268_63703_0|SrvcGrp|100272|2022|PDM|13.20|99|0.00|IIV3 VACCINE SPLT 0.25 ML IM|
20|FH_F125471_34471_0|SrvcGrp|73841|2022|PDM|432.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|2096.00|99|0.00|AEG 5  (NO REV)|
20|FH_F35411_0_0|SrvcGrp|13152|2022|PDM|8050.00|99|0.00|RADIO FREQUENCY ABLATION|
20|FH_F128445_85704_0|SrvcGrp|16069|2022|PDM|1048.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F141870_85224_0|SrvcGrp|86828|2022|PDM|70.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F142818_34209_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD AW) - BDSS|
20|FH_F86293_0_0|SrvcGrp|27348|2022|PDM|2794.00|99|0.00|OP SURGERY (CPT 58662)|
20|FH_F109606_0_0|CSTM-ALL|CSTM-00|2020|PDM|808.00|99|0.00|AEG 2 (NO REV)|
20|FH_F44025_0_0|CSTM-ALL|CSTM-00|2020|PDM|374.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F117087_0_0|SrvcGrp|107168|2022|PDM|2494.00|99|0.00|REMOVAL OF POLYPS|
20|FH_F92676_15063_0|SrvcGrp|79040|2022|PDM|700.71|99|0.00|MON VALLEY ASC 122|
20|FH_F92676_15063_0|SrvcGrp|79055|2022|PDM|519.47|99|0.00|MON VALLEY ASC 130|
20|FH_F40728_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|ASPG II|
20|FH_F88223_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AEG 10 (NO REV)|
20|FH_F50440_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F38079_0_0|SrvcGrp|10503|2022|PDM|250.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F120390_91316_0|SrvcGrp|74668|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F97543_33542_0|SrvcGrp|90854|2022|PDM|2662.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F146212_57108_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F72859_0_0|SrvcGrp|15498|2022|PDM|48.74|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F133493_90255_0|CSTM-ALL|CSTM-00|2020|PDM|4830.00|99|0.00|AEG 7 (NO REV)|
20|FH_F81373_64064_0|SrvcGrp|73841|2022|PDM|281.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ACUTE PSYCH|
20|FH_F120195_28403_0|SrvcGrp|89149|2022|PDM|176.00|99|0.00|OP INTENSIVE|
20|FH_F132051_74464_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F90362_0_0|SrvcGrp|89948|2022|PDM|1667.00|99|0.00|LIGAMENT RECONSTRUCTION|
20|FH_F140913_63017_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93136_0_0|SrvcGrp|72998|2022|PDM|717.00|99|0.00|AEG 5|
20|FH_F44582_0_0|SrvcGrp|39100|2022|PDM|32000.00|99|0.00|CV SURGERY|
20|FH_F125899_07645_0|SrvcGrp|76321|2022|PDM|4312.00|99|0.00|AETNA ALL INPATIENT SERVICES|
20|FH_F90872_0_0|SrvcGrp|29428|2022|PDM|1949.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT|
20|FH_F143783_0_0|SrvcGrp|93098|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F50184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F129683_45255_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F129547_35476_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F99960_0_0|SrvcGrp|72996|2022|PDM|986.00|99|0.00|AEG 4|
20|FH_F38591_0_0|SrvcGrp|941|2022|PDM|3682.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F108762_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)|
20|FH_F129305_45614_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116731_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F143783_0_0|SrvcGrp|113451|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F83251_32751_0|SrvcGrp|75545|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 8 (NO REV)|
20|FH_F128307_43219_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F109180_18015_0|SrvcGrp|91398|2022|PDM|123.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AJ)|
20|FH_F120059_0_0|SrvcGrp|106799|2022|PDM|6500.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F115733_33012_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F120308_07901_0|SrvcGrp|86723|2022|PDM|392.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F120001_0_0|SrvcGrp|73483|2022|PDM|459.00|99|0.00|AETNA SUBACUTE III|
20|FH_F37733_0_0|SrvcGrp|27215|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 5  (NO REV)|
20|FH_F135219_68506_0|CSTM-ALL|CSTM-00|2020|PDM|4950.88|99|0.00|AEG 6 (NO REV)|
20|FH_F40438_0_0|SrvcGrp|13849|2022|PCT|0.65|99|0.00|LITHOTRIPSY|
20|FH_F64440_0_0|SrvcGrp|111603|2022|PDM|877.00|99|0.00|CT W/ & W/O CONTRAST|
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|WELLPATH ASC IV|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|ASPG VI|
20|FH_F137573_33764_0|SrvcGrp|89149|2022|PDM|202.00|99|0.00|OP INTENSIVE|
20|FH_F39279_0_0|SrvcGrp|30274|2022|PCT|0.55|99|0.00|BLOOD SERVICES|
20|FH_F123464_63841_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114916_30309_0|SrvcGrp|105632|2022|PDM|1000.00|99|0.00|AMPUTATION OF TOE|
20|FH_F130767_67133_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130214_30144_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|16732|2022|PDM|4184.00|99|0.00|HYSTEROSCOPY ABLATION|
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_F93881_15009_0|SrvcGrp|72984|2022|PDM|150.00|99|0.00|CHEMOTHERAPY|
20|FH_F130523_04605_0|SrvcGrp|103717|2022|PCT|0.84|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F137427_89146_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F123312_54115_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115063_78550_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35388_0_0|SrvcGrp|16873|2022|PDM|1200.00|99|0.00|MAGNETIC RESONANCE ANGIOGRAPHY|
20|FH_F44177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1633.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F125899_07645_0|SrvcGrp|75507|2022|PCT|0.73|99|0.00|CHEMOTHERAPY|
20|FH_F135216_64064_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|1370.00|99|0.00|AEG 6 (NO REV)|
20|FH_F117082_66216_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F150314_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F131128_0_0|SrvcGrp|33986|2022|PDM|955.00|99|0.00|CPT 26055|
20|FH_F65159_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TEMPLE LABS MOD QW|
20|FH_F87474_0_0|SrvcGrp|14500|2022|PDM|30.00|99|0.00|STATIONARY/AMBULATORY/DISPOSAL PUMPS|
20|FH_F87915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129975_0_0|SrvcGrp|111414|2022|PCT|6.50|99|0.00|MEDICINE CODES|
20|FH_F40191_0_0|SrvcGrp|12014|2022|PDM|607.00|99|0.00|SKILLED NURSING SVCS|
20|FH_F46832_0_0|SrvcGrp|17015|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F38411_0_0|SrvcGrp|19308|2022|PCT|0.80|99|0.00|MS DRG 886|
20|FH_F118803_0_0|SrvcGrp|104883|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F42258_0_0|SrvcGrp|30038|2022|PDM|1400.00|99|0.00|NICU INTENSIVE CARE LEVEL II|
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|1534.30|99|0.00|AEG 9 (NO REV)|
20|FH_F83754_0_0|SrvcGrp|30608|2022|PCT|0.86|99|0.00|THERAPY SERVICES|
20|FH_F121476_0_0|SrvcGrp|111253|2022|PDM|4340.00|99|0.00|CATHETER|
20|FH_F119227_01752_0|SrvcGrp|58464|2022|PCT|1.00|99|0.00|J-CODES|
20|FH_F145562_70458_0|SrvcGrp|86853|2022|PDM|10.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F120603_66112_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143581_02130_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129548_44130_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F109400_80026_0|SrvcGrp|48394|2022|PDM|22.52|99|0.00|SKILLED NURSING SERVICES|
20|FH_F87775_15106_0|SrvcGrp|23681|2022|PDM|90.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F143650_0_0|SrvcGrp|34603|2022|PDM|2800.00|99|0.00|CPT 24341|
20|FH_F150304_16146_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114444_19602_0|SrvcGrp|91782|2022|PDM|65.00|99|0.00|AETNA GROUP THERAPY (MOD HO)(HCFA)|
20|FH_F100784_59923_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F63131_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F81494_0_0|SrvcGrp|14101|2022|PCT|1.00|99|0.00|DRUGS|
20|FH_F142931_60644_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F110606_0_0|SrvcGrp|87077|2022|PDM|165.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F133268_63703_0|SrvcGrp|109209|2022|PDM|13.20|99|0.00|IIV4 VACC NO PRSV 0.25 ML IM|
20|FH_F150001_33064_0|SrvcGrp|86854|2022|PDM|26.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F150500_85253_0|SrvcGrp|89337|2022|PDM|1200.00|99|0.00|DETOXIFICATION|
20|FH_F44296_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148494_0_0|SrvcGrp|113840|2022|PDM|15500.00|99|0.00|REVISE HIP ARTHROPLASTY|
20|FH_F101840_76054_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F113131_19013_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|1145.83|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F91216_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F92977_64067_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F133533_33901_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F67192_0_0|CSTM-ALL|CSTM-00|2020|PDM|837.00|99|0.00|CD ADULT REHAB|
20|FH_F133009_19038_0|SrvcGrp|48385|2022|PDM|107.00|99|0.00|SPEECH THERAPY|
20|FH_F117838_12901_0|SrvcGrp|33165|2022|PDM|285.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F67379_0_0|SrvcGrp|40589|2022|PDM|8476.00|99|0.00|MS DRG 028-030 ONLY SPINE SURGERY|
20|FH_F50440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|123.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 138 W/O REV|
20|FH_F143057_15767_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F39723_0_0|SrvcGrp|30951|2022|PDM|580.00|99|0.00|HOSPICE|
20|FH_F117009_0_0|SrvcGrp|107274|2022|PDM|2113.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133467_03301_0|SrvcGrp|89337|2022|PDM|1825.00|99|0.00|DETOXIFICATION|
20|FH_F136002_0_0|SrvcGrp|46605|2022|PDM|81.60|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F32382_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118476_17815_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38153_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.40|99|0.00|OP SVCS|
20|FH_F126975_43551_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F34706_0_0|SrvcGrp|361|2022|PDM|766.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F98620_43920_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F146375_06751_0|SrvcGrp|108484|2022|PDM|2061.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F46352_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|SKILLED NURSING CARE|
20|FH_F33865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|GENERAL ACUTE CARE|
20|FH_F141612_19605_0|SrvcGrp|16069|2022|PDM|927.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F101851_78024_0|SrvcGrp|89337|2022|PDM|923.00|99|0.00|DETOXIFICATION|
20|FH_F42779_0_0|SrvcGrp|36510|2022|PDM|521.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F132594_78229_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F122245_0_0|SrvcGrp|91340|2022|PDM|1750.00|99|0.00|PENILE IMPLANT PROCEDURES|
20|FH_F101840_76054_0|SrvcGrp|73483|2022|PDM|580.00|99|0.00|AETNA SUBACUTE III|
20|FH_F92854_63028_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128246_0_0|SrvcGrp|111046|2022|PDM|726.00|99|0.00|REVISE EYELASHES|
20|FH_F136393_0_0|SrvcGrp|76024|2022|PDM|6000.00|99|0.00|PACEMAKER|
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|ASPG X|
20|FH_F128703_68638_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133006_48067_0|SrvcGrp|89417|2022|PDM|360.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F126762_91311_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148864_81303_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F113906_0_0|SrvcGrp|73000|2022|PDM|665.00|99|0.00|AEG 6|
20|FH_F139707_84010_0|SrvcGrp|114710|2022|PDM|13372.00|99|0.00|SPINAL PROCEDURES|
20|FH_F150745_03301_0|SrvcGrp|27968|2022|PDM|54.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150882_84041_0|SrvcGrp|86837|2022|PDM|19.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F133677_15601_0|SrvcGrp|48385|2022|PDM|107.00|99|0.00|SPEECH THERAPY|
20|FH_F36165_0_0|SrvcGrp|11798|2022|PDM|90.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F150459_08021_0|SrvcGrp|95660|2022|PDM|635.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F101280_63111_0|SrvcGrp|89149|2022|PDM|170.00|99|0.00|OP INTENSIVE|
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|1495.00|99|0.00|AEG 6 (NO REV)|
20|FH_F36683_0_0|SrvcGrp|18873|2022|PDM|26758.00|99|0.00|MS DRG 232|
20|FH_F138540_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F128583_45154_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F110783_93013_0|SrvcGrp|112059|2022|PDM|55.00|99|0.00|RENFLEXIS|
20|FH_F41363_0_0|SrvcGrp|69399|2022|PCT|1.00|99|0.00|PREVENTATIVE CODES|
20|FH_F97184_26101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128583_45154_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F139147_0_0|SrvcGrp|93432|2022|PDM|14057.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F33719_0_0|SrvcGrp|15361|2022|PDM|3351.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F138018_17313_0|SrvcGrp|26869|2022|PDM|103.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F139947_43209_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117714_94301_0|SrvcGrp|73842|2022|PDM|395.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F98623_97006_0|SrvcGrp|73602|2022|PDM|3744.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F125081_15218_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F35743_34202_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F151579_19802_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119023_91406_0|SrvcGrp|14944|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F119004_06850_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118926_30135_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118932_07652_0|SrvcGrp|72992|2022|PDM|1538.00|99|0.00|AEG 2|
20|FH_F118943_64506_0|SrvcGrp|13929|2022|PDM|10.00|99|0.00|GROWTH HORMONE|
20|FH_F118943_64506_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F76144_0_0|SrvcGrp|42550|2022|PDM|3186.25|99|0.00|OP SURGERY CPT 66984|
20|FH_F79503_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F117221_23434_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F137850_32826_0|SrvcGrp|46903|2022|PDM|550.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F137938_29036_0|SrvcGrp|12121|2022|PCT|0.66|99|0.00|IP OBSERVATION SVCS|
20|FH_F110720_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F110720_0_0|SrvcGrp|73002|2022|PDM|3083.00|99|0.00|AEG 7|
20|FH_F90880_15108_0|SrvcGrp|88857|2022|PCT|1.00|99|0.00|THERAPEUTIC ACTIVITIES|
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|3520.00|99|0.00|AEG 9 (NO REV)|
20|FH_F129892_0_0|SrvcGrp|84939|2022|PDM|2550.00|99|0.00|SHOULDER JOINT|
20|FH_F131472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F69364_0_0|CSTM-ALL|CSTM-00|2020|PDM|2105.00|99|0.00|ASPG VII|
20|FH_F69347_0_0|SrvcGrp|12342|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F132544_0_0|SrvcGrp|97159|2022|PDM|7850.00|99|0.00|TRANSPEDICULAR, 1 SEG, LUMBAR|
20|FH_F148379_89129_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F148544_60439_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F45392_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141411_0_0|SrvcGrp|83837|2022|PDM|17500.00|99|0.00|EXCISION EXCESSIVE SKIN|
20|FH_F128657_19008_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F88956_0_0|SrvcGrp|76619|2022|PCT|1.51|99|0.00|THERAPY|
20|FH_F148639_0_0|SrvcGrp|88739|2022|PDM|3400.00|99|0.00|IMPLANT SPINAL CANAL|
20|FH_F51123_0_0|SrvcGrp|10623|2022|PDM|120.75|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F40056_0_0|SrvcGrp|38|2022|PDM|3600.00|99|0.00|NORMAL DELIVERY|
20|FH_F144109_63376_0|SrvcGrp|106315|2022|PDM|500.00|99|0.00|AMBULANCE SERVICE NO TRANSPORT (HCFA)|
20|FH_F113326_80014_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD AW)|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.51|99|0.00|AETNA SLEEP STUDIES|
20|FH_F118496_92627_0|SrvcGrp|93919|2022|PDM|630.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 5  (NO REV)|
20|FH_F119437_0_0|SrvcGrp|71666|2022|PDM|5000.00|99|0.00|CPT 63655|
20|FH_F133005_32726_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|77.45|99|0.00|AETNA SLEEP STUDY|
20|FH_F128893_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F78205_0_0|SrvcGrp|17083|2022|PDM|5058.00|99|0.00|ASPG X|
20|FH_F43296_0_0|SrvcGrp|26228|2022|PCT|0.50|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F39844_0_0|CSTM-ALL|CSTM-00|2020|PDM|7426.00|99|0.00|MS DRG 243-244|
20|FH_F117717_68410_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F136002_0_0|SrvcGrp|48396|2022|PDM|81.60|99|0.00|OT SERVICES|
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 490|
20|FH_F133517_49221_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F45977_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 642|
20|FH_F133627_89113_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PDM|709.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F112853_22408_0|SrvcGrp|41424|2022|PDM|0.90|99|0.00|ENTERAL FORMULA - BLENDERIZED|
20|FH_F148886_60621_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F102822_84065_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F31827_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|ASPG VI|
20|FH_F145328_90301_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F117559_08619_0|SrvcGrp|114532|2022|PDM|40.00|99|0.00|ADM SARS COV2 30MCG/0.3 ML (3RD)|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.85|99|0.00|DELAWARE VALLEY- ASC 124|
20|FH_F128559_43524_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F75743_0_0|SrvcGrp|14221|2022|PCT|0.50|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F147800_0_0|SrvcGrp|115142|2022|PDM|660.00|99|0.00|NJX AA&/STRD GNCLR NRV BRNCH|
20|FH_F67192_0_0|SrvcGrp|29817|2022|PDM|4548.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F32301_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|TRANSPLANT SVCS|
20|FH_F41679_0_0|SrvcGrp|16420|2022|PDM|380.00|99|0.00|PSYCH RESIDENTIAL TREATMENT|
20|FH_F57592_0_0|SrvcGrp|29280|2022|PDM|10000.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|917.00|99|0.00|ASPG II - IOWA|
20|FH_F102561_75146_0|SrvcGrp|78377|2022|PDM|1100.00|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F133287_40215_0|SrvcGrp|112254|2022|PDM|3329.00|99|0.00|GROUPER 9 CODES 2017 MEDICARE|
20|FH_F144088_48706_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F93421_0_0|SrvcGrp|12403|2022|PDM|32.24|99|0.00|CONTINUOUS HOMECARE|
20|FH_F96120_67207_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F101851_78024_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F37188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97181_33143_0|SrvcGrp|93919|2022|PDM|1200.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F111784_32901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2138.00|99|0.00|AEG 8 (NO REV)|
20|FH_F41594_0_0|SrvcGrp|28561|2022|PDM|106.19|99|0.00|CPT 92526|
20|FH_F118253_89052_0|SrvcGrp|89149|2022|PDM|225.00|99|0.00|OP INTENSIVE|
20|FH_F148546_0_0|SrvcGrp|16|2022|PDM|970.00|99|0.00|ACUTE REHABILITATION|
20|FH_F133753_84015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145562_70458_0|SrvcGrp|86852|2022|PDM|22.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F125549_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F123646_91350_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|PARTIAL HOSPITALIZATION PSYCHIATRIC|
20|FH_F150222_98026_0|SrvcGrp|90854|2022|PDM|1000.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F121700_60938_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114800_68510_0|SrvcGrp|46605|2022|PDM|92.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F112023_12866_0|SrvcGrp|75506|2022|PCT|0.62|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F71647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142376_0_0|SrvcGrp|80135|2022|PDM|19877.00|99|0.00|INSERT SPINAL INFUSION|
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1636.40|99|0.00|AEG 8 (NO REV)|
20|FH_F87775_15106_0|SrvcGrp|34566|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132969_84003_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130468_0_0|SrvcGrp|97741|2022|PDM|21005.80|99|0.00|REVISE KNEE|
20|FH_F111882_51560_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F133972_27103_0|SrvcGrp|65621|2022|PDM|24.00|99|0.00|RN NURSING|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|1990.00|99|0.00|ASPG X|
20|FH_F118803_0_0|SrvcGrp|107878|2022|PDM|2601.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F85995_64111_0|SrvcGrp|43567|2022|PDM|136.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F110881_63125_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113041_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG VIII|
20|FH_F133749_84604_0|SrvcGrp|97704|2022|PDM|94.50|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F134928_0_0|SrvcGrp|93924|2022|PDM|2100.00|99|0.00|AETNA MEDICAL SERVICES|
20|FH_F133724_84041_0|SrvcGrp|93099|2022|PDM|474.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY|
20|FH_F146103_63851_0|SrvcGrp|79099|2022|PDM|1100.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F145641_06902_0|SrvcGrp|98523|2022|PDM|4228.00|99|0.00|CAPSULOTOMY|
20|FH_F139678_25601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137362_0_0|SrvcGrp|25688|2022|PDM|500.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F123623_03246_0|SrvcGrp|109282|2022|PCT|1.00|99|0.00|BLOOD TYPING SEROLOGIC ABO|
20|FH_F110921_53014_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112665_0_0|SrvcGrp|67279|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY|
20|FH_F135670_01749_0|SrvcGrp|29076|2022|PDM|35.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F120661_57001_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F78584_0_0|SrvcGrp|36991|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F143674_34208_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133749_84604_0|SrvcGrp|112434|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F118253_89052_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113453_80020_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F85353_16407_0|SrvcGrp|63831|2022|PDM|493.23|99|0.00|HAPA WPA-NWPA 2012-13 ASC 406|
20|FH_F133972_27103_0|SrvcGrp|86829|2022|PDM|4.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F112468_0_0|SrvcGrp|72992|2022|PDM|637.00|99|0.00|AEG 2|
20|FH_F119227_01752_0|SrvcGrp|86841|2022|PDM|135.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F34852_0_0|SrvcGrp|38|2022|PDM|2600.00|99|0.00|NORMAL DELIVERY|
20|FH_F146559_71901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113435_19027_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F119999_0_0|SrvcGrp|12491|2022|PCT|0.50|99|0.00|PACEMAKER|
20|FH_F119763_17402_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F145562_70458_0|SrvcGrp|86841|2022|PDM|50.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F148799_50125_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F89219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|MT NITTANY ASC 6|
20|FH_F145759_18452_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F54592_0_0|SrvcGrp|17005|2022|PDM|67.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS|
20|FH_F84712_0_0|SrvcGrp|74586|2022|PCT|0.33|99|0.00|AETNA OP HIGH COST DRUGS|
20|FH_F98780_35022_0|SrvcGrp|73659|2022|PDM|4505.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F115892_83263_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F115909_38133_0|SrvcGrp|46903|2022|PDM|649.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F77665_0_0|SrvcGrp|15477|2022|PDM|65.00|99|0.00|PHYSICAL THERAPY SVCS INITIAL EVAL|
20|FH_F146501_68025_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146716_46733_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132213_17543_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132964_06484_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133494_90023_0|CSTM-ALL|CSTM-00|2020|PDM|1867.00|99|0.00|AEG 2 (NO REV)|
20|FH_F111662_80601_0|SrvcGrp|33659|2022|PDM|361.00|99|0.00|DIALYSIS SERVICES|
20|FH_F134822_06513_0|SrvcGrp|75545|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F121970_92653_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130066_84107_0|SrvcGrp|73605|2022|PDM|800.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F34317_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86911_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|HOME HEALTH MOD TD|
20|FH_F87054_0_0|SrvcGrp|46890|2022|PDM|2205.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 10 (NO REV)|
20|FH_F114916_30309_0|SrvcGrp|93433|2022|PDM|16500.00|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F114916_30309_0|SrvcGrp|74039|2022|PDM|6050.00|99|0.00|LAMINECTOMY|
20|FH_F114916_30309_0|CSTM-ALL|CSTM-00|2020|PDM|2184.00|99|0.00|AEG 9 (NO REV)|
20|FH_F105480_19940_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F135491_0_0|SrvcGrp|112137|2022|PDM|2640.00|99|0.00|XCAPSL CTRC RMVL W/ECP|
20|FH_F116485_17033_0|SrvcGrp|114752|2022|PDM|369.77|99|0.00|EDUCATIONALLY BEHAVIORAL SUPPORTS LEVEL 1|
20|FH_F132988_0_0|SrvcGrp|100043|2022|PDM|12171.25|99|0.00|FUSION OF FOOT BONES|
20|FH_F43665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F124180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124927_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F131505_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 7 (NO REV)|
20|FH_F122170_60120_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124059_64055_0|SrvcGrp|43567|2022|PDM|83.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F124082_78526_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F146985_12205_0|SrvcGrp|48396|2022|PDM|89.00|99|0.00|OT SERVICES|
20|FH_F147059_28806_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38983_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F39066_0_0|SrvcGrp|997|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F39956_0_0|SrvcGrp|97|2022|PDM|3090.00|99|0.00|C-SECTION|
20|FH_F129549_01238_0|SrvcGrp|48394|2022|PDM|26.25|99|0.00|SKILLED NURSING SERVICES|
20|FH_F124173_66215_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F124222_92625_0|SrvcGrp|74668|2022|PDM|700.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124222_92625_0|SrvcGrp|108061|2022|PDM|300.00|99|0.00|OP THERAPY SERVICES|
20|FH_F124234_33410_0|SrvcGrp|46903|2022|PDM|1200.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F124676_45503_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128360_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F128613_68111_0|SrvcGrp|89149|2022|PDM|196.00|99|0.00|OP INTENSIVE|
20|FH_F63185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F71443_0_0|SrvcGrp|24290|2022|PDM|12.00|99|0.00|HOME HEALTH THERAPY VISITS|
20|FH_F137248_0_0|SrvcGrp|83236|2022|PDM|4058.00|99|0.00|AETNA ANKLE REPAIR|
20|FH_F114726_45213_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|2374.00|99|0.00|AEG 4 (NO REV)|
20|FH_F137933_0_0|SrvcGrp|113158|2022|PDM|3500.00|99|0.00|KIDNEY ENDOSCOPY & BIOPSY|
20|FH_F148553_85016_0|SrvcGrp|115456|2022|PDM|1301.00|99|0.00|REMOVE PULSE GENERATOR|
20|FH_F127448_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F42917_0_0|SrvcGrp|30222|2022|PDM|400.00|99|0.00|PSYCH - PARTIAL HOSPITALIZATION|
20|FH_F43412_0_0|SrvcGrp|37265|2022|PDM|200.00|99|0.00|ADULT REHABILITATION HALF DAY|
20|FH_F43447_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.43|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F134746_83318_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134817_30339_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES|
20|FH_F135761_70127_0|SrvcGrp|75419|2022|PDM|1250.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F136823_63048_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136913_68803_0|SrvcGrp|73500|2022|PDM|454.00|99|0.00|AETNA ER LEVEL I|
20|FH_F136914_64081_0|SrvcGrp|13262|2022|PDM|6.25|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F141170_0_0|SrvcGrp|36591|2022|PDM|21999.00|99|0.00|CPT 63685|
20|FH_F39622_0_0|SrvcGrp|6|2022|PCT|0.79|99|0.00|OP SURGERY|
20|FH_F115210_21043_0|SrvcGrp|92821|2022|PDM|3500.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR|
20|FH_F115210_21043_0|SrvcGrp|72121|2022|PDM|3077.00|99|0.00|ARTHOSCOPY|
20|FH_F116339_41064_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116233_33612_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F147299_02072_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F147389_81632_0|SrvcGrp|75419|2022|PDM|1850.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F147586_44124_0|SrvcGrp|34606|2022|PDM|3601.00|99|0.00|CPT 29827|
20|FH_F41463_0_0|SrvcGrp|34357|2022|PDM|93.45|99|0.00|PHYSICAL THERAPY SVCS MOD GP|
20|FH_F42024_0_0|SrvcGrp|14617|2022|PDM|145.00|99|0.00|CLINIC VISIT|
20|FH_F42402_0_0|SrvcGrp|36006|2022|PCT|0.90|99|0.00|SONOGRAM|
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|3750.00|99|0.00|MS DRG 490|
20|FH_F39346_0_0|SrvcGrp|16|2022|PDM|867.00|99|0.00|ACUTE REHABILITATION|
20|FH_F43872_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91331_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F129673_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1322.00|99|0.00|AEG 3 (NO REV)|
20|FH_F82357_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|106% OF ASP DRUGS/IMMUN UPDATE QUARTERLY|
20|FH_F138887_71822_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F83792_0_0|SrvcGrp|73559|2022|PDM|1837.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F114572_0_0|SrvcGrp|36591|2022|PDM|6500.00|99|0.00|CPT 63685|
20|FH_F102063_0_0|SrvcGrp|27969|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE|
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|3689.00|99|0.00|AEG 4 (NO REV)|
20|FH_F151503_30067_0|SrvcGrp|98003|2022|PDM|6186.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F123193_33431_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132054_30339_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132054_30339_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135457_67214_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135462_06795_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F91764_93710_0|SrvcGrp|57383|2022|PDM|26646.00|99|0.00|MS DRG 466-468 ONLY|
20|FH_F100763_24202_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F100880_67735_0|SrvcGrp|89893|2022|PDM|5157.00|99|0.00|SURGICAL CARE|
20|FH_F131520_19144_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131566_60559_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116501_17801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121763_07202_0|SrvcGrp|106251|2022|PCT|6.31|99|0.00|LABORATORY SERVICES|
20|FH_F130774_57401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111363_33169_0|SrvcGrp|82759|2022|PDM|46.00|99|0.00|ASSAY CPK IN BLOOD|
20|FH_F141651_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG VII|
20|FH_F131000_0_0|SrvcGrp|63466|2022|PDM|3608.00|99|0.00|CPT 52005|
20|FH_F132328_0_0|SrvcGrp|45063|2022|PDM|1340.00|99|0.00|CPT 64493  INJECTION CARVE OUT|
20|FH_F105421_0_0|SrvcGrp|73841|2022|PDM|325.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F112092_46845_0|SrvcGrp|90495|2022|PCT|1.00|99|0.00|FLULAVAL VACC 3 YRS & > IM|
20|FH_F112138_80120_0|SrvcGrp|79720|2022|PDM|1566.00|99|0.00|ACUTE REHAB II|
20|FH_F130206_78209_0|SrvcGrp|74668|2022|PDM|180.25|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129240_10028_0|SrvcGrp|29076|2022|PDM|35.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F111204_10023_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F128031_0_0|SrvcGrp|72996|2022|PDM|957.00|99|0.00|AEG 4|
20|FH_F123445_0_0|SrvcGrp|94780|2022|PDM|190.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F54055_70006_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131324_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|AEG 2 (NO REV)|
20|FH_F98161_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|2402.00|99|0.00|AEG 6 (NO REV)|
20|FH_F132810_0_0|SrvcGrp|17013|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F136374_34461_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F136491_08068_0|SrvcGrp|86722|2022|PDM|202.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F136542_02446_0|SrvcGrp|72602|2022|PDM|504.00|99|0.00|ECT|
20|FH_F120418_43015_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120489_63552_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F134007_27101_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134075_78230_0|SrvcGrp|48385|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F134126_11554_0|SrvcGrp|75506|2022|PCT|1.17|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F134147_19342_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F137048_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137231_25550_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F137267_62906_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114979_77979_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F142590_18336_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142667_63017_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142691_30328_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F138548_24090_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138778_90066_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140568_46506_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|GENERAL ACUTE CARE|
20|FH_F151609_17601_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F109884_36117_0|SrvcGrp|89417|2022|PDM|542.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F76144_0_0|SrvcGrp|26278|2022|PDM|2317.30|99|0.00|CPT 29881|
20|FH_F117267_07728_0|SrvcGrp|11259|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F147929_03820_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F147926_19063_0|SrvcGrp|75419|2022|PDM|406.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F117131_45209_0|SrvcGrp|93337|2022|PDM|413.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F117190_84020_0|SrvcGrp|85759|2022|PCT|0.00|99|0.00|DETOXIFICATION|
20|FH_F137930_51546_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F39352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F90613_05001_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
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|CSTM-ALL|CSTM-00|2020|PDM|3080.00|99|0.00|AEG 6 (NO REV)|
20|FH_F146112_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129487_0_0|SrvcGrp|74585|2022|PCT|1.05|99|0.00|AETNA OP IMPLANTS|
20|FH_F135315_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95880_02726_0|SrvcGrp|86323|2022|PDM|82.07|99|0.00|OTORHINOLARYNGOLOGIC SERVICES|
20|FH_F72544_0_0|SrvcGrp|4109|2022|PDM|1685.00|99|0.00|ACUTE PSYCH|
20|FH_F148644_06890_0|SrvcGrp|34606|2022|PDM|8225.00|99|0.00|CPT 29827|
20|FH_F36756_0_0|SrvcGrp|23963|2022|PDM|65.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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_F147992_63452_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117087_0_0|SrvcGrp|107174|2022|PDM|2494.00|99|0.00|REBUILD OUTER EAR CANAL|
20|FH_F43411_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36756_0_0|SrvcGrp|23965|2022|PDM|65.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F112165_0_0|SrvcGrp|73002|2022|PDM|2550.00|99|0.00|AEG 7|
20|FH_F46914_0_0|SrvcGrp|10410|2022|PDM|79.00|99|0.00|SKILLED NURSING CARE|
20|FH_F64940_0_0|SrvcGrp|1168|2022|PDM|38.25|99|0.00|CONTINUOUS HOMECARE|
20|FH_F111403_37167_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F89112_16509_0|SrvcGrp|58974|2022|PDM|4391.00|99|0.00|OP CARDIAC CATH|
20|FH_F133546_61611_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133474_0_0|SrvcGrp|112762|2022|PDM|45.23|99|0.00|INFECTIOUS AGENT ANTIGEN DETECTION|
20|FH_F128097_68801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|1282.00|99|0.00|AEG 8 (NO REV)|
20|FH_F100700_20110_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150121_29072_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91194_33511_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F133268_63703_0|SrvcGrp|109945|2022|PDM|13.20|99|0.00|VACCINE|
20|FH_F97181_33143_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F150902_21713_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117372_07442_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F50372_0_0|SrvcGrp|46585|2022|PDM|190.00|99|0.00|CPT 99204|
20|FH_F146139_37604_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43539_0_0|SrvcGrp|38023|2022|PDM|65.00|99|0.00|SPEECH THERAPY|
20|FH_F73502_0_0|SrvcGrp|12403|2022|PDM|180.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F38394_0_0|SrvcGrp|17083|2022|PDM|1000.80|99|0.00|ASPG X|
20|FH_F69104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PDM|1414.00|99|0.00|ASPG VIII|
20|FH_F72972_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118542_60188_0|SrvcGrp|88620|2022|PDM|115.00|99|0.00|SKILLED NURSING RN|
20|FH_F133268_63703_0|SrvcGrp|109210|2022|PDM|13.20|99|0.00|CCIIV4 VACC ABX FREE IM|
20|FH_F108700_63857_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F141893_65655_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142008_74301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136393_0_0|SrvcGrp|109497|2022|PDM|2000.00|99|0.00|REPOSITION PACING-DEFIB LEA|
20|FH_F91155_16105_0|SrvcGrp|73000|2022|PDM|1823.00|99|0.00|AEG 6|
20|FH_F97182_21502_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.05|99|0.00|ASPG 211|
20|FH_F32530_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40980_0_0|SrvcGrp|12184|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F125255_34769_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F132837_64118_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131982_0_0|SrvcGrp|82222|2022|PDM|143.00|99|0.00|HOSPICE CARE|
20|FH_F92676_15063_0|CSTM-ALL|CSTM-00|2020|PCT|2.81|99|0.00|MON VALLEY NISC 2013|
20|FH_F112905_62088_0|SrvcGrp|81859|2022|PCT|0.81|99|0.00|AETNA CARDIAC CATH|
20|FH_F116988_0_0|SrvcGrp|75481|2022|PDM|599.00|99|0.00|AEG 2|
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|1873.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132224_89119_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F97182_21502_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143194_19973_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F111789_25301_0|SrvcGrp|997|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F132612_0_0|SrvcGrp|51672|2022|PDM|3989.00|99|0.00|MS DRG 286-287 ONLY|
20|FH_F132737_0_0|SrvcGrp|112077|2022|PDM|46309.00|99|0.00|CV SURGERY|
20|FH_F39716_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|PDM|195.00|99|0.00|HAPA EPA ASC 29|
20|FH_F126666_44053_0|SrvcGrp|91398|2022|PDM|83.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AJ)|
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|1078.00|99|0.00|AEG 2 (NO REV)|
20|FH_F108700_63857_0|SrvcGrp|93098|2022|PDM|108.00|99|0.00|HOSPICE CARE|
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_F150949_0_0|SrvcGrp|113856|2022|PDM|10000.00|99|0.00|SPINE PROCEDURES|
20|FH_F37035_0_0|SrvcGrp|23585|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F43411_0_0|SrvcGrp|31134|2022|PDM|1980.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F91634_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH|
20|FH_F97541_33021_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F148556_13206_0|SrvcGrp|28536|2022|PCT|0.85|99|0.00|J CODES|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PDM|1082.00|99|0.00|ASPG V|
20|FH_F89112_16509_0|SrvcGrp|43588|2022|PDM|4391.00|99|0.00|CARDIAC CATH|
20|FH_F117132_0_0|SrvcGrp|80618|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBTANCE|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|79.00|99|0.00|HAPA EPA ASC 14|
20|FH_F130563_85122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80855_0_0|SrvcGrp|73002|2022|PDM|1200.00|99|0.00|AEG 7|
20|FH_F41796_0_0|SrvcGrp|109|2022|PDM|475.00|99|0.00|CD - DETOX|
20|FH_F119400_0_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F71268_0_0|SrvcGrp|15559|2022|PDM|3200.00|99|0.00|ACUTE MED & SURG SVCS|
20|FH_F132446_19063_0|SrvcGrp|88621|2022|PDM|76.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133412_84129_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F107120_22560_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137896_0_0|SrvcGrp|107863|2022|PCT|1.00|99|0.00|AETNA IMMUNIZATIONS|
20|FH_F125212_76301_0|SrvcGrp|89337|2022|PDM|694.00|99|0.00|DETOXIFICATION|
20|FH_F41785_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 6 (NO REV)|
20|FH_F114024_0_0|SrvcGrp|75491|2022|PDM|1017.00|99|0.00|AEG 7|
20|FH_F151061_02720_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139441_91324_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F139679_75050_0|SrvcGrp|46903|2022|PDM|770.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F139680_76006_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F139707_84010_0|CSTM-ALL|CSTM-00|2020|PDM|1183.00|99|0.00|AEG 1 (NO REV)|
20|FH_F150765_05001_0|SrvcGrp|46104|2022|PDM|161.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F150881_52722_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F127886_62930_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35454_0_0|SrvcGrp|16858|2022|PDM|8.00|99|0.00|MONO TEST|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|176.63|99|0.00|ASPG 117|
20|FH_F118196_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133028_08021_0|SrvcGrp|103385|2022|PDM|35.64|99|0.00|MED NUTRITION, INDIV, INIT (HCFA)|
20|FH_F141987_02859_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F44607_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F57834_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F104180_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F82813_0_0|SrvcGrp|72998|2022|PDM|1044.00|99|0.00|AEG 5|
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130606_41144_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150905_01608_0|SrvcGrp|115862|2022|PDM|18.78|99|0.00|FAMILY TRAINING & COUNSELING (MOD EP) (0-21 YRS)|
20|FH_F133118_33143_0|SrvcGrp|89337|2022|PDM|886.00|99|0.00|DETOXIFICATION|
20|FH_F124608_0_0|SrvcGrp|92412|2022|PDM|6452.00|99|0.00|SPINAL CRD DECOMP->2 CERVIC|
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|1074.36|99|0.00|AEG 8 (NO REV)|
20|FH_F83031_0_0|SrvcGrp|43268|2022|PDM|120.00|99|0.00|PICC LINE CATH CARE|
20|FH_F148881_33018_0|SrvcGrp|105022|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY EVALUATION (HCFA)|
20|FH_F133019_23236_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117945_78957_0|SrvcGrp|107483|2022|PCT|1.10|99|0.00|OP THERAPY SERVICE|
20|FH_F49354_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F38016_0_0|SrvcGrp|43|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F144851_60123_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37886_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD NU|
20|FH_F88280_0_0|SrvcGrp|74543|2022|PCT|1.75|99|0.00|MRI/CT SCAN|
20|FH_F143030_02895_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F128648_44256_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149781_37404_0|SrvcGrp|12491|2022|PCT|0.40|99|0.00|PACEMAKER|
20|FH_F111520_81601_0|SrvcGrp|104336|2022|PCT|1.00|99|0.00|DENOSUMAB INJECTION|
20|FH_F40267_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|C CODE IMPLANTS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1157.41|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1406 W/O REV|
20|FH_F44724_0_0|SrvcGrp|33164|2022|PDM|260.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F139377_02301_0|SrvcGrp|73841|2022|PDM|190.07|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F139441_91324_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F139707_84010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117581_21211_0|SrvcGrp|76501|2022|PDM|330.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 4 (NO REV)|
20|FH_F140143_24874_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F99380_90503_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP LABORATORY|
20|FH_F137767_01841_0|SrvcGrp|74443|2022|PDM|475.00|99|0.00|CARDIAC TESTING|
20|FH_F136779_0_0|SrvcGrp|96939|2022|PDM|3463.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F33632_52349_0|SrvcGrp|87995|2022|PDM|173.42|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F128366_32901_0|SrvcGrp|73842|2022|PDM|186.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149662_85015_0|SrvcGrp|92958|2022|PCT|1.05|99|0.00|SLEEP STUDIES|
20|FH_F110824_83221_0|SrvcGrp|2738|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F146859_0_0|SrvcGrp|104096|2022|PDM|3514.00|99|0.00|ANKLE ARTHROSCOPY/SURGERY|
20|FH_F98360_11554_0|SrvcGrp|73559|2022|PDM|9640.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F89851_83854_0|SrvcGrp|31916|2022|PDM|19084.00|99|0.00|MS DRG 473 ONLY|
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F37771_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP|
20|FH_F149379_53213_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128753_32501_0|SrvcGrp|83824|2022|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES|
20|FH_F138018_17313_0|SrvcGrp|14947|2022|PDM|12.50|99|0.00|HOME INFUSION|
20|FH_F127553_44321_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F124291_44122_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F129562_38668_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116793_0_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F111038_62960_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97183_25304_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F117762_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F148964_30101_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137788_72632_0|SrvcGrp|79699|2022|PCT|0.90|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F129765_43015_0|SrvcGrp|111385|2022|PCT|1.00|99|0.00|PATHOLOGY|
20|FH_F148667_0_0|SrvcGrp|72121|2022|PDM|2584.00|99|0.00|ARTHOSCOPY|
20|FH_F150926_17404_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36906_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F90223_0_0|SrvcGrp|23683|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F150947_37660_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125656_92868_0|SrvcGrp|86848|2022|PDM|35.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F131371_0_0|SrvcGrp|80139|2022|PDM|31485.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F150944_18052_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98940_70506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F92299_62016_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35217_0_0|SrvcGrp|22102|2022|PDM|1877.00|99|0.00|MS DRG 052-053 W/ REV CODES|
20|FH_F89674_18640_0|SrvcGrp|46424|2022|PDM|68.25|99|0.00|HI TECH SKILLED NURSING SERVICES|
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_F130309_17044_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F149459_06615_0|SrvcGrp|27968|2022|PDM|32.00|99|0.00|SKILLED NURSING LPN|
20|FH_F130331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146266_0_0|SrvcGrp|58993|2022|PDM|7892.00|99|0.00|DISKECTOMY|
20|FH_F138017_73129_0|SrvcGrp|78097|2022|PDM|6196.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F36903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|KEITH RATHBOON PT DME 65%|
20|FH_F76826_0_0|SrvcGrp|74445|2022|PDM|93.00|99|0.00|CARDIAC TESTING|
20|FH_F94643_90501_0|SrvcGrp|24745|2022|PDM|48.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F138018_17313_0|SrvcGrp|22588|2022|PDM|41.10|99|0.00|CHEMOTHERAPY|
20|FH_F93354_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F110969_63084_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146859_0_0|SrvcGrp|108306|2022|PDM|1443.00|99|0.00|AETNA REPAIR ULNA FRACTURE|
20|FH_F150819_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|OP SVCS|
20|FH_F148667_0_0|SrvcGrp|82112|2022|PDM|2856.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F117762_0_0|SrvcGrp|78093|2022|PDM|3120.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F138018_17313_0|SrvcGrp|17006|2022|PDM|105.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS|
20|FH_F149043_72021_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F129966_18017_0|SrvcGrp|86723|2022|PDM|324.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|2081.00|99|0.00|AEG 3 (NO REV)|
20|FH_F134869_08854_0|SrvcGrp|102982|2022|PDM|198.00|99|0.00|PSYTX WPT W E/M 60 MIN|
20|FH_F151619_73505_0|SrvcGrp|75479|2022|PDM|384.00|99|0.00|AEG 1|
20|FH_F138410_19130_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|COVID-19 INFUSION ADMIN - ELI LILLY|
20|FH_F112794_01040_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F114585_11501_0|SrvcGrp|91065|2022|PDM|70.04|99|0.00|PSYCHIATRIC CPT 90853 (HCFA)|
20|FH_F107980_08005_0|SrvcGrp|89149|2022|PDM|150.00|99|0.00|OP INTENSIVE|
20|FH_F91938_70121_0|SrvcGrp|76094|2022|PDM|147.09|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F117714_94301_0|SrvcGrp|89417|2022|PDM|520.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F147214_48162_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138007_24314_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37267_0_0|SrvcGrp|13703|2022|PDM|26.75|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F138018_17313_0|SrvcGrp|24744|2022|PDM|205.00|99|0.00|PICC LINE INSERTION|
20|FH_F36715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CV SURGERY|
20|FH_F117605_85260_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F115269_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F124288_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130581_40356_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39443_0_0|SrvcGrp|30297|2022|PDM|300.00|99|0.00|HAPA WPA ASC 109|
20|FH_F31166_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149273_0_0|SrvcGrp|89404|2022|PDM|6800.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|AEG 4 (NO REV)|
20|FH_F36299_0_0|SrvcGrp|24|2022|PCT|0.80|99|0.00|CARDIAC CATH|
20|FH_F39443_0_0|SrvcGrp|30667|2022|PDM|3125.00|99|0.00|DIAGNOSTIC CARDIAC CATH|
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|741.17|99|0.00|ASPG IX|
20|FH_F111266_30339_0|SrvcGrp|24761|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F130919_33314_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F94643_90501_0|SrvcGrp|86848|2022|PDM|48.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F97521_30824_0|CSTM-ALL|CSTM-00|2020|PDM|427.00|99|0.00|AETNA OP CT SCANS (CTSCAN) - HCFA|
20|FH_F85772_0_0|SrvcGrp|83839|2022|PDM|2991.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 6 (NO REV)|
20|FH_F33650_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F98020_50138_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
20|FH_F97480_08204_0|SrvcGrp|88977|2022|PDM|8696.00|99|0.00|C-SECTION DELIVERY|
20|FH_F128741_92879_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138387_02886_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122377_91007_0|SrvcGrp|73500|2022|PDM|1928.00|99|0.00|AETNA ER LEVEL I|
20|FH_F140167_16101_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140036_07702_0|SrvcGrp|104796|2022|PDM|185.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F143427_30442_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F75803_0_0|SrvcGrp|12290|2022|PDM|801.00|99|0.00|DETOXIFICATION|
20|FH_F101752_0_0|SrvcGrp|88977|2022|PDM|6401.00|99|0.00|C-SECTION DELIVERY|
20|FH_F103060_0_0|SrvcGrp|78096|2022|PDM|3121.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F47952_0_0|SrvcGrp|36066|2022|PDM|27.50|99|0.00|NURSING CARE|
20|FH_F132353_66423_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132418_84042_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F32141_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116698_07470_0|SrvcGrp|86825|2022|PDM|78.75|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F119993_71913_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F126435_77459_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F84394_17402_0|SrvcGrp|114120|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F51276_0_0|SrvcGrp|26867|2022|PDM|80.00|99|0.00|ANTI-EMETICS INFUSION THERAPY|
20|FH_F98622_45005_0|SrvcGrp|73605|2022|PDM|2103.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F98622_45005_0|SrvcGrp|73485|2022|PDM|3135.00|99|0.00|AETNA REHAB|
20|FH_F131208_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F143467_0_0|SrvcGrp|85778|2022|PDM|4200.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F49954_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING|
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)|
20|FH_F49338_0_0|SrvcGrp|36809|2022|PCT|1.00|99|0.00|OCN F/S PRICING:POS FACILITY  GLOBAL (DME)|
20|FH_F34253_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125138_63663_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F148222_18603_0|SrvcGrp|27968|2022|PDM|51.00|99|0.00|SKILLED NURSING LPN|
20|FH_F38151_0_0|SrvcGrp|28280|2022|PCT|0.85|99|0.00|ANGIOPLASTY|
20|FH_F130207_33458_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F114511_0_0|SrvcGrp|46903|2022|PDM|624.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F56293_0_0|SrvcGrp|52843|2022|PDM|500.00|99|0.00|GI PROCEDURE GROUP B|
20|FH_F121084_13114_0|SrvcGrp|89149|2022|PDM|150.00|99|0.00|OP INTENSIVE|
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_F123372_0_0|SrvcGrp|16|2022|PDM|1711.00|99|0.00|ACUTE REHABILITATION|
20|FH_F38798_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F128012_64628_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F108762_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F88254_33411_0|SrvcGrp|24745|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F139515_0_0|SrvcGrp|34606|2022|PDM|3200.00|99|0.00|CPT 29827|
20|FH_F115075_77833_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F33712_0_0|SrvcGrp|13065|2022|PCT|0.75|99|0.00|EMERGENCY ROOM|
20|FH_F120296_97223_0|SrvcGrp|85017|2022|PCT|0.70|99|0.00|DME|
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F72183_0_0|SrvcGrp|3208|2022|PDM|600.00|99|0.00|SUBACUTE CARE|
20|FH_F110002_16901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F110925_01104_0|SrvcGrp|86132|2022|PDM|1.00|99|0.00|FACTOR IX NON RECOMBINANT|
20|FH_F102020_0_0|SrvcGrp|9832|2022|PDM|143.00|99|0.00|ST SVCS|
20|FH_F105221_01757_0|SrvcGrp|46424|2022|PDM|84.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F90818_0_0|SrvcGrp|79589|2022|PDM|3600.00|99|0.00|UPPER GI|
20|FH_F77504_0_0|SrvcGrp|7|2022|PDM|1275.00|99|0.00|NEONATAL INTENSIVE|
20|FH_F141801_80534_0|SrvcGrp|73842|2022|PDM|275.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F33782_0_0|SrvcGrp|14110|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F62750_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F95021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134999_89106_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F82235_0_0|SrvcGrp|73004|2022|PDM|1070.30|99|0.00|AEG 8|
20|FH_F66687_0_0|SrvcGrp|21108|2022|PDM|44886.00|99|0.00|MS DRG 243 ONLY|
20|FH_F93949_02720_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F125028_19061_0|SrvcGrp|17015|2022|PDM|15.75|99|0.00|HOME INFUSION THERAPY|
20|FH_F150982_0_0|SrvcGrp|77021|2022|PDM|5726.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F93332_0_0|SrvcGrp|74039|2022|PDM|6695.00|99|0.00|LAMINECTOMY|
20|FH_F70984_0_0|SrvcGrp|26281|2022|PDM|2200.00|99|0.00|CPT 58353|
20|FH_F124048_47304_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F126242_32796_0|SrvcGrp|3178|2022|PDM|928.00|99|0.00|ACUTE PSYCH|
20|FH_F40499_0_0|SrvcGrp|471|2022|PDM|540.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F86319_16365_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F143902_41018_0|SrvcGrp|75419|2022|PDM|414.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148440_16506_0|CSTM-ALL|CSTM-00|2020|PDM|977.00|99|0.00|AEG 5  (NO REV)|
20|FH_F100660_56303_0|SrvcGrp|73559|2022|PDM|6799.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)|
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|1173.00|99|0.00|AEG 5  (NO REV)|
20|FH_F124783_92408_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|2060.45|99|0.00|ASPG VIII|
20|FH_F40066_0_0|SrvcGrp|701|2022|PDM|2070.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F72183_0_0|SrvcGrp|69580|2022|PDM|1300.00|99|0.00|TELEMETRY|
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F82696_16335_0|SrvcGrp|82319|2022|PDM|383.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F123488_65559_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129968_98004_0|SrvcGrp|108484|2022|PDM|1668.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F143820_28405_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F130487_98004_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F73013_0_0|SrvcGrp|42974|2022|PDM|182.86|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F125011_74467_0|SrvcGrp|110029|2022|PDM|6000.00|99|0.00|INTERSTIM NEURO ELECTRODE IMPLANTATION|
20|FH_F82173_72712_0|SrvcGrp|9494|2022|PDM|1893.00|99|0.00|SUBACUTE CARE|
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_F145542_70503_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F51520_0_0|SrvcGrp|45783|2022|PDM|145.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2408.00|99|0.00|AEG 7 (NO REV)|
20|FH_F127877_43560_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|6300.00|99|0.00|AEG 3 (NO REV)|
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97540_32114_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS|
20|FH_F142073_0_0|SrvcGrp|77021|2022|PDM|5980.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F109246_10018_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F135077_60014_0|SrvcGrp|81779|2022|PCT|1.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F135178_84049_0|SrvcGrp|75419|2022|PDM|880.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F114976_78539_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116955_16801_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F63432_0_0|SrvcGrp|71779|2022|PDM|563.00|99|0.00|SLEEP STUDY (95800-95801, 95806, G0398-G0399)|
20|FH_F148320_02130_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F55212_0_0|SrvcGrp|52006|2022|PDM|457.00|99|0.00|INITIAL HOSPITAL II|
20|FH_F51359_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F114064_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F46832_0_0|SrvcGrp|14945|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F130721_04769_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AETNA OP CT SCANS (CTSCAN) - HCFA|
20|FH_F130721_04769_0|SrvcGrp|72984|2022|PCT|0.89|99|0.00|CHEMOTHERAPY|
20|FH_F130911_06001_0|SrvcGrp|472|2022|PDM|578.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F98002_27103_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F113325_80004_0|SrvcGrp|75545|2022|PDM|309.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F114683_0_0|SrvcGrp|72994|2022|PDM|1168.00|99|0.00|AEG 3|
20|FH_F145558_43950_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F112023_12866_0|SrvcGrp|82037|2022|PDM|4542.00|99|0.00|AETNA ICU|
20|FH_F126555_44906_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F143578_63033_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F142376_0_0|SrvcGrp|68048|2022|PDM|6977.00|99|0.00|CPT 64581|
20|FH_F145604_14850_0|SrvcGrp|86837|2022|PDM|25.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F121597_30315_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F121628_19533_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F85340_98195_0|CSTM-ALL|CSTM-00|2020|PCT|2.18|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F115430_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F121225_98902_0|SrvcGrp|29898|2022|PDM|201.60|99|0.00|RN VISIT|
20|FH_F39586_0_0|SrvcGrp|3810|2022|PDM|135.31|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F110642_17901_0|SrvcGrp|471|2022|PDM|367.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F70208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1807.00|99|0.00|ASPG IX|
20|FH_F134604_64050_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|1492.00|99|0.00|AEG 3 (NO REV)|
20|FH_F100782_0_0|SrvcGrp|97510|2022|PDM|1112.46|99|0.00|WINDBER MEDICAL CNTR ASC 3|
20|FH_F96780_0_0|SrvcGrp|46906|2022|PDM|1786.00|99|0.00|CORNEAL TISSUE|
20|FH_F147987_65674_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F112650_85016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F133805_83401_0|SrvcGrp|83857|2022|PDM|660.00|99|0.00|IP HOSPICE SVCS|
20|FH_F110453_0_0|SrvcGrp|72994|2022|PDM|548.00|99|0.00|AEG 3|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|488.27|99|0.00|HAPA WPA-NWPA 2012-13 ASC 110 W/O REV|
20|FH_F81852_0_0|CSTM-ALL|CSTM-00|2020|PDM|953.00|99|0.00|ASPG V|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|1652.00|99|0.00|ASPG VI|
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|2142.00|99|0.00|ASPG IX|
20|FH_F133749_84604_0|SrvcGrp|112428|2022|PDM|25.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F133950_06029_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127589_45459_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126354_91321_0|SrvcGrp|108061|2022|PCT|1.10|99|0.00|OP THERAPY SERVICES|
20|FH_F111732_33771_0|SrvcGrp|104470|2022|PDM|1400.00|99|0.00|ANTEPARTUM CARE ONLY (7 OR MORE VISITS)|
20|FH_F120123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F144808_0_0|SrvcGrp|89404|2022|PDM|7215.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F85353_16407_0|SrvcGrp|63770|2022|PDM|1625.13|99|0.00|HAPA WPA-NWPA 2012-13 ASC 908|
20|FH_F132822_95125_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
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_F113041_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|OP SVCS|
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|2861.00|99|0.00|AEG 8 (NO REV)|
20|FH_F90334_23323_0|SrvcGrp|76501|2022|PDM|278.25|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F133880_06488_0|SrvcGrp|75545|2022|PDM|340.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F146039_89511_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F37910_0_0|SrvcGrp|13368|2022|PCT|0.85|99|0.00|OP SURGERY|
20|FH_F134593_60007_0|SrvcGrp|86827|2022|PDM|65.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F148186_0_0|SrvcGrp|13262|2022|PDM|6.00|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F127616_17403_0|SrvcGrp|471|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146103_63851_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F70208_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F143067_0_0|SrvcGrp|111388|2022|PDM|279.00|99|0.00|ACUTE KIDNEY INJURY - IPD/CAPD/CCPD - NO ESRD|
20|FH_F134365_60084_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F148644_06890_0|CSTM-ALL|CSTM-00|2020|PDM|2012.00|99|0.00|AEG 6 (NO REV)|
20|FH_F148643_71343_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112082_30720_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111731_47802_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F81698_10457_0|SrvcGrp|24745|2022|PDM|31.50|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|2804.00|99|0.00|AEG 5  (NO REV)|
20|FH_F31595_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|NORMAL DELIVERY|
20|FH_F121225_98902_0|SrvcGrp|29347|2022|PDM|103.95|99|0.00|HOME HEALTH AIDE|
20|FH_F111986_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PDM|573.00|99|0.00|ASPG III|
20|FH_F117300_0_0|SrvcGrp|89840|2022|PDM|7853.00|99|0.00|THORAX SPINE FUSION|
20|FH_F100782_0_0|SrvcGrp|97508|2022|PDM|806.77|99|0.00|WINDBER MEDICAL CNTR ASC 1|
20|FH_F120709_64116_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F61072_0_0|SrvcGrp|42830|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F119783_46360_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F41660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|HOSPICE SVCS|
20|FH_F125513_40071_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F112827_26452_0|SrvcGrp|27969|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F137567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F135610_06451_0|SrvcGrp|88620|2022|PDM|94.42|99|0.00|SKILLED NURSING RN|
20|FH_F130763_0_0|SrvcGrp|100920|2022|PDM|6239.00|99|0.00|SPINE PRO DEVICE|
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)|
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 2 (NO REV)|
20|FH_F146117_0_0|SrvcGrp|99163|2022|PDM|2804.00|99|0.00|CPT 27703|
20|FH_F130017_02302_0|SrvcGrp|16069|2022|PDM|832.91|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F110311_17078_0|SrvcGrp|91683|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F150307_84111_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F85652_98034_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F36552_0_0|SrvcGrp|18889|2022|PDM|20890.00|99|0.00|MS DRG 235|
20|FH_F138507_62208_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133972_27103_0|SrvcGrp|86838|2022|PDM|30.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F150144_39452_0|SrvcGrp|108484|2022|PDM|670.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F148923_71854_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F69606_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HAPA OHIO 2014 NISC 100%|
20|FH_F134492_85201_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F122564_53809_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F84912_0_0|SrvcGrp|83177|2022|PDM|1800.00|99|0.00|DME|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|104.69|99|0.00|HAPA WPA-NWPA 2012-13 ASC 240 W/O REV|
20|FH_F70684_0_0|SrvcGrp|46642|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- ALL|
20|FH_F102200_06416_0|SrvcGrp|17013|2022|PDM|55.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F105145_75075_0|SrvcGrp|10107|2022|PCT|1.15|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F115903_43560_0|SrvcGrp|108484|2022|PDM|1038.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F75842_0_0|SrvcGrp|13768|2022|PDM|3676.42|99|0.00|NICU|
20|FH_F115972_92675_0|SrvcGrp|89149|2022|PDM|330.00|99|0.00|OP INTENSIVE|
20|FH_F116055_59804_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F133047_74012_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F131702_17022_0|SrvcGrp|73742|2022|PCT|1.05|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F115990_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F113744_80301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F86911_0_0|SrvcGrp|85617|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F86911_0_0|SrvcGrp|43262|2022|PDM|3.60|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 5  (NO REV)|
20|FH_F116043_0_0|SrvcGrp|29353|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F114916_30309_0|SrvcGrp|41334|2022|PDM|16500.00|99|0.00|TOTAL KNEE|
20|FH_F142321_29401_0|SrvcGrp|74668|2022|PDM|256.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F112163_0_0|SrvcGrp|104746|2022|PDM|608.00|99|0.00|HOSPICE R & B NURSING FACIL|
20|FH_F112967_0_0|SrvcGrp|47411|2022|PDM|115.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F105362_44601_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F105440_46383_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F105581_19053_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132627_0_0|SrvcGrp|65621|2022|PDM|66.30|99|0.00|RN NURSING|
20|FH_F62252_0_0|SrvcGrp|474|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F124180_0_0|SrvcGrp|47544|2022|PDM|2500.00|99|0.00|PERCUTANEOUS IMPLANT OF NEUROSTIMULATOR ELECTRODES|
20|FH_F124081_64154_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146807_28655_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F146921_43050_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F91998_0_0|SrvcGrp|73004|2022|PDM|1054.00|99|0.00|AEG 8|
20|FH_F93232_0_0|SrvcGrp|474|2022|PDM|235.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F100703_0_0|SrvcGrp|19921|2022|PDM|4726.00|99|0.00|ARTHROSCOPICALLY LIGAMENT REPAIR|
20|FH_F132864_71101_0|SrvcGrp|104363|2022|PCT|2.15|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F124618_32340_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F127995_84010_0|SrvcGrp|86828|2022|PDM|10.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F67888_0_0|SrvcGrp|22954|2022|PDM|138.78|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F98042_10468_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F136568_92562_0|SrvcGrp|89417|2022|PDM|525.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F114629_19131_0|SrvcGrp|110812|2022|PDM|292.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F114726_45213_0|SrvcGrp|73841|2022|PDM|300.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F113937_15301_0|SrvcGrp|48396|2022|PDM|91.00|99|0.00|OT SERVICES|
20|FH_F138630_72616_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148424_01440_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F134735_91362_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136913_68803_0|SrvcGrp|73496|2022|PDM|5202.00|99|0.00|AETNA ER LEVEL V|
20|FH_F136914_64081_0|SrvcGrp|106291|2022|PDM|325.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F136914_64081_0|SrvcGrp|100961|2022|PDM|456.75|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY|
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|AEG 3 (NO REV)|
20|FH_F38826_0_0|SrvcGrp|17365|2022|PDM|5125.00|99|0.00|AIR AMBULANCE SVCS|
20|FH_F116393_07002_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F147519_52627_0|SrvcGrp|115057|2022|PCT|2.76|99|0.00|LABORATORY SERVICES|
20|FH_F147563_60160_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F41832_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F42153_0_0|CSTM-ALL|CSTM-00|2020|PDM|3195.00|99|0.00|NICU LEVEL V|
20|FH_F134828_30531_0|SrvcGrp|113097|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME) (HCFA)|
20|FH_F34477_0_0|SrvcGrp|63741|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F113246_72687_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120657_54220_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F37257_0_0|SrvcGrp|13123|2022|PDM|450.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F37850_0_0|SrvcGrp|701|2022|PDM|2163.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F140987_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F39633_0_0|SrvcGrp|17065|2022|PDM|619.00|99|0.00|ASPG I|
20|FH_F113585_20155_0|SrvcGrp|17014|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F113585_20155_0|SrvcGrp|17015|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138634_33125_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F138807_32207_0|SrvcGrp|46605|2022|PDM|137.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F138936_01040_0|SrvcGrp|112223|2022|PCT|1.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F138973_45036_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F57953_0_0|SrvcGrp|31186|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC (DME)|
20|FH_F113390_0_0|SrvcGrp|88823|2022|PDM|2200.00|99|0.00|REPAIR OF EARDRUM|
20|FH_F113390_0_0|SrvcGrp|78093|2022|PDM|1673.10|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 2 (NO REV)|
20|FH_F151420_60654_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F135470_83201_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136127_15658_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129456_30809_0|SrvcGrp|113850|2022|PCT|1.00|99|0.00|INFECTIOUS ANTIGEN DETECTION DNA AMPLI|
20|FH_F130557_66012_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116461_77536_0|SrvcGrp|73842|2022|PDM|192.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F116464_13088_0|SrvcGrp|90017|2022|PDM|83.00|99|0.00|AETNA PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F116527_70443_0|SrvcGrp|73000|2022|PDM|1400.00|99|0.00|AEG 6|
20|FH_F131361_18235_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F127399_0_0|SrvcGrp|97896|2022|PDM|14045.00|99|0.00|TREAT KNEE|
20|FH_F127399_0_0|SrvcGrp|90357|2022|PDM|2913.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F33685_0_0|SrvcGrp|115|2022|PDM|522.00|99|0.00|SKILLED NURSING CARE|
20|FH_F42347_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F65959_0_0|SrvcGrp|12889|2022|PCT|1.20|99|0.00|RADIOLOGY|
20|FH_F134322_98001_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F33081_0_0|CSTM-ALL|CSTM-00|2020|PDM|5000.00|99|0.00|OP SVCS|
20|FH_F140340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54272_0_0|SrvcGrp|31213|2022|PCT|0.45|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F132328_0_0|SrvcGrp|88163|2022|PDM|14566.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F132328_0_0|SrvcGrp|65403|2022|PDM|3612.00|99|0.00|CPT 42830|
20|FH_F72666_0_0|SrvcGrp|16|2022|PDM|1122.00|99|0.00|ACUTE REHABILITATION|
20|FH_F118651_0_0|SrvcGrp|104554|2022|PCT|0.00|99|0.00|RELEASE OF URETER|
20|FH_F112152_34994_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F98626_29118_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F102325_62691_0|SrvcGrp|43569|2022|PDM|60.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F98300_30236_0|SrvcGrp|89317|2022|PDM|1329.00|99|0.00|AETNA SLEEP STUDIES|
20|FH_F132090_60915_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F132347_01605_0|SrvcGrp|93099|2022|PDM|450.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY|
20|FH_F132347_01605_0|SrvcGrp|93100|2022|PDM|110.00|99|0.00|RESPITE CARE|
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 10 (NO REV)|
20|FH_F31884_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48772_66044_0|SrvcGrp|105581|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F95101_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F132810_0_0|SrvcGrp|86841|2022|PDM|150.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F126770_43050_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F63316_0_0|SrvcGrp|1168|2022|PDM|41.46|99|0.00|CONTINUOUS HOMECARE|
20|FH_F90314_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F115166_0_0|SrvcGrp|73842|2022|PDM|165.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F118170_18901_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120456_67117_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F93177_73044_0|SrvcGrp|79699|2022|PCT|0.80|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F93363_63123_0|SrvcGrp|93147|2022|PDM|78.00|99|0.00|DIABETIC MANAGEMENT PROGRAM (HCFA)|
20|FH_F137235_66061_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F137241_07481_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138961_33430_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F142690_31774_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_F138584_30912_0|SrvcGrp|113391|2022|PDM|1100.00|99|0.00|MANDIBULAR FRACTURE TREATMENT|
20|FH_F139456_47501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F140343_89052_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F140633_17901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F140727_16046_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140756_63141_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140837_34947_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140868_63103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122067_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149604_08505_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149663_45219_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F151603_27609_0|SrvcGrp|36591|2022|PDM|9039.98|99|0.00|CPT 63685|
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|42216.00|99|0.00|MS DRG 230|
20|FH_F109884_36117_0|SrvcGrp|73841|2022|PDM|542.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F101161_0_0|SrvcGrp|15325|2022|PDM|700.00|99|0.00|ER LEVEL III|
20|FH_F37878_0_0|SrvcGrp|104433|2022|PDM|100.00|99|0.00|HIGH TECH SPECIALITY NURSE (MOD TG)|
20|FH_F112526_0_0|SrvcGrp|93098|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F91472_96001_0|SrvcGrp|111615|2022|PCT|0.40|99|0.00|TOTAL KNEE REPLACEMENT|
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109513_0_0|SrvcGrp|90418|2022|PDM|2800.00|99|0.00|ENLARGE BREAST WITH IMPLANT|
20|FH_F119538_60959_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140035_0_0|SrvcGrp|26001|2022|PDM|249.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F148548_37909_0|SrvcGrp|108267|2022|PCT|0.00|99|0.00|AETNA IMAGING|
20|FH_F35411_0_0|SrvcGrp|8968|2022|PDM|2512.00|99|0.00|NICU LEVEL III & IV|
20|FH_F45435_0_0|SrvcGrp|17766|2022|PDM|90.00|99|0.00|HOME HEALTH - PT/OT/ST|
20|FH_F130553_18640_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F98600_91730_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F151518_60506_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F121016_32607_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123545_44512_0|SrvcGrp|48168|2022|PDM|280.00|99|0.00|HEMODIALYSIS|
20|FH_F126858_43113_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F125352_90034_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142769_21204_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148886_60621_0|SrvcGrp|112224|2022|PCT|1.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F42352_0_0|SrvcGrp|3069|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F97882_32407_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F118819_76226_0|SrvcGrp|46903|2022|PDM|796.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F48892_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS|
20|FH_F101840_76054_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F144109_63376_0|SrvcGrp|13597|2022|PCT|1.76|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F129812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F149999_33150_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97541_33021_0|SrvcGrp|73643|2022|PDM|983.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F35453_0_0|SrvcGrp|72|2022|PDM|403.00|99|0.00|NEWBORN NURSERY|
20|FH_F142847_07003_0|SrvcGrp|111928|2022|PCT|1.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F51438_0_0|SrvcGrp|13692|2022|PDM|2905.00|99|0.00|OP CARDIAC CATH|
20|FH_F111806_33020_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132127_61053_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38700_0_0|SrvcGrp|18145|2022|PCT|0.80|99|0.00|MS DRG 248|
20|FH_F132118_92240_0|SrvcGrp|86722|2022|PDM|259.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F109625_27330_0|SrvcGrp|78800|2022|PCT|0.00|99|0.00|VENIPUNCTURE|
20|FH_F94300_0_0|SrvcGrp|80617|2022|PDM|4200.00|99|0.00|ARTHOPLASTY|
20|FH_F54552_0_0|SrvcGrp|22387|2022|PDM|150.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F92833_0_0|SrvcGrp|11673|2022|PDM|2215.00|99|0.00|CPT 29888|
20|FH_F150062_92501_0|SrvcGrp|46903|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.00|99|0.00|AEG 3 (NO REV)|
20|FH_F133403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42159_0_0|SrvcGrp|12146|2022|PDM|1400.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F92677_08003_0|SrvcGrp|38247|2022|PDM|408.45|99|0.00|SLEEP STUDIES|
20|FH_F150908_38570_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F127181_64155_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133287_40215_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F78205_0_0|SrvcGrp|17077|2022|PDM|2914.21|99|0.00|ASPG VII|
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1929.00|99|0.00|AEG 6 (NO REV)|
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|1415.00|99|0.00|ASPG VII|
20|FH_F72859_0_0|SrvcGrp|10644|2022|PDM|107.00|99|0.00|MIDLINE INSERTION NURSING|
20|FH_F44016_0_0|SrvcGrp|63|2022|PDM|972.00|99|0.00|SUBACUTE CARE|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD AU"|
20|FH_F118819_76226_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|INTRAOCULAR LENS|
20|FH_F55113_0_0|SrvcGrp|3069|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F117555_72802_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F117855_62246_0|SrvcGrp|27968|2022|PDM|28.00|99|0.00|SKILLED NURSING LPN|
20|FH_F68040_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F31446_0_0|SrvcGrp|212|2022|PDM|295.00|99|0.00|CD (ADULT) - DAY TREATMENT|
20|FH_F144628_21146_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F32281_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126812_44137_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137638_0_0|SrvcGrp|73841|2022|PDM|484.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F34739_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35411_0_0|SrvcGrp|9911|2022|PDM|4928.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F44016_0_0|SrvcGrp|10419|2022|PDM|972.00|99|0.00|SKILLED NURSING CARE|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD UE KE"|
20|FH_F45977_0_0|SrvcGrp|11113|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME|
20|FH_F112905_62088_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37573_0_0|CSTM-ALL|CSTM-00|2020|PDM|1223.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F120437_85202_0|SrvcGrp|48396|2022|PDM|182.34|99|0.00|OT SERVICES|
20|FH_F42935_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F134467_84321_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F100700_20110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|78971|2022|PDM|1590.84|99|0.00|MON VALLEY ASC 301|
20|FH_F97543_33542_0|SrvcGrp|73643|2022|PDM|2408.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F113326_80014_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F150020_70601_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143057_15767_0|SrvcGrp|98040|2022|PDM|28.61|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F133493_90255_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F103106_04101_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F151059_60435_0|SrvcGrp|29346|2022|PDM|50.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F151063_44094_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F121385_89102_0|CSTM-ALL|CSTM-00|2020|PDM|3386.00|99|0.00|AEG 3 (NO REV)|
20|FH_F139597_07009_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139676_76901_0|SrvcGrp|86723|2022|PDM|250.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F150700_90028_0|SrvcGrp|74668|2022|PDM|375.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F150769_02302_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F93381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97300_47501_0|SrvcGrp|82369|2022|PCT|2.50|99|0.00|AETNA LABORATORY|
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.21|99|0.00|AEG 5  (NO REV)|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PDM|991.00|99|0.00|ASPG VI|
20|FH_F134916_16421_0|SrvcGrp|13597|2022|PDM|204.87|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F147176_17701_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134847_0_0|SrvcGrp|88493|2022|PDM|6110.00|99|0.00|AETNA VERTEBROPLASTY ADDL INJECT|
20|FH_F139247_77657_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F143668_0_0|SrvcGrp|115713|2022|PDM|262.50|99|0.00|SEGMENTAL PNEUMATIC CHEST (MOD UE)|
20|FH_F98880_50158_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F39443_0_0|SrvcGrp|30339|2022|PDM|134.00|99|0.00|HAPA WPA ASC 223|
20|FH_F119008_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F149641_87113_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148961_33403_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F114848_50533_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F137772_27320_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140608_0_0|SrvcGrp|46605|2022|PDM|134.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F127418_0_0|SrvcGrp|89861|2022|PDM|5487.89|99|0.00|LUMBAR LAMINOTOMY|
20|FH_F39443_0_0|SrvcGrp|30358|2022|PDM|538.00|99|0.00|HAPA WPA ASC 403|
20|FH_F124695_33401_0|SrvcGrp|113928|2022|PDM|488.00|99|0.00|PARTIAL HOSPITAL (>=18 YRS)|
20|FH_F133519_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|ASPG 5 PIEDMONT OUTPATIENT SURGERY CENTER|
20|FH_F138478_0_0|SrvcGrp|107792|2022|PDM|5622.94|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F110783_93013_0|SrvcGrp|10577|2022|PDM|35.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F40885_0_0|SrvcGrp|22921|2022|PDM|850.00|99|0.00|CPT 95808 MOD TC|
20|FH_F137627_78382_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|4008.00|99|0.00|AEG 8 (NO REV)|
20|FH_F101861_19567_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F102365_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150981_33140_0|SrvcGrp|82981|2022|PDM|135.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F120157_93103_0|SrvcGrp|54142|2022|PDM|275.00|99|0.00|OP INTENSIVE SERVICES|
20|FH_F132160_0_0|SrvcGrp|42551|2022|PDM|1721.00|99|0.00|OP SURGERY|
20|FH_F142826_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F73643_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124433_77338_0|SrvcGrp|86723|2022|PDM|435.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)|
20|FH_F149459_06615_0|SrvcGrp|48398|2022|PDM|121.00|99|0.00|PT SERVICES|
20|FH_F116373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD KN"|
20|FH_F40590_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.00|99|0.00|HEAD INJURY REHAB|
20|FH_F147422_84121_0|SrvcGrp|89337|2022|PDM|872.00|99|0.00|DETOXIFICATION|
20|FH_F98900_42001_0|SrvcGrp|73559|2022|PDM|6576.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F114207_35243_0|SrvcGrp|13929|2022|PDM|15.00|99|0.00|GROWTH HORMONE|
20|FH_F39772_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (PROFESSIONAL) (HCFA)|
20|FH_F46433_0_0|SrvcGrp|17007|2022|PDM|85.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS|
20|FH_F98860_96706_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137789_48146_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F97100_23462_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F111857_68005_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC|
20|FH_F67419_0_0|SrvcGrp|47183|2022|PDM|80.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F127324_0_0|SrvcGrp|12664|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F75243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148860_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127886_62930_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35745_33952_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F33255_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F137728_47203_0|SrvcGrp|112868|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F47819_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151010_85007_0|SrvcGrp|74668|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F107840_07006_0|SrvcGrp|73842|2022|PDM|165.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F98880_50158_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F131571_63301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111723_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F39772_0_0|SrvcGrp|36989|2022|PDM|2015.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F36634_0_0|SrvcGrp|361|2022|PDM|1352.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F97260_06111_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F147375_32503_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136779_0_0|SrvcGrp|112921|2022|PDM|2218.00|99|0.00|SHOULDER ANDOSCOPY PROCEDURES|
20|FH_F120104_97223_0|SrvcGrp|100859|2022|PDM|225.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F117615_30525_0|SrvcGrp|82981|2022|PDM|169.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F98280_31015_0|SrvcGrp|75545|2022|PDM|412.50|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F149273_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34786_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124727_0_0|SrvcGrp|108081|2022|PDM|182.14|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F39443_0_0|SrvcGrp|30352|2022|PDM|140.00|99|0.00|HAPA WPA ASC 308|
20|FH_F143347_16001_0|CSTM-ALL|CSTM-00|2020|PDM|3506.00|99|0.00|AEG 6 (NO REV)|
20|FH_F143536_47546_0|SrvcGrp|100239|2022|PCT|0.00|99|0.00|GLUCOSE|
20|FH_F143536_47546_0|SrvcGrp|100256|2022|PCT|1.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (2.6 - 5.0 CM)|
20|FH_F75305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F84631_0_0|SrvcGrp|9916|2022|PCT|0.83|99|0.00|OBSERVATION SVCS|
20|FH_F95800_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F101806_0_0|SrvcGrp|75495|2022|PDM|1481.20|99|0.00|AEG 9|
20|FH_F103060_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115208_0_0|SrvcGrp|64732|2022|PDM|716.00|99|0.00|CPT 43239|
20|FH_F47812_0_0|SrvcGrp|42871|2022|PDM|40.12|99|0.00|SPEECH THERAPY VISIT|
20|FH_F48224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132467_33825_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116552_70001_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F116698_07470_0|SrvcGrp|86852|2022|PDM|39.90|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F116756_77477_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F116915_30308_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F83292_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|OP SVCS|
20|FH_F118792_63379_0|SrvcGrp|73806|2022|PCT|0.74|99|0.00|AETNA ER|
20|FH_F118815_61021_0|SrvcGrp|86722|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130152_48025_0|SrvcGrp|57965|2022|PCT|1.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F43007_0_0|SrvcGrp|170|2022|PDM|267.00|99|0.00|CD (ADOLESCENT) - REHAB|
20|FH_F48133_0_0|SrvcGrp|42870|2022|PDM|40.12|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|901.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F130038_08021_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F83451_0_0|SrvcGrp|81562|2022|PDM|1500.00|99|0.00|STEREOTACTIC COMPUTER|
20|FH_F82931_18847_0|SrvcGrp|18071|2022|PDM|60.00|99|0.00|AMBULANCE RESPONSE/TREATMENT - NO TRANSPORT|
20|FH_F82197_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139241_0_0|SrvcGrp|77585|2022|PDM|1858.00|99|0.00|CPT 58558 - 58563|
20|FH_F118194_50841_0|SrvcGrp|86851|2022|PDM|145.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F40046_0_0|SrvcGrp|16|2022|PDM|1089.00|99|0.00|ACUTE REHABILITATION|
20|FH_F130317_0_0|SrvcGrp|473|2022|PDM|1872.63|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120672_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|729.00|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_F102302_0_0|SrvcGrp|73006|2022|PDM|1934.00|99|0.00|AEG 9|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|345.43|99|0.00|HAPA WPA-NWPA 2012-13 ASC 105 W/O REV|
20|FH_F39531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F137239_0_0|SrvcGrp|90854|2022|PDM|885.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F137614_17602_0|SrvcGrp|73841|2022|PDM|370.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F98922_40351_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F120672_0_0|SrvcGrp|3378|2022|PCT|0.87|99|0.00|OBSERVATION SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|384.57|99|0.00|HAPA WPA-NWPA 2012-13 ASC 305 W/O REV|
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 10 (NO REV)|
20|FH_F89779_0_0|SrvcGrp|41335|2022|PDM|20500.00|99|0.00|TOTAL HIP|
20|FH_F140998_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.00|99|0.00|OP SVCS|
20|FH_F137067_0_0|SrvcGrp|71666|2022|PDM|15750.00|99|0.00|CPT 63655|
20|FH_F137972_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F147941_06023_0|SrvcGrp|74602|2022|PDM|454.00|99|0.00|AETNA INITIAL PSYCH EVALUATION CPT 90791|
20|FH_F121525_78613_0|SrvcGrp|104079|2022|PCT|1.75|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F121525_78613_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F123953_84003_0|SrvcGrp|73605|2022|PDM|1079.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F150460_48334_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F70645_0_0|SrvcGrp|3259|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION|
20|FH_F89111_0_0|SrvcGrp|33166|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F93881_15009_0|SrvcGrp|81406|2022|PDM|30.00|99|0.00|URINALYSIS|
20|FH_F118194_50841_0|SrvcGrp|62154|2022|PDM|240.00|99|0.00|PICC LINES|
20|FH_F137067_0_0|SrvcGrp|74039|2022|PDM|6983.00|99|0.00|LAMINECTOMY|
20|FH_F39969_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F143528_0_0|SrvcGrp|83644|2022|PDM|4076.10|99|0.00|CPT 30465|
20|FH_F107800_34609_0|CSTM-ALL|CSTM-00|2020|PDM|390.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F148265_06067_0|SrvcGrp|88158|2022|PDM|7095.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F143528_0_0|SrvcGrp|92364|2022|PDM|6517.35|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|830.00|99|0.00|AEG 2 (NO REV)|
20|FH_F123922_84102_0|SrvcGrp|108484|2022|PDM|750.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F111206_63011_0|SrvcGrp|92760|2022|PCT|1.15|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|691.00|99|0.00|AEG 1 (NO REV)|
20|FH_F88864_29601_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F148200_26554_0|SrvcGrp|111482|2022|PCT|0.75|99|0.00|CARDIAC STUDIES|
20|FH_F129653_0_0|SrvcGrp|72994|2022|PDM|1365.00|99|0.00|AEG 3|
20|FH_F66222_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|S CODES|
20|FH_F137972_0_0|SrvcGrp|90567|2022|PDM|957.00|99|0.00|CILIARY BODY DESTRUCTION|
20|FH_F149523_0_0|SrvcGrp|114173|2022|PDM|3000.00|99|0.00|CARDIAC CATHERIZATION INCL INJECTIONS|
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_F38341_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F141591_92630_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F115049_78539_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F120155_63114_0|SrvcGrp|86635|2022|PCT|0.75|99|0.00|DME|
20|FH_F129969_33908_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130157_84049_0|SrvcGrp|89337|2022|PDM|1000.00|99|0.00|DETOXIFICATION|
20|FH_F128136_48025_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129536_0_0|SrvcGrp|46890|2022|PDM|2200.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F127441_45822_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135072_65712_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PDM|1351.00|99|0.00|AEG 5  (NO REV)|
20|FH_F126523_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F125473_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F89111_0_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F135252_21911_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139515_0_0|SrvcGrp|67119|2022|PDM|11840.00|99|0.00|ARTHODESIS|
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87411_0_0|SrvcGrp|85682|2022|PDM|797.21|99|0.00|POLYSOMNOGRAPHY (MOD TC)|
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128278_21401_0|SrvcGrp|89149|2022|PDM|246.00|99|0.00|OP INTENSIVE|
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)|
20|FH_F136359_0_0|SrvcGrp|112860|2022|PDM|1450.00|99|0.00|TREAT LOWER LEG DISLOCATION|
20|FH_F100782_0_0|SrvcGrp|105126|2022|PDM|522.62|99|0.00|WINDBER MEDICAL CNTR ASC 231|
20|FH_F133207_0_0|SrvcGrp|90157|2022|PDM|2632.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F133950_06029_0|SrvcGrp|82981|2022|PDM|151.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F89335_64628_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F89219_0_0|SrvcGrp|26690|2022|PDM|104172.00|99|0.00|MS DRG 215 ONLY|
20|FH_F116753_0_0|SrvcGrp|77494|2022|PDM|7465.00|99|0.00|AETNA HYSTEROSCOPY BIOPSY|
20|FH_F121476_0_0|SrvcGrp|108833|2022|PDM|3695.00|99|0.00|PATIENT PROGRAMMER NEUROSTIM|
20|FH_F145882_02368_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F132883_31602_0|SrvcGrp|86852|2022|PDM|20.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD AU"|
20|FH_F118146_33062_0|SrvcGrp|108484|2022|PDM|623.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F120549_19087_0|SrvcGrp|108519|2022|PDM|567.00|99|0.00|FEMALE GENITAL SYSTEM|
20|FH_F85212_71075_0|SrvcGrp|2738|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|131.59|99|0.00|HAPA WPA-NWPA 2012-13 ASC 143 W/O REV|
20|FH_F111744_32514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39378_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F117202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F149259_64050_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F138026_46143_0|SrvcGrp|89417|2022|PDM|386.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F80172_0_0|SrvcGrp|16555|2022|PDM|70.64|99|0.00|DIURETIC THERAPY|
20|FH_F51393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F148439_0_0|SrvcGrp|104330|2022|PDM|1500.00|99|0.00|AETNA ACUTE REHAB II|
20|FH_F134208_21502_0|SrvcGrp|110767|2022|PDM|408.00|99|0.00|2ND LEVEL INJ PARAVERT F JNT L/S|
20|FH_F130017_02302_0|SrvcGrp|13880|2022|PCT|0.67|99|0.00|IMPLANTS|
20|FH_F117531_0_0|SrvcGrp|29428|2022|PDM|525.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|91.04|99|0.00|HAPA WPA-NWPA 2012-13 ASC 316 W/O REV|
20|FH_F143677_62301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F142376_0_0|SrvcGrp|87124|2022|PDM|268.00|99|0.00|INJ PERIPHERAL NERVE|
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG III|
20|FH_F134168_70526_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_F124159_92506_0|SrvcGrp|3178|2022|PDM|943.00|99|0.00|ACUTE PSYCH|
20|FH_F149603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146103_63851_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F150281_76309_0|SrvcGrp|74668|2022|PDM|164.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F112004_15401_0|SrvcGrp|48396|2022|PDM|145.00|99|0.00|OT SERVICES|
20|FH_F149263_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F51115_0_0|SrvcGrp|42827|2022|PDM|108.24|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F150165_06032_0|SrvcGrp|109504|2022|PDM|4392.00|99|0.00|REMV & REPLC PM GEN DUAL LEAD|
20|FH_F59872_0_0|SrvcGrp|13880|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F112024_0_0|SrvcGrp|72992|2022|PDM|1826.00|99|0.00|AEG 2|
20|FH_F133207_0_0|SrvcGrp|100920|2022|PDM|5040.00|99|0.00|SPINE PRO DEVICE|
20|FH_F127651_44124_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F110344_37421_0|SrvcGrp|86648|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F118267_45005_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138147_18018_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F146113_26719_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137610_0_0|SrvcGrp|73605|2022|PDM|958.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F149005_16830_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134353_84123_0|SrvcGrp|95661|2022|PDM|693.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F112987_46222_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F110504_37027_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136359_0_0|SrvcGrp|107187|2022|PDM|3120.00|99|0.00|REVISE TWO EYE MUSCLES|
20|FH_F110453_0_0|SrvcGrp|72992|2022|PDM|479.00|99|0.00|AEG 2|
20|FH_F117206_0_0|SrvcGrp|77021|2022|PDM|3605.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F52672_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F132969_84003_0|SrvcGrp|17014|2022|PDM|22.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F81698_10457_0|SrvcGrp|26869|2022|PDM|31.50|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F145604_14850_0|SrvcGrp|86834|2022|PDM|35.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F70208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1343.00|99|0.00|ASPG VII|
20|FH_F134655_14221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121603_46761_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|HAPA WPA/NWPA 2016 NISC 100%|
20|FH_F110660_85741_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F81852_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HAPA WPA/NWPA 2014 RAD 100%|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|378.13|99|0.00|HAPA WPA-NWPA 2012-13 ASC 103 W/O REV|
20|FH_F90416_73013_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F85213_02840_0|SrvcGrp|112224|2022|PDM|565.70|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F63701_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F91313_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|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_F86836_0_0|SrvcGrp|105569|2022|PDM|4750.00|99|0.00|PRIVATE MED/SURG/GYN|
20|FH_F71964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72768_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101100_50314_0|SrvcGrp|97903|2022|PDM|11034.00|99|0.00|REMOVAL OF STOMACH PARTIAL|
20|FH_F105143_26062_0|SrvcGrp|73500|2022|PDM|595.00|99|0.00|AETNA ER LEVEL I|
20|FH_F105361_80104_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F115788_02904_0|SrvcGrp|73842|2022|PDM|155.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115814_53235_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F63625_0_0|SrvcGrp|16|2022|PDM|1742.00|99|0.00|ACUTE REHABILITATION|
20|FH_F68442_0_0|SrvcGrp|33165|2022|PDM|375.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F146654_80524_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F120795_27514_0|SrvcGrp|10393|2022|PDM|8620.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F131697_33444_0|SrvcGrp|38007|2022|PDM|700.00|99|0.00|CPT CODE 59425|
20|FH_F131959_31709_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111604_16505_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F111662_80601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114931_0_0|SrvcGrp|105756|2022|PDM|1850.00|99|0.00|SURGICAL ANORECTAL EXAM|
20|FH_F129130_92562_0|SrvcGrp|2738|2022|PCT|0.46|99|0.00|IMPLANTS|
20|FH_F37823_0_0|SrvcGrp|9510|2022|PDM|600.00|99|0.00|SKILLED NURSING CARE|
20|FH_F91818_02828_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F91832_06106_0|SrvcGrp|27969|2022|PDM|18.90|99|0.00|HOME HEALTH AIDE|
20|FH_F109484_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 2 (NO REV)|
20|FH_F63414_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F77067_0_0|SrvcGrp|9510|2022|PDM|1288.00|99|0.00|SKILLED NURSING CARE|
20|FH_F77067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F91072_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.70|99|0.00|OP SVCS|
20|FH_F141207_0_0|SrvcGrp|95660|2022|PDM|995.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F116485_17033_0|SrvcGrp|110063|2022|PDM|31.83|99|0.00|MULTIPLE FAMILY ADAPTIVE BH TREATMENT 15 MINS|
20|FH_F132627_0_0|SrvcGrp|17001|2022|PDM|220.00|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F93252_0_0|SrvcGrp|80617|2022|PDM|7000.00|99|0.00|ARTHOPLASTY|
20|FH_F36318_0_0|SrvcGrp|21585|2022|PCT|0.37|99|0.00|HIGH COST DRUGS|
20|FH_F38233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F100703_0_0|SrvcGrp|97079|2022|PDM|3466.00|99|0.00|MENISCUS REPAIR, MED OR LAT|
20|FH_F124663_65608_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 2 (NO REV)|
20|FH_F125134_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F150910_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.43|99|0.00|HSS ASC|
20|FH_F97040_31901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F130039_80228_0|SrvcGrp|73841|2022|PDM|425.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F132890_87544_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136659_62821_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136708_06443_0|SrvcGrp|87131|2022|PDM|357.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F113787_31909_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122674_94904_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F42940_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.75|99|0.00|HSS APC GROUPED|
20|FH_F43135_0_0|SrvcGrp|16|2022|PDM|710.00|99|0.00|ACUTE REHABILITATION|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PDM|594.00|99|0.00|ASPG III|
20|FH_F134791_98034_0|SrvcGrp|29464|2022|PCT|0.00|99|0.00|HOME HEALTH VISIT NEWBORN CARE|
20|FH_F106963_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.50|99|0.00|OP SVCS|
20|FH_F136796_24016_0|SrvcGrp|88757|2022|PDM|2907.56|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F136930_73114_0|SrvcGrp|72998|2022|PDM|6722.00|99|0.00|AEG 5|
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|WELLPATH PROPIETARY ASC X (MINOR PROCEDURE)|
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|3300.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F115567_91711_0|SrvcGrp|86753|2022|PCT|1.25|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F147299_02072_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F147559_70433_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F41463_0_0|SrvcGrp|34173|2022|PDM|126.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F42024_0_0|SrvcGrp|13249|2022|PDM|756.00|99|0.00|MRI|
20|FH_F42250_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42797_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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|115|2022|PDM|558.00|99|0.00|SKILLED NURSING CARE|
20|FH_F132545_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|EMERGENCY ROOM|
20|FH_F38037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138491_0_0|SrvcGrp|89781|2022|PDM|85.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|2195.00|99|0.00|AEG 4 (NO REV)|
20|FH_F82357_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|CHEMICAL DEPENDENCY|
20|FH_F113585_20155_0|SrvcGrp|86846|2022|PDM|50.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F57953_0_0|SrvcGrp|31190|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC (DME)|
20|FH_F67167_0_0|SrvcGrp|21460|2022|PDM|4887.00|99|0.00|MS DRG 775 ONLY REPLACEMENT 807|
20|FH_F83792_0_0|SrvcGrp|74580|2022|PCT|0.68|99|0.00|AETNA IP IMPLANTS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1230.89|99|0.00|HAPA WPA-NWPA 2012-13 ASC 7 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|375.31|99|0.00|HAPA WPA-NWPA 2012-13 ASC 111 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HAPA WPA/NWPA 2018 NISC 100%|
20|FH_F151340_30040_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F151341_75904_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151511_14094_0|SrvcGrp|114917|2022|PCT|0.00|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F122140_66064_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F135384_28714_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135440_32561_0|SrvcGrp|73842|2022|PDM|195.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F135489_70508_0|SrvcGrp|90101|2022|PDM|0.10|99|0.00|AETNA MED RECORD COPY|
20|FH_F135489_70508_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135923_60453_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F100880_67735_0|SrvcGrp|9438|2022|PCT|0.83|99|0.00|TRAUMA CARE|
20|FH_F130547_85712_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131407_07607_0|SrvcGrp|86846|2022|PDM|30.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F121454_34990_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121707_85745_0|SrvcGrp|75419|2022|PDM|750.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F121731_20164_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F33785_0_0|SrvcGrp|361|2022|PDM|1500.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F130774_57401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111301_33122_0|SrvcGrp|73462|2022|PDM|2141.00|99|0.00|AETNA NICU III|
20|FH_F141651_0_0|SrvcGrp|78093|2022|PDM|2200.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F132328_0_0|SrvcGrp|35668|2022|PDM|2205.00|99|0.00|CPT 29824|
20|FH_F118651_0_0|SrvcGrp|101526|2022|PDM|5092.32|99|0.00|LAPARO-ASST VAG HYSTERECTOMY|
20|FH_F102325_62691_0|SrvcGrp|53987|2022|PCT|1.30|99|0.00|PHOTOTHERAPY|
20|FH_F102960_50613_0|CSTM-ALL|CSTM-00|2020|PDM|8608.00|99|0.00|AEG 9 (NO REV)|
20|FH_F33381_0_0|SrvcGrp|3224|2022|PCT|0.78|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F67820_15009_0|SrvcGrp|10503|2022|PDM|47.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F70844_15317_0|SrvcGrp|10431|2022|PDM|47.00|99|0.00|SPEECH THERAPY|
20|FH_F97261_06098_0|SrvcGrp|73601|2022|PDM|10748.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F95221_0_0|SrvcGrp|73006|2022|PDM|1406.00|99|0.00|AEG 9|
20|FH_F132810_0_0|SrvcGrp|86842|2022|PDM|35.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F58856_0_0|SrvcGrp|22401|2022|PDM|956.00|99|0.00|ASPG I (REV CODE + CPT/HCPCS)|
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136299_75218_0|SrvcGrp|72984|2022|PCT|2.00|99|0.00|CHEMOTHERAPY|
20|FH_F136398_23502_0|SrvcGrp|3178|2022|PDM|911.00|99|0.00|ACUTE PSYCH|
20|FH_F136404_06410_0|SrvcGrp|472|2022|PDM|505.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120489_63552_0|SrvcGrp|79699|2022|PCT|0.75|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F120490_64133_0|SrvcGrp|86843|2022|PDM|34.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F134126_11554_0|SrvcGrp|112047|2022|PCT|1.25|99|0.00|RADIOLOGY|
20|FH_F137048_60714_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F142547_70002_0|SrvcGrp|29076|2022|PDM|25.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F142547_70002_0|SrvcGrp|86835|2022|PDM|10.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F53732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97600_46151_0|SrvcGrp|88977|2022|PDM|12398.00|99|0.00|C-SECTION DELIVERY|
20|FH_F138584_30912_0|SrvcGrp|113372|2022|PDM|1900.00|99|0.00|REPAIR CRANIOFACIAL FRACTURE|
20|FH_F134654_0_0|SrvcGrp|110062|2022|PDM|75.00|99|0.00|FAMILY ADAPTIVE BH TREATMENT 15 MINS|
20|FH_F77782_66061_0|SrvcGrp|27966|2022|PCT|0.80|99|0.00|MS DRG 163-165 ONLY|
20|FH_F139267_30253_0|SrvcGrp|73483|2022|PDM|1375.00|99|0.00|AETNA SUBACUTE III|
20|FH_F140450_18104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140553_37205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140846_48207_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F80284_16354_0|CSTM-ALL|CSTM-00|2020|PDM|1614.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80284_16354_0|SrvcGrp|64105|2022|PDM|780.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 4|
20|FH_F151606_64772_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118932_07652_0|SrvcGrp|474|2022|PDM|610.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F38000_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92636_90230_0|SrvcGrp|29347|2022|PDM|15.75|99|0.00|HOME HEALTH AIDE|
20|FH_F109883_35007_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109884_36117_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F92852_0_0|SrvcGrp|87759|2022|PDM|1320.00|99|0.00|REINFORCE/GRAFT EYE WALL|
20|FH_F117325_19342_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F147882_44056_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117107_33704_0|SrvcGrp|106977|2022|PCT|1.00|99|0.00|RHOGAM INJECTION|
20|FH_F117107_33704_0|SrvcGrp|78420|2022|PDM|2300.00|99|0.00|INTERIM LABOR|
20|FH_F117211_15143_0|SrvcGrp|88620|2022|PDM|70.00|99|0.00|SKILLED NURSING RN|
20|FH_F35210_0_0|SrvcGrp|47252|2022|PCT|0.65|99|0.00|MS DRG 216-237 ONLY|
20|FH_F90735_94070_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F90876_18447_0|SrvcGrp|83519|2022|PDM|110.25|99|0.00|HOSPICE CARE (ALL OTHER)|
20|FH_F91472_96001_0|SrvcGrp|103713|2022|PCT|0.40|99|0.00|POSTERIOR CERVICAL FUSION OR REFUSION WITH ALLOGRAFT|
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|986.58|99|0.00|ASPG VIII|
20|FH_F109513_0_0|SrvcGrp|83839|2022|PDM|2800.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F56274_0_0|SrvcGrp|34389|2022|PDM|155.00|99|0.00|SPEECH THERAPY|
20|FH_F119417_78212_0|SrvcGrp|90338|2022|PDM|95.00|99|0.00|SKILLED NURSING RN (HCFA)|
20|FH_F119256_63031_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F148419_01453_0|SrvcGrp|115400|2022|PCT|1.00|99|0.00|COVID-19 VACCINE - REGENERON|
20|FH_F148425_01507_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148479_49519_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148542_43517_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148554_85016_0|SrvcGrp|115437|2022|PDM|3213.00|99|0.00|INSERT HEART PM ATRIAL & VENT|
20|FH_F148644_06890_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F133287_40215_0|CSTM-ALL|CSTM-00|2020|PCT|0.32|99|0.00|MS DRG 461-462 ONLY OTLR|
20|FH_F43719_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ACUTE PSYCH|
20|FH_F92677_08003_0|SrvcGrp|86851|2022|PDM|52.50|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F142775_72801_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133447_53120_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132279_63775_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|755.46|99|0.00|HAPA WPA-NWPA 2012-13 ASC 401 W/O REV|
20|FH_F42803_0_0|SrvcGrp|38|2022|PDM|1000.00|99|0.00|NORMAL DELIVERY|
20|FH_F122928_39563_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
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_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|1087.90|99|0.00|ASPG VIII|
20|FH_F144022_32118_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F116828_0_0|SrvcGrp|92501|2022|PDM|133.35|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F42779_0_0|SrvcGrp|36590|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F115448_80031_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128648_44256_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F146324_70810_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138054_0_0|SrvcGrp|66265|2022|PDM|144.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F41396_0_0|SrvcGrp|34273|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF (DME)|
20|FH_F100786_24740_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F41166_0_0|SrvcGrp|11606|2022|PDM|510.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)|
20|FH_F117995_60126_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F55113_0_0|SrvcGrp|360|2022|PDM|2590.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F34998_0_0|SrvcGrp|72|2022|PDM|450.00|99|0.00|NEWBORN NURSERY|
20|FH_F59274_0_0|SrvcGrp|48398|2022|PDM|32.00|99|0.00|PT SERVICES|
20|FH_F142967_65065_0|SrvcGrp|90492|2022|PCT|1.00|99|0.00|BEHAVRAL QUALIT ANALYS VOICE|
20|FH_F97061_85012_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F128130_10027_0|SrvcGrp|110239|2022|PDM|985.00|99|0.00|3D RENDERING W/ INTERPRETA|
20|FH_F133477_90247_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F118645_19103_0|SrvcGrp|472|2022|PDM|446.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F125352_90034_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F117950_37110_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128485_44667_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F103400_33426_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F149513_0_0|SrvcGrp|13722|2022|PDM|188.74|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE|
20|FH_F128648_44256_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F133214_75024_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F55113_0_0|SrvcGrp|29949|2022|PCT|0.70|99|0.00|TRAUMA|
20|FH_F97622_75051_0|SrvcGrp|73601|2022|PDM|9830.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F123872_75006_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124957_60473_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F70487_0_0|SrvcGrp|67299|2022|PDM|400.00|99|0.00|NORMAL NEWBORN|
20|FH_F150906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43953_0_0|SrvcGrp|3224|2022|PCT|0.66|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F117793_90405_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F149840_80002_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ANESTHESIOLOGIST/CRNA (HAN2)(HSUR)|
20|FH_F79902_0_0|SrvcGrp|33012|2022|PDM|1912.00|99|0.00|LONG TERM ACUTE CARE|
20|FH_F41396_0_0|SrvcGrp|34278|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F111809_93003_0|SrvcGrp|20071|2022|PDM|6142.00|99|0.00|MS DRG 945-946|
20|FH_F109625_27330_0|SrvcGrp|78862|2022|PCT|0.77|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F146211_68144_0|SrvcGrp|92821|2022|PDM|4433.71|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR|
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|932.00|99|0.00|AEG 6 (NO REV)|
20|FH_F143197_34957_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F128917_57212_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142779_64083_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F115324_78852_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F143848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90955_06053_0|SrvcGrp|48396|2022|PDM|84.00|99|0.00|OT SERVICES|
20|FH_F100786_24740_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F116440_0_0|SrvcGrp|24027|2022|PDM|65.00|99|0.00|PHYSICAL/OCCUPATIONAL/SPEECH THERAPY|
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PDM|783.00|99|0.00|EATING DISORDER RESIDENTIAL|
20|FH_F141802_17042_0|SrvcGrp|75506|2022|PCT|0.68|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F72859_0_0|SrvcGrp|11794|2022|PDM|17.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F100682_97401_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F32869_0_0|SrvcGrp|6|2022|PDM|2800.00|99|0.00|OP SURGERY|
20|FH_F128554_87102_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147800_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F133108_98221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150533_76051_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F50618_0_0|SrvcGrp|17077|2022|PDM|1312.24|99|0.00|ASPG VII|
20|FH_F133008_78382_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33241_0_0|SrvcGrp|13123|2022|PDM|550.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F67639_0_0|SrvcGrp|63468|2022|PDM|650.00|99|0.00|CPT 52281|
20|FH_F100785_54660_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F96261_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100741_0_0|SrvcGrp|73008|2022|PDM|969.00|99|0.00|AEG 10|
20|FH_F133287_40215_0|SrvcGrp|79851|2022|PDM|99.00|99|0.00|AETNA EKG|
20|FH_F46196_0_0|SrvcGrp|17419|2022|PDM|70.00|99|0.00|SPEECH THERAPY|
20|FH_F123539_65265_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46473_0_0|SrvcGrp|3388|2022|PDM|969.00|99|0.00|SUBACUTE CARE|
20|FH_F148880_26807_0|SrvcGrp|29347|2022|PDM|55.83|99|0.00|HOME HEALTH AIDE|
20|FH_F151056_17821_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151279_15301_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139428_65270_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F150768_03054_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150782_19444_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150839_03833_0|SrvcGrp|104229|2022|PDM|212.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|2162.00|99|0.00|COVENTRY ENHANCED GROUPER 9 MOD 50|
20|FH_F37385_0_0|SrvcGrp|15391|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F98940_70506_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F137788_72632_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F75944_0_0|SrvcGrp|68193|2022|PDM|2461.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 9|
20|FH_F111044_0_0|SrvcGrp|102459|2022|PDM|1648.00|99|0.00|CPT 29894|
20|FH_F109460_98003_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F69123_0_0|SrvcGrp|44042|2022|PDM|70.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F114825_32789_0|SrvcGrp|89149|2022|PDM|180.00|99|0.00|OP INTENSIVE|
20|FH_F123745_0_0|SrvcGrp|67069|2022|PDM|4000.00|99|0.00|CPT 22634|
20|FH_F134869_08854_0|SrvcGrp|69073|2022|PDM|180.00|99|0.00|CPT 99215|
20|FH_F141250_95062_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134847_0_0|SrvcGrp|99067|2022|PDM|5135.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F124470_90025_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F58974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127189_49503_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F34951_0_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|577036 SPLS PT,OT,ST|
20|FH_F113957_73554_0|SrvcGrp|92958|2022|PCT|1.15|99|0.00|SLEEP STUDIES|
20|FH_F112805_46011_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F137627_78382_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F84532_0_0|SrvcGrp|14614|2022|PDM|6717.00|99|0.00|LITHOTRIPSY|
20|FH_F150940_92708_0|SrvcGrp|92760|2022|PCT|0.40|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150322_68301_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F78009_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|148.34|99|0.00|SALLY BALIN,999182,ASC 222|
20|FH_F140990_0_0|SrvcGrp|107747|2022|PDM|575.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F122377_91007_0|SrvcGrp|1943|2022|PDM|5185.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F46284_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|SKILLED NURSING CARE|
20|FH_F37304_0_0|SrvcGrp|12043|2022|PDM|205.00|99|0.00|CPT 99205|
20|FH_F140295_0_0|SrvcGrp|26275|2022|PDM|3303.00|99|0.00|CPT 29826|
20|FH_F134819_0_0|SrvcGrp|28513|2022|PDM|2955.00|99|0.00|HYSTEROSCOPY|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|97.00|99|0.00|HAPA EPA ASC 16|
20|FH_F117762_0_0|SrvcGrp|88340|2022|PDM|7280.00|99|0.00|SPINAL FUSION|
20|FH_F67419_0_0|SrvcGrp|43569|2022|PDM|40.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F141155_34952_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|2717.00|99|0.00|AEG 7 (NO REV)|
20|FH_F124441_0_0|SrvcGrp|16289|2022|PDM|1425.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F97100_23462_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F114308_70601_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120679_0_0|CSTM-ALL|CSTM-00|2020|PDM|2724.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38742_0_0|SrvcGrp|28932|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MOD UE (A & K CODES)|
20|FH_F74424_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F137797_70123_0|SrvcGrp|27968|2022|PDM|49.37|99|0.00|SKILLED NURSING LPN|
20|FH_F92413_07631_0|SrvcGrp|27969|2022|PDM|25.38|99|0.00|HOME HEALTH AIDE|
20|FH_F149539_06032_0|SrvcGrp|23683|2022|PCT|0.00|99|0.00|SKILLED NURSING RN|
20|FH_F134847_0_0|SrvcGrp|58993|2022|PDM|6110.00|99|0.00|DISKECTOMY|
20|FH_F114585_11501_0|SrvcGrp|90040|2022|PDM|400.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F151660_77074_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116575_0_0|SrvcGrp|83646|2022|PDM|1800.00|99|0.00|CPT 31276|
20|FH_F147174_75231_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123745_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PDM|3577.00|99|0.00|AEG 2 (NO REV)|
20|FH_F124739_64429_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117426_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146266_0_0|SrvcGrp|67068|2022|PDM|20512.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F124316_28112_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F140233_35216_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143533_30013_0|SrvcGrp|114120|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F98480_0_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132446_19063_0|SrvcGrp|23683|2022|PDM|46.00|99|0.00|SKILLED NURSING RN|
20|FH_F116571_70433_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F116698_07470_0|SrvcGrp|86837|2022|PDM|210.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F91372_63043_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F51276_0_0|SrvcGrp|27044|2022|PDM|30.50|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS (MOD SH)|
20|FH_F51276_0_0|SrvcGrp|14949|2022|PDM|80.00|99|0.00|HOME INFUSION|
20|FH_F112705_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F39996_0_0|SrvcGrp|24|2022|PDM|1400.00|99|0.00|CARDIAC CATH|
20|FH_F142454_0_0|SrvcGrp|114518|2022|PDM|6000.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F150280_0_0|SrvcGrp|3259|2022|PDM|1509.00|99|0.00|ACUTE REHABILITATION|
20|FH_F61292_0_0|SrvcGrp|99068|2022|PDM|31051.00|99|0.00|MS DRG 228-229 ONLY OTHER CARDIOTHORACIC PROC|
20|FH_F123160_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.40|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_F135065_08043_0|SrvcGrp|90632|2022|PDM|350.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|652.00|99|0.00|AEG 3 (NO REV)|
20|FH_F74242_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F124972_64644_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124048_47304_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150026_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141607_27021_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F135006_63353_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F90714_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|ASPG IX|
20|FH_F32604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.96|99|0.00|OP SVCS|
20|FH_F145535_92708_0|SrvcGrp|74668|2022|PDM|374.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120059_0_0|SrvcGrp|104098|2022|PDM|4800.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F82714_18848_0|CSTM-ALL|CSTM-00|2020|PDM|1414.00|99|0.00|AEG 4 (NO REV)|
20|FH_F137087_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F137943_0_0|SrvcGrp|113198|2022|PDM|1400.00|99|0.00|BIOPSY OF CORNEA|
20|FH_F118311_35211_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F110132_23451_0|SrvcGrp|73700|2022|PDM|55.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F89563_29407_0|SrvcGrp|94736|2022|PCT|1.00|99|0.00|FLULAVAL VACC IM (>=3 YRS)|
20|FH_F90852_0_0|SrvcGrp|16|2022|PDM|945.00|99|0.00|ACUTE REHABILITATION|
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128401_44615_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F97440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|PATHOLOGY|
20|FH_F39479_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F35388_0_0|SrvcGrp|14320|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F149523_0_0|SrvcGrp|98566|2022|PDM|15000.00|99|0.00|ARTHRDSIS LAT MINI DISKECT|
20|FH_F125703_02907_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F143528_0_0|SrvcGrp|93641|2022|PDM|3491.25|99|0.00|KNEE ARTHROSCOPIC SURGERY|
20|FH_F73013_0_0|SrvcGrp|42973|2022|PDM|182.86|99|0.00|SPEECH  THERAPIST|
20|FH_F38526_0_0|CSTM-ALL|CSTM-00|2020|PDM|7800.00|99|0.00|MSDRG 246-251 ANGIOPLASTY|
20|FH_F42951_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.50|99|0.00|OP SVCS|
20|FH_F130025_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F126242_32796_0|SrvcGrp|87317|2022|PDM|928.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F38847_0_0|SrvcGrp|38|2022|PDM|2400.00|99|0.00|NORMAL DELIVERY|
20|FH_F121090_07848_0|SrvcGrp|104441|2022|PDM|50.00|99|0.00|AETNA DRUG TEST PRSMV DIR OPT OBS (HCFA)|
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|ADOLESCENT RESIDENTIAL TREATMENT|
20|FH_F41201_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142073_0_0|SrvcGrp|35668|2022|PDM|2300.00|99|0.00|CPT 29824|
20|FH_F129627_06037_0|SrvcGrp|43567|2022|PDM|118.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F37679_0_0|SrvcGrp|27068|2022|PDM|30.50|99|0.00|PAIN MANAGAMENT - INTERMITTENT (MOD SH)|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 219-221 CARDIAC VLV PX+OTR MJR CARDIOTHORACIC PX W/CC|
20|FH_F42160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F126439_92627_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F143821_60559_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F90362_0_0|SrvcGrp|80617|2022|PDM|11670.00|99|0.00|ARTHOPLASTY|
20|FH_F125323_43213_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F110925_01104_0|SrvcGrp|14944|2022|PDM|13.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F134994_33162_0|SrvcGrp|108484|2022|PDM|735.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F138533_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|AEG 2 (NO REV)|
20|FH_F137940_0_0|SrvcGrp|2067|2022|PDM|595.64|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100790_10512_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F39969_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148182_23324_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F148354_44471_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F147162_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88254_33411_0|SrvcGrp|28630|2022|PDM|65.00|99|0.00|HOME INFUSION SKILLED NURSING|
20|FH_F133714_03570_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130523_04605_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|AEG 3 (NO REV)|
20|FH_F135219_68506_0|CSTM-ALL|CSTM-00|2020|PCT|0.81|99|0.00|OP SVCS|
20|FH_F138450_0_0|SrvcGrp|113275|2022|PDM|100.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT|
20|FH_F39041_0_0|CSTM-ALL|CSTM-00|2020|PDM|797.00|99|0.00|ACUTE PSYCH|
20|FH_F120285_32960_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|2322.00|99|0.00|AEG 8 (NO REV)|
20|FH_F143773_30350_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112377_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_F121539_27511_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F130514_33316_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F74342_0_0|SrvcGrp|46802|2022|PDM|72.00|99|0.00|IV SERVICES|
20|FH_F136510_0_0|SrvcGrp|28548|2022|PDM|3882.00|99|0.00|VITRECTOMY|
20|FH_F91663_19901_0|SrvcGrp|48396|2022|PDM|120.00|99|0.00|OT SERVICES|
20|FH_F148400_33401_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_F115768_15301_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F34795_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141607_27021_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SERVICES|
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|791.00|99|0.00|ASPG II|
20|FH_F135219_68506_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|1138.00|99|0.00|AEG 3 (NO REV)|
20|FH_F131965_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F131254_92211_0|SrvcGrp|111797|2022|PCT|1.00|99|0.00|ALL OUTPATIENT DRUGS W/O CPT 99601|
20|FH_F140907_28601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141527_36830_0|SrvcGrp|14947|2022|PDM|3.00|99|0.00|HOME INFUSION|
20|FH_F66687_0_0|SrvcGrp|21356|2022|PCT|0.85|99|0.00|MS DRG 254 ONLY|
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|AEG 10 (NO REV)|
20|FH_F149523_0_0|SrvcGrp|101280|2022|PDM|15500.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F148549_60523_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F122898_63011_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137057_0_0|SrvcGrp|98062|2022|PDM|432.00|99|0.00|HOSPICE INPATIENT RESPITE CARE PER DIEM|
20|FH_F149179_0_0|SrvcGrp|27343|2022|PDM|3500.00|99|0.00|OP SURGERY (CPT 25607 - 25609)|
20|FH_F123792_90803_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F60112_0_0|SrvcGrp|42824|2022|PDM|85.50|99|0.00|SKILLED NURSING VISIT|
20|FH_F37478_0_0|SrvcGrp|15|2022|PDM|3638.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F98002_27103_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F146480_75042_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120930_0_0|SrvcGrp|88147|2022|PDM|3000.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA|
20|FH_F79623_0_0|SrvcGrp|73004|2022|PDM|4958.00|99|0.00|AEG 8|
20|FH_F66259_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F96160_32207_0|SrvcGrp|84559|2022|PCT|1.14|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F133749_84604_0|SrvcGrp|112426|2022|PDM|25.00|99|0.00|PAIN MGMT HOME INFUSION THERAPY|
20|FH_F85213_02840_0|SrvcGrp|112225|2022|PDM|132.70|99|0.00|COVID-19 SPECIMEN COLLECTION|
20|FH_F113470_74010_0|SrvcGrp|473|2022|PDM|340.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F36753_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD TC|
20|FH_F109405_73106_0|SrvcGrp|89149|2022|PDM|120.00|99|0.00|OP INTENSIVE|
20|FH_F86131_28215_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F90501_71101_0|SrvcGrp|73488|2022|PCT|1.00|99|0.00|AETNA HOSPITAL OP DIALYSIS|
20|FH_F139873_0_0|SrvcGrp|26275|2022|PDM|2215.00|99|0.00|CPT 29826|
20|FH_F111986_0_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F125133_20601_0|SrvcGrp|110075|2022|PDM|26.52|99|0.00|COLLAGEN DRSG >16 <=48 SQ IN|
20|FH_F127908_60640_0|SrvcGrp|110869|2022|PCT|1.40|99|0.00|OP SERVICES|
20|FH_F48092_0_0|SrvcGrp|14112|2022|PDM|28.75|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F52713_0_0|SrvcGrp|62153|2022|PDM|4000.00|99|0.00|RADIOLOGY SVCS|
20|FH_F150242_60025_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120930_0_0|SrvcGrp|96563|2022|PDM|3000.00|99|0.00|HYSTERCTOMY AND VAGINA REPAIR|
20|FH_F120425_11106_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F110507_33462_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F126354_91321_0|SrvcGrp|46903|2022|PDM|800.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F150165_06032_0|SrvcGrp|115163|2022|PDM|4500.00|99|0.00|NOSE REPAIR|
20|FH_F149266_38556_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63785|2022|PDM|1306.70|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1301|
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|1694.00|99|0.00|AEG 7 (NO REV)|
20|FH_F111986_0_0|SrvcGrp|104123|2022|PDM|1442.00|99|0.00|REMOVE TONSILS AND ADENOIDS|
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1227.00|99|0.00|AEG 6 (NO REV)|
20|FH_F125870_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F110402_74361_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F149050_22844_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150165_06032_0|SrvcGrp|34605|2022|PDM|5000.00|99|0.00|CPT 28299|
20|FH_F111986_0_0|SrvcGrp|27347|2022|PDM|1236.00|99|0.00|CPT 58558|
20|FH_F109364_52349_0|SrvcGrp|103343|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F72785_0_0|CSTM-ALL|CSTM-00|2020|PDM|1748.00|99|0.00|ACUTE PSYCH|
20|FH_F120670_0_0|SrvcGrp|89404|2022|PDM|16000.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F142894_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124162_73127_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F86132_27105_0|SrvcGrp|472|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133585_0_0|SrvcGrp|107793|2022|PDM|13560.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F112082_30720_0|SrvcGrp|14948|2022|PDM|188.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.83|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1601 W/O REV|
20|FH_F132883_31602_0|SrvcGrp|86828|2022|PDM|30.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F149044_60463_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133775_83401_0|SrvcGrp|73701|2022|PDM|54.11|99|0.00|AETNA - SKILLED NURSING|
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|2020.00|99|0.00|AEG 9 (NO REV)|
20|FH_F144808_0_0|SrvcGrp|88491|2022|PDM|7215.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F149084_33401_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F91633_33907_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147980_0_0|SrvcGrp|104226|2022|PDM|20.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.85|99|0.00|HAPA WPA-NWPA 2012-13 ASC 406 W/O REV|
20|FH_F122930_0_0|SrvcGrp|73002|2022|PDM|3898.00|99|0.00|AEG 7|
20|FH_F145880_80303_0|SrvcGrp|108484|2022|PDM|570.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F134618_14892_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146650_29690_0|SrvcGrp|90854|2022|PDM|991.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F34182_0_0|SrvcGrp|12117|2022|PDM|736.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F138147_18018_0|SrvcGrp|113206|2022|PDM|31.28|99|0.00|MULTISYSTEMIC THERAPY|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F111986_0_0|SrvcGrp|92366|2022|PDM|2472.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F120408_0_0|SrvcGrp|90572|2022|PDM|287.38|99|0.00|INTENSIVE OP PSYCH (HCFA)|
20|FH_F145965_50325_0|SrvcGrp|3178|2022|PDM|1010.00|99|0.00|ACUTE PSYCH|
20|FH_F134324_26354_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133815_46526_0|SrvcGrp|54670|2022|PDM|2375.00|99|0.00|NORMAL DELIVERY|
20|FH_F112712_63005_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145642_15108_0|SrvcGrp|86839|2022|PDM|30.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F129548_44130_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F32613_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67887_0_0|SrvcGrp|12263|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F63297_0_0|SrvcGrp|59428|2022|PDM|75.00|99|0.00|ST|
20|FH_F134494_33612_0|SrvcGrp|89417|2022|PDM|508.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F87053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F80185_0_0|SrvcGrp|44107|2022|PDM|48.00|99|0.00|SPEECH THERAPY|
20|FH_F85211_0_0|SrvcGrp|78448|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F63625_0_0|SrvcGrp|47103|2022|PCT|0.80|99|0.00|UNGROUPED OUTPATIENT SURGERY|
20|FH_F66782_0_0|SrvcGrp|42974|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F68442_0_0|SrvcGrp|33166|2022|PDM|475.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F77665_0_0|SrvcGrp|10519|2022|PDM|15.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F146812_50401_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F146855_60069_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115972_92675_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F116040_24637_0|SrvcGrp|86832|2022|PDM|3.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F116040_24637_0|SrvcGrp|106409|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJECTION DRUGS|
20|FH_F133583_77074_0|SrvcGrp|16069|2022|PDM|933.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F133581_84790_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F111601_15203_0|SrvcGrp|89149|2022|PDM|161.00|99|0.00|OP INTENSIVE|
20|FH_F111602_17102_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F121971_33021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122007_30701_0|SrvcGrp|101562|2022|PCT|1.00|99|0.00|HOSPICE/PHYSICIAN|
20|FH_F129130_92562_0|SrvcGrp|39870|2022|PDM|30230.00|99|0.00|MS DRG 619-621 ONLY|
20|FH_F82933_0_0|SrvcGrp|40147|2022|PDM|5636.49|99|0.00|CVTY ENHANCED UNGROUPED|
20|FH_F97720_70084_0|SrvcGrp|73602|2022|PDM|807.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F74562_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|ACUTE PSYCH|
20|FH_F78243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F87054_0_0|SrvcGrp|72998|2022|PDM|1130.00|99|0.00|AEG 5|
20|FH_F87054_0_0|SrvcGrp|72994|2022|PDM|998.00|99|0.00|AEG 3|
20|FH_F89037_0_0|SrvcGrp|72994|2022|PDM|614.72|99|0.00|AEG 3|
20|FH_F115875_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1259.00|99|0.00|AEG 4 (NO REV)|
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1035.00|99|0.00|AEG 4 (NO REV)|
20|FH_F138929_0_0|SrvcGrp|88163|2022|PDM|13750.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F94786_07974_0|SrvcGrp|41456|2022|PDM|0.65|99|0.00|ENTERAL FORMULA - PEDIATRICS (CALORICALLY DENSE)|
20|FH_F132988_0_0|SrvcGrp|83643|2022|PDM|4493.01|99|0.00|CPT 29885|
20|FH_F136818_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F72162_0_0|SrvcGrp|46605|2022|PDM|135.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F141050_46410_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F141127_62286_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F72204_0_0|SrvcGrp|69306|2022|PCT|1.00|99|0.00|A, K & E CODES|
20|FH_F93252_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119214_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|464.94|99|0.00|AEG 1 (NO REV)|
20|FH_F64180_0_0|SrvcGrp|11442|2022|PDM|643.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F121426_0_0|SrvcGrp|3448|2022|PDM|1177.00|99|0.00|MRI|
20|FH_F124180_0_0|SrvcGrp|109737|2022|PDM|3161.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL|
20|FH_F39537_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F45976_0_0|SrvcGrp|17069|2022|PDM|801.00|99|0.00|ASPG III|
20|FH_F132348_16214_0|SrvcGrp|90707|2022|PDM|95.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F122174_16511_0|SrvcGrp|472|2022|PDM|406.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F146715_34240_0|SrvcGrp|114751|2022|PCT|1.00|99|0.00|WOUND CARE|
20|FH_F146985_12205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39066_0_0|SrvcGrp|3029|2022|PDM|400.00|99|0.00|NEWBORN NURSERY|
20|FH_F40302_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|ACUTE PSYCH|
20|FH_F47636_0_0|SrvcGrp|3327|2022|PDM|135.99|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F91998_0_0|SrvcGrp|16289|2022|PDM|895.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F67172_0_0|SrvcGrp|30223|2022|PCT|1.00|99|0.00|NITRIC OXIDE THERAPY|
20|FH_F114678_78745_0|SrvcGrp|87317|2022|PDM|932.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F114727_44512_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F113845_32746_0|CSTM-ALL|CSTM-00|2020|PDM|28.17|99|0.00|AETNA OBSERVATIONS BEHAVIORAL 30 MINS|
20|FH_F113847_20910_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148553_85016_0|SrvcGrp|115453|2022|PDM|2081.00|99|0.00|REMOVAL OF PM GENERATOR|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BIENVILLE MED CTR ALL OTHER OP MOD 26|
20|FH_F134727_30650_0|CSTM-ALL|CSTM-00|2020|PDM|1322.00|99|0.00|AEG 4 (NO REV)|
20|FH_F134814_62230_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135718_33172_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135747_76208_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F136796_24016_0|SrvcGrp|11673|2022|PDM|3634.46|99|0.00|CPT 29888|
20|FH_F136824_08034_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F136913_68803_0|SrvcGrp|107734|2022|PDM|8303.00|99|0.00|VAGINAL DELIVERY|
20|FH_F136930_73114_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F115631_65201_0|SrvcGrp|35672|2022|PDM|3177.00|99|0.00|CPT 23412|
20|FH_F115631_65201_0|CSTM-ALL|CSTM-00|2020|PDM|1511.00|99|0.00|AEG 6 (NO REV)|
20|FH_F116233_33612_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F147519_52627_0|SrvcGrp|3378|2022|PDM|330.72|99|0.00|OBSERVATION SVCS|
20|FH_F41489_0_0|SrvcGrp|38|2022|PDM|1500.00|99|0.00|NORMAL DELIVERY|
20|FH_F42654_0_0|SrvcGrp|36068|2022|PDM|90.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F76824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132545_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1636.00|99|0.00|AEG 4 (NO REV)|
20|FH_F113226_30025_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F113246_72687_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F138491_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F150939_0_0|SrvcGrp|94423|2022|PDM|10.00|99|0.00|IMMUNIZATIONS|
20|FH_F37257_0_0|SrvcGrp|12180|2022|PCT|0.75|99|0.00|ER SVCS|
20|FH_F114853_0_0|SrvcGrp|88163|2022|PDM|5296.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F54552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F138730_22602_0|SrvcGrp|55677|2022|PDM|2500.00|99|0.00|VAGINAL DELIVERY ONLY|
20|FH_F86377_0_0|SrvcGrp|26001|2022|PDM|126.33|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F101044_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|283.84|99|0.00|HAPA WPA-NWPA 2012-13 ASC 230 W/O REV|
20|FH_F147231_49440_0|SrvcGrp|26160|2022|PDM|13.47|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F91953_99508_0|SrvcGrp|79238|2022|PDM|1150.00|99|0.00|TRANSFER|
20|FH_F141275_07004_0|SrvcGrp|13597|2022|PCT|1.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F94643_90501_0|SrvcGrp|22389|2022|PDM|15.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F92154_74023_0|SrvcGrp|78504|2022|PCT|0.71|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|376.42|99|0.00|SALLY BALIN,999182,ASC 211|
20|FH_F148667_0_0|SrvcGrp|67072|2022|PDM|3410.00|99|0.00|CPT 22845|
20|FH_F142370_0_0|SrvcGrp|113919|2022|PDM|1450.00|99|0.00|AIR FLUID BEDS|
20|FH_F102525_73134_0|SrvcGrp|89812|2022|PDM|7000.00|99|0.00|MS DRG 497 ONLY|
20|FH_F115483_62002_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150360_68112_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F31547_0_0|SrvcGrp|109840|2022|PCT|1.00|99|0.00|RADIOLOGY F/S - STAND ALONE|
20|FH_F68460_0_0|SrvcGrp|74614|2022|PDM|419.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F116332_0_0|SrvcGrp|113480|2022|PDM|16575.00|99|0.00|GASTRIC RESTRICTIVE|
20|FH_F136843_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116373_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC|
20|FH_F151042_60659_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F114585_11501_0|SrvcGrp|89149|2022|PDM|168.00|99|0.00|OP INTENSIVE|
20|FH_F131595_58103_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F67281_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114207_35243_0|SrvcGrp|86852|2022|PDM|35.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F39443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97480_08204_0|SrvcGrp|73659|2022|PDM|12124.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|657.00|99|0.00|AEG 1 (NO REV)|
20|FH_F94330_43220_0|SrvcGrp|57968|2022|PDM|31.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F94643_90501_0|SrvcGrp|19742|2022|PDM|300.00|99|0.00|MID-LINE INSERTION|
20|FH_F137748_95231_0|SrvcGrp|112965|2022|PDM|9024.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F36594_0_0|SrvcGrp|9828|2022|PDM|42.00|99|0.00|HOME HEALTH AIDE|
20|FH_F124749_90211_0|SrvcGrp|93337|2022|PDM|603.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F138018_17313_0|SrvcGrp|34566|2022|PDM|90.43|99|0.00|HOME INFUSION THERAPY|
20|FH_F139928_37228_0|SrvcGrp|72602|2022|PDM|794.00|99|0.00|ECT|
20|FH_F139950_76240_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F143347_16001_0|SrvcGrp|73806|2022|PDM|854.00|99|0.00|AETNA ER|
20|FH_F143348_16214_0|SrvcGrp|16|2022|PCT|0.89|99|0.00|ACUTE REHABILITATION|
20|FH_F143411_78212_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F143536_47546_0|SrvcGrp|96499|2022|PCT|1.00|99|0.00|ADMIN OF PNEUMOCOCCAL VACCINE|
20|FH_F63234_0_0|SrvcGrp|32407|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (RADIOLOGY)|
20|FH_F131093_49690_0|SrvcGrp|97507|2022|PDM|130.00|99|0.00|AETNA HOSPICE|
20|FH_F131093_49690_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131173_17043_0|SrvcGrp|88620|2022|PDM|106.00|99|0.00|SKILLED NURSING RN|
20|FH_F131173_17043_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F48473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1222.30|99|0.00|ASPG III|
20|FH_F132419_84042_0|SrvcGrp|89337|2022|PDM|871.58|99|0.00|DETOXIFICATION|
20|FH_F120799_92651_0|SrvcGrp|46903|2022|PDM|1250.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F112687_30474_0|SrvcGrp|73701|2022|PDM|63.80|99|0.00|AETNA - SKILLED NURSING|
20|FH_F116629_83467_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F116802_41224_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F83292_0_0|SrvcGrp|69531|2022|PCT|5.00|99|0.00|BARNESVILLE LABS @ 100% W/ OP SURG|
20|FH_F120974_27607_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|AEG 10 (NO REV)|
20|FH_F120977_50510_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F49895_0_0|SrvcGrp|31191|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF (DME)|
20|FH_F59732_0_0|SrvcGrp|34173|2022|PDM|135.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F59732_0_0|SrvcGrp|15596|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|3762.00|99|0.00|ASPG VIII - FH SW CUSTOM GROUPERS|
20|FH_F139515_0_0|SrvcGrp|89857|2022|PDM|8549.00|99|0.00|REMOVAL OF SPINAL LAMINA|
20|FH_F123926_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F66412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F128272_60640_0|SrvcGrp|86844|2022|PDM|50.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F79645_0_0|SrvcGrp|62260|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F89475_71202_0|SrvcGrp|73605|2022|PDM|892.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F129782_0_0|SrvcGrp|109760|2022|PCT|1.00|99|0.00|TRANSLUM DIL EYE CANAL|
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F38591_0_0|SrvcGrp|13187|2022|PCT|0.70|99|0.00|INTRAOCULAR LENSES|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY|
20|FH_F39476_0_0|SrvcGrp|8950|2022|PDM|1496.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F115121_32250_0|SrvcGrp|89417|2022|PDM|955.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F149888_68506_0|CSTM-ALL|CSTM-00|2020|PDM|2740.00|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_F94862_0_0|SrvcGrp|12491|2022|PCT|0.50|99|0.00|PACEMAKER|
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 10 (NO REV)|
20|FH_F102302_0_0|SrvcGrp|73002|2022|PDM|1644.00|99|0.00|AEG 7|
20|FH_F83255_32025_0|SrvcGrp|75545|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F41021_0_0|SrvcGrp|17069|2022|PDM|2763.00|99|0.00|ASPG III|
20|FH_F148549_60523_0|SrvcGrp|27969|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F149740_33912_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|98.25|99|0.00|HAPA WPA-NWPA 2012-13 ASC 244 W/O REV|
20|FH_F151460_68137_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F31927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F135609_37027_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136186_46307_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F136211_74447_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F100848_17202_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F116527_70443_0|SrvcGrp|10944|2022|PDM|225.00|99|0.00|EMERGENCY ROOM|
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 5  (NO REV)|
20|FH_F127399_0_0|SrvcGrp|91567|2022|PDM|2913.00|99|0.00|REPAIR OF KNEECAP TENDON|
20|FH_F67986_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101200_19020_0|SrvcGrp|90635|2022|PCT|1.15|99|0.00|AETNA PSYTX PT & FAMILY 60 MINUTES|
20|FH_F101665_10027_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F121731_20164_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121808_70390_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F42098_0_0|CSTM-ALL|CSTM-00|2020|PDM|65.00|99|0.00|PEDIATRIC RN ROUTINE NURSING|
20|FH_F130010_77384_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133565_32570_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111291_52501_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F111292_33136_0|SrvcGrp|82751|2022|PDM|29.00|99|0.00|GONADOTROIN CHORINIC (HCG) QUANTITATIVE|
20|FH_F134263_15628_0|SrvcGrp|90632|2022|PDM|145.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F141651_0_0|SrvcGrp|105244|2022|PDM|198.00|99|0.00|INCISION OF EARDRUM|
20|FH_F75806_0_0|SrvcGrp|10545|2022|PDM|332.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F132328_0_0|SrvcGrp|90157|2022|PDM|2562.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F43895_0_0|SrvcGrp|45884|2022|PDM|125.00|99|0.00|ST|
20|FH_F72666_0_0|SrvcGrp|8968|2022|PDM|1941.00|99|0.00|NICU LEVEL III & IV|
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1172.78|99|0.00|AEG 8 (NO REV)|
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129419_27407_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F102282_06795_0|SrvcGrp|74546|2022|PDM|671.32|99|0.00|HOSPICE SERVICES|
20|FH_F129220_18445_0|SrvcGrp|102979|2022|PDM|146.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AH)|
20|FH_F96960_35404_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132347_01605_0|SrvcGrp|65720|2022|PDM|110.00|99|0.00|RESPITE CARE|
20|FH_F143542_0_0|SrvcGrp|85966|2022|PDM|7459.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|435.75|99|0.00|AEG 1 (NO REV)|
20|FH_F36704_0_0|SrvcGrp|9834|2022|PDM|1100.00|99|0.00|ACUTE IP MEDICAL SVCS|
20|FH_F41605_0_0|SrvcGrp|97|2022|PDM|4327.00|99|0.00|C-SECTION|
20|FH_F67820_15009_0|SrvcGrp|13985|2022|PDM|47.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|1239.00|99|0.00|AEG 5  (NO REV)|
20|FH_F100906_0_0|SrvcGrp|67073|2022|PDM|2000.00|99|0.00|CPT 22851|
20|FH_F109279_0_0|SrvcGrp|79594|2022|PDM|600.00|99|0.00|CPT 45380|
20|FH_F69968_0_0|SrvcGrp|72739|2022|PDM|6685.29|99|0.00|CARDIAC CATH|
20|FH_F136414_54548_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118152_20151_0|SrvcGrp|86838|2022|PDM|15.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F118195_44039_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93358_63084_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137007_43160_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F137036_60504_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137237_33304_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F137238_70056_0|SrvcGrp|90854|2022|PDM|963.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F139751_84065_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142449_62220_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F138469_70433_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F125053_0_0|SrvcGrp|79595|2022|PDM|2535.00|99|0.00|CPT 45385|
20|FH_F140312_77365_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140343_89052_0|SrvcGrp|86854|2022|PDM|30.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F140387_72202_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F140468_46825_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140791_20678_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140887_43338_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F149531_80237_0|SrvcGrp|74668|2022|PDM|292.50|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151609_17601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F119003_78070_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F119023_91406_0|SrvcGrp|86846|2022|PDM|35.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F118943_64506_0|SrvcGrp|43568|2022|PDM|83.00|99|0.00|SKILLED NURSING - RN|
20|FH_F92506_07666_0|SrvcGrp|73806|2022|PDM|845.00|99|0.00|AETNA ER|
20|FH_F67880_0_0|SrvcGrp|13880|2022|PCT|0.75|99|0.00|IMPLANTS|
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|557.70|99|0.00|AETNA GLENNVILLE 2016 AEG 1|
20|FH_F117295_70006_0|SrvcGrp|73701|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F147725_06002_0|SrvcGrp|99174|2022|PDM|2590.00|99|0.00|CPT 30140|
20|FH_F147801_90703_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F147779_34240_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129483_77030_0|SrvcGrp|14948|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129483_77030_0|SrvcGrp|84260|2022|PCT|1.00|99|0.00|AETNA ALL DRUGS|
20|FH_F129524_48104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F117098_20186_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F137806_83702_0|SrvcGrp|89149|2022|PDM|235.00|99|0.00|OP INTENSIVE|
20|FH_F137850_32826_0|SrvcGrp|73841|2022|PDM|296.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F137891_23451_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F39893_0_0|SrvcGrp|24703|2022|PDM|320.00|99|0.00|NEWBORN NURSERY|
20|FH_F109652_0_0|SrvcGrp|78843|2022|PDM|3761.00|99|0.00|INTENSITY MODULATED RADIOTHERAPY PLAN|
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90880_15108_0|SrvcGrp|10505|2022|PCT|1.00|99|0.00|CPT CODE 97001 PHYSICAL THERAPY INITIAL EVALUATION|
20|FH_F52716_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F51016_0_0|SrvcGrp|471|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132544_0_0|SrvcGrp|96354|2022|PDM|7850.00|99|0.00|REMOVAL OF ANKLE JOINT|
20|FH_F148554_85016_0|CSTM-ALL|CSTM-00|2020|PDM|1510.00|99|0.00|AEG 9 (NO REV)|
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PDM|666.51|99|0.00|AEG 3 (NO REV)|
20|FH_F106740_02886_0|SrvcGrp|81340|2022|PCT|2.20|99|0.00|AETNA LABORATORY|
20|FH_F148861_18706_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F117835_14551_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F49637_0_0|SrvcGrp|33198|2022|PDM|12600.00|99|0.00|MS DRG 330 ONLY|
20|FH_F87615_80033_0|SrvcGrp|87995|2022|PDM|464.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F117794_06473_0|SrvcGrp|473|2022|PDM|593.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F101840_76054_0|SrvcGrp|73559|2022|PDM|2957.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F101923_98104_0|SrvcGrp|14727|2022|PCT|0.82|99|0.00|TRAUMA CARE|
20|FH_F128762_78231_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146217_0_0|SrvcGrp|82222|2022|PDM|178.66|99|0.00|HOSPICE CARE|
20|FH_F60101_0_0|SrvcGrp|42824|2022|PDM|84.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F40645_0_0|SrvcGrp|1306|2022|PDM|546.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F113324_17055_0|SrvcGrp|105212|2022|PDM|1100.00|99|0.00|SKILLED CARE LEVEL 4|
20|FH_F133427_48811_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141802_17042_0|SrvcGrp|21457|2022|PCT|0.68|99|0.00|CPT CODE 95811|
20|FH_F133397_23233_0|SrvcGrp|87536|2022|PDM|416.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|79046|2022|PDM|660.18|99|0.00|MON VALLEY ASC 125|
20|FH_F113586_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F89932_10940_0|SrvcGrp|78403|2022|PDM|0.50|99|0.00|AETNA MED RECORD|
20|FH_F68121_0_0|SrvcGrp|64319|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|ASPG VI|
20|FH_F118845_71111_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F41429_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F126666_44053_0|SrvcGrp|105372|2022|PDM|53.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MIN|
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120437_85202_0|SrvcGrp|99031|2022|PDM|39.39|99|0.00|ANTIBIOTIC Q12H (HCFA)|
20|FH_F140790_0_0|SrvcGrp|28548|2022|PDM|2750.00|99|0.00|VITRECTOMY|
20|FH_F133135_48235_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150500_85253_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F94300_0_0|SrvcGrp|93601|2022|PDM|4200.00|99|0.00|REVISON OF KNEE JOINT(HCFA)|
20|FH_F133095_30024_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_F34696_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F106540_26330_0|SrvcGrp|31505|2022|PCT|0.50|99|0.00|TRAUMA CARE|
20|FH_F78682_0_0|SrvcGrp|75662|2022|PDM|1200.00|99|0.00|ENDOSCOPY|
20|FH_F64940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F106580_33321_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F106600_99202_0|SrvcGrp|86648|2022|PCT|1.05|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F123091_92627_0|SrvcGrp|46903|2022|PDM|1200.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F147995_67037_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F132690_87571_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144348_22601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132528_64014_0|SrvcGrp|29347|2022|PDM|26.00|99|0.00|HOME HEALTH AIDE|
20|FH_F148662_01583_0|SrvcGrp|471|2022|PDM|700.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F88512_0_0|SrvcGrp|107496|2022|PDM|24749.14|99|0.00|ATHERECTOMY PROCEDURES|
20|FH_F133472_27607_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116428_0_0|SrvcGrp|92502|2022|PDM|573.47|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F87592_85614_0|SrvcGrp|82138|2022|PDM|2541.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|2684.00|99|0.00|AEG 9 (NO REV)|
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|1725.00|99|0.00|AEG 9 (NO REV)|
20|FH_F119226_07746_0|SrvcGrp|90070|2022|PDM|115.00|99|0.00|GROUP RX|
20|FH_F144088_48706_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F32869_0_0|SrvcGrp|18253|2022|PDM|4000.00|99|0.00|MS DRG 287|
20|FH_F141657_85715_0|SrvcGrp|108484|2022|PDM|630.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD UE) - BDSS|
20|FH_F144008_11413_0|SrvcGrp|88621|2022|PDM|75.00|99|0.00|SKILLED NURSING LPN|
20|FH_F94300_0_0|SrvcGrp|84939|2022|PDM|4200.00|99|0.00|SHOULDER JOINT|
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1550.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 7|
20|FH_F64943_0_0|SrvcGrp|61039|2022|PDM|783.00|99|0.00|ELECTROCONVULSIVE THERAPY (ECT)|
20|FH_F117372_07442_0|SrvcGrp|89149|2022|PDM|180.00|99|0.00|OP INTENSIVE|
20|FH_F91152_60061_0|SrvcGrp|43523|2022|PDM|205.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F117087_0_0|SrvcGrp|65402|2022|PDM|2494.00|99|0.00|CPT 42145|
20|FH_F63301_0_0|SrvcGrp|24029|2022|PDM|25.00|99|0.00|RN HOURLY|
20|FH_F63301_0_0|SrvcGrp|43429|2022|PDM|120.00|99|0.00|RN HOURLY, HIGH TECH PEDS|
20|FH_F145288_45345_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F33908_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.90|99|0.00|OP SVCS|
20|FH_F118542_60188_0|SrvcGrp|19742|2022|PDM|78.00|99|0.00|MID-LINE INSERTION|
20|FH_F35454_0_0|SrvcGrp|3403|2022|PDM|60.00|99|0.00|CPT 99203|
20|FH_F126676_43537_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F39844_0_0|CSTM-ALL|CSTM-00|2020|PDM|981.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F147996_21014_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F97581_60141_0|SrvcGrp|73461|2022|PDM|7581.00|99|0.00|AETNA NICU IV|
20|FH_F148890_45133_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148040_90631_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F148555_0_0|SrvcGrp|115497|2022|PDM|5522.00|99|0.00|EP & ABLATE VENTRIC TACHY|
20|FH_F132934_63005_0|SrvcGrp|31771|2022|PDM|12242.00|99|0.00|MS DRG 417-419 ONLY  LAP CHOLE|
20|FH_F88956_0_0|SrvcGrp|20075|2022|PDM|5537.00|99|0.00|MS DRG 286 ONLY|
20|FH_F143054_26147_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F117385_48091_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F36118_0_0|SrvcGrp|10410|2022|PDM|47.00|99|0.00|SKILLED NURSING CARE|
20|FH_F88956_0_0|SrvcGrp|74580|2022|PCT|0.50|99|0.00|AETNA IP IMPLANTS|
20|FH_F125176_20785_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/MOD RR (TX)|
20|FH_F117901_27526_0|SrvcGrp|94735|2022|PCT|1.10|99|0.00|AFLURIA VACC IM (>=3 YRS)|
20|FH_F128597_37129_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F62560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40943_0_0|SrvcGrp|472|2022|PDM|377.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F32861_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F122928_39563_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F69648_0_0|SrvcGrp|48396|2022|PDM|11.25|99|0.00|OT SERVICES|
20|FH_F38663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BURMANS APOTHECARY DME MOD NU|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|201.90|99|0.00|ASPG 309|
20|FH_F69071_0_0|SrvcGrp|13683|2022|PDM|864.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F52032_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (BREAKOUT)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|960.49|99|0.00|HAPA WPA-NWPA 2012-13 ASC 6 W/O REV|
20|FH_F148867_20191_0|SrvcGrp|73701|2022|PDM|63.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F151141_24014_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F151155_26508_0|SrvcGrp|74668|2022|PDM|243.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139347_06471_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139454_32839_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150820_83843_0|CSTM-ALL|CSTM-00|2020|PDM|1959.00|99|0.00|AEG 4 (NO REV)|
20|FH_F146859_0_0|SrvcGrp|101117|2022|PDM|2150.00|99|0.00|INCISION EXTENSOR TENDON|
20|FH_F37092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F137788_72632_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F130661_04441_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|GENERAL ACUTE CARE|
20|FH_F109515_15301_0|SrvcGrp|79458|2022|PDM|0.25|99|0.00|MED RECORD COPY|
20|FH_F98801_93274_0|SrvcGrp|73559|2022|PDM|10385.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F138478_0_0|SrvcGrp|109508|2022|PDM|4763.37|99|0.00|REMOVAL OF PM GENERATOR|
20|FH_F149160_02180_0|SrvcGrp|113171|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F146266_0_0|SrvcGrp|82114|2022|PDM|2690.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|161.85|99|0.00|SALLY BALIN,999182,ASC 221|
20|FH_F128386_60124_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F126116_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F31087_0_0|SrvcGrp|10521|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY|
20|FH_F120435_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|35315.00|99|0.00|CV SURGERY|
20|FH_F93172_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149379_53213_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|100% 2007 MEDICARE TN DME MOD AU|
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PDM|3577.00|99|0.00|AEG 10 (NO REV)|
20|FH_F35446_0_0|SrvcGrp|177|2022|PDM|2652.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F114707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|148.06|99|0.00|SALLY BALIN,999182,ASC 119|
20|FH_F131392_17004_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F97880_63501_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|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_F97260_06111_0|SrvcGrp|73559|2022|PDM|4812.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F117762_0_0|SrvcGrp|88161|2022|PDM|4992.00|99|0.00|LAMINECTOMY W/FACE-THORACIC|
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|3740.00|99|0.00|AEG 8 (NO REV)|
20|FH_F136806_0_0|SrvcGrp|55071|2022|PDM|2218.00|99|0.00|ARTHROSCOPY SHOULDER|
20|FH_F148667_0_0|SrvcGrp|100059|2022|PDM|2856.00|99|0.00|REPAIR ULNA FRACTURE|
20|FH_F128490_88240_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F47558_0_0|SrvcGrp|40404|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K  CODES)- MOD AU|
20|FH_F138017_73129_0|SrvcGrp|97471|2022|PDM|8122.00|99|0.00|REMOVAL OF THYROID DUCT LESION|
20|FH_F138018_17313_0|SrvcGrp|29023|2022|PDM|103.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F126914_44136_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117762_0_0|SrvcGrp|83646|2022|PDM|3120.00|99|0.00|CPT 31276|
20|FH_F151003_33162_0|SrvcGrp|46903|2022|PDM|670.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F148255_72703_0|SrvcGrp|17014|2022|PDM|31.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F122536_0_0|CSTM-ALL|CSTM-00|2020|PDM|8000.00|99|0.00|ASPG III|
20|FH_F36366_0_0|SrvcGrp|22919|2022|PDM|152.00|99|0.00|CPT 95806|
20|FH_F39022_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
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_F41350_0_0|CSTM-ALL|CSTM-00|2020|PDM|990.00|99|0.00|ASPG IV|
20|FH_F87254_0_0|SrvcGrp|72996|2022|PDM|874.00|99|0.00|AEG 4|
20|FH_F135267_19002_0|SrvcGrp|89337|2022|PDM|1123.00|99|0.00|DETOXIFICATION|
20|FH_F141802_17042_0|SrvcGrp|112224|2022|PDM|95.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F84135_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F38280_0_0|SrvcGrp|28703|2022|PDM|60.00|99|0.00|PT/ST/OT|
20|FH_F55613_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123278_20850_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139551_0_0|SrvcGrp|33967|2022|PDM|3495.00|99|0.00|CPT 47562|
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|851.00|99|0.00|AEG 6 (NO REV)|
20|FH_F82696_16335_0|SrvcGrp|76010|2022|PDM|1154.00|99|0.00|EMERGENCY ROOM SVCS LEVEL III|
20|FH_F37443_0_0|SrvcGrp|360|2022|PDM|2100.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F122687_0_0|SrvcGrp|96539|2022|PDM|3825.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F124017_0_0|SrvcGrp|86199|2022|PDM|3500.00|99|0.00|ARTHROSCOPY HIP|
20|FH_F145552_86301_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F110925_01104_0|SrvcGrp|73700|2022|PDM|50.43|99|0.00|AETNA - SKILLED NURSING|
20|FH_F118194_50841_0|SrvcGrp|29077|2022|PDM|545.00|99|0.00|HOME TRANSFUSION|
20|FH_F141410_13045_0|CSTM-ALL|CSTM-00|2020|PDM|1360.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F39476_0_0|SrvcGrp|3066|2022|PCT|0.45|99|0.00|HIGH-COST DRUGS|
20|FH_F123407_04605_0|SrvcGrp|104084|2022|PDM|521.00|99|0.00|RESIDENTIAL ADULT CD(<= 17 YRS)|
20|FH_F128982_44221_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F72765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS|
20|FH_F32935_0_0|SrvcGrp|16|2022|PDM|968.00|99|0.00|ACUTE REHABILITATION|
20|FH_F98801_93274_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F137943_0_0|SrvcGrp|68281|2022|PDM|1700.00|99|0.00|CPT 67041|
20|FH_F56276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F145550_62034_0|SrvcGrp|82223|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F75425_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63276_0_0|SrvcGrp|42826|2022|PDM|140.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|2345.00|99|0.00|AEG 2 (NO REV)|
20|FH_F65440_0_0|SrvcGrp|14614|2022|PDM|4285.00|99|0.00|LITHOTRIPSY|
20|FH_F129011_15857_0|SrvcGrp|46605|2022|PDM|130.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F49920_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F60019_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F137087_0_0|SrvcGrp|41335|2022|PDM|23000.00|99|0.00|TOTAL HIP|
20|FH_F37884_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD AV|
20|FH_F137946_0_0|SrvcGrp|113231|2022|PDM|105.33|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 TITER|
20|FH_F41776_0_0|CSTM-ALL|CSTM-00|2020|PDM|1709.00|99|0.00|ASPG II|
20|FH_F38034_0_0|SrvcGrp|11283|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER|
20|FH_F43118_0_0|SrvcGrp|38566|2022|PCT|0.70|99|0.00|INTRACARDIAC ABLATION + ELECTROPHYSIOLOGY|
20|FH_F120215_92064_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F89475_71202_0|SrvcGrp|73559|2022|PDM|2715.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F143783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F142073_0_0|SrvcGrp|89861|2022|PDM|5980.00|99|0.00|LUMBAR LAMINOTOMY|
20|FH_F51358_0_0|SrvcGrp|46234|2022|PDM|130.00|99|0.00|SKILLED NURSING|
20|FH_F33456_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F86031_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122433_0_0|SrvcGrp|88760|2022|PDM|1000.00|99|0.00|CERVICAL ARTHRODESIS|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHYSICIAN CLINIC VISIT NATL F/S (MOD UE)|
20|FH_F62915_0_0|SrvcGrp|58796|2022|PCT|1.87|99|0.00|OCN F/S SURGERY CPT (HCFA) (MOD 26 53 TC) GLOBAL|
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1692.03|99|0.00|AEG 4 (NO REV)|
20|FH_F109645_0_0|SrvcGrp|34389|2022|PDM|88.00|99|0.00|SPEECH THERAPY|
20|FH_F60317_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123895_52722_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130747_0_0|SrvcGrp|98498|2022|PDM|8843.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC|
20|FH_F89779_0_0|SrvcGrp|73006|2022|PDM|3500.00|99|0.00|AEG 9|
20|FH_F126465_37190_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|1406.00|99|0.00|AEG 6 (NO REV)|
20|FH_F128272_60640_0|SrvcGrp|86846|2022|PDM|50.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F127205_44125_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102302_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F151524_84121_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37330_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F135021_37160_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F137460_42103_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F41350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1564.00|99|0.00|ASPG X|
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 4 (NO REV)|
20|FH_F39022_0_0|SrvcGrp|97|2022|PDM|2610.00|99|0.00|C-SECTION|
20|FH_F130716_76013_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F130051_31707_0|CSTM-ALL|CSTM-00|2020|PDM|1684.00|99|0.00|AEG 1 (NO REV)|
20|FH_F40063_0_0|SrvcGrp|31700|2022|PDM|806.00|99|0.00|CD DETOX|
20|FH_F73985_0_0|SrvcGrp|26214|2022|PDM|18982.00|99|0.00|SPINE SURGERY|
20|FH_F135052_18702_0|SrvcGrp|473|2022|PDM|403.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F110086_21742_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150521_0_0|CSTM-ALL|CSTM-00|2020|PDM|557.00|99|0.00|AEG 1 (NO REV)|
20|FH_F151699_01752_0|SrvcGrp|14945|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F147339_08837_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148667_0_0|SrvcGrp|104112|2022|PDM|2856.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F39450_0_0|CSTM-ALL|CSTM-00|2020|PDM|1190.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F120848_20912_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F98940_70506_0|SrvcGrp|73643|2022|PDM|1491.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F81312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F144651_0_0|SrvcGrp|114172|2022|PDM|3000.00|99|0.00|SPINE FIXATION|
20|FH_F75724_0_0|SrvcGrp|28398|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHO/IMPLANTS|
20|FH_F124329_37874_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146266_0_0|SrvcGrp|99073|2022|PDM|1.35|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F32777_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F150941_68124_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F40644_0_0|SrvcGrp|11199|2022|PCT|0.80|99|0.00|HYPERBARIC CHAMBER|
20|FH_F146859_0_0|SrvcGrp|103574|2022|PDM|4945.00|99|0.00|ANKLE ARTHROSCOPY|
20|FH_F134872_32168_0|CSTM-ALL|CSTM-00|2020|PCT|0.20|99|0.00|OP SVCS|
20|FH_F147227_48302_0|SrvcGrp|57967|2022|PDM|208.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F91799_15010_0|SrvcGrp|75545|2022|PDM|366.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F134968_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113545_11201_0|SrvcGrp|101679|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION (HCFA)|
20|FH_F36323_0_0|SrvcGrp|474|2022|PDM|325.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F75606_0_0|SrvcGrp|20752|2022|PDM|19390.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F92431_80033_0|SrvcGrp|48394|2022|PDM|72.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F127418_0_0|SrvcGrp|100919|2022|PDM|5419.19|99|0.00|SPINE PROSTH DEVICE|
20|FH_F127487_60169_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F71108_0_0|SrvcGrp|21460|2022|PDM|5200.00|99|0.00|MS DRG 775 ONLY REPLACEMENT 807|
20|FH_F125656_92868_0|SrvcGrp|24745|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F73923_0_0|SrvcGrp|71219|2022|PDM|796.00|99|0.00|COLONOSCOPY CPT 45382|
20|FH_F92431_80033_0|SrvcGrp|88620|2022|PDM|146.00|99|0.00|SKILLED NURSING RN|
20|FH_F124727_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F37490_0_0|SrvcGrp|26430|2022|PDM|5000.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F146266_0_0|SrvcGrp|97741|2022|PDM|10928.00|99|0.00|REVISE KNEE|
20|FH_F149023_44122_0|SrvcGrp|58634|2022|PDM|6500.00|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|390.54|99|0.00|SALLY BALIN,999182,ASC 210|
20|FH_F90232_15126_0|SrvcGrp|26868|2022|PDM|47.25|99|0.00|DIURETIC IV THERAPY|
20|FH_F128583_45154_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F39443_0_0|SrvcGrp|30350|2022|PDM|248.00|99|0.00|HAPA WPA ASC 306|
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_F38496_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F131392_17004_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F122336_67042_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41463_0_0|SrvcGrp|35467|2022|PCT|0.00|99|0.00|OXYGEN PURCHASE (NO PAY) (E0443/E0444)|
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123745_0_0|SrvcGrp|88492|2022|PDM|2500.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|73.00|99|0.00|HAPA EPA ASC 12|
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F138254_75446_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140131_62870_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F71747_0_0|SrvcGrp|42784|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F102920_0_0|SrvcGrp|87679|2022|PDM|2026.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)|
20|FH_F151754_71943_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151764_03801_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F47952_0_0|SrvcGrp|44283|2022|PDM|500.00|99|0.00|HOSPICE CARE|
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.00|99|0.00|ASPG IV|
20|FH_F120233_24368_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F120747_19129_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116633_37217_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120974_27607_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51276_0_0|SrvcGrp|24747|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F33925_0_0|SrvcGrp|18107|2022|PDM|22990.00|99|0.00|MS DRG 236|
20|FH_F35685_0_0|SrvcGrp|11227|2022|PDM|17640.00|99|0.00|DRG 557 PERCUTANEOUS CV PX W/DRUG-ELUTING STENT W/MAJ CV DX|
20|FH_F41015_0_0|SrvcGrp|472|2022|PDM|395.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F42177_0_0|SrvcGrp|12146|2022|PDM|1250.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F98621_41042_0|SrvcGrp|88977|2022|PDM|6277.00|99|0.00|C-SECTION DELIVERY|
20|FH_F62579_0_0|SrvcGrp|22592|2022|PDM|80.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F63235_0_0|SrvcGrp|73002|2022|PDM|2784.00|99|0.00|AEG 7|
20|FH_F133749_84604_0|SrvcGrp|112442|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F110542_10035_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F111986_0_0|SrvcGrp|104124|2022|PDM|2060.00|99|0.00|ARTHROSCOPY SERVICES|
20|FH_F130329_64114_0|SrvcGrp|46104|2022|PDM|50.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F124369_0_0|SrvcGrp|33973|2022|PDM|9350.00|99|0.00|CPT 28119|
20|FH_F61072_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132092_0_0|SrvcGrp|63297|2022|PDM|169.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F64140_0_0|SrvcGrp|62477|2022|PDM|60.50|99|0.00|E & M CODES|
20|FH_F122705_33351_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F62797_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|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_F130715_98503_0|SrvcGrp|109798|2022|PCT|1.10|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F130755_04401_0|SrvcGrp|107806|2022|PCT|2.25|99|0.00|CHEMOTHERAPY/ALL OTHER DRUGS|
20|FH_F130775_61701_0|CSTM-ALL|CSTM-00|2020|PDM|461.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F77044_0_0|SrvcGrp|74141|2022|PCT|1.00|99|0.00|INFUSION S-CODES|
20|FH_F96160_32207_0|SrvcGrp|86833|2022|PDM|25.89|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F37910_0_0|SrvcGrp|27761|2022|PCT|0.85|99|0.00|ICU/CCU|
20|FH_F118147_33801_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136353_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F145702_22192_0|SrvcGrp|73701|2022|PDM|31.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F146420_18940_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F50474_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F150165_06032_0|SrvcGrp|66305|2022|PDM|2270.00|99|0.00|CPT 53450|
20|FH_F136359_0_0|SrvcGrp|104856|2022|PDM|6125.00|99|0.00|PERCUTANEIOUS VERTEBROPLASY|
20|FH_F132606_0_0|SrvcGrp|70749|2022|PDM|1305.00|99|0.00|CPT 29823|
20|FH_F50657_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F31998_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121476_0_0|SrvcGrp|108839|2022|PDM|1670.00|99|0.00|ADHESION BARRIER|
20|FH_F112041_19020_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114527_39047_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F110506_98901_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|1417.00|99|0.00|AEG 2 (NO REV)|
20|FH_F128816_43537_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F85353_16407_0|SrvcGrp|63866|2022|PDM|342.21|99|0.00|HAPA WPA-NWPA 2012-13 ASC 120|
20|FH_F120715_83440_0|SrvcGrp|102420|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F148429_0_0|SrvcGrp|16|2022|PDM|1372.00|99|0.00|ACUTE REHABILITATION|
20|FH_F84593_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127091_62016_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F134207_19116_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111882_51560_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134668_08003_0|SrvcGrp|73842|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F127642_07047_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F130017_02302_0|SrvcGrp|29757|2022|PDM|28990.81|99|0.00|MS DRG 251 ONLY|
20|FH_F112023_12866_0|SrvcGrp|131|2022|PCT|0.65|99|0.00|PACEMAKER DEVICE|
20|FH_F145882_02368_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142376_0_0|SrvcGrp|113729|2022|PDM|17800.00|99|0.00|INSJ STABLJ DEV W/DCMPRN|
20|FH_F133207_0_0|SrvcGrp|82114|2022|PDM|3529.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F110521_98034_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|1961.00|99|0.00|AEG 9 (NO REV)|
20|FH_F83995_16748_0|SrvcGrp|11336|2022|PCT|1.00|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F80613_0_0|SrvcGrp|15850|2022|PDM|120.00|99|0.00|HOSPICE SVCS|
20|FH_F133922_70563_0|SrvcGrp|112504|2022|PDM|391.51|99|0.00|SLEEP EEG|
20|FH_F150165_06032_0|SrvcGrp|28548|2022|PDM|4800.00|99|0.00|VITRECTOMY|
20|FH_F130826_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130017_02302_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F78524_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150139_71667_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137610_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F145667_01905_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132969_84003_0|SrvcGrp|86854|2022|PDM|25.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F83978_66739_0|SrvcGrp|63469|2022|PDM|1792.00|99|0.00|CPT 55700|
20|FH_F146650_29690_0|SrvcGrp|108484|2022|PDM|711.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F135610_06451_0|SrvcGrp|93734|2022|PCT|1.05|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F35966_0_0|SrvcGrp|16898|2022|PDM|495.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F86112_63501_0|SrvcGrp|76744|2022|PCT|0.47|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F145641_06902_0|SrvcGrp|100922|2022|PDM|2236.00|99|0.00|AETNA SURGE|
20|FH_F138047_77027_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F77943_0_0|SrvcGrp|20252|2022|PDM|84768.89|99|0.00|MS DRG 224-225 ONLY|
20|FH_F92598_21236_0|SrvcGrp|48398|2022|PDM|125.00|99|0.00|PT SERVICES|
20|FH_F116806_0_0|SrvcGrp|104909|2022|PDM|1923.16|99|0.00|EXCISE PAROTID GLAND/LESION|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|392.78|99|0.00|HAPA WPA-NWPA 2012-13 ASC 118 W/O REV|
20|FH_F150307_84111_0|SrvcGrp|74668|2022|PDM|287.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F135623_53115_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 10 (NO REV)|
20|FH_F126157_34210_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F60253_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F132922_91302_0|SrvcGrp|73842|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121225_98902_0|SrvcGrp|21711|2022|PDM|269.88|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAMPTON ROADS GAST MOD AV|
20|FH_F134655_14221_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F132969_84003_0|SrvcGrp|95660|2022|PDM|474.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F143742_60410_0|SrvcGrp|73602|2022|PDM|568.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F60072_0_0|SrvcGrp|4109|2022|PDM|1100.00|99|0.00|ACUTE PSYCH|
20|FH_F149145_33460_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F112863_0_0|SrvcGrp|104250|2022|PDM|2002.00|99|0.00|FOREHEAD FLAP WITH PRESERV|
20|FH_F132969_84003_0|SrvcGrp|63297|2022|PDM|93.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F150161_63361_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F150165_06032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83380_0_0|CSTM-ALL|CSTM-00|2020|PDM|38.00|99|0.00|NURSING CARE MOD TE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|537.66|99|0.00|HAPA WPA-NWPA 2012-13 ASC 217 W/O REV|
20|FH_F135610_06451_0|SrvcGrp|95660|2022|PDM|515.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F146005_67037_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133876_27405_0|SrvcGrp|89149|2022|PDM|221.00|99|0.00|OP INTENSIVE|
20|FH_F133972_27103_0|SrvcGrp|86840|2022|PDM|35.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F150165_06032_0|CSTM-ALL|CSTM-00|2020|PDM|2163.00|99|0.00|AEG 6 (NO REV)|
20|FH_F149149_32937_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F144248_0_0|SrvcGrp|92549|2022|PDM|5738.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F85995_64111_0|SrvcGrp|48394|2022|PDM|75.56|99|0.00|SKILLED NURSING SERVICES|
20|FH_F93179_73460_0|SrvcGrp|79699|2022|PCT|0.68|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F110423_33401_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F83380_0_0|SrvcGrp|37767|2022|PDM|50.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F110441_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F145558_43950_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114526_33401_0|SrvcGrp|73841|2022|PDM|401.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F134650_07921_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F135451_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.20|99|0.00|OP SVCS|
20|FH_F72584_0_0|SrvcGrp|42827|2022|PDM|130.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F71550_0_0|SrvcGrp|17140|2022|PDM|134.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F149139_07522_0|SrvcGrp|113231|2022|PDM|105.33|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 TITER|
20|FH_F143650_0_0|SrvcGrp|73004|2022|PDM|2190.00|99|0.00|AEG 8|
20|FH_F134172_33126_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F87571_0_0|SrvcGrp|10906|2022|PCT|0.60|99|0.00|EMERGENCY ROOM LEVEL IV|
20|FH_F119379_0_0|SrvcGrp|107842|2022|PDM|885.00|99|0.00|SKIN GRAFT PROCEDURE|
20|FH_F111986_0_0|SrvcGrp|63466|2022|PDM|1442.00|99|0.00|CPT 52005|
20|FH_F133727_33511_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F88744_71103_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F119227_01752_0|SrvcGrp|22592|2022|PDM|38.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F112665_0_0|SrvcGrp|88157|2022|PDM|7215.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F127638_44720_0|SrvcGrp|95661|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F129633_0_0|SrvcGrp|72059|2022|PCT|1.00|99|0.00|OP SURGERY CPT AND HCPCS|
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|ASPG X|
20|FH_F59872_0_0|CSTM-ALL|CSTM-00|2020|PDM|3615.00|99|0.00|ASPG VII|
20|FH_F75087_0_0|SrvcGrp|44067|2022|PDM|1200.00|99|0.00|CPT 52240|
20|FH_F110404_17821_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F145641_06902_0|SrvcGrp|98465|2022|PDM|3802.00|99|0.00|OPEN TXMT METATARSOPHALANGEAL|
20|FH_F119732_37660_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F150165_06032_0|SrvcGrp|72121|2022|PDM|2807.00|99|0.00|ARTHOSCOPY|
20|FH_F120720_24541_0|SrvcGrp|53746|2022|PDM|80.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F110541_99336_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F124371_0_0|SrvcGrp|13595|2022|PDM|344.16|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F116806_0_0|SrvcGrp|107031|2022|PDM|1923.16|99|0.00|RECONSTRUCT FACIAL CONTOUR|
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1330.00|99|0.00|AEG 6 (NO REV)|
20|FH_F147962_85008_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|VALLEYWISE MSDRG|
20|FH_F129509_0_0|SrvcGrp|67066|2022|PDM|7175.00|99|0.00|CERVICAL SURGERY|
20|FH_F120719_27540_0|SrvcGrp|108565|2022|PCT|0.71|99|0.00|PT OT ST|
20|FH_F121816_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F96780_0_0|SrvcGrp|46887|2022|PDM|1761.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F54592_0_0|SrvcGrp|26871|2022|PDM|95.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3 HRS|
20|FH_F63297_0_0|SrvcGrp|59426|2022|PDM|75.00|99|0.00|PT|
20|FH_F134495_84321_0|SrvcGrp|48396|2022|PDM|85.50|99|0.00|OT SERVICES|
20|FH_F105143_26062_0|SrvcGrp|11306|2022|PCT|1.25|99|0.00|IMPLANTS|
20|FH_F105361_80104_0|SrvcGrp|72996|2022|PDM|1799.00|99|0.00|AEG 4|
20|FH_F66782_0_0|SrvcGrp|62736|2022|PDM|25.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F75842_0_0|SrvcGrp|30063|2022|PCT|0.49|99|0.00|HIGH COST DRUGS|
20|FH_F146881_83661_0|SrvcGrp|29155|2022|PDM|140.00|99|0.00|HOSPICE SVCS|
20|FH_F115950_08648_0|SrvcGrp|86747|2022|PCT|1.05|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F115972_92675_0|SrvcGrp|86748|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F116056_73018_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F133592_63957_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133401_33404_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F133415_90066_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F133478_40165_0|SrvcGrp|73605|2022|PDM|725.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F134826_19067_0|SrvcGrp|89149|2022|PDM|210.00|99|0.00|OP INTENSIVE|
20|FH_F134826_19067_0|SrvcGrp|90649|2022|PDM|150.00|99|0.00|AETNA FAMILY PSYTX W/O PATIENT (HCFA)|
20|FH_F35404_0_0|SrvcGrp|9793|2022|PDM|455.00|99|0.00|NEWBORN NURSERY|
20|FH_F133132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F133536_0_0|SrvcGrp|67065|2022|PDM|17600.00|99|0.00|CERVICAL SURGERY|
20|FH_F110824_83221_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F127324_0_0|SrvcGrp|87059|2022|PDM|3105.00|99|0.00|REPAIR OF TENDON|
20|FH_F47424_0_0|SrvcGrp|42785|2022|PDM|75.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F142327_0_0|SrvcGrp|71087|2022|PDM|1000.00|99|0.00|CARVE OUTS V2787|
20|FH_F35167_0_0|SrvcGrp|72|2022|PDM|860.00|99|0.00|NEWBORN NURSERY|
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_F146204_0_0|SrvcGrp|101523|2022|PDM|1500.00|99|0.00|CERCLAGE OF CERVIX|
20|FH_F35410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|INFI- SS CODES|
20|FH_F40624_0_0|SrvcGrp|360|2022|PDM|675.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F117605_85260_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F35086_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS|
20|FH_F114676_91911_0|SrvcGrp|89022|2022|PDM|35.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F124526_05301_0|SrvcGrp|61040|2022|PDM|648.00|99|0.00|ADOLESCENT ACUTE RESIDENTIAL|
20|FH_F114206_37203_0|SrvcGrp|24752|2022|PDM|15.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1580.00|99|0.00|AEG 10 (NO REV)|
20|FH_F141287_14830_0|SrvcGrp|112223|2022|PDM|110.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F149273_0_0|SrvcGrp|88030|2022|PDM|6763.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F124441_0_0|SrvcGrp|104448|2022|PDM|11244.20|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE|
20|FH_F108680_0_0|SrvcGrp|102723|2022|PDM|3850.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F43293_0_0|SrvcGrp|3165|2022|PCT|0.85|99|0.00|EMERGENCY ROOM|
20|FH_F111260_0_0|SrvcGrp|82981|2022|PDM|175.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F43081_0_0|CSTM-ALL|CSTM-00|2020|PDM|399.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36094_0_0|SrvcGrp|57483|2022|PDM|55.00|99|0.00|PHYSICAL THERAPY W/O 97001-97004|
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV)|
20|FH_F90151_24382_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F117426_0_0|SrvcGrp|75545|2022|PDM|245.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F131392_17004_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147210_70633_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F112045_90301_0|SrvcGrp|103702|2022|PDM|8820.00|99|0.00|LITHOTRIPSY|
20|FH_F143307_72223_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F84631_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.46|99|0.00|HAPA WPA/NWPA 2016 RAD 100%|
20|FH_F47812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116907_75093_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125479_17501_0|SrvcGrp|100859|2022|PDM|212.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F126970_45601_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F118792_63379_0|SrvcGrp|99190|2022|PCT|0.00|99|0.00|NORMAL DELIVERY|
20|FH_F84394_17402_0|SrvcGrp|11673|2022|PDM|7240.00|99|0.00|CPT 29888|
20|FH_F51276_0_0|SrvcGrp|21711|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F40855_0_0|SrvcGrp|97|2022|PDM|3467.00|99|0.00|C-SECTION|
20|FH_F42964_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102950_86040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F103004_75840_0|SrvcGrp|72990|2022|PDM|466.00|99|0.00|AEG 1|
20|FH_F111201_25301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
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|519.00|99|0.00|AEG 2 (NO REV)|
20|FH_F142454_0_0|SrvcGrp|99073|2022|PDM|1.24|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F49895_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEBA|
20|FH_F49895_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F47884_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F50137_0_0|SrvcGrp|10542|2022|PDM|115.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
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_F39855_0_0|SrvcGrp|360|2022|PDM|954.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F120253_44646_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38591_0_0|SrvcGrp|705|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F125935_44024_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F91994_0_0|SrvcGrp|63471|2022|PDM|17842.00|99|0.00|CPT 64590|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S AZ/NV - MOD KM|
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|323.00|99|0.00|AEG 1 (NO REV)|
20|FH_F38473_0_0|SrvcGrp|15846|2022|PDM|47.00|99|0.00|HOME VISIT|
20|FH_F66222_0_0|SrvcGrp|28536|2022|PCT|1.00|99|0.00|J CODES|
20|FH_F47656_0_0|SrvcGrp|35886|2022|PDM|2275.00|99|0.00|OBSTETRICAL CARE (DRGS 370-374)|
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|327.00|99|0.00|AEG 9 (NO REV)|
20|FH_F115772_26250_0|SrvcGrp|104847|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F130523_04605_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|AEG 10 (NO REV)|
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|1857.00|99|0.00|AEG 5  (NO REV)|
20|FH_F130013_16509_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F70984_0_0|CSTM-ALL|CSTM-00|2020|PDM|762.00|99|0.00|COVENTRY ENHANCED GROUPER 2 GA NO CRESCENT|
20|FH_F41178_0_0|CSTM-ALL|CSTM-00|2020|PDM|886.00|99|0.00|EATING DISORDER|
20|FH_F127165_32112_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115018_78410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F34496_0_0|CSTM-ALL|CSTM-00|2020|PDM|798.00|99|0.00|ACUTE PSYCH|
20|FH_F37659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F149862_76051_0|SrvcGrp|46903|2022|PDM|483.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F129653_0_0|SrvcGrp|67072|2022|PDM|4000.00|99|0.00|CPT 22845|
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|1305.00|99|0.00|AEG 6 (NO REV)|
20|FH_F141873_0_0|SrvcGrp|75419|2022|PDM|419.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F49895_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUBA|
20|FH_F59992_0_0|SrvcGrp|56104|2022|PDM|200.00|99|0.00|DELIVERY PLACENTA ONLY|
20|FH_F42706_0_0|SrvcGrp|17861|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F123964_86303_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F143748_02904_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F33712_0_0|SrvcGrp|12146|2022|PDM|1800.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F131577_89148_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
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_F39531_0_0|SrvcGrp|43|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F114963_62062_0|SrvcGrp|46104|2022|PDM|184.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F73010_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148265_06067_0|SrvcGrp|100920|2022|PDM|8007.00|99|0.00|SPINE PRO DEVICE|
20|FH_F131965_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F86752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F89779_0_0|SrvcGrp|80617|2022|PDM|16000.00|99|0.00|ARTHOPLASTY|
20|FH_F102302_0_0|SrvcGrp|98585|2022|PDM|18450.00|99|0.00|INC FOR VAGUS N ELECT IMPL|
20|FH_F129536_0_0|SrvcGrp|46884|2022|PDM|759.00|99|0.00|REPAIR EYELID DEFECT|
20|FH_F114930_71101_0|SrvcGrp|45752|2022|PDM|66.00|99|0.00|GROUP THERAPY|
20|FH_F65182_0_0|SrvcGrp|43893|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F126153_44663_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97540_32114_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F93332_0_0|SrvcGrp|88162|2022|PDM|7025.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F116059_62959_0|SrvcGrp|90726|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F89563_29407_0|SrvcGrp|90489|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F116760_68512_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F56276_0_0|SrvcGrp|52955|2022|PDM|175.00|99|0.00|HISTORY AND PHYSICAL|
20|FH_F115737_78660_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F123320_43558_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F47656_0_0|SrvcGrp|941|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F82173_72712_0|SrvcGrp|105465|2022|PCT|0.77|99|0.00|AETNA THERAPIES|
20|FH_F131254_92211_0|SrvcGrp|22396|2022|PDM|35.00|99|0.00|IV IMMUNOGLOBULIN|
20|FH_F92276_32308_0|SrvcGrp|13880|2022|PCT|0.53|99|0.00|IMPLANTS|
20|FH_F148220_70578_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145758_20745_0|CSTM-ALL|CSTM-00|2020|PDM|771.12|99|0.00|AEG 4 (NO REV)|
20|FH_F102302_0_0|SrvcGrp|98590|2022|PDM|14300.00|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F93720_12303_0|SrvcGrp|113912|2022|PDM|26.79|99|0.00|CRISIS INTERV SERV 15 MINUTES|
20|FH_F130747_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
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_F131228_01826_0|SrvcGrp|10107|2022|PCT|1.11|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F41313_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F113546_0_0|SrvcGrp|48396|2022|PDM|90.00|99|0.00|OT SERVICES|
20|FH_F51120_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F93702_63128_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F50184_0_0|SrvcGrp|28074|2022|PCT|0.90|99|0.00|HIGH COST PHARMACEUTICALS|
20|FH_F79625_0_0|SrvcGrp|473|2022|PDM|489.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F139515_0_0|SrvcGrp|59841|2022|PDM|1200.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F73985_0_0|SrvcGrp|17083|2022|PDM|2212.00|99|0.00|ASPG X|
20|FH_F33642_0_0|SrvcGrp|941|2022|PDM|1300.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F51733_0_0|SrvcGrp|44427|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY SVCS (VISIT LVL)|
20|FH_F151146_0_0|SrvcGrp|87842|2022|PDM|6896.00|99|0.00|LAPAROSCOPY - GASTRIC|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PDM|801.00|99|0.00|ASPG III|
20|FH_F37679_0_0|SrvcGrp|17002|2022|PDM|110.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS|
20|FH_F133671_89102_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|22000.00|99|0.00|MSDRG 233-234 CORONARY BYPASS|
20|FH_F73985_0_0|SrvcGrp|9840|2022|PDM|4983.00|99|0.00|ICU UNIT|
20|FH_F39212_0_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|ACUTE PSYCH|
20|FH_F132092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139551_0_0|SrvcGrp|93059|2022|PDM|4574.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F110220_0_0|SrvcGrp|92189|2022|PDM|701.23|99|0.00|CPT 95808  (HCFA)|
20|FH_F129023_15501_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38591_0_0|SrvcGrp|29074|2022|PCT|1.00|99|0.00|AMBULATORY SERVICES|
20|FH_F132372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F93902_04043_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F31798_0_0|SrvcGrp|361|2022|PCT|0.85|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F41776_0_0|SrvcGrp|11442|2022|PDM|827.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F42755_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F134287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.20|99|0.00|OP SVCS|
20|FH_F90852_0_0|SrvcGrp|10391|2022|PDM|1260.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F120169_83814_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F145537_02061_0|SrvcGrp|90388|2022|PDM|504.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F130630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F82753_18840_0|SrvcGrp|73496|2022|PDM|1401.00|99|0.00|AETNA ER LEVEL V|
20|FH_F39476_0_0|SrvcGrp|43|2022|PCT|0.45|99|0.00|IMPLANTS|
20|FH_F66501_0_0|SrvcGrp|33643|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|798.00|99|0.00|AEG 9 (NO REV)|
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_F148122_49435_0|SrvcGrp|90854|2022|PDM|775.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F43167_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|CD INTENSIVE OUTPATIENT SVCS|
20|FH_F40063_0_0|SrvcGrp|31978|2022|PDM|9206.00|99|0.00|CARDIAC ABLATION|
20|FH_F92174_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142073_0_0|SrvcGrp|88157|2022|PDM|11900.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F137574_68130_0|SrvcGrp|27969|2022|PCT|1.00|99|0.00|HOME HEALTH AIDE|
20|FH_F141592_80233_0|SrvcGrp|113789|2022|PDM|824.00|99|0.00|CAT SCAN|
20|FH_F69651_0_0|SrvcGrp|58847|2022|PDM|125.00|99|0.00|HOSPICE RESPITE CARE|
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_F110000_0_0|SrvcGrp|10946|2022|PDM|1064.00|99|0.00|EMERGENCY ROOM|
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 3 (NO REV)|
20|FH_F139300_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F74562_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89037_0_0|SrvcGrp|73002|2022|PDM|1199.90|99|0.00|AEG 7|
20|FH_F114566_46224_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113385_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F104840_32565_0|SrvcGrp|73606|2022|PCT|0.69|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F38450_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F39426_0_0|SrvcGrp|472|2022|PDM|405.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F94786_07974_0|SrvcGrp|41444|2022|PDM|0.42|99|0.00|ENTERAL FORMULA - NUTRITIONALLY COMPLETE|
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1351.00|99|0.00|AEG 4 (NO REV)|
20|FH_F120901_0_0|SrvcGrp|92819|2022|PDM|4682.00|99|0.00|HIP ARTHOSCOPY|
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|3769.00|99|0.00|AEG 10 (NO REV)|
20|FH_F82195_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50415_0_0|SrvcGrp|44703|2022|PDM|80.00|99|0.00|NURSING CARE|
20|FH_F119214_0_0|SrvcGrp|75489|2022|PDM|1366.00|99|0.00|AEG 6|
20|FH_F141353_26452_0|SrvcGrp|10107|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F34276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F55812_0_0|SrvcGrp|10538|2022|PDM|26.00|99|0.00|NURSING CARE|
20|FH_F147010_82930_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36318_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ST LUKES SO HOSP LABS|
20|FH_F39561_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F129973_48030_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|IP/OP MBPR SERVICES|
20|FH_F124227_01230_0|SrvcGrp|3923|2022|PCT|1.00|99|0.00|LOVENOX/ENOXAPARIN|
20|FH_F124246_71655_0|SrvcGrp|89337|2022|PDM|500.00|99|0.00|DETOXIFICATION|
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 7 (NO REV)|
20|FH_F97083_90670_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F64779_0_0|SrvcGrp|42830|2022|PDM|163.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F131494_0_0|SrvcGrp|75282|2022|PDM|265.00|99|0.00|DIAGNOSTIC HYSTEROSCOPY|
20|FH_F114666_30342_0|SrvcGrp|83641|2022|PDM|3700.00|99|0.00|CPT 29889|
20|FH_F114666_30342_0|SrvcGrp|70749|2022|PDM|2500.00|99|0.00|CPT 29823|
20|FH_F114666_30342_0|SrvcGrp|92366|2022|PDM|2100.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F122635_06410_0|SrvcGrp|23683|2022|PDM|48.80|99|0.00|SKILLED NURSING RN|
20|FH_F43321_0_0|SrvcGrp|45726|2022|PCT|0.88|99|0.00|OCN F/S: LAB GLOBAL|
20|FH_F113708_32025_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F39622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
20|FH_F115210_21043_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F115210_21043_0|SrvcGrp|92820|2022|PDM|3500.00|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY|
20|FH_F147586_44124_0|SrvcGrp|72121|2022|PDM|3601.00|99|0.00|ARTHOSCOPY|
20|FH_F147560_30809_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F41489_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135351_0_0|SrvcGrp|35669|2022|PDM|30498.00|99|0.00|CPT 63650|
20|FH_F82357_0_0|SrvcGrp|9832|2022|PDM|50.00|99|0.00|ST SVCS|
20|FH_F114853_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F114853_0_0|SrvcGrp|98498|2022|PDM|7215.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC|
20|FH_F113585_20155_0|SrvcGrp|29464|2022|PCT|1.00|99|0.00|HOME HEALTH VISIT NEWBORN CARE|
20|FH_F113390_0_0|SrvcGrp|94989|2022|PDM|2475.00|99|0.00|SINUS ENDO W/ BALLOON DILATION|
20|FH_F102063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151379_21045_0|SrvcGrp|72998|2022|PDM|822.00|99|0.00|AEG 5|
20|FH_F151440_84095_0|SrvcGrp|46903|2022|PDM|510.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F151501_30265_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132163_17601_0|SrvcGrp|113276|2022|PCT|1.25|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F132258_45404_0|SrvcGrp|86848|2022|PDM|34.98|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F132268_07060_0|SrvcGrp|90486|2022|PDM|42.46|99|0.00|ORTHOTIC MANAGEMENT|
20|FH_F135350_60014_0|SrvcGrp|88779|2022|PDM|24.00|99|0.00|PHYSICAL THERAPY|
20|FH_F135462_06795_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135988_75703_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119892_47586_0|SrvcGrp|94781|2022|PDM|100.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F131374_08009_0|SrvcGrp|90631|2022|PDM|175.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F140629_0_0|SrvcGrp|113688|2022|PDM|2497.00|99|0.00|URETERONEOCYSTO LAPAROSCOPIC|
20|FH_F121823_46234_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|1597.00|99|0.00|AEG 5  (NO REV)|
20|FH_F42347_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F44113_0_0|SrvcGrp|20534|2022|PDM|600.00|99|0.00|SKILLED NURSING|
20|FH_F111363_33169_0|SrvcGrp|82744|2022|PDM|72.00|99|0.00|URINE CULTURE COLONY COUNT|
20|FH_F94340_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F36344_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|720223_LABS_MOD TC|
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1873.00|99|0.00|AEG 8 (NO REV)|
20|FH_F131000_0_0|SrvcGrp|106264|2022|PDM|5114.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION|
20|FH_F132328_0_0|SrvcGrp|91577|2022|PDM|10592.00|99|0.00|FEM/POPL REVASC STNT & ATHER|
20|FH_F40260_0_0|SrvcGrp|3029|2022|PDM|400.00|99|0.00|NEWBORN NURSERY|
20|FH_F62092_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F114569_0_0|SrvcGrp|105543|2022|PDM|52.40|99|0.00|AETHA ALCOHOL/SUBS INTERV > 30 MINS (MOD GT)|
20|FH_F87557_33309_0|SrvcGrp|86835|2022|PDM|10.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F87557_33309_0|SrvcGrp|86830|2022|PDM|30.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F127713_30012_0|SrvcGrp|48398|2022|PDM|155.00|99|0.00|PT SERVICES|
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|1559.00|99|0.00|AEG 3 (NO REV)|
20|FH_F140102_0_0|SrvcGrp|113620|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F129151_43950_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F102960_50613_0|SrvcGrp|99070|2022|PDM|1134.00|99|0.00|IP REHAB|
20|FH_F103004_75840_0|SrvcGrp|2738|2022|PCT|0.88|99|0.00|IMPLANTS|
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87092_60101_0|SrvcGrp|73008|2022|PDM|4200.00|99|0.00|AEG 10|
20|FH_F57073_0_0|SrvcGrp|3066|2022|PCT|0.75|99|0.00|HIGH-COST DRUGS|
20|FH_F109501_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F74602_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|TRAUMA SERVICES|
20|FH_F71923_0_0|SrvcGrp|68899|2022|PDM|212.18|99|0.00|DIALYSIS TRAINING|
20|FH_F136390_46321_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134011_84102_0|SrvcGrp|97702|2022|PDM|112.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F134011_84102_0|SrvcGrp|30609|2022|PDM|29.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F134011_84102_0|SrvcGrp|86849|2022|PDM|25.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F134113_61614_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137147_75006_0|SrvcGrp|93431|2022|PDM|26762.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F142307_74066_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142737_77703_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|1414.00|99|0.00|AEG 7 (NO REV)|
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 6 (NO REV)|
20|FH_F139267_30253_0|SrvcGrp|113543|2022|PDM|156.89|99|0.00|COVID-19 SARSCOV2&INF A&B&RSV AMP PRB|
20|FH_F138583_60644_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F140488_07039_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140648_75070_0|SrvcGrp|74668|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F140765_30315_0|SrvcGrp|112676|2022|PDM|42.13|99|0.00|COVID-19 SARS-COV-2 ANTIBODY|
20|FH_F120152_0_0|SrvcGrp|88163|2022|PDM|19800.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F149580_98198_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151603_27609_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151606_64772_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F119023_91406_0|SrvcGrp|86854|2022|PDM|56.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F119090_91502_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F118943_64506_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F52832_0_0|SrvcGrp|42785|2022|PDM|175.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F66835_0_0|SrvcGrp|14165|2022|PDM|245.00|99|0.00|PARTIAL HOSP PSYCH/CD|
20|FH_F147861_45239_0|SrvcGrp|12659|2022|PDM|900.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F129427_92262_0|SrvcGrp|89337|2022|PDM|1200.00|99|0.00|DETOXIFICATION|
20|FH_F129483_77030_0|SrvcGrp|10577|2022|PDM|35.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F129511_44044_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129524_48104_0|SrvcGrp|111385|2022|PCT|1.00|99|0.00|PATHOLOGY|
20|FH_F117105_77619_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117218_32025_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F137937_20032_0|SrvcGrp|113191|2022|PCT|0.00|99|0.00|HOME HEALTH|
20|FH_F109652_0_0|SrvcGrp|87993|2022|PDM|5265.00|99|0.00|COMPENSATOR BASED BEAM (HIPPA 2/1/2015)|
20|FH_F109907_0_0|SrvcGrp|27969|2022|PDM|27.05|99|0.00|HOME HEALTH AIDE|
20|FH_F90613_05001_0|SrvcGrp|90162|2022|PDM|1248.00|99|0.00|AETNA IP PSYCH CONSTANT OBS (>= 18 YEARS OF AGE)|
20|FH_F119285_0_0|SrvcGrp|38909|2022|PDM|1751.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F129487_0_0|SrvcGrp|72998|2022|PDM|1934.00|99|0.00|AEG 5|
20|FH_F69347_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F132544_0_0|SrvcGrp|97319|2022|PDM|8007.00|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F148379_89129_0|SrvcGrp|66264|2022|PDM|80.75|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F148485_13021_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F148554_85016_0|SrvcGrp|112276|2022|PDM|5167.00|99|0.00|TIBIA WITH ATHERECTOMY|
20|FH_F146257_83713_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97566_79902_0|SrvcGrp|73601|2022|PDM|8206.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F142775_72801_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
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_F87432_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36207_0_0|SrvcGrp|19605|2022|PDM|0.83|99|0.00|WHEELCHAIR VAN MILEAGE-PER MILE|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|499.57|99|0.00|ASPG 303|
20|FH_F103781_0_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F38089_0_0|SrvcGrp|290|2022|PDM|7797.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F31824_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ACUTE MEDICAL & SURGICAL|
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_F36756_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD KM|
20|FH_F144748_19707_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F81861_0_0|SrvcGrp|46856|2022|PCT|1.05|99|0.00|IMPLANTS W SLIN SUBSTITUTE ALODERM W MS DRG 579-581|
20|FH_F37698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|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_F127090_45601_0|SrvcGrp|22592|2022|PDM|49.98|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F149322_19023_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F50657_0_0|SrvcGrp|31186|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC (DME)|
20|FH_F145883_71106_0|SrvcGrp|73605|2022|PDM|1056.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F150162_39402_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146420_18940_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120930_0_0|SrvcGrp|38013|2022|PDM|3000.00|99|0.00|HYSTEROSCOPY|
20|FH_F85214_70360_0|SrvcGrp|73601|2022|PDM|1417.50|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F132922_91302_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F150281_76309_0|SrvcGrp|75419|2022|PDM|375.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F134350_46601_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F130763_0_0|SrvcGrp|27261|2022|PDM|15683.00|99|0.00|CPT 27446|
20|FH_F145883_71106_0|SrvcGrp|75419|2022|PDM|435.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F134536_48080_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122470_78229_0|SrvcGrp|471|2022|PDM|705.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F122475_37659_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F85012_0_0|SrvcGrp|17100|2022|PCT|0.00|99|0.00|SKILLED NURSING|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|185.71|99|0.00|HAPA WPA-NWPA 2012-13 ASC 312 W/O REV|
20|FH_F71042_0_0|SrvcGrp|13268|2022|PCT|0.70|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F78344_0_0|SrvcGrp|3809|2022|PDM|725.00|99|0.00|HOSPICE CARE|
20|FH_F102200_06416_0|SrvcGrp|22593|2022|PDM|75.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F102200_06416_0|SrvcGrp|14944|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F105145_75075_0|CSTM-ALL|CSTM-00|2020|PDM|4500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|MEDICAP 151 INFUSION- IV SERVICES (MOD SH)|
20|FH_F126783_80021_0|SrvcGrp|74668|2022|PDM|795.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F47140_0_0|SrvcGrp|28729|2022|PDM|76.05|99|0.00|SLEEP STUDIES CPT 95806 W/MODIFIER 26|
20|FH_F47140_0_0|SrvcGrp|28730|2022|PDM|105.12|99|0.00|SLEEP STUDIES CPT 95806 W/MODIFIER TC|
20|FH_F131747_80108_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IP/OP MBPR SERVICES|
20|FH_F42159_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|PEDIATRIC IP SVCS|
20|FH_F151155_26508_0|SrvcGrp|90662|2022|PDM|133.00|99|0.00|EVALUATION AND MANAGEMENT CPT 99214|
20|FH_F151179_84074_0|SrvcGrp|14614|2022|PDM|2900.00|99|0.00|LITHOTRIPSY|
20|FH_F121338_37756_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121385_89102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129130_92562_0|SrvcGrp|114924|2022|PCT|4.39|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F37333_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|812.69|99|0.00|DELAWARE VALLEY- ASC 5|
20|FH_F106822_0_0|SrvcGrp|22379|2022|PDM|30.00|99|0.00|CPT CODE 94010|
20|FH_F118275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F73025_0_0|SrvcGrp|48394|2022|PDM|13.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F39343_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F104840_32565_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER UEKC|
20|FH_F51555_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F114389_50131_0|SrvcGrp|86837|2022|PDM|490.42|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F114389_50131_0|SrvcGrp|14945|2022|PDM|16.09|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F124927_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F89582_0_0|SrvcGrp|3327|2022|PDM|134.37|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F91898_0_0|SrvcGrp|14066|2022|PCT|0.80|99|0.00|HOSPICE SVCS|
20|FH_F127972_68061_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100000_45417_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F124233_92648_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F116097_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130036_43232_0|SrvcGrp|12659|2022|PDM|867.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F136617_76118_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136708_06443_0|SrvcGrp|90631|2022|PDM|120.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F114678_78745_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F114726_45213_0|SrvcGrp|73842|2022|PDM|173.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139556_85006_0|SrvcGrp|74793|2022|PCT|1.89|99|0.00|POLYSOMNOGRAPHY|
20|FH_F81893_23114_0|SrvcGrp|27775|2022|PDM|720.00|99|0.00|RADIATION THERAPY SVCS (GAMMA KNIFE)|
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|3751.00|99|0.00|AEG 7 (NO REV)|
20|FH_F134672_44060_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135719_45502_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135719_45502_0|SrvcGrp|74670|2022|PCT|0.40|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F136799_75061_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F112505_51503_0|SrvcGrp|91294|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F112505_51503_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F115631_65201_0|CSTM-ALL|CSTM-00|2020|PDM|1779.00|99|0.00|AEG 8 (NO REV)|
20|FH_F147362_33137_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147305_90755_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F147501_52655_0|SrvcGrp|83804|2022|PCT|0.90|99|0.00|SKILLED CARE LEVEL I AND II|
20|FH_F42001_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F129231_30060_0|CSTM-ALL|CSTM-00|2020|PDM|813.00|99|0.00|AEG 4 (NO REV)|
20|FH_F115081_37185_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129221_84325_0|SrvcGrp|74668|2022|PDM|850.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121525_78613_0|SrvcGrp|108061|2022|PCT|1.75|99|0.00|OP THERAPY SERVICES|
20|FH_F38677_0_0|SrvcGrp|17379|2022|PDM|135.00|99|0.00|CCPD TRAINING|
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG VI|
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_F115075_77833_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129182_24171_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F129231_30060_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 7 (NO REV)|
20|FH_F92091_0_0|SrvcGrp|89982|2022|PDM|3000.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY|
20|FH_F117079_01085_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F79212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F94402_0_0|CSTM-ALL|CSTM-00|2020|PDM|588.00|99|0.00|AETNA AMBULATORY SURGERY (NO REV)|
20|FH_F34550_0_0|SrvcGrp|361|2022|PDM|1019.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F116760_68512_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F110086_21742_0|CSTM-ALL|CSTM-00|2020|PDM|1461.00|99|0.00|AEG 7 (NO REV)|
20|FH_F148201_82716_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F116747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111222_15701_0|SrvcGrp|473|2022|PDM|366.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F114963_62062_0|SrvcGrp|106904|2022|PCT|1.20|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F148121_21734_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
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_F143790_83440_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 4 (NO REV)|
20|FH_F116747_0_0|SrvcGrp|26160|2022|PDM|26.80|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F86319_16365_0|SrvcGrp|93924|2022|PDM|2347.00|99|0.00|AETNA MEDICAL SERVICES|
20|FH_F91663_19901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40198_0_0|SrvcGrp|65|2022|PDM|1717.00|99|0.00|OBSTETRICAL CARE|
20|FH_F118703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124802_72301_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F55054_0_0|SrvcGrp|51271|2022|PDM|160.00|99|0.00|OP INTENSIVE PSYCH|
20|FH_F37433_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32771_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F129181_28164_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132735_97068_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F123922_84102_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F50873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111288_0_0|SrvcGrp|58993|2022|PDM|7831.00|99|0.00|DISKECTOMY|
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|933.00|99|0.00|AEG 5  (NO REV)|
20|FH_F123285_54157_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54614_0_0|SrvcGrp|50906|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 2 (NO REV)|
20|FH_F118910_0_0|SrvcGrp|97507|2022|PDM|113.30|99|0.00|AETNA HOSPICE|
20|FH_F124048_47304_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F148255_72703_0|SrvcGrp|86853|2022|PDM|31.50|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F40063_0_0|SrvcGrp|30711|2022|PDM|13945.00|99|0.00|BRACHYTHERAPY SVCS|
20|FH_F99441_0_0|SrvcGrp|42550|2022|PDM|1380.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F148265_06067_0|SrvcGrp|97741|2022|PDM|14249.00|99|0.00|REVISE KNEE|
20|FH_F141212_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F117082_66216_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F92993_0_0|SrvcGrp|42723|2022|PDM|85.83|99|0.00|SLEEP STUDIES CPT 95806 W/MODIFIER TC|
20|FH_F40834_0_0|SrvcGrp|3277|2022|PCT|0.80|99|0.00|SKILLED NURSING CARE|
20|FH_F89211_0_0|SrvcGrp|9939|2022|PDM|875.00|99|0.00|ACUTE MEDICAL SVCS|
20|FH_F72765_0_0|SrvcGrp|29930|2022|PDM|400.00|99|0.00|DIALYSIS|
20|FH_F62719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|WELLPATH ASC I|
20|FH_F139173_0_0|SrvcGrp|95660|2022|PDM|911.62|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F123943_84041_0|SrvcGrp|94781|2022|PDM|90.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F102302_0_0|SrvcGrp|72990|2022|PDM|615.00|99|0.00|AEG 1|
20|FH_F77883_0_0|SrvcGrp|74934|2022|PDM|360.58|99|0.00|BASIC TELE-MONITORING|
20|FH_F139551_0_0|SrvcGrp|89404|2022|PDM|16500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F63307_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F86696_16063_0|SrvcGrp|48398|2022|PDM|75.00|99|0.00|PT SERVICES|
20|FH_F86872_15215_0|SrvcGrp|86841|2022|PDM|119.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F86991_15122_0|SrvcGrp|85484|2022|PDM|1000.00|99|0.00|TRABECULECTOMY|
20|FH_F55212_0_0|SrvcGrp|27253|2022|PDM|78.00|99|0.00|INDIVIDUAL PSYCHOTHERAPY|
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|3105.00|99|0.00|AEG 9 (NO REV)|
20|FH_F114064_0_0|SrvcGrp|73000|2022|PDM|1051.00|99|0.00|AEG 6|
20|FH_F89372_0_0|SrvcGrp|73463|2022|PDM|5606.00|99|0.00|AETNA NICU II|
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_F88545_78734_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_F40191_0_0|SrvcGrp|361|2022|PDM|2667.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F117550_0_0|SrvcGrp|85963|2022|PDM|28.00|99|0.00|SELF CARE MANGEMENT TRAINING|
20|FH_F117550_0_0|SrvcGrp|98688|2022|PDM|25.60|99|0.00|GROUP THERAPY 2 OR MORE|
20|FH_F150000_30152_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F34706_0_0|SrvcGrp|2116|2022|PDM|12412.00|99|0.00|DRG 121 CIRCULATORY DISORDERS|
20|FH_F115324_78852_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F32215_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32927_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101853_77840_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F101922_98055_0|SrvcGrp|88697|2022|PCT|1.65|99|0.00|DRUGS|
20|FH_F115889_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133510_26003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115329_79424_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F118788_91355_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F140690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101811_64116_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|GENERAL ACUTE CARE|
20|FH_F49637_0_0|SrvcGrp|45522|2022|PDM|14700.00|99|0.00|MS DRG 614 ONLY|
20|FH_F117072_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F101840_76054_0|SrvcGrp|19633|2022|PDM|56600.00|99|0.00|MS DRG 226 ONLY|
20|FH_F81485_0_0|SrvcGrp|79359|2022|PCT|2.00|99|0.00|2014 WMS CHRISTIAN MRI/CT IN ER|
20|FH_F106540_26330_0|SrvcGrp|41335|2022|PDM|31744.00|99|0.00|TOTAL HIP|
20|FH_F146135_87112_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F92677_08003_0|SrvcGrp|86830|2022|PDM|105.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F133510_26003_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F49354_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F108700_63857_0|SrvcGrp|65720|2022|PDM|108.00|99|0.00|RESPITE CARE|
20|FH_F130108_0_0|SrvcGrp|9936|2022|PCT|0.75|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F120411_14541_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F45977_0_0|SrvcGrp|40405|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD AV|
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)|
20|FH_F81494_0_0|SrvcGrp|537|2022|PDM|93.00|99|0.00|OBSERVATION SERVICES|
20|FH_F146370_19355_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97563_83201_0|SrvcGrp|73461|2022|PDM|10794.00|99|0.00|AETNA NICU IV|
20|FH_F64943_0_0|SrvcGrp|80|2022|PDM|1900.00|99|0.00|ACUTE PSYCH|
20|FH_F132886_0_0|SrvcGrp|13597|2022|PDM|327.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103360_68845_0|SrvcGrp|73488|2022|PCT|7.50|99|0.00|AETNA HOSPITAL OP DIALYSIS|
20|FH_F145881_46011_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F117550_0_0|SrvcGrp|87537|2022|PDM|350.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F38865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F97042_64804_0|SrvcGrp|73603|2022|PDM|1975.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F55375_0_0|SrvcGrp|17079|2022|PDM|8000.00|99|0.00|ASPG VIII|
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)|
20|FH_F40765_0_0|SrvcGrp|109|2022|PDM|648.00|99|0.00|CD - DETOX|
20|FH_F89932_10940_0|SrvcGrp|78878|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F145988_06105_0|CSTM-ALL|CSTM-00|2020|PDM|9871.00|99|0.00|AEG 7 (NO REV)|
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|3178.00|99|0.00|AEG 9 (NO REV)|
20|FH_F31184_0_0|SrvcGrp|72|2022|PDM|400.00|99|0.00|NEWBORN NURSERY|
20|FH_F132594_78229_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38352_0_0|SrvcGrp|29021|2022|PCT|0.65|99|0.00|DME AND SUPPLIES|
20|FH_F111421_32216_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F38407_0_0|SrvcGrp|26732|2022|PDM|850.00|99|0.00|CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE|
20|FH_F89851_83854_0|CSTM-ALL|CSTM-00|2020|PDM|1316.00|99|0.00|AEG 1 (NO REV)|
20|FH_F111540_16823_0|SrvcGrp|104430|2022|PDM|67.24|99|0.00|AETNA OFFICE OUTPATIENT VISIT EST (MOD AF)(HCFA)|
20|FH_F31928_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|CAESAREAN SECTION|
20|FH_F117335_0_0|SrvcGrp|73000|2022|PDM|997.00|99|0.00|AEG 6|
20|FH_F89932_10940_0|SrvcGrp|31072|2022|PDM|1215.00|99|0.00|MS DRG 794 ONLY|
20|FH_F119128_93619_0|SrvcGrp|89417|2022|PDM|575.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F133477_90247_0|SrvcGrp|75506|2022|PCT|0.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F133118_33143_0|SrvcGrp|73841|2022|PDM|457.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138611_0_0|SrvcGrp|11306|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F100788_01420_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F40267_0_0|SrvcGrp|32175|2022|PCT|0.85|99|0.00|MS DRG DEFAULT|
20|FH_F95661_27217_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F142967_65065_0|SrvcGrp|90491|2022|PCT|1.00|99|0.00|EVALUATE SPEECH PRODUCTION|
20|FH_F68868_0_0|SrvcGrp|941|2022|PDM|3126.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1645.60|99|0.00|AEG 8 (NO REV)|
20|FH_F31204_0_0|SrvcGrp|11975|2022|PDM|520.00|99|0.00|ELECTRO CONVULSIVE THERAPY|
20|FH_F72750_0_0|CSTM-ALL|CSTM-00|2020|PDM|1427.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F151151_76504_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151280_20740_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F121910_27104_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139428_65270_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139428_65270_0|SrvcGrp|23683|2022|PDM|41.20|99|0.00|SKILLED NURSING RN|
20|FH_F139707_84010_0|SrvcGrp|114741|2022|PDM|4873.00|99|0.00|ORTHOPEDIC/PODIATRY|
20|FH_F139707_84010_0|SrvcGrp|86505|2022|PDM|1183.00|99|0.00|DENTAL SURGERY|
20|FH_F150880_90036_0|SrvcGrp|90854|2022|PDM|1275.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD KN|
20|FH_F44279_0_0|SrvcGrp|3378|2022|PDM|600.00|99|0.00|OBSERVATION SVCS|
20|FH_F122377_91007_0|SrvcGrp|73498|2022|PDM|2276.00|99|0.00|AETNA ER LEVEL III|
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|3750.00|99|0.00|AEG 9 (NO REV)|
20|FH_F41363_0_0|SrvcGrp|69559|2022|PCT|1.10|99|0.00|LAB CODES 87001-89398|
20|FH_F37342_0_0|SrvcGrp|23387|2022|PDM|52.00|99|0.00|PT/OT/ST|
20|FH_F36803_0_0|SrvcGrp|72|2022|PDM|400.00|99|0.00|NEWBORN NURSERY|
20|FH_F55876_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84413_0_0|SrvcGrp|25688|2022|PDM|420.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F127464_15106_0|SrvcGrp|46605|2022|PDM|125.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F149269_73120_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F134410_46807_0|SrvcGrp|46903|2022|PDM|1550.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F72590_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F127418_0_0|SrvcGrp|110757|2022|PDM|5529.43|99|0.00|CERVICAL VERTEBRAL CORPECTOMY|
20|FH_F122841_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F113869_40215_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|1499.00|99|0.00|ASPG VII|
20|FH_F139785_92629_0|SrvcGrp|46903|2022|PDM|2835.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F98880_50158_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F131072_26416_0|SrvcGrp|78067|2022|PDM|325.00|99|0.00|SUBACUTE CARE|
20|FH_F102620_0_0|SrvcGrp|58122|2022|PDM|170.78|99|0.00|IOP / MENTAL HEALTH / SUBSTANCE ABUSE|
20|FH_F59312_0_0|SrvcGrp|43283|2022|PDM|74.00|99|0.00|PHYSICAL THERAPY|
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|19600.00|99|0.00|MSDRG 250-251 PERCUTANEOUS CARDIO PROC|
20|FH_F151699_01752_0|SrvcGrp|26868|2022|PDM|45.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F124381_27610_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F127464_15106_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1017.00|99|0.00|COVENTRY ENHANCED GROUPER 4 MOD 50|
20|FH_F31087_0_0|SrvcGrp|472|2022|PDM|387.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F146859_0_0|SrvcGrp|114849|2022|PDM|3514.00|99|0.00|SUBTALAR ARTHRO W/ FUSION|
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151025_11230_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116332_0_0|SrvcGrp|115363|2022|PDM|16182.00|99|0.00|LAPAROSCOPY|
20|FH_F110724_33064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110732_31513_0|SrvcGrp|104137|2022|PDM|1563.00|99|0.00|EMERGENCY CARE LEVEL IV|
20|FH_F75606_0_0|SrvcGrp|3029|2022|PDM|567.00|99|0.00|NEWBORN NURSERY|
20|FH_F146266_0_0|SrvcGrp|94904|2022|PDM|3865.00|99|0.00|REPAIR/REVISE WRIST JOINT|
20|FH_F122282_30080_0|SrvcGrp|87317|2022|PDM|875.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F139814_24333_0|SrvcGrp|86723|2022|PDM|361.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F117714_94301_0|SrvcGrp|73841|2022|PDM|520.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F150982_0_0|SrvcGrp|111589|2022|PDM|1382.00|99|0.00|REVISE ULNAR NERVE AT WRIST|
20|FH_F137772_27320_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137730_46563_0|SrvcGrp|90854|2022|PDM|999.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F44455_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F109251_62269_0|SrvcGrp|27969|2022|PDM|26.01|99|0.00|HOME HEALTH AIDE|
20|FH_F97623_38008_0|SrvcGrp|90854|2022|PDM|2466.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F124389_84115_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47558_0_0|SrvcGrp|43265|2022|PDM|80.00|99|0.00|MID-LINE INSERTION|
20|FH_F148347_0_0|SrvcGrp|92418|2022|PDM|11616.00|99|0.00|LAPAROSCOPY|
20|FH_F116437_0_0|SrvcGrp|88269|2022|PCT|1.10|99|0.00|RETINAL TAMPONADE DEVICE|
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122277_98045_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91772_0_0|SrvcGrp|72990|2022|PDM|480.00|99|0.00|AEG 1|
20|FH_F114585_11501_0|SrvcGrp|73841|2022|PDM|294.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F128536_88240_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F44132_0_0|SrvcGrp|33224|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F40899_0_0|SrvcGrp|31187|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF (DME)|
20|FH_F117711_73080_0|SrvcGrp|79786|2022|PCT|1.45|99|0.00|SLEEP STUDIES|
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|760.00|99|0.00|AEG 2 (NO REV)|
20|FH_F47558_0_0|SrvcGrp|43267|2022|PDM|80.00|99|0.00|PICC LINE INSERTION|
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)|
20|FH_F134869_08854_0|SrvcGrp|73842|2022|PDM|270.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147422_84121_0|SrvcGrp|108484|2022|PDM|550.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F120332_0_0|SrvcGrp|48398|2022|PDM|75.00|99|0.00|PT SERVICES|
20|FH_F40657_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|1586.00|99|0.00|AEG 9 (NO REV)|
20|FH_F98880_50158_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F146859_0_0|SrvcGrp|85198|2022|PDM|3404.00|99|0.00|AETNA KNEE ARTHROSCOPY|
20|FH_F31087_0_0|SrvcGrp|3810|2022|PDM|132.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F37312_0_0|SrvcGrp|14404|2022|PCT|0.60|99|0.00|HOME HEALTH CARE MEDICAL SUPPLIES|
20|FH_F139928_37228_0|SrvcGrp|16069|2022|PDM|771.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F140134_52732_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140090_37221_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143347_16001_0|CSTM-ALL|CSTM-00|2020|PDM|4706.00|99|0.00|AEG 7 (NO REV)|
20|FH_F143413_75061_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143536_47546_0|SrvcGrp|100276|2022|PCT|1.00|99|0.00|MCV4 MENACWY VACCINE IM|
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1213.00|99|0.00|AEG 4 (NO REV)|
20|FH_F103140_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|ICU|
20|FH_F101806_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130917_48658_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130925_34652_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F131067_57105_0|SrvcGrp|73497|2022|PDM|1982.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F47952_0_0|SrvcGrp|43957|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132351_19342_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132418_84042_0|SrvcGrp|73605|2022|PDM|956.96|99|0.00|AETNA ACUTE PSYCH|
20|FH_F132416_92270_0|SrvcGrp|93337|2022|PDM|488.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F116756_77477_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F82771_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F119924_14070_0|SrvcGrp|473|2022|PDM|285.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F125479_17501_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F33925_0_0|SrvcGrp|18145|2022|PDM|9750.00|99|0.00|MS DRG 248|
20|FH_F39272_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F39996_0_0|SrvcGrp|3029|2022|PDM|200.00|99|0.00|NEWBORN NURSERY|
20|FH_F63129_0_0|SrvcGrp|48394|2022|PDM|8.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F131612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F121597_30315_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD UE KE"|
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|1790.71|99|0.00|AEG 8 (NO REV)|
20|FH_F134568_12946_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148885_23226_0|SrvcGrp|13722|2022|PDM|136.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE|
20|FH_F134174_63141_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|CPT 95811 (W/MOD TC)|
20|FH_F117206_0_0|SrvcGrp|72996|2022|PDM|860.00|99|0.00|AEG 4|
20|FH_F120930_0_0|SrvcGrp|96560|2022|PDM|3000.00|99|0.00|TOTAL HYSTERCECTOMY|
20|FH_F32214_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F113764_0_0|SrvcGrp|24029|2022|PDM|25.00|99|0.00|RN HOURLY|
20|FH_F150165_06032_0|SrvcGrp|33984|2022|PDM|2300.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F148924_44003_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F70603_0_0|SrvcGrp|52843|2022|PDM|360.00|99|0.00|GI PROCEDURE GROUP B|
20|FH_F50654_0_0|SrvcGrp|28551|2022|PCT|1.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F118123_67226_0|SrvcGrp|14949|2022|PDM|125.00|99|0.00|HOME INFUSION|
20|FH_F85212_71075_0|SrvcGrp|72994|2022|PDM|762.00|99|0.00|AEG 3|
20|FH_F124162_73127_0|SrvcGrp|90854|2022|PDM|808.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PDM|760.00|99|0.00|ASPG II - FH SW CUSTOM GROUPERS|
20|FH_F85732_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F131613_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118252_32216_0|SrvcGrp|89337|2022|PDM|1183.00|99|0.00|DETOXIFICATION|
20|FH_F61673_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121685_75093_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F90438_08873_0|SrvcGrp|70381|2022|PDM|284.00|99|0.00|PSYCH PARTIAL HOSP (FULL & PARTIAL DAY) PER VISIT|
20|FH_F131127_0_0|SrvcGrp|86460|2022|PDM|3278.00|99|0.00|REVISE BREAST RECONSTRUCTION|
20|FH_F85353_16407_0|SrvcGrp|63804|2022|PDM|703.25|99|0.00|HAPA WPA-NWPA 2012-13 ASC 302|
20|FH_F127950_45150_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149517_0_0|SrvcGrp|95660|2022|PDM|692.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F147990_64701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112408_0_0|SrvcGrp|472|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134608_18017_0|SrvcGrp|112606|2022|PDM|20.00|99|0.00|WET MOUNT SMEAR|
20|FH_F127579_44321_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F146124_06112_0|SrvcGrp|90665|2022|PCT|0.00|99|0.00|IP DETOX SERVICES|
20|FH_F145667_01905_0|SrvcGrp|114256|2022|PCT|1.00|99|0.00|COVID-19 TESTING/LAB/ADMIN|
20|FH_F138050_52301_0|CSTM-ALL|CSTM-00|2020|PDM|3157.00|99|0.00|AEG 3 (NO REV)|
20|FH_F119227_01752_0|SrvcGrp|86830|2022|PDM|60.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|539.00|99|0.00|AEG 1 (NO REV)|
20|FH_F149302_75032_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130468_0_0|SrvcGrp|92360|2022|PDM|10503.00|99|0.00|REMOVAL OF HIP PROSTHESIS|
20|FH_F120719_27540_0|SrvcGrp|9539|2022|PDM|526.00|99|0.00|SUBACUTE CARE|
20|FH_F143715_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145641_06902_0|SrvcGrp|26273|2022|PDM|5530.00|99|0.00|CPT 29880|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|347.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 220 W/O REV|
20|FH_F51318_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|IMPLANTS 274-276, 278  LINE LEVEL|
20|FH_F145604_14850_0|SrvcGrp|14893|2022|PDM|35.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F139727_66035_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F49572_0_0|SrvcGrp|15132|2022|PDM|1250.00|99|0.00|ACUTE IP MEDICAL SVCS|
20|FH_F85492_0_0|SrvcGrp|9861|2022|PDM|1736.00|99|0.00|ACUTE REHABILITATION|
20|FH_F126431_77338_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149199_73005_0|CSTM-ALL|CSTM-00|2020|PDM|1053.00|99|0.00|AEG 3 (NO REV)|
20|FH_F138024_40509_0|SrvcGrp|86722|2022|PDM|170.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|87.22|99|0.00|HAPA WPA-NWPA 2012-13 ASC 243 W/O REV|
20|FH_F110466_06870_0|SrvcGrp|73841|2022|PDM|512.53|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F143561_16001_0|SrvcGrp|23683|2022|PDM|33.00|99|0.00|SKILLED NURSING RN|
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|814.00|99|0.00|AEG 1 (NO REV)|
20|FH_F133585_0_0|SrvcGrp|73610|2022|PCT|0.00|99|0.00|AETNA IMPLANTS|
20|FH_F130329_64114_0|SrvcGrp|86832|2022|PDM|4.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F142376_0_0|SrvcGrp|113980|2022|PDM|1432.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.82|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1201 W/O REV|
20|FH_F133292_75042_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F132928_64114_0|SrvcGrp|112070|2022|PDM|157.00|99|0.00|ENTEROSTOMAL THERAPY (HCFA)|
20|FH_F133170_50501_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130657_04614_0|SrvcGrp|106251|2022|PCT|4.24|99|0.00|LABORATORY SERVICES|
20|FH_F133491_74012_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F131702_17022_0|SrvcGrp|43569|2022|PDM|117.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F111566_75093_0|SrvcGrp|104270|2022|PCT|1.50|99|0.00|CHEMOTHERAPY & ALL OTHER DRUGS|
20|FH_F39346_0_0|SrvcGrp|29702|2022|PDM|7077.00|99|0.00|CV SURGERY MS DRG 260-262 ONLY|
20|FH_F49033_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PDM|958.80|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 6 W/O REV|
20|FH_F82234_0_0|SrvcGrp|9263|2022|PDM|152.03|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F46433_0_0|SrvcGrp|14948|2022|PDM|140.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F77625_0_0|SrvcGrp|12401|2022|PDM|90.00|99|0.00|RN VISIT|
20|FH_F82357_0_0|SrvcGrp|22954|2022|PDM|138.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F82357_0_0|SrvcGrp|8962|2022|PDM|50.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F120695_15017_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F41013_0_0|SrvcGrp|28919|2022|PDM|34.00|99|0.00|CPT 97750|
20|FH_F41989_0_0|CSTM-ALL|CSTM-00|2020|PDM|179.00|99|0.00|OP SVCS|
20|FH_F138856_48092_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F151503_30067_0|SrvcGrp|89989|2022|PDM|6666.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F132163_17601_0|SrvcGrp|90573|2022|PDM|223.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F145468_60615_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F135587_37334_0|SrvcGrp|104301|2022|PCT|1.00|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136074_67206_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136164_63965_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F119886_25504_0|SrvcGrp|48396|2022|PDM|130.00|99|0.00|OT SERVICES|
20|FH_F100763_24202_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F129456_30809_0|SrvcGrp|113489|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F131228_01826_0|SrvcGrp|105465|2022|PCT|0.87|99|0.00|AETNA THERAPIES|
20|FH_F130547_85712_0|SrvcGrp|103320|2022|PDM|14.09|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F116397_33404_0|SrvcGrp|14948|2022|PDM|125.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116431_76104_0|SrvcGrp|35538|2022|PCT|0.85|99|0.00|IMPLANTS|
20|FH_F130766_04967_0|SrvcGrp|112727|2022|PDM|45.23|99|0.00|COVID-19 IA NFCT AB SARS COV 2|
20|FH_F127399_0_0|SrvcGrp|85778|2022|PDM|2913.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F101556_81004_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121871_65401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F33785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F33791_0_0|SrvcGrp|675|2022|PDM|700.00|99|0.00|PEDIATRIC INPATIENT SVCS|
20|FH_F46918_0_0|SrvcGrp|10624|2022|PDM|68.00|99|0.00|CPT CODE 99347|
20|FH_F128201_33334_0|SrvcGrp|108484|2022|PDM|460.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F111292_33136_0|CSTM-ALL|CSTM-00|2020|PDM|20029.00|99|0.00|INTRACRANIAL EMBOLIZATION|
20|FH_F111292_33136_0|SrvcGrp|82750|2022|PDM|32.00|99|0.00|CHORIONIC GONADOTROPIN ASSAY|
20|FH_F111292_33136_0|SrvcGrp|82754|2022|PDM|40.00|99|0.00|ASSAY THYROID STIM HORMONE|
20|FH_F111301_33122_0|SrvcGrp|82749|2022|PDM|60.00|99|0.00|AUTOMAT HEMOGRAM COMPLET DIF|
20|FH_F111301_33122_0|SrvcGrp|82756|2022|PDM|79.00|99|0.00|ASSAY BLOOD LIPASE|
20|FH_F111363_33169_0|SrvcGrp|82745|2022|PDM|95.00|99|0.00|CULT BACT NO URINE/BLD/STOOL|
20|FH_F33390_0_0|CSTM-ALL|CSTM-00|2020|PDM|1502.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43137_0_0|SrvcGrp|13159|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F41780_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|ASPG V|
20|FH_F116430_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|2217.00|99|0.00|AEG 6 (NO REV)|
20|FH_F40260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1275.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F87496_17055_0|SrvcGrp|85601|2022|PCT|1.45|99|0.00|PT/OT REHAB SERV|
20|FH_F102228_08846_0|SrvcGrp|86749|2022|PCT|1.05|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F102282_06795_0|SrvcGrp|27968|2022|PDM|49.81|99|0.00|SKILLED NURSING LPN|
20|FH_F102064_63565_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132090_60915_0|SrvcGrp|101280|2022|PDM|9500.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F132090_60915_0|SrvcGrp|96350|2022|PDM|9500.00|99|0.00|SHOULDER JOINT|
20|FH_F148061_11223_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35685_0_0|SrvcGrp|11182|2022|PDM|37485.00|99|0.00|DRG 547 CORONARY BYP W/CARDIAC CATH W/DIAGNOSIS|
20|FH_F35685_0_0|CSTM-ALL|CSTM-00|2020|PDM|4961.00|99|0.00|NORMAL DELIVERY|
20|FH_F98624_15701_0|SrvcGrp|73559|2022|PDM|11022.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F100783_03431_0|SrvcGrp|90854|2022|PDM|4035.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F110621_0_0|SrvcGrp|103867|2022|PCT|1.10|99|0.00|AETNA IMPLANTS|
20|FH_F128031_0_0|SrvcGrp|75659|2022|PDM|1980.00|99|0.00|ARTHRODESIS|
20|FH_F46972_0_0|SrvcGrp|10528|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F122953_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
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|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 5  (NO REV)|
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|792.00|99|0.00|AEG 2 (NO REV)|
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|503.84|99|0.00|AEG 1 (NO REV)|
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_F46832_0_0|SrvcGrp|17009|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F123741_20850_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F58856_0_0|SrvcGrp|54973|2022|PDM|41600.00|99|0.00|MS DRG 225 ONLY|
20|FH_F64999_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|(JCODES-IMMUN) OCN F/S PRICING: ALL|
20|FH_F118201_35126_0|SrvcGrp|92502|2022|PDM|579.41|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F138019_79705_0|SrvcGrp|86723|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F138892_46341_0|SrvcGrp|3178|2022|PDM|698.00|99|0.00|ACUTE PSYCH|
20|FH_F66765_0_0|SrvcGrp|62537|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F97582_46307_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F138735_50583_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F140367_70510_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F140733_45005_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F79691_30014_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F149701_0_0|SrvcGrp|30089|2022|PDM|400.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F38000_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F92634_08244_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F147941_06023_0|SrvcGrp|106303|2022|PDM|1228.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F137270_82901_0|SrvcGrp|23683|2022|PDM|42.25|99|0.00|SKILLED NURSING RN|
20|FH_F137270_82901_0|SrvcGrp|88621|2022|PDM|60.75|99|0.00|SKILLED NURSING LPN|
20|FH_F39303_0_0|SrvcGrp|19108|2022|PDM|17745.00|99|0.00|MS DRG 619|
20|FH_F109652_0_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F109652_0_0|SrvcGrp|72994|2022|PDM|2373.00|99|0.00|AEG 3|
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 2 (NO REV)|
20|FH_F90880_15108_0|SrvcGrp|90492|2022|PCT|1.00|99|0.00|BEHAVRAL QUALIT ANALYS VOICE|
20|FH_F124923_23518_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139817_75119_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139433_37115_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F33460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|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_F132212_0_0|SrvcGrp|65720|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F126663_91423_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F108940_15642_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F117340_68144_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F109882_36695_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F91155_16105_0|SrvcGrp|72994|2022|PDM|954.00|99|0.00|AEG 3|
20|FH_F147995_67037_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F141870_85224_0|SrvcGrp|86835|2022|PDM|25.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F123539_65265_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148040_90631_0|SrvcGrp|74668|2022|PDM|375.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F87577_80016_0|SrvcGrp|73601|2022|PDM|8275.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F132992_04662_0|SrvcGrp|48385|2022|PDM|89.00|99|0.00|SPEECH THERAPY|
20|FH_F150001_33064_0|SrvcGrp|86838|2022|PDM|11.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F118376_46052_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87592_85614_0|SrvcGrp|75505|2022|PCT|1.00|99|0.00|CARDIAC STUDIES|
20|FH_F102561_75146_0|SrvcGrp|997|2022|PCT|1.15|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F39517_0_0|SrvcGrp|24703|2022|PDM|740.00|99|0.00|NEWBORN NURSERY|
20|FH_F144048_91324_0|SrvcGrp|75419|2022|PDM|2660.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F132934_63005_0|SrvcGrp|112109|2022|PCT|0.71|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F40154_0_0|SrvcGrp|12840|2022|PCT|0.80|99|0.00|PACEMAKER|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|296.44|99|0.00|HAPA WPA-NWPA 2012-13 ASC 118 W/O REV|
20|FH_F118034_60645_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F142994_54313_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F125348_84660_0|SrvcGrp|74668|2022|PDM|325.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|1995.00|99|0.00|AEG 3 (NO REV)|
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|387.00|99|0.00|ASPG I|
20|FH_F142043_45503_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F117954_17961_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F142027_37217_0|SrvcGrp|48394|2022|PDM|60.00|99|0.00|SKILLED NURSING SERVICES|
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_F142891_54022_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120437_85202_0|SrvcGrp|108452|2022|PDM|0.02|99|0.00|IMMUNE GLOBULIN SUBCUTANEOUS|
20|FH_F67192_0_0|SrvcGrp|3178|2022|PDM|837.00|99|0.00|ACUTE PSYCH|
20|FH_F130108_0_0|SrvcGrp|83885|2022|PDM|6000.00|99|0.00|CARDIAC CATH|
20|FH_F142888_77095_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F146135_87112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144769_0_0|SrvcGrp|73605|2022|PDM|1155.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F89851_83854_0|SrvcGrp|26666|2022|PDM|14062.00|99|0.00|MS DRG 482 ONLY|
20|FH_F68888_0_0|SrvcGrp|474|2022|PDM|250.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|INSERT ANT SEGMENT DRAIN|
20|FH_F87592_85614_0|SrvcGrp|81779|2022|PCT|1.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F119076_41001_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F110400_0_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F128421_27016_0|SrvcGrp|537|2022|PCT|0.80|99|0.00|OBSERVATION SERVICES|
20|FH_F36993_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD KM|
20|FH_F34998_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F133458_18929_0|SrvcGrp|75419|2022|PDM|1250.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F71926_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SKILLED NURSING|
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1185.47|99|0.00|AEG 6 (NO REV)|
20|FH_F39546_0_0|SrvcGrp|115|2022|PDM|700.00|99|0.00|SKILLED NURSING CARE|
20|FH_F146218_50009_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119096_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148493_38008_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F67861_0_0|SrvcGrp|3448|2022|PCT|0.60|99|0.00|MRI|
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|2098.00|99|0.00|AEG 9 (NO REV)|
20|FH_F44016_0_0|CSTM-ALL|CSTM-00|2020|PDM|2126.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F150903_45805_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132118_92240_0|SrvcGrp|89417|2022|PDM|520.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F33581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F67136_0_0|SrvcGrp|60|2022|PDM|8427.00|99|0.00|NEWBORN NURSERY - LEVEL II|
20|FH_F38845_0_0|SrvcGrp|3069|2022|PCT|0.37|99|0.00|IMPLANTS|
20|FH_F150499_32405_0|SrvcGrp|115724|2022|PCT|1.00|99|0.00|COVID VACCINE ADMINISTRATION|
20|FH_F145907_03867_0|SrvcGrp|42622|2022|PDM|652.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F145862_66209_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120745_0_0|SrvcGrp|82137|2022|PCT|0.90|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F117945_78957_0|SrvcGrp|73063|2022|PDM|570.00|99|0.00|OBSERVATION SERVICES|
20|FH_F41739_0_0|SrvcGrp|14018|2022|PDM|33330.00|99|0.00|DRG 001 ONLY CRANIOTOMY W/CC|
20|FH_F39664_0_0|CSTM-ALL|CSTM-00|2020|PDM|115.00|99|0.00|OP SVCS|
20|FH_F145917_37604_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120746_29621_0|SrvcGrp|92501|2022|PDM|132.40|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F50974_0_0|SrvcGrp|23683|2022|PDM|47.00|99|0.00|SKILLED NURSING RN|
20|FH_F40465_0_0|SrvcGrp|3585|2022|PCT|0.75|99|0.00|DRG 118 CARDIAC PACE DEV REPLACEMNT|
20|FH_F114024_0_0|SrvcGrp|75497|2022|PDM|521.00|99|0.00|AEG 10|
20|FH_F130652_51101_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|2038.00|99|0.00|AEG 9 (NO REV)|
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|168.00|99|0.00|CD - ADOLESCENT HALF DAY|
20|FH_F91255_19401_0|SrvcGrp|88777|2022|PCT|1.25|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F42340_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F117717_68410_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F145988_06105_0|SrvcGrp|114479|2022|PDM|26173.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F112852_73112_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F40797_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PDM|20.00|99|0.00|HOME HEALTH AIDE MOD TF|
20|FH_F49354_0_0|SrvcGrp|31186|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC (DME)|
20|FH_F133495_70301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F92676_15063_0|SrvcGrp|79077|2022|PDM|323.03|99|0.00|MON VALLEY ASC 140|
20|FH_F44354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F78682_0_0|SrvcGrp|58775|2022|PDM|5000.00|99|0.00|CORPECTOMY|
20|FH_F38089_0_0|SrvcGrp|3138|2022|PDM|851.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F133391_61032_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147800_0_0|SrvcGrp|110571|2022|PDM|880.00|99|0.00|NERVE BLOCK INJECTION 8|
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_F124854_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139132_36532_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139172_40207_0|SrvcGrp|89417|2022|PDM|372.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F139430_63017_0|SrvcGrp|46605|2022|PDM|101.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F139667_84078_0|SrvcGrp|29346|2022|PDM|26.75|99|0.00|SKILLED NURSING- LPN|
20|FH_F139679_75050_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F150839_03833_0|SrvcGrp|46605|2022|PDM|167.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F139150_75206_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F149579_95815_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|PARTIAL HOSP EATING DISORDER|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F136947_0_0|SrvcGrp|106314|2022|PDM|700.00|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F120154_77498_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F90232_15126_0|SrvcGrp|46104|2022|PDM|91.35|99|0.00|HOME VISIT - PRENATAL|
20|FH_F131418_75215_0|SrvcGrp|86722|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F146266_0_0|SrvcGrp|93433|2022|PDM|14740.00|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F131356_19131_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F131371_0_0|SrvcGrp|111810|2022|PDM|17000.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F138478_0_0|SrvcGrp|109496|2022|PDM|6732.64|99|0.00|UPGRADE OF IMPLANTED PACEMAK|
20|FH_F129811_53573_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37385_0_0|SrvcGrp|15390|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F37267_0_0|SrvcGrp|12264|2022|PDM|60.75|99|0.00|DIETICIAN OR LPN SERVICES|
20|FH_F130140_68845_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149539_06032_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F98820_81401_0|SrvcGrp|73559|2022|PDM|7959.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F150442_28451_0|SrvcGrp|89842|2022|PDM|14360.00|99|0.00|LUMBAR|
20|FH_F129757_0_0|SrvcGrp|3142|2022|PDM|1400.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F75724_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F136887_0_0|SrvcGrp|112975|2022|PDM|9018.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F139785_92629_0|SrvcGrp|108484|2022|PDM|2835.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1575124_CPT_ MOD 26|
20|FH_F33366_33952_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F74646_0_0|SrvcGrp|26180|2022|PDM|55.00|99|0.00|ST|
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|AEG 5  (NO REV)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1011.10|99|0.00|HAPA WPA-NWPA 2012-13 ASC 504 W/O REV|
20|FH_F100782_0_0|SrvcGrp|97685|2022|PDM|2540.75|99|0.00|WINDBER MEDICAL CNTR ASC 907|
20|FH_F145604_14850_0|SrvcGrp|86847|2022|PDM|70.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F145604_14850_0|SrvcGrp|86839|2022|PDM|75.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F145819_03431_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F150225_03051_0|SrvcGrp|115602|2022|PCT|1.00|99|0.00|TELEMEDICINE|
20|FH_F135670_01749_0|SrvcGrp|22589|2022|PDM|50.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F93359_63084_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F126525_0_0|SrvcGrp|108443|2022|PDM|450.00|99|0.00|HEMODIALYSIS W/ TRAINING|
20|FH_F134619_14304_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F100782_0_0|SrvcGrp|105139|2022|PDM|178.85|99|0.00|WINDBER MEDICAL CNTR ASC 245|
20|FH_F124262_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134593_60007_0|SrvcGrp|17016|2022|PDM|48.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132883_31602_0|SrvcGrp|86832|2022|PDM|3.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.00|99|0.00|AEG 1 (NO REV)|
20|FH_F139207_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.28|99|0.00|HSS ASC|
20|FH_F70863_0_0|SrvcGrp|9828|2022|PDM|74.00|99|0.00|HOME HEALTH AIDE|
20|FH_F134492_85201_0|SrvcGrp|73841|2022|PDM|504.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F84712_0_0|SrvcGrp|82739|2022|PDM|33.00|99|0.00|LIPID PROFILE|
20|FH_F84712_0_0|SrvcGrp|82757|2022|PDM|15.00|99|0.00|ASSAY BLOOD CREATININE|
20|FH_F98800_85021_0|SrvcGrp|73659|2022|PDM|5795.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F115788_02904_0|SrvcGrp|89417|2022|PDM|206.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F66427_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F146655_80226_0|SrvcGrp|87131|2022|PDM|481.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F146881_83661_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F116063_43220_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)|
20|FH_F133478_40165_0|CSTM-ALL|CSTM-00|2020|PDM|3629.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 7 (NO REV)|
20|FH_F37772_0_0|SrvcGrp|27301|2022|PDM|20.00|99|0.00|CPT 92567|
20|FH_F31754_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F134087_0_0|SrvcGrp|93057|2022|PDM|3607.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F147211_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IP MULTI ROOM COMPARISON|
20|FH_F38431_0_0|SrvcGrp|23012|2022|PDM|650.00|99|0.00|V5247|
20|FH_F49895_0_0|SrvcGrp|36809|2022|PCT|1.00|99|0.00|OCN F/S PRICING:POS FACILITY  GLOBAL (DME)|
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|813.25|99|0.00|AEG 1 (NO REV)|
20|FH_F58692_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F137067_0_0|SrvcGrp|98497|2022|PDM|16800.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F40198_0_0|CSTM-ALL|CSTM-00|2020|PDM|1325.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114977_78550_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F139173_0_0|SrvcGrp|93078|2022|PDM|450.00|99|0.00|CERVICAL ARTHRODESIS (HCFA)|
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 3 (NO REV)|
20|FH_F78162_0_0|SrvcGrp|67283|2022|PDM|57.00|99|0.00|PT SUBSEQUENT VISIT 97799|
20|FH_F125986_62656_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F90874_0_0|SrvcGrp|111216|2022|PDM|1968.00|99|0.00|ACUTE KIDNEY INJURY HEMODIALYSIS NO ESRD|
20|FH_F132779_0_0|SrvcGrp|87307|2022|PDM|32847.00|99|0.00|MSDRG 270 ONLY|
20|FH_F139551_0_0|SrvcGrp|41325|2022|PDM|3620.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F66481_0_0|SrvcGrp|42973|2022|PDM|100.00|99|0.00|SPEECH  THERAPIST|
20|FH_F91078_0_0|SrvcGrp|43523|2022|PDM|170.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F128878_11203_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F33642_0_0|SrvcGrp|9511|2022|PCT|0.60|99|0.00|OBSERVATION SVCS|
20|FH_F42364_0_0|CSTM-ALL|CSTM-00|2020|PCT|52.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32917_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135052_18702_0|SrvcGrp|471|2022|PDM|682.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F141795_89509_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|1596.00|99|0.00|AEG 8 (NO REV)|
20|FH_F93538_87124_0|SrvcGrp|93339|2022|PDM|24.89|99|0.00|AETNA MED NUTRITION GROUP|
20|FH_F138450_0_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F147941_06023_0|SrvcGrp|114473|2022|PDM|2500.00|99|0.00|VISIT ESKETAMINE > 56M|
20|FH_F128863_57701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130524_43701_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131254_92211_0|SrvcGrp|29077|2022|PDM|12.50|99|0.00|HOME TRANSFUSION|
20|FH_F129969_33908_0|SrvcGrp|73841|2022|PDM|320.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F114511_0_0|SrvcGrp|93919|2022|PDM|624.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F137067_0_0|SrvcGrp|92416|2022|PDM|2520.00|99|0.00|CERVICAL LAMINOTOMY|
20|FH_F93742_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149839_80002_0|SrvcGrp|48385|2022|PDM|135.00|99|0.00|SPEECH THERAPY|
20|FH_F88212_20151_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F110161_31329_0|SrvcGrp|104217|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500) (EXCEPT SKN TYPE OF BILL)|
20|FH_F125028_19061_0|SrvcGrp|86829|2022|PDM|52.50|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F147941_06023_0|SrvcGrp|13262|2022|PDM|18.36|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F148265_06067_0|SrvcGrp|26273|2022|PDM|4858.00|99|0.00|CPT 29880|
20|FH_F120285_32960_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137940_0_0|SrvcGrp|13683|2022|PDM|499.11|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F133099_66801_0|SrvcGrp|537|2022|PCT|0.80|99|0.00|OBSERVATION SERVICES|
20|FH_F117902_0_0|SrvcGrp|15473|2022|PDM|900.00|99|0.00|CPT CODE 42820|
20|FH_F34112_0_0|SrvcGrp|360|2022|PDM|1025.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F119355_0_0|SrvcGrp|105425|2022|PDM|90.00|99|0.00|AETNA EXPOSURE ADAPTIVE BH TREATMENT 60 MINS|
20|FH_F151619_73505_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134847_0_0|SrvcGrp|99073|2022|PDM|1.60|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F116583_0_0|SrvcGrp|80918|2022|PDM|150.00|99|0.00|RESPITE CARE|
20|FH_F117615_30525_0|SrvcGrp|42785|2022|PDM|141.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F37312_0_0|SrvcGrp|25938|2022|PDM|99.00|99|0.00|SOCIAL WORKER (MEDICAL)|
20|FH_F35410_0_0|SrvcGrp|29489|2022|PCT|1.00|99|0.00|DIGESTIVE TRACT ACCESS DEVICES|
20|FH_F35416_0_0|SrvcGrp|11049|2022|PCT|0.80|99|0.00|OP LITHOTRIPSY|
20|FH_F97300_47501_0|SrvcGrp|84137|2022|PDM|3500.00|99|0.00|SURGERY W/ ER|
20|FH_F128753_32501_0|SrvcGrp|73603|2022|PCT|0.64|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F97640_37043_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|1331.00|99|0.00|AEG 5  (NO REV)|
20|FH_F149003_62208_0|SrvcGrp|23683|2022|PDM|51.50|99|0.00|SKILLED NURSING RN|
20|FH_F146859_0_0|SrvcGrp|98203|2022|PDM|2087.00|99|0.00|BUNION CORRECTION|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F124548_12414_0|SrvcGrp|86722|2022|PDM|125.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F111266_30339_0|SrvcGrp|29023|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F40853_0_0|SrvcGrp|701|2022|PDM|1125.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F36683_0_0|SrvcGrp|18803|2022|PDM|31218.00|99|0.00|MS DRG 218|
20|FH_F123745_0_0|SrvcGrp|67064|2022|PDM|2500.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F148979_44512_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F35747_34223_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F150442_28451_0|SrvcGrp|89404|2022|PDM|11447.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F35678_0_0|SrvcGrp|20402|2022|PDM|16952.00|99|0.00|MS DRG 025-027 ONLY CRANIOTOMY|
20|FH_F141156_04401_0|CSTM-ALL|CSTM-00|2020|PDM|1042.00|99|0.00|AEG 6 (NO REV)|
20|FH_F51557_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149662_85015_0|SrvcGrp|86444|2022|PCT|0.00|99|0.00|CHEMOTHERAPY AND RADIATION|
20|FH_F140990_0_0|SrvcGrp|113705|2022|PDM|246.00|99|0.00|CAPD/CCPD|
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 5  (NO REV)|
20|FH_F137748_95231_0|SrvcGrp|705|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F111122_63376_0|SrvcGrp|48385|2022|PDM|81.50|99|0.00|SPEECH THERAPY|
20|FH_F98880_50158_0|SrvcGrp|90854|2022|PDM|2994.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F117762_0_0|SrvcGrp|27345|2022|PDM|3016.00|99|0.00|OP SURGERY (CPT 49650)|
20|FH_F136779_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|3008.00|99|0.00|LAPAROSCOPY CHOLECYSTECTOMY (HCFA)|
20|FH_F37771_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN|
20|FH_F35097_16508_0|SrvcGrp|20534|2022|PDM|300.00|99|0.00|SKILLED NURSING|
20|FH_F149539_06032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137713_50025_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F31087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS|
20|FH_F35280_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F148519_83201_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F69183_0_0|SrvcGrp|8968|2022|PDM|1500.00|99|0.00|NICU LEVEL III & IV|
20|FH_F35741_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|924.00|99|0.00|AEG 2 (NO REV)|
20|FH_F127553_44321_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F74845_0_0|SrvcGrp|14177|2022|PDM|19495.00|99|0.00|BARIATRIC SVCS|
20|FH_F92431_80033_0|SrvcGrp|46605|2022|PDM|146.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F90232_15126_0|SrvcGrp|29023|2022|PDM|85.05|99|0.00|HOME INFUSION THERAPY|
20|FH_F122392_78207_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F128369_72901_0|SrvcGrp|46903|2022|PDM|371.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F143367_81003_0|SrvcGrp|96519|2022|PCT|1.00|99|0.00|IP PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F123185_0_0|SrvcGrp|72992|2022|PDM|531.00|99|0.00|AEG 2|
20|FH_F131107_43140_0|SrvcGrp|89781|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F49458_0_0|SrvcGrp|45568|2022|PDM|247.29|99|0.00|MASTECTOMY PROSTHESIS|
20|FH_F132479_90290_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132416_92270_0|SrvcGrp|105819|2022|PDM|1226.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F116633_37217_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F116802_41224_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F126054_30022_0|SrvcGrp|74694|2022|PDM|1049.00|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F31150_0_0|SrvcGrp|177|2022|PDM|1400.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F91372_63043_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F36420_0_0|SrvcGrp|997|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F43008_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F49895_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F115685_64064_0|SrvcGrp|99050|2022|PDM|75.00|99|0.00|HEMODAILYSIS (HCFA)|
20|FH_F57032_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F110142_39056_0|SrvcGrp|26001|2022|PDM|137.21|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F126153_44663_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F130051_31707_0|CSTM-ALL|CSTM-00|2020|PDM|1333.00|99|0.00|AEG 10 (NO REV)|
20|FH_F150982_0_0|SrvcGrp|47142|2022|PDM|4404.00|99|0.00|CPT 49650|
20|FH_F99100_0_0|SrvcGrp|96059|2022|PDM|1586.20|99|0.00|CATHETER|
20|FH_F55532_0_0|SrvcGrp|9510|2022|PDM|675.00|99|0.00|SKILLED NURSING CARE|
20|FH_F124388_0_0|SrvcGrp|27402|2022|PDM|2755.50|99|0.00|LASER PROCEDURES|
20|FH_F86332_75081_0|SrvcGrp|13154|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F114975_78596_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F109246_10018_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F82714_18848_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125074_18104_0|SrvcGrp|92502|2022|PDM|625.80|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F77066_0_0|SrvcGrp|13366|2022|PDM|1500.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F84215_0_0|SrvcGrp|77452|2022|PDM|2750.00|99|0.00|CPT 54405|
20|FH_F70126_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)|
20|FH_F125028_19061_0|SrvcGrp|94093|2022|PCT|1.05|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F33249_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F125516_50574_0|SrvcGrp|75505|2022|PCT|0.90|99|0.00|CARDIAC STUDIES|
20|FH_F128190_45342_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)|
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|1401.61|99|0.00|AEG 9 (NO REV)|
20|FH_F34472_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F114963_62062_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F145551_04106_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148260_0_0|SrvcGrp|104754|2022|PDM|1671.00|99|0.00|CYSTOMETROGRAM W/ VP&UP|
20|FH_F89563_29407_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F94665_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F82695_15014_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F58592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F37679_0_0|SrvcGrp|26858|2022|PDM|15.25|99|0.00|HOME INFUSION THERAPY (MOD SJ)|
20|FH_F81172_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F148440_16506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121090_07848_0|SrvcGrp|108735|2022|PDM|50.00|99|0.00|DRUG TEST PRSMV DIR OPT OBS|
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|817.00|99|0.00|AEG 2 (NO REV)|
20|FH_F37647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F56136_0_0|SrvcGrp|22814|2022|PCT|0.92|99|0.00|LAPAROSCOPIC APPENDECTOMY|
20|FH_F82931_18847_0|SrvcGrp|14557|2022|PDM|50.00|99|0.00|AMBULANCE SVCS - WHEELCHAIR VAN|
20|FH_F92276_32308_0|CSTM-ALL|CSTM-00|2020|PDM|8159.00|99|0.00|AEG 1 (NO REV)|
20|FH_F116049_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F127877_43560_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37679_0_0|SrvcGrp|17013|2022|PDM|61.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F123276_20737_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|773.00|99|0.00|AEG 2 (NO REV)|
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2501000 MOD NU (HCFA)|
20|FH_F68970_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109951_0_0|SrvcGrp|11663|2022|PCT|0.45|99|0.00|IMPLANTS|
20|FH_F91873_12723_0|SrvcGrp|31705|2022|PDM|3310.00|99|0.00|MS DRG 791 ONLY|
20|FH_F115150_0_0|SrvcGrp|103927|2022|PDM|135.87|99|0.00|SLEEP STUDY UNATTENDED(HCFA)|
20|FH_F114864_78155_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F105362_44601_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F105440_46383_0|SrvcGrp|89149|2022|PDM|191.00|99|0.00|OP INTENSIVE|
20|FH_F105591_17601_0|SrvcGrp|73002|2022|PDM|1875.00|99|0.00|AEG 7|
20|FH_F132627_0_0|SrvcGrp|17015|2022|PDM|43.86|99|0.00|HOME INFUSION THERAPY|
20|FH_F128027_0_0|SrvcGrp|64732|2022|PDM|1050.00|99|0.00|CPT 43239|
20|FH_F144828_0_0|SrvcGrp|83145|2022|PDM|4400.00|99|0.00|AETNA BREAST RECONSTRUCTION|
20|FH_F43536_0_0|SrvcGrp|941|2022|PCT|0.77|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F124180_0_0|SrvcGrp|109733|2022|PDM|3796.50|99|0.00|NSL/SINS NDSC W/ SINS DILATION|
20|FH_F146974_19709_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146906_60445_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F48552_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F64441_0_0|SrvcGrp|42782|2022|PDM|68.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F34938_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F39910_0_0|SrvcGrp|38|2022|PDM|2864.00|99|0.00|NORMAL DELIVERY|
20|FH_F39956_0_0|SrvcGrp|3029|2022|PDM|237.00|99|0.00|NEWBORN NURSERY|
20|FH_F47636_0_0|SrvcGrp|11442|2022|PDM|589.27|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F87822_0_0|SrvcGrp|81023|2022|PDM|206.85|99|0.00|AETNA CAPD CCPD IPD DIALYSIS PROC|
20|FH_F102180_0_0|SrvcGrp|471|2022|PCT|0.84|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F124234_33410_0|SrvcGrp|104079|2022|PCT|1.50|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F124237_95023_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F124567_33144_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124611_64804_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F132439_0_0|SrvcGrp|94780|2022|PDM|178.17|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F127995_84010_0|SrvcGrp|86845|2022|PDM|25.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F97083_90670_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130036_43232_0|SrvcGrp|87441|2022|PDM|867.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F137248_0_0|SrvcGrp|104747|2022|PDM|4058.00|99|0.00|INCISION OF HEEL BONE|
20|FH_F136667_23603_0|SrvcGrp|73605|2022|PDM|1035.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F114666_30342_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114666_30342_0|SrvcGrp|78403|2022|PDM|0.25|99|0.00|AETNA MED RECORD|
20|FH_F113847_20910_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138696_64772_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F139662_51106_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|7500.00|99|0.00|AEG 7 (NO REV)|
20|FH_F122610_73139_0|SrvcGrp|72219|2022|PCT|1.48|99|0.00|LABORATORY|
20|FH_F43913_0_0|SrvcGrp|16141|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F136830_22003_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F34496_0_0|SrvcGrp|8950|2022|PDM|3638.25|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F31863_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F128276_66441_0|SrvcGrp|89417|2022|PDM|198.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F87619_0_0|SrvcGrp|72998|2022|PDM|901.00|99|0.00|AEG 5|
20|FH_F93920_0_0|SrvcGrp|72998|2022|PDM|6000.00|99|0.00|AEG 5|
20|FH_F121523_33406_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS|
20|FH_F116092_83254_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS|
20|FH_F125690_67211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129657_77479_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F67383_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115112_48035_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F33630_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136790_0_0|SrvcGrp|3404|2022|PDM|154.00|99|0.00|CPT 99211|
20|FH_F83520_18704_0|SrvcGrp|473|2022|PDM|357.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|1417.00|99|0.00|AEG 2 (NO REV)|
20|FH_F39041_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F130681_15701_0|SrvcGrp|111987|2022|PCT|1.45|99|0.00|VIRTUAL CHECK-IN|
20|FH_F139515_0_0|SrvcGrp|78282|2022|PDM|3348.00|99|0.00|CPT 47563|
20|FH_F148179_48065_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F82931_18847_0|SrvcGrp|63|2022|PDM|789.00|99|0.00|SUBACUTE CARE|
20|FH_F42706_0_0|SrvcGrp|36412|2022|PCT|1.10|99|0.00|TISSUE GRAFTS|
20|FH_F148255_72703_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120906_65542_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|501.00|99|0.00|AEG 3 (NO REV)|
20|FH_F31908_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F54513_0_0|SrvcGrp|10545|2022|PDM|110.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F42019_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F102500_0_0|SrvcGrp|72992|2022|PDM|696.00|99|0.00|AEG 2|
20|FH_F140427_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|783.00|99|0.00|AEG 5  (NO REV)|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD UE|
20|FH_F80245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F78285_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|PDM|826.00|99|0.00|AEG 6 (NO REV)|
20|FH_F38798_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KIDS HOME INFUSION SERVICES|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|967.52|99|0.00|HAPA WPA-NWPA 2012-13 ASC 706 W/O REV|
20|FH_F115954_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F32478_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102302_0_0|SrvcGrp|16670|2022|PDM|1817.00|99|0.00|ULNAR NERVE AT ELBOW|
20|FH_F141354_63556_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34513_0_0|SrvcGrp|9510|2022|PDM|364.00|99|0.00|SKILLED NURSING CARE|
20|FH_F130747_0_0|SrvcGrp|27315|2022|PDM|5306.00|99|0.00|TENDON REPAIR|
20|FH_F151525_30349_0|SrvcGrp|114975|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F131992_62832_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123943_84041_0|SrvcGrp|97703|2022|PDM|90.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F116647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F65103_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP|
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|1366.00|99|0.00|AEG 5  (NO REV)|
20|FH_F150462_30458_0|SrvcGrp|24748|2022|PDM|50.00|99|0.00|CORTICOSTEROID THERAPY|
20|FH_F149140_07522_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F132559_0_0|SrvcGrp|77582|2022|PDM|2800.00|99|0.00|CPT 31255|
20|FH_F38798_0_0|SrvcGrp|23683|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F128159_45356_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130112_0_0|SrvcGrp|77453|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F151400_0_0|SrvcGrp|58755|2022|PDM|3500.00|99|0.00|INJECTION PROC FOR JOINT|
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PDM|595.00|99|0.00|CHILD PSYCHIATRIC|
20|FH_F112708_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F124972_64644_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123400_04605_0|SrvcGrp|104085|2022|PDM|435.00|99|0.00|RESIDENTIAL ADULT CD(>= 18 YRS)|
20|FH_F79645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F123464_63841_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|1265.00|99|0.00|ASPG 4 HEARTLAND HEALTHCARE|
20|FH_F39273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126687_72560_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102302_0_0|SrvcGrp|93740|2022|PDM|14300.00|99|0.00|REVISE/REMOVE NEURO RECEIVER|
20|FH_F102302_0_0|SrvcGrp|98596|2022|PDM|10850.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F134999_89106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109240_21201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37679_0_0|SrvcGrp|27130|2022|PDM|7.50|99|0.00|HORMONE INJECTION THERAPY (MOD SH)|
20|FH_F93880_95476_0|SrvcGrp|12837|2022|PCT|0.30|99|0.00|INTRAOCULAR LENSES|
20|FH_F72051_0_0|SrvcGrp|59426|2022|PDM|75.00|99|0.00|PT|
20|FH_F65159_0_0|SrvcGrp|9114|2022|PDM|4961.00|99|0.00|OTHER INTENSIVE CARE|
20|FH_F38560_0_0|SrvcGrp|29516|2022|PDM|7000.00|99|0.00|ADULT ELECTROPHYSIOLOGY|
20|FH_F146520_80435_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116473_0_0|SrvcGrp|88030|2022|PDM|15000.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F145781_0_0|SrvcGrp|27261|2022|PDM|10500.00|99|0.00|CPT 27446|
20|FH_F150141_63103_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F130763_0_0|SrvcGrp|82114|2022|PDM|3450.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F100782_0_0|SrvcGrp|105062|2022|PDM|730.64|99|0.00|WINDBER MEDICAL CNTR ASC 107|
20|FH_F110268_02891_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F133869_19947_0|SrvcGrp|72602|2022|PDM|695.00|99|0.00|ECT|
20|FH_F52956_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F73125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126990_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOSPICE (UHSP) SAME DOS|
20|FH_F134350_46601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145694_84770_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123646_91350_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114444_19602_0|SrvcGrp|104418|2022|PDM|85.00|99|0.00|OFFICE/OUTPATIENT VISIT EST (HCFA)(MOD AF)|
20|FH_F85651_33549_0|SrvcGrp|38004|2022|PDM|5225.00|99|0.00|CPT CODE 59400|
20|FH_F138026_46143_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F123609_28451_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F126550_43085_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F134230_60098_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134614_84651_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F97041_71603_0|SrvcGrp|73603|2022|PDM|9293.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F129509_0_0|SrvcGrp|72994|2022|PDM|744.00|99|0.00|AEG 3|
20|FH_F149219_01966_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117300_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F84450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|848.00|99|0.00|AEG 4 (NO REV)|
20|FH_F70205_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F122947_29532_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F63312_0_0|SrvcGrp|10542|2022|PDM|79.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F145702_22192_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F141248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F88744_71103_0|SrvcGrp|111962|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F146124_06112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88744_71103_0|SrvcGrp|87667|2022|PDM|1638.00|99|0.00|TRAUMA/ER/OBSERVATION|
20|FH_F40725_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87812_33919_0|SrvcGrp|85017|2022|PCT|1.10|99|0.00|DME|
20|FH_F117206_0_0|SrvcGrp|79595|2022|PDM|700.00|99|0.00|CPT 45385|
20|FH_F135670_01749_0|SrvcGrp|86845|2022|PDM|35.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F149099_23901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F121225_98902_0|SrvcGrp|73605|2022|PDM|1500.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F121597_30315_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119110_91773_0|SrvcGrp|48385|2022|PDM|120.00|99|0.00|SPEECH THERAPY|
20|FH_F145562_70458_0|SrvcGrp|47183|2022|PDM|60.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F100680_43130_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F129440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.15|99|0.00|MID-LEVEL|
20|FH_F98021_07012_0|SrvcGrp|73656|2022|PDM|843.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F110501_07652_0|SrvcGrp|86723|2022|PDM|621.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|418.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 208 W/O REV|
20|FH_F121225_98902_0|SrvcGrp|89317|2022|PCT|0.85|99|0.00|AETNA SLEEP STUDIES|
20|FH_F135623_53115_0|SrvcGrp|83521|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F115616_0_0|SrvcGrp|35672|2022|PDM|3121.00|99|0.00|CPT 23412|
20|FH_F144848_0_0|SrvcGrp|58755|2022|PDM|5959.00|99|0.00|INJECTION PROC FOR JOINT|
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|1782.00|99|0.00|AEG 8 (NO REV)|
20|FH_F110562_33409_0|SrvcGrp|75754|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F134324_26354_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F130763_0_0|SrvcGrp|100045|2022|PDM|3882.00|99|0.00|REVISION OF FOOT TENDON|
20|FH_F119783_46360_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F110501_07652_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F145675_33761_0|SrvcGrp|29347|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133922_70563_0|SrvcGrp|86604|2022|PDM|71.39|99|0.00|SLEEP STUDIES (MOD 26)|
20|FH_F100782_0_0|SrvcGrp|97667|2022|PDM|1440.99|99|0.00|WINDBER MEDICAL CNTR ASC 504|
20|FH_F148862_85390_0|SrvcGrp|105820|2022|PDM|1500.00|99|0.00|IP PSYCH EATING DISORDERS|
20|FH_F133877_84117_0|SrvcGrp|100663|2022|PDM|615.00|99|0.00|HOSPICE IP CARE|
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|2956.00|99|0.00|AEG 5  (NO REV)|
20|FH_F149027_60402_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F50703_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|106% OF ASP DRUGS/IMMUN UPDATE QUARTERLY|
20|FH_F133724_84041_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F147502_0_0|SrvcGrp|95661|2022|PDM|150.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F128833_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F133749_84604_0|SrvcGrp|112469|2022|PDM|630.00|99|0.00|HOSPICE ROUT HOME CARE-DIEM (HCFA)|
20|FH_F100782_0_0|CSTM-ALL|CSTM-00|2020|PDM|1943.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124159_92506_0|SrvcGrp|89417|2022|PDM|472.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F111986_0_0|SrvcGrp|63468|2022|PDM|1133.00|99|0.00|CPT 52281|
20|FH_F133868_40202_0|SrvcGrp|58509|2022|PDM|258.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F130017_02302_0|SrvcGrp|29755|2022|PDM|32904.95|99|0.00|MS DRG 245 ONLY|
20|FH_F132707_83716_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F142376_0_0|SrvcGrp|98561|2022|PDM|1815.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F110344_37421_0|SrvcGrp|73841|2022|PDM|542.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F136913_68803_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F115157_06851_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115210_21043_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 5  (NO REV)|
20|FH_F115266_66736_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F42342_0_0|SrvcGrp|9830|2022|PDM|131.25|99|0.00|OT SVCS|
20|FH_F42399_0_0|SrvcGrp|33165|2022|PDM|374.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F134612_0_0|SrvcGrp|112593|2022|PDM|6200.00|99|0.00|VASC EMBOLIZE/OCCLUDE ARTERY|
20|FH_F135351_0_0|SrvcGrp|78096|2022|PDM|3850.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F39887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F131501_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39825_0_0|SrvcGrp|31338|2022|PCT|0.85|99|0.00|ANCILLARY SERVICES|
20|FH_F44459_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48836_0_0|SrvcGrp|28847|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY|
20|FH_F54552_0_0|SrvcGrp|10580|2022|PDM|55.00|99|0.00|HYDRATION THERAPY - 3 LITERS|
20|FH_F138697_53219_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110233_0_0|SrvcGrp|75505|2022|PCT|0.94|99|0.00|CARDIAC STUDIES|
20|FH_F88893_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F151302_80227_0|SrvcGrp|74668|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151307_63127_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151401_36607_0|SrvcGrp|103739|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F151427_04106_0|SrvcGrp|104483|2022|PDM|66.25|99|0.00|HYDRATE IV INFUSION ADD-ON|
20|FH_F151510_15928_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151514_35242_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F130671_42701_0|SrvcGrp|90854|2022|PDM|809.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F36492_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F135477_50501_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135924_02906_0|SrvcGrp|111930|2022|PDM|73.60|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F135972_18509_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F130547_85712_0|SrvcGrp|103319|2022|PDM|7.54|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F131132_44077_0|CSTM-ALL|CSTM-00|2020|PDM|4682.00|99|0.00|AEG 6 (NO REV)|
20|FH_F131407_07607_0|SrvcGrp|86839|2022|PDM|30.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F116527_70443_0|SrvcGrp|105803|2022|PCT|0.00|99|0.00|AETNA ALL DRUGS AGENTS|
20|FH_F116488_79925_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1302.00|99|0.00|AETNA CPT 49560|
20|FH_F121731_20164_0|SrvcGrp|48394|2022|PDM|34.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F121740_98119_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F146125_0_0|SrvcGrp|26273|2022|PDM|3245.00|99|0.00|CPT 29880|
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|2137.00|99|0.00|AEG 9 (NO REV)|
20|FH_F33685_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F44113_0_0|SrvcGrp|3349|2022|PDM|3000.00|99|0.00|LITHOTRIPSY SVCS|
20|FH_F130817_18103_0|SrvcGrp|48160|2022|PCT|1.00|99|0.00|BOTULINUM TOXIN TYPE A, PER UNIT|
20|FH_F111363_33169_0|SrvcGrp|82764|2022|PDM|57.00|99|0.00|HEPATIC FUNCTION PANEL|
20|FH_F111363_33169_0|SrvcGrp|81402|2022|PDM|105.00|99|0.00|METABOLIC PANEL|
20|FH_F111880_50003_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F47906_0_0|SrvcGrp|29666|2022|PCT|1.00|99|0.00|DME MOD RR|
20|FH_F148243_0_0|SrvcGrp|79593|2022|PDM|650.00|99|0.00|CPT 45378|
20|FH_F36238_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54272_0_0|SrvcGrp|51323|2022|PDM|125.00|99|0.00|ST SERVICES|
20|FH_F87534_19464_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F129240_10028_0|SrvcGrp|22589|2022|PDM|35.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F103004_75840_0|SrvcGrp|14532|2022|PDM|1302.00|99|0.00|OBSERVATION SVCS|
20|FH_F36704_0_0|SrvcGrp|941|2022|PDM|1800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F148344_0_0|SrvcGrp|108484|2022|PDM|773.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F95101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109279_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70303_0_0|SrvcGrp|14494|2022|PDM|53.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F122725_32216_0|CSTM-ALL|CSTM-00|2020|PDM|21.73|99|0.00|INTERV HLTH/BEHAV FAM W/ PT|
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|928.00|99|0.00|ASPG VIII|
20|FH_F86851_0_0|SrvcGrp|79583|2022|PDM|676.00|99|0.00|CPT 45381|
20|FH_F88639_80204_0|SrvcGrp|75497|2022|PDM|5087.85|99|0.00|AEG 10|
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|94.68|99|0.00|AETNA SLEEP STUDIES|
20|FH_F149179_0_0|SrvcGrp|115611|2022|PDM|7000.00|99|0.00|CATH DIALYSIS CIRCUIT|
20|FH_F46832_0_0|SrvcGrp|21711|2022|PDM|165.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F123809_26155_0|SrvcGrp|75505|2022|PCT|0.72|99|0.00|CARDIAC STUDIES|
20|FH_F132810_0_0|SrvcGrp|29077|2022|PDM|25.00|99|0.00|HOME TRANSFUSION|
20|FH_F40702_0_0|SrvcGrp|13631|2022|PDM|110.00|99|0.00|CPT 99213|
20|FH_F58856_0_0|SrvcGrp|22403|2022|PDM|1462.00|99|0.00|ASPG III (REV CODE + CPT)|
20|FH_F136386_30901_0|SrvcGrp|31028|2022|PDM|15750.00|99|0.00|MS DRG 489 ONLY|
20|FH_F136542_02446_0|SrvcGrp|109653|2022|PDM|354.00|99|0.00|PARTIAL HOSPITALIZATION >=18|
20|FH_F93187_08043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93292_62234_0|SrvcGrp|48398|2022|PDM|86.00|99|0.00|PT SERVICES|
20|FH_F134011_84102_0|SrvcGrp|17016|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134011_84102_0|SrvcGrp|86837|2022|PDM|10.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F138958_78410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142387_70454_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F97602_40121_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F138575_66053_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F78403_15552_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139267_30253_0|SrvcGrp|113547|2022|PDM|156.89|99|0.00|COVID-19 NFCT DS VIR RESP RNA 3 TRGT|
20|FH_F139267_30253_0|SrvcGrp|113173|2022|PDM|18.63|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - PFIZER|
20|FH_F140468_46825_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122067_0_0|SrvcGrp|92549|2022|PDM|550.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F118959_44830_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F66835_0_0|SrvcGrp|35966|2022|PDM|745.00|99|0.00|ECT|
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|870.00|99|0.00|AEG 4 (NO REV)|
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OP IMAGING ENHANC. SUBSTANCES (IMAGENHANCE)|
20|FH_F115452_15235_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F129474_92701_0|SrvcGrp|75442|2022|PDM|900.00|99|0.00|OBSERVATION - REV 762|
20|FH_F117108_37841_0|SrvcGrp|79099|2022|PDM|2000.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F117217_80304_0|SrvcGrp|75419|2022|PDM|481.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F117240_37334_0|SrvcGrp|10363|2022|PDM|765.00|99|0.00|CPT CODE 99283|
20|FH_F137270_82901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F137930_51546_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F90838_16146_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE|
20|FH_F139433_37115_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|1816.00|99|0.00|AEG 6 (NO REV)|
20|FH_F95880_02726_0|SrvcGrp|90489|2022|PDM|56.65|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F119245_19010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137951_0_0|SrvcGrp|58634|2022|PDM|3000.00|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F137951_0_0|SrvcGrp|113168|2022|PDM|1479.00|99|0.00|REMOVAL OF KNEECAP BURSA|
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 3 (NO REV)|
20|FH_F148644_06890_0|SrvcGrp|114443|2022|PDM|9183.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F105921_80014_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F117450_63131_0|SrvcGrp|29347|2022|PDM|24.00|99|0.00|HOME HEALTH AIDE|
20|FH_F141887_65605_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150164_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F149840_80002_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141927_71901_0|CSTM-ALL|CSTM-00|2020|PDM|1654.00|99|0.00|AEG 9 (NO REV)|
20|FH_F43433_0_0|SrvcGrp|32443|2022|PDM|7699.00|99|0.00|JACKSON MADISON HOSP ASPG 7|
20|FH_F100740_15206_0|SrvcGrp|73601|2022|PDM|5565.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F147995_67037_0|SrvcGrp|114975|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F117559_08619_0|SrvcGrp|104055|2022|PDM|20.00|99|0.00|INFLUENZA VACCINE|
20|FH_F121016_32607_0|SrvcGrp|106977|2022|PCT|1.00|99|0.00|RHOGAM INJECTION|
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|OP PARTIAL HOSPITALIZATION (8-12 HOURS)|
20|FH_F111815_35904_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F67803_0_0|SrvcGrp|42827|2022|PDM|120.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F117368_68114_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F133021_00910_0|SrvcGrp|112281|2022|PDM|75.00|99|0.00|MONITORING|
20|FH_F55375_0_0|SrvcGrp|11301|2022|PDM|875.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F101922_98055_0|SrvcGrp|82242|2022|PCT|0.63|99|0.00|AETNA PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY|
20|FH_F144008_11413_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F89112_16509_0|SrvcGrp|10361|2022|PDM|109.00|99|0.00|CPT CODE 99281|
20|FH_F97564_52246_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F142831_08053_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148662_01583_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41438_0_0|SrvcGrp|34280|2022|PDM|25.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F141927_71901_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F102561_75146_0|SrvcGrp|73497|2022|PDM|1750.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|1838.81|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|1175.00|99|0.00|AEG 8 (NO REV)|
20|FH_F92972_0_0|SrvcGrp|79699|2022|PCT|0.63|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F38700_0_0|SrvcGrp|18838|2022|PCT|0.80|99|0.00|MS DRG 226|
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 3 (NO REV)|
20|FH_F89932_10940_0|CSTM-ALL|CSTM-00|2020|PDM|1055.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|377.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 108 W/O REV|
20|FH_F33537_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127327_27401_0|SrvcGrp|10391|2022|PDM|1774.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F102062_35447_0|SrvcGrp|46104|2022|PDM|150.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F117827_75235_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117995_60126_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F94165_0_0|SrvcGrp|73601|2022|PCT|0.85|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F82378_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45977_0_0|SrvcGrp|40406|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD AW|
20|FH_F117756_75402_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F141802_17042_0|SrvcGrp|105809|2022|PCT|0.68|99|0.00|PT OT ST|
20|FH_F40465_0_0|SrvcGrp|360|2022|PCT|0.75|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F120829_85283_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126812_44137_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F83995_16748_0|SrvcGrp|3809|2022|PDM|525.00|99|0.00|HOSPICE CARE|
20|FH_F134205_33410_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F54592_0_0|SrvcGrp|21711|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F134495_84321_0|SrvcGrp|29346|2022|PDM|26.75|99|0.00|SKILLED NURSING- LPN|
20|FH_F84712_0_0|SrvcGrp|82748|2022|PDM|37.00|99|0.00|HEMO/PLATELET CNT AUTOMATED|
20|FH_F84912_0_0|SrvcGrp|83179|2022|PDM|21.28|99|0.00|CEPHALOGRAM ORTHODONTIC|
20|FH_F70684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|INFUSION- IV SERVICES (MOD SH)|
20|FH_F75963_0_0|SrvcGrp|48396|2022|PDM|18.00|99|0.00|OT SERVICES|
20|FH_F75963_0_0|SrvcGrp|66265|2022|PDM|8.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F75963_0_0|SrvcGrp|48385|2022|PDM|18.00|99|0.00|SPEECH THERAPY|
20|FH_F115909_38133_0|SrvcGrp|42625|2022|PDM|500.00|99|0.00|BEHAVIORAL HEALTH GENERAL|
20|FH_F66427_0_0|SrvcGrp|58855|2022|PCT|0.80|99|0.00|HIGH COST DRUGS|
20|FH_F146667_37110_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F146782_19034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120528_60559_0|SrvcGrp|472|2022|PDM|480.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116023_10027_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F116114_37033_0|SrvcGrp|23587|2022|PDM|668.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F131930_46205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131957_23226_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151155_26508_0|SrvcGrp|104442|2022|PDM|95.00|99|0.00|AETNA OFFICE/OP VISIT EST (HCFA)|
20|FH_F151221_71857_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 3 (NO REV)|
20|FH_F33744_0_0|CSTM-ALL|CSTM-00|2020|PDM|1738.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F37625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110381_0_0|SrvcGrp|85538|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F117399_0_0|SrvcGrp|103550|2022|PDM|400.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F71365_0_0|SrvcGrp|59426|2022|PDM|90.00|99|0.00|PT|
20|FH_F74562_0_0|SrvcGrp|109|2022|PDM|535.00|99|0.00|CD - DETOX|
20|FH_F113784_0_0|SrvcGrp|42971|2022|PDM|80.00|99|0.00|SKN RN|
20|FH_F115264_0_0|SrvcGrp|74348|2022|PCT|6.00|99|0.00|EVALUATION AND MANAGEMENT|
20|FH_F116143_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F113794_0_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F117623_0_0|SrvcGrp|107550|2022|PDM|27.00|99|0.00|EXPOSE BEHAV ASSESSMENT (HCFA)|
20|FH_F138751_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F95341_08701_0|SrvcGrp|94761|2022|PCT|1.00|99|0.00|FLULAVAL VACC IM (>=3 YRS)|
20|FH_F131047_0_0|SrvcGrp|111663|2022|PDM|3421.00|99|0.00|ACUTE MEDICAL SURGICAL SERVICES|
20|FH_F132988_0_0|SrvcGrp|100044|2022|PDM|5846.69|99|0.00|INCISION OF HEEL BONE|
20|FH_F134027_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F130274_63033_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F118786_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HSS ASC|
20|FH_F137897_0_0|SrvcGrp|110173|2022|PCT|1.00|99|0.00|INJECTABLES (Q CODES)|
20|FH_F39941_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|PDM|714.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F49943_0_0|SrvcGrp|45945|2022|PDM|105.00|99|0.00|RN NURSING SVCS|
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|1365.00|99|0.00|AEG 1 (NO REV)|
20|FH_F129549_01238_0|SrvcGrp|48396|2022|PDM|107.62|99|0.00|OT SERVICES|
20|FH_F124188_29621_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|OP SVCS|
20|FH_F150910_0_0|SrvcGrp|93431|2022|PDM|10500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F127995_84010_0|SrvcGrp|22589|2022|PDM|33.60|99|0.00|CHEMOTHERAPY NOC|
20|FH_F124112_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F136611_43764_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136623_01830_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114629_19131_0|SrvcGrp|88819|2022|PDM|986.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F114666_30342_0|SrvcGrp|80617|2022|PDM|22500.00|99|0.00|ARTHOPLASTY|
20|FH_F114666_30342_0|SrvcGrp|26430|2022|PDM|3750.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F122610_73139_0|SrvcGrp|12491|2022|PCT|0.50|99|0.00|PACEMAKER|
20|FH_F117085_40207_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F117069_15236_0|SrvcGrp|27969|2022|PCT|0.00|99|0.00|HOME HEALTH AIDE|
20|FH_F136807_43220_0|SrvcGrp|23683|2022|PDM|41.00|99|0.00|SKILLED NURSING RN|
20|FH_F38826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F49016_0_0|SrvcGrp|31377|2022|PCT|0.60|99|0.00|EMERGENCY ROOM LEVEL V|
20|FH_F115267_67156_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F115631_65201_0|CSTM-ALL|CSTM-00|2020|PDM|1817.00|99|0.00|AEG 7 (NO REV)|
20|FH_F116383_63026_0|SrvcGrp|73841|2022|PDM|424.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F147563_60160_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F147586_44124_0|SrvcGrp|88821|2022|PDM|1595.00|99|0.00|CPT 31536|
20|FH_F147501_52655_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42156_0_0|SrvcGrp|97|2022|PDM|2546.00|99|0.00|C-SECTION|
20|FH_F42422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|OP SVCS|
20|FH_F42522_0_0|SrvcGrp|10361|2022|PDM|772.00|99|0.00|CPT CODE 99281|
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)|
20|FH_F111829_32257_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|508.90|99|0.00|2005 ASPG GROUPER II|
20|FH_F68322_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113025_0_0|SrvcGrp|75489|2022|PDM|865.00|99|0.00|AEG 6|
20|FH_F134087_0_0|SrvcGrp|97730|2022|PDM|10455.00|99|0.00|REVERSE HIP JOINT|
20|FH_F35381_0_0|SrvcGrp|413|2022|PCT|0.70|99|0.00|TRANSPLANT SVCS|
20|FH_F146253_60419_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139825_0_0|SrvcGrp|85966|2022|PDM|7459.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F146370_19355_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F77663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F132612_0_0|SrvcGrp|107733|2022|PDM|5274.00|99|0.00|CESAREAN SECTION|
20|FH_F40256_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F89932_10940_0|SrvcGrp|89282|2022|PDM|14665.00|99|0.00|ANGIOPLASTY|
20|FH_F69123_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INFUSION- IV SERVICES|
20|FH_F40350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117087_0_0|SrvcGrp|78093|2022|PDM|2093.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F133021_00910_0|SrvcGrp|112255|2022|PDM|6000.00|99|0.00|PTCA|
20|FH_F125255_34769_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F117508_90232_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F73684_0_0|SrvcGrp|3259|2022|PDM|600.00|99|0.00|ACUTE REHABILITATION|
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1351.00|99|0.00|AEG 6 (NO REV)|
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1019.00|99|0.00|AEG 3 (NO REV)|
20|FH_F133261_78041_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40943_0_0|SrvcGrp|43285|2022|PDM|71.00|99|0.00|SPEECH THERAPY|
20|FH_F41796_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|ACUTE PSYCH|
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|865.16|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F43443_0_0|CSTM-ALL|CSTM-00|2020|PDM|230.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F141753_63334_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133028_08021_0|SrvcGrp|102980|2022|PDM|102.00|99|0.00|PSYTX WPT W E/M 30 MIN|
20|FH_F149781_37404_0|SrvcGrp|34606|2022|PDM|4635.00|99|0.00|CPT 29827|
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|895.00|99|0.00|ASPG III|
20|FH_F128246_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F80363_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51129_0_0|SrvcGrp|3409|2022|PDM|800.00|99|0.00|NEWBORN NURSERY|
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|762.19|99|0.00|AEG 4 (NO REV)|
20|FH_F144588_60090_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F133477_90247_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F50974_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|ANTIBIOTIC THERAPY Q6 (MOD SH)|
20|FH_F151048_15122_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151144_35801_0|SrvcGrp|114518|2022|PDM|1922.67|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F151241_15139_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121326_60957_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F138745_29642_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F139627_80537_0|SrvcGrp|92760|2022|PCT|1.85|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150719_30012_0|SrvcGrp|57967|2022|PDM|166.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F150882_84041_0|SrvcGrp|48394|2022|PDM|47.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F115963_0_0|SrvcGrp|46482|2022|PDM|190.00|99|0.00|S9083 PER VISIT|
20|FH_F128924_0_0|SrvcGrp|106655|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F36634_0_0|SrvcGrp|701|2022|PDM|1874.00|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_F38123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F148859_0_0|SrvcGrp|16469|2022|PDM|3378.00|99|0.00|PROSTATE RESECTION|
20|FH_F40490_0_0|SrvcGrp|9793|2022|PDM|824.00|99|0.00|NEWBORN NURSERY|
20|FH_F132235_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F148667_0_0|SrvcGrp|16289|2022|PDM|1704.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F99920_63141_0|SrvcGrp|97704|2022|PDM|110.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F114294_18235_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134797_0_0|SrvcGrp|72992|2022|PDM|579.00|99|0.00|AEG 2|
20|FH_F124433_77338_0|SrvcGrp|86722|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F149645_92708_0|SrvcGrp|75419|2022|PDM|550.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F35416_0_0|SrvcGrp|11301|2022|PDM|1200.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F41463_0_0|SrvcGrp|35109|2022|PCT|1.00|99|0.00|CARECENTRIX AWP (AT COST) (MANUAL REVIEW)|
20|FH_F36943_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD 53|
20|FH_F147160_80260_0|SrvcGrp|58509|2022|PDM|367.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F110783_93013_0|SrvcGrp|86849|2022|PDM|50.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F118907_0_0|SrvcGrp|107896|2022|PDM|333.89|99|0.00|SLEEP STUDIES (HCFA)|
20|FH_F112045_90301_0|SrvcGrp|87995|2022|PDM|260.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149579_95815_0|SrvcGrp|16069|2022|PDM|1200.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F36338_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34783_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133569_17202_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F128741_92879_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35167_0_0|SrvcGrp|3102|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F151699_01752_0|SrvcGrp|86838|2022|PDM|15.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F128490_88240_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128753_32501_0|SrvcGrp|76340|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F98623_97006_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F146266_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F146266_0_0|SrvcGrp|93071|2022|PDM|6188.00|99|0.00|POSTERIOR SEGMENTAL INSTRU|
20|FH_F147422_84121_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PDM|1221.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F36348_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F148181_0_0|SrvcGrp|94781|2022|PDM|155.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F135351_0_0|SrvcGrp|34606|2022|PDM|7150.00|99|0.00|CPT 29827|
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|481.00|99|0.00|AEG 2 (NO REV)|
20|FH_F120695_15017_0|SrvcGrp|46903|2022|PDM|583.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F72445_0_0|SrvcGrp|9829|2022|PDM|60.00|99|0.00|PT SVCS|
20|FH_F131169_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F34999_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F121219_0_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|2796.00|99|0.00|AEG 4 (NO REV)|
20|FH_F132268_07060_0|SrvcGrp|90479|2022|PDM|56.65|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F144968_18702_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135384_28714_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135575_50597_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135978_06851_0|SrvcGrp|91098|2022|PDM|290.00|99|0.00|AETNA INTENSIVE OP PSYCH (UB)|
20|FH_F136153_62960_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100763_24202_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F55857_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F128104_57702_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F101644_75116_0|SrvcGrp|29347|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F121420_06418_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|GENERAL ACUTE CARE|
20|FH_F69205_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F128353_22191_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133711_46131_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111292_33136_0|SrvcGrp|103913|2022|PCT|0.86|99|0.00|OP DIALYSIS|
20|FH_F134290_67209_0|SrvcGrp|108484|2022|PDM|568.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F134322_98001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48581_0_0|SrvcGrp|10400|2022|PDM|1500.00|99|0.00|IP SURGERY|
20|FH_F51272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131000_0_0|SrvcGrp|26275|2022|PDM|2494.00|99|0.00|CPT 29826|
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|82114|2022|PDM|2049.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F112187_98272_0|CSTM-ALL|CSTM-00|2020|PDM|2736.00|99|0.00|AEG 2 (NO REV)|
20|FH_F102862_30606_0|SrvcGrp|73485|2022|PDM|990.00|99|0.00|AETNA REHAB|
20|FH_F129240_10028_0|SrvcGrp|29023|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F101320_26062_0|SrvcGrp|48394|2022|PDM|18.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F132347_01605_0|SrvcGrp|66264|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F51276_0_0|SrvcGrp|22589|2022|PDM|75.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|2126.00|99|0.00|ASPG X|
20|FH_F35685_0_0|SrvcGrp|11187|2022|PDM|27563.00|99|0.00|DRG 550 CORONARY BYPASS W/O CC W/O|
20|FH_F42177_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F98621_41042_0|SrvcGrp|73601|2022|PDM|12830.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F100780_24153_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F122953_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F91975_0_0|SrvcGrp|91858|2022|PDM|611.00|99|0.00|SIGMOIDOSCOPY CODE W/ ULTRASOUND|
20|FH_F122694_33334_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F86872_15215_0|SrvcGrp|86840|2022|PDM|47.50|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F74602_0_0|SrvcGrp|65651|2022|PDM|4500.00|99|0.00|DIAGNOSTIC CARDIAC CATHETERIZATION|
20|FH_F88639_80204_0|SrvcGrp|73496|2022|PDM|6444.61|99|0.00|AETNA ER LEVEL V|
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.82|99|0.00|AETNA SLEEP STUDIES|
20|FH_F42633_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F118152_20151_0|SrvcGrp|86840|2022|PDM|50.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F118152_20151_0|SrvcGrp|14949|2022|PDM|70.00|99|0.00|HOME INFUSION|
20|FH_F134126_11554_0|SrvcGrp|73489|2022|PDM|1895.00|99|0.00|AETNA TRAUMA|
20|FH_F137048_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137147_75006_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137235_66061_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137237_33304_0|SrvcGrp|89149|2022|PDM|205.00|99|0.00|OP INTENSIVE|
20|FH_F142527_89109_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F97566_79902_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F97601_67218_0|SrvcGrp|88977|2022|PDM|6795.00|99|0.00|C-SECTION DELIVERY|
20|FH_F136314_19013_0|SrvcGrp|89417|2022|PDM|306.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F139267_30253_0|SrvcGrp|113550|2022|PDM|56.44|99|0.00|COVID-19 LAB TESTING|
20|FH_F140312_77365_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F80284_16354_0|SrvcGrp|113166|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F120152_0_0|SrvcGrp|67068|2022|PDM|22000.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F119130_0_0|SrvcGrp|108082|2022|PDM|75.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 10 (NO REV)|
20|FH_F151603_27609_0|SrvcGrp|92405|2022|PDM|2721.00|99|0.00|PERQ LUMBOSACRAL INJECTION|
20|FH_F119023_91406_0|SrvcGrp|17015|2022|PDM|12.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F37545_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92506_07666_0|SrvcGrp|91564|2022|PCT|0.34|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F92506_07666_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F76144_0_0|CSTM-ALL|CSTM-00|2020|PDM|1177.87|99|0.00|ASPG II F/S - BDSS|
20|FH_F91913_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92852_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F117371_77059_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F117295_70006_0|SrvcGrp|48385|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F131175_06757_0|SrvcGrp|111761|2022|PDM|1950.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F86717_0_0|CSTM-ALL|CSTM-00|2020|PDM|707.94|99|0.00|AEG 2 (NO REV)|
20|FH_F116806_0_0|SrvcGrp|107091|2022|PDM|973.15|99|0.00|BONE BIOPSY OPEN SUPERFICIAL|
20|FH_F97183_25304_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F41033_0_0|SrvcGrp|17083|2022|PDM|561.00|99|0.00|ASPG X|
20|FH_F99920_63141_0|SrvcGrp|65720|2022|PDM|110.00|99|0.00|RESPITE CARE|
20|FH_F110963_30535_0|SrvcGrp|48396|2022|PDM|170.00|99|0.00|OT SERVICES|
20|FH_F126299_20176_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116332_0_0|SrvcGrp|82298|2022|PDM|18188.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SAINT ALEXIUS FH MOD UE|
20|FH_F150360_68112_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114568_08097_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151043_71901_0|SrvcGrp|3178|2022|PDM|840.00|99|0.00|ACUTE PSYCH|
20|FH_F92413_07631_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F127258_79912_0|SrvcGrp|73841|2022|PDM|412.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F117762_0_0|SrvcGrp|89853|2022|PDM|3120.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG|
20|FH_F101441_0_0|SrvcGrp|96349|2022|PDM|8105.00|99|0.00|NECK SPINE FUSE|
20|FH_F115982_0_0|SrvcGrp|11669|2022|PDM|2300.00|99|0.00|OP SURG|
20|FH_F120040_72703_0|SrvcGrp|73605|2022|PDM|941.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F150360_68112_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137797_70123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F140233_35216_0|SrvcGrp|88163|2022|PDM|9000.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F143347_16001_0|SrvcGrp|89417|2022|PDM|486.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F143348_16214_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F72749_0_0|SrvcGrp|12591|2022|PDM|328.00|99|0.00|CD FULL DAY|
20|FH_F84631_0_0|SrvcGrp|10518|2022|PDM|111.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT|
20|FH_F102224_0_0|SrvcGrp|67072|2022|PDM|2300.00|99|0.00|CPT 22845|
20|FH_F151761_20019_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|328.00|99|0.00|GA RETINA SURG CTR ASC 12|
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|2089.00|99|0.00|ASPG IX|
20|FH_F120196_33161_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132436_33144_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132472_32547_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F83292_0_0|CSTM-ALL|CSTM-00|2020|PCT|5.00|99|0.00|BARNESVILLE LABS @ 100%|
20|FH_F119992_67062_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F120866_51652_0|SrvcGrp|471|2022|PDM|530.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F125479_17501_0|SrvcGrp|105350|2022|PDM|443.00|99|0.00|AETNA PARTIAL HOSPITALIZATION|
20|FH_F113649_01752_0|SrvcGrp|86830|2022|PDM|100.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F84394_17402_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F84611_30281_0|SrvcGrp|73602|2022|PDM|798.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F84611_30281_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F84394_17402_0|SrvcGrp|113629|2022|PDM|7240.00|99|0.00|RECONSTRUCT ELBOW JOINT|
20|FH_F51276_0_0|SrvcGrp|33166|2022|PDM|635.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F51276_0_0|SrvcGrp|24752|2022|PDM|19.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F35685_0_0|SrvcGrp|2868|2022|PDM|45203.00|99|0.00|DRG 536 CARDIAC DEFIBRULATOR IMPLANTS|
20|FH_F39272_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F41874_0_0|SrvcGrp|109|2022|PDM|505.00|99|0.00|CD - DETOX|
20|FH_F38411_0_0|SrvcGrp|3208|2022|PDM|600.00|99|0.00|SUBACUTE CARE|
20|FH_F125069_0_0|SrvcGrp|72992|2022|PDM|912.00|99|0.00|AEG 2|
20|FH_F72935_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F49031_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.10|99|0.00|GENERAL ACUTE CARE|
20|FH_F77044_0_0|SrvcGrp|74146|2022|PCT|0.33|99|0.00|INFUSION B-CODES (MOD SJ)|
20|FH_F31714_0_0|SrvcGrp|11227|2022|PDM|13900.00|99|0.00|DRG 557 PERCUTANEOUS CV PX W/DRUG-ELUTING STENT W/MAJ CV DX|
20|FH_F150165_06032_0|SrvcGrp|66307|2022|PDM|1110.00|99|0.00|CPT 53020|
20|FH_F149265_64429_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F109400_80026_0|SrvcGrp|48398|2022|PDM|98.00|99|0.00|PT SERVICES|
20|FH_F134234_49525_0|SrvcGrp|89417|2022|PDM|330.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F77943_0_0|SrvcGrp|9984|2022|PCT|0.70|99|0.00|URGENT CARE|
20|FH_F127638_44720_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144248_0_0|SrvcGrp|91759|2022|PCT|1.04|99|0.00|OCULAR IMPLANT|
20|FH_F121699_73703_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F131464_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F149244_85201_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133747_80634_0|SrvcGrp|110637|2022|PCT|0.00|99|0.00|LABORATORY|
20|FH_F133749_84604_0|SrvcGrp|46607|2022|PDM|50.00|99|0.00|NEWBORN CARE HOME VISIT|
20|FH_F37877_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F93122_01854_0|SrvcGrp|90573|2022|PDM|172.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F145677_34208_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134169_08831_0|SrvcGrp|75419|2022|PDM|381.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F38373_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F70883_0_0|SrvcGrp|14500|2022|PDM|38.00|99|0.00|STATIONARY/AMBULATORY/DISPOSAL PUMPS|
20|FH_F118138_60532_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145641_06902_0|SrvcGrp|114233|2022|PDM|6840.00|99|0.00|EXC ARM/ELBOW LES SC < 3 CM|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|355.77|99|0.00|HAPA WPA-NWPA 2012-13 ASC 219 W/O REV|
20|FH_F85777_77030_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F135656_74820_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F113424_60626_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F148643_71343_0|SrvcGrp|87077|2022|PDM|115.00|99|0.00|AETNA URGENT CARE CENTERS|
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_F90438_08873_0|SrvcGrp|89417|2022|PDM|284.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F133877_84117_0|SrvcGrp|97704|2022|PDM|93.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F127090_45601_0|SrvcGrp|65621|2022|PDM|50.39|99|0.00|RN NURSING|
20|FH_F119227_01752_0|SrvcGrp|86838|2022|PDM|18.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F122942_89512_0|SrvcGrp|73841|2022|PDM|450.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F146103_63851_0|SrvcGrp|103913|2022|PCT|0.75|99|0.00|OP DIALYSIS|
20|FH_F149219_01966_0|SrvcGrp|107288|2022|PCT|1.00|99|0.00|INJ INTERFERON BETA|
20|FH_F70208_0_0|CSTM-ALL|CSTM-00|2020|PDM|688.00|99|0.00|ASPG III|
20|FH_F86112_63501_0|SrvcGrp|76259|2022|PCT|0.47|99|0.00|OP DIALYSIS|
20|FH_F114444_19602_0|SrvcGrp|91399|2022|PDM|75.00|99|0.00|AETNA PSYCH PT & FAMILY 45MINS (MOD AJ)|
20|FH_F71049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|GENERAL ACUTE CARE|
20|FH_F121303_15501_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F80224_0_0|SrvcGrp|31125|2022|PDM|1543.00|99|0.00|MS DRG 789-794 ONLY SICK BABY|
20|FH_F120743_44116_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F148668_33177_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F34182_0_0|SrvcGrp|21172|2022|PDM|20737.00|99|0.00|MS DRG 665 ONLY|
20|FH_F130364_01331_0|SrvcGrp|73841|2022|PDM|400.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F130923_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F90232_15126_0|SrvcGrp|86838|2022|PDM|14.18|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F145641_06902_0|SrvcGrp|70749|2022|PDM|6619.00|99|0.00|CPT 29823|
20|FH_F145579_67226_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97840_54729_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F150124_44107_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F145562_70458_0|SrvcGrp|86833|2022|PDM|10.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F145641_06902_0|SrvcGrp|93730|2022|PDM|1947.00|99|0.00|INJ PERIPHERAL NERVE|
20|FH_F118384_0_0|SrvcGrp|107771|2022|PCT|1.00|99|0.00|INJECTABLES (A & B CODES)|
20|FH_F112665_0_0|SrvcGrp|35670|2022|PDM|7699.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F133207_0_0|SrvcGrp|58671|2022|PDM|1624.00|99|0.00|ASC CARVE OUT 64721|
20|FH_F97861_62223_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_F114506_15946_0|SrvcGrp|75545|2022|PDM|383.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F54592_0_0|SrvcGrp|10577|2022|PDM|80.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F86836_0_0|SrvcGrp|3259|2022|PDM|3200.00|99|0.00|ACUTE REHABILITATION|
20|FH_F72768_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|P.R. HORTON IV THERAPY|
20|FH_F118699_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F101100_50314_0|SrvcGrp|97923|2022|PDM|6890.00|99|0.00|DEVISION OF FALLOPIAN TUBE|
20|FH_F80513_0_0|SrvcGrp|53150|2022|PDM|9127.00|99|0.00|MS DRG 065-066 ONLY|
20|FH_F120522_53549_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F120528_60559_0|SrvcGrp|473|2022|PDM|355.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F116040_24637_0|SrvcGrp|86843|2022|PDM|25.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F116056_73018_0|SrvcGrp|73701|2022|PDM|37.50|99|0.00|AETNA - SKILLED NURSING|
20|FH_F116088_46410_0|SrvcGrp|90854|2022|PDM|768.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F133448_44094_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG IV|
20|FH_F133536_0_0|SrvcGrp|26274|2022|PDM|3145.00|99|0.00|CPT 29877|
20|FH_F143467_0_0|SrvcGrp|98460|2022|PDM|1424.00|99|0.00|AMPUTATION FOOT TRANSMETATARSAL|
20|FH_F87538_0_0|SrvcGrp|59290|2022|PDM|568.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F128272_60640_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46359_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.49|99|0.00|ASPG X|
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|3520.00|99|0.00|AEG 7 (NO REV)|
20|FH_F110161_31329_0|SrvcGrp|103910|2022|PDM|451.00|99|0.00|SUBACUTE LVL II W/TOB 210-28Z|
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC STUDIES|
20|FH_F52854_0_0|CSTM-ALL|CSTM-00|2020|PDM|101.00|99|0.00|SPEECH THERAPY|
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|574.00|99|0.00|AEG 3 (NO REV)|
20|FH_F102020_0_0|SrvcGrp|22954|2022|PDM|214.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F137087_0_0|SrvcGrp|113020|2022|PDM|4000.00|99|0.00|LAMINECTOMY|
20|FH_F111288_0_0|SrvcGrp|113482|2022|PDM|8670.00|99|0.00|LAPAROSCOPY|
20|FH_F103621_63122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86319_16365_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F72546_0_0|SrvcGrp|114300|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (LAB) (HCFA)|
20|FH_F125323_43213_0|SrvcGrp|48394|2022|PDM|47.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F123507_63869_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F40043_0_0|SrvcGrp|13641|2022|PDM|1920.00|99|0.00|TELEMETRY/STEP DOWN UNIT|
20|FH_F125899_07645_0|SrvcGrp|98546|2022|PDM|497.00|99|0.00|HEMATOLOGY/ONCOLOGY PHYSICIAN SERVICES|
20|FH_F78603_0_0|SrvcGrp|20744|2022|PDM|36897.02|99|0.00|MS DRG 242 ONLY|
20|FH_F120876_85250_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F83451_0_0|SrvcGrp|81571|2022|PDM|2200.00|99|0.00|NASAL ENDOSCOPY W/ SINUS OSTIA DILATION|
20|FH_F37937_0_0|SrvcGrp|11073|2022|PDM|85.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F90874_0_0|SrvcGrp|29428|2022|PDM|1949.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT|
20|FH_F137611_30909_0|SrvcGrp|73841|2022|PDM|404.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F89779_0_0|SrvcGrp|86233|2022|PDM|19500.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F33513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|DME F/S (MOD TC) - MHAC|
20|FH_F137615_16335_0|SrvcGrp|108484|2022|PDM|557.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F130061_84097_0|SrvcGrp|75419|2022|PDM|1050.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F116731_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F102302_0_0|SrvcGrp|98595|2022|PDM|10850.00|99|0.00|SPINAL CRD DECOMP->2 LUMBAR|
20|FH_F98920_46526_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F127036_43724_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F149879_80045_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F92034_0_0|SrvcGrp|96104|2022|PDM|1000.00|99|0.00|IMPLANTABLE NEUROSTIMULATOR|
20|FH_F128358_46072_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F67261_0_0|CSTM-ALL|CSTM-00|2020|PDM|1381.00|99|0.00|ASPG II - FH SW CUSTOM GROUPERS|
20|FH_F73985_0_0|SrvcGrp|17067|2022|PDM|1579.00|99|0.00|ASPG II|
20|FH_F149523_0_0|SrvcGrp|96899|2022|PDM|15000.00|99|0.00|LUMBAR ARTIF DISCECTOMY|
20|FH_F127550_43026_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F38034_0_0|SrvcGrp|24|2022|PDM|4171.00|99|0.00|CARDIAC CATH|
20|FH_F81033_0_0|SrvcGrp|78663|2022|PDM|892.50|99|0.00|AETNA HYSTEROSCOPY BIOPSY|
20|FH_F104520_0_0|SrvcGrp|24739|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F143528_0_0|SrvcGrp|75002|2022|PDM|3925.95|99|0.00|ARTHOSCOPY|
20|FH_F111826_0_0|SrvcGrp|72992|2022|PDM|907.50|99|0.00|AEG 2|
20|FH_F132559_0_0|SrvcGrp|59841|2022|PDM|1635.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F39041_0_0|SrvcGrp|453|2022|PDM|461.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F135210_61080_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|POLYSOMNOGRAPHY W/O MOD 26 & TC|
20|FH_F31139_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F143780_33873_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116760_68512_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F133671_89102_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F73742_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F115685_64064_0|SrvcGrp|86831|2022|PDM|3.80|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F139515_0_0|SrvcGrp|109965|2022|PDM|8549.00|99|0.00|THORAX SPINE DISK SURGERY|
20|FH_F36822_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F90492_0_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F109607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148324_93101_0|SrvcGrp|46903|2022|PDM|775.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F122536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F122240_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F39855_0_0|SrvcGrp|6|2022|PCT|0.77|99|0.00|OP SURGERY|
20|FH_F97440_0_0|SrvcGrp|74348|2022|PCT|5.50|99|0.00|EVALUATION AND MANAGEMENT|
20|FH_F92618_0_0|SrvcGrp|26001|2022|PDM|143.06|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F82753_18840_0|SrvcGrp|111928|2022|PDM|56.44|99|0.00|COVID-19 BARTONELLA|
20|FH_F33642_0_0|SrvcGrp|18204|2022|PCT|0.75|99|0.00|MS DRG 027|
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|814.00|99|0.00|AEG 6 (NO REV)|
20|FH_F35468_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F106822_0_0|SrvcGrp|25385|2022|PDM|30.00|99|0.00|CPT 10060|
20|FH_F135178_84049_0|SrvcGrp|75754|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F79645_0_0|SrvcGrp|62261|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F100790_10512_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F131254_92211_0|SrvcGrp|86828|2022|PDM|45.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F141427_22003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39857_0_0|SrvcGrp|360|2022|PDM|2080.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F93920_0_0|SrvcGrp|73008|2022|PDM|1200.00|99|0.00|AEG 10|
20|FH_F38982_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F123170_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F111826_0_0|SrvcGrp|73004|2022|PDM|1540.00|99|0.00|AEG 8|
20|FH_F40499_0_0|SrvcGrp|474|2022|PDM|325.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F138010_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|34672.00|99|0.00|MS DRG 222-223|
20|FH_F115046_77964_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F33322_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F65680_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44582_0_0|SrvcGrp|23206|2022|PCT|0.70|99|0.00|PTCA|
20|FH_F116093_47327_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F150936_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123372_0_0|SrvcGrp|62963|2022|PCT|0.52|99|0.00|SURGICAL|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|444.44|99|0.00|HAPA WPA-NWPA 2012-13 ASC 203 W/O REV|
20|FH_F77763_0_0|SrvcGrp|10542|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F110000_0_0|SrvcGrp|40485|2022|PCT|1.00|99|0.00|OP CARDIOLOGY|
20|FH_F106822_0_0|SrvcGrp|95103|2022|PDM|57.00|99|0.00|LASER SURGERY|
20|FH_F76085_0_0|SrvcGrp|72981|2022|PDM|290.00|99|0.00|RESIDENTIAL SKILLED NURSING|
20|FH_F142447_72758_0|SrvcGrp|87537|2022|PDM|1000.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F100620_37027_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F105581_19053_0|SrvcGrp|48398|2022|PDM|130.00|99|0.00|PT SERVICES|
20|FH_F130400_26505_0|SrvcGrp|81779|2022|PCT|2.50|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|392.00|99|0.00|AEG 1 (NO REV)|
20|FH_F41539_0_0|SrvcGrp|33823|2022|PDM|315.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG I|
20|FH_F44358_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F94786_07974_0|SrvcGrp|86834|2022|PDM|15.75|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F133002_0_0|SrvcGrp|46906|2022|PDM|1716.00|99|0.00|CORNEAL TISSUE|
20|FH_F129507_70002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137817_17050_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F101945_0_0|SrvcGrp|26275|2022|PDM|2726.00|99|0.00|CPT 29826|
20|FH_F109652_0_0|SrvcGrp|9529|2022|PDM|621.00|99|0.00|HOSPICE SVCS|
20|FH_F124893_40311_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F143450_0_0|SrvcGrp|114026|2022|PDM|727.00|99|0.00|UPPER GI ENDOSCOPY W/US FN BX|
20|FH_F147363_0_0|SrvcGrp|16|2022|PDM|1000.00|99|0.00|ACUTE REHABILITATION|
20|FH_F47452_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117485_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F119444_72903_0|SrvcGrp|73605|2022|PDM|941.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F137951_0_0|SrvcGrp|95819|2022|PDM|2050.00|99|0.00|GONIOTOMY|
20|FH_F148419_01453_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F86293_0_0|SrvcGrp|58671|2022|PDM|1592.00|99|0.00|ASC CARVE OUT 64721|
20|FH_F72859_0_0|SrvcGrp|474|2022|PDM|190.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F119437_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|368.51|99|0.00|HAPA WPA-NWPA 2012-13 ASC 110 W/O REV|
20|FH_F148900_0_0|SrvcGrp|87679|2022|PDM|1293.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F73304_0_0|CSTM-ALL|CSTM-00|2020|PDM|942.00|99|0.00|ASPG VII|
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|317.00|99|0.00|AEG 1 (NO REV)|
20|FH_F123872_75006_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F118540_32064_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F141747_20688_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127204_44420_0|SrvcGrp|48398|2022|PDM|116.00|99|0.00|PT SERVICES|
20|FH_F128796_57445_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F81591_70112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F95980_20016_0|SrvcGrp|73849|2022|PDM|311.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F141887_65605_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OP IMAGING ENHANC. SUBSTANCES (IMAGENHANCE)|
20|FH_F123545_44512_0|SrvcGrp|107267|2022|PDM|280.00|99|0.00|HEMODIALYSIS|
20|FH_F118496_92627_0|SrvcGrp|86648|2022|PCT|1.20|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F72024_0_0|SrvcGrp|42784|2022|PDM|68.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F111780_38603_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F123144_0_0|SrvcGrp|72990|2022|PDM|354.00|99|0.00|AEG 1|
20|FH_F78682_0_0|SrvcGrp|75661|2022|PDM|1500.00|99|0.00|GU|
20|FH_F148556_13206_0|SrvcGrp|17013|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F130108_0_0|SrvcGrp|18197|2022|PCT|0.75|99|0.00|MS DRG 025|
20|FH_F147800_0_0|SrvcGrp|115143|2022|PDM|880.00|99|0.00|INJ ANES AGT; SUP HYPOGASTR|
20|FH_F36993_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD AU|
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|990.00|99|0.00|AEG 3 (NO REV)|
20|FH_F44612_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115330_34113_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|MS DRG 774-775, 767-768 NORMAL DELIVERY (MS DRG ONLY)|
20|FH_F149840_80002_0|SrvcGrp|26160|2022|PDM|75.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F51123_0_0|SrvcGrp|29303|2022|PDM|120.75|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F142084_82009_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F67861_0_0|SrvcGrp|46030|2022|PDM|19800.00|99|0.00|GASTRIC REDUCTION - DUODENAL SWITCH|
20|FH_F39723_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120707_0_0|SrvcGrp|102419|2022|PCT|0.89|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F127412_15301_0|SrvcGrp|110737|2022|PDM|370.00|99|0.00|OTHER EYE PROCEDURES|
20|FH_F150002_28761_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150899_17243_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148662_01583_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F134533_67801_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F101802_17201_0|SrvcGrp|23681|2022|PDM|134.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F130615_95350_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118496_92627_0|SrvcGrp|46903|2022|PDM|630.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F117802_0_0|SrvcGrp|107625|2022|PDM|217.00|99|0.00|CAPD/CCPD TRAINING W/ TREATMENT|
20|FH_F91220_32064_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F46196_0_0|SrvcGrp|40691|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY MOD 59|
20|FH_F97042_64804_0|SrvcGrp|73485|2022|PDM|1871.00|99|0.00|AETNA REHAB|
20|FH_F91152_60061_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F55375_0_0|SrvcGrp|17069|2022|PDM|1920.00|99|0.00|ASPG III|
20|FH_F127325_0_0|SrvcGrp|72990|2022|PDM|318.00|99|0.00|AEG 1|
20|FH_F36118_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F144288_46322_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|782.00|99|0.00|HAPA EPA ASC 5|
20|FH_F88355_0_0|SrvcGrp|80126|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANICNG SUBSTANCE|
20|FH_F34706_0_0|CSTM-ALL|CSTM-00|2020|PDM|1201.00|99|0.00|DELIVERY BABY ONLY(DRG 385-391)|
20|FH_F32090_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F122627_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS|
20|FH_F97140_91730_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F97564_52246_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F146135_87112_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F92673_44041_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|SPINAL FUSION|
20|FH_F142831_08053_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136818_0_0|SrvcGrp|58755|2022|PDM|3600.00|99|0.00|INJECTION PROC FOR JOINT|
20|FH_F114389_50131_0|SrvcGrp|86842|2022|PDM|80.47|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F35448_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118184_0_0|SrvcGrp|112812|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER|
20|FH_F132348_16214_0|SrvcGrp|65720|2022|PDM|95.00|99|0.00|RESPITE CARE|
20|FH_F146880_74105_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146890_44115_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F38233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|S CODES MOD SH|
20|FH_F43800_0_0|CSTM-ALL|CSTM-00|2020|PDM|961.00|99|0.00|HEAD INJURY REHABILITATION|
20|FH_F100703_0_0|SrvcGrp|16669|2022|PDM|3535.00|99|0.00|ACROMINOPLASTY OF SHOULDER|
20|FH_F101390_0_0|SrvcGrp|112098|2022|PCT|2.00|99|0.00|COVID-19 CODES|
20|FH_F147899_0_0|SrvcGrp|115220|2022|PDM|6000.00|99|0.00|IMPLANT NEUROELECTRODES (HCFA)|
20|FH_F132973_28054_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F116572_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136609_72601_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136686_43551_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F114666_30342_0|SrvcGrp|67065|2022|PDM|8000.00|99|0.00|CERVICAL SURGERY|
20|FH_F113809_47302_0|CSTM-ALL|CSTM-00|2020|PDM|260.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F100664_03104_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F148424_01440_0|SrvcGrp|107288|2022|PCT|1.00|99|0.00|INJ INTERFERON BETA|
20|FH_F42917_0_0|SrvcGrp|12290|2022|PDM|920.00|99|0.00|DETOXIFICATION|
20|FH_F43352_0_0|CSTM-ALL|CSTM-00|2020|PDM|531.00|99|0.00|WELLPATH PROPIETARY ASC I|
20|FH_F43833_0_0|SrvcGrp|12787|2022|PCT|0.30|99|0.00|IMPLANTS|
20|FH_F134814_62230_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136778_62034_0|SrvcGrp|112966|2022|PCT|0.00|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F136796_24016_0|SrvcGrp|88160|2022|PDM|5396.49|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F113713_17013_0|SrvcGrp|70642|2022|PDM|14.09|99|0.00|CONSULTANT THERAPIST|
20|FH_F141170_0_0|SrvcGrp|103591|2022|PDM|6000.00|99|0.00|SUBCLAVIAN ART|
20|FH_F38488_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37847_0_0|SrvcGrp|9829|2022|PDM|93.50|99|0.00|PT SVCS|
20|FH_F115266_66736_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F147416_19095_0|SrvcGrp|87077|2022|PDM|148.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F147701_31093_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147527_60645_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F41795_0_0|SrvcGrp|15403|2022|PDM|70.00|99|0.00|SPEECH THERAPY SVCS INITIAL EVAL|
20|FH_F42708_0_0|SrvcGrp|1306|2022|PDM|311.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F100101_24018_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120639_73078_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F72986_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39988_0_0|SrvcGrp|65|2022|PDM|1756.00|99|0.00|OBSTETRICAL CARE|
20|FH_F50994_0_0|SrvcGrp|22954|2022|PDM|75.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F138857_90025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F86377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PDM|1286.00|99|0.00|ASPG VII|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|404.29|99|0.00|HAPA WPA-NWPA 2012-13 ASC 219 W/O REV|
20|FH_F82379_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F151302_80227_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F151501_30265_0|SrvcGrp|33984|2022|PDM|2090.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F151507_32327_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122032_32413_0|SrvcGrp|108801|2022|PDM|24.00|99|0.00|GROUP THERAPY|
20|FH_F127923_69130_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135584_10977_0|SrvcGrp|78419|2022|PDM|2800.00|99|0.00|VBAC DELIVERY|
20|FH_F135851_25414_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F135924_02906_0|SrvcGrp|88819|2022|PDM|439.50|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F136006_44709_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136180_92253_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119886_25504_0|SrvcGrp|111242|2022|PDM|110.00|99|0.00|PT ASSISTANT (HCFA)|
20|FH_F100763_24202_0|SrvcGrp|73559|2022|PDM|6232.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F131407_07607_0|SrvcGrp|22593|2022|PDM|30.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F127399_0_0|SrvcGrp|110677|2022|PDM|2289.00|99|0.00|CLOSURE OF VAGINA|
20|FH_F101644_75116_0|SrvcGrp|48385|2022|PDM|107.50|99|0.00|SPEECH THERAPY|
20|FH_F121713_84747_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F42098_0_0|SrvcGrp|11068|2022|PDM|50.00|99|0.00|PT SVCS|
20|FH_F55574_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|GENERAL ACUTE CARE|
20|FH_F111291_52501_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111301_33122_0|SrvcGrp|75506|2022|PCT|0.84|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F111363_33169_0|SrvcGrp|997|2022|PCT|0.63|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F134322_98001_0|SrvcGrp|112565|2022|PCT|1.00|99|0.00|AMIKACIN SULFATE INJECTION|
20|FH_F117486_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F149239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33081_0_0|SrvcGrp|13268|2022|PCT|0.70|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F36344_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|S CODES-AWP|
20|FH_F116430_0_0|SrvcGrp|106711|2022|PDM|1713.00|99|0.00|PODIATRY SURGERY|
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|2497.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132328_0_0|SrvcGrp|96799|2022|PDM|2049.00|99|0.00|DESTROY C/TH FACET JNT ADDL|
20|FH_F123647_66441_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F62579_0_0|SrvcGrp|24744|2022|PDM|115.00|99|0.00|PICC LINE INSERTION|
20|FH_F63246_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|WITHERSPOON CARVE-OUTS|
20|FH_F130725_33020_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F130908_32708_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138302_15701_0|SrvcGrp|10577|2022|PDM|25.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F77943_0_0|SrvcGrp|62332|2022|PDM|5616.83|99|0.00|ACUTE MED/SURG|
20|FH_F110466_06870_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F97861_62223_0|SrvcGrp|73656|2022|PDM|586.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F117300_0_0|SrvcGrp|98499|2022|PDM|7360.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F85353_16407_0|SrvcGrp|63772|2022|PDM|1450.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1405|
20|FH_F126550_43085_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F73228_0_0|SrvcGrp|17067|2022|PDM|3074.00|99|0.00|ASPG II|
20|FH_F51613_0_0|SrvcGrp|10951|2022|PDM|424.00|99|0.00|PARTIAL HOSPITALIZATION PSYCH/CD|
20|FH_F109577_0_0|SrvcGrp|98424|2022|PDM|123.00|99|0.00|DIABETES MANAGMENT INDIVIDUAL|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1088.86|99|0.00|HAPA WPA-NWPA 2012-13 ASC 502 W/O REV|
20|FH_F127638_44720_0|SrvcGrp|94781|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|849.00|99|0.00|AEG 6 (NO REV)|
20|FH_F95440_0_0|SrvcGrp|35669|2022|PDM|5600.00|99|0.00|CPT 63650|
20|FH_F76022_0_0|SrvcGrp|12290|2022|PDM|936.00|99|0.00|DETOXIFICATION|
20|FH_F110504_37027_0|SrvcGrp|89149|2022|PDM|304.47|99|0.00|OP INTENSIVE|
20|FH_F145885_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.25|99|0.00|HSS ASC|
20|FH_F85415_27612_0|SrvcGrp|73701|2022|PDM|36.80|99|0.00|AETNA - SKILLED NURSING|
20|FH_F100782_0_0|SrvcGrp|105162|2022|PDM|841.01|99|0.00|WINDBER MEDICAL CNTR ASC 407|
20|FH_F121225_98902_0|SrvcGrp|108712|2022|PCT|0.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F49459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OBSERVATION > 24 HRS|
20|FH_F132193_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149199_73005_0|SrvcGrp|75506|2022|PCT|0.55|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F80613_0_0|SrvcGrp|10541|2022|PDM|95.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F126056_29824_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145641_06902_0|SrvcGrp|107835|2022|PDM|2698.00|99|0.00|NERVE REPAIR|
20|FH_F149147_66221_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146650_29690_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F150222_98026_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F138149_24112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85652_98034_0|SrvcGrp|104540|2022|PCT|2.00|99|0.00|LABORATORY SERVICES|
20|FH_F119732_37660_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69787_0_0|SrvcGrp|33662|2022|PDM|8500.00|99|0.00|CYBERKNIFE|
20|FH_F137799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100782_0_0|SrvcGrp|97509|2022|PDM|999.57|99|0.00|WINDBER MEDICAL CNTR ASC 2|
20|FH_F49452_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141210_0_0|SrvcGrp|88823|2022|PDM|5305.00|99|0.00|REPAIR OF EARDRUM|
20|FH_F85212_71075_0|SrvcGrp|75506|2022|PCT|1.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 3 (NO REV)|
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1598.00|99|0.00|AEG 4 (NO REV)|
20|FH_F148862_85390_0|SrvcGrp|105819|2022|PDM|1236.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F119999_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F120608_19901_0|SrvcGrp|73701|2022|PDM|50.96|99|0.00|AETNA - SKILLED NURSING|
20|FH_F70603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F116806_0_0|SrvcGrp|107056|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MOUTH|
20|FH_F121597_30315_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F85652_98034_0|SrvcGrp|74464|2022|PDM|42438.00|99|0.00|AETNA MS DRG 247 ONLY|
20|FH_F112665_0_0|SrvcGrp|74039|2022|PDM|7215.00|99|0.00|LAMINECTOMY|
20|FH_F133207_0_0|SrvcGrp|88599|2022|PDM|3529.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F134235_70403_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125870_0_0|SrvcGrp|38909|2022|PDM|2445.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F126157_34210_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F150239_75569_0|SrvcGrp|22593|2022|PCT|1.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F50654_0_0|SrvcGrp|46888|2022|PCT|1.00|99|0.00|VITRECTOMY|
20|FH_F81698_10457_0|SrvcGrp|19742|2022|PDM|57.75|99|0.00|MID-LINE INSERTION|
20|FH_F146471_63110_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123851_03235_0|SrvcGrp|88620|2022|PDM|160.00|99|0.00|SKILLED NURSING RN|
20|FH_F85353_16407_0|SrvcGrp|63782|2022|PDM|1352.85|99|0.00|HAPA WPA-NWPA 2012-13 ASC 801|
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_F122434_40207_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F122470_78229_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122526_22203_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122532_46385_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F84712_0_0|SrvcGrp|82755|2022|PDM|39.00|99|0.00|ASSAY BLOOD MAGNESIUM|
20|FH_F84912_0_0|SrvcGrp|13627|2022|PDM|154.17|99|0.00|SLEEP STUDY|
20|FH_F70607_0_0|SrvcGrp|3558|2022|PDM|686.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F115786_57701_0|SrvcGrp|73700|2022|PDM|49.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F115865_78621_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F76028_0_0|SrvcGrp|62537|2022|PDM|130.00|99|0.00|SPEECH THERAPY|
20|FH_F149781_37404_0|SrvcGrp|92821|2022|PDM|4500.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR|
20|FH_F88512_0_0|SrvcGrp|17067|2022|PDM|1964.85|99|0.00|ASPG II|
20|FH_F97182_21502_0|SrvcGrp|73643|2022|PDM|1130.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F143147_80124_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F136751_0_0|SrvcGrp|77021|2022|PDM|9500.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F100785_54660_0|SrvcGrp|73485|2022|PDM|3359.00|99|0.00|AETNA REHAB|
20|FH_F144318_32696_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.60|99|0.00|HAPA WPA-NWPA 2012-13 ASC 902 W/O REV|
20|FH_F142907_60640_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F51438_0_0|CSTM-ALL|CSTM-00|2020|PDM|3100.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F113792_0_0|SrvcGrp|45924|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F87155_04105_0|SrvcGrp|17014|2022|PDM|57.78|99|0.00|HOME INFUSION THERAPY|
20|FH_F136417_0_0|SrvcGrp|111785|2022|PDM|834.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F138487_85297_0|SrvcGrp|87441|2022|PDM|1127.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F139215_32218_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139627_80537_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AETNA OP PET SCANS (PET)|
20|FH_F150745_03301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150943_15537_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F110724_33064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127079_33026_0|SrvcGrp|100499|2022|PDM|850.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F132254_40207_0|SrvcGrp|86849|2022|PDM|50.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F128583_45154_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F148979_44512_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97100_23462_0|SrvcGrp|88978|2022|PDM|4175.00|99|0.00|VAGINAL DELIVERY|
20|FH_F117615_30525_0|SrvcGrp|75481|2022|PCT|0.85|99|0.00|AEG 2|
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 1 (NO REV)|
20|FH_F150982_0_0|SrvcGrp|98005|2022|PDM|1976.00|99|0.00|DISTAL PHALANGEAL FRACTURE|
20|FH_F40979_0_0|SrvcGrp|10364|2022|PDM|350.00|99|0.00|CPT CODE 99284|
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|2118.00|99|0.00|AEG 9 (NO REV)|
20|FH_F147321_24523_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F110963_30535_0|SrvcGrp|27969|2022|PDM|60.68|99|0.00|HOME HEALTH AIDE|
20|FH_F131495_77407_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132095_67042_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125656_92868_0|SrvcGrp|86828|2022|PDM|45.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F124470_90025_0|SrvcGrp|23683|2022|PDM|55.00|99|0.00|SKILLED NURSING RN|
20|FH_F129030_21204_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F35987_0_0|SrvcGrp|3078|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F35527_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS|
20|FH_F117762_0_0|SrvcGrp|99160|2022|PDM|1872.00|99|0.00|DRILL FOR OSTEOCH/BONE GRAFT|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|26.50|99|0.00|FACTOR VIII & IX THERAPY (MOD KP/SC/SH)|
20|FH_F150926_17404_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F118220_0_0|SrvcGrp|60781|2022|PDM|600.00|99|0.00|CPT 93229|
20|FH_F126933_33174_0|SrvcGrp|73842|2022|PDM|130.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124441_0_0|SrvcGrp|97730|2022|PDM|12825.00|99|0.00|REVERSE HIP JOINT|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD AW RATE|
20|FH_F74424_0_0|SrvcGrp|48005|2022|PDM|231.00|99|0.00|HOME HEALTH AIDE|
20|FH_F127418_0_0|SrvcGrp|110765|2022|PDM|5481.88|99|0.00|2ND LEVEL INJ PARAVERT F JNT C/T|
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F115982_0_0|SrvcGrp|96799|2022|PDM|550.00|99|0.00|DESTROY C/TH FACET JNT ADDL|
20|FH_F140508_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148961_33403_0|SrvcGrp|75419|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F136806_0_0|SrvcGrp|11673|2022|PDM|2814.00|99|0.00|CPT 29888|
20|FH_F150938_02062_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147223_49444_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_F147166_03444_0|SrvcGrp|74668|2022|PDM|900.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F122267_62656_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137730_46563_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F90817_0_0|SrvcGrp|82107|2022|PDM|1574.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F35741_32216_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150383_29853_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47573_0_0|SrvcGrp|42825|2022|PDM|65.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F140608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F92299_62016_0|SrvcGrp|73004|2022|PCT|0.75|99|0.00|AEG 8|
20|FH_F117799_0_0|SrvcGrp|74039|2022|PDM|4244.00|99|0.00|LAMINECTOMY|
20|FH_F134869_08854_0|SrvcGrp|104796|2022|PDM|300.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PDM|1298.00|99|0.00|AEG 9 (NO REV)|
20|FH_F129682_07034_0|SrvcGrp|23683|2022|PDM|52.50|99|0.00|SKILLED NURSING RN|
20|FH_F101083_0_0|SrvcGrp|3932|2022|PDM|3780.00|99|0.00|LITHOTRIPSY|
20|FH_F132254_40207_0|SrvcGrp|10577|2022|PDM|50.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F111266_30339_0|SrvcGrp|86836|2022|PDM|10.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F110732_31513_0|SrvcGrp|44564|2022|PDM|499.00|99|0.00|NEWBORN NURSERY|
20|FH_F149522_83221_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F124291_44122_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F127396_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.50|99|0.00|OP SVCS|
20|FH_F37764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|O2 SOLUTIONS MOD UE|
20|FH_F136947_0_0|SrvcGrp|2067|2022|PDM|800.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F36251_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34675_0_0|SrvcGrp|17109|2022|PCT|0.70|99|0.00|CORNEAL TRANSPLANT|
20|FH_F122377_91007_0|SrvcGrp|75481|2022|PDM|6052.00|99|0.00|AEG 2|
20|FH_F139951_92870_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140296_32068_0|SrvcGrp|82981|2022|PDM|220.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F139950_76240_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|869.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F93281_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 5  (NO REV)|
20|FH_F102341_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123185_0_0|SrvcGrp|73000|2022|PDM|1020.00|99|0.00|AEG 6|
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)|
20|FH_F47036_0_0|SrvcGrp|12403|2022|PDM|24.50|99|0.00|CONTINUOUS HOMECARE|
20|FH_F47600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F49329_0_0|SrvcGrp|45362|2022|PDM|128.00|99|0.00|PT / OT / ST|
20|FH_F120216_68134_0|SrvcGrp|46903|2022|PDM|523.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F116533_33619_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120888_63823_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F113649_01752_0|SrvcGrp|22592|2022|PDM|60.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F113649_01752_0|SrvcGrp|86833|2022|PDM|15.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F118815_61021_0|SrvcGrp|86747|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F143467_0_0|SrvcGrp|33980|2022|PDM|4067.00|99|0.00|CPT 28298|
20|FH_F33183_0_0|SrvcGrp|14547|2022|PDM|1200.00|99|0.00|HERNIA REPAIR|
20|FH_F45332_0_0|SrvcGrp|37904|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F100742_00616_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|ASPG III|
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|1477.00|99|0.00|AEG 6 (NO REV)|
20|FH_F79625_0_0|SrvcGrp|472|2022|PDM|597.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER UEKF|
20|FH_F128973_44256_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F54513_0_0|SrvcGrp|10538|2022|PDM|42.00|99|0.00|NURSING CARE|
20|FH_F33672_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F139515_0_0|SrvcGrp|36865|2022|PDM|4101.00|99|0.00|NUCLEOPLASTY|
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|1175.00|99|0.00|AEG 5  (NO REV)|
20|FH_F145534_02155_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 5  (NO REV)|
20|FH_F148549_60523_0|SrvcGrp|23683|2022|PDM|55.00|99|0.00|SKILLED NURSING RN|
20|FH_F116731_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F132559_0_0|SrvcGrp|88824|2022|PDM|3100.00|99|0.00|CPT 69631|
20|FH_F145551_04106_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F93881_15009_0|SrvcGrp|36591|2022|PDM|16486.00|99|0.00|CPT 63685|
20|FH_F148543_71103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145758_20745_0|SrvcGrp|92364|2022|PDM|4569.60|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F149919_85390_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148265_06067_0|SrvcGrp|34605|2022|PDM|3875.00|99|0.00|CPT 28299|
20|FH_F137460_42103_0|SrvcGrp|89149|2022|PDM|153.00|99|0.00|OP INTENSIVE|
20|FH_F139515_0_0|SrvcGrp|105235|2022|PDM|3348.00|99|0.00|PARTIAL REMOVAL OF THYROID|
20|FH_F124788_0_0|SrvcGrp|72994|2022|PDM|510.00|99|0.00|AEG 3|
20|FH_F129088_68763_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137067_0_0|SrvcGrp|11673|2022|PDM|9975.00|99|0.00|CPT 29888|
20|FH_F124965_0_0|SrvcGrp|73008|2022|PCT|0.00|99|0.00|AEG 10|
20|FH_F147941_06023_0|CSTM-ALL|CSTM-00|2020|PDM|12700.00|99|0.00|AEG 5  (NO REV)|
20|FH_F115740_78957_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 10 (NO REV)|
20|FH_F102184_0_0|SrvcGrp|88159|2022|PDM|7215.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F150460_48334_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F120280_64701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F93880_95476_0|SrvcGrp|75506|2022|PCT|0.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F49735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130747_0_0|SrvcGrp|26432|2022|PDM|5202.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F149086_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137946_0_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F137457_32216_0|SrvcGrp|88819|2022|PDM|830.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F79704_0_0|SrvcGrp|12403|2022|PDM|32.61|99|0.00|CONTINUOUS HOMECARE|
20|FH_F131254_92211_0|SrvcGrp|86836|2022|PDM|12.50|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F113386_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122687_0_0|SrvcGrp|63472|2022|PDM|8742.00|99|0.00|CPT 64581|
20|FH_F97102_83501_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110925_01104_0|SrvcGrp|48385|2022|PDM|94.56|99|0.00|SPEECH THERAPY|
20|FH_F150982_0_0|SrvcGrp|95559|2022|PDM|27527.00|99|0.00|HIP JOINT|
20|FH_F150982_0_0|SrvcGrp|115929|2022|PDM|3971.00|99|0.00|LAPAROSCOPY|
20|FH_F93424_53578_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 028-030 SPINE SURGERY|
20|FH_F137067_0_0|SrvcGrp|35672|2022|PDM|6825.00|99|0.00|CPT 23412|
20|FH_F137707_32724_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130682_0_0|SrvcGrp|78098|2022|PDM|4980.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F125935_44024_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F135173_06519_0|SrvcGrp|91065|2022|PDM|101.00|99|0.00|PSYCHIATRIC CPT 90853 (HCFA)|
20|FH_F37679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F140579_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F36918_0_0|SrvcGrp|24829|2022|PDM|73.50|99|0.00|PT/OT|
20|FH_F116281_19013_0|SrvcGrp|106720|2022|PDM|717.00|99|0.00|INDUCED ABORTION BY ORAL INGESTION OF MEDICATION|
20|FH_F38151_0_0|SrvcGrp|290|2022|PCT|0.85|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F151540_17055_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148184_29527_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141607_27021_0|SrvcGrp|46605|2022|PDM|135.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F125249_0_0|SrvcGrp|108254|2022|PDM|1700.00|99|0.00|AETNA CPT CODES 29828-29887|
20|FH_F143821_60559_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149799_33484_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118386_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F142992_0_0|SrvcGrp|82981|2022|PDM|250.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
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_F31056_0_0|SrvcGrp|3673|2022|PDM|867.00|99|0.00|ACUTE PSYCHIATRIC|
20|FH_F111282_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126042_97005_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137427_89146_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|3906.00|99|0.00|AEG 5  (NO REV)|
20|FH_F150982_0_0|SrvcGrp|44068|2022|PDM|3303.00|99|0.00|CPT 52332|
20|FH_F131254_92211_0|SrvcGrp|29023|2022|PDM|56.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F131213_30606_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F39886_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|ACUTE PSYCH|
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|807.00|99|0.00|AEG 6 (NO REV)|
20|FH_F142073_0_0|SrvcGrp|89857|2022|PDM|5980.00|99|0.00|REMOVAL OF SPINAL LAMINA|
20|FH_F37359_0_0|SrvcGrp|16173|2022|PDM|400.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F36433_0_0|SrvcGrp|360|2022|PDM|1190.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F40525_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL|
20|FH_F137611_30909_0|SrvcGrp|108484|2022|PDM|589.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F66501_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HILLCREST IV THERAPY - MOD SH|
20|FH_F148255_72703_0|SrvcGrp|22389|2022|PDM|10.50|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F122725_32216_0|SrvcGrp|104804|2022|PDM|125.00|99|0.00|PSYTX CRISIS INITIAL 60 MIN|
20|FH_F62579_0_0|SrvcGrp|17013|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F63249_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130665_67202_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130748_43762_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130897_03103_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|1683.00|99|0.00|AEG 8 (NO REV)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1378.12|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1402 W/O REV|
20|FH_F145562_70458_0|SrvcGrp|86828|2022|PDM|10.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F85353_16407_0|SrvcGrp|63771|2022|PDM|1485.29|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1404|
20|FH_F113465_28204_0|SrvcGrp|57968|2022|PDM|31.99|99|0.00|CONTINUOUS HOMECARE|
20|FH_F85212_71075_0|SrvcGrp|72980|2022|PCT|1.00|99|0.00|AETNA LABORATORY|
20|FH_F127080_77520_0|SrvcGrp|73841|2022|PDM|468.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F134226_66533_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110506_98901_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134358_63068_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113322_38119_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127598_43232_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F120207_0_0|SrvcGrp|12491|2022|PCT|0.40|99|0.00|PACEMAKER|
20|FH_F113453_80020_0|SrvcGrp|471|2022|PDM|541.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146657_01105_0|SrvcGrp|114679|2022|PDM|32.69|99|0.00|THERAPEUTIC BEHAV SERV (MOD HO)|
20|FH_F122941_62702_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124262_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|AEG 2 (NO REV)|
20|FH_F145604_14850_0|SrvcGrp|14948|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F77585_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121687_04401_0|SrvcGrp|28536|2022|PCT|1.00|99|0.00|J CODES|
20|FH_F149044_60463_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130763_0_0|SrvcGrp|64517|2022|PDM|6796.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F134943_17402_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134992_34112_0|SrvcGrp|89417|2022|PDM|470.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F111027_32817_0|SrvcGrp|86722|2022|PDM|264.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F138951_41101_0|SrvcGrp|24745|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F134593_60007_0|SrvcGrp|112587|2022|PCT|0.85|99|0.00|LANADELUMAB-FLYO INJ|
20|FH_F119588_0_0|SrvcGrp|102420|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F133867_84075_0|SrvcGrp|112468|2022|PDM|615.00|99|0.00|HOSPICE ROUT HOME CARE-DIEM|
20|FH_F132723_61265_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_F111986_0_0|SrvcGrp|90417|2022|PDM|2472.00|99|0.00|TREATMENT OF JOINT|
20|FH_F135670_01749_0|SrvcGrp|29023|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F127090_45601_0|SrvcGrp|58588|2022|PDM|68.34|99|0.00|INFUSION|
20|FH_F120555_68405_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147981_60035_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F138313_75479_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|1000.00|99|0.00|AEG 6 (NO REV)|
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|1069.00|99|0.00|AEG 6 (NO REV)|
20|FH_F83978_66739_0|SrvcGrp|110871|2022|PDM|691.00|99|0.00|EGD DIAGNOSTIC AND BIOPSY|
20|FH_F39701_0_0|SrvcGrp|36405|2022|PCT|1.00|99|0.00|CORNEAL TISSUE IMPLANTS|
20|FH_F100782_0_0|SrvcGrp|105157|2022|PDM|187.75|99|0.00|WINDBER MEDICAL CNTR ASC 317|
20|FH_F85371_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130017_02302_0|SrvcGrp|113462|2022|PDM|3544.69|99|0.00|LITHOTRIPSY ESWL|
20|FH_F149517_0_0|SrvcGrp|63297|2022|PDM|198.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F71550_0_0|SrvcGrp|1168|2022|PDM|28.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F86101_76063_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|859.37|99|0.00|AEG 6 (NO REV)|
20|FH_F149148_15330_0|SrvcGrp|48396|2022|PDM|91.00|99|0.00|OT SERVICES|
20|FH_F96721_99504_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F138447_22041_0|SrvcGrp|102159|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F134601_94010_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146399_0_0|SrvcGrp|108082|2022|PDM|25.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F49279_0_0|SrvcGrp|45333|2022|PDM|200.00|99|0.00|FLUOROSCOPIC GUIDANCE|
20|FH_F81852_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HAPA WPA 2014 3RD Q INJ 100%|
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|EXTENSIVE HYSTERCTOMY|
20|FH_F130123_24171_0|SrvcGrp|93100|2022|PDM|120.00|99|0.00|RESPITE CARE|
20|FH_F138050_52301_0|SrvcGrp|72602|2022|PDM|1005.00|99|0.00|ECT|
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134655_14221_0|SrvcGrp|473|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120207_0_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F96721_99504_0|SrvcGrp|73461|2022|PDM|9773.00|99|0.00|AETNA NICU IV|
20|FH_F80613_0_0|SrvcGrp|27968|2022|PDM|27.50|99|0.00|SKILLED NURSING LPN|
20|FH_F138951_41101_0|SrvcGrp|86825|2022|PDM|60.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F124369_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F113345_25301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F138147_18018_0|SrvcGrp|105376|2022|PDM|2.75|99|0.00|SKILLS TRAINING DEVELOPMENT - 15 MIN|
20|FH_F132969_84003_0|SrvcGrp|88621|2022|PDM|60.75|99|0.00|SKILLED NURSING LPN|
20|FH_F139678_25601_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F75862_0_0|SrvcGrp|12403|2022|PDM|38.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F150165_06032_0|SrvcGrp|104008|2022|PDM|5200.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS|
20|FH_F54592_0_0|SrvcGrp|9543|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F105143_26062_0|SrvcGrp|72990|2022|PDM|3137.00|99|0.00|AEG 1|
20|FH_F115870_98225_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F75842_0_0|SrvcGrp|17775|2022|PDM|282.02|99|0.00|ULTRASOUND|
20|FH_F146459_48154_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146672_47424_0|SrvcGrp|90854|2022|PDM|903.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F120528_60559_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F120795_27514_0|SrvcGrp|73659|2022|PDM|4448.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F115952_44484_0|SrvcGrp|86747|2022|PCT|1.05|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F116088_46410_0|SrvcGrp|93919|2022|PDM|508.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F116114_37033_0|SrvcGrp|54142|2022|PDM|239.00|99|0.00|OP INTENSIVE SERVICES|
20|FH_F131698_01862_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F68944_0_0|SrvcGrp|43985|2022|PCT|1.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F148644_06890_0|SrvcGrp|35668|2022|PDM|3908.00|99|0.00|CPT 29824|
20|FH_F148644_06890_0|CSTM-ALL|CSTM-00|2020|PDM|2950.00|99|0.00|AEG 4 (NO REV)|
20|FH_F151179_84074_0|SrvcGrp|72996|2022|PDM|1087.00|99|0.00|AEG 4|
20|FH_F121949_80246_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2501000 MOD KF (HCFA)|
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|117.45|99|0.00|DELAWARE VALLEY- ASC 120|
20|FH_F72090_0_0|SrvcGrp|3810|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F72662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91873_12723_0|SrvcGrp|88697|2022|PCT|1.30|99|0.00|DRUGS|
20|FH_F106822_0_0|SrvcGrp|94423|2022|PDM|7.95|99|0.00|IMMUNIZATIONS|
20|FH_F142334_33186_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PDM|3348.00|99|0.00|AEG 10 (NO REV)|
20|FH_F115895_0_0|SrvcGrp|67065|2022|PDM|6365.00|99|0.00|CERVICAL SURGERY|
20|FH_F115208_0_0|SrvcGrp|106173|2022|PDM|2016.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F104840_32565_0|SrvcGrp|73602|2022|PCT|0.69|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F119581_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER UE|
20|FH_F43717_0_0|CSTM-ALL|CSTM-00|2020|PDM|816.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F132988_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F132988_0_0|SrvcGrp|77021|2022|PDM|4493.01|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F129189_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F62252_0_0|SrvcGrp|473|2022|PDM|380.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F141336_16947_0|CSTM-ALL|CSTM-00|2020|PDM|1416.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F49487_0_0|SrvcGrp|14948|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F92959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F118184_0_0|SrvcGrp|111931|2022|PDM|35.91|99|0.00|COVID-19 CDC TESTING LAB|
20|FH_F37394_0_0|SrvcGrp|474|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F116040_24637_0|SrvcGrp|43568|2022|PDM|60.00|99|0.00|SKILLED NURSING - RN|
20|FH_F132293_50595_0|SrvcGrp|109219|2022|PCT|0.90|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F133478_40165_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|CHEMOTHERAPHY DRUGS|
20|FH_F133494_90023_0|CSTM-ALL|CSTM-00|2020|PDM|6439.00|99|0.00|AEG 9 (NO REV)|
20|FH_F133471_47901_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F131318_53211_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111601_15203_0|SrvcGrp|46903|2022|PDM|520.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F111602_17102_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F111605_80524_0|SrvcGrp|75545|2022|PDM|309.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F121949_80246_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130066_84107_0|SrvcGrp|87573|2022|PDM|90.00|99|0.00|CPT 90847 W/REV 916|
20|FH_F72090_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110381_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F106822_0_0|SrvcGrp|36669|2022|PDM|7.95|99|0.00|IMMUNIZATION ADMIN|
20|FH_F111001_0_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F35499_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F117299_0_0|SrvcGrp|104022|2022|PDM|6867.00|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE|
20|FH_F76085_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114916_30309_0|SrvcGrp|92362|2022|PDM|10000.00|99|0.00|AUTOLOG CHONDROCYTE IMP KNEE|
20|FH_F100640_48097_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103880_85014_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F105440_46383_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F105480_19940_0|SrvcGrp|75545|2022|PDM|290.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY GLOBAL|
20|FH_F44172_0_0|SrvcGrp|25934|2022|PDM|1400.00|99|0.00|SKILLED NURSING|
20|FH_F135491_0_0|SrvcGrp|46906|2022|PDM|1980.00|99|0.00|CORNEAL TISSUE|
20|FH_F138929_0_0|SrvcGrp|88155|2022|PDM|13520.00|99|0.00|REVISE KNEECAP WITH IMPLANT|
20|FH_F131608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132627_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132988_0_0|SrvcGrp|100007|2022|PDM|12526.11|99|0.00|FUSION OF ANKLE JOINT|
20|FH_F141050_46410_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F40333_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_F39537_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F55812_0_0|SrvcGrp|44423|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE (VISIT LVL)|
20|FH_F124059_64055_0|SrvcGrp|24750|2022|PDM|10.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F124060_76040_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F147081_02130_0|SrvcGrp|88819|2022|PDM|504.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|ASPG VII|
20|FH_F38047_0_0|SrvcGrp|115|2022|PDM|313.00|99|0.00|SKILLED NURSING CARE|
20|FH_F124235_92840_0|SrvcGrp|75442|2022|PDM|900.00|99|0.00|OBSERVATION - REV 762|
20|FH_F150910_0_0|SrvcGrp|113852|2022|PDM|1125.00|99|0.00|STENT PACEMT ANTE COROTID|
20|FH_F150226_0_0|SrvcGrp|13595|2022|PDM|198.55|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F128613_68111_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F127995_84010_0|SrvcGrp|43569|2022|PDM|50.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F76163_0_0|SrvcGrp|3809|2022|PDM|646.00|99|0.00|HOSPICE CARE|
20|FH_F92599_0_0|SrvcGrp|75489|2022|PDM|1194.00|99|0.00|AEG 6|
20|FH_F133697_63129_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136546_33176_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136617_76118_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113809_47302_0|SrvcGrp|89024|2022|PDM|70.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F138716_20151_0|SrvcGrp|79237|2022|PDM|2500.00|99|0.00|VBAC DELIVERY|
20|FH_F137933_0_0|SrvcGrp|77451|2022|PDM|5800.00|99|0.00|CPT 53440|
20|FH_F144039_0_0|SrvcGrp|109346|2022|PDM|4590.00|99|0.00|EXCISION OF CHALAZION DIFFERENT LIDS|
20|FH_F122635_06410_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F43418_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|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_F117026_17961_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F134670_95628_0|SrvcGrp|90854|2022|PDM|1150.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F134675_60134_0|SrvcGrp|73841|2022|PDM|391.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F134727_30650_0|SrvcGrp|705|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F136914_64081_0|SrvcGrp|27968|2022|PDM|44.00|99|0.00|SKILLED NURSING LPN|
20|FH_F112248_53223_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F112371_19047_0|SrvcGrp|17146|2022|PDM|450.00|99|0.00|MRI|
20|FH_F112371_19047_0|CSTM-ALL|CSTM-00|2020|PDM|3186.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|AEG 3 (NO REV)|
20|FH_F37847_0_0|SrvcGrp|59713|2022|PDM|44.00|99|0.00|SKILLED RN HOURLY|
20|FH_F62922_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115608_24171_0|SrvcGrp|16|2022|PDM|1550.00|99|0.00|ACUTE REHABILITATION|
20|FH_F116383_63026_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F147501_52655_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F42402_0_0|SrvcGrp|12118|2022|PCT|0.90|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|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_F35404_0_0|SrvcGrp|9978|2022|PDM|2500.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS|
20|FH_F139573_0_0|SrvcGrp|57965|2022|PDM|373.33|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F150939_0_0|SrvcGrp|90489|2022|PDM|82.51|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F131169_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F41989_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|ACUTE PSYCH|
20|FH_F113585_20155_0|SrvcGrp|21920|2022|PDM|60.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F138787_32258_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F146789_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.70|99|0.00|OP SVCS|
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|294.35|99|0.00|HAPA WPA-NWPA 2012-13 ASC 228 W/O REV|
20|FH_F151512_27587_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132258_45404_0|SrvcGrp|27969|2022|PDM|20.14|99|0.00|HOME HEALTH AIDE|
20|FH_F145248_19477_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135350_60014_0|SrvcGrp|112744|2022|PCT|0.00|99|0.00|HOME HEALTH PROSPECTIVE PAYMENT SYSTEM (HHRG)|
20|FH_F135440_32561_0|SrvcGrp|90040|2022|PDM|325.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F91764_93710_0|SrvcGrp|111927|2022|PCT|2.19|99|0.00|COVID-19 NON CDC|
20|FH_F135960_33141_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136081_71742_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130766_04967_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|AEG 10 (NO REV)|
20|FH_F127399_0_0|SrvcGrp|105000|2022|PDM|2913.00|99|0.00|REPAIR OF KNEECAP FRACTURE|
20|FH_F127399_0_0|SrvcGrp|41325|2022|PDM|2497.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F140629_0_0|SrvcGrp|88748|2022|PDM|2497.00|99|0.00|HIP ARTHROSCOPY|
20|FH_F121771_91405_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F146125_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|1336.00|99|0.00|ASPG IV|
20|FH_F42098_0_0|SrvcGrp|15071|2022|PDM|112.00|99|0.00|PHOTOTHERAPY (BILIRUBIN)|
20|FH_F111292_33136_0|SrvcGrp|83059|2022|PDM|9396.00|99|0.00|TRAUMA / BURNS (MSDRG ONLY)|
20|FH_F111292_33136_0|SrvcGrp|79786|2022|PCT|0.86|99|0.00|SLEEP STUDIES|
20|FH_F111292_33136_0|SrvcGrp|99362|2022|PDM|171.00|99|0.00|DX MAMMO INCL CAD BI|
20|FH_F111301_33122_0|SrvcGrp|110047|2022|PCT|2.24|99|0.00|DRUGS|
20|FH_F111301_33122_0|SrvcGrp|82757|2022|PDM|16.00|99|0.00|ASSAY BLOOD CREATININE|
20|FH_F134322_98001_0|SrvcGrp|112570|2022|PDM|471.00|99|0.00|CAPD/CCPD PERITONEAL DIALYSIS|
20|FH_F69202_0_0|SrvcGrp|72|2022|PDM|400.00|99|0.00|NEWBORN NURSERY|
20|FH_F116430_0_0|SrvcGrp|58671|2022|PDM|1151.00|99|0.00|ASC CARVE OUT 64721|
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|843.00|99|0.00|AEG 10 (NO REV)|
20|FH_F132328_0_0|SrvcGrp|89848|2022|PDM|14566.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F112082_30720_0|SrvcGrp|43567|2022|PDM|148.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F112187_98272_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F140102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129220_18445_0|SrvcGrp|110062|2022|PDM|23.70|99|0.00|FAMILY ADAPTIVE BH TREATMENT 15 MINS|
20|FH_F96960_35404_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F132347_01605_0|SrvcGrp|23683|2022|PDM|68.94|99|0.00|SKILLED NURSING RN|
20|FH_F132347_01605_0|SrvcGrp|89783|2022|PDM|110.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F140007_0_0|SrvcGrp|19920|2022|PDM|3470.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F131235_36049_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F123820_91316_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F134088_32209_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137033_87108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142373_78727_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F138584_30912_0|SrvcGrp|113369|2022|PDM|2100.00|99|0.00|RECONSTRUCT MIDFACE LEFORT 2|
20|FH_F137951_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F140407_63841_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140652_92626_0|SrvcGrp|73841|2022|PDM|525.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F149377_22102_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151603_27609_0|CSTM-ALL|CSTM-00|2020|PDM|1694.08|99|0.00|AEG 10 (NO REV)|
20|FH_F151611_30032_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118932_07652_0|SrvcGrp|537|2022|PDM|1910.00|99|0.00|OBSERVATION SERVICES|
20|FH_F92634_08244_0|SrvcGrp|80679|2022|PCT|0.70|99|0.00|AETNA RADIOLOGY|
20|FH_F109983_98607_0|SrvcGrp|93919|2022|PDM|400.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F109983_98607_0|SrvcGrp|87317|2022|PDM|625.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F66835_0_0|SrvcGrp|26596|2022|PDM|290.00|99|0.00|PARTIAL HOSP PSYCH/CD (HALF DAY)|
20|FH_F117221_23434_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F35210_0_0|SrvcGrp|24|2022|PCT|0.65|99|0.00|CARDIAC CATH|
20|FH_F109652_0_0|SrvcGrp|46526|2022|PDM|8775.00|99|0.00|OP AICD|
20|FH_F111593_0_0|SrvcGrp|38364|2022|PDM|6966.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F90613_05001_0|SrvcGrp|89149|2022|PDM|268.00|99|0.00|OP INTENSIVE|
20|FH_F124893_40311_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F138543_60130_0|SrvcGrp|89417|2022|PDM|364.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F69364_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ASPG IV|
20|FH_F129487_0_0|SrvcGrp|72994|2022|PDM|1718.00|99|0.00|AEG 3|
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|20475.00|99|0.00|MS DRG 237|
20|FH_F117224_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|593.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132544_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F119449_84032_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148492_28027_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F148644_06890_0|SrvcGrp|86460|2022|PDM|5583.00|99|0.00|REVISE BREAST RECONSTRUCTION|
20|FH_F148644_06890_0|SrvcGrp|88154|2022|PDM|5572.00|99|0.00|LASER TREATMENT OLD RETINA|
20|FH_F113257_19034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|DME - MOD 26|
20|FH_F119825_0_0|SrvcGrp|104228|2022|PDM|100.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F101557_81004_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1078.00|99|0.00|AEG 2 (NO REV)|
20|FH_F103004_75840_0|SrvcGrp|73559|2022|PDM|1911.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F138197_0_0|SrvcGrp|19991|2022|PDM|2312.00|99|0.00|NERVOUS SYSTEM SERVICES|
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|AEG 3 (NO REV)|
20|FH_F130302_0_0|SrvcGrp|78504|2022|PDM|4800.00|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F123083_0_0|SrvcGrp|28549|2022|PDM|1233.94|99|0.00|VITRECTOMY|
20|FH_F98161_0_0|SrvcGrp|72992|2022|PDM|513.00|99|0.00|AEG 2|
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PDM|969.00|99|0.00|AEG 1 (NO REV)|
20|FH_F86917_61108_0|SrvcGrp|76528|2022|PDM|115.50|99|0.00|HOSPICE LTCH|
20|FH_F86991_15122_0|SrvcGrp|72996|2022|PDM|727.00|99|0.00|AEG 4|
20|FH_F32189_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|2259.00|99|0.00|AEG 7 (NO REV)|
20|FH_F86851_0_0|SrvcGrp|79577|2022|PDM|520.00|99|0.00|CPT 43244|
20|FH_F89372_0_0|SrvcGrp|107733|2022|PDM|6848.00|99|0.00|CESAREAN SECTION|
20|FH_F138588_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32995_0_0|SrvcGrp|9511|2022|PDM|46.00|99|0.00|OBSERVATION SVCS|
20|FH_F132810_0_0|SrvcGrp|112060|2022|PCT|0.95|99|0.00|HAEGARDA|
20|FH_F136307_65791_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136371_29720_0|SrvcGrp|89337|2022|PDM|984.00|99|0.00|DETOXIFICATION|
20|FH_F136411_67031_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F93175_73438_0|SrvcGrp|78504|2022|PCT|0.70|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F137247_40160_0|SrvcGrp|73842|2022|PDM|156.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138892_46341_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F77782_66061_0|CSTM-ALL|CSTM-00|2020|PCT|0.81|99|0.00|OP SVCS|
20|FH_F140332_19041_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140332_19041_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140387_72202_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140447_84106_0|SrvcGrp|48396|2022|PDM|90.00|99|0.00|OT SERVICES|
20|FH_F140747_34461_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92506_07666_0|SrvcGrp|92502|2022|PDM|1140.70|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F91913_0_0|SrvcGrp|72998|2022|PDM|717.00|99|0.00|AEG 5|
20|FH_F117270_32073_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117301_01887_0|SrvcGrp|16|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION|
20|FH_F147726_18017_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F129448_43235_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101945_0_0|SrvcGrp|90366|2022|PDM|2261.00|99|0.00|RHINOPLASTY COMPLETE EXT PRT|
20|FH_F137937_20032_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F109821_0_0|SrvcGrp|103081|2022|PDM|1020.00|99|0.00|AUDITORY SURGERY|
20|FH_F110342_0_0|SrvcGrp|41334|2022|PDM|8323.20|99|0.00|TOTAL KNEE|
20|FH_F90880_15108_0|SrvcGrp|90498|2022|PCT|1.00|99|0.00|NOS FLU VACC 3 YRS & > IM|
20|FH_F90880_15108_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F138051_75069_0|SrvcGrp|73842|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F91067_0_0|SrvcGrp|39906|2022|PDM|2500.00|99|0.00|MASTECTOMY, SIMPLE, COMPLETE|
20|FH_F148720_0_0|SrvcGrp|90489|2022|PDM|115.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F40296_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|PHYSICIANS SERVICES (CMS 1500)|
20|FH_F111594_0_0|SrvcGrp|88159|2022|PDM|7215.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F119321_71040_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F119507_92627_0|SrvcGrp|89337|2022|PDM|1100.00|99|0.00|DETOXIFICATION|
20|FH_F148554_85016_0|SrvcGrp|115491|2022|PDM|3225.00|99|0.00|PERC DRUG-EL COR STENT SING|
20|FH_F148554_85016_0|CSTM-ALL|CSTM-00|2020|PDM|1075.00|99|0.00|AEG 8 (NO REV)|
20|FH_F148641_92505_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133268_63703_0|SrvcGrp|36669|2022|PDM|5.50|99|0.00|IMMUNIZATION ADMIN|
20|FH_F40851_0_0|SrvcGrp|33353|2022|PDM|1067.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F89112_16509_0|CSTM-ALL|CSTM-00|2020|PDM|2196.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|ASPG I|
20|FH_F67136_0_0|CSTM-ALL|CSTM-00|2020|PDM|8427.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117733_91362_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1409.00|99|0.00|AEG 3 (NO REV)|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120089_0_0|SrvcGrp|75487|2022|PDM|718.00|99|0.00|AEG 5|
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|689.00|99|0.00|AEG 4 (NO REV)|
20|FH_F107140_0_0|SrvcGrp|24739|2022|PDM|30.00|99|0.00|RESPITE CARE|
20|FH_F36917_0_0|SrvcGrp|3577|2022|PDM|200.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F123373_0_0|SrvcGrp|12918|2022|PDM|2367.00|99|0.00|GYNECOLOGICAL MED/SURG|
20|FH_F148906_79336_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125049_44131_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F101923_98104_0|SrvcGrp|83057|2022|PCT|3.17|99|0.00|AETNA THERAPEUTIC EXERCISES|
20|FH_F49354_0_0|SrvcGrp|32385|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKE (DME)|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F115330_34113_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F128893_0_0|SrvcGrp|94780|2022|PDM|160.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F136608_0_0|SrvcGrp|107749|2022|PDM|164.00|99|0.00|CAPD/CCPD|
20|FH_F130195_44143_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F81763_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.50|99|0.00|OP SVCS|
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1780.00|99|0.00|ASPG VIII|
20|FH_F43078_0_0|SrvcGrp|12403|2022|PDM|140.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F83031_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F132612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1952.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144020_15401_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|GENERAL ACUTE CARE|
20|FH_F115312_78550_0|SrvcGrp|90388|2022|PDM|845.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F37575_0_0|SrvcGrp|1168|2022|PDM|521.72|99|0.00|CONTINUOUS HOMECARE|
20|FH_F115329_79424_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F50237_0_0|SrvcGrp|34086|2022|PDM|85.00|99|0.00|PT/OT/ST|
20|FH_F54552_0_0|SrvcGrp|22588|2022|PDM|75.00|99|0.00|CHEMOTHERAPY|
20|FH_F39723_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (HCFA)|
20|FH_F150001_33064_0|SrvcGrp|22589|2022|PDM|35.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F148599_98034_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|APC "N" NOT PAYABLE|
20|FH_F38700_0_0|SrvcGrp|11000|2022|PCT|0.83|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F119070_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F146218_50009_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72859_0_0|SrvcGrp|10565|2022|PDM|180.00|99|0.00|HOME INFUSION|
20|FH_F39546_0_0|SrvcGrp|13881|2022|PCT|1.05|99|0.00|PACEMAKER DEVICE|
20|FH_F45435_0_0|SrvcGrp|12856|2022|PDM|50.00|99|0.00|NURSING CARE|
20|FH_F40340_0_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|ADULT / PEDIATRIC BRAIN SURGERY|
20|FH_F43774_0_0|SrvcGrp|9829|2022|PDM|115.00|99|0.00|PT SVCS|
20|FH_F134490_62801_0|CSTM-ALL|CSTM-00|2020|PDM|1019.00|99|0.00|AEG 3 (NO REV)|
20|FH_F133307_14580_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F98620_43920_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F150899_17243_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F43078_0_0|SrvcGrp|9483|2022|PDM|130.00|99|0.00|RESIDENTIAL HOSPICE SVCS|
20|FH_F101923_98104_0|SrvcGrp|3477|2022|PCT|0.73|99|0.00|CLINIC VISIT|
20|FH_F147995_67037_0|CSTM-ALL|CSTM-00|2020|PDM|3307.00|99|0.00|AEG 10 (NO REV)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|283.21|99|0.00|HAPA WPA-NWPA 2012-13 ASC 120 W/O REV|
20|FH_F31446_0_0|SrvcGrp|12718|2022|PDM|225.00|99|0.00|CD DAY TREATMENT - ADULT|
20|FH_F66839_0_0|CSTM-ALL|CSTM-00|2020|PDM|340.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120817_53051_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F46288_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50618_0_0|SrvcGrp|17067|2022|PDM|588.35|99|0.00|ASPG II|
20|FH_F41739_0_0|SrvcGrp|28049|2022|PDM|34240.00|99|0.00|DRG 475 (565/566) ONLY|
20|FH_F63145_0_0|SrvcGrp|27325|2022|PCT|0.77|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F91198_46714_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F143198_75219_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F127197_23111_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F46196_0_0|SrvcGrp|28847|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY|
20|FH_F96261_0_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F68944_0_0|SrvcGrp|21826|2022|PDM|4819.00|99|0.00|PTCA (MS DRG ONLY)|
20|FH_F141802_17042_0|SrvcGrp|3378|2022|PCT|0.68|99|0.00|OBSERVATION SVCS|
20|FH_F117372_07442_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F33103_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119079_41018_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F54552_0_0|SrvcGrp|14945|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F46196_0_0|SrvcGrp|33643|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F126735_38018_0|SrvcGrp|87131|2022|PDM|320.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F144869_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37562_0_0|SrvcGrp|25665|2022|PCT|0.60|99|0.00|PHARMACY|
20|FH_F133287_40215_0|SrvcGrp|76095|2022|PCT|0.53|99|0.00|AETNA OBSERVATION SERVICES W/ER|
20|FH_F38848_0_0|SrvcGrp|72|2022|PDM|600.00|99|0.00|NEWBORN NURSERY|
20|FH_F40906_0_0|SrvcGrp|13595|2022|PDM|330.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F150021_02725_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F42355_0_0|CSTM-ALL|CSTM-00|2020|PDM|169.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F123069_75070_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142970_43055_0|SrvcGrp|13597|2022|PCT|0.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F42494_0_0|SrvcGrp|11659|2022|PDM|1400.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F97560_23249_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F132285_89103_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F67763_0_0|SrvcGrp|44250|2022|PDM|375.00|99|0.00|CCPD TRAINING|
20|FH_F142927_52402_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134487_14843_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F133287_40215_0|CSTM-ALL|CSTM-00|2020|PDM|2203.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 5 (NO REV)|
20|FH_F33241_0_0|SrvcGrp|72|2022|PDM|250.00|99|0.00|NEWBORN NURSERY|
20|FH_F38089_0_0|SrvcGrp|38|2022|PDM|2835.00|99|0.00|NORMAL DELIVERY|
20|FH_F89011_75006_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KD|
20|FH_F141790_85374_0|SrvcGrp|41563|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F148644_06890_0|SrvcGrp|41325|2022|PDM|4690.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F151179_84074_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_F138467_32216_0|SrvcGrp|73841|2022|PDM|876.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F139673_63011_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F139150_75206_0|SrvcGrp|48398|2022|PDM|105.00|99|0.00|PT SERVICES|
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|389.00|99|0.00|ASPG I|
20|FH_F90232_15126_0|SrvcGrp|86845|2022|PDM|56.70|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F137747_62278_0|CSTM-ALL|CSTM-00|2020|PCT|0.26|99|0.00|OP SVCS|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD MS OR  MOD RR/MS RATE|
20|FH_F45856_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|OP SVCS|
20|FH_F127163_74437_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117901_27526_0|SrvcGrp|94737|2022|PCT|1.10|99|0.00|FLUVIRIN VACC IM (>=3 YRS)|
20|FH_F133490_90650_0|CSTM-ALL|CSTM-00|2020|PDM|3462.00|99|0.00|AEG 5  (NO REV)|
20|FH_F31928_0_0|SrvcGrp|9511|2022|PDM|790.00|99|0.00|OBSERVATION SVCS|
20|FH_F142051_06604_0|SrvcGrp|471|2022|PDM|565.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2007 DME DBL MODIFIERS - NU/KC|
20|FH_F113261_38464_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F72226_65804_0|SrvcGrp|48947|2022|PCT|0.73|99|0.00|MSDRG 880-887,894-897,945-946|
20|FH_F117965_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133552_77006_0|SrvcGrp|46903|2022|PDM|520.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F71066_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120032_0_0|SrvcGrp|79589|2022|PDM|580.00|99|0.00|UPPER GI|
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F117995_60126_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F98620_43920_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F115330_34113_0|SrvcGrp|93919|2022|PDM|500.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F60101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F125176_20785_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F40738_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|HEAD INJURY REHAB|
20|FH_F82813_0_0|SrvcGrp|73004|2022|PDM|1548.00|99|0.00|AEG 8|
20|FH_F91152_60061_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1850.00|99|0.00|AEG 2 (NO REV)|
20|FH_F100784_59923_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F128717_54449_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F98921_64503_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F133329_40202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71043_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F34706_0_0|CSTM-ALL|CSTM-00|2020|PDM|6338.00|99|0.00|DRG 141 ONLY - SYNCOPE & COLLAPSE W/CC|
20|FH_F133021_00910_0|SrvcGrp|112279|2022|PDM|4000.00|99|0.00|ABLATION|
20|FH_F88512_0_0|SrvcGrp|73871|2022|PDM|30561.30|99|0.00|BARIATRIC SURGERY|
20|FH_F38508_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F123538_21206_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F123091_92627_0|SrvcGrp|108061|2022|PDM|300.00|99|0.00|OP THERAPY SERVICES|
20|FH_F40542_0_0|SrvcGrp|32647|2022|PCT|1.50|99|0.00|OTHER DIAGNOSTIC TESTING - CPT/GLOBAL|
20|FH_F97622_75051_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37611_0_0|SrvcGrp|474|2022|PDM|250.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F142067_45211_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F78167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67305_0_0|SrvcGrp|9518|2022|PCT|0.75|99|0.00|EMERGENCY ROOM|
20|FH_F102561_75146_0|SrvcGrp|73008|2022|PDM|2000.00|99|0.00|AEG 10|
20|FH_F73304_0_0|CSTM-ALL|CSTM-00|2020|PDM|597.00|99|0.00|ASPG IV|
20|FH_F143054_26147_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150000_30152_0|SrvcGrp|115802|2022|PCT|1.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F132543_79549_0|SrvcGrp|88977|2022|PDM|3500.00|99|0.00|C-SECTION DELIVERY|
20|FH_F40728_0_0|CSTM-ALL|CSTM-00|2020|PDM|1414.00|99|0.00|ASPG VIII|
20|FH_F149840_80002_0|SrvcGrp|88779|2022|PDM|115.00|99|0.00|PHYSICAL THERAPY|
20|FH_F40906_0_0|SrvcGrp|13682|2022|PDM|265.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) PARAMEDIC INTERCEPT|
20|FH_F141870_85224_0|SrvcGrp|14945|2022|PDM|5.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F63250_0_0|SrvcGrp|27969|2022|PDM|44.00|99|0.00|HOME HEALTH AIDE|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PDM|1392.00|99|0.00|ASPG X|
20|FH_F138236_0_0|SrvcGrp|82222|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F128472_53129_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128597_37129_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|2112.00|99|0.00|AEG 7 (NO REV)|
20|FH_F41845_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKE|
20|FH_F127412_15301_0|SrvcGrp|104358|2022|PDM|1210.00|99|0.00|CONJUNCTIVOPLASTY|
20|FH_F31928_0_0|SrvcGrp|9527|2022|PDM|1300.00|99|0.00|NORMAL DELIVERY|
20|FH_F51658_0_0|SrvcGrp|45924|2022|PDM|46.00|99|0.00|HOME HEALTH AIDE|
20|FH_F67683_0_0|SrvcGrp|80|2022|PDM|652.00|99|0.00|ACUTE PSYCH|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD AV"|
20|FH_F97563_83201_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F146229_60031_0|SrvcGrp|75419|2022|PDM|492.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F142970_43055_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38914_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|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_F41461_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F63301_0_0|CSTM-ALL|CSTM-00|2020|PDM|130.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|2432.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F149841_73114_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|AEG 10 (NO REV)|
20|FH_F106241_93309_0|SrvcGrp|87537|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F149721_76522_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126626_80906_0|SrvcGrp|108484|2022|PDM|765.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F148761_33311_0|SrvcGrp|105023|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY EVALUATION (HCFA)|
20|FH_F151144_35801_0|SrvcGrp|85897|2022|PDM|1273.10|99|0.00|PARTIAL REMOVAL OF EYE FLUID|
20|FH_F100703_0_0|SrvcGrp|97139|2022|PDM|7876.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F100703_0_0|SrvcGrp|97362|2022|PDM|7876.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F48174_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F129549_01238_0|SrvcGrp|94780|2022|PDM|177.45|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F128613_68111_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F131101_45840_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F63185_0_0|SrvcGrp|46424|2022|PDM|30.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F98042_10468_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136590_71263_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F136617_76118_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114629_19131_0|SrvcGrp|87441|2022|PDM|986.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F113785_35763_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138052_19462_0|SrvcGrp|104796|2022|PDM|192.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F139113_21804_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F144039_0_0|SrvcGrp|42551|2022|PDM|1721.00|99|0.00|OP SURGERY|
20|FH_F122608_84123_0|SrvcGrp|27968|2022|PDM|32.10|99|0.00|SKILLED NURSING LPN|
20|FH_F134672_44060_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134687_14226_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136814_70605_0|SrvcGrp|87077|2022|PDM|115.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F136913_68803_0|SrvcGrp|72984|2022|PCT|0.75|99|0.00|CHEMOTHERAPY|
20|FH_F138219_0_0|SrvcGrp|113090|2022|PDM|424.00|99|0.00|HEMODIALYSIS|
20|FH_F38826_0_0|SrvcGrp|12969|2022|PDM|325.00|99|0.00|NEWBORN NURSERY|
20|FH_F49005_0_0|SrvcGrp|45362|2022|PDM|200.00|99|0.00|PT / OT / ST|
20|FH_F115144_71373_0|SrvcGrp|30089|2022|PDM|459.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F116233_33612_0|SrvcGrp|86722|2022|PDM|125.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F116393_07002_0|SrvcGrp|111282|2022|PDM|7.65|99|0.00|PROTHROMBIN TIME|
20|FH_F147584_37664_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147394_14031_0|SrvcGrp|471|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F147725_06002_0|SrvcGrp|99073|2022|PCT|1.25|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F41463_0_0|SrvcGrp|22594|2022|PDM|80.00|99|0.00|IMIGLUCERASE|
20|FH_F132213_17543_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133667_83642_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133667_83642_0|SrvcGrp|89149|2022|PDM|225.00|99|0.00|OP INTENSIVE|
20|FH_F111601_15203_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F111841_85212_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134828_30531_0|SrvcGrp|112658|2022|PDM|46.00|99|0.00|XRAY EXAM OF LOWER SPINE (HCFA)|
20|FH_F134828_30531_0|SrvcGrp|111930|2022|PDM|15.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F133579_0_0|SrvcGrp|28550|2022|PDM|2175.00|99|0.00|VITRECTOMY|
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|SrvcGrp|12491|2022|PCT|0.41|99|0.00|PACEMAKER|
20|FH_F120639_73078_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F37186_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|OP SVCS|
20|FH_F37850_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F42095_0_0|SrvcGrp|22018|2022|PDM|37.50|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F114853_0_0|SrvcGrp|98494|2022|PDM|7699.00|99|0.00|ARTHRODESIS PRE-SACRAL|
20|FH_F49832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F54552_0_0|SrvcGrp|24758|2022|PDM|19.00|99|0.00|HOME INJECTABLE THERAPY|
20|FH_F113585_20155_0|SrvcGrp|86827|2022|PDM|80.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F138936_01040_0|SrvcGrp|110428|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F82382_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83799_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F151420_60654_0|CSTM-ALL|CSTM-00|2020|PDM|1053.00|99|0.00|AEG 3 (NO REV)|
20|FH_F151443_34741_0|SrvcGrp|115830|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F151511_14094_0|CSTM-ALL|CSTM-00|2020|PDM|1936.64|99|0.00|AEG 4 (NO REV)|
20|FH_F132268_07060_0|SrvcGrp|86323|2022|PDM|85.38|99|0.00|OTORHINOLARYNGOLOGIC SERVICES|
20|FH_F122024_75751_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123191_15012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135447_53226_0|SrvcGrp|78422|2022|PDM|5000.00|99|0.00|VBAC DELIVERY|
20|FH_F135462_06795_0|SrvcGrp|75545|2022|PDM|495.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F135489_70508_0|SrvcGrp|73601|2022|PDM|1470.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F135809_50501_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F135893_74006_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136194_80909_0|SrvcGrp|92760|2022|PCT|1.30|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136217_63112_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F131463_19096_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F131334_60062_0|SrvcGrp|92501|2022|PDM|100.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F131407_07607_0|SrvcGrp|86850|2022|PDM|60.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F116527_70443_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F101644_75116_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121763_07202_0|SrvcGrp|75506|2022|PCT|9.31|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F33791_0_0|SrvcGrp|111924|2022|PDM|2200.00|99|0.00|C-SECTION DELIVERY INCLUDES NEWBORN|
20|FH_F42098_0_0|SrvcGrp|28284|2022|PDM|50.00|99|0.00|SUBSEQUENT  SPECIALTY NURSING S9123 MOD TF|
20|FH_F55574_0_0|SrvcGrp|51543|2022|PCT|0.86|99|0.00|AMBULATORY SURGERY|
20|FH_F133711_46131_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F129967_18915_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F111363_33169_0|SrvcGrp|103359|2022|PCT|2.24|99|0.00|AETNA DRUGS|
20|FH_F86851_0_0|SrvcGrp|79592|2022|PDM|547.00|99|0.00|CPT 44388|
20|FH_F87474_0_0|SrvcGrp|12073|2022|PDM|46.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F87474_0_0|SrvcGrp|9832|2022|PDM|50.00|99|0.00|ST SVCS|
20|FH_F123809_26155_0|SrvcGrp|82369|2022|PCT|1.00|99|0.00|AETNA LABORATORY|
20|FH_F117465_0_0|SrvcGrp|75481|2022|PDM|800.00|99|0.00|AEG 2|
20|FH_F118198_38119_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120489_63552_0|SrvcGrp|73602|2022|PDM|427.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F134122_45255_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134126_11554_0|SrvcGrp|79099|2022|PDM|1953.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F142448_15701_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F142307_74066_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142727_21222_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142742_44112_0|SrvcGrp|75442|2022|PDM|850.00|99|0.00|OBSERVATION - REV 762|
20|FH_F140343_89052_0|SrvcGrp|86842|2022|PDM|25.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F140627_68651_0|CSTM-ALL|CSTM-00|2020|PCT|0.96|99|0.00|OP SVCS|
20|FH_F140730_84106_0|SrvcGrp|113663|2022|PDM|615.00|99|0.00|HOSPICE ROUT HOME CARE-DIEM (HCFA)|
20|FH_F149701_0_0|SrvcGrp|73483|2022|PDM|486.00|99|0.00|AETNA SUBACUTE III|
20|FH_F118914_43015_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F118914_43015_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F118943_64506_0|SrvcGrp|26869|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F92852_0_0|SrvcGrp|53703|2022|PDM|1320.00|99|0.00|REVISE AQUEOUS SHUNT TO EXTRAOCULAR RESIVOIR|
20|FH_F117377_71303_0|CSTM-ALL|CSTM-00|2020|PDM|141.34|99|0.00|HOSPICE ROUTINE HOME CARE (DAYS 0-60)|
20|FH_F147930_21244_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F117107_33704_0|SrvcGrp|3483|2022|PDM|4750.00|99|0.00|CPT CODE 59400|
20|FH_F117108_37841_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F117240_37334_0|SrvcGrp|75493|2022|PDM|4000.00|99|0.00|AEG 8|
20|FH_F110342_0_0|SrvcGrp|102420|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F128804_0_0|SrvcGrp|89853|2022|PDM|3520.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG|
20|FH_F84091_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.20|99|0.00|GENERAL ACUTE CARE|
20|FH_F109513_0_0|SrvcGrp|90424|2022|PDM|2500.00|99|0.00|ANKLE ARTHROSCOPY SURGERY|
20|FH_F131379_0_0|SrvcGrp|107748|2022|PDM|400.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|29505.00|99|0.00|MS DRGS 222-225 CV SURGERY|
20|FH_F95880_02726_0|SrvcGrp|90479|2022|PDM|56.65|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F143988_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.10|99|0.00|HSS ASC|
20|FH_F43698_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|CD RESIDENTIAL TREATMENT|
20|FH_F59732_0_0|SrvcGrp|28630|2022|PDM|140.00|99|0.00|HOME INFUSION SKILLED NURSING|
20|FH_F125512_85295_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F123844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109926_0_0|SrvcGrp|103786|2022|PCT|1.00|99|0.00|GANCICLOVIR IMPLANT/1UNIT MAX|
20|FH_F123385_03561_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F56136_0_0|SrvcGrp|9263|2022|PDM|803.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F90852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92034_0_0|SrvcGrp|72998|2022|PDM|945.00|99|0.00|AEG 5|
20|FH_F126070_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39279_0_0|CSTM-ALL|CSTM-00|2020|PDM|1495.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F120251_21122_0|SrvcGrp|108484|2022|PDM|1500.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F62750_0_0|SrvcGrp|15132|2022|PDM|1400.00|99|0.00|ACUTE IP MEDICAL SVCS|
20|FH_F129305_45614_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122536_0_0|CSTM-ALL|CSTM-00|2020|PDM|11637.00|99|0.00|ASPG VIII|
20|FH_F99960_0_0|SrvcGrp|33967|2022|PDM|1760.00|99|0.00|CPT 47562|
20|FH_F36669_0_0|SrvcGrp|16304|2022|PDM|585.52|99|0.00|HOSPICE CARE|
20|FH_F130051_31707_0|CSTM-ALL|CSTM-00|2020|PDM|10660.00|99|0.00|AEG 9 (NO REV)|
20|FH_F116021_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F83313_0_0|SrvcGrp|81297|2022|PDM|220.00|99|0.00|URGENT CARE|
20|FH_F40043_0_0|CSTM-ALL|CSTM-00|2020|PDM|1685.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F40063_0_0|CSTM-ALL|CSTM-00|2020|PDM|5399.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY|
20|FH_F91787_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 10 (NO REV)|
20|FH_F140988_22041_0|SrvcGrp|113706|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F81033_0_0|SrvcGrp|78664|2022|PDM|892.50|99|0.00|AETNA HYSTEROSCOPY ABLATION|
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1923.35|99|0.00|AEG 9 (NO REV)|
20|FH_F120059_0_0|SrvcGrp|108119|2022|PDM|1550.00|99|0.00|ARTERY-VEIN FUSION|
20|FH_F89475_71202_0|SrvcGrp|73485|2022|PDM|1127.00|99|0.00|AETNA REHAB|
20|FH_F143528_0_0|SrvcGrp|114084|2022|PDM|1518.30|99|0.00|REVISE EYE MUSCLE|
20|FH_F102184_0_0|SrvcGrp|95559|2022|PDM|7215.00|99|0.00|HIP JOINT|
20|FH_F127072_30458_0|SrvcGrp|75419|2022|PDM|625.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F39760_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HEARING AIDS|
20|FH_F131254_92211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141001_24739_0|SrvcGrp|82981|2022|PDM|180.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F40032_0_0|SrvcGrp|453|2022|PDM|200.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F148265_06067_0|SrvcGrp|99163|2022|PDM|21728.00|99|0.00|CPT 27703|
20|FH_F148279_15009_0|SrvcGrp|79804|2022|PDM|1500.00|99|0.00|AETNA MEDICAL/SURGICAL|
20|FH_F78285_0_0|SrvcGrp|9832|2022|PDM|50.00|99|0.00|ST SVCS|
20|FH_F139551_0_0|SrvcGrp|100920|2022|PDM|4411.00|99|0.00|SPINE PRO DEVICE|
20|FH_F78022_0_0|SrvcGrp|75080|2022|PDM|200.00|99|0.00|NURSERY|
20|FH_F102302_0_0|SrvcGrp|72992|2022|PDM|901.00|99|0.00|AEG 2|
20|FH_F132190_0_0|SrvcGrp|96999|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F133099_66801_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F126033_15301_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35202_0_0|SrvcGrp|12856|2022|PDM|42.00|99|0.00|NURSING CARE|
20|FH_F131809_37355_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124965_0_0|SrvcGrp|73004|2022|PDM|1500.00|99|0.00|AEG 8|
20|FH_F38709_0_0|SrvcGrp|3987|2022|PCT|0.80|99|0.00|TRAUMA CARE|
20|FH_F78903_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F141390_19007_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F40417_0_0|SrvcGrp|439|2022|PDM|1800.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F128186_43230_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120952_25303_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F118373_21205_0|SrvcGrp|80|2022|PDM|3014.00|99|0.00|ACUTE PSYCH|
20|FH_F123844_0_0|SrvcGrp|93098|2022|PDM|194.00|99|0.00|HOSPICE CARE|
20|FH_F93881_15009_0|SrvcGrp|16|2022|PDM|1430.00|99|0.00|ACUTE REHABILITATION|
20|FH_F115063_78550_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F122687_0_0|SrvcGrp|92364|2022|PDM|12402.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F148543_71103_0|SrvcGrp|115411|2022|PCT|1.00|99|0.00|COVID 19 VACCINE ADMINISTRATION|
20|FH_F97500_32025_0|SrvcGrp|73559|2022|PDM|10233.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F77925_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS|
20|FH_F114975_78596_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130013_16509_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F141802_17042_0|SrvcGrp|107734|2022|PDM|13615.00|99|0.00|VAGINAL DELIVERY|
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_F135052_18702_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F139173_0_0|SrvcGrp|46605|2022|PDM|192.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F37945_0_0|SrvcGrp|9774|2022|PDM|1417.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F118194_50841_0|SrvcGrp|89620|2022|PDM|900.00|99|0.00|HOSPICE CARE|
20|FH_F82173_72712_0|SrvcGrp|116078|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F100761_02539_0|SrvcGrp|90854|2022|PDM|2783.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F31056_0_0|SrvcGrp|65|2022|PDM|2641.00|99|0.00|OBSTETRICAL CARE|
20|FH_F92091_0_0|SrvcGrp|10985|2022|PDM|2800.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F137574_68130_0|SrvcGrp|42404|2022|PCT|1.00|99|0.00|VENIPUNCTURE|
20|FH_F139173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130747_0_0|SrvcGrp|111586|2022|PDM|6763.00|99|0.00|BONE MARROW ASPIR BONE GRFG|
20|FH_F127255_03104_0|SrvcGrp|74694|2022|PDM|675.00|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F135231_90265_0|SrvcGrp|89417|2022|PDM|1000.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F72764_0_0|SrvcGrp|8950|2022|PDM|1730.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F63141_0_0|SrvcGrp|3259|2022|PDM|1300.00|99|0.00|ACUTE REHABILITATION|
20|FH_F151562_26003_0|SrvcGrp|104230|2022|PDM|103.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F142073_0_0|SrvcGrp|97730|2022|PDM|11900.00|99|0.00|REVERSE HIP JOINT|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1012.94|99|0.00|HAPA WPA-NWPA 2012-13 ASC 8 W/O REV|
20|FH_F53872_0_0|SrvcGrp|10527|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F58012_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F143528_0_0|SrvcGrp|104170|2022|PDM|2625.00|99|0.00|AETNA ARTHROSCOPY SURGERY|
20|FH_F90362_0_0|SrvcGrp|73004|2022|PDM|1288.00|99|0.00|AEG 8|
20|FH_F87619_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F108762_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F137946_0_0|SrvcGrp|113230|2022|PDM|42.13|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 SCR|
20|FH_F67261_0_0|CSTM-ALL|CSTM-00|2020|PDM|1033.00|99|0.00|ASPG I - FH SW CUSTOM GROUPERS|
20|FH_F98920_46526_0|SrvcGrp|73643|2022|PDM|3449.00|99|0.00|AETNA SUBACUTE CARE|
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_F143539_0_0|SrvcGrp|42428|2022|PDM|1607.00|99|0.00|OP SURGERY CPT 65855|
20|FH_F145508_0_0|SrvcGrp|104230|2022|PDM|181.21|99|0.00|RESPITE CARE (HCFA)|
20|FH_F74602_0_0|SrvcGrp|15351|2022|PDM|4500.00|99|0.00|PTCA ANGIOPLASTY|
20|FH_F63129_0_0|SrvcGrp|48385|2022|PDM|30.00|99|0.00|SPEECH THERAPY|
20|FH_F105593_0_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F130775_61701_0|SrvcGrp|90040|2022|PDM|350.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F130858_67026_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|767.25|99|0.00|HAPA WPA-NWPA 2012-13 ASC 5 W/O REV|
20|FH_F87775_15106_0|SrvcGrp|16750|2022|PDM|109.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F130364_01331_0|SrvcGrp|109057|2022|PCT|1.75|99|0.00|CARDIAC STUDIES|
20|FH_F38790_0_0|CSTM-ALL|CSTM-00|2020|PDM|722.00|99|0.00|ACUTE PSYCH|
20|FH_F149081_63028_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117206_0_0|SrvcGrp|90563|2022|PDM|1485.00|99|0.00|REMOVAL OF LENS MATERIAL|
20|FH_F119227_01752_0|SrvcGrp|29077|2022|PDM|18.00|99|0.00|HOME TRANSFUSION|
20|FH_F149219_01966_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F121603_46761_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F134656_02852_0|SrvcGrp|471|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F85353_16407_0|SrvcGrp|63756|2022|PDM|2396.82|99|0.00|HAPA WPA-NWPA 2012-13 ASC 14|
20|FH_F69708_0_0|SrvcGrp|42913|2022|PDM|13.00|99|0.00|CATHETER CARE-DOUBLE LUMEN|
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AEG 6 (NO REV)|
20|FH_F147962_85008_0|CSTM-ALL|CSTM-00|2020|PDM|4193.00|99|0.00|AEG 8 (NO REV)|
20|FH_F134969_34474_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133748_77081_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F133767_61254_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146039_89511_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F145641_06902_0|SrvcGrp|109834|2022|PDM|6724.00|99|0.00|REPAIR HUMERUS FRACTURE|
20|FH_F129757_0_0|SrvcGrp|1259|2022|PDM|1400.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F150943_15537_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F34853_0_0|SrvcGrp|9984|2022|PDM|175.00|99|0.00|URGENT CARE|
20|FH_F125656_92868_0|SrvcGrp|13929|2022|PDM|12.50|99|0.00|GROWTH HORMONE|
20|FH_F142370_0_0|SrvcGrp|14048|2022|PDM|1450.00|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN|
20|FH_F124749_90211_0|SrvcGrp|108484|2022|PDM|838.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F147215_48105_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IP MULTI ROOM COMPARISON|
20|FH_F35088_0_0|SrvcGrp|24|2022|PCT|0.65|99|0.00|CARDIAC CATH|
20|FH_F35744_32177_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F35557_0_0|SrvcGrp|20724|2022|PDM|0.70|99|0.00|ENTERNAL FORMULA|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD PD - CARECENTRIX|
20|FH_F126717_66103_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F69123_0_0|SrvcGrp|42972|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F120435_0_0|SrvcGrp|103551|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F132254_40207_0|SrvcGrp|86844|2022|PDM|50.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F37864_0_0|SrvcGrp|70820|2022|PCT|1.00|99|0.00|(PREVENTATIVE) OCN F/S PRICING: ALL|
20|FH_F132095_67042_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117799_0_0|SrvcGrp|104857|2022|PDM|23499.00|99|0.00|LUMBAR FUSION|
20|FH_F99380_90503_0|SrvcGrp|62396|2022|PCT|0.85|99|0.00|OP PET/CT/MRI/NUCLEAR MEDICINE|
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|90381|2022|PDM|2280.00|99|0.00|KNEE ARTHROSCOPY SURGICAL|
20|FH_F126732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112045_90301_0|SrvcGrp|89922|2022|PCT|0.40|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F133677_15601_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F124441_0_0|SrvcGrp|67068|2022|PDM|7125.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F117615_30525_0|SrvcGrp|42784|2022|PDM|141.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F90817_0_0|SrvcGrp|90370|2022|PDM|1057.00|99|0.00|REVISE EXTERNAL EAR|
20|FH_F116642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151008_92625_0|SrvcGrp|108484|2022|PDM|725.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F45226_0_0|SrvcGrp|11069|2022|PDM|80.00|99|0.00|OT SVCS|
20|FH_F66405_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137458_08857_0|SrvcGrp|73842|2022|PDM|196.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F76887_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F71468_0_0|SrvcGrp|11798|2022|PDM|95.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F148960_13045_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149049_28401_0|SrvcGrp|114518|2022|PDM|2700.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F146266_0_0|SrvcGrp|76604|2022|PDM|2775.00|99|0.00|CPT 25447|
20|FH_F149085_0_0|SrvcGrp|79720|2022|PDM|1350.00|99|0.00|ACUTE REHAB II|
20|FH_F41363_0_0|SrvcGrp|11033|2022|PCT|1.00|99|0.00|OP REFERENCE LAB|
20|FH_F90223_0_0|SrvcGrp|27968|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F111044_0_0|SrvcGrp|26277|2022|PDM|2266.00|99|0.00|CPT 29874|
20|FH_F148667_0_0|SrvcGrp|70749|2022|PDM|2856.00|99|0.00|CPT 29823|
20|FH_F136779_0_0|SrvcGrp|57864|2022|PDM|1380.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F147160_80260_0|SrvcGrp|89412|2022|PDM|360.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F78185_0_0|SrvcGrp|75301|2022|PCT|0.82|99|0.00|AWP J CODES|
20|FH_F116100_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|915.00|99|0.00|AEG 4 (NO REV)|
20|FH_F97101_98003_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F32494_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110783_93013_0|SrvcGrp|86845|2022|PDM|35.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F126147_45241_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F41463_0_0|SrvcGrp|34132|2022|PDM|61.00|99|0.00|ARALAST THERAPY|
20|FH_F148926_28803_0|SrvcGrp|98701|2022|PDM|325.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F90817_0_0|SrvcGrp|90358|2022|PDM|1692.00|99|0.00|EXPLORE/DRAIN EYE SOCKET|
20|FH_F36485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% 2007 MEDICARE TN DME MOD 26|
20|FH_F147221_49442_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147237_40006_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F33632_52349_0|SrvcGrp|89297|2022|PDM|703.62|99|0.00|INPATIENT DETOXIFICATION SERVICES|
20|FH_F32666_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|GENERAL ACUTE CARE|
20|FH_F149022_25271_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134874_80120_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F150924_90029_0|SrvcGrp|74668|2022|PDM|365.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F122271_79416_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F150399_53045_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139807_33064_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F84631_0_0|SrvcGrp|63|2022|PDM|954.00|99|0.00|SUBACUTE CARE|
20|FH_F125249_0_0|SrvcGrp|26431|2022|PDM|9000.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F114931_0_0|SrvcGrp|92418|2022|PDM|3200.00|99|0.00|LAPAROSCOPY|
20|FH_F131107_43140_0|SrvcGrp|94781|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F120233_24368_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F136247_28804_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F132401_32796_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132479_90290_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F112670_47150_0|SrvcGrp|472|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120974_27607_0|SrvcGrp|77304|2022|PCT|0.44|99|0.00|DIAGNOSTIC DRUGS|
20|FH_F38289_0_0|SrvcGrp|28705|2022|PDM|1057.23|99|0.00|CENTER FOR SPINE CARE DISCOGRAM|
20|FH_F51276_0_0|SrvcGrp|10527|2022|PDM|115.00|99|0.00|HOSPICE SVCS|
20|FH_F39355_0_0|CSTM-ALL|CSTM-00|2020|PDM|215.00|99|0.00|CD DAY TREATMENT|
20|FH_F130711_06716_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130897_03103_0|SrvcGrp|111634|2022|PDM|270.00|99|0.00|ORAL MEDICATION ADMIN|
20|FH_F128278_21401_0|SrvcGrp|89417|2022|PDM|546.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|2488.00|99|0.00|AEG 9 (NO REV)|
20|FH_F145642_15108_0|SrvcGrp|24753|2022|PDM|10.00|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F85212_71075_0|SrvcGrp|83677|2022|PDM|2100.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F83978_66739_0|SrvcGrp|73006|2022|PDM|1865.00|99|0.00|AEG 9|
20|FH_F127091_62016_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|192.47|99|0.00|HAPA WPA-NWPA 2012-13 ASC 128 W/O REV|
20|FH_F145781_0_0|SrvcGrp|90063|2022|PDM|3000.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F79863_0_0|SrvcGrp|50166|2022|PDM|90.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 3 HRS|
20|FH_F123851_03235_0|SrvcGrp|48396|2022|PDM|169.00|99|0.00|OT SERVICES|
20|FH_F119379_0_0|SrvcGrp|103563|2022|PDM|764.00|99|0.00|REPAIR HAND TENDON|
20|FH_F111986_0_0|SrvcGrp|27918|2022|PDM|2472.00|99|0.00|CPT 23410, 23412|
20|FH_F41135_0_0|SrvcGrp|17073|2022|PDM|692.55|99|0.00|ASPG V|
20|FH_F143615_92612_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F109244_19808_0|SrvcGrp|90632|2022|PDM|115.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F144848_0_0|SrvcGrp|113729|2022|PDM|16163.00|99|0.00|INSJ STABLJ DEV W/DCMPRN|
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)|
20|FH_F150299_22046_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F36753_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD RR|
20|FH_F110943_80026_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|408.03|99|0.00|HAPA WPA-NWPA 2012-13 ASC 115 W/O REV|
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 10 (NO REV)|
20|FH_F127585_45069_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F124372_0_0|SrvcGrp|113580|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F90438_08873_0|SrvcGrp|86723|2022|PDM|284.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F69787_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F85415_27612_0|SrvcGrp|48385|2022|PDM|78.75|99|0.00|SPEECH THERAPY|
20|FH_F142376_0_0|SrvcGrp|113968|2022|PDM|1459.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN|
20|FH_F139569_15063_0|SrvcGrp|113700|2022|PDM|798.00|99|0.00|PODIATRY SERVICES|
20|FH_F130763_0_0|SrvcGrp|67064|2022|PDM|5823.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F132883_31602_0|SrvcGrp|86834|2022|PDM|10.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F145562_70458_0|SrvcGrp|86836|2022|PDM|10.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F51258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F87012_0_0|SrvcGrp|72990|2022|PDM|568.37|99|0.00|AEG 1|
20|FH_F133867_84075_0|SrvcGrp|48393|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES (PER HOUR)|
20|FH_F90316_17701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F122243_30655_0|SrvcGrp|75419|2022|PDM|430.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F100782_0_0|SrvcGrp|105060|2022|PDM|532.09|99|0.00|WINDBER MEDICAL CNTR ASC 16|
20|FH_F133749_84604_0|SrvcGrp|46693|2022|PDM|26.75|99|0.00|LPN NURSING SERVICES|
20|FH_F103220_0_0|SrvcGrp|99146|2022|PDM|3300.00|99|0.00|LIFEPORT 5 YEARS OR OLDER|
20|FH_F52754_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F96800_32308_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F145641_06902_0|SrvcGrp|109973|2022|PDM|5672.00|99|0.00|ARTHROSCOPY / SURGERY|
20|FH_F149147_66221_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121225_98902_0|SrvcGrp|34566|2022|PCT|0.85|99|0.00|HOME INFUSION THERAPY|
20|FH_F120583_43219_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F83754_0_0|SrvcGrp|20752|2022|PCT|0.81|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F87571_0_0|SrvcGrp|10904|2022|PDM|550.00|99|0.00|EMERGENCY ROOM LEVEL II|
20|FH_F149302_75032_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PDM|10779.00|99|0.00|2007 MEDICARE ASPG VII|
20|FH_F133957_84121_0|SrvcGrp|48398|2022|PDM|85.50|99|0.00|PT SERVICES|
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_F93190_26456_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110509_71351_0|SrvcGrp|13990|2022|PCT|1.05|99|0.00|PACEMAKER|
20|FH_F85097_0_0|SrvcGrp|8968|2022|PDM|3724.00|99|0.00|NICU LEVEL III & IV|
20|FH_F124173_66215_0|SrvcGrp|14949|2022|PDM|125.00|99|0.00|HOME INFUSION|
20|FH_F79863_0_0|SrvcGrp|77242|2022|PDM|180.00|99|0.00|AETNA HIT CONT CHEMOTHERAPY INFUSION|
20|FH_F121699_73703_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F49598_0_0|CSTM-ALL|CSTM-00|2020|PDM|1157.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143650_0_0|SrvcGrp|104002|2022|PDM|1800.00|99|0.00|ELBOW ARTHROSCOPY|
20|FH_F100782_0_0|SrvcGrp|105108|2022|PDM|863.83|99|0.00|WINDBER MEDICAL CNTR ASC 208|
20|FH_F133103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F44278_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F90332_07060_0|SrvcGrp|472|2022|PDM|481.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F111732_33771_0|SrvcGrp|54670|2022|PDM|4750.00|99|0.00|NORMAL DELIVERY|
20|FH_F110905_54452_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F124262_0_0|SrvcGrp|109753|2022|PDM|138.00|99|0.00|PROCTOSIGMOIDOSCOPY DIAGNOSTIC|
20|FH_F54592_0_0|SrvcGrp|27046|2022|PDM|33.50|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS (MOD SH)|
20|FH_F69606_0_0|SrvcGrp|26290|2022|PCT|0.50|99|0.00|OP SURGERY|
20|FH_F73024_0_0|SrvcGrp|48385|2022|PDM|30.00|99|0.00|SPEECH THERAPY|
20|FH_F84712_0_0|SrvcGrp|73559|2022|PDM|4415.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F87053_0_0|SrvcGrp|72990|2022|PDM|369.00|99|0.00|AEG 1|
20|FH_F74583_0_0|SrvcGrp|46248|2022|PDM|56.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F115877_63556_0|SrvcGrp|79699|2022|PDM|2800.00|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F146673_19085_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F120775_28805_0|SrvcGrp|73842|2022|PDM|185.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F40393_0_0|SrvcGrp|38|2022|PDM|1313.00|99|0.00|NORMAL DELIVERY|
20|FH_F116040_24637_0|SrvcGrp|14949|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F116063_43220_0|SrvcGrp|89149|2022|PDM|147.00|99|0.00|OP INTENSIVE|
20|FH_F131757_06320_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133461_61277_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_F133133_32433_0|SrvcGrp|87317|2022|PDM|660.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F46732_0_0|SrvcGrp|13703|2022|PDM|40.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F45832_0_0|SrvcGrp|941|2022|PDM|1984.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F141519_51566_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F93384_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129115_85716_0|SrvcGrp|73605|2022|PDM|1028.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F147941_06023_0|SrvcGrp|114020|2022|PCT|4.00|99|0.00|LABORATORY SERVICES|
20|FH_F55054_0_0|SrvcGrp|23477|2022|PDM|4415.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F93136_0_0|SrvcGrp|73004|2022|PDM|973.00|99|0.00|AEG 8|
20|FH_F83198_44125_0|SrvcGrp|16526|2022|PDM|180.00|99|0.00|DIALYSIS|
20|FH_F39740_0_0|SrvcGrp|20744|2022|PDM|17343.00|99|0.00|MS DRG 242 ONLY|
20|FH_F131207_19947_0|SrvcGrp|90635|2022|PCT|1.25|99|0.00|AETNA PSYTX PT & FAMILY 60 MINUTES|
20|FH_F130807_20721_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F138636_0_0|CSTM-ALL|CSTM-00|2020|PDM|734.00|99|0.00|AEG 2 (NO REV)|
20|FH_F39138_0_0|SrvcGrp|701|2022|PDM|1944.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F93880_95476_0|SrvcGrp|12280|2022|PCT|0.30|99|0.00|IMPLANTS|
20|FH_F123953_84003_0|SrvcGrp|75419|2022|PDM|506.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148355_37601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F113410_0_0|SrvcGrp|104948|2022|PDM|1681.00|99|0.00|MASTECTOMY FOR GYNECOMASTIA|
20|FH_F122433_0_0|SrvcGrp|58638|2022|PDM|1500.00|99|0.00|CPT 63688|
20|FH_F34413_0_0|SrvcGrp|16|2022|PDM|700.00|99|0.00|ACUTE REHABILITATION|
20|FH_F131228_01826_0|CSTM-ALL|CSTM-00|2020|PDM|3262.32|99|0.00|AEG 2 (NO REV)|
20|FH_F130051_31707_0|CSTM-ALL|CSTM-00|2020|PDM|8416.00|99|0.00|AEG 7 (NO REV)|
20|FH_F125249_0_0|SrvcGrp|104112|2022|PDM|1200.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F77504_0_0|SrvcGrp|29557|2022|PCT|1.00|99|0.00|TISSUE PLASMINOGEN ACTIVATOR|
20|FH_F129305_45614_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|AEG 10 (NO REV)|
20|FH_F124899_45246_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F124017_0_0|SrvcGrp|108265|2022|PDM|4100.00|99|0.00|AETNA INSJ BIOMECHANICAL DEVICE|
20|FH_F141169_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F70090_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|OP SVCS|
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|893.75|99|0.00|ASPG V|
20|FH_F128358_46072_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F37215_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F83451_0_0|SrvcGrp|81566|2022|PDM|1575.00|99|0.00|ALLOGRAFT FOR SPINE SURGERY|
20|FH_F132092_0_0|SrvcGrp|93098|2022|PDM|169.00|99|0.00|HOSPICE CARE|
20|FH_F114930_71101_0|SrvcGrp|105746|2022|PCT|1.05|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S AZ - MOD AU|
20|FH_F117504_31088_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F93881_15009_0|SrvcGrp|87113|2022|PDM|37.00|99|0.00|HEMATOCRIT|
20|FH_F143902_41018_0|SrvcGrp|108484|2022|PDM|546.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F101711_0_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F121164_61761_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141407_76226_0|SrvcGrp|29346|2022|PDM|37.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F134993_75034_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115119_10003_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149739_77087_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148169_33138_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F121183_75093_0|SrvcGrp|86722|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F120248_77008_0|SrvcGrp|73841|2022|PDM|375.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|134.32|99|0.00|AETNA SLEEP STUDY|
20|FH_F94662_0_0|SrvcGrp|90477|2022|PDM|199.00|99|0.00|HOSPICE|
20|FH_F97540_32114_0|SrvcGrp|90854|2022|PDM|1727.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F110086_21742_0|SrvcGrp|103834|2022|PDM|1600.00|99|0.00|AETNA REMOVE BLADDER STONE|
20|FH_F118194_50841_0|SrvcGrp|86832|2022|PDM|16.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PDM|2311.20|99|0.00|ASPG VIII|
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AEG 9 (NO REV)|
20|FH_F92659_0_0|SrvcGrp|85563|2022|PDM|962.00|99|0.00|INCISION OF EYE|
20|FH_F135779_0_0|SrvcGrp|109330|2022|PCT|0.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F129345_60623_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 3 (NO REV)|
20|FH_F116021_60714_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|1660.00|99|0.00|WELLPATH ASC VIII|
20|FH_F148201_82716_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (BREAKOUT)|
20|FH_F111288_0_0|SrvcGrp|53065|2022|PDM|1029.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F72183_0_0|SrvcGrp|30158|2022|PCT|1.80|99|0.00|LABORATORY MOD 26|
20|FH_F150462_30458_0|SrvcGrp|17004|2022|PDM|50.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS|
20|FH_F149866_07401_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F130747_0_0|SrvcGrp|92013|2022|PDM|5202.00|99|0.00|REPAIR OF COLLATERAL LIGAMENT|
20|FH_F114980_78061_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F70984_0_0|SrvcGrp|67997|2022|PDM|3250.00|99|0.00|CPT 58541 58544|
20|FH_F109000_0_0|SrvcGrp|40003|2022|PDM|10285.00|99|0.00|TOTAL KNEE|
20|FH_F118194_50841_0|SrvcGrp|103382|2022|PDM|136.00|99|0.00|HOME INFUSION THERAPY (PICC) NURSING SVCS ONLY (UP TO 2 HRS)|
20|FH_F91819_0_0|SrvcGrp|91686|2022|PDM|1500.00|99|0.00|ORTHOPEDIC SURGERY PROCEDURE|
20|FH_F122433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100662_27534_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|876.00|99|0.00|AEG 4 (NO REV)|
20|FH_F38034_0_0|CSTM-ALL|CSTM-00|2020|PDM|2264.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F32034_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136756_0_0|SrvcGrp|112965|2022|PDM|1980.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F32284_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F98801_93274_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F75425_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|491.00|99|0.00|AEG 2 (NO REV)|
20|FH_F123293_18087_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122433_0_0|SrvcGrp|96839|2022|PDM|750.00|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F141410_13045_0|SrvcGrp|113740|2022|PCT|3.50|99|0.00|LABORATORY SERVICES|
20|FH_F115109_20032_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120294_46322_0|SrvcGrp|48398|2022|PDM|98.00|99|0.00|PT SERVICES|
20|FH_F65159_0_0|SrvcGrp|11962|2022|PDM|4961.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F113738_27006_0|SrvcGrp|88620|2022|PDM|130.00|99|0.00|SKILLED NURSING RN|
20|FH_F62867_0_0|SrvcGrp|25686|2022|PDM|745.00|99|0.00|ACUTE PSYCH IP SVCS|
20|FH_F97721_01053_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F68841_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73231_0_0|SrvcGrp|44706|2022|PDM|105.45|99|0.00|NURSING CARE|
20|FH_F114916_30309_0|SrvcGrp|92820|2022|PDM|13500.00|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY|
20|FH_F104840_32565_0|SrvcGrp|73560|2022|PCT|0.69|99|0.00|AETNA SLEEP STUDIES|
20|FH_F113541_0_0|SrvcGrp|84181|2022|PDM|6662.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS|
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_F129254_0_0|CSTM-ALL|CSTM-00|2020|PDM|1688.96|99|0.00|ASPG IX|
20|FH_F132988_0_0|SrvcGrp|97363|2022|PDM|4493.01|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F132988_0_0|SrvcGrp|112154|2022|PDM|2057.62|99|0.00|REPAIR THUMB FRACTURE|
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|1952.00|99|0.00|AEG 3 (NO REV)|
20|FH_F147081_02130_0|SrvcGrp|108484|2022|PDM|473.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F40302_0_0|SrvcGrp|97|2022|PDM|4229.00|99|0.00|C-SECTION|
20|FH_F40603_0_0|SrvcGrp|13640|2022|PDM|90.00|99|0.00|CPT 99202|
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|6206.00|99|0.00|AEG 1 (NO REV)|
20|FH_F92493_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F67882_0_0|CSTM-ALL|CSTM-00|2020|PDM|324.00|99|0.00|ADULT PARTIAL DAY|
20|FH_F136544_06426_0|SrvcGrp|75545|2022|PDM|455.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F139113_21804_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138280_75215_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137933_0_0|SrvcGrp|113161|2022|PDM|4300.00|99|0.00|PERC CRYO ABLATE RENAL TUM|
20|FH_F43192_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F43249_0_0|CSTM-ALL|CSTM-00|2020|PDM|744.00|99|0.00|ACUTE PSYCH|
20|FH_F134727_30650_0|SrvcGrp|75506|2022|PCT|1.43|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F136778_62034_0|CSTM-ALL|CSTM-00|2020|PDM|480.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F136914_64081_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F112411_28207_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F112416_71449_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F38826_0_0|SrvcGrp|360|2022|PCT|0.73|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F49016_0_0|SrvcGrp|10905|2022|PDM|550.00|99|0.00|EMERGENCY ROOM LEVEL III|
20|FH_F116383_63026_0|SrvcGrp|89149|2022|PDM|233.00|99|0.00|OP INTENSIVE|
20|FH_F147389_81632_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147519_52627_0|SrvcGrp|106820|2022|PDM|137.80|99|0.00|CLINIC - GENERAL|
20|FH_F147527_60645_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120639_73078_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F80511_0_0|SrvcGrp|17574|2022|PDM|176.00|99|0.00|BEHAVIORAL HEALTH INTENSIVE OUTPT|
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)|
20|FH_F106500_0_0|SrvcGrp|73485|2022|PDM|1017.00|99|0.00|AETNA REHAB|
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 5  (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 406 W/O REV|
20|FH_F151302_80227_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F122116_60942_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135388_48601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135431_33414_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F91764_93710_0|SrvcGrp|112727|2022|PCT|2.19|99|0.00|COVID-19 IA NFCT AB SARS COV 2|
20|FH_F135972_18509_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116467_13031_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F127399_0_0|SrvcGrp|92819|2022|PDM|6763.00|99|0.00|HIP ARTHOSCOPY|
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1347.00|99|0.00|AEG 6 (NO REV)|
20|FH_F128990_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121428_40202_0|SrvcGrp|104911|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F121701_70420_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121763_07202_0|SrvcGrp|705|2022|PCT|0.40|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F44113_0_0|SrvcGrp|58433|2022|PDM|600.00|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)|
20|FH_F128370_76132_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F134315_89106_0|SrvcGrp|26869|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F47906_0_0|SrvcGrp|29963|2022|PCT|1.00|99|0.00|DME MOD UE|
20|FH_F33081_0_0|SrvcGrp|14017|2022|PDM|4600.00|99|0.00|TOTAL ABDOMINAL HYSTERECTOMY|
20|FH_F40684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1415.00|99|0.00|AEG 6 (NO REV)|
20|FH_F67502_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87501_32055_0|SrvcGrp|16304|2022|PDM|660.27|99|0.00|HOSPICE CARE|
20|FH_F123036_0_0|SrvcGrp|108830|2022|PDM|18203.00|99|0.00|IMPLT NROSTM PLS GEN DUA NON|
20|FH_F102222_19720_0|SrvcGrp|86837|2022|PDM|10.50|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F102222_19720_0|SrvcGrp|86832|2022|PDM|3.15|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F102862_30606_0|SrvcGrp|78579|2022|PDM|1320.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
20|FH_F129220_18445_0|SrvcGrp|104415|2022|PDM|213.00|99|0.00|PSYCH DIAGNOSTIC (HCFA)(MOD AF)|
20|FH_F132090_60915_0|CSTM-ALL|CSTM-00|2020|PDM|3279.15|99|0.00|AEG 9 (NO REV)|
20|FH_F148100_22406_0|SrvcGrp|73701|2022|PDM|32.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F102948_43606_0|SrvcGrp|93919|2022|PDM|434.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F111190_30512_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40634_0_0|SrvcGrp|3409|2022|PDM|292.00|99|0.00|NEWBORN NURSERY|
20|FH_F140007_0_0|SrvcGrp|19991|2022|PDM|7887.00|99|0.00|NERVOUS SYSTEM SERVICES|
20|FH_F128031_0_0|SrvcGrp|72992|2022|PDM|567.00|99|0.00|AEG 2|
20|FH_F140873_0_0|SrvcGrp|82223|2022|PDM|152.00|99|0.00|HOSPICE CARE|
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|AEG 1 (NO REV)|
20|FH_F122725_32216_0|SrvcGrp|104799|2022|PDM|294.00|99|0.00|ELECTROENCEPHALOGRAM|
20|FH_F86872_15215_0|SrvcGrp|86843|2022|PDM|45.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F50635_0_0|SrvcGrp|16173|2022|PDM|365.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F86851_0_0|SrvcGrp|79587|2022|PDM|520.00|99|0.00|CPT 43202|
20|FH_F86851_0_0|SrvcGrp|36608|2022|PDM|391.00|99|0.00|SIGMOIDOSCOPY|
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 8 (NO REV)|
20|FH_F88115_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F149179_0_0|SrvcGrp|115612|2022|PDM|5722.00|99|0.00|HIP ARTHRO W/ FEMOROPLASTY|
20|FH_F46832_0_0|SrvcGrp|24748|2022|PDM|80.00|99|0.00|CORTICOSTEROID THERAPY|
20|FH_F102623_0_0|SrvcGrp|94502|2022|PDM|180.00|99|0.00|PERITONEAL/CAPD/CCPD|
20|FH_F93177_73044_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F134126_11554_0|CSTM-ALL|CSTM-00|2020|PCT|2.66|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138108_47130_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F142448_15701_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F142547_70002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138558_60107_0|SrvcGrp|3178|2022|PDM|959.00|99|0.00|ACUTE PSYCH|
20|FH_F138571_65807_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F140548_60527_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140571_46514_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|GENERAL ACUTE CARE|
20|FH_F140833_19454_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140868_63103_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F120152_0_0|SrvcGrp|84939|2022|PDM|24750.00|99|0.00|SHOULDER JOINT|
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1065.00|99|0.00|AEG 6 (NO REV)|
20|FH_F149561_76667_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149584_77045_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129504_02871_0|SrvcGrp|43569|2022|PDM|118.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F137832_89118_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F137938_29036_0|SrvcGrp|113925|2022|PCT|0.68|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F35210_0_0|CSTM-ALL|CSTM-00|2020|PDM|744.00|99|0.00|MULTIPLE BIRTH|
20|FH_F128804_0_0|SrvcGrp|23585|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|453.36|99|0.00|ASPG II|
20|FH_F69364_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72544_0_0|SrvcGrp|16|2022|PDM|3162.00|99|0.00|ACUTE REHABILITATION|
20|FH_F111594_0_0|SrvcGrp|89840|2022|PDM|7699.00|99|0.00|THORAX SPINE FUSION|
20|FH_F111594_0_0|SrvcGrp|98500|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F148554_85016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148644_06890_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149884_68516_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145988_06105_0|SrvcGrp|114498|2022|PCT|1.19|99|0.00|CHEMOTHERAPY & ALL OTHER DRUGS|
20|FH_F71145_0_0|SrvcGrp|44244|2022|PDM|395.00|99|0.00|HEMODIALYSIS - HOME TRAINING|
20|FH_F34971_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F141871_33024_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F38700_0_0|SrvcGrp|18381|2022|PCT|0.80|99|0.00|MS DRG 483|
20|FH_F132543_79549_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F133427_48811_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F101840_76054_0|SrvcGrp|80839|2022|PDM|12752.00|99|0.00|MSDRG 520 ONLY|
20|FH_F56793_0_0|SrvcGrp|42972|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE|
20|FH_F146211_68144_0|SrvcGrp|104112|2022|PDM|6280.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F127412_15301_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|AEG 6 (NO REV)|
20|FH_F149664_33428_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F78682_0_0|CSTM-ALL|CSTM-00|2020|PDM|760.84|99|0.00|ASPG II|
20|FH_F128379_0_0|SrvcGrp|88164|2022|PDM|14306.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F146543_89511_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135626_20176_0|SrvcGrp|74668|2022|PDM|233.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133749_84604_0|SrvcGrp|112410|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F133778_38119_0|SrvcGrp|35005|2022|PCT|1.00|99|0.00|HOSPICE PHYSICIAN SERVICES|
20|FH_F112468_0_0|SrvcGrp|73000|2022|PDM|928.00|99|0.00|AEG 6|
20|FH_F113453_80020_0|SrvcGrp|93291|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA ESRD USE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|122.77|99|0.00|HAPA WPA-NWPA 2012-13 ASC 239 W/O REV|
20|FH_F118127_30078_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F120670_0_0|SrvcGrp|93071|2022|PDM|6500.00|99|0.00|POSTERIOR SEGMENTAL INSTRU|
20|FH_F136359_0_0|SrvcGrp|100080|2022|PDM|4920.00|99|0.00|UNLISTED PROC FOOT OR TOES|
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|1535.00|99|0.00|AEG 9 (NO REV)|
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|564.00|99|0.00|AEG 2 (NO REV)|
20|FH_F124161_95932_0|SrvcGrp|73004|2022|PDM|6242.00|99|0.00|AEG 8|
20|FH_F132728_0_0|SrvcGrp|47427|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F90438_08873_0|SrvcGrp|86722|2022|PDM|177.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F129509_0_0|SrvcGrp|99166|2022|PDM|3767.00|99|0.00|CPT 63005|
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_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|2575.00|99|0.00|AEG 7 (NO REV)|
20|FH_F85995_64111_0|SrvcGrp|46424|2022|PDM|136.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F81852_0_0|SrvcGrp|10507|2022|PDM|50.00|99|0.00|OCCUPATIONAL THERAPY SVCS RE-EVAL|
20|FH_F124743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F96160_32207_0|SrvcGrp|86849|2022|PDM|68.65|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F134593_60007_0|SrvcGrp|86841|2022|PDM|68.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F72124_0_0|SrvcGrp|48745|2022|PDM|682.00|99|0.00|PSYCH|
20|FH_F132969_84003_0|SrvcGrp|86837|2022|PDM|10.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F109577_0_0|SrvcGrp|90341|2022|PDM|135.00|99|0.00|SKILLED NURSING LPN (HCFA)|
20|FH_F149319_07670_0|SrvcGrp|104328|2022|PCT|0.85|99|0.00|PRESCRIPTION DRUG|
20|FH_F61072_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119783_46360_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F76146_0_0|SrvcGrp|68190|2022|PDM|1446.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 6|
20|FH_F147502_0_0|SrvcGrp|29155|2022|PDM|150.00|99|0.00|HOSPICE SVCS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|484.84|99|0.00|HAPA WPA-NWPA 2012-13 ASC 2 W/O REV|
20|FH_F90501_71101_0|SrvcGrp|81779|2022|PCT|1.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F124369_0_0|SrvcGrp|89988|2022|PDM|2544.30|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F100782_0_0|SrvcGrp|105135|2022|PDM|258.76|99|0.00|WINDBER MEDICAL CNTR ASC 240|
20|FH_F145642_15108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F35966_0_0|SrvcGrp|19605|2022|PDM|0.83|99|0.00|WHEELCHAIR VAN MILEAGE-PER MILE|
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121476_0_0|SrvcGrp|40826|2022|PDM|476.00|99|0.00|DISPOSABLE DRUG DELIVERY SYSTEM|
20|FH_F121303_15501_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F134568_12946_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F144228_0_0|SrvcGrp|101118|2022|PDM|13985.00|99|0.00|ARTHROSCOPY REPAIR|
20|FH_F88744_71103_0|SrvcGrp|111961|2022|PDM|5757.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F149263_0_0|SrvcGrp|89404|2022|PDM|6800.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F68251_0_0|SrvcGrp|43893|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F90501_71101_0|SrvcGrp|16719|2022|PCT|0.37|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F100060_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F80613_0_0|SrvcGrp|43957|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|2060.00|99|0.00|AEG 7 (NO REV)|
20|FH_F39701_0_0|SrvcGrp|13297|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F110268_02891_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121225_98902_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|SKILLED NURSING|
20|FH_F146595_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.60|99|0.00|HSS ASC|
20|FH_F132969_84003_0|SrvcGrp|73742|2022|PDM|4.41|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F109400_80026_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63926|2022|PDM|32.42|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1001|
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PDM|935.00|99|0.00|AEG 6 (NO REV)|
20|FH_F119379_0_0|SrvcGrp|107824|2022|PDM|885.00|99|0.00|REMOVE WRIST/FOREARM LESION|
20|FH_F83380_0_0|SrvcGrp|61476|2022|PCT|1.00|99|0.00|KS FS 3247 (A&K CODES)- ALL|
20|FH_F134326_14094_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F85353_16407_0|SrvcGrp|63815|2022|PDM|551.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 208|
20|FH_F149120_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143708_19031_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F130123_24171_0|SrvcGrp|63297|2022|PDM|145.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F149263_0_0|SrvcGrp|27343|2022|PDM|3570.00|99|0.00|OP SURGERY (CPT 25607 - 25609)|
20|FH_F126198_44236_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F87775_15106_0|SrvcGrp|43571|2022|PDM|90.00|99|0.00|MID-LINE INSERTION|
20|FH_F87333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F110343_38139_0|SrvcGrp|89417|2022|PDM|542.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F134188_83201_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F72543_0_0|SrvcGrp|12403|2022|PDM|40.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F72543_0_0|SrvcGrp|46108|2022|PDM|54.00|99|0.00|SKILLED NURSING (ADDITIONAL HOUR)|
20|FH_F134496_66062_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F101100_50314_0|SrvcGrp|97916|2022|PDM|12012.00|99|0.00|REPAIR OF BOWEL OPENING 2|
20|FH_F102200_06416_0|SrvcGrp|10577|2022|PDM|50.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F111363_33169_0|SrvcGrp|78687|2022|PDM|205.00|99|0.00|AETNA DUAL ENERGY X-RAY ABSORBTION|
20|FH_F148243_0_0|SrvcGrp|93724|2022|PDM|900.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F40423_0_0|SrvcGrp|32550|2022|PDM|385.00|99|0.00|NEWBORN NURSERY|
20|FH_F40423_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F102325_62691_0|SrvcGrp|22592|2022|PDM|70.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F101320_26062_0|SrvcGrp|17016|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132090_60915_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PDM|8100.00|99|0.00|MSDRG 250-251 PERCUTANEOUS CARDIO PROC|
20|FH_F39355_0_0|SrvcGrp|12969|2022|PDM|350.00|99|0.00|NEWBORN NURSERY|
20|FH_F120112_0_0|SrvcGrp|89781|2022|PDM|94.50|99|0.00|RESPITE CARE (HCFA)|
20|FH_F106980_0_0|SrvcGrp|73006|2022|PDM|1481.00|99|0.00|AEG 9|
20|FH_F86917_61108_0|SrvcGrp|10527|2022|PDM|115.50|99|0.00|HOSPICE SVCS|
20|FH_F43250_0_0|CSTM-ALL|CSTM-00|2020|PDM|3400.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F43450_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|ACUTE PSYCH|
20|FH_F89736_0_0|SrvcGrp|115056|2022|PDM|7736.00|99|0.00|LAPAROSCOPY SERVICES|
20|FH_F44449_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|767.03|99|0.00|POLYSOMNOGRAPHY W/O MOD 26 & TC|
20|FH_F132016_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC|
20|FH_F69944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123601_30680_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123784_03264_0|SrvcGrp|43567|2022|PDM|154.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F132810_0_0|SrvcGrp|86847|2022|PDM|40.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F132810_0_0|SrvcGrp|22593|2022|PDM|60.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F136373_17055_0|SrvcGrp|48398|2022|PDM|120.00|99|0.00|PT SERVICES|
20|FH_F136377_75240_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F136430_46710_0|SrvcGrp|75545|2022|PDM|496.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F118152_20151_0|SrvcGrp|22389|2022|PDM|15.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F118154_17042_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120444_84037_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F120489_63552_0|SrvcGrp|12491|2022|PCT|0.65|99|0.00|PACEMAKER|
20|FH_F120490_64133_0|SrvcGrp|86847|2022|PDM|25.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F134150_01801_0|SrvcGrp|90161|2022|PDM|836.00|99|0.00|AETNA INPATIENT DETOX (<= 17 YEARS OF AGE)|
20|FH_F138108_47130_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F114979_77979_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F142413_61342_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F97600_46151_0|SrvcGrp|73643|2022|PDM|734.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F138545_39503_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F138627_82901_0|SrvcGrp|88826|2022|PDM|95.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F138627_82901_0|SrvcGrp|88807|2022|PDM|175.00|99|0.00|TOTAL PARENTERAL NUTRITION; < 2 LITERS (HCFA)|
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_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 3 (NO REV)|
20|FH_F149375_26101_0|SrvcGrp|75419|2022|PDM|455.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F118789_92211_0|SrvcGrp|93919|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F118959_44830_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F118955_48239_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F118914_43015_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117286_17202_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117377_71303_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147941_06023_0|SrvcGrp|10393|2022|PDM|10200.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F117153_34113_0|SrvcGrp|89417|2022|PDM|350.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F117189_60085_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F110720_0_0|SrvcGrp|19922|2022|PDM|4882.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F90880_15108_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F114567_43235_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|984.66|99|0.00|2005 ASPG GROUPER X|
20|FH_F119374_62263_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119538_60959_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F148425_01507_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148432_01585_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F142891_54022_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132612_0_0|SrvcGrp|941|2022|PDM|2872.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F102561_75146_0|SrvcGrp|98013|2022|PDM|4961.00|99|0.00|COLONOSCOPY|
20|FH_F133469_33404_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F128421_27016_0|SrvcGrp|11108|2022|PCT|0.80|99|0.00|NEWBORN NURSERY|
20|FH_F117366_33162_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92676_15063_0|CSTM-ALL|CSTM-00|2020|PDM|8993.00|99|0.00|LITHOTRIPSY - BILATERAL (MOD 50)|
20|FH_F72909_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44019_0_0|SrvcGrp|473|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F141870_85224_0|SrvcGrp|86829|2022|PDM|5.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.64|99|0.00|AEG 2 (NO REV)|
20|FH_F139825_0_0|SrvcGrp|84279|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F72523_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128349_43082_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F81494_0_0|SrvcGrp|16619|2022|PDM|136.00|99|0.00|OT SVCS|
20|FH_F133493_90255_0|CSTM-ALL|CSTM-00|2020|PDM|6439.00|99|0.00|AEG 9 (NO REV)|
20|FH_F133472_27607_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F37042_0_0|SrvcGrp|17075|2022|PDM|1326.00|99|0.00|ASPG VI|
20|FH_F128144_45697_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F142775_72801_0|SrvcGrp|73841|2022|PDM|424.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F150164_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148556_13206_0|SrvcGrp|17014|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F150024_08079_0|CSTM-ALL|CSTM-00|2020|PDM|2890.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132420_84660_0|SrvcGrp|75419|2022|PDM|575.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)|
20|FH_F115274_15235_0|SrvcGrp|94780|2022|PDM|135.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F150021_02725_0|SrvcGrp|115412|2022|PCT|0.85|99|0.00|DRUGS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|95.15|99|0.00|HAPA WPA-NWPA 2012-13 ASC 243 W/O REV|
20|FH_F117006_0_0|SrvcGrp|92502|2022|PDM|573.47|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F141870_85224_0|SrvcGrp|63156|2022|PCT|0.83|99|0.00|IMMUNE GLOBULIN INTRAVENOUS|
20|FH_F45435_0_0|SrvcGrp|9828|2022|PDM|60.00|99|0.00|HOME HEALTH AIDE|
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100785_54660_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F120437_85202_0|SrvcGrp|86848|2022|PDM|76.51|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F100682_97401_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F132934_63005_0|SrvcGrp|74403|2022|PCT|0.71|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F31184_0_0|SrvcGrp|18791|2022|PDM|61500.00|99|0.00|MS DRG 215|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|244.51|99|0.00|HAPA WPA-NWPA 2012-13 ASC 233 W/O REV|
20|FH_F117340_68144_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F106540_26330_0|SrvcGrp|72994|2022|PDM|3762.00|99|0.00|AEG 3|
20|FH_F69242_0_0|SrvcGrp|43955|2022|PDM|90.00|99|0.00|NURSING CARE|
20|FH_F133270_77025_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F40203_0_0|SrvcGrp|16|2022|PDM|660.00|99|0.00|ACUTE REHABILITATION|
20|FH_F40267_0_0|SrvcGrp|74880|2022|PDM|38.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F133018_84037_0|SrvcGrp|46104|2022|PDM|50.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F97541_33021_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F38089_0_0|SrvcGrp|72|2022|PDM|354.00|99|0.00|NEWBORN NURSERY|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1004.00|99|0.00|COVENTRY ENHANCED GROUPER 5 MOD 50|
20|FH_F67861_0_0|SrvcGrp|9911|2022|PCT|0.75|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F40591_0_0|SrvcGrp|33087|2022|PDM|8500.00|99|0.00|ROBOTIC ASSISTED SURGERY|
20|FH_F43245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F147993_65622_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F43147_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126762_91311_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88956_0_0|SrvcGrp|73606|2022|PDM|1560.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F132612_0_0|SrvcGrp|701|2022|PDM|2872.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F91255_19401_0|CSTM-ALL|CSTM-00|2020|PDM|3427.00|99|0.00|AEG 6 (NO REV)|
20|FH_F87615_80033_0|SrvcGrp|89268|2022|PDM|239.00|99|0.00|AETNA INITIAPSYCH DIAGNOSTIC EVALUATION|
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1232.00|99|0.00|AEG 5  (NO REV)|
20|FH_F62601_0_0|SrvcGrp|48398|2022|PDM|30.00|99|0.00|PT SERVICES|
20|FH_F147993_65622_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F57592_0_0|SrvcGrp|29609|2022|PDM|55000.00|99|0.00|MS DRG 232 ONLY|
20|FH_F94300_0_0|SrvcGrp|93597|2022|PDM|4200.00|99|0.00|REVISE RECONSTRUCT SHOULDER JOINT(HCFA)|
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)|
20|FH_F119437_0_0|SrvcGrp|98497|2022|PDM|4750.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F125368_24153_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F66403_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F42779_0_0|SrvcGrp|471|2022|PDM|1207.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F114310_0_0|SrvcGrp|54943|2022|PDM|3200.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F128349_43082_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F133307_14580_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F43147_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|ACUTE PSYCH|
20|FH_F146229_60031_0|SrvcGrp|89337|2022|PDM|847.00|99|0.00|DETOXIFICATION|
20|FH_F88280_0_0|SrvcGrp|11108|2022|PDM|663.00|99|0.00|NEWBORN NURSERY|
20|FH_F133287_40215_0|SrvcGrp|14320|2022|PCT|0.28|99|0.00|OP IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F111809_93003_0|SrvcGrp|81779|2022|PCT|8.53|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F51129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|PTE SURGERY|
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 8 (NO REV)|
20|FH_F141731_92590_0|SrvcGrp|73841|2022|PDM|463.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F41396_0_0|SrvcGrp|34272|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC (DME)|
20|FH_F75743_0_0|SrvcGrp|13368|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F132566_38751_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38848_0_0|SrvcGrp|177|2022|PDM|1800.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F34706_0_0|SrvcGrp|14197|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F130615_95350_0|SrvcGrp|89149|2022|PDM|300.00|99|0.00|OP INTENSIVE|
20|FH_F89015_74017_0|SrvcGrp|53144|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120058_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131282_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 2 (NO REV)|
20|FH_F146117_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F117340_68144_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F42984_0_0|CSTM-ALL|CSTM-00|2020|PDM|373.00|99|0.00|ADOLESCENT RESIDENTIAL TREATMENT|
20|FH_F100786_24740_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F150770_43113_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132849_0_0|SrvcGrp|360|2022|PDM|1435.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F122248_33441_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F92431_80033_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147213_48609_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SUPPLIES A CODES - CARECENTRIX|
20|FH_F117615_30525_0|SrvcGrp|75493|2022|PCT|0.85|99|0.00|AEG 8|
20|FH_F120767_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F37304_0_0|SrvcGrp|12035|2022|PDM|6440.00|99|0.00|PTCA W/O STENT|
20|FH_F111266_30339_0|SrvcGrp|24752|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F39772_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (TECHNICAL) (HCFA)|
20|FH_F92299_62016_0|SrvcGrp|82369|2022|PCT|1.05|99|0.00|AETNA LABORATORY|
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AMBULATORY DETOX - ALCOHOL AND DRUG REHAB|
20|FH_F125656_92868_0|SrvcGrp|10578|2022|PDM|31.00|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F120848_20912_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F52092_0_0|SrvcGrp|9874|2022|PDM|44.00|99|0.00|DIETICIAN|
20|FH_F122260_98034_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147216_48307_0|SrvcGrp|42623|2022|PDM|539.00|99|0.00|SUBACUTE - LEVEL III|
20|FH_F138410_19130_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|5500.00|99|0.00|AEG 7 (NO REV)|
20|FH_F100663_56537_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F110121_0_0|SrvcGrp|73000|2022|PDM|3570.00|99|0.00|AEG 6|
20|FH_F110727_34994_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F130813_85014_0|SrvcGrp|108484|2022|PDM|428.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F99523_80016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F148965_62025_0|SrvcGrp|16|2022|PDM|1835.00|99|0.00|ACUTE REHABILITATION|
20|FH_F86714_0_0|SrvcGrp|29898|2022|PDM|191.60|99|0.00|RN VISIT|
20|FH_F108180_29526_0|SrvcGrp|3178|2022|PDM|998.00|99|0.00|ACUTE PSYCH|
20|FH_F131418_75215_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F124526_05301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139442_60143_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F114207_35243_0|SrvcGrp|105302|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJECTION DRUGS|
20|FH_F114271_08721_0|SrvcGrp|92760|2022|PCT|1.04|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149023_44122_0|CSTM-ALL|CSTM-00|2020|PDM|1795.00|99|0.00|AEG 4 (NO REV)|
20|FH_F110783_93013_0|SrvcGrp|24754|2022|PDM|12.50|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F76826_0_0|SrvcGrp|74448|2022|PDM|6191.00|99|0.00|ROBOTICS|
20|FH_F148859_0_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F137458_08857_0|SrvcGrp|73841|2022|PDM|318.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138987_0_0|SrvcGrp|113451|2022|PDM|30.00|99|0.00|HOSPICE CARE|
20|FH_F35369_0_0|SrvcGrp|3064|2022|PDM|2350.00|99|0.00|ICU/CCU|
20|FH_F129966_18017_0|SrvcGrp|86722|2022|PDM|227.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F74902_0_0|SrvcGrp|66481|2022|PDM|75.00|99|0.00|SOCIAL WORKER|
20|FH_F147360_06415_0|SrvcGrp|100245|2022|PCT|1.00|99|0.00|INFLUENZA ASSAY W/ OPTIC|
20|FH_F122277_98045_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F124465_84123_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F93254_0_0|SrvcGrp|3809|2022|PDM|539.93|99|0.00|HOSPICE CARE|
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|1660.00|99|0.00|AEG 8 (NO REV)|
20|FH_F145583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147082_02359_0|SrvcGrp|90397|2022|PDM|284.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F91938_70121_0|SrvcGrp|3809|2022|PDM|566.93|99|0.00|HOSPICE CARE|
20|FH_F130179_62447_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130939_40353_0|SrvcGrp|58509|2022|PDM|336.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|946.00|99|0.00|ASPG IV|
20|FH_F149645_92708_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1127.78|99|0.00|SALLY BALIN,999182,ASC 801|
20|FH_F69123_0_0|SrvcGrp|42974|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F129256_89146_0|SrvcGrp|106048|2022|PDM|1130.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F35416_0_0|SrvcGrp|13476|2022|PCT|0.80|99|0.00|TRAUMA CARE|
20|FH_F138453_74135_0|SrvcGrp|46903|2022|PDM|515.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F147201_48234_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146859_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F143407_75021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143533_30013_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143536_47546_0|SrvcGrp|100254|2022|PCT|1.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (20.1 - 30.0 CM)|
20|FH_F125249_0_0|SrvcGrp|88065|2022|PDM|12000.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F103140_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AETNA NON TRAUMA INJURY|
20|FH_F102920_0_0|SrvcGrp|76847|2022|PDM|3152.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F102920_0_0|SrvcGrp|98779|2022|PDM|3096.00|99|0.00|INCISION OF TENDON SHEATH|
20|FH_F103060_0_0|SrvcGrp|72998|2022|PDM|2523.00|99|0.00|AEG 5|
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|2120.00|99|0.00|AEG 3 (NO REV)|
20|FH_F102522_0_0|SrvcGrp|98688|2022|PDM|24.08|99|0.00|GROUP THERAPY 2 OR MORE|
20|FH_F130937_98002_0|SrvcGrp|73842|2022|PDM|196.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120171_33770_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F120190_92624_0|SrvcGrp|89337|2022|PDM|950.00|99|0.00|DETOXIFICATION|
20|FH_F112687_30474_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119992_67062_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F44438_0_0|SrvcGrp|16|2022|PDM|991.00|99|0.00|ACUTE REHABILITATION|
20|FH_F40091_0_0|SrvcGrp|17073|2022|PCT|0.70|99|0.00|ASPG V|
20|FH_F45832_0_0|SrvcGrp|361|2022|PDM|1350.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F87031_0_0|SrvcGrp|73000|2022|PDM|1284.00|99|0.00|AEG 6|
20|FH_F149885_68502_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|802.00|99|0.00|ASPG VI|
20|FH_F138010_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F123915_0_0|SrvcGrp|95660|2022|PDM|678.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F44198_0_0|SrvcGrp|14557|2022|PDM|40.00|99|0.00|AMBULANCE SVCS - WHEELCHAIR VAN|
20|FH_F87031_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS|
20|FH_F31111_0_0|SrvcGrp|111932|2022|PDM|87.00|99|0.00|COVID-19 NON-CDC TESTING LAB|
20|FH_F114930_71101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123895_52722_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F93791_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)|
20|FH_F41350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1564.00|99|0.00|ASPG VII|
20|FH_F93881_15009_0|SrvcGrp|3178|2022|PDM|1335.00|99|0.00|ACUTE PSYCH|
20|FH_F135228_98003_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148166_0_0|SrvcGrp|106792|2022|PDM|190.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F125249_0_0|SrvcGrp|108262|2022|PDM|1000.00|99|0.00|AETNA PARTIAL REMOVAL OF FIBULA|
20|FH_F40661_0_0|SrvcGrp|439|2022|PDM|1786.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F145546_52732_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125899_07645_0|SrvcGrp|110235|2022|PDM|1004.00|99|0.00|IP 3D RENDERING W/ INTERPRETA|
20|FH_F137943_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F93920_0_0|SrvcGrp|73004|2022|PDM|8200.00|99|0.00|AEG 8|
20|FH_F42431_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143528_0_0|SrvcGrp|114089|2022|PDM|5250.00|99|0.00|REPAIR OF TENDONS|
20|FH_F77042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F121149_76021_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F131234_32207_0|SrvcGrp|89149|2022|PDM|193.00|99|0.00|OP INTENSIVE|
20|FH_F123282_03222_0|SrvcGrp|108404|2022|PCT|1.00|99|0.00|OP SVCS AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|2384.00|99|0.00|AEG 10 (NO REV)|
20|FH_F143833_63703_0|SrvcGrp|75419|2022|PDM|425.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F55054_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38357_0_0|SrvcGrp|29021|2022|PCT|0.65|99|0.00|DME AND SUPPLIES|
20|FH_F46094_0_0|SrvcGrp|39995|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME|
20|FH_F31111_0_0|SrvcGrp|58436|2022|PCT|1.00|99|0.00|HEARING SERVICES|
20|FH_F138416_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|HOSPICE SERVICES|
20|FH_F34735_0_0|SrvcGrp|9510|2022|PDM|1000.00|99|0.00|SKILLED NURSING CARE|
20|FH_F148700_0_0|SrvcGrp|75419|2022|PDM|714.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F125935_44024_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F38392_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MOD 26|
20|FH_F128272_60640_0|SrvcGrp|16750|2022|PDM|110.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F133099_66801_0|SrvcGrp|88978|2022|PCT|0.80|99|0.00|VAGINAL DELIVERY|
20|FH_F120155_63114_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118720_0_0|CSTM-ALL|CSTM-00|2020|PDM|531.00|99|0.00|AEG 1 (NO REV)|
20|FH_F94862_0_0|SrvcGrp|73008|2022|PDM|575.00|99|0.00|AEG 10|
20|FH_F131763_06002_0|SrvcGrp|471|2022|PDM|587.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F110925_01104_0|SrvcGrp|21917|2022|PDM|17.87|99|0.00|NASOGASTRIC TUBING|
20|FH_F148221_06477_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F100662_27534_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F96902_0_0|SrvcGrp|80317|2022|PDM|440.00|99|0.00|RESPITE CARE|
20|FH_F147941_06023_0|SrvcGrp|115244|2022|PCT|0.69|99|0.00|MICROBIOLOGY CULTURE|
20|FH_F135221_62691_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129324_24701_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137457_32216_0|SrvcGrp|16069|2022|PDM|830.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F34735_0_0|SrvcGrp|9793|2022|PDM|600.00|99|0.00|NEWBORN NURSERY|
20|FH_F34691_0_0|CSTM-ALL|CSTM-00|2020|PDM|1710.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114918_78748_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F90362_0_0|SrvcGrp|89946|2022|PDM|1667.00|99|0.00|REPAIR OF KNEE LIGAMENT|
20|FH_F143768_34785_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35202_0_0|SrvcGrp|13703|2022|PDM|26.25|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F143528_0_0|SrvcGrp|92197|2022|PDM|3952.20|99|0.00|CORRECTION OF BUNION|
20|FH_F131965_0_0|SrvcGrp|83521|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 6 (NO REV)|
20|FH_F151526_28208_0|SrvcGrp|108190|2022|PDM|4143.00|99|0.00|ARTERY-VEIN GRAFT|
20|FH_F139241_0_0|SrvcGrp|28080|2022|PDM|765.00|99|0.00|DIALYSIS|
20|FH_F135248_84651_0|SrvcGrp|12496|2022|PDM|753.00|99|0.00|ACUTE REHABILITATION|
20|FH_F66465_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO|
20|FH_F33642_0_0|SrvcGrp|361|2022|PDM|900.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F147941_06023_0|SrvcGrp|53144|2022|PDM|247.00|99|0.00|SPEECH THERAPY|
20|FH_F148255_72703_0|SrvcGrp|16750|2022|PDM|84.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F131254_92211_0|SrvcGrp|86851|2022|PDM|35.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F66222_0_0|SrvcGrp|43430|2022|PDM|131.07|99|0.00|LPN HOME VISIT|
20|FH_F78022_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139515_0_0|SrvcGrp|106265|2022|PDM|4352.00|99|0.00|NSL/SINS NDSC TOTAL|
20|FH_F83352_06114_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F123259_54501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120338_83226_0|SrvcGrp|46903|2022|PDM|1755.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F116049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137633_85202_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150699_0_0|SrvcGrp|115839|2022|PDM|2028.00|99|0.00|REVISE POCKET PACEMAKER|
20|FH_F123481_90049_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F106822_0_0|SrvcGrp|68241|2022|PDM|2.13|99|0.00|DESTRUCTION WARTS - 2ND - 4TH LESIONS|
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1526.00|99|0.00|ASPG VI|
20|FH_F121539_27511_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F132051_74464_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F110061_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110161_31329_0|SrvcGrp|92606|2022|PDM|495.00|99|0.00|SUB-ACUTE CARE LEVEL III|
20|FH_F38798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|DME - MOD 26|
20|FH_F40834_0_0|SrvcGrp|63|2022|PCT|0.80|99|0.00|SUBACUTE CARE|
20|FH_F148255_72703_0|SrvcGrp|22593|2022|PDM|31.50|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F65159_0_0|SrvcGrp|8950|2022|PDM|3648.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F139569_15063_0|CSTM-ALL|CSTM-00|2020|PDM|1122.00|99|0.00|AEG 5  (NO REV)|
20|FH_F50477_0_0|SrvcGrp|29402|2022|PDM|135.00|99|0.00|HOME HEALTH THERAPY VISITS OP|
20|FH_F133875_80027_0|SrvcGrp|16069|2022|PDM|1067.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F120930_0_0|SrvcGrp|26281|2022|PDM|3000.00|99|0.00|CPT 58353|
20|FH_F146474_78572_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149121_01520_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133912_20852_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150165_06032_0|SrvcGrp|89404|2022|PDM|12731.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F119379_0_0|SrvcGrp|107847|2022|PDM|764.00|99|0.00|REVISE ULNAR NERVE AT ELBOW|
20|FH_F121700_60938_0|SrvcGrp|108484|2022|PDM|875.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139443_37705_0|SrvcGrp|108484|2022|PDM|800.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F132802_68022_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F132883_31602_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F147502_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118123_67226_0|SrvcGrp|24745|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|982.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F130763_0_0|SrvcGrp|69964|2022|PDM|2954.00|99|0.00|CPT 23120|
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|798.00|99|0.00|ASPG III|
20|FH_F37877_0_0|SrvcGrp|70820|2022|PCT|1.00|99|0.00|(PREVENTATIVE) OCN F/S PRICING: ALL|
20|FH_F117531_0_0|SrvcGrp|103551|2022|PDM|304.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F79824_0_0|SrvcGrp|17065|2022|PDM|1087.00|99|0.00|ASPG I|
20|FH_F145641_06902_0|SrvcGrp|82112|2022|PDM|5568.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F120930_0_0|SrvcGrp|38364|2022|PDM|4000.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F134593_60007_0|SrvcGrp|22589|2022|PDM|36.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F111942_92647_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F127957_89521_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F127957_89521_0|SrvcGrp|105350|2022|PDM|520.00|99|0.00|AETNA PARTIAL HOSPITALIZATION|
20|FH_F134247_66049_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145642_15108_0|SrvcGrp|86832|2022|PDM|3.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F93190_26456_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F138026_46143_0|SrvcGrp|112868|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F80172_0_0|SrvcGrp|24745|2022|PCT|0.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F143650_0_0|SrvcGrp|89980|2022|PDM|3900.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F124372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F110466_06870_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146124_06112_0|SrvcGrp|99189|2022|PCT|0.00|99|0.00|C-SECTION|
20|FH_F114683_0_0|SrvcGrp|84912|2022|PDM|4500.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F68909_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F52713_0_0|SrvcGrp|50062|2022|PCT|0.60|99|0.00|IMRT|
20|FH_F133753_84015_0|SrvcGrp|471|2022|PDM|608.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F125870_0_0|SrvcGrp|28548|2022|PDM|2445.00|99|0.00|VITRECTOMY|
20|FH_F149263_0_0|SrvcGrp|65350|2022|PDM|5098.00|99|0.00|KNEE ARTHRO/ANTER|
20|FH_F149246_95603_0|SrvcGrp|75419|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F130468_0_0|SrvcGrp|65350|2022|PDM|2847.40|99|0.00|KNEE ARTHRO/ANTER|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1505.81|99|0.00|HAPA WPA-NWPA 2012-13 ASC 703 W/O REV|
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1935.00|99|0.00|AEG 5  (NO REV)|
20|FH_F148186_0_0|SrvcGrp|106300|2022|PDM|247.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F135670_01749_0|SrvcGrp|86831|2022|PDM|7.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F133877_84117_0|SrvcGrp|97507|2022|PDM|93.00|99|0.00|AETNA HOSPICE|
20|FH_F95440_0_0|SrvcGrp|73004|2022|PDM|2858.00|99|0.00|AEG 8|
20|FH_F125244_0_0|SrvcGrp|63471|2022|PDM|17500.00|99|0.00|CPT 64590|
20|FH_F134614_84651_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F118267_45005_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F112023_12866_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125124_0_0|SrvcGrp|73008|2022|PDM|360.00|99|0.00|AEG 10|
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|ASPG VII - FH SW CUSTOM GROUPERS|
20|FH_F138050_52301_0|SrvcGrp|112967|2022|PCT|1.36|99|0.00|LABORATORY SERVICES|
20|FH_F130123_24171_0|SrvcGrp|89783|2022|PDM|145.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F133018_84037_0|SrvcGrp|21920|2022|PDM|25.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
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_F117756_75402_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1405.80|99|0.00|HAPA WPA-NWPA 2012-13 ASC 907 W/O REV|
20|FH_F128605_20910_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F87155_04105_0|SrvcGrp|26868|2022|PDM|57.78|99|0.00|DIURETIC IV THERAPY|
20|FH_F150559_60018_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120844_66061_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42195_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.80|99|0.00|OP SVCS|
20|FH_F97882_32407_0|SrvcGrp|73559|2022|PDM|7662.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F44772_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71667_0_0|SrvcGrp|13778|2022|PDM|754.00|99|0.00|PSYCH/CD|
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97141_93933_0|SrvcGrp|73656|2022|PDM|814.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F100740_15206_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F130652_51101_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F141870_85224_0|SrvcGrp|17013|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F102561_75146_0|SrvcGrp|73606|2022|PDM|900.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F92676_15063_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AETNA OP LABORATORY|
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_F43027_0_0|SrvcGrp|33164|2022|PDM|250.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F133287_40215_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F126666_44053_0|SrvcGrp|86645|2022|PDM|68.00|99|0.00|AETNA PSYTX PT & FAM 45 MINS (MOD TD)|
20|FH_F39721_0_0|SrvcGrp|21814|2022|PDM|210.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F89011_75006_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F118034_60645_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149940_02645_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F87592_85614_0|SrvcGrp|73806|2022|PDM|700.00|99|0.00|AETNA ER|
20|FH_F56793_0_0|SrvcGrp|28933|2022|PCT|1.00|99|0.00|OCN F/S PRICING:  (A & K CODES ONLY)|
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|AEG 8 (NO REV)|
20|FH_F123085_21921_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F125570_66104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127197_23111_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40895_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ASC- GH|
20|FH_F112886_34109_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F114310_0_0|SrvcGrp|34606|2022|PDM|3200.00|99|0.00|CPT 29827|
20|FH_F148599_98034_0|CSTM-ALL|CSTM-00|2020|PCT|2.47|99|0.00|HSS APC A PROCEDURE NOT ON FS OR W/O WEIGHT|
20|FH_F124608_0_0|SrvcGrp|93432|2022|PDM|8160.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F115289_90057_0|SrvcGrp|46903|2022|PDM|500.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F38700_0_0|SrvcGrp|18140|2022|PCT|0.80|99|0.00|MS DRG 246|
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|1071.00|99|0.00|AEG 6 (NO REV)|
20|FH_F142770_51546_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148662_01583_0|SrvcGrp|473|2022|PDM|435.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F150532_16801_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97181_33143_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F44855_0_0|SrvcGrp|30197|2022|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F148899_44041_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142067_45211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117717_68410_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|316.70|99|0.00|ASPG 109|
20|FH_F123085_21921_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F130573_02882_0|SrvcGrp|48398|2022|PDM|120.00|99|0.00|PT SERVICES|
20|FH_F113288_38104_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ADOLESCENT PSYCH PARTIAL HOSP|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|384.47|99|0.00|HAPA WPA-NWPA 2012-13 ASC 106 W/O REV|
20|FH_F71323_68114_0|CSTM-ALL|CSTM-00|2020|PDM|2791.00|99|0.00|MS DRG 133-134 ONLY|
20|FH_F51059_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F47857_0_0|SrvcGrp|68510|2022|PDM|130.00|99|0.00|CD - EVENING HOSPITALIZATION|
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 1 (NO REV)|
20|FH_F142759_15074_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F115391_63123_0|SrvcGrp|48382|2022|PDM|70.00|99|0.00|CPT 92507|
20|FH_F141802_17042_0|SrvcGrp|109057|2022|PCT|0.68|99|0.00|CARDIAC STUDIES|
20|FH_F37562_0_0|SrvcGrp|22387|2022|PDM|58.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F144769_0_0|SrvcGrp|11000|2022|PCT|0.21|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F103281_32086_0|SrvcGrp|89939|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F120390_91316_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F45977_0_0|SrvcGrp|11069|2022|PDM|100.00|99|0.00|OT SVCS|
20|FH_F39410_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS|
20|FH_F133271_72204_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37640_0_0|CSTM-ALL|CSTM-00|2020|PDM|579.00|99|0.00|ASPG III|
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 1 (NO REV)|
20|FH_F50974_0_0|SrvcGrp|14892|2022|PDM|95.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F73304_0_0|SrvcGrp|41563|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F148867_20191_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F102200_06416_0|SrvcGrp|86834|2022|PDM|15.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F105145_75075_0|SrvcGrp|77021|2022|PDM|10450.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F105361_80104_0|SrvcGrp|3208|2022|PDM|1742.00|99|0.00|SUBACUTE CARE|
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_F146654_80524_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F146672_47424_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F127656_06068_0|SrvcGrp|95660|2022|PDM|706.65|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F131698_01862_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F133590_33064_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133581_84790_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 10 (NO REV)|
20|FH_F132671_60123_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133494_90023_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F131430_17566_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F111823_32539_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F46433_0_0|SrvcGrp|22588|2022|PDM|80.00|99|0.00|CHEMOTHERAPY|
20|FH_F134087_0_0|SrvcGrp|89980|2022|PDM|5332.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F134087_0_0|SrvcGrp|85792|2022|PDM|4668.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F133536_0_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F133536_0_0|SrvcGrp|104739|2022|PDM|3000.00|99|0.00|REPAIR OF  TENDON(S)|
20|FH_F133536_0_0|SrvcGrp|72120|2022|PDM|1149.00|99|0.00|TENOTOMY|
20|FH_F100161_17325_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F77625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120635_22903_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F73731_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66569_0_0|SrvcGrp|47225|2022|PDM|85.00|99|0.00|OT RC434, CPT97003-97004|
20|FH_F79429_0_0|CSTM-ALL|CSTM-00|2020|PDM|20.59|99|0.00|VACCINE|
20|FH_F39825_0_0|SrvcGrp|31339|2022|PCT|0.85|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F41803_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42244_0_0|SrvcGrp|24703|2022|PDM|260.00|99|0.00|NEWBORN NURSERY|
20|FH_F42942_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F48295_0_0|SrvcGrp|44425|2022|PDM|85.00|99|0.00|NURSING CARE (VISIT LVL)|
20|FH_F54552_0_0|SrvcGrp|28638|2022|PDM|21.66|99|0.00|HOME INFUSION THERAPY (MOD SJ)|
20|FH_F138936_01040_0|SrvcGrp|113560|2022|PDM|1854.00|99|0.00|OBSERVATION W/ ER|
20|FH_F138685_18017_0|SrvcGrp|73842|2022|PDM|177.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F73204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89580_0_0|SrvcGrp|23585|2022|PCT|0.46|99|0.00|IMPLANTS|
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|2350.26|99|0.00|AEG 7 (NO REV)|
20|FH_F88893_0_0|SrvcGrp|81904|2022|PDM|1836.00|99|0.00|LAP PARASOPHAG HERNIA REPAIR|
20|FH_F101388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|GENERAL ACUTE CARE|
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|375.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F117715_0_0|SrvcGrp|75479|2022|PDM|572.00|99|0.00|AEG 1|
20|FH_F143832_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|176.79|99|0.00|HAPA WPA-NWPA 2012-13 ASC 131 W/O REV|
20|FH_F91933_0_0|SrvcGrp|8950|2022|PDM|1400.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F113527_31023_0|SrvcGrp|75489|2022|PCT|0.80|99|0.00|AEG 6|
20|FH_F151425_19111_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F123184_20906_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135495_33145_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135572_89106_0|SrvcGrp|112551|2022|PCT|1.00|99|0.00|ALL OUTPATIENT DRUGS (C, J, Q & S CODES)|
20|FH_F135951_34711_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F100852_61068_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F116501_17801_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F140629_0_0|SrvcGrp|111804|2022|PDM|1016.00|99|0.00|CYSTOSCOPY & REVISE URETHRA|
20|FH_F65959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|GENERAL ACUTE CARE|
20|FH_F111301_33122_0|SrvcGrp|111184|2022|PDM|7104.00|99|0.00|GASTRIC SLEEVE WITH HERNIA REPAIR|
20|FH_F40838_0_0|SrvcGrp|439|2022|PDM|1300.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F43801_0_0|CSTM-ALL|CSTM-00|2020|PDM|847.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132328_0_0|SrvcGrp|71666|2022|PDM|4138.00|99|0.00|CPT 63655|
20|FH_F87557_33309_0|SrvcGrp|21920|2022|PDM|30.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F87557_33309_0|SrvcGrp|86843|2022|PDM|25.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F127713_30012_0|SrvcGrp|48394|2022|PDM|65.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F102282_06795_0|SrvcGrp|48396|2022|PDM|103.74|99|0.00|OT SERVICES|
20|FH_F102862_30606_0|SrvcGrp|80839|2022|PDM|8983.80|99|0.00|MSDRG 520 ONLY|
20|FH_F129220_18445_0|SrvcGrp|91390|2022|PDM|213.00|99|0.00|AETNA PSYCH DIAG EVAL W/MED (MOD AF)|
20|FH_F151204_24073_0|SrvcGrp|74668|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121404_32216_0|SrvcGrp|51585|2022|PDM|516.00|99|0.00|CONTINUOUS AIRWAY PRESSURE|
20|FH_F33744_0_0|SrvcGrp|38|2022|PDM|3498.00|99|0.00|NORMAL DELIVERY|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1412.12|99|0.00|DELAWARE VALLEY- ASC 902|
20|FH_F97780_43614_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F109627_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|950.00|99|0.00|AEG 4 (NO REV)|
20|FH_F111925_0_0|SrvcGrp|104562|2022|PDM|1602.00|99|0.00|AETNA ENCIRCLING MATERIAL|
20|FH_F131412_0_0|SrvcGrp|104230|2022|PDM|165.42|99|0.00|RESPITE CARE (HCFA)|
20|FH_F143898_0_0|SrvcGrp|104230|2022|PDM|160.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F94786_07974_0|SrvcGrp|86843|2022|PDM|52.50|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F132627_0_0|SrvcGrp|29076|2022|PDM|80.58|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F132988_0_0|SrvcGrp|112167|2022|PDM|6196.43|99|0.00|REPAIR ELBOW FRACTURE|
20|FH_F43612_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F114389_50131_0|SrvcGrp|86844|2022|PDM|130.65|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|ASPG III|
20|FH_F119266_0_0|SrvcGrp|108041|2022|PDM|500.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F146991_80918_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F43832_0_0|SrvcGrp|47622|2022|PDM|152.00|99|0.00|ENTEROSTOMAL THERAPY|
20|FH_F34938_0_0|SrvcGrp|17624|2022|PCT|0.75|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_F42363_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100703_0_0|SrvcGrp|44461|2022|PDM|8034.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F124246_71655_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132592_68305_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|GENERAL ACUTE CARE|
20|FH_F90653_0_0|SrvcGrp|58764|2022|PCT|0.70|99|0.00|PHYSICIANS FEES|
20|FH_F124407_0_0|CSTM-ALL|CSTM-00|2020|PDM|503.00|99|0.00|AEG 2 (NO REV)|
20|FH_F50976_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS|
20|FH_F150763_0_0|SrvcGrp|107744|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F148424_01440_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117069_15236_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F134791_98034_0|SrvcGrp|88620|2022|PDM|307.00|99|0.00|SKILLED NURSING RN|
20|FH_F134815_35016_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135719_45502_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|OP SVCS|
20|FH_F135722_33461_0|SrvcGrp|73842|2022|PDM|145.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F112371_19047_0|SrvcGrp|73806|2022|PDM|645.00|99|0.00|AETNA ER|
20|FH_F141170_0_0|SrvcGrp|103588|2022|PDM|6000.00|99|0.00|CAROTID/INOM ART|
20|FH_F141170_0_0|SrvcGrp|92408|2022|PDM|4880.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F115625_63110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115728_78404_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F116339_41064_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F147305_90755_0|SrvcGrp|66264|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F147520_61614_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F41798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F42024_0_0|SrvcGrp|9795|2022|PDM|960.00|99|0.00|SUBACUTE REHAB|
20|FH_F42522_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F139707_84010_0|SrvcGrp|116280|2022|PDM|5165.00|99|0.00|ORTHOPEDIC/PODIATRY|
20|FH_F126116_0_0|SrvcGrp|108191|2022|PDM|2311.00|99|0.00|ILIAC REVASC|
20|FH_F132039_92008_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F114416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120157_93103_0|SrvcGrp|105350|2022|PDM|475.00|99|0.00|AETNA PARTIAL HOSPITALIZATION|
20|FH_F117617_80439_0|SrvcGrp|107588|2022|PDM|165.00|99|0.00|HOSPICE CARE PROV NURSING LTC FAC|
20|FH_F97100_23462_0|SrvcGrp|73643|2022|PDM|944.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES|
20|FH_F84532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147167_75605_0|SrvcGrp|74668|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F37493_0_0|CSTM-ALL|CSTM-00|2020|PDM|2099.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F132235_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F110732_31513_0|SrvcGrp|74605|2022|PDM|503.00|99|0.00|AETNA INITIAL PSYCH EVALUATION|
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.57|99|0.00|ASPG II|
20|FH_F149160_02180_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F124291_44122_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F124465_84123_0|SrvcGrp|73842|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F97420_75052_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113869_40215_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F148667_0_0|SrvcGrp|67065|2022|PDM|7918.00|99|0.00|CERVICAL SURGERY|
20|FH_F40627_0_0|CSTM-ALL|CSTM-00|2020|PDM|926.00|99|0.00|MULTIPLE BIRTH|
20|FH_F39443_0_0|SrvcGrp|30351|2022|PDM|203.00|99|0.00|HAPA WPA ASC 307|
20|FH_F35369_0_0|SrvcGrp|19768|2022|PDM|4000.00|99|0.00|SHORT STAY SURGICAL|
20|FH_F148667_0_0|SrvcGrp|92010|2022|PDM|1118.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE|
20|FH_F122425_75082_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)|
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_F147213_48609_0|SrvcGrp|42623|2022|PDM|539.00|99|0.00|SUBACUTE - LEVEL III|
20|FH_F146266_0_0|SrvcGrp|90063|2022|PDM|5425.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F150313_78666_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F111266_30339_0|SrvcGrp|24753|2022|PDM|10.00|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F139970_16142_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116437_0_0|SrvcGrp|84121|2022|PCT|1.10|99|0.00|OCULAR IMPLANTS|
20|FH_F136541_0_0|SrvcGrp|111932|2022|PDM|51.31|99|0.00|COVID-19 NON-CDC TESTING LAB|
20|FH_F149609_78624_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146859_0_0|SrvcGrp|114853|2022|PDM|2046.00|99|0.00|MCP JOINT ARTHROSCOPY|
20|FH_F137767_01841_0|SrvcGrp|113131|2022|PCT|2.25|99|0.00|LABORATORY SERVICES|
20|FH_F115982_0_0|SrvcGrp|85778|2022|PDM|1750.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|1769.00|99|0.00|AEG 5  (NO REV)|
20|FH_F111266_30339_0|SrvcGrp|86831|2022|PDM|3.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F140093_33467_0|SrvcGrp|89337|2022|PDM|1030.00|99|0.00|DETOXIFICATION|
20|FH_F125695_52033_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43244_0_0|SrvcGrp|40820|2022|PDM|1200.00|99|0.00|ICU/CCU|
20|FH_F108680_0_0|SrvcGrp|67065|2022|PDM|12100.00|99|0.00|CERVICAL SURGERY|
20|FH_F149662_85015_0|SrvcGrp|131|2022|PCT|0.29|99|0.00|PACEMAKER DEVICE|
20|FH_F111266_30339_0|SrvcGrp|86779|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F35416_0_0|SrvcGrp|941|2022|PDM|3960.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97480_08204_0|SrvcGrp|73461|2022|PDM|12199.00|99|0.00|AETNA NICU IV|
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151043_71901_0|SrvcGrp|73485|2022|PDM|475.00|99|0.00|AETNA REHAB|
20|FH_F128191_28642_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F101844_0_0|SrvcGrp|89856|2022|PDM|8943.00|99|0.00|LAMIN EXCIS EXTRADURAL LUMB|
20|FH_F139755_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|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_F34918_0_0|SrvcGrp|177|2022|PDM|2815.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F108080_77081_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97620_75904_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|1444.59|99|0.00|ASPG VII|
20|FH_F110963_30535_0|SrvcGrp|27968|2022|PDM|84.96|99|0.00|SKILLED NURSING LPN|
20|FH_F138017_73129_0|SrvcGrp|109057|2022|PCT|1.57|99|0.00|CARDIAC STUDIES|
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 3 (NO REV)|
20|FH_F35798_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F35384_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F128753_32501_0|SrvcGrp|83677|2022|PCT|0.64|99|0.00|AETNA CARDIAC CATH|
20|FH_F128490_88240_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131498_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F139907_42266_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143347_16001_0|CSTM-ALL|CSTM-00|2020|PDM|4128.00|99|0.00|AEG 8 (NO REV)|
20|FH_F103140_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F101540_0_0|SrvcGrp|471|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F151743_20001_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F47600_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F132436_33144_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116579_45822_0|SrvcGrp|73842|2022|PDM|149.88|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F113649_01752_0|SrvcGrp|86779|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F118845_71111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118792_63379_0|SrvcGrp|75999|2022|PCT|0.00|99|0.00|OP URGENT CARE|
20|FH_F39355_0_0|SrvcGrp|411|2022|PDM|3200.00|99|0.00|OP CARDIAC CATH|
20|FH_F42177_0_0|SrvcGrp|177|2022|PDM|1250.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F111204_10023_0|SrvcGrp|74694|2022|PDM|1308.00|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F100906_0_0|SrvcGrp|97462|2022|PDM|5000.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F104802_0_0|SrvcGrp|33812|2022|PDM|200.00|99|0.00|IOP / MENTAL HEALTH / SUBSTANCE ABUSE|
20|FH_F137951_0_0|SrvcGrp|27315|2022|PDM|3223.00|99|0.00|TENDON REPAIR|
20|FH_F138283_0_0|SrvcGrp|92501|2022|PDM|120.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F148552_68114_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F112853_22408_0|SrvcGrp|53987|2022|PDM|50.00|99|0.00|PHOTOTHERAPY|
20|FH_F135466_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150528_78644_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1405 W/O REV|
20|FH_F43330_0_0|SrvcGrp|11796|2022|PDM|65.00|99|0.00|DIETICIAN|
20|FH_F86293_0_0|SrvcGrp|23585|2022|PCT|0.33|99|0.00|IMPLANTS|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|113.00|99|0.00|FAMILY PSYTX W PT 50 MINS (HCFA)|
20|FH_F38700_0_0|SrvcGrp|360|2022|PDM|1387.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F55375_0_0|SrvcGrp|17073|2022|PDM|4800.00|99|0.00|ASPG V|
20|FH_F124839_71360_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F56793_0_0|SrvcGrp|14948|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F92676_15063_0|SrvcGrp|79038|2022|PDM|735.71|99|0.00|MON VALLEY ASC 230|
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_F142051_06604_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128099_70403_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F101754_63141_0|SrvcGrp|97986|2022|PCT|0.75|99|0.00|HEARING AID SUP/ACCESS/DEV|
20|FH_F141731_92590_0|SrvcGrp|89417|2022|PDM|463.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F111784_32901_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F43164_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F148556_13206_0|SrvcGrp|17007|2022|PDM|50.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS|
20|FH_F148494_0_0|SrvcGrp|114171|2022|PDM|1250.00|99|0.00|STENT PACEMT ANTE COROTID|
20|FH_F89932_10940_0|SrvcGrp|73479|2022|PDM|9240.00|99|0.00|C-SECTION DELIVERY MSDRG 765-766 REPLACEMENT 783-788|
20|FH_F67379_0_0|SrvcGrp|44564|2022|PDM|423.00|99|0.00|NEWBORN NURSERY|
20|FH_F97140_91730_0|SrvcGrp|73461|2022|PDM|7391.00|99|0.00|AETNA NICU IV|
20|FH_F129644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134544_03874_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F120924_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.75|99|0.00|HSS ASC|
20|FH_F126762_91311_0|SrvcGrp|23683|2022|PDM|55.00|99|0.00|SKILLED NURSING RN|
20|FH_F38700_0_0|SrvcGrp|18889|2022|PCT|0.80|99|0.00|MS DRG 235|
20|FH_F35173_0_0|SrvcGrp|24|2022|PDM|3663.00|99|0.00|CARDIAC CATH|
20|FH_F37035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43433_0_0|SrvcGrp|12846|2022|PCT|0.50|99|0.00|PHARMACY SVCS|
20|FH_F113588_0_0|SrvcGrp|12403|2022|PDM|306.05|99|0.00|CONTINUOUS HOMECARE|
20|FH_F130066_84107_0|SrvcGrp|89337|2022|PDM|850.00|99|0.00|DETOXIFICATION|
20|FH_F129130_92562_0|SrvcGrp|73601|2022|PDM|5405.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F139667_84078_0|SrvcGrp|106927|2022|PDM|93.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F150679_32534_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147166_03444_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F98623_97006_0|SrvcGrp|73659|2022|PDM|13974.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F84833_17109_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F86714_0_0|SrvcGrp|34865|2022|PDM|76.42|99|0.00|HOME HEALTH AIDE|
20|FH_F149022_25271_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149030_37919_0|CSTM-ALL|CSTM-00|2020|PDM|4480.50|99|0.00|AEG 9 (NO REV)|
20|FH_F127291_86426_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131532_46952_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138018_17313_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F139576_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F47659_0_0|SrvcGrp|16|2022|PCT|0.80|99|0.00|ACUTE REHABILITATION|
20|FH_F120154_77498_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 10 (NO REV)|
20|FH_F114206_37203_0|SrvcGrp|17015|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116583_0_0|SrvcGrp|80920|2022|PDM|650.00|99|0.00|HOSPICE SERVICES|
20|FH_F124441_0_0|SrvcGrp|67065|2022|PDM|11400.00|99|0.00|CERVICAL SURGERY|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SAINT ALEXIUS FH MOD AW|
20|FH_F97183_25304_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F124270_46256_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|1687.00|99|0.00|AEG 9 (NO REV)|
20|FH_F123745_0_0|SrvcGrp|97741|2022|PDM|16500.00|99|0.00|REVISE KNEE|
20|FH_F39443_0_0|SrvcGrp|30300|2022|PDM|239.00|99|0.00|HAPA WPA ASC 112|
20|FH_F36036_0_0|SrvcGrp|10764|2022|PDM|75.00|99|0.00|CPT CODE 93226|
20|FH_F129966_18017_0|SrvcGrp|104187|2022|PDM|5.00|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F110193_70444_0|SrvcGrp|86722|2022|PDM|233.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F35458_0_0|SrvcGrp|12852|2022|PDM|1750.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F141155_34952_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F128197_84123_0|SrvcGrp|29346|2022|PDM|36.50|99|0.00|SKILLED NURSING- LPN|
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 5  (NO REV)|
20|FH_F147343_17011_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133087_61107_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145920_0_0|SrvcGrp|74670|2022|PCT|1.00|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F150921_21620_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110804_11373_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F109515_15301_0|SrvcGrp|73485|2022|PDM|1273.00|99|0.00|AETNA REHAB|
20|FH_F114308_70601_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F150953_74953_0|SrvcGrp|10363|2022|PDM|506.00|99|0.00|CPT CODE 99283|
20|FH_F120154_77498_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F117762_0_0|SrvcGrp|88599|2022|PDM|3120.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F49300_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE|
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|TRAUMA CARE|
20|FH_F140295_0_0|SrvcGrp|100043|2022|PDM|3785.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F142370_0_0|SrvcGrp|113544|2022|PDM|41.38|99|0.00|COVID-19 SARS-COV-2 W/ OPTIC|
20|FH_F150925_33936_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F139147_0_0|SrvcGrp|78283|2022|PDM|5305.00|99|0.00|CPT 49505|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|507.00|99|0.00|HAPA EPA ASC 53|
20|FH_F41802_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALTERNACARE INF THERAPY|
20|FH_F40590_0_0|SrvcGrp|248|2022|PDM|1081.00|99|0.00|PEDIATRIC REHABILITATION|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OP SVCS (CMS 1500)|
20|FH_F124703_65711_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F133140_0_0|SrvcGrp|14614|2022|PDM|2300.00|99|0.00|LITHOTRIPSY|
20|FH_F117615_30525_0|SrvcGrp|75506|2022|PCT|0.85|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F35416_0_0|SrvcGrp|38285|2022|PCT|1.00|99|0.00|PROTON ACCELERATOR|
20|FH_F141287_14830_0|SrvcGrp|113465|2022|PCT|1.10|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F101441_0_0|SrvcGrp|44461|2022|PDM|8105.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F120104_97223_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112746_33844_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151699_01752_0|SrvcGrp|86779|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F138016_19808_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F124441_0_0|SrvcGrp|84307|2022|PDM|3040.00|99|0.00|TENDON REPAIR|
20|FH_F37444_0_0|SrvcGrp|16619|2022|PCT|0.72|99|0.00|OT SVCS|
20|FH_F114825_32789_0|SrvcGrp|73842|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC|
20|FH_F138018_17313_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F37104_0_0|SrvcGrp|23449|2022|PCT|1.00|99|0.00|SUPPLIES|
20|FH_F97623_38008_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F97603_77901_0|SrvcGrp|88977|2022|PDM|5424.00|99|0.00|C-SECTION DELIVERY|
20|FH_F150441_76132_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36343_0_0|SrvcGrp|10564|2022|PDM|106.25|99|0.00|HOME INFUSION|
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|849.00|99|0.00|AEG 6 (NO REV)|
20|FH_F149602_07109_0|SrvcGrp|113226|2022|PDM|42.28|99|0.00|COVID-19 SVNT SARSCOV2 ELISA PLSM SRM|
20|FH_F92677_08003_0|SrvcGrp|86837|2022|PDM|210.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F132279_63775_0|SrvcGrp|104363|2022|PCT|0.50|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F42452_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F126626_80906_0|SrvcGrp|86722|2022|PDM|271.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F133490_90650_0|SrvcGrp|103913|2022|PCT|0.00|99|0.00|OP DIALYSIS|
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 4 (NO REV)|
20|FH_F41456_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|1356.00|99|0.00|AEG 4 (NO REV)|
20|FH_F92676_15063_0|SrvcGrp|14242|2022|PDM|765.00|99|0.00|EMERGENCY ROOM SVCS LEVEL IV|
20|FH_F142991_43920_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F102561_75146_0|SrvcGrp|73488|2022|PCT|1.50|99|0.00|AETNA HOSPITAL OP DIALYSIS|
20|FH_F141870_85224_0|SrvcGrp|86840|2022|PDM|40.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F142931_60644_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F34706_0_0|SrvcGrp|11839|2022|PDM|4845.00|99|0.00|DRG 311 TRNSURETHRL PRC W/O CC|
20|FH_F111809_93003_0|SrvcGrp|10364|2022|PDM|6929.00|99|0.00|CPT CODE 99284|
20|FH_F142776_65338_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133396_72301_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133490_90650_0|CSTM-ALL|CSTM-00|2020|PDM|5555.00|99|0.00|AEG 8 (NO REV)|
20|FH_F67683_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC|
20|FH_F35454_0_0|SrvcGrp|16854|2022|PDM|10.00|99|0.00|PPD TEST|
20|FH_F128492_49010_0|SrvcGrp|29155|2022|PDM|130.00|99|0.00|HOSPICE SVCS|
20|FH_F148021_80907_0|SrvcGrp|73524|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY|
20|FH_F137240_0_0|SrvcGrp|14320|2022|PCT|0.59|99|0.00|OP IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F97141_93933_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126806_44125_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149979_15701_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F40297_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1083.00|99|0.00|AEG 4 (NO REV)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|528.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 11 W/O REV|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|212.24|99|0.00|HAPA WPA-NWPA 2012-13 ASC 312 W/O REV|
20|FH_F39716_0_0|SrvcGrp|16684|2022|PCT|1.00|99|0.00|DRUGS|
20|FH_F143190_46168_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F128390_0_0|SrvcGrp|80918|2022|PDM|125.00|99|0.00|RESPITE CARE|
20|FH_F101853_77840_0|SrvcGrp|43523|2022|PDM|185.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F57592_0_0|SrvcGrp|24598|2022|PDM|2250.00|99|0.00|MS DRG 945-946 ONLY|
20|FH_F41547_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PATHOLOGY|
20|FH_F42807_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F37641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1520.00|99|0.00|ASPG X|
20|FH_F64940_0_0|SrvcGrp|12157|2022|PDM|93.50|99|0.00|RN VISIT|
20|FH_F136751_0_0|SrvcGrp|88159|2022|PDM|9500.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F141728_71203_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F34706_0_0|SrvcGrp|63|2022|PDM|773.00|99|0.00|SUBACUTE CARE|
20|FH_F133530_11237_0|SrvcGrp|112128|2022|PCT|1.50|99|0.00|CAT SCAN|
20|FH_F69063_0_0|SrvcGrp|30609|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128120_76513_0|SrvcGrp|89337|2022|PDM|815.00|99|0.00|DETOXIFICATION|
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1115.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F129535_0_0|SrvcGrp|109800|2022|PDM|725.00|99|0.00|REPAIR ANAL FISTULA|
20|FH_F50237_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F91080_67212_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F144020_15401_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS|
20|FH_F90811_0_0|SrvcGrp|90423|2022|PDM|3500.00|99|0.00|FUSION GRAFT OF WRIST JOINT|
20|FH_F38865_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117891_19034_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150525_16056_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120803_38606_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F127422_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_F92676_15063_0|SrvcGrp|79036|2022|PDM|748.15|99|0.00|MON VALLEY ASC 121|
20|FH_F108700_63857_0|SrvcGrp|102739|2022|PDM|10.00|99|0.00|PRIVATE DUTY/INDEP NURSE SVC|
20|FH_F55113_0_0|SrvcGrp|9774|2022|PDM|2250.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F42807_0_0|SrvcGrp|12280|2022|PCT|0.75|99|0.00|IMPLANTS|
20|FH_F97041_71603_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|499.57|99|0.00|ASPG 405|
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|290.00|99|0.00|CHEMICAL DEPENDENCY|
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_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1229.21|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1404 W/O REV|
20|FH_F126672_0_0|SrvcGrp|104003|2022|PDM|2607.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES|
20|FH_F118476_17815_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148644_06890_0|SrvcGrp|27347|2022|PDM|3756.00|99|0.00|CPT 58558|
20|FH_F151060_02493_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151140_33134_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F151144_35801_0|SrvcGrp|95819|2022|PDM|1626.00|99|0.00|GONIOTOMY|
20|FH_F151155_26508_0|SrvcGrp|69072|2022|PDM|265.00|99|0.00|CPT 99205|
20|FH_F90362_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|789.00|99|0.00|AEG 5  (NO REV)|
20|FH_F94621_07728_0|SrvcGrp|471|2022|PDM|530.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F140137_15235_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F62713_0_0|SrvcGrp|22954|2022|PDM|135.11|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F101709_0_0|SrvcGrp|112026|2022|PDM|8441.00|99|0.00|TOTAL KNEE ARTHROPLASTY|
20|FH_F101709_0_0|SrvcGrp|72994|2022|PDM|2130.00|99|0.00|AEG 3|
20|FH_F101709_0_0|SrvcGrp|73008|2022|PDM|1261.00|99|0.00|AEG 10|
20|FH_F102224_0_0|SrvcGrp|88739|2022|PDM|4000.00|99|0.00|IMPLANT SPINAL CANAL|
20|FH_F131107_43140_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F131173_17043_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F120191_91360_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132414_30571_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F116915_30308_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F120887_78750_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120974_27607_0|SrvcGrp|74586|2022|PCT|0.46|99|0.00|AETNA OP HIGH COST DRUGS|
20|FH_F125287_92374_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113563_70560_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 5  (NO REV)|
20|FH_F118874_29926_0|SrvcGrp|89337|2022|PDM|1000.00|99|0.00|DETOXIFICATION|
20|FH_F118792_63379_0|SrvcGrp|106811|2022|PCT|0.00|99|0.00|IP DETOXIFICATION|
20|FH_F39028_0_0|SrvcGrp|25350|2022|PCT|1.00|99|0.00|ALL VALID CODES W/ 26 MOD|
20|FH_F33925_0_0|SrvcGrp|18247|2022|PDM|4730.00|99|0.00|MS DRG 286|
20|FH_F38411_0_0|SrvcGrp|18283|2022|PCT|0.80|99|0.00|MS DRG 461|
20|FH_F105593_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135840_0_0|SrvcGrp|87187|2022|PDM|550.00|99|0.00|CPT 43259|
20|FH_F130656_04401_0|SrvcGrp|114504|2022|PCT|4.24|99|0.00|LABORATORY SERVICES|
20|FH_F130658_44484_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 9 (NO REV)|
20|FH_F119657_39111_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PDM|1011.00|99|0.00|AEG 5  (NO REV)|
20|FH_F125513_40071_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F82671_0_0|SrvcGrp|66563|2022|PDM|1362.00|99|0.00|COVENTRY ENHANCED DEFAULT 10021-69990 WITH REV CODE|
20|FH_F41401_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|GENERAL ACUTE CARE|
20|FH_F146117_0_0|SrvcGrp|93433|2022|PDM|3118.00|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F69708_0_0|SrvcGrp|26253|2022|PDM|118.00|99|0.00|LIPIDS|
20|FH_F148644_06890_0|CSTM-ALL|CSTM-00|2020|PDM|1904.00|99|0.00|AEG 10 (NO REV)|
20|FH_F143742_60410_0|SrvcGrp|3178|2022|PDM|969.00|99|0.00|ACUTE PSYCH|
20|FH_F133972_27103_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F109267_12202_0|SrvcGrp|73842|2022|PDM|85.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114525_72401_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F134593_60007_0|SrvcGrp|16750|2022|PDM|68.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F110580_71106_0|SrvcGrp|85977|2022|PDM|680.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F127090_45601_0|SrvcGrp|28630|2022|PDM|101.00|99|0.00|HOME INFUSION SKILLED NURSING|
20|FH_F145642_15108_0|SrvcGrp|86849|2022|PDM|30.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F125328_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1041.70|99|0.00|HAPA WPA-NWPA 2012-13 ASC 704 W/O REV|
20|FH_F132969_84003_0|SrvcGrp|86839|2022|PDM|25.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F85995_64111_0|SrvcGrp|73700|2022|PDM|68.01|99|0.00|AETNA - SKILLED NURSING|
20|FH_F146064_17331_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145642_15108_0|SrvcGrp|17014|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F117831_0_0|SrvcGrp|35669|2022|PDM|6375.00|99|0.00|CPT 63650|
20|FH_F71523_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F132969_84003_0|SrvcGrp|86835|2022|PDM|10.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F145759_18452_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F83995_16748_0|SrvcGrp|30502|2022|PCT|0.82|99|0.00|PT/OT/ST|
20|FH_F114407_19002_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F90416_73013_0|SrvcGrp|46605|2022|PDM|105.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F73228_0_0|SrvcGrp|17069|2022|PDM|3516.00|99|0.00|ASPG III|
20|FH_F122930_0_0|SrvcGrp|38907|2022|PDM|3274.00|99|0.00|CPT 66170 - FISTULIZATION OF SCLERA FOR GLAUCOMA|
20|FH_F126341_27284_0|SrvcGrp|17013|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129509_0_0|SrvcGrp|73008|2022|PDM|959.00|99|0.00|AEG 10|
20|FH_F79763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126089_62420_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133869_19947_0|SrvcGrp|89337|2022|PDM|927.00|99|0.00|DETOXIFICATION|
20|FH_F119227_01752_0|SrvcGrp|92097|2022|PDM|750.00|99|0.00|AETNA HOME VENT NON-INVASIVE INTERFACE|
20|FH_F83995_16748_0|SrvcGrp|82624|2022|PDM|740.00|99|0.00|ER SETTING W/ OP SURGERY LEVEL III|
20|FH_F35966_0_0|SrvcGrp|16897|2022|PDM|415.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F132802_68022_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F146207_73139_0|SrvcGrp|82222|2022|PDM|134.00|99|0.00|HOSPICE CARE|
20|FH_F87775_15106_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F67180_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1428.00|99|0.00|AEG 9 (NO REV)|
20|FH_F127918_45640_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139727_66035_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121700_60938_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F118123_67226_0|SrvcGrp|29023|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F143571_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150165_06032_0|SrvcGrp|113888|2022|PDM|1625.00|99|0.00|SURGERY FOR VULVA LESION|
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SERVICES|
20|FH_F38568_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89912_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.70|99|0.00|OP SVCS|
20|FH_F40347_0_0|SrvcGrp|9774|2022|PDM|2000.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F118152_20151_0|SrvcGrp|86837|2022|PDM|15.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F118232_24970_0|SrvcGrp|74403|2022|PCT|0.79|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F134011_84102_0|SrvcGrp|26868|2022|PDM|25.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F134011_84102_0|SrvcGrp|88621|2022|PDM|73.00|99|0.00|SKILLED NURSING LPN|
20|FH_F134126_11554_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F137127_72761_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137147_75006_0|SrvcGrp|21122|2022|PDM|66872.00|99|0.00|MS DRG 459 ONLY|
20|FH_F138627_82901_0|SrvcGrp|86832|2022|PDM|12.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F132733_0_0|SrvcGrp|941|2022|PDM|4250.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F140567_46350_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F140569_46975_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F140615_73013_0|CSTM-ALL|CSTM-00|2020|PDM|1984.00|99|0.00|AEG 4 (NO REV)|
20|FH_F140616_43338_0|SrvcGrp|111929|2022|PCT|1.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F140688_98405_0|SrvcGrp|74579|2022|PCT|0.95|99|0.00|TRAUMA SERVICES|
20|FH_F120152_0_0|SrvcGrp|110955|2022|PDM|1.22|99|0.00|INJ BUPIVACAINE LIPOSOME (HCFA)|
20|FH_F151603_27609_0|SrvcGrp|67279|2022|PDM|17379.00|99|0.00|CERVICAL SURGERY|
20|FH_F109883_35007_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F52832_0_0|SrvcGrp|68140|2022|PDM|90.00|99|0.00|HOME HEALTH AID|
20|FH_F147901_95008_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129483_77030_0|SrvcGrp|86832|2022|PDM|5.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F129524_48104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|RADIOLOGY W/MOD 26|
20|FH_F117102_39355_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137973_24457_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F51254_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F109652_0_0|SrvcGrp|101719|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F109652_0_0|SrvcGrp|4109|2022|PDM|1055.00|99|0.00|ACUTE PSYCH|
20|FH_F109821_0_0|SrvcGrp|102259|2022|PDM|2550.00|99|0.00|AETNA INSERTION OF HEART ELECTRODE|
20|FH_F91572_30076_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|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_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1298.00|99|0.00|AEG 7 (NO REV)|
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|2597.00|99|0.00|ASPG IX|
20|FH_F42921_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.60|99|0.00|OP SVCS|
20|FH_F142454_0_0|SrvcGrp|95819|2022|PDM|6200.00|99|0.00|GONIOTOMY|
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|AEG 3 (NO REV)|
20|FH_F36676_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|DME MOD TC|
20|FH_F49895_0_0|SrvcGrp|32388|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKE (DME)|
20|FH_F50715_0_0|SrvcGrp|12403|2022|PDM|32.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F50715_0_0|SrvcGrp|3809|2022|PDM|600.00|99|0.00|HOSPICE CARE|
20|FH_F60273_0_0|SrvcGrp|56464|2022|PDM|8379.00|99|0.00|CPT 55873|
20|FH_F97440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F139515_0_0|SrvcGrp|67069|2022|PDM|16995.00|99|0.00|CPT 22634|
20|FH_F36006_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120215_92064_0|SrvcGrp|87131|2022|PDM|411.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F115967_60123_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F78852_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89453_75069_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F150026_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F38591_0_0|SrvcGrp|11663|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F129334_43016_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128982_44221_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F121084_13114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145800_22003_0|SrvcGrp|23683|2022|PDM|42.00|99|0.00|SKILLED NURSING RN|
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|1596.85|99|0.00|AEG 10 (NO REV)|
20|FH_F145544_93536_0|SrvcGrp|74668|2022|PDM|500.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|1772.00|99|0.00|AEG 8 (NO REV)|
20|FH_F131228_01826_0|CSTM-ALL|CSTM-00|2020|PDM|4812.93|99|0.00|AEG 5  (NO REV)|
20|FH_F34403_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F98920_46526_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|721.00|99|0.00|AEG 1 (NO REV)|
20|FH_F116311_02657_0|CSTM-ALL|CSTM-00|2020|PDM|792.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F140427_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|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_F92091_0_0|SrvcGrp|73004|2022|PDM|2062.00|99|0.00|AEG 8|
20|FH_F82955_34266_0|SrvcGrp|73488|2022|PCT|0.00|99|0.00|AETNA HOSPITAL OP DIALYSIS|
20|FH_F39041_0_0|SrvcGrp|13236|2022|PDM|2736.00|99|0.00|ICU/CCU|
20|FH_F121533_26241_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40416_0_0|SrvcGrp|97|2022|PDM|3662.00|99|0.00|C-SECTION|
20|FH_F145536_90265_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F135235_01830_0|SrvcGrp|87317|2022|PDM|1199.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F65182_0_0|SrvcGrp|49862|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53|
20|FH_F38341_0_0|SrvcGrp|28847|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY|
20|FH_F38392_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|FLORIDA GLOBAL CT CARVEOUT CODES|
20|FH_F52854_0_0|SrvcGrp|17073|2022|PDM|1843.00|99|0.00|ASPG V|
20|FH_F58396_0_0|SrvcGrp|17139|2022|PDM|803.00|99|0.00|HOSPICE CARE|
20|FH_F127651_44124_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F114444_19602_0|SrvcGrp|105371|2022|PDM|100.00|99|0.00|PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 1 (NO REV)|
20|FH_F95623_84015_0|SrvcGrp|27969|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132938_33710_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118123_67226_0|SrvcGrp|73742|2022|PDM|3.50|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F127199_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F138056_64055_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F83380_0_0|SrvcGrp|43268|2022|PDM|120.00|99|0.00|PICC LINE CATH CARE|
20|FH_F143567_62207_0|SrvcGrp|44042|2022|PDM|88.43|99|0.00|SKILLED NURSING - LPN|
20|FH_F114409_18447_0|SrvcGrp|46605|2022|PDM|152.25|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F43861_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F133753_84015_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F121225_98902_0|SrvcGrp|73806|2022|PCT|0.85|99|0.00|AETNA ER|
20|FH_F114407_19002_0|SrvcGrp|73701|2022|PDM|26.25|99|0.00|AETNA - SKILLED NURSING|
20|FH_F54592_0_0|SrvcGrp|11258|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F63297_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39776_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47717_0_0|SrvcGrp|33484|2022|PDM|62.00|99|0.00|THERAPY SERVICES|
20|FH_F125036_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|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_F105145_75075_0|SrvcGrp|82720|2022|PDM|6990.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F105361_80104_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F115786_57701_0|SrvcGrp|94882|2022|PDM|13.50|99|0.00|FLU VIRUS VACC-SPLIT 3 YRS & ABOVE|
20|FH_F115865_78621_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F76028_0_0|SrvcGrp|43432|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE HOURLY|
20|FH_F146605_72205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120795_27514_0|SrvcGrp|74581|2022|PCT|0.55|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|1625.00|99|0.00|AEG 2 (NO REV)|
20|FH_F131677_50009_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133478_40165_0|SrvcGrp|19846|2022|PDM|21619.00|99|0.00|MS DRG 249 ONLY|
20|FH_F131212_63017_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F111601_15203_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F134828_30531_0|SrvcGrp|112662|2022|PDM|35.00|99|0.00|XRAY EXAM OF WRIST (HCFA)|
20|FH_F134828_30531_0|SrvcGrp|112673|2022|PDM|34.00|99|0.00|XRAY EXAM OF FOOT (HCFA)|
20|FH_F31872_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36439_0_0|SrvcGrp|23003|2022|PDM|1600.00|99|0.00|V5258|
20|FH_F45832_0_0|SrvcGrp|16058|2022|PCT|0.72|99|0.00|CHEMOTHERAPY/RADIATION|
20|FH_F60273_0_0|SrvcGrp|55084|2022|PDM|3210.48|99|0.00|CPT 52648|
20|FH_F61292_0_0|SrvcGrp|29334|2022|PCT|0.49|99|0.00|EMERGENCY ROOM SRVCS|
20|FH_F43663_0_0|SrvcGrp|16173|2022|PDM|221.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F40043_0_0|SrvcGrp|18241|2022|PDM|5990.00|99|0.00|MS DRG 285|
20|FH_F148352_74637_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F89475_71202_0|CSTM-ALL|CSTM-00|2020|PDM|1369.00|99|0.00|AEG 2 (NO REV)|
20|FH_F88114_32205_0|SrvcGrp|22954|2022|PDM|144.89|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F135077_60014_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114980_78061_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137531_62959_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F111206_63011_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130157_84049_0|SrvcGrp|111348|2022|PCT|1.20|99|0.00|OP THERAPY SERVICES|
20|FH_F126926_32250_0|SrvcGrp|89417|2022|PDM|902.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F56137_0_0|SrvcGrp|45883|2022|PDM|95.00|99|0.00|OT|
20|FH_F33630_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F82173_72712_0|SrvcGrp|10944|2022|PCT|0.77|99|0.00|EMERGENCY ROOM|
20|FH_F148169_33138_0|SrvcGrp|112225|2022|PCT|1.00|99|0.00|COVID-19 SPECIMEN COLLECTION|
20|FH_F62915_0_0|SrvcGrp|42824|2022|PDM|208.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F32366_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77066_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41494_0_0|CSTM-ALL|CSTM-00|2020|PDM|1910.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90691_0_0|SrvcGrp|72992|2022|PDM|504.00|99|0.00|AEG 2|
20|FH_F141410_13045_0|SrvcGrp|75507|2022|PCT|0.87|99|0.00|CHEMOTHERAPY|
20|FH_F97500_32025_0|SrvcGrp|73656|2022|PDM|635.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F129653_0_0|SrvcGrp|72996|2022|PDM|1625.00|99|0.00|AEG 4|
20|FH_F141587_40242_0|SrvcGrp|73841|2022|PDM|379.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F131236_84041_0|SrvcGrp|94780|2022|PDM|93.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F134994_33162_0|SrvcGrp|89417|2022|PDM|419.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F137940_0_0|SrvcGrp|13595|2022|PDM|348.22|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F137460_42103_0|SrvcGrp|89417|2022|PDM|265.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F72842_0_0|SrvcGrp|3458|2022|PCT|0.66|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F110023_33936_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F130452_48801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39917_0_0|SrvcGrp|12043|2022|PDM|230.00|99|0.00|CPT 99205|
20|FH_F66222_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F133207_0_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F31959_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F123293_18087_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F93332_0_0|SrvcGrp|67072|2022|PDM|2295.00|99|0.00|CPT 22845|
20|FH_F32917_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F33712_0_0|SrvcGrp|9511|2022|PCT|0.60|99|0.00|OBSERVATION SVCS|
20|FH_F126489_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F37756_0_0|SrvcGrp|12154|2022|PDM|5513.00|99|0.00|LITHOTRIPSY|
20|FH_F118057_47906_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F141591_92630_0|SrvcGrp|89149|2022|PDM|360.50|99|0.00|OP INTENSIVE|
20|FH_F150462_30458_0|SrvcGrp|24745|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F34496_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.50|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F115740_78957_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F90691_0_0|SrvcGrp|73008|2022|PDM|761.00|99|0.00|AEG 10|
20|FH_F32621_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F63432_0_0|SrvcGrp|47482|2022|PCT|0.76|99|0.00|OP MENTAL HEALTH|
20|FH_F130889_68818_0|SrvcGrp|103913|2022|PCT|0.96|99|0.00|OP DIALYSIS|
20|FH_F93881_15009_0|SrvcGrp|81402|2022|PDM|37.00|99|0.00|METABOLIC PANEL|
20|FH_F125011_74467_0|SrvcGrp|73614|2022|PDM|4400.00|99|0.00|AETNA LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F135311_33146_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141802_17042_0|SrvcGrp|111927|2022|PDM|95.00|99|0.00|COVID-19 NON CDC|
20|FH_F71386_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.40|99|0.00|OP SVCS|
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|688.00|99|0.00|AEG 4 (NO REV)|
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG II|
20|FH_F139515_0_0|SrvcGrp|88493|2022|PDM|5665.00|99|0.00|AETNA VERTEBROPLASTY ADDL INJECT|
20|FH_F123486_61764_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139302_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F38360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F116341_12180_0|SrvcGrp|104080|2022|PCT|1.05|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F123466_93420_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F148339_71303_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F52393_0_0|SrvcGrp|49103|2022|PDM|950.00|99|0.00|HEARING AID|
20|FH_F91994_0_0|SrvcGrp|73008|2022|PDM|1200.00|99|0.00|AEG 10|
20|FH_F132190_0_0|SrvcGrp|109620|2022|PDM|2600.00|99|0.00|RELIEVE SPINAL CORD PRESSURE|
20|FH_F121118_06479_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145755_08050_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F116115_14437_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F34104_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F135052_18702_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F34487_0_0|SrvcGrp|14149|2022|PDM|93.00|99|0.00|CLINIC VISIT|
20|FH_F63422_0_0|SrvcGrp|3087|2022|PDM|525.00|99|0.00|CD - DETOX|
20|FH_F130253_65082_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F54293_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F66687_0_0|SrvcGrp|22781|2022|PDM|38159.00|99|0.00|MS DRG 244 ONLY|
20|FH_F110263_0_0|SrvcGrp|113463|2022|PCT|0.00|99|0.00|LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F138416_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F89563_29407_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F34487_0_0|SrvcGrp|12179|2022|PCT|1.00|99|0.00|CPT CODES 70000-79999 (RAD)|
20|FH_F38792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97104_53545_0|SrvcGrp|73601|2022|PDM|8464.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F133534_33483_0|SrvcGrp|73841|2022|PDM|394.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F39945_0_0|SrvcGrp|350|2022|PDM|1400.00|99|0.00|SURGICAL CARE|
20|FH_F137067_0_0|SrvcGrp|58993|2022|PDM|7350.00|99|0.00|DISKECTOMY|
20|FH_F77903_0_0|SrvcGrp|997|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137460_42103_0|SrvcGrp|90854|2022|PDM|648.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F102184_0_0|SrvcGrp|88491|2022|PDM|7215.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F100662_27534_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F130716_76013_0|SrvcGrp|48385|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F98041_10027_0|SrvcGrp|90854|2022|PDM|3880.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F97740_01605_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F109484_0_0|SrvcGrp|72990|2022|PDM|333.00|99|0.00|AEG 1|
20|FH_F69785_0_0|SrvcGrp|45924|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F71365_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F73231_0_0|SrvcGrp|44711|2022|PDM|115.99|99|0.00|PT SVCS|
20|FH_F115150_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88456_0_0|SrvcGrp|27402|2022|PDM|4313.00|99|0.00|LASER PROCEDURES|
20|FH_F114916_30309_0|SrvcGrp|84313|2022|PDM|1250.00|99|0.00|TENDON REPAIR|
20|FH_F142344_16693_0|SrvcGrp|12514|2022|PDM|557.00|99|0.00|TRANSITIONAL LIVING CENTER|
20|FH_F142448_15701_0|SrvcGrp|17016|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F104840_32565_0|SrvcGrp|73603|2022|PCT|0.69|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F104840_32565_0|SrvcGrp|74584|2022|PCT|0.69|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F131759_06032_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F55694_0_0|SrvcGrp|20293|2022|PDM|40140.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY|
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1365.00|99|0.00|AEG 8 (NO REV)|
20|FH_F126345_0_0|SrvcGrp|73006|2022|PDM|1689.00|99|0.00|AEG 9|
20|FH_F141343_62047_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137897_0_0|SrvcGrp|91627|2022|PDM|105.45|99|0.00|SKILLED NURSE SERVICES 15 MINS (HCFA)|
20|FH_F122198_20708_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1550.00|99|0.00|AEG 9 (NO REV)|
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|2731.00|99|0.00|AEG 5  (NO REV)|
20|FH_F98042_10468_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113785_35763_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F139652_42211_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138984_06896_0|SrvcGrp|75545|2022|PDM|455.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PDM|145.69|99|0.00|DEVELOPMENTAL TEST EXTEND|
20|FH_F144039_0_0|SrvcGrp|109768|2022|PDM|2433.00|99|0.00|COVER EYE W/ MEMBRANE SUTURE|
20|FH_F122610_73139_0|SrvcGrp|46903|2022|PDM|515.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F122689_92009_0|SrvcGrp|71106|2022|PDM|12.00|99|0.00|DISPOSABLE SENSOR|
20|FH_F134697_32566_0|SrvcGrp|46903|2022|PDM|774.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F134817_30339_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F136775_64701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136913_68803_0|SrvcGrp|31074|2022|PDM|2340.00|99|0.00|MS DRG 795 ONLY|
20|FH_F112371_19047_0|SrvcGrp|22020|2022|PDM|450.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F115263_47129_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147702_75240_0|SrvcGrp|75419|2022|PDM|425.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F147584_37664_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147414_92656_0|SrvcGrp|111348|2022|PCT|1.50|99|0.00|OP THERAPY SERVICES|
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_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD NU KC RATE|
20|FH_F135351_0_0|SrvcGrp|87679|2022|PDM|1199.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F98361_12065_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F120683_80238_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150939_0_0|SrvcGrp|73362|2022|PDM|10.00|99|0.00|VACCINE SERVICES|
20|FH_F40088_0_0|SrvcGrp|474|2022|PDM|690.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F113585_20155_0|SrvcGrp|22592|2022|PDM|60.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F138681_39301_0|SrvcGrp|89337|2022|PDM|958.00|99|0.00|DETOXIFICATION|
20|FH_F138687_77477_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F138870_45176_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138907_01040_0|SrvcGrp|48385|2022|PDM|103.00|99|0.00|SPEECH THERAPY|
20|FH_F138992_72703_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138992_72703_0|SrvcGrp|109057|2022|PCT|1.48|99|0.00|CARDIAC STUDIES|
20|FH_F86377_0_0|SrvcGrp|3809|2022|PDM|531.22|99|0.00|HOSPICE CARE|
20|FH_F88893_0_0|SrvcGrp|115846|2022|PDM|1210.00|99|0.00|BOWEL TO BOWEL FUSION|
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PDM|3014.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F151501_30265_0|SrvcGrp|104039|2022|PDM|2090.00|99|0.00|CORRECTION HALLUX VALGUS|
20|FH_F132258_45404_0|SrvcGrp|47183|2022|PDM|85.65|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F145468_60615_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F123191_15012_0|SrvcGrp|48398|2022|PDM|91.00|99|0.00|PT SERVICES|
20|FH_F135439_33825_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F135483_53226_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F135583_17331_0|SrvcGrp|73806|2022|PCT|0.82|99|0.00|AETNA ER|
20|FH_F135763_20678_0|SrvcGrp|75419|2022|PDM|1250.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F136130_10029_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136186_46307_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F136220_63638_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119885_13753_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131265_84106_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F131132_44077_0|SrvcGrp|109959|2022|PDM|31212.00|99|0.00|IMPLANT NEURORECEIVER|
20|FH_F116469_92543_0|SrvcGrp|705|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F116469_92543_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F116468_49660_0|SrvcGrp|89149|2022|PDM|170.00|99|0.00|OP INTENSIVE|
20|FH_F31220_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F55857_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130766_04967_0|SrvcGrp|104363|2022|PCT|0.88|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F35053_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F121428_40202_0|SrvcGrp|12840|2022|PCT|0.27|99|0.00|PACEMAKER|
20|FH_F67923_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|OP SVCS|
20|FH_F111292_33136_0|SrvcGrp|81405|2022|PDM|16.00|99|0.00|URINALYSIS W/ MICROSCPY|
20|FH_F111301_33122_0|SrvcGrp|109220|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F134263_15628_0|SrvcGrp|86723|2022|PDM|352.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F141651_0_0|SrvcGrp|107167|2022|PDM|3850.00|99|0.00|RHINOPLASTY|
20|FH_F132328_0_0|SrvcGrp|27315|2022|PDM|2876.00|99|0.00|TENDON REPAIR|
20|FH_F137243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72666_0_0|SrvcGrp|30661|2022|PDM|4620.00|99|0.00|LITHOTRIPSY SVCS|
20|FH_F112129_62220_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F88831_84123_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F125054_16365_0|SrvcGrp|46605|2022|PDM|119.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F124892_32535_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129240_10028_0|SrvcGrp|63156|2022|PCT|0.83|99|0.00|IMMUNE GLOBULIN INTRAVENOUS|
20|FH_F97221_29406_0|SrvcGrp|79720|2022|PDM|1000.00|99|0.00|ACUTE REHAB II|
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PDM|1004.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F54055_70006_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|GENERAL ACUTE CARE|
20|FH_F70844_15317_0|SrvcGrp|81878|2022|PCT|1.00|99|0.00|RADIOLOGY W/ REV/HCPC|
20|FH_F132772_0_0|SrvcGrp|108082|2022|PDM|362.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F128341_41139_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F86872_15215_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|AEG 1 (NO REV)|
20|FH_F123783_03860_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126527_0_0|SrvcGrp|82222|2022|PDM|110.00|99|0.00|HOSPICE CARE|
20|FH_F136299_75218_0|SrvcGrp|112834|2022|PCT|1.75|99|0.00|RADIOLOGY SERVICES|
20|FH_F136299_75218_0|SrvcGrp|111288|2022|PCT|0.00|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F136390_46321_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F118186_97070_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F137267_62906_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142387_70454_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142690_31774_0|SrvcGrp|48394|2022|PDM|34.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F140833_19454_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F80284_16354_0|SrvcGrp|64104|2022|PDM|887.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 5|
20|FH_F145762_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F151609_17601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119090_91502_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F118932_07652_0|SrvcGrp|103913|2022|PCT|1.50|99|0.00|OP DIALYSIS|
20|FH_F39623_0_0|SrvcGrp|32555|2022|PDM|450.00|99|0.00|IV HYDRATION FOR HYPEREMESIS|
20|FH_F92506_07666_0|SrvcGrp|92501|2022|PDM|256.14|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F109883_35007_0|SrvcGrp|86747|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F115452_15235_0|SrvcGrp|73701|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F147930_21244_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129438_08234_0|SrvcGrp|58509|2022|PDM|475.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F129483_77030_0|SrvcGrp|17013|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129483_77030_0|SrvcGrp|16750|2022|PDM|110.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F117126_12801_0|CSTM-ALL|CSTM-00|2020|PDM|6030.00|99|0.00|AEG 8 (NO REV)|
20|FH_F109652_0_0|SrvcGrp|361|2022|PDM|3105.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F109652_0_0|SrvcGrp|72996|2022|PDM|2886.00|99|0.00|AEG 4|
20|FH_F109652_0_0|SrvcGrp|78841|2022|PDM|627.00|99|0.00|ELECTRO & DIAG MAPPING STUDIES|
20|FH_F112263_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F111593_0_0|SrvcGrp|72998|2022|PDM|1760.00|99|0.00|AEG 5|
20|FH_F112080_0_0|SrvcGrp|72990|2022|PDM|660.00|99|0.00|AEG 1|
20|FH_F124837_65625_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124893_40311_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F61773_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148459_15241_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120954_0_0|SrvcGrp|108538|2022|PCT|0.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F124928_04210_0|SrvcGrp|87401|2022|PDM|39.62|99|0.00|HCPCS G0156 (HCFA)|
20|FH_F101562_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78205_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F113326_80014_0|SrvcGrp|104329|2022|PCT|1.00|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F103400_33426_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F80363_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F147800_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F101840_76054_0|SrvcGrp|47004|2022|PDM|8207.00|99|0.00|MS DRG 626 ONLY|
20|FH_F97182_21502_0|SrvcGrp|73656|2022|PDM|404.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F148881_33018_0|SrvcGrp|9539|2022|PDM|360.00|99|0.00|SUBACUTE CARE|
20|FH_F101840_76054_0|SrvcGrp|131|2022|PCT|0.32|99|0.00|PACEMAKER DEVICE|
20|FH_F118728_33409_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD KL"|
20|FH_F144288_46322_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145988_06105_0|SrvcGrp|105465|2022|PCT|0.69|99|0.00|AETNA THERAPIES|
20|FH_F92677_08003_0|SrvcGrp|92810|2022|PDM|9.45|99|0.00|ENTERAL FEEDING SUPPLY KIT GRAVITY (HCFA)|
20|FH_F117366_33162_0|SrvcGrp|38004|2022|PDM|3700.00|99|0.00|CPT CODE 59400|
20|FH_F133287_40215_0|SrvcGrp|73483|2022|PDM|944.00|99|0.00|AETNA SUBACUTE III|
20|FH_F149840_80002_0|SrvcGrp|95660|2022|PDM|618.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F149881_03038_0|SrvcGrp|471|2022|PDM|652.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F97542_32960_0|SrvcGrp|73602|2022|PDM|1636.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|277.09|99|0.00|HAPA WPA-NWPA 2012-13 ASC 121 W/O REV|
20|FH_F117385_48091_0|SrvcGrp|105427|2022|PDM|30.00|99|0.00|AETNA OBSERVATIONS BEHAVIORAL 30 MINS|
20|FH_F31542_0_0|SrvcGrp|13123|2022|PDM|450.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F128390_0_0|SrvcGrp|90707|2022|PDM|115.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F144008_11413_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150559_60018_0|SrvcGrp|23683|2022|PDM|65.00|99|0.00|SKILLED NURSING RN|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|101.00|99|0.00|PSYTX W PT 60 MINS|
20|FH_F137896_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133350_39532_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97622_75051_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142891_54022_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132285_89103_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F148555_0_0|SrvcGrp|115460|2022|PDM|5871.00|99|0.00|REMOVE & REPLACE DEFIB GEN MULTI LEAD|
20|FH_F102325_62691_0|SrvcGrp|47183|2022|PDM|60.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F117368_68114_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|29532.00|99|0.00|DRG 109 ONLY|
20|FH_F101104_0_0|SrvcGrp|87393|2022|PDM|147.00|99|0.00|HCPCS G0151 (HCFA)|
20|FH_F148325_0_0|SrvcGrp|92501|2022|PDM|151.98|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F93881_15009_0|SrvcGrp|87104|2022|PDM|178.00|99|0.00|X-RAY EXAM LOWER SPINE|
20|FH_F110925_01104_0|SrvcGrp|85819|2022|PDM|677.50|99|0.00|ENTERAL NUTRITION INFUSION (MOD NU)|
20|FH_F104520_0_0|SrvcGrp|80317|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F139515_0_0|SrvcGrp|88158|2022|PDM|8549.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F91994_0_0|SrvcGrp|23585|2022|PCT|1.15|99|0.00|IMPLANTS|
20|FH_F145800_22003_0|SrvcGrp|29347|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F135248_84651_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AEG 3 (NO REV)|
20|FH_F65103_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN|
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|970.00|99|0.00|AEG 10 (NO REV)|
20|FH_F56293_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131228_01826_0|SrvcGrp|79699|2022|PCT|0.87|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|1343.00|99|0.00|ASPG VII|
20|FH_F150699_0_0|SrvcGrp|92406|2022|PDM|28614.00|99|0.00|REMOVAL & REPLACE PULSE GEN 1 LEAD|
20|FH_F137067_0_0|SrvcGrp|92414|2022|PDM|5250.00|99|0.00|SPINAL CRD DECOMP->2 LUMBAR|
20|FH_F139580_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F139719_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F33126_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F116115_14437_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F93881_15009_0|SrvcGrp|75506|2022|PCT|0.55|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)|
20|FH_F38357_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F105221_01757_0|SrvcGrp|46605|2022|PDM|84.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F150982_0_0|SrvcGrp|88163|2022|PDM|13213.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F148255_72703_0|SrvcGrp|86825|2022|PDM|57.75|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1015.74|99|0.00|HAPA WPA-NWPA 2012-13 ASC 702 W/O REV|
20|FH_F114980_78061_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116700_11787_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F110061_0_0|SrvcGrp|75485|2022|PDM|667.00|99|0.00|AEG 4|
20|FH_F135235_01830_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F148666_34205_0|SrvcGrp|90854|2022|PDM|875.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F37679_0_0|SrvcGrp|20480|2022|PDM|61.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F147941_06023_0|SrvcGrp|114616|2022|PDM|12234.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F39857_0_0|SrvcGrp|701|2022|PDM|2080.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F135764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1030.14|99|0.00|ASPG VI|
20|FH_F83198_44125_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141387_63108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130747_0_0|SrvcGrp|88739|2022|PDM|4682.00|99|0.00|IMPLANT SPINAL CANAL|
20|FH_F124965_0_0|SrvcGrp|72990|2022|PDM|540.00|99|0.00|AEG 1|
20|FH_F77883_0_0|SrvcGrp|74927|2022|PDM|206.66|99|0.00|SPEECH THERAPY|
20|FH_F149888_68506_0|SrvcGrp|84928|2022|PDM|4004.00|99|0.00|OP SURGERY|
20|FH_F100660_56303_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F123507_63869_0|SrvcGrp|75545|2022|PDM|327.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F36211_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126027_63069_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|2300.00|99|0.00|AEG 2 (NO REV)|
20|FH_F97102_83501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148666_34205_0|SrvcGrp|3178|2022|PDM|875.00|99|0.00|ACUTE PSYCH|
20|FH_F121490_86314_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F130051_31707_0|CSTM-ALL|CSTM-00|2020|PDM|9538.00|99|0.00|AEG 8 (NO REV)|
20|FH_F123385_03561_0|SrvcGrp|48398|2022|PDM|166.00|99|0.00|PT SERVICES|
20|FH_F86159_15139_0|SrvcGrp|472|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F86917_61108_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|OCN F/S PRICING: ALL|
20|FH_F68837_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62614_0_0|SrvcGrp|48385|2022|PDM|30.00|99|0.00|SPEECH THERAPY|
20|FH_F60292_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130656_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 4 (NO REV)|
20|FH_F145562_70458_0|SrvcGrp|86844|2022|PDM|25.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F49459_0_0|SrvcGrp|38223|2022|PDM|762.00|99|0.00|ADULT DETOX|
20|FH_F150165_06032_0|SrvcGrp|27344|2022|PDM|2350.00|99|0.00|OP SURGERY (CPT 42821)|
20|FH_F83978_66739_0|SrvcGrp|110872|2022|PDM|2378.00|99|0.00|SHOULDER AND KNEE ARTHROSCOPY|
20|FH_F129509_0_0|SrvcGrp|67279|2022|PDM|5125.00|99|0.00|CERVICAL SURGERY|
20|FH_F137610_0_0|SrvcGrp|73842|2022|PDM|151.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F100782_0_0|SrvcGrp|105088|2022|PDM|402.10|99|0.00|WINDBER MEDICAL CNTR ASC 133|
20|FH_F121597_30315_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F121225_98902_0|SrvcGrp|14945|2022|PCT|0.85|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F149048_77090_0|SrvcGrp|94880|2022|PDM|145.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F100782_0_0|SrvcGrp|9537|2022|PDM|2298.00|99|0.00|CARDIAC CARE UNIT|
20|FH_F124173_66215_0|SrvcGrp|24745|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F121603_46761_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F126063_43078_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F148186_0_0|SrvcGrp|106314|2022|PDM|675.00|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F88744_71103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126188_59404_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PDM|1516.00|99|0.00|AEG 9 (NO REV)|
20|FH_F134169_08831_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114409_18447_0|SrvcGrp|88620|2022|PDM|118.65|99|0.00|SKILLED NURSING RN|
20|FH_F133778_38119_0|SrvcGrp|3809|2022|PDM|430.00|99|0.00|HOSPICE CARE|
20|FH_F81838_0_0|SrvcGrp|9832|2022|PDM|83.00|99|0.00|ST SVCS|
20|FH_F142376_0_0|SrvcGrp|98584|2022|PDM|14466.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F149319_07670_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95623_84015_0|SrvcGrp|93098|2022|PDM|90.00|99|0.00|HOSPICE CARE|
20|FH_F31714_0_0|SrvcGrp|12179|2022|PCT|2.00|99|0.00|CPT CODES 70000-79999 (RAD)|
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 10 (NO REV)|
20|FH_F130468_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F146657_01105_0|SrvcGrp|114666|2022|PDM|16.15|99|0.00|THERAPEUTIC BEHAV (MOD SE U2)|
20|FH_F139569_15063_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 7 (NO REV)|
20|FH_F134568_12946_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133770_34601_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F110604_0_0|SrvcGrp|93724|2022|PDM|1650.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F70208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1380.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109364_52349_0|SrvcGrp|48398|2022|PDM|184.00|99|0.00|PT SERVICES|
20|FH_F147984_63664_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143620_81504_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139780_75605_0|SrvcGrp|48398|2022|PDM|105.00|99|0.00|PT SERVICES|
20|FH_F139446_87106_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F88935_0_0|SrvcGrp|3809|2022|PDM|576.45|99|0.00|HOSPICE CARE|
20|FH_F149141_27262_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130763_0_0|SrvcGrp|91879|2022|PDM|4043.00|99|0.00|PROSTATE LASER ENUCLEATION|
20|FH_F71634_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149103_32803_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F120719_27540_0|SrvcGrp|114917|2022|PCT|0.71|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F115448_80031_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F85118_40403_0|SrvcGrp|65720|2022|PDM|131.25|99|0.00|RESPITE CARE|
20|FH_F133818_01027_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F70863_0_0|SrvcGrp|9228|2022|PDM|161.00|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|1595.00|99|0.00|AEG 2 (NO REV)|
20|FH_F121640_75062_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F100782_0_0|SrvcGrp|105158|2022|PDM|163.63|99|0.00|WINDBER MEDICAL CNTR ASC 319|
20|FH_F148547_01908_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114824_44484_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F81861_0_0|SrvcGrp|64105|2022|PDM|1510.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 4|
20|FH_F133585_0_0|SrvcGrp|107878|2022|PDM|2852.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F111908_07677_0|SrvcGrp|96402|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PDM|162.00|99|0.00|NEBULIZER (DME) (MOD NU)|
20|FH_F147980_0_0|SrvcGrp|82222|2022|PDM|20.00|99|0.00|HOSPICE CARE|
20|FH_F130763_0_0|SrvcGrp|88740|2022|PDM|5823.00|99|0.00|SP BONE ALGRFT|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 3247 MOD UE|
20|FH_F146595_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|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132899_01002_0|SrvcGrp|112087|2022|PDM|524.00|99|0.00|PARTIAL HOSP EATING DISORDERS (>=18 YRS)|
20|FH_F110420_60649_0|SrvcGrp|72992|2022|PDM|513.00|99|0.00|AEG 2|
20|FH_F134593_60007_0|SrvcGrp|86825|2022|PDM|65.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|756.17|99|0.00|HAPA WPA-NWPA 2012-13 ASC 501 W/O REV|
20|FH_F119227_01752_0|SrvcGrp|86848|2022|PDM|38.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F122526_22203_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F101847_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F84712_0_0|SrvcGrp|79299|2022|PDM|128.00|99|0.00|AETNA X-RAY (CPT 77056)|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|319.25|99|0.00|HAPA WPA-NWPA 2012-13 ASC 16 W/O REV|
20|FH_F98800_85021_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F102142_80014_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F105361_80104_0|SrvcGrp|73000|2022|PDM|2465.00|99|0.00|AEG 6|
20|FH_F66782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77665_0_0|SrvcGrp|10624|2022|PDM|50.00|99|0.00|CPT CODE 99347|
20|FH_F80064_0_0|SrvcGrp|8950|2022|PDM|1730.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F146776_64506_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146805_45662_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131628_26505_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131454_06422_0|SrvcGrp|472|2022|PDM|364.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)|
20|FH_F132187_66111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133478_40165_0|SrvcGrp|112334|2022|PCT|0.54|99|0.00|OBSERVATION W/ SURGERY|
20|FH_F133133_32433_0|SrvcGrp|73841|2022|PDM|350.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F133494_90023_0|SrvcGrp|81779|2022|PCT|1.40|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F133700_92808_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111580_77004_0|SrvcGrp|12840|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F134826_19067_0|SrvcGrp|52951|2022|PDM|150.00|99|0.00|PSYCHIATRIC CPT 90846|
20|FH_F136393_0_0|SrvcGrp|91959|2022|PDM|6000.00|99|0.00|INSERT PULSE GENERATOR|
20|FH_F123091_92627_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F123091_92627_0|SrvcGrp|75442|2022|PDM|900.00|99|0.00|OBSERVATION - REV 762|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|994.80|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1303 W/O REV|
20|FH_F122646_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F31446_0_0|SrvcGrp|12720|2022|PDM|120.00|99|0.00|CD DAY TREATMENT - ADULT|
20|FH_F128571_29532_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F44435_0_0|SrvcGrp|31382|2022|PDM|4000.00|99|0.00|RIVERVIEW ASC CARVE OUT|
20|FH_F120550_91355_0|SrvcGrp|86635|2022|PCT|0.85|99|0.00|DME|
20|FH_F127994_19301_0|SrvcGrp|52953|2022|PDM|90.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F150122_75020_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133018_84037_0|SrvcGrp|93099|2022|PDM|474.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY|
20|FH_F109404_0_0|SrvcGrp|74348|2022|PCT|0.90|99|0.00|EVALUATION AND MANAGEMENT|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|453.98|99|0.00|HAPA WPA-NWPA 2012-13 ASC 304 W/O REV|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F97141_93933_0|SrvcGrp|90854|2022|PDM|5789.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F38425_0_0|SrvcGrp|28628|2022|PDM|41.00|99|0.00|SKILLED NURSING|
20|FH_F106540_26330_0|SrvcGrp|72996|2022|PDM|3802.00|99|0.00|AEG 4|
20|FH_F71929_15090_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F107400_0_0|SrvcGrp|48394|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F44755_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F123085_21921_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F146211_68144_0|SrvcGrp|88164|2022|PDM|28522.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F67763_0_0|SrvcGrp|44245|2022|PDM|150.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F100741_0_0|SrvcGrp|73006|2022|PDM|1453.00|99|0.00|AEG 9|
20|FH_F67639_0_0|SrvcGrp|63471|2022|PDM|12562.00|99|0.00|CPT 64590|
20|FH_F130615_95350_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133478_40165_0|SrvcGrp|112342|2022|PDM|228.00|99|0.00|ABDOMINAL DRAIN|
20|FH_F127191_44720_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F117954_17961_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F126666_44053_0|SrvcGrp|86647|2022|PDM|67.00|99|0.00|AETNA OFFICE OP VISIT EST (MOD TD)|
20|FH_F40738_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|SPINAL CORD REHAB|
20|FH_F123538_21206_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150002_28761_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133493_90255_0|SrvcGrp|537|2022|PDM|2273.00|99|0.00|OBSERVATION SERVICES|
20|FH_F41814_0_0|SrvcGrp|12099|2022|PDM|5382.00|99|0.00|CAESAREAN SECTION|
20|FH_F133029_61264_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F34706_0_0|SrvcGrp|11182|2022|PDM|49160.00|99|0.00|DRG 547 CORONARY BYP W/CARDIAC CATH W/DIAGNOSIS|
20|FH_F71323_68114_0|SrvcGrp|37348|2022|PDM|2975.00|99|0.00|MS DRG 864-866 ONLY|
20|FH_F87592_85614_0|SrvcGrp|75507|2022|PCT|1.00|99|0.00|CHEMOTHERAPY|
20|FH_F151054_06473_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151141_24014_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 5  (NO REV)|
20|FH_F121887_53144_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150768_03054_0|SrvcGrp|104229|2022|PDM|212.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F47212_0_0|SrvcGrp|42975|2022|PDM|105.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F127418_0_0|SrvcGrp|67119|2022|PDM|6830.78|99|0.00|ARTHODESIS|
20|FH_F37230_0_0|SrvcGrp|15388|2022|PDM|117.00|99|0.00|SPEECH THERAPY|
20|FH_F131591_67203_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134738_0_0|SrvcGrp|59840|2022|PDM|2100.00|99|0.00|TYMPANOSTOMY|
20|FH_F147228_49441_0|SrvcGrp|92501|2022|PDM|186.78|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F114568_08097_0|SrvcGrp|86747|2022|PCT|1.05|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F41463_0_0|SrvcGrp|34229|2022|PDM|53.00|99|0.00|FACTOR VIII & IX THERAPY|
20|FH_F37771_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO|
20|FH_F124364_38611_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|8150.00|99|0.00|MS DRG 490|
20|FH_F147209_60202_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F37267_0_0|SrvcGrp|9832|2022|PDM|84.50|99|0.00|ST SVCS|
20|FH_F97280_20018_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F73764_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127418_0_0|SrvcGrp|88740|2022|PDM|6121.50|99|0.00|SP BONE ALGRFT|
20|FH_F40501_0_0|CSTM-ALL|CSTM-00|2020|PDM|131.00|99|0.00|OP PSYCHIATRIC TREATMENT (4-7 HRS)|
20|FH_F146204_0_0|SrvcGrp|33977|2022|PDM|1500.00|99|0.00|CPT 59820|
20|FH_F124739_64429_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F149642_95678_0|SrvcGrp|46903|2022|PDM|800.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F134847_0_0|SrvcGrp|41335|2022|PDM|14238.00|99|0.00|TOTAL HIP|
20|FH_F134887_33409_0|SrvcGrp|86635|2022|PCT|1.05|99|0.00|DME|
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|2393.00|99|0.00|AEG 4 (NO REV)|
20|FH_F148965_62025_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149022_25271_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F90201_15650_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F97260_06111_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F97101_98003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134869_08854_0|SrvcGrp|112682|2022|PDM|198.00|99|0.00|PSYTX WPT W E/M 60 MIN (HCFA)|
20|FH_F138932_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F35750_0_0|SrvcGrp|16|2022|PDM|1103.00|99|0.00|ACUTE REHABILITATION|
20|FH_F90455_0_0|SrvcGrp|90064|2022|PDM|69.50|99|0.00|PHOTOTHERAPY|
20|FH_F147171_76036_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134828_30531_0|SrvcGrp|112655|2022|PDM|57.00|99|0.00|XRAY EXAM OF THORAX SPINE|
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|1678.60|99|0.00|AEG 8 (NO REV)|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F133536_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F133536_0_0|SrvcGrp|93431|2022|PDM|20350.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F134598_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|GENERAL ACUTE CARE|
20|FH_F150939_0_0|SrvcGrp|82745|2022|PDM|7.00|99|0.00|CULT BACT NO URINE/BLD/STOOL|
20|FH_F48693_0_0|SrvcGrp|12044|2022|PDM|760.82|99|0.00|SLEEP STUDIES|
20|FH_F138784_32216_0|SrvcGrp|46903|2022|PDM|741.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F88893_0_0|SrvcGrp|97903|2022|PDM|3520.00|99|0.00|REMOVAL OF STOMACH PARTIAL|
20|FH_F113390_0_0|SrvcGrp|105240|2022|PDM|1320.00|99|0.00|EXCISION OF TONGUE FOLD|
20|FH_F127207_0_0|SrvcGrp|73656|2022|PDM|450.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F149242_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151501_30265_0|CSTM-ALL|CSTM-00|2020|PDM|2218.00|99|0.00|AEG 9 (NO REV)|
20|FH_F151509_77076_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151514_35242_0|SrvcGrp|104248|2022|PDM|1500.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F145251_45107_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F135427_19610_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F91764_93710_0|SrvcGrp|113223|2022|PCT|2.12|99|0.00|COVID-19 ANTIBODY SARS-COV-2 TITER(S)|
20|FH_F131228_01826_0|SrvcGrp|111783|2022|PDM|292.25|99|0.00|CHEMOTHERAPY|
20|FH_F131463_19096_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116404_20191_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F116431_76104_0|SrvcGrp|82137|2022|PCT|0.80|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F131361_18235_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F36479_0_0|SrvcGrp|38|2022|PDM|1476.00|99|0.00|NORMAL DELIVERY|
20|FH_F101200_19020_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F121873_54303_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F69205_0_0|SrvcGrp|29406|2022|PDM|172.80|99|0.00|PHYSICAL THERAPY|
20|FH_F134322_98001_0|SrvcGrp|112544|2022|PCT|1.00|99|0.00|STREPTOMYCIN INJECTION|
20|FH_F114166_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F51558_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F51272_0_0|SrvcGrp|33751|2022|PCT|0.65|99|0.00|OP SURGERY|
20|FH_F56573_0_0|SrvcGrp|13621|2022|PCT|0.00|99|0.00|SLEEP STUDIES|
20|FH_F131000_0_0|SrvcGrp|104108|2022|PDM|3024.00|99|0.00|EXCISION OF BREAST LESION ID|
20|FH_F132328_0_0|SrvcGrp|36865|2022|PDM|5108.00|99|0.00|NUCLEOPLASTY|
20|FH_F112082_30720_0|SrvcGrp|48394|2022|PDM|103.70|99|0.00|SKILLED NURSING SERVICES|
20|FH_F88831_84123_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F128695_50049_0|SrvcGrp|66265|2022|PDM|119.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F123036_0_0|SrvcGrp|108834|2022|PDM|22889.00|99|0.00|IMPLT NROSTM PLS GEN SNG REC|
20|FH_F98626_29118_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F98300_30236_0|SrvcGrp|73602|2022|PDM|703.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F102960_50613_0|SrvcGrp|94064|2022|PDM|623.00|99|0.00|OP BEHAVIORAL OBSERVATION|
20|FH_F148061_11223_0|SrvcGrp|27969|2022|PDM|23.00|99|0.00|HOME HEALTH AIDE|
20|FH_F151241_15139_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F121385_89102_0|SrvcGrp|79786|2022|PCT|2.07|99|0.00|SLEEP STUDIES|
20|FH_F114968_0_0|SrvcGrp|75545|2022|PDM|615.96|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F113926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129130_92562_0|SrvcGrp|73606|2022|PDM|1895.40|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F129130_92562_0|CSTM-ALL|CSTM-00|2020|PDM|9438.44|99|0.00|AEG 5  (NO REV) W/O HERNIA/LAPAROSCOPIC|
20|FH_F118661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|201.81|99|0.00|DELAWARE VALLEY- ASC 112|
20|FH_F69582_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS SNF PART B DRUGS|
20|FH_F98040_89406_0|SrvcGrp|73659|2022|PDM|7898.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F101387_0_0|SrvcGrp|112098|2022|PCT|2.00|99|0.00|COVID-19 CODES|
20|FH_F106822_0_0|SrvcGrp|100284|2022|PDM|7.95|99|0.00|2+ IMMUNIZATION ADMIN (HCFA)|
20|FH_F106822_0_0|SrvcGrp|101742|2022|PDM|3.00|99|0.00|IMMUN ADMIN ORAL/NASAL ADDL|
20|FH_F111001_0_0|SrvcGrp|104237|2022|PDM|3.00|99|0.00|UNSKILLED RESPITE CARE|
20|FH_F116019_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116323_0_0|SrvcGrp|89404|2022|PDM|30112.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F120305_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117001_0_0|SrvcGrp|24405|2022|PDM|500.00|99|0.00|HEARING AIDE|
20|FH_F117299_0_0|SrvcGrp|68056|2022|PDM|2601.00|99|0.00|CPT 55700|
20|FH_F86911_0_0|SrvcGrp|43268|2022|PDM|120.00|99|0.00|PICC LINE CATH CARE|
20|FH_F89071_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114916_30309_0|SrvcGrp|88157|2022|PDM|18000.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F110803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|546.00|99|0.00|AEG 2 (NO REV)|
20|FH_F123774_0_0|SrvcGrp|72994|2022|PDM|770.00|99|0.00|AEG 3|
20|FH_F94786_07974_0|SrvcGrp|26868|2022|PDM|36.75|99|0.00|DIURETIC IV THERAPY|
20|FH_F132988_0_0|SrvcGrp|109189|2022|PDM|6632.83|99|0.00|TARSAL BONE DISLOCATION TREATMENT|
20|FH_F129189_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F114389_50131_0|SrvcGrp|24750|2022|PDM|83.32|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F45976_0_0|SrvcGrp|17067|2022|PDM|645.00|99|0.00|ASPG II|
20|FH_F41035_0_0|SrvcGrp|72996|2022|PDM|700.00|99|0.00|AEG 4|
20|FH_F49943_0_0|SrvcGrp|45924|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE|
20|FH_F85655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
20|FH_F129549_01238_0|SrvcGrp|80920|2022|PDM|741.30|99|0.00|HOSPICE SERVICES|
20|FH_F129549_01238_0|SrvcGrp|13238|2022|PDM|13.49|99|0.00|VENIPUNCTURE|
20|FH_F40507_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F138387_02886_0|SrvcGrp|84185|2022|PDM|137.00|99|0.00|RESPITE CARE|
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)|
20|FH_F117574_49022_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F124322_64131_0|SrvcGrp|65621|2022|PDM|42.00|99|0.00|RN NURSING|
20|FH_F42979_0_0|CSTM-ALL|CSTM-00|2020|PDM|610.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146266_0_0|SrvcGrp|105636|2022|PDM|10928.00|99|0.00|REALIGNMENT OF KNEE|
20|FH_F149160_02180_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|COVID-19 INFUSION ADMIN - ELI LILLY|
20|FH_F128753_32501_0|SrvcGrp|75481|2022|PCT|0.64|99|0.00|AEG 2|
20|FH_F111266_30339_0|SrvcGrp|86827|2022|PDM|55.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F149522_83221_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F146765_0_0|SrvcGrp|80920|2022|PDM|100.00|99|0.00|HOSPICE SERVICES|
20|FH_F110661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F107980_08005_0|SrvcGrp|90397|2022|PDM|335.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F117617_80439_0|SrvcGrp|88620|2022|PDM|150.00|99|0.00|SKILLED NURSING RN|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD UEKC|
20|FH_F111246_80027_0|SrvcGrp|104329|2022|PCT|1.00|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F108080_77081_0|SrvcGrp|74668|2022|PDM|192.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER RRKC|
20|FH_F134387_60106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97420_75052_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F146266_0_0|SrvcGrp|27330|2022|PDM|3525.00|99|0.00|CPT 27096|
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_F138254_75446_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140231_60540_0|SrvcGrp|108484|2022|PDM|928.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F114931_0_0|SrvcGrp|90778|2022|PDM|3200.00|99|0.00|HEMIOPLASTY|
20|FH_F131173_17043_0|SrvcGrp|89783|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F48224_0_0|SrvcGrp|36991|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F49552_0_0|SrvcGrp|26521|2022|PDM|46.00|99|0.00|CPT CODES 00100-01999|
20|FH_F120171_33770_0|SrvcGrp|90040|2022|PDM|345.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F136280_54915_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136299_75218_0|CSTM-ALL|CSTM-00|2020|PDM|6077.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132371_19083_0|SrvcGrp|42404|2022|PDM|7.00|99|0.00|VENIPUNCTURE|
20|FH_F132479_90290_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116645_71457_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116571_70433_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F116904_17543_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119913_31545_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120974_27607_0|CSTM-ALL|CSTM-00|2020|PDM|13581.00|99|0.00|AEG 9 (NO REV)|
20|FH_F125479_17501_0|SrvcGrp|23587|2022|PDM|782.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F126243_32132_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F113649_01752_0|SrvcGrp|47183|2022|PDM|117.50|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|22990.00|99|0.00|MS DRG 237|
20|FH_F36372_0_0|SrvcGrp|13606|2022|PDM|35.00|99|0.00|HOME INFUSION|
20|FH_F36472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F39919_0_0|SrvcGrp|28243|2022|PCT|1.10|99|0.00|SUPPLIES AND DEVICES|
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F37970_0_0|SrvcGrp|471|2022|PDM|1142.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F135840_0_0|SrvcGrp|75481|2022|PDM|468.00|99|0.00|AEG 2|
20|FH_F130659_44410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F130715_98503_0|SrvcGrp|73605|2022|PDM|1300.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F31178_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1085.08|99|0.00|HAPA WPA-NWPA 2012-13 ASC 503 W/O REV|
20|FH_F132883_31602_0|SrvcGrp|86831|2022|PDM|3.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F80172_0_0|SrvcGrp|11785|2022|PDM|70.64|99|0.00|HOME INFUSION THERAPY|
20|FH_F134593_60007_0|SrvcGrp|24745|2022|PDM|47.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F40725_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F150165_06032_0|SrvcGrp|100043|2022|PDM|7725.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F120930_0_0|SrvcGrp|77582|2022|PDM|2200.00|99|0.00|CPT 31255|
20|FH_F100782_0_0|SrvcGrp|105132|2022|PDM|317.13|99|0.00|WINDBER MEDICAL CNTR ASC 237|
20|FH_F110223_31750_0|SrvcGrp|79699|2022|PCT|0.90|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F42646_0_0|SrvcGrp|97|2022|PDM|2600.00|99|0.00|C-SECTION|
20|FH_F146369_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F125139_84096_0|SrvcGrp|73605|2022|PDM|861.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F148644_06890_0|SrvcGrp|115479|2022|PDM|2200.00|99|0.00|BIOPSY OF VAGINA|
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 10 (NO REV)|
20|FH_F142376_0_0|SrvcGrp|113981|2022|PDM|1159.00|99|0.00|RF ABLTJ NRV NRVTG SI JT|
20|FH_F135316_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48846_0_0|SrvcGrp|24289|2022|PDM|40.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F132925_84041_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80694_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|2390.00|99|0.00|AEG 7 (NO REV)|
20|FH_F88171_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71669_0_0|SrvcGrp|16277|2022|PCT|0.50|99|0.00|HIGH COST DRUGS|
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.00|99|0.00|AEG 2 (NO REV)|
20|FH_F130017_02302_0|SrvcGrp|3378|2022|PDM|3362.58|99|0.00|OBSERVATION SVCS|
20|FH_F132958_79903_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F63318_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146544_78705_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F87333_0_0|SrvcGrp|73000|2022|PDM|1332.94|99|0.00|AEG 6|
20|FH_F85995_64111_0|SrvcGrp|73701|2022|PDM|60.46|99|0.00|AETNA - SKILLED NURSING|
20|FH_F97861_62223_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F34182_0_0|SrvcGrp|18140|2022|PDM|2729.00|99|0.00|MS DRG 246|
20|FH_F146005_67037_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F138302_15701_0|SrvcGrp|21920|2022|PDM|25.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F83113_0_0|SrvcGrp|12073|2022|PDM|46.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F109273_77339_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F134608_18017_0|SrvcGrp|108126|2022|PCT|1.00|99|0.00|INDUCED ABORTION INTRA-AMNIOTIC INJ D&C|
20|FH_F134371_62002_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149261_75457_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F77184_0_0|SrvcGrp|46424|2022|PDM|18.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F130763_0_0|SrvcGrp|89980|2022|PDM|5165.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F120720_24541_0|SrvcGrp|73742|2022|PDM|8.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F132740_46250_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148668_33177_0|SrvcGrp|99459|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY EVALUATION|
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_F126341_27284_0|SrvcGrp|14949|2022|PCT|1.00|99|0.00|HOME INFUSION|
20|FH_F133877_84117_0|SrvcGrp|97702|2022|PDM|93.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F121597_30315_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F85212_71075_0|SrvcGrp|79786|2022|PCT|1.00|99|0.00|SLEEP STUDIES|
20|FH_F120720_24541_0|SrvcGrp|73700|2022|PDM|42.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F133747_80634_0|SrvcGrp|81919|2022|PCT|0.92|99|0.00|AETNA CARDIAC CATH|
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F85652_98034_0|SrvcGrp|13227|2022|PDM|1026.00|99|0.00|CPT CODE 99283|
20|FH_F143611_84065_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F149084_33401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F130468_0_0|SrvcGrp|95559|2022|PDM|11776.00|99|0.00|HIP JOINT|
20|FH_F90438_08873_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F150165_06032_0|SrvcGrp|70746|2022|PDM|4138.00|99|0.00|CPT 28292|
20|FH_F131100_0_0|SrvcGrp|111737|2022|PDM|1268.00|99|0.00|DRAIN THIGH/KNEE LESION|
20|FH_F50477_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F58396_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134947_14227_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F149219_01966_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.81|99|0.00|OP SVCS|
20|FH_F93173_73401_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F126417_77338_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111986_0_0|SrvcGrp|11673|2022|PDM|3605.00|99|0.00|CPT 29888|
20|FH_F42467_0_0|SrvcGrp|3029|2022|PDM|220.00|99|0.00|NEWBORN NURSERY|
20|FH_F145926_45243_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122470_78229_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F122470_78229_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122522_54024_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F84712_0_0|SrvcGrp|82744|2022|PDM|59.00|99|0.00|URINE CULTURE COLONY COUNT|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|271.53|99|0.00|HAPA WPA-NWPA 2012-13 ASC 226 W/O REV|
20|FH_F79644_0_0|SrvcGrp|68401|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F105145_75075_0|SrvcGrp|98271|2022|PDM|3500.00|99|0.00|ARTHROSCOPY|
20|FH_F105145_75075_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F68442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F146668_30189_0|SrvcGrp|114611|2022|PDM|5250.00|99|0.00|EXPLORATION OF A FOOT JOINT|
20|FH_F131674_72501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131697_33444_0|SrvcGrp|38004|2022|PDM|3900.00|99|0.00|CPT CODE 59400|
20|FH_F131976_74571_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133583_77074_0|SrvcGrp|89417|2022|PDM|435.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F146622_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F132213_17543_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F132937_88201_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F132167_06040_0|SrvcGrp|75545|2022|PDM|437.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F131430_17566_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F132191_66757_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82234_0_0|SrvcGrp|80285|2022|PDM|146.97|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|534.54|99|0.00|ASPG II|
20|FH_F46433_0_0|SrvcGrp|26868|2022|PDM|71.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F63081_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.43|99|0.00|AEG 1 (NO REV)|
20|FH_F133536_0_0|SrvcGrp|82107|2022|PDM|2750.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F143467_0_0|SrvcGrp|114043|2022|PDM|3140.00|99|0.00|LEG TENDON REPAIR|
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 4 (NO REV)|
20|FH_F37200_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REGIONAL HEALTH SVCS OF HOWARD-DME-MOD RR|
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F93881_15009_0|SrvcGrp|106285|2022|PCT|1.39|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F143772_75225_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F91622_0_0|SrvcGrp|10364|2022|PDM|1350.00|99|0.00|CPT CODE 99284|
20|FH_F119824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115737_78660_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F82173_72712_0|SrvcGrp|79786|2022|PCT|2.45|99|0.00|SLEEP STUDIES|
20|FH_F38357_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)|
20|FH_F131176_28712_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129241_54409_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148200_26554_0|SrvcGrp|3378|2022|PCT|0.75|99|0.00|OBSERVATION SVCS|
20|FH_F130681_15701_0|SrvcGrp|112038|2022|PCT|1.45|99|0.00|URGENT CARE TELEMEDICINE NEW PATIENT (MOD  GT)|
20|FH_F123918_76012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125028_19061_0|SrvcGrp|14945|2022|PDM|4.20|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|363.00|99|0.00|ASPG 1- PROGRESSIVE SURG|
20|FH_F110161_31329_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|GENERAL ACUTE CARE|
20|FH_F71927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F100320_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F141427_22003_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F110925_01104_0|SrvcGrp|16750|2022|PDM|108.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F92659_0_0|SrvcGrp|92542|2022|PDM|806.00|99|0.00|REVISION OF EYELID|
20|FH_F120349_38774_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F145815_30540_0|SrvcGrp|113224|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS DNA&RNA 21 SARSCOV2|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKE|
20|FH_F88254_33411_0|SrvcGrp|22593|2022|PDM|30.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F141802_17042_0|SrvcGrp|13238|2022|PDM|9.68|99|0.00|VENIPUNCTURE|
20|FH_F137617_84112_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|GENERAL ACUTE CARE|
20|FH_F38526_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
20|FH_F116268_19064_0|SrvcGrp|76501|2022|PDM|260.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F129653_0_0|SrvcGrp|111401|2022|PDM|2000.00|99|0.00|TREAT SPINAL CANAL LESION 16|
20|FH_F139173_0_0|SrvcGrp|73701|2022|PDM|164.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F130747_0_0|SrvcGrp|92415|2022|PDM|8843.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F132243_29571_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145756_03801_0|SrvcGrp|472|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F87619_0_0|SrvcGrp|72996|2022|PDM|791.00|99|0.00|AEG 4|
20|FH_F141794_50548_0|SrvcGrp|3378|2022|PCT|0.75|99|0.00|OBSERVATION SVCS|
20|FH_F143783_0_0|SrvcGrp|80918|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F71185_0_0|SrvcGrp|16684|2022|PCT|0.49|99|0.00|DRUGS|
20|FH_F126439_92627_0|SrvcGrp|89337|2022|PDM|1100.00|99|0.00|DETOXIFICATION|
20|FH_F130527_66044_0|SrvcGrp|73842|2022|PDM|185.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149140_07522_0|SrvcGrp|113234|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2 & INF A&B AMP PRB|
20|FH_F110061_0_0|SrvcGrp|75497|2022|PDM|540.00|99|0.00|AEG 10|
20|FH_F66630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|669.00|99|0.00|AEG 4 (NO REV)|
20|FH_F96902_0_0|SrvcGrp|94781|2022|PDM|165.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F130500_33317_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135187_80229_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F90714_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|DEVICE INSERTION|
20|FH_F105680_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|592.00|99|0.00|AEG 2 (NO REV)|
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|330.00|99|0.00|AEG 1 (NO REV)|
20|FH_F83251_32751_0|SrvcGrp|33166|2022|PDM|420.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F150982_0_0|SrvcGrp|27402|2022|PDM|3083.00|99|0.00|LASER PROCEDURES|
20|FH_F127036_43724_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F89453_75069_0|SrvcGrp|87396|2022|PDM|95.00|99|0.00|HCPCS G0155 (HCFA)|
20|FH_F135149_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135172_33157_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F122687_0_0|SrvcGrp|100043|2022|PDM|4371.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F91994_0_0|SrvcGrp|77452|2022|PDM|13245.00|99|0.00|CPT 54405|
20|FH_F52854_0_0|SrvcGrp|9936|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|ASPG VII|
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|ADULT PSYCH PARTIAL HOSPITALIZATION|
20|FH_F129536_0_0|SrvcGrp|23936|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F129367_89117_0|SrvcGrp|3178|2022|PDM|1047.00|99|0.00|ACUTE PSYCH|
20|FH_F110142_39056_0|SrvcGrp|3809|2022|PDM|576.77|99|0.00|HOSPICE CARE|
20|FH_F38357_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F37884_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD NU|
20|FH_F143908_52233_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149839_80002_0|SrvcGrp|65720|2022|PDM|144.00|99|0.00|RESPITE CARE|
20|FH_F129943_77584_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124018_75067_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F34487_0_0|SrvcGrp|9861|2022|PDM|1201.00|99|0.00|ACUTE REHABILITATION|
20|FH_F48927_0_0|SrvcGrp|72|2022|PDM|600.00|99|0.00|NEWBORN NURSERY|
20|FH_F40092_0_0|SrvcGrp|30733|2022|PDM|574.00|99|0.00|SKILLED NURSING CARE|
20|FH_F139515_0_0|SrvcGrp|89842|2022|PDM|31261.00|99|0.00|LUMBAR|
20|FH_F88254_33411_0|SrvcGrp|34566|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F135219_68506_0|SrvcGrp|33967|2022|PDM|5728.08|99|0.00|CPT 47562|
20|FH_F52854_0_0|SrvcGrp|16525|2022|PDM|6312.00|99|0.00|ELECTRO PHYSIOLOGY STUDIES|
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|AEG 3 (NO REV)|
20|FH_F93424_53578_0|SrvcGrp|43523|2022|PDM|239.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F110925_01104_0|SrvcGrp|86149|2022|PDM|90.90|99|0.00|CANAKINUMAB INJECTION|
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F82173_72712_0|CSTM-ALL|CSTM-00|2020|PDM|4270.00|99|0.00|AEG 8 (NO REV)|
20|FH_F116923_85259_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F149523_0_0|SrvcGrp|114172|2022|PDM|3000.00|99|0.00|SPINE FIXATION|
20|FH_F126422_77375_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F98040_89406_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F98041_10027_0|SrvcGrp|73656|2022|PDM|904.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F110000_0_0|SrvcGrp|33825|2022|PDM|1150.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 3|
20|FH_F97740_01605_0|SrvcGrp|90854|2022|PDM|2536.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F111207_0_0|SrvcGrp|25697|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F100620_37027_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|541.00|99|0.00|EXTENDED RECOVERY/OBSERVATION (5-7 HRS)(HCFA)|
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AEG 10 (NO REV)|
20|FH_F138929_0_0|SrvcGrp|92408|2022|PDM|4290.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F132627_0_0|SrvcGrp|17302|2022|PDM|64.26|99|0.00|HYDRATION THERAPY - 3+ LITERS|
20|FH_F133002_0_0|SrvcGrp|73006|2022|PDM|562.00|99|0.00|AEG 9|
20|FH_F137067_0_0|SrvcGrp|93063|2022|PDM|18900.00|99|0.00|LUMBAR ARTIF DISKECTOMY|
20|FH_F137067_0_0|SrvcGrp|41334|2022|PDM|18900.00|99|0.00|TOTAL KNEE|
20|FH_F130267_57248_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F78447_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F114389_50131_0|SrvcGrp|98936|2022|PDM|135.39|99|0.00|HIT CONT CHEMOTX (HCFA)|
20|FH_F141336_16947_0|SrvcGrp|98352|2022|PCT|0.83|99|0.00|IP TRAUMA 684|
20|FH_F141336_16947_0|SrvcGrp|111926|2022|PDM|39.51|99|0.00|COVID-19 LAB TESTING|
20|FH_F146901_78006_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146896_78636_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F69923_0_0|SrvcGrp|44704|2022|PDM|208.00|99|0.00|NURSING CARE|
20|FH_F37901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124173_66215_0|SrvcGrp|88621|2022|PDM|73.00|99|0.00|SKILLED NURSING LPN|
20|FH_F124173_66215_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F124234_33410_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F124611_64804_0|SrvcGrp|75545|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F125134_0_0|SrvcGrp|110069|2022|PDM|320.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F97083_90670_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F126073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114629_19131_0|SrvcGrp|114093|2022|PDM|511.00|99|0.00|PARTIAL HOSPITAL SUBSTANCE ABUSE|
20|FH_F114666_30342_0|CSTM-ALL|CSTM-00|2020|PDM|1664.00|99|0.00|AEG 7 (NO REV)|
20|FH_F138207_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F139652_42211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139113_21804_0|SrvcGrp|79720|2022|PDM|1076.00|99|0.00|ACUTE REHAB II|
20|FH_F114985_32073_0|SrvcGrp|16|2022|PDM|1898.00|99|0.00|ACUTE REHABILITATION|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|MANUAL BODY MUSCLE TESTING|
20|FH_F100664_03104_0|SrvcGrp|73605|2022|PDM|2669.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F136796_24016_0|SrvcGrp|103540|2022|PDM|6749.71|99|0.00|INSERT SPINAL INFUSION|
20|FH_F136930_73114_0|SrvcGrp|72996|2022|PDM|6139.00|99|0.00|AEG 4|
20|FH_F38826_0_0|SrvcGrp|65|2022|PCT|0.73|99|0.00|OBSTETRICAL CARE|
20|FH_F116393_07002_0|CSTM-ALL|CSTM-00|2020|PDM|52.36|99|0.00|COGNITIVE SKILLS DEVELOPMENT|
20|FH_F116393_07002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147586_44124_0|SrvcGrp|33986|2022|PDM|903.00|99|0.00|CPT 26055|
20|FH_F147404_37863_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147560_30809_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F147520_61614_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41663_0_0|SrvcGrp|9907|2022|PDM|1300.00|99|0.00|ACUTE MEDICAL/SURGICAL SVCS|
20|FH_F42024_0_0|SrvcGrp|9511|2022|PDM|140.00|99|0.00|OBSERVATION SVCS|
20|FH_F42539_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F42654_0_0|SrvcGrp|10542|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F120612_23314_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150939_0_0|SrvcGrp|109210|2022|PDM|28.37|99|0.00|CCIIV4 VACC ABX FREE IM|
20|FH_F114853_0_0|SrvcGrp|67279|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY|
20|FH_F39839_0_0|SrvcGrp|3029|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F138936_01040_0|SrvcGrp|105442|2022|PDM|618.00|99|0.00|ABH OP TERANIAL MAGN|
20|FH_F138992_72703_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F151420_60654_0|SrvcGrp|101519|2022|PDM|3160.00|99|0.00|T1H UTERUS (<250G)|
20|FH_F151503_30067_0|SrvcGrp|96542|2022|PDM|4606.00|99|0.00|REPAIR OF LEG TENDON|
20|FH_F151511_14094_0|SrvcGrp|10365|2022|PDM|1072.00|99|0.00|CPT CODE 99285|
20|FH_F151511_14094_0|SrvcGrp|109057|2022|PCT|1.00|99|0.00|CARDIAC STUDIES|
20|FH_F132163_17601_0|SrvcGrp|90572|2022|PDM|223.00|99|0.00|INTENSIVE OP PSYCH (HCFA)|
20|FH_F132238_27615_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F144991_43607_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133119_46545_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F135609_37027_0|SrvcGrp|86722|2022|PDM|257.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F131265_84106_0|SrvcGrp|46903|2022|PDM|880.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F116468_49660_0|SrvcGrp|89417|2022|PDM|380.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|658.00|99|0.00|AEG 1 (NO REV)|
20|FH_F121407_73701_0|SrvcGrp|997|2022|PCT|0.39|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F129329_07039_0|SrvcGrp|91070|2022|PDM|325.00|99|0.00|AETNA MH CRISIS INTERVENTION (HCFA)|
20|FH_F111301_33122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F134263_15628_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134312_76301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD TC|
20|FH_F69202_0_0|SrvcGrp|20293|2022|PDM|22000.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY|
20|FH_F150619_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F54272_0_0|SrvcGrp|109|2022|PDM|1116.00|99|0.00|CD - DETOX|
20|FH_F87557_33309_0|SrvcGrp|22593|2022|PDM|30.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F141035_0_0|SrvcGrp|35667|2022|PDM|6016.00|99|0.00|CPT 20680|
20|FH_F128695_50049_0|SrvcGrp|23683|2022|PDM|60.00|99|0.00|SKILLED NURSING RN|
20|FH_F102228_08846_0|SrvcGrp|86748|2022|PCT|1.05|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F98300_30236_0|SrvcGrp|75443|2022|PDM|1094.00|99|0.00|OBSERVATION - REV 769|
20|FH_F96960_35404_0|SrvcGrp|73659|2022|PDM|7089.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F134202_0_0|SrvcGrp|63472|2022|PDM|4480.39|99|0.00|CPT 64581|
20|FH_F143648_0_0|SrvcGrp|108124|2022|PDM|784.00|99|0.00|REMOVE INTRAUTERINE DEVICE|
20|FH_F102948_43606_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F136429_0_0|SrvcGrp|82310|2022|PDM|700.00|99|0.00|COLORECTAL CANCER SCREENING|
20|FH_F124212_33407_0|SrvcGrp|46903|2022|PDM|680.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F47872_83330_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS|
20|FH_F70762_90805_0|SrvcGrp|80|2022|PDM|635.00|99|0.00|ACUTE PSYCH|
20|FH_F95221_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F86157_75090_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F89736_0_0|SrvcGrp|111946|2022|PDM|13212.00|99|0.00|SPINE PROCEDURES (HIGH ACUITY)|
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F74602_0_0|SrvcGrp|71879|2022|PDM|800.00|99|0.00|ER|
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|1084.86|99|0.00|AEG 5  (NO REV)|
20|FH_F88639_80204_0|SrvcGrp|73499|2022|PDM|1402.77|99|0.00|AETNA ER LEVEL II|
20|FH_F123785_62298_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132810_0_0|SrvcGrp|111526|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F58856_0_0|SrvcGrp|20898|2022|PDM|19500.00|99|0.00|MS DRG 246 ONLY|
20|FH_F62577_0_0|SrvcGrp|58463|2022|PDM|1074.00|99|0.00|ASPG X|
20|FH_F115166_0_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F136386_30901_0|SrvcGrp|34553|2022|PDM|8925.00|99|0.00|MS DRG 313 ONLY CHEST PAIN|
20|FH_F136390_46321_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F120424_03060_0|SrvcGrp|73842|2022|PDM|182.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120490_64133_0|SrvcGrp|86828|2022|PDM|125.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F93358_63084_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F136952_78218_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F137054_22041_0|SrvcGrp|92501|2022|PDM|180.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F137147_75006_0|SrvcGrp|26682|2022|PDM|136216.00|99|0.00|MS DRG 453 ONLY|
20|FH_F137147_75006_0|SrvcGrp|31928|2022|PDM|86231.00|99|0.00|MS DRG 456 ONLY|
20|FH_F137237_33304_0|SrvcGrp|73841|2022|PDM|420.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F142741_03264_0|SrvcGrp|109798|2022|PCT|1.10|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F138584_30912_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 2 (NO REV) W/O FACIAL SURGERY|
20|FH_F137287_0_0|SrvcGrp|113071|2022|PDM|600.00|99|0.00|FULL DAY OP THERAPY|
20|FH_F140571_46514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F149701_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151603_27609_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F151611_30032_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119023_91406_0|SrvcGrp|86836|2022|PDM|12.50|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F92506_07666_0|SrvcGrp|76619|2022|PDM|210.00|99|0.00|THERAPY|
20|FH_F109884_36117_0|SrvcGrp|89337|2022|PDM|881.00|99|0.00|DETOXIFICATION|
20|FH_F109925_81301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117261_43543_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147861_45239_0|SrvcGrp|90388|2022|PDM|900.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F129483_77030_0|SrvcGrp|14947|2022|PDM|5.00|99|0.00|HOME INFUSION|
20|FH_F137818_31602_0|SrvcGrp|73841|2022|PDM|503.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F109652_0_0|SrvcGrp|78790|2022|PDM|5812.00|99|0.00|LAPAROSCOPY|
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|647.00|99|0.00|AEG 2 (NO REV)|
20|FH_F119285_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT|
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|623.00|99|0.00|AEG 3 (NO REV)|
20|FH_F69364_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SURGERY|
20|FH_F85757_0_0|SrvcGrp|82222|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F42952_0_0|CSTM-ALL|CSTM-00|2020|PDM|1299.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69347_0_0|SrvcGrp|44767|2022|PDM|9737.00|99|0.00|PORTLAND ADVENTIST ASPG VI|
20|FH_F111594_0_0|SrvcGrp|41335|2022|PDM|7215.00|99|0.00|TOTAL HIP|
20|FH_F132212_0_0|SrvcGrp|14494|2022|PDM|18.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F148425_01507_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F68868_0_0|SrvcGrp|20752|2022|PDM|19390.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F148555_0_0|SrvcGrp|115503|2022|PDM|10300.00|99|0.00|EP & ABLATE SUPRAVENT ARRHYT|
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_F120437_85202_0|SrvcGrp|64601|2022|PDM|69.05|99|0.00|HIGH COST DRUGS J1557|
20|FH_F120406_84047_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F33866_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45179_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F87615_80033_0|SrvcGrp|42625|2022|PDM|444.00|99|0.00|BEHAVIORAL HEALTH GENERAL|
20|FH_F88280_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F124585_33070_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F124653_64062_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F124679_64052_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F60365_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F127995_84010_0|SrvcGrp|86854|2022|PDM|25.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F67882_0_0|SrvcGrp|24714|2022|PCT|0.75|99|0.00|INTRAOCULAR LENS|
20|FH_F113937_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139306_08854_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114985_32073_0|SrvcGrp|102982|2022|PDM|104.00|99|0.00|PSYTX WPT W E/M 60 MIN|
20|FH_F114985_32073_0|SrvcGrp|89500|2022|PDM|182.00|99|0.00|SPEECH SOUND LANGUAGE|
20|FH_F148553_85016_0|SrvcGrp|115491|2022|PDM|3290.00|99|0.00|PERC DRUG-EL COR STENT SING|
20|FH_F127448_0_0|SrvcGrp|107879|2022|PDM|1900.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F127448_0_0|SrvcGrp|73002|2022|PDM|1500.00|99|0.00|AEG 7|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PDM|1120.00|99|0.00|ASPG VII|
20|FH_F134675_60134_0|SrvcGrp|86723|2022|PDM|391.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F136783_40069_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F112189_81212_0|SrvcGrp|471|2022|PDM|541.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|812.00|99|0.00|AEG 5  (NO REV)|
20|FH_F77234_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147586_44124_0|SrvcGrp|88592|2022|PDM|1595.00|99|0.00|LARYNGOSCOPY DIRECT OPERATION|
20|FH_F147621_74338_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41695_0_0|SrvcGrp|34766|2022|PDM|46.00|99|0.00|GHP THERAPY SERVICES|
20|FH_F139679_75050_0|SrvcGrp|73841|2022|PDM|473.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F150700_90028_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150839_03833_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150839_03833_0|SrvcGrp|27968|2022|PDM|56.18|99|0.00|SKILLED NURSING LPN|
20|FH_F134394_92101_0|SrvcGrp|112563|2022|PDM|604.00|99|0.00|PARTIAL HOSP (12-17 YRS)|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|409.77|99|0.00|SALLY BALIN,999182,ASC 304|
20|FH_F147170_53051_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F35768_32827_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148519_83201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PDM|1596.00|99|0.00|ASPG V|
20|FH_F122264_75972_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151007_90048_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F73768_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F150442_28451_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 10 (NO REV)|
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 7 (NO REV)|
20|FH_F37444_0_0|SrvcGrp|9861|2022|PCT|0.70|99|0.00|ACUTE REHABILITATION|
20|FH_F50415_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|HOME HEALTH MOD TD|
20|FH_F130044_0_0|SrvcGrp|111413|2022|PDM|185.00|99|0.00|OB C-SECTION|
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|1850.00|99|0.00|NASAL ENDO EUSTACHIAN TUBE|
20|FH_F75944_0_0|SrvcGrp|68185|2022|PDM|642.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 1|
20|FH_F111266_30339_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F150982_0_0|SrvcGrp|76603|2022|PDM|1382.00|99|0.00|CPT 25111|
20|FH_F34853_0_0|SrvcGrp|3029|2022|PDM|700.00|99|0.00|NEWBORN NURSERY|
20|FH_F109251_62269_0|SrvcGrp|103223|2022|PDM|92.60|99|0.00|APPLY MULTLAY COMPRS LWR LEG|
20|FH_F109762_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F38986_0_0|CSTM-ALL|CSTM-00|2020|PDM|1185.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F67924_0_0|SrvcGrp|43891|2022|PDM|60.00|99|0.00|RN HOURLY PEDS|
20|FH_F139974_37214_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147226_48154_0|SrvcGrp|42623|2022|PDM|539.00|99|0.00|SUBACUTE - LEVEL III|
20|FH_F136395_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F69183_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|MS DRG 774-775, 767-768 NORMAL DELIVERY (MS DRG ONLY)|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|ASPG III|
20|FH_F120104_97223_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F37487_0_0|SrvcGrp|9230|2022|PDM|79.00|99|0.00|HOME IV THERAPY SVCS|
20|FH_F145920_0_0|SrvcGrp|114371|2022|PDM|1712.00|99|0.00|EXC BACK LES SC = 3 CM|
20|FH_F138017_73129_0|SrvcGrp|86425|2022|PDM|6196.00|99|0.00|EGD LESION ABLATION|
20|FH_F41160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F36634_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F126272_70403_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146266_0_0|SrvcGrp|70749|2022|PDM|3200.00|99|0.00|CPT 29823|
20|FH_F128741_92879_0|SrvcGrp|44424|2022|PDM|190.69|99|0.00|MEDICAL SOCIAL WORKER (VISIT LVL)|
20|FH_F114207_35243_0|SrvcGrp|86847|2022|PDM|35.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F90817_0_0|SrvcGrp|90366|2022|PDM|1880.00|99|0.00|RHINOPLASTY COMPLETE EXT PRT|
20|FH_F131571_63301_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123386_0_0|SrvcGrp|63381|2022|PCT|0.50|99|0.00|OP SURGERY|
20|FH_F122392_78207_0|SrvcGrp|73842|2022|PDM|202.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F44476_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F99142_80233_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.20|99|0.00|AEG 2 (NO REV)|
20|FH_F130661_04441_0|SrvcGrp|106251|2022|PCT|4.24|99|0.00|LABORATORY SERVICES|
20|FH_F151158_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123570_0_0|SrvcGrp|41337|2022|PDM|3090.00|99|0.00|LAPAROSCOPIC PROCEDURES|
20|FH_F111266_30339_0|SrvcGrp|74147|2022|PDM|30.00|99|0.00|INFUSION S-CODE PER MONTH|
20|FH_F110783_93013_0|SrvcGrp|22589|2022|PDM|50.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F117372_07442_0|SrvcGrp|90631|2022|PDM|145.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F121068_18036_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F103360_68845_0|SrvcGrp|98249|2022|PDM|29730.00|99|0.00|CARDIAC CATH|
20|FH_F44097_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F128615_78520_0|SrvcGrp|73842|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F118027_28801_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F107082_21015_0|SrvcGrp|75545|2022|PDM|393.75|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F102561_75146_0|SrvcGrp|98015|2022|PDM|2850.00|99|0.00|CYSTOURETHROSCOPY|
20|FH_F133395_98801_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC|
20|FH_F106100_26651_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117009_0_0|SrvcGrp|38909|2022|PDM|2243.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F126650_68105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141870_85224_0|SrvcGrp|22592|2022|PDM|40.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F123096_28210_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133118_33143_0|SrvcGrp|86722|2022|PDM|218.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F147995_67037_0|SrvcGrp|75506|2022|PCT|1.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F92676_15063_0|SrvcGrp|78943|2022|PDM|3183.92|99|0.00|MON VALLEY ASC 701|
20|FH_F141668_47978_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147998_07030_0|SrvcGrp|109798|2022|PCT|1.10|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F33660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F149860_80112_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F130108_0_0|SrvcGrp|13715|2022|PCT|0.60|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F56792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL FEES F/S|
20|FH_F62560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F112832_06776_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1210.00|99|0.00|AEG 3 (NO REV)|
20|FH_F133455_60110_0|SrvcGrp|88620|2022|PDM|116.00|99|0.00|SKILLED NURSING RN|
20|FH_F92854_63028_0|SrvcGrp|78534|2022|PDM|0.35|99|0.00|AETNA MED RECORD|
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F44016_0_0|SrvcGrp|10425|2022|PDM|791.00|99|0.00|NEWBORN NURSERY|
20|FH_F126626_80906_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F37641_0_0|SrvcGrp|68580|2022|PCT|1.00|99|0.00|IMMUNIZATIONS|
20|FH_F89932_10940_0|SrvcGrp|89143|2022|PCT|3.45|99|0.00|RADIATION TREATMENT DELIVERY|
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AETNA OP IMAGING ENHANC. SUBSTANCES (IMAGENHANCE)|
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80537_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|GENERAL ACUTE CARE|
20|FH_F40599_0_0|SrvcGrp|411|2022|PDM|3852.00|99|0.00|OP CARDIAC CATH|
20|FH_F128246_0_0|SrvcGrp|111034|2022|PDM|726.00|99|0.00|REPAIR EYELID DEFECT|
20|FH_F116440_0_0|SrvcGrp|73483|2022|PDM|500.00|99|0.00|AETNA SUBACUTE III|
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 9 (NO REV)|
20|FH_F32288_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F98640_0_0|SrvcGrp|88613|2022|PDM|1818.00|99|0.00|REMOVAL OF TONSILS|
20|FH_F72387_0_0|SrvcGrp|3934|2022|PDM|220.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS|
20|FH_F101840_76054_0|SrvcGrp|21220|2022|PDM|14641.00|99|0.00|MS DRG 742 ONLY|
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F127432_18015_0|SrvcGrp|11306|2022|PCT|0.10|99|0.00|IMPLANTS|
20|FH_F132900_06074_0|SrvcGrp|112084|2022|PDM|371.00|99|0.00|INTENSIVE OUTPATIENT EATING DISORDERS (0-17 YRS)|
20|FH_F128299_44134_0|SrvcGrp|94780|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F136751_0_0|SrvcGrp|88491|2022|PDM|9500.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F149344_0_0|SrvcGrp|13683|2022|PDM|594.21|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F133287_40215_0|SrvcGrp|8950|2022|PDM|2247.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F112936_32081_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126975_43551_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149605_0_0|SrvcGrp|63297|2022|PDM|153.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F89851_83854_0|SrvcGrp|75505|2022|PCT|2.00|99|0.00|CARDIAC STUDIES|
20|FH_F90811_0_0|SrvcGrp|90438|2022|PDM|2500.00|99|0.00|ARM SURGICAL PROCEDURES|
20|FH_F141870_85224_0|SrvcGrp|111025|2022|PCT|0.83|99|0.00|SUPPLIES|
20|FH_F36576_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ORTHOPEDIC PROCEDURES|
20|FH_F112862_46176_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149781_37404_0|SrvcGrp|92819|2022|PDM|4500.00|99|0.00|HIP ARTHOSCOPY|
20|FH_F55375_0_0|SrvcGrp|17071|2022|PDM|2778.00|99|0.00|ASPG IV|
20|FH_F125352_90034_0|SrvcGrp|75419|2022|PDM|550.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F101983_17578_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37537_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132591_75146_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F141870_85224_0|SrvcGrp|86851|2022|PDM|40.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F120437_85202_0|SrvcGrp|17014|2022|PDM|77.66|99|0.00|HOME INFUSION THERAPY|
20|FH_F146217_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126666_44053_0|SrvcGrp|91780|2022|PDM|44.00|99|0.00|AETNA GROUP THERAPY MOD (MOD AJ)(HCFA)|
20|FH_F133490_90650_0|CSTM-ALL|CSTM-00|2020|PDM|2857.00|99|0.00|AEG 4 (NO REV)|
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|1343.00|99|0.00|AEG 3 (NO REV)|
20|FH_F90811_0_0|SrvcGrp|84181|2022|PDM|2700.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS|
20|FH_F132420_84660_0|SrvcGrp|73063|2022|PDM|802.77|99|0.00|OBSERVATION SERVICES|
20|FH_F132587_57105_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER NUKC|
20|FH_F141753_63334_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151061_02720_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F151085_15905_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151087_60548_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151280_20740_0|SrvcGrp|74668|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121404_32216_0|SrvcGrp|108778|2022|PDM|173.00|99|0.00|HEATED HUMIDIFIER (MOD NU) (HCFA)|
20|FH_F129468_15010_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F111857_68005_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F37338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F74424_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149400_83301_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F31547_0_0|SrvcGrp|12707|2022|PCT|1.00|99|0.00|OPHTHALMOLOGIC SURGERY|
20|FH_F144831_0_0|SrvcGrp|48398|2022|PDM|14.50|99|0.00|PT SERVICES|
20|FH_F40104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|18459.00|99|0.00|MS DRGS 248, 250-251 (PTCA W/O STENT)|
20|FH_F117576_21207_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134603_0_0|SrvcGrp|83824|2022|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES|
20|FH_F133677_15601_0|SrvcGrp|92501|2022|PDM|129.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F90817_0_0|SrvcGrp|90377|2022|PDM|1198.00|99|0.00|FUSION OF FINGER JOINT|
20|FH_F92032_32308_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|615.00|99|0.00|AEG 3 (NO REV)|
20|FH_F36094_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117762_0_0|SrvcGrp|35669|2022|PDM|3328.00|99|0.00|CPT 63650|
20|FH_F83431_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.46|99|0.00|GENERAL ACUTE CARE|
20|FH_F124976_0_0|SrvcGrp|89337|2022|PDM|998.00|99|0.00|DETOXIFICATION|
20|FH_F146266_0_0|SrvcGrp|100000|2022|PDM|6582.00|99|0.00|RECONSTRUCT WRIST DIST ULNA|
20|FH_F120099_86305_0|SrvcGrp|89337|2022|PDM|1601.00|99|0.00|DETOXIFICATION|
20|FH_F35798_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37493_0_0|SrvcGrp|38|2022|PDM|5905.00|99|0.00|NORMAL DELIVERY|
20|FH_F113116_23847_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116806_0_0|SrvcGrp|107093|2022|PDM|973.15|99|0.00|REMOVAL OF SKIN LESION|
20|FH_F146859_0_0|SrvcGrp|114850|2022|PDM|1096.00|99|0.00|NERVOUS SYSTEM PROCEDURE|
20|FH_F38986_0_0|SrvcGrp|38|2022|PDM|2535.00|99|0.00|NORMAL DELIVERY|
20|FH_F84433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150382_80821_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F113545_11201_0|SrvcGrp|86746|2022|PCT|1.02|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F36943_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD KM|
20|FH_F48855_0_0|SrvcGrp|44302|2022|PDM|70.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP|
20|FH_F39673_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111080_18103_0|SrvcGrp|89417|2022|PDM|330.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD RR|
20|FH_F116753_0_0|SrvcGrp|102360|2022|PDM|7465.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY|
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|1675.00|99|0.00|DEVICE INSERTION|
20|FH_F137767_01841_0|CSTM-ALL|CSTM-00|2020|PDM|3365.00|99|0.00|AEG 4 (NO REV)|
20|FH_F150925_33936_0|SrvcGrp|30089|2022|PDM|500.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F97080_85122_0|SrvcGrp|73643|2022|PDM|1096.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F71468_0_0|SrvcGrp|14893|2022|PDM|47.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F93172_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F39082_0_0|SrvcGrp|941|2022|PDM|2452.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F113765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F74845_0_0|SrvcGrp|941|2022|PCT|0.85|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F48254_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP|
20|FH_F74844_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|SKILLED NURSING|
20|FH_F33566_0_0|SrvcGrp|7|2022|PDM|1750.00|99|0.00|NEONATAL INTENSIVE|
20|FH_F137748_95231_0|SrvcGrp|72984|2022|PCT|1.00|99|0.00|CHEMOTHERAPY|
20|FH_F35847_0_0|SrvcGrp|6|2022|PCT|0.66|99|0.00|OP SURGERY|
20|FH_F37267_0_0|SrvcGrp|10410|2022|PDM|42.25|99|0.00|SKILLED NURSING CARE|
20|FH_F37338_0_0|SrvcGrp|26107|2022|PDM|118.00|99|0.00|URGENT CARE|
20|FH_F139910_0_0|CSTM-ALL|CSTM-00|2020|PDM|404.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F149030_37919_0|CSTM-ALL|CSTM-00|2020|PDM|4986.23|99|0.00|LAPARO HERNIA REPAIR|
20|FH_F67924_0_0|SrvcGrp|44949|2022|PDM|44.00|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F94621_07728_0|SrvcGrp|87899|2022|PCT|1.00|99|0.00|AMPHOTERCIN B 50MG|
20|FH_F111266_30339_0|SrvcGrp|86850|2022|PDM|30.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F90196_10467_0|SrvcGrp|86753|2022|PCT|1.05|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F139565_0_0|SrvcGrp|109348|2022|PDM|2869.00|99|0.00|EXCISION OF LESION OF EYELID|
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132254_40207_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136493_0_0|SrvcGrp|97506|2022|PDM|56.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F108680_0_0|SrvcGrp|88163|2022|PDM|6710.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F151009_07649_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139785_92629_0|SrvcGrp|73605|2022|PDM|2835.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F116806_0_0|SrvcGrp|107083|2022|PDM|1923.16|99|0.00|TREATMENT OF MANDIBULAR FRACTURE W/O INTERDENTAL FIXATION|
20|FH_F113869_40215_0|SrvcGrp|93919|2022|PDM|503.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F116575_0_0|SrvcGrp|79101|2022|PDM|1600.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F147140_89103_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F111246_80027_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|GENERAL ACUTE CARE|
20|FH_F37708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148964_30101_0|SrvcGrp|58509|2022|PDM|360.00|99|0.00|DRUGS AND ALCOHOL REHAB|
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_F134847_0_0|SrvcGrp|93059|2022|PDM|5135.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134919_02155_0|SrvcGrp|46605|2022|PDM|102.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F36992_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD TC|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD AW|
20|FH_F42016_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F119310_20850_0|SrvcGrp|63379|2022|PDM|170.00|99|0.00|CARDIAC REHABILITATION|
20|FH_F111266_30339_0|SrvcGrp|47183|2022|PDM|60.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F118907_0_0|SrvcGrp|74794|2022|PDM|172.21|99|0.00|SLEEP STUDY|
20|FH_F126554_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F139792_26034_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143249_89801_0|SrvcGrp|22593|2022|PDM|30.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F143347_16001_0|CSTM-ALL|CSTM-00|2020|PDM|2443.00|99|0.00|AEG 3 (NO REV)|
20|FH_F143410_77845_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F101566_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F102224_0_0|SrvcGrp|93724|2022|PDM|4000.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F82375_28601_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD AU|
20|FH_F49286_0_0|SrvcGrp|10518|2022|PDM|25.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT|
20|FH_F120171_33770_0|SrvcGrp|89149|2022|PDM|207.00|99|0.00|OP INTENSIVE|
20|FH_F116552_70001_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116802_41224_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F91372_63043_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F91392_63105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F36372_0_0|SrvcGrp|10648|2022|PDM|2.00|99|0.00|HOME INFUSION|
20|FH_F133100_0_0|SrvcGrp|111630|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F38808_0_0|SrvcGrp|17083|2022|PDM|561.00|99|0.00|ASPG X|
20|FH_F38808_0_0|SrvcGrp|17065|2022|PDM|366.00|99|0.00|ASPG I|
20|FH_F150663_0_0|SrvcGrp|90854|2022|PDM|876.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F119417_78212_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F119496_37917_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140035_0_0|SrvcGrp|48385|2022|PDM|197.00|99|0.00|SPEECH THERAPY|
20|FH_F148431_60523_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97182_21502_0|SrvcGrp|73601|2022|PDM|5606.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F115505_21014_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F38770_0_0|SrvcGrp|537|2022|PCT|0.55|99|0.00|OBSERVATION SERVICES|
20|FH_F89112_16509_0|SrvcGrp|10503|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F97141_93933_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F106243_92780_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117829_45227_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F98620_43920_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F124608_0_0|SrvcGrp|89857|2022|PDM|6452.00|99|0.00|REMOVAL OF SPINAL LAMINA|
20|FH_F86293_0_0|SrvcGrp|78878|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F71667_0_0|SrvcGrp|16277|2022|PCT|0.50|99|0.00|HIGH COST DRUGS|
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)|
20|FH_F39995_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION|
20|FH_F113326_80014_0|SrvcGrp|104336|2022|PCT|1.00|99|0.00|DENOSUMAB INJECTION|
20|FH_F126806_44125_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151519_35758_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133018_84037_0|SrvcGrp|34566|2022|PDM|22.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F56793_0_0|SrvcGrp|43567|2022|PDM|80.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F150525_16056_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121168_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F101840_76054_0|SrvcGrp|87311|2022|PDM|15935.00|99|0.00|MSDRG 274 ONLY|
20|FH_F42117_0_0|SrvcGrp|38009|2022|PDM|125.00|99|0.00|RHO D IMMUNE GLOB|
20|FH_F126815_02118_0|SrvcGrp|72984|2022|PCT|0.55|99|0.00|CHEMOTHERAPY|
20|FH_F146211_68144_0|SrvcGrp|114503|2022|PCT|1.00|99|0.00|COVID 19 VACCINE ADMINISTRATION|
20|FH_F132737_0_0|SrvcGrp|40820|2022|PDM|2933.00|99|0.00|ICU/CCU|
20|FH_F123144_0_0|SrvcGrp|73006|2022|PDM|1405.00|99|0.00|AEG 9|
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_F148556_13206_0|SrvcGrp|24758|2022|PDM|10.00|99|0.00|HOME INJECTABLE THERAPY|
20|FH_F146104_33410_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: BREAKOUT|
20|FH_F120058_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F121304_61520_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F147997_92620_0|SrvcGrp|46903|2022|PDM|3300.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F111423_34952_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F117793_90405_0|SrvcGrp|74615|2022|PDM|350.00|99|0.00|INTENSIVE OUTPATIENT|
20|FH_F63417_0_0|SrvcGrp|44883|2022|PDM|18.00|99|0.00|RT/PT/ST/OT|
20|FH_F67680_0_0|SrvcGrp|50842|2022|PDM|135.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39723_0_0|SrvcGrp|16555|2022|PDM|80.00|99|0.00|DIURETIC THERAPY|
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|686.00|99|0.00|AEG 10 (NO REV)|
20|FH_F44272_0_0|CSTM-ALL|CSTM-00|2020|PDM|170.00|99|0.00|OP SVCS|
20|FH_F35750_0_0|SrvcGrp|3409|2022|PDM|579.00|99|0.00|NEWBORN NURSERY|
20|FH_F46433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2010 B CODES (MOD RR)|
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_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|3017.00|99|0.00|AEG 6 (NO REV)|
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|787.00|99|0.00|AEG 2 (NO REV)|
20|FH_F147237_40006_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F137798_0_0|SrvcGrp|95660|2022|PDM|567.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F144651_0_0|SrvcGrp|40002|2022|PDM|15500.00|99|0.00|TOTAL HIP|
20|FH_F36883_0_0|SrvcGrp|69441|2022|PDM|25.00|99|0.00|CLINIC VISIT|
20|FH_F35410_0_0|SrvcGrp|11798|2022|PDM|86.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F131392_17004_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F140233_35216_0|SrvcGrp|71666|2022|PDM|21000.00|99|0.00|CPT 63655|
20|FH_F143249_89801_0|SrvcGrp|17016|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F143536_47546_0|SrvcGrp|82745|2022|PCT|1.00|99|0.00|CULT BACT NO URINE/BLD/STOOL|
20|FH_F140552_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|PRIMARY CHILDREN'S MED CTR 10%_FIRST CHOICE|
20|FH_F101540_0_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F151752_63017_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120196_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|866.00|99|0.00|AEG 1 (NO REV)|
20|FH_F120851_66112_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F120856_78247_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120885_66224_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120977_50510_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F118889_17701_0|SrvcGrp|92760|2022|PCT|1.13|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F51276_0_0|SrvcGrp|27053|2022|PDM|31.66|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3HRS(MOD SJ)|
20|FH_F35685_0_0|SrvcGrp|11205|2022|PDM|12679.00|99|0.00|DRG 544 MAJOR JOINT REPLACEMENT/REATTACHMENT OF LWR EXTRMTY|
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_F39967_0_0|SrvcGrp|10111|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F42177_0_0|SrvcGrp|19595|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F63235_0_0|SrvcGrp|15473|2022|PDM|2005.00|99|0.00|CPT CODE 42820|
20|FH_F38411_0_0|SrvcGrp|19528|2022|PCT|0.80|99|0.00|MS DRG 808|
20|FH_F135840_0_0|SrvcGrp|79594|2022|PDM|550.00|99|0.00|CPT 45380|
20|FH_F130721_04769_0|SrvcGrp|111928|2022|PCT|1.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F148521_0_0|CSTM-ALL|CSTM-00|2020|PDM|398.00|99|0.00|AEG 2 (NO REV)|
20|FH_F110442_98003_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F144228_0_0|SrvcGrp|114142|2022|PDM|1078.00|99|0.00|TREAT KNEE DISLOCATION|
20|FH_F146640_54155_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F130017_02302_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|AEG 10 (NO REV)|
20|FH_F110345_37919_0|SrvcGrp|86748|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F110522_13501_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130017_02302_0|SrvcGrp|53152|2022|PDM|17230.28|99|0.00|MS DRG 259 ONLY|
20|FH_F45200_0_0|SrvcGrp|39652|2022|PDM|264.00|99|0.00|SKILLED NURSING VENT SUPPORT|
20|FH_F85098_33486_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F130763_0_0|SrvcGrp|82108|2022|PDM|4391.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F120719_27540_0|SrvcGrp|10362|2022|PDM|424.00|99|0.00|CPT CODE 99282|
20|FH_F118123_67226_0|SrvcGrp|48398|2022|PDM|83.00|99|0.00|PT SERVICES|
20|FH_F81698_10457_0|SrvcGrp|86836|2022|PDM|10.50|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|16823.00|99|0.00|MS DRG 466-468|
20|FH_F83978_66739_0|SrvcGrp|53065|2022|PDM|693.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F132728_0_0|SrvcGrp|51672|2022|PDM|7161.00|99|0.00|MS DRG 286-287 ONLY|
20|FH_F112987_46222_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110453_0_0|SrvcGrp|73008|2022|PDM|677.00|99|0.00|AEG 10|
20|FH_F88744_71103_0|SrvcGrp|3378|2022|PCT|0.65|99|0.00|OBSERVATION SVCS|
20|FH_F112060_07514_0|SrvcGrp|75545|2022|PDM|390.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F87775_15106_0|SrvcGrp|53145|2022|PDM|90.00|99|0.00|SOCIAL WORKER|
20|FH_F133585_0_0|SrvcGrp|17622|2022|PDM|151.00|99|0.00|CPT 75774|
20|FH_F86101_76063_0|SrvcGrp|46424|2022|PDM|95.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F118123_67226_0|SrvcGrp|88620|2022|PDM|83.00|99|0.00|SKILLED NURSING RN|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|610.00|99|0.00|MULTIPLE SPECT SCAN|
20|FH_F143620_81504_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F134610_33426_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F34182_0_0|SrvcGrp|18145|2022|PDM|2729.00|99|0.00|MS DRG 248|
20|FH_F143560_03079_0|SrvcGrp|81945|2022|PDM|500.00|99|0.00|AETNA 64 SLICE CTA|
20|FH_F73583_0_0|SrvcGrp|33414|2022|PDM|125.00|99|0.00|SNF VENTILATOR SUPPORT|
20|FH_F100063_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F110441_60062_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149342_72204_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F79245_0_0|SrvcGrp|59427|2022|PDM|75.00|99|0.00|OT|
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|512.00|99|0.00|AEG 3 (NO REV)|
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)|
20|FH_F142376_0_0|SrvcGrp|98609|2022|PDM|7405.00|99|0.00|POSTERIOR SEGMENTAL INSTRU|
20|FH_F118138_60532_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110420_60649_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F109577_0_0|SrvcGrp|29347|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F85272_77375_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37877_0_0|CSTM-ALL|CSTM-00|2020|PDM|664.00|99|0.00|ASPG IV|
20|FH_F127148_63011_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F70208_0_0|SrvcGrp|8950|2022|PDM|1610.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F127418_0_0|SrvcGrp|93063|2022|PDM|72664.26|99|0.00|LUMBAR ARTIF DISKECTOMY|
20|FH_F49552_0_0|SrvcGrp|11121|2022|PDM|81.00|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F133808_73401_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1847.00|99|0.00|AEG 4 (NO REV)|
20|FH_F135663_24401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F44278_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F149219_01966_0|SrvcGrp|115384|2022|PCT|1.00|99|0.00|COVID-19 INFUSION ADMINISTRATION COMBINATION - ELI LILLY|
20|FH_F148862_85390_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F80613_0_0|SrvcGrp|10544|2022|PDM|73.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F91777_29577_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F117206_0_0|SrvcGrp|72998|2022|PDM|1090.00|99|0.00|AEG 5|
20|FH_F133815_46526_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F118147_33801_0|SrvcGrp|73842|2022|PDM|198.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F85213_02840_0|SrvcGrp|73841|2022|PDM|1061.10|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F126157_34210_0|SrvcGrp|89149|2022|PDM|241.00|99|0.00|OP INTENSIVE|
20|FH_F110580_71106_0|SrvcGrp|84720|2022|PCT|0.00|99|0.00|AETNA LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F144291_0_0|SrvcGrp|107749|2022|PDM|182.00|99|0.00|CAPD/CCPD|
20|FH_F83054_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.03|99|0.00|AETNA AMFS ACE PEDIATRIC THERAPY|
20|FH_F126443_77089_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134431_92647_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F122434_40207_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F122672_44089_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F84712_0_0|SrvcGrp|73008|2022|PDM|3532.00|99|0.00|AEG 10|
20|FH_F84712_0_0|SrvcGrp|82765|2022|PDM|54.00|99|0.00|ELECTROLYTE PANEL|
20|FH_F86552_0_0|SrvcGrp|35669|2022|PDM|6000.00|99|0.00|CPT 63650|
20|FH_F80185_0_0|SrvcGrp|44106|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F101100_50314_0|SrvcGrp|97901|2022|PDM|13845.00|99|0.00|LIGATION OF ABDOMEN ARTERY|
20|FH_F105145_75075_0|SrvcGrp|73496|2022|PDM|2000.00|99|0.00|AETNA ER LEVEL V|
20|FH_F105361_80104_0|SrvcGrp|73605|2022|PDM|1633.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F146479_20782_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146798_44011_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120795_27514_0|SrvcGrp|74005|2022|PDM|5296.00|99|0.00|AETNA PET|
20|FH_F125440_04043_0|SrvcGrp|89417|2022|PDM|397.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|1223.00|99|0.00|AEG 1 (NO REV)|
20|FH_F116040_24637_0|SrvcGrp|86842|2022|PDM|25.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F116040_24637_0|SrvcGrp|24761|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F131677_50009_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F57834_0_0|SrvcGrp|41368|2022|PDM|1470.00|99|0.00|TELEMETRY|
20|FH_F148680_33311_0|SrvcGrp|472|2022|PDM|505.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F151279_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121338_37756_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F129130_92562_0|CSTM-ALL|CSTM-00|2020|PDM|12619.00|99|0.00|AEG 9 (NO REV) W/O KIDNEY LITHOTRIPSY AND ABLATION|
20|FH_F129130_92562_0|CSTM-ALL|CSTM-00|2020|PDM|2651.00|99|0.00|AEG 1 (NO REV) W/O CPT BONE TESTING/BLADDER PROCEDURES|
20|FH_F118661_0_0|SrvcGrp|82307|2022|PDM|903.00|99|0.00|COLORECTAL CANCER SCREENING|
20|FH_F38023_0_0|SrvcGrp|15850|2022|PDM|105.00|99|0.00|HOSPICE SVCS|
20|FH_F97721_01053_0|SrvcGrp|73559|2022|PDM|12096.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F97780_43614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F106822_0_0|SrvcGrp|100264|2022|PDM|30.00|99|0.00|REMOVE IMPACTED EAR WAX|
20|FH_F86911_0_0|SrvcGrp|85619|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F87201_0_0|SrvcGrp|42976|2022|PDM|125.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F113784_0_0|SrvcGrp|45924|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F88456_0_0|SrvcGrp|74670|2022|PCT|0.00|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F114916_30309_0|SrvcGrp|26275|2022|PDM|1600.00|99|0.00|CPT 29826|
20|FH_F142315_33701_0|SrvcGrp|113911|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F113130_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 2 (NO REV)|
20|FH_F130419_72476_0|SrvcGrp|73339|2022|PCT|0.90|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|1479.50|99|0.00|AEG 9 (NO REV)|
20|FH_F119581_0_0|SrvcGrp|107885|2022|PDM|2546.00|99|0.00|TRLUML BALO ANGIOP 1ST VEIN|
20|FH_F100401_15317_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F138751_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F131047_0_0|SrvcGrp|42529|2022|PDM|1815.00|99|0.00|NICU|
20|FH_F131047_0_0|SrvcGrp|14609|2022|PCT|0.57|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F132988_0_0|SrvcGrp|92364|2022|PDM|20434.62|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.00|99|0.00|AEG 1 (NO REV)|
20|FH_F130297_41042_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F141070_64093_0|SrvcGrp|48385|2022|PDM|127.00|99|0.00|SPEECH THERAPY|
20|FH_F72204_0_0|SrvcGrp|29744|2022|PDM|50.00|99|0.00|SKILLED NURSING CARE - MOD TD|
20|FH_F72204_0_0|SrvcGrp|44042|2022|PDM|80.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F114389_50131_0|SrvcGrp|86825|2022|PDM|123.08|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F49487_0_0|SrvcGrp|14949|2022|PDM|80.00|99|0.00|HOME INFUSION|
20|FH_F124180_0_0|SrvcGrp|22915|2022|PDM|3184.50|99|0.00|CPT CODE 42820|
20|FH_F124059_64055_0|SrvcGrp|19742|2022|PDM|83.00|99|0.00|MID-LINE INSERTION|
20|FH_F124136_75860_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F31595_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F145641_06902_0|SrvcGrp|88159|2022|PDM|3905.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F118127_30078_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116753_0_0|SrvcGrp|88297|2022|PCT|2.55|99|0.00|AETNA RADIOLOGY SVCS|
20|FH_F139767_15217_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127585_45069_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143581_02130_0|SrvcGrp|115386|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F31152_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133585_0_0|SrvcGrp|91577|2022|PDM|14572.00|99|0.00|FEM/POPL REVASC STNT & ATHER|
20|FH_F130017_02302_0|CSTM-ALL|CSTM-00|2020|PDM|3427.92|99|0.00|AEG 3 (NO REV)|
20|FH_F87012_0_0|SrvcGrp|73004|2022|PDM|1645.77|99|0.00|AEG 8|
20|FH_F130017_02302_0|SrvcGrp|9866|2022|PDM|4819.45|99|0.00|IP OBSERVATION SVCS|
20|FH_F78584_0_0|SrvcGrp|75647|2022|PCT|0.50|99|0.00|OP SURGERY|
20|FH_F149199_73005_0|CSTM-ALL|CSTM-00|2020|PDM|1481.00|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_F120539_89029_0|SrvcGrp|48396|2022|PDM|120.00|99|0.00|OT SERVICES|
20|FH_F145604_14850_0|SrvcGrp|13929|2022|PDM|35.00|99|0.00|GROWTH HORMONE|
20|FH_F117206_0_0|SrvcGrp|90601|2022|PDM|1485.00|99|0.00|REMOVAL OF LENS MATERIAL|
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|1597.00|99|0.00|AEG 2 (NO REV)|
20|FH_F92641_34994_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109244_19808_0|SrvcGrp|90631|2022|PDM|115.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F77943_0_0|SrvcGrp|23477|2022|PDM|15675.39|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F127090_45601_0|SrvcGrp|42404|2022|PCT|1.00|99|0.00|VENIPUNCTURE|
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|830.00|99|0.00|AEG 1 (NO REV)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1421.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 9 W/O REV|
20|FH_F121225_98902_0|SrvcGrp|17001|2022|PCT|0.85|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F149149_32937_0|SrvcGrp|115587|2022|PCT|1.00|99|0.00|COVID-19 VACCINES AND ADMINSTRATION|
20|FH_F90501_71101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F138507_62208_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F113325_80004_0|SrvcGrp|104336|2022|PCT|1.00|99|0.00|DENOSUMAB INJECTION|
20|FH_F142376_0_0|SrvcGrp|98589|2022|PDM|13983.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F118803_0_0|SrvcGrp|107881|2022|PDM|2162.15|99|0.00|STENT PLMT CTR DIALYSIS SEG|
20|FH_F85097_0_0|SrvcGrp|73202|2022|PCT|1.25|99|0.00|NORTH PHIL RADIOLOGY OCN F/S PRICING|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1505.81|99|0.00|HAPA WPA-NWPA 2012-13 ASC 3 W/O REV|
20|FH_F148779_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F133913_61008_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120291_0_0|SrvcGrp|95661|2022|PDM|249.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|210.36|99|0.00|HAPA WPA-NWPA 2012-13 ASC 237 W/O REV|
20|FH_F150239_75569_0|SrvcGrp|24754|2022|PCT|1.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|943.00|99|0.00|AEG 2 (NO REV)|
20|FH_F145708_89030_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F118310_60108_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F90496_13159_0|SrvcGrp|89337|2022|PDM|550.00|99|0.00|DETOXIFICATION|
20|FH_F134507_0_0|SrvcGrp|82804|2022|PDM|416.00|99|0.00|INHALATION SERVICES|
20|FH_F145604_14850_0|SrvcGrp|26868|2022|PDM|70.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F145641_06902_0|SrvcGrp|100923|2022|PDM|2204.00|99|0.00|DRUGS|
20|FH_F54592_0_0|SrvcGrp|27048|2022|PDM|37.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS(MOD SH)|
20|FH_F72543_0_0|SrvcGrp|69020|2022|PDM|91.80|99|0.00|LPN|
20|FH_F86137_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F84712_0_0|SrvcGrp|72994|2022|PDM|2523.00|99|0.00|AEG 3|
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PDM|2143.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F98800_85021_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F146499_72206_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120795_27514_0|SrvcGrp|73841|2022|PDM|858.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F116040_24637_0|SrvcGrp|14948|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F133581_84790_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132276_33179_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133461_61277_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132928_64114_0|SrvcGrp|88781|2022|PDM|147.60|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F132898_06088_0|SrvcGrp|75545|2022|PDM|437.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F111566_75093_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|GENERAL ACUTE CARE|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.60|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 5 W/O REV|
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|379.97|99|0.00|2005 ASPG GROUPER I|
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|88740|2022|PDM|2195.00|99|0.00|SP BONE ALGRFT|
20|FH_F113154_70359_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113154_70359_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|AEG 10 (NO REV)|
20|FH_F133536_0_0|SrvcGrp|83642|2022|PDM|2400.00|99|0.00|CPT 29883|
20|FH_F36439_0_0|SrvcGrp|24406|2022|PDM|400.00|99|0.00|HEARING AIDS|
20|FH_F39075_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.60|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_F83420_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F46732_0_0|SrvcGrp|10623|2022|PDM|144.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F49895_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F59732_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|PEDIATRIC OCCUPATIONAL THERAPY|
20|FH_F59732_0_0|SrvcGrp|24748|2022|PDM|85.00|99|0.00|CORTICOSTEROID THERAPY|
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|1493.00|99|0.00|ASPG II - FH SW CUSTOM GROUPERS|
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|AEG 4 (NO REV)|
20|FH_F52854_0_0|SrvcGrp|17139|2022|PDM|632.00|99|0.00|HOSPICE CARE|
20|FH_F141527_36830_0|SrvcGrp|22593|2022|PDM|26.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F51074_0_0|SrvcGrp|11336|2022|PCT|0.55|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F137487_74447_0|SrvcGrp|49682|2022|PCT|1.15|99|0.00|HSS DRG GROUPED|
20|FH_F37863_0_0|CSTM-ALL|CSTM-00|2020|PDM|42.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F124388_0_0|SrvcGrp|77450|2022|PDM|1254.00|99|0.00|CPT 54161|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|444.43|99|0.00|HAPA WPA-NWPA 2012-13 ASC 303 W/O REV|
20|FH_F109601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135290_60115_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63464_0_0|SrvcGrp|29021|2022|PCT|1.00|99|0.00|DME AND SUPPLIES|
20|FH_F149720_81212_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F135069_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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119578_0_0|SrvcGrp|108041|2022|PDM|435.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F148167_43950_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132779_0_0|SrvcGrp|87308|2022|PDM|32027.00|99|0.00|MSDRG 271 ONLY|
20|FH_F102184_0_0|SrvcGrp|67279|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY|
20|FH_F92659_0_0|SrvcGrp|86863|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F129782_0_0|CSTM-ALL|CSTM-00|2020|PDM|1142.00|99|0.00|AEG 6 (NO REV)|
20|FH_F122536_0_0|CSTM-ALL|CSTM-00|2020|PDM|10676.00|99|0.00|ASPG V|
20|FH_F120338_83226_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|466.85|99|0.00|AEG 2 (NO REV)|
20|FH_F97500_32025_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F125743_45640_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139551_0_0|SrvcGrp|41327|2022|PDM|1615.00|99|0.00|OP SURGERY CPT 28308|
20|FH_F117082_66216_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F32487_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91078_0_0|SrvcGrp|3178|2022|PDM|840.00|99|0.00|ACUTE PSYCH|
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|2284.00|99|0.00|AEG 6 (NO REV)|
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 4 (NO REV)|
20|FH_F130916_33701_0|SrvcGrp|108484|2022|PDM|177.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F37440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F148255_72703_0|SrvcGrp|86844|2022|PDM|31.50|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F148161_98198_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F100962_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
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_F49653_0_0|CSTM-ALL|CSTM-00|2020|PDM|2894.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY|
20|FH_F127711_0_0|SrvcGrp|14614|2022|PDM|4213.00|99|0.00|LITHOTRIPSY|
20|FH_F135259_21090_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F39740_0_0|SrvcGrp|20898|2022|PDM|15687.00|99|0.00|MS DRG 246 ONLY|
20|FH_F149885_68502_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F135231_90265_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F43167_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|CHILD PSYCH RESIDENTIAL TREAT|
20|FH_F78285_0_0|SrvcGrp|73948|2022|PDM|310.00|99|0.00|SKILLED NURSING|
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|1145.00|99|0.00|AEG 5  (NO REV)|
20|FH_F109581_0_0|SrvcGrp|75491|2022|PDM|1114.00|99|0.00|AEG 7|
20|FH_F47963_0_0|SrvcGrp|22387|2022|PDM|49.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F126033_15301_0|SrvcGrp|48385|2022|PDM|90.46|99|0.00|SPEECH THERAPY|
20|FH_F71144_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126923_33612_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F125935_44024_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F78603_0_0|SrvcGrp|28163|2022|PDM|86157.15|99|0.00|MS DRG 222 ONLY|
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|1291.00|99|0.00|AEG 5  (NO REV)|
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 8 (NO REV)|
20|FH_F38473_0_0|SrvcGrp|10540|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE|
20|FH_F32935_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|OP SVCS|
20|FH_F148265_06067_0|SrvcGrp|26280|2022|PDM|3265.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F117378_16148_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F128002_27260_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117079_01085_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F39479_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F149865_95624_0|SrvcGrp|113194|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F39339_0_0|SrvcGrp|3690|2022|PDM|3260.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F115739_78722_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F123529_31021_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F73202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131128_0_0|SrvcGrp|107833|2022|PDM|1546.00|99|0.00|FUSION/GRAFT OF FINGER JOINT|
20|FH_F151146_0_0|SrvcGrp|11000|2022|PCT|0.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F124018_75067_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109281_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F40438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1175.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145800_22003_0|SrvcGrp|48396|2022|PDM|84.00|99|0.00|OT SERVICES|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AETNA SLEEP STUDIES|
20|FH_F150982_0_0|SrvcGrp|92821|2022|PDM|16516.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR|
20|FH_F143528_0_0|SrvcGrp|100067|2022|PDM|2625.00|99|0.00|ANKLE ARTHROSCOPY SURGERY|
20|FH_F139515_0_0|SrvcGrp|95559|2022|PDM|8442.00|99|0.00|HIP JOINT|
20|FH_F114918_78748_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F34112_0_0|SrvcGrp|361|2022|PDM|1540.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F124899_45246_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F149523_0_0|SrvcGrp|113840|2022|PDM|15500.00|99|0.00|REVISE HIP ARTHROPLASTY|
20|FH_F125249_0_0|SrvcGrp|108251|2022|PDM|2000.00|99|0.00|AETNA GRAFT INTO CARPAL BONE|
20|FH_F134994_33162_0|SrvcGrp|89412|2022|PDM|354.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F82696_16335_0|SrvcGrp|21457|2022|PCT|1.00|99|0.00|CPT CODE 95811|
20|FH_F32108_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124972_64644_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110061_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102184_0_0|SrvcGrp|67065|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY|
20|FH_F78762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.43|99|0.00|OP SVCS|
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F44177_0_0|SrvcGrp|360|2022|PDM|618.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F118194_50841_0|SrvcGrp|14945|2022|PDM|21.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F135219_68506_0|SrvcGrp|109057|2022|PCT|0.81|99|0.00|CARDIAC STUDIES|
20|FH_F41776_0_0|SrvcGrp|3499|2022|PCT|0.60|99|0.00|IMPLANTS|
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_F33744_0_0|SrvcGrp|16150|2022|PDM|14840.00|99|0.00|CARDIAC BRACHYTHERAPY SVCS|
20|FH_F82933_0_0|SrvcGrp|29817|2022|PDM|4642.17|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F82933_0_0|CSTM-ALL|CSTM-00|2020|PDM|5636.49|99|0.00|COVENTRY ENHANCED GROUPER 4|
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_F72845_0_0|SrvcGrp|29817|2022|PDM|5192.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F119595_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F103880_85014_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F104840_32565_0|SrvcGrp|72984|2022|PCT|0.69|99|0.00|CHEMOTHERAPY|
20|FH_F130400_26505_0|SrvcGrp|537|2022|PCT|0.74|99|0.00|OBSERVATION SERVICES|
20|FH_F113392_0_0|SrvcGrp|86460|2022|PDM|2750.00|99|0.00|REVISE BREAST RECONSTRUCTION|
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94786_07974_0|SrvcGrp|86848|2022|PDM|36.75|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F132627_0_0|SrvcGrp|22591|2022|PDM|69.36|99|0.00|IMPLANTED PUMP|
20|FH_F132988_0_0|SrvcGrp|108260|2022|PDM|1154.34|99|0.00|AETNA FIXATION OF KNEE JOINT|
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137067_0_0|SrvcGrp|80617|2022|PDM|19425.00|99|0.00|ARTHOPLASTY|
20|FH_F120901_0_0|SrvcGrp|102419|2022|PDM|4427.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|3709.00|99|0.00|AEG 6 (NO REV)|
20|FH_F63457_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.30|99|0.00|AEG 2 (NO REV)|
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 1 (NO REV)|
20|FH_F114389_50131_0|SrvcGrp|24748|2022|PDM|102.25|99|0.00|CORTICOSTEROID THERAPY|
20|FH_F141336_16947_0|SrvcGrp|90797|2022|PDM|4902.00|99|0.00|INSERT SPINAL INFUSION DEV16|
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147085_92780_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40603_0_0|SrvcGrp|3405|2022|PDM|90.00|99|0.00|CPT 99212|
20|FH_F41035_0_0|SrvcGrp|27315|2022|PDM|900.00|99|0.00|TENDON REPAIR|
20|FH_F98380_43055_0|SrvcGrp|73601|2022|PDM|7824.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F150910_0_0|SrvcGrp|89842|2022|PDM|10500.00|99|0.00|LUMBAR|
20|FH_F66439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127995_84010_0|SrvcGrp|24750|2022|PDM|10.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
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|CSTM-ALL|CSTM-00|2020|PDM|2185.00|99|0.00|AEG 6 (NO REV)|
20|FH_F136569_16506_0|SrvcGrp|46903|2022|PDM|557.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F114638_25309_0|SrvcGrp|67944|2022|PDM|386.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F113809_47302_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F114985_32073_0|SrvcGrp|89267|2022|PDM|61.00|99|0.00|PSYTX PT/FAMILY 30 MINUTES|
20|FH_F122571_53555_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F134670_95628_0|SrvcGrp|73842|2022|PDM|330.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136778_62034_0|CSTM-ALL|CSTM-00|2020|PDM|5953.00|99|0.00|AEG 8 (NO REV)|
20|FH_F115210_21043_0|SrvcGrp|99073|2022|PCT|1.11|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F115631_65201_0|CSTM-ALL|CSTM-00|2020|PDM|679.00|99|0.00|AEG 1 (NO REV)|
20|FH_F116393_07002_0|SrvcGrp|111268|2022|PDM|46.99|99|0.00|X-RAY EXAM OF SHOULDER|
20|FH_F147586_44124_0|SrvcGrp|27347|2022|PDM|1597.00|99|0.00|CPT 58558|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|28.00|99|0.00|ENTERAL NUTRITION (B9000)|
20|FH_F39839_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F50459_0_0|SrvcGrp|33165|2022|PDM|405.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F138936_01040_0|SrvcGrp|90573|2022|PDM|288.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F117715_0_0|SrvcGrp|107642|2022|PDM|2041.91|99|0.00|CYSTOURETHROSCOPY SERVICES|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|109.74|99|0.00|HAPA WPA-NWPA 2012-13 ASC 142 W/O REV|
20|FH_F151341_75904_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151440_84095_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F151501_30265_0|SrvcGrp|100048|2022|PDM|6622.00|99|0.00|INCISE/GRAFT MIDFOOT BONES|
20|FH_F122035_84020_0|SrvcGrp|46903|2022|PDM|711.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F135447_53226_0|SrvcGrp|63458|2022|PDM|1125.00|99|0.00|ANTEPARTUM VISITS 7 OR MORE|
20|FH_F135924_02906_0|CSTM-ALL|CSTM-00|2020|PDM|6886.40|99|0.00|INPATIENT DETOX SERVICES >17 YRS|
20|FH_F130756_04901_0|SrvcGrp|92958|2022|PCT|0.89|99|0.00|SLEEP STUDIES|
20|FH_F116464_13088_0|SrvcGrp|104076|2022|PCT|1.05|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F116468_49660_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116468_49660_0|SrvcGrp|73842|2022|PDM|170.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130766_04967_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|AEG 3 (NO REV)|
20|FH_F101661_08879_0|SrvcGrp|46903|2022|PDM|624.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F33785_0_0|SrvcGrp|15554|2022|PDM|1700.00|99|0.00|ONCOLOGY|
20|FH_F63881_0_0|SrvcGrp|47999|2022|PDM|120.00|99|0.00|CAPD SUPPLEMENT DAY|
20|FH_F133711_46131_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111363_33169_0|SrvcGrp|45622|2022|PCT|0.00|99|0.00|SUBACUTE|
20|FH_F33081_0_0|SrvcGrp|9774|2022|PDM|2650.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F112152_34994_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F87496_17055_0|SrvcGrp|73485|2022|PDM|1231.00|99|0.00|AETNA REHAB|
20|FH_F87557_33309_0|SrvcGrp|86848|2022|PDM|30.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F102325_62691_0|SrvcGrp|34566|2022|PDM|85.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 4 (NO REV)|
20|FH_F98622_45005_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F103004_75840_0|SrvcGrp|90854|2022|PDM|550.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F140873_0_0|SrvcGrp|29155|2022|PDM|152.00|99|0.00|HOSPICE SVCS|
20|FH_F104802_0_0|SrvcGrp|9811|2022|PDM|425.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F106980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43250_0_0|SrvcGrp|360|2022|PDM|500.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F139689_0_0|SrvcGrp|107750|2022|PDM|25.76|99|0.00|TRAINING INCL A TREATMENT|
20|FH_F86851_0_0|SrvcGrp|85001|2022|PDM|371.00|99|0.00|CPT 45910|
20|FH_F89340_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F89495_0_0|SrvcGrp|73000|2022|PDM|854.00|99|0.00|AEG 6|
20|FH_F89778_0_0|SrvcGrp|88823|2022|PDM|1099.69|99|0.00|REPAIR OF EARDRUM|
20|FH_F87915_0_0|SrvcGrp|13631|2022|PDM|154.00|99|0.00|CPT 99213|
20|FH_F46832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F123763_80130_0|SrvcGrp|89417|2022|PDM|415.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F123783_03860_0|SrvcGrp|27968|2022|PDM|53.04|99|0.00|SKILLED NURSING LPN|
20|FH_F58856_0_0|SrvcGrp|20910|2022|PDM|34600.00|99|0.00|MS DRG 234 ONLY|
20|FH_F64999_0_0|SrvcGrp|69699|2022|PCT|1.15|99|0.00|OCN F/S PRICING: LAB CPT CODES 80047-86999|
20|FH_F136377_75240_0|SrvcGrp|73842|2022|PDM|195.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F118244_30040_0|SrvcGrp|92502|2022|PDM|604.59|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F120473_98055_0|CSTM-ALL|CSTM-00|2020|PCT|2.81|99|0.00|HSS APC GROUPED|
20|FH_F120489_63552_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F120489_63552_0|SrvcGrp|75481|2022|PCT|0.75|99|0.00|AEG 2|
20|FH_F134011_84102_0|SrvcGrp|14893|2022|PDM|30.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F134075_78230_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134160_19006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137030_46256_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137209_60515_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138961_33430_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F138108_47130_0|SrvcGrp|90854|2022|PDM|989.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F114979_77979_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142530_60148_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F142690_31774_0|SrvcGrp|24750|2022|PDM|45.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F142690_31774_0|SrvcGrp|29077|2022|PDM|205.00|99|0.00|HOME TRANSFUSION|
20|FH_F117552_0_0|SrvcGrp|103646|2022|PDM|9500.00|99|0.00|AETNA TIB/ PER REVASE STENT & ATHER|
20|FH_F138584_30912_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)|
20|FH_F140329_78570_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140343_89052_0|SrvcGrp|24744|2022|PDM|55.00|99|0.00|PICC LINE INSERTION|
20|FH_F140447_84106_0|SrvcGrp|48385|2022|PDM|84.50|99|0.00|SPEECH THERAPY|
20|FH_F140493_67107_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F80284_16354_0|SrvcGrp|64099|2022|PDM|1300.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 14|
20|FH_F80284_16354_0|SrvcGrp|76009|2022|PDM|299.00|99|0.00|EMERGENCY ROOM SVCS LEVEL II|
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|3135.00|99|0.00|AEG 9 (NO REV)|
20|FH_F149511_62626_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119023_91406_0|SrvcGrp|86852|2022|PDM|35.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F92506_07666_0|SrvcGrp|92762|2022|PCT|0.34|99|0.00|AETNA ALL OTHER DRUGS|
20|FH_F129838_17555_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F109930_73109_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F109983_98607_0|SrvcGrp|79280|2022|PDM|400.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F48292_0_0|SrvcGrp|44247|2022|PDM|192.00|99|0.00|CAPD TRAINING|
20|FH_F147779_34240_0|SrvcGrp|87077|2022|PDM|135.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F129477_70403_0|SrvcGrp|29347|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE|
20|FH_F129511_44044_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F129524_48104_0|SrvcGrp|35982|2022|PDM|50.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F117108_37841_0|SrvcGrp|17100|2022|PDM|1600.00|99|0.00|SKILLED NURSING|
20|FH_F117211_15143_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F117126_12801_0|SrvcGrp|75506|2022|PCT|0.75|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F137270_82901_0|SrvcGrp|48398|2022|PDM|85.50|99|0.00|PT SERVICES|
20|FH_F114145_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F124438_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F129535_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149864_32905_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F111809_93003_0|SrvcGrp|537|2022|PCT|0.97|99|0.00|OBSERVATION SERVICES|
20|FH_F88956_0_0|SrvcGrp|39522|2022|PDM|44292.00|99|0.00|MS DRG 216-218 ONLY|
20|FH_F80859_65616_0|SrvcGrp|90356|2022|PCT|0.56|99|0.00|OP DIALYSIS|
20|FH_F87577_80016_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS|
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|681.00|99|0.00|ASPG I - IOWA|
20|FH_F118964_0_0|CSTM-ALL|CSTM-00|2020|PDM|734.00|99|0.00|AEG 1 (NO REV)|
20|FH_F129303_33139_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117821_90049_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146221_72560_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138236_0_0|SrvcGrp|80317|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F116644_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136751_0_0|SrvcGrp|27261|2022|PDM|20500.00|99|0.00|CPT 27446|
20|FH_F96120_67207_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F35454_0_0|SrvcGrp|25390|2022|PDM|55.00|99|0.00|PATIENT VISIT MODERATE|
20|FH_F44025_0_0|CSTM-ALL|CSTM-00|2020|PDM|639.00|99|0.00|CD - REHABILITATION|
20|FH_F37575_0_0|SrvcGrp|3810|2022|PDM|89.59|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F79902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88818_0_0|SrvcGrp|75497|2022|PDM|365.00|99|0.00|AEG 10|
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F114310_0_0|SrvcGrp|27315|2022|PDM|3200.00|99|0.00|TENDON REPAIR|
20|FH_F117807_86426_0|SrvcGrp|48398|2022|PDM|125.00|99|0.00|PT SERVICES|
20|FH_F135711_61401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117613_08221_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118541_15222_0|SrvcGrp|107777|2022|PCT|1.00|99|0.00|VBAC DELIVERY|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F133474_0_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F125467_67206_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124608_0_0|SrvcGrp|84939|2022|PDM|9149.00|99|0.00|SHOULDER JOINT|
20|FH_F56793_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111806_33020_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F83031_0_0|SrvcGrp|43269|2022|PDM|35.00|99|0.00|CATHETER REPAIR|
20|FH_F71323_68114_0|SrvcGrp|112098|2022|PCT|1.00|99|0.00|COVID-19 CODES|
20|FH_F140175_0_0|SrvcGrp|113609|2022|PCT|0.00|99|0.00|HYPERBARIC CHAMBER INCIDENTAL|
20|FH_F45977_0_0|CSTM-ALL|CSTM-00|2020|PDM|55.00|99|0.00|HOME HEALTH MOD TD|
20|FH_F145870_0_0|SrvcGrp|110821|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F144588_60090_0|SrvcGrp|33722|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F41814_0_0|SrvcGrp|72|2022|PDM|478.00|99|0.00|NEWBORN NURSERY|
20|FH_F44023_0_0|SrvcGrp|3224|2022|PCT|0.71|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F92676_15063_0|SrvcGrp|78930|2022|PDM|4038.50|99|0.00|MON VALLEY ASC 904|
20|FH_F132543_79549_0|SrvcGrp|537|2022|PDM|2000.00|99|0.00|OBSERVATION SERVICES|
20|FH_F126815_02118_0|CSTM-ALL|CSTM-00|2020|PDM|1545.87|99|0.00|AEG 2 (NO REV)|
20|FH_F49932_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|943.00|99|0.00|AEG 2 (NO REV)|
20|FH_F44607_0_0|SrvcGrp|39487|2022|PDM|2750.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F117559_08619_0|SrvcGrp|94423|2022|PDM|15.00|99|0.00|IMMUNIZATIONS|
20|FH_F77025_0_0|SrvcGrp|14614|2022|PDM|3500.00|99|0.00|LITHOTRIPSY|
20|FH_F150559_60018_0|SrvcGrp|48385|2022|PDM|155.00|99|0.00|SPEECH THERAPY|
20|FH_F36207_0_0|SrvcGrp|19607|2022|PDM|750.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F36207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129364_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F141870_85224_0|SrvcGrp|14948|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F81485_0_0|SrvcGrp|12290|2022|PDM|711.00|99|0.00|DETOXIFICATION|
20|FH_F34706_0_0|SrvcGrp|11188|2022|PDM|16229.00|99|0.00|DRG 552 OTHER PERMANENT CARDIAC PACEMAKER IMP W/O CV DX|
20|FH_F71145_0_0|SrvcGrp|44249|2022|PDM|165.00|99|0.00|CAPD TRAINING|
20|FH_F134490_62801_0|CSTM-ALL|CSTM-00|2020|PDM|1608.00|99|0.00|AEG 10 (NO REV)|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PDM|1929.00|99|0.00|ASPG VII|
20|FH_F151046_10036_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151141_24014_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F89778_0_0|SrvcGrp|88241|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|AEG 8 (NO REV)|
20|FH_F35365_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
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_F40191_0_0|SrvcGrp|24|2022|PDM|3647.00|99|0.00|CARDIAC CATH|
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F63316_0_0|SrvcGrp|10407|2022|PDM|35.65|99|0.00|HOME INFUSION|
20|FH_F69968_0_0|SrvcGrp|17073|2022|PDM|1875.35|99|0.00|ASPG V|
20|FH_F96182_0_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F136386_30901_0|SrvcGrp|112509|2022|PDM|1000.00|99|0.00|MRI/MRA|
20|FH_F136489_25428_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F123489_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F53732_0_0|SrvcGrp|22389|2022|PDM|19.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|ASPG X|
20|FH_F130363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140332_19041_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140875_63363_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|1375.00|99|0.00|AEG 4 (NO REV)|
20|FH_F119023_91406_0|SrvcGrp|22389|2022|PDM|12.50|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F119046_74012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F38948_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 286-287|
20|FH_F110308_0_0|SrvcGrp|72994|2022|PDM|500.00|99|0.00|AEG 3|
20|FH_F124754_84403_0|SrvcGrp|89337|2022|PDM|996.00|99|0.00|DETOXIFICATION|
20|FH_F124890_76119_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119413_95123_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138283_0_0|SrvcGrp|29347|2022|PDM|37.00|99|0.00|HOME HEALTH AIDE|
20|FH_F126626_80906_0|SrvcGrp|90854|2022|PDM|1101.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F44724_0_0|SrvcGrp|33165|2022|PDM|360.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F31093_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IV THERAPY SVCS|
20|FH_F97621_75801_0|SrvcGrp|73605|2022|PDM|2796.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F132543_79549_0|SrvcGrp|112102|2022|PDM|2000.00|99|0.00|HSS ASC WITH OBSERVATION|
20|FH_F102062_35447_0|SrvcGrp|43569|2022|PDM|150.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F149781_37404_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F149861_85225_0|SrvcGrp|74668|2022|PDM|166.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F38700_0_0|SrvcGrp|18873|2022|PCT|0.80|99|0.00|MS DRG 232|
20|FH_F35173_0_0|CSTM-ALL|CSTM-00|2020|PDM|2361.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.10|99|0.00|AEG 4 (NO REV)|
20|FH_F148430_06278_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F138236_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1512.00|99|0.00|ASPG VI|
20|FH_F111269_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115274_15235_0|SrvcGrp|65720|2022|PDM|140.00|99|0.00|RESPITE CARE|
20|FH_F142900_32792_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F68947_0_0|SrvcGrp|59705|2022|PDM|5367.60|99|0.00|SEPTOPLASTY|
20|FH_F150001_33064_0|SrvcGrp|29023|2022|PDM|26.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F70711_0_0|SrvcGrp|20073|2022|PDM|54.00|99|0.00|CPT 99100-99140|
20|FH_F47640_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130108_0_0|SrvcGrp|941|2022|PDM|1300.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F62627_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SURG|
20|FH_F148019_54311_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117087_0_0|SrvcGrp|107182|2022|PDM|2494.00|99|0.00|REVISE MIDDLE EAR & MASTOID|
20|FH_F120838_01603_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F92676_15063_0|SrvcGrp|78978|2022|PDM|1371.39|99|0.00|MON VALLEY ASC 303|
20|FH_F95661_27217_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F120437_85202_0|SrvcGrp|111384|2022|PCT|1.12|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F42807_0_0|SrvcGrp|11258|2022|PCT|0.75|99|0.00|DRUGS|
20|FH_F39859_0_0|SrvcGrp|10361|2022|PDM|129.00|99|0.00|CPT CODE 99281|
20|FH_F46352_0_0|SrvcGrp|12403|2022|PDM|72.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F45132_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F55375_0_0|SrvcGrp|51472|2022|PDM|140.00|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F44135_0_0|SrvcGrp|10545|2022|PDM|70.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F38508_0_0|SrvcGrp|76459|2022|PDM|400.00|99|0.00|SKILLED NURSING CARE|
20|FH_F133467_03301_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F38508_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F120437_85202_0|SrvcGrp|86841|2022|PDM|216.09|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F91212_62864_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F34263_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F45653_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F111403_37167_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F49776_0_0|SrvcGrp|42830|2022|PDM|102.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F119226_07746_0|SrvcGrp|87317|2022|PDM|883.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F125033_93305_0|SrvcGrp|93919|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F150024_08079_0|SrvcGrp|115811|2022|PCT|0.00|99|0.00|PERCUTANEOUS LUMBAR|
20|FH_F97042_64804_0|SrvcGrp|73601|2022|PDM|8727.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F115505_21014_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F111437_33305_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F106660_26554_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F151751_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F87155_04105_0|SrvcGrp|47183|2022|PDM|99.80|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F130656_04401_0|SrvcGrp|113275|2022|PCT|1.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT|
20|FH_F132487_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F41796_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F47727_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117900_19118_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F49617_0_0|SrvcGrp|82446|2022|PCT|0.80|99|0.00|HOME HEALTH SERVICES|
20|FH_F135179_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F149840_80002_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100786_24740_0|SrvcGrp|73485|2022|PDM|2310.00|99|0.00|AETNA REHAB|
20|FH_F111401_29425_0|SrvcGrp|73700|2022|PDM|55.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F132338_18901_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F146362_76048_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|789.00|99|0.00|AEG 5  (NO REV)|
20|FH_F150480_14043_0|SrvcGrp|115830|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
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_F144011_60616_0|SrvcGrp|79786|2022|PCT|1.31|99|0.00|SLEEP STUDIES|
20|FH_F127105_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F141411_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS|
20|FH_F54552_0_0|SrvcGrp|24287|2022|PDM|60.00|99|0.00|IV PUMP MAINTENANCE|
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|AEG 1 (NO REV)|
20|FH_F150884_75503_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131982_0_0|SrvcGrp|29155|2022|PDM|143.00|99|0.00|HOSPICE SVCS|
20|FH_F74883_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_F34706_0_0|SrvcGrp|2960|2022|PDM|6652.00|99|0.00|DRG 494 LAPAROSCOPIC CHOLECYSTECTOMY W/O CMN DUCT EXP W/O CC|
20|FH_F75706_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100786_24740_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F133907_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F132338_18901_0|SrvcGrp|73605|2022|PDM|819.25|99|0.00|AETNA ACUTE PSYCH|
20|FH_F67288_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|EMERGENCY ROOM SERVICES ON UB|
20|FH_F34739_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F55375_0_0|SrvcGrp|12117|2022|PDM|750.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F103360_68845_0|SrvcGrp|74582|2022|PDM|7116.00|99|0.00|AETNA VAGINAL DELIVERY MSDRG 767-768, 774-775|
20|FH_F151159_46322_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F121338_37756_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F129130_92562_0|SrvcGrp|111294|2022|PDM|8166.15|99|0.00|LAPAROSCOPY APPENDECTOMY|
20|FH_F129130_92562_0|CSTM-ALL|CSTM-00|2020|PDM|5099.00|99|0.00|AEG 2 (NO REV)|
20|FH_F138742_33125_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F139677_77087_0|SrvcGrp|89149|2022|PDM|180.00|99|0.00|OP INTENSIVE|
20|FH_F150679_32534_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134847_0_0|SrvcGrp|88162|2022|PDM|8415.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F94222_62269_0|SrvcGrp|72379|2022|PDM|62.17|99|0.00|SPEECH THERAPY|
20|FH_F131175_06757_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F33334_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150920_19490_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F129682_07034_0|SrvcGrp|27968|2022|PDM|50.00|99|0.00|SKILLED NURSING LPN|
20|FH_F147142_33870_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147347_70806_0|SrvcGrp|108484|2022|PDM|540.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F134867_32068_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
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_F50415_0_0|SrvcGrp|39996|2022|PDM|25.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F147201_48234_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36883_0_0|SrvcGrp|90076|2022|PCT|0.52|99|0.00|CARDIC CATH PROCEDURES|
20|FH_F36036_0_0|SrvcGrp|22093|2022|PDM|15.00|99|0.00|HCPCS A4250|
20|FH_F42352_0_0|SrvcGrp|290|2022|PDM|3270.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|5991.00|99|0.00|AEG 9 (NO REV)|
20|FH_F136806_0_0|SrvcGrp|35670|2022|PDM|4593.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F138017_73129_0|SrvcGrp|72984|2022|PCT|0.00|99|0.00|CHEMOTHERAPY|
20|FH_F146266_0_0|SrvcGrp|54965|2022|PDM|7669.00|99|0.00|APPLICATION OF AMULTIPLAN|
20|FH_F90183_80031_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (HCFA)|
20|FH_F38123_0_0|SrvcGrp|31190|2022|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER UEKC (DME)|
20|FH_F147341_19720_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F99920_63141_0|SrvcGrp|97702|2022|PDM|110.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F119203_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F146266_0_0|SrvcGrp|35671|2022|PDM|2775.00|99|0.00|TRANSPLANT FOREARM TENDON|
20|FH_F35056_0_0|SrvcGrp|14997|2022|PCT|0.78|99|0.00|DRUGS|
20|FH_F110732_31513_0|SrvcGrp|10364|2022|PDM|781.00|99|0.00|CPT CODE 99284|
20|FH_F131551_68355_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F91940_0_0|SrvcGrp|86919|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F151004_87121_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148860_0_0|SrvcGrp|89238|2022|PCT|0.00|99|0.00|LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F35771_32578_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS|
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|1138.00|99|0.00|AEG 3 (NO REV)|
20|FH_F50078_0_0|CSTM-ALL|CSTM-00|2020|PDM|47.00|99|0.00|HOME INFUSION NURSING SERVICES MOD SD|
20|FH_F113957_73554_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149579_95815_0|SrvcGrp|115681|2022|PDM|66.63|99|0.00|PSYCHIATRIC COLLABORATIVE CARE 1ST SBSQ|
20|FH_F146266_0_0|SrvcGrp|88158|2022|PDM|7168.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F113765_0_0|SrvcGrp|42971|2022|PDM|85.00|99|0.00|SKN RN|
20|FH_F148859_0_0|SrvcGrp|3932|2022|PDM|4280.00|99|0.00|LITHOTRIPSY|
20|FH_F138410_19130_0|SrvcGrp|113176|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - MODERNA|
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1486.00|99|0.00|AEG 5  (NO REV)|
20|FH_F110841_53012_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F45798_0_0|SrvcGrp|3029|2022|PDM|1043.00|99|0.00|NEWBORN NURSERY|
20|FH_F132732_0_0|SrvcGrp|47427|2022|PCT|0.69|99|0.00|IMPLANTS|
20|FH_F120435_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|1152.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F81312_0_0|SrvcGrp|29121|2022|PCT|0.65|99|0.00|LABORATORY|
20|FH_F34853_0_0|SrvcGrp|14077|2022|PDM|11664.00|99|0.00|BRACHYTHERAPY SVCS|
20|FH_F101709_0_0|SrvcGrp|72992|2022|PDM|1433.00|99|0.00|AEG 2|
20|FH_F136247_28804_0|SrvcGrp|89417|2022|PDM|460.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F136250_73026_0|SrvcGrp|73842|2022|PDM|330.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F116595_92506_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120885_66224_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F126438_50029_0|SrvcGrp|89337|2022|PDM|855.00|99|0.00|DETOXIFICATION|
20|FH_F125287_92374_0|SrvcGrp|75442|2022|PDM|770.00|99|0.00|OBSERVATION - REV 762|
20|FH_F118874_29926_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F84442_79606_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131612_0_0|SrvcGrp|107863|2022|PCT|1.00|99|0.00|AETNA IMMUNIZATIONS|
20|FH_F130775_61701_0|SrvcGrp|3178|2022|PDM|705.00|99|0.00|ACUTE PSYCH|
20|FH_F51124_0_0|SrvcGrp|10623|2022|PDM|120.75|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F132883_31602_0|SrvcGrp|86853|2022|PDM|20.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F145641_06902_0|SrvcGrp|67065|2022|PDM|15759.00|99|0.00|CERVICAL SURGERY|
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|392.78|99|0.00|HAPA WPA-NWPA 2012-13 ASC 227 W/O REV|
20|FH_F135656_74820_0|SrvcGrp|108484|2022|PDM|464.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F88698_18951_0|SrvcGrp|86722|2022|PDM|152.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F92641_34994_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F110504_37027_0|SrvcGrp|89417|2022|PDM|555.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F81838_0_0|SrvcGrp|12073|2022|PDM|46.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F31714_0_0|SrvcGrp|3489|2022|PDM|13200.00|99|0.00|DRG 498 SPINAL FUSION EXCEPT CERVICAL|
20|FH_F95631_33705_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F127589_45459_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F134969_34474_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F61513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133207_0_0|SrvcGrp|90822|2022|PDM|3529.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY|
20|FH_F85353_16407_0|SrvcGrp|63865|2022|PDM|342.50|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1601|
20|FH_F83995_16748_0|SrvcGrp|14080|2022|PDM|98.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F130329_64114_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F114506_15946_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123623_03246_0|SrvcGrp|109292|2022|PCT|1.00|99|0.00|HEPB VACC 4 DOSE IMMUNSUP IM|
20|FH_F136037_0_0|SrvcGrp|89417|2022|PDM|416.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F143687_70461_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F96721_99504_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F145641_06902_0|SrvcGrp|114231|2022|PDM|5672.00|99|0.00|REPAIR CLAVICLE DISLOCATION|
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1274.00|99|0.00|AEG 3 (NO REV)|
20|FH_F133887_17013_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134972_84117_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138021_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|783.00|99|0.00|AEG 3 (NO REV)|
20|FH_F83978_66739_0|SrvcGrp|110744|2022|PCT|0.00|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.85|99|0.00|HAPA WPA-NWPA 2012-13 ASC 216 W/O REV|
20|FH_F134918_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121476_0_0|SrvcGrp|108869|2022|PDM|26565.00|99|0.00|CARDIOVERTER DEFIBRILLATOR|
20|FH_F110580_71106_0|SrvcGrp|28512|2022|PDM|1140.00|99|0.00|REPAIR BLADDER DEFECT|
20|FH_F31714_0_0|SrvcGrp|10904|2022|PDM|318.00|99|0.00|EMERGENCY ROOM LEVEL II|
20|FH_F124369_0_0|SrvcGrp|105632|2022|PDM|3850.00|99|0.00|AMPUTATION OF TOE|
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|377.00|99|0.00|AEG 10 (NO REV)|
20|FH_F149079_70809_0|SrvcGrp|82037|2022|PDM|1681.00|99|0.00|AETNA ICU|
20|FH_F118123_67226_0|SrvcGrp|46605|2022|PDM|50.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|1625.00|99|0.00|AEG 6 (NO REV)|
20|FH_F112987_46222_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F93173_73401_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|AEG 6 (NO REV)|
20|FH_F110268_02891_0|SrvcGrp|90017|2022|PDM|78.00|99|0.00|AETNA PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F112082_30720_0|SrvcGrp|73701|2022|PDM|76.12|99|0.00|AETNA - SKILLED NURSING|
20|FH_F118270_30606_0|SrvcGrp|101562|2022|PCT|1.00|99|0.00|HOSPICE/PHYSICIAN|
20|FH_F111908_07677_0|SrvcGrp|59795|2022|PCT|1.00|99|0.00|TPN|
20|FH_F143669_78577_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F138050_52301_0|SrvcGrp|73485|2022|PDM|1161.00|99|0.00|AETNA REHAB|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|284.46|99|0.00|HAPA WPA-NWPA 2012-13 ASC 226 W/O REV|
20|FH_F124162_73127_0|SrvcGrp|108484|2022|PDM|525.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F148600_30328_0|SrvcGrp|90822|2022|PDM|3520.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY|
20|FH_F133748_77081_0|SrvcGrp|82981|2022|PDM|140.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F98021_07012_0|SrvcGrp|73485|2022|PDM|3344.00|99|0.00|AETNA REHAB|
20|FH_F127343_0_0|SrvcGrp|12664|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F111912_30720_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|GENERAL ACUTE CARE|
20|FH_F114527_39047_0|SrvcGrp|93919|2022|PDM|663.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F119107_22601_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|SINGLE SPECT SCAN|
20|FH_F134171_72301_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F114444_19602_0|SrvcGrp|86645|2022|PDM|75.00|99|0.00|AETNA PSYTX PT & FAM 45 MINS (MOD TD)|
20|FH_F51393_0_0|SrvcGrp|42827|2022|PDM|64.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
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_F109364_52349_0|SrvcGrp|88620|2022|PDM|166.00|99|0.00|SKILLED NURSING RN|
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73125_0_0|SrvcGrp|46424|2022|PDM|12.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F146882_84532_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|GENERAL ACUTE CARE|
20|FH_F146907_24521_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38233_0_0|SrvcGrp|13606|2022|PDM|35.00|99|0.00|HOME INFUSION|
20|FH_F39561_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
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|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F124653_64062_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F124687_64024_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134809_0_0|SrvcGrp|87537|2022|PDM|420.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F127995_84010_0|SrvcGrp|29023|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F92599_0_0|SrvcGrp|75481|2022|PDM|641.00|99|0.00|AEG 2|
20|FH_F131494_0_0|SrvcGrp|89869|2022|PDM|410.00|99|0.00|SPONTANEOUS ABORTION|
20|FH_F122200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100787_69162_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F148424_01440_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F43246_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F43444_0_0|SrvcGrp|24|2022|PDM|6000.00|99|0.00|CARDIAC CATH|
20|FH_F43859_0_0|SrvcGrp|37404|2022|PDM|90.00|99|0.00|PT SVCS|
20|FH_F117085_40207_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F136778_62034_0|SrvcGrp|112943|2022|PDM|4477.00|99|0.00|MATERNITY CARE VAGINAL DELIVERY|
20|FH_F136796_24016_0|CSTM-ALL|CSTM-00|2020|PDM|3305.03|99|0.00|AEG 9 (NO REV)|
20|FH_F136914_64081_0|SrvcGrp|106294|2022|PDM|438.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F136547_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS|
20|FH_F49005_0_0|SrvcGrp|40062|2022|PDM|200.00|99|0.00|PT / OT / ST|
20|FH_F115144_71373_0|SrvcGrp|73483|2022|PDM|816.00|99|0.00|AETNA SUBACUTE III|
20|FH_F116383_63026_0|SrvcGrp|73842|2022|PDM|233.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F116365_11417_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F116339_41064_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F147299_02072_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F147305_90755_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F147530_49441_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147414_92656_0|SrvcGrp|105820|2022|PDM|2200.00|99|0.00|IP PSYCH EATING DISORDERS|
20|FH_F41832_0_0|SrvcGrp|14892|2022|PDM|108.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD NUKF RATE|
20|FH_F132851_44805_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133335_84790_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132868_43551_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133478_40165_0|SrvcGrp|112254|2022|PDM|2332.00|99|0.00|GROUPER 9 CODES 2017 MEDICARE|
20|FH_F133494_90023_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F131596_60433_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39346_0_0|SrvcGrp|20900|2022|PDM|17682.00|99|0.00|MS DRG 248 ONLY|
20|FH_F129673_0_0|SrvcGrp|103608|2022|PDM|164.00|99|0.00|SKILLED NURSING|
20|FH_F120639_73078_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150939_0_0|SrvcGrp|94882|2022|PDM|12.70|99|0.00|FLU VIRUS VACC-SPLIT 3 YRS & ABOVE|
20|FH_F114853_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F39098_0_0|SrvcGrp|22661|2022|PCT|0.75|99|0.00|ANGIOPLASTY|
20|FH_F139115_32504_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_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|1188.52|99|0.00|AEG 7 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|380.06|99|0.00|HAPA WPA-NWPA 2012-13 ASC 16 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|254.70|99|0.00|HAPA WPA-NWPA 2012-13 ASC 125 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|142.41|99|0.00|HAPA WPA-NWPA 2012-13 ASC 314 W/O REV|
20|FH_F102063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124542_0_0|SrvcGrp|80537|2022|PDM|323.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 1|
20|FH_F151340_30040_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 6 (NO REV)|
20|FH_F151340_30040_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 3 (NO REV)|
20|FH_F151420_60654_0|SrvcGrp|27348|2022|PDM|3045.00|99|0.00|OP SURGERY (CPT 58662)|
20|FH_F151443_34741_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151501_30265_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 10 (NO REV)|
20|FH_F151503_30067_0|SrvcGrp|33984|2022|PDM|2090.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F132258_45404_0|SrvcGrp|86832|2022|PDM|6.65|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F122140_66064_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135352_32225_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135485_20171_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135572_89106_0|SrvcGrp|10577|2022|PCT|1.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F91700_15601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F91764_93710_0|SrvcGrp|105465|2022|PCT|1.00|99|0.00|AETNA THERAPIES|
20|FH_F116464_13088_0|CSTM-ALL|CSTM-00|2020|PDM|173.00|99|0.00|NEW PATIENT VISIT|
20|FH_F140629_0_0|SrvcGrp|113677|2022|PDM|2497.00|99|0.00|UNLISTED LIVER LAPAROSCOPY|
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1718.00|99|0.00|AEG 8 (NO REV)|
20|FH_F121444_47720_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F121464_15701_0|SrvcGrp|471|2022|PDM|574.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F121763_07202_0|SrvcGrp|52953|2022|PDM|32.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F43237_0_0|SrvcGrp|3165|2022|PCT|0.80|99|0.00|EMERGENCY ROOM|
20|FH_F67425_0_0|SrvcGrp|30133|2022|PDM|7165.00|99|0.00|LASER SURGERY|
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117206_0_0|SrvcGrp|33986|2022|PDM|700.00|99|0.00|CPT 26055|
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|3530.00|99|0.00|AEG 5  (NO REV)|
20|FH_F109273_77339_0|SrvcGrp|89149|2022|PDM|220.00|99|0.00|OP INTENSIVE|
20|FH_F149301_44122_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120670_0_0|SrvcGrp|67279|2022|PDM|16000.00|99|0.00|CERVICAL SURGERY|
20|FH_F110470_98335_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION MOD AJ (HCFA)|
20|FH_F149345_45044_0|SrvcGrp|92760|2022|PCT|1.21|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134537_03060_0|SrvcGrp|89417|2022|PDM|354.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F122463_17109_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F84057_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|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_F80513_0_0|SrvcGrp|28120|2022|PDM|23066.00|99|0.00|MS DRG 467 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_F146668_30189_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 10 (NO REV)|
20|FH_F120528_60559_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116063_43220_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F116063_43220_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F133667_83642_0|SrvcGrp|16069|2022|PDM|1000.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F133478_40165_0|SrvcGrp|28166|2022|PDM|50098.00|99|0.00|MS DRG 229 ONLY|
20|FH_F133153_44113_0|SrvcGrp|89417|2022|PDM|382.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F133700_92808_0|SrvcGrp|79280|2022|PDM|1300.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F111602_17102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TRC VACV 28 FS MOD 53|
20|FH_F68823_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F142454_0_0|SrvcGrp|92551|2022|PDM|832.00|99|0.00|TREATMENT OF RETINA|
20|FH_F50672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F59732_0_0|SrvcGrp|14944|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F61292_0_0|SrvcGrp|290|2022|PDM|5726.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F133534_33483_0|SrvcGrp|46903|2022|PDM|609.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116237_43235_0|SrvcGrp|73842|2022|PDM|172.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F82173_72712_0|SrvcGrp|14005|2022|PCT|0.80|99|0.00|AIR AMBULANCE SVCS|
20|FH_F141592_80233_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2375.00|99|0.00|AEG 10 (NO REV)|
20|FH_F75722_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F141169_0_0|SrvcGrp|113733|2022|PDM|362.00|99|0.00|COLPOSCOPY|
20|FH_F126883_78621_0|SrvcGrp|73841|2022|PDM|410.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F148265_06067_0|CSTM-ALL|CSTM-00|2020|PDM|3322.00|99|0.00|AEG 4 (NO REV)|
20|FH_F130747_0_0|SrvcGrp|88164|2022|PDM|36414.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F49338_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F115018_78410_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F34472_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35202_0_0|SrvcGrp|12263|2022|PDM|17.85|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1170.00|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_F116245_0_0|SrvcGrp|76094|2022|PDM|148.79|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F145758_20745_0|SrvcGrp|103327|2022|PDM|12699.00|99|0.00|INSJ STABLJ DEV W/DCMPRN|
20|FH_F41021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139515_0_0|SrvcGrp|88065|2022|PDM|14420.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F128272_60640_0|SrvcGrp|22589|2022|PDM|50.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F133534_33483_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F90654_0_0|SrvcGrp|15659|2022|PCT|0.70|99|0.00|CHEMOTHERAPY|
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|1375.00|99|0.00|AEG 10 (NO REV)|
20|FH_F37679_0_0|SrvcGrp|24748|2022|PDM|61.00|99|0.00|CORTICOSTEROID THERAPY|
20|FH_F141527_36830_0|SrvcGrp|13929|2022|PDM|11.00|99|0.00|GROWTH HORMONE|
20|FH_F150462_30458_0|SrvcGrp|21711|2022|PDM|110.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F47152_0_0|SrvcGrp|39542|2022|PDM|155000.00|99|0.00|MS DRG 005-006 LIVER TRANSPLANT - LIVE DONOR|
20|FH_F133207_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F151524_84121_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F48215_0_0|SrvcGrp|9829|2022|PDM|85.50|99|0.00|PT SVCS|
20|FH_F120876_85250_0|SrvcGrp|74668|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F122687_0_0|SrvcGrp|88493|2022|PDM|5464.00|99|0.00|AETNA VERTEBROPLASTY ADDL INJECT|
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|2229.00|99|0.00|ASPG IX|
20|FH_F130747_0_0|SrvcGrp|99073|2022|PDM|1.45|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F116065_06708_0|SrvcGrp|76501|2022|PDM|275.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F148320_02130_0|SrvcGrp|113171|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F40043_0_0|SrvcGrp|9053|2022|PDM|13958.00|99|0.00|GASTRIC BYPASS|
20|FH_F65182_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F141802_17042_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F130807_20721_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|2406.00|99|0.00|AEG 7 (NO REV)|
20|FH_F102302_0_0|SrvcGrp|38015|2022|PDM|29900.00|99|0.00|ARTHRODESIS|
20|FH_F114916_30309_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|AEG 3 (NO REV)|
20|FH_F123844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F101182_07863_0|SrvcGrp|42622|2022|PCT|0.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F111363_33169_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111880_50003_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F51272_0_0|SrvcGrp|47596|2022|PCT|0.75|99|0.00|HOSPICE SERVICES|
20|FH_F101442_0_0|SrvcGrp|92197|2022|PDM|1501.22|99|0.00|CORRECTION OF BUNION|
20|FH_F131000_0_0|SrvcGrp|67064|2022|PDM|4457.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F87496_17055_0|SrvcGrp|48385|2022|PDM|104.00|99|0.00|SPEECH THERAPY|
20|FH_F88831_84123_0|SrvcGrp|24739|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F102862_30606_0|SrvcGrp|26686|2022|PDM|42642.00|99|0.00|MS DRG 455 ONLY|
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F51113_15501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F134192_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F128341_41139_0|SrvcGrp|88620|2022|PDM|90.00|99|0.00|SKILLED NURSING RN|
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|335.00|99|0.00|AEG 10 (NO REV)|
20|FH_F122900_65203_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122905_41018_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|941.00|99|0.00|ASPG VII|
20|FH_F124443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89495_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88398_15601_0|SrvcGrp|48398|2022|PDM|83.65|99|0.00|PT SERVICES|
20|FH_F87222_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.22|99|0.00|POLYSOMNOGRAPHY W/O MOD 26 & TC|
20|FH_F123785_62298_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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_F134254_33462_0|SrvcGrp|89417|2022|PDM|492.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F120456_67117_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F93178_73448_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134011_84102_0|SrvcGrp|24745|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F137236_17603_0|SrvcGrp|109330|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138961_33430_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142473_07663_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142470_32935_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F142690_31774_0|SrvcGrp|22384|2022|PDM|150.00|99|0.00|HOME VISIT PRENATAL|
20|FH_F53732_0_0|SrvcGrp|17012|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138468_63128_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138607_02760_0|SrvcGrp|108420|2022|PDM|25.49|99|0.00|BLOOD GLUCOSE TEST|
20|FH_F138627_82901_0|SrvcGrp|41444|2022|PDM|0.65|99|0.00|ENTERAL FORMULA - NUTRITIONALLY COMPLETE|
20|FH_F134654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118959_44830_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F118932_07652_0|SrvcGrp|107975|2022|PCT|0.00|99|0.00|ALL DRUGS W/O CHEMOTHERAPY DRUGS|
20|FH_F118943_64506_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F92593_21031_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F147900_48038_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147879_93309_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F147879_93309_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147941_06023_0|SrvcGrp|114474|2022|PDM|4746.00|99|0.00|CONDITION OF PREGNANCY (MOTHER ONLY)|
20|FH_F129483_77030_0|SrvcGrp|86836|2022|PDM|25.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F129483_77030_0|SrvcGrp|86833|2022|PDM|25.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F129504_02871_0|SrvcGrp|48396|2022|PDM|111.00|99|0.00|OT SERVICES|
20|FH_F117105_77619_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F117108_37841_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117190_84020_0|SrvcGrp|105046|2022|PCT|0.00|99|0.00|AETNA RES TREATMENT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F117126_12801_0|SrvcGrp|72984|2022|PCT|0.75|99|0.00|CHEMOTHERAPY|
20|FH_F137806_83702_0|SrvcGrp|86723|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F109652_0_0|SrvcGrp|8950|2022|PDM|4528.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F110720_0_0|SrvcGrp|104096|2022|PDM|4882.00|99|0.00|ANKLE ARTHROSCOPY/SURGERY|
20|FH_F90613_05001_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F130035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113709_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66101_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119491_19904_0|SrvcGrp|23683|2022|PDM|36.75|99|0.00|SKILLED NURSING RN|
20|FH_F148554_85016_0|SrvcGrp|115450|2022|PDM|3060.00|99|0.00|REMOVE & REPLACE PM GEN MULTI LEADS|
20|FH_F100784_59923_0|SrvcGrp|73485|2022|PDM|3954.00|99|0.00|AETNA REHAB|
20|FH_F36756_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD 26|
20|FH_F148903_51101_0|SrvcGrp|48396|2022|PDM|124.00|99|0.00|OT SERVICES|
20|FH_F117340_68144_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113403_62274_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F150119_34205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133530_11237_0|SrvcGrp|73806|2022|PDM|914.00|99|0.00|AETNA ER|
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|792.23|99|0.00|AEG 5  (NO REV)|
20|FH_F101811_64116_0|SrvcGrp|95499|2022|PCT|1.00|99|0.00|AETNA OP AMFS DEFAULT W/O HH|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1550.18|99|0.00|HAPA WPA-NWPA 2012-13 ASC 9 W/O REV|
20|FH_F132032_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F150524_64106_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132934_63005_0|SrvcGrp|12837|2022|PCT|0.50|99|0.00|INTRAOCULAR LENSES|
20|FH_F101840_76054_0|SrvcGrp|97490|2022|PDM|1321.00|99|0.00|ENDO CHOLANGIOPANCREATOGRAPH|
20|FH_F126678_44870_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F121090_07848_0|SrvcGrp|108484|2022|PDM|737.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 309-310 CARDIAC ARRHYTHMIA|
20|FH_F109240_21201_0|SrvcGrp|89590|2022|PDM|344.00|99|0.00|SPECIAL PHYSICS CONSULTATION|
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 10 (NO REV)|
20|FH_F84135_0_0|SrvcGrp|108081|2022|PDM|397.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F39349_0_0|CSTM-ALL|CSTM-00|2020|PDM|1359.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92276_32308_0|SrvcGrp|79786|2022|PDM|3541.00|99|0.00|SLEEP STUDIES|
20|FH_F78603_0_0|SrvcGrp|19633|2022|PDM|66875.99|99|0.00|MS DRG 226 ONLY|
20|FH_F142073_0_0|SrvcGrp|88160|2022|PDM|5980.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F93880_95476_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F115667_16101_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38798_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KIDS HOME INFUSION THERAPY|
20|FH_F107782_0_0|SrvcGrp|102522|2022|PDM|2600.00|99|0.00|BARIATRIC SURGERY|
20|FH_F40709_0_0|CSTM-ALL|CSTM-00|2020|PDM|470.00|99|0.00|ASPG I|
20|FH_F123488_65559_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F34816_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|OP SVCS|
20|FH_F134995_37055_0|SrvcGrp|46903|2022|PDM|782.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F38792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F141607_27021_0|SrvcGrp|88621|2022|PDM|35.00|99|0.00|SKILLED NURSING LPN|
20|FH_F143971_34986_0|SrvcGrp|90854|2022|PDM|850.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F37884_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE NO MOD|
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|2526.00|99|0.00|IMPLANTS|
20|FH_F113410_0_0|SrvcGrp|86462|2022|PDM|1786.00|99|0.00|AREOLA RECONSTRUCTION|
20|FH_F135235_01830_0|SrvcGrp|108484|2022|PDM|969.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F32292_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F139515_0_0|SrvcGrp|82298|2022|PDM|9270.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY|
20|FH_F128992_90808_0|SrvcGrp|89337|2022|PDM|1173.00|99|0.00|DETOXIFICATION|
20|FH_F131254_92211_0|SrvcGrp|86849|2022|PDM|50.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F116061_80110_0|SrvcGrp|91392|2022|PDM|225.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AF)|
20|FH_F52854_0_0|SrvcGrp|9937|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F130487_98004_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F86332_75081_0|SrvcGrp|10648|2022|PDM|10.00|99|0.00|HOME INFUSION|
20|FH_F90492_0_0|SrvcGrp|70381|2022|PDM|325.00|99|0.00|PSYCH PARTIAL HOSP (FULL & PARTIAL DAY) PER VISIT|
20|FH_F139509_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F32513_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128237_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 10 (NO REV)|
20|FH_F111826_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F139515_0_0|SrvcGrp|92405|2022|PDM|5665.00|99|0.00|PERQ LUMBOSACRAL INJECTION|
20|FH_F63438_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F140247_0_0|CSTM-ALL|CSTM-00|2020|PCT|300.00|99|0.00|HSS ASC|
20|FH_F39278_0_0|SrvcGrp|8962|2022|PDM|166.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F127209_45365_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129231_30060_0|SrvcGrp|111259|2022|PDM|1789.00|99|0.00|REPAIR RETINAL DETACH CPLX (MOD RT)|
20|FH_F31643_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F40081_0_0|SrvcGrp|31828|2022|PDM|500.00|99|0.00|PSYCHIATRIC EATING DISORDERS|
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|617.00|99|0.00|ASPG I|
20|FH_F91832_06106_0|SrvcGrp|88621|2022|PDM|78.75|99|0.00|SKILLED NURSING LPN|
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 10 (NO REV)|
20|FH_F87201_0_0|SrvcGrp|29345|2022|PDM|38.00|99|0.00|SKILLED NURSING - LPN - MOD TE|
20|FH_F104840_32565_0|SrvcGrp|75485|2022|PCT|0.69|99|0.00|AEG 4|
20|FH_F105700_08865_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|OP SVCS|
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AEG 7 (NO REV)|
20|FH_F133016_67114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F138751_0_0|SrvcGrp|113367|2022|PDM|182.00|99|0.00|CAPD/CCPD|
20|FH_F138929_0_0|SrvcGrp|58634|2022|PDM|5500.00|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F95282_77975_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F132988_0_0|SrvcGrp|82634|2022|PDM|4493.01|99|0.00|REPAIR OF KNEE LIGAMENTS|
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 3 (NO REV)|
20|FH_F141036_02347_0|SrvcGrp|82981|2022|PDM|174.72|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F86611_0_0|CSTM-ALL|CSTM-00|2020|PDM|197.00|99|0.00|OP SVCS|
20|FH_F126345_0_0|SrvcGrp|63471|2022|PDM|2899.00|99|0.00|CPT 64590|
20|FH_F119603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124180_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F77944_0_0|SrvcGrp|21040|2022|PDM|52478.00|99|0.00|MS DRG 652 ONLY - KIDNEY TRANSPLANT|
20|FH_F146800_74128_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146880_74105_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147081_02130_0|SrvcGrp|91070|2022|PDM|284.00|99|0.00|AETNA MH CRISIS INTERVENTION (HCFA)|
20|FH_F38983_0_0|SrvcGrp|115|2022|PDM|525.00|99|0.00|SKILLED NURSING CARE|
20|FH_F100703_0_0|SrvcGrp|97019|2022|PDM|4284.00|99|0.00|ARTHROSCOPY BICEPS TENODESIS|
20|FH_F129549_01238_0|SrvcGrp|90707|2022|PDM|177.45|99|0.00|AETNA HOSPICE CARE|
20|FH_F124183_01109_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F124235_92840_0|SrvcGrp|87131|2022|PDM|900.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F127995_84010_0|SrvcGrp|53987|2022|PDM|239.49|99|0.00|PHOTOTHERAPY|
20|FH_F42913_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F133697_63129_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100787_69162_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F136568_92562_0|SrvcGrp|46903|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F136568_92562_0|SrvcGrp|86722|2022|PDM|365.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F114666_30342_0|SrvcGrp|72121|2022|PDM|2500.00|99|0.00|ARTHOSCOPY|
20|FH_F114678_78745_0|SrvcGrp|89337|2022|PDM|932.00|99|0.00|DETOXIFICATION|
20|FH_F114727_44512_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F114792_48849_0|SrvcGrp|72602|2022|PDM|695.00|99|0.00|ECT|
20|FH_F148553_85016_0|SrvcGrp|115477|2022|PDM|4517.00|99|0.00|PERC D-E COR REVASC CHRO SIN|
20|FH_F42937_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F135762_70001_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136796_24016_0|SrvcGrp|103538|2022|PDM|3945.98|99|0.00|ARTHROSCOPY HIP W/ FEMOROPLASTY|
20|FH_F141170_0_0|SrvcGrp|103592|2022|PDM|6000.00|99|0.00|VERTEBRAL ART|
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|789.00|99|0.00|ASPG V|
20|FH_F116199_75042_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F116393_07002_0|SrvcGrp|89080|2022|PDM|59.01|99|0.00|X-RAY EXAM OF NECK SPINE|
20|FH_F116393_07002_0|CSTM-ALL|CSTM-00|2020|PDM|20.05|99|0.00|MANUAL LIMB MUSCLE TESTING|
20|FH_F147660_75110_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F39633_0_0|SrvcGrp|17079|2022|PDM|1797.00|99|0.00|ASPG VIII|
20|FH_F54552_0_0|SrvcGrp|17004|2022|PDM|54.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS|
20|FH_F54552_0_0|SrvcGrp|10579|2022|PDM|50.00|99|0.00|HYDRATION THERAPY - 2 LITERS|
20|FH_F54552_0_0|SrvcGrp|21711|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F54552_0_0|SrvcGrp|17013|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138807_32207_0|SrvcGrp|88620|2022|PDM|137.00|99|0.00|SKILLED NURSING RN|
20|FH_F57953_0_0|SrvcGrp|32388|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKE (DME)|
20|FH_F83792_0_0|SrvcGrp|73659|2022|PDM|1837.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F89580_0_0|SrvcGrp|88421|2022|PCT|0.46|99|0.00|OP DIAPHRAGMATIC PACEMAKER IMP|
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1280.43|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1404 W/O REV|
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|699.00|99|0.00|AEG 4 (NO REV)|
20|FH_F113527_31023_0|SrvcGrp|75479|2022|PCT|0.80|99|0.00|AEG 1|
20|FH_F151380_90701_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F151401_36607_0|SrvcGrp|92518|2022|PDM|145.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F151439_18104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151503_30067_0|SrvcGrp|104008|2022|PDM|5709.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS|
20|FH_F132258_45404_0|SrvcGrp|86842|2022|PDM|31.80|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F123194_97222_0|SrvcGrp|87317|2022|PDM|950.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F135432_16335_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135453_70726_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F135572_89106_0|SrvcGrp|14949|2022|PCT|1.00|99|0.00|HOME INFUSION|
20|FH_F135587_37334_0|SrvcGrp|472|2022|PDM|422.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F97142_94535_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F135781_60643_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135979_66451_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F136174_89146_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F119892_47586_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F151143_0_0|SrvcGrp|100960|2022|PDM|79.00|99|0.00|FIXED WING AIR MILEAGE|
20|FH_F43237_0_0|SrvcGrp|31931|2022|PDM|2178.00|99|0.00|SKILLED NURSING CARE|
20|FH_F128370_76132_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F111341_80501_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F117486_0_0|SrvcGrp|103550|2022|PDM|400.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F33081_0_0|SrvcGrp|58|2022|PDM|3800.00|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F41780_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F131000_0_0|SrvcGrp|76604|2022|PDM|2971.00|99|0.00|CPT 25447|
20|FH_F112146_87102_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132090_60915_0|SrvcGrp|94561|2022|PDM|3501.00|99|0.00|HIP ARTHRO W/ FEMOROPLASTY|
20|FH_F111190_30512_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100681_73104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F134192_0_0|SrvcGrp|106798|2022|PDM|4100.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F95101_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F95221_0_0|SrvcGrp|72994|2022|PDM|546.00|99|0.00|AEG 3|
20|FH_F110604_0_0|SrvcGrp|36591|2022|PDM|48400.00|99|0.00|CPT 63685|
20|FH_F32287_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124443_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F89340_0_0|SrvcGrp|44066|2022|PDM|1848.00|99|0.00|CPT 57288|
20|FH_F117465_0_0|SrvcGrp|40003|2022|PDM|9000.00|99|0.00|TOTAL KNEE|
20|FH_F118171_00674_0|SrvcGrp|107735|2022|PDM|4500.00|99|0.00|LITHOTRIPSY|
20|FH_F120489_63552_0|SrvcGrp|10107|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F93132_73134_0|SrvcGrp|46104|2022|PDM|60.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F93292_62234_0|SrvcGrp|96499|2022|PDM|5.00|99|0.00|ADMIN OF PNEUMOCOCCAL VACCINE|
20|FH_F134075_78230_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134126_11554_0|SrvcGrp|74403|2022|PDM|2871.00|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F134126_11554_0|SrvcGrp|112510|2022|PCT|2.00|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F134155_07016_0|SrvcGrp|89412|2022|PDM|405.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F114092_83350_0|CSTM-ALL|CSTM-00|2020|PDM|8439.00|99|0.00|AEG 5  (NO REV)|
20|FH_F142448_15701_0|SrvcGrp|43569|2022|PDM|60.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F142511_78597_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F73403_0_0|SrvcGrp|45966|2022|PDM|140.00|99|0.00|SOCIAL WORKER|
20|FH_F83831_0_0|SrvcGrp|12073|2022|PDM|46.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138512_62236_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132733_0_0|CSTM-ALL|CSTM-00|2020|PDM|2306.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139456_47501_0|SrvcGrp|21342|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F140573_46517_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140615_73013_0|CSTM-ALL|CSTM-00|2020|PDM|1294.00|99|0.00|AEG 2 (NO REV)|
20|FH_F140889_33071_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F149378_44074_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151608_30236_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 7 (NO REV)|
20|FH_F118943_64506_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F129838_17555_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F50519_0_0|SrvcGrp|46767|2022|PDM|80.00|99|0.00|CPT CODE 90806 PER VISIT|
20|FH_F117093_40041_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F137817_17050_0|SrvcGrp|46903|2022|PDM|541.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|AEG 1 (NO REV)|
20|FH_F137818_31602_0|SrvcGrp|90040|2022|PDM|354.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F37878_0_0|SrvcGrp|100947|2022|PDM|80.00|99|0.00|HOME HEALTH RN SERVICE|
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
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|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 10 (NO REV)|
20|FH_F134797_0_0|SrvcGrp|105233|2022|PDM|2500.00|99|0.00|REMOVAL OF THYROID|
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117087_0_0|SrvcGrp|89853|2022|PDM|2093.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG|
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)|
20|FH_F119437_0_0|SrvcGrp|93069|2022|PDM|4750.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F133477_90247_0|SrvcGrp|81779|2022|PCT|1.40|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F97882_32407_0|SrvcGrp|90854|2022|PDM|2943.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F150003_22630_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F88512_0_0|SrvcGrp|79978|2022|PCT|0.53|99|0.00|IMPLANTS/PROSTHETICS/DRUGS|
20|FH_F117906_91606_0|SrvcGrp|73700|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F68944_0_0|SrvcGrp|3208|2022|PDM|1236.00|99|0.00|SUBACUTE CARE|
20|FH_F90921_77702_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F49637_0_0|SrvcGrp|28624|2022|PCT|0.50|99|0.00|HIGH COST DRUGS|
20|FH_F109815_52241_0|SrvcGrp|12514|2022|PDM|1534.00|99|0.00|TRANSITIONAL LIVING CENTER|
20|FH_F38249_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F128508_37210_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142891_54022_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F68944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F102561_75146_0|SrvcGrp|16|2022|PDM|1100.00|99|0.00|ACUTE REHABILITATION|
20|FH_F123154_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90921_77702_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F56793_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BARTON COUNTY IV SERVICES|
20|FH_F90811_0_0|SrvcGrp|27343|2022|PDM|4000.00|99|0.00|OP SURGERY (CPT 25607 - 25609)|
20|FH_F31096_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F72387_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148555_0_0|SrvcGrp|109219|2022|PDM|3709.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F42640_0_0|SrvcGrp|28145|2022|PDM|275.00|99|0.00|SKILLED NURSING|
20|FH_F117970_15963_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148903_51101_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F70487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.96|99|0.00|GENERAL ACUTE CARE|
20|FH_F97560_23249_0|SrvcGrp|73603|2022|PDM|11254.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F112848_06032_0|SrvcGrp|473|2022|PDM|488.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F45132_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F117450_63131_0|SrvcGrp|27968|2022|PDM|55.00|99|0.00|SKILLED NURSING LPN|
20|FH_F118645_19103_0|SrvcGrp|471|2022|PDM|446.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F44701_0_0|SrvcGrp|28547|2022|PDM|1550.00|99|0.00|VITRECTOMY|
20|FH_F133287_40215_0|SrvcGrp|73498|2022|PDM|499.00|99|0.00|AETNA ER LEVEL III|
20|FH_F130632_44145_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146211_68144_0|SrvcGrp|90417|2022|PDM|3913.00|99|0.00|TREATMENT OF JOINT|
20|FH_F81313_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133018_84037_0|SrvcGrp|27969|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE|
20|FH_F132543_79549_0|SrvcGrp|73601|2022|PDM|1560.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F100665_07939_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46772_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72648_0_0|SrvcGrp|44250|2022|PDM|280.00|99|0.00|CCPD TRAINING|
20|FH_F40442_0_0|SrvcGrp|38|2022|PDM|2500.00|99|0.00|NORMAL DELIVERY|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/MOD KN (TX)|
20|FH_F117272_24333_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F133154_27401_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F142782_16201_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F89932_10940_0|SrvcGrp|73008|2022|PDM|2200.00|99|0.00|AEG 10|
20|FH_F133493_90255_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F100841_0_0|SrvcGrp|87077|2022|PDM|105.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F92833_0_0|SrvcGrp|84280|2022|PDM|2992.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F51658_0_0|SrvcGrp|45944|2022|PDM|46.00|99|0.00|HOME HEALTH AIDE SVCS|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|COVENTRY ENHANCED GROUPER 4 MOD 50|
20|FH_F87171_32578_0|SrvcGrp|471|2022|PDM|472.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F150480_14043_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F106540_26330_0|SrvcGrp|73000|2022|PDM|4200.00|99|0.00|AEG 6|
20|FH_F133019_23236_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117906_91606_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F111809_93003_0|SrvcGrp|113615|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F40994_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F97621_75801_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F111269_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F49637_0_0|SrvcGrp|23458|2022|PDM|345.00|99|0.00|URGENT CARE SERVICES|
20|FH_F43411_0_0|SrvcGrp|24|2022|PCT|0.75|99|0.00|CARDIAC CATH|
20|FH_F150538_90056_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F92676_15063_0|SrvcGrp|78956|2022|PDM|2685.96|99|0.00|MON VALLEY ASC 1303|
20|FH_F35454_0_0|SrvcGrp|16511|2022|PDM|35.00|99|0.00|CPT 69210|
20|FH_F109840_62832_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97141_93933_0|SrvcGrp|73485|2022|PDM|2866.00|99|0.00|AETNA REHAB|
20|FH_F101840_76054_0|SrvcGrp|97471|2022|PDM|8207.00|99|0.00|REMOVAL OF THYROID DUCT LESION|
20|FH_F34412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|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_F132543_79549_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F31530_0_0|SrvcGrp|473|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F40448_0_0|SrvcGrp|16|2022|PDM|811.00|99|0.00|ACUTE REHABILITATION|
20|FH_F83053_0_0|SrvcGrp|11000|2022|PCT|0.26|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F100740_15206_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F92677_08003_0|SrvcGrp|41451|2022|PDM|0.89|99|0.00|ENTERAL FORMULA - CALORICALLY DENSE|
20|FH_F113324_17055_0|SrvcGrp|48168|2022|PDM|765.00|99|0.00|HEMODIALYSIS|
20|FH_F100784_59923_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F66712_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F118667_95131_0|SrvcGrp|88620|2022|PDM|130.00|99|0.00|SKILLED NURSING RN|
20|FH_F148881_33018_0|SrvcGrp|105021|2022|PDM|75.00|99|0.00|EVALUATION OF SPEECH (HCFA)|
20|FH_F139825_0_0|SrvcGrp|42551|2022|PDM|1721.00|99|0.00|OP SURGERY|
20|FH_F133021_00910_0|SrvcGrp|112267|2022|PDM|15550.00|99|0.00|ENDOVASCULAR REPAIR ABDOMINAL AORTA|
20|FH_F150001_33064_0|SrvcGrp|26869|2022|PDM|26.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F145854_37015_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F70711_0_0|SrvcGrp|16469|2022|PDM|4699.00|99|0.00|PROSTATE RESECTION|
20|FH_F40008_0_0|SrvcGrp|22954|2022|PDM|105.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F101840_76054_0|SrvcGrp|35921|2022|PDM|13911.00|99|0.00|BARIATRIC SURGERY|
20|FH_F113326_80014_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F133530_11237_0|CSTM-ALL|CSTM-00|2020|PDM|2920.00|99|0.00|AEG 4 (NO REV) (W/O ENDOSCOPIC PROCEDURES)|
20|FH_F40975_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F150559_60018_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F35176_0_0|SrvcGrp|9832|2022|PDM|84.50|99|0.00|ST SVCS|
20|FH_F37408_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.89|99|0.00|GENERAL ACUTE CARE|
20|FH_F112165_0_0|SrvcGrp|72994|2022|PDM|2800.00|99|0.00|AEG 3|
20|FH_F97542_32960_0|SrvcGrp|73485|2022|PDM|2301.00|99|0.00|AETNA REHAB|
20|FH_F87455_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F92676_15063_0|SrvcGrp|79072|2022|PDM|332.81|99|0.00|MON VALLEY ASC 138|
20|FH_F134487_14843_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F101943_17701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151747_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F92676_15063_0|SrvcGrp|78958|2022|PDM|2593.33|99|0.00|MON VALLEY ASC 6|
20|FH_F32953_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PDM|2019.00|99|0.00|ASPG IX|
20|FH_F144709_48076_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F65139_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117340_68144_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133008_78382_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F56793_0_0|SrvcGrp|42976|2022|PDM|90.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F117911_86403_0|SrvcGrp|73701|2022|PDM|39.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F92676_15063_0|SrvcGrp|79004|2022|PDM|1078.08|99|0.00|MON VALLEY ASC 218|
20|FH_F124954_17055_0|SrvcGrp|106300|2022|PDM|310.98|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F138611_0_0|SrvcGrp|93431|2022|PDM|14894.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F118027_28801_0|SrvcGrp|86722|2022|PDM|231.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F123012_27703_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F113131_19013_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F144769_0_0|SrvcGrp|11336|2022|PCT|0.21|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F36579_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALLIED MED-MOD UE|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|591.79|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26 AND TC)|
20|FH_F127197_23111_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F133028_08021_0|SrvcGrp|52953|2022|PDM|108.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F37641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1129.00|99|0.00|ASPG VII|
20|FH_F38977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F68562_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F40267_0_0|SrvcGrp|12889|2022|PCT|1.00|99|0.00|RADIOLOGY|
20|FH_F92531_0_0|SrvcGrp|74585|2022|PCT|1.10|99|0.00|AETNA OP IMPLANTS|
20|FH_F102561_75146_0|SrvcGrp|72998|2022|PDM|2700.00|99|0.00|AEG 5|
20|FH_F133412_84129_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F147800_0_0|SrvcGrp|45063|2022|PDM|880.00|99|0.00|CPT 64493  INJECTION CARVE OUT|
20|FH_F134430_86301_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133427_48811_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F92677_08003_0|SrvcGrp|86827|2022|PDM|113.40|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F113792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118379_32079_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39171_61362_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F48929_0_0|SrvcGrp|42784|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F36052_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F118542_60188_0|SrvcGrp|24750|2022|PDM|35.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F118542_60188_0|SrvcGrp|14944|2022|PDM|5.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F102721_38118_0|SrvcGrp|83960|2022|PCT|0.40|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F115505_21014_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146361_66215_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111467_33761_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC|
20|FH_F73684_0_0|SrvcGrp|3087|2022|PDM|790.00|99|0.00|CD - DETOX|
20|FH_F124608_0_0|SrvcGrp|88155|2022|PDM|7650.00|99|0.00|REVISE KNEECAP WITH IMPLANT|
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|307.00|99|0.00|AEG 1 (NO REV)|
20|FH_F124505_0_0|SrvcGrp|80543|2022|PDM|968.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 7|
20|FH_F151144_35801_0|SrvcGrp|90599|2022|PDM|1273.10|99|0.00|REMOVAL OF LENS LESION|
20|FH_F121954_60706_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113139_0_0|SrvcGrp|104923|2022|PCT|1.00|99|0.00|CATHETER INTRAVASCULAR ULTRS|
20|FH_F112844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129130_92562_0|CSTM-ALL|CSTM-00|2020|PDM|1079.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F139172_40207_0|CSTM-ALL|CSTM-00|2020|PDM|804.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F139707_84010_0|CSTM-ALL|CSTM-00|2020|PDM|4069.00|99|0.00|AEG 9 (NO REV)|
20|FH_F139150_75206_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F127418_0_0|SrvcGrp|88158|2022|PDM|23957.33|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F126116_0_0|SrvcGrp|91577|2022|PDM|11944.00|99|0.00|FEM/POPL REVASC STNT & ATHER|
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1785.00|99|0.00|AEG 8 (NO REV)|
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|1303.00|99|0.00|AEG 1 (NO REV)|
20|FH_F47902_0_0|SrvcGrp|23235|2022|PCT|1.00|99|0.00|DME (GLOBAL)|
20|FH_F35750_0_0|SrvcGrp|361|2022|PDM|2094.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F143201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150961_89169_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F36594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125656_92868_0|SrvcGrp|16750|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F124291_44122_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F94643_90501_0|SrvcGrp|116238|2022|PCT|1.00|99|0.00|DRUGS (C, J, Q & S CODES)|
20|FH_F98020_50138_0|SrvcGrp|88978|2022|PDM|7023.00|99|0.00|VAGINAL DELIVERY|
20|FH_F149651_90046_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149602_07109_0|SrvcGrp|113236|2022|PDM|41.38|99|0.00|COVID-19 SARS-COV-2 W/ OPTIC|
20|FH_F132672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147228_49441_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37312_0_0|SrvcGrp|25939|2022|PDM|99.00|99|0.00|SPEECH THERAPY|
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|3603.00|99|0.00|AEG 8 (NO REV)|
20|FH_F52092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F123745_0_0|SrvcGrp|93431|2022|PDM|11000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F149539_06032_0|SrvcGrp|88620|2022|PDM|168.00|99|0.00|SKILLED NURSING RN|
20|FH_F150982_0_0|SrvcGrp|87385|2022|PDM|1382.00|99|0.00|PARTIAL REMOVAL OF EYE FLUID|
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F101441_0_0|SrvcGrp|99073|2022|PDM|1.43|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F150941_68124_0|SrvcGrp|90854|2022|PDM|1000.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F35729_34667_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F143564_0_0|SrvcGrp|92418|2022|PDM|2998.00|99|0.00|LAPAROSCOPY|
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|2245.00|99|0.00|AEG 9 (NO REV)|
20|FH_F134390_27012_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG IX|
20|FH_F144651_0_0|SrvcGrp|98566|2022|PDM|15000.00|99|0.00|ARTHRDSIS LAT MINI DISKECT|
20|FH_F120157_93103_0|SrvcGrp|67684|2022|PDM|275.00|99|0.00|PSYCH VISIT|
20|FH_F130813_85014_0|SrvcGrp|74668|2022|PDM|214.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F141287_14830_0|SrvcGrp|113185|2022|PCT|6.72|99|0.00|RADIOLOGY SERVICES|
20|FH_F35987_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.00|99|0.00|ACUTE PSYCH|
20|FH_F132056_32080_0|SrvcGrp|89149|2022|PDM|208.00|99|0.00|OP INTENSIVE|
20|FH_F138478_0_0|SrvcGrp|109500|2022|PDM|1341.77|99|0.00|REPAIR LEAD PACE-DEFIB ONE|
20|FH_F35452_0_0|SrvcGrp|12212|2022|PCT|0.85|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)|
20|FH_F137986_0_0|SrvcGrp|26273|2022|PDM|1436.00|99|0.00|CPT 29880|
20|FH_F97100_23462_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|AEG 1 (NO REV)|
20|FH_F116575_0_0|SrvcGrp|106265|2022|PDM|2650.00|99|0.00|NSL/SINS NDSC TOTAL|
20|FH_F80834_0_0|SrvcGrp|3069|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F111320_0_0|SrvcGrp|104357|2022|PDM|1750.00|99|0.00|DACRYOCYSTORHINOSTOMY|
20|FH_F97081_21122_0|SrvcGrp|3809|2022|PDM|609.03|99|0.00|HOSPICE CARE|
20|FH_F45798_0_0|SrvcGrp|16|2022|PDM|1539.00|99|0.00|ACUTE REHABILITATION|
20|FH_F50100_0_0|SrvcGrp|46116|2022|PDM|110.64|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F122377_91007_0|SrvcGrp|75485|2022|PDM|7624.00|99|0.00|AEG 4|
20|FH_F150952_85008_0|SrvcGrp|109330|2022|PCT|1.03|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F76285_0_0|SrvcGrp|26160|2022|PDM|60.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F117714_94301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F90817_0_0|SrvcGrp|45583|2022|PDM|2350.00|99|0.00|CPT 65730|
20|FH_F149522_83221_0|SrvcGrp|29346|2022|PDM|45.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F133677_15601_0|SrvcGrp|23683|2022|PDM|107.00|99|0.00|SKILLED NURSING RN|
20|FH_F124467_27529_0|SrvcGrp|46903|2022|PDM|631.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F36992_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90455_0_0|SrvcGrp|43567|2022|PDM|128.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F137767_01841_0|SrvcGrp|72984|2022|PDM|250.00|99|0.00|CHEMOTHERAPY|
20|FH_F41167_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ACUTE PSYCH|
20|FH_F147372_0_0|SrvcGrp|75419|2022|PDM|533.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F149648_89148_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149585_46012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F71468_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HILLCREST IV THERAPY - MOD SH|
20|FH_F147080_02446_0|SrvcGrp|46903|2022|PDM|473.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F50220_0_0|SrvcGrp|28074|2022|PCT|0.90|99|0.00|HIGH COST PHARMACEUTICALS|
20|FH_F127258_79912_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F114416_0_0|SrvcGrp|93098|2022|PDM|120.00|99|0.00|HOSPICE CARE|
20|FH_F117762_0_0|SrvcGrp|92366|2022|PDM|1976.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F129764_48084_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL|
20|FH_F42538_0_0|SrvcGrp|22954|2022|PDM|148.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1094.00|99|0.00|AEG 4 (NO REV)|
20|FH_F111122_63376_0|SrvcGrp|48396|2022|PDM|81.50|99|0.00|OT SERVICES|
20|FH_F138995_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F147347_70806_0|SrvcGrp|105409|2022|PDM|75.00|99|0.00|AETNA PHARMACOLOGIC MANAGEMENT|
20|FH_F36079_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SHEEPLESS NIGHTS MOD NU|
20|FH_F94643_90501_0|SrvcGrp|86830|2022|PDM|45.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F40490_0_0|SrvcGrp|32558|2022|PDM|1606.00|99|0.00|ACUTE REHAB|
20|FH_F36943_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD KN|
20|FH_F128091_37129_0|SrvcGrp|89337|2022|PDM|830.00|99|0.00|DETOXIFICATION|
20|FH_F143351_21157_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143536_47546_0|SrvcGrp|73362|2022|PCT|1.00|99|0.00|VACCINE SERVICES|
20|FH_F98480_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|AEG 1 (NO REV)|
20|FH_F101709_0_0|SrvcGrp|72996|2022|PDM|2681.00|99|0.00|AEG 4|
20|FH_F47600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F47792_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION|
20|FH_F136247_28804_0|SrvcGrp|73842|2022|PDM|310.76|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132373_47130_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F112679_85711_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116683_64730_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F116802_41224_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116907_75093_0|SrvcGrp|100859|2022|PDM|275.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F83292_0_0|SrvcGrp|69527|2022|PCT|2.25|99|0.00|BARNESVILLE  OP REHAB @ 100% W/ OP SURG|
20|FH_F120974_27607_0|SrvcGrp|115926|2022|PCT|3.05|99|0.00|RADIOLOGY SERVICES|
20|FH_F126054_30022_0|SrvcGrp|100520|2022|PDM|394.00|99|0.00|INTENSIVE OP EATING DISORDERS|
20|FH_F126243_32132_0|SrvcGrp|90854|2022|PDM|872.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F38092_0_0|SrvcGrp|17000|2022|PCT|0.60|99|0.00|OUTPATIENT SURGERY|
20|FH_F33925_0_0|SrvcGrp|9984|2022|PDM|105.00|99|0.00|URGENT CARE|
20|FH_F62694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|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_F130755_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|AEG 3 (NO REV)|
20|FH_F98002_27103_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F133747_80634_0|SrvcGrp|88277|2022|PCT|0.92|99|0.00|PT/OT/ST|
20|FH_F112082_30720_0|SrvcGrp|53987|2022|PCT|1.46|99|0.00|PHOTOTHERAPY|
20|FH_F149021_44514_0|SrvcGrp|102120|2022|PDM|775.28|99|0.00|REVISE EYE MUSCLE|
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|2020.00|99|0.00|AEG 9 (NO REV)|
20|FH_F142376_0_0|SrvcGrp|113983|2022|PDM|1051.00|99|0.00|NJX AA&/STRD TFRM EPI C/T|
20|FH_F85315_15217_0|SrvcGrp|471|2022|PDM|440.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117206_0_0|SrvcGrp|67072|2022|PDM|2781.00|99|0.00|CPT 22845|
20|FH_F133972_27103_0|SrvcGrp|19742|2022|PDM|60.00|99|0.00|MID-LINE INSERTION|
20|FH_F132790_38901_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120720_24541_0|SrvcGrp|88620|2022|PDM|70.00|99|0.00|SKILLED NURSING RN|
20|FH_F83995_16748_0|SrvcGrp|26336|2022|PDM|107.00|99|0.00|T1001|
20|FH_F117206_0_0|SrvcGrp|71666|2022|PDM|2500.00|99|0.00|CPT 63655|
20|FH_F116126_0_0|SrvcGrp|3809|2022|PDM|573.47|99|0.00|HOSPICE CARE|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|666.00|99|0.00|ASPG I|
20|FH_F145604_14850_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F116753_0_0|CSTM-ALL|CSTM-00|2020|PDM|3456.00|99|0.00|AEG 7 (NO REV)|
20|FH_F85097_0_0|SrvcGrp|71980|2022|PCT|1.15|99|0.00|OCN F/S PRICING: LAB NORTH PHIL|
20|FH_F132883_31602_0|SrvcGrp|29075|2022|PDM|20.00|99|0.00|HYDRATION THERAPY|
20|FH_F112082_30720_0|SrvcGrp|16750|2022|PDM|166.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F146544_78705_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F118943_64506_0|SrvcGrp|29023|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118943_64506_0|SrvcGrp|88620|2022|PDM|83.00|99|0.00|SKILLED NURSING RN|
20|FH_F118943_64506_0|SrvcGrp|88621|2022|PDM|73.00|99|0.00|SKILLED NURSING LPN|
20|FH_F38332_0_0|SrvcGrp|18119|2022|PDM|12064.00|99|0.00|MS DRG 240|
20|FH_F109930_73109_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F66835_0_0|SrvcGrp|12290|2022|PDM|630.00|99|0.00|DETOXIFICATION|
20|FH_F147726_18017_0|CSTM-ALL|CSTM-00|2020|PDM|535.00|99|0.00|AEG 2 (NO REV)|
20|FH_F88797_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F38699_0_0|SrvcGrp|17071|2022|PDM|786.00|99|0.00|ASPG IV|
20|FH_F111593_0_0|SrvcGrp|73004|2022|PDM|2344.10|99|0.00|AEG 8|
20|FH_F91472_96001_0|SrvcGrp|103746|2022|PCT|0.40|99|0.00|TOTAL ELBOW REPLACEMENT|
20|FH_F124893_40311_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F138543_60130_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F91067_0_0|SrvcGrp|72992|2022|PDM|547.00|99|0.00|AEG 2|
20|FH_F36732_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135653_0_0|SrvcGrp|96353|2022|PDM|12500.00|99|0.00|RECONSTRUCT ANKLE JOINT|
20|FH_F49444_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F147403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50137_0_0|SrvcGrp|45944|2022|PDM|26.00|99|0.00|HOME HEALTH AIDE SVCS|
20|FH_F59732_0_0|SrvcGrp|19742|2022|PDM|115.00|99|0.00|MID-LINE INSERTION|
20|FH_F59732_0_0|SrvcGrp|10580|2022|PDM|55.00|99|0.00|HYDRATION THERAPY - 3 LITERS|
20|FH_F83533_70433_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F125249_0_0|SrvcGrp|41325|2022|PDM|1200.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F47656_0_0|CSTM-ALL|CSTM-00|2020|PDM|6100.00|99|0.00|CV SURGERY (MS DRG)|
20|FH_F116136_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F88212_20151_0|SrvcGrp|46424|2022|PDM|95.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F135056_06401_0|SrvcGrp|109330|2022|PCT|1.03|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F84778_0_0|SrvcGrp|78448|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F52854_0_0|SrvcGrp|16434|2022|PDM|10712.00|99|0.00|PACEMAKER IMPLANT|
20|FH_F37945_0_0|SrvcGrp|12920|2022|PDM|1591.00|99|0.00|EMERGENCY CRITICAL CARE|
20|FH_F48215_0_0|SrvcGrp|9828|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE|
20|FH_F139551_0_0|SrvcGrp|99073|2022|PDM|2.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F35344_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135171_22601_0|SrvcGrp|73842|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F77042_0_0|SrvcGrp|74382|2022|PDM|18.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F100761_02539_0|SrvcGrp|73485|2022|PDM|2919.00|99|0.00|AETNA REHAB|
20|FH_F150982_0_0|SrvcGrp|104751|2022|PDM|3303.00|99|0.00|REPAIR RECTUM & VAGINA|
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116093_47327_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F130051_31707_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F128136_48025_0|SrvcGrp|33722|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F76303_0_0|SrvcGrp|53145|2022|PDM|18.00|99|0.00|SOCIAL WORKER|
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|AEG 1 (NO REV)|
20|FH_F110925_01104_0|SrvcGrp|86123|2022|PDM|40.00|99|0.00|AETNA INJ IVIG PRIVIGEN|
20|FH_F135072_65712_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)|
20|FH_F143528_0_0|SrvcGrp|100007|2022|PDM|7680.75|99|0.00|FUSION OF ANKLE JOINT|
20|FH_F126070_0_0|SrvcGrp|72992|2022|PDM|543.00|99|0.00|AEG 2|
20|FH_F42511_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F116065_06708_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1308.77|99|0.00|HAPA WPA-NWPA 2012-13 ASC 904 W/O REV|
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|665.00|99|0.00|ASPG III|
20|FH_F35388_0_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F34487_0_0|SrvcGrp|9795|2022|PDM|624.00|99|0.00|SUBACUTE REHAB|
20|FH_F63141_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F145536_90265_0|SrvcGrp|87317|2022|PDM|2835.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F109180_18015_0|SrvcGrp|89417|2022|PDM|321.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F145758_20745_0|SrvcGrp|84912|2022|PDM|2550.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F125810_67301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1004.85|99|0.00|HAPA WPA-NWPA 2012-13 ASC 704 W/O REV|
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PDM|1740.00|99|0.00|ASPG VIII|
20|FH_F97102_83501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F140913_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129969_33908_0|SrvcGrp|89417|2022|PDM|320.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F143928_21061_0|SrvcGrp|43569|2022|PDM|131.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F74342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F40834_0_0|SrvcGrp|16|2022|PCT|0.80|99|0.00|ACUTE REHABILITATION|
20|FH_F110925_01104_0|SrvcGrp|14947|2022|PDM|38.00|99|0.00|HOME INFUSION|
20|FH_F49299_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F100761_02539_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F116697_11703_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F117378_16148_0|SrvcGrp|23683|2022|PDM|38.00|99|0.00|SKILLED NURSING RN|
20|FH_F35202_0_0|SrvcGrp|9828|2022|PDM|35.70|99|0.00|HOME HEALTH AIDE|
20|FH_F125011_74467_0|SrvcGrp|102261|2022|PDM|5000.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F141129_0_0|SrvcGrp|42824|2022|PDM|43.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F140893_19720_0|SrvcGrp|48398|2022|PDM|113.00|99|0.00|PT SERVICES|
20|FH_F40427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1008.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147991_65625_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F83995_16748_0|SrvcGrp|81779|2022|PCT|1.50|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F134614_84651_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40294_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|484.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 11 W/O REV|
20|FH_F145641_06902_0|SrvcGrp|106093|2022|PDM|5814.00|99|0.00|HIP ARTHROSCOPY|
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.00|99|0.00|AEG 6 (NO REV)|
20|FH_F70883_0_0|SrvcGrp|9832|2022|PDM|66.00|99|0.00|ST SVCS|
20|FH_F146423_28401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.60|99|0.00|ASPG III|
20|FH_F111957_30024_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134174_63141_0|CSTM-ALL|CSTM-00|2020|PDM|128.49|99|0.00|AETNA SLEEP STUDIES (CMS-1500)|
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F131100_0_0|SrvcGrp|35667|2022|PDM|1274.00|99|0.00|CPT 20680|
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 4 (NO REV)|
20|FH_F143567_62207_0|SrvcGrp|42972|2022|PDM|56.00|99|0.00|HOME HEALTH AIDE|
20|FH_F111986_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 IX|
20|FH_F113453_80020_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F118123_67226_0|SrvcGrp|17013|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F128825_45211_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F32073_0_0|SrvcGrp|17710|2022|PDM|2205.00|99|0.00|RESPIRATORY DEPENDENT PATIENT|
20|FH_F145562_70458_0|SrvcGrp|86832|2022|PDM|2.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F133207_0_0|SrvcGrp|112221|2022|PDM|4774.00|99|0.00|INCISION OF METATARSAL|
20|FH_F150166_91401_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136359_0_0|SrvcGrp|65403|2022|PDM|2625.00|99|0.00|CPT 42830|
20|FH_F120930_0_0|SrvcGrp|96540|2022|PDM|3000.00|99|0.00|EXTENSIVE HYSTERCTOMY|
20|FH_F87775_15106_0|SrvcGrp|24761|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F85415_27612_0|SrvcGrp|46424|2022|PDM|78.75|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.96|99|0.00|HAPA WPA-NWPA 2012-13 ASC 13 W/O REV|
20|FH_F145641_06902_0|SrvcGrp|76603|2022|PDM|2639.00|99|0.00|CPT 25111|
20|FH_F120930_0_0|SrvcGrp|70749|2022|PDM|3500.00|99|0.00|CPT 29823|
20|FH_F37698_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F149005_16830_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F81698_10457_0|SrvcGrp|86824|2022|PDM|63.00|99|0.00|CPT CODE 99601 (HCFA)|
20|FH_F145641_06902_0|SrvcGrp|75002|2022|PDM|2409.00|99|0.00|ARTHOSCOPY|
20|FH_F39015_0_0|CSTM-ALL|CSTM-00|2020|PDM|1258.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134327_12853_0|SrvcGrp|471|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F135610_06451_0|SrvcGrp|88621|2022|PDM|83.81|99|0.00|SKILLED NURSING LPN|
20|FH_F35042_0_0|CSTM-ALL|CSTM-00|2020|PDM|683.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F150239_75569_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132727_61108_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110420_60649_0|SrvcGrp|73806|2022|PCT|0.60|99|0.00|AETNA ER|
20|FH_F38069_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS|
20|FH_F138050_52301_0|SrvcGrp|42784|2022|PDM|140.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F139569_15063_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 10 (NO REV)|
20|FH_F146657_01105_0|SrvcGrp|114671|2022|PDM|116.93|99|0.00|MH SVC PLAN DEV BY NON-MD (MOD U2)|
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 4 (NO REV)|
20|FH_F122942_89512_0|SrvcGrp|89417|2022|PDM|450.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F79824_0_0|SrvcGrp|17071|2022|PDM|2173.00|99|0.00|ASPG IV|
20|FH_F144808_0_0|SrvcGrp|114177|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149106_07042_0|CSTM-ALL|CSTM-00|2020|PDM|1886.00|99|0.00|AEG 6 (NO REV)|
20|FH_F133869_19947_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|756.36|99|0.00|ASPG IV|
20|FH_F112863_0_0|SrvcGrp|104255|2022|PDM|1141.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F95440_0_0|SrvcGrp|93721|2022|PDM|4635.00|99|0.00|LAP BAND|
20|FH_F120291_0_0|SrvcGrp|47411|2022|PDM|243.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F112908_0_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F35796_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F86252_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F84712_0_0|SrvcGrp|73004|2022|PDM|4794.00|99|0.00|AEG 8|
20|FH_F70684_0_0|SrvcGrp|42974|2022|PDM|115.99|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F101100_50314_0|SrvcGrp|9866|2022|PDM|1264.00|99|0.00|IP OBSERVATION SVCS|
20|FH_F75842_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (HCFA) OUTPATIENT|
20|FH_F146499_72206_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125698_44070_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F115950_08648_0|SrvcGrp|89412|2022|PDM|550.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F132671_60123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PDM|724.80|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 4 W/O REV|
20|FH_F114151_0_0|SrvcGrp|24739|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F129673_0_0|SrvcGrp|111405|2022|PDM|185.00|99|0.00|MED SOC SERVICE|
20|FH_F113154_70359_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 7 (NO REV)|
20|FH_F47884_0_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F125074_18104_0|SrvcGrp|14494|2022|PDM|34.07|99|0.00|CONTINUOUS HOMECARE|
20|FH_F131207_19947_0|SrvcGrp|111772|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES W/O CPT 90837|
20|FH_F148161_98198_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145758_20745_0|SrvcGrp|89860|2022|PDM|765.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F139391_30127_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139597_07009_0|SrvcGrp|113985|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F139679_75050_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F150770_43113_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134869_08854_0|SrvcGrp|90635|2022|PDM|182.00|99|0.00|AETNA PSYTX PT & FAMILY 60 MINUTES|
20|FH_F35557_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1414794 AM HOME PAT DME MOD KM|
20|FH_F124526_05301_0|SrvcGrp|89417|2022|PDM|530.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F147418_0_0|SrvcGrp|112538|2022|PDM|13000.00|99|0.00|KNEE REPLACEMENT|
20|FH_F117023_0_0|SrvcGrp|72990|2022|PDM|548.00|99|0.00|AEG 1|
20|FH_F66760_0_0|SrvcGrp|63445|2022|PDM|115.00|99|0.00|RHGAM FULL DOSE|
20|FH_F76124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125656_92868_0|SrvcGrp|24752|2022|PDM|12.50|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F147082_02359_0|SrvcGrp|114167|2022|PDM|398.00|99|0.00|PARTIAL HOSPITAL (0-17 YRS)|
20|FH_F41374_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|CHILD PSYCHIATRIC|
20|FH_F73768_0_0|SrvcGrp|26745|2022|PDM|5400.00|99|0.00|DIABETIC INSULIN PUMP|
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1175.00|99|0.00|AEG 5  (NO REV)|
20|FH_F93237_0_0|SrvcGrp|82981|2022|PDM|184.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F149001_37055_0|SrvcGrp|84185|2022|PDM|160.00|99|0.00|RESPITE CARE|
20|FH_F97260_06111_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F128366_32901_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F114294_18235_0|SrvcGrp|88403|2022|PCT|1.39|99|0.00|CMS SNF PPS|
20|FH_F117711_73080_0|SrvcGrp|104363|2022|PCT|1.25|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F37312_0_0|SrvcGrp|24289|2022|PDM|55.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F120040_72703_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|111802|2022|PDM|1322.00|99|0.00|REVISION OF PENIS|
20|FH_F125695_52033_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36343_0_0|SrvcGrp|13155|2022|PDM|106.25|99|0.00|HOME INFUSION THERAPY|
20|FH_F37078_0_0|SrvcGrp|472|2022|PDM|338.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F36343_0_0|SrvcGrp|10565|2022|PDM|106.25|99|0.00|HOME INFUSION|
20|FH_F149579_95815_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138017_73129_0|SrvcGrp|97469|2022|PDM|8122.00|99|0.00|REMOVAL OF THYROID|
20|FH_F132149_60624_0|SrvcGrp|86723|2022|PDM|418.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F122377_91007_0|SrvcGrp|75489|2022|PDM|8629.00|99|0.00|AEG 6|
20|FH_F114571_34613_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111189_0_0|SrvcGrp|89337|2022|PDM|750.00|99|0.00|DETOXIFICATION|
20|FH_F35557_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1414794 AM HOME PAT DME MOD AW|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|292.86|99|0.00|SALLY BALIN,999182,ASC 306|
20|FH_F124466_32724_0|SrvcGrp|46903|2022|PDM|484.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F140295_0_0|SrvcGrp|92819|2022|PDM|6212.00|99|0.00|HIP ARTHOSCOPY|
20|FH_F132008_85226_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145920_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F147231_49440_0|SrvcGrp|27969|2022|PDM|70.35|99|0.00|HOME HEALTH AIDE|
20|FH_F149419_33966_0|SrvcGrp|115724|2022|PCT|1.00|99|0.00|COVID VACCINE ADMINISTRATION|
20|FH_F109247_73102_0|SrvcGrp|90854|2022|PDM|690.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F147086_84751_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F39489_0_0|SrvcGrp|72|2022|PDM|595.00|99|0.00|NEWBORN NURSERY|
20|FH_F116806_0_0|SrvcGrp|107131|2022|PDM|887.26|99|0.00|REMOVAL OF JAW BONE LESION|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.65|99|0.00|SALLY BALIN,999182,ASC 202|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|CARECENTRIX AWP + 5% (MANUAL REVIEW)|
20|FH_F147170_53051_0|SrvcGrp|13807|2022|PCT|0.69|99|0.00|OBSERVATION SVCS|
20|FH_F40104_0_0|SrvcGrp|9832|2022|PDM|107.71|99|0.00|ST SVCS|
20|FH_F139967_37205_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128583_45154_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F128091_37129_0|SrvcGrp|108484|2022|PDM|574.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1714.00|99|0.00|AEG 8 (NO REV)|
20|FH_F129289_54153_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F91799_15010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F101747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129183_24084_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132254_40207_0|SrvcGrp|22389|2022|PDM|25.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F149023_44122_0|SrvcGrp|88065|2022|PDM|18593.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F147225_48093_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39756_0_0|SrvcGrp|31093|2022|PDM|440.00|99|0.00|CUMBERLAND SURGERY CTR - CARVE OUTS|
20|FH_F74670_0_0|SrvcGrp|15403|2022|PDM|120.00|99|0.00|SPEECH THERAPY SVCS INITIAL EVAL|
20|FH_F149579_95815_0|SrvcGrp|115697|2022|PDM|161.17|99|0.00|PSYCHIATRIC COLLABORATIVE CARE MGMT 1ST (MOD TD)|
20|FH_F146266_0_0|SrvcGrp|107361|2022|PDM|15794.00|99|0.00|SECOND LEVEL CER DISKECTOMY|
20|FH_F110824_83221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F35167_0_0|SrvcGrp|997|2022|PCT|0.55|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F140143_24874_0|SrvcGrp|13683|2022|PDM|499.11|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F36323_0_0|SrvcGrp|19984|2022|PDM|45.00|99|0.00|THERAPY|
20|FH_F142327_0_0|SrvcGrp|113924|2022|PDM|1000.00|99|0.00|OCCUPATIONAL MULTIFOCAL LENS|
20|FH_F124492_30040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140036_07702_0|SrvcGrp|113606|2022|PDM|25.75|99|0.00|VIVITROL INJECTION ADMIN (HCFA)|
20|FH_F143347_16001_0|SrvcGrp|79867|2022|PDM|7205.00|99|0.00|VENA CAVA FILTER INSERTION/ADJUSTMENT|
20|FH_F143347_16001_0|CSTM-ALL|CSTM-00|2020|PDM|1563.00|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F143968_94520_0|SrvcGrp|108484|2022|PDM|760.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F39339_0_0|CSTM-ALL|CSTM-00|2020|PDM|1460.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139515_0_0|SrvcGrp|93807|2022|PDM|8837.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F37996_0_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S AZ/NV - MOD AV|
20|FH_F129305_45614_0|SrvcGrp|472|2022|PDM|475.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F39662_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127711_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
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_F115019_78414_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F145815_30540_0|SrvcGrp|113223|2022|PDM|42.13|99|0.00|COVID-19 ANTIBODY SARS-COV-2 TITER(S)|
20|FH_F94145_34994_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F82753_18840_0|SrvcGrp|80496|2022|PDM|14865.00|99|0.00|INSERTION OF PULSE GENERATOR|
20|FH_F130466_53916_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F31519_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126027_63069_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131236_84041_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129011_15857_0|SrvcGrp|88620|2022|PDM|130.00|99|0.00|SKILLED NURSING RN|
20|FH_F118910_0_0|SrvcGrp|93098|2022|PDM|113.30|99|0.00|HOSPICE CARE|
20|FH_F135207_76053_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F38677_0_0|SrvcGrp|21814|2022|PDM|135.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F67261_0_0|SrvcGrp|63057|2022|PDM|4595.00|99|0.00|NEURO STIMULATOR|
20|FH_F91819_0_0|SrvcGrp|78283|2022|PDM|1000.00|99|0.00|CPT 49505|
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 5  (NO REV)|
20|FH_F42706_0_0|SrvcGrp|36413|2022|PDM|100.00|99|0.00|SPEECH  THERAPY|
20|FH_F142073_0_0|SrvcGrp|93431|2022|PDM|11900.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F136092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F110180_0_0|SrvcGrp|12118|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F77925_0_0|SrvcGrp|35560|2022|PCT|0.53|99|0.00|PHARMACY SVCS|
20|FH_F73985_0_0|SrvcGrp|16|2022|PDM|1519.00|99|0.00|ACUTE REHABILITATION|
20|FH_F34550_0_0|CSTM-ALL|CSTM-00|2020|PDM|7072.00|99|0.00|ANGIOPLASTY|
20|FH_F139551_0_0|SrvcGrp|27261|2022|PDM|16000.00|99|0.00|CPT 27446|
20|FH_F121564_35080_0|SrvcGrp|46903|2022|PDM|1365.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F129011_15857_0|SrvcGrp|48396|2022|PDM|120.00|99|0.00|OT SERVICES|
20|FH_F129653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F123282_03222_0|SrvcGrp|53987|2022|PDM|75.00|99|0.00|PHOTOTHERAPY|
20|FH_F93791_0_0|SrvcGrp|93432|2022|PDM|4200.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F72407_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125011_74467_0|SrvcGrp|106251|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F128580_0_0|SrvcGrp|109135|2022|PDM|2248.00|99|0.00|AV FISTULA EXCISION|
20|FH_F129231_30060_0|SrvcGrp|92552|2022|PDM|709.00|99|0.00|AMNIOTIC MEMBRANE|
20|FH_F37679_0_0|SrvcGrp|17004|2022|PDM|61.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS|
20|FH_F130920_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72183_0_0|SrvcGrp|26156|2022|PCT|1.80|99|0.00|OTHER DIAGNOSTIC TESTING|
20|FH_F126070_0_0|SrvcGrp|72994|2022|PDM|620.00|99|0.00|AEG 3|
20|FH_F112545_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|OP SVCS|
20|FH_F124050_75089_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.61|99|0.00|ASPG X|
20|FH_F112717_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS|
20|FH_F82753_18840_0|SrvcGrp|80519|2022|PDM|6835.00|99|0.00|KERATOPLASTY|
20|FH_F128307_43219_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F132092_0_0|SrvcGrp|97506|2022|PDM|169.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F34241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149888_68506_0|SrvcGrp|33967|2022|PDM|3297.00|99|0.00|CPT 47562|
20|FH_F34496_0_0|SrvcGrp|10095|2022|PDM|5678.40|99|0.00|DRG 370 ONLY CESAREAN SECTION W/ CC|
20|FH_F125028_19061_0|SrvcGrp|24752|2022|PDM|15.75|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F88335_71019_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F122433_0_0|SrvcGrp|73008|2022|PDM|630.00|99|0.00|AEG 10|
20|FH_F141527_36830_0|SrvcGrp|86847|2022|PDM|26.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F139515_0_0|SrvcGrp|35667|2022|PDM|2122.00|99|0.00|CPT 20680|
20|FH_F149888_68506_0|SrvcGrp|27347|2022|PDM|3062.00|99|0.00|CPT 58558|
20|FH_F66501_0_0|SrvcGrp|10541|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F40834_0_0|SrvcGrp|299|2022|PCT|0.85|99|0.00|GAMMA KNIFE|
20|FH_F125899_07645_0|SrvcGrp|44282|2022|PDM|3308.00|99|0.00|OBSERVATION SVCS|
20|FH_F129305_45614_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F35259_0_0|CSTM-ALL|CSTM-00|2020|PDM|3456.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151541_01436_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F34454_0_0|SrvcGrp|12264|2022|PDM|60.75|99|0.00|DIETICIAN OR LPN SERVICES|
20|FH_F51733_0_0|SrvcGrp|46234|2022|PDM|90.00|99|0.00|SKILLED NURSING|
20|FH_F110102_0_0|SrvcGrp|104188|2022|PDM|650.00|99|0.00|IP HOSPICE|
20|FH_F148549_60523_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F39895_0_0|SrvcGrp|1306|2022|PDM|270.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F111840_0_0|SrvcGrp|75491|2022|PDM|995.00|99|0.00|AEG 7|
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43139_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F36401_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.90|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_F85039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F85674_0_0|SrvcGrp|83884|2022|PDM|110.63|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)|
20|FH_F142447_72758_0|SrvcGrp|87536|2022|PDM|551.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F105581_19053_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40397_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.01|99|0.00|GENERAL ACUTE CARE|
20|FH_F44358_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F132800_0_0|SrvcGrp|112054|2022|PDM|65.00|99|0.00|COVID-19 ANTIBODY|
20|FH_F130297_41042_0|SrvcGrp|3016|2022|PDM|325.00|99|0.00|HEMODIALYSIS|
20|FH_F144828_0_0|SrvcGrp|83838|2022|PDM|3351.00|99|0.00|SUSPENSION OF BREAST|
20|FH_F88933_0_0|SrvcGrp|99073|2022|PDM|1.36|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F118909_0_0|SrvcGrp|90707|2022|PDM|133.90|99|0.00|AETNA HOSPICE CARE|
20|FH_F120901_0_0|SrvcGrp|84939|2022|PDM|8973.00|99|0.00|SHOULDER JOINT|
20|FH_F72204_0_0|SrvcGrp|69303|2022|PCT|1.00|99|0.00|J & Q CODES|
20|FH_F93252_0_0|SrvcGrp|33967|2022|PDM|2500.00|99|0.00|CPT 47562|
20|FH_F124180_0_0|SrvcGrp|106170|2022|PDM|2462.50|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F38945_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F45976_0_0|SrvcGrp|37642|2022|PDM|1950.00|99|0.00|LAP HERNIORRHAPY|
20|FH_F146895_28751_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|OP SVCS|
20|FH_F44341_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F49943_0_0|SrvcGrp|45948|2022|PDM|140.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F127972_68061_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97040_31901_0|SrvcGrp|73656|2022|PDM|586.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F130036_43232_0|SrvcGrp|90388|2022|PDM|867.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 7 (NO REV)|
20|FH_F137248_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|1171.00|99|0.00|AEG 6 (NO REV)|
20|FH_F136596_72117_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136686_43551_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114666_30342_0|SrvcGrp|105631|2022|PDM|1000.00|99|0.00|REMOVE BONE FIXATION DEVICE|
20|FH_F114678_78745_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F114726_45213_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113845_32746_0|CSTM-ALL|CSTM-00|2020|PDM|113.97|99|0.00|AETNA BEHAVIORAL ID ASSESSMENT|
20|FH_F113845_32746_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F139662_51106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115048_78520_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F150763_0_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F148553_85016_0|SrvcGrp|115459|2022|PDM|3570.00|99|0.00|REMOVE & REPLACE DEFIB GEN 2 LEAD|
20|FH_F122885_39571_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F43192_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PDM|519.00|99|0.00|ASPG II|
20|FH_F134689_60190_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F134693_92270_0|SrvcGrp|46903|2022|PDM|1000.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F134734_90068_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135719_45502_0|SrvcGrp|97715|2022|PCT|1.00|99|0.00|AETNA ALL DRUGS AGENTS|
20|FH_F112371_19047_0|SrvcGrp|74584|2022|PDM|75.00|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F112465_28401_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F115631_65201_0|SrvcGrp|84939|2022|PDM|11903.00|99|0.00|SHOULDER JOINT|
20|FH_F116339_41064_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147331_90045_0|SrvcGrp|66265|2022|PDM|71.40|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F41463_0_0|SrvcGrp|34146|2022|PDM|134.40|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F41666_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F41832_0_0|SrvcGrp|12856|2022|PDM|120.00|99|0.00|NURSING CARE|
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138989_02861_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|318.88|99|0.00|HAPA WPA-NWPA 2012-13 ASC 116 W/O REV|
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|2802.00|99|0.00|AEG 7 (NO REV)|
20|FH_F113544_62946_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F151412_71909_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151516_63023_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F132248_44060_0|SrvcGrp|73842|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132258_45404_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132262_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122032_32413_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F145528_76501_0|SrvcGrp|23683|2022|PDM|53.00|99|0.00|SKILLED NURSING RN|
20|FH_F123184_20906_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F128181_62690_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135438_29030_0|SrvcGrp|73841|2022|PDM|430.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F135583_17331_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F91764_93710_0|SrvcGrp|113224|2022|PCT|2.19|99|0.00|COVID-19 NFCT DS DNA&RNA 21 SARSCOV2|
20|FH_F136038_33018_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136133_77707_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131228_01826_0|SrvcGrp|79786|2022|PCT|0.87|99|0.00|SLEEP STUDIES|
20|FH_F131132_44077_0|CSTM-ALL|CSTM-00|2020|PDM|6346.00|99|0.00|AEG 9 (NO REV)|
20|FH_F116397_33404_0|SrvcGrp|86839|2022|PDM|40.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F116431_76104_0|SrvcGrp|44564|2022|PDM|492.00|99|0.00|NEWBORN NURSERY|
20|FH_F116431_76104_0|SrvcGrp|79099|2022|PDM|1311.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F116461_77536_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F116370_0_0|SrvcGrp|105357|2022|PDM|400.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F146125_0_0|SrvcGrp|83835|2022|PDM|2100.00|99|0.00|REPLACE TISSUE EXPANDER|
20|FH_F131407_07607_0|SrvcGrp|86779|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F128370_76132_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F130010_77384_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128201_33334_0|SrvcGrp|73842|2022|PDM|120.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111301_33122_0|SrvcGrp|73602|2022|PDM|823.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F111301_33122_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS|
20|FH_F134315_89106_0|SrvcGrp|34566|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F82198_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F48581_0_0|SrvcGrp|23024|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F40598_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F41339_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F94060_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87557_33309_0|SrvcGrp|86839|2022|PDM|30.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F87557_33309_0|SrvcGrp|86837|2022|PDM|10.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F141035_0_0|SrvcGrp|82720|2022|PDM|3932.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F123036_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.20|99|0.00|HSS ASC|
20|FH_F102902_33764_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F129194_33161_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F98622_45005_0|SrvcGrp|73461|2022|PDM|10585.00|99|0.00|AETNA NICU IV|
20|FH_F100780_24153_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F34048_0_0|SrvcGrp|43|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F128341_41139_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F100906_0_0|SrvcGrp|72996|2022|PDM|1007.00|99|0.00|AEG 4|
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INTRAOCULAR LENS|
20|FH_F68837_0_0|SrvcGrp|38024|2022|PDM|1011.00|99|0.00|DIALYSIS/PLASMAPHRESIS|
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)|
20|FH_F88639_80204_0|SrvcGrp|72984|2022|PCT|1.70|99|0.00|CHEMOTHERAPY|
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|915.23|99|0.00|POLYSOMNOGRAPHY W/O MOD 26 & TC|
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F123809_26155_0|SrvcGrp|73643|2022|PDM|349.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F123809_26155_0|CSTM-ALL|CSTM-00|2020|PDM|4392.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134254_33462_0|SrvcGrp|73841|2022|PDM|492.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F136542_02446_0|SrvcGrp|16069|2022|PDM|504.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F118195_44039_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120490_64133_0|SrvcGrp|86835|2022|PDM|10.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F93175_73438_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F93292_62234_0|SrvcGrp|73700|2022|PDM|92.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F114092_83350_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F53732_0_0|SrvcGrp|24761|2022|PDM|42.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F97602_40121_0|SrvcGrp|73603|2022|PDM|9494.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F80284_16354_0|SrvcGrp|76013|2022|PDM|418.00|99|0.00|EMERGENCY ROOM SVCS LEVEL VI|
20|FH_F120152_0_0|SrvcGrp|27330|2022|PDM|2200.00|99|0.00|CPT 27096|
20|FH_F149527_62859_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149647_92651_0|SrvcGrp|89337|2022|PDM|1250.00|99|0.00|DETOXIFICATION|
20|FH_F151601_89118_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 9 (NO REV)|
20|FH_F117267_07728_0|SrvcGrp|106285|2022|PCT|0.50|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F129504_02871_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F137937_20032_0|SrvcGrp|113190|2022|PCT|0.00|99|0.00|DIALYSIS (TOB)|
20|FH_F39352_0_0|SrvcGrp|997|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F90613_05001_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F129487_0_0|SrvcGrp|89988|2022|PDM|2369.00|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40296_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F148425_01507_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148552_68114_0|CSTM-ALL|CSTM-00|2020|PDM|1549.38|99|0.00|AEG 5  (NO REV)|
20|FH_F97560_23249_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F91255_19401_0|SrvcGrp|88977|2022|PDM|9343.00|99|0.00|C-SECTION DELIVERY|
20|FH_F133307_14580_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F139825_0_0|SrvcGrp|109762|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESION(S)|
20|FH_F120954_0_0|SrvcGrp|108540|2022|PCT|0.00|99|0.00|AIDE HOME HEALTH|
20|FH_F39546_0_0|SrvcGrp|13292|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F132289_89145_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F132080_0_0|SrvcGrp|90707|2022|PDM|169.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F97621_75801_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F132571_24739_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F45977_0_0|SrvcGrp|40419|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- NO MOD|
20|FH_F122245_0_0|SrvcGrp|91341|2022|PDM|1750.00|99|0.00|CORRECT BLADDER FUNCTION|
20|FH_F125471_34471_0|SrvcGrp|89417|2022|PDM|432.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 7 (NO REV)|
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|AEG 2 (NO REV)|
20|FH_F118704_0_0|SrvcGrp|107749|2022|PDM|651.00|99|0.00|CAPD/CCPD|
20|FH_F109840_62832_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F132118_92240_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F35454_0_0|SrvcGrp|16848|2022|PDM|50.00|99|0.00|SPLINTER REMOVAL - HAND|
20|FH_F117880_91730_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F47433_0_0|SrvcGrp|42048|2022|PCT|0.83|99|0.00|OP SURGERY|
20|FH_F143347_16001_0|SrvcGrp|79851|2022|PCT|2.00|99|0.00|AETNA EKG|
20|FH_F75803_0_0|SrvcGrp|13236|2022|PDM|2529.00|99|0.00|ICU/CCU|
20|FH_F101700_0_0|SrvcGrp|87679|2022|PDM|862.19|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F93740_0_0|SrvcGrp|91578|2022|PDM|3000.00|99|0.00|CENTRAL VENOUS ACCESS|
20|FH_F103060_0_0|SrvcGrp|89840|2022|PDM|8323.00|99|0.00|THORAX SPINE FUSION|
20|FH_F130937_98002_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136267_73703_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116645_71457_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE|
20|FH_F116698_07470_0|SrvcGrp|29347|2022|PDM|13.65|99|0.00|HOME HEALTH AIDE|
20|FH_F116739_78501_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F119918_38201_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F120895_19460_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120977_50510_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147403_0_0|SrvcGrp|82981|2022|PDM|250.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F36439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72183_0_0|SrvcGrp|12406|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F141795_89509_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F39022_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|CV SURGERY|
20|FH_F137067_0_0|SrvcGrp|89861|2022|PDM|4515.00|99|0.00|LUMBAR LAMINOTOMY|
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|782.00|99|0.00|AEG 3 (NO REV)|
20|FH_F48927_0_0|SrvcGrp|8968|2022|PDM|2400.00|99|0.00|NICU LEVEL III & IV|
20|FH_F149839_80002_0|SrvcGrp|94781|2022|PDM|144.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F118194_50841_0|SrvcGrp|86845|2022|PDM|145.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F139515_0_0|SrvcGrp|80617|2022|PDM|13792.00|99|0.00|ARTHOPLASTY|
20|FH_F121547_46805_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F93332_0_0|SrvcGrp|93080|2022|PDM|7416.00|99|0.00|LUMBAR (HCFA)|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126730_84737_0|SrvcGrp|89337|2022|PDM|1100.00|99|0.00|DETOXIFICATION|
20|FH_F145546_52732_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39385_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F149869_03253_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92174_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F129650_49417_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47656_0_0|SrvcGrp|16|2022|PCT|0.80|99|0.00|ACUTE REHABILITATION|
20|FH_F92659_0_0|SrvcGrp|68282|2022|PDM|1485.00|99|0.00|CPT 67042|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD NU) - CPD 1963706|
20|FH_F123272_54901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118194_50841_0|SrvcGrp|73700|2022|PDM|90.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F91622_0_0|SrvcGrp|73608|2022|PDM|7220.00|99|0.00|AETNA MATERNITY CARE (C-SECTION)|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|LAB - RONL/HSOH|
20|FH_F37937_0_0|SrvcGrp|11068|2022|PDM|100.00|99|0.00|PT SVCS|
20|FH_F112717_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PDM|1414.00|99|0.00|ASPG VIII F/S - BDSS|
20|FH_F39349_0_0|SrvcGrp|269|2022|PDM|2978.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F76402_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131286_0_0|SrvcGrp|82981|2022|PDM|110.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F139241_0_0|SrvcGrp|113562|2022|PDM|1858.00|99|0.00|ARTHROSCOPY|
20|FH_F135262_02148_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148182_23324_0|SrvcGrp|29347|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKE|
20|FH_F126585_45039_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F77463_0_0|SrvcGrp|33166|2022|PDM|375.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F129782_0_0|CSTM-ALL|CSTM-00|2020|PDM|1271.00|99|0.00|AEG 2 (NO REV)|
20|FH_F39269_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125899_07645_0|SrvcGrp|103261|2022|PCT|1.84|99|0.00|AETNA IMAGING ENHANCING SUBTANCE|
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1193.00|99|0.00|AEG 6 (NO REV)|
20|FH_F141427_22003_0|SrvcGrp|88621|2022|PDM|79.00|99|0.00|SKILLED NURSING LPN|
20|FH_F93881_15009_0|SrvcGrp|87117|2022|PDM|744.00|99|0.00|GLOBAL STRESS THALLIUM TESTING|
20|FH_F89475_71202_0|SrvcGrp|58380|2022|PDM|17083.00|99|0.00|MS DRG 239 ONLY|
20|FH_F142710_0_0|SrvcGrp|80920|2022|PDM|500.00|99|0.00|HOSPICE SERVICES|
20|FH_F72830_0_0|SrvcGrp|177|2022|PDM|2330.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F141795_89509_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73985_0_0|SrvcGrp|30623|2022|PDM|7592.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F149523_0_0|SrvcGrp|101103|2022|PDM|15000.00|99|0.00|REVIS SHOULDER JOINT|
20|FH_F140995_33040_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F39866_0_0|SrvcGrp|30393|2022|PDM|1600.00|99|0.00|MRI|
20|FH_F110263_0_0|SrvcGrp|113462|2022|PDM|7140.00|99|0.00|LITHOTRIPSY ESWL|
20|FH_F88694_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54513_0_0|SrvcGrp|3327|2022|PDM|140.00|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F34636_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MSDRG TRANSPLANT SERVICES|
20|FH_F116960_91505_0|SrvcGrp|86748|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F93132_73134_0|SrvcGrp|29346|2022|PDM|36.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F89563_29407_0|SrvcGrp|90493|2022|PCT|1.00|99|0.00|ELEC STIM OTHER THAN WOUND|
20|FH_F139173_0_0|SrvcGrp|89781|2022|PDM|172.09|99|0.00|RESPITE CARE (HCFA)|
20|FH_F130747_0_0|SrvcGrp|75002|2022|PDM|6763.00|99|0.00|ARTHOSCOPY|
20|FH_F130747_0_0|SrvcGrp|111588|2022|PDM|4682.00|99|0.00|REPAIR OF THIGH MUSCLE|
20|FH_F151400_0_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F38392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135052_18702_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP|
20|FH_F39866_0_0|SrvcGrp|8950|2022|PDM|1800.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F52854_0_0|SrvcGrp|12600|2022|PDM|105.00|99|0.00|POOL THERAPY|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|627.90|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1201 W/O REV|
20|FH_F100660_56303_0|SrvcGrp|73601|2022|PDM|5186.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F115772_26250_0|SrvcGrp|75545|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F101711_0_0|SrvcGrp|23683|2022|PCT|0.00|99|0.00|SKILLED NURSING RN|
20|FH_F51192_0_0|SrvcGrp|33166|2022|PDM|550.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F48998_0_0|SrvcGrp|44949|2022|PDM|18.00|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F65559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F149666_33460_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F88199_0_0|SrvcGrp|46605|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F35468_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTLIE|
20|FH_F124050_75089_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F149888_68506_0|SrvcGrp|114925|2022|PDM|2791.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F55054_0_0|SrvcGrp|47250|2022|PDM|810.00|99|0.00|MS DRG 876, 880-887 ONLY|
20|FH_F129594_02842_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F67261_0_0|CSTM-ALL|CSTM-00|2020|PDM|4150.00|99|0.00|ASPG IX - FH SW CUSTOM GROUPERS|
20|FH_F40022_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129115_85716_0|SrvcGrp|46903|2022|PDM|500.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F66410_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F122725_32216_0|SrvcGrp|90631|2022|PDM|124.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F122900_65203_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F133211_0_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F62920_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62579_0_0|SrvcGrp|10578|2022|PDM|40.00|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F63235_0_0|SrvcGrp|73000|2022|PDM|2311.00|99|0.00|AEG 6|
20|FH_F63275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130755_04401_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90613_05001_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120930_0_0|SrvcGrp|72121|2022|PDM|2000.00|99|0.00|ARTHOSCOPY|
20|FH_F120539_89029_0|SrvcGrp|48385|2022|PDM|120.00|99|0.00|SPEECH THERAPY|
20|FH_F130923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117208_0_0|SrvcGrp|78093|2022|PDM|3410.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F80172_0_0|SrvcGrp|46802|2022|PDM|154.00|99|0.00|IV SERVICES|
20|FH_F121225_98902_0|SrvcGrp|45539|2022|PDM|201.60|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F149145_33460_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133749_84604_0|SrvcGrp|112416|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F120719_27540_0|SrvcGrp|76768|2022|PCT|0.76|99|0.00|MS DRG 001-002 ONLY|
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|ASPG IX - FH SW CUSTOM GROUPERS|
20|FH_F133767_61254_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123633_70506_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F148885_23226_0|SrvcGrp|92501|2022|PDM|372.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F113457_17011_0|SrvcGrp|46605|2022|PDM|88.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F132728_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F118144_33418_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F150165_06032_0|SrvcGrp|68000|2022|PDM|2095.00|99|0.00|CPT 58561|
20|FH_F149079_70809_0|SrvcGrp|67944|2022|PDM|500.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F72124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F118088_71261_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120670_0_0|SrvcGrp|88156|2022|PDM|15000.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F68251_0_0|SrvcGrp|33164|2022|PDM|305.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F34852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F127073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145965_50325_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F150279_91767_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133972_27103_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING-OP W/O HOME INFUSION|
20|FH_F100782_0_0|SrvcGrp|105097|2022|PDM|244.82|99|0.00|WINDBER MEDICAL CNTR ASC 142|
20|FH_F93179_73460_0|SrvcGrp|78504|2022|PCT|0.68|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F148600_30328_0|SrvcGrp|115422|2022|PDM|2933.00|99|0.00|GRAFT CARTILAGE|
20|FH_F126990_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|MID-LEVEL|
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PDM|895.00|99|0.00|ASPG III - FH SW CUSTOM GROUPERS|
20|FH_F120291_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43861_0_0|SrvcGrp|30958|2022|PDM|65.00|99|0.00|SKILLED LPN VISIT|
20|FH_F134662_54853_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137799_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F49853_0_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F60072_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 643|
20|FH_F96160_32207_0|SrvcGrp|86840|2022|PDM|68.65|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F91412_0_0|SrvcGrp|90317|2022|PDM|8908.90|99|0.00|NECK SPINE FUSE|
20|FH_F132969_84003_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F126354_91321_0|SrvcGrp|87131|2022|PDM|410.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F138951_41101_0|SrvcGrp|86844|2022|PDM|40.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F109267_12202_0|SrvcGrp|86722|2022|PDM|85.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F97182_21502_0|SrvcGrp|90854|2022|PDM|1797.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|412.00|99|0.00|AEG 2 (NO REV)|
20|FH_F74883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F49044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F147997_92620_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F146258_90004_0|SrvcGrp|110812|2022|PCT|0.60|99|0.00|INTENSIVE OP PSYCH|
20|FH_F44312_0_0|CSTM-ALL|CSTM-00|2020|PDM|565.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F96261_0_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F145960_33414_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150884_75503_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133155_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F68479_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145328_90301_0|SrvcGrp|113336|2022|PDM|195.00|99|0.00|INTAKE ACT W/MED EXAM|
20|FH_F128130_10027_0|SrvcGrp|98546|2022|PDM|497.00|99|0.00|HEMATOLOGY/ONCOLOGY PHYSICIAN SERVICES|
20|FH_F120437_85202_0|SrvcGrp|14949|2022|PDM|183.46|99|0.00|HOME INFUSION|
20|FH_F142749_15212_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F62601_0_0|SrvcGrp|46350|2022|PDM|30.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F136393_0_0|SrvcGrp|96385|2022|PDM|3200.00|99|0.00|AETNA IMPLANT DEFIBRILLATOR|
20|FH_F40943_0_0|SrvcGrp|43284|2022|PDM|71.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F118027_28801_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F127412_15301_0|SrvcGrp|105285|2022|PDM|507.00|99|0.00|TEMPORAL ARTERY|
20|FH_F35660_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|168.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 235 W/O REV|
20|FH_F142014_33170_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F80859_65616_0|SrvcGrp|62264|2022|PCT|0.88|99|0.00|DME E OR K CODES|
20|FH_F118462_21740_0|SrvcGrp|472|2022|PDM|549.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133307_14580_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F115889_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141870_85224_0|SrvcGrp|16750|2022|PDM|110.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F97140_91730_0|SrvcGrp|73601|2022|PDM|7208.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F74084_15206_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133477_90247_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 1 (NO REV)|
20|FH_F119437_0_0|SrvcGrp|74039|2022|PDM|4750.00|99|0.00|LAMINECTOMY|
20|FH_F46854_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97882_32407_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F81771_0_0|SrvcGrp|57968|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F132543_79549_0|SrvcGrp|3178|2022|PDM|300.00|99|0.00|ACUTE PSYCH|
20|FH_F118517_33316_0|SrvcGrp|73842|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F97561_30030_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F79902_0_0|SrvcGrp|12290|2022|PDM|1196.00|99|0.00|DETOXIFICATION|
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_F117900_19118_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F92676_15063_0|SrvcGrp|78947|2022|PDM|3125.01|99|0.00|MON VALLEY ASC 13|
20|FH_F103106_04101_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F69648_0_0|SrvcGrp|66005|2022|PDM|11.25|99|0.00|SKILLED NURSING HCPC|
20|FH_F120437_85202_0|SrvcGrp|86122|2022|PDM|57.35|99|0.00|AETNA GAMMAGARD LIQUID INJ|
20|FH_F96261_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125296_18337_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43433_0_0|SrvcGrp|2738|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F109815_52241_0|SrvcGrp|14510|2022|PDM|705.00|99|0.00|SKILLED NURSING|
20|FH_F118539_44256_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|551.00|99|0.00|AEG 2 (NO REV)|
20|FH_F34706_0_0|SrvcGrp|10331|2022|PDM|2259.00|99|0.00|DRG 542 ECMO W/O O.R. PROC|
20|FH_F111780_38603_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F132338_18901_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F43539_0_0|SrvcGrp|30551|2022|PDM|80.00|99|0.00|EARLY INTERVENTION PHYSICAL THERAPY|
20|FH_F118486_95060_0|SrvcGrp|86753|2022|PCT|1.15|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F41785_0_0|SrvcGrp|29021|2022|PCT|1.00|99|0.00|DME AND SUPPLIES|
20|FH_F143198_75219_0|SrvcGrp|108484|2022|PDM|418.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F101840_76054_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|3675.00|99|0.00|AEG 6 (NO REV)|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|323.86|99|0.00|ASPG 215|
20|FH_F141987_02859_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_F46288_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F117555_72802_0|SrvcGrp|93919|2022|PDM|520.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F151087_60548_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151284_72703_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F139667_84078_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F150659_84604_0|SrvcGrp|74668|2022|PDM|775.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F150719_30012_0|SrvcGrp|92501|2022|PDM|415.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F34777_0_0|SrvcGrp|3598|2022|PDM|3820.00|99|0.00|ELECTROPHYSIOLOGY|
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 5  (NO REV)|
20|FH_F141228_23181_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134472_84624_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F134936_01020_0|SrvcGrp|48396|2022|PDM|125.00|99|0.00|OT SERVICES|
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|2110.00|99|0.00|AEG 4 (NO REV)|
20|FH_F36883_0_0|SrvcGrp|73605|2022|PDM|756.08|99|0.00|AETNA ACUTE PSYCH|
20|FH_F147159_62615_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130654_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F41457_0_0|SrvcGrp|13244|2022|PDM|450.00|99|0.00|HOSPICE SVCS|
20|FH_F127418_0_0|SrvcGrp|88024|2022|PDM|14259.26|99|0.00|REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION|
20|FH_F35987_0_0|SrvcGrp|70921|2022|PDM|39526.00|99|0.00|CV SURGERY|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|144.00|99|0.00|HAPA EPA ASC 23|
20|FH_F112754_98057_0|SrvcGrp|73700|2022|PDM|136.36|99|0.00|AETNA - SKILLED NURSING|
20|FH_F39008_34452_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141287_14830_0|SrvcGrp|113742|2022|PCT|0.93|99|0.00|MINOR SURGERY|
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|703.00|99|0.00|AEG 5  (NO REV)|
20|FH_F124695_33401_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F150953_74953_0|SrvcGrp|79699|2022|PCT|0.77|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F126150_80202_0|SrvcGrp|87077|2022|PDM|187.25|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F90172_81301_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F137769_85234_0|SrvcGrp|92761|2022|PCT|1.60|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147167_75605_0|SrvcGrp|75419|2022|PDM|350.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F110729_15068_0|SrvcGrp|89149|2022|PDM|161.00|99|0.00|OP INTENSIVE|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.28|99|0.00|SALLY BALIN,999182,ASC 109|
20|FH_F37487_0_0|SrvcGrp|15145|2022|PCT|0.70|99|0.00|DIALYSIS|
20|FH_F114206_37203_0|SrvcGrp|86853|2022|PDM|35.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F149004_67025_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131376_66215_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131449_19073_0|SrvcGrp|473|2022|PDM|430.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F35174_0_0|CSTM-ALL|CSTM-00|2020|PDM|1380.00|99|0.00|SKILLED NURSING FACILITY|
20|FH_F84833_17109_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F38475_0_0|SrvcGrp|10540|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE|
20|FH_F39443_0_0|SrvcGrp|30289|2022|PDM|435.00|99|0.00|HAPA WPA ASC 101|
20|FH_F125656_92868_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137797_70123_0|SrvcGrp|88621|2022|PDM|108.00|99|0.00|SKILLED NURSING LPN|
20|FH_F116806_0_0|SrvcGrp|107103|2022|PDM|887.26|99|0.00|GINGIVECTOMY EACH QUADRANT|
20|FH_F98001_27603_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F98880_50158_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F117711_73080_0|SrvcGrp|107655|2022|PCT|0.00|99|0.00|AETNA ALL DRUGS W/O CHEMOTHERAPY DRUGS|
20|FH_F149579_95815_0|SrvcGrp|115693|2022|PDM|161.17|99|0.00|PSYCHIATRIC COLLABORATIVE CARE MGMT 1ST (MOD AF)|
20|FH_F90817_0_0|SrvcGrp|91026|2022|PDM|2256.00|99|0.00|REPAIR EARDRUM STRUCTURES (HCFA)|
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147221_49442_0|SrvcGrp|110537|2022|PDM|392.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F120099_86305_0|SrvcGrp|75419|2022|PDM|978.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F110804_11373_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F137767_01841_0|SrvcGrp|18008|2022|PDM|1325.00|99|0.00|DOPPLER FLOW TESTING|
20|FH_F90817_0_0|SrvcGrp|90361|2022|PDM|2914.00|99|0.00|REPAIR FRACTURE RADIUS/ULNA|
20|FH_F36743_0_0|SrvcGrp|453|2022|PDM|520.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F50415_0_0|SrvcGrp|39995|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME|
20|FH_F84872_18510_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|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_F108180_29526_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F131028_49735_0|SrvcGrp|94781|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F132254_40207_0|SrvcGrp|24745|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F91940_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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1355.00|99|0.00|ASPG V|
20|FH_F144831_0_0|SrvcGrp|88621|2022|PDM|105.45|99|0.00|SKILLED NURSING LPN|
20|FH_F110728_13069_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F117762_0_0|SrvcGrp|81571|2022|PDM|2497.00|99|0.00|NASAL ENDOSCOPY W/ SINUS OSTIA DILATION|
20|FH_F47573_0_0|SrvcGrp|42827|2022|PDM|158.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F84433_0_0|SrvcGrp|27969|2022|PDM|16.97|99|0.00|HOME HEALTH AIDE|
20|FH_F74845_0_0|SrvcGrp|13295|2022|PDM|1890.00|99|0.00|PET SCAN|
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|1093.00|99|0.00|AEG 7 (NO REV)|
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PDM|1397.00|99|0.00|AEG 2 (NO REV)|
20|FH_F124465_84123_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132254_40207_0|SrvcGrp|13929|2022|PDM|25.00|99|0.00|GROWTH HORMONE|
20|FH_F90232_15126_0|SrvcGrp|24750|2022|PDM|47.25|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F56472_0_0|SrvcGrp|10623|2022|PDM|85.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F134919_02155_0|SrvcGrp|48398|2022|PDM|102.50|99|0.00|PT SERVICES|
20|FH_F139951_92870_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F143488_84770_0|CSTM-ALL|CSTM-00|2020|PDM|813.00|99|0.00|AEG 10 (NO REV)|
20|FH_F143536_47546_0|SrvcGrp|90489|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE|
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_F101752_0_0|SrvcGrp|75943|2022|PDM|5600.00|99|0.00|AETNA INPATIENT SURGICAL CARE|
20|FH_F102542_0_0|SrvcGrp|11199|2022|PDM|500.00|99|0.00|HYPERBARIC CHAMBER|
20|FH_F101806_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F101806_0_0|SrvcGrp|75491|2022|PDM|1100.55|99|0.00|AEG 7|
20|FH_F151761_20019_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136299_75218_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132467_33825_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132480_92054_0|SrvcGrp|89337|2022|PDM|795.00|99|0.00|DETOXIFICATION|
20|FH_F112670_47150_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119993_71913_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F125012_64658_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118845_71111_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F118917_33317_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F84411_32063_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F35685_0_0|SrvcGrp|2797|2022|PDM|2150.00|99|0.00|POST INTENSIVE CARE UNIT|
20|FH_F38831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40800_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY|
20|FH_F40855_0_0|SrvcGrp|38|2022|PDM|1981.00|99|0.00|NORMAL DELIVERY|
20|FH_F41874_0_0|SrvcGrp|3029|2022|PDM|235.00|99|0.00|NEWBORN NURSERY|
20|FH_F71550_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F133585_0_0|SrvcGrp|109135|2022|PDM|3092.00|99|0.00|AV FISTULA EXCISION|
20|FH_F133935_19958_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|2911.70|99|0.00|AEG 5  (NO REV)|
20|FH_F133749_84604_0|SrvcGrp|112422|2022|PDM|25.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F133916_66090_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F81483_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|972.81|99|0.00|HAPA WPA-NWPA 2012-13 ASC 707 W/O REV|
20|FH_F126403_77304_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145645_77089_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F59872_0_0|SrvcGrp|12179|2022|PCT|1.05|99|0.00|CPT CODES 70000-79999 (RAD)|
20|FH_F116806_0_0|SrvcGrp|27311|2022|PDM|1923.16|99|0.00|EXCISION PAROTID GLAND/LESION|
20|FH_F134947_14227_0|SrvcGrp|76501|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F123646_91350_0|SrvcGrp|108484|2022|PDM|575.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F125828_67547_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150165_06032_0|SrvcGrp|41327|2022|PDM|3850.00|99|0.00|OP SURGERY CPT 28308|
20|FH_F149106_07042_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F126555_44906_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F44278_0_0|SrvcGrp|20534|2022|PCT|0.85|99|0.00|SKILLED NURSING|
20|FH_F118803_0_0|SrvcGrp|107880|2022|PDM|1560.60|99|0.00|BALO ANGIOP CTR DIALYSIS SEG|
20|FH_F89219_0_0|SrvcGrp|20900|2022|PDM|29452.00|99|0.00|MS DRG 248 ONLY|
20|FH_F130017_02302_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F124162_73127_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F149299_43351_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 4 (NO REV)|
20|FH_F143567_62207_0|SrvcGrp|88621|2022|PDM|135.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150239_75569_0|SrvcGrp|22592|2022|PCT|1.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F131630_0_0|SrvcGrp|59840|2022|PDM|1873.00|99|0.00|TYMPANOSTOMY|
20|FH_F96160_32207_0|SrvcGrp|16750|2022|PDM|158.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F117206_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F109405_73106_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F93743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92598_21236_0|SrvcGrp|48385|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|329.58|99|0.00|HAPA WPA-NWPA 2012-13 ASC 124 W/O REV|
20|FH_F126904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F79923_0_0|SrvcGrp|46631|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY|
20|FH_F134331_61021_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F144228_0_0|SrvcGrp|101843|2022|PDM|5560.00|99|0.00|OPEN TREATMENT OF DISTAL RADIAL|
20|FH_F86094_16748_0|SrvcGrp|92760|2022|PCT|1.43|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F127486_06776_0|SrvcGrp|65621|2022|PDM|52.43|99|0.00|RN NURSING|
20|FH_F143611_84065_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146650_29690_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F85353_16407_0|SrvcGrp|63799|2022|PDM|869.48|99|0.00|HAPA WPA-NWPA 2012-13 ASC 402|
20|FH_F91171_0_0|SrvcGrp|83646|2022|PDM|783.00|99|0.00|CPT 31276|
20|FH_F126904_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F97840_54729_0|SrvcGrp|90854|2022|PDM|2103.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F97861_62223_0|SrvcGrp|73659|2022|PDM|7426.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F121700_60938_0|SrvcGrp|75419|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F34182_0_0|SrvcGrp|18889|2022|PDM|2729.00|99|0.00|MS DRG 235|
20|FH_F93122_01854_0|CSTM-ALL|CSTM-00|2020|PDM|334.00|99|0.00|AETNA PARTIAL HOSPITALIZATION (<18 YRS)|
20|FH_F69708_0_0|SrvcGrp|42825|2022|PDM|79.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F84191_16001_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F135617_52001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125870_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149319_07670_0|SrvcGrp|112785|2022|PCT|1.00|99|0.00|TELEHEALTH SERVICES|
20|FH_F93333_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F39378_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F45120_0_0|SrvcGrp|13881|2022|PCT|0.21|99|0.00|PACEMAKER DEVICE|
20|FH_F119379_0_0|SrvcGrp|107850|2022|PDM|672.00|99|0.00|EXC HAND LES SC < 1.5 CM|
20|FH_F149048_77090_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F132606_0_0|SrvcGrp|88159|2022|PDM|2809.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F133585_0_0|SrvcGrp|111518|2022|PDM|330.00|99|0.00|STAB PHLEBECT VV 1 EXT|
20|FH_F113345_25301_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F85492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124371_0_0|SrvcGrp|2067|2022|PDM|588.69|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F116806_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F149105_66215_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133827_98663_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143568_85006_0|SrvcGrp|74792|2022|PCT|2.23|99|0.00|POLYSOMNOGRAPHY|
20|FH_F133847_21702_0|SrvcGrp|83800|2022|PDM|3500.00|99|0.00|VBAC DELIVERY|
20|FH_F143739_33440_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121687_04401_0|SrvcGrp|108919|2022|PCT|1.00|99|0.00|HYDRATION IV INFUSION|
20|FH_F91171_0_0|SrvcGrp|36864|2022|PDM|5665.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD KM"|
20|FH_F64639_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F122470_78229_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F125036_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F45093_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84712_0_0|SrvcGrp|73602|2022|PDM|630.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F87053_0_0|SrvcGrp|73004|2022|PDM|1420.00|99|0.00|AEG 8|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|148.50|99|0.00|HAPA WPA-NWPA 2012-13 ASC 131 W/O REV|
20|FH_F74583_0_0|SrvcGrp|42974|2022|PDM|56.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F98780_35022_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F105145_75075_0|SrvcGrp|89317|2022|PCT|0.00|99|0.00|AETNA SLEEP STUDIES|
20|FH_F115892_83263_0|SrvcGrp|92760|2022|PCT|1.20|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115903_43560_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F146654_80524_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F146668_30189_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 2 (NO REV)|
20|FH_F120795_27514_0|SrvcGrp|76768|2022|PCT|0.75|99|0.00|MS DRG 001-002 ONLY|
20|FH_F115972_92675_0|SrvcGrp|86746|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F133581_84790_0|SrvcGrp|41335|2022|PDM|5000.00|99|0.00|TOTAL HIP|
20|FH_F133667_83642_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133478_40165_0|SrvcGrp|112335|2022|PCT|0.54|99|0.00|HAND REPLANTATION|
20|FH_F111602_17102_0|SrvcGrp|86722|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F47097_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134087_0_0|SrvcGrp|112556|2022|PDM|3607.00|99|0.00|REPAIR OF TENDON(S)|
20|FH_F36676_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F68976_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F46732_0_0|SrvcGrp|29303|2022|PDM|144.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F129839_63640_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37945_0_0|SrvcGrp|360|2022|PDM|562.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F113255_0_0|SrvcGrp|72990|2022|PDM|509.00|99|0.00|AEG 1|
20|FH_F116092_83254_0|SrvcGrp|103913|2022|PCT|0.92|99|0.00|OP DIALYSIS|
20|FH_F57912_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD AU|
20|FH_F125011_74467_0|SrvcGrp|72990|2022|PDM|1050.00|99|0.00|AEG 1|
20|FH_F54513_0_0|SrvcGrp|10541|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F91622_0_0|CSTM-ALL|CSTM-00|2020|PDM|1372.00|99|0.00|AEG 2 (NO REV) ANTHONY MED CTR|
20|FH_F131254_92211_0|SrvcGrp|86847|2022|PDM|35.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F123910_19125_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F135219_68506_0|SrvcGrp|88157|2022|PDM|22295.52|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F128580_0_0|SrvcGrp|109137|2022|PDM|2248.00|99|0.00|AV FISTULA REVISION|
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148355_37601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141794_50548_0|SrvcGrp|79699|2022|PCT|0.75|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F124017_0_0|SrvcGrp|109668|2022|PDM|8500.00|99|0.00|ARTHRODESIS, POSTERIOR, LUMBAR|
20|FH_F33471_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F63422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F149868_0_0|SrvcGrp|63297|2022|PDM|194.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F92276_32308_0|SrvcGrp|73483|2022|PDM|927.00|99|0.00|AETNA SUBACUTE III|
20|FH_F125512_85295_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F64519_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F33181_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F93171_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F125993_64850_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|387.94|99|0.00|HAPA WPA-NWPA 2012-13 ASC 214 W/O REV|
20|FH_F89453_75069_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F121118_06479_0|SrvcGrp|472|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F108762_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F52854_0_0|SrvcGrp|16440|2022|PDM|3156.00|99|0.00|OPERATIONS OF URETER, TRANSURETHRAL RMOVAL OF OBSTRUCTION|
20|FH_F126002_11946_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F34487_0_0|SrvcGrp|12211|2022|PDM|946.00|99|0.00|ACUTE PHYSICAL REHAB|
20|FH_F148255_72703_0|SrvcGrp|86847|2022|PDM|31.50|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F70104_0_0|SrvcGrp|47183|2022|PDM|96.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|353.00|99|0.00|AEG 1 (NO REV)|
20|FH_F128992_90808_0|SrvcGrp|73842|2022|PDM|363.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F143780_33873_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135066_02908_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122687_0_0|SrvcGrp|90420|2022|PDM|3825.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F35581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F40026_0_0|SrvcGrp|997|2022|PCT|0.73|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 8 (NO REV)|
20|FH_F131809_37355_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146011_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.20|99|0.00|OP SVCS|
20|FH_F72183_0_0|SrvcGrp|66224|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|OP SVCS|
20|FH_F82955_34266_0|SrvcGrp|9511|2022|PCT|0.66|99|0.00|OBSERVATION SVCS|
20|FH_F97104_53545_0|SrvcGrp|88978|2022|PDM|7023.00|99|0.00|VAGINAL DELIVERY|
20|FH_F78603_0_0|SrvcGrp|19846|2022|PDM|16337.36|99|0.00|MS DRG 249 ONLY|
20|FH_F115685_64064_0|SrvcGrp|86846|2022|PDM|75.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F39866_0_0|SrvcGrp|31371|2022|PCT|0.70|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F130747_0_0|SrvcGrp|76602|2022|PDM|4682.00|99|0.00|CPT 25000|
20|FH_F147941_06023_0|SrvcGrp|100247|2022|PCT|1.26|99|0.00|NASAL FLU VACCINE|
20|FH_F88451_0_0|SrvcGrp|43285|2022|PDM|126.00|99|0.00|SPEECH THERAPY|
20|FH_F149523_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38591_0_0|SrvcGrp|23477|2022|PDM|6366.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F136510_0_0|SrvcGrp|84278|2022|PDM|3882.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F123400_04605_0|SrvcGrp|89149|2022|PDM|170.00|99|0.00|OP INTENSIVE|
20|FH_F108762_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F45632_0_0|SrvcGrp|41499|2022|PDM|57.00|99|0.00|MSW SVCS|
20|FH_F143528_0_0|SrvcGrp|114082|2022|PDM|1518.30|99|0.00|EXPLORE/TREAT EYE SOCKET|
20|FH_F55532_0_0|SrvcGrp|15887|2022|PCT|1.00|99|0.00|PHARMACY SERVICES|
20|FH_F124738_0_0|SrvcGrp|73000|2022|PDM|820.00|99|0.00|AEG 6|
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112755_43215_0|SrvcGrp|104307|2022|PCT|0.15|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F91876_0_0|SrvcGrp|88599|2022|PDM|2345.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F121118_06479_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F62915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F32123_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130916_33701_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F32772_0_0|SrvcGrp|115031|2022|PCT|0.95|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F117216_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|762.19|99|0.00|AEG 4 (NO REV)|
20|FH_F121090_07848_0|SrvcGrp|52953|2022|PDM|51.25|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F33407_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F143528_0_0|SrvcGrp|41334|2022|PDM|14700.00|99|0.00|TOTAL KNEE|
20|FH_F126883_78621_0|SrvcGrp|108484|2022|PDM|575.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F40063_0_0|SrvcGrp|32011|2022|PCT|0.76|99|0.00|TRAUMA CARE|
20|FH_F71364_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F150982_0_0|SrvcGrp|107165|2022|PDM|7228.00|99|0.00|EAR CARTILAGE GRAFT|
20|FH_F131254_92211_0|SrvcGrp|29076|2022|PDM|35.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F140929_67206_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F58215_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141527_36830_0|SrvcGrp|29075|2022|PDM|26.00|99|0.00|HYDRATION THERAPY|
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|1183.00|99|0.00|ASPG V|
20|FH_F32538_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84215_0_0|SrvcGrp|26278|2022|PDM|1181.00|99|0.00|CPT 29881|
20|FH_F148340_28269_0|SrvcGrp|75419|2022|PDM|430.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F86332_75081_0|SrvcGrp|49070|2022|PDM|65.00|99|0.00|IMMUNOMODULATING AGENTS VIG|
20|FH_F125138_63663_0|SrvcGrp|23683|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F145815_30540_0|SrvcGrp|113228|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 4 TRGT|
20|FH_F123407_04605_0|SrvcGrp|109358|2022|PDM|435.00|99|0.00|RESIDENTIAL TREATMENT (>= 18 YRS)|
20|FH_F118194_50841_0|SrvcGrp|86839|2022|PDM|114.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F138450_0_0|SrvcGrp|112064|2022|PCT|0.93|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F102020_0_0|SrvcGrp|57968|2022|PDM|60.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 1 (NO REV)|
20|FH_F40427_0_0|SrvcGrp|701|2022|PDM|1623.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F46094_0_0|SrvcGrp|27767|2022|PDM|50.00|99|0.00|SKILLED IV NURSING HOURLY|
20|FH_F63419_0_0|SrvcGrp|3259|2022|PDM|712.00|99|0.00|ACUTE REHABILITATION|
20|FH_F69651_0_0|SrvcGrp|10545|2022|PDM|95.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F91873_12723_0|SrvcGrp|81779|2022|PCT|2.92|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F97761_04072_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F109484_0_0|SrvcGrp|73004|2022|PDM|973.00|99|0.00|AEG 8|
20|FH_F74562_0_0|SrvcGrp|3458|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F87197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F114916_30309_0|CSTM-ALL|CSTM-00|2020|PDM|1217.00|99|0.00|AEG 10 (NO REV)|
20|FH_F142319_19403_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F111925_0_0|SrvcGrp|92659|2022|PDM|1602.00|99|0.00|REPAIR OF RETINAL DETACHMENT|
20|FH_F103780_64804_0|SrvcGrp|114014|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F103780_64804_0|CSTM-ALL|CSTM-00|2020|PDM|2651.00|99|0.00|AEG 10 (NO REV)|
20|FH_F112064_0_0|SrvcGrp|103901|2022|PDM|641.00|99|0.00|RESPITE CARE|
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 10 (NO REV)|
20|FH_F33807_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|CHEMOTHERAPY|
20|FH_F94786_07974_0|SrvcGrp|86779|2022|PDM|36.75|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F95341_08701_0|SrvcGrp|90491|2022|PCT|0.80|99|0.00|EVALUATE SPEECH PRODUCTION|
20|FH_F144828_0_0|SrvcGrp|104943|2022|PDM|3850.00|99|0.00|DELAYED BREAST PROSTHESIS|
20|FH_F114386_07090_0|SrvcGrp|88620|2022|PDM|78.35|99|0.00|SKILLED NURSING RN|
20|FH_F110343_38139_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F81698_10457_0|SrvcGrp|86844|2022|PDM|31.50|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F148923_71854_0|SrvcGrp|75419|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F59872_0_0|SrvcGrp|13526|2022|PCT|1.05|99|0.00|CPT CODES 80000-89999 - (LAB)|
20|FH_F100782_0_0|SrvcGrp|97671|2022|PDM|1516.49|99|0.00|WINDBER MEDICAL CNTR ASC 601|
20|FH_F90574_22560_0|SrvcGrp|471|2022|PDM|472.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130763_0_0|SrvcGrp|84181|2022|PDM|3951.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS|
20|FH_F123623_03246_0|SrvcGrp|109283|2022|PCT|1.00|99|0.00|BLOOD TYPING RBC ANTIGENS|
20|FH_F121225_98902_0|SrvcGrp|103911|2022|PDM|997.50|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY|
20|FH_F49287_0_0|SrvcGrp|58931|2022|PCT|0.80|99|0.00|LAB GLOBAL|
20|FH_F150165_06032_0|SrvcGrp|59841|2022|PDM|2400.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F120930_0_0|SrvcGrp|41335|2022|PDM|8000.00|99|0.00|TOTAL HIP|
20|FH_F134593_60007_0|SrvcGrp|86847|2022|PDM|48.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F135670_01749_0|SrvcGrp|86840|2022|PDM|42.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F110580_71106_0|SrvcGrp|103992|2022|PDM|710.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F149279_17022_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F85353_16407_0|SrvcGrp|63802|2022|PDM|791.06|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1202|
20|FH_F73228_0_0|SrvcGrp|17077|2022|PDM|8575.00|99|0.00|ASPG VII|
20|FH_F132883_31602_0|SrvcGrp|47183|2022|PDM|60.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F133847_21702_0|SrvcGrp|38004|2022|PDM|3500.00|99|0.00|CPT CODE 59400|
20|FH_F109364_52349_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135670_01749_0|SrvcGrp|74147|2022|PDM|45.00|99|0.00|INFUSION S-CODE PER MONTH|
20|FH_F70804_0_0|SrvcGrp|14371|2022|PDM|17.99|99|0.00|DISPOSABLE DRUG DELIVERY|
20|FH_F127589_45459_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F150139_71667_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134593_60007_0|SrvcGrp|86844|2022|PDM|48.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F85214_70360_0|SrvcGrp|10391|2022|PDM|1312.50|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F45317_0_0|CSTM-ALL|CSTM-00|2020|PCT|35.00|99|0.00|OP SVCS|
20|FH_F138302_15701_0|SrvcGrp|48396|2022|PDM|65.00|99|0.00|OT SERVICES|
20|FH_F133935_19958_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123646_91350_0|SrvcGrp|100859|2022|PDM|371.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F63297_0_0|SrvcGrp|59423|2022|PDM|75.00|99|0.00|RN VISIT|
20|FH_F134472_84624_0|SrvcGrp|86660|2022|PDM|71.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F134472_84624_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134509_14075_0|SrvcGrp|92760|2022|PCT|0.92|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134494_33612_0|SrvcGrp|73842|2022|PDM|243.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F122522_54024_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F84712_0_0|SrvcGrp|78645|2022|PDM|38.00|99|0.00|AETNA COMPUTER - AIDED DETECTION CPT 77052|
20|FH_F101100_50314_0|SrvcGrp|97907|2022|PDM|20582.00|99|0.00|PARTIAL REMOVAL OF COLON|
20|FH_F102142_80014_0|SrvcGrp|48394|2022|PDM|33.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F105361_80104_0|SrvcGrp|73004|2022|PDM|3451.00|99|0.00|AEG 8|
20|FH_F115865_78621_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146776_64506_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146812_50401_0|CSTM-ALL|CSTM-00|2020|PDM|2402.10|99|0.00|AEG 5  (NO REV)|
20|FH_F116040_24637_0|SrvcGrp|24752|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F131757_06320_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133581_84790_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133700_92808_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F74602_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F113815_0_0|SrvcGrp|73002|2022|PDM|233.00|99|0.00|AEG 7|
20|FH_F89372_0_0|SrvcGrp|73559|2022|PDM|10437.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F42633_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F34040_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40191_0_0|SrvcGrp|9889|2022|PDM|2036.00|99|0.00|NICU LEVEL I & II|
20|FH_F123735_32708_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123763_80130_0|SrvcGrp|89149|2022|PDM|240.00|99|0.00|OP INTENSIVE|
20|FH_F123784_03264_0|SrvcGrp|53987|2022|PDM|75.00|99|0.00|PHOTOTHERAPY|
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|AEG 2 (NO REV)|
20|FH_F137187_64015_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137247_40160_0|SrvcGrp|89149|2022|PDM|156.00|99|0.00|OP INTENSIVE|
20|FH_F114092_83350_0|SrvcGrp|80246|2022|PCT|0.00|99|0.00|AETNA NURSERY|
20|FH_F114092_83350_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138019_79705_0|SrvcGrp|73841|2022|PDM|466.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F142654_73034_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F53732_0_0|SrvcGrp|34146|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F138545_39503_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138627_82901_0|SrvcGrp|99010|2022|PDM|85.00|99|0.00|ANTIBIOTIC Q24H (HCFA)|
20|FH_F140343_89052_0|SrvcGrp|86852|2022|PDM|30.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F140447_84106_0|SrvcGrp|23683|2022|PDM|42.25|99|0.00|SKILLED NURSING RN|
20|FH_F148739_47129_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F149378_44074_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149501_34471_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F149580_98198_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151562_26003_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119046_74012_0|SrvcGrp|105493|2022|PDM|325.00|99|0.00|AETNA CAT SCANS|
20|FH_F136735_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F88733_0_0|SrvcGrp|73485|2022|PDM|840.00|99|0.00|AETNA REHAB|
20|FH_F42556_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132348_16214_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F122194_66104_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146903_72901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F64819_0_0|SrvcGrp|537|2022|PDM|68.00|99|0.00|OBSERVATION SERVICES|
20|FH_F74102_0_0|SrvcGrp|11068|2022|PDM|105.00|99|0.00|PT SVCS|
20|FH_F38233_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F38688_0_0|SrvcGrp|17081|2022|PDM|1400.00|99|0.00|ASPG IX|
20|FH_F38983_0_0|SrvcGrp|3029|2022|PDM|425.00|99|0.00|NEWBORN NURSERY|
20|FH_F49943_0_0|SrvcGrp|45944|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE SVCS|
20|FH_F98380_43055_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F124267_29671_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124611_64804_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F124613_64735_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F32007_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F127995_84010_0|SrvcGrp|86838|2022|PDM|10.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F67888_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136607_68632_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136658_50401_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F136659_62821_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136659_62821_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F114629_19131_0|SrvcGrp|3178|2022|PDM|1293.00|99|0.00|ACUTE PSYCH|
20|FH_F114645_34952_0|SrvcGrp|89149|2022|PDM|191.00|99|0.00|OP INTENSIVE|
20|FH_F114726_45213_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148553_85016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F122664_07005_0|SrvcGrp|49682|2022|PCT|1.70|99|0.00|HSS DRG GROUPED|
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_F134727_30650_0|SrvcGrp|79099|2022|PDM|2200.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F136830_22003_0|SrvcGrp|73841|2022|PDM|420.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F136914_64081_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F38826_0_0|SrvcGrp|361|2022|PCT|0.73|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F116345_78626_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F147319_32763_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F147311_37421_0|SrvcGrp|114008|2022|PDM|390.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F147462_84741_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147586_44124_0|SrvcGrp|39906|2022|PDM|2770.00|99|0.00|MASTECTOMY, SIMPLE, COMPLETE|
20|FH_F42024_0_0|CSTM-ALL|CSTM-00|2020|PDM|3540.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133536_0_0|SrvcGrp|69982|2022|PDM|1000.00|99|0.00|HCPC E0673|
20|FH_F43867_0_0|SrvcGrp|30955|2022|PDM|115.00|99|0.00|SKILLED RN VISIT|
20|FH_F48836_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F50459_0_0|SrvcGrp|471|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138807_32207_0|SrvcGrp|48385|2022|PDM|137.00|99|0.00|SPEECH THERAPY|
20|FH_F138936_01040_0|CSTM-ALL|CSTM-00|2020|PDM|3579.00|99|0.00|AEG 9 (NO REV)|
20|FH_F138992_72703_0|SrvcGrp|86444|2022|PCT|1.41|99|0.00|CHEMOTHERAPY AND RADIATION|
20|FH_F57953_0_0|SrvcGrp|31187|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF (DME)|
20|FH_F57953_0_0|SrvcGrp|33643|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F138963_0_0|SrvcGrp|79720|2022|PDM|1034.00|99|0.00|ACUTE REHAB II|
20|FH_F143832_0_0|SrvcGrp|114107|2022|PDM|2405.06|99|0.00|FEM/POPL REVASC W/ STENT|
20|FH_F151402_70508_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151419_07852_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F151511_14094_0|SrvcGrp|10363|2022|PDM|564.00|99|0.00|CPT CODE 99283|
20|FH_F122114_91364_0|SrvcGrp|114093|2022|PDM|525.00|99|0.00|PARTIAL HOSPITAL SUBSTANCE ABUSE|
20|FH_F133608_33602_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F37809_0_0|SrvcGrp|27398|2022|PDM|6360.00|99|0.00|OP SURGERY|
20|FH_F135438_29030_0|SrvcGrp|90854|2022|PDM|965.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F135964_33805_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136180_92253_0|SrvcGrp|108484|2022|PDM|1100.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F130670_32204_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F130584_32812_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131407_07607_0|SrvcGrp|22592|2022|PDM|30.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F116464_13088_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F116488_79925_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F130766_04967_0|SrvcGrp|3378|2022|PCT|0.88|99|0.00|OBSERVATION SVCS|
20|FH_F121407_73701_0|SrvcGrp|3208|2022|PDM|815.00|99|0.00|SUBACUTE CARE|
20|FH_F121428_40202_0|SrvcGrp|90854|2022|PDM|1054.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F121824_92675_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F121824_92675_0|SrvcGrp|74668|2022|PDM|280.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F67425_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111292_33136_0|SrvcGrp|63457|2022|PDM|245.00|99|0.00|ULTRASOUND|
20|FH_F111301_33122_0|SrvcGrp|10391|2022|PDM|1975.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F134290_67209_0|SrvcGrp|75419|2022|PDM|335.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F65882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69202_0_0|SrvcGrp|88|2022|PDM|6050.00|99|0.00|OP LITHOTRIPSY|
20|FH_F36344_0_0|SrvcGrp|10565|2022|PDM|140.00|99|0.00|HOME INFUSION|
20|FH_F116430_0_0|SrvcGrp|106704|2022|PDM|2440.00|99|0.00|CYSTOURETHROSCOPY|
20|FH_F132328_0_0|SrvcGrp|84939|2022|PDM|15232.00|99|0.00|SHOULDER JOINT|
20|FH_F132328_0_0|SrvcGrp|87677|2022|PDM|2049.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F118651_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132347_01605_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F102947_44084_0|SrvcGrp|46903|2022|PDM|434.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F38808_0_0|SrvcGrp|29719|2022|PCT|0.45|99|0.00|IMPLANTS|
20|FH_F38808_0_0|SrvcGrp|17071|2022|PDM|693.00|99|0.00|ASPG IV|
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 9 (NO REV)|
20|FH_F123445_0_0|SrvcGrp|93098|2022|PDM|190.00|99|0.00|HOSPICE CARE|
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_F119795_0_0|SrvcGrp|16289|2022|PDM|1685.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F87114_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.30|99|0.00|OP SVCS|
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 4 (NO REV)|
20|FH_F117147_0_0|SrvcGrp|82981|2022|PDM|148.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F89778_0_0|SrvcGrp|87053|2022|PDM|1178.04|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F88633_32570_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149179_0_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F35308_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD AU) - BDSS|
20|FH_F123756_45324_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F64999_0_0|CSTM-ALL|CSTM-00|2020|PDM|1937.00|99|0.00|ASPG IX|
20|FH_F136373_17055_0|SrvcGrp|83199|2022|PDM|120.00|99|0.00|IP HOSPICE RESPICE CARE|
20|FH_F136386_30901_0|SrvcGrp|26666|2022|PDM|21000.00|99|0.00|MS DRG 482 ONLY|
20|FH_F137209_60515_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F138019_79705_0|SrvcGrp|46903|2022|PDM|670.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F142448_15701_0|SrvcGrp|22389|2022|PDM|25.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F142547_70002_0|SrvcGrp|86851|2022|PDM|25.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F142690_31774_0|SrvcGrp|17014|2022|PDM|95.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F97601_67218_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F77782_66061_0|SrvcGrp|26001|2022|PDM|225.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F140343_89052_0|SrvcGrp|29076|2022|PDM|30.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F140343_89052_0|SrvcGrp|86833|2022|PDM|10.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F140450_18104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140830_70056_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140844_48083_0|SrvcGrp|26160|2022|PDM|39.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F132738_0_0|SrvcGrp|1306|2022|PDM|444.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F149644_91367_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F149646_71129_0|SrvcGrp|87317|2022|PDM|800.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F118789_92211_0|SrvcGrp|89337|2022|PDM|1000.00|99|0.00|DETOXIFICATION|
20|FH_F119004_06850_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118932_07652_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147882_44056_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F129504_02871_0|SrvcGrp|48385|2022|PDM|111.00|99|0.00|SPEECH THERAPY|
20|FH_F117221_23434_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F124754_84403_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F109513_0_0|SrvcGrp|73004|2022|PDM|1233.00|99|0.00|AEG 8|
20|FH_F145988_06105_0|SrvcGrp|111934|2022|PCT|1.47|99|0.00|COVID-19 NUCLEIC ACID|
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|64454.00|99|0.00|MS DRG 226-227|
20|FH_F67861_0_0|SrvcGrp|3208|2022|PDM|1155.00|99|0.00|SUBACUTE CARE|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97541_33021_0|SrvcGrp|90854|2022|PDM|2986.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F41429_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117829_45227_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
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_F119128_93619_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F150001_33064_0|SrvcGrp|86779|2022|PDM|26.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F118393_21032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F111502_33331_0|SrvcGrp|72379|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HORMONAL THERAPY (LEUPROLIDE/GOSERLINE)|
20|FH_F151519_35758_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45977_0_0|SrvcGrp|37767|2022|PDM|25.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F87455_63141_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F150065_16001_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F89011_75006_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP DIALYSIS|
20|FH_F37183_0_0|CSTM-ALL|CSTM-00|2020|PDM|52.00|99|0.00|OP SVCS|
20|FH_F88956_0_0|SrvcGrp|16|2022|PDM|1662.00|99|0.00|ACUTE REHABILITATION|
20|FH_F127422_0_0|SrvcGrp|72990|2022|PDM|333.00|99|0.00|AEG 1|
20|FH_F31184_0_0|SrvcGrp|18827|2022|PDM|39300.00|99|0.00|MS DRG 224|
20|FH_F100788_01420_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F63618_0_0|SrvcGrp|11258|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F117272_24333_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F101851_78024_0|SrvcGrp|73849|2022|PDM|465.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F71905_0_0|SrvcGrp|66481|2022|PDM|75.00|99|0.00|SOCIAL WORKER|
20|FH_F115685_64064_0|SrvcGrp|86834|2022|PDM|20.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F130013_16509_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150982_0_0|SrvcGrp|77461|2022|PDM|3176.00|99|0.00|CPT 52356|
20|FH_F125703_02907_0|SrvcGrp|472|2022|PDM|480.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F48192_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F114930_71101_0|SrvcGrp|73483|2022|PDM|816.00|99|0.00|AETNA SUBACUTE III|
20|FH_F133207_0_0|SrvcGrp|112222|2022|PDM|6496.00|99|0.00|SPINAL SURGERY|
20|FH_F71686_0_0|SrvcGrp|36991|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41053_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128906_48423_0|SrvcGrp|82222|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F127036_43724_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F47656_0_0|SrvcGrp|11336|2022|PCT|0.75|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F97242_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40321_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F82696_16335_0|SrvcGrp|76008|2022|PDM|670.00|99|0.00|EMERGENCY ROOM SVCS LEVEL I|
20|FH_F74964_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149868_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F110925_01104_0|SrvcGrp|86146|2022|PDM|36.33|99|0.00|AETNA ESTERASE BERINERT|
20|FH_F130204_40807_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F90798_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F148892_0_0|SrvcGrp|87677|2022|PDM|1293.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F143819_29485_0|SrvcGrp|46903|2022|PDM|761.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F41776_0_0|SrvcGrp|18920|2022|PDM|5237.00|99|0.00|MS DRG 766 REPLACEMENT CODES 785, 788|
20|FH_F72183_0_0|SrvcGrp|60|2022|PDM|600.00|99|0.00|NEWBORN NURSERY - LEVEL II|
20|FH_F37756_0_0|SrvcGrp|19514|2022|PDM|579.00|99|0.00|MS DRG 795|
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|1530.00|99|0.00|AEG 7 (NO REV)|
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135065_08043_0|SrvcGrp|102279|2022|PDM|42.00|99|0.00|AETNA METHADONE MAINTENANCE (HCFA)|
20|FH_F148355_37601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F129964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136490_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F38357_0_0|SrvcGrp|16746|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F63433_0_0|SrvcGrp|59715|2022|PCT|1.15|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 2 (NO REV)|
20|FH_F118194_50841_0|SrvcGrp|24753|2022|PDM|33.51|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F48998_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141427_22003_0|SrvcGrp|46605|2022|PDM|84.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F125999_77064_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F51672_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F41776_0_0|SrvcGrp|27221|2022|PCT|0.60|99|0.00|HIGH COST DRUGS|
20|FH_F44177_0_0|SrvcGrp|30031|2022|PDM|3149.00|99|0.00|PTCA + CATH|
20|FH_F122705_33351_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F62917_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|OP SVCS|
20|FH_F62579_0_0|SrvcGrp|15402|2022|PDM|75.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F142332_0_0|SrvcGrp|29346|2022|PDM|50.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F130755_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F98002_27103_0|SrvcGrp|88977|2022|PDM|7717.00|99|0.00|C-SECTION DELIVERY|
20|FH_F138348_04096_0|SrvcGrp|108799|2022|PCT|1.20|99|0.00|OP THERAPY SERVICE|
20|FH_F90232_15126_0|SrvcGrp|86840|2022|PDM|56.70|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F81698_10457_0|SrvcGrp|17015|2022|PDM|10.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F91633_33907_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F134627_74030_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F143560_03079_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143579_43160_0|SrvcGrp|114975|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F70863_0_0|SrvcGrp|13703|2022|PDM|121.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F119379_0_0|SrvcGrp|107838|2022|PDM|1060.00|99|0.00|REPAIR HAND JOINT WITH GRAFT|
20|FH_F132740_46250_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149005_16830_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F85315_15217_0|SrvcGrp|472|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F34286_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121476_0_0|SrvcGrp|108867|2022|PDM|3551.00|99|0.00|ADAPTOR/EXTENSION|
20|FH_F112987_46222_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F77184_0_0|SrvcGrp|48396|2022|PDM|18.00|99|0.00|OT SERVICES|
20|FH_F31595_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|C-SECTION|
20|FH_F110580_71106_0|CSTM-ALL|CSTM-00|2020|PDM|896.00|99|0.00|AEG 4 (NO REV)|
20|FH_F141167_0_0|SrvcGrp|108043|2022|PDM|214.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F97840_54729_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F133867_84075_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F63114_0_0|SrvcGrp|46604|2022|PDM|25.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PDM|728.00|99|0.00|AEG 4 (NO REV)|
20|FH_F49913_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130763_0_0|SrvcGrp|96539|2022|PDM|5268.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F133530_11237_0|CSTM-ALL|CSTM-00|2020|PDM|2920.00|99|0.00|AEG 1 (NO REV) (W/O ENDOSCOPIC PROCEDURES)|
20|FH_F117909_92405_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F123144_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117450_63131_0|SrvcGrp|46605|2022|PDM|114.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F126733_83713_0|SrvcGrp|75419|2022|PDM|368.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F137638_0_0|SrvcGrp|108484|2022|PDM|774.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53|
20|FH_F97882_32407_0|SrvcGrp|73601|2022|PDM|7565.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F78542_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F144017_33873_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|388.12|99|0.00|HAPA WPA-NWPA 2012-13 ASC 219 W/O REV|
20|FH_F123538_21206_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F126676_43537_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F89112_16509_0|CSTM-ALL|CSTM-00|2020|PCT|1.85|99|0.00|HAPA WPA/NWPA 2018 RAD 100%|
20|FH_F142755_33916_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F38630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|100% 2007 MEDICARE TN DME MOD KF|
20|FH_F32850_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115315_43011_0|SrvcGrp|94740|2022|PCT|1.00|99|0.00|AFLURIA VACC IM (>=3 YRS)|
20|FH_F117891_19034_0|SrvcGrp|73700|2022|PDM|36.75|99|0.00|AETNA - SKILLED NURSING|
20|FH_F91255_19401_0|CSTM-ALL|CSTM-00|2020|PDM|2490.00|99|0.00|AEG 4 (NO REV)|
20|FH_F129688_74066_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F51438_0_0|SrvcGrp|10905|2022|PDM|595.00|99|0.00|EMERGENCY ROOM LEVEL III|
20|FH_F145988_06105_0|SrvcGrp|107733|2022|PDM|19051.00|99|0.00|CESAREAN SECTION|
20|FH_F142027_37217_0|SrvcGrp|48385|2022|PDM|140.00|99|0.00|SPEECH THERAPY|
20|FH_F97622_75051_0|SrvcGrp|73656|2022|PDM|605.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F101922_98055_0|SrvcGrp|73002|2022|PDM|4700.00|99|0.00|AEG 7|
20|FH_F56793_0_0|SrvcGrp|43569|2022|PDM|40.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F149779_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F133530_11237_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F141728_71203_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F72859_0_0|SrvcGrp|15496|2022|PDM|38.63|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F123545_44512_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F125215_78130_0|SrvcGrp|13187|2022|PCT|1.10|99|0.00|INTRAOCULAR LENSES|
20|FH_F148002_78209_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91155_16105_0|SrvcGrp|73603|2022|PDM|521.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F66480_0_0|SrvcGrp|14306|2022|PDM|247.00|99|0.00|WELL MOM/WELL BABY VISIT|
20|FH_F118672_29036_0|CSTM-ALL|CSTM-00|2020|PDM|2871.00|99|0.00|AEG 10 (NO REV)|
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 9 (NO REV)|
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|1304.00|99|0.00|AEG 7 (NO REV)|
20|FH_F143200_91602_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F106660_26554_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|2285.00|99|0.00|AEG 4 (NO REV)|
20|FH_F102721_38118_0|SrvcGrp|80679|2022|PCT|0.25|99|0.00|AETNA RADIOLOGY|
20|FH_F112953_06066_0|SrvcGrp|76501|2022|PDM|368.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F145941_64119_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114519_0_0|SrvcGrp|72996|2022|PDM|1299.00|99|0.00|AEG 4|
20|FH_F151059_60435_0|SrvcGrp|48398|2022|PDM|125.00|99|0.00|PT SERVICES|
20|FH_F151081_85225_0|SrvcGrp|75419|2022|PDM|577.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F151120_71901_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121946_43209_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F138745_29642_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139707_84010_0|SrvcGrp|114699|2022|PDM|6189.00|99|0.00|BREAST PROCEDURES|
20|FH_F150741_81506_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150768_03054_0|SrvcGrp|23683|2022|PDM|79.00|99|0.00|SKILLED NURSING RN|
20|FH_F150820_83843_0|CSTM-ALL|CSTM-00|2020|PDM|2734.00|99|0.00|AEG 6 (NO REV)|
20|FH_F111272_74012_0|SrvcGrp|83683|2022|PDM|1082.00|99|0.00|ACUTE REHAB II|
20|FH_F101441_0_0|SrvcGrp|16692|2022|PDM|3567.00|99|0.00|KNEE SCOPE|
20|FH_F113806_53083_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F151158_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F39443_0_0|SrvcGrp|9522|2022|PDM|3260.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F131028_49735_0|SrvcGrp|97705|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F148839_0_0|SrvcGrp|95819|2022|PDM|1919.00|99|0.00|GONIOTOMY|
20|FH_F149273_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F110732_31513_0|SrvcGrp|42785|2022|PDM|109.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|1744.00|99|0.00|AEG 7 (NO REV)|
20|FH_F35775_32055_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS|
20|FH_F37312_0_0|SrvcGrp|22387|2022|PDM|49.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F94100_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40853_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|335.00|99|0.00|AEG 1 (NO REV)|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD KM|
20|FH_F134919_02155_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F138987_0_0|SrvcGrp|113454|2022|PDM|32.00|99|0.00|HOSPICE CARE|
20|FH_F117762_0_0|SrvcGrp|88159|2022|PDM|4992.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1575124_HCPCS_  MOD AU|
20|FH_F131385_76457_0|SrvcGrp|86723|2022|PDM|425.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F138017_73129_0|SrvcGrp|77582|2022|PDM|6883.00|99|0.00|CPT 31255|
20|FH_F150922_02452_0|SrvcGrp|115840|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUG|
20|FH_F102163_0_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F150443_77536_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110726_19720_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|335.00|99|0.00|AEG 1 (NO REV)|
20|FH_F124288_15701_0|SrvcGrp|75481|2022|PDM|425.00|99|0.00|AEG 2|
20|FH_F116583_0_0|SrvcGrp|104327|2022|PDM|150.00|99|0.00|HOSPICE HOME CARE|
20|FH_F137767_01841_0|CSTM-ALL|CSTM-00|2020|PDM|3775.00|99|0.00|AEG 7 (NO REV)|
20|FH_F36554_0_0|SrvcGrp|70819|2022|PCT|0.80|99|0.00|(HCPCS) OCN F/S PRICING: ALL|
20|FH_F108680_0_0|SrvcGrp|74039|2022|PDM|5720.00|99|0.00|LAMINECTOMY|
20|FH_F37777_0_0|SrvcGrp|36235|2022|PDM|875.00|99|0.00|ORTHO / GENERAL|
20|FH_F42352_0_0|SrvcGrp|13437|2022|PDM|3270.00|99|0.00|LITHOTRIPSY|
20|FH_F112128_63017_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F86714_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131331_0_0|SrvcGrp|82222|2022|PDM|55.66|99|0.00|HOSPICE CARE|
20|FH_F39889_0_0|SrvcGrp|3409|2022|PDM|295.00|99|0.00|NEWBORN NURSERY|
20|FH_F40490_0_0|SrvcGrp|32562|2022|PDM|1319.00|99|0.00|ACUTE PSYCH/CD|
20|FH_F148702_32606_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F149579_95815_0|SrvcGrp|115686|2022|PDM|65.96|99|0.00|PHYSIOLOGIC MONITORING REM PARAM DEV (HCFA)|
20|FH_F128191_28642_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F39756_0_0|SrvcGrp|31519|2022|PDM|607.20|99|0.00|CUMBERLAND SURGERY CTR-ASPG III|
20|FH_F47424_0_0|SrvcGrp|42784|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F111266_30339_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP WITHOUT CPT 99601|
20|FH_F35088_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS|
20|FH_F126147_45241_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F141287_14830_0|SrvcGrp|73499|2022|PDM|736.00|99|0.00|AETNA ER LEVEL II|
20|FH_F147229_60523_0|SrvcGrp|92502|2022|PDM|789.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F141278_80218_0|SrvcGrp|86729|2022|PCT|1.00|99|0.00|COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE|
20|FH_F150982_0_0|SrvcGrp|59840|2022|PDM|1872.00|99|0.00|TYMPANOSTOMY|
20|FH_F148667_0_0|SrvcGrp|85778|2022|PDM|2727.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 9 (NO REV)|
20|FH_F113826_51445_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41161_0_0|SrvcGrp|13811|2022|PDM|273.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F125081_15218_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F36883_0_0|SrvcGrp|89417|2022|PDM|312.50|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F124719_64093_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F138478_0_0|SrvcGrp|104009|2022|PDM|5394.02|99|0.00|REMOVE AND REPLACE PM GEN SINGL|
20|FH_F146266_0_0|SrvcGrp|67072|2022|PDM|6188.00|99|0.00|CPT 22845|
20|FH_F124703_65711_0|SrvcGrp|75545|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
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_F76522_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F149480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F93392_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|PDM|3917.00|99|0.00|AEG 7 (NO REV)|
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_F125656_92868_0|SrvcGrp|26869|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F132254_40207_0|SrvcGrp|86836|2022|PDM|25.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F144831_0_0|SrvcGrp|48385|2022|PDM|15.82|99|0.00|SPEECH THERAPY|
20|FH_F150982_0_0|SrvcGrp|91940|2022|PDM|1382.00|99|0.00|TYMPANIC MEMBRANE REPAIR|
20|FH_F43293_0_0|SrvcGrp|16|2022|PDM|550.00|99|0.00|ACUTE REHABILITATION|
20|FH_F36883_0_0|SrvcGrp|89149|2022|PDM|260.00|99|0.00|OP INTENSIVE|
20|FH_F141250_95062_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F139928_37228_0|SrvcGrp|12659|2022|PDM|771.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F140176_51445_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143488_84770_0|SrvcGrp|109219|2022|PDM|1500.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F72749_0_0|SrvcGrp|16|2022|PDM|1660.00|99|0.00|ACUTE REHABILITATION|
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 3 (NO REV)|
20|FH_F123185_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F101606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F131093_49690_0|SrvcGrp|65720|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD AV)|
20|FH_F120240_37013_0|SrvcGrp|471|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F116629_83467_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|GENERAL ACUTE CARE|
20|FH_F116683_64730_0|SrvcGrp|94737|2022|PCT|1.00|99|0.00|FLUVIRIN VACC IM (>=3 YRS)|
20|FH_F126970_45601_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F127033_54501_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39621_0_0|SrvcGrp|22954|2022|PDM|115.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F63020_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F62579_0_0|SrvcGrp|40824|2022|PDM|90.00|99|0.00|DELIVERY/SERVICE (HIGH RISK)|
20|FH_F133748_77081_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132740_46250_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F131100_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F72244_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F120425_11106_0|SrvcGrp|46903|2022|PDM|500.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132899_01002_0|SrvcGrp|86638|2022|PDM|998.00|99|0.00|AETNA IP PSYCHIATRIC (>=18 YRS)|
20|FH_F119213_66209_0|SrvcGrp|90492|2022|PCT|1.00|99|0.00|BEHAVRAL QUALIT ANALYS VOICE|
20|FH_F145597_78644_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63906|2022|PDM|143.01|99|0.00|HAPA WPA-NWPA 2012-13 ASC 315|
20|FH_F143742_60410_0|SrvcGrp|82037|2022|PDM|3500.00|99|0.00|AETNA ICU|
20|FH_F128816_43537_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150165_06032_0|SrvcGrp|81571|2022|PDM|4668.00|99|0.00|NASAL ENDOSCOPY W/ SINUS OSTIA DILATION|
20|FH_F138951_41101_0|SrvcGrp|86848|2022|PDM|40.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F130763_0_0|SrvcGrp|100044|2022|PDM|3882.00|99|0.00|INCISION OF HEEL BONE|
20|FH_F120719_27540_0|CSTM-ALL|CSTM-00|2020|PDM|8977.00|99|0.00|AEG 5  (NO REV)|
20|FH_F143650_0_0|SrvcGrp|72994|2022|PDM|1700.00|99|0.00|AEG 3|
20|FH_F85652_98034_0|SrvcGrp|31704|2022|PDM|3910.00|99|0.00|MS DRG 790 ONLY|
20|FH_F80613_0_0|SrvcGrp|23683|2022|PDM|55.00|99|0.00|SKILLED NURSING RN|
20|FH_F112023_12866_0|SrvcGrp|75507|2022|PCT|0.62|99|0.00|CHEMOTHERAPY|
20|FH_F109242_18466_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F138828_78629_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133749_84604_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109405_73106_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV)|
20|FH_F126550_43085_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT 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_F134353_84123_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109264_33431_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F88744_71103_0|SrvcGrp|2738|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F133207_0_0|SrvcGrp|91941|2022|PDM|3529.00|99|0.00|NASAL/SINUS ENDOSCOPY WITH DILATION|
20|FH_F127642_07047_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131127_0_0|SrvcGrp|86462|2022|PDM|3278.00|99|0.00|AREOLA RECONSTRUCTION|
20|FH_F31714_0_0|SrvcGrp|3581|2022|PDM|14600.00|99|0.00|DRG 111 MAJOR CV PROC W/O CC|
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1099.60|99|0.00|AEG 6 (NO REV)|
20|FH_F70863_0_0|SrvcGrp|12264|2022|PDM|74.00|99|0.00|DIETICIAN OR LPN 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_F143620_81504_0|SrvcGrp|88620|2022|PDM|115.00|99|0.00|SKILLED NURSING RN|
20|FH_F145604_14850_0|SrvcGrp|22389|2022|PDM|35.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F100063_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F145642_15108_0|SrvcGrp|21920|2022|PDM|30.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F109266_33319_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131128_0_0|SrvcGrp|75002|2022|PDM|4774.00|99|0.00|ARTHOSCOPY|
20|FH_F130763_0_0|SrvcGrp|70746|2022|PDM|3450.00|99|0.00|CPT 28292|
20|FH_F110341_81212_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F145759_18452_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149121_01520_0|SrvcGrp|471|2022|PDM|700.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F116753_0_0|SrvcGrp|103571|2022|PDM|7465.00|99|0.00|REMOVAL LOOSE BODY|
20|FH_F87333_0_0|SrvcGrp|72998|2022|PDM|1817.64|99|0.00|AEG 5|
20|FH_F80613_0_0|SrvcGrp|41563|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F81698_10457_0|SrvcGrp|86848|2022|PDM|31.50|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F100782_0_0|SrvcGrp|105091|2022|PDM|319.65|99|0.00|WINDBER MEDICAL CNTR ASC 136|
20|FH_F112791_0_0|SrvcGrp|72996|2022|PDM|661.00|99|0.00|AEG 4|
20|FH_F148924_44003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130337_62948_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143650_0_0|SrvcGrp|33724|2022|PDM|1800.00|99|0.00|ARTHROSCOPY|
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118088_71261_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F134507_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146626_60612_0|SrvcGrp|82981|2022|PDM|250.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F107520_66612_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136359_0_0|SrvcGrp|38364|2022|PDM|5100.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F49853_0_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F139446_87106_0|SrvcGrp|46903|2022|PDM|800.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F100782_0_0|SrvcGrp|105107|2022|PDM|69.76|99|0.00|WINDBER MEDICAL CNTR ASC 152|
20|FH_F134174_63141_0|CSTM-ALL|CSTM-00|2020|PDM|128.49|99|0.00|AETNA SLEEP STUDIES|
20|FH_F34182_0_0|SrvcGrp|3044|2022|PCT|0.80|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F149139_07522_0|SrvcGrp|113226|2022|PDM|42.28|99|0.00|COVID-19 SVNT SARSCOV2 ELISA PLSM SRM|
20|FH_F127665_44124_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F51021_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|OP SVCS|
20|FH_F37877_0_0|CSTM-ALL|CSTM-00|2020|PDM|1049.00|99|0.00|ASPG VII|
20|FH_F117896_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F129525_48446_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|(JCODES-IMMUN) OCN F/S PRICING: ALL|
20|FH_F85894_0_0|SrvcGrp|13367|2022|PDM|1957.00|99|0.00|ICU/CCU|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|309.44|99|0.00|HAPA WPA-NWPA 2012-13 ASC 112 W/O REV|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|247.25|99|0.00|HAPA WPA-NWPA 2012-13 ASC 228 W/O REV|
20|FH_F146668_30189_0|SrvcGrp|84307|2022|PDM|7950.00|99|0.00|TENDON REPAIR|
20|FH_F146672_47424_0|SrvcGrp|3178|2022|PDM|903.00|99|0.00|ACUTE PSYCH|
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|2075.00|99|0.00|AEG 6 (NO REV)|
20|FH_F129310_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36049_0_0|SrvcGrp|22136|2022|PDM|303.00|99|0.00|CT SCAN|
20|FH_F33389_0_0|SrvcGrp|12299|2022|PCT|0.70|99|0.00|PROSTHETICS/IMPLANTS/DEVICES|
20|FH_F35404_0_0|SrvcGrp|8968|2022|PDM|3000.00|99|0.00|NICU LEVEL III & IV|
20|FH_F142454_0_0|SrvcGrp|110845|2022|PDM|2795.00|99|0.00|REPAIR OF ECTROPION|
20|FH_F150025_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F49895_0_0|SrvcGrp|43320|2022|PDM|303.00|99|0.00|CT SCANS|
20|FH_F67339_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67339_0_0|SrvcGrp|9937|2022|PDM|65.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F50137_0_0|SrvcGrp|46248|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F63095_0_0|SrvcGrp|29815|2022|PDM|3734.00|99|0.00|MS DRG 003-004, 207-208 ONLY|
20|FH_F131228_01826_0|SrvcGrp|112722|2022|PCT|0.87|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F115772_26250_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127375_28621_0|SrvcGrp|78403|2022|PDM|0.25|99|0.00|AETNA MED RECORD|
20|FH_F126883_78621_0|SrvcGrp|86723|2022|PDM|410.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F82235_0_0|SrvcGrp|72996|2022|PDM|693.00|99|0.00|AEG 4|
20|FH_F72784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F119511_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128170_61920_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151526_28208_0|CSTM-ALL|CSTM-00|2020|PDM|624.00|99|0.00|AEG 1 (NO REV)|
20|FH_F148255_72703_0|SrvcGrp|86830|2022|PDM|31.50|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F71686_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127567_44070_0|SrvcGrp|104874|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92091_0_0|SrvcGrp|16289|2022|PDM|1600.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F118386_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102302_0_0|SrvcGrp|97119|2022|PDM|10850.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F118194_50841_0|SrvcGrp|86831|2022|PDM|21.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F94662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128883_89521_0|SrvcGrp|48394|2022|PDM|52.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F129025_57451_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F34513_0_0|SrvcGrp|14149|2022|PDM|94.00|99|0.00|CLINIC VISIT|
20|FH_F139515_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F128883_89521_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121547_46805_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F34454_0_0|SrvcGrp|3809|2022|PDM|483.00|99|0.00|HOSPICE CARE|
20|FH_F32112_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F87031_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F129345_60623_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125028_19061_0|SrvcGrp|86841|2022|PDM|114.45|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.85|99|0.00|ASPG II|
20|FH_F109277_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS|
20|FH_F52854_0_0|SrvcGrp|13954|2022|PDM|1010.00|99|0.00|OP FALSE LABOR|
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 9 (NO REV)|
20|FH_F128274_81501_0|SrvcGrp|76321|2022|PCT|0.80|99|0.00|AETNA ALL INPATIENT SERVICES|
20|FH_F61332_0_0|SrvcGrp|16|2022|PDM|1150.00|99|0.00|ACUTE REHABILITATION|
20|FH_F123464_63841_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F148255_72703_0|SrvcGrp|86854|2022|PDM|31.50|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F109607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148122_49435_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS|
20|FH_F137462_03062_0|SrvcGrp|471|2022|PDM|652.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F97540_32114_0|SrvcGrp|73461|2022|PDM|6816.00|99|0.00|AETNA NICU IV|
20|FH_F109000_0_0|SrvcGrp|102960|2022|PDM|6600.00|99|0.00|SP BONE|
20|FH_F139173_0_0|SrvcGrp|80918|2022|PDM|409.24|99|0.00|RESPITE CARE|
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|CHILD PARTIAL HOSPITALIZATION|
20|FH_F48192_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F130134_08724_0|SrvcGrp|111489|2022|PDM|400.00|99|0.00|IP REHAB SERVICES (18-99 YRS)|
20|FH_F137367_89139_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F137462_03062_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F44218_0_0|SrvcGrp|14210|2022|PDM|225.00|99|0.00|PSYCH INTENSIVE OUTPATIENT|
20|FH_F78343_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F90157_0_0|SrvcGrp|22528|2022|PCT|0.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F56136_0_0|SrvcGrp|20752|2022|PCT|0.85|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F38875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|3D CARDIO FH MRI/CT|
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141527_36830_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.00|99|0.00|AEG 2 (NO REV)|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|360.94|99|0.00|HAPA WPA-NWPA 2012-13 ASC 103 W/O REV|
20|FH_F58012_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F110061_0_0|SrvcGrp|75495|2022|PDM|1418.00|99|0.00|AEG 9|
20|FH_F55054_0_0|SrvcGrp|29949|2022|PCT|0.70|99|0.00|TRAUMA|
20|FH_F41776_0_0|SrvcGrp|53562|2022|PDM|7277.00|99|0.00|DIAGNOSTIC CARDIAC CATH|
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|937.00|99|0.00|AEG 4 (NO REV)|
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F118050_77565_0|SrvcGrp|89337|2022|PDM|750.00|99|0.00|DETOXIFICATION|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F150982_0_0|SrvcGrp|63471|2022|PDM|8320.00|99|0.00|CPT 64590|
20|FH_F91622_0_0|CSTM-ALL|CSTM-00|2020|PDM|1890.00|99|0.00|AEG 4 (NO REV) ANTHONY MED CTR|
20|FH_F151562_26003_0|SrvcGrp|84185|2022|PDM|103.00|99|0.00|RESPITE CARE|
20|FH_F32429_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
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_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|688.00|99|0.00|ASPG III|
20|FH_F137637_03103_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F89563_29407_0|SrvcGrp|89503|2022|PCT|1.00|99|0.00|GAIT TRAINING THERAPY|
20|FH_F135065_08043_0|SrvcGrp|74668|2022|PDM|550.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124254_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F116327_75701_0|SrvcGrp|86722|2022|PDM|192.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F143788_21230_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F135268_11231_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149739_77087_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116731_0_0|SrvcGrp|97507|2022|PDM|100.00|99|0.00|AETNA HOSPICE|
20|FH_F128401_44615_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F135248_84651_0|SrvcGrp|76501|2022|PDM|260.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F148440_16506_0|SrvcGrp|114442|2022|PDM|4500.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F37625_0_0|SrvcGrp|17378|2022|PDM|150.00|99|0.00|CAPD TRAINING|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|342.35|99|0.00|DELAWARE VALLEY- ASC 103|
20|FH_F71549_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F91873_12723_0|SrvcGrp|12491|2022|PCT|0.68|99|0.00|PACEMAKER|
20|FH_F111001_0_0|CSTM-ALL|CSTM-00|2020|PDM|18.00|99|0.00|RN HIGH TECH HOURLY|
20|FH_F117001_0_0|SrvcGrp|24404|2022|PDM|450.00|99|0.00|HEARING AIDE|
20|FH_F68660_0_0|SrvcGrp|14096|2022|PCT|0.65|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F114916_30309_0|SrvcGrp|88162|2022|PDM|3000.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F142447_72758_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F103880_85014_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD HOMEHEALTH|
20|FH_F104840_32565_0|SrvcGrp|78377|2022|PCT|0.69|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F105591_17601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133178_0_0|SrvcGrp|103837|2022|PDM|833.00|99|0.00|AETNA DESTRUCTION PENIS LESION|
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|544.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132988_0_0|SrvcGrp|78096|2022|PDM|4493.01|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F132988_0_0|SrvcGrp|112151|2022|PDM|3144.78|99|0.00|REPAIR ARM/LEG NERVE|
20|FH_F133002_0_0|SrvcGrp|84279|2022|PDM|1716.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F136832_0_0|SrvcGrp|30089|2022|PDM|408.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F130297_41042_0|SrvcGrp|111525|2022|PDM|129.00|99|0.00|CAPD/CCPD (INCLUDES TRAINING)|
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F141050_46410_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F141148_63043_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114389_50131_0|SrvcGrp|105626|2022|PDM|62.69|99|0.00|PORTABLE GASEOUS OXYGEN SYSTEM (MOD RR)|
20|FH_F114389_50131_0|SrvcGrp|88807|2022|PDM|337.29|99|0.00|TOTAL PARENTERAL NUTRITION; < 2 LITERS (HCFA)|
20|FH_F149719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43665_0_0|CSTM-ALL|CSTM-00|2020|PDM|331.00|99|0.00|SKILLED NURSING CARE|
20|FH_F49812_0_0|SrvcGrp|45867|2022|PDM|50.00|99|0.00|CPT 92557|
20|FH_F49812_0_0|SrvcGrp|45869|2022|PDM|14.00|99|0.00|CPT 92568|
20|FH_F55812_0_0|SrvcGrp|10534|2022|PDM|70.00|99|0.00|NURSING CARE|
20|FH_F118184_0_0|SrvcGrp|112813|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER|
20|FH_F124059_64055_0|SrvcGrp|46104|2022|PDM|50.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F146880_74105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F64441_0_0|SrvcGrp|42784|2022|PDM|68.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F40603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40643_0_0|CSTM-ALL|CSTM-00|2020|PDM|1004.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91998_0_0|SrvcGrp|91886|2022|PDM|1100.00|99|0.00|REPAIR FLEXOR TENDON ZONE 2|
20|FH_F92493_0_0|SrvcGrp|92012|2022|PDM|1949.64|99|0.00|EXCISION OF HAND OR FINGER|
20|FH_F124227_01230_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F124663_65608_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F55694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|OP SVCS|
20|FH_F76544_0_0|CSTM-ALL|CSTM-00|2020|PDM|516.00|99|0.00|REHABILITATION HALF DAY|
20|FH_F58636_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.00|99|0.00|OP SVCS|
20|FH_F114666_30342_0|SrvcGrp|91567|2022|PDM|1400.00|99|0.00|REPAIR OF KNEECAP TENDON|
20|FH_F122739_43558_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F43444_0_0|SrvcGrp|708|2022|PDM|4000.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F136914_64081_0|SrvcGrp|106300|2022|PDM|365.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F37847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115631_65201_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F116233_33612_0|SrvcGrp|89149|2022|PDM|125.00|99|0.00|OP INTENSIVE|
20|FH_F42024_0_0|CSTM-ALL|CSTM-00|2020|PDM|17000.00|99|0.00|MS DRG 003-004, 163-165|
20|FH_F135351_0_0|SrvcGrp|112739|2022|PDM|809.00|99|0.00|NJX INTERLAMINAR CRV/THRC|
20|FH_F141837_0_0|SrvcGrp|106314|2022|PDM|900.00|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F41013_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1151.81|99|0.00|HAPA WPA-NWPA 2012-13 ASC 706 W/O REV|
20|FH_F92474_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F132163_17601_0|SrvcGrp|46903|2022|PDM|1050.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F122148_62664_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131132_44077_0|SrvcGrp|41334|2022|PDM|22889.00|99|0.00|TOTAL KNEE|
20|FH_F131407_07607_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F121700_60938_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F121803_66502_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F146125_0_0|SrvcGrp|88147|2022|PDM|3150.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA|
20|FH_F33785_0_0|SrvcGrp|12543|2022|PDM|5000.00|99|0.00|LAPAROSCOPIC HYSTERECTOMY|
20|FH_F40174_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131000_0_0|SrvcGrp|82114|2022|PDM|3343.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F72666_0_0|SrvcGrp|23477|2022|PDM|4614.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1103.00|99|0.00|AEG 7 (NO REV)|
20|FH_F134615_38478_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F127642_07047_0|SrvcGrp|108461|2022|PDM|3121.00|99|0.00|SLIDING REPAIR ING HERNIA|
20|FH_F118803_0_0|SrvcGrp|107876|2022|PDM|504.97|99|0.00|MECH REMV PERICATH MATL SEP|
20|FH_F139569_15063_0|SrvcGrp|102261|2022|PDM|798.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F146399_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F111349_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F144248_0_0|SrvcGrp|42550|2022|PDM|5738.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F35805_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130763_0_0|SrvcGrp|88599|2022|PDM|4367.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F146543_89511_0|SrvcGrp|112844|2022|PDM|1061.00|99|0.00|IP PSYCHIATRIC EATING DISORDERS|
20|FH_F133798_20774_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125244_0_0|SrvcGrp|17327|2022|PDM|3000.00|99|0.00|HYSTEROSCOPY|
20|FH_F85212_71075_0|SrvcGrp|80260|2022|PCT|0.00|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F111986_0_0|SrvcGrp|98003|2022|PDM|2472.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|1405.00|99|0.00|AEG 10 (NO REV)|
20|FH_F122942_89512_0|SrvcGrp|106722|2022|PDM|1200.00|99|0.00|IP REHAB|
20|FH_F41594_0_0|SrvcGrp|76092|2022|PDM|86.00|99|0.00|SPEECH THERAPY INITIAL EVALUATION|
20|FH_F81852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F136359_0_0|SrvcGrp|64517|2022|PDM|5275.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F146421_72758_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51934_0_0|SrvcGrp|48395|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F120661_57001_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145642_15108_0|SrvcGrp|22592|2022|PDM|30.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F149148_15330_0|SrvcGrp|29347|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F117245_0_0|SrvcGrp|73008|2022|PDM|1275.00|99|0.00|AEG 10|
20|FH_F47473_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|953.91|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1302 W/O REV|
20|FH_F149121_01520_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F109405_73106_0|SrvcGrp|58509|2022|PDM|285.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|1625.00|99|0.00|ASPG VII|
20|FH_F143742_60410_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F130329_64114_0|SrvcGrp|86848|2022|PDM|25.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F52713_0_0|SrvcGrp|39522|2022|PDM|93894.00|99|0.00|MS DRG 216-218 ONLY|
20|FH_F112073_65020_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|2884.00|99|0.00|AEG 9 (NO REV)|
20|FH_F114415_16509_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F54592_0_0|SrvcGrp|16559|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F54592_0_0|SrvcGrp|24758|2022|PDM|19.00|99|0.00|HOME INJECTABLE THERAPY|
20|FH_F134488_14086_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F84454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F85055_0_0|SrvcGrp|72990|2022|PDM|466.00|99|0.00|AEG 1|
20|FH_F70607_0_0|SrvcGrp|40685|2022|PCT|1.00|99|0.00|DEVICES/SUPPLIES|
20|FH_F115865_78621_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F75842_0_0|SrvcGrp|17075|2022|PDM|3016.71|99|0.00|ASPG VI|
20|FH_F120811_53525_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F126783_80021_0|SrvcGrp|87131|2022|PDM|1095.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F115966_16801_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F115979_46107_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133590_33064_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F132250_12550_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F133415_90066_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F133047_74012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F111829_32257_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134826_19067_0|SrvcGrp|90648|2022|PDM|125.00|99|0.00|PSYTX PT/FAMILY 45 MINUTES (HCFA)|
20|FH_F39346_0_0|SrvcGrp|20914|2022|PDM|30441.00|99|0.00|MS DRG 233 ONLY|
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F144648_0_0|SrvcGrp|108082|2022|PDM|25.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F80511_0_0|SrvcGrp|78180|2022|PDM|781.00|99|0.00|AETNA RESIDENTIAL TREATMENT|
20|FH_F131501_0_0|SrvcGrp|83519|2022|PDM|100.00|99|0.00|HOSPICE CARE (ALL OTHER)|
20|FH_F43867_0_0|SrvcGrp|37403|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F138677_43793_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138880_92392_0|SrvcGrp|46903|2022|PDM|950.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F138893_98903_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138685_18017_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F67167_0_0|SrvcGrp|14320|2022|PCT|0.65|99|0.00|OP IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F91641_0_0|SrvcGrp|91459|2022|PDM|1976.76|99|0.00|LAPAROSCOPY|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|323.96|99|0.00|HAPA WPA-NWPA 2012-13 ASC 114 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|99.11|99|0.00|HAPA WPA-NWPA 2012-13 ASC 243 W/O REV|
20|FH_F92474_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|753.00|99|0.00|AEG 2 (NO REV)|
20|FH_F40073_0_0|SrvcGrp|17083|2022|PCT|0.70|99|0.00|ASPG X|
20|FH_F135583_17331_0|SrvcGrp|109057|2022|PCT|0.82|99|0.00|CARDIAC STUDIES|
20|FH_F91764_93710_0|SrvcGrp|113231|2022|PCT|2.19|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 TITER|
20|FH_F135767_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135924_02906_0|SrvcGrp|112224|2022|PDM|565.70|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F135952_74501_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118932_07652_0|SrvcGrp|107600|2022|PCT|1.50|99|0.00|AETNA CHEMOTHERAPY DRUGS|
20|FH_F38332_0_0|SrvcGrp|115|2022|PDM|497.00|99|0.00|SKILLED NURSING CARE|
20|FH_F67880_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115452_15235_0|SrvcGrp|73700|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F129474_92701_0|SrvcGrp|108061|2022|PDM|300.00|99|0.00|OP THERAPY SERVICES|
20|FH_F137934_51054_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F38948_0_0|SrvcGrp|24703|2022|PDM|506.00|99|0.00|NEWBORN NURSERY|
20|FH_F109632_0_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION|
20|FH_F110342_0_0|SrvcGrp|72990|2022|PDM|840.00|99|0.00|AEG 1|
20|FH_F90876_18447_0|SrvcGrp|22384|2022|PDM|66.15|99|0.00|HOME VISIT PRENATAL|
20|FH_F90880_15108_0|SrvcGrp|90490|2022|PCT|1.00|99|0.00|EVALUATION OF SPEECH FLUENCY|
20|FH_F124828_74074_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F32848_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|965.00|99|0.00|AEG 5  (NO REV)|
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|544.00|99|0.00|AEG 2 (NO REV)|
20|FH_F109513_0_0|SrvcGrp|83838|2022|PDM|1850.00|99|0.00|SUSPENSION OF BREAST|
20|FH_F131379_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F147340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151144_35801_0|SrvcGrp|112180|2022|PDM|1273.10|99|0.00|INCISE INNER EYE ADHESIONS|
20|FH_F121385_89102_0|CSTM-ALL|CSTM-00|2020|PCT|0.46|99|0.00|OP SVCS|
20|FH_F121887_53144_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130066_84107_0|SrvcGrp|87317|2022|PDM|800.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F130066_84107_0|SrvcGrp|108484|2022|PDM|650.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|461.00|99|0.00|AEG 2 (NO REV)|
20|FH_F38564_0_0|SrvcGrp|1168|2022|PDM|28.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F32628_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F142070_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91873_12723_0|CSTM-ALL|CSTM-00|2020|PDM|1855.00|99|0.00|AETNA OP PET SCANS (PET)|
20|FH_F97660_29401_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F109484_0_0|SrvcGrp|72994|2022|PDM|510.00|99|0.00|AEG 3|
20|FH_F111207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F73231_0_0|SrvcGrp|37767|2022|PDM|25.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F86911_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|HOME HEALTH AIDE MOD TF|
20|FH_F114916_30309_0|SrvcGrp|67065|2022|PDM|8000.00|99|0.00|CERVICAL SURGERY|
20|FH_F103780_64804_0|SrvcGrp|79786|2022|PCT|0.68|99|0.00|SLEEP STUDIES|
20|FH_F37294_0_0|CSTM-ALL|CSTM-00|2020|PDM|1391.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F138929_0_0|SrvcGrp|99166|2022|PDM|6600.00|99|0.00|CPT 63005|
20|FH_F132627_0_0|SrvcGrp|111529|2022|PDM|153.00|99|0.00|MID-LINE INSERTION (HCFA)|
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|AEG 7 (NO REV)|
20|FH_F88933_0_0|SrvcGrp|112910|2022|PDM|8610.00|99|0.00|NECK-SPINE FUSION|
20|FH_F118909_0_0|SrvcGrp|97506|2022|PDM|133.90|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F72204_0_0|SrvcGrp|17139|2022|PDM|528.00|99|0.00|HOSPICE CARE|
20|FH_F72204_0_0|SrvcGrp|15850|2022|PDM|120.00|99|0.00|HOSPICE SVCS|
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1044.75|99|0.00|AEG 7 (NO REV)|
20|FH_F116664_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112722_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77944_0_0|SrvcGrp|29334|2022|PDM|4104.00|99|0.00|EMERGENCY ROOM SRVCS|
20|FH_F109248_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F92493_0_0|SrvcGrp|89842|2022|PDM|21411.50|99|0.00|LUMBAR|
20|FH_F92493_0_0|SrvcGrp|92361|2022|PDM|12999.53|99|0.00|TREAT PELVIC RING FRACTURE|
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132864_71101_0|SrvcGrp|73606|2022|PDM|877.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F98380_43055_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F60365_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63185_0_0|SrvcGrp|48394|2022|PDM|6.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F87856_0_0|SrvcGrp|111584|2022|PDM|1293.00|99|0.00|REMOVAL OF TISSUE FOR GRAFT|
20|FH_F89273_0_0|SrvcGrp|88245|2022|PDM|1600.00|99|0.00|EYE SURGERY|
20|FH_F122200_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F122200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135327_0_0|SrvcGrp|112737|2022|PDM|1168.00|99|0.00|FOOT PROCEDURES|
20|FH_F100787_69162_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F100787_69162_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F136708_06443_0|SrvcGrp|90635|2022|PDM|80.00|99|0.00|AETNA PSYTX PT & FAMILY 60 MINUTES|
20|FH_F113913_70065_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138855_84067_0|SrvcGrp|75419|2022|PDM|880.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F81893_23114_0|SrvcGrp|106752|2022|PDM|917.00|99|0.00|CAT SCANS|
20|FH_F132721_0_0|SrvcGrp|16|2022|PDM|1611.00|99|0.00|ACUTE REHABILITATION|
20|FH_F43447_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134691_33445_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F136913_68803_0|SrvcGrp|31704|2022|PDM|50509.00|99|0.00|MS DRG 790 ONLY|
20|FH_F62922_0_0|SrvcGrp|3577|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F115567_91711_0|SrvcGrp|100499|2022|PDM|790.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F147519_52627_0|SrvcGrp|109057|2022|PCT|0.89|99|0.00|CARDIAC STUDIES|
20|FH_F147527_60645_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125287_92374_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F118917_33317_0|SrvcGrp|89149|2022|PDM|186.00|99|0.00|OP INTENSIVE|
20|FH_F36372_0_0|SrvcGrp|11786|2022|PDM|14.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F38387_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138350_0_0|SrvcGrp|12664|2022|PCT|0.78|99|0.00|IMPLANTS|
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|993.00|99|0.00|AEG 7 (NO REV)|
20|FH_F100906_0_0|SrvcGrp|33967|2022|PDM|2500.00|99|0.00|CPT 47562|
20|FH_F39346_0_0|CSTM-ALL|CSTM-00|2020|PDM|23418.00|99|0.00|MS DRG 237 ONLY|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PDM|586.80|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 3 W/O REV|
20|FH_F50515_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F133132_0_0|SrvcGrp|3178|2022|PDM|900.00|99|0.00|ACUTE PSYCH|
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.00|99|0.00|AEG 4 (NO REV)|
20|FH_F100161_17325_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F120635_22903_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 7 (NO REV)|
20|FH_F42244_0_0|SrvcGrp|25|2022|PCT|0.70|99|0.00|LITHOTRIPSY|
20|FH_F50459_0_0|SrvcGrp|11258|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138807_32207_0|SrvcGrp|73701|2022|PDM|51.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F138936_01040_0|SrvcGrp|113185|2022|PCT|1.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F138685_18017_0|SrvcGrp|46903|2022|PDM|547.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F32921_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F135027_0_0|SrvcGrp|46482|2022|PDM|125.00|99|0.00|S9083 PER VISIT|
20|FH_F72606_0_0|SrvcGrp|30475|2022|PDM|4300.00|99|0.00|INTENSIVE CARE SVCS|
20|FH_F72606_0_0|SrvcGrp|3087|2022|PDM|2500.00|99|0.00|CD - DETOX|
20|FH_F151503_30067_0|SrvcGrp|99169|2022|PDM|2090.00|99|0.00|CPT 28200|
20|FH_F145528_76501_0|SrvcGrp|48385|2022|PDM|113.00|99|0.00|SPEECH THERAPY|
20|FH_F135431_33414_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135462_06795_0|SrvcGrp|471|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F91764_93710_0|SrvcGrp|9866|2022|PDM|5440.00|99|0.00|IP OBSERVATION SVCS|
20|FH_F91764_93710_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F135805_98225_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135836_60804_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F131407_07607_0|SrvcGrp|86852|2022|PDM|30.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F116404_20191_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127399_0_0|SrvcGrp|96539|2022|PDM|2913.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F140629_0_0|SrvcGrp|113675|2022|PDM|2497.00|99|0.00|LAPARO ABLATE LIVER TUMOR RF|
20|FH_F121763_07202_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F121823_46234_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F121823_46234_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F146125_0_0|SrvcGrp|104750|2022|PDM|2369.00|99|0.00|REPAIR BLADDER & VAGINA|
20|FH_F42347_0_0|SrvcGrp|29021|2022|PCT|1.00|99|0.00|DME AND SUPPLIES|
20|FH_F127926_62832_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111880_50003_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F34864_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|ASPG VIII|
20|FH_F131000_0_0|SrvcGrp|90795|2022|PDM|2787.00|99|0.00|EXCISION INFERIOR TURBINATE|
20|FH_F131000_0_0|SrvcGrp|16289|2022|PDM|1539.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F132328_0_0|SrvcGrp|38909|2022|PDM|3490.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)|
20|FH_F141035_0_0|SrvcGrp|76603|2022|PDM|3932.00|99|0.00|CPT 25111|
20|FH_F102228_08846_0|SrvcGrp|89149|2022|PDM|239.00|99|0.00|OP INTENSIVE|
20|FH_F132972_78589_0|SrvcGrp|86722|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F150781_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F132544_0_0|SrvcGrp|106146|2022|PDM|7850.00|99|0.00|REVERSE HIP JOINT|
20|FH_F119289_43040_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119289_43040_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148419_01453_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F54832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MS DRG UNGROUPABLE INPATIENT|
20|FH_F31093_0_0|SrvcGrp|10713|2022|PDM|2800.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F40659_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F31093_0_0|SrvcGrp|11010|2022|PDM|55.00|99|0.00|PT SVCS|
20|FH_F136751_0_0|SrvcGrp|41334|2022|PDM|20500.00|99|0.00|TOTAL KNEE|
20|FH_F132224_89119_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F66839_0_0|SrvcGrp|10503|2022|PDM|49.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F82572_0_0|SrvcGrp|80533|2022|PDM|70.00|99|0.00|SPEECH THERAPY|
20|FH_F127191_44720_0|SrvcGrp|73700|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F133473_21702_0|SrvcGrp|48385|2022|PDM|169.74|99|0.00|SPEECH THERAPY|
20|FH_F150001_33064_0|SrvcGrp|24761|2022|PDM|21.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F149840_80002_0|SrvcGrp|87396|2022|PDM|135.00|99|0.00|HCPCS G0155 (HCFA)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|43.31|99|0.00|HAPA WPA-NWPA 2012-13 ASC 247 W/O REV|
20|FH_F68622_0_0|SrvcGrp|8960|2022|PCT|0.80|99|0.00|SPEECH THERAPY|
20|FH_F128919_48075_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41355_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OP SVCS|
20|FH_F115315_43011_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F43411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CV SERVICES (MS DRG)|
20|FH_F118309_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F111482_33020_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|912.00|99|0.00|AEG 2 (NO REV)|
20|FH_F32192_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F119226_07746_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133647_32952_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72750_0_0|CSTM-ALL|CSTM-00|2020|PDM|1923.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F97061_85012_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F141872_20707_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F67861_0_0|SrvcGrp|46028|2022|PDM|95.00|99|0.00|URGENT CARE/PROMPT CARE CLINIC|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|96.87|99|0.00|AETNA SLEEP STUDIES|
20|FH_F98921_64503_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F41785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92531_0_0|SrvcGrp|67065|2022|PDM|11275.00|99|0.00|CERVICAL SURGERY|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD TC|
20|FH_F136407_0_0|SrvcGrp|36864|2022|PDM|16500.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F117368_68114_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F128678_68048_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118004_74133_0|SrvcGrp|104330|2022|PDM|1135.00|99|0.00|AETNA ACUTE REHAB II|
20|FH_F87592_85614_0|SrvcGrp|537|2022|PDM|1167.00|99|0.00|OBSERVATION SERVICES|
20|FH_F40851_0_0|SrvcGrp|38422|2022|PCT|0.50|99|0.00|INTERLUKEN II & DRUGS (OP))|
20|FH_F81494_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|2790.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F141772_80124_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43330_0_0|SrvcGrp|11080|2022|PDM|80.00|99|0.00|NURSING CARE|
20|FH_F34706_0_0|SrvcGrp|10329|2022|PDM|2259.00|99|0.00|DRG 541 ECMO W/ O.R. PROCEDURE|
20|FH_F58574_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO|
20|FH_F111809_93003_0|SrvcGrp|107142|2022|PDM|13400.00|99|0.00|ENDOVASCULAR GRAFT|
20|FH_F128144_45697_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F115383_80734_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F140690_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F119079_41018_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD RR"|
20|FH_F71926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149513_0_0|SrvcGrp|3327|2022|PDM|442.19|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F107400_0_0|SrvcGrp|48398|2022|PDM|139.00|99|0.00|PT SERVICES|
20|FH_F142043_45503_0|SrvcGrp|75419|2022|PDM|453.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128950_53538_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41461_0_0|SrvcGrp|97|2022|PDM|2800.00|99|0.00|C-SECTION|
20|FH_F125266_44515_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F92676_15063_0|SrvcGrp|79002|2022|PDM|1095.61|99|0.00|MON VALLEY ASC 217|
20|FH_F38770_0_0|SrvcGrp|63|2022|PDM|770.00|99|0.00|SUBACUTE CARE|
20|FH_F78682_0_0|SrvcGrp|75681|2022|PDM|3695.00|99|0.00|LAMINECTOMY/DISCECTOMY|
20|FH_F128312_45230_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F102681_34237_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F133018_84037_0|SrvcGrp|24750|2022|PDM|10.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F129688_74066_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F45392_0_0|SrvcGrp|9774|2022|PDM|1600.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F147988_78759_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F47433_0_0|SrvcGrp|537|2022|PDM|2850.00|99|0.00|OBSERVATION SERVICES|
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.37|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F144628_21146_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F39180_0_0|SrvcGrp|30625|2022|PCT|0.70|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F145854_37015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97566_79902_0|SrvcGrp|90854|2022|PDM|1636.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F148555_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F67861_0_0|SrvcGrp|3099|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F100682_97401_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F35262_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F36350_0_0|SrvcGrp|975|2022|PDM|4084.00|99|0.00|TUBILIZATION|
20|FH_F32751_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F103281_32086_0|SrvcGrp|82981|2022|PCT|0.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F102721_38118_0|SrvcGrp|73002|2022|PDM|1500.00|99|0.00|AEG 7|
20|FH_F40906_0_0|SrvcGrp|13597|2022|PDM|174.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F148881_33018_0|SrvcGrp|88857|2022|PDM|75.00|99|0.00|THERAPEUTIC ACTIVITIES|
20|FH_F38630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72750_0_0|SrvcGrp|26949|2022|PDM|650.00|99|0.00|EMERGENCY ROOM|
20|FH_F111401_29425_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133135_48235_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F115289_90057_0|SrvcGrp|86746|2022|PCT|1.15|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.57|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F88956_0_0|SrvcGrp|73602|2022|PDM|975.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F88956_0_0|SrvcGrp|75491|2022|PDM|3196.00|99|0.00|AEG 7|
20|FH_F150909_70032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43443_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|ACUTE PSYCH|
20|FH_F89932_10940_0|SrvcGrp|89274|2022|PDM|570.00|99|0.00|MINOR SURGERY|
20|FH_F123091_92627_0|SrvcGrp|104079|2022|PCT|1.50|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F124928_04210_0|SrvcGrp|90340|2022|PDM|132.30|99|0.00|SKILLED NURSING LPN|
20|FH_F131506_18901_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130933_47129_0|SrvcGrp|108484|2022|PDM|520.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F130756_04901_0|SrvcGrp|111928|2022|PCT|1.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F38843_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F121444_47720_0|SrvcGrp|107288|2022|PCT|1.00|99|0.00|INJ INTERFERON BETA|
20|FH_F121700_60938_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F121701_70420_0|SrvcGrp|46903|2022|PDM|800.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F130774_57401_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111383_62233_0|SrvcGrp|75505|2022|PCT|0.88|99|0.00|CARDIAC STUDIES|
20|FH_F134315_89106_0|SrvcGrp|22589|2022|PCT|1.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F33081_0_0|SrvcGrp|3029|2022|PDM|650.00|99|0.00|NEWBORN NURSERY|
20|FH_F101442_0_0|SrvcGrp|98459|2022|PDM|1847.10|99|0.00|RESECT FOOT TOE TUMOR|
20|FH_F72666_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F112187_98272_0|SrvcGrp|3259|2022|PDM|1339.00|99|0.00|ACUTE REHABILITATION|
20|FH_F96480_15224_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129240_10028_0|SrvcGrp|14893|2022|PDM|35.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F96960_35404_0|SrvcGrp|73603|2022|PDM|9293.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F102064_63565_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101320_26062_0|SrvcGrp|29076|2022|PDM|204.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F132090_60915_0|SrvcGrp|94565|2022|PDM|2250.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE|
20|FH_F148079_06512_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F151179_84074_0|SrvcGrp|114177|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F113866_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114968_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F112844_0_0|SrvcGrp|90707|2022|PDM|115.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F98041_10027_0|SrvcGrp|73659|2022|PDM|5904.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F91873_12723_0|SrvcGrp|79802|2022|PDM|700.00|99|0.00|AETNA CHEMOTHERAPY|
20|FH_F97761_04072_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F90173_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F115895_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|5027.00|99|0.00|AEG 7 (NO REV)|
20|FH_F100640_48097_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F104840_32565_0|SrvcGrp|75487|2022|PCT|0.69|99|0.00|AEG 5|
20|FH_F119581_0_0|SrvcGrp|107878|2022|PDM|2646.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F138929_0_0|SrvcGrp|35669|2022|PDM|4730.00|99|0.00|CPT 63650|
20|FH_F143457_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94786_07974_0|SrvcGrp|17015|2022|PDM|15.75|99|0.00|HOME INFUSION THERAPY|
20|FH_F94786_07974_0|SrvcGrp|94104|2022|PCT|1.05|99|0.00|DURABLE MEDICAL EQUIPMENT/SERVICES|
20|FH_F95341_08701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132627_0_0|SrvcGrp|17009|2022|PDM|84.66|99|0.00|HOME INFUSION THERAPY|
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 6 (NO REV)|
20|FH_F144828_0_0|SrvcGrp|114197|2022|PDM|1100.00|99|0.00|REPAIR NASAL SEPTAL FRACTURE|
20|FH_F141070_64093_0|SrvcGrp|27969|2022|PDM|26.00|99|0.00|HOME HEALTH AIDE|
20|FH_F72204_0_0|SrvcGrp|29463|2022|PDM|25.00|99|0.00|HOSPICE PAIN MANAGEMENT KIT|
20|FH_F114389_50131_0|SrvcGrp|14949|2022|PDM|215.85|99|0.00|HOME INFUSION|
20|FH_F49487_0_0|SrvcGrp|27601|2022|PCT|0.90|99|0.00|SYNAGIS (50 MG)|
20|FH_F77944_0_0|SrvcGrp|12126|2022|PDM|3593.00|99|0.00|OP PET SCAN|
20|FH_F83231_0_0|SrvcGrp|69044|2022|PDM|1800.00|99|0.00|SUB-ACUTE REHAB I|
20|FH_F88733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122194_66104_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F45372_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ACUTE PSYCH|
20|FH_F100000_45417_0|SrvcGrp|73485|2022|PDM|860.00|99|0.00|AETNA REHAB|
20|FH_F124212_33407_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F124613_64735_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F124624_31792_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124663_65608_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F134809_0_0|SrvcGrp|73485|2022|PDM|787.00|99|0.00|AETNA REHAB|
20|FH_F132439_0_0|SrvcGrp|92502|2022|PDM|693.10|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F136609_72601_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119725_0_0|SrvcGrp|106314|2022|PDM|597.36|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F42917_0_0|SrvcGrp|9500|2022|PDM|875.00|99|0.00|PSYCH INTENSIVE CARE UNIT|
20|FH_F43444_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F134691_33445_0|SrvcGrp|108484|2022|PDM|2047.50|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F136778_62034_0|SrvcGrp|109732|2022|PDM|242.00|99|0.00|COFINITY  GLOBAL FEE URGENT CARE CENTERS|
20|FH_F136783_40069_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136807_43220_0|SrvcGrp|46605|2022|PDM|83.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F112248_53223_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F65979_0_0|SrvcGrp|61556|2022|PDM|2660.00|99|0.00|MUSCULOSKELETAL SURGERY|
20|FH_F116343_33701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116393_07002_0|SrvcGrp|11258|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F147380_78520_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147380_78520_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147725_06002_0|SrvcGrp|98470|2022|PDM|9800.00|99|0.00|AMPUTATION TOE|
20|FH_F41540_0_0|SrvcGrp|33828|2022|PDM|1480.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 6|
20|FH_F139172_40207_0|SrvcGrp|46903|2022|PDM|608.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F112152_34994_0|SrvcGrp|73842|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F87557_33309_0|SrvcGrp|24752|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F102862_30606_0|SrvcGrp|20968|2022|PDM|20516.00|99|0.00|MS DRG 480 ONLY|
20|FH_F103004_75840_0|SrvcGrp|73483|2022|PDM|608.00|99|0.00|AETNA SUBACUTE III|
20|FH_F103004_75840_0|SrvcGrp|97968|2022|PDM|579.00|99|0.00|CT SCAN|
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_F148665_65270_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_F122688_19904_0|SrvcGrp|76501|2022|PDM|440.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F86872_15215_0|SrvcGrp|17013|2022|PDM|55.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F55212_0_0|SrvcGrp|27252|2022|PDM|108.00|99|0.00|INDIVIDUAL PSYCHOTHERAPY|
20|FH_F55212_0_0|SrvcGrp|51064|2022|PDM|173.00|99|0.00|SUBSEQUENT HOSPITAL CARE|
20|FH_F118555_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F74602_0_0|CSTM-ALL|CSTM-00|2020|PDM|2755.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F90136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F34240_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40191_0_0|SrvcGrp|11258|2022|PCT|0.46|99|0.00|DRUGS|
20|FH_F46832_0_0|SrvcGrp|40824|2022|PDM|50.00|99|0.00|DELIVERY/SERVICE (HIGH RISK)|
20|FH_F123735_32708_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F123752_44502_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F123783_03860_0|SrvcGrp|43569|2022|PDM|157.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F136474_95742_0|SrvcGrp|108484|2022|PDM|725.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F134011_84102_0|SrvcGrp|87799|2022|PDM|112.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F137047_73120_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137147_75006_0|SrvcGrp|113042|2022|PDM|1050.00|99|0.00|CAT SCAN|
20|FH_F137147_75006_0|CSTM-ALL|CSTM-00|2020|PDM|7272.00|99|0.00|AEG 8 (NO REV)|
20|FH_F137147_75006_0|CSTM-ALL|CSTM-00|2020|PDM|6300.00|99|0.00|AEG 10 (NO REV)|
20|FH_F142267_78240_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F142742_44112_0|SrvcGrp|87317|2022|PDM|1000.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F53732_0_0|SrvcGrp|50142|2022|PDM|54.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 24 HRS|
20|FH_F66765_0_0|SrvcGrp|44392|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F140343_89052_0|SrvcGrp|24761|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F140616_43338_0|SrvcGrp|111928|2022|PCT|1.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F140647_66210_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F140733_45005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F80284_16354_0|SrvcGrp|16429|2022|PDM|54.00|99|0.00|OBSERVATION SVCS|
20|FH_F122067_0_0|SrvcGrp|85966|2022|PDM|1540.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F140209_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149640_50022_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149663_45219_0|SrvcGrp|27261|2022|PDM|9876.00|99|0.00|CPT 27446|
20|FH_F151603_27609_0|SrvcGrp|67065|2022|PDM|18207.00|99|0.00|CERVICAL SURGERY|
20|FH_F118955_48239_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F109883_35007_0|SrvcGrp|87317|2022|PDM|637.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F67239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76144_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147725_06002_0|SrvcGrp|107184|2022|PDM|2525.00|99|0.00|REVISE MIDDLE EAR BONE|
20|FH_F147927_19083_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F147779_34240_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F117108_37841_0|SrvcGrp|80246|2022|PCT|0.00|99|0.00|AETNA NURSERY|
20|FH_F117126_12801_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|663.00|99|0.00|AEG 10 (NO REV)|
20|FH_F90791_79106_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130676_0_0|SrvcGrp|87536|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|728.83|99|0.00|ASPG V|
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F109513_0_0|SrvcGrp|86462|2022|PDM|1500.00|99|0.00|AREOLA RECONSTRUCTION|
20|FH_F131379_0_0|SrvcGrp|107749|2022|PDM|161.00|99|0.00|CAPD/CCPD|
20|FH_F131379_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95880_02726_0|SrvcGrp|90485|2022|PDM|29.53|99|0.00|COGNITIVE SKILLS DEVELOPMENT|
20|FH_F148554_85016_0|SrvcGrp|86303|2022|PDM|2040.00|99|0.00|PTCA W/O STENT|
20|FH_F125212_76301_0|SrvcGrp|3178|2022|PDM|694.00|99|0.00|ACUTE PSYCH|
20|FH_F35176_0_0|SrvcGrp|26001|2022|PDM|94.50|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F130108_0_0|SrvcGrp|48950|2022|PCT|0.60|99|0.00|RADIOLOGY (WITHOUT MRI AND CT SCANS)|
20|FH_F89932_10940_0|SrvcGrp|13129|2022|PDM|1135.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F128615_78520_0|SrvcGrp|106048|2022|PDM|700.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F78682_0_0|CSTM-ALL|CSTM-00|2020|PDM|2284.22|99|0.00|ASPG IX|
20|FH_F89932_10940_0|SrvcGrp|89344|2022|PDM|1820.00|99|0.00|HYPERBARIC OXYGEN|
20|FH_F38016_0_0|SrvcGrp|23635|2022|PDM|3245.00|99|0.00|CV SURGERY (MS DRG ONLY)|
20|FH_F117087_0_0|SrvcGrp|107165|2022|PDM|2494.00|99|0.00|EAR CARTILAGE GRAFT|
20|FH_F128312_45230_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141648_60050_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133021_00910_0|SrvcGrp|112283|2022|PDM|1000.00|99|0.00|STENT IMPLANT|
20|FH_F42343_0_0|CSTM-ALL|CSTM-00|2020|PDM|517.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39082_0_0|SrvcGrp|361|2022|PDM|2452.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F130553_18640_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|257.00|99|0.00|HAPA EPA ASC 33|
20|FH_F139430_63017_0|SrvcGrp|29347|2022|PDM|26.52|99|0.00|HOME HEALTH AIDE|
20|FH_F150820_83843_0|SrvcGrp|82114|2022|PDM|2000.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F150882_84041_0|SrvcGrp|86852|2022|PDM|47.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F38986_0_0|SrvcGrp|12846|2022|PCT|0.60|99|0.00|PHARMACY SVCS|
20|FH_F128029_48154_0|SrvcGrp|33722|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F34853_0_0|SrvcGrp|11259|2022|PCT|0.80|99|0.00|DRUGS|
20|FH_F111260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112045_90301_0|SrvcGrp|78818|2022|PDM|8379.00|99|0.00|LITHOTRIPSY ESWL|
20|FH_F86717_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F40647_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37764_0_0|SrvcGrp|26732|2022|PDM|950.00|99|0.00|CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE|
20|FH_F132818_24701_0|SrvcGrp|80260|2022|PDM|1078.00|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|460.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F37198_0_0|SrvcGrp|36991|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F132732_0_0|SrvcGrp|112077|2022|PDM|59209.00|99|0.00|CV SURGERY|
20|FH_F98820_81401_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F36403_0_0|SrvcGrp|22116|2022|PDM|575.00|99|0.00|R&B OTHER|
20|FH_F117762_0_0|SrvcGrp|88491|2022|PDM|4992.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F124380_83406_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130578_43950_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97223_94028_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101861_19567_0|SrvcGrp|38007|2022|PDM|400.00|99|0.00|CPT CODE 59425|
20|FH_F33632_52349_0|SrvcGrp|74584|2022|PCT|0.88|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F89851_83854_0|SrvcGrp|3066|2022|PCT|1.35|99|0.00|HIGH-COST DRUGS|
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.50|99|0.00|AEG 2 (NO REV)|
20|FH_F36590_0_0|SrvcGrp|701|2022|PDM|1926.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F131558_63028_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|139.00|99|0.00|HAPA EPA ASC 21|
20|FH_F134397_27513_0|SrvcGrp|73841|2022|PDM|467.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F128366_32901_0|SrvcGrp|89149|2022|PDM|186.00|99|0.00|OP INTENSIVE|
20|FH_F149662_85015_0|SrvcGrp|115734|2022|PDM|6034.00|99|0.00|SPINAL CORD RELEASE/SPINAL VESSEL REVISION|
20|FH_F115982_0_0|SrvcGrp|89989|2022|PDM|2250.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F139877_32615_0|SrvcGrp|113243|2022|PDM|42.28|99|0.00|COVID-19 SVNT SARSCOV2 ELISA PLSM SRM (HCFA)|
20|FH_F40899_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F32825_0_0|SrvcGrp|268|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER|
20|FH_F97620_75904_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37304_0_0|SrvcGrp|12032|2022|PDM|2941.00|99|0.00|TRANSURETHRAL MICROWAVE THERAPY|
20|FH_F137798_0_0|SrvcGrp|80920|2022|PDM|567.00|99|0.00|HOSPICE SERVICES|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|10700.00|99|0.00|MS DRG 619-621 GASTROPLASTY PROCEDURE OBESITY|
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 3 (NO REV)|
20|FH_F140215_93301_0|SrvcGrp|41563|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F36343_0_0|SrvcGrp|3810|2022|PDM|115.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F122425_75082_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F141228_23181_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149023_44122_0|SrvcGrp|115573|2022|PDM|2470.00|99|0.00|LAMINOTOMY/SPINE SURGERY|
20|FH_F112794_01040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143668_0_0|SrvcGrp|114071|2022|PDM|225.00|99|0.00|PNEUMATIC COMPRESSION DEVICE (MOD RR)|
20|FH_F147213_48609_0|SrvcGrp|110537|2022|PDM|392.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F134869_08854_0|SrvcGrp|58705|2022|PDM|180.00|99|0.00|EVALUATION & MANAGEMENT NEW PATIENT (HCFA)|
20|FH_F136376_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F151029_52241_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE 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_F137767_01841_0|SrvcGrp|81779|2022|PCT|2.25|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F146859_0_0|SrvcGrp|114844|2022|PDM|1394.00|99|0.00|FINGER FRACTURE REPAIR|
20|FH_F94621_07728_0|SrvcGrp|472|2022|PDM|401.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117581_21211_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F37385_0_0|SrvcGrp|15392|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY|
20|FH_F117711_73080_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124467_27529_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F140170_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143451_50635_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F84774_0_0|SrvcGrp|16526|2022|PDM|169.05|99|0.00|DIALYSIS|
20|FH_F101709_0_0|SrvcGrp|11673|2022|PDM|3104.00|99|0.00|CPT 29888|
20|FH_F101709_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131107_43140_0|SrvcGrp|93098|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F151746_20032_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F49329_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F116579_45822_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116835_94538_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F119992_67062_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120974_27607_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F113649_01752_0|SrvcGrp|26869|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F118845_71111_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118874_29926_0|SrvcGrp|93919|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139394_07424_0|SrvcGrp|113273|2022|PCT|0.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F150768_03054_0|SrvcGrp|104230|2022|PDM|212.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F150861_92592_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F149516_65233_0|SrvcGrp|108484|2022|PDM|483.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F98360_11554_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F116753_0_0|SrvcGrp|42724|2022|PDM|299.00|99|0.00|SLEEP STUDY|
20|FH_F129256_89146_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1571.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F40653_0_0|SrvcGrp|38|2022|PDM|4020.00|99|0.00|NORMAL DELIVERY|
20|FH_F131385_76457_0|SrvcGrp|46903|2022|PDM|585.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|538.00|99|0.00|COVENTRY ENHANCED GROUPER 1 MOD 50|
20|FH_F140140_07722_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148964_30101_0|SrvcGrp|89023|2022|PDM|70.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F132254_40207_0|SrvcGrp|86828|2022|PDM|110.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F84433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F141021_0_0|SrvcGrp|105819|2022|PDM|1270.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F137769_85234_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F145599_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F98001_27603_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F150982_0_0|SrvcGrp|89988|2022|PDM|1976.00|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F127467_44202_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F92454_0_0|SrvcGrp|14614|2022|PDM|5000.00|99|0.00|LITHOTRIPSY|
20|FH_F108680_0_0|SrvcGrp|67066|2022|PDM|8800.00|99|0.00|CERVICAL SURGERY|
20|FH_F132254_40207_0|SrvcGrp|86838|2022|PDM|25.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F41160_0_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110783_93013_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115483_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|AEG 5  (NO REV)|
20|FH_F35779_32514_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F98623_97006_0|SrvcGrp|73559|2022|PDM|21751.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F130044_0_0|SrvcGrp|111412|2022|PDM|185.00|99|0.00|OB SERVICES|
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 10 (NO REV)|
20|FH_F108460_32746_0|SrvcGrp|91437|2022|PCT|0.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F98840_31021_0|SrvcGrp|73485|2022|PDM|3234.00|99|0.00|AETNA REHAB|
20|FH_F149030_37919_0|SrvcGrp|83839|2022|PDM|5150.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F90055_33805_0|SrvcGrp|472|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148882_20814_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F147360_06415_0|SrvcGrp|111926|2022|PCT|1.00|99|0.00|COVID-19 LAB TESTING|
20|FH_F131284_76502_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151022_17016_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124441_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F34777_0_0|SrvcGrp|14373|2022|PDM|4052.00|99|0.00|LITHOTRIPSY SVCS|
20|FH_F97183_25304_0|SrvcGrp|73659|2022|PDM|11966.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F134869_08854_0|SrvcGrp|73841|2022|PDM|477.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F34853_0_0|SrvcGrp|12047|2022|PCT|2.00|99|0.00|CPT CODES 80000-89999, 36415 (LAB)|
20|FH_F125214_12428_0|SrvcGrp|112734|2022|PCT|0.00|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.49|99|0.00|AEG 1 (NO REV)|
20|FH_F35804_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150950_17522_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137797_70123_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137731_92262_0|SrvcGrp|114008|2022|PDM|510.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F114206_37203_0|SrvcGrp|86850|2022|PDM|35.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F131449_19073_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F31547_0_0|SrvcGrp|9830|2022|PDM|90.29|99|0.00|OT SVCS|
20|FH_F102525_73134_0|SrvcGrp|75442|2022|PDM|1050.00|99|0.00|OBSERVATION - REV 762|
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|792.00|99|0.00|AEG 4 (NO REV)|
20|FH_F132160_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
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_F86714_0_0|SrvcGrp|87714|2022|PDM|269.10|99|0.00|RN INFUSION W/ SPECIALTY SKN|
20|FH_F76285_0_0|SrvcGrp|73521|2022|PDM|48.00|99|0.00|RESPIRATORY THERAPY HOURLY|
20|FH_F120332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F97881_38703_0|SrvcGrp|73603|2022|PDM|7969.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F150440_35077_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134732_0_0|SrvcGrp|109135|2022|PDM|2248.00|99|0.00|AV FISTULA EXCISION|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|10794.00|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F119376_0_0|SrvcGrp|73004|2022|PDM|1168.00|99|0.00|AEG 8|
20|FH_F150459_08021_0|SrvcGrp|95661|2022|PDM|133.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F149522_83221_0|SrvcGrp|104230|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F128715_71201_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120848_20912_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F128753_32501_0|SrvcGrp|75487|2022|PCT|0.64|99|0.00|AEG 5|
20|FH_F99420_91326_0|SrvcGrp|62398|2022|PCT|2.00|99|0.00|OP LAB DRAW|
20|FH_F128198_34208_0|SrvcGrp|46903|2022|PDM|635.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F143249_89801_0|SrvcGrp|24761|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F143347_16001_0|SrvcGrp|74444|2022|PCT|2.00|99|0.00|CARDIAC TESTING|
20|FH_F143536_47546_0|SrvcGrp|100242|2022|PCT|0.00|99|0.00|ANTIBODY|
20|FH_F143536_47546_0|SrvcGrp|91631|2022|PCT|1.00|99|0.00|OFFICE VISIT|
20|FH_F90559_0_0|SrvcGrp|72992|2022|PDM|671.00|99|0.00|AEG 2|
20|FH_F101700_0_0|SrvcGrp|53065|2022|PDM|362.31|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F101752_0_0|SrvcGrp|90356|2022|PCT|0.90|99|0.00|OP DIALYSIS|
20|FH_F131090_44622_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F82375_28601_0|SrvcGrp|48394|2022|PDM|82.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F47600_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
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|635.00|99|0.00|GA RETINA SURG CTR ASC 14|
20|FH_F132534_18407_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116633_37217_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F116835_94538_0|SrvcGrp|107156|2022|PDM|1843.00|99|0.00|AETNA IP PSYCHIATRIC (6-11 YRS)|
20|FH_F116835_94538_0|SrvcGrp|109216|2022|PDM|126.00|99|0.00|PSYCH TEST EVALUATION EACH ADD'L HOUR|
20|FH_F119918_38201_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120871_14068_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F120866_51652_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120887_78750_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F68976_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120973_34653_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F115669_07652_0|SrvcGrp|98748|2022|PDM|420.00|99|0.00|AETNA PARTIAL HOSP PSYCH (UB)|
20|FH_F52854_0_0|SrvcGrp|16|2022|PDM|1827.00|99|0.00|ACUTE REHABILITATION|
20|FH_F33642_0_0|SrvcGrp|13715|2022|PCT|0.60|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F34546_0_0|SrvcGrp|11108|2022|PDM|200.00|99|0.00|NEWBORN NURSERY|
20|FH_F110925_01104_0|SrvcGrp|63445|2022|PDM|84.00|99|0.00|RHGAM FULL DOSE|
20|FH_F47130_0_0|SrvcGrp|8|2022|PDM|2270.00|99|0.00|BURN INTENSIVE CARE|
20|FH_F139515_0_0|SrvcGrp|27346|2022|PDM|1850.00|99|0.00|REPAIR BLADDER DEFECT|
20|FH_F82695_15014_0|SrvcGrp|75545|2022|PDM|347.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F93791_0_0|SrvcGrp|93431|2022|PDM|4200.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE NO MOD|
20|FH_F55054_0_0|SrvcGrp|16|2022|PDM|1170.00|99|0.00|ACUTE REHABILITATION|
20|FH_F55532_0_0|SrvcGrp|9861|2022|PDM|825.00|99|0.00|ACUTE REHABILITATION|
20|FH_F102184_0_0|SrvcGrp|11669|2022|PDM|2887.00|99|0.00|OP SURG|
20|FH_F45632_0_0|SrvcGrp|22954|2022|PDM|155.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F131577_89148_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F145544_93536_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F40454_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43663_0_0|CSTM-ALL|CSTM-00|2020|PDM|729.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150460_48334_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F79904_0_0|SrvcGrp|3809|2022|PDM|531.25|99|0.00|HOSPICE CARE|
20|FH_F86332_75081_0|SrvcGrp|65621|2022|PDM|85.00|99|0.00|RN NURSING|
20|FH_F129404_33461_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117082_66216_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F76303_0_0|SrvcGrp|48428|2022|PDM|125.00|99|0.00|RESPIRATORY THERAPY INITIAL|
20|FH_F115985_0_0|SrvcGrp|78403|2022|PDM|0.10|99|0.00|AETNA MED RECORD|
20|FH_F32509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F38982_0_0|SrvcGrp|115|2022|PDM|566.00|99|0.00|SKILLED NURSING CARE|
20|FH_F130681_15701_0|SrvcGrp|82981|2022|PDM|250.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|1733.00|99|0.00|AEG 8 (NO REV)|
20|FH_F70984_0_0|SrvcGrp|67999|2022|PDM|3250.00|99|0.00|CPT 58570 58573|
20|FH_F129182_24171_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117078_01420_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121090_07848_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F44582_0_0|SrvcGrp|12258|2022|PCT|0.70|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F141390_19007_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39866_0_0|SrvcGrp|701|2022|PDM|1800.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 691-692 URINARY STONES|
20|FH_F47963_0_0|SrvcGrp|11796|2022|PDM|71.50|99|0.00|DIETICIAN|
20|FH_F70984_0_0|SrvcGrp|33977|2022|PDM|1400.00|99|0.00|CPT 59820|
20|FH_F123957_84321_0|SrvcGrp|89337|2022|PDM|872.00|99|0.00|DETOXIFICATION|
20|FH_F100662_27534_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F35599_0_0|SrvcGrp|20846|2022|PDM|925.00|99|0.00|ABORTION 16-24.5 WEEKS|
20|FH_F83451_0_0|SrvcGrp|107695|2022|PDM|1575.00|99|0.00|LAPAROSCOPY SERVICES|
20|FH_F137347_26003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F38417_0_0|SrvcGrp|29063|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F93920_0_0|SrvcGrp|86582|2022|PDM|6500.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F55794_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115763_16433_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC|
20|FH_F149919_85390_0|SrvcGrp|98701|2022|PDM|412.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F34413_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG X|
20|FH_F128973_44256_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F141588_60062_0|SrvcGrp|86722|2022|PDM|377.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F35599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40332_0_0|SrvcGrp|12299|2022|PCT|0.65|99|0.00|PROSTHETICS/IMPLANTS/DEVICES|
20|FH_F128982_44221_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|2355.00|99|0.00|AEG 10 (NO REV)|
20|FH_F120362_23321_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F84611_30281_0|SrvcGrp|82634|2022|PDM|7538.00|99|0.00|REPAIR OF KNEE LIGAMENTS|
20|FH_F36372_0_0|SrvcGrp|10577|2022|PDM|28.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F39272_0_0|SrvcGrp|28847|2022|PDM|65.00|99|0.00|PHYSICAL THERAPY|
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1530.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132544_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F119351_95377_0|SrvcGrp|705|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F119449_84032_0|SrvcGrp|74668|2022|PDM|325.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148432_01585_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F148501_21550_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F148554_85016_0|SrvcGrp|115438|2022|PDM|2408.00|99|0.00|INSERTION OF HEART ELECTRODE|
20|FH_F148554_85016_0|SrvcGrp|108169|2022|PDM|2255.00|99|0.00|ILIAC REVASC|
20|FH_F149781_37404_0|SrvcGrp|100043|2022|PDM|8200.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F111423_34952_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|HAPA EPA ASC 43|
20|FH_F141753_63334_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133287_40215_0|SrvcGrp|112251|2022|PDM|493.00|99|0.00|HOLTER MONITOR|
20|FH_F133367_40065_0|SrvcGrp|10944|2022|PDM|405.00|99|0.00|EMERGENCY ROOM|
20|FH_F126560_43606_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F136393_0_0|SrvcGrp|109500|2022|PDM|2000.00|99|0.00|REPAIR LEAD PACE-DEFIB ONE|
20|FH_F111789_25301_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE|
20|FH_F109526_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37568_0_0|SrvcGrp|26035|2022|PDM|25.00|99|0.00|HOME HEALTH THERAPY VISITS|
20|FH_F111526_32226_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F123545_44512_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F133371_63077_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101802_17201_0|SrvcGrp|48385|2022|PDM|134.00|99|0.00|SPEECH THERAPY|
20|FH_F101802_17201_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F124608_0_0|SrvcGrp|88065|2022|PDM|7956.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F81494_0_0|SrvcGrp|16618|2022|PDM|136.00|99|0.00|ST SVCS|
20|FH_F69122_0_0|SrvcGrp|32555|2022|PDM|512.50|99|0.00|IV HYDRATION FOR HYPEREMESIS|
20|FH_F149840_80002_0|SrvcGrp|89783|2022|PDM|144.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F39716_0_0|SrvcGrp|39582|2022|PCT|1.00|99|0.00|IMPLANTS/ PROSTHETICS|
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|ASPG V|
20|FH_F65899_0_0|SrvcGrp|16|2022|PDM|1238.00|99|0.00|ACUTE REHABILITATION|
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|3204.00|99|0.00|AEG 6 (NO REV)|
20|FH_F91155_16105_0|SrvcGrp|73605|2022|PDM|724.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F31381_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91198_46714_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F107180_80723_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F52293_0_0|SrvcGrp|33018|2022|PDM|400.00|99|0.00|DIALYSIS|
20|FH_F148019_54311_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126735_38018_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F102721_38118_0|SrvcGrp|75505|2022|PCT|0.40|99|0.00|CARDIAC STUDIES|
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_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|ASPG II|
20|FH_F101104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71268_0_0|SrvcGrp|3178|2022|PDM|1773.00|99|0.00|ACUTE PSYCH|
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.81|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F119095_08536_0|SrvcGrp|705|2022|PCT|0.30|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F45977_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 949|
20|FH_F67861_0_0|SrvcGrp|9774|2022|PDM|3300.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F127432_18015_0|SrvcGrp|109057|2022|PCT|0.38|99|0.00|CARDIAC STUDIES|
20|FH_F125013_85251_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149867_62901_0|CSTM-ALL|CSTM-00|2020|PCT|1.27|99|0.00|HSS ASC|
20|FH_F143053_89501_0|SrvcGrp|114008|2022|PDM|670.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F32779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F39558_0_0|SrvcGrp|17071|2022|PDM|736.00|99|0.00|ASPG IV|
20|FH_F45436_0_0|SrvcGrp|12856|2022|PDM|70.00|99|0.00|NURSING CARE|
20|FH_F31928_0_0|SrvcGrp|12918|2022|PDM|790.00|99|0.00|GYNECOLOGICAL MED/SURG|
20|FH_F143171_18411_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F39859_0_0|SrvcGrp|37087|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F133516_44004_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F136751_0_0|SrvcGrp|88164|2022|PDM|16000.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F88512_0_0|SrvcGrp|17079|2022|PDM|4148.43|99|0.00|ASPG VIII|
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|2343.00|99|0.00|ASPG VII|
20|FH_F141870_85224_0|SrvcGrp|86825|2022|PDM|60.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F150001_33064_0|SrvcGrp|14949|2022|PDM|11.00|99|0.00|HOME INFUSION|
20|FH_F151747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|885.00|99|0.00|AEG 5  (NO REV)|
20|FH_F127412_15301_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|IMPLANTS|
20|FH_F39627_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F63618_0_0|CSTM-ALL|CSTM-00|2020|PDM|27000.00|99|0.00|ORTHOPEDIC SURGERY|
20|FH_F69063_0_0|SrvcGrp|36068|2022|PDM|55.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F117728_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145960_33414_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F108700_63857_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F98801_93274_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F141527_36830_0|SrvcGrp|16750|2022|PDM|53.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F140762_0_0|SrvcGrp|113694|2022|PDM|785.51|99|0.00|SURGERY OF EYE|
20|FH_F117078_01420_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121488_77478_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F120338_83226_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F110102_0_0|SrvcGrp|104195|2022|PDM|150.00|99|0.00|HOSPICE SNF|
20|FH_F110102_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.00|99|0.00|HCFA HOSPICE HOME CARE|
20|FH_F52854_0_0|SrvcGrp|16891|2022|PDM|3787.00|99|0.00|DIAGNOSTIC CARDIAC CATHETERIZATION|
20|FH_F80245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147941_06023_0|SrvcGrp|46586|2022|PDM|531.00|99|0.00|CPT 99205|
20|FH_F78709_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|JEFFERSON OP SURGERY|
20|FH_F52854_0_0|CSTM-ALL|CSTM-00|2020|PDM|6076.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F141587_40242_0|SrvcGrp|108484|2022|PDM|596.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F120906_65542_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F135779_0_0|SrvcGrp|89149|2022|PDM|217.00|99|0.00|OP INTENSIVE|
20|FH_F110263_0_0|SrvcGrp|86233|2022|PDM|12703.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F116188_72211_0|SrvcGrp|86722|2022|PDM|207.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F148486_03110_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137366_87505_0|SrvcGrp|87077|2022|PDM|160.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F86872_15215_0|SrvcGrp|86834|2022|PDM|15.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F43450_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F55212_0_0|SrvcGrp|3397|2022|PDM|43.00|99|0.00|CPT 90849|
20|FH_F38411_0_0|SrvcGrp|21354|2022|PCT|0.80|99|0.00|MS DRG 250-251 ONLY|
20|FH_F130656_04401_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC) (HCFA)|
20|FH_F130755_04401_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F98002_27103_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAMPTON ROADS GAST MOD KN|
20|FH_F121603_46761_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F85415_27612_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|489.51|99|0.00|HAPA WPA-NWPA 2012-13 ASC 109 W/O REV|
20|FH_F119379_0_0|SrvcGrp|107831|2022|PDM|1428.00|99|0.00|REPAIR WRIST FRACTURE|
20|FH_F145641_06902_0|SrvcGrp|67066|2022|PDM|11452.00|99|0.00|CERVICAL SURGERY|
20|FH_F125173_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F81698_10457_0|SrvcGrp|65621|2022|PDM|26.25|99|0.00|RN NURSING|
20|FH_F134613_08852_0|SrvcGrp|111348|2022|PCT|1.10|99|0.00|OP THERAPY SERVICES|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|380.65|99|0.00|HAPA WPA-NWPA 2012-13 ASC 119 W/O REV|
20|FH_F80172_0_0|SrvcGrp|65621|2022|PDM|77.17|99|0.00|RN NURSING|
20|FH_F150140_28714_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145642_15108_0|SrvcGrp|86851|2022|PDM|30.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F121303_15501_0|SrvcGrp|113174|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - PFIZER|
20|FH_F134328_13088_0|SrvcGrp|76501|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F143711_78405_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141874_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110580_71106_0|SrvcGrp|16468|2022|PDM|960.00|99|0.00|LASER PROCEDURES|
20|FH_F121476_0_0|SrvcGrp|103865|2022|PDM|1848.00|99|0.00|PT PRGRM FOR IMPLT NEUROSTIM|
20|FH_F109630_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|523.36|99|0.00|HAPA WPA-NWPA 2012-13 ASC 218 W/O REV|
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|1413.00|99|0.00|AEG 9 (NO REV)|
20|FH_F90416_73013_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F116753_0_0|SrvcGrp|106787|2022|PDM|7465.00|99|0.00|LAPAROSCOPY|
20|FH_F116753_0_0|SrvcGrp|103913|2022|PCT|0.63|99|0.00|OP DIALYSIS|
20|FH_F36753_0_0|SrvcGrp|23966|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F116657_0_0|SrvcGrp|474|2022|PDM|295.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F133943_01606_0|SrvcGrp|109703|2022|PCT|1.00|99|0.00|LEUPROLID ACET PER 1MG/20 MX|
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112649_63764_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125328_0_0|SrvcGrp|73004|2022|PDM|950.00|99|0.00|AEG 8|
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135670_01749_0|SrvcGrp|86847|2022|PDM|42.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F126354_91321_0|SrvcGrp|75419|2022|PDM|600.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F130017_02302_0|SrvcGrp|91177|2022|PDM|1720.39|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F121601_47446_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F79863_0_0|SrvcGrp|43571|2022|PDM|90.00|99|0.00|MID-LINE INSERTION|
20|FH_F120930_0_0|SrvcGrp|95462|2022|PDM|2500.00|99|0.00|REPAIR OF ANKLE LIGAMENT|
20|FH_F136359_0_0|SrvcGrp|35669|2022|PDM|8000.00|99|0.00|CPT 63650|
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|2744.00|99|0.00|AEG 5  (NO REV)|
20|FH_F51121_0_0|SrvcGrp|26001|2022|PDM|152.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F114527_39047_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F125328_0_0|SrvcGrp|79589|2022|PDM|1923.00|99|0.00|UPPER GI|
20|FH_F100782_0_0|SrvcGrp|69923|2022|PDM|4429.00|99|0.00|PTCA W/ STENT|
20|FH_F121650_60153_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F134607_80222_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F111986_0_0|SrvcGrp|73008|2022|PDM|1133.00|99|0.00|AEG 10|
20|FH_F139678_25601_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|1098.52|99|0.00|ASPG VI|
20|FH_F124369_0_0|SrvcGrp|34605|2022|PDM|9350.00|99|0.00|CPT 28299|
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|2141.40|99|0.00|AEG 5  (NO REV)|
20|FH_F149259_64050_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F59872_0_0|SrvcGrp|31377|2022|PDM|1025.00|99|0.00|EMERGENCY ROOM LEVEL V|
20|FH_F111986_0_0|SrvcGrp|64517|2022|PDM|2472.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F117300_0_0|SrvcGrp|88157|2022|PDM|7360.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1109.03|99|0.00|HAPA WPA-NWPA 2012-13 ASC 5 W/O REV|
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 10 (NO REV)|
20|FH_F148186_0_0|SrvcGrp|106294|2022|PDM|300.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F133207_0_0|SrvcGrp|78093|2022|PDM|3809.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F83978_66739_0|SrvcGrp|2738|2022|PCT|0.42|99|0.00|IMPLANTS|
20|FH_F134988_61834_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150239_75569_0|SrvcGrp|29075|2022|PCT|1.00|99|0.00|HYDRATION THERAPY|
20|FH_F144291_0_0|SrvcGrp|111468|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F146586_71602_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143560_03079_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138447_22041_0|SrvcGrp|73700|2022|PDM|55.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.55|99|0.00|ASPG V|
20|FH_F79743_0_0|SrvcGrp|105690|2022|PCT|0.57|99|0.00|LABORATORY SERVICES|
20|FH_F54592_0_0|SrvcGrp|24752|2022|PDM|19.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F134494_33612_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F122459_15221_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F71042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71964_0_0|SrvcGrp|68863|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY|
20|FH_F102200_06416_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F105145_75075_0|SrvcGrp|12849|2022|PCT|1.15|99|0.00|PHARMACY SVCS|
20|FH_F115890_75067_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F73967_0_0|SrvcGrp|22954|2022|PDM|147.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F63124_0_0|SrvcGrp|46248|2022|PDM|135.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F115979_46107_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F131904_18915_0|SrvcGrp|48398|2022|PDM|123.00|99|0.00|PT SERVICES|
20|FH_F133126_48059_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132088_34981_0|SrvcGrp|90854|2022|PDM|739.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F133402_10007_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111666_06517_0|SrvcGrp|46903|2022|PDM|515.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F90136_0_0|SrvcGrp|33722|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F88639_80204_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F42896_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.40|99|0.00|OP SVCS|
20|FH_F123848_03257_0|SrvcGrp|23683|2022|PDM|80.11|99|0.00|SKILLED NURSING RN|
20|FH_F132810_0_0|SrvcGrp|65621|2022|PDM|55.00|99|0.00|RN NURSING|
20|FH_F69968_0_0|SrvcGrp|67265|2022|PDM|15193.82|99|0.00|RECHANNELING OF ARTERY|
20|FH_F136478_75605_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134126_11554_0|SrvcGrp|106303|2022|PDM|770.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F137147_75006_0|SrvcGrp|31916|2022|PDM|30924.00|99|0.00|MS DRG 473 ONLY|
20|FH_F137227_64133_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137231_25550_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F137242_52722_0|SrvcGrp|12659|2022|PDM|927.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F122009_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F51276_0_0|SrvcGrp|24934|2022|PDM|75.00|99|0.00|NUTRITIONAL ASSESSMENT (INITIAL)|
20|FH_F97600_46151_0|SrvcGrp|73601|2022|PDM|14750.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F138627_82901_0|SrvcGrp|99037|2022|PDM|115.00|99|0.00|ANTIBIOTIC Q6H (HCFA)|
20|FH_F77782_66061_0|SrvcGrp|37389|2022|PCT|0.80|99|0.00|MS DRG 286-287 ONLY CARDIAC CATH|
20|FH_F140367_70510_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F140837_34947_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137530_0_0|SrvcGrp|107878|2022|PDM|4847.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F151608_30236_0|SrvcGrp|84307|2022|PDM|5996.00|99|0.00|TENDON REPAIR|
20|FH_F118955_48239_0|SrvcGrp|93919|2022|PDM|400.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F118914_43015_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F118943_64506_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109883_35007_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F109930_73109_0|SrvcGrp|75545|2022|PDM|433.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F117267_07728_0|SrvcGrp|75506|2022|PCT|5.32|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F129483_77030_0|SrvcGrp|86835|2022|PDM|25.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F36861_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40213_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117218_32025_0|SrvcGrp|46903|2022|PDM|599.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F109652_0_0|SrvcGrp|78787|2022|PDM|6393.00|99|0.00|LAPAROSCOPY/HYSTEROSCOPY|
20|FH_F110720_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F91472_96001_0|SrvcGrp|83467|2022|PCT|0.40|99|0.00|EXTERNAL FIXATION TIBIA/FIBULA|
20|FH_F124923_23518_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F56274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F92677_08003_0|SrvcGrp|86839|2022|PDM|63.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F81591_70112_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127412_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148644_06890_0|CSTM-ALL|CSTM-00|2020|PDM|3205.00|99|0.00|AEG 5  (NO REV)|
20|FH_F151142_35406_0|CSTM-ALL|CSTM-00|2020|PDM|451.00|99|0.00|AEG 1 (NO REV)|
20|FH_F151155_26508_0|SrvcGrp|113330|2022|PDM|7272.00|99|0.00|MED TX INSERT/REMOVE IMP|
20|FH_F121962_75009_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F122013_75503_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F77763_0_0|SrvcGrp|10543|2022|PDM|85.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F91818_02828_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F116323_0_0|SrvcGrp|36591|2022|PDM|25737.00|99|0.00|CPT 63685|
20|FH_F33530_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|TRAUMA SERVICES|
20|FH_F86911_0_0|SrvcGrp|79338|2022|PDM|50.00|99|0.00|PAIN MGMT KIT|
20|FH_F115150_0_0|SrvcGrp|93688|2022|PDM|594.62|99|0.00|POLYSOMNOGRAPHY (HCFA)|
20|FH_F114916_30309_0|SrvcGrp|11663|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F114916_30309_0|CSTM-ALL|CSTM-00|2020|PDM|1541.00|99|0.00|AEG 8 (NO REV)|
20|FH_F142335_60624_0|SrvcGrp|3178|2022|PDM|959.00|99|0.00|ACUTE PSYCH|
20|FH_F38450_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_F135491_0_0|SrvcGrp|91759|2022|PCT|1.21|99|0.00|OCULAR IMPLANT|
20|FH_F138929_0_0|SrvcGrp|58638|2022|PDM|3850.00|99|0.00|CPT 63688|
20|FH_F141207_0_0|SrvcGrp|94780|2022|PDM|205.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F94786_07974_0|SrvcGrp|17016|2022|PDM|36.75|99|0.00|HOME INFUSION THERAPY|
20|FH_F132627_0_0|SrvcGrp|81857|2022|PDM|29.58|99|0.00|HOME HEALTH AIDE SERVICES|
20|FH_F136832_0_0|SrvcGrp|78579|2022|PDM|1632.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|AEG 7 (NO REV)|
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|676.00|99|0.00|AEG 1 (NO REV)|
20|FH_F50415_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 643|
20|FH_F114389_50131_0|SrvcGrp|24746|2022|PDM|102.25|99|0.00|HOME INFUSION THERAPY|
20|FH_F124059_64055_0|SrvcGrp|27968|2022|PDM|37.00|99|0.00|SKILLED NURSING LPN|
20|FH_F146886_77378_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F34652_0_0|SrvcGrp|72|2022|PDM|851.00|99|0.00|NEWBORN NURSERY|
20|FH_F38233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92493_0_0|SrvcGrp|77021|2022|PDM|14674.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F92493_0_0|SrvcGrp|71666|2022|PDM|8110.30|99|0.00|CPT 63655|
20|FH_F100703_0_0|SrvcGrp|96350|2022|PDM|8034.00|99|0.00|SHOULDER JOINT|
20|FH_F132864_71101_0|SrvcGrp|114613|2022|PCT|2.20|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F124173_66215_0|SrvcGrp|46104|2022|PDM|50.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F124246_71655_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F150910_0_0|SrvcGrp|80617|2022|PDM|10500.00|99|0.00|ARTHOPLASTY|
20|FH_F81115_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F114666_30342_0|SrvcGrp|105635|2022|PDM|3750.00|99|0.00|INCISION OF FEMUR|
20|FH_F115048_78520_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F144039_0_0|SrvcGrp|84934|2022|PDM|6885.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F148553_85016_0|CSTM-ALL|CSTM-00|2020|PDM|1118.00|99|0.00|AEG 8 (NO REV)|
20|FH_F134690_46237_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F134727_30650_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F136907_44833_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38488_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F115733_33012_0|SrvcGrp|86723|2022|PDM|368.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F116383_63026_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F116393_07002_0|SrvcGrp|111266|2022|PDM|59.01|99|0.00|X-RAY EXAM NECK SPINE 3/<VWS|
20|FH_F116393_07002_0|SrvcGrp|82749|2022|PDM|13.11|99|0.00|AUTOMAT HEMOGRAM COMPLET DIF|
20|FH_F147319_32763_0|SrvcGrp|114018|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F147305_90755_0|SrvcGrp|48398|2022|PDM|134.00|99|0.00|PT SERVICES|
20|FH_F147519_52627_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|OP SVCS|
20|FH_F147700_21401_0|CSTM-ALL|CSTM-00|2020|PDM|1153.00|99|0.00|AEG 6 (NO REV)|
20|FH_F41801_0_0|SrvcGrp|439|2022|PDM|550.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F125885_78741_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113595_29527_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F84611_30281_0|SrvcGrp|12342|2022|PCT|0.74|99|0.00|IMPLANTS|
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|538.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F51276_0_0|SrvcGrp|12403|2022|PDM|834.43|99|0.00|CONTINUOUS HOMECARE|
20|FH_F36372_0_0|SrvcGrp|10573|2022|PDM|28.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F98622_45005_0|SrvcGrp|88977|2022|PDM|9273.00|99|0.00|C-SECTION DELIVERY|
20|FH_F98624_15701_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F129850_0_0|SrvcGrp|35982|2022|PDM|36.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F48692_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150939_0_0|SrvcGrp|100270|2022|PDM|16.30|99|0.00|IIV3 VACC NO PRSV 0.25 ML IM|
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|12674|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|593.00|99|0.00|WILLS COMM SURG SVC ASC 1|
20|FH_F113585_20155_0|SrvcGrp|22384|2022|PCT|1.00|99|0.00|HOME VISIT PRENATAL|
20|FH_F138680_53005_0|SrvcGrp|89417|2022|PDM|405.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F138807_32207_0|SrvcGrp|48396|2022|PDM|137.00|99|0.00|OT SERVICES|
20|FH_F143832_0_0|SrvcGrp|106798|2022|PDM|3133.75|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1558.06|99|0.00|HAPA WPA-NWPA 2012-13 ASC 904 W/O REV|
20|FH_F102063_0_0|SrvcGrp|46605|2022|PDM|190.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F113544_62946_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F132258_45404_0|SrvcGrp|86845|2022|PDM|34.98|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F55113_0_0|SrvcGrp|3388|2022|PDM|680.00|99|0.00|SUBACUTE CARE|
20|FH_F148555_0_0|SrvcGrp|28401|2022|PDM|3090.00|99|0.00|CPT CODE 93622|
20|FH_F103781_0_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F40734_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41392_0_0|CSTM-ALL|CSTM-00|2020|PDM|415.00|99|0.00|ASPG I|
20|FH_F130593_48103_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97561_30030_0|SrvcGrp|88977|2022|PDM|5157.00|99|0.00|C-SECTION DELIVERY|
20|FH_F100666_81301_0|SrvcGrp|73659|2022|PDM|5455.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F102561_75146_0|SrvcGrp|74403|2022|PDM|3266.00|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F113291_37055_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F73728_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148863_33021_0|SrvcGrp|74668|2022|PDM|328.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151062_17584_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F90136_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
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_F87480_0_0|SrvcGrp|80126|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANICNG SUBSTANCE|
20|FH_F136467_0_0|SrvcGrp|27261|2022|PDM|7575.00|99|0.00|CPT 27446|
20|FH_F123856_54963_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123741_20850_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134008_11221_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F134011_84102_0|SrvcGrp|86840|2022|PDM|22.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F134070_20017_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137238_70056_0|SrvcGrp|109330|2022|PCT|1.10|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142448_15701_0|SrvcGrp|14947|2022|PDM|95.00|99|0.00|HOME INFUSION|
20|FH_F66765_0_0|SrvcGrp|12263|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F140343_89052_0|SrvcGrp|86847|2022|PDM|30.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F140841_07410_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140868_63103_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 5  (NO REV)|
20|FH_F148908_10710_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151610_77304_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119090_91502_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F66835_0_0|SrvcGrp|61039|2022|PDM|500.00|99|0.00|ELECTROCONVULSIVE THERAPY (ECT)|
20|FH_F94581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129450_17201_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F129467_45449_0|SrvcGrp|73700|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F129483_77030_0|SrvcGrp|14949|2022|PDM|70.00|99|0.00|HOME INFUSION|
20|FH_F117153_34113_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F137334_90405_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F115868_0_0|SrvcGrp|90477|2022|PDM|100.00|99|0.00|HOSPICE|
20|FH_F137934_51054_0|SrvcGrp|73701|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F109652_0_0|SrvcGrp|89632|2022|PCT|1.57|99|0.00|SLEEP STUDIES|
20|FH_F109821_0_0|SrvcGrp|91879|2022|PDM|3264.00|99|0.00|PROSTATE LASER ENUCLEATION|
20|FH_F112526_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_F129500_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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119285_0_0|SrvcGrp|108057|2022|PDM|1751.00|99|0.00|REPAIR RETINAL DETACHMENT|
20|FH_F73022_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39238_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49895_0_0|SrvcGrp|33643|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F50137_0_0|SrvcGrp|42972|2022|PDM|26.00|99|0.00|HOME HEALTH AIDE|
20|FH_F59732_0_0|SrvcGrp|22589|2022|PDM|75.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F31709_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|2415.00|99|0.00|AEG 4 (NO REV)|
20|FH_F116061_80110_0|SrvcGrp|91390|2022|PDM|225.00|99|0.00|AETNA PSYCH DIAG EVAL W/MED (MOD AF)|
20|FH_F145815_30540_0|SrvcGrp|113359|2022|PDM|73.49|99|0.00|COVID-19 SARSCOV & INF VIR A&B AG IA|
20|FH_F32799_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD KF|
20|FH_F135779_0_0|SrvcGrp|86722|2022|PDM|217.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F122536_0_0|SrvcGrp|12670|2022|PCT|0.80|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F82955_34266_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F66630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F41133_0_0|CSTM-ALL|CSTM-00|2020|PDM|686.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|3150.00|99|0.00|AEG 7 (NO REV)|
20|FH_F141407_76226_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F149885_68502_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35010_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F125254_30306_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F49653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|OP SVCS|
20|FH_F131254_92211_0|SrvcGrp|86779|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F40472_0_0|SrvcGrp|30934|2022|PDM|60.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F53373_0_0|SrvcGrp|36991|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|AEG 1 (NO REV)|
20|FH_F137615_16335_0|SrvcGrp|90854|2022|PDM|641.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F133099_66801_0|SrvcGrp|112064|2022|PCT|0.80|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F77883_0_0|SrvcGrp|74928|2022|PDM|217.42|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F146324_70810_0|SrvcGrp|57968|2022|PDM|37.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F106540_26330_0|SrvcGrp|10944|2022|PCT|0.43|99|0.00|EMERGENCY ROOM|
20|FH_F125212_76301_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F91155_16105_0|SrvcGrp|76007|2022|PDM|178.00|99|0.00|PULMONARY REHAB|
20|FH_F81373_64064_0|SrvcGrp|13881|2022|PCT|0.25|99|0.00|PACEMAKER DEVICE|
20|FH_F130626_42345_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117786_71446_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F119775_0_0|SrvcGrp|72996|2022|PDM|667.00|99|0.00|AEG 4|
20|FH_F120437_85202_0|SrvcGrp|86827|2022|PDM|114.77|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F122648_0_0|SrvcGrp|104358|2022|PDM|1306.00|99|0.00|CONJUNCTIVOPLASTY|
20|FH_F111789_25301_0|SrvcGrp|75505|2022|PCT|0.77|99|0.00|CARDIAC STUDIES|
20|FH_F99720_0_0|SrvcGrp|72992|2022|PDM|1397.00|99|0.00|AEG 2|
20|FH_F97542_32960_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F101922_98055_0|SrvcGrp|73500|2022|PDM|919.00|99|0.00|AETNA ER LEVEL I|
20|FH_F41785_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F41276_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125352_90034_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F148001_15601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F67302_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F68831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118708_33455_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F101840_76054_0|SrvcGrp|74039|2022|PDM|9042.00|99|0.00|LAMINECTOMY|
20|FH_F41796_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F74163_0_0|SrvcGrp|14110|2022|PDM|18.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.60|99|0.00|AEG 5  (NO REV)|
20|FH_F34706_0_0|SrvcGrp|9080|2022|PDM|65265.00|99|0.00|DRG 103 HT TRANSP OR IMPLNT OF HT|
20|FH_F67861_0_0|SrvcGrp|46032|2022|PDM|13200.00|99|0.00|GASTRIC REDUCTION - LAP BANDING|
20|FH_F74163_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F97565_83301_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F118303_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F71323_68114_0|SrvcGrp|37342|2022|PDM|2454.00|99|0.00|MS DRG 391 ONLY|
20|FH_F47479_0_0|CSTM-ALL|CSTM-00|2020|PDM|95.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F38700_0_0|SrvcGrp|18795|2022|PCT|0.80|99|0.00|MS DRG 216|
20|FH_F146380_85203_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143198_75219_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149664_33428_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F113271_72205_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116988_0_0|SrvcGrp|75497|2022|PDM|446.00|99|0.00|AEG 10|
20|FH_F146221_72560_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|79030|2022|PDM|800.38|99|0.00|MON VALLEY ASC 227|
20|FH_F132446_19063_0|SrvcGrp|46605|2022|PDM|76.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F141872_20707_0|SrvcGrp|90854|2022|PDM|890.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F142967_65065_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111813_08080_0|SrvcGrp|96403|2022|PCT|1.00|99|0.00|CIPROFLOXACIN IV|
20|FH_F112905_62088_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F117335_0_0|SrvcGrp|72998|2022|PDM|854.00|99|0.00|AEG 5|
20|FH_F119437_0_0|SrvcGrp|75489|2022|PDM|2000.00|99|0.00|AEG 6|
20|FH_F117885_81506_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F118400_16701_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117550_0_0|SrvcGrp|79720|2022|PDM|1100.00|99|0.00|ACUTE REHAB II|
20|FH_F130652_51101_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F146211_68144_0|SrvcGrp|98267|2022|PDM|12473.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F146373_66092_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117230_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F141927_71901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132118_92240_0|SrvcGrp|89149|2022|PDM|259.00|99|0.00|OP INTENSIVE|
20|FH_F77787_0_0|SrvcGrp|75139|2022|PCT|1.00|99|0.00|CROFAB W/ ER|
20|FH_F95980_20016_0|SrvcGrp|94840|2022|PDM|311.00|99|0.00|AETNA MEDICARE PARTIAL HOSPITAL|
20|FH_F146211_68144_0|SrvcGrp|98006|2022|PDM|4384.00|99|0.00|PHALANGEAL SHAFT FRACTURE|
20|FH_F120550_91355_0|SrvcGrp|82846|2022|PCT|0.85|99|0.00|AETNA DME|
20|FH_F42453_0_0|SrvcGrp|115|2022|PDM|269.00|99|0.00|SKILLED NURSING CARE|
20|FH_F148644_06890_0|SrvcGrp|24542|2022|PDM|3000.00|99|0.00|PARTIAL REMOVAL OF HYMEN|
20|FH_F148680_33311_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F151082_18020_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151201_90020_0|SrvcGrp|108484|2022|PDM|800.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F121347_29401_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121404_32216_0|SrvcGrp|108775|2022|PDM|1300.00|99|0.00|RAD W/O BACKUP NON-INV INTFC (MOD NU)|
20|FH_F121970_92653_0|SrvcGrp|73842|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114968_0_0|SrvcGrp|472|2022|PDM|696.30|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F139676_76901_0|SrvcGrp|90854|2022|PDM|600.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F150760_44833_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F35557_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1414794 AM HOME PAT DME MOD AU|
20|FH_F35730_0_0|SrvcGrp|11326|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY|
20|FH_F148980_18603_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F98922_40351_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F37679_0_0|SrvcGrp|17001|2022|PDM|110.00|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F143783_0_0|SrvcGrp|83857|2022|PDM|525.00|99|0.00|IP HOSPICE SVCS|
20|FH_F123627_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37679_0_0|SrvcGrp|27070|2022|PDM|3.25|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN (MOD SH)|
20|FH_F40661_0_0|SrvcGrp|33080|2022|PDM|487.00|99|0.00|SKILLED NURSING|
20|FH_F93791_0_0|SrvcGrp|11663|2022|PCT|1.03|99|0.00|IMPLANTS|
20|FH_F69764_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.20|99|0.00|OP SVCS|
20|FH_F122687_0_0|SrvcGrp|88491|2022|PDM|8742.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F32286_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93332_0_0|SrvcGrp|88161|2022|PDM|6386.00|99|0.00|LAMINECTOMY W/FACE-THORACIC|
20|FH_F59333_0_0|SrvcGrp|26001|2022|PDM|139.76|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F127036_43724_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F82173_72712_0|SrvcGrp|72984|2022|PCT|1.40|99|0.00|CHEMOTHERAPY|
20|FH_F38842_0_0|SrvcGrp|3069|2022|PCT|0.37|99|0.00|IMPLANTS|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148320_02130_0|SrvcGrp|104328|2022|PCT|0.85|99|0.00|PRESCRIPTION DRUG|
20|FH_F46359_0_0|SrvcGrp|26742|2022|PDM|147.00|99|0.00|PT|
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|330.00|99|0.00|AEG 10 (NO REV)|
20|FH_F123282_03222_0|SrvcGrp|27968|2022|PDM|46.00|99|0.00|SKILLED NURSING LPN|
20|FH_F37590_0_0|SrvcGrp|13703|2022|PDM|26.25|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F145538_34997_0|SrvcGrp|89337|2022|PDM|796.00|99|0.00|DETOXIFICATION|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F137574_68130_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129656_15005_0|SrvcGrp|53987|2022|PDM|30.00|99|0.00|PHOTOTHERAPY|
20|FH_F72183_0_0|SrvcGrp|15132|2022|PDM|1225.00|99|0.00|ACUTE IP MEDICAL SVCS|
20|FH_F91622_0_0|SrvcGrp|89268|2022|PDM|134.00|99|0.00|AETNA INITIAPSYCH DIAGNOSTIC EVALUATION|
20|FH_F93332_0_0|SrvcGrp|93057|2022|PDM|1906.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F33513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|DME F/S (MOD QW) - MHAC|
20|FH_F118121_46001_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135077_60014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141517_73034_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F102020_0_0|SrvcGrp|8962|2022|PDM|135.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F131176_28712_0|SrvcGrp|91214|2022|PDM|25.00|99|0.00|MED NUTRITION|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 020-022|
20|FH_F150699_0_0|SrvcGrp|109501|2022|PDM|4068.00|99|0.00|REPAIR LEAD PACE-DEFIB DUAL|
20|FH_F148255_72703_0|SrvcGrp|86842|2022|PDM|26.25|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F149868_0_0|SrvcGrp|29353|2022|PDM|190.00|99|0.00|HOSPICE SVCS|
20|FH_F121495_92009_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F123468_63384_0|SrvcGrp|471|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F151408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122687_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PDM|1438.00|99|0.00|ASPG VII|
20|FH_F41202_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31798_0_0|SrvcGrp|3029|2022|PDM|524.00|99|0.00|NEWBORN NURSERY|
20|FH_F116237_43235_0|SrvcGrp|90854|2022|PDM|713.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F132559_0_0|SrvcGrp|105235|2022|PDM|3100.00|99|0.00|PARTIAL REMOVAL OF THYROID|
20|FH_F54614_0_0|SrvcGrp|50903|2022|PDM|75.00|99|0.00|SOCIAL WORKER|
20|FH_F38847_0_0|SrvcGrp|13162|2022|PCT|1.10|99|0.00|HIGH COST DRUGS|
20|FH_F118338_94952_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146644_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.07|99|0.00|HSS ASC|
20|FH_F37756_0_0|SrvcGrp|1306|2022|PDM|469.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SERVICES|
20|FH_F143528_0_0|SrvcGrp|103585|2022|PDM|3045.00|99|0.00|REMOVE SPINE ELTRD PLATE|
20|FH_F71686_0_0|SrvcGrp|3409|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F99100_0_0|SrvcGrp|96099|2022|PDM|1586.20|99|0.00|CATHETER (HCFA)|
20|FH_F40318_0_0|SrvcGrp|32393|2022|PDM|45.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F48998_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F95021_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F138533_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129627_06037_0|SrvcGrp|48385|2022|PDM|111.00|99|0.00|SPEECH THERAPY|
20|FH_F116115_14437_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F122893_29135_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F86872_15215_0|SrvcGrp|19742|2022|PDM|90.00|99|0.00|MID-LINE INSERTION|
20|FH_F86917_61108_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F86991_15122_0|SrvcGrp|72998|2022|PDM|828.00|99|0.00|AEG 5|
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38560_0_0|SrvcGrp|29549|2022|PDM|5500.00|99|0.00|OP KIDNEY LITHOTRIPSY W/STENT|
20|FH_F50462_0_0|SrvcGrp|46693|2022|PDM|90.00|99|0.00|LPN NURSING SERVICES|
20|FH_F130656_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 5  (NO REV)|
20|FH_F130805_17404_0|SrvcGrp|88149|2022|PCT|1.70|99|0.00|RELEASE OF EYE FLUID|
20|FH_F130841_49315_0|SrvcGrp|97702|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F148905_85390_0|SrvcGrp|3178|2022|PDM|1400.00|99|0.00|ACUTE PSYCH|
20|FH_F118042_33401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139207_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F112827_26452_0|SrvcGrp|73701|2022|PDM|35.00|99|0.00|AETNA - SKILLED NURSING|
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_F133847_21702_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135477_50501_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135493_07514_0|SrvcGrp|90854|2022|PDM|530.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F97143_80012_0|SrvcGrp|73559|2022|PDM|10506.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F97143_80012_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F135834_74434_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135924_02906_0|SrvcGrp|79786|2022|PCT|1.03|99|0.00|SLEEP STUDIES|
20|FH_F136019_63044_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F100765_73735_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F131132_44077_0|SrvcGrp|64477|2022|PDM|2281.00|99|0.00|CPT CODE 74177|
20|FH_F131407_07607_0|SrvcGrp|86849|2022|PDM|30.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F116431_76104_0|SrvcGrp|88277|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F116463_76501_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130766_04967_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC) (HCFA)|
20|FH_F140629_0_0|SrvcGrp|67989|2022|PDM|2497.00|99|0.00|CPT 49320|
20|FH_F121466_84057_0|SrvcGrp|108484|2022|PDM|625.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F121763_07202_0|SrvcGrp|54142|2022|PDM|115.00|99|0.00|OP INTENSIVE SERVICES|
20|FH_F42098_0_0|SrvcGrp|11085|2022|PDM|28.00|99|0.00|HOME HEALTH AIDE|
20|FH_F75205_0_0|SrvcGrp|62539|2022|PDM|130.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F128370_76132_0|SrvcGrp|73841|2022|PDM|375.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F111292_33136_0|SrvcGrp|60|2022|PDM|3050.00|99|0.00|NEWBORN NURSERY - LEVEL II|
20|FH_F111301_33122_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F111301_33122_0|SrvcGrp|82761|2022|PDM|39.00|99|0.00|AUTOMATED WITHOUT MICRO|
20|FH_F65882_0_0|SrvcGrp|42828|2022|PDM|54.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F40684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F54272_0_0|SrvcGrp|51322|2022|PDM|125.00|99|0.00|OT SERVICES|
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|1188.00|99|0.00|AEG 5  (NO REV)|
20|FH_F131000_0_0|SrvcGrp|82112|2022|PDM|3343.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F132328_0_0|SrvcGrp|99073|2022|PDM|1.45|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F132328_0_0|SrvcGrp|103642|2022|PDM|10862.00|99|0.00|AETNA FEM/POPL REVASE W/ATHER|
20|FH_F112152_34994_0|SrvcGrp|89417|2022|PDM|404.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F102228_08846_0|SrvcGrp|89022|2022|PDM|35.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F102325_62691_0|SrvcGrp|53145|2022|PDM|45.00|99|0.00|SOCIAL WORKER|
20|FH_F129220_18445_0|SrvcGrp|110064|2022|PDM|23.70|99|0.00|GROUP BH TREATMENT 15 MINS|
20|FH_F101320_26062_0|SrvcGrp|29077|2022|PDM|72.00|99|0.00|HOME TRANSFUSION|
20|FH_F101320_26062_0|SrvcGrp|43569|2022|PDM|60.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F148061_11223_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F32324_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148485_13021_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148548_37909_0|CSTM-ALL|CSTM-00|2020|PDM|620.00|99|0.00|AEG 2 (NO REV)|
20|FH_F125348_84660_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F132934_63005_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS|
20|FH_F125342_78754_0|SrvcGrp|87317|2022|PDM|875.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F35368_0_0|SrvcGrp|29|2022|PDM|3465.00|99|0.00|ELECTROPHYSIOLOGY|
20|FH_F97621_75801_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F97566_79902_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F141927_71901_0|CSTM-ALL|CSTM-00|2020|PDM|1193.00|99|0.00|AEG 6 (NO REV)|
20|FH_F117559_08619_0|SrvcGrp|111060|2022|PDM|20.00|99|0.00|TOXOIDS VACCINES|
20|FH_F40659_0_0|SrvcGrp|27856|2022|PDM|46.00|99|0.00|THERAPY|
20|FH_F68868_0_0|CSTM-ALL|CSTM-00|2020|PDM|2460.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133052_33462_0|SrvcGrp|46903|2022|PDM|734.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132080_0_0|SrvcGrp|94780|2022|PDM|169.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F125009_17042_0|SrvcGrp|73841|2022|PDM|412.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F150526_16335_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133478_40165_0|SrvcGrp|16069|2022|PDM|585.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F119226_07746_0|SrvcGrp|87131|2022|PDM|301.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F68161_0_0|SrvcGrp|12491|2022|PCT|0.55|99|0.00|PACEMAKER|
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1447.00|99|0.00|AEG 8 (NO REV)|
20|FH_F103360_68845_0|SrvcGrp|73497|2022|PDM|2846.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F89851_83854_0|SrvcGrp|75507|2022|PCT|1.40|99|0.00|CHEMOTHERAPY|
20|FH_F111625_0_0|SrvcGrp|79720|2022|PDM|965.00|99|0.00|ACUTE REHAB II|
20|FH_F87155_04105_0|SrvcGrp|73701|2022|PDM|31.52|99|0.00|AETNA - SKILLED NURSING|
20|FH_F39180_0_0|SrvcGrp|72|2022|PDM|292.00|99|0.00|NEWBORN NURSERY|
20|FH_F48787_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142991_43920_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127994_19301_0|SrvcGrp|104796|2022|PDM|175.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127197_23111_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F121168_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F121009_76180_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F111412_33777_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40267_0_0|SrvcGrp|17065|2022|PDM|380.00|99|0.00|ASPG I|
20|FH_F31542_0_0|SrvcGrp|3420|2022|PDM|4000.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F133021_00910_0|SrvcGrp|112261|2022|PDM|19595.00|99|0.00|AORTIC VALVE REPLACEMENT WITH CORONARY ARTERY BYPASS|
20|FH_F42779_0_0|SrvcGrp|705|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F70545_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92677_08003_0|SrvcGrp|92104|2022|PDM|157.50|99|0.00|AETNA OXYGEN CONCENTRATOR 1 PORT|
20|FH_F133478_40165_0|CSTM-ALL|CSTM-00|2020|PDM|2734.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 4 (NO REV)|
20|FH_F133009_19038_0|SrvcGrp|100982|2022|PCT|1.00|99|0.00|AETNA OP SVCS HH AMFS DEFAULT|
20|FH_F91262_77036_0|SrvcGrp|73700|2022|PDM|52.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F52032_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F137240_0_0|SrvcGrp|16214|2022|PCT|0.59|99|0.00|HIGH COST DRUGS|
20|FH_F42807_0_0|SrvcGrp|1021|2022|PCT|0.75|99|0.00|VENTILATOR EQUIPMENT|
20|FH_F36521_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F146104_33410_0|SrvcGrp|41563|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F146250_67601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F144851_60123_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117385_48091_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F150024_08079_0|SrvcGrp|74039|2022|PDM|3500.00|99|0.00|LAMINECTOMY|
20|FH_F132285_89103_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F115431_32821_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F117009_0_0|SrvcGrp|84934|2022|PDM|1279.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F71323_68114_0|SrvcGrp|37350|2022|PDM|2543.00|99|0.00|MS DRG 689-690 ONLY|
20|FH_F117335_0_0|SrvcGrp|73004|2022|PDM|1135.00|99|0.00|AEG 8|
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)|
20|FH_F90032_15234_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117717_68410_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F113291_37055_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F111813_08080_0|SrvcGrp|96401|2022|PCT|1.00|99|0.00|ACYELOVIR INJECTION|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD KF"|
20|FH_F118667_95131_0|SrvcGrp|27968|2022|PDM|55.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133546_61611_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35176_0_0|SrvcGrp|12403|2022|PDM|26.25|99|0.00|CONTINUOUS HOMECARE|
20|FH_F148900_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F133095_30024_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|TELEMEDICINE SERVICES|
20|FH_F40797_0_0|SrvcGrp|439|2022|PDM|725.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F133490_90650_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F51129_0_0|SrvcGrp|11919|2022|PCT|0.75|99|0.00|ORGAN TRANSPLANT SVCS|
20|FH_F131699_08210_0|SrvcGrp|88621|2022|PDM|154.35|99|0.00|SKILLED NURSING LPN|
20|FH_F149605_0_0|SrvcGrp|83519|2022|PDM|153.00|99|0.00|HOSPICE CARE (ALL OTHER)|
20|FH_F72934_0_0|SrvcGrp|9438|2022|PCT|0.85|99|0.00|TRAUMA CARE|
20|FH_F150541_37922_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45752_0_0|SrvcGrp|30401|2022|PCT|1.10|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1105.74|99|0.00|HAPA WPA-NWPA 2012-13 ASC 706 W/O REV|
20|FH_F120411_14541_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F142907_60640_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40591_0_0|SrvcGrp|360|2022|PDM|2739.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F51059_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F40030_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F38250_0_0|SrvcGrp|11232|2022|PDM|283.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F138977_64468_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139268_36695_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139676_76901_0|SrvcGrp|73841|2022|PDM|250.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F150701_33437_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150859_14620_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F37018_0_0|SrvcGrp|16|2022|PDM|650.00|99|0.00|ACUTE REHABILITATION|
20|FH_F148326_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F39211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76222_0_0|SrvcGrp|115|2022|PDM|1513.00|99|0.00|SKILLED NURSING CARE|
20|FH_F35734_32405_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS|
20|FH_F114568_08097_0|SrvcGrp|90631|2022|PDM|125.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1529.00|99|0.00|AEG 7 (NO REV)|
20|FH_F42165_0_0|SrvcGrp|3660|2022|PCT|0.85|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)|
20|FH_F124288_15701_0|SrvcGrp|99349|2022|PCT|1.00|99|0.00|IN OFFICE SURGICAL PATHOLOGY|
20|FH_F78009_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PDM|2019.00|99|0.00|ASPG IX|
20|FH_F146266_0_0|SrvcGrp|114014|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F124719_64093_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F112045_90301_0|SrvcGrp|14188|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F151202_0_0|SrvcGrp|46903|2022|PDM|450.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F90223_0_0|SrvcGrp|88814|2022|PDM|120.00|99|0.00|HOME THERAPY VISITS (HCFA)|
20|FH_F133087_61107_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150982_0_0|SrvcGrp|78093|2022|PDM|2753.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F127189_49503_0|SrvcGrp|84185|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F32299_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F148667_0_0|SrvcGrp|108348|2022|PDM|2856.00|99|0.00|TREAT FRACTURE RADIUS/ULNA|
20|FH_F147183_17701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136806_0_0|SrvcGrp|27315|2022|PDM|3463.00|99|0.00|TENDON REPAIR|
20|FH_F92152_74133_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40624_0_0|CSTM-ALL|CSTM-00|2020|PDM|1657.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F39211_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F37081_0_0|SrvcGrp|537|2022|PDM|1500.00|99|0.00|OBSERVATION SERVICES|
20|FH_F110902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118957_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F127343_0_0|SrvcGrp|106666|2022|PDM|14830.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F124369_0_0|SrvcGrp|70746|2022|PDM|7480.00|99|0.00|CPT 28292|
20|FH_F51021_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|TRANSPLANT SVCS|
20|FH_F134593_60007_0|SrvcGrp|86834|2022|PDM|12.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F49552_0_0|SrvcGrp|17071|2022|PDM|747.47|99|0.00|ASPG IV|
20|FH_F43863_0_0|SrvcGrp|37406|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F143567_62207_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|565.29|99|0.00|HAPA WPA-NWPA 2012-13 ASC 101 W/O REV|
20|FH_F85353_16407_0|SrvcGrp|63924|2022|PDM|50.75|99|0.00|HAPA WPA-NWPA 2012-13 ASC 10|
20|FH_F143742_60410_0|SrvcGrp|73659|2022|PDM|2500.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F86101_76063_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F146544_78705_0|SrvcGrp|74668|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133868_40202_0|SrvcGrp|46903|2022|PDM|446.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F114683_0_0|SrvcGrp|72990|2022|PDM|644.00|99|0.00|AEG 1|
20|FH_F138951_41101_0|SrvcGrp|86840|2022|PDM|40.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F132899_01002_0|SrvcGrp|91070|2022|PDM|441.00|99|0.00|AETNA MH CRISIS INTERVENTION (HCFA)|
20|FH_F125124_0_0|SrvcGrp|79595|2022|PDM|2535.00|99|0.00|CPT 45385|
20|FH_F125124_0_0|SrvcGrp|72998|2022|PDM|889.00|99|0.00|AEG 5|
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139569_15063_0|CSTM-ALL|CSTM-00|2020|PDM|694.00|99|0.00|AEG 3 (NO REV)|
20|FH_F149528_0_0|SrvcGrp|90854|2022|PDM|1150.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F79863_0_0|SrvcGrp|74080|2022|PDM|195.00|99|0.00|HOME INFUSION|
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AEG 4 (NO REV)|
20|FH_F49280_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133972_27103_0|SrvcGrp|17015|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F39378_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F81838_0_0|SrvcGrp|26253|2022|PDM|33.00|99|0.00|LIPIDS|
20|FH_F38790_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F85353_16407_0|SrvcGrp|63883|2022|PDM|261.68|99|0.00|HAPA WPA-NWPA 2012-13 ASC 127|
20|FH_F149021_44514_0|CSTM-ALL|CSTM-00|2020|PDM|557.00|99|0.00|AEG 3 (NO REV)|
20|FH_F99161_0_0|SrvcGrp|75485|2022|PDM|1389.73|99|0.00|AEG 4|
20|FH_F145562_70458_0|SrvcGrp|14893|2022|PDM|30.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F134992_34112_0|SrvcGrp|73841|2022|PDM|470.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F43679_0_0|SrvcGrp|166|2022|PDM|625.00|99|0.00|CD (ADULT) - DETOXIFICATION|
20|FH_F110344_37421_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
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_F127642_07047_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F110470_98335_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|AETNA PSYTX W PT 45 MIN MOD AJ (HCFA)|
20|FH_F143581_02130_0|SrvcGrp|104964|2022|PCT|1.00|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F145642_15108_0|SrvcGrp|24744|2022|PDM|55.00|99|0.00|PICC LINE INSERTION|
20|FH_F132740_46250_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F42646_0_0|SrvcGrp|701|2022|PDM|1600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F110604_0_0|SrvcGrp|84912|2022|PDM|2640.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F132883_31602_0|SrvcGrp|24745|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F128816_43537_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F87775_15106_0|SrvcGrp|77223|2022|PDM|120.00|99|0.00|AETNA HOME INFUSION - S5520|
20|FH_F144248_0_0|SrvcGrp|109762|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESION(S)|
20|FH_F145641_06902_0|SrvcGrp|114237|2022|PDM|5767.00|99|0.00|EXC LEG/ANKLE TUM < 3 CM|
20|FH_F134614_84651_0|SrvcGrp|46903|2022|PDM|800.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F76146_0_0|SrvcGrp|68189|2022|PDM|1255.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 5|
20|FH_F143669_78577_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F125173_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F85133_85251_0|SrvcGrp|48385|2022|PDM|126.00|99|0.00|SPEECH THERAPY|
20|FH_F90501_71101_0|SrvcGrp|73560|2022|PCT|1.00|99|0.00|AETNA SLEEP STUDIES|
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F49552_0_0|SrvcGrp|37389|2022|PDM|2680.00|99|0.00|MS DRG 286-287 ONLY CARDIAC CATH|
20|FH_F116126_0_0|SrvcGrp|76094|2022|PDM|148.79|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|390.47|99|0.00|HAPA WPA-NWPA 2012-13 ASC 306 W/O REV|
20|FH_F119379_0_0|SrvcGrp|76604|2022|PDM|1453.00|99|0.00|CPT 25447|
20|FH_F117300_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F115616_0_0|SrvcGrp|27343|2022|PDM|3121.00|99|0.00|OP SURGERY (CPT 25607 - 25609)|
20|FH_F143581_02130_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F112082_30720_0|SrvcGrp|73742|2022|PCT|1.10|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F85393_0_0|SrvcGrp|42975|2022|PDM|75.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|23.48|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1001 W/O REV|
20|FH_F78344_0_0|SrvcGrp|75241|2022|PDM|35.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F102200_06416_0|SrvcGrp|86840|2022|PDM|47.50|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F105145_75075_0|SrvcGrp|101884|2022|PDM|5500.00|99|0.00|AETNA AEG 6 WITHOUT 58570-58573|
20|FH_F105361_80104_0|SrvcGrp|88793|2022|PDM|37581.00|99|0.00|CARDIAC PACEMAKER INSERTS|
20|FH_F115870_98225_0|SrvcGrp|73842|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F77665_0_0|SrvcGrp|10543|2022|PDM|60.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F146655_80226_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F146805_45662_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131697_33444_0|SrvcGrp|55677|2022|PDM|1500.00|99|0.00|VAGINAL DELIVERY ONLY|
20|FH_F149459_06615_0|SrvcGrp|48385|2022|PDM|137.00|99|0.00|SPEECH THERAPY|
20|FH_F122416_72364_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40736_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134869_08854_0|SrvcGrp|86722|2022|PDM|270.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F37304_0_0|SrvcGrp|23678|2022|PDM|87.00|99|0.00|HOME HEALTH SVCS|
20|FH_F124322_64131_0|SrvcGrp|34566|2022|PDM|22.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F126554_0_0|SrvcGrp|35670|2022|PDM|16500.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F74845_0_0|SrvcGrp|58|2022|PCT|0.85|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F112956_0_0|SrvcGrp|75487|2022|PDM|783.00|99|0.00|AEG 5|
20|FH_F125214_12428_0|SrvcGrp|12837|2022|PCT|0.70|99|0.00|INTRAOCULAR LENSES|
20|FH_F117799_0_0|SrvcGrp|89721|2022|PDM|9813.00|99|0.00|SPINAL NEUROSTIMULATION|
20|FH_F151679_62881_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F75404_0_0|SrvcGrp|64758|2022|PCT|1.00|99|0.00|HCPCS|
20|FH_F39756_0_0|SrvcGrp|31078|2022|PDM|192.50|99|0.00|AMALGAM-ONE SURFACE, PRIMARY OR PERMANENT|
20|FH_F94621_07728_0|SrvcGrp|87907|2022|PCT|1.00|99|0.00|GANCICLOVIR SODIUM, PER 500MG|
20|FH_F138452_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AETNA HIGH COST DRUGS|
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98820_81401_0|SrvcGrp|73605|2022|PDM|2818.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F127040_63867_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F97080_85122_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F35557_0_0|SrvcGrp|11788|2022|PDM|43.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F78023_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F137748_95231_0|CSTM-ALL|CSTM-00|2020|PDM|3188.00|99|0.00|AEG 4 (NO REV)|
20|FH_F112794_01040_0|SrvcGrp|94738|2022|PCT|1.00|99|0.00|FLUZONE VACC IM (>=3 YRS)|
20|FH_F122248_33441_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147181_27514_0|SrvcGrp|111927|2022|PCT|1.00|99|0.00|COVID-19 NON CDC|
20|FH_F147231_49440_0|SrvcGrp|57968|2022|PDM|43.24|99|0.00|CONTINUOUS HOMECARE|
20|FH_F147310_77036_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132254_40207_0|SrvcGrp|86122|2022|PCT|0.85|99|0.00|AETNA GAMMAGARD LIQUID INJ|
20|FH_F114308_70601_0|SrvcGrp|105595|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O THERAPY|
20|FH_F97084_91911_0|SrvcGrp|90854|2022|PDM|3665.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F150442_28451_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 7 (NO REV)|
20|FH_F100540_0_0|SrvcGrp|73004|2022|PDM|1413.00|99|0.00|AEG 8|
20|FH_F129970_34986_0|SrvcGrp|73842|2022|PDM|231.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F117615_30525_0|SrvcGrp|90356|2022|PCT|0.00|99|0.00|OP DIALYSIS|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|3986.00|99|0.00|ASPG VIII|
20|FH_F98022_89015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137767_01841_0|SrvcGrp|86701|2022|PDM|1195.00|99|0.00|ECHO TRANSESOPHAGEAL 4|
20|FH_F147160_80260_0|SrvcGrp|109330|2022|PCT|1.03|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F116806_0_0|SrvcGrp|107163|2022|PDM|1923.16|99|0.00|SINUSOTOMY RADICAL CALDWELL-LUC|
20|FH_F37181_0_0|SrvcGrp|6|2022|PCT|0.87|99|0.00|OP SURGERY|
20|FH_F38999_0_0|SrvcGrp|15|2022|PDM|3441.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F122649_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90232_15126_0|SrvcGrp|43567|2022|PDM|91.35|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F137748_95231_0|SrvcGrp|73496|2022|PDM|3756.00|99|0.00|AETNA ER LEVEL V|
20|FH_F127418_0_0|SrvcGrp|89848|2022|PDM|8123.26|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F97620_75904_0|SrvcGrp|73659|2022|PDM|6872.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F117617_80439_0|SrvcGrp|88621|2022|PDM|150.00|99|0.00|SKILLED NURSING LPN|
20|FH_F124364_38611_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F136843_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149648_89148_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F32980_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F37580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35775_32055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F117711_73080_0|SrvcGrp|105465|2022|PCT|1.05|99|0.00|AETNA THERAPIES|
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1716.00|99|0.00|AEG 10 (NO REV)|
20|FH_F139147_0_0|SrvcGrp|41334|2022|PDM|14057.00|99|0.00|TOTAL KNEE|
20|FH_F114207_35243_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F71468_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HILLCREST IV THERAPY|
20|FH_F149085_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|300.00|99|0.00|AEG 1 (NO REV)|
20|FH_F151699_01752_0|SrvcGrp|86834|2022|PDM|15.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F114825_32789_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F125762_66701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117799_0_0|SrvcGrp|88163|2022|PDM|14396.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F151041_60647_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117714_94301_0|SrvcGrp|108484|2022|PDM|675.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|3917.00|99|0.00|AEG 7 (NO REV)|
20|FH_F129237_72833_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F125182_0_0|SrvcGrp|73000|2022|PDM|905.00|99|0.00|AEG 6|
20|FH_F140689_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130309_17044_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF|
20|FH_F72749_0_0|CSTM-ALL|CSTM-00|2020|PDM|1035.00|99|0.00|MENTAL HEALTH/DETOX|
20|FH_F120187_76522_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F132431_79606_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F116698_07470_0|SrvcGrp|24745|2022|PDM|39.38|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F116806_0_0|SrvcGrp|107125|2022|PDM|887.26|99|0.00|BIOPSY OF SALIVARY GLAND|
20|FH_F35387_0_0|CSTM-ALL|CSTM-00|2020|PDM|1830.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97183_25304_0|SrvcGrp|73461|2022|PDM|10752.00|99|0.00|AETNA NICU IV|
20|FH_F115982_0_0|SrvcGrp|84939|2022|PDM|6875.00|99|0.00|SHOULDER JOINT|
20|FH_F117615_30525_0|SrvcGrp|104577|2022|PCT|0.00|99|0.00|ALL DRUGS|
20|FH_F37081_0_0|SrvcGrp|18148|2022|PDM|19600.00|99|0.00|MS DRG 249|
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|2149.00|99|0.00|AEG 5  (NO REV)|
20|FH_F41602_0_0|SrvcGrp|16173|2022|PDM|334.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F147140_89103_0|SrvcGrp|29347|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F97480_08204_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS|
20|FH_F114571_34613_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F110783_93013_0|SrvcGrp|108450|2022|PDM|15.86|99|0.00|INJ CUVITRU, 100 MG|
20|FH_F110783_93013_0|SrvcGrp|14945|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F37490_0_0|SrvcGrp|26429|2022|PDM|2250.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F78185_0_0|SrvcGrp|75300|2022|PDM|39.00|99|0.00|ENTERAL NUTRITION|
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.60|99|0.00|AEG 4 (NO REV)|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU KF"|
20|FH_F89851_83854_0|SrvcGrp|38662|2022|PDM|24075.00|99|0.00|MS DRG 327 ONLY|
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|508.00|99|0.00|ASPG 2 SURGICAL EYE CENTER|
20|FH_F150360_68112_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47037_0_0|SrvcGrp|10541|2022|PDM|92.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F116583_0_0|SrvcGrp|104841|2022|PDM|650.00|99|0.00|HOSPICE CARE PROVIDED IP HOSPICE FAC|
20|FH_F134732_0_0|SrvcGrp|108077|2022|PDM|2248.00|99|0.00|ARTERIOVENOUS ANASTOMOSIS|
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|1433.00|99|0.00|AEG 5  (NO REV)|
20|FH_F136843_0_0|SrvcGrp|108043|2022|PDM|164.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F131387_76001_0|SrvcGrp|86723|2022|PDM|414.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F148667_0_0|SrvcGrp|100061|2022|PDM|2856.00|99|0.00|REPAIR THUMB FRACTURE|
20|FH_F130331_0_0|SrvcGrp|57968|2022|PDM|32.50|99|0.00|CONTINUOUS HOMECARE|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD RR KE"|
20|FH_F140576_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|2952.00|99|0.00|AEG 9 (NO REV)|
20|FH_F150913_70068_0|SrvcGrp|114975|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F130939_40353_0|SrvcGrp|86723|2022|PDM|381.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F80834_0_0|SrvcGrp|537|2022|PCT|0.59|99|0.00|OBSERVATION SERVICES|
20|FH_F124467_27529_0|SrvcGrp|73842|2022|PDM|222.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F112306_81428_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1575124_HCPCS_  MOD NU|
20|FH_F131270_38133_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149582_01534_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F148859_0_0|SrvcGrp|28512|2022|PDM|2683.00|99|0.00|REPAIR BLADDER DEFECT|
20|FH_F150982_0_0|SrvcGrp|28551|2022|PDM|2392.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F137767_01841_0|SrvcGrp|79786|2022|PDM|3625.00|99|0.00|SLEEP STUDIES|
20|FH_F97101_98003_0|SrvcGrp|73603|2022|PDM|12398.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F37304_0_0|SrvcGrp|12039|2022|PDM|103.00|99|0.00|CAPD/CCPD|
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146261_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.80|99|0.00|OP SVCS|
20|FH_F139947_43209_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120767_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F50461_0_0|SrvcGrp|16274|2022|PCT|1.00|99|0.00|ORGAN ACQUISITION|
20|FH_F139928_37228_0|SrvcGrp|88819|2022|PDM|771.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F93740_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F46893_0_0|SrvcGrp|36122|2022|PDM|50.85|99|0.00|ANESTHESIA SERVICES (HCFA)|
20|FH_F47245_0_0|SrvcGrp|42434|2022|PDM|45.00|99|0.00|OUTPATIENT THERAPY SVCS|
20|FH_F47600_0_0|SrvcGrp|43318|2022|PDM|500.00|99|0.00|MRI|
20|FH_F48476_0_0|SrvcGrp|36066|2022|PDM|26.00|99|0.00|NURSING CARE|
20|FH_F48476_0_0|SrvcGrp|42973|2022|PDM|100.00|99|0.00|SPEECH  THERAPIST|
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|1119.00|99|0.00|ASPG V- MOD 50|
20|FH_F49054_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC|
20|FH_F83292_0_0|SrvcGrp|19973|2022|PDM|1393.00|99|0.00|CAT SCAN|
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|1556.00|99|0.00|AEG 9 (NO REV)|
20|FH_F59732_0_0|SrvcGrp|24758|2022|PDM|19.00|99|0.00|HOME INJECTABLE THERAPY|
20|FH_F148222_18603_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F151540_17055_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118720_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|AEG 10 (NO REV)|
20|FH_F67261_0_0|CSTM-ALL|CSTM-00|2020|PDM|2220.00|99|0.00|ASPG V - FH SW CUSTOM GROUPERS|
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116093_47327_0|SrvcGrp|90854|2022|PDM|768.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F97540_32114_0|SrvcGrp|73656|2022|PDM|411.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F115985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139515_0_0|SrvcGrp|67072|2022|PDM|10197.00|99|0.00|CPT 22845|
20|FH_F41201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ANGIOPLASTY|
20|FH_F148500_50129_0|SrvcGrp|79699|2022|PCT|0.80|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F124788_0_0|SrvcGrp|73004|2022|PDM|973.00|99|0.00|AEG 8|
20|FH_F124017_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F120362_23321_0|SrvcGrp|48385|2022|PDM|93.00|99|0.00|SPEECH THERAPY|
20|FH_F78603_0_0|SrvcGrp|20910|2022|PDM|45910.92|99|0.00|MS DRG 234 ONLY|
20|FH_F143888_32205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F56276_0_0|SrvcGrp|52947|2022|PDM|94.00|99|0.00|PSYCHIATRIC CPT 90808|
20|FH_F120374_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F117010_10549_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F109346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|1672.00|99|0.00|AEG 9 (NO REV)|
20|FH_F135005_06460_0|SrvcGrp|23683|2022|PDM|42.00|99|0.00|SKILLED NURSING RN|
20|FH_F114916_30309_0|SrvcGrp|84316|2022|PDM|800.00|99|0.00|ANKLE SURGERY|
20|FH_F123064_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F129255_34952_0|SrvcGrp|89149|2022|PDM|210.00|99|0.00|OP INTENSIVE|
20|FH_F110102_0_0|SrvcGrp|104133|2022|PDM|650.00|99|0.00|IP HOSPICE|
20|FH_F122433_0_0|SrvcGrp|109086|2022|PDM|1150.00|99|0.00|CYSTOURETHROSCOPY|
20|FH_F93881_15009_0|SrvcGrp|87116|2022|PDM|224.00|99|0.00|GLOBAL ELECTROMYOGRAPHY|
20|FH_F127375_28621_0|SrvcGrp|12840|2022|PCT|0.70|99|0.00|PACEMAKER|
20|FH_F39273_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F33513_0_0|SrvcGrp|34865|2022|PCT|0.77|99|0.00|HOME HEALTH AIDE|
20|FH_F132282_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F127375_28621_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|GENERAL ACUTE CARE|
20|FH_F37679_0_0|SrvcGrp|27141|2022|PDM|3.75|99|0.00|HORMONAL INJECTION THERAPY (MOD SJ)|
20|FH_F142073_0_0|SrvcGrp|33982|2022|PDM|1400.00|99|0.00|CPT 28296|
20|FH_F37173_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 8 (NO REV)|
20|FH_F129666_71901_0|SrvcGrp|48394|2022|PDM|70.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F32014_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85291_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F143783_0_0|SrvcGrp|95661|2022|PDM|105.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F141591_92630_0|SrvcGrp|73842|2022|PDM|360.50|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F37679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121533_26241_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129594_02842_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129397_17847_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148500_50129_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F93880_95476_0|SrvcGrp|80679|2022|PCT|1.25|99|0.00|AETNA RADIOLOGY|
20|FH_F79800_0_0|SrvcGrp|77012|2022|PCT|1.00|99|0.00|PT OT ST|
20|FH_F101201_0_0|SrvcGrp|86723|2022|PDM|275.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F137367_89139_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F97000_24201_0|SrvcGrp|73485|2022|PDM|907.00|99|0.00|AETNA REHAB|
20|FH_F124608_0_0|SrvcGrp|109910|2022|PDM|2354.00|99|0.00|HYSTEROSCOPY BIOPSY|
20|FH_F116924_91203_0|CSTM-ALL|CSTM-00|2020|PCT|3.50|99|0.00|HSS ASC|
20|FH_F140578_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86456_79761_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F135219_68506_0|SrvcGrp|47142|2022|PDM|5728.08|99|0.00|CPT 49650|
20|FH_F41279_0_0|CSTM-ALL|CSTM-00|2020|PDM|372.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149888_68506_0|SrvcGrp|16732|2022|PDM|3562.00|99|0.00|HYSTEROSCOPY ABLATION|
20|FH_F82714_18848_0|CSTM-ALL|CSTM-00|2020|PDM|27.19|99|0.00|HOSPITAL OBSERVATION (5-23 HOURS)|
20|FH_F120308_07901_0|SrvcGrp|89149|2022|PDM|249.00|99|0.00|OP INTENSIVE|
20|FH_F123964_86303_0|SrvcGrp|74668|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129656_15005_0|SrvcGrp|16750|2022|PDM|85.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F55634_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120872_74120_0|SrvcGrp|73842|2022|PDM|192.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131809_37355_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F73662_0_0|SrvcGrp|14320|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F38473_0_0|SrvcGrp|28628|2022|PDM|102.00|99|0.00|SKILLED NURSING|
20|FH_F132779_0_0|SrvcGrp|360|2022|PDM|2492.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F72746_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F93881_15009_0|SrvcGrp|87679|2022|PDM|2308.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F86319_16365_0|SrvcGrp|73483|2022|PDM|1003.00|99|0.00|AETNA SUBACUTE III|
20|FH_F131254_92211_0|SrvcGrp|86830|2022|PDM|45.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F83313_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F91078_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F110925_01104_0|SrvcGrp|24753|2022|PDM|18.91|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F39551_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F115050_77995_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F141169_0_0|SrvcGrp|113732|2022|PDM|403.00|99|0.00|EXAM OF VAGINA|
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|1421.00|99|0.00|AEG 5  (NO REV)|
20|FH_F116092_83254_0|SrvcGrp|75505|2022|PCT|0.92|99|0.00|CARDIAC STUDIES|
20|FH_F123898_45121_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F82753_18840_0|SrvcGrp|73498|2022|PDM|1022.00|99|0.00|AETNA ER LEVEL III|
20|FH_F143528_0_0|SrvcGrp|99174|2022|PDM|1914.15|99|0.00|CPT 30140|
20|FH_F122725_32216_0|SrvcGrp|105749|2022|PDM|43.00|99|0.00|ORTHC/PROSTC MGMT SBSQ ENC|
20|FH_F55212_0_0|SrvcGrp|51122|2022|PDM|22.00|99|0.00|THERAPEUTIC BEHAVIORAL SERVICES|
20|FH_F57073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F141031_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F62579_0_0|SrvcGrp|50142|2022|PDM|54.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 24 HRS|
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135840_0_0|SrvcGrp|82307|2022|PDM|550.00|99|0.00|COLORECTAL CANCER SCREENING|
20|FH_F130659_44410_0|SrvcGrp|10107|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F130805_17404_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 8 (NO REV)|
20|FH_F116908_33461_0|SrvcGrp|105057|2022|PDM|832.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F120871_14068_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F120853_61201_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F48915_0_0|SrvcGrp|44790|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F130662_07032_0|SrvcGrp|111555|2022|PDM|80.00|99|0.00|GROUP PSYCHOTHERAPY|
20|FH_F130755_04401_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC) (HCFA)|
20|FH_F130775_61701_0|SrvcGrp|89417|2022|PDM|346.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F130775_61701_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130821_85712_0|SrvcGrp|75545|2022|PDM|382.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F130825_65742_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147991_65625_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109577_0_0|SrvcGrp|73524|2022|PDM|135.00|99|0.00|PHYSICAL THERAPY|
20|FH_F127090_45601_0|SrvcGrp|29076|2022|PDM|48.96|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F114510_33445_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F149148_15330_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F149300_53158_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139380_33062_0|SrvcGrp|86723|2022|PDM|484.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F150305_18848_0|SrvcGrp|44007|2022|PDM|327.80|99|0.00|EMERGENCY ROOM (CPT CODE 99285)|
20|FH_F124162_73127_0|SrvcGrp|46903|2022|PDM|525.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F121225_98902_0|SrvcGrp|73461|2022|PDM|6190.00|99|0.00|AETNA NICU IV|
20|FH_F132883_31602_0|SrvcGrp|14949|2022|PDM|30.00|99|0.00|HOME INFUSION|
20|FH_F120539_89029_0|SrvcGrp|48398|2022|PDM|120.00|99|0.00|PT SERVICES|
20|FH_F90316_17701_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63762|2022|PDM|1847.30|99|0.00|HAPA WPA-NWPA 2012-13 ASC 902|
20|FH_F122243_30655_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F71550_0_0|SrvcGrp|3810|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F80186_0_0|CSTM-ALL|CSTM-00|2020|PDM|629.20|99|0.00|AEG 2 (NO REV)|
20|FH_F81698_10457_0|SrvcGrp|86830|2022|PDM|31.50|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F51393_0_0|SrvcGrp|12403|2022|PDM|948.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|228.10|99|0.00|HAPA WPA-NWPA 2012-13 ASC 234 W/O REV|
20|FH_F133972_27103_0|SrvcGrp|86847|2022|PDM|35.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F119227_01752_0|SrvcGrp|86853|2022|PDM|38.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F135666_37601_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F31714_0_0|SrvcGrp|3585|2022|PDM|8700.00|99|0.00|DRG 118 CARDIAC PACE DEV REPLACEMNT|
20|FH_F150165_06032_0|SrvcGrp|99163|2022|PDM|13390.00|99|0.00|CPT 27703|
20|FH_F117300_0_0|SrvcGrp|95559|2022|PDM|7360.00|99|0.00|HIP JOINT|
20|FH_F133877_84117_0|SrvcGrp|95661|2022|PDM|93.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F100782_0_0|SrvcGrp|105075|2022|PDM|577.14|99|0.00|WINDBER MEDICAL CNTR ASC 120|
20|FH_F127665_44124_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|292.72|99|0.00|HAPA WPA-NWPA 2012-13 ASC 311 W/O REV|
20|FH_F83978_66739_0|SrvcGrp|71221|2022|PDM|1527.00|99|0.00|EGD W/BALLOON DIALATION CPT 43249|
20|FH_F142376_0_0|SrvcGrp|80136|2022|PDM|19380.00|99|0.00|IMPLANT SPINAL INFUSION|
20|FH_F107520_66612_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F96160_32207_0|SrvcGrp|26868|2022|PDM|68.65|99|0.00|DIURETIC IV THERAPY|
20|FH_F129273_57783_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148439_0_0|SrvcGrp|73606|2022|PCT|0.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F147984_63664_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|2952.00|99|0.00|AEG 9 (NO REV)|
20|FH_F83534_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F133778_38119_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|338.47|99|0.00|HAPA WPA-NWPA 2012-13 ASC 308 W/O REV|
20|FH_F119227_01752_0|SrvcGrp|86851|2022|PDM|38.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F79763_0_0|SrvcGrp|59428|2022|PDM|90.00|99|0.00|ST|
20|FH_F133875_80027_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
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_F71843_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F66406_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F85353_16407_0|SrvcGrp|63820|2022|PDM|540.55|99|0.00|HAPA WPA-NWPA 2012-13 ASC 211|
20|FH_F150165_06032_0|SrvcGrp|86233|2022|PDM|13390.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F144291_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F133876_27405_0|SrvcGrp|89337|2022|PDM|943.00|99|0.00|DETOXIFICATION|
20|FH_F146160_52803_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111986_0_0|SrvcGrp|67990|2022|PDM|2472.00|99|0.00|CPT 58660 58661 58662|
20|FH_F132969_84003_0|SrvcGrp|43567|2022|PDM|50.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F145675_33761_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116806_0_0|SrvcGrp|107065|2022|PDM|1923.16|99|0.00|LENGTHENING OF PALATE|
20|FH_F124369_0_0|SrvcGrp|99171|2022|PDM|12155.00|99|0.00|CPT 28485|
20|FH_F136359_0_0|SrvcGrp|27315|2022|PDM|5980.00|99|0.00|TENDON REPAIR|
20|FH_F58396_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: ALL|
20|FH_F134668_08003_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F122520_46383_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F84454_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88058_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.70|99|0.00|HAPA WPA-NWPA 2012-13 ASC 241 W/O REV|
20|FH_F105145_75075_0|SrvcGrp|11669|2022|PDM|28320.00|99|0.00|OP SURG|
20|FH_F132213_17543_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F133335_84790_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133401_33404_0|SrvcGrp|111929|2022|PDM|20.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F132131_33060_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133219_89119_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F133574_91607_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111561_10002_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F111603_19529_0|SrvcGrp|90854|2022|PDM|634.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F111604_16505_0|SrvcGrp|46903|2022|PDM|520.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F134826_19067_0|SrvcGrp|86722|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F67086_0_0|SrvcGrp|17139|2022|PDM|601.02|99|0.00|HOSPICE CARE|
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|2976.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F46433_0_0|SrvcGrp|42322|2022|PDM|35.00|99|0.00|HOME THERAPY|
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 10 (NO REV)|
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113226_30025_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F80511_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F111951_80111_0|SrvcGrp|75545|2022|PDM|345.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F113585_20155_0|SrvcGrp|86779|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F138880_92392_0|SrvcGrp|75419|2022|PDM|650.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F138936_01040_0|SrvcGrp|111929|2022|PCT|1.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F139016_47460_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F81823_0_0|SrvcGrp|59428|2022|PDM|75.00|99|0.00|ST|
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|1198.00|99|0.00|2006 MEDICARE ASPG VI|
20|FH_F89580_0_0|SrvcGrp|24714|2022|PCT|0.50|99|0.00|INTRAOCULAR LENS|
20|FH_F113885_0_0|SrvcGrp|57968|2022|PDM|33.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1083.99|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1302 W/O REV|
20|FH_F151379_21045_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151427_04106_0|SrvcGrp|116009|2022|PDM|662.08|99|0.00|CHEMOTHERAPY ADMINISTRATION (HCFA)|
20|FH_F151503_30067_0|SrvcGrp|705|2022|PCT|0.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F151503_30067_0|SrvcGrp|33982|2022|PDM|2090.00|99|0.00|CPT 28296|
20|FH_F132262_60062_0|SrvcGrp|93337|2022|PDM|365.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F132054_30339_0|SrvcGrp|63119|2022|PDM|31.00|99|0.00|BASIC HOME HOSPICE CARE|
20|FH_F135389_43123_0|SrvcGrp|73841|2022|PDM|468.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F91764_93710_0|SrvcGrp|112678|2022|PCT|2.12|99|0.00|COVID-19 SPECIMEN COLLECT|
20|FH_F135943_76051_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135978_06851_0|SrvcGrp|112783|2022|PDM|254.00|99|0.00|INTENSIVE OP (>=19 YRS)|
20|FH_F136070_46410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121761_44130_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F121823_46234_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132689_18436_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F111292_33136_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F111303_19087_0|SrvcGrp|86749|2022|PCT|1.05|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F134309_63125_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F41780_0_0|SrvcGrp|31186|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC (DME)|
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|2006 MEDICARE ASPG X|
20|FH_F72666_0_0|SrvcGrp|33793|2022|PDM|8010.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F114569_0_0|SrvcGrp|105539|2022|PDM|12.94|99|0.00|AETHA ANNUAL ALCOHOL SCREEN 15 MINS (MOD GT)|
20|FH_F112129_62220_0|SrvcGrp|90573|2022|PDM|252.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F112152_34994_0|SrvcGrp|108484|2022|PDM|636.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|2952.00|99|0.00|AEG 9 (NO REV)|
20|FH_F121385_89102_0|SrvcGrp|73659|2022|PDM|4819.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F121954_60706_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33744_0_0|SrvcGrp|941|2022|PCT|0.75|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F65761_0_0|SrvcGrp|42827|2022|PDM|175.05|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F97761_04072_0|SrvcGrp|73605|2022|PDM|928.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F78243_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|DIGESTIVE SURGERY|
20|FH_F32728_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115204_0_0|SrvcGrp|471|2022|PDM|856.98|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F88456_0_0|SrvcGrp|107441|2022|PDM|3403.00|99|0.00|AETNA CYSTOSCOPY PROSTATIC IMPLANTS|
20|FH_F105381_66845_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F105480_19940_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119435_0_0|SrvcGrp|107792|2022|PDM|7630.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F119435_0_0|SrvcGrp|107880|2022|PDM|543.00|99|0.00|BALO ANGIOP CTR DIALYSIS SEG|
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F123774_0_0|SrvcGrp|72998|2022|PDM|1008.00|99|0.00|AEG 5|
20|FH_F43694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133178_0_0|SrvcGrp|33977|2022|PDM|1255.00|99|0.00|CPT 59820|
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 9 (NO REV)|
20|FH_F94786_07974_0|SrvcGrp|14949|2022|PDM|36.75|99|0.00|HOME INFUSION|
20|FH_F95341_08701_0|SrvcGrp|75545|2022|PDM|365.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F132627_0_0|SrvcGrp|92675|2022|PCT|0.90|99|0.00|AETNA DRUGS/AGENTS/INJ DRUGS/NUTRITION SOLUTIONS|
20|FH_F105361_80104_0|SrvcGrp|73603|2022|PDM|5227.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F105361_80104_0|SrvcGrp|89871|2022|PCT|0.98|99|0.00|GROUND TRANSPORTATION|
20|FH_F115786_57701_0|SrvcGrp|48396|2022|PDM|94.00|99|0.00|OT SERVICES|
20|FH_F115811_33410_0|SrvcGrp|80260|2022|PCT|0.00|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F66782_0_0|SrvcGrp|42975|2022|PDM|80.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F77665_0_0|SrvcGrp|11796|2022|PDM|50.00|99|0.00|DIETICIAN|
20|FH_F146702_70508_0|SrvcGrp|31931|2022|PDM|368.55|99|0.00|SKILLED NURSING CARE|
20|FH_F120795_27514_0|SrvcGrp|82858|2022|PCT|0.55|99|0.00|NUCLEAR MEDICINE|
20|FH_F120811_53525_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116040_24637_0|SrvcGrp|22593|2022|PDM|30.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F116056_73018_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F131964_89120_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133415_90066_0|SrvcGrp|75419|2022|PDM|725.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F133478_40165_0|SrvcGrp|54975|2022|PDM|61968.00|99|0.00|MS DRG 223 ONLY|
20|FH_F133478_40165_0|SrvcGrp|74586|2022|PCT|0.28|99|0.00|AETNA OP HIGH COST DRUGS|
20|FH_F133153_44113_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133007_76010_0|SrvcGrp|73842|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F35216_0_0|SrvcGrp|941|2022|PDM|1200.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F36049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39346_0_0|SrvcGrp|20075|2022|PDM|9056.00|99|0.00|MS DRG 286 ONLY|
20|FH_F39346_0_0|SrvcGrp|20096|2022|PDM|53000.00|99|0.00|MS DRG 222-223 ONLY|
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AEG 8 (NO REV)|
20|FH_F38135_0_0|SrvcGrp|439|2022|PDM|2839.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F143467_0_0|SrvcGrp|112221|2022|PDM|3140.00|99|0.00|INCISION OF METATARSAL|
20|FH_F40755_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F139292_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F59732_0_0|SrvcGrp|24761|2022|PDM|42.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F91876_0_0|SrvcGrp|28551|2022|PDM|2345.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F93171_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141410_13045_0|SrvcGrp|112722|2022|PCT|0.87|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F123921_89128_0|SrvcGrp|108484|2022|PDM|1300.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F79800_0_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F97242_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F135219_68506_0|SrvcGrp|11673|2022|PDM|7103.73|99|0.00|CPT 29888|
20|FH_F135236_02840_0|SrvcGrp|75506|2022|PCT|1.01|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F66501_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F123922_84102_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F34658_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117082_66216_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F119384_0_0|SrvcGrp|108043|2022|PDM|280.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F139551_0_0|SrvcGrp|93057|2022|PDM|4574.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F67423_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140762_0_0|SrvcGrp|113696|2022|PDM|1723.00|99|0.00|AQUEOUS SHUNT EYE W/O GRAFT|
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F128973_44256_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127988_85258_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F35271_0_0|SrvcGrp|9911|2022|PCT|0.70|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F115985_0_0|SrvcGrp|82037|2022|PDM|1585.00|99|0.00|AETNA ICU|
20|FH_F123895_52722_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F130051_31707_0|CSTM-ALL|CSTM-00|2020|PDM|6172.00|99|0.00|AEG 5  (NO REV)|
20|FH_F90714_0_0|SrvcGrp|73002|2022|PDM|1033.00|99|0.00|AEG 7|
20|FH_F73013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F92392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
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_F148265_06067_0|SrvcGrp|100919|2022|PDM|7718.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F126042_97005_0|SrvcGrp|89149|2022|PDM|150.00|99|0.00|OP INTENSIVE|
20|FH_F125249_0_0|SrvcGrp|90357|2022|PDM|1200.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F44218_0_0|SrvcGrp|12591|2022|PDM|160.00|99|0.00|CD FULL DAY|
20|FH_F135232_34471_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F149140_07522_0|SrvcGrp|113226|2022|PDM|42.28|99|0.00|COVID-19 SVNT SARSCOV2 ELISA PLSM SRM|
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|931.00|99|0.00|AEG 5  (NO REV)|
20|FH_F89779_0_0|SrvcGrp|88160|2022|PDM|13000.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F37937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143894_70001_0|CSTM-ALL|CSTM-00|2020|PCT|0.20|99|0.00|OP SVCS|
20|FH_F131948_23226_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91640_98166_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F39920_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137943_0_0|SrvcGrp|113197|2022|PDM|1660.00|99|0.00|FISTULIZATION OF SCLERA|
20|FH_F90691_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148549_60523_0|SrvcGrp|88620|2022|PDM|115.00|99|0.00|SKILLED NURSING RN|
20|FH_F141549_33403_0|SrvcGrp|75419|2022|PDM|575.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F73013_0_0|SrvcGrp|3809|2022|PDM|959.02|99|0.00|HOSPICE CARE|
20|FH_F34487_0_0|SrvcGrp|9936|2022|PDM|93.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F125028_19061_0|SrvcGrp|86839|2022|PDM|63.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F37753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132988_0_0|SrvcGrp|92370|2022|PDM|2057.62|99|0.00|FUSION OF KNUCKLE JOINT|
20|FH_F88933_0_0|SrvcGrp|112911|2022|PDM|7957.00|99|0.00|PACEMAKER INSERTION|
20|FH_F114389_50131_0|SrvcGrp|17007|2022|PDM|224.99|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS|
20|FH_F114389_50131_0|SrvcGrp|88806|2022|PDM|419.42|99|0.00|TOTAL PARENTERAL NUTRITION; < 3 LITERS (HCFA)|
20|FH_F141336_16947_0|SrvcGrp|12837|2022|PCT|0.39|99|0.00|INTRAOCULAR LENSES|
20|FH_F141336_16947_0|SrvcGrp|33166|2022|PDM|593.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F40370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F72085_0_0|SrvcGrp|64298|2022|PDM|314.00|99|0.00|CCPE|
20|FH_F76782_0_0|SrvcGrp|22954|2022|PDM|159.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F115971_0_0|SrvcGrp|73006|2022|PDM|1082.00|99|0.00|AEG 9|
20|FH_F36830_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.40|99|0.00|OP SVCS|
20|FH_F36318_0_0|SrvcGrp|361|2022|PDM|2210.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F124173_66215_0|SrvcGrp|24761|2022|PDM|37.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F124593_07033_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F124681_69337_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|831.00|99|0.00|AEG 4 (NO REV)|
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_F87856_0_0|SrvcGrp|75479|2022|PDM|432.00|99|0.00|AEG 1|
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 6 (NO REV)|
20|FH_F114666_30342_0|SrvcGrp|93431|2022|PDM|22500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F113847_20910_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F113910_16508_0|SrvcGrp|473|2022|PDM|330.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F114985_32073_0|SrvcGrp|52952|2022|PDM|101.00|99|0.00|PSYCHIATRIC CPT 90847|
20|FH_F122610_73139_0|SrvcGrp|72994|2022|PDM|5393.00|99|0.00|AEG 3|
20|FH_F134675_60134_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F134697_32566_0|SrvcGrp|108484|2022|PDM|774.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F134733_19460_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135763_20678_0|SrvcGrp|90397|2022|PDM|1750.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F136778_62034_0|SrvcGrp|105421|2022|PDM|413.00|99|0.00|AETNA TERANIAL MAGN STIM TX PLAN|
20|FH_F136828_32405_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F112411_28207_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F113713_17013_0|SrvcGrp|106470|2022|PDM|72.00|99|0.00|AETNA OFFICE OUTPATIENT VISIT EST (MOD TD)|
20|FH_F113713_17013_0|SrvcGrp|86643|2022|PDM|45.00|99|0.00|AETNA PSYTX PT & FAMILY 30 MINS (MOD TD)|
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|ASPG IV|
20|FH_F115267_67156_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F115728_78404_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147700_21401_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 9 (NO REV)|
20|FH_F41463_0_0|SrvcGrp|17302|2022|PDM|57.00|99|0.00|HYDRATION THERAPY - 3+ LITERS|
20|FH_F42522_0_0|SrvcGrp|11000|2022|PCT|0.60|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F139172_40207_0|SrvcGrp|72602|2022|PDM|643.00|99|0.00|ECT|
20|FH_F139441_91324_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F139667_84078_0|SrvcGrp|23683|2022|PDM|60.75|99|0.00|SKILLED NURSING RN|
20|FH_F139150_75206_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F97480_08204_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F37490_0_0|SrvcGrp|26422|2022|PDM|75.00|99|0.00|RADIOLOGY - SPINE|
20|FH_F131371_0_0|SrvcGrp|40003|2022|PDM|17000.00|99|0.00|TOTAL KNEE|
20|FH_F125214_12428_0|SrvcGrp|12280|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F129764_48084_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|IP/OP MBPR SERVICES|
20|FH_F146266_0_0|SrvcGrp|99168|2022|PDM|1076.00|99|0.00|CPT 22899|
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|18900.00|99|0.00|MS DRG 484|
20|FH_F138478_0_0|SrvcGrp|109498|2022|PDM|4867.04|99|0.00|INSERT 1 ELECTRODE PM-DEFIB|
20|FH_F117799_0_0|SrvcGrp|41334|2022|PDM|11935.00|99|0.00|TOTAL KNEE|
20|FH_F126116_0_0|SrvcGrp|109443|2022|PDM|390.00|99|0.00|HEART ELECTROCONVERSION|
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|605.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132160_0_0|SrvcGrp|42427|2022|PDM|6885.00|99|0.00|OP SURGERY CPT 65420|
20|FH_F40979_0_0|SrvcGrp|3964|2022|PCT|0.80|99|0.00|PT SVCS|
20|FH_F32986_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148667_0_0|SrvcGrp|76604|2022|PDM|2856.00|99|0.00|CPT 25447|
20|FH_F31087_0_0|SrvcGrp|474|2022|PDM|234.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F150961_89169_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|2030.00|99|0.00|AEG 8 (NO REV)|
20|FH_F31087_0_0|SrvcGrp|471|2022|PDM|495.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F141270_89103_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME HEALTH CARE|
20|FH_F36403_0_0|SrvcGrp|43438|2022|PDM|81.00|99|0.00|THERAPY|
20|FH_F37081_0_0|SrvcGrp|18247|2022|PDM|6950.00|99|0.00|MS DRG 286|
20|FH_F110727_34994_0|SrvcGrp|73842|2022|PDM|217.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F97082_90012_0|SrvcGrp|73659|2022|PDM|10930.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F35140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F37230_0_0|SrvcGrp|15390|2022|PDM|54.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F78023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F107840_07006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CARECENTRIX AWP (MANUAL REVIEW)|
20|FH_F36826_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPEN MRI OF LEE PET SCANS (RENTAL)|
20|FH_F149240_0_0|SrvcGrp|29155|2022|PDM|717.20|99|0.00|HOSPICE SVCS|
20|FH_F108260_63141_0|SrvcGrp|27968|2022|PDM|25.00|99|0.00|SKILLED NURSING LPN|
20|FH_F38584_0_0|SrvcGrp|28783|2022|PCT|0.50|99|0.00|UNGROUPED SURGERY|
20|FH_F138018_17313_0|SrvcGrp|22589|2022|PDM|139.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F150941_68124_0|SrvcGrp|74668|2022|PDM|206.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147229_60523_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F113545_11201_0|SrvcGrp|86748|2022|PCT|1.02|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F97280_20018_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F35990_0_0|SrvcGrp|22147|2022|PDM|127.00|99|0.00|PSYCH PARTIAL HOSP (HALF DAY)|
20|FH_F130044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F149579_95815_0|SrvcGrp|115683|2022|PDM|37.21|99|0.00|CHRONIC CARE MGMT STAFF ADDL|
20|FH_F150441_76132_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|519.31|99|0.00|SALLY BALIN,999182,ASC 201|
20|FH_F149579_95815_0|SrvcGrp|115695|2022|PDM|161.17|99|0.00|PSYCHIATRIC COLLABORATIVE CARE MGMT 1ST (MOD AH)|
20|FH_F37487_0_0|SrvcGrp|16616|2022|PDM|27.00|99|0.00|HOME HEALTH AIDE|
20|FH_F40567_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116806_0_0|SrvcGrp|107098|2022|PDM|887.26|99|0.00|PREPARE FACE/ORAL PROSTHESIS|
20|FH_F146859_0_0|SrvcGrp|114851|2022|PDM|3867.00|99|0.00|SPINE ELTRD PERQ ARAY REMOVE|
20|FH_F110732_31513_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F125022_67035_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132818_24701_0|SrvcGrp|89417|2022|PDM|348.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F119316_27104_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116600_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98860_96706_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F34024_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36165_0_0|SrvcGrp|22386|2022|PDM|650.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F37304_0_0|SrvcGrp|17732|2022|PDM|79.00|99|0.00|PT/OT/ST|
20|FH_F148519_83201_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35987_0_0|SrvcGrp|16679|2022|PDM|4743.00|99|0.00|LAPAROSCOPIC PROCEDURES|
20|FH_F129030_21204_0|CSTM-ALL|CSTM-00|2020|PCT|1.45|99|0.00|HSS ASC|
20|FH_F127487_60169_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F36590_0_0|SrvcGrp|65|2022|PDM|1597.00|99|0.00|OBSTETRICAL CARE|
20|FH_F149579_95815_0|SrvcGrp|115692|2022|PDM|161.17|99|0.00|PSYCHIATRIC COLLABORATIVE CARE MGMT 1ST (MOD AF)(HCFA)|
20|FH_F117905_0_0|SrvcGrp|105356|2022|PCT|0.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD - INCL CODES|
20|FH_F110824_83221_0|SrvcGrp|43758|2022|PDM|2618.00|99|0.00|CARDIAC CARE UNIT|
20|FH_F117762_0_0|SrvcGrp|27261|2022|PDM|14560.00|99|0.00|CPT 27446|
20|FH_F40453_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117615_30525_0|SrvcGrp|75487|2022|PCT|0.85|99|0.00|AEG 5|
20|FH_F124433_77338_0|SrvcGrp|104079|2022|PCT|1.06|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F94303_0_0|SrvcGrp|83379|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F147201_48234_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140090_37221_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F101901_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F101752_0_0|SrvcGrp|89939|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F130918_01606_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151740_77504_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F48476_0_0|SrvcGrp|42976|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|ASPG II- MOD 50|
20|FH_F132446_19063_0|SrvcGrp|29346|2022|PDM|42.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F82894_0_0|SrvcGrp|80285|2022|PDM|126.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F120977_50510_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F126243_32132_0|SrvcGrp|89149|2022|PDM|215.00|99|0.00|OP INTENSIVE|
20|FH_F113563_70560_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 7 (NO REV)|
20|FH_F118879_93063_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F84611_30281_0|SrvcGrp|78680|2022|PDM|6236.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|22990.00|99|0.00|MSDRG 231-232 CORONARY BYPASS|
20|FH_F36372_0_0|SrvcGrp|11798|2022|PDM|54.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98622_45005_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F100783_03431_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
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_F46972_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE|
20|FH_F72544_0_0|SrvcGrp|9529|2022|PCT|0.80|99|0.00|HOSPICE SVCS|
20|FH_F132212_0_0|SrvcGrp|94781|2022|PDM|90.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F132544_0_0|SrvcGrp|40003|2022|PDM|8007.00|99|0.00|TOTAL KNEE|
20|FH_F148482_20136_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148554_85016_0|SrvcGrp|115471|2022|PDM|2850.00|99|0.00|RIGHT HEART ART/GRFT ANGIO|
20|FH_F59274_0_0|SrvcGrp|48394|2022|PDM|18.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F38396_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|GENERAL ACUTE CARE|
20|FH_F149781_37404_0|SrvcGrp|115767|2022|PDM|18000.00|99|0.00|TOTAL JOINT REPLACEMENT|
20|FH_F132543_79549_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F41696_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F35408_0_0|SrvcGrp|16982|2022|PDM|0.83|99|0.00|ADDITIONAL MILEAGE - WHEELCHAIR VAN|
20|FH_F38039_0_0|SrvcGrp|9830|2022|PDM|82.50|99|0.00|OT SVCS|
20|FH_F42238_0_0|SrvcGrp|26152|2022|PDM|545.00|99|0.00|DIALYSIS|
20|FH_F73304_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F127422_0_0|SrvcGrp|104003|2022|PDM|1400.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES|
20|FH_F148886_60621_0|SrvcGrp|73602|2022|PDM|510.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F123278_20850_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F110925_01104_0|SrvcGrp|21916|2022|PDM|1.24|99|0.00|STOMACH TUBE|
20|FH_F89475_71202_0|SrvcGrp|73602|2022|PDM|472.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F136756_0_0|SrvcGrp|72990|2022|PDM|447.70|99|0.00|AEG 1|
20|FH_F35344_0_0|SrvcGrp|528|2022|PDM|1785.00|99|0.00|TELEMETRY UNIT|
20|FH_F151526_28208_0|SrvcGrp|108078|2022|PDM|2387.00|99|0.00|ARTERY-VEIN FUSION|
20|FH_F47733_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION|
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|2516.00|99|0.00|DEVICE INSERTION|
20|FH_F123331_45373_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F87538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121427_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F149819_75067_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125028_19061_0|SrvcGrp|24744|2022|PDM|94.50|99|0.00|PICC LINE INSERTION|
20|FH_F38591_0_0|SrvcGrp|10107|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F50873_0_0|SrvcGrp|42824|2022|PDM|75.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F42822_0_0|SrvcGrp|170|2022|PDM|350.00|99|0.00|CD (ADOLESCENT) - REHAB|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|719.06|99|0.00|HAPA WPA-NWPA 2012-13 ASC 503 W/O REV|
20|FH_F91876_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141427_22003_0|SrvcGrp|48385|2022|PDM|84.00|99|0.00|SPEECH THERAPY|
20|FH_F136756_0_0|SrvcGrp|38364|2022|PDM|5372.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F143580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F83533_70433_0|SrvcGrp|87077|2022|PDM|183.73|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F129305_45614_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F118703_0_0|SrvcGrp|73008|2022|PDM|583.00|99|0.00|AEG 10|
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_F128136_48025_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F129656_15005_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F116697_11703_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F142073_0_0|SrvcGrp|92415|2022|PDM|5980.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F31525_0_0|SrvcGrp|16|2022|PDM|1015.00|99|0.00|ACUTE REHABILITATION|
20|FH_F87201_0_0|SrvcGrp|65405|2022|PDM|160.00|99|0.00|ROUTINE HOME CARE|
20|FH_F119581_0_0|SrvcGrp|107544|2022|PDM|6525.00|99|0.00|ILIAC REVASC W/ STENT|
20|FH_F40471_0_0|CSTM-ALL|CSTM-00|2020|PDM|470.00|99|0.00|ASC III ENDOSCOPY CTR CENTRAL PA|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER AU|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PDM|1153.00|99|0.00|ASPG VII|
20|FH_F95341_08701_0|SrvcGrp|90488|2022|PCT|0.80|99|0.00|ORAL FUNCTION THERAPY|
20|FH_F132988_0_0|SrvcGrp|103570|2022|PDM|6530.93|99|0.00|ARTHROSCOPIC FRACTURE|
20|FH_F130310_66604_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
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_F42161_0_0|SrvcGrp|20801|2022|PCT|0.88|99|0.00|HOME HEALTH|
20|FH_F72204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|INFUSION THERAPY (MOD SJ)|
20|FH_F114389_50131_0|SrvcGrp|24753|2022|PDM|30.30|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|857.00|99|0.00|AEG 2 (NO REV)|
20|FH_F83115_0_0|SrvcGrp|76501|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F124180_0_0|SrvcGrp|109736|2022|PDM|3364.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT|
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118180_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|OP SVCS|
20|FH_F129849_0_0|SrvcGrp|35982|2022|PDM|48.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F124059_64055_0|SrvcGrp|88621|2022|PDM|73.00|99|0.00|SKILLED NURSING LPN|
20|FH_F147081_02130_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F150910_0_0|SrvcGrp|84939|2022|PDM|10500.00|99|0.00|SHOULDER JOINT|
20|FH_F131656_51401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F75662_0_0|SrvcGrp|10503|2022|PDM|49.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F123620_0_0|SrvcGrp|13681|2022|PDM|247.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F130039_80228_0|SrvcGrp|86722|2022|PDM|220.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F136708_06443_0|SrvcGrp|75442|2022|PDM|622.00|99|0.00|OBSERVATION - REV 762|
20|FH_F127448_0_0|SrvcGrp|107792|2022|PDM|5600.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F122591_84010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F122610_73139_0|SrvcGrp|73008|2022|PDM|5393.00|99|0.00|AEG 10|
20|FH_F122689_92009_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122638_59715_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F42917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F43862_0_0|SrvcGrp|30961|2022|PDM|12.50|99|0.00|HOME HEALTH AIDE|
20|FH_F134791_98034_0|SrvcGrp|23681|2022|PCT|0.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F136778_62034_0|SrvcGrp|74586|2022|PCT|0.18|99|0.00|AETNA OP HIGH COST DRUGS|
20|FH_F136786_25302_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F136796_24016_0|SrvcGrp|78096|2022|PDM|2440.83|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39622_0_0|SrvcGrp|13811|2022|PDM|520.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F115631_65201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116393_07002_0|SrvcGrp|22529|2022|PCT|0.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F147443_06469_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147586_44124_0|SrvcGrp|96539|2022|PDM|4685.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F41795_0_0|SrvcGrp|16746|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F42156_0_0|SrvcGrp|38|2022|PDM|1591.00|99|0.00|NORMAL DELIVERY|
20|FH_F42654_0_0|SrvcGrp|10541|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F139916_0_0|SrvcGrp|89417|2022|PDM|453.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F91155_16105_0|SrvcGrp|73004|2022|PDM|2399.00|99|0.00|AEG 8|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|99.31|99|0.00|HAPA WPA-NWPA 2012-13 ASC 316 W/O REV|
20|FH_F144191_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F117335_0_0|SrvcGrp|85966|2022|PDM|1485.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|2355.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F144769_0_0|SrvcGrp|4035|2022|PDM|15400.00|99|0.00|DRG 334 MAJ MALE PELVIC PROC  W/CC|
20|FH_F125255_34769_0|SrvcGrp|89337|2022|PDM|788.00|99|0.00|DETOXIFICATION|
20|FH_F133018_84037_0|SrvcGrp|10577|2022|PDM|25.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F40388_0_0|CSTM-ALL|CSTM-00|2020|PDM|878.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119530_0_0|SrvcGrp|75479|2022|PDM|450.00|99|0.00|AEG 1|
20|FH_F35411_0_0|SrvcGrp|3029|2022|PDM|576.00|99|0.00|NEWBORN NURSERY|
20|FH_F112854_53225_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F92676_15063_0|SrvcGrp|79008|2022|PDM|1036.80|99|0.00|MON VALLEY ASC 107|
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.48|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F123872_75006_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120437_85202_0|SrvcGrp|86850|2022|PDM|76.51|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F51438_0_0|SrvcGrp|17608|2022|PDM|900.00|99|0.00|MENTAL HEALTH / DETOX|
20|FH_F37640_0_0|CSTM-ALL|CSTM-00|2020|PDM|1099.00|99|0.00|ASPG VIII|
20|FH_F133261_78041_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F92644_06053_0|SrvcGrp|472|2022|PDM|604.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F108940_15642_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111437_33305_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120437_85202_0|SrvcGrp|46605|2022|PDM|182.34|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F81853_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137896_0_0|SrvcGrp|92104|2022|PDM|173.80|99|0.00|AETNA OXYGEN CONCENTRATOR 1 PORT|
20|FH_F132032_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F111809_93003_0|CSTM-ALL|CSTM-00|2020|PDM|8919.00|99|0.00|AEG 5  (NO REV)|
20|FH_F100784_59923_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F50615_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC|
20|FH_F132487_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F81494_0_0|SrvcGrp|16617|2022|PDM|122.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F95980_20016_0|SrvcGrp|89337|2022|PDM|813.00|99|0.00|DETOXIFICATION|
20|FH_F113287_72501_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F40267_0_0|SrvcGrp|17079|2022|PDM|1152.00|99|0.00|ASPG VIII|
20|FH_F140808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100682_97401_0|SrvcGrp|73601|2022|PDM|7901.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F133018_84037_0|SrvcGrp|17016|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F150948_0_0|SrvcGrp|98497|2022|PDM|10800.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F42779_0_0|SrvcGrp|3070|2022|PDM|1158.00|99|0.00|PEDIATRIC SVCS|
20|FH_F135649_0_0|CSTM-ALL|CSTM-00|2020|PDM|619.00|99|0.00|AEG 2 (NO REV)|
20|FH_F146324_70810_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 1 (NO REV)|
20|FH_F150024_08079_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119095_08536_0|SrvcGrp|11663|2022|PCT|0.30|99|0.00|IMPLANTS|
20|FH_F111813_08080_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119079_41018_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F93375_0_0|SrvcGrp|72996|2022|PDM|661.00|99|0.00|AEG 4|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|138.80|99|0.00|ASPG 223|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|122.21|99|0.00|HAPA WPA-NWPA 2012-13 ASC 139 W/O REV|
20|FH_F43330_0_0|SrvcGrp|11085|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F38161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|FL VISTA RADIOLOGY NO MOD|
20|FH_F132543_79549_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F42807_0_0|SrvcGrp|97|2022|PDM|5616.00|99|0.00|C-SECTION|
20|FH_F123583_72756_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F125672_92663_0|SrvcGrp|90631|2022|PDM|600.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F102561_75146_0|SrvcGrp|80679|2022|PCT|2.00|99|0.00|AETNA RADIOLOGY|
20|FH_F90921_77702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139607_0_0|SrvcGrp|46890|2022|PDM|1836.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F133329_40202_0|SrvcGrp|73485|2022|PDM|1564.00|99|0.00|AETNA REHAB|
20|FH_F100666_81301_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F92676_15063_0|SrvcGrp|78992|2022|PDM|1197.08|99|0.00|MON VALLEY ASC 214|
20|FH_F111806_33020_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F72980_0_0|SrvcGrp|69961|2022|PCT|0.90|99|0.00|AIR AMBULANCE|
20|FH_F128774_53140_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146254_83651_0|SrvcGrp|75419|2022|PDM|475.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F92676_15063_0|SrvcGrp|79018|2022|PDM|972.81|99|0.00|MON VALLEY ASC 111|
20|FH_F33282_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72859_0_0|SrvcGrp|15506|2022|PDM|6.54|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F97621_75801_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS|
20|FH_F124854_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F123539_65265_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F132729_0_0|SrvcGrp|33793|2022|PDM|13426.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F141411_0_0|SrvcGrp|84182|2022|PDM|5400.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE|
20|FH_F92676_15063_0|SrvcGrp|79027|2022|PDM|826.52|99|0.00|MON VALLEY ASC 116|
20|FH_F97581_60141_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F141731_92590_0|SrvcGrp|73842|2022|PDM|232.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130841_49315_0|SrvcGrp|97703|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F31164_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149031_80525_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F139565_0_0|SrvcGrp|45583|2022|PDM|9754.00|99|0.00|CPT 65730|
20|FH_F150146_95401_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD KF"|
20|FH_F119567_04072_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119573_95864_0|SrvcGrp|114008|2022|PDM|544.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F134667_19110_0|SrvcGrp|73842|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F49287_0_0|SrvcGrp|58932|2022|PCT|0.80|99|0.00|RAD GLOBAL|
20|FH_F116727_0_0|SrvcGrp|35669|2022|PDM|5200.00|99|0.00|CPT 63650|
20|FH_F125328_0_0|SrvcGrp|27348|2022|PDM|8520.00|99|0.00|OP SURGERY (CPT 58662)|
20|FH_F138302_15701_0|SrvcGrp|24744|2022|PDM|50.00|99|0.00|PICC LINE INSERTION|
20|FH_F41135_0_0|SrvcGrp|17069|2022|PDM|492.54|99|0.00|ASPG III|
20|FH_F52713_0_0|SrvcGrp|21354|2022|PDM|26051.00|99|0.00|MS DRG 250-251 ONLY|
20|FH_F126191_43616_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149031_80525_0|SrvcGrp|74668|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130468_0_0|SrvcGrp|111434|2022|PDM|9919.40|99|0.00|ATRAUMATIC DISLOC NO ANESTH|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|ASPG I|
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1425.00|99|0.00|AEG 8 (NO REV)|
20|FH_F33269_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F130329_64114_0|SrvcGrp|86849|2022|PDM|25.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F149005_16830_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F126990_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|NON-ANESTHESIOLOGIST/CRNA (HAN3)|
20|FH_F100782_0_0|SrvcGrp|105110|2022|PDM|832.74|99|0.00|WINDBER MEDICAL CNTR ASC 214|
20|FH_F81852_0_0|SrvcGrp|11108|2022|PDM|576.00|99|0.00|NEWBORN NURSERY|
20|FH_F100782_0_0|SrvcGrp|105086|2022|PDM|413.54|99|0.00|WINDBER MEDICAL CNTR ASC 131|
20|FH_F130017_02302_0|CSTM-ALL|CSTM-00|2020|PDM|4265.99|99|0.00|AEG 6 (NO REV)|
20|FH_F127418_0_0|SrvcGrp|11306|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F128148_0_0|SrvcGrp|34866|2022|PDM|130.00|99|0.00|HOME HEALTH - PT/OT/ST|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F52713_0_0|SrvcGrp|20293|2022|PDM|46751.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|402.89|99|0.00|HAPA WPA-NWPA 2012-13 ASC 305 W/O REV|
20|FH_F118147_33801_0|CSTM-ALL|CSTM-00|2020|PDM|593.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F124146_46321_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F114444_19602_0|CSTM-ALL|CSTM-00|2020|PDM|85.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION MOD HO (HCFA)|
20|FH_F145561_80210_0|SrvcGrp|111348|2022|PCT|1.10|99|0.00|OP THERAPY SERVICES|
20|FH_F135316_0_0|SrvcGrp|73485|2022|PDM|1050.00|99|0.00|AETNA REHAB|
20|FH_F116806_0_0|SrvcGrp|107053|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MOUTH|
20|FH_F149106_07042_0|SrvcGrp|104946|2022|PDM|3518.00|99|0.00|REMOVAL OF BREAST CAPSULE|
20|FH_F133770_34601_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 10 (NO REV)|
20|FH_F110509_71351_0|SrvcGrp|72990|2022|PDM|1300.00|99|0.00|AEG 1|
20|FH_F150221_63131_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F126188_59404_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F39586_0_0|SrvcGrp|1168|2022|PDM|32.91|99|0.00|CONTINUOUS HOMECARE|
20|FH_F85213_02840_0|SrvcGrp|75507|2022|PCT|1.03|99|0.00|CHEMOTHERAPY|
20|FH_F61513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F51479_0_0|SrvcGrp|24654|2022|PCT|1.06|99|0.00|EPOGEN|
20|FH_F120719_27540_0|SrvcGrp|116119|2022|PCT|0.71|99|0.00|CHEMOTHERAPY|
20|FH_F125513_40071_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F127651_44124_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F114844_17061_0|SrvcGrp|75545|2022|PDM|333.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F52713_0_0|SrvcGrp|49462|2022|PDM|250.00|99|0.00|HOMECARE|
20|FH_F145641_06902_0|SrvcGrp|34606|2022|PDM|6458.00|99|0.00|CPT 29827|
20|FH_F150599_0_0|CSTM-ALL|CSTM-00|2020|PDM|516.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1 & 2|
20|FH_F133207_0_0|SrvcGrp|100919|2022|PDM|5040.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F110247_08865_0|CSTM-ALL|CSTM-00|2020|PCT|2.60|99|0.00|HSS APC GROUPED|
20|FH_F147962_85008_0|CSTM-ALL|CSTM-00|2020|PDM|1369.00|99|0.00|AEG 2 (NO REV)|
20|FH_F150165_06032_0|SrvcGrp|33967|2022|PDM|3050.00|99|0.00|CPT 47562|
20|FH_F111027_32817_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F132969_84003_0|SrvcGrp|80920|2022|PDM|474.00|99|0.00|HOSPICE SERVICES|
20|FH_F98021_07012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33916_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135627_77070_0|SrvcGrp|112762|2022|PDM|45.23|99|0.00|INFECTIOUS AGENT ANTIGEN DETECTION|
20|FH_F110521_98034_0|SrvcGrp|93919|2022|PDM|477.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F138457_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F136353_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125513_40071_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109273_77339_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
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_F135622_34471_0|SrvcGrp|73842|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F54592_0_0|SrvcGrp|33164|2022|PDM|400.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F134537_03060_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F129101_27006_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F84652_0_0|SrvcGrp|471|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F87577_80016_0|SrvcGrp|20900|2022|PDM|13838.00|99|0.00|MS DRG 248 ONLY|
20|FH_F103360_68845_0|SrvcGrp|73500|2022|PDM|362.00|99|0.00|AETNA ER LEVEL I|
20|FH_F148879_33018_0|SrvcGrp|76501|2022|PDM|360.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F151144_35801_0|SrvcGrp|102120|2022|PDM|915.43|99|0.00|REVISE EYE MUSCLE|
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F32995_0_0|SrvcGrp|15768|2022|PDM|750.00|99|0.00|MRI|
20|FH_F40191_0_0|SrvcGrp|80|2022|PDM|633.00|99|0.00|ACUTE PSYCH|
20|FH_F43417_0_0|SrvcGrp|37018|2022|PDM|250.00|99|0.00|BOARDER BABY|
20|FH_F46832_0_0|SrvcGrp|22588|2022|PDM|80.00|99|0.00|CHEMOTHERAPY|
20|FH_F123741_20850_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F136314_19013_0|SrvcGrp|109330|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136378_07104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F93187_08043_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134011_84102_0|SrvcGrp|22592|2022|PDM|22.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F134075_78230_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F136952_78218_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F139751_84065_0|SrvcGrp|75419|2022|PDM|880.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F114979_77979_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138019_79705_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F142547_70002_0|SrvcGrp|86837|2022|PDM|10.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F142654_73034_0|SrvcGrp|73841|2022|PDM|430.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138607_02760_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F125053_0_0|SrvcGrp|67989|2022|PDM|2370.00|99|0.00|CPT 49320|
20|FH_F125053_0_0|SrvcGrp|72994|2022|PDM|549.00|99|0.00|AEG 3|
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|915.04|99|0.00|2006 MEDICARE ASPG IV|
20|FH_F137310_0_0|SrvcGrp|14494|2022|PDM|56.00|99|0.00|CONTINUOUS HOMECARE|
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_F149531_80237_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F118789_92211_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F119003_78070_0|SrvcGrp|58509|2022|PDM|411.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F119004_06850_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F52832_0_0|SrvcGrp|42782|2022|PDM|175.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F117267_07728_0|SrvcGrp|102419|2022|PDM|5000.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F147839_33983_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147726_18017_0|CSTM-ALL|CSTM-00|2020|PDM|960.00|99|0.00|AEG 10 (NO REV)|
20|FH_F129467_45449_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F137817_17050_0|SrvcGrp|86723|2022|PDM|300.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F109907_0_0|SrvcGrp|88620|2022|PDM|92.60|99|0.00|SKILLED NURSING RN|
20|FH_F110720_0_0|SrvcGrp|64761|2022|PDM|4882.00|99|0.00|DISCECTOMY|
20|FH_F110720_0_0|SrvcGrp|73006|2022|PDM|3409.00|99|0.00|AEG 9|
20|FH_F110720_0_0|SrvcGrp|72994|2022|PDM|2335.00|99|0.00|AEG 3|
20|FH_F90791_79106_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F129053_0_0|SrvcGrp|85792|2022|PDM|2081.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)|
20|FH_F39085_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73022_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F51016_0_0|SrvcGrp|43893|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F149679_0_0|SrvcGrp|13683|2022|PDM|594.21|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F150280_0_0|SrvcGrp|87536|2022|PDM|437.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|ASPG I|
20|FH_F89475_71202_0|CSTM-ALL|CSTM-00|2020|PDM|3734.00|99|0.00|AEG 9 (NO REV)|
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1052.00|99|0.00|AEG 8 (NO REV)|
20|FH_F120902_64085_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|1751.00|99|0.00|ELECTROSHOCK W/O EATING DISORDER|
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG III|
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F140586_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F128878_11203_0|SrvcGrp|111181|2022|PDM|140.00|99|0.00|PSYTX W PT W E/M 45 MINS (MOD AF) (HCFA)|
20|FH_F102302_0_0|SrvcGrp|97159|2022|PDM|10850.00|99|0.00|TRANSPEDICULAR, 1 SEG, LUMBAR|
20|FH_F102302_0_0|SrvcGrp|98606|2022|PDM|1817.00|99|0.00|REVISE HAND/FOOT NERVE|
20|FH_F86416_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F125703_02907_0|SrvcGrp|75545|2022|PDM|390.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F135259_21090_0|SrvcGrp|108484|2022|PDM|969.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F127550_43026_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F131577_89148_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F124660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148259_99163_0|SrvcGrp|107861|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|1305.00|99|0.00|AEG 7 (NO REV)|
20|FH_F116061_80110_0|SrvcGrp|104075|2022|PCT|1.40|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F123259_54501_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.45|99|0.00|HAPA WPA-NWPA 2012-13 ASC 202 W/O REV|
20|FH_F145755_08050_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91876_0_0|SrvcGrp|72992|2022|PDM|1197.00|99|0.00|AEG 2|
20|FH_F125011_74467_0|SrvcGrp|102420|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F137637_03103_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F148480_03079_0|CSTM-ALL|CSTM-00|2020|PDM|3025.00|99|0.00|AEG 9 (NO REV)|
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|1744.00|99|0.00|AEG 9 (NO REV)|
20|FH_F120635_22903_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F150939_0_0|SrvcGrp|68241|2022|PDM|1.70|99|0.00|DESTRUCTION WARTS - 2ND - 4TH LESIONS|
20|FH_F138876_25302_0|SrvcGrp|26868|2022|PDM|40.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F67167_0_0|SrvcGrp|941|2022|PDM|3920.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|605.00|99|0.00|2006 MEDICARE ASPG II|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|142.41|99|0.00|HAPA WPA-NWPA 2012-13 ASC 136 W/O REV|
20|FH_F84297_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151340_30040_0|CSTM-ALL|CSTM-00|2020|PDM|541.00|99|0.00|AEG 1 (NO REV)|
20|FH_F151420_60654_0|SrvcGrp|26275|2022|PDM|2272.00|99|0.00|CPT 29826|
20|FH_F151420_60654_0|CSTM-ALL|CSTM-00|2020|PDM|967.00|99|0.00|AEG 2 (NO REV)|
20|FH_F151460_68137_0|SrvcGrp|74668|2022|PDM|469.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151501_30265_0|SrvcGrp|104114|2022|PDM|2090.00|99|0.00|INCISION OF FOOT FASCIA|
20|FH_F151509_77076_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151511_14094_0|CSTM-ALL|CSTM-00|2020|PDM|1554.20|99|0.00|AEG 3 (NO REV)|
20|FH_F145168_15601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123191_15012_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136127_15658_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100880_67735_0|SrvcGrp|73605|2022|PDM|1633.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F131132_44077_0|SrvcGrp|31931|2022|PDM|987.00|99|0.00|SKILLED NURSING CARE|
20|FH_F131132_44077_0|SrvcGrp|89404|2022|PDM|22889.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F131407_07607_0|SrvcGrp|26869|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F116447_21601_0|SrvcGrp|106850|2022|PCT|1.00|99|0.00|HOSPICE/PHYSICIAN|
20|FH_F116527_70443_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140629_0_0|SrvcGrp|92019|2022|PDM|2497.00|99|0.00|ARTHROSCOPY|
20|FH_F140629_0_0|SrvcGrp|113681|2022|PDM|2497.00|99|0.00|URETEROLITHOTOMY LAPAROSCOPY|
20|FH_F101558_80443_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F121763_07202_0|SrvcGrp|109215|2022|PDM|94.00|99|0.00|PSYCH TEST EVALUATION 1ST HOUR|
20|FH_F36341_0_0|SrvcGrp|3095|2022|PDM|578.00|99|0.00|ROOM AND BOARD PRIVATE|
20|FH_F42347_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F128370_76132_0|SrvcGrp|90854|2022|PDM|800.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F129329_07039_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F129329_07039_0|SrvcGrp|58509|2022|PDM|550.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F111291_52501_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F111303_19087_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F111341_80501_0|SrvcGrp|471|2022|PDM|541.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F111363_33169_0|SrvcGrp|79786|2022|PCT|0.84|99|0.00|SLEEP STUDIES|
20|FH_F134322_98001_0|SrvcGrp|87280|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F47906_0_0|SrvcGrp|43847|2022|PCT|1.00|99|0.00|DME POS FACILITY MOD 53|
20|FH_F47906_0_0|SrvcGrp|29665|2022|PCT|1.00|99|0.00|DME MOD NU|
20|FH_F87153_0_0|CSTM-ALL|CSTM-00|2020|PDM|54.94|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F82198_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34864_0_0|SrvcGrp|9828|2022|PDM|74.00|99|0.00|HOME HEALTH AIDE|
20|FH_F34864_0_0|SrvcGrp|15779|2022|PDM|74.00|99|0.00|PT/OT/ST|
20|FH_F116430_0_0|SrvcGrp|106715|2022|PDM|2175.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F131000_0_0|SrvcGrp|27345|2022|PDM|3121.00|99|0.00|OP SURGERY (CPT 49650)|
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)|
20|FH_F105421_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112086_33713_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F128549_44224_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F128695_50049_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F102325_62691_0|SrvcGrp|73742|2022|PCT|1.30|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F132090_60915_0|CSTM-ALL|CSTM-00|2020|PDM|1435.40|99|0.00|AEG 3 (NO REV)|
20|FH_F148061_11223_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F136987_0_0|SrvcGrp|30089|2022|PDM|408.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F134265_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66922_66211_0|SrvcGrp|91277|2022|PCT|1.40|99|0.00|AETNA URGENT CARE|
20|FH_F92871_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F87092_60101_0|SrvcGrp|73006|2022|PDM|5355.00|99|0.00|AEG 9|
20|FH_F46832_0_0|SrvcGrp|10580|2022|PDM|65.00|99|0.00|HYDRATION THERAPY - 3 LITERS|
20|FH_F123661_30060_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132810_0_0|SrvcGrp|26868|2022|PDM|35.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F58856_0_0|SrvcGrp|21104|2022|PDM|35800.00|99|0.00|MS DRG 220 ONLY|
20|FH_F64999_0_0|CSTM-ALL|CSTM-00|2020|PDM|1187.00|99|0.00|ASPG VI|
20|FH_F118201_35126_0|SrvcGrp|57968|2022|PDM|31.34|99|0.00|CONTINUOUS HOMECARE|
20|FH_F134011_84102_0|SrvcGrp|23683|2022|PDM|50.70|99|0.00|SKILLED NURSING RN|
20|FH_F134075_78230_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F134126_11554_0|SrvcGrp|109057|2022|PCT|1.27|99|0.00|CARDIAC STUDIES|
20|FH_F134156_32174_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F134160_19006_0|SrvcGrp|106294|2022|PDM|285.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F134160_19006_0|SrvcGrp|106314|2022|PDM|624.00|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F134167_10032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137147_75006_0|SrvcGrp|93432|2022|PDM|26762.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F139751_84065_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F97582_46307_0|SrvcGrp|73559|2022|PDM|22491.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F97582_46307_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128878_11203_0|SrvcGrp|111178|2022|PDM|106.00|99|0.00|PSYTX W PT W E/M 30 MINS (MOD AF)|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD RR) - CPD 1963706|
20|FH_F123915_0_0|SrvcGrp|89781|2022|PDM|190.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F131213_30606_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F123501_64831_0|SrvcGrp|472|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148255_72703_0|SrvcGrp|24745|2022|PDM|31.50|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F31398_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|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_F100762_51104_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F100790_10512_0|SrvcGrp|73485|2022|PDM|3496.00|99|0.00|AETNA REHAB|
20|FH_F37292_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73010_0_0|SrvcGrp|69962|2022|PCT|0.70|99|0.00|HOME STUDIES|
20|FH_F46094_0_0|SrvcGrp|11072|2022|PDM|100.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F135259_21090_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F123372_0_0|SrvcGrp|10667|2022|PDM|657.00|99|0.00|BOARDER BABY SVCS|
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F109645_0_0|SrvcGrp|34390|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F121090_07848_0|SrvcGrp|108736|2022|PDM|50.00|99|0.00|DRUG TEST PRSMV INSTRUMENT|
20|FH_F115063_78550_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F115064_78582_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F100662_27534_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F109645_0_0|SrvcGrp|103783|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY (MOD GO) (HCFA)|
20|FH_F127036_43724_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F128401_44615_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130850_67401_0|SrvcGrp|27968|2022|PDM|31.00|99|0.00|SKILLED NURSING LPN|
20|FH_F136510_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F149740_33912_0|SrvcGrp|73742|2022|PCT|1.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F109277_0_0|SrvcGrp|3259|2022|PDM|1597.00|99|0.00|ACUTE REHABILITATION|
20|FH_F89453_75069_0|SrvcGrp|87395|2022|PDM|95.00|99|0.00|HCPCS G0153 (HCFA)|
20|FH_F40272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F148319_37042_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120308_07901_0|SrvcGrp|46903|2022|PDM|1095.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F32707_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F148666_34205_0|SrvcGrp|89022|2022|PDM|36.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F33642_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION|
20|FH_F129943_77584_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F39740_0_0|SrvcGrp|20077|2022|PDM|25442.00|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR|
20|FH_F93880_95476_0|SrvcGrp|88977|2022|PDM|14504.00|99|0.00|C-SECTION DELIVERY|
20|FH_F123533_63825_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F123282_03222_0|SrvcGrp|46605|2022|PDM|144.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F143970_92656_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F33642_0_0|SrvcGrp|18200|2022|PCT|0.75|99|0.00|MS DRG 026|
20|FH_F100662_27534_0|SrvcGrp|73659|2022|PDM|5224.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 3 (NO REV)|
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 6 (NO REV)|
20|FH_F135175_45121_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148202_47933_0|SrvcGrp|106054|2022|PCT|1.00|99|0.00|DME|
20|FH_F140929_67206_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148260_0_0|SrvcGrp|101520|2022|PDM|14871.00|99|0.00|T1H W/T/O (<250G)|
20|FH_F117504_31088_0|CSTM-ALL|CSTM-00|2020|PDM|154.77|99|0.00|HOSPICE ROUTINE HOME CARE (DAYS 0-60)|
20|FH_F130500_33317_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128859_57702_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F148182_23324_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F63419_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86872_15215_0|SrvcGrp|21920|2022|PDM|67.50|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F86872_15215_0|SrvcGrp|22389|2022|PDM|15.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F45052_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS|
20|FH_F36788_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F130898_06405_0|SrvcGrp|471|2022|PDM|560.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130166_65065_0|SrvcGrp|3178|2022|PDM|955.00|99|0.00|ACUTE PSYCH|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|234.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 310 W/O REV|
20|FH_F149150_75407_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F85311_18702_0|SrvcGrp|22954|2022|PDM|104.50|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|6050.00|99|0.00|AEG 9 (NO REV)|
20|FH_F126341_27284_0|SrvcGrp|29023|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PDM|1020.00|99|0.00|ASPG IV - FH SW CUSTOM GROUPERS|
20|FH_F136207_0_0|SrvcGrp|73601|2022|PDM|1850.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F88094_0_0|SrvcGrp|3932|2022|PDM|2181.00|99|0.00|LITHOTRIPSY|
20|FH_F132822_95125_0|SrvcGrp|29346|2022|PDM|57.50|99|0.00|SKILLED NURSING- LPN|
20|FH_F145598_23462_0|SrvcGrp|87077|2022|PDM|128.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F138107_15201_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F125133_20601_0|SrvcGrp|110078|2022|PDM|21.22|99|0.00|FOAM DRG >16 <=48 SQ IN W/BDR|
20|FH_F126076_75231_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72584_0_0|SrvcGrp|42824|2022|PDM|120.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145619_17603_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97601_67218_0|SrvcGrp|73559|2022|PDM|11874.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F138471_84663_0|SrvcGrp|88621|2022|PDM|60.75|99|0.00|SKILLED NURSING LPN|
20|FH_F120152_0_0|SrvcGrp|108352|2022|PDM|6600.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F119130_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F119023_91406_0|SrvcGrp|24752|2022|PDM|12.50|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F118914_43015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118943_64506_0|SrvcGrp|14948|2022|PDM|125.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F92506_07666_0|SrvcGrp|112049|2022|PDM|6615.00|99|0.00|VAGINAL DELIVERY (MOTHER & BABY)|
20|FH_F109930_73109_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F117325_19342_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F129483_77030_0|SrvcGrp|26869|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F117098_20186_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117108_37841_0|SrvcGrp|73601|2022|PDM|2000.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F117219_77515_0|SrvcGrp|90854|2022|PDM|675.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F101945_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F38699_0_0|SrvcGrp|21342|2022|PCT|1.05|99|0.00|IMPLANTS|
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_F109652_0_0|SrvcGrp|73004|2022|PDM|3819.00|99|0.00|AEG 8|
20|FH_F109652_0_0|SrvcGrp|72998|2022|PDM|3300.00|99|0.00|AEG 5|
20|FH_F109652_0_0|SrvcGrp|74005|2022|PDM|2759.00|99|0.00|AETNA PET|
20|FH_F38135_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F52152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F50446_0_0|SrvcGrp|33165|2022|PDM|405.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F58272_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP|
20|FH_F111594_0_0|SrvcGrp|88491|2022|PDM|7215.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F148554_85016_0|SrvcGrp|114107|2022|PDM|2949.00|99|0.00|FEM/POPL REVASC W/ STENT|
20|FH_F97103_53295_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F43333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F120032_0_0|CSTM-ALL|CSTM-00|2020|PDM|402.00|99|0.00|AEG 1 (NO REV)|
20|FH_F124928_04210_0|SrvcGrp|97703|2022|PDM|144.58|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F133009_19038_0|SrvcGrp|88620|2022|PDM|107.00|99|0.00|SKILLED NURSING RN|
20|FH_F142043_45503_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F150904_22306_0|SrvcGrp|46605|2022|PDM|137.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F118540_32064_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
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_F122648_0_0|SrvcGrp|82570|2022|PDM|817.00|99|0.00|REVISION EYELID/EXCESS SKIN|
20|FH_F35176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141870_85224_0|SrvcGrp|10577|2022|PDM|35.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F120437_85202_0|SrvcGrp|27615|2022|PDM|140.18|99|0.00|AETNA DRUGS|
20|FH_F118612_21502_0|SrvcGrp|471|2022|PDM|808.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 10 (NO REV)|
20|FH_F140790_0_0|SrvcGrp|46887|2022|PDM|2750.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F101840_76054_0|SrvcGrp|79101|2022|PDM|6260.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F63618_0_0|CSTM-ALL|CSTM-00|2020|PDM|12000.00|99|0.00|GHP CAPITAL REION MED MS DRG|
20|FH_F132571_24739_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|732.16|99|0.00|AEG 10 (NO REV)|
20|FH_F38376_0_0|SrvcGrp|1168|2022|PDM|25.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F39995_0_0|SrvcGrp|97|2022|PDM|3100.00|99|0.00|C-SECTION|
20|FH_F150024_08079_0|SrvcGrp|88740|2022|PDM|750.00|99|0.00|SP BONE ALGRFT|
20|FH_F92676_15063_0|SrvcGrp|110104|2022|PCT|0.85|99|0.00|LAB SERVICES WITH SURGERY|
20|FH_F135714_01922_0|SrvcGrp|80918|2022|PDM|200.00|99|0.00|RESPITE CARE|
20|FH_F132543_79549_0|SrvcGrp|110428|2022|PCT|1.20|99|0.00|LABORATORY SERVICES|
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 4 (NO REV)|
20|FH_F115330_34113_0|SrvcGrp|100499|2022|PDM|385.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F80855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92677_08003_0|SrvcGrp|86834|2022|PDM|15.75|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F67192_0_0|SrvcGrp|13715|2022|PCT|0.52|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F126858_43113_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1688.87|99|0.00|ASPG 902|
20|FH_F141654_15217_0|SrvcGrp|88620|2022|PDM|97.85|99|0.00|SKILLED NURSING RN|
20|FH_F133270_77025_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F126930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F55113_0_0|SrvcGrp|941|2022|PDM|3405.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F49776_0_0|SrvcGrp|3809|2022|PDM|600.00|99|0.00|HOSPICE CARE|
20|FH_F133467_03301_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F92677_08003_0|SrvcGrp|86846|2022|PDM|63.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F136330_0_0|SrvcGrp|11442|2022|PDM|780.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F117366_33162_0|SrvcGrp|86729|2022|PCT|1.00|99|0.00|COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE|
20|FH_F120437_85202_0|SrvcGrp|86121|2022|PDM|49.79|99|0.00|AETNA GAMUNEX-C|
20|FH_F33415_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34706_0_0|SrvcGrp|2077|2022|PDM|37866.00|99|0.00|DRG 515 CV SURG CARDIAC DEFIBRILLATOR|
20|FH_F150120_93619_0|SrvcGrp|75419|2022|PDM|493.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F123181_75057_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F141668_47978_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F86293_0_0|SrvcGrp|33982|2022|PDM|2625.00|99|0.00|CPT 28296|
20|FH_F118845_71111_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F97566_79902_0|SrvcGrp|88978|2022|PDM|7682.00|99|0.00|VAGINAL DELIVERY|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|528.91|99|0.00|HAPA WPA-NWPA 2012-13 ASC 2 W/O REV|
20|FH_F146132_76801_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F106580_33321_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F41429_0_0|SrvcGrp|1306|2022|PDM|263.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF|
20|FH_F150903_45805_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133458_18929_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|ASPG II|
20|FH_F67136_0_0|SrvcGrp|62718|2022|PCT|0.95|99|0.00|TRAUMA|
20|FH_F55375_0_0|SrvcGrp|9774|2022|PDM|3200.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F128325_19904_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126733_83713_0|SrvcGrp|87131|2022|PDM|411.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F146135_87112_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132934_63005_0|SrvcGrp|8|2022|PCT|0.70|99|0.00|BURN INTENSIVE CARE|
20|FH_F103400_33426_0|SrvcGrp|43525|2022|PDM|409.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC|
20|FH_F144789_48304_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F101104_0_0|SrvcGrp|53144|2022|PDM|160.00|99|0.00|SPEECH THERAPY|
20|FH_F142770_51546_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F109561_97216_0|SrvcGrp|92324|2022|PCT|0.00|99|0.00|VBAC DELIVERY|
20|FH_F31466_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|PSYCHIATRIC OP SVCS|
20|FH_F133493_90255_0|SrvcGrp|10944|2022|PDM|1159.00|99|0.00|EMERGENCY ROOM|
20|FH_F133490_90650_0|SrvcGrp|105465|2022|PCT|1.40|99|0.00|AETNA THERAPIES|
20|FH_F125660_46706_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F115383_80734_0|SrvcGrp|104336|2022|PCT|1.00|99|0.00|DENOSUMAB INJECTION|
20|FH_F69648_0_0|SrvcGrp|46424|2022|PDM|11.25|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F146211_68144_0|SrvcGrp|27261|2022|PDM|14473.00|99|0.00|CPT 27446|
20|FH_F88280_0_0|SrvcGrp|10523|2022|PDM|475.00|99|0.00|EMERGENCY ROOM|
20|FH_F133495_70301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F31928_0_0|SrvcGrp|9998|2022|PCT|0.85|99|0.00|OP SURG|
20|FH_F100841_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F82813_0_0|SrvcGrp|73000|2022|PDM|1223.00|99|0.00|AEG 6|
20|FH_F120954_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|SKILLED NURSING|
20|FH_F133341_23860_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 4 (NO REV)|
20|FH_F132934_63005_0|SrvcGrp|74581|2022|PCT|0.50|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F145288_45345_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97542_32960_0|SrvcGrp|73659|2022|PDM|6238.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F148494_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F151151_76504_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151155_26508_0|SrvcGrp|69073|2022|PDM|189.00|99|0.00|CPT 99215|
20|FH_F121385_89102_0|SrvcGrp|82037|2022|PDM|7298.00|99|0.00|AETNA ICU|
20|FH_F121385_89102_0|SrvcGrp|79099|2022|PDM|4819.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F121385_89102_0|SrvcGrp|72984|2022|PCT|2.07|99|0.00|CHEMOTHERAPY|
20|FH_F121930_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F129130_92562_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138742_33125_0|SrvcGrp|89417|2022|PDM|225.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F139128_49503_0|SrvcGrp|74668|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139377_02301_0|SrvcGrp|46903|2022|PDM|347.39|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F150882_84041_0|SrvcGrp|14893|2022|PDM|52.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F124441_0_0|SrvcGrp|100059|2022|PDM|3040.00|99|0.00|REPAIR ULNA FRACTURE|
20|FH_F94643_90501_0|SrvcGrp|22593|2022|PDM|35.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F122260_98034_0|SrvcGrp|79237|2022|PDM|1100.00|99|0.00|VBAC DELIVERY|
20|FH_F122282_30080_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125656_92868_0|SrvcGrp|86847|2022|PDM|35.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F37960_0_0|SrvcGrp|9480|2022|PDM|1010.00|99|0.00|CD RESIDENTIAL TREATMENT|
20|FH_F97184_26101_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F147213_48609_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IP MULTI ROOM COMPARISON|
20|FH_F97280_20018_0|SrvcGrp|88977|2022|PDM|6574.00|99|0.00|C-SECTION DELIVERY|
20|FH_F132039_92008_0|SrvcGrp|87317|2022|PDM|1100.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F117762_0_0|SrvcGrp|88024|2022|PDM|7280.00|99|0.00|REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION|
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG II|
20|FH_F100663_56537_0|SrvcGrp|73601|2022|PDM|5262.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F109460_98003_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|GENERAL ACUTE CARE|
20|FH_F138478_0_0|SrvcGrp|109495|2022|PDM|6861.39|99|0.00|INSERT PULSE GEN DUAL LEADS|
20|FH_F122323_60450_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124441_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F149000_07701_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F141330_65075_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139167_42240_0|SrvcGrp|90854|2022|PDM|820.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F124452_31322_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|1525.00|99|0.00|AEG 6 (NO REV)|
20|FH_F122277_98045_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134410_46807_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F36299_0_0|SrvcGrp|21976|2022|PCT|0.75|99|0.00|LAPAROSCOPIC SERVICES|
20|FH_F36663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S MOD KF (CPD 1364768)|
20|FH_F84652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F75963_0_0|SrvcGrp|48398|2022|PDM|18.00|99|0.00|PT SERVICES|
20|FH_F79644_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|AMBULANCE F/S -  JRCH|
20|FH_F85211_0_0|SrvcGrp|83626|2022|PDM|2310.00|99|0.00|ORTHO SHOULDER PROCEDURES|
20|FH_F75842_0_0|SrvcGrp|12343|2022|PDM|5468.18|99|0.00|PET SCAN|
20|FH_F146668_30189_0|SrvcGrp|107983|2022|PDM|4850.00|99|0.00|PART REMOVAL OF ANKLE/HEEL|
20|FH_F120795_27514_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F120795_27514_0|SrvcGrp|11000|2022|PCT|0.58|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F133583_77074_0|SrvcGrp|89149|2022|PDM|234.00|99|0.00|OP INTENSIVE|
20|FH_F133269_78624_0|SrvcGrp|73841|2022|PDM|410.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F133272_23834_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130657_04614_0|SrvcGrp|73806|2022|PCT|0.86|99|0.00|AETNA ER|
20|FH_F131702_17022_0|SrvcGrp|46605|2022|PDM|117.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F111584_07002_0|SrvcGrp|69073|2022|PDM|144.00|99|0.00|CPT 99215|
20|FH_F111603_19529_0|SrvcGrp|89149|2022|PDM|161.00|99|0.00|OP INTENSIVE|
20|FH_F151139_0_0|SrvcGrp|100960|2022|PDM|79.00|99|0.00|FIXED WING AIR MILEAGE|
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|854.00|99|0.00|AEG 3 (NO REV)|
20|FH_F87474_0_0|SrvcGrp|10648|2022|PDM|6.00|99|0.00|HOME INFUSION|
20|FH_F136467_0_0|SrvcGrp|89980|2022|PDM|1624.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F46832_0_0|SrvcGrp|17005|2022|PDM|81.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS|
20|FH_F151559_0_0|SrvcGrp|79238|2022|PDM|625.00|99|0.00|TRANSFER|
20|FH_F64999_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ASPG III|
20|FH_F118152_20151_0|SrvcGrp|86831|2022|PDM|4.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F118198_38119_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F120418_43015_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F134011_84102_0|SrvcGrp|86845|2022|PDM|25.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F134011_84102_0|SrvcGrp|86841|2022|PDM|50.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F134126_11554_0|SrvcGrp|73806|2022|PDM|1070.00|99|0.00|AETNA ER|
20|FH_F142413_61342_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F142730_20646_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138468_63128_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F78402_15905_0|SrvcGrp|9494|2022|PDM|1030.00|99|0.00|SUBACUTE CARE|
20|FH_F78404_16646_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140343_89052_0|SrvcGrp|86846|2022|PDM|30.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F140407_63841_0|SrvcGrp|16|2022|PDM|427.00|99|0.00|ACUTE REHABILITATION|
20|FH_F120152_0_0|SrvcGrp|93071|2022|PDM|11000.00|99|0.00|POSTERIOR SEGMENTAL INSTRU|
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 10 (NO REV)|
20|FH_F149511_62626_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92533_27810_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F109920_39180_0|SrvcGrp|75485|2022|PDM|990.00|99|0.00|AEG 4|
20|FH_F109925_81301_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F109982_33592_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F147725_06002_0|SrvcGrp|114518|2022|PDM|4300.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F129477_70403_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F117093_40041_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F117131_45209_0|SrvcGrp|100499|2022|PDM|879.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F34371_0_0|SrvcGrp|10545|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F39538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F109632_0_0|SrvcGrp|87537|2022|PDM|927.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F111593_0_0|SrvcGrp|14614|2022|PDM|8250.00|99|0.00|LITHOTRIPSY|
20|FH_F91472_96001_0|SrvcGrp|83418|2022|PDM|131000.00|99|0.00|NEURO-SPINE SURGERY|
20|FH_F129053_0_0|SrvcGrp|70746|2022|PDM|1665.00|99|0.00|CPT 28292|
20|FH_F114630_48205_0|SrvcGrp|3178|2022|PDM|832.00|99|0.00|ACUTE PSYCH|
20|FH_F109513_0_0|SrvcGrp|90421|2022|PDM|4000.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F55113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F150903_45805_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117366_33162_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F151142_35406_0|CSTM-ALL|CSTM-00|2020|PDM|1398.00|99|0.00|AEG 8 (NO REV)|
20|FH_F151144_35801_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 10 (NO REV)|
20|FH_F151155_26508_0|SrvcGrp|113332|2022|PDM|1660.00|99|0.00|MED TX NALTREXONE|
20|FH_F151155_26508_0|SrvcGrp|58699|2022|PDM|265.00|99|0.00|EVALUATION & MANAGEMENT NEW PATIENT (HCFA)|
20|FH_F151179_84074_0|SrvcGrp|73000|2022|PDM|1260.00|99|0.00|AEG 6|
20|FH_F121936_17543_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97721_01053_0|SrvcGrp|73656|2022|PDM|586.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F114916_30309_0|SrvcGrp|105633|2022|PDM|4000.00|99|0.00|LENGTHENING OF FEMUR|
20|FH_F114916_30309_0|SrvcGrp|98003|2022|PDM|3000.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F114916_30309_0|CSTM-ALL|CSTM-00|2020|PDM|1217.00|99|0.00|AEG 5  (NO REV)|
20|FH_F100640_48097_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F117623_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|MULT FAM BEHAV TREAT GUIDE (HCFA)|
20|FH_F39209_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F44172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110211_78666_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138929_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132627_0_0|SrvcGrp|88620|2022|PDM|133.00|99|0.00|SKILLED NURSING RN|
20|FH_F132988_0_0|SrvcGrp|112149|2022|PDM|1154.34|99|0.00|TREAT SHOULDER DISLOCATION|
20|FH_F79824_0_0|SrvcGrp|17079|2022|PDM|3261.00|99|0.00|ASPG VIII|
20|FH_F124173_66215_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121687_04401_0|SrvcGrp|108924|2022|PCT|1.38|99|0.00|CHEMOTHERAPY ADMINISTRATION|
20|FH_F126003_79403_0|SrvcGrp|73841|2022|PDM|597.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 10 (NO REV)|
20|FH_F50657_0_0|SrvcGrp|31188|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC (DME)|
20|FH_F133808_73401_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F144228_0_0|SrvcGrp|108306|2022|PDM|5695.00|99|0.00|AETNA REPAIR ULNA FRACTURE|
20|FH_F133585_0_0|SrvcGrp|108195|2022|PDM|2922.00|99|0.00|LAP INSERT TUNNEL IP CATH|
20|FH_F134608_18017_0|SrvcGrp|82738|2022|PDM|11.00|99|0.00|NON-AUTOMATED WITHOUT MICRO|
20|FH_F128816_43537_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F100782_0_0|SrvcGrp|105064|2022|PDM|725.59|99|0.00|WINDBER MEDICAL CNTR ASC 109|
20|FH_F83113_0_0|SrvcGrp|9828|2022|PDM|39.00|99|0.00|HOME HEALTH AIDE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|362.08|99|0.00|HAPA WPA-NWPA 2012-13 ASC 218 W/O REV|
20|FH_F120930_0_0|SrvcGrp|26278|2022|PDM|2000.00|99|0.00|CPT 29881|
20|FH_F149268_74820_0|SrvcGrp|78504|2022|PCT|0.85|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F150161_63361_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145604_14850_0|SrvcGrp|19742|2022|PDM|80.00|99|0.00|MID-LINE INSERTION|
20|FH_F70883_0_0|SrvcGrp|9829|2022|PDM|66.00|99|0.00|PT SVCS|
20|FH_F32998_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120719_27540_0|SrvcGrp|116117|2022|PCT|2.81|99|0.00|COVID-19 TESTING|
20|FH_F150199_62226_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146124_06112_0|CSTM-ALL|CSTM-00|2020|PDM|4009.00|99|0.00|AEG 2 (NO REV)|
20|FH_F130763_0_0|SrvcGrp|88159|2022|PDM|7319.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F138240_64114_0|SrvcGrp|48385|2022|PDM|122.00|99|0.00|SPEECH THERAPY|
20|FH_F134613_08852_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|1145.00|99|0.00|AEG 4 (NO REV)|
20|FH_F129101_27006_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F85416_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.06|99|0.00|OP SVCS|
20|FH_F72963_0_0|SrvcGrp|45386|2022|PDM|5000.00|99|0.00|DA VINCI ROBOTIC SURGERY|
20|FH_F63625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP CLINIC|
20|FH_F146855_60069_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F127656_06068_0|SrvcGrp|94781|2022|PDM|161.70|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F133478_40165_0|SrvcGrp|29606|2022|PDM|55498.00|99|0.00|MS DRG 218 ONLY|
20|FH_F132028_68776_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F133491_74012_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131702_17022_0|SrvcGrp|29346|2022|PDM|56.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F117199_0_0|CSTM-ALL|CSTM-00|2020|PDM|733.22|99|0.00|AEG 1 (NO REV)|
20|FH_F46433_0_0|SrvcGrp|24746|2022|PDM|85.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 2 (NO REV)|
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|1741.00|99|0.00|AEG 5  (NO REV)|
20|FH_F120612_23314_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F150939_0_0|SrvcGrp|100262|2022|PDM|100.00|99|0.00|TREAT DEHISCENCE W/ PACKING|
20|FH_F36261_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F37257_0_0|SrvcGrp|13749|2022|PDM|650.00|99|0.00|OP MRI|
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 4 (NO REV)|
20|FH_F114853_0_0|SrvcGrp|41334|2022|PDM|7215.00|99|0.00|TOTAL KNEE|
20|FH_F67167_0_0|SrvcGrp|361|2022|PDM|3382.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F32886_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|388.80|99|0.00|HAPA WPA-NWPA 2012-13 ASC 308 W/O REV|
20|FH_F113527_31023_0|SrvcGrp|10391|2022|PDM|1528.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F151380_90701_0|SrvcGrp|110812|2022|PDM|234.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F151460_68137_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F151501_30265_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 1 (NO REV)|
20|FH_F151511_14094_0|SrvcGrp|114288|2022|PCT|0.00|99|0.00|PROFESSIONAL FEES (NON-CLINICAL)|
20|FH_F145148_60162_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128244_62254_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135473_33759_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91766_25401_0|SrvcGrp|88621|2022|PDM|126.00|99|0.00|SKILLED NURSING LPN|
20|FH_F100880_67735_0|SrvcGrp|73603|2022|PDM|5227.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F130620_18940_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F116455_26003_0|SrvcGrp|471|2022|PDM|531.25|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F116501_17801_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130766_04967_0|SrvcGrp|105465|2022|PCT|0.88|99|0.00|AETNA THERAPIES|
20|FH_F38686_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46918_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129967_18915_0|SrvcGrp|91393|2022|PDM|74.80|99|0.00|AETNA OFFICE OPT VISIT EST (MOD AF)|
20|FH_F111301_33122_0|SrvcGrp|109057|2022|PCT|0.84|99|0.00|CARDIAC STUDIES|
20|FH_F134315_89106_0|SrvcGrp|29076|2022|PCT|1.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F40174_0_0|SrvcGrp|16746|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG II|
20|FH_F134930_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_F131000_0_0|SrvcGrp|82107|2022|PDM|3343.00|99|0.00|SHOULDER ARTHROSCOPY|
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|36591|2022|PDM|4323.00|99|0.00|CPT 63685|
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|2006 MEDICARE ASPG VI|
20|FH_F55895_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F113487_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F87557_33309_0|SrvcGrp|86852|2022|PDM|30.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F88831_84123_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F91619_32091_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F123036_0_0|SrvcGrp|96104|2022|PDM|376.00|99|0.00|IMPLANTABLE NEUROSTIMULATOR|
20|FH_F123036_0_0|SrvcGrp|40002|2022|PDM|13393.00|99|0.00|TOTAL HIP|
20|FH_F102325_62691_0|SrvcGrp|22589|2022|PDM|80.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F102325_62691_0|SrvcGrp|17015|2022|PDM|19.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132090_60915_0|SrvcGrp|94568|2022|PDM|3501.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY|
20|FH_F121989_43026_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F113906_0_0|SrvcGrp|72996|2022|PDM|665.00|99|0.00|AEG 4|
20|FH_F37333_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|RS 580 MRI CODES|
20|FH_F97720_70084_0|SrvcGrp|73659|2022|PDM|6716.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F116323_0_0|SrvcGrp|105657|2022|PDM|322.00|99|0.00|C-ARM AND LASER FLUOROSCOPY (HCFA)|
20|FH_F72939_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F87054_0_0|SrvcGrp|72996|2022|PDM|1024.00|99|0.00|AEG 4|
20|FH_F114864_78155_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100640_48097_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F105591_17601_0|SrvcGrp|73000|2022|PDM|1567.00|99|0.00|AEG 6|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC|
20|FH_F138929_0_0|SrvcGrp|99161|2022|PDM|17600.00|99|0.00|CPT 27138|
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|AEG 9 (NO REV)|
20|FH_F94740_32904_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F95341_08701_0|SrvcGrp|86323|2022|PCT|0.80|99|0.00|OTORHINOLARYNGOLOGIC SERVICES|
20|FH_F132988_0_0|SrvcGrp|112163|2022|PDM|12588.77|99|0.00|REVISE RECONST ELBOW JOINT|
20|FH_F133002_0_0|SrvcGrp|112173|2022|PDM|1716.00|99|0.00|SUBCONJUNCTIVE PLACEMENT|
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 6 (NO REV)|
20|FH_F144828_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F88933_0_0|SrvcGrp|16241|2022|PDM|1800.00|99|0.00|SHOULDER SCOPE|
20|FH_F141036_02347_0|CSTM-ALL|CSTM-00|2020|PDM|330.00|99|0.00|COVID-19 INFUSION ADMINISTRATION - ELI LILLY|
20|FH_F50415_0_0|SrvcGrp|44705|2022|PDM|70.00|99|0.00|NURSING CARE|
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_F119214_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F141336_16947_0|SrvcGrp|113615|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F42042_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146990_80206_0|SrvcGrp|108484|2022|PDM|530.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F124246_71655_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F136657_70806_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F136701_45150_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114638_25309_0|SrvcGrp|109057|2022|PCT|0.75|99|0.00|CARDIAC STUDIES|
20|FH_F114645_34952_0|SrvcGrp|73842|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F113787_31909_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F113913_70065_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138527_64506_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F42940_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.75|99|0.00|HSS APC HOLD HARMLESS|
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|814.00|99|0.00|WELLPATH PROPIETARY ASC III|
20|FH_F136796_24016_0|CSTM-ALL|CSTM-00|2020|PDM|1102.44|99|0.00|AEG 2 (NO REV)|
20|FH_F136913_68803_0|SrvcGrp|81656|2022|PDM|15785.00|99|0.00|MS DRG 789 ONLY|
20|FH_F112187_98272_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|797.50|99|0.00|AEG 2 (NO REV)|
20|FH_F74283_0_0|SrvcGrp|17139|2022|PDM|540.00|99|0.00|HOSPICE CARE|
20|FH_F115631_65201_0|SrvcGrp|88163|2022|PDM|7575.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F115728_78404_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147440_71334_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F42176_0_0|SrvcGrp|177|2022|PDM|1100.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F138467_32216_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F139550_75219_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F150745_03301_0|SrvcGrp|29155|2022|PDM|212.00|99|0.00|HOSPICE SVCS|
20|FH_F150768_03054_0|SrvcGrp|73742|2022|PDM|9.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F150820_83843_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 10 (NO REV)|
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AEG 7 (NO REV)|
20|FH_F89851_83854_0|SrvcGrp|75228|2022|PCT|1.35|99|0.00|AETNA IMPLANTS|
20|FH_F90455_0_0|SrvcGrp|46104|2022|PDM|128.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F36943_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD AV|
20|FH_F151679_62881_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|376.42|99|0.00|SALLY BALIN,999182,ASC 305|
20|FH_F147532_0_0|SrvcGrp|89781|2022|PDM|144.84|99|0.00|RESPITE CARE (HCFA)|
20|FH_F111265_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|84279|2022|PDM|2392.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F40853_0_0|SrvcGrp|592|2022|PDM|240.00|99|0.00|SUB-ACUTE CARE|
20|FH_F36720_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2004 NATIONAL OTHER DIAGNOSTIC F/S|
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_F36803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CV SURGERY|
20|FH_F36992_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD 26|
20|FH_F133002_0_0|CSTM-ALL|CSTM-00|2020|PDM|2834.00|99|0.00|DEVICE INSERTION|
20|FH_F136818_0_0|SrvcGrp|112935|2022|PDM|10000.00|99|0.00|KNEES, HIP & JOINT RECONSTRUCTION|
20|FH_F141014_29732_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141050_46410_0|SrvcGrp|88620|2022|PDM|115.00|99|0.00|SKILLED NURSING RN|
20|FH_F141127_62286_0|SrvcGrp|75506|2022|PCT|0.80|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F119214_0_0|SrvcGrp|75481|2022|PDM|737.00|99|0.00|AEG 2|
20|FH_F126345_0_0|SrvcGrp|73004|2022|PDM|1336.00|99|0.00|AEG 8|
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|SrvcGrp|68800|2022|PDM|875.00|99|0.00|REPAIR OF RETINAL DETACHMENT|
20|FH_F119603_0_0|SrvcGrp|82981|2022|PDM|185.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F55812_0_0|SrvcGrp|10544|2022|PDM|73.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F72085_0_0|SrvcGrp|44248|2022|PDM|168.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F35448_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|AMBULANCE SERVICES|
20|FH_F122170_60120_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124129_33603_0|SrvcGrp|109330|2022|PCT|1.03|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F146807_28655_0|SrvcGrp|103913|2022|PCT|0.85|99|0.00|OP DIALYSIS|
20|FH_F146894_73505_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42363_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F100000_45417_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F124183_01109_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F124584_28204_0|SrvcGrp|73842|2022|PDM|223.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124679_64052_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F127995_84010_0|SrvcGrp|94780|2022|PDM|107.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F55694_0_0|SrvcGrp|28170|2022|PDM|3497.00|99|0.00|ICU/CCU|
20|FH_F101702_0_0|SrvcGrp|111497|2022|PDM|3873.00|99|0.00|ONCOLOGY BREAST MRNA|
20|FH_F128188_0_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F136657_70806_0|SrvcGrp|74668|2022|PDM|218.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114666_30342_0|SrvcGrp|35668|2022|PDM|2000.00|99|0.00|CPT 29824|
20|FH_F114666_30342_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 4 (NO REV)|
20|FH_F113830_96002_0|SrvcGrp|73842|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139655_17078_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PDM|30.00|99|0.00|MANUAL HAND MUSCLE TESTING|
20|FH_F100664_03104_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|892.00|99|0.00|2005 ASPG GROUPER III|
20|FH_F122610_73139_0|SrvcGrp|72990|2022|PDM|3578.00|99|0.00|AEG 1|
20|FH_F122740_71038_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F43295_0_0|SrvcGrp|9539|2022|PDM|555.00|99|0.00|SUBACUTE CARE|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PDM|387.00|99|0.00|ASPG I|
20|FH_F134689_60190_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F134727_30650_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 3 (NO REV)|
20|FH_F136772_89109_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136813_06518_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F115210_21043_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AEG 7 (NO REV)|
20|FH_F130152_48025_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F33925_0_0|SrvcGrp|18143|2022|PDM|9500.00|99|0.00|MS DRG 247|
20|FH_F35685_0_0|SrvcGrp|16|2022|PDM|1213.00|99|0.00|ACUTE REHABILITATION|
20|FH_F36132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F103004_75840_0|SrvcGrp|73008|2022|PDM|714.00|99|0.00|AEG 10|
20|FH_F36704_0_0|SrvcGrp|6|2022|PCT|0.85|99|0.00|OP SURGERY|
20|FH_F109279_0_0|SrvcGrp|79588|2022|PDM|600.00|99|0.00|CPT 43235|
20|FH_F134087_0_0|SrvcGrp|67119|2022|PDM|9017.00|99|0.00|ARTHODESIS|
20|FH_F113154_70359_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1332.00|99|0.00|AEG 5  (NO REV)|
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|2195.00|99|0.00|AEG 10 (NO REV)|
20|FH_F54552_0_0|SrvcGrp|24750|2022|PDM|80.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F113585_20155_0|SrvcGrp|10577|2022|PDM|50.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F113585_20155_0|SrvcGrp|86840|2022|PDM|60.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F138681_39301_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138876_25302_0|SrvcGrp|22389|2022|PDM|15.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F151302_80227_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F151321_92626_0|SrvcGrp|46903|2022|PDM|650.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F151439_18104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151501_30265_0|SrvcGrp|109068|2022|PDM|2090.00|99|0.00|PARTIAL REMOVAL OF FOOT BONE|
20|FH_F144989_07701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97501_31501_0|CSTM-ALL|CSTM-00|2020|PCT|0.36|99|0.00|OP SVCS|
20|FH_F135583_17331_0|SrvcGrp|38252|2022|PDM|53549.00|99|0.00|MS DRG 460-470 ONLY|
20|FH_F136016_67209_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136147_63901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130756_04901_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 1 (NO REV)|
20|FH_F131112_99163_0|SrvcGrp|73842|2022|PDM|159.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133468_74873_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F140629_0_0|SrvcGrp|44067|2022|PDM|1016.00|99|0.00|CPT 52240|
20|FH_F48258_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101200_19020_0|SrvcGrp|86749|2022|PCT|1.05|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F121763_07202_0|SrvcGrp|537|2022|PDM|2851.00|99|0.00|OBSERVATION SERVICES|
20|FH_F151143_0_0|SrvcGrp|12869|2022|PDM|155.00|99|0.00|AIR AMBULANCE|
20|FH_F36341_0_0|SrvcGrp|16876|2022|PDM|759.00|99|0.00|SLEEP STUDIES|
20|FH_F141511_0_0|SrvcGrp|73483|2022|PCT|0.00|99|0.00|AETNA SUBACUTE III|
20|FH_F102525_73134_0|SrvcGrp|80679|2022|PCT|1.10|99|0.00|AETNA RADIOLOGY|
20|FH_F117711_73080_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F132235_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F42165_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|PEDIATRIC IP SVCS|
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1569.00|99|0.00|AEG 6 (NO REV)|
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 2 (NO REV)|
20|FH_F102069_19034_0|SrvcGrp|94880|2022|PDM|131.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F131069_54724_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F102163_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F40607_0_0|SrvcGrp|27173|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F148963_56301_0|SrvcGrp|75419|2022|PDM|370.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F36892_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F41033_0_0|SrvcGrp|17081|2022|PDM|1473.00|99|0.00|ASPG IX|
20|FH_F74902_0_0|SrvcGrp|72079|2022|PCT|1.00|99|0.00|VACCINES AND ADMINISTRATION|
20|FH_F124288_15701_0|SrvcGrp|75479|2022|PDM|317.00|99|0.00|AEG 1|
20|FH_F101441_0_0|SrvcGrp|97362|2022|PDM|7946.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1158.00|99|0.00|COVENTRY ENHANCED GROUPER 5 MOD 50|
20|FH_F150982_0_0|SrvcGrp|26277|2022|PDM|2202.00|99|0.00|CPT 29874|
20|FH_F39772_0_0|SrvcGrp|39459|2022|PCT|1.05|99|0.00|AZT (ZIDOVUDINE)|
20|FH_F124441_0_0|SrvcGrp|15473|2022|PDM|2375.00|99|0.00|CPT CODE 42820|
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_F148883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F33719_0_0|SrvcGrp|62|2022|PCT|0.80|99|0.00|HEART TRANSPLANT|
20|FH_F131028_49735_0|SrvcGrp|97703|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F131449_19073_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F124760_34997_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F124322_64131_0|SrvcGrp|14947|2022|PDM|5.00|99|0.00|HOME INFUSION|
20|FH_F147180_19050_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137767_01841_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|AEG 3 (NO REV)|
20|FH_F35088_0_0|SrvcGrp|16|2022|PDM|1515.00|99|0.00|ACUTE REHABILITATION|
20|FH_F125762_66701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116806_0_0|SrvcGrp|107127|2022|PDM|887.26|99|0.00|DRAINAGE OF THROAT ABSCESS|
20|FH_F35987_0_0|SrvcGrp|97|2022|PDM|5156.00|99|0.00|C-SECTION|
20|FH_F113957_73554_0|SrvcGrp|72992|2022|PDM|1050.00|99|0.00|AEG 2|
20|FH_F137719_28269_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F35990_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F138017_73129_0|CSTM-ALL|CSTM-00|2020|PDM|2345.00|99|0.00|AEG 6 (NO REV)|
20|FH_F128155_62249_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_F93377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139147_0_0|SrvcGrp|79594|2022|PDM|1804.00|99|0.00|CPT 45380|
20|FH_F148882_20814_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F120119_0_0|SrvcGrp|42550|2022|PDM|1057.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F138410_19130_0|SrvcGrp|113171|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F134676_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F92300_37303_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F140295_0_0|SrvcGrp|41334|2022|PDM|20085.00|99|0.00|TOTAL KNEE|
20|FH_F143347_16001_0|SrvcGrp|22380|2022|PCT|2.00|99|0.00|CPT CODE 94060|
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|986.00|99|0.00|AEG 3 (NO REV)|
20|FH_F102224_0_0|SrvcGrp|88487|2022|PDM|4000.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F131173_17043_0|SrvcGrp|94780|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F151719_02138_0|SrvcGrp|98701|2022|PDM|238.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F48476_0_0|SrvcGrp|36068|2022|PDM|45.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F48994_0_0|SrvcGrp|86340|2022|PCT|1.00|99|0.00|HCPC IMPLANT & PROSTHESIS|
20|FH_F120196_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F120225_29644_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F116756_77477_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F125012_64658_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F84394_17402_0|SrvcGrp|96539|2022|PDM|7240.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F39028_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME EXCLUSIONS|
20|FH_F44438_0_0|SrvcGrp|2741|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F140007_0_0|SrvcGrp|112026|2022|PDM|7887.00|99|0.00|TOTAL KNEE ARTHROPLASTY|
20|FH_F56753_15086_0|SrvcGrp|10431|2022|PDM|78.00|99|0.00|SPEECH THERAPY|
20|FH_F120112_0_0|SrvcGrp|95660|2022|PDM|446.25|99|0.00|HOSPICE SERVICES (HCFA)|
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_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|3203.00|99|0.00|AEG 6 (NO REV)|
20|FH_F119417_78212_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F137951_0_0|SrvcGrp|67065|2022|PDM|3000.00|99|0.00|CERVICAL SURGERY|
20|FH_F148554_85016_0|CSTM-ALL|CSTM-00|2020|PDM|802.00|99|0.00|AEG 5  (NO REV)|
20|FH_F148644_06890_0|SrvcGrp|78096|2022|PDM|6479.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F120837_33309_0|SrvcGrp|86722|2022|PDM|238.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F142759_15074_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143057_15767_0|SrvcGrp|74668|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F43018_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F101840_76054_0|SrvcGrp|47040|2022|PDM|21185.00|99|0.00|MS DRG 749 ONLY|
20|FH_F126735_38018_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133565_32570_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111292_33136_0|SrvcGrp|82747|2022|PDM|64.00|99|0.00|THROMBOPLASTIN TIME PARTIAL|
20|FH_F111292_33136_0|SrvcGrp|82758|2022|PDM|59.00|99|0.00|CHEMISTRY|
20|FH_F111303_19087_0|SrvcGrp|86747|2022|PCT|1.05|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F134260_02155_0|SrvcGrp|89149|2022|PDM|215.00|99|0.00|OP INTENSIVE|
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_F59052_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|ER/URGENT CARE SERVICES|
20|FH_F40698_0_0|SrvcGrp|13640|2022|PDM|90.00|99|0.00|CPT 99202|
20|FH_F101442_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F125253_15601_0|SrvcGrp|76501|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F130206_78209_0|SrvcGrp|108484|2022|PDM|489.25|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F96960_35404_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F132544_0_0|SrvcGrp|97199|2022|PDM|7850.00|99|0.00|THORAX SPINE DISK SURGERY|
20|FH_F132544_0_0|SrvcGrp|96355|2022|PDM|7850.00|99|0.00|SPINE FIXATION|
20|FH_F119496_37917_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138283_0_0|SrvcGrp|43567|2022|PDM|112.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F133427_48811_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F40542_0_0|SrvcGrp|12163|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F46196_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F126735_38018_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1158.00|99|0.00|ASPG IV|
20|FH_F92676_15063_0|SrvcGrp|79094|2022|PDM|72.45|99|0.00|MON VALLEY ASC 1001|
20|FH_F141872_20707_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 6 (NO REV)|
20|FH_F128299_44134_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F132285_89103_0|SrvcGrp|27968|2022|PDM|35.00|99|0.00|SKILLED NURSING LPN|
20|FH_F67065_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1105.00|99|0.00|ASPG IV|
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 5  (NO REV)|
20|FH_F149840_80002_0|SrvcGrp|87393|2022|PDM|135.00|99|0.00|HCPCS G0151 (HCFA)|
20|FH_F145964_10993_0|SrvcGrp|73665|2022|PCT|1.29|99|0.00|OTHER OP DRUGS|
20|FH_F132594_78229_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133287_40215_0|SrvcGrp|99363|2022|PDM|151.00|99|0.00|SCR MAMMO BI INCL CAD|
20|FH_F34888_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F91255_19401_0|SrvcGrp|17100|2022|PDM|2247.00|99|0.00|SKILLED NURSING|
20|FH_F141870_85224_0|SrvcGrp|86852|2022|PDM|40.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F72226_65804_0|SrvcGrp|114014|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90811_0_0|SrvcGrp|86460|2022|PDM|2700.00|99|0.00|REVISE BREAST RECONSTRUCTION|
20|FH_F91155_16105_0|SrvcGrp|74666|2022|PDM|18.42|99|0.00|AETNA PHYSICIAN SERVICES|
20|FH_F105921_80014_0|SrvcGrp|73701|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F109840_62832_0|SrvcGrp|89922|2022|PCT|0.80|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F97560_23249_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|192.40|99|0.00|HAPA WPA-NWPA 2012-13 ASC 130 W/O REV|
20|FH_F108700_63857_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F128421_27016_0|SrvcGrp|73601|2022|PCT|0.80|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F97543_33542_0|SrvcGrp|73603|2022|PDM|3563.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F45915_0_0|SrvcGrp|33166|2022|PDM|650.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F103360_68845_0|SrvcGrp|98255|2022|PDM|12756.00|99|0.00|EP/CARDIAC PROCEDURES|
20|FH_F133460_63031_0|SrvcGrp|99064|2022|PCT|1.08|99|0.00|RADIOLOGY SERVICES|
20|FH_F101840_76054_0|SrvcGrp|81779|2022|PCT|1.50|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F117901_27526_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111461_32607_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|PDM|1569.00|99|0.00|AEG 8 (NO REV)|
20|FH_F51438_0_0|SrvcGrp|10400|2022|PDM|1345.00|99|0.00|IP SURGERY|
20|FH_F146139_37604_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92648_90248_0|SrvcGrp|73700|2022|PDM|42.59|99|0.00|AETNA - SKILLED NURSING|
20|FH_F133493_90255_0|SrvcGrp|106251|2022|PCT|1.40|99|0.00|LABORATORY SERVICES|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|316.70|99|0.00|ASPG 217|
20|FH_F125176_20785_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F87295_40351_0|SrvcGrp|72980|2022|PCT|1.25|99|0.00|AETNA LABORATORY|
20|FH_F130599_41472_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141835_78676_0|SrvcGrp|75419|2022|PDM|475.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F116988_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F115330_34113_0|SrvcGrp|73842|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F101840_76054_0|SrvcGrp|78093|2022|PDM|6260.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F45436_0_0|SrvcGrp|9828|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE|
20|FH_F139825_0_0|SrvcGrp|109759|2022|PDM|5738.00|99|0.00|REMOVAL CORNEAL EPITHELIUM|
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_F69104_0_0|SrvcGrp|58670|2022|PDM|1794.57|99|0.00|ASC CARVE OUTS 29848, 29877, 29880-29881|
20|FH_F133018_84037_0|SrvcGrp|29023|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F125660_46706_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F43411_0_0|SrvcGrp|40820|2022|PDM|2475.00|99|0.00|ICU/CCU|
20|FH_F150948_0_0|SrvcGrp|89842|2022|PDM|10500.00|99|0.00|LUMBAR|
20|FH_F97041_71603_0|SrvcGrp|88977|2022|PDM|7552.00|99|0.00|C-SECTION DELIVERY|
20|FH_F109846_16502_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F33517_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F41173_0_0|CSTM-ALL|CSTM-00|2020|PDM|364.00|99|0.00|CHILD RESIDENTIAL TREATMENT|
20|FH_F142900_32792_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141657_85715_0|SrvcGrp|46903|2022|PDM|630.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F117786_71446_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|404.36|99|0.00|HAPA WPA-NWPA 2012-13 ASC 104 W/O REV|
20|FH_F132729_0_0|SrvcGrp|58|2022|PDM|9668.00|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F150660_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F32524_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.25|99|0.00|OP SVCS|
20|FH_F119076_41001_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F43411_0_0|SrvcGrp|12290|2022|PDM|1225.00|99|0.00|DETOXIFICATION|
20|FH_F43411_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|ACUTE PSYCH|
20|FH_F145988_06105_0|SrvcGrp|73805|2022|PDM|25698.00|99|0.00|AETNA MSDRG 621 ONLY|
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1947.61|99|0.00|ASPG X|
20|FH_F149882_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F126030_29835_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F121223_0_0|SrvcGrp|108180|2022|PDM|435.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F94300_0_0|SrvcGrp|93666|2022|PDM|2310.00|99|0.00|IMMEDIATE BREAST PROSTHESIS - HCFA|
20|FH_F88280_0_0|SrvcGrp|107734|2022|PDM|4306.00|99|0.00|VAGINAL DELIVERY|
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 3 (NO REV)|
20|FH_F111813_08080_0|SrvcGrp|96400|2022|PCT|1.00|99|0.00|INTERFERON ALFACON|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU"|
20|FH_F142897_07018_0|SrvcGrp|111926|2022|PCT|1.00|99|0.00|COVID-19 LAB TESTING|
20|FH_F127410_53551_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149840_80002_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANESTHESIOLOGIST/CRNA (HAN1)|
20|FH_F138611_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F108700_63857_0|SrvcGrp|89822|2022|PDM|108.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F141833_31707_0|SrvcGrp|13422|2022|PDM|450.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F130108_0_0|SrvcGrp|18200|2022|PCT|0.75|99|0.00|MS DRG 026|
20|FH_F36576_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F130573_02882_0|SrvcGrp|48385|2022|PDM|120.00|99|0.00|SPEECH THERAPY|
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|1103.00|99|0.00|AEG 8 (NO REV)|
20|FH_F130195_44143_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78205_0_0|SrvcGrp|17081|2022|PDM|5010.32|99|0.00|ASPG IX|
20|FH_F38725_0_0|SrvcGrp|21342|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F67803_0_0|SrvcGrp|29137|2022|PDM|23.00|99|0.00|HOME HEALTH AIDE|
20|FH_F103360_68845_0|SrvcGrp|31706|2022|PDM|17595.00|99|0.00|MS DRG 792 ONLY|
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|6885.00|99|0.00|DEVICE INSERTION|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.58|99|0.00|HAPA WPA-NWPA 2012-13 ASC 306 W/O REV|
20|FH_F98060_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F80535_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F133021_00910_0|SrvcGrp|112276|2022|PDM|10000.00|99|0.00|TIBIA WITH ATHERECTOMY|
20|FH_F87577_80016_0|SrvcGrp|21354|2022|PDM|13838.00|99|0.00|MS DRG 250-251 ONLY|
20|FH_F63250_0_0|SrvcGrp|59415|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY SVCS EXCLD MOD GO|
20|FH_F145864_65084_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F68121_0_0|SrvcGrp|64322|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F42779_0_0|SrvcGrp|1943|2022|PDM|1481.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F40975_0_0|SrvcGrp|6|2022|PCT|0.78|99|0.00|OP SURGERY|
20|FH_F124854_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F115431_32821_0|CSTM-ALL|CSTM-00|2020|PDM|92.12|99|0.00|NEUROPSYCHOLOGICAL TESTING|
20|FH_F136751_0_0|SrvcGrp|90063|2022|PDM|7500.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F133018_84037_0|SrvcGrp|13929|2022|PDM|10.00|99|0.00|GROWTH HORMONE|
20|FH_F133021_00910_0|SrvcGrp|112271|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F92677_08003_0|SrvcGrp|86847|2022|PDM|63.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F100682_97401_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F100740_15206_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F103400_33426_0|SrvcGrp|89337|2022|PDM|822.00|99|0.00|DETOXIFICATION|
20|FH_F115312_78550_0|SrvcGrp|73842|2022|PDM|227.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147745_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128703_68638_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|1266.00|99|0.00|AEG 10 (NO REV)|
20|FH_F97141_93933_0|SrvcGrp|73602|2022|PDM|3361.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F150904_22306_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F132553_65340_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50372_0_0|SrvcGrp|46584|2022|PDM|140.00|99|0.00|CPT 99203|
20|FH_F137638_0_0|SrvcGrp|89417|2022|PDM|499.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F113792_0_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F127994_19301_0|SrvcGrp|90662|2022|PDM|86.00|99|0.00|EVALUATION AND MANAGEMENT CPT 99214|
20|FH_F133477_90247_0|SrvcGrp|537|2022|PDM|2273.00|99|0.00|OBSERVATION SERVICES|
20|FH_F63543_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82813_0_0|SrvcGrp|73002|2022|PDM|1403.00|99|0.00|AEG 7|
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F144088_48706_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125049_44131_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F146373_66092_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111467_33761_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F128421_27016_0|SrvcGrp|88978|2022|PCT|0.80|99|0.00|VAGINAL DELIVERY|
20|FH_F109242_18466_0|SrvcGrp|91390|2022|PDM|214.00|99|0.00|AETNA PSYCH DIAG EVAL W/MED (MOD AF)|
20|FH_F128442_57430_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F50472_0_0|SrvcGrp|41563|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F133287_40215_0|SrvcGrp|90778|2022|PDM|2619.00|99|0.00|HEMIOPLASTY|
20|FH_F148019_54311_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145917_37604_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92676_15063_0|SrvcGrp|79043|2022|PDM|688.66|99|0.00|MON VALLEY ASC 123|
20|FH_F142027_37217_0|SrvcGrp|103343|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128130_10027_0|CSTM-ALL|CSTM-00|2020|PDM|5733.00|99|0.00|AEG 4 (NO REV)|
20|FH_F105921_80014_0|SrvcGrp|53987|2022|PCT|1.00|99|0.00|PHOTOTHERAPY|
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|ASPG V - IOWA|
20|FH_F126666_44053_0|SrvcGrp|91400|2022|PDM|72.00|99|0.00|AETNA FAMILY PSYTX W/PATIENT (MOD AJ)|
20|FH_F86091_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1330.10|99|0.00|ASPG 701|
20|FH_F101104_0_0|SrvcGrp|86825|2022|PDM|200.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F44016_0_0|SrvcGrp|53423|2022|PDM|4375.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F144709_48076_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|ASPG IX|
20|FH_F150123_60515_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42807_0_0|CSTM-ALL|CSTM-00|2020|PDM|1664.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84591_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F117555_72802_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133291_33563_0|SrvcGrp|46903|2022|PDM|561.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F144017_33873_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149401_0_0|SrvcGrp|98701|2022|PDM|323.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F144191_0_0|SrvcGrp|76604|2022|PDM|3183.00|99|0.00|CPT 25447|
20|FH_F125541_07825_0|SrvcGrp|73842|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F95360_08720_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F57396_0_0|SrvcGrp|46588|2022|PDM|80.00|99|0.00|CPT 99212|
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_F43018_0_0|SrvcGrp|36802|2022|PCT|0.75|99|0.00|MS DRG 215-238, 258-262  ONLY CV SURGERY|
20|FH_F87155_04105_0|SrvcGrp|22389|2022|PDM|18.91|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F42340_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F139268_36695_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139347_06471_0|SrvcGrp|75545|2022|PDM|420.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F139444_32966_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139707_84010_0|SrvcGrp|92704|2022|PDM|5230.00|99|0.00|LITHOTRIPSY|
20|FH_F150620_53402_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150700_90028_0|SrvcGrp|75419|2022|PDM|530.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F150862_75082_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150881_52722_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F149376_34239_0|SrvcGrp|114975|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F111035_30535_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|1587.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F148964_30101_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97420_75052_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F47212_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HCPC CODES VNA MIDLANDS|
20|FH_F81951_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148926_28803_0|SrvcGrp|109036|2022|PDM|1050.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F117603_92210_0|SrvcGrp|74615|2022|PDM|350.00|99|0.00|INTENSIVE OUTPATIENT|
20|FH_F124976_0_0|SrvcGrp|86723|2022|PDM|531.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F132160_0_0|SrvcGrp|84280|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F33504_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|BURN INTENSIVE CARE|
20|FH_F122377_91007_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F36683_0_0|SrvcGrp|18809|2022|PDM|27873.00|99|0.00|MS DRG 219|
20|FH_F47659_0_0|SrvcGrp|360|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F36683_0_0|SrvcGrp|18881|2022|PDM|23413.00|99|0.00|MS DRG 233|
20|FH_F93268_0_0|SrvcGrp|473|2022|PDM|426.40|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F34336_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F117762_0_0|SrvcGrp|98497|2022|PDM|4836.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F124316_28112_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F35678_0_0|SrvcGrp|18140|2022|PDM|11300.00|99|0.00|MS DRG 246|
20|FH_F149579_95815_0|SrvcGrp|115690|2022|PDM|41.84|99|0.00|PHYSIOLOGIC MONITORING REM ADDL 20 MINS (HCFA)|
20|FH_F111080_18103_0|SrvcGrp|90854|2022|PDM|634.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F111038_62960_0|SrvcGrp|75505|2022|PCT|0.84|99|0.00|CARDIAC STUDIES|
20|FH_F132595_0_0|SrvcGrp|177|2022|PDM|2374.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F147228_49441_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F113957_73554_0|SrvcGrp|73006|2022|PDM|3150.00|99|0.00|AEG 9|
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97603_77901_0|CSTM-ALL|CSTM-00|2020|PCT|0.29|99|0.00|OP SVCS|
20|FH_F126299_20176_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148859_0_0|SrvcGrp|107498|2022|PDM|728.00|99|0.00|AETNA VASECTOMY, UNILAT OR BILAT|
20|FH_F112306_81428_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149045_45679_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97420_75052_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F149602_07109_0|SrvcGrp|112762|2022|PDM|45.23|99|0.00|INFECTIOUS AGENT ANTIGEN DETECTION|
20|FH_F124492_30040_0|SrvcGrp|113234|2022|PDM|156.89|99|0.00|COVID-19 SARSCOV2 & INF A&B AMP PRB|
20|FH_F113957_73554_0|SrvcGrp|81779|2022|PCT|1.25|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F139442_60143_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F140576_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36903_0_0|SrvcGrp|24612|2022|PDM|70.00|99|0.00|PT/OT/ST|
20|FH_F94222_62269_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F114848_50533_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F149002_80014_0|SrvcGrp|88377|2022|PDM|1950.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F116806_0_0|SrvcGrp|107126|2022|PDM|887.26|99|0.00|CLOSURE OF SALIVARY FISTULA|
20|FH_F124719_64093_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F38742_0_0|SrvcGrp|29347|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE|
20|FH_F117763_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F114825_32789_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F114171_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F97620_75904_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F35987_0_0|SrvcGrp|33793|2022|PDM|6087.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F123745_0_0|SrvcGrp|26279|2022|PDM|4500.00|99|0.00|CPT 29884|
20|FH_F36715_0_0|SrvcGrp|16|2022|PDM|899.00|99|0.00|ACUTE REHABILITATION|
20|FH_F131449_19073_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F92152_74133_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F122263_37072_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F115483_62002_0|SrvcGrp|29817|2022|PDM|5305.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F97101_98003_0|SrvcGrp|73602|2022|PDM|7314.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F129682_07034_0|SrvcGrp|46605|2022|PDM|105.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133569_17202_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F31547_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F114206_37203_0|SrvcGrp|29023|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F131495_77407_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139877_32615_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F138017_73129_0|SrvcGrp|104750|2022|PDM|6883.00|99|0.00|REPAIR BLADDER & VAGINA|
20|FH_F74845_0_0|SrvcGrp|59838|2022|PCT|1.15|99|0.00|ALBUMIN|
20|FH_F128741_92879_0|SrvcGrp|27968|2022|PDM|98.05|99|0.00|SKILLED NURSING LPN|
20|FH_F108080_77081_0|SrvcGrp|89337|2022|PDM|926.00|99|0.00|DETOXIFICATION|
20|FH_F131028_49735_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139928_37228_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F143249_89801_0|SrvcGrp|21920|2022|PDM|30.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F143347_16001_0|SrvcGrp|81779|2022|PCT|2.69|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F143536_47546_0|SrvcGrp|100248|2022|PCT|1.00|99|0.00|REMOVAL OF SKIN TAGS|
20|FH_F143536_47546_0|SrvcGrp|82746|2022|PCT|1.00|99|0.00|CULT BACT BLD AEROIC ISOLA|
20|FH_F143536_47546_0|SrvcGrp|94882|2022|PCT|1.00|99|0.00|FLU VIRUS VACC-SPLIT 3 YRS & ABOVE|
20|FH_F143536_47546_0|SrvcGrp|53786|2022|PCT|1.00|99|0.00|BREATHING DEVICE|
20|FH_F101700_0_0|SrvcGrp|44461|2022|PDM|1700.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F151755_03303_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F132390_60018_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|2655.00|99|0.00|AEG 7 (NO REV)|
20|FH_F45832_0_0|SrvcGrp|29817|2022|PDM|5914.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F61292_0_0|SrvcGrp|29098|2022|PDM|23802.00|99|0.00|GAMMA KNIFE|
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|2168.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130138_02915_0|SrvcGrp|87995|2022|PCT|0.96|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115019_78414_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F129639_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130747_0_0|SrvcGrp|111589|2022|PDM|2809.00|99|0.00|REVISE ULNAR NERVE AT WRIST|
20|FH_F47341_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89563_29407_0|SrvcGrp|93267|2022|PCT|1.50|99|0.00|INJECTION|
20|FH_F129754_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F34454_0_0|SrvcGrp|26001|2022|PDM|94.50|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F128982_44221_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F137367_89139_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F128272_60640_0|SrvcGrp|86849|2022|PDM|50.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F132675_53154_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F137558_36116_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151541_01436_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F148221_06477_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F135161_33128_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F82753_18840_0|SrvcGrp|113637|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F120279_98005_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F116115_14437_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F118028_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.50|99|0.00|OP SVCS|
20|FH_F77883_0_0|SrvcGrp|74931|2022|PDM|911.67|99|0.00|HOSPICE LEVEL 3|
20|FH_F125249_0_0|SrvcGrp|100044|2022|PDM|1200.00|99|0.00|INCISION OF HEEL BONE|
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F77883_0_0|SrvcGrp|113847|2022|PDM|175.45|99|0.00|LACTATION SUPPORT|
20|FH_F104640_21204_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130182_0_0|SrvcGrp|111516|2022|PDM|79.00|99|0.00|INJECT SUPRVLV AORTOGRAPHY|
20|FH_F107840_07006_0|SrvcGrp|89149|2022|PDM|165.00|99|0.00|OP INTENSIVE|
20|FH_F146266_0_0|SrvcGrp|33986|2022|PDM|1450.00|99|0.00|CPT 26055|
20|FH_F40446_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ACUTE PSYCH|
20|FH_F36943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F151699_01752_0|SrvcGrp|16750|2022|PDM|119.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F108260_63141_0|SrvcGrp|23683|2022|PDM|35.00|99|0.00|SKILLED NURSING RN|
20|FH_F137986_0_0|SrvcGrp|88491|2022|PDM|3000.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F149662_85015_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150442_28451_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 4 (NO REV)|
20|FH_F35446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|TRAUMA CARE|
20|FH_F97881_38703_0|SrvcGrp|88978|2022|PDM|3995.00|99|0.00|VAGINAL DELIVERY|
20|FH_F115483_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|AEG 4 (NO REV)|
20|FH_F73803_0_0|CSTM-ALL|CSTM-00|2020|PDM|358.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F36403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F44255_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F122330_75771_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150946_75783_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130654_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|CARDIAC STUDIES|
20|FH_F37422_0_0|SrvcGrp|471|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|22500.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F147140_89103_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F117023_0_0|SrvcGrp|72994|2022|PDM|840.00|99|0.00|AEG 3|
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125656_92868_0|SrvcGrp|17016|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F97260_06111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F134870_97015_0|SrvcGrp|112407|2022|PCT|2.24|99|0.00|SURGERY AND RADIOLOGY|
20|FH_F120332_0_0|SrvcGrp|46605|2022|PDM|76.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133087_61107_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111080_18103_0|SrvcGrp|73842|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F39443_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAPA WPA LAB 112%|
20|FH_F139576_0_0|SrvcGrp|96939|2022|PDM|2497.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F101184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148859_0_0|SrvcGrp|47544|2022|PDM|3919.00|99|0.00|PERCUTANEOUS IMPLANT OF NEUROSTIMULATOR ELECTRODES|
20|FH_F40579_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|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_F129811_53573_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122396_90024_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F35432_0_0|SrvcGrp|16|2022|PDM|563.00|99|0.00|ACUTE REHABILITATION|
20|FH_F139823_32250_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F140147_34785_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F140248_42420_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143368_33028_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143488_84770_0|SrvcGrp|114039|2022|PDM|950.00|99|0.00|REVISE EYE WITH IMPLANT|
20|FH_F143536_47546_0|SrvcGrp|45307|2022|PCT|1.00|99|0.00|ADMIN OF INFLUENZA VIRUS VACCINE|
20|FH_F123185_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F93740_0_0|SrvcGrp|91583|2022|PDM|5300.00|99|0.00|CAROTID DIAGNOSTIC|
20|FH_F103060_0_0|SrvcGrp|73008|2022|PDM|1040.00|99|0.00|AEG 10|
20|FH_F151754_71943_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F82375_28601_0|SrvcGrp|46605|2022|PDM|195.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|802.00|99|0.00|GA RETINA SURG CTR ASC 17|
20|FH_F120187_76522_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F132390_60018_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119921_83213_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|GENERAL ACUTE CARE|
20|FH_F120974_27607_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F120974_27607_0|SrvcGrp|3378|2022|PDM|6090.00|99|0.00|OBSERVATION SVCS|
20|FH_F113649_01752_0|SrvcGrp|24761|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F113649_01752_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP WITHOUT CPT 99601|
20|FH_F36372_0_0|SrvcGrp|17013|2022|PDM|28.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F60112_0_0|SrvcGrp|473|2022|PDM|318.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F130748_43762_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130841_49315_0|SrvcGrp|94780|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F139169_0_0|SrvcGrp|36591|2022|PDM|7500.00|99|0.00|CPT 63685|
20|FH_F88744_71103_0|SrvcGrp|114917|2022|PCT|0.65|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F125244_0_0|SrvcGrp|101522|2022|PDM|5500.00|99|0.00|T1H W/T/O UTERUS (>250G)|
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1592.00|99|0.00|ASPG VII|
20|FH_F52713_0_0|SrvcGrp|9774|2022|PDM|5000.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F130364_01331_0|SrvcGrp|79786|2022|PDM|1650.00|99|0.00|SLEEP STUDIES|
20|FH_F134918_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F100782_0_0|SrvcGrp|105100|2022|PDM|227.05|99|0.00|WINDBER MEDICAL CNTR ASC 145|
20|FH_F87775_15106_0|SrvcGrp|73700|2022|PDM|36.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F134353_84123_0|SrvcGrp|97704|2022|PDM|103.95|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F136359_0_0|SrvcGrp|49205|2022|PDM|4000.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F134230_60098_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F91777_29577_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146590_77449_0|SrvcGrp|23683|2022|PDM|54.00|99|0.00|SKILLED NURSING RN|
20|FH_F74163_0_0|SrvcGrp|14114|2022|PDM|18.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F38376_0_0|SrvcGrp|11442|2022|PDM|600.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F51123_0_0|SrvcGrp|10519|2022|PDM|141.75|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F56792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F46352_0_0|SrvcGrp|22954|2022|PDM|295.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F141947_63367_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142047_21853_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134447_12883_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F44025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F120437_85202_0|SrvcGrp|99010|2022|PDM|39.39|99|0.00|ANTIBIOTIC Q24H (HCFA)|
20|FH_F148644_06890_0|SrvcGrp|39909|2022|PDM|3305.00|99|0.00|PARTIAL MASTECTOMY|
20|FH_F151119_66018_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151152_19150_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151154_91761_0|SrvcGrp|88621|2022|PDM|120.00|99|0.00|SKILLED NURSING LPN|
20|FH_F151160_61350_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F88639_80204_0|SrvcGrp|102420|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F87474_0_0|SrvcGrp|9228|2022|PDM|50.00|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F46832_0_0|SrvcGrp|26867|2022|PDM|80.00|99|0.00|ANTI-EMETICS INFUSION THERAPY|
20|FH_F123783_03860_0|SrvcGrp|104874|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121250_47401_0|SrvcGrp|89417|2022|PDM|340.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F132810_0_0|SrvcGrp|86833|2022|PDM|25.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F69968_0_0|SrvcGrp|13768|2022|PDM|2612.76|99|0.00|NICU|
20|FH_F107200_0_0|SrvcGrp|101519|2022|PDM|6242.00|99|0.00|T1H UTERUS (<250G)|
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|68000|2022|PDM|3641.00|99|0.00|CPT 58561|
20|FH_F136308_34481_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136496_61832_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F118232_24970_0|SrvcGrp|75506|2022|PCT|0.79|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F118236_25901_0|SrvcGrp|109029|2022|PCT|0.76|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F120475_81052_0|SrvcGrp|104336|2022|PCT|1.00|99|0.00|DENOSUMAB INJECTION|
20|FH_F93175_73438_0|SrvcGrp|79699|2022|PCT|0.70|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F93187_08043_0|SrvcGrp|76501|2022|PDM|246.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F93358_63084_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F137147_75006_0|SrvcGrp|98005|2022|PDM|5577.00|99|0.00|DISTAL PHALANGEAL FRACTURE|
20|FH_F142403_65201_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142403_65201_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126567_0_0|SrvcGrp|107749|2022|PDM|650.00|99|0.00|CAPD/CCPD|
20|FH_F139456_47501_0|SrvcGrp|113568|2022|PCT|0.80|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F140648_75070_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F140753_75038_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140765_30315_0|SrvcGrp|112980|2022|PCT|1.21|99|0.00|E&M|
20|FH_F140893_19720_0|SrvcGrp|23683|2022|PDM|56.00|99|0.00|SKILLED NURSING RN|
20|FH_F120152_0_0|SrvcGrp|88065|2022|PDM|19800.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F148739_47129_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151603_27609_0|SrvcGrp|88487|2022|PDM|6243.23|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F92634_08244_0|SrvcGrp|82369|2022|PCT|0.72|99|0.00|AETNA LABORATORY|
20|FH_F129448_43235_0|SrvcGrp|48385|2022|PDM|113.00|99|0.00|SPEECH THERAPY|
20|FH_F129483_77030_0|SrvcGrp|86828|2022|PDM|70.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F129504_02871_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137270_82901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137335_08096_0|SrvcGrp|89149|2022|PDM|210.00|99|0.00|OP INTENSIVE|
20|FH_F137927_52241_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F90613_05001_0|SrvcGrp|86638|2022|PDM|1152.00|99|0.00|AETNA IP PSYCHIATRIC (>=18 YRS)|
20|FH_F90880_15108_0|SrvcGrp|90488|2022|PCT|1.00|99|0.00|ORAL FUNCTION THERAPY|
20|FH_F91472_96001_0|SrvcGrp|103752|2022|PCT|0.40|99|0.00|OPEN REDUCTION/INTERNAL FIXATION OF THE WRIST|
20|FH_F91472_96001_0|SrvcGrp|31931|2022|PDM|3368.00|99|0.00|SKILLED NURSING CARE|
20|FH_F124837_65625_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128804_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38321_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F31783_0_0|SrvcGrp|18143|2022|PCT|0.70|99|0.00|MS DRG 247|
20|FH_F149679_0_0|SrvcGrp|106294|2022|PDM|198.55|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F60273_0_0|SrvcGrp|38364|2022|PDM|4189.50|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|1012.00|99|0.00|AEG 3 (NO REV)|
20|FH_F32466_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F66501_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HILLCREST IV THERAPY|
20|FH_F149839_80002_0|SrvcGrp|46605|2022|PDM|135.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F151526_28208_0|SrvcGrp|108076|2022|PDM|4143.00|99|0.00|AV FUSION / FOREARM VEIN|
20|FH_F130840_21738_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F41201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F123922_84102_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F38591_0_0|SrvcGrp|58|2022|PDM|8594.00|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F130024_78229_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110220_0_0|SrvcGrp|103929|2022|PDM|193.54|99|0.00|SLEEP STUDY UNATTENDED RESPIRATORY EFFORT(HCFA)|
20|FH_F90362_0_0|SrvcGrp|89949|2022|PDM|4509.00|99|0.00|HIP ARTHOSCOPY|
20|FH_F34454_0_0|SrvcGrp|9828|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE|
20|FH_F73013_0_0|SrvcGrp|12403|2022|PDM|56.62|99|0.00|CONTINUOUS HOMECARE|
20|FH_F141471_0_0|SrvcGrp|107794|2022|PDM|3877.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F116955_16801_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125011_74467_0|CSTM-ALL|CSTM-00|2020|PDM|810.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F129115_85716_0|SrvcGrp|87317|2022|PDM|1028.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F145756_03801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F35259_0_0|SrvcGrp|69840|2022|PCT|0.68|99|0.00|DIRECTIONAL CORONARY ATHERECTOMY|
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F150982_0_0|SrvcGrp|92369|2022|PDM|4160.00|99|0.00|REPAIR OF ANKLE LIGAMENTS|
20|FH_F148255_72703_0|SrvcGrp|86852|2022|PDM|31.50|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F129766_48236_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F102500_0_0|SrvcGrp|73000|2022|PDM|1283.00|99|0.00|AEG 6|
20|FH_F151400_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F125028_19061_0|SrvcGrp|86828|2022|PDM|126.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F32405_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120352_52556_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F37945_0_0|CSTM-ALL|CSTM-00|2020|PDM|890.00|99|0.00|ASPG X|
20|FH_F134894_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F123488_65559_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F36669_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129969_33908_0|SrvcGrp|87441|2022|PDM|625.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|2496.00|99|0.00|AEG 9 (NO REV)|
20|FH_F148162_29412_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F32604_0_0|SrvcGrp|10542|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F125993_64850_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F87254_0_0|SrvcGrp|11306|2022|PCT|0.67|99|0.00|IMPLANTS|
20|FH_F110004_75149_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128878_11203_0|CSTM-ALL|CSTM-00|2020|PDM|130.00|99|0.00|PSYTX W PT 45 MINS (HCFA)|
20|FH_F120195_28403_0|SrvcGrp|73842|2022|PDM|176.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F110061_0_0|SrvcGrp|103865|2022|PDM|3300.00|99|0.00|PT PRGRM FOR IMPLT NEUROSTIM|
20|FH_F35166_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|IMPLANTS|
20|FH_F36366_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111826_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F148221_06477_0|SrvcGrp|115342|2022|PCT|1.05|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F33712_0_0|SrvcGrp|9510|2022|PDM|575.00|99|0.00|SKILLED NURSING CARE|
20|FH_F148222_18603_0|SrvcGrp|88779|2022|PDM|62.00|99|0.00|PHYSICAL THERAPY|
20|FH_F123385_03561_0|SrvcGrp|46605|2022|PDM|163.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F102302_0_0|SrvcGrp|98598|2022|PDM|10850.00|99|0.00|LUMBAR LAMINOTOMY|
20|FH_F127851_68106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F93119_0_0|SrvcGrp|93274|2022|PDM|675.51|99|0.00|SKILLED CARE LEVEL I AND II|
20|FH_F125519_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.25|99|0.00|OP SVCS|
20|FH_F39943_0_0|SrvcGrp|97|2022|PDM|3000.00|99|0.00|C-SECTION|
20|FH_F137427_89146_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F148440_16506_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 2 (NO REV)|
20|FH_F148543_71103_0|SrvcGrp|73601|2022|PDM|1676.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F143783_0_0|SrvcGrp|65720|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F65182_0_0|SrvcGrp|43892|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F102184_0_0|SrvcGrp|78096|2022|PDM|2887.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F39531_0_0|SrvcGrp|997|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
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_F121183_75093_0|SrvcGrp|89417|2022|PDM|386.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|1433.00|99|0.00|AEG 9 (NO REV)|
20|FH_F100790_10512_0|SrvcGrp|90854|2022|PDM|2830.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F133671_89102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F65200_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKE|
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_F40063_0_0|SrvcGrp|3987|2022|PDM|3527.00|99|0.00|TRAUMA CARE|
20|FH_F145537_02061_0|SrvcGrp|74668|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F49434_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|9344.00|99|0.00|MSDRG 250-251 PERCUTANEOUS CARDIO PROC|
20|FH_F130747_0_0|SrvcGrp|58636|2022|PDM|15086.00|99|0.00|CPT 62362|
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|2284.00|99|0.00|AEG 6 (NO REV)|
20|FH_F31882_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F57032_0_0|SrvcGrp|53487|2022|PDM|134.00|99|0.00|DIBETIC SHOES|
20|FH_F141507_0_0|SrvcGrp|26916|2022|PCT|0.00|99|0.00|IMPLANTS/PROSHETICS/ORTHOTICS|
20|FH_F140931_24014_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113546_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147941_06023_0|CSTM-ALL|CSTM-00|2020|PDM|12270.00|99|0.00|AEG 9 (NO REV) W/O KIDNEY LITHOTRIPSY AND ABLATION|
20|FH_F125890_43054_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F136846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F63249_0_0|SrvcGrp|42973|2022|PDM|95.00|99|0.00|SPEECH  THERAPIST|
20|FH_F63275_0_0|SrvcGrp|12403|2022|PDM|31.76|99|0.00|CONTINUOUS HOMECARE|
20|FH_F130755_04401_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F93557_15147_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148169_33138_0|SrvcGrp|112678|2022|PDM|23.46|99|0.00|COVID-19 SPECIMEN COLLECT|
20|FH_F128358_46072_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F72369_0_0|SrvcGrp|25751|2022|PDM|300.00|99|0.00|OCULAR CONFORMER, FABRICATION AND FITTING|
20|FH_F66687_0_0|SrvcGrp|54975|2022|PCT|0.85|99|0.00|MS DRG 223 ONLY|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKE|
20|FH_F116924_91203_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F50218_0_0|SrvcGrp|45327|2022|PDM|125.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F66222_0_0|SrvcGrp|42869|2022|PDM|229.36|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)|
20|FH_F134994_33162_0|SrvcGrp|90854|2022|PDM|900.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F124388_0_0|SrvcGrp|87055|2022|PDM|1870.00|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION|
20|FH_F52854_0_0|CSTM-ALL|CSTM-00|2020|PDM|101.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F141410_13045_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS|
20|FH_F89475_71202_0|CSTM-ALL|CSTM-00|2020|PDM|2728.00|99|0.00|AEG 8 (NO REV)|
20|FH_F83451_0_0|SrvcGrp|81569|2022|PDM|2415.00|99|0.00|SURGICAL SPINE PROCEDURES|
20|FH_F34112_0_0|SrvcGrp|16199|2022|PDM|5600.00|99|0.00|ANGIOPLASTY|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145758_20745_0|CSTM-ALL|CSTM-00|2020|PDM|545.70|99|0.00|AEG 10 (NO REV)|
20|FH_F123385_03561_0|SrvcGrp|104874|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129658_77043_0|SrvcGrp|81779|2022|PCT|1.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F34487_0_0|SrvcGrp|9510|2022|PDM|364.00|99|0.00|SKILLED NURSING CARE|
20|FH_F120279_98005_0|SrvcGrp|46903|2022|PDM|750.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F105680_0_0|SrvcGrp|75487|2022|PDM|1625.00|99|0.00|AEG 5|
20|FH_F141527_36830_0|SrvcGrp|86848|2022|PDM|26.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F139515_0_0|SrvcGrp|92408|2022|PDM|6775.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|531.00|99|0.00|AEG 10 (NO REV)|
20|FH_F109240_21201_0|SrvcGrp|102988|2022|PDM|1887.00|99|0.00|PROTON TRMT, SIMPLE W/COMP|
20|FH_F116027_17745_0|SrvcGrp|472|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F141507_0_0|SrvcGrp|12491|2022|PCT|0.00|99|0.00|PACEMAKER|
20|FH_F128079_67456_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F45632_0_0|SrvcGrp|41500|2022|PDM|43.00|99|0.00|DIETICIAN SVCS|
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|968.00|99|0.00|AEG 4 (NO REV)|
20|FH_F125011_74467_0|SrvcGrp|103503|2022|PDM|4500.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93881_15009_0|SrvcGrp|76007|2022|PDM|190.00|99|0.00|PULMONARY REHAB|
20|FH_F37679_0_0|SrvcGrp|26860|2022|PDM|15.25|99|0.00|DIURETIC IV THERAPY (MOD SJ)|
20|FH_F131995_04730_0|SrvcGrp|48396|2022|PDM|135.00|99|0.00|OT SERVICES|
20|FH_F127165_32112_0|SrvcGrp|46903|2022|PDM|593.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F111222_15701_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92034_0_0|SrvcGrp|73002|2022|PDM|1311.00|99|0.00|AEG 7|
20|FH_F119760_0_0|SrvcGrp|97507|2022|PDM|105.00|99|0.00|AETNA HOSPICE|
20|FH_F93557_15147_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128237_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F116061_80110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117784_0_0|SrvcGrp|13422|2022|PDM|147.90|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F112568_0_0|SrvcGrp|104845|2022|PDM|180.71|99|0.00|HOME HEALTH AIDE IN HOME|
20|FH_F100762_51104_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F125867_78748_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F40427_0_0|SrvcGrp|3029|2022|PDM|337.00|99|0.00|NEWBORN NURSERY|
20|FH_F148122_49435_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F91891_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137347_26003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|894.21|99|0.00|2005 ASPG GROUPER V|
20|FH_F150699_0_0|SrvcGrp|109506|2022|PDM|30061.00|99|0.00|INSRT PULSE GEN W/ DUAL LEADS|
20|FH_F121566_91360_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F129221_84325_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F92034_0_0|SrvcGrp|72990|2022|PDM|600.00|99|0.00|AEG 1|
20|FH_F148182_23324_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F115075_77833_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122687_0_0|SrvcGrp|54943|2022|PDM|3825.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F38526_0_0|SrvcGrp|13482|2022|PDM|2040.00|99|0.00|INTERMEDIATE CARDIAC CARE UNIT|
20|FH_F140907_28601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F41133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PDM|3197.00|99|0.00|ASPG X|
20|FH_F62892_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130024_78229_0|SrvcGrp|111510|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F66501_0_0|SrvcGrp|10542|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F109346_0_0|SrvcGrp|103264|2022|PDM|1650.00|99|0.00|TRANSFER TO HOSPITAL|
20|FH_F131228_01826_0|CSTM-ALL|CSTM-00|2020|PDM|4704.79|99|0.00|AEG 4 (NO REV)|
20|FH_F119384_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F98922_40351_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F62702_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33456_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125463_50459_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130895_07726_0|SrvcGrp|89417|2022|PDM|278.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F130908_32708_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F48092_0_0|SrvcGrp|3259|2022|PDM|1200.00|99|0.00|ACUTE REHABILITATION|
20|FH_F145926_45243_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144248_0_0|SrvcGrp|109760|2022|PDM|6885.00|99|0.00|TRANSLUM DIL EYE CANAL|
20|FH_F150599_0_0|CSTM-ALL|CSTM-00|2020|PDM|516.00|99|0.00|AEG 1 (NO REV)|
20|FH_F109264_33431_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F85213_02840_0|SrvcGrp|112677|2022|PDM|144.00|99|0.00|COVID-19 SPEC COLL SNF/LAB|
20|FH_F147962_85008_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F112082_30720_0|SrvcGrp|22593|2022|PDM|94.42|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F141340_66208_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134327_12853_0|SrvcGrp|473|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F100782_0_0|SrvcGrp|105114|2022|PDM|766.16|99|0.00|WINDBER MEDICAL CNTR ASC 219|
20|FH_F43199_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F114851_15301_0|SrvcGrp|42785|2022|PDM|54.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F130329_64114_0|SrvcGrp|48385|2022|PDM|88.00|99|0.00|SPEECH THERAPY|
20|FH_F138050_52301_0|SrvcGrp|81779|2022|PCT|1.36|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F88698_18951_0|SrvcGrp|73849|2022|PDM|247.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F145604_14850_0|SrvcGrp|14949|2022|PDM|100.00|99|0.00|HOME INFUSION|
20|FH_F114509_10010_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F117831_0_0|SrvcGrp|84912|2022|PDM|4200.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F124369_0_0|SrvcGrp|102480|2022|PDM|11220.00|99|0.00|CPT 29897|
20|FH_F61072_0_0|SrvcGrp|42825|2022|PDM|32.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F112082_30720_0|SrvcGrp|14944|2022|PDM|4.70|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F47499_0_0|SrvcGrp|13928|2022|PDM|371.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F134593_60007_0|SrvcGrp|17014|2022|PDM|36.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F125870_0_0|SrvcGrp|72992|2022|PDM|992.00|99|0.00|AEG 2|
20|FH_F137610_0_0|SrvcGrp|89417|2022|PDM|381.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|991.29|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1301 W/O REV|
20|FH_F34182_0_0|SrvcGrp|16138|2022|PDM|2278.00|99|0.00|ACUTE MEDICAL SVCS|
20|FH_F93122_01854_0|SrvcGrp|54142|2022|PDM|149.00|99|0.00|OP INTENSIVE SERVICES|
20|FH_F126550_43085_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F127090_45601_0|SrvcGrp|10577|2022|PDM|49.98|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F149272_64057_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116753_0_0|SrvcGrp|73614|2022|PDM|7465.00|99|0.00|AETNA LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F133869_19947_0|SrvcGrp|74668|2022|PDM|257.50|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F146039_89511_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F114526_33401_0|SrvcGrp|89149|2022|PDM|192.00|99|0.00|OP INTENSIVE|
20|FH_F128379_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F133775_83401_0|SrvcGrp|27969|2022|PDM|29.50|99|0.00|HOME HEALTH AIDE|
20|FH_F126341_27284_0|SrvcGrp|86123|2022|PDM|40.25|99|0.00|AETNA INJ IVIG PRIVIGEN|
20|FH_F120384_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138050_52301_0|SrvcGrp|73483|2022|PDM|968.00|99|0.00|AETNA SUBACUTE III|
20|FH_F138302_15701_0|SrvcGrp|113265|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F90232_15126_0|SrvcGrp|86841|2022|PDM|102.90|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F141337_60077_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F116806_0_0|SrvcGrp|104387|2022|PDM|2499.85|99|0.00|REMOVAL OF BONE FOR GRAFT|
20|FH_F41799_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121225_98902_0|SrvcGrp|22592|2022|PDM|105.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F135627_77070_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37667_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|BONE MARROW TRANSPLANT|
20|FH_F129509_0_0|SrvcGrp|111328|2022|PDM|5332.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F117210_0_0|CSTM-ALL|CSTM-00|2020|PDM|494.00|99|0.00|AEG 1 (NO REV)|
20|FH_F133753_84015_0|SrvcGrp|86661|2022|PDM|71.00|99|0.00|SPEECH THERAPY|
20|FH_F37877_0_0|CSTM-ALL|CSTM-00|2020|PDM|1033.00|99|0.00|ASPG VIII|
20|FH_F113276_38506_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F81698_10457_0|SrvcGrp|86849|2022|PDM|31.50|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|1297.00|99|0.00|AEG 8 (NO REV)|
20|FH_F143650_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F117206_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F134590_53223_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125244_0_0|SrvcGrp|68000|2022|PDM|4000.00|99|0.00|CPT 58561|
20|FH_F119379_0_0|SrvcGrp|82720|2022|PDM|1298.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F130763_0_0|SrvcGrp|72121|2022|PDM|4705.00|99|0.00|ARTHOSCOPY|
20|FH_F118267_45005_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F71669_0_0|SrvcGrp|9826|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F50703_0_0|SrvcGrp|46968|2022|PDM|400.00|99|0.00|REMICAIDE INFUSION|
20|FH_F150303_19150_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F89219_0_0|SrvcGrp|112747|2022|PDM|8240.00|99|0.00|MSDRG 019 ONLY|
20|FH_F110522_13501_0|SrvcGrp|90854|2022|PDM|450.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F146124_06112_0|CSTM-ALL|CSTM-00|2020|PDM|5634.00|99|0.00|AEG 3 (NO REV)|
20|FH_F36381_0_0|SrvcGrp|972|2022|PCT|0.55|99|0.00|OP DIALYSIS|
20|FH_F149319_07670_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|1179.00|99|0.00|AEG 3 (NO REV)|
20|FH_F50832_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.30|99|0.00|GENERAL ACUTE CARE|
20|FH_F86101_76063_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110580_71106_0|CSTM-ALL|CSTM-00|2020|PDM|773.00|99|0.00|AEG 3 (NO REV)|
20|FH_F67261_0_0|SrvcGrp|63058|2022|PDM|2000.00|99|0.00|UNLISTED CODES OP SURGERY|
20|FH_F38569_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|RALEIGH HAND ORTHOTIC CODES|
20|FH_F33513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|DME F/S (MOD RR) - MHAC|
20|FH_F64160_0_0|SrvcGrp|26001|2022|PDM|189.98|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F122694_33334_0|SrvcGrp|89149|2022|PDM|207.00|99|0.00|OP INTENSIVE|
20|FH_F86872_15215_0|SrvcGrp|86779|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F43450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F36532_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F62579_0_0|SrvcGrp|34388|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F50462_0_0|SrvcGrp|46691|2022|PDM|36.00|99|0.00|HOME HEALTH AID SERVICES|
20|FH_F130825_65742_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F84132_48026_0|SrvcGrp|73002|2022|PDM|1323.00|99|0.00|AEG 7|
20|FH_F145697_52302_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|AEG 4 (NO REV)|
20|FH_F85652_98034_0|SrvcGrp|81656|2022|PCT|0.51|99|0.00|MS DRG 789 ONLY|
20|FH_F133811_29615_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133870_60618_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F36552_0_0|SrvcGrp|18148|2022|PDM|9940.00|99|0.00|MS DRG 249|
20|FH_F45120_0_0|SrvcGrp|30455|2022|PCT|0.21|99|0.00|IMPLANTS|
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|1815.00|99|0.00|AEG 8 (NO REV)|
20|FH_F97041_71603_0|SrvcGrp|73602|2022|PDM|2070.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F85212_71075_0|SrvcGrp|73006|2022|PDM|2001.00|99|0.00|AEG 9|
20|FH_F144808_0_0|SrvcGrp|98499|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F149061_44122_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87775_15106_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F83995_16748_0|SrvcGrp|82627|2022|PDM|862.00|99|0.00|ER SETTING W/ OP SURGERY LEVEL VI|
20|FH_F87775_15106_0|SrvcGrp|43572|2022|PDM|90.00|99|0.00|PICC-LINE INSERTION|
20|FH_F39902_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL|
20|FH_F134365_60084_0|SrvcGrp|73339|2022|PCT|0.92|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131128_0_0|SrvcGrp|82881|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBTANCE|
20|FH_F41135_0_0|SrvcGrp|17081|2022|PDM|492.54|99|0.00|ASPG IX|
20|FH_F43197_0_0|SrvcGrp|11089|2022|PDM|40.00|99|0.00|NURSING CARE|
20|FH_F150165_06032_0|SrvcGrp|115167|2022|PDM|3628.00|99|0.00|MIDDLE EAR PROCEDURES|
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|1149.00|99|0.00|AEG 4 (NO REV)|
20|FH_F50013_0_0|CSTM-ALL|CSTM-00|2020|PDM|1212.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F96160_32207_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124161_95932_0|SrvcGrp|109248|2022|PCT|2.08|99|0.00|LABORATORY SERVICES|
20|FH_F126341_27284_0|SrvcGrp|86129|2022|PDM|1.00|99|0.00|AETNA XYNTHA INJ|
20|FH_F133585_0_0|SrvcGrp|109137|2022|PDM|3092.00|99|0.00|AV FISTULA REVISION|
20|FH_F39378_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F125870_0_0|SrvcGrp|46890|2022|PDM|3095.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F125260_0_0|SrvcGrp|48398|2022|PDM|202.86|99|0.00|PT SERVICES|
20|FH_F52713_0_0|SrvcGrp|14508|2022|PCT|0.60|99|0.00|PHARMACY SVCS|
20|FH_F149219_01966_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|COVID-19 INFUSION ADMIN - ELI LILLY|
20|FH_F137362_0_0|SrvcGrp|113090|2022|PDM|500.00|99|0.00|HEMODIALYSIS|
20|FH_F138302_15701_0|SrvcGrp|19742|2022|PDM|50.00|99|0.00|MID-LINE INSERTION|
20|FH_F148541_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.60|99|0.00|HSS ASC|
20|FH_F121476_0_0|SrvcGrp|108836|2022|PDM|44567.00|99|0.00|COCHLEAR DEVICE/SYSTEM|
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120583_43219_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F147980_0_0|SrvcGrp|104230|2022|PDM|95.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F146657_01105_0|SrvcGrp|114661|2022|PDM|30.96|99|0.00|SCREENING FOR PROG/TREATMENT|
20|FH_F79245_0_0|SrvcGrp|66482|2022|PDM|35.00|99|0.00|HOME HEALTH AID|
20|FH_F150165_06032_0|SrvcGrp|101520|2022|PDM|9569.00|99|0.00|T1H W/T/O (<250G)|
20|FH_F112023_12866_0|SrvcGrp|82369|2022|PCT|0.51|99|0.00|AETNA LABORATORY|
20|FH_F51934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F143579_43160_0|SrvcGrp|106251|2022|PCT|2.15|99|0.00|LABORATORY SERVICES|
20|FH_F130364_01331_0|SrvcGrp|10364|2022|PDM|882.00|99|0.00|CPT CODE 99284|
20|FH_F59872_0_0|SrvcGrp|13293|2022|PCT|0.50|99|0.00|HIGH-COST DRUGS|
20|FH_F127895_31516_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133207_0_0|SrvcGrp|26278|2022|PDM|3529.00|99|0.00|CPT 29881|
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|1744.00|99|0.00|AEG 7 (NO REV)|
20|FH_F91171_0_0|SrvcGrp|89853|2022|PDM|783.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG|
20|FH_F114606_0_0|SrvcGrp|82223|2022|PDM|27.54|99|0.00|HOSPICE CARE|
20|FH_F121303_15501_0|SrvcGrp|113180|2022|PCT|1.00|99|0.00|COVID-19 VACCINE - JANSSEN|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1074.36|99|0.00|HAPA WPA-NWPA 2012-13 ASC 12 W/O REV|
20|FH_F132899_01002_0|SrvcGrp|90348|2022|PDM|1401.00|99|0.00|AETNA RESIDENTIAL PSYCHIATRIC  EATING DISORDERS <=17 YRS|
20|FH_F80186_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141447_0_0|SrvcGrp|58755|2022|PDM|1452.00|99|0.00|INJECTION PROC FOR JOINT|
20|FH_F36552_0_0|SrvcGrp|997|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F114407_19002_0|SrvcGrp|88621|2022|PDM|73.50|99|0.00|SKILLED NURSING LPN|
20|FH_F138302_15701_0|SrvcGrp|14945|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F145675_33761_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F114444_19602_0|SrvcGrp|91390|2022|PDM|190.00|99|0.00|AETNA PSYCH DIAG EVAL W/MED (MOD AF)|
20|FH_F134451_63670_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122470_78229_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129525_48446_0|SrvcGrp|35982|2022|PDM|65.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F86452_0_0|SrvcGrp|15473|2022|PDM|1253.00|99|0.00|CPT CODE 42820|
20|FH_F85211_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F101100_50314_0|SrvcGrp|97926|2022|PDM|8761.00|99|0.00|REMOVAL OF OVERY/TUBE 2|
20|FH_F115811_33410_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F115936_75093_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F80513_0_0|SrvcGrp|27815|2022|PDM|7346.00|99|0.00|MS DRG 281 ONLY|
20|FH_F146668_30189_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|AEG 6 (NO REV)|
20|FH_F120775_28805_0|SrvcGrp|89149|2022|PDM|185.00|99|0.00|OP INTENSIVE|
20|FH_F115952_44484_0|SrvcGrp|86723|2022|PDM|208.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F115979_46107_0|SrvcGrp|27969|2022|PDM|24.00|99|0.00|HOME HEALTH AIDE|
20|FH_F116063_43220_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F133249_33603_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133401_33404_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132964_06484_0|SrvcGrp|471|2022|PDM|675.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133491_74012_0|SrvcGrp|94780|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F111601_15203_0|SrvcGrp|93919|2022|PDM|520.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F134828_30531_0|SrvcGrp|112672|2022|PDM|31.00|99|0.00|XRAY EXAM OF ANKLE (HCFA)|
20|FH_F145721_0_0|SrvcGrp|80920|2022|PDM|925.00|99|0.00|HOSPICE SERVICES|
20|FH_F46433_0_0|SrvcGrp|26867|2022|PDM|80.00|99|0.00|ANTI-EMETICS INFUSION THERAPY|
20|FH_F47999_0_0|SrvcGrp|42824|2022|PDM|104.50|99|0.00|SKILLED NURSING VISIT|
20|FH_F72404_0_0|SrvcGrp|3932|2022|PDM|4087.00|99|0.00|LITHOTRIPSY|
20|FH_F113025_0_0|SrvcGrp|85906|2022|PDM|475.00|99|0.00|CPT 66710|
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 3 (NO REV)|
20|FH_F33389_0_0|SrvcGrp|13390|2022|PCT|0.65|99|0.00|DIALYSIS SVCS|
20|FH_F35381_0_0|SrvcGrp|3066|2022|PCT|0.75|99|0.00|HIGH-COST DRUGS|
20|FH_F113154_70359_0|SrvcGrp|87123|2022|PDM|950.00|99|0.00|DESTROY LUMB/SAC FACET JNT|
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PDM|1934.90|99|0.00|AEG 9 (NO REV)|
20|FH_F98361_12065_0|SrvcGrp|73643|2022|PDM|1061.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F100260_97116_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F82357_0_0|SrvcGrp|20000|2022|PDM|165.00|99|0.00|CATHETER CARE SUPPLIES|
20|FH_F150939_0_0|SrvcGrp|36668|2022|PDM|188.00|99|0.00|ZOSTER (SHINGLES VACCINE)|
20|FH_F39887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66569_0_0|SrvcGrp|62259|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F72445_0_0|SrvcGrp|12403|2022|PDM|893.00|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_F132163_17601_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F122035_84020_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133119_46545_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F135371_61032_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|GENERAL ACUTE CARE|
20|FH_F135432_16335_0|SrvcGrp|27968|2022|PDM|20.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135435_06067_0|SrvcGrp|75545|2022|PDM|495.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F135964_33805_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135979_66451_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136003_19380_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119892_47586_0|SrvcGrp|95660|2022|PDM|475.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F100880_67735_0|SrvcGrp|73008|2022|PDM|2465.00|99|0.00|AEG 10|
20|FH_F130670_32204_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F131132_44077_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F116397_33404_0|SrvcGrp|86847|2022|PDM|40.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F127399_0_0|SrvcGrp|11673|2022|PDM|3954.00|99|0.00|CPT 29888|
20|FH_F140629_0_0|SrvcGrp|63464|2022|PDM|1016.00|99|0.00|CPT 52276|
20|FH_F121824_92675_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F111301_33122_0|SrvcGrp|73605|2022|PDM|1020.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F111301_33122_0|SrvcGrp|82764|2022|PDM|57.00|99|0.00|HEPATIC FUNCTION PANEL|
20|FH_F111301_33122_0|SrvcGrp|72996|2022|PDM|1922.00|99|0.00|AEG 4|
20|FH_F111363_33169_0|SrvcGrp|82756|2022|PDM|79.00|99|0.00|ASSAY BLOOD LIPASE|
20|FH_F43137_0_0|SrvcGrp|10587|2022|PDM|140.00|99|0.00|PARENTERAL NUTRITION|
20|FH_F131000_0_0|SrvcGrp|26274|2022|PDM|3343.00|99|0.00|CPT 29877|
20|FH_F94060_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|OP SVCS|
20|FH_F114569_0_0|SrvcGrp|105679|2022|PCT|1.00|99|0.00|AETNA BH TELEMEDICINE/OP THERAPY SVCS (MOD GT/HO)|
20|FH_F87500_16823_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F102325_62691_0|SrvcGrp|43567|2022|PDM|60.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F102862_30606_0|SrvcGrp|99059|2022|PDM|10120.00|99|0.00|AETNA MS DRG 052 ONLY|
20|FH_F102940_35034_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143542_0_0|SrvcGrp|46906|2022|PDM|9754.00|99|0.00|CORNEAL TISSUE|
20|FH_F151280_20740_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F34963_0_0|SrvcGrp|12074|2022|PDM|130.00|99|0.00|RESIDENTIAL HOSPICE SERVICES|
20|FH_F35212_0_0|SrvcGrp|12264|2022|PDM|60.75|99|0.00|DIETICIAN OR LPN SERVICES|
20|FH_F113741_63303_0|SrvcGrp|44042|2022|PDM|66.30|99|0.00|SKILLED NURSING - LPN|
20|FH_F32628_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91873_12723_0|SrvcGrp|89282|2022|PDM|14665.00|99|0.00|ANGIOPLASTY|
20|FH_F97740_01605_0|SrvcGrp|73643|2022|PDM|1652.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F97740_01605_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F97761_04072_0|SrvcGrp|73559|2022|PDM|12695.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F97780_43614_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F112153_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150281_76309_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F130763_0_0|SrvcGrp|35668|2022|PDM|4391.00|99|0.00|CPT 29824|
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|1459.00|99|0.00|AEG 5  (NO REV)|
20|FH_F80172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F63318_0_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F72785_0_0|SrvcGrp|3029|2022|PDM|790.00|99|0.00|NEWBORN NURSERY|
20|FH_F149141_27262_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F147962_85008_0|SrvcGrp|88819|2022|PDM|1000.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|2435.00|99|0.00|AEG 3 (NO REV)|
20|FH_F119590_29607_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121303_15501_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F100782_0_0|SrvcGrp|105180|2022|PDM|192.50|99|0.00|WINDBER MEDICAL CNTR ASC 1501|
20|FH_F111986_0_0|SrvcGrp|89981|2022|PDM|3605.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY|
20|FH_F123633_70506_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132925_84041_0|SrvcGrp|76501|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F128828_44122_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133749_84604_0|SrvcGrp|48395|2022|PDM|85.50|99|0.00|OT SERVICES|
20|FH_F123851_03235_0|SrvcGrp|46104|2022|PDM|157.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F149300_53158_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145642_15108_0|SrvcGrp|86837|2022|PDM|10.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F126225_23413_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F113428_19446_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149279_17022_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123851_03235_0|SrvcGrp|27968|2022|PDM|54.10|99|0.00|SKILLED NURSING LPN|
20|FH_F150142_76018_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F146480_75042_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149660_0_0|SrvcGrp|13683|2022|PDM|595.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F110420_60649_0|SrvcGrp|73602|2022|PDM|750.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F149199_73005_0|SrvcGrp|74982|2022|PDM|605.00|99|0.00|AETNA REHABILITATION MSDRG 945-946|
20|FH_F85212_71075_0|SrvcGrp|73488|2022|PCT|0.00|99|0.00|AETNA HOSPITAL OP DIALYSIS|
20|FH_F85353_16407_0|SrvcGrp|63915|2022|PDM|114.97|99|0.00|HAPA WPA-NWPA 2012-13 ASC 243|
20|FH_F117206_0_0|SrvcGrp|92408|2022|PDM|1000.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F51393_0_0|SrvcGrp|42828|2022|PDM|64.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F138050_52301_0|SrvcGrp|78452|2022|PDM|1565.00|99|0.00|AETNA EMERGENCY CRITICAL CARE|
20|FH_F150165_06032_0|SrvcGrp|73495|2022|PDM|5994.00|99|0.00|AETNA MYOMECTOMY|
20|FH_F111957_30024_0|SrvcGrp|76501|2022|PDM|640.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F133747_80634_0|SrvcGrp|93266|2022|PCT|0.92|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F133875_80027_0|SrvcGrp|12659|2022|PDM|1067.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F100782_0_0|SrvcGrp|105058|2022|PDM|61.25|99|0.00|WINDBER MEDICAL CNTR ASC 10|
20|FH_F112065_20852_0|SrvcGrp|48394|2022|PDM|60.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F117401_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145642_15108_0|SrvcGrp|10577|2022|PDM|30.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F149150_75407_0|SrvcGrp|89337|2022|PDM|1050.00|99|0.00|DETOXIFICATION|
20|FH_F72828_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F34852_0_0|SrvcGrp|59078|2022|PCT|0.70|99|0.00|RADIOLOGY|
20|FH_F111027_32817_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F149199_73005_0|CSTM-ALL|CSTM-00|2020|PDM|2055.00|99|0.00|AEG 7 (NO REV)|
20|FH_F84652_0_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F115907_12206_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F80064_0_0|SrvcGrp|12118|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F125440_04043_0|SrvcGrp|108484|2022|PDM|546.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F115950_08648_0|SrvcGrp|73842|2022|PDM|208.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115966_16801_0|SrvcGrp|48385|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F131867_37211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133707_73072_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133398_43204_0|CSTM-ALL|CSTM-00|2020|PDM|484.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F133408_01095_0|SrvcGrp|113554|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F131702_17022_0|SrvcGrp|23683|2022|PDM|56.00|99|0.00|SKILLED NURSING RN|
20|FH_F111584_07002_0|SrvcGrp|90632|2022|PDM|276.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PDM|513.60|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 2 W/O REV|
20|FH_F134087_0_0|SrvcGrp|88162|2022|PDM|5410.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F113154_70359_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 6 (NO REV)|
20|FH_F70493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F52753_0_0|SrvcGrp|49204|2022|PDM|1700.00|99|0.00|VITRECTOMY|
20|FH_F52753_0_0|SrvcGrp|49205|2022|PDM|1700.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F136756_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141410_13045_0|SrvcGrp|112223|2022|PDM|110.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F93332_0_0|SrvcGrp|91047|2022|PDM|3090.00|99|0.00|REVISE MEDIAN NERVE AT WRIST (HCFA)|
20|FH_F141607_27021_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F37590_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F131560_62946_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117484_15601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87254_0_0|SrvcGrp|72994|2022|PDM|819.00|99|0.00|AEG 3|
20|FH_F143809_62401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115303_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F105480_19940_0|SrvcGrp|471|2022|PDM|490.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1219.00|99|0.00|EXTENDED RECOVERY/OBSERVATION (8-15 HRS)(HCFA)|
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1289.00|99|0.00|AEG 7 (NO REV)|
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138751_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143898_0_0|SrvcGrp|95661|2022|PDM|160.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F94786_07974_0|SrvcGrp|86850|2022|PDM|36.75|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F132275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132988_0_0|SrvcGrp|93807|2022|PDM|7118.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F134270_0_0|SrvcGrp|41334|2022|PDM|19000.00|99|0.00|TOTAL KNEE|
20|FH_F88933_0_0|SrvcGrp|11043|2022|PDM|1688.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F114389_50131_0|SrvcGrp|29023|2022|PDM|160.95|99|0.00|HOME INFUSION THERAPY|
20|FH_F50622_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122170_60120_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F146797_44906_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
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|32539|2022|PDM|11000.00|99|0.00|MS DRG 222-227 ONLY|
20|FH_F40643_0_0|SrvcGrp|10107|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F41035_0_0|SrvcGrp|72998|2022|PDM|788.00|99|0.00|AEG 5|
20|FH_F91998_0_0|SrvcGrp|91889|2022|PDM|1530.00|99|0.00|ARTHROSCOPY TMJ|
20|FH_F132864_71101_0|SrvcGrp|114925|2022|PDM|5234.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F124222_92625_0|SrvcGrp|87131|2022|PDM|900.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F131507_64154_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97083_90670_0|SrvcGrp|73601|2022|PDM|13469.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F97040_31901_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
20|FH_F135327_0_0|SrvcGrp|112735|2022|PDM|5300.00|99|0.00|CORNEAL IMPLANTS|
20|FH_F136658_50401_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127448_0_0|SrvcGrp|107885|2022|PDM|2150.00|99|0.00|TRLUML BALO ANGIOP 1ST VEIN|
20|FH_F134815_35016_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F115152_77058_0|SrvcGrp|108484|2022|PDM|538.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F116393_07002_0|SrvcGrp|89704|2022|PDM|76.49|99|0.00|CONTRAST X-RAY OF BLADDER|
20|FH_F116393_07002_0|SrvcGrp|106520|2022|PDM|15.30|99|0.00|MICROBE SUSCEPTIBLE|
20|FH_F147586_44124_0|SrvcGrp|104907|2022|PDM|2934.00|99|0.00|EXCISE PAROTID GLAND/LESION|
20|FH_F42024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
20|FH_F139159_76011_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139550_75219_0|SrvcGrp|100499|2022|PDM|567.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F150659_84604_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F150760_44833_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F37364_0_0|SrvcGrp|361|2022|PDM|1800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F151699_01752_0|SrvcGrp|14944|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F110726_19720_0|SrvcGrp|89337|2022|PDM|800.00|99|0.00|DETOXIFICATION|
20|FH_F116575_0_0|SrvcGrp|78098|2022|PDM|1600.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F149030_37919_0|SrvcGrp|90418|2022|PDM|4350.00|99|0.00|ENLARGE BREAST WITH IMPLANT|
20|FH_F92278_01440_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F124420_33442_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76522_0_0|SrvcGrp|24714|2022|PCT|0.45|99|0.00|INTRAOCULAR LENS|
20|FH_F129764_48084_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139576_0_0|SrvcGrp|13925|2022|PDM|3716.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1575124_HCPCS_  MOD UE|
20|FH_F33719_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F150982_0_0|SrvcGrp|33984|2022|PDM|1976.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F151042_60659_0|SrvcGrp|29347|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 4 (NO REV)|
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|2023.00|99|0.00|AEG 6 (NO REV)|
20|FH_F35987_0_0|SrvcGrp|177|2022|PDM|2111.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F128500_37215_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F76826_0_0|SrvcGrp|14247|2022|PDM|370.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F148961_33403_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F99523_80016_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F101640_32218_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F110783_93013_0|SrvcGrp|86848|2022|PDM|35.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F126977_34990_0|SrvcGrp|114975|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F139970_16142_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F98000_59102_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F138655_63873_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F36343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110727_34994_0|SrvcGrp|89417|2022|PDM|442.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F90232_15126_0|SrvcGrp|86848|2022|PDM|47.25|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F110193_70444_0|SrvcGrp|86723|2022|PDM|379.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F138478_0_0|SrvcGrp|95339|2022|PDM|6974.46|99|0.00|INSERT PACING LEAD & CONNECT|
20|FH_F97480_08204_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F36107_0_0|SrvcGrp|3810|2022|PDM|105.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PDM|1625.00|99|0.00|ASPG 4 PIEDMONT OUTPATIENT SURGERY CENTER|
20|FH_F129256_89146_0|SrvcGrp|89337|2022|PDM|1130.00|99|0.00|DETOXIFICATION|
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2705.00|99|0.00|AEG 5  (NO REV)|
20|FH_F54592_0_0|SrvcGrp|27042|2022|PDM|27.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS(MOD SH)|
20|FH_F54592_0_0|SrvcGrp|26868|2022|PDM|80.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F54592_0_0|SrvcGrp|17015|2022|PDM|19.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F54592_0_0|SrvcGrp|22589|2022|PDM|75.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F35571_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F122551_75605_0|SrvcGrp|86722|2022|PDM|232.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PDM|2197.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|119.63|99|0.00|HAPA WPA-NWPA 2012-13 ASC 136 W/O REV|
20|FH_F70607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F74583_0_0|SrvcGrp|48385|2022|PDM|14.00|99|0.00|SPEECH THERAPY|
20|FH_F105145_75075_0|SrvcGrp|73498|2022|PDM|750.00|99|0.00|AETNA ER LEVEL III|
20|FH_F75842_0_0|SrvcGrp|36503|2022|PDM|5468.18|99|0.00|MS DRG 286 287 INPATIENT CARDIAC CATH|
20|FH_F75842_0_0|SrvcGrp|72739|2022|PDM|9406.88|99|0.00|CARDIAC CATH|
20|FH_F80513_0_0|SrvcGrp|32539|2022|PDM|28120.00|99|0.00|MS DRG 222-227 ONLY|
20|FH_F120795_27514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127656_06068_0|SrvcGrp|94780|2022|PDM|161.70|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F40393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115952_44484_0|SrvcGrp|46903|2022|PDM|426.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F131738_72143_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131706_72404_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133269_78624_0|SrvcGrp|86722|2022|PDM|195.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F133544_78227_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F133153_44113_0|SrvcGrp|73842|2022|PDM|171.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F135891_0_0|SrvcGrp|90101|2022|PDM|0.10|99|0.00|AETNA MED RECORD COPY|
20|FH_F143539_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|1860.00|99|0.00|AEG 7 (NO REV)|
20|FH_F89372_0_0|SrvcGrp|73653|2022|PDM|394.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|610.62|99|0.00|AETNA POLYSOMNOGRAPHY|
20|FH_F88398_15601_0|SrvcGrp|92518|2022|PDM|92.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 6 (NO REV)|
20|FH_F123741_20850_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F40347_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F64999_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|ASPG X|
20|FH_F96182_0_0|SrvcGrp|474|2022|PDM|275.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1561.00|99|0.00|AEG 9 (NO REV)|
20|FH_F136475_89119_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F136488_16828_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F118201_35126_0|SrvcGrp|105361|2022|PCT|1.00|99|0.00|HOSPICE/PHYSICIAN|
20|FH_F120490_64133_0|SrvcGrp|43567|2022|PDM|83.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F120475_81052_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134011_84102_0|SrvcGrp|43569|2022|PDM|50.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F134113_61614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137147_75006_0|SrvcGrp|38662|2022|PDM|26970.00|99|0.00|MS DRG 327 ONLY|
20|FH_F137147_75006_0|SrvcGrp|88903|2022|PDM|31500.00|99|0.00|MS DRG 581 ONLY|
20|FH_F138108_47130_0|SrvcGrp|86638|2022|PDM|989.00|99|0.00|AETNA IP PSYCHIATRIC (>=18 YRS)|
20|FH_F142547_70002_0|SrvcGrp|86848|2022|PDM|25.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F122009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|921.00|99|0.00|AEG 4 (NO REV)|
20|FH_F138469_70433_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138545_39503_0|SrvcGrp|73841|2022|PDM|733.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F74264_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140343_89052_0|SrvcGrp|86834|2022|PDM|10.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F140844_48083_0|SrvcGrp|88809|2022|PDM|29.00|99|0.00|HOME HEALTH AIDE (HCFA)|
20|FH_F140844_48083_0|SrvcGrp|73524|2022|PDM|129.00|99|0.00|PHYSICAL THERAPY|
20|FH_F149644_91367_0|SrvcGrp|46903|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F119004_06850_0|SrvcGrp|42429|2022|PDM|1017.00|99|0.00|OP SURGERY CPT 66761|
20|FH_F119090_91502_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F38332_0_0|SrvcGrp|18868|2022|PDM|42216.00|99|0.00|MS DRG 231|
20|FH_F92551_18508_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F92506_07666_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F109983_98607_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F91913_0_0|SrvcGrp|72992|2022|PDM|446.00|99|0.00|AEG 2|
20|FH_F92852_0_0|SrvcGrp|45583|2022|PDM|2200.00|99|0.00|CPT 65730|
20|FH_F117261_43543_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117261_43543_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F147726_18017_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|AEG 5  (NO REV)|
20|FH_F129467_45449_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F129483_77030_0|SrvcGrp|86842|2022|PDM|35.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F129483_77030_0|SrvcGrp|86837|2022|PDM|25.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F129507_70002_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F117107_33704_0|SrvcGrp|63458|2022|PDM|1400.00|99|0.00|ANTEPARTUM VISITS 7 OR MORE|
20|FH_F117240_37334_0|SrvcGrp|8950|2022|PDM|1690.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F137938_29036_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F137938_29036_0|SrvcGrp|79786|2022|PCT|0.66|99|0.00|SLEEP STUDIES|
20|FH_F137980_03101_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40490_0_0|CSTM-ALL|CSTM-00|2020|PDM|2266.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F35280_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|CARDIAC EVENT MONITORING F/S - TMSS|
20|FH_F125656_92868_0|SrvcGrp|24747|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F117617_80439_0|SrvcGrp|95779|2022|PDM|165.00|99|0.00|HOSPICE CARE|
20|FH_F151699_01752_0|SrvcGrp|15596|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F139353_67124_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139576_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F39162_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97880_63501_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F97100_23462_0|SrvcGrp|90854|2022|PDM|1711.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F140295_0_0|SrvcGrp|88820|2022|PDM|4130.00|99|0.00|CPT 24359|
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 2 (NO REV)|
20|FH_F122263_37072_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111038_62960_0|SrvcGrp|537|2022|PCT|0.84|99|0.00|OBSERVATION SERVICES|
20|FH_F39772_0_0|SrvcGrp|409|2022|PCT|0.80|99|0.00|ER SVCS|
20|FH_F122841_0_0|SrvcGrp|91456|2022|PDM|972.00|99|0.00|LAGOPHTHALMOS CORRECTION|
20|FH_F37777_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F147225_48093_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PDM|1814.50|99|0.00|AEG 4 (NO REV)|
20|FH_F40991_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OP SVCS|
20|FH_F76826_0_0|SrvcGrp|70419|2022|PDM|63.00|99|0.00|OBSERVATION W/ CATH, LITHO, SURGERY, OR ER|
20|FH_F117615_30525_0|SrvcGrp|75479|2022|PCT|0.85|99|0.00|AEG 1|
20|FH_F128753_32501_0|SrvcGrp|75491|2022|PCT|0.64|99|0.00|AEG 7|
20|FH_F47996_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.50|99|0.00|OP SVCS|
20|FH_F36299_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F145920_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F150919_17603_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137986_0_0|SrvcGrp|79757|2022|PDM|1436.00|99|0.00|ESOPHAGUS ENDOSCOPY REPAIR|
20|FH_F114848_50533_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|948.00|99|0.00|ASPG 6 SURGICAL EYE CENTER|
20|FH_F47558_0_0|SrvcGrp|39704|2022|PCT|1.00|99|0.00|KS FS 3247 (A&E CODES)- W MOD MS OR MOD RR AND MS|
20|FH_F90817_0_0|SrvcGrp|91007|2022|PDM|6580.00|99|0.00|REVISION OF KNEE JOINTLANT (HCFA)|
20|FH_F131331_0_0|SrvcGrp|82223|2022|PDM|55.66|99|0.00|HOSPICE CARE|
20|FH_F138410_19130_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F127258_79912_0|SrvcGrp|90854|2022|PDM|822.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F149539_06032_0|SrvcGrp|48396|2022|PDM|184.00|99|0.00|OT SERVICES|
20|FH_F146266_0_0|SrvcGrp|26273|2022|PDM|2770.00|99|0.00|CPT 29880|
20|FH_F139912_04101_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F139951_92870_0|SrvcGrp|89337|2022|PDM|1000.00|99|0.00|DETOXIFICATION|
20|FH_F139810_60938_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143347_16001_0|SrvcGrp|79858|2022|PDM|5166.00|99|0.00|ENDOSCOPY - BILE DUCT/PANCREAS|
20|FH_F143410_77845_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F143494_34474_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54512_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102224_0_0|SrvcGrp|71666|2022|PDM|6000.00|99|0.00|CPT 63655|
20|FH_F130917_48658_0|SrvcGrp|83857|2022|PDM|550.00|99|0.00|IP HOSPICE SVCS|
20|FH_F47600_0_0|SrvcGrp|32386|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKL (DME)|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1059.00|99|0.00|GA RETINA SURG CTR ASC 25|
20|FH_F116913_77024_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F82771_0_0|SrvcGrp|58638|2022|PDM|1575.00|99|0.00|CPT 63688|
20|FH_F120866_51652_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F127820_62626_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F31150_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F35685_0_0|CSTM-ALL|CSTM-00|2020|PDM|15435.00|99|0.00|DRG 519 ONLY|
20|FH_F39266_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F39272_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F40517_0_0|SrvcGrp|15873|2022|PDM|40.17|99|0.00|HOSPICE SERVICE - CONTINUOUS HOME CARE|
20|FH_F40600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F42177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|PEDIATRIC IP SVCS|
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F98621_41042_0|SrvcGrp|73559|2022|PDM|16047.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F102947_44084_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F54612_07631_0|SrvcGrp|9828|2022|PDM|55.80|99|0.00|HOME HEALTH AIDE|
20|FH_F120112_0_0|SrvcGrp|89783|2022|PDM|94.50|99|0.00|RESPITE CARE (HCFA)|
20|FH_F129850_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F133107_73071_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F92516_0_0|SrvcGrp|73006|2022|PDM|1352.00|99|0.00|AEG 9|
20|FH_F92516_0_0|SrvcGrp|73002|2022|PDM|1005.00|99|0.00|AEG 7|
20|FH_F132544_0_0|SrvcGrp|19991|2022|PDM|7850.00|99|0.00|NERVOUS SYSTEM SERVICES|
20|FH_F132544_0_0|SrvcGrp|113594|2022|PDM|8007.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F119495_34711_0|SrvcGrp|114975|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F138283_0_0|SrvcGrp|92502|2022|PDM|525.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F148561_17022_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F42352_0_0|SrvcGrp|903|2022|PDM|4600.00|99|0.00|PTC ANGIOPLASTY|
20|FH_F71323_68114_0|SrvcGrp|35210|2022|PDM|2964.00|99|0.00|MS DRG 204 ONLY|
20|FH_F39627_0_0|SrvcGrp|30711|2022|PDM|12500.00|99|0.00|BRACHYTHERAPY 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_F109652_0_0|SrvcGrp|76861|2022|PDM|31244.00|99|0.00|MSDRG 619-621, 983 ONLY BARIATRIC SURGERY|
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.00|99|0.00|AEG 10 (NO REV)|
20|FH_F90791_79106_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F91472_96001_0|SrvcGrp|10391|2022|PDM|10700.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F130035_0_0|SrvcGrp|108041|2022|PDM|473.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F148720_0_0|SrvcGrp|103552|2022|PDM|75.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F113503_0_0|SrvcGrp|73806|2022|PCT|0.70|99|0.00|AETNA ER|
20|FH_F95880_02726_0|SrvcGrp|90488|2022|PDM|81.43|99|0.00|ORAL FUNCTION THERAPY|
20|FH_F148740_93230_0|SrvcGrp|89412|2022|PDM|501.56|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F151144_35801_0|SrvcGrp|115930|2022|PDM|795.00|99|0.00|EYELID REVISION|
20|FH_F121404_32216_0|SrvcGrp|82846|2022|PCT|1.05|99|0.00|AETNA DME|
20|FH_F122013_75503_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|LAP INC HERN REPAIR COMP|
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|SrvcGrp|104921|2022|PDM|400.00|99|0.00|HEART FLOW RESERVE MEASURE-CONCUR|
20|FH_F129130_92562_0|SrvcGrp|997|2022|PCT|0.46|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|474.34|99|0.00|DELAWARE VALLEY- ASC 201|
20|FH_F69651_0_0|SrvcGrp|10544|2022|PDM|73.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F151500_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91873_12723_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F91873_12723_0|SrvcGrp|3932|2022|PDM|6450.00|99|0.00|LITHOTRIPSY|
20|FH_F40391_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|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_F117001_0_0|SrvcGrp|106598|2022|PDM|1300.00|99|0.00|HEARING AID, PROG, BIN, ITC|
20|FH_F86911_0_0|SrvcGrp|86058|2022|PCT|0.50|99|0.00|INFUSION THERAPY W/ MOD SH|
20|FH_F119595_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F114916_30309_0|SrvcGrp|105000|2022|PDM|3000.00|99|0.00|REPAIR OF KNEECAP FRACTURE|
20|FH_F132988_0_0|SrvcGrp|112156|2022|PDM|2057.62|99|0.00|PIN FINGER DISLOCATION|
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1154.15|99|0.00|ASPG III|
20|FH_F72204_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INFUSION THERAPY|
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|1152.35|99|0.00|AEG 6 (NO REV)|
20|FH_F49487_0_0|SrvcGrp|10519|2022|PDM|30.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F122198_20708_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F146674_70778_0|SrvcGrp|89337|2022|PDM|800.00|99|0.00|DETOXIFICATION|
20|FH_F62624_0_0|SrvcGrp|9774|2022|PDM|2700.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F36318_0_0|SrvcGrp|3069|2022|PCT|0.37|99|0.00|IMPLANTS|
20|FH_F91898_0_0|SrvcGrp|12670|2022|PCT|0.72|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F91898_0_0|SrvcGrp|91658|2022|PDM|6356.00|99|0.00|AETNA MATERNITY CARE (NORMAL DELIVERY)|
20|FH_F124178_01604_0|SrvcGrp|10003|2022|PCT|1.00|99|0.00|LUPRON DEPOT/LEUPROLIDE ACETATE|
20|FH_F124212_33407_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F124586_14850_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124611_64804_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F124636_85008_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F132592_68305_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F136674_16335_0|SrvcGrp|92760|2022|PCT|3.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136736_65483_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F136741_60523_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138779_62703_0|SrvcGrp|89149|2022|PDM|240.00|99|0.00|OP INTENSIVE|
20|FH_F138855_84067_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F100664_03104_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F134735_91362_0|SrvcGrp|106248|2022|PDM|560.00|99|0.00|PARTIAL HOSP PSYCH|
20|FH_F136796_24016_0|SrvcGrp|90063|2022|PDM|3115.24|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F115210_21043_0|SrvcGrp|82107|2022|PDM|2122.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F115631_65201_0|SrvcGrp|92819|2022|PDM|2419.00|99|0.00|HIP ARTHOSCOPY|
20|FH_F147519_52627_0|CSTM-ALL|CSTM-00|2020|PDM|6996.93|99|0.00|AEG 9 (NO REV)|
20|FH_F147725_06002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41463_0_0|SrvcGrp|34388|2022|PDM|134.40|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F42024_0_0|SrvcGrp|35559|2022|PDM|4500.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY - OP|
20|FH_F126970_45601_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F113649_01752_0|SrvcGrp|16750|2022|PDM|119.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118950_33312_0|SrvcGrp|75522|2022|PDM|1025.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD|
20|FH_F118792_63379_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118815_61021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F51276_0_0|SrvcGrp|17005|2022|PDM|67.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS|
20|FH_F51276_0_0|SrvcGrp|24762|2022|PDM|150.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F130152_48025_0|SrvcGrp|57966|2022|PCT|1.00|99|0.00|HOSPICE CARE|
20|FH_F48772_66044_0|SrvcGrp|24934|2022|PCT|1.00|99|0.00|NUTRITIONAL ASSESSMENT (INITIAL)|
20|FH_F131235_36049_0|SrvcGrp|73605|2022|PDM|1072.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F106980_0_0|SrvcGrp|72998|2022|PDM|1000.00|99|0.00|AEG 5|
20|FH_F76824_0_0|SrvcGrp|47343|2022|PDM|80.00|99|0.00|LPN HOURLY|
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PDM|2217.00|99|0.00|AEG 4 (NO REV)|
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 2 (NO REV)|
20|FH_F151399_0_0|SrvcGrp|2067|2022|PDM|3945.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 6 (NO REV)|
20|FH_F135351_0_0|SrvcGrp|41334|2022|PDM|13750.00|99|0.00|TOTAL KNEE|
20|FH_F135351_0_0|SrvcGrp|88160|2022|PDM|7370.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|501.00|99|0.00|AEG 1 (NO REV)|
20|FH_F114853_0_0|SrvcGrp|77021|2022|PDM|7215.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F48693_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F54552_0_0|SrvcGrp|13929|2022|PDM|19.00|99|0.00|GROWTH HORMONE|
20|FH_F113585_20155_0|SrvcGrp|22389|2022|PDM|15.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F138879_17837_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138887_71822_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138936_01040_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F77933_0_0|CSTM-ALL|CSTM-00|2020|PDM|374.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89580_0_0|SrvcGrp|778|2022|PDM|9421.00|99|0.00|OP TRAUMA|
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|368.38|99|0.00|HAPA WPA-NWPA 2012-13 ASC 112 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|139.51|99|0.00|HAPA WPA-NWPA 2012-13 ASC 239 W/O REV|
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|756.22|99|0.00|AEG 5  (NO REV)|
20|FH_F151401_36607_0|SrvcGrp|14494|2022|PDM|56.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F151420_60654_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F132258_45404_0|SrvcGrp|22593|2022|PDM|30.74|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F145528_76501_0|SrvcGrp|29347|2022|PDM|31.00|99|0.00|HOME HEALTH AIDE|
20|FH_F135462_06795_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135924_02906_0|SrvcGrp|112676|2022|PDM|238.30|99|0.00|COVID-19 SARS-COV-2 ANTIBODY|
20|FH_F136042_90066_0|SrvcGrp|79280|2022|PDM|1300.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F131407_07607_0|SrvcGrp|86834|2022|PDM|10.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F127399_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F40409_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36479_0_0|SrvcGrp|361|2022|PDM|1748.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F121707_85745_0|SrvcGrp|108484|2022|PDM|1115.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F121803_66502_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151143_0_0|SrvcGrp|115963|2022|PDM|12.00|99|0.00|NON-EMERGENT FIXED WING AIR MILEAGE (MOD NE)|
20|FH_F111291_52501_0|SrvcGrp|472|2022|PDM|448.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F111363_33169_0|SrvcGrp|109220|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F111385_33308_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134315_89106_0|SrvcGrp|24744|2022|PCT|1.00|99|0.00|PICC LINE INSERTION|
20|FH_F134315_89106_0|SrvcGrp|14945|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F69202_0_0|SrvcGrp|20077|2022|PDM|30000.00|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR|
20|FH_F33081_0_0|SrvcGrp|14320|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F54272_0_0|SrvcGrp|10708|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F132328_0_0|SrvcGrp|98404|2022|PDM|2143.00|99|0.00|ARTHROSCOPIC FRACTURE TX|
20|FH_F102960_50613_0|SrvcGrp|99086|2022|PDM|851.00|99|0.00|PSYCH RESIDENTIAL TREATMENT|
20|FH_F101320_26062_0|SrvcGrp|46605|2022|PDM|108.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F132090_60915_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F101807_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PDM|1189.00|99|0.00|AEG 4 (NO REV)|
20|FH_F132544_0_0|SrvcGrp|40002|2022|PDM|8007.00|99|0.00|TOTAL HIP|
20|FH_F148552_68114_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F148554_85016_0|SrvcGrp|115446|2022|PDM|2000.00|99|0.00|LEFT VENTRIC PACING LEAD ADD-ON|
20|FH_F148561_17022_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121009_76180_0|SrvcGrp|472|2022|PDM|475.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|AEG 10 (NO REV)|
20|FH_F128707_72601_0|SrvcGrp|103551|2022|PDM|215.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F117906_91606_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F43333_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY|
20|FH_F128130_10027_0|CSTM-ALL|CSTM-00|2020|PDM|4190.00|99|0.00|AEG 1 (NO REV)|
20|FH_F102822_84065_0|SrvcGrp|46424|2022|PDM|85.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F141654_15217_0|SrvcGrp|48394|2022|PDM|30.90|99|0.00|SKILLED NURSING SERVICES|
20|FH_F91152_60061_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F94165_0_0|SrvcGrp|73605|2022|PCT|0.85|99|0.00|AETNA ACUTE PSYCH|
20|FH_F148881_33018_0|SrvcGrp|99460|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY EVALUATION|
20|FH_F101840_76054_0|SrvcGrp|97478|2022|PDM|6608.00|99|0.00|RELIEVE BLADDER CONTRACTURE|
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_F150522_95864_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132594_78229_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F101802_17201_0|SrvcGrp|13238|2022|PDM|7.80|99|0.00|VENIPUNCTURE|
20|FH_F123085_21921_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F103106_04101_0|SrvcGrp|75442|2022|PDM|470.00|99|0.00|OBSERVATION - REV 762|
20|FH_F134448_66203_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F38630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|100% 2007 MEDICARE TN DME MOD AU|
20|FH_F133009_19038_0|SrvcGrp|43569|2022|PDM|107.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F34706_0_0|SrvcGrp|11612|2022|PDM|28362.00|99|0.00|DRG 546 SPINAL FUSIONS EXPT CERV W/CVTR SPINE OR MLGNCY|
20|FH_F52795_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133470_97068_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F126769_43701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89015_74017_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|HOME INF- REV 640 MOD SH|
20|FH_F127422_0_0|SrvcGrp|73000|2022|PDM|826.00|99|0.00|AEG 6|
20|FH_F102561_75146_0|SrvcGrp|86880|2022|PDM|5330.00|99|0.00|AETNA LAPAROSCOPY SERVICES|
20|FH_F125212_76301_0|SrvcGrp|87317|2022|PDM|627.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F97541_33021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117471_19111_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F122388_0_0|SrvcGrp|72992|2022|PDM|482.00|99|0.00|AEG 2|
20|FH_F62513_0_0|SrvcGrp|36663|2022|PCT|1.00|99|0.00|IMPLANTS/PROSTHETICS/DEVICES/SUPPLIES|
20|FH_F44607_0_0|SrvcGrp|38809|2022|PDM|2800.00|99|0.00|CPT 29880-29881, 29876,-29877, 29822-29823,28290|
20|FH_F67639_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_F120437_85202_0|SrvcGrp|86854|2022|PDM|90.04|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F148556_13206_0|SrvcGrp|22593|2022|PDM|30.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F49637_0_0|SrvcGrp|21359|2022|PDM|18480.00|99|0.00|MS DRG 460 ONLY|
20|FH_F150065_16001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50618_0_0|SrvcGrp|17069|2022|PDM|672.40|99|0.00|ASPG III|
20|FH_F130652_51101_0|SrvcGrp|75545|2022|PDM|370.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|465.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F40738_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F146375_06751_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130553_18640_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89932_10940_0|SrvcGrp|88697|2022|PCT|1.30|99|0.00|DRUGS|
20|FH_F111520_81601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97622_75051_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F148904_85255_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F119599_0_0|SrvcGrp|87077|2022|PDM|135.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F97061_85012_0|SrvcGrp|73559|2022|PDM|13415.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F115889_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F92676_15063_0|SrvcGrp|79015|2022|PDM|994.97|99|0.00|MON VALLEY ASC 110|
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100880_67735_0|SrvcGrp|73806|2022|PCT|0.78|99|0.00|AETNA ER|
20|FH_F54372_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F102721_38118_0|SrvcGrp|72994|2022|PDM|900.00|99|0.00|AEG 3|
20|FH_F141830_92592_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F115315_43011_0|SrvcGrp|94736|2022|PCT|1.00|99|0.00|FLULAVAL VACC IM (>=3 YRS)|
20|FH_F36993_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD TC|
20|FH_F117733_91362_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F112632_66207_0|SrvcGrp|16|2022|PDM|980.00|99|0.00|ACUTE REHABILITATION|
20|FH_F143191_17512_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123085_21921_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F127325_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87615_80033_0|SrvcGrp|52951|2022|PDM|140.00|99|0.00|PSYCHIATRIC CPT 90846|
20|FH_F83053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125256_77365_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F127327_27401_0|SrvcGrp|30089|2022|PDM|522.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F109242_18466_0|SrvcGrp|91392|2022|PDM|214.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AF)|
20|FH_F128615_78520_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F40980_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F143487_0_0|CSTM-ALL|CSTM-00|2020|PDM|952.00|99|0.00|AEG 2 (NO REV)|
20|FH_F133118_33143_0|SrvcGrp|3044|2022|PDM|738.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F32088_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F115330_34113_0|SrvcGrp|106048|2022|PDM|500.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F125009_17042_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F97181_33143_0|SrvcGrp|43524|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F72542_0_0|SrvcGrp|25535|2022|PDM|1400.00|99|0.00|ICU|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1875.00|99|0.00|COVENTRY ENHANCED GROUPER 9 MOD 50|
20|FH_F149781_37404_0|CSTM-ALL|CSTM-00|2020|PDM|1872.00|99|0.00|AEG 3 (NO REV)|
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|441.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F124505_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150883_14727_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F32192_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF|
20|FH_F37567_0_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|ASPG V|
20|FH_F117385_48091_0|CSTM-ALL|CSTM-00|2020|PDM|80.00|99|0.00|AETNA FAMILY ADAPTIVE BH TREATMENT W/O PATIENT|
20|FH_F40331_0_0|SrvcGrp|15|2022|PDM|3441.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F120707_0_0|SrvcGrp|3378|2022|PCT|0.89|99|0.00|OBSERVATION SVCS|
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|2784.00|99|0.00|AEG 4 (NO REV)|
20|FH_F97563_83201_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F145881_46011_0|SrvcGrp|75419|2022|PDM|377.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F88512_0_0|SrvcGrp|14174|2022|PDM|1746.13|99|0.00|MRI|
20|FH_F107400_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_F117802_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137638_0_0|SrvcGrp|46903|2022|PDM|752.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F148555_0_0|SrvcGrp|115445|2022|PDM|3090.00|99|0.00|INSERT PACING LEAD & CONNECT|
20|FH_F113131_19013_0|SrvcGrp|89024|2022|PDM|83.64|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
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_F147800_0_0|SrvcGrp|110766|2022|PDM|458.00|99|0.00|3RD LEVEL INJ PARAVERT F JNT C/T|
20|FH_F133021_00910_0|SrvcGrp|112277|2022|PDM|4000.00|99|0.00|ABLATION THERAPY|
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 7 (NO REV)|
20|FH_F89112_16509_0|SrvcGrp|99621|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SVCS RE-EVAL|
20|FH_F108700_63857_0|SrvcGrp|94781|2022|PDM|108.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F128421_27016_0|SrvcGrp|109057|2022|PCT|0.80|99|0.00|CARDIAC STUDIES|
20|FH_F146401_76401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F85753_0_0|SrvcGrp|57968|2022|PDM|31.90|99|0.00|CONTINUOUS HOMECARE|
20|FH_F40659_0_0|SrvcGrp|33165|2022|PDM|400.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F32861_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.50|99|0.00|OP SVCS|
20|FH_F133052_33462_0|SrvcGrp|73842|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F107140_0_0|SrvcGrp|48398|2022|PDM|65.00|99|0.00|PT SERVICES|
20|FH_F111461_32607_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F117446_31322_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F118819_76226_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F87155_04105_0|SrvcGrp|48396|2022|PDM|94.56|99|0.00|OT SERVICES|
20|FH_F125540_19462_0|SrvcGrp|109658|2022|PDM|190.00|99|0.00|INTENSIVE OUTPATIENT (<=17 YRS)|
20|FH_F40786_0_0|CSTM-ALL|CSTM-00|2020|PDM|541.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F124608_0_0|SrvcGrp|35669|2022|PDM|4080.00|99|0.00|CPT 63650|
20|FH_F111540_16823_0|SrvcGrp|104414|2022|PDM|210.00|99|0.00|PSYCH DIAGNOSTIC EVALUATION (HCFA)(MOD AF)|
20|FH_F44048_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|ADOLESCENT RESIDENTIAL TREATMENT|
20|FH_F106540_26330_0|SrvcGrp|16392|2022|PCT|0.98|99|0.00|AMBULANCE|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKL|
20|FH_F119226_07746_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F148494_0_0|SrvcGrp|98561|2022|PDM|12000.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F47970_0_0|SrvcGrp|97505|2022|PDM|525.00|99|0.00|UPPER GI ENDOSCOPY PROCEDURES|
20|FH_F120773_77706_0|SrvcGrp|74668|2022|PDM|185.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F92676_15063_0|SrvcGrp|14239|2022|PDM|266.00|99|0.00|EMERGENCY ROOM SVCS LEVEL I|
20|FH_F36207_0_0|SrvcGrp|16898|2022|PDM|495.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F89112_16509_0|SrvcGrp|11108|2022|PDM|913.00|99|0.00|NEWBORN NURSERY|
20|FH_F145988_06105_0|SrvcGrp|112812|2022|PDM|10.10|99|0.00|COVID-19 LAB TRANSFER|
20|FH_F146121_71857_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F96261_0_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F54552_0_0|SrvcGrp|24761|2022|PDM|42.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|727.38|99|0.00|HAPA WPA-NWPA 2012-13 ASC 402 W/O REV|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F133550_90630_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141887_65605_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F136401_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123181_75057_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F128492_49010_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F44093_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134490_62801_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|683.00|99|0.00|AEG 5  (NO REV)|
20|FH_F73684_0_0|SrvcGrp|12591|2022|PDM|250.00|99|0.00|CD FULL DAY|
20|FH_F146217_0_0|SrvcGrp|29155|2022|PDM|141.22|99|0.00|HOSPICE SVCS|
20|FH_F45176_0_0|SrvcGrp|39607|2022|PDM|2200.00|99|0.00|LAPAROSCOPY|
20|FH_F133018_84037_0|SrvcGrp|22592|2022|PDM|22.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F89932_10940_0|SrvcGrp|3932|2022|PDM|6450.00|99|0.00|LITHOTRIPSY|
20|FH_F126815_02118_0|CSTM-ALL|CSTM-00|2020|PDM|2050.33|99|0.00|AEG 3 (NO REV)|
20|FH_F68363_0_0|SrvcGrp|13632|2022|PDM|210.00|99|0.00|CPT 99215|
20|FH_F143684_0_0|SrvcGrp|109250|2022|PCT|0.00|99|0.00|IMPLANT NEURORECEIVER 23|
20|FH_F37751_0_0|SrvcGrp|27698|2022|PDM|40.00|99|0.00|ONE TO ONE PERSONAL SITTERS|
20|FH_F140175_0_0|SrvcGrp|89344|2022|PDM|250.00|99|0.00|HYPERBARIC OXYGEN|
20|FH_F126663_91423_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F71271_0_0|SrvcGrp|68263|2022|PDM|12.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F133350_39532_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F89932_10940_0|SrvcGrp|72998|2022|PDM|3040.00|99|0.00|AEG 5|
20|FH_F139175_98229_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139680_76006_0|SrvcGrp|89417|2022|PDM|473.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F139707_84010_0|SrvcGrp|116120|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F150881_52722_0|CSTM-ALL|CSTM-00|2020|PDM|730.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F125656_92868_0|SrvcGrp|17014|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F148902_40509_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F33566_0_0|SrvcGrp|16|2022|PDM|1035.00|99|0.00|ACUTE REHABILITATION|
20|FH_F110193_70444_0|SrvcGrp|86749|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F124270_46256_0|SrvcGrp|73700|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F98001_27603_0|SrvcGrp|73605|2022|PDM|2514.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F139177_0_0|SrvcGrp|11663|2022|PCT|0.32|99|0.00|IMPLANTS|
20|FH_F40690_0_0|SrvcGrp|12031|2022|PCT|0.80|99|0.00|DURABLE MEDICAL EQUIPMENT (DME)|
20|FH_F149651_90046_0|SrvcGrp|114093|2022|PDM|525.00|99|0.00|PARTIAL HOSPITAL SUBSTANCE ABUSE|
20|FH_F41033_0_0|SrvcGrp|17075|2022|PDM|826.00|99|0.00|ASPG VI|
20|FH_F129340_43212_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PDM|1408.05|99|0.00|ASPG VIII|
20|FH_F138478_0_0|SrvcGrp|107879|2022|PDM|2558.53|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F76303_0_0|SrvcGrp|48645|2022|PDM|18.00|99|0.00|OP SKILLED NURSING|
20|FH_F126439_92627_0|SrvcGrp|108484|2022|PDM|935.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F88254_33411_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F118194_50841_0|SrvcGrp|26869|2022|PDM|145.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
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_F115079_62062_0|SrvcGrp|81779|2022|PCT|1.85|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 4 (NO REV)|
20|FH_F134994_33162_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F143748_02904_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F49042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F143894_70001_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F143928_21061_0|SrvcGrp|46104|2022|PDM|131.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F146940_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F148203_60190_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F98920_46526_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F123512_64089_0|SrvcGrp|75545|2022|PDM|327.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F148549_60523_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F37679_0_0|SrvcGrp|27055|2022|PDM|8.38|99|0.00|HYDRATION THERAPY - 1 LITER (MOD SJ)|
20|FH_F91876_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F121467_75165_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F126923_33612_0|CSTM-ALL|CSTM-00|2020|PDM|371.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F148221_06477_0|SrvcGrp|89781|2022|PDM|168.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F118072_38133_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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_F83451_0_0|SrvcGrp|81565|2022|PDM|1625.00|99|0.00|ARTHOSCOPY SHOULDER|
20|FH_F136684_0_0|SrvcGrp|112918|2022|PCT|1.00|99|0.00|POSTERIOR CHAMBER INTRAOCULA|
20|FH_F93593_33414_0|SrvcGrp|89417|2022|PDM|339.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F125817_78613_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127988_85258_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|ASPG II|
20|FH_F118373_21205_0|SrvcGrp|44488|2022|PDM|3014.00|99|0.00|TRAUMATIC BRAIN INJURY SERVICES|
20|FH_F126465_37190_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139515_0_0|SrvcGrp|89983|2022|PDM|1942.00|99|0.00|KNEE ARTHROSCOPY / SURGERY|
20|FH_F148265_06067_0|SrvcGrp|26278|2022|PDM|6086.00|99|0.00|CPT 29881|
20|FH_F43171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F33233_0_0|SrvcGrp|3259|2022|PDM|822.15|99|0.00|ACUTE REHABILITATION|
20|FH_F148600_30328_0|CSTM-ALL|CSTM-00|2020|PDM|464.00|99|0.00|AEG 1 (NO REV)|
20|FH_F104941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131228_01826_0|SrvcGrp|12840|2022|PCT|1.11|99|0.00|PACEMAKER|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 296-298|
20|FH_F126153_44663_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 9 (NO REV)|
20|FH_F40032_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH|
20|FH_F62892_0_0|SrvcGrp|10542|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F125249_0_0|SrvcGrp|108261|2022|PDM|1000.00|99|0.00|AETNA EXPLORE TREAT ANKLE JOINT|
20|FH_F34496_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F131952_06002_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F91622_0_0|SrvcGrp|31931|2022|PDM|2324.00|99|0.00|SKILLED NURSING CARE|
20|FH_F143783_0_0|SrvcGrp|95660|2022|PDM|105.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F111826_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F109180_18015_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130807_20721_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F78162_0_0|SrvcGrp|17754|2022|PDM|67.00|99|0.00|DRESSING SET FOR  NEG PRESSURE WOUND THERAPY ELEC PUMP|
20|FH_F148254_89503_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F77762_0_0|SrvcGrp|42973|2022|PDM|135.00|99|0.00|SPEECH  THERAPIST|
20|FH_F129782_0_0|CSTM-ALL|CSTM-00|2020|PDM|1880.00|99|0.00|AEG 10 (NO REV)|
20|FH_F94942_0_0|SrvcGrp|36591|2022|PDM|3824.39|99|0.00|CPT 63685|
20|FH_F142073_0_0|SrvcGrp|58993|2022|PDM|5980.00|99|0.00|DISKECTOMY|
20|FH_F110925_01104_0|SrvcGrp|86119|2022|PDM|1.00|99|0.00|AETNA FACTOR IX COMPLEX|
20|FH_F49092_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.20|99|0.00|GENERAL ACUTE CARE|
20|FH_F113410_0_0|SrvcGrp|104555|2022|PDM|2101.00|99|0.00|HYSTEROSCOPY REMOVE FB|
20|FH_F148123_91301_0|SrvcGrp|74668|2022|PDM|375.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F150026_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F151541_01436_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F62915_0_0|SrvcGrp|63|2022|PDM|645.00|99|0.00|SUBACUTE CARE|
20|FH_F118050_77565_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F56136_0_0|SrvcGrp|8950|2022|PDM|2810.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F129594_02842_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151523_86333_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F116176_0_0|SrvcGrp|26001|2022|PDM|133.35|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F128878_11203_0|SrvcGrp|86646|2022|PDM|105.00|99|0.00|AETNA PSYTX PT & FAM W E&M 45 MINS (MOD TD)|
20|FH_F141407_76226_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F149666_33460_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149740_33912_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122433_0_0|SrvcGrp|37317|2022|PDM|1425.00|99|0.00|LITHOTRIPSY|
20|FH_F33566_0_0|SrvcGrp|31038|2022|PDM|26530.00|99|0.00|MS DRG 233-234 ONLY|
20|FH_F131471_67203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131574_64131_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F74646_0_0|SrvcGrp|26179|2022|PDM|55.00|99|0.00|OT|
20|FH_F149019_34114_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F147224_48026_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138017_73129_0|SrvcGrp|35670|2022|PDM|2730.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F151005_17044_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97101_98003_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F145583_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HSS ASC|
20|FH_F117762_0_0|SrvcGrp|92415|2022|PDM|4992.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F149655_78539_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116793_0_0|SrvcGrp|472|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F97100_23462_0|SrvcGrp|73601|2022|PDM|8079.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F147166_03444_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F139715_0_0|SrvcGrp|36991|2022|PCT|0.45|99|0.00|IMPLANTS|
20|FH_F92498_07442_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F124316_28112_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147341_19720_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F48695_0_0|SrvcGrp|30089|2022|PDM|650.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F98860_96706_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|515.00|99|0.00|AEG 2 (NO REV)|
20|FH_F131152_33403_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PDM|1403.00|99|0.00|ASPG VI|
20|FH_F97623_38008_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)|
20|FH_F114571_34613_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137627_78382_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137730_46563_0|SrvcGrp|46903|2022|PDM|670.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F149662_85015_0|SrvcGrp|109057|2022|PCT|0.00|99|0.00|CARDIAC STUDIES|
20|FH_F41457_0_0|SrvcGrp|34345|2022|PDM|875.00|99|0.00|EMERGENCY ROOM LEVEL IV|
20|FH_F37487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F151023_77384_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40853_0_0|SrvcGrp|38|2022|PDM|2450.00|99|0.00|NORMAL DELIVERY|
20|FH_F50415_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 581|
20|FH_F39443_0_0|SrvcGrp|30302|2022|PDM|195.00|99|0.00|HAPA WPA ASC 114|
20|FH_F146765_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F115269_0_0|SrvcGrp|86723|2022|PDM|375.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F129966_18017_0|SrvcGrp|46903|2022|PDM|842.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F39944_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F131152_33403_0|SrvcGrp|73842|2022|PDM|189.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132095_67042_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117711_73080_0|SrvcGrp|73806|2022|PDM|367.00|99|0.00|AETNA ER|
20|FH_F124322_64131_0|SrvcGrp|107697|2022|PCT|1.00|99|0.00|AETNA ALL DRUGS AGENTS INJ|
20|FH_F146266_0_0|SrvcGrp|88156|2022|PDM|10213.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F98900_42001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F147330_34761_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130813_85014_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F116554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1166.00|99|0.00|AEG 8 (NO REV)|
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F41314_0_0|SrvcGrp|30941|2022|PDM|564.00|99|0.00|NEWBORN NURSERY|
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|572.00|99|0.00|AEG 1 (NO REV)|
20|FH_F123386_0_0|SrvcGrp|11259|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F93961_0_0|SrvcGrp|93750|2022|PDM|1090.00|99|0.00|ERCP REMOVE FOREIGN BODY DUCT|
20|FH_F140231_60540_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F143231_11101_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143529_84737_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F84061_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67147_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F103060_0_0|SrvcGrp|88159|2022|PDM|7803.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|769.00|99|0.00|AEG 3 (NO REV)|
20|FH_F116633_37217_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120974_27607_0|SrvcGrp|109057|2022|PCT|0.71|99|0.00|CARDIAC STUDIES|
20|FH_F54535_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F100742_00616_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F58292_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
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_F128878_11203_0|SrvcGrp|86644|2022|PDM|79.50|99|0.00|AETNA PSYTX PT & FAM W / E&M 30 MINS (MOD TD)|
20|FH_F78022_0_0|SrvcGrp|35142|2022|PDM|2400.00|99|0.00|DELIVERY|
20|FH_F40043_0_0|SrvcGrp|361|2022|PDM|1920.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F92276_32308_0|SrvcGrp|109976|2022|PDM|49245.00|99|0.00|OTHER MAJOR CARDIOVASCULAR PROC W/MCC|
20|FH_F102302_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118194_50841_0|SrvcGrp|16750|2022|PDM|148.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F44582_0_0|SrvcGrp|15132|2022|PDM|2600.00|99|0.00|ACUTE IP MEDICAL SVCS|
20|FH_F93881_15009_0|SrvcGrp|79999|2022|PDM|671.00|99|0.00|AETNA ECHO EXAM|
20|FH_F137459_0_0|SrvcGrp|3178|2022|PDM|800.00|99|0.00|ACUTE PSYCH|
20|FH_F82753_18840_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS|
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|1721.40|99|0.00|ASPG V|
20|FH_F64160_0_0|SrvcGrp|12403|2022|PDM|43.02|99|0.00|CONTINUOUS HOMECARE|
20|FH_F117525_0_0|SrvcGrp|73000|2022|PDM|1200.00|99|0.00|AEG 6|
20|FH_F91873_12723_0|SrvcGrp|72996|2022|PDM|2731.00|99|0.00|AEG 4|
20|FH_F97720_70084_0|SrvcGrp|73485|2022|PDM|2946.00|99|0.00|AETNA REHAB|
20|FH_F106822_0_0|SrvcGrp|45307|2022|PDM|7.95|99|0.00|ADMIN OF INFLUENZA VIRUS VACCINE|
20|FH_F108800_0_0|SrvcGrp|101186|2022|PDM|9000.00|99|0.00|AETNA COMPLEX SPINE|
20|FH_F72690_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F77067_0_0|SrvcGrp|3409|2022|PDM|676.00|99|0.00|NEWBORN NURSERY|
20|FH_F85039_0_0|SrvcGrp|75489|2022|PDM|909.00|99|0.00|AEG 6|
20|FH_F114916_30309_0|SrvcGrp|88492|2022|PDM|2500.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F142448_15701_0|SrvcGrp|29075|2022|PDM|30.00|99|0.00|HYDRATION THERAPY|
20|FH_F111925_0_0|SrvcGrp|73610|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F115875_0_0|SrvcGrp|106326|2022|PDM|412.00|99|0.00|SCAN PROC CRANIAL EXTRA (HCFA)|
20|FH_F130466_53916_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141207_0_0|SrvcGrp|89783|2022|PDM|185.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F131087_0_0|SrvcGrp|72990|2022|PDM|465.00|99|0.00|AEG 1|
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|1548.00|99|0.00|AEG 7 (NO REV)|
20|FH_F129189_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F130267_57248_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77662_0_0|SrvcGrp|42870|2022|PDM|65.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F92959_0_0|SrvcGrp|3809|2022|PDM|585.52|99|0.00|HOSPICE CARE|
20|FH_F77944_0_0|CSTM-ALL|CSTM-00|2020|PDM|3099.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F146674_70778_0|SrvcGrp|105409|2022|PDM|70.00|99|0.00|AETNA PHARMACOLOGIC MANAGEMENT|
20|FH_F147039_06374_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F48752_0_0|SrvcGrp|42871|2022|PDM|45.00|99|0.00|SPEECH THERAPY VISIT|
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_F37546_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F91898_0_0|SrvcGrp|60112|2022|PDM|9662.00|99|0.00|ICU/CCU 200-203, 208-213, 219|
20|FH_F129549_01238_0|SrvcGrp|53987|2022|PDM|40.55|99|0.00|PHOTOTHERAPY|
20|FH_F124225_92506_0|SrvcGrp|73605|2022|PDM|970.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F124267_29671_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|GENERAL ACUTE CARE|
20|FH_F124671_64844_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
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_F127995_84010_0|SrvcGrp|86837|2022|PDM|10.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F133694_89117_0|SrvcGrp|48396|2022|PDM|135.00|99|0.00|OT SERVICES|
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PDM|526.00|99|0.00|AEG 4 (NO REV)|
20|FH_F136657_70806_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F114629_19131_0|SrvcGrp|105703|2022|PDM|345.00|99|0.00|AETNA TERANIAL MAGN STIM TX PLAN (HCFA)|
20|FH_F138855_84067_0|SrvcGrp|89337|2022|PDM|1700.00|99|0.00|DETOXIFICATION|
20|FH_F138981_85123_0|SrvcGrp|89417|2022|PDM|400.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F144039_0_0|SrvcGrp|114443|2022|PDM|10328.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F122885_39571_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136914_64081_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F115631_65201_0|SrvcGrp|77021|2022|PDM|3177.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F116383_63026_0|SrvcGrp|106722|2022|PDM|928.00|99|0.00|IP REHAB|
20|FH_F116393_07002_0|SrvcGrp|106516|2022|PDM|6.56|99|0.00|SEDIMENTATION RATE|
20|FH_F147462_84741_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F147519_52627_0|SrvcGrp|88819|2022|PDM|764.55|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|CEREZYME THERAPY (MOD SH)|
20|FH_F42754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F139573_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F117820_0_0|SrvcGrp|89781|2022|PDM|82.34|99|0.00|RESPITE CARE (HCFA)|
20|FH_F150939_0_0|SrvcGrp|100280|2022|PDM|2.69|99|0.00|NEBULIZER ADMINISTRATION SET|
20|FH_F90839_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F131501_0_0|SrvcGrp|95441|2022|PDM|100.00|99|0.00|HOSPICE OR HOME CARE|
20|FH_F39633_0_0|SrvcGrp|31322|2022|PDM|947.00|99|0.00|DREYER AMB SURGERY - ASPG III|
20|FH_F54552_0_0|SrvcGrp|27050|2022|PDM|44.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS(MOD SH)|
20|FH_F138787_32258_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F81823_0_0|SrvcGrp|3066|2022|PDM|20.59|99|0.00|HIGH-COST DRUGS|
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 4 (NO REV)|
20|FH_F106500_0_0|SrvcGrp|471|2022|PDM|926.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117715_0_0|SrvcGrp|47545|2022|PDM|18767.27|99|0.00|INSERTION/REPLACEMENT OF PERIPHERAL/GASTRIC NEUROSTIMULATOR|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|395.40|99|0.00|HAPA WPA-NWPA 2012-13 ASC 220 W/O REV|
20|FH_F102063_0_0|SrvcGrp|88620|2022|PDM|140.00|99|0.00|SKILLED NURSING RN|
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|6042.00|99|0.00|AEG 7 (NO REV)|
20|FH_F151479_75605_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151503_30067_0|SrvcGrp|104039|2022|PDM|2090.00|99|0.00|CORRECTION HALLUX VALGUS|
20|FH_F151512_27587_0|SrvcGrp|72379|2022|PCT|1.17|99|0.00|SPEECH THERAPY|
20|FH_F151516_63023_0|SrvcGrp|74668|2022|PDM|255.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F122076_17543_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122148_62664_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F144991_43607_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97501_31501_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F135435_06067_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135572_89106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135911_32256_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136040_75080_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136186_46307_0|SrvcGrp|26160|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F140629_0_0|SrvcGrp|113674|2022|PDM|2497.00|99|0.00|UNLISTED LAPAROSCOPY|
20|FH_F33725_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS|
20|FH_F32803_0_0|SrvcGrp|80|2022|PDM|875.00|99|0.00|ACUTE PSYCH|
20|FH_F44754_0_0|SrvcGrp|10542|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F63881_0_0|SrvcGrp|21815|2022|PDM|120.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F111292_33136_0|SrvcGrp|72996|2022|PDM|4987.00|99|0.00|AEG 4|
20|FH_F132328_0_0|SrvcGrp|26277|2022|PDM|2049.00|99|0.00|CPT 29874|
20|FH_F87501_32055_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F127713_30012_0|SrvcGrp|74802|2022|PCT|1.00|99|0.00|AETNA CPT 36415|
20|FH_F127445_51054_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F102322_32233_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F148061_11223_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F103004_75840_0|SrvcGrp|100699|2022|PDM|695.00|99|0.00|AETNA OP MRI/MRA W/ OBS|
20|FH_F56753_15086_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|2082.00|99|0.00|AEG 5  (NO REV)|
20|FH_F69971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86991_15122_0|SrvcGrp|78878|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F43250_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F89372_0_0|SrvcGrp|12659|2022|PDM|751.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F88639_80204_0|SrvcGrp|79800|2022|PDM|1207.00|99|0.00|AETNA SLEEP STUDIES|
20|FH_F151559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71628_0_0|SrvcGrp|48398|2022|PDM|15.00|99|0.00|PT SERVICES|
20|FH_F107200_0_0|SrvcGrp|78878|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F136398_23502_0|SrvcGrp|108484|2022|PDM|546.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F136542_02446_0|SrvcGrp|12659|2022|PDM|504.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F120489_63552_0|SrvcGrp|103717|2022|PCT|0.75|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F120489_63552_0|SrvcGrp|75505|2022|PCT|0.75|99|0.00|CARDIAC STUDIES|
20|FH_F120489_63552_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F120490_64133_0|SrvcGrp|86839|2022|PDM|25.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F120475_81052_0|SrvcGrp|472|2022|PDM|446.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134126_11554_0|SrvcGrp|42785|2022|PDM|143.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F134152_70563_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136952_78218_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137231_25550_0|SrvcGrp|48385|2022|PDM|92.00|99|0.00|SPEECH THERAPY|
20|FH_F137246_66064_0|SrvcGrp|108484|2022|PDM|650.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139107_61024_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138892_46341_0|CSTM-ALL|CSTM-00|2020|PDM|698.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F142491_06033_0|SrvcGrp|80920|2022|PDM|850.00|99|0.00|HOSPICE SERVICES|
20|FH_F142547_70002_0|SrvcGrp|113960|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F142690_31774_0|SrvcGrp|21920|2022|PDM|160.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F142742_44112_0|SrvcGrp|104079|2022|PCT|1.15|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F125053_0_0|SrvcGrp|79590|2022|PDM|1884.00|99|0.00|CPT 43248|
20|FH_F140496_38627_0|SrvcGrp|46903|2022|PDM|678.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F140765_30315_0|SrvcGrp|113235|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2&INF A&B&RSV AMP PRB|
20|FH_F122067_0_0|SrvcGrp|104003|2022|PCT|1.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES|
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|919.00|99|0.00|AEG 5  (NO REV)|
20|FH_F92506_07666_0|CSTM-ALL|CSTM-00|2020|PDM|8820.00|99|0.00|C-SECTION DELIVERY (MOTHER & BABY)|
20|FH_F92506_07666_0|SrvcGrp|27969|2022|PDM|35.85|99|0.00|HOME HEALTH AIDE|
20|FH_F109886_36303_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F109982_33592_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F80366_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F117261_43543_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117371_77059_0|SrvcGrp|87317|2022|PDM|700.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F129448_43235_0|SrvcGrp|88620|2022|PDM|103.00|99|0.00|SKILLED NURSING RN|
20|FH_F117091_28144_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F117190_84020_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137806_83702_0|SrvcGrp|89417|2022|PDM|450.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F38699_0_0|SrvcGrp|17077|2022|PDM|1181.00|99|0.00|ASPG VII|
20|FH_F111593_0_0|SrvcGrp|87055|2022|PDM|3245.00|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION|
20|FH_F112526_0_0|SrvcGrp|65720|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F90880_15108_0|SrvcGrp|90493|2022|PCT|1.00|99|0.00|ELEC STIM OTHER THAN WOUND|
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 1 (NO REV)|
20|FH_F109513_0_0|SrvcGrp|87059|2022|PDM|2700.00|99|0.00|REPAIR OF TENDON|
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|13650.00|99|0.00|MS DRG 238|
20|FH_F36237_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119444_72903_0|SrvcGrp|46903|2022|PDM|695.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F31466_0_0|SrvcGrp|23587|2022|PDM|694.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F103360_68845_0|SrvcGrp|31704|2022|PDM|41400.00|99|0.00|MS DRG 790 ONLY|
20|FH_F113324_17055_0|SrvcGrp|105214|2022|PDM|705.00|99|0.00|SKILLED CARE LEVEL 3|
20|FH_F97542_32960_0|CSTM-ALL|CSTM-00|2020|PCT|0.34|99|0.00|OP SVCS|
20|FH_F93561_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F120753_61701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92676_15063_0|SrvcGrp|78929|2022|PDM|4059.20|99|0.00|MON VALLEY ASC 1402|
20|FH_F92677_08003_0|SrvcGrp|92190|2022|PDM|651.00|99|0.00|CPT 95810  (HCFA)|
20|FH_F100880_67735_0|SrvcGrp|72996|2022|PDM|1799.00|99|0.00|AEG 4|
20|FH_F118400_16701_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|5768.00|99|0.00|BURN TRANSITIONAL|
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|909.00|99|0.00|ASPG VI|
20|FH_F141930_72032_0|SrvcGrp|113835|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F121011_68510_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F127191_44720_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F34706_0_0|SrvcGrp|3584|2022|PDM|9810.00|99|0.00|DRG 117 CARDIAC PACE REVISION|
20|FH_F138451_0_0|SrvcGrp|83960|2022|PCT|0.90|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F146282_08244_0|SrvcGrp|111348|2022|PCT|1.50|99|0.00|OP THERAPY SERVICES|
20|FH_F123545_44512_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132934_63005_0|SrvcGrp|360|2022|PDM|4937.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F141967_89509_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F91155_16105_0|SrvcGrp|73606|2022|PDM|645.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F146320_27610_0|CSTM-ALL|CSTM-00|2020|PDM|2089.10|99|0.00|AEG 9 (NO REV)|
20|FH_F31405_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113131_19013_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F146061_24502_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|349.88|99|0.00|ASPG 306|
20|FH_F89932_10940_0|SrvcGrp|72990|2022|PDM|1591.00|99|0.00|AEG 1|
20|FH_F92677_08003_0|SrvcGrp|19742|2022|PDM|113.40|99|0.00|MID-LINE INSERTION|
20|FH_F97041_71603_0|SrvcGrp|73485|2022|PDM|2289.00|99|0.00|AETNA REHAB|
20|FH_F136407_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F117087_0_0|SrvcGrp|91941|2022|PDM|2093.00|99|0.00|NASAL/SINUS ENDOSCOPY WITH DILATION|
20|FH_F118542_60188_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F129364_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F144308_44512_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132272_16127_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125212_76301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F88223_0_0|SrvcGrp|46424|2022|PDM|88.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F111423_34952_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F43018_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.00|99|0.00|AEG 2 (NO REV)|
20|FH_F38865_0_0|SrvcGrp|39|2022|PCT|0.75|99|0.00|TISSUE PLASMINOGEN ACTIVATOR|
20|FH_F113403_62274_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1297.45|99|0.00|ASPG 801|
20|FH_F87155_04105_0|SrvcGrp|24754|2022|PDM|18.91|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F124928_04210_0|SrvcGrp|73523|2022|PDM|148.86|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F111401_29425_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132999_19901_0|SrvcGrp|48385|2022|PDM|89.00|99|0.00|SPEECH THERAPY|
20|FH_F133021_00910_0|SrvcGrp|35775|2022|PDM|5000.00|99|0.00|DA VINCI SURGICAL|
20|FH_F117872_33462_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F150533_76051_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F60101_0_0|SrvcGrp|42831|2022|PDM|48.00|99|0.00|DIETICIAN VISIT|
20|FH_F115274_15235_0|SrvcGrp|95661|2022|PDM|140.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F111417_33613_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F57834_0_0|SrvcGrp|9774|2022|PDM|1628.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F73542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AMBULANCE - ALL OTHER SERVICES|
20|FH_F109803_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F39121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F119437_0_0|SrvcGrp|75483|2022|PDM|1450.00|99|0.00|AEG 3|
20|FH_F102561_75146_0|SrvcGrp|98009|2022|PDM|375.00|99|0.00|DEBRIDEMENT OPEN WOUND|
20|FH_F148907_01810_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137896_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F38700_0_0|SrvcGrp|11336|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F149781_37404_0|SrvcGrp|109956|2022|PDM|9579.00|99|0.00|INSERT SPINE FIXATION DEVICE|
20|FH_F98620_43920_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F112852_73112_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116324_0_0|SrvcGrp|75487|2022|PDM|550.00|99|0.00|AEG 5|
20|FH_F148001_15601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146141_77598_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146110_48433_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115406_79902_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F87171_32578_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F45436_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 2 (NO REV)|
20|FH_F133530_11237_0|SrvcGrp|73488|2022|PCT|2.20|99|0.00|AETNA HOSPITAL OP DIALYSIS|
20|FH_F44225_0_0|SrvcGrp|14566|2022|PDM|1000.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)|
20|FH_F128468_37087_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132224_89119_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F80859_65616_0|SrvcGrp|3069|2022|PCT|0.73|99|0.00|IMPLANTS|
20|FH_F133469_33404_0|SrvcGrp|74668|2022|PDM|475.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|669.00|99|0.00|AEG 3 (NO REV)|
20|FH_F120172_92653_0|SrvcGrp|73841|2022|PDM|495.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F123915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F75105_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|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_F129025_57451_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148222_18603_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F121566_91360_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F49338_0_0|SrvcGrp|31191|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF (DME)|
20|FH_F115740_78957_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F72887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76171_0_0|SrvcGrp|48382|2022|PDM|172.00|99|0.00|CPT 92507|
20|FH_F132051_74464_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F129666_71901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131236_84041_0|SrvcGrp|46605|2022|PDM|90.75|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F40043_0_0|SrvcGrp|18231|2022|PDM|5990.00|99|0.00|MS DRG 283|
20|FH_F148260_0_0|SrvcGrp|115341|2022|PDM|10009.00|99|0.00|LYSIS LAPAROSCOPY|
20|FH_F129221_84325_0|SrvcGrp|108061|2022|PCT|0.75|99|0.00|OP THERAPY SERVICES|
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F37590_0_0|SrvcGrp|12264|2022|PDM|59.85|99|0.00|DIETICIAN OR LPN SERVICES|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|709.49|99|0.00|HAPA WPA-NWPA 2012-13 ASC 12 W/O REV|
20|FH_F104941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F39385_0_0|SrvcGrp|3029|2022|PDM|941.00|99|0.00|NEWBORN NURSERY|
20|FH_F49338_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F66412_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F100962_0_0|SrvcGrp|73004|2022|PDM|1301.00|99|0.00|AEG 8|
20|FH_F117902_0_0|SrvcGrp|35967|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F40519_0_0|SrvcGrp|32645|2022|PCT|1.50|99|0.00|RADIOLOGY - CPT/MOD 26|
20|FH_F80283_0_0|SrvcGrp|26001|2022|PDM|220.13|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F35202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F82753_18840_0|SrvcGrp|90177|2022|PCT|0.87|99|0.00|AETNA HOSPITAL OP DIALYSIS|
20|FH_F123466_93420_0|SrvcGrp|75522|2022|PDM|925.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD|
20|FH_F82696_16335_0|CSTM-ALL|CSTM-00|2020|PCT|3.10|99|0.00|HAPA WPA/NWPA 2017 RAD 100%|
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|4464.60|99|0.00|LAP INC HERNIA REPAIR|
20|FH_F115685_64064_0|SrvcGrp|86828|2022|PDM|120.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F113410_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F129115_85716_0|SrvcGrp|74668|2022|PDM|193.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PDM|2414.00|99|0.00|ASPG IV|
20|FH_F115736_77459_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120362_23321_0|SrvcGrp|48398|2022|PDM|93.00|99|0.00|PT SERVICES|
20|FH_F123538_21206_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F110925_01104_0|CSTM-ALL|CSTM-00|2020|PDM|2.81|99|0.00|AETNA HYDROXYPROGESTERONE|
20|FH_F65559_0_0|CSTM-ALL|CSTM-00|2020|PDM|1919.00|99|0.00|ACUTE IP REHAB LEVEL B|
20|FH_F39945_0_0|SrvcGrp|3409|2022|PDM|365.00|99|0.00|NEWBORN NURSERY|
20|FH_F137616_48823_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F121084_13114_0|SrvcGrp|73842|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130523_04605_0|SrvcGrp|106251|2022|PCT|4.24|99|0.00|LABORATORY SERVICES|
20|FH_F33601_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127036_43724_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|422.78|99|0.00|HAPA WPA-NWPA 2012-13 ASC 205 W/O REV|
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|AEG 5  (NO REV)|
20|FH_F130032_72034_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F82173_72712_0|SrvcGrp|116080|2022|PDM|8704.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F137460_42103_0|CSTM-ALL|CSTM-00|2020|PDM|301.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F116327_75701_0|SrvcGrp|89337|2022|PDM|650.00|99|0.00|DETOXIFICATION|
20|FH_F145550_62034_0|SrvcGrp|48398|2022|PDM|105.00|99|0.00|PT SERVICES|
20|FH_F143903_06249_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F141470_71913_0|SrvcGrp|73559|2022|PDM|1350.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F67423_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS|
20|FH_F47963_0_0|SrvcGrp|10540|2022|PDM|44.00|99|0.00|HOME HEALTH AIDE|
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|1576.00|99|0.00|AEG 6 (NO REV)|
20|FH_F91876_0_0|SrvcGrp|72998|2022|PDM|1925.00|99|0.00|AEG 5|
20|FH_F34496_0_0|SrvcGrp|16|2022|PDM|1123.50|99|0.00|ACUTE REHABILITATION|
20|FH_F86991_15122_0|SrvcGrp|73002|2022|PDM|1148.00|99|0.00|AEG 7|
20|FH_F87092_60101_0|SrvcGrp|72998|2022|PDM|3360.00|99|0.00|AEG 5|
20|FH_F63195_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F38411_0_0|SrvcGrp|4109|2022|PDM|900.00|99|0.00|ACUTE PSYCH|
20|FH_F135840_0_0|SrvcGrp|79589|2022|PDM|550.00|99|0.00|UPPER GI|
20|FH_F130725_33020_0|SrvcGrp|73842|2022|PDM|285.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F98002_27103_0|SrvcGrp|73485|2022|PDM|4274.00|99|0.00|AETNA REHAB|
20|FH_F124146_46321_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F116753_0_0|CSTM-ALL|CSTM-00|2020|PDM|2470.00|99|0.00|AEG 5  (NO REV)|
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 3 (NO REV)|
20|FH_F48092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
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_F145988_06105_0|SrvcGrp|63496|2022|PCT|0.63|99|0.00|OP TRAUMA ACTIVATION|
20|FH_F110140_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.72|99|0.00|HSS ASC|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F97042_64804_0|SrvcGrp|73659|2022|PDM|8639.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F147982_65706_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147800_0_0|SrvcGrp|103236|2022|PDM|16390.00|99|0.00|AETNA INSJ STABLJ DEV|
20|FH_F148879_33018_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F151053_17602_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132810_0_0|SrvcGrp|86829|2022|PDM|8.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F126770_43050_0|SrvcGrp|90707|2022|PDM|130.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F107200_0_0|SrvcGrp|101520|2022|PDM|6242.00|99|0.00|T1H W/T/O (<250G)|
20|FH_F136426_19006_0|SrvcGrp|107353|2022|PDM|336.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)|
20|FH_F136488_16828_0|SrvcGrp|94880|2022|PDM|138.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F118152_20151_0|SrvcGrp|75323|2022|PCT|1.00|99|0.00|DME|
20|FH_F120489_63552_0|SrvcGrp|12840|2022|PCT|0.65|99|0.00|PACEMAKER|
20|FH_F134126_11554_0|SrvcGrp|112040|2022|PCT|2.00|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F142267_78240_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F142690_31774_0|SrvcGrp|14945|2022|PDM|36.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F53732_0_0|SrvcGrp|15402|2022|PDM|75.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F97601_67218_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F138545_39503_0|SrvcGrp|12659|2022|PDM|718.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F139267_30253_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138308_50036_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140730_84106_0|SrvcGrp|95660|2022|PDM|474.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F140844_48083_0|SrvcGrp|95761|2022|PDM|65.00|99|0.00|NURSING CARE (HCFA)|
20|FH_F119023_91406_0|SrvcGrp|65621|2022|PDM|45.00|99|0.00|RN NURSING|
20|FH_F119023_91406_0|SrvcGrp|17016|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118955_48239_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F118943_64506_0|SrvcGrp|43567|2022|PDM|83.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F126853_19053_0|SrvcGrp|48398|2022|PDM|75.00|99|0.00|PT SERVICES|
20|FH_F147725_06002_0|SrvcGrp|98524|2022|PDM|3120.00|99|0.00|EXCISION OF BONE CYST|
20|FH_F129483_77030_0|SrvcGrp|86851|2022|PDM|40.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F117093_40041_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F117126_12801_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F137276_83127_0|SrvcGrp|48385|2022|PDM|84.50|99|0.00|SPEECH THERAPY|
20|FH_F137333_51012_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F137938_29036_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F100790_10512_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143783_0_0|SrvcGrp|97704|2022|PDM|105.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F37590_0_0|SrvcGrp|12263|2022|PDM|17.85|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F109180_18015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139296_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95962_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F105221_01757_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD HOME HEALTH|
20|FH_F110132_23451_0|SrvcGrp|48385|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F82753_18840_0|SrvcGrp|86444|2022|PCT|0.87|99|0.00|CHEMOTHERAPY AND RADIATION|
20|FH_F38867_0_0|CSTM-ALL|CSTM-00|2020|PDM|182.50|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F135236_02840_0|SrvcGrp|73498|2022|PDM|1446.80|99|0.00|AETNA ER LEVEL III|
20|FH_F123926_0_0|SrvcGrp|86505|2022|PDM|1785.00|99|0.00|DENTAL SURGERY|
20|FH_F72369_0_0|SrvcGrp|25749|2022|PDM|400.00|99|0.00|OCULAR PROSTHESIS, ENLARGEMENT|
20|FH_F72830_0_0|SrvcGrp|70049|2022|PDM|3300.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 9|
20|FH_F140893_19720_0|SrvcGrp|48385|2022|PDM|113.00|99|0.00|SPEECH THERAPY|
20|FH_F145551_04106_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F77903_0_0|SrvcGrp|14187|2022|PDM|2500.00|99|0.00|MRI|
20|FH_F139515_0_0|SrvcGrp|109958|2022|PDM|15862.00|99|0.00|REVISE LUMBAR ARTIF DISC|
20|FH_F37937_0_0|SrvcGrp|27768|2022|PDM|100.00|99|0.00|SKILLED LPN VISIT|
20|FH_F129011_15857_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|HOSPICE INPATIENT RESPITE CARE (HCFA)|
20|FH_F82173_72712_0|SrvcGrp|111979|2022|PDM|230.00|99|0.00|PT/OT/ST HOME|
20|FH_F115010_20105_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F135051_37130_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135173_06519_0|SrvcGrp|52953|2022|PDM|101.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F122687_0_0|SrvcGrp|109187|2022|PDM|2404.00|99|0.00|OLECRANON BURSA EXCISION|
20|FH_F70645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F143903_06249_0|SrvcGrp|102239|2022|PDM|95.00|99|0.00|AETNA METHADONE MAINTENANCE|
20|FH_F129782_0_0|SrvcGrp|102420|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F137718_80107_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F31798_0_0|SrvcGrp|14177|2022|PDM|19495.00|99|0.00|BARIATRIC SVCS|
20|FH_F145545_01602_0|SrvcGrp|114167|2022|PDM|398.00|99|0.00|PARTIAL HOSPITAL (0-17 YRS)|
20|FH_F128358_46072_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F87716_0_0|SrvcGrp|12342|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F140929_67206_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F98801_93274_0|CSTM-ALL|CSTM-00|2020|PCT|0.38|99|0.00|OP SVCS|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F42464_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F110925_01104_0|SrvcGrp|104198|2022|PCT|1.05|99|0.00|INFUSION AND INJECTABLE DRUGS|
20|FH_F110562_33409_0|SrvcGrp|86722|2022|PDM|308.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F133748_77081_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F132969_84003_0|SrvcGrp|86840|2022|PDM|22.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F126003_79403_0|SrvcGrp|86722|2022|PDM|327.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|522.00|99|0.00|AEG 3 (NO REV)|
20|FH_F112665_0_0|SrvcGrp|98500|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|966.14|99|0.00|ASPG VII|
20|FH_F141829_0_0|SrvcGrp|106291|2022|PDM|281.18|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F31248_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F119227_01752_0|SrvcGrp|86779|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F31714_0_0|SrvcGrp|11193|2022|PDM|11600.00|99|0.00|DRG 555 PERCUTANEOUS CARDIOVASCULAR PROCEDURE W/ MAJOR DX|
20|FH_F95623_84015_0|SrvcGrp|87799|2022|PDM|90.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F109387_35630_0|SrvcGrp|46903|2022|PDM|637.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F143563_32828_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F143561_16001_0|SrvcGrp|27969|2022|PDM|41.00|99|0.00|HOME HEALTH AIDE|
20|FH_F150165_06032_0|SrvcGrp|113885|2022|PDM|1825.00|99|0.00|REVISION OF KIDNEY/URETER|
20|FH_F50703_0_0|SrvcGrp|46965|2022|PDM|40.00|99|0.00|CHEMO (CPT 96415)|
20|FH_F112024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111023_13905_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145708_89030_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F32275_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F111732_33771_0|SrvcGrp|91993|2022|PDM|1900.00|99|0.00|VAGINAL DELIVERY ONLY|
20|FH_F133749_84604_0|SrvcGrp|46692|2022|PDM|42.25|99|0.00|RN NURSING SERVICES|
20|FH_F33335_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|OP SVCS|
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|611.00|99|0.00|AEG 4 (NO REV)|
20|FH_F52713_0_0|CSTM-ALL|CSTM-00|2020|PDM|10331.00|99|0.00|OP CARDIAC CATH|
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|1975.00|99|0.00|AEG 10 (NO REV)|
20|FH_F117206_0_0|SrvcGrp|63472|2022|PDM|1500.00|99|0.00|CPT 64581|
20|FH_F83113_0_0|SrvcGrp|10649|2022|PDM|8.00|99|0.00|HOME INFUSION|
20|FH_F120735_40012_0|SrvcGrp|90854|2022|PDM|772.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F145598_23462_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120715_83440_0|SrvcGrp|102419|2022|PCT|0.96|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F150281_76309_0|SrvcGrp|87317|2022|PDM|738.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F49485_0_0|SrvcGrp|27579|2022|PDM|85.00|99|0.00|RESPIRATORY THERAPY INITIAL VISIT|
20|FH_F33639_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F147502_0_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F31714_0_0|SrvcGrp|3499|2022|PCT|0.89|99|0.00|IMPLANTS|
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1078.00|99|0.00|AEG 2 (NO REV)|
20|FH_F116806_0_0|SrvcGrp|107012|2022|PDM|1923.16|99|0.00|AUGMENTATION LOWER JAW BONE|
20|FH_F146620_0_0|CSTM-ALL|CSTM-00|2020|PCT|38.70|99|0.00|OP SVCS|
20|FH_F115347_0_0|SrvcGrp|82648|2022|PDM|1550.00|99|0.00|ERCP LITHOTRIPSY|
20|FH_F68251_0_0|SrvcGrp|33166|2022|PDM|475.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F146124_06112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F128379_0_0|SrvcGrp|99164|2022|PDM|7553.00|99|0.00|CPT 22846|
20|FH_F85415_27612_0|SrvcGrp|27969|2022|PDM|19.40|99|0.00|HOME HEALTH AIDE|
20|FH_F109364_52349_0|SrvcGrp|88621|2022|PDM|166.00|99|0.00|SKILLED NURSING LPN|
20|FH_F51121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F119554_16506_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126341_27284_0|SrvcGrp|86131|2022|PDM|0.80|99|0.00|AETNA ANTIHEMOPHILIC|
20|FH_F89219_0_0|SrvcGrp|13226|2022|PDM|1423.00|99|0.00|CPT CODE 99282|
20|FH_F42626_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F127943_68939_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144808_0_0|SrvcGrp|88164|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F70863_0_0|SrvcGrp|10649|2022|PDM|9.00|99|0.00|HOME INFUSION|
20|FH_F114407_19002_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|848.00|99|0.00|AEG 4 (NO REV)|
20|FH_F59652_0_0|SrvcGrp|55794|2022|PDM|420.00|99|0.00|RESIDENTIAL TREATMENT - YOUTH AND ADULT|
20|FH_F112631_0_0|SrvcGrp|73008|2022|PDM|796.00|99|0.00|AEG 10|
20|FH_F143687_70461_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F112023_12866_0|SrvcGrp|93302|2022|PDM|157.00|99|0.00|PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY|
20|FH_F145641_06902_0|SrvcGrp|26430|2022|PDM|4902.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F133877_84117_0|SrvcGrp|100664|2022|PDM|615.00|99|0.00|HOSPICE IP CARE (HCFA)|
20|FH_F61673_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF|
20|FH_F138951_41101_0|SrvcGrp|24744|2022|PDM|60.00|99|0.00|PICC LINE INSERTION|
20|FH_F50703_0_0|SrvcGrp|46982|2022|PDM|15.85|99|0.00|HOME SUPPLIES (A4222)|
20|FH_F111942_92647_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F92598_21236_0|SrvcGrp|73700|2022|PDM|55.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F85995_64111_0|SrvcGrp|84345|2022|PDM|181.00|99|0.00|AETNA HOME VISIT NEW PATIENT|
20|FH_F118146_33062_0|SrvcGrp|74668|2022|PDM|192.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F145641_06902_0|SrvcGrp|90976|2022|PDM|769.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT|
20|FH_F54592_0_0|SrvcGrp|14412|2022|PDM|635.74|99|0.00|HOSPICE CARE|
20|FH_F71103_0_0|SrvcGrp|68139|2022|PDM|110.00|99|0.00|RN VISIT|
20|FH_F122520_46383_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122552_03103_0|SrvcGrp|90854|2022|PDM|1109.93|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F84712_0_0|SrvcGrp|87968|2022|PDM|10316.00|99|0.00|GASTRIC SLEEVE W/ HERINA REPAIR|
20|FH_F108700_63857_0|SrvcGrp|89781|2022|PDM|108.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F119775_0_0|SrvcGrp|73006|2022|PDM|1517.00|99|0.00|AEG 9|
20|FH_F112865_46135_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F151144_35801_0|SrvcGrp|90562|2022|PDM|1273.10|99|0.00|FISTULIZATION OF SCLERA|
20|FH_F151155_26508_0|SrvcGrp|108484|2022|PDM|699.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F151155_26508_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121329_33015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121989_43026_0|SrvcGrp|109330|2022|PCT|1.03|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F115884_0_0|SrvcGrp|80317|2022|PDM|125.00|99|0.00|RESPITE CARE|
20|FH_F115990_0_0|SrvcGrp|73002|2022|PDM|1525.00|99|0.00|AEG 7|
20|FH_F150767_34741_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F150769_02302_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F125214_12428_0|SrvcGrp|73485|2022|PCT|0.00|99|0.00|AETNA REHAB|
20|FH_F97480_08204_0|SrvcGrp|73656|2022|PDM|635.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F42979_0_0|SrvcGrp|3406|2022|PDM|84.00|99|0.00|CPT 99214|
20|FH_F138017_73129_0|SrvcGrp|113307|2022|PDM|6883.00|99|0.00|VAGINAL HYSTERECTOMY|
20|FH_F35416_0_0|SrvcGrp|16088|2022|PCT|0.60|99|0.00|DME/IMPLANTS/PROSTHETICS/PACEMAKERS/CARDIAC DEFIB|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1334.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F113806_53083_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110783_93013_0|SrvcGrp|86779|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F148667_0_0|SrvcGrp|11663|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F113806_53083_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92152_74133_0|SrvcGrp|78504|2022|PCT|0.60|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F123570_0_0|SrvcGrp|72990|2022|PDM|471.02|99|0.00|AEG 1|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1571.00|99|0.00|COVENTRY ENHANCED GROUPER 8 MOD 50|
20|FH_F114676_91911_0|SrvcGrp|73842|2022|PDM|270.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F38742_0_0|SrvcGrp|23681|2022|PDM|90.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F40593_0_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F120848_20912_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|8.65|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F147422_84121_0|SrvcGrp|58509|2022|PDM|457.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F93381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39756_0_0|SrvcGrp|31526|2022|PDM|683.76|99|0.00|CUMBERLAND SURGERY CTR - ASPG X|
20|FH_F97300_47501_0|SrvcGrp|75441|2022|PDM|900.00|99|0.00|OBSERVATION - REV 760|
20|FH_F122377_91007_0|SrvcGrp|20752|2022|PDM|33382.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F134887_33409_0|SrvcGrp|35250|2022|PDM|32.00|99|0.00|A5513|
20|FH_F150982_0_0|SrvcGrp|101522|2022|PDM|2759.00|99|0.00|T1H W/T/O UTERUS (>250G)|
20|FH_F129757_0_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148962_08109_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F137748_95231_0|SrvcGrp|113157|2022|PCT|1.85|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F129588_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97620_75904_0|SrvcGrp|73656|2022|PDM|607.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F151659_17013_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PDM|1659.00|99|0.00|ASPG VII|
20|FH_F150922_02452_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F41463_0_0|SrvcGrp|34134|2022|PDM|200.00|99|0.00|PROLASTIN THERAPY|
20|FH_F90817_0_0|SrvcGrp|91033|2022|PDM|2256.00|99|0.00|REVISE AQUEOUS SHUNT EYE (HCFA)|
20|FH_F110726_19720_0|SrvcGrp|74668|2022|PDM|217.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F36663_0_0|SrvcGrp|16|2022|PDM|1190.00|99|0.00|ACUTE REHABILITATION|
20|FH_F36094_0_0|SrvcGrp|37043|2022|PCT|1.00|99|0.00|L-CODES|
20|FH_F101861_19567_0|SrvcGrp|38004|2022|PDM|2500.00|99|0.00|CPT CODE 59400|
20|FH_F141267_0_0|SrvcGrp|29155|2022|PDM|172.00|99|0.00|HOSPICE SVCS|
20|FH_F85772_0_0|SrvcGrp|84181|2022|PDM|2214.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS|
20|FH_F90698_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|AEG 2 (NO REV)|
20|FH_F35416_0_0|SrvcGrp|361|2022|PDM|2070.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F117581_21211_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F149030_37919_0|CSTM-ALL|CSTM-00|2020|PDM|1725.00|99|0.00|AEG 3 (NO REV)|
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 3 (NO REV)|
20|FH_F117905_0_0|SrvcGrp|103550|2022|PDM|420.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 8 (NO REV)|
20|FH_F123570_0_0|SrvcGrp|73000|2022|PDM|1180.20|99|0.00|AEG 6|
20|FH_F148667_0_0|SrvcGrp|26432|2022|PDM|2856.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F39756_0_0|SrvcGrp|31522|2022|PDM|994.40|99|0.00|CUMBERLAND SURGERY CTR - ASPG VI|
20|FH_F149662_85015_0|CSTM-ALL|CSTM-00|2020|PDM|3445.00|99|0.00|AEG 9 (NO REV)|
20|FH_F46433_0_0|SrvcGrp|17006|2022|PDM|80.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS|
20|FH_F97100_23462_0|SrvcGrp|73485|2022|PDM|3417.00|99|0.00|AETNA REHAB|
20|FH_F149602_07109_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F150940_92708_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F110732_31513_0|SrvcGrp|73000|2022|PDM|1822.00|99|0.00|AEG 6|
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)|
20|FH_F76826_0_0|SrvcGrp|14253|2022|PDM|9.48|99|0.00|GROUND MILEAGE PER STATUTE MILE|
20|FH_F92092_74055_0|SrvcGrp|82137|2022|PCT|0.52|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F114308_70601_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F39443_0_0|SrvcGrp|30345|2022|PDM|626.00|99|0.00|HAPA WPA ASC 301|
20|FH_F35731_33709_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125656_92868_0|SrvcGrp|86833|2022|PDM|12.50|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F149516_65233_0|SrvcGrp|74668|2022|PDM|166.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F134847_0_0|SrvcGrp|33982|2022|PDM|2541.00|99|0.00|CPT 28296|
20|FH_F141021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F90196_10467_0|CSTM-ALL|CSTM-00|2020|PDM|161.00|99|0.00|NEW PATIENT OFF OP VISIT|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F146204_0_0|SrvcGrp|38708|2022|PDM|1922.00|99|0.00|HYSTEROSCOPY|
20|FH_F129307_54174_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141156_04401_0|SrvcGrp|77507|2022|PDM|3850.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F140295_0_0|SrvcGrp|109967|2022|PDM|4319.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F80834_0_0|SrvcGrp|8950|2022|PDM|5989.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F124714_64081_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F112128_63017_0|SrvcGrp|93337|2022|PDM|271.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F131261_19111_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F40507_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137288_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47902_0_0|SrvcGrp|29962|2022|PCT|1.00|99|0.00|DME MOD TC|
20|FH_F138453_74135_0|SrvcGrp|73841|2022|PDM|424.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F140036_07702_0|SrvcGrp|90644|2022|PDM|25.75|99|0.00|AETNA MEDICATION ASSISTED TRTMT MAINTENANCE INJECTION (HCFA)|
20|FH_F93287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101755_0_0|CSTM-ALL|CSTM-00|2020|PCT|52.00|99|0.00|OP SVCS|
20|FH_F101709_0_0|SrvcGrp|96350|2022|PDM|8610.00|99|0.00|SHOULDER JOINT|
20|FH_F102224_0_0|SrvcGrp|88162|2022|PDM|4300.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F130917_48658_0|SrvcGrp|33722|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F48224_0_0|SrvcGrp|72994|2022|PDM|604.00|99|0.00|AEG 3|
20|FH_F48785_0_0|SrvcGrp|22562|2022|PDM|70.00|99|0.00|SPEECH THERAPY|
20|FH_F116907_75093_0|SrvcGrp|100499|2022|PDM|520.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F120974_27607_0|SrvcGrp|12110|2022|PDM|6370.00|99|0.00|CARDIAC CATH LAB OP SVCS|
20|FH_F118792_63379_0|SrvcGrp|99189|2022|PCT|0.00|99|0.00|C-SECTION|
20|FH_F117208_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F31595_0_0|SrvcGrp|9230|2022|PDM|92.00|99|0.00|HOME IV THERAPY SVCS|
20|FH_F148923_71854_0|SrvcGrp|46903|2022|PDM|620.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F85353_16407_0|SrvcGrp|63840|2022|PDM|459.58|99|0.00|HAPA WPA-NWPA 2012-13 ASC 107|
20|FH_F148600_30328_0|CSTM-ALL|CSTM-00|2020|PDM|878.00|99|0.00|AEG 4 (NO REV)|
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115430_0_0|SrvcGrp|44461|2022|PDM|7150.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F126308_44515_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F146200_70815_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
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_F143628_32810_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139780_75605_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F85353_16407_0|SrvcGrp|63848|2022|PDM|444.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 223|
20|FH_F149219_01966_0|SrvcGrp|115400|2022|PCT|1.00|99|0.00|COVID-19 VACCINE - REGENERON|
20|FH_F125870_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110604_0_0|SrvcGrp|96799|2022|PDM|1100.00|99|0.00|DESTROY C/TH FACET JNT ADDL|
20|FH_F126341_27284_0|SrvcGrp|47183|2022|PDM|160.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F147984_63664_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145641_06902_0|SrvcGrp|90063|2022|PDM|6509.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F76146_0_0|SrvcGrp|68185|2022|PDM|583.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 1|
20|FH_F80172_0_0|SrvcGrp|81437|2022|PCT|0.85|99|0.00|AETNA HOME INFUSION DRUGS|
20|FH_F119379_0_0|SrvcGrp|107840|2022|PDM|911.00|99|0.00|TREAT WRIST FRACTURE|
20|FH_F126157_34210_0|SrvcGrp|46903|2022|PDM|650.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132883_31602_0|SrvcGrp|86844|2022|PDM|20.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F110501_07652_0|SrvcGrp|89149|2022|PDM|339.00|99|0.00|OP INTENSIVE|
20|FH_F81698_10457_0|SrvcGrp|29075|2022|PDM|26.50|99|0.00|HYDRATION THERAPY|
20|FH_F146543_89511_0|SrvcGrp|46903|2022|PDM|721.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F36552_0_0|SrvcGrp|18868|2022|PDM|37915.00|99|0.00|MS DRG 231|
20|FH_F149244_85201_0|SrvcGrp|74668|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133724_84041_0|SrvcGrp|88620|2022|PDM|103.00|99|0.00|SKILLED NURSING RN|
20|FH_F79623_0_0|SrvcGrp|72992|2022|PDM|2283.00|99|0.00|AEG 2|
20|FH_F139873_0_0|SrvcGrp|45583|2022|PDM|2992.00|99|0.00|CPT 65730|
20|FH_F85097_0_0|SrvcGrp|32585|2022|PDM|504.00|99|0.00|DIALYSIS|
20|FH_F147502_0_0|SrvcGrp|104229|2022|PDM|150.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F121601_47446_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F120930_0_0|SrvcGrp|63472|2022|PDM|4000.00|99|0.00|CPT 64581|
20|FH_F133724_84041_0|SrvcGrp|53746|2022|PDM|93.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F112631_0_0|SrvcGrp|73006|2022|PDM|1153.00|99|0.00|AEG 9|
20|FH_F133207_0_0|SrvcGrp|77582|2022|PDM|3529.00|99|0.00|CPT 31255|
20|FH_F149263_0_0|SrvcGrp|88030|2022|PDM|6630.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F72584_0_0|SrvcGrp|42830|2022|PDM|140.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F123850_0_0|SrvcGrp|30609|2022|PDM|43.86|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F114683_0_0|SrvcGrp|88343|2022|PDM|7800.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F125407_68756_0|SrvcGrp|79699|2022|PCT|0.98|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F111702_07652_0|SrvcGrp|93268|2022|PCT|1.00|99|0.00|LOVENOX/ENOXAPARIN|
20|FH_F130123_24171_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F121476_0_0|SrvcGrp|108851|2022|PDM|169.00|99|0.00|ALLODERM|
20|FH_F89219_0_0|SrvcGrp|57384|2022|PDM|36011.00|99|0.00|MS DRG 469-470 ONLY|
20|FH_F44278_0_0|SrvcGrp|37261|2022|PCT|0.85|99|0.00|HOSPICE|
20|FH_F129666_71901_0|SrvcGrp|48396|2022|PDM|155.00|99|0.00|OT SERVICES|
20|FH_F118338_94952_0|SrvcGrp|104079|2022|PCT|1.15|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F52854_0_0|CSTM-ALL|CSTM-00|2020|PDM|101.00|99|0.00|PHYSICAL THERAPY|
20|FH_F50184_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F123943_84041_0|SrvcGrp|95661|2022|PDM|90.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F125663_66614_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131952_06002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131995_04730_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F66481_0_0|SrvcGrp|45924|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F90654_0_0|SrvcGrp|58763|2022|PCT|0.70|99|0.00|IMMUNE ENHANCING/SUPPRESSANT PHARMACY|
20|FH_F149868_0_0|SrvcGrp|89822|2022|PDM|194.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F150982_0_0|SrvcGrp|83837|2022|PDM|6606.00|99|0.00|EXCISION EXCESSIVE SKIN|
20|FH_F116923_85259_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F115736_77459_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F32327_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1460.80|99|0.00|ASPG 9- PROGRESSIVE SURG|
20|FH_F76171_0_0|SrvcGrp|44884|2022|PDM|172.00|99|0.00|PT SVCS INITIAL EVAL 97001 VISIT LEVEL|
20|FH_F43118_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MS DRG UNGROUPABLE INPATIENT|
20|FH_F130767_67133_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F92276_32308_0|SrvcGrp|21354|2022|PDM|23483.00|99|0.00|MS DRG 250-251 ONLY|
20|FH_F123964_86303_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F37376_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F87031_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F127487_60169_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128869_45458_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127036_43724_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F138488_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F67261_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F102184_0_0|SrvcGrp|72121|2022|PDM|2887.00|99|0.00|ARTHOSCOPY|
20|FH_F125940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F128228_40047_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F102302_0_0|SrvcGrp|98572|2022|PDM|29900.00|99|0.00|SPINE INFUSION|
20|FH_F129334_43016_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F141802_17042_0|SrvcGrp|101141|2022|PDM|665.00|99|0.00|MRI/MRA W/ER|
20|FH_F143297_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F65159_0_0|CSTM-ALL|CSTM-00|2020|PDM|4815.00|99|0.00|ASPG IX|
20|FH_F36646_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F62614_0_0|SrvcGrp|48396|2022|PDM|30.00|99|0.00|OT SERVICES|
20|FH_F62614_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F50462_0_0|SrvcGrp|23683|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F133847_21702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F52713_0_0|SrvcGrp|9838|2022|PDM|4400.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F133972_27103_0|SrvcGrp|17013|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F127642_07047_0|SrvcGrp|72990|2022|PDM|962.00|99|0.00|AEG 1|
20|FH_F150160_01301_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F124372_0_0|SrvcGrp|107749|2022|PDM|164.00|99|0.00|CAPD/CCPD|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|67.60|99|0.00|CPT 95805 (W/MOD 26)|
20|FH_F119110_91773_0|SrvcGrp|73700|2022|PDM|60.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F110509_71351_0|SrvcGrp|73006|2022|PDM|6800.00|99|0.00|AEG 9|
20|FH_F127199_0_0|SrvcGrp|94781|2022|PDM|114.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F51934_0_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F139716_50208_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|1588.00|99|0.00|ASPG VIII|
20|FH_F111163_0_0|SrvcGrp|88494|2022|PDM|3200.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F81698_10457_0|SrvcGrp|14945|2022|PDM|3.15|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F114444_19602_0|SrvcGrp|91781|2022|PDM|65.00|99|0.00|AETNA GROUP THERAPY (MOD TD)(HCFA)|
20|FH_F133724_84041_0|SrvcGrp|48385|2022|PDM|84.50|99|0.00|SPEECH THERAPY|
20|FH_F149199_73005_0|SrvcGrp|92958|2022|PCT|0.55|99|0.00|SLEEP STUDIES|
20|FH_F133724_84041_0|SrvcGrp|65720|2022|PDM|93.00|99|0.00|RESPITE CARE|
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 2 (NO REV)|
20|FH_F127908_60640_0|SrvcGrp|91437|2022|PCT|1.40|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F88744_71103_0|SrvcGrp|20272|2022|PDM|33469.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VLV PROC W/O CA CAT|
20|FH_F149270_98004_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F85353_16407_0|SrvcGrp|63773|2022|PDM|1427.83|99|0.00|HAPA WPA-NWPA 2012-13 ASC 7|
20|FH_F124371_0_0|SrvcGrp|106314|2022|PDM|498.38|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F121597_30315_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F146657_01105_0|SrvcGrp|114675|2022|PDM|19.17|99|0.00|SKILLS TRAINING DEV (MOD HN)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|2053.99|99|0.00|HAPA WPA-NWPA 2012-13 ASC 9 W/O REV|
20|FH_F120719_27540_0|SrvcGrp|11000|2022|PCT|0.36|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F33063_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F110642_17901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F90501_71101_0|SrvcGrp|75491|2022|PDM|4200.00|99|0.00|AEG 7|
20|FH_F150259_15668_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123646_91350_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F130329_64114_0|SrvcGrp|86840|2022|PDM|22.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F132827_0_0|SrvcGrp|22596|2022|PDM|150.00|99|0.00|HOSPICE CARE|
20|FH_F134208_21502_0|SrvcGrp|53065|2022|PDM|408.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F133943_01606_0|SrvcGrp|472|2022|PDM|515.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1405 W/O REV|
20|FH_F129316_65066_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PDM|384.00|99|0.00|AEG 10 (NO REV)|
20|FH_F128379_0_0|SrvcGrp|92410|2022|PDM|7553.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F133876_27405_0|SrvcGrp|108484|2022|PDM|632.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F100782_0_0|SrvcGrp|97680|2022|PDM|2846.46|99|0.00|WINDBER MEDICAL CNTR ASC 902|
20|FH_F149365_77642_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149139_07522_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|112.02|99|0.00|HAPA WPA-NWPA 2012-13 ASC 138 W/O REV|
20|FH_F132747_60174_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F143579_43160_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F74024_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F72244_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116959_0_0|SrvcGrp|19922|2022|PDM|5000.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F145641_06902_0|SrvcGrp|82107|2022|PDM|6619.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F120719_27540_0|SrvcGrp|82858|2022|PCT|0.44|99|0.00|NUCLEAR MEDICINE|
20|FH_F132690_87571_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F87775_15106_0|SrvcGrp|21920|2022|PDM|60.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F54592_0_0|SrvcGrp|34388|2022|PDM|150.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F122552_03103_0|SrvcGrp|89417|2022|PDM|325.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|147.23|99|0.00|HAPA WPA-NWPA 2012-13 ASC 235 W/O REV|
20|FH_F105103_39652_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F66782_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MEDICAP 151 INFUSION- IV SERVICES|
20|FH_F120795_27514_0|SrvcGrp|107733|2022|PDM|4776.00|99|0.00|CESAREAN SECTION|
20|FH_F120795_27514_0|SrvcGrp|107734|2022|PDM|3714.00|99|0.00|VAGINAL DELIVERY|
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|PSYCHIATRIC PARTIAL HOSPITALIZATION (OP) - ADOLESCENT|
20|FH_F116056_73018_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F131674_72501_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133133_32433_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133494_90023_0|CSTM-ALL|CSTM-00|2020|PDM|3462.00|99|0.00|AEG 5  (NO REV)|
20|FH_F49033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F102641_0_0|SrvcGrp|16289|2022|PDM|1182.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F137906_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F46433_0_0|SrvcGrp|17013|2022|PDM|72.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F35381_0_0|SrvcGrp|6|2022|PCT|0.65|99|0.00|OP SURGERY|
20|FH_F113180_23507_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F143988_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.10|99|0.00|HSS ASC INVOICE|
20|FH_F150200_0_0|SrvcGrp|88065|2022|PDM|10200.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F138651_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|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_F118056_29464_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F92659_0_0|SrvcGrp|92552|2022|PCT|1.00|99|0.00|AMNIOTIC MEMBRANE|
20|FH_F115740_78957_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F110925_01104_0|SrvcGrp|14945|2022|PDM|13.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F39740_0_0|CSTM-ALL|CSTM-00|2020|PDM|2185.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69423_0_0|SrvcGrp|65624|2022|PDM|1000.00|99|0.00|CPT 31254 AND 31267|
20|FH_F38360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101021_0_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F98922_40351_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD 26) - PMRS|
20|FH_F89475_71202_0|SrvcGrp|20912|2022|PDM|23222.00|99|0.00|MS DRG 236 ONLY|
20|FH_F40063_0_0|SrvcGrp|15866|2022|PDM|2818.00|99|0.00|TRAUMA HEAD/SPINE REHAB|
20|FH_F120195_28403_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150982_0_0|SrvcGrp|67989|2022|PDM|4955.00|99|0.00|CPT 49320|
20|FH_F44177_0_0|SrvcGrp|21826|2022|PDM|3149.00|99|0.00|PTCA (MS DRG ONLY)|
20|FH_F127032_33573_0|SrvcGrp|57968|2022|PDM|40.06|99|0.00|CONTINUOUS HOMECARE|
20|FH_F72830_0_0|SrvcGrp|70042|2022|PDM|1800.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 2|
20|FH_F126070_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F128343_48035_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143948_44870_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135005_06460_0|SrvcGrp|88620|2022|PDM|89.00|99|0.00|SKILLED NURSING RN|
20|FH_F123895_52722_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F72183_0_0|SrvcGrp|12258|2022|PDM|2500.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F130630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102500_0_0|SrvcGrp|73004|2022|PDM|1511.00|99|0.00|AEG 8|
20|FH_F91663_19901_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F63018_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F130504_33756_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72784_0_0|SrvcGrp|3418|2022|PDM|3262.11|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F131952_06002_0|SrvcGrp|472|2022|PDM|461.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F127556_66725_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F85212_71075_0|SrvcGrp|73605|2022|PDM|875.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F143650_0_0|SrvcGrp|26432|2022|PDM|1800.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F139472_06902_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F90232_15126_0|SrvcGrp|86833|2022|PDM|14.18|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F51115_0_0|SrvcGrp|26001|2022|PDM|137.82|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F118042_33401_0|SrvcGrp|86723|2022|PDM|475.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F135623_53115_0|SrvcGrp|83522|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F90438_08873_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|ASPG II|
20|FH_F69647_0_0|SrvcGrp|17071|2022|PDM|1100.00|99|0.00|ASPG IV|
20|FH_F50583_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|1045.00|99|0.00|AEG 3 (NO REV)|
20|FH_F127529_43230_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111986_0_0|SrvcGrp|16732|2022|PDM|2266.00|99|0.00|HYSTEROSCOPY ABLATION|
20|FH_F133805_83401_0|SrvcGrp|80918|2022|PDM|127.00|99|0.00|RESPITE CARE|
20|FH_F85213_02840_0|SrvcGrp|112727|2022|PDM|255.90|99|0.00|COVID-19 IA NFCT AB SARS COV 2|
20|FH_F150165_06032_0|SrvcGrp|63471|2022|PDM|8020.00|99|0.00|CPT 64590|
20|FH_F85353_16407_0|SrvcGrp|63923|2022|PDM|51.77|99|0.00|HAPA WPA-NWPA 2012-13 ASC 247|
20|FH_F61513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117206_0_0|SrvcGrp|73008|2022|PDM|914.00|99|0.00|AEG 10|
20|FH_F143708_19031_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114444_19602_0|SrvcGrp|86866|2022|PDM|85.00|99|0.00|AETNA PSYCH DIAG EVAL W/MED SRVC (MOD TD)(HCFA)|
20|FH_F121303_15501_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122243_30655_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F149121_01520_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117208_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F51258_0_0|SrvcGrp|473|2022|PDM|318.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F133798_20774_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134509_14075_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F122526_22203_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F75963_0_0|SrvcGrp|46605|2022|PDM|18.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F105143_26062_0|SrvcGrp|13187|2022|PCT|1.25|99|0.00|INTRAOCULAR LENSES|
20|FH_F105361_80104_0|SrvcGrp|12152|2022|PCT|0.98|99|0.00|AIR AMBULANCE SVCS|
20|FH_F115811_33410_0|SrvcGrp|89149|2022|PDM|208.00|99|0.00|OP INTENSIVE|
20|FH_F115903_43560_0|SrvcGrp|73841|2022|PDM|820.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F75842_0_0|SrvcGrp|17065|2022|PDM|1244.41|99|0.00|ASPG I|
20|FH_F146499_72206_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116040_24637_0|SrvcGrp|86840|2022|PDM|30.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F116063_43220_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F116088_46410_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F116114_37033_0|SrvcGrp|89337|2022|PDM|833.00|99|0.00|DETOXIFICATION|
20|FH_F132937_88201_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132937_88201_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F133249_33603_0|SrvcGrp|108484|2022|PDM|743.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F111666_06517_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134828_30531_0|SrvcGrp|111926|2022|PDM|35.92|99|0.00|COVID-19 LAB TESTING|
20|FH_F39346_0_0|SrvcGrp|20297|2022|PDM|30874.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VALVE PROC|
20|FH_F67086_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HAPA OHIO 2014 NISC 100%|
20|FH_F76824_0_0|SrvcGrp|29137|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133536_0_0|SrvcGrp|109366|2022|PDM|9500.00|99|0.00|RELIEVE SPINAL CORD PRESSURE|
20|FH_F133536_0_0|SrvcGrp|26275|2022|PDM|3300.00|99|0.00|CPT 29826|
20|FH_F143509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120612_23314_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
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_F37186_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80511_0_0|SrvcGrp|78182|2022|PDM|1215.00|99|0.00|AETNA OP CAT SCAN|
20|FH_F47462_0_0|SrvcGrp|10507|2022|PDM|130.00|99|0.00|OCCUPATIONAL THERAPY SVCS RE-EVAL|
20|FH_F51492_0_0|SrvcGrp|46549|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F54552_0_0|SrvcGrp|27051|2022|PDM|29.33|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS (MOD SJ)|
20|FH_F138784_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F138936_01040_0|SrvcGrp|110146|2022|PDM|288.00|99|0.00|SUPPLEMENTAL INTENSIVE OUTPATIENT PSYCH|
20|FH_F83792_0_0|SrvcGrp|74581|2022|PCT|0.68|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|537.89|99|0.00|AEG 3 (NO REV)|
20|FH_F151404_71655_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151405_65109_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132258_45404_0|SrvcGrp|17013|2022|PDM|50.88|99|0.00|HOME INFUSION THERAPY|
20|FH_F122064_64633_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135427_19610_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F135438_29030_0|SrvcGrp|73842|2022|PDM|239.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F135608_19348_0|SrvcGrp|46903|2022|PDM|574.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F91764_93710_0|SrvcGrp|114504|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F136174_89146_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F131228_01826_0|SrvcGrp|113740|2022|PCT|2.87|99|0.00|LABORATORY SERVICES|
20|FH_F130756_04901_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|GENERAL ACUTE CARE|
20|FH_F131132_44077_0|SrvcGrp|97730|2022|PDM|22889.00|99|0.00|REVERSE HIP JOINT|
20|FH_F130557_66012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127399_0_0|SrvcGrp|42472|2022|PDM|2913.00|99|0.00|CPT 58670|
20|FH_F121407_73701_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121763_07202_0|SrvcGrp|108629|2022|PDM|193.00|99|0.00|PARTIAL HOSPITALIZATION-SUBSTANCE ABUSE|
20|FH_F33685_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F33785_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F38013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|SAOF OP SERVICES MOD UE|
20|FH_F111301_33122_0|SrvcGrp|88678|2022|PCT|0.00|99|0.00|ACUTE REHAB I|
20|FH_F111363_33169_0|SrvcGrp|82752|2022|PDM|20.00|99|0.00|ASSAY BUN|
20|FH_F145587_0_0|SrvcGrp|26273|2022|PDM|1262.70|99|0.00|CPT 29880|
20|FH_F33081_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|LAPAROSCOPIC SUPRACERVICAL HYSTERECTOMY|
20|FH_F40698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F51272_0_0|SrvcGrp|27718|2022|PDM|28000.00|99|0.00|CYBER KNIFE|
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)|
20|FH_F89732_0_0|SrvcGrp|88426|2022|PCT|0.48|99|0.00|AETNA IMPLANTS/HIGH COST DRUGS|
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|AEG 1 (NO REV)|
20|FH_F87496_17055_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F141035_0_0|SrvcGrp|103564|2022|PDM|3932.00|99|0.00|REPAIR FINGER TENDON|
20|FH_F123036_0_0|SrvcGrp|108836|2022|PDM|30000.00|99|0.00|COCHLEAR DEVICE/SYSTEM|
20|FH_F102222_19720_0|SrvcGrp|86842|2022|PDM|26.25|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F102862_30606_0|SrvcGrp|73483|2022|PDM|935.00|99|0.00|AETNA SUBACUTE III|
20|FH_F96960_35404_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F132090_60915_0|SrvcGrp|85198|2022|PDM|5094.00|99|0.00|AETNA KNEE ARTHROSCOPY|
20|FH_F132090_60915_0|CSTM-ALL|CSTM-00|2020|PDM|936.60|99|0.00|AEG 1 (NO REV)|
20|FH_F121936_17543_0|SrvcGrp|471|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F121980_66104_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F38564_0_0|SrvcGrp|17139|2022|PDM|573.00|99|0.00|HOSPICE CARE|
20|FH_F40144_0_0|SrvcGrp|31753|2022|PDM|975.00|99|0.00|SPINAL CORD CARE|
20|FH_F101281_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91873_12723_0|SrvcGrp|537|2022|PDM|5040.00|99|0.00|OBSERVATION SERVICES|
20|FH_F111840_0_0|SrvcGrp|75489|2022|PDM|826.00|99|0.00|AEG 6|
20|FH_F111840_0_0|SrvcGrp|75485|2022|PDM|630.00|99|0.00|AEG 4|
20|FH_F116019_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35622_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F117001_0_0|SrvcGrp|106601|2022|PDM|1600.00|99|0.00|HEARING AID, DIGIT, BIN, CIC|
20|FH_F114864_78155_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F114916_30309_0|SrvcGrp|92009|2022|PDM|3000.00|99|0.00|CARPAL SCAPHOID FRACTURE|
20|FH_F142288_44714_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F112967_0_0|SrvcGrp|94781|2022|PDM|115.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|1212.00|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_F129785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141131_20850_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F72204_0_0|SrvcGrp|43567|2022|PDM|80.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F114002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F45976_0_0|SrvcGrp|17073|2022|PDM|1082.00|99|0.00|ASPG V|
20|FH_F92600_0_0|CSTM-ALL|CSTM-00|2020|PDM|588.00|99|0.00|AEG 1 (NO REV)|
20|FH_F122181_66538_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147014_33612_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F62624_0_0|SrvcGrp|29702|2022|PDM|8800.00|99|0.00|CV SURGERY MS DRG 260-262 ONLY|
20|FH_F49937_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F124225_92506_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F87856_0_0|SrvcGrp|84183|2022|PDM|1693.00|99|0.00|AETNA SURGERY OF BREAST CAPSULE|
20|FH_F137248_0_0|SrvcGrp|19922|2022|PDM|4058.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F35347_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F114666_30342_0|SrvcGrp|97741|2022|PDM|18500.00|99|0.00|REVISE KNEE|
20|FH_F114666_30342_0|SrvcGrp|88492|2022|PDM|2500.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F138247_76201_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F100664_03104_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F148553_85016_0|SrvcGrp|115466|2022|PDM|3121.00|99|0.00|PRQ CARD STENT W/ ANGIO 1 VS|
20|FH_F132595_0_0|SrvcGrp|23477|2022|PDM|5871.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F122689_92009_0|SrvcGrp|108903|2022|PDM|5.25|99|0.00|LANCET|
20|FH_F43444_0_0|CSTM-ALL|CSTM-00|2020|PDM|5000.00|99|0.00|CV SERVICES (MS DRG)|
20|FH_F134727_30650_0|SrvcGrp|81779|2022|PCT|1.43|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F135718_33172_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F135719_45502_0|SrvcGrp|33198|2022|PDM|22301.56|99|0.00|MS DRG 330 ONLY|
20|FH_F113713_17013_0|SrvcGrp|105561|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F74143_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41254_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F42522_0_0|SrvcGrp|11336|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F139676_76901_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F150769_02302_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F150802_15401_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150820_83843_0|SrvcGrp|105408|2022|PDM|3500.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY|
20|FH_F150841_84757_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F84912_0_0|SrvcGrp|13640|2022|PDM|68.27|99|0.00|CPT 99202|
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F74583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100907_85206_0|SrvcGrp|11577|2022|PDM|433.00|99|0.00|DIALYSIS|
20|FH_F101100_50314_0|SrvcGrp|97915|2022|PDM|6832.00|99|0.00|REPAIR OF BOWEL OPENING|
20|FH_F105145_75075_0|SrvcGrp|12846|2022|PCT|1.15|99|0.00|PHARMACY SVCS|
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146522_74133_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40903_0_0|SrvcGrp|13422|2022|PDM|209.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
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|595.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F115950_08648_0|SrvcGrp|89022|2022|PDM|40.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F115952_44484_0|SrvcGrp|89417|2022|PDM|208.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F116114_37033_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F131737_15025_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F133581_84790_0|SrvcGrp|27261|2022|PDM|5000.00|99|0.00|CPT 27446|
20|FH_F133133_32433_0|SrvcGrp|89417|2022|PDM|350.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F133133_32433_0|CSTM-ALL|CSTM-00|2020|PDM|240.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F133047_74012_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F133448_44094_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134828_30531_0|SrvcGrp|112666|2022|PDM|35.00|99|0.00|XRAY EXAM OF FINGERS (HCFA)|
20|FH_F32994_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OBSERVATION SERVICES|
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|674.81|99|0.00|AEG 2 (NO REV)|
20|FH_F88398_15601_0|SrvcGrp|48396|2022|PDM|83.65|99|0.00|OT SERVICES|
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F132810_0_0|SrvcGrp|74147|2022|PDM|8.00|99|0.00|INFUSION S-CODE PER MONTH|
20|FH_F47495_0_0|SrvcGrp|30165|2022|PCT|0.70|99|0.00|BLOOD PRODUCTS|
20|FH_F69968_0_0|SrvcGrp|17081|2022|PDM|4354.99|99|0.00|ASPG IX|
20|FH_F102623_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115166_0_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F136371_29720_0|SrvcGrp|89149|2022|PDM|210.00|99|0.00|OP INTENSIVE|
20|FH_F118152_20151_0|SrvcGrp|65621|2022|PDM|50.00|99|0.00|RN NURSING|
20|FH_F120489_63552_0|SrvcGrp|84720|2022|PCT|0.00|99|0.00|AETNA LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F134011_84102_0|SrvcGrp|27969|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F134011_84102_0|SrvcGrp|73742|2022|PDM|4.41|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F137236_17603_0|SrvcGrp|90632|2022|PDM|175.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F142448_15701_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F142473_07663_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F142210_61356_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F53732_0_0|SrvcGrp|50166|2022|PDM|95.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 3 HRS|
20|FH_F83831_0_0|SrvcGrp|9874|2022|PDM|39.00|99|0.00|DIETICIAN|
20|FH_F138778_90066_0|SrvcGrp|89149|2022|PDM|325.00|99|0.00|OP INTENSIVE|
20|FH_F140407_63841_0|SrvcGrp|3378|2022|PCT|0.75|99|0.00|OBSERVATION SVCS|
20|FH_F140730_84106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149647_92651_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F151603_27609_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119003_78070_0|SrvcGrp|89149|2022|PDM|129.00|99|0.00|OP INTENSIVE|
20|FH_F119026_36274_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F119046_74012_0|SrvcGrp|92582|2022|PDM|375.00|99|0.00|DIALYSIS SERVICES|
20|FH_F119064_01581_0|SrvcGrp|108484|2022|PDM|482.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F92475_15931_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92636_90230_0|SrvcGrp|73700|2022|PDM|36.75|99|0.00|AETNA - SKILLED NURSING|
20|FH_F147799_18052_0|SrvcGrp|23683|2022|PDM|54.79|99|0.00|SKILLED NURSING RN|
20|FH_F81761_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.50|99|0.00|OP SVCS|
20|FH_F117098_20186_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F137276_83127_0|SrvcGrp|46605|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F137333_51012_0|SrvcGrp|113074|2022|PCT|0.00|99|0.00|HALFWAY HOUSE|
20|FH_F115868_0_0|SrvcGrp|94781|2022|PDM|100.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F35210_0_0|SrvcGrp|33793|2022|PCT|0.65|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F110720_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F90735_94070_0|SrvcGrp|90281|2022|PDM|2500.00|99|0.00|CYTOGENETIC STUDY|
20|FH_F129892_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F110160_0_0|SrvcGrp|72996|2022|PDM|928.00|99|0.00|AEG 4|
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|581.00|99|0.00|AEG 3 (NO REV)|
20|FH_F128312_45230_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F148680_33311_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F148760_12953_0|SrvcGrp|48398|2022|PDM|147.00|99|0.00|PT SERVICES|
20|FH_F130066_84107_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F36386_0_0|SrvcGrp|3327|2022|PDM|90.00|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|515.00|99|0.00|ASPG II|
20|FH_F38807_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|526.10|99|0.00|DELAWARE VALLEY- ASC 401|
20|FH_F91873_12723_0|SrvcGrp|73004|2022|PDM|3565.00|99|0.00|AEG 8|
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|101744|2022|PDM|5.00|99|0.00|IM ADMIN EACH ADDL COMPONENT|
20|FH_F111207_0_0|SrvcGrp|58764|2022|PCT|0.70|99|0.00|PHYSICIANS FEES|
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F116043_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F125214_12428_0|SrvcGrp|74403|2022|PDM|3558.00|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|655.00|99|0.00|AEG 2 (NO REV)|
20|FH_F36597_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F111266_30339_0|SrvcGrp|34566|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F114207_35243_0|SrvcGrp|86825|2022|PDM|60.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F126189_89129_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140295_0_0|SrvcGrp|93433|2022|PDM|12731.00|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F150442_28451_0|SrvcGrp|88160|2022|PDM|6223.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F151619_73505_0|SrvcGrp|99073|2022|PCT|1.05|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F37312_0_0|SrvcGrp|12263|2022|PDM|16.50|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F112128_63017_0|SrvcGrp|100859|2022|PDM|238.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F131069_54724_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119652_0_0|SrvcGrp|108224|2022|PDM|300.00|99|0.00|AETNA RESPIRATORY SERVICES|
20|FH_F151619_73505_0|SrvcGrp|75495|2022|PDM|1547.00|99|0.00|AEG 9|
20|FH_F147375_32503_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F123745_0_0|SrvcGrp|109530|2022|PDM|4500.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F147166_03444_0|SrvcGrp|108484|2022|PDM|1550.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F101441_0_0|SrvcGrp|96999|2022|PDM|3497.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F132126_08037_0|SrvcGrp|46903|2022|PDM|672.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F124413_30067_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F115982_0_0|SrvcGrp|41335|2022|PDM|7000.00|99|0.00|TOTAL HIP|
20|FH_F67419_0_0|SrvcGrp|42972|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F39211_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F110727_34994_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125419_44110_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F147083_46304_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F35990_0_0|SrvcGrp|941|2022|PDM|2749.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F110783_93013_0|SrvcGrp|86840|2022|PDM|35.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F123386_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F98022_89015_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F148347_0_0|SrvcGrp|79589|2022|PDM|2125.20|99|0.00|UPPER GI|
20|FH_F151699_01752_0|SrvcGrp|86840|2022|PDM|47.50|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F124760_34997_0|SrvcGrp|3178|2022|PDM|902.00|99|0.00|ACUTE PSYCH|
20|FH_F147299_02072_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1361.00|99|0.00|HAPA EPA ASC 56|
20|FH_F149020_78653_0|SrvcGrp|75419|2022|PDM|465.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F94303_0_0|SrvcGrp|73006|2022|PDM|1008.00|99|0.00|AEG 9|
20|FH_F131356_19131_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F39443_0_0|SrvcGrp|30305|2022|PDM|171.00|99|0.00|HAPA WPA ASC 117|
20|FH_F97620_75904_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F80974_0_0|SrvcGrp|33165|2022|PDM|310.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F110824_83221_0|SrvcGrp|103913|2022|PCT|0.85|99|0.00|OP DIALYSIS|
20|FH_F84535_0_0|CSTM-ALL|CSTM-00|2020|PCT|9500.00|99|0.00|TIMELY FILING|
20|FH_F140295_0_0|SrvcGrp|92820|2022|PDM|6668.00|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY|
20|FH_F127143_68716_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129174_20910_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F35930_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F110666_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF|
20|FH_F139877_32615_0|SrvcGrp|113247|2022|PDM|45.23|99|0.00|COVID19 SARSCOV CORONAVIRUS AG IA (HCFA)|
20|FH_F108680_0_0|SrvcGrp|102724|2022|PCT|0.00|99|0.00|DESTROY LUMB/SAC FACET JNT|
20|FH_F114585_11501_0|SrvcGrp|89417|2022|PDM|294.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ORTHOTICS/PROSTHETICS - CARECENTRIX|
20|FH_F42944_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS APC GROUPED|
20|FH_F42979_0_0|SrvcGrp|3392|2022|PDM|96.00|99|0.00|CPT 90806|
20|FH_F81951_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL|
20|FH_F36343_0_0|SrvcGrp|22396|2022|PDM|38.25|99|0.00|IV IMMUNOGLOBULIN|
20|FH_F41033_0_0|SrvcGrp|29063|2022|PCT|0.45|99|0.00|IMPLANTS|
20|FH_F98840_31021_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F37304_0_0|SrvcGrp|12041|2022|PDM|245.00|99|0.00|DIALYSIS|
20|FH_F132160_0_0|SrvcGrp|109769|2022|PCT|0.00|99|0.00|COVER EYE W/ MEMBRANE SUTURE INCIDENTAL CODES|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.00|99|0.00|ASPG I|
20|FH_F125214_12428_0|SrvcGrp|92958|2022|PCT|0.00|99|0.00|SLEEP STUDIES|
20|FH_F98360_11554_0|CSTM-ALL|CSTM-00|2020|PCT|0.31|99|0.00|OP SVCS|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD NU - CARECENTRIX|
20|FH_F109762_0_0|SrvcGrp|72990|2022|PDM|375.00|99|0.00|AEG 1|
20|FH_F113957_73554_0|SrvcGrp|72990|2022|PDM|787.50|99|0.00|AEG 1|
20|FH_F71362_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37364_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F149662_85015_0|CSTM-ALL|CSTM-00|2020|PDM|1945.00|99|0.00|AEG 3 (NO REV)|
20|FH_F151619_73505_0|SrvcGrp|75483|2022|PDM|589.00|99|0.00|AEG 3|
20|FH_F132849_0_0|SrvcGrp|72|2022|PDM|398.00|99|0.00|NEWBORN NURSERY|
20|FH_F147360_06415_0|SrvcGrp|100246|2022|PCT|1.00|99|0.00|STREP A ASSAY W/ OPTIC|
20|FH_F139928_37228_0|SrvcGrp|90388|2022|PDM|771.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F143249_89801_0|SrvcGrp|43569|2022|PDM|120.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F143347_16001_0|SrvcGrp|79860|2022|PDM|6253.00|99|0.00|ANGIOGRAPHY|
20|FH_F114916_30309_0|SrvcGrp|88491|2022|PDM|5200.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F142335_60624_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113903_0_0|SrvcGrp|87077|2022|PDM|200.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F105591_17601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F43860_0_0|SrvcGrp|30961|2022|PDM|12.50|99|0.00|HOME HEALTH AIDE|
20|FH_F134317_0_0|SrvcGrp|80258|2022|PDM|500.00|99|0.00|AETNA SKILLED CARE|
20|FH_F131047_0_0|SrvcGrp|13268|2022|PCT|0.57|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F132627_0_0|SrvcGrp|14947|2022|PDM|18.36|99|0.00|HOME INFUSION|
20|FH_F141050_46410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F50415_0_0|SrvcGrp|44711|2022|PDM|80.00|99|0.00|PT SVCS|
20|FH_F114389_50131_0|SrvcGrp|98969|2022|PDM|102.25|99|0.00|HIT ANTI TNF (HCFA)|
20|FH_F49487_0_0|SrvcGrp|17001|2022|PDM|126.00|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|508.00|99|0.00|AEG 3 (NO REV)|
20|FH_F146894_73505_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147039_06374_0|SrvcGrp|471|2022|PDM|520.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F147081_02130_0|SrvcGrp|114167|2022|PDM|398.00|99|0.00|PARTIAL HOSPITAL (0-17 YRS)|
20|FH_F43800_0_0|SrvcGrp|16|2022|PDM|847.00|99|0.00|ACUTE REHABILITATION|
20|FH_F124687_64024_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F125134_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F127995_84010_0|SrvcGrp|93098|2022|PDM|107.00|99|0.00|HOSPICE CARE|
20|FH_F133694_89117_0|SrvcGrp|88620|2022|PDM|135.00|99|0.00|SKILLED NURSING RN|
20|FH_F81115_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87856_0_0|SrvcGrp|86462|2022|PDM|1218.00|99|0.00|AREOLA RECONSTRUCTION|
20|FH_F89273_0_0|SrvcGrp|88270|2022|PDM|400.00|99|0.00|RETINAL TAMPONADE DEVICE (HCFA)|
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 3 (NO REV)|
20|FH_F92599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136596_72117_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F114666_30342_0|SrvcGrp|63471|2022|PDM|6500.00|99|0.00|CPT 64590|
20|FH_F114666_30342_0|SrvcGrp|67074|2022|PDM|2400.00|99|0.00|AC SURGERY|
20|FH_F114705_77018_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F113870_10536_0|SrvcGrp|89417|2022|PDM|385.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F114985_32073_0|SrvcGrp|83683|2022|PCT|0.00|99|0.00|ACUTE REHAB II|
20|FH_F148487_28210_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F144039_0_0|SrvcGrp|42428|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 65855|
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_F122610_73139_0|SrvcGrp|109153|2022|PDM|118.00|99|0.00|PT/ST/OT - SPECIFIC REVENUE CODES|
20|FH_F122727_64030_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43421_0_0|CSTM-ALL|CSTM-00|2020|PDM|132.00|99|0.00|ADULT CD OUTPATIENT SVCS|
20|FH_F135719_45502_0|SrvcGrp|82137|2022|PCT|0.48|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F136913_68803_0|SrvcGrp|82137|2022|PCT|0.75|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F136913_68803_0|SrvcGrp|75506|2022|PCT|0.75|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F136927_45690_0|SrvcGrp|48398|2022|PDM|83.00|99|0.00|PT SERVICES|
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|ASPG II|
20|FH_F115631_65201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147305_90755_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147586_44124_0|SrvcGrp|12491|2022|PCT|0.44|99|0.00|PACEMAKER|
20|FH_F147541_44805_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F42708_0_0|CSTM-ALL|CSTM-00|2020|PDM|684.00|99|0.00|ACUTE PSYCH|
20|FH_F113649_01752_0|SrvcGrp|15596|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F84394_17402_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F39028_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HIV MEDICATIONS|
20|FH_F39080_0_0|SrvcGrp|38|2022|PDM|3600.00|99|0.00|NORMAL DELIVERY|
20|FH_F41934_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ASPG I - CPD 1281588|
20|FH_F103004_75840_0|SrvcGrp|72992|2022|PDM|624.00|99|0.00|AEG 2|
20|FH_F38476_0_0|SrvcGrp|10407|2022|PDM|55.00|99|0.00|HOME INFUSION|
20|FH_F69245_84047_0|SrvcGrp|89417|2022|PDM|469.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F46433_0_0|SrvcGrp|29076|2022|PDM|60.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F46433_0_0|SrvcGrp|19742|2022|PDM|125.00|99|0.00|MID-LINE INSERTION|
20|FH_F134087_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F35381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|EPILEPSY PROGRAM|
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139916_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F141937_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|6353.00|99|0.00|AEG 7 (NO REV)|
20|FH_F82357_0_0|SrvcGrp|9829|2022|PDM|50.00|99|0.00|PT SVCS|
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 8 (NO REV)|
20|FH_F39098_0_0|SrvcGrp|3029|2022|PDM|457.00|99|0.00|NEWBORN NURSERY|
20|FH_F41989_0_0|CSTM-ALL|CSTM-00|2020|PDM|179.00|99|0.00|ADULT PSYCH SERVICES|
20|FH_F42985_0_0|SrvcGrp|110|2022|PDM|360.00|99|0.00|CD - REHABILITATION|
20|FH_F51492_0_0|SrvcGrp|48002|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F54552_0_0|SrvcGrp|26617|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F113585_20155_0|SrvcGrp|43568|2022|PDM|90.00|99|0.00|SKILLED NURSING - RN|
20|FH_F90422_0_0|SrvcGrp|1168|2022|PDM|76.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F72606_0_0|SrvcGrp|1306|2022|PDM|450.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F151405_65109_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151420_60654_0|SrvcGrp|82107|2022|PDM|2791.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F122107_11229_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133119_46545_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AETNA IP LABORATORY|
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|1670.00|99|0.00|ASPG II|
20|FH_F135979_66451_0|SrvcGrp|66265|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F119892_47586_0|SrvcGrp|47183|2022|PDM|100.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F100765_73735_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F131228_01826_0|SrvcGrp|18008|2022|PDM|314.11|99|0.00|DOPPLER FLOW TESTING|
20|FH_F130547_85712_0|SrvcGrp|75545|2022|PDM|382.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F130756_04901_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F116488_79925_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F34709_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F116370_0_0|SrvcGrp|103551|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F127399_0_0|SrvcGrp|108255|2022|PDM|3641.00|99|0.00|AETNA REPAIR CLAVICLE DISLOCATION|
20|FH_F121707_85745_0|SrvcGrp|108061|2022|PCT|1.25|99|0.00|OP THERAPY SERVICES|
20|FH_F121763_07202_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121823_46234_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F33785_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F38013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|SAOF OP SERVICES MOD TC|
20|FH_F129967_18915_0|SrvcGrp|106470|2022|PDM|95.90|99|0.00|AETNA OFFICE OUTPATIENT VISIT EST (MOD TD)|
20|FH_F129967_18915_0|SrvcGrp|86870|2022|PDM|63.58|99|0.00|AETNA OFFICE OP VISIT EST (MOD TD) (HCFA)|
20|FH_F111363_33169_0|SrvcGrp|73602|2022|PDM|823.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 8 (NO REV)|
20|FH_F55577_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F131000_0_0|SrvcGrp|85778|2022|PDM|3502.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F132328_0_0|SrvcGrp|58993|2022|PDM|6950.00|99|0.00|DISKECTOMY|
20|FH_F132328_0_0|SrvcGrp|67064|2022|PDM|5202.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F112082_30720_0|SrvcGrp|48385|2022|PDM|213.00|99|0.00|SPEECH THERAPY|
20|FH_F112129_62220_0|SrvcGrp|73841|2022|PDM|317.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F101904_17057_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F102282_06795_0|SrvcGrp|88620|2022|PDM|103.74|99|0.00|SKILLED NURSING RN|
20|FH_F102325_62691_0|SrvcGrp|24752|2022|PDM|65.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F102902_33764_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F101320_26062_0|SrvcGrp|53987|2022|PCT|0.00|99|0.00|PHOTOTHERAPY|
20|FH_F101320_26062_0|SrvcGrp|95582|2022|PCT|1.00|99|0.00|OP SERVICES AMFS(H) DEFAULT|
20|FH_F77462_0_0|SrvcGrp|30609|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F78003_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F111594_0_0|SrvcGrp|88157|2022|PDM|7215.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F113709_0_0|SrvcGrp|87077|2022|PDM|122.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F119417_78212_0|SrvcGrp|87401|2022|PDM|30.00|99|0.00|HCPCS G0156 (HCFA)|
20|FH_F119448_07083_0|SrvcGrp|73842|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119413_95123_0|SrvcGrp|104079|2022|PCT|1.50|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F125352_90034_0|SrvcGrp|46903|2022|PDM|1100.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F40599_0_0|SrvcGrp|26916|2022|PCT|0.60|99|0.00|IMPLANTS/PROSHETICS/ORTHOTICS|
20|FH_F120437_85202_0|SrvcGrp|86842|2022|PDM|106.93|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F149781_37404_0|SrvcGrp|109790|2022|PDM|8446.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F141772_80124_0|SrvcGrp|12957|2022|PCT|1.00|99|0.00|DME|
20|FH_F40084_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F150001_33064_0|SrvcGrp|14944|2022|PDM|2.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F92677_08003_0|SrvcGrp|92098|2022|PDM|424.20|99|0.00|AETNA COUGH STIMULATING DEVICE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|355.04|99|0.00|HAPA WPA-NWPA 2012-13 ASC 225 W/O REV|
20|FH_F130652_51101_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1711.00|99|0.00|AEG 7 (NO REV)|
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|AEG 3 (NO REV)|
20|FH_F72065_0_0|SrvcGrp|17140|2022|PDM|187.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F128559_43524_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F70343_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F68782_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F117885_81506_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F57592_0_0|SrvcGrp|53962|2022|PDM|201471.00|99|0.00|LIVER TRANSPLANT SURGERY|
20|FH_F57592_0_0|SrvcGrp|29606|2022|PDM|28500.00|99|0.00|MS DRG 218 ONLY|
20|FH_F31542_0_0|SrvcGrp|9808|2022|PDM|5000.00|99|0.00|PTCA WITH STENT|
20|FH_F88956_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|AETNA OP SVCS|
20|FH_F130108_0_0|SrvcGrp|360|2022|PDM|725.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F132528_64014_0|SrvcGrp|27968|2022|PDM|44.00|99|0.00|SKILLED NURSING LPN|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F50297_0_0|SrvcGrp|42973|2022|PDM|82.00|99|0.00|SPEECH  THERAPIST|
20|FH_F50615_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F49044_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F40812_0_0|CSTM-ALL|CSTM-00|2020|PDM|231.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|ASPG II|
20|FH_F68479_0_0|CSTM-ALL|CSTM-00|2020|PDM|385.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD UE KC"|
20|FH_F63250_0_0|SrvcGrp|27968|2022|PDM|28.00|99|0.00|SKILLED NURSING LPN|
20|FH_F146159_89102_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F141767_62312_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F144324_67467_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120753_61701_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92676_15063_0|SrvcGrp|78949|2022|PDM|3101.75|99|0.00|MON VALLEY ASC 3|
20|FH_F69123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100682_97401_0|SrvcGrp|73559|2022|PDM|9691.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F80532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149661_0_0|SrvcGrp|14510|2022|PDM|800.00|99|0.00|SKILLED NURSING|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|115.72|99|0.00|ASPG 226|
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)|
20|FH_F118540_32064_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F44813_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37554_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141870_85224_0|SrvcGrp|24750|2022|PDM|40.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F56793_0_0|SrvcGrp|43568|2022|PDM|80.00|99|0.00|SKILLED NURSING - RN|
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_F131282_0_0|SrvcGrp|111426|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F36118_0_0|SrvcGrp|1168|2022|PDM|25.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F146211_68144_0|SrvcGrp|41325|2022|PDM|6180.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F80855_0_0|SrvcGrp|35668|2022|PDM|2100.00|99|0.00|CPT 29824|
20|FH_F146211_68144_0|SrvcGrp|89856|2022|PDM|6473.00|99|0.00|LAMIN EXCIS EXTRADURAL LUMB|
20|FH_F100788_01420_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F97564_52246_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F141940_50023_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F67861_0_0|SrvcGrp|11336|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F143171_18411_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119095_08536_0|SrvcGrp|11259|2022|PCT|0.25|99|0.00|DRUGS|
20|FH_F38700_0_0|SrvcGrp|18834|2022|PCT|0.80|99|0.00|MS DRG 225|
20|FH_F67136_0_0|SrvcGrp|21354|2022|PDM|8427.00|99|0.00|MS DRG 250-251 ONLY|
20|FH_F51129_0_0|SrvcGrp|941|2022|PCT|0.75|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F117366_33162_0|SrvcGrp|38006|2022|PDM|800.00|99|0.00|CPT CODE 59426|
20|FH_F54552_0_0|SrvcGrp|14947|2022|PDM|65.00|99|0.00|HOME INFUSION|
20|FH_F118456_30012_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F81494_0_0|SrvcGrp|9518|2022|PDM|575.00|99|0.00|EMERGENCY ROOM|
20|FH_F112886_34109_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD AW"|
20|FH_F124928_04210_0|SrvcGrp|90341|2022|PDM|132.30|99|0.00|SKILLED NURSING LPN (HCFA)|
20|FH_F133287_40215_0|SrvcGrp|23279|2022|PDM|383.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F117875_70601_0|SrvcGrp|73601|2022|PDM|1613.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F133391_61032_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F86293_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|510.00|99|0.00|AEG 2 (NO REV)|
20|FH_F71882_15228_0|SrvcGrp|81879|2022|PCT|1.00|99|0.00|LABORATORY W/ REV/HCPC|
20|FH_F148555_0_0|SrvcGrp|115441|2022|PDM|3090.00|99|0.00|INSERT 1 ELECTRODE PM DEFIB|
20|FH_F138532_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F113271_72205_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F88280_0_0|SrvcGrp|19886|2022|PDM|14579.00|99|0.00|MS DRG 466-468 ONLY|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|321.49|99|0.00|ASPG 108|
20|FH_F137240_0_0|SrvcGrp|11124|2022|PCT|0.59|99|0.00|IMPLANTS|
20|FH_F117794_06473_0|SrvcGrp|16|2022|PDM|938.00|99|0.00|ACUTE REHABILITATION|
20|FH_F68161_0_0|SrvcGrp|11663|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F141833_31707_0|SrvcGrp|100961|2022|PDM|1000.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY|
20|FH_F150951_0_0|SrvcGrp|103911|2022|PDM|100.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY|
20|FH_F40546_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F118708_33455_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67683_0_0|SrvcGrp|63488|2022|PDM|150.00|99|0.00|PSYCH/CHEM REHAB|
20|FH_F97564_52246_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F108960_47403_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F39838_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87620_80014_0|SrvcGrp|81779|2022|PCT|1.03|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138467_32216_0|SrvcGrp|46903|2022|PDM|1231.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F139673_63011_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F111272_74012_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36883_0_0|SrvcGrp|90356|2022|PCT|0.52|99|0.00|OP DIALYSIS|
20|FH_F35416_0_0|SrvcGrp|16144|2022|PCT|0.70|99|0.00|AZT (ZIDOVUDINE)|
20|FH_F98623_97006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F56672_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134732_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F112755_43215_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130328_0_0|SrvcGrp|104228|2022|PDM|190.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F35174_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|TRAUMA CARE|
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|997.00|99|0.00|AEG 3 (NO REV)|
20|FH_F114571_34613_0|SrvcGrp|46903|2022|PDM|675.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F37304_0_0|SrvcGrp|26140|2022|PDM|22.00|99|0.00|EPOGEN|
20|FH_F148347_0_0|SrvcGrp|109476|2022|PDM|3765.00|99|0.00|ENDOVENOUS ABLATION THERAPY|
20|FH_F146266_0_0|SrvcGrp|35670|2022|PDM|1450.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F128369_72901_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F150938_02062_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F114825_32789_0|SrvcGrp|89412|2022|PDM|296.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F38842_0_0|SrvcGrp|10639|2022|PDM|500.00|99|0.00|CT SCAN|
20|FH_F32758_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139515_0_0|SrvcGrp|67279|2022|PDM|13261.00|99|0.00|CERVICAL SURGERY|
20|FH_F141507_0_0|SrvcGrp|113775|2022|PDM|2400.00|99|0.00|INSJ AQUEOUS DRAIN DEV 1ST & ADDL|
20|FH_F124017_0_0|SrvcGrp|107374|2022|PDM|8500.00|99|0.00|AETNA ARTHRODESIS INTERSPC|
20|FH_F116269_92627_0|SrvcGrp|73842|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F106020_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F134995_37055_0|SrvcGrp|89337|2022|PDM|1029.00|99|0.00|DETOXIFICATION|
20|FH_F40055_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F109240_21201_0|SrvcGrp|89643|2022|PDM|330.00|99|0.00|SET RADIATION THERAPY FIELD|
20|FH_F71686_0_0|SrvcGrp|14566|2022|PDM|900.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)|
20|FH_F130716_76013_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112374_0_0|SrvcGrp|10393|2022|PDM|1560.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F55552_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F125983_82301_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F42312_0_0|CSTM-ALL|CSTM-00|2020|PDM|196.00|99|0.00|CD DAY TREATMENT|
20|FH_F141001_24739_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92276_32308_0|SrvcGrp|87306|2022|PDM|50715.00|99|0.00|MSDRG 269 ONLY|
20|FH_F141587_40242_0|SrvcGrp|72602|2022|PDM|630.00|99|0.00|ECT|
20|FH_F141410_13045_0|SrvcGrp|3378|2022|PDM|3300.00|99|0.00|OBSERVATION SVCS|
20|FH_F125710_02860_0|SrvcGrp|472|2022|PDM|480.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F43858_0_0|SrvcGrp|27725|2022|PDM|40.00|99|0.00|SKILLED RN HOURLY|
20|FH_F118373_21205_0|SrvcGrp|12496|2022|PDM|3180.00|99|0.00|ACUTE REHABILITATION|
20|FH_F44495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38277_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151560_76012_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129768_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F148892_0_0|SrvcGrp|87679|2022|PDM|1293.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F51520_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127255_03104_0|SrvcGrp|46903|2022|PDM|675.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F121524_87111_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F92276_32308_0|SrvcGrp|89297|2022|PDM|1575.00|99|0.00|INPATIENT DETOXIFICATION SERVICES|
20|FH_F136499_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F39479_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|2680.00|99|0.00|AEG 8 (NO REV)|
20|FH_F118121_46001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148340_28269_0|SrvcGrp|74668|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131213_30606_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F137367_89139_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|1900.00|99|0.00|AEG 7 (NO REV)|
20|FH_F151526_28208_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|AEG 2 (NO REV)|
20|FH_F121819_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_F52393_0_0|SrvcGrp|49109|2022|PDM|1800.00|99|0.00|HEARING AID|
20|FH_F125074_18104_0|SrvcGrp|48396|2022|PDM|118.65|99|0.00|OT SERVICES|
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)|
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151542_32224_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC|
20|FH_F131965_0_0|SrvcGrp|30609|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F126027_63069_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143772_75225_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149479_0_0|SrvcGrp|105819|2022|PDM|1375.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F123384_72076_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|1580.13|99|0.00|ASPG VII|
20|FH_F127032_33573_0|SrvcGrp|57967|2022|PDM|181.40|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|1641.00|99|0.00|ASPG VII|
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|2788.00|99|0.00|AEG 8 (NO REV)|
20|FH_F97440_0_0|SrvcGrp|92141|2022|PDM|34.00|99|0.00|ANETHESIA SERVICES|
20|FH_F69651_0_0|SrvcGrp|10534|2022|PDM|90.00|99|0.00|NURSING CARE|
20|FH_F98041_10027_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS|
20|FH_F91873_12723_0|SrvcGrp|91180|2022|PDM|130.00|99|0.00|BEHAVIORAL HEALTH PHARMACY MANAGEMENT SERVICES|
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|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_F114864_78155_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F40471_0_0|CSTM-ALL|CSTM-00|2020|PDM|414.00|99|0.00|ASC I ENDOSCOPY CTR CENTRAL PA|
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|AEG 3 (NO REV)|
20|FH_F138929_0_0|SrvcGrp|97895|2022|PDM|16500.00|99|0.00|REVISE KNEE 2|
20|FH_F138929_0_0|SrvcGrp|35672|2022|PDM|4620.00|99|0.00|CPT 23412|
20|FH_F116525_26003_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS|
20|FH_F95282_77975_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|802.00|99|0.00|ASPG VI|
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_F125946_0_0|SrvcGrp|92501|2022|PDM|333.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F49487_0_0|SrvcGrp|27602|2022|PCT|1.80|99|0.00|SYNAGIS (100 MG)|
20|FH_F147039_06374_0|SrvcGrp|75545|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F64441_0_0|SrvcGrp|12023|2022|PDM|147.00|99|0.00|HOSPICE RESPITE SERVICES|
20|FH_F38688_0_0|SrvcGrp|17065|2022|PDM|600.00|99|0.00|ASPG I|
20|FH_F102180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114848_50533_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F32825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|MS DRG 619-621|
20|FH_F115982_0_0|SrvcGrp|73006|2022|PDM|1411.00|99|0.00|AEG 9|
20|FH_F47659_0_0|SrvcGrp|3029|2022|PDM|740.00|99|0.00|NEWBORN NURSERY|
20|FH_F115483_62002_0|SrvcGrp|104363|2022|PCT|1.60|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F99380_90503_0|SrvcGrp|62398|2022|PCT|2.00|99|0.00|OP LAB DRAW|
20|FH_F110824_83221_0|SrvcGrp|91077|2022|PDM|4553.00|99|0.00|AETNA INPATIENT SURGICAL CARE|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: BREAKOUT|
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|933.00|99|0.00|AEG 5  (NO REV)|
20|FH_F142785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123570_0_0|SrvcGrp|103862|2022|PDM|1802.50|99|0.00|ARTHOSCOPY PROCEDURES|
20|FH_F108260_63141_0|SrvcGrp|88620|2022|PDM|88.00|99|0.00|SKILLED NURSING RN|
20|FH_F90817_0_0|SrvcGrp|16289|2022|PDM|1217.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F148860_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F151407_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149539_06032_0|SrvcGrp|88621|2022|PDM|165.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)|
20|FH_F91259_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|1477.00|99|0.00|AEG 6 (NO REV)|
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1479.00|99|0.00|AEG 6 (NO REV)|
20|FH_F40564_0_0|SrvcGrp|65|2022|PDM|2000.00|99|0.00|OBSTETRICAL CARE|
20|FH_F149023_44122_0|SrvcGrp|67065|2022|PDM|13119.00|99|0.00|CERVICAL SURGERY|
20|FH_F140295_0_0|SrvcGrp|67065|2022|PDM|10079.00|99|0.00|CERVICAL SURGERY|
20|FH_F90055_33805_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147214_48162_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|341.00|99|0.00|HAPA EPA ASC 40|
20|FH_F81312_0_0|SrvcGrp|3259|2022|PDM|3332.00|99|0.00|ACUTE REHABILITATION|
20|FH_F110783_93013_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F97084_91911_0|SrvcGrp|73602|2022|PDM|7215.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F138018_17313_0|SrvcGrp|111527|2022|PDM|41.10|99|0.00|HOME INFUSION (HCFA)|
20|FH_F128197_84123_0|SrvcGrp|88621|2022|PDM|73.00|99|0.00|SKILLED NURSING LPN|
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F73768_0_0|SrvcGrp|71108|2022|PDM|525.00|99|0.00|HCPCS A9278|
20|FH_F107840_07006_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F134869_08854_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F149662_85015_0|SrvcGrp|114018|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F151619_73505_0|SrvcGrp|115557|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F111086_29501_0|SrvcGrp|46903|2022|PDM|644.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F122841_0_0|SrvcGrp|84123|2022|PDM|2178.00|99|0.00|INSERT ANT SEGMENT DRAIN EXT|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F114294_18235_0|SrvcGrp|49682|2022|PCT|1.39|99|0.00|HSS DRG GROUPED|
20|FH_F127132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F117615_30525_0|SrvcGrp|75485|2022|PCT|0.85|99|0.00|AEG 4|
20|FH_F92413_07631_0|SrvcGrp|48394|2022|PDM|55.83|99|0.00|SKILLED NURSING SERVICES|
20|FH_F91799_15010_0|SrvcGrp|471|2022|PDM|686.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F102365_0_0|SrvcGrp|472|2022|PDM|448.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150952_85008_0|SrvcGrp|115898|2022|PDM|427.00|99|0.00|CRISIS INTERVENTION|
20|FH_F111086_29501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119316_27104_0|SrvcGrp|86723|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F90817_0_0|SrvcGrp|82110|2022|PDM|1574.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC|
20|FH_F84535_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|AEG 5  (NO REV)|
20|FH_F116437_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F126554_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|323.00|99|0.00|AEG 1 (NO REV)|
20|FH_F64739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147418_0_0|SrvcGrp|104642|2022|PDM|13000.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F149001_37055_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 1 (NO REV)|
20|FH_F148347_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F35446_0_0|SrvcGrp|997|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F122396_90024_0|SrvcGrp|74668|2022|PDM|765.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F56232_0_0|SrvcGrp|37399|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (REFERENCE LAB)|
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|999.00|99|0.00|AEG 6 (NO REV)|
20|FH_F41808_0_0|SrvcGrp|3809|2022|PDM|601.02|99|0.00|HOSPICE CARE|
20|FH_F114207_35243_0|SrvcGrp|86839|2022|PDM|35.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F143536_47546_0|SrvcGrp|100258|2022|PCT|1.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (12.6 - 20.0 CM)|
20|FH_F84774_0_0|SrvcGrp|16325|2022|PDM|393.75|99|0.00|HEMODIALYSIS SVCS|
20|FH_F93740_0_0|SrvcGrp|91590|2022|PDM|6000.00|99|0.00|PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA)|
20|FH_F102920_0_0|SrvcGrp|74039|2022|PDM|3602.00|99|0.00|LAMINECTOMY|
20|FH_F101806_0_0|SrvcGrp|75483|2022|PDM|564.65|99|0.00|AEG 3|
20|FH_F130937_98002_0|SrvcGrp|73841|2022|PDM|403.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F131040_47715_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F46893_0_0|SrvcGrp|29284|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD AU)|
20|FH_F132446_19063_0|SrvcGrp|42404|2022|PDM|6.00|99|0.00|VENIPUNCTURE|
20|FH_F133701_0_0|SrvcGrp|82981|2022|PDM|162.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F32001_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F127995_84010_0|SrvcGrp|86853|2022|PDM|10.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F127995_84010_0|SrvcGrp|86827|2022|PDM|50.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F97040_31901_0|SrvcGrp|73601|2022|PDM|7245.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F131101_45840_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F131494_0_0|SrvcGrp|67994|2022|PDM|299.00|99|0.00|CPT 58120|
20|FH_F136589_72601_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136590_71263_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F113845_32746_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F113937_15301_0|SrvcGrp|27969|2022|PDM|41.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132595_0_0|SrvcGrp|3015|2022|PCT|0.57|99|0.00|SUPPLIES|
20|FH_F43693_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F134689_60190_0|SrvcGrp|112072|2022|PDM|1550.00|99|0.00|RESIDENITAL TREATMENT EATING DISORDER (AGE 0-17)|
20|FH_F134735_91362_0|SrvcGrp|108484|2022|PDM|648.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F135761_70127_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F136778_62034_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F62864_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F136796_24016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|28.50|99|0.00|HYDRATION FOUR LITER (MOD SH)|
20|FH_F42694_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|106% OF ASP DRUGS/IMMUN UPDATE QUARTERLY|
20|FH_F133579_0_0|SrvcGrp|49205|2022|PDM|2205.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F98361_12065_0|SrvcGrp|73603|2022|PDM|9293.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F120688_68124_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114853_0_0|SrvcGrp|88159|2022|PDM|7215.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F115185_0_0|SrvcGrp|87077|2022|PDM|157.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F43867_0_0|SrvcGrp|27769|2022|PDM|25.00|99|0.00|SKILLED LPN HOURLY|
20|FH_F48836_0_0|SrvcGrp|31189|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF (DME)|
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|WILLS COMM SURG SVC ASC 4|
20|FH_F138658_75022_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F138681_39301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F138730_22602_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138787_32258_0|SrvcGrp|112785|2022|PCT|1.00|99|0.00|TELEHEALTH SERVICES|
20|FH_F58013_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|OP SVCS|
20|FH_F83792_0_0|SrvcGrp|73601|2022|PDM|1837.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F113390_0_0|SrvcGrp|27316|2022|PDM|2200.00|99|0.00|TONSILS & ADENOIDS (42820)|
20|FH_F143832_0_0|SrvcGrp|108166|2022|PDM|1218.06|99|0.00|ESTABLISH ACCESS TO AORTA|
20|FH_F122076_17543_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F97501_31501_0|SrvcGrp|88977|2022|PDM|8524.00|99|0.00|C-SECTION DELIVERY|
20|FH_F135572_89106_0|SrvcGrp|24745|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F91764_93710_0|SrvcGrp|113226|2022|PCT|2.19|99|0.00|COVID-19 SVNT SARSCOV2 ELISA PLSM SRM|
20|FH_F129456_30809_0|SrvcGrp|100244|2022|PCT|1.00|99|0.00|CHYLMD TRACH|
20|FH_F116455_26003_0|SrvcGrp|472|2022|PDM|437.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133468_74873_0|SrvcGrp|112323|2022|PDM|400.00|99|0.00|LABORATORY|
20|FH_F31220_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101200_19020_0|SrvcGrp|70642|2022|PDM|15.30|99|0.00|CONSULTANT THERAPIST|
20|FH_F129329_07039_0|SrvcGrp|86722|2022|PDM|208.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F130817_18103_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F129967_18915_0|SrvcGrp|106467|2022|PDM|38.15|99|0.00|AETNA OFFICE OUTPATIENT VISIT EST (MOD TD) (HCFA)|
20|FH_F111363_33169_0|SrvcGrp|79904|2022|PDM|5258.00|99|0.00|HEART GROUP I MSDRG ONLY|
20|FH_F111383_62233_0|SrvcGrp|537|2022|PCT|0.88|99|0.00|OBSERVATION SERVICES|
20|FH_F134315_89106_0|SrvcGrp|29077|2022|PCT|1.00|99|0.00|HOME TRANSFUSION|
20|FH_F148243_0_0|SrvcGrp|35669|2022|PDM|6500.00|99|0.00|CPT 63650|
20|FH_F149239_0_0|SrvcGrp|104745|2022|PDM|155.60|99|0.00|HOSPICE|
20|FH_F132328_0_0|SrvcGrp|111955|2022|PDM|3371.00|99|0.00|MALE GENITAL PROCEDURES|
20|FH_F112092_46845_0|SrvcGrp|90479|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F88831_84123_0|SrvcGrp|74546|2022|PDM|425.00|99|0.00|HOSPICE SERVICES|
20|FH_F132791_44122_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|1765.00|99|0.00|AEG 9 (NO REV)|
20|FH_F98625_08103_0|SrvcGrp|73603|2022|PDM|8148.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F140007_0_0|SrvcGrp|97219|2022|PDM|7887.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON|
20|FH_F38708_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|MSDRG 894-897 CHEMICAL DEPENDENCY|
20|FH_F38808_0_0|SrvcGrp|17079|2022|PDM|1070.00|99|0.00|ASPG VIII|
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 1 (NO REV)|
20|FH_F142087_0_0|SrvcGrp|113856|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES|
20|FH_F71628_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134254_33462_0|SrvcGrp|89149|2022|PDM|246.00|99|0.00|OP INTENSIVE|
20|FH_F136387_61244_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136394_78240_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F118156_19446_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F93360_64730_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134029_06517_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137147_75006_0|SrvcGrp|82298|2022|PDM|6720.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY|
20|FH_F137147_75006_0|SrvcGrp|112966|2022|PCT|0.75|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F137238_70056_0|SrvcGrp|89149|2022|PDM|253.00|99|0.00|OP INTENSIVE|
20|FH_F114092_83350_0|SrvcGrp|10391|2022|PDM|7700.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F142491_06033_0|SrvcGrp|82222|2022|PDM|160.00|99|0.00|HOSPICE CARE|
20|FH_F142608_02842_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F142715_32757_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140343_89052_0|SrvcGrp|86831|2022|PDM|3.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F140841_07410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80754_31601_0|SrvcGrp|78578|2022|PCT|1.10|99|0.00|DIAGNOSTIC RADIOLOGY SERVICES W/O CT SCAN|
20|FH_F149610_76543_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119003_78070_0|SrvcGrp|73842|2022|PDM|129.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F118932_07652_0|SrvcGrp|75507|2022|PDM|265.00|99|0.00|CHEMOTHERAPY|
20|FH_F118932_07652_0|SrvcGrp|106313|2022|PDM|265.00|99|0.00|PT/OT/ST|
20|FH_F39466_0_0|SrvcGrp|4109|2022|PDM|735.00|99|0.00|ACUTE PSYCH|
20|FH_F117261_43543_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F129441_19134_0|SrvcGrp|90854|2022|PDM|650.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|1259.00|99|0.00|AEG 9 (NO REV)|
20|FH_F137982_68510_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F109632_0_0|SrvcGrp|74382|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F90876_18447_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F138732_60016_0|SrvcGrp|89149|2022|PDM|214.00|99|0.00|OP INTENSIVE|
20|FH_F132736_0_0|SrvcGrp|107734|2022|PDM|4476.00|99|0.00|VAGINAL DELIVERY|
20|FH_F148720_0_0|SrvcGrp|115638|2022|PDM|325.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD (HCFA)|
20|FH_F31783_0_0|SrvcGrp|18157|2022|PDM|8610.00|99|0.00|MS DRG 252|
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119526_60435_0|SrvcGrp|472|2022|PDM|714.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F140035_0_0|SrvcGrp|57968|2022|PDM|60.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F148431_60523_0|SrvcGrp|104229|2022|PDM|105.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F148644_06890_0|SrvcGrp|101520|2022|PDM|6365.00|99|0.00|T1H W/T/O (<250G)|
20|FH_F34706_0_0|SrvcGrp|2112|2022|PDM|23566.00|99|0.00|DRG 002 CRANIOTOMY W/O CC|
20|FH_F138611_0_0|SrvcGrp|89404|2022|PDM|14894.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F119076_41001_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F69727_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67861_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F134430_86301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F62175_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F76864_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128796_57445_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126815_02118_0|CSTM-ALL|CSTM-00|2020|PDM|2425.13|99|0.00|AEG 5  (NO REV)|
20|FH_F72936_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F148886_60621_0|CSTM-ALL|CSTM-00|2020|PDM|1701.00|99|0.00|AEG 6 (NO REV)|
20|FH_F51548_0_0|SrvcGrp|22933|2022|PDM|35.00|99|0.00|RESPITE CARE|
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 1 (NO REV)|
20|FH_F112836_06040_0|SrvcGrp|472|2022|PDM|691.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F136751_0_0|SrvcGrp|80617|2022|PDM|16000.00|99|0.00|ARTHOPLASTY|
20|FH_F128717_54449_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117807_86426_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F44855_0_0|SrvcGrp|30205|2022|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F125033_93305_0|SrvcGrp|89149|2022|PDM|300.00|99|0.00|OP INTENSIVE|
20|FH_F113291_37055_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F149840_80002_0|SrvcGrp|88778|2022|PDM|115.00|99|0.00|PHYSICAL THERAPY|
20|FH_F35411_0_0|SrvcGrp|13150|2022|PDM|8050.00|99|0.00|ELECTROPHYSIOLOGY|
20|FH_F106540_26330_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F118462_21740_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F31542_0_0|SrvcGrp|9774|2022|PDM|1400.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F86434_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F42640_0_0|SrvcGrp|28147|2022|PDM|440.00|99|0.00|SKILLED NURSING|
20|FH_F43147_0_0|SrvcGrp|110|2022|PDM|460.00|99|0.00|CD - REHABILITATION|
20|FH_F34706_0_0|SrvcGrp|21|2022|PDM|38811.00|99|0.00|DRG 108 OTHER CARDIOTHORACIC PROCEDURE|
20|FH_F144532_19606_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|4590.00|99|0.00|IMPLANTS|
20|FH_F43245_0_0|SrvcGrp|31134|2022|PDM|750.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F100741_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F134490_62801_0|SrvcGrp|105039|2022|PDM|56.23|99|0.00|ASA CODES & CPT4 CODE (HCFA)|
20|FH_F133118_33143_0|SrvcGrp|89149|2022|PDM|218.00|99|0.00|OP INTENSIVE|
20|FH_F92677_08003_0|SrvcGrp|14944|2022|PDM|9.45|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F81151_16801_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F120437_85202_0|SrvcGrp|14944|2022|PDM|11.26|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F151520_44134_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87615_80033_0|SrvcGrp|89265|2022|PCT|0.00|99|0.00|AMBULATORY DETOX - ALCOHOL AND DRUG REHAB|
20|FH_F113324_17055_0|SrvcGrp|105264|2022|PDM|765.00|99|0.00|HEMODIALYSIS (HCFA)|
20|FH_F117272_24333_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F92676_15063_0|SrvcGrp|79016|2022|PDM|994.23|99|0.00|MON VALLEY ASC 223|
20|FH_F133516_44004_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F40980_0_0|SrvcGrp|18881|2022|PDM|59298.00|99|0.00|MS DRG 233|
20|FH_F146282_08244_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F141833_31707_0|SrvcGrp|13683|2022|PDM|900.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F116683_64730_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116766_06460_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F116918_06488_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|AEG 9 (NO REV)|
20|FH_F119591_75034_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F150102_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F56092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|PROFESSIONAL FEES ON CMS1500|
20|FH_F56092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|GENERAL ACUTE CARE|
20|FH_F61292_0_0|SrvcGrp|57322|2022|PDM|5233.00|99|0.00|OP DIAGNOSTIC CARDIAC CATH|
20|FH_F110263_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F39855_0_0|SrvcGrp|997|2022|PCT|0.75|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F97000_24201_0|SrvcGrp|107250|2022|PCT|1.00|99|0.00|AETNA PT/OT/ST|
20|FH_F127209_45365_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F62719_0_0|SrvcGrp|44711|2022|PDM|108.00|99|0.00|PT SVCS|
20|FH_F92659_0_0|SrvcGrp|68284|2022|PDM|1800.00|99|0.00|CPT 67113|
20|FH_F100762_51104_0|SrvcGrp|73485|2022|PDM|3006.00|99|0.00|AETNA REHAB|
20|FH_F93332_0_0|SrvcGrp|93074|2022|PDM|2295.00|99|0.00|INSERT SPINE FIXATION DEVICE (HCFA)|
20|FH_F145800_22003_0|SrvcGrp|29346|2022|PDM|32.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F115685_64064_0|SrvcGrp|105290|2022|PCT|1.00|99|0.00|AETNA DRUGS/AGENTS/INJ DRUG (HCFA)|
20|FH_F114975_78596_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F40472_0_0|SrvcGrp|30935|2022|PDM|60.00|99|0.00|PT & OT|
20|FH_F137614_17602_0|SrvcGrp|73842|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F122433_0_0|SrvcGrp|58671|2022|PDM|725.00|99|0.00|ASC CARVE OUT 64721|
20|FH_F39339_0_0|SrvcGrp|3069|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F130681_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F120279_98005_0|SrvcGrp|74668|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F116637_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|876.00|99|0.00|AEG 10 (NO REV)|
20|FH_F141590_90049_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100762_51104_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F92276_32308_0|SrvcGrp|89937|2022|PDM|24675.00|99|0.00|MS DRG 273-274 ONLY|
20|FH_F141129_0_0|SrvcGrp|45783|2022|PDM|40.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F149739_77087_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|4682.00|99|0.00|AEG 9 (NO REV)|
20|FH_F135221_62691_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|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_F89475_71202_0|SrvcGrp|39522|2022|PDM|44082.00|99|0.00|MS DRG 216-218 ONLY|
20|FH_F83313_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F135219_68506_0|SrvcGrp|41334|2022|PDM|22295.52|99|0.00|TOTAL KNEE|
20|FH_F149866_07401_0|SrvcGrp|75545|2022|PDM|444.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F113682_0_0|SrvcGrp|471|2022|PDM|982.21|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133215_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F82696_16335_0|SrvcGrp|21456|2022|PCT|1.00|99|0.00|SLEEP STUDIES|
20|FH_F37937_0_0|SrvcGrp|11072|2022|PDM|100.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F37679_0_0|SrvcGrp|89787|2022|PCT|0.50|99|0.00|HCPCS CODES|
20|FH_F135771_0_0|SrvcGrp|92502|2022|PDM|654.59|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 6 (NO REV)|
20|FH_F125028_19061_0|SrvcGrp|24761|2022|PDM|52.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F42511_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE|
20|FH_F52393_0_0|SrvcGrp|49107|2022|PDM|1750.00|99|0.00|HEARING AID|
20|FH_F32707_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109240_21201_0|SrvcGrp|92760|2022|PCT|1.05|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148480_03079_0|CSTM-ALL|CSTM-00|2020|PDM|3142.00|99|0.00|AEG 8 (NO REV)  W/O INTRAOCULAR LENS PROCEDURES|
20|FH_F76303_0_0|SrvcGrp|42975|2022|PDM|150.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F129228_72432_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F93920_0_0|SrvcGrp|72990|2022|PDM|1200.00|99|0.00|AEG 1|
20|FH_F82955_34266_0|SrvcGrp|79800|2022|PCT|0.66|99|0.00|AETNA SLEEP STUDIES|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/MOD AW  (TN)|
20|FH_F128176_24201_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F92276_32308_0|SrvcGrp|20912|2022|PDM|53251.00|99|0.00|MS DRG 236 ONLY|
20|FH_F77504_0_0|SrvcGrp|38|2022|PDM|3200.00|99|0.00|NORMAL DELIVERY|
20|FH_F115120_19083_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F72830_0_0|SrvcGrp|15325|2022|PDM|550.00|99|0.00|ER LEVEL III|
20|FH_F89475_71202_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F70984_0_0|SrvcGrp|67994|2022|PDM|1000.00|99|0.00|CPT 58120|
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F114916_30309_0|SrvcGrp|105631|2022|PDM|1000.00|99|0.00|REMOVE BONE FIXATION DEVICE|
20|FH_F109343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40358_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION|
20|FH_F32996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1944.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F124660_0_0|SrvcGrp|73002|2022|PDM|1175.00|99|0.00|AEG 7|
20|FH_F40515_0_0|SrvcGrp|30941|2022|PDM|287.00|99|0.00|NEWBORN NURSERY|
20|FH_F130038_08021_0|SrvcGrp|73842|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F86319_16365_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F74242_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DENIAL CODES|
20|FH_F119660_0_0|SrvcGrp|83857|2022|PDM|450.00|99|0.00|IP HOSPICE SVCS|
20|FH_F143528_0_0|SrvcGrp|93807|2022|PDM|5490.45|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F129255_34952_0|SrvcGrp|89337|2022|PDM|796.00|99|0.00|DETOXIFICATION|
20|FH_F124017_0_0|SrvcGrp|97179|2022|PDM|5200.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON|
20|FH_F130013_16509_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F145758_20745_0|SrvcGrp|67279|2022|PDM|2244.00|99|0.00|CERVICAL SURGERY|
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP DIALYSIS|
20|FH_F49338_0_0|SrvcGrp|32383|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KL (DME)|
20|FH_F34735_0_0|SrvcGrp|18382|2022|PCT|0.75|99|0.00|MS DRG 313|
20|FH_F115020_67301_0|SrvcGrp|73842|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F123844_0_0|SrvcGrp|65720|2022|PDM|194.00|99|0.00|RESPITE CARE|
20|FH_F37679_0_0|SrvcGrp|26871|2022|PDM|61.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3 HRS|
20|FH_F123278_20850_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126242_32796_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40519_0_0|SrvcGrp|32644|2022|PCT|1.50|99|0.00|RADIOLOGY - CPT/GLOBAL|
20|FH_F131998_67401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F84193_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F148440_16506_0|CSTM-ALL|CSTM-00|2020|PDM|646.00|99|0.00|AEG 3 (NO REV)|
20|FH_F128496_46936_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F86872_15215_0|SrvcGrp|111742|2022|PCT|1.00|99|0.00|ADULT ENTERAL FORMULA|
20|FH_F87092_60101_0|SrvcGrp|16719|2022|PCT|1.03|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F138667_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F133211_0_0|SrvcGrp|112224|2022|PDM|95.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F135840_0_0|SrvcGrp|79593|2022|PDM|550.00|99|0.00|CPT 45378|
20|FH_F85097_0_0|SrvcGrp|63|2022|PDM|1307.00|99|0.00|SUBACUTE CARE|
20|FH_F120719_27540_0|SrvcGrp|115534|2022|PCT|2.81|99|0.00|LABORATORY SERVICES|
20|FH_F148521_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119227_01752_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP WITHOUT CPT 99601|
20|FH_F123851_03235_0|SrvcGrp|48385|2022|PDM|163.00|99|0.00|SPEECH THERAPY|
20|FH_F145694_84770_0|SrvcGrp|108484|2022|PDM|1500.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F117206_0_0|SrvcGrp|99067|2022|PDM|2781.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F92598_21236_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD COMPREHENSIVE|
20|FH_F145882_02368_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F145641_06902_0|SrvcGrp|100083|2022|PDM|5626.00|99|0.00|REVISION OF UNSTABLE KNEECAP|
20|FH_F125765_83617_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145641_06902_0|SrvcGrp|67279|2022|PDM|11399.00|99|0.00|CERVICAL SURGERY|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|297.28|99|0.00|HAPA WPA-NWPA 2012-13 ASC 113 W/O REV|
20|FH_F114483_47905_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130763_0_0|SrvcGrp|91941|2022|PDM|4367.00|99|0.00|NASAL/SINUS ENDOSCOPY WITH DILATION|
20|FH_F89219_0_0|CSTM-ALL|CSTM-00|2020|PDM|1931.00|99|0.00|SKILLED NURSING|
20|FH_F134398_0_0|SrvcGrp|112574|2022|PDM|647.00|99|0.00|SKIN FULL GRAFT PROCEDURE|
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|2712.00|99|0.00|AEG 4 (NO REV)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|278.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 128 W/O REV|
20|FH_F93076_85016_0|SrvcGrp|10533|2022|PDM|1154.43|99|0.00|SUBACUTE ANTEPARTUM SVCS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|224.14|99|0.00|HAPA WPA-NWPA 2012-13 ASC 233 W/O REV|
20|FH_F120555_68405_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143562_76665_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145921_73139_0|SrvcGrp|48394|2022|PDM|30.90|99|0.00|SKILLED NURSING SERVICES|
20|FH_F145642_15108_0|SrvcGrp|24761|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 1 (NO REV)|
20|FH_F126550_43085_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F93359_63084_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F125870_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F138056_64055_0|SrvcGrp|48394|2022|PDM|48.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F82631_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116806_0_0|SrvcGrp|107049|2022|PDM|1923.16|99|0.00|REMOVAL OF FACE BONE LESION|
20|FH_F93190_26456_0|SrvcGrp|48385|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F148600_30328_0|SrvcGrp|59841|2022|PDM|2200.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F143567_62207_0|SrvcGrp|92760|2022|PCT|1.30|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146540_78013_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133749_84604_0|SrvcGrp|112481|2022|PDM|4.41|99|0.00|ROUTINE VENIPUNCTURE|
20|FH_F88744_71103_0|SrvcGrp|90177|2022|PCT|2.15|99|0.00|AETNA HOSPITAL OP DIALYSIS|
20|FH_F100782_0_0|SrvcGrp|108214|2022|PDM|1750.00|99|0.00|TOT DISC ARTHRP|
20|FH_F144808_0_0|SrvcGrp|90343|2022|PDM|7215.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL|
20|FH_F116806_0_0|SrvcGrp|107055|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MOUTH|
20|FH_F146520_80435_0|SrvcGrp|73845|2022|PDM|750.00|99|0.00|AETNA OB BEHAVIOR HEALTH - REV 914|
20|FH_F146626_60612_0|SrvcGrp|113553|2022|PCT|1.00|99|0.00|COVID-19 DIAGNOSTIC|
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F90232_15126_0|SrvcGrp|29075|2022|PDM|52.50|99|0.00|HYDRATION THERAPY|
20|FH_F50657_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150165_06032_0|SrvcGrp|83351|2022|PDM|3430.00|99|0.00|AETNA LAPAR ORCHIOPEXY|
20|FH_F113435_19027_0|SrvcGrp|86722|2022|PDM|165.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F119554_16506_0|SrvcGrp|75545|2022|PDM|368.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F112060_07514_0|SrvcGrp|104475|2022|PCT|1.00|99|0.00|INJ FILGRASTIM EXCL BIOSIMIL|
20|FH_F125124_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F134655_14221_0|SrvcGrp|471|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F123185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F101752_0_0|SrvcGrp|79099|2022|PDM|2618.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F102542_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F46893_0_0|SrvcGrp|9506|2022|PDM|1724.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F48857_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116756_77477_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F116907_75093_0|SrvcGrp|98748|2022|PDM|460.00|99|0.00|AETNA PARTIAL HOSP PSYCH (UB)|
20|FH_F119913_31545_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F44438_0_0|SrvcGrp|38683|2022|PCT|0.65|99|0.00|DIALYSIS SERVICES|
20|FH_F46158_0_0|SrvcGrp|17079|2022|PCT|0.65|99|0.00|ASPG VIII|
20|FH_F36372_0_0|SrvcGrp|22018|2022|PDM|40.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F102947_44084_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F126339_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F51113_15501_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F66922_66211_0|SrvcGrp|90681|2022|PDM|2732.00|99|0.00|MS DRG 469 W/ICD|
20|FH_F142087_0_0|SrvcGrp|113854|2022|PDM|6600.00|99|0.00|REMOVE/REINSER SPINE FIXATION DEVICE|
20|FH_F130302_0_0|SrvcGrp|72996|2022|PDM|1624.00|99|0.00|AEG 4|
20|FH_F69347_0_0|SrvcGrp|44765|2022|PDM|6804.00|99|0.00|PORTLAND ADVENTIST ASPG IV|
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|2407.00|99|0.00|AEG 10 (NO REV)|
20|FH_F56792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CARVEOUTS VANCOUVER ENDOSCOPY|
20|FH_F50618_0_0|SrvcGrp|46906|2022|PDM|1766.11|99|0.00|CORNEAL TISSUE|
20|FH_F125672_92663_0|SrvcGrp|75419|2022|PDM|1700.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F149940_02645_0|SrvcGrp|113171|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F146320_27610_0|CSTM-ALL|CSTM-00|2020|PDM|795.60|99|0.00|AEG 3 (NO REV)|
20|FH_F129175_0_0|SrvcGrp|53065|2022|PDM|292.50|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 3 (NO REV)|
20|FH_F121012_29732_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|GENERAL ACUTE CARE|
20|FH_F111625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43539_0_0|SrvcGrp|30552|2022|PDM|80.00|99|0.00|EARLY INTERVENTION OCCUPATIONAL THERAPY|
20|FH_F146211_68144_0|SrvcGrp|79786|2022|PCT|1.20|99|0.00|SLEEP STUDIES|
20|FH_F101840_76054_0|SrvcGrp|77021|2022|PDM|9042.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F141867_62258_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113586_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1484.00|99|0.00|ASPG IV|
20|FH_F97581_60141_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F74163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F40372_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F151521_45882_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133367_40065_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144011_60616_0|SrvcGrp|113188|2022|PCT|1.31|99|0.00|LABORATORY SERVICES|
20|FH_F117613_08221_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128421_27016_0|SrvcGrp|10391|2022|PDM|900.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.00|99|0.00|AEG 1 (NO REV)|
20|FH_F142818_34209_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F87577_80016_0|SrvcGrp|82037|2022|PDM|10513.00|99|0.00|AETNA ICU|
20|FH_F102561_75146_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F126815_02118_0|SrvcGrp|110428|2022|PCT|0.55|99|0.00|LABORATORY SERVICES|
20|FH_F132591_75146_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1148.80|99|0.00|HAPA WPA-NWPA 2012-13 ASC 703 W/O REV|
20|FH_F31542_0_0|SrvcGrp|12212|2022|PDM|800.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)|
20|FH_F139779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97622_75051_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F40599_0_0|SrvcGrp|180|2022|PDM|1751.00|99|0.00|INTENSIVE CARE SERVICES|
20|FH_F88280_0_0|SrvcGrp|20744|2022|PDM|6804.00|99|0.00|MS DRG 242 ONLY|
20|FH_F42494_0_0|SrvcGrp|9879|2022|PDM|400.00|99|0.00|SKILLED NURSING CARE- IP|
20|FH_F37640_0_0|SrvcGrp|69399|2022|PCT|1.15|99|0.00|PREVENTATIVE CODES|
20|FH_F123085_21921_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F35454_0_0|SrvcGrp|16863|2022|PDM|10.00|99|0.00|DESTRUCTION WARTS - 2ND - 4TH LESIONS|
20|FH_F89932_10940_0|SrvcGrp|89142|2022|PDM|14665.00|99|0.00|ELECTROPHYSIOLOGY STUDIES|
20|FH_F93911_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F63899_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F68831_0_0|SrvcGrp|9832|2022|PDM|99.00|99|0.00|ST SVCS|
20|FH_F47640_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1269.00|99|0.00|AEG 6 (NO REV)|
20|FH_F42003_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100666_81301_0|SrvcGrp|90854|2022|PDM|2474.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F121009_76180_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F35857_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F88956_0_0|SrvcGrp|20252|2022|PDM|40692.00|99|0.00|MS DRG 224-225 ONLY|
20|FH_F79902_0_0|SrvcGrp|6|2022|PCT|0.50|99|0.00|OP SURGERY|
20|FH_F136752_0_0|CSTM-ALL|CSTM-00|2020|PDM|666.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1 & 2|
20|FH_F143198_75219_0|SrvcGrp|46903|2022|PDM|418.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F57834_0_0|SrvcGrp|10679|2022|PDM|1418.00|99|0.00|ACUTE MEDICAL & SURGICAL SVCS|
20|FH_F139825_0_0|SrvcGrp|84934|2022|PDM|6885.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F145988_06105_0|SrvcGrp|114496|2022|PDM|37749.00|99|0.00|PERC D-E COR REVASC W AMI S|
20|FH_F110507_33462_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130017_02302_0|SrvcGrp|73499|2022|PDM|720.67|99|0.00|AETNA ER LEVEL II|
20|FH_F112082_30720_0|SrvcGrp|10577|2022|PDM|76.22|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F114800_68510_0|SrvcGrp|23683|2022|PDM|46.00|99|0.00|SKILLED NURSING RN|
20|FH_F101041_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F44278_0_0|SrvcGrp|15302|2022|PDM|600.00|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)|
20|FH_F127914_28602_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134211_17961_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110466_06870_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F114444_19602_0|SrvcGrp|91779|2022|PDM|65.00|99|0.00|AETNA GROUP THERAPY (MOD AH)(HCFA)|
20|FH_F54592_0_0|SrvcGrp|28638|2022|PDM|21.66|99|0.00|HOME INFUSION THERAPY (MOD SJ)|
20|FH_F70684_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INFUSION- IV SERVICES|
20|FH_F101100_50314_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA - APC GROUPER M|
20|FH_F101100_50314_0|SrvcGrp|97909|2022|PDM|7647.00|99|0.00|REMOVAL OF COLON|
20|FH_F102200_06416_0|SrvcGrp|86849|2022|PDM|55.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F102200_06416_0|SrvcGrp|86844|2022|PDM|67.50|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F105361_80104_0|SrvcGrp|109112|2022|PDM|41004.00|99|0.00|ESOPHAGEAL RECORDING|
20|FH_F73967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146422_80210_0|SrvcGrp|94843|2022|PDM|550.00|99|0.00|AETNA MEDICARE INTENSIVE OP|
20|FH_F127656_06068_0|SrvcGrp|63297|2022|PDM|161.70|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F44638_0_0|SrvcGrp|167|2022|PDM|425.00|99|0.00|CD (ADULT) - REHABILITATION|
20|FH_F115950_08648_0|SrvcGrp|89149|2022|PDM|208.00|99|0.00|OP INTENSIVE|
20|FH_F116040_24637_0|SrvcGrp|86837|2022|PDM|10.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F131698_01862_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F131858_38732_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133658_60053_0|SrvcGrp|88621|2022|PDM|125.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132213_17543_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F133478_40165_0|SrvcGrp|28165|2022|PDM|62854.00|99|0.00|MS DRG 228 ONLY|
20|FH_F131702_17022_0|SrvcGrp|48398|2022|PDM|117.00|99|0.00|PT SERVICES|
20|FH_F35216_0_0|SrvcGrp|11259|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F143539_0_0|SrvcGrp|114518|2022|PDM|6427.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F44449_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F114064_0_0|SrvcGrp|72990|2022|PDM|420.00|99|0.00|AEG 1|
20|FH_F90136_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F88545_78734_0|SrvcGrp|79720|2022|PDM|1004.00|99|0.00|ACUTE REHAB II|
20|FH_F128378_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F132016_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F141877_0_0|SrvcGrp|83825|2022|PCT|0.00|99|0.00|CARDIAC CATH|
20|FH_F58714_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|2313.00|99|0.00|ASPG VI|
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123784_03264_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132810_0_0|SrvcGrp|86848|2022|PDM|35.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F132810_0_0|SrvcGrp|24761|2022|PDM|8.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|36.00|99|0.00|AEG 10 (NO REV)|
20|FH_F136314_19013_0|SrvcGrp|86722|2022|PDM|199.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F136487_71269_0|SrvcGrp|73841|2022|PDM|470.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F118152_20151_0|SrvcGrp|86827|2022|PDM|60.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F137047_73120_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137147_75006_0|SrvcGrp|33967|2022|PDM|28728.00|99|0.00|CPT 47562|
20|FH_F137249_30046_0|SrvcGrp|113060|2022|PDM|215.00|99|0.00|HOSPICE|
20|FH_F56832_0_0|SrvcGrp|439|2022|PDM|3500.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F97600_46151_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F138558_60107_0|SrvcGrp|86723|2022|PDM|379.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F138584_30912_0|SrvcGrp|113360|2022|PCT|1.00|99|0.00|SURGICAL SERVICES|
20|FH_F138627_82901_0|SrvcGrp|86851|2022|PDM|85.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 7 (NO REV)|
20|FH_F78626_91402_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140756_63141_0|SrvcGrp|91357|2022|PDM|48.00|99|0.00|ASA CODES & CPT4 CODE|
20|FH_F140844_48083_0|SrvcGrp|87396|2022|PDM|129.00|99|0.00|HCPCS G0155 (HCFA)|
20|FH_F120152_0_0|SrvcGrp|58638|2022|PDM|22000.00|99|0.00|CPT 63688|
20|FH_F149540_64083_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149561_76667_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149640_50022_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119046_74012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117371_77059_0|SrvcGrp|89417|2022|PDM|375.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F67403_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117102_39355_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F137307_65233_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|928.00|99|0.00|AEG 6 (NO REV)|
20|FH_F137832_89118_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109652_0_0|SrvcGrp|104136|2022|PDM|4967.00|99|0.00|PSYCH INTENSIVE CARE UNIT|
20|FH_F39085_0_0|SrvcGrp|7|2022|PCT|0.85|99|0.00|NEONATAL INTENSIVE|
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1222.00|99|0.00|ASPG IV|
20|FH_F97141_93933_0|SrvcGrp|73603|2022|PDM|9675.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 6 (NO REV)|
20|FH_F126935_33615_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148864_81303_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (BREAKOUT)|
20|FH_F151144_35801_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F151154_91761_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121946_43209_0|SrvcGrp|3178|2022|PDM|857.00|99|0.00|ACUTE PSYCH|
20|FH_F113866_0_0|SrvcGrp|24739|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F32066_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE|
20|FH_F82933_0_0|CSTM-ALL|CSTM-00|2020|PDM|4568.30|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F110381_0_0|SrvcGrp|103970|2022|PDM|2332.00|99|0.00|AETNA SHOULDER ARTHROSCOPY SURGERY|
20|FH_F91873_12723_0|SrvcGrp|89117|2022|PCT|0.68|99|0.00|DIAGNOSTIC RADIOPHARMACEUTICALS|
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 8 (NO REV)|
20|FH_F111207_0_0|SrvcGrp|25696|2022|PDM|950.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 7 (NO REV)|
20|FH_F117299_0_0|SrvcGrp|47544|2022|PDM|4994.00|99|0.00|PERCUTANEOUS IMPLANT OF NEUROSTIMULATOR ELECTRODES|
20|FH_F86911_0_0|SrvcGrp|44705|2022|PDM|75.00|99|0.00|NURSING CARE|
20|FH_F142318_21218_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142319_19403_0|SrvcGrp|113450|2022|PDM|617.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH/CD|
20|FH_F142321_29401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115895_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F112064_0_0|SrvcGrp|103898|2022|PDM|160.00|99|0.00|CONTINUOUS HOME CARE|
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|AEG 3 (NO REV)|
20|FH_F136132_0_0|SrvcGrp|112813|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER|
20|FH_F136818_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F130274_63033_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F119214_0_0|SrvcGrp|75483|2022|PDM|1100.00|99|0.00|AEG 3|
20|FH_F126345_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F141336_16947_0|SrvcGrp|111929|2022|PDM|7.70|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|879.62|99|0.00|AEG 10 (NO REV)|
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.00|99|0.00|AEG 7 (NO REV)|
20|FH_F115971_0_0|SrvcGrp|12491|2022|PCT|0.33|99|0.00|PACEMAKER|
20|FH_F146674_70778_0|SrvcGrp|89023|2022|PDM|70.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F146886_77378_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36318_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|CHEMOTHERAPY > 17 YRS|
20|FH_F37394_0_0|SrvcGrp|472|2022|PDM|800.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F91998_0_0|SrvcGrp|91890|2022|PDM|1224.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F98380_43055_0|SrvcGrp|73603|2022|PDM|5000.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F129549_01238_0|SrvcGrp|14893|2022|PDM|47.19|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F124178_01604_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124414_92653_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 8 (NO REV)|
20|FH_F50976_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130796_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132890_87544_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F100787_69162_0|SrvcGrp|73485|2022|PDM|3004.00|99|0.00|AETNA REHAB|
20|FH_F136650_72543_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138055_16146_0|SrvcGrp|46903|2022|PDM|541.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F81832_13827_0|SrvcGrp|48398|2022|PDM|184.00|99|0.00|PT SERVICES|
20|FH_F146040_0_0|SrvcGrp|82981|2022|PDM|182.35|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F132595_0_0|CSTM-ALL|CSTM-00|2020|PDM|1158.00|99|0.00|ACUTE PSYCH|
20|FH_F43779_0_0|SrvcGrp|359|2022|PDM|1128.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F43862_0_0|SrvcGrp|37405|2022|PDM|90.00|99|0.00|OT SVCS|
20|FH_F43953_0_0|SrvcGrp|27569|2022|PCT|0.70|99|0.00|MEDICAL/SURGICAL SUPPLIES|
20|FH_F134727_30650_0|SrvcGrp|73485|2022|PDM|1563.00|99|0.00|AETNA REHAB|
20|FH_F134791_98034_0|SrvcGrp|27968|2022|PCT|0.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135762_70001_0|SrvcGrp|108484|2022|PDM|1550.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F136796_24016_0|CSTM-ALL|CSTM-00|2020|PDM|823.38|99|0.00|AEG 1 (NO REV)|
20|FH_F136829_29615_0|SrvcGrp|86722|2022|PDM|406.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F136913_68803_0|SrvcGrp|31706|2022|PDM|22110.00|99|0.00|MS DRG 792 ONLY|
20|FH_F112189_81212_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113713_17013_0|SrvcGrp|91750|2022|PDM|65.00|99|0.00|AETNA GROUP THERAPY (MOD AH)|
20|FH_F46752_0_0|SrvcGrp|13570|2022|PDM|100.00|99|0.00|HIGH TECH/SPECIALTY NURSING/MC PEDS (OB, PEDS, ET, MOM/BABY)|
20|FH_F65979_0_0|SrvcGrp|61558|2022|PDM|1450.00|99|0.00|MUSCULOSKELETAL SURGERY|
20|FH_F147389_81632_0|SrvcGrp|89337|2022|PDM|2300.00|99|0.00|DETOXIFICATION|
20|FH_F147400_77707_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147586_44124_0|SrvcGrp|93431|2022|PDM|18000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F147586_44124_0|SrvcGrp|88030|2022|PDM|11000.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F147586_44124_0|CSTM-ALL|CSTM-00|2020|PDM|1363.00|99|0.00|AEG 4 (NO REV)|
20|FH_F41749_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118792_63379_0|SrvcGrp|112044|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F84611_30281_0|SrvcGrp|76619|2022|PCT|0.73|99|0.00|THERAPY|
20|FH_F41535_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH|
20|FH_F35685_0_0|SrvcGrp|10059|2022|PDM|8930.00|99|0.00|DRG 124 ONLY CIRCULATORY DISORDERS W/CARDIAC CATH COMPLEX DX|
20|FH_F36372_0_0|SrvcGrp|17016|2022|PDM|28.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F98624_15701_0|SrvcGrp|90854|2022|PDM|2103.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F100780_24153_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F103004_75840_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|AETNA IP MRI AND MRA SCANS (MRIMRA)|
20|FH_F103004_75840_0|SrvcGrp|73002|2022|PDM|1393.00|99|0.00|AEG 7|
20|FH_F70444_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F32708_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F70762_90805_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: DME|
20|FH_F123083_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|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_F46433_0_0|SrvcGrp|22389|2022|PDM|25.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F134087_0_0|SrvcGrp|97895|2022|PDM|10455.00|99|0.00|REVISE KNEE 2|
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 2 (NO REV)|
20|FH_F138784_32216_0|SrvcGrp|108484|2022|PDM|741.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F78265_0_0|CSTM-ALL|CSTM-00|2020|PDM|3166.00|99|0.00|ASPG VIII|
20|FH_F36719_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151340_30040_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 4 (NO REV)|
20|FH_F151513_44718_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122027_61847_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97501_31501_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|2544.00|99|0.00|ASPG III|
20|FH_F135384_28714_0|SrvcGrp|14494|2022|PDM|41.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F135388_48601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135483_53226_0|CSTM-ALL|CSTM-00|2020|PCT|3.15|99|0.00|HSS ASC|
20|FH_F135924_02906_0|SrvcGrp|112834|2022|PCT|1.03|99|0.00|RADIOLOGY SERVICES|
20|FH_F135978_06851_0|SrvcGrp|112779|2022|PDM|441.00|99|0.00|PARTIAL HOSPITALIZATION (>=19 YRS) (HCFA)|
20|FH_F136042_90066_0|SrvcGrp|73063|2022|PDM|965.00|99|0.00|OBSERVATION SERVICES|
20|FH_F136086_63701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131228_01826_0|SrvcGrp|10364|2022|PDM|1111.47|99|0.00|CPT CODE 99284|
20|FH_F131112_99163_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F116527_70443_0|SrvcGrp|72990|2022|PDM|900.00|99|0.00|AEG 1|
20|FH_F116527_70443_0|SrvcGrp|75505|2022|PCT|1.00|99|0.00|CARDIAC STUDIES|
20|FH_F116488_79925_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F35053_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36258_0_0|SrvcGrp|22563|2022|PDM|45.00|99|0.00|PT|
20|FH_F121763_07202_0|SrvcGrp|104796|2022|PDM|160.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F121763_07202_0|SrvcGrp|109216|2022|PDM|94.00|99|0.00|PSYCH TEST EVALUATION EACH ADD'L HOUR|
20|FH_F128370_76132_0|SrvcGrp|89417|2022|PDM|375.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F101182_07863_0|SrvcGrp|59795|2022|PCT|1.00|99|0.00|TPN|
20|FH_F111880_50003_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F134309_63125_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148243_0_0|SrvcGrp|85966|2022|PDM|1250.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|794.66|99|0.00|2005 ASPG GROUPER IV|
20|FH_F131000_0_0|SrvcGrp|78093|2022|PDM|3608.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F132328_0_0|SrvcGrp|92410|2022|PDM|14566.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112166_72143_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F87557_33309_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F98626_29118_0|SrvcGrp|73559|2022|PDM|11405.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F102862_30606_0|SrvcGrp|60134|2022|PDM|12581.00|99|0.00|MS DRG 509 ONLY|
20|FH_F101320_26062_0|SrvcGrp|22589|2022|PDM|60.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F143542_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F148425_01507_0|SrvcGrp|115383|2022|PCT|1.00|99|0.00|COVID-19 INFUSION ADMINISTRATION - REGENERON|
20|FH_F148641_92505_0|SrvcGrp|90854|2022|PDM|1150.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F132591_75146_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F33139_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F118539_44256_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F81771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F38079_0_0|SrvcGrp|12957|2022|PCT|1.00|99|0.00|DME|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|218.84|99|0.00|HAPA WPA-NWPA 2012-13 ASC 126 W/O REV|
20|FH_F38725_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|ASPG VI|
20|FH_F113287_72501_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F141807_33020_0|SrvcGrp|108484|2022|PDM|752.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F150531_16148_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126735_38018_0|SrvcGrp|46903|2022|PDM|1200.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PDM|2778.00|99|0.00|AEG 3 (NO REV)|
20|FH_F43296_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F144449_04619_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37567_0_0|CSTM-ALL|CSTM-00|2020|PDM|390.00|99|0.00|ASPG I|
20|FH_F118550_21133_0|SrvcGrp|471|2022|PDM|808.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F125176_20785_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148703_33853_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148556_13206_0|SrvcGrp|10577|2022|PDM|35.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|AEG 4 (NO REV)|
20|FH_F146159_89102_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F106600_99202_0|SrvcGrp|86753|2022|PCT|1.05|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F144191_0_0|SrvcGrp|90063|2022|PDM|2600.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 2 (NO REV)|
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|747.00|99|0.00|AEG 4 (NO REV)|
20|FH_F126868_60451_0|SrvcGrp|3178|2022|PDM|952.00|99|0.00|ACUTE PSYCH|
20|FH_F146121_71857_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F36579_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALLIED MED-MOD KF|
20|FH_F150905_01608_0|SrvcGrp|115856|2022|PDM|27.81|99|0.00|CRISIS INTERV SERV (MOD HN) (0-21 YRS)|
20|FH_F128442_57430_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87155_04105_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F47479_0_0|SrvcGrp|42975|2022|PDM|70.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F45977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|HOME INF- REV 640 MOD SJ|
20|FH_F144408_21617_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117087_0_0|SrvcGrp|107175|2022|PDM|2494.00|99|0.00|MASTOIDECTOMY|
20|FH_F117368_68114_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F99720_0_0|SrvcGrp|104739|2022|PDM|3174.00|99|0.00|REPAIR OF  TENDON(S)|
20|FH_F44025_0_0|CSTM-ALL|CSTM-00|2020|PDM|639.00|99|0.00|CD - DETOXIFICATION|
20|FH_F138054_0_0|SrvcGrp|57968|2022|PDM|57.36|99|0.00|CONTINUOUS HOMECARE|
20|FH_F49044_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F33241_0_0|SrvcGrp|411|2022|PDM|3600.00|99|0.00|OP CARDIAC CATH|
20|FH_F146227_66210_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F66480_0_0|SrvcGrp|17621|2022|PDM|168.00|99|0.00|HOME HEALTH SVCS|
20|FH_F142810_77087_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143190_46168_0|SrvcGrp|75419|2022|PDM|415.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F123538_21206_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F39995_0_0|SrvcGrp|701|2022|PDM|1550.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F72226_65804_0|SrvcGrp|116073|2022|PCT|0.88|99|0.00|DURABLE MEDICAL EQUIPMENT|
20|FH_F87577_80016_0|SrvcGrp|110462|2022|PCT|0.72|99|0.00|AMBULATORY SURGERY|
20|FH_F37640_0_0|CSTM-ALL|CSTM-00|2020|PDM|932.00|99|0.00|ASPG VI|
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|37450.00|99|0.00|DRG 108 ONLY OTHER CARDIOTHORACIC PROC|
20|FH_F92676_15063_0|SrvcGrp|78940|2022|PDM|3318.86|99|0.00|MON VALLEY ASC 1404|
20|FH_F141411_0_0|SrvcGrp|83839|2022|PDM|28200.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F141731_92590_0|SrvcGrp|89149|2022|PDM|232.00|99|0.00|OP INTENSIVE|
20|FH_F109404_0_0|SrvcGrp|15052|2022|PCT|1.10|99|0.00|RADIOLOGY SVCS|
20|FH_F87577_80016_0|SrvcGrp|21350|2022|PDM|13838.00|99|0.00|MS DRG 287 ONLY|
20|FH_F133148_71446_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133118_33143_0|SrvcGrp|23587|2022|PDM|756.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F127558_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)|
20|FH_F91155_16105_0|SrvcGrp|29347|2022|PDM|22.12|99|0.00|HOME HEALTH AIDE|
20|FH_F133490_90650_0|SrvcGrp|111928|2022|PDM|100.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F149781_37404_0|CSTM-ALL|CSTM-00|2020|PDM|2202.00|99|0.00|AEG 5  (NO REV)|
20|FH_F83031_0_0|SrvcGrp|44706|2022|PDM|105.00|99|0.00|NURSING CARE|
20|FH_F125368_24153_0|SrvcGrp|75419|2022|PDM|383.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F89233_0_0|SrvcGrp|86582|2022|PCT|0.85|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F132446_19063_0|SrvcGrp|48385|2022|PDM|76.00|99|0.00|SPEECH THERAPY|
20|FH_F151062_17584_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89778_0_0|SrvcGrp|34606|2022|PDM|2455.44|99|0.00|CPT 29827|
20|FH_F129926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F46832_0_0|SrvcGrp|40826|2022|PDM|20.00|99|0.00|DISPOSABLE DRUG DELIVERY SYSTEM|
20|FH_F123661_30060_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136373_17055_0|SrvcGrp|88620|2022|PDM|112.00|99|0.00|SKILLED NURSING RN|
20|FH_F136386_30901_0|SrvcGrp|12840|2022|PCT|0.40|99|0.00|PACEMAKER|
20|FH_F118152_20151_0|SrvcGrp|19742|2022|PDM|60.00|99|0.00|MID-LINE INSERTION|
20|FH_F120424_03060_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120475_81052_0|SrvcGrp|93291|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA ESRD USE|
20|FH_F120475_81052_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93187_08043_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F93360_64730_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F142307_74066_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142547_70002_0|SrvcGrp|24744|2022|PDM|50.00|99|0.00|PICC LINE INSERTION|
20|FH_F97600_46151_0|SrvcGrp|73559|2022|PDM|22239.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F97601_67218_0|SrvcGrp|73605|2022|PDM|2103.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F138558_60107_0|SrvcGrp|89417|2022|PDM|379.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F140387_72202_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149647_92651_0|SrvcGrp|75419|2022|PDM|475.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F151601_89118_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F151604_44266_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|1645.60|99|0.00|AETNA GLENNVILLE 2016 AEG 8|
20|FH_F147801_90703_0|SrvcGrp|72602|2022|PDM|1498.00|99|0.00|ECT|
20|FH_F147922_10031_0|SrvcGrp|74668|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129477_70403_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F117217_80304_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F117126_12801_0|SrvcGrp|107237|2022|PCT|0.75|99|0.00|UNSPECIFIED CHEMOTHERAPY|
20|FH_F137331_33165_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F95900_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT|
20|FH_F101945_0_0|SrvcGrp|26276|2022|PDM|2726.00|99|0.00|CPT 29819|
20|FH_F118473_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|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_F111593_0_0|SrvcGrp|72994|2022|PDM|2200.00|99|0.00|AEG 3|
20|FH_F124754_84403_0|SrvcGrp|46903|2022|PDM|500.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F41166_0_0|CSTM-ALL|CSTM-00|2020|PDM|65.00|99|0.00|OP SVCS|
20|FH_F92676_15063_0|SrvcGrp|78984|2022|PDM|1233.76|99|0.00|MON VALLEY ASC 209|
20|FH_F132543_79549_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F125023_45246_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117909_92405_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F123872_75006_0|SrvcGrp|75545|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F49776_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F113146_15001_0|SrvcGrp|109921|2022|PDM|503.00|99|0.00|RESIDENTIAL TREATMENT (13-17 YRS)|
20|FH_F144288_46322_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F146211_68144_0|SrvcGrp|45063|2022|PDM|979.00|99|0.00|CPT 64493  INJECTION CARVE OUT|
20|FH_F146285_76109_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148639_0_0|SrvcGrp|76604|2022|PDM|1800.00|99|0.00|CPT 25447|
20|FH_F39079_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43296_0_0|SrvcGrp|109234|2022|PDM|450.00|99|0.00|BOARDER BABY|
20|FH_F41696_0_0|SrvcGrp|110|2022|PDM|504.00|99|0.00|CD - REHABILITATION|
20|FH_F141790_85374_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (BREAKOUT)|
20|FH_F98921_64503_0|SrvcGrp|73485|2022|PDM|3331.00|99|0.00|AETNA REHAB|
20|FH_F130573_02882_0|SrvcGrp|27969|2022|PCT|1.00|99|0.00|HOME HEALTH AIDE|
20|FH_F117807_86426_0|SrvcGrp|73701|2022|PDM|39.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F118819_76226_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F117368_68114_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|666.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F134487_14843_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F101840_76054_0|SrvcGrp|73601|2022|PDM|2957.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F44435_0_0|SrvcGrp|27345|2022|PDM|2950.00|99|0.00|OP SURGERY (CPT 49650)|
20|FH_F146108_66762_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F141804_70503_0|SrvcGrp|92502|2022|PDM|573.47|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F128144_45697_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117087_0_0|SrvcGrp|36864|2022|PDM|5941.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F36052_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38508_0_0|SrvcGrp|11336|2022|PCT|0.85|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F46097_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F45513_0_0|SrvcGrp|60816|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F44660_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149881_03038_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F46357_0_0|SrvcGrp|41335|2022|PDM|3400.00|99|0.00|TOTAL HIP|
20|FH_F111789_25301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F100740_15206_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F144572_34203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133270_77025_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC|
20|FH_F44660_0_0|SrvcGrp|9907|2022|PDM|1300.00|99|0.00|ACUTE MEDICAL/SURGICAL SVCS|
20|FH_F141870_85224_0|SrvcGrp|24753|2022|PDM|25.00|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F118486_95060_0|SrvcGrp|89417|2022|PDM|550.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F150024_08079_0|CSTM-ALL|CSTM-00|2020|PDM|2814.00|99|0.00|AEG 7 (NO REV)|
20|FH_F117087_0_0|SrvcGrp|97471|2022|PDM|2494.00|99|0.00|REMOVAL OF THYROID DUCT LESION|
20|FH_F128919_48075_0|SrvcGrp|29155|2022|PDM|130.00|99|0.00|HOSPICE SVCS|
20|FH_F127422_0_0|SrvcGrp|28549|2022|PDM|1675.00|99|0.00|VITRECTOMY|
20|FH_F118785_33315_0|SrvcGrp|107949|2022|PDM|650.00|99|0.00|PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F44855_0_0|SrvcGrp|30208|2022|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F132118_92240_0|SrvcGrp|73841|2022|PDM|520.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F40728_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|ASPG IV|
20|FH_F139132_36532_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139627_80537_0|SrvcGrp|113083|2022|PDM|525.00|99|0.00|CT SCAN|
20|FH_F139700_42104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150662_20901_0|SrvcGrp|88620|2022|PDM|138.00|99|0.00|SKILLED NURSING RN|
20|FH_F150700_90028_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F150800_44256_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122392_78207_0|SrvcGrp|90397|2022|PDM|276.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F149030_37919_0|SrvcGrp|84180|2022|PDM|1725.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS|
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|2790.00|99|0.00|AEG 5  (NO REV)|
20|FH_F36485_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132149_60624_0|SrvcGrp|89417|2022|PDM|418.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F98000_59102_0|SrvcGrp|73602|2022|PDM|3772.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F36903_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KEITH RATHBOON PT HCPC MOD KN|
20|FH_F148347_0_0|SrvcGrp|82298|2022|PDM|14056.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY|
20|FH_F42979_0_0|SrvcGrp|3395|2022|PDM|96.00|99|0.00|CPT 90809|
20|FH_F128755_62702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134847_0_0|SrvcGrp|34606|2022|PDM|5161.00|99|0.00|CPT 29827|
20|FH_F138018_17313_0|SrvcGrp|107669|2022|PCT|0.90|99|0.00|DRUGS AND NUTRITIONAL SOLUTIONS|
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|3750.00|99|0.00|AEG 8 (NO REV)|
20|FH_F147369_43608_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD NU KE RATE|
20|FH_F149160_02180_0|SrvcGrp|115384|2022|PCT|1.00|99|0.00|COVID-19 INFUSION ADMINISTRATION COMBINATION - ELI LILLY|
20|FH_F141654_15217_0|SrvcGrp|48396|2022|PDM|90.18|99|0.00|OT SERVICES|
20|FH_F121168_0_0|SrvcGrp|94780|2022|PDM|100.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F133287_40215_0|SrvcGrp|105601|2022|PCT|0.00|99|0.00|IP IMAGING ENHANCING SUBSTANCE|
20|FH_F149860_80112_0|SrvcGrp|108484|2022|PDM|483.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F91262_77036_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES|
20|FH_F133142_19076_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44079_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F147800_0_0|SrvcGrp|110768|2022|PDM|458.00|99|0.00|3RD LEVEL INJ PARAVERT F JNT L/S|
20|FH_F101983_17578_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F31944_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|PHYSICAL THERAPY|
20|FH_F111502_33331_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F95641_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F112627_26062_0|SrvcGrp|76501|2022|PDM|257.50|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F109882_36695_0|SrvcGrp|46903|2022|PDM|637.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F117858_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1495.74|99|0.00|HAPA WPA-NWPA 2012-13 ASC 904 W/O REV|
20|FH_F133108_98221_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|621.75|99|0.00|ASPG 302|
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89011_75006_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F67379_0_0|SrvcGrp|27813|2022|PDM|11300.00|99|0.00|MS DRG 280 ONLY|
20|FH_F150909_70032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100661_63640_0|SrvcGrp|73605|2022|PDM|2393.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F72750_0_0|SrvcGrp|2738|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F115315_43011_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F49637_0_0|SrvcGrp|27974|2022|PDM|9765.00|99|0.00|MS DRG 333-334 ONLY|
20|FH_F64142_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F81485_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|2014 WMS CHRISTIAN RAD|
20|FH_F32686_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71594_15644_0|SrvcGrp|81878|2022|PCT|1.00|99|0.00|RADIOLOGY W/ REV/HCPC|
20|FH_F117717_68410_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F134830_0_0|SrvcGrp|57967|2022|PDM|175.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F136393_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F141728_71203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129176_48098_0|SrvcGrp|82223|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F91198_46714_0|SrvcGrp|70381|2022|PDM|287.00|99|0.00|PSYCH PARTIAL HOSP (FULL & PARTIAL DAY) PER VISIT|
20|FH_F35173_0_0|SrvcGrp|15663|2022|PCT|0.90|99|0.00|TRAUMA CARE|
20|FH_F127204_44420_0|SrvcGrp|48385|2022|PDM|116.00|99|0.00|SPEECH THERAPY|
20|FH_F136606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F48892_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|GENERAL ACUTE CARE|
20|FH_F148644_06890_0|SrvcGrp|82112|2022|PDM|3604.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F148760_12953_0|SrvcGrp|66265|2022|PDM|120.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F151086_60649_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151224_85301_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130066_84107_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F129130_92562_0|SrvcGrp|3803|2022|PCT|0.42|99|0.00|TRAUMA CARE|
20|FH_F139627_80537_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F150769_02302_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F73128_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F40624_0_0|SrvcGrp|11000|2022|PCT|0.60|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F149579_95815_0|SrvcGrp|115696|2022|PDM|161.17|99|0.00|PSYCHIATRIC COLLABORATIVE CARE MGMT 1ST (MOD TD)(HCFA)|
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|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_F39450_0_0|SrvcGrp|701|2022|PDM|1770.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F40521_0_0|SrvcGrp|32550|2022|PDM|250.00|99|0.00|NEWBORN NURSERY|
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|887.12|99|0.00|AEG 3 (NO REV)|
20|FH_F35990_0_0|SrvcGrp|3015|2022|PCT|0.60|99|0.00|SUPPLIES|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1334.00|99|0.00|COVENTRY ENHANCED GROUPER 6 MOD 50|
20|FH_F115483_62002_0|CSTM-ALL|CSTM-00|2020|PDM|2223.00|99|0.00|AETNA OP PET SCANS (PET)|
20|FH_F109252_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_F109221_15084_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F135263_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F133519_0_0|SrvcGrp|103513|2022|PDM|74.00|99|0.00|VAGINA EXAMINATION & BIOPSY|
20|FH_F122377_91007_0|SrvcGrp|75487|2022|PDM|8510.00|99|0.00|AEG 5|
20|FH_F151023_77384_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F145599_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F42395_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F94330_43220_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F98940_70506_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F137772_27320_0|SrvcGrp|3809|2022|PDM|699.00|99|0.00|HOSPICE CARE|
20|FH_F98001_27603_0|SrvcGrp|73559|2022|PDM|22095.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F119352_0_0|SrvcGrp|29428|2022|PDM|185.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT|
20|FH_F134397_27513_0|SrvcGrp|89417|2022|PDM|467.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
20|FH_F148667_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F36883_0_0|SrvcGrp|90854|2022|PDM|756.08|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F84655_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37304_0_0|SrvcGrp|12038|2022|PDM|229.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F35369_0_0|SrvcGrp|9438|2022|PCT|0.80|99|0.00|TRAUMA CARE|
20|FH_F122271_79416_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|776.00|99|0.00|AEG 2 (NO REV)|
20|FH_F138016_19808_0|SrvcGrp|90854|2022|PDM|583.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F94426_47403_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F98623_97006_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F114585_11501_0|SrvcGrp|89024|2022|PDM|77.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F39443_0_0|SrvcGrp|30342|2022|PDM|91.00|99|0.00|HAPA WPA ASC 226|
20|FH_F36943_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD 26|
20|FH_F132254_40207_0|SrvcGrp|86853|2022|PDM|40.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F110729_15068_0|SrvcGrp|106048|2022|PDM|603.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F92413_07631_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145920_0_0|SrvcGrp|79589|2022|PDM|1931.00|99|0.00|UPPER GI|
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|610.00|99|0.00|AEG 5  (NO REV)|
20|FH_F146266_0_0|SrvcGrp|99067|2022|PDM|5527.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F38742_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|SUNSHINE HHC INFUSION THERAPY MOD SJ|
20|FH_F90817_0_0|SrvcGrp|91036|2022|PDM|2096.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR) (HCFA)|
20|FH_F148859_0_0|SrvcGrp|68054|2022|PDM|1248.00|99|0.00|CPT 52332|
20|FH_F98623_97006_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F122394_75979_0|SrvcGrp|73841|2022|PDM|400.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F35753_33770_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F149003_62208_0|SrvcGrp|48398|2022|PDM|105.00|99|0.00|PT SERVICES|
20|FH_F92278_01440_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134869_08854_0|CSTM-ALL|CSTM-00|2020|PDM|813.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F80834_0_0|SrvcGrp|12981|2022|PDM|6887.00|99|0.00|ICU|
20|FH_F128987_65737_0|SrvcGrp|107479|2022|PCT|1.00|99|0.00|CINACALCET ORAL (FOR ESRD ON DIALYSIS|
20|FH_F131261_19111_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F137767_01841_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F43293_0_0|SrvcGrp|360|2022|PDM|1150.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F38475_0_0|SrvcGrp|10615|2022|PDM|120.00|99|0.00|HOME HEALTH AIDE|
20|FH_F78023_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F125214_12428_0|SrvcGrp|81779|2022|PCT|0.60|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F109470_15370_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F90196_10467_0|SrvcGrp|86749|2022|PCT|1.05|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F116806_0_0|SrvcGrp|107134|2022|PDM|875.13|99|0.00|SPEECH AID PROSTHESIS|
20|FH_F41167_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F150312_89103_0|SrvcGrp|46903|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F113826_51445_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F115483_62002_0|SrvcGrp|84186|2022|PCT|0.00|99|0.00|LITHOTRIPSY ESWL|
20|FH_F110121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45798_0_0|SrvcGrp|11193|2022|PDM|20500.00|99|0.00|DRG 555 PERCUTANEOUS CARDIOVASCULAR PROCEDURE W/ MAJOR DX|
20|FH_F117581_21211_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F48855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114207_35243_0|SrvcGrp|21920|2022|PDM|35.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F122377_91007_0|SrvcGrp|109115|2022|PDM|45600.00|99|0.00|CARDIAC SERVICES|
20|FH_F148979_44512_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F92152_74133_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150313_78666_0|SrvcGrp|74668|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139928_37228_0|SrvcGrp|89149|2022|PDM|276.00|99|0.00|OP INTENSIVE|
20|FH_F140134_52732_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140036_07702_0|SrvcGrp|91065|2022|PDM|92.70|99|0.00|PSYCHIATRIC CPT 90853 (HCFA)|
20|FH_F72749_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|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_F102224_0_0|SrvcGrp|77021|2022|PDM|6000.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F131067_57105_0|SrvcGrp|74584|2022|PDM|1942.00|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F151752_63017_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F47952_0_0|SrvcGrp|43956|2022|PDM|55.00|99|0.00|NURSING CARE|
20|FH_F49051_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC|
20|FH_F132401_32796_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132426_33844_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|698.00|99|0.00|OP SVCS|
20|FH_F119918_38201_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120856_78247_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120921_75835_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120974_27607_0|SrvcGrp|116119|2022|PCT|0.71|99|0.00|CHEMOTHERAPY|
20|FH_F143467_0_0|SrvcGrp|114050|2022|PDM|1424.00|99|0.00|REPAIR OF TOE FRACTURE|
20|FH_F45166_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OP SVCS|
20|FH_F93805_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F47539_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_F126581_45638_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F135311_33146_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F40358_0_0|SrvcGrp|12235|2022|PDM|1450.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F125938_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F75307_0_0|SrvcGrp|46104|2022|PDM|99.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F33181_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F148179_48065_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37679_0_0|SrvcGrp|26854|2022|PDM|15.25|99|0.00|CHELATION THERAPY (MOD SJ)|
20|FH_F141515_50010_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F72830_0_0|SrvcGrp|37015|2022|PDM|1150.00|99|0.00|CHILD & ADOLESCENT PSYCH|
20|FH_F117783_0_0|SrvcGrp|104003|2022|PCT|1.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES|
20|FH_F123400_04605_0|SrvcGrp|90397|2022|PDM|226.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F76402_0_0|CSTM-ALL|CSTM-00|2020|PCT|56650.00|99|0.00|CAPD TRAINING|
20|FH_F126964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F34550_0_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER NUKE|
20|FH_F148169_33138_0|SrvcGrp|113773|2022|PCT|1.00|99|0.00|TELEMEDICINE (MOD 95, GT)|
20|FH_F86319_16365_0|SrvcGrp|3178|2022|PDM|1151.00|99|0.00|ACUTE PSYCH|
20|FH_F40182_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F115121_32250_0|SrvcGrp|73841|2022|PDM|955.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F118050_77565_0|SrvcGrp|73841|2022|PDM|375.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F131577_89148_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F127550_43026_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F90714_0_0|SrvcGrp|72994|2022|PDM|555.00|99|0.00|AEG 3|
20|FH_F49338_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F116093_47327_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F111661_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F38771_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86319_16365_0|SrvcGrp|9518|2022|PCT|0.63|99|0.00|EMERGENCY ROOM|
20|FH_F125249_0_0|SrvcGrp|92009|2022|PDM|1200.00|99|0.00|CARPAL SCAPHOID FRACTURE|
20|FH_F139515_0_0|SrvcGrp|33982|2022|PDM|1803.00|99|0.00|CPT 28296|
20|FH_F49299_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F32521_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F82235_0_0|SrvcGrp|72990|2022|PDM|366.30|99|0.00|AEG 1|
20|FH_F84135_0_0|SrvcGrp|108180|2022|PDM|927.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F39973_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116700_11787_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F46612_0_0|CSTM-ALL|CSTM-00|2020|PDM|166.00|99|0.00|SOCIAL WORKER|
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)|
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139551_0_0|SrvcGrp|11673|2022|PDM|5400.00|99|0.00|CPT 29888|
20|FH_F107800_34609_0|SrvcGrp|46903|2022|PDM|390.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F39022_0_0|SrvcGrp|16|2022|PDM|1330.00|99|0.00|ACUTE REHABILITATION|
20|FH_F118249_0_0|SrvcGrp|108063|2022|PDM|4300.00|99|0.00|IMPLANT NEUROELECTRODES 29|
20|FH_F132125_0_0|SrvcGrp|471|2022|PDM|1300.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F145536_90265_0|SrvcGrp|75522|2022|PDM|2835.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD|
20|FH_F116049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125899_07645_0|SrvcGrp|3165|2022|PDM|2426.00|99|0.00|EMERGENCY ROOM|
20|FH_F128401_44615_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
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_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S AZ - MOD RR|
20|FH_F131254_92211_0|SrvcGrp|22389|2022|PDM|12.50|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F40063_0_0|SrvcGrp|11336|2022|PCT|0.50|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F34496_0_0|SrvcGrp|3066|2022|PCT|0.46|99|0.00|HIGH-COST DRUGS|
20|FH_F151526_28208_0|SrvcGrp|107879|2022|PDM|3771.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F51120_0_0|SrvcGrp|3809|2022|PDM|694.00|99|0.00|HOSPICE CARE|
20|FH_F90818_0_0|SrvcGrp|90816|2022|PDM|4100.00|99|0.00|REPAIR HERNIA INIT (>5 YRS)|
20|FH_F116998_17701_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F95021_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F124796_37641_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72051_0_0|SrvcGrp|59427|2022|PDM|75.00|99|0.00|OT|
20|FH_F93920_0_0|SrvcGrp|79786|2022|PCT|0.75|99|0.00|SLEEP STUDIES|
20|FH_F103100_47150_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD RR|
20|FH_F82714_18848_0|SrvcGrp|2738|2022|PCT|0.39|99|0.00|IMPLANTS|
20|FH_F93132_73134_0|SrvcGrp|23683|2022|PDM|36.00|99|0.00|SKILLED NURSING RN|
20|FH_F148265_06067_0|SrvcGrp|88159|2022|PDM|8254.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F91622_0_0|CSTM-ALL|CSTM-00|2020|PDM|2860.00|99|0.00|AEG 7 (NO REV) ANTHONY MED CTR|
20|FH_F116093_47327_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F148279_15009_0|SrvcGrp|73601|2022|PDM|1750.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|3975.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F41519_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139551_0_0|SrvcGrp|84939|2022|PDM|17500.00|99|0.00|SHOULDER JOINT|
20|FH_F36433_0_0|SrvcGrp|3029|2022|PDM|378.00|99|0.00|NEWBORN NURSERY|
20|FH_F143784_16801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143833_63703_0|SrvcGrp|74668|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F40295_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116245_0_0|SrvcGrp|3809|2022|PDM|573.47|99|0.00|HOSPICE CARE|
20|FH_F38961_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123896_68114_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F89475_71202_0|CSTM-ALL|CSTM-00|2020|PDM|1020.00|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F44177_0_0|SrvcGrp|8968|2022|PDM|2030.00|99|0.00|NICU LEVEL III & IV|
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F38360_0_0|SrvcGrp|17419|2022|PDM|70.00|99|0.00|SPEECH THERAPY|
20|FH_F151526_28208_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128358_46072_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47963_0_0|SrvcGrp|25941|2022|PDM|99.00|99|0.00|PHYSICAL THERAPY|
20|FH_F38151_0_0|SrvcGrp|28277|2022|PCT|0.85|99|0.00|AZT / TPA / PENTAMIDINE|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD TC) - PMRS|
20|FH_F125463_50459_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63307_0_0|CSTM-ALL|CSTM-00|2020|PDM|95.00|99|0.00|DBPT PT-OT-ST|
20|FH_F122905_41018_0|SrvcGrp|89337|2022|PDM|816.00|99|0.00|DETOXIFICATION|
20|FH_F129518_54002_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE|
20|FH_F86872_15215_0|SrvcGrp|22592|2022|PDM|60.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F43250_0_0|SrvcGrp|40820|2022|PDM|1900.00|99|0.00|ICU/CCU|
20|FH_F55212_0_0|SrvcGrp|80|2022|PDM|655.00|99|0.00|ACUTE PSYCH|
20|FH_F63020_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62579_0_0|SrvcGrp|21711|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F31029_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|537.00|99|0.00|AEG 1 (NO REV)|
20|FH_F149145_33460_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F85132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|2221.10|99|0.00|AEG 6 (NO REV)|
20|FH_F110223_31750_0|SrvcGrp|74403|2022|PCT|0.90|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F49601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F77943_0_0|SrvcGrp|10944|2022|PCT|0.70|99|0.00|EMERGENCY ROOM|
20|FH_F79863_0_0|SrvcGrp|77223|2022|PDM|130.00|99|0.00|AETNA HOME INFUSION - S5520|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|176.36|99|0.00|HAPA WPA-NWPA 2012-13 ASC 130 W/O REV|
20|FH_F81852_0_0|SrvcGrp|15363|2022|PCT|0.50|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2652.00|99|0.00|AEG 6 (NO REV)|
20|FH_F133913_61008_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149106_07042_0|CSTM-ALL|CSTM-00|2020|PDM|1853.00|99|0.00|AEG 4 (NO REV)|
20|FH_F120720_24541_0|SrvcGrp|27968|2022|PDM|28.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132969_84003_0|SrvcGrp|53987|2022|PDM|239.49|99|0.00|PHOTOTHERAPY|
20|FH_F110305_70403_0|SrvcGrp|76094|2022|PDM|141.83|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F123644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.80|99|0.00|AEG 8 (NO REV)|
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_F114510_33445_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F134587_64114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150165_06032_0|SrvcGrp|92406|2022|PDM|8116.00|99|0.00|REMOVAL & REPLACE PULSE GEN 1 LEAD|
20|FH_F145708_89030_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F114409_18447_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F91777_29577_0|SrvcGrp|73524|2022|PCT|1.00|99|0.00|PHYSICAL THERAPY|
20|FH_F111908_07677_0|SrvcGrp|87911|2022|PCT|1.00|99|0.00|CYCLOSPORINE ORAL 100MG|
20|FH_F145619_17603_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F71748_0_0|SrvcGrp|3810|2022|PDM|168.44|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F111908_07677_0|SrvcGrp|87910|2022|PCT|1.00|99|0.00|VANCOMYCIN HCL INJECT 500MG|
20|FH_F112631_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148429_0_0|SrvcGrp|11577|2022|PDM|495.00|99|0.00|DIALYSIS|
20|FH_F134655_14221_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F110223_31750_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|1064.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F100782_0_0|SrvcGrp|105070|2022|PDM|621.15|99|0.00|WINDBER MEDICAL CNTR ASC 115|
20|FH_F124369_0_0|SrvcGrp|98523|2022|PDM|2750.00|99|0.00|CAPSULOTOMY|
20|FH_F118384_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F51500_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|GENERAL ACUTE CARE|
20|FH_F90232_15126_0|SrvcGrp|48396|2022|PDM|89.25|99|0.00|OT SERVICES|
20|FH_F150304_16146_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F113424_60626_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F114525_72401_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F73583_0_0|SrvcGrp|10503|2022|PDM|47.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F81835_0_0|SrvcGrp|74662|2022|PDM|465.18|99|0.00|AETNA SLEEP STUDIES|
20|FH_F127090_45601_0|SrvcGrp|43567|2022|PDM|92.25|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F120670_0_0|SrvcGrp|11673|2022|PDM|4700.00|99|0.00|CPT 29888|
20|FH_F146200_70815_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134593_60007_0|SrvcGrp|86139|2022|PCT|0.86|99|0.00|IDURSULFASE INJECTIONS|
20|FH_F123623_03246_0|SrvcGrp|109276|2022|PCT|1.00|99|0.00|CCIIV4 VACC ABX FREE IM|
20|FH_F150199_62226_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F114444_19602_0|SrvcGrp|86642|2022|PDM|85.00|99|0.00|AETNA PSYCH DIAG EVAL W/MED SRVC (MOD TD)|
20|FH_F119829_83221_0|SrvcGrp|92760|2022|PCT|0.76|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128828_44122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132193_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG III|
20|FH_F133749_84604_0|SrvcGrp|83522|2022|PDM|94.50|99|0.00|RESPITE CARE|
20|FH_F133868_40202_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F145562_70458_0|SrvcGrp|114246|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F130329_64114_0|SrvcGrp|86835|2022|PDM|10.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|ACTIGRAPHY TESTING (MOD 26)|
20|FH_F142376_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|1816.00|99|0.00|AEG 9 (NO REV)|
20|FH_F91067_0_0|SrvcGrp|72994|2022|PDM|630.00|99|0.00|AEG 3|
20|FH_F109513_0_0|SrvcGrp|72992|2022|PDM|643.50|99|0.00|AEG 2|
20|FH_F109513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150025_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|656.33|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F49895_0_0|SrvcGrp|43318|2022|PDM|500.00|99|0.00|MRI|
20|FH_F40834_0_0|SrvcGrp|3102|2022|PCT|0.85|99|0.00|IMPLANTS|
20|FH_F116341_12180_0|CSTM-ALL|CSTM-00|2020|PDM|173.00|99|0.00|NEW PATIENT OFF OP VISIT|
20|FH_F130025_0_0|SrvcGrp|111477|2022|PDM|279.00|99|0.00|WOUND CARE (HCFA)|
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_F91876_0_0|SrvcGrp|89882|2022|PDM|2645.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F132735_97068_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F60073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126926_32250_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130747_0_0|SrvcGrp|103329|2022|PDM|6242.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN|
20|FH_F34735_0_0|SrvcGrp|20765|2022|PCT|0.75|99|0.00|MS DRG 001-002 W/O ICD-9 PROC CODE 37.66|
20|FH_F143528_0_0|SrvcGrp|88159|2022|PDM|5250.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F131254_92211_0|SrvcGrp|86848|2022|PDM|35.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F41021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40198_0_0|SrvcGrp|3029|2022|PDM|514.00|99|0.00|NEWBORN NURSERY|
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F100962_0_0|SrvcGrp|72998|2022|PDM|1061.00|99|0.00|AEG 5|
20|FH_F131254_92211_0|SrvcGrp|21920|2022|PDM|35.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F127072_30458_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F129168_43050_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F115064_78582_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129305_45614_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|143.85|99|0.00|AETNA SLEEP STUDY|
20|FH_F103902_89118_0|SrvcGrp|46424|2022|PDM|85.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F93880_95476_0|SrvcGrp|78377|2022|PDM|5939.00|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F139551_0_0|SrvcGrp|26273|2022|PDM|2800.00|99|0.00|CPT 29880|
20|FH_F143528_0_0|SrvcGrp|34606|2022|PDM|5250.00|99|0.00|CPT 29827|
20|FH_F70984_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.00|99|0.00|COVENTRY ENHANCED GROUPER 3 GA NO CRESCENT|
20|FH_F97104_53545_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F129400_32726_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124048_47304_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F51074_0_0|SrvcGrp|16|2022|PDM|935.00|99|0.00|ACUTE REHABILITATION|
20|FH_F139515_0_0|SrvcGrp|86426|2022|PDM|1648.00|99|0.00|REMOVE INT/EXT HEM GROUP 2|
20|FH_F90654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F33233_0_0|SrvcGrp|15886|2022|PCT|1.00|99|0.00|PHARMACY SERVICES|
20|FH_F43167_0_0|SrvcGrp|80|2022|PDM|925.00|99|0.00|ACUTE PSYCH|
20|FH_F38473_0_0|SrvcGrp|10407|2022|PDM|55.00|99|0.00|HOME INFUSION|
20|FH_F110925_01104_0|SrvcGrp|64601|2022|PDM|38.50|99|0.00|HIGH COST DRUGS J1557|
20|FH_F130138_02915_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120872_74120_0|SrvcGrp|46903|2022|PDM|461.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F34262_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44177_0_0|SrvcGrp|3066|2022|PCT|0.55|99|0.00|HIGH-COST DRUGS|
20|FH_F151526_28208_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F125746_45331_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F91973_0_0|SrvcGrp|91646|2022|PDM|4532.00|99|0.00|AETNA MACON SURGICAL CARVE-OUTS|
20|FH_F137067_0_0|SrvcGrp|67065|2022|PDM|16800.00|99|0.00|CERVICAL SURGERY|
20|FH_F55054_0_0|SrvcGrp|3388|2022|PDM|650.00|99|0.00|SUBACUTE CARE|
20|FH_F148200_26554_0|SrvcGrp|114504|2022|PCT|1.50|99|0.00|LABORATORY SERVICES|
20|FH_F137495_36701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F123466_93420_0|SrvcGrp|86723|2022|PDM|550.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F73126_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F99100_0_0|SrvcGrp|96103|2022|PDM|679.80|99|0.00|CERVICAL AND THORACIC INJECTION (HCFA)|
20|FH_F129115_85716_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F36211_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F78324_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F71069_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F83793_77477_0|SrvcGrp|76421|2022|PDM|420.00|99|0.00|HEMODIALYSIS|
20|FH_F123921_89128_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F118086_66604_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F62924_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93881_15009_0|SrvcGrp|76662|2022|PDM|74.00|99|0.00|CPT 73630|
20|FH_F93791_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F112377_0_0|SrvcGrp|87077|2022|PDM|164.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F140967_20735_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139241_0_0|SrvcGrp|33984|2022|PDM|1420.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F72143_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39138_0_0|SrvcGrp|26179|2022|PDM|98.00|99|0.00|OT|
20|FH_F81481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F149839_80002_0|SrvcGrp|80920|2022|PDM|618.00|99|0.00|HOSPICE SERVICES|
20|FH_F148892_0_0|SrvcGrp|45063|2022|PDM|668.00|99|0.00|CPT 64493  INJECTION CARVE OUT|
20|FH_F151526_28208_0|SrvcGrp|109137|2022|PDM|4143.00|99|0.00|AV FISTULA REVISION|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD NU) - PMRS|
20|FH_F133957_84121_0|SrvcGrp|27969|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE|
20|FH_F150165_06032_0|SrvcGrp|82110|2022|PDM|1910.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC|
20|FH_F110465_30328_0|SrvcGrp|73842|2022|PDM|297.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F54592_0_0|SrvcGrp|27052|2022|PDM|47.50|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3HRS(MOD SH)|
20|FH_F122968_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113645_0_0|SrvcGrp|105356|2022|PCT|0.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD - INCL CODES|
20|FH_F47724_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115788_02904_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|1280.00|99|0.00|AEG 3 (NO REV)|
20|FH_F116040_24637_0|SrvcGrp|34566|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F111563_02116_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F111603_19529_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 9 (NO REV)|
20|FH_F89372_0_0|SrvcGrp|14886|2022|PCT|1.00|99|0.00|TRANSPORTATION|
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|423.22|99|0.00|AETNA SLEEP STUDIES|
20|FH_F123735_32708_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA IP LABORATORY|
20|FH_F121250_47401_0|SrvcGrp|94880|2022|PDM|88.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F151559_0_0|SrvcGrp|104464|2022|PDM|2000.00|99|0.00|VAGINAL DELIVERY (W/ OR W/O EPISIOTOMY)|
20|FH_F69968_0_0|SrvcGrp|17067|2022|PDM|1206.25|99|0.00|ASPG II|
20|FH_F136487_71269_0|SrvcGrp|89417|2022|PDM|470.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F118152_20151_0|SrvcGrp|22593|2022|PDM|40.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F118178_37909_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93132_73134_0|SrvcGrp|53987|2022|PCT|1.00|99|0.00|PHOTOTHERAPY|
20|FH_F93363_63123_0|SrvcGrp|73523|2022|PCT|0.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F134011_84102_0|SrvcGrp|53987|2022|PDM|239.49|99|0.00|PHOTOTHERAPY|
20|FH_F134126_11554_0|SrvcGrp|106298|2022|PDM|360.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT|
20|FH_F142473_07663_0|SrvcGrp|53144|2022|PCT|1.00|99|0.00|SPEECH THERAPY|
20|FH_F53732_0_0|SrvcGrp|22592|2022|PDM|80.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F134654_0_0|SrvcGrp|105425|2022|PDM|33.26|99|0.00|AETNA EXPOSURE ADAPTIVE BH TREATMENT 60 MINS|
20|FH_F139267_30253_0|SrvcGrp|73659|2022|PDM|1760.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F119004_06850_0|CSTM-ALL|CSTM-00|2020|PDM|798.00|99|0.00|AEG 10 (NO REV)|
20|FH_F119067_94080_0|SrvcGrp|48385|2022|PDM|120.00|99|0.00|SPEECH THERAPY|
20|FH_F118955_48239_0|SrvcGrp|46903|2022|PDM|400.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F92593_21031_0|SrvcGrp|3809|2022|PDM|639.48|99|0.00|HOSPICE CARE|
20|FH_F117267_07728_0|SrvcGrp|81779|2022|PCT|5.40|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F147725_06002_0|SrvcGrp|27344|2022|PDM|2700.00|99|0.00|OP SURGERY (CPT 42821)|
20|FH_F147901_95008_0|SrvcGrp|74668|2022|PDM|325.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137815_15501_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F137817_17050_0|SrvcGrp|90854|2022|PDM|644.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F137818_31602_0|SrvcGrp|73842|2022|PDM|262.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137938_29036_0|SrvcGrp|107734|2022|PDM|8222.00|99|0.00|VAGINAL DELIVERY|
20|FH_F109652_0_0|SrvcGrp|87448|2022|PDM|6268.00|99|0.00|AETNA KYPHOPLASTY (2015 HIPPA)|
20|FH_F91472_96001_0|SrvcGrp|103736|2022|PCT|0.40|99|0.00|ANTERIOR CERVICAL FUSION OR REFUSION WITH ALLOGRAFT|
20|FH_F91472_96001_0|SrvcGrp|103760|2022|PCT|0.40|99|0.00|EXTERNAL FIXATION WRIST|
20|FH_F37734_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F141827_80003_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F127191_44720_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F151046_10036_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121880_54935_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F121971_33021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115884_0_0|SrvcGrp|93098|2022|PDM|111.00|99|0.00|HOSPICE CARE|
20|FH_F36386_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97761_04072_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F32914_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|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_F117299_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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|633.74|99|0.00|AETNA SLEEP STUDY CPT 95810|
20|FH_F86911_0_0|SrvcGrp|85854|2022|PDM|4.95|99|0.00|HOME INFUSION THERAPY|
20|FH_F114566_46224_0|SrvcGrp|473|2022|PDM|300.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F111862_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100640_48097_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F103961_63017_0|SrvcGrp|9529|2022|PDM|475.00|99|0.00|HOSPICE SVCS|
20|FH_F105440_46383_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F41516_0_0|SrvcGrp|34550|2022|PCT|0.95|99|0.00|CAT SCAN|
20|FH_F132800_0_0|SrvcGrp|111932|2022|PDM|87.00|99|0.00|COVID-19 NON-CDC TESTING LAB|
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|AEG 8 (NO REV)|
20|FH_F43612_0_0|SrvcGrp|1306|2022|PDM|250.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F126345_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114389_50131_0|SrvcGrp|105627|2022|PDM|139.78|99|0.00|LIGHTWEIGHT WHEELCHAIR (MOD RR)|
20|FH_F141336_16947_0|SrvcGrp|11663|2022|PCT|0.39|99|0.00|IMPLANTS|
20|FH_F49487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F49487_0_0|SrvcGrp|14944|2022|PDM|2.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F72085_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F83231_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129596_0_0|SrvcGrp|8950|2022|PDM|1730.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F42999_0_0|SrvcGrp|10540|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F40063_0_0|SrvcGrp|9506|2022|PDM|2843.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F125028_19061_0|SrvcGrp|86852|2022|PDM|63.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F141607_27021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33642_0_0|SrvcGrp|12406|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F143528_0_0|SrvcGrp|67065|2022|PDM|10474.80|99|0.00|CERVICAL SURGERY|
20|FH_F137087_0_0|SrvcGrp|11673|2022|PDM|6150.00|99|0.00|CPT 29888|
20|FH_F72546_0_0|SrvcGrp|114298|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME) (HCFA)|
20|FH_F34550_0_0|SrvcGrp|115|2022|PDM|596.00|99|0.00|SKILLED NURSING CARE|
20|FH_F119660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F114918_78748_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F102020_0_0|SrvcGrp|9830|2022|PDM|143.00|99|0.00|OT SVCS|
20|FH_F65159_0_0|CSTM-ALL|CSTM-00|2020|PDM|4232.00|99|0.00|ASPG VII|
20|FH_F63129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38411_0_0|SrvcGrp|20908|2022|PCT|0.80|99|0.00|MS DRG 247 ONLY|
20|FH_F135840_0_0|SrvcGrp|82310|2022|PDM|550.00|99|0.00|COLORECTAL CANCER SCREENING|
20|FH_F130715_98503_0|SrvcGrp|75419|2022|PDM|695.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F130755_04401_0|SrvcGrp|537|2022|PCT|0.93|99|0.00|OBSERVATION SERVICES|
20|FH_F130775_61701_0|SrvcGrp|73842|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130841_49315_0|SrvcGrp|89781|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F130905_60187_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134656_02852_0|SrvcGrp|76501|2022|PDM|250.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F99760_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F119107_22601_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F134593_60007_0|SrvcGrp|112060|2022|PCT|0.85|99|0.00|HAEGARDA|
20|FH_F120484_31419_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F100782_0_0|SrvcGrp|108208|2022|PDM|1207.50|99|0.00|TRANSCATHETER DLVR|
20|FH_F138149_24112_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F81838_0_0|SrvcGrp|9830|2022|PDM|83.00|99|0.00|OT SVCS|
20|FH_F134669_17403_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133585_0_0|SrvcGrp|77290|2022|PDM|424.00|99|0.00|AETNA REMV TUNNLD CVC W/O SUBQ PORT|
20|FH_F149345_45044_0|SrvcGrp|87536|2022|PDM|664.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F67887_0_0|SrvcGrp|43430|2022|PDM|66.00|99|0.00|LPN HOME VISIT|
20|FH_F121303_15501_0|SrvcGrp|78067|2022|PDM|438.00|99|0.00|SUBACUTE CARE|
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_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|39.27|99|0.00|HAPA WPA-NWPA 2012-13 ASC 247 W/O REV|
20|FH_F110470_98335_0|SrvcGrp|90854|2022|PDM|443.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F81698_10457_0|SrvcGrp|86851|2022|PDM|31.50|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F33532_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F138447_22041_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135660_77061_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F89319_41001_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F69647_0_0|SrvcGrp|17077|2022|PDM|1750.00|99|0.00|ASPG VII|
20|FH_F130017_02302_0|SrvcGrp|73602|2022|PDM|1473.49|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F77597_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F114683_0_0|SrvcGrp|41334|2022|PDM|6750.00|99|0.00|TOTAL KNEE|
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|5404.00|99|0.00|AEG 8 (NO REV)|
20|FH_F85133_85251_0|SrvcGrp|48396|2022|PDM|126.00|99|0.00|OT SERVICES|
20|FH_F133805_83401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1996.83|99|0.00|HAPA WPA-NWPA 2012-13 ASC 903 W/O REV|
20|FH_F120735_40012_0|SrvcGrp|73842|2022|PDM|171.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|1321.31|99|0.00|AEG 8 (NO REV)|
20|FH_F134593_60007_0|SrvcGrp|86850|2022|PDM|48.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F127589_45459_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F126354_91321_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F134172_33126_0|SrvcGrp|73842|2022|PDM|453.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F125407_68756_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F111732_33771_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120719_27540_0|SrvcGrp|109057|2022|PCT|0.71|99|0.00|CARDIAC STUDIES|
20|FH_F37963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|589.35|99|0.00|HAPA WPA-NWPA 2012-13 ASC 405 W/O REV|
20|FH_F86132_27105_0|SrvcGrp|471|2022|PDM|472.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F79743_0_0|CSTM-ALL|CSTM-00|2020|PDM|3083.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F109400_80026_0|SrvcGrp|48396|2022|PDM|98.00|99|0.00|OT SERVICES|
20|FH_F85652_98034_0|CSTM-ALL|CSTM-00|2020|PCT|2.36|99|0.00|AETNA - APC GROUPER F|
20|FH_F79863_0_0|SrvcGrp|77231|2022|PDM|90.00|99|0.00|AETNA HOME INFUSION S9325|
20|FH_F71866_0_0|SrvcGrp|68846|2022|PDM|700.00|99|0.00|SKILLED NURSING|
20|FH_F85492_0_0|SrvcGrp|22529|2022|PCT|0.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F150239_75569_0|SrvcGrp|115816|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|2430.00|99|0.00|AEG 6 (NO REV)|
20|FH_F89219_0_0|SrvcGrp|20908|2022|PDM|34850.00|99|0.00|MS DRG 247 ONLY|
20|FH_F133801_87107_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F125164_15206_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148923_71854_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132958_79903_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F110466_06870_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F109248_0_0|SrvcGrp|71666|2022|PDM|2200.00|99|0.00|CPT 63655|
20|FH_F124059_64055_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F146807_28655_0|SrvcGrp|3378|2022|PCT|0.85|99|0.00|OBSERVATION SVCS|
20|FH_F146912_90025_0|SrvcGrp|90854|2022|PDM|1421.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F146985_12205_0|SrvcGrp|73701|2022|PDM|32.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F146985_12205_0|SrvcGrp|88621|2022|PDM|79.00|99|0.00|SKILLED NURSING LPN|
20|FH_F147014_33612_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|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38233_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F91898_0_0|SrvcGrp|32560|2022|PCT|0.95|99|0.00|BURN SERVICES (MS DRG)|
20|FH_F91998_0_0|SrvcGrp|72998|2022|PDM|774.00|99|0.00|AEG 5|
20|FH_F92493_0_0|SrvcGrp|95559|2022|PDM|16193.10|99|0.00|HIP JOINT|
20|FH_F129973_48030_0|SrvcGrp|35982|2022|PDM|50.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F124414_92653_0|SrvcGrp|87131|2022|PDM|410.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F150910_0_0|SrvcGrp|89404|2022|PDM|10950.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F97083_90670_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F63185_0_0|SrvcGrp|48395|2022|PDM|30.00|99|0.00|OT SERVICES|
20|FH_F98042_10468_0|SrvcGrp|73643|2022|PDM|987.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F114705_77018_0|SrvcGrp|73842|2022|PDM|213.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138984_06896_0|SrvcGrp|472|2022|PDM|555.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F137933_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 3 (NO REV)|
20|FH_F127448_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F43000_0_0|SrvcGrp|17126|2022|PDM|75.00|99|0.00|PT SVCS|
20|FH_F134670_95628_0|SrvcGrp|46903|2022|PDM|660.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F134697_32566_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136913_68803_0|SrvcGrp|11663|2022|PCT|1.15|99|0.00|IMPLANTS|
20|FH_F46938_0_0|SrvcGrp|42046|2022|PDM|595.00|99|0.00|HOSPICE CARE|
20|FH_F62922_0_0|SrvcGrp|3259|2022|PDM|650.00|99|0.00|ACUTE REHABILITATION|
20|FH_F115144_71373_0|SrvcGrp|11199|2022|PDM|510.00|99|0.00|HYPERBARIC CHAMBER|
20|FH_F115152_77058_0|SrvcGrp|75419|2022|PDM|415.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F115210_21043_0|SrvcGrp|92819|2022|PDM|3500.00|99|0.00|HIP ARTHOSCOPY|
20|FH_F116339_41064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116393_07002_0|SrvcGrp|111274|2022|PDM|19.67|99|0.00|PROT; ELEC-PHORE FRACTIONATI|
20|FH_F147400_77707_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147519_52627_0|CSTM-ALL|CSTM-00|2020|PDM|4636.69|99|0.00|AEG 6 (NO REV)|
20|FH_F147585_60402_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|ENTERAL NUTRITION (B4035) (MOD SH)|
20|FH_F126435_77459_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113649_01752_0|SrvcGrp|86837|2022|PDM|225.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F36418_0_0|SrvcGrp|14174|2022|PCT|1.00|99|0.00|MRI|
20|FH_F33381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F38476_0_0|SrvcGrp|11798|2022|PDM|112.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F151002_0_0|SrvcGrp|16719|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F123445_0_0|SrvcGrp|90707|2022|PDM|194.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F51113_15501_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
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_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|1563.00|99|0.00|AEG 8 (NO REV)|
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|3025.00|99|0.00|AEG 7 (NO REV)|
20|FH_F100906_0_0|SrvcGrp|94682|2022|PDM|1500.00|99|0.00|SPINE OSTEOTOMY POSTERIOR|
20|FH_F100906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39346_0_0|SrvcGrp|20908|2022|PDM|17625.00|99|0.00|MS DRG 247 ONLY|
20|FH_F47999_0_0|SrvcGrp|26001|2022|PDM|159.50|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F141837_0_0|SrvcGrp|2067|2022|PDM|1275.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F120657_54220_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38846_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|ACUTE PSYCH|
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_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 2 (NO REV)|
20|FH_F51492_0_0|SrvcGrp|44131|2022|PDM|75.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F113585_20155_0|SrvcGrp|89474|2022|PCT|1.00|99|0.00|ALL DRUGS/AGENTS/ INJ DRUG|
20|FH_F138684_44484_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F138876_25302_0|SrvcGrp|24744|2022|PDM|60.00|99|0.00|PICC LINE INSERTION|
20|FH_F138387_02886_0|SrvcGrp|93358|2022|PDM|115.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F78265_0_0|SrvcGrp|9795|2022|PDM|1234.00|99|0.00|SUBACUTE REHAB|
20|FH_F119888_0_0|SrvcGrp|106317|2022|PDM|715.98|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143832_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F151380_90701_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151479_75605_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151503_30067_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151508_60435_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145068_63084_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135493_07514_0|SrvcGrp|86722|2022|PDM|186.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F136026_66062_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F100880_67735_0|SrvcGrp|88791|2022|PDM|14564.00|99|0.00|BARIATRIC SURGERY|
20|FH_F131463_19096_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F130996_34110_0|SrvcGrp|89860|2022|PDM|5300.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F114851_15301_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F69708_0_0|SrvcGrp|12886|2022|PDM|232.00|99|0.00|HOSPICE SVCS (HOME CARE)|
20|FH_F134613_08852_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F133922_70563_0|SrvcGrp|38247|2022|PDM|661.75|99|0.00|SLEEP STUDIES|
20|FH_F77184_0_0|SrvcGrp|46605|2022|PDM|18.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F149150_75407_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1505.73|99|0.00|HAPA WPA-NWPA 2012-13 ASC 704 W/O REV|
20|FH_F54592_0_0|SrvcGrp|24761|2022|PDM|42.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134472_84624_0|SrvcGrp|473|2022|PDM|318.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F98800_85021_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F101084_15459_0|SrvcGrp|472|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F101100_50314_0|SrvcGrp|30623|2022|PDM|7440.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F105143_26062_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F105361_80104_0|SrvcGrp|73602|2022|PDM|1596.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F115877_63556_0|SrvcGrp|73606|2022|PDM|350.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F115934_70605_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F77665_0_0|SrvcGrp|10545|2022|PDM|60.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F131904_18915_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F131964_89120_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131596_60433_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111603_19529_0|SrvcGrp|46903|2022|PDM|520.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F111605_80524_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|1730.30|99|0.00|AEG 10 (NO REV)|
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|718.86|99|0.00|2005 ASPG GROUPER IV|
20|FH_F46433_0_0|SrvcGrp|27601|2022|PDM|1038.78|99|0.00|SYNAGIS (50 MG)|
20|FH_F47999_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35404_0_0|SrvcGrp|9937|2022|PDM|120.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F135351_0_0|SrvcGrp|88491|2022|PDM|7370.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F117820_0_0|SrvcGrp|80317|2022|PDM|82.34|99|0.00|RESPITE CARE|
20|FH_F114853_0_0|SrvcGrp|88160|2022|PDM|7215.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F117509_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.00|99|0.00|AEG 1 (NO REV)|
20|FH_F138857_90025_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F67167_0_0|SrvcGrp|12670|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F89580_0_0|CSTM-ALL|CSTM-00|2020|PDM|5869.00|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_F72606_0_0|SrvcGrp|21826|2022|PDM|9525.00|99|0.00|PTCA (MS DRG ONLY)|
20|FH_F151304_31520_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)|
20|FH_F151340_30040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151501_30265_0|SrvcGrp|27310|2022|PDM|2090.00|99|0.00|ENDOSCOPIC PLANTAR FASCIOTOMY|
20|FH_F151511_14094_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F151514_35242_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F151515_77901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132258_45404_0|SrvcGrp|22589|2022|PDM|50.88|99|0.00|CHEMOTHERAPY NOC|
20|FH_F132262_60062_0|SrvcGrp|90573|2022|PDM|336.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F132268_07060_0|SrvcGrp|94738|2022|PDM|56.65|99|0.00|FLUZONE VACC IM (>=3 YRS)|
20|FH_F144989_07701_0|SrvcGrp|73523|2022|PCT|1.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F135350_60014_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F135352_32225_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42554_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116397_33404_0|SrvcGrp|14893|2022|PDM|28.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F116447_21601_0|SrvcGrp|82222|2022|PDM|166.00|99|0.00|HOSPICE CARE|
20|FH_F116527_70443_0|SrvcGrp|10391|2022|PDM|1400.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F116527_70443_0|SrvcGrp|79099|2022|PDM|1400.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 6 (NO REV)|
20|FH_F127399_0_0|SrvcGrp|84939|2022|PDM|14045.00|99|0.00|SHOULDER JOINT|
20|FH_F127399_0_0|SrvcGrp|33965|2022|PDM|4682.00|99|0.00|CPT 58552|
20|FH_F127399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140629_0_0|SrvcGrp|87053|2022|PDM|1016.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F101556_81004_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPT CARE OF MUNCY FH - DME|
20|FH_F101182_07863_0|SrvcGrp|93268|2022|PCT|1.00|99|0.00|LOVENOX/ENOXAPARIN|
20|FH_F111301_33122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F65882_0_0|SrvcGrp|42825|2022|PDM|41.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F131000_0_0|SrvcGrp|33985|2022|PDM|2494.00|99|0.00|CPT 19120|
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PDM|1754.00|99|0.00|AEG 10 (NO REV)|
20|FH_F114569_0_0|SrvcGrp|105675|2022|PCT|1.00|99|0.00|AETNA BH TELEMEDICINE/OP THERAPY SVCS (MOD GT)|
20|FH_F118651_0_0|SrvcGrp|27348|2022|PDM|2652.25|99|0.00|OP SURGERY (CPT 58662)|
20|FH_F112092_46845_0|SrvcGrp|90494|2022|PCT|1.00|99|0.00|AFLURIA VACC 3 YRS & > IM|
20|FH_F87532_32110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F88831_84123_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F102222_19720_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F98626_29118_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F102282_06795_0|SrvcGrp|63297|2022|PDM|153.62|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F129220_18445_0|SrvcGrp|110058|2022|PDM|16.26|99|0.00|BEHAVIOR ASSESSMENT 15 MINS|
20|FH_F130766_04967_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F127399_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F127399_0_0|SrvcGrp|34606|2022|PDM|3017.00|99|0.00|CPT 29827|
20|FH_F38843_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|ACUTE REHABILITATION|
20|FH_F101718_50702_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121871_65401_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67923_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38013_0_0|SrvcGrp|12045|2022|PDM|545.00|99|0.00|SLEEP STUDIES|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPTION CARE OF MUNCY INF FH|
20|FH_F44754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128353_22191_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F130774_57401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111301_33122_0|SrvcGrp|82746|2022|PDM|106.00|99|0.00|CULT BACT BLD AEROIC ISOLA|
20|FH_F111301_33122_0|SrvcGrp|45582|2022|PDM|40.00|99|0.00|CPT 85610|
20|FH_F134290_67209_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|902.00|99|0.00|AEG 5  (NO REV)|
20|FH_F145587_0_0|SrvcGrp|109068|2022|PDM|1262.70|99|0.00|PARTIAL REMOVAL OF FOOT BONE|
20|FH_F55577_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132328_0_0|SrvcGrp|74039|2022|PDM|6097.00|99|0.00|LAMINECTOMY|
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|1119.00|99|0.00|2006 MEDICARE ASPG VIII|
20|FH_F87496_17055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98626_29118_0|SrvcGrp|73602|2022|PDM|2958.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F129240_10028_0|SrvcGrp|29077|2022|PDM|25.00|99|0.00|HOME TRANSFUSION|
20|FH_F148101_33462_0|SrvcGrp|74668|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119526_60435_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137951_0_0|SrvcGrp|92408|2022|PDM|3000.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F148561_17022_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130553_18640_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F110971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90811_0_0|SrvcGrp|88748|2022|PDM|2500.00|99|0.00|HIP ARTHROSCOPY|
20|FH_F79902_0_0|SrvcGrp|3029|2022|PDM|2152.00|99|0.00|NEWBORN NURSERY|
20|FH_F142931_60644_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47433_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CHESTER CTY RADIOLOGY|
20|FH_F145988_06105_0|SrvcGrp|72984|2022|PCT|0.69|99|0.00|CHEMOTHERAPY|
20|FH_F81657_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F44257_0_0|CSTM-ALL|CSTM-00|2020|PDM|522.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F106241_93309_0|SrvcGrp|87536|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F118667_95131_0|SrvcGrp|48398|2022|PDM|120.00|99|0.00|PT SERVICES|
20|FH_F148556_13206_0|SrvcGrp|26868|2022|PDM|35.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F108940_15642_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F118468_21502_0|SrvcGrp|471|2022|PDM|808.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F98600_91730_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|174.01|99|0.00|HAPA WPA-NWPA 2012-13 ASC 234 W/O REV|
20|FH_F103281_32086_0|SrvcGrp|74588|2022|PDM|7000.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F129303_33139_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133021_00910_0|SrvcGrp|53663|2022|PCT|0.70|99|0.00|PAIN MANAGEMENT SERVICES|
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_F149781_37404_0|SrvcGrp|92410|2022|PDM|3990.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1433.00|99|0.00|AEG 5  (NO REV)|
20|FH_F136728_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.00|99|0.00|AEG 3 (NO REV)|
20|FH_F33139_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1108.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F71268_0_0|SrvcGrp|3212|2022|PDM|600.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F133018_84037_0|SrvcGrp|63119|2022|PDM|615.00|99|0.00|BASIC HOME HOSPICE CARE|
20|FH_F40599_0_0|SrvcGrp|27776|2022|PDM|515.00|99|0.00|OP MRI|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F133291_33563_0|SrvcGrp|89149|2022|PDM|290.00|99|0.00|OP INTENSIVE|
20|FH_F126663_91423_0|SrvcGrp|73701|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F109842_28337_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F141907_74021_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129535_0_0|SrvcGrp|75495|2022|PDM|1000.00|99|0.00|AEG 9|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|115.08|99|0.00|HAPA WPA-NWPA 2012-13 ASC 241 W/O REV|
20|FH_F72750_0_0|CSTM-ALL|CSTM-00|2020|PDM|2346.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F133271_72204_0|SrvcGrp|108484|2022|PDM|662.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F117965_60714_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F108700_63857_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|1126.00|99|0.00|AEG 7 (NO REV)|
20|FH_F150531_16148_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|588.83|99|0.00|HAPA WPA-NWPA 2012-13 ASC 302 W/O REV|
20|FH_F87155_04105_0|SrvcGrp|29023|2022|PDM|78.80|99|0.00|HOME INFUSION THERAPY|
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|486.00|99|0.00|AEG 3 (NO REV)|
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|1751.00|99|0.00|AEG 7 (NO REV)|
20|FH_F109669_28376_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F132289_89145_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F108940_15642_0|SrvcGrp|89149|2022|PDM|159.00|99|0.00|OP INTENSIVE|
20|FH_F126560_43606_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F125176_20785_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|142.66|99|0.00|SLEEP STUDY CPT 95800|
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1655.00|99|0.00|AEG 9 (NO REV)|
20|FH_F119437_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141930_72032_0|CSTM-ALL|CSTM-00|2020|PDM|1019.00|99|0.00|AEG 5  (NO REV)|
20|FH_F106243_92780_0|SrvcGrp|16|2022|PDM|1003.00|99|0.00|ACUTE REHABILITATION|
20|FH_F117950_37110_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111813_08080_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F87577_80016_0|SrvcGrp|3493|2022|PCT|0.50|99|0.00|PHARMACY SVCS|
20|FH_F102325_62691_0|SrvcGrp|64636|2022|PDM|700.00|99|0.00|HOSPICE CONTINUOUS HOME CARE|
20|FH_F145988_06105_0|SrvcGrp|79786|2022|PCT|0.00|99|0.00|SLEEP STUDIES|
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146116_34233_0|SrvcGrp|92502|2022|PDM|842.10|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F133540_72687_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145328_90301_0|SrvcGrp|113320|2022|PDM|225.00|99|0.00|MED ASSIST TX METH WK|
20|FH_F37778_0_0|SrvcGrp|27417|2022|PDM|1884.00|99|0.00|LAPAROSCOPIC PROCEDURES|
20|FH_F145901_45205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F92676_15063_0|SrvcGrp|79035|2022|PDM|762.96|99|0.00|MON VALLEY ASC 228|
20|FH_F128492_49010_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F81373_64064_0|SrvcGrp|79699|2022|PCT|0.66|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F74084_15206_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F102561_75146_0|SrvcGrp|73002|2022|PDM|3200.00|99|0.00|AEG 7|
20|FH_F100784_59923_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125368_24153_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F41181_0_0|SrvcGrp|1306|2022|PDM|442.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F117962_17603_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146282_08244_0|SrvcGrp|74668|2022|PDM|1660.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121011_68510_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146110_48433_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F50472_0_0|SrvcGrp|44819|2022|PDM|65.00|99|0.00|SPEECH THERAPY|
20|FH_F126849_67337_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54552_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|HOME NURSING / SPECIALIZED NURSING|
20|FH_F139347_06471_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139487_60076_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F139677_77087_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F150841_84757_0|SrvcGrp|108484|2022|PDM|1300.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139150_75206_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151042_60659_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110824_83221_0|SrvcGrp|88977|2022|PDM|6401.00|99|0.00|C-SECTION DELIVERY|
20|FH_F40899_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F35774_33573_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F129237_72833_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F148940_44077_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35678_0_0|SrvcGrp|1943|2022|PDM|1412.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F124441_0_0|SrvcGrp|92364|2022|PDM|13300.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F140140_07722_0|SrvcGrp|86457|2022|PDM|1252.00|99|0.00|AETNA ACUTE REHABILITATION|
20|FH_F132123_91360_0|SrvcGrp|75419|2022|PDM|650.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F137797_70123_0|SrvcGrp|23683|2022|PDM|60.93|99|0.00|SKILLED NURSING RN|
20|FH_F146266_0_0|SrvcGrp|114328|2022|PDM|8661.00|99|0.00|REVISE ELBOW JOINT|
20|FH_F122333_67010_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40593_0_0|SrvcGrp|472|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F35742_33407_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1331.00|99|0.00|AEG 5  (NO REV)|
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.00|99|0.00|AEG 4 (NO REV)|
20|FH_F131284_76502_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97623_38008_0|SrvcGrp|88978|2022|PDM|6918.00|99|0.00|VAGINAL DELIVERY|
20|FH_F122271_79416_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F110732_31513_0|SrvcGrp|29817|2022|PDM|3660.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F134847_0_0|SrvcGrp|112644|2022|PDM|4090.00|99|0.00|JOINT ARTHROSCOPY|
20|FH_F49093_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F40490_0_0|SrvcGrp|32560|2022|PCT|0.88|99|0.00|BURN SERVICES (MS DRG)|
20|FH_F125182_0_0|SrvcGrp|72994|2022|PDM|549.00|99|0.00|AEG 3|
20|FH_F131387_76001_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F117426_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 310|
20|FH_F109762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40521_0_0|CSTM-ALL|CSTM-00|2020|PDM|870.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 7 (NO REV)|
20|FH_F127418_0_0|SrvcGrp|90978|2022|PDM|3718.75|99|0.00|INJECTION CERVICAL OR THORACIC TRANSFORAMINAL EPIDURAL|
20|FH_F117581_21211_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F76887_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100540_0_0|SrvcGrp|12491|2022|PCT|1.05|99|0.00|PACEMAKER|
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F39082_0_0|SrvcGrp|15|2022|PDM|2147.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F117762_0_0|SrvcGrp|99176|2022|PDM|1279.00|99|0.00|REMOVE TONSILS AND ADENOIDS|
20|FH_F35557_0_0|SrvcGrp|10569|2022|PDM|43.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|53.00|99|0.00|GROWTH HORMONE THERAPY|
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134868_32504_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42775_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F140295_0_0|SrvcGrp|99163|2022|PDM|13261.00|99|0.00|CPT 27703|
20|FH_F98623_97006_0|SrvcGrp|73643|2022|PDM|939.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F127189_49503_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120119_0_0|SrvcGrp|114518|2022|PDM|3126.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F147217_33781_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125214_12428_0|SrvcGrp|42785|2022|PDM|110.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|38486.00|99|0.00|MSDRG 233-234 CORONARY BYPASS|
20|FH_F147347_70806_0|SrvcGrp|89023|2022|PDM|75.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F122377_91007_0|SrvcGrp|109165|2022|PDM|6379.00|99|0.00|SURGICAL CARE|
20|FH_F84058_0_0|SrvcGrp|13262|2022|PDM|7.59|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
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_F40104_0_0|SrvcGrp|9828|2022|PDM|61.01|99|0.00|HOME HEALTH AIDE|
20|FH_F37422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150419_64119_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124470_90025_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F90817_0_0|SrvcGrp|90371|2022|PDM|2096.00|99|0.00|REBUILD OUTER EAR CANAL|
20|FH_F114332_19973_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F140093_33467_0|SrvcGrp|87317|2022|PDM|927.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F84058_0_0|SrvcGrp|82448|2022|PDM|437.37|99|0.00|AMBULANCE SVC ADV LIFE SUPPORT EMERGENCY|
20|FH_F92299_62016_0|SrvcGrp|77979|2022|PCT|0.75|99|0.00|THERAPY|
20|FH_F131385_76457_0|SrvcGrp|86722|2022|PDM|198.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AEG 6 (NO REV)|
20|FH_F117762_0_0|SrvcGrp|67065|2022|PDM|13520.00|99|0.00|CERVICAL SURGERY|
20|FH_F116575_0_0|SrvcGrp|27344|2022|PDM|1600.00|99|0.00|OP SURGERY (CPT 42821)|
20|FH_F149522_83221_0|SrvcGrp|95660|2022|PDM|550.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F130328_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F124452_31322_0|SrvcGrp|48385|2022|PDM|130.00|99|0.00|SPEECH THERAPY|
20|FH_F132672_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 2 (NO REV)|
20|FH_F114206_37203_0|SrvcGrp|14947|2022|PDM|4.00|99|0.00|HOME INFUSION|
20|FH_F139928_37228_0|SrvcGrp|86723|2022|PDM|550.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F143214_92506_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F143471_02895_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143533_30013_0|SrvcGrp|99363|2022|PDM|222.00|99|0.00|SCR MAMMO BI INCL CAD|
20|FH_F93740_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93740_0_0|SrvcGrp|91584|2022|PDM|8800.00|99|0.00|PTCA W/ DRUG ELUDING STENT (DES)|
20|FH_F102920_0_0|SrvcGrp|87677|2022|PDM|2026.00|99|0.00|CERVICAL OR THORACIC 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|88494|2022|PDM|2400.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F130917_48658_0|SrvcGrp|29155|2022|PDM|130.00|99|0.00|HOSPICE SVCS|
20|FH_F130917_48658_0|SrvcGrp|84185|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F120171_33770_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F112712_63005_0|SrvcGrp|24753|2022|PCT|1.00|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F116683_64730_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F49895_0_0|SrvcGrp|32390|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKE (DME)|
20|FH_F48133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F57093_0_0|SrvcGrp|17808|2022|PDM|550.00|99|0.00|ELECTRO CONVULSIVE THERAPY|
20|FH_F59992_0_0|SrvcGrp|56103|2022|PDM|2600.00|99|0.00|VAGINAL DELIVERY WITH POST PARTUM|
20|FH_F83451_0_0|SrvcGrp|81564|2022|PDM|1625.00|99|0.00|ARTHROSCOPY HIP|
20|FH_F110086_21742_0|SrvcGrp|63459|2022|PDM|1700.00|99|0.00|CPT 52601|
20|FH_F55673_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90654_0_0|SrvcGrp|16778|2022|PCT|0.70|99|0.00|DIALYSIS|
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 8 (NO REV)|
20|FH_F58592_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|OP SURGERY (MOD SG)|
20|FH_F37884_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD RR|
20|FH_F33642_0_0|SrvcGrp|15363|2022|PCT|0.60|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F121523_33406_0|SrvcGrp|89337|2022|PDM|1248.00|99|0.00|DETOXIFICATION|
20|FH_F123505_64468_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128402_80233_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128982_44221_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F115464_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F141407_76226_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F130013_16509_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F39531_0_0|SrvcGrp|72|2022|PDM|400.00|99|0.00|NEWBORN NURSERY|
20|FH_F56136_0_0|SrvcGrp|3029|2022|PDM|603.00|99|0.00|NEWBORN NURSERY|
20|FH_F126581_45638_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F37756_0_0|SrvcGrp|31769|2022|PDM|9923.00|99|0.00|CARDIAC ABLATION|
20|FH_F130889_68818_0|CSTM-ALL|CSTM-00|2020|PCT|0.96|99|0.00|GENERAL ACUTE CARE|
20|FH_F125891_45219_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F136092_0_0|SrvcGrp|65720|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F141390_19007_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145797_46250_0|SrvcGrp|113911|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F115685_64064_0|SrvcGrp|86845|2022|PDM|75.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F49338_0_0|SrvcGrp|31190|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC (DME)|
20|FH_F151560_76012_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116311_02657_0|SrvcGrp|89337|2022|PDM|847.00|99|0.00|DETOXIFICATION|
20|FH_F148255_72703_0|SrvcGrp|17016|2022|PDM|31.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F143900_63303_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1075.00|99|0.00|AEG 8 (NO REV)|
20|FH_F151526_28208_0|CSTM-ALL|CSTM-00|2020|PDM|2507.00|99|0.00|AEG 9 (NO REV)|
20|FH_F123511_64076_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131952_06002_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145545_01602_0|SrvcGrp|17698|2022|PDM|1104.00|99|0.00|ACUTE PSYCH (>=18 YRS)|
20|FH_F136510_0_0|SrvcGrp|38909|2022|PDM|3882.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|363.99|99|0.00|HAPA WPA-NWPA 2012-13 ASC 102 W/O REV|
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)|
20|FH_F130452_48801_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F62719_0_0|SrvcGrp|46183|2022|PCT|0.70|99|0.00|WOUND CARE / MEDICAL SUPPLIES|
20|FH_F118079_37642_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F118338_94952_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F127032_33573_0|SrvcGrp|104226|2022|PDM|181.40|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F39740_0_0|SrvcGrp|21122|2022|PDM|17853.00|99|0.00|MS DRG 459 ONLY|
20|FH_F101021_0_0|SrvcGrp|93098|2022|PDM|83.00|99|0.00|HOSPICE CARE|
20|FH_F149888_68506_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PDM|2251.00|99|0.00|AEG 9 (NO REV)|
20|FH_F148440_16506_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 10 (NO REV)|
20|FH_F136510_0_0|SrvcGrp|107611|2022|PDM|3882.00|99|0.00|IMPLTJ NTRSTRML CRNL RNG SEGMENTS|
20|FH_F56136_0_0|SrvcGrp|21818|2022|PCT|0.92|99|0.00|DIAGNOSTIC CARDIAC CATH|
20|FH_F97104_53545_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|1494.00|99|0.00|AEG 6 (NO REV)|
20|FH_F84911_0_0|CSTM-ALL|CSTM-00|2020|PCT|9500.00|99|0.00|TIMELY FILING|
20|FH_F143819_29485_0|SrvcGrp|75419|2022|PDM|478.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148255_72703_0|SrvcGrp|24750|2022|PDM|31.50|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F82714_18848_0|SrvcGrp|73496|2022|PDM|1360.00|99|0.00|AETNA ER LEVEL V|
20|FH_F36679_0_0|CSTM-ALL|CSTM-00|2020|PDM|65.00|99|0.00|5781263-GA-PT/OT/ST-CPT|
20|FH_F120674_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.41|99|0.00|OP SVCS|
20|FH_F42360_0_0|SrvcGrp|33165|2022|PDM|285.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F125983_82301_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F38433_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F99100_0_0|SrvcGrp|96060|2022|PDM|1801.47|99|0.00|DISECTOMY|
20|FH_F79746_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_F90818_0_0|SrvcGrp|11673|2022|PDM|7500.00|99|0.00|CPT 29888|
20|FH_F137460_42103_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F132559_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F89779_0_0|SrvcGrp|72998|2022|PDM|3300.00|99|0.00|AEG 5|
20|FH_F78162_0_0|SrvcGrp|67284|2022|PDM|57.00|99|0.00|OT SUBSEQUENT VISIT 97139|
20|FH_F106941_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F78603_0_0|SrvcGrp|28164|2022|PDM|79236.91|99|0.00|MS DRG 224 ONLY|
20|FH_F149839_80002_0|SrvcGrp|27969|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE|
20|FH_F127415_45822_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91321_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51358_0_0|SrvcGrp|45950|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F148266_45419_0|CSTM-ALL|CSTM-00|2020|PDM|1871.00|99|0.00|AEG 9 (NO REV)|
20|FH_F33479_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F73730_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128982_44221_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F88212_20151_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87031_0_0|SrvcGrp|72998|2022|PDM|1117.00|99|0.00|AEG 5|
20|FH_F92276_32308_0|SrvcGrp|73659|2022|PDM|3465.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F35476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS|
20|FH_F123529_31021_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F34735_0_0|SrvcGrp|18374|2022|PCT|0.75|99|0.00|MS DRG 311|
20|FH_F118194_50841_0|SrvcGrp|86834|2022|PDM|33.51|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F115020_67301_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F149839_80002_0|SrvcGrp|95661|2022|PDM|142.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F33712_0_0|SrvcGrp|360|2022|PDM|725.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F65444_0_0|SrvcGrp|76207|2022|PDM|75.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN|
20|FH_F91617_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|PROLONGED SERVICE (HCFA MOD 25)|
20|FH_F141169_0_0|SrvcGrp|113731|2022|PDM|1389.00|99|0.00|INDUCED ABORTION BY DILATION AND EVACUATION|
20|FH_F72183_0_0|SrvcGrp|12154|2022|PDM|3500.00|99|0.00|LITHOTRIPSY|
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|489.00|99|0.00|AEG 1 (NO REV)|
20|FH_F131809_37355_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F106020_0_0|SrvcGrp|27347|2022|PDM|1366.00|99|0.00|CPT 58558|
20|FH_F97242_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102302_0_0|SrvcGrp|98588|2022|PDM|14750.00|99|0.00|REMOVE SPINE INFUSION DEVI16|
20|FH_F124899_45246_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130846_28304_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 3 (NO REV)|
20|FH_F130134_08724_0|SrvcGrp|105017|2022|PDM|425.00|99|0.00|RESIDENTIAL TREATMENT (13-17 YRS)|
20|FH_F56952_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F55212_0_0|SrvcGrp|51065|2022|PDM|173.00|99|0.00|HOSP DISCHARGE DAY MGMT 30 MINS OR LESS|
20|FH_F62579_0_0|SrvcGrp|26867|2022|PDM|80.00|99|0.00|ANTI-EMETICS INFUSION THERAPY|
20|FH_F135840_0_0|SrvcGrp|75491|2022|PDM|1045.00|99|0.00|AEG 7|
20|FH_F130662_07032_0|SrvcGrp|73842|2022|PDM|222.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151300_0_0|CSTM-ALL|CSTM-00|2020|PDM|310.00|99|0.00|AEG 1 (NO REV)|
20|FH_F120539_89029_0|SrvcGrp|29346|2022|PDM|55.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F127090_45601_0|SrvcGrp|24761|2022|PDM|59.16|99|0.00|HOME INFUSION THERAPY|
20|FH_F139569_15063_0|CSTM-ALL|CSTM-00|2020|PDM|1237.00|99|0.00|AEG 8 (NO REV)|
20|FH_F124162_73127_0|SrvcGrp|86723|2022|PDM|367.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F49601_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|OP SURGERY MOD SG|
20|FH_F117300_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F113345_25301_0|SrvcGrp|103913|2022|PCT|0.70|99|0.00|OP DIALYSIS|
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_F149121_01520_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43863_0_0|SrvcGrp|37405|2022|PDM|90.00|99|0.00|OT SVCS|
20|FH_F123851_03235_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83035_0_0|SrvcGrp|76094|2022|PDM|118.14|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F121597_30315_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F88935_0_0|SrvcGrp|76094|2022|PDM|129.05|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F132609_0_0|SrvcGrp|360|2022|PDM|1520.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F116806_0_0|SrvcGrp|107006|2022|PDM|10683.28|99|0.00|ARTHROPLASTY W/ PROSTHETIC JOINT REPLACEMENT|
20|FH_F110507_33462_0|SrvcGrp|89417|2022|PDM|390.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F97840_54729_0|SrvcGrp|73656|2022|PDM|586.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F124369_0_0|SrvcGrp|100065|2022|PDM|4400.00|99|0.00|DEEP ANT OR POSTER TIBIAL|
20|FH_F70883_0_0|SrvcGrp|22954|2022|PDM|175.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F144228_0_0|SrvcGrp|114150|2022|PDM|1203.00|99|0.00|SIGMOIDOSCOPY|
20|FH_F69744_0_0|SrvcGrp|10111|2022|PCT|0.56|99|0.00|IMPLANTS|
20|FH_F92477_0_0|SrvcGrp|90101|2022|PDM|0.10|99|0.00|AETNA MED RECORD COPY|
20|FH_F138828_78629_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132790_38901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149270_98004_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F143650_0_0|SrvcGrp|85792|2022|PDM|3900.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F43197_0_0|SrvcGrp|11076|2022|PDM|70.00|99|0.00|NURSING CARE|
20|FH_F134610_33426_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F79863_0_0|SrvcGrp|77246|2022|PDM|90.00|99|0.00|AETNA HIT ANTIBIOTIC PER DIEM|
20|FH_F110420_60649_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F31714_0_0|SrvcGrp|44454|2022|PDM|625.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F138050_52301_0|SrvcGrp|104569|2022|PDM|449.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F135900_0_0|SrvcGrp|73483|2022|PDM|500.00|99|0.00|AETNA SUBACUTE III|
20|FH_F145554_53066_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F139723_30066_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F100782_0_0|SrvcGrp|97698|2022|PDM|1687.89|99|0.00|WINDBER MEDICAL CNTR ASC 1406|
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|984.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F145819_03431_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93909_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|798.00|99|0.00|ASPG X|
20|FH_F145641_06902_0|SrvcGrp|102481|2022|PDM|3697.00|99|0.00|CPT 29898|
20|FH_F112023_12866_0|SrvcGrp|73006|2022|PDM|6442.00|99|0.00|AEG 9|
20|FH_F149021_44514_0|SrvcGrp|104003|2022|PDM|2639.23|99|0.00|INSERT AQUEOUS DRAIN DEVICES|
20|FH_F150221_63131_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127199_0_0|SrvcGrp|95661|2022|PDM|114.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F118123_67226_0|SrvcGrp|47183|2022|PDM|83.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F114824_44484_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F143561_16001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143739_33440_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F110311_17078_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100782_0_0|SrvcGrp|105141|2022|PDM|142.08|99|0.00|WINDBER MEDICAL CNTR ASC 247|
20|FH_F132922_91302_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F110509_71351_0|SrvcGrp|72992|2022|PDM|1520.00|99|0.00|AEG 2|
20|FH_F112023_12866_0|SrvcGrp|72998|2022|PDM|5209.00|99|0.00|AEG 5|
20|FH_F116806_0_0|SrvcGrp|107059|2022|PDM|1923.16|99|0.00|REMOVE PALATE/LESION|
20|FH_F109267_12202_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F87541_0_0|SrvcGrp|73004|2022|PDM|1172.00|99|0.00|AEG 8|
20|FH_F149050_22844_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49552_0_0|SrvcGrp|17067|2022|PDM|529.92|99|0.00|ASPG II|
20|FH_F98021_07012_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F145839_45244_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F127080_77520_0|SrvcGrp|86722|2022|PDM|224.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F124369_0_0|SrvcGrp|95462|2022|PDM|4400.00|99|0.00|REPAIR OF ANKLE LIGAMENT|
20|FH_F119107_22601_0|SrvcGrp|29347|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F127090_45601_0|SrvcGrp|43569|2022|PDM|46.73|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F122470_78229_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F122520_46383_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122553_92705_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F31960_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84755_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F102200_06416_0|SrvcGrp|86837|2022|PDM|225.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F105143_26062_0|SrvcGrp|102340|2022|PCT|0.80|99|0.00|ER LEVEL I W/ SURGERY|
20|FH_F105361_80104_0|SrvcGrp|93924|2022|PDM|4130.00|99|0.00|AETNA MEDICAL SERVICES|
20|FH_F115786_57701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F66404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F75842_0_0|SrvcGrp|46517|2022|PDM|9406.88|99|0.00|LAMINECTOMIES|
20|FH_F146668_30189_0|SrvcGrp|109792|2022|PDM|8755.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F120522_53549_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120795_27514_0|SrvcGrp|116119|2022|PCT|0.71|99|0.00|CHEMOTHERAPY|
20|FH_F120795_27514_0|SrvcGrp|10361|2022|PDM|318.00|99|0.00|CPT CODE 99281|
20|FH_F51136_0_0|SrvcGrp|14938|2022|PDM|1575.00|99|0.00|PROGRESSIVE TELEMETRY|
20|FH_F133544_78227_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133478_40165_0|SrvcGrp|112339|2022|PCT|0.54|99|0.00|THUMB REPLANTATION|
20|FH_F111829_32257_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134826_19067_0|SrvcGrp|90650|2022|PDM|175.00|99|0.00|AETNA FAMILY PSYTX W/PATIENT (HCFA)|
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143539_0_0|SrvcGrp|99073|2022|PDM|1.81|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F74602_0_0|CSTM-ALL|CSTM-00|2020|PDM|1520.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F117611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F132810_0_0|SrvcGrp|14945|2022|PDM|8.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F136307_65791_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136426_19006_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93187_08043_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134152_70563_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F134155_07016_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137147_75006_0|SrvcGrp|80839|2022|PDM|15225.00|99|0.00|MSDRG 520 ONLY|
20|FH_F114264_51449_0|SrvcGrp|103717|2022|PCT|0.83|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F114264_51449_0|SrvcGrp|75505|2022|PCT|0.83|99|0.00|CARDIAC STUDIES|
20|FH_F138108_47130_0|SrvcGrp|73842|2022|PDM|221.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F142377_14626_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F142690_31774_0|SrvcGrp|22593|2022|PDM|155.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F139267_30253_0|SrvcGrp|113545|2022|PDM|7.70|99|0.00|COVID-19 SPECIMEN HANDLING OFFICE-LAB|
20|FH_F140343_89052_0|SrvcGrp|14945|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F149663_45219_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F151608_30236_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118914_43015_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F92593_21031_0|SrvcGrp|26001|2022|PDM|148.70|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F129504_02871_0|SrvcGrp|93098|2022|PDM|165.00|99|0.00|HOSPICE CARE|
20|FH_F117102_39355_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117221_23434_0|SrvcGrp|33165|2022|PDM|375.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F90733_63080_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F90880_15108_0|SrvcGrp|90496|2022|PCT|1.00|99|0.00|FLUVIRIN VACC 3 YRS & > IM|
20|FH_F112817_37027_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F119285_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH|
20|FH_F63459_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|ADV ORTHO MRI|
20|FH_F56274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F38352_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F97542_32960_0|SrvcGrp|88978|2022|PDM|5688.00|99|0.00|VAGINAL DELIVERY|
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_F148760_12953_0|SrvcGrp|48385|2022|PDM|147.00|99|0.00|SPEECH THERAPY|
20|FH_F151061_02720_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F151063_44094_0|SrvcGrp|89337|2022|PDM|950.00|99|0.00|DETOXIFICATION|
20|FH_F151145_39365_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121910_27104_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F122007_30701_0|SrvcGrp|92502|2022|PDM|640.15|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 3 (NO REV)|
20|FH_F72690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F73231_0_0|SrvcGrp|44704|2022|PDM|105.45|99|0.00|NURSING CARE|
20|FH_F87054_0_0|SrvcGrp|73008|2022|PDM|992.00|99|0.00|AEG 10|
20|FH_F114566_46224_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114916_30309_0|SrvcGrp|35669|2022|PDM|4000.00|99|0.00|CPT 63650|
20|FH_F142288_44714_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F133016_67114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116525_26003_0|SrvcGrp|83960|2022|PCT|0.62|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F132988_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132988_0_0|SrvcGrp|109789|2022|PDM|12268.93|99|0.00|REPAIR OF FOOT BONES|
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|105632|2022|PDM|2057.62|99|0.00|AMPUTATION OF TOE|
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1463.00|99|0.00|AEG 5  (NO REV)|
20|FH_F141053_17201_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93252_0_0|SrvcGrp|93030|2022|PDM|2000.00|99|0.00|UROLOGY SURGICAL PROCEDURES|
20|FH_F126345_0_0|SrvcGrp|72996|2022|PDM|859.00|99|0.00|AEG 4|
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 5  (NO REV)|
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|AEG 2 (NO REV)|
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|541.00|99|0.00|AEG 1 (NO REV)|
20|FH_F115971_0_0|SrvcGrp|42427|2022|PDM|670.00|99|0.00|OP SURGERY CPT 65420|
20|FH_F122198_20708_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F124060_76040_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F124081_64154_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146800_74128_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146807_28655_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F63196_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|PDM|466.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F42466_0_0|SrvcGrp|38|2022|PDM|2016.00|99|0.00|NORMAL DELIVERY|
20|FH_F98380_43055_0|SrvcGrp|73659|2022|PDM|7618.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F124177_59254_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F124178_01604_0|SrvcGrp|109718|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA ESRD USE|
20|FH_F124227_01230_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F89273_0_0|SrvcGrp|88262|2022|PDM|795.00|99|0.00|AETNA AQUEOUS SHUNT (HCFA)|
20|FH_F98042_10468_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F138247_76201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139306_08854_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F122872_67208_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117026_17961_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134694_94945_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F134796_70001_0|CSTM-ALL|CSTM-00|2020|PCT|0.17|99|0.00|OP SVCS|
20|FH_F136796_24016_0|SrvcGrp|94989|2022|PDM|2907.56|99|0.00|SINUS ENDO W/ BALLOON DILATION|
20|FH_F112187_98272_0|SrvcGrp|75506|2022|PCT|0.81|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F112410_46112_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F38826_0_0|SrvcGrp|941|2022|PCT|0.73|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG IX|
20|FH_F115210_21043_0|SrvcGrp|88157|2022|PDM|10000.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F116365_11417_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F147462_84741_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F147540_54871_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41463_0_0|SrvcGrp|14944|2022|PDM|12.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F42433_0_0|SrvcGrp|471|2022|PDM|520.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F113649_01752_0|SrvcGrp|26253|2022|PDM|5.17|99|0.00|LIPIDS|
20|FH_F118792_63379_0|SrvcGrp|78533|2022|PDM|0.35|99|0.00|AETNA MED RECORD|
20|FH_F39028_0_0|SrvcGrp|474|2022|PDM|305.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F42177_0_0|SrvcGrp|20801|2022|PCT|0.85|99|0.00|HOME HEALTH|
20|FH_F102950_86040_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F48132_33308_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F69245_84047_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F67086_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PDM|528.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 11 W/O REV|
20|FH_F119594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2113.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1804.00|99|0.00|AEG 5  (NO REV)|
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|2642.00|99|0.00|AEG 9 (NO REV)|
20|FH_F135351_0_0|SrvcGrp|26278|2022|PDM|7700.00|99|0.00|CPT 29881|
20|FH_F144548_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|1155.00|99|0.00|AEG 1 (NO REV)|
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.34|99|0.00|2005 ASPG GROUPER III|
20|FH_F52772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F57953_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F89580_0_0|SrvcGrp|88419|2022|PCT|0.48|99|0.00|IP NITRIX OXIDE|
20|FH_F89580_0_0|SrvcGrp|33096|2022|PCT|0.46|99|0.00|INTRAOCULAR LENS|
20|FH_F88893_0_0|SrvcGrp|87844|2022|PDM|4400.00|99|0.00|LAPARASCOPY - GASTRIC|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|411.23|99|0.00|HAPA WPA-NWPA 2012-13 ASC 105 W/O REV|
20|FH_F93138_0_0|SrvcGrp|87077|2022|PDM|105.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F113527_31023_0|SrvcGrp|9500|2022|PDM|1114.00|99|0.00|PSYCH INTENSIVE CARE UNIT|
20|FH_F151304_31520_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132205_45342_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F122087_62684_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F123193_33431_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132054_30339_0|SrvcGrp|83857|2022|PDM|567.00|99|0.00|IP HOSPICE SVCS|
20|FH_F36492_0_0|SrvcGrp|72990|2022|PDM|570.00|99|0.00|AEG 1|
20|FH_F91766_25401_0|SrvcGrp|48396|2022|PDM|120.75|99|0.00|OT SERVICES|
20|FH_F135775_60614_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135983_22030_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136107_63801_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136183_72756_0|SrvcGrp|46903|2022|PDM|950.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F100763_24202_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F130756_04901_0|SrvcGrp|112727|2022|PCT|1.00|99|0.00|COVID-19 IA NFCT AB SARS COV 2|
20|FH_F130756_04901_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 9 (NO REV)|
20|FH_F116488_79925_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|AEG 2 (NO REV)|
20|FH_F140629_0_0|SrvcGrp|27316|2022|PDM|2497.00|99|0.00|TONSILS & ADENOIDS (42820)|
20|FH_F140629_0_0|SrvcGrp|33988|2022|PDM|1016.00|99|0.00|CPT 19101|
20|FH_F121763_07202_0|SrvcGrp|73008|2022|PDM|2838.00|99|0.00|AEG 10|
20|FH_F121803_66502_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F67425_0_0|SrvcGrp|4109|2022|PDM|1620.00|99|0.00|ACUTE PSYCH|
20|FH_F131407_07607_0|SrvcGrp|14945|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F131650_50211_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134257_62681_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134315_89106_0|SrvcGrp|14948|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134322_98001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148243_0_0|SrvcGrp|79579|2022|PDM|879.00|99|0.00|CPT 43251|
20|FH_F33081_0_0|CSTM-ALL|CSTM-00|2020|PDM|6200.00|99|0.00|ANGIOPLASTY|
20|FH_F112086_33713_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125745_66025_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F128549_44224_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F102282_06795_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101620_47401_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F120734_0_0|CSTM-ALL|CSTM-00|2020|PDM|2326.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84446_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119245_19010_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119374_62263_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE|
20|FH_F150002_28761_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|471.41|99|0.00|ASPG 208|
20|FH_F133561_70364_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148599_98034_0|CSTM-ALL|CSTM-00|2020|PDM|251.00|99|0.00|AETNA - APC GROUPER P|
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|AEG 3 (NO REV)|
20|FH_F136417_0_0|SrvcGrp|82981|2022|PDM|246.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F101923_98104_0|SrvcGrp|21456|2022|PDM|3191.00|99|0.00|SLEEP STUDIES|
20|FH_F43078_0_0|SrvcGrp|26001|2022|PDM|525.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F119825_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F91155_16105_0|SrvcGrp|48396|2022|PDM|102.00|99|0.00|OT SERVICES|
20|FH_F124983_44514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F32142_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME HEALTH RN SERVICE|
20|FH_F148881_33018_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F91194_33511_0|SrvcGrp|83800|2022|PDM|4750.00|99|0.00|VBAC DELIVERY|
20|FH_F100786_24740_0|SrvcGrp|73659|2022|PDM|4260.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F49637_0_0|SrvcGrp|45524|2022|PDM|15435.00|99|0.00|MS DRG 800 ONLY|
20|FH_F90811_0_0|SrvcGrp|90419|2022|PDM|4000.00|99|0.00|REPAIR HAND DISLOCATION|
20|FH_F151518_60506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F69123_0_0|SrvcGrp|14893|2022|PDM|40.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F122970_97222_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F128912_44313_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F41173_0_0|CSTM-ALL|CSTM-00|2020|PDM|655.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39268_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F133270_77025_0|SrvcGrp|86722|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F95980_20016_0|SrvcGrp|94842|2022|PDM|170.00|99|0.00|AETNA MEDICARE INTENSIVE OP|
20|FH_F96102_33884_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133474_0_0|SrvcGrp|100860|2022|PDM|170.00|99|0.00|OFFICE/OUTPATIENT VISIT NEW|
20|FH_F39304_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150948_0_0|SrvcGrp|88157|2022|PDM|10950.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F150024_08079_0|CSTM-ALL|CSTM-00|2020|PDM|2584.00|99|0.00|AEG 5  (NO REV)|
20|FH_F146377_85007_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F75342_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41785_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F109242_18466_0|SrvcGrp|73841|2022|PDM|321.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F35173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS|
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|15469.00|99|0.00|MSDRG 280-281 CIRCULATORY DISORDERS|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F48929_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111316_0_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F41347_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118517_33316_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119437_0_0|SrvcGrp|75495|2022|PDM|2700.00|99|0.00|AEG 9|
20|FH_F148041_41017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97541_33021_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|1281.00|99|0.00|AEG 8 (NO REV)|
20|FH_F32870_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F138236_0_0|SrvcGrp|84185|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F79902_0_0|SrvcGrp|14242|2022|PDM|478.00|99|0.00|EMERGENCY ROOM SVCS LEVEL IV|
20|FH_F40622_0_0|CSTM-ALL|CSTM-00|2020|PDM|742.00|99|0.00|ACUTE PSYCH|
20|FH_F119437_0_0|SrvcGrp|75487|2022|PDM|1775.00|99|0.00|AEG 5|
20|FH_F98300_30236_0|SrvcGrp|75497|2022|PDM|2969.00|99|0.00|AEG 10|
20|FH_F113906_0_0|SrvcGrp|72998|2022|PDM|665.00|99|0.00|AEG 5|
20|FH_F97720_70084_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F111840_0_0|SrvcGrp|75497|2022|PDM|630.00|99|0.00|AEG 10|
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|2275.00|99|0.00|AEG 8 (NO REV)|
20|FH_F151663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F73231_0_0|SrvcGrp|44707|2022|PDM|105.45|99|0.00|NURSING CARE|
20|FH_F94786_07974_0|SrvcGrp|29076|2022|PDM|36.75|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F131047_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 5  (NO REV)|
20|FH_F141053_17201_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F93252_0_0|SrvcGrp|93017|2022|PDM|8000.00|99|0.00|TOTAL HIP REPLACEMENT|
20|FH_F114389_50131_0|SrvcGrp|88826|2022|PDM|137.28|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|1869.55|99|0.00|AEG 9 (NO REV)|
20|FH_F77662_0_0|SrvcGrp|42871|2022|PDM|65.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F77944_0_0|SrvcGrp|29817|2022|PDM|8980.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F118184_0_0|SrvcGrp|111932|2022|PDM|51.31|99|0.00|COVID-19 NON-CDC TESTING LAB|
20|FH_F124058_61081_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F43832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F39066_0_0|SrvcGrp|24|2022|PDM|5000.00|99|0.00|CARDIAC CATH|
20|FH_F41035_0_0|SrvcGrp|73002|2022|PDM|1103.00|99|0.00|AEG 7|
20|FH_F132864_71101_0|CSTM-ALL|CSTM-00|2020|PDM|2036.00|99|0.00|AEG 4 (NO REV)|
20|FH_F124225_92506_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F124414_92653_0|SrvcGrp|87317|2022|PDM|970.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F121799_0_0|SrvcGrp|83857|2022|PDM|525.00|99|0.00|IP HOSPICE SVCS|
20|FH_F127995_84010_0|SrvcGrp|110926|2022|PDM|545.00|99|0.00|IP HOSPICE RESPITE CARE|
20|FH_F97083_90670_0|SrvcGrp|73656|2022|PDM|633.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F97040_31901_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F129143_68739_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126073_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F132890_87544_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F131888_71852_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114684_80547_0|SrvcGrp|69074|2022|PDM|148.00|99|0.00|CPT 99203|
20|FH_F114792_48849_0|SrvcGrp|88819|2022|PDM|695.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F113913_70065_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F138327_39402_0|SrvcGrp|92761|2022|PCT|0.80|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114985_32073_0|SrvcGrp|104799|2022|PDM|294.00|99|0.00|ELECTROENCEPHALOGRAM|
20|FH_F122675_07055_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F43249_0_0|CSTM-ALL|CSTM-00|2020|PDM|1521.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134817_30339_0|SrvcGrp|27968|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135762_70001_0|SrvcGrp|112323|2022|PDM|400.00|99|0.00|LABORATORY|
20|FH_F136914_64081_0|SrvcGrp|73656|2022|PDM|675.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F136930_73114_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F112485_61032_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113713_17013_0|SrvcGrp|91782|2022|PDM|65.00|99|0.00|AETNA GROUP THERAPY (MOD HO)(HCFA)|
20|FH_F147519_52627_0|SrvcGrp|73497|2022|PDM|2111.10|99|0.00|AETNA ER LEVEL IV|
20|FH_F147585_60402_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F147586_44124_0|SrvcGrp|115112|2022|PDM|10000.00|99|0.00|THORACIC DISKECTOMY|
20|FH_F42754_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|ACUTE PSYCH|
20|FH_F42814_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150765_05001_0|SrvcGrp|48394|2022|PDM|68.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F150879_75056_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F132123_91360_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F136806_0_0|SrvcGrp|105489|2022|PDM|2218.00|99|0.00|SHOULDER ARTHOSCOPY PROCEDURES|
20|FH_F127189_49503_0|SrvcGrp|33722|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F119601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.39|99|0.00|OP SVCS|
20|FH_F111266_30339_0|SrvcGrp|91685|2022|PDM|775.00|99|0.00|HOME VENT|
20|FH_F116806_0_0|SrvcGrp|107138|2022|PDM|788.84|99|0.00|PREPARE FACE/ORAL PROSTHESIS|
20|FH_F146266_0_0|SrvcGrp|88492|2022|PDM|5914.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F122277_98045_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147341_19720_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37341_0_0|SrvcGrp|26002|2022|PDM|250.00|99|0.00|C-ARM AND LASER|
20|FH_F124975_63366_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34777_0_0|SrvcGrp|60357|2022|PDM|6995.00|99|0.00|PTC ANGIOPLASTY|
20|FH_F76588_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101844_0_0|SrvcGrp|98327|2022|PDM|8943.00|99|0.00|LAMINECTOMY FOR MYELOTOMY|
20|FH_F110732_31513_0|SrvcGrp|89297|2022|PDM|1125.00|99|0.00|INPATIENT DETOXIFICATION SERVICES|
20|FH_F74845_0_0|CSTM-ALL|CSTM-00|2020|PDM|1840.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F97082_90012_0|SrvcGrp|90854|2022|PDM|4788.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F69123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F138655_63873_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F98860_96706_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128924_0_0|SrvcGrp|111216|2022|PDM|424.00|99|0.00|ACUTE KIDNEY INJURY HEMODIALYSIS NO ESRD|
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 6 (NO REV)|
20|FH_F132254_40207_0|SrvcGrp|29077|2022|PDM|25.00|99|0.00|HOME TRANSFUSION|
20|FH_F90201_15650_0|SrvcGrp|471|2022|PDM|515.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F89932_10940_0|SrvcGrp|89117|2022|PCT|0.45|99|0.00|DIAGNOSTIC RADIOPHARMACEUTICALS|
20|FH_F150000_30152_0|SrvcGrp|115602|2022|PCT|1.00|99|0.00|TELEMEDICINE|
20|FH_F132785_17961_0|SrvcGrp|109057|2022|PCT|0.38|99|0.00|CARDIAC STUDIES|
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|AEG 10 (NO REV)|
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F130616_43615_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|PDM|1089.00|99|0.00|AEG 7 (NO REV)|
20|FH_F150907_17543_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F49354_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|220.92|99|0.00|HAPA WPA-NWPA 2012-13 ASC 311 W/O REV|
20|FH_F103281_32086_0|SrvcGrp|91437|2022|PDM|300.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F112587_37058_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149781_37404_0|SrvcGrp|74039|2022|PDM|4244.00|99|0.00|LAMINECTOMY|
20|FH_F127197_23111_0|SrvcGrp|27969|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE|
20|FH_F109625_27330_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|2266.00|99|0.00|AEG 6 (NO REV)|
20|FH_F68947_0_0|SrvcGrp|15473|2022|PDM|4865.08|99|0.00|CPT CODE 42820|
20|FH_F106940_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 9 (NO REV)|
20|FH_F42803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F55375_0_0|SrvcGrp|16304|2022|PDM|1200.00|99|0.00|HOSPICE CARE|
20|FH_F133350_39532_0|SrvcGrp|74668|2022|PDM|850.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 4 (NO REV)|
20|FH_F97042_64804_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS|
20|FH_F146320_27610_0|SrvcGrp|107793|2022|PDM|15534.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F92676_15063_0|SrvcGrp|79062|2022|PDM|433.32|99|0.00|MON VALLEY ASC 237|
20|FH_F35477_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS|
20|FH_F136751_0_0|SrvcGrp|88065|2022|PDM|16000.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F101922_98055_0|SrvcGrp|73008|2022|PDM|4300.00|99|0.00|AEG 10|
20|FH_F150532_16801_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138702_43614_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139172_40207_0|SrvcGrp|86722|2022|PDM|209.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F139430_63017_0|SrvcGrp|88620|2022|PDM|101.00|99|0.00|SKILLED NURSING RN|
20|FH_F150745_03301_0|SrvcGrp|48394|2022|PDM|68.34|99|0.00|SKILLED NURSING SERVICES|
20|FH_F143035_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F148963_56301_0|SrvcGrp|74668|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124514_21215_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F141330_65075_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151699_01752_0|SrvcGrp|24752|2022|PDM|15.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F147303_70508_0|SrvcGrp|29347|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F90698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F100663_56537_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F126147_45241_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F60296_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149400_83301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F42395_0_0|SrvcGrp|97|2022|PDM|2864.00|99|0.00|C-SECTION|
20|FH_F35750_0_0|SrvcGrp|941|2022|PDM|2536.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F37230_0_0|SrvcGrp|25698|2022|PDM|117.00|99|0.00|RN VISIT|
20|FH_F66405_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F110783_93013_0|SrvcGrp|86853|2022|PDM|35.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F108180_29526_0|SrvcGrp|46903|2022|PDM|580.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F39443_0_0|SrvcGrp|30369|2022|PDM|837.00|99|0.00|HAPA WPA ASC 12|
20|FH_F132595_0_0|SrvcGrp|22148|2022|PDM|293.00|99|0.00|PSYCH PARTIAL HOSP (FULL DAY)|
20|FH_F110726_19720_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|PROLASTIN THERAPY (MOD KP/SQ/SH)|
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 8 (NO REV)|
20|FH_F90232_15126_0|SrvcGrp|86849|2022|PDM|56.70|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F137767_01841_0|SrvcGrp|74442|2022|PDM|795.00|99|0.00|CARDIAC TESTING|
20|FH_F35245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F36202_0_0|SrvcGrp|997|2022|PCT|0.75|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F40647_0_0|SrvcGrp|33147|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F90182_80443_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151042_60659_0|SrvcGrp|23683|2022|PDM|55.00|99|0.00|SKILLED NURSING RN|
20|FH_F101861_19567_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116753_0_0|SrvcGrp|92190|2022|PDM|1250.00|99|0.00|CPT 95810  (HCFA)|
20|FH_F140295_0_0|SrvcGrp|91566|2022|PDM|4509.00|99|0.00|REVISE FINGER JOINT|
20|FH_F35750_0_0|SrvcGrp|9510|2022|PDM|1103.00|99|0.00|SKILLED NURSING CARE|
20|FH_F136779_0_0|SrvcGrp|19921|2022|PDM|2814.00|99|0.00|ARTHROSCOPICALLY LIGAMENT REPAIR|
20|FH_F128397_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F134390_27012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54056_0_0|SrvcGrp|22954|2022|PDM|135.11|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F130203_29601_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|487.28|99|0.00|SALLY BALIN,999182,ASC 403|
20|FH_F36663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S MOD UE (CPD 1364768)|
20|FH_F128191_28642_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES|
20|FH_F69183_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1997.00|99|0.00|AEG 9 (NO REV)|
20|FH_F94502_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F35416_0_0|SrvcGrp|15132|2022|PDM|2850.00|99|0.00|ACUTE IP MEDICAL SVCS|
20|FH_F134887_33409_0|SrvcGrp|112691|2022|PDM|105.00|99|0.00|DIABETICS FITTING|
20|FH_F36165_0_0|SrvcGrp|20296|2022|PDM|90.00|99|0.00|CPT 99506|
20|FH_F151027_16652_0|SrvcGrp|75419|2022|PDM|370.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|406.85|99|0.00|AEG 1 (NO REV)|
20|FH_F138018_17313_0|SrvcGrp|16750|2022|PDM|204.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F86714_0_0|SrvcGrp|32996|2022|PDM|199.13|99|0.00|OCCUPATIONAL THERAPY SVCS INITIAL EVAL|
20|FH_F98623_97006_0|SrvcGrp|90854|2022|PDM|2977.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)|
20|FH_F34924_0_0|SrvcGrp|360|2022|PDM|1250.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F116753_0_0|SrvcGrp|93688|2022|PDM|1278.00|99|0.00|POLYSOMNOGRAPHY (HCFA)|
20|FH_F147159_62615_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124291_44122_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F151044_19606_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F41363_0_0|CSTM-ALL|CSTM-00|2020|PDM|684.00|99|0.00|ASPG III|
20|FH_F41463_0_0|SrvcGrp|35466|2022|PCT|0.00|99|0.00|OXYGEN PURCHASE (NO PAY) (E0441/E0442)|
20|FH_F111260_0_0|SrvcGrp|87077|2022|PDM|175.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F132254_40207_0|SrvcGrp|111025|2022|PCT|0.83|99|0.00|SUPPLIES|
20|FH_F33719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F147221_49442_0|SrvcGrp|42623|2022|PDM|528.00|99|0.00|SUBACUTE - LEVEL III|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PDM|52.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F39443_0_0|SrvcGrp|30340|2022|PDM|123.00|99|0.00|HAPA WPA ASC 224|
20|FH_F143412_70503_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F143471_02895_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F143494_34474_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143536_47546_0|SrvcGrp|36668|2022|PCT|1.00|99|0.00|ZOSTER (SHINGLES VACCINE)|
20|FH_F75803_0_0|SrvcGrp|11000|2022|PCT|0.70|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 9 (NO REV)|
20|FH_F123185_0_0|SrvcGrp|72998|2022|PDM|979.00|99|0.00|AEG 5|
20|FH_F101709_0_0|SrvcGrp|73006|2022|PDM|2801.00|99|0.00|AEG 9|
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 6 (NO REV)|
20|FH_F131107_43140_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F131173_17043_0|SrvcGrp|93098|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F151753_03104_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|PDM|1264.00|99|0.00|GA RETINA SURG CTR ASC 28|
20|FH_F48476_0_0|SrvcGrp|43957|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F120233_24368_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132371_19083_0|SrvcGrp|43567|2022|PDM|99.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F132394_15317_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132479_90290_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F112712_63005_0|SrvcGrp|10577|2022|PCT|1.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F116698_07470_0|SrvcGrp|86831|2022|PDM|15.75|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F116698_07470_0|SrvcGrp|23681|2022|PCT|1.05|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F120974_27607_0|SrvcGrp|10361|2022|PDM|318.00|99|0.00|CPT CODE 99281|
20|FH_F142454_0_0|SrvcGrp|113938|2022|PDM|3400.00|99|0.00|INJECT ANT CHAMB MEDICATION|
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 8 (NO REV)|
20|FH_F54535_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F59732_0_0|SrvcGrp|26867|2022|PDM|80.00|99|0.00|ANTI-EMETICS INFUSION THERAPY|
20|FH_F61292_0_0|SrvcGrp|11920|2022|PCT|0.49|99|0.00|PHARMACY SVCS|
20|FH_F51358_0_0|SrvcGrp|46248|2022|PDM|130.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F36006_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F137847_0_0|SrvcGrp|46903|2022|PDM|605.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F82714_18848_0|SrvcGrp|131|2022|PCT|0.39|99|0.00|PACEMAKER DEVICE|
20|FH_F93126_63108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132190_0_0|SrvcGrp|98580|2022|PDM|7000.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F109645_0_0|SrvcGrp|27968|2022|PDM|25.00|99|0.00|SKILLED NURSING LPN|
20|FH_F130936_06107_0|SrvcGrp|471|2022|PDM|656.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F126784_80809_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F148221_06477_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137067_0_0|SrvcGrp|104170|2022|PDM|2625.00|99|0.00|AETNA ARTHROSCOPY SURGERY|
20|FH_F148666_34205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F151526_28208_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40834_0_0|SrvcGrp|14067|2022|PCT|0.80|99|0.00|PROFESSIONAL FEES ON UB04|
20|FH_F120294_46322_0|SrvcGrp|29347|2022|PDM|24.00|99|0.00|HOME HEALTH AIDE|
20|FH_F128992_90808_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F137067_0_0|SrvcGrp|78096|2022|PDM|5775.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F91876_0_0|SrvcGrp|73006|2022|PDM|3595.00|99|0.00|AEG 9|
20|FH_F32529_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142073_0_0|SrvcGrp|92414|2022|PDM|5980.00|99|0.00|SPINAL CRD DECOMP->2 LUMBAR|
20|FH_F89453_75069_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129708_54403_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93880_95476_0|SrvcGrp|93689|2022|PDM|9620.00|99|0.00|ORTHOPEDIC JOINT PROCEDURES|
20|FH_F119824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117784_0_0|SrvcGrp|106291|2022|PDM|147.90|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F39138_0_0|SrvcGrp|411|2022|PDM|4259.00|99|0.00|OP CARDIAC CATH|
20|FH_F80245_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DENIAL CODES|
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|1330.05|99|0.00|ASPG IX|
20|FH_F102500_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F80245_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37945_0_0|SrvcGrp|9938|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F92276_32308_0|SrvcGrp|13881|2022|PCT|0.53|99|0.00|PACEMAKER DEVICE|
20|FH_F139551_0_0|SrvcGrp|26432|2022|PDM|4400.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F39138_0_0|SrvcGrp|16|2022|PDM|1038.00|99|0.00|ACUTE REHABILITATION|
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1099.00|99|0.00|AEG 2 (NO REV)|
20|FH_F116065_06708_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1282.22|99|0.00|HAPA WPA-NWPA 2012-13 ASC 905 W/O REV|
20|FH_F41494_0_0|SrvcGrp|72|2022|PDM|490.00|99|0.00|NEWBORN NURSERY|
20|FH_F115120_19083_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F82714_18848_0|SrvcGrp|3378|2022|PDM|3300.00|99|0.00|OBSERVATION SVCS|
20|FH_F52854_0_0|SrvcGrp|537|2022|PCT|0.60|99|0.00|OBSERVATION SERVICES|
20|FH_F93424_53578_0|SrvcGrp|86749|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F121118_06479_0|SrvcGrp|471|2022|PDM|575.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F38473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124763_61821_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123507_63869_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|1685.00|99|0.00|AEG 8 (NO REV)|
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142073_0_0|SrvcGrp|98498|2022|PDM|5980.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC|
20|FH_F137847_0_0|SrvcGrp|108484|2022|PDM|605.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F99441_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_F94367_15601_0|SrvcGrp|92761|2022|PCT|1.25|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40519_0_0|SrvcGrp|12163|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|870.45|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1303 W/O REV|
20|FH_F109180_18015_0|SrvcGrp|70642|2022|PDM|14.02|99|0.00|CONSULTANT THERAPIST|
20|FH_F123533_63825_0|SrvcGrp|471|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131128_0_0|SrvcGrp|85792|2022|PDM|4774.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F109180_18015_0|SrvcGrp|89267|2022|PDM|108.00|99|0.00|PSYTX PT/FAMILY 30 MINUTES|
20|FH_F130747_0_0|SrvcGrp|82107|2022|PDM|5202.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F32375_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F120371_63136_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125421_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F43154_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91819_0_0|SrvcGrp|28243|2022|PCT|0.50|99|0.00|SUPPLIES AND DEVICES|
20|FH_F93620_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F38771_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.00|99|0.00|OP SVCS|
20|FH_F143790_83440_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)|
20|FH_F140586_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|OP SVCS|
20|FH_F103902_89118_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F101021_0_0|SrvcGrp|89781|2022|PDM|140.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F32532_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F34112_0_0|SrvcGrp|115|2022|PDM|680.00|99|0.00|SKILLED NURSING CARE|
20|FH_F148892_0_0|SrvcGrp|90976|2022|PDM|668.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT|
20|FH_F125048_94583_0|SrvcGrp|73841|2022|PDM|600.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F98801_93274_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F38875_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97000_24201_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F72765_0_0|SrvcGrp|8950|2022|PDM|1730.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F130897_03103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F127914_28602_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130364_01331_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 2 (NO REV)|
20|FH_F143631_52248_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146103_63851_0|SrvcGrp|73659|2022|PDM|1139.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F117202_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F37667_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119542_45417_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F112023_12866_0|SrvcGrp|73004|2022|PDM|6049.00|99|0.00|AEG 8|
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|AEG 7 (NO REV)|
20|FH_F145641_06902_0|SrvcGrp|89988|2022|PDM|4475.00|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F112863_0_0|SrvcGrp|104251|2022|PDM|1141.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F146399_0_0|SrvcGrp|111468|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F119227_01752_0|SrvcGrp|86840|2022|PDM|38.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F145555_72204_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F127579_44321_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F87541_0_0|SrvcGrp|72998|2022|PDM|864.00|99|0.00|AEG 5|
20|FH_F134619_14304_0|SrvcGrp|473|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F132609_0_0|SrvcGrp|107734|2022|PDM|4090.00|99|0.00|VAGINAL DELIVERY|
20|FH_F138951_41101_0|SrvcGrp|10577|2022|PDM|40.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F123386_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34985_0_0|SrvcGrp|13367|2022|PDM|1320.00|99|0.00|ICU/CCU|
20|FH_F33255_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112306_81428_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F134396_80045_0|SrvcGrp|108484|2022|PDM|968.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F114206_37203_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F149579_95815_0|SrvcGrp|110811|2022|PDM|400.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F39756_0_0|SrvcGrp|31518|2022|PDM|531.30|99|0.00|CUMBERLAND SURGERY CTR-ASPG II|
20|FH_F141287_14830_0|SrvcGrp|11663|2022|PCT|0.39|99|0.00|IMPLANTS|
20|FH_F67132_0_0|CSTM-ALL|CSTM-00|2020|PCT|37.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F151009_07649_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F74646_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|2680.00|99|0.00|ASPG 9 PIEDMONT OUTPATIENT SURGERY CENTER|
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|817.00|99|0.00|ASPG 5 SURGICAL EYE CENTER|
20|FH_F137458_08857_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F84556_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|773.00|99|0.00|ASPG III|
20|FH_F94643_90501_0|SrvcGrp|17013|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F39912_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F37385_0_0|SrvcGrp|15389|2022|PDM|125.00|99|0.00|SOCIAL WORKER (MEDICAL)|
20|FH_F40446_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|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_F150520_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35557_0_0|SrvcGrp|11792|2022|PDM|52.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|45140.00|99|0.00|MSDRG 233-234 CORONARY BYPASS|
20|FH_F126914_44136_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F117711_73080_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F138017_73129_0|SrvcGrp|105701|2022|PDM|6883.00|99|0.00|REPAIR OF VAGINA|
20|FH_F134843_83638_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|1367.00|99|0.00|AEG 2 (NO REV)|
20|FH_F120100_98390_0|SrvcGrp|108484|2022|PDM|1208.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F127132_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F110783_93013_0|SrvcGrp|24750|2022|PDM|35.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F75944_0_0|SrvcGrp|68188|2022|PDM|1214.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 4|
20|FH_F132442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125022_67035_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F36943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130723_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F147209_60202_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F34924_0_0|SrvcGrp|97|2022|PDM|4500.00|99|0.00|C-SECTION|
20|FH_F138710_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F35755_34950_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|GENERAL ACUTE CARE|
20|FH_F150920_19490_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151001_80501_0|SrvcGrp|111348|2022|PCT|1.45|99|0.00|OP THERAPY SERVICES|
20|FH_F35088_0_0|SrvcGrp|411|2022|PDM|3407.00|99|0.00|OP CARDIAC CATH|
20|FH_F139792_26034_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143249_89801_0|SrvcGrp|110782|2022|PCT|1.00|99|0.00|ROUTINE VENIPUNCTURE|
20|FH_F143451_50635_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F103060_0_0|SrvcGrp|98495|2022|PDM|8323.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F131153_66203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151720_03301_0|SrvcGrp|113276|2022|PCT|1.10|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F47952_0_0|SrvcGrp|36068|2022|PDM|55.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (GLOBAL)|
20|FH_F49478_0_0|SrvcGrp|45863|2022|PDM|1405.00|99|0.00|CPT 65730|
20|FH_F120225_29644_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F116699_46347_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F120921_75835_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F118874_29926_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F84611_30281_0|SrvcGrp|27402|2022|PDM|7637.00|99|0.00|LASER PROCEDURES|
20|FH_F36372_0_0|SrvcGrp|15515|2022|PDM|54.00|99|0.00|HYDRATION THERAPY|
20|FH_F42953_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F103004_75840_0|SrvcGrp|95584|2022|PCT|1.00|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F131609_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F122953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F47693_16148_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100906_0_0|SrvcGrp|97463|2022|PDM|2250.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F119538_60959_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148495_03038_0|SrvcGrp|472|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F57372_0_0|SrvcGrp|53743|2022|PDM|1560.00|99|0.00|ICU (VENT DEPENDENT MEDICALLY COMPLEX)|
20|FH_F116825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F43433_0_0|SrvcGrp|22106|2022|PDM|750.00|99|0.00|CAT SCAN|
20|FH_F107120_22560_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149652_37212_0|SrvcGrp|109036|2022|PDM|626.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F133473_21702_0|SrvcGrp|88621|2022|PDM|163.38|99|0.00|SKILLED NURSING LPN|
20|FH_F63618_0_0|SrvcGrp|8950|2022|PDM|3500.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F134448_66203_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134993_75034_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F110302_15931_0|SrvcGrp|27969|2022|PDM|19.13|99|0.00|HOME HEALTH AIDE|
20|FH_F121225_98902_0|SrvcGrp|108708|2022|PCT|0.00|99|0.00|INPATIENT HOSPICE|
20|FH_F88744_71103_0|SrvcGrp|73601|2022|PDM|2083.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F126341_27284_0|SrvcGrp|91194|2022|PCT|0.70|99|0.00|AETNA INJ IMM GLOB BIVIGAM|
20|FH_F112023_12866_0|SrvcGrp|73643|2022|PDM|714.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F74024_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F83995_16748_0|SrvcGrp|76013|2022|PDM|813.00|99|0.00|EMERGENCY ROOM SVCS LEVEL VI|
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|1245.00|99|0.00|AEG 6 (NO REV)|
20|FH_F126043_30339_0|SrvcGrp|89417|2022|PDM|428.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F119864_63141_0|SrvcGrp|48396|2022|PDM|105.00|99|0.00|OT SERVICES|
20|FH_F133775_83401_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F134358_63068_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149106_07042_0|SrvcGrp|74670|2022|PCT|1.00|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F117206_0_0|SrvcGrp|67065|2022|PDM|4326.00|99|0.00|CERVICAL SURGERY|
20|FH_F133727_33511_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111986_0_0|SrvcGrp|33985|2022|PDM|1545.00|99|0.00|CPT 19120|
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|1502.00|99|0.00|AEG 6 (NO REV)|
20|FH_F134328_13088_0|SrvcGrp|471|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133887_17013_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F119107_22601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145819_03431_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F144228_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F138302_15701_0|SrvcGrp|17013|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F81297_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.90|99|0.00|OP SVCS|
20|FH_F131127_0_0|SrvcGrp|84180|2022|PDM|4480.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS|
20|FH_F81852_0_0|SrvcGrp|63|2022|PDM|643.00|99|0.00|SUBACUTE CARE|
20|FH_F79824_0_0|SrvcGrp|63|2022|PDM|725.00|99|0.00|SUBACUTE CARE|
20|FH_F149321_44691_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63830|2022|PDM|498.44|99|0.00|HAPA WPA-NWPA 2012-13 ASC 103|
20|FH_F133868_40202_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F100782_0_0|SrvcGrp|105065|2022|PDM|712.87|99|0.00|WINDBER MEDICAL CNTR ASC 110|
20|FH_F72828_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F116753_0_0|SrvcGrp|106784|2022|PDM|7465.00|99|0.00|LAPAROSCOPY|
20|FH_F135610_06451_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83754_0_0|SrvcGrp|16392|2022|PCT|0.86|99|0.00|AMBULANCE|
20|FH_F133585_0_0|SrvcGrp|103640|2022|PDM|8249.00|99|0.00|AETNA OPEN/PERQ PLACE STENT SAME|
20|FH_F121476_0_0|SrvcGrp|111248|2022|PDM|1085.00|99|0.00|LEVONORGESTREL|
20|FH_F127943_68939_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|1775.00|99|0.00|AEG 9 (NO REV)|
20|FH_F50497_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132840_65201_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149241_30161_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133585_0_0|SrvcGrp|109485|2022|PDM|307.00|99|0.00|ILIAC REVASC W/STENT ADD-ON|
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|471.00|99|0.00|AEG 2 (NO REV)|
20|FH_F77082_0_0|SrvcGrp|941|2022|PDM|5624.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F127090_45601_0|SrvcGrp|26869|2022|PDM|49.98|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F41608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F134528_63670_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122459_15221_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122526_22203_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41773_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F84712_0_0|SrvcGrp|14614|2022|PDM|6938.00|99|0.00|LITHOTRIPSY|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|336.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 107 W/O REV|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|73.88|99|0.00|HAPA WPA-NWPA 2012-13 ASC 145 W/O REV|
20|FH_F98800_85021_0|SrvcGrp|73559|2022|PDM|9675.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F105145_75075_0|SrvcGrp|98005|2022|PDM|6640.00|99|0.00|DISTAL PHALANGEAL FRACTURE|
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F146422_80210_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120795_27514_0|CSTM-ALL|CSTM-00|2020|PDM|14671.00|99|0.00|AEG 8 (NO REV)|
20|FH_F126376_23936_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131976_74571_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133269_78624_0|SrvcGrp|86723|2022|PDM|410.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F133398_43204_0|SrvcGrp|108484|2022|PDM|420.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F133544_78227_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F133494_90023_0|SrvcGrp|72984|2022|PCT|1.40|99|0.00|CHEMOTHERAPY|
20|FH_F133170_50501_0|SrvcGrp|89149|2022|PDM|168.00|99|0.00|OP INTENSIVE|
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|1075.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119795_0_0|SrvcGrp|36865|2022|PDM|3106.00|99|0.00|NUCLEOPLASTY|
20|FH_F74602_0_0|CSTM-ALL|CSTM-00|2020|PDM|1683.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F113815_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F89340_0_0|SrvcGrp|63467|2022|PDM|1430.00|99|0.00|CPT 64585|
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1306.00|99|0.00|AEG 6 (NO REV)|
20|FH_F88545_78734_0|SrvcGrp|11577|2022|PDM|420.00|99|0.00|DIALYSIS|
20|FH_F129975_0_0|SrvcGrp|87037|2022|PDM|160.00|99|0.00|SURGERY|
20|FH_F132338_18901_0|SrvcGrp|89337|2022|PDM|797.94|99|0.00|DETOXIFICATION|
20|FH_F63618_0_0|SrvcGrp|16|2022|PDM|3000.00|99|0.00|ACUTE REHABILITATION|
20|FH_F116644_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F127412_15301_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 9 (NO REV)|
20|FH_F79902_0_0|SrvcGrp|13360|2022|PDM|239.00|99|0.00|EMERGENCY ROOM SVCS LEVEL II|
20|FH_F44350_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F63417_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F137896_0_0|SrvcGrp|91627|2022|PDM|105.45|99|0.00|SKILLED NURSE SERVICES 15 MINS (HCFA)|
20|FH_F92676_15063_0|SrvcGrp|78951|2022|PDM|3000.01|99|0.00|MON VALLEY ASC 705|
20|FH_F97103_53295_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F92531_0_0|SrvcGrp|81859|2022|PDM|2408.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F128130_10027_0|SrvcGrp|82369|2022|PCT|3.58|99|0.00|AETNA LABORATORY|
20|FH_F60101_0_0|SrvcGrp|42830|2022|PDM|68.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F133021_00910_0|SrvcGrp|112297|2022|PDM|1800.00|99|0.00|GASTROSTOMY PERCUTANEOUS|
20|FH_F92677_08003_0|SrvcGrp|14949|2022|PDM|151.20|99|0.00|HOME INFUSION|
20|FH_F133003_49012_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F80537_0_0|SrvcGrp|61916|2022|PCT|0.74|99|0.00|OP SURGERY|
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 3 (NO REV)|
20|FH_F134487_14843_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141833_31707_0|SrvcGrp|106314|2022|PDM|900.00|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F134490_62801_0|CSTM-ALL|CSTM-00|2020|PDM|1989.00|99|0.00|AEG 7 (NO REV)|
20|FH_F150001_33064_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118486_95060_0|SrvcGrp|86746|2022|PCT|1.15|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F40728_0_0|CSTM-ALL|CSTM-00|2020|PDM|1082.00|99|0.00|ASPG V|
20|FH_F49637_0_0|SrvcGrp|21124|2022|PDM|21735.00|99|0.00|MS DRG 471 ONLY|
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|AEG 3 (NO REV)|
20|FH_F120437_85202_0|SrvcGrp|17002|2022|PDM|185.71|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS|
20|FH_F70487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.96|99|0.00|OP SVCS|
20|FH_F148900_0_0|SrvcGrp|58638|2022|PDM|2940.00|99|0.00|CPT 63688|
20|FH_F89932_10940_0|SrvcGrp|73002|2022|PDM|3701.00|99|0.00|AEG 7|
20|FH_F144191_0_0|SrvcGrp|114139|2022|PDM|1400.00|99|0.00|REMOVAL OF TISSUE FOR GRAFT|
20|FH_F132612_0_0|SrvcGrp|81036|2022|PCT|0.75|99|0.00|ANGIOPLASTY|
20|FH_F148599_98034_0|SrvcGrp|73481|2022|PDM|9367.00|99|0.00|VAGINAL DELIVERY MSDRG 767-768 ONLY|
20|FH_F89233_0_0|CSTM-ALL|CSTM-00|2020|PDM|1827.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132279_63775_0|SrvcGrp|3069|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F97561_30030_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F141870_85224_0|SrvcGrp|22593|2022|PDM|40.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F117335_0_0|SrvcGrp|73008|2022|PDM|833.00|99|0.00|AEG 10|
20|FH_F111540_16823_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115312_78550_0|SrvcGrp|89149|2022|PDM|227.00|99|0.00|OP INTENSIVE|
20|FH_F111812_11222_0|SrvcGrp|75419|2022|PDM|350.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F121009_76180_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F144008_11413_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|1872.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150019_19380_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F92676_15063_0|SrvcGrp|78991|2022|PDM|1200.94|99|0.00|MON VALLEY ASC 213|
20|FH_F148907_01810_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F108660_63775_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME HEALTH (NEWBORN CARE)|
20|FH_F125296_18337_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148872_45723_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97542_32960_0|SrvcGrp|73601|2022|PDM|6489.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F40457_0_0|CSTM-ALL|CSTM-00|2020|PDM|1591.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147800_0_0|SrvcGrp|100864|2022|PDM|55.00|99|0.00|DRAIN/INJ JOINT/BURSA W/O U|
20|FH_F101840_76054_0|SrvcGrp|58368|2022|PDM|18548.00|99|0.00|MS DRG 030 ONLY|
20|FH_F109625_27330_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F37568_0_0|SrvcGrp|24286|2022|PDM|25.00|99|0.00|SKILLED NURSING CARE|
20|FH_F101840_76054_0|SrvcGrp|90063|2022|PDM|6956.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F80952_45669_0|CSTM-ALL|CSTM-00|2020|PDM|1187.79|99|0.00|AEG 5  (NO REV)|
20|FH_F57592_0_0|SrvcGrp|28624|2022|PCT|0.50|99|0.00|HIGH COST DRUGS|
20|FH_F92677_08003_0|SrvcGrp|14947|2022|PDM|105.00|99|0.00|HOME INFUSION|
20|FH_F97201_15068_0|SrvcGrp|73700|2022|PDM|38.50|99|0.00|AETNA - SKILLED NURSING|
20|FH_F43411_0_0|SrvcGrp|43871|2022|PDM|450.00|99|0.00|NEWBORN NURSERY|
20|FH_F128919_48075_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88512_0_0|SrvcGrp|72739|2022|PDM|10889.63|99|0.00|CARDIAC CATH|
20|FH_F148919_32806_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F90955_06053_0|SrvcGrp|48385|2022|PDM|84.00|99|0.00|SPEECH THERAPY|
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126676_43537_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F115327_45320_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133021_00910_0|SrvcGrp|112331|2022|PDM|1200.00|99|0.00|FLUOROSCOPY|
20|FH_F117872_33462_0|SrvcGrp|73842|2022|PDM|239.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F109404_0_0|SrvcGrp|92141|2022|PDM|48.00|99|0.00|ANETHESIA SERVICES|
20|FH_F31542_0_0|SrvcGrp|11259|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F111421_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129965_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F42168_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F77663_0_0|SrvcGrp|23587|2022|PDM|300.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
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_F72859_0_0|SrvcGrp|10648|2022|PDM|15.00|99|0.00|HOME INFUSION|
20|FH_F141872_20707_0|SrvcGrp|98701|2022|PDM|307.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F97581_60141_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F97621_75801_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F103106_04101_0|SrvcGrp|90397|2022|PDM|350.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F151059_60435_0|SrvcGrp|66264|2022|PDM|106.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F151061_02720_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151079_17011_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|HSS ASC|
20|FH_F151122_10462_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F88096_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 2 (NO REV)|
20|FH_F89372_0_0|SrvcGrp|73806|2022|PCT|0.59|99|0.00|AETNA ER|
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|53.58|99|0.00|AETNA SLEEP STUDIES (MOD TC)|
20|FH_F87480_0_0|SrvcGrp|86234|2022|PDM|1800.00|99|0.00|AETHA IMPLANT SPINAL CANAL CATH|
20|FH_F149179_0_0|SrvcGrp|115606|2022|PDM|5098.00|99|0.00|REVISE CERV ARTIFIC DISC|
20|FH_F40191_0_0|SrvcGrp|29089|2022|PDM|3647.00|99|0.00|CPT CODE CARDIAC CATHETERIZATION|
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136390_46321_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134126_11554_0|SrvcGrp|13595|2022|PDM|402.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F137147_75006_0|SrvcGrp|47006|2022|PDM|17854.00|99|0.00|MS DRG 627 ONLY|
20|FH_F137241_07481_0|SrvcGrp|109330|2022|PCT|1.19|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F137249_30046_0|SrvcGrp|35005|2022|PCT|1.10|99|0.00|HOSPICE PHYSICIAN SERVICES|
20|FH_F142448_15701_0|SrvcGrp|24753|2022|PDM|25.00|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F142547_70002_0|SrvcGrp|86827|2022|PDM|50.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F117552_0_0|SrvcGrp|58634|2022|PDM|4400.00|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F62683_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97600_46151_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F97602_40121_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F138584_30912_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 8 (NO REV)|
20|FH_F130363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137287_0_0|SrvcGrp|113072|2022|PDM|300.00|99|0.00|HALF DAY OP THERAPY|
20|FH_F77782_66061_0|CSTM-ALL|CSTM-00|2020|PDM|2214.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F140338_40475_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140548_60527_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148679_57328_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149650_96819_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151608_30236_0|SrvcGrp|109787|2022|PDM|1186.00|99|0.00|EXC FOOT/TOE TUM SC < 1.5 CM|
20|FH_F92475_15931_0|SrvcGrp|471|2022|PDM|686.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F109882_36695_0|SrvcGrp|86648|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F70665_0_0|SrvcGrp|42831|2022|PDM|48.00|99|0.00|DIETICIAN VISIT|
20|FH_F76144_0_0|CSTM-ALL|CSTM-00|2020|PDM|2505.54|99|0.00|ASPG VII F/S - BDSS|
20|FH_F117261_43543_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117325_19342_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147725_06002_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 10 (NO REV)|
20|FH_F147779_34240_0|SrvcGrp|115180|2022|PCT|1.00|99|0.00|COVID-19 VACCINES AND ADMINSTRATION|
20|FH_F147925_06457_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F129483_77030_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F115868_0_0|SrvcGrp|94780|2022|PDM|18.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F45303_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F109652_0_0|SrvcGrp|12787|2022|PCT|0.26|99|0.00|IMPLANTS|
20|FH_F109821_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F90735_94070_0|SrvcGrp|90282|2022|PDM|32.50|99|0.00|FANCONI ANEMIA-GROUP C|
20|FH_F129892_0_0|SrvcGrp|70749|2022|PDM|1495.00|99|0.00|CPT 29823|
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|682.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132736_0_0|SrvcGrp|112077|2022|PDM|48747.00|99|0.00|CV SURGERY|
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|1190.00|99|0.00|AEG 8 (NO REV)|
20|FH_F110160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147211_0_0|SrvcGrp|12846|2022|PCT|0.60|99|0.00|PHARMACY SVCS|
20|FH_F38431_0_0|SrvcGrp|23016|2022|PDM|500.00|99|0.00|V5060|
20|FH_F39567_0_0|SrvcGrp|38|2022|PDM|1000.00|99|0.00|NORMAL DELIVERY|
20|FH_F40755_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|RAD MOD 26|
20|FH_F93805_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F40403_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F49895_0_0|SrvcGrp|31189|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF (DME)|
20|FH_F59732_0_0|SrvcGrp|24934|2022|PDM|75.00|99|0.00|NUTRITIONAL ASSESSMENT (INITIAL)|
20|FH_F148123_91301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F116700_11787_0|SrvcGrp|73842|2022|PDM|165.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121090_07848_0|SrvcGrp|69075|2022|PDM|76.88|99|0.00|CPT 99213|
20|FH_F36081_0_0|SrvcGrp|22142|2022|PCT|1.00|99|0.00|GO328 MOD QW|
20|FH_F129968_98004_0|SrvcGrp|100520|2022|PDM|515.00|99|0.00|INTENSIVE OP EATING DISORDERS|
20|FH_F129019_62650_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39273_0_0|SrvcGrp|29021|2022|PCT|1.00|99|0.00|DME AND SUPPLIES|
20|FH_F117044_37352_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F62892_0_0|SrvcGrp|14254|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F42979_0_0|SrvcGrp|26350|2022|PDM|212.00|99|0.00|CPT 90802|
20|FH_F131175_06757_0|SrvcGrp|111763|2022|PDM|1575.00|99|0.00|PARTIAL HOSPITAL|
20|FH_F142785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45798_0_0|SrvcGrp|9059|2022|PDM|33900.00|99|0.00|DRG 497 ONLY|
20|FH_F138410_19130_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F150961_89169_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F114207_35243_0|SrvcGrp|19742|2022|PDM|60.00|99|0.00|MID-LINE INSERTION|
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|1179.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F122394_75979_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F35458_0_0|SrvcGrp|3378|2022|PDM|2625.00|99|0.00|OBSERVATION SVCS|
20|FH_F124316_28112_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134847_0_0|SrvcGrp|102120|2022|PDM|2270.00|99|0.00|REVISE EYE MUSCLE|
20|FH_F148966_37865_0|SrvcGrp|90854|2022|PDM|835.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F91996_33805_0|SrvcGrp|26001|2022|PDM|136.78|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F35729_34667_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F69123_0_0|SrvcGrp|43569|2022|PDM|40.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|2350.00|99|0.00|AEG 4 (NO REV)|
20|FH_F122386_70578_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133140_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F97480_08204_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F132132_77040_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|2349.00|99|0.00|AEG 9 (NO REV)|
20|FH_F40853_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115705_0_0|SrvcGrp|26001|2022|PDM|120.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F151699_01752_0|SrvcGrp|65621|2022|PDM|58.75|99|0.00|RN NURSING|
20|FH_F151699_01752_0|SrvcGrp|86831|2022|PDM|10.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F139715_0_0|SrvcGrp|63667|2022|PCT|0.45|99|0.00|OP ORPHAN DRUGS|
20|FH_F97881_38703_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F138271_75040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110193_70444_0|SrvcGrp|73841|2022|PDM|379.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F100540_0_0|SrvcGrp|72990|2022|PDM|480.00|99|0.00|AEG 1|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.42|99|0.00|ASPG II|
20|FH_F147219_48207_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35167_0_0|SrvcGrp|20077|2022|PCT|0.65|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR|
20|FH_F129340_43212_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F128753_32501_0|SrvcGrp|76522|2022|PCT|0.64|99|0.00|CHEMOTHERAPY DRUGS|
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_F137986_0_0|SrvcGrp|35672|2022|PDM|3132.00|99|0.00|CPT 23412|
20|FH_F128583_45154_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F124703_65711_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F139807_33064_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143249_89801_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143536_47546_0|SrvcGrp|100246|2022|PCT|0.00|99|0.00|STREP A ASSAY W/ OPTIC|
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_F103060_0_0|SrvcGrp|72121|2022|PDM|3121.00|99|0.00|ARTHOSCOPY|
20|FH_F114931_0_0|SrvcGrp|87845|2022|PDM|3200.00|99|0.00|GASTRIC RESTRICTIVE PROCEDURE|
20|FH_F131173_17043_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F47969_0_0|SrvcGrp|22954|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F48476_0_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD UE/KC)|
20|FH_F49329_0_0|SrvcGrp|45336|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE (ADDITIONAL HOURS)|
20|FH_F132479_90290_0|SrvcGrp|87131|2022|PDM|508.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F84372_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F114914_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F84611_30281_0|SrvcGrp|73461|2022|PDM|4384.00|99|0.00|AETNA NICU IV|
20|FH_F46158_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F51276_0_0|SrvcGrp|14944|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F33925_0_0|SrvcGrp|15782|2022|PDM|5539.00|99|0.00|LITHOTRIPSY - BILATERAL (MOD 50)|
20|FH_F35685_0_0|SrvcGrp|11191|2022|PDM|22050.00|99|0.00|DRG 551 PERMANENT CARDIAC PACEMAKER|
20|FH_F35685_0_0|SrvcGrp|11223|2022|PDM|15435.00|99|0.00|DRG 558 PERC CV PX W/DRUG-ELUTING STENT W/O MAJOR CV DX|
20|FH_F36132_0_0|SrvcGrp|22350|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F40345_0_0|SrvcGrp|439|2022|PDM|1545.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F42953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F43007_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F38560_0_0|SrvcGrp|29498|2022|PDM|2500.00|99|0.00|ICU|
20|FH_F130908_32708_0|SrvcGrp|108484|2022|PDM|645.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F130908_32708_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149106_07042_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120930_0_0|SrvcGrp|97730|2022|PDM|6500.00|99|0.00|REVERSE HIP JOINT|
20|FH_F127486_06776_0|SrvcGrp|48396|2022|PDM|109.20|99|0.00|OT SERVICES|
20|FH_F130763_0_0|SrvcGrp|26275|2022|PDM|3346.00|99|0.00|CPT 29826|
20|FH_F133947_93950_0|SrvcGrp|108484|2022|PDM|679.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F81838_0_0|SrvcGrp|13606|2022|PDM|33.00|99|0.00|HOME INFUSION|
20|FH_F50657_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F130329_64114_0|SrvcGrp|86847|2022|PDM|25.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F57453_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BERKS UROLOGIC SURGERY CTR|
20|FH_F49552_0_0|SrvcGrp|31387|2022|PDM|81.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F129975_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F123661_30060_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F126770_43050_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40347_0_0|SrvcGrp|3029|2022|PDM|350.00|99|0.00|NEWBORN NURSERY|
20|FH_F134254_33462_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136371_29720_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136542_02446_0|SrvcGrp|91070|2022|PDM|284.00|99|0.00|AETNA MH CRISIS INTERVENTION (HCFA)|
20|FH_F118152_20151_0|SrvcGrp|86839|2022|PDM|40.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F118171_00674_0|SrvcGrp|107751|2022|PDM|5200.00|99|0.00|TIPS|
20|FH_F114092_83350_0|SrvcGrp|75506|2022|PDM|4000.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F142333_28387_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F97601_67218_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F138627_82901_0|SrvcGrp|98991|2022|PDM|75.00|99|0.00|HYDRATION THERAPY 1 LITER (HCFA)|
20|FH_F140727_16046_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140893_19720_0|SrvcGrp|26160|2022|PCT|1.11|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F80284_16354_0|SrvcGrp|64100|2022|PDM|1231.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 7|
20|FH_F120152_0_0|SrvcGrp|103570|2022|PDM|6600.00|99|0.00|ARTHROSCOPIC FRACTURE|
20|FH_F149607_76548_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149663_45219_0|CSTM-ALL|CSTM-00|2020|PDM|1114.00|99|0.00|AEG 3 (NO REV)|
20|FH_F151603_27609_0|SrvcGrp|92409|2022|PDM|2721.00|99|0.00|PERQ CERVICOTHORACIC INJECT|
20|FH_F118959_44830_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F119067_94080_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F118914_43015_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F41481_0_0|SrvcGrp|17083|2022|PDM|366.00|99|0.00|ASPG X|
20|FH_F49039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F70665_0_0|SrvcGrp|42826|2022|PDM|68.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F117255_68520_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F147801_90703_0|SrvcGrp|111112|2022|PDM|1071.00|99|0.00|INPATIENT PSYCHIATRIC (>=65 YRS)|
20|FH_F147879_93309_0|SrvcGrp|46605|2022|PDM|165.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F129504_02871_0|SrvcGrp|94781|2022|PDM|165.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F117218_32025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137270_82901_0|SrvcGrp|48396|2022|PDM|85.50|99|0.00|OT SERVICES|
20|FH_F137815_15501_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137891_23451_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F109821_0_0|SrvcGrp|86235|2022|PDM|1020.00|99|0.00|AETHA HAND SURGERY|
20|FH_F111593_0_0|SrvcGrp|72996|2022|PDM|1562.00|99|0.00|AEG 4|
20|FH_F90876_18447_0|SrvcGrp|89783|2022|PDM|110.25|99|0.00|RESPITE CARE (HCFA)|
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79443_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F56274_0_0|SrvcGrp|3810|2022|PDM|161.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F92677_08003_0|SrvcGrp|86849|2022|PDM|63.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F151142_35406_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F151179_84074_0|SrvcGrp|72998|2022|PDM|1244.00|99|0.00|AEG 5|
20|FH_F114931_0_0|SrvcGrp|105761|2022|PDM|1850.00|99|0.00|CHEMODENERVATION OF INTERNAL|
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 5  (NO REV)|
20|FH_F130066_84107_0|SrvcGrp|58509|2022|PDM|410.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F38807_0_0|SrvcGrp|17071|2022|PDM|630.00|99|0.00|ASPG IV|
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|GENERAL ACUTE CARE|
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|117.45|99|0.00|DELAWARE VALLEY- ASC 219|
20|FH_F113726_61520_0|SrvcGrp|472|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F110381_0_0|SrvcGrp|73004|2022|PDM|2650.00|99|0.00|AEG 8|
20|FH_F110381_0_0|SrvcGrp|73000|2022|PDM|1484.00|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_F74562_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AEG 4 (NO REV)|
20|FH_F111925_0_0|SrvcGrp|28548|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_F125163_0_0|SrvcGrp|108081|2022|PDM|557.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PDM|1255.05|99|0.00|ASPG VII|
20|FH_F133178_0_0|SrvcGrp|112207|2022|PDM|832.00|99|0.00|DESTROY VULVA LESIONS|
20|FH_F132988_0_0|SrvcGrp|100063|2022|PDM|6031.49|99|0.00|REPAIR FOOT DISLOCATION|
20|FH_F133002_0_0|SrvcGrp|92659|2022|PDM|1716.00|99|0.00|REPAIR OF RETINAL DETACHMENT|
20|FH_F133529_0_0|SrvcGrp|79644|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 4 (NO REV)|
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 7 (NO REV)|
20|FH_F49487_0_0|SrvcGrp|38756|2022|PDM|20.00|99|0.00|NUTRITION PRODUCTS VIA PUMP|
20|FH_F124180_0_0|SrvcGrp|68281|2022|PDM|3500.00|99|0.00|CPT 67041|
20|FH_F88733_0_0|SrvcGrp|79720|2022|PDM|1050.00|99|0.00|ACUTE REHAB II|
20|FH_F122198_20708_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146974_19709_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146906_60445_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146990_80206_0|SrvcGrp|75419|2022|PDM|430.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F64819_0_0|CSTM-ALL|CSTM-00|2020|PDM|5217.00|99|0.00|MS DRG 765-766 ONLY C-SECTION|
20|FH_F39753_0_0|SrvcGrp|701|2022|PDM|2494.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F40302_0_0|SrvcGrp|439|2022|PDM|2180.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F132864_71101_0|SrvcGrp|73806|2022|PDM|532.00|99|0.00|AETNA ER|
20|FH_F124663_65608_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F124671_64844_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150910_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F127995_84010_0|SrvcGrp|47411|2022|PDM|107.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|1982.00|99|0.00|ASPG II|
20|FH_F90653_0_0|SrvcGrp|471|2022|PDM|1800.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F123620_0_0|SrvcGrp|106317|2022|PDM|823.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F132890_87544_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F114666_30342_0|SrvcGrp|88740|2022|PDM|2500.00|99|0.00|SP BONE ALGRFT|
20|FH_F113791_32055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113845_32746_0|CSTM-ALL|CSTM-00|2020|PDM|75.98|99|0.00|AETNA FAMILY ADAPTIVE BH TREATMENT W/O PATIENT|
20|FH_F138310_60461_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100664_03104_0|SrvcGrp|73601|2022|PDM|8102.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F81832_13827_0|SrvcGrp|3809|2022|PDM|943.00|99|0.00|HOSPICE CARE|
20|FH_F43120_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F43249_0_0|SrvcGrp|360|2022|PDM|2590.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F135719_45502_0|SrvcGrp|97968|2022|PDM|551.00|99|0.00|CT SCAN|
20|FH_F136807_43220_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112371_19047_0|SrvcGrp|79099|2022|PDM|1685.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F113713_17013_0|SrvcGrp|98041|2022|PDM|8.63|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F115608_24171_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115664_72758_0|SrvcGrp|79238|2022|PDM|623.00|99|0.00|TRANSFER|
20|FH_F116339_41064_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F116393_07002_0|SrvcGrp|48159|2022|PCT|0.70|99|0.00|BOTULINUM TOXIN TYPE B, PER 100 UNITS|
20|FH_F41463_0_0|SrvcGrp|21711|2022|PDM|152.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F41463_0_0|SrvcGrp|29346|2022|PDM|48.30|99|0.00|SKILLED NURSING- LPN|
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_F34660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113649_01752_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_F51276_0_0|SrvcGrp|29075|2022|PDM|50.00|99|0.00|HYDRATION THERAPY|
20|FH_F33925_0_0|SrvcGrp|360|2022|PDM|575.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F35685_0_0|SrvcGrp|11193|2022|PDM|17640.00|99|0.00|DRG 555 PERCUTANEOUS CARDIOVASCULAR PROCEDURE W/ MAJOR DX|
20|FH_F39355_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F103241_06002_0|SrvcGrp|75545|2022|PDM|532.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F36704_0_0|SrvcGrp|588|2022|PDM|1675.00|99|0.00|CORONARY CARE UNIT|
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 5  (NO REV)|
20|FH_F140007_0_0|SrvcGrp|97159|2022|PDM|7887.00|99|0.00|TRANSPEDICULAR, 1 SEG, LUMBAR|
20|FH_F120112_0_0|SrvcGrp|63297|2022|PDM|94.50|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F130302_0_0|SrvcGrp|72994|2022|PDM|1423.00|99|0.00|AEG 3|
20|FH_F130302_0_0|SrvcGrp|72990|2022|PDM|1008.00|99|0.00|AEG 1|
20|FH_F134087_0_0|SrvcGrp|88340|2022|PDM|5410.00|99|0.00|SPINAL FUSION|
20|FH_F98361_12065_0|SrvcGrp|73559|2022|PDM|11718.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F80511_0_0|SrvcGrp|3224|2022|PCT|0.60|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F51492_0_0|SrvcGrp|45783|2022|PDM|75.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F54552_0_0|SrvcGrp|17003|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS|
20|FH_F138700_76802_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138787_32258_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F138847_67156_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138936_01040_0|SrvcGrp|49682|2022|PCT|1.40|99|0.00|HSS DRG GROUPED|
20|FH_F139012_78516_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138685_18017_0|SrvcGrp|108484|2022|PDM|547.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F78265_0_0|CSTM-ALL|CSTM-00|2020|PDM|2788.00|99|0.00|ASPG VI|
20|FH_F89580_0_0|SrvcGrp|8968|2022|PDM|6485.00|99|0.00|NICU LEVEL III & IV|
20|FH_F151419_07852_0|SrvcGrp|75419|2022|PDM|361.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F132258_45404_0|SrvcGrp|86840|2022|PDM|34.98|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F135388_48601_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135432_16335_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F119892_47586_0|SrvcGrp|73700|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F131566_60559_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116397_33404_0|SrvcGrp|22593|2022|PDM|40.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F116463_76501_0|SrvcGrp|104077|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F116527_70443_0|SrvcGrp|73485|2022|PDM|750.00|99|0.00|AETNA REHAB|
20|FH_F116527_70443_0|SrvcGrp|73008|2022|PDM|900.00|99|0.00|AEG 10|
20|FH_F131361_18235_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F131682_50109_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F121466_84057_0|SrvcGrp|74668|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131407_07607_0|SrvcGrp|111660|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F130010_77384_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128353_22191_0|SrvcGrp|27969|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133565_32570_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111292_33136_0|SrvcGrp|105604|2022|PCT|2.44|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F134256_36117_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134930_0_0|SrvcGrp|16|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION|
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|1128.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132328_0_0|SrvcGrp|79593|2022|PDM|1500.00|99|0.00|CPT 45378|
20|FH_F43895_0_0|SrvcGrp|37822|2022|PDM|1105.00|99|0.00|ACUTE REHABILITATION|
20|FH_F118194_50841_0|SrvcGrp|73742|2022|PDM|5.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F35513_0_0|SrvcGrp|16494|2022|PDM|425.00|99|0.00|MULTIPLE SLEEP LATENCY|
20|FH_F150982_0_0|SrvcGrp|37317|2022|PDM|6386.00|99|0.00|LITHOTRIPSY|
20|FH_F41178_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|2117.50|99|0.00|AEG 4 (NO REV)|
20|FH_F36595_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|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_F78922_0_0|SrvcGrp|76093|2022|PCT|0.20|99|0.00|HIGH COST DRUGS|
20|FH_F75307_0_0|SrvcGrp|42973|2022|PDM|105.00|99|0.00|SPEECH  THERAPIST|
20|FH_F135219_68506_0|CSTM-ALL|CSTM-00|2020|PDM|6489.91|99|0.00|AEG 9 (NO REV)|
20|FH_F116024_13203_0|SrvcGrp|58509|2022|PDM|290.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F139515_0_0|SrvcGrp|83350|2022|PDM|3348.00|99|0.00|AETNA LAPAR HERNIA REPAIR|
20|FH_F127826_65583_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F112325_0_0|SrvcGrp|83519|2022|PDM|100.00|99|0.00|HOSPICE CARE (ALL OTHER)|
20|FH_F128136_48025_0|SrvcGrp|29155|2022|PDM|130.00|99|0.00|HOSPICE SVCS|
20|FH_F38730_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|952.00|99|0.00|AEG 1 (NO REV)|
20|FH_F125025_67401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139551_0_0|SrvcGrp|88161|2022|PDM|5769.00|99|0.00|LAMINECTOMY W/FACE-THORACIC|
20|FH_F78042_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F54172_0_0|SrvcGrp|9529|2022|PDM|643.00|99|0.00|HOSPICE SVCS|
20|FH_F142073_0_0|SrvcGrp|41335|2022|PDM|11900.00|99|0.00|TOTAL HIP|
20|FH_F125899_07645_0|SrvcGrp|73006|2022|PDM|8269.00|99|0.00|AEG 9|
20|FH_F134996_83467_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143790_83440_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F93384_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F121533_26241_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131995_04730_0|SrvcGrp|88621|2022|PDM|126.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133099_66801_0|SrvcGrp|79699|2022|PCT|0.80|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F109538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149868_0_0|SrvcGrp|93099|2022|PDM|678.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY|
20|FH_F31959_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|EMERGENCY MEDICAL SERVICES (EMS)|
20|FH_F39819_0_0|SrvcGrp|31217|2022|PDM|3533.00|99|0.00|NY DRG 143 ONLY|
20|FH_F141509_07058_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|PDM|875.00|99|0.00|AEG 3 (NO REV)|
20|FH_F116176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110925_01104_0|SrvcGrp|41454|2022|PDM|1.06|99|0.00|ENTERAL FORMULA - PEDIATRICS|
20|FH_F143969_71129_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F137427_89146_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116984_28092_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F143790_83440_0|CSTM-ALL|CSTM-00|2020|PDM|724.00|99|0.00|AEG 2 (NO REV)|
20|FH_F119384_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F143888_32205_0|SrvcGrp|111123|2022|PCT|1.00|99|0.00|E&M|
20|FH_F93114_85016_0|SrvcGrp|88620|2022|PDM|145.00|99|0.00|SKILLED NURSING RN|
20|FH_F134993_75034_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F95200_16201_0|SrvcGrp|78403|2022|PDM|0.10|99|0.00|AETNA MED RECORD|
20|FH_F139515_0_0|SrvcGrp|47142|2022|PDM|2850.00|99|0.00|CPT 49650|
20|FH_F137454_64068_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116269_92627_0|SrvcGrp|86753|2022|PCT|1.15|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|357.17|99|0.00|HAPA WPA-NWPA 2012-13 ASC 216 W/O REV|
20|FH_F39385_0_0|SrvcGrp|14174|2022|PDM|2556.00|99|0.00|MRI|
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_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|327.00|99|0.00|AEG 1 (NO REV)|
20|FH_F123312_54115_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_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|455.00|99|0.00|AEG 1 (NO REV)|
20|FH_F128333_71001_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F120899_72758_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|1242.00|99|0.00|AEG 7 (NO REV)|
20|FH_F145689_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.25|99|0.00|HSS ASC|
20|FH_F137459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135092_46410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34241_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OP SVCS|
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|AEG 10 (NO REV)|
20|FH_F128136_48025_0|SrvcGrp|82223|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F89475_71202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148400_33401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F43167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F48215_0_0|SrvcGrp|12263|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F129666_71901_0|SrvcGrp|48398|2022|PDM|155.00|99|0.00|PT SERVICES|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|972.23|99|0.00|HAPA WPA-NWPA 2012-13 ASC 705 W/O REV|
20|FH_F143528_0_0|SrvcGrp|67068|2022|PDM|10500.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F32293_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F141427_22003_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F38341_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F37679_0_0|SrvcGrp|17007|2022|PDM|61.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS|
20|FH_F120248_77008_0|SrvcGrp|90854|2022|PDM|750.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F127036_43724_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F87557_33309_0|SrvcGrp|86828|2022|PDM|45.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F87557_33309_0|SrvcGrp|86846|2022|PDM|30.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F96280_06340_0|SrvcGrp|58509|2022|PDM|419.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F102222_19720_0|SrvcGrp|86846|2022|PDM|31.50|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F129240_10028_0|SrvcGrp|86839|2022|PDM|40.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F129220_18445_0|SrvcGrp|13810|2022|PDM|885.00|99|0.00|ACUTE PSYCH|
20|FH_F98300_30236_0|SrvcGrp|73603|2022|PDM|1681.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1499.00|99|0.00|AEG 5  (NO REV)|
20|FH_F148119_30165_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132544_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F119321_71040_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F119321_71040_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148459_15241_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126733_83713_0|SrvcGrp|73605|2022|PDM|861.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F148921_91356_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F42420_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|ACUTE PSYCH|
20|FH_F98640_0_0|SrvcGrp|95819|2022|PDM|1280.00|99|0.00|GONIOTOMY|
20|FH_F49932_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F148881_33018_0|SrvcGrp|472|2022|PDM|505.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F123539_65265_0|SrvcGrp|75545|2022|PDM|327.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F128299_44134_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F150541_37922_0|SrvcGrp|115639|2022|PCT|1.25|99|0.00|RADIOLOGY SERVICES|
20|FH_F141927_71901_0|CSTM-ALL|CSTM-00|2020|PDM|1019.00|99|0.00|AEG 5  (NO REV)|
20|FH_F129175_0_0|SrvcGrp|87677|2022|PDM|546.96|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKE|
20|FH_F150479_53223_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F74163_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F87615_80033_0|SrvcGrp|12659|2022|PDM|1005.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F109624_15401_0|SrvcGrp|472|2022|PDM|365.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117471_19111_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101851_78024_0|SrvcGrp|43525|2022|PDM|465.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC|
20|FH_F117954_17961_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|115.08|99|0.00|HAPA WPA-NWPA 2012-13 ASC 141 W/O REV|
20|FH_F142991_43920_0|SrvcGrp|13681|2022|PDM|275.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F134490_62801_0|CSTM-ALL|CSTM-00|2020|PDM|1256.00|99|0.00|AEG 4 (NO REV)|
20|FH_F117911_86403_0|SrvcGrp|73700|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F63301_0_0|SrvcGrp|59634|2022|PCT|0.50|99|0.00|HOME INFUSION - MOD SH|
20|FH_F117816_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F78205_0_0|SrvcGrp|17067|2022|PDM|1064.83|99|0.00|ASPG II|
20|FH_F135714_01922_0|SrvcGrp|95661|2022|PDM|200.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F148886_60621_0|SrvcGrp|91148|2022|PDM|16602.00|99|0.00|MSDRG 268-272 ONLY|
20|FH_F44016_0_0|SrvcGrp|17739|2022|PDM|2796.00|99|0.00|ICU/CCU|
20|FH_F141830_92592_0|SrvcGrp|74668|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F83294_0_0|SrvcGrp|42973|2022|PDM|85.00|99|0.00|SPEECH  THERAPIST|
20|FH_F46473_0_0|SrvcGrp|12995|2022|PDM|485.00|99|0.00|DIALYSIS|
20|FH_F150001_33064_0|SrvcGrp|22389|2022|PDM|11.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F133490_90650_0|SrvcGrp|75506|2022|PCT|0.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F141893_65655_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F103281_32086_0|SrvcGrp|43524|2022|PDM|225.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F42807_0_0|SrvcGrp|705|2022|PCT|0.75|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F146377_85007_0|SrvcGrp|3178|2022|PDM|927.00|99|0.00|ACUTE PSYCH|
20|FH_F118486_95060_0|SrvcGrp|86747|2022|PCT|1.15|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F100786_24740_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91255_19401_0|CSTM-ALL|CSTM-00|2020|PDM|937.00|99|0.00|AEG 1 (NO REV)|
20|FH_F111403_37167_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F143197_34957_0|SrvcGrp|46903|2022|PDM|630.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F51123_0_0|SrvcGrp|40582|2022|PDM|250.00|99|0.00|HOSPICE SVCS|
20|FH_F143054_26147_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F128130_10027_0|SrvcGrp|75506|2022|PCT|4.41|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102900_44883_0|SrvcGrp|3178|2022|PDM|900.00|99|0.00|ACUTE PSYCH|
20|FH_F38977_0_0|SrvcGrp|3029|2022|PDM|298.00|99|0.00|NEWBORN NURSERY|
20|FH_F119079_41018_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F133154_27401_0|SrvcGrp|73842|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F43078_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F63250_0_0|SrvcGrp|46104|2022|PDM|99.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F141612_19605_0|SrvcGrp|72602|2022|PDM|955.00|99|0.00|ECT|
20|FH_F133367_40065_0|SrvcGrp|16374|2022|PCT|0.43|99|0.00|IMPLANTS|
20|FH_F45436_0_0|SrvcGrp|26798|2022|PDM|70.00|99|0.00|LICENSED PRACTICAL NURSE|
20|FH_F120437_85202_0|SrvcGrp|104216|2022|PDM|17.76|99|0.00|HYQVIA 100MG IMMUNEGLOBULIN|
20|FH_F47479_0_0|SrvcGrp|47463|2022|PDM|70.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F100788_01420_0|SrvcGrp|73659|2022|PDM|5740.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F67136_0_0|SrvcGrp|36137|2022|PCT|0.70|99|0.00|TRANSPLANT SVCS|
20|FH_F79902_0_0|SrvcGrp|13168|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F127204_44420_0|SrvcGrp|48394|2022|PDM|47.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F103281_32086_0|SrvcGrp|82369|2022|PCT|0.80|99|0.00|AETNA LABORATORY|
20|FH_F42248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CD DAY TREATMENT|
20|FH_F150164_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F133530_11237_0|SrvcGrp|112360|2022|PCT|1.66|99|0.00|ALL OTHER DRUGS|
20|FH_F100665_07939_0|SrvcGrp|73559|2022|PDM|7116.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F87155_04105_0|SrvcGrp|29076|2022|PDM|57.78|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F127383_46825_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145884_72113_0|SrvcGrp|113276|2022|PCT|1.10|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F97622_75051_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F92792_0_0|SrvcGrp|84280|2022|PDM|2200.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F132553_65340_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100785_54660_0|SrvcGrp|73559|2022|PDM|7768.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1769.00|99|0.00|AEG 6 (NO REV)|
20|FH_F138611_0_0|SrvcGrp|84939|2022|PDM|14894.00|99|0.00|SHOULDER JOINT|
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|1004.00|99|0.00|AEG 7 (NO REV)|
20|FH_F115315_43011_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F68622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F142931_60644_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F115274_15235_0|SrvcGrp|80918|2022|PDM|140.00|99|0.00|RESPITE CARE|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/GLOBAL (TX)|
20|FH_F146257_83713_0|SrvcGrp|90854|2022|PDM|1100.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F91198_46714_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F45977_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|NURSING CARE MOD TE|
20|FH_F131699_08210_0|SrvcGrp|29347|2022|PDM|30.16|99|0.00|HOME HEALTH AIDE|
20|FH_F139584_10281_0|SrvcGrp|113502|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F139707_84010_0|SrvcGrp|114707|2022|PDM|2546.00|99|0.00|UROLOGY PROCEDURES|
20|FH_F150745_03301_0|SrvcGrp|104229|2022|PDM|208.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F110732_31513_0|SrvcGrp|11663|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F50415_0_0|CSTM-ALL|CSTM-00|2020|PDM|20.00|99|0.00|HOME HEALTH AIDE MOD TF|
20|FH_F130578_43950_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124703_65711_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F124492_30040_0|SrvcGrp|87077|2022|PDM|152.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F114206_37203_0|SrvcGrp|26869|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F98820_81401_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F40624_0_0|SrvcGrp|20293|2022|PDM|36409.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY|
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_F39443_0_0|SrvcGrp|30371|2022|PDM|1400.00|99|0.00|HAPA WPA ASC 14|
20|FH_F39443_0_0|SrvcGrp|13363|2022|PDM|440.00|99|0.00|EMERGENCY ROOM SVCS LEVEL V|
20|FH_F122393_76020_0|SrvcGrp|74668|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F110963_30535_0|SrvcGrp|88621|2022|PDM|170.00|99|0.00|SKILLED NURSING LPN|
20|FH_F117617_80439_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F145563_0_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F146765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139576_0_0|SrvcGrp|16468|2022|PDM|2174.00|99|0.00|LASER PROCEDURES|
20|FH_F125081_15218_0|SrvcGrp|95660|2022|PDM|550.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.00|99|0.00|AEG 8 (NO REV)|
20|FH_F44279_0_0|SrvcGrp|38451|2022|PDM|200.00|99|0.00|DIAGNOSTIC TESTING|
20|FH_F98623_97006_0|SrvcGrp|73601|2022|PDM|14109.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F33527_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F130328_0_0|SrvcGrp|95661|2022|PDM|692.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|480.08|99|0.00|PHENYLEPHRINE KETOROLAC|
20|FH_F115982_0_0|SrvcGrp|26273|2022|PDM|1350.00|99|0.00|CPT 29880|
20|FH_F36299_0_0|SrvcGrp|22785|2022|PDM|592.00|99|0.00|SUBACUTE WITHOUT  VENTILATOR|
20|FH_F119376_0_0|SrvcGrp|108116|2022|PDM|1698.78|99|0.00|AV FUSION / UPPER ARM VEIN|
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|AEG 1 (NO REV)|
20|FH_F139967_37205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149030_37919_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113826_51445_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F36343_0_0|SrvcGrp|22018|2022|PDM|55.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F142370_0_0|SrvcGrp|73559|2022|PDM|1595.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F124389_84115_0|SrvcGrp|92141|2022|PDM|42.00|99|0.00|ANETHESIA SERVICES|
20|FH_F150383_29853_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F31547_0_0|SrvcGrp|12264|2022|PDM|75.25|99|0.00|DIETICIAN OR LPN SERVICES|
20|FH_F123570_0_0|SrvcGrp|41334|2022|PDM|3502.00|99|0.00|TOTAL KNEE|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|106.24|99|0.00|SALLY BALIN,999182,ASC 122|
20|FH_F116806_0_0|SrvcGrp|107136|2022|PDM|828.77|99|0.00|PREPARE FACE/ORAL PROSTHESIS|
20|FH_F128191_28642_0|SrvcGrp|46605|2022|PDM|90.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F150981_33140_0|SrvcGrp|87077|2022|PDM|135.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F40644_0_0|SrvcGrp|33081|2022|PCT|0.50|99|0.00|OP CHEMOTHERAPY DRUGS|
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|1282.00|99|0.00|AEG 8 (NO REV)|
20|FH_F39443_0_0|SrvcGrp|30323|2022|PDM|475.00|99|0.00|HAPA WPA ASC 207|
20|FH_F134846_06437_0|SrvcGrp|472|2022|PDM|595.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F114173_18901_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F124467_27529_0|SrvcGrp|73841|2022|PDM|419.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F97183_25304_0|SrvcGrp|73656|2022|PDM|629.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133677_15601_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F116575_0_0|SrvcGrp|106266|2022|PDM|2624.13|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT|
20|FH_F122725_32216_0|SrvcGrp|98688|2022|PDM|23.00|99|0.00|GROUP THERAPY 2 OR MORE|
20|FH_F122694_33334_0|SrvcGrp|16069|2022|PDM|716.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|668.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F63246_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F130801_57717_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130805_17404_0|CSTM-ALL|CSTM-00|2020|PCT|2.50|99|0.00|DEVICE INSERTION|
20|FH_F130805_17404_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F130841_49315_0|SrvcGrp|87799|2022|PDM|130.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F145781_0_0|SrvcGrp|114306|2022|PDM|1300.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F49279_0_0|SrvcGrp|26228|2022|PCT|0.55|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 649|
20|FH_F126308_44515_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F36753_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD KM|
20|FH_F79863_0_0|SrvcGrp|77239|2022|PDM|22.00|99|0.00|AETNA HOME TRANSFUSION OF BLOOD|
20|FH_F150165_06032_0|SrvcGrp|113886|2022|PDM|1720.00|99|0.00|REVISION OF KIDNEY/URETER|
20|FH_F145641_06902_0|SrvcGrp|100065|2022|PDM|3697.00|99|0.00|DEEP ANT OR POSTER TIBIAL|
20|FH_F135663_24401_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F110562_33409_0|SrvcGrp|89149|2022|PDM|308.00|99|0.00|OP INTENSIVE|
20|FH_F71669_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F132938_33710_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51479_0_0|SrvcGrp|37282|2022|PCT|1.06|99|0.00|EPOGEN|
20|FH_F122930_0_0|SrvcGrp|72994|2022|PDM|1575.00|99|0.00|AEG 3|
20|FH_F132965_60459_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149084_33401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119575_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F85353_16407_0|SrvcGrp|63881|2022|PDM|266.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 311|
20|FH_F126343_07018_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F123851_03235_0|SrvcGrp|88621|2022|PDM|123.00|99|0.00|SKILLED NURSING LPN|
20|FH_F141167_0_0|SrvcGrp|113580|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F145659_29646_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125828_67547_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143669_78577_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|2186.00|99|0.00|ASPG IX|
20|FH_F35042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F145558_43950_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F109577_0_0|SrvcGrp|103609|2022|PDM|123.00|99|0.00|DIABETIC MGMT PROGRAM - FOLLOWUP|
20|FH_F111942_92647_0|SrvcGrp|23683|2022|PDM|55.00|99|0.00|SKILLED NURSING RN|
20|FH_F113368_37752_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F71273_0_0|CSTM-ALL|CSTM-00|2020|PDM|603.00|99|0.00|SKILLED NURSING|
20|FH_F110423_33401_0|SrvcGrp|89149|2022|PDM|160.00|99|0.00|OP INTENSIVE|
20|FH_F90613_05001_0|SrvcGrp|90197|2022|PDM|584.00|99|0.00|AETNA RESIDENTIAL TREATMENT CHEMICAL DEPENDENCY|
20|FH_F119379_0_0|SrvcGrp|103564|2022|PDM|764.00|99|0.00|REPAIR FINGER TENDON|
20|FH_F48034_0_0|SrvcGrp|3392|2022|PDM|125.00|99|0.00|CPT 90806|
20|FH_F120123_0_0|SrvcGrp|73485|2022|PDM|1071.00|99|0.00|AETNA REHAB|
20|FH_F133922_70563_0|SrvcGrp|33843|2022|PDM|25.33|99|0.00|CPT CODE 94762|
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 10 (NO REV)|
20|FH_F43863_0_0|SrvcGrp|30961|2022|PDM|12.50|99|0.00|HOME HEALTH AIDE|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD 26|
20|FH_F113435_19027_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|213.00|99|0.00|OP ADOLESCENT PARTIAL HOSPITALIZATION (CD)|
20|FH_F124369_0_0|SrvcGrp|102479|2022|PDM|12155.00|99|0.00|AETNA CPT 29895|
20|FH_F79743_0_0|SrvcGrp|103241|2022|PDM|4180.00|99|0.00|ICU UNIT|
20|FH_F143571_0_0|SrvcGrp|90477|2022|PDM|153.00|99|0.00|HOSPICE|
20|FH_F109577_0_0|SrvcGrp|80920|2022|PDM|855.00|99|0.00|HOSPICE SERVICES|
20|FH_F145641_06902_0|SrvcGrp|82109|2022|PDM|2704.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F128791_57201_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145641_06902_0|SrvcGrp|92007|2022|PDM|5310.00|99|0.00|PROXIMAL HUMERAL|
20|FH_F72543_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F87053_0_0|SrvcGrp|73008|2022|PDM|770.00|99|0.00|AEG 10|
20|FH_F72963_0_0|SrvcGrp|17083|2022|PCT|0.50|99|0.00|ASPG X|
20|FH_F78344_0_0|SrvcGrp|75380|2022|PCT|1.00|99|0.00|DRUG HCPCS CODES|
20|FH_F85314_0_0|SrvcGrp|83901|2022|PDM|640.00|99|0.00|AETNA COLONSCOPY|
20|FH_F105361_80104_0|SrvcGrp|88791|2022|PDM|14564.00|99|0.00|BARIATRIC SURGERY|
20|FH_F115786_57701_0|SrvcGrp|88620|2022|PDM|93.00|99|0.00|SKILLED NURSING RN|
20|FH_F115890_75067_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F66427_0_0|SrvcGrp|11301|2022|PCT|0.80|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F75842_0_0|CSTM-ALL|CSTM-00|2020|PDM|3581.95|99|0.00|MS DRG BAPTIST MEM HOSP SURGICAL|
20|FH_F116056_73018_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F131853_24017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131867_37211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111566_75093_0|SrvcGrp|10107|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F39346_0_0|SrvcGrp|27813|2022|PDM|10160.00|99|0.00|MS DRG 280 ONLY|
20|FH_F102641_0_0|SrvcGrp|91528|2022|PDM|1295.00|99|0.00|SPINAL CORD IMPLANT|
20|FH_F87152_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113178_44035_0|SrvcGrp|105527|2022|PDM|280.00|99|0.00|AETNA PARTIAL HOSP|
20|FH_F113246_72687_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37081_0_0|SrvcGrp|18253|2022|PDM|6950.00|99|0.00|MS DRG 287|
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F124484_83837_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F76124_0_0|SrvcGrp|473|2022|PDM|318.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F114207_35243_0|SrvcGrp|86850|2022|PDM|35.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F38007_0_0|SrvcGrp|941|2022|PDM|3195.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|1615.00|99|0.00|AEG 6 (NO REV)|
20|FH_F112794_01040_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116575_0_0|SrvcGrp|106916|2022|PDM|1900.00|99|0.00|NASAL/SINUS ENDOSCPOY - W/ARTERY LIGAMENT|
20|FH_F124466_32724_0|SrvcGrp|73841|2022|PDM|311.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F149579_95815_0|SrvcGrp|87441|2022|PDM|1200.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F97603_77901_0|SrvcGrp|73643|2022|PDM|1045.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F136376_0_0|SrvcGrp|89149|2022|PDM|205.00|99|0.00|OP INTENSIVE|
20|FH_F139947_43209_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|1392.00|99|0.00|AEG 4 (NO REV)|
20|FH_F98820_81401_0|SrvcGrp|90854|2022|PDM|2818.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F97183_25304_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F43934_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
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_F139576_0_0|SrvcGrp|113637|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F127086_62246_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F32825_0_0|SrvcGrp|18376|2022|PCT|0.70|99|0.00|MS DRG 482|
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PDM|1859.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F114204_53191_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134738_0_0|SrvcGrp|27316|2022|PDM|2100.00|99|0.00|TONSILS & ADENOIDS (42820)|
20|FH_F40627_0_0|SrvcGrp|3409|2022|PDM|926.00|99|0.00|NEWBORN NURSERY|
20|FH_F129970_34986_0|SrvcGrp|89149|2022|PDM|231.00|99|0.00|OP INTENSIVE|
20|FH_F32693_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90817_0_0|SrvcGrp|91029|2022|PDM|2350.00|99|0.00|CORNEAL TRANSPLANT (HCFA)|
20|FH_F71468_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F110821_31513_0|SrvcGrp|42785|2022|PDM|110.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F37493_0_0|SrvcGrp|701|2022|PDM|3602.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|1798.00|99|0.00|AEG 2 (NO REV)|
20|FH_F41155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F146904_0_0|SrvcGrp|87077|2022|PDM|114.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F143249_89801_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DRUGS|
20|FH_F143347_16001_0|SrvcGrp|74441|2022|PCT|2.00|99|0.00|CARDIAC TESTING|
20|FH_F143411_78212_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F101752_0_0|SrvcGrp|92825|2022|PCT|0.90|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F132371_19083_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F132418_84042_0|SrvcGrp|73063|2022|PDM|802.77|99|0.00|OBSERVATION SERVICES|
20|FH_F132421_74538_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132480_92054_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132530_38930_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116756_77477_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F120974_27607_0|SrvcGrp|10364|2022|PDM|2017.00|99|0.00|CPT CODE 99284|
20|FH_F100742_00616_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F50715_0_0|SrvcGrp|22954|2022|PDM|132.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88254_33411_0|SrvcGrp|86827|2022|PDM|60.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F130551_33161_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F66687_0_0|SrvcGrp|28164|2022|PCT|0.85|99|0.00|MS DRG 224 ONLY|
20|FH_F116923_85259_0|SrvcGrp|98699|2022|PDM|944.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F110925_01104_0|SrvcGrp|83917|2022|PDM|1.78|99|0.00|AETNA TRIAMCINOL ACET PR 10MG/10MX|
20|FH_F135236_02840_0|SrvcGrp|75507|2022|PCT|1.01|99|0.00|CHEMOTHERAPY|
20|FH_F115075_77833_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150982_0_0|SrvcGrp|107868|2022|PDM|3664.00|99|0.00|AETNA LAPAROSCOPY SURGICAL|
20|FH_F133099_66801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1176.82|99|0.00|HAPA WPA-NWPA 2012-13 ASC 908 W/O REV|
20|FH_F145815_30540_0|SrvcGrp|113275|2022|PDM|100.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT|
20|FH_F148354_44471_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139551_0_0|SrvcGrp|82298|2022|PDM|10764.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY|
20|FH_F34155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F110161_31329_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|SKILLED NURSING FACILITY W/TOB 210-28Z|
20|FH_F36277_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F151562_26003_0|SrvcGrp|95660|2022|PDM|520.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F110925_01104_0|SrvcGrp|24761|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F139551_0_0|SrvcGrp|93431|2022|PDM|17500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F111852_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34661_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_F72047_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|IMPLANTS|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127090_45601_0|SrvcGrp|48396|2022|PDM|92.25|99|0.00|OT SERVICES|
20|FH_F39902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129509_0_0|SrvcGrp|73000|2022|PDM|1210.00|99|0.00|AEG 6|
20|FH_F59872_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F138050_52301_0|CSTM-ALL|CSTM-00|2020|PDM|2061.00|99|0.00|AEG 1 (NO REV)|
20|FH_F34852_0_0|SrvcGrp|131|2022|PCT|0.70|99|0.00|PACEMAKER DEVICE|
20|FH_F133749_84604_0|SrvcGrp|48399|2022|PDM|84.50|99|0.00|SPEECH THERAPY|
20|FH_F133887_17013_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143566_98264_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150165_06032_0|SrvcGrp|77445|2022|PDM|2560.00|99|0.00|REMOVAL OF HYDROCELE|
20|FH_F149341_39194_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128148_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|NON-ANESTHESIOLOGIST/CRNA (HAN3)|
20|FH_F127957_89521_0|SrvcGrp|108484|2022|PDM|585.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F149247_02760_0|SrvcGrp|115602|2022|PCT|1.00|99|0.00|TELEMEDICINE|
20|FH_F148600_30328_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F139658_02893_0|SrvcGrp|75545|2022|PDM|250.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F114444_19602_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|AETNA PSYTX W PT 45 MIN MOD AJ (HCFA)|
20|FH_F49913_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING|
20|FH_F134229_0_0|SrvcGrp|104642|2022|PDM|15000.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F149219_01966_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F80613_0_0|SrvcGrp|46729|2022|PDM|35.00|99|0.00|RESPITE CARE|
20|FH_F121255_76132_0|SrvcGrp|3178|2022|PDM|884.00|99|0.00|ACUTE PSYCH|
20|FH_F126647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117245_0_0|SrvcGrp|72994|2022|PDM|842.00|99|0.00|AEG 3|
20|FH_F79863_0_0|SrvcGrp|42912|2022|PDM|10.00|99|0.00|CATHETER CARE-SINGLE LUMEN|
20|FH_F125244_0_0|SrvcGrp|27348|2022|PDM|4000.00|99|0.00|OP SURGERY (CPT 58662)|
20|FH_F134904_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F85212_71075_0|SrvcGrp|72990|2022|PDM|497.00|99|0.00|AEG 1|
20|FH_F125124_0_0|SrvcGrp|72990|2022|PDM|360.00|99|0.00|AEG 1|
20|FH_F120715_83440_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132969_84003_0|SrvcGrp|88620|2022|PDM|85.50|99|0.00|SKILLED NURSING RN|
20|FH_F119227_01752_0|SrvcGrp|24761|2022|PDM|70.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F121640_75062_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F111908_07677_0|SrvcGrp|96399|2022|PCT|1.00|99|0.00|FOUNDAPARINUX SODIUM|
20|FH_F115616_0_0|SrvcGrp|98003|2022|PDM|3121.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F81861_0_0|SrvcGrp|64106|2022|PDM|1495.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 12|
20|FH_F72785_0_0|CSTM-ALL|CSTM-00|2020|PDM|3564.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119810_31525_0|SrvcGrp|92502|2022|PDM|592.65|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F81563_0_0|CSTM-ALL|CSTM-00|2020|PDM|731.26|99|0.00|AEG 2 (NO REV)|
20|FH_F85353_16407_0|SrvcGrp|63867|2022|PDM|341.45|99|0.00|HAPA WPA-NWPA 2012-13 ASC 228|
20|FH_F39418_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F116849_0_0|SrvcGrp|44012|2022|PDM|789.70|99|0.00|RESIDENTIAL REHABILITATION|
20|FH_F79824_0_0|SrvcGrp|9522|2022|PDM|4658.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F148922_32073_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F145642_15108_0|SrvcGrp|86779|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F128816_43537_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|499.86|99|0.00|HAPA WPA-NWPA 2012-13 ASC 108 W/O REV|
20|FH_F149528_0_0|SrvcGrp|108484|2022|PDM|730.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F132740_46250_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F81861_0_0|SrvcGrp|64101|2022|PDM|2350.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 8|
20|FH_F32275_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134172_33126_0|SrvcGrp|73841|2022|PDM|572.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F134327_12853_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F133747_80634_0|SrvcGrp|82137|2022|PCT|0.92|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F119227_01752_0|SrvcGrp|19742|2022|PDM|65.00|99|0.00|MID-LINE INSERTION|
20|FH_F130166_65065_0|SrvcGrp|90854|2022|PDM|955.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F122459_15221_0|SrvcGrp|75545|2022|PDM|361.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F85012_0_0|SrvcGrp|13927|2022|PCT|0.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F84175_0_0|SrvcGrp|472|2022|PDM|703.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F98780_35022_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F101100_50314_0|SrvcGrp|97917|2022|PDM|8293.00|99|0.00|APPENDECTOMY|
20|FH_F101100_50314_0|SrvcGrp|82369|2022|PCT|1.38|99|0.00|AETNA LABORATORY|
20|FH_F102200_06416_0|SrvcGrp|21920|2022|PDM|67.50|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F105143_26062_0|SrvcGrp|73000|2022|PDM|8154.00|99|0.00|AEG 6|
20|FH_F115934_70605_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F115936_75093_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F146667_37110_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F120795_27514_0|SrvcGrp|8950|2022|PDM|7166.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F127656_06068_0|SrvcGrp|43569|2022|PDM|115.50|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F115950_08648_0|SrvcGrp|86753|2022|PCT|1.05|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F116056_73018_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F131957_23226_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133583_77074_0|SrvcGrp|106048|2022|PDM|916.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F133592_63957_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133398_43204_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F132293_50595_0|SrvcGrp|537|2022|PCT|0.90|99|0.00|OBSERVATION SERVICES|
20|FH_F128859_57702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102267_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F130253_65082_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86412_32258_0|SrvcGrp|472|2022|PDM|472.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F87254_0_0|SrvcGrp|104613|2022|PDM|2000.00|99|0.00|REMOVE ARMPIT LYMPH NODES|
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1515.00|99|0.00|AEG 6 (NO REV)|
20|FH_F32996_0_0|SrvcGrp|14533|2022|PDM|3240.00|99|0.00|CORONARY CARE UNIT|
20|FH_F125938_0_0|SrvcGrp|17100|2022|PCT|0.75|99|0.00|SKILLED NURSING|
20|FH_F39992_0_0|SrvcGrp|9828|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE|
20|FH_F93880_95476_0|SrvcGrp|72996|2022|PDM|5290.00|99|0.00|AEG 4|
20|FH_F150699_0_0|SrvcGrp|109496|2022|PDM|12055.00|99|0.00|UPGRADE OF IMPLANTED PACEMAK|
20|FH_F35388_0_0|SrvcGrp|17000|2022|PDM|1800.00|99|0.00|OUTPATIENT SURGERY|
20|FH_F63494_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F123957_84321_0|SrvcGrp|46903|2022|PDM|500.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F135259_21090_0|SrvcGrp|87317|2022|PDM|1199.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F65719_0_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F124738_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F88254_33411_0|SrvcGrp|86828|2022|PDM|80.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F38357_0_0|SrvcGrp|29090|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY|
20|FH_F37590_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130520_43947_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128906_48423_0|SrvcGrp|33722|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F39819_0_0|SrvcGrp|31234|2022|PDM|6406.00|99|0.00|NY DRG 370 ONLY|
20|FH_F37539_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F51520_0_0|SrvcGrp|41563|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F37884_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33782_0_0|SrvcGrp|12159|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F50218_0_0|SrvcGrp|46246|2022|PDM|120.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F118194_50841_0|SrvcGrp|24750|2022|PDM|93.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F124388_0_0|SrvcGrp|77461|2022|PDM|2755.50|99|0.00|CPT 52356|
20|FH_F123529_31021_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F135052_18702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F93791_0_0|SrvcGrp|93604|2022|PDM|2520.00|99|0.00|KNEE ARTHO/ANT CRUCIATE LIG REPAIR(HCFA)|
20|FH_F38151_0_0|SrvcGrp|3432|2022|PCT|0.85|99|0.00|IMPLANTS|
20|FH_F37679_0_0|SrvcGrp|27128|2022|PDM|7.50|99|0.00|INTERMITTENT ANTICOAGULANT THERAPY (MOD SH)|
20|FH_F116960_91505_0|SrvcGrp|86753|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F115120_19083_0|SrvcGrp|73842|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F94662_0_0|SrvcGrp|80317|2022|PDM|221.00|99|0.00|RESPITE CARE|
20|FH_F137573_33764_0|SrvcGrp|73841|2022|PDM|367.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AEG 3 (NO REV)|
20|FH_F129011_15857_0|SrvcGrp|48394|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F124050_75089_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F151542_32224_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148200_26554_0|SrvcGrp|76259|2022|PCT|0.75|99|0.00|OP DIALYSIS|
20|FH_F148549_60523_0|SrvcGrp|66265|2022|PDM|102.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F34112_0_0|SrvcGrp|38|2022|PDM|1275.00|99|0.00|NORMAL DELIVERY|
20|FH_F125676_02892_0|SrvcGrp|75545|2022|PDM|390.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F141549_33403_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F127375_28621_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F137427_89146_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F130025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148221_06477_0|SrvcGrp|29346|2022|PDM|53.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F86319_16365_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|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F38900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F122725_32216_0|SrvcGrp|102983|2022|PDM|33.00|99|0.00|MULTIPLE FAMILY GROUP PSYTX|
20|FH_F122905_41018_0|SrvcGrp|73605|2022|PDM|851.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F86872_15215_0|SrvcGrp|24744|2022|PDM|90.00|99|0.00|PICC LINE INSERTION|
20|FH_F87092_60101_0|SrvcGrp|85624|2022|PDM|1050.00|99|0.00|INFUSION THERAPY ADDITIONAL|
20|FH_F60292_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F38411_0_0|SrvcGrp|29006|2022|PDM|3050.00|99|0.00|ACUTE SURGICAL SERVICES|
20|FH_F31595_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|BOARDER BABY|
20|FH_F125139_84096_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F41135_0_0|SrvcGrp|17079|2022|PDM|944.29|99|0.00|ASPG VIII|
20|FH_F150281_76309_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F85340_98195_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F63241_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|GENERAL ACUTE CARE|
20|FH_F121476_0_0|SrvcGrp|108862|2022|PDM|5533.00|99|0.00|NOS SKIN SUBSTITUTE|
20|FH_F90316_17701_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134324_26354_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F60041_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F120417_63124_0|CSTM-ALL|CSTM-00|2020|PDM|395.00|99|0.00|AEG 1 (NO REV)|
20|FH_F134324_26354_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|GENERAL ACUTE CARE|
20|FH_F112712_63005_0|SrvcGrp|20480|2022|PDM|37.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126003_79403_0|SrvcGrp|73842|2022|PDM|327.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F144228_0_0|SrvcGrp|114141|2022|PDM|3112.00|99|0.00|REPAIR LOWER JAW FRACTURE|
20|FH_F120683_80238_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F42427_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F39098_0_0|CSTM-ALL|CSTM-00|2020|PDM|578.00|99|0.00|ACUTE PSYCH|
20|FH_F138867_77021_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|ASPG II|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|747.50|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1201 W/O REV|
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|470.40|99|0.00|AEG 2 (NO REV)|
20|FH_F83152_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F151427_04106_0|SrvcGrp|90620|2022|PDM|158.13|99|0.00|CHEMOTHERAPY ADMINISTRATION|
20|FH_F122103_62548_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F135435_06067_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135489_70508_0|SrvcGrp|93924|2022|PDM|1260.00|99|0.00|AETNA MEDICAL SERVICES|
20|FH_F91735_92653_0|SrvcGrp|73700|2022|PDM|47.25|99|0.00|AETNA - SKILLED NURSING|
20|FH_F135893_74006_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136165_60637_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F100880_67735_0|CSTM-ALL|CSTM-00|2020|PDM|588.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F130996_34110_0|SrvcGrp|95559|2022|PDM|17000.00|99|0.00|HIP JOINT|
20|FH_F116488_79925_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F121763_07202_0|SrvcGrp|108741|2022|PCT|0.00|99|0.00|DRUGS|
20|FH_F53416_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.50|99|0.00|OP SVCS|
20|FH_F36341_0_0|SrvcGrp|12280|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F69205_0_0|SrvcGrp|10519|2022|PDM|172.80|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F65882_0_0|SrvcGrp|42829|2022|PDM|54.00|99|0.00|RESPIRATORY THERAPY VISIT|
20|FH_F148243_0_0|SrvcGrp|82301|2022|PDM|260.00|99|0.00|HEMORRHOIDECTOMY|
20|FH_F139304_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F150619_0_0|SrvcGrp|16719|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F51518_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F40698_0_0|SrvcGrp|3406|2022|PDM|100.00|99|0.00|CPT 99214|
20|FH_F101442_0_0|SrvcGrp|41327|2022|PDM|926.81|99|0.00|OP SURGERY CPT 28308|
20|FH_F72666_0_0|SrvcGrp|69686|2022|PCT|0.75|99|0.00|OP CARDIAC CATHETERIZATION|
20|FH_F87557_33309_0|SrvcGrp|86825|2022|PDM|55.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F96280_06340_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F102325_62691_0|SrvcGrp|14945|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F102325_62691_0|SrvcGrp|14947|2022|PDM|30.00|99|0.00|HOME INFUSION|
20|FH_F129240_10028_0|SrvcGrp|22389|2022|PDM|25.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F129220_18445_0|SrvcGrp|109330|2022|PCT|1.15|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F98300_30236_0|SrvcGrp|75489|2022|PDM|5838.00|99|0.00|AEG 6|
20|FH_F101320_26062_0|SrvcGrp|21920|2022|PDM|60.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F121962_75009_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F129130_92562_0|SrvcGrp|73602|2022|PDM|1698.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|1149.00|99|0.00|ASPG VII|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|526.10|99|0.00|DELAWARE VALLEY- ASC 301|
20|FH_F62867_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|OP SVCS|
20|FH_F110381_0_0|SrvcGrp|89404|2022|PDM|16250.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F97761_04072_0|CSTM-ALL|CSTM-00|2020|PCT|0.35|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_F68660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.58|99|0.00|AETNA SLEEP STUDY CPT 95805|
20|FH_F88456_0_0|SrvcGrp|73610|2022|PCT|0.00|99|0.00|AETNA IMPLANTS|
20|FH_F111141_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103880_85014_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F136793_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|500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F138929_0_0|SrvcGrp|97741|2022|PDM|15400.00|99|0.00|REVISE KNEE|
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|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132988_0_0|SrvcGrp|100072|2022|PDM|6034.45|99|0.00|SHORTEN RADIUS/ULNA|
20|FH_F132988_0_0|SrvcGrp|112142|2022|PDM|4493.01|99|0.00|REPAIR NON-UNION HAND|
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 1 (NO REV)|
20|FH_F42161_0_0|SrvcGrp|20534|2022|PCT|0.88|99|0.00|SKILLED NURSING|
20|FH_F72204_0_0|SrvcGrp|42976|2022|PDM|80.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F43665_0_0|SrvcGrp|37516|2022|PDM|331.00|99|0.00|VENTILATOR MANAGEMENT|
20|FH_F131505_0_0|SrvcGrp|27347|2022|PDM|473.00|99|0.00|CPT 58558|
20|FH_F92600_0_0|CSTM-ALL|CSTM-00|2020|PDM|371.00|99|0.00|AEG 10 (NO REV)|
20|FH_F122181_66538_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F32957_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43832_0_0|SrvcGrp|42824|2022|PDM|152.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F40603_0_0|SrvcGrp|3403|2022|PDM|140.00|99|0.00|CPT 99203|
20|FH_F92493_0_0|SrvcGrp|33986|2022|PDM|1171.17|99|0.00|CPT 26055|
20|FH_F129549_01238_0|SrvcGrp|43568|2022|PDM|114.08|99|0.00|SKILLED NURSING - RN|
20|FH_F124653_64062_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F98042_10468_0|SrvcGrp|73461|2022|PDM|9773.00|99|0.00|AETNA NICU IV|
20|FH_F136568_92562_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136607_68632_0|SrvcGrp|109057|2022|PCT|0.97|99|0.00|CARDIAC STUDIES|
20|FH_F114645_34952_0|SrvcGrp|90040|2022|PDM|315.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F113910_16508_0|SrvcGrp|76501|2022|PDM|330.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F138456_33543_0|SrvcGrp|3178|2022|PDM|958.00|99|0.00|ACUTE PSYCH|
20|FH_F139113_21804_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148424_01440_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F43421_0_0|CSTM-ALL|CSTM-00|2020|PDM|276.00|99|0.00|ADULT PSYCH DAY TREATMENT|
20|FH_F43444_0_0|SrvcGrp|9520|2022|PDM|6000.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F134691_33445_0|SrvcGrp|89337|2022|PDM|2474.50|99|0.00|DETOXIFICATION|
20|FH_F134697_32566_0|SrvcGrp|73842|2022|PDM|217.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F135758_98229_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136796_24016_0|SrvcGrp|76604|2022|PDM|2440.83|99|0.00|CPT 25447|
20|FH_F136914_64081_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F112268_19087_0|SrvcGrp|29347|2022|PDM|15.75|99|0.00|HOME HEALTH AIDE|
20|FH_F113713_17013_0|SrvcGrp|104414|2022|PDM|190.00|99|0.00|PSYCH DIAGNOSTIC EVALUATION (HCFA)(MOD AF)|
20|FH_F132133_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115144_71373_0|SrvcGrp|93924|2022|PDM|1428.00|99|0.00|AETNA MEDICAL SERVICES|
20|FH_F115631_65201_0|SrvcGrp|27315|2022|PDM|3177.00|99|0.00|TENDON REPAIR|
20|FH_F115631_65201_0|SrvcGrp|88159|2022|PDM|2419.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F147439_84003_0|SrvcGrp|471|2022|PDM|608.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F147586_44124_0|SrvcGrp|88599|2022|PDM|2447.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F42176_0_0|SrvcGrp|35532|2022|PCT|0.88|99|0.00|ECHOCARDIOGRAM|
20|FH_F139487_60076_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150700_90028_0|SrvcGrp|46903|2022|PDM|750.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F150839_03833_0|SrvcGrp|80918|2022|PDM|704.00|99|0.00|RESPITE CARE|
20|FH_F39443_0_0|SrvcGrp|30335|2022|PDM|203.00|99|0.00|HAPA WPA ASC 219|
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|28472.00|99|0.00|MS DRG 237|
20|FH_F34914_0_0|SrvcGrp|9861|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION|
20|FH_F147231_49440_0|SrvcGrp|73524|2022|PDM|43.31|99|0.00|PHYSICAL THERAPY|
20|FH_F44644_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F137561_43935_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F119316_27104_0|SrvcGrp|86722|2022|PDM|275.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F141275_07004_0|SrvcGrp|13262|2022|PCT|1.00|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 7 (NO REV)|
20|FH_F120083_13501_0|SrvcGrp|472|2022|PDM|335.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F71468_0_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F98623_97006_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F98820_81401_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PDM|7800.00|99|0.00|MSDRG 246-251 ANGIOPLASTY|
20|FH_F37490_0_0|SrvcGrp|11673|2022|PDM|4250.00|99|0.00|CPT 29888|
20|FH_F125214_12428_0|SrvcGrp|72984|2022|PCT|0.70|99|0.00|CHEMOTHERAPY|
20|FH_F34882_0_0|SrvcGrp|9510|2022|PDM|1124.00|99|0.00|SKILLED NURSING CARE|
20|FH_F45798_0_0|SrvcGrp|11205|2022|PDM|17600.00|99|0.00|DRG 544 MAJOR JOINT REPLACEMENT/REATTACHMENT OF LWR EXTRMTY|
20|FH_F113957_73554_0|SrvcGrp|3273|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F137902_0_0|SrvcGrp|90854|2022|PDM|713.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F137458_08857_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F37081_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F34985_0_0|SrvcGrp|10419|2022|PDM|660.00|99|0.00|SKILLED NURSING CARE|
20|FH_F44255_0_0|CSTM-ALL|CSTM-00|2020|PDM|583.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150947_37660_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144651_0_0|SrvcGrp|101102|2022|PDM|15000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F108180_29526_0|SrvcGrp|87317|2022|PDM|998.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F114206_37203_0|SrvcGrp|86832|2022|PDM|3.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F144651_0_0|SrvcGrp|96899|2022|PDM|15000.00|99|0.00|LUMBAR ARTIF DISCECTOMY|
20|FH_F35736_34952_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F131371_0_0|SrvcGrp|101280|2022|PDM|17000.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F97880_63501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F149003_62208_0|SrvcGrp|29346|2022|PDM|47.74|99|0.00|SKILLED NURSING- LPN|
20|FH_F147375_32503_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F35999_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139824_24801_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F116332_0_0|SrvcGrp|89404|2022|PDM|17619.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F40899_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F151004_87121_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F76826_0_0|SrvcGrp|13954|2022|PDM|58.00|99|0.00|OP FALSE LABOR|
20|FH_F33719_0_0|SrvcGrp|11086|2022|PDM|1178.00|99|0.00|CSECT (MOTHER ONLY)|
20|FH_F115982_0_0|SrvcGrp|27261|2022|PDM|5250.00|99|0.00|CPT 27446|
20|FH_F64739_0_0|SrvcGrp|60858|2022|PDM|605.00|99|0.00|HOSPICE SERVICE -  GENERAL INPATIENT CARE NON RESPITE|
20|FH_F138017_73129_0|CSTM-ALL|CSTM-00|2020|PDM|947.00|99|0.00|AEG 1 (NO REV) W/O BONE QUALITY TESTING|
20|FH_F125656_92868_0|SrvcGrp|26868|2022|PDM|35.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F150382_80821_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149043_72021_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97623_38008_0|SrvcGrp|73485|2022|PDM|3687.00|99|0.00|AETNA REHAB|
20|FH_F84433_0_0|SrvcGrp|44885|2022|PDM|93.36|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL PER VISIT|
20|FH_F137986_0_0|SrvcGrp|89980|2022|PDM|4508.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F150442_28451_0|SrvcGrp|84939|2022|PDM|11447.00|99|0.00|SHOULDER JOINT|
20|FH_F149373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1392.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS|
20|FH_F39772_0_0|CSTM-ALL|CSTM-00|2020|PDM|655.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F148702_32606_0|SrvcGrp|74668|2022|PDM|290.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139565_0_0|SrvcGrp|109769|2022|PDM|2433.00|99|0.00|COVER EYE W/ MEMBRANE SUTURE INCIDENTAL CODES|
20|FH_F108680_0_0|SrvcGrp|89848|2022|PDM|3276.90|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F37580_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|SCHCP CT 450|
20|FH_F128583_45154_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F147226_48154_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110193_70444_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F101441_0_0|SrvcGrp|97079|2022|PDM|3567.00|99|0.00|MENISCUS REPAIR, MED OR LAT|
20|FH_F137748_95231_0|SrvcGrp|16141|2022|PCT|0.50|99|0.00|PACEMAKER|
20|FH_F37341_0_0|CSTM-ALL|CSTM-00|2020|PDM|1230.00|99|0.00|ASPG VI|
20|FH_F148667_0_0|SrvcGrp|115492|2022|PDM|2052.00|99|0.00|PALM CONTRACTURE RELEASE|
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)|
20|FH_F139912_04101_0|SrvcGrp|89149|2022|PDM|185.00|99|0.00|OP INTENSIVE|
20|FH_F140090_37221_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143227_50312_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143347_16001_0|SrvcGrp|113925|2022|PCT|0.56|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F143347_16001_0|SrvcGrp|110618|2022|PDM|6623.00|99|0.00|LAPAROSCOPY SERVICES|
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 6 (NO REV)|
20|FH_F116698_07470_0|SrvcGrp|86854|2022|PDM|81.90|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F120921_75835_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F35685_0_0|SrvcGrp|537|2022|PDM|83.00|99|0.00|OBSERVATION SERVICES|
20|FH_F39621_0_0|SrvcGrp|14412|2022|PDM|545.00|99|0.00|HOSPICE CARE|
20|FH_F103004_75840_0|SrvcGrp|88978|2022|PDM|2050.00|99|0.00|VAGINAL DELIVERY|
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_F67739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39541_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40431_0_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76286_16038_0|SrvcGrp|81879|2022|PCT|1.00|99|0.00|LABORATORY W/ REV/HCPC|
20|FH_F91975_0_0|SrvcGrp|86863|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129007_21532_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139825_0_0|SrvcGrp|109761|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESIONS|
20|FH_F126698_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F77787_0_0|SrvcGrp|29092|2022|PDM|630.00|99|0.00|AMBULANCE SVCS|
20|FH_F86655_0_0|SrvcGrp|78878|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F144990_44708_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41396_0_0|SrvcGrp|34275|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF (DME)|
20|FH_F92673_44041_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F56792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|ASPG II WITH MOD SG|
20|FH_F132420_84660_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F149867_62901_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|2011 DALLAS TX LAB (MOD QW)|
20|FH_F68947_0_0|SrvcGrp|65401|2022|PDM|5367.60|99|0.00|CPT 21335|
20|FH_F102721_38118_0|SrvcGrp|72990|2022|PDM|575.00|99|0.00|AEG 1|
20|FH_F108960_47403_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F112848_06032_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118534_07652_0|SrvcGrp|52953|2022|PCT|1.10|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F40176_0_0|SrvcGrp|32012|2022|PDM|140.00|99|0.00|PT, OT ST|
20|FH_F118544_21550_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148881_33018_0|SrvcGrp|72379|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F92677_08003_0|SrvcGrp|92094|2022|PDM|157.50|99|0.00|AETNA STATIONARY LIQUID OXYGEN SYSTEM|
20|FH_F73304_0_0|CSTM-ALL|CSTM-00|2020|PDM|679.00|99|0.00|ASPG V|
20|FH_F132487_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F110240_0_0|SrvcGrp|91480|2022|PDM|743.00|99|0.00|COLONOSCOPY W/ LESION REMOVAL  (HCFA)|
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|1114.00|99|0.00|AEG 3 (NO REV)|
20|FH_F117559_08619_0|SrvcGrp|115658|2022|PDM|65.00|99|0.00|INFLUENZA VACCINE AIIV4|
20|FH_F128648_44256_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F35411_0_0|CSTM-ALL|CSTM-00|2020|PDM|1794.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143202_32114_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F122245_0_0|SrvcGrp|85966|2022|PDM|2240.50|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F39180_0_0|SrvcGrp|24|2022|PDM|2819.00|99|0.00|CARDIAC CATH|
20|FH_F139594_0_0|SrvcGrp|84704|2022|PDM|938.00|99|0.00|CYSTOURETHROSCOPY W/ REMOVAL OF FOREIGN BODY|
20|FH_F133368_61401_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F42340_0_0|SrvcGrp|31186|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC (DME)|
20|FH_F94165_0_0|SrvcGrp|73485|2022|PCT|0.85|99|0.00|AETNA REHAB|
20|FH_F133530_11237_0|CSTM-ALL|CSTM-00|2020|PDM|2920.00|99|0.00|AEG 2 (NO REV) (W/O ENDOSCPOIC PROCEDURES)|
20|FH_F117555_72802_0|SrvcGrp|73842|2022|PDM|198.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F55375_0_0|SrvcGrp|1306|2022|PDM|325.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F132934_63005_0|SrvcGrp|92580|2022|PDM|3769.00|99|0.00|ADULT SURGICAL CARE (>= 18 YRS)|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|2160.00|99|0.00|AEG 9 (NO REV)|
20|FH_F108700_63857_0|SrvcGrp|90707|2022|PDM|108.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F109561_97216_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95360_08720_0|SrvcGrp|94046|2022|PCT|1.00|99|0.00|TOBRAMYCIN COMP UNIT|
20|FH_F32614_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|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_F42807_0_0|SrvcGrp|3029|2022|PDM|468.00|99|0.00|NEWBORN NURSERY|
20|FH_F130553_18640_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F133490_90650_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 1 (NO REV)|
20|FH_F117206_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111732_33771_0|SrvcGrp|78422|2022|PDM|4750.00|99|0.00|VBAC DELIVERY|
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 7 (NO REV)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1472.23|99|0.00|HAPA WPA-NWPA 2012-13 ASC 705 W/O REV|
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|AEG 1 (NO REV)|
20|FH_F120719_27540_0|CSTM-ALL|CSTM-00|2020|PDM|7514.00|99|0.00|AEG 4 (NO REV)|
20|FH_F34145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138210_60540_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120384_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F42626_0_0|SrvcGrp|115|2022|PDM|477.00|99|0.00|SKILLED NURSING CARE|
20|FH_F146650_29690_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F138050_52301_0|CSTM-ALL|CSTM-00|2020|PDM|2758.00|99|0.00|AEG 2 (NO REV)|
20|FH_F150309_33323_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F138050_52301_0|SrvcGrp|73497|2022|PDM|1821.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F88698_18951_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F128795_57469_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F121225_98902_0|SrvcGrp|73606|2022|PDM|1500.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F77184_0_0|SrvcGrp|48394|2022|PDM|8.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F125828_67547_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114851_15301_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F150199_62226_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F120930_0_0|SrvcGrp|33982|2022|PDM|2500.00|99|0.00|CPT 28296|
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.00|99|0.00|AEG 8 (NO REV)|
20|FH_F116753_0_0|SrvcGrp|106783|2022|PDM|5599.00|99|0.00|TRLUML BALO ANGIOP 1ST ART|
20|FH_F121603_46761_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127598_43232_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F81838_0_0|SrvcGrp|62154|2022|PDM|66.00|99|0.00|PICC LINES|
20|FH_F111912_30720_0|SrvcGrp|92825|2022|PCT|0.67|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F138256_68803_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|710.00|99|0.00|AEG 3 (NO REV)|
20|FH_F103220_0_0|SrvcGrp|99149|2022|PDM|6600.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F70883_0_0|SrvcGrp|13606|2022|PDM|41.00|99|0.00|HOME INFUSION|
20|FH_F77585_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145852_67203_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F127343_0_0|SrvcGrp|87060|2022|PDM|3105.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY|
20|FH_F148927_0_0|SrvcGrp|13990|2022|PCT|0.47|99|0.00|PACEMAKER|
20|FH_F150165_06032_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 10 (NO REV)|
20|FH_F145702_22192_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|5000.00|99|0.00|OP SVCS|
20|FH_F133585_0_0|SrvcGrp|77294|2022|PDM|42.00|99|0.00|AETNA DECLOT VASCULAR DEVICE|
20|FH_F142376_0_0|SrvcGrp|98570|2022|PDM|7405.00|99|0.00|INSERT SPINE FIXATION DEVICE|
20|FH_F42577_0_0|CSTM-ALL|CSTM-00|2020|PDM|607.00|99|0.00|ACUTE PSYCH|
20|FH_F133876_27405_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|2072.00|99|0.00|AEG 3 (NO REV)|
20|FH_F145604_14850_0|SrvcGrp|86833|2022|PDM|35.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|MINOR PROCEDURES|
20|FH_F109577_0_0|SrvcGrp|73701|2022|PDM|59.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F119509_0_0|SrvcGrp|85537|2022|PCT|1.25|99|0.00|ALL DRUGS|
20|FH_F112408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110507_33462_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110906_54481_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|GENERAL ACUTE CARE|
20|FH_F50657_0_0|SrvcGrp|32388|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKE (DME)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|215.02|99|0.00|HAPA WPA-NWPA 2012-13 ASC 236 W/O REV|
20|FH_F39898_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|963.00|99|0.00|AEG 10 (NO REV)|
20|FH_F139723_30066_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F100782_0_0|SrvcGrp|105177|2022|PDM|2192.47|99|0.00|WINDBER MEDICAL CNTR ASC 1402|
20|FH_F71273_0_0|SrvcGrp|3029|2022|PDM|835.00|99|0.00|NEWBORN NURSERY|
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|949.00|99|0.00|AEG 8 (NO REV)|
20|FH_F105303_15136_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F146422_80210_0|SrvcGrp|74668|2022|PDM|1150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F146673_19085_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F125698_44070_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47140_0_0|SrvcGrp|28734|2022|PDM|122.30|99|0.00|SLEEP STUDIES CPT 95808 W/MODIFIER 26|
20|FH_F133590_33064_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F132213_17543_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132131_33060_0|SrvcGrp|46903|2022|PDM|250.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F131430_17566_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F131808_74525_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131212_63017_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133491_74012_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F111566_75093_0|SrvcGrp|12280|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|369.00|99|0.00|AEG 9 (NO REV)|
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|1304.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F123783_03860_0|SrvcGrp|48385|2022|PDM|163.00|99|0.00|SPEECH THERAPY|
20|FH_F69968_0_0|SrvcGrp|20988|2022|PDM|1507.23|99|0.00|MSDRG 945-946 AND REV CODE 110, 128 ACUTE REHABILITATION|
20|FH_F84134_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|OP SVCS|
20|FH_F119220_75068_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88512_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (HCFA) OUTPATIENT|
20|FH_F94300_0_0|SrvcGrp|93599|2022|PDM|4200.00|99|0.00|PARTIAL HIP REPLACEMENT(HCFA)|
20|FH_F81494_0_0|SrvcGrp|16616|2022|PDM|79.00|99|0.00|HOME HEALTH AIDE|
20|FH_F92677_08003_0|SrvcGrp|40699|2022|PDM|12.60|99|0.00|ENTERAL FEEDING SUPPLY KIT, PUMP|
20|FH_F142775_72801_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 10 (NO REV)|
20|FH_F151144_35801_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F148346_0_0|SrvcGrp|46903|2022|PDM|1191.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F117465_0_0|SrvcGrp|75495|2022|PDM|1500.00|99|0.00|AEG 9|
20|FH_F58856_0_0|SrvcGrp|22409|2022|PDM|4000.00|99|0.00|ASPG IX (REV CODE + CPT/HCPCS)|
20|FH_F136386_30901_0|SrvcGrp|73461|2022|PDM|7350.00|99|0.00|AETNA NICU IV|
20|FH_F136496_61832_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136496_61832_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118193_06241_0|CSTM-ALL|CSTM-00|2020|PDM|43.24|99|0.00|AETNA ADAPTIVE BEHAVIOR TREATMNT MODIFIED 30 MINS|
20|FH_F120424_03060_0|SrvcGrp|89417|2022|PDM|313.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F120418_43015_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F120489_63552_0|SrvcGrp|10391|2022|PDM|1540.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F137036_60504_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137068_81147_0|SrvcGrp|112813|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER|
20|FH_F137147_75006_0|SrvcGrp|21130|2022|PDM|32760.00|99|0.00|MS DRG 492 ONLY|
20|FH_F137147_75006_0|SrvcGrp|33724|2022|PDM|15947.00|99|0.00|ARTHROSCOPY|
20|FH_F137231_25550_0|SrvcGrp|88620|2022|PDM|91.00|99|0.00|SKILLED NURSING RN|
20|FH_F142491_06033_0|SrvcGrp|95661|2022|PDM|160.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F142387_70454_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142707_02891_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F53732_0_0|SrvcGrp|10579|2022|PDM|50.00|99|0.00|HYDRATION THERAPY - 2 LITERS|
20|FH_F138471_84663_0|SrvcGrp|80920|2022|PDM|474.00|99|0.00|HOSPICE SERVICES|
20|FH_F140343_89052_0|SrvcGrp|86838|2022|PDM|10.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F140750_89119_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F140846_48207_0|SrvcGrp|92760|2022|PCT|0.80|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120152_0_0|SrvcGrp|89980|2022|PDM|6050.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F149378_44074_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F118943_64506_0|SrvcGrp|24750|2022|PDM|10.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F118943_64506_0|SrvcGrp|17014|2022|PDM|22.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F92852_0_0|SrvcGrp|82570|2022|PDM|1045.00|99|0.00|REVISION EYELID/EXCESS SKIN|
20|FH_F117295_70006_0|SrvcGrp|48396|2022|PDM|105.00|99|0.00|OT SERVICES|
20|FH_F147839_33983_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117107_33704_0|SrvcGrp|79238|2022|PDM|2300.00|99|0.00|TRANSFER|
20|FH_F117154_43017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117218_32025_0|SrvcGrp|90854|2022|PDM|732.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F115868_0_0|SrvcGrp|74546|2022|PDM|500.00|99|0.00|HOSPICE SERVICES|
20|FH_F137905_91364_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F91472_96001_0|SrvcGrp|104911|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F138051_75069_0|SrvcGrp|86722|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F132736_0_0|SrvcGrp|107733|2022|PDM|6266.00|99|0.00|CESAREAN SECTION|
20|FH_F140207_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131379_0_0|SrvcGrp|108043|2022|PDM|161.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 9 (NO REV)|
20|FH_F150280_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F56136_0_0|SrvcGrp|16|2022|PDM|1070.00|99|0.00|ACUTE REHABILITATION|
20|FH_F139515_0_0|SrvcGrp|106267|2022|PDM|2900.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL|
20|FH_F66501_0_0|SrvcGrp|14893|2022|PDM|47.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F129135_68756_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101607_0_0|SrvcGrp|73610|2022|PCT|1.05|99|0.00|AETNA IMPLANTS|
20|FH_F127281_68516_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F46359_0_0|CSTM-ALL|CSTM-00|2020|PDM|158.00|99|0.00|SOCIAL WORKER|
20|FH_F137943_0_0|SrvcGrp|94902|2022|PDM|4240.00|99|0.00|INSERT ANT SEGMENT DRAIN EXT|
20|FH_F135311_33146_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114970_28403_0|SrvcGrp|93337|2022|PDM|290.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F150982_0_0|SrvcGrp|100067|2022|PDM|3854.00|99|0.00|ANKLE ARTHROSCOPY SURGERY|
20|FH_F90853_0_0|SrvcGrp|73483|2022|PDM|850.00|99|0.00|AETNA SUBACUTE III|
20|FH_F67383_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1401.00|99|0.00|AEG 8 (NO REV)|
20|FH_F114976_78539_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F133215_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F33509_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84215_0_0|SrvcGrp|73000|2022|PDM|1005.00|99|0.00|AEG 6|
20|FH_F94942_0_0|SrvcGrp|72992|2022|PDM|602.55|99|0.00|AEG 2|
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.60|99|0.00|DEVICE INSERTION|
20|FH_F116065_06708_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F40525_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148666_34205_0|SrvcGrp|109330|2022|PCT|1.28|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|AEG 6 (NO REV)|
20|FH_F123844_0_0|SrvcGrp|80918|2022|PDM|692.00|99|0.00|RESPITE CARE|
20|FH_F130889_68818_0|SrvcGrp|537|2022|PCT|0.96|99|0.00|OBSERVATION SERVICES|
20|FH_F125999_77064_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F78709_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F115103_31405_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122687_0_0|SrvcGrp|92410|2022|PDM|5464.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F125025_67401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116700_11787_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F31340_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|SKILLED NURSING CARE|
20|FH_F116392_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130500_33317_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149919_85390_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F88254_33411_0|SrvcGrp|24761|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F66465_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN|
20|FH_F118050_77565_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F129064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F83938_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F128863_57701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120876_85250_0|SrvcGrp|87317|2022|PDM|1131.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F125011_74467_0|SrvcGrp|37918|2022|PDM|540.00|99|0.00|NUCLEAR MEDICINE SCAN|
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|990.00|99|0.00|AEG 5  (NO REV)|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/MOD NU  (TN)|
20|FH_F135248_84651_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100660_56303_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F72887_0_0|SrvcGrp|33165|2022|PDM|422.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F81481_0_0|CSTM-ALL|CSTM-00|2020|PDM|892.00|99|0.00|AETNA AMBULATORY SURGERY (NO REV)|
20|FH_F124017_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2198.00|99|0.00|AEG 5  (NO REV)|
20|FH_F148265_06067_0|SrvcGrp|80617|2022|PDM|21089.00|99|0.00|ARTHOPLASTY|
20|FH_F121177_33407_0|SrvcGrp|73842|2022|PDM|170.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F146569_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F34487_0_0|SrvcGrp|16311|2022|PDM|93.00|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PDM|2019.00|99|0.00|ASPG IX|
20|FH_F128682_57701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109246_10018_0|SrvcGrp|74668|2022|PDM|85.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89475_71202_0|SrvcGrp|73461|2022|PDM|2986.00|99|0.00|AETNA NICU IV|
20|FH_F40063_0_0|SrvcGrp|8|2022|PCT|0.70|99|0.00|BURN INTENSIVE CARE|
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|1362.00|99|0.00|ASPG VI|
20|FH_F129653_0_0|SrvcGrp|45063|2022|PDM|2000.00|99|0.00|CPT 64493  INJECTION CARVE OUT|
20|FH_F46612_0_0|SrvcGrp|3809|2022|PDM|1391.00|99|0.00|HOSPICE CARE|
20|FH_F39857_0_0|SrvcGrp|11258|2022|PCT|0.75|99|0.00|DRUGS|
20|FH_F116697_11703_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F148222_18603_0|SrvcGrp|29347|2022|PDM|22.50|99|0.00|HOME HEALTH AIDE|
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F118720_0_0|CSTM-ALL|CSTM-00|2020|PDM|713.00|99|0.00|AEG 2 (NO REV)|
20|FH_F66687_0_0|SrvcGrp|21350|2022|PDM|14185.00|99|0.00|MS DRG 287 ONLY|
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_F131998_67401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141410_13045_0|SrvcGrp|33166|2022|PDM|722.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F130051_31707_0|CSTM-ALL|CSTM-00|2020|PDM|7294.00|99|0.00|AEG 6 (NO REV)|
20|FH_F40063_0_0|SrvcGrp|31974|2022|PCT|0.70|99|0.00|CRANIOTOMY MS DRG 023-027, 955 ONLY|
20|FH_F33642_0_0|SrvcGrp|12163|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F64140_0_0|SrvcGrp|62480|2022|PCT|1.10|99|0.00|LANCASTER CARVEOUTS|
20|FH_F65159_0_0|SrvcGrp|16131|2022|PDM|9923.00|99|0.00|DRG 370-371 ONLY C-SECTION|
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_F122725_32216_0|SrvcGrp|89269|2022|PDM|79.00|99|0.00|PSYTX PT/FAMILY 45 MINUTES|
20|FH_F145508_0_0|SrvcGrp|104228|2022|PDM|181.21|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|1860.00|99|0.00|AEG 5  (NO REV)|
20|FH_F62579_0_0|SrvcGrp|22389|2022|PDM|19.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F63129_0_0|SrvcGrp|48396|2022|PDM|30.00|99|0.00|OT SERVICES|
20|FH_F124369_0_0|SrvcGrp|107984|2022|PDM|9350.00|99|0.00|PARTIAL REMOVAL OF HEEL|
20|FH_F138107_15201_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110343_38139_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F34182_0_0|SrvcGrp|18161|2022|PCT|0.78|99|0.00|MS DRG 253|
20|FH_F147962_85008_0|CSTM-ALL|CSTM-00|2020|PDM|3043.00|99|0.00|AEG 4 (NO REV)|
20|FH_F121225_98902_0|SrvcGrp|78448|2022|PCT|0.85|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F112023_12866_0|SrvcGrp|23279|2022|PDM|915.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F134659_83628_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132609_0_0|SrvcGrp|107733|2022|PDM|5274.00|99|0.00|CESAREAN SECTION|
20|FH_F143742_60410_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139446_87106_0|SrvcGrp|73605|2022|PDM|950.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F111908_07677_0|SrvcGrp|93268|2022|PCT|1.00|99|0.00|LOVENOX/ENOXAPARIN|
20|FH_F119706_63021_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F90232_15126_0|SrvcGrp|86829|2022|PDM|51.45|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F83035_0_0|SrvcGrp|57968|2022|PDM|28.73|99|0.00|CONTINUOUS HOMECARE|
20|FH_F139472_06902_0|SrvcGrp|472|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F135656_74820_0|SrvcGrp|89337|2022|PDM|559.00|99|0.00|DETOXIFICATION|
20|FH_F110507_33462_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F77082_0_0|SrvcGrp|14221|2022|PCT|0.72|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F93175_73438_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F139110_33912_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138958_78410_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F139107_61024_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F142377_14626_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142690_31774_0|SrvcGrp|14944|2022|PDM|31.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F138471_84663_0|SrvcGrp|89783|2022|PDM|93.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F77782_66061_0|SrvcGrp|33169|2022|PDM|2393.00|99|0.00|MRI W/CONTRAST|
20|FH_F122067_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|1540.00|99|0.00|AEG 3 (NO REV)|
20|FH_F146933_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|HSS ASC|
20|FH_F148739_47129_0|SrvcGrp|89337|2022|PDM|1825.00|99|0.00|DETOXIFICATION|
20|FH_F149639_96822_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126853_19053_0|SrvcGrp|88621|2022|PDM|70.00|99|0.00|SKILLED NURSING LPN|
20|FH_F50519_0_0|SrvcGrp|46768|2022|PDM|80.00|99|0.00|CPT CODE 90847 PER VISIT|
20|FH_F66835_0_0|SrvcGrp|16|2022|PDM|630.00|99|0.00|ACUTE REHABILITATION|
20|FH_F129477_70403_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F137898_46540_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F110342_0_0|SrvcGrp|73008|2022|PDM|1500.00|99|0.00|AEG 10|
20|FH_F124801_67110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F73022_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F95880_02726_0|SrvcGrp|94736|2022|PDM|56.65|99|0.00|FLULAVAL VACC IM (>=3 YRS)|
20|FH_F67202_0_0|SrvcGrp|63004|2022|PCT|1.30|99|0.00|EVALUATION & MANAGEMENT|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF|
20|FH_F33106_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F40728_0_0|CSTM-ALL|CSTM-00|2020|PDM|52.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F148879_33018_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151141_24014_0|CSTM-ALL|CSTM-00|2020|PDM|2168.00|99|0.00|AEG 7 (NO REV)|
20|FH_F151160_61350_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151222_72958_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113677_0_0|SrvcGrp|87077|2022|PDM|165.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F33744_0_0|SrvcGrp|24|2022|PDM|5300.00|99|0.00|CARDIAC CATH|
20|FH_F37823_0_0|SrvcGrp|3069|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F39895_0_0|SrvcGrp|13811|2022|PDM|270.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F110000_0_0|SrvcGrp|10905|2022|PDM|531.00|99|0.00|EMERGENCY ROOM LEVEL III|
20|FH_F71863_0_0|SrvcGrp|9829|2022|PDM|104.50|99|0.00|PT SVCS|
20|FH_F87201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|INFUSION- IV SERVICES (MOD SH)|
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1181.40|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_F105588_15228_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F112453_0_0|SrvcGrp|93098|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F41539_0_0|SrvcGrp|33832|2022|PDM|482.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 10|
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132800_0_0|SrvcGrp|112106|2022|PDM|87.00|99|0.00|COVID-19 AMP PRB (HCFA)|
20|FH_F94786_07974_0|SrvcGrp|86840|2022|PDM|36.75|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F95341_08701_0|SrvcGrp|94763|2022|PCT|1.00|99|0.00|FLUZONE VACC IM (>=3 YRS)|
20|FH_F131047_0_0|SrvcGrp|111665|2022|PDM|3421.00|99|0.00|ACUTE SURGICAL SERVICES|
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|90357|2022|PDM|4493.01|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 5  (NO REV)|
20|FH_F141336_16947_0|SrvcGrp|113185|2022|PCT|4.25|99|0.00|RADIOLOGY SERVICES|
20|FH_F124060_76040_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F146991_80918_0|SrvcGrp|46903|2022|PDM|535.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F43832_0_0|SrvcGrp|17766|2022|PDM|152.00|99|0.00|HOME HEALTH - PT/OT/ST|
20|FH_F92493_0_0|SrvcGrp|27315|2022|PDM|2601.06|99|0.00|TENDON REPAIR|
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|2524.83|99|0.00|AEG 9 (NO REV)|
20|FH_F98380_43055_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F124575_33351_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F97083_90670_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F133694_89117_0|SrvcGrp|48385|2022|PDM|135.00|99|0.00|SPEECH THERAPY|
20|FH_F113847_20910_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138716_20151_0|SrvcGrp|104464|2022|PDM|2500.00|99|0.00|VAGINAL DELIVERY (W/ OR W/O EPISIOTOMY)|
20|FH_F138284_98052_0|CSTM-ALL|CSTM-00|2020|PCT|2.20|99|0.00|HSS ASC|
20|FH_F138310_60461_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F114985_32073_0|SrvcGrp|84961|2022|PDM|216.00|99|0.00|CPT 43201|
20|FH_F114985_32073_0|SrvcGrp|72379|2022|PDM|94.00|99|0.00|SPEECH THERAPY|
20|FH_F81832_13827_0|SrvcGrp|27969|2022|PDM|92.00|99|0.00|HOME HEALTH AIDE|
20|FH_F137933_0_0|SrvcGrp|77452|2022|PDM|13300.00|99|0.00|CPT 54405|
20|FH_F148553_85016_0|SrvcGrp|115464|2022|PDM|1427.00|99|0.00|REMOVE ENDOVAS VENA CAVA FILTER|
20|FH_F122635_06410_0|SrvcGrp|88620|2022|PDM|115.00|99|0.00|SKILLED NURSING RN|
20|FH_F43653_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|TRAUMATIC BRAIN INJURY|
20|FH_F134727_30650_0|SrvcGrp|74586|2022|PCT|0.60|99|0.00|AETNA OP HIGH COST DRUGS|
20|FH_F136927_45690_0|SrvcGrp|88621|2022|PDM|82.00|99|0.00|SKILLED NURSING LPN|
20|FH_F112505_51503_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121402_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34498_0_0|SrvcGrp|12693|2022|PDM|1364.00|99|0.00|CAPD/CCPD TRAINING|
20|FH_F77234_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115733_33012_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F119934_0_0|SrvcGrp|82981|2022|PDM|185.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F124369_0_0|SrvcGrp|33984|2022|PDM|5610.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F133869_19947_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F127651_44124_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F110425_01752_0|SrvcGrp|48394|2022|PDM|76.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F128825_45211_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F134226_66533_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F47173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F84450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCES|
20|FH_F133585_0_0|SrvcGrp|111139|2022|PDM|3092.00|99|0.00|ARTERY-VEIN GRAFT|
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103320_0_0|SrvcGrp|72992|2022|PDM|655.00|99|0.00|AEG 2|
20|FH_F41962_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126194_61111_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139569_15063_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F138951_41101_0|SrvcGrp|86835|2022|PDM|15.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F120207_0_0|SrvcGrp|83835|2022|PDM|4800.00|99|0.00|REPLACE TISSUE EXPANDER|
20|FH_F43199_0_0|SrvcGrp|9832|2022|PDM|131.25|99|0.00|ST SVCS|
20|FH_F114527_39047_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F144228_0_0|SrvcGrp|114146|2022|PDM|7161.00|99|0.00|NASAL STENOSIS REPAIR|
20|FH_F137587_0_0|SrvcGrp|108180|2022|PDM|652.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F51039_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|2010 LABORATORY (GLOBAL)|
20|FH_F120555_68405_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F79763_0_0|SrvcGrp|59427|2022|PDM|90.00|99|0.00|OT|
20|FH_F146016_34108_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119227_01752_0|SrvcGrp|65621|2022|PDM|33.00|99|0.00|RN NURSING|
20|FH_F148600_30328_0|SrvcGrp|107183|2022|PDM|3933.00|99|0.00|REVISE MIDDLE EAR BONE|
20|FH_F79863_0_0|SrvcGrp|50167|2022|PDM|90.00|99|0.00|ANTI INFECTIVE THERAPY - UNSPECIFIED DOSAGE|
20|FH_F129633_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F134608_18017_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|112.84|99|0.00|HAPA WPA-NWPA 2012-13 ASC 245 W/O REV|
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 6 (NO REV)|
20|FH_F125244_0_0|SrvcGrp|101525|2022|PDM|5500.00|99|0.00|MYOMECTOMY|
20|FH_F111986_0_0|SrvcGrp|27261|2022|PDM|7725.00|99|0.00|CPT 27446|
20|FH_F79743_0_0|CSTM-ALL|CSTM-00|2020|PDM|2495.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F112060_07514_0|SrvcGrp|96401|2022|PCT|1.00|99|0.00|ACYELOVIR INJECTION|
20|FH_F109242_18466_0|SrvcGrp|102983|2022|PDM|113.00|99|0.00|MULTIPLE FAMILY GROUP PSYTX|
20|FH_F134234_49525_0|SrvcGrp|89412|2022|PDM|240.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F123644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F123325_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124159_92506_0|SrvcGrp|86722|2022|PDM|265.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F119627_27288_0|SrvcGrp|75505|2022|PCT|0.75|99|0.00|CARDIAC STUDIES|
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|2303.00|99|0.00|AEG 6 (NO REV)|
20|FH_F138302_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127157_43614_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F114444_19602_0|SrvcGrp|104420|2022|PDM|75.00|99|0.00|OFFICE/OUTPATIENT VISIT EST (HCFA)(MOD AF)|
20|FH_F133920_64057_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|PDM|1078.00|99|0.00|AEG 8 (NO REV)|
20|FH_F87775_15106_0|SrvcGrp|22389|2022|PDM|15.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F42577_0_0|CSTM-ALL|CSTM-00|2020|PDM|337.00|99|0.00|PSYCHIATRIC RESIDENTIAL TREATMENT|
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 10 (NO REV)|
20|FH_F73125_0_0|SrvcGrp|48385|2022|PDM|12.00|99|0.00|SPEECH THERAPY|
20|FH_F146663_25311_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145554_53066_0|SrvcGrp|108484|2022|PDM|880.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F83995_16748_0|SrvcGrp|30312|2022|PCT|0.82|99|0.00|OP SURGERY|
20|FH_F129548_44130_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F109273_77339_0|SrvcGrp|89417|2022|PDM|428.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F120603_66112_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F85353_16407_0|SrvcGrp|63851|2022|PDM|430.69|99|0.00|HAPA WPA-NWPA 2012-13 ASC 111|
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|502.00|99|0.00|AEG 1 (NO REV)|
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1916.00|99|0.00|AEG 6 (NO REV)|
20|FH_F130126_33413_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F85894_0_0|SrvcGrp|13168|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F85894_0_0|SrvcGrp|10361|2022|PDM|90.64|99|0.00|CPT CODE 99281|
20|FH_F76063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 9 (NO REV)|
20|FH_F105103_39652_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146776_64506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146839_17601_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120522_53549_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120795_27514_0|CSTM-ALL|CSTM-00|2020|PDM|11299.00|99|0.00|AEG 5  (NO REV)|
20|FH_F127656_06068_0|SrvcGrp|23683|2022|PDM|52.43|99|0.00|SKILLED NURSING RN|
20|FH_F51136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F116023_10027_0|SrvcGrp|98319|2022|PDM|210.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY (HCFA)|
20|FH_F131698_01862_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F131927_66043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132276_33179_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150060_0_0|SrvcGrp|46903|2022|PDM|800.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132167_06040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133249_33603_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F132671_60123_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133219_89119_0|SrvcGrp|27968|2022|PDM|45.00|99|0.00|SKILLED NURSING LPN|
20|FH_F130657_04614_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 10 (NO REV)|
20|FH_F130657_04614_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AETNA OP CT SCANS (CTSCAN) - HCFA|
20|FH_F111601_15203_0|SrvcGrp|73842|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111602_17102_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134826_19067_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F37772_0_0|SrvcGrp|27302|2022|PDM|14.00|99|0.00|CPT 92568|
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F149267_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F46433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|HOME INFUSION (TOTAL PARENTERAL NUTRITION)|
20|FH_F47999_0_0|SrvcGrp|42827|2022|PDM|104.50|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F47999_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
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_F141837_0_0|SrvcGrp|106291|2022|PDM|450.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F77625_0_0|SrvcGrp|9828|2022|PDM|39.00|99|0.00|HOME HEALTH AIDE|
20|FH_F120635_22903_0|SrvcGrp|29347|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F49832_0_0|SrvcGrp|42826|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F138681_39301_0|SrvcGrp|88819|2022|PDM|733.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|909.00|99|0.00|AEG 6 (NO REV)|
20|FH_F62876_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|OP SVCS|
20|FH_F127207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151340_30040_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 10 (NO REV)|
20|FH_F151380_90701_0|SrvcGrp|113276|2022|PCT|1.15|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F151503_30067_0|SrvcGrp|100044|2022|PDM|6496.00|99|0.00|INCISION OF HEEL BONE|
20|FH_F135453_70726_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F135507_02859_0|SrvcGrp|76501|2022|PDM|280.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F135572_89106_0|SrvcGrp|24744|2022|PCT|1.00|99|0.00|PICC LINE INSERTION|
20|FH_F135609_37027_0|SrvcGrp|89149|2022|PDM|257.00|99|0.00|OP INTENSIVE|
20|FH_F91766_25401_0|SrvcGrp|43567|2022|PDM|78.75|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F136031_62220_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136165_60637_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136226_28638_0|SrvcGrp|22954|2022|PDM|175.95|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F130547_85712_0|SrvcGrp|87914|2022|PDM|12.13|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F130996_34110_0|SrvcGrp|84939|2022|PDM|17000.00|99|0.00|SHOULDER JOINT|
20|FH_F130996_34110_0|SrvcGrp|92410|2022|PDM|6000.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F130996_34110_0|SrvcGrp|90343|2022|PDM|5500.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL|
20|FH_F130564_74834_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130620_18940_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F116527_70443_0|SrvcGrp|73603|2022|PDM|650.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F33015_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F101200_19020_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121444_47720_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|ASPG III|
20|FH_F128370_76132_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F132689_18436_0|SrvcGrp|89149|2022|PDM|230.00|99|0.00|OP INTENSIVE|
20|FH_F111303_19087_0|SrvcGrp|86748|2022|PCT|1.05|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F39178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1685.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47906_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|CT|
20|FH_F34864_0_0|SrvcGrp|10430|2022|PDM|5200.00|99|0.00|DIAGNOSTIC CARDIAC CATH|
20|FH_F41780_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F94280_0_0|SrvcGrp|74585|2022|PCT|1.00|99|0.00|AETNA OP IMPLANTS|
20|FH_F118651_0_0|SrvcGrp|83348|2022|PDM|4959.71|99|0.00|AETNA LAPAR-ASST HYSTERECTOMY|
20|FH_F112092_46845_0|SrvcGrp|75545|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F87557_33309_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F128549_44224_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F102222_19720_0|SrvcGrp|86827|2022|PDM|57.75|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F129220_18445_0|SrvcGrp|110059|2022|PDM|16.26|99|0.00|ADAPTIVE BH 15 MINS|
20|FH_F98300_30236_0|SrvcGrp|73461|2022|PDM|4002.00|99|0.00|AETNA NICU IV|
20|FH_F102960_50613_0|SrvcGrp|58509|2022|PDM|685.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F101320_26062_0|SrvcGrp|17013|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132090_60915_0|SrvcGrp|111922|2022|PDM|9500.00|99|0.00|ANKLE JOINT RECONSTRUCTION|
20|FH_F134202_0_0|SrvcGrp|107441|2022|PDM|2896.08|99|0.00|AETNA CYSTOSCOPY PROSTATIC IMPLANTS|
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|1282.00|99|0.00|AEG 8 (NO REV)|
20|FH_F148079_06512_0|SrvcGrp|29346|2022|PDM|49.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F151282_46402_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F122006_66839_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F115990_0_0|SrvcGrp|72994|2022|PDM|950.00|99|0.00|AEG 3|
20|FH_F37823_0_0|SrvcGrp|177|2022|PDM|1400.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|836.00|99|0.00|AEG 10 (NO REV)|
20|FH_F97761_04072_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97780_43614_0|SrvcGrp|73603|2022|PDM|6270.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F111207_0_0|SrvcGrp|17990|2022|PCT|0.70|99|0.00|CT / MRI|
20|FH_F34463_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|TRAUMA CARE|
20|FH_F103780_64804_0|CSTM-ALL|CSTM-00|2020|PDM|1084.00|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F103880_85014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F112453_0_0|SrvcGrp|63119|2022|PDM|24.15|99|0.00|BASIC HOME HOSPICE CARE|
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|382.00|99|0.00|AEG 1 (NO REV)|
20|FH_F138929_0_0|SrvcGrp|74039|2022|PDM|6600.00|99|0.00|LAMINECTOMY|
20|FH_F132988_0_0|SrvcGrp|67279|2022|PDM|12555.41|99|0.00|CERVICAL SURGERY|
20|FH_F129785_0_0|SrvcGrp|82981|2022|PDM|140.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1688.00|99|0.00|AEG 10 (NO REV)|
20|FH_F114389_50131_0|SrvcGrp|3809|2022|PDM|852.09|99|0.00|HOSPICE CARE|
20|FH_F92959_0_0|SrvcGrp|57968|2022|PDM|31.94|99|0.00|CONTINUOUS HOMECARE|
20|FH_F84893_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F35448_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|TRANSPLANT SVCS|
20|FH_F132348_16214_0|SrvcGrp|48394|2022|PDM|47.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F124067_15425_0|SrvcGrp|49682|2022|PCT|1.05|99|0.00|HSS DRG GROUPED|
20|FH_F147081_02130_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F105320_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F100703_0_0|SrvcGrp|113594|2022|PDM|7876.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F124233_92648_0|SrvcGrp|87131|2022|PDM|900.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F150910_0_0|CSTM-ALL|CSTM-00|2020|PDM|9000.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL|
20|FH_F97083_90670_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F64779_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|305.00|99|0.00|CAPD/CCPD INCLUDES TRAINING|
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1457.00|99|0.00|AEG 2 (NO REV)|
20|FH_F114666_30342_0|CSTM-ALL|CSTM-00|2020|PDM|2184.00|99|0.00|AEG 9 (NO REV)|
20|FH_F138267_75087_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F137933_0_0|SrvcGrp|113164|2022|PDM|12900.00|99|0.00|INSERT PENILE PROSTH/NON-INF|
20|FH_F148553_85016_0|SrvcGrp|115455|2022|PDM|1250.00|99|0.00|REMOVE PACEMAKER ELECTRODE|
20|FH_F122689_92009_0|SrvcGrp|71108|2022|PDM|430.00|99|0.00|HCPCS A9278|
20|FH_F43295_0_0|CSTM-ALL|CSTM-00|2020|PDM|929.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43779_0_0|SrvcGrp|37944|2022|PCT|1.00|99|0.00|FACTOR VIII|
20|FH_F43862_0_0|SrvcGrp|30958|2022|PDM|65.00|99|0.00|SKILLED LPN VISIT|
20|FH_F117085_40207_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F136796_24016_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F112187_98272_0|SrvcGrp|105465|2022|PCT|0.81|99|0.00|AETNA THERAPIES|
20|FH_F141170_0_0|SrvcGrp|99166|2022|PDM|3890.00|99|0.00|CPT 63005|
20|FH_F149248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F49005_0_0|SrvcGrp|44709|2022|PDM|125.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F63317_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|SKILLED NURSING|
20|FH_F115181_78602_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115631_65201_0|SrvcGrp|102479|2022|PDM|3177.00|99|0.00|AETNA CPT 29895|
20|FH_F115631_65201_0|SrvcGrp|89860|2022|PDM|3177.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F116393_07002_0|SrvcGrp|106518|2022|PDM|7.65|99|0.00|SYPHILIS TEST NON-TREP QUAL|
20|FH_F147305_90755_0|SrvcGrp|23683|2022|PDM|66.00|99|0.00|SKILLED NURSING RN|
20|FH_F147466_18355_0|SrvcGrp|90854|2022|PDM|950.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F147414_92656_0|SrvcGrp|89337|2022|PDM|1450.00|99|0.00|DETOXIFICATION|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|EPOPROSTENOL THERAPY (MOD SH)|
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139550_75219_0|CSTM-ALL|CSTM-00|2020|PDM|1539.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS|
20|FH_F131605_0_0|SrvcGrp|75545|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|2650.00|99|0.00|AEG 8 (NO REV)|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|CPT CODE 99281|
20|FH_F35452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1043.00|99|0.00|ASPG IX|
20|FH_F50461_0_0|SrvcGrp|13778|2022|PDM|754.00|99|0.00|PSYCH/CD|
20|FH_F128198_34208_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F111266_30339_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|26273|2022|PDM|2202.00|99|0.00|CPT 29880|
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|1682.00|99|0.00|AEG 7 (NO REV)|
20|FH_F33435_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|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_F150938_02062_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F50220_0_0|SrvcGrp|33166|2022|PDM|515.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F146266_0_0|SrvcGrp|111588|2022|PDM|6699.00|99|0.00|REPAIR OF THIGH MUSCLE|
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|2076.00|99|0.00|AEG 2 (NO REV)|
20|FH_F35750_0_0|SrvcGrp|18791|2022|PCT|0.65|99|0.00|MS DRG 215|
20|FH_F143668_0_0|SrvcGrp|115711|2022|PDM|2475.00|99|0.00|PNEUMATIC COMPRESSOR (MOD UE)|
20|FH_F110783_93013_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA PROMPTCARE ANCD|
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 7 (NO REV)|
20|FH_F35366_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F114206_37203_0|SrvcGrp|86851|2022|PDM|35.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F44061_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F115982_0_0|SrvcGrp|54943|2022|PDM|1300.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F128839_0_0|SrvcGrp|73841|2022|PDM|304.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F150442_28451_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV)|
20|FH_F120721_0_0|CSTM-ALL|CSTM-00|2020|PDM|2237.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131415_73071_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HSS APC GROUPED|
20|FH_F114585_11501_0|SrvcGrp|73842|2022|PDM|168.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137790_62568_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133677_15601_0|SrvcGrp|92502|2022|PDM|575.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|2958.00|99|0.00|AEG 9 (NO REV)|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.64|99|0.00|SALLY BALIN,999182,ASC 903|
20|FH_F132123_91360_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F150999_20678_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F90817_0_0|SrvcGrp|77579|2022|PDM|2096.00|99|0.00|CPT 23410 - 23412|
20|FH_F35941_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127324_0_0|SrvcGrp|103538|2022|PDM|3105.00|99|0.00|ARTHROSCOPY HIP W/ FEMOROPLASTY|
20|FH_F137789_48146_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141287_14830_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS|
20|FH_F38873_66434_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|GENERAL ACUTE CARE|
20|FH_F142327_0_0|SrvcGrp|42550|2022|PDM|1500.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F150441_76132_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F89640_98133_0|CSTM-ALL|CSTM-00|2020|PCT|2.77|99|0.00|AETNA - APC GROUPER B|
20|FH_F92299_62016_0|SrvcGrp|73006|2022|PCT|0.75|99|0.00|AEG 9|
20|FH_F151699_01752_0|SrvcGrp|17016|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F111266_30339_0|SrvcGrp|86840|2022|PDM|30.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F150982_0_0|SrvcGrp|63469|2022|PDM|1652.00|99|0.00|CPT 55700|
20|FH_F129183_24084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84532_0_0|SrvcGrp|73004|2022|PDM|2281.00|99|0.00|AEG 8|
20|FH_F137767_01841_0|SrvcGrp|1943|2022|PDM|2065.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F124466_32724_0|SrvcGrp|90854|2022|PDM|593.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F37304_0_0|SrvcGrp|9838|2022|PDM|1341.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F114173_18901_0|SrvcGrp|76501|2022|PDM|304.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F132039_92008_0|SrvcGrp|23587|2022|PDM|1800.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F130182_0_0|SrvcGrp|111518|2022|PDM|364.00|99|0.00|STAB PHLEBECT VV 1 EXT|
20|FH_F124739_64429_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138228_76208_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F36485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% 2007 MEDICARE TN DME MOD  AV|
20|FH_F117762_0_0|SrvcGrp|78282|2022|PDM|3120.00|99|0.00|CPT 47563|
20|FH_F128583_45154_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F120144_77031_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143536_47546_0|SrvcGrp|100255|2022|PCT|1.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (OVER 30.0 CM)|
20|FH_F143536_47546_0|SrvcGrp|82757|2022|PCT|1.00|99|0.00|ASSAY BLOOD CREATININE|
20|FH_F103060_0_0|SrvcGrp|88163|2022|PDM|5722.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F130917_48658_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132401_32796_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132515_19382_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116698_07470_0|SrvcGrp|73700|2022|PDM|31.50|99|0.00|AETNA - SKILLED NURSING|
20|FH_F120977_50510_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F126054_30022_0|SrvcGrp|90632|2022|PDM|210.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F125012_64658_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125287_92374_0|SrvcGrp|73605|2022|PDM|970.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F51276_0_0|SrvcGrp|26868|2022|PDM|80.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F39080_0_0|SrvcGrp|97|2022|PDM|5400.00|99|0.00|C-SECTION|
20|FH_F41015_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F43156_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ACUTE PSYCH|
20|FH_F98624_15701_0|SrvcGrp|73643|2022|PDM|1631.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F98625_08103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F102947_44084_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F36704_0_0|SrvcGrp|19906|2022|PDM|2700.00|99|0.00|OBSTETRICAL CARE|
20|FH_F38476_0_0|SrvcGrp|10545|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|346.00|99|0.00|AEG 1 (NO REV)|
20|FH_F38708_0_0|SrvcGrp|21340|2022|PDM|425.00|99|0.00|SUBACUTE CARE|
20|FH_F40431_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|PULMONARY SVCS|
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110604_0_0|SrvcGrp|109967|2022|PDM|48400.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F111594_0_0|SrvcGrp|98498|2022|PDM|7215.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC|
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2887.00|99|0.00|AEG 9 (NO REV)|
20|FH_F137951_0_0|SrvcGrp|63471|2022|PDM|3000.00|99|0.00|CPT 64590|
20|FH_F148552_68114_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F145988_06105_0|SrvcGrp|30599|2022|PDM|12908.00|99|0.00|LAPAROSCOPY  CHOLECYSTECTOMY|
20|FH_F91155_16105_0|SrvcGrp|73700|2022|PDM|47.90|99|0.00|AETNA - SKILLED NURSING|
20|FH_F91255_19401_0|SrvcGrp|79099|2022|PDM|1200.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F148886_60621_0|CSTM-ALL|CSTM-00|2020|PDM|905.00|99|0.00|AEG 2 (NO REV)|
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|572.00|99|0.00|AEG 1 (NO REV)|
20|FH_F92644_06053_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F50974_0_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F88956_0_0|SrvcGrp|79786|2022|PCT|1.51|99|0.00|SLEEP STUDIES|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|1085.00|99|0.00|HAPA EPA ASC 7|
20|FH_F145988_06105_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F123373_0_0|CSTM-ALL|CSTM-00|2020|PDM|837.00|99|0.00|CD ADULT REHAB|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2007 DME (TX) DBL MODIFIERS - NU/KF|
20|FH_F133516_44004_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F141967_89509_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F52617_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111563_02116_0|SrvcGrp|93337|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F34477_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|GENERAL ACUTE CARE|
20|FH_F46433_0_0|SrvcGrp|24758|2022|PDM|60.00|99|0.00|HOME INJECTABLE THERAPY|
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|2524.00|99|0.00|AEG 9 (NO REV)|
20|FH_F35381_0_0|SrvcGrp|190|2022|PCT|0.75|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F113246_72687_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36439_0_0|SrvcGrp|23011|2022|PDM|1600.00|99|0.00|V5250|
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|1495.00|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_F115049_78539_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F51520_0_0|SrvcGrp|42827|2022|PDM|150.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F135171_22601_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F143895_47631_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F32877_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|3234.00|99|0.00|AEG 9 (NO REV)|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F100460_0_0|SrvcGrp|96104|2022|PCT|0.00|99|0.00|IMPLANTABLE NEUROSTIMULATOR|
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135052_18702_0|SrvcGrp|472|2022|PDM|507.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F131311_64804_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|607.00|99|0.00|AEG 1 (NO REV)|
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)|
20|FH_F123468_63384_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)|
20|FH_F38360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F115772_26250_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F143814_18062_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 9 (NO REV)|
20|FH_F94942_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F126595_32308_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F125676_02892_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126883_78621_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|355.06|99|0.00|HAPA WPA-NWPA 2012-13 ASC 217 W/O REV|
20|FH_F115043_77954_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F90714_0_0|SrvcGrp|73000|2022|PDM|915.00|99|0.00|AEG 6|
20|FH_F77762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F121149_76021_0|SrvcGrp|471|2022|PDM|555.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117078_01420_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71070_0_0|SrvcGrp|47545|2022|PDM|3000.00|99|0.00|INSERTION/REPLACEMENT OF PERIPHERAL/GASTRIC NEUROSTIMULATOR|
20|FH_F123898_45121_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F125710_02860_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F79746_0_0|SrvcGrp|13238|2022|PCT|1.00|99|0.00|VENIPUNCTURE|
20|FH_F45169_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F130038_08021_0|SrvcGrp|86722|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F116923_85259_0|SrvcGrp|100499|2022|PDM|631.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F42429_0_0|SrvcGrp|13368|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F137611_30909_0|SrvcGrp|86723|2022|PDM|418.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F123302_33407_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148170_04005_0|SrvcGrp|106291|2022|PDM|537.08|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F137460_42103_0|SrvcGrp|73841|2022|PDM|265.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F121566_91360_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F40332_0_0|SrvcGrp|9774|2022|PDM|1600.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F124017_0_0|SrvcGrp|98560|2022|PDM|8500.00|99|0.00|LUMBAR|
20|FH_F82235_0_0|SrvcGrp|80126|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANICNG SUBSTANCE|
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 5  (NO REV)|
20|FH_F114975_78596_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F110220_0_0|SrvcGrp|92188|2022|PDM|435.68|99|0.00|CPT 95805  (HCFA)|
20|FH_F39740_0_0|SrvcGrp|20900|2022|PDM|13723.00|99|0.00|MS DRG 248 ONLY|
20|FH_F123285_54157_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125813_66030_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115685_64064_0|SrvcGrp|88826|2022|PDM|95.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F137573_33764_0|SrvcGrp|89412|2022|PDM|372.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F36822_0_0|SrvcGrp|58543|2022|PDM|8500.00|99|0.00|MS DRG 619-621|
20|FH_F120296_97223_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F72850_0_0|SrvcGrp|29817|2022|PDM|5389.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F132190_0_0|SrvcGrp|98584|2022|PDM|9000.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F69322_0_0|CSTM-ALL|CSTM-00|2020|PDM|402.00|99|0.00|CD PARTIAL HOSPITALIZATION - CHILD|
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F149939_91942_0|SrvcGrp|109330|2022|PCT|1.15|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130747_0_0|SrvcGrp|92410|2022|PDM|36414.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F40472_0_0|SrvcGrp|16746|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F143833_63703_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F144888_15370_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F42340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146374_84102_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143007_60640_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F41739_0_0|SrvcGrp|38|2022|PDM|5724.00|99|0.00|NORMAL DELIVERY|
20|FH_F145288_45345_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132999_19901_0|SrvcGrp|88621|2022|PDM|79.00|99|0.00|SKILLED NURSING LPN|
20|FH_F89011_75006_0|SrvcGrp|46424|2022|PDM|95.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F115312_78550_0|SrvcGrp|3178|2022|PDM|953.00|99|0.00|ACUTE PSYCH|
20|FH_F97564_52246_0|SrvcGrp|88978|2022|PDM|7005.00|99|0.00|VAGINAL DELIVERY|
20|FH_F128312_45230_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F38039_0_0|SrvcGrp|12401|2022|PDM|82.50|99|0.00|RN VISIT|
20|FH_F127204_44420_0|SrvcGrp|23683|2022|PDM|47.00|99|0.00|SKILLED NURSING RN|
20|FH_F90935_29073_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F126806_44125_0|SrvcGrp|63297|2022|PDM|130.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F94300_0_0|SrvcGrp|93603|2022|PDM|3675.00|99|0.00|CERVICAL SURGERY(HCFA)|
20|FH_F97563_83201_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F117880_91730_0|SrvcGrp|73700|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F133530_11237_0|CSTM-ALL|CSTM-00|2020|PDM|2920.00|99|0.00|AEG 10 (NO REV) (W/O ENDOSCOPIC PROCEDURES)|
20|FH_F97201_15068_0|SrvcGrp|46424|2022|PDM|82.50|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F44394_0_0|CSTM-ALL|CSTM-00|2020|PDM|222.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111780_38603_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F40173_28304_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F72024_0_0|SrvcGrp|17139|2022|PDM|643.00|99|0.00|HOSPICE CARE|
20|FH_F73842_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101104_0_0|SrvcGrp|87396|2022|PDM|195.00|99|0.00|HCPCS G0155 (HCFA)|
20|FH_F147800_0_0|SrvcGrp|105640|2022|PDM|900.00|99|0.00|NJX INTERLAMINAR CRV/THRC|
20|FH_F120437_85202_0|SrvcGrp|107480|2022|PDM|84.06|99|0.00|HEPAGAM B IM INJ|
20|FH_F148920_40207_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144011_60616_0|SrvcGrp|75797|2022|PCT|0.42|99|0.00|EMERGENCY ROOM LEVEL 4|
20|FH_F124928_04210_0|SrvcGrp|97702|2022|PDM|144.58|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 3 (NO REV)|
20|FH_F148039_92629_0|SrvcGrp|75419|2022|PDM|530.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F109574_62859_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F32910_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F66839_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F120838_01603_0|SrvcGrp|108484|2022|PDM|445.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F133530_11237_0|SrvcGrp|82933|2022|PCT|2.20|99|0.00|AETNA CHEMOTHERAPY DRUGS|
20|FH_F31446_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|CD - ADULT|
20|FH_F106660_26554_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136393_0_0|SrvcGrp|112876|2022|PDM|3200.00|99|0.00|INSERTION OF HEART ELECTRODE|
20|FH_F140790_0_0|SrvcGrp|113187|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F31542_0_0|SrvcGrp|9911|2022|PDM|500.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F42879_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F150905_01608_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118486_95060_0|SrvcGrp|86722|2022|PDM|330.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2007 DME (TX) DBL MODIFIERS - UE/KF|
20|FH_F115431_32821_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F38410_0_0|SrvcGrp|10615|2022|PDM|120.00|99|0.00|HOME HEALTH AIDE|
20|FH_F97565_83301_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F128601_29340_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71067_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138054_0_0|SrvcGrp|3327|2022|PDM|257.00|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F88512_0_0|SrvcGrp|30063|2022|PCT|0.49|99|0.00|HIGH COST DRUGS|
20|FH_F141940_50023_0|SrvcGrp|78403|2022|PDM|0.10|99|0.00|AETNA MED RECORD|
20|FH_F118672_29036_0|SrvcGrp|113911|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F43296_0_0|SrvcGrp|9539|2022|PDM|940.00|99|0.00|SUBACUTE CARE|
20|FH_F67379_0_0|SrvcGrp|63158|2022|PDM|3107.00|99|0.00|ORTHPEDIC SURGERY|
20|FH_F102900_44883_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F105921_80014_0|SrvcGrp|94021|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F92977_64067_0|SrvcGrp|92799|2022|PDM|418.00|99|0.00|AETNA RESIDENTIAL TREATMENT PYCH & CD (AGE 18-150)|
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PDM|2703.41|99|0.00|ASPG VII|
20|FH_F35158_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.20|99|0.00|GENERAL ACUTE CARE|
20|FH_F50221_0_0|SrvcGrp|44820|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F70711_0_0|SrvcGrp|3932|2022|PDM|9545.00|99|0.00|LITHOTRIPSY|
20|FH_F128097_68801_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119206_35007_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F63250_0_0|SrvcGrp|42973|2022|PDM|105.00|99|0.00|SPEECH  THERAPIST|
20|FH_F148639_0_0|SrvcGrp|87679|2022|PDM|1722.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F91080_67212_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151054_06473_0|SrvcGrp|111928|2022|PCT|1.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F151059_60435_0|SrvcGrp|29347|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F74602_0_0|CSTM-ALL|CSTM-00|2020|PDM|1895.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F88096_0_0|SrvcGrp|86578|2022|PDM|1800.00|99|0.00|ARTHROSCOPY SVCS|
20|FH_F89778_0_0|SrvcGrp|28549|2022|PDM|1764.40|99|0.00|VITRECTOMY|
20|FH_F148346_0_0|SrvcGrp|74668|2022|PDM|281.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F35365_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F33712_0_0|SrvcGrp|9938|2022|PCT|0.75|99|0.00|SPEECH THERAPY|
20|FH_F88451_0_0|SrvcGrp|25665|2022|PCT|0.60|99|0.00|PHARMACY|
20|FH_F84215_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F141370_20866_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F34550_0_0|SrvcGrp|360|2022|PDM|825.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F145538_34997_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F76402_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103100_47150_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
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_F59333_0_0|SrvcGrp|12403|2022|PDM|788.55|99|0.00|CONTINUOUS HOMECARE|
20|FH_F78922_0_0|SrvcGrp|76040|2022|PCT|0.20|99|0.00|HIGH COST DRUG|
20|FH_F148354_44471_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F47963_0_0|SrvcGrp|10538|2022|PDM|71.50|99|0.00|NURSING CARE|
20|FH_F39138_0_0|SrvcGrp|18253|2022|PDM|5848.00|99|0.00|MS DRG 287|
20|FH_F129241_54409_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130032_72034_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F113410_0_0|SrvcGrp|84182|2022|PDM|1786.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE|
20|FH_F133099_66801_0|SrvcGrp|8950|2022|PCT|0.80|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F34735_0_0|SrvcGrp|9774|2022|PDM|2200.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F66408_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F66711_0_0|SrvcGrp|60057|2022|PDM|90.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F76074_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114267_0_0|SrvcGrp|102260|2022|PDM|10000.00|99|0.00|AETNA TOTAL JOINT REPLACEMENT|
20|FH_F91832_06106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91873_12723_0|SrvcGrp|31707|2022|PDM|1430.00|99|0.00|MS DRG 793 ONLY|
20|FH_F116019_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F115150_0_0|SrvcGrp|92189|2022|PDM|563.60|99|0.00|CPT 95808  (HCFA)|
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|747.00|99|0.00|AEG 10 (NO REV)|
20|FH_F89037_0_0|SrvcGrp|72996|2022|PDM|759.35|99|0.00|AEG 4|
20|FH_F105440_46383_0|SrvcGrp|73842|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F117623_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|SOCIAL SKILLS TRAINING GROUP (HCFA)|
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)|
20|FH_F41539_0_0|SrvcGrp|33831|2022|PDM|1265.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 9|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F43694_0_0|SrvcGrp|37542|2022|PDM|500.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F42161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F141148_63043_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F50415_0_0|SrvcGrp|44712|2022|PDM|80.00|99|0.00|OT SVCS|
20|FH_F114389_50131_0|SrvcGrp|105618|2022|PDM|404.09|99|0.00|RESPIRATORY ASSIST DEVICE (MOD RR)|
20|FH_F77944_0_0|SrvcGrp|35010|2022|PDM|50287.00|99|0.00|MS DRG 242-251 ONLY|
20|FH_F146880_74105_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147081_02130_0|SrvcGrp|12659|2022|PDM|504.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F34652_0_0|SrvcGrp|3066|2022|PCT|0.60|99|0.00|HIGH-COST DRUGS|
20|FH_F36667_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38047_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41035_0_0|SrvcGrp|72990|2022|PDM|370.00|99|0.00|AEG 1|
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|7500.00|99|0.00|AETNA MEDICAL CARE MS DRG|
20|FH_F100703_0_0|SrvcGrp|3932|2022|PDM|4410.00|99|0.00|LITHOTRIPSY|
20|FH_F124585_33070_0|SrvcGrp|73842|2022|PDM|134.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124611_64804_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 6 (NO REV)|
20|FH_F72416_0_0|SrvcGrp|48085|2022|PDM|80.00|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)|
20|FH_F136734_46410_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F114645_34952_0|SrvcGrp|89412|2022|PDM|315.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F148553_85016_0|SrvcGrp|108169|2022|PDM|2167.00|99|0.00|ILIAC REVASC|
20|FH_F42954_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F43249_0_0|SrvcGrp|37018|2022|PDM|584.00|99|0.00|BOARDER BABY|
20|FH_F43444_0_0|SrvcGrp|31134|2022|PDM|1300.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F43779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CV SURGERY|
20|FH_F43833_0_0|SrvcGrp|675|2022|PDM|900.00|99|0.00|PEDIATRIC INPATIENT SVCS|
20|FH_F113708_32025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136547_0_0|SrvcGrp|79720|2022|PDM|1014.00|99|0.00|ACUTE REHAB II|
20|FH_F141170_0_0|SrvcGrp|35669|2022|PDM|5450.00|99|0.00|CPT 63650|
20|FH_F49016_0_0|SrvcGrp|45145|2022|PDM|85.00|99|0.00|PT/OT/ST|
20|FH_F115267_67156_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115608_24171_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F116343_33701_0|CSTM-ALL|CSTM-00|2020|PDM|375.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F116199_75042_0|SrvcGrp|3178|2022|PDM|804.00|99|0.00|ACUTE PSYCH|
20|FH_F116233_33612_0|SrvcGrp|90040|2022|PDM|364.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F147599_76240_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147701_31093_0|CSTM-ALL|CSTM-00|2020|PDM|7359.00|99|0.00|AEG 9 (NO REV)|
20|FH_F41652_0_0|SrvcGrp|109|2022|PDM|389.00|99|0.00|CD - DETOX|
20|FH_F41832_0_0|SrvcGrp|29678|2022|PDM|60.00|99|0.00|HOME INFUSION NURSING SVCS MOD SD|
20|FH_F42708_0_0|SrvcGrp|109|2022|PDM|620.00|99|0.00|CD - DETOX|
20|FH_F37850_0_0|SrvcGrp|3029|2022|PDM|541.00|99|0.00|NEWBORN NURSERY|
20|FH_F66569_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F113585_20155_0|SrvcGrp|24750|2022|PDM|50.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F46832_0_0|SrvcGrp|17001|2022|PDM|145.00|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F120441_33065_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F120489_63552_0|SrvcGrp|705|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F134126_11554_0|SrvcGrp|112509|2022|PDM|1321.00|99|0.00|MRI/MRA|
20|FH_F137027_63960_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139110_33912_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F142547_70002_0|SrvcGrp|22589|2022|PDM|33.60|99|0.00|CHEMOTHERAPY NOC|
20|FH_F138471_84663_0|SrvcGrp|88620|2022|PDM|85.50|99|0.00|SKILLED NURSING RN|
20|FH_F138584_30912_0|SrvcGrp|113408|2022|PDM|750.00|99|0.00|PALATAL OR MAXILLARY FRACTURE TREATMENT|
20|FH_F139456_47501_0|SrvcGrp|113185|2022|PCT|1.35|99|0.00|RADIOLOGY SERVICES|
20|FH_F114865_77488_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140615_73013_0|CSTM-ALL|CSTM-00|2020|PDM|3734.00|99|0.00|AEG 9 (NO REV)|
20|FH_F140652_92626_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F140893_19720_0|SrvcGrp|42404|2022|PDM|8.80|99|0.00|VENIPUNCTURE|
20|FH_F149527_62859_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F92533_27810_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F92593_21031_0|SrvcGrp|76094|2022|PDM|165.90|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F109930_73109_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F70665_0_0|SrvcGrp|42824|2022|PDM|84.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F147725_06002_0|SrvcGrp|115166|2022|PDM|4160.00|99|0.00|EXTERNAL EAR PROCEDURES|
20|FH_F147941_06023_0|SrvcGrp|3178|2022|PDM|2950.00|99|0.00|ACUTE PSYCH|
20|FH_F70546_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|398.00|99|0.00|AEG 1 (NO REV)|
20|FH_F137934_51054_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F109652_0_0|SrvcGrp|20299|2022|PDM|64052.00|99|0.00|MS DRG 228-230 ONLY OTHER CARDIOTHORACIC PROC|
20|FH_F138732_60016_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139820_75657_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_F102760_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|MEDICAL/SURGICAL SUPPLIES AND ADMINISTRATION|
20|FH_F137359_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148720_0_0|SrvcGrp|105357|2022|PDM|325.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F109513_0_0|SrvcGrp|90376|2022|PDM|10000.00|99|0.00|REVISION OF KNEE JOINTLANT|
20|FH_F36439_0_0|SrvcGrp|23004|2022|PDM|650.00|99|0.00|V5257|
20|FH_F36676_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|INJECTABLES|
20|FH_F38431_0_0|SrvcGrp|23010|2022|PDM|1300.00|99|0.00|V5251|
20|FH_F47884_0_0|SrvcGrp|11049|2022|PDM|4812.00|99|0.00|OP LITHOTRIPSY|
20|FH_F50137_0_0|SrvcGrp|24345|2022|PDM|120.00|99|0.00|RESPIRATORY THERAPY VISIT|
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.65|99|0.00|ASPG IV|
20|FH_F35259_0_0|SrvcGrp|411|2022|PDM|8759.00|99|0.00|OP CARDIAC CATH|
20|FH_F143928_21061_0|SrvcGrp|114122|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F138450_0_0|SrvcGrp|112676|2022|PDM|42.13|99|0.00|COVID-19 SARS-COV-2 ANTIBODY|
20|FH_F100662_27534_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F77504_0_0|SrvcGrp|27826|2022|PDM|450.00|99|0.00|CHEMOTHERAPY|
20|FH_F143891_19808_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129221_84325_0|SrvcGrp|46903|2022|PDM|1425.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F145550_62034_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F128170_61920_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128363_60062_0|SrvcGrp|73841|2022|PDM|438.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F135235_01830_0|SrvcGrp|89337|2022|PDM|1199.00|99|0.00|DETOXIFICATION|
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_F38982_0_0|SrvcGrp|701|2022|PDM|2391.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F102267_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F75595_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93741_85006_0|SrvcGrp|80245|2022|PCT|0.00|99|0.00|AETNA STEP DOWN/TELEMETRY|
20|FH_F126581_45638_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F149720_81212_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|1267.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F87619_0_0|SrvcGrp|72990|2022|PDM|417.00|99|0.00|AEG 1|
20|FH_F38900_0_0|SrvcGrp|997|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F82235_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F122687_0_0|SrvcGrp|90361|2022|PDM|3825.00|99|0.00|REPAIR FRACTURE RADIUS/ULNA|
20|FH_F32604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.96|99|0.00|GENERAL ACUTE CARE|
20|FH_F127262_68064_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F148549_60523_0|SrvcGrp|66264|2022|PDM|102.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F70090_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38855_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F130716_76013_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F120337_85004_0|SrvcGrp|87077|2022|PDM|143.50|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F145534_02155_0|SrvcGrp|75419|2022|PDM|650.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F145758_20745_0|SrvcGrp|103236|2022|PDM|10536.60|99|0.00|AETNA INSJ STABLJ DEV|
20|FH_F135259_21090_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F125516_50574_0|SrvcGrp|103913|2022|PCT|0.90|99|0.00|OP DIALYSIS|
20|FH_F148265_06067_0|SrvcGrp|85778|2022|PDM|2801.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|AEG 4 (NO REV)|
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1019.00|99|0.00|AEG 5  (NO REV)|
20|FH_F129596_0_0|SrvcGrp|32703|2022|PDM|1900.00|99|0.00|ICU|
20|FH_F91451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116960_91505_0|SrvcGrp|86746|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F126883_78621_0|SrvcGrp|89417|2022|PDM|410.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F66687_0_0|SrvcGrp|20908|2022|PDM|51270.00|99|0.00|MS DRG 247 ONLY|
20|FH_F36669_0_0|SrvcGrp|12403|2022|PDM|31.94|99|0.00|CONTINUOUS HOMECARE|
20|FH_F116245_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F130717_85006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129338_19114_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F44218_0_0|SrvcGrp|33813|2022|PDM|650.00|99|0.00|CD - DETOX|
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|594.00|99|0.00|AEG 1 (NO REV)|
20|FH_F115043_77954_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125011_74467_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F64440_0_0|SrvcGrp|108688|2022|PDM|762.00|99|0.00|CT W/ CONTRAST|
20|FH_F121525_78613_0|SrvcGrp|108484|2022|PDM|1000.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 233-234 CORONARY BYPASS|
20|FH_F63514_0_0|SrvcGrp|17140|2022|PDM|139.52|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F98920_46526_0|SrvcGrp|73605|2022|PDM|2637.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F40063_0_0|SrvcGrp|941|2022|PDM|4383.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F149740_33912_0|SrvcGrp|53987|2022|PCT|1.00|99|0.00|PHOTOTHERAPY|
20|FH_F141550_33619_0|SrvcGrp|86723|2022|PDM|385.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 10 (NO REV)|
20|FH_F130503_98102_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F56293_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102302_0_0|SrvcGrp|98577|2022|PDM|29900.00|99|0.00|REMOVE VERTEBRAL BODY ADD-ON|
20|FH_F113682_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_F130850_67401_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F123894_60927_0|SrvcGrp|472|2022|PDM|714.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F71070_0_0|SrvcGrp|68051|2022|PDM|1200.00|99|0.00|CPT 52005|
20|FH_F135290_60115_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F82871_33160_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F32453_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|823.99|99|0.00|AEG 5  (NO REV)|
20|FH_F41665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127032_33573_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40089_0_0|SrvcGrp|16746|2022|PDM|50.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 8 (NO REV)|
20|FH_F86872_15215_0|SrvcGrp|86854|2022|PDM|69.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F86872_15215_0|SrvcGrp|29075|2022|PDM|40.00|99|0.00|HYDRATION THERAPY|
20|FH_F86991_15122_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F86991_15122_0|SrvcGrp|72994|2022|PDM|589.00|99|0.00|AEG 3|
20|FH_F74602_0_0|SrvcGrp|8968|2022|PDM|2100.00|99|0.00|NICU LEVEL III & IV|
20|FH_F38411_0_0|SrvcGrp|19886|2022|PCT|0.80|99|0.00|MS DRG 466-468 ONLY|
20|FH_F130656_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|OP SVCS|
20|FH_F130821_85712_0|SrvcGrp|97365|2022|PDM|47.82|99|0.00|ERTAPENEM INJECTION|
20|FH_F31181_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F130017_02302_0|SrvcGrp|21108|2022|PDM|31792.22|99|0.00|MS DRG 243 ONLY|
20|FH_F38227_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|PDM|700.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F117245_0_0|SrvcGrp|73004|2022|PDM|1606.00|99|0.00|AEG 8|
20|FH_F149150_75407_0|SrvcGrp|89412|2022|PDM|411.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124371_0_0|SrvcGrp|13681|2022|PDM|289.81|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F110453_0_0|SrvcGrp|73004|2022|PDM|1050.00|99|0.00|AEG 8|
20|FH_F59872_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|ASPG X|
20|FH_F37146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F110441_60062_0|SrvcGrp|89417|2022|PDM|578.60|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F145926_45243_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111732_33771_0|SrvcGrp|104467|2022|PDM|950.00|99|0.00|ANTEPARTUM CARE ONLY (4-6 VISITS)|
20|FH_F39902_0_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120698_75082_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F113325_80004_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145641_06902_0|SrvcGrp|83639|2022|PDM|4902.00|99|0.00|CPT 29886|
20|FH_F118252_32216_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F31595_0_0|SrvcGrp|12857|2022|PDM|30.00|99|0.00|HOME HEALTH AID|
20|FH_F48034_0_0|SrvcGrp|44005|2022|PDM|150.00|99|0.00|INTENSIVE OUTPATIENT - ADULT/ADOLESCENT|
20|FH_F81483_0_0|SrvcGrp|40304|2022|PDM|896.00|99|0.00|CVTY ENHANCED ASPG 2|
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1557.00|99|0.00|ASPG VIII|
20|FH_F74024_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F149106_07042_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F145983_45213_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F109577_0_0|SrvcGrp|103613|2022|PDM|123.00|99|0.00|MED NUTRITION IND SUBSEQUENT|
20|FH_F110465_30328_0|SrvcGrp|89417|2022|PDM|539.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F83978_66739_0|SrvcGrp|110878|2022|PDM|5166.00|99|0.00|VARIOUS ORTHOPEDIC SURGERIES 1|
20|FH_F100782_0_0|SrvcGrp|97577|2022|PDM|913.31|99|0.00|WINDBER MEDICAL CNTR ASC 204|
20|FH_F110260_27546_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F81698_10457_0|SrvcGrp|86832|2022|PDM|3.15|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F112863_0_0|SrvcGrp|104256|2022|PDM|1141.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F88744_71103_0|CSTM-ALL|CSTM-00|2020|PDM|2924.00|99|0.00|AEG 7 (NO REV)|
20|FH_F149145_33460_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F135670_01749_0|SrvcGrp|86850|2022|PDM|35.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F134507_0_0|SrvcGrp|69359|2022|PDM|1800.00|99|0.00|SKILLED NURSING LEVEL 2|
20|FH_F134627_74030_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|533.00|99|0.00|ASPG I|
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|346.45|99|0.00|AEG 1 (NO REV)|
20|FH_F69708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F63312_0_0|SrvcGrp|18025|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F129509_0_0|SrvcGrp|89842|2022|PDM|3659.00|99|0.00|LUMBAR|
20|FH_F48092_0_0|SrvcGrp|19610|2022|PDM|1200.00|99|0.00|GENERAL ACUTE CARE LEVEL II|
20|FH_F70448_0_0|SrvcGrp|67284|2022|PDM|57.00|99|0.00|OT SUBSEQUENT VISIT 97139|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|192.47|99|0.00|HAPA WPA-NWPA 2012-13 ASC 312 W/O REV|
20|FH_F125124_0_0|SrvcGrp|85000|2022|PDM|2410.00|99|0.00|CPT 45384|
20|FH_F114444_19602_0|SrvcGrp|104414|2022|PDM|190.00|99|0.00|PSYCH DIAGNOSTIC EVALUATION (HCFA)(MOD AF)|
20|FH_F120670_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F146640_54155_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134618_14892_0|SrvcGrp|76501|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD AV"|
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG I|
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117896_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133808_73401_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F133912_20852_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134593_60007_0|SrvcGrp|86842|2022|PDM|34.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F130763_0_0|SrvcGrp|88162|2022|PDM|7319.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F119227_01752_0|SrvcGrp|86833|2022|PDM|18.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F100782_0_0|SrvcGrp|537|2022|PCT|0.65|99|0.00|OBSERVATION SERVICES|
20|FH_F133585_0_0|SrvcGrp|112390|2022|PDM|51.00|99|0.00|US GUID VASC ACSS SITE PERM (HCFA)|
20|FH_F133207_0_0|SrvcGrp|94989|2022|PDM|3529.00|99|0.00|SINUS ENDO W/ BALLOON DILATION|
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|1466.00|99|0.00|AEG 8 (NO REV)|
20|FH_F133887_17013_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F121225_98902_0|SrvcGrp|22590|2022|PCT|0.85|99|0.00|PAIN MANAGAMENT - INTERMITTENT|
20|FH_F121476_0_0|SrvcGrp|108868|2022|PDM|23963.00|99|0.00|CARDIOVERTER DEFIBRILLATOR|
20|FH_F54592_0_0|SrvcGrp|27053|2022|PDM|31.66|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3HRS(MOD SJ)|
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F63625_0_0|SrvcGrp|39870|2022|PDM|23476.00|99|0.00|MS DRG 619-621 ONLY|
20|FH_F77665_0_0|SrvcGrp|10517|2022|PDM|8.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F146805_45662_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146839_17601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146881_83661_0|SrvcGrp|104229|2022|PDM|140.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F120795_27514_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F126359_24228_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116040_24637_0|SrvcGrp|29023|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F131957_23226_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133133_32433_0|SrvcGrp|110040|2022|PDM|14.09|99|0.00|BEHAVIOR TREATMENT|
20|FH_F111584_07002_0|SrvcGrp|90648|2022|PDM|126.00|99|0.00|PSYTX PT/FAMILY 45 MINUTES (HCFA)|
20|FH_F111603_19529_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F111841_85212_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134828_30531_0|SrvcGrp|113096|2022|PDM|51.31|99|0.00|COVID-19 NON CDC (HCFA)|
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_F38135_0_0|SrvcGrp|28227|2022|PCT|0.75|99|0.00|ANGIOPLASTY|
20|FH_F120630_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F150939_0_0|SrvcGrp|104055|2022|PDM|13.47|99|0.00|INFLUENZA VACCINE|
20|FH_F42244_0_0|SrvcGrp|15116|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|2255.00|99|0.00|WILLS COMM SURG SVC ASC 9|
20|FH_F113585_20155_0|SrvcGrp|86836|2022|PDM|20.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F138787_32258_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F138857_90025_0|SrvcGrp|23587|2022|PDM|1300.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.00|99|0.00|AEG 7 (NO REV)|
20|FH_F90422_0_0|SrvcGrp|15873|2022|PDM|76.00|99|0.00|HOSPICE SERVICE - CONTINUOUS HOME CARE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|375.31|99|0.00|HAPA WPA-NWPA 2012-13 ASC 224 W/O REV|
20|FH_F92474_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F151420_60654_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132163_17601_0|SrvcGrp|91398|2022|PDM|100.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AJ)|
20|FH_F122038_34606_0|SrvcGrp|89337|2022|PDM|743.00|99|0.00|DETOXIFICATION|
20|FH_F122103_62548_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F144948_83704_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145528_76501_0|SrvcGrp|48398|2022|PDM|117.00|99|0.00|PT SERVICES|
20|FH_F127923_69130_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135493_07514_0|SrvcGrp|86723|2022|PDM|318.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F135572_89106_0|SrvcGrp|34566|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F136174_89146_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116345_78626_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F116393_07002_0|SrvcGrp|111267|2022|PDM|52.45|99|0.00|FLUOROGUIDE FOR SPINE INJECTION|
20|FH_F116393_07002_0|SrvcGrp|89198|2022|PDM|43.71|99|0.00|X-RAY EXAM OF COLLARBONE|
20|FH_F147725_06002_0|SrvcGrp|100043|2022|PDM|7800.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F41835_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F42402_0_0|SrvcGrp|177|2022|PCT|0.90|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F125479_17501_0|SrvcGrp|79280|2022|PDM|680.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F32739_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118792_63379_0|SrvcGrp|79786|2022|PCT|0.74|99|0.00|SLEEP STUDIES|
20|FH_F84611_30281_0|SrvcGrp|75226|2022|PCT|0.73|99|0.00|AETNA URGENT CARE|
20|FH_F39028_0_0|SrvcGrp|29957|2022|PCT|1.00|99|0.00|DME MOD AW|
20|FH_F41015_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F98621_41042_0|SrvcGrp|88978|2022|PDM|5710.00|99|0.00|VAGINAL DELIVERY|
20|FH_F102948_43606_0|SrvcGrp|89417|2022|PDM|356.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F36704_0_0|SrvcGrp|15|2022|PDM|1750.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F100681_73104_0|CSTM-ALL|CSTM-00|2020|PCT|0.38|99|0.00|OP SVCS|
20|FH_F48772_66044_0|SrvcGrp|104226|2022|PDM|528.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F142087_0_0|CSTM-ALL|CSTM-00|2020|PDM|10000.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL|
20|FH_F148665_65270_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F51197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F47999_0_0|SrvcGrp|3809|2022|PDM|550.00|99|0.00|HOSPICE CARE|
20|FH_F68322_0_0|SrvcGrp|17079|2022|PDM|1740.00|99|0.00|ASPG VIII|
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_F135351_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80511_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F90839_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113585_20155_0|SrvcGrp|86830|2022|PDM|5.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F113585_20155_0|SrvcGrp|24761|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138992_72703_0|CSTM-ALL|CSTM-00|2020|PDM|3934.00|99|0.00|AEG 9 (NO REV) W/O KIDNEY LITHOTRIPSY AND ABLATION|
20|FH_F151443_34741_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F122038_34606_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135572_89106_0|SrvcGrp|17016|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F135800_28731_0|SrvcGrp|22954|2022|PDM|175.95|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F135978_06851_0|SrvcGrp|112781|2022|PDM|441.00|99|0.00|PARTIAL HOSPITALIZATION (>=19 YRS)|
20|FH_F130756_04901_0|SrvcGrp|72984|2022|PCT|0.89|99|0.00|CHEMOTHERAPY|
20|FH_F116397_33404_0|SrvcGrp|86830|2022|PDM|3.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F116488_79925_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121454_34990_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121854_28613_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F146125_0_0|SrvcGrp|82720|2022|PDM|3150.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F128201_33334_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F111301_33122_0|SrvcGrp|73004|2022|PDM|2642.00|99|0.00|AEG 8|
20|FH_F111303_19087_0|SrvcGrp|86648|2022|PCT|1.05|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F134315_89106_0|SrvcGrp|16750|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F141651_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES|
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|29817|2022|PDM|3300.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|1262.70|99|0.00|RELEASE OF TOE JOINT|
20|FH_F148243_0_0|SrvcGrp|90606|2022|PDM|1250.00|99|0.00|INSERT LENS PROSTHESIS|
20|FH_F94280_0_0|SrvcGrp|47544|2022|PDM|2528.00|99|0.00|PERCUTANEOUS IMPLANT OF NEUROSTIMULATOR ELECTRODES|
20|FH_F66469_0_0|SrvcGrp|61999|2022|PDM|2600.00|99|0.00|LITHOTRIPSY|
20|FH_F87557_33309_0|SrvcGrp|86853|2022|PDM|30.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F141035_0_0|SrvcGrp|100081|2022|PDM|3309.00|99|0.00|EXC HAND TUM DEEP|
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PDM|1057.00|99|0.00|AEG 8 (NO REV)|
20|FH_F140102_0_0|SrvcGrp|29155|2022|PDM|105.00|99|0.00|HOSPICE SVCS|
20|FH_F98300_30236_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|AEG 3 (NO REV)|
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|697.08|99|0.00|2005 ASPG GROUPER II|
20|FH_F132544_0_0|SrvcGrp|97039|2022|PDM|3454.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F119417_78212_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119413_95123_0|SrvcGrp|108061|2022|PCT|1.50|99|0.00|OP THERAPY SERVICES|
20|FH_F137951_0_0|SrvcGrp|26274|2022|PDM|1436.00|99|0.00|CPT 29877|
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148431_60523_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148495_03038_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148542_43517_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F148548_37909_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F148554_85016_0|SrvcGrp|115451|2022|PDM|5100.00|99|0.00|INSERT PULSE GEN W/ DUAL LEADS|
20|FH_F148554_85016_0|SrvcGrp|108174|2022|PDM|3765.00|99|0.00|TIB/PER REVASC W/TLA|
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|745.00|99|0.00|AEG 10 (NO REV)|
20|FH_F129965_0_0|SrvcGrp|111385|2022|PCT|1.10|99|0.00|PATHOLOGY|
20|FH_F92677_08003_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD NBN INFUSIONS|
20|FH_F97561_30030_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F150904_22306_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38700_0_0|SrvcGrp|18312|2022|PCT|0.80|99|0.00|MS DRG 466|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1983.58|99|0.00|HAPA WPA-NWPA 2012-13 ASC 14 W/O REV|
20|FH_F100880_67735_0|SrvcGrp|113848|2022|PCT|0.49|99|0.00|HIGH COST DRUGS|
20|FH_F129456_30809_0|SrvcGrp|115588|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F116461_77536_0|SrvcGrp|89149|2022|PDM|192.00|99|0.00|OP INTENSIVE|
20|FH_F116488_79925_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F131361_18235_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
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|108461|2022|PDM|1302.00|99|0.00|SLIDING REPAIR ING HERNIA|
20|FH_F140629_0_0|SrvcGrp|98525|2022|PDM|1016.00|99|0.00|CYSTOURETHROSCOPY|
20|FH_F101665_10027_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F121763_07202_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F121824_92675_0|SrvcGrp|73605|2022|PDM|970.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F111363_33169_0|SrvcGrp|104284|2022|PDM|11518.00|99|0.00|GASTRIC SLEEVE|
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|AEG 3 (NO REV)|
20|FH_F131000_0_0|SrvcGrp|26432|2022|PDM|3343.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F102862_30606_0|SrvcGrp|26682|2022|PDM|78315.00|99|0.00|MS DRG 453 ONLY|
20|FH_F102862_30606_0|SrvcGrp|31020|2022|PDM|16560.00|99|0.00|MS DRG 470 ONLY|
20|FH_F96960_35404_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F121385_89102_0|SrvcGrp|16429|2022|PDM|4919.00|99|0.00|OBSERVATION SVCS|
20|FH_F121962_75009_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|728.00|99|0.00|ASPG IV|
20|FH_F142070_0_0|SrvcGrp|108043|2022|PDM|300.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F151045_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117001_0_0|SrvcGrp|106599|2022|PDM|800.00|99|0.00|HEARING ID, DIGIT, MON, CIC|
20|FH_F71863_0_0|SrvcGrp|1168|2022|PDM|40.70|99|0.00|CONTINUOUS HOMECARE|
20|FH_F86911_0_0|SrvcGrp|43270|2022|PDM|50.00|99|0.00|CATHETER REPAIR|
20|FH_F115150_0_0|SrvcGrp|103928|2022|PDM|73.77|99|0.00|SLEEP STUDY UNATTENDED ANALYSIS(HCFA)|
20|FH_F115150_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112967_0_0|SrvcGrp|89781|2022|PDM|115.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F103780_64804_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F112064_0_0|SrvcGrp|103897|2022|PDM|641.00|99|0.00|HOSPICE CONTINUOUS HOME CARE|
20|FH_F113392_0_0|SrvcGrp|104249|2022|PDM|1650.00|99|0.00|FULL GRAFT PROCEDURE|
20|FH_F136132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F95282_77975_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129785_0_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F88933_0_0|SrvcGrp|40002|2022|PDM|11255.00|99|0.00|TOTAL HIP|
20|FH_F141050_46410_0|SrvcGrp|27968|2022|PDM|35.00|99|0.00|SKILLED NURSING LPN|
20|FH_F72204_0_0|SrvcGrp|29345|2022|PDM|45.00|99|0.00|SKILLED NURSING - LPN - MOD TE|
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|661.50|99|0.00|AEG 10 (NO REV)|
20|FH_F114386_07090_0|SrvcGrp|48385|2022|PDM|76.07|99|0.00|SPEECH THERAPY|
20|FH_F125946_0_0|SrvcGrp|89199|2022|PDM|552.00|99|0.00|RESIDENTIAL HOSPICE SERVICES|
20|FH_F137897_0_0|CSTM-ALL|CSTM-00|2020|PDM|173.80|99|0.00|SINGLE PORT O2 CONCENTRATOR (MOD RR) (HCFA)|
20|FH_F124180_0_0|SrvcGrp|72996|2022|PDM|1519.00|99|0.00|AEG 4|
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|901.00|99|0.00|AEG 4 (NO REV)|
20|FH_F146715_34240_0|SrvcGrp|82037|2022|PDM|2273.00|99|0.00|AETNA ICU|
20|FH_F64441_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F64819_0_0|SrvcGrp|11108|2022|PDM|607.00|99|0.00|NEWBORN NURSERY|
20|FH_F69923_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CARVE OUTS NO MOD|
20|FH_F42466_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F132864_71101_0|SrvcGrp|103617|2022|PDM|3451.00|99|0.00|NORMAL DELIVERY (MOM)|
20|FH_F132864_71101_0|CSTM-ALL|CSTM-00|2020|PDM|2316.00|99|0.00|AEG 5  (NO REV)|
20|FH_F124225_92506_0|SrvcGrp|74668|2022|PDM|390.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F67172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F136657_70806_0|SrvcGrp|75419|2022|PDM|380.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F43779_0_0|SrvcGrp|24|2022|PCT|0.75|99|0.00|CARDIAC CATH|
20|FH_F134727_30650_0|SrvcGrp|73806|2022|PDM|875.00|99|0.00|AETNA ER|
20|FH_F134791_98034_0|SrvcGrp|27969|2022|PCT|0.00|99|0.00|HOME HEALTH AIDE|
20|FH_F134815_35016_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|533.00|99|0.00|AEG 2 (NO REV)|
20|FH_F74143_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F39659_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|OP SVCS|
20|FH_F74283_0_0|CSTM-ALL|CSTM-00|2020|PDM|20.59|99|0.00|VACCINE|
20|FH_F147389_81632_0|SrvcGrp|87317|2022|PDM|1950.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F147526_32216_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42342_0_0|SrvcGrp|12263|2022|PDM|26.25|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F42688_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42654_0_0|SrvcGrp|27969|2022|PDM|65.00|99|0.00|HOME HEALTH AIDE|
20|FH_F138347_77701_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F139667_84078_0|SrvcGrp|48396|2022|PDM|101.00|99|0.00|OT SERVICES|
20|FH_F150768_03054_0|SrvcGrp|88621|2022|PDM|135.00|99|0.00|SKILLED NURSING LPN|
20|FH_F90201_15650_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97420_75052_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F147215_48105_0|SrvcGrp|42622|2022|PDM|638.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111857_68005_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F124441_0_0|SrvcGrp|63471|2022|PDM|23750.00|99|0.00|CPT 64590|
20|FH_F131471_67203_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F111320_0_0|SrvcGrp|46890|2022|PDM|2100.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F37304_0_0|SrvcGrp|16|2022|PDM|749.00|99|0.00|ACUTE REHABILITATION|
20|FH_F117725_38036_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2007 DME (TX) DBL MODIFIERS - RR/KF|
20|FH_F111409_33761_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F127204_44420_0|SrvcGrp|48396|2022|PDM|116.00|99|0.00|OT SERVICES|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ASPG II|
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|AEG 1 (NO REV)|
20|FH_F136751_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F150602_59718_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F113586_0_0|SrvcGrp|75487|2022|PDM|1428.00|99|0.00|AEG 5|
20|FH_F117289_01028_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F44135_0_0|SrvcGrp|14893|2022|PDM|47.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|179.00|99|0.00|HAPA EPA ASC 28|
20|FH_F141860_60610_0|SrvcGrp|74668|2022|PDM|245.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F150905_01608_0|SrvcGrp|115857|2022|PDM|41.49|99|0.00|CRISIS INTERV SERV (MOD HO) (0-21 YRS)|
20|FH_F71268_0_0|SrvcGrp|8968|2022|PDM|4100.00|99|0.00|NICU LEVEL III & IV|
20|FH_F149864_32905_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F42902_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS|
20|FH_F150463_50701_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 2 (NO REV)|
20|FH_F38039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100665_07939_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|363.00|99|0.00|AEG 1 (NO REV)|
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 3 (NO REV)|
20|FH_F82572_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40297_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SURGERY|
20|FH_F146375_06751_0|SrvcGrp|75419|2022|PDM|1062.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F71644_0_0|SrvcGrp|20155|2022|PDM|78105.00|99|0.00|MS DRG 010|
20|FH_F40980_0_0|SrvcGrp|16679|2022|PDM|23404.00|99|0.00|LAPAROSCOPIC PROCEDURES|
20|FH_F117807_86426_0|SrvcGrp|46605|2022|PDM|125.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F68831_0_0|SrvcGrp|3809|2022|PDM|605.00|99|0.00|HOSPICE CARE|
20|FH_F132566_38751_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F99720_0_0|SrvcGrp|84939|2022|PDM|12800.00|99|0.00|SHOULDER JOINT|
20|FH_F130573_02882_0|SrvcGrp|88620|2022|PDM|125.00|99|0.00|SKILLED NURSING RN|
20|FH_F71644_0_0|SrvcGrp|13778|2022|PDM|754.00|99|0.00|PSYCH/CD|
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 4 (NO REV)|
20|FH_F133487_24293_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101840_76054_0|SrvcGrp|20900|2022|PDM|23801.00|99|0.00|MS DRG 248 ONLY|
20|FH_F38352_0_0|SrvcGrp|16746|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY|
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_F72859_0_0|SrvcGrp|11788|2022|PDM|70.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F91275_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142673_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F50420_0_0|SrvcGrp|33166|2022|PDM|515.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F126934_72064_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130656_04401_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F89932_10940_0|CSTM-ALL|CSTM-00|2020|PDM|1855.00|99|0.00|AETNA OP PET SCANS (PET)|
20|FH_F101840_76054_0|SrvcGrp|20898|2022|PDM|25700.00|99|0.00|MS DRG 246 ONLY|
20|FH_F101754_63141_0|SrvcGrp|97976|2022|PDM|65.72|99|0.00|CONDITIONING PLAY AUDIOMETRY|
20|FH_F126666_44053_0|SrvcGrp|105373|2022|PDM|53.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MIN (HCFA)|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|336.92|99|0.00|ASPG 307|
20|FH_F106740_02886_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F37568_0_0|SrvcGrp|10517|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F113146_15001_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F129175_0_0|SrvcGrp|110768|2022|PDM|97.04|99|0.00|3RD LEVEL INJ PARAVERT F JNT L/S|
20|FH_F141411_0_0|SrvcGrp|107095|2022|PDM|4500.00|99|0.00|COMPLEX  WOUND DRAINAGE|
20|FH_F128390_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|336.92|99|0.00|ASPG 214|
20|FH_F91155_16105_0|SrvcGrp|74584|2022|PCT|0.38|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F112852_73112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F142991_43920_0|SrvcGrp|13595|2022|PDM|406.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F117009_0_0|SrvcGrp|107273|2022|PDM|1221.00|99|0.00|REVISION OF LOWER EYELID|
20|FH_F113287_72501_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38700_0_0|SrvcGrp|18827|2022|PCT|0.80|99|0.00|MS DRG 224|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|129.34|99|0.00|HAPA WPA-NWPA 2012-13 ASC 137 W/O REV|
20|FH_F117372_07442_0|SrvcGrp|73842|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F117340_68144_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F120437_85202_0|SrvcGrp|24750|2022|PDM|85.54|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F130593_48103_0|SrvcGrp|83857|2022|PDM|550.00|99|0.00|IP HOSPICE SVCS|
20|FH_F115431_32821_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F105921_80014_0|SrvcGrp|46424|2022|PDM|100.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F127560_0_0|SrvcGrp|46482|2022|PDM|150.00|99|0.00|S9083 PER VISIT|
20|FH_F146131_37160_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67136_0_0|SrvcGrp|16|2022|PDM|5056.00|99|0.00|ACUTE REHABILITATION|
20|FH_F112853_22408_0|SrvcGrp|90339|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F141654_15217_0|SrvcGrp|22384|2022|PDM|101.29|99|0.00|HOME VISIT PRENATAL|
20|FH_F149781_37404_0|SrvcGrp|705|2022|PCT|0.40|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F120837_33309_0|SrvcGrp|73841|2022|PDM|518.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F145920_0_0|SrvcGrp|108935|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F134732_0_0|SrvcGrp|107793|2022|PDM|9725.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F119946_36109_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F149023_44122_0|SrvcGrp|36591|2022|PDM|21707.00|99|0.00|CPT 63685|
20|FH_F90817_0_0|SrvcGrp|27343|2022|PDM|2914.00|99|0.00|OP SURGERY (CPT 25607 - 25609)|
20|FH_F132732_0_0|CSTM-ALL|CSTM-00|2020|PDM|2199.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35475_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|618180-OPGH-THERAPY|
20|FH_F132123_91360_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F147339_08837_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)|
20|FH_F148326_0_0|SrvcGrp|90383|2022|PDM|8489.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F36485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% 2007 MEDICARE DMETN  MOD KM|
20|FH_F36597_0_0|SrvcGrp|3378|2022|PDM|34.00|99|0.00|OBSERVATION SVCS|
20|FH_F35432_0_0|SrvcGrp|12394|2022|PCT|0.74|99|0.00|PROSTHETICS/IMPLANTS/DEVICES|
20|FH_F108260_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35097_16508_0|SrvcGrp|81878|2022|PCT|1.00|99|0.00|RADIOLOGY W/ REV/HCPC|
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F117799_0_0|SrvcGrp|104851|2022|PDM|1710.00|99|0.00|REVISION / REMOVAL SINUS|
20|FH_F132860_0_0|SrvcGrp|88|2022|PDM|6760.00|99|0.00|OP LITHOTRIPSY|
20|FH_F138018_17313_0|SrvcGrp|24746|2022|PDM|103.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F40490_0_0|SrvcGrp|31931|2022|PDM|982.00|99|0.00|SKILLED NURSING CARE|
20|FH_F40644_0_0|SrvcGrp|115|2022|PDM|453.00|99|0.00|SKILLED NURSING CARE|
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PDM|2475.00|99|0.00|ASPG 6 PIEDMONT OUTPATIENT SURGERY CENTER|
20|FH_F35557_0_0|SrvcGrp|17013|2022|PDM|28.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F110783_93013_0|SrvcGrp|86830|2022|PDM|45.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F147343_17011_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117617_80439_0|SrvcGrp|107592|2022|PDM|165.00|99|0.00|HOSPICE CARE PROV INPT HOSP|
20|FH_F146286_0_0|CSTM-ALL|CSTM-00|2020|PDM|2419.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38372_0_0|SrvcGrp|109|2022|PDM|350.00|99|0.00|CD - DETOX|
20|FH_F124759_34108_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|1626.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F36165_0_0|SrvcGrp|22384|2022|PDM|150.00|99|0.00|HOME VISIT PRENATAL|
20|FH_F35557_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|100% OF AWP DRUGS W/ DIRECT RATES|
20|FH_F124719_64093_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F34882_0_0|SrvcGrp|941|2022|PDM|2584.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F136493_0_0|SrvcGrp|80918|2022|PDM|190.00|99|0.00|RESPITE CARE|
20|FH_F97620_75904_0|CSTM-ALL|CSTM-00|2020|PCT|0.36|99|0.00|OP SVCS|
20|FH_F117576_21207_0|SrvcGrp|473|2022|PDM|380.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F118907_0_0|SrvcGrp|103927|2022|PDM|172.21|99|0.00|SLEEP STUDY UNATTENDED(HCFA)|
20|FH_F132254_40207_0|SrvcGrp|24761|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F97100_23462_0|SrvcGrp|88977|2022|PDM|4321.00|99|0.00|C-SECTION DELIVERY|
20|FH_F35884_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F113765_0_0|SrvcGrp|44042|2022|PDM|60.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|747.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F150521_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|AEG 2 (NO REV)|
20|FH_F97480_08204_0|SrvcGrp|88978|2022|PDM|6712.00|99|0.00|VAGINAL DELIVERY|
20|FH_F124719_64093_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148351_33012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35167_0_0|SrvcGrp|411|2022|PCT|0.63|99|0.00|OP CARDIAC CATH|
20|FH_F122425_75082_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F98840_31021_0|SrvcGrp|73643|2022|PDM|1777.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F41457_0_0|SrvcGrp|10956|2022|PDM|90.00|99|0.00|PT/OT/ST|
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|1725.00|99|0.00|AEG 7 (NO REV)|
20|FH_F87993_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|698.00|99|0.00|AEG 4 (NO REV)|
20|FH_F101380_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD 26|
20|FH_F48224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F48476_0_0|SrvcGrp|43956|2022|PDM|52.00|99|0.00|NURSING CARE|
20|FH_F136247_28804_0|CSTM-ALL|CSTM-00|2020|PDM|957.45|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F116552_70001_0|SrvcGrp|88621|2022|PDM|97.00|99|0.00|SKILLED NURSING LPN|
20|FH_F116698_07470_0|SrvcGrp|86851|2022|PDM|39.90|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F120851_66112_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F120974_27607_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS|
20|FH_F38092_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHYSICIANS EYE SURG CTR ASPG|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|2466.00|99|0.00|ASPG VI|
20|FH_F98624_15701_0|SrvcGrp|73656|2022|PDM|586.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F102948_43606_0|SrvcGrp|89149|2022|PDM|168.00|99|0.00|OP INTENSIVE|
20|FH_F32127_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140007_0_0|SrvcGrp|97199|2022|PDM|7887.00|99|0.00|THORAX SPINE DISK SURGERY|
20|FH_F140007_0_0|SrvcGrp|93741|2022|PDM|7887.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY|
20|FH_F140007_0_0|SrvcGrp|16694|2022|PDM|3470.00|99|0.00|KNEE SCOPE, CHONDROPLASTY|
20|FH_F48348_61605_0|SrvcGrp|9875|2022|PDM|2403.00|99|0.00|ACUTE IP MEDICAL SERVICES|
20|FH_F134192_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|1291.00|99|0.00|2005 ASPG GROUPER VI|
20|FH_F132212_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F132212_0_0|SrvcGrp|63297|2022|PDM|90.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F137951_0_0|SrvcGrp|41334|2022|PDM|9393.00|99|0.00|TOTAL KNEE|
20|FH_F139566_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132737_0_0|SrvcGrp|112088|2022|PCT|0.65|99|0.00|CARDIAC ABLATION|
20|FH_F89851_83854_0|CSTM-ALL|CSTM-00|2020|PDM|5162.00|99|0.00|AEG 10 (NO REV)|
20|FH_F33581_0_0|SrvcGrp|11606|2022|PDM|918.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)|
20|FH_F137353_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150719_30012_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150882_84041_0|SrvcGrp|43567|2022|PDM|105.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F40739_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F151660_77074_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138347_77701_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F75547_0_0|SrvcGrp|9826|2022|PCT|0.60|99|0.00|OP SURGERY|
20|FH_F137902_0_0|SrvcGrp|86723|2022|PDM|269.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F44061_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122377_91007_0|SrvcGrp|109221|2022|PCT|0.00|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F126914_44136_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F130641_40205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130182_0_0|SrvcGrp|41334|2022|PDM|8323.00|99|0.00|TOTAL KNEE|
20|FH_F150312_89103_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F146266_0_0|SrvcGrp|54943|2022|PDM|4100.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F35557_0_0|SrvcGrp|11786|2022|PDM|14.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F122377_91007_0|CSTM-ALL|CSTM-00|2020|PDM|16114.00|99|0.00|ELECTROPHYSIOLOGY STUDIES|
20|FH_F112794_01040_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35475_0_0|SrvcGrp|9518|2022|PDM|300.00|99|0.00|EMERGENCY ROOM|
20|FH_F94643_90501_0|SrvcGrp|86833|2022|PDM|15.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F136592_0_0|SrvcGrp|107793|2022|PDM|9450.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F132056_32080_0|SrvcGrp|108484|2022|PDM|650.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F87711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|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_F39360_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|1377.00|99|0.00|AEG 1 (NO REV)|
20|FH_F138018_17313_0|SrvcGrp|17011|2022|PDM|90.43|99|0.00|HOME INFUSION THERAPY|
20|FH_F49338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F90817_0_0|SrvcGrp|90063|2022|PDM|2096.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|2923.00|99|0.00|AEG 8 (NO REV)|
20|FH_F40346_0_0|SrvcGrp|13692|2022|PCT|0.75|99|0.00|OP CARDIAC CATH|
20|FH_F146859_0_0|SrvcGrp|104163|2022|PDM|4444.00|99|0.00|KYPHOPLASTY|
20|FH_F147218_48026_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IP MULTI ROOM COMPARISON|
20|FH_F147360_06415_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F122282_30080_0|SrvcGrp|109035|2022|PDM|267.00|99|0.00|INTENSIVE OP EATING DISORDER|
20|FH_F109247_73102_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F92299_62016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 8 (NO REV)|
20|FH_F90223_0_0|SrvcGrp|88813|2022|PDM|80.00|99|0.00|POSTNATAL HOME VISIT (HCFA)|
20|FH_F111080_18103_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F132672_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F125656_92868_0|SrvcGrp|86829|2022|PDM|35.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F148959_77375_0|SrvcGrp|74668|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F37198_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F117762_0_0|SrvcGrp|83642|2022|PDM|1872.00|99|0.00|CPT 29883|
20|FH_F125214_12428_0|SrvcGrp|31700|2022|PDM|1248.00|99|0.00|CD DETOX|
20|FH_F149512_62550_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150944_18052_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F90232_15126_0|SrvcGrp|14949|2022|PDM|94.50|99|0.00|HOME INFUSION|
20|FH_F39443_0_0|SrvcGrp|30373|2022|PDM|280.00|99|0.00|HAPA WPA ASC 16|
20|FH_F134868_32504_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F131471_67203_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F147220_49417_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|2016.00|99|0.00|AEG 2 (NO REV)|
20|FH_F97623_38008_0|SrvcGrp|88977|2022|PDM|7181.00|99|0.00|C-SECTION DELIVERY|
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.00|99|0.00|AEG 10 (NO REV)|
20|FH_F120154_77498_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F93172_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F146859_0_0|SrvcGrp|77485|2022|PDM|1765.00|99|0.00|AETNA REMOVAL OF IMPLANT|
20|FH_F35716_0_0|SrvcGrp|26001|2022|PDM|94.50|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|911.00|99|0.00|HAPA EPA ASC 6|
20|FH_F138017_73129_0|SrvcGrp|97482|2022|PDM|6196.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F37764_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|O2 SOLUTIONS AWP|
20|FH_F113545_11201_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F111857_68005_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F36892_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36202_0_0|SrvcGrp|14937|2022|PDM|2999.00|99|0.00|ICU/CCU|
20|FH_F140097_19145_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F75305_0_0|SrvcGrp|9511|2022|PCT|0.60|99|0.00|OBSERVATION SVCS|
20|FH_F101752_0_0|SrvcGrp|80260|2022|PCT|0.00|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F103060_0_0|SrvcGrp|88164|2022|PDM|8323.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F131104_98007_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F82375_28601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD UE KC|
20|FH_F48224_0_0|SrvcGrp|62738|2022|PDM|500.00|99|0.00|SURGICAL CARVEOUTS|
20|FH_F49054_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING|
20|FH_F138973_45036_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138973_45036_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139012_78516_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|GENERAL ACUTE CARE|
20|FH_F96321_0_0|SrvcGrp|108771|2022|PDM|743.05|99|0.00|NEEDLE BIOPSY OF LIVER|
20|FH_F117715_0_0|SrvcGrp|107643|2022|PDM|929.68|99|0.00|CYSTOURETHROSCOPY/MALE GENITAL SERVICES|
20|FH_F138963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|387.74|99|0.00|HAPA WPA-NWPA 2012-13 ASC 222 W/O REV|
20|FH_F151379_21045_0|SrvcGrp|115557|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F151410_00717_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F151503_30067_0|SrvcGrp|100043|2022|PDM|13352.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F145068_63084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144989_07701_0|SrvcGrp|53144|2022|PCT|1.00|99|0.00|SPEECH THERAPY|
20|FH_F130671_42701_0|SrvcGrp|89149|2022|PDM|187.00|99|0.00|OP INTENSIVE|
20|FH_F135347_68784_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135350_60014_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F135375_60014_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135583_17331_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F135584_10977_0|SrvcGrp|55677|2022|PDM|2800.00|99|0.00|VAGINAL DELIVERY ONLY|
20|FH_F100765_73735_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F131463_19096_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F131407_07607_0|SrvcGrp|86833|2022|PDM|10.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F116527_70443_0|SrvcGrp|73602|2022|PDM|500.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F140629_0_0|SrvcGrp|113671|2022|PDM|2497.00|99|0.00|SPLEEN LAPAROSCOPE|
20|FH_F121707_85745_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F46918_0_0|SrvcGrp|10615|2022|PDM|120.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132947_45342_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129967_18915_0|SrvcGrp|108484|2022|PDM|785.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F129967_18915_0|SrvcGrp|104186|2022|PDM|23.00|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F111363_33169_0|SrvcGrp|131|2022|PCT|0.63|99|0.00|PACEMAKER DEVICE|
20|FH_F112092_46845_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127713_30012_0|SrvcGrp|88781|2022|PDM|155.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F128185_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F102282_06795_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143648_0_0|SrvcGrp|103516|2022|PDM|2784.00|99|0.00|INSERT INTRAUTERINE DEVICE|
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)|
20|FH_F111201_25301_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|OP SVCS|
20|FH_F38708_0_0|SrvcGrp|20071|2022|PDM|650.00|99|0.00|MS DRG 945-946|
20|FH_F50516_15014_0|SrvcGrp|10503|2022|PDM|47.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F86872_15215_0|SrvcGrp|26253|2022|PDM|5.17|99|0.00|LIPIDS|
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|2851.94|99|0.00|AEG 9 (NO REV)|
20|FH_F145508_0_0|SrvcGrp|104229|2022|PDM|181.21|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F89778_0_0|SrvcGrp|88599|2022|PDM|1135.88|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F35308_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD NU) - BDSS|
20|FH_F40191_0_0|SrvcGrp|3157|2022|PDM|893.00|99|0.00|ACUTE REHABILITATION|
20|FH_F123601_30680_0|SrvcGrp|42782|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F123741_20850_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F136398_23502_0|SrvcGrp|46903|2022|PDM|546.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F136542_02446_0|SrvcGrp|46903|2022|PDM|473.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F134011_84102_0|SrvcGrp|46605|2022|PDM|99.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F134057_32570_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137242_52722_0|SrvcGrp|3178|2022|PDM|973.00|99|0.00|ACUTE PSYCH|
20|FH_F138892_46341_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142448_15701_0|SrvcGrp|46104|2022|PDM|60.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F142608_02842_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142690_31774_0|SrvcGrp|46605|2022|PDM|145.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F97582_46307_0|SrvcGrp|73601|2022|PDM|13081.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F138575_66053_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138584_30912_0|SrvcGrp|113383|2022|PDM|1300.00|99|0.00|EXTENSIVE JAW SURGERY|
20|FH_F77782_66061_0|SrvcGrp|10393|2022|PDM|4276.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F78402_15905_0|SrvcGrp|11336|2022|PCT|0.34|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F140407_63841_0|SrvcGrp|113302|2022|PDM|28.39|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - ASTRAZENECA|
20|FH_F140612_60070_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140627_68651_0|SrvcGrp|103913|2022|PCT|0.96|99|0.00|OP DIALYSIS|
20|FH_F140647_66210_0|SrvcGrp|89417|2022|PDM|1032.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F140648_75070_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F140727_16046_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140761_33172_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F140888_75119_0|SrvcGrp|108484|2022|PDM|646.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F122067_0_0|SrvcGrp|84280|2022|PDM|1430.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149579_95815_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F151601_89118_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F118932_07652_0|SrvcGrp|471|2022|PDM|955.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F76144_0_0|CSTM-ALL|CSTM-00|2020|PDM|838.87|99|0.00|ASPG I F/S - BDSS|
20|FH_F133493_90255_0|SrvcGrp|75505|2022|PCT|0.00|99|0.00|CARDIAC STUDIES|
20|FH_F38508_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F139825_0_0|SrvcGrp|109765|2022|PDM|1721.00|99|0.00|CLOSURE OF LACRIMAL PUNCTUM|
20|FH_F71644_0_0|SrvcGrp|46903|2022|PDM|480.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F44312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F89233_0_0|SrvcGrp|131|2022|PCT|0.76|99|0.00|PACEMAKER DEVICE|
20|FH_F116581_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145877_0_0|SrvcGrp|33659|2022|PDM|400.00|99|0.00|DIALYSIS SERVICES|
20|FH_F149979_15701_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139594_0_0|SrvcGrp|77444|2022|PDM|960.00|99|0.00|VASECTOMY|
20|FH_F97563_83201_0|SrvcGrp|73602|2022|PDM|3417.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F42159_0_0|SrvcGrp|12117|2022|PCT|0.95|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F87620_80014_0|SrvcGrp|110199|2022|PDM|455.00|99|0.00|FLUOROSCOPY|
20|FH_F140502_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40465_0_0|SrvcGrp|8|2022|PCT|0.75|99|0.00|BURN INTENSIVE CARE|
20|FH_F141940_50023_0|SrvcGrp|99073|2022|PCT|1.14|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F133307_14580_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F43539_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|2845.00|99|0.00|AEG 2 (NO REV)|
20|FH_F50372_0_0|SrvcGrp|46593|2022|PDM|225.00|99|0.00|CPT 99215|
20|FH_F122648_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1828.00|99|0.00|ASPG VII|
20|FH_F72387_0_0|SrvcGrp|80|2022|PDM|550.00|99|0.00|ACUTE PSYCH|
20|FH_F133469_33404_0|SrvcGrp|89412|2022|PDM|650.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F97141_93933_0|SrvcGrp|88977|2022|PDM|9410.00|99|0.00|C-SECTION DELIVERY|
20|FH_F111809_93003_0|CSTM-ALL|CSTM-00|2020|PDM|14432.00|99|0.00|AEG 9 (NO REV)|
20|FH_F141940_50023_0|SrvcGrp|113844|2022|PDM|14375.00|99|0.00|TOTAL JOINT PROCEDURES|
20|FH_F125013_85251_0|SrvcGrp|73842|2022|PDM|450.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F92977_64067_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150905_01608_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|AEG 4 (NO REV)|
20|FH_F38725_0_0|SrvcGrp|11033|2022|PCT|1.10|99|0.00|OP REFERENCE LAB|
20|FH_F117993_32054_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145988_06105_0|SrvcGrp|220|2022|PCT|0.50|99|0.00|INTRAOCULAR LENSES|
20|FH_F103440_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F96102_33884_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F102721_38118_0|SrvcGrp|131|2022|PCT|0.37|99|0.00|PACEMAKER DEVICE|
20|FH_F150001_33064_0|SrvcGrp|86825|2022|PDM|53.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F117885_81506_0|SrvcGrp|73700|2022|PDM|57.50|99|0.00|AETNA - SKILLED NURSING|
20|FH_F144888_15370_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133018_84037_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|545.00|99|0.00|ASPG I|
20|FH_F110240_0_0|CSTM-ALL|CSTM-00|2020|PDM|435.00|99|0.00|AEG 1 (NO REV)|
20|FH_F45435_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F67305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F122245_0_0|SrvcGrp|63469|2022|PDM|7468.00|99|0.00|CPT 55700|
20|FH_F102721_38118_0|SrvcGrp|90356|2022|PCT|0.40|99|0.00|OP DIALYSIS|
20|FH_F130593_48103_0|SrvcGrp|29155|2022|PDM|140.00|99|0.00|HOSPICE SVCS|
20|FH_F117911_86403_0|SrvcGrp|46605|2022|PDM|125.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F116988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F99720_0_0|SrvcGrp|72996|2022|PDM|1967.00|99|0.00|AEG 4|
20|FH_F100786_24740_0|SrvcGrp|73605|2022|PDM|1902.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F119007_0_0|SrvcGrp|88739|2022|PDM|2033.00|99|0.00|IMPLANT SPINAL CANAL|
20|FH_F103281_32086_0|SrvcGrp|84900|2022|PDM|18700.00|99|0.00|AETNA GASTRIC BYPASS W/O LAPAROSCOPY|
20|FH_F92676_15063_0|SrvcGrp|79065|2022|PDM|361.62|99|0.00|MON VALLEY ASC 239|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F100880_67735_0|SrvcGrp|13627|2022|PDM|404.00|99|0.00|SLEEP STUDY|
20|FH_F120844_66061_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120437_85202_0|SrvcGrp|103613|2022|PDM|181.20|99|0.00|MED NUTRITION IND SUBSEQUENT|
20|FH_F145877_0_0|SrvcGrp|13188|2022|PCT|0.29|99|0.00|DRUGS|
20|FH_F38700_0_0|SrvcGrp|18328|2022|PCT|0.80|99|0.00|MS DRG 469|
20|FH_F117006_0_0|SrvcGrp|104226|2022|PDM|148.79|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F103400_33426_0|SrvcGrp|87317|2022|PDM|822.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F35509_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118391_77040_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA) - HCFA|
20|FH_F149821_21202_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F128442_57430_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F99720_0_0|SrvcGrp|72990|2022|PDM|1166.00|99|0.00|AEG 1|
20|FH_F133477_90247_0|CSTM-ALL|CSTM-00|2020|PDM|4106.00|99|0.00|AEG 6 (NO REV)|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1347.35|99|0.00|ASPG 8|
20|FH_F111780_38603_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87577_80016_0|SrvcGrp|39871|2022|PCT|0.71|99|0.00|MS DRG 619-621 ONLY OTLR|
20|FH_F151152_19150_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151155_26508_0|SrvcGrp|113342|2022|PDM|106.00|99|0.00|TAKE HOME BUPRENORPHINE|
20|FH_F89778_0_0|SrvcGrp|83646|2022|PDM|1735.13|99|0.00|CPT 31276|
20|FH_F88398_15601_0|SrvcGrp|73742|2022|PDM|9.78|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F149179_0_0|SrvcGrp|99073|2022|PDM|1.36|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|2081.00|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_F132810_0_0|SrvcGrp|86838|2022|PDM|25.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F136347_30328_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F136377_75240_0|SrvcGrp|86722|2022|PDM|195.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F120490_64133_0|SrvcGrp|86845|2022|PDM|25.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F93363_63123_0|SrvcGrp|23683|2022|PDM|35.00|99|0.00|SKILLED NURSING RN|
20|FH_F134047_32628_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134075_78230_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F134160_19006_0|SrvcGrp|13597|2022|PDM|238.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F137054_22041_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137068_81147_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F138168_63084_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F142314_19102_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F142737_77703_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F56832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F97602_40121_0|SrvcGrp|73485|2022|PDM|3353.00|99|0.00|AETNA REHAB|
20|FH_F74763_63010_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|GENERAL ACUTE CARE|
20|FH_F78267_18702_0|SrvcGrp|10592|2022|PDM|72.00|99|0.00|PARENTERAL NUTRITION|
20|FH_F80205_33161_0|SrvcGrp|472|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F80284_16354_0|SrvcGrp|64109|2022|PDM|553.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 2|
20|FH_F149374_38855_0|SrvcGrp|75419|2022|PDM|425.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F149530_80014_0|SrvcGrp|46903|2022|PDM|650.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F149663_45219_0|CSTM-ALL|CSTM-00|2020|PDM|1343.00|99|0.00|AEG 10 (NO REV)|
20|FH_F35587_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130800_06078_0|SrvcGrp|75545|2022|PDM|390.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F109884_36117_0|SrvcGrp|86648|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F147725_06002_0|SrvcGrp|65403|2022|PDM|2812.00|99|0.00|CPT 42830|
20|FH_F147932_78613_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F137276_83127_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F38699_0_0|SrvcGrp|17083|2022|PDM|786.00|99|0.00|ASPG X|
20|FH_F38948_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|ACUTE PSYCH|
20|FH_F109652_0_0|SrvcGrp|39824|2022|PDM|376.00|99|0.00|ER SERVICES LEVEL 1 & 2|
20|FH_F109652_0_0|SrvcGrp|15774|2022|PDM|189.00|99|0.00|TREATMENT ROOM|
20|FH_F31783_0_0|SrvcGrp|13215|2022|PCT|0.60|99|0.00|PHARMACY SVCS|
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|26460.00|99|0.00|MSDRG 233-234 CORONARY BYPASS|
20|FH_F95880_02726_0|SrvcGrp|94737|2022|PDM|56.65|99|0.00|FLUVIRIN VACC IM (>=3 YRS)|
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|1103.00|99|0.00|AEG 10 (NO REV)|
20|FH_F143467_0_0|SrvcGrp|89989|2022|PDM|4551.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F138296_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|IMPLANTS|
20|FH_F61292_0_0|SrvcGrp|20906|2022|PDM|18371.00|99|0.00|MS DRG 243-244 ONLY CARDIAC PACEMAKER|
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|935.00|99|0.00|AEG 2 (NO REV)|
20|FH_F41776_0_0|CSTM-ALL|CSTM-00|2020|PDM|3197.00|99|0.00|ASPG VI|
20|FH_F93114_85016_0|SrvcGrp|48398|2022|PDM|151.00|99|0.00|PT SERVICES|
20|FH_F130936_06107_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131254_92211_0|SrvcGrp|29075|2022|PDM|30.00|99|0.00|HYDRATION THERAPY|
20|FH_F145815_30540_0|SrvcGrp|112762|2022|PDM|45.23|99|0.00|INFECTIOUS AGENT ANTIGEN DETECTION|
20|FH_F150460_48334_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F39917_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|NEW PATIENT - SHORT VISIT|
20|FH_F137451_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F102302_0_0|SrvcGrp|98604|2022|PDM|4550.00|99|0.00|IMPLANT SPINAL CANAL|
20|FH_F38984_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124738_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125899_07645_0|SrvcGrp|72992|2022|PDM|4741.00|99|0.00|AEG 2|
20|FH_F86332_75081_0|SrvcGrp|13606|2022|PDM|30.00|99|0.00|HOME INFUSION|
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1590.00|99|0.00|AEG 6 (NO REV)|
20|FH_F32220_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38392_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|FLORIDA GLOBAL MRI CARVEOUT CODES|
20|FH_F151146_0_0|SrvcGrp|47142|2022|PDM|2500.00|99|0.00|CPT 49650|
20|FH_F135259_21090_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F128878_11203_0|SrvcGrp|86868|2022|PDM|97.50|99|0.00|AETNA PSYTX PT & FAM 45 MINS (MOD TD)(HCFA)|
20|FH_F131228_01826_0|SrvcGrp|113465|2022|PCT|1.01|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F44774_0_0|SrvcGrp|32407|2022|PCT|1.20|99|0.00|OCN F/S PRICING: GLOBAL (RADIOLOGY)|
20|FH_F135771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129556_65233_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F67261_0_0|SrvcGrp|36991|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140762_0_0|SrvcGrp|104719|2022|PDM|1723.00|99|0.00|RELIEVE INNER EYE PRESSURE|
20|FH_F139515_0_0|SrvcGrp|88163|2022|PDM|11473.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F33712_0_0|SrvcGrp|15350|2022|PCT|0.75|99|0.00|TRAUMA ACTIVATION|
20|FH_F82753_18840_0|SrvcGrp|111926|2022|PDM|39.51|99|0.00|COVID-19 LAB TESTING|
20|FH_F124388_0_0|SrvcGrp|63466|2022|PDM|1254.00|99|0.00|CPT 52005|
20|FH_F109645_0_0|SrvcGrp|34357|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS MOD GP|
20|FH_F141407_76226_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F47656_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 10 (NO REV)|
20|FH_F147725_06002_0|SrvcGrp|89989|2022|PDM|5512.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F147725_06002_0|CSTM-ALL|CSTM-00|2020|PDM|1205.00|99|0.00|AEG 2 (NO REV)|
20|FH_F147741_80012_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F147921_19083_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129411_24540_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129483_77030_0|SrvcGrp|26868|2022|PDM|35.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F38438_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F117093_40041_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117211_15143_0|SrvcGrp|48394|2022|PDM|33.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1353.00|99|0.00|AEG 7 (NO REV)|
20|FH_F115868_0_0|SrvcGrp|89822|2022|PDM|18.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F35210_0_0|SrvcGrp|72220|2022|PCT|0.65|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F38948_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F109821_0_0|SrvcGrp|11663|2022|PCT|1.02|99|0.00|IMPLANTS|
20|FH_F111593_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|OP SVCS|
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1603.00|99|0.00|ASPG VI|
20|FH_F110160_0_0|SrvcGrp|73008|2022|PDM|928.00|99|0.00|AEG 10|
20|FH_F34316_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|1520.76|99|0.00|2005 ASPG GROUPER VIII|
20|FH_F126666_44053_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F146211_68144_0|SrvcGrp|89980|2022|PDM|6180.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F94300_0_0|SrvcGrp|93596|2022|PDM|4200.00|99|0.00|SHOULDER JOINT(HCFA)|
20|FH_F134830_0_0|SrvcGrp|92501|2022|PDM|450.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F50618_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37778_0_0|SrvcGrp|27316|2022|PDM|1240.00|99|0.00|TONSILS & ADENOIDS (42820)|
20|FH_F60101_0_0|SrvcGrp|42829|2022|PDM|68.00|99|0.00|RESPIRATORY THERAPY VISIT|
20|FH_F144572_34203_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|1517.00|99|0.00|AEG 5  (NO REV)|
20|FH_F106420_18510_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE|
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|697.40|99|0.00|AEG 9 (NO REV)|
20|FH_F117880_91730_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F117346_75093_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F49035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F97581_60141_0|SrvcGrp|73603|2022|PDM|6868.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F92677_08003_0|SrvcGrp|40695|2022|PDM|9.45|99|0.00|ENTERAL FEEDING SUPPLY KIT, GRAVITY|
20|FH_F92833_0_0|SrvcGrp|41336|2022|PDM|2215.00|99|0.00|VAGINAL HYSTERECTOMY|
20|FH_F120707_0_0|SrvcGrp|75506|2022|PCT|0.89|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F50974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F97581_60141_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F123324_0_0|SrvcGrp|15363|2022|PCT|0.52|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F35278_0_0|SrvcGrp|16746|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F113131_19013_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F40591_0_0|SrvcGrp|3409|2022|PDM|928.00|99|0.00|NEWBORN NURSERY|
20|FH_F113131_19013_0|SrvcGrp|89022|2022|PDM|31.62|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 8 (NO REV)|
20|FH_F120032_0_0|SrvcGrp|79594|2022|PDM|580.00|99|0.00|CPT 45380|
20|FH_F97882_32407_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F67639_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.55|99|0.00|ASPG V|
20|FH_F43411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F117909_92405_0|SrvcGrp|73700|2022|PDM|55.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 4 (NO REV)|
20|FH_F128699_0_0|SrvcGrp|82223|2022|PDM|90.00|99|0.00|HOSPICE CARE|
20|FH_F102561_75146_0|SrvcGrp|88978|2022|PDM|3500.00|99|0.00|VAGINAL DELIVERY|
20|FH_F102561_75146_0|SrvcGrp|98100|2022|PCT|1.50|99|0.00|AETNA SLEEP STUDIES|
20|FH_F38700_0_0|SrvcGrp|18803|2022|PCT|0.80|99|0.00|MS DRG 218|
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PDM|2831.00|99|0.00|AEG 9 (NO REV)|
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118645_19103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71162_0_0|SrvcGrp|43893|2022|PDM|67.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|1071.00|99|0.00|AEG 5  (NO REV)|
20|FH_F115289_90057_0|SrvcGrp|93919|2022|PDM|500.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F92676_15063_0|SrvcGrp|79068|2022|PDM|369.13|99|0.00|MON VALLEY ASC 314|
20|FH_F103781_0_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F117559_08619_0|SrvcGrp|113297|2022|PDM|40.00|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - PFIZER|
20|FH_F136751_0_0|SrvcGrp|36591|2022|PDM|36000.00|99|0.00|CPT 63685|
20|FH_F90935_29073_0|SrvcGrp|43524|2022|PDM|120.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F145854_37015_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125103_0_0|SrvcGrp|28786|2022|PDM|550.00|99|0.00|CPT CODE 90937|
20|FH_F88512_0_0|SrvcGrp|104423|2022|PDM|2455.10|99|0.00|AETNA REHABILITATION|
20|FH_F38700_0_0|SrvcGrp|18624|2022|PCT|0.80|99|0.00|MS DRG 419|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|132.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1501 W/O REV|
20|FH_F123085_21921_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F40465_0_0|SrvcGrp|3584|2022|PDM|7000.00|99|0.00|DRG 117 CARDIAC PACE REVISION|
20|FH_F44314_0_0|SrvcGrp|26775|2022|PDM|46.00|99|0.00|OT|
20|FH_F148899_44041_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103400_33426_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F32727_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149442_0_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F130767_67133_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43858_0_0|SrvcGrp|37403|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F39821_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F139515_0_0|SrvcGrp|77582|2022|PDM|2926.00|99|0.00|CPT 31255|
20|FH_F72589_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37945_0_0|SrvcGrp|9978|2022|PDM|1207.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS|
20|FH_F137573_33764_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F38090_0_0|SrvcGrp|63|2022|PDM|624.00|99|0.00|SUBACUTE CARE|
20|FH_F124783_92408_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F66687_0_0|SrvcGrp|29127|2022|PCT|0.85|99|0.00|MSDRG 265 ONLY|
20|FH_F52393_0_0|SrvcGrp|49113|2022|PDM|4600.00|99|0.00|HEARING AID|
20|FH_F102302_0_0|SrvcGrp|98574|2022|PDM|29900.00|99|0.00|SPINE DISK SURGERY THORAX|
20|FH_F135002_54971_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F101081_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F128272_60640_0|SrvcGrp|13929|2022|PDM|25.00|99|0.00|GROWTH HORMONE|
20|FH_F130154_33607_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|HSS ASC|
20|FH_F39740_0_0|SrvcGrp|28015|2022|PDM|9887.00|99|0.00|MSDRG 466-470 ONLY MAJOR JOINT/LIMB PROC|
20|FH_F100962_0_0|SrvcGrp|72992|2022|PDM|832.00|99|0.00|AEG 2|
20|FH_F40416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F132092_0_0|SrvcGrp|83857|2022|PDM|675.00|99|0.00|IP HOSPICE SVCS|
20|FH_F126784_80809_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F104740_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135650_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125899_07645_0|SrvcGrp|78527|2022|PCT|6.84|99|0.00|RADIOLOGY|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 601 W/O REV|
20|FH_F86332_75081_0|SrvcGrp|10574|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F114930_71101_0|SrvcGrp|105745|2022|PCT|1.05|99|0.00|PHYSICAL THERAPY|
20|FH_F137087_0_0|SrvcGrp|113021|2022|PDM|20000.00|99|0.00|KNEE SERVICES|
20|FH_F125516_50574_0|SrvcGrp|79699|2022|PCT|0.90|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F102184_0_0|SrvcGrp|11673|2022|PDM|4812.00|99|0.00|CPT 29888|
20|FH_F113410_0_0|SrvcGrp|100007|2022|PDM|4307.00|99|0.00|FUSION OF ANKLE JOINT|
20|FH_F117078_01420_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F110925_01104_0|SrvcGrp|29077|2022|PDM|19.50|99|0.00|HOME TRANSFUSION|
20|FH_F135252_21911_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111180_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66222_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40046_0_0|SrvcGrp|3069|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F137239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F82871_33160_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F150982_0_0|SrvcGrp|46890|2022|PDM|2808.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F126439_92627_0|SrvcGrp|75419|2022|PDM|632.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F40255_0_0|SrvcGrp|17100|2022|PDM|946.00|99|0.00|SKILLED NURSING|
20|FH_F73985_0_0|SrvcGrp|17075|2022|PDM|2963.00|99|0.00|ASPG VI|
20|FH_F141370_20866_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F125899_07645_0|SrvcGrp|73000|2022|PDM|6836.00|99|0.00|AEG 6|
20|FH_F126730_84737_0|SrvcGrp|46903|2022|PDM|1050.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F40321_0_0|SrvcGrp|701|2022|PDM|2856.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F127550_43026_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F58112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F62333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F62579_0_0|SrvcGrp|50046|2022|PDM|150.00|99|0.00|PHOTOTHERAPY VISIT|
20|FH_F63235_0_0|SrvcGrp|72994|2022|PDM|1426.00|99|0.00|AEG 3|
20|FH_F135840_0_0|SrvcGrp|85000|2022|PDM|550.00|99|0.00|CPT 45384|
20|FH_F130825_65742_0|SrvcGrp|111627|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F130858_67026_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133869_19947_0|SrvcGrp|12659|2022|PDM|695.25|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F71669_0_0|SrvcGrp|11283|2022|PCT|0.75|99|0.00|HYPERBARIC CHAMBER|
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|238.00|99|0.00|ADULT PSYCH PARTIAL HOSPITALIZATION|
20|FH_F130017_02302_0|SrvcGrp|73500|2022|PDM|482.30|99|0.00|AETNA ER LEVEL I|
20|FH_F63318_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F139446_87106_0|SrvcGrp|108799|2022|PCT|1.20|99|0.00|OP THERAPY SERVICE|
20|FH_F126525_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F71634_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F110442_98003_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F127080_77520_0|SrvcGrp|73842|2022|PDM|224.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F84132_48026_0|SrvcGrp|79561|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F121225_98902_0|SrvcGrp|108705|2022|PCT|0.00|99|0.00|HOSPICE SERVICES|
20|FH_F134611_04103_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F51393_0_0|SrvcGrp|42825|2022|PDM|46.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F111882_51560_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F119125_0_0|SrvcGrp|13705|2022|PDM|2197.00|99|0.00|ACUTE PHYSICAL REHAB|
20|FH_F124743_0_0|SrvcGrp|83857|2022|PDM|575.00|99|0.00|IP HOSPICE SVCS|
20|FH_F117208_0_0|SrvcGrp|90822|2022|PDM|4015.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY|
20|FH_F117245_0_0|SrvcGrp|73000|2022|PDM|1363.00|99|0.00|AEG 6|
20|FH_F56512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150305_18848_0|SrvcGrp|92760|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F88744_71103_0|SrvcGrp|39522|2022|PDM|49037.00|99|0.00|MS DRG 216-218 ONLY|
20|FH_F42646_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F44813_0_0|CSTM-ALL|CSTM-00|2020|PDM|240.00|99|0.00|RESIDENTIAL TREATMENT SVCS|
20|FH_F146320_27610_0|CSTM-ALL|CSTM-00|2020|PDM|695.50|99|0.00|AEG 2 (NO REV)|
20|FH_F120437_85202_0|SrvcGrp|86843|2022|PDM|97.36|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F132553_65340_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128130_10027_0|CSTM-ALL|CSTM-00|2020|PDM|5182.00|99|0.00|AEG 3 (NO REV)|
20|FH_F118845_71111_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F133493_90255_0|SrvcGrp|11663|2022|PCT|0.25|99|0.00|IMPLANTS|
20|FH_F125478_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F132991_84790_0|SrvcGrp|88621|2022|PDM|60.75|99|0.00|SKILLED NURSING LPN|
20|FH_F89851_83854_0|SrvcGrp|89957|2022|PDM|4641.00|99|0.00|ACL|
20|FH_F90811_0_0|SrvcGrp|90420|2022|PDM|4000.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|404.60|99|0.00|ASPG 104|
20|FH_F67683_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F44016_0_0|SrvcGrp|8950|2022|PDM|2370.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F47479_0_0|CSTM-ALL|CSTM-00|2020|PDM|47.00|99|0.00|HOME INFUSION NURSING SERVICES MOD SD|
20|FH_F130593_48103_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F94300_0_0|SrvcGrp|93598|2022|PDM|4200.00|99|0.00|REVISE RECONSTRUCT SHOULDER JOINT(HCFA)|
20|FH_F105842_70433_0|SrvcGrp|73485|2022|PDM|945.00|99|0.00|AETNA REHAB|
20|FH_F148903_51101_0|SrvcGrp|48398|2022|PDM|128.00|99|0.00|PT SERVICES|
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|493.00|99|0.00|AEG 2 (NO REV)|
20|FH_F68363_0_0|SrvcGrp|13630|2022|PDM|190.00|99|0.00|CPT 99204|
20|FH_F133214_75024_0|SrvcGrp|98701|2022|PDM|428.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F125043_53545_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91155_16105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F38394_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME ADMNSTRTN DRUG THERAPY - AEROSOLIZED|
20|FH_F150519_92626_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132999_19901_0|SrvcGrp|88620|2022|PDM|89.00|99|0.00|SKILLED NURSING RN|
20|FH_F132722_71373_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F40591_0_0|CSTM-ALL|CSTM-00|2020|PDM|5175.00|99|0.00|MSDRG 246-251 ANGIOPLASTY|
20|FH_F111809_93003_0|SrvcGrp|10363|2022|PDM|2336.00|99|0.00|CPT CODE 99283|
20|FH_F133530_11237_0|SrvcGrp|72984|2022|PCT|2.20|99|0.00|CHEMOTHERAPY|
20|FH_F67202_0_0|SrvcGrp|10503|2022|PDM|118.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F141913_65560_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149840_80002_0|SrvcGrp|87401|2022|PDM|75.00|99|0.00|HCPCS G0156 (HCFA)|
20|FH_F33659_0_0|SrvcGrp|15388|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F82136_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS|
20|FH_F139385_37762_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139584_10281_0|SrvcGrp|82981|2022|PDM|135.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F150768_03054_0|SrvcGrp|29155|2022|PDM|212.00|99|0.00|HOSPICE SVCS|
20|FH_F150861_92592_0|SrvcGrp|90854|2022|PDM|1250.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F150950_17522_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F125081_15218_0|SrvcGrp|80920|2022|PDM|550.00|99|0.00|HOSPICE SERVICES|
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_F36328_0_0|SrvcGrp|72|2022|PDM|260.00|99|0.00|NEWBORN NURSERY|
20|FH_F147223_49444_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IP MULTI ROOM COMPARISON|
20|FH_F93961_0_0|SrvcGrp|93749|2022|PDM|1654.00|99|0.00|ERCP DUCT STENT PLACEMENT|
20|FH_F98001_27603_0|SrvcGrp|88977|2022|PDM|4125.00|99|0.00|C-SECTION DELIVERY|
20|FH_F137986_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F93377_0_0|SrvcGrp|82223|2022|PDM|27.00|99|0.00|HOSPICE CARE|
20|FH_F64739_0_0|SrvcGrp|60856|2022|PDM|132.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE|
20|FH_F111266_30339_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F122248_33441_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F125081_15218_0|SrvcGrp|94780|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F128753_32501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F148979_44512_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|55.10|99|0.00|SALLY BALIN,999182,ASC 126|
20|FH_F147143_18706_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149648_89148_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F151639_90034_0|SrvcGrp|90854|2022|PDM|1250.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F132254_40207_0|SrvcGrp|14945|2022|PDM|9.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F131392_17004_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F136806_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149379_53213_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F39443_0_0|SrvcGrp|30511|2022|PCT|0.45|99|0.00|JEFFERSON PROSTHETICS/ORTHOTICS|
20|FH_F150953_74953_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111122_63376_0|SrvcGrp|48398|2022|PDM|81.50|99|0.00|PT SERVICES|
20|FH_F131449_19073_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F36992_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE|
20|FH_F149023_44122_0|SrvcGrp|89860|2022|PDM|2340.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F45158_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OP SVCS|
20|FH_F150938_02062_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F108260_63141_0|SrvcGrp|48398|2022|PDM|83.00|99|0.00|PT SERVICES|
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|1608.00|99|0.00|AEG 10 (NO REV)|
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F124703_65711_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F120190_92624_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F116698_07470_0|SrvcGrp|17013|2022|PDM|39.90|99|0.00|HOME INFUSION THERAPY|
20|FH_F116904_17543_0|SrvcGrp|76501|2022|PDM|304.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F120974_27607_0|SrvcGrp|76981|2022|PDM|1803.00|99|0.00|HOSPICE|
20|FH_F141527_36830_0|SrvcGrp|86838|2022|PDM|11.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F141550_33619_0|SrvcGrp|73842|2022|PDM|188.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F40418_0_0|SrvcGrp|177|2022|PDM|1900.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F139515_0_0|SrvcGrp|99073|2022|PDM|1.61|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F37679_0_0|SrvcGrp|26852|2022|PDM|15.25|99|0.00|ANTI-EMETICS INFUSION THERAPY (SJ)|
20|FH_F112508_0_0|SrvcGrp|472|2022|PDM|832.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|1269.07|99|0.00|ASPG II|
20|FH_F40066_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F125744_66048_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F87031_0_0|SrvcGrp|72996|2022|PDM|983.00|99|0.00|AEG 4|
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|ASPG IX|
20|FH_F137367_89139_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F131653_50314_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F78343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F130214_30144_0|SrvcGrp|75419|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 10 (NO REV)|
20|FH_F143888_32205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F82173_72712_0|CSTM-ALL|CSTM-00|2020|PDM|4337.00|99|0.00|AEG 7 (NO REV)|
20|FH_F113410_0_0|SrvcGrp|33984|2022|PDM|1786.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F42706_0_0|SrvcGrp|70939|2022|PCT|0.27|99|0.00|DRUGS|
20|FH_F48998_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F105680_0_0|SrvcGrp|75479|2022|PDM|920.00|99|0.00|AEG 1|
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1083.00|99|0.00|AEG 7 (NO REV)|
20|FH_F32996_0_0|SrvcGrp|14522|2022|PDM|3240.00|99|0.00|INTENSIVE/INTERMEDIATE CARE UNIT|
20|FH_F83772_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.28|99|0.00|OP SVCS|
20|FH_F93563_98499_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F131286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F98922_40351_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F141527_36830_0|SrvcGrp|17016|2022|PDM|26.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F46359_0_0|SrvcGrp|9937|2022|PDM|147.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F70984_0_0|SrvcGrp|68000|2022|PDM|1800.00|99|0.00|CPT 58561|
20|FH_F140427_0_0|SrvcGrp|109505|2022|PDM|900.00|99|0.00|REMV & REPLC PM GEN MULT LEADS|
20|FH_F86518_20721_0|SrvcGrp|472|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117082_66216_0|SrvcGrp|75545|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|CD INTENSIVE OUTPATIENT SVCS|
20|FH_F92276_32308_0|SrvcGrp|104363|2022|PCT|0.51|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F132372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101021_0_0|SrvcGrp|94780|2022|PDM|83.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
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_F78048_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F82173_72712_0|SrvcGrp|92501|2022|PDM|355.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F148265_06067_0|SrvcGrp|89842|2022|PDM|16218.00|99|0.00|LUMBAR|
20|FH_F136092_0_0|SrvcGrp|97506|2022|PDM|105.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F37679_0_0|SrvcGrp|27067|2022|PDM|15.25|99|0.00|HOME INFUSION THERAPY, PAIN MGMT (MOD SJ)|
20|FH_F106020_0_0|SrvcGrp|77582|2022|PDM|2101.00|99|0.00|CPT 31255|
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|2104.00|99|0.00|AEG 3 (NO REV)|
20|FH_F93791_0_0|SrvcGrp|93603|2022|PDM|3675.00|99|0.00|CERVICAL SURGERY(HCFA)|
20|FH_F131254_92211_0|SrvcGrp|86835|2022|PDM|12.50|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F131168_33912_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F139551_0_0|SrvcGrp|89980|2022|PDM|4965.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F115985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130204_40807_0|SrvcGrp|46903|2022|PDM|522.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137943_0_0|SrvcGrp|113196|2022|PDM|1660.00|99|0.00|ECP CILIARY BODY DESTRUCTION|
20|FH_F116923_85259_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F40063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS|
20|FH_F97104_53545_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143902_41018_0|SrvcGrp|90854|2022|PDM|852.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F31370_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1474.00|99|0.00|AEG 1 (NO REV)|
20|FH_F66687_0_0|SrvcGrp|20926|2022|PDM|77368.00|99|0.00|MS DRG 235 ONLY|
20|FH_F129567_60616_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116955_16801_0|SrvcGrp|88620|2022|PDM|91.00|99|0.00|SKILLED NURSING RN|
20|FH_F130977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|GENERAL ACUTE CARE|
20|FH_F109240_21201_0|SrvcGrp|89596|2022|PDM|538.00|99|0.00|SPECIAL RADIATION TREATMENT|
20|FH_F116700_11787_0|SrvcGrp|89412|2022|PDM|275.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F33249_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111288_0_0|SrvcGrp|84939|2022|PDM|22187.00|99|0.00|SHOULDER JOINT|
20|FH_F131995_04730_0|SrvcGrp|88620|2022|PDM|126.00|99|0.00|SKILLED NURSING RN|
20|FH_F93881_15009_0|SrvcGrp|74443|2022|PDM|4.00|99|0.00|CARDIAC TESTING|
20|FH_F126730_84737_0|SrvcGrp|87317|2022|PDM|1100.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F66220_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F42368_0_0|CSTM-ALL|CSTM-00|2020|PCT|52.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39943_0_0|SrvcGrp|38|2022|PDM|2530.00|99|0.00|NORMAL DELIVERY|
20|FH_F117784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG I|
20|FH_F134919_02155_0|SrvcGrp|29347|2022|PDM|34.50|99|0.00|HOME HEALTH AIDE|
20|FH_F149522_83221_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F89851_83854_0|SrvcGrp|28213|2022|PDM|25179.00|99|0.00|MS DRG 472 ONLY|
20|FH_F148550_48126_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113826_51445_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41463_0_0|SrvcGrp|34135|2022|PDM|61.00|99|0.00|ZEMAIRA THERAPY|
20|FH_F147170_53051_0|SrvcGrp|104173|2022|PCT|2.00|99|0.00|IMMUNIZATIONS AND INJECTIONS|
20|FH_F97300_47501_0|SrvcGrp|78680|2022|PDM|5500.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F151699_01752_0|SrvcGrp|86827|2022|PDM|90.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F37487_0_0|SrvcGrp|9861|2022|PCT|0.70|99|0.00|ACUTE REHABILITATION|
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.00|99|0.00|AEG 2 (NO REV)|
20|FH_F74845_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|CV SURGERY|
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|706.00|99|0.00|ASPG IV - GNADEN HUETTEN|
20|FH_F134603_0_0|SrvcGrp|705|2022|PCT|0.44|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F132595_0_0|CSTM-ALL|CSTM-00|2020|PDM|1931.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F137769_85234_0|SrvcGrp|43602|2022|PCT|1.00|99|0.00|DME|
20|FH_F35990_0_0|SrvcGrp|16|2022|PDM|1265.00|99|0.00|ACUTE REHABILITATION|
20|FH_F45226_0_0|SrvcGrp|11090|2022|PDM|80.00|99|0.00|NURSING CARE|
20|FH_F32666_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (HCFA) OUTPATIENT|
20|FH_F90817_0_0|SrvcGrp|26432|2022|PDM|2444.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F132849_0_0|SrvcGrp|24537|2022|PDM|558.00|99|0.00|DIALYSIS|
20|FH_F108680_0_0|SrvcGrp|92408|2022|PDM|7700.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F47037_0_0|SrvcGrp|18024|2022|PDM|65.00|99|0.00|NUTRITNAL CNSLNG/DIABETES EDU|
20|FH_F97881_38703_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F149001_37055_0|SrvcGrp|115562|2022|PDM|665.00|99|0.00|HOSPICE|
20|FH_F117603_92210_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F67381_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F38123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F147082_02359_0|SrvcGrp|16069|2022|PDM|504.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F147343_17011_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129764_48084_0|SrvcGrp|111385|2022|PCT|1.00|99|0.00|PATHOLOGY|
20|FH_F116332_0_0|SrvcGrp|83677|2022|PDM|5854.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|658.00|99|0.00|AEG 2 (NO REV)|
20|FH_F130179_62447_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F115483_62002_0|SrvcGrp|2738|2022|PCT|0.47|99|0.00|IMPLANTS|
20|FH_F125182_0_0|SrvcGrp|67989|2022|PDM|2370.00|99|0.00|CPT 49320|
20|FH_F97640_37043_0|SrvcGrp|73643|2022|PDM|1004.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F124316_28112_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F39756_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120104_97223_0|SrvcGrp|93337|2022|PDM|500.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F149419_33966_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|722.00|99|0.00|AEG 5  (NO REV)|
20|FH_F139150_75206_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140036_07702_0|SrvcGrp|90643|2022|PDM|25.75|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F143249_89801_0|SrvcGrp|53987|2022|PDM|30.00|99|0.00|PHOTOTHERAPY|
20|FH_F143347_16001_0|SrvcGrp|12491|2022|PCT|0.40|99|0.00|PACEMAKER|
20|FH_F143348_16214_0|SrvcGrp|114100|2022|PCT|0.89|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F143454_94550_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F101752_0_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION|
20|FH_F131107_43140_0|SrvcGrp|87799|2022|PDM|130.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F151752_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47245_0_0|SrvcGrp|30733|2022|PDM|564.00|99|0.00|SKILLED NURSING CARE|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|924.00|99|0.00|GA RETINA SURG CTR ASC 20|
20|FH_F47952_0_0|SrvcGrp|42976|2022|PDM|95.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F49552_0_0|SrvcGrp|16898|2022|PDM|429.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F120208_20109_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F136299_75218_0|SrvcGrp|73496|2022|PDM|2500.00|99|0.00|AETNA ER LEVEL V|
20|FH_F116552_70001_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F116684_30701_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F120853_61201_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120895_19460_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F34660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F84611_30281_0|SrvcGrp|79298|2022|PDM|136.00|99|0.00|AETNA X-RAY (CPT 77055)|
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F63249_0_0|SrvcGrp|46118|2022|PDM|65.00|99|0.00|NUTRITNAL CNSLNG/DIABETES EDU|
20|FH_F130805_17404_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)|
20|FH_F130891_41175_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|108.49|99|0.00|HAPA WPA-NWPA 2012-13 ASC 140 W/O REV|
20|FH_F127616_17403_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F143581_02130_0|SrvcGrp|104328|2022|PCT|0.85|99|0.00|PRESCRIPTION DRUG|
20|FH_F114444_19602_0|SrvcGrp|89149|2022|PDM|120.00|99|0.00|OP INTENSIVE|
20|FH_F120719_27540_0|SrvcGrp|472|2022|PDM|723.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F126085_76002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|634.17|99|0.00|HAPA WPA-NWPA 2012-13 ASC 205 W/O REV|
20|FH_F100782_0_0|SrvcGrp|105063|2022|PDM|728.10|99|0.00|WINDBER MEDICAL CNTR ASC 108|
20|FH_F111163_0_0|SrvcGrp|84912|2022|PDM|4200.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F136359_0_0|SrvcGrp|112858|2022|PDM|11680.00|99|0.00|PROCEDURES OF FOOT BONES|
20|FH_F86094_16748_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: BREAKOUT|
20|FH_F85353_16407_0|SrvcGrp|72980|2022|PCT|1.55|99|0.00|AETNA LABORATORY|
20|FH_F130763_0_0|SrvcGrp|86233|2022|PDM|11056.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F126990_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANESTHESIOLOGIST/CRNA (HAN5) SAME DOS|
20|FH_F52713_0_0|SrvcGrp|49522|2022|PDM|21188.00|99|0.00|PACEMAKER IMPLANT|
20|FH_F141337_60077_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F146207_73139_0|SrvcGrp|104228|2022|PDM|134.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F126341_27284_0|SrvcGrp|24754|2022|PCT|1.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F118252_32216_0|SrvcGrp|73841|2022|PDM|600.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|438.98|99|0.00|HAPA WPA-NWPA 2012-13 ASC 407 W/O REV|
20|FH_F134608_18017_0|SrvcGrp|106718|2022|PCT|1.00|99|0.00|INDUCED ABORTION BY DILATION AND CURETTAGE|
20|FH_F113345_25301_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F111500_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F121225_98902_0|SrvcGrp|79804|2022|PDM|3890.00|99|0.00|AETNA MEDICAL/SURGICAL|
20|FH_F149199_73005_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F96160_32207_0|SrvcGrp|86846|2022|PDM|68.65|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F109577_0_0|SrvcGrp|93146|2022|PDM|123.00|99|0.00|DIABETIC MANAGEMENT PROGRAM|
20|FH_F134611_04103_0|SrvcGrp|74668|2022|PDM|1046.50|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F116506_0_0|SrvcGrp|106880|2022|PDM|733.00|99|0.00|PARAVERTEBRAL FACET JOINT NERVE DESTRUCTION|
20|FH_F134988_61834_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F134593_60007_0|SrvcGrp|86830|2022|PDM|32.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F85353_16407_0|SrvcGrp|63858|2022|PDM|372.10|99|0.00|HAPA WPA-NWPA 2012-13 ASC 115|
20|FH_F135626_20176_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134610_33426_0|SrvcGrp|46903|2022|PDM|2047.50|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F88744_71103_0|SrvcGrp|87274|2022|PCT|0.75|99|0.00|TRAUMA W/ ER|
20|FH_F145694_84770_0|SrvcGrp|75419|2022|PDM|1050.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F144808_0_0|SrvcGrp|78096|2022|PDM|2888.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F83617_0_0|CSTM-ALL|CSTM-00|2020|PCT|4.85|99|0.00|HSS APC GROUPED|
20|FH_F118265_46268_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133972_27103_0|SrvcGrp|100866|2022|PDM|336.00|99|0.00|CHEMOTHERAPY ADMINISTRATION|
20|FH_F150165_06032_0|CSTM-ALL|CSTM-00|2020|PDM|2652.00|99|0.00|AEG 8 (NO REV)|
20|FH_F133485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F111702_07652_0|SrvcGrp|96403|2022|PCT|1.00|99|0.00|CIPROFLOXACIN IV|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|546.59|99|0.00|CPT 95811 (W/MOD TC)|
20|FH_F76146_0_0|SrvcGrp|68192|2022|PDM|1703.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 8|
20|FH_F85492_0_0|SrvcGrp|84502|2022|PDM|1465.00|99|0.00|LEVEL 1 ADULT REHAB|
20|FH_F127651_44124_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F134207_19116_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138951_41101_0|SrvcGrp|86842|2022|PDM|35.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F120930_0_0|SrvcGrp|11673|2022|PDM|3500.00|99|0.00|CPT 29888|
20|FH_F130468_0_0|SrvcGrp|41334|2022|PDM|19232.00|99|0.00|TOTAL KNEE|
20|FH_F143681_61938_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141829_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149021_44514_0|CSTM-ALL|CSTM-00|2020|PDM|1460.00|99|0.00|AEG 9 (NO REV)|
20|FH_F133867_84075_0|SrvcGrp|112469|2022|PDM|615.00|99|0.00|HOSPICE ROUT HOME CARE-DIEM (HCFA)|
20|FH_F86132_27105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F120670_0_0|SrvcGrp|103538|2022|PDM|4200.00|99|0.00|ARTHROSCOPY HIP W/ FEMOROPLASTY|
20|FH_F120719_27540_0|SrvcGrp|11336|2022|PCT|0.34|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F52713_0_0|SrvcGrp|49463|2022|PDM|68659.00|99|0.00|MS DRG 219 - 220 ONLY|
20|FH_F114510_33445_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F135617_52001_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F72543_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F122532_46385_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F84712_0_0|SrvcGrp|82751|2022|PDM|24.00|99|0.00|GONADOTROIN CHORINIC (HCG) QUANTITATIVE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|213.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 233 W/O REV|
20|FH_F105361_80104_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F146582_75146_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133408_01095_0|SrvcGrp|112324|2022|PCT|1.00|99|0.00|COVID-19 CODES|
20|FH_F111601_15203_0|SrvcGrp|86723|2022|PDM|330.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG VI|
20|FH_F114151_0_0|SrvcGrp|80317|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F129673_0_0|SrvcGrp|14494|2022|PDM|55.30|99|0.00|CONTINUOUS HOMECARE|
20|FH_F45832_0_0|SrvcGrp|16624|2022|PCT|0.72|99|0.00|PHARMACY SVCS|
20|FH_F50137_0_0|SrvcGrp|28629|2022|PDM|105.00|99|0.00|HIGH TECH SKILLED NURSING|
20|FH_F113253_72206_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134996_83467_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F121539_27511_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135248_84651_0|SrvcGrp|472|2022|PDM|377.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F34112_0_0|SrvcGrp|6|2022|PCT|0.82|99|0.00|OP SURGERY|
20|FH_F131357_17545_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F123468_63384_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148165_29169_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 7 (NO REV)|
20|FH_F121524_87111_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F141587_40242_0|SrvcGrp|46903|2022|PDM|596.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F38392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109277_0_0|SrvcGrp|22528|2022|PDM|773.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F39138_0_0|SrvcGrp|18143|2022|PDM|13078.00|99|0.00|MS DRG 247|
20|FH_F150314_0_0|SrvcGrp|89337|2022|PDM|800.00|99|0.00|DETOXIFICATION|
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1785.00|99|0.00|AEG 8 (NO REV)|
20|FH_F148179_48065_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F92276_32308_0|CSTM-ALL|CSTM-00|2020|PDM|15330.00|99|0.00|AEG 7 (NO REV)|
20|FH_F79800_0_0|SrvcGrp|75545|2022|PDM|283.25|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F89475_71202_0|SrvcGrp|73659|2022|PDM|2209.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F34735_0_0|SrvcGrp|18791|2022|PCT|0.75|99|0.00|MS DRG 215|
20|FH_F93881_15009_0|SrvcGrp|82686|2022|PDM|595.00|99|0.00|AETNA CT SCAN|
20|FH_F115685_64064_0|SrvcGrp|98978|2022|PDM|120.00|99|0.00|TPN ONE LITER PER DAY (HCFA)|
20|FH_F40472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114970_28403_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F114980_78061_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F115127_0_0|SrvcGrp|103552|2022|PDM|75.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F39819_0_0|SrvcGrp|31236|2022|PDM|4412.00|99|0.00|NY DRG 139 ONLY|
20|FH_F131254_92211_0|SrvcGrp|19742|2022|PDM|75.00|99|0.00|MID-LINE INSERTION|
20|FH_F91622_0_0|CSTM-ALL|CSTM-00|2020|PDM|1014.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F88199_0_0|SrvcGrp|27968|2022|PDM|27.50|99|0.00|SKILLED NURSING LPN|
20|FH_F86752_0_0|SrvcGrp|75485|2022|PDM|821.00|99|0.00|AEG 4|
20|FH_F66222_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|S CODES MOD SJ|
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146260_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.20|99|0.00|GENERAL ACUTE CARE|
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|4682.00|99|0.00|AEG 6 (NO REV)|
20|FH_F39943_0_0|SrvcGrp|6|2022|PCT|0.90|99|0.00|OP SURGERY|
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)|
20|FH_F114930_71101_0|SrvcGrp|82037|2022|PDM|1632.00|99|0.00|AETNA ICU|
20|FH_F129627_06037_0|SrvcGrp|88621|2022|PDM|111.00|99|0.00|SKILLED NURSING LPN|
20|FH_F33513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|DME F/S (MOD 26) - MHAC|
20|FH_F125744_66048_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110925_01104_0|SrvcGrp|86136|2022|PDM|151.00|99|0.00|AETNA LUMIZYME INJ|
20|FH_F130145_98043_0|SrvcGrp|104056|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE - INTRAMUSCULAR|
20|FH_F120876_85250_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F125463_50459_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128159_45356_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F34112_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F38933_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F37679_0_0|SrvcGrp|26861|2022|PDM|30.50|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC (MOD SH)|
20|FH_F83493_21220_0|SrvcGrp|471|2022|PDM|577.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1890.00|99|0.00|AEG 8 (NO REV)|
20|FH_F57032_0_0|SrvcGrp|53485|2022|PDM|16.00|99|0.00|LANCING DEVICE|
20|FH_F130747_0_0|SrvcGrp|35672|2022|PDM|6503.00|99|0.00|CPT 23412|
20|FH_F127710_44139_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91994_0_0|SrvcGrp|38364|2022|PDM|4800.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ASPG I|
20|FH_F37679_0_0|SrvcGrp|27152|2022|PDM|30.50|99|0.00|HOME INFUSION THERAPY (MOD SH)|
20|FH_F120215_92064_0|SrvcGrp|87317|2022|PDM|1100.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F148320_02130_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F148103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F53872_0_0|SrvcGrp|42046|2022|PDM|595.00|99|0.00|HOSPICE CARE|
20|FH_F129305_45614_0|SrvcGrp|471|2022|PDM|555.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130747_0_0|SrvcGrp|54962|2022|PDM|6503.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)|
20|FH_F145545_01602_0|SrvcGrp|88819|2022|PDM|504.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F102500_0_0|SrvcGrp|72990|2022|PDM|519.00|99|0.00|AEG 1|
20|FH_F40026_0_0|SrvcGrp|958|2022|PDM|1114.00|99|0.00|VENTILATOR SERVICES|
20|FH_F98920_46526_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F150982_0_0|SrvcGrp|93069|2022|PDM|3854.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F128906_48423_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131995_04730_0|SrvcGrp|27968|2022|PDM|63.00|99|0.00|SKILLED NURSING LPN|
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145755_08050_0|SrvcGrp|113553|2022|PCT|1.00|99|0.00|COVID-19 DIAGNOSTIC|
20|FH_F139241_0_0|SrvcGrp|13187|2022|PCT|0.55|99|0.00|INTRAOCULAR LENSES|
20|FH_F77903_0_0|SrvcGrp|3388|2022|PDM|1020.00|99|0.00|SUBACUTE CARE|
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 8 (NO REV)|
20|FH_F136790_0_0|SrvcGrp|13632|2022|PDM|1187.00|99|0.00|CPT 99215|
20|FH_F125935_44024_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F143820_28405_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F143528_0_0|SrvcGrp|82720|2022|PDM|3491.25|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F40149_0_0|SrvcGrp|72|2022|PDM|506.00|99|0.00|NEWBORN NURSERY|
20|FH_F151146_0_0|CSTM-ALL|CSTM-00|2020|PDM|2045.00|99|0.00|AEG 5  (NO REV)|
20|FH_F148480_03079_0|CSTM-ALL|CSTM-00|2020|PDM|2073.75|99|0.00|AEG 4 (NO REV)|
20|FH_F127567_44070_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F130598_73601_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120872_74120_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116806_0_0|SrvcGrp|107015|2022|PDM|1923.16|99|0.00|REDUCTION OF FOREHEAD|
20|FH_F139569_15063_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F120583_43219_0|SrvcGrp|48396|2022|PDM|90.00|99|0.00|OT SERVICES|
20|FH_F144808_0_0|SrvcGrp|67065|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY|
20|FH_F34182_0_0|SrvcGrp|21077|2022|PDM|22932.00|99|0.00|MS DRG 037 ONLY|
20|FH_F131464_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149061_44122_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC|
20|FH_F89551_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134208_21502_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AEG 8 (NO REV)|
20|FH_F139169_0_0|SrvcGrp|113478|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F91777_29577_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F111725_33066_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146626_60612_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F77082_0_0|SrvcGrp|3378|2022|PCT|0.75|99|0.00|OBSERVATION SVCS|
20|FH_F98741_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112065_20852_0|SrvcGrp|73700|2022|PDM|55.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F49853_0_0|SrvcGrp|474|2022|PDM|275.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F87333_0_0|SrvcGrp|72992|2022|PDM|788.75|99|0.00|AEG 2|
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 10 (NO REV)|
20|FH_F36552_0_0|SrvcGrp|18247|2022|PDM|7250.00|99|0.00|MS DRG 286|
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F146470_68025_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138026_46143_0|SrvcGrp|3178|2022|PDM|999.00|99|0.00|ACUTE PSYCH|
20|FH_F35042_0_0|SrvcGrp|72|2022|PDM|656.00|99|0.00|NEWBORN NURSERY|
20|FH_F125139_84096_0|SrvcGrp|87317|2022|PDM|861.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F120930_0_0|SrvcGrp|84307|2022|PDM|2500.00|99|0.00|TENDON REPAIR|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|156.82|99|0.00|HAPA WPA-NWPA 2012-13 ASC 315 W/O REV|
20|FH_F100782_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.75|99|0.00|HAPA WPA/NWPA 2015 NISC 100%|
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|1977.00|99|0.00|AEG 3 (NO REV)|
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)|
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 4 (NO REV)|
20|FH_F111027_32817_0|SrvcGrp|73842|2022|PDM|264.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133876_27405_0|SrvcGrp|73841|2022|PDM|479.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63297_0_0|SrvcGrp|59424|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F134472_84624_0|SrvcGrp|86659|2022|PDM|71.00|99|0.00|PHYSICAL THERAPY|
20|FH_F134488_14086_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117344_75062_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F122551_75605_0|SrvcGrp|89149|2022|PDM|232.00|99|0.00|OP INTENSIVE|
20|FH_F85894_0_0|SrvcGrp|17065|2022|PDM|817.00|99|0.00|ASPG I|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|210.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1602 W/O REV|
20|FH_F115788_02904_0|SrvcGrp|73841|2022|PDM|206.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F73967_0_0|SrvcGrp|26001|2022|PDM|155.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F80087_0_0|SrvcGrp|57607|2022|PCT|1.00|99|0.00|LABORATORY/PATHOLOGY|
20|FH_F80513_0_0|SrvcGrp|53151|2022|PDM|24092.00|99|0.00|MS DRG 242 OR 245 ONLY|
20|FH_F146672_47424_0|SrvcGrp|108484|2022|PDM|595.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F126783_80021_0|SrvcGrp|73605|2022|PDM|2195.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F115972_92675_0|SrvcGrp|86747|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F133569_17202_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132213_17543_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F133494_90023_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130657_04614_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 8 (NO REV)|
20|FH_F133491_74012_0|SrvcGrp|95660|2022|PDM|550.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F111581_77401_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F145721_0_0|SrvcGrp|84185|2022|PDM|135.00|99|0.00|RESPITE CARE|
20|FH_F145721_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38037_0_0|SrvcGrp|9829|2022|PDM|88.00|99|0.00|PT SVCS|
20|FH_F38135_0_0|SrvcGrp|65|2022|PDM|1323.00|99|0.00|OBSTETRICAL CARE|
20|FH_F113178_44035_0|SrvcGrp|75760|2022|PDM|469.00|99|0.00|AMBULATORY DETOX REHAB|
20|FH_F113178_44035_0|SrvcGrp|75759|2022|PDM|469.00|99|0.00|AMBULATORY DETOX REHAB|
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|2010.00|99|0.00|AEG 5  (NO REV)|
20|FH_F37850_0_0|SrvcGrp|131|2022|PCT|0.65|99|0.00|PACEMAKER DEVICE|
20|FH_F80511_0_0|SrvcGrp|3178|2022|PDM|781.00|99|0.00|ACUTE PSYCH|
20|FH_F90839_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F47462_0_0|SrvcGrp|15478|2022|PDM|130.00|99|0.00|OCCUPATIONAL THERAPY SVCS INITIAL EVAL|
20|FH_F54552_0_0|SrvcGrp|3327|2022|PDM|155.61|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F138681_39301_0|SrvcGrp|16069|2022|PDM|733.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F138707_44138_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138807_32207_0|SrvcGrp|88621|2022|PDM|137.00|99|0.00|SKILLED NURSING LPN|
20|FH_F138876_25302_0|SrvcGrp|10577|2022|PDM|40.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F138907_01040_0|SrvcGrp|27969|2022|PDM|34.85|99|0.00|HOME HEALTH AIDE|
20|FH_F44293_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.20|99|0.00|GENERAL ACUTE CARE|
20|FH_F90422_0_0|SrvcGrp|13722|2022|PDM|85.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE|
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|643.00|99|0.00|AEG 4 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1569.84|99|0.00|HAPA WPA-NWPA 2012-13 ASC 903 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|314.71|99|0.00|HAPA WPA-NWPA 2012-13 ASC 117 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|167.18|99|0.00|HAPA WPA-NWPA 2012-13 ASC 237 W/O REV|
20|FH_F62719_0_0|SrvcGrp|17139|2022|PDM|675.00|99|0.00|HOSPICE CARE|
20|FH_F42822_0_0|SrvcGrp|167|2022|PDM|350.00|99|0.00|CD (ADULT) - REHABILITATION|
20|FH_F113255_0_0|SrvcGrp|86426|2022|PDM|737.00|99|0.00|REMOVE INT/EXT HEM GROUP 2|
20|FH_F128358_46072_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F78709_0_0|SrvcGrp|3069|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F101201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143809_62401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F115685_64064_0|SrvcGrp|94379|2022|PDM|50.00|99|0.00|HOME INFUSION (HCFA)|
20|FH_F41350_0_0|CSTM-ALL|CSTM-00|2020|PDM|657.00|99|0.00|ASPG II|
20|FH_F123282_03222_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63307_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|(DME) OCN F/S PRICING: ALL|
20|FH_F60112_0_0|SrvcGrp|43430|2022|PDM|60.75|99|0.00|LPN HOME VISIT|
20|FH_F130721_04769_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 10 (NO REV)|
20|FH_F92477_0_0|SrvcGrp|10391|2022|PDM|1260.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F138951_41101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119588_0_0|SrvcGrp|110853|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|765.13|99|0.00|AEG 2 (NO REV)|
20|FH_F146590_77449_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134620_73112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112863_0_0|SrvcGrp|104257|2022|PDM|1141.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F121597_30315_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F51039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F114824_44484_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F145562_70458_0|SrvcGrp|86839|2022|PDM|25.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F148267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127090_45601_0|SrvcGrp|17015|2022|PDM|15.30|99|0.00|HOME INFUSION THERAPY|
20|FH_F123609_28451_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F122942_89512_0|SrvcGrp|86722|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F109577_0_0|SrvcGrp|63119|2022|PDM|47.00|99|0.00|BASIC HOME HOSPICE CARE|
20|FH_F97840_54729_0|SrvcGrp|73603|2022|PDM|9293.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F134593_60007_0|SrvcGrp|112789|2022|PCT|0.87|99|0.00|INJECTION EPTINEZUMAB-JJMR 1 MG|
20|FH_F126354_91321_0|SrvcGrp|108484|2022|PDM|800.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F118803_0_0|SrvcGrp|103638|2022|PDM|3818.57|99|0.00|AETNA OPEN/PERQ PLACE STENT 1ST|
20|FH_F124161_95932_0|SrvcGrp|75506|2022|PCT|2.08|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F132969_84003_0|SrvcGrp|22592|2022|PDM|22.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F126063_43078_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F143560_03079_0|SrvcGrp|115131|2022|PDM|595.07|99|0.00|MRI/MRA W/O CONTRAST|
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111942_92647_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133724_84041_0|SrvcGrp|63297|2022|PDM|93.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145641_06902_0|SrvcGrp|80617|2022|PDM|17180.00|99|0.00|ARTHOPLASTY|
20|FH_F110344_37421_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F77044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|INFUSION S-CODE PER MONTH (MOD SH)|
20|FH_F127080_77520_0|SrvcGrp|108484|2022|PDM|624.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F77943_0_0|SrvcGrp|31038|2022|PDM|77263.16|99|0.00|MS DRG 233-234 ONLY|
20|FH_F118310_60108_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|GENERAL ACUTE CARE|
20|FH_F110423_33401_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F148547_01908_0|SrvcGrp|115412|2022|PCT|0.85|99|0.00|DRUGS|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F127091_62016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134208_21502_0|CSTM-ALL|CSTM-00|2020|PDM|1193.00|99|0.00|AEG 7 (NO REV)|
20|FH_F36552_0_0|CSTM-ALL|CSTM-00|2020|PDM|11515.00|99|0.00|MS DRG 238|
20|FH_F127091_62016_0|SrvcGrp|27969|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133585_0_0|SrvcGrp|108077|2022|PDM|3092.00|99|0.00|ARTERIOVENOUS ANASTOMOSIS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1562.48|99|0.00|HAPA WPA-NWPA 2012-13 ASC 701 W/O REV|
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|646.00|99|0.00|AEG 2 (NO REV)|
20|FH_F135627_77070_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145791_67205_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149048_77090_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F90334_23323_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F126341_27284_0|SrvcGrp|24752|2022|PCT|1.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F150166_91401_0|SrvcGrp|108484|2022|PDM|725.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F126308_44515_0|SrvcGrp|66264|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F117300_0_0|SrvcGrp|72121|2022|PDM|2945.00|99|0.00|ARTHOSCOPY|
20|FH_F49914_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116473_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|1752.00|99|0.00|AEG 6 (NO REV)|
20|FH_F54592_0_0|SrvcGrp|24754|2022|PDM|19.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F71103_0_0|SrvcGrp|42782|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F67741_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|OP SVCS|
20|FH_F106942_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
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|73006|2022|PDM|1839.20|99|0.00|AEG 9|
20|FH_F115877_63556_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|OP SVCS|
20|FH_F66782_0_0|SrvcGrp|14893|2022|PDM|40.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F72606_0_0|SrvcGrp|9911|2022|PCT|0.85|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F83939_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F151382_30501_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122088_75098_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F122106_60035_0|SrvcGrp|73842|2022|PDM|201.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F122168_66214_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135583_17331_0|SrvcGrp|31931|2022|PDM|837.00|99|0.00|SKILLED NURSING CARE|
20|FH_F136127_15658_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F136133_77707_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136247_28804_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F100880_67735_0|SrvcGrp|27877|2022|PDM|201.00|99|0.00|ULTRASOUND|
20|FH_F116397_33404_0|SrvcGrp|29075|2022|PDM|40.00|99|0.00|HYDRATION THERAPY|
20|FH_F116467_13031_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F126305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127399_0_0|SrvcGrp|102481|2022|PDM|3225.00|99|0.00|CPT 29898|
20|FH_F114927_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F121407_73701_0|SrvcGrp|131|2022|PCT|0.39|99|0.00|PACEMAKER DEVICE|
20|FH_F121719_63122_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F121823_46234_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121873_54303_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132689_18436_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F111301_33122_0|SrvcGrp|73006|2022|PDM|3000.00|99|0.00|AEG 9|
20|FH_F111394_46012_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134288_33919_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F134322_98001_0|SrvcGrp|3924|2022|PCT|1.00|99|0.00|ROCEPHIN/CEFTRIAXONE|
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|ASPG X|
20|FH_F131000_0_0|SrvcGrp|100919|2022|PDM|4776.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F132328_0_0|SrvcGrp|111951|2022|PDM|2425.00|99|0.00|URINARY PROCEDURES|
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.90|99|0.00|AEG 8 (NO REV)|
20|FH_F127713_30012_0|SrvcGrp|48385|2022|PDM|155.00|99|0.00|SPEECH THERAPY|
20|FH_F102222_19720_0|SrvcGrp|86848|2022|PDM|31.50|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F101852_78758_0|SrvcGrp|43523|2022|PDM|185.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F132090_60915_0|SrvcGrp|94562|2022|PDM|3501.00|99|0.00|HIP ARTHRO ACETABULOPLASTY|
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)|
20|FH_F113139_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F40144_0_0|SrvcGrp|31755|2022|PCT|0.73|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F101281_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|OP SVCS|
20|FH_F109648_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F91832_06106_0|SrvcGrp|73701|2022|PDM|26.25|99|0.00|AETNA - SKILLED NURSING|
20|FH_F106822_0_0|SrvcGrp|97972|2022|PDM|10.27|99|0.00|TYMPANOMETRY IMPEDANCE TEST|
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 6 (NO REV)|
20|FH_F111442_0_0|SrvcGrp|29993|2022|PDM|29.87|99|0.00|POOL THERAPY|
20|FH_F72939_0_0|SrvcGrp|9438|2022|PCT|0.85|99|0.00|TRAUMA CARE|
20|FH_F115264_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|OLD MOULTRIE SURGERY DEFAULT|
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 7 (NO REV)|
20|FH_F126600_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|935.00|99|0.00|AEG 2 (NO REV)|
20|FH_F146125_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F116485_17033_0|SrvcGrp|110061|2022|PDM|31.83|99|0.00|ADAPTIVE BH TREATMENT 15 MINS|
20|FH_F94786_07974_0|SrvcGrp|21920|2022|PDM|36.75|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F132988_0_0|SrvcGrp|100045|2022|PDM|4493.01|99|0.00|REVISION OF FOOT TENDON|
20|FH_F137067_0_0|SrvcGrp|67068|2022|PDM|21000.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F40333_0_0|SrvcGrp|9795|2022|PDM|975.00|99|0.00|SUBACUTE REHAB|
20|FH_F124180_0_0|SrvcGrp|108935|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F150910_0_0|SrvcGrp|98497|2022|PDM|10800.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F87856_0_0|SrvcGrp|75485|2022|PDM|818.00|99|0.00|AEG 4|
20|FH_F144039_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F119725_0_0|SrvcGrp|2067|2022|PDM|705.97|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F148553_85016_0|SrvcGrp|86303|2022|PDM|2000.00|99|0.00|PTCA W/O STENT|
20|FH_F146043_0_0|CSTM-ALL|CSTM-00|2020|PDM|1386.00|99|0.00|AEG 2 (NO REV)|
20|FH_F122610_73139_0|SrvcGrp|11259|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F135761_70127_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F49016_0_0|SrvcGrp|19973|2022|PDM|575.00|99|0.00|CAT SCAN|
20|FH_F116339_41064_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F116339_41064_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116393_07002_0|SrvcGrp|72379|2022|PCT|1.25|99|0.00|SPEECH THERAPY|
20|FH_F147519_52627_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F147539_68359_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|OP SVCS|
20|FH_F147586_44124_0|CSTM-ALL|CSTM-00|2020|PDM|1051.00|99|0.00|AEG 3 (NO REV)|
20|FH_F147700_21401_0|CSTM-ALL|CSTM-00|2020|PDM|1001.00|99|0.00|AEG 5  (NO REV)|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|INOTROPIC THERAPY (MOD SH)|
20|FH_F42402_0_0|SrvcGrp|35532|2022|PCT|0.90|99|0.00|ECHOCARDIOGRAM|
20|FH_F42433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F42654_0_0|SrvcGrp|15070|2022|PDM|40.00|99|0.00|HOME HEALTH (NEWBORN CARE)|
20|FH_F130620_18940_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F139430_63017_0|SrvcGrp|88621|2022|PDM|92.70|99|0.00|SKILLED NURSING LPN|
20|FH_F139590_98908_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139824_24801_0|SrvcGrp|79699|2022|PCT|0.95|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F97880_63501_0|SrvcGrp|73656|2022|PDM|357.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F39772_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (HCFA)|
20|FH_F132096_89118_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F149515_66002_0|SrvcGrp|74668|2022|PDM|166.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120154_77498_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F101184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F58974_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|DME/ORTHOTICS/PROSTHETICS|
20|FH_F114848_50533_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F146266_0_0|SrvcGrp|88164|2022|PDM|20512.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114206_37203_0|SrvcGrp|86844|2022|PDM|35.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|3162.00|99|0.00|AEG 9 (NO REV)|
20|FH_F36079_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F98001_27603_0|SrvcGrp|73656|2022|PDM|643.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F132254_40207_0|SrvcGrp|86832|2022|PDM|8.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F122377_91007_0|SrvcGrp|72984|2022|PCT|2.89|99|0.00|CHEMOTHERAPY|
20|FH_F150982_0_0|SrvcGrp|85966|2022|PDM|1382.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|103.00|99|0.00|SALLY BALIN,999182,ASC 311|
20|FH_F147222_49544_0|SrvcGrp|42622|2022|PDM|625.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F140608_0_0|SrvcGrp|48398|2022|PDM|134.00|99|0.00|PT SERVICES|
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|755.00|99|0.00|AEG 4 (NO REV)|
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|ASPG IX- GNADEN HUETTEN|
20|FH_F130939_40353_0|SrvcGrp|108484|2022|PDM|522.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F131574_64131_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150982_0_0|SrvcGrp|100923|2022|PDM|1040.00|99|0.00|DRUGS|
20|FH_F117762_0_0|SrvcGrp|88163|2022|PDM|9360.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F114207_35243_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114207_35243_0|SrvcGrp|86843|2022|PDM|35.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F99420_91326_0|SrvcGrp|11336|2022|PCT|0.85|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F127418_0_0|SrvcGrp|37984|2022|PDM|7951.56|99|0.00|LUMBAR INJECTIONS PROCEDURE|
20|FH_F149662_85015_0|SrvcGrp|104642|2022|PDM|7630.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F147167_75605_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F150912_19344_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40627_0_0|SrvcGrp|9510|2022|PDM|1208.00|99|0.00|SKILLED NURSING CARE|
20|FH_F124322_64131_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F37764_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|NEBULIZER (DME) (MOD NU)|
20|FH_F98840_31021_0|SrvcGrp|90854|2022|PDM|2201.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F149004_67025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132105_61554_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131548_32003_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147080_02446_0|SrvcGrp|74668|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F67924_0_0|SrvcGrp|42824|2022|PDM|120.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|4500.00|99|0.00|AEG 5  (NO REV)|
20|FH_F147214_48162_0|SrvcGrp|108622|2022|PDM|444.00|99|0.00|SUB ACUTE CARE LEVEL II|
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F99920_63141_0|SrvcGrp|97506|2022|PDM|110.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F134919_02155_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150930_64485_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F141270_89103_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F149030_37919_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F110783_93013_0|SrvcGrp|86833|2022|PDM|12.50|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F127418_0_0|SrvcGrp|110763|2022|PDM|3661.67|99|0.00|LUMBAR VERTEBRAL CORPECTOMY|
20|FH_F134847_0_0|SrvcGrp|67072|2022|PDM|5135.00|99|0.00|CPT 22845|
20|FH_F149001_37055_0|SrvcGrp|80918|2022|PDM|160.00|99|0.00|RESPITE CARE|
20|FH_F139877_32615_0|SrvcGrp|113226|2022|PDM|42.28|99|0.00|COVID-19 SVNT SARSCOV2 ELISA PLSM SRM|
20|FH_F149536_76642_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122396_90024_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F128715_71201_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|GENERAL ACUTE CARE|
20|FH_F114206_37203_0|SrvcGrp|14949|2022|PDM|70.00|99|0.00|HOME INFUSION|
20|FH_F143249_89801_0|SrvcGrp|24745|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F143347_16001_0|SrvcGrp|93008|2022|PDM|1296.00|99|0.00|AETNA OP BH OBSERVATION|
20|FH_F143536_47546_0|SrvcGrp|100277|2022|PCT|1.00|99|0.00|HEPB VACCINE ADULT|
20|FH_F101709_0_0|SrvcGrp|82112|2022|PDM|2985.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F131093_49690_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151719_02138_0|SrvcGrp|107667|2022|PDM|625.00|99|0.00|AETNA PARTIAL HOSP EATING DIS FULL DAY|
20|FH_F151743_20001_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132417_38119_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F116683_64730_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116684_30701_0|SrvcGrp|90484|2022|PCT|1.00|99|0.00|NOS FLU VACC 3 YRS & > IM|
20|FH_F116698_07470_0|SrvcGrp|86840|2022|PDM|39.90|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F120921_75835_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120974_27607_0|SrvcGrp|73659|2022|PDM|5022.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F84274_46805_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F51276_0_0|SrvcGrp|22592|2022|PDM|80.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F36132_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP MAFS MOD AU|
20|FH_F98624_15701_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 9 (NO REV)|
20|FH_F140007_0_0|SrvcGrp|97179|2022|PDM|8045.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON|
20|FH_F128031_0_0|SrvcGrp|72994|2022|PDM|766.00|99|0.00|AEG 3|
20|FH_F123445_0_0|SrvcGrp|87799|2022|PDM|198.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F70762_90805_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|YOUTH PARTIAL HOS/PSYCH/CHEMICAL DEPENDENCY|
20|FH_F95101_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F132544_0_0|SrvcGrp|85198|2022|PDM|4803.00|99|0.00|AETNA KNEE ARTHROSCOPY|
20|FH_F119495_34711_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148359_60191_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HSS ASC|
20|FH_F148542_43517_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148644_06890_0|SrvcGrp|99073|2022|PCT|1.12|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F101943_17701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F56793_0_0|SrvcGrp|14949|2022|PDM|120.00|99|0.00|HOME INFUSION|
20|FH_F142008_74301_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41739_0_0|SrvcGrp|34765|2022|PCT|1.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F92676_15063_0|SrvcGrp|78931|2022|PDM|3956.56|99|0.00|MON VALLEY ASC 905|
20|FH_F76284_0_0|SrvcGrp|22954|2022|PDM|167.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146792_0_0|SrvcGrp|11306|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F41261_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F101922_98055_0|SrvcGrp|73496|2022|PDM|4676.00|99|0.00|AETNA ER LEVEL V|
20|FH_F133477_90247_0|SrvcGrp|75505|2022|PCT|0.00|99|0.00|CARDIAC STUDIES|
20|FH_F55375_0_0|SrvcGrp|360|2022|PDM|1800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F101840_76054_0|SrvcGrp|21079|2022|PDM|17546.00|99|0.00|MS DRG 041 ONLY|
20|FH_F78205_0_0|SrvcGrp|36508|2022|PDM|531.33|99|0.00|ULTRASOUND|
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|15000.00|99|0.00|MS DRG 242-244 PACEMAKER IMPLANT|
20|FH_F41547_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PATHOLOGY MOD 26|
20|FH_F111806_33020_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F148900_0_0|SrvcGrp|90974|2022|PDM|668.00|99|0.00|CERVICAL OR THORACIC INJECTION W/ IMAGING GUIDANCE|
20|FH_F100785_54660_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F146211_68144_0|SrvcGrp|90423|2022|PDM|9473.00|99|0.00|FUSION GRAFT OF WRIST JOINT|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|33.80|99|0.00|AETNA SLEEP STUDIES (MOD TC)|
20|FH_F148639_0_0|SrvcGrp|82109|2022|PDM|1131.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F44606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119007_0_0|SrvcGrp|87679|2022|PDM|785.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F117613_08221_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F126663_91423_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PDM|2660.49|99|0.00|ASPG VIII|
20|FH_F82475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F41181_0_0|SrvcGrp|10107|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F126676_43537_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F76284_0_0|SrvcGrp|12403|2022|PDM|41.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89851_83854_0|SrvcGrp|80837|2022|PDM|27831.00|99|0.00|MSDRG 518 ONLY|
20|FH_F150522_95864_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F141967_89509_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F127383_46825_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|1368.48|99|0.00|ASPG V|
20|FH_F83031_0_0|SrvcGrp|37767|2022|PDM|50.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F126589_62881_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126663_91423_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F145964_10993_0|SrvcGrp|87537|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F115313_11216_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F100784_59923_0|SrvcGrp|73559|2022|PDM|9013.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F150019_19380_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F68868_0_0|SrvcGrp|1943|2022|PDM|2605.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F101840_76054_0|SrvcGrp|85040|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F150059_54494_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F126663_91423_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133516_44004_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38700_0_0|SrvcGrp|941|2022|PDM|3195.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F49637_0_0|CSTM-ALL|CSTM-00|2020|PDM|2541.00|99|0.00|OK SURGICAL HOSPITAL CVTY ENHANCED GROUPER 3|
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F92676_15063_0|SrvcGrp|79034|2022|PDM|764.67|99|0.00|MON VALLEY ASC 120|
20|FH_F130108_0_0|SrvcGrp|12163|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F147800_0_0|SrvcGrp|115019|2022|PDM|11000.00|99|0.00|PERQ NJX ALGC FLUOR LMBR 1ST|
20|FH_F144011_60616_0|CSTM-ALL|CSTM-00|2020|PDM|4657.00|99|0.00|AEG 7 (NO REV)|
20|FH_F126676_43537_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F148039_92629_0|SrvcGrp|46903|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F100786_24740_0|SrvcGrp|73601|2022|PDM|4711.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|463.23|99|0.00|ASPG 1|
20|FH_F91255_19401_0|SrvcGrp|74581|2022|PCT|1.00|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F67136_0_0|SrvcGrp|3354|2022|PCT|0.70|99|0.00|HIGH COST DRUGS|
20|FH_F44048_0_0|CSTM-ALL|CSTM-00|2020|PDM|609.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F34641_0_0|SrvcGrp|11241|2022|PDM|950.00|99|0.00|CD - DETOXIFICATION|
20|FH_F133516_44004_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F141872_20707_0|CSTM-ALL|CSTM-00|2020|PDM|997.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
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_F127163_74437_0|SrvcGrp|73841|2022|PDM|400.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F141930_72032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F119226_07746_0|SrvcGrp|89337|2022|PDM|840.00|99|0.00|DETOXIFICATION|
20|FH_F47679_0_0|SrvcGrp|42782|2022|PDM|40.12|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F70324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F35308_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD KN) - BDSS|
20|FH_F123739_61820_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F63316_0_0|SrvcGrp|47190|2022|PCT|1.00|99|0.00|DME AND SUPPLIES|
20|FH_F90314_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136488_16828_0|SrvcGrp|94879|2022|PDM|138.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F134011_84102_0|SrvcGrp|27968|2022|PDM|32.10|99|0.00|SKILLED NURSING LPN|
20|FH_F137147_75006_0|SrvcGrp|27402|2022|PDM|9604.00|99|0.00|LASER PROCEDURES|
20|FH_F142448_15701_0|SrvcGrp|48394|2022|PDM|34.22|99|0.00|SKILLED NURSING SERVICES|
20|FH_F142470_32935_0|SrvcGrp|113911|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F142333_28387_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F142590_18336_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142667_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F66765_0_0|SrvcGrp|17139|2022|PDM|657.00|99|0.00|HOSPICE CARE|
20|FH_F138607_02760_0|SrvcGrp|108423|2022|PDM|8.00|99|0.00|REPLACEMENT BEAST PUMP SHIELD|
20|FH_F140750_89119_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F140890_30906_0|SrvcGrp|86723|2022|PDM|455.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F149563_75840_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149584_77045_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118789_92211_0|SrvcGrp|87317|2022|PDM|1000.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F92506_07666_0|CSTM-ALL|CSTM-00|2020|PDM|980.00|99|0.00|AETNA ENDOSCOPY (ENDO)|
20|FH_F109920_39180_0|SrvcGrp|75493|2022|PDM|1540.00|99|0.00|AEG 8|
20|FH_F52832_0_0|SrvcGrp|68139|2022|PDM|250.00|99|0.00|RN VISIT|
20|FH_F76144_0_0|CSTM-ALL|CSTM-00|2020|PDM|1315.99|99|0.00|ASPG III F/S - BDSS|
20|FH_F117295_70006_0|SrvcGrp|88620|2022|PDM|90.00|99|0.00|SKILLED NURSING RN|
20|FH_F117098_20186_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F117240_37334_0|SrvcGrp|75491|2022|PDM|3500.00|99|0.00|AEG 7|
20|FH_F115868_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137934_51054_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F110900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111046_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F111593_0_0|SrvcGrp|73000|2022|PDM|2043.80|99|0.00|AEG 6|
20|FH_F90876_18447_0|SrvcGrp|65720|2022|PDM|110.25|99|0.00|RESPITE CARE|
20|FH_F69364_0_0|CSTM-ALL|CSTM-00|2020|PDM|1753.00|99|0.00|ASPG VI|
20|FH_F141527_36830_0|SrvcGrp|26868|2022|PDM|26.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F116176_0_0|SrvcGrp|3809|2022|PDM|573.47|99|0.00|HOSPICE CARE|
20|FH_F123915_0_0|SrvcGrp|87799|2022|PDM|190.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F132051_74464_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F130747_0_0|SrvcGrp|88161|2022|PDM|8843.00|99|0.00|LAMINECTOMY W/FACE-THORACIC|
20|FH_F126784_80809_0|SrvcGrp|74668|2022|PDM|795.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F34104_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141550_33619_0|SrvcGrp|89149|2022|PDM|188.00|99|0.00|OP INTENSIVE|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|ASPG VII|
20|FH_F148255_72703_0|SrvcGrp|14945|2022|PDM|3.15|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F79645_0_0|SrvcGrp|76928|2022|PCT|0.70|99|0.00|IV & IM DRUGS|
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.26|99|0.00|AEG 8 (NO REV)|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|DRUG/INJECTABLES - RONL/HSOH|
20|FH_F71346_0_0|SrvcGrp|17139|2022|PDM|565.00|99|0.00|HOSPICE CARE|
20|FH_F118194_50841_0|SrvcGrp|106790|2022|PCT|1.35|99|0.00|ALL DRUGS, AGENTS, INJ. DRUGS|
20|FH_F129627_06037_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129262_33813_0|SrvcGrp|105684|2022|PDM|212.00|99|0.00|INTENSIVE OUTPATIENT 13-17 YRS|
20|FH_F132092_0_0|SrvcGrp|80918|2022|PDM|169.00|99|0.00|RESPITE CARE|
20|FH_F100790_10512_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F41776_0_0|CSTM-ALL|CSTM-00|2020|PDM|4190.00|99|0.00|MS DRG 775|
20|FH_F38526_0_0|SrvcGrp|361|2022|PDM|2300.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F150982_0_0|SrvcGrp|72121|2022|PDM|3303.00|99|0.00|ARTHOSCOPY|
20|FH_F132735_97068_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F116327_75701_0|SrvcGrp|104076|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F145815_30540_0|SrvcGrp|113302|2022|PDM|28.39|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - ASTRAZENECA|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD 26|
20|FH_F135081_63080_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116760_68512_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F82695_15014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F63556_0_0|SrvcGrp|37389|2022|PDM|4000.00|99|0.00|MS DRG 286-287 ONLY CARDIAC CATH|
20|FH_F141527_36830_0|SrvcGrp|29077|2022|PDM|11.00|99|0.00|HOME TRANSFUSION|
20|FH_F99960_0_0|SrvcGrp|73000|2022|PDM|1304.00|99|0.00|AEG 6|
20|FH_F34513_0_0|SrvcGrp|16311|2022|PDM|94.00|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F100320_0_0|SrvcGrp|75495|2022|PDM|1433.00|99|0.00|AEG 9|
20|FH_F44582_0_0|SrvcGrp|23477|2022|PDM|7000.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F116602_0_0|CSTM-ALL|CSTM-00|2020|PCT|49.00|99|0.00|OP SVCS|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F66422_0_0|SrvcGrp|44105|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY|
20|FH_F71962_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120322_60016_0|SrvcGrp|75545|2022|PDM|496.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F37171_0_0|SrvcGrp|23387|2022|PDM|60.00|99|0.00|PT/OT/ST|
20|FH_F127205_44125_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F132887_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|OP SVCS|
20|FH_F141354_63556_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79645_0_0|SrvcGrp|3140|2022|PCT|0.70|99|0.00|PHARMACY SERVICES|
20|FH_F118373_21205_0|SrvcGrp|9861|2022|PDM|2524.00|99|0.00|ACUTE REHABILITATION|
20|FH_F55054_0_0|SrvcGrp|53542|2022|PDM|845.00|99|0.00|CHEMICAL DEPENDENCY UNIT - DETOX|
20|FH_F128272_60640_0|SrvcGrp|86850|2022|PDM|50.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F125249_0_0|SrvcGrp|67066|2022|PDM|4500.00|99|0.00|CERVICAL SURGERY|
20|FH_F127441_45822_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F135065_08043_0|SrvcGrp|104796|2022|PDM|400.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F130747_0_0|SrvcGrp|93431|2022|PDM|19768.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F34854_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F92964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F91873_12723_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F97660_29401_0|SrvcGrp|73601|2022|PDM|12033.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F97780_43614_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F114916_30309_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F114916_30309_0|SrvcGrp|84314|2022|PDM|1200.00|99|0.00|MINOR SURGERY|
20|FH_F142312_62301_0|SrvcGrp|89337|2022|PDM|600.00|99|0.00|DETOXIFICATION|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131412_0_0|SrvcGrp|82223|2022|PDM|34.91|99|0.00|HOSPICE CARE|
20|FH_F135491_0_0|SrvcGrp|74670|2022|PCT|0.00|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F138929_0_0|SrvcGrp|27261|2022|PDM|15400.00|99|0.00|CPT 27446|
20|FH_F132627_0_0|SrvcGrp|26868|2022|PDM|18.36|99|0.00|DIURETIC IV THERAPY|
20|FH_F88933_0_0|SrvcGrp|112909|2022|PDM|1351.00|99|0.00|REMOVAL OF TISSUE FOR GRAFT|
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1182.00|99|0.00|AEG 3 (NO REV)|
20|FH_F141147_02571_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F114389_50131_0|SrvcGrp|73701|2022|PDM|80.47|99|0.00|AETNA - SKILLED NURSING|
20|FH_F114389_50131_0|SrvcGrp|48385|2022|PDM|170.42|99|0.00|SPEECH THERAPY|
20|FH_F40333_0_0|SrvcGrp|3029|2022|PDM|350.00|99|0.00|NEWBORN NURSERY|
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|ASPG II|
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 10 (NO REV)|
20|FH_F91998_0_0|SrvcGrp|58636|2022|PDM|1836.00|99|0.00|CPT 62362|
20|FH_F124414_92653_0|SrvcGrp|75442|2022|PDM|770.00|99|0.00|OBSERVATION - REV 762|
20|FH_F124687_64024_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F127995_84010_0|SrvcGrp|86841|2022|PDM|50.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F76544_0_0|CSTM-ALL|CSTM-00|2020|PDM|1907.00|99|0.00|IP LEVEL A|
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 6 (NO REV)|
20|FH_F114645_34952_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F114666_30342_0|SrvcGrp|97730|2022|PDM|18000.00|99|0.00|REVERSE HIP JOINT|
20|FH_F114666_30342_0|SrvcGrp|82109|2022|PDM|1000.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F115048_78520_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F137933_0_0|SrvcGrp|86942|2022|PDM|13300.00|99|0.00|CPT 53445|
20|FH_F148553_85016_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|AEG 10 (NO REV)|
20|FH_F127448_0_0|SrvcGrp|73004|2022|PDM|1500.00|99|0.00|AEG 8|
20|FH_F122675_07055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F43421_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136778_62034_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F136799_75061_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F113713_17013_0|SrvcGrp|105368|2022|PDM|45.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MINS(HCFA)|
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG X|
20|FH_F115144_71373_0|SrvcGrp|45751|2022|PDM|102.00|99|0.00|INDIVIDUAL THERAPY|
20|FH_F147586_44124_0|SrvcGrp|101520|2022|PDM|4669.00|99|0.00|T1H W/T/O (<250G)|
20|FH_F41463_0_0|SrvcGrp|17014|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F41463_0_0|SrvcGrp|34390|2022|PDM|93.45|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F42176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F42342_0_0|SrvcGrp|9832|2022|PDM|131.25|99|0.00|ST SVCS|
20|FH_F42539_0_0|SrvcGrp|22954|2022|PDM|137.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|210.00|99|0.00|AEG 1 (NO REV)|
20|FH_F82357_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F89580_0_0|SrvcGrp|13990|2022|PCT|0.46|99|0.00|PACEMAKER|
20|FH_F91641_0_0|SrvcGrp|86505|2022|PDM|1560.60|99|0.00|DENTAL SURGERY|
20|FH_F37644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118986_0_0|SrvcGrp|75479|2022|PDM|477.29|99|0.00|AEG 1|
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|613.36|99|0.00|HAPA WPA-NWPA 2012-13 ASC 302 W/O REV|
20|FH_F151501_30265_0|SrvcGrp|41327|2022|PDM|2090.00|99|0.00|OP SURGERY CPT 28308|
20|FH_F122085_70360_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135470_83201_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F91764_93710_0|CSTM-ALL|CSTM-00|2020|PDM|5440.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135805_98225_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135924_02906_0|SrvcGrp|79699|2022|PCT|1.03|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F77665_0_0|SrvcGrp|10541|2022|PDM|60.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F146672_47424_0|SrvcGrp|74668|2022|PDM|181.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120528_60559_0|SrvcGrp|471|2022|PDM|705.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F126783_80021_0|SrvcGrp|89337|2022|PDM|1995.00|99|0.00|DETOXIFICATION|
20|FH_F116040_24637_0|SrvcGrp|22589|2022|PDM|25.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F131454_06422_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133269_78624_0|SrvcGrp|90854|2022|PDM|800.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F132270_33414_0|CSTM-ALL|CSTM-00|2020|PCT|0.43|99|0.00|OP SVCS|
20|FH_F132131_33060_0|SrvcGrp|90397|2022|PDM|475.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F133494_90023_0|SrvcGrp|12491|2022|PCT|0.25|99|0.00|PACEMAKER|
20|FH_F133176_32751_0|SrvcGrp|89417|2022|PDM|470.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|1023.00|99|0.00|AEG 1 (NO REV)|
20|FH_F40347_0_0|SrvcGrp|9795|2022|PDM|975.00|99|0.00|SUBACUTE REHAB|
20|FH_F58856_0_0|SrvcGrp|28166|2022|PDM|30950.00|99|0.00|MS DRG 229 ONLY|
20|FH_F136373_17055_0|SrvcGrp|48396|2022|PDM|120.00|99|0.00|OT SERVICES|
20|FH_F136386_30901_0|SrvcGrp|26651|2022|PDM|6405.00|99|0.00|MS DRG 310 ONLY|
20|FH_F136424_34470_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136542_02446_0|SrvcGrp|88819|2022|PDM|504.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F134011_84102_0|SrvcGrp|86832|2022|PDM|2.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F137048_60714_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F137241_07481_0|SrvcGrp|113051|2022|PCT|1.19|99|0.00|PSYCH TEST EVAL PHYS|
20|FH_F142400_75090_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142347_75140_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117552_0_0|SrvcGrp|91577|2022|PDM|10000.00|99|0.00|FEM/POPL REVASC STNT & ATHER|
20|FH_F66765_0_0|SrvcGrp|62539|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F114650_17104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F140837_34947_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120152_0_0|SrvcGrp|99067|2022|PDM|5500.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F120152_0_0|SrvcGrp|35667|2022|PDM|2200.00|99|0.00|CPT 20680|
20|FH_F128270_0_0|SrvcGrp|42784|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F151606_64772_0|SrvcGrp|90854|2022|PDM|958.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F119004_06850_0|CSTM-ALL|CSTM-00|2020|PDM|1232.00|99|0.00|AEG 5  (NO REV)|
20|FH_F109920_39180_0|SrvcGrp|12491|2022|PCT|0.33|99|0.00|PACEMAKER|
20|FH_F80366_0_0|SrvcGrp|72990|2022|PCT|0.94|99|0.00|AEG 1|
20|FH_F117286_17202_0|SrvcGrp|75545|2022|PDM|333.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F129483_77030_0|SrvcGrp|86844|2022|PDM|50.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F137267_62906_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F137276_83127_0|SrvcGrp|88620|2022|PDM|85.50|99|0.00|SKILLED NURSING RN|
20|FH_F137333_51012_0|SrvcGrp|73841|2022|PDM|406.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F137806_83702_0|SrvcGrp|86722|2022|PDM|235.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F109652_0_0|SrvcGrp|78786|2022|PDM|10656.00|99|0.00|ELECTROPHYSIOLOGIC & MAPPING STUDIES|
20|FH_F110308_0_0|SrvcGrp|73004|2022|PDM|900.00|99|0.00|AEG 8|
20|FH_F112080_0_0|SrvcGrp|72998|2022|PDM|1040.00|99|0.00|AEG 5|
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1305.00|99|0.00|AEG 8 (NO REV)|
20|FH_F109513_0_0|SrvcGrp|90426|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY SURGERY|
20|FH_F109513_0_0|SrvcGrp|73008|2022|PDM|913.50|99|0.00|AEG 10|
20|FH_F127204_44420_0|SrvcGrp|29347|2022|PDM|16.00|99|0.00|HOME HEALTH AIDE|
20|FH_F148863_33021_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F151047_20860_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151061_02720_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F151144_35801_0|SrvcGrp|95114|2022|PDM|795.00|99|0.00|CONJUNCTIVA|
20|FH_F121954_60706_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F118661_0_0|SrvcGrp|82310|2022|PDM|894.00|99|0.00|COLORECTAL CANCER SCREENING|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86911_0_0|SrvcGrp|85649|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY - TPN|
20|FH_F87201_0_0|SrvcGrp|15402|2022|PDM|65.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F91072_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F100640_48097_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F113392_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F113392_0_0|SrvcGrp|64517|2022|PDM|2750.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F43860_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|1143.00|99|0.00|AEG 7 (NO REV)|
20|FH_F129046_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130274_63033_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F141070_64093_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F72204_0_0|SrvcGrp|14893|2022|PDM|40.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F122174_16511_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146895_28751_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PDM|1156.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F34546_0_0|SrvcGrp|16890|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F47636_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92493_0_0|SrvcGrp|26274|2022|PDM|2601.06|99|0.00|CPT 29877|
20|FH_F132864_71101_0|SrvcGrp|73605|2022|PDM|911.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F124188_29621_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F124234_33410_0|SrvcGrp|87131|2022|PDM|900.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F124585_33070_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97500_32025_0|SrvcGrp|88977|2022|PDM|8835.00|99|0.00|C-SECTION DELIVERY|
20|FH_F105221_01757_0|SrvcGrp|48396|2022|PDM|84.00|99|0.00|OT SERVICES|
20|FH_F31056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F92964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150699_0_0|SrvcGrp|109504|2022|PDM|12296.00|99|0.00|REMV & REPLC PM GEN DUAL LEAD|
20|FH_F120059_0_0|SrvcGrp|106798|2022|PDM|4200.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.00|99|0.00|AEG 1 (NO REV)|
20|FH_F141527_36830_0|SrvcGrp|86831|2022|PDM|3.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F123943_84041_0|SrvcGrp|87799|2022|PDM|125.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F40272_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F149523_0_0|SrvcGrp|40003|2022|PDM|15000.00|99|0.00|TOTAL KNEE|
20|FH_F148354_44471_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125011_74467_0|SrvcGrp|103993|2022|PDM|3730.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F63481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS|
20|FH_F93791_0_0|SrvcGrp|93602|2022|PDM|4200.00|99|0.00|TOTAL KNEE(HCFA)|
20|FH_F70510_0_0|SrvcGrp|17139|2022|PDM|605.00|99|0.00|HOSPICE CARE|
20|FH_F148420_33437_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F34454_0_0|SrvcGrp|9829|2022|PDM|85.50|99|0.00|PT SVCS|
20|FH_F148265_06067_0|SrvcGrp|100067|2022|PDM|2700.00|99|0.00|ANKLE ARTHROSCOPY SURGERY|
20|FH_F120308_07901_0|SrvcGrp|94880|2022|PDM|247.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F33712_0_0|SrvcGrp|9937|2022|PCT|0.75|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F141515_50010_0|SrvcGrp|89149|2022|PDM|181.00|99|0.00|OP INTENSIVE|
20|FH_F78042_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125890_43054_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F130747_0_0|SrvcGrp|41334|2022|PDM|26010.00|99|0.00|TOTAL KNEE|
20|FH_F110061_0_0|SrvcGrp|58755|2022|PDM|4000.00|99|0.00|INJECTION PROC FOR JOINT|
20|FH_F102184_0_0|SrvcGrp|77021|2022|PDM|7215.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F93920_0_0|SrvcGrp|82242|2022|PCT|0.75|99|0.00|AETNA PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY|
20|FH_F52854_0_0|SrvcGrp|17079|2022|PDM|2588.00|99|0.00|ASPG VIII|
20|FH_F136756_0_0|SrvcGrp|72998|2022|PDM|1043.90|99|0.00|AEG 5|
20|FH_F42706_0_0|SrvcGrp|474|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F137637_03103_0|SrvcGrp|73842|2022|PDM|187.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F81172_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F62915_0_0|SrvcGrp|9518|2022|PCT|0.69|99|0.00|EMERGENCY ROOM|
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|733.00|99|0.00|AEG 4 (NO REV)|
20|FH_F58514_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN|
20|FH_F135237_31015_0|SrvcGrp|23683|2022|PCT|0.00|99|0.00|SKILLED NURSING RN|
20|FH_F93119_0_0|SrvcGrp|472|2022|PDM|675.51|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F91056_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
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_F118910_0_0|SrvcGrp|95660|2022|PDM|540.75|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F123486_61764_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F83451_0_0|SrvcGrp|112111|2022|PDM|12500.00|99|0.00|TOTAL JOINT CODES|
20|FH_F124955_98225_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F93413_0_0|SrvcGrp|57968|2022|PDM|29.09|99|0.00|CONTINUOUS HOMECARE|
20|FH_F54513_0_0|SrvcGrp|10534|2022|PDM|110.00|99|0.00|NURSING CARE|
20|FH_F91622_0_0|CSTM-ALL|CSTM-00|2020|PDM|2088.00|99|0.00|AEG 5 (NO REV) ANTHONY MED CTR|
20|FH_F148497_32162_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130514_33316_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135456_0_0|CSTM-ALL|CSTM-00|2020|PDM|511.00|99|0.00|AEG 1 (NO REV)|
20|FH_F150982_0_0|SrvcGrp|92410|2022|PDM|4404.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F120349_38774_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122725_32216_0|SrvcGrp|52952|2022|PDM|101.00|99|0.00|PSYCHIATRIC CPT 90847|
20|FH_F86872_15215_0|SrvcGrp|24747|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F62579_0_0|SrvcGrp|28630|2022|PDM|140.00|99|0.00|HOME INFUSION SKILLED NURSING|
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|ASPG VIII|
20|FH_F128278_21401_0|SrvcGrp|86648|2022|PCT|1.25|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F139780_75605_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F130923_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F118803_0_0|SrvcGrp|107882|2022|PDM|2162.15|99|0.00|DIALYSIS CIRCUIT EMBOLJ|
20|FH_F121685_75093_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F135627_77070_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F149528_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F111986_0_0|SrvcGrp|25518|2022|PDM|2163.00|99|0.00|LAPAROSCOPY SURGICAL CHOLECYSTECTOMY|
20|FH_F133492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F133207_0_0|SrvcGrp|82112|2022|PDM|3529.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F67887_0_0|SrvcGrp|72779|2022|PDM|100.00|99|0.00|RN - VISIT LEVEL|
20|FH_F100782_0_0|SrvcGrp|105096|2022|PDM|258.76|99|0.00|WINDBER MEDICAL CNTR ASC 141|
20|FH_F132728_0_0|SrvcGrp|941|2022|PDM|4141.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F146039_89511_0|SrvcGrp|29347|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F146124_06112_0|SrvcGrp|80246|2022|PCT|0.00|99|0.00|AETNA NURSERY|
20|FH_F49552_0_0|SrvcGrp|9518|2022|PDM|590.00|99|0.00|EMERGENCY ROOM|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|139.44|99|0.00|CPT 95810 (W/MOD 26)|
20|FH_F150162_39402_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F127090_45601_0|SrvcGrp|88621|2022|PDM|91.02|99|0.00|SKILLED NURSING LPN|
20|FH_F118042_33401_0|SrvcGrp|73842|2022|PDM|375.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F83978_66739_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124663_65608_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F127995_84010_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F97040_31901_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F87856_0_0|SrvcGrp|84181|2022|PDM|2332.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS|
20|FH_F136708_06443_0|SrvcGrp|52952|2022|PDM|80.00|99|0.00|PSYCHIATRIC CPT 90847|
20|FH_F139556_85006_0|SrvcGrp|21456|2022|PCT|1.89|99|0.00|SLEEP STUDIES|
20|FH_F137933_0_0|SrvcGrp|113162|2022|PDM|12200.00|99|0.00|INSERT TANDEM CUFF|
20|FH_F144039_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F122610_73139_0|SrvcGrp|66459|2022|PDM|717.00|99|0.00|CT SCAN|
20|FH_F112465_28401_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147331_90045_0|SrvcGrp|29347|2022|PDM|39.78|99|0.00|HOME HEALTH AIDE|
20|FH_F147539_68359_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147725_06002_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F42024_0_0|SrvcGrp|35556|2022|PCT|1.00|99|0.00|BLOOD AND BLOOD PRODUCTS - IP|
20|FH_F42342_0_0|SrvcGrp|9829|2022|PDM|131.25|99|0.00|PT SVCS|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHOENIX HH S CODES|
20|FH_F113649_01752_0|SrvcGrp|24747|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F84394_17402_0|SrvcGrp|83641|2022|PDM|14232.00|99|0.00|CPT 29889|
20|FH_F51276_0_0|SrvcGrp|26871|2022|PDM|95.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3 HRS|
20|FH_F33925_0_0|SrvcGrp|10393|2022|PDM|1672.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F39355_0_0|SrvcGrp|7|2022|PDM|1400.00|99|0.00|NEONATAL INTENSIVE|
20|FH_F43720_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F40560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F98621_41042_0|SrvcGrp|73603|2022|PDM|10888.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F98624_15701_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F102947_44084_0|SrvcGrp|43525|2022|PDM|356.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC|
20|FH_F111190_30512_0|SrvcGrp|75399|2022|PDM|0.25|99|0.00|MED RECORD COPY|
20|FH_F128031_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F142087_0_0|SrvcGrp|41334|2022|PDM|15000.00|99|0.00|TOTAL KNEE|
20|FH_F95101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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|27817|2022|PDM|6950.00|99|0.00|MSDRG 282 ONLY CIRCULATORY DISORDERS W/O CC|
20|FH_F67086_0_0|SrvcGrp|3810|2022|PDM|135.11|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F46433_0_0|SrvcGrp|14893|2022|PDM|60.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F60356_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134087_0_0|SrvcGrp|58993|2022|PDM|5410.00|99|0.00|DISKECTOMY|
20|FH_F33389_0_0|SrvcGrp|14888|2022|PCT|0.70|99|0.00|NUCLEAR MEDICINE|
20|FH_F113180_23507_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F113250_71901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133579_0_0|SrvcGrp|28549|2022|PDM|2175.00|99|0.00|VITRECTOMY|
20|FH_F144648_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|460.55|99|0.00|2005 ASPG GROUPER I|
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 10 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.39|99|0.00|HAPA WPA-NWPA 2012-13 ASC 201 W/O REV|
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|1194.00|99|0.00|AEG 10 (NO REV)|
20|FH_F151401_36607_0|SrvcGrp|14412|2022|PDM|900.00|99|0.00|HOSPICE CARE|
20|FH_F151507_32327_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151511_14094_0|SrvcGrp|75506|2022|PCT|1.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F144928_02703_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F135495_33145_0|SrvcGrp|89149|2022|PDM|196.00|99|0.00|OP INTENSIVE|
20|FH_F135972_18509_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F131463_19096_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F130756_04901_0|SrvcGrp|79699|2022|PCT|0.89|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F131132_44077_0|SrvcGrp|73498|2022|PDM|877.00|99|0.00|AETNA ER LEVEL III|
20|FH_F131407_07607_0|SrvcGrp|29023|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F127399_0_0|SrvcGrp|80617|2022|PDM|14045.00|99|0.00|ARTHOPLASTY|
20|FH_F33725_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|PHYSICAL THERAPY|
20|FH_F146125_0_0|SrvcGrp|26275|2022|PDM|3147.00|99|0.00|CPT 29826|
20|FH_F33785_0_0|SrvcGrp|15553|2022|PDM|1700.00|99|0.00|ONCOLOGY|
20|FH_F39796_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36344_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 2 (NO REV)|
20|FH_F112129_62220_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F128549_44224_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F123036_0_0|SrvcGrp|98565|2022|PDM|16423.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F101320_26062_0|SrvcGrp|22389|2022|PDM|30.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F143542_0_0|SrvcGrp|42429|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 66761|
20|FH_F72544_0_0|SrvcGrp|8950|2022|PDM|5364.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F72544_0_0|SrvcGrp|40242|2022|PDM|5364.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F119351_95377_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F119448_07083_0|SrvcGrp|89149|2022|PDM|210.00|99|0.00|OP INTENSIVE|
20|FH_F119256_63031_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148552_68114_0|CSTM-ALL|CSTM-00|2020|PDM|2103.24|99|0.00|AEG 8 (NO REV)|
20|FH_F113271_72205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72859_0_0|SrvcGrp|10522|2022|PDM|125.00|99|0.00|PICC LINE INSERT|
20|FH_F92676_15063_0|SrvcGrp|79042|2022|PDM|689.99|99|0.00|MON VALLEY ASC 232|
20|FH_F132289_89145_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F95623_84015_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT HH|
20|FH_F133207_0_0|SrvcGrp|96539|2022|PDM|4256.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F146016_34108_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F107520_66612_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F93219_26354_0|SrvcGrp|73700|2022|PDM|49.50|99|0.00|AETNA - SKILLED NURSING|
20|FH_F88744_71103_0|SrvcGrp|20910|2022|PDM|33748.00|99|0.00|MS DRG 234 ONLY|
20|FH_F109364_52349_0|SrvcGrp|65645|2022|PDM|166.00|99|0.00|NURSING CARE IN HOME - S9123|
20|FH_F149340_19136_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F60072_0_0|SrvcGrp|16|2022|PDM|1150.00|99|0.00|ACUTE REHABILITATION|
20|FH_F124159_92506_0|SrvcGrp|109330|2022|PCT|1.15|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F79863_0_0|SrvcGrp|77103|2022|PCT|1.00|99|0.00|AETNA ALL DRUGS/AGENTS/INJECTION DRUGS|
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE|
20|FH_F135900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111732_33771_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133957_84121_0|SrvcGrp|80920|2022|PDM|483.00|99|0.00|HOSPICE SERVICES|
20|FH_F112041_19020_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146540_78013_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150160_01301_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F100782_0_0|SrvcGrp|97659|2022|PDM|1148.74|99|0.00|WINDBER MEDICAL CNTR ASC 404|
20|FH_F71445_0_0|SrvcGrp|1168|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F114823_15701_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F150219_38578_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F112023_12866_0|SrvcGrp|73497|2022|PDM|1285.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F96160_32207_0|SrvcGrp|17015|2022|PDM|25.89|99|0.00|HOME INFUSION THERAPY|
20|FH_F133724_84041_0|SrvcGrp|27969|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE|
20|FH_F110604_0_0|SrvcGrp|63462|2022|PDM|2318.00|99|0.00|CPT 64595|
20|FH_F31714_0_0|SrvcGrp|10947|2022|PDM|800.00|99|0.00|EMERGENCY ROOM|
20|FH_F141210_0_0|SrvcGrp|16289|2022|PDM|4120.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F80814_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F138739_21157_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F111882_51560_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F149660_0_0|SrvcGrp|13595|2022|PDM|199.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F145681_38301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F96160_32207_0|SrvcGrp|86844|2022|PDM|81.03|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F110420_60649_0|SrvcGrp|88978|2022|PDM|2800.00|99|0.00|VAGINAL DELIVERY|
20|FH_F111986_0_0|SrvcGrp|92007|2022|PDM|3605.00|99|0.00|PROXIMAL HUMERAL|
20|FH_F87541_0_0|SrvcGrp|72996|2022|PDM|759.00|99|0.00|AEG 4|
20|FH_F70863_0_0|SrvcGrp|13606|2022|PDM|37.00|99|0.00|HOME INFUSION|
20|FH_F120740_45817_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150222_98026_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F87775_15106_0|SrvcGrp|14947|2022|PDM|100.00|99|0.00|HOME INFUSION|
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|3061.00|99|0.00|AEG 9 (NO REV)|
20|FH_F100782_0_0|SrvcGrp|97664|2022|PDM|1564.04|99|0.00|WINDBER MEDICAL CNTR ASC 501|
20|FH_F132728_0_0|SrvcGrp|40820|2022|PDM|3088.00|99|0.00|ICU/CCU|
20|FH_F149359_33301_0|SrvcGrp|112223|2022|PCT|0.75|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F126157_34210_0|SrvcGrp|108484|2022|PDM|650.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F110921_53014_0|SrvcGrp|104173|2022|PCT|2.00|99|0.00|IMMUNIZATIONS AND INJECTIONS|
20|FH_F85213_02840_0|SrvcGrp|115926|2022|PCT|1.03|99|0.00|RADIOLOGY SERVICES|
20|FH_F148923_71854_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F134234_49525_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F131464_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F68251_0_0|SrvcGrp|33165|2022|PDM|375.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F143561_16001_0|SrvcGrp|48385|2022|PDM|89.00|99|0.00|SPEECH THERAPY|
20|FH_F150165_06032_0|SrvcGrp|88160|2022|PDM|5941.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F133207_0_0|SrvcGrp|100044|2022|PDM|3136.00|99|0.00|INCISION OF HEEL BONE|
20|FH_F134508_14072_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F134451_63670_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|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_F86137_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SURGERY|
20|FH_F84712_0_0|SrvcGrp|78646|2022|PDM|170.00|99|0.00|AETNA DUAL - ENERGY X-RAY ABSORBTION|
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1703.00|99|0.00|2007 MEDICARE ASPG VIII|
20|FH_F68887_0_0|SrvcGrp|44107|2022|PDM|48.00|99|0.00|SPEECH THERAPY|
20|FH_F70607_0_0|SrvcGrp|65609|2022|PDM|32.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F71964_0_0|SrvcGrp|90598|2022|PDM|110.00|99|0.00|RN VISIT|
20|FH_F105145_75075_0|SrvcGrp|93432|2022|PDM|28320.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F105361_80104_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F80513_0_0|SrvcGrp|29757|2022|PDM|14236.00|99|0.00|MS DRG 251 ONLY|
20|FH_F120795_27514_0|SrvcGrp|20752|2022|PDM|26845.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F120811_53525_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F115952_44484_0|SrvcGrp|90854|2022|PDM|426.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F116040_24637_0|SrvcGrp|17013|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116063_43220_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F133583_77074_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F132851_44805_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132937_88201_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F132167_06040_0|SrvcGrp|472|2022|PDM|495.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F135978_06851_0|SrvcGrp|90572|2022|PDM|290.00|99|0.00|INTENSIVE OP PSYCH (HCFA)|
20|FH_F136161_27106_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136174_89146_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F100765_73735_0|CSTM-ALL|CSTM-00|2020|PCT|0.33|99|0.00|OP SVCS|
20|FH_F130996_34110_0|SrvcGrp|100919|2022|PDM|6000.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F130766_04967_0|SrvcGrp|73262|2022|PCT|0.88|99|0.00|AETNA OP OBSERVATION W/ER|
20|FH_F42347_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F128370_76132_0|SrvcGrp|86722|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F129967_18915_0|SrvcGrp|89023|2022|PDM|84.68|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F111363_33169_0|SrvcGrp|82765|2022|PDM|59.00|99|0.00|ELECTROLYTE PANEL|
20|FH_F48355_0_0|CSTM-ALL|CSTM-00|2020|PDM|2282.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145587_0_0|SrvcGrp|26279|2022|PDM|1262.70|99|0.00|CPT 29884|
20|FH_F148243_0_0|SrvcGrp|91989|2022|PDM|770.00|99|0.00|COLONOSCOPY LESION REMOVAL|
20|FH_F33081_0_0|SrvcGrp|9911|2022|PDM|3000.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F101442_0_0|SrvcGrp|33980|2022|PDM|1278.37|99|0.00|CPT 28298|
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|740.00|99|0.00|AEG 2 (NO REV)|
20|FH_F131000_0_0|SrvcGrp|89861|2022|PDM|6155.00|99|0.00|LUMBAR LAMINOTOMY|
20|FH_F132328_0_0|SrvcGrp|102120|2022|PDM|2081.00|99|0.00|REVISE EYE MUSCLE|
20|FH_F129225_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F102228_08846_0|SrvcGrp|69075|2022|PDM|105.00|99|0.00|CPT 99213|
20|FH_F98300_30236_0|SrvcGrp|95599|2022|PCT|2.00|99|0.00|AETNA ECHOCARDIOGRAM|
20|FH_F47872_83330_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F47872_83330_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|GENERAL ACUTE CARE|
20|FH_F67820_15009_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|1393.00|99|0.00|DEVICE INSERTION|
20|FH_F122694_33334_0|SrvcGrp|73841|2022|PDM|383.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F86851_0_0|SrvcGrp|84987|2022|PDM|788.00|99|0.00|CPT 44394|
20|FH_F86851_0_0|SrvcGrp|84967|2022|PDM|520.00|99|0.00|CPT 43226|
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|3329.00|99|0.00|AEG 8 (NO REV)|
20|FH_F46832_0_0|SrvcGrp|17302|2022|PDM|65.00|99|0.00|HYDRATION THERAPY - 3+ LITERS|
20|FH_F132810_0_0|SrvcGrp|24745|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F69968_0_0|SrvcGrp|36503|2022|PDM|3886.14|99|0.00|MS DRG 286 287 INPATIENT CARDIAC CATH|
20|FH_F115166_0_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F136374_34461_0|SrvcGrp|90854|2022|PDM|849.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F136390_46321_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F136394_78240_0|SrvcGrp|86722|2022|PDM|380.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F136488_16828_0|SrvcGrp|109330|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F118152_20151_0|SrvcGrp|24761|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118169_27514_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F120490_64133_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F120520_54401_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134011_84102_0|SrvcGrp|26869|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F137147_75006_0|SrvcGrp|41325|2022|PDM|20736.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F142690_31774_0|SrvcGrp|48398|2022|PDM|145.00|99|0.00|PT SERVICES|
20|FH_F142727_21222_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138607_02760_0|SrvcGrp|71104|2022|PDM|2.67|99|0.00|HCPCS A4232|
20|FH_F132733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F138583_60644_0|SrvcGrp|89149|2022|PDM|243.00|99|0.00|OP INTENSIVE|
20|FH_F140343_89052_0|SrvcGrp|86779|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F140627_68651_0|SrvcGrp|112064|2022|PCT|0.96|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F140647_66210_0|SrvcGrp|89149|2022|PDM|510.00|99|0.00|OP INTENSIVE|
20|FH_F149579_95815_0|SrvcGrp|3178|2022|PDM|1375.00|99|0.00|ACUTE PSYCH|
20|FH_F151603_27609_0|SrvcGrp|88163|2022|PDM|17628.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F151608_30236_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 3 (NO REV)|
20|FH_F118932_07652_0|SrvcGrp|79099|2022|PDM|610.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F117267_07728_0|SrvcGrp|12491|2022|PCT|0.50|99|0.00|PACEMAKER|
20|FH_F147799_18052_0|SrvcGrp|43569|2022|PDM|109.57|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F147941_06023_0|SrvcGrp|1259|2022|PDM|9016.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F67403_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F117098_20186_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117153_34113_0|SrvcGrp|73841|2022|PDM|350.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F137815_15501_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PDM|972.00|99|0.00|AEG 2 (NO REV)|
20|FH_F33483_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F143450_0_0|SrvcGrp|108935|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F62579_0_0|SrvcGrp|22588|2022|PDM|75.00|99|0.00|CHEMOTHERAPY|
20|FH_F130662_07032_0|SrvcGrp|111554|2022|PDM|265.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS (HCFA)|
20|FH_F130711_06716_0|SrvcGrp|75545|2022|PDM|450.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F130765_34113_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F74509_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F150159_06511_0|SrvcGrp|98701|2022|PDM|270.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F120719_27540_0|SrvcGrp|39870|2022|PDM|26862.00|99|0.00|MS DRG 619-621 ONLY|
20|FH_F119783_46360_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F79743_0_0|SrvcGrp|13268|2022|PCT|0.57|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F127090_45601_0|SrvcGrp|14944|2022|PDM|3.06|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F84191_16001_0|SrvcGrp|75545|2022|PDM|347.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|89.90|99|0.00|ASPG 227|
20|FH_F97201_15068_0|SrvcGrp|27969|2022|PDM|16.50|99|0.00|HOME HEALTH AIDE|
20|FH_F42340_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F146131_37160_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F72523_0_0|SrvcGrp|12403|2022|PDM|41.50|99|0.00|CONTINUOUS HOMECARE|
20|FH_F72972_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F97201_15068_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA WESTARM HOMECARE AMFS|
20|FH_F35454_0_0|SrvcGrp|16860|2022|PDM|15.00|99|0.00|QUICK STREP TEST|
20|FH_F146211_68144_0|CSTM-ALL|CSTM-00|2020|PDM|12900.00|99|0.00|AEG 6 (NO REV)|
20|FH_F44093_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|ACUTE PSYCH|
20|FH_F141648_60050_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F101983_17578_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F49637_0_0|SrvcGrp|9511|2022|PCT|0.60|99|0.00|OBSERVATION SVCS|
20|FH_F144348_22601_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132503_73086_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F118542_60188_0|SrvcGrp|21920|2022|PDM|60.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|837.00|99|0.00|AEG 6 (NO REV)|
20|FH_F43719_0_0|CSTM-ALL|CSTM-00|2020|PDM|515.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F111789_25301_0|SrvcGrp|75506|2022|PCT|0.77|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F97581_60141_0|SrvcGrp|73605|2022|PDM|3326.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F114519_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|AEG 5  (NO REV)|
20|FH_F133490_90650_0|SrvcGrp|705|2022|PCT|0.25|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F97882_32407_0|SrvcGrp|73602|2022|PDM|4425.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F133028_08021_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F126815_02118_0|CSTM-ALL|CSTM-00|2020|PDM|2607.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132601_92677_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F67136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|BURN SERVICES|
20|FH_F130649_98055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144448_04901_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136608_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F142027_37217_0|SrvcGrp|48398|2022|PDM|140.00|99|0.00|PT SERVICES|
20|FH_F106640_78642_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F41999_0_0|SrvcGrp|35143|2022|PDM|800.00|99|0.00|LABOR|
20|FH_F40659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79902_0_0|SrvcGrp|63|2022|PDM|1035.00|99|0.00|SUBACUTE CARE|
20|FH_F37751_0_0|SrvcGrp|27697|2022|PDM|125.00|99|0.00|THERAPY VISIT|
20|FH_F103360_68845_0|SrvcGrp|73499|2022|PDM|880.00|99|0.00|AETNA ER LEVEL II|
20|FH_F150001_33064_0|SrvcGrp|24745|2022|PDM|26.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F127994_19301_0|SrvcGrp|90643|2022|PDM|25.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F45199_0_0|CSTM-ALL|CSTM-00|2020|PDM|708.00|99|0.00|ASPG X|
20|FH_F127558_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119437_0_0|SrvcGrp|88492|2022|PDM|4750.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F126733_83713_0|SrvcGrp|74668|2022|PDM|129.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F38780_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F127994_19301_0|SrvcGrp|58699|2022|PDM|110.00|99|0.00|EVALUATION & MANAGEMENT NEW PATIENT (HCFA)|
20|FH_F106540_26330_0|SrvcGrp|75798|2022|PDM|1195.00|99|0.00|EMERGENCY ROOM LEVEL 2|
20|FH_F150001_33064_0|SrvcGrp|86828|2022|PDM|11.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|2519.00|99|0.00|AEG 7 (NO REV)|
20|FH_F35019_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 10 (NO REV)|
20|FH_F150951_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F141217_0_0|SrvcGrp|93433|2022|PDM|9500.00|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F115431_32821_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F141935_76033_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F87173_15136_0|SrvcGrp|48396|2022|PDM|104.00|99|0.00|OT SERVICES|
20|FH_F146211_68144_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|2805.00|99|0.00|AEG 6 (NO REV)|
20|FH_F119229_90804_0|SrvcGrp|73701|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F145988_06105_0|SrvcGrp|105522|2022|PDM|24495.00|99|0.00|DISCECTOMY SERVICES|
20|FH_F133490_90650_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F115289_90057_0|SrvcGrp|86749|2022|PCT|1.15|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F44016_0_0|SrvcGrp|4109|2022|PDM|1136.00|99|0.00|ACUTE PSYCH|
20|FH_F68944_0_0|SrvcGrp|10951|2022|PCT|0.70|99|0.00|PARTIAL HOSPITALIZATION PSYCH/CD|
20|FH_F115315_43011_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F141852_78102_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F133021_00910_0|SrvcGrp|112289|2022|PDM|5000.00|99|0.00|PROSTATE LASER VAPORIZATION|
20|FH_F133021_00910_0|SrvcGrp|108173|2022|PDM|10000.00|99|0.00|FEM/POPL REVASC STNT & ATHER|
20|FH_F117821_90049_0|SrvcGrp|100499|2022|PDM|676.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F100665_07939_0|SrvcGrp|73485|2022|PDM|2391.00|99|0.00|AETNA REHAB|
20|FH_F150062_92501_0|SrvcGrp|75419|2022|PDM|530.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F146282_08244_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F50974_0_0|SrvcGrp|47764|2022|PDM|70.00|99|0.00|HOSPICE CARE/ IN HOME S9126 VISIT LEVEL|
20|FH_F49552_0_0|CSTM-ALL|CSTM-00|2020|PDM|130.00|99|0.00|INFUSION THERAPY|
20|FH_F138418_51201_0|SrvcGrp|109057|2022|PCT|0.90|99|0.00|CARDIAC STUDIES|
20|FH_F109360_32514_0|SrvcGrp|73842|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F134249_05060_0|SrvcGrp|56103|2022|PDM|2792.00|99|0.00|VAGINAL DELIVERY WITH POST PARTUM|
20|FH_F148484_19462_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F110420_60649_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124159_92506_0|SrvcGrp|87317|2022|PDM|827.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F107702_01053_0|SrvcGrp|472|2022|PDM|482.40|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F74024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146470_68025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133749_84604_0|SrvcGrp|80920|2022|PDM|483.00|99|0.00|HOSPICE SERVICES|
20|FH_F126555_44906_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F149199_73005_0|SrvcGrp|15788|2022|PDM|72.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F149340_19136_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F111986_0_0|SrvcGrp|72992|2022|PDM|603.00|99|0.00|AEG 2|
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 4 (NO REV)|
20|FH_F139727_66035_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128148_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANESTHESIOLOGIST/CRNA (HAN2)(HSUR)|
20|FH_F132193_0_0|SrvcGrp|101320|2022|PDM|2500.00|99|0.00|PARAVERTEBRAL FACET JOINT NERVE|
20|FH_F114510_33445_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F79824_0_0|SrvcGrp|16|2022|PDM|1267.00|99|0.00|ACUTE REHABILITATION|
20|FH_F143617_49412_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125124_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F111986_0_0|SrvcGrp|73000|2022|PDM|1339.00|99|0.00|AEG 6|
20|FH_F135670_01749_0|SrvcGrp|86832|2022|PDM|7.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F132883_31602_0|SrvcGrp|86854|2022|PDM|20.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|AEG 7 (NO REV)|
20|FH_F110702_0_0|SrvcGrp|83683|2022|PDM|812.00|99|0.00|ACUTE REHAB II|
20|FH_F120291_0_0|SrvcGrp|80918|2022|PDM|249.00|99|0.00|RESPITE CARE|
20|FH_F138050_52301_0|SrvcGrp|73498|2022|PDM|1156.00|99|0.00|AETNA ER LEVEL III|
20|FH_F145642_15108_0|SrvcGrp|17013|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F125260_0_0|SrvcGrp|48385|2022|PDM|220.60|99|0.00|SPEECH THERAPY|
20|FH_F143289_0_0|SrvcGrp|74668|2022|PDM|206.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F44278_0_0|SrvcGrp|36144|2022|PCT|0.85|99|0.00|OP SURGERY|
20|FH_F124161_95932_0|SrvcGrp|109057|2022|PCT|2.08|99|0.00|CARDIAC STUDIES|
20|FH_F131100_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F121687_04401_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145641_06902_0|SrvcGrp|34609|2022|PDM|4407.00|99|0.00|PODIATRIC PROCEDURE CPT 28080|
20|FH_F85353_16407_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AICD REV 278|
20|FH_F109367_32751_0|SrvcGrp|93337|2022|PDM|340.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F146293_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.43|99|0.00|OP SVCS|
20|FH_F148521_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119213_66209_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F142376_0_0|SrvcGrp|98590|2022|PDM|6892.00|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F135617_52001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126063_43078_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F132707_83716_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143581_02130_0|SrvcGrp|81622|2022|PCT|1.00|99|0.00|GENERAL PHARMACY|
20|FH_F124395_0_0|SrvcGrp|87077|2022|PDM|140.45|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F149044_60463_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PDM|776.60|99|0.00|AEG 5  (NO REV)|
20|FH_F145942_72019_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F146590_77449_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F134610_33426_0|SrvcGrp|89337|2022|PDM|2474.50|99|0.00|DETOXIFICATION|
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F126427_77082_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37877_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|OCN F/S PRICING: ALL|
20|FH_F120720_24541_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|4400.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132802_68022_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135900_0_0|SrvcGrp|79720|2022|PDM|1000.00|99|0.00|ACUTE REHAB II|
20|FH_F150165_06032_0|SrvcGrp|114518|2022|PDM|4562.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F111957_30024_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F73084_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS|
20|FH_F73024_0_0|SrvcGrp|46424|2022|PDM|30.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F134488_14086_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122522_54024_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F122522_54024_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122532_46385_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F122553_92705_0|SrvcGrp|23587|2022|PDM|674.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F85894_0_0|SrvcGrp|10365|2022|PDM|1288.00|99|0.00|CPT CODE 99285|
20|FH_F98780_35022_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F102142_80014_0|SrvcGrp|98274|2022|PCT|1.00|99|0.00|AETNA AMFS DEFAULT INTEGRITY HH|
20|FH_F105145_75075_0|SrvcGrp|90356|2022|PCT|0.00|99|0.00|OP DIALYSIS|
20|FH_F66404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F146422_80210_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F131212_63017_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F134828_30531_0|SrvcGrp|113095|2022|PDM|35.92|99|0.00|COVID-19 LAB TESTING (HCFA)|
20|FH_F51938_0_0|SrvcGrp|11258|2022|PCT|0.90|99|0.00|DRUGS|
20|FH_F102641_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|676.00|99|0.00|AEG 1 (NO REV)|
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|2425.00|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_F139238_0_0|CSTM-ALL|CSTM-00|2020|PDM|1139.60|99|0.00|AEG 10 (NO REV)|
20|FH_F120688_68124_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
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_F47356_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54552_0_0|SrvcGrp|27043|2022|PDM|18.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS (MOD SJ)|
20|FH_F54552_0_0|SrvcGrp|22389|2022|PDM|19.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F138670_53045_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138687_77477_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F138697_53219_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F119544_0_0|SrvcGrp|108081|2022|PDM|214.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|1162.46|99|0.00|AEG 8 (NO REV)|
20|FH_F151508_60435_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132268_07060_0|SrvcGrp|81622|2022|PCT|0.95|99|0.00|GENERAL PHARMACY|
20|FH_F145168_15601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145531_61614_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135583_17331_0|CSTM-ALL|CSTM-00|2020|PDM|3162.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F135979_66451_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F130766_04967_0|SrvcGrp|112676|2022|PDM|42.13|99|0.00|COVID-19 SARS-COV-2 ANTIBODY|
20|FH_F127399_0_0|SrvcGrp|92820|2022|PDM|6763.00|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY|
20|FH_F127399_0_0|SrvcGrp|92821|2022|PDM|6763.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR|
20|FH_F33015_0_0|SrvcGrp|3259|2022|PDM|295.00|99|0.00|ACUTE REHABILITATION|
20|FH_F101558_80443_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F121411_33063_0|SrvcGrp|73842|2022|PDM|170.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121700_60938_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121854_28613_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F44754_0_0|SrvcGrp|10543|2022|PDM|70.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F111292_33136_0|SrvcGrp|73605|2022|PDM|1020.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F111292_33136_0|SrvcGrp|82748|2022|PDM|45.00|99|0.00|HEMO/PLATELET CNT AUTOMATED|
20|FH_F141651_0_0|SrvcGrp|90366|2022|PDM|3850.00|99|0.00|RHINOPLASTY COMPLETE EXT PRT|
20|FH_F51558_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36344_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|S CODES-SH/SJ MOD|
20|FH_F131000_0_0|SrvcGrp|92415|2022|PDM|6155.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F132328_0_0|SrvcGrp|49205|2022|PDM|3641.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F132328_0_0|SrvcGrp|111949|2022|PDM|2425.00|99|0.00|MALE GENITAL PROCEDURES|
20|FH_F132328_0_0|SrvcGrp|34606|2022|PDM|2241.00|99|0.00|CPT 29827|
20|FH_F129141_21221_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130027_76201_0|SrvcGrp|106048|2022|PDM|834.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F148061_11223_0|SrvcGrp|27968|2022|PDM|32.00|99|0.00|SKILLED NURSING LPN|
20|FH_F113741_63303_0|SrvcGrp|46605|2022|PDM|81.60|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F98041_10027_0|SrvcGrp|73605|2022|PDM|3880.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F108800_0_0|SrvcGrp|101182|2022|PDM|3000.00|99|0.00|AETNA SHOULDER|
20|FH_F109484_0_0|SrvcGrp|73006|2022|PDM|1339.00|99|0.00|AEG 9|
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|1874.00|99|0.00|AEG 3 (NO REV)|
20|FH_F45795_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F56252_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87201_0_0|SrvcGrp|85968|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F113033_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F104840_32565_0|SrvcGrp|73488|2022|PCT|0.69|99|0.00|AETNA HOSPITAL OP DIALYSIS|
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|2821.00|99|0.00|AEG 5  (NO REV)|
20|FH_F33856_0_0|SrvcGrp|12117|2022|PCT|0.85|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F136473_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F132627_0_0|SrvcGrp|17011|2022|PDM|69.36|99|0.00|HOME INFUSION THERAPY|
20|FH_F136818_0_0|SrvcGrp|112934|2022|PDM|1015.00|99|0.00|MUSCULOSKELETAL SURGERY|
20|FH_F137067_0_0|SrvcGrp|88164|2022|PDM|21000.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F114389_50131_0|SrvcGrp|26617|2022|PDM|48.28|99|0.00|HOME INFUSION THERAPY|
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|DEVICE INSERTION|
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 8 (NO REV)|
20|FH_F42556_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F124058_61081_0|SrvcGrp|86582|2022|PCT|0.65|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F38983_0_0|SrvcGrp|701|2022|PDM|2300.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F41035_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F47736_0_0|SrvcGrp|3809|2022|PDM|535.00|99|0.00|HOSPICE CARE|
20|FH_F49943_0_0|SrvcGrp|44042|2022|PDM|90.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F132864_71101_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F116097_0_0|SrvcGrp|3809|2022|PDM|573.47|99|0.00|HOSPICE CARE|
20|FH_F114985_32073_0|SrvcGrp|104796|2022|PDM|139.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F122641_72365_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43421_0_0|CSTM-ALL|CSTM-00|2020|PDM|489.00|99|0.00|CD ADULT REHAB|
20|FH_F135758_98229_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136829_29615_0|SrvcGrp|73841|2022|PDM|986.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F113713_17013_0|SrvcGrp|91751|2022|PDM|65.00|99|0.00|AETNA GROUP THERAPY (MOD AJ)|
20|FH_F49005_0_0|SrvcGrp|45302|2022|PDM|150.00|99|0.00|IP SKILLED NURSING VISIT|
20|FH_F115152_77058_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F147530_49441_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|545.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F42342_0_0|SrvcGrp|8962|2022|PDM|131.25|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F42522_0_0|SrvcGrp|10362|2022|PDM|772.00|99|0.00|CPT CODE 99282|
20|FH_F42748_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139667_84078_0|SrvcGrp|84185|2022|PDM|93.00|99|0.00|RESPITE CARE|
20|FH_F139676_76901_0|SrvcGrp|89149|2022|PDM|150.00|99|0.00|OP INTENSIVE|
20|FH_F150882_84041_0|SrvcGrp|86842|2022|PDM|61.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F150882_84041_0|SrvcGrp|86832|2022|PDM|6.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F134396_80045_0|SrvcGrp|89337|2022|PDM|1383.00|99|0.00|DETOXIFICATION|
20|FH_F47424_0_0|SrvcGrp|40582|2022|PDM|185.00|99|0.00|HOSPICE SVCS|
20|FH_F40727_0_0|SrvcGrp|31734|2022|PCT|1.10|99|0.00|OP SURGERY SERVICES (RC 490)|
20|FH_F139247_77657_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F146266_0_0|SrvcGrp|87677|2022|PDM|1928.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F34853_0_0|SrvcGrp|9808|2022|PDM|24494.00|99|0.00|PTCA WITH STENT|
20|FH_F120144_77031_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F141327_65566_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132254_40207_0|SrvcGrp|86837|2022|PDM|25.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F150982_0_0|SrvcGrp|103570|2022|PDM|2202.00|99|0.00|ARTHROSCOPIC FRACTURE|
20|FH_F37341_0_0|CSTM-ALL|CSTM-00|2020|PDM|390.00|99|0.00|ASPG I|
20|FH_F124322_64131_0|SrvcGrp|29076|2022|PDM|25.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F150961_89169_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F132512_0_0|SrvcGrp|93337|2022|PDM|587.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F34853_0_0|SrvcGrp|12863|2022|PDM|16289.00|99|0.00|PACEMAKER SVCS|
20|FH_F110824_83221_0|SrvcGrp|93924|2022|PDM|2618.00|99|0.00|AETNA MEDICAL SERVICES|
20|FH_F90196_10467_0|SrvcGrp|86648|2022|PCT|1.05|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F37341_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ASPG II|
20|FH_F146266_0_0|SrvcGrp|88980|2022|PDM|4395.00|99|0.00|NURSERY NEWBORN|
20|FH_F151029_52241_0|SrvcGrp|115294|2022|PDM|225.00|99|0.00|DIALYSIS INPT|
20|FH_F139576_0_0|SrvcGrp|16692|2022|PDM|2812.00|99|0.00|KNEE SCOPE|
20|FH_F134390_27012_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F64739_0_0|SrvcGrp|60857|2022|PDM|167.20|99|0.00|HOSPICE SERVICE -  INPATIENT RESPITE CARE|
20|FH_F131942_50833_0|SrvcGrp|88621|2022|PDM|108.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132039_92008_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F125081_15218_0|SrvcGrp|93098|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F124466_32724_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F123386_0_0|SrvcGrp|22899|2022|PDM|2800.00|99|0.00|ICU|
20|FH_F149400_83301_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F138017_73129_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110728_13069_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F33649_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34924_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F150950_17522_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117762_0_0|SrvcGrp|95462|2022|PDM|1976.00|99|0.00|REPAIR OF ANKLE LIGAMENT|
20|FH_F31087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|GENERAL ACUTE CARE|
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_F97640_37043_0|CSTM-ALL|CSTM-00|2020|PCT|0.37|99|0.00|OP SVCS|
20|FH_F39443_0_0|SrvcGrp|30343|2022|PDM|50.00|99|0.00|HAPA WPA ASC 227|
20|FH_F47573_0_0|SrvcGrp|42830|2022|PDM|178.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F122264_75972_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F147418_0_0|SrvcGrp|99073|2022|PDM|1.28|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F76285_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39443_0_0|SrvcGrp|30293|2022|PDM|339.00|99|0.00|HAPA WPA ASC 105|
20|FH_F97183_25304_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F117023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F75243_0_0|SrvcGrp|9811|2022|PDM|410.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F93377_0_0|SrvcGrp|82222|2022|PDM|27.00|99|0.00|HOSPICE CARE|
20|FH_F128029_48154_0|SrvcGrp|82222|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F124441_0_0|SrvcGrp|74039|2022|PDM|5700.00|99|0.00|LAMINECTOMY|
20|FH_F38007_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F125081_15218_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG VIII|
20|FH_F35987_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F124526_05301_0|SrvcGrp|89149|2022|PDM|284.00|99|0.00|OP INTENSIVE|
20|FH_F43236_0_0|SrvcGrp|31134|2022|PDM|950.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F115483_62002_0|SrvcGrp|3066|2022|PCT|0.33|99|0.00|HIGH-COST DRUGS|
20|FH_F147166_03444_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F39443_0_0|SrvcGrp|30322|2022|PDM|526.00|99|0.00|HAPA WPA ASC 206|
20|FH_F140295_0_0|SrvcGrp|58993|2022|PDM|10603.00|99|0.00|DISKECTOMY|
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|775.00|99|0.00|AEG 2 (NO REV)|
20|FH_F133087_61107_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F148963_56301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149045_45679_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131548_32003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117762_0_0|SrvcGrp|67066|2022|PDM|8840.00|99|0.00|CERVICAL SURGERY|
20|FH_F89011_75006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145964_10993_0|SrvcGrp|73606|2022|PDM|1060.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F133490_90650_0|CSTM-ALL|CSTM-00|2020|PDM|4106.00|99|0.00|AEG 6 (NO REV)|
20|FH_F34706_0_0|SrvcGrp|13982|2022|PDM|6017.00|99|0.00|DRG 182 ONLY|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1875.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F139454_32839_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F124976_0_0|SrvcGrp|106048|2022|PDM|998.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F37267_0_0|SrvcGrp|9829|2022|PDM|85.50|99|0.00|PT SVCS|
20|FH_F34806_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F94643_90501_0|SrvcGrp|29077|2022|PDM|12.50|99|0.00|HOME TRANSFUSION|
20|FH_F47037_0_0|SrvcGrp|18025|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F116806_0_0|SrvcGrp|107090|2022|PDM|1149.97|99|0.00|INSERT AND REMOVE BONE PIN|
20|FH_F40399_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F114568_08097_0|SrvcGrp|105682|2022|PDM|186.00|99|0.00|INTENSIVE OUTPATIENT >=18 YRS|
20|FH_F134390_27012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36348_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F138995_0_0|SrvcGrp|91421|2022|PDM|1199.00|99|0.00|REMOVAL OF ADENOIDS|
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 6 (NO REV)|
20|FH_F150953_74953_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148347_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F151679_62881_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F50461_0_0|SrvcGrp|20153|2022|PDM|180242.00|99|0.00|SINGLE LUNG TRANSPLANT|
20|FH_F150912_19344_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117763_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149046_53022_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134427_64014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35557_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F133087_61107_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F99920_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F37864_0_0|SrvcGrp|68580|2022|PCT|1.00|99|0.00|IMMUNIZATIONS|
20|FH_F119946_36109_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F149648_89148_0|SrvcGrp|48398|2022|PDM|135.00|99|0.00|PT SERVICES|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|ASPG II|
20|FH_F134847_0_0|SrvcGrp|88487|2022|PDM|5836.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F40690_0_0|SrvcGrp|33214|2022|PCT|0.92|99|0.00|RADIOLOGY SVCS|
20|FH_F140295_0_0|SrvcGrp|113628|2022|PDM|5835.00|99|0.00|REVISE KNUCKLE JOINT|
20|FH_F146204_0_0|SrvcGrp|27348|2022|PDM|2376.00|99|0.00|OP SURGERY (CPT 58662)|
20|FH_F134968_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F66545_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|333.00|99|0.00|AEG 10 (NO REV)|
20|FH_F114825_32789_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F146859_0_0|SrvcGrp|94561|2022|PDM|2873.00|99|0.00|HIP ARTHRO W/ FEMOROPLASTY|
20|FH_F32221_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F138540_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149648_89148_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F150941_68124_0|SrvcGrp|108484|2022|PDM|659.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F47212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|HCPC CODES VNA MIDLANDS W/MOD SJ|
20|FH_F132818_24701_0|SrvcGrp|112044|2022|PCT|2.00|99|0.00|LABORATORY SERVICES|
20|FH_F90817_0_0|SrvcGrp|91010|2022|PDM|2280.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY (HCFA)|
20|FH_F49300_0_0|SrvcGrp|10528|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F129757_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148962_08109_0|SrvcGrp|115559|2022|PCT|1.00|99|0.00|OPIOID TREATMENT|
20|FH_F90223_0_0|SrvcGrp|88825|2022|PDM|14.80|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F127418_0_0|SrvcGrp|93057|2022|PDM|3466.97|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F150925_33936_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131605_0_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148979_44512_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150981_33140_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F36743_0_0|SrvcGrp|361|2022|PDM|2300.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F127464_15106_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F35527_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|GENERAL ACUTE CARE|
20|FH_F116332_0_0|SrvcGrp|12491|2022|PCT|0.80|99|0.00|PACEMAKER|
20|FH_F40899_0_0|SrvcGrp|29021|2022|PCT|1.00|99|0.00|DME AND SUPPLIES|
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PDM|5962.00|99|0.00|AEG 9 (NO REV)|
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F136541_0_0|SrvcGrp|111931|2022|PDM|35.91|99|0.00|COVID-19 CDC TESTING LAB|
20|FH_F144029_0_0|SrvcGrp|107748|2022|PDM|500.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F138452_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|TELEHEALTH SERVICES|
20|FH_F97300_47501_0|SrvcGrp|82137|2022|PDM|3500.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|3149.00|99|0.00|AEG 7 (NO REV)|
20|FH_F138995_0_0|SrvcGrp|113277|2022|PDM|1575.00|99|0.00|AETNA ARTHROSCOPY SURGERY|
20|FH_F91259_0_0|CSTM-ALL|CSTM-00|2020|PDM|1364.00|99|0.00|AEG 2 (NO REV)|
20|FH_F35174_0_0|SrvcGrp|21354|2022|PCT|0.75|99|0.00|MS DRG 250-251 ONLY|
20|FH_F131261_19111_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F90455_0_0|SrvcGrp|46605|2022|PDM|185.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F149582_01534_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137730_46563_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F147359_54911_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150929_17325_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F69183_0_0|SrvcGrp|65651|2022|PDM|4500.00|99|0.00|DIAGNOSTIC CARDIAC CATHETERIZATION|
20|FH_F128839_0_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F90817_0_0|SrvcGrp|91001|2022|PDM|1433.00|99|0.00|REP FLX TEND ZONE 2 DIGT SEC (HCFA)|
20|FH_F147224_48026_0|SrvcGrp|42623|2022|PDM|528.00|99|0.00|SUBACUTE - LEVEL III|
20|FH_F139822_30338_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F140127_64131_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143454_94550_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143536_47546_0|SrvcGrp|100278|2022|PCT|1.00|99|0.00|INJ DEXAMETHASONE ACETATE|
20|FH_F75803_0_0|SrvcGrp|3932|2022|PCT|0.70|99|0.00|LITHOTRIPSY|
20|FH_F62172_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
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_F49478_0_0|SrvcGrp|65284|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F116579_45822_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F116629_83467_0|SrvcGrp|75506|2022|PCT|0.82|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F119843_14103_0|SrvcGrp|473|2022|PDM|285.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120885_66224_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120888_63823_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126884_28379_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F46158_0_0|SrvcGrp|17069|2022|PCT|0.65|99|0.00|ASPG III|
20|FH_F51276_0_0|SrvcGrp|34388|2022|PDM|150.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F38980_0_0|SrvcGrp|29986|2022|PDM|125.00|99|0.00|REHAB THERAPY|
20|FH_F39355_0_0|SrvcGrp|290|2022|PDM|3800.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F98625_08103_0|SrvcGrp|73461|2022|PDM|9893.00|99|0.00|AETNA NICU IV|
20|FH_F102947_44084_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F111186_15213_0|SrvcGrp|73841|2022|PDM|575.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F34048_0_0|SrvcGrp|39|2022|PCT|0.65|99|0.00|TISSUE PLASMINOGEN ACTIVATOR|
20|FH_F119491_19904_0|SrvcGrp|27969|2022|PDM|18.90|99|0.00|HOME HEALTH AIDE|
20|FH_F138283_0_0|SrvcGrp|57650|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY SVCS MOD GO|
20|FH_F148431_60523_0|SrvcGrp|95660|2022|PDM|485.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F148432_01585_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148554_85016_0|SrvcGrp|115473|2022|PDM|2965.00|99|0.00|RIGHT & LEFT HEART ART/VENTRICLE ANGIO|
20|FH_F39558_0_0|SrvcGrp|17079|2022|PDM|1141.00|99|0.00|ASPG VIII|
20|FH_F118819_76226_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F113264_71860_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80855_0_0|SrvcGrp|78095|2022|PDM|2625.00|99|0.00|AETNA LAPARO HERNIA REPAIR|
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|323.00|99|0.00|AEG 1 (NO REV)|
20|FH_F67560_0_0|SrvcGrp|17065|2022|PCT|0.83|99|0.00|ASPG I|
20|FH_F133333_74132_0|SrvcGrp|79699|2022|PCT|0.62|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F133018_84037_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144211_30012_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F126702_33139_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115431_32821_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F128316_22192_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_F97882_32407_0|SrvcGrp|88978|2022|PDM|4091.00|99|0.00|VAGINAL DELIVERY|
20|FH_F71268_0_0|SrvcGrp|31505|2022|PCT|0.80|99|0.00|TRAUMA CARE|
20|FH_F115505_21014_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F92676_15063_0|SrvcGrp|67748|2022|PDM|9311.00|99|0.00|KYPHOPLASTY|
20|FH_F128912_44313_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133478_40165_0|CSTM-ALL|CSTM-00|2020|PDM|1028.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|AEG 10 (NO REV)|
20|FH_F99720_0_0|SrvcGrp|72994|2022|PDM|1595.00|99|0.00|AEG 3|
20|FH_F141940_50023_0|CSTM-ALL|CSTM-00|2020|PDM|1621.38|99|0.00|AEG 1 (NO REV)|
20|FH_F118456_30012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F68888_0_0|SrvcGrp|44105|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY|
20|FH_F144324_67467_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43953_0_0|SrvcGrp|941|2022|PDM|4201.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|417.00|99|0.00|AEG 1 (NO REV)|
20|FH_F117087_0_0|SrvcGrp|91880|2022|PDM|5941.00|99|0.00|OSSEOINTEGRATED IMPLANT|
20|FH_F98921_64503_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F92676_15063_0|SrvcGrp|67740|2022|PCT|0.85|99|0.00|HAPA WPA: ANTITHROMBOTIC W/ SURGERY|
20|FH_F49049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
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_F142807_67114_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148861_18706_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133493_90255_0|CSTM-ALL|CSTM-00|2020|PDM|2335.00|99|0.00|AEG 3 (NO REV)|
20|FH_F147800_0_0|SrvcGrp|87679|2022|PDM|1650.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F117720_23323_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F122627_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100788_01420_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112848_06032_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143190_46168_0|SrvcGrp|3178|2022|PDM|1052.00|99|0.00|ACUTE PSYCH|
20|FH_F37035_0_0|SrvcGrp|33832|2022|PDM|564.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 10|
20|FH_F44135_0_0|SrvcGrp|10543|2022|PDM|70.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F150024_08079_0|SrvcGrp|100919|2022|PDM|750.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F34894_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100841_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148881_33018_0|SrvcGrp|79720|2022|PDM|1100.00|99|0.00|ACUTE REHAB II|
20|FH_F117272_24333_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F148494_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103360_68845_0|SrvcGrp|98244|2022|PDM|9134.00|99|0.00|INSERT IA PERCUT DEVICE/AORTIC|
20|FH_F132722_71373_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F133493_90255_0|SrvcGrp|107595|2022|PCT|1.40|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F138054_0_0|SrvcGrp|48396|2022|PDM|144.00|99|0.00|OT SERVICES|
20|FH_F149781_37404_0|CSTM-ALL|CSTM-00|2020|PDM|1014.00|99|0.00|AEG 1 (NO REV)|
20|FH_F113792_0_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F33659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F81485_0_0|SrvcGrp|537|2022|PCT|0.75|99|0.00|OBSERVATION SERVICES|
20|FH_F37491_0_0|SrvcGrp|3577|2022|PDM|340.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F33788_0_0|SrvcGrp|177|2022|PDM|1250.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F115315_43011_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126733_83713_0|SrvcGrp|46903|2022|PDM|414.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F43147_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F80859_65616_0|SrvcGrp|16429|2022|PCT|0.56|99|0.00|OBSERVATION SVCS|
20|FH_F31093_0_0|SrvcGrp|63|2022|PDM|475.00|99|0.00|SUBACUTE CARE|
20|FH_F38396_0_0|SrvcGrp|29022|2022|PCT|1.00|99|0.00|IMPLANTS (HEART TRANSPLANT)|
20|FH_F89112_16509_0|SrvcGrp|64104|2022|PDM|1968.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 5|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.24|99|0.00|HAPA WPA-NWPA 2012-13 ASC 707 W/O REV|
20|FH_F117885_81506_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101104_0_0|SrvcGrp|87395|2022|PDM|160.00|99|0.00|HCPCS G0153 (HCFA)|
20|FH_F97563_83201_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F148556_13206_0|SrvcGrp|24752|2022|PDM|12.50|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F146324_70810_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F111815_35904_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|GENERAL ACUTE CARE|
20|FH_F148886_60621_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F126733_83713_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F68831_0_0|SrvcGrp|14494|2022|PDM|35.20|99|0.00|CONTINUOUS HOMECARE|
20|FH_F138236_0_0|SrvcGrp|82223|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F43837_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|INITIAL VESTIBULAR EVAL & TESTING|
20|FH_F132900_06074_0|SrvcGrp|112086|2022|PDM|649.00|99|0.00|PARTIAL HOSP EATING DISORDERS (0-17 YRS)|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD NU/KF)|
20|FH_F150600_44270_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F74163_0_0|SrvcGrp|10411|2022|PDM|18.00|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F91255_19401_0|SrvcGrp|1943|2022|PDM|2247.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F130108_0_0|SrvcGrp|111493|2022|PDM|6500.00|99|0.00|PTCA ANGIOPLASTY|
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|411.00|99|0.00|AEG 1 (NO REV)|
20|FH_F89340_0_0|SrvcGrp|63472|2022|PDM|3300.00|99|0.00|CPT 64581|
20|FH_F89372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|AETNA OP SVCS|
20|FH_F151559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126770_43050_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F134255_01201_0|SrvcGrp|46903|2022|PDM|210.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F136423_61254_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136542_02446_0|SrvcGrp|88905|2022|PDM|1167.00|99|0.00|PSYCHIATRIC CARE (AGE 0-17)|
20|FH_F118198_38119_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134011_84102_0|SrvcGrp|86852|2022|PDM|22.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F134029_06517_0|SrvcGrp|472|2022|PDM|472.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134126_11554_0|SrvcGrp|12837|2022|PCT|0.45|99|0.00|INTRAOCULAR LENSES|
20|FH_F137147_75006_0|SrvcGrp|76602|2022|PDM|4586.00|99|0.00|CPT 25000|
20|FH_F142491_06033_0|SrvcGrp|80918|2022|PDM|160.00|99|0.00|RESPITE CARE|
20|FH_F142473_07663_0|SrvcGrp|73524|2022|PCT|1.00|99|0.00|PHYSICAL THERAPY|
20|FH_F142527_89109_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F142715_32757_0|CSTM-ALL|CSTM-00|2020|PCT|1.03|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F117552_0_0|SrvcGrp|90061|2022|PDM|8500.00|99|0.00|AETNA RECONSTRUCT SHOULDER JOINT|
20|FH_F138584_30912_0|SrvcGrp|113388|2022|PDM|1250.00|99|0.00|MANDIBLE OSTEOTOMY|
20|FH_F140765_30315_0|SrvcGrp|113231|2022|PDM|105.33|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 TITER|
20|FH_F119003_78070_0|SrvcGrp|73841|2022|PDM|368.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F119023_91406_0|SrvcGrp|22589|2022|PDM|50.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F118926_30135_0|SrvcGrp|75545|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F55255_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F117218_32025_0|SrvcGrp|89417|2022|PDM|382.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F117126_12801_0|CSTM-ALL|CSTM-00|2020|PDM|5200.00|99|0.00|AEG 6 (NO REV)|
20|FH_F117240_37334_0|SrvcGrp|75483|2022|PDM|1300.00|99|0.00|AEG 3|
20|FH_F115868_0_0|SrvcGrp|89781|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F137905_91364_0|SrvcGrp|87131|2022|PDM|410.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F110720_0_0|SrvcGrp|73008|2022|PDM|1273.00|99|0.00|AEG 10|
20|FH_F90880_15108_0|SrvcGrp|75545|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F139287_33544_0|CSTM-ALL|CSTM-00|2020|PCT|1.26|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.40|99|0.00|ASPG IV|
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|538.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1093.00|99|0.00|AEG 7 (NO REV)|
20|FH_F150200_0_0|SrvcGrp|35669|2022|PDM|4682.00|99|0.00|CPT 63650|
20|FH_F38431_0_0|SrvcGrp|23013|2022|PDM|650.00|99|0.00|V5246|
20|FH_F138296_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F49895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F66961_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP|
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149865_95624_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F32453_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F151543_95630_0|SrvcGrp|75419|2022|PDM|600.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|AEG 2 (NO REV)|
20|FH_F83533_70433_0|SrvcGrp|82981|2022|PDM|183.73|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F74307_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F121149_76021_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F43118_0_0|SrvcGrp|38127|2022|PCT|0.50|99|0.00|DEVICES / SUPPLIES|
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F98801_93274_0|SrvcGrp|73605|2022|PDM|4185.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F123507_63869_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F66222_0_0|SrvcGrp|48003|2022|PDM|333.64|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F39892_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39857_0_0|SrvcGrp|72|2022|PDM|468.00|99|0.00|NEWBORN NURSERY|
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|522.00|99|0.00|AEG 1 (NO REV)|
20|FH_F78446_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F129268_54220_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F34100_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|OP SVCS|
20|FH_F143772_75225_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125011_74467_0|SrvcGrp|72992|2022|PDM|1680.00|99|0.00|AEG 2|
20|FH_F135065_08043_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137617_84112_0|SrvcGrp|13221|2022|PCT|0.88|99|0.00|AIR AMBULANCE SERVICES|
20|FH_F148182_23324_0|SrvcGrp|48398|2022|PDM|84.00|99|0.00|PT SERVICES|
20|FH_F43294_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F149862_76051_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F99960_0_0|SrvcGrp|54943|2022|PDM|2180.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F135764_0_0|SrvcGrp|3212|2022|PDM|400.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F38798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40421_0_0|SrvcGrp|9793|2022|PDM|390.00|99|0.00|NEWBORN NURSERY|
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F64440_0_0|SrvcGrp|108687|2022|PDM|486.00|99|0.00|CT W/O CONTRAST|
20|FH_F148255_72703_0|SrvcGrp|86840|2022|PDM|31.50|99|0.00|HCPCS S9338 (HCFA)|
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_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 8 (NO REV)|
20|FH_F32002_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F120672_0_0|SrvcGrp|75505|2022|PCT|0.87|99|0.00|CARDIAC STUDIES|
20|FH_F41350_0_0|SrvcGrp|36991|2022|PCT|1.20|99|0.00|IMPLANTS|
20|FH_F123910_19125_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137940_0_0|SrvcGrp|13422|2022|PDM|219.93|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F31836_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148221_06477_0|SrvcGrp|93098|2022|PDM|168.00|99|0.00|HOSPICE CARE|
20|FH_F123170_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F142073_0_0|SrvcGrp|70749|2022|PDM|2300.00|99|0.00|CPT 29823|
20|FH_F38151_0_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|ACUTE PSYCH|
20|FH_F128992_90808_0|SrvcGrp|73841|2022|PDM|550.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F130025_0_0|SrvcGrp|73601|2022|PDM|1464.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F135065_08043_0|SrvcGrp|46903|2022|PDM|1000.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F42755_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|CD RESIDENTIAL TREATMENT|
20|FH_F109346_0_0|SrvcGrp|103604|2022|PCT|0.00|99|0.00|TRANSFER TO HOSPITAL|
20|FH_F37937_0_0|SrvcGrp|27769|2022|PDM|45.00|99|0.00|SKILLED LPN HOURLY|
20|FH_F92129_0_0|SrvcGrp|11663|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F128402_80233_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38357_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F130807_20721_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F78945_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134995_37055_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148320_02130_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PDM|2419.00|99|0.00|AEG 9 (NO REV)|
20|FH_F78162_0_0|SrvcGrp|64200|2022|PCT|1.00|99|0.00|RAD AND LAB|
20|FH_F114976_78539_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40957_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F70043_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F99100_0_0|SrvcGrp|96102|2022|PDM|566.50|99|0.00|LUMBAR INJECTION (HCFA)|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F77642_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F139241_0_0|SrvcGrp|11673|2022|PDM|2022.00|99|0.00|CPT 29888|
20|FH_F40358_0_0|SrvcGrp|9774|2022|PDM|2000.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F39850_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/MOD AU  (TN)|
20|FH_F87254_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80834_0_0|CSTM-ALL|CSTM-00|2020|PDM|1298.00|99|0.00|SKILLED NURSING|
20|FH_F74825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F31547_0_0|SrvcGrp|12694|2022|PDM|90.29|99|0.00|PT SVCS|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112755_43215_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F91938_70121_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F140032_60550_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140097_19145_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F143488_84770_0|CSTM-ALL|CSTM-00|2020|PDM|1151.00|99|0.00|AEG 5  (NO REV)|
20|FH_F133247_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F93740_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F131067_57105_0|SrvcGrp|79786|2022|PCT|1.70|99|0.00|SLEEP STUDIES|
20|FH_F151762_17042_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F47036_0_0|SrvcGrp|26001|2022|PDM|110.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F132416_92270_0|SrvcGrp|23587|2022|PDM|650.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F112711_80909_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116698_07470_0|SrvcGrp|43568|2022|PDM|110.25|99|0.00|SKILLED NURSING - RN|
20|FH_F116699_46347_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|1890.00|99|0.00|AEG 4 (NO REV)|
20|FH_F119918_38201_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F150102_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F40091_0_0|SrvcGrp|17083|2022|PCT|0.70|99|0.00|ASPG X|
20|FH_F43008_0_0|CSTM-ALL|CSTM-00|2020|PDM|3611.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F59732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F136690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F91663_19901_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F33789_0_0|SrvcGrp|45626|2022|PCT|0.70|99|0.00|OP SURGERY BILATERAL|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PDM|3859.00|99|0.00|ASPG VII|
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|1070.00|99|0.00|ASPG VIII|
20|FH_F43243_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|1433.00|99|0.00|AEG 9 (NO REV)|
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)|
20|FH_F33789_0_0|SrvcGrp|6|2022|PCT|0.78|99|0.00|OP SURGERY|
20|FH_F126923_33612_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F124017_0_0|SrvcGrp|40003|2022|PDM|12800.00|99|0.00|TOTAL KNEE|
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|ASPG 2 HEARTLAND HEALTHCARE|
20|FH_F41313_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149839_80002_0|SrvcGrp|94780|2022|PDM|144.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F89779_0_0|SrvcGrp|73002|2022|PDM|3500.00|99|0.00|AEG 7|
20|FH_F35276_0_0|SrvcGrp|3499|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F83493_21220_0|SrvcGrp|76501|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F51074_0_0|SrvcGrp|9510|2022|PDM|545.00|99|0.00|SKILLED NURSING CARE|
20|FH_F88212_20151_0|SrvcGrp|48396|2022|PDM|90.00|99|0.00|OT SERVICES|
20|FH_F143903_06249_0|SrvcGrp|89024|2022|PDM|80.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F110263_0_0|SrvcGrp|89404|2022|PDM|12703.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F42312_0_0|SrvcGrp|35798|2022|PCT|0.90|99|0.00|DDI VIDEX|
20|FH_F129768_0_0|SrvcGrp|111385|2022|PCT|1.50|99|0.00|PATHOLOGY|
20|FH_F39286_0_0|SrvcGrp|15123|2022|PCT|0.82|99|0.00|CARDIAC CATH LAB OP SVCS|
20|FH_F110220_0_0|SrvcGrp|92190|2022|PDM|693.80|99|0.00|CPT 95810  (HCFA)|
20|FH_F41665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38377_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F116188_72211_0|SrvcGrp|73842|2022|PDM|207.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F92276_32308_0|SrvcGrp|20926|2022|PDM|55125.00|99|0.00|MS DRG 235 ONLY|
20|FH_F38392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MOD 26 (100%)|
20|FH_F125011_74467_0|SrvcGrp|79786|2022|PCT|0.63|99|0.00|SLEEP STUDIES|
20|FH_F118703_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F110925_01104_0|SrvcGrp|86145|2022|PDM|48.27|99|0.00|ESTERASE CINRYZE|
20|FH_F143891_19808_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37863_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|ANESTHESIA SVCS - OBSTETRIC|
20|FH_F34454_0_0|SrvcGrp|9832|2022|PDM|84.50|99|0.00|ST SVCS|
20|FH_F148260_0_0|SrvcGrp|27347|2022|PDM|4426.00|99|0.00|CPT 58558|
20|FH_F141527_36830_0|SrvcGrp|22589|2022|PDM|35.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 5  (NO REV)|
20|FH_F145544_93536_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F149866_07401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131277_29340_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148255_72703_0|SrvcGrp|86833|2022|PDM|10.50|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F129656_15005_0|SrvcGrp|106904|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F139551_0_0|SrvcGrp|63466|2022|PDM|1654.00|99|0.00|CPT 52005|
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)|
20|FH_F135236_02840_0|SrvcGrp|111930|2022|PDM|73.60|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F149863_68127_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116697_11703_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F36154_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F145800_22003_0|SrvcGrp|48398|2022|PDM|84.00|99|0.00|PT SERVICES|
20|FH_F131176_28712_0|SrvcGrp|93339|2022|PDM|15.00|99|0.00|AETNA MED NUTRITION GROUP|
20|FH_F148260_0_0|SrvcGrp|115349|2022|PDM|14871.00|99|0.00|HYSTERECTOMY|
20|FH_F150462_30458_0|SrvcGrp|17006|2022|PDM|50.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS|
20|FH_F145538_34997_0|SrvcGrp|75419|2022|PDM|424.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F118057_47906_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114976_78539_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129627_06037_0|SrvcGrp|90707|2022|PDM|165.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F129305_45614_0|SrvcGrp|75545|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F82714_18848_0|SrvcGrp|113740|2022|PCT|4.14|99|0.00|LABORATORY SERVICES|
20|FH_F71945_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F135165_15728_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F36433_0_0|CSTM-ALL|CSTM-00|2020|PDM|2812.00|99|0.00|MSDRG 243, 249 CV SURGERY|
20|FH_F82173_72712_0|SrvcGrp|111978|2022|PDM|251.00|99|0.00|HOME HEALTH VISIT|
20|FH_F51074_0_0|SrvcGrp|80|2022|PDM|607.00|99|0.00|ACUTE PSYCH|
20|FH_F71185_0_0|SrvcGrp|58618|2022|PCT|0.49|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F67101_0_0|SrvcGrp|62722|2022|PCT|0.90|99|0.00|TRAUMA WITH ER|
20|FH_F82173_72712_0|SrvcGrp|96124|2022|PCT|0.80|99|0.00|AETNA LAND AMBULANCE|
20|FH_F84778_0_0|SrvcGrp|72994|2022|PDM|1733.00|99|0.00|AEG 3|
20|FH_F122687_0_0|SrvcGrp|100072|2022|PDM|3825.00|99|0.00|SHORTEN RADIUS/ULNA|
20|FH_F150982_0_0|SrvcGrp|27348|2022|PDM|4371.00|99|0.00|OP SURGERY (CPT 58662)|
20|FH_F118249_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F127415_45822_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F88254_33411_0|SrvcGrp|17016|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F130551_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132579_0_0|SrvcGrp|14494|2022|PDM|15.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F129397_17847_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136510_0_0|SrvcGrp|95819|2022|PDM|3881.00|99|0.00|GONIOTOMY|
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|690.00|99|0.00|AEG 2 (NO REV)|
20|FH_F37945_0_0|CSTM-ALL|CSTM-00|2020|PDM|2817.00|99|0.00|ASPG IX|
20|FH_F33521_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F115669_07652_0|SrvcGrp|106263|2022|PDM|420.00|99|0.00|AETNA PARTIAL HOSP PSYCH|
20|FH_F51192_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F38526_0_0|SrvcGrp|23928|2022|PDM|5900.00|99|0.00|ABDOMINAL LAPAROSCOPIC PROCEDURES|
20|FH_F135840_0_0|SrvcGrp|79578|2022|PDM|550.00|99|0.00|CPT 43246|
20|FH_F130721_04769_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F130755_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS|
20|FH_F124369_0_0|SrvcGrp|107985|2022|PDM|8415.00|99|0.00|DECOMPRESSION OF TIBIA NERVE|
20|FH_F91171_0_0|SrvcGrp|88599|2022|PDM|783.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F114800_68510_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145641_06902_0|SrvcGrp|99171|2022|PDM|3504.00|99|0.00|CPT 28485|
20|FH_F143624_73069_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F111725_33066_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG X|
20|FH_F150165_06032_0|SrvcGrp|111956|2022|PDM|2140.00|99|0.00|MALE GENITAL PROCEDURES|
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|1168.16|99|0.00|ASPG VIII|
20|FH_F148186_0_0|SrvcGrp|13681|2022|PDM|247.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F83995_16748_0|SrvcGrp|107734|2022|PDM|4582.00|99|0.00|VAGINAL DELIVERY|
20|FH_F76022_0_0|SrvcGrp|11258|2022|PCT|0.85|99|0.00|DRUGS|
20|FH_F114823_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143568_85006_0|SrvcGrp|38247|2022|PCT|2.23|99|0.00|SLEEP STUDIES|
20|FH_F121225_98902_0|SrvcGrp|81340|2022|PCT|0.85|99|0.00|AETNA LABORATORY|
20|FH_F83380_0_0|SrvcGrp|72960|2022|PDM|105.00|99|0.00|REVENUE 642 AND HCPCS S5522|
20|FH_F146400_71860_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2409.00|99|0.00|AEG 7 (NO REV)|
20|FH_F130327_03867_0|SrvcGrp|27969|2022|PDM|28.56|99|0.00|HOME HEALTH AIDE|
20|FH_F134327_12853_0|SrvcGrp|76501|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F110343_38139_0|SrvcGrp|86748|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F121687_04401_0|SrvcGrp|90643|2022|PCT|1.38|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F122243_30655_0|SrvcGrp|109035|2022|PDM|267.00|99|0.00|INTENSIVE OP EATING DISORDER|
20|FH_F121476_0_0|SrvcGrp|108837|2022|PDM|8595.00|99|0.00|AUD OSSEO DEV INT/EXT COMP|
20|FH_F134371_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|OP SVCS|
20|FH_F49552_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ST CHARLES LAB MOD QW|
20|FH_F134993_75034_0|SrvcGrp|86723|2022|PDM|380.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F111702_07652_0|SrvcGrp|87902|2022|PCT|1.00|99|0.00|CEFTRIAXON SOD PER 250MG/8MX|
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 8 (NO REV)|
20|FH_F127545_45227_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F134610_33426_0|SrvcGrp|3178|2022|PDM|1240.00|99|0.00|ACUTE PSYCH|
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 2 (NO REV)|
20|FH_F142376_0_0|SrvcGrp|113972|2022|PDM|462.00|99|0.00|DRAIN CEREBRO SPINAL FLUID|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|338.66|99|0.00|HAPA WPA-NWPA 2012-13 ASC 109 W/O REV|
20|FH_F146586_71602_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135657_27612_0|SrvcGrp|89149|2022|PDM|198.00|99|0.00|OP INTENSIVE|
20|FH_F110341_81212_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149061_44122_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (BREAKOUT)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1533.57|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1406 W/O REV|
20|FH_F120737_45877_0|SrvcGrp|107861|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F145604_14850_0|SrvcGrp|73742|2022|PDM|7.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
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_F106822_0_0|SrvcGrp|100251|2022|PDM|57.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (2.6 - 7.5 CM)|
20|FH_F67984_0_0|SrvcGrp|3810|2022|PDM|130.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F122688_19904_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F86872_15215_0|SrvcGrp|29023|2022|PDM|69.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F86872_15215_0|SrvcGrp|97951|2022|PCT|1.00|99|0.00|AETNA AMFS DEFAULT BIOSCRIP|
20|FH_F86991_15122_0|SrvcGrp|72990|2022|PDM|384.00|99|0.00|AEG 1|
20|FH_F63129_0_0|SrvcGrp|48399|2022|PDM|30.00|99|0.00|SPEECH THERAPY|
20|FH_F134608_18017_0|SrvcGrp|58464|2022|PCT|1.00|99|0.00|J-CODES|
20|FH_F129548_44130_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F83380_0_0|SrvcGrp|44704|2022|PDM|105.00|99|0.00|NURSING CARE|
20|FH_F85764_33308_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)|
20|FH_F130329_64114_0|SrvcGrp|86843|2022|PDM|34.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F114404_73044_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD RR KF"|
20|FH_F127686_67432_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124161_95932_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F103220_0_0|SrvcGrp|99147|2022|PDM|3850.00|99|0.00|BIOPSY BREAST MASTECTOMY|
20|FH_F85415_27612_0|SrvcGrp|73700|2022|PDM|36.80|99|0.00|AETNA - SKILLED NURSING|
20|FH_F113428_19446_0|SrvcGrp|472|2022|PDM|477.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F84132_48026_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F31595_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS|
20|FH_F143571_0_0|SrvcGrp|90478|2022|PDM|153.00|99|0.00|HOSPICE|
20|FH_F50477_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146421_72758_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F96700_02135_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F110466_06870_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F125244_0_0|SrvcGrp|104751|2022|PDM|3700.00|99|0.00|REPAIR RECTUM & VAGINA|
20|FH_F133815_46526_0|SrvcGrp|106977|2022|PCT|0.00|99|0.00|RHOGAM INJECTION|
20|FH_F36552_0_0|SrvcGrp|18212|2022|PDM|8425.00|99|0.00|MS DRG 280|
20|FH_F150160_01301_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F113322_38119_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F83978_66739_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F130364_01331_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148547_01908_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F84132_48026_0|SrvcGrp|72996|2022|PDM|906.00|99|0.00|AEG 4|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU KL"|
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|599.00|99|0.00|AEG 2 (NO REV)|
20|FH_F126003_79403_0|SrvcGrp|46903|2022|PDM|696.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F112665_0_0|SrvcGrp|98495|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F139747_06241_0|SrvcGrp|75545|2022|PDM|435.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F90501_71101_0|SrvcGrp|13990|2022|PCT|0.37|99|0.00|PACEMAKER|
20|FH_F135670_01749_0|SrvcGrp|86830|2022|PDM|45.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F37877_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|(LAB) OCN F/S PRICING: ALL|
20|FH_F90391_33774_0|SrvcGrp|76501|2022|PDM|278.25|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F110905_54452_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F120719_27540_0|SrvcGrp|16|2022|PDM|1742.00|99|0.00|ACUTE REHABILITATION|
20|FH_F109264_33431_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F141347_52807_0|SrvcGrp|89149|2022|PDM|301.00|99|0.00|OP INTENSIVE|
20|FH_F134593_60007_0|SrvcGrp|86851|2022|PDM|48.00|99|0.00|HCPCS S9363 (HCFA)|
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_F148439_0_0|SrvcGrp|73483|2022|PCT|0.00|99|0.00|AETNA SUBACUTE III|
20|FH_F77943_0_0|SrvcGrp|8950|2022|PDM|5906.72|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F142930_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F117300_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F133585_0_0|SrvcGrp|112386|2022|PDM|195.00|99|0.00|CONTRAST X-RAY EXAM OF AORTA (HCFA)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|118.56|99|0.00|HAPA WPA-NWPA 2012-13 ASC 137 W/O REV|
20|FH_F90500_32446_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135626_20176_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F51934_0_0|SrvcGrp|48393|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES (PER HOUR)|
20|FH_F40635_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F148923_71854_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F126555_44906_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F132969_84003_0|SrvcGrp|14944|2022|PDM|2.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 642|
20|FH_F125124_0_0|SrvcGrp|79594|2022|PDM|2259.00|99|0.00|CPT 45380|
20|FH_F145642_15108_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F134371_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F138026_46143_0|SrvcGrp|108484|2022|PDM|675.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F70804_0_0|SrvcGrp|8962|2022|PDM|69.23|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F38567_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|ACUTE PSYCH|
20|FH_F143650_0_0|SrvcGrp|83839|2022|PDM|4100.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F54592_0_0|SrvcGrp|10538|2022|PDM|90.00|99|0.00|NURSING CARE|
20|FH_F122532_46385_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F85012_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F100907_85206_0|SrvcGrp|9861|2022|PDM|1529.00|99|0.00|ACUTE REHABILITATION|
20|FH_F32411_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130775_61701_0|SrvcGrp|58509|2022|PDM|350.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F110184_0_0|SrvcGrp|15860|2022|PDM|800.00|99|0.00|SUB-ACUTE REHAB|
20|FH_F121597_30315_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F120207_0_0|SrvcGrp|84180|2022|PDM|3914.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS|
20|FH_F118147_33801_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F130017_02302_0|SrvcGrp|113041|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.61|99|0.00|HAPA WPA-NWPA 2012-13 ASC 120 W/O REV|
20|FH_F148186_0_0|SrvcGrp|2067|2022|PDM|823.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|982.00|99|0.00|AEG 10 (NO REV)|
20|FH_F116849_0_0|SrvcGrp|12514|2022|PDM|550.00|99|0.00|TRANSITIONAL LIVING CENTER|
20|FH_F110346_38501_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F83113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F125260_0_0|SrvcGrp|27969|2022|PCT|0.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132599_0_0|SrvcGrp|87077|2022|PDM|115.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F146207_73139_0|SrvcGrp|80918|2022|PDM|134.00|99|0.00|RESPITE CARE|
20|FH_F132883_31602_0|SrvcGrp|22593|2022|PDM|20.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F73125_0_0|SrvcGrp|48394|2022|PDM|7.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F149660_0_0|SrvcGrp|13681|2022|PDM|173.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F81483_0_0|SrvcGrp|14614|2022|PDM|6345.00|99|0.00|LITHOTRIPSY|
20|FH_F133972_27103_0|SrvcGrp|112493|2022|PDM|336.00|99|0.00|CHEMOTHERAPY ADMINISTRATION  (HCFA)|
20|FH_F114506_15946_0|SrvcGrp|471|2022|PDM|612.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F126157_34210_0|SrvcGrp|73842|2022|PDM|241.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F127526_62917_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134618_14892_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F138302_15701_0|SrvcGrp|46104|2022|PDM|50.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F121476_0_0|SrvcGrp|108845|2022|PDM|2100.00|99|0.00|STENT COATED/COVERED|
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 9 (NO REV)|
20|FH_F150165_06032_0|SrvcGrp|101522|2022|PDM|9290.00|99|0.00|T1H W/T/O UTERUS (>250G)|
20|FH_F133749_84604_0|SrvcGrp|112441|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY (HCFA)|
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|559.97|99|0.00|AEG 1 (NO REV)|
20|FH_F110268_02891_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F90232_15126_0|SrvcGrp|22593|2022|PDM|56.70|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F109367_32751_0|SrvcGrp|105819|2022|PDM|1300.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F84552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|78.80|99|0.00|HAPA WPA-NWPA 2012-13 ASC 317 W/O REV|
20|FH_F120719_27540_0|SrvcGrp|10364|2022|PDM|2017.00|99|0.00|CPT CODE 99284|
20|FH_F146399_0_0|SrvcGrp|107749|2022|PDM|182.00|99|0.00|CAPD/CCPD|
20|FH_F118123_67226_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F100782_0_0|SrvcGrp|105102|2022|PDM|199.15|99|0.00|WINDBER MEDICAL CNTR ASC 147|
20|FH_F119107_22601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F133767_61254_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120715_83440_0|SrvcGrp|75505|2022|PCT|0.96|99|0.00|CARDIAC STUDIES|
20|FH_F110442_98003_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133972_27103_0|SrvcGrp|21920|2022|PDM|35.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F114444_19602_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F89358_64735_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100680_43130_0|SrvcGrp|73659|2022|PDM|5336.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F149159_53220_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93219_26354_0|SrvcGrp|46605|2022|PDM|99.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F138302_15701_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F100063_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F116506_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F119864_63141_0|SrvcGrp|48398|2022|PDM|105.00|99|0.00|PT SERVICES|
20|FH_F109577_0_0|SrvcGrp|95660|2022|PDM|855.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F111349_0_0|SrvcGrp|472|2022|PDM|496.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143581_02130_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116753_0_0|SrvcGrp|12253|2022|PDM|7465.00|99|0.00|LAPAROSCOPIC APPENDECTOMY|
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|493.00|99|0.00|AEG 2 (NO REV)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121628_19533_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1041.76|99|0.00|HAPA WPA-NWPA 2012-13 ASC 703 W/O REV|
20|FH_F125328_0_0|SrvcGrp|82301|2022|PDM|2233.50|99|0.00|HEMORRHOIDECTOMY|
20|FH_F121225_98902_0|SrvcGrp|17013|2022|PDM|105.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F59872_0_0|SrvcGrp|14187|2022|PDM|875.00|99|0.00|MRI|
20|FH_F111064_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F133957_84121_0|SrvcGrp|88621|2022|PDM|60.75|99|0.00|SKILLED NURSING LPN|
20|FH_F120698_75082_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136359_0_0|SrvcGrp|104481|2022|PDM|2450.00|99|0.00|ECHO GUIDE FOR BIOPSY|
20|FH_F124173_66215_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F127090_45601_0|SrvcGrp|103379|2022|PDM|15.30|99|0.00|HOME INJECTABLE THERAPY, GROWTH HORMONE|
20|FH_F134328_13088_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F125328_0_0|SrvcGrp|42472|2022|PDM|11371.50|99|0.00|CPT 58670|
20|FH_F88744_71103_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F54592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129101_27006_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F84712_0_0|SrvcGrp|72990|2022|PDM|1640.00|99|0.00|AEG 1|
20|FH_F70607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F72963_0_0|SrvcGrp|3409|2022|PDM|565.00|99|0.00|NEWBORN NURSERY|
20|FH_F85314_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80064_0_0|SrvcGrp|32703|2022|PDM|1900.00|99|0.00|ICU|
20|FH_F146654_80524_0|SrvcGrp|75419|2022|PDM|740.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F146798_44011_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146846_73139_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116088_46410_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F131698_01862_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F131596_60433_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121887_53144_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121930_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F38564_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|100% ASP NEBRASKA|
20|FH_F38607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F66711_0_0|SrvcGrp|62537|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F39907_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116323_0_0|SrvcGrp|88740|2022|PDM|19303.00|99|0.00|SP BONE ALGRFT|
20|FH_F73231_0_0|SrvcGrp|29826|2022|PCT|0.95|99|0.00|AWP  J & Q CODES|
20|FH_F85039_0_0|SrvcGrp|75493|2022|PDM|1070.00|99|0.00|AEG 8|
20|FH_F100640_48097_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F100640_48097_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F105591_17601_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F123774_0_0|SrvcGrp|73006|2022|PDM|1338.00|99|0.00|AEG 9|
20|FH_F102041_35010_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F39209_0_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F40471_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138929_0_0|SrvcGrp|108260|2022|PDM|1320.00|99|0.00|AETNA FIXATION OF KNEE JOINT|
20|FH_F132988_0_0|SrvcGrp|107008|2022|PDM|4493.01|99|0.00|REMOVAL OF BONE FOR GRAFT|
20|FH_F128027_0_0|SrvcGrp|64720|2022|PDM|1260.00|99|0.00|CPT 45385|
20|FH_F120901_0_0|SrvcGrp|102420|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F32769_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149719_0_0|SrvcGrp|107747|2022|PDM|550.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F43536_0_0|SrvcGrp|97|2022|PDM|1959.00|99|0.00|C-SECTION|
20|FH_F115971_0_0|SrvcGrp|72994|2022|PDM|569.00|99|0.00|AEG 3|
20|FH_F146972_17931_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146974_19709_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F64819_0_0|SrvcGrp|19886|2022|PDM|13342.00|99|0.00|MS DRG 466-468 ONLY|
20|FH_F44341_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F91998_0_0|SrvcGrp|83641|2022|PDM|1734.00|99|0.00|CPT 29889|
20|FH_F127995_84010_0|SrvcGrp|86839|2022|PDM|25.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F136570_32084_0|SrvcGrp|46903|2022|PDM|625.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F114666_30342_0|SrvcGrp|105633|2022|PDM|4000.00|99|0.00|LENGTHENING OF FEMUR|
20|FH_F139372_34698_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138052_19462_0|SrvcGrp|90635|2022|PDM|117.00|99|0.00|AETNA PSYTX PT & FAMILY 60 MINUTES|
20|FH_F148424_01440_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148553_85016_0|SrvcGrp|115449|2022|PDM|2750.00|99|0.00|REMOVE & REPLACE PM GEN DUAL LEAD|
20|FH_F132595_0_0|SrvcGrp|941|2022|PDM|3092.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F122610_73139_0|SrvcGrp|109154|2022|PDM|219.00|99|0.00|INTENSIVE OP MENTAL HEALTH & CHEMICAL DEP|
20|FH_F122885_39571_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F43412_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|PARTIAL HOSPITAL|
20|FH_F43444_0_0|SrvcGrp|18932|2022|PDM|1300.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806|
20|FH_F43693_0_0|SrvcGrp|13811|2022|PDM|257.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F134670_95628_0|SrvcGrp|89149|2022|PDM|330.00|99|0.00|OP INTENSIVE|
20|FH_F134733_19460_0|SrvcGrp|112632|2022|PCT|1.30|99|0.00|OP THERAPY SERVICES|
20|FH_F134742_52806_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136820_65483_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136913_68803_0|SrvcGrp|31707|2022|PDM|37881.00|99|0.00|MS DRG 793 ONLY|
20|FH_F112378_60505_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F38331_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1086154 REG W MED CTR LAB W/MOD TC|
20|FH_F116393_07002_0|SrvcGrp|106506|2022|PDM|77.98|99|0.00|STRAPING OF KNEE|
20|FH_F147619_72034_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F147620_67119_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41463_0_0|SrvcGrp|34167|2022|PDM|126.00|99|0.00|RESPIRATORY THERAPY VISIT|
20|FH_F43872_0_0|SrvcGrp|474|2022|PDM|248.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F91331_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|1730.00|99|0.00|AEG 10 (NO REV)|
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_F113250_71901_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117820_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131501_0_0|SrvcGrp|80317|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F47462_0_0|SrvcGrp|27172|2022|PDM|130.00|99|0.00|PHYSICAL THERAPY SVCS- RE EVAL|
20|FH_F138658_75022_0|SrvcGrp|89417|2022|PDM|350.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F127207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.88|99|0.00|HAPA WPA-NWPA 2012-13 ASC 8 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|859.29|99|0.00|HAPA WPA-NWPA 2012-13 ASC 502 W/O REV|
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PDM|1795.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F113527_31023_0|SrvcGrp|44564|2022|PDM|637.00|99|0.00|NEWBORN NURSERY|
20|FH_F132163_17601_0|SrvcGrp|93337|2022|PDM|360.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F132258_45404_0|SrvcGrp|19742|2022|PDM|71.00|99|0.00|MID-LINE INSERTION|
20|FH_F123193_33431_0|SrvcGrp|75419|2022|PDM|600.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F40073_0_0|SrvcGrp|17067|2022|PDM|1419.00|99|0.00|ASPG II|
20|FH_F135350_60014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135407_62320_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135440_32561_0|SrvcGrp|90854|2022|PDM|800.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F135440_32561_0|SrvcGrp|89417|2022|PDM|450.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F135477_50501_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135507_02859_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F135583_17331_0|SrvcGrp|3378|2022|PCT|0.82|99|0.00|OBSERVATION SVCS|
20|FH_F136086_63701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136186_46307_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130847_53098_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131132_44077_0|SrvcGrp|88157|2022|PDM|22889.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34266_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|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_F121704_90405_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|2370.00|99|0.00|ASPG VIII|
20|FH_F141651_0_0|SrvcGrp|107058|2022|PDM|3575.00|99|0.00|PARTIAL REMOVAL OF TONGUE|
20|FH_F148243_0_0|SrvcGrp|79588|2022|PDM|650.00|99|0.00|CPT 43235|
20|FH_F43137_0_0|SrvcGrp|36972|2022|PCT|1.00|99|0.00|SIGNATURE INFUSION PHARMACY|
20|FH_F36344_0_0|SrvcGrp|10646|2022|PDM|110.00|99|0.00|MIDLINE INSERTION KIT|
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|2015.71|99|0.00|AEG 6 (NO REV)|
20|FH_F130249_62034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|3042.00|99|0.00|AEG 7 (NO REV)|
20|FH_F102960_50613_0|SrvcGrp|67942|2022|PDM|347.00|99|0.00|NUTRITNAL CNSLNG/DIABETES EDU|
20|FH_F39080_0_0|SrvcGrp|30060|2022|PDM|5400.00|99|0.00|NORMAL DELIVERY|
20|FH_F42715_0_0|SrvcGrp|592|2022|PDM|717.00|99|0.00|SUB-ACUTE CARE|
20|FH_F98625_08103_0|CSTM-ALL|CSTM-00|2020|PCT|0.38|99|0.00|OP SVCS|
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1527.00|99|0.00|AEG 8 (NO REV)|
20|FH_F100681_73104_0|SrvcGrp|73605|2022|PDM|2171.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F134192_0_0|SrvcGrp|106799|2022|PDM|3500.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F92516_0_0|SrvcGrp|72996|2022|PDM|636.00|99|0.00|AEG 4|
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|1632.00|99|0.00|AEG 7 (NO REV)|
20|FH_F100906_0_0|SrvcGrp|92676|2022|PCT|0.00|99|0.00|IMAGING ENHANCED SUBSTANCE|
20|FH_F139689_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|1277.00|99|0.00|AEG 5  (NO REV)|
20|FH_F114064_0_0|SrvcGrp|73004|2022|PDM|1237.00|99|0.00|AEG 8|
20|FH_F90136_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F87474_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: ALL|
20|FH_F136467_0_0|SrvcGrp|84102|2022|PDM|910.00|99|0.00|AEG 2 W/O CPT 64721|
20|FH_F149179_0_0|SrvcGrp|36591|2022|PDM|3900.00|99|0.00|CPT 63685|
20|FH_F46832_0_0|SrvcGrp|17004|2022|PDM|73.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS|
20|FH_F123848_03257_0|SrvcGrp|43569|2022|PDM|154.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F121250_47401_0|SrvcGrp|94879|2022|PDM|88.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F63316_0_0|SrvcGrp|3810|2022|PDM|170.48|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F120520_54401_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93360_64730_0|SrvcGrp|92807|2022|PDM|430.00|99|0.00|AETNA RESIDENTIAL TREATMENT PYCH & CD (AGE 13-17)|
20|FH_F134122_45255_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134159_80228_0|SrvcGrp|75419|2022|PDM|575.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F137033_87108_0|SrvcGrp|30089|2022|PDM|450.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F137036_60504_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F137147_75006_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F142314_19102_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F142547_70002_0|SrvcGrp|14947|2022|PDM|3.00|99|0.00|HOME INFUSION|
20|FH_F142690_31774_0|SrvcGrp|16750|2022|PDM|196.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142730_20646_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 2 (NO REV)|
20|FH_F138575_66053_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140338_40475_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140343_89052_0|SrvcGrp|112596|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140570_46996_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|GENERAL ACUTE CARE|
20|FH_F140753_75038_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F149663_45219_0|SrvcGrp|103971|2022|PDM|2511.00|99|0.00|AETNA KNEE ARTHROSCOPY & REPAIR|
20|FH_F151600_17866_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151601_89118_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118789_92211_0|SrvcGrp|75419|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F118959_44830_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F38332_0_0|SrvcGrp|131|2022|PCT|0.50|99|0.00|PACEMAKER DEVICE|
20|FH_F70665_0_0|SrvcGrp|17139|2022|PDM|803.00|99|0.00|HOSPICE CARE|
20|FH_F117261_43543_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F147879_93309_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F147803_33952_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F129427_92262_0|SrvcGrp|73605|2022|PDM|1200.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F117221_23434_0|SrvcGrp|471|2022|PDM|575.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|AEG 6 (NO REV)|
20|FH_F137927_52241_0|SrvcGrp|87537|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F39538_0_0|SrvcGrp|13551|2022|PDM|607.00|99|0.00|NEWBORN NURSERY|
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)|
20|FH_F112080_0_0|SrvcGrp|35669|2022|PDM|6000.00|99|0.00|CPT 63650|
20|FH_F91472_96001_0|SrvcGrp|103756|2022|PCT|0.40|99|0.00|IMPLANT HEART ASSIST SYSTEM|
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|837.16|99|0.00|ASPG VI|
20|FH_F132544_0_0|SrvcGrp|97139|2022|PDM|7850.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F137951_0_0|SrvcGrp|11673|2022|PDM|4326.00|99|0.00|CPT 29888|
20|FH_F148548_37909_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F133021_00910_0|SrvcGrp|112268|2022|PDM|17000.00|99|0.00|THROMBOENDARTERECTOMY|
20|FH_F117733_91362_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F142810_77087_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41461_0_0|SrvcGrp|526|2022|PDM|1350.00|99|0.00|CARDIAC CARE UNIT|
20|FH_F134497_47126_0|SrvcGrp|89023|2022|PDM|70.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F102062_35447_0|SrvcGrp|90065|2022|PDM|20.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F36973_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|53.67|99|0.00|CPT 95805 (W/MOD 26)|
20|FH_F143027_16504_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|549.00|99|0.00|AEG 1 (NO REV)|
20|FH_F104963_15146_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130108_0_0|SrvcGrp|15363|2022|PCT|0.60|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F97182_21502_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146376_53188_0|SrvcGrp|46903|2022|PDM|2123.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F97562_29803_0|SrvcGrp|73603|2022|PDM|6005.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F148494_0_0|SrvcGrp|114173|2022|PDM|3000.00|99|0.00|CARDIAC CATHERIZATION INCL INJECTIONS|
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|1580.00|99|0.00|AEG 5  (NO REV)|
20|FH_F128605_20910_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148899_44041_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F66839_0_0|SrvcGrp|13985|2022|PDM|49.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F38394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F87577_80016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F133251_89521_0|SrvcGrp|73842|2022|PDM|234.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.33|99|0.00|ASPG III|
20|FH_F87155_04105_0|SrvcGrp|43571|2022|PDM|68.29|99|0.00|MID-LINE INSERTION|
20|FH_F125033_93305_0|SrvcGrp|86722|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F50495_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F37562_0_0|SrvcGrp|10540|2022|PDM|52.00|99|0.00|HOME HEALTH AIDE|
20|FH_F151520_44134_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F103360_68845_0|SrvcGrp|73501|2022|PDM|3623.00|99|0.00|AETNA OBSERVATION|
20|FH_F142897_07018_0|SrvcGrp|113995|2022|PCT|1.00|99|0.00|IMMUNIZATION ADMINISTRATION|
20|FH_F136393_0_0|SrvcGrp|91577|2022|PDM|12000.00|99|0.00|FEM/POPL REVASC STNT & ATHER|
20|FH_F40350_0_0|SrvcGrp|9795|2022|PDM|975.00|99|0.00|SUBACUTE REHAB|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PDM|115.23|99|0.00|NEWBORN HEARING TEST|
20|FH_F144011_60616_0|CSTM-ALL|CSTM-00|2020|PDM|4899.00|99|0.00|AEG 8 (NO REV)|
20|FH_F37640_0_0|CSTM-ALL|CSTM-00|2020|PDM|1520.00|99|0.00|ASPG IX|
20|FH_F150039_34236_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117835_14551_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117555_72802_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F36118_0_0|SrvcGrp|9830|2022|PDM|102.00|99|0.00|OT SVCS|
20|FH_F133021_00910_0|SrvcGrp|112303|2022|PDM|2300.00|99|0.00|MRI GUIDANCE BX|
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|ASPG VII|
20|FH_F112632_66207_0|SrvcGrp|31931|2022|PDM|925.00|99|0.00|SKILLED NURSING CARE|
20|FH_F149781_37404_0|SrvcGrp|92007|2022|PDM|8699.00|99|0.00|PROXIMAL HUMERAL|
20|FH_F115289_90057_0|SrvcGrp|86722|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F92833_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|746.90|99|0.00|AEG 2 (NO REV)|
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1285.00|99|0.00|AEG 10 (NO REV)|
20|FH_F120757_83843_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F128492_49010_0|SrvcGrp|33722|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F109642_80501_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F65899_0_0|SrvcGrp|941|2022|PDM|2850.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F94165_0_0|SrvcGrp|73501|2022|PCT|0.85|99|0.00|AETNA OBSERVATION|
20|FH_F92677_08003_0|SrvcGrp|22592|2022|PDM|63.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F141872_20707_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F57592_0_0|SrvcGrp|28167|2022|PDM|99000.00|99|0.00|MS DRG 231 ONLY|
20|FH_F143030_02895_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120437_85202_0|SrvcGrp|14945|2022|PDM|11.26|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 1 (NO REV)|
20|FH_F57592_0_0|SrvcGrp|53603|2022|PDM|25000.00|99|0.00|MS DRG 494 ONLY|
20|FH_F147995_67037_0|CSTM-ALL|CSTM-00|2020|PDM|3497.00|99|0.00|AEG 6 (NO REV)|
20|FH_F42355_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|ACUTE PSYCH|
20|FH_F118496_92627_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F41785_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F150528_78644_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146241_91326_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132934_63005_0|SrvcGrp|75506|2022|PCT|0.71|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F141790_85374_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: BREAKOUT|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|83.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION MOD AJ (HCFA)|
20|FH_F71594_15644_0|SrvcGrp|29611|2022|PDM|125.00|99|0.00|VENTILATOR SUPPORT|
20|FH_F89851_83854_0|SrvcGrp|88277|2022|PCT|1.80|99|0.00|PT/OT/ST|
20|FH_F148881_33018_0|SrvcGrp|73485|2022|PDM|950.00|99|0.00|AETNA REHAB|
20|FH_F132032_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F68622_0_0|SrvcGrp|13927|2022|PCT|0.80|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|491.00|99|0.00|AEG 2 (NO REV)|
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_F139607_0_0|SrvcGrp|107695|2022|PDM|1613.00|99|0.00|LAPAROSCOPY SERVICES|
20|FH_F142041_44846_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F75202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F91937_0_0|SrvcGrp|26001|2022|PDM|131.83|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F120954_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F128472_53129_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1565.00|99|0.00|AEG 9 (NO REV)|
20|FH_F97201_15068_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120437_85202_0|SrvcGrp|86840|2022|PDM|77.66|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F90935_29073_0|SrvcGrp|89337|2022|PDM|400.00|99|0.00|DETOXIFICATION|
20|FH_F49637_0_0|SrvcGrp|13526|2022|PCT|1.00|99|0.00|CPT CODES 80000-89999 - (LAB)|
20|FH_F37042_0_0|SrvcGrp|17073|2022|PDM|1196.00|99|0.00|ASPG V|
20|FH_F148555_0_0|SrvcGrp|115498|2022|PDM|5522.00|99|0.00|TX ATRIAL FIB PULM VEIN ISOL|
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1262.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F150522_95864_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F77787_0_0|CSTM-ALL|CSTM-00|2020|PDM|1494.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34706_0_0|SrvcGrp|13501|2022|PDM|12218.00|99|0.00|DRG 533 ONLY|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|329.42|99|0.00|ASPG 107|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|456.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 209 W/O REV|
20|FH_F103281_32086_0|SrvcGrp|77979|2022|PCT|0.51|99|0.00|THERAPY|
20|FH_F144011_60616_0|SrvcGrp|113186|2022|PCT|1.21|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F47479_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F111526_32226_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F47970_0_0|SrvcGrp|97711|2022|PDM|750.00|99|0.00|COLONOSCOPY|
20|FH_F133287_40215_0|SrvcGrp|112326|2022|PCT|0.28|99|0.00|HIGH COST DRUGS|
20|FH_F132934_63005_0|SrvcGrp|10107|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F48935_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F148880_26807_0|SrvcGrp|73701|2022|PDM|81.20|99|0.00|AETNA - SKILLED NURSING|
20|FH_F151083_66223_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151144_35801_0|SrvcGrp|110848|2022|PDM|915.43|99|0.00|REPAIR OF ENTROPION|
20|FH_F151155_26508_0|SrvcGrp|113340|2022|PDM|43.26|99|0.00|TAKE HOME METHADONE|
20|FH_F151204_24073_0|SrvcGrp|75419|2022|PDM|410.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F139707_84010_0|SrvcGrp|36864|2022|PDM|5295.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F150839_03833_0|SrvcGrp|48394|2022|PDM|67.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 7 (NO REV)|
20|FH_F114207_35243_0|SrvcGrp|17013|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F147176_17701_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F101441_0_0|SrvcGrp|97239|2022|PDM|7946.00|99|0.00|DISKECTOMY CERVICAL SINGLE|
20|FH_F74845_0_0|SrvcGrp|61197|2022|PCT|1.15|99|0.00|IVG|
20|FH_F134432_85053_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F134871_28205_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F150313_78666_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F131498_0_0|SrvcGrp|83519|2022|PDM|100.00|99|0.00|HOSPICE CARE (ALL OTHER)|
20|FH_F127886_62930_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147160_80260_0|SrvcGrp|111556|2022|PDM|153.00|99|0.00|GROUP PSYCHOTHERAPY (HCFA)|
20|FH_F36826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147229_60523_0|SrvcGrp|57968|2022|PDM|43.24|99|0.00|CONTINUOUS HOMECARE|
20|FH_F131175_06757_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F147082_02359_0|SrvcGrp|87441|2022|PDM|504.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1525.00|99|0.00|AEG 5  (NO REV)|
20|FH_F130661_04441_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F138478_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134919_02155_0|SrvcGrp|23683|2022|PDM|52.50|99|0.00|SKILLED NURSING RN|
20|FH_F151619_73505_0|SrvcGrp|75481|2022|PDM|516.00|99|0.00|AEG 2|
20|FH_F133087_61107_0|SrvcGrp|107267|2022|PDM|280.00|99|0.00|HEMODIALYSIS|
20|FH_F150950_17522_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124760_34997_0|SrvcGrp|16069|2022|PDM|716.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F37304_0_0|SrvcGrp|919|2022|PDM|119.00|99|0.00|OP URGENT CARE|
20|FH_F146266_0_0|SrvcGrp|92013|2022|PDM|2280.00|99|0.00|REPAIR OF COLLATERAL LIGAMENT|
20|FH_F35056_0_0|SrvcGrp|28177|2022|PDM|2550.00|99|0.00|ASPG SURG UNGROUPABLE|
20|FH_F73485_0_0|SrvcGrp|46424|2022|PDM|15.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F38676_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F124466_32724_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37312_0_0|SrvcGrp|14402|2022|PDM|44.00|99|0.00|HOME HEALTH AIDE|
20|FH_F40561_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36743_0_0|SrvcGrp|23929|2022|PCT|0.65|99|0.00|HIGH COST DRUGS|
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|1254.00|99|0.00|ASPG V|
20|FH_F149023_44122_0|SrvcGrp|93724|2022|PDM|1237.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F117617_80439_0|SrvcGrp|107593|2022|PDM|165.00|99|0.00|HOSPICE CARE PROV INPT HOSP (HCFA)|
20|FH_F124322_64131_0|SrvcGrp|88621|2022|PDM|73.00|99|0.00|SKILLED NURSING LPN|
20|FH_F37777_0_0|SrvcGrp|36233|2022|PDM|390.00|99|0.00|STROKE, NEURO DAY TREATMENT|
20|FH_F97084_91911_0|SrvcGrp|88977|2022|PDM|10669.00|99|0.00|C-SECTION DELIVERY|
20|FH_F124526_05301_0|SrvcGrp|88905|2022|PDM|1252.00|99|0.00|PSYCHIATRIC CARE (AGE 0-17)|
20|FH_F115483_62002_0|SrvcGrp|112967|2022|PCT|1.55|99|0.00|LABORATORY SERVICES|
20|FH_F35527_0_0|SrvcGrp|16496|2022|PDM|900.00|99|0.00|POLYSOMNOGRAPHY - CPAP|
20|FH_F98860_96706_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F76826_0_0|SrvcGrp|10933|2022|PDM|6956.00|99|0.00|LITHOTRIPSY|
20|FH_F117629_06514_0|SrvcGrp|471|2022|PDM|725.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F35088_0_0|SrvcGrp|413|2022|PCT|0.75|99|0.00|TRANSPLANT SVCS|
20|FH_F71064_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|OCN F/S PRICING: ALL (SOURCE AA W/ NO REDUCTIONS)|
20|FH_F38372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MS DRG 005-006 LIVER TRANSPLANT|
20|FH_F37342_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F116806_0_0|SrvcGrp|107057|2022|PDM|887.26|99|0.00|EXCIS TONGUE LESION|
20|FH_F36036_0_0|SrvcGrp|57363|2022|PDM|1450.00|99|0.00|CPT CODE 93229|
20|FH_F128536_88240_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116583_0_0|SrvcGrp|106925|2022|PDM|650.00|99|0.00|HOSPICE IN INPT PSYCH (HCFA)|
20|FH_F90232_15126_0|SrvcGrp|13929|2022|PDM|14.18|99|0.00|GROWTH HORMONE|
20|FH_F114206_37203_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110725_48047_0|SrvcGrp|86722|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F84433_0_0|SrvcGrp|46104|2022|PDM|107.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F134394_92101_0|SrvcGrp|112560|2022|PDM|414.00|99|0.00|INTENSIVE OP (12-17 YRS) (HCFA)|
20|FH_F40497_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F131418_75215_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F56232_0_0|CSTM-ALL|CSTM-00|2020|PDM|1714.61|99|0.00|ASPG VII|
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|2497.00|99|0.00|AEG 4 (NO REV)|
20|FH_F39151_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F151699_01752_0|SrvcGrp|22589|2022|PDM|45.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F132099_67487_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122841_0_0|SrvcGrp|28551|2022|PDM|2497.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F134887_33409_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)|
20|FH_F134410_46807_0|SrvcGrp|90397|2022|PDM|1750.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F84833_17109_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|AEG 6 (NO REV)|
20|FH_F140131_62870_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140187_61061_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140231_60540_0|SrvcGrp|75419|2022|PDM|591.22|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F143347_16001_0|CSTM-ALL|CSTM-00|2020|PDM|3719.00|99|0.00|AETNA OP PET SCANS (PET)|
20|FH_F143412_70503_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F143536_47546_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130914_51103_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F131093_49690_0|SrvcGrp|95661|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F116683_64730_0|SrvcGrp|104847|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116698_07470_0|SrvcGrp|86846|2022|PDM|39.38|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F116698_07470_0|SrvcGrp|106973|2022|PCT|1.00|99|0.00|OP AMFS(H) DEFAULT W/O HH|
20|FH_F116904_17543_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|AEG 8 (NO REV)|
20|FH_F83292_0_0|SrvcGrp|59163|2022|PCT|1.00|99|0.00|OP SURGICAL ANCILLARY SERVICES|
20|FH_F120974_27607_0|CSTM-ALL|CSTM-00|2020|PDM|10686.00|99|0.00|AEG 7 (NO REV)|
20|FH_F125479_17501_0|SrvcGrp|91065|2022|PDM|96.09|99|0.00|PSYCHIATRIC CPT 90853 (HCFA)|
20|FH_F118879_93063_0|SrvcGrp|73701|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F84611_30281_0|SrvcGrp|73501|2022|PCT|0.73|99|0.00|AETNA OBSERVATION|
20|FH_F84611_30281_0|SrvcGrp|82076|2022|PDM|989.00|99|0.00|TOMOGRAPHY PROCEDURE|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|981.00|99|0.00|ASPG I|
20|FH_F33522_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46257_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F143973_28040_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F139515_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2007 DME DBL MODIFIERS - UE/KC|
20|FH_F38034_0_0|SrvcGrp|3188|2022|PDM|852.00|99|0.00|NEWBORN NURSERY|
20|FH_F120365_30043_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125899_07645_0|SrvcGrp|72994|2022|PDM|5182.00|99|0.00|AEG 3|
20|FH_F129415_69361_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F55552_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F97104_53545_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
20|FH_F141355_63134_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145815_30540_0|SrvcGrp|82981|2022|PDM|165.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F33782_0_0|SrvcGrp|14112|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 288-290 ACUTE & SUBACUTE ENDOCARDITIS|
20|FH_F129968_98004_0|SrvcGrp|89149|2022|PDM|300.00|99|0.00|OP INTENSIVE|
20|FH_F82955_34266_0|SrvcGrp|10944|2022|PCT|0.66|99|0.00|EMERGENCY ROOM|
20|FH_F111288_0_0|SrvcGrp|87844|2022|PDM|22542.00|99|0.00|LAPARASCOPY - GASTRIC|
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F127826_65583_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|75.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F51733_0_0|SrvcGrp|45944|2022|PDM|46.00|99|0.00|HOME HEALTH AIDE SVCS|
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 4 (NO REV)|
20|FH_F38090_0_0|SrvcGrp|43|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F76171_0_0|SrvcGrp|73521|2022|PDM|48.00|99|0.00|RESPIRATORY THERAPY HOURLY|
20|FH_F148182_23324_0|SrvcGrp|46605|2022|PDM|84.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F129782_0_0|CSTM-ALL|CSTM-00|2020|PDM|1841.00|99|0.00|AEG 8 (NO REV)|
20|FH_F128272_60640_0|SrvcGrp|86842|2022|PDM|45.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F125074_18104_0|SrvcGrp|48385|2022|PDM|118.65|99|0.00|SPEECH THERAPY|
20|FH_F90492_0_0|SrvcGrp|73849|2022|PDM|325.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F143834_06511_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F100762_51104_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F124018_75067_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|962.00|99|0.00|AEG 10 (NO REV)|
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130013_16509_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F141801_80534_0|SrvcGrp|89149|2022|PDM|275.00|99|0.00|OP INTENSIVE|
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG X|
20|FH_F36918_0_0|SrvcGrp|19963|2022|PDM|1950.00|99|0.00|LAP HERNIORRHAPY|
20|FH_F130985_0_0|SrvcGrp|11606|2022|PDM|1450.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)|
20|FH_F70984_0_0|CSTM-ALL|CSTM-00|2020|PDM|2287.00|99|0.00|COVENTRY ENHANCED GROUPER 9 GA NO CRESCENT|
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|1840.00|99|0.00|ASPG 7 HEARTLAND HEALTHCARE|
20|FH_F37659_0_0|CSTM-ALL|CSTM-00|2020|PDM|274.00|99|0.00|CD SVCS|
20|FH_F129656_15005_0|SrvcGrp|29077|2022|PDM|180.00|99|0.00|HOME TRANSFUSION|
20|FH_F130551_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138020_20016_0|SrvcGrp|14560|2022|PDM|782.25|99|0.00|ER|
20|FH_F99960_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133671_89102_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F145536_90265_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F123320_43558_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F39819_0_0|SrvcGrp|31231|2022|PDM|6887.00|99|0.00|NY DRG 359 ONLY|
20|FH_F89563_29407_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F148122_49435_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F118910_0_0|SrvcGrp|97506|2022|PDM|126.18|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F93881_15009_0|SrvcGrp|92405|2022|PDM|4087.00|99|0.00|PERQ LUMBOSACRAL INJECTION|
20|FH_F130051_31707_0|CSTM-ALL|CSTM-00|2020|PDM|5050.00|99|0.00|AEG 4 (NO REV)|
20|FH_F90362_0_0|SrvcGrp|72996|2022|PDM|721.00|99|0.00|AEG 4|
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|960.00|99|0.00|AEG 6 (NO REV)|
20|FH_F32935_0_0|SrvcGrp|118|2022|PDM|1339.00|99|0.00|LONG-TERM CARE|
20|FH_F71346_0_0|SrvcGrp|17140|2022|PDM|131.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F110925_01104_0|SrvcGrp|40695|2022|PDM|5.10|99|0.00|ENTERAL FEEDING SUPPLY KIT, GRAVITY|
20|FH_F149839_80002_0|SrvcGrp|66264|2022|PDM|115.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F141801_80534_0|SrvcGrp|86723|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F97104_53545_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F140581_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F122433_0_0|SrvcGrp|82109|2022|PDM|725.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|3400.00|99|0.00|ASPG VIII|
20|FH_F44177_0_0|SrvcGrp|30135|2022|PDM|6634.00|99|0.00|LAP SURGERY|
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131220_08062_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|GENERAL ACUTE CARE|
20|FH_F128992_90808_0|SrvcGrp|89417|2022|PDM|550.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F42706_0_0|SrvcGrp|18006|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY|
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 4 (NO REV)|
20|FH_F39943_0_0|SrvcGrp|115|2022|PDM|400.00|99|0.00|SKILLED NURSING CARE|
20|FH_F136092_0_0|SrvcGrp|83522|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F131002_40977_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F89563_29407_0|SrvcGrp|91294|2022|PCT|1.50|99|0.00|LINEZOLID INJECTION|
20|FH_F71945_0_0|SrvcGrp|9826|2022|PCT|0.65|99|0.00|OP SURGERY|
20|FH_F55054_0_0|SrvcGrp|51267|2022|PDM|32460.00|99|0.00|CARDIOVASCULAR SURGERY|
20|FH_F132372_0_0|SrvcGrp|82981|2022|PDM|193.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F35259_0_0|SrvcGrp|9826|2022|PCT|0.71|99|0.00|OP SURGERY|
20|FH_F118338_94952_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|ASPG III|
20|FH_F92276_32308_0|SrvcGrp|73485|2022|PDM|2903.00|99|0.00|AETNA REHAB|
20|FH_F97500_32025_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F110925_01104_0|SrvcGrp|78197|2022|PDM|222.03|99|0.00|AETNA ECULIZUMAB INJECTION|
20|FH_F131176_28712_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F86332_75081_0|SrvcGrp|77511|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F42573_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141527_36830_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F148221_06477_0|SrvcGrp|66264|2022|PDM|89.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F110220_0_0|SrvcGrp|103927|2022|PDM|169.04|99|0.00|SLEEP STUDY UNATTENDED(HCFA)|
20|FH_F32704_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F115010_20105_0|SrvcGrp|22529|2022|PDM|329.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F91622_0_0|SrvcGrp|1306|2022|PDM|390.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F102184_0_0|SrvcGrp|88163|2022|PDM|5296.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F99960_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122433_0_0|SrvcGrp|27402|2022|PDM|1150.00|99|0.00|LASER PROCEDURES|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S NV - MOD RR|
20|FH_F109581_0_0|SrvcGrp|75479|2022|PDM|663.00|99|0.00|AEG 1|
20|FH_F93332_0_0|SrvcGrp|93085|2022|PDM|7416.00|99|0.00|SPINAL DISK SURGERY ADD-ON (HCFA)|
20|FH_F148254_89503_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63095_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F63419_0_0|SrvcGrp|11232|2022|PDM|285.00|99|0.00|PARTIAL HOSPITALIZATION|
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_F37970_0_0|SrvcGrp|592|2022|PDM|1241.00|99|0.00|SUB-ACUTE CARE|
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PDM|4800.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F98002_27103_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F146559_71901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F134615_38478_0|SrvcGrp|46903|2022|PDM|900.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|457.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F112665_0_0|SrvcGrp|95559|2022|PDM|7215.00|99|0.00|HIP JOINT|
20|FH_F148643_71343_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F114823_15701_0|SrvcGrp|89417|2022|PDM|250.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F114444_19602_0|SrvcGrp|104419|2022|PDM|85.00|99|0.00|OFFICE/OUTPATIENT VISIT EST (MOD AF)|
20|FH_F89176_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|ASPG II|
20|FH_F110341_81212_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150165_06032_0|SrvcGrp|106267|2022|PDM|6180.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL|
20|FH_F83754_0_0|SrvcGrp|107733|2022|PDM|4216.00|99|0.00|CESAREAN SECTION|
20|FH_F52713_0_0|SrvcGrp|26690|2022|PDM|134802.00|99|0.00|MS DRG 215 ONLY|
20|FH_F69604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119763_17402_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F143742_60410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAMPTON ROADS GAST MOD TC|
20|FH_F149105_66215_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133748_77081_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F99528_0_0|CSTM-ALL|CSTM-00|2020|PCT|48.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F81483_0_0|SrvcGrp|29369|2022|PDM|6345.00|99|0.00|CPT 28890|
20|FH_F145641_06902_0|SrvcGrp|34605|2022|PDM|4229.00|99|0.00|CPT 28299|
20|FH_F149084_33401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149261_75457_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144848_0_0|SrvcGrp|64761|2022|PDM|3700.00|99|0.00|DISCECTOMY|
20|FH_F90594_63304_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F143581_02130_0|SrvcGrp|471|2022|PDM|638.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146657_01105_0|SrvcGrp|114668|2022|PDM|7.74|99|0.00|HLTH BHV IVNTJ GRP EA ADDL (MOD U1)|
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|3697.10|99|0.00|AEG 7 (NO REV)|
20|FH_F133957_84121_0|SrvcGrp|88620|2022|PDM|85.50|99|0.00|SKILLED NURSING RN|
20|FH_F133972_27103_0|SrvcGrp|22389|2022|PDM|30.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F121225_98902_0|SrvcGrp|29076|2022|PCT|0.85|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F121225_98902_0|SrvcGrp|55742|2022|PCT|1.13|99|0.00|RESPIRATORY ASSIST DEVICE|
20|FH_F133920_64057_0|SrvcGrp|29346|2022|PDM|40.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F113276_38506_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|701.32|99|0.00|AEG 1 (NO REV)|
20|FH_F129638_0_0|SrvcGrp|109057|2022|PCT|0.00|99|0.00|CARDIAC STUDIES|
20|FH_F143742_60410_0|SrvcGrp|3378|2022|PCT|0.64|99|0.00|OBSERVATION SVCS|
20|FH_F119783_46360_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150165_06032_0|SrvcGrp|33987|2022|PDM|1185.00|99|0.00|CPT 57522|
20|FH_F85353_16407_0|SrvcGrp|63850|2022|PDM|430.69|99|0.00|HAPA WPA-NWPA 2012-13 ASC 224|
20|FH_F80186_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88744_71103_0|SrvcGrp|73806|2022|PDM|532.00|99|0.00|AETNA ER|
20|FH_F127157_43614_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F134613_08852_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|2436.00|99|0.00|AEG 9 (NO REV)|
20|FH_F131613_0_0|SrvcGrp|16|2022|PDM|1050.00|99|0.00|ACUTE REHABILITATION|
20|FH_F133749_84604_0|SrvcGrp|92138|2022|PDM|85.50|99|0.00|SKILLED NURSING RN|
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|AEG 5  (NO REV)|
20|FH_F119567_04072_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120743_44116_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F145604_14850_0|SrvcGrp|86835|2022|PDM|35.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F113345_25301_0|SrvcGrp|537|2022|PCT|0.70|99|0.00|OBSERVATION SERVICES|
20|FH_F87571_0_0|SrvcGrp|31074|2022|PDM|240.00|99|0.00|MS DRG 795 ONLY|
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|432.00|99|0.00|AEG 2 (NO REV)|
20|FH_F98021_07012_0|SrvcGrp|73659|2022|PDM|5472.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F145942_72019_0|SrvcGrp|46903|2022|PDM|489.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F93219_26354_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F58396_0_0|SrvcGrp|42825|2022|PDM|84.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F131127_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F133747_80634_0|SrvcGrp|79699|2022|PCT|0.92|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F146702_70508_0|SrvcGrp|79720|2022|PDM|1020.60|99|0.00|ACUTE REHAB II|
20|FH_F125440_04043_0|SrvcGrp|73841|2022|PDM|397.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F116088_46410_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F131853_24017_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133581_84790_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F111602_17102_0|SrvcGrp|90854|2022|PDM|654.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F139428_65270_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139649_40108_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150766_33952_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149023_44122_0|SrvcGrp|93807|2022|PDM|6895.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F137767_01841_0|SrvcGrp|73602|2022|PDM|1375.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F128366_32901_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F151027_16652_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F138017_73129_0|SrvcGrp|75506|2022|PCT|1.57|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F122393_76020_0|SrvcGrp|46903|2022|PDM|489.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F117737_75001_0|CSTM-ALL|CSTM-00|2020|PCT|1.65|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F36743_0_0|SrvcGrp|43|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|VERTICAL PLUS MRI OP SERVICES MOD 53|
20|FH_F38742_0_0|SrvcGrp|10542|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F90817_0_0|SrvcGrp|87769|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F36036_0_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|RN VISIT|
20|FH_F52513_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F102525_73134_0|SrvcGrp|73000|2022|PDM|1894.00|99|0.00|AEG 6|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|30.50|99|0.00|ZEMAIRA THERAPY (MOD KP/SC/SH)|
20|FH_F74845_0_0|SrvcGrp|13292|2022|PCT|1.15|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F151699_01752_0|SrvcGrp|86851|2022|PDM|45.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F39450_0_0|SrvcGrp|177|2022|PDM|1268.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F125207_32904_0|SrvcGrp|103817|2022|PCT|1.00|99|0.00|DISPOSABLEEXT URETHRAL DEV|
20|FH_F81312_0_0|SrvcGrp|29092|2022|PCT|1.00|99|0.00|AMBULANCE SVCS|
20|FH_F76522_0_0|SrvcGrp|23585|2022|PCT|0.45|99|0.00|IMPLANTS|
20|FH_F138016_19808_0|CSTM-ALL|CSTM-00|2020|PDM|318.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F111035_30535_0|SrvcGrp|90101|2022|PDM|0.25|99|0.00|AETNA MED RECORD COPY|
20|FH_F126189_89129_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F90055_33805_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F35904_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F112045_90301_0|SrvcGrp|10393|2022|PDM|6728.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F115483_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|AEG 9 (NO REV)|
20|FH_F97480_08204_0|SrvcGrp|73603|2022|PDM|8391.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F35990_0_0|SrvcGrp|23477|2022|PDM|5219.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F110785_10040_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F148964_30101_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F86714_0_0|SrvcGrp|34868|2022|PDM|182.99|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F34914_0_0|SrvcGrp|16116|2022|PDM|80.00|99|0.00|PT/OT/ST|
20|FH_F130182_0_0|SrvcGrp|111517|2022|PDM|79.00|99|0.00|INJECT PULM ART HRT CATH|
20|FH_F128197_84123_0|SrvcGrp|94781|2022|PDM|112.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|ANTIBIOTIC THERAPY Q3 (MOD SH)|
20|FH_F123745_0_0|SrvcGrp|67066|2022|PDM|4000.00|99|0.00|CERVICAL SURGERY|
20|FH_F150961_89169_0|SrvcGrp|29346|2022|PDM|40.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F110783_93013_0|SrvcGrp|22592|2022|PDM|35.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F120848_20912_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F37864_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|OCN F/S PRICING: ALL|
20|FH_F125656_92868_0|SrvcGrp|24754|2022|PDM|12.50|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F149403_69210_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F141287_14830_0|SrvcGrp|3378|2022|PDM|3300.00|99|0.00|OBSERVATION SVCS|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|100% 2007 MEDICARE TN DME  MOD 53|
20|FH_F134847_0_0|SrvcGrp|68000|2022|PDM|3054.00|99|0.00|CPT 58561|
20|FH_F151699_01752_0|SrvcGrp|14948|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F130331_0_0|SrvcGrp|57967|2022|PDM|140.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F45226_0_0|SrvcGrp|11089|2022|PDM|40.00|99|0.00|NURSING CARE|
20|FH_F120118_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144831_0_0|SrvcGrp|48394|2022|PDM|48.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F110783_93013_0|SrvcGrp|86847|2022|PDM|35.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F124433_77338_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F147082_02359_0|SrvcGrp|72602|2022|PDM|504.00|99|0.00|ECT|
20|FH_F149641_87113_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150930_64485_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117762_0_0|SrvcGrp|98003|2022|PDM|3640.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F128753_32501_0|SrvcGrp|73602|2022|PCT|0.64|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F117711_73080_0|SrvcGrp|105480|2022|PCT|1.55|99|0.00|RADIOLOGY SERVICES|
20|FH_F56712_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F151029_52241_0|SrvcGrp|83683|2022|PCT|0.00|99|0.00|ACUTE REHAB II|
20|FH_F140127_64131_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140268_17960_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143494_34474_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F75305_0_0|SrvcGrp|15052|2022|PCT|1.90|99|0.00|RADIOLOGY SVCS|
20|FH_F101700_0_0|SrvcGrp|98102|2022|PDM|42.41|99|0.00|DRAIN INJ JOING/BURSA W/US|
20|FH_F112448_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F145702_22192_0|SrvcGrp|48398|2022|PDM|84.00|99|0.00|PT SERVICES|
20|FH_F146474_78572_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125124_0_0|SrvcGrp|79589|2022|PDM|1923.00|99|0.00|UPPER GI|
20|FH_F120719_27540_0|SrvcGrp|941|2022|PDM|3652.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F49601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F120484_31419_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F149517_0_0|SrvcGrp|104226|2022|PDM|198.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F112672_11788_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F54592_0_0|SrvcGrp|10545|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F87053_0_0|SrvcGrp|24714|2022|PCT|1.00|99|0.00|INTRAOCULAR LENS|
20|FH_F72963_0_0|SrvcGrp|29817|2022|PDM|4850.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F102200_06416_0|SrvcGrp|24761|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F102200_06416_0|SrvcGrp|97950|2022|PCT|1.00|99|0.00|AETNA ANCD DEFAULT BIOSCRIP|
20|FH_F105143_26062_0|SrvcGrp|79561|2022|PDM|6064.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F115870_98225_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F66782_0_0|SrvcGrp|10527|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F80513_0_0|SrvcGrp|12342|2022|PCT|0.74|99|0.00|IMPLANTS|
20|FH_F146668_30189_0|SrvcGrp|33982|2022|PDM|4850.00|99|0.00|CPT 28296|
20|FH_F115298_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F126783_80021_0|SrvcGrp|108061|2022|PCT|0.70|99|0.00|OP THERAPY SERVICES|
20|FH_F116040_24637_0|SrvcGrp|14947|2022|PDM|30.00|99|0.00|HOME INFUSION|
20|FH_F116056_73018_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F35212_0_0|SrvcGrp|12401|2022|PDM|85.50|99|0.00|RN VISIT|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|272.03|99|0.00|DELAWARE VALLEY- ASC 213|
20|FH_F97720_70084_0|SrvcGrp|73559|2022|PDM|9586.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F97740_01605_0|SrvcGrp|73656|2022|PDM|577.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F33421_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.10|99|0.00|GENERAL ACUTE CARE|
20|FH_F117442_0_0|SrvcGrp|92502|2022|PDM|573.47|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F115204_0_0|SrvcGrp|30089|2022|PDM|455.28|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F114916_30309_0|SrvcGrp|41325|2022|PDM|2200.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F104840_32565_0|SrvcGrp|83824|2022|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES|
20|FH_F104840_32565_0|SrvcGrp|81779|2022|PCT|0.69|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F138929_0_0|SrvcGrp|71666|2022|PDM|13520.00|99|0.00|CPT 63655|
20|FH_F134270_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 9 (NO REV)|
20|FH_F128027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130310_66604_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F58932_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141047_23661_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F64579_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126345_0_0|SrvcGrp|38364|2022|PDM|2278.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F33635_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F77944_0_0|CSTM-ALL|CSTM-00|2020|PDM|4625.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F147017_35976_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38047_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F132864_71101_0|SrvcGrp|73603|2022|PDM|797.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F127995_84010_0|SrvcGrp|24761|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F97040_31901_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F56693_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F123620_0_0|SrvcGrp|106294|2022|PDM|285.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F100787_69162_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136681_60004_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136736_65483_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F114645_34952_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F114666_30342_0|SrvcGrp|89989|2022|PDM|3500.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F114783_70810_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113809_47302_0|SrvcGrp|93919|2022|PDM|544.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F138456_33543_0|SrvcGrp|89149|2022|PDM|217.00|99|0.00|OP INTENSIVE|
20|FH_F100664_03104_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F81893_23114_0|SrvcGrp|11577|2022|PDM|982.00|99|0.00|DIALYSIS|
20|FH_F132595_0_0|SrvcGrp|112077|2022|PDM|44461.00|99|0.00|CV SURGERY|
20|FH_F122610_73139_0|SrvcGrp|109155|2022|PDM|966.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)|
20|FH_F134694_94945_0|SrvcGrp|75419|2022|PDM|650.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F134727_30650_0|SrvcGrp|10107|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F136786_25302_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F136796_24016_0|CSTM-ALL|CSTM-00|2020|PDM|2408.13|99|0.00|AEG 8 (NO REV)|
20|FH_F136831_78728_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F112187_98272_0|SrvcGrp|13807|2022|PDM|100.00|99|0.00|OBSERVATION SVCS|
20|FH_F45573_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91263_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115210_21043_0|SrvcGrp|54943|2022|PDM|3077.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F115210_21043_0|SrvcGrp|76604|2022|PDM|2016.00|99|0.00|CPT 25447|
20|FH_F147389_81632_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F147519_52627_0|CSTM-ALL|CSTM-00|2020|PDM|3956.51|99|0.00|AEG 10 (NO REV)|
20|FH_F147526_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147699_83704_0|SrvcGrp|75419|2022|PDM|480.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F41463_0_0|SrvcGrp|17004|2022|PDM|80.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS|
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|838.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F41818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1479.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD AU RATE|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PDM|598.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F71165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129673_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|1417.00|99|0.00|AEG 3 (NO REV)|
20|FH_F38955_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F41013_0_0|SrvcGrp|31186|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC (DME)|
20|FH_F54552_0_0|SrvcGrp|17015|2022|PDM|19.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138658_75022_0|SrvcGrp|73841|2022|PDM|350.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138907_01040_0|SrvcGrp|82222|2022|PDM|170.00|99|0.00|HOSPICE CARE|
20|FH_F83792_0_0|SrvcGrp|74585|2022|PCT|0.68|99|0.00|AETNA OP IMPLANTS|
20|FH_F41236_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F101044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|529.09|99|0.00|HAPA WPA-NWPA 2012-13 ASC 303 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|43.75|99|0.00|HAPA WPA-NWPA 2012-13 ASC 10 W/O REV|
20|FH_F151404_71655_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151511_14094_0|SrvcGrp|3378|2022|PDM|2631.00|99|0.00|OBSERVATION SVCS|
20|FH_F151515_77901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132251_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135350_60014_0|SrvcGrp|88621|2022|PDM|115.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135371_61032_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135384_28714_0|SrvcGrp|22596|2022|PDM|175.95|99|0.00|HOSPICE CARE|
20|FH_F135924_02906_0|SrvcGrp|112225|2022|PDM|132.70|99|0.00|COVID-19 SPECIMEN COLLECTION|
20|FH_F135924_02906_0|SrvcGrp|110427|2022|PDM|2119.90|99|0.00|TRAUMA TEAM LEVEL 1|
20|FH_F135948_60471_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135978_06851_0|SrvcGrp|90550|2022|PDM|459.00|99|0.00|AETNA PARTIAL HOSPITALIZATION (<=18 YRS)|
20|FH_F119892_47586_0|SrvcGrp|43567|2022|PDM|90.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F130996_34110_0|SrvcGrp|89842|2022|PDM|14000.00|99|0.00|LUMBAR|
20|FH_F133468_74873_0|SrvcGrp|75419|2022|PDM|1250.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F34119_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101644_75116_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F134257_62681_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|2200.00|99|0.00|AEG 2 (NO REV)|
20|FH_F114166_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_F131000_0_0|SrvcGrp|44068|2022|PDM|3608.00|99|0.00|CPT 52332|
20|FH_F132328_0_0|SrvcGrp|67073|2022|PDM|5826.00|99|0.00|CPT 22851|
20|FH_F132328_0_0|SrvcGrp|109974|2022|PDM|2383.00|99|0.00|ELBOW ARTHROSCOPY / SURGERY|
20|FH_F132328_0_0|SrvcGrp|83640|2022|PDM|2049.00|99|0.00|CPT 29887|
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|513.00|99|0.00|2006 MEDICARE ASPG II|
20|FH_F72666_0_0|SrvcGrp|69683|2022|PDM|21762.00|99|0.00|CARDIOVASCULAR SURGERY MS DRG ONLY|
20|FH_F114569_0_0|SrvcGrp|105678|2022|PCT|1.00|99|0.00|AETNA BH TELEMEDICINE/OP THERAPY SVCS (MOD GT/AJ)|
20|FH_F112187_98272_0|SrvcGrp|113114|2022|PCT|0.81|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F102222_19720_0|SrvcGrp|86844|2022|PDM|31.50|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F101620_47401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39266_0_0|SrvcGrp|17419|2022|PDM|70.00|99|0.00|SPEECH THERAPY|
20|FH_F39272_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102948_43606_0|CSTM-ALL|CSTM-00|2020|PDM|434.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F140007_0_0|SrvcGrp|99073|2022|PDM|1.42|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F140007_0_0|SrvcGrp|96959|2022|PDM|3539.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F48772_66044_0|SrvcGrp|44042|2022|PDM|100.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F92516_0_0|SrvcGrp|72990|2022|PDM|336.00|99|0.00|AEG 1|
20|FH_F145508_0_0|SrvcGrp|80920|2022|PDM|956.15|99|0.00|HOSPICE SERVICES|
20|FH_F86851_0_0|SrvcGrp|84999|2022|PDM|676.00|99|0.00|CPT 45379|
20|FH_F89372_0_0|SrvcGrp|111201|2022|PDM|324.00|99|0.00|TRANSCRANIAL MAGNETIC STIMULATION|
20|FH_F89495_0_0|SrvcGrp|72990|2022|PDM|345.00|99|0.00|AEG 1|
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|156.40|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)|
20|FH_F87474_0_0|SrvcGrp|3810|2022|PDM|138.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F101814_0_0|CSTM-ALL|CSTM-00|2020|PCT|37.00|99|0.00|OP SVCS|
20|FH_F118152_20151_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118171_00674_0|SrvcGrp|72679|2022|PDM|55.00|99|0.00|ANESTHESIA SERVICES (HCFA)|
20|FH_F134113_61614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134155_07016_0|SrvcGrp|58509|2022|PDM|405.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F137147_75006_0|SrvcGrp|98271|2022|PDM|2940.00|99|0.00|ARTHROSCOPY|
20|FH_F137187_64015_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139751_84065_0|SrvcGrp|108484|2022|PDM|1300.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|921.00|99|0.00|AEG 10 (NO REV)|
20|FH_F97602_40121_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F125053_0_0|SrvcGrp|73000|2022|PDM|905.00|99|0.00|AEG 6|
20|FH_F140343_89052_0|SrvcGrp|17016|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F149563_75840_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149639_96822_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151600_17866_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151608_30236_0|SrvcGrp|100043|2022|PDM|13352.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F76144_0_0|CSTM-ALL|CSTM-00|2020|PDM|3371.64|99|0.00|ASPG IX F/S - BDSS|
20|FH_F117261_43543_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129434_98271_0|SrvcGrp|89337|2022|PDM|1326.00|99|0.00|DETOXIFICATION|
20|FH_F129448_43235_0|SrvcGrp|73700|2022|PDM|48.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F129511_44044_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F117107_33704_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117108_37841_0|SrvcGrp|75506|2022|PCT|0.30|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F117182_68127_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F117240_37334_0|SrvcGrp|75481|2022|PDM|1000.00|99|0.00|AEG 2|
20|FH_F137898_46540_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F109652_0_0|SrvcGrp|37918|2022|PDM|607.00|99|0.00|NUCLEAR MEDICINE SCAN|
20|FH_F110342_0_0|SrvcGrp|72994|2022|PDM|1140.00|99|0.00|AEG 3|
20|FH_F90671_33701_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F114567_43235_0|SrvcGrp|86747|2022|PCT|0.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F132544_0_0|SrvcGrp|80139|2022|PDM|8007.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F137951_0_0|SrvcGrp|113167|2022|PDM|1436.00|99|0.00|PERCUTANEOUS SKELETAL FIX|
20|FH_F137951_0_0|SrvcGrp|79757|2022|PDM|1436.00|99|0.00|ESOPHAGUS ENDOSCOPY REPAIR|
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88512_0_0|SrvcGrp|46521|2022|PDM|10889.63|99|0.00|SPINAL FUSION|
20|FH_F92676_15063_0|SrvcGrp|78950|2022|PDM|3100.68|99|0.00|MON VALLEY ASC 704|
20|FH_F144368_48315_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F97561_30030_0|SrvcGrp|73605|2022|PDM|2955.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F32870_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40350_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F137240_0_0|SrvcGrp|360|2022|PDM|2179.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F71162_0_0|SrvcGrp|43892|2022|PDM|67.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F133397_23233_0|SrvcGrp|112321|2022|PDM|770.00|99|0.00|CAT SCAN|
20|FH_F92531_0_0|SrvcGrp|89989|2022|PDM|3721.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F120390_91316_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F32779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F132594_78229_0|SrvcGrp|48398|2022|PDM|105.00|99|0.00|PT SERVICES|
20|FH_F111522_81067_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|360.30|99|0.00|HAPA WPA-NWPA 2012-13 ASC 111 W/O REV|
20|FH_F97160_77436_0|SrvcGrp|108484|2022|PDM|674.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F92676_15063_0|SrvcGrp|79082|2022|PDM|268.14|99|0.00|MON VALLEY ASC 143|
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_F149781_37404_0|CSTM-ALL|CSTM-00|2020|PDM|3556.00|99|0.00|AEG 10 (NO REV)|
20|FH_F138532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132999_19901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|129.00|99|0.00|PSYTX W PT 60 MINS (HCFA)|
20|FH_F144588_60090_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F142847_07003_0|SrvcGrp|113992|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|2408.00|99|0.00|AEG 9 (NO REV)|
20|FH_F89932_10940_0|SrvcGrp|41798|2022|PDM|8225.00|99|0.00|MS DRG 774-775 ONLY NORMAL DELIVERY|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PDM|162.00|99|0.00|NEBULIZER DME (MOD NU)|
20|FH_F128130_10027_0|SrvcGrp|3165|2022|PDM|2426.00|99|0.00|EMERGENCY ROOM|
20|FH_F118587_20721_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150024_08079_0|SrvcGrp|98326|2022|PDM|3630.00|99|0.00|PERQ LAMOT/LAM LUMBAR|
20|FH_F92676_15063_0|SrvcGrp|79009|2022|PDM|1024.88|99|0.00|MON VALLEY ASC 220|
20|FH_F40030_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F146211_68144_0|SrvcGrp|100007|2022|PDM|12473.00|99|0.00|FUSION OF ANKLE JOINT|
20|FH_F111815_35904_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35368_0_0|SrvcGrp|14197|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F123324_0_0|SrvcGrp|62963|2022|PCT|0.52|99|0.00|SURGICAL|
20|FH_F138532_0_0|SrvcGrp|113367|2022|PDM|182.00|99|0.00|CAPD/CCPD|
20|FH_F49637_0_0|CSTM-ALL|CSTM-00|2020|PDM|3696.00|99|0.00|OK SURGICAL HOSPITAL CVTY  ENHANCED GROUPER 6|
20|FH_F133005_32726_0|SrvcGrp|86729|2022|PCT|1.00|99|0.00|COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE|
20|FH_F98060_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F108700_63857_0|SrvcGrp|48394|2022|PDM|50.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F113586_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F124928_04210_0|SrvcGrp|95660|2022|PDM|643.69|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F150001_33064_0|SrvcGrp|86848|2022|PDM|26.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F120437_85202_0|SrvcGrp|86839|2022|PDM|76.51|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F146320_27610_0|CSTM-ALL|CSTM-00|2020|PDM|982.80|99|0.00|AEG 4 (NO REV)|
20|FH_F126942_39540_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F100661_63640_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F146320_27610_0|SrvcGrp|109488|2022|PDM|9260.00|99|0.00|VASC EMBOLIZE/OCCLUDE ARTERY|
20|FH_F144569_71055_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F125176_20785_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124608_0_0|SrvcGrp|74039|2022|PDM|5865.00|99|0.00|LAMINECTOMY|
20|FH_F149344_0_0|SrvcGrp|13597|2022|PDM|166.11|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F126858_43113_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F115274_15235_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40943_0_0|SrvcGrp|474|2022|PDM|260.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F145988_06105_0|CSTM-ALL|CSTM-00|2020|PDM|9616.00|99|0.00|AEG 6 (NO REV)|
20|FH_F33411_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F124928_04210_0|SrvcGrp|23683|2022|PDM|66.40|99|0.00|SKILLED NURSING RN|
20|FH_F118400_16701_0|SrvcGrp|471|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F111551_32825_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|631.00|99|0.00|AEG 9 (NO REV)|
20|FH_F44607_0_0|SrvcGrp|38803|2022|PDM|2750.00|99|0.00|ICU|
20|FH_F150948_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97061_85012_0|CSTM-ALL|CSTM-00|2020|PCT|0.37|99|0.00|OP SVCS|
20|FH_F100785_54660_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F37573_0_0|SrvcGrp|3069|2022|PCT|0.83|99|0.00|IMPLANTS|
20|FH_F126868_60451_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133168_62035_0|SrvcGrp|107861|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F67861_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F128120_76513_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148644_06890_0|SrvcGrp|34605|2022|PDM|4025.00|99|0.00|CPT 28299|
20|FH_F148761_33311_0|SrvcGrp|99459|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY EVALUATION|
20|FH_F148864_81303_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F151153_77591_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151155_26508_0|SrvcGrp|113341|2022|PDM|43.26|99|0.00|TAKE HOME METHADONE (HCFA)|
20|FH_F138467_32216_0|SrvcGrp|89337|2022|PDM|1288.00|99|0.00|DETOXIFICATION|
20|FH_F150839_03833_0|SrvcGrp|43569|2022|PDM|158.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F151039_16749_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F115483_62002_0|SrvcGrp|105480|2022|PCT|1.55|99|0.00|RADIOLOGY SERVICES|
20|FH_F86714_0_0|SrvcGrp|59098|2022|PDM|199.13|99|0.00|SPEECH THERAPY|
20|FH_F41363_0_0|CSTM-ALL|CSTM-00|2020|PDM|1335.00|99|0.00|ASPG VII|
20|FH_F141327_65566_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138987_0_0|SrvcGrp|97506|2022|PDM|125.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F97880_63501_0|SrvcGrp|73643|2022|PDM|2449.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F134738_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F148519_83201_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F144831_0_0|SrvcGrp|114180|2022|PDM|143.00|99|0.00|HOSPICE HOME HEALTH IN ASST LIVING|
20|FH_F117711_73080_0|SrvcGrp|75506|2022|PCT|1.55|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F37181_0_0|SrvcGrp|72|2022|PDM|487.00|99|0.00|NEWBORN NURSERY|
20|FH_F97603_77901_0|SrvcGrp|73656|2022|PDM|382.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F149585_46012_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148347_0_0|SrvcGrp|115377|2022|PDM|1980.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F134847_0_0|SrvcGrp|46887|2022|PDM|3486.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F129765_43015_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F38007_0_0|SrvcGrp|15457|2022|PDM|2500.00|99|0.00|PEDIATRIC IP SERVICES|
20|FH_F126116_0_0|SrvcGrp|104315|2022|PDM|390.00|99|0.00|EVALUATION CARDIO TILT TABL|
20|FH_F109470_15370_0|SrvcGrp|79458|2022|PDM|0.25|99|0.00|MED RECORD COPY|
20|FH_F149023_44122_0|SrvcGrp|115574|2022|PDM|3120.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL|
20|FH_F35557_0_0|SrvcGrp|10649|2022|PDM|4.00|99|0.00|HOME INFUSION|
20|FH_F35678_0_0|SrvcGrp|18189|2022|PDM|16952.00|99|0.00|MS DRG 023|
20|FH_F33504_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|TRAUMA CARE|
20|FH_F90817_0_0|SrvcGrp|91006|2022|PDM|7520.00|99|0.00|TOTAL HIP ARTHROPLASTY (HCFA)|
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|2398.00|99|0.00|AEG 6 (NO REV)|
20|FH_F113545_11201_0|SrvcGrp|89412|2022|PDM|295.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F134432_85053_0|SrvcGrp|89412|2022|PDM|502.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F130939_40353_0|SrvcGrp|73841|2022|PDM|381.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F36683_0_0|SrvcGrp|18886|2022|PDM|23413.00|99|0.00|MS DRG 234|
20|FH_F149539_06032_0|SrvcGrp|48394|2022|PDM|68.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F37267_0_0|SrvcGrp|12263|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142587_0_0|SrvcGrp|92501|2022|PDM|415.30|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|311.00|99|0.00|AEG 1 (NO REV)|
20|FH_F128543_44413_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F128924_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114207_35243_0|SrvcGrp|86832|2022|PDM|3.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F103109_33462_0|SrvcGrp|86722|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F40521_0_0|SrvcGrp|14197|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F144651_0_0|SrvcGrp|98560|2022|PDM|15000.00|99|0.00|LUMBAR|
20|FH_F131261_19111_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|VERTICAL PLUS MRI MOD KF|
20|FH_F132818_24701_0|SrvcGrp|100859|2022|PDM|161.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F94621_07728_0|SrvcGrp|94041|2022|PCT|1.00|99|0.00|GAMMA GLOBULIN  INTRAMUS 1CC|
20|FH_F138017_73129_0|SrvcGrp|112965|2022|PDM|4914.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126147_45241_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F35384_0_0|SrvcGrp|11083|2022|PDM|1117.00|99|0.00|NORMAL DELIVERY (MOTHER ONLY)|
20|FH_F150459_08021_0|SrvcGrp|84185|2022|PDM|133.00|99|0.00|RESPITE CARE|
20|FH_F122425_75082_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F128392_01026_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F35097_16508_0|SrvcGrp|99621|2022|PDM|50.00|99|0.00|OCCUPATIONAL THERAPY SVCS RE-EVAL|
20|FH_F138995_0_0|SrvcGrp|98402|2022|PDM|2150.00|99|0.00|RHINO INCL MJR SEPTAL RPR|
20|FH_F35056_0_0|SrvcGrp|13805|2022|PDM|3200.00|99|0.00|CARDIAC CATH LAB IP SVCS|
20|FH_F80834_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS|
20|FH_F150819_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98020_50138_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F76826_0_0|SrvcGrp|8960|2022|PDM|123.00|99|0.00|SPEECH THERAPY|
20|FH_F36883_0_0|SrvcGrp|98181|2022|PDM|484.64|99|0.00|OP BH OBSERVATION|
20|FH_F143201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|83646|2022|PDM|2753.00|99|0.00|CPT 31276|
20|FH_F34853_0_0|SrvcGrp|9937|2022|PDM|170.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F140143_24874_0|SrvcGrp|13262|2022|PDM|6.55|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F111723_0_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F141511_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49984_0_0|SrvcGrp|24289|2022|PDM|40.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F127418_0_0|SrvcGrp|67069|2022|PDM|24871.88|99|0.00|CPT 22634|
20|FH_F115982_0_0|SrvcGrp|35670|2022|PDM|12750.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F137798_0_0|SrvcGrp|104228|2022|PDM|743.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F98860_96706_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F136395_0_0|SrvcGrp|14188|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F132096_89118_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F35990_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F39772_0_0|SrvcGrp|97|2022|PDM|3713.00|99|0.00|C-SECTION|
20|FH_F115483_62002_0|SrvcGrp|113111|2022|PDM|7235.00|99|0.00|PACEMAKERS|
20|FH_F120100_98390_0|SrvcGrp|46903|2022|PDM|1208.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F41363_0_0|CSTM-ALL|CSTM-00|2020|PDM|447.00|99|0.00|ASPG I|
20|FH_F35567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE|
20|FH_F149019_34114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F56232_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139928_37228_0|SrvcGrp|86722|2022|PDM|276.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F140137_15235_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F84774_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F125249_0_0|SrvcGrp|11663|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F102920_0_0|SrvcGrp|72994|2022|PDM|985.00|99|0.00|AEG 3|
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 9 (NO REV)|
20|FH_F131093_49690_0|SrvcGrp|94780|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F136247_28804_0|SrvcGrp|58509|2022|PDM|329.02|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F136299_75218_0|CSTM-ALL|CSTM-00|2020|PDM|3090.00|99|0.00|AEG 3 (NO REV)|
20|FH_F116698_07470_0|SrvcGrp|88620|2022|PDM|63.00|99|0.00|SKILLED NURSING RN|
20|FH_F116907_75093_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F119918_38201_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F120948_53188_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118879_93063_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F41535_0_0|SrvcGrp|701|2022|PDM|1600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F44438_0_0|SrvcGrp|400|2022|PCT|0.70|99|0.00|NUCLEAR MEDICINE|
20|FH_F33925_0_0|SrvcGrp|18817|2022|PDM|22990.00|99|0.00|MS DRG 222|
20|FH_F35685_0_0|SrvcGrp|11212|2022|PDM|15435.00|99|0.00|DRG 556 PERCUTANEUS CV PX W/NON DRUG ELUTING STENT W/O MC DX|
20|FH_F150200_0_0|SrvcGrp|92364|2022|PDM|9020.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F150200_0_0|SrvcGrp|77461|2022|PDM|2865.00|99|0.00|CPT 52356|
20|FH_F50137_0_0|SrvcGrp|46244|2022|PDM|115.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F135173_06519_0|SrvcGrp|90854|2022|PDM|948.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F56136_0_0|SrvcGrp|31038|2022|PCT|0.85|99|0.00|MS DRG 233-234 ONLY|
20|FH_F129025_57451_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137454_64068_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F82871_33160_0|SrvcGrp|473|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120249_43215_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F42722_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 IP OBSERVATION >= 24 HOURS|
20|FH_F100761_02539_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F89563_29407_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38855_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141410_13045_0|SrvcGrp|111928|2022|PDM|56.44|99|0.00|COVID-19 BARTONELLA|
20|FH_F105680_0_0|SrvcGrp|75489|2022|PDM|1800.00|99|0.00|AEG 6|
20|FH_F93791_0_0|SrvcGrp|67065|2022|PDM|3675.00|99|0.00|CERVICAL SURGERY|
20|FH_F125463_50459_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37590_0_0|SrvcGrp|9829|2022|PDM|84.00|99|0.00|PT SVCS|
20|FH_F50218_0_0|SrvcGrp|46245|2022|PDM|120.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|2318.00|99|0.00|HERNIA PROCEDURES|
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|494.00|99|0.00|AEG 10 (NO REV)|
20|FH_F130716_76013_0|SrvcGrp|27968|2022|PDM|35.00|99|0.00|SKILLED NURSING LPN|
20|FH_F131254_92211_0|SrvcGrp|86854|2022|PDM|56.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F129656_15005_0|SrvcGrp|29076|2022|PDM|54.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F143743_26501_0|SrvcGrp|114052|2022|PCT|1.00|99|0.00|COVID-19 ADMIN|
20|FH_F56136_0_0|SrvcGrp|12659|2022|PCT|0.89|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F91321_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F137637_03103_0|SrvcGrp|108484|2022|PDM|450.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F33233_0_0|SrvcGrp|14593|2022|PDM|3402.00|99|0.00|NEURO - PSYCH EXAM|
20|FH_F109645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135237_31015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148203_60190_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F91622_0_0|CSTM-ALL|CSTM-00|2020|PDM|3130.00|99|0.00|AEG 8 (NO REV) ANTHONY MED CTR|
20|FH_F139551_0_0|SrvcGrp|67066|2022|PDM|13897.00|99|0.00|CERVICAL SURGERY|
20|FH_F143528_0_0|SrvcGrp|109966|2022|PDM|5250.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON|
20|FH_F115050_77995_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F110925_01104_0|SrvcGrp|34566|2022|PDM|59.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER NUKL|
20|FH_F52854_0_0|SrvcGrp|16441|2022|PDM|4419.00|99|0.00|EXCISION OF INTERVERTEGRAL DISC|
20|FH_F116065_06708_0|SrvcGrp|471|2022|PDM|575.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148892_0_0|SrvcGrp|110571|2022|PDM|668.00|99|0.00|NERVE BLOCK INJECTION 8|
20|FH_F121113_33613_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F127567_44070_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F90362_0_0|SrvcGrp|89941|2022|PDM|1109.00|99|0.00|ARTHROSCOPY PROCEDURES|
20|FH_F125028_19061_0|SrvcGrp|26868|2022|PDM|52.50|99|0.00|DIURETIC IV THERAPY|
20|FH_F92276_32308_0|CSTM-ALL|CSTM-00|2020|PDM|9975.00|99|0.00|AEG 3 (NO REV)|
20|FH_F91876_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149980_0_0|SrvcGrp|115788|2022|PDM|3480.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F90818_0_0|SrvcGrp|77450|2022|PDM|3200.00|99|0.00|CPT 54161|
20|FH_F124254_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40499_0_0|SrvcGrp|472|2022|PDM|528.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F40011_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OBSTETRICAL CARE|
20|FH_F141510_95123_0|SrvcGrp|73842|2022|PDM|325.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F33712_0_0|SrvcGrp|15399|2022|PCT|0.60|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F90362_0_0|SrvcGrp|27261|2022|PDM|11670.00|99|0.00|CPT 27446|
20|FH_F130747_0_0|SrvcGrp|88162|2022|PDM|8843.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F122926_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F80283_0_0|SrvcGrp|12403|2022|PDM|57.62|99|0.00|CONTINUOUS HOMECARE|
20|FH_F143809_62401_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F110086_21742_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|AEG 4 (NO REV)|
20|FH_F131228_01826_0|SrvcGrp|12491|2022|PCT|1.11|99|0.00|PACEMAKER|
20|FH_F130523_04605_0|SrvcGrp|105465|2022|PCT|0.84|99|0.00|AETNA THERAPIES|
20|FH_F143528_0_0|SrvcGrp|89861|2022|PDM|3360.00|99|0.00|LUMBAR LAMINOTOMY|
20|FH_F130145_98043_0|SrvcGrp|15423|2022|PCT|1.00|99|0.00|ENGERIX-B HEPATITIS B|
20|FH_F86332_75081_0|SrvcGrp|11784|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|1130.00|99|0.00|AEG 6 (NO REV)|
20|FH_F128186_43230_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|754.23|99|0.00|ASPG V|
20|FH_F88335_71019_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F135219_68506_0|SrvcGrp|75399|2022|PDM|0.10|99|0.00|MED RECORD COPY|
20|FH_F135259_21090_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F149140_07522_0|SrvcGrp|113228|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 4 TRGT|
20|FH_F100762_51104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F56137_0_0|SrvcGrp|52247|2022|PDM|95.00|99|0.00|CARDIAC REHAB|
20|FH_F139274_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 6 (NO REV)|
20|FH_F137573_33764_0|SrvcGrp|72602|2022|PDM|752.00|99|0.00|ECT|
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1365.00|99|0.00|AEG 7 (NO REV)|
20|FH_F116108_0_0|SrvcGrp|3809|2022|PDM|573.47|99|0.00|HOSPICE CARE|
20|FH_F130061_84097_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F143976_80504_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F71905_0_0|SrvcGrp|66480|2022|PDM|75.00|99|0.00|RN VISIT|
20|FH_F137367_89139_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F123844_0_0|SrvcGrp|80920|2022|PDM|706.00|99|0.00|HOSPICE SERVICES|
20|FH_F116984_28092_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F151526_28208_0|SrvcGrp|108075|2022|PDM|4143.00|99|0.00|AV FUSION / UPPER ARM VEIN|
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|ASPG I|
20|FH_F82173_72712_0|SrvcGrp|51470|2022|PDM|224.00|99|0.00|SOCIAL WORKER VISIT|
20|FH_F31218_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71927_0_0|SrvcGrp|16274|2022|PCT|1.00|99|0.00|ORGAN ACQUISITION|
20|FH_F40499_0_0|SrvcGrp|473|2022|PDM|429.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F106020_0_0|SrvcGrp|33967|2022|PDM|2364.00|99|0.00|CPT 47562|
20|FH_F130840_21738_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F129627_06037_0|SrvcGrp|80918|2022|PDM|170.00|99|0.00|RESPITE CARE|
20|FH_F116311_02657_0|SrvcGrp|86648|2022|PCT|1.12|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F139719_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F132374_0_0|SrvcGrp|11673|2022|PDM|2704.34|99|0.00|CPT 29888|
20|FH_F136756_0_0|SrvcGrp|72992|2022|PDM|558.80|99|0.00|AEG 2|
20|FH_F148355_37601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125249_0_0|SrvcGrp|108253|2022|PDM|1700.00|99|0.00|AETNA REPAIR ELBOW FRACTURE|
20|FH_F139515_0_0|SrvcGrp|92364|2022|PDM|14420.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F143834_06511_0|SrvcGrp|75419|2022|PDM|350.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F135237_31015_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F42019_0_0|SrvcGrp|3029|2022|PDM|220.00|99|0.00|NEWBORN NURSERY|
20|FH_F115736_77459_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F39917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129627_06037_0|SrvcGrp|46605|2022|PDM|111.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F93094_21227_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133099_66801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123943_84041_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132190_0_0|SrvcGrp|109619|2022|PDM|6000.00|99|0.00|NECK SPINE FUSE & REMOVE BEL C|
20|FH_F71282_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|HIGH COST DRUGS|
20|FH_F82114_0_0|SrvcGrp|74662|2022|PDM|533.50|99|0.00|AETNA SLEEP STUDIES|
20|FH_F122900_65203_0|SrvcGrp|92761|2022|PCT|1.20|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1152.10|99|0.00|ASPG VI|
20|FH_F62579_0_0|SrvcGrp|24934|2022|PDM|75.00|99|0.00|NUTRITIONAL ASSESSMENT (INITIAL)|
20|FH_F105593_0_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F149259_64050_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35221_0_0|SrvcGrp|72|2022|PDM|350.00|99|0.00|NEWBORN NURSERY|
20|FH_F120555_68405_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F145659_29646_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|416.15|99|0.00|HAPA WPA-NWPA 2012-13 ASC 304 W/O REV|
20|FH_F89574_0_0|SrvcGrp|73483|2022|PDM|630.00|99|0.00|AETNA SUBACUTE III|
20|FH_F118123_67226_0|SrvcGrp|107697|2022|PCT|1.00|99|0.00|AETNA ALL DRUGS AGENTS INJ|
20|FH_F81698_10457_0|SrvcGrp|14948|2022|PDM|47.25|99|0.00|HOME INFUSION THERAPY|
20|FH_F31916_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133749_84604_0|SrvcGrp|112453|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F126099_34237_0|SrvcGrp|74668|2022|PDM|235.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130017_02302_0|SrvcGrp|92958|2022|PCT|0.69|99|0.00|SLEEP STUDIES|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 3247 MOD NU|
20|FH_F59652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120670_0_0|SrvcGrp|58776|2022|PDM|9000.00|99|0.00|DISKECTOMY|
20|FH_F133875_80027_0|SrvcGrp|73841|2022|PDM|549.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F136359_0_0|SrvcGrp|36591|2022|PDM|9500.00|99|0.00|CPT 63685|
20|FH_F121628_19533_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F60253_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127598_43232_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150239_75569_0|SrvcGrp|14944|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F116124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F114444_19602_0|SrvcGrp|91750|2022|PDM|65.00|99|0.00|AETNA GROUP THERAPY (MOD AH)|
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112827_26452_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES|
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AEG 10 (NO REV)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|38.50|99|0.00|HAPA WPA-NWPA 2012-13 ASC 10 W/O REV|
20|FH_F120583_43219_0|SrvcGrp|42404|2022|PCT|1.00|99|0.00|VENIPUNCTURE|
20|FH_F138951_41101_0|SrvcGrp|86831|2022|PDM|4.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|318.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1602 W/O REV|
20|FH_F125139_84096_0|SrvcGrp|87131|2022|PDM|411.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F119542_45417_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F81698_10457_0|SrvcGrp|86843|2022|PDM|26.50|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 3 (NO REV)|
20|FH_F110311_17078_0|SrvcGrp|103940|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F70208_0_0|SrvcGrp|42782|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F90501_71101_0|SrvcGrp|75493|2022|PDM|4100.00|99|0.00|AEG 8|
20|FH_F132606_0_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|1235.00|99|0.00|AEG 7 (NO REV)|
20|FH_F110466_06870_0|SrvcGrp|89149|2022|PDM|280.34|99|0.00|OP INTENSIVE|
20|FH_F138589_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F85442_27573_0|SrvcGrp|83827|2022|PCT|1.65|99|0.00|REFERENCE LABORATORY SERVICES|
20|FH_F95623_84015_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F146470_68025_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124789_44514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109273_77339_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|2089.00|99|0.00|ASPG IX- MOD 50|
20|FH_F100782_0_0|SrvcGrp|70119|2022|PDM|4429.00|99|0.00|HAPA WPA:PTCA W/DRUG ELUTING STENT|
20|FH_F112468_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F118123_67226_0|SrvcGrp|29076|2022|PDM|25.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F92652_76531_0|SrvcGrp|92761|2022|PCT|0.95|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118088_71261_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F143742_60410_0|SrvcGrp|73483|2022|PDM|568.00|99|0.00|AETNA SUBACUTE III|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1119.00|99|0.00|ASPG V|
20|FH_F120930_0_0|SrvcGrp|41336|2022|PDM|3000.00|99|0.00|VAGINAL HYSTERECTOMY|
20|FH_F133922_70563_0|SrvcGrp|74794|2022|PDM|189.61|99|0.00|SLEEP STUDY|
20|FH_F150165_06032_0|SrvcGrp|104555|2022|PDM|1450.00|99|0.00|HYSTEROSCOPY REMOVE FB|
20|FH_F72785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS|
20|FH_F111163_0_0|SrvcGrp|101320|2022|PDM|1000.00|99|0.00|PARAVERTEBRAL FACET JOINT NERVE|
20|FH_F67887_0_0|SrvcGrp|42830|2022|PDM|114.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F134593_60007_0|SrvcGrp|115909|2022|PCT|0.84|99|0.00|PATISIRAN INJECTION|
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109267_12202_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|2016.00|99|0.00|AEG 4 (NO REV)|
20|FH_F149148_15330_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67963_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93219_26354_0|SrvcGrp|27969|2022|PDM|44.00|99|0.00|HOME HEALTH AIDE|
20|FH_F146016_34108_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F85133_85251_0|SrvcGrp|48398|2022|PDM|126.00|99|0.00|PT SERVICES|
20|FH_F73024_0_0|SrvcGrp|48394|2022|PDM|13.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F134488_14086_0|SrvcGrp|76501|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F122470_78229_0|SrvcGrp|472|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F122553_92705_0|SrvcGrp|90573|2022|PDM|259.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F86435_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|121.30|99|0.00|HAPA WPA-NWPA 2012-13 ASC 135 W/O REV|
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|AEG 3 (NO REV)|
20|FH_F101100_50314_0|SrvcGrp|65161|2022|PDM|1643.00|99|0.00|NEWBORN HIGHER LEVEL|
20|FH_F102200_06416_0|SrvcGrp|97951|2022|PCT|1.00|99|0.00|AETNA AMFS DEFAULT BIOSCRIP|
20|FH_F105361_80104_0|SrvcGrp|12889|2022|PDM|90.00|99|0.00|RADIOLOGY|
20|FH_F105361_80104_0|SrvcGrp|27877|2022|PDM|201.00|99|0.00|ULTRASOUND|
20|FH_F120522_53549_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F120795_27514_0|SrvcGrp|12110|2022|PDM|15296.00|99|0.00|CARDIAC CATH LAB OP SVCS|
20|FH_F127656_06068_0|SrvcGrp|48385|2022|PDM|109.20|99|0.00|SPEECH THERAPY|
20|FH_F40393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F131741_19037_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131957_23226_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132213_17543_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F132971_77063_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F133176_32751_0|SrvcGrp|108484|2022|PDM|743.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F133170_50501_0|SrvcGrp|86722|2022|PDM|168.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 8 (NO REV)|
20|FH_F130066_84107_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F39646_0_0|SrvcGrp|46106|2022|PDM|55.00|99|0.00|ANESTHESIA|
20|FH_F114267_0_0|SrvcGrp|76847|2022|PDM|1800.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F80711_0_0|SrvcGrp|42827|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F86911_0_0|SrvcGrp|86060|2022|PCT|1.00|99|0.00|HOME IV THERAPY|
20|FH_F87054_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP DIALYSIS|
20|FH_F105588_15228_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36584_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F94786_07974_0|SrvcGrp|16750|2022|PDM|91.87|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_F141047_23661_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|492.54|99|0.00|ASPG III|
20|FH_F49487_0_0|SrvcGrp|27541|2022|PDM|475.00|99|0.00|REMICAIDE INFUSION (AFTER BUSINESS HOURS)|
20|FH_F77944_0_0|SrvcGrp|3719|2022|PDM|1707.00|99|0.00|NEWBORN NURSERY|
20|FH_F124059_64055_0|SrvcGrp|29023|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F124060_76040_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F33558_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36830_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F38233_0_0|SrvcGrp|10646|2022|PDM|110.00|99|0.00|MIDLINE INSERTION KIT|
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|15072.00|99|0.00|AEG 7 (NO REV)|
20|FH_F100703_0_0|SrvcGrp|97259|2022|PDM|8034.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F129549_01238_0|SrvcGrp|80918|2022|PDM|177.45|99|0.00|RESPITE CARE|
20|FH_F124178_01604_0|SrvcGrp|3870|2022|PCT|1.00|99|0.00|LUPRON/LEUPROLIDE ACETATE|
20|FH_F124585_33070_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F60365_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|TRANSPLANT SVCS|
20|FH_F127995_84010_0|SrvcGrp|86844|2022|PDM|25.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F87856_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AREOLA RECONSTRUCTION|
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|3017.00|99|0.00|AEG 8 (NO REV)|
20|FH_F98042_10468_0|SrvcGrp|73656|2022|PDM|678.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F136567_94578_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F114645_34952_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F114666_30342_0|SrvcGrp|90343|2022|PDM|5000.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL|
20|FH_F115048_78520_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F148553_85016_0|SrvcGrp|108174|2022|PDM|3619.00|99|0.00|TIB/PER REVASC W/TLA|
20|FH_F43862_0_0|SrvcGrp|27725|2022|PDM|40.00|99|0.00|SKILLED RN HOURLY|
20|FH_F134747_83404_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136796_24016_0|SrvcGrp|35669|2022|PDM|7788.11|99|0.00|CPT 63650|
20|FH_F136807_43220_0|SrvcGrp|29347|2022|PDM|16.50|99|0.00|HOME HEALTH AIDE|
20|FH_F136930_73114_0|SrvcGrp|11283|2022|PCT|0.63|99|0.00|HYPERBARIC CHAMBER|
20|FH_F112371_19047_0|CSTM-ALL|CSTM-00|2020|PDM|909.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132133_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|14.00|99|0.00|ENTERAL NUTRITION (B9000) (MOD SH)|
20|FH_F41540_0_0|SrvcGrp|33825|2022|PDM|966.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 3|
20|FH_F114151_0_0|SrvcGrp|83519|2022|PDM|90.00|99|0.00|HOSPICE CARE (ALL OTHER)|
20|FH_F137906_0_0|SrvcGrp|104228|2022|PDM|100.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F140511_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113250_71901_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F135351_0_0|SrvcGrp|71666|2022|PDM|38500.00|99|0.00|CPT 63655|
20|FH_F42244_0_0|SrvcGrp|360|2022|PCT|0.75|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F138867_77021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138907_01040_0|SrvcGrp|48398|2022|PDM|103.00|99|0.00|PT SERVICES|
20|FH_F138992_72703_0|CSTM-ALL|CSTM-00|2020|PDM|2652.00|99|0.00|AEG 6 (NO REV)|
20|FH_F138685_18017_0|SrvcGrp|73841|2022|PDM|291.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F146668_30189_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 1 (NO REV)|
20|FH_F131927_66043_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132150_66083_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132931_57350_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132928_64114_0|SrvcGrp|15402|2022|PDM|84.35|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F133478_40165_0|SrvcGrp|20900|2022|PDM|23108.00|99|0.00|MS DRG 248 ONLY|
20|FH_F132898_06088_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F34477_0_0|SrvcGrp|16496|2022|PDM|900.00|99|0.00|POLYSOMNOGRAPHY - CPAP|
20|FH_F102641_0_0|SrvcGrp|72994|2022|PDM|985.00|99|0.00|AEG 3|
20|FH_F126104_0_0|SrvcGrp|108081|2022|PDM|192.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F71502_0_0|SrvcGrp|64778|2022|PCT|1.00|99|0.00|(IMMUN) OCN F/S PRICING: W/REV CODES 250-259, 631-637|
20|FH_F116443_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F150939_0_0|SrvcGrp|101743|2022|PDM|10.00|99|0.00|IM ADMIN 1ST/ONLY COMPONENT|
20|FH_F48295_0_0|SrvcGrp|44429|2022|PDM|90.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES (VISIT LVL)|
20|FH_F50994_0_0|SrvcGrp|12403|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F113585_20155_0|SrvcGrp|27968|2022|PDM|45.00|99|0.00|SKILLED NURSING LPN|
20|FH_F113585_20155_0|SrvcGrp|86842|2022|PDM|55.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F138697_53219_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138870_45176_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
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_F127207_0_0|SrvcGrp|82222|2022|PDM|90.00|99|0.00|HOSPICE CARE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|181.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 234 W/O REV|
20|FH_F83475_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.50|99|0.00|OP SVCS|
20|FH_F151501_30265_0|SrvcGrp|109792|2022|PDM|4606.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F123184_20906_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F130671_42701_0|SrvcGrp|86722|2022|PDM|187.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F47212_0_0|SrvcGrp|79517|2022|PDM|30.00|99|0.00|IMMUNIZATION|
20|FH_F135583_17331_0|SrvcGrp|37258|2022|PDM|9130.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F91700_15601_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F135907_74501_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135920_32211_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136211_74447_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F100765_73735_0|SrvcGrp|90854|2022|PDM|3461.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F130756_04901_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 7 (NO REV)|
20|FH_F131374_08009_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F131407_07607_0|SrvcGrp|17016|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116431_76104_0|SrvcGrp|3178|2022|PDM|749.00|99|0.00|ACUTE PSYCH|
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|2221.00|99|0.00|AEG 9 (NO REV)|
20|FH_F101581_16371_0|SrvcGrp|472|2022|PDM|490.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F121428_40202_0|SrvcGrp|93924|2022|PDM|1746.00|99|0.00|AETNA MEDICAL SERVICES|
20|FH_F121761_44130_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F42347_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F128353_22191_0|SrvcGrp|48394|2022|PDM|34.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F111292_33136_0|SrvcGrp|82756|2022|PDM|79.00|99|0.00|ASSAY BLOOD LIPASE|
20|FH_F111301_33122_0|SrvcGrp|97968|2022|PDM|1299.00|99|0.00|CT SCAN|
20|FH_F134290_67209_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|508.00|99|0.00|AEG 2 (NO REV)|
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1660.00|99|0.00|ASPG IV|
20|FH_F54272_0_0|SrvcGrp|16962|2022|PDM|408.00|99|0.00|CHEMOTHERAPY|
20|FH_F131000_0_0|SrvcGrp|84181|2022|PDM|3024.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS|
20|FH_F132328_0_0|SrvcGrp|63459|2022|PDM|3371.00|99|0.00|CPT 52601|
20|FH_F118651_0_0|SrvcGrp|107868|2022|PDM|4959.71|99|0.00|AETNA LAPAROSCOPY SURGICAL|
20|FH_F112187_98272_0|CSTM-ALL|CSTM-00|2020|PDM|11579.00|99|0.00|AEG 5  (NO REV)|
20|FH_F96340_23704_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F101852_78758_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132090_60915_0|CSTM-ALL|CSTM-00|2020|PDM|2801.40|99|0.00|AEG 7 (NO REV)|
20|FH_F114931_0_0|SrvcGrp|104617|2022|PDM|1850.00|99|0.00|INCISION OF RECTAL ABSCESS|
20|FH_F118661_0_0|SrvcGrp|79589|2022|PDM|1018.00|99|0.00|UPPER GI|
20|FH_F33744_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
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|117.45|99|0.00|DELAWARE VALLEY- ASC 308|
20|FH_F66711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F82933_0_0|SrvcGrp|11258|2022|PCT|0.57|99|0.00|DRUGS|
20|FH_F110381_0_0|SrvcGrp|72990|2022|PDM|615.00|99|0.00|AEG 1|
20|FH_F91832_06106_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA - ANCD ( HOME HEALTH)|
20|FH_F91873_12723_0|SrvcGrp|31074|2022|PDM|950.00|99|0.00|MS DRG 795 ONLY|
20|FH_F97660_29401_0|SrvcGrp|73659|2022|PDM|11980.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F97761_04072_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F97780_43614_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS|
20|FH_F68841_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|179.56|99|0.00|AETNA SLEEP STUDY CPT 95806|
20|FH_F114916_30309_0|SrvcGrp|58993|2022|PDM|5200.00|99|0.00|DISKECTOMY|
20|FH_F112163_0_0|SrvcGrp|24739|2022|PDM|236.00|99|0.00|RESPITE CARE|
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PDM|3348.00|99|0.00|AEG 7 (NO REV)|
20|FH_F115045_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103880_85014_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F101752_0_0|SrvcGrp|75505|2022|PCT|0.90|99|0.00|CARDIAC STUDIES|
20|FH_F102542_0_0|SrvcGrp|30089|2022|PDM|400.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F103060_0_0|SrvcGrp|88157|2022|PDM|7803.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F102224_0_0|SrvcGrp|96350|2022|PDM|9900.00|99|0.00|SHOULDER JOINT|
20|FH_F49458_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F112712_63005_0|SrvcGrp|24745|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F116835_94538_0|SrvcGrp|114318|2022|PDM|126.00|99|0.00|PSYCL/NRPSYC TST AUTO RESULT|
20|FH_F116908_33461_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120961_66615_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F39028_0_0|SrvcGrp|30195|2022|PCT|1.00|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F39028_0_0|SrvcGrp|30127|2022|PCT|1.00|99|0.00|UNLISTED J-CODES|
20|FH_F39274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F33925_0_0|SrvcGrp|13131|2022|PDM|1359.00|99|0.00|OBSERVATION SVCS|
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|SrvcGrp|20297|2022|PDM|28200.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VALVE PROC|
20|FH_F135688_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F50715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1278.20|99|0.00|ASPG VII|
20|FH_F55532_0_0|SrvcGrp|472|2022|PDM|775.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F151524_84121_0|SrvcGrp|75419|2022|PDM|421.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F141410_13045_0|SrvcGrp|11663|2022|PCT|0.39|99|0.00|IMPLANTS|
20|FH_F41350_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|NEUROLOGICAL INSTITUTE ASC CARVE OUTS CVTY|
20|FH_F143772_75225_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F137457_32216_0|SrvcGrp|72602|2022|PDM|802.00|99|0.00|ECT|
20|FH_F124965_0_0|SrvcGrp|72996|2022|PDM|1100.00|99|0.00|AEG 4|
20|FH_F122687_0_0|SrvcGrp|96543|2022|PDM|2404.00|99|0.00|REVISION OF CALF TENDON|
20|FH_F142073_0_0|SrvcGrp|99161|2022|PDM|11900.00|99|0.00|CPT 27138|
20|FH_F72746_0_0|SrvcGrp|12403|2022|PDM|39.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F50218_0_0|SrvcGrp|46241|2022|PDM|120.00|99|0.00|HOME VISIT MECHANICAL VENTILATION CARE|
20|FH_F125028_19061_0|SrvcGrp|21920|2022|PDM|63.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F120251_21122_0|SrvcGrp|46903|2022|PDM|1500.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F78603_0_0|SrvcGrp|20912|2022|PDM|35841.45|99|0.00|MS DRG 236 ONLY|
20|FH_F76502_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F148160_29732_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141802_17042_0|SrvcGrp|73262|2022|PCT|0.68|99|0.00|AETNA OP OBSERVATION W/ER|
20|FH_F149839_80002_0|SrvcGrp|27968|2022|PDM|55.00|99|0.00|SKILLED NURSING LPN|
20|FH_F77983_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|ZERO ALLOWABLE - INPATIENT SERVICES|
20|FH_F110925_01104_0|SrvcGrp|26869|2022|PDM|57.78|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F70043_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|OP SVCS|
20|FH_F135005_06460_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134876_0_0|SrvcGrp|57967|2022|PDM|331.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F116984_28092_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F83352_06114_0|SrvcGrp|73701|2022|PDM|26.25|99|0.00|AETNA - SKILLED NURSING|
20|FH_F93881_15009_0|SrvcGrp|21458|2022|PDM|362.00|99|0.00|SLEEP STUDIES|
20|FH_F89475_71202_0|SrvcGrp|75506|2022|PCT|1.90|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F77463_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98922_40351_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F98801_93274_0|SrvcGrp|73659|2022|PDM|7467.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 10 (NO REV)|
20|FH_F143748_02904_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F116984_28092_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F84215_0_0|SrvcGrp|73008|2022|PDM|651.00|99|0.00|AEG 10|
20|FH_F115010_20105_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F125118_99201_0|SrvcGrp|3398|2022|PDM|300.00|99|0.00|CPT 90853 GROUP PSYCHOTHERAPY|
20|FH_F137611_30909_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F38034_0_0|SrvcGrp|115|2022|PDM|862.00|99|0.00|SKILLED NURSING CARE|
20|FH_F123473_65109_0|SrvcGrp|472|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F137946_0_0|SrvcGrp|113240|2022|PDM|100.00|99|0.00|COVID-19 TEST NON-CDC HGH THRU (HCFA)|
20|FH_F116697_11703_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F41665_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPEN MRI OF NAPLES MRI/CT MOD 26|
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AEG 5  (NO REV)|
20|FH_F49653_0_0|SrvcGrp|63|2022|PDM|719.00|99|0.00|SUBACUTE CARE|
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|2368.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F73013_0_0|SrvcGrp|77238|2022|PDM|25.93|99|0.00|AETNA HOME INFUSION S9537|
20|FH_F82753_18840_0|SrvcGrp|3378|2022|PDM|3399.00|99|0.00|OBSERVATION SVCS|
20|FH_F116203_63901_0|SrvcGrp|88621|2022|PDM|75.00|99|0.00|SKILLED NURSING LPN|
20|FH_F139515_0_0|SrvcGrp|67065|2022|PDM|14069.00|99|0.00|CERVICAL SURGERY|
20|FH_F120365_30043_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110925_01104_0|SrvcGrp|41444|2022|PDM|0.48|99|0.00|ENTERAL FORMULA - NUTRITIONALLY COMPLETE|
20|FH_F148279_15009_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141519_51566_0|SrvcGrp|104338|2022|PCT|0.95|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|1496.00|99|0.00|AEG 8 (NO REV)|
20|FH_F40694_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F135175_45121_0|SrvcGrp|3178|2022|PDM|740.00|99|0.00|ACUTE PSYCH|
20|FH_F149980_0_0|SrvcGrp|115789|2022|PDM|3300.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL INSERT LENS|
20|FH_F148265_06067_0|SrvcGrp|88161|2022|PDM|6886.00|99|0.00|LAMINECTOMY W/FACE-THORACIC|
20|FH_F42512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F52516_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138929_0_0|SrvcGrp|82114|2022|PDM|3300.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F132627_0_0|SrvcGrp|88621|2022|PDM|80.58|99|0.00|SKILLED NURSING LPN|
20|FH_F132988_0_0|SrvcGrp|90361|2022|PDM|6242.51|99|0.00|REPAIR FRACTURE RADIUS/ULNA|
20|FH_F72162_0_0|SrvcGrp|48385|2022|PDM|135.00|99|0.00|SPEECH THERAPY|
20|FH_F118909_0_0|SrvcGrp|97507|2022|PDM|123.60|99|0.00|AETNA HOSPICE|
20|FH_F141151_75150_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93252_0_0|SrvcGrp|93021|2022|PDM|4700.00|99|0.00|CERVICAL LAMINECTOMY|
20|FH_F114389_50131_0|SrvcGrp|22588|2022|PDM|135.39|99|0.00|CHEMOTHERAPY|
20|FH_F69504_0_0|SrvcGrp|66005|2022|PDM|27.00|99|0.00|SKILLED NURSING HCPC|
20|FH_F131505_0_0|SrvcGrp|33977|2022|PDM|578.00|99|0.00|CPT 59820|
20|FH_F81731_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F38688_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|OCN F/S PRICING: ALL|
20|FH_F90956_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS SNF PART B SERVICES|
20|FH_F92493_0_0|SrvcGrp|26275|2022|PDM|2601.06|99|0.00|CPT 29826|
20|FH_F129549_01238_0|SrvcGrp|89783|2022|PDM|177.45|99|0.00|RESPITE CARE (HCFA)|
20|FH_F124178_01604_0|SrvcGrp|472|2022|PDM|515.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F124417_85364_0|SrvcGrp|12957|2022|PCT|1.00|99|0.00|DME|
20|FH_F124611_64804_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124653_64062_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F64779_0_0|SrvcGrp|42826|2022|PDM|163.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F69685_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.81|99|0.00|OP SVCS|
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F43913_0_0|SrvcGrp|13739|2022|PDM|350.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F136778_62034_0|SrvcGrp|112834|2022|PCT|1.25|99|0.00|RADIOLOGY SERVICES|
20|FH_F136828_32405_0|SrvcGrp|72602|2022|PDM|724.00|99|0.00|ECT|
20|FH_F136914_64081_0|SrvcGrp|107353|2022|PDM|456.75|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)|
20|FH_F112416_71449_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F132611_0_0|SrvcGrp|112034|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETIC|
20|FH_F115631_65201_0|SrvcGrp|26432|2022|PDM|3177.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F147446_76844_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147519_52627_0|SrvcGrp|12659|2022|PDM|764.55|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F147519_52627_0|SrvcGrp|73498|2022|PDM|1603.99|99|0.00|AETNA ER LEVEL III|
20|FH_F41809_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY|
20|FH_F150769_02302_0|SrvcGrp|113171|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F150820_83843_0|CSTM-ALL|CSTM-00|2020|PDM|1550.00|99|0.00|AEG 3 (NO REV)|
20|FH_F150882_84041_0|SrvcGrp|46104|2022|PDM|105.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F97881_38703_0|SrvcGrp|73643|2022|PDM|1617.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F149043_72021_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F59312_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|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_F37764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116332_0_0|SrvcGrp|80617|2022|PDM|16730.00|99|0.00|ARTHOPLASTY|
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)|
20|FH_F35446_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F34675_0_0|SrvcGrp|17093|2022|PCT|0.70|99|0.00|COCHLEAR IMPLANT SERVICES|
20|FH_F149512_62550_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F94643_90501_0|SrvcGrp|86839|2022|PDM|35.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F101685_0_0|SrvcGrp|73008|2022|PDM|384.00|99|0.00|AEG 10|
20|FH_F147167_75605_0|SrvcGrp|46903|2022|PDM|550.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F147222_49544_0|SrvcGrp|108622|2022|PDM|444.00|99|0.00|SUB ACUTE CARE LEVEL II|
20|FH_F110728_13069_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F147140_89103_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F137986_0_0|SrvcGrp|88487|2022|PDM|3000.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F115269_0_0|SrvcGrp|89149|2022|PDM|190.00|99|0.00|OP INTENSIVE|
20|FH_F49984_0_0|SrvcGrp|27579|2022|PDM|85.00|99|0.00|RESPIRATORY THERAPY INITIAL VISIT|
20|FH_F108180_29526_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F138420_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F84532_0_0|SrvcGrp|82808|2022|PDM|9572.00|99|0.00|CARDIO CARVEOUTS|
20|FH_F116575_0_0|SrvcGrp|88599|2022|PDM|1600.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F38584_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F90817_0_0|SrvcGrp|91049|2022|PDM|2096.00|99|0.00|REPAIR BICEPS TENDON RUPTURE (HCFA)|
20|FH_F97101_98003_0|SrvcGrp|73461|2022|PDM|10891.00|99|0.00|AETNA NICU IV|
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|52864.00|99|0.00|MS DRG 216-218|
20|FH_F147216_48307_0|SrvcGrp|110537|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F98001_27603_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F102525_73134_0|SrvcGrp|21359|2022|PDM|25000.00|99|0.00|MS DRG 460 ONLY|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|195.00|99|0.00|HAPA EPA ASC 29|
20|FH_F36348_0_0|SrvcGrp|3780|2022|PDM|28875.00|99|0.00|BARIATRIC SERVICES|
20|FH_F149662_85015_0|SrvcGrp|3378|2022|PDM|2182.00|99|0.00|OBSERVATION SVCS|
20|FH_F150944_18052_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125182_0_0|SrvcGrp|82301|2022|PDM|2233.50|99|0.00|HEMORRHOIDECTOMY|
20|FH_F110828_32757_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147214_48162_0|SrvcGrp|108761|2022|PCT|1.00|99|0.00|PROFESSIONAL/CLINICS (UB)|
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PDM|494.00|99|0.00|AEG 3 (NO REV)|
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1709.00|99|0.00|AEG 7 (NO REV)|
20|FH_F81172_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F91787_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37659_0_0|CSTM-ALL|CSTM-00|2020|PDM|549.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F143902_41018_0|SrvcGrp|74668|2022|PDM|232.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90691_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92276_32308_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F98922_40351_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F126730_84737_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137507_62901_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F38591_0_0|SrvcGrp|360|2022|PDM|1831.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F43250_0_0|CSTM-ALL|CSTM-00|2020|PDM|1120.00|99|0.00|CV SERVICES (MS DRG)|
20|FH_F143539_0_0|SrvcGrp|85966|2022|PDM|7820.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|1471.00|99|0.00|AEG 6 (NO REV)|
20|FH_F89372_0_0|SrvcGrp|63381|2022|PCT|0.71|99|0.00|OP SURGERY|
20|FH_F89495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111594_0_0|SrvcGrp|98493|2022|PDM|7699.00|99|0.00|THORACIC|
20|FH_F148554_85016_0|SrvcGrp|115469|2022|PDM|2850.00|99|0.00|CORONARY ART/GRFT ANGIO S&I|
20|FH_F146250_67601_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1026.00|99|0.00|AEG 6 (NO REV)|
20|FH_F100785_54660_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|331.31|99|0.00|HAPA WPA-NWPA 2012-13 ASC 407 W/O REV|
20|FH_F141870_85224_0|SrvcGrp|24745|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F43411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F145988_06105_0|SrvcGrp|12280|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F137240_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F117087_0_0|SrvcGrp|107189|2022|PDM|1153.00|99|0.00|BIOPSY OF UPPER NOSE/THROAT|
20|FH_F42992_0_0|SrvcGrp|13643|2022|PDM|1950.00|99|0.00|DRG 372 NORMAL DELIVERY (MOTHER ONLY)|
20|FH_F83113_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|106% OF ASP DRUGS/IMMUN UPDATE QUARTERLY|
20|FH_F91255_19401_0|SrvcGrp|941|2022|PDM|2798.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F150908_38570_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133021_00910_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 1 (NO REV)|
20|FH_F37751_0_0|SrvcGrp|592|2022|PDM|1241.00|99|0.00|SUB-ACUTE CARE|
20|FH_F44097_0_0|CSTM-ALL|CSTM-00|2020|PDM|312.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F41785_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F125540_19462_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F115405_06010_0|SrvcGrp|102279|2022|PDM|20.00|99|0.00|AETNA METHADONE MAINTENANCE (HCFA)|
20|FH_F143007_60640_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118476_17815_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148662_01583_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F133371_63077_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42807_0_0|SrvcGrp|701|2022|PDM|2080.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F149880_33150_0|SrvcGrp|46903|2022|PDM|830.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F98620_43920_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F119076_41001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F41436_0_0|SrvcGrp|34349|2022|PCT|0.80|99|0.00|HOME HEALTH|
20|FH_F112853_22408_0|SrvcGrp|37386|2022|PDM|1.10|99|0.00|AMINO ACIDS|
20|FH_F111415_33180_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42779_0_0|SrvcGrp|16|2022|PDM|1207.00|99|0.00|ACUTE REHABILITATION|
20|FH_F100682_97401_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F43433_0_0|SrvcGrp|20260|2022|PCT|1.00|99|0.00|ER LEVEL V|
20|FH_F143191_17512_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111423_34952_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133351_84003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1315.00|99|0.00|ASPG V|
20|FH_F80955_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133029_61264_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F126815_02118_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F40267_0_0|SrvcGrp|17071|2022|PDM|728.00|99|0.00|ASPG IV|
20|FH_F106241_93309_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F50420_0_0|SrvcGrp|44820|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD AV) - BDSS|
20|FH_F146105_76016_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PDM|654.00|99|0.00|ADOLESCENT PARTIAL HOSPITALIZATION|
20|FH_F56792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1384.00|99|0.00|ASPG IV WITH MOD SG|
20|FH_F129965_0_0|SrvcGrp|64758|2022|PCT|1.10|99|0.00|HCPCS|
20|FH_F45324_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP DIALYSIS|
20|FH_F120406_84047_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F111403_37167_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F40591_0_0|SrvcGrp|29|2022|PCT|0.85|99|0.00|ELECTROPHYSIOLOGY|
20|FH_F38725_0_0|SrvcGrp|68580|2022|PCT|1.00|99|0.00|IMMUNIZATIONS|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F115406_79902_0|SrvcGrp|90397|2022|PDM|268.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F141657_85715_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F41739_0_0|SrvcGrp|14428|2022|PCT|1.00|99|0.00|ORGAN ACQUISITION|
20|FH_F34706_0_0|SrvcGrp|10492|2022|PDM|4753.00|99|0.00|DRG 183 ESOPHGTS/GASTRO/MISC DIGESTIVE DISORDERS W/O CC|
20|FH_F97561_30030_0|SrvcGrp|73602|2022|PDM|1798.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F142990_06488_0|SrvcGrp|75545|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F141753_63334_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141791_22572_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F91155_16105_0|SrvcGrp|73006|2022|PDM|1892.00|99|0.00|AEG 9|
20|FH_F146253_60419_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F72859_0_0|SrvcGrp|11789|2022|PDM|90.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F50440_0_0|SrvcGrp|33166|2022|PDM|515.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F103281_32086_0|SrvcGrp|3932|2022|PDM|7900.00|99|0.00|LITHOTRIPSY|
20|FH_F133261_78041_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F44016_0_0|SrvcGrp|12290|2022|PDM|1136.00|99|0.00|DETOXIFICATION|
20|FH_F132886_0_0|SrvcGrp|106317|2022|PDM|594.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F128445_85704_0|SrvcGrp|3178|2022|PDM|1048.00|99|0.00|ACUTE PSYCH|
20|FH_F97565_83301_0|SrvcGrp|88978|2022|PDM|7005.00|99|0.00|VAGINAL DELIVERY|
20|FH_F105842_70433_0|SrvcGrp|78579|2022|PDM|1260.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
20|FH_F133261_78041_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F133396_72301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117880_91730_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F73542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS AMBULANCE MS (00512-00) SUPER-RURAL|
20|FH_F115405_06010_0|SrvcGrp|102239|2022|PDM|20.00|99|0.00|AETNA METHADONE MAINTENANCE|
20|FH_F133478_40165_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|OP SVCS|
20|FH_F80952_45669_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F51658_0_0|SrvcGrp|46234|2022|PDM|90.00|99|0.00|SKILLED NURSING|
20|FH_F104963_15146_0|SrvcGrp|76501|2022|PDM|260.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F111780_38603_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F79902_0_0|SrvcGrp|15366|2022|PDM|2950.00|99|0.00|ICU/CCU|
20|FH_F97141_93933_0|SrvcGrp|73605|2022|PDM|5789.00|99|0.00|AETNA ACUTE PSYCH|
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_F148921_91356_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F128312_45230_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F37600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97140_91730_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F117875_70601_0|SrvcGrp|10391|2022|PDM|1551.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F115329_79424_0|SrvcGrp|89417|2022|PDM|400.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F43164_0_0|CSTM-ALL|CSTM-00|2020|PDM|876.00|99|0.00|SPINAL CORD REHAB|
20|FH_F71323_68114_0|CSTM-ALL|CSTM-00|2020|PDM|2807.00|99|0.00|DRG 143-145 ONLY|
20|FH_F148740_93230_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F148880_26807_0|SrvcGrp|48385|2022|PDM|162.00|99|0.00|SPEECH THERAPY|
20|FH_F151121_60455_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151201_90020_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F121329_33015_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F121946_43209_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F87411_0_0|SrvcGrp|83884|2022|PDM|137.27|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)|
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 10 (NO REV)|
20|FH_F32995_0_0|SrvcGrp|1259|2022|PDM|1275.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG IX|
20|FH_F123783_03860_0|SrvcGrp|46605|2022|PDM|166.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F132810_0_0|SrvcGrp|16750|2022|PDM|150.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F58856_0_0|SrvcGrp|22405|2022|PDM|3219.00|99|0.00|ASPG V (REV CODE + CPT)|
20|FH_F63316_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136347_30328_0|SrvcGrp|73605|2022|PDM|1176.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F136426_19006_0|SrvcGrp|13262|2022|PDM|5.00|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F118152_20151_0|SrvcGrp|86825|2022|PDM|60.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F93363_63123_0|SrvcGrp|73524|2022|PCT|0.00|99|0.00|PHYSICAL THERAPY|
20|FH_F137147_75006_0|CSTM-ALL|CSTM-00|2020|PDM|3465.00|99|0.00|AEG 2 (NO REV)|
20|FH_F142547_70002_0|SrvcGrp|24750|2022|PDM|10.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F53732_0_0|SrvcGrp|17009|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138584_30912_0|SrvcGrp|107092|2022|PCT|1.00|99|0.00|RESECT FACE TUM < 2 CM|
20|FH_F140756_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149640_50022_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F119021_03060_0|SrvcGrp|73841|2022|PDM|350.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F36915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117267_07728_0|SrvcGrp|79820|2022|PDM|6820.00|99|0.00|MS-DRG 880-897 ONLY|
20|FH_F147726_18017_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AEG 8 (NO REV)|
20|FH_F129477_70403_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F129483_77030_0|SrvcGrp|21920|2022|PDM|50.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F41979_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90791_79106_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F130676_0_0|SrvcGrp|79720|2022|PDM|1575.00|99|0.00|ACUTE REHAB II|
20|FH_F138732_60016_0|SrvcGrp|86723|2022|PDM|402.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F31783_0_0|SrvcGrp|18145|2022|PDM|14910.00|99|0.00|MS DRG 248|
20|FH_F31525_0_0|SrvcGrp|360|2022|PDM|616.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F97720_70084_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118275_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS ASC|
20|FH_F73231_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F73231_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INFUSION REV CODE 643|
20|FH_F74562_0_0|SrvcGrp|290|2022|PCT|0.80|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F36715_0_0|SrvcGrp|14428|2022|PCT|1.00|99|0.00|ORGAN ACQUISITION|
20|FH_F98000_59102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F97620_75904_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F37339_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113957_73554_0|SrvcGrp|73002|2022|PDM|2730.00|99|0.00|AEG 7|
20|FH_F97081_21122_0|SrvcGrp|26001|2022|PDM|141.62|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F149582_01534_0|SrvcGrp|113171|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F149522_83221_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F148181_0_0|SrvcGrp|80920|2022|PDM|1000.00|99|0.00|HOSPICE SERVICES|
20|FH_F40627_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|1115.00|99|0.00|ASPG VII- GNADEN HUETTEN|
20|FH_F39489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F134797_0_0|SrvcGrp|72994|2022|PDM|1205.00|99|0.00|AEG 3|
20|FH_F134847_0_0|SrvcGrp|93057|2022|PDM|5135.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F150982_0_0|SrvcGrp|92547|2022|PDM|2202.00|99|0.00|SKIN FULL GRAFT PROCEDURE|
20|FH_F127189_49503_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F125419_44110_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F94502_0_0|SrvcGrp|73485|2022|PDM|713.00|99|0.00|AETNA REHAB|
20|FH_F125762_66701_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125081_15218_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F124413_30067_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F35735_33870_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F35245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150961_89169_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F138017_73129_0|CSTM-ALL|CSTM-00|2020|PDM|1856.00|99|0.00|AEG 4 (NO REV)|
20|FH_F132849_0_0|CSTM-ALL|CSTM-00|2020|PDM|1515.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F101640_32218_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F129237_72833_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME HEALTH CARE|
20|FH_F136779_0_0|SrvcGrp|112922|2022|PDM|2364.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY|
20|FH_F92431_80033_0|SrvcGrp|47622|2022|PDM|146.00|99|0.00|ENTEROSTOMAL THERAPY|
20|FH_F138254_75446_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139823_32250_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F140248_42420_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139913_33407_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F32617_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F131173_17043_0|SrvcGrp|89781|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F151740_77504_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_F49329_0_0|SrvcGrp|45302|2022|PDM|108.00|99|0.00|IP SKILLED NURSING VISIT|
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1065.85|99|0.00|ASPG II|
20|FH_F112712_63005_0|SrvcGrp|29023|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116913_77024_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116918_06488_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120921_75835_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120977_50510_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120966_60707_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41535_0_0|SrvcGrp|177|2022|PDM|950.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F44438_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F36372_0_0|SrvcGrp|474|2022|PDM|275.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F43720_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102948_43606_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140007_0_0|SrvcGrp|97059|2022|PDM|3539.00|99|0.00|MENISCUS REPAIR, MED OR LAT|
20|FH_F123445_0_0|SrvcGrp|80918|2022|PDM|692.00|99|0.00|RESPITE CARE|
20|FH_F48772_66044_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63628_30824_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142087_0_0|SrvcGrp|113857|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES|
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|1211.00|99|0.00|AEG 9 (NO REV)|
20|FH_F109279_0_0|CSTM-ALL|CSTM-00|2020|PDM|402.00|99|0.00|AEG 1 (NO REV)|
20|FH_F72544_0_0|SrvcGrp|3518|2022|PCT|0.70|99|0.00|GASTRIC BYPASS|
20|FH_F72544_0_0|SrvcGrp|9793|2022|PDM|1043.00|99|0.00|NEWBORN NURSERY|
20|FH_F111594_0_0|SrvcGrp|71666|2022|PDM|6737.00|99|0.00|CPT 63655|
20|FH_F119417_78212_0|SrvcGrp|90340|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F119538_60959_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F148495_03038_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146132_76801_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124966_60559_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F132991_84790_0|SrvcGrp|27968|2022|PDM|26.75|99|0.00|SKILLED NURSING LPN|
20|FH_F117895_28170_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97561_30030_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F141887_65605_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150905_01608_0|SrvcGrp|115858|2022|PDM|18.26|99|0.00|SKILLS TRAINING DEV (MOD HN) (0-21 YRS)|
20|FH_F148703_33853_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2205.00|99|0.00|AEG 4 (NO REV)|
20|FH_F97622_75051_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F119437_0_0|SrvcGrp|93071|2022|PDM|4750.00|99|0.00|POSTERIOR SEGMENTAL INSTRU|
20|FH_F115875_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F115208_0_0|SrvcGrp|106181|2022|PDM|2652.00|99|0.00|PARTIAL REMOVAL OF THYROID|
20|FH_F104840_32565_0|SrvcGrp|75506|2022|PCT|0.69|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F117623_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119784_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F116485_17033_0|SrvcGrp|105425|2022|PDM|30.55|99|0.00|AETNA EXPOSURE ADAPTIVE BH TREATMENT 60 MINS|
20|FH_F94740_32904_0|SrvcGrp|3809|2022|PDM|570.51|99|0.00|HOSPICE CARE|
20|FH_F94786_07974_0|SrvcGrp|19742|2022|PDM|73.50|99|0.00|MID-LINE INSERTION|
20|FH_F132988_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F144828_0_0|SrvcGrp|104946|2022|PDM|2241.00|99|0.00|REMOVAL OF BREAST CAPSULE|
20|FH_F118909_0_0|SrvcGrp|89783|2022|PDM|133.90|99|0.00|RESPITE CARE (HCFA)|
20|FH_F141131_20850_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82432_0_0|SrvcGrp|80920|2022|PDM|498.75|99|0.00|HOSPICE SERVICES|
20|FH_F114389_50131_0|SrvcGrp|17015|2022|PDM|32.19|99|0.00|HOME INFUSION THERAPY|
20|FH_F114389_50131_0|SrvcGrp|98978|2022|PDM|157.40|99|0.00|TPN ONE LITER PER DAY (HCFA)|
20|FH_F141343_62047_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|338.00|99|0.00|AEG 2 (NO REV)|
20|FH_F124129_33603_0|SrvcGrp|69075|2022|PDM|57.97|99|0.00|CPT 99213|
20|FH_F146912_90025_0|SrvcGrp|75419|2022|PDM|997.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F39066_0_0|SrvcGrp|3066|2022|PCT|0.50|99|0.00|HIGH-COST DRUGS|
20|FH_F92493_0_0|SrvcGrp|82720|2022|PDM|3250.17|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F38436_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F127932_32117_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|578.00|99|0.00|AEG 2 (NO REV)|
20|FH_F100787_69162_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F136734_46410_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F114726_45213_0|SrvcGrp|89149|2022|PDM|173.00|99|0.00|OP INTENSIVE|
20|FH_F139771_54534_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122885_39571_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43693_0_0|CSTM-ALL|CSTM-00|2020|PDM|257.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F43779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|TRAUMA CARE|
20|FH_F117085_40207_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136786_25302_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F112410_46112_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115206_80923_0|SrvcGrp|86722|2022|PDM|258.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F116383_63026_0|SrvcGrp|46903|2022|PDM|663.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|76.00|99|0.00|TPN TWO LITER (MOD SH)|
20|FH_F41666_0_0|CSTM-ALL|CSTM-00|2020|PDM|457.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40600_0_0|SrvcGrp|109|2022|PDM|916.00|99|0.00|CD - DETOX|
20|FH_F98625_08103_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F126339_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33381_0_0|SrvcGrp|16|2022|PDM|1004.00|99|0.00|ACUTE REHABILITATION|
20|FH_F140007_0_0|SrvcGrp|96355|2022|PDM|7887.00|99|0.00|SPINE FIXATION|
20|FH_F122953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F70762_90805_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F95101_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F102844_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 10 (NO REV)|
20|FH_F134822_06513_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG III|
20|FH_F107360_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|2885.00|99|0.00|AEG 8 (NO REV)|
20|FH_F113178_44035_0|SrvcGrp|43523|2022|PDM|125.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F98361_12065_0|SrvcGrp|73601|2022|PDM|7956.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F138674_75149_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138681_39301_0|SrvcGrp|87441|2022|PDM|708.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F138989_02861_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F89580_0_0|CSTM-ALL|CSTM-00|2020|PDM|28800.00|99|0.00|EXTRA CORPOREAL MEMBRANE|
20|FH_F110233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|573.00|99|0.00|AEG 3 (NO REV)|
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PDM|3135.00|99|0.00|AEG 9 (NO REV)|
20|FH_F114572_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|480.15|99|0.00|HAPA WPA-NWPA 2012-13 ASC 208 W/O REV|
20|FH_F84139_0_0|SrvcGrp|4109|2022|PDM|800.00|99|0.00|ACUTE PSYCH|
20|FH_F132258_45404_0|SrvcGrp|26868|2022|PDM|34.98|99|0.00|DIURETIC IV THERAPY|
20|FH_F122027_61847_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122032_32413_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F144948_83704_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F144928_02703_0|SrvcGrp|12659|2022|PDM|504.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F135877_74403_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136041_87107_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136081_71742_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F119886_25504_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F116461_77536_0|SrvcGrp|104077|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F130766_04967_0|SrvcGrp|92958|2022|PCT|0.88|99|0.00|SLEEP STUDIES|
20|FH_F141870_85224_0|SrvcGrp|86121|2022|PCT|0.83|99|0.00|AETNA GAMUNEX-C|
20|FH_F117471_19111_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F128917_57212_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117346_75093_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F112852_73112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F146211_68144_0|SrvcGrp|112150|2022|PDM|1356.00|99|0.00|DRAINAGE OF FINGER ABSCESS|
20|FH_F43078_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142973_62448_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F32751_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136417_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|GENERAL ACUTE CARE|
20|FH_F107140_0_0|SrvcGrp|74546|2022|PDM|540.00|99|0.00|HOSPICE SERVICES|
20|FH_F114024_0_0|SrvcGrp|75495|2022|PDM|1286.00|99|0.00|AEG 9|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1111.12|99|0.00|HAPA WPA-NWPA 2012-13 ASC 705 W/O REV|
20|FH_F117385_48091_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F123538_21206_0|SrvcGrp|471|2022|PDM|700.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 4 (NO REV)|
20|FH_F150039_34236_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142028_45714_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142907_60640_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MOD 53|
20|FH_F57592_0_0|SrvcGrp|28161|2022|PDM|65000.00|99|0.00|MS DRG 216 ONLY|
20|FH_F91194_33511_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132934_63005_0|SrvcGrp|9506|2022|PDM|4443.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF|
20|FH_F134267_0_0|SrvcGrp|82981|2022|PDM|128.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F75251_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F118647_21811_0|SrvcGrp|75545|2022|PDM|343.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F103281_32086_0|SrvcGrp|12491|2022|PCT|0.31|99|0.00|PACEMAKER|
20|FH_F117875_70601_0|SrvcGrp|10393|2022|PDM|1799.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F92912_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149243_64114_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F103360_68845_0|CSTM-ALL|CSTM-00|2020|PDM|8865.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132594_78229_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133455_60110_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F49637_0_0|SrvcGrp|33197|2022|PDM|9765.00|99|0.00|MS DRG 331 ONLY|
20|FH_F111522_81067_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F120437_85202_0|SrvcGrp|108453|2022|PDM|144.05|99|0.00|HEPAGAM B INTRAVENOUS INJ|
20|FH_F141657_85715_0|SrvcGrp|87131|2022|PDM|600.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F43147_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F92676_15063_0|SrvcGrp|79078|2022|PDM|310.72|99|0.00|MON VALLEY ASC 141|
20|FH_F42779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1158.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F41396_0_0|SrvcGrp|34276|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC (DME)|
20|FH_F144327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133395_98801_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|629.00|99|0.00|AEG 10 (NO REV)|
20|FH_F146211_68144_0|SrvcGrp|80617|2022|PDM|12473.00|99|0.00|ARTHOPLASTY|
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.00|99|0.00|AEG 6 (NO REV)|
20|FH_F118785_33315_0|SrvcGrp|73841|2022|PDM|650.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F42500_0_0|SrvcGrp|439|2022|PDM|1150.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F39417_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GI DX LAB & RAD CARVEOUTS MOD 26|
20|FH_F112953_06066_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F69723_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142779_64083_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111417_33613_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F44097_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|RESIDENTIAL TREATMENT SVCS|
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|846.00|99|0.00|AEG 5  (NO REV)|
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|1693.00|99|0.00|AEG 9 (NO REV)|
20|FH_F89851_83854_0|SrvcGrp|90374|2022|PDM|750.00|99|0.00|CT SCANS|
20|FH_F44135_0_0|SrvcGrp|22954|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F111526_32226_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F86855_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F35411_0_0|CSTM-ALL|CSTM-00|2020|PDM|26312.00|99|0.00|CV SURGERY|
20|FH_F117087_0_0|SrvcGrp|107170|2022|PDM|2494.00|99|0.00|EXCISION OF NECK CYST|
20|FH_F79927_0_0|SrvcGrp|46482|2022|PDM|147.00|99|0.00|S9083 PER VISIT|
20|FH_F120746_29621_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F141657_85715_0|SrvcGrp|89337|2022|PDM|1300.00|99|0.00|DETOXIFICATION|
20|FH_F98921_64503_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F151059_60435_0|SrvcGrp|46605|2022|PDM|125.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F151144_35801_0|SrvcGrp|109760|2022|PDM|2195.30|99|0.00|TRANSLUM DIL EYE CANAL|
20|FH_F151144_35801_0|SrvcGrp|104257|2022|PDM|1015.97|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F151155_26508_0|SrvcGrp|113327|2022|PDM|6985.00|99|0.00|MED ASSIST TX IMPLANT (HCFA)|
20|FH_F137057_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|35.00|99|0.00|AEG 5  (NO REV)|
20|FH_F58856_0_0|SrvcGrp|29757|2022|PDM|17250.00|99|0.00|MS DRG 251 ONLY|
20|FH_F69968_0_0|SrvcGrp|46531|2022|PDM|376.22|99|0.00|EMERGENCY ROOM LEVEL 2|
20|FH_F140629_0_0|SrvcGrp|90436|2022|PDM|8400.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F121428_40202_0|SrvcGrp|102419|2022|PCT|0.33|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F146125_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F65959_0_0|SrvcGrp|29121|2022|PCT|1.20|99|0.00|LABORATORY|
20|FH_F111303_19087_0|SrvcGrp|89417|2022|PDM|375.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F111394_46012_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F36476_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150619_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39925_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F41780_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F54272_0_0|SrvcGrp|51783|2022|PCT|0.45|99|0.00|IP PHARMACY|
20|FH_F54272_0_0|SrvcGrp|1135|2022|PDM|139.00|99|0.00|CLINIC VISIT|
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1821.00|99|0.00|AEG 7 (NO REV)|
20|FH_F131000_0_0|SrvcGrp|91879|2022|PDM|3096.00|99|0.00|PROSTATE LASER ENUCLEATION|
20|FH_F43895_0_0|SrvcGrp|3157|2022|PDM|966.00|99|0.00|ACUTE REHABILITATION|
20|FH_F141035_0_0|SrvcGrp|103563|2022|PDM|3932.00|99|0.00|REPAIR HAND TENDON|
20|FH_F102222_19720_0|SrvcGrp|86849|2022|PDM|31.50|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F102901_85006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F129240_10028_0|SrvcGrp|22592|2022|PDM|40.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F129240_10028_0|SrvcGrp|19742|2022|PDM|60.00|99|0.00|MID-LINE INSERTION|
20|FH_F102960_50613_0|CSTM-ALL|CSTM-00|2020|PDM|4330.00|99|0.00|AEG 4 (NO REV)|
20|FH_F60292_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F130659_44410_0|SrvcGrp|705|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F130775_61701_0|SrvcGrp|86722|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F125870_0_0|SrvcGrp|72998|2022|PDM|1495.00|99|0.00|AEG 5|
20|FH_F117531_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130364_01331_0|SrvcGrp|91117|2022|PDM|1673.00|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F145604_14850_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F133867_84075_0|SrvcGrp|48399|2022|PDM|84.50|99|0.00|SPEECH THERAPY|
20|FH_F150165_06032_0|SrvcGrp|107184|2022|PDM|2525.00|99|0.00|REVISE MIDDLE EAR BONE|
20|FH_F145641_06902_0|CSTM-ALL|CSTM-00|2020|PDM|1445.00|99|0.00|AEG 8 (NO REV)|
20|FH_F125870_0_0|SrvcGrp|73002|2022|PDM|2247.00|99|0.00|AEG 7|
20|FH_F145641_06902_0|SrvcGrp|100070|2022|PDM|4902.00|99|0.00|REVISION OF UNSTABLE KNEECAP|
20|FH_F130017_02302_0|SrvcGrp|20908|2022|PDM|40349.57|99|0.00|MS DRG 247 ONLY|
20|FH_F99021_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "GLOBAL"|
20|FH_F51115_0_0|SrvcGrp|42830|2022|PDM|108.24|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F45212_0_0|CSTM-ALL|CSTM-00|2020|PDM|1727.00|99|0.00|CD RESIDENTIAL TREATMENT|
20|FH_F121476_0_0|SrvcGrp|108855|2022|PDM|4225.00|99|0.00|HALLUX IMPLANT|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|659.60|99|0.00|HAPA WPA-NWPA 2012-13 ASC 402 W/O REV|
20|FH_F119227_01752_0|SrvcGrp|86849|2022|PDM|38.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F127957_89521_0|SrvcGrp|110812|2022|PDM|259.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F92477_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F121601_47446_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F77597_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40374_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F81698_10457_0|SrvcGrp|86847|2022|PDM|31.50|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F126341_27284_0|SrvcGrp|115834|2022|PCT|0.85|99|0.00|J CODES/NDC|
20|FH_F132740_46250_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F139678_25601_0|SrvcGrp|112864|2022|PDM|300.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F114800_68510_0|SrvcGrp|27968|2022|PDM|31.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150310_07035_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133209_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|HSS ASC|
20|FH_F77943_0_0|SrvcGrp|9522|2022|PDM|13846.75|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F111986_0_0|CSTM-ALL|CSTM-00|2020|PDM|2060.00|99|0.00|AETNA CPT 49560|
20|FH_F85652_98034_0|SrvcGrp|31705|2022|PDM|4044.00|99|0.00|MS DRG 791 ONLY|
20|FH_F125133_20601_0|SrvcGrp|48396|2022|PDM|180.00|99|0.00|OT SERVICES|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|502.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 220 W/O REV|
20|FH_F133972_27103_0|SrvcGrp|47183|2022|PDM|60.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F149362_19446_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F51115_0_0|SrvcGrp|42825|2022|PDM|57.30|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F133920_64057_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150299_22046_0|SrvcGrp|66264|2022|PDM|84.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F149106_07042_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F50703_0_0|SrvcGrp|46224|2022|PDM|120.00|99|0.00|NUTRITIONAL ASSESSMENT (INITIAL) VISIT OP|
20|FH_F120719_27540_0|SrvcGrp|76884|2022|PCT|0.50|99|0.00|HOSPITAL BASED CLINIC FACILITY FEES|
20|FH_F133747_80634_0|SrvcGrp|73605|2022|PDM|800.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F119657_39111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150142_76018_0|SrvcGrp|74668|2022|PDM|185.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F146103_63851_0|SrvcGrp|3378|2022|PCT|0.75|99|0.00|OBSERVATION SVCS|
20|FH_F149148_15330_0|SrvcGrp|73701|2022|PDM|25.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F144228_0_0|SrvcGrp|96349|2022|PDM|17085.00|99|0.00|NECK SPINE FUSE|
20|FH_F93076_85016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F149199_73005_0|SrvcGrp|114253|2022|PCT|1.10|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|127.07|99|0.00|HAPA WPA-NWPA 2012-13 ASC 135 W/O REV|
20|FH_F85353_16407_0|SrvcGrp|63855|2022|PDM|391.86|99|0.00|HAPA WPA-NWPA 2012-13 ASC 113|
20|FH_F71628_0_0|SrvcGrp|48396|2022|PDM|15.00|99|0.00|OT SERVICES|
20|FH_F102623_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F107200_0_0|SrvcGrp|83348|2022|PDM|5202.00|99|0.00|AETNA LAPAR-ASST HYSTERECTOMY|
20|FH_F118152_20151_0|SrvcGrp|17016|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F93360_64730_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F134011_84102_0|SrvcGrp|86854|2022|PDM|25.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F134062_32308_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134062_32308_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134126_11554_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134156_32174_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F137040_76011_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F137147_75006_0|SrvcGrp|33982|2022|PDM|22680.00|99|0.00|CPT 28296|
20|FH_F139751_84065_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F142508_29108_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142547_70002_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F142654_73034_0|SrvcGrp|89149|2022|PDM|262.00|99|0.00|OP INTENSIVE|
20|FH_F97582_46307_0|SrvcGrp|73643|2022|PDM|1967.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F97601_67218_0|SrvcGrp|73603|2022|PDM|9293.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F78626_91402_0|SrvcGrp|73668|2022|PCT|1.20|99|0.00|LABORATORY|
20|FH_F138778_90066_0|SrvcGrp|73841|2022|PDM|475.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F140329_78570_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140343_89052_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F140652_92626_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F80062_27612_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151601_89118_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F109920_39180_0|SrvcGrp|75489|2022|PDM|1320.00|99|0.00|AEG 6|
20|FH_F117371_77059_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F129483_77030_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137276_83127_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137938_29036_0|SrvcGrp|10944|2022|PCT|0.66|99|0.00|EMERGENCY ROOM|
20|FH_F137938_29036_0|SrvcGrp|75506|2022|PCT|0.66|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F110308_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F91472_96001_0|SrvcGrp|103763|2022|PCT|0.40|99|0.00|POSTERIOR THOR/THORACOLUMBAR W/ ALLOGRAFT|
20|FH_F91472_96001_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F130035_0_0|SrvcGrp|108043|2022|PDM|203.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F80084_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F61292_0_0|SrvcGrp|48183|2022|PCT|0.49|99|0.00|RADIOLOGY|
20|FH_F72830_0_0|SrvcGrp|70045|2022|PDM|2900.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 5|
20|FH_F110132_23451_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F147941_06023_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F110925_01104_0|SrvcGrp|73701|2022|PDM|31.52|99|0.00|AETNA - SKILLED NURSING|
20|FH_F139293_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143930_16101_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F73013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F35975_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37679_0_0|SrvcGrp|26857|2022|PDM|30.50|99|0.00|HOME INFUSION THERAPY (MOD SH)|
20|FH_F140893_19720_0|SrvcGrp|48396|2022|PDM|113.00|99|0.00|OT SERVICES|
20|FH_F125690_67211_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F77925_0_0|SrvcGrp|8968|2022|PDM|7560.00|99|0.00|NICU LEVEL III & IV|
20|FH_F115075_77833_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136092_0_0|SrvcGrp|63297|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F148325_0_0|SrvcGrp|92502|2022|PDM|654.59|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F35259_0_0|SrvcGrp|91|2022|PCT|0.68|99|0.00|KIDNEY TRANSPLANT|
20|FH_F62892_0_0|SrvcGrp|53747|2022|PDM|35.00|99|0.00|RESPITE CARE|
20|FH_F109180_18015_0|SrvcGrp|73841|2022|PDM|321.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F83533_70433_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41279_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F68343_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F148265_06067_0|SrvcGrp|113629|2022|PDM|12780.00|99|0.00|RECONSTRUCT ELBOW JOINT|
20|FH_F133232_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132735_97068_0|SrvcGrp|112072|2022|PDM|1550.00|99|0.00|RESIDENITAL TREATMENT EATING DISORDER (AGE 0-17)|
20|FH_F110925_01104_0|SrvcGrp|86131|2022|PDM|0.80|99|0.00|AETNA ANTIHEMOPHILIC|
20|FH_F94942_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F121177_33407_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40438_0_0|SrvcGrp|2741|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F48215_0_0|SrvcGrp|8962|2022|PDM|82.50|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F143528_0_0|SrvcGrp|88162|2022|PDM|5250.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F129603_34769_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F97104_53545_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F116952_01020_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F68966_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149404_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F76502_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122649_0_0|SrvcGrp|90707|2022|PDM|112.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F143650_0_0|SrvcGrp|27261|2022|PDM|4100.00|99|0.00|CPT 27446|
20|FH_F145677_34208_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146520_80435_0|SrvcGrp|74668|2022|PDM|1150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121601_47446_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F87012_0_0|SrvcGrp|73008|2022|PDM|1149.32|99|0.00|AEG 10|
20|FH_F130017_02302_0|SrvcGrp|114015|2022|PDM|6192.76|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F127849_43920_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F110425_01752_0|SrvcGrp|104033|2022|PCT|1.00|99|0.00|OP SERVICES W/O HH|
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 1 (NO REV)|
20|FH_F120608_19901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149219_01966_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120719_27540_0|SrvcGrp|75506|2022|PCT|0.71|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F145562_70458_0|SrvcGrp|86843|2022|PDM|33.60|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F150241_60714_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F112065_20852_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)|
20|FH_F122243_30655_0|SrvcGrp|87317|2022|PDM|875.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F90496_13159_0|SrvcGrp|87317|2022|PDM|550.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F146657_01105_0|SrvcGrp|74668|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F125173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133943_01606_0|SrvcGrp|109704|2022|PCT|1.00|99|0.00|LEUPROLIDE ACETATE IMPLANT|
20|FH_F145781_0_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F81698_10457_0|SrvcGrp|14892|2022|PDM|63.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F142376_0_0|SrvcGrp|97319|2022|PDM|13055.00|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|713.00|99|0.00|AEG 4 (NO REV)|
20|FH_F54532_0_0|SrvcGrp|16173|2022|PDM|270.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F127486_06776_0|SrvcGrp|90707|2022|PDM|161.70|99|0.00|AETNA HOSPICE CARE|
20|FH_F81838_0_0|SrvcGrp|9874|2022|PDM|39.00|99|0.00|DIETICIAN|
20|FH_F112082_30720_0|SrvcGrp|29077|2022|PDM|295.00|99|0.00|HOME TRANSFUSION|
20|FH_F149247_02760_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122526_22203_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F85911_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F68626_0_0|SrvcGrp|13188|2022|PCT|0.40|99|0.00|DRUGS|
20|FH_F102200_06416_0|SrvcGrp|24745|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F105143_26062_0|SrvcGrp|102342|2022|PDM|1080.00|99|0.00|ER LEVEL III W/ SURGERY|
20|FH_F105145_75075_0|SrvcGrp|41334|2022|PDM|24731.00|99|0.00|TOTAL KNEE|
20|FH_F115877_63556_0|SrvcGrp|79804|2022|PDM|925.00|99|0.00|AETNA MEDICAL/SURGICAL|
20|FH_F146501_68025_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F126783_80021_0|SrvcGrp|108484|2022|PDM|1595.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F115950_08648_0|SrvcGrp|73841|2022|PDM|345.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F133269_78624_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F132845_63841_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133249_33603_0|SrvcGrp|86723|2022|PDM|419.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F133688_44504_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111563_02116_0|SrvcGrp|100499|2022|PDM|600.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F111584_07002_0|SrvcGrp|86722|2022|PDM|177.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F150745_03301_0|SrvcGrp|82222|2022|PDM|204.00|99|0.00|HOSPICE CARE|
20|FH_F150879_75056_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F150882_84041_0|SrvcGrp|37386|2022|PDM|3.00|99|0.00|AMINO ACIDS|
20|FH_F130661_04441_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 10 (NO REV)|
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1513.00|99|0.00|AEG 6 (NO REV)|
20|FH_F40624_0_0|SrvcGrp|30546|2022|PDM|18909.00|99|0.00|MS DRG 246-247 ONLY|
20|FH_F138995_0_0|SrvcGrp|59840|2022|PDM|930.00|99|0.00|TYMPANOSTOMY|
20|FH_F147360_06415_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42165_0_0|SrvcGrp|22461|2022|PCT|0.85|99|0.00|INPATIENT HOSPICE SVCS|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|ASPG X|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1575124_CPT_NO MOD|
20|FH_F39673_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F147176_17701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138995_0_0|SrvcGrp|83835|2022|PDM|4200.00|99|0.00|REPLACE TISSUE EXPANDER|
20|FH_F126116_0_0|SrvcGrp|108192|2022|PDM|3331.00|99|0.00|FEM/POPL REVAS W/TLA|
20|FH_F112754_98057_0|SrvcGrp|29464|2022|PDM|263.87|99|0.00|HOME HEALTH VISIT NEWBORN CARE|
20|FH_F35678_0_0|SrvcGrp|18245|2022|PDM|16952.00|99|0.00|MS DRG 032|
20|FH_F129297_97828_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F151042_60659_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F97603_77901_0|SrvcGrp|73602|2022|PDM|1520.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F124322_64131_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F35752_33470_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|GENERAL ACUTE CARE|
20|FH_F148181_0_0|SrvcGrp|65720|2022|PDM|155.00|99|0.00|RESPITE CARE|
20|FH_F148519_83201_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F151009_07649_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F39443_0_0|SrvcGrp|29294|2022|PDM|895.00|99|0.00|ACUTE REHAB|
20|FH_F125656_92868_0|SrvcGrp|86837|2022|PDM|12.50|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F117574_49022_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 6 (NO REV)|
20|FH_F112956_0_0|SrvcGrp|105031|2022|PDM|630.00|99|0.00|AETNA SURGICAL CARVEOUT|
20|FH_F132092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123963_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F110102_0_0|SrvcGrp|63297|2022|PDM|150.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F135764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F116984_28092_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.00|99|0.00|AEG 5  (NO REV)|
20|FH_F87254_0_0|SrvcGrp|78284|2022|PDM|921.00|99|0.00|CPT 46200|
20|FH_F148265_06067_0|SrvcGrp|92408|2022|PDM|7540.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F93920_0_0|SrvcGrp|73006|2022|PDM|9000.00|99|0.00|AEG 9|
20|FH_F39041_0_0|SrvcGrp|3029|2022|PDM|806.00|99|0.00|NEWBORN NURSERY|
20|FH_F39269_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F135002_54971_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F112508_0_0|SrvcGrp|73485|2022|PDM|832.00|99|0.00|AETNA REHAB|
20|FH_F137707_32724_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|PDM|225.00|99|0.00|ADOLOESCENT PARTIAL HOSPITALIZATION|
20|FH_F123915_0_0|SrvcGrp|94780|2022|PDM|198.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F120352_52556_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F118741_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|1193.00|99|0.00|AEG 4 (NO REV)|
20|FH_F40709_0_0|CSTM-ALL|CSTM-00|2020|PDM|470.00|99|0.00|ASPG X|
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 2 (NO REV)|
20|FH_F118194_50841_0|SrvcGrp|108148|2022|PCT|1.00|99|0.00|DME|
20|FH_F113410_0_0|SrvcGrp|101525|2022|PDM|5463.00|99|0.00|MYOMECTOMY|
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112568_0_0|SrvcGrp|104839|2022|PDM|240.60|99|0.00|HOSPICE CARE|
20|FH_F86319_16365_0|SrvcGrp|16|2022|PDM|1033.00|99|0.00|ACUTE REHABILITATION|
20|FH_F57032_0_0|SrvcGrp|53488|2022|PDM|244.00|99|0.00|INSERTS|
20|FH_F136790_0_0|SrvcGrp|12043|2022|PDM|1187.00|99|0.00|CPT 99205|
20|FH_F120155_63114_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F60073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141169_0_0|SrvcGrp|113730|2022|PDM|1389.00|99|0.00|INDUCED ABORTION BY DILATION AND CURETTAGE|
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F139719_0_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F36433_0_0|CSTM-ALL|CSTM-00|2020|PDM|12360.00|99|0.00|MS DRG 469-470|
20|FH_F123276_20737_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F125899_07645_0|SrvcGrp|82369|2022|PCT|3.58|99|0.00|AETNA LABORATORY|
20|FH_F123627_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102184_0_0|SrvcGrp|98495|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F121090_07848_0|SrvcGrp|104796|2022|PDM|149.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F122725_32216_0|SrvcGrp|72299|2022|PDM|387.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F122694_33334_0|SrvcGrp|3178|2022|PDM|830.00|99|0.00|ACUTE PSYCH|
20|FH_F133211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F74602_0_0|SrvcGrp|13778|2022|PDM|1200.00|99|0.00|PSYCH/CD|
20|FH_F62579_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|PEDIATRIC OCCUPATIONAL THERAPY|
20|FH_F37478_0_0|SrvcGrp|8968|2022|PCT|0.80|99|0.00|NICU LEVEL III & IV|
20|FH_F103821_0_0|SrvcGrp|75545|2022|PDM|703.31|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F135840_0_0|SrvcGrp|112794|2022|PDM|550.00|99|0.00|BREAST PROCEDURE|
20|FH_F130662_07032_0|SrvcGrp|90631|2022|PDM|265.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F130721_04769_0|SrvcGrp|111927|2022|PCT|1.00|99|0.00|COVID-19 NON CDC|
20|FH_F145641_06902_0|SrvcGrp|100039|2022|PDM|3802.00|99|0.00|REPAIR OF HEEL FRACTURE|
20|FH_F149105_66215_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121476_0_0|SrvcGrp|84706|2022|PDM|1590.00|99|0.00|SYNTHETIC IMPLANT|
20|FH_F127090_45601_0|SrvcGrp|62154|2022|PDM|71.40|99|0.00|PICC LINES|
20|FH_F91171_0_0|SrvcGrp|59841|2022|PDM|778.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F138191_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146543_89511_0|SrvcGrp|108484|2022|PDM|743.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F81483_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F59872_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG I|
20|FH_F43865_0_0|SrvcGrp|37403|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F148547_01908_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128148_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BONE MARROW W/BIOPSY (HBMW) (HBIO)|
20|FH_F138147_18018_0|CSTM-ALL|CSTM-00|2020|PDM|239.00|99|0.00|LEVEL AUTISM DX INTERVIEW (MOD AH)|
20|FH_F81861_0_0|SrvcGrp|64113|2022|PDM|88.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 10|
20|FH_F139380_33062_0|SrvcGrp|73842|2022|PDM|237.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F79863_0_0|SrvcGrp|77235|2022|PDM|195.00|99|0.00|AETNA HOME INFUSION S9364|
20|FH_F145965_50325_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146064_17331_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|1517.00|99|0.00|AEG 9 (NO REV)|
20|FH_F149305_76036_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F96160_32207_0|SrvcGrp|22589|2022|PDM|61.90|99|0.00|CHEMOTHERAPY NOC|
20|FH_F149021_44514_0|CSTM-ALL|CSTM-00|2020|PDM|529.00|99|0.00|AEG 10 (NO REV)|
20|FH_F100782_0_0|SrvcGrp|97576|2022|PDM|931.07|99|0.00|WINDBER MEDICAL CNTR ASC 203|
20|FH_F123609_28451_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F36552_0_0|SrvcGrp|18809|2022|PDM|29295.00|99|0.00|MS DRG 219|
20|FH_F50654_0_0|SrvcGrp|46889|2022|PCT|1.00|99|0.00|LASER TREATMENT OF RETINA|
20|FH_F92151_74104_0|SrvcGrp|78504|2022|PCT|0.58|99|0.00|AETNA CARDIAC CATHETERIZATION|
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_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 7 (NO REV)|
20|FH_F130836_53406_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35802_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84872_18510_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97620_75904_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|2618.00|99|0.00|INSERT ANT SEGMENT DRAIN IN (HCFA)|
20|FH_F149662_85015_0|SrvcGrp|2738|2022|PCT|0.29|99|0.00|IMPLANTS|
20|FH_F111044_0_0|SrvcGrp|33724|2022|PDM|2266.00|99|0.00|ARTHROSCOPY|
20|FH_F94621_07728_0|SrvcGrp|94042|2022|PCT|1.00|99|0.00|GAMMA GLOBULIN  INTRAM>10 CC|
20|FH_F110732_31513_0|SrvcGrp|10391|2022|PDM|1478.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F90817_0_0|SrvcGrp|90379|2022|PDM|2280.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY|
20|FH_F37364_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 10 (NO REV)|
20|FH_F147220_49417_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|35043.00|99|0.00|MS DRG 219-221|
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|2132.00|99|0.00|AETNA CPT 49560|
20|FH_F92278_01440_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148550_48126_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F76826_0_0|SrvcGrp|16449|2022|PDM|69.00|99|0.00|AIR AMBULANCE|
20|FH_F149273_0_0|SrvcGrp|115612|2022|PDM|5610.00|99|0.00|HIP ARTHRO W/ FEMOROPLASTY|
20|FH_F139167_42240_0|SrvcGrp|73842|2022|PDM|213.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130919_33314_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F151517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F71468_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F144651_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F128753_32501_0|SrvcGrp|73560|2022|PCT|0.64|99|0.00|AETNA SLEEP STUDIES|
20|FH_F38475_0_0|SrvcGrp|22387|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F151001_80501_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130939_40353_0|SrvcGrp|89149|2022|PDM|184.00|99|0.00|OP INTENSIVE|
20|FH_F129340_43212_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F125182_0_0|SrvcGrp|73004|2022|PDM|950.00|99|0.00|AEG 8|
20|FH_F147082_02359_0|SrvcGrp|88905|2022|PDM|1167.00|99|0.00|PSYCHIATRIC CARE (AGE 0-17)|
20|FH_F131284_76502_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F97082_90012_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F98000_59102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120104_97223_0|SrvcGrp|106248|2022|PDM|450.00|99|0.00|PARTIAL HOSP PSYCH|
20|FH_F134432_85053_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F131371_0_0|SrvcGrp|44461|2022|PDM|45162.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD AU RATE|
20|FH_F139950_76240_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F151748_20037_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151748_20037_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151761_20019_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F47056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD RR KC|
20|FH_F136296_73170_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132371_19083_0|SrvcGrp|112065|2022|PCT|1.00|99|0.00|AMFS DEFAULT W/O HOME HEALTH|
20|FH_F132515_19382_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116595_92506_0|SrvcGrp|73842|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F116633_37217_0|SrvcGrp|48385|2022|PDM|150.00|99|0.00|SPEECH THERAPY|
20|FH_F116698_07470_0|SrvcGrp|86850|2022|PDM|39.90|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F116915_30308_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F113649_01752_0|SrvcGrp|22589|2022|PDM|45.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F84394_17402_0|SrvcGrp|72121|2022|PDM|7457.00|99|0.00|ARTHOSCOPY|
20|FH_F149679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40091_0_0|SrvcGrp|17075|2022|PCT|0.70|99|0.00|ASPG VI|
20|FH_F40043_0_0|CSTM-ALL|CSTM-00|2020|PDM|5351.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F151146_0_0|CSTM-ALL|CSTM-00|2020|PDM|2575.00|99|0.00|HERNIA REPAIR W/ MESH|
20|FH_F123407_04605_0|SrvcGrp|91070|2022|PDM|226.00|99|0.00|AETNA MH CRISIS INTERVENTION (HCFA)|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F120693_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F95200_16201_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119824_0_0|SrvcGrp|108153|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F151146_0_0|CSTM-ALL|CSTM-00|2020|PDM|966.00|99|0.00|AEG 2 (NO REV)|
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1056.00|99|0.00|AEG 2 (NO REV)|
20|FH_F141129_0_0|SrvcGrp|24028|2022|PDM|23.00|99|0.00|LICENSED PRACTICAL NURSE|
20|FH_F148122_49435_0|SrvcGrp|74668|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F143528_0_0|SrvcGrp|11674|2022|PDM|5250.00|99|0.00|OP SURG|
20|FH_F149740_33912_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F148265_06067_0|SrvcGrp|67066|2022|PDM|15338.00|99|0.00|CERVICAL SURGERY|
20|FH_F83293_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F38709_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F118194_50841_0|SrvcGrp|86840|2022|PDM|252.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F134568_12946_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120720_24541_0|SrvcGrp|43569|2022|PDM|70.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F117437_0_0|SrvcGrp|104226|2022|PDM|180.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F112082_30720_0|SrvcGrp|73700|2022|PDM|107.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F138951_41101_0|SrvcGrp|17016|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F119227_01752_0|SrvcGrp|86843|2022|PDM|60.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F110580_71106_0|CSTM-ALL|CSTM-00|2020|PDM|1274.00|99|0.00|AEG 8 (NO REV)|
20|FH_F96160_32207_0|SrvcGrp|17014|2022|PDM|68.65|99|0.00|HOME INFUSION THERAPY|
20|FH_F126063_43078_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150239_75569_0|SrvcGrp|29023|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132606_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F120727_54301_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F145959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120719_27540_0|SrvcGrp|77305|2022|PCT|0.46|99|0.00|DIAGNOSTIC DRUGS|
20|FH_F112073_65020_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149263_0_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F129633_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118127_30078_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F145593_92660_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F121687_04401_0|SrvcGrp|27287|2022|PCT|1.38|99|0.00|CHEMOTHERAPY ADMINISTRATION|
20|FH_F85777_77030_0|SrvcGrp|13807|2022|PCT|0.75|99|0.00|OBSERVATION SVCS|
20|FH_F127957_89521_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116806_0_0|SrvcGrp|104908|2022|PDM|1923.16|99|0.00|EXCISE PAROTID GLAND/LESION|
20|FH_F148439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122425_75082_0|SrvcGrp|76501|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F31053_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|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_F50074_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130126_33413_0|SrvcGrp|108484|2022|PDM|1040.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F146668_30189_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F146796_43334_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F127656_06068_0|SrvcGrp|88620|2022|PDM|109.20|99|0.00|SKILLED NURSING RN|
20|FH_F47140_0_0|SrvcGrp|28728|2022|PDM|478.10|99|0.00|SLEEP STUDIES CPT 95805 W/MODIFIER TC|
20|FH_F131747_80108_0|SrvcGrp|111412|2022|PDM|2150.00|99|0.00|OB SERVICES|
20|FH_F133652_50310_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132868_43551_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131430_17566_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F111836_12901_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F134828_30531_0|SrvcGrp|112667|2022|PDM|46.00|99|0.00|XRAY EXAM HIP UNI 1 VIEW (HCFA)|
20|FH_F34477_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DURABLE MEDICAL EQUIPMENT (DME) W/MOD RR - WINN|
20|FH_F119795_0_0|SrvcGrp|92823|2022|PDM|4474.00|99|0.00|REVISE KNUCKLE WITH IMPLANT|
20|FH_F114064_0_0|SrvcGrp|73008|2022|PDM|803.00|99|0.00|AEG 10|
20|FH_F89372_0_0|SrvcGrp|88429|2022|PCT|0.51|99|0.00|AETNA SKIN SUBSTITUTCE PRODUCTS|
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|642.53|99|0.00|AETNA POLYSOMNOGRAPHY|
20|FH_F88115_0_0|SrvcGrp|16|2022|PDM|708.00|99|0.00|ACUTE REHABILITATION|
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|2197.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132810_0_0|SrvcGrp|111529|2022|PDM|80.00|99|0.00|MID-LINE INSERTION (HCFA)|
20|FH_F107200_0_0|SrvcGrp|89869|2022|PDM|1561.00|99|0.00|SPONTANEOUS ABORTION|
20|FH_F136399_70445_0|SrvcGrp|17100|2022|PDM|900.00|99|0.00|SKILLED NURSING|
20|FH_F136475_89119_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F118232_24970_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F134167_10032_0|SrvcGrp|48396|2022|PDM|109.00|99|0.00|OT SERVICES|
20|FH_F114178_19083_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142527_89109_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F97582_46307_0|SrvcGrp|73602|2022|PDM|2905.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F138584_30912_0|SrvcGrp|113419|2022|PDM|440.00|99|0.00|REMOVAL OF JAW BONE LESION|
20|FH_F138627_82901_0|SrvcGrp|41452|2022|PDM|1.17|99|0.00|ENTERAL FORMULA - SPECIAL METABOLIC NEEDS|
20|FH_F138627_82901_0|SrvcGrp|113452|2022|PDM|85.00|99|0.00|INFUSION SUPPLIES (HCFA)|
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1413.23|99|0.00|2006 MEDICARE ASPG VIII|
20|FH_F137310_0_0|SrvcGrp|108899|2022|PDM|1200.00|99|0.00|HOSPICE INPATIENT RESPITE CARE|
20|FH_F77782_66061_0|SrvcGrp|20814|2022|PCT|0.80|99|0.00|MS DRG 001-002 ONLY - HEART TRANSPLANT|
20|FH_F138735_50583_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140687_98001_0|SrvcGrp|74579|2022|PCT|0.90|99|0.00|TRAUMA SERVICES|
20|FH_F80284_16354_0|SrvcGrp|34923|2022|PDM|733.00|99|0.00|ACUTE PSYCH|
20|FH_F149604_08505_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119004_06850_0|SrvcGrp|28548|2022|PDM|2817.00|99|0.00|VITRECTOMY|
20|FH_F38332_0_0|SrvcGrp|18889|2022|PDM|42216.00|99|0.00|MS DRG 235|
20|FH_F40402_0_0|SrvcGrp|38|2022|PDM|1273.00|99|0.00|NORMAL DELIVERY|
20|FH_F109886_36303_0|SrvcGrp|73841|2022|PDM|542.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F76144_0_0|SrvcGrp|21342|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F92852_0_0|SrvcGrp|28550|2022|PDM|2200.00|99|0.00|VITRECTOMY|
20|FH_F147725_06002_0|SrvcGrp|106265|2022|PDM|5700.00|99|0.00|NSL/SINS NDSC TOTAL|
20|FH_F147725_06002_0|SrvcGrp|115165|2022|PDM|4867.00|99|0.00|MIDDLE EAR PROCEDURES|
20|FH_F117093_40041_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|1373.00|99|0.00|AEG 9 (NO REV)|
20|FH_F38360_0_0|SrvcGrp|29021|2022|PCT|0.65|99|0.00|DME AND SUPPLIES|
20|FH_F151542_32224_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109581_0_0|SrvcGrp|75489|2022|PDM|928.00|99|0.00|AEG 6|
20|FH_F121523_33406_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|GENERAL ACUTE CARE|
20|FH_F143974_28204_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F125011_74467_0|SrvcGrp|73006|2022|PDM|3150.00|99|0.00|AEG 9|
20|FH_F145593_92660_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141607_27021_0|SrvcGrp|66264|2022|PDM|120.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F39819_0_0|SrvcGrp|31194|2022|PDM|3415.00|99|0.00|NY DRG 373 ONLY|
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|1512.54|99|0.00|ASPG IV|
20|FH_F111661_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 2 (NO REV)|
20|FH_F38526_0_0|CSTM-ALL|CSTM-00|2020|PDM|1770.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F129023_15501_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122687_0_0|SrvcGrp|104112|2022|PDM|3825.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F145537_02061_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F145815_30540_0|SrvcGrp|112676|2022|PDM|42.13|99|0.00|COVID-19 SARS-COV-2 ANTIBODY|
20|FH_F129666_71901_0|SrvcGrp|23683|2022|PDM|55.00|99|0.00|SKILLED NURSING RN|
20|FH_F102302_0_0|SrvcGrp|80139|2022|PDM|18450.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F119760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137984_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F117784_0_0|SrvcGrp|13597|2022|PDM|130.07|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F148263_30830_0|CSTM-ALL|CSTM-00|2020|PDM|1326.64|99|0.00|GENERAL ACUTE CARE|
20|FH_F110061_0_0|SrvcGrp|75487|2022|PDM|759.00|99|0.00|AEG 5|
20|FH_F41494_0_0|SrvcGrp|38|2022|PDM|3230.00|99|0.00|NORMAL DELIVERY|
20|FH_F145545_01602_0|SrvcGrp|16069|2022|PDM|504.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F126678_44870_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43171_0_0|CSTM-ALL|CSTM-00|2020|PDM|105.00|99|0.00|INTENSIVE PSYCH OP SERVICES|
20|FH_F139551_0_0|SrvcGrp|26274|2022|PDM|2537.00|99|0.00|CPT 29877|
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|438.00|99|0.00|AEG 2 (NO REV)|
20|FH_F130747_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F123895_52722_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F78603_0_0|SrvcGrp|21350|2022|PDM|10214.81|99|0.00|MS DRG 287 ONLY|
20|FH_F123486_61764_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F72830_0_0|SrvcGrp|10425|2022|PDM|370.00|99|0.00|NEWBORN NURSERY|
20|FH_F141169_0_0|SrvcGrp|113734|2022|PDM|136.00|99|0.00|EXAM OF VAGINA|
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_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)|
20|FH_F129338_19114_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F127281_68516_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F100320_0_0|SrvcGrp|86919|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F114980_78061_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122687_0_0|SrvcGrp|80617|2022|PDM|13413.00|99|0.00|ARTHOPLASTY|
20|FH_F127988_85258_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129828_0_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F149865_95624_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F56676_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148340_28269_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F45632_0_0|SrvcGrp|41483|2022|PCT|1.00|99|0.00|OMNICARE IV DRUGS|
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_F41201_0_0|SrvcGrp|360|2022|PCT|0.73|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F132092_0_0|SrvcGrp|94780|2022|PDM|169.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F60812_0_0|SrvcGrp|13365|2022|PDM|4883.00|99|0.00|INTENSIVE MEDICAL CARE|
20|FH_F120672_0_0|SrvcGrp|103913|2022|PCT|0.87|99|0.00|OP DIALYSIS|
20|FH_F72183_0_0|SrvcGrp|28074|2022|PCT|0.70|99|0.00|HIGH COST PHARMACEUTICALS|
20|FH_F75595_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F130157_84049_0|SrvcGrp|75419|2022|PDM|1050.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F56136_0_0|SrvcGrp|22822|2022|PCT|0.92|99|0.00|CPAP|
20|FH_F136790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38420_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123464_63841_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
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_F119795_0_0|SrvcGrp|82108|2022|PDM|5202.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F51359_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114064_0_0|SrvcGrp|72994|2022|PDM|1000.00|99|0.00|AEG 3|
20|FH_F89372_0_0|SrvcGrp|73602|2022|PDM|1244.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F89372_0_0|SrvcGrp|16392|2022|PCT|1.00|99|0.00|AMBULANCE|
20|FH_F132544_0_0|SrvcGrp|97079|2022|PDM|3454.00|99|0.00|MENISCUS REPAIR, MED OR LAT|
20|FH_F119449_84032_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148432_01585_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148495_03038_0|SrvcGrp|473|2022|PDM|391.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F148552_68114_0|CSTM-ALL|CSTM-00|2020|PDM|1100.58|99|0.00|AEG 3 (NO REV)|
20|FH_F150065_16001_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149820_75040_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100880_67735_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F90831_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|ASPG IX|
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1560.60|99|0.00|AEG 10 (NO REV)|
20|FH_F110233_0_0|SrvcGrp|89939|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F124542_0_0|SrvcGrp|99073|2022|PDM|1.32|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F132163_17601_0|SrvcGrp|69075|2022|PDM|93.81|99|0.00|CPT 99213|
20|FH_F132268_07060_0|SrvcGrp|94737|2022|PDM|56.65|99|0.00|FLUVIRIN VACC IM (>=3 YRS)|
20|FH_F122168_66214_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F135347_68784_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135388_48601_0|SrvcGrp|106314|2022|PDM|768.48|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F135609_37027_0|SrvcGrp|90854|2022|PDM|1178.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F136026_66062_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136042_90066_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F100765_73735_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F100880_67735_0|SrvcGrp|12809|2022|PCT|0.49|99|0.00|RADIATION THERAPY SVCS|
20|FH_F100880_67735_0|SrvcGrp|73002|2022|PDM|2709.00|99|0.00|AEG 7|
20|FH_F131132_44077_0|SrvcGrp|3178|2022|PDM|1677.00|99|0.00|ACUTE PSYCH|
20|FH_F131407_07607_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F116467_13031_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F116527_70443_0|SrvcGrp|73004|2022|PDM|1600.00|99|0.00|AEG 8|
20|FH_F121428_40202_0|SrvcGrp|73601|2022|PDM|2036.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F85135_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42098_0_0|SrvcGrp|10544|2022|PDM|53.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F42347_0_0|SrvcGrp|31188|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC (DME)|
20|FH_F111292_33136_0|SrvcGrp|10391|2022|PDM|2874.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F111301_33122_0|SrvcGrp|107505|2022|PDM|158.00|99|0.00|X-RAY EXAM CHEST SINGLE VIEW|
20|FH_F111341_80501_0|SrvcGrp|472|2022|PDM|433.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F111385_33308_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134315_89106_0|SrvcGrp|14944|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F47906_0_0|SrvcGrp|43842|2022|PCT|1.00|99|0.00|DME MOD RRKE|
20|FH_F43801_0_0|CSTM-ALL|CSTM-00|2020|PDM|961.00|99|0.00|HEAD INJURY REHABILITATION|
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|1144.00|99|0.00|2006 MEDICARE ASPG VII|
20|FH_F127713_30012_0|SrvcGrp|48396|2022|PDM|155.00|99|0.00|OT SERVICES|
20|FH_F126023_70748_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102222_19720_0|SrvcGrp|86829|2022|PDM|31.50|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F102322_32233_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148079_06512_0|SrvcGrp|66264|2022|PDM|87.55|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F39272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F98625_08103_0|SrvcGrp|73485|2022|PDM|5174.00|99|0.00|AETNA REHAB|
20|FH_F103004_75840_0|SrvcGrp|79786|2022|PCT|1.00|99|0.00|SLEEP STUDIES|
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_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|1490.00|99|0.00|AEG 2 (NO REV)|
20|FH_F129850_0_0|SrvcGrp|111422|2022|PCT|5.50|99|0.00|PHYSICAL MEDICINE|
20|FH_F133660_53225_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F92516_0_0|SrvcGrp|72994|2022|PDM|516.00|99|0.00|AEG 3|
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PDM|4951.00|99|0.00|AEG 8 (NO REV)|
20|FH_F55212_0_0|CSTM-ALL|CSTM-00|2020|PDM|655.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 9 (NO REV)|
20|FH_F86851_0_0|SrvcGrp|79578|2022|PDM|651.00|99|0.00|CPT 43246|
20|FH_F90354_0_0|SrvcGrp|92501|2022|PDM|144.24|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|2975.00|99|0.00|AEG 7 (NO REV)|
20|FH_F61512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69968_0_0|SrvcGrp|46504|2022|PDM|4690.70|99|0.00|MS DRG 215-241,245, 250-265 CARDIAC /CCU SURGERY|
20|FH_F69968_0_0|SrvcGrp|17071|2022|PDM|1607.94|99|0.00|ASPG IV|
20|FH_F136347_30328_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136475_89119_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F136475_89119_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134160_19006_0|SrvcGrp|100961|2022|PDM|336.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY|
20|FH_F136952_78218_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F137147_75006_0|SrvcGrp|31927|2022|PDM|44226.00|99|0.00|MS DRG 457 ONLY|
20|FH_F142690_31774_0|SrvcGrp|111384|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F138584_30912_0|SrvcGrp|107008|2022|PCT|1.00|99|0.00|REMOVAL OF BONE FOR GRAFT|
20|FH_F138627_82901_0|SrvcGrp|86852|2022|PDM|85.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F125053_0_0|SrvcGrp|79579|2022|PDM|3315.00|99|0.00|CPT 43251|
20|FH_F139267_30253_0|SrvcGrp|113541|2022|PDM|56.44|99|0.00|COVID-19 AMP PRB|
20|FH_F138583_60644_0|SrvcGrp|73841|2022|PDM|379.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F140335_70435_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F140616_43338_0|SrvcGrp|111926|2022|PCT|1.00|99|0.00|COVID-19 LAB TESTING|
20|FH_F148739_47129_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F149377_22102_0|SrvcGrp|98701|2022|PDM|400.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F149563_75840_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118959_44830_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F52832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F67239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129467_45449_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F137334_90405_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F109907_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117182_68127_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC|
20|FH_F117211_15143_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117189_60085_0|SrvcGrp|89337|2022|PDM|842.00|99|0.00|DETOXIFICATION|
20|FH_F137814_61820_0|SrvcGrp|86723|2022|PDM|393.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F137829_62948_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F91472_96001_0|SrvcGrp|111616|2022|PCT|0.40|99|0.00|REPLACEMENT OF JOINT OF FOOT AND TOE|
20|FH_F146112_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F52716_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134434_30607_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 6 (NO REV)|
20|FH_F115884_0_0|SrvcGrp|89781|2022|PDM|111.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F113906_0_0|SrvcGrp|73008|2022|PDM|665.00|99|0.00|AEG 10|
20|FH_F129130_92562_0|SrvcGrp|73485|2022|PDM|3255.21|99|0.00|AETNA REHAB|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|380.17|99|0.00|DELAWARE VALLEY- ASC 208|
20|FH_F98041_10027_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F110000_0_0|SrvcGrp|33830|2022|PDM|2370.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 8|
20|FH_F91873_12723_0|SrvcGrp|41798|2022|PDM|8225.00|99|0.00|MS DRG 774-775 ONLY NORMAL DELIVERY|
20|FH_F97660_29401_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F86911_0_0|SrvcGrp|43264|2022|PDM|4.00|99|0.00|IMPLANTABLE PORTS CATH CARE|
20|FH_F114916_30309_0|SrvcGrp|78096|2022|PDM|3000.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F114916_30309_0|SrvcGrp|67074|2022|PDM|2400.00|99|0.00|AC SURGERY|
20|FH_F142288_44714_0|SrvcGrp|75419|2022|PDM|453.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F113033_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112453_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40471_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.00|99|0.00|ASC II ENDOSCOPY CTR CENTRAL PA|
20|FH_F41112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F118909_0_0|SrvcGrp|63297|2022|PDM|133.90|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F40333_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92212_0_0|SrvcGrp|92086|2022|PDM|945.00|99|0.00|VITRECTOMY|
20|FH_F124058_61081_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F85154_0_0|SrvcGrp|75545|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F87816_0_0|SrvcGrp|16526|2022|PDM|183.75|99|0.00|DIALYSIS|
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92493_0_0|SrvcGrp|92365|2022|PDM|12999.53|99|0.00|FUSION OF SACROILIAC JOINT|
20|FH_F98380_43055_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F124225_92506_0|SrvcGrp|87131|2022|PDM|410.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F124679_64052_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133399_72211_0|SrvcGrp|46903|2022|PDM|635.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F136745_34772_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114666_30342_0|SrvcGrp|16289|2022|PDM|1000.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F138527_64506_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F138693_45723_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138875_78041_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F81893_23114_0|SrvcGrp|66226|2022|PDM|116.00|99|0.00|SPEECH THERAPY|
20|FH_F122643_72501_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122727_64030_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F43444_0_0|SrvcGrp|40820|2022|PDM|1800.00|99|0.00|ICU/CCU|
20|FH_F134670_95628_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F134746_83318_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136786_25302_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136828_32405_0|SrvcGrp|12659|2022|PDM|724.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F136831_78728_0|SrvcGrp|86722|2022|PDM|195.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F136930_73114_0|SrvcGrp|9916|2022|PDM|2280.00|99|0.00|OBSERVATION SVCS|
20|FH_F132809_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|ASPG I|
20|FH_F49005_0_0|SrvcGrp|44987|2022|PDM|75.00|99|0.00|SKILLED NURSING (ADDITIONAL HOURS)|
20|FH_F115144_71373_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115631_65201_0|SrvcGrp|16289|2022|PDM|1182.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F147519_52627_0|CSTM-ALL|CSTM-00|2020|PDM|4063.45|99|0.00|AEG 5  (NO REV)|
20|FH_F147519_52627_0|SrvcGrp|113903|2022|PCT|2.76|99|0.00|RADIOLOGY SERVICES|
20|FH_F147586_44124_0|SrvcGrp|103236|2022|PDM|12578.00|99|0.00|AETNA INSJ STABLJ DEV|
20|FH_F147394_14031_0|SrvcGrp|76501|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F84611_30281_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F51276_0_0|SrvcGrp|17008|2022|PDM|88.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS|
20|FH_F36372_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BROOKVIEW NURSING S CODES|
20|FH_F40474_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F69245_84047_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F102881_0_0|CSTM-ALL|CSTM-00|2020|PDM|1831.00|99|0.00|AEG 4 (NO REV)|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PDM|972.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PDM|382.80|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 1 W/O REV|
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2885.00|99|0.00|AEG 6 (NO REV)|
20|FH_F133536_0_0|SrvcGrp|100002|2022|PDM|3145.00|99|0.00|REPAIR SHOULDER CAPSULE|
20|FH_F100101_24018_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120612_23314_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F46672_0_0|SrvcGrp|12401|2022|PDM|90.00|99|0.00|RN VISIT|
20|FH_F72445_0_0|SrvcGrp|14371|2022|PDM|13.00|99|0.00|DISPOSABLE DRUG DELIVERY|
20|FH_F80511_0_0|SrvcGrp|78181|2022|PDM|1215.00|99|0.00|AETNA CAT SCAN|
20|FH_F143053_89501_0|SrvcGrp|109036|2022|PDM|945.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F119095_08536_0|SrvcGrp|12491|2022|PCT|0.30|99|0.00|PACEMAKER|
20|FH_F88280_0_0|SrvcGrp|19731|2022|PDM|11535.00|99|0.00|MS DRG 469-470 ONLY|
20|FH_F132690_87571_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F141870_85224_0|SrvcGrp|31973|2022|PDM|25.00|99|0.00|HOME THERAPY|
20|FH_F142752_19428_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150001_33064_0|SrvcGrp|86842|2022|PDM|26.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F78205_0_0|SrvcGrp|17079|2022|PDM|4524.44|99|0.00|ASPG VIII|
20|FH_F143007_60640_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F128648_44256_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F81591_70112_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|GENERAL ACUTE CARE|
20|FH_F100786_24740_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F53572_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F112165_0_0|SrvcGrp|73004|2022|PDM|2600.00|99|0.00|AEG 8|
20|FH_F76864_0_0|SrvcGrp|73948|2022|PDM|325.00|99|0.00|SKILLED NURSING|
20|FH_F133028_08021_0|SrvcGrp|103613|2022|PDM|30.66|99|0.00|MED NUTRITION IND SUBSEQUENT|
20|FH_F114024_0_0|SrvcGrp|75487|2022|PDM|735.00|99|0.00|AEG 5|
20|FH_F87577_80016_0|SrvcGrp|13720|2022|PDM|544.00|99|0.00|RESIDENTIAL HOSPICE SVCS|
20|FH_F150001_33064_0|SrvcGrp|24744|2022|PDM|53.00|99|0.00|PICC LINE INSERTION|
20|FH_F69123_0_0|SrvcGrp|29744|2022|PDM|40.00|99|0.00|SKILLED NURSING CARE - MOD TD|
20|FH_F128657_19008_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F80855_0_0|SrvcGrp|78282|2022|PDM|3375.00|99|0.00|CPT 47563|
20|FH_F132837_64118_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133550_90630_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F73502_0_0|SrvcGrp|22954|2022|PDM|100.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F123324_0_0|SrvcGrp|10667|2022|PDM|657.00|99|0.00|BOARDER BABY SVCS|
20|FH_F117087_0_0|SrvcGrp|44144|2022|PDM|2494.00|99|0.00|CPT 42440|
20|FH_F133517_49221_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F146211_68144_0|SrvcGrp|114015|2022|PDM|1533.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F132551_39194_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F44795_0_0|SrvcGrp|37027|2022|PDM|80.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F71667_0_0|SrvcGrp|11283|2022|PCT|0.75|99|0.00|HYPERBARIC CHAMBER|
20|FH_F51545_0_0|SrvcGrp|45783|2022|PDM|145.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F120032_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133287_40215_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F101840_76054_0|SrvcGrp|28213|2022|PDM|15337.00|99|0.00|MS DRG 472 ONLY|
20|FH_F101840_76054_0|SrvcGrp|72998|2022|PDM|2059.00|99|0.00|AEG 5|
20|FH_F150001_33064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39859_0_0|SrvcGrp|12280|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F65899_0_0|SrvcGrp|9510|2022|PDM|1238.00|99|0.00|SKILLED NURSING CARE|
20|FH_F133009_19038_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F67202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133458_18929_0|SrvcGrp|46903|2022|PDM|1550.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F92677_08003_0|SrvcGrp|86836|2022|PDM|18.90|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|AEG 1 (NO REV)|
20|FH_F137240_0_0|SrvcGrp|65460|2022|PDM|44959.00|99|0.00|GAMMA KNIFE|
20|FH_F98640_0_0|SrvcGrp|59840|2022|PDM|1818.00|99|0.00|TYMPANOSTOMY|
20|FH_F146211_68144_0|SrvcGrp|72984|2022|PCT|1.20|99|0.00|CHEMOTHERAPY|
20|FH_F40994_0_0|SrvcGrp|7|2022|PDM|1000.00|99|0.00|NEONATAL INTENSIVE|
20|FH_F46281_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125009_17042_0|SrvcGrp|89417|2022|PDM|412.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F104963_15146_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F101840_76054_0|SrvcGrp|31032|2022|PDM|10650.00|99|0.00|MS DRG 508 ONLY|
20|FH_F145964_10993_0|SrvcGrp|63379|2022|PDM|63.00|99|0.00|CARDIAC REHABILITATION|
20|FH_F145937_75240_0|SrvcGrp|29346|2022|PDM|40.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F143030_02895_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F111316_0_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F90955_06053_0|SrvcGrp|48398|2022|PDM|84.00|99|0.00|PT SERVICES|
20|FH_F133371_63077_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F72859_0_0|SrvcGrp|11790|2022|PDM|110.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F81485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2014 WMS CHRISTIAN LAB|
20|FH_F142947_76043_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132571_24739_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117132_0_0|SrvcGrp|81859|2022|PDM|1250.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F60101_0_0|SrvcGrp|3810|2022|PDM|180.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F87436_0_0|SrvcGrp|21342|2022|PCT|0.30|99|0.00|IMPLANTS|
20|FH_F71594_15644_0|SrvcGrp|81879|2022|PCT|1.00|99|0.00|LABORATORY W/ REV/HCPC|
20|FH_F103360_68845_0|SrvcGrp|103237|2022|PDM|16337.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F49637_0_0|SrvcGrp|45763|2022|PDM|5000.00|99|0.00|INTERSTIM PERM|
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1105.00|99|0.00|ASPG X|
20|FH_F146324_70810_0|SrvcGrp|92501|2022|PDM|162.59|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F100666_81301_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F117006_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F133490_90650_0|SrvcGrp|89149|2022|PDM|292.00|99|0.00|OP INTENSIVE|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F121168_0_0|SrvcGrp|89783|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F97562_29803_0|SrvcGrp|73602|2022|PDM|2631.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F141927_71901_0|SrvcGrp|113835|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F51492_0_0|SrvcGrp|43893|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F54552_0_0|SrvcGrp|16750|2022|PDM|135.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138680_53005_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F138992_72703_0|CSTM-ALL|CSTM-00|2020|PDM|1939.00|99|0.00|AEG 4 (NO REV) W/O LITHOTRIPSY/TRANSURETHRAL SURGICAL|
20|FH_F117715_0_0|SrvcGrp|28512|2022|PDM|2107.98|99|0.00|REPAIR BLADDER DEFECT|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1610.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 902 W/O REV|
20|FH_F124542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151340_30040_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 2 (NO REV)|
20|FH_F151419_07852_0|SrvcGrp|74668|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151460_68137_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151503_30067_0|SrvcGrp|104114|2022|PDM|2090.00|99|0.00|INCISION OF FOOT FASCIA|
20|FH_F132258_45404_0|SrvcGrp|86838|2022|PDM|11.93|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F132258_45404_0|SrvcGrp|46104|2022|PDM|168.75|99|0.00|HOME VISIT - PRENATAL|
20|FH_F122089_68010_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA REFERENCE LAB|
20|FH_F144989_07701_0|SrvcGrp|23683|2022|PDM|65.00|99|0.00|SKILLED NURSING RN|
20|FH_F145468_60615_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F135379_61530_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135385_38614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135583_17331_0|SrvcGrp|116019|2022|PCT|0.82|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F135590_84066_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F135943_76051_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136042_90066_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F100763_24202_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F121420_06418_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121713_84747_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F121763_07202_0|SrvcGrp|105324|2022|PDM|32.00|99|0.00|OFFICE/OUTPATIENT VISIT EST|
20|FH_F33791_0_0|SrvcGrp|3178|2022|PDM|300.00|99|0.00|ACUTE PSYCH|
20|FH_F65959_0_0|SrvcGrp|61616|2022|PCT|1.20|99|0.00|ORTHOTICS AND PROSTHETICS|
20|FH_F111301_33122_0|SrvcGrp|66517|2022|PCT|0.00|99|0.00|NICU|
20|FH_F111363_33169_0|SrvcGrp|73000|2022|PDM|2092.00|99|0.00|AEG 6|
20|FH_F131000_0_0|SrvcGrp|90418|2022|PDM|3608.00|99|0.00|ENLARGE BREAST WITH IMPLANT|
20|FH_F141035_0_0|SrvcGrp|92367|2022|PDM|7129.00|99|0.00|TRANSPLANT HAND TENDON|
20|FH_F123036_0_0|SrvcGrp|40003|2022|PDM|17750.00|99|0.00|TOTAL KNEE|
20|FH_F97221_29406_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F101320_26062_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143648_0_0|SrvcGrp|114091|2022|PDM|1960.00|99|0.00|INCISION AND DRAINAGE|
20|FH_F148432_01585_0|SrvcGrp|113171|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F148479_49519_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35123_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F92677_08003_0|SrvcGrp|92093|2022|PDM|37.80|99|0.00|AETNA PORTABLE LIQUID OXYGEN SYSTEM|
20|FH_F66403_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F128615_78520_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F89851_83854_0|SrvcGrp|81418|2022|PDM|4847.00|99|0.00|AETNA LAPARO CHOLECYSTECOMY|
20|FH_F146267_78626_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F41679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F90811_0_0|SrvcGrp|90432|2022|PDM|2000.00|99|0.00|REMOVAL OF BREAST IMPLANT|
20|FH_F128559_43524_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F144011_60616_0|CSTM-ALL|CSTM-00|2020|PDM|1255.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F137240_0_0|SrvcGrp|177|2022|PDM|3795.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F69242_0_0|SrvcGrp|42974|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F118819_76226_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F89932_10940_0|SrvcGrp|89025|2022|PCT|0.45|99|0.00|DIAGNOSTIC RADIOPHARMACEUTICALS|
20|FH_F34706_0_0|SrvcGrp|3480|2022|PDM|4725.00|99|0.00|DRG 125 CIRCULATORY DISORDER W/ CC W/O COMP DX|
20|FH_F47319_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F148865_0_0|SrvcGrp|63297|2022|PDM|140.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F40734_0_0|SrvcGrp|30733|2022|PDM|350.00|99|0.00|SKILLED NURSING CARE|
20|FH_F132571_24739_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F149940_02645_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144532_19606_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147800_0_0|SrvcGrp|115176|2022|PDM|468.00|99|0.00|INJ ANES AGT; SUP HYPOGASTR|
20|FH_F132080_0_0|SrvcGrp|95661|2022|PDM|169.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F36207_0_0|SrvcGrp|16901|2022|PDM|5.35|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F71929_15090_0|SrvcGrp|81879|2022|PCT|1.00|99|0.00|LABORATORY W/ REV/HCPC|
20|FH_F67192_0_0|SrvcGrp|3418|2022|PDM|2914.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F78682_0_0|SrvcGrp|26216|2022|PDM|3275.00|99|0.00|ARTHROSCOPY|
20|FH_F102721_38118_0|SrvcGrp|82369|2022|PCT|0.25|99|0.00|AETNA LABORATORY|
20|FH_F106580_33321_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F128657_19008_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F68831_0_0|SrvcGrp|9830|2022|PDM|99.00|99|0.00|OT SVCS|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKE|
20|FH_F128657_19008_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F146131_37160_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F62627_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F133478_40165_0|SrvcGrp|26471|2022|PDM|134.00|99|0.00|CPT CODE 90945|
20|FH_F145664_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.62|99|0.00|GENERAL ACUTE CARE|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F117807_86426_0|SrvcGrp|48385|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F92677_08003_0|SrvcGrp|92220|2022|PDM|3.15|99|0.00|HCPCS A7003 MOD NU|
20|FH_F116825_0_0|SrvcGrp|1259|2022|PDM|1537.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F118542_60188_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F43333_0_0|SrvcGrp|350|2022|PDM|875.00|99|0.00|SURGICAL CARE|
20|FH_F49035_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING|
20|FH_F119437_0_0|SrvcGrp|93059|2022|PDM|4750.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F151122_10462_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F121980_66104_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F114931_0_0|SrvcGrp|104614|2022|PDM|1850.00|99|0.00|BIOPSY OF RECTUM|
20|FH_F88639_80204_0|SrvcGrp|114563|2022|PCT|1.70|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F149179_0_0|SrvcGrp|10986|2022|PDM|5098.00|99|0.00|ARTHROSCOPIC KNEE REPAIR|
20|FH_F46832_0_0|SrvcGrp|17012|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F123763_80130_0|SrvcGrp|3178|2022|PDM|1226.00|99|0.00|ACUTE PSYCH|
20|FH_F69968_0_0|SrvcGrp|13123|2022|PDM|703.84|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F136299_75218_0|SrvcGrp|73498|2022|PDM|2050.00|99|0.00|AETNA ER LEVEL III|
20|FH_F118232_24970_0|SrvcGrp|75505|2022|PCT|0.79|99|0.00|CARDIAC STUDIES|
20|FH_F120424_03060_0|SrvcGrp|73841|2022|PDM|313.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F134159_80228_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F114092_83350_0|CSTM-ALL|CSTM-00|2020|PDM|4657.00|99|0.00|AEG 6 (NO REV)|
20|FH_F53732_0_0|SrvcGrp|29679|2022|PDM|125.00|99|0.00|SKILLED NURSING NON IV RELATED- MOD TJ|
20|FH_F53732_0_0|SrvcGrp|26867|2022|PDM|80.00|99|0.00|ANTI-EMETICS INFUSION THERAPY|
20|FH_F97600_46151_0|SrvcGrp|73461|2022|PDM|14528.00|99|0.00|AETNA NICU IV|
20|FH_F78402_15905_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS|
20|FH_F139267_30253_0|SrvcGrp|113177|2022|PDM|18.63|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - ASTRAZENECA|
20|FH_F140447_84106_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F140652_92626_0|SrvcGrp|89417|2022|PDM|525.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F80062_27612_0|SrvcGrp|472|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F149374_38855_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F149377_22102_0|SrvcGrp|109036|2022|PDM|780.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F151562_26003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119026_36274_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118943_64506_0|SrvcGrp|46104|2022|PDM|50.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F76144_0_0|SrvcGrp|33967|2022|PDM|2824.17|99|0.00|CPT 47562|
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F117371_77059_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F129483_77030_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117105_77619_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F117154_43017_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F117214_84020_0|SrvcGrp|108484|2022|PDM|1100.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F117219_77515_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F137333_51012_0|SrvcGrp|89149|2022|PDM|204.00|99|0.00|OP INTENSIVE|
20|FH_F137806_83702_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137832_89118_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP|
20|FH_F104700_0_0|SrvcGrp|73008|2022|PDM|1245.00|99|0.00|AEG 10|
20|FH_F107926_0_0|SrvcGrp|86033|2022|PDM|1875.00|99|0.00|CPT 67107|
20|FH_F110342_0_0|SrvcGrp|27261|2022|PDM|3121.20|99|0.00|CPT 27446|
20|FH_F110720_0_0|SrvcGrp|96919|2022|PDM|4882.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F90876_18447_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129892_0_0|SrvcGrp|33967|2022|PDM|1495.00|99|0.00|CPT 47562|
20|FH_F112817_37027_0|SrvcGrp|73701|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F139711_16037_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114567_43235_0|SrvcGrp|89149|2022|PDM|266.00|99|0.00|OP INTENSIVE|
20|FH_F52152_0_0|CSTM-ALL|CSTM-00|2020|PDM|2392.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119285_0_0|SrvcGrp|108058|2022|PDM|1751.00|99|0.00|VITRECTOMY PARS PLANA APPROACH|
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|518.42|99|0.00|ASPG III|
20|FH_F58272_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN|
20|FH_F31525_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F91818_02828_0|SrvcGrp|90854|2022|PDM|583.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 2 (NO REV)|
20|FH_F111207_0_0|SrvcGrp|11199|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER|
20|FH_F117442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F90173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F104840_32565_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F105362_44601_0|SrvcGrp|89149|2022|PDM|145.00|99|0.00|OP INTENSIVE|
20|FH_F113392_0_0|SrvcGrp|105202|2022|PDM|1650.00|99|0.00|MUSCLE FLAP|
20|FH_F129758_54405_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138929_0_0|SrvcGrp|88161|2022|PDM|6600.00|99|0.00|LAMINECTOMY W/FACE-THORACIC|
20|FH_F94740_32904_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132988_0_0|SrvcGrp|100062|2022|PDM|5914.35|99|0.00|REPAIR FIBULA NONUNION|
20|FH_F137067_0_0|SrvcGrp|96839|2022|PDM|36750.00|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F114389_50131_0|SrvcGrp|10580|2022|PDM|117.09|99|0.00|HYDRATION THERAPY - 3 LITERS|
20|FH_F114389_50131_0|SrvcGrp|24744|2022|PDM|123.08|99|0.00|PICC LINE INSERTION|
20|FH_F141336_16947_0|SrvcGrp|73496|2022|PDM|1401.00|99|0.00|AETNA ER LEVEL V|
20|FH_F141336_16947_0|SrvcGrp|105465|2022|PCT|0.55|99|0.00|AETNA THERAPIES|
20|FH_F141353_26452_0|SrvcGrp|17100|2022|PDM|400.00|99|0.00|SKILLED NURSING|
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|ACUTE IP REHAB LEVEL B|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F39410_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37042_0_0|SrvcGrp|17079|2022|PDM|1563.00|99|0.00|ASPG VIII|
20|FH_F117945_78957_0|SrvcGrp|89337|2022|PDM|800.00|99|0.00|DETOXIFICATION|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|BILIRUBIN TOTAL|
20|FH_F45199_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.45|99|0.00|(JCODES-IMMUN) OCN F/S PRICING: ALL|
20|FH_F133477_90247_0|SrvcGrp|13187|2022|PCT|0.25|99|0.00|INTRAOCULAR LENSES|
20|FH_F139789_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F94300_0_0|SrvcGrp|88354|2022|PDM|1155.00|99|0.00|CPT 63685 (HCFA)|
20|FH_F72024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F59274_0_0|SrvcGrp|46605|2022|PDM|35.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F117906_91606_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|2338.00|99|0.00|AEG 7 (NO REV)|
20|FH_F124608_0_0|SrvcGrp|80617|2022|PDM|9149.00|99|0.00|ARTHOPLASTY|
20|FH_F117550_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F57396_0_0|SrvcGrp|46585|2022|PDM|160.00|99|0.00|CPT 99204|
20|FH_F118376_46052_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F103106_04101_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F128312_45230_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F128657_19008_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F115289_90057_0|SrvcGrp|86648|2022|PCT|1.15|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F113705_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|OP SVCS|
20|FH_F81313_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92676_15063_0|SrvcGrp|78990|2022|PDM|1922.91|99|0.00|MON VALLEY ASC 404|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|138.80|99|0.00|ASPG 310|
20|FH_F142011_02859_0|SrvcGrp|75545|2022|PDM|250.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F125013_85251_0|SrvcGrp|73841|2022|PDM|600.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F31824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F148040_90631_0|SrvcGrp|46903|2022|PDM|746.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F123158_0_0|SrvcGrp|98526|2022|PDM|1300.00|99|0.00|CYSTOURETHROSCOPY|
20|FH_F100682_97401_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F102561_75146_0|SrvcGrp|76847|2022|PDM|4200.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F71644_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F129801_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F130593_48103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146211_68144_0|SrvcGrp|92007|2022|PDM|8172.00|99|0.00|PROXIMAL HUMERAL|
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.00|99|0.00|AEG 3 (NO REV)|
20|FH_F126975_43551_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F49637_0_0|SrvcGrp|45882|2022|PDM|72.00|99|0.00|PT|
20|FH_F38700_0_0|SrvcGrp|18881|2022|PCT|0.80|99|0.00|MS DRG 233|
20|FH_F38352_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F127432_18015_0|SrvcGrp|82981|2022|PCT|1.17|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F42807_0_0|SrvcGrp|11259|2022|PCT|0.75|99|0.00|DRUGS|
20|FH_F139327_62220_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139627_80537_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150768_03054_0|SrvcGrp|48396|2022|PDM|170.00|99|0.00|OT SERVICES|
20|FH_F147333_18704_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F128753_32501_0|SrvcGrp|74584|2022|PCT|0.64|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F133087_61107_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F115483_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|AEG 6 (NO REV)|
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 4 (NO REV)|
20|FH_F137767_01841_0|SrvcGrp|3378|2022|PDM|3675.00|99|0.00|OBSERVATION SVCS|
20|FH_F97300_47501_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F142327_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|AEG 6 (NO REV)|
20|FH_F150419_64119_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F98820_81401_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F140295_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F40236_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F150440_35077_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F110727_34994_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|1243.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F37490_0_0|SrvcGrp|26431|2022|PDM|4750.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F124714_64081_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F114188_15205_0|SrvcGrp|48385|2022|PDM|99.34|99|0.00|SPEECH THERAPY|
20|FH_F122386_70578_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132907_72949_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35742_33407_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F150912_19344_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F38123_0_0|SrvcGrp|31187|2022|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER NUKF (DME)|
20|FH_F141275_07004_0|SrvcGrp|13681|2022|PCT|1.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F35780_32073_0|CSTM-ALL|CSTM-00|2020|PCT|0.46|99|0.00|OP SVCS|
20|FH_F120207_0_0|SrvcGrp|78282|2022|PDM|3009.00|99|0.00|CPT 47563|
20|FH_F129970_34986_0|SrvcGrp|73841|2022|PDM|473.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F47558_0_0|SrvcGrp|40418|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD UE|
20|FH_F120057_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F124760_34997_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F38584_0_0|SrvcGrp|17065|2022|PDM|535.00|99|0.00|ASPG I|
20|FH_F149512_62550_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F83231_0_0|SrvcGrp|17735|2022|PDM|400.00|99|0.00|DIALYSIS|
20|FH_F124059_64055_0|SrvcGrp|26868|2022|PDM|25.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F124059_64055_0|SrvcGrp|17016|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F146972_17931_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146994_74462_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F146903_72901_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147010_82930_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F38688_0_0|SrvcGrp|17069|2022|PDM|1010.00|99|0.00|ASPG III|
20|FH_F45372_0_0|SrvcGrp|30941|2022|PDM|306.00|99|0.00|NEWBORN NURSERY|
20|FH_F47636_0_0|SrvcGrp|22954|2022|PDM|132.94|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F87822_0_0|SrvcGrp|26470|2022|PDM|138.60|99|0.00|SELF DIALYSIS TRAINING CAPD|
20|FH_F132864_71101_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F124225_92506_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124671_64844_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150226_0_0|SrvcGrp|13683|2022|PDM|594.21|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F133399_72211_0|SrvcGrp|108484|2022|PDM|635.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F75662_0_0|SrvcGrp|13985|2022|PDM|49.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F89273_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113787_31909_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113830_96002_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138052_19462_0|SrvcGrp|105047|2022|PDM|197.00|99|0.00|AETNA PSYCH DIAG EVAL W/ MED SVCS (HCFA)|
20|FH_F148553_85016_0|SrvcGrp|115458|2022|PDM|3641.00|99|0.00|REMOVE & REPLACE PULSE GEN 1 LEAD|
20|FH_F122608_84123_0|SrvcGrp|46605|2022|PDM|99.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F122635_06410_0|SrvcGrp|88621|2022|PDM|115.00|99|0.00|SKILLED NURSING LPN|
20|FH_F43412_0_0|SrvcGrp|109|2022|PDM|700.00|99|0.00|CD - DETOX|
20|FH_F117085_40207_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F113713_17013_0|SrvcGrp|86868|2022|PDM|75.00|99|0.00|AETNA PSYTX PT & FAM 45 MINS (MOD TD)(HCFA)|
20|FH_F131529_0_0|SrvcGrp|63119|2022|PDM|23.00|99|0.00|BASIC HOME HOSPICE CARE|
20|FH_F115210_21043_0|SrvcGrp|26275|2022|PDM|2440.00|99|0.00|CPT 29826|
20|FH_F115631_65201_0|SrvcGrp|26273|2022|PDM|3177.00|99|0.00|CPT 29880|
20|FH_F147305_90755_0|SrvcGrp|29347|2022|PDM|29.00|99|0.00|HOME HEALTH AIDE|
20|FH_F39967_0_0|SrvcGrp|10107|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F100780_24153_0|SrvcGrp|73605|2022|PDM|2552.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F102947_44084_0|SrvcGrp|75749|2022|PDM|431.00|99|0.00|AMBULATORY DETOX REHAB|
20|FH_F131208_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136987_0_0|SrvcGrp|73559|2022|PDM|1836.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F40634_0_0|SrvcGrp|12790|2022|PCT|0.70|99|0.00|TISSUE PLASMINOGEN ACTIVATOR|
20|FH_F98161_0_0|SrvcGrp|72996|2022|PDM|725.00|99|0.00|AEG 4|
20|FH_F104802_0_0|SrvcGrp|10951|2022|PDM|350.00|99|0.00|PARTIAL HOSPITALIZATION PSYCH/CD|
20|FH_F151139_0_0|SrvcGrp|12868|2022|PDM|24000.00|99|0.00|AIR AMBULANCE|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PDM|565.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F46433_0_0|SrvcGrp|22591|2022|PDM|35.00|99|0.00|IMPLANTED PUMP|
20|FH_F113180_23507_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F133536_0_0|SrvcGrp|90436|2022|PDM|18700.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F133579_0_0|SrvcGrp|84279|2022|PDM|2551.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F139238_0_0|SrvcGrp|11259|2022|PCT|0.26|99|0.00|DRUGS|
20|FH_F150939_0_0|SrvcGrp|100240|2022|PCT|0.00|99|0.00|CHEMISTRY|
20|FH_F117509_0_0|SrvcGrp|57967|2022|PDM|148.79|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F39098_0_0|SrvcGrp|411|2022|PCT|0.75|99|0.00|OP CARDIAC CATH|
20|FH_F111951_80111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113585_20155_0|SrvcGrp|86835|2022|PDM|15.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F138907_01040_0|SrvcGrp|46104|2022|PDM|103.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F138665_53186_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F89580_0_0|SrvcGrp|86582|2022|PCT|0.66|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F88893_0_0|SrvcGrp|33967|2022|PDM|1430.00|99|0.00|CPT 47562|
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|1001.00|99|0.00|AEG 8 (NO REV)|
20|FH_F151511_14094_0|CSTM-ALL|CSTM-00|2020|PDM|2184.74|99|0.00|AEG 5  (NO REV)|
20|FH_F151516_63023_0|SrvcGrp|46903|2022|PDM|765.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F144928_02703_0|SrvcGrp|90388|2022|PDM|504.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F144968_18702_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F135379_61530_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97142_94535_0|SrvcGrp|90854|2022|PDM|2335.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F130996_34110_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F116404_20191_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F128990_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.00|99|0.00|OP SVCS|
20|FH_F121411_33063_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121428_40202_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F121444_47720_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121871_65401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F101182_07863_0|SrvcGrp|87911|2022|PCT|1.00|99|0.00|CYCLOSPORINE ORAL 100MG|
20|FH_F111341_80501_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INJECTION, PEGFILGRASTIM 6MG|
20|FH_F141651_0_0|SrvcGrp|94989|2022|PDM|3850.00|99|0.00|SINUS ENDO W/ BALLOON DILATION|
20|FH_F89360_0_0|SrvcGrp|38588|2022|PDM|48.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F51518_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51272_0_0|SrvcGrp|10944|2022|PCT|0.75|99|0.00|EMERGENCY ROOM|
20|FH_F56573_0_0|SrvcGrp|10708|2022|PDM|60.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F131000_0_0|SrvcGrp|100045|2022|PDM|2971.00|99|0.00|REVISION OF FOOT TENDON|
20|FH_F132328_0_0|SrvcGrp|28549|2022|PDM|3490.00|99|0.00|VITRECTOMY|
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F68043_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F87557_33309_0|SrvcGrp|17013|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F127445_51054_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F98626_29118_0|SrvcGrp|73605|2022|PDM|2582.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F101320_26062_0|SrvcGrp|29347|2022|PDM|48.00|99|0.00|HOME HEALTH AIDE|
20|FH_F143542_0_0|SrvcGrp|84934|2022|PDM|6885.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F148101_33462_0|SrvcGrp|90040|2022|PDM|850.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F62579_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|PARENTERAL NUTRITION|
20|FH_F38560_0_0|SrvcGrp|1259|2022|PDM|1750.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F50462_0_0|SrvcGrp|27968|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F142332_0_0|SrvcGrp|23683|2022|PDM|74.00|99|0.00|SKILLED NURSING RN|
20|FH_F130662_07032_0|SrvcGrp|89149|2022|PDM|222.00|99|0.00|OP INTENSIVE|
20|FH_F100982_75601_0|SrvcGrp|73559|2022|PDM|1850.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F144808_0_0|SrvcGrp|54943|2022|PDM|2888.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F148862_85390_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|533.96|99|0.00|HAPA WPA-NWPA 2012-13 ASC 301 W/O REV|
20|FH_F149048_77090_0|SrvcGrp|3178|2022|PDM|880.00|99|0.00|ACUTE PSYCH|
20|FH_F123325_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F150239_75569_0|SrvcGrp|17015|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F123157_0_0|SrvcGrp|75481|2022|PDM|400.00|99|0.00|AEG 2|
20|FH_F34182_0_0|SrvcGrp|13055|2022|PCT|0.78|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F114483_47905_0|SrvcGrp|92760|2022|PCT|1.15|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F87012_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|2449.92|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1401 W/O REV|
20|FH_F121476_0_0|SrvcGrp|108853|2022|PDM|695.00|99|0.00|INDWELLING PORT|
20|FH_F143067_0_0|SrvcGrp|105357|2022|PDM|735.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F110442_98003_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F36753_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD KN|
20|FH_F77943_0_0|SrvcGrp|29755|2022|PDM|55799.50|99|0.00|MS DRG 245 ONLY|
20|FH_F146039_89511_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F88057_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|1265.00|99|0.00|AEG 8 (NO REV)|
20|FH_F90501_71101_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F130017_02302_0|SrvcGrp|73659|2022|PDM|4988.13|99|0.00|AETNA MED & SURG SVCS|
20|FH_F91412_0_0|SrvcGrp|87062|2022|PDM|861.30|99|0.00|REVISE ULNAR NERVE AT ELBOW|
20|FH_F146124_06112_0|CSTM-ALL|CSTM-00|2020|PDM|7252.00|99|0.00|AEG 5  (NO REV)|
20|FH_F120930_0_0|SrvcGrp|65625|2022|PDM|2200.00|99|0.00|CPT 30520|
20|FH_F148661_45429_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F90496_13159_0|SrvcGrp|89149|2022|PDM|140.00|99|0.00|OP INTENSIVE|
20|FH_F121597_30315_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134620_73112_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F118127_30078_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F129509_0_0|SrvcGrp|111326|2022|PDM|3767.00|99|0.00|SPINAL CORD DECOMPRESS-THOR|
20|FH_F83380_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|HOME INF- REV 640 MOD SH|
20|FH_F118253_89052_0|SrvcGrp|105820|2022|PDM|1200.00|99|0.00|IP PSYCH EATING DISORDERS|
20|FH_F138024_40509_0|SrvcGrp|3178|2022|PDM|718.00|99|0.00|ACUTE PSYCH|
20|FH_F139443_37705_0|SrvcGrp|75419|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PDM|162.00|99|0.00|NEBULIZER (DME) (MOD NU)|
20|FH_F100782_0_0|SrvcGrp|105103|2022|PDM|187.75|99|0.00|WINDBER MEDICAL CNTR ASC 148|
20|FH_F132882_63857_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|233.81|99|0.00|HAPA WPA-NWPA 2012-13 ASC 123 W/O REV|
20|FH_F149245_78576_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145641_06902_0|SrvcGrp|92013|2022|PDM|3204.00|99|0.00|REPAIR OF COLLATERAL LIGAMENT|
20|FH_F85213_02840_0|SrvcGrp|12659|2022|PDM|439.50|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F83754_0_0|SrvcGrp|31038|2022|PCT|0.81|99|0.00|MS DRG 233-234 ONLY|
20|FH_F81698_10457_0|SrvcGrp|24752|2022|PDM|10.50|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F150141_63103_0|SrvcGrp|74668|2022|PDM|120.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148661_45429_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121225_98902_0|SrvcGrp|73463|2022|PDM|2500.00|99|0.00|AETNA NICU II|
20|FH_F116806_0_0|SrvcGrp|107017|2022|PDM|1923.16|99|0.00|CONTOUR CRANIAL BONE LESION|
20|FH_F150165_06032_0|SrvcGrp|77451|2022|PDM|3700.00|99|0.00|CPT 53440|
20|FH_F145629_45243_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.00|99|0.00|AEG 7 (NO REV)|
20|FH_F85492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125139_84096_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|543.00|99|0.00|AEG 3 (NO REV)|
20|FH_F125328_0_0|SrvcGrp|72990|2022|PDM|360.00|99|0.00|AEG 1|
20|FH_F81698_10457_0|SrvcGrp|29077|2022|PDM|10.50|99|0.00|HOME TRANSFUSION|
20|FH_F130763_0_0|SrvcGrp|93059|2022|PDM|5823.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG VI|
20|FH_F127418_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111046_0_0|SrvcGrp|13597|2022|PDM|283.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F110720_0_0|SrvcGrp|12309|2022|PDM|4882.00|99|0.00|MICRODISKETOMY|
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 5  (NO REV)|
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 3 (NO REV)|
20|FH_F72427_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F119285_0_0|SrvcGrp|88154|2022|PDM|1751.00|99|0.00|LASER TREATMENT OLD RETINA|
20|FH_F40983_0_0|SrvcGrp|28818|2022|PCT|1.00|99|0.00|SUPPLIES AND DEVICES|
20|FH_F129888_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F148379_89129_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F148425_01507_0|SrvcGrp|107288|2022|PCT|1.00|99|0.00|INJ INTERFERON BETA|
20|FH_F148552_68114_0|CSTM-ALL|CSTM-00|2020|PDM|1822.78|99|0.00|AEG 6 (NO REV)|
20|FH_F148554_85016_0|CSTM-ALL|CSTM-00|2020|PDM|598.00|99|0.00|AEG 3 (NO REV)|
20|FH_F38848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ACUTE PSYCH|
20|FH_F97041_71603_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F38394_0_0|SrvcGrp|17081|2022|PDM|2128.96|99|0.00|ASPG IX|
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|736.00|99|0.00|AEG 5  (NO REV)|
20|FH_F117006_0_0|SrvcGrp|82222|2022|PDM|148.79|99|0.00|HOSPICE CARE|
20|FH_F113131_19013_0|SrvcGrp|102239|2022|PDM|131.00|99|0.00|AETNA METHADONE MAINTENANCE|
20|FH_F148001_15601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F124608_0_0|SrvcGrp|33965|2022|PDM|5396.00|99|0.00|CPT 58552|
20|FH_F146373_66092_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|1099.41|99|0.00|AEG 7 (NO REV)|
20|FH_F143202_32114_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F99720_0_0|SrvcGrp|104736|2022|PDM|2560.00|99|0.00|ADD'L NECK SPINE FUSION|
20|FH_F125266_44515_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F70605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F117872_33462_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F92644_06053_0|SrvcGrp|471|2022|PDM|614.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F85753_0_0|SrvcGrp|9263|2022|PDM|136.94|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F116145_0_0|SrvcGrp|76094|2022|PDM|148.79|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F122245_0_0|SrvcGrp|100923|2022|PDM|1017.20|99|0.00|DRUGS|
20|FH_F99720_0_0|SrvcGrp|104744|2022|PDM|4608.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F40554_0_0|SrvcGrp|350|2022|PCT|0.65|99|0.00|SURGICAL CARE|
20|FH_F115405_06010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F41263_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119229_90804_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F92677_08003_0|SrvcGrp|92095|2022|PDM|220.50|99|0.00|AETNA OXYGEN TENT, EXCLUDING CROUP|
20|FH_F146380_85203_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148662_01583_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F140808_0_0|CSTM-ALL|CSTM-00|2020|PDM|711.00|99|0.00|AEG 2 (NO REV)|
20|FH_F55113_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44855_0_0|SrvcGrp|26732|2022|PDM|850.00|99|0.00|CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE|
20|FH_F132612_0_0|SrvcGrp|10107|2022|PCT|0.67|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F118004_74133_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147992_63452_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123158_0_0|SrvcGrp|63469|2022|PDM|2200.00|99|0.00|CPT 55700|
20|FH_F117272_24333_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F117380_60020_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F144769_0_0|SrvcGrp|44564|2022|PDM|539.00|99|0.00|NEWBORN NURSERY|
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|1233.00|99|0.00|AEG 8 (NO REV)|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|843.91|99|0.00|ASPG 401|
20|FH_F87334_16507_0|SrvcGrp|48398|2022|PDM|104.00|99|0.00|PT SERVICES|
20|FH_F97563_83201_0|SrvcGrp|88977|2022|PDM|6590.00|99|0.00|C-SECTION DELIVERY|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 459-460|
20|FH_F128120_76513_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F91255_19401_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F79902_0_0|SrvcGrp|360|2022|PDM|2152.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|ASPG VI|
20|FH_F92912_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|OP SVCS|
20|FH_F133018_84037_0|SrvcGrp|73700|2022|PDM|42.25|99|0.00|AETNA - SKILLED NURSING|
20|FH_F41796_0_0|SrvcGrp|110|2022|PDM|440.00|99|0.00|CD - REHABILITATION|
20|FH_F88512_0_0|SrvcGrp|31769|2022|PDM|24749.14|99|0.00|CARDIAC ABLATION|
20|FH_F35408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147800_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F40554_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F113146_15001_0|SrvcGrp|89417|2022|PDM|251.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F92676_15063_0|SrvcGrp|78967|2022|PDM|2039.74|99|0.00|MON VALLEY ASC 401|
20|FH_F117559_08619_0|SrvcGrp|114536|2022|PDM|40.00|99|0.00|ADM SARS COV2 30MCG/0.3 ML BST|
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.00|99|0.00|ASPG X|
20|FH_F118004_74133_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F46772_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F145328_90301_0|SrvcGrp|113332|2022|PDM|1360.00|99|0.00|MED TX NALTREXONE|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|314.01|99|0.00|CPT 95805 (W/MOD TC)|
20|FH_F142814_16511_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F106540_26330_0|SrvcGrp|72998|2022|PDM|4200.00|99|0.00|AEG 5|
20|FH_F150540_63401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F67379_0_0|SrvcGrp|63157|2022|PDM|16952.00|99|0.00|CRANIOTOMY/NERVOUS SYSTEM|
20|FH_F35729_34667_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F136779_0_0|SrvcGrp|106217|2022|PDM|2218.00|99|0.00|ARTHROSCOPY SHOULDER|
20|FH_F136806_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F150399_53045_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67419_0_0|SrvcGrp|14893|2022|PDM|40.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F129289_54153_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F86714_0_0|SrvcGrp|87712|2022|PDM|269.10|99|0.00|RN ASSESSMENT W/ SPECIALTY SKN|
20|FH_F125081_15218_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F75606_0_0|SrvcGrp|16|2022|PDM|1185.00|99|0.00|ACUTE REHABILITATION|
20|FH_F40904_0_0|SrvcGrp|64|2022|PCT|0.90|99|0.00|AMBULATORY SURGERY|
20|FH_F35990_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 10 (NO REV)|
20|FH_F138478_0_0|SrvcGrp|96380|2022|PDM|23546.99|99|0.00|AETNA INS/REP SUBQ DEFIBRILLATOR|
20|FH_F35174_0_0|SrvcGrp|20900|2022|PCT|0.75|99|0.00|MS DRG 248 ONLY|
20|FH_F110963_30535_0|SrvcGrp|94119|2022|PCT|1.49|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ASPG I|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F92431_80033_0|SrvcGrp|48396|2022|PDM|146.00|99|0.00|OT SERVICES|
20|FH_F128369_72901_0|SrvcGrp|73842|2022|PDM|159.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F51557_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F98860_96706_0|SrvcGrp|73485|2022|PDM|3877.00|99|0.00|AETNA REHAB|
20|FH_F36634_0_0|SrvcGrp|16|2022|PDM|1084.00|99|0.00|ACUTE REHABILITATION|
20|FH_F39443_0_0|SrvcGrp|30366|2022|PDM|1679.00|99|0.00|HAPA WPA ASC 901|
20|FH_F149559_60012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110805_45227_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|676.00|99|0.00|AEG 3 (NO REV)|
20|FH_F149023_44122_0|CSTM-ALL|CSTM-00|2020|PDM|2129.00|99|0.00|AEG 8 (NO REV)|
20|FH_F97620_75904_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149662_85015_0|SrvcGrp|82691|2022|PDM|5200.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F59312_0_0|SrvcGrp|43285|2022|PDM|74.00|99|0.00|SPEECH THERAPY|
20|FH_F128987_65737_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40624_0_0|SrvcGrp|3178|2022|PDM|766.00|99|0.00|ACUTE PSYCH|
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F74902_0_0|SrvcGrp|66360|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F147214_48162_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|572.00|99|0.00|ASPG III - GNADEN HUETTEN|
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|986.00|99|0.00|AEG 2 (NO REV)|
20|FH_F97100_23462_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F151024_30024_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F36343_0_0|SrvcGrp|10542|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F36485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% 2007 MEDICARE DME  TN MOD KN|
20|FH_F124486_0_0|SrvcGrp|87759|2022|PDM|1009.00|99|0.00|REINFORCE/GRAFT EYE WALL|
20|FH_F115269_0_0|SrvcGrp|86722|2022|PDM|190.00|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_F37244_0_0|CSTM-ALL|CSTM-00|2020|PDM|170.00|99|0.00|OP SVCS|
20|FH_F149522_83221_0|SrvcGrp|104226|2022|PDM|130.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F56472_0_0|SrvcGrp|36068|2022|PDM|40.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F35738_33180_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F122649_0_0|SrvcGrp|97506|2022|PDM|112.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F35730_0_0|SrvcGrp|11328|2022|PDM|90.00|99|0.00|RN VISIT|
20|FH_F147180_19050_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146266_0_0|SrvcGrp|111325|2022|PDM|7892.00|99|0.00|SPINAL CORD DECOMPRESS-CERVICAL|
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)|
20|FH_F76826_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|(LAB/RAD) OCN F/S PRICING: ALL|
20|FH_F139928_37228_0|SrvcGrp|73842|2022|PDM|276.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139870_71075_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F140036_07702_0|SrvcGrp|86723|2022|PDM|355.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F140268_17960_0|SrvcGrp|82981|2022|PCT|1.17|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F143347_16001_0|SrvcGrp|16069|2022|PDM|607.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F143454_94550_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F143471_02895_0|SrvcGrp|75545|2022|PDM|250.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
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_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1001.00|99|0.00|AEG 8 (NO REV)|
20|FH_F103060_0_0|SrvcGrp|67065|2022|PDM|8323.00|99|0.00|CERVICAL SURGERY|
20|FH_F120216_68134_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F136299_75218_0|CSTM-ALL|CSTM-00|2020|PDM|4635.00|99|0.00|AEG 4 (NO REV)|
20|FH_F120799_92651_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F116698_07470_0|SrvcGrp|22592|2022|PDM|39.90|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F116907_75093_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F83292_0_0|CSTM-ALL|CSTM-00|2020|PDM|3213.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83292_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BARNESVILLE  MRI AND CAT SCANS|
20|FH_F32360_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F59732_0_0|SrvcGrp|50142|2022|PDM|54.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 24 HRS|
20|FH_F43171_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|CD SVCS (ADULT)|
20|FH_F41519_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F72764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F72664_0_0|SrvcGrp|68381|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|792.23|99|0.00|AEG 10 (NO REV)|
20|FH_F44607_0_0|SrvcGrp|17065|2022|PDM|1200.00|99|0.00|ASPG I|
20|FH_F100740_15206_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F150021_02725_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F101925_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133478_40165_0|SrvcGrp|23279|2022|PDM|613.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F131982_0_0|SrvcGrp|57968|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F128246_0_0|SrvcGrp|104722|2022|PDM|726.00|99|0.00|REPAIR EYELID DEFECT|
20|FH_F149581_0_0|SrvcGrp|79720|2022|PDM|1008.00|99|0.00|ACUTE REHAB II|
20|FH_F141860_60610_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F101851_78024_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 3 (NO REV)|
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1687.00|99|0.00|ASPG V|
20|FH_F117275_16936_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|938.00|99|0.00|AEG 6 (NO REV)|
20|FH_F50618_0_0|SrvcGrp|17081|2022|PDM|1766.11|99|0.00|ASPG IX|
20|FH_F102561_75146_0|SrvcGrp|75506|2022|PCT|2.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F133021_00910_0|SrvcGrp|112284|2022|PDM|2675.00|99|0.00|DRUG ELUTING STENT|
20|FH_F150540_63401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F40980_0_0|SrvcGrp|63|2022|PDM|3627.00|99|0.00|SUBACUTE CARE|
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_F118587_20721_0|SrvcGrp|472|2022|PDM|549.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F146790_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F133268_63703_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1148.80|99|0.00|HAPA WPA-NWPA 2012-13 ASC 3 W/O REV|
20|FH_F148555_0_0|SrvcGrp|115450|2022|PDM|4120.00|99|0.00|REMOVE & REPLACE PM GEN MULTI LEADS|
20|FH_F130553_18640_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F145988_06105_0|SrvcGrp|107734|2022|PDM|11554.00|99|0.00|VAGINAL DELIVERY|
20|FH_F54552_0_0|SrvcGrp|34146|2022|PDM|150.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F150602_59718_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F128657_19008_0|SrvcGrp|471|2022|PDM|604.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148021_80907_0|SrvcGrp|53145|2022|PDM|100.00|99|0.00|SOCIAL WORKER|
20|FH_F34412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F106660_26554_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F139148_70006_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139428_65270_0|SrvcGrp|46605|2022|PDM|97.85|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F139467_46182_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150719_30012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150741_81506_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150882_84041_0|SrvcGrp|86841|2022|PDM|140.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F150927_64836_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 9 (NO REV)|
20|FH_F42538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144651_0_0|SrvcGrp|98565|2022|PDM|15000.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|921.00|99|0.00|AEG 5  (NO REV)|
20|FH_F134887_33409_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110725_48047_0|SrvcGrp|73841|2022|PDM|350.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F36943_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD RR|
20|FH_F97260_06111_0|SrvcGrp|73643|2022|PDM|1249.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F150224_0_0|SrvcGrp|57967|2022|PDM|179.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F92152_74133_0|SrvcGrp|79699|2022|PCT|0.60|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F97260_06111_0|SrvcGrp|73659|2022|PDM|4148.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F150953_74953_0|SrvcGrp|114253|2022|PCT|1.10|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F151027_16652_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40653_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142370_0_0|SrvcGrp|73485|2022|PDM|990.00|99|0.00|AETNA REHAB|
20|FH_F76826_0_0|SrvcGrp|26690|2022|PCT|0.50|99|0.00|MS DRG 215 ONLY|
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)|
20|FH_F36343_0_0|SrvcGrp|13606|2022|PDM|4.00|99|0.00|HOME INFUSION|
20|FH_F134732_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|AEG 4 (NO REV)|
20|FH_F122419_37043_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F128988_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F41374_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138478_0_0|SrvcGrp|109503|2022|PDM|1193.56|99|0.00|REPOSITION L VENTRIC LEAD|
20|FH_F41161_0_0|SrvcGrp|1306|2022|PDM|273.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F64879_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO|
20|FH_F94621_07728_0|SrvcGrp|93291|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA ESRD USE|
20|FH_F137748_95231_0|SrvcGrp|17520|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F111080_18103_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F108460_32746_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F147181_27514_0|SrvcGrp|112224|2022|PCT|1.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PDM|3300.00|99|0.00|ASPG X|
20|FH_F50415_0_0|SrvcGrp|27767|2022|PDM|40.00|99|0.00|SKILLED IV NURSING HOURLY|
20|FH_F149002_80014_0|SrvcGrp|89337|2022|PDM|2300.00|99|0.00|DETOXIFICATION|
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|546.00|99|0.00|OP SVCS|
20|FH_F120719_27540_0|SrvcGrp|471|2022|PDM|1010.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138050_52301_0|SrvcGrp|12659|2022|PDM|1005.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F143650_0_0|SrvcGrp|82114|2022|PDM|1800.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F134472_84624_0|SrvcGrp|76501|2022|PDM|260.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F134509_14075_0|SrvcGrp|473|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F122526_22203_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F74583_0_0|CSTM-ALL|CSTM-00|2020|PDM|14.00|99|0.00|SKILLED NURSING HCPC|
20|FH_F102200_06416_0|SrvcGrp|22592|2022|PDM|60.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F115811_33410_0|SrvcGrp|58509|2022|PDM|343.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F115909_38133_0|SrvcGrp|89417|2022|PDM|436.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F120528_60559_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|3365.00|99|0.00|AEG 9 (NO REV)|
20|FH_F131964_89120_0|SrvcGrp|23683|2022|PDM|44.00|99|0.00|SKILLED NURSING RN|
20|FH_F132270_33414_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F132928_64114_0|SrvcGrp|47183|2022|PDM|162.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)|
20|FH_F133176_32751_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139377_02301_0|SrvcGrp|90854|2022|PDM|517.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F139385_37762_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139649_40108_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F139667_84078_0|SrvcGrp|103899|2022|PDM|93.00|99|0.00|HOSPICE OR HOME HLTH IN HOME|
20|FH_F139673_63011_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F150745_03301_0|SrvcGrp|43567|2022|PDM|158.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F150769_02302_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F150882_84041_0|SrvcGrp|88828|2022|PDM|13.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|812.00|99|0.00|AEG 4 (NO REV)|
20|FH_F32825_0_0|CSTM-ALL|CSTM-00|2020|PDM|3491.00|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F138017_73129_0|SrvcGrp|97486|2022|PDM|6196.00|99|0.00|ERCP|
20|FH_F38246_66606_0|SrvcGrp|9861|2022|PDM|1055.00|99|0.00|ACUTE REHABILITATION|
20|FH_F41161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F124896_43220_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40690_0_0|SrvcGrp|9518|2022|PCT|0.92|99|0.00|EMERGENCY ROOM|
20|FH_F45226_0_0|SrvcGrp|11072|2022|PDM|80.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F140215_93301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (BREAKOUT)|
20|FH_F39443_0_0|SrvcGrp|30353|2022|PDM|123.00|99|0.00|HAPA WPA ASC 309|
20|FH_F35780_32073_0|CSTM-ALL|CSTM-00|2020|PCT|0.46|99|0.00|GENERAL ACUTE CARE|
20|FH_F140292_06902_0|SrvcGrp|472|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F90223_0_0|SrvcGrp|82638|2022|PDM|75.00|99|0.00|HIT CONT PAIN MGMT INFUSION|
20|FH_F36429_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F94222_62269_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F47037_0_0|SrvcGrp|12157|2022|PDM|92.00|99|0.00|RN VISIT|
20|FH_F139147_0_0|SrvcGrp|88599|2022|PDM|5305.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F101640_32218_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F41802_0_0|SrvcGrp|64601|2022|PDM|38.20|99|0.00|HIGH COST DRUGS J1557|
20|FH_F122248_33441_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F124441_0_0|SrvcGrp|89404|2022|PDM|14250.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1491.00|99|0.00|AEG 8 (NO REV)|
20|FH_F109762_0_0|SrvcGrp|73008|2022|PDM|630.00|99|0.00|AEG 10|
20|FH_F116437_0_0|SrvcGrp|84123|2022|PDM|870.00|99|0.00|INSERT ANT SEGMENT DRAIN EXT|
20|FH_F131942_50833_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F32825_0_0|SrvcGrp|3409|2022|PDM|393.00|99|0.00|NEWBORN NURSERY|
20|FH_F97640_37043_0|SrvcGrp|73659|2022|PDM|8122.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F142370_0_0|SrvcGrp|113542|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2 & INF A&B AMP PRB|
20|FH_F39756_0_0|SrvcGrp|31080|2022|PDM|247.50|99|0.00|DENTAL PROCEDURES - CHILD|
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F75764_0_0|CSTM-ALL|CSTM-00|2020|PDM|105.00|99|0.00|OP SVCS|
20|FH_F56232_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F114206_37203_0|SrvcGrp|86835|2022|PDM|15.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F151008_92625_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F47558_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F101441_0_0|SrvcGrp|80139|2022|PDM|7946.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F134432_85053_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112754_98057_0|SrvcGrp|73742|2022|PDM|5.55|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F134847_0_0|SrvcGrp|95564|2022|PDM|6788.00|99|0.00|NASAL SINUS ENDOSCOPY SURGICAL|
20|FH_F47836_0_0|SrvcGrp|44325|2022|PDM|1300.00|99|0.00|CPT  40819,41115,69205, 69424|
20|FH_F94426_47403_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F40581_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F101441_0_0|SrvcGrp|97059|2022|PDM|3567.00|99|0.00|MENISCUS REPAIR, MED OR LAT|
20|FH_F150982_0_0|SrvcGrp|46887|2022|PDM|2392.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F126256_24293_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149240_0_0|SrvcGrp|80918|2022|PDM|144.84|99|0.00|RESPITE CARE|
20|FH_F38364_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97100_23462_0|SrvcGrp|73461|2022|PDM|9773.00|99|0.00|AETNA NICU IV|
20|FH_F36594_0_0|SrvcGrp|22021|2022|PDM|47.00|99|0.00|RN, INTERMITTENT VISIT|
20|FH_F139877_32615_0|SrvcGrp|112223|2022|PDM|75.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F116100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131028_49735_0|SrvcGrp|90707|2022|PDM|130.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F141156_04401_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F149662_85015_0|SrvcGrp|114020|2022|PCT|1.15|99|0.00|LABORATORY SERVICES|
20|FH_F47836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|ENT SURGERY CTR CARVEOUT 2|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PDM|1874.00|99|0.00|ASPG III|
20|FH_F40644_0_0|CSTM-ALL|CSTM-00|2020|PDM|1423.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134887_33409_0|SrvcGrp|82846|2022|PCT|1.05|99|0.00|AETNA DME|
20|FH_F138018_17313_0|SrvcGrp|22591|2022|PDM|91.79|99|0.00|IMPLANTED PUMP|
20|FH_F110722_19966_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
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_F149651_90046_0|SrvcGrp|110811|2022|PDM|350.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F137719_28269_0|SrvcGrp|89337|2022|PDM|1122.00|99|0.00|DETOXIFICATION|
20|FH_F60296_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|77447|2022|PDM|1802.00|99|0.00|ENDOSCOPIC INJECTION|
20|FH_F150946_75783_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|1452.00|99|0.00|AEG 8 (NO REV)|
20|FH_F147339_08837_0|SrvcGrp|67068|2022|PDM|2775.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F35167_0_0|SrvcGrp|12991|2022|PCT|0.55|99|0.00|DRUGS|
20|FH_F36720_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|RADIOLOGY F/S|
20|FH_F89851_83854_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|2383.00|99|0.00|AEG 9 (NO REV)|
20|FH_F93961_0_0|SrvcGrp|91862|2022|PDM|452.00|99|0.00|COLONOSCOPY PROCEDURES 2|
20|FH_F138017_73129_0|SrvcGrp|90063|2022|PDM|6883.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F46433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F109247_73102_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F36328_0_0|SrvcGrp|115|2022|PDM|468.00|99|0.00|SKILLED NURSING CARE|
20|FH_F97184_26101_0|SrvcGrp|90854|2022|PDM|1797.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F140231_60540_0|SrvcGrp|46903|2022|PDM|956.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F143488_84770_0|SrvcGrp|110820|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F143488_84770_0|SrvcGrp|46890|2022|PDM|1688.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F101901_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F101540_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)|
20|FH_F47600_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|GA RETINA SURG CTR ASC 23|
20|FH_F136280_54915_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132473_38018_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132473_38018_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112679_85711_0|SrvcGrp|48396|2022|PDM|117.00|99|0.00|OT SERVICES|
20|FH_F116869_15146_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F119591_75034_0|SrvcGrp|73841|2022|PDM|429.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F119918_38201_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F119992_67062_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F120866_51652_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F113649_01752_0|SrvcGrp|14944|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F84394_17402_0|SrvcGrp|106684|2022|PDM|14232.00|99|0.00|RECONSTRUCT ANKLE JOINT|
20|FH_F33618_0_0|SrvcGrp|6|2022|PCT|0.95|99|0.00|OP SURGERY|
20|FH_F141861_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_F49895_0_0|SrvcGrp|36808|2022|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53  (DME)|
20|FH_F100742_00616_0|SrvcGrp|90854|2022|PDM|1256.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F61292_0_0|SrvcGrp|12413|2022|PDM|8720.00|99|0.00|PTCA|
20|FH_F31433_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F67261_0_0|CSTM-ALL|CSTM-00|2020|PDM|3025.00|99|0.00|ASPG VI - FH SW CUSTOM GROUPERS|
20|FH_F120175_19606_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F51120_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F37679_0_0|SrvcGrp|24747|2022|PDM|61.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F121547_46805_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F101854_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|AEG 10 (NO REV)|
20|FH_F94862_0_0|SrvcGrp|73004|2022|PDM|998.00|99|0.00|AEG 8|
20|FH_F69322_0_0|SrvcGrp|167|2022|PDM|641.00|99|0.00|CD (ADULT) - REHABILITATION|
20|FH_F123507_63869_0|SrvcGrp|471|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F72830_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F121490_86314_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F72664_0_0|SrvcGrp|68380|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F40415_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129969_33908_0|SrvcGrp|16069|2022|PDM|625.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F92091_0_0|SrvcGrp|88159|2022|PDM|7800.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F121164_61761_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F46612_0_0|SrvcGrp|9937|2022|PDM|154.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F138416_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|HOSPICE CARE|
20|FH_F110923_54768_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128401_44615_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F130747_0_0|SrvcGrp|92010|2022|PDM|5202.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE|
20|FH_F121524_87111_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134994_33162_0|SrvcGrp|58509|2022|PDM|354.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F41350_0_0|CSTM-ALL|CSTM-00|2020|PDM|523.00|99|0.00|ASPG I|
20|FH_F109581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89453_75069_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F33181_0_0|CSTM-ALL|CSTM-00|2020|PDM|17000.00|99|0.00|MS DRGS 216-221 CARDIAC VALVE|
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F139515_0_0|SrvcGrp|11673|2022|PDM|3200.00|99|0.00|CPT 29888|
20|FH_F115103_31405_0|SrvcGrp|79804|2022|PDM|1400.30|99|0.00|AETNA MEDICAL/SURGICAL|
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|ASPG III|
20|FH_F145758_20745_0|CSTM-ALL|CSTM-00|2020|PDM|877.20|99|0.00|AEG 5  (NO REV)|
20|FH_F118050_77565_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F135219_68506_0|SrvcGrp|113910|2022|PCT|1.00|99|0.00|COVID-19 SPECIMEN HANDLING OFFICE LAB|
20|FH_F114930_71101_0|SrvcGrp|87995|2022|PDM|290.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F89563_29407_0|SrvcGrp|94743|2022|PCT|1.00|99|0.00|FLUZONE VACC IM (>=3 YRS)|
20|FH_F103902_89118_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F130127_77071_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F130747_0_0|SrvcGrp|103327|2022|PDM|6242.00|99|0.00|INSJ STABLJ DEV W/DCMPRN|
20|FH_F147941_06023_0|SrvcGrp|109215|2022|PDM|288.00|99|0.00|PSYCH TEST EVALUATION 1ST HOUR|
20|FH_F82173_72712_0|SrvcGrp|110638|2022|PDM|1584.00|99|0.00|HOSPICE GENERAL INPATIENT CARE|
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|486.20|99|0.00|ASPG 2- PROGRESSIVE SURG|
20|FH_F130807_20721_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F82173_72712_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F135456_0_0|CSTM-ALL|CSTM-00|2020|PDM|511.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F84215_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F70984_0_0|SrvcGrp|67996|2022|PDM|1500.00|99|0.00|CPT 58260 58263|
20|FH_F38187_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72183_0_0|SrvcGrp|46644|2022|PDM|600.00|99|0.00|EMERGENCY ROOM|
20|FH_F131961_06040_0|SrvcGrp|75545|2022|PDM|437.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F141410_13045_0|SrvcGrp|73606|2022|PDM|556.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F125519_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F120279_98005_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116327_75701_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F50218_0_0|SrvcGrp|24345|2022|PDM|120.00|99|0.00|RESPIRATORY THERAPY VISIT|
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 7 (NO REV)|
20|FH_F106020_0_0|SrvcGrp|27261|2022|PDM|3047.00|99|0.00|CPT 27446|
20|FH_F137946_0_0|SrvcGrp|113238|2022|PDM|51.31|99|0.00|COVID-19 LAB TEST NON-CDC (HCFA)|
20|FH_F62869_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F143834_06511_0|SrvcGrp|102239|2022|PDM|90.00|99|0.00|AETNA METHADONE MAINTENANCE|
20|FH_F91622_0_0|CSTM-ALL|CSTM-00|2020|PDM|2088.00|99|0.00|AEG 10 (NO REV) ANTHONY MED CTR|
20|FH_F69965_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38320_0_0|SrvcGrp|472|2022|PDM|475.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F37679_0_0|SrvcGrp|21920|2022|PDM|61.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F131603_53051_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC|
20|FH_F139551_0_0|SrvcGrp|84313|2022|PDM|1850.00|99|0.00|TENDON REPAIR|
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.71|99|0.00|2005 ASPG GROUPER IV|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|3400.00|99|0.00|ASPG VIII|
20|FH_F78285_0_0|SrvcGrp|9873|2022|PDM|50.00|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F76402_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRGS 258-262 PACEMAKER REVISION OR REPLACEMENT|
20|FH_F116203_63901_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F140427_0_0|SrvcGrp|104925|2022|PDM|5300.00|99|0.00|PRQ CARDIAC ANGIOPLAST 1 ART-CONCUR|
20|FH_F109601_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F130479_67526_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|GENERAL ACUTE CARE|
20|FH_F141470_71913_0|SrvcGrp|10391|2022|PDM|1350.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F135013_46321_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F74242_0_0|SrvcGrp|11306|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F149140_07522_0|SrvcGrp|111926|2022|PDM|35.92|99|0.00|COVID-19 LAB TESTING|
20|FH_F31036_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121495_92009_0|SrvcGrp|87317|2022|PDM|1250.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F148182_23324_0|SrvcGrp|29346|2022|PDM|32.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F127415_45822_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F77903_0_0|SrvcGrp|12804|2022|PDM|1274.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F91876_0_0|SrvcGrp|73008|2022|PDM|1691.00|99|0.00|AEG 10|
20|FH_F126585_45039_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F115103_31405_0|SrvcGrp|42784|2022|PDM|129.80|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F125028_19061_0|SrvcGrp|65621|2022|PDM|38.85|99|0.00|RN NURSING|
20|FH_F82173_72712_0|CSTM-ALL|CSTM-00|2020|PDM|3994.00|99|0.00|AEG 6 (NO REV)|
20|FH_F115685_64064_0|SrvcGrp|86847|2022|PDM|75.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F124048_47304_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F35271_0_0|SrvcGrp|9774|2022|PDM|1300.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F148319_37042_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F131965_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F147661_0_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F131207_19947_0|SrvcGrp|104186|2022|PDM|10.00|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F143528_0_0|SrvcGrp|100011|2022|PDM|5250.00|99|0.00|ANKLE ARTHROSCOPY|
20|FH_F38591_0_0|SrvcGrp|12104|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F149888_68506_0|SrvcGrp|104555|2022|PDM|2115.00|99|0.00|HYSTEROSCOPY REMOVE FB|
20|FH_F39943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS|
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149140_07522_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141012_22901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F44582_0_0|SrvcGrp|8968|2022|PDM|3300.00|99|0.00|NICU LEVEL III & IV|
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|821.48|99|0.00|ASPG VI|
20|FH_F148260_0_0|SrvcGrp|104755|2022|PDM|550.00|99|0.00|ANAL/URINARY MUSCLE STUDY|
20|FH_F107800_34609_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F111288_0_0|SrvcGrp|93057|2022|PDM|1034.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F105221_01757_0|SrvcGrp|27968|2022|PDM|26.25|99|0.00|SKILLED NURSING LPN|
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PDM|789.00|99|0.00|ASPG V|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1012.74|99|0.00|HAPA WPA-NWPA 2012-13 ASC 13 W/O REV|
20|FH_F128012_64628_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148265_06067_0|SrvcGrp|92358|2022|PDM|17811.00|99|0.00|REMOVAL OF KNEE PROSTHESIS|
20|FH_F127255_03104_0|SrvcGrp|104186|2022|PDM|10.00|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F125864_78748_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|9954.00|99|0.00|AEG 8 (NO REV)|
20|FH_F114963_62062_0|SrvcGrp|48385|2022|PDM|131.00|99|0.00|SPEECH THERAPY|
20|FH_F92655_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 2 (NO REV)|
20|FH_F124017_0_0|SrvcGrp|73616|2022|PDM|3500.00|99|0.00|AETNA WRIST ENDOSCOPY|
20|FH_F117902_0_0|SrvcGrp|107656|2022|PDM|1300.00|99|0.00|AETNA CARVE OUT CODES SERIES A|
20|FH_F131763_06002_0|SrvcGrp|75545|2022|PDM|437.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F34854_0_0|SrvcGrp|453|2022|PDM|325.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F92411_0_0|SrvcGrp|57968|2022|PDM|31.97|99|0.00|CONTINUOUS HOMECARE|
20|FH_F148265_06067_0|CSTM-ALL|CSTM-00|2020|PDM|2494.00|99|0.00|AEG 8 (NO REV)|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|ASPG V|
20|FH_F43663_0_0|SrvcGrp|14165|2022|PDM|293.00|99|0.00|PARTIAL HOSP PSYCH/CD|
20|FH_F63627_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|WELLPATH ASC V|
20|FH_F129969_33908_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F90691_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F137984_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|OP SVCS|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC|
20|FH_F115685_64064_0|SrvcGrp|86853|2022|PDM|20.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F139515_0_0|SrvcGrp|98497|2022|PDM|16995.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F67261_0_0|SrvcGrp|22020|2022|PDM|750.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F73985_0_0|SrvcGrp|17077|2022|PDM|3525.00|99|0.00|ASPG VII|
20|FH_F37679_0_0|SrvcGrp|27144|2022|PDM|7.50|99|0.00|HOME INJECTABLE THERAPY (MOD SH)|
20|FH_F148239_74012_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F33642_0_0|SrvcGrp|18197|2022|PCT|0.75|99|0.00|MS DRG 025|
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1030.00|99|0.00|AEG 5  (NO REV)|
20|FH_F38360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F121523_33406_0|SrvcGrp|87131|2022|PDM|1248.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F67101_0_0|SrvcGrp|12124|2022|PCT|1.00|99|0.00|ORGAN TRANSPLANT SERVICES|
20|FH_F62579_0_0|SrvcGrp|24748|2022|PDM|85.00|99|0.00|CORTICOSTEROID THERAPY|
20|FH_F62579_0_0|SrvcGrp|17015|2022|PDM|19.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F130895_07726_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F110501_07652_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|3685.00|99|0.00|AEG 9 (NO REV)|
20|FH_F139565_0_0|SrvcGrp|109759|2022|PDM|5738.00|99|0.00|REMOVAL CORNEAL EPITHELIUM|
20|FH_F97861_62223_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F83995_16748_0|SrvcGrp|22387|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|224.14|99|0.00|HAPA WPA-NWPA 2012-13 ASC 125 W/O REV|
20|FH_F135663_24401_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F122930_0_0|SrvcGrp|72996|2022|PDM|1778.00|99|0.00|AEG 4|
20|FH_F38567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|GENERAL ACUTE CARE|
20|FH_F79824_0_0|SrvcGrp|34394|2022|PCT|0.57|99|0.00|RADIATION ONCOLOGY|
20|FH_F138050_52301_0|CSTM-ALL|CSTM-00|2020|PDM|5109.00|99|0.00|AEG 6 (NO REV)|
20|FH_F91777_29577_0|SrvcGrp|73523|2022|PCT|1.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F118803_0_0|SrvcGrp|77290|2022|PDM|349.70|99|0.00|AETNA REMV TUNNLD CVC W/O SUBQ PORT|
20|FH_F146626_60612_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F35042_0_0|SrvcGrp|16|2022|PDM|1512.00|99|0.00|ACUTE REHABILITATION|
20|FH_F119783_46360_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PDM|1118.00|99|0.00|ASPG VII|
20|FH_F111731_47802_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F110453_0_0|SrvcGrp|73000|2022|PDM|892.00|99|0.00|AEG 6|
20|FH_F85353_16407_0|SrvcGrp|63892|2022|PDM|203.32|99|0.00|HAPA WPA-NWPA 2012-13 ASC 132|
20|FH_F134614_84651_0|SrvcGrp|89337|2022|PDM|1200.00|99|0.00|DETOXIFICATION|
20|FH_F135670_01749_0|SrvcGrp|86841|2022|PDM|80.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F100782_0_0|SrvcGrp|108211|2022|PDM|61.25|99|0.00|PREP TUMOR|
20|FH_F85311_18702_0|SrvcGrp|12403|2022|PDM|27.50|99|0.00|CONTINUOUS HOMECARE|
20|FH_F143561_16001_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111986_0_0|SrvcGrp|42472|2022|PDM|2472.00|99|0.00|CPT 58670|
20|FH_F112665_0_0|SrvcGrp|88158|2022|PDM|7215.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F143561_16001_0|SrvcGrp|48396|2022|PDM|86.00|99|0.00|OT SERVICES|
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)|
20|FH_F124161_95932_0|SrvcGrp|73006|2022|PDM|8323.00|99|0.00|AEG 9|
20|FH_F130661_04441_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 7 (NO REV)|
20|FH_F141247_18902_0|SrvcGrp|73842|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149609_78624_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43293_0_0|SrvcGrp|37018|2022|PDM|200.00|99|0.00|BOARDER BABY|
20|FH_F139877_32615_0|SrvcGrp|113240|2022|PDM|75.00|99|0.00|COVID-19 TEST NON-CDC HGH THRU (HCFA)|
20|FH_F97100_23462_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148347_0_0|SrvcGrp|80063|2022|PDM|1932.00|99|0.00|HEMORRHOIDECTOMY|
20|FH_F112306_81428_0|SrvcGrp|93291|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA ESRD USE|
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 3 (NO REV)|
20|FH_F36803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F131111_33304_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142327_0_0|SrvcGrp|62740|2022|PDM|2800.00|99|0.00|SURGERY CARVE OUTS|
20|FH_F147218_48026_0|SrvcGrp|42622|2022|PDM|638.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F90223_0_0|SrvcGrp|88815|2022|PDM|37.50|99|0.00|HOME VISIT (MOD SH) (HCFA)|
20|FH_F140087_62864_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143347_16001_0|SrvcGrp|74666|2022|PCT|2.00|99|0.00|AETNA PHYSICIAN SERVICES|
20|FH_F103060_0_0|SrvcGrp|77021|2022|PDM|7803.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F46893_0_0|SrvcGrp|3069|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F48937_0_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F120240_37013_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F136286_73120_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F132433_34952_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116698_07470_0|SrvcGrp|14945|2022|PDM|15.75|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F116739_78501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116915_30308_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120050_92626_0|SrvcGrp|89337|2022|PDM|1225.00|99|0.00|DETOXIFICATION|
20|FH_F126054_30022_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F40207_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F84394_17402_0|SrvcGrp|110355|2022|PDM|14659.00|99|0.00|NECK SPINE FUSE & REMOVE BEL C|
20|FH_F36372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|100% AWP HCPC|
20|FH_F36418_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F38980_0_0|SrvcGrp|8960|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F39272_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F36439_0_0|SrvcGrp|24404|2022|PDM|450.00|99|0.00|HEARING AIDE|
20|FH_F100742_00616_0|CSTM-ALL|CSTM-00|2020|PCT|0.37|99|0.00|OP SVCS|
20|FH_F49029_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|3272.00|99|0.00|ASPG VI - FH SW CUSTOM GROUPERS|
20|FH_F63481_0_0|SrvcGrp|26233|2022|PDM|425.00|99|0.00|SLEEP STUDIES|
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|551.00|99|0.00|AEG 1 (NO REV)|
20|FH_F42364_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F34112_0_0|SrvcGrp|12906|2022|PDM|4925.00|99|0.00|IP LITHOTRIPSY|
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|2640.00|99|0.00|DEVICE INSERTION|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD AW) - PMRS|
20|FH_F89475_71202_0|CSTM-ALL|CSTM-00|2020|PDM|1975.00|99|0.00|AEG 10 (NO REV)|
20|FH_F148244_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F148265_06067_0|SrvcGrp|89404|2022|PDM|19500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F37945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1614.00|99|0.00|ASPG VI|
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_F145546_52732_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93881_15009_0|SrvcGrp|21456|2022|PDM|943.00|99|0.00|SLEEP STUDIES|
20|FH_F31253_0_0|SrvcGrp|1259|2022|PDM|1200.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124017_0_0|SrvcGrp|11043|2022|PDM|1450.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F39855_0_0|SrvcGrp|65|2022|PDM|1829.00|99|0.00|OBSTETRICAL CARE|
20|FH_F123285_54157_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F83255_32025_0|SrvcGrp|471|2022|PDM|446.25|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148320_02130_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44095_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F135260_18655_0|SrvcGrp|108484|2022|PDM|716.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F39866_0_0|SrvcGrp|31370|2022|PCT|0.75|99|0.00|OP NUCLEAR MEDICINE|
20|FH_F102522_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F33472_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115064_78582_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146569_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F93949_02720_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F33712_0_0|SrvcGrp|10906|2022|PCT|0.75|99|0.00|EMERGENCY ROOM LEVEL IV|
20|FH_F127441_45822_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 4 (NO REV)|
20|FH_F116952_01020_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F93880_95476_0|SrvcGrp|12840|2022|PCT|0.30|99|0.00|PACEMAKER|
20|FH_F56276_0_0|SrvcGrp|52948|2022|PDM|170.00|99|0.00|PSYCHIATRIC CPT 90809|
20|FH_F38377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148170_04005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148265_06067_0|SrvcGrp|26279|2022|PDM|2976.00|99|0.00|CPT 29884|
20|FH_F148666_34205_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME NO MOD|
20|FH_F123898_45121_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F145550_62034_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F145781_0_0|SrvcGrp|90061|2022|PDM|11000.00|99|0.00|AETNA RECONSTRUCT SHOULDER JOINT|
20|FH_F110268_02891_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F63375_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1915.97|99|0.00|HAPA WPA-NWPA 2012-13 ASC 906 W/O REV|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1381.46|99|0.00|HAPA WPA-NWPA 2012-13 ASC 903 W/O REV|
20|FH_F132969_84003_0|SrvcGrp|86851|2022|PDM|25.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|13128.00|99|0.00|MS DRG 280|
20|FH_F112729_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS|
20|FH_F134669_17403_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F143581_02130_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34603_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.55|99|0.00|OP SVCS|
20|FH_F134587_64114_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133920_64057_0|SrvcGrp|88621|2022|PDM|115.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150161_63361_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F145642_15108_0|SrvcGrp|14949|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F117206_0_0|SrvcGrp|107322|2022|PDM|1970.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F146666_75154_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120720_24541_0|SrvcGrp|46605|2022|PDM|70.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F145819_03431_0|SrvcGrp|471|2022|PDM|652.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F136359_0_0|SrvcGrp|89856|2022|PDM|5850.00|99|0.00|LAMIN EXCIS EXTRADURAL LUMB|
20|FH_F87333_0_0|SrvcGrp|73004|2022|PDM|1638.08|99|0.00|AEG 8|
20|FH_F146289_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.38|99|0.00|OP SVCS|
20|FH_F85652_98034_0|CSTM-ALL|CSTM-00|2020|PCT|2.92|99|0.00|AETNA - APC GROUPER B|
20|FH_F121225_98902_0|SrvcGrp|16|2022|PDM|1500.00|99|0.00|ACUTE REHABILITATION|
20|FH_F141210_0_0|SrvcGrp|88599|2022|PDM|5305.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F127585_45069_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F31714_0_0|SrvcGrp|11205|2022|PDM|9400.00|99|0.00|DRG 544 MAJOR JOINT REPLACEMENT/REATTACHMENT OF LWR EXTRMTY|
20|FH_F149106_07042_0|SrvcGrp|99073|2022|PCT|1.03|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F118138_60532_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F132690_87571_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F36616_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134249_05060_0|SrvcGrp|104469|2022|PDM|5280.00|99|0.00|VBAC DELIVERY|
20|FH_F89219_0_0|SrvcGrp|112750|2022|PDM|6836.00|99|0.00|MSDRG 018 ONLY|
20|FH_F49031_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.10|99|0.00|OP SVCS|
20|FH_F119613_90035_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143669_78577_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F114444_19602_0|SrvcGrp|91393|2022|PDM|75.00|99|0.00|AETNA OFFICE OPT VISIT EST (MOD AF)|
20|FH_F133811_29615_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132969_84003_0|SrvcGrp|19742|2022|PDM|50.00|99|0.00|MID-LINE INSERTION|
20|FH_F134489_90305_0|SrvcGrp|89417|2022|PDM|450.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F122434_40207_0|SrvcGrp|74668|2022|PDM|264.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F122463_17109_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F68887_0_0|SrvcGrp|44105|2022|PDM|48.00|99|0.00|PHYSICAL THERAPY|
20|FH_F74583_0_0|SrvcGrp|66005|2022|PDM|14.00|99|0.00|SKILLED NURSING HCPC|
20|FH_F79644_0_0|SrvcGrp|89730|2022|PDM|1561.00|99|0.00|ER SVCS|
20|FH_F115811_33410_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F146776_64506_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115979_46107_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F131675_71753_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133658_60053_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132213_17543_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150060_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F111662_80601_0|SrvcGrp|75545|2022|PDM|309.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F89372_0_0|SrvcGrp|70381|2022|PDM|629.00|99|0.00|PSYCH PARTIAL HOSP (FULL & PARTIAL DAY) PER VISIT|
20|FH_F89495_0_0|SrvcGrp|72996|2022|PDM|653.00|99|0.00|AEG 4|
20|FH_F32709_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139703_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F115166_0_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F136390_46321_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F118193_06241_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F134008_11221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134011_84102_0|SrvcGrp|86846|2022|PDM|25.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F134011_84102_0|SrvcGrp|10577|2022|PDM|25.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F134126_11554_0|SrvcGrp|2067|2022|PDM|824.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F137187_64015_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139067_66935_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142690_31774_0|SrvcGrp|24761|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142742_44112_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F53732_0_0|SrvcGrp|50162|2022|PDM|61.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 12 HRS|
20|FH_F62683_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F83831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F97582_46307_0|SrvcGrp|73659|2022|PDM|13074.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F138542_40324_0|SrvcGrp|108484|2022|PDM|495.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F138584_30912_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 4 (NO REV) W/O CHEEK BONE FRACTURE REPAIR|
20|FH_F140468_46825_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34735_0_0|SrvcGrp|3069|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|3150.00|99|0.00|AEG 4 (NO REV)|
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|851.00|99|0.00|AEG 4 (NO REV)|
20|FH_F38526_0_0|SrvcGrp|11971|2022|PCT|0.90|99|0.00|TRAUMA CARE|
20|FH_F97540_32114_0|SrvcGrp|73643|2022|PDM|1267.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|1149.00|99|0.00|AEG 10 (NO REV)|
20|FH_F32151_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|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_F133207_0_0|SrvcGrp|80617|2022|PDM|14004.00|99|0.00|ARTHOPLASTY|
20|FH_F52854_0_0|SrvcGrp|26291|2022|PDM|3535.00|99|0.00|PET SCAN|
20|FH_F141471_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F115967_60123_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129656_15005_0|SrvcGrp|14948|2022|PDM|95.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F42722_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37884_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD KM|
20|FH_F97242_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F45632_0_0|SrvcGrp|41497|2022|PDM|57.00|99|0.00|ST SVCS|
20|FH_F148265_06067_0|SrvcGrp|88065|2022|PDM|20449.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F90654_0_0|SrvcGrp|471|2022|PDM|1800.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F73985_0_0|CSTM-ALL|CSTM-00|2020|PDM|4462.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111282_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F117078_01420_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F128333_71001_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F114970_28403_0|SrvcGrp|90573|2022|PDM|176.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F137611_30909_0|SrvcGrp|89149|2022|PDM|182.00|99|0.00|OP INTENSIVE|
20|FH_F141354_63556_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F145550_62034_0|SrvcGrp|80920|2022|PDM|660.00|99|0.00|HOSPICE SERVICES|
20|FH_F134894_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109601_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F143902_41018_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F54293_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82173_72712_0|SrvcGrp|11259|2022|PCT|2.00|99|0.00|DRUGS|
20|FH_F133714_03570_0|SrvcGrp|471|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149140_07522_0|SrvcGrp|113220|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS 22 TRGT SARS-COV-2|
20|FH_F131234_32207_0|SrvcGrp|90854|2022|PDM|896.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F141169_0_0|SrvcGrp|85981|2022|PDM|2468.00|99|0.00|CPT 58671|
20|FH_F40519_0_0|SrvcGrp|473|2022|PDM|285.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F124965_0_0|SrvcGrp|72994|2022|PDM|950.00|99|0.00|AEG 3|
20|FH_F118910_0_0|SrvcGrp|95661|2022|PDM|113.30|99|0.00|RESPITE CARE (HCFA)|
20|FH_F135052_18702_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131902_46402_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72850_0_0|SrvcGrp|30623|2022|PDM|11682.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F128272_60640_0|SrvcGrp|84260|2022|PCT|1.00|99|0.00|AETNA ALL DRUGS|
20|FH_F150982_0_0|SrvcGrp|92819|2022|PDM|16516.00|99|0.00|HIP ARTHOSCOPY|
20|FH_F140910_53005_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F116237_43235_0|SrvcGrp|89417|2022|PDM|363.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F86319_16365_0|SrvcGrp|9866|2022|PDM|2347.00|99|0.00|IP OBSERVATION SVCS|
20|FH_F115768_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135165_15728_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F101021_0_0|SrvcGrp|95221|2022|PDM|140.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F32720_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F55212_0_0|SrvcGrp|26354|2022|PDM|108.00|99|0.00|CPT 90846|
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133211_0_0|SrvcGrp|112223|2022|PDM|95.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|1731.00|99|0.00|AEG 8 (NO REV)|
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|1505.48|99|0.00|AEG 7 (NO REV)|
20|FH_F89778_0_0|SrvcGrp|65403|2022|PDM|2107.64|99|0.00|CPT 42830|
20|FH_F113709_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137951_0_0|SrvcGrp|85792|2022|PDM|4490.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F148419_01453_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148425_01507_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|COVID-19 INFUSION ADMIN - ELI LILLY|
20|FH_F38161_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|FLORIDA GLOBAL CT CARVEOUT CODES|
20|FH_F117875_70601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F62601_0_0|SrvcGrp|46424|2022|PDM|30.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F138827_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F107120_22560_0|SrvcGrp|26001|2022|PDM|142.45|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92676_15063_0|SrvcGrp|79026|2022|PDM|831.45|99|0.00|MON VALLEY ASC 115|
20|FH_F127422_0_0|SrvcGrp|72992|2022|PDM|446.00|99|0.00|AEG 2|
20|FH_F117756_75402_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F34843_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F100666_81301_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F148886_60621_0|CSTM-ALL|CSTM-00|2020|PDM|1940.00|99|0.00|AEG 8 (NO REV)|
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|1558.00|99|0.00|AEG 4 (NO REV)|
20|FH_F69063_0_0|SrvcGrp|42976|2022|PDM|95.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F146375_06751_0|SrvcGrp|74668|2022|PDM|722.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148703_33853_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140488_07039_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140753_75038_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F140787_66427_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140893_19720_0|SrvcGrp|88620|2022|PDM|125.00|99|0.00|SKILLED NURSING RN|
20|FH_F80754_31601_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|AETNA VALDOSTA AMFS|
20|FH_F120152_0_0|SrvcGrp|35669|2022|PDM|8800.00|99|0.00|CPT 63650|
20|FH_F151604_44266_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F118959_44830_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F119004_06850_0|SrvcGrp|42551|2022|PDM|2503.00|99|0.00|OP SURGERY|
20|FH_F117295_70006_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F147725_06002_0|SrvcGrp|83646|2022|PDM|4160.00|99|0.00|CPT 31276|
20|FH_F147900_48038_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147931_29732_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129483_77030_0|SrvcGrp|86852|2022|PDM|40.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F117108_37841_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F137333_51012_0|SrvcGrp|113076|2022|PCT|0.00|99|0.00|ALCOHOL/DRUG ABUSE HOUSE|
20|FH_F137806_83702_0|SrvcGrp|73841|2022|PDM|450.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F137815_15501_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F109652_0_0|SrvcGrp|45751|2022|PDM|1004.00|99|0.00|INDIVIDUAL THERAPY|
20|FH_F90613_05001_0|SrvcGrp|90160|2022|PDM|1152.00|99|0.00|AETNA INPATIENT DETOX (>= 18 YEARS OF AGE)|
20|FH_F90880_15108_0|SrvcGrp|91067|2022|PCT|1.50|99|0.00|AETNA LINEZOLID INJECTION (MOD TC)|
20|FH_F83997_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|20475.00|99|0.00|MSDRG 235-236 CORONARY BYPASS|
20|FH_F148880_26807_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|MCARE2 OCN F/S PRICING W/O HOME HEALTH|
20|FH_F151122_10462_0|SrvcGrp|66265|2022|PDM|121.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F151284_72703_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F121326_60957_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F113139_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F115884_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_F129130_92562_0|SrvcGrp|51672|2022|PDM|11626.64|99|0.00|MS DRG 286-287 ONLY|
20|FH_F37823_0_0|SrvcGrp|3378|2022|PCT|0.80|99|0.00|OBSERVATION SVCS|
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|300.00|99|0.00|ADULT PSYCH PARTIAL DAY TREATMNT|
20|FH_F97721_01053_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F73231_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INFUSION REV CODE 640|
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111925_0_0|SrvcGrp|28547|2022|PDM|1602.00|99|0.00|VITRECTOMY|
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AEG 4 (NO REV)|
20|FH_F133376_33414_0|SrvcGrp|89149|2022|PDM|194.00|99|0.00|OP INTENSIVE|
20|FH_F131047_0_0|CSTM-ALL|CSTM-00|2020|PDM|3690.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1633.00|99|0.00|AEG 8 (NO REV)|
20|FH_F118909_0_0|SrvcGrp|94781|2022|PDM|123.60|99|0.00|HOSPICE IN LTCH (HCFA)|
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|2273.00|99|0.00|AEG 2 (NO REV)|
20|FH_F141131_20850_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F93252_0_0|SrvcGrp|93028|2022|PDM|2000.00|99|0.00|BREAST BIOPSY SURGERIES|
20|FH_F119214_0_0|SrvcGrp|75495|2022|PDM|2216.00|99|0.00|AEG 9|
20|FH_F64579_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F114345_27597_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124180_0_0|SrvcGrp|86034|2022|PDM|3500.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F122198_20708_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F37603_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F39066_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F40302_0_0|SrvcGrp|72|2022|PDM|291.00|99|0.00|NEWBORN NURSERY|
20|FH_F49937_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC|
20|FH_F48174_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|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_F132592_68305_0|SrvcGrp|103913|2022|PCT|0.94|99|0.00|OP DIALYSIS|
20|FH_F132592_68305_0|SrvcGrp|109057|2022|PCT|0.94|99|0.00|CARDIAC STUDIES|
20|FH_F76544_0_0|CSTM-ALL|CSTM-00|2020|PDM|1529.00|99|0.00|IP LEVEL B|
20|FH_F98042_10468_0|CSTM-ALL|CSTM-00|2020|PCT|0.29|99|0.00|OP SVCS|
20|FH_F136622_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136734_46410_0|SrvcGrp|112744|2022|PCT|0.00|99|0.00|HOME HEALTH PROSPECTIVE PAYMENT SYSTEM (HHRG)|
20|FH_F114645_34952_0|SrvcGrp|86723|2022|PDM|390.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F114985_32073_0|SrvcGrp|90635|2022|PDM|118.00|99|0.00|AETNA PSYTX PT & FAMILY 60 MINUTES|
20|FH_F114985_32073_0|SrvcGrp|90490|2022|PDM|104.00|99|0.00|EVALUATION OF SPEECH FLUENCY|
20|FH_F150763_0_0|SrvcGrp|114925|2022|PDM|3698.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|3698.00|99|0.00|AEG 8 (NO REV)|
20|FH_F122610_73139_0|SrvcGrp|9916|2022|PDM|2280.00|99|0.00|OBSERVATION SVCS|
20|FH_F122675_07055_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F43295_0_0|CSTM-ALL|CSTM-00|2020|PDM|222.00|99|0.00|CD SVCS (ADULT)|
20|FH_F134670_95628_0|SrvcGrp|86723|2022|PDM|480.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F134674_06473_0|SrvcGrp|102239|2022|PDM|32.66|99|0.00|AETNA METHADONE MAINTENANCE|
20|FH_F134735_91362_0|SrvcGrp|90854|2022|PDM|648.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F135722_33461_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136796_24016_0|SrvcGrp|74039|2022|PDM|5396.49|99|0.00|LAMINECTOMY|
20|FH_F127217_29650_0|SrvcGrp|73841|2022|PDM|440.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F150525_16056_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97103_53295_0|SrvcGrp|73559|2022|PDM|17919.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F143168_60563_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118462_21740_0|SrvcGrp|75545|2022|PDM|343.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F98921_64503_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101840_76054_0|SrvcGrp|26686|2022|PDM|23371.00|99|0.00|MS DRG 455 ONLY|
20|FH_F130108_0_0|SrvcGrp|16301|2022|PDM|4500.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F141790_85374_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F110240_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151522_72712_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F133493_90255_0|SrvcGrp|105465|2022|PCT|1.40|99|0.00|AETNA THERAPIES|
20|FH_F35660_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F143187_52565_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F144308_44512_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117717_68410_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F146116_34233_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111809_93003_0|CSTM-ALL|CSTM-00|2020|PDM|3540.00|99|0.00|AEG 1 (NO REV)|
20|FH_F38770_0_0|SrvcGrp|29652|2022|PCT|0.55|99|0.00|OP CARDIAC CATHETERIZATION|
20|FH_F92614_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.20|99|0.00|OP SVCS|
20|FH_F37567_0_0|SrvcGrp|15363|2022|PCT|1.10|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F41441_0_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91212_62864_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67192_0_0|SrvcGrp|77348|2022|PDM|6557.00|99|0.00|CARDIAC CATH|
20|FH_F42494_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F68363_0_0|SrvcGrp|12043|2022|PDM|210.00|99|0.00|CPT 99205|
20|FH_F130573_02882_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88816_0_0|SrvcGrp|471|2022|PDM|462.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F142897_07018_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143202_32114_0|SrvcGrp|73841|2022|PDM|300.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F102681_34237_0|SrvcGrp|81563|2022|PDM|600.00|99|0.00|ABLATION ONE OR MORE|
20|FH_F133287_40215_0|SrvcGrp|57382|2022|PCT|0.55|99|0.00|MS DRG 456-458 ONLY|
20|FH_F92676_15063_0|SrvcGrp|79037|2022|PDM|748.15|99|0.00|MON VALLEY ASC 229|
20|FH_F143198_75219_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F126815_02118_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F40622_0_0|CSTM-ALL|CSTM-00|2020|PDM|742.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F102681_34237_0|SrvcGrp|73006|2022|PDM|800.00|99|0.00|AEG 9|
20|FH_F75706_0_0|SrvcGrp|42829|2022|PDM|50.00|99|0.00|RESPIRATORY THERAPY VISIT|
20|FH_F111401_29425_0|SrvcGrp|48396|2022|PDM|120.00|99|0.00|OT SERVICES|
20|FH_F68968_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F95980_20016_0|SrvcGrp|86746|2022|PCT|1.05|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F148662_01583_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F119220_75068_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F146258_90004_0|SrvcGrp|113276|2022|PCT|1.10|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F92676_15063_0|SrvcGrp|78959|2022|PDM|2592.00|99|0.00|MON VALLEY ASC 601|
20|FH_F133490_90650_0|SrvcGrp|36204|2022|PDM|1005.00|99|0.00|ACUTE PSYCH|
20|FH_F133480_85374_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129176_48098_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F133530_11237_0|CSTM-ALL|CSTM-00|2020|PDM|2920.00|99|0.00|AEG 6 (NO REV)|
20|FH_F68842_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD UE"|
20|FH_F114024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72648_0_0|SrvcGrp|44247|2022|PDM|280.00|99|0.00|CAPD TRAINING|
20|FH_F125352_90034_0|SrvcGrp|108484|2022|PDM|1100.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F144728_33541_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F148639_0_0|SrvcGrp|35669|2022|PDM|3495.00|99|0.00|CPT 63650|
20|FH_F133351_84003_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112627_26062_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130649_98055_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F31542_0_0|SrvcGrp|9511|2022|PDM|42.00|99|0.00|OBSERVATION SVCS|
20|FH_F108940_15642_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F109606_0_0|CSTM-ALL|CSTM-00|2020|PDM|749.00|99|0.00|AEG 10 (NO REV)|
20|FH_F88956_0_0|SrvcGrp|72984|2022|PCT|1.51|99|0.00|CHEMOTHERAPY|
20|FH_F122262_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F83031_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|INTERIM INFUSION REV CODE 640 W/MOD SJ|
20|FH_F148900_0_0|SrvcGrp|92408|2022|PDM|4704.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F135714_01922_0|SrvcGrp|82223|2022|PDM|145.00|99|0.00|HOSPICE CARE|
20|FH_F101754_63141_0|SrvcGrp|97972|2022|PDM|14.42|99|0.00|TYMPANOMETRY IMPEDANCE TEST|
20|FH_F32978_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F97041_71603_0|SrvcGrp|73605|2022|PDM|1629.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F92644_06053_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31204_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129175_0_0|SrvcGrp|96799|2022|PDM|166.68|99|0.00|DESTROY C/TH FACET JNT ADDL|
20|FH_F132667_62025_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141830_92592_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F141940_50023_0|CSTM-ALL|CSTM-00|2020|PDM|4052.54|99|0.00|AEG 6 (NO REV)|
20|FH_F136796_24016_0|SrvcGrp|27137|2022|PDM|2440.83|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F112378_60505_0|SrvcGrp|27969|2022|PDM|23.00|99|0.00|HOME HEALTH AIDE|
20|FH_F113713_17013_0|SrvcGrp|91397|2022|PDM|75.00|99|0.00|AETNA PSYCH PT & FAMILY 45MINS (MOD HO)|
20|FH_F141170_0_0|SrvcGrp|88159|2022|PDM|5010.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F115206_80923_0|SrvcGrp|88819|2022|PDM|859.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F115267_67156_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115567_91711_0|SrvcGrp|93339|2022|PDM|15.30|99|0.00|AETNA MED NUTRITION GROUP|
20|FH_F115631_65201_0|SrvcGrp|26276|2022|PDM|3177.00|99|0.00|CPT 29819|
20|FH_F147416_19095_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147586_44124_0|SrvcGrp|114518|2022|PDM|1921.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F41675_0_0|SrvcGrp|27776|2022|PDM|760.00|99|0.00|OP MRI|
20|FH_F42694_0_0|SrvcGrp|9228|2022|PDM|80.00|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F40600_0_0|SrvcGrp|13019|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F98622_45005_0|SrvcGrp|73659|2022|PDM|14291.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F98625_08103_0|SrvcGrp|73656|2022|PDM|848.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F111201_25301_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110621_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1299.00|99|0.00|AEG 6 (NO REV)|
20|FH_F140007_0_0|SrvcGrp|96350|2022|PDM|8045.00|99|0.00|SHOULDER JOINT|
20|FH_F100681_73104_0|SrvcGrp|90854|2022|PDM|2171.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F142087_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|600.00|99|0.00|AEG 3 (NO REV)|
20|FH_F117820_0_0|SrvcGrp|94780|2022|PDM|105.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F150939_0_0|SrvcGrp|100273|2022|PDM|62.50|99|0.00|MEASLES MUMPS&RUBELLA VAC LI|
20|FH_F37850_0_0|SrvcGrp|220|2022|PCT|0.65|99|0.00|INTRAOCULAR LENSES|
20|FH_F48836_0_0|SrvcGrp|31191|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF (DME)|
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117715_0_0|SrvcGrp|104450|2022|PDM|2041.91|99|0.00|CYSTOURETHRO W/ ADDL IMPLANT|
20|FH_F75826_0_0|SrvcGrp|40222|2022|PDM|100.00|99|0.00|OP SVCS|
20|FH_F84139_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151304_31520_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F151439_18104_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151511_14094_0|SrvcGrp|10364|2022|PDM|822.00|99|0.00|CPT CODE 99284|
20|FH_F132268_07060_0|SrvcGrp|94740|2022|PDM|58.94|99|0.00|AFLURIA VACC IM (>=3 YRS)|
20|FH_F122137_75633_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F144928_02703_0|SrvcGrp|114167|2022|PDM|398.00|99|0.00|PARTIAL HOSPITAL (0-17 YRS)|
20|FH_F135375_60014_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135407_62320_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135485_20171_0|SrvcGrp|88621|2022|PDM|74.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135489_70508_0|SrvcGrp|112752|2022|PCT|1.00|99|0.00|WOUND CARE|
20|FH_F135572_89106_0|SrvcGrp|14945|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F135583_17331_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F97143_80012_0|SrvcGrp|73603|2022|PDM|6538.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F91735_92653_0|SrvcGrp|82223|2022|PDM|94.50|99|0.00|HOSPICE CARE|
20|FH_F135907_74501_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135972_18509_0|SrvcGrp|76501|2022|PDM|302.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F136183_72756_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F119892_47586_0|SrvcGrp|94780|2022|PDM|100.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F100765_73735_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F116461_77536_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F116468_49660_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F121731_20164_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|OP SVCS|
20|FH_F131407_07607_0|SrvcGrp|24744|2022|PDM|55.00|99|0.00|PICC LINE INSERTION|
20|FH_F132097_66845_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101182_07863_0|SrvcGrp|91294|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F117486_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33081_0_0|SrvcGrp|9511|2022|PDM|2800.00|99|0.00|OBSERVATION SVCS|
20|FH_F43137_0_0|SrvcGrp|28068|2022|PDM|50.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F132328_0_0|SrvcGrp|93057|2022|PDM|5202.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F118651_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F112086_33713_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126853_19053_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F96960_35404_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
20|FH_F101320_26062_0|SrvcGrp|92518|2022|PDM|117.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F77462_0_0|SrvcGrp|24740|2022|PDM|610.00|99|0.00|HOSPICE CARE|
20|FH_F132212_0_0|SrvcGrp|90707|2022|PDM|90.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F132544_0_0|SrvcGrp|16669|2022|PDM|3523.00|99|0.00|ACROMINOPLASTY OF SHOULDER|
20|FH_F148359_60191_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F71323_68114_0|SrvcGrp|21290|2022|PDM|2795.00|99|0.00|MS DRG 202 ONLY|
20|FH_F121009_76180_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125009_17042_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|78960|2022|PDM|2259.90|99|0.00|MON VALLEY ASC 5|
20|FH_F118672_29036_0|SrvcGrp|114012|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F56793_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|BARTON COUNTY IV SERVICES MOD SJ|
20|FH_F151144_35801_0|CSTM-ALL|CSTM-00|2020|PDM|765.00|99|0.00|AEG 3 (NO REV)|
20|FH_F121404_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88639_80204_0|SrvcGrp|90356|2022|PCT|1.70|99|0.00|OP DIALYSIS|
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F132810_0_0|SrvcGrp|86832|2022|PDM|8.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F58856_0_0|SrvcGrp|21106|2022|PDM|19500.00|99|0.00|MS DRG 250 ONLY|
20|FH_F67300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F136372_19046_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F136542_02446_0|SrvcGrp|17698|2022|PDM|1104.00|99|0.00|ACUTE PSYCH (>=18 YRS)|
20|FH_F120444_84037_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134150_01801_0|SrvcGrp|109653|2022|PDM|345.00|99|0.00|PARTIAL HOSPITALIZATION >=18|
20|FH_F134151_17509_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137147_75006_0|SrvcGrp|73803|2022|PDM|34387.00|99|0.00|MSDRG 619 ONLY|
20|FH_F137147_75006_0|CSTM-ALL|CSTM-00|2020|PDM|2625.00|99|0.00|AEG 1 (NO REV)|
20|FH_F137242_52722_0|SrvcGrp|89149|2022|PDM|218.00|99|0.00|OP INTENSIVE|
20|FH_F114092_83350_0|CSTM-ALL|CSTM-00|2020|PDM|7205.00|99|0.00|AEG 2 W/O IMPLANTED CARDIAC ELECTRODE (NO REV)|
20|FH_F142320_07747_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F142400_75090_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142430_38863_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142210_61356_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F125053_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F140343_89052_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F80754_31601_0|SrvcGrp|73542|2022|PDM|605.00|99|0.00|AETNA MRI/MRA|
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|85778|2022|PDM|3850.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F149663_45219_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151605_78209_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38000_0_0|SrvcGrp|62597|2022|PDM|760.00|99|0.00|HCPCS L0637|
20|FH_F92634_08244_0|SrvcGrp|82137|2022|PCT|0.70|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F109884_36117_0|SrvcGrp|87317|2022|PDM|637.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F66835_0_0|SrvcGrp|3178|2022|PDM|630.00|99|0.00|ACUTE PSYCH|
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|455.00|99|0.00|AEG 1 (NO REV)|
20|FH_F129477_70403_0|SrvcGrp|48394|2022|PDM|34.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F129483_77030_0|SrvcGrp|29077|2022|PDM|25.00|99|0.00|HOME TRANSFUSION|
20|FH_F129511_44044_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F117221_23434_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|791.00|99|0.00|AEG 10 (NO REV)|
20|FH_F137850_32826_0|SrvcGrp|73842|2022|PDM|211.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F91472_96001_0|SrvcGrp|88977|2022|PDM|6287.00|99|0.00|C-SECTION DELIVERY|
20|FH_F130676_0_0|SrvcGrp|87537|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F143450_0_0|SrvcGrp|114024|2022|PDM|706.00|99|0.00|ENDOSCOPIC US EXAM ESOPH|
20|FH_F47575_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|OP SVCS|
20|FH_F56274_0_0|SrvcGrp|27968|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F95880_02726_0|SrvcGrp|94742|2022|PDM|56.65|99|0.00|FLUVIRIN VACC IM (>=3 YRS)|
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F65761_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91873_12723_0|SrvcGrp|89025|2022|PCT|0.68|99|0.00|DIAGNOSTIC RADIOPHARMACEUTICALS|
20|FH_F106822_0_0|SrvcGrp|100276|2022|PDM|121.00|99|0.00|MCV4 MENACWY VACCINE IM|
20|FH_F117399_0_0|SrvcGrp|103551|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F71863_0_0|SrvcGrp|17140|2022|PDM|154.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F88456_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F114916_30309_0|SrvcGrp|100919|2022|PDM|2100.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F142427_36607_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F115208_0_0|SrvcGrp|70062|2022|PDM|2652.00|99|0.00|THYROIDECTOMY|
20|FH_F138929_0_0|SrvcGrp|92366|2022|PDM|4400.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PDM|1210.00|99|0.00|AEG 10 (NO REV)|
20|FH_F143898_0_0|SrvcGrp|110638|2022|PDM|665.00|99|0.00|HOSPICE GENERAL INPATIENT CARE|
20|FH_F131047_0_0|SrvcGrp|14187|2022|PCT|0.57|99|0.00|MRI|
20|FH_F132988_0_0|SrvcGrp|99171|2022|PDM|5849.23|99|0.00|CPT 28485|
20|FH_F132988_0_0|SrvcGrp|107845|2022|PDM|1279.81|99|0.00|REVISE FINGER/TOE NERVE|
20|FH_F133002_0_0|SrvcGrp|73002|2022|PDM|1267.00|99|0.00|AEG 7|
20|FH_F136832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137067_0_0|SrvcGrp|36591|2022|PDM|46200.00|99|0.00|CPT 63685|
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|4427.00|99|0.00|AEG 7 (NO REV)|
20|FH_F126345_0_0|SrvcGrp|27347|2022|PDM|3035.00|99|0.00|CPT 58558|
20|FH_F114389_50131_0|SrvcGrp|34566|2022|PDM|227.22|99|0.00|HOME INFUSION THERAPY|
20|FH_F141343_62047_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F124180_0_0|SrvcGrp|44461|2022|PDM|7132.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F49026_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F124059_64055_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F146896_78636_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100703_0_0|SrvcGrp|19991|2022|PDM|8034.00|99|0.00|NERVOUS SYSTEM SERVICES|
20|FH_F124225_92506_0|SrvcGrp|46903|2022|PDM|800.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F124227_01230_0|SrvcGrp|87282|2022|PCT|1.00|99|0.00|EPOETIN ALFA|
20|FH_F124611_64804_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F127995_84010_0|SrvcGrp|46104|2022|PDM|50.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F89273_0_0|SrvcGrp|88267|2022|PDM|595.00|99|0.00|CONNECTIVE TISSUE|
20|FH_F92599_0_0|SrvcGrp|75479|2022|PDM|479.00|99|0.00|AEG 1|
20|FH_F98042_10468_0|SrvcGrp|73601|2022|PDM|10516.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F136662_45345_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114666_30342_0|SrvcGrp|105657|2022|PDM|240.00|99|0.00|C-ARM AND LASER FLUOROSCOPY (HCFA)|
20|FH_F138284_98052_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138310_60461_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F139113_21804_0|SrvcGrp|87537|2022|PDM|469.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F122610_73139_0|SrvcGrp|72992|2022|PDM|4423.00|99|0.00|AEG 2|
20|FH_F134687_14226_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134727_30650_0|CSTM-ALL|CSTM-00|2020|PDM|1983.00|99|0.00|AEG 7 W/O CARDIAC CATH (NO REV)|
20|FH_F136796_24016_0|SrvcGrp|88491|2022|PDM|5396.49|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F136796_24016_0|SrvcGrp|83646|2022|PDM|2907.56|99|0.00|CPT 31276|
20|FH_F136830_22003_0|SrvcGrp|86723|2022|PDM|420.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F112189_81212_0|SrvcGrp|472|2022|PDM|433.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
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|96839|2022|PDM|12980.00|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F77234_0_0|SrvcGrp|17073|2022|PDM|2075.00|99|0.00|ASPG V|
20|FH_F116199_75042_0|SrvcGrp|72602|2022|PDM|796.00|99|0.00|ECT|
20|FH_F147311_37421_0|SrvcGrp|74668|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147331_90045_0|SrvcGrp|88620|2022|PDM|171.00|99|0.00|SKILLED NURSING RN|
20|FH_F147530_49441_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F41695_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100783_03431_0|SrvcGrp|73605|2022|PDM|4035.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|3575.00|99|0.00|AEG 8 (NO REV)|
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 7 (NO REV)|
20|FH_F140873_0_0|SrvcGrp|104229|2022|PDM|152.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F106980_0_0|SrvcGrp|72992|2022|PDM|725.00|99|0.00|AEG 2|
20|FH_F109279_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111829_32257_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134822_06513_0|SrvcGrp|472|2022|PDM|405.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|1730.30|99|0.00|AEG 7 (NO REV)|
20|FH_F36541_0_0|SrvcGrp|9978|2022|PDM|1800.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS|
20|FH_F68322_0_0|SrvcGrp|17077|2022|PDM|1750.00|99|0.00|ASPG VII|
20|FH_F38183_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS|
20|FH_F151399_0_0|SrvcGrp|113574|2022|PDM|13066.00|99|0.00|AMBULANCE AIR TRANSPORT (HCFA)|
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1376.11|99|0.00|2005 ASPG GROUPER VII|
20|FH_F49832_0_0|SrvcGrp|24029|2022|PDM|45.00|99|0.00|RN HOURLY|
20|FH_F54552_0_0|SrvcGrp|10578|2022|PDM|40.00|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F138870_45176_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138876_25302_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138936_01040_0|SrvcGrp|73498|2022|PDM|824.00|99|0.00|AETNA ER LEVEL III|
20|FH_F138992_72703_0|SrvcGrp|113083|2022|PDM|800.00|99|0.00|CT SCAN|
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1456.56|99|0.00|DEVICE INSERTION|
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F88893_0_0|SrvcGrp|67989|2022|PDM|3630.00|99|0.00|CPT 49320|
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_F151503_30067_0|SrvcGrp|108095|2022|PDM|2090.00|99|0.00|PARTIAL REMOVAL FOOT FASCIA|
20|FH_F132248_44060_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F122027_61847_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F122140_66064_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145068_63084_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133119_46545_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F135440_32561_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F91764_93710_0|CSTM-ALL|CSTM-00|2020|PDM|7069.00|99|0.00|AEG 8  W/O CARDIAC CATH PROCEDURES (NO REV)|
20|FH_F135924_02906_0|SrvcGrp|112677|2022|PDM|144.00|99|0.00|COVID-19 SPEC COLL SNF/LAB|
20|FH_F136147_63901_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136183_72756_0|SrvcGrp|89337|2022|PDM|1000.00|99|0.00|DETOXIFICATION|
20|FH_F130557_66012_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116463_76501_0|SrvcGrp|73842|2022|PDM|192.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121420_06418_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F121761_44130_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F42939_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F111385_33308_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F134322_98001_0|SrvcGrp|112547|2022|PCT|1.00|99|0.00|PROCHLORPERAZINE INJECTION|
20|FH_F47906_0_0|SrvcGrp|43846|2022|PCT|1.00|99|0.00|DME MOD UEKF|
20|FH_F148243_0_0|SrvcGrp|99073|2022|PDM|1.28|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PDM|1363.00|99|0.00|AEG 2 (NO REV)|
20|FH_F40598_0_0|SrvcGrp|115|2022|PDM|450.00|99|0.00|SKILLED NURSING CARE|
20|FH_F72666_0_0|SrvcGrp|29|2022|PDM|5939.00|99|0.00|ELECTROPHYSIOLOGY|
20|FH_F112135_80910_0|SrvcGrp|104650|2022|PDM|67.06|99|0.00|AETNA OUTPATIENT CLINIC SERVICES|
20|FH_F87500_16823_0|SrvcGrp|48385|2022|PDM|104.00|99|0.00|SPEECH THERAPY|
20|FH_F102222_19720_0|SrvcGrp|86830|2022|PDM|31.50|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F102960_50613_0|CSTM-ALL|CSTM-00|2020|PDM|6835.00|99|0.00|AEG 7 (NO REV)|
20|FH_F101320_26062_0|SrvcGrp|16750|2022|PDM|126.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F148100_22406_0|SrvcGrp|29347|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F148061_11223_0|SrvcGrp|23683|2022|PDM|42.00|99|0.00|SKILLED NURSING RN|
20|FH_F120930_0_0|SrvcGrp|26273|2022|PDM|2000.00|99|0.00|CPT 29880|
20|FH_F79102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F130468_0_0|SrvcGrp|99161|2022|PDM|11776.00|99|0.00|CPT 27138|
20|FH_F149263_0_0|SrvcGrp|115612|2022|PDM|5610.00|99|0.00|HIP ARTHRO W/ FEMOROPLASTY|
20|FH_F144808_0_0|SrvcGrp|67068|2022|PDM|7699.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F139747_06241_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134593_60007_0|SrvcGrp|47183|2022|PDM|60.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|343.87|99|0.00|HAPA WPA-NWPA 2012-13 ASC 122 W/O REV|
20|FH_F150308_48180_0|SrvcGrp|74668|2022|PDM|287.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129509_0_0|SrvcGrp|88493|2022|PDM|5139.00|99|0.00|AETNA VERTEBROPLASTY ADDL INJECT|
20|FH_F124369_0_0|SrvcGrp|107987|2022|PDM|5610.00|99|0.00|REMOVAL OF SESAMOID BONE|
20|FH_F85213_02840_0|SrvcGrp|79786|2022|PCT|1.03|99|0.00|SLEEP STUDIES|
20|FH_F148923_71854_0|SrvcGrp|90854|2022|PDM|745.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F148267_0_0|SrvcGrp|57968|2022|PDM|37.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F139658_02893_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|2921.00|99|0.00|AEG 10 (NO REV)|
20|FH_F119227_01752_0|SrvcGrp|43568|2022|PDM|65.00|99|0.00|SKILLED NURSING - RN|
20|FH_F87012_0_0|SrvcGrp|72992|2022|PDM|760.59|99|0.00|AEG 2|
20|FH_F42258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F110184_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION|
20|FH_F135670_01749_0|SrvcGrp|26868|2022|PDM|35.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PDM|368.50|99|0.00|AEG 1 (NO REV)|
20|FH_F120709_64116_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|278.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 312 W/O REV|
20|FH_F138286_50014_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F110245_46016_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F126043_30339_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F145629_45243_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120603_66112_0|SrvcGrp|75545|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F97861_62223_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F134593_60007_0|SrvcGrp|86846|2022|PDM|47.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F136207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133724_84041_0|SrvcGrp|30609|2022|PDM|615.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F126550_43085_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130763_0_0|SrvcGrp|26279|2022|PDM|3450.00|99|0.00|CPT 29884|
20|FH_F143650_0_0|SrvcGrp|109975|2022|PCT|0.00|99|0.00|TOTAL JOINT REPLACEMENTS|
20|FH_F51613_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AEG 10 (NO REV)|
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|2075.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.30|99|0.00|AEG 4 (NO REV)|
20|FH_F150166_91401_0|SrvcGrp|90854|2022|PDM|1265.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F126249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|GENERAL ACUTE CARE|
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|AEG 2 (NO REV)|
20|FH_F128833_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F120719_27540_0|SrvcGrp|113275|2022|PDM|100.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT|
20|FH_F145697_52302_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114851_15301_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F117206_0_0|SrvcGrp|27347|2022|PDM|810.00|99|0.00|CPT 58558|
20|FH_F50952_0_0|SrvcGrp|82137|2022|PCT|0.80|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F37877_0_0|CSTM-ALL|CSTM-00|2020|PDM|470.00|99|0.00|ASPG II|
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 6 (NO REV)|
20|FH_F110509_71351_0|SrvcGrp|80679|2022|PCT|1.40|99|0.00|AETNA RADIOLOGY|
20|FH_F149319_07670_0|SrvcGrp|115642|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 3 (NO REV)|
20|FH_F109400_80026_0|SrvcGrp|73742|2022|PCT|1.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F112082_30720_0|SrvcGrp|17014|2022|PDM|94.42|99|0.00|HOME INFUSION THERAPY|
20|FH_F114509_10010_0|SrvcGrp|58509|2022|PDM|225.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F40566_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138050_52301_0|SrvcGrp|89149|2022|PDM|225.00|99|0.00|OP INTENSIVE|
20|FH_F43865_0_0|SrvcGrp|37404|2022|PDM|90.00|99|0.00|PT SVCS|
20|FH_F139578_70433_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F109273_77339_0|SrvcGrp|73841|2022|PDM|428.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F127486_06776_0|SrvcGrp|48394|2022|PDM|69.91|99|0.00|SKILLED NURSING SERVICES|
20|FH_F128816_43537_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F146657_01105_0|SrvcGrp|114673|2022|PDM|116.93|99|0.00|MH HEALTH ASSESS BY NON-MD (MOD U2)|
20|FH_F136359_0_0|SrvcGrp|35668|2022|PDM|2795.00|99|0.00|CPT 29824|
20|FH_F133950_06029_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110562_33409_0|SrvcGrp|73842|2022|PDM|308.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F72262_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F122520_46383_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F122532_46385_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F122532_46385_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F84652_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|PCT|0.66|99|0.00|OP SVCS|
20|FH_F133847_21702_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F31714_0_0|SrvcGrp|2866|2022|PDM|38000.00|99|0.00|DRG 535 CARDIAC DEFIBRILLATOR IMPLANT W/CARD CATH W/AMI|
20|FH_F111882_51560_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36552_0_0|SrvcGrp|18205|2022|PDM|10410.00|99|0.00|MS DRG 264|
20|FH_F109577_0_0|SrvcGrp|103385|2022|PDM|123.00|99|0.00|MED NUTRITION, INDIV, INIT (HCFA)|
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_F85097_0_0|SrvcGrp|13297|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F44278_0_0|SrvcGrp|20801|2022|PCT|0.85|99|0.00|HOME HEALTH|
20|FH_F109387_35630_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114824_44484_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F150130_70359_0|CSTM-ALL|CSTM-00|2020|PCT|0.17|99|0.00|OP SVCS|
20|FH_F124369_0_0|SrvcGrp|109791|2022|PDM|17765.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F130763_0_0|SrvcGrp|54943|2022|PDM|4705.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F127598_43232_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F110509_71351_0|SrvcGrp|73806|2022|PDM|600.00|99|0.00|AETNA ER|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|2450.00|99|0.00|NORMAL DELIVERY|
20|FH_F111030_05641_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F149139_07522_0|SrvcGrp|113228|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 4 TRGT|
20|FH_F71445_0_0|SrvcGrp|68383|2022|PDM|35.00|99|0.00|HOME HEALTH AID|
20|FH_F88698_18951_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F127090_45601_0|SrvcGrp|48398|2022|PDM|92.25|99|0.00|PT SERVICES|
20|FH_F60112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTLIE|
20|FH_F133876_27405_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F85353_16407_0|SrvcGrp|63769|2022|PDM|1698.68|99|0.00|HAPA WPA-NWPA 2012-13 ASC 907|
20|FH_F144248_0_0|SrvcGrp|84934|2022|PDM|6885.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F146657_01105_0|SrvcGrp|114660|2022|PDM|35.53|99|0.00|EVAL/TREAT HANDICAP CHILDREN|
20|FH_F100782_0_0|SrvcGrp|105146|2022|PDM|829.59|99|0.00|WINDBER MEDICAL CNTR ASC 306|
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 8 (NO REV)|
20|FH_F100782_0_0|SrvcGrp|105095|2022|PDM|262.56|99|0.00|WINDBER MEDICAL CNTR ASC 140|
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|AEG 4 (NO REV)|
20|FH_F117206_0_0|SrvcGrp|35669|2022|PDM|1500.00|99|0.00|CPT 63650|
20|FH_F81698_10457_0|SrvcGrp|86837|2022|PDM|10.50|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F139299_0_0|SrvcGrp|86723|2022|PDM|435.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F145641_06902_0|SrvcGrp|92821|2022|PDM|5647.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR|
20|FH_F146620_0_0|CSTM-ALL|CSTM-00|2020|PCT|38.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F109244_19808_0|SrvcGrp|75419|2022|PDM|300.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F85212_71075_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F110237_94501_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F69647_0_0|SrvcGrp|17075|2022|PDM|1480.00|99|0.00|ASPG VI|
20|FH_F89335_64628_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F134249_05060_0|SrvcGrp|104467|2022|PDM|897.00|99|0.00|ANTEPARTUM CARE ONLY (4-6 VISITS)|
20|FH_F85353_16407_0|SrvcGrp|63803|2022|PDM|703.86|99|0.00|HAPA WPA-NWPA 2012-13 ASC 301|
20|FH_F137610_0_0|SrvcGrp|46903|2022|PDM|411.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PDM|20.00|99|0.00|HOME HEALTH AIDE MOD TF|
20|FH_F141248_0_0|SrvcGrp|3178|2022|PDM|927.00|99|0.00|ACUTE PSYCH|
20|FH_F97041_71603_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
20|FH_F142376_0_0|SrvcGrp|68742|2022|PDM|26208.00|99|0.00|CRANIAL DEVICE INSERTION/REPLACEMENT|
20|FH_F97840_54729_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F85132_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 8 (NO REV)|
20|FH_F128816_43537_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F54592_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|ANTIBIOTIC AEROSOLIZED THERAPY (MOD SH)|
20|FH_F84712_0_0|SrvcGrp|88142|2022|PDM|220.00|99|0.00|AETNA ULTRASOUND BREAST(S)|
20|FH_F84912_0_0|SrvcGrp|3406|2022|PDM|105.97|99|0.00|CPT 99214|
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 2 (NO REV)|
20|FH_F70684_0_0|SrvcGrp|42971|2022|PDM|105.45|99|0.00|SKN RN|
20|FH_F102142_80014_0|SrvcGrp|73700|2022|PDM|35.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F102200_06416_0|SrvcGrp|24747|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F105143_26062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F105145_75075_0|SrvcGrp|11673|2022|PDM|13483.00|99|0.00|CPT 29888|
20|FH_F63625_0_0|SrvcGrp|12343|2022|PCT|0.80|99|0.00|PET SCAN|
20|FH_F80513_0_0|SrvcGrp|20908|2022|PDM|17066.00|99|0.00|MS DRG 247 ONLY|
20|FH_F115979_46107_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F133707_73072_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133707_73072_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)|
20|FH_F133478_40165_0|SrvcGrp|112336|2022|PCT|0.54|99|0.00|DIGIT REPLANTATION|
20|FH_F134828_30531_0|SrvcGrp|113100|2022|PDM|15.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB (HCFA)|
20|FH_F32370_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F33389_0_0|SrvcGrp|13188|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.00|99|0.00|AEG 3 (NO REV)|
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_F117225_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F120630_33161_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F150939_0_0|SrvcGrp|100243|2022|PCT|0.00|99|0.00|CULTURE SCREEN|
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_F146212_57108_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118391_77040_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F38630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|100% 2007 MEDICARE DME TN  MOD TC|
20|FH_F150602_59718_0|SrvcGrp|95661|2022|PDM|153.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F146659_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F141807_33020_0|SrvcGrp|109036|2022|PDM|1032.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F62601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F148886_60621_0|SrvcGrp|73601|2022|PDM|2002.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F146061_24502_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132279_63775_0|SrvcGrp|110428|2022|PCT|1.45|99|0.00|LABORATORY SERVICES|
20|FH_F115330_34113_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F132080_0_0|SrvcGrp|97702|2022|PDM|169.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|119.64|99|0.00|HAPA WPA-NWPA 2012-13 ASC 140 W/O REV|
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|1407.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F62627_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SVCS|
20|FH_F141870_85224_0|SrvcGrp|86779|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F148556_13206_0|SrvcGrp|10579|2022|PDM|35.00|99|0.00|HYDRATION THERAPY - 2 LITERS|
20|FH_F33241_0_0|SrvcGrp|9774|2022|PDM|1400.00|99|0.00|INTENSIVE CARE UNIT|
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_F50974_0_0|CSTM-ALL|CSTM-00|2020|PDM|28.00|99|0.00|ANTIBIOTIC THERAPY Q4 (MOD SH)|
20|FH_F127994_19301_0|SrvcGrp|89149|2022|PDM|220.00|99|0.00|OP INTENSIVE|
20|FH_F50221_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|AEG 5  (NO REV)|
20|FH_F140472_0_0|SrvcGrp|15788|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F128703_68638_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125176_20785_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F143993_07621_0|SrvcGrp|114102|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F40286_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F117508_90232_0|SrvcGrp|106247|2022|PDM|1150.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F102681_34237_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F142081_54929_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88956_0_0|SrvcGrp|73501|2022|PCT|0.52|99|0.00|AETNA OBSERVATION|
20|FH_F42377_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F125266_44515_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67204_0_0|CSTM-ALL|CSTM-00|2020|PDM|5460.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.37|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F103540_24740_0|SrvcGrp|59291|2022|PDM|440.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F124839_71360_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121168_0_0|SrvcGrp|95661|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F42992_0_0|SrvcGrp|37018|2022|PDM|250.00|99|0.00|BOARDER BABY|
20|FH_F100661_63640_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F120437_85202_0|SrvcGrp|17015|2022|PDM|33.77|99|0.00|HOME INFUSION THERAPY|
20|FH_F62601_0_0|SrvcGrp|48399|2022|PDM|30.00|99|0.00|SPEECH THERAPY|
20|FH_F146320_27610_0|CSTM-ALL|CSTM-00|2020|PDM|795.60|99|0.00|AEG 10 (NO REV)|
20|FH_F143030_02895_0|SrvcGrp|75545|2022|PDM|250.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F141657_85715_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F116440_0_0|SrvcGrp|87536|2022|PDM|200.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F132571_24739_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F126930_0_0|SrvcGrp|109330|2022|PCT|0.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F51545_0_0|SrvcGrp|42826|2022|PDM|150.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F101104_0_0|SrvcGrp|86824|2022|PDM|175.00|99|0.00|CPT CODE 99601 (HCFA)|
20|FH_F136393_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F125256_77365_0|SrvcGrp|86723|2022|PDM|325.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F118550_21133_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148865_0_0|SrvcGrp|82223|2022|PDM|140.00|99|0.00|HOSPICE CARE|
20|FH_F81373_64064_0|SrvcGrp|3029|2022|PDM|1203.00|99|0.00|NEWBORN NURSERY|
20|FH_F120437_85202_0|SrvcGrp|22593|2022|PDM|76.51|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F118376_46052_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118542_60188_0|SrvcGrp|14947|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F132612_0_0|SrvcGrp|12280|2022|PCT|0.67|99|0.00|IMPLANTS|
20|FH_F126733_83713_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|MIDLINE INSERTION NURSING|
20|FH_F151520_44134_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41739_0_0|SrvcGrp|9561|2022|PCT|0.79|99|0.00|DRG 545 ONLY|
20|FH_F42340_0_0|SrvcGrp|17419|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PDM|2460.00|99|0.00|ASPG IX|
20|FH_F101840_76054_0|SrvcGrp|97480|2022|PDM|6260.00|99|0.00|BASAL/SINUS ENDOSCOPY|
20|FH_F133028_08021_0|SrvcGrp|91214|2022|PDM|35.64|99|0.00|MED NUTRITION|
20|FH_F89932_10940_0|SrvcGrp|72984|2022|PDM|700.00|99|0.00|CHEMOTHERAPY|
20|FH_F100788_01420_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F33241_0_0|SrvcGrp|10924|2022|PDM|3800.00|99|0.00|PTCA W/O STENT|
20|FH_F44992_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F150120_93619_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F104180_0_0|SrvcGrp|75545|2022|PDM|440.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F41785_0_0|SrvcGrp|16746|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F127504_22556_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131904_18915_0|SrvcGrp|100982|2022|PCT|1.00|99|0.00|AETNA OP SVCS HH AMFS DEFAULT|
20|FH_F139887_0_0|SrvcGrp|33982|2022|PDM|1848.00|99|0.00|CPT 28296|
20|FH_F133478_40165_0|SrvcGrp|26690|2022|PCT|0.56|99|0.00|MS DRG 215 ONLY|
20|FH_F133133_32433_0|CSTM-ALL|CSTM-00|2020|PDM|545.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F111580_77004_0|SrvcGrp|12837|2022|PCT|1.10|99|0.00|INTRAOCULAR LENSES|
20|FH_F111603_19529_0|SrvcGrp|86723|2022|PDM|330.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F56054_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|PROFESSIONAL FEES ON UB04|
20|FH_F108460_32746_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F76588_0_0|SrvcGrp|48645|2022|PDM|18.00|99|0.00|OP SKILLED NURSING|
20|FH_F146266_0_0|SrvcGrp|92364|2022|PDM|15038.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F50461_0_0|SrvcGrp|40962|2022|PCT|0.50|99|0.00|HIGH COST DRUGS|
20|FH_F130203_29601_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97084_91911_0|SrvcGrp|73559|2022|PDM|27939.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|CARECENTRIX AWP + 15%|
20|FH_F124420_33442_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125214_12428_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PDM|2040.00|99|0.00|ASPG 8 PIEDMONT OUTPATIENT SURGERY CENTER|
20|FH_F140289_52246_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F98900_42001_0|SrvcGrp|90854|2022|PDM|2335.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F38172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97260_06111_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140295_0_0|SrvcGrp|67072|2022|PDM|7501.00|99|0.00|CPT 22845|
20|FH_F110821_31513_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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_F122277_98045_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132039_92008_0|SrvcGrp|79280|2022|PDM|900.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|5913.00|99|0.00|AEG 10 (NO REV)|
20|FH_F131595_58103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147142_33870_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F101441_0_0|SrvcGrp|96355|2022|PDM|8105.00|99|0.00|SPINE FIXATION|
20|FH_F147237_40006_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F40490_0_0|SrvcGrp|12981|2022|PDM|3625.00|99|0.00|ICU|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F148939_62650_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149049_28401_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|AEG 2 (NO REV)|
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1077.00|99|0.00|AEG 5  (NO REV)|
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125214_12428_0|SrvcGrp|112321|2022|PDM|1016.00|99|0.00|CAT SCAN|
20|FH_F99142_80233_0|SrvcGrp|75545|2022|PDM|358.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F130661_04441_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 3 (NO REV)|
20|FH_F126732_0_0|SrvcGrp|87077|2022|PDM|135.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F147160_80260_0|SrvcGrp|52953|2022|PDM|150.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F136947_0_0|SrvcGrp|13681|2022|PDM|450.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F108180_29526_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134919_02155_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F99281_81147_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F149049_28401_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SAINT ALEXIUS FH MOD NU|
20|FH_F113524_0_0|SrvcGrp|105218|2022|PDM|12700.00|99|0.00|LUMBAR OR THORACIC SPINAL FUSION|
20|FH_F124325_37643_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|1400.00|99|0.00|AEG 9 (NO REV)|
20|FH_F134869_08854_0|SrvcGrp|102980|2022|PDM|125.00|99|0.00|PSYTX WPT W E/M 30 MIN|
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122394_75979_0|SrvcGrp|86722|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD UE|
20|FH_F101441_0_0|SrvcGrp|64761|2022|PDM|7946.00|99|0.00|DISCECTOMY|
20|FH_F150961_89169_0|SrvcGrp|88778|2022|PDM|81.00|99|0.00|PHYSICAL THERAPY|
20|FH_F137986_0_0|SrvcGrp|58634|2022|PDM|3000.00|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F90232_15126_0|SrvcGrp|10577|2022|PDM|47.25|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F144831_0_0|SrvcGrp|80920|2022|PDM|926.40|99|0.00|HOSPICE SERVICES|
20|FH_F150922_02452_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|374.00|99|0.00|AEG 2 (NO REV)|
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138018_17313_0|SrvcGrp|17003|2022|PDM|208.00|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS|
20|FH_F122386_70578_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150982_0_0|SrvcGrp|115931|2022|PDM|1382.00|99|0.00|PALM CONTRACTURE RELEASE|
20|FH_F146266_0_0|SrvcGrp|104007|2022|PDM|5794.00|99|0.00|ENDOSCOPIC DCMPR 1|
20|FH_F139877_32615_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F108180_29526_0|SrvcGrp|89337|2022|PDM|998.00|99|0.00|DETOXIFICATION|
20|FH_F108460_32746_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F137731_92262_0|SrvcGrp|46903|2022|PDM|650.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F91978_34471_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F98860_96706_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F124318_29020_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|37.00|99|0.00|AMBULANCE WAITING TIME|
20|FH_F150939_0_0|SrvcGrp|82757|2022|PDM|4.00|99|0.00|ASSAY BLOOD CREATININE|
20|FH_F113585_20155_0|SrvcGrp|86841|2022|PDM|125.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F138687_77477_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138992_72703_0|SrvcGrp|113462|2022|PDM|1444.00|99|0.00|LITHOTRIPSY ESWL|
20|FH_F83792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F89580_0_0|SrvcGrp|88477|2022|PCT|0.47|99|0.00|IP HIGH COST DRUGS|
20|FH_F119888_0_0|SrvcGrp|13683|2022|PDM|605.83|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
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|CSTM-ALL|CSTM-00|2020|PDM|699.00|99|0.00|AEG 1 (NO REV)|
20|FH_F148601_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.32|99|0.00|HSS ASC|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|786.94|99|0.00|HAPA WPA-NWPA 2012-13 ASC 401 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|128.40|99|0.00|HAPA WPA-NWPA 2012-13 ASC 138 W/O REV|
20|FH_F84139_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151285_72956_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151441_98664_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132163_17601_0|SrvcGrp|108484|2022|PDM|1103.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F122035_84020_0|SrvcGrp|108484|2022|PDM|711.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F133608_33602_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91764_93710_0|SrvcGrp|113234|2022|PCT|2.19|99|0.00|COVID-19 SARSCOV2 & INF A&B AMP PRB|
20|FH_F135772_61364_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135775_60614_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135930_02879_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119886_25504_0|SrvcGrp|48398|2022|PDM|130.00|99|0.00|PT SERVICES|
20|FH_F130996_34110_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F131132_44077_0|SrvcGrp|105465|2022|PCT|0.59|99|0.00|AETNA THERAPIES|
20|FH_F116397_33404_0|SrvcGrp|17013|2022|PDM|43.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F127399_0_0|CSTM-ALL|CSTM-00|2020|PDM|3537.00|99|0.00|LAP INC HERN RECUR COMP|
20|FH_F101665_10027_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F121704_90405_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F121763_07202_0|SrvcGrp|109218|2022|PDM|47.00|99|0.00|PSYCH/NEUROPSYCH TEST EACH ADD'L 30 MINUTES|
20|FH_F42098_0_0|SrvcGrp|26694|2022|PDM|60.00|99|0.00|INITIAL SPECIALTY NURSING S9123 MOD TG|
20|FH_F101182_07863_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F111292_33136_0|SrvcGrp|81403|2022|PDM|151.00|99|0.00|COMPREHEN METABOLIC PANEL|
20|FH_F111363_33169_0|SrvcGrp|82746|2022|PDM|106.00|99|0.00|CULT BACT BLD AEROIC ISOLA|
20|FH_F134315_89106_0|SrvcGrp|10577|2022|PCT|1.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F132720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F36344_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F132328_0_0|SrvcGrp|26274|2022|PDM|2195.00|99|0.00|CPT 29877|
20|FH_F132328_0_0|SrvcGrp|59840|2022|PDM|1717.00|99|0.00|TYMPANOSTOMY|
20|FH_F143542_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F143542_0_0|SrvcGrp|45583|2022|PDM|9754.00|99|0.00|CPT 65730|
20|FH_F134202_0_0|SrvcGrp|63466|2022|PDM|842.10|99|0.00|CPT 52005|
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 5  (NO REV)|
20|FH_F151282_46402_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F116809_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F37823_0_0|SrvcGrp|9522|2022|PCT|0.80|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F151500_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F110000_0_0|SrvcGrp|33829|2022|PDM|2424.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 7|
20|FH_F91818_02828_0|SrvcGrp|73841|2022|PDM|288.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F34463_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73231_0_0|SrvcGrp|46642|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- ALL|
20|FH_F86911_0_0|SrvcGrp|43265|2022|PDM|90.00|99|0.00|MID-LINE INSERTION|
20|FH_F88456_0_0|SrvcGrp|77444|2022|PDM|1280.00|99|0.00|VASECTOMY|
20|FH_F142448_15701_0|SrvcGrp|26868|2022|PDM|35.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F115045_0_0|SrvcGrp|55677|2022|PDM|3500.00|99|0.00|VAGINAL DELIVERY ONLY|
20|FH_F103780_64804_0|CSTM-ALL|CSTM-00|2020|PDM|2651.00|99|0.00|AEG 9 (NO REV)|
20|FH_F138929_0_0|SrvcGrp|88159|2022|PDM|6600.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F132988_0_0|SrvcGrp|107095|2022|PDM|1766.05|99|0.00|COMPLEX  WOUND DRAINAGE|
20|FH_F128027_0_0|SrvcGrp|64718|2022|PDM|1190.00|99|0.00|CPT 45384|
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|1855.00|99|0.00|AEG 1 (NO REV)|
20|FH_F141050_46410_0|SrvcGrp|73700|2022|PDM|41.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F141053_17201_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F49487_0_0|SrvcGrp|24934|2022|PDM|120.00|99|0.00|NUTRITIONAL ASSESSMENT (INITIAL)|
20|FH_F50163_0_0|SrvcGrp|109|2022|PDM|600.00|99|0.00|CD - DETOX|
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ASPG V|
20|FH_F124180_0_0|SrvcGrp|45863|2022|PDM|3500.00|99|0.00|CPT 65730|
20|FH_F124082_78526_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F66411_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F39066_0_0|SrvcGrp|1306|2022|PDM|200.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F132864_71101_0|SrvcGrp|13881|2022|PCT|0.65|99|0.00|PACEMAKER DEVICE|
20|FH_F124613_64735_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F127995_84010_0|SrvcGrp|86835|2022|PDM|10.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F131656_51401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F87856_0_0|SrvcGrp|84184|2022|PDM|1693.00|99|0.00|AETNA REMOVAL OF BREAST IMPLANT|
20|FH_F90653_0_0|SrvcGrp|25697|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F132890_87544_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F114629_19131_0|SrvcGrp|94880|2022|PDM|155.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F150322_68301_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F101640_32218_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F139907_42266_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F75803_0_0|SrvcGrp|63|2022|PDM|591.00|99|0.00|SUBACUTE CARE|
20|FH_F123185_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F125249_0_0|SrvcGrp|67065|2022|PDM|11000.00|99|0.00|CERVICAL SURGERY|
20|FH_F131107_43140_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F47952_0_0|SrvcGrp|42974|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F132373_47130_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112711_80909_0|SrvcGrp|472|2022|PDM|433.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F71585_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F116835_94538_0|SrvcGrp|114319|2022|PDM|2028.00|99|0.00|PSYCH EATING DISORDERS (12-17 YRS)|
20|FH_F120974_27607_0|CSTM-ALL|CSTM-00|2020|PDM|5876.00|99|0.00|AEG 3 (NO REV)|
20|FH_F39272_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F141861_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1034.00|99|0.00|AEG 6 (NO REV)|
20|FH_F59732_0_0|SrvcGrp|50163|2022|PDM|67.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 8 HRS|
20|FH_F129354_19152_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PDM|2019.00|99|0.00|ASPG IX F/S - BDSS|
20|FH_F148255_72703_0|SrvcGrp|21920|2022|PDM|31.50|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F135236_02840_0|SrvcGrp|112677|2022|PDM|144.00|99|0.00|COVID-19 SPEC COLL SNF/LAB|
20|FH_F33712_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|1900.00|99|0.00|ASPG IV|
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|5518.00|99|0.00|AEG 9 (NO REV)|
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|AEG 5  (NO REV)|
20|FH_F66409_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F149866_07401_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|AEG 1 (NO REV)|
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|2292.00|99|0.00|AEG 4 (NO REV)|
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F82714_18848_0|SrvcGrp|111926|2022|PDM|39.51|99|0.00|COVID-19 LAB TESTING|
20|FH_F129011_15857_0|SrvcGrp|23683|2022|PDM|130.00|99|0.00|SKILLED NURSING RN|
20|FH_F110925_01104_0|SrvcGrp|43569|2022|PDM|94.56|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F68160_0_0|SrvcGrp|10503|2022|PDM|47.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F91891_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F151400_0_0|SrvcGrp|93740|2022|PDM|2205.00|99|0.00|REVISE/REMOVE NEURO RECEIVER|
20|FH_F148263_30830_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F37679_0_0|SrvcGrp|26869|2022|PDM|61.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F60812_0_0|SrvcGrp|10533|2022|PCT|0.75|99|0.00|SUBACUTE ANTEPARTUM SVCS|
20|FH_F72766_0_0|SrvcGrp|32703|2022|PDM|1900.00|99|0.00|ICU|
20|FH_F71686_0_0|SrvcGrp|20801|2022|PCT|0.85|99|0.00|HOME HEALTH|
20|FH_F47733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90872_0_0|SrvcGrp|106655|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F141410_13045_0|SrvcGrp|75506|2022|PCT|0.87|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F120294_46322_0|SrvcGrp|27968|2022|PDM|38.00|99|0.00|SKILLED NURSING LPN|
20|FH_F145758_20745_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F86752_0_0|SrvcGrp|75497|2022|PDM|821.00|99|0.00|AEG 10|
20|FH_F143888_32205_0|SrvcGrp|114113|2022|PDM|25.46|99|0.00|COVID-19 SPECIMEN COLLECT|
20|FH_F135016_37203_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F90362_0_0|SrvcGrp|89944|2022|PDM|2380.00|99|0.00|NEUROSTIMULATOR PERMANENT|
20|FH_F41519_0_0|SrvcGrp|3029|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F39850_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97500_32025_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F123384_72076_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F139580_0_0|SrvcGrp|113580|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F125249_0_0|SrvcGrp|107361|2022|PDM|4000.00|99|0.00|SECOND LEVEL CER DISKECTOMY|
20|FH_F147941_06023_0|SrvcGrp|74604|2022|PDM|491.00|99|0.00|AETNA INITIAL PSYCH EVALUATION CPT 90792|
20|FH_F89779_0_0|SrvcGrp|88158|2022|PDM|12500.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F32906_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123512_64089_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143528_0_0|SrvcGrp|36591|2022|PDM|8400.00|99|0.00|CPT 63685|
20|FH_F41776_0_0|SrvcGrp|22966|2022|PDM|23153.00|99|0.00|GAMMA KNIFE|
20|FH_F128878_11203_0|SrvcGrp|86869|2022|PDM|79.50|99|0.00|AETNA PSYTX PT & FAM W / E&M 30 MINS (MOD TD)|
20|FH_F135005_06460_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F123512_64089_0|SrvcGrp|471|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|ACUTE PSYCH|
20|FH_F131948_23226_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132779_0_0|SrvcGrp|89813|2022|PDM|14783.00|99|0.00|MS DRG 498 ONLY|
20|FH_F130503_98102_0|SrvcGrp|111499|2022|PDM|1600.00|99|0.00|MOLECULAR PATHOLOGY|
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|ASPG X|
20|FH_F72664_0_0|SrvcGrp|68384|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY|
20|FH_F129547_35476_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149886_68112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147941_06023_0|SrvcGrp|79786|2022|PCT|6.57|99|0.00|SLEEP STUDIES|
20|FH_F38297_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38473_0_0|SrvcGrp|22387|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F148255_72703_0|SrvcGrp|86779|2022|PDM|47.25|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F128363_60062_0|SrvcGrp|89149|2022|PDM|248.00|99|0.00|OP INTENSIVE|
20|FH_F138327_39402_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139556_85006_0|SrvcGrp|93607|2022|PCT|1.89|99|0.00|HOME SLEEP TEST TYPE IV|
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|2952.00|99|0.00|AEG 9 (NO REV)|
20|FH_F137447_0_0|SrvcGrp|106314|2022|PDM|698.10|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F122608_84123_0|SrvcGrp|27969|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F42906_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F43172_0_0|SrvcGrp|16|2022|PDM|1500.00|99|0.00|ACUTE REHABILITATION|
20|FH_F43859_0_0|SrvcGrp|37406|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F117085_40207_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134687_14226_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F134697_32566_0|SrvcGrp|90854|2022|PDM|928.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F135748_60455_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
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_F62922_0_0|SrvcGrp|3934|2022|PDM|174.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS|
20|FH_F115206_80923_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F115210_21043_0|SrvcGrp|86424|2022|PDM|1485.00|99|0.00|REMOVE INT/EXT HEM 1 GROUP|
20|FH_F115608_24171_0|SrvcGrp|80246|2022|PCT|0.00|99|0.00|AETNA NURSERY|
20|FH_F115723_78363_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147319_32763_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147519_52627_0|SrvcGrp|92958|2022|PCT|0.89|99|0.00|SLEEP STUDIES|
20|FH_F147586_44124_0|SrvcGrp|107099|2022|PDM|1331.00|99|0.00|TREATMENT OF NOSE FRACTURE|
20|FH_F41801_0_0|SrvcGrp|109|2022|PDM|555.00|99|0.00|CD - DETOX|
20|FH_F139128_49503_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F139347_06471_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F139447_40336_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139553_30084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150764_33919_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F150882_84041_0|SrvcGrp|86779|2022|PDM|114.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F90817_0_0|SrvcGrp|91041|2022|PDM|1607.00|99|0.00|WRIST ENDOSCOPY/SURGERY (HCFA)|
20|FH_F37338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92300_37303_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F101083_0_0|SrvcGrp|72996|2022|PDM|998.00|99|0.00|AEG 4|
20|FH_F128743_57252_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F36170_0_0|SrvcGrp|4109|2022|PDM|618.00|99|0.00|ACUTE PSYCH|
20|FH_F117762_0_0|SrvcGrp|89404|2022|PDM|14560.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F41161_0_0|SrvcGrp|34206|2022|PDM|658.00|99|0.00|ELECTROCONVULSIVE THERAPY|
20|FH_F134936_01020_0|SrvcGrp|66264|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F78023_0_0|SrvcGrp|30094|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY|
20|FH_F39082_0_0|SrvcGrp|3493|2022|PCT|0.65|99|0.00|PHARMACY SVCS|
20|FH_F47836_0_0|SrvcGrp|44322|2022|PDM|1450.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122371_83276_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|GENERAL ACUTE CARE|
20|FH_F38475_0_0|SrvcGrp|10545|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F150999_20678_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90455_0_0|SrvcGrp|48385|2022|PDM|152.00|99|0.00|SPEECH THERAPY|
20|FH_F125656_92868_0|SrvcGrp|14944|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F147223_49444_0|SrvcGrp|108622|2022|PDM|453.00|99|0.00|SUB ACUTE CARE LEVEL II|
20|FH_F150947_37660_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151009_07649_0|SrvcGrp|114012|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F40564_0_0|SrvcGrp|30941|2022|PDM|400.00|99|0.00|NEWBORN NURSERY|
20|FH_F39443_0_0|SrvcGrp|30359|2022|PDM|503.00|99|0.00|HAPA WPA ASC 404|
20|FH_F91772_0_0|SrvcGrp|82138|2022|PDM|480.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F38999_0_0|CSTM-ALL|CSTM-00|2020|PDM|2484.00|99|0.00|NICU LEVEL V|
20|FH_F141287_14830_0|SrvcGrp|113739|2022|PCT|2.04|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F124698_45380_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150999_20678_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98880_50158_0|SrvcGrp|73659|2022|PDM|7608.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F84532_0_0|SrvcGrp|72992|2022|PDM|1240.00|99|0.00|AEG 2|
20|FH_F35384_0_0|SrvcGrp|8968|2022|PDM|1830.00|99|0.00|NICU LEVEL III & IV|
20|FH_F114188_15205_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F32666_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|FIRST HEALTH OF CAROL LAB|
20|FH_F150322_68301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F35557_0_0|SrvcGrp|10648|2022|PDM|2.00|99|0.00|HOME INFUSION|
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F110969_63084_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124334_68022_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128197_84123_0|SrvcGrp|95660|2022|PDM|112.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F145543_0_0|SrvcGrp|54084|2022|PDM|1339.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F132944_06480_0|SrvcGrp|471|2022|PDM|575.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F128375_03909_0|CSTM-ALL|CSTM-00|2020|PDM|651.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F112306_81428_0|SrvcGrp|471|2022|PDM|557.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117603_92210_0|SrvcGrp|74614|2022|PDM|550.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|545.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F116806_0_0|SrvcGrp|107088|2022|PDM|1149.97|99|0.00|JAW ARTHROSCOPY/TMJ SURG|
20|FH_F149459_06615_0|SrvcGrp|23683|2022|PDM|42.00|99|0.00|SKILLED NURSING RN|
20|FH_F93880_95476_0|SrvcGrp|73461|2022|PDM|3167.00|99|0.00|AETNA NICU IV|
20|FH_F59093_0_0|SrvcGrp|42974|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F110925_01104_0|SrvcGrp|46605|2022|PDM|94.56|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F149523_0_0|SrvcGrp|114176|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES|
20|FH_F141802_17042_0|SrvcGrp|112225|2022|PDM|23.00|99|0.00|COVID-19 SPECIMEN COLLECTION|
20|FH_F149888_68506_0|SrvcGrp|103538|2022|PDM|5252.00|99|0.00|ARTHROSCOPY HIP W/ FEMOROPLASTY|
20|FH_F39279_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F148221_06477_0|SrvcGrp|23683|2022|PDM|58.00|99|0.00|SKILLED NURSING RN|
20|FH_F139515_0_0|SrvcGrp|107361|2022|PDM|14420.00|99|0.00|SECOND LEVEL CER DISKECTOMY|
20|FH_F48192_0_0|SrvcGrp|474|2022|PDM|295.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|951.00|99|0.00|AEG 5  (NO REV)|
20|FH_F82931_18847_0|SrvcGrp|13595|2022|PDM|369.47|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F82114_0_0|SrvcGrp|75326|2022|PDM|86.06|99|0.00|SLEEP STUDY CPT 95801|
20|FH_F130497_33321_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150982_0_0|SrvcGrp|80617|2022|PDM|15689.00|99|0.00|ARTHOPLASTY|
20|FH_F115737_78660_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F128371_40207_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150840_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54974_0_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123331_45373_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F83257_32404_0|SrvcGrp|471|2022|PDM|446.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F122642_72212_0|SrvcGrp|73339|2022|PCT|0.90|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122725_32216_0|CSTM-ALL|CSTM-00|2020|PDM|23.29|99|0.00|INTERVENE HLTH/BEHAVE INDIV|
20|FH_F86872_15215_0|SrvcGrp|13929|2022|PCT|1.00|99|0.00|GROWTH HORMONE|
20|FH_F57073_0_0|SrvcGrp|997|2022|PCT|0.75|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F86851_0_0|SrvcGrp|84998|2022|PDM|598.00|99|0.00|CPT 45338|
20|FH_F66101_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F119447_64081_0|SrvcGrp|73842|2022|PDM|188.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119449_84032_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F148419_01453_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F148552_68114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148554_85016_0|SrvcGrp|115449|2022|PDM|2861.00|99|0.00|REMOVE & REPLACE PM GEN DUAL LEAD|
20|FH_F41845_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F56793_0_0|SrvcGrp|29463|2022|PDM|25.00|99|0.00|HOSPICE PAIN MANAGEMENT KIT|
20|FH_F92677_08003_0|SrvcGrp|13929|2022|PDM|15.75|99|0.00|GROWTH HORMONE|
20|FH_F137240_0_0|SrvcGrp|3944|2022|PDM|8227.00|99|0.00|CORONARY CARE UNIT|
20|FH_F47679_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142752_19428_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F126815_02118_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F120763_60957_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124928_04210_0|SrvcGrp|80918|2022|PDM|149.67|99|0.00|RESPITE CARE|
20|FH_F111540_16823_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F142078_73110_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113324_17055_0|SrvcGrp|105193|2022|PCT|1.00|99|0.00|MULTIPLE INJECTIONS|
20|FH_F126733_83713_0|SrvcGrp|108484|2022|PDM|414.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F140472_0_0|SrvcGrp|16|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION|
20|FH_F148060_01001_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37567_0_0|CSTM-ALL|CSTM-00|2020|PDM|1710.00|99|0.00|ASPG VIII|
20|FH_F37567_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|ASPG IX|
20|FH_F44025_0_0|CSTM-ALL|CSTM-00|2020|PDM|639.00|99|0.00|CD RESIDENTIAL TREATMENT|
20|FH_F97565_83301_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS|
20|FH_F141870_85224_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F66480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34706_0_0|SrvcGrp|11186|2022|PDM|45380.00|99|0.00|DRG 549 CORONARY BYPASS W/O CC W/MAJOR CV DX|
20|FH_F87155_04105_0|SrvcGrp|65621|2022|PDM|49.91|99|0.00|RN NURSING|
20|FH_F132992_04662_0|SrvcGrp|48396|2022|PDM|89.00|99|0.00|OT SERVICES|
20|FH_F133493_90255_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 1 (NO REV)|
20|FH_F124608_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F87615_80033_0|SrvcGrp|109330|2022|PCT|1.09|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F41166_0_0|SrvcGrp|115|2022|PDM|350.00|99|0.00|SKILLED NURSING CARE|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL|
20|FH_F44048_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F108700_63857_0|SrvcGrp|80317|2022|PDM|149.32|99|0.00|RESPITE CARE|
20|FH_F128127_57028_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F106243_92780_0|SrvcGrp|22528|2022|PCT|0.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F130615_95350_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F32987_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F42340_0_0|SrvcGrp|16746|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F128485_44667_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141648_60050_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144048_91324_0|SrvcGrp|73605|2022|PDM|2835.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F132420_84660_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117733_91362_0|SrvcGrp|73700|2022|PDM|55.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F144728_33541_0|SrvcGrp|14494|2022|PDM|1211.02|99|0.00|CONTINUOUS HOMECARE|
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126735_38018_0|SrvcGrp|75442|2022|PDM|625.00|99|0.00|OBSERVATION - REV 762|
20|FH_F92676_15063_0|SrvcGrp|78932|2022|PDM|3907.73|99|0.00|MON VALLEY ASC 1403|
20|FH_F36409_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F128130_10027_0|CSTM-ALL|CSTM-00|2020|PDM|4312.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118704_0_0|SrvcGrp|107746|2022|PCT|0.80|99|0.00|PARSABIV|
20|FH_F134490_62801_0|CSTM-ALL|CSTM-00|2020|PDM|668.00|99|0.00|AEG 1 (NO REV)|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1393.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F146159_89102_0|SrvcGrp|29347|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F137240_0_0|SrvcGrp|359|2022|PDM|1302.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F111401_29425_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F117555_72802_0|SrvcGrp|73841|2022|PDM|401.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F118496_92627_0|SrvcGrp|86746|2022|PCT|1.20|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F134490_62801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97581_60141_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|GENERAL ACUTE CARE|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|COVENTRY ENHANCED GROUPER 3 MOD 50|
20|FH_F146108_66762_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F39723_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (HCFA)|
20|FH_F142807_67114_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F63417_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F45436_0_0|SrvcGrp|13703|2022|PDM|35.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F103360_68845_0|SrvcGrp|98243|2022|PDM|9134.00|99|0.00|REMOVE SPINE FIXATION|
20|FH_F40056_0_0|SrvcGrp|30060|2022|PDM|5400.00|99|0.00|NORMAL DELIVERY|
20|FH_F91198_46714_0|SrvcGrp|3178|2022|PDM|800.00|99|0.00|ACUTE PSYCH|
20|FH_F115431_32821_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F36450_0_0|SrvcGrp|23854|2022|PDM|6225.00|99|0.00|LITHOTRIPSY|
20|FH_F145988_06105_0|SrvcGrp|111931|2022|PCT|1.47|99|0.00|COVID-19 CDC TESTING LAB|
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1021.00|99|0.00|AEG 7 (NO REV)|
20|FH_F126815_02118_0|SrvcGrp|83141|2022|PCT|0.55|99|0.00|AETNA SLEEP STUDIES|
20|FH_F133021_00910_0|SrvcGrp|112294|2022|PDM|16000.00|99|0.00|ELECTROPHYSIOLOGIC|
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|2744.00|99|0.00|AEG 9 (NO REV)|
20|FH_F117550_0_0|SrvcGrp|88857|2022|PDM|28.00|99|0.00|THERAPEUTIC ACTIVITIES|
20|FH_F44042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F97140_91730_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F151223_73077_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F121999_67002_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F122013_75503_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113588_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128378_0_0|SrvcGrp|80918|2022|PDM|175.00|99|0.00|RESPITE CARE|
20|FH_F32995_0_0|SrvcGrp|10924|2022|PDM|4832.00|99|0.00|PTCA W/O STENT|
20|FH_F35308_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F132810_0_0|SrvcGrp|86852|2022|PDM|40.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F132810_0_0|SrvcGrp|112061|2022|PCT|0.95|99|0.00|ICATIBANT|
20|FH_F69968_0_0|SrvcGrp|79978|2022|PCT|0.55|99|0.00|IMPLANTS/PROSTHETICS/DRUGS|
20|FH_F115166_0_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F136300_67206_0|SrvcGrp|112844|2022|PDM|896.00|99|0.00|IP PSYCHIATRIC EATING DISORDERS|
20|FH_F136367_72210_0|SrvcGrp|108484|2022|PDM|621.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F136378_07104_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136422_29180_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118152_20151_0|SrvcGrp|86835|2022|PDM|15.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F134150_01801_0|SrvcGrp|109658|2022|PDM|220.00|99|0.00|INTENSIVE OUTPATIENT (<=17 YRS)|
20|FH_F136952_78218_0|SrvcGrp|29346|2022|PDM|40.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F137241_07481_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F142448_15701_0|SrvcGrp|34566|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142393_33142_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F138584_30912_0|SrvcGrp|113410|2022|PDM|700.00|99|0.00|RESET DISLOCATED JAW|
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1944.83|99|0.00|2006 MEDICARE ASPG IX|
20|FH_F140343_89052_0|SrvcGrp|113627|2022|PCT|1.00|99|0.00|ALL OP DRUGS|
20|FH_F140496_38627_0|SrvcGrp|86723|2022|PDM|475.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F140734_71105_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F140887_43338_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140888_75119_0|SrvcGrp|89417|2022|PDM|391.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F80366_0_0|SrvcGrp|77999|2022|PCT|0.88|99|0.00|AETNA RADIOLOGY|
20|FH_F147861_45239_0|SrvcGrp|72602|2022|PDM|900.00|99|0.00|ECT|
20|FH_F129491_90245_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F129504_02871_0|SrvcGrp|88620|2022|PDM|111.00|99|0.00|SKILLED NURSING RN|
20|FH_F117108_37841_0|SrvcGrp|36204|2022|PCT|0.00|99|0.00|ACUTE PSYCH|
20|FH_F137930_51546_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F124754_84403_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F112817_37027_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F138732_60016_0|SrvcGrp|3178|2022|PDM|970.00|99|0.00|ACUTE PSYCH|
20|FH_F110160_0_0|SrvcGrp|72990|2022|PDM|580.00|99|0.00|AEG 1|
20|FH_F50446_0_0|SrvcGrp|44820|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F129130_92562_0|SrvcGrp|10364|2022|PDM|2955.00|99|0.00|CPT CODE 99284|
20|FH_F110381_0_0|SrvcGrp|11673|2022|PDM|2332.00|99|0.00|CPT 29888|
20|FH_F114267_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F35088_0_0|CSTM-ALL|CSTM-00|2020|PDM|3407.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127396_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F84413_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139878_33161_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140131_62870_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101709_0_0|SrvcGrp|73002|2022|PDM|2566.00|99|0.00|AEG 7|
20|FH_F102920_0_0|SrvcGrp|72996|2022|PDM|1098.00|99|0.00|AEG 4|
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)|
20|FH_F116684_30701_0|SrvcGrp|94735|2022|PCT|1.00|99|0.00|AFLURIA VACC IM (>=3 YRS)|
20|FH_F116698_07470_0|SrvcGrp|24744|2022|PDM|78.75|99|0.00|PICC LINE INSERTION|
20|FH_F119929_70364_0|SrvcGrp|57968|2022|PDM|29.83|99|0.00|CONTINUOUS HOMECARE|
20|FH_F119929_70364_0|SrvcGrp|92501|2022|PDM|130.96|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F125436_60506_0|SrvcGrp|89149|2022|PDM|205.00|99|0.00|OP INTENSIVE|
20|FH_F113649_01752_0|SrvcGrp|29023|2022|PDM|69.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F84611_30281_0|SrvcGrp|30623|2022|PDM|6995.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|1614.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F36372_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BROOKVIEW NURSING RADIOLOGY CPT MOD 26|
20|FH_F135688_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 10 (NO REV)|
20|FH_F40033_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129850_0_0|SrvcGrp|111418|2022|PDM|9.55|99|0.00|SURGERY|
20|FH_F69347_0_0|SrvcGrp|44763|2022|PDM|4066.00|99|0.00|PORTLAND ADVENTIST ASPG II|
20|FH_F148554_85016_0|SrvcGrp|115442|2022|PDM|3060.00|99|0.00|INSERT 2 ELECTRODE PM DEFIB|
20|FH_F148554_85016_0|SrvcGrp|80496|2022|PDM|1950.00|99|0.00|INSERTION OF PULSE GENERATOR|
20|FH_F148561_17022_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F85753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97543_33542_0|SrvcGrp|73605|2022|PDM|2662.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F89011_75006_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F111522_81067_0|SrvcGrp|104329|2022|PCT|1.00|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|862.00|99|0.00|AEG 1 (NO REV)|
20|FH_F130108_0_0|SrvcGrp|18791|2022|PCT|0.75|99|0.00|MS DRG 215|
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_F33581_0_0|SrvcGrp|1943|2022|PDM|3240.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F149840_80002_0|SrvcGrp|73523|2022|PDM|135.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F109882_36695_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F51658_0_0|SrvcGrp|45949|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F109815_52241_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|418.00|99|0.00|AEG 1 (NO REV)|
20|FH_F133009_19038_0|SrvcGrp|23683|2022|PDM|42.00|99|0.00|SKILLED NURSING RN|
20|FH_F88512_0_0|SrvcGrp|68422|2022|PDM|1092.00|99|0.00|NICU III|
20|FH_F141802_17042_0|SrvcGrp|13627|2022|PDM|669.00|99|0.00|SLEEP STUDY|
20|FH_F69104_0_0|SrvcGrp|17083|2022|PDM|1273.92|99|0.00|ASPG X|
20|FH_F40542_0_0|SrvcGrp|32645|2022|PCT|1.50|99|0.00|RADIOLOGY - CPT/MOD 26|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF|
20|FH_F34831_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F142038_45152_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F72859_0_0|SrvcGrp|15494|2022|PDM|14.40|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F139566_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F150479_53223_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133487_24293_0|SrvcGrp|48396|2022|PDM|125.00|99|0.00|OT SERVICES|
20|FH_F67379_0_0|SrvcGrp|16|2022|PDM|1024.00|99|0.00|ACUTE REHABILITATION|
20|FH_F143057_15767_0|SrvcGrp|70642|2022|PDM|21.52|99|0.00|CONSULTANT THERAPIST|
20|FH_F127191_44720_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F98921_64503_0|SrvcGrp|90854|2022|PDM|2229.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F133214_75024_0|SrvcGrp|105819|2022|PDM|1425.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F112853_22408_0|SrvcGrp|26160|2022|PCT|1.05|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F149344_0_0|SrvcGrp|13681|2022|PDM|172.33|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F72387_0_0|SrvcGrp|9811|2022|PDM|550.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F150902_21713_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F147800_0_0|SrvcGrp|92408|2022|PDM|6050.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F121168_0_0|SrvcGrp|83522|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F117647_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132331_89107_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F111403_37167_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|307.94|99|0.00|HAPA WPA-NWPA 2012-13 ASC 115 W/O REV|
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|ASPG X|
20|FH_F78682_0_0|SrvcGrp|35669|2022|PDM|2000.00|99|0.00|CPT 63650|
20|FH_F144011_60616_0|SrvcGrp|114130|2022|PCT|2.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F136751_0_0|SrvcGrp|99161|2022|PDM|20500.00|99|0.00|CPT 27138|
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 5  (NO REV)|
20|FH_F101922_98055_0|SrvcGrp|73499|2022|PDM|1126.00|99|0.00|AETNA ER LEVEL II|
20|FH_F144011_60616_0|CSTM-ALL|CSTM-00|2020|PDM|3714.00|99|0.00|AEG 5  (NO REV)|
20|FH_F69071_0_0|SrvcGrp|13682|2022|PDM|549.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) PARAMEDIC INTERCEPT|
20|FH_F39859_0_0|SrvcGrp|12920|2022|PCT|0.63|99|0.00|EMERGENCY CRITICAL CARE|
20|FH_F115431_32821_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F37640_0_0|SrvcGrp|21342|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F95661_27217_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F87054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F114566_46224_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F142315_33701_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PDM|2318.00|99|0.00|AEG 3 (NO REV)|
20|FH_F100640_48097_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F105623_77901_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F119838_0_0|SrvcGrp|78702|2022|PDM|1350.00|99|0.00|AETNA EXTRACAPSULAR CATARAC|
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|873.00|99|0.00|AEG 5  (NO REV)|
20|FH_F138929_0_0|SrvcGrp|72121|2022|PDM|3520.00|99|0.00|ARTHOSCOPY|
20|FH_F143457_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F95341_08701_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132988_0_0|SrvcGrp|87677|2022|PDM|1279.81|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F130310_66604_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F43612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F141018_70125_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141134_84720_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC|
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|2248.11|99|0.00|ASPG VII|
20|FH_F72204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F92959_0_0|SrvcGrp|26001|2022|PDM|136.71|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F146921_43050_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146903_72901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F62624_0_0|SrvcGrp|29755|2022|PDM|11000.00|99|0.00|MS DRG 245 ONLY|
20|FH_F41885_0_0|SrvcGrp|350|2022|PDM|950.00|99|0.00|SURGICAL CARE|
20|FH_F89582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129549_01238_0|SrvcGrp|63297|2022|PDM|177.45|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F127995_84010_0|SrvcGrp|22592|2022|PDM|22.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F131101_45840_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137248_0_0|SrvcGrp|99063|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F114985_32073_0|SrvcGrp|90488|2022|PDM|79.00|99|0.00|ORAL FUNCTION THERAPY|
20|FH_F148553_85016_0|SrvcGrp|114107|2022|PDM|3068.00|99|0.00|FEM/POPL REVASC W/ STENT|
20|FH_F122608_84123_0|SrvcGrp|48394|2022|PDM|43.20|99|0.00|SKILLED NURSING SERVICES|
20|FH_F122680_53511_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F42980_0_0|SrvcGrp|50204|2022|PDM|125.00|99|0.00|OP OFFICE VISIT- ESTABLISHED PATIENT|
20|FH_F43833_0_0|SrvcGrp|177|2022|PDM|1100.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134727_30650_0|SrvcGrp|78403|2022|PDM|0.10|99|0.00|AETNA MED RECORD|
20|FH_F136796_24016_0|SrvcGrp|99073|2022|PCT|1.11|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F136824_08034_0|SrvcGrp|94879|2022|PDM|239.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F136829_29615_0|SrvcGrp|89149|2022|PDM|406.00|99|0.00|OP INTENSIVE|
20|FH_F112268_19087_0|SrvcGrp|88621|2022|PDM|84.00|99|0.00|SKILLED NURSING LPN|
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F116199_75042_0|SrvcGrp|87317|2022|PDM|804.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F147586_44124_0|SrvcGrp|84939|2022|PDM|18000.00|99|0.00|SHOULDER JOINT|
20|FH_F147586_44124_0|SrvcGrp|33982|2022|PDM|1634.00|99|0.00|CPT 28296|
20|FH_F41652_0_0|CSTM-ALL|CSTM-00|2020|PDM|174.00|99|0.00|CD (ADULT) RESIDENTIAL CARE|
20|FH_F40634_0_0|SrvcGrp|33413|2022|PCT|1.00|99|0.00|TRANSPORTATION SERVICES|
20|FH_F43136_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F70762_90805_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F120112_0_0|SrvcGrp|93098|2022|PDM|94.50|99|0.00|HOSPICE CARE|
20|FH_F148665_65270_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F95221_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110604_0_0|SrvcGrp|63471|2022|PDM|43560.00|99|0.00|CPT 64590|
20|FH_F111847_70301_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F114151_0_0|SrvcGrp|63297|2022|PDM|90.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F46433_0_0|SrvcGrp|29077|2022|PDM|150.00|99|0.00|HOME TRANSFUSION|
20|FH_F134087_0_0|SrvcGrp|77021|2022|PDM|5332.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141837_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F46672_0_0|SrvcGrp|42037|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE (ADDITIONAL HOURS)|
20|FH_F72445_0_0|SrvcGrp|9874|2022|PDM|44.00|99|0.00|DIETICIAN|
20|FH_F138681_39301_0|SrvcGrp|89149|2022|PDM|171.00|99|0.00|OP INTENSIVE|
20|FH_F138857_90025_0|SrvcGrp|75442|2022|PDM|850.00|99|0.00|OBSERVATION - REV 762|
20|FH_F138876_25302_0|SrvcGrp|22589|2022|PDM|45.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F67167_0_0|SrvcGrp|43722|2022|PDM|38555.00|99|0.00|GAMMA KNIFE|
20|FH_F77933_0_0|SrvcGrp|64200|2022|PCT|1.00|99|0.00|RAD AND LAB|
20|FH_F37644_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PT EVALS|
20|FH_F102063_0_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F124542_0_0|SrvcGrp|80544|2022|PDM|956.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 8|
20|FH_F151402_70508_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151511_14094_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135388_48601_0|SrvcGrp|13683|2022|PDM|768.48|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F135485_20171_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F135607_21613_0|SrvcGrp|89337|2022|PDM|1825.00|99|0.00|DETOXIFICATION|
20|FH_F135608_19348_0|SrvcGrp|73841|2022|PDM|367.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F91764_93710_0|SrvcGrp|111930|2022|PCT|2.12|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F135874_74403_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136042_90066_0|SrvcGrp|110811|2022|PDM|500.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F104963_15146_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F65359_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|DRUGS|
20|FH_F133474_0_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F40465_0_0|SrvcGrp|10053|2022|PDM|12000.00|99|0.00|DRG 116 ONLY OTH CARDIAC PACEMKR (552)|
20|FH_F98600_91730_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AMFS HOMEHEALTH|
20|FH_F41173_0_0|SrvcGrp|109|2022|PDM|598.00|99|0.00|CD - DETOX|
20|FH_F34706_0_0|SrvcGrp|13490|2022|PDM|7751.00|99|0.00|DRG 499 ONLY|
20|FH_F150500_85253_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F98620_43920_0|SrvcGrp|73559|2022|PDM|9745.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1681.88|99|0.00|ASPG 901|
20|FH_F150003_22630_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F63417_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|638.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F44135_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F46357_0_0|SrvcGrp|10986|2022|PDM|2300.00|99|0.00|ARTHROSCOPIC KNEE REPAIR|
20|FH_F146229_60031_0|CSTM-ALL|CSTM-00|2020|PDM|295.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F128445_85704_0|SrvcGrp|72602|2022|PDM|1048.00|99|0.00|ECT|
20|FH_F118672_29036_0|SrvcGrp|113988|2022|PCT|5.04|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F148494_0_0|SrvcGrp|98566|2022|PDM|15000.00|99|0.00|ARTHRDSIS LAT MINI DISKECT|
20|FH_F38848_0_0|SrvcGrp|439|2022|PDM|1900.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F117901_27526_0|SrvcGrp|90479|2022|PCT|1.10|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F48929_0_0|SrvcGrp|12403|2022|PDM|936.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F57592_0_0|SrvcGrp|10927|2022|PDM|1050.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F134497_47126_0|SrvcGrp|73842|2022|PDM|170.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F50618_0_0|SrvcGrp|17079|2022|PDM|1290.17|99|0.00|ASPG VIII|
20|FH_F67683_0_0|SrvcGrp|3259|2022|PDM|652.00|99|0.00|ACUTE REHABILITATION|
20|FH_F119100_66086_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117087_0_0|SrvcGrp|107171|2022|PDM|2494.00|99|0.00|EXCISION OF LINGUAL TONSIL|
20|FH_F41392_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|OCN F/S PRICING: ALL|
20|FH_F37778_0_0|SrvcGrp|27314|2022|PDM|1749.00|99|0.00|SHOULDER REPAIR|
20|FH_F120837_33309_0|SrvcGrp|46903|2022|PDM|623.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F41696_0_0|CSTM-ALL|CSTM-00|2020|PDM|281.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F112627_26062_0|SrvcGrp|472|2022|PDM|417.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F132685_63146_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136606_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F151144_35801_0|SrvcGrp|87391|2022|PDM|1984.57|99|0.00|REAPIR RETINAL DETACHMENT|
20|FH_F151144_35801_0|SrvcGrp|28551|2022|PDM|1984.57|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F88096_0_0|SrvcGrp|76243|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F113815_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|350.00|99|0.00|AEG 1 (NO REV)|
20|FH_F58856_0_0|SrvcGrp|28167|2022|PDM|40000.00|99|0.00|MS DRG 231 ONLY|
20|FH_F62886_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS|
20|FH_F69968_0_0|SrvcGrp|29816|2022|PCT|0.55|99|0.00|IMPLANTS/PROSTHETICS/DRUGS|
20|FH_F96182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F136314_19013_0|SrvcGrp|87317|2022|PDM|673.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F136542_02446_0|SrvcGrp|111638|2022|PDM|398.00|99|0.00|PARTIAL HOSPITALIZATION (<=17 YRS) (HCFA)|
20|FH_F114092_83350_0|SrvcGrp|112040|2022|PCT|1.15|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F142267_78240_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F139456_47501_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F139456_47501_0|SrvcGrp|79786|2022|PCT|1.35|99|0.00|SLEEP STUDIES|
20|FH_F140888_75119_0|SrvcGrp|89337|2022|PDM|880.00|99|0.00|DETOXIFICATION|
20|FH_F140890_30906_0|SrvcGrp|86722|2022|PDM|221.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F140890_30906_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148679_57328_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F120152_0_0|SrvcGrp|67066|2022|PDM|16500.00|99|0.00|CERVICAL SURGERY|
20|FH_F149663_45219_0|SrvcGrp|103973|2022|PDM|9405.00|99|0.00|AETNA DISK SURGERY|
20|FH_F149663_45219_0|CSTM-ALL|CSTM-00|2020|PDM|2511.14|99|0.00|AEG 7 (NO REV)|
20|FH_F118914_43015_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F126853_19053_0|SrvcGrp|48396|2022|PDM|75.00|99|0.00|OT SERVICES|
20|FH_F109930_73109_0|SrvcGrp|472|2022|PDM|433.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F66835_0_0|SrvcGrp|23587|2022|PDM|425.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F92852_0_0|SrvcGrp|84280|2022|PDM|2200.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F137334_90405_0|SrvcGrp|73842|2022|PDM|360.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137817_17050_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137850_32826_0|SrvcGrp|89337|2022|PDM|771.00|99|0.00|DETOXIFICATION|
20|FH_F112452_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91472_96001_0|SrvcGrp|83417|2022|PDM|109534.00|99|0.00|OPEN HEART SURGERY|
20|FH_F124754_84403_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F124834_75246_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124954_17055_0|SrvcGrp|106291|2022|PDM|233.24|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F128804_0_0|SrvcGrp|111209|2022|PDM|1210.00|99|0.00|TONGUE BASE VOL REDUCTION|
20|FH_F114567_43235_0|SrvcGrp|86753|2022|PCT|0.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F31783_0_0|SrvcGrp|43|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F147211_0_0|SrvcGrp|28221|2022|PDM|950.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F70493_0_0|SrvcGrp|67284|2022|PDM|57.00|99|0.00|OT SUBSEQUENT VISIT 97139|
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|ASPG I|
20|FH_F59732_0_0|SrvcGrp|50165|2022|PDM|88.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 4 HRS|
20|FH_F136194_80909_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131334_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131132_44077_0|CSTM-ALL|CSTM-00|2020|PDM|7517.00|99|0.00|AEG 7 (NO REV)|
20|FH_F33556_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111292_33136_0|SrvcGrp|82757|2022|PDM|46.00|99|0.00|ASSAY BLOOD CREATININE|
20|FH_F111301_33122_0|SrvcGrp|63457|2022|PDM|219.00|99|0.00|ULTRASOUND|
20|FH_F111363_33169_0|SrvcGrp|73006|2022|PDM|3000.00|99|0.00|AEG 9|
20|FH_F47906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F65882_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PERSONAL CARE IV SERVICES LEASED|
20|FH_F148243_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F33081_0_0|CSTM-ALL|CSTM-00|2020|PDM|3800.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY|
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1709.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131000_0_0|SrvcGrp|54943|2022|PDM|3608.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F131000_0_0|SrvcGrp|88599|2022|PDM|3343.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F132328_0_0|SrvcGrp|27344|2022|PDM|2229.00|99|0.00|OP SURGERY (CPT 42821)|
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F89732_0_0|SrvcGrp|42822|2022|PDM|715.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F118651_0_0|SrvcGrp|73495|2022|PDM|4402.74|99|0.00|AETNA MYOMECTOMY|
20|FH_F128549_44224_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F140102_0_0|SrvcGrp|103911|2022|PDM|105.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY|
20|FH_F102325_62691_0|SrvcGrp|26868|2022|PDM|80.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F102325_62691_0|SrvcGrp|16750|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F102862_30606_0|SrvcGrp|73601|2022|PDM|1485.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F98300_30236_0|SrvcGrp|78720|2022|PDM|3751.00|99|0.00|AETNA PET SCAN|
20|FH_F132347_01605_0|SrvcGrp|94780|2022|PDM|110.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F143542_0_0|SrvcGrp|84280|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F63249_0_0|SrvcGrp|27968|2022|PDM|25.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135626_20176_0|SrvcGrp|75419|2022|PDM|504.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F77044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F81852_0_0|CSTM-ALL|CSTM-00|2020|PDM|678.00|99|0.00|ASPG III|
20|FH_F145642_15108_0|SrvcGrp|86843|2022|PDM|25.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F111903_26241_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127486_06776_0|SrvcGrp|103739|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F118147_33801_0|CSTM-ALL|CSTM-00|2020|PDM|876.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F150165_06032_0|SrvcGrp|74039|2022|PDM|5768.00|99|0.00|LAMINECTOMY|
20|FH_F121699_73703_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F127075_64772_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149199_73005_0|CSTM-ALL|CSTM-00|2020|PDM|1302.00|99|0.00|AEG 4 (NO REV)|
20|FH_F109577_0_0|SrvcGrp|80918|2022|PDM|195.00|99|0.00|RESPITE CARE|
20|FH_F49572_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F100782_0_0|SrvcGrp|105138|2022|PDM|218.17|99|0.00|WINDBER MEDICAL CNTR ASC 243|
20|FH_F89574_0_0|SrvcGrp|79720|2022|PDM|1050.00|99|0.00|ACUTE REHAB II|
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 4 (NO REV)|
20|FH_F132740_46250_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F145555_72204_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150165_06032_0|SrvcGrp|27348|2022|PDM|2292.00|99|0.00|OP SURGERY (CPT 58662)|
20|FH_F124371_0_0|SrvcGrp|13262|2022|PDM|6.47|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F132958_79903_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F70303_0_0|SrvcGrp|3810|2022|PDM|218.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F110562_33409_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F128148_0_0|SrvcGrp|22596|2022|PDM|250.00|99|0.00|HOSPICE CARE|
20|FH_F118469_0_0|SrvcGrp|107792|2022|PDM|4100.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F120737_45877_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110425_01752_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F139569_15063_0|CSTM-ALL|CSTM-00|2020|PDM|985.00|99|0.00|AEG 4 (NO REV)|
20|FH_F121476_0_0|SrvcGrp|108861|2022|PDM|2030.00|99|0.00|METACARPOPHALANGEAL JOINT|
20|FH_F127529_43230_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F63102_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 949|
20|FH_F133943_01606_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F146124_06112_0|SrvcGrp|107682|2022|PCT|1.18|99|0.00|LABORATORY SERVICES|
20|FH_F127849_43920_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F123623_03246_0|SrvcGrp|107749|2022|PDM|470.00|99|0.00|CAPD/CCPD|
20|FH_F146103_63851_0|SrvcGrp|73483|2022|PDM|1139.00|99|0.00|AETNA SUBACUTE III|
20|FH_F146120_45040_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114800_68510_0|SrvcGrp|48394|2022|PDM|37.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F120539_89029_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F87775_15106_0|SrvcGrp|29464|2022|PDM|90.00|99|0.00|HOME HEALTH VISIT NEWBORN CARE|
20|FH_F123157_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F125870_0_0|SrvcGrp|46887|2022|PDM|2445.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F110311_17078_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F100782_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.60|99|0.00|HAPA WPA/NWPA 2015 RAD 100%|
20|FH_F112827_26452_0|SrvcGrp|88620|2022|PDM|90.00|99|0.00|SKILLED NURSING RN|
20|FH_F112791_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F61292_0_0|SrvcGrp|39870|2022|PDM|2168.00|99|0.00|MS DRG 619-621 ONLY|
20|FH_F145542_70503_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F89734_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F143785_19713_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149740_33912_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|2601.00|99|0.00|AEG 3 (NO REV)|
20|FH_F129656_15005_0|SrvcGrp|17013|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F63391_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109180_18015_0|SrvcGrp|102982|2022|PDM|131.00|99|0.00|PSYTX WPT W E/M 60 MIN|
20|FH_F149740_33912_0|SrvcGrp|73701|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|1869.00|99|0.00|AEG 8 (NO REV)|
20|FH_F56276_0_0|SrvcGrp|52945|2022|PDM|81.00|99|0.00|PSYCHIATRIC CPT 90805|
20|FH_F98922_40351_0|SrvcGrp|90854|2022|PDM|2572.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F148254_89503_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|3161.00|99|0.00|AEG 9 (NO REV)|
20|FH_F49338_0_0|SrvcGrp|31188|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC (DME)|
20|FH_F135220_21532_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F31056_0_0|SrvcGrp|360|2022|PDM|1387.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F129969_33908_0|SrvcGrp|12659|2022|PDM|625.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F121925_0_0|SrvcGrp|71221|2022|PDM|729.94|99|0.00|EGD W/BALLOON DIALATION CPT 43249|
20|FH_F37679_0_0|SrvcGrp|24745|2022|PDM|61.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F123894_60927_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148320_02130_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F137946_0_0|SrvcGrp|111926|2022|PDM|35.92|99|0.00|COVID-19 LAB TESTING|
20|FH_F145550_62034_0|SrvcGrp|104837|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|623.16|99|0.00|HAPA WPA-NWPA 2012-13 ASC 403 W/O REV|
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 2 (NO REV)|
20|FH_F143768_34785_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F127072_30458_0|SrvcGrp|108484|2022|PDM|710.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1760.00|99|0.00|ASPG VII|
20|FH_F137637_03103_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135267_19002_0|SrvcGrp|89417|2022|PDM|357.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F128272_60640_0|SrvcGrp|14947|2022|PDM|13.00|99|0.00|HOME INFUSION|
20|FH_F132675_53154_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118910_0_0|SrvcGrp|94780|2022|PDM|126.18|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F55054_0_0|SrvcGrp|28074|2022|PCT|0.65|99|0.00|HIGH COST PHARMACEUTICALS|
20|FH_F51733_0_0|SrvcGrp|45948|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F38473_0_0|SrvcGrp|11798|2022|PDM|112.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F139551_0_0|SrvcGrp|35669|2022|PDM|6000.00|99|0.00|CPT 63650|
20|FH_F39857_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|ACUTE PSYCH|
20|FH_F40652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51672_0_0|SrvcGrp|41601|2022|PCT|1.00|99|0.00|IMMUNE GLOBULIN|
20|FH_F122240_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F40499_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F128384_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|OP SVCS|
20|FH_F31982_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F45632_0_0|SrvcGrp|26001|2022|PDM|155.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F135236_02840_0|SrvcGrp|88678|2022|PDM|3251.40|99|0.00|ACUTE REHAB I|
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 1 (NO REV)|
20|FH_F118086_66604_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F151526_28208_0|SrvcGrp|109136|2022|PDM|4143.00|99|0.00|AV FISTULA REVISION|
20|FH_F125864_78748_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F32802_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|794.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F89563_29407_0|SrvcGrp|471|2022|PDM|555.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130024_78229_0|SrvcGrp|75545|2022|PDM|459.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F93880_95476_0|SrvcGrp|76257|2022|PCT|0.70|99|0.00|CARDIAC STUDIES|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHYSICIAN CLINIC VISIT NATL F/S (MOD NU)|
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.73|99|0.00|ASPG X|
20|FH_F54172_0_0|SrvcGrp|14254|2022|PDM|52.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F129627_06037_0|SrvcGrp|48396|2022|PDM|111.00|99|0.00|OT SERVICES|
20|FH_F130747_0_0|SrvcGrp|41335|2022|PDM|26010.00|99|0.00|TOTAL HIP|
20|FH_F131577_89148_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F128228_40047_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119511_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC|
20|FH_F84215_0_0|SrvcGrp|72994|2022|PDM|625.00|99|0.00|AEG 3|
20|FH_F93880_95476_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS|
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_F39022_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|PSYCHIATRIC EATING DISORDERS|
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F94402_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F56136_0_0|SrvcGrp|33484|2022|PCT|0.92|99|0.00|THERAPY SERVICES|
20|FH_F148265_06067_0|SrvcGrp|84307|2022|PDM|2801.00|99|0.00|TENDON REPAIR|
20|FH_F147941_06023_0|CSTM-ALL|CSTM-00|2020|PDM|2642.00|99|0.00|AEG 8 (NO REV)|
20|FH_F86319_16365_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F120672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS|
20|FH_F79923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126157_34210_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F138240_64114_0|SrvcGrp|73701|2022|PDM|44.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F85353_16407_0|SrvcGrp|42503|2022|PDM|157.00|99|0.00|RABIES IMMUNIZATION W/ ER|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1694.91|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1401 W/O REV|
20|FH_F85777_77030_0|SrvcGrp|107492|2022|PCT|0.73|99|0.00|PHARMACY|
20|FH_F128828_44122_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F145694_84770_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130123_24171_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F97861_62223_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F149266_38556_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP 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_F133943_01606_0|SrvcGrp|109702|2022|PCT|1.00|99|0.00|LEUPROL ACET PER 3.75MG/1 MX|
20|FH_F114683_0_0|SrvcGrp|105730|2022|PDM|5000.00|99|0.00|LOW BACK & NECK DISK SURGERY|
20|FH_F110589_70809_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F80172_0_0|SrvcGrp|77224|2022|PDM|142.00|99|0.00|AETNA HOME INFUSION S5521|
20|FH_F133951_48310_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F125024_66523_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F112631_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH|
20|FH_F119934_0_0|SrvcGrp|87077|2022|PDM|185.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F141337_60077_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139380_33062_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F141829_0_0|SrvcGrp|106317|2022|PDM|508.09|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F124161_95932_0|SrvcGrp|16|2022|PDM|2330.00|99|0.00|ACUTE REHABILITATION|
20|FH_F138302_15701_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F145686_52591_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F100782_0_0|SrvcGrp|97677|2022|PDM|2002.91|99|0.00|WINDBER MEDICAL CNTR ASC 706|
20|FH_F50654_0_0|SrvcGrp|46890|2022|PCT|1.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F50497_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|OP SVCS|
20|FH_F85097_0_0|SrvcGrp|6|2022|PCT|0.50|99|0.00|OP SURGERY|
20|FH_F138147_18018_0|SrvcGrp|73842|2022|PDM|127.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F110470_98335_0|SrvcGrp|73842|2022|PDM|120.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114432_75035_0|SrvcGrp|472|2022|PDM|435.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F73024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F105145_75075_0|SrvcGrp|12491|2022|PCT|1.15|99|0.00|PACEMAKER|
20|FH_F105145_75075_0|SrvcGrp|88155|2022|PDM|24731.00|99|0.00|REVISE KNEECAP WITH IMPLANT|
20|FH_F105145_75075_0|SrvcGrp|90365|2022|PDM|12350.00|99|0.00|REPAIR METACARPAL FRACTURE|
20|FH_F115909_38133_0|SrvcGrp|106049|2022|PCT|1.00|99|0.00|DEVELOPMENT SCREEN|
20|FH_F115784_06831_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66427_0_0|SrvcGrp|11975|2022|PCT|0.80|99|0.00|ELECTRO CONVULSIVE THERAPY|
20|FH_F146716_46733_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115966_16801_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F116114_37033_0|SrvcGrp|105350|2022|PDM|515.00|99|0.00|AETNA PARTIAL HOSPITALIZATION|
20|FH_F133461_61277_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133047_74012_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F139209_22556_0|SrvcGrp|113469|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F150770_43113_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150882_84041_0|SrvcGrp|43568|2022|PDM|105.00|99|0.00|SKILLED NURSING - RN|
20|FH_F38742_0_0|SrvcGrp|24744|2022|PDM|80.00|99|0.00|PICC LINE INSERTION|
20|FH_F92092_74055_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119376_0_0|SrvcGrp|108118|2022|PDM|1698.78|99|0.00|ARTERIOVENOUS ANASTOMOSIS|
20|FH_F120848_20912_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F44132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F48695_0_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F123570_0_0|SrvcGrp|72994|2022|PDM|721.38|99|0.00|AEG 3|
20|FH_F73262_0_0|SrvcGrp|12982|2022|PDM|500.00|99|0.00|NEONATAL INTENSIVE CARE II|
20|FH_F148902_40509_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35416_0_0|SrvcGrp|70342|2022|PDM|20700.00|99|0.00|THORACIC SURGERY|
20|FH_F76826_0_0|SrvcGrp|75999|2022|PCT|0.66|99|0.00|OP URGENT CARE|
20|FH_F151001_80501_0|SrvcGrp|109798|2022|PCT|1.45|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F139715_0_0|SrvcGrp|107112|2022|PCT|0.48|99|0.00|DENTAL SERVICES UNDER ANESTHESIA|
20|FH_F50078_0_0|SrvcGrp|42973|2022|PDM|70.00|99|0.00|SPEECH  THERAPIST|
20|FH_F137789_48146_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F36590_0_0|SrvcGrp|72|2022|PDM|589.00|99|0.00|NEWBORN NURSERY|
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37444_0_0|SrvcGrp|9230|2022|PCT|0.72|99|0.00|HOME IV THERAPY SVCS|
20|FH_F37018_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F83920_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116332_0_0|SrvcGrp|87843|2022|PDM|13568.00|99|0.00|REVISE STOMACH - BOWEL FUSION|
20|FH_F98022_89015_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F131954_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F41155_0_0|SrvcGrp|97|2022|PDM|2809.00|99|0.00|C-SECTION|
20|FH_F125113_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F98860_96706_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F38986_0_0|SrvcGrp|177|2022|PDM|1321.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F102069_19034_0|SrvcGrp|3178|2022|PDM|1083.00|99|0.00|ACUTE PSYCH|
20|FH_F146204_0_0|SrvcGrp|83817|2022|PDM|2376.00|99|0.00|LAPAROSCOPY LYSIS ADHESIONS|
20|FH_F41133_0_0|SrvcGrp|1306|2022|PDM|311.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F137427_89146_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F37155_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44198_0_0|SrvcGrp|13681|2022|PDM|289.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F131236_84041_0|SrvcGrp|63297|2022|PDM|93.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F132263_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F85475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41021_0_0|SrvcGrp|17065|2022|PDM|1803.00|99|0.00|ASPG I|
20|FH_F49942_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS|
20|FH_F45052_0_0|SrvcGrp|29898|2022|PDM|115.00|99|0.00|RN VISIT|
20|FH_F130805_17404_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 6 (NO REV)|
20|FH_F130821_85712_0|SrvcGrp|103320|2022|PDM|14.09|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F68844_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|TRAUMA CARE|
20|FH_F120661_57001_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F31714_0_0|SrvcGrp|3002|2022|PDM|7900.00|99|0.00|DRG 518 PERCUTANEOUS CARDIO PROC|
20|FH_F138050_52301_0|SrvcGrp|16069|2022|PDM|1005.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F85652_98034_0|SrvcGrp|31706|2022|PDM|3640.00|99|0.00|MS DRG 792 ONLY|
20|FH_F149244_85201_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F110980_53566_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F109264_33431_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148429_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150139_71667_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|514.25|99|0.00|HAPA WPA-NWPA 2012-13 ASC 219 W/O REV|
20|FH_F126056_29824_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37045_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123589_52402_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145641_06902_0|SrvcGrp|88596|2022|PDM|5294.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE|
20|FH_F93173_73401_0|SrvcGrp|79699|2022|PCT|0.68|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 2 (NO REV)|
20|FH_F146049_60462_0|SrvcGrp|83235|2022|PCT|1.10|99|0.00|AMBULATORY SURGERY|
20|FH_F146103_63851_0|SrvcGrp|88678|2022|PCT|0.00|99|0.00|ACUTE REHAB I|
20|FH_F112060_07514_0|SrvcGrp|87902|2022|PCT|1.00|99|0.00|CEFTRIAXON SOD PER 250MG/8MX|
20|FH_F138951_41101_0|SrvcGrp|86779|2022|PDM|55.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F118123_67226_0|SrvcGrp|16750|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F149265_64429_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148659_28134_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120484_31419_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134669_17403_0|SrvcGrp|89149|2022|PDM|210.00|99|0.00|OP INTENSIVE|
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|673.00|99|0.00|AEG 2 (NO REV)|
20|FH_F145641_06902_0|SrvcGrp|105638|2022|PDM|5814.00|99|0.00|HIP ARTHROSCOPY|
20|FH_F72785_0_0|SrvcGrp|3271|2022|PDM|5462.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG VII|
20|FH_F139873_0_0|SrvcGrp|84278|2022|PDM|2992.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F130364_01331_0|SrvcGrp|73461|2022|PDM|1500.00|99|0.00|AETNA NICU IV|
20|FH_F149299_43351_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F87775_15106_0|SrvcGrp|73524|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F107580_77018_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110268_02891_0|SrvcGrp|90644|2022|PDM|25.00|99|0.00|AETNA MEDICATION ASSISTED TRTMT MAINTENANCE INJECTION (HCFA)|
20|FH_F145641_06902_0|SrvcGrp|34603|2022|PDM|6619.00|99|0.00|CPT 24341|
20|FH_F119783_46360_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F110562_33409_0|SrvcGrp|73841|2022|PDM|955.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F134171_72301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116806_0_0|SrvcGrp|107060|2022|PDM|1923.16|99|0.00|RECONSTRUCT CLEFT PALATE|
20|FH_F109577_0_0|SrvcGrp|103610|2022|PDM|123.00|99|0.00|DIABETIC MGMT PROGRAM - GROUP|
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE|
20|FH_F95623_84015_0|SrvcGrp|94781|2022|PDM|90.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F122930_0_0|SrvcGrp|73008|2022|PDM|1650.00|99|0.00|AEG 10|
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 2 (NO REV)|
20|FH_F116753_0_0|CSTM-ALL|CSTM-00|2020|PDM|1405.00|99|0.00|AEG 2 (NO REV)|
20|FH_F51393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: ALL|
20|FH_F148186_0_0|SrvcGrp|13683|2022|PDM|675.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F109360_32514_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133876_27405_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F143681_61938_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145597_78644_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F114683_0_0|SrvcGrp|104015|2022|PDM|4500.00|99|0.00|INSERT STABILIZATION DEVICE|
20|FH_F110503_10016_0|SrvcGrp|89417|2022|PDM|621.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F143615_92612_0|SrvcGrp|74668|2022|PDM|418.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149343_44134_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141337_60077_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F139767_15217_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|2222.00|99|0.00|AEG 10 (NO REV)|
20|FH_F124173_66215_0|SrvcGrp|23683|2022|PDM|42.00|99|0.00|SKILLED NURSING RN|
20|FH_F149319_07670_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136787_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101844_0_0|SrvcGrp|89404|2022|PDM|8943.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F33632_52349_0|SrvcGrp|75505|2022|PCT|0.88|99|0.00|CARDIAC STUDIES|
20|FH_F111723_0_0|SrvcGrp|86722|2022|PDM|178.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F90817_0_0|SrvcGrp|88149|2022|PDM|1866.00|99|0.00|RELEASE OF EYE FLUID|
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|847.00|99|0.00|AEG 2 (NO REV)|
20|FH_F148020_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110732_31513_0|SrvcGrp|72996|2022|PDM|1322.00|99|0.00|AEG 4|
20|FH_F134394_92101_0|SrvcGrp|109653|2022|PDM|525.00|99|0.00|PARTIAL HOSPITALIZATION >=18|
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 7 (NO REV)|
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|3604.00|99|0.00|AEG 10 (NO REV)|
20|FH_F114951_20002_0|SrvcGrp|10391|2022|PDM|1821.08|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F134847_0_0|SrvcGrp|112646|2022|PDM|1698.00|99|0.00|FEMALE GENITAL PROCEDURES|
20|FH_F98360_11554_0|SrvcGrp|73485|2022|PDM|3774.00|99|0.00|AETNA REHAB|
20|FH_F123162_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F112956_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT|
20|FH_F116583_0_0|SrvcGrp|106930|2022|PDM|150.00|99|0.00|HOSPICE IN LT NON-SNF|
20|FH_F147080_02446_0|SrvcGrp|108484|2022|PDM|473.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F76382_0_0|SrvcGrp|44131|2022|PDM|110.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F52278_0_0|CSTM-ALL|CSTM-00|2020|PDM|765.00|99|0.00|ASPG II|
20|FH_F67924_0_0|SrvcGrp|42827|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F132254_40207_0|SrvcGrp|22589|2022|PDM|50.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F40490_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.58|99|0.00|OP SVCS|
20|FH_F109221_15084_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F67924_0_0|SrvcGrp|45783|2022|PDM|115.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|5900.00|99|0.00|AEG 8 (NO REV)|
20|FH_F37304_0_0|SrvcGrp|17047|2022|PDM|33.00|99|0.00|HOME HEALTH AIDE|
20|FH_F35990_0_0|SrvcGrp|97|2022|PDM|5156.00|99|0.00|C-SECTION|
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|1190.00|99|0.00|ASPG I|
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|646.00|99|0.00|AEG 3 (NO REV)|
20|FH_F148999_46218_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F150313_78666_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F151043_71901_0|SrvcGrp|3378|2022|PDM|370.00|99|0.00|OBSERVATION SVCS|
20|FH_F108260_63141_0|SrvcGrp|43568|2022|PDM|100.00|99|0.00|SKILLED NURSING - RN|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PDM|1439.89|99|0.00|ASPG VII|
20|FH_F140295_0_0|SrvcGrp|16289|2022|PDM|2678.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F42746_0_0|SrvcGrp|28068|2022|PDM|55.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F98623_97006_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F97082_90012_0|SrvcGrp|73605|2022|PDM|4788.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F36403_0_0|SrvcGrp|12496|2022|PDM|475.00|99|0.00|ACUTE REHABILITATION|
20|FH_F139807_33064_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143249_89801_0|SrvcGrp|19742|2022|PDM|55.00|99|0.00|MID-LINE INSERTION|
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123185_0_0|SrvcGrp|73008|2022|PDM|735.00|99|0.00|AEG 10|
20|FH_F103060_0_0|SrvcGrp|72996|2022|PDM|2315.00|99|0.00|AEG 4|
20|FH_F101360_0_0|SrvcGrp|11306|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F102224_0_0|SrvcGrp|106146|2022|PDM|11000.00|99|0.00|REVERSE HIP JOINT|
20|FH_F131090_44622_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131104_98007_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151741_15090_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|PDM|1487.00|99|0.00|GA RETINA SURG CTR ASC 31|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|111.00|99|0.00|GA RETINA SURG CTR ASC 2|
20|FH_F48224_0_0|SrvcGrp|25959|2022|PDM|46.00|99|0.00|CPT CODES 00100-01999|
20|FH_F48785_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD RR/KC)|
20|FH_F120205_53545_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132419_84042_0|SrvcGrp|89412|2022|PDM|456.78|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F120747_19129_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F116533_33619_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|HSS ASC|
20|FH_F116662_15801_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116698_07470_0|SrvcGrp|24752|2022|PDM|21.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F116802_41224_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F120961_66615_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120977_50510_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F35685_0_0|SrvcGrp|21622|2022|PDM|1213.00|99|0.00|ER WITH TRAUMA|
20|FH_F36472_0_0|SrvcGrp|10107|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F43008_0_0|SrvcGrp|9539|2022|PDM|3275.00|99|0.00|SUBACUTE CARE|
20|FH_F46258_0_0|CSTM-ALL|CSTM-00|2020|PDM|140.00|99|0.00|PRE-TRANSPLANT ENVIRONMENTAL ASSESSMENT|
20|FH_F60273_0_0|SrvcGrp|16506|2022|PDM|3197.25|99|0.00|CPT 52647|
20|FH_F78603_0_0|SrvcGrp|28161|2022|PDM|100581.15|99|0.00|MS DRG 216 ONLY|
20|FH_F115667_16101_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F125028_19061_0|SrvcGrp|86848|2022|PDM|52.50|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F42368_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F112508_0_0|SrvcGrp|30089|2022|PDM|442.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F141355_63134_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F72850_0_0|CSTM-ALL|CSTM-00|2020|PDM|1541.00|99|0.00|ACUTE PSYCH|
20|FH_F141802_17042_0|SrvcGrp|112223|2022|PDM|95.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F70863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OCN F/S PRICING: ALL|
20|FH_F77082_0_0|SrvcGrp|10966|2022|PDM|7306.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F127090_45601_0|SrvcGrp|29023|2022|PDM|75.48|99|0.00|HOME INFUSION THERAPY|
20|FH_F111882_51560_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|5885.00|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_F133957_84121_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F85995_64111_0|SrvcGrp|73742|2022|PCT|1.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F133870_60618_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100782_0_0|SrvcGrp|105151|2022|PDM|483.31|99|0.00|WINDBER MEDICAL CNTR ASC 311|
20|FH_F54592_0_0|SrvcGrp|29087|2022|PDM|45.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F122475_37659_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F130126_33413_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F84935_0_0|SrvcGrp|10700|2022|PDM|702.00|99|0.00|INTENSIVE SVCS|
20|FH_F85553_0_0|SrvcGrp|14241|2022|PDM|318.00|99|0.00|EMERGENCY ROOM SVCS LEVEL III|
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|583.00|99|0.00|2007 MEDICARE ASPG I|
20|FH_F101100_50314_0|SrvcGrp|97904|2022|PDM|10887.00|99|0.00|REPAIR OF STOMACH LESION|
20|FH_F102142_80014_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F115936_75093_0|SrvcGrp|90854|2022|PDM|812.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F75842_0_0|SrvcGrp|46502|2022|PDM|6600.27|99|0.00|MS DRG 215-241,245, 250-265 CARDIAC SURGERY|
20|FH_F77665_0_0|SrvcGrp|26336|2022|PDM|60.00|99|0.00|T1001|
20|FH_F63124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F116040_24637_0|SrvcGrp|29076|2022|PDM|30.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F131711_25550_0|SrvcGrp|75506|2022|PCT|0.88|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F132213_17543_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F130657_04614_0|SrvcGrp|75506|2022|PCT|0.86|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F133402_10007_0|SrvcGrp|83057|2022|PDM|43.00|99|0.00|AETNA THERAPEUTIC EXERCISES|
20|FH_F111662_80601_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
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_F49033_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F135351_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)|
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)|
20|FH_F57953_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F57953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER QW|
20|FH_F73204_0_0|SrvcGrp|3809|2022|PDM|644.00|99|0.00|HOSPICE CARE|
20|FH_F89580_0_0|SrvcGrp|88420|2022|PDM|6485.00|99|0.00|CICU|
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.50|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_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|204.29|99|0.00|HAPA WPA-NWPA 2012-13 ASC 129 W/O REV|
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|3163.00|99|0.00|AEG 3 (NO REV)|
20|FH_F151507_32327_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122064_64633_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F145468_60615_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135583_17331_0|SrvcGrp|105465|2022|PCT|0.82|99|0.00|AETNA THERAPIES|
20|FH_F135775_60614_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135978_06851_0|SrvcGrp|112782|2022|PDM|441.00|99|0.00|PARTIAL HOSPITALIZATION (>=19 YRS)|
20|FH_F136006_44709_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136040_75080_0|SrvcGrp|86722|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F100763_24202_0|SrvcGrp|90854|2022|PDM|2072.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F130756_04901_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 2 (NO REV)|
20|FH_F131285_47150_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F131407_07607_0|SrvcGrp|10577|2022|PDM|60.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F131407_07607_0|SrvcGrp|86842|2022|PDM|25.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F116461_77536_0|SrvcGrp|87317|2022|PDM|500.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F127399_0_0|SrvcGrp|72121|2022|PDM|3121.00|99|0.00|ARTHOSCOPY|
20|FH_F140629_0_0|SrvcGrp|113664|2022|PDM|2497.00|99|0.00|LAPAROSCOPY GASTROSTOMY|
20|FH_F35093_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F121444_47720_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F130817_18103_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 6 (NO REV)|
20|FH_F134256_36117_0|SrvcGrp|57968|2022|PDM|15.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F87153_0_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F34246_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.10|99|0.00|OP SVCS|
20|FH_F33081_0_0|SrvcGrp|12670|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F43137_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43801_0_0|SrvcGrp|16|2022|PDM|847.00|99|0.00|ACUTE REHABILITATION|
20|FH_F116430_0_0|SrvcGrp|106713|2022|PDM|7957.00|99|0.00|NECK & SPINE FUSION|
20|FH_F132328_0_0|SrvcGrp|77582|2022|PDM|7117.00|99|0.00|CPT 31255|
20|FH_F112092_46845_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F130206_78209_0|SrvcGrp|75419|2022|PDM|381.10|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F129240_10028_0|SrvcGrp|10577|2022|PDM|35.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F101620_47401_0|SrvcGrp|89417|2022|PDM|308.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F132877_06105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143648_0_0|SrvcGrp|89865|2022|PDM|7000.00|99|0.00|AETNA ENDOMETRIAL CRYOABLATION|
20|FH_F122007_30701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F116960_91505_0|SrvcGrp|86749|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F121547_46805_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F148202_47933_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F128272_60640_0|SrvcGrp|86125|2022|PCT|0.85|99|0.00|AETNA FLEBOGAMMA INJ|
20|FH_F124738_0_0|SrvcGrp|72994|2022|PDM|500.00|99|0.00|AEG 3|
20|FH_F58014_0_0|CSTM-ALL|CSTM-00|2020|PDM|130.00|99|0.00|OP SVCS|
20|FH_F148266_45419_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F71686_0_0|SrvcGrp|12146|2022|PDM|2300.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F37539_0_0|SrvcGrp|16|2022|PDM|975.00|99|0.00|ACUTE REHABILITATION|
20|FH_F93881_15009_0|SrvcGrp|107505|2022|PDM|104.00|99|0.00|X-RAY EXAM CHEST SINGLE VIEW|
20|FH_F123918_76012_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|471.00|99|0.00|AEG 1 (NO REV)|
20|FH_F127487_60169_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F38090_0_0|SrvcGrp|701|2022|PDM|2105.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F105680_0_0|SrvcGrp|75485|2022|PDM|1440.00|99|0.00|AEG 4|
20|FH_F137588_33852_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151543_95630_0|SrvcGrp|74668|2022|PDM|263.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F126422_77375_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147941_06023_0|SrvcGrp|114517|2022|PDM|1007.00|99|0.00|CRITICAL CARE ADD'L 30 FOR ER SERVICES|
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AEG 7 (NO REV)|
20|FH_F110363_0_0|SrvcGrp|103947|2022|PDM|782.00|99|0.00|HOSPICE OR HOME HLTH IN HOME|
20|FH_F87031_0_0|SrvcGrp|78878|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F131207_19947_0|SrvcGrp|90662|2022|PDM|105.00|99|0.00|EVALUATION AND MANAGEMENT CPT 99214|
20|FH_F111852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F40709_0_0|CSTM-ALL|CSTM-00|2020|PDM|1620.00|99|0.00|ASPG VIII|
20|FH_F77862_0_0|SrvcGrp|45541|2022|PDM|99.17|99|0.00|SPEECH THERAPY|
20|FH_F143891_19808_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F109240_21201_0|SrvcGrp|102989|2022|PDM|2422.00|99|0.00|PROTON TRMT, INTERMEDIATE|
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101021_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2016 BETTER HOME CARE AGENCY|
20|FH_F147941_06023_0|SrvcGrp|114563|2022|PCT|1.38|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F151146_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F127567_44070_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F141410_13045_0|SrvcGrp|103913|2022|PCT|0.87|99|0.00|OP DIALYSIS|
20|FH_F110925_01104_0|SrvcGrp|86124|2022|PDM|48.00|99|0.00|AETNA OCTAGAM INJ|
20|FH_F126883_78621_0|SrvcGrp|46903|2022|PDM|575.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F49653_0_0|SrvcGrp|3950|2022|PCT|1.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F130588_41171_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141550_33619_0|SrvcGrp|73841|2022|PDM|385.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F78165_0_0|SrvcGrp|30094|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY|
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|689.00|99|0.00|AEG 10 (NO REV)|
20|FH_F34691_0_0|SrvcGrp|15645|2022|PDM|721.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F80283_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|3670.00|99|0.00|AEG 7 (NO REV)|
20|FH_F149442_0_0|SrvcGrp|111928|2022|PDM|95.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F125983_82301_0|SrvcGrp|73605|2022|PDM|957.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F118194_50841_0|SrvcGrp|21920|2022|PDM|240.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F122240_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F135207_76053_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F70984_0_0|SrvcGrp|67995|2022|PDM|2800.00|99|0.00|CPT 57287 57288|
20|FH_F148319_37042_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129408_48034_0|SrvcGrp|33722|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F113255_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131254_92211_0|SrvcGrp|86840|2022|PDM|35.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F142073_0_0|SrvcGrp|80617|2022|PDM|11900.00|99|0.00|ARTHOPLASTY|
20|FH_F115740_78957_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F33712_0_0|SrvcGrp|18204|2022|PCT|0.75|99|0.00|MS DRG 027|
20|FH_F123850_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F101201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F33642_0_0|SrvcGrp|9510|2022|PDM|575.00|99|0.00|SKILLED NURSING CARE|
20|FH_F52854_0_0|CSTM-ALL|CSTM-00|2020|PDM|101.00|99|0.00|SKILLED NURSING RN|
20|FH_F117902_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F131236_84041_0|SrvcGrp|27969|2022|PDM|19.25|99|0.00|HOME HEALTH AIDE|
20|FH_F128237_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F124388_0_0|SrvcGrp|63468|2022|PDM|1254.00|99|0.00|CPT 52281|
20|FH_F123481_90049_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143809_62401_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F102302_0_0|SrvcGrp|98576|2022|PDM|29900.00|99|0.00|REMOVE VERTEBRAL BODY ADD-ON|
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F149047_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|GENERAL ACUTE CARE|
20|FH_F135021_37160_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F52854_0_0|SrvcGrp|15860|2022|PDM|1170.00|99|0.00|SUB-ACUTE REHAB|
20|FH_F125028_19061_0|SrvcGrp|86835|2022|PDM|15.75|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F37679_0_0|SrvcGrp|17003|2022|PDM|110.00|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS|
20|FH_F119417_78212_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F119417_78212_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F138283_0_0|SrvcGrp|90340|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F128545_29569_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41429_0_0|SrvcGrp|13811|2022|PDM|263.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F144191_0_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F125216_66755_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150579_16652_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146220_72112_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38700_0_0|SrvcGrp|18338|2022|PCT|0.80|99|0.00|MS DRG 471|
20|FH_F120437_85202_0|SrvcGrp|86836|2022|PDM|33.77|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F141654_15217_0|SrvcGrp|27969|2022|PDM|44.56|99|0.00|HOME HEALTH AIDE|
20|FH_F133028_08021_0|SrvcGrp|73841|2022|PDM|407.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F56792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1912.00|99|0.00|ASPG VII WITH MOD SG|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|NURSING CARE|
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100665_07939_0|SrvcGrp|90854|2022|PDM|2744.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F133028_08021_0|SrvcGrp|86723|2022|PDM|407.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F111809_93003_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F100788_01420_0|SrvcGrp|73601|2022|PDM|6189.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F112832_06776_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120746_29621_0|SrvcGrp|92502|2022|PDM|558.43|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F72936_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133261_78041_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F97042_64804_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F94165_0_0|SrvcGrp|76257|2022|PCT|0.85|99|0.00|CARDIAC STUDIES|
20|FH_F38394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F125365_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150122_75020_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132934_63005_0|SrvcGrp|73842|2022|PDM|674.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F132080_0_0|SrvcGrp|94781|2022|PDM|169.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KD|
20|FH_F128559_43524_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F148555_0_0|SrvcGrp|21781|2022|PDM|5871.00|99|0.00|OP AICD 33249|
20|FH_F146139_37604_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F72859_0_0|SrvcGrp|11793|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F111789_25301_0|SrvcGrp|537|2022|PCT|0.77|99|0.00|OBSERVATION SERVICES|
20|FH_F48230_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148555_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|97.92|99|0.00|DELAWARE VALLEY- ASC 222|
20|FH_F35857_0_0|CSTM-ALL|CSTM-00|2020|PDM|915.00|99|0.00|AEG 2 (NO REV)|
20|FH_F147998_07030_0|SrvcGrp|111348|2022|PCT|1.10|99|0.00|OP THERAPY SERVICES|
20|FH_F146361_66215_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.52|99|0.00|HAPA WPA-NWPA 2012-13 ASC 231 W/O REV|
20|FH_F133019_23236_0|SrvcGrp|48394|2022|PDM|34.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F129007_21532_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111809_93003_0|SrvcGrp|78782|2022|PDM|36183.00|99|0.00|INTRACARDIAC CATHETER PROCEDURES|
20|FH_F128144_45697_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F46286_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|5885.00|99|0.00|AEG 9 (NO REV)|
20|FH_F117945_78957_0|SrvcGrp|78180|2022|PDM|650.00|99|0.00|AETNA RESIDENTIAL TREATMENT|
20|FH_F67639_0_0|SrvcGrp|63466|2022|PDM|800.00|99|0.00|CPT 52005|
20|FH_F87173_15136_0|SrvcGrp|48398|2022|PDM|104.00|99|0.00|PT SERVICES|
20|FH_F112953_06066_0|SrvcGrp|472|2022|PDM|691.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150526_16335_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111540_16823_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F36756_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD AV|
20|FH_F115329_79424_0|SrvcGrp|86723|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F132591_75146_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119070_0_0|SrvcGrp|106798|2022|PDM|4100.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F101840_76054_0|SrvcGrp|21214|2022|PDM|14641.00|99|0.00|MS DRG 739 ONLY|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/MOD AV (TX)|
20|FH_F133214_75024_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|944.00|99|0.00|AEG 5  (NO REV)|
20|FH_F87594_81501_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|OP SVCS|
20|FH_F68944_0_0|SrvcGrp|3499|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F101840_76054_0|SrvcGrp|76847|2022|PDM|5565.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F43411_0_0|CSTM-ALL|CSTM-00|2020|PDM|5265.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F38663_0_0|SrvcGrp|10542|2022|PDM|74.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F39516_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|25783.00|99|0.00|MS DRG 238|
20|FH_F146211_68144_0|SrvcGrp|112727|2022|PCT|1.00|99|0.00|COVID-19 IA NFCT AB SARS COV 2|
20|FH_F117559_08619_0|SrvcGrp|73362|2022|PDM|15.00|99|0.00|VACCINE SERVICES|
20|FH_F62601_0_0|SrvcGrp|46604|2022|PDM|31.25|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F114974_0_0|SrvcGrp|79561|2022|PDM|1650.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F133052_33462_0|SrvcGrp|89149|2022|PDM|230.00|99|0.00|OP INTENSIVE|
20|FH_F150001_33064_0|SrvcGrp|86834|2022|PDM|11.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F92676_15063_0|SrvcGrp|78964|2022|PDM|2189.27|99|0.00|MON VALLEY ASC 12|
20|FH_F139594_0_0|SrvcGrp|38364|2022|PDM|4800.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PDM|388.57|99|0.00|AEG 1 (NO REV)|
20|FH_F145328_90301_0|SrvcGrp|113330|2022|PDM|5600.00|99|0.00|MED TX INSERT/REMOVE IMP|
20|FH_F111421_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67379_0_0|SrvcGrp|20908|2022|PDM|11300.00|99|0.00|MS DRG 247 ONLY|
20|FH_F95641_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|779.00|99|0.00|AEG 10 (NO REV)|
20|FH_F68842_0_0|SrvcGrp|12159|2022|PDM|133.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F73304_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110240_0_0|SrvcGrp|79593|2022|PDM|743.00|99|0.00|CPT 45378|
20|FH_F148599_98034_0|SrvcGrp|73480|2022|PDM|7933.00|99|0.00|VAGINAL COMPLEX DELIVERY MSDRG 774-775 ONLY|
20|FH_F145884_72113_0|SrvcGrp|87317|2022|PDM|849.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F128605_20910_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F33537_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F128492_49010_0|SrvcGrp|84185|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|2424.00|99|0.00|AEG 8 (NO REV)|
20|FH_F49035_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F148761_33311_0|SrvcGrp|88857|2022|PDM|75.00|99|0.00|THERAPEUTIC ACTIVITIES|
20|FH_F151058_18064_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151140_33134_0|CSTM-ALL|CSTM-00|2020|PCT|1.12|99|0.00|HSS ASC|
20|FH_F151152_19150_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151155_26508_0|SrvcGrp|58705|2022|PDM|189.00|99|0.00|EVALUATION & MANAGEMENT NEW PATIENT (HCFA)|
20|FH_F151199_77511_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151226_33155_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151259_16505_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151259_16505_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121897_28144_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114968_0_0|SrvcGrp|30089|2022|PDM|455.28|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F145690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132810_0_0|SrvcGrp|92184|2022|PDM|8.00|99|0.00|HCPCS S9340 (HCFA)|
20|FH_F67901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69968_0_0|SrvcGrp|46530|2022|PDM|182.91|99|0.00|EMERGENCY ROOM LEVEL 1|
20|FH_F107200_0_0|SrvcGrp|101525|2022|PDM|5722.00|99|0.00|MYOMECTOMY|
20|FH_F136299_75218_0|SrvcGrp|73499|2022|PDM|1500.00|99|0.00|AETNA ER LEVEL II|
20|FH_F136400_70360_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118156_19446_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118198_38119_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F120444_84037_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F134011_84102_0|SrvcGrp|14945|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F134066_33881_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137247_40160_0|SrvcGrp|73841|2022|PDM|271.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F114092_83350_0|SrvcGrp|79786|2022|PDM|225.00|99|0.00|SLEEP STUDIES|
20|FH_F142654_73034_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140407_63841_0|SrvcGrp|113297|2022|PDM|16.94|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - PFIZER|
20|FH_F140450_18104_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140493_67107_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140570_46996_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F149643_91367_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F119023_91406_0|SrvcGrp|86838|2022|PDM|12.50|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F118818_19808_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F38332_0_0|SrvcGrp|18809|2022|PDM|42216.00|99|0.00|MS DRG 219|
20|FH_F92634_08244_0|SrvcGrp|76619|2022|PCT|0.70|99|0.00|THERAPY|
20|FH_F109920_39180_0|SrvcGrp|30089|2022|PDM|357.50|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F70665_0_0|SrvcGrp|42825|2022|PDM|48.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F92852_0_0|SrvcGrp|88154|2022|PDM|2200.00|99|0.00|LASER TREATMENT OLD RETINA|
20|FH_F147927_19083_0|SrvcGrp|74668|2022|PDM|231.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147940_33626_0|SrvcGrp|115228|2022|PDM|230.00|99|0.00|INTENSIVE OP (12-25 YRS)|
20|FH_F129483_77030_0|SrvcGrp|86827|2022|PDM|60.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F129504_02871_0|SrvcGrp|89783|2022|PDM|165.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F117240_37334_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F137901_60089_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F111593_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90880_15108_0|SrvcGrp|89503|2022|PCT|1.00|99|0.00|GAIT TRAINING THERAPY|
20|FH_F31783_0_0|SrvcGrp|18253|2022|PDM|7400.00|99|0.00|MS DRG 287|
20|FH_F129130_92562_0|CSTM-ALL|CSTM-00|2020|PCT|0.34|99|0.00|OP SVCS|
20|FH_F36386_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F86911_0_0|SrvcGrp|85655|2022|PDM|5.80|99|0.00|VIA GARVITY|
20|FH_F142312_62301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|835.00|99|0.00|AEG 3 (NO REV)|
20|FH_F113392_0_0|SrvcGrp|84182|2022|PDM|1177.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE|
20|FH_F113541_0_0|SrvcGrp|83835|2022|PDM|2579.00|99|0.00|REPLACE TISSUE EXPANDER|
20|FH_F39209_0_0|SrvcGrp|29930|2022|PDM|400.00|99|0.00|DIALYSIS|
20|FH_F110211_78666_0|SrvcGrp|46903|2022|PDM|660.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F110212_17013_0|SrvcGrp|89337|2022|PDM|746.00|99|0.00|DETOXIFICATION|
20|FH_F136132_0_0|SrvcGrp|112812|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER|
20|FH_F138929_0_0|SrvcGrp|109834|2022|PDM|4620.00|99|0.00|REPAIR HUMERUS FRACTURE|
20|FH_F134270_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F141127_62286_0|SrvcGrp|74403|2022|PCT|0.80|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F114389_50131_0|SrvcGrp|99034|2022|PDM|155.54|99|0.00|ANTIBIOTIC Q18H (HCFA)|
20|FH_F141336_16947_0|SrvcGrp|12840|2022|PCT|0.39|99|0.00|PACEMAKER|
20|FH_F124129_33603_0|SrvcGrp|69073|2022|PDM|149.00|99|0.00|CPT 99215|
20|FH_F146921_43050_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38047_0_0|SrvcGrp|97|2022|PDM|2994.00|99|0.00|C-SECTION|
20|FH_F38081_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47636_0_0|SrvcGrp|12403|2022|PDM|32.33|99|0.00|CONTINUOUS HOMECARE|
20|FH_F49943_0_0|SrvcGrp|42975|2022|PDM|140.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F124173_66215_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F124414_92653_0|SrvcGrp|74668|2022|PDM|275.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124653_64062_0|SrvcGrp|75545|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F124687_64024_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F114912_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|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_F127995_84010_0|SrvcGrp|16750|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F89273_0_0|SrvcGrp|88261|2022|PDM|275.00|99|0.00|OCULAR IMPLANTS (HCFA)|
20|FH_F98042_10468_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F136622_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136701_45150_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F113787_31909_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F138247_76201_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F144039_0_0|SrvcGrp|42550|2022|PDM|5738.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F132721_0_0|SrvcGrp|360|2022|PDM|2059.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F135720_90025_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F112187_98272_0|SrvcGrp|72984|2022|PCT|0.81|99|0.00|CHEMOTHERAPY|
20|FH_F141170_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F115181_78602_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147586_44124_0|SrvcGrp|35668|2022|PDM|1634.00|99|0.00|CPT 29824|
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|1140.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F42754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|PSYCHIATRIC OP SVCS|
20|FH_F98621_41042_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F103004_75840_0|SrvcGrp|73602|2022|PDM|522.00|99|0.00|AETNA NEWBORN NURSERY I|
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_F48772_66044_0|SrvcGrp|87799|2022|PDM|118.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F140873_0_0|SrvcGrp|84185|2022|PDM|152.00|99|0.00|RESPITE CARE|
20|FH_F95221_0_0|SrvcGrp|73002|2022|PDM|1066.00|99|0.00|AEG 7|
20|FH_F111836_12901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145721_0_0|SrvcGrp|83857|2022|PDM|925.00|99|0.00|IP HOSPICE SVCS|
20|FH_F39346_0_0|SrvcGrp|27815|2022|PDM|6950.00|99|0.00|MS DRG 281 ONLY|
20|FH_F102641_0_0|SrvcGrp|73000|2022|PDM|1394.00|99|0.00|AEG 6|
20|FH_F68322_0_0|SrvcGrp|17075|2022|PDM|1480.00|99|0.00|ASPG VI|
20|FH_F134087_0_0|SrvcGrp|93059|2022|PDM|3607.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F134612_0_0|SrvcGrp|108120|2022|PDM|1500.00|99|0.00|REPL TUNNLD CNTRL CVC W/O PORT/PUMP|
20|FH_F144648_0_0|SrvcGrp|107749|2022|PDM|182.00|99|0.00|CAPD/CCPD|
20|FH_F120683_80238_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
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|CSTM-ALL|CSTM-00|2020|PDM|1541.00|99|0.00|WILLS COMM SURG SVC ASC 6|
20|FH_F54552_0_0|SrvcGrp|8961|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F138634_33125_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138936_01040_0|SrvcGrp|112678|2022|PCT|1.00|99|0.00|COVID-19 SPECIMEN COLLECT|
20|FH_F138992_72703_0|SrvcGrp|112967|2022|PCT|1.69|99|0.00|LABORATORY SERVICES|
20|FH_F89580_0_0|SrvcGrp|16632|2022|PDM|8972.00|99|0.00|TRAUMA SVCS|
20|FH_F117715_0_0|SrvcGrp|74585|2022|PCT|0.50|99|0.00|AETNA OP IMPLANTS|
20|FH_F151427_04106_0|SrvcGrp|116011|2022|PDM|158.13|99|0.00|CHEMOTHERAPY ADMINISTRATION (HCFA)|
20|FH_F132258_45404_0|SrvcGrp|17014|2022|PDM|34.98|99|0.00|HOME INFUSION THERAPY|
20|FH_F144928_02703_0|SrvcGrp|72602|2022|PDM|504.00|99|0.00|ECT|
20|FH_F123184_20906_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F135379_61530_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135435_06067_0|SrvcGrp|472|2022|PDM|595.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F135453_70726_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F100880_67735_0|SrvcGrp|30623|2022|PDM|4530.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F131463_19096_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F130996_34110_0|SrvcGrp|41334|2022|PDM|17000.00|99|0.00|TOTAL KNEE|
20|FH_F116397_33404_0|SrvcGrp|19742|2022|PDM|65.00|99|0.00|MID-LINE INSERTION|
20|FH_F116461_77536_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F116527_70443_0|SrvcGrp|104363|2022|PCT|1.00|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F127399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140629_0_0|SrvcGrp|113673|2022|PDM|2497.00|99|0.00|ENTEROLYSIS LAPAROSCOPY|
20|FH_F140629_0_0|SrvcGrp|107440|2022|PDM|1016.00|99|0.00|AETNA CYSTOSCOPY|
20|FH_F101681_46123_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|772.00|99|0.00|AEG 2 (NO REV)|
20|FH_F31229_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|588.00|99|0.00|ACUTE PSYCH|
20|FH_F72586_0_0|SrvcGrp|10503|2022|PDM|47.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F128353_22191_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111292_33136_0|SrvcGrp|16|2022|PDM|1967.00|99|0.00|ACUTE REHABILITATION|
20|FH_F140987_0_0|SrvcGrp|86233|2022|PDM|3750.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|1814.71|99|0.00|AEG 9 (NO REV)|
20|FH_F145587_0_0|SrvcGrp|82111|2022|PDM|1262.70|99|0.00|KNEE ARTHROSCOPY SURGICAL|
20|FH_F33081_0_0|SrvcGrp|3458|2022|PDM|2650.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F34864_0_0|CSTM-ALL|CSTM-00|2020|PDM|1446.00|99|0.00|ASPG III|
20|FH_F72889_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F113487_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102325_62691_0|SrvcGrp|10577|2022|PDM|80.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F129220_18445_0|SrvcGrp|104442|2022|PDM|72.00|99|0.00|AETNA OFFICE/OP VISIT EST (HCFA)|
20|FH_F62333_0_0|SrvcGrp|3810|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F37970_0_0|SrvcGrp|27699|2022|PCT|1.00|99|0.00|DME|
20|FH_F130656_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 1 (NO REV)|
20|FH_F130662_07032_0|SrvcGrp|86722|2022|PDM|222.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F130725_33020_0|SrvcGrp|46903|2022|PDM|854.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F128278_21401_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F92477_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120484_31419_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|1740.70|99|0.00|2005 ASPG GROUPER IX|
20|FH_F100782_0_0|SrvcGrp|105179|2022|PDM|1750.00|99|0.00|WINDBER MEDICAL CNTR ASC 1405|
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_F134613_08852_0|SrvcGrp|3178|2022|PDM|1240.00|99|0.00|ACUTE PSYCH|
20|FH_F127486_06776_0|SrvcGrp|63119|2022|PDM|15.72|99|0.00|BASIC HOME HOSPICE CARE|
20|FH_F148643_71343_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110921_53014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F117206_0_0|SrvcGrp|73006|2022|PDM|3880.00|99|0.00|AEG 9|
20|FH_F100782_0_0|SrvcGrp|97521|2022|PDM|2892.72|99|0.00|WINDBER MEDICAL CNTR ASC 14|
20|FH_F120719_27540_0|CSTM-ALL|CSTM-00|2020|PDM|9706.00|99|0.00|AEG 6 (NO REV)|
20|FH_F87571_0_0|SrvcGrp|45882|2022|PDM|85.00|99|0.00|PT|
20|FH_F88744_71103_0|SrvcGrp|99068|2022|PDM|40498.00|99|0.00|MS DRG 228-229 ONLY OTHER CARDIOTHORACIC PROC|
20|FH_F145702_22192_0|SrvcGrp|88620|2022|PDM|84.00|99|0.00|SKILLED NURSING RN|
20|FH_F145642_15108_0|SrvcGrp|86831|2022|PDM|3.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|4590.00|99|0.00|IMPLANTS|
20|FH_F145579_67226_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F110604_0_0|SrvcGrp|100661|2022|PDM|1485.00|99|0.00|AETNA OP SURGERY|
20|FH_F77943_0_0|SrvcGrp|28002|2022|PDM|28613.02|99|0.00|MS DRG 253-254 ONLY|
20|FH_F145604_14850_0|SrvcGrp|29347|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE|
20|FH_F129273_57783_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F127642_07047_0|SrvcGrp|99073|2022|PDM|1.32|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F110420_60649_0|SrvcGrp|73461|2022|PDM|2500.00|99|0.00|AETNA NICU IV|
20|FH_F130364_01331_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139299_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F117206_0_0|SrvcGrp|104450|2022|PDM|1500.00|99|0.00|CYSTOURETHRO W/ ADDL IMPLANT|
20|FH_F110507_33462_0|SrvcGrp|46903|2022|PDM|635.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F149084_33401_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F85353_16407_0|SrvcGrp|63901|2022|PDM|161.83|99|0.00|HAPA WPA-NWPA 2012-13 ASC 239|
20|FH_F125870_0_0|SrvcGrp|49205|2022|PDM|2445.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F85214_70360_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F49452_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F135626_20176_0|SrvcGrp|108484|2022|PDM|780.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|AEG 5  (NO REV)|
20|FH_F112060_07514_0|SrvcGrp|96402|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA|
20|FH_F143771_0_0|SrvcGrp|103911|2022|PDM|641.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY|
20|FH_F81838_0_0|SrvcGrp|10649|2022|PDM|8.00|99|0.00|HOME INFUSION|
20|FH_F80172_0_0|SrvcGrp|24754|2022|PCT|0.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F130327_03867_0|SrvcGrp|23683|2022|PDM|80.11|99|0.00|SKILLED NURSING RN|
20|FH_F136318_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F79863_0_0|SrvcGrp|49466|2022|PDM|22.00|99|0.00|GROWTH HORMONE|
20|FH_F144808_0_0|SrvcGrp|89842|2022|PDM|7699.00|99|0.00|LUMBAR|
20|FH_F134371_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.35|99|0.00|GENERAL ACUTE CARE|
20|FH_F133815_46526_0|SrvcGrp|92002|2022|PCT|0.00|99|0.00|VBAC DELIVERY|
20|FH_F120559_29108_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F138050_52301_0|SrvcGrp|73842|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|124.97|99|0.00|HAPA WPA-NWPA 2012-13 ASC 244 W/O REV|
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130763_0_0|SrvcGrp|104008|2022|PDM|3450.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS|
20|FH_F146657_01105_0|SrvcGrp|114674|2022|PDM|29.20|99|0.00|CRISIS INTERV SERV (MOD HN)|
20|FH_F118469_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F85097_0_0|SrvcGrp|3029|2022|PDM|2717.00|99|0.00|NEWBORN NURSERY|
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PDM|965.00|99|0.00|AEG 4 (NO REV)|
20|FH_F145641_06902_0|SrvcGrp|69964|2022|PDM|5672.00|99|0.00|CPT 23120|
20|FH_F134593_60007_0|SrvcGrp|22592|2022|PDM|48.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F130017_02302_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F124173_66215_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F89358_64735_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F139873_0_0|SrvcGrp|41336|2022|PDM|2215.00|99|0.00|VAGINAL HYSTERECTOMY|
20|FH_F54592_0_0|SrvcGrp|24750|2022|PDM|80.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F85894_0_0|CSTM-ALL|CSTM-00|2020|PDM|978.00|99|0.00|SKILLED NURSING|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|238.42|99|0.00|HAPA WPA-NWPA 2012-13 ASC 230 W/O REV|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F66782_0_0|SrvcGrp|42976|2022|PDM|80.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F146716_46733_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120795_27514_0|SrvcGrp|77304|2022|PCT|0.55|99|0.00|DIAGNOSTIC DRUGS|
20|FH_F33515_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F133667_83642_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F133478_40165_0|SrvcGrp|28163|2022|PDM|72257.00|99|0.00|MS DRG 222 ONLY|
20|FH_F130657_04614_0|SrvcGrp|107806|2022|PCT|2.25|99|0.00|CHEMOTHERAPY/ALL OTHER DRUGS|
20|FH_F133700_92808_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F111601_15203_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F139428_65270_0|SrvcGrp|88620|2022|PDM|97.85|99|0.00|SKILLED NURSING RN|
20|FH_F139667_84078_0|SrvcGrp|48398|2022|PDM|101.00|99|0.00|PT SERVICES|
20|FH_F150745_03301_0|SrvcGrp|48398|2022|PDM|167.00|99|0.00|PT SERVICES|
20|FH_F150841_84757_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F134869_08854_0|SrvcGrp|108369|2022|PDM|125.00|99|0.00|PSYTX W PT W E/M 30 MINS (HCFA)|
20|FH_F40289_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F50078_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F149608_19116_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124714_64081_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F140608_0_0|SrvcGrp|48385|2022|PDM|134.00|99|0.00|SPEECH THERAPY|
20|FH_F47558_0_0|SrvcGrp|40409|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD NU KC|
20|FH_F97280_20018_0|SrvcGrp|73485|2022|PDM|5320.00|99|0.00|AETNA REHAB|
20|FH_F132694_0_0|SrvcGrp|11000|2022|PCT|0.49|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F124492_30040_0|SrvcGrp|111927|2022|PDM|56.44|99|0.00|COVID-19 NON CDC|
20|FH_F132105_61554_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PDM|807.50|99|0.00|AEG 1 (NO REV)|
20|FH_F117645_90034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124433_77338_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132512_0_0|SrvcGrp|100499|2022|PDM|995.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F138018_17313_0|SrvcGrp|22592|2022|PDM|90.43|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F128198_34208_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F116753_0_0|SrvcGrp|73606|2022|PDM|971.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F116753_0_0|SrvcGrp|104977|2022|PDM|1473.00|99|0.00|CAT SCAN (HCFA)|
20|FH_F134394_92101_0|SrvcGrp|112558|2022|PDM|414.00|99|0.00|INTENSIVE OP (12-17 YRS)|
20|FH_F150931_65201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147532_0_0|SrvcGrp|113613|2022|PDM|87.23|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|1024.00|99|0.00|ACUTE PSYCH|
20|FH_F122396_90024_0|SrvcGrp|108484|2022|PDM|1224.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F138018_17313_0|SrvcGrp|22590|2022|PDM|41.72|99|0.00|PAIN MANAGAMENT - INTERMITTENT|
20|FH_F37081_0_0|SrvcGrp|18145|2022|PDM|20200.00|99|0.00|MS DRG 248|
20|FH_F109762_0_0|SrvcGrp|72998|2022|PDM|717.00|99|0.00|AEG 5|
20|FH_F34853_0_0|SrvcGrp|9838|2022|PDM|2449.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F39443_0_0|SrvcGrp|30344|2022|PDM|687.00|99|0.00|HAPA WPA ASC 3|
20|FH_F37198_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F151699_01752_0|SrvcGrp|10577|2022|PDM|50.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F114848_50533_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F90232_15126_0|SrvcGrp|43568|2022|PDM|70.35|99|0.00|SKILLED NURSING - RN|
20|FH_F47558_0_0|SrvcGrp|43263|2022|PDM|3.80|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F132254_40207_0|SrvcGrp|86842|2022|PDM|45.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F132878_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147166_03444_0|SrvcGrp|90397|2022|PDM|1750.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F110732_31513_0|SrvcGrp|537|2022|PCT|0.60|99|0.00|OBSERVATION SERVICES|
20|FH_F35778_33321_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|GENERAL ACUTE CARE|
20|FH_F35369_0_0|SrvcGrp|413|2022|PCT|0.80|99|0.00|TRANSPLANT SVCS|
20|FH_F94643_90501_0|SrvcGrp|86834|2022|PDM|25.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F40657_0_0|CSTM-ALL|CSTM-00|2020|PDM|1379.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36620_0_0|SrvcGrp|473|2022|PDM|447.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F148539_33548_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147310_77036_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139927_0_0|SrvcGrp|471|2022|PDM|818.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F126189_89129_0|SrvcGrp|73842|2022|PDM|206.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131449_19073_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124441_0_0|SrvcGrp|107835|2022|PDM|2375.00|99|0.00|NERVE REPAIR|
20|FH_F36943_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD NU|
20|FH_F101441_0_0|SrvcGrp|19922|2022|PDM|4323.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F150924_90029_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F36803_0_0|SrvcGrp|701|2022|PDM|2027.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F149459_06615_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F126256_24293_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 8 (NO REV)|
20|FH_F36720_0_0|SrvcGrp|12299|2022|PCT|1.10|99|0.00|PROSTHETICS/IMPLANTS/DEVICES|
20|FH_F101441_0_0|SrvcGrp|16669|2022|PDM|3567.00|99|0.00|ACROMINOPLASTY OF SHOULDER|
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 4 (NO REV)|
20|FH_F37361_0_0|SrvcGrp|9832|2022|PDM|82.50|99|0.00|ST SVCS|
20|FH_F146266_0_0|SrvcGrp|99162|2022|PDM|15452.00|99|0.00|CPT 24366|
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|2250.00|99|0.00|AEG 4 (NO REV)|
20|FH_F33366_33952_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|77450|2022|PDM|1322.00|99|0.00|CPT 54161|
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|AEG 1 (NO REV)|
20|FH_F74424_0_0|SrvcGrp|42870|2022|PDM|255.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F97184_26101_0|SrvcGrp|73602|2022|PDM|3429.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F35745_33952_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|GENERAL ACUTE CARE|
20|FH_F126116_0_0|SrvcGrp|103644|2022|PDM|11291.00|99|0.00|AETNA TIB/ PER REVASE W/ ATHER|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F111266_30339_0|SrvcGrp|16750|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F140210_60643_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F84631_0_0|SrvcGrp|26160|2022|PDM|49.52|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F84631_0_0|SrvcGrp|62389|2022|PDM|111.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F151785_03104_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD UE|
20|FH_F49286_0_0|SrvcGrp|10519|2022|PDM|125.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F132371_19083_0|SrvcGrp|48396|2022|PDM|102.00|99|0.00|OT SERVICES|
20|FH_F132419_84042_0|SrvcGrp|108484|2022|PDM|1120.36|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F132446_19063_0|SrvcGrp|23681|2022|PDM|76.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F112712_63005_0|SrvcGrp|29075|2022|PCT|1.00|99|0.00|HYDRATION THERAPY|
20|FH_F119921_83213_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|OP SVCS|
20|FH_F120948_53188_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120974_27607_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F128517_57301_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F35685_0_0|SrvcGrp|11186|2022|PDM|27563.00|99|0.00|DRG 549 CORONARY BYPASS W/O CC W/MAJOR CV DX|
20|FH_F36472_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F36464_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2098.00|99|0.00|AEG 10 (NO REV)|
20|FH_F36533_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|1108.00|99|0.00|AEG 8 (NO REV)|
20|FH_F151084_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93881_15009_0|SrvcGrp|103503|2022|PDM|5795.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F91056_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F136510_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|ASPG X|
20|FH_F40046_0_0|SrvcGrp|10543|2022|PDM|125.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|1818.00|99|0.00|AEG 6 (NO REV)|
20|FH_F143895_47631_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F116176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145542_70503_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F130840_21738_0|SrvcGrp|112073|2022|PDM|1375.00|99|0.00|RESIDENITAL TREATMENT EATING DISORDER (AGE 18-99)|
20|FH_F102302_0_0|SrvcGrp|98563|2022|PDM|39100.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F133714_03570_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F40043_0_0|SrvcGrp|33269|2022|PCT|0.76|99|0.00|GA ASPG IX|
20|FH_F110066_36608_0|SrvcGrp|82981|2022|PDM|145.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F34112_0_0|SrvcGrp|16099|2022|PDM|5550.00|99|0.00|LAPAROSCOPIC PROSTATECTOMY|
20|FH_F93881_15009_0|SrvcGrp|81409|2022|PDM|37.00|99|0.00|ASSAY SERUM IRON|
20|FH_F102184_0_0|SrvcGrp|79644|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72887_0_0|SrvcGrp|33164|2022|PDM|310.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F34112_0_0|SrvcGrp|16097|2022|PDM|5550.00|99|0.00|LAPAROSCOPIC HYSTERECTOMY|
20|FH_F34241_0_0|SrvcGrp|3259|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION|
20|FH_F120215_92064_0|SrvcGrp|75419|2022|PDM|404.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F116061_80110_0|SrvcGrp|89149|2022|PDM|290.00|99|0.00|OP INTENSIVE|
20|FH_F116269_92627_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F135065_08043_0|SrvcGrp|108484|2022|PDM|1000.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F73985_0_0|SrvcGrp|17608|2022|PDM|1424.00|99|0.00|MENTAL HEALTH / DETOX|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 228-230|
20|FH_F33592_0_0|CSTM-ALL|CSTM-00|2020|PDM|109.00|99|0.00|OP SVCS|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD UE|
20|FH_F141510_95123_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F145536_90265_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F118194_50841_0|SrvcGrp|14893|2022|PDM|90.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F99960_0_0|SrvcGrp|67989|2022|PDM|1760.00|99|0.00|CPT 49320|
20|FH_F39617_0_0|SrvcGrp|3277|2022|PDM|637.00|99|0.00|SKILLED NURSING CARE|
20|FH_F82753_18840_0|SrvcGrp|80520|2022|PDM|33356.00|99|0.00|STEREOTACTIC STIMULATION OF SPINAL CORD|
20|FH_F63481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|GENERAL ACUTE CARE|
20|FH_F39920_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ACUTE PSYCH|
20|FH_F115685_64064_0|SrvcGrp|86827|2022|PDM|80.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F137611_30909_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F139952_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 9 (NO REV)|
20|FH_F145845_37167_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100666_81301_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|543.40|99|0.00|ASPG II|
20|FH_F111809_93003_0|SrvcGrp|113939|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F92676_15063_0|SrvcGrp|78987|2022|PDM|1963.44|99|0.00|MON VALLEY ASC 403|
20|FH_F73304_0_0|CSTM-ALL|CSTM-00|2020|PDM|929.00|99|0.00|ASPG VIII|
20|FH_F106540_26330_0|CSTM-ALL|CSTM-00|2020|PCT|0.43|99|0.00|OP SVCS|
20|FH_F139707_84010_0|SrvcGrp|114706|2022|PDM|4912.00|99|0.00|UROLOGY PROCEDURES|
20|FH_F150881_52722_0|SrvcGrp|108484|2022|PDM|730.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F150882_84041_0|SrvcGrp|86845|2022|PDM|47.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 9 (NO REV)|
20|FH_F149480_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: BREAKOUT|
20|FH_F42979_0_0|SrvcGrp|3401|2022|PDM|96.00|99|0.00|CPT 90887|
20|FH_F149602_07109_0|SrvcGrp|113222|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS 22 TRGT SARS-COV-2|
20|FH_F133519_0_0|SrvcGrp|33977|2022|PDM|1255.00|99|0.00|CPT 59820|
20|FH_F47902_0_0|SrvcGrp|29665|2022|PCT|1.00|99|0.00|DME MOD NU|
20|FH_F37943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35751_34613_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 8 (NO REV)|
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|2265.00|99|0.00|AEG 8 (NO REV)|
20|FH_F150942_66743_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1575124_HCPCS_  MOD RR|
20|FH_F32825_0_0|SrvcGrp|10111|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F138017_73129_0|SrvcGrp|74039|2022|PDM|8949.00|99|0.00|LAMINECTOMY|
20|FH_F41320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PDM|2740.00|99|0.00|ASPG IX|
20|FH_F114206_37203_0|SrvcGrp|21920|2022|PDM|35.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F149539_06032_0|SrvcGrp|92502|2022|PDM|1188.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F148859_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151007_90048_0|SrvcGrp|75419|2022|PDM|540.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F45798_0_0|SrvcGrp|9529|2022|PDM|911.00|99|0.00|HOSPICE SVCS|
20|FH_F56232_0_0|CSTM-ALL|CSTM-00|2020|PDM|768.72|99|0.00|ASPG II|
20|FH_F134407_63801_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|2372.00|99|0.00|AEG 6 (NO REV)|
20|FH_F149522_83221_0|SrvcGrp|29155|2022|PDM|130.00|99|0.00|HOSPICE SVCS|
20|FH_F132672_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F91076_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90817_0_0|SrvcGrp|91039|2022|PDM|1866.00|99|0.00|RELEASE OF EYE FLUID (HCFA)|
20|FH_F114571_34613_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F150383_29853_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F32825_0_0|SrvcGrp|18543|2022|PCT|0.65|99|0.00|MS DRG 742|
20|FH_F31087_0_0|SrvcGrp|3140|2022|PCT|0.97|99|0.00|PHARMACY SERVICES|
20|FH_F34882_0_0|CSTM-ALL|CSTM-00|2020|PDM|2856.20|99|0.00|MS DRG 775|
20|FH_F124322_64131_0|SrvcGrp|24750|2022|PDM|10.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F118907_0_0|SrvcGrp|107723|2022|PDM|663.75|99|0.00|SLEEP STUDIES|
20|FH_F37943_0_0|SrvcGrp|3810|2022|PDM|105.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F76826_0_0|SrvcGrp|12866|2022|PDM|116.00|99|0.00|NUTRITNAL CNSLNG/DIABETES EDU|
20|FH_F147224_48026_0|SrvcGrp|110537|2022|PDM|392.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F132105_61554_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117762_0_0|SrvcGrp|58775|2022|PDM|5720.00|99|0.00|CORPECTOMY|
20|FH_F102125_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F47037_0_0|SrvcGrp|10518|2022|PDM|92.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT|
20|FH_F131261_19111_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F131072_26416_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 2 (NO REV)|
20|FH_F101685_0_0|SrvcGrp|72994|2022|PDM|646.00|99|0.00|AEG 3|
20|FH_F31225_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98880_50158_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F126116_0_0|CSTM-ALL|CSTM-00|2020|PDM|736.00|99|0.00|AEG 1 (NO REV)|
20|FH_F126147_45241_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F108460_32746_0|SrvcGrp|73842|2022|PDM|165.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148860_0_0|SrvcGrp|3932|2022|PDM|5900.00|99|0.00|LITHOTRIPSY|
20|FH_F116753_0_0|SrvcGrp|106772|2022|PDM|1250.00|99|0.00|POLYSOMNOGRAPHY (HCFA)|
20|FH_F137748_95231_0|SrvcGrp|81779|2022|PCT|1.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F37081_0_0|SrvcGrp|18381|2022|PDM|18900.00|99|0.00|MS DRG 483|
20|FH_F134887_33409_0|SrvcGrp|84559|2022|PCT|1.05|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F149529_68102_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F139814_24333_0|SrvcGrp|90854|2022|PDM|724.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F97080_85122_0|SrvcGrp|73605|2022|PDM|2551.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F86717_0_0|CSTM-ALL|CSTM-00|2020|PDM|589.94|99|0.00|AEG 10 (NO REV)|
20|FH_F94643_90501_0|SrvcGrp|86852|2022|PDM|48.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F97480_08204_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F141278_80218_0|CSTM-ALL|CSTM-00|2020|PCT|1.24|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132160_0_0|SrvcGrp|109762|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESION(S)|
20|FH_F149160_02180_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|4284.00|99|0.00|AEG 8 (NO REV)|
20|FH_F41602_0_0|CSTM-ALL|CSTM-00|2020|PDM|668.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143928_21061_0|SrvcGrp|48385|2022|PDM|126.00|99|0.00|SPEECH THERAPY|
20|FH_F39714_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F121566_91360_0|SrvcGrp|74668|2022|PDM|551.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148103_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F102302_0_0|SrvcGrp|98607|2022|PDM|1817.00|99|0.00|REVISE ARM/LEG NERVE|
20|FH_F87254_0_0|SrvcGrp|63472|2022|PDM|1200.00|99|0.00|CPT 64581|
20|FH_F120251_21122_0|SrvcGrp|87317|2022|PDM|1700.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F141519_51566_0|SrvcGrp|112064|2022|PCT|0.95|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F110925_01104_0|SrvcGrp|26868|2022|PDM|59.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F120693_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|AETNA LABORATORY|
20|FH_F36135_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F130134_08724_0|SrvcGrp|111488|2022|PDM|700.00|99|0.00|IP PSYCHIATRIC SERVICES (12-99 YRS)|
20|FH_F68943_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F127441_45822_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F34550_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F145590_45242_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129782_0_0|CSTM-ALL|CSTM-00|2020|PDM|1406.00|99|0.00|AEG 7 (NO REV)|
20|FH_F120294_46322_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114977_78550_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F129653_0_0|SrvcGrp|72990|2022|PDM|1007.00|99|0.00|AEG 1|
20|FH_F89475_71202_0|CSTM-ALL|CSTM-00|2020|PDM|2774.00|99|0.00|AEG 7 (NO REV)|
20|FH_F88864_29601_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147941_06023_0|CSTM-ALL|CSTM-00|2020|PDM|31541.00|99|0.00|AEG 6 (NO REV)|
20|FH_F129968_98004_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|2029.00|99|0.00|AEG 8 (NO REV)|
20|FH_F39212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F146013_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|1500.00|99|0.00|AEG 2 (NO REV)|
20|FH_F66687_0_0|SrvcGrp|62296|2022|PDM|10381.00|99|0.00|HEART CATHETERIZATION - COMBINED RIGHT AND LEFT|
20|FH_F110086_21742_0|SrvcGrp|77461|2022|PDM|3000.00|99|0.00|CPT 52356|
20|FH_F32002_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33220_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123501_64831_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130424_41102_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134993_75034_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148265_06067_0|SrvcGrp|83639|2022|PDM|5113.00|99|0.00|CPT 29886|
20|FH_F125011_74467_0|SrvcGrp|72996|2022|PDM|2100.00|99|0.00|AEG 4|
20|FH_F38151_0_0|SrvcGrp|72|2022|PDM|423.00|99|0.00|NEWBORN NURSERY|
20|FH_F116269_92627_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F122694_33334_0|SrvcGrp|105439|2022|PDM|195.00|99|0.00|AETNA TERANIAL MAGN STIM TX DELI|
20|FH_F122694_33334_0|SrvcGrp|73842|2022|PDM|207.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F38696_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F119356_47150_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138283_0_0|SrvcGrp|53145|2022|PDM|107.00|99|0.00|SOCIAL WORKER|
20|FH_F148419_01453_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148425_01507_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F148432_01585_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F117909_92405_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132886_0_0|SrvcGrp|13262|2022|PDM|10.92|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F117087_0_0|SrvcGrp|107169|2022|PDM|2494.00|99|0.00|SPHENOID SINUSOTOMY W/WO BIO|
20|FH_F132032_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F51438_0_0|CSTM-ALL|CSTM-00|2020|PDM|2350.00|99|0.00|ASPG VII|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|91.00|99|0.00|FAMILY PSYTX W PT 50 MINS|
20|FH_F132289_89145_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F87559_0_0|SrvcGrp|42723|2022|PDM|107.06|99|0.00|SLEEP STUDIES CPT 95806 W/MODIFIER TC|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD AV|
20|FH_F147800_0_0|SrvcGrp|110767|2022|PDM|458.00|99|0.00|2ND LEVEL INJ PARAVERT F JNT L/S|
20|FH_F51438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|ASPG III|
20|FH_F101853_77840_0|SrvcGrp|89337|2022|PDM|923.00|99|0.00|DETOXIFICATION|
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|1308.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F88818_0_0|SrvcGrp|75493|2022|PDM|600.00|99|0.00|AEG 8|
20|FH_F37724_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1181.65|99|0.00|HAPA WPA-NWPA 2012-13 ASC 7 W/O REV|
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_F150602_59718_0|SrvcGrp|104230|2022|PDM|153.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F40154_0_0|SrvcGrp|10107|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F34706_0_0|CSTM-ALL|CSTM-00|2020|PDM|4816.00|99|0.00|DRG 142 SYNCOPE & COLLAPSE W/O CC|
20|FH_F102361_44024_0|SrvcGrp|75545|2022|PDM|831.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F115315_43011_0|SrvcGrp|90479|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F146105_76016_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F46352_0_0|SrvcGrp|9828|2022|PDM|63.00|99|0.00|HOME HEALTH AIDE|
20|FH_F141907_74021_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F80859_65616_0|SrvcGrp|75506|2022|PCT|0.56|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F98921_64503_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F102822_84065_0|SrvcGrp|23683|2022|PDM|35.00|99|0.00|SKILLED NURSING RN|
20|FH_F125043_53545_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117872_33462_0|SrvcGrp|89149|2022|PDM|239.00|99|0.00|OP INTENSIVE|
20|FH_F49049_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F145937_75240_0|SrvcGrp|46605|2022|PDM|105.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|470.48|99|0.00|HAPA WPA-NWPA 2012-13 ASC 207 W/O REV|
20|FH_F68842_0_0|SrvcGrp|12401|2022|PDM|118.00|99|0.00|RN VISIT|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F72859_0_0|SrvcGrp|10567|2022|PDM|190.00|99|0.00|HOME INFUSION|
20|FH_F36756_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS NO MOD|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|53.64|99|0.00|DELAWARE VALLEY- ASC 125|
20|FH_F100788_01420_0|SrvcGrp|90854|2022|PDM|2627.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F38663_0_0|SrvcGrp|10644|2022|PDM|125.00|99|0.00|MIDLINE INSERTION NURSING|
20|FH_F116324_0_0|SrvcGrp|75493|2022|PDM|550.00|99|0.00|AEG 8|
20|FH_F133455_60110_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F43433_0_0|SrvcGrp|32438|2022|PDM|2076.00|99|0.00|JACKSON MADISON HOSP ASPG 2|
20|FH_F35454_0_0|SrvcGrp|16850|2022|PDM|24.00|99|0.00|ARM SPLINT|
20|FH_F89932_10940_0|SrvcGrp|89147|2022|PDM|5590.00|99|0.00|SPINAL PROCEDURES|
20|FH_F121304_61520_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F141802_17042_0|SrvcGrp|81779|2022|PCT|0.68|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F92676_15063_0|SrvcGrp|78981|2022|PDM|1292.27|99|0.00|MON VALLEY ASC 206|
20|FH_F92977_64067_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|102.58|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F44724_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109566_28601_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F101811_64116_0|SrvcGrp|99442|2022|PDM|108.00|99|0.00|SKILLED NURSING LPN|
20|FH_F31184_0_0|SrvcGrp|18848|2022|PDM|28000.00|99|0.00|MS DRG 228|
20|FH_F119775_0_0|SrvcGrp|72990|2022|PDM|371.00|99|0.00|AEG 1|
20|FH_F133019_23236_0|SrvcGrp|29347|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE|
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 10 (NO REV)|
20|FH_F36579_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALLIED MED-MOD RR|
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F132289_89145_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F50618_0_0|SrvcGrp|17073|2022|PDM|945.56|99|0.00|ASPG V|
20|FH_F133028_08021_0|SrvcGrp|89149|2022|PDM|242.00|99|0.00|OP INTENSIVE|
20|FH_F51545_0_0|SrvcGrp|42827|2022|PDM|150.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F127994_19301_0|SrvcGrp|69072|2022|PDM|110.00|99|0.00|CPT 99205|
20|FH_F132543_79549_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|HSS ASC WITH EMERGENCY|
20|FH_F38394_0_0|SrvcGrp|17065|2022|PDM|529.46|99|0.00|ASPG I|
20|FH_F112853_22408_0|SrvcGrp|87397|2022|PDM|100.00|99|0.00|CPT 99500 (HCFA)|
20|FH_F115329_79424_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F35278_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133021_00910_0|SrvcGrp|112266|2022|PDM|15550.00|99|0.00|EMBOLECTOMY/THROMBECTOMY|
20|FH_F150121_29072_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122245_0_0|SrvcGrp|3932|2022|PDM|3180.00|99|0.00|LITHOTRIPSY|
20|FH_F109625_27330_0|SrvcGrp|23853|2022|PCT|0.00|99|0.00|CLINIC VISITS|
20|FH_F120841_16201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118667_95131_0|SrvcGrp|48385|2022|PDM|120.00|99|0.00|SPEECH THERAPY|
20|FH_F133021_00910_0|SrvcGrp|112272|2022|PCT|1.10|99|0.00|BLOOD & DERIVATE|
20|FH_F133006_48067_0|SrvcGrp|86722|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F89112_16509_0|SrvcGrp|12290|2022|PDM|1192.00|99|0.00|DETOXIFICATION|
20|FH_F146104_33410_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F56792_0_0|SrvcGrp|34145|2022|PDM|2005.00|99|0.00|IOL PROCEDURES - CPD 1896590|
20|FH_F69727_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F115329_79424_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F38691_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F118785_33315_0|SrvcGrp|89337|2022|PDM|1275.00|99|0.00|DETOXIFICATION|
20|FH_F42343_0_0|CSTM-ALL|CSTM-00|2020|PDM|255.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F139607_0_0|SrvcGrp|12491|2022|PCT|0.30|99|0.00|PACEMAKER|
20|FH_F125475_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F77025_0_0|SrvcGrp|73944|2022|PDM|1383.00|99|0.00|CYSTOSCOPY|
20|FH_F148599_98034_0|CSTM-ALL|CSTM-00|2020|PCT|2.92|99|0.00|HSS APC E PROCEDURE NOT ON FS OR W/O WEIGHT|
20|FH_F37641_0_0|CSTM-ALL|CSTM-00|2020|PDM|932.00|99|0.00|ASPG VI|
20|FH_F111809_93003_0|SrvcGrp|114118|2022|PCT|9.35|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F151047_20860_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151144_35801_0|SrvcGrp|114442|2022|PDM|2589.70|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F151155_26508_0|SrvcGrp|113333|2022|PDM|1710.00|99|0.00|MED TX NALTREXONE (HCFA)|
20|FH_F43417_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132810_0_0|SrvcGrp|86854|2022|PDM|50.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F136489_25428_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F118193_06241_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120456_67117_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134156_32174_0|SrvcGrp|23587|2022|PDM|756.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F137147_75006_0|SrvcGrp|21124|2022|PDM|58435.00|99|0.00|MS DRG 471 ONLY|
20|FH_F114092_83350_0|SrvcGrp|88978|2022|PDM|3561.00|99|0.00|VAGINAL DELIVERY|
20|FH_F142314_19102_0|SrvcGrp|110811|2022|PDM|210.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F142667_63017_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125053_0_0|SrvcGrp|72992|2022|PDM|482.00|99|0.00|AEG 2|
20|FH_F140615_73013_0|CSTM-ALL|CSTM-00|2020|PDM|3093.00|99|0.00|AEG 7 (NO REV)|
20|FH_F149643_91367_0|SrvcGrp|75419|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F92852_0_0|SrvcGrp|28549|2022|PDM|2200.00|99|0.00|VITRECTOMY|
20|FH_F117267_07728_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F147801_90703_0|CSTM-ALL|CSTM-00|2020|PDM|1071.00|99|0.00|OBSERVATION SERVICES (12-17 YRS)|
20|FH_F129411_24540_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F129483_77030_0|SrvcGrp|86830|2022|PDM|5.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F129501_67831_0|SrvcGrp|103913|2022|PCT|1.00|99|0.00|OP DIALYSIS|
20|FH_F117219_77515_0|SrvcGrp|86723|2022|PDM|375.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F137901_60089_0|SrvcGrp|89149|2022|PDM|222.00|99|0.00|OP INTENSIVE|
20|FH_F137938_29036_0|SrvcGrp|105465|2022|PCT|0.66|99|0.00|AETNA THERAPIES|
20|FH_F34371_0_0|SrvcGrp|10542|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F109652_0_0|SrvcGrp|104397|2022|PDM|37263.00|99|0.00|LEFT VENTRICULAR ASSIST DEVICE (LVAD)|
20|FH_F109907_0_0|SrvcGrp|88621|2022|PDM|92.60|99|0.00|SKILLED NURSING LPN|
20|FH_F90671_33701_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)|
20|FH_F37625_0_0|SrvcGrp|24649|2022|PDM|370.00|99|0.00|HEMODIALYSIS|
20|FH_F37625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F66688_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|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F114267_0_0|SrvcGrp|105551|2022|PDM|1800.00|99|0.00|AETNA LAPAROSCOPY|
20|FH_F97780_43614_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F114916_30309_0|SrvcGrp|83641|2022|PDM|3700.00|99|0.00|CPT 29889|
20|FH_F114916_30309_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 4 (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|CSTM-ALL|CSTM-00|2020|PDM|3348.00|99|0.00|AEG 5  (NO REV)|
20|FH_F105381_66845_0|SrvcGrp|101401|2022|PDM|80.44|99|0.00|FREESTAND CLINIC VISIT|
20|FH_F40082_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER KM|
20|FH_F94786_07974_0|SrvcGrp|14944|2022|PDM|8.40|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F132627_0_0|SrvcGrp|21920|2022|PDM|18.36|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F132988_0_0|SrvcGrp|112153|2022|PDM|2057.62|99|0.00|REPAIR FOREARM TENDON/MUSCLE|
20|FH_F144828_0_0|SrvcGrp|114191|2022|PDM|3850.00|99|0.00|EXCISION EXCESSIVE SKIN|
20|FH_F118962_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.00|99|0.00|AEG 1 (NO REV)|
20|FH_F124180_0_0|SrvcGrp|72994|2022|PDM|2300.00|99|0.00|AEG 3|
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 4 (NO REV)|
20|FH_F124082_78526_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F146715_34240_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|510.00|99|0.00|ASPG X|
20|FH_F39956_0_0|CSTM-ALL|CSTM-00|2020|PDM|1004.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100000_45417_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124237_95023_0|SrvcGrp|75419|2022|PDM|900.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F124258_53140_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|990.00|99|0.00|AEG 2 (NO REV)|
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|2266.00|99|0.00|ASPG III|
20|FH_F89273_0_0|SrvcGrp|80263|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F113791_32055_0|SrvcGrp|92760|2022|PCT|1.18|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138855_84067_0|SrvcGrp|75754|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F43833_0_0|SrvcGrp|9533|2022|PDM|900.00|99|0.00|ONCOLOGY|
20|FH_F136913_68803_0|SrvcGrp|112971|2022|PDM|16163.00|99|0.00|CESAREAN SECTION (MOM ONLY)|
20|FH_F115157_06851_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115631_65201_0|SrvcGrp|26278|2022|PDM|3177.00|99|0.00|CPT 29881|
20|FH_F147331_90045_0|SrvcGrp|46605|2022|PDM|168.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F147539_68359_0|SrvcGrp|109029|2022|PCT|0.98|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F147586_44124_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F147586_44124_0|SrvcGrp|104257|2022|PDM|1065.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F41463_0_0|SrvcGrp|17001|2022|PDM|152.00|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F41463_0_0|SrvcGrp|22591|2022|PCT|0.60|99|0.00|IMPLANTED PUMP|
20|FH_F42814_0_0|CSTM-ALL|CSTM-00|2020|PDM|55.00|99|0.00|OP SVCS|
20|FH_F40345_0_0|SrvcGrp|115|2022|PDM|515.00|99|0.00|SKILLED NURSING CARE|
20|FH_F40600_0_0|SrvcGrp|705|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F111186_15213_0|SrvcGrp|73842|2022|PDM|314.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|2630.00|99|0.00|AEG 5  (NO REV)|
20|FH_F134192_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F129850_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|RADIOLOGY W/MOD 26|
20|FH_F111841_85212_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F114853_0_0|SrvcGrp|27261|2022|PDM|8661.00|99|0.00|CPT 27446|
20|FH_F131169_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F50994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112947_47303_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138787_32258_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F138907_01040_0|SrvcGrp|53987|2022|PDM|38.71|99|0.00|PHOTOTHERAPY|
20|FH_F67167_0_0|SrvcGrp|360|2022|PDM|1827.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F67167_0_0|SrvcGrp|359|2022|PDM|1091.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F78265_0_0|CSTM-ALL|CSTM-00|2020|PDM|4316.00|99|0.00|ASPG IX|
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|2006 MEDICARE ASPG V|
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 8 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|79.16|99|0.00|HAPA WPA-NWPA 2012-13 ASC 246 W/O REV|
20|FH_F151321_92626_0|SrvcGrp|90854|2022|PDM|1100.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F151507_32327_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135607_21613_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135930_02879_0|SrvcGrp|75522|2022|PCT|1.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD|
20|FH_F136180_92253_0|SrvcGrp|87131|2022|PDM|750.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F116397_33404_0|SrvcGrp|14949|2022|PDM|105.00|99|0.00|HOME INFUSION|
20|FH_F116468_49660_0|SrvcGrp|93919|2022|PDM|580.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F131361_18235_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F127399_0_0|SrvcGrp|73000|2022|PDM|3121.00|99|0.00|AEG 6|
20|FH_F121813_75701_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111301_33122_0|SrvcGrp|10107|2022|PCT|0.63|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F111301_33122_0|SrvcGrp|82750|2022|PDM|44.00|99|0.00|CHORIONIC GONADOTROPIN ASSAY|
20|FH_F111301_33122_0|SrvcGrp|72998|2022|PDM|2185.00|99|0.00|AEG 5|
20|FH_F134263_15628_0|SrvcGrp|86722|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|4750.00|99|0.00|AEG 8 (NO REV)|
20|FH_F54272_0_0|SrvcGrp|51785|2022|PCT|0.45|99|0.00|OP BLOOD PRODUCTS|
20|FH_F131000_0_0|SrvcGrp|44067|2022|PDM|3608.00|99|0.00|CPT 52240|
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|79595|2022|PDM|1800.00|99|0.00|CPT 45385|
20|FH_F36127_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118651_0_0|SrvcGrp|107870|2022|PDM|3713.15|99|0.00|AETNA EXC ABD TUM OVER 5 CM|
20|FH_F125745_66025_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141035_0_0|SrvcGrp|104255|2022|PDM|4450.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F102222_19720_0|SrvcGrp|86845|2022|PDM|31.50|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F102325_62691_0|SrvcGrp|65621|2022|PDM|15.00|99|0.00|RN NURSING|
20|FH_F148100_22406_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F37970_0_0|SrvcGrp|27693|2022|PCT|1.00|99|0.00|RADIOLOGY|
20|FH_F145604_14850_0|SrvcGrp|53987|2022|PDM|53.22|99|0.00|PHOTOTHERAPY|
20|FH_F81698_10457_0|SrvcGrp|17016|2022|PDM|31.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F139873_0_0|SrvcGrp|11673|2022|PDM|2215.00|99|0.00|CPT 29888|
20|FH_F150165_06032_0|SrvcGrp|47142|2022|PDM|3200.00|99|0.00|CPT 49650|
20|FH_F149199_73005_0|CSTM-ALL|CSTM-00|2020|PDM|1481.00|99|0.00|AEG 10 (NO REV) WITHOUT CHEMISTRY|
20|FH_F121639_06830_0|SrvcGrp|75545|2022|PDM|610.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F120670_0_0|SrvcGrp|14614|2022|PDM|4000.00|99|0.00|LITHOTRIPSY|
20|FH_F77943_0_0|SrvcGrp|87309|2022|PDM|40060.72|99|0.00|MSDRG 272 ONLY|
20|FH_F110442_98003_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F125244_0_0|SrvcGrp|78285|2022|PDM|4000.00|99|0.00|CPT 58671|
20|FH_F136359_0_0|SrvcGrp|88162|2022|PDM|8500.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F134608_18017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F100782_0_0|SrvcGrp|97673|2022|PDM|2191.94|99|0.00|WINDBER MEDICAL CNTR ASC 702|
20|FH_F122930_0_0|SrvcGrp|72990|2022|PDM|893.00|99|0.00|AEG 1|
20|FH_F123646_91350_0|SrvcGrp|67684|2022|PDM|255.00|99|0.00|PSYCH VISIT|
20|FH_F127486_06776_0|SrvcGrp|89781|2022|PDM|159.60|99|0.00|RESPITE CARE (HCFA)|
20|FH_F120417_63124_0|CSTM-ALL|CSTM-00|2020|PDM|1510.00|99|0.00|AEG 9 (NO REV)|
20|FH_F114824_44484_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CAREPOINT PARTNERS OF WV S CODES|
20|FH_F134191_75025_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F127638_44720_0|SrvcGrp|95660|2022|PDM|550.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F148924_44003_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112863_0_0|SrvcGrp|104249|2022|PDM|2002.00|99|0.00|FULL GRAFT PROCEDURE|
20|FH_F132606_0_0|SrvcGrp|26273|2022|PDM|1305.00|99|0.00|CPT 29880|
20|FH_F145885_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F85340_98195_0|SrvcGrp|73605|2022|PDM|1686.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F133724_84041_0|SrvcGrp|46605|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F146100_17403_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134507_0_0|SrvcGrp|104049|2022|PDM|416.00|99|0.00|RENAL DIALYSIS|
20|FH_F145642_15108_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F87012_0_0|SrvcGrp|73002|2022|PDM|1696.72|99|0.00|AEG 7|
20|FH_F100782_0_0|SrvcGrp|3388|2022|PDM|876.00|99|0.00|SUBACUTE CARE|
20|FH_F114683_0_0|SrvcGrp|86233|2022|PDM|5075.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F96780_0_0|SrvcGrp|84934|2022|PDM|1613.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F81294_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F99760_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109577_0_0|SrvcGrp|87396|2022|PDM|133.00|99|0.00|HCPCS G0155 (HCFA)|
20|FH_F71049_0_0|SrvcGrp|22954|2022|PDM|295.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F134608_18017_0|SrvcGrp|82737|2022|PDM|20.00|99|0.00|URINALYSIS|
20|FH_F133207_0_0|SrvcGrp|106266|2022|PDM|5293.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT|
20|FH_F130327_03867_0|SrvcGrp|48385|2022|PDM|169.00|99|0.00|SPEECH THERAPY|
20|FH_F34503_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F88357_0_0|SrvcGrp|78045|2022|PCT|1.00|99|0.00|AETNA AMNIOTIC MEMBRANE|
20|FH_F133207_0_0|SrvcGrp|83839|2022|PDM|5040.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F120740_45817_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F123623_03246_0|SrvcGrp|109278|2022|PCT|1.00|99|0.00|PLATELET PHERES LEUKOREDUCED|
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|323.00|99|0.00|AEG 1 (NO REV)|
20|FH_F87775_15106_0|SrvcGrp|26868|2022|PDM|50.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F71669_0_0|SrvcGrp|1306|2022|PDM|342.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F130123_24171_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F50703_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PRECISION HLTH - S CODES|
20|FH_F113325_80004_0|SrvcGrp|472|2022|PDM|433.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F115616_0_0|SrvcGrp|106223|2022|PDM|3433.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F81483_0_0|SrvcGrp|40306|2022|PDM|1269.00|99|0.00|CVTY ENHANCED ASPG 4|
20|FH_F111064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F110465_30328_0|SrvcGrp|86723|2022|PDM|539.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F126341_27284_0|SrvcGrp|86842|2022|PDM|35.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F71049_0_0|SrvcGrp|26001|2022|PDM|270.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F131127_0_0|SrvcGrp|64517|2022|PDM|4371.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F144808_0_0|SrvcGrp|95559|2022|PDM|7215.00|99|0.00|HIP JOINT|
20|FH_F43863_0_0|SrvcGrp|30958|2022|PDM|65.00|99|0.00|SKILLED LPN VISIT|
20|FH_F52754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F110245_46016_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133875_80027_0|SrvcGrp|73842|2022|PDM|271.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149059_19702_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F130329_64114_0|SrvcGrp|86850|2022|PDM|25.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F120291_0_0|SrvcGrp|24739|2022|PDM|249.00|99|0.00|RESPITE CARE|
20|FH_F134353_84123_0|SrvcGrp|97705|2022|PDM|103.95|99|0.00|RESPITE CARE (HCFA)|
20|FH_F139446_87106_0|SrvcGrp|108484|2022|PDM|800.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F130763_0_0|SrvcGrp|104108|2022|PDM|3951.00|99|0.00|EXCISION OF BREAST LESION ID|
20|FH_F112023_12866_0|SrvcGrp|81035|2022|PDM|24144.00|99|0.00|OBESITY SURGERY|
20|FH_F144808_0_0|SrvcGrp|88159|2022|PDM|7215.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F150165_06032_0|SrvcGrp|99172|2022|PDM|4635.00|99|0.00|CPT 28740|
20|FH_F72926_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109394_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F36749_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|326.59|99|0.00|HAPA WPA-NWPA 2012-13 ASC 221 W/O REV|
20|FH_F85257_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F105361_80104_0|SrvcGrp|73806|2022|PCT|0.78|99|0.00|AETNA ER|
20|FH_F75842_0_0|SrvcGrp|104423|2022|PDM|2120.81|99|0.00|AETNA REHABILITATION|
20|FH_F66705_0_0|SrvcGrp|43428|2022|PDM|25.00|99|0.00|RN HOURLY|
20|FH_F116055_59804_0|SrvcGrp|90364|2022|PDM|1840.00|99|0.00|AETNA MRI/MRA|
20|FH_F131737_15025_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133707_73072_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130657_04614_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC) (HCFA)|
20|FH_F139430_63017_0|SrvcGrp|73701|2022|PDM|31.83|99|0.00|AETNA - SKILLED NURSING|
20|FH_F150679_32534_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150701_33437_0|CSTM-ALL|CSTM-00|2020|PCT|1.75|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F150768_03054_0|SrvcGrp|104228|2022|PDM|204.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F150799_44041_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122377_91007_0|SrvcGrp|103913|2022|PCT|2.89|99|0.00|OP DIALYSIS|
20|FH_F76588_0_0|SrvcGrp|73524|2022|PDM|18.00|99|0.00|PHYSICAL THERAPY|
20|FH_F39443_0_0|SrvcGrp|30296|2022|PDM|318.00|99|0.00|HAPA WPA ASC 108|
20|FH_F149642_95678_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F111044_0_0|SrvcGrp|26273|2022|PDM|2266.00|99|0.00|CPT 29880|
20|FH_F98880_50158_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F40739_0_0|SrvcGrp|13551|2022|PDM|550.00|99|0.00|NEWBORN NURSERY|
20|FH_F147140_89103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147327_19010_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F42352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F46433_0_0|SrvcGrp|14944|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F129966_18017_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F71108_0_0|SrvcGrp|15985|2022|PCT|0.70|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F35557_0_0|SrvcGrp|10646|2022|PDM|110.00|99|0.00|MIDLINE INSERTION KIT|
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|2860.00|99|0.00|DEVICE INSERTION|
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117711_73080_0|SrvcGrp|73002|2022|PDM|2100.00|99|0.00|AEG 7|
20|FH_F37198_0_0|SrvcGrp|9774|2022|PCT|0.75|99|0.00|INTENSIVE CARE UNIT|
20|FH_F35987_0_0|SrvcGrp|701|2022|PDM|3008.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F33504_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F150953_74953_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F114585_11501_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F93377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97881_38703_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F127292_85705_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F139877_32615_0|SrvcGrp|113228|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 4 TRGT|
20|FH_F35758_33710_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F146266_0_0|SrvcGrp|112168|2022|PDM|7945.00|99|0.00|REMOVE WRIST JOINT IMPLANT|
20|FH_F36663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S MOD RR (CPD 1364768)|
20|FH_F147223_49444_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150981_33140_0|SrvcGrp|115908|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F149023_44122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101083_0_0|SrvcGrp|72992|2022|PDM|693.00|99|0.00|AEG 2|
20|FH_F125214_12428_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F116806_0_0|SrvcGrp|107129|2022|PDM|887.26|99|0.00|CONTROL THROAT BLEEDING|
20|FH_F35743_34202_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|280.00|99|0.00|AEG 1 (NO REV)|
20|FH_F101441_0_0|SrvcGrp|97259|2022|PDM|7946.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F116806_0_0|SrvcGrp|107101|2022|PDM|887.26|99|0.00|DRAINAGE OF MOUTH LESION|
20|FH_F137986_0_0|SrvcGrp|82114|2022|PDM|1478.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F139877_32615_0|SrvcGrp|112762|2022|PDM|45.23|99|0.00|INFECTIOUS AGENT ANTIGEN DETECTION|
20|FH_F130182_0_0|SrvcGrp|109454|2022|PDM|1457.00|99|0.00|R&L HRT ART/VENTRICLE ANGIO|
20|FH_F149662_85015_0|SrvcGrp|81765|2022|PCT|1.10|99|0.00|AETNA OP RADIOLOGY (RAD)|
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 4 (NO REV)|
20|FH_F134732_0_0|SrvcGrp|111139|2022|PDM|2248.00|99|0.00|ARTERY-VEIN GRAFT|
20|FH_F124719_64093_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147302_33573_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39443_0_0|SrvcGrp|13360|2022|PDM|148.00|99|0.00|EMERGENCY ROOM SVCS LEVEL II|
20|FH_F81951_0_0|SrvcGrp|30733|2022|PDM|307.00|99|0.00|SKILLED NURSING CARE|
20|FH_F38123_0_0|SrvcGrp|31189|2022|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER RRKF (DME)|
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|NEWBORN NURSERY - LEVEL I|
20|FH_F138995_0_0|SrvcGrp|106265|2022|PDM|1900.00|99|0.00|NSL/SINS NDSC TOTAL|
20|FH_F132033_60134_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F109543_63552_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117617_80439_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F35174_0_0|SrvcGrp|19846|2022|PCT|0.75|99|0.00|MS DRG 249 ONLY|
20|FH_F150940_92708_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F118907_0_0|SrvcGrp|107721|2022|PDM|508.10|99|0.00|SLEEP STUDIES|
20|FH_F107980_08005_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F39211_0_0|SrvcGrp|29021|2022|PCT|1.00|99|0.00|DME AND SUPPLIES|
20|FH_F132254_40207_0|SrvcGrp|24750|2022|PDM|40.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F94643_90501_0|SrvcGrp|86825|2022|PDM|300.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F138453_74135_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F124526_05301_0|SrvcGrp|90162|2022|PDM|1324.00|99|0.00|AETNA IP PSYCH CONSTANT OBS (>= 18 YEARS OF AGE)|
20|FH_F97101_98003_0|SrvcGrp|73601|2022|PDM|14433.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|2702.00|99|0.00|AEG 5  (NO REV)|
20|FH_F130023_0_0|SrvcGrp|111477|2022|PDM|279.00|99|0.00|WOUND CARE (HCFA)|
20|FH_F36663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S MOD AU (CPD 1364768)|
20|FH_F97881_38703_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F144029_0_0|SrvcGrp|107747|2022|PDM|475.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F125081_15218_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F35924_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F35779_32514_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS|
20|FH_F138995_0_0|SrvcGrp|35669|2022|PDM|2520.00|99|0.00|CPT 63650|
20|FH_F150927_64836_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134869_08854_0|SrvcGrp|89412|2022|PDM|480.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F38742_0_0|SrvcGrp|29464|2022|PDM|50.00|99|0.00|HOME HEALTH VISIT NEWBORN CARE|
20|FH_F113826_51445_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F139913_33407_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143536_47546_0|SrvcGrp|100270|2022|PCT|1.00|99|0.00|IIV3 VACC NO PRSV 0.25 ML IM|
20|FH_F54512_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)|
20|FH_F101709_0_0|SrvcGrp|26275|2022|PDM|2985.00|99|0.00|CPT 29826|
20|FH_F103060_0_0|SrvcGrp|89842|2022|PDM|8323.00|99|0.00|LUMBAR|
20|FH_F130937_98002_0|SrvcGrp|46903|2022|PDM|446.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F48937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112711_80909_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119929_70364_0|SrvcGrp|101562|2022|PCT|1.00|99|0.00|HOSPICE/PHYSICIAN|
20|FH_F120050_92626_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F120974_27607_0|SrvcGrp|107734|2022|PDM|3641.00|99|0.00|VAGINAL DELIVERY|
20|FH_F120974_27607_0|CSTM-ALL|CSTM-00|2020|PDM|3819.00|99|0.00|AEG 2 (NO REV)|
20|FH_F113649_01752_0|SrvcGrp|86834|2022|PDM|15.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F118845_71111_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F118879_93063_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F118792_63379_0|SrvcGrp|11108|2022|PDM|1331.00|99|0.00|NEWBORN NURSERY|
20|FH_F36420_0_0|SrvcGrp|72|2022|PDM|500.00|99|0.00|NEWBORN NURSERY|
20|FH_F39355_0_0|SrvcGrp|110|2022|PDM|475.00|99|0.00|CD - REHABILITATION|
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 10 (NO REV)|
20|FH_F45332_0_0|SrvcGrp|37907|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F93114_85016_0|SrvcGrp|43569|2022|PDM|145.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F128973_44256_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F34496_0_0|SrvcGrp|941|2022|PDM|2871.75|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F148221_06477_0|SrvcGrp|94781|2022|PDM|168.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F89475_71202_0|SrvcGrp|105465|2022|PCT|2.48|99|0.00|AETNA THERAPIES|
20|FH_F130145_98043_0|SrvcGrp|96499|2022|PCT|1.00|99|0.00|ADMIN OF PNEUMOCOCCAL VACCINE|
20|FH_F93791_0_0|SrvcGrp|12491|2022|PCT|1.03|99|0.00|PACEMAKER|
20|FH_F91973_0_0|SrvcGrp|91647|2022|PDM|6232.00|99|0.00|AETNA OTHER SPINAL SURGERIES|
20|FH_F129338_19114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F46612_0_0|SrvcGrp|9828|2022|PDM|66.00|99|0.00|HOME HEALTH AIDE|
20|FH_F114963_62062_0|SrvcGrp|73700|2022|PDM|94.56|99|0.00|AETNA - SKILLED NURSING|
20|FH_F54172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|ZERO ALLOWABLE - OUTPATIENT SERVICES|
20|FH_F111852_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 5  (NO REV)|
20|FH_F148255_72703_0|SrvcGrp|14948|2022|PDM|47.25|99|0.00|HOME INFUSION THERAPY|
20|FH_F116923_85259_0|SrvcGrp|93919|2022|PDM|572.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F125743_45640_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110262_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F135151_61874_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F82753_18840_0|SrvcGrp|131|2022|PCT|0.39|99|0.00|PACEMAKER DEVICE|
20|FH_F137633_85202_0|SrvcGrp|113126|2022|PDM|84.42|99|0.00|BILIRUBIN LIGHT WITH PHOTOMETER (MOD RR) (HCFA)|
20|FH_F97540_32114_0|SrvcGrp|73605|2022|PDM|1727.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F129294_53925_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38526_0_0|SrvcGrp|6|2022|PCT|0.79|99|0.00|OP SURGERY|
20|FH_F97540_32114_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F100460_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F129969_33908_0|SrvcGrp|90388|2022|PDM|625.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F99960_0_0|SrvcGrp|73008|2022|PDM|1124.00|99|0.00|AEG 10|
20|FH_F151408_0_0|CSTM-ALL|CSTM-00|2020|PDM|37.00|99|0.00|AEG 9 (NO REV)|
20|FH_F143528_0_0|SrvcGrp|97471|2022|PDM|3980.55|99|0.00|REMOVAL OF THYROID DUCT LESION|
20|FH_F116952_01020_0|SrvcGrp|75545|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F135056_06401_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F148161_98198_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125254_30306_0|SrvcGrp|108484|2022|PDM|755.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F112708_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F65681_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OUTPATIENT (THERAPIES)|
20|FH_F125028_19061_0|SrvcGrp|13929|2022|PDM|15.75|99|0.00|GROWTH HORMONE|
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 10 (NO REV)|
20|FH_F128358_46072_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F142073_0_0|SrvcGrp|76603|2022|PDM|990.00|99|0.00|CPT 25111|
20|FH_F135267_19002_0|SrvcGrp|94879|2022|PDM|146.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F138636_0_0|CSTM-ALL|CSTM-00|2020|PDM|734.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1 & 2|
20|FH_F127877_43560_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148221_06477_0|SrvcGrp|48385|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F38218_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F120352_52556_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F127375_28621_0|SrvcGrp|74403|2022|PCT|0.69|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F132768_0_0|SrvcGrp|471|2022|PDM|1150.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|ASPG II|
20|FH_F93791_0_0|SrvcGrp|93599|2022|PDM|4200.00|99|0.00|PARTIAL HIP REPLACEMENT(HCFA)|
20|FH_F31825_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|482.00|99|0.00|AEG 1 (NO REV)|
20|FH_F135165_15728_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F44495_0_0|SrvcGrp|38692|2022|PDM|179.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F115763_16433_0|SrvcGrp|471|2022|PDM|465.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F128307_43219_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F93702_63128_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130523_04605_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F149799_33484_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F37996_0_0|SrvcGrp|474|2022|PDM|250.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F49338_0_0|SrvcGrp|32386|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKL (DME)|
20|FH_F123385_03561_0|SrvcGrp|48396|2022|PDM|169.00|99|0.00|OT SERVICES|
20|FH_F148322_93060_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F118366_17110_0|SrvcGrp|65720|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F42822_0_0|SrvcGrp|166|2022|PDM|567.00|99|0.00|CD (ADULT) - DETOXIFICATION|
20|FH_F92276_32308_0|CSTM-ALL|CSTM-00|2020|PDM|11025.00|99|0.00|AEG 10 (NO REV)|
20|FH_F110925_01104_0|SrvcGrp|41451|2022|PDM|0.38|99|0.00|ENTERAL FORMULA - CALORICALLY DENSE|
20|FH_F41201_0_0|SrvcGrp|359|2022|PCT|0.73|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F128358_46072_0|SrvcGrp|472|2022|PDM|575.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130253_65082_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F83793_77477_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|43.86|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F115772_26250_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
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_F60072_0_0|SrvcGrp|3499|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F70645_0_0|SrvcGrp|12512|2022|PDM|1000.00|99|0.00|ACUTE REHABILITATION|
20|FH_F99100_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F143903_06249_0|SrvcGrp|89022|2022|PDM|20.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F93593_33414_0|SrvcGrp|43523|2022|PDM|212.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F79645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F92993_0_0|SrvcGrp|42722|2022|PDM|48.50|99|0.00|SLEEP STUDIES CPT 95806 W/MODIFIER 26|
20|FH_F38792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: BREAKOUT|
20|FH_F38677_0_0|SrvcGrp|17378|2022|PDM|135.00|99|0.00|CAPD TRAINING|
20|FH_F31056_0_0|SrvcGrp|3029|2022|PDM|578.00|99|0.00|NEWBORN NURSERY|
20|FH_F39866_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97102_83501_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 248, 250-251 W/ ICD9|
20|FH_F31688_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137454_64068_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F69971_0_0|SrvcGrp|36608|2022|PDM|218.00|99|0.00|SIGMOIDOSCOPY|
20|FH_F86991_15122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87014_65203_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F89372_0_0|SrvcGrp|4109|2022|PDM|2100.00|99|0.00|ACUTE PSYCH|
20|FH_F88398_15601_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F137951_0_0|SrvcGrp|70749|2022|PDM|1478.00|99|0.00|CPT 29823|
20|FH_F148485_13021_0|SrvcGrp|74668|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148554_85016_0|SrvcGrp|115461|2022|PDM|1291.00|99|0.00|INSERT/REPLACE SUBQ DEFIB|
20|FH_F148644_06890_0|SrvcGrp|38909|2022|PDM|5252.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F44016_0_0|SrvcGrp|27726|2022|PCT|0.35|99|0.00|OP SURGERY|
20|FH_F40812_0_0|CSTM-ALL|CSTM-00|2020|PDM|613.00|99|0.00|ACUTE PSYCH|
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|15469.00|99|0.00|MS DRG 242-244 PACEMAKER IMPLANT|
20|FH_F148881_33018_0|SrvcGrp|88858|2022|PDM|75.00|99|0.00|EVALUATION OF SPEECH FLUENCY|
20|FH_F38848_0_0|SrvcGrp|38|2022|PDM|2700.00|99|0.00|NORMAL DELIVERY|
20|FH_F149840_80002_0|SrvcGrp|88780|2022|PDM|115.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F39082_0_0|SrvcGrp|360|2022|PDM|2215.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F129688_74066_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|ROUTINE VENIPUNCTURE|
20|FH_F72226_65804_0|SrvcGrp|88980|2022|PDM|802.00|99|0.00|NURSERY NEWBORN|
20|FH_F38407_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.00|99|0.00|NEBULIZER (DME) (MOD NU)|
20|FH_F111813_08080_0|SrvcGrp|96399|2022|PCT|1.00|99|0.00|FOUNDAPARINUX SODIUM|
20|FH_F38663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F117885_81506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F42159_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|196.12|99|0.00|HAPA WPA-NWPA 2012-13 ASC 129 W/O REV|
20|FH_F88956_0_0|SrvcGrp|74581|2022|PCT|0.50|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F34363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F46276_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|581.00|99|0.00|AEG 4 (NO REV)|
20|FH_F117906_91606_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F120437_85202_0|SrvcGrp|98082|2022|PDM|50.65|99|0.00|HIT ANTIBIOTIC Q3H DIEM (HCFA)|
20|FH_F71882_15228_0|SrvcGrp|29611|2022|PDM|195.00|99|0.00|VENTILATOR SUPPORT|
20|FH_F37567_0_0|CSTM-ALL|CSTM-00|2020|PDM|1230.00|99|0.00|ASPG VI|
20|FH_F150948_0_0|SrvcGrp|113852|2022|PDM|1125.00|99|0.00|STENT PACEMT ANTE COROTID|
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92673_44041_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38663_0_0|SrvcGrp|27968|2022|PDM|19.00|99|0.00|SKILLED NURSING LPN|
20|FH_F45199_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F125256_77365_0|SrvcGrp|46903|2022|PDM|480.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F60254_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F101840_76054_0|SrvcGrp|28120|2022|PDM|17529.00|99|0.00|MS DRG 467 ONLY|
20|FH_F125215_78130_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F44135_0_0|SrvcGrp|10541|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F40685_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47479_0_0|SrvcGrp|42976|2022|PDM|70.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F146244_76028_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|PDM|2261.85|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_F119825_0_0|SrvcGrp|104226|2022|PDM|100.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F117756_75402_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F100666_81301_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F150024_08079_0|SrvcGrp|92364|2022|PDM|4000.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F146211_68144_0|SrvcGrp|54943|2022|PDM|6780.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F103281_32086_0|CSTM-ALL|CSTM-00|2020|PDM|2083.00|99|0.00|AEG 2 (NO REV)|
20|FH_F113324_17055_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133510_26003_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F71271_0_0|SrvcGrp|66265|2022|PDM|8.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F89851_83854_0|SrvcGrp|80839|2022|PDM|9550.00|99|0.00|MSDRG 520 ONLY|
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|1217.00|99|0.00|AEG 10 (NO REV)|
20|FH_F48475_0_0|SrvcGrp|473|2022|PDM|594.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F73542_0_0|SrvcGrp|70980|2022|PCT|1.00|99|0.00|CMS AMBULANCE MS (00512-00) RURAL GROUND MILEAGE|
20|FH_F125033_93305_0|SrvcGrp|73842|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F89932_10940_0|SrvcGrp|10107|2022|PCT|0.45|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F132794_40324_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150899_17243_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|2011 DALLAS TX RAD (MOD TC)|
20|FH_F101922_98055_0|SrvcGrp|73498|2022|PDM|1822.00|99|0.00|AETNA ER LEVEL III|
20|FH_F111813_08080_0|SrvcGrp|59795|2022|PCT|1.00|99|0.00|TPN|
20|FH_F114024_0_0|SrvcGrp|75489|2022|PDM|851.00|99|0.00|AEG 6|
20|FH_F68622_0_0|SrvcGrp|9541|2022|PCT|0.80|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F100880_67735_0|SrvcGrp|97379|2022|PDM|1384.00|99|0.00|AETNA SLEEP STUDIES|
20|FH_F37641_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: ALL|
20|FH_F128605_20910_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F148904_85255_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F144628_21146_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114519_0_0|SrvcGrp|73008|2022|PDM|1083.00|99|0.00|AEG 10|
20|FH_F113326_80014_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F115967_60123_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F125028_19061_0|SrvcGrp|86851|2022|PDM|52.50|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F82931_18847_0|SrvcGrp|72784|2022|PDM|121.03|99|0.00|MEDICAL SOCIAL WORKER - VISIT LEVEL|
20|FH_F129653_0_0|SrvcGrp|72998|2022|PDM|1755.00|99|0.00|AEG 5|
20|FH_F127415_45822_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F38034_0_0|SrvcGrp|28271|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F103100_47150_0|SrvcGrp|72990|2022|PDM|680.00|99|0.00|AEG 1|
20|FH_F116027_17745_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92276_32308_0|SrvcGrp|75506|2022|PDM|882.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F97102_83501_0|SrvcGrp|73605|2022|PDM|2103.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F143528_0_0|SrvcGrp|89857|2022|PDM|5250.00|99|0.00|REMOVAL OF SPINAL LAMINA|
20|FH_F92276_32308_0|SrvcGrp|31038|2022|PDM|73815.00|99|0.00|MS DRG 233-234 ONLY|
20|FH_F58615_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62579_0_0|SrvcGrp|26617|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F130721_04769_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|GENERAL ACUTE CARE|
20|FH_F130895_07726_0|SrvcGrp|109330|2022|PCT|1.10|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F119613_90035_0|SrvcGrp|73605|2022|PDM|970.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F134668_08003_0|SrvcGrp|89417|2022|PDM|406.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F119706_63021_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F42438_0_0|SrvcGrp|29985|2022|PCT|1.05|99|0.00|SUPPLIES|
20|FH_F32204_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144848_0_0|SrvcGrp|98580|2022|PDM|16570.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F130017_02302_0|SrvcGrp|73559|2022|PDM|5756.46|99|0.00|AETNA INTENSIVE CARE|
20|FH_F114526_33401_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F145921_73139_0|SrvcGrp|48396|2022|PDM|97.85|99|0.00|OT SERVICES|
20|FH_F135610_06451_0|SrvcGrp|29346|2022|PDM|30.77|99|0.00|SKILLED NURSING- LPN|
20|FH_F31595_0_0|SrvcGrp|9832|2022|PDM|85.00|99|0.00|ST SVCS|
20|FH_F112082_30720_0|SrvcGrp|22589|2022|PDM|94.42|99|0.00|CHEMOTHERAPY NOC|
20|FH_F51039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1229.00|99|0.00|TRAUMATIC BRAIN INJURY|
20|FH_F117245_0_0|SrvcGrp|72992|2022|PDM|736.00|99|0.00|AEG 2|
20|FH_F120559_29108_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F110470_98335_0|SrvcGrp|54142|2022|PDM|120.00|99|0.00|OP INTENSIVE SERVICES|
20|FH_F39902_0_0|SrvcGrp|474|2022|PDM|270.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F78584_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|MS DRG UNGROUPABLE INPATIENT|
20|FH_F97861_62223_0|SrvcGrp|73605|2022|PDM|2103.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F96160_32207_0|SrvcGrp|86837|2022|PDM|25.89|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F139723_30066_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149105_66215_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F52713_0_0|SrvcGrp|50085|2022|PDM|15661.00|99|0.00|OP PTCA|
20|FH_F134172_33126_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1289.00|99|0.00|ASPG VI|
20|FH_F34378_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F98741_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134226_66533_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F76146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145642_15108_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F96160_32207_0|SrvcGrp|86841|2022|PDM|158.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F79743_0_0|SrvcGrp|30623|2022|PDM|9775.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F34503_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49485_0_0|SrvcGrp|26732|2022|PDM|720.00|99|0.00|CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE|
20|FH_F133724_84041_0|SrvcGrp|106681|2022|PDM|615.00|99|0.00|CONTINUOUS HOSPICE CARE (HCFA)|
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|AEG 10 (NO REV)|
20|FH_F135670_01749_0|SrvcGrp|111526|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F100782_0_0|SrvcGrp|108212|2022|PDM|192.50|99|0.00|BONE MARROW|
20|FH_F119379_0_0|SrvcGrp|76603|2022|PDM|885.00|99|0.00|CPT 25111|
20|FH_F126194_61111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F70883_0_0|SrvcGrp|10648|2022|PDM|6.00|99|0.00|HOME INFUSION|
20|FH_F134972_84117_0|SrvcGrp|29346|2022|PDM|26.75|99|0.00|SKILLED NURSING- LPN|
20|FH_F143611_84065_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F134659_83628_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F117206_0_0|SrvcGrp|67064|2022|PDM|2884.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F79863_0_0|SrvcGrp|77234|2022|PDM|90.00|99|0.00|AETNA HOME INFUSION S9373|
20|FH_F129638_0_0|SrvcGrp|20260|2022|PDM|1800.00|99|0.00|ER LEVEL V|
20|FH_F145645_77089_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100060_0_0|SrvcGrp|705|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F127957_89521_0|SrvcGrp|90854|2022|PDM|779.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F145641_06902_0|CSTM-ALL|CSTM-00|2020|PDM|1312.00|99|0.00|AEG 5  (NO REV)|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 581|
20|FH_F130329_64114_0|SrvcGrp|111526|2022|PDM|125.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F148484_19462_0|SrvcGrp|74668|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124159_92506_0|SrvcGrp|73842|2022|PDM|265.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132969_84003_0|SrvcGrp|43569|2022|PDM|50.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F143563_32828_0|SrvcGrp|87077|2022|PDM|135.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F150165_06032_0|SrvcGrp|15473|2022|PDM|2884.00|99|0.00|CPT CODE 42820|
20|FH_F85353_16407_0|SrvcGrp|63763|2022|PDM|1821.01|99|0.00|HAPA WPA-NWPA 2012-13 ASC 903|
20|FH_F122520_46383_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F93375_0_0|SrvcGrp|73004|2022|PDM|1102.00|99|0.00|AEG 8|
20|FH_F143147_80124_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F97543_33542_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F101922_98055_0|SrvcGrp|72990|2022|PDM|2500.00|99|0.00|AEG 1|
20|FH_F113792_0_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F151142_35406_0|CSTM-ALL|CSTM-00|2020|PDM|1188.00|99|0.00|AEG 4 (NO REV)|
20|FH_F121404_32216_0|SrvcGrp|86635|2022|PCT|1.05|99|0.00|DME|
20|FH_F113588_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149179_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F123741_20850_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F132810_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F58856_0_0|SrvcGrp|29606|2022|PDM|37500.00|99|0.00|MS DRG 218 ONLY|
20|FH_F67300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F136374_34461_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136390_46321_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F136423_61254_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F120456_67117_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F134011_84102_0|SrvcGrp|86779|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F142608_02842_0|SrvcGrp|75545|2022|PDM|250.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F142690_31774_0|SrvcGrp|43569|2022|PDM|150.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F101389_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F138471_84663_0|SrvcGrp|63297|2022|PDM|93.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F140582_46514_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F149701_0_0|SrvcGrp|31931|2022|PDM|351.00|99|0.00|SKILLED NURSING CARE|
20|FH_F149650_96819_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149663_45219_0|SrvcGrp|103970|2022|PDM|2511.00|99|0.00|AETNA SHOULDER ARTHROSCOPY SURGERY|
20|FH_F119064_01581_0|SrvcGrp|46903|2022|PDM|482.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F118955_48239_0|SrvcGrp|73842|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117286_17202_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117371_77059_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F147803_33952_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC|
20|FH_F43004_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F70546_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F117240_37334_0|SrvcGrp|75487|2022|PDM|2500.00|99|0.00|AEG 5|
20|FH_F137335_08096_0|SrvcGrp|73842|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137938_29036_0|SrvcGrp|83960|2022|PCT|0.66|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F109907_0_0|SrvcGrp|48398|2022|PDM|92.60|99|0.00|PT SERVICES|
20|FH_F138543_60130_0|SrvcGrp|90854|2022|PDM|959.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F139350_70056_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F91067_0_0|SrvcGrp|73000|2022|PDM|1019.00|99|0.00|AEG 6|
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)|
20|FH_F38421_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|338.50|99|0.00|ASPG I|
20|FH_F95880_02726_0|SrvcGrp|99459|2022|PDM|81.49|99|0.00|PHYSICAL THERAPY EVALUATION|
20|FH_F110000_0_0|SrvcGrp|33831|2022|PDM|3338.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 9|
20|FH_F120305_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F87054_0_0|SrvcGrp|12491|2022|PCT|0.70|99|0.00|PACEMAKER|
20|FH_F103780_64804_0|SrvcGrp|83960|2022|PCT|0.68|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F105588_15228_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|958.32|99|0.00|AEG 5  (NO REV)|
20|FH_F110212_17013_0|SrvcGrp|3178|2022|PDM|1096.00|99|0.00|ACUTE PSYCH|
20|FH_F133178_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PDM|1760.00|99|0.00|AEG 7 (NO REV)|
20|FH_F131608_0_0|SrvcGrp|90707|2022|PDM|34.91|99|0.00|AETNA HOSPICE CARE|
20|FH_F132988_0_0|SrvcGrp|54943|2022|PDM|4493.01|99|0.00|REPAIR OF SLAP LESION|
20|FH_F132988_0_0|SrvcGrp|98347|2022|PDM|4493.01|99|0.00|HIP ARTHROSCOPY / SURGERY|
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133002_0_0|SrvcGrp|28550|2022|PDM|1716.00|99|0.00|VITRECTOMY|
20|FH_F114389_50131_0|SrvcGrp|105617|2022|PDM|2703.18|99|0.00|WOUND THERAPY ELECTRICAL PUMP (MOD RR)|
20|FH_F114389_50131_0|SrvcGrp|88805|2022|PDM|132.55|99|0.00|TOTAL PARENTERAL NUTRITION; > 3 LITERS (HCFA)|
20|FH_F124180_0_0|SrvcGrp|91522|2022|PDM|3000.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F38945_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F124173_66215_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F124618_32340_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124671_64844_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F67882_0_0|SrvcGrp|12682|2022|PCT|0.80|99|0.00|GROUP THERAPY|
20|FH_F90653_0_0|SrvcGrp|11199|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER|
20|FH_F136355_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F32834_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F98042_10468_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F136708_06443_0|SrvcGrp|52951|2022|PDM|80.00|99|0.00|PSYCHIATRIC CPT 90846|
20|FH_F136729_62704_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114783_70810_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F138052_19462_0|SrvcGrp|86722|2022|PDM|221.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F122591_84010_0|SrvcGrp|472|2022|PDM|448.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F43000_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43249_0_0|CSTM-ALL|CSTM-00|2020|PDM|5544.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F117069_15236_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F134694_94945_0|SrvcGrp|58509|2022|PDM|500.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F134727_30650_0|SrvcGrp|97968|2022|PDM|583.00|99|0.00|CT SCAN|
20|FH_F134727_30650_0|SrvcGrp|110428|2022|PCT|1.10|99|0.00|LABORATORY SERVICES|
20|FH_F113713_17013_0|SrvcGrp|89149|2022|PDM|120.00|99|0.00|OP INTENSIVE|
20|FH_F113713_17013_0|SrvcGrp|105558|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F141170_0_0|SrvcGrp|67068|2022|PDM|18000.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F141170_0_0|SrvcGrp|103589|2022|PDM|6000.00|99|0.00|CAROTID/INOM ART|
20|FH_F42169_0_0|SrvcGrp|12146|2022|PDM|1700.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F49005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F115267_67156_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F147519_52627_0|SrvcGrp|110147|2022|PDM|435.45|99|0.00|OP BEHAVIORAL OBSERVATION|
20|FH_F147621_74338_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42153_0_0|SrvcGrp|115|2022|PDM|809.00|99|0.00|SKILLED NURSING CARE|
20|FH_F42539_0_0|SrvcGrp|3809|2022|PDM|602.00|99|0.00|HOSPICE CARE|
20|FH_F98624_15701_0|SrvcGrp|73659|2022|PDM|8054.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F102947_44084_0|SrvcGrp|75759|2022|PDM|431.00|99|0.00|AMBULATORY DETOX REHAB|
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F104802_0_0|SrvcGrp|44858|2022|PDM|20.00|99|0.00|DAY TREATMENT|
20|FH_F106980_0_0|SrvcGrp|73008|2022|PDM|696.90|99|0.00|AEG 10|
20|FH_F134828_30531_0|SrvcGrp|112649|2022|PDM|35.00|99|0.00|XRAY EXAM CHEST TWO VIEWS (HCFA)|
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|755.07|99|0.00|ASPG IV|
20|FH_F46433_0_0|SrvcGrp|24754|2022|PDM|25.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F107360_0_0|SrvcGrp|10391|2022|PDM|1566.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F33512_0_0|SrvcGrp|9907|2022|PDM|1300.00|99|0.00|ACUTE MEDICAL/SURGICAL SVCS|
20|FH_F35404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F38037_0_0|SrvcGrp|9828|2022|PDM|40.70|99|0.00|HOME HEALTH AIDE|
20|FH_F100161_17325_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F82357_0_0|SrvcGrp|3809|2022|PDM|616.00|99|0.00|HOSPICE CARE|
20|FH_F38949_0_0|SrvcGrp|360|2022|PDM|850.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|1066.00|99|0.00|WILLS COMM SURG SVC ASC 11|
20|FH_F54552_0_0|SrvcGrp|10577|2022|PDM|80.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F138847_67156_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138407_60025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89580_0_0|SrvcGrp|16|2022|PDM|3212.00|99|0.00|ACUTE REHABILITATION|
20|FH_F149242_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F151401_36607_0|SrvcGrp|48394|2022|PDM|84.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F151440_84095_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F122114_91364_0|SrvcGrp|74668|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F128115_52001_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135427_19610_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F135453_70726_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135572_89106_0|SrvcGrp|22592|2022|PCT|1.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F135572_89106_0|SrvcGrp|22589|2022|PCT|1.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F135607_21613_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F130620_18940_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F116455_26003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127399_0_0|SrvcGrp|97895|2022|PDM|14045.00|99|0.00|REVISE KNEE 2|
20|FH_F127399_0_0|SrvcGrp|107868|2022|PDM|4682.00|99|0.00|AETNA LAPAROSCOPY SURGICAL|
20|FH_F121803_66502_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121873_54303_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F33785_0_0|SrvcGrp|3138|2022|PDM|750.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPT CARE OF MUNCY FH -AV|
20|FH_F46918_0_0|SrvcGrp|10542|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F72586_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F111292_33136_0|CSTM-ALL|CSTM-00|2020|PDM|13768.00|99|0.00|AETNA ANGIOPLASTY|
20|FH_F111880_50003_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F134260_02155_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F134290_67209_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F134315_89106_0|SrvcGrp|22389|2022|PCT|1.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|ASPG X|
20|FH_F148243_0_0|SrvcGrp|107988|2022|PDM|585.00|99|0.00|PARTIAL REMOVAL OF TOE|
20|FH_F133994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F126023_70748_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141035_0_0|SrvcGrp|58671|2022|PDM|4359.00|99|0.00|ASC CARVE OUT 64721|
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|1927.00|99|0.00|AEG 4 (NO REV)|
20|FH_F128695_50049_0|SrvcGrp|66264|2022|PDM|119.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F132347_01605_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|2265.00|99|0.00|AEG 8 (NO REV)|
20|FH_F37970_0_0|SrvcGrp|27696|2022|PCT|1.00|99|0.00|DIALYSIS|
20|FH_F50462_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F114931_0_0|SrvcGrp|105760|2022|PDM|1850.00|99|0.00|REMOVE HEMORRHOIDS & FISSURE|
20|FH_F115884_0_0|SrvcGrp|65720|2022|PDM|111.00|99|0.00|RESPITE CARE|
20|FH_F129130_92562_0|SrvcGrp|72984|2022|PCT|2.08|99|0.00|CHEMOTHERAPY|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|144.40|99|0.00|DELAWARE VALLEY- ASC 218|
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)|
20|FH_F108800_0_0|SrvcGrp|101180|2022|PDM|1000.00|99|0.00|AETNA HIP AND KNEE|
20|FH_F111207_0_0|SrvcGrp|25695|2022|PDM|1300.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F71365_0_0|SrvcGrp|66481|2022|PDM|75.00|99|0.00|SOCIAL WORKER|
20|FH_F73025_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|1694.00|99|0.00|AEG 1 (NO REV)|
20|FH_F103780_64804_0|CSTM-ALL|CSTM-00|2020|PDM|1498.00|99|0.00|AEG 2 (NO REV)|
20|FH_F40397_0_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PDM|956.00|99|0.00|ASPG VI|
20|FH_F130928_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.22|99|0.00|OP SVCS|
20|FH_F135491_0_0|SrvcGrp|112817|2022|PCT|1.21|99|0.00|INJ BIMATOPROST INTRACAMERAL IMPLANT|
20|FH_F94786_07974_0|SrvcGrp|86833|2022|PDM|15.75|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F131047_0_0|CSTM-ALL|CSTM-00|2020|PDM|1949.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F132627_0_0|SrvcGrp|14945|2022|PDM|18.36|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F141036_02347_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE|
20|FH_F91039_0_0|SrvcGrp|89978|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F93252_0_0|SrvcGrp|88163|2022|PDM|2500.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F141349_26440_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F45976_0_0|SrvcGrp|17079|2022|PDM|1414.00|99|0.00|ASPG VIII|
20|FH_F132348_16214_0|SrvcGrp|53987|2022|PCT|1.05|99|0.00|PHOTOTHERAPY|
20|FH_F38688_0_0|SrvcGrp|17079|2022|PDM|1400.00|99|0.00|ASPG VIII|
20|FH_F92493_0_0|SrvcGrp|11673|2022|PDM|3899.28|99|0.00|CPT 29888|
20|FH_F124222_92625_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F124417_85364_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F136589_72601_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136607_68632_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS|
20|FH_F136693_17754_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114684_80547_0|SrvcGrp|105708|2022|PDM|148.00|99|0.00|OFFICE/OUTPATIENT VISIT NEW (HCFA)|
20|FH_F114985_32073_0|SrvcGrp|104804|2022|PDM|125.00|99|0.00|PSYTX CRISIS INITIAL 60 MIN|
20|FH_F144039_0_0|SrvcGrp|46886|2022|PDM|4590.00|99|0.00|REMOVAL OF EYELID LESION|
20|FH_F43913_0_0|SrvcGrp|37873|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F136778_62034_0|CSTM-ALL|CSTM-00|2020|PDM|2576.00|99|0.00|AEG 2 (NO REV)|
20|FH_F136828_32405_0|SrvcGrp|88819|2022|PDM|724.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F136914_64081_0|SrvcGrp|32189|2022|PDM|180.00|99|0.00|RESPITE CARE|
20|FH_F115210_21043_0|SrvcGrp|58772|2022|PDM|1697.00|99|0.00|HEMORRHOIDOPEXY|
20|FH_F41801_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|RESIDENTIAL PSYCH / CD (ADOLESCENT)|
20|FH_F42024_0_0|SrvcGrp|35557|2022|PCT|1.00|99|0.00|BLOOD AND BLOOD PRODUCTS - OP|
20|FH_F42539_0_0|SrvcGrp|12403|2022|PDM|42.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F138347_77701_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F139172_40207_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F139327_62220_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139430_63017_0|SrvcGrp|73700|2022|PDM|42.44|99|0.00|AETNA - SKILLED NURSING|
20|FH_F150745_03301_0|SrvcGrp|48396|2022|PDM|167.00|99|0.00|OT SERVICES|
20|FH_F127487_60169_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F127258_79912_0|SrvcGrp|89417|2022|PDM|412.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F119442_72205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131385_76457_0|SrvcGrp|89417|2022|PDM|425.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F130757_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F35475_0_0|SrvcGrp|17525|2022|PDM|600.00|99|0.00|HYPERBARIC CHAMBER|
20|FH_F151039_16749_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132442_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F32376_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F122364_67203_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143668_0_0|SrvcGrp|114066|2022|PDM|220.00|99|0.00|SEGMENTAL PNEUMATIC (MOD NU)|
20|FH_F36743_0_0|SrvcGrp|290|2022|PDM|5900.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F39151_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|GENERAL ACUTE CARE|
20|FH_F124466_32724_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F131392_17004_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F109160_63129_0|SrvcGrp|89149|2022|PDM|203.00|99|0.00|OP INTENSIVE|
20|FH_F92454_0_0|SrvcGrp|36591|2022|PDM|9700.00|99|0.00|CPT 63685|
20|FH_F47558_0_0|SrvcGrp|40405|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD AV|
20|FH_F124526_05301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134707_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F98020_50138_0|SrvcGrp|73656|2022|PDM|586.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F110804_11373_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F148008_0_0|SrvcGrp|75545|2022|PDM|472.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F98280_31015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41155_0_0|SrvcGrp|10107|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F76285_0_0|CSTM-ALL|CSTM-00|2020|PDM|10.00|99|0.00|LVN HOURLY|
20|FH_F137627_78382_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|ANTIBIOTIC AEROSOLIZED THERAPY (MOD SH)|
20|FH_F120040_72703_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124719_64093_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F130821_85712_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138302_15701_0|SrvcGrp|14949|2022|PDM|10.00|99|0.00|HOME INFUSION|
20|FH_F77943_0_0|SrvcGrp|37263|2022|PCT|0.70|99|0.00|MRI|
20|FH_F149048_77090_0|SrvcGrp|89337|2022|PDM|880.00|99|0.00|DETOXIFICATION|
20|FH_F117300_0_0|SrvcGrp|78096|2022|PDM|2945.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F71445_0_0|SrvcGrp|3810|2022|PDM|75.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F132969_84003_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F150165_06032_0|SrvcGrp|92197|2022|PDM|3475.00|99|0.00|CORRECTION OF BUNION|
20|FH_F70208_0_0|SrvcGrp|14320|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F36381_0_0|SrvcGrp|9460|2022|PDM|700.00|99|0.00|ACUTE REHABILITATION|
20|FH_F110542_10035_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F143561_16001_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119110_91773_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F145883_71106_0|SrvcGrp|113276|2022|PCT|1.10|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F121255_76132_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F150165_06032_0|SrvcGrp|114442|2022|PDM|4300.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F114444_19602_0|SrvcGrp|105376|2022|PDM|7.06|99|0.00|SKILLS TRAINING DEVELOPMENT - 15 MIN|
20|FH_F135623_53115_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132883_31602_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F130364_01331_0|CSTM-ALL|CSTM-00|2020|PDM|2785.00|99|0.00|AEG 6 (NO REV)|
20|FH_F85353_16407_0|SrvcGrp|63777|2022|PDM|1398.54|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1406|
20|FH_F112468_0_0|SrvcGrp|73002|2022|PDM|1114.00|99|0.00|AEG 7|
20|FH_F138240_64114_0|SrvcGrp|48396|2022|PDM|122.00|99|0.00|OT SERVICES|
20|FH_F147502_0_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F85353_16407_0|SrvcGrp|63891|2022|PDM|203.32|99|0.00|HAPA WPA-NWPA 2012-13 ASC 235|
20|FH_F133943_01606_0|SrvcGrp|93291|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA ESRD USE|
20|FH_F117382_0_0|SrvcGrp|103550|2022|PDM|400.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F141248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F146207_73139_0|SrvcGrp|95661|2022|PDM|134.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F134593_60007_0|SrvcGrp|86853|2022|PDM|48.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F126157_34210_0|SrvcGrp|3178|2022|PDM|897.00|99|0.00|ACUTE PSYCH|
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|5537.00|99|0.00|AEG 7 (NO REV)|
20|FH_F81483_0_0|SrvcGrp|35921|2022|PDM|7947.00|99|0.00|BARIATRIC SURGERY|
20|FH_F87571_0_0|SrvcGrp|14174|2022|PDM|650.00|99|0.00|MRI|
20|FH_F127282_98004_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 1 (NO REV)|
20|FH_F133749_84604_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F127080_77520_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142376_0_0|SrvcGrp|99073|2022|PDM|246.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F150146_95401_0|SrvcGrp|108484|2022|PDM|678.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F130364_01331_0|SrvcGrp|88678|2022|PCT|0.00|99|0.00|ACUTE REHAB I|
20|FH_F145686_52591_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130017_02302_0|SrvcGrp|114504|2022|PCT|1.33|99|0.00|LABORATORY SERVICES|
20|FH_F43863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F80613_0_0|SrvcGrp|10534|2022|PDM|90.00|99|0.00|NURSING CARE|
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|1030.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F136327_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F132716_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111942_92647_0|SrvcGrp|48396|2022|PDM|122.00|99|0.00|OT SERVICES|
20|FH_F143650_0_0|SrvcGrp|75002|2022|PDM|3900.00|99|0.00|ARTHOSCOPY|
20|FH_F121597_30315_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F77943_0_0|SrvcGrp|62333|2022|PCT|0.70|99|0.00|HOME INFUSION|
20|FH_F127642_07047_0|SrvcGrp|73000|2022|PDM|2210.00|99|0.00|AEG 6|
20|FH_F138250_64145_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123609_28451_0|SrvcGrp|73841|2022|PDM|419.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F143742_60410_0|SrvcGrp|113185|2022|PCT|0.64|99|0.00|RADIOLOGY SERVICES|
20|FH_F110184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70804_0_0|SrvcGrp|9228|2022|PDM|69.23|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F143067_0_0|SrvcGrp|107634|2022|PDM|279.00|99|0.00|PERITONEAL TREATMENTS W/ PATIENT TRAINGING|
20|FH_F89219_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MT NITTANY GH LAB|
20|FH_F134608_18017_0|SrvcGrp|108139|2022|PDM|250.00|99|0.00|VAGINA EXAMINATION & BIOPSY (HCFA)|
20|FH_F79824_0_0|SrvcGrp|29111|2022|PDM|21726.00|99|0.00|SPINAL FUSION|
20|FH_F133585_0_0|SrvcGrp|108076|2022|PDM|3092.00|99|0.00|AV FUSION / FOREARM VEIN|
20|FH_F113465_28204_0|SrvcGrp|26001|2022|PDM|138.03|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F83054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120930_0_0|SrvcGrp|16732|2022|PDM|3000.00|99|0.00|HYSTEROSCOPY ABLATION|
20|FH_F133972_27103_0|SrvcGrp|17016|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F133585_0_0|SrvcGrp|111519|2022|PDM|364.00|99|0.00|STAB PHLEBECT VV 1 EXT; >20|
20|FH_F120740_45817_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144291_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1232.86|99|0.00|HAPA WPA-NWPA 2012-13 ASC 908 W/O REV|
20|FH_F145604_14850_0|SrvcGrp|86836|2022|PDM|35.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F114510_33445_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135627_77070_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143742_60410_0|SrvcGrp|1943|2022|PDM|694.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F133805_83401_0|SrvcGrp|65720|2022|PDM|75.00|99|0.00|RESPITE CARE|
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 8 (NO REV)|
20|FH_F113484_43015_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F130017_02302_0|CSTM-ALL|CSTM-00|2020|PDM|2976.91|99|0.00|AEG 1 (NO REV)|
20|FH_F148600_30328_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134324_26354_0|SrvcGrp|103913|2022|PCT|0.84|99|0.00|OP DIALYSIS|
20|FH_F85353_16407_0|SrvcGrp|63853|2022|PDM|427.32|99|0.00|HAPA WPA-NWPA 2012-13 ASC 112|
20|FH_F124917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F54592_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|HOME NURSING / SPECIALIZED NURSING|
20|FH_F69606_0_0|SrvcGrp|64108|2022|PDM|572.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 11|
20|FH_F134488_14086_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F84712_0_0|SrvcGrp|73501|2022|PDM|1980.00|99|0.00|AETNA OBSERVATION|
20|FH_F84935_0_0|SrvcGrp|80|2022|PDM|1879.00|99|0.00|ACUTE PSYCH|
20|FH_F72963_0_0|SrvcGrp|62718|2022|PCT|0.75|99|0.00|TRAUMA|
20|FH_F85211_0_0|SrvcGrp|73008|2022|PDM|808.50|99|0.00|AEG 10|
20|FH_F105145_75075_0|SrvcGrp|83641|2022|PDM|4269.00|99|0.00|CPT 29889|
20|FH_F105303_15136_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|GENERAL ACUTE CARE|
20|FH_F105361_80104_0|SrvcGrp|12345|2022|PCT|0.84|99|0.00|OP TRAUMA|
20|FH_F115909_38133_0|SrvcGrp|87317|2022|PDM|960.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F120795_27514_0|SrvcGrp|32011|2022|PDM|4936.00|99|0.00|TRAUMA CARE|
20|FH_F115952_44484_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115956_06516_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115972_92675_0|SrvcGrp|86648|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F132964_06484_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133402_10007_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111580_77004_0|SrvcGrp|10107|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F139444_32966_0|SrvcGrp|108484|2022|PDM|800.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139447_40336_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139550_75219_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F139707_84010_0|SrvcGrp|114711|2022|PDM|6236.00|99|0.00|SPINAL PROCEDURES|
20|FH_F150765_05001_0|SrvcGrp|73742|2022|PDM|9.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F151026_63129_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F117799_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F147359_54911_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1375.00|99|0.00|AEG 9 (NO REV)|
20|FH_F115982_0_0|SrvcGrp|99171|2022|PDM|1400.00|99|0.00|CPT 28485|
20|FH_F128506_77304_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F147231_49440_0|SrvcGrp|90339|2022|PDM|39.62|99|0.00|SKILLED NURSING RN|
20|FH_F116806_0_0|SrvcGrp|107076|2022|PDM|1923.16|99|0.00|EXCISION BENIGN TUMOR/CYST|
20|FH_F38742_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F116806_0_0|SrvcGrp|107113|2022|PDM|887.26|99|0.00|PARTIAL EXCISION OF LIP|
20|FH_F35452_0_0|SrvcGrp|13977|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F56672_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F124691_78003_0|SrvcGrp|89337|2022|PDM|1400.00|99|0.00|DETOXIFICATION|
20|FH_F120040_72703_0|SrvcGrp|89337|2022|PDM|902.00|99|0.00|DETOXIFICATION|
20|FH_F135263_0_0|SrvcGrp|112742|2022|PDM|900.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F147080_02446_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F111320_0_0|SrvcGrp|104358|2022|PDM|1750.00|99|0.00|CONJUNCTIVOPLASTY|
20|FH_F123162_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F117023_0_0|SrvcGrp|73002|2022|PDM|1639.00|99|0.00|AEG 7|
20|FH_F110732_31513_0|SrvcGrp|73845|2022|PDM|98.35|99|0.00|AETNA OB BEHAVIOR HEALTH - REV 914|
20|FH_F146645_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS ASC|
20|FH_F137769_85234_0|SrvcGrp|106054|2022|PCT|1.60|99|0.00|DME|
20|FH_F131449_19073_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97420_75052_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F124486_0_0|SrvcGrp|95819|2022|PDM|1803.00|99|0.00|GONIOTOMY|
20|FH_F47902_0_0|SrvcGrp|43841|2022|PCT|1.00|99|0.00|DME MOD RRKC|
20|FH_F39151_0_0|SrvcGrp|34882|2022|PCT|1.00|99|0.00|IMPLANTS (HEART TRANSPLANT)|
20|FH_F140295_0_0|SrvcGrp|58638|2022|PDM|3598.00|99|0.00|CPT 63688|
20|FH_F39202_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F129757_0_0|SrvcGrp|30733|2022|PDM|1400.00|99|0.00|SKILLED NURSING CARE|
20|FH_F124441_0_0|SrvcGrp|77021|2022|PDM|5700.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F75944_0_0|SrvcGrp|68187|2022|PDM|983.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 3|
20|FH_F131385_76457_0|SrvcGrp|89149|2022|PDM|198.00|99|0.00|OP INTENSIVE|
20|FH_F66545_0_0|SrvcGrp|62098|2022|PDM|110.00|99|0.00|RN VISIT|
20|FH_F108260_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137748_95231_0|SrvcGrp|104568|2022|PDM|26010.00|99|0.00|IP TRAUMA|
20|FH_F139565_0_0|SrvcGrp|109764|2022|PDM|4590.00|99|0.00|REPAIR EYELID DEFECT|
20|FH_F149045_45679_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146204_0_0|SrvcGrp|110676|2022|PDM|2376.00|99|0.00|LAPAROSCOPIC TREAT OF ECTOP|
20|FH_F97084_91911_0|SrvcGrp|73659|2022|PDM|20078.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F124322_64131_0|SrvcGrp|17016|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F110609_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F117615_30525_0|SrvcGrp|75483|2022|PCT|0.85|99|0.00|AEG 3|
20|FH_F146266_0_0|SrvcGrp|97895|2022|PDM|7945.00|99|0.00|REVISE KNEE 2|
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 9 (NO REV)|
20|FH_F112045_90301_0|SrvcGrp|17100|2022|PDM|1823.00|99|0.00|SKILLED NURSING|
20|FH_F137731_92262_0|SrvcGrp|74668|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119376_0_0|SrvcGrp|103503|2022|PDM|1700.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F36903_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD AU|
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|2338.00|99|0.00|AEG 7 (NO REV)|
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|1298.00|99|0.00|AEG 5  (NO REV)|
20|FH_F39849_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98860_96706_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|S CODES MOD 53|
20|FH_F37342_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F128583_45154_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117645_90034_0|SrvcGrp|89149|2022|PDM|350.00|99|0.00|OP INTENSIVE|
20|FH_F127418_0_0|SrvcGrp|27330|2022|PDM|7877.98|99|0.00|CPT 27096|
20|FH_F35726_33324_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F150924_90029_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F117583_21208_0|SrvcGrp|76501|2022|PDM|330.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 5  (NO REV)|
20|FH_F143447_53204_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151719_02138_0|SrvcGrp|74694|2022|PDM|999.00|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F132479_90290_0|SrvcGrp|46903|2022|PDM|1250.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132416_92270_0|SrvcGrp|87131|2022|PDM|650.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F116595_92506_0|SrvcGrp|86748|2022|PCT|1.15|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F116802_41224_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116913_77024_0|SrvcGrp|105819|2022|PDM|1250.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F120853_61201_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F118889_17701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36372_0_0|SrvcGrp|10564|2022|PDM|120.00|99|0.00|HOME INFUSION|
20|FH_F36372_0_0|SrvcGrp|19967|2022|PDM|29.00|99|0.00|LIPIDS|
20|FH_F150200_0_0|SrvcGrp|67065|2022|PDM|10200.00|99|0.00|CERVICAL SURGERY|
20|FH_F38883_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS|
20|FH_F100742_00616_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F59732_0_0|SrvcGrp|16559|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F130630_0_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F141590_90049_0|SrvcGrp|75442|2022|PDM|1058.64|99|0.00|OBSERVATION - REV 762|
20|FH_F70104_0_0|SrvcGrp|42973|2022|PDM|48.00|99|0.00|SPEECH  THERAPIST|
20|FH_F130716_76013_0|SrvcGrp|88780|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F114970_28403_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F49653_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|LOCK HAVEN/BERWICK LABS (GH)|
20|FH_F124783_92408_0|SrvcGrp|87317|2022|PDM|1498.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F88254_33411_0|SrvcGrp|14949|2022|PDM|80.00|99|0.00|HOME INFUSION|
20|FH_F118373_21205_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143528_0_0|SrvcGrp|103542|2022|PDM|4476.15|99|0.00|ANKLE ARTHROSCOPY/SURGERY|
20|FH_F33712_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION|
20|FH_F41350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1534.00|99|0.00|ASPG VIII|
20|FH_F125676_02892_0|SrvcGrp|472|2022|PDM|480.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F141550_33619_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F120872_74120_0|SrvcGrp|89149|2022|PDM|192.00|99|0.00|OP INTENSIVE|
20|FH_F143821_60559_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F137637_03103_0|SrvcGrp|86722|2022|PDM|187.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F102302_0_0|SrvcGrp|12309|2022|PDM|10850.00|99|0.00|MICRODISKETOMY|
20|FH_F121525_78613_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F130682_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F48215_0_0|SrvcGrp|12264|2022|PDM|60.75|99|0.00|DIETICIAN OR LPN SERVICES|
20|FH_F143746_85006_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124017_0_0|SrvcGrp|109673|2022|PDM|5200.00|99|0.00|LAMINOPLASTY, CERVICAL|
20|FH_F79212_0_0|SrvcGrp|12403|2022|PDM|35.57|99|0.00|CONTINUOUS HOMECARE|
20|FH_F146013_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F128343_48035_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111288_0_0|SrvcGrp|99174|2022|PDM|2564.00|99|0.00|CPT 30140|
20|FH_F60072_0_0|SrvcGrp|8950|2022|PDM|2650.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F123501_64831_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
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_F77482_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F93094_21227_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F139515_0_0|SrvcGrp|33967|2022|PDM|2850.00|99|0.00|CPT 47562|
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|AEG 1 (NO REV)|
20|FH_F126523_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148166_0_0|SrvcGrp|92501|2022|PDM|515.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F125710_02860_0|SrvcGrp|75545|2022|PDM|390.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F130523_04605_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS|
20|FH_F83451_0_0|SrvcGrp|23585|2022|PCT|0.68|99|0.00|IMPLANTS|
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|2055.00|99|0.00|AEG 9 (NO REV)|
20|FH_F151523_86333_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F125965_66720_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129096_77833_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125249_0_0|SrvcGrp|34606|2022|PDM|3200.00|99|0.00|CPT 29827|
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)|
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F52854_0_0|SrvcGrp|36075|2022|PDM|4103.00|99|0.00|VITREOUS AND RETINAL PROCEDURES|
20|FH_F37756_0_0|SrvcGrp|3810|2022|PDM|276.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F33592_0_0|CSTM-ALL|CSTM-00|2020|PDM|480.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116188_72211_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F92659_0_0|SrvcGrp|92548|2022|PDM|652.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F140427_0_0|SrvcGrp|104924|2022|PCT|1.00|99|0.00|GUIDE WIRE|
20|FH_F148480_03079_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F134876_0_0|SrvcGrp|92501|2022|PDM|804.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F40499_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116700_11787_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F120352_52556_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F33642_0_0|SrvcGrp|13359|2022|PDM|750.00|99|0.00|EMERGENCY ROOM SVCS LEVEL I|
20|FH_F72830_0_0|SrvcGrp|70046|2022|PDM|2900.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 6|
20|FH_F146569_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F37679_0_0|SrvcGrp|26863|2022|PDM|30.50|99|0.00|MISC INFUSION THERAPY (MOD SH)|
20|FH_F50218_0_0|SrvcGrp|46243|2022|PDM|120.00|99|0.00|HOME VISIT NEWBORN CARE|
20|FH_F121566_91360_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128973_44256_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F137591_33411_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141407_76226_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F137946_0_0|SrvcGrp|113234|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2 & INF A&B AMP PRB|
20|FH_F92276_32308_0|SrvcGrp|73559|2022|PDM|4961.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F146569_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F49042_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F114916_30309_0|SrvcGrp|89988|2022|PDM|1000.00|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F115064_78582_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F70984_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|COVENTRY ENHANCED GROUPER 10 GA NO CRESCENT|
20|FH_F140247_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F41201_0_0|SrvcGrp|20012|2022|PCT|0.85|99|0.00|KIDNEY TRANSPLANT|
20|FH_F93553_65065_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139515_0_0|SrvcGrp|99164|2022|PDM|10197.00|99|0.00|CPT 22846|
20|FH_F129768_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER NUKF|
20|FH_F40515_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|GENERAL ACUTE CARE|
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_F127550_43026_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F133215_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F122705_33351_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F86872_15215_0|SrvcGrp|17015|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F119795_0_0|SrvcGrp|67073|2022|PDM|3019.00|99|0.00|CPT 22851|
20|FH_F114064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89372_0_0|SrvcGrp|88432|2022|PDM|2882.00|99|0.00|AETNA IP REHAB|
20|FH_F113709_0_0|SrvcGrp|88246|2022|PDM|95.80|99|0.00|INFLUENZA DNA AMP PROBE|
20|FH_F132212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134797_0_0|SrvcGrp|73006|2022|PDM|1696.00|99|0.00|AEG 9|
20|FH_F119315_70663_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F148644_06890_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 4 (NO REV)|
20|FH_F145960_33414_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124608_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F117885_81506_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F118025_60641_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42003_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F139607_0_0|SrvcGrp|74670|2022|PCT|0.30|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F136002_0_0|SrvcGrp|48398|2022|PDM|81.60|99|0.00|PT SERVICES|
20|FH_F123158_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F45324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147995_67037_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F92648_90248_0|SrvcGrp|73701|2022|PDM|30.88|99|0.00|AETNA - SKILLED NURSING|
20|FH_F109566_28601_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|IP PARTIAL HOSPITALIZATION (8-12 HOURS)|
20|FH_F133021_00910_0|SrvcGrp|29985|2022|PDM|60.00|99|0.00|SUPPLIES|
20|FH_F143200_91602_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F31944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|GENERAL ACUTE CARE|
20|FH_F101104_0_0|SrvcGrp|73523|2022|PDM|148.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F125255_34769_0|SrvcGrp|3178|2022|PDM|788.00|99|0.00|ACUTE PSYCH|
20|FH_F35176_0_0|SrvcGrp|12856|2022|PDM|42.25|99|0.00|NURSING CARE|
20|FH_F38700_0_0|SrvcGrp|18346|2022|PCT|0.80|99|0.00|MS DRG 473|
20|FH_F133307_14580_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38016_0_0|SrvcGrp|23477|2022|PDM|6490.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F105921_80014_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F111409_33761_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F45176_0_0|SrvcGrp|39604|2022|PDM|2400.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F144408_21617_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F41438_0_0|SrvcGrp|11442|2022|PDM|623.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F150499_32405_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F92677_08003_0|SrvcGrp|41452|2022|PDM|4.46|99|0.00|ENTERAL FORMULA - SPECIAL METABOLIC NEEDS|
20|FH_F92677_08003_0|SrvcGrp|86840|2022|PDM|63.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F117756_75402_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F35088_0_0|SrvcGrp|997|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F35056_0_0|SrvcGrp|15411|2022|PDM|1500.00|99|0.00|SURGICAL SVCS|
20|FH_F150938_02062_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F37187_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OP SVCS|
20|FH_F38999_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F134847_0_0|SrvcGrp|80617|2022|PDM|12381.00|99|0.00|ARTHOPLASTY|
20|FH_F35432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1114.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F48695_0_0|SrvcGrp|472|2022|PDM|1600.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F114206_37203_0|SrvcGrp|22592|2022|PDM|35.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F112045_90301_0|SrvcGrp|83418|2022|PDM|73880.00|99|0.00|NEURO-SPINE SURGERY|
20|FH_F131068_43055_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F110732_31513_0|SrvcGrp|104625|2022|PCT|0.60|99|0.00|AETNA ALL DRUGS AGENTS|
20|FH_F120157_93103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F125656_92868_0|SrvcGrp|22589|2022|PDM|50.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|2454.00|99|0.00|AEG 7 (NO REV)|
20|FH_F35369_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F128197_84123_0|SrvcGrp|48385|2022|PDM|103.00|99|0.00|SPEECH THERAPY|
20|FH_F50078_0_0|SrvcGrp|48428|2022|PDM|70.00|99|0.00|RESPIRATORY THERAPY INITIAL|
20|FH_F32401_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147226_48154_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IP MULTI ROOM COMPARISON|
20|FH_F150982_0_0|SrvcGrp|87053|2022|PDM|2532.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F41363_0_0|CSTM-ALL|CSTM-00|2020|PDM|845.00|99|0.00|ASPG X|
20|FH_F141287_14830_0|SrvcGrp|10107|2022|PCT|0.39|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F50612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98860_96706_0|SrvcGrp|73605|2022|PDM|3326.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F36743_0_0|SrvcGrp|701|2022|PDM|2400.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F147080_02446_0|SrvcGrp|90854|2022|PDM|896.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F138417_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F32825_0_0|SrvcGrp|18148|2022|PDM|10058.00|99|0.00|MS DRG 249|
20|FH_F147303_70508_0|SrvcGrp|66264|2022|PDM|74.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F94643_90501_0|SrvcGrp|86854|2022|PDM|59.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F141270_89103_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F112805_46011_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F90817_0_0|SrvcGrp|91016|2022|PDM|1880.00|99|0.00|RHINOPLASTY COMPLETE EXT PRT (HCFA)|
20|FH_F37081_0_0|SrvcGrp|360|2022|PDM|2848.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F143347_16001_0|SrvcGrp|9866|2022|PDM|986.00|99|0.00|IP OBSERVATION SVCS|
20|FH_F32838_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131093_49690_0|SrvcGrp|93098|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F151741_15090_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151743_20001_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|298.00|99|0.00|GA RETINA SURG CTR ASC 10|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD RR)|
20|FH_F132419_84042_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112670_47150_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F116913_77024_0|SrvcGrp|98748|2022|PDM|460.00|99|0.00|AETNA PARTIAL HOSP PSYCH (UB)|
20|FH_F113595_29527_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F118889_17701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F84611_30281_0|SrvcGrp|73002|2022|PDM|3643.00|99|0.00|AEG 7|
20|FH_F84611_30281_0|SrvcGrp|82369|2022|PCT|1.40|99|0.00|AETNA LABORATORY|
20|FH_F51276_0_0|SrvcGrp|14412|2022|PDM|635.74|99|0.00|HOSPICE CARE|
20|FH_F98621_41042_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124710_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F140007_0_0|SrvcGrp|38015|2022|PDM|8045.00|99|0.00|ARTHRODESIS|
20|FH_F128031_0_0|SrvcGrp|109143|2022|PDM|3080.00|99|0.00|SPINAL INSTRUMENTATION|
20|FH_F100681_73104_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F142087_0_0|SrvcGrp|88157|2022|PDM|15500.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|803.00|99|0.00|AEG 3 (NO REV)|
20|FH_F91975_0_0|SrvcGrp|79757|2022|PDM|926.00|99|0.00|ESOPHAGUS ENDOSCOPY REPAIR|
20|FH_F62579_0_0|SrvcGrp|41464|2022|PDM|60.00|99|0.00|REPAIR OF INFUSION DEVICE|
20|FH_F37478_0_0|CSTM-ALL|CSTM-00|2020|PDM|1747.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130721_04769_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 7 (NO REV)|
20|FH_F112827_26452_0|SrvcGrp|46605|2022|PDM|90.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F134972_84117_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F129509_0_0|SrvcGrp|103327|2022|PDM|7688.00|99|0.00|INSJ STABLJ DEV W/DCMPRN|
20|FH_F100782_0_0|SrvcGrp|97675|2022|PDM|2099.32|99|0.00|WINDBER MEDICAL CNTR ASC 704|
20|FH_F42467_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH|
20|FH_F49913_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F149517_0_0|SrvcGrp|90707|2022|PDM|194.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1111.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F90391_33774_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F77943_0_0|SrvcGrp|20293|2022|PDM|74751.89|99|0.00|MS DRG 235-236 ONLY CV SURGERY|
20|FH_F145562_70458_0|SrvcGrp|86851|2022|PDM|25.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F145702_22192_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F103220_0_0|SrvcGrp|79757|2022|PDM|2805.00|99|0.00|ESOPHAGUS ENDOSCOPY REPAIR|
20|FH_F127094_61802_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F122338_0_0|SrvcGrp|72992|2022|PDM|1485.00|99|0.00|AEG 2|
20|FH_F95980_20016_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F146211_68144_0|SrvcGrp|113553|2022|PCT|1.00|99|0.00|COVID-19 DIAGNOSTIC|
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|2732.00|99|0.00|AEG 9 (NO REV)|
20|FH_F100661_63640_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F51123_0_0|SrvcGrp|26001|2022|PDM|150.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|599.00|99|0.00|AEG 1 (NO REV)|
20|FH_F128648_44256_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F130108_0_0|SrvcGrp|9511|2022|PCT|0.60|99|0.00|OBSERVATION SVCS|
20|FH_F149605_0_0|SrvcGrp|65720|2022|PDM|153.00|99|0.00|RESPITE CARE|
20|FH_F132571_24739_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F149344_0_0|SrvcGrp|2067|2022|PDM|1118.17|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F128699_0_0|SrvcGrp|29155|2022|PDM|90.00|99|0.00|HOSPICE SVCS|
20|FH_F100661_63640_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F50974_0_0|SrvcGrp|47463|2022|PDM|70.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F132080_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F40943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132601_92677_0|SrvcGrp|89412|2022|PDM|411.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F91155_16105_0|SrvcGrp|74802|2022|PDM|8.11|99|0.00|AETNA CPT 36415|
20|FH_F133487_24293_0|SrvcGrp|48385|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F139825_0_0|SrvcGrp|95107|2022|PDM|5738.00|99|0.00|INTRAOCULAR LENS PROSTHESIS|
20|FH_F91044_74010_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F125415_64701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118400_16701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133530_11237_0|SrvcGrp|80679|2022|PCT|1.50|99|0.00|AETNA RADIOLOGY|
20|FH_F100880_67735_0|SrvcGrp|81779|2022|PDM|90.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F38352_0_0|SrvcGrp|28919|2022|PDM|34.00|99|0.00|CPT 97750|
20|FH_F120844_66061_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F102062_35447_0|SrvcGrp|98482|2022|PDM|60.00|99|0.00|PHOTOTHERAPY (HCFA)|
20|FH_F126733_83713_0|SrvcGrp|108061|2022|PCT|1.20|99|0.00|OP THERAPY SERVICES|
20|FH_F127188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132594_78229_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F142078_73110_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F131699_08210_0|SrvcGrp|48398|2022|PDM|154.35|99|0.00|PT SERVICES|
20|FH_F111401_29425_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F119220_75068_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F146220_72112_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|42.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 10 W/O REV|
20|FH_F108940_15642_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F128657_19008_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136407_0_0|SrvcGrp|12664|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F44992_0_0|SrvcGrp|8950|2022|PDM|1318.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F111316_0_0|SrvcGrp|86722|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F42159_0_0|SrvcGrp|24032|2022|PCT|0.95|99|0.00|LITHOTRIPSY|
20|FH_F125212_76301_0|SrvcGrp|46903|2022|PDM|430.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F120838_01603_0|SrvcGrp|46903|2022|PDM|445.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F148701_32708_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148780_70739_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F151082_18020_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151144_35801_0|SrvcGrp|110847|2022|PDM|915.43|99|0.00|REVISION OF EYELID|
20|FH_F151222_72958_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F121385_89102_0|SrvcGrp|99072|2022|PDM|6775.00|99|0.00|AETNA MATERNITY DELIVERY|
20|FH_F146785_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.40|99|0.00|OP SVCS|
20|FH_F87219_0_0|SrvcGrp|83880|2022|PDM|63.75|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F87219_0_0|SrvcGrp|83881|2022|PDM|59.91|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F137057_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32211_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F117465_0_0|SrvcGrp|75493|2022|PDM|1200.00|99|0.00|AEG 8|
20|FH_F132810_0_0|SrvcGrp|86836|2022|PDM|30.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F136299_75218_0|SrvcGrp|112769|2022|PCT|1.75|99|0.00|LABORATORY SERVICES (MOD TC)|
20|FH_F136314_19013_0|SrvcGrp|46903|2022|PDM|673.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F136475_89119_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F118152_20151_0|SrvcGrp|86841|2022|PDM|100.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F118232_24970_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137147_75006_0|SrvcGrp|47002|2022|PDM|17854.00|99|0.00|MS DRG 625 ONLY|
20|FH_F142508_29108_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142511_78597_0|SrvcGrp|46903|2022|PDM|669.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F142547_70002_0|SrvcGrp|86833|2022|PDM|10.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F142590_18336_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142690_31774_0|SrvcGrp|29076|2022|PDM|103.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F142737_77703_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F53732_0_0|SrvcGrp|50046|2022|PDM|150.00|99|0.00|PHOTOTHERAPY VISIT|
20|FH_F66765_0_0|SrvcGrp|10410|2022|PDM|25.00|99|0.00|SKILLED NURSING CARE|
20|FH_F125053_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F140548_60527_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|473.00|99|0.00|AEG 1 (NO REV)|
20|FH_F149524_28806_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132824_0_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F79743_0_0|SrvcGrp|105702|2022|PCT|0.57|99|0.00|EMERGENCY ROOM SERVICE|
20|FH_F110509_71351_0|SrvcGrp|103658|2022|PCT|1.30|99|0.00|LABORATORY SERVICES|
20|FH_F149021_44514_0|SrvcGrp|109348|2022|PDM|182.16|99|0.00|EXCISION OF LESION OF EYELID|
20|FH_F100782_0_0|SrvcGrp|105119|2022|PDM|702.75|99|0.00|WINDBER MEDICAL CNTR ASC 224|
20|FH_F120719_27540_0|SrvcGrp|74581|2022|PCT|0.44|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F127556_66725_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150165_06032_0|SrvcGrp|12491|2022|PCT|0.00|99|0.00|PACEMAKER|
20|FH_F81698_10457_0|SrvcGrp|86828|2022|PDM|47.25|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F144228_0_0|SrvcGrp|85985|2022|PDM|1637.00|99|0.00|CPT 11404|
20|FH_F132883_31602_0|SrvcGrp|86837|2022|PDM|10.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F80613_0_0|SrvcGrp|47463|2022|PDM|75.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F88744_71103_0|SrvcGrp|19961|2022|PDM|38251.00|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA|
20|FH_F125407_68756_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|GENERAL ACUTE CARE|
20|FH_F126484_30078_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F71748_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|1101.00|99|0.00|AEG 8 (NO REV)|
20|FH_F145642_15108_0|SrvcGrp|14947|2022|PDM|30.00|99|0.00|HOME INFUSION|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|314.48|99|0.00|ELECTROENCEPHALOGRAM (MOD TC)|
20|FH_F149517_0_0|SrvcGrp|89781|2022|PDM|194.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F149359_33301_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139723_30066_0|SrvcGrp|31512|2022|PCT|1.00|99|0.00|LABORATORY|
20|FH_F141210_0_0|SrvcGrp|73610|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F110702_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_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 2 (NO REV)|
20|FH_F34182_0_0|SrvcGrp|675|2022|PDM|2953.00|99|0.00|PEDIATRIC INPATIENT SVCS|
20|FH_F111741_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS SNF PART B DRUGS|
20|FH_F130329_64114_0|SrvcGrp|43567|2022|PDM|83.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F130763_0_0|SrvcGrp|78096|2022|PDM|4705.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F57853_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F56512_0_0|SrvcGrp|42870|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F144248_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F138050_52301_0|SrvcGrp|73496|2022|PDM|2232.00|99|0.00|AETNA ER LEVEL V|
20|FH_F138147_18018_0|SrvcGrp|113203|2022|PDM|28.88|99|0.00|MENTAL HEALTH ASSESSMENT (HCFA)|
20|FH_F130468_0_0|SrvcGrp|36591|2022|PDM|15023.40|99|0.00|CPT 63685|
20|FH_F133585_0_0|SrvcGrp|107794|2022|PDM|5571.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130329_64114_0|SrvcGrp|86845|2022|PDM|25.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F116806_0_0|SrvcGrp|107067|2022|PDM|1923.16|99|0.00|REPAIR PALATE|
20|FH_F124369_0_0|SrvcGrp|98468|2022|PDM|2113.10|99|0.00|EXC FOOT/TOE TUM DEEP|
20|FH_F83754_0_0|SrvcGrp|113016|2022|PDM|1312.00|99|0.00|NORMAL NEWBORN VIA NORMAL DELIVERY|
20|FH_F149105_66215_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133749_84604_0|SrvcGrp|112463|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY DOUBLE/TRIPLE LUMEN (HCFA)|
20|FH_F133868_40202_0|SrvcGrp|73842|2022|PDM|129.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F50654_0_0|SrvcGrp|46886|2022|PCT|1.00|99|0.00|REMOVAL OF EYELID LESION|
20|FH_F121225_98902_0|SrvcGrp|78504|2022|PCT|0.85|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F133775_83401_0|SrvcGrp|88620|2022|PDM|140.00|99|0.00|SKILLED NURSING RN|
20|FH_F100782_0_0|SrvcGrp|9793|2022|PDM|810.00|99|0.00|NEWBORN NURSERY|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|406.42|99|0.00|HAPA WPA-NWPA 2012-13 ASC 214 W/O REV|
20|FH_F145604_14850_0|SrvcGrp|29075|2022|PDM|75.00|99|0.00|HYDRATION THERAPY|
20|FH_F120719_27540_0|SrvcGrp|76981|2022|PDM|1803.00|99|0.00|HOSPICE|
20|FH_F31714_0_0|SrvcGrp|21|2022|PDM|29400.00|99|0.00|DRG 108 OTHER CARDIOTHORACIC PROCEDURE|
20|FH_F145604_14850_0|SrvcGrp|86828|2022|PDM|100.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F120930_0_0|SrvcGrp|84910|2022|PDM|2200.00|99|0.00|ENDOSCOPY|
20|FH_F132609_0_0|SrvcGrp|361|2022|PDM|1860.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F70804_0_0|SrvcGrp|12401|2022|PDM|91.36|99|0.00|RN VISIT|
20|FH_F122942_89512_0|SrvcGrp|9866|2022|PDM|1200.00|99|0.00|IP OBSERVATION SVCS|
20|FH_F147962_85008_0|CSTM-ALL|CSTM-00|2020|PDM|1089.00|99|0.00|AEG 1 (NO REV)|
20|FH_F121225_98902_0|SrvcGrp|80124|2022|PCT|0.85|99|0.00|AETNA CHEMOTHERAPY DRUGS|
20|FH_F133747_80634_0|SrvcGrp|91177|2022|PDM|800.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F113325_80004_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
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_F110442_98003_0|SrvcGrp|73842|2022|PDM|125.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F123851_03235_0|SrvcGrp|53987|2022|PDM|75.00|99|0.00|PHOTOTHERAPY|
20|FH_F116727_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F122532_46385_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F128955_70071_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F84712_0_0|SrvcGrp|73610|2022|PCT|0.63|99|0.00|AETNA IMPLANTS|
20|FH_F86375_0_0|SrvcGrp|80918|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|242.46|99|0.00|HAPA WPA-NWPA 2012-13 ASC 229 W/O REV|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|197.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 15 W/O REV|
20|FH_F70684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|INFUSION- IV SERVICES (MOD SJ)|
20|FH_F79644_0_0|SrvcGrp|3069|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F149640_50022_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151608_30236_0|SrvcGrp|109790|2022|PDM|18541.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F118789_92211_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F109882_36695_0|SrvcGrp|86753|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|AEG 8 (NO REV)|
20|FH_F147803_33952_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F147941_06023_0|SrvcGrp|45085|2022|PCT|0.00|99|0.00|CCU|
20|FH_F129501_67831_0|SrvcGrp|110820|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F129504_02871_0|SrvcGrp|63297|2022|PDM|165.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F117098_20186_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F117217_80304_0|SrvcGrp|58509|2022|PDM|366.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F117219_77515_0|SrvcGrp|86722|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F117240_37334_0|SrvcGrp|106811|2022|PCT|0.00|99|0.00|IP DETOXIFICATION|
20|FH_F137817_17050_0|SrvcGrp|108484|2022|PDM|541.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F115868_0_0|SrvcGrp|89783|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F109652_0_0|SrvcGrp|72992|2022|PDM|2061.00|99|0.00|AEG 2|
20|FH_F124923_23518_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F129892_0_0|SrvcGrp|27261|2022|PDM|1530.00|99|0.00|CPT 27446|
20|FH_F132736_0_0|CSTM-ALL|CSTM-00|2020|PDM|2059.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|AEG 6 (NO REV)|
20|FH_F145448_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 1 (NO REV)|
20|FH_F110160_0_0|SrvcGrp|104172|2022|PDM|1793.00|99|0.00|AEG 9 W/O CPT 29862|
20|FH_F51016_0_0|SrvcGrp|33166|2022|PDM|550.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F32201_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|170.84|99|0.00|DELAWARE VALLEY- ASC 216|
20|FH_F109462_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|OP SVCS|
20|FH_F101341_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F108800_0_0|SrvcGrp|35669|2022|PDM|5000.00|99|0.00|CPT 63650|
20|FH_F80711_0_0|SrvcGrp|22954|2022|PDM|138.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F88456_0_0|SrvcGrp|111858|2022|PDM|1232.00|99|0.00|CYSTOSCOPY|
20|FH_F88456_0_0|SrvcGrp|84704|2022|PDM|1003.00|99|0.00|CYSTOURETHROSCOPY W/ REMOVAL OF FOREIGN BODY|
20|FH_F114916_30309_0|SrvcGrp|105658|2022|PDM|3000.00|99|0.00|REPAIR FRACTURE OF RADIUS|
20|FH_F142448_15701_0|SrvcGrp|113820|2022|PCT|0.90|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|3395.00|99|0.00|AEG 4 (NO REV)|
20|FH_F119535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS|
20|FH_F43694_0_0|SrvcGrp|33813|2022|PDM|650.00|99|0.00|CD - DETOX|
20|FH_F131412_0_0|SrvcGrp|104229|2022|PDM|165.42|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94786_07974_0|SrvcGrp|13929|2022|PDM|15.75|99|0.00|GROWTH HORMONE|
20|FH_F132988_0_0|SrvcGrp|112165|2022|PDM|11824.53|99|0.00|REPAIR/GRAFT HEEL FRACTURE|
20|FH_F132988_0_0|SrvcGrp|104612|2022|PDM|1766.05|99|0.00|EXC FOOT/TOE TUM SC > 1.5 CM|
20|FH_F42161_0_0|SrvcGrp|177|2022|PDM|1100.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F72162_0_0|SrvcGrp|43569|2022|PDM|114.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F141336_16947_0|SrvcGrp|71666|2022|PDM|7574.00|99|0.00|CPT 63655|
20|FH_F124180_0_0|SrvcGrp|68048|2022|PDM|6139.50|99|0.00|CPT 64581|
20|FH_F124059_64055_0|SrvcGrp|23683|2022|PDM|42.00|99|0.00|SKILLED NURSING RN|
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|ASPG VIII|
20|FH_F40603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92493_0_0|SrvcGrp|72121|2022|PDM|2989.14|99|0.00|ARTHOSCOPY|
20|FH_F132864_71101_0|CSTM-ALL|CSTM-00|2020|PDM|1664.00|99|0.00|AEG 3 (NO REV)|
20|FH_F124233_92648_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F124585_33070_0|SrvcGrp|89149|2022|PDM|134.00|99|0.00|OP INTENSIVE|
20|FH_F124679_64052_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F127995_84010_0|SrvcGrp|30609|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F131848_83651_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F72416_0_0|SrvcGrp|45883|2022|PDM|80.00|99|0.00|OT|
20|FH_F98042_10468_0|SrvcGrp|90854|2022|PDM|3108.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F136568_92562_0|SrvcGrp|86723|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F114666_30342_0|SrvcGrp|11669|2022|PDM|2500.00|99|0.00|OP SURG|
20|FH_F137933_0_0|SrvcGrp|109629|2022|PDM|13100.00|99|0.00|CENTER FOR UROLOGIC SURGERY LLC|
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 1 (NO REV)|
20|FH_F117085_40207_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F112189_81212_0|SrvcGrp|104545|2022|PCT|1.00|99|0.00|AETNA CARVEOUT DRUGS|
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 4 (NO REV)|
20|FH_F147586_44124_0|SrvcGrp|83839|2022|PDM|6889.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F147586_44124_0|SrvcGrp|105235|2022|PDM|2836.00|99|0.00|PARTIAL REMOVAL OF THYROID|
20|FH_F41695_0_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F39967_0_0|SrvcGrp|701|2022|PDM|1785.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F98624_15701_0|SrvcGrp|73602|2022|PDM|3772.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|AEG 2 (NO REV)|
20|FH_F118446_0_0|SrvcGrp|84185|2022|PDM|150.00|99|0.00|RESPITE CARE|
20|FH_F133660_53225_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F98161_0_0|SrvcGrp|73000|2022|PDM|950.00|99|0.00|AEG 6|
20|FH_F151139_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32362_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F46433_0_0|SrvcGrp|14949|2022|PDM|140.00|99|0.00|HOME INFUSION|
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|3400.00|99|0.00|AEG 10 (NO REV)|
20|FH_F102200_06416_0|SrvcGrp|24744|2022|PDM|90.00|99|0.00|PICC LINE INSERTION|
20|FH_F105145_75075_0|SrvcGrp|98270|2022|PDM|7000.00|99|0.00|INJECT SPINE L/S (CD)|
20|FH_F115907_12206_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F146668_30189_0|SrvcGrp|108095|2022|PDM|3000.00|99|0.00|PARTIAL REMOVAL FOOT FASCIA|
20|FH_F120522_53549_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F120775_28805_0|SrvcGrp|112868|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F126783_80021_0|SrvcGrp|75419|2022|PDM|1095.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F66705_0_0|SrvcGrp|42763|2022|PDM|85.00|99|0.00|SKILLED NURSING CARE VISIT|
20|FH_F131697_33444_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F131451_61455_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132937_88201_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F150768_03054_0|SrvcGrp|88620|2022|PDM|173.00|99|0.00|SKILLED NURSING RN|
20|FH_F150882_84041_0|SrvcGrp|53746|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
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_F91076_0_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F137627_78382_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F149376_34239_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147306_70115_0|SrvcGrp|114012|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|100% 2007 MEDICARE TN DME MOD  AV|
20|FH_F138017_73129_0|SrvcGrp|87703|2022|PDM|6883.00|99|0.00|AETNA ENDOMETRIAL ABLATION|
20|FH_F134870_97015_0|SrvcGrp|35982|2022|PCT|1.17|99|0.00|ANESTHESIA SERVICES|
20|FH_F39287_0_0|SrvcGrp|30268|2022|PDM|130.00|99|0.00|HCPCS A4634 - REPLACE BULB/LAMP ULTRAVIOLET THERAPY SYSTEMS|
20|FH_F97101_98003_0|SrvcGrp|88978|2022|PDM|8632.00|99|0.00|VAGINAL DELIVERY|
20|FH_F133087_61107_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F43486_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F128753_32501_0|SrvcGrp|75505|2022|PCT|0.64|99|0.00|CARDIAC STUDIES|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F101441_0_0|SrvcGrp|96350|2022|PDM|7946.00|99|0.00|SHOULDER JOINT|
20|FH_F38986_0_0|SrvcGrp|19594|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F118907_0_0|SrvcGrp|103929|2022|PDM|171.01|99|0.00|SLEEP STUDY UNATTENDED RESPIRATORY EFFORT(HCFA)|
20|FH_F99281_81147_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F39756_0_0|SrvcGrp|31084|2022|PDM|924.00|99|0.00|DENTAL PROCEDURES - CHILD|
20|FH_F103180_85283_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD HOME HEALTH|
20|FH_F50078_0_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F33566_0_0|SrvcGrp|10013|2022|PDM|689.00|99|0.00|NEWBORN NURSERY|
20|FH_F41033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F45798_0_0|SrvcGrp|3489|2022|PDM|26500.00|99|0.00|DRG 498 SPINAL FUSION EXCEPT CERVICAL|
20|FH_F90232_15126_0|SrvcGrp|19742|2022|PDM|85.05|99|0.00|MID-LINE INSERTION|
20|FH_F141287_14830_0|SrvcGrp|111927|2022|PDM|56.44|99|0.00|COVID-19 NON CDC|
20|FH_F124291_44122_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39772_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (HCFA)|
20|FH_F89674_18640_0|SrvcGrp|48398|2022|PDM|68.25|99|0.00|PT SERVICES|
20|FH_F117581_21211_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F138478_0_0|SrvcGrp|107794|2022|PDM|3722.40|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F36435_0_0|SrvcGrp|13946|2022|PCT|1.00|99|0.00|RADIOLOGY|
20|FH_F112863_0_0|SrvcGrp|104261|2022|PDM|1141.00|99|0.00|FORMATION OF SKIN PEDICLE|
20|FH_F47037_0_0|SrvcGrp|10543|2022|PDM|92.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F39889_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F36554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|ASPG VI|
20|FH_F138478_0_0|SrvcGrp|113286|2022|PDM|2066.18|99|0.00|HEMODIALYSIS|
20|FH_F119897_78229_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F101685_0_0|SrvcGrp|73002|2022|PDM|1151.00|99|0.00|AEG 7|
20|FH_F84058_0_0|SrvcGrp|82451|2022|PDM|748.14|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F97420_75052_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|2330.00|99|0.00|AEG 9 (NO REV)|
20|FH_F123745_0_0|SrvcGrp|90420|2022|PDM|6800.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|798.00|99|0.00|AEG 3 (NO REV)|
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|3242.00|99|0.00|AEG 6 (NO REV)|
20|FH_F89674_18640_0|SrvcGrp|48396|2022|PDM|68.25|99|0.00|OT SERVICES|
20|FH_F132056_32080_0|SrvcGrp|89417|2022|PDM|416.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F124383_39056_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130939_40353_0|SrvcGrp|89412|2022|PDM|336.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F124514_21215_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1158.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F109251_62269_0|SrvcGrp|48396|2022|PDM|91.56|99|0.00|OT SERVICES|
20|FH_F40527_0_0|SrvcGrp|20071|2022|PDM|950.00|99|0.00|MS DRG 945-946|
20|FH_F122841_0_0|SrvcGrp|28548|2022|PDM|2497.00|99|0.00|VITRECTOMY|
20|FH_F134819_0_0|SrvcGrp|19922|2022|PDM|3102.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F151699_01752_0|SrvcGrp|19742|2022|PDM|90.00|99|0.00|MID-LINE INSERTION|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1607.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F136887_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F131449_19073_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F124691_78003_0|SrvcGrp|108061|2022|PCT|1.50|99|0.00|OP THERAPY SERVICES|
20|FH_F138417_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F119940_60126_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HSS ASC|
20|FH_F137798_0_0|SrvcGrp|95661|2022|PDM|140.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F117605_85260_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F133536_0_0|SrvcGrp|55071|2022|PDM|2750.00|99|0.00|ARTHROSCOPY SHOULDER|
20|FH_F150939_0_0|SrvcGrp|115899|2022|PDM|9.97|99|0.00|IIV4 VACCINE SPLT 0.25 ML IM|
20|FH_F42095_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F38955_0_0|CSTM-ALL|CSTM-00|2020|PDM|2465.33|99|0.00|ACUTE IP MED SVCS|
20|FH_F113585_20155_0|SrvcGrp|53987|2022|PCT|1.00|99|0.00|PHOTOTHERAPY|
20|FH_F138777_43140_0|SrvcGrp|73842|2022|PDM|181.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138876_25302_0|SrvcGrp|29075|2022|PDM|35.00|99|0.00|HYDRATION THERAPY|
20|FH_F138876_25302_0|SrvcGrp|112596|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F32921_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127207_0_0|SrvcGrp|104229|2022|PDM|90.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F148601_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|2611.00|99|0.00|AEG 1 (NO REV)|
20|FH_F151420_60654_0|SrvcGrp|26273|2022|PDM|2132.00|99|0.00|CPT 29880|
20|FH_F151420_60654_0|CSTM-ALL|CSTM-00|2020|PDM|1741.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132258_45404_0|SrvcGrp|43569|2022|PDM|39.64|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F122032_32413_0|SrvcGrp|73842|2022|PDM|186.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F145468_60615_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F40334_0_0|SrvcGrp|350|2022|PDM|2333.00|99|0.00|SURGICAL CARE|
20|FH_F135495_33145_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F91764_93710_0|SrvcGrp|92117|2022|PDM|31618.00|99|0.00|TOTAL JOINT|
20|FH_F135874_74403_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F100848_17202_0|SrvcGrp|75545|2022|PDM|338.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F100880_67735_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F130996_34110_0|SrvcGrp|99161|2022|PDM|17000.00|99|0.00|CPT 27138|
20|FH_F131265_84106_0|SrvcGrp|58509|2022|PDM|509.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F131132_44077_0|SrvcGrp|110820|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F131112_99163_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F116488_79925_0|SrvcGrp|66265|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F140629_0_0|SrvcGrp|113615|2022|PDM|1098.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F121454_34990_0|SrvcGrp|108807|2022|PCT|1.00|99|0.00|BREAST TOMOSYNTHESIS BI|
20|FH_F32803_0_0|SrvcGrp|13768|2022|PDM|1599.00|99|0.00|NICU|
20|FH_F129329_07039_0|SrvcGrp|89022|2022|PDM|40.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F128201_33334_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F111363_33169_0|SrvcGrp|75506|2022|PCT|0.84|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F111394_46012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134322_98001_0|SrvcGrp|109719|2022|PCT|1.00|99|0.00|CILAS SOD;IMIP PR 250MG/32MX|
20|FH_F47906_0_0|SrvcGrp|29960|2022|PCT|1.00|99|0.00|DME MOD KN|
20|FH_F42026_0_0|SrvcGrp|36511|2022|PCT|0.90|99|0.00|INDIVIDUAL COUNSELING SERVICES|
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.90|99|0.00|AEG 1 (NO REV)|
20|FH_F112138_80120_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F87557_33309_0|SrvcGrp|86836|2022|PDM|10.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F88831_84123_0|SrvcGrp|46424|2022|PDM|85.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F123036_0_0|SrvcGrp|103865|2022|PDM|1206.00|99|0.00|PT PRGRM FOR IMPLT NEUROSTIM|
20|FH_F102862_30606_0|SrvcGrp|80837|2022|PDM|22264.00|99|0.00|MSDRG 518 ONLY|
20|FH_F132090_60915_0|SrvcGrp|94563|2022|PDM|3501.00|99|0.00|HIP ARTHRO W/ LABRAL REPAIR|
20|FH_F132347_01605_0|SrvcGrp|48385|2022|PDM|147.00|99|0.00|SPEECH THERAPY|
20|FH_F120734_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS|
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|1252.65|99|0.00|AEG 7 (NO REV)|
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PDM|1799.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130662_07032_0|SrvcGrp|108484|2022|PDM|650.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F123638_0_0|SrvcGrp|108043|2022|PDM|409.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F90334_23323_0|SrvcGrp|33165|2022|PDM|315.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F110184_0_0|SrvcGrp|10393|2022|PDM|1600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F122243_30655_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|392.78|99|0.00|HAPA WPA-NWPA 2012-13 ASC 309 W/O REV|
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F125139_84096_0|SrvcGrp|89337|2022|PDM|784.00|99|0.00|DETOXIFICATION|
20|FH_F111732_33771_0|SrvcGrp|104469|2022|PDM|4750.00|99|0.00|VBAC DELIVERY|
20|FH_F31481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F133913_61008_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F93122_01854_0|SrvcGrp|76762|2022|PDM|413.00|99|0.00|ECT SERVICES|
20|FH_F99161_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F126896_60010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135622_34471_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F120603_66112_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F80613_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F118384_0_0|SrvcGrp|107773|2022|PCT|1.00|99|0.00|INJECTABLES (Q CODES)|
20|FH_F127908_60640_0|SrvcGrp|110650|2022|PCT|1.40|99|0.00|ACUTE PSYCH|
20|FH_F100782_0_0|SrvcGrp|105142|2022|PDM|81.17|99|0.00|WINDBER MEDICAL CNTR ASC 248|
20|FH_F143562_76665_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143742_60410_0|SrvcGrp|114163|2022|PCT|0.64|99|0.00|LABORATORY SERVICES|
20|FH_F110423_33401_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134359_36904_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F127090_45601_0|SrvcGrp|46104|2022|PDM|199.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F85353_16407_0|SrvcGrp|63776|2022|PDM|1398.82|99|0.00|HAPA WPA-NWPA 2012-13 ASC 8|
20|FH_F127418_0_0|SrvcGrp|53066|2022|PDM|2800.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL|
20|FH_F120144_77031_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F101280_63111_0|SrvcGrp|73849|2022|PDM|325.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F92431_80033_0|SrvcGrp|23683|2022|PDM|72.00|99|0.00|SKILLED NURSING RN|
20|FH_F114416_0_0|SrvcGrp|74546|2022|PDM|573.00|99|0.00|HOSPICE SERVICES|
20|FH_F124441_0_0|SrvcGrp|109831|2022|PDM|6175.00|99|0.00|SPINE FUSION|
20|FH_F140170_15301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140036_07702_0|SrvcGrp|89149|2022|PDM|249.00|99|0.00|OP INTENSIVE|
20|FH_F143347_16001_0|SrvcGrp|103262|2022|PDM|6798.00|99|0.00|AETNA PTCA TRANSLUMINAL|
20|FH_F90559_0_0|SrvcGrp|72990|2022|PDM|500.00|99|0.00|AEG 1|
20|FH_F66649_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F101806_0_0|SrvcGrp|75487|2022|PDM|793.50|99|0.00|AEG 5|
20|FH_F103060_0_0|SrvcGrp|88158|2022|PDM|7803.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F131107_43140_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F48473_0_0|SrvcGrp|12694|2022|PDM|93.50|99|0.00|PT SVCS|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD KM)|
20|FH_F49329_0_0|SrvcGrp|44703|2022|PDM|108.00|99|0.00|NURSING CARE|
20|FH_F120240_37013_0|SrvcGrp|76501|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F136296_73170_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F49895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F66420_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F129241_54409_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111263_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F110236_0_0|SrvcGrp|82137|2022|PDM|1350.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F93114_85016_0|SrvcGrp|46104|2022|PDM|145.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F102020_0_0|SrvcGrp|12401|2022|PDM|135.00|99|0.00|RN VISIT|
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F39022_0_0|SrvcGrp|30038|2022|PDM|1422.00|99|0.00|NICU INTENSIVE CARE LEVEL II|
20|FH_F148325_0_0|SrvcGrp|104745|2022|PDM|169.46|99|0.00|HOSPICE|
20|FH_F116924_91203_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F120693_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS|
20|FH_F71665_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111288_0_0|SrvcGrp|26278|2022|PDM|2849.00|99|0.00|CPT 29881|
20|FH_F41494_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F37359_0_0|SrvcGrp|26165|2022|PCT|0.63|99|0.00|HOME HEALTH SERVICES|
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F73743_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F148480_03079_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OTHER OP  SERV MOD 26|
20|FH_F89475_71202_0|SrvcGrp|73603|2022|PDM|788.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F123372_0_0|CSTM-ALL|CSTM-00|2020|PDM|1711.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40043_0_0|SrvcGrp|13000|2022|PCT|0.76|99|0.00|OBSERVATION SVCS|
20|FH_F57032_0_0|SrvcGrp|53482|2022|PDM|70.00|99|0.00|GLUCOSE METER|
20|FH_F70984_0_0|SrvcGrp|67989|2022|PDM|900.00|99|0.00|CPT 49320|
20|FH_F150982_0_0|SrvcGrp|35669|2022|PDM|4404.00|99|0.00|CPT 63650|
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 2 (NO REV)|
20|FH_F118194_50841_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER NUKC|
20|FH_F149140_07522_0|SrvcGrp|112762|2022|PDM|45.23|99|0.00|INFECTIOUS AGENT ANTIGEN DETECTION|
20|FH_F123915_0_0|SrvcGrp|65720|2022|PDM|198.00|99|0.00|RESPITE CARE|
20|FH_F66687_0_0|SrvcGrp|21358|2022|PCT|0.85|99|0.00|MS DRG 258-259 ONLY|
20|FH_F130747_0_0|SrvcGrp|90063|2022|PDM|5306.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F131254_92211_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F33913_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F123894_60927_0|SrvcGrp|75545|2022|PDM|496.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F126883_78621_0|SrvcGrp|89149|2022|PDM|195.00|99|0.00|OP INTENSIVE|
20|FH_F141795_89509_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F137387_32605_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40416_0_0|SrvcGrp|13551|2022|PDM|403.00|99|0.00|NEWBORN NURSERY|
20|FH_F145542_70503_0|SrvcGrp|48394|2022|PDM|34.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.33|99|0.00|AEG 4 (NO REV)|
20|FH_F38804_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F130523_04605_0|SrvcGrp|75505|2022|PCT|0.84|99|0.00|CARDIAC STUDIES|
20|FH_F93114_85016_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127375_28621_0|SrvcGrp|12491|2022|PCT|0.70|99|0.00|PACEMAKER|
20|FH_F135005_06460_0|SrvcGrp|48396|2022|PDM|89.00|99|0.00|OT SERVICES|
20|FH_F40089_0_0|SrvcGrp|27173|2022|PDM|50.00|99|0.00|PHYSICAL THERAPY SVCS|
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_F49338_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F76171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62719_0_0|SrvcGrp|37403|2022|PDM|40.50|99|0.00|HOME HEALTH AIDE|
20|FH_F85475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141801_80534_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F38090_0_0|SrvcGrp|7|2022|PDM|2055.00|99|0.00|NEONATAL INTENSIVE|
20|FH_F91636_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F140427_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F48927_0_0|SrvcGrp|10391|2022|PDM|2400.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F37605_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F141354_63556_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135666_37601_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F43679_0_0|SrvcGrp|555|2022|PDM|115.00|99|0.00|INTENSIVE OP SVCS|
20|FH_F133801_87107_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110345_37919_0|SrvcGrp|86746|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F126403_77304_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124173_66215_0|SrvcGrp|24744|2022|PDM|83.00|99|0.00|PICC LINE INSERTION|
20|FH_F123623_03246_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F96700_02135_0|SrvcGrp|3178|2022|PDM|1008.00|99|0.00|ACUTE PSYCH|
20|FH_F150159_06511_0|SrvcGrp|114008|2022|PDM|310.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F149364_19335_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F51124_0_0|SrvcGrp|29406|2022|PDM|124.00|99|0.00|PHYSICAL THERAPY|
20|FH_F120555_68405_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145641_06902_0|SrvcGrp|105637|2022|PDM|4638.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F51124_0_0|SrvcGrp|26001|2022|PDM|150.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F95631_33705_0|SrvcGrp|73601|2022|PDM|10771.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F87775_15106_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F130123_24171_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139169_0_0|SrvcGrp|113479|2022|PDM|1000.00|99|0.00|ESOPH ENDOSCOPY|
20|FH_F120735_40012_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F122243_30655_0|SrvcGrp|109036|2022|PDM|520.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F150165_06032_0|SrvcGrp|78285|2022|PDM|2737.00|99|0.00|CPT 58671|
20|FH_F149359_33301_0|SrvcGrp|112224|2022|PCT|0.75|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F100782_0_0|SrvcGrp|105084|2022|PDM|469.36|99|0.00|WINDBER MEDICAL CNTR ASC 129|
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|1851.00|99|0.00|AEG 1 (NO REV)|
20|FH_F124173_66215_0|SrvcGrp|29023|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|AEG 2 (NO REV)|
20|FH_F34852_0_0|SrvcGrp|9852|2022|PCT|0.70|99|0.00|LABORATORY|
20|FH_F112712_63005_0|SrvcGrp|24761|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132969_84003_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129509_0_0|SrvcGrp|88159|2022|PDM|3767.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F117382_0_0|SrvcGrp|103551|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F124369_0_0|SrvcGrp|98470|2022|PDM|1815.00|99|0.00|AMPUTATION TOE|
20|FH_F96160_32207_0|SrvcGrp|86847|2022|PDM|68.65|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F135670_01749_0|SrvcGrp|15402|2022|PDM|66.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F34852_0_0|SrvcGrp|997|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F145641_06902_0|SrvcGrp|58671|2022|PDM|3162.00|99|0.00|ASC CARVE OUT 64721|
20|FH_F142376_0_0|SrvcGrp|98604|2022|PDM|5091.00|99|0.00|IMPLANT SPINAL CANAL|
20|FH_F125328_0_0|SrvcGrp|73000|2022|PDM|905.00|99|0.00|AEG 6|
20|FH_F121225_98902_0|SrvcGrp|24744|2022|PDM|225.00|99|0.00|PICC LINE INSERTION|
20|FH_F130327_03867_0|SrvcGrp|43569|2022|PDM|157.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F85353_16407_0|SrvcGrp|63870|2022|PDM|329.25|99|0.00|HAPA WPA-NWPA 2012-13 ASC 230|
20|FH_F126882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F145604_14850_0|SrvcGrp|86842|2022|PDM|75.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F71049_0_0|SrvcGrp|3809|2022|PDM|1159.00|99|0.00|HOSPICE CARE|
20|FH_F121225_98902_0|SrvcGrp|79099|2022|PDM|3890.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F122942_89512_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122520_46383_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F102142_80014_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F105361_80104_0|SrvcGrp|90854|2022|PDM|3472.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F80513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|GENERAL ACUTE CARE|
20|FH_F146668_30189_0|SrvcGrp|107986|2022|PDM|2950.00|99|0.00|REMOVAL OF FOOT LESION|
20|FH_F146776_64506_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F111605_80524_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139428_65270_0|SrvcGrp|29347|2022|PDM|25.75|99|0.00|HOME HEALTH AIDE|
20|FH_F150765_05001_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|106.24|99|0.00|SALLY BALIN,999182,ASC 225|
20|FH_F97480_08204_0|SrvcGrp|73601|2022|PDM|12226.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F122377_91007_0|SrvcGrp|75483|2022|PDM|7520.00|99|0.00|AEG 3|
20|FH_F90232_15126_0|SrvcGrp|88621|2022|PDM|99.75|99|0.00|SKILLED NURSING LPN|
20|FH_F124322_64131_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F39211_0_0|SrvcGrp|17419|2022|PDM|70.00|99|0.00|SPEECH THERAPY|
20|FH_F36053_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|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_F109762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150941_68124_0|SrvcGrp|46903|2022|PDM|659.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F97084_91911_0|SrvcGrp|73603|2022|PDM|11197.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F150439_03110_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F150930_64485_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116332_0_0|SrvcGrp|115362|2022|PDM|12220.00|99|0.00|FUSION OF STOMACH AND BOWEL|
20|FH_F150982_0_0|SrvcGrp|102240|2022|PDM|2202.00|99|0.00|AETNA BLEPHARAPLASTY UPPER EYELID|
20|FH_F90817_0_0|SrvcGrp|90360|2022|PDM|2162.00|99|0.00|REPAIR FRACTURE OF ULNA|
20|FH_F33632_52349_0|SrvcGrp|16069|2022|PDM|770.58|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F97640_37043_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F91876_0_0|SrvcGrp|72990|2022|PDM|604.00|99|0.00|AEG 1|
20|FH_F82696_16335_0|SrvcGrp|3178|2022|PDM|889.00|99|0.00|ACUTE PSYCH|
20|FH_F74467_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F100790_10512_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F145593_92660_0|SrvcGrp|46903|2022|PDM|1300.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F138218_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F125028_19061_0|SrvcGrp|86845|2022|PDM|63.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F37756_0_0|SrvcGrp|3499|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F139551_0_0|SrvcGrp|82114|2022|PDM|2950.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F118079_37642_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|GENERAL ACUTE CARE|
20|FH_F91994_0_0|SrvcGrp|77461|2022|PDM|2000.00|99|0.00|CPT 52356|
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PDM|349.79|99|0.00|ASPG I|
20|FH_F148219_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F118703_0_0|SrvcGrp|72992|2022|PDM|508.00|99|0.00|AEG 2|
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|1033.00|99|0.00|AEG 6 (NO REV)|
20|FH_F145545_01602_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F90798_0_0|SrvcGrp|474|2022|PDM|250.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|363.00|99|0.00|AEG 1 (NO REV)|
20|FH_F70126_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F39479_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F39819_0_0|SrvcGrp|31240|2022|PDM|6861.00|99|0.00|NY DRG 182 ONLY|
20|FH_F74342_0_0|SrvcGrp|26253|2022|PDM|25.00|99|0.00|LIPIDS|
20|FH_F116327_75701_0|SrvcGrp|104077|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F123407_04605_0|SrvcGrp|90397|2022|PDM|226.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F101021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125028_19061_0|SrvcGrp|14949|2022|PDM|126.00|99|0.00|HOME INFUSION|
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 2 (NO REV)|
20|FH_F36646_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78003_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F111594_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|825.00|99|0.00|AEG 10 (NO REV)|
20|FH_F148545_84047_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133021_00910_0|SrvcGrp|10393|2022|PDM|1485.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F40388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F144532_19606_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F39517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F117272_24333_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F86293_0_0|SrvcGrp|26278|2022|PDM|2714.00|99|0.00|CPT 29881|
20|FH_F111809_93003_0|SrvcGrp|114116|2022|PDM|17558.00|99|0.00|ELECTROPHYSIOLOGY EVALUATION|
20|FH_F68622_0_0|SrvcGrp|12512|2022|PDM|1394.00|99|0.00|ACUTE REHABILITATION|
20|FH_F103781_0_0|SrvcGrp|88621|2022|PDM|70.00|99|0.00|SKILLED NURSING LPN|
20|FH_F128316_22192_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F134467_84321_0|SrvcGrp|471|2022|PDM|608.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F111456_33884_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F107180_80723_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F148921_91356_0|SrvcGrp|46903|2022|PDM|737.50|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F120838_01603_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F118391_77040_0|SrvcGrp|70819|2022|PCT|0.00|99|0.00|(HCPCS) OCN F/S PRICING: ALL|
20|FH_F102062_35447_0|SrvcGrp|48398|2022|PDM|145.00|99|0.00|PT SERVICES|
20|FH_F63145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F132934_63005_0|SrvcGrp|941|2022|PDM|4937.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F143053_89501_0|SrvcGrp|98701|2022|PDM|474.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F149881_03038_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F31093_0_0|SrvcGrp|10981|2022|PDM|600.00|99|0.00|MAGNETIC RESONANCE ANGIOGRAPHY|
20|FH_F81373_64064_0|SrvcGrp|31655|2022|PCT|0.69|99|0.00|TRACHEOSTOMY (MS DRG)|
20|FH_F133307_14580_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97160_77436_0|SrvcGrp|46903|2022|PDM|674.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F120550_91355_0|SrvcGrp|84559|2022|PCT|0.85|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F128099_70403_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F74463_0_0|SrvcGrp|71668|2022|PDM|3100.00|99|0.00|SURGERY CARVE OUTS|
20|FH_F77787_0_0|SrvcGrp|13084|2022|PDM|2044.00|99|0.00|ICU/CCU|
20|FH_F145854_37015_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149840_80002_0|SrvcGrp|90338|2022|PDM|135.00|99|0.00|SKILLED NURSING RN (HCFA)|
20|FH_F94165_0_0|SrvcGrp|74470|2022|PCT|0.85|99|0.00|AETNA SLEEP STUDIES|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1507.04|99|0.00|HAPA WPA-NWPA 2012-13 ASC 903 W/O REV|
20|FH_F123144_0_0|SrvcGrp|73008|2022|PDM|762.00|99|0.00|AEG 10|
20|FH_F87173_15136_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F141927_71901_0|SrvcGrp|113834|2022|PDM|894.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F112905_62088_0|SrvcGrp|537|2022|PCT|0.81|99|0.00|OBSERVATION SERVICES|
20|FH_F127197_23111_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F130599_41472_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143993_07621_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F44079_0_0|SrvcGrp|24289|2022|PDM|70.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F132737_0_0|SrvcGrp|360|2022|PDM|1957.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132612_0_0|SrvcGrp|361|2022|PDM|1860.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F141654_15217_0|SrvcGrp|48385|2022|PDM|90.18|99|0.00|SPEECH THERAPY|
20|FH_F36826_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPEN MRI OF LEE MRI SCANS (RENTAL)|
20|FH_F147086_84751_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F124695_33401_0|SrvcGrp|104187|2022|PDM|11.00|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F35452_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY|
20|FH_F122377_91007_0|SrvcGrp|73499|2022|PDM|2126.00|99|0.00|AETNA ER LEVEL II|
20|FH_F150952_85008_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F100663_56537_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110727_34994_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F107840_07006_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F98022_89015_0|SrvcGrp|73659|2022|PDM|8770.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F34853_0_0|SrvcGrp|411|2022|PDM|7039.00|99|0.00|OP CARDIAC CATH|
20|FH_F43324_0_0|SrvcGrp|38023|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F40653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F149002_80014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F138018_17313_0|SrvcGrp|19742|2022|PDM|208.00|99|0.00|MID-LINE INSERTION|
20|FH_F40490_0_0|SrvcGrp|12163|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F134869_08854_0|SrvcGrp|89269|2022|PDM|159.00|99|0.00|PSYTX PT/FAMILY 45 MINUTES|
20|FH_F117711_73080_0|SrvcGrp|72990|2022|PDM|525.00|99|0.00|AEG 1|
20|FH_F73803_0_0|CSTM-ALL|CSTM-00|2020|PDM|548.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F140295_0_0|SrvcGrp|69981|2022|PDM|3480.00|99|0.00|CPT 24358|
20|FH_F118907_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137986_0_0|SrvcGrp|16289|2022|PDM|890.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F132096_89118_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F80024_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS|
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_F97183_25304_0|SrvcGrp|88978|2022|PDM|7398.00|99|0.00|VAGINAL DELIVERY|
20|FH_F122277_98045_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F132442_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F36926_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124486_0_0|SrvcGrp|109847|2022|PDM|1803.00|99|0.00|INSERT ANT DRAINAGE DEVICE (HCFA)|
20|FH_F83431_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.46|99|0.00|OP SVCS|
20|FH_F122377_91007_0|SrvcGrp|16|2022|PDM|5083.00|99|0.00|ACUTE REHABILITATION|
20|FH_F97223_94028_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130371_0_0|SrvcGrp|103913|2022|PCT|0.92|99|0.00|OP DIALYSIS|
20|FH_F111044_0_0|SrvcGrp|103542|2022|PDM|1648.00|99|0.00|ANKLE ARTHROSCOPY/SURGERY|
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|2067.00|99|0.00|ASPG III|
20|FH_F150953_74953_0|SrvcGrp|115897|2022|PCT|0.77|99|0.00|CHEMOTHERAPY DRUGS/HIGH COST DRUGS|
20|FH_F151039_16749_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|5515.00|99|0.00|AEG 9 (NO REV)|
20|FH_F138995_0_0|SrvcGrp|15473|2022|PDM|2300.00|99|0.00|CPT CODE 42820|
20|FH_F150982_0_0|SrvcGrp|63468|2022|PDM|1652.00|99|0.00|CPT 52281|
20|FH_F149579_95815_0|SrvcGrp|115685|2022|PDM|19.89|99|0.00|PHYSIOLOGIC REM MONITORING SETUP|
20|FH_F124291_44122_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|78.14|99|0.00|SALLY BALIN,999182,ASC 227|
20|FH_F122277_98045_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40719_0_0|CSTM-ALL|CSTM-00|2020|PDM|947.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|105640|2022|PDM|1040.00|99|0.00|NJX INTERLAMINAR CRV/THRC|
20|FH_F91978_34471_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F149160_02180_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F143249_89801_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F93740_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F102224_0_0|SrvcGrp|87677|2022|PDM|2080.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F151754_71943_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151761_20019_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F49054_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F120191_91360_0|SrvcGrp|75419|2022|PDM|650.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F33223_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84372_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116595_92506_0|SrvcGrp|86648|2022|PCT|1.15|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F116684_30701_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F116907_75093_0|SrvcGrp|90573|2022|PDM|275.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F116918_06488_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120866_51652_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120856_78247_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126243_32132_0|SrvcGrp|73842|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F51276_0_0|SrvcGrp|24751|2022|PDM|80.00|99|0.00|INTERMITTENT ANTICOAGULANT THERAPY|
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_F40091_0_0|SrvcGrp|17000|2022|PCT|0.70|99|0.00|OUTPATIENT SURGERY|
20|FH_F45832_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|NOVANT PIEDMONT LABS|
20|FH_F61292_0_0|SrvcGrp|3950|2022|PDM|5726.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F143973_28040_0|SrvcGrp|108484|2022|PDM|640.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F92276_32308_0|SrvcGrp|114313|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F113410_0_0|SrvcGrp|59840|2022|PDM|1576.00|99|0.00|TYMPANOSTOMY|
20|FH_F131228_01826_0|SrvcGrp|73606|2022|PDM|1720.13|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F119660_0_0|SrvcGrp|82223|2022|PDM|90.00|99|0.00|HOSPICE CARE|
20|FH_F130716_76013_0|SrvcGrp|88779|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY|
20|FH_F100786_24740_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F118539_44256_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149884_68516_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F72859_0_0|SrvcGrp|12401|2022|PDM|80.00|99|0.00|RN VISIT|
20|FH_F117087_0_0|SrvcGrp|107177|2022|PDM|2494.00|99|0.00|REMOVE EAR LESION|
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F142067_45211_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|ASPG IX|
20|FH_F46281_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F146211_68144_0|SrvcGrp|114014|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F118034_60645_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150903_45805_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141747_20688_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146320_27610_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132543_79549_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F92644_06053_0|SrvcGrp|473|2022|PDM|399.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F128707_72601_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|2371.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113306_33458_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137950_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F92792_0_0|SrvcGrp|28548|2022|PDM|1320.00|99|0.00|VITRECTOMY|
20|FH_F113131_19013_0|SrvcGrp|73842|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ACUTE PSYCH|
20|FH_F33155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F37909_0_0|SrvcGrp|21875|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F40448_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.00|99|0.00|HEAD INJURY REHABILITATION|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF|
20|FH_F141849_76053_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148886_60621_0|CSTM-ALL|CSTM-00|2020|PDM|1228.00|99|0.00|AEG 4 (NO REV)|
20|FH_F150559_60018_0|SrvcGrp|48398|2022|PDM|155.00|99|0.00|PT SERVICES|
20|FH_F148644_06890_0|SrvcGrp|78282|2022|PDM|4635.00|99|0.00|CPT 47563|
20|FH_F148644_06890_0|SrvcGrp|75282|2022|PDM|3756.00|99|0.00|DIAGNOSTIC HYSTEROSCOPY|
20|FH_F88639_80204_0|SrvcGrp|75483|2022|PDM|5087.85|99|0.00|AEG 3|
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP DIALYSIS|
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|3060.00|99|0.00|AEG 9 (NO REV)|
20|FH_F46832_0_0|SrvcGrp|22591|2022|PDM|35.00|99|0.00|IMPLANTED PUMP|
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|AEG 4 (NO REV)|
20|FH_F58856_0_0|SrvcGrp|29609|2022|PDM|37500.00|99|0.00|MS DRG 232 ONLY|
20|FH_F107200_0_0|SrvcGrp|101523|2022|PDM|1665.00|99|0.00|CERCLAGE OF CERVIX|
20|FH_F136300_67206_0|SrvcGrp|3178|2022|PDM|896.00|99|0.00|ACUTE PSYCH|
20|FH_F120489_63552_0|SrvcGrp|11258|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F120489_63552_0|SrvcGrp|11663|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F134011_84102_0|SrvcGrp|86844|2022|PDM|25.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F134150_01801_0|SrvcGrp|17698|2022|PDM|914.00|99|0.00|ACUTE PSYCH (>=18 YRS)|
20|FH_F134155_07016_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137147_75006_0|SrvcGrp|26684|2022|PDM|110250.00|99|0.00|MS DRG 454 ONLY|
20|FH_F137249_30046_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114092_83350_0|SrvcGrp|109057|2022|PDM|4000.00|99|0.00|CARDIAC STUDIES|
20|FH_F138746_60174_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142273_51012_0|SrvcGrp|75506|2022|PCT|0.84|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F142313_14788_0|SrvcGrp|108484|2022|PDM|151.53|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F142715_32757_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F83831_0_0|SrvcGrp|22954|2022|PDM|138.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F97600_46151_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|OP SVCS|
20|FH_F138471_84663_0|SrvcGrp|65720|2022|PDM|93.00|99|0.00|RESPITE CARE|
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|2050.00|99|0.00|AEG 8 (NO REV)|
20|FH_F140652_92626_0|SrvcGrp|89149|2022|PDM|365.00|99|0.00|OP INTENSIVE|
20|FH_F80284_16354_0|SrvcGrp|29817|2022|PDM|3667.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F148699_19403_0|SrvcGrp|90854|2022|PDM|1165.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F149584_77045_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149663_45219_0|CSTM-ALL|CSTM-00|2020|PDM|1567.00|99|0.00|AEG 6 (NO REV)|
20|FH_F118818_19808_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118818_19808_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F38332_0_0|SrvcGrp|43|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F92533_27810_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F109882_36695_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F109983_98607_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117371_77059_0|SrvcGrp|46903|2022|PDM|475.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F147940_33626_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129438_08234_0|SrvcGrp|73841|2022|PDM|340.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F129483_77030_0|SrvcGrp|86847|2022|PDM|40.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F129483_77030_0|SrvcGrp|86825|2022|PDM|60.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1873.00|99|0.00|AEG 9 (NO REV)|
20|FH_F137905_91364_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F109652_0_0|SrvcGrp|473|2022|PDM|592.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F143450_0_0|SrvcGrp|87187|2022|PDM|706.00|99|0.00|CPT 43259|
20|FH_F39085_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ACUTE PSYCH|
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120362_23321_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
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_F127281_68516_0|SrvcGrp|73841|2022|PDM|424.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F137630_24266_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127375_28621_0|SrvcGrp|90356|2022|PCT|1.00|99|0.00|OP DIALYSIS|
20|FH_F135207_76053_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F40615_0_0|SrvcGrp|97|2022|PDM|4369.00|99|0.00|C-SECTION|
20|FH_F93384_0_0|SrvcGrp|42782|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F66501_0_0|SrvcGrp|10545|2022|PDM|70.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F84135_0_0|SrvcGrp|108041|2022|PDM|927.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F125323_43213_0|SrvcGrp|23683|2022|PDM|7.00|99|0.00|SKILLED NURSING RN|
20|FH_F90874_0_0|SrvcGrp|105470|2022|PDM|2025.00|99|0.00|TRAINING INCL A TREATMENT|
20|FH_F120952_25303_0|SrvcGrp|48396|2022|PDM|130.00|99|0.00|OT SERVICES|
20|FH_F92091_0_0|SrvcGrp|10986|2022|PDM|4200.00|99|0.00|ARTHROSCOPIC KNEE REPAIR|
20|FH_F109810_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124048_47304_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F40032_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F116341_12180_0|SrvcGrp|104079|2022|PCT|1.05|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F130038_08021_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F143928_21061_0|SrvcGrp|53987|2022|PCT|1.05|99|0.00|PHOTOTHERAPY|
20|FH_F37659_0_0|SrvcGrp|26989|2022|PDM|120783.00|99|0.00|LUNG-DOUBLE TRANSPLANT|
20|FH_F116161_28112_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128002_27260_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F32135_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F78048_0_0|SrvcGrp|30095|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F40043_0_0|SrvcGrp|941|2022|PDM|2792.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F124017_0_0|SrvcGrp|84442|2022|PDM|7800.00|99|0.00|REVISION KNEE|
20|FH_F143528_0_0|SrvcGrp|89860|2022|PDM|5250.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F109240_21201_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120362_23321_0|SrvcGrp|88621|2022|PDM|93.00|99|0.00|SKILLED NURSING LPN|
20|FH_F125516_50574_0|SrvcGrp|75506|2022|PCT|0.90|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F125473_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F150462_30458_0|SrvcGrp|17002|2022|PDM|120.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS|
20|FH_F138215_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F91973_0_0|SrvcGrp|90376|2022|PDM|10197.00|99|0.00|REVISION OF KNEE JOINTLANT|
20|FH_F125074_18104_0|SrvcGrp|73700|2022|PDM|54.76|99|0.00|AETNA - SKILLED NURSING|
20|FH_F148440_16506_0|SrvcGrp|114443|2022|PDM|4613.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F130682_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|2431.80|99|0.00|AEG 7 (NO REV)|
20|FH_F137611_30909_0|SrvcGrp|90854|2022|PDM|1007.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F39278_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F82753_18840_0|SrvcGrp|113739|2022|PCT|1.65|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F137946_0_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F137614_17602_0|SrvcGrp|86723|2022|PDM|370.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F92012_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.20|99|0.00|GENERAL ACUTE CARE|
20|FH_F137940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F51733_0_0|SrvcGrp|44428|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY SVCS (VISIT LVL)|
20|FH_F150980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F115057_15601_0|SrvcGrp|52953|2022|PCT|1.10|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F100660_56303_0|SrvcGrp|73659|2022|PDM|4735.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F121090_07848_0|SrvcGrp|89417|2022|PDM|413.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F79212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112508_0_0|SrvcGrp|471|2022|PDM|832.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F150982_0_0|SrvcGrp|77449|2022|PDM|3028.00|99|0.00|CPT 52352|
20|FH_F37404_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F118057_47906_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142073_0_0|SrvcGrp|76604|2022|PDM|1740.00|99|0.00|CPT 25447|
20|FH_F146011_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.20|99|0.00|GENERAL ACUTE CARE|
20|FH_F126939_32405_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F141802_17042_0|SrvcGrp|80258|2022|PDM|1685.00|99|0.00|AETNA SKILLED CARE|
20|FH_F93920_0_0|SrvcGrp|73806|2022|PCT|0.80|99|0.00|AETNA ER|
20|FH_F44582_0_0|SrvcGrp|9511|2022|PCT|0.70|99|0.00|OBSERVATION SVCS|
20|FH_F40417_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69971_0_0|SrvcGrp|36722|2022|PDM|108.00|99|0.00|SIGMOIDOSCOPY|
20|FH_F86872_15215_0|SrvcGrp|86850|2022|PDM|50.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 6 (NO REV)|
20|FH_F37365_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F90136_0_0|SrvcGrp|73656|2022|PDM|475.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F72544_0_0|SrvcGrp|413|2022|PCT|0.75|99|0.00|TRANSPLANT SVCS|
20|FH_F78003_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F119289_43040_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 9 (NO REV)|
20|FH_F138283_0_0|SrvcGrp|34146|2022|PDM|118.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F138283_0_0|SrvcGrp|113272|2022|PDM|112.00|99|0.00|NURSING ASSESSMENT/EVAL|
20|FH_F148485_13021_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F150883_14727_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F92677_08003_0|SrvcGrp|26869|2022|PDM|52.50|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F68699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS|
20|FH_F44225_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F63301_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F133135_48235_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127217_29650_0|SrvcGrp|87317|2022|PDM|1018.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG VI|
20|FH_F89932_10940_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F124505_0_0|SrvcGrp|99073|2022|PDM|1.32|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F123545_44512_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F41438_0_0|SrvcGrp|9263|2022|PDM|145.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F141802_17042_0|SrvcGrp|68483|2022|PDM|584.00|99|0.00|SLEEP STUDY MOD 52|
20|FH_F111437_33305_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|PDM|1734.00|99|0.00|AEG 8 (NO REV)|
20|FH_F128912_44313_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F136393_0_0|SrvcGrp|112882|2022|PDM|3200.00|99|0.00|ILIAC REVASC|
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 8 (NO REV)|
20|FH_F125256_77365_0|SrvcGrp|89417|2022|PDM|325.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F133458_18929_0|SrvcGrp|112323|2022|PDM|400.00|99|0.00|LABORATORY|
20|FH_F122245_0_0|SrvcGrp|73008|2022|PDM|900.00|99|0.00|AEG 10|
20|FH_F48935_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F143684_0_0|SrvcGrp|88494|2022|PDM|5202.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F126735_38018_0|SrvcGrp|87317|2022|PDM|765.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F97564_52246_0|SrvcGrp|88977|2022|PDM|6795.00|99|0.00|C-SECTION DELIVERY|
20|FH_F82475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F89112_16509_0|SrvcGrp|64107|2022|PDM|1398.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 3|
20|FH_F100786_24740_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F50372_0_0|SrvcGrp|46583|2022|PDM|80.00|99|0.00|CPT 99202|
20|FH_F57396_0_0|SrvcGrp|46592|2022|PDM|160.00|99|0.00|CPT 99214|
20|FH_F134467_84321_0|SrvcGrp|473|2022|PDM|318.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F133268_63703_0|SrvcGrp|104054|2022|PDM|13.20|99|0.00|INFLUENZA VACCINE - PRESERVATIVE FREE|
20|FH_F40554_0_0|SrvcGrp|439|2022|PDM|1400.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F89233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F43652_0_0|SrvcGrp|37504|2022|PDM|247.91|99|0.00|CIRCUMCISION|
20|FH_F123373_0_0|SrvcGrp|63|2022|PDM|1711.00|99|0.00|SUBACUTE CARE|
20|FH_F67265_0_0|SrvcGrp|3259|2022|PDM|600.00|99|0.00|ACUTE REHABILITATION|
20|FH_F150001_33064_0|SrvcGrp|86836|2022|PDM|11.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F43296_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F34363_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46357_0_0|SrvcGrp|34069|2022|PDM|3000.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F150904_22306_0|SrvcGrp|88621|2022|PDM|137.00|99|0.00|SKILLED NURSING LPN|
20|FH_F95360_08720_0|SrvcGrp|75545|2022|PDM|260.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F142818_34209_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F102561_75146_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F133397_23233_0|SrvcGrp|92760|2022|PCT|1.41|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36756_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD AW|
20|FH_F70026_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146254_83651_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133647_32952_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148639_0_0|SrvcGrp|27343|2022|PDM|2968.00|99|0.00|OP SURGERY (CPT 25607 - 25609)|
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_F42168_0_0|SrvcGrp|12146|2022|PDM|1400.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F132722_71373_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 2 (NO REV)|
20|FH_F102561_75146_0|SrvcGrp|98007|2022|PDM|2898.00|99|0.00|FINGER/THUMB AMPUTATION|
20|FH_F149665_65689_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F72226_65804_0|SrvcGrp|109057|2022|PCT|0.56|99|0.00|CARDIAC STUDIES|
20|FH_F147993_65622_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F42343_0_0|SrvcGrp|110|2022|PDM|485.00|99|0.00|CD - REHABILITATION|
20|FH_F98620_43920_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F142176_98040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47834_0_0|SrvcGrp|20483|2022|PCT|1.10|99|0.00|RADIOLOGY SVCS (MOD 26)|
20|FH_F112848_06032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144494_62526_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F137896_0_0|SrvcGrp|111643|2022|PDM|1625.00|99|0.00|HOME VENTILATOR (MOD RR)|
20|FH_F71882_15228_0|CSTM-ALL|CSTM-00|2020|PDM|375.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148761_33311_0|SrvcGrp|88858|2022|PDM|75.00|99|0.00|EVALUATION OF SPEECH FLUENCY|
20|FH_F151179_84074_0|SrvcGrp|72990|2022|PDM|525.00|99|0.00|AEG 1|
20|FH_F113866_0_0|SrvcGrp|80317|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F123752_44502_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F64999_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.45|99|0.00|OCN F/S PRICING: ALL|
20|FH_F136399_70445_0|SrvcGrp|73559|2022|PDM|1800.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F118171_00674_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|OP SVCS|
20|FH_F120489_63552_0|SrvcGrp|75479|2022|PCT|0.75|99|0.00|AEG 1|
20|FH_F137147_75006_0|SrvcGrp|33984|2022|PDM|13608.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F137237_33304_0|SrvcGrp|89337|2022|PDM|830.00|99|0.00|DETOXIFICATION|
20|FH_F137237_33304_0|SrvcGrp|87317|2022|PDM|725.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F114264_51449_0|SrvcGrp|82137|2022|PCT|0.83|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F148761_33311_0|SrvcGrp|105019|2022|PDM|75.00|99|0.00|THERAPEUTIC ACTIVITIES (HCFA)|
20|FH_F151048_15122_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151079_17011_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F114931_0_0|SrvcGrp|82301|2022|PDM|1850.00|99|0.00|HEMORRHOIDECTOMY|
20|FH_F129130_92562_0|SrvcGrp|10391|2022|PDM|5099.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F76074_0_0|SrvcGrp|40222|2022|PDM|90.00|99|0.00|OP SVCS|
20|FH_F91873_12723_0|SrvcGrp|31072|2022|PDM|1145.00|99|0.00|MS DRG 794 ONLY|
20|FH_F97761_04072_0|SrvcGrp|73601|2022|PDM|11799.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F113794_0_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F130439_85014_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F94786_07974_0|SrvcGrp|37386|2022|PDM|1.99|99|0.00|AMINO ACIDS|
20|FH_F94786_07974_0|SrvcGrp|41454|2022|PDM|0.81|99|0.00|ENTERAL FORMULA - PEDIATRICS|
20|FH_F131047_0_0|SrvcGrp|19973|2022|PCT|0.57|99|0.00|CAT SCAN|
20|FH_F131608_0_0|SrvcGrp|93098|2022|PDM|34.91|99|0.00|HOSPICE CARE|
20|FH_F132988_0_0|SrvcGrp|92006|2022|PDM|4493.01|99|0.00|SCAPULAR FRACTURE|
20|FH_F133002_0_0|SrvcGrp|104003|2022|PDM|2287.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES|
20|FH_F133529_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132351_19342_0|SrvcGrp|84559|2022|PCT|1.05|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F34546_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91898_0_0|SrvcGrp|73602|2022|PDM|1644.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F132864_71101_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F124628_33064_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|2439.80|99|0.00|AEG 9 (NO REV)|
20|FH_F34165_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F114666_30342_0|CSTM-ALL|CSTM-00|2020|PDM|1217.00|99|0.00|AEG 5  (NO REV)|
20|FH_F113937_15301_0|SrvcGrp|48385|2022|PDM|91.00|99|0.00|SPEECH THERAPY|
20|FH_F138310_60461_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139662_51106_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F81893_23114_0|SrvcGrp|66224|2022|PDM|116.00|99|0.00|PHYSICAL THERAPY|
20|FH_F148487_28210_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F148553_85016_0|SrvcGrp|115437|2022|PDM|3213.00|99|0.00|INSERT HEART PM ATRIAL & VENT|
20|FH_F134675_60134_0|SrvcGrp|73842|2022|PDM|252.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136814_70605_0|SrvcGrp|82981|2022|PDM|115.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F136814_70605_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112248_53223_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F112505_51503_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136547_0_0|SrvcGrp|73485|2022|PDM|892.50|99|0.00|AETNA REHAB|
20|FH_F141170_0_0|SrvcGrp|99168|2022|PDM|970.00|99|0.00|CPT 22899|
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F115144_71373_0|SrvcGrp|103958|2022|PDM|128.00|99|0.00|AETNA FAMILY THERAPY|
20|FH_F115263_47129_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116393_07002_0|SrvcGrp|59868|2022|PDM|1429.00|99|0.00|ACUTE REHABILITATION REV CODE 128|
20|FH_F147519_52627_0|SrvcGrp|15480|2022|PDM|93.70|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F42176_0_0|SrvcGrp|12118|2022|PCT|0.88|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F119918_38201_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125885_78741_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F126243_32132_0|SrvcGrp|73841|2022|PDM|447.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F125287_92374_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F51276_0_0|SrvcGrp|10578|2022|PDM|40.00|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F128517_57301_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F33381_0_0|SrvcGrp|15055|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETICS/STENTS/BLOOD PRODUCTS|
20|FH_F100681_73104_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132928_64114_0|SrvcGrp|48396|2022|PDM|162.00|99|0.00|OT SERVICES|
20|FH_F132250_12550_0|SrvcGrp|86642|2022|PDM|131.88|99|0.00|AETNA PSYCH DIAG EVAL W/MED SRVC (MOD TD)|
20|FH_F132293_50595_0|SrvcGrp|109057|2022|PCT|0.90|99|0.00|CARDIAC STUDIES|
20|FH_F111841_85212_0|SrvcGrp|84897|2022|PCT|0.55|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F134828_30531_0|SrvcGrp|76661|2022|PDM|32.00|99|0.00|CPT 73610|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TRC VACV 28 FS MOD 26|
20|FH_F46433_0_0|SrvcGrp|24748|2022|PDM|80.00|99|0.00|CORTICOSTEROID THERAPY|
20|FH_F113226_30025_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133536_0_0|SrvcGrp|35669|2022|PDM|3183.00|99|0.00|CPT 63650|
20|FH_F120635_22903_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F38949_0_0|SrvcGrp|38|2022|PDM|1913.00|99|0.00|NORMAL DELIVERY|
20|FH_F40535_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40715_0_0|SrvcGrp|177|2022|PDM|1815.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F47605_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54552_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|LIPIDS|
20|FH_F138876_25302_0|SrvcGrp|86843|2022|PDM|45.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F138989_02861_0|SrvcGrp|75545|2022|PDM|275.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F89580_0_0|SrvcGrp|17520|2022|PCT|0.46|99|0.00|IMPLANTS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|490.09|99|0.00|HAPA WPA-NWPA 2012-13 ASC 207 W/O REV|
20|FH_F84751_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|GENERAL ACUTE CARE|
20|FH_F151420_60654_0|SrvcGrp|41547|2022|PDM|3045.00|99|0.00|OP LAPAROSCOPIC HYSTERECTOMY|
20|FH_F151501_30265_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 3 (NO REV)|
20|FH_F114264_51449_0|SrvcGrp|537|2022|PCT|0.83|99|0.00|OBSERVATION SERVICES|
20|FH_F142313_14788_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F142547_70002_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F138607_02760_0|SrvcGrp|71102|2022|PDM|9.73|99|0.00|HCPCS A4230|
20|FH_F149580_98198_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119046_74012_0|SrvcGrp|73559|2022|PDM|1800.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F119046_74012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F119004_06850_0|CSTM-ALL|CSTM-00|2020|PDM|1397.00|99|0.00|AEG 6 (NO REV)|
20|FH_F119090_91502_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F109920_39180_0|SrvcGrp|75481|2022|PDM|715.00|99|0.00|AEG 2|
20|FH_F86815_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F115452_15235_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F147921_19083_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F129467_45449_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F129474_92701_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F137850_32826_0|SrvcGrp|108484|2022|PDM|550.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F137927_52241_0|SrvcGrp|73485|2022|PDM|1100.00|99|0.00|AETNA REHAB|
20|FH_F137938_29036_0|SrvcGrp|31074|2022|PDM|1231.00|99|0.00|MS DRG 795 ONLY|
20|FH_F137938_29036_0|SrvcGrp|113903|2022|PCT|0.68|99|0.00|RADIOLOGY SERVICES|
20|FH_F34371_0_0|SrvcGrp|10540|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F35210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MS DRG 238 ONLY|
20|FH_F112080_0_0|SrvcGrp|73002|2022|PDM|1442.00|99|0.00|AEG 7|
20|FH_F90733_63080_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F90733_63080_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124837_65625_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129053_0_0|SrvcGrp|88596|2022|PDM|2549.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE|
20|FH_F129487_0_0|SrvcGrp|72992|2022|PDM|1203.00|99|0.00|AEG 2|
20|FH_F35212_0_0|SrvcGrp|3809|2022|PDM|483.00|99|0.00|HOSPICE CARE|
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|953.00|99|0.00|ASPG VI|
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PDM|2106.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F91873_12723_0|SrvcGrp|73006|2022|PDM|3565.00|99|0.00|AEG 9|
20|FH_F87054_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F116043_0_0|SrvcGrp|90478|2022|PDM|100.00|99|0.00|HOSPICE|
20|FH_F142447_72758_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F113903_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|GENERAL ACUTE CARE|
20|FH_F113541_0_0|SrvcGrp|84184|2022|PDM|2580.00|99|0.00|AETNA REMOVAL OF BREAST IMPLANT|
20|FH_F101410_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114389_50131_0|SrvcGrp|17005|2022|PDM|155.54|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS|
20|FH_F45976_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 8 (NO REV)|
20|FH_F124129_33603_0|SrvcGrp|104796|2022|PDM|250.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F146985_12205_0|SrvcGrp|88620|2022|PDM|89.00|99|0.00|SKILLED NURSING RN|
20|FH_F69923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36318_0_0|SrvcGrp|3029|2022|PDM|630.00|99|0.00|NEWBORN NURSERY|
20|FH_F91752_0_0|SrvcGrp|3327|2022|PDM|119.56|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F124233_92648_0|SrvcGrp|75442|2022|PDM|900.00|99|0.00|OBSERVATION - REV 762|
20|FH_F124624_31792_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124636_85008_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F124653_64062_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F114666_30342_0|SrvcGrp|105636|2022|PDM|3750.00|99|0.00|REALIGNMENT OF KNEE|
20|FH_F114792_48849_0|SrvcGrp|3178|2022|PDM|1472.00|99|0.00|ACUTE PSYCH|
20|FH_F138693_45723_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148553_85016_0|SrvcGrp|115469|2022|PDM|2850.00|99|0.00|CORONARY ART/GRFT ANGIO S&I|
20|FH_F146043_0_0|CSTM-ALL|CSTM-00|2020|PDM|1407.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F122571_53555_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43321_0_0|SrvcGrp|45724|2022|PCT|0.88|99|0.00|OCN F/S: LAB MOD QW|
20|FH_F43447_0_0|SrvcGrp|37018|2022|PDM|432.00|99|0.00|BOARDER BABY|
20|FH_F134690_46237_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F134727_30650_0|SrvcGrp|112040|2022|PCT|1.10|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F134735_91362_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134747_83404_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134764_73568_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135761_70127_0|SrvcGrp|112323|2022|PDM|400.00|99|0.00|LABORATORY|
20|FH_F136828_32405_0|SrvcGrp|73841|2022|PDM|403.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F113713_17013_0|SrvcGrp|91779|2022|PDM|65.00|99|0.00|AETNA GROUP THERAPY (MOD AH)(HCFA)|
20|FH_F91263_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F115210_21043_0|CSTM-ALL|CSTM-00|2020|PDM|1433.00|99|0.00|AEG 8 (NO REV)|
20|FH_F147348_19406_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F147599_76240_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147444_32839_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F147700_21401_0|CSTM-ALL|CSTM-00|2020|PDM|349.00|99|0.00|AEG 10 (NO REV)|
20|FH_F42522_0_0|SrvcGrp|10365|2022|PCT|0.60|99|0.00|CPT CODE 99285|
20|FH_F42654_0_0|SrvcGrp|10407|2022|PDM|40.00|99|0.00|HOME INFUSION|
20|FH_F39967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F39996_0_0|SrvcGrp|13292|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F143036_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 8 (NO REV)|
20|FH_F92871_0_0|SrvcGrp|114519|2022|PDM|1275.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F145251_45107_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F128244_62254_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91766_25401_0|SrvcGrp|23683|2022|PDM|36.75|99|0.00|SKILLED NURSING RN|
20|FH_F135916_33614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130847_53098_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130670_32204_0|SrvcGrp|73841|2022|PDM|364.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F130756_04901_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC) (HCFA)|
20|FH_F131132_44077_0|SrvcGrp|73499|2022|PDM|516.00|99|0.00|AETNA ER LEVEL II|
20|FH_F131361_18235_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F127399_0_0|SrvcGrp|96559|2022|PDM|5930.00|99|0.00|TOTAL HYSTERCECTOMY|
20|FH_F127399_0_0|SrvcGrp|54963|2022|PDM|3329.00|99|0.00|CORACOACROMIAL LIGAMENT RELEASE|
20|FH_F121444_47720_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F121763_07202_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F121763_07202_0|SrvcGrp|52951|2022|PDM|58.00|99|0.00|PSYCHIATRIC CPT 90846|
20|FH_F51352_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPT CARE OF MUNCY FH -KF|
20|FH_F111292_33136_0|SrvcGrp|79904|2022|PDM|5817.00|99|0.00|HEART GROUP I MSDRG ONLY|
20|FH_F111363_33169_0|SrvcGrp|103864|2022|PCT|2.24|99|0.00|AETNA ALL DRUGS AGENTS|
20|FH_F47906_0_0|SrvcGrp|29962|2022|PCT|1.00|99|0.00|DME MOD TC|
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|1265.67|99|0.00|AEG 8 (NO REV)|
20|FH_F59052_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116430_0_0|SrvcGrp|106709|2022|PDM|5305.00|99|0.00|NECK & SPINE SURGERY|
20|FH_F131000_0_0|SrvcGrp|55084|2022|PDM|3096.00|99|0.00|CPT 52648|
20|FH_F132328_0_0|SrvcGrp|83643|2022|PDM|2091.00|99|0.00|CPT 29885|
20|FH_F87500_16823_0|SrvcGrp|85601|2022|PCT|1.45|99|0.00|PT/OT REHAB SERV|
20|FH_F102960_50613_0|SrvcGrp|82369|2022|PCT|3.13|99|0.00|AETNA LABORATORY|
20|FH_F103780_64804_0|SrvcGrp|13297|2022|PCT|0.69|99|0.00|IMPLANTS|
20|FH_F63129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F142332_0_0|SrvcGrp|27969|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F130752_43701_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130775_61701_0|SrvcGrp|46903|2022|PDM|461.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F130858_67026_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136318_0_0|SrvcGrp|86638|2022|PDM|1103.00|99|0.00|AETNA IP PSYCHIATRIC (>=18 YRS)|
20|FH_F110902_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F109577_0_0|SrvcGrp|87395|2022|PDM|133.00|99|0.00|HCPCS G0153 (HCFA)|
20|FH_F110943_80026_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F96721_99504_0|SrvcGrp|73602|2022|PDM|5852.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F143650_0_0|SrvcGrp|26275|2022|PDM|1800.00|99|0.00|CPT 29826|
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 7 (NO REV)|
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|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|GENERAL ACUTE CARE|
20|FH_F120603_66112_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F90232_15126_0|SrvcGrp|86836|2022|PDM|14.18|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.00|99|0.00|MSDRG 228-230|
20|FH_F149339_44147_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F85340_98195_0|CSTM-ALL|CSTM-00|2020|PCT|2.83|99|0.00|AETNA - APC GROUPER Y|
20|FH_F112791_0_0|SrvcGrp|72990|2022|PDM|349.00|99|0.00|AEG 1|
20|FH_F149005_16830_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|740.00|99|0.00|AEG 3 (NO REV)|
20|FH_F121476_0_0|SrvcGrp|105317|2022|PDM|2061.00|99|0.00|ANCHOR/SCREW FOR OPPOSING|
20|FH_F145642_15108_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F121225_98902_0|SrvcGrp|108702|2022|PDM|175.25|99|0.00|INPATIENT HOSPICE|
20|FH_F150311_18106_0|SrvcGrp|82981|2022|PDM|155.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139565_0_0|SrvcGrp|46906|2022|PDM|9754.00|99|0.00|CORNEAL TISSUE|
20|FH_F143739_33440_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129509_0_0|SrvcGrp|92405|2022|PDM|3241.00|99|0.00|PERQ LUMBOSACRAL INJECTION|
20|FH_F100782_0_0|SrvcGrp|105087|2022|PDM|408.46|99|0.00|WINDBER MEDICAL CNTR ASC 132|
20|FH_F88744_71103_0|SrvcGrp|105465|2022|PCT|2.15|99|0.00|AETNA THERAPIES|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.27|99|0.00|HAPA WPA-NWPA 2012-13 ASC 12 W/O REV|
20|FH_F114824_44484_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 10 (NO REV)|
20|FH_F112665_0_0|SrvcGrp|71666|2022|PDM|6737.00|99|0.00|CPT 63655|
20|FH_F79863_0_0|SrvcGrp|65642|2022|PDM|90.00|99|0.00|HOME INFUSION NURSING - S9379|
20|FH_F143711_78405_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150241_60714_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F83978_66739_0|SrvcGrp|71666|2022|PDM|19268.00|99|0.00|CPT 63655|
20|FH_F51121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F110423_33401_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F148499_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC|
20|FH_F120930_0_0|SrvcGrp|27344|2022|PDM|2000.00|99|0.00|OP SURGERY (CPT 42821)|
20|FH_F50654_0_0|SrvcGrp|46884|2022|PCT|1.00|99|0.00|REPAIR EYELID DEFECT|
20|FH_F90438_08873_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F81483_0_0|SrvcGrp|40309|2022|PDM|1994.00|99|0.00|CVTY ENHANCED ASPG 7|
20|FH_F145604_14850_0|SrvcGrp|86846|2022|PDM|85.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F116806_0_0|SrvcGrp|107047|2022|PDM|1923.16|99|0.00|EXCISION OF BONE-MANDIBLE|
20|FH_F85732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F132822_95125_0|SrvcGrp|88621|2022|PDM|115.00|99|0.00|SKILLED NURSING LPN|
20|FH_F111836_12901_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F134826_19067_0|SrvcGrp|90637|2022|PDM|350.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT INDUCTION|
20|FH_F133536_0_0|SrvcGrp|26277|2022|PDM|3215.00|99|0.00|CPT 29874|
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1012.00|99|0.00|AEG 2 (NO REV)|
20|FH_F120639_73078_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F120688_68124_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F150939_0_0|SrvcGrp|100245|2022|PCT|0.00|99|0.00|INFLUENZA ASSAY W/ OPTIC|
20|FH_F46672_0_0|SrvcGrp|38692|2022|PDM|125.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F72445_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: ALL|
20|FH_F114853_0_0|SrvcGrp|88158|2022|PDM|7215.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F117509_0_0|SrvcGrp|92501|2022|PDM|133.35|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F129912_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F41803_0_0|SrvcGrp|34873|2022|PCT|0.80|99|0.00|INTRAOCULAR LENS|
20|FH_F49832_0_0|SrvcGrp|24028|2022|PDM|40.00|99|0.00|LICENSED PRACTICAL NURSE|
20|FH_F51492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138867_77021_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138876_25302_0|SrvcGrp|14947|2022|PDM|50.00|99|0.00|HOME INFUSION|
20|FH_F138665_53186_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F81823_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119888_0_0|SrvcGrp|13595|2022|PDM|418.57|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|1017.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132248_44060_0|SrvcGrp|109330|2022|PCT|1.02|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F145468_60615_0|SrvcGrp|29346|2022|PDM|43.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F97143_80012_0|SrvcGrp|73643|2022|PDM|2523.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F135969_33904_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136009_76051_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136009_76051_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131228_01826_0|SrvcGrp|10363|2022|PDM|737.53|99|0.00|CPT CODE 99283|
20|FH_F116488_79925_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F140629_0_0|SrvcGrp|27137|2022|PDM|2497.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F121763_07202_0|SrvcGrp|103503|2022|PDM|2609.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F44113_0_0|SrvcGrp|16|2022|PDM|700.00|99|0.00|ACUTE REHABILITATION|
20|FH_F130817_18103_0|SrvcGrp|11663|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F129967_18915_0|SrvcGrp|104430|2022|PDM|44.89|99|0.00|AETNA OFFICE OUTPATIENT VISIT EST (MOD AF)(HCFA)|
20|FH_F111363_33169_0|SrvcGrp|82751|2022|PDM|26.00|99|0.00|GONADOTROIN CHORINIC (HCG) QUANTITATIVE|
20|FH_F111363_33169_0|SrvcGrp|14614|2022|PDM|6396.00|99|0.00|LITHOTRIPSY|
20|FH_F111383_62233_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F36238_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS|
20|FH_F67150_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F56573_0_0|SrvcGrp|9541|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.60|99|0.00|AEG 6 (NO REV)|
20|FH_F96480_15224_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130249_62034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102862_30606_0|SrvcGrp|21124|2022|PDM|33419.00|99|0.00|MS DRG 471 ONLY|
20|FH_F135840_0_0|SrvcGrp|79579|2022|PDM|550.00|99|0.00|CPT 43251|
20|FH_F130659_44410_0|SrvcGrp|12491|2022|PCT|1.05|99|0.00|PACEMAKER|
20|FH_F41962_0_0|SrvcGrp|38|2022|PDM|850.00|99|0.00|NORMAL DELIVERY|
20|FH_F88744_71103_0|SrvcGrp|114898|2022|PCT|2.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F85353_16407_0|SrvcGrp|63760|2022|PDM|1847.98|99|0.00|HAPA WPA-NWPA 2012-13 ASC 4|
20|FH_F149342_72204_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113457_17011_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136359_0_0|SrvcGrp|63472|2022|PDM|5100.00|99|0.00|CPT 64581|
20|FH_F114409_18447_0|SrvcGrp|73700|2022|PDM|42.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F119379_0_0|SrvcGrp|107839|2022|PDM|1026.00|99|0.00|INCISE FLEXOR CARPI RADIALIS|
20|FH_F130763_0_0|SrvcGrp|88160|2022|PDM|7319.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F120735_40012_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|873.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F114526_33401_0|SrvcGrp|73842|2022|PDM|192.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124161_95932_0|SrvcGrp|105465|2022|PCT|1.56|99|0.00|AETNA THERAPIES|
20|FH_F149139_07522_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F100782_0_0|SrvcGrp|105117|2022|PDM|716.69|99|0.00|WINDBER MEDICAL CNTR ASC 222|
20|FH_F67963_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|PHYSICIANS SERVICES (CMS 1500)|
20|FH_F144848_0_0|SrvcGrp|93741|2022|PDM|5825.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY|
20|FH_F119646_65804_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135670_01749_0|SrvcGrp|17007|2022|PDM|48.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS|
20|FH_F132790_38901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122942_89512_0|SrvcGrp|89412|2022|PDM|500.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F127957_89521_0|SrvcGrp|105819|2022|PDM|1226.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F93122_01854_0|SrvcGrp|93919|2022|PDM|446.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F145562_70458_0|SrvcGrp|86838|2022|PDM|10.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F116806_0_0|SrvcGrp|107071|2022|PDM|1923.16|99|0.00|DRAINAGE OF THROAT ABSCESS|
20|FH_F149149_32937_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F132883_31602_0|SrvcGrp|86829|2022|PDM|20.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F85212_71075_0|SrvcGrp|75442|2022|PDM|650.00|99|0.00|OBSERVATION - REV 762|
20|FH_F120549_19087_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F123623_03246_0|SrvcGrp|109274|2022|PCT|1.00|99|0.00|LAIV4 VACCINE INTRANASAL|
20|FH_F117206_0_0|SrvcGrp|88162|2022|PDM|3605.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F34286_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F141167_0_0|SrvcGrp|107750|2022|PDM|25.00|99|0.00|TRAINING INCL A TREATMENT|
20|FH_F112468_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150309_33323_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F124395_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63905|2022|PDM|147.33|99|0.00|HAPA WPA-NWPA 2012-13 ASC 139|
20|FH_F130329_64114_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F88744_71103_0|SrvcGrp|73603|2022|PDM|797.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F114444_19602_0|SrvcGrp|91396|2022|PDM|65.00|99|0.00|AETNA GROUP PSYCHOTHERAPY (MOD HO)|
20|FH_F144228_0_0|SrvcGrp|64736|2022|PDM|1099.00|99|0.00|CPT 45338|
20|FH_F142930_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F150124_44107_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F41594_0_0|SrvcGrp|28570|2022|PDM|144.26|99|0.00|CPT 92610|
20|FH_F149103_32803_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121303_15501_0|SrvcGrp|113178|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - ASTRAZENECA|
20|FH_F119542_45417_0|SrvcGrp|90854|2022|PDM|904.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F150279_91767_0|SrvcGrp|74668|2022|PDM|325.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|931.48|99|0.00|AEG 6 (NO REV)|
20|FH_F112827_26452_0|SrvcGrp|48396|2022|PDM|90.00|99|0.00|OT SERVICES|
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_F133207_0_0|SrvcGrp|27344|2022|PDM|2632.00|99|0.00|OP SURGERY (CPT 42821)|
20|FH_F110642_17901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F110470_98335_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F143742_60410_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F150165_06032_0|CSTM-ALL|CSTM-00|2020|PDM|1316.00|99|0.00|AEG 2 (NO REV)|
20|FH_F110470_98335_0|SrvcGrp|91398|2022|PDM|90.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AJ)|
20|FH_F121225_98902_0|SrvcGrp|76619|2022|PCT|0.85|99|0.00|THERAPY|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|2025.66|99|0.00|HAPA WPA-NWPA 2012-13 ASC 902 W/O REV|
20|FH_F73583_0_0|SrvcGrp|10431|2022|PDM|47.00|99|0.00|SPEECH THERAPY|
20|FH_F118384_0_0|SrvcGrp|107770|2022|PCT|1.00|99|0.00|INJECTABLES (S CODES)|
20|FH_F130123_24171_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F112668_0_0|SrvcGrp|73000|2022|PDM|945.00|99|0.00|AEG 6|
20|FH_F63312_0_0|SrvcGrp|10518|2022|PDM|85.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT|
20|FH_F120484_31419_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F150239_75569_0|SrvcGrp|17014|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118300_0_0|SrvcGrp|104745|2022|PDM|148.79|99|0.00|HOSPICE|
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145641_06902_0|SrvcGrp|26432|2022|PDM|4643.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F138213_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F72262_0_0|SrvcGrp|30089|2022|PDM|400.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F117344_75062_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F84755_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F102200_06416_0|SrvcGrp|116018|2022|PCT|0.97|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F115786_57701_0|SrvcGrp|48398|2022|PDM|94.00|99|0.00|PT SERVICES|
20|FH_F115877_63556_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F75842_0_0|SrvcGrp|17677|2022|PDM|2640.44|99|0.00|LONG-TERM ACUTE CARE|
20|FH_F127656_06068_0|SrvcGrp|65621|2022|PDM|52.43|99|0.00|RN NURSING|
20|FH_F131930_46205_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133126_48059_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139128_49503_0|SrvcGrp|75419|2022|PDM|350.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F139377_02301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F150771_44512_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F127418_0_0|SrvcGrp|46857|2022|PDM|4446.75|99|0.00|CPT CODE 62284|
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)|
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 2 (NO REV)|
20|FH_F38753_0_0|SrvcGrp|3810|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|2431.00|99|0.00|AEG 4 (NO REV)|
20|FH_F99420_91326_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|ACUTE PSYCH|
20|FH_F111266_30339_0|SrvcGrp|86845|2022|PDM|30.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92299_62016_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|AETNA RADIOLOGY|
20|FH_F67924_0_0|SrvcGrp|42826|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F124749_90211_0|SrvcGrp|100859|2022|PDM|363.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F138217_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|DIAGNOSTIC RADIOLOGY SERVICES|
20|FH_F125214_12428_0|SrvcGrp|11663|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F131545_64057_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F129773_0_0|CSTM-ALL|CSTM-00|2020|PDM|14.50|99|0.00|ASC 5 GROUPINGS|
20|FH_F117711_73080_0|SrvcGrp|72998|2022|PDM|1890.00|99|0.00|AEG 5|
20|FH_F37312_0_0|SrvcGrp|26017|2022|PDM|99.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F132254_40207_0|SrvcGrp|111026|2022|PCT|0.83|99|0.00|SUPPLIES|
20|FH_F111266_30339_0|SrvcGrp|22593|2022|PDM|30.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F133569_17202_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F38123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F84712_0_0|SrvcGrp|73601|2022|PDM|4415.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F86552_0_0|SrvcGrp|82881|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBTANCE|
20|FH_F85314_0_0|SrvcGrp|64744|2022|PDM|409.00|99|0.00|CPT 45331|
20|FH_F101100_50314_0|SrvcGrp|74582|2022|PDM|5210.00|99|0.00|AETNA VAGINAL DELIVERY MSDRG 767-768, 774-775|
20|FH_F101100_50314_0|SrvcGrp|97738|2022|PDM|8487.00|99|0.00|TREAT THIGH FRACTURE 3|
20|FH_F115786_57701_0|SrvcGrp|45307|2022|PDM|10.00|99|0.00|ADMIN OF INFLUENZA VIRUS VACCINE|
20|FH_F115788_02904_0|SrvcGrp|89149|2022|PDM|155.00|99|0.00|OP INTENSIVE|
20|FH_F75842_0_0|SrvcGrp|68422|2022|PDM|943.14|99|0.00|NICU III|
20|FH_F146776_64506_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146812_50401_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F146812_50401_0|CSTM-ALL|CSTM-00|2020|PDM|1482.06|99|0.00|AEG 2 (NO REV)|
20|FH_F146881_83661_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F146881_83661_0|SrvcGrp|46605|2022|PDM|150.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F63124_0_0|SrvcGrp|46234|2022|PDM|135.00|99|0.00|SKILLED NURSING|
20|FH_F131711_25550_0|SrvcGrp|109029|2022|PCT|0.88|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F133047_74012_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F131702_17022_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F111584_07002_0|SrvcGrp|73841|2022|PDM|338.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F111584_07002_0|SrvcGrp|89269|2022|PDM|126.00|99|0.00|PSYTX PT/FAMILY 45 MINUTES|
20|FH_F111823_32539_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F149024_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F34477_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DURABLE MEDICAL EQUIPMENT (DME) W/MOD AU - WINN|
20|FH_F128378_0_0|SrvcGrp|82222|2022|PDM|160.00|99|0.00|HOSPICE CARE|
20|FH_F123739_61820_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132810_0_0|SrvcGrp|20480|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134253_48879_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F136367_72210_0|SrvcGrp|89149|2022|PDM|202.00|99|0.00|OP INTENSIVE|
20|FH_F136374_34461_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F136394_78240_0|SrvcGrp|89149|2022|PDM|380.00|99|0.00|OP INTENSIVE|
20|FH_F136474_95742_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136542_02446_0|SrvcGrp|89149|2022|PDM|191.00|99|0.00|OP INTENSIVE|
20|FH_F120441_33065_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120418_43015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93363_63123_0|SrvcGrp|93146|2022|PDM|78.00|99|0.00|DIABETIC MANAGEMENT PROGRAM|
20|FH_F137036_60504_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F142491_06033_0|SrvcGrp|104229|2022|PDM|160.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F142547_70002_0|SrvcGrp|14948|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F97601_67218_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138471_84663_0|SrvcGrp|106115|2022|PDM|615.00|99|0.00|HOSPICE ROUT HOME CARE-DIEM (HCFA)|
20|FH_F138584_30912_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F77782_66061_0|SrvcGrp|11000|2022|PCT|0.80|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F138967_67208_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140343_89052_0|SrvcGrp|86841|2022|PDM|80.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F140496_38627_0|SrvcGrp|73842|2022|PDM|207.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F140760_07003_0|SrvcGrp|86723|2022|PDM|291.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F140844_48083_0|SrvcGrp|104828|2022|PDM|49.00|99|0.00|NURSING CARE LPN (HCFA)|
20|FH_F140888_75119_0|SrvcGrp|73842|2022|PDM|194.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F140890_30906_0|SrvcGrp|46903|2022|PDM|624.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F151608_30236_0|SrvcGrp|116045|2022|PDM|6204.00|99|0.00|ACHILLES TENDON REPAIR|
20|FH_F119003_78070_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F63054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F67880_0_0|SrvcGrp|13881|2022|PCT|0.75|99|0.00|PACEMAKER DEVICE|
20|FH_F76144_0_0|SrvcGrp|11673|2022|PDM|3186.25|99|0.00|CPT 29888|
20|FH_F147941_06023_0|SrvcGrp|106301|2022|PDM|748.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT|
20|FH_F129514_79605_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F43004_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.40|99|0.00|OP SVCS|
20|FH_F137832_89118_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137905_91364_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F109513_0_0|SrvcGrp|90061|2022|PDM|10000.00|99|0.00|AETNA RECONSTRUCT SHOULDER JOINT|
20|FH_F149605_0_0|SrvcGrp|103846|2022|PDM|87.23|99|0.00|HOSPICE CARE|
20|FH_F111589_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103281_32086_0|CSTM-ALL|CSTM-00|2020|PDM|3702.00|99|0.00|AEG 7 (NO REV)|
20|FH_F148761_33311_0|SrvcGrp|85963|2022|PDM|75.00|99|0.00|SELF CARE MANGEMENT TRAINING|
20|FH_F148880_26807_0|SrvcGrp|73700|2022|PDM|96.43|99|0.00|AETNA - SKILLED NURSING|
20|FH_F148880_26807_0|SrvcGrp|88621|2022|PDM|137.00|99|0.00|SKILLED NURSING LPN|
20|FH_F151059_60435_0|SrvcGrp|48396|2022|PDM|125.00|99|0.00|OT SERVICES|
20|FH_F151081_85225_0|SrvcGrp|73605|2022|PDM|1135.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F151121_60455_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121385_89102_0|SrvcGrp|110428|2022|PCT|2.07|99|0.00|LABORATORY SERVICES|
20|FH_F113866_0_0|SrvcGrp|95440|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F129130_92562_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F129130_92562_0|SrvcGrp|13807|2022|PDM|2792.00|99|0.00|OBSERVATION SVCS|
20|FH_F110381_0_0|SrvcGrp|705|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F91873_12723_0|SrvcGrp|91900|2022|PDM|760.00|99|0.00|ENDOSCOPIC PROCEDURE|
20|FH_F134410_46807_0|SrvcGrp|108484|2022|PDM|1550.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|1554.00|99|0.00|AEG 4 (NO REV)|
20|FH_F124719_64093_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F111266_30339_0|SrvcGrp|86847|2022|PDM|30.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F84532_0_0|SrvcGrp|72990|2022|PDM|924.00|99|0.00|AEG 1|
20|FH_F148926_28803_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148979_44512_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117615_30525_0|SrvcGrp|81340|2022|PCT|1.80|99|0.00|AETNA LABORATORY|
20|FH_F37777_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39082_0_0|SrvcGrp|8950|2022|PDM|1606.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F132160_0_0|SrvcGrp|62740|2022|PDM|5738.00|99|0.00|SURGERY CARVE OUTS|
20|FH_F126299_20176_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F76285_0_0|SrvcGrp|48631|2022|PDM|154.00|99|0.00|OCCUPATIONAL THERAPY SVCS RE-EVAL|
20|FH_F124487_89502_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F66545_0_0|SrvcGrp|61818|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F144831_0_0|SrvcGrp|36066|2022|PDM|105.45|99|0.00|NURSING CARE|
20|FH_F125419_44110_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97300_47501_0|SrvcGrp|10944|2022|PDM|1250.00|99|0.00|EMERGENCY ROOM|
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|2652.00|99|0.00|AEG 6 (NO REV)|
20|FH_F136779_0_0|SrvcGrp|112931|2022|PDM|7957.00|99|0.00|PACEMAKER|
20|FH_F149023_44122_0|SrvcGrp|98267|2022|PDM|13251.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F56232_0_0|CSTM-ALL|CSTM-00|2020|PDM|572.89|99|0.00|ASPG I|
20|FH_F134603_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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40346_0_0|SrvcGrp|13526|2022|PCT|0.75|99|0.00|CPT CODES 80000-89999 - (LAB)|
20|FH_F97080_85122_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F83871_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|456.00|99|0.00|AEG 2 (NO REV)|
20|FH_F141247_18902_0|SrvcGrp|89024|2022|PDM|82.40|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F141287_14830_0|SrvcGrp|105465|2022|PCT|0.93|99|0.00|AETNA THERAPIES|
20|FH_F50493_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS|
20|FH_F138478_0_0|SrvcGrp|107793|2022|PDM|9060.49|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F33719_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.00|99|0.00|ACUTE PSYCH|
20|FH_F102525_73134_0|SrvcGrp|12491|2022|PCT|0.35|99|0.00|PACEMAKER|
20|FH_F35736_34952_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F119946_36109_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F149579_95815_0|SrvcGrp|115682|2022|PDM|37.21|99|0.00|CHRONIC CARE MGMT STAFF ADDL (HCFA)|
20|FH_F151024_30024_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F98840_31021_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F147176_17701_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147302_33573_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F41617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F142370_0_0|SrvcGrp|113920|2022|PDM|7.00|99|0.00|COVID-19 SPECIMEN HANDLING OFFICE-LAB (HCFA)|
20|FH_F107980_08005_0|SrvcGrp|73841|2022|PDM|297.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F34777_0_0|CSTM-ALL|CSTM-00|2020|PDM|9400.00|99|0.00|ORTHOPEDIC SURGERY|
20|FH_F147222_49544_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90817_0_0|SrvcGrp|83644|2022|PDM|1880.00|99|0.00|CPT 30465|
20|FH_F97620_75904_0|SrvcGrp|73605|2022|PDM|2744.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1466.00|99|0.00|AEG 2 (NO REV)|
20|FH_F35765_32547_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F122277_98045_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F119946_36109_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F131385_76457_0|SrvcGrp|106048|2022|PDM|775.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F147181_27514_0|SrvcGrp|114012|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F91076_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124514_21215_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F137798_0_0|SrvcGrp|82223|2022|PDM|743.00|99|0.00|HOSPICE CARE|
20|FH_F116753_0_0|SrvcGrp|93924|2022|PDM|2187.00|99|0.00|AETNA MEDICAL SERVICES|
20|FH_F122336_67042_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F94643_90501_0|SrvcGrp|10577|2022|PDM|35.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F37018_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140131_62870_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F140167_16101_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140036_07702_0|SrvcGrp|113605|2022|PDM|25.00|99|0.00|VIVITROL INJECTION ADMIN|
20|FH_F123185_0_0|SrvcGrp|73006|2022|PDM|1169.00|99|0.00|AEG 9|
20|FH_F102224_0_0|SrvcGrp|93071|2022|PDM|5000.00|99|0.00|POSTERIOR SEGMENTAL INSTRU|
20|FH_F131093_49690_0|SrvcGrp|97506|2022|PDM|130.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F120839_19380_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F112679_85711_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F116684_30701_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149679_0_0|SrvcGrp|106300|2022|PDM|172.33|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F39567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F40091_0_0|SrvcGrp|17081|2022|PCT|0.70|99|0.00|ASPG IX|
20|FH_F49895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD 26|
20|FH_F46258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|B CODES (MOD NU) - WALGREENS|
20|FH_F110783_93013_0|SrvcGrp|86836|2022|PDM|12.50|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|1243.00|99|0.00|AEG 6 (NO REV)|
20|FH_F124294_66614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139823_32250_0|SrvcGrp|86723|2022|PDM|481.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F143227_50312_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143249_89801_0|SrvcGrp|22592|2022|PDM|30.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F143249_89801_0|SrvcGrp|17013|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F143249_89801_0|SrvcGrp|16750|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F143347_16001_0|SrvcGrp|113740|2022|PCT|2.59|99|0.00|LABORATORY SERVICES|
20|FH_F143454_94550_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP|
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_F102542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101380_0_0|CSTM-ALL|CSTM-00|2020|PDM|1757.00|99|0.00|AEG 2 (NO REV)|
20|FH_F103060_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F131067_57105_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F151745_27312_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F49286_0_0|SrvcGrp|45324|2022|PDM|115.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F132349_66111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112670_47150_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116595_92506_0|SrvcGrp|86753|2022|PCT|1.15|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F120888_63823_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118950_33312_0|SrvcGrp|73841|2022|PDM|650.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F91372_63043_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F51276_0_0|SrvcGrp|33164|2022|PDM|400.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F130152_48025_0|SrvcGrp|57968|2022|PCT|1.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|1121.00|99|0.00|AEG 8 (NO REV)|
20|FH_F46258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|B CODES (GLOBAL) - WALGREENS|
20|FH_F59732_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|PEDIATRIC SPEECH THERAPY|
20|FH_F115685_64064_0|SrvcGrp|86779|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F135211_63119_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|PDM|826.00|99|0.00|ASPG VI|
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 4 (NO REV)|
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.20|99|0.00|AEG 3 (NO REV)|
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119824_0_0|SrvcGrp|108152|2022|PDM|424.00|99|0.00|HEMODIALYSIS INCLUDES TRAINING|
20|FH_F118366_17110_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F34496_0_0|SrvcGrp|16635|2022|PDM|28250.25|99|0.00|GAMMA KNIFE|
20|FH_F149086_0_0|SrvcGrp|83857|2022|PDM|675.00|99|0.00|IP HOSPICE SVCS|
20|FH_F102267_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F86031_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|OP SVCS|
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)|
20|FH_F110086_21742_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F39278_0_0|SrvcGrp|72783|2022|PDM|166.00|99|0.00|ST SVCS - VISIT LEVEL|
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_F75084_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143528_0_0|SrvcGrp|99171|2022|PDM|4361.70|99|0.00|CPT 28485|
20|FH_F40063_0_0|SrvcGrp|29518|2022|PDM|2413.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F131763_06002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131254_92211_0|SrvcGrp|86837|2022|PDM|12.50|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F115739_78722_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F137943_0_0|SrvcGrp|106216|2022|PDM|2859.00|99|0.00|CORNEAL TRANSPLANT ENDOTHELIAL|
20|FH_F34408_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F116237_43235_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F32097_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90818_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122687_0_0|SrvcGrp|72121|2022|PDM|3825.00|99|0.00|ARTHOSCOPY|
20|FH_F137574_68130_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F141588_60062_0|SrvcGrp|86723|2022|PDM|710.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F129810_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132372_0_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F39992_0_0|SrvcGrp|9832|2022|PDM|84.50|99|0.00|ST SVCS|
20|FH_F149869_03253_0|SrvcGrp|27969|2022|PDM|29.00|99|0.00|HOME HEALTH AIDE|
20|FH_F149523_0_0|SrvcGrp|96353|2022|PDM|16400.00|99|0.00|RECONSTRUCT ANKLE JOINT|
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|573.00|99|0.00|AEG 3 (NO REV)|
20|FH_F148265_06067_0|SrvcGrp|27261|2022|PDM|21558.00|99|0.00|CPT 27446|
20|FH_F130682_0_0|SrvcGrp|91422|2022|PDM|4980.00|99|0.00|REMOVAL OF ADENOIDS|
20|FH_F149140_07522_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F75307_0_0|SrvcGrp|46118|2022|PDM|72.00|99|0.00|NUTRITNAL CNSLNG/DIABETES EDU|
20|FH_F116061_80110_0|SrvcGrp|104078|2022|PCT|1.40|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F111288_0_0|SrvcGrp|67066|2022|PDM|6144.00|99|0.00|CERVICAL SURGERY|
20|FH_F122687_0_0|SrvcGrp|109188|2022|PDM|4371.00|99|0.00|TIBIAL RODDING|
20|FH_F118121_46001_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117044_37352_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F144021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82714_18848_0|SrvcGrp|79786|2022|PCT|0.72|99|0.00|SLEEP STUDIES|
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|1485.00|99|0.00|AEG 4 (NO REV)|
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PDM|1266.00|99|0.00|AEG 10 (NO REV)|
20|FH_F86911_0_0|SrvcGrp|86057|2022|PCT|0.25|99|0.00|INFUSION THERAPY W/ MOD SJ|
20|FH_F87201_0_0|SrvcGrp|28933|2022|PCT|1.00|99|0.00|OCN F/S PRICING:  (A & K CODES ONLY)|
20|FH_F113143_0_0|SrvcGrp|72992|2022|PDM|468.00|99|0.00|AEG 2|
20|FH_F115208_0_0|SrvcGrp|106176|2022|PDM|2546.00|99|0.00|EXCISE PAROTID GLAND/LESION|
20|FH_F103780_64804_0|SrvcGrp|72984|2022|PCT|0.68|99|0.00|CHEMOTHERAPY|
20|FH_F105581_19053_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|MRI/MRA CARVEOUTS|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF|
20|FH_F138929_0_0|SrvcGrp|70749|2022|PDM|3520.00|99|0.00|CPT 29823|
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 5  (NO REV)|
20|FH_F131608_0_0|SrvcGrp|65720|2022|PDM|165.42|99|0.00|RESPITE CARE|
20|FH_F137067_0_0|SrvcGrp|112959|2022|PDM|21000.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F137067_0_0|SrvcGrp|107361|2022|PDM|18900.00|99|0.00|SECOND LEVEL CER DISKECTOMY|
20|FH_F130274_63033_0|SrvcGrp|88620|2022|PDM|70.00|99|0.00|SKILLED NURSING RN|
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|844.00|99|0.00|AEG 2 (NO REV)|
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|1357.60|99|0.00|AEG 8 (NO REV)|
20|FH_F124180_0_0|SrvcGrp|68282|2022|PDM|3500.00|99|0.00|CPT 67042|
20|FH_F122170_60120_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146985_12205_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F36318_0_0|SrvcGrp|8950|2022|PDM|3533.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F37394_0_0|SrvcGrp|471|2022|PDM|950.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F124414_92653_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F127995_84010_0|SrvcGrp|86833|2022|PDM|10.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F130036_43232_0|SrvcGrp|88819|2022|PDM|867.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136570_32084_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136603_60654_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F114629_19131_0|SrvcGrp|105440|2022|PDM|378.00|99|0.00|AETNA TERANIAL MAGN STIM REDETEMINE|
20|FH_F114727_44512_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F113870_10536_0|SrvcGrp|89149|2022|PDM|191.00|99|0.00|OP INTENSIVE|
20|FH_F138207_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117195_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|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_F43295_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F43779_0_0|SrvcGrp|12969|2022|PDM|677.00|99|0.00|NEWBORN NURSERY|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BIENVILLE MED CTR ALL OTHER OP MOD 53|
20|FH_F134687_14226_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F134770_14420_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134817_30339_0|SrvcGrp|48385|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F135761_70127_0|SrvcGrp|108484|2022|PDM|1550.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F136813_06518_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F112371_19047_0|SrvcGrp|74588|2022|PDM|3020.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F112371_19047_0|SrvcGrp|76619|2022|PCT|1.00|99|0.00|THERAPY|
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115608_24171_0|SrvcGrp|8950|2022|PDM|1550.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F116345_78626_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F147331_90045_0|SrvcGrp|48398|2022|PDM|171.00|99|0.00|PT SERVICES|
20|FH_F147479_75077_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147519_52627_0|CSTM-ALL|CSTM-00|2020|PDM|3207.98|99|0.00|AEG 3 (NO REV)|
20|FH_F147519_52627_0|SrvcGrp|89412|2022|PDM|303.16|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F147599_76240_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41798_0_0|CSTM-ALL|CSTM-00|2020|PDM|218.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F42522_0_0|SrvcGrp|10363|2022|PDM|772.00|99|0.00|CPT CODE 99283|
20|FH_F34797_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F84394_17402_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|1361.00|99|0.00|ASPG IX|
20|FH_F111204_10023_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F100681_73104_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|704.00|99|0.00|AEG 2 (NO REV)|
20|FH_F110604_0_0|SrvcGrp|103236|2022|PDM|18150.00|99|0.00|AETNA INSJ STABLJ DEV|
20|FH_F100260_97116_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F120630_33161_0|SrvcGrp|46903|2022|PDM|640.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F72445_0_0|SrvcGrp|9828|2022|PDM|44.00|99|0.00|HOME HEALTH AIDE|
20|FH_F39098_0_0|CSTM-ALL|CSTM-00|2020|PDM|1234.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48295_0_0|SrvcGrp|10527|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F48836_0_0|SrvcGrp|31187|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF (DME)|
20|FH_F48836_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F54552_0_0|SrvcGrp|27044|2022|PDM|30.50|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS (MOD SH)|
20|FH_F138681_39301_0|SrvcGrp|86722|2022|PDM|171.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F138807_32207_0|SrvcGrp|48398|2022|PDM|137.00|99|0.00|PT SERVICES|
20|FH_F138907_01040_0|SrvcGrp|43569|2022|PDM|103.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F113390_0_0|SrvcGrp|105235|2022|PDM|2200.00|99|0.00|PARTIAL REMOVAL OF THYROID|
20|FH_F130523_04605_0|SrvcGrp|92958|2022|PCT|0.84|99|0.00|SLEEP STUDIES|
20|FH_F86332_75081_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F135207_76053_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135219_68506_0|CSTM-ALL|CSTM-00|2020|PDM|4397.95|99|0.00|AEG 10 (NO REV)|
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F109180_18015_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PDM|944.29|99|0.00|ASPG VIII|
20|FH_F130850_67401_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F93094_21227_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F99441_0_0|SrvcGrp|104003|2022|PDM|2653.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES|
20|FH_F120248_77008_0|SrvcGrp|73842|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F43294_0_0|SrvcGrp|31134|2022|PDM|1400.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|777.00|99|0.00|AEG 4 (NO REV)|
20|FH_F38677_0_0|SrvcGrp|21815|2022|PDM|135.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F56137_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143908_52233_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43436_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F63433_0_0|SrvcGrp|17067|2022|PDM|900.00|99|0.00|ASPG II|
20|FH_F130889_68818_0|SrvcGrp|75506|2022|PCT|0.96|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F120952_25303_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F149740_33912_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F38034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP ELECTROPHYSIOLOGY + ANGIO|
20|FH_F145815_30540_0|SrvcGrp|113226|2022|PDM|42.28|99|0.00|COVID-19 SVNT SARSCOV2 ELISA PLSM SRM|
20|FH_F148170_04005_0|SrvcGrp|13262|2022|PDM|15.24|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F145535_92708_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F141550_33619_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F143928_21061_0|SrvcGrp|66265|2022|PDM|126.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F89475_71202_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129354_19152_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42755_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|PARTIAL HOSPITAL|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 224-225 CARDIAC DEFIB W/O AMI/HF SHOCK|
20|FH_F120169_83814_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127550_43026_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F44073_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116115_14437_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F142073_0_0|SrvcGrp|88156|2022|PDM|11900.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F148343_70810_0|SrvcGrp|13928|2022|PDM|300.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F111288_0_0|SrvcGrp|82114|2022|PDM|2849.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F72143_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ACUTE PSYCH|
20|FH_F86518_20721_0|SrvcGrp|75545|2022|PDM|262.50|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F90492_0_0|SrvcGrp|89417|2022|PDM|325.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F135236_02840_0|SrvcGrp|73499|2022|PDM|554.60|99|0.00|AETNA ER LEVEL II|
20|FH_F130936_06107_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148320_02130_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F128228_40047_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F56136_0_0|SrvcGrp|52742|2022|PCT|0.92|99|0.00|LAMINECTOMY|
20|FH_F33322_0_0|SrvcGrp|913|2022|PCT|0.80|99|0.00|ELECTROSHOCK TREATMENT|
20|FH_F37679_0_0|SrvcGrp|27066|2022|PDM|30.50|99|0.00|HOME INFUSION THERAPY, PAIN MGMT (MOD SH)|
20|FH_F77883_0_0|SrvcGrp|74926|2022|PDM|206.66|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F135210_61080_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F149523_0_0|SrvcGrp|40002|2022|PDM|15500.00|99|0.00|TOTAL HIP|
20|FH_F40043_0_0|SrvcGrp|13651|2022|PDM|2267.00|99|0.00|TELEMETRY/STEP DOWN UNIT (SURGICAL)|
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_F70984_0_0|CSTM-ALL|CSTM-00|2020|PDM|1699.00|99|0.00|COVENTRY ENHANCED GROUPER 7 GA NO CRESCENT|
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F137427_89146_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F151146_0_0|CSTM-ALL|CSTM-00|2020|PDM|379.00|99|0.00|AEG 1 (NO REV)|
20|FH_F140907_28601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35748_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49852_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97102_83501_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F130916_33701_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F131653_50314_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150982_0_0|SrvcGrp|67279|2022|PDM|8258.00|99|0.00|CERVICAL SURGERY|
20|FH_F130682_0_0|SrvcGrp|65402|2022|PDM|11184.00|99|0.00|CPT 42145|
20|FH_F125249_0_0|SrvcGrp|100002|2022|PDM|2600.00|99|0.00|REPAIR SHOULDER CAPSULE|
20|FH_F46094_0_0|SrvcGrp|11076|2022|PDM|80.00|99|0.00|NURSING CARE|
20|FH_F131168_33912_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F77042_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F125048_94583_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD RR|
20|FH_F143790_83440_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 9 (NO REV)|
20|FH_F99960_0_0|SrvcGrp|78403|2022|PDM|1.00|99|0.00|AETNA MED RECORD|
20|FH_F67261_0_0|CSTM-ALL|CSTM-00|2020|PDM|3478.00|99|0.00|ASPG VIII - FH SW CUSTOM GROUPERS|
20|FH_F40834_0_0|CSTM-ALL|CSTM-00|2020|PDM|1517.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F131228_01826_0|SrvcGrp|20902|2022|PDM|25703.15|99|0.00|MS DRG 249 ONLY|
20|FH_F139551_0_0|SrvcGrp|82113|2022|PDM|2537.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F121488_77478_0|SrvcGrp|108484|2022|PDM|900.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F103100_47150_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F148339_71303_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1055.00|99|0.00|ASPG X|
20|FH_F128272_60640_0|SrvcGrp|14949|2022|PDM|110.00|99|0.00|HOME INFUSION|
20|FH_F120253_44646_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F101021_0_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F122687_0_0|SrvcGrp|107001|2022|PDM|12381.00|99|0.00|REVISE/RECONSTRUCT/REMOVAL OF ANKLE IMPLANT|
20|FH_F38360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F43118_0_0|SrvcGrp|38126|2022|PCT|0.50|99|0.00|DME / ORTHOTICS / PROSTHETICS / IMPLANTS|
20|FH_F97500_32025_0|SrvcGrp|73601|2022|PDM|7054.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PDM|3750.00|99|0.00|AEG 5  (NO REV)|
20|FH_F123902_19140_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125993_64850_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39819_0_0|SrvcGrp|31208|2022|PDM|21654.00|99|0.00|NY DRG 584 ONLY|
20|FH_F120001_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33845_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F98922_40351_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F132735_97068_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137067_0_0|SrvcGrp|77021|2022|PDM|7350.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F120910_63021_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F54974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F90818_0_0|SrvcGrp|72121|2022|PDM|6500.00|99|0.00|ARTHOSCOPY|
20|FH_F41776_0_0|SrvcGrp|3934|2022|PDM|303.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS|
20|FH_F135219_68506_0|SrvcGrp|11306|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F36433_0_0|CSTM-ALL|CSTM-00|2020|PDM|1406.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|AEG 1 (NO REV)|
20|FH_F122433_0_0|SrvcGrp|93807|2022|PDM|750.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PDM|946.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41776_0_0|SrvcGrp|1306|2022|PDM|469.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F112325_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40026_0_0|SrvcGrp|3448|2022|PCT|0.73|99|0.00|MRI|
20|FH_F52854_0_0|SrvcGrp|22596|2022|PDM|142.00|99|0.00|HOSPICE CARE|
20|FH_F123282_03222_0|SrvcGrp|43569|2022|PDM|135.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F130524_43701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46359_0_0|SrvcGrp|42762|2022|PDM|158.00|99|0.00|NURSING CARE|
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 1 (NO REV)|
20|FH_F102302_0_0|SrvcGrp|44461|2022|PDM|18450.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F38090_0_0|SrvcGrp|16|2022|PDM|788.00|99|0.00|ACUTE REHABILITATION|
20|FH_F34496_0_0|SrvcGrp|359|2022|PDM|798.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F78165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F129328_33311_0|SrvcGrp|73842|2022|PDM|187.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130157_84049_0|SrvcGrp|58509|2022|PDM|611.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F78603_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F122725_32216_0|CSTM-ALL|CSTM-00|2020|PDM|78.00|99|0.00|BIOFEEDBACK PERI/URO/RECTAL|
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F63235_0_0|SrvcGrp|27726|2022|PDM|2499.00|99|0.00|OP SURGERY|
20|FH_F135840_0_0|SrvcGrp|84972|2022|PDM|550.00|99|0.00|CPT 43247|
20|FH_F130721_04769_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130775_61701_0|SrvcGrp|89149|2022|PDM|215.00|99|0.00|OP INTENSIVE|
20|FH_F130841_49315_0|SrvcGrp|97704|2022|PDM|130.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F98002_27103_0|SrvcGrp|73461|2022|PDM|7118.00|99|0.00|AETNA NICU IV|
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|633.00|99|0.00|AEG 4 (NO REV)|
20|FH_F141340_66208_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|210.36|99|0.00|HAPA WPA-NWPA 2012-13 ASC 133 W/O REV|
20|FH_F133920_64057_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F110542_10035_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F139873_0_0|SrvcGrp|84280|2022|PDM|2992.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F143624_73069_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F143650_0_0|SrvcGrp|82298|2022|PDM|4000.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY|
20|FH_F134568_12946_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F85371_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F85132_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|AETNA REHAB|
20|FH_F150148_71901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149241_30161_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F51318_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F139569_15063_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|AEG 2 (NO REV)|
20|FH_F52713_0_0|SrvcGrp|41367|2022|PDM|34802.00|99|0.00|MS DRG 242-244 ONLY|
20|FH_F137610_0_0|SrvcGrp|86722|2022|PDM|151.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F127900_63080_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149342_72204_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|HSS ASC|
20|FH_F150143_27320_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138951_41101_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F133727_33511_0|SrvcGrp|82981|2022|PDM|140.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F110425_01752_0|SrvcGrp|48398|2022|PDM|125.00|99|0.00|PT SERVICES|
20|FH_F114444_19602_0|SrvcGrp|98041|2022|PDM|8.63|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F39714_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148222_18603_0|SrvcGrp|88621|2022|PDM|102.00|99|0.00|SKILLED NURSING LPN|
20|FH_F125028_19061_0|SrvcGrp|24750|2022|PDM|36.75|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1352.72|99|0.00|HAPA WPA-NWPA 2012-13 ASC 4 W/O REV|
20|FH_F139241_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F75483_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|HOME HEALTH|
20|FH_F55054_0_0|SrvcGrp|13854|2022|PDM|1035.00|99|0.00|HYPERBARIC CHAMBER|
20|FH_F149799_33484_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130061_84097_0|SrvcGrp|111348|2022|PCT|1.20|99|0.00|OP THERAPY SERVICES|
20|FH_F126523_0_0|SrvcGrp|73008|2022|PDM|800.00|99|0.00|AEG 10|
20|FH_F132125_0_0|SrvcGrp|472|2022|PDM|1000.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120337_85004_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123320_43558_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F50184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F78603_0_0|SrvcGrp|27569|2022|PCT|0.53|99|0.00|MEDICAL/SURGICAL SUPPLIES|
20|FH_F62719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F38792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F134813_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F40272_0_0|SrvcGrp|701|2022|PDM|1750.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F52854_0_0|SrvcGrp|31578|2022|PDM|8206.00|99|0.00|CARDIAC CATH ABLATION|
20|FH_F111263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F141517_73034_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F39819_0_0|SrvcGrp|31192|2022|PDM|1465.00|99|0.00|NY DRG 629 ONLY|
20|FH_F86872_15215_0|SrvcGrp|15596|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F119795_0_0|SrvcGrp|11669|2022|PDM|5202.00|99|0.00|OP SURG|
20|FH_F119795_0_0|SrvcGrp|92822|2022|PDM|4474.00|99|0.00|REPAIR OF RUPTURED TENDON|
20|FH_F113815_0_0|SrvcGrp|72996|2022|PDM|233.00|99|0.00|AEG 4|
20|FH_F111594_0_0|SrvcGrp|90343|2022|PDM|7215.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL|
20|FH_F119500_01570_0|SrvcGrp|472|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148419_01453_0|SrvcGrp|115401|2022|PCT|1.00|99|0.00|COVID-19 VACCINE COMBINATION - ELI LILLY|
20|FH_F148425_01507_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F125471_34471_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F44019_0_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F118612_21502_0|SrvcGrp|75545|2022|PDM|343.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F117895_28170_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F150002_28761_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67639_0_0|SrvcGrp|63469|2022|PDM|520.00|99|0.00|CPT 55700|
20|FH_F140790_0_0|SrvcGrp|38909|2022|PDM|1434.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F124928_04210_0|SrvcGrp|90707|2022|PDM|144.58|99|0.00|AETNA HOSPICE CARE|
20|FH_F31542_0_0|SrvcGrp|12715|2022|PCT|0.65|99|0.00|RADIOLOGY SVCS|
20|FH_F44992_0_0|SrvcGrp|9526|2022|PDM|425.00|99|0.00|DIALYSIS|
20|FH_F87334_16507_0|SrvcGrp|73485|2022|PDM|1231.00|99|0.00|AETNA REHAB|
20|FH_F133327_0_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F97140_91730_0|SrvcGrp|73659|2022|PDM|6950.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F114024_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F125467_67206_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149883_43920_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F109803_0_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F120058_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F69063_0_0|SrvcGrp|43957|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F142967_65065_0|SrvcGrp|75545|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 9 (NO REV)|
20|FH_F142970_43055_0|SrvcGrp|13595|2022|PDM|380.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F141411_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F37562_0_0|SrvcGrp|11796|2022|PDM|84.50|99|0.00|DIETICIAN|
20|FH_F133287_40215_0|SrvcGrp|28963|2022|PCT|0.55|99|0.00|MS DRG 461-462 ONLY|
20|FH_F117965_60714_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F72859_0_0|SrvcGrp|10541|2022|PDM|108.22|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F92676_15063_0|SrvcGrp|14241|2022|PDM|567.00|99|0.00|EMERGENCY ROOM SVCS LEVEL III|
20|FH_F115315_43011_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F112587_37058_0|SrvcGrp|472|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F55375_0_0|SrvcGrp|44453|2022|PDM|725.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F76662_0_0|SrvcGrp|66481|2022|PDM|85.00|99|0.00|SOCIAL WORKER|
20|FH_F113131_19013_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F117995_60126_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124928_04210_0|SrvcGrp|92760|2022|PCT|1.05|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133460_63031_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F33659_0_0|SrvcGrp|15391|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F100665_07939_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F148556_13206_0|SrvcGrp|19742|2022|PDM|75.00|99|0.00|MID-LINE INSERTION|
20|FH_F146217_0_0|SrvcGrp|82223|2022|PDM|178.66|99|0.00|HOSPICE CARE|
20|FH_F143007_60640_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120032_0_0|SrvcGrp|79595|2022|PDM|580.00|99|0.00|CPT 45385|
20|FH_F41845_0_0|SrvcGrp|109|2022|PDM|545.00|99|0.00|CD - DETOX|
20|FH_F143147_80124_0|SrvcGrp|41563|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F133455_60110_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117720_23323_0|SrvcGrp|33165|2022|PDM|315.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F133172_66066_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F72606_0_0|SrvcGrp|23477|2022|PDM|9525.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F83853_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F151306_21030_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151410_00717_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F151501_30265_0|SrvcGrp|102481|2022|PDM|2090.00|99|0.00|CPT 29898|
20|FH_F151513_44718_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F132206_67152_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132268_07060_0|SrvcGrp|94744|2022|PDM|58.94|99|0.00|NOS FLU VACC IM (>=3 YRS)|
20|FH_F122024_75751_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122114_91364_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37809_0_0|SrvcGrp|14614|2022|PDM|7950.00|99|0.00|LITHOTRIPSY|
20|FH_F135587_37334_0|SrvcGrp|471|2022|PDM|515.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F91735_92653_0|SrvcGrp|87395|2022|PDM|110.25|99|0.00|HCPCS G0153 (HCFA)|
20|FH_F135924_02906_0|CSTM-ALL|CSTM-00|2020|PDM|2731.50|99|0.00|INPATIENT PSYCHIATRIC CARE <18 YRS|
20|FH_F136183_72756_0|SrvcGrp|108484|2022|PDM|950.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F136223_60954_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100765_73735_0|SrvcGrp|73601|2022|PDM|5294.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F130996_34110_0|SrvcGrp|88162|2022|PDM|5500.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F130670_32204_0|SrvcGrp|89412|2022|PDM|364.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F131285_47150_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F116527_70443_0|SrvcGrp|73601|2022|PDM|1450.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F121428_40202_0|SrvcGrp|88678|2022|PCT|0.00|99|0.00|ACUTE REHAB I|
20|FH_F121444_47720_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
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_F129329_07039_0|SrvcGrp|73842|2022|PDM|208.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111301_33122_0|SrvcGrp|73559|2022|PDM|2965.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F111363_33169_0|CSTM-ALL|CSTM-00|2020|PDM|1987.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F34864_0_0|CSTM-ALL|CSTM-00|2020|PDM|2028.00|99|0.00|ASPG V|
20|FH_F44396_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.00|99|0.00|OP SVCS|
20|FH_F134930_0_0|SrvcGrp|31931|2022|PCT|0.00|99|0.00|SKILLED NURSING CARE|
20|FH_F36344_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F41780_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44336_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|CD PARTIAL HOSP - DAY TREATMENT|
20|FH_F132328_0_0|SrvcGrp|28547|2022|PDM|4110.00|99|0.00|VITRECTOMY|
20|FH_F132328_0_0|SrvcGrp|84279|2022|PDM|3839.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F132328_0_0|SrvcGrp|82570|2022|PDM|2039.00|99|0.00|REVISION EYELID/EXCESS SKIN|
20|FH_F112092_46845_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)|
20|FH_F112187_98272_0|SrvcGrp|113186|2022|PCT|0.81|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F127713_30012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130206_78209_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F129141_21221_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_F102862_30606_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F96960_35404_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F132090_60915_0|SrvcGrp|77485|2022|PDM|1469.00|99|0.00|AETNA REMOVAL OF IMPLANT|
20|FH_F77462_0_0|SrvcGrp|74546|2022|PDM|141.00|99|0.00|HOSPICE SERVICES|
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|2092.80|99|0.00|2005 ASPG GROUPER IX|
20|FH_F119507_92627_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F40173_28304_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F150019_19380_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39171_61362_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|GENERAL ACUTE CARE|
20|FH_F120605_0_0|SrvcGrp|11673|2022|PDM|2625.00|99|0.00|CPT 29888|
20|FH_F33581_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F111520_81601_0|SrvcGrp|471|2022|PDM|541.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F40591_0_0|CSTM-ALL|CSTM-00|2020|PDM|5175.00|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F129175_0_0|SrvcGrp|110765|2022|PDM|93.53|99|0.00|2ND LEVEL INJ PARAVERT F JNT C/T|
20|FH_F78682_0_0|SrvcGrp|16732|2022|PDM|2000.00|99|0.00|HYSTEROSCOPY ABLATION|
20|FH_F117272_24333_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F39723_0_0|SrvcGrp|22018|2022|PDM|45.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117891_19034_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F89932_10940_0|SrvcGrp|12280|2022|PCT|0.45|99|0.00|IMPLANTS|
20|FH_F98060_0_0|SrvcGrp|95699|2022|PCT|1.50|99|0.00|CHEMOTHERAPY/OTHER  DRUGS|
20|FH_F111809_93003_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F117335_0_0|SrvcGrp|72990|2022|PDM|424.00|99|0.00|AEG 1|
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|984.00|99|0.00|AEG 8 (NO REV)|
20|FH_F133474_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149840_80002_0|SrvcGrp|90707|2022|PDM|144.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F142776_65338_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100666_81301_0|SrvcGrp|73601|2022|PDM|5906.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F148430_06278_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|756.36|99|0.00|ASPG X|
20|FH_F134593_60007_0|SrvcGrp|17015|2022|PDM|12.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F88673_71105_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F103220_0_0|SrvcGrp|41546|2022|PDM|6600.00|99|0.00|LAPAROSCOPIC APPENDECTOMY|
20|FH_F49598_0_0|SrvcGrp|9774|2022|PDM|1697.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F119110_91773_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|674.96|99|0.00|HAPA WPA-NWPA 2012-13 ASC 202 W/O REV|
20|FH_F110441_60062_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F125024_66523_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F83978_66739_0|SrvcGrp|33984|2022|PDM|2703.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|551.19|99|0.00|HAPA WPA-NWPA 2012-13 ASC 102 W/O REV|
20|FH_F134613_08852_0|SrvcGrp|46903|2022|PDM|2047.50|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F33532_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120719_27540_0|SrvcGrp|77304|2022|PCT|0.44|99|0.00|DIAGNOSTIC DRUGS|
20|FH_F118384_0_0|SrvcGrp|107772|2022|PCT|1.00|99|0.00|IMMUNIZATIONS|
20|FH_F138127_44857_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118088_71261_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117300_0_0|SrvcGrp|36591|2022|PDM|7853.00|99|0.00|CPT 63685|
20|FH_F149272_64057_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145642_15108_0|SrvcGrp|86842|2022|PDM|25.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F32482_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F132969_84003_0|SrvcGrp|26869|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F133207_0_0|SrvcGrp|100045|2022|PDM|3136.00|99|0.00|REVISION OF FOOT TENDON|
20|FH_F100782_0_0|SrvcGrp|105061|2022|PDM|731.91|99|0.00|WINDBER MEDICAL CNTR ASC 106|
20|FH_F133868_40202_0|SrvcGrp|3178|2022|PDM|676.00|99|0.00|ACUTE PSYCH|
20|FH_F112631_0_0|SrvcGrp|38364|2022|PDM|1417.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F51855_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122470_78229_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F122672_44089_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F86836_0_0|SrvcGrp|11606|2022|PDM|3800.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)|
20|FH_F101084_15459_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F75842_0_0|SrvcGrp|46525|2022|PDM|21379.24|99|0.00|PACEMAKER|
20|FH_F80513_0_0|SrvcGrp|21108|2022|PDM|11995.00|99|0.00|MS DRG 243 ONLY|
20|FH_F146795_44122_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120795_27514_0|SrvcGrp|60|2022|PDM|3120.00|99|0.00|NEWBORN NURSERY - LEVEL II|
20|FH_F131737_15025_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F132250_12550_0|SrvcGrp|86645|2022|PDM|104.60|99|0.00|AETNA PSYTX PT & FAM 45 MINS (MOD TD)|
20|FH_F133494_90023_0|SrvcGrp|10944|2022|PDM|1159.00|99|0.00|EMERGENCY ROOM|
20|FH_F133408_01095_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F139208_30309_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139677_77087_0|SrvcGrp|86723|2022|PDM|395.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F150768_03054_0|SrvcGrp|46605|2022|PDM|170.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F150839_03833_0|SrvcGrp|82222|2022|PDM|204.00|99|0.00|HOSPICE CARE|
20|FH_F150881_52722_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142370_0_0|SrvcGrp|113173|2022|PDM|16.94|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - PFIZER|
20|FH_F111266_30339_0|SrvcGrp|86839|2022|PDM|30.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F148667_0_0|SrvcGrp|92014|2022|PDM|2052.00|99|0.00|PHALANGEAL SHAFT FRACTURE|
20|FH_F111080_18103_0|SrvcGrp|73841|2022|PDM|330.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F120154_77498_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F116753_0_0|SrvcGrp|81035|2022|PDM|21329.00|99|0.00|OBESITY SURGERY|
20|FH_F74424_0_0|SrvcGrp|42869|2022|PDM|252.00|99|0.00|PHYSICAL THERAPY VISIT|
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_F118907_0_0|SrvcGrp|42724|2022|PDM|171.01|99|0.00|SLEEP STUDY|
20|FH_F120207_0_0|SrvcGrp|103643|2022|PDM|2870.00|99|0.00|AETNA FEM/POPL REVASE W/ STENT|
20|FH_F148181_0_0|SrvcGrp|89781|2022|PDM|155.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|ASPG IX|
20|FH_F146266_0_0|SrvcGrp|75002|2022|PDM|3665.00|99|0.00|ARTHOSCOPY|
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 9 (NO REV)|
20|FH_F41167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F110783_93013_0|SrvcGrp|86837|2022|PDM|12.50|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F116806_0_0|SrvcGrp|107078|2022|PDM|1923.16|99|0.00|EXCISION LESION ROOF OF MOUTH|
20|FH_F134919_02155_0|SrvcGrp|48385|2022|PDM|102.50|99|0.00|SPEECH THERAPY|
20|FH_F134847_0_0|SrvcGrp|88492|2022|PDM|5135.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F123570_0_0|SrvcGrp|41336|2022|PDM|3399.00|99|0.00|VAGINAL HYSTERECTOMY|
20|FH_F97881_38703_0|SrvcGrp|73485|2022|PDM|2261.00|99|0.00|AETNA REHAB|
20|FH_F151042_60659_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F90698_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F128369_72901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F41363_0_0|SrvcGrp|23936|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F35747_34223_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F101685_0_0|SrvcGrp|104022|2022|PDM|4400.00|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|733.56|99|0.00|SALLY BALIN,999182,ASC 401|
20|FH_F114204_53191_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F139694_42718_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54952_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F67379_0_0|SrvcGrp|39870|2022|PDM|19000.00|99|0.00|MS DRG 619-621 ONLY|
20|FH_F118667_95131_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F148060_01001_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F64940_0_0|SrvcGrp|17140|2022|PDM|145.20|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PDM|5177.00|99|0.00|AEG 9 (NO REV)|
20|FH_F90811_0_0|SrvcGrp|90425|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY SURGERY|
20|FH_F95360_08720_0|SrvcGrp|94041|2022|PCT|1.00|99|0.00|GAMMA GLOBULIN  INTRAMUS 1CC|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|463.25|99|0.00|ASPG 209|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|282.58|99|0.00|HAPA WPA-NWPA 2012-13 ASC 228 W/O REV|
20|FH_F49046_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F49027_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC|
20|FH_F91061_63043_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41441_0_0|SrvcGrp|115|2022|PDM|530.00|99|0.00|SKILLED NURSING CARE|
20|FH_F101840_76054_0|SrvcGrp|97465|2022|PDM|6608.00|99|0.00|REMOVE PROSTATE REGROWTH|
20|FH_F126806_44125_0|SrvcGrp|87799|2022|PDM|130.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F38352_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F40980_0_0|SrvcGrp|18143|2022|PDM|20625.00|99|0.00|MS DRG 247|
20|FH_F114024_0_0|SrvcGrp|75485|2022|PDM|643.00|99|0.00|AEG 4|
20|FH_F133517_49221_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F44557_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F124854_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117087_0_0|SrvcGrp|107042|2022|PDM|2494.00|99|0.00|REPAIR MOUTH/NOSE FISTULA|
20|FH_F140472_0_0|SrvcGrp|8950|2022|PDM|850.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F51859_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133516_44004_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133455_60110_0|SrvcGrp|29346|2022|PDM|46.35|99|0.00|SKILLED NURSING- LPN|
20|FH_F117945_78957_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F38039_0_0|SrvcGrp|9828|2022|PDM|38.50|99|0.00|HOME HEALTH AIDE|
20|FH_F146117_0_0|SrvcGrp|113637|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PDM|583.03|99|0.00|AEG 2 (NO REV)|
20|FH_F142897_07018_0|SrvcGrp|112223|2022|PCT|1.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F42248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F146211_68144_0|SrvcGrp|65625|2022|PDM|3172.00|99|0.00|CPT 30520|
20|FH_F97541_33021_0|SrvcGrp|73601|2022|PDM|6991.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F118647_21811_0|SrvcGrp|471|2022|PDM|808.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F118517_33316_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143993_07621_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|68.00|99|0.00|AETNA PSYTX W/PT 45 MIN MOD HO (HCFA)|
20|FH_F128912_44313_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F116428_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100682_97401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|ASPG I|
20|FH_F128950_53538_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120437_85202_0|SrvcGrp|16750|2022|PDM|216.09|99|0.00|HOME INFUSION THERAPY|
20|FH_F146179_37687_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|1395.00|99|0.00|ASPG VIII|
20|FH_F97564_52246_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132991_84790_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F68944_0_0|SrvcGrp|65580|2022|PCT|0.70|99|0.00|PACEMAKER/AICD/REPAIR/REVISION|
20|FH_F133108_98221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150602_59718_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F146110_48433_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120407_84070_0|SrvcGrp|74668|2022|PDM|325.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F117559_08619_0|SrvcGrp|114539|2022|PDM|40.00|99|0.00|ADM SARS COV2 10MCG TRS-SUCR 1|
20|FH_F129176_48098_0|SrvcGrp|82222|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F120773_77706_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F122245_0_0|SrvcGrp|56464|2022|PDM|8750.00|99|0.00|CPT 55873|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F128912_44313_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F83031_0_0|SrvcGrp|44705|2022|PDM|75.00|99|0.00|NURSING CARE|
20|FH_F132528_64014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145881_46011_0|SrvcGrp|46903|2022|PDM|645.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F116988_0_0|SrvcGrp|75483|2022|PDM|682.00|99|0.00|AEG 3|
20|FH_F132729_0_0|SrvcGrp|107733|2022|PDM|6266.00|99|0.00|CESAREAN SECTION|
20|FH_F111520_81601_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F69123_0_0|SrvcGrp|29463|2022|PDM|25.00|99|0.00|HOSPICE PAIN MANAGEMENT KIT|
20|FH_F39706_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50974_0_0|SrvcGrp|43958|2022|PDM|70.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F141870_85224_0|SrvcGrp|29077|2022|PDM|25.00|99|0.00|HOME TRANSFUSION|
20|FH_F100682_97401_0|SrvcGrp|73643|2022|PDM|2488.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F101840_76054_0|SrvcGrp|54962|2022|PDM|6956.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)|
20|FH_F90811_0_0|SrvcGrp|90422|2022|PDM|3500.00|99|0.00|REPAIR GRAFT RADIUS OR ULNA|
20|FH_F139377_02301_0|SrvcGrp|89417|2022|PDM|190.07|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F139527_15642_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139707_84010_0|SrvcGrp|114703|2022|PDM|6963.00|99|0.00|GYNECOLOGY PROCEDURES|
20|FH_F150782_19444_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110824_83221_0|SrvcGrp|88978|2022|PDM|2561.00|99|0.00|VAGINAL DELIVERY|
20|FH_F134916_16421_0|SrvcGrp|106314|2022|PDM|624.00|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F148354_44471_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149539_06032_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|1884.22|99|0.00|ORTHOTICS/PROSTHETICS|
20|FH_F134870_97015_0|SrvcGrp|71640|2022|PCT|1.39|99|0.00|E-IMMUNIZATION ADMIN C/O CODES|
20|FH_F112306_81428_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F35088_0_0|SrvcGrp|16777|2022|PCT|1.00|99|0.00|ORGAN ACQUISITION|
20|FH_F125656_92868_0|SrvcGrp|14948|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F35255_98310_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F133519_0_0|SrvcGrp|106719|2022|PDM|1255.00|99|0.00|INDUCED ABORTION BY DILATION AND EVACUATION|
20|FH_F35174_0_0|CSTM-ALL|CSTM-00|2020|PDM|5426.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F122392_78207_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F33366_33952_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F35678_0_0|SrvcGrp|18251|2022|PDM|16952.00|99|0.00|MS DRG 033|
20|FH_F90232_15126_0|SrvcGrp|73701|2022|PDM|25.20|99|0.00|AETNA - SKILLED NURSING|
20|FH_F112750_63379_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134868_32504_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F150359_30106_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122841_0_0|SrvcGrp|95108|2022|PDM|302.00|99|0.00|RETINAL DETACHMENT|
20|FH_F137797_70123_0|SrvcGrp|48394|2022|PDM|39.97|99|0.00|SKILLED NURSING SERVICES|
20|FH_F76826_0_0|SrvcGrp|74442|2022|PDM|443.00|99|0.00|CARDIAC TESTING|
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_F129297_97828_0|SrvcGrp|99072|2022|PDM|3150.00|99|0.00|AETNA MATERNITY DELIVERY|
20|FH_F38742_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SUNSHINE HHC INFUSION SERVICES|
20|FH_F148347_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F147303_70508_0|SrvcGrp|88621|2022|PDM|79.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150938_02062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32825_0_0|SrvcGrp|360|2022|PDM|1582.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F149001_37055_0|SrvcGrp|82222|2022|PDM|122.00|99|0.00|HOSPICE CARE|
20|FH_F50100_0_0|SrvcGrp|46115|2022|PDM|110.64|99|0.00|ST VISIT|
20|FH_F112045_90301_0|SrvcGrp|104593|2022|PDM|23163.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F39443_0_0|SrvcGrp|30347|2022|PDM|475.00|99|0.00|HAPA WPA ASC 303|
20|FH_F148020_0_0|SrvcGrp|471|2022|PDM|603.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F103760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F115483_62002_0|SrvcGrp|113083|2022|PDM|1082.00|99|0.00|CT SCAN|
20|FH_F124975_63366_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F76826_0_0|SrvcGrp|74943|2022|PDM|443.00|99|0.00|CARDIAC REHAB|
20|FH_F37364_0_0|SrvcGrp|8950|2022|PDM|1800.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F118243_0_0|SrvcGrp|107639|2022|PDM|450.00|99|0.00|HEMODIALYSIS|
20|FH_F136806_0_0|SrvcGrp|112954|2022|PDM|7957.00|99|0.00|PACEMAKER|
20|FH_F122276_83252_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F131028_49735_0|SrvcGrp|97704|2022|PDM|130.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F140032_60550_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F140097_19145_0|SrvcGrp|89149|2022|PDM|210.00|99|0.00|OP INTENSIVE|
20|FH_F140231_60540_0|SrvcGrp|89337|2022|PDM|1125.79|99|0.00|DETOXIFICATION|
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|493.00|99|0.00|AEG 2 (NO REV)|
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|732.00|99|0.00|AEG 5  (NO REV)|
20|FH_F101806_0_0|SrvcGrp|75481|2022|PDM|493.35|99|0.00|AEG 2|
20|FH_F151762_17042_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_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|772.00|99|0.00|GA RETINA SURG CTR ASC 16|
20|FH_F132407_62035_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112687_30474_0|SrvcGrp|48396|2022|PDM|169.40|99|0.00|OT SERVICES|
20|FH_F112712_63005_0|SrvcGrp|26868|2022|PCT|1.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F120887_78750_0|SrvcGrp|471|2022|PDM|555.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F120888_63823_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F84394_17402_0|SrvcGrp|26275|2022|PDM|2904.00|99|0.00|CPT 29826|
20|FH_F33618_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F38980_0_0|SrvcGrp|16|2022|PDM|1000.00|99|0.00|ACUTE REHABILITATION|
20|FH_F38431_0_0|SrvcGrp|23001|2022|PDM|1300.00|99|0.00|V5260|
20|FH_F57093_0_0|SrvcGrp|11232|2022|PDM|272.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F57093_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F59732_0_0|SrvcGrp|10579|2022|PDM|50.00|99|0.00|HYDRATION THERAPY - 2 LITERS|
20|FH_F136499_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135219_68506_0|SrvcGrp|103913|2022|PCT|0.00|99|0.00|OP DIALYSIS|
20|FH_F121488_77478_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F84193_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F131961_06040_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141370_20866_0|SrvcGrp|113706|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F75105_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2018.00|99|0.00|AEG 6 (NO REV)|
20|FH_F124660_0_0|SrvcGrp|72990|2022|PDM|443.00|99|0.00|AEG 1|
20|FH_F125625_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39022_0_0|SrvcGrp|10425|2022|PDM|710.00|99|0.00|NEWBORN NURSERY|
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|1345.00|99|0.00|AEG 2 (NO REV)|
20|FH_F130138_02915_0|SrvcGrp|184|2022|PDM|2137.80|99|0.00|MEDICAL INTENSIVE CARE|
20|FH_F85353_16407_0|SrvcGrp|63893|2022|PDM|196.08|99|0.00|HAPA WPA-NWPA 2012-13 ASC 236|
20|FH_F51138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F112468_0_0|SrvcGrp|38364|2022|PDM|1417.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F124173_66215_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F134208_21502_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|AEG 5  (NO REV)|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|ASPG III|
20|FH_F149150_75407_0|SrvcGrp|73063|2022|PDM|770.00|99|0.00|OBSERVATION SERVICES|
20|FH_F96160_32207_0|SrvcGrp|29075|2022|PDM|61.90|99|0.00|HYDRATION THERAPY|
20|FH_F51934_0_0|SrvcGrp|48397|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F127071_82435_0|SrvcGrp|73605|2022|PDM|860.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F84132_48026_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121601_47446_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139169_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F119379_0_0|SrvcGrp|107832|2022|PDM|1428.00|99|0.00|REPAIR FINGER FRACTURE|
20|FH_F92477_0_0|SrvcGrp|73601|2022|PDM|1470.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F125328_0_0|SrvcGrp|72996|2022|PDM|680.00|99|0.00|AEG 4|
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|688.00|99|0.00|AEG 1 (NO REV)|
20|FH_F138951_41101_0|SrvcGrp|86829|2022|PDM|35.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F120715_83440_0|SrvcGrp|104363|2022|PCT|0.96|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F86033_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F121225_98902_0|SrvcGrp|16750|2022|PDM|486.64|99|0.00|HOME INFUSION THERAPY|
20|FH_F85340_98195_0|CSTM-ALL|CSTM-00|2020|PCT|2.18|99|0.00|AETNA - APC GROUPER A|
20|FH_F142894_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110905_54452_0|SrvcGrp|104173|2022|PCT|2.00|99|0.00|IMMUNIZATIONS AND INJECTIONS|
20|FH_F134608_18017_0|SrvcGrp|108143|2022|PDM|100.00|99|0.00|INSERT INTRAUTERINE DEVICE (HCFA)|
20|FH_F150299_22046_0|SrvcGrp|88621|2022|PDM|84.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132609_0_0|SrvcGrp|701|2022|PDM|2872.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F87919_01950_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F100782_0_0|SrvcGrp|105181|2022|PDM|413.37|99|0.00|WINDBER MEDICAL CNTR ASC 1601|
20|FH_F103320_0_0|SrvcGrp|73000|2022|PDM|1213.00|99|0.00|AEG 6|
20|FH_F136037_0_0|SrvcGrp|108484|2022|PDM|655.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1831.00|99|0.00|AEG 6 (NO REV)|
20|FH_F90438_08873_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143560_03079_0|SrvcGrp|115130|2022|PDM|703.26|99|0.00|MRI/MRA W/ CONTRAST|
20|FH_F125244_0_0|SrvcGrp|27346|2022|PDM|4000.00|99|0.00|REPAIR BLADDER DEFECT|
20|FH_F135663_24401_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F133775_83401_0|SrvcGrp|48394|2022|PDM|35.77|99|0.00|SKILLED NURSING SERVICES|
20|FH_F133868_40202_0|SrvcGrp|89417|2022|PDM|257.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F133753_84015_0|SrvcGrp|12496|2022|PDM|753.00|99|0.00|ACUTE REHABILITATION|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|657.80|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1201 W/O REV|
20|FH_F135610_06451_0|SrvcGrp|84185|2022|PDM|119.00|99|0.00|RESPITE CARE|
20|FH_F121476_0_0|SrvcGrp|108856|2022|PDM|8549.00|99|0.00|IMPLANTABLE JOINT DEVICE|
20|FH_F37877_0_0|SrvcGrp|68580|2022|PCT|1.00|99|0.00|IMMUNIZATIONS|
20|FH_F48034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F141874_0_0|SrvcGrp|22596|2022|PDM|175.46|99|0.00|HOSPICE CARE|
20|FH_F112665_0_0|SrvcGrp|11669|2022|PDM|2887.00|99|0.00|OP SURG|
20|FH_F54592_0_0|SrvcGrp|27050|2022|PDM|44.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS(MOD SH)|
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|333.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F86953_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.38|99|0.00|HAPA WPA-NWPA 2012-13 ASC 118 W/O REV|
20|FH_F84175_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F85257_0_0|SrvcGrp|83544|2022|PCT|0.55|99|0.00|THERAPEUTIC RADIOPHARMACEUTICALS|
20|FH_F101100_50314_0|SrvcGrp|65163|2022|PDM|1643.00|99|0.00|NEWBORN LOWER LEVEL|
20|FH_F115890_75067_0|SrvcGrp|73841|2022|PDM|430.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F63625_0_0|SrvcGrp|9511|2022|PDM|966.00|99|0.00|OBSERVATION SVCS|
20|FH_F146419_68504_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120522_53549_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120795_27514_0|SrvcGrp|11336|2022|PCT|0.56|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F133583_77074_0|SrvcGrp|46903|2022|PDM|552.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F133658_60053_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F133494_90023_0|SrvcGrp|105465|2022|PCT|1.40|99|0.00|AETNA THERAPIES|
20|FH_F133050_78216_0|SrvcGrp|100499|2022|PDM|850.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F133700_92808_0|SrvcGrp|110812|2022|PDM|400.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F135891_0_0|SrvcGrp|87537|2022|PDM|450.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
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_F102641_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F102641_0_0|SrvcGrp|96799|2022|PDM|2026.00|99|0.00|DESTROY C/TH FACET JNT ADDL|
20|FH_F71502_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87474_0_0|SrvcGrp|26253|2022|PDM|33.00|99|0.00|LIPIDS|
20|FH_F87480_0_0|SrvcGrp|76847|2022|PDM|1800.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F136467_0_0|SrvcGrp|69981|2022|PDM|1118.00|99|0.00|CPT 24358|
20|FH_F84894_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS|
20|FH_F69968_0_0|SrvcGrp|20980|2022|PDM|670.27|99|0.00|MS DRG 789-794 & REV CODE 173 NURSERY LEVEL III|
20|FH_F136404_06410_0|SrvcGrp|471|2022|PDM|560.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F33472_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F129115_85716_0|SrvcGrp|75419|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 252-254 CV SURGERY|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PDM|23153.00|99|0.00|CPT CODE 61793|
20|FH_F128363_60062_0|SrvcGrp|73842|2022|PDM|248.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F31936_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125973_63830_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130523_04605_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F90852_0_0|SrvcGrp|30089|2022|PDM|420.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72369_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F128992_90808_0|SrvcGrp|46903|2022|PDM|832.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F83198_44125_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F49338_0_0|SrvcGrp|36807|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER QW (DME)|
20|FH_F50218_0_0|SrvcGrp|10519|2022|PDM|125.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F125546_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F147941_06023_0|SrvcGrp|109216|2022|PDM|288.00|99|0.00|PSYCH TEST EVALUATION EACH ADD'L HOUR|
20|FH_F82114_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F129656_15005_0|SrvcGrp|14949|2022|PDM|80.00|99|0.00|HOME INFUSION|
20|FH_F65559_0_0|SrvcGrp|59290|2022|PDM|647.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F116327_75701_0|SrvcGrp|93919|2022|PDM|431.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F127826_65583_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F88254_33411_0|SrvcGrp|29023|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F147941_06023_0|SrvcGrp|110729|2022|PDM|3118.00|99|0.00|IP HOSPICE|
20|FH_F51733_0_0|SrvcGrp|45949|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F121490_86314_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141468_75160_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129011_15857_0|SrvcGrp|92501|2022|PDM|425.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F100761_02539_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|PDM|2000.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F82696_16335_0|SrvcGrp|59159|2022|PCT|0.65|99|0.00|OP SURGERY|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD KM|
20|FH_F123921_89128_0|SrvcGrp|74668|2022|PDM|600.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F88254_33411_0|SrvcGrp|86523|2022|PCT|1.00|99|0.00|AETNA DRUGS/AGENTS/INJ DRUG|
20|FH_F130747_0_0|SrvcGrp|35671|2022|PDM|4682.00|99|0.00|TRANSPLANT FOREARM TENDON|
20|FH_F125028_19061_0|SrvcGrp|14948|2022|PDM|126.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F120285_32960_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F119760_0_0|SrvcGrp|94780|2022|PDM|105.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F135175_45121_0|CSTM-ALL|CSTM-00|2020|PDM|740.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|1809.00|99|0.00|AEG 8 (NO REV)|
20|FH_F94862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129656_15005_0|SrvcGrp|22592|2022|PDM|54.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F56136_0_0|SrvcGrp|31099|2022|PDM|683.00|99|0.00|NORMAL NEWBORN VIA C-SECTION|
20|FH_F59333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121523_33406_0|SrvcGrp|104079|2022|PCT|1.14|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F130523_04605_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC) (HCFA)|
20|FH_F54513_0_0|SrvcGrp|10543|2022|PDM|110.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F56136_0_0|SrvcGrp|23477|2022|PCT|0.85|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F131357_17545_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F91622_0_0|SrvcGrp|17100|2022|PDM|2324.00|99|0.00|SKILLED NURSING|
20|FH_F141527_36830_0|SrvcGrp|17013|2022|PDM|26.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F44198_0_0|SrvcGrp|18071|2022|PDM|50.00|99|0.00|AMBULANCE RESPONSE/TREATMENT - NO TRANSPORT|
20|FH_F67504_0_0|SrvcGrp|43892|2022|PDM|93.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F109260_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38591_0_0|CSTM-ALL|CSTM-00|2020|PDM|1831.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38677_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92276_32308_0|SrvcGrp|20297|2022|PDM|77506.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VALVE PROC|
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148201_82716_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125011_74467_0|SrvcGrp|103913|2022|PCT|0.63|99|0.00|OP DIALYSIS|
20|FH_F115075_77833_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F110923_54768_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F37651_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE|
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115667_16101_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F32512_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F110925_01104_0|SrvcGrp|41456|2022|PDM|0.79|99|0.00|ENTERAL FORMULA - PEDIATRICS (CALORICALLY DENSE)|
20|FH_F129782_0_0|CSTM-ALL|CSTM-00|2020|PDM|1772.00|99|0.00|AEG 9 (NO REV)|
20|FH_F125028_19061_0|SrvcGrp|14947|2022|PDM|105.00|99|0.00|HOME INFUSION|
20|FH_F82235_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F31056_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|LAP CHOLECYSTECTOMY|
20|FH_F37651_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD NU|
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|732.00|99|0.00|AEG 5  (NO REV)|
20|FH_F128358_46072_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F142710_0_0|SrvcGrp|82222|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F136411_67031_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136481_61350_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F118152_20151_0|SrvcGrp|86833|2022|PDM|15.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F120418_43015_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F120418_43015_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP|
20|FH_F93185_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134126_11554_0|SrvcGrp|111426|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F114092_83350_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F138019_79705_0|SrvcGrp|108484|2022|PDM|670.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F142448_15701_0|SrvcGrp|17015|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142448_15701_0|SrvcGrp|47183|2022|PDM|60.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F117552_0_0|SrvcGrp|72992|2022|PDM|536.00|99|0.00|AEG 2|
20|FH_F53732_0_0|SrvcGrp|17015|2022|PDM|19.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F97600_46151_0|SrvcGrp|88978|2022|PDM|10030.00|99|0.00|VAGINAL DELIVERY|
20|FH_F126759_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F77782_66061_0|SrvcGrp|45046|2022|PDM|2214.00|99|0.00|IP OBSERVATION SVCS|
20|FH_F140688_98405_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|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_F119018_47802_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F39623_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109930_73109_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP|
20|FH_F129483_77030_0|SrvcGrp|86779|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F117211_15143_0|SrvcGrp|48398|2022|PDM|70.00|99|0.00|PT SERVICES|
20|FH_F117214_84020_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137329_81224_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F38948_0_0|SrvcGrp|29919|2022|PDM|1899.00|99|0.00|SURGICAL ICU|
20|FH_F145448_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.40|99|0.00|ASPG X|
20|FH_F121347_29401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F121954_60706_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121999_67002_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|398.89|99|0.00|DELAWARE VALLEY- ASC 206|
20|FH_F113715_45005_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|1903.00|99|0.00|ASPG VIII|
20|FH_F98040_89406_0|SrvcGrp|88977|2022|PDM|6795.00|99|0.00|C-SECTION DELIVERY|
20|FH_F110381_0_0|SrvcGrp|41334|2022|PDM|15500.00|99|0.00|TOTAL KNEE|
20|FH_F106822_0_0|SrvcGrp|100273|2022|PDM|62.50|99|0.00|MEASLES MUMPS&RUBELLA VAC LI|
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 1 (NO REV)|
20|FH_F111840_0_0|SrvcGrp|75487|2022|PDM|717.00|99|0.00|AEG 5|
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F36710_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114916_30309_0|SrvcGrp|82108|2022|PDM|2000.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PDM|730.00|99|0.00|ASPG IV|
20|FH_F95341_08701_0|SrvcGrp|90492|2022|PCT|0.80|99|0.00|BEHAVRAL QUALIT ANALYS VOICE|
20|FH_F132627_0_0|SrvcGrp|22590|2022|PDM|69.36|99|0.00|PAIN MANAGAMENT - INTERMITTENT|
20|FH_F132988_0_0|SrvcGrp|100010|2022|PDM|4493.01|99|0.00|KNEE RECONSTRUCTION|
20|FH_F137067_0_0|SrvcGrp|84939|2022|PDM|25200.00|99|0.00|SHOULDER JOINT|
20|FH_F141070_64093_0|SrvcGrp|46605|2022|PDM|127.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F93252_0_0|SrvcGrp|93020|2022|PDM|4000.00|99|0.00|KYPHOPLASTY-VERTEBROPLASTY LUMBAR|
20|FH_F141343_62047_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148488_0_0|SrvcGrp|75419|2022|PDM|300.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F83231_0_0|SrvcGrp|69048|2022|PDM|1400.00|99|0.00|SUB-ACUTE REHAB III|
20|FH_F124129_33603_0|SrvcGrp|3178|2022|PDM|798.00|99|0.00|ACUTE PSYCH|
20|FH_F147081_02130_0|SrvcGrp|113928|2022|PDM|354.00|99|0.00|PARTIAL HOSPITAL (>=18 YRS)|
20|FH_F124636_85008_0|SrvcGrp|108484|2022|PDM|900.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F132439_0_0|SrvcGrp|22596|2022|PDM|178.17|99|0.00|HOSPICE CARE|
20|FH_F66439_0_0|CSTM-ALL|CSTM-00|2020|PCT|56.00|99|0.00|OP SVCS|
20|FH_F89273_0_0|SrvcGrp|88268|2022|PDM|595.00|99|0.00|CONNECTIVE TISSUE (HCFA)|
20|FH_F90653_0_0|SrvcGrp|58763|2022|PCT|0.70|99|0.00|IMMUNE ENHANCING/SUPPRESSANT PHARMACY|
20|FH_F124407_0_0|CSTM-ALL|CSTM-00|2020|PDM|255.00|99|0.00|AEG 1 (NO REV)|
20|FH_F114645_34952_0|SrvcGrp|86722|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F114666_30342_0|SrvcGrp|105638|2022|PDM|13500.00|99|0.00|HIP ARTHROSCOPY|
20|FH_F114783_70810_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F113845_32746_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F119725_0_0|SrvcGrp|106297|2022|PDM|217.22|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F136772_89109_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F136930_73114_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F42169_0_0|SrvcGrp|20534|2022|PCT|0.85|99|0.00|SKILLED NURSING|
20|FH_F115631_65201_0|SrvcGrp|78096|2022|PDM|2419.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F116393_07002_0|SrvcGrp|111264|2022|PDM|76.49|99|0.00|CONTRAST X-RAY OF BLADDER|
20|FH_F147528_72114_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147660_75110_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42551_0_0|CSTM-ALL|CSTM-00|2020|PDM|205.00|99|0.00|CD (ADULT) - DAY TREATMENT|
20|FH_F42748_0_0|SrvcGrp|110|2022|PDM|500.00|99|0.00|CD - REHABILITATION|
20|FH_F42581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F98621_41042_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F131208_0_0|SrvcGrp|106294|2022|PDM|594.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F40033_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F75787_85137_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F129850_0_0|SrvcGrp|71083|2022|PDM|1.25|99|0.00|RADIOLOGY SERVICES|
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F106980_0_0|SrvcGrp|12491|2022|PCT|1.05|99|0.00|PACEMAKER|
20|FH_F133536_0_0|SrvcGrp|82112|2022|PDM|3215.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F114853_0_0|SrvcGrp|72121|2022|PDM|2887.00|99|0.00|ARTHOSCOPY|
20|FH_F138784_32216_0|SrvcGrp|16069|2022|PDM|777.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F138880_92392_0|SrvcGrp|89337|2022|PDM|1000.00|99|0.00|DETOXIFICATION|
20|FH_F138880_92392_0|SrvcGrp|74668|2022|PDM|500.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F77933_0_0|SrvcGrp|48382|2022|PDM|57.00|99|0.00|CPT 92507|
20|FH_F78265_0_0|SrvcGrp|9510|2022|PDM|542.00|99|0.00|SKILLED NURSING CARE|
20|FH_F37644_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|PDM|2475.00|99|0.00|AEG 5  (NO REV)|
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|6645.00|99|0.00|AEG 9 (NO REV)|
20|FH_F132258_45404_0|SrvcGrp|26869|2022|PDM|34.98|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F123184_20906_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F97501_31501_0|SrvcGrp|73656|2022|PDM|767.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F135435_06067_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135439_33825_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F135799_99114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135924_02906_0|SrvcGrp|112727|2022|PDM|255.90|99|0.00|COVID-19 IA NFCT AB SARS COV 2|
20|FH_F135943_76051_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135988_75703_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136127_15658_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116397_33404_0|SrvcGrp|26869|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F116397_33404_0|SrvcGrp|86848|2022|PDM|40.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F131361_18235_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F127399_0_0|SrvcGrp|92367|2022|PDM|2913.00|99|0.00|TRANSPLANT HAND TENDON|
20|FH_F121428_40202_0|SrvcGrp|79726|2022|PCT|0.33|99|0.00|TRAUMA|
20|FH_F121444_47720_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121763_07202_0|SrvcGrp|90643|2022|PDM|27.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F121771_91405_0|SrvcGrp|87317|2022|PDM|970.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|1518.00|99|0.00|ASPG V|
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|AEG 10 (NO REV)|
20|FH_F132689_18436_0|SrvcGrp|89417|2022|PDM|479.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F101182_07863_0|SrvcGrp|96401|2022|PCT|1.00|99|0.00|ACYELOVIR INJECTION|
20|FH_F111292_33136_0|SrvcGrp|82749|2022|PDM|61.00|99|0.00|AUTOMAT HEMOGRAM COMPLET DIF|
20|FH_F111301_33122_0|CSTM-ALL|CSTM-00|2020|PDM|1987.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F111303_19087_0|SrvcGrp|86723|2022|PDM|375.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F111363_33169_0|SrvcGrp|82753|2022|PDM|71.00|99|0.00|TROPONIN QUANT|
20|FH_F111363_33169_0|SrvcGrp|82758|2022|PDM|59.00|99|0.00|CHEMISTRY|
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F33081_0_0|SrvcGrp|12359|2022|PDM|2200.00|99|0.00|TELEMETRY SVCS|
20|FH_F33081_0_0|CSTM-ALL|CSTM-00|2020|PDM|5200.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F41780_0_0|SrvcGrp|29021|2022|PCT|1.00|99|0.00|DME AND SUPPLIES|
20|FH_F96480_15224_0|SrvcGrp|74694|2022|PDM|1525.00|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F102862_30606_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS APC GROUPED|
20|FH_F96960_35404_0|SrvcGrp|73559|2022|PDM|9208.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F96960_35404_0|SrvcGrp|88977|2022|PDM|6795.00|99|0.00|C-SECTION DELIVERY|
20|FH_F101320_26062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132854_77379_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132347_01605_0|SrvcGrp|63297|2022|PDM|110.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F148079_06512_0|SrvcGrp|48398|2022|PDM|103.00|99|0.00|PT SERVICES|
20|FH_F119538_60959_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F148552_68114_0|CSTM-ALL|CSTM-00|2020|PDM|862.49|99|0.00|AEG 1 (NO REV)|
20|FH_F146108_66762_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|78948|2022|PDM|3101.75|99|0.00|MON VALLEY ASC 703|
20|FH_F141807_33020_0|SrvcGrp|46903|2022|PDM|752.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F142831_08053_0|SrvcGrp|109330|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133021_00910_0|SrvcGrp|112292|2022|PDM|5000.00|99|0.00|ELECTROPHYSIOLOGY|
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 10 (NO REV)|
20|FH_F38770_0_0|CSTM-ALL|CSTM-00|2020|PDM|363.00|99|0.00|SKILLED NURSING|
20|FH_F38394_0_0|SrvcGrp|17075|2022|PDM|1314.80|99|0.00|ASPG VI|
20|FH_F111444_33401_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|1094.93|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F117795_36272_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F97042_64804_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F143087_97411_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F118542_60188_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111401_29425_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F127163_74437_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F145988_06105_0|CSTM-ALL|CSTM-00|2020|PDM|7274.00|99|0.00|AEG 9 (NO REV)|
20|FH_F48929_0_0|SrvcGrp|26001|2022|PDM|165.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|2779.00|99|0.00|ASPG IX - IOWA|
20|FH_F42343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F40525_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F141802_17042_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F87412_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS SNF PART B DRUGS|
20|FH_F89475_71202_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F88114_32205_0|SrvcGrp|3809|2022|PDM|646.18|99|0.00|HOSPICE CARE|
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)|
20|FH_F34513_0_0|SrvcGrp|9936|2022|PDM|94.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F145544_93536_0|SrvcGrp|87317|2022|PDM|1000.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F139551_0_0|SrvcGrp|77021|2022|PDM|5769.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F122725_32216_0|SrvcGrp|104807|2022|PDM|34.00|99|0.00|BIOFEEDBACK ANY METHOD|
20|FH_F86872_15215_0|SrvcGrp|14949|2022|PDM|120.00|99|0.00|HOME INFUSION|
20|FH_F133211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|OP SVCS|
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|1178.00|99|0.00|AEG 4 (NO REV)|
20|FH_F89340_0_0|SrvcGrp|14614|2022|PDM|4180.00|99|0.00|LITHOTRIPSY|
20|FH_F89495_0_0|SrvcGrp|87769|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F148479_49519_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36207_0_0|SrvcGrp|16897|2022|PDM|415.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F92676_15063_0|SrvcGrp|79010|2022|PDM|1018.59|99|0.00|MON VALLEY ASC 108|
20|FH_F111540_16823_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F133477_90247_0|CSTM-ALL|CSTM-00|2020|PDM|2857.00|99|0.00|AEG 4 (NO REV)|
20|FH_F97182_21502_0|SrvcGrp|73602|2022|PDM|5214.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F146211_68144_0|SrvcGrp|10365|2022|PDM|1813.00|99|0.00|CPT CODE 99285|
20|FH_F89952_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|1923.00|99|0.00|AEG 9 (NO REV)|
20|FH_F38725_0_0|CSTM-ALL|CSTM-00|2020|PDM|1617.00|99|0.00|ASPG IX|
20|FH_F120390_91316_0|SrvcGrp|87317|2022|PDM|900.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F118196_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F50221_0_0|SrvcGrp|33164|2022|PDM|315.00|99|0.00|SKILLED NURSING - LEVEL I|
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_F117858_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F120437_85202_0|SrvcGrp|63156|2022|PDM|49.53|99|0.00|IMMUNE GLOBULIN INTRAVENOUS|
20|FH_F37909_0_0|SrvcGrp|16748|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY RE-EVAL|
20|FH_F89233_0_0|SrvcGrp|63|2022|PDM|979.00|99|0.00|SUBACUTE CARE|
20|FH_F133516_44004_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F123872_75006_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F46914_0_0|SrvcGrp|9937|2022|PDM|147.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F133021_00910_0|SrvcGrp|48968|2022|PDM|4000.00|99|0.00|RENAL ABLATION|
20|FH_F150480_14043_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F69063_0_0|SrvcGrp|43956|2022|PDM|55.00|99|0.00|NURSING CARE|
20|FH_F118025_60641_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F71929_15090_0|CSTM-ALL|CSTM-00|2020|PDM|340.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121168_0_0|SrvcGrp|97506|2022|PDM|100.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F37751_0_0|SrvcGrp|27693|2022|PCT|1.00|99|0.00|RADIOLOGY|
20|FH_F117909_92405_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F89932_10940_0|SrvcGrp|71182|2022|PDM|130.00|99|0.00|URGENT CARE|
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|367.94|99|0.00|AEG 1 (NO REV)|
20|FH_F134434_30607_0|SrvcGrp|75419|2022|PDM|550.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F125070_64117_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|AEG 4 (NO REV)|
20|FH_F118486_95060_0|SrvcGrp|73842|2022|PDM|330.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F50221_0_0|SrvcGrp|28074|2022|PCT|0.90|99|0.00|HIGH COST PHARMACEUTICALS|
20|FH_F115313_11216_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F100788_01420_0|SrvcGrp|73643|2022|PDM|1641.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F72024_0_0|SrvcGrp|12023|2022|PDM|147.00|99|0.00|HOSPICE RESPITE SERVICES|
20|FH_F117911_86403_0|SrvcGrp|88620|2022|PDM|122.00|99|0.00|SKILLED NURSING RN|
20|FH_F50472_0_0|SrvcGrp|46724|2022|PDM|55.00|99|0.00|WORK HARDENING|
20|FH_F127163_74437_0|SrvcGrp|46903|2022|PDM|520.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F90935_29073_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F100741_0_0|SrvcGrp|90726|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F63301_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INFUSION|
20|FH_F140790_0_0|SrvcGrp|28551|2022|PDM|2750.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F133287_40215_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 10 (NO REV)|
20|FH_F117827_75235_0|SrvcGrp|73842|2022|PDM|147.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F49354_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F68831_0_0|SrvcGrp|22954|2022|PDM|148.50|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F128762_78231_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F34706_0_0|SrvcGrp|537|2022|PCT|0.57|99|0.00|OBSERVATION SERVICES|
20|FH_F148639_0_0|SrvcGrp|92364|2022|PDM|7164.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F126868_60451_0|SrvcGrp|73841|2022|PDM|395.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|4199.00|99|0.00|AEG 5  (NO REV)|
20|FH_F142991_43920_0|SrvcGrp|14557|2022|PCT|0.00|99|0.00|AMBULANCE SVCS - WHEELCHAIR VAN|
20|FH_F143200_91602_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F89932_10940_0|SrvcGrp|86919|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F150530_63031_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F44097_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150602_59718_0|SrvcGrp|104226|2022|PDM|153.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F94300_0_0|SrvcGrp|84181|2022|PDM|2310.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS|
20|FH_F69063_0_0|SrvcGrp|42975|2022|PDM|95.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKE|
20|FH_F102721_38118_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|487.00|99|0.00|AEG 2 (NO REV)|
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|28500.00|99|0.00|DRG 108 ONLY OTHER CARDIOTHORACIC PROC|
20|FH_F150022_32539_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC INVOICE|
20|FH_F115274_15235_0|SrvcGrp|63297|2022|PDM|135.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F92676_15063_0|SrvcGrp|79096|2022|PDM|894.53|99|0.00|MON VALLEY ASC 408|
20|FH_F124928_04210_0|SrvcGrp|93098|2022|PDM|144.58|99|0.00|HOSPICE CARE|
20|FH_F111809_93003_0|SrvcGrp|104544|2022|PDM|13401.00|99|0.00|APPENDECTOMY LAPAROSCOPY|
20|FH_F133368_61401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118391_77040_0|SrvcGrp|80261|2022|PCT|1.00|99|0.00|AETNA RADIOLOGY SERVICES|
20|FH_F42803_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F146211_68144_0|SrvcGrp|87679|2022|PDM|1690.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F128390_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F145884_72113_0|SrvcGrp|72602|2022|PDM|690.00|99|0.00|ECT|
20|FH_F51972_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38376_0_0|SrvcGrp|3327|2022|PDM|90.00|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F39640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|DME - MOD TC|
20|FH_F97561_30030_0|SrvcGrp|73603|2022|PDM|4735.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F97141_93933_0|SrvcGrp|73659|2022|PDM|13717.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F126934_72064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92636_90230_0|SrvcGrp|46605|2022|PDM|89.25|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F125540_19462_0|SrvcGrp|89022|2022|PDM|30.60|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F126935_33615_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F41785_0_0|SrvcGrp|31191|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF (DME)|
20|FH_F145988_06105_0|SrvcGrp|47545|2022|PDM|45472.00|99|0.00|INSERTION/REPLACEMENT OF PERIPHERAL/GASTRIC NEUROSTIMULATOR|
20|FH_F116159_0_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F120605_0_0|SrvcGrp|64517|2022|PDM|2625.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F125176_20785_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F150534_08879_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97201_15068_0|SrvcGrp|48398|2022|PDM|82.50|99|0.00|PT SERVICES|
20|FH_F144188_76502_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35368_0_0|SrvcGrp|36369|2022|PCT|1.05|99|0.00|HIGH COST PHARMACEUTICALS|
20|FH_F142769_21204_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132543_79549_0|SrvcGrp|14096|2022|PCT|0.70|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F77787_0_0|SrvcGrp|12267|2022|PCT|1.00|99|0.00|AIR AMBULANCE|
20|FH_F111412_33777_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F74883_0_0|SrvcGrp|72041|2022|PDM|130.00|99|0.00|OFFICE VISIT|
20|FH_F38410_0_0|SrvcGrp|10407|2022|PDM|55.00|99|0.00|HOME INFUSION|
20|FH_F88512_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (HCFA) INPATIENT|
20|FH_F129364_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F97140_91730_0|SrvcGrp|73602|2022|PDM|1721.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F127412_15301_0|SrvcGrp|95819|2022|PDM|1600.00|99|0.00|GONIOTOMY|
20|FH_F39180_0_0|SrvcGrp|38|2022|PDM|1794.00|99|0.00|NORMAL DELIVERY|
20|FH_F80855_0_0|SrvcGrp|65625|2022|PDM|1100.00|99|0.00|CPT 30520|
20|FH_F141830_92592_0|SrvcGrp|90854|2022|PDM|1250.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F143684_0_0|SrvcGrp|93807|2022|PDM|6291.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F97560_23249_0|SrvcGrp|73659|2022|PDM|13834.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F141833_31707_0|SrvcGrp|106291|2022|PDM|450.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F63301_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|WASTE POLICY  (MOD 53)|
20|FH_F148599_98034_0|SrvcGrp|29757|2022|PDM|34843.00|99|0.00|MS DRG 251 ONLY|
20|FH_F119437_0_0|SrvcGrp|88162|2022|PDM|4750.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F102561_75146_0|SrvcGrp|37317|2022|PDM|4000.00|99|0.00|LITHOTRIPSY|
20|FH_F133018_84037_0|SrvcGrp|65720|2022|PDM|93.00|99|0.00|RESPITE CARE|
20|FH_F134447_12883_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F132612_0_0|SrvcGrp|107734|2022|PDM|4090.00|99|0.00|VAGINAL DELIVERY|
20|FH_F139666_26175_0|SrvcGrp|111934|2022|PDM|51.31|99|0.00|COVID-19 NUCLEIC ACID|
20|FH_F150771_44512_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137986_0_0|SrvcGrp|90420|2022|PDM|4296.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F150360_68112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35056_0_0|SrvcGrp|9527|2022|PDM|2500.00|99|0.00|NORMAL DELIVERY|
20|FH_F111038_62960_0|CSTM-ALL|CSTM-00|2020|PDM|1545.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37304_0_0|SrvcGrp|3406|2022|PDM|95.00|99|0.00|CPT 99214|
20|FH_F117762_0_0|SrvcGrp|67072|2022|PDM|8840.00|99|0.00|CPT 22845|
20|FH_F44132_0_0|SrvcGrp|33166|2022|PDM|480.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|53.00|99|0.00|BIOLOGICAL RESPONSE MODIFIERS THERAPY|
20|FH_F125214_12428_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127418_0_0|SrvcGrp|93069|2022|PDM|15787.41|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F91076_0_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F38986_0_0|SrvcGrp|24|2022|PCT|0.65|99|0.00|CARDIAC CATH|
20|FH_F151041_60647_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149045_45679_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|281.51|99|0.00|SALLY BALIN,999182,ASC 215|
20|FH_F100661_63640_0|SrvcGrp|73601|2022|PDM|5165.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F146401_76401_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F90935_29073_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149781_37404_0|SrvcGrp|26274|2022|PDM|3146.00|99|0.00|CPT 29877|
20|FH_F119076_41001_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F117275_16936_0|SrvcGrp|46903|2022|PDM|480.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132587_57105_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132528_64014_0|SrvcGrp|88620|2022|PDM|127.00|99|0.00|SKILLED NURSING RN|
20|FH_F38161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132647_60067_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F86434_0_0|SrvcGrp|96104|2022|PDM|5000.00|99|0.00|IMPLANTABLE NEUROSTIMULATOR|
20|FH_F44023_0_0|SrvcGrp|10675|2022|PDM|3152.00|99|0.00|ICU/CCU|
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1758.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1561.00|99|0.00|AEG 10 (NO REV)|
20|FH_F92677_08003_0|SrvcGrp|40690|2022|PDM|7.35|99|0.00|ENTERAL FEEDING SUPPLY KIT, BOLUS|
20|FH_F113586_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F90955_06053_0|SrvcGrp|48394|2022|PDM|36.75|99|0.00|SKILLED NURSING SERVICES|
20|FH_F83031_0_0|SrvcGrp|43265|2022|PDM|105.00|99|0.00|MID-LINE INSERTION|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|101.00|99|0.00|PSYTX W PT 60 MINS (HCFA)|
20|FH_F67683_0_0|SrvcGrp|26596|2022|PDM|250.00|99|0.00|PARTIAL HOSP PSYCH/CD (HALF DAY)|
20|FH_F132446_19063_0|SrvcGrp|34167|2022|PDM|76.00|99|0.00|RESPIRATORY THERAPY VISIT|
20|FH_F148556_13206_0|SrvcGrp|17008|2022|PDM|50.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS|
20|FH_F125660_46706_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F147997_92620_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F146257_83713_0|SrvcGrp|113276|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F100784_59923_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F64659_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111423_34952_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F42453_0_0|CSTM-ALL|CSTM-00|2020|PDM|459.00|99|0.00|CHEMICAL DEPENDENCY - ADOLESCENT|
20|FH_F133018_84037_0|SrvcGrp|112178|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F31824_0_0|SrvcGrp|13212|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|1161.00|99|0.00|AEG 6 (NO REV)|
20|FH_F148644_06890_0|SrvcGrp|104108|2022|PDM|2710.00|99|0.00|EXCISION OF BREAST LESION ID|
20|FH_F151153_77591_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151159_46322_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F121976_44505_0|SrvcGrp|3178|2022|PDM|900.00|99|0.00|ACUTE PSYCH|
20|FH_F113677_0_0|SrvcGrp|82981|2022|PDM|165.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F129468_15010_0|SrvcGrp|89149|2022|PDM|180.00|99|0.00|OP INTENSIVE|
20|FH_F130066_84107_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F149179_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F123818_43452_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123763_80130_0|SrvcGrp|90854|2022|PDM|1226.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F123820_91316_0|SrvcGrp|108484|2022|PDM|1200.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F132810_0_0|SrvcGrp|86846|2022|PDM|35.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F117465_0_0|SrvcGrp|98360|2022|PDM|4000.00|99|0.00|AETNA LAMINECTOMY W/FACE-LUMBAR|
20|FH_F118152_20151_0|SrvcGrp|86845|2022|PDM|40.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F118152_20151_0|SrvcGrp|29076|2022|PDM|40.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F120489_63552_0|SrvcGrp|12280|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F120489_63552_0|SrvcGrp|14614|2022|PDM|2854.00|99|0.00|LITHOTRIPSY|
20|FH_F93360_64730_0|SrvcGrp|92799|2022|PDM|418.00|99|0.00|AETNA RESIDENTIAL TREATMENT PYCH & CD (AGE 18-150)|
20|FH_F134126_11554_0|CSTM-ALL|CSTM-00|2020|PDM|2009.00|99|0.00|AEG 3 (NO REV)|
20|FH_F137051_64096_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F137147_75006_0|SrvcGrp|31017|2022|PDM|37494.00|99|0.00|MS DRG 468 ONLY|
20|FH_F137232_28210_0|SrvcGrp|10391|2022|PDM|1200.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F137236_17603_0|SrvcGrp|113049|2022|PDM|1251.00|99|0.00|PSYCHIATRIC CARE (AGE 0-17)|
20|FH_F142448_15701_0|SrvcGrp|82222|2022|PDM|178.89|99|0.00|HOSPICE CARE|
20|FH_F142247_61244_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F142742_44112_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F53732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97582_46307_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F138471_84663_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F134654_0_0|SrvcGrp|110058|2022|PDM|16.63|99|0.00|BEHAVIOR ASSESSMENT 15 MINS|
20|FH_F140609_16063_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140753_75038_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP|
20|FH_F149378_44074_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149378_44074_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151606_64772_0|SrvcGrp|3178|2022|PDM|958.00|99|0.00|ACUTE PSYCH|
20|FH_F38332_0_0|SrvcGrp|19108|2022|PDM|15759.00|99|0.00|MS DRG 619|
20|FH_F109920_39180_0|SrvcGrp|16|2022|PDM|880.00|99|0.00|ACUTE REHABILITATION|
20|FH_F147861_45239_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F129483_77030_0|SrvcGrp|17016|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F40110_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117126_12801_0|SrvcGrp|93302|2022|PDM|175.00|99|0.00|PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY|
20|FH_F117240_37334_0|SrvcGrp|75479|2022|PDM|900.00|99|0.00|AEG 1|
20|FH_F150442_28451_0|CSTM-ALL|CSTM-00|2020|PDM|3600.00|99|0.00|AEG 5  (NO REV)|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F145920_0_0|SrvcGrp|79594|2022|PDM|1931.00|99|0.00|CPT 45380|
20|FH_F148939_62650_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43324_0_0|SrvcGrp|36028|2022|PDM|34.00|99|0.00|FUNCTIONAL CAPACITY EVALUATION|
20|FH_F142327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129174_20910_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150929_17325_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116583_0_0|SrvcGrp|103899|2022|PDM|150.00|99|0.00|HOSPICE OR HOME HLTH IN HOME|
20|FH_F90817_0_0|SrvcGrp|41325|2022|PDM|7520.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F129297_97828_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|1742.00|99|0.00|ASPG VIII|
20|FH_F149516_65233_0|SrvcGrp|90854|2022|PDM|567.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F118220_0_0|SrvcGrp|60784|2022|PDM|60.00|99|0.00|CPT 93226|
20|FH_F36683_0_0|SrvcGrp|18151|2022|PDM|11149.00|99|0.00|MS DRG 250|
20|FH_F151659_17013_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F113765_0_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F98880_50158_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F137986_0_0|SrvcGrp|72121|2022|PDM|3131.00|99|0.00|ARTHOSCOPY|
20|FH_F147316_70433_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139877_32615_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131471_67203_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F92155_74437_0|SrvcGrp|78504|2022|PCT|0.69|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F149542_89169_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F116600_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|OP SVCS|
20|FH_F118907_0_0|SrvcGrp|107899|2022|PDM|663.75|99|0.00|SLEEP STUDIES (HCFA)|
20|FH_F132096_89118_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F141287_14830_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.04|99|0.00|ASPG I|
20|FH_F150982_0_0|SrvcGrp|33986|2022|PDM|1382.00|99|0.00|CPT 26055|
20|FH_F101747_0_0|SrvcGrp|87077|2022|PDM|105.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F131261_19111_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F136191_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35088_0_0|SrvcGrp|23342|2022|PCT|0.90|99|0.00|TRAUMA CARE|
20|FH_F35678_0_0|SrvcGrp|941|2022|PDM|2119.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F52513_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113545_11201_0|SrvcGrp|89024|2022|PDM|76.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|2350.00|99|0.00|AEG 3 (NO REV)|
20|FH_F120144_77031_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F97603_77901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F117799_0_0|SrvcGrp|107662|2022|PDM|2565.00|99|0.00|NASAL/SINUS PROCEDURES|
20|FH_F147332_19406_0|SrvcGrp|113911|2022|PCT|1.01|99|0.00|COVID-19 TESTING|
20|FH_F132008_85226_0|SrvcGrp|111912|2022|PCT|0.80|99|0.00|WHEELCHAIR ACCESSORY COMBINATION TILT AND RECLINE|
20|FH_F69183_0_0|SrvcGrp|10904|2022|PCT|0.50|99|0.00|EMERGENCY ROOM LEVEL II|
20|FH_F98900_42001_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F35416_0_0|SrvcGrp|12231|2022|PCT|0.70|99|0.00|TPA|
20|FH_F137719_28269_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F41161_0_0|CSTM-ALL|CSTM-00|2020|PDM|548.00|99|0.00|ACUTE PSYCH|
20|FH_F47902_0_0|SrvcGrp|43922|2022|PCT|1.00|99|0.00|DME MOD KL|
20|FH_F35458_0_0|SrvcGrp|58929|2022|PDM|5600.00|99|0.00|ORTHO SURGERY|
20|FH_F37081_0_0|SrvcGrp|18370|2022|PDM|10300.00|99|0.00|MS DRG 481|
20|FH_F40653_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|ACUTE PSYCH|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PDM|481.89|99|0.00|ASPG I|
20|FH_F146859_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F39443_0_0|SrvcGrp|30330|2022|PDM|332.00|99|0.00|HAPA WPA ASC 214|
20|FH_F151699_01752_0|SrvcGrp|29023|2022|PDM|69.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129256_89146_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F147219_48207_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114676_91911_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|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F124466_32724_0|SrvcGrp|89417|2022|PDM|311.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F101083_0_0|SrvcGrp|72990|2022|PDM|452.00|99|0.00|AEG 1|
20|FH_F150982_0_0|SrvcGrp|83643|2022|PDM|2202.00|99|0.00|CPT 29885|
20|FH_F112045_90301_0|SrvcGrp|104596|2022|PCT|0.40|99|0.00|IMPLANTS W/O MS-DRG 619-621|
20|FH_F138647_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F93961_0_0|SrvcGrp|86863|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F140134_52732_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140036_07702_0|CSTM-ALL|CSTM-00|2020|PDM|701.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F143249_89801_0|SrvcGrp|24744|2022|PDM|55.00|99|0.00|PICC LINE INSERTION|
20|FH_F143347_16001_0|SrvcGrp|111934|2022|PDM|51.31|99|0.00|COVID-19 NUCLEIC ACID|
20|FH_F143411_78212_0|SrvcGrp|74668|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F143536_47546_0|SrvcGrp|101741|2022|PCT|1.00|99|0.00|IMMUN ADMIN ORAL/NASAL|
20|FH_F75803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F101700_0_0|SrvcGrp|74585|2022|PCT|1.00|99|0.00|AETNA OP IMPLANTS|
20|FH_F103060_0_0|SrvcGrp|71666|2022|PDM|7283.00|99|0.00|CPT 63655|
20|FH_F151720_03301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|ASPG I- MOD 50|
20|FH_F116552_70001_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F116595_92506_0|SrvcGrp|86746|2022|PCT|1.15|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F116835_94538_0|SrvcGrp|114316|2022|PDM|126.00|99|0.00|PSYCH TEST EVALUATION EACH ADD'L HOUR|
20|FH_F120887_78750_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120974_27607_0|SrvcGrp|77305|2022|PCT|0.46|99|0.00|DIAGNOSTIC DRUGS|
20|FH_F84611_30281_0|SrvcGrp|79857|2022|PDM|7637.00|99|0.00|AETNA LAPAROSCOPY SERVICES|
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2406.00|99|0.00|AEG 6 (NO REV)|
20|FH_F33925_0_0|SrvcGrp|19661|2022|PDM|22990.00|99|0.00|MS DRG 216-218 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH|
20|FH_F37578_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|SCHCP CT 400|
20|FH_F38431_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|HEARING AIDS|
20|FH_F70493_0_0|SrvcGrp|29977|2022|PDM|59.00|99|0.00|WOUND CARE CANISTER SET|
20|FH_F50672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F118194_50841_0|SrvcGrp|43569|2022|PDM|272.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F72243_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F38377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|CHILDREN'S MERCY IV THERAPY- MOD SJ|
20|FH_F116061_80110_0|SrvcGrp|104079|2022|PCT|1.40|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F149863_68127_0|SrvcGrp|90854|2022|PDM|567.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F123468_63384_0|SrvcGrp|75545|2022|PDM|327.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F145542_70503_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F130021_77904_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35202_0_0|SrvcGrp|11442|2022|PDM|483.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F46094_0_0|SrvcGrp|11069|2022|PDM|100.00|99|0.00|OT SVCS|
20|FH_F41279_0_0|SrvcGrp|1306|2022|PDM|266.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F115685_64064_0|SrvcGrp|86833|2022|PDM|20.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F147941_06023_0|SrvcGrp|22596|2022|PDM|463.00|99|0.00|HOSPICE CARE|
20|FH_F139515_0_0|SrvcGrp|109967|2022|PDM|10653.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F124018_75067_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F129536_0_0|SrvcGrp|111358|2022|PDM|1670.00|99|0.00|EYE PROCEDURES|
20|FH_F128272_60640_0|SrvcGrp|29023|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F110925_01104_0|SrvcGrp|27601|2022|PDM|1265.22|99|0.00|SYNAGIS (50 MG)|
20|FH_F125249_0_0|SrvcGrp|100071|2022|PDM|1200.00|99|0.00|REVISION OF THIGH MUSCLES|
20|FH_F34710_0_0|SrvcGrp|22596|2022|PDM|140.00|99|0.00|HOSPICE CARE|
20|FH_F120876_85250_0|SrvcGrp|75442|2022|PDM|883.00|99|0.00|OBSERVATION - REV 762|
20|FH_F46612_0_0|SrvcGrp|12403|2022|PDM|76.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F148222_18603_0|SrvcGrp|88780|2022|PDM|62.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F38804_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|PROFESSIONAL FEES ON UB04|
20|FH_F31253_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35513_0_0|SrvcGrp|11323|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F137487_74447_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135175_45121_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F116998_17701_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
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_F31798_0_0|SrvcGrp|11258|2022|PCT|0.75|99|0.00|DRUGS|
20|FH_F93881_15009_0|SrvcGrp|93731|2022|PDM|1058.00|99|0.00|INJEC PROC FOR SACROILIAC JOINT|
20|FH_F86319_16365_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F139515_0_0|SrvcGrp|89860|2022|PDM|8549.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F142073_0_0|SrvcGrp|92411|2022|PDM|5980.00|99|0.00|RELIEVE SPINAL CORD PRESSURE|
20|FH_F120872_74120_0|SrvcGrp|86648|2022|PCT|1.16|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F129627_06037_0|SrvcGrp|48398|2022|PDM|111.00|99|0.00|PT SERVICES|
20|FH_F137367_89139_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F38961_0_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|2024.00|99|0.00|AEG 3 (NO REV)|
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|1344.00|99|0.00|AEG 3 (NO REV)|
20|FH_F40032_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148161_98198_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F100320_0_0|SrvcGrp|75483|2022|PDM|546.00|99|0.00|AEG 3|
20|FH_F129064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC|
20|FH_F133224_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143748_02904_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147941_06023_0|SrvcGrp|114472|2022|PDM|2000.00|99|0.00|VISIT ESKETAMINE 56M OR LESS|
20|FH_F38732_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|841.00|99|0.00|ASPG III|
20|FH_F118910_0_0|SrvcGrp|94781|2022|PDM|113.30|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F87254_0_0|SrvcGrp|63466|2022|PDM|1100.00|99|0.00|CPT 52005|
20|FH_F93741_85006_0|SrvcGrp|73559|2022|PDM|1747.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F77066_0_0|SrvcGrp|3388|2022|PDM|750.00|99|0.00|SUBACUTE CARE|
20|FH_F118072_38133_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F102302_0_0|SrvcGrp|98571|2022|PDM|29900.00|99|0.00|REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION|
20|FH_F137946_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100761_02539_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F128307_43219_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F52393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F139515_0_0|SrvcGrp|42472|2022|PDM|3296.00|99|0.00|CPT 58670|
20|FH_F38320_0_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F115733_33012_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137333_51012_0|SrvcGrp|86723|2022|PDM|406.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F137817_17050_0|SrvcGrp|89149|2022|PDM|191.00|99|0.00|OP INTENSIVE|
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1353.00|99|0.00|AEG 10 (NO REV)|
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|524.00|99|0.00|AEG 2 (NO REV)|
20|FH_F118473_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F39893_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|ACUTE PSYCH|
20|FH_F128804_0_0|SrvcGrp|88599|2022|PDM|3520.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F112817_37027_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F109513_0_0|SrvcGrp|88748|2022|PDM|2500.00|99|0.00|HIP ARTHROSCOPY|
20|FH_F97721_01053_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F97761_04072_0|SrvcGrp|73656|2022|PDM|629.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PDM|2034.00|99|0.00|AEG 7 (NO REV)|
20|FH_F86911_0_0|SrvcGrp|85653|2022|PDM|150.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142335_60624_0|SrvcGrp|74668|2022|PDM|234.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F142448_15701_0|SrvcGrp|29023|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F119581_0_0|SrvcGrp|103638|2022|PDM|4694.00|99|0.00|AETNA OPEN/PERQ PLACE STENT 1ST|
20|FH_F131494_0_0|SrvcGrp|111848|2022|PDM|484.00|99|0.00|REVISION OF CERVIX|
20|FH_F131759_06032_0|SrvcGrp|75545|2022|PDM|437.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F33856_0_0|SrvcGrp|115|2022|PCT|0.85|99|0.00|SKILLED NURSING CARE|
20|FH_F38450_0_0|SrvcGrp|474|2022|PDM|325.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F110211_78666_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F94786_07974_0|SrvcGrp|29077|2022|PDM|210.00|99|0.00|HOME TRANSFUSION|
20|FH_F132988_0_0|SrvcGrp|112168|2022|PDM|4493.01|99|0.00|REMOVE WRIST JOINT IMPLANT|
20|FH_F132988_0_0|SrvcGrp|95462|2022|PDM|4493.01|99|0.00|REPAIR OF ANKLE LIGAMENT|
20|FH_F133002_0_0|SrvcGrp|73004|2022|PDM|1238.00|99|0.00|AEG 8|
20|FH_F128880_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141336_16947_0|CSTM-ALL|CSTM-00|2020|PDM|1541.00|99|0.00|AEG 10 (NO REV)|
20|FH_F141349_26440_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F148488_0_0|SrvcGrp|108484|2022|PDM|440.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F124059_64055_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|ASPG IV|
20|FH_F45372_0_0|CSTM-ALL|CSTM-00|2020|PDM|1046.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92493_0_0|SrvcGrp|90063|2022|PDM|2601.06|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F132864_71101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124234_33410_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F124584_28204_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F124653_64062_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F124671_64844_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|2746.00|99|0.00|ASPG X|
20|FH_F87856_0_0|SrvcGrp|83644|2022|PDM|2000.00|99|0.00|CPT 30465|
20|FH_F90653_0_0|SrvcGrp|17990|2022|PCT|0.70|99|0.00|CT / MRI|
20|FH_F137248_0_0|SrvcGrp|99073|2022|PDM|1.34|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F136681_60004_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F113937_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137933_0_0|SrvcGrp|107575|2022|PDM|3500.00|99|0.00|REMOVAL OF KIDNEY STONE|
20|FH_F132595_0_0|SrvcGrp|361|2022|PDM|2320.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F122638_59715_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F43653_0_0|SrvcGrp|7|2022|PDM|735.00|99|0.00|NEONATAL INTENSIVE|
20|FH_F135762_70001_0|SrvcGrp|90397|2022|PDM|1750.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F136772_89109_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F136930_73114_0|SrvcGrp|109185|2022|PDM|376.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F112505_51503_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49016_0_0|SrvcGrp|42830|2022|PDM|60.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F115625_63110_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F116393_07002_0|SrvcGrp|111262|2022|PDM|103.00|99|0.00|X-RAY EXAM NECK SPINE 6/>VWS|
20|FH_F116393_07002_0|SrvcGrp|48160|2022|PCT|0.70|99|0.00|BOTULINUM TOXIN TYPE A, PER UNIT|
20|FH_F147586_44124_0|SrvcGrp|101522|2022|PDM|4669.00|99|0.00|T1H W/T/O UTERUS (>250G)|
20|FH_F147586_44124_0|SrvcGrp|105233|2022|PDM|2836.00|99|0.00|REMOVAL OF THYROID|
20|FH_F147414_92656_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F41818_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|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_F42433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F102950_86040_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|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_F123445_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F142087_0_0|SrvcGrp|88164|2022|PDM|15000.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F138197_0_0|SrvcGrp|109220|2022|PDM|1720.95|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F100906_0_0|SrvcGrp|73008|2022|PDM|793.00|99|0.00|AEG 10|
20|FH_F134368_0_0|SrvcGrp|82981|2022|PDM|110.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F39346_0_0|SrvcGrp|97|2022|PDM|1350.00|99|0.00|C-SECTION|
20|FH_F137906_0_0|SrvcGrp|33722|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|1365.00|99|0.00|AEG 5  (NO REV)|
20|FH_F134087_0_0|SrvcGrp|84939|2022|PDM|5273.00|99|0.00|SHOULDER JOINT|
20|FH_F151399_0_0|SrvcGrp|12868|2022|PDM|13589.00|99|0.00|AIR AMBULANCE|
20|FH_F82357_0_0|SrvcGrp|12401|2022|PDM|66.00|99|0.00|RN VISIT|
20|FH_F120657_54220_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F128859_57702_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39819_0_0|SrvcGrp|31200|2022|PDM|6445.00|99|0.00|NY DRG 372 ONLY|
20|FH_F115685_64064_0|SrvcGrp|86848|2022|PDM|75.00|99|0.00|HCPCS S9361 (HCFA)|
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_F125074_18104_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F77925_0_0|SrvcGrp|74999|2022|PCT|0.80|99|0.00|OUTPATIENT SURGERY|
20|FH_F135216_64064_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135219_68506_0|SrvcGrp|77021|2022|PDM|7103.73|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F137462_03062_0|SrvcGrp|472|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F37884_0_0|SrvcGrp|13626|2022|PDM|647.00|99|0.00|SLEEP STUDIES|
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F55854_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F148279_15009_0|SrvcGrp|73485|2022|PDM|1200.00|99|0.00|AETNA REHAB|
20|FH_F149442_0_0|SrvcGrp|112224|2022|PDM|95.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F39041_0_0|SrvcGrp|30175|2022|PCT|0.75|99|0.00|CV SURGERY (MS DRG)|
20|FH_F116960_91505_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F120248_77008_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F34148_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F135173_06519_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F140427_0_0|SrvcGrp|104923|2022|PCT|1.00|99|0.00|CATHETER INTRAVASCULAR ULTRS|
20|FH_F62579_0_0|SrvcGrp|17002|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS|
20|FH_F38560_0_0|SrvcGrp|24|2022|PDM|1800.00|99|0.00|CARDIAC CATH|
20|FH_F105593_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100982_75601_0|SrvcGrp|73659|2022|PDM|1450.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F127849_43920_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|530.60|99|0.00|AEG 3 (NO REV)|
20|FH_F70863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F72828_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F74024_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F138210_60540_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138418_51201_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F134211_17961_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116806_0_0|SrvcGrp|107033|2022|PDM|1923.16|99|0.00|REPAIR NASOETHMOID FRACTURE|
20|FH_F121597_30315_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
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_F149079_70809_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F88744_71103_0|SrvcGrp|75506|2022|PCT|2.15|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F63312_0_0|SrvcGrp|12401|2022|PDM|80.00|99|0.00|RN VISIT|
20|FH_F131464_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138050_52301_0|SrvcGrp|73605|2022|PDM|1050.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F91633_33907_0|SrvcGrp|77012|2022|PCT|1.00|99|0.00|PT OT ST|
20|FH_F41962_0_0|SrvcGrp|97|2022|PDM|850.00|99|0.00|C-SECTION|
20|FH_F111732_33771_0|SrvcGrp|86728|2022|PCT|1.00|99|0.00|RHOGAM INJECTION|
20|FH_F51015_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|TRANSPLANT SVCS|
20|FH_F135627_77070_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F138302_15701_0|SrvcGrp|48394|2022|PDM|20.00|99|0.00|SKILLED NURSING SERVICES|
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_F88744_71103_0|SrvcGrp|88978|2022|PDM|3451.00|99|0.00|VAGINAL DELIVERY|
20|FH_F110311_17078_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F83380_0_0|SrvcGrp|44706|2022|PDM|105.00|99|0.00|NURSING CARE|
20|FH_F134593_60007_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F98021_07012_0|SrvcGrp|73559|2022|PDM|6792.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F150165_06032_0|SrvcGrp|78097|2022|PDM|4000.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F87796_63376_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F87012_0_0|SrvcGrp|73000|2022|PDM|1396.69|99|0.00|AEG 6|
20|FH_F134969_34474_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F145942_72019_0|SrvcGrp|74668|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F150165_06032_0|SrvcGrp|113878|2022|PDM|5620.00|99|0.00|TCAT INSJ/RPL PERM LDLS PM|
20|FH_F134611_04103_0|SrvcGrp|111348|2022|PCT|1.10|99|0.00|OP THERAPY SERVICES|
20|FH_F150165_06032_0|SrvcGrp|63472|2022|PDM|5230.00|99|0.00|CPT 64581|
20|FH_F57453_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F149102_33433_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136780_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F141901_0_0|SrvcGrp|100983|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F111942_92647_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD HOME HEALTH|
20|FH_F139299_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F85777_77030_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148644_06890_0|CSTM-ALL|CSTM-00|2020|PDM|2240.00|99|0.00|AEG 8 (NO REV)|
20|FH_F146103_63851_0|SrvcGrp|11108|2022|PDM|250.00|99|0.00|NEWBORN NURSERY|
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115347_0_0|SrvcGrp|106101|2022|PDM|1125.00|99|0.00|ENDOSCOPY|
20|FH_F134604_64050_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F85097_0_0|SrvcGrp|33012|2022|PDM|2415.00|99|0.00|LONG TERM ACUTE CARE|
20|FH_F141210_0_0|SrvcGrp|89404|2022|PDM|13648.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F132802_68022_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F110940_0_0|SrvcGrp|81859|2022|PDM|2200.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F113585_20155_0|SrvcGrp|16750|2022|PDM|125.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138876_25302_0|SrvcGrp|14949|2022|PDM|55.00|99|0.00|HOME INFUSION|
20|FH_F138879_17837_0|CSTM-ALL|CSTM-00|2020|PCT|4.85|99|0.00|HSS APC GROUPED|
20|FH_F138907_01040_0|SrvcGrp|14892|2022|PDM|109.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F113390_0_0|SrvcGrp|93642|2022|PDM|1673.10|99|0.00|BIOPSY REMOVAL LYMPH NODES|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|88.71|99|0.00|HAPA WPA-NWPA 2012-13 ASC 245 W/O REV|
20|FH_F72606_0_0|SrvcGrp|3029|2022|PDM|950.00|99|0.00|NEWBORN NURSERY|
20|FH_F72606_0_0|SrvcGrp|31771|2022|PDM|9525.00|99|0.00|MS DRG 417-419 ONLY  LAP CHOLE|
20|FH_F151382_30501_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132258_45404_0|SrvcGrp|86825|2022|PDM|71.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F122088_75098_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F43239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135447_53226_0|SrvcGrp|106990|2022|PCT|1.00|99|0.00|RHOGAM INJECTION|
20|FH_F135447_53226_0|SrvcGrp|54670|2022|PDM|4625.00|99|0.00|NORMAL DELIVERY|
20|FH_F136153_62960_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136180_92253_0|SrvcGrp|73605|2022|PDM|1500.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F130933_47129_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130756_04901_0|SrvcGrp|73063|2022|PCT|0.89|99|0.00|OBSERVATION SERVICES|
20|FH_F130756_04901_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|OP SVCS|
20|FH_F133468_74873_0|SrvcGrp|89337|2022|PDM|1825.00|99|0.00|DETOXIFICATION|
20|FH_F133468_74873_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F130766_04967_0|SrvcGrp|114020|2022|PCT|4.24|99|0.00|LABORATORY SERVICES|
20|FH_F127399_0_0|SrvcGrp|101522|2022|PDM|4890.00|99|0.00|T1H W/T/O UTERUS (>250G)|
20|FH_F121444_47720_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F121771_91405_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|2060.00|99|0.00|ASPG VI|
20|FH_F42098_0_0|SrvcGrp|11080|2022|PDM|65.00|99|0.00|NURSING CARE|
20|FH_F131407_07607_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F111341_80501_0|SrvcGrp|93291|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA ESRD USE|
20|FH_F111880_50003_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F40174_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33081_0_0|SrvcGrp|12047|2022|PCT|0.70|99|0.00|CPT CODES 80000-89999, 36415 (LAB)|
20|FH_F39925_0_0|SrvcGrp|439|2022|PDM|1200.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F132328_0_0|SrvcGrp|111950|2022|PDM|2819.00|99|0.00|HERNIA REPAIR|
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)|
20|FH_F112082_30720_0|SrvcGrp|19742|2022|PDM|136.00|99|0.00|MID-LINE INSERTION|
20|FH_F87500_16823_0|SrvcGrp|48396|2022|PDM|104.00|99|0.00|OT SERVICES|
20|FH_F88831_84123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101320_26062_0|SrvcGrp|73700|2022|PDM|54.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F132347_01605_0|SrvcGrp|94781|2022|PDM|110.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 4 (NO REV)|
20|FH_F63083_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F135840_0_0|SrvcGrp|79590|2022|PDM|550.00|99|0.00|CPT 43248|
20|FH_F130662_07032_0|SrvcGrp|91065|2022|PDM|80.00|99|0.00|PSYCHIATRIC CPT 90853 (HCFA)|
20|FH_F130805_17404_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F72935_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111942_92647_0|SrvcGrp|48385|2022|PDM|122.00|99|0.00|SPEECH THERAPY|
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F71748_0_0|SrvcGrp|1168|2022|PDM|40.96|99|0.00|CONTINUOUS HOMECARE|
20|FH_F126341_27284_0|SrvcGrp|86125|2022|PDM|38.00|99|0.00|AETNA FLEBOGAMMA INJ|
20|FH_F116806_0_0|SrvcGrp|83844|2022|PDM|1923.16|99|0.00|OPEN TREATMENT OF MANDIBULAR FRACTURE|
20|FH_F139443_37705_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F123157_0_0|SrvcGrp|75497|2022|PDM|300.00|99|0.00|AEG 10|
20|FH_F117437_0_0|SrvcGrp|82223|2022|PDM|180.00|99|0.00|HOSPICE CARE|
20|FH_F148923_71854_0|SrvcGrp|88377|2022|PDM|830.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F38373_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116506_0_0|SrvcGrp|75481|2022|PDM|480.00|99|0.00|AEG 2|
20|FH_F127638_44720_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143742_60410_0|SrvcGrp|10944|2022|PCT|0.67|99|0.00|EMERGENCY ROOM|
20|FH_F103122_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F84552_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F149517_0_0|SrvcGrp|104228|2022|PDM|190.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F118135_38109_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149266_38556_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138047_77027_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133585_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F100782_0_0|SrvcGrp|105111|2022|PDM|813.22|99|0.00|WINDBER MEDICAL CNTR ASC 215|
20|FH_F122930_0_0|SrvcGrp|73000|2022|PDM|3274.00|99|0.00|AEG 6|
20|FH_F138286_50014_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123623_03246_0|SrvcGrp|109295|2022|PCT|1.00|99|0.00|FLU VACC IIV3 NO PRESERV ID|
20|FH_F110311_17078_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F124743_0_0|SrvcGrp|84185|2022|PDM|125.00|99|0.00|RESPITE CARE|
20|FH_F134943_17402_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F119627_27288_0|SrvcGrp|103913|2022|PCT|0.75|99|0.00|OP DIALYSIS|
20|FH_F118088_71261_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|104.92|99|0.00|ELECTROENCEPHALOGRAM (MOD 26)|
20|FH_F121255_76132_0|SrvcGrp|74668|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F134608_18017_0|SrvcGrp|106720|2022|PDM|550.00|99|0.00|INDUCED ABORTION BY ORAL INGESTION OF MEDICATION|
20|FH_F144848_0_0|SrvcGrp|93740|2022|PDM|2437.00|99|0.00|REVISE/REMOVE NEURO RECEIVER|
20|FH_F123851_03235_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120207_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|PDM|915.20|99|0.00|AEG 6 (NO REV)|
20|FH_F85213_02840_0|SrvcGrp|112223|2022|PDM|565.70|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F111163_0_0|SrvcGrp|35669|2022|PDM|6375.00|99|0.00|CPT 63650|
20|FH_F100680_43130_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F110521_98034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145641_06902_0|SrvcGrp|105636|2022|PDM|4783.00|99|0.00|REALIGNMENT OF KNEE|
20|FH_F51039_0_0|SrvcGrp|28535|2022|PDM|1346.00|99|0.00|VENTILATOR REHABILITATION|
20|FH_F149048_77090_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F82591_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F116124_0_0|SrvcGrp|38588|2022|PDM|40.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F142376_0_0|SrvcGrp|47544|2022|PDM|6590.00|99|0.00|PERCUTANEOUS IMPLANT OF NEUROSTIMULATOR ELECTRODES|
20|FH_F149261_75457_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F73084_0_0|SrvcGrp|46109|2022|PDM|76.00|99|0.00|HI-TECH NURSING (1 HOUR)|
20|FH_F117344_75062_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F85211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F105143_26062_0|SrvcGrp|78377|2022|PDM|972.00|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F105143_26062_0|SrvcGrp|75506|2022|PCT|0.70|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F105361_80104_0|SrvcGrp|88794|2022|PDM|83588.00|99|0.00|AICD|
20|FH_F80513_0_0|SrvcGrp|20898|2022|PDM|26028.00|99|0.00|MS DRG 246 ONLY|
20|FH_F115950_08648_0|SrvcGrp|86648|2022|PCT|1.05|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F116040_24637_0|SrvcGrp|86830|2022|PDM|30.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F116114_37033_0|SrvcGrp|79280|2022|PDM|663.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F131747_80108_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133478_40165_0|SrvcGrp|90778|2022|PDM|3629.00|99|0.00|HEMIOPLASTY|
20|FH_F132964_06484_0|SrvcGrp|472|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133491_74012_0|SrvcGrp|90707|2022|PDM|130.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F39346_0_0|SrvcGrp|27973|2022|PDM|18282.00|99|0.00|MS DRG 288-290 ONLY|
20|FH_F39346_0_0|SrvcGrp|21798|2022|PDM|10293.00|99|0.00|MS DRG 252 ONLY|
20|FH_F63081_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F87463_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F134087_0_0|SrvcGrp|88164|2022|PDM|9017.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F86872_15215_0|SrvcGrp|86851|2022|PDM|45.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F74602_0_0|SrvcGrp|30623|2022|PDM|4200.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F89778_0_0|SrvcGrp|78283|2022|PDM|1511.75|99|0.00|CPT 49505|
20|FH_F42931_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F123604_72104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123752_44502_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F117465_0_0|SrvcGrp|85198|2022|PDM|5000.00|99|0.00|AETNA KNEE ARTHROSCOPY|
20|FH_F118244_30040_0|CSTM-ALL|CSTM-00|2020|PDM|156.23|99|0.00|HOSPICE ROUTINE HOME CARE (DAYS 0-60)|
20|FH_F134122_45255_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137007_43160_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137246_66064_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F114092_83350_0|CSTM-ALL|CSTM-00|2020|PDM|4805.00|99|0.00|AEG 7 W/O SURG CARVEOUT (NO REV)|
20|FH_F139107_61024_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142347_75140_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142547_70002_0|SrvcGrp|86830|2022|PDM|3.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F142608_02842_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138545_39503_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F114865_77488_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F80284_16354_0|SrvcGrp|76008|2022|PDM|269.00|99|0.00|EMERGENCY ROOM SVCS LEVEL I|
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 3 (NO REV)|
20|FH_F70665_0_0|SrvcGrp|42830|2022|PDM|68.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F147940_33626_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F62732_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117240_37334_0|SrvcGrp|72984|2022|PCT|1.45|99|0.00|CHEMOTHERAPY|
20|FH_F126502_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|1280.00|99|0.00|AEG 7 (NO REV)|
20|FH_F90876_18447_0|SrvcGrp|80317|2022|PDM|110.25|99|0.00|RESPITE CARE|
20|FH_F90880_15108_0|SrvcGrp|90483|2022|PCT|1.00|99|0.00|FLUZONE VACC 3 YRS & > IM|
20|FH_F70005_0_0|SrvcGrp|23585|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F135653_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F121404_32216_0|SrvcGrp|108776|2022|PDM|133.00|99|0.00|RAD W/O BACKUP NON-INV INTFC (MOD KH, KI, KJ, KX, RR)|
20|FH_F35212_0_0|SrvcGrp|22954|2022|PDM|94.50|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F69651_0_0|SrvcGrp|44423|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE (VISIT LVL)|
20|FH_F51374_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|OP SVCS|
20|FH_F77763_0_0|SrvcGrp|10541|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F110381_0_0|SrvcGrp|73006|2022|PDM|3710.00|99|0.00|AEG 9|
20|FH_F106822_0_0|SrvcGrp|90489|2022|PDM|77.85|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F85039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F73228_0_0|SrvcGrp|17071|2022|PDM|4342.00|99|0.00|ASPG IV|
20|FH_F96160_32207_0|SrvcGrp|86830|2022|PDM|5.62|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F149263_0_0|SrvcGrp|115607|2022|PDM|3450.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F145739_0_0|SrvcGrp|114177|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132969_84003_0|SrvcGrp|24752|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F139658_02893_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133778_38119_0|CSTM-ALL|CSTM-00|2020|PDM|98.00|99|0.00|HOSPICE|
20|FH_F127282_98004_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F96800_32308_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|OP SVCS|
20|FH_F133868_40202_0|SrvcGrp|73841|2022|PDM|257.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|2095.00|99|0.00|AEG 5  (NO REV)|
20|FH_F40294_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|GENERAL ACUTE CARE|
20|FH_F134615_38478_0|SrvcGrp|108484|2022|PDM|900.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F51934_0_0|SrvcGrp|46424|2022|PDM|100.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F140827_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F109387_35630_0|SrvcGrp|89337|2022|PDM|881.00|99|0.00|DETOXIFICATION|
20|FH_F135900_0_0|SrvcGrp|75399|2022|PDM|0.10|99|0.00|MED RECORD COPY|
20|FH_F120930_0_0|SrvcGrp|84939|2022|PDM|5000.00|99|0.00|SHOULDER JOINT|
20|FH_F133887_17013_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|326.73|99|0.00|HAPA WPA-NWPA 2012-13 ASC 111 W/O REV|
20|FH_F143567_62207_0|SrvcGrp|115662|2022|PCT|1.00|99|0.00|DRUGS|
20|FH_F149061_44122_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F134593_60007_0|SrvcGrp|19742|2022|PDM|65.00|99|0.00|MID-LINE INSERTION|
20|FH_F32073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F117531_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133207_0_0|SrvcGrp|65625|2022|PDM|2577.00|99|0.00|CPT 30520|
20|FH_F134947_14227_0|SrvcGrp|104301|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150165_06032_0|SrvcGrp|109508|2022|PDM|4774.00|99|0.00|REMOVAL OF PM GENERATOR|
20|FH_F69787_0_0|SrvcGrp|66343|2022|PDM|5000.00|99|0.00|CYBERKNIFE|
20|FH_F134947_14227_0|SrvcGrp|471|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133805_83401_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118252_32216_0|SrvcGrp|46903|2022|PDM|914.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F44278_0_0|SrvcGrp|12146|2022|PDM|2700.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F109264_33431_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|374.41|99|0.00|HAPA WPA-NWPA 2012-13 ASC 228 W/O REV|
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F147962_85008_0|SrvcGrp|79786|2022|PCT|1.20|99|0.00|SLEEP STUDIES|
20|FH_F91171_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F32613_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F112665_0_0|SrvcGrp|58993|2022|PDM|7215.00|99|0.00|DISKECTOMY|
20|FH_F90501_71101_0|SrvcGrp|83677|2022|PDM|3000.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F150160_01301_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F148659_28134_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111986_0_0|SrvcGrp|33987|2022|PDM|1236.00|99|0.00|CPT 57522|
20|FH_F149021_44514_0|SrvcGrp|95819|2022|PDM|117.76|99|0.00|GONIOTOMY|
20|FH_F113764_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F138348_04096_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F69606_0_0|SrvcGrp|64102|2022|PDM|1077.70|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 13|
20|FH_F122475_37659_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F84712_0_0|SrvcGrp|87943|2022|PDM|6307.00|99|0.00|AETNA ANGIOPLASTY|
20|FH_F85055_0_0|SrvcGrp|72992|2022|PDM|600.00|99|0.00|AEG 2|
20|FH_F87053_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|227.08|99|0.00|HAPA WPA-NWPA 2012-13 ASC 122 W/O REV|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|191.49|99|0.00|HAPA WPA-NWPA 2012-13 ASC 126 W/O REV|
20|FH_F102200_06416_0|SrvcGrp|86854|2022|PDM|69.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F105143_26062_0|SrvcGrp|72996|2022|PDM|6112.00|99|0.00|AEG 4|
20|FH_F105145_75075_0|SrvcGrp|98266|2022|PDM|24731.00|99|0.00|REVISE KNEECAP|
20|FH_F105361_80104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F105361_80104_0|SrvcGrp|106257|2022|PCT|2.40|99|0.00|LABORATORY SERVICES|
20|FH_F115936_75093_0|SrvcGrp|46903|2022|PDM|633.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F66427_0_0|SrvcGrp|33789|2022|PDM|5821.00|99|0.00|MS DRG 880-887 ONLY|
20|FH_F146671_72205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F115972_92675_0|SrvcGrp|73841|2022|PDM|500.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F116040_24637_0|SrvcGrp|86848|2022|PDM|30.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F133398_43204_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133478_40165_0|SrvcGrp|102419|2022|PDM|12254.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F132898_06088_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131490_29909_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139385_37762_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139487_60076_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F150745_03301_0|SrvcGrp|95661|2022|PDM|690.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F110821_31513_0|SrvcGrp|471|2022|PDM|775.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F137767_01841_0|SrvcGrp|3932|2022|PDM|5250.00|99|0.00|LITHOTRIPSY|
20|FH_F136806_0_0|SrvcGrp|59841|2022|PDM|1380.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F94643_90501_0|SrvcGrp|86841|2022|PDM|120.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F150924_90029_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F87054_0_0|SrvcGrp|84934|2022|PDM|1260.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F115264_0_0|SrvcGrp|75746|2022|PCT|6.00|99|0.00|AETNA PT AND CHIRO|
20|FH_F114916_30309_0|SrvcGrp|105635|2022|PDM|3750.00|99|0.00|INCISION OF FEMUR|
20|FH_F36584_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD RR|
20|FH_F131047_0_0|SrvcGrp|103241|2022|PDM|5002.00|99|0.00|ICU UNIT|
20|FH_F132988_0_0|SrvcGrp|91567|2022|PDM|4717.66|99|0.00|REPAIR OF KNEECAP TENDON|
20|FH_F72204_0_0|SrvcGrp|43568|2022|PDM|80.00|99|0.00|SKILLED NURSING - RN|
20|FH_F126345_0_0|SrvcGrp|73008|2022|PDM|979.00|99|0.00|AEG 10|
20|FH_F148488_0_0|SrvcGrp|46903|2022|PDM|440.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F115971_0_0|SrvcGrp|73004|2022|PDM|1085.00|99|0.00|AEG 8|
20|FH_F124059_64055_0|SrvcGrp|14893|2022|PDM|42.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F39956_0_0|SrvcGrp|16|2022|PDM|670.00|99|0.00|ACUTE REHABILITATION|
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|3100.00|99|0.00|AEG 3 (NO REV)|
20|FH_F150959_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_F135327_0_0|CSTM-ALL|CSTM-00|2020|PDM|404.00|99|0.00|AEG 1 (NO REV)|
20|FH_F114666_30342_0|SrvcGrp|67279|2022|PDM|6600.00|99|0.00|CERVICAL SURGERY|
20|FH_F114666_30342_0|SrvcGrp|98003|2022|PDM|3000.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F113787_31909_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F148553_85016_0|SrvcGrp|115470|2022|PDM|2850.00|99|0.00|RIGHT HEART CORONARY ARTERY ANGIO|
20|FH_F42837_0_0|SrvcGrp|12044|2022|PDM|875.00|99|0.00|SLEEP STUDIES|
20|FH_F43249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|OP SVCS|
20|FH_F134690_46237_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135762_70001_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F49005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|ASPG I|
20|FH_F147445_76844_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F41652_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_F98622_45005_0|SrvcGrp|90854|2022|PDM|2103.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F102947_44084_0|CSTM-ALL|CSTM-00|2020|PDM|516.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F111190_30512_0|SrvcGrp|15788|2022|PDM|79.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|4312.00|99|0.00|AEG 9 (NO REV)|
20|FH_F131609_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F100681_73104_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F97261_06098_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F38037_0_0|SrvcGrp|9832|2022|PDM|82.50|99|0.00|ST SVCS|
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_F98361_12065_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F91594_0_0|SrvcGrp|14532|2022|PCT|0.85|99|0.00|OBSERVATION SVCS|
20|FH_F37257_0_0|SrvcGrp|12158|2022|PCT|0.80|99|0.00|PT/OT/ST|
20|FH_F138734_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|1304.00|99|0.00|WILLS COMM SURG SVC ASC 5|
20|FH_F54552_0_0|SrvcGrp|47662|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY|
20|FH_F138857_90025_0|SrvcGrp|74668|2022|PDM|500.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F88893_0_0|SrvcGrp|87845|2022|PDM|957.00|99|0.00|GASTRIC RESTRICTIVE PROCEDURE|
20|FH_F127207_0_0|SrvcGrp|104228|2022|PDM|90.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|1314.82|99|0.00|AEG 3 (NO REV)|
20|FH_F148601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS|
20|FH_F151306_21030_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151379_21045_0|SrvcGrp|72994|2022|PDM|674.00|99|0.00|AEG 3|
20|FH_F151410_00717_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F122107_11229_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F145468_60615_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F130671_42701_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F128244_62254_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135439_33825_0|SrvcGrp|74694|2022|PDM|549.00|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F135583_17331_0|SrvcGrp|359|2022|PDM|1947.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F135583_17331_0|SrvcGrp|79786|2022|PCT|0.82|99|0.00|SLEEP STUDIES|
20|FH_F91735_92653_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136180_92253_0|SrvcGrp|73063|2022|PDM|855.00|99|0.00|OBSERVATION SERVICES|
20|FH_F119892_47586_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F131407_07607_0|SrvcGrp|86836|2022|PDM|10.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F116488_79925_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140629_0_0|SrvcGrp|113683|2022|PDM|2497.00|99|0.00|LAPARO SLING OPERATION|
20|FH_F140629_0_0|SrvcGrp|103835|2022|PDM|1016.00|99|0.00|AETNA REMOVE BLADDER STONE|
20|FH_F121713_84747_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F67425_0_0|SrvcGrp|3066|2022|PCT|0.55|99|0.00|HIGH-COST DRUGS|
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1210.00|99|0.00|AEG 6 (NO REV)|
20|FH_F148243_0_0|SrvcGrp|79591|2022|PDM|400.00|99|0.00|CPT 43450|
20|FH_F101442_0_0|SrvcGrp|89989|2022|PDM|1490.63|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F132328_0_0|SrvcGrp|26273|2022|PDM|2239.00|99|0.00|CPT 29880|
20|FH_F112152_34994_0|SrvcGrp|73841|2022|PDM|404.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F87496_17055_0|SrvcGrp|79720|2022|PDM|1231.00|99|0.00|ACUTE REHAB II|
20|FH_F130269_74107_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129240_10028_0|SrvcGrp|86125|2022|PCT|0.83|99|0.00|AETNA FLEBOGAMMA INJ|
20|FH_F102960_50613_0|CSTM-ALL|CSTM-00|2020|PDM|5841.00|99|0.00|AEG 6 (NO REV)|
20|FH_F101320_26062_0|SrvcGrp|24761|2022|PDM|14.40|99|0.00|HOME INFUSION THERAPY|
20|FH_F112823_0_0|SrvcGrp|85966|2022|PDM|1915.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|331.00|99|0.00|AEG 1 (NO REV)|
20|FH_F34777_0_0|SrvcGrp|13811|2022|PDM|355.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F134427_64014_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F37095_17543_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 10 (NO REV)|
20|FH_F84433_0_0|SrvcGrp|46605|2022|PDM|141.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F111044_0_0|SrvcGrp|104171|2022|PDM|1648.00|99|0.00|AETNA ARTHROSCOPY SURGERY SYNOVECT|
20|FH_F124487_89502_0|SrvcGrp|48398|2022|PDM|120.00|99|0.00|PT SERVICES|
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|1144.00|99|0.00|AEG 10 (NO REV)|
20|FH_F131028_49735_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F108680_0_0|SrvcGrp|102725|2022|PCT|0.00|99|0.00|DESTROY C/TH FACET JNT ADDL|
20|FH_F148980_18603_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132849_0_0|SrvcGrp|3140|2022|PCT|0.63|99|0.00|PHARMACY SERVICES|
20|FH_F139576_0_0|SrvcGrp|75725|2022|PDM|2174.00|99|0.00|LASER PROCEDURES|
20|FH_F124435_03882_0|SrvcGrp|89417|2022|PDM|313.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F35716_0_0|SrvcGrp|22954|2022|PDM|94.50|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F140215_93301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: BREAKOUT|
20|FH_F102125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137986_0_0|SrvcGrp|41335|2022|PDM|10500.00|99|0.00|TOTAL HIP|
20|FH_F124441_0_0|SrvcGrp|109830|2022|PDM|11400.00|99|0.00|INSERTION  BIOMECHANICAL DEVICE|
20|FH_F43865_0_0|SrvcGrp|30958|2022|PDM|65.00|99|0.00|SKILLED LPN VISIT|
20|FH_F94643_90501_0|SrvcGrp|86831|2022|PDM|9.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F126398_77090_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150359_30106_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F33719_0_0|SrvcGrp|109|2022|PDM|500.00|99|0.00|CD - DETOX|
20|FH_F42979_0_0|SrvcGrp|3397|2022|PDM|42.00|99|0.00|CPT 90849|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF|
20|FH_F35678_0_0|SrvcGrp|18233|2022|PDM|8476.00|99|0.00|MS DRG 030|
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_F123745_0_0|SrvcGrp|109527|2022|PDM|7500.00|99|0.00|REPAIR ANKLE DISLOCATION|
20|FH_F124433_77338_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F90817_0_0|SrvcGrp|91013|2022|PDM|2280.00|99|0.00|KNEE ARTHROSCOPY SURGICAL (HCFA)|
20|FH_F128977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131371_0_0|SrvcGrp|106146|2022|PDM|17000.00|99|0.00|REVERSE HIP JOINT|
20|FH_F39443_0_0|SrvcGrp|30311|2022|PDM|119.00|99|0.00|HAPA WPA ASC 121|
20|FH_F40118_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD NU|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|VERTICAL PLUS MRI MOD TC|
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.00|99|0.00|AEG 10 (NO REV)|
20|FH_F130182_0_0|SrvcGrp|88156|2022|PDM|8323.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F122248_33441_0|SrvcGrp|87131|2022|PDM|700.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F35775_32055_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124470_90025_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F141270_89103_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F114568_08097_0|SrvcGrp|90632|2022|PDM|125.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F116437_0_0|SrvcGrp|78045|2022|PCT|1.10|99|0.00|AETNA AMNIOTIC MEMBRANE|
20|FH_F139824_24801_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|377.00|99|0.00|HAPA EPA ASC 44|
20|FH_F143351_21157_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125249_0_0|SrvcGrp|71666|2022|PDM|7000.00|99|0.00|CPT 63655|
20|FH_F101806_0_0|SrvcGrp|75493|2022|PDM|1083.30|99|0.00|AEG 8|
20|FH_F151753_03104_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F136289_73099_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132349_66111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116633_37217_0|SrvcGrp|43568|2022|PDM|120.00|99|0.00|SKILLED NURSING - RN|
20|FH_F116662_15801_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|611.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F120856_78247_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F120853_61201_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F120885_66224_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|869.25|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F100742_00616_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F116188_72211_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F35476_0_0|SrvcGrp|12403|2022|PDM|681.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F132138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118194_50841_0|SrvcGrp|48398|2022|PDM|190.00|99|0.00|PT SERVICES|
20|FH_F149919_85390_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|AEG 7 (NO REV)|
20|FH_F124788_0_0|SrvcGrp|73006|2022|PDM|1339.00|99|0.00|AEG 9|
20|FH_F116268_19064_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123501_64831_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F102267_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F48927_0_0|SrvcGrp|17739|2022|PDM|2400.00|99|0.00|ICU/CCU|
20|FH_F91973_0_0|SrvcGrp|90436|2022|PDM|10197.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F66501_0_0|SrvcGrp|27579|2022|PDM|70.00|99|0.00|RESPIRATORY THERAPY INITIAL VISIT|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 238|
20|FH_F139867_70816_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|CHEMICAL DEPENDENCY|
20|FH_F124291_44122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F128506_77304_0|SrvcGrp|74670|2022|PCT|1.10|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.49|99|0.00|SALLY BALIN,999182,ASC 308|
20|FH_F47837_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F47212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F97184_26101_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD TC|
20|FH_F114090_19023_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133677_15601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SAINT ALEXIUS FH MOD AU|
20|FH_F39008_34452_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F150999_20678_0|SrvcGrp|111930|2022|PDM|15.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F114207_35243_0|SrvcGrp|24750|2022|PDM|35.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|100% 2007 MEDICARETN DME MOD QW|
20|FH_F97260_06111_0|SrvcGrp|73461|2022|PDM|3474.00|99|0.00|AETNA NICU IV|
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|1486.00|99|0.00|AEG 8 (NO REV)|
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|892.50|99|0.00|AEG 5  (NO REV)|
20|FH_F42165_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125214_12428_0|SrvcGrp|13187|2022|PCT|0.70|99|0.00|INTRAOCULAR LENSES|
20|FH_F150439_03110_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|834.86|99|0.00|SALLY BALIN,999182,ASC 501|
20|FH_F124760_34997_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116806_0_0|SrvcGrp|107116|2022|PDM|887.26|99|0.00|RECONSTRUCT LIP WITH FLAP|
20|FH_F124281_44286_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F110783_93013_0|SrvcGrp|86851|2022|PDM|35.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F36165_0_0|SrvcGrp|22388|2022|PDM|150.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F150383_29853_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132008_85226_0|SrvcGrp|107224|2022|PCT|0.80|99|0.00|POWER WHEELCHAIR GROUP 2|
20|FH_F98880_50158_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F98880_50158_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F41463_0_0|SrvcGrp|34133|2022|PDM|142.50|99|0.00|PIC LINE INSERTION KIT|
20|FH_F117581_21211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F73768_0_0|SrvcGrp|73143|2022|PDM|40.00|99|0.00|HCPC E0602|
20|FH_F147342_08012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35432_0_0|CSTM-ALL|CSTM-00|2020|PDM|5315.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD KL"|
20|FH_F138995_0_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F124487_89502_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|1252.00|99|0.00|AEG 4 (NO REV)|
20|FH_F98900_42001_0|SrvcGrp|73485|2022|PDM|3388.00|99|0.00|AETNA REHAB|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG VI|
20|FH_F150439_03110_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F138662_78624_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F98840_31021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F36883_0_0|SrvcGrp|75506|2022|PCT|0.52|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F37493_0_0|SrvcGrp|73308|2022|PDM|2099.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F37152_0_0|SrvcGrp|11232|2022|PDM|550.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F146266_0_0|SrvcGrp|87679|2022|PDM|1928.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|999.46|99|0.00|AEG 7 (NO REV)|
20|FH_F114848_50533_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F40624_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)|
20|FH_F149023_44122_0|CSTM-ALL|CSTM-00|2020|PDM|2858.00|99|0.00|AEG 9 (NO REV)|
20|FH_F137731_92262_0|SrvcGrp|89337|2022|PDM|1150.00|99|0.00|DETOXIFICATION|
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 5  (NO REV)|
20|FH_F151639_90034_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F150938_02062_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F149376_34239_0|SrvcGrp|113911|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F134394_92101_0|SrvcGrp|109330|2022|PCT|1.10|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138478_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F149522_83221_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F135263_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F143249_89801_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F143367_81003_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|ER (POS 23) (HCFA)|
20|FH_F143494_34474_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143536_47546_0|SrvcGrp|100274|2022|PCT|1.00|99|0.00|TETANUS DIPHTHERIA TOXOI|
20|FH_F75903_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PINEHURST RAD|
20|FH_F102224_0_0|SrvcGrp|108270|2022|PDM|11000.00|99|0.00|REVISE TOTAL KNEE REPAIR|
20|FH_F47952_0_0|SrvcGrp|42973|2022|PDM|95.00|99|0.00|SPEECH  THERAPIST|
20|FH_F132495_33157_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120866_51652_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F126970_45601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113649_01752_0|SrvcGrp|86843|2022|PDM|45.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F132972_78589_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F148061_11223_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F119356_47150_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148554_85016_0|SrvcGrp|110101|2022|PDM|2182.00|99|0.00|TRLUML BALO ANGIOP 1ST ART|
20|FH_F115274_15235_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F128919_48075_0|SrvcGrp|84185|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F62560_0_0|SrvcGrp|11306|2022|PCT|0.25|99|0.00|IMPLANTS|
20|FH_F126666_44053_0|SrvcGrp|91751|2022|PDM|44.00|99|0.00|AETNA GROUP THERAPY (MOD AJ)|
20|FH_F148886_60621_0|SrvcGrp|73603|2022|PDM|1306.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F69242_0_0|SrvcGrp|30609|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F149781_37404_0|SrvcGrp|89848|2022|PDM|3990.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F88512_0_0|SrvcGrp|46515|2022|PDM|10889.63|99|0.00|LAPAROSCOPIC VAGINAL HYSTERECTOMY|
20|FH_F133350_39532_0|SrvcGrp|73605|2022|PDM|950.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F47479_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F39859_0_0|SrvcGrp|37251|2022|PCT|0.60|99|0.00|THROMBOLYTIC|
20|FH_F97182_21502_0|SrvcGrp|73485|2022|PDM|2301.00|99|0.00|AETNA REHAB|
20|FH_F115485_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88280_0_0|SrvcGrp|108001|2022|PCT|1.50|99|0.00|HAPA-NWPA LAB W/ SURG 2018|
20|FH_F133478_40165_0|SrvcGrp|537|2022|PCT|0.54|99|0.00|OBSERVATION SERVICES|
20|FH_F118788_91355_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F117009_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F101802_17201_0|SrvcGrp|27969|2022|PDM|18.39|99|0.00|HOME HEALTH AIDE|
20|FH_F32640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F97140_91730_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|AEG 4 (NO REV)|
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|834.90|99|0.00|ASPG V|
20|FH_F98620_43920_0|SrvcGrp|73643|2022|PDM|2410.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F38508_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F45977_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 581|
20|FH_F141870_85224_0|SrvcGrp|86834|2022|PDM|15.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F79902_0_0|SrvcGrp|71980|2022|PCT|1.00|99|0.00|OCN F/S PRICING: LAB NORTH PHIL|
20|FH_F147800_0_0|SrvcGrp|92364|2022|PDM|16453.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F41142_0_0|SrvcGrp|167|2022|PDM|433.00|99|0.00|CD (ADULT) - REHABILITATION|
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|1347.70|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F71644_0_0|SrvcGrp|11283|2022|PCT|0.75|99|0.00|HYPERBARIC CHAMBER|
20|FH_F35173_0_0|SrvcGrp|6|2022|PCT|0.71|99|0.00|OP SURGERY|
20|FH_F132555_39466_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71947_15227_0|SrvcGrp|81879|2022|PCT|1.00|99|0.00|LABORATORY W/ REV/HCPC|
20|FH_F143684_0_0|SrvcGrp|111807|2022|PDM|1700.00|99|0.00|INTERSPINOUS IMPLANT|
20|FH_F112953_06066_0|SrvcGrp|471|2022|PDM|725.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F43210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F87594_81501_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|GENERAL ACUTE CARE|
20|FH_F148023_34471_0|SrvcGrp|82981|2022|PDM|135.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F91155_16105_0|SrvcGrp|78504|2022|PDM|3243.00|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F49669_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F112853_22408_0|SrvcGrp|53145|2022|PCT|1.05|99|0.00|SOCIAL WORKER|
20|FH_F67639_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG III|
20|FH_F38663_0_0|SrvcGrp|10543|2022|PDM|74.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F41461_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|SKILLED NURSING CARE|
20|FH_F50472_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|329.00|99|0.00|HAPA EPA ASC 39|
20|FH_F132934_63005_0|SrvcGrp|15|2022|PDM|5588.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|457.30|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F117559_08619_0|SrvcGrp|114537|2022|PDM|40.00|99|0.00|ADM SARS COV2 VAC AD26 .5ML B|
20|FH_F141833_31707_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144728_33541_0|SrvcGrp|92502|2022|PDM|886.68|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F128912_44313_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F105842_70433_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.00|99|0.00|AEG 2 (NO REV)|
20|FH_F112587_37058_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|2314.00|99|0.00|ASPG VI|
20|FH_F118550_21133_0|SrvcGrp|472|2022|PDM|549.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F103360_68845_0|CSTM-ALL|CSTM-00|2020|PDM|7581.00|99|0.00|AEG 6 (NO REV)|
20|FH_F149781_37404_0|SrvcGrp|36591|2022|PDM|12731.00|99|0.00|CPT 63685|
20|FH_F100740_15206_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F67560_0_0|SrvcGrp|17069|2022|PCT|0.83|99|0.00|ASPG III|
20|FH_F120390_91316_0|SrvcGrp|108484|2022|PDM|1600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG IX|
20|FH_F72226_65804_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F69104_0_0|SrvcGrp|11306|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|268.00|99|0.00|HAPA EPA ASC 36|
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|2090.00|99|0.00|AEG 6 (NO REV)|
20|FH_F141772_80124_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|1159.40|99|0.00|ASPG VII|
20|FH_F92676_15063_0|SrvcGrp|79039|2022|PDM|700.71|99|0.00|MON VALLEY ASC 231|
20|FH_F142904_50322_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136393_0_0|SrvcGrp|103646|2022|PDM|6400.00|99|0.00|AETNA TIB/ PER REVASE STENT & ATHER|
20|FH_F118889_17701_0|SrvcGrp|75545|2022|PDM|394.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F36420_0_0|SrvcGrp|131|2022|PCT|0.80|99|0.00|PACEMAKER DEVICE|
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_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|AEG 7 (NO REV)|
20|FH_F37200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66420_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F45832_0_0|SrvcGrp|9518|2022|PCT|0.72|99|0.00|EMERGENCY ROOM|
20|FH_F50137_0_0|SrvcGrp|46246|2022|PDM|115.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F59732_0_0|SrvcGrp|42322|2022|PDM|60.00|99|0.00|HOME THERAPY|
20|FH_F61292_0_0|SrvcGrp|57222|2022|PDM|23802.00|99|0.00|GAMMA KNIFE RADIOSURGERY|
20|FH_F91663_19901_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F115685_64064_0|SrvcGrp|98929|2022|PDM|75.00|99|0.00|HIT PAIN IMP PUMP (HCFA)|
20|FH_F135262_02148_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138218_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F130013_16509_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F97102_83501_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F42706_0_0|SrvcGrp|471|2022|PDM|839.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F100962_0_0|SrvcGrp|73000|2022|PDM|1144.00|99|0.00|AEG 6|
20|FH_F36955_0_0|SrvcGrp|3087|2022|PDM|770.00|99|0.00|CD - DETOX|
20|FH_F120296_97223_0|SrvcGrp|84897|2022|PCT|0.70|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F40043_0_0|SrvcGrp|3029|2022|PDM|611.00|99|0.00|NEWBORN NURSERY|
20|FH_F98920_46526_0|SrvcGrp|73485|2022|PDM|3870.00|99|0.00|AETNA REHAB|
20|FH_F148255_72703_0|SrvcGrp|24744|2022|PDM|57.75|99|0.00|PICC LINE INSERTION|
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|836.00|99|0.00|AEG 10 (NO REV)|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PDM|848.21|99|0.00|ASPG I|
20|FH_F136756_0_0|SrvcGrp|72994|2022|PDM|772.20|99|0.00|AEG 3|
20|FH_F148348_16803_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150982_0_0|SrvcGrp|92408|2022|PDM|7268.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F127415_45822_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F142227_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F40834_0_0|SrvcGrp|33368|2022|PDM|2146.00|99|0.00|MULTIPLE BIRTH - NICU LEVEL II|
20|FH_F73742_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125876_78254_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 1 (NO REV)|
20|FH_F147941_06023_0|SrvcGrp|91629|2022|PDM|247.00|99|0.00|SKILLED NURSE SERVICES 15 MINS|
20|FH_F33712_0_0|SrvcGrp|15363|2022|PCT|0.60|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F92091_0_0|SrvcGrp|88030|2022|PDM|10000.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F116049_0_0|SrvcGrp|104745|2022|PDM|148.79|99|0.00|HOSPICE|
20|FH_F93126_63108_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118194_50841_0|SrvcGrp|106054|2022|PCT|1.35|99|0.00|DME|
20|FH_F114976_78539_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F31056_0_0|SrvcGrp|3069|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F38320_0_0|SrvcGrp|592|2022|PDM|650.00|99|0.00|SUB-ACUTE CARE|
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|ASPG III|
20|FH_F123501_64831_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77983_0_0|SrvcGrp|75004|2022|PCT|1.00|99|0.00|MICROSLIDE CONSULTATION|
20|FH_F120172_92653_0|SrvcGrp|73842|2022|PDM|340.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F127564_66002_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141507_0_0|SrvcGrp|74670|2022|PCT|0.00|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F73985_0_0|SrvcGrp|360|2022|PDM|1329.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F40198_0_0|SrvcGrp|701|2022|PDM|1590.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F49338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD 26|
20|FH_F128170_61920_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93332_0_0|SrvcGrp|93061|2022|PDM|3090.00|99|0.00|PERQ CERVICOTHORACIC INJECTION|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|397.24|99|0.00|HAPA WPA-NWPA 2012-13 ASC 404 W/O REV|
20|FH_F42312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F126033_15301_0|SrvcGrp|27969|2022|PDM|27.60|99|0.00|HOME HEALTH AIDE|
20|FH_F130747_0_0|SrvcGrp|92819|2022|PDM|5202.00|99|0.00|HIP ARTHOSCOPY|
20|FH_F141410_13045_0|SrvcGrp|73499|2022|PDM|758.00|99|0.00|AETNA ER LEVEL II|
20|FH_F115685_64064_0|SrvcGrp|86842|2022|PDM|75.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F34546_0_0|SrvcGrp|97|2022|PDM|2100.00|99|0.00|C-SECTION|
20|FH_F129653_0_0|SrvcGrp|53066|2022|PDM|2000.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL|
20|FH_F130682_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|PDM|1273.00|99|0.00|ASPG VIII|
20|FH_F88220_63664_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|650.00|99|0.00|AEG 1 (NO REV)|
20|FH_F149888_68506_0|SrvcGrp|47142|2022|PDM|3180.00|99|0.00|CPT 49650|
20|FH_F133099_66801_0|SrvcGrp|112210|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F133671_89102_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F151526_28208_0|CSTM-ALL|CSTM-00|2020|PDM|1180.00|99|0.00|AEG 4 (NO REV)|
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.00|99|0.00|AEG 2 (NO REV)|
20|FH_F141129_0_0|SrvcGrp|72780|2022|PDM|19.50|99|0.00|HOME HEALTH AIDE - VISIT LEVEL|
20|FH_F141507_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F105680_0_0|SrvcGrp|75491|2022|PDM|1920.00|99|0.00|AEG 7|
20|FH_F102184_0_0|SrvcGrp|98497|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F135260_18655_0|SrvcGrp|46903|2022|PDM|716.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F129334_43016_0|SrvcGrp|48385|2022|PDM|123.00|99|0.00|SPEECH THERAPY|
20|FH_F129535_0_0|SrvcGrp|75491|2022|PDM|950.00|99|0.00|AEG 7|
20|FH_F100665_07939_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F118790_98640_0|SrvcGrp|74668|2022|PDM|717.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148903_51101_0|SrvcGrp|88621|2022|PDM|124.00|99|0.00|SKILLED NURSING LPN|
20|FH_F128316_22192_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F119226_07746_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F100785_54660_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F130108_0_0|SrvcGrp|361|2022|PDM|900.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F141804_70503_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149344_0_0|SrvcGrp|13595|2022|PDM|198.55|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|870.00|99|0.00|ASPG III|
20|FH_F44314_0_0|SrvcGrp|33164|2022|PDM|275.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F68544_0_0|SrvcGrp|50842|2022|PDM|140.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92673_44041_0|SrvcGrp|3178|2022|PDM|900.00|99|0.00|ACUTE PSYCH|
20|FH_F121306_32207_0|SrvcGrp|85017|2022|PCT|1.07|99|0.00|DME|
20|FH_F67192_0_0|SrvcGrp|63|2022|PDM|1711.00|99|0.00|SUBACUTE CARE|
20|FH_F128279_77043_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F117272_24333_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F44607_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|229.00|99|0.00|HAPA EPA ASC 31|
20|FH_F55113_0_0|SrvcGrp|51269|2022|PDM|29400.00|99|0.00|GAMMA|
20|FH_F120437_85202_0|SrvcGrp|10578|2022|PDM|95.67|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F38700_0_0|SrvcGrp|18342|2022|PCT|0.80|99|0.00|MS DRG 472|
20|FH_F41796_0_0|SrvcGrp|71244|2022|PDM|240.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F149781_37404_0|SrvcGrp|67072|2022|PDM|3193.00|99|0.00|CPT 22845|
20|FH_F146211_68144_0|SrvcGrp|3378|2022|PDM|510.00|99|0.00|OBSERVATION SVCS|
20|FH_F97566_79902_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F40599_0_0|SrvcGrp|16374|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F136407_0_0|SrvcGrp|90822|2022|PDM|3960.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY|
20|FH_F38663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|BURMANS APOTHECARY IV THERAPY MOD SH|
20|FH_F111482_33020_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F78682_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|353.64|99|0.00|HAPA WPA-NWPA 2012-13 ASC 112 W/O REV|
20|FH_F59274_0_0|SrvcGrp|48397|2022|PDM|32.00|99|0.00|PT SERVICES|
20|FH_F89372_0_0|SrvcGrp|90004|2022|PDM|46354.00|99|0.00|MS DRG ONLY|
20|FH_F88639_80204_0|SrvcGrp|113940|2022|PDM|7600.21|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F129975_0_0|SrvcGrp|65559|2022|PCT|5.90|99|0.00|E&M CODES|
20|FH_F48292_0_0|SrvcGrp|44242|2022|PDM|446.00|99|0.00|HEMO/HOME DIALYSIS SVCS|
20|FH_F121250_47401_0|SrvcGrp|3178|2022|PDM|984.00|99|0.00|ACUTE PSYCH|
20|FH_F132810_0_0|SrvcGrp|86843|2022|PDM|35.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F67901_0_0|SrvcGrp|26253|2022|PDM|4.95|99|0.00|LIPIDS|
20|FH_F67901_0_0|SrvcGrp|64135|2022|PDM|49.34|99|0.00|PUMP ANALYSIS REPROGRAMABLE|
20|FH_F69968_0_0|SrvcGrp|17775|2022|PDM|200.26|99|0.00|ULTRASOUND|
20|FH_F136358_06070_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F120456_67117_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F93360_64730_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134070_20017_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137068_81147_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137232_28210_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F142373_78727_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142590_18336_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83831_0_0|SrvcGrp|26253|2022|PDM|33.00|99|0.00|LIPIDS|
20|FH_F140609_16063_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140609_16063_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140890_30906_0|SrvcGrp|73841|2022|PDM|455.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F80284_16354_0|SrvcGrp|64108|2022|PDM|572.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 11|
20|FH_F120152_0_0|SrvcGrp|16289|2022|PDM|4400.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F149374_38855_0|SrvcGrp|74668|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151601_89118_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F109886_36303_0|SrvcGrp|86753|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F85713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147801_90703_0|SrvcGrp|16069|2022|PDM|1454.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F129483_77030_0|SrvcGrp|86838|2022|PDM|25.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F129504_02871_0|SrvcGrp|80918|2022|PDM|170.00|99|0.00|RESPITE CARE|
20|FH_F117217_80304_0|SrvcGrp|89412|2022|PDM|366.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F117219_77515_0|SrvcGrp|46903|2022|PDM|500.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F117221_23434_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|AEG 4 (NO REV)|
20|FH_F137930_51546_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F109652_0_0|SrvcGrp|47083|2022|PDM|981.00|99|0.00|CT SCAN|
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|1275.00|99|0.00|AEG 8 (NO REV)|
20|FH_F130676_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F119285_0_0|SrvcGrp|104003|2022|PDM|3050.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES|
20|FH_F109513_0_0|SrvcGrp|90437|2022|PDM|2700.00|99|0.00|ANKLE SURGICAL PROCEDURES|
20|FH_F151061_02720_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F151082_18020_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151144_35801_0|SrvcGrp|115967|2022|PDM|915.43|99|0.00|EYELID INCISION|
20|FH_F34963_0_0|SrvcGrp|3327|2022|PDM|525.00|99|0.00|HOSPICE SERVICE - IP RESPITE|
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|208.36|99|0.00|DELAWARE VALLEY- ASC 306|
20|FH_F77763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F98040_89406_0|SrvcGrp|88978|2022|PDM|7005.00|99|0.00|VAGINAL DELIVERY|
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 4 (NO REV)|
20|FH_F72845_0_0|SrvcGrp|3029|2022|PDM|832.00|99|0.00|NEWBORN NURSERY|
20|FH_F114916_30309_0|SrvcGrp|102481|2022|PDM|2000.00|99|0.00|CPT 29898|
20|FH_F114916_30309_0|SrvcGrp|26277|2022|PDM|1500.00|99|0.00|CPT 29874|
20|FH_F111925_0_0|SrvcGrp|90564|2022|PDM|1602.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F104840_32565_0|SrvcGrp|75505|2022|PCT|0.69|99|0.00|CARDIAC STUDIES|
20|FH_F33856_0_0|SrvcGrp|147|2022|PCT|0.85|99|0.00|HOME HEALTH CARE|
20|FH_F39209_0_0|SrvcGrp|474|2022|PDM|900.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F135491_0_0|SrvcGrp|90606|2022|PDM|1084.00|99|0.00|INSERT LENS PROSTHESIS|
20|FH_F145784_0_0|SrvcGrp|39906|2022|PDM|3500.00|99|0.00|MASTECTOMY, SIMPLE, COMPLETE|
20|FH_F129713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F78447_0_0|SrvcGrp|75501|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY|
20|FH_F114389_50131_0|SrvcGrp|31973|2022|PDM|31.24|99|0.00|HOME THERAPY|
20|FH_F114389_50131_0|SrvcGrp|26253|2022|PCT|0.82|99|0.00|LIPIDS|
20|FH_F141349_26440_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F136735_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|1457.00|99|0.00|AEG 9 (NO REV)|
20|FH_F83231_0_0|SrvcGrp|69046|2022|PDM|1600.00|99|0.00|SUB-ACUTE REHAB II|
20|FH_F129849_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F122198_20708_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F105320_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F64819_0_0|CSTM-ALL|CSTM-00|2020|PDM|1483.00|99|0.00|OP SVCS|
20|FH_F49943_0_0|SrvcGrp|42971|2022|PDM|105.00|99|0.00|SKN RN|
20|FH_F100703_0_0|SrvcGrp|97199|2022|PDM|8034.00|99|0.00|THORAX SPINE DISK SURGERY|
20|FH_F63185_0_0|SrvcGrp|46605|2022|PDM|35.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F136674_16335_0|SrvcGrp|3178|2022|PDM|925.00|99|0.00|ACUTE PSYCH|
20|FH_F114727_44512_0|SrvcGrp|90854|2022|PDM|730.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F113809_47302_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F138855_84067_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F122571_53555_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122635_06410_0|SrvcGrp|27968|2022|PDM|37.13|99|0.00|SKILLED NURSING LPN|
20|FH_F122674_94904_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F43249_0_0|SrvcGrp|24|2022|PDM|5828.00|99|0.00|CARDIAC CATH|
20|FH_F136783_40069_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F112444_07102_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|ASPG VI|
20|FH_F46752_0_0|SrvcGrp|22595|2022|PDM|90.00|99|0.00|SPECIAL NURSE VISIT (SUBSQ. W/O INFUSION)|
20|FH_F116365_11417_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F147519_52627_0|SrvcGrp|73500|2022|PDM|587.58|99|0.00|AETNA ER LEVEL I|
20|FH_F147501_52655_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116904_17543_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119992_67062_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120961_66615_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F51276_0_0|SrvcGrp|27042|2022|PDM|27.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS(MOD SH)|
20|FH_F36132_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP MAFS  MOD TC|
20|FH_F36372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F39355_0_0|CSTM-ALL|CSTM-00|2020|PDM|1175.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41158_0_0|SrvcGrp|109|2022|PDM|450.00|99|0.00|CD - DETOX|
20|FH_F140007_0_0|SrvcGrp|19922|2022|PDM|4206.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F123445_0_0|SrvcGrp|63297|2022|PDM|198.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|1089.90|99|0.00|AEG 4 (NO REV)|
20|FH_F130302_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133415_90066_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F133478_40165_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111603_19529_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F49033_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC|
20|FH_F35404_0_0|SrvcGrp|59453|2022|PDM|5155.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F38037_0_0|SrvcGrp|9830|2022|PDM|88.00|99|0.00|OT SVCS|
20|FH_F150939_0_0|SrvcGrp|100248|2022|PDM|48.00|99|0.00|REMOVAL OF SKIN TAGS|
20|FH_F41013_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F42985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS|
20|FH_F138876_25302_0|SrvcGrp|86837|2022|PDM|150.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F138936_01040_0|CSTM-ALL|CSTM-00|2020|PDM|3162.00|99|0.00|AEG 7 (NO REV)|
20|FH_F83792_0_0|SrvcGrp|73483|2022|PDM|683.00|99|0.00|AETNA SUBACUTE III|
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|AEG 1 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|103.45|99|0.00|HAPA WPA-NWPA 2012-13 ASC 143 W/O REV|
20|FH_F72606_0_0|SrvcGrp|69679|2022|PDM|9525.00|99|0.00|AICD MS DRG ONLY|
20|FH_F84751_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.60|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132258_45404_0|SrvcGrp|17016|2022|PDM|34.98|99|0.00|HOME INFUSION THERAPY|
20|FH_F132268_07060_0|SrvcGrp|94735|2022|PDM|56.65|99|0.00|AFLURIA VACC IM (>=3 YRS)|
20|FH_F132268_07060_0|SrvcGrp|104306|2022|PCT|0.95|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F144991_43607_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145531_61614_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123191_15012_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F123096_28210_0|SrvcGrp|73605|2022|PDM|1650.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F150021_02725_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F146211_68144_0|SrvcGrp|31020|2022|PDM|14687.00|99|0.00|MS DRG 470 ONLY|
20|FH_F121223_0_0|SrvcGrp|108082|2022|PDM|75.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F142755_33916_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133474_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146179_37687_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F37904_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F72859_0_0|SrvcGrp|10542|2022|PDM|102.63|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F92792_0_0|SrvcGrp|45583|2022|PDM|2200.00|99|0.00|CPT 65730|
20|FH_F89233_0_0|SrvcGrp|2738|2022|PCT|0.76|99|0.00|IMPLANTS|
20|FH_F133530_11237_0|SrvcGrp|110281|2022|PCT|1.50|99|0.00|AETNA OP MRI/MRA (MRIMRA)|
20|FH_F38425_0_0|SrvcGrp|15846|2022|PDM|47.00|99|0.00|HOME VISIT|
20|FH_F148921_91356_0|SrvcGrp|108484|2022|PDM|737.50|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F72750_0_0|SrvcGrp|997|2022|PCT|0.40|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F92676_15063_0|SrvcGrp|78921|2022|PCT|2.43|99|0.00|MON VALLEY RAD W/ ASC|
20|FH_F133018_84037_0|SrvcGrp|14945|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F133214_75024_0|SrvcGrp|105820|2022|PDM|1899.00|99|0.00|IP PSYCH EATING DISORDERS|
20|FH_F34719_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141940_50023_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F138236_0_0|SrvcGrp|104230|2022|PDM|105.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F92676_15063_0|SrvcGrp|78996|2022|PDM|1140.87|99|0.00|MON VALLEY ASC 215|
20|FH_F116324_0_0|SrvcGrp|75497|2022|PDM|550.00|99|0.00|AEG 10|
20|FH_F139444_32966_0|SrvcGrp|108799|2022|PCT|1.20|99|0.00|OP THERAPY SERVICE|
20|FH_F139667_84078_0|SrvcGrp|48385|2022|PDM|84.50|99|0.00|SPEECH THERAPY|
20|FH_F139667_84078_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150882_84041_0|SrvcGrp|86831|2022|PDM|6.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F150882_84041_0|SrvcGrp|43569|2022|PDM|105.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F150882_84041_0|SrvcGrp|48396|2022|PDM|109.00|99|0.00|OT SERVICES|
20|FH_F113826_51445_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150224_0_0|SrvcGrp|92501|2022|PDM|350.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F128988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147360_06415_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 9 (NO REV)|
20|FH_F37267_0_0|SrvcGrp|9828|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE|
20|FH_F119442_72205_0|SrvcGrp|8950|2022|PDM|1525.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F80834_0_0|SrvcGrp|30623|2022|PDM|10173.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F150979_44060_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146986_0_0|SrvcGrp|82981|2022|PDM|174.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F140295_0_0|SrvcGrp|88492|2022|PDM|3706.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F148496_17112_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F113765_0_0|SrvcGrp|22954|2022|PDM|105.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F150982_0_0|SrvcGrp|82111|2022|PDM|2202.00|99|0.00|KNEE ARTHROSCOPY SURGICAL|
20|FH_F36435_0_0|SrvcGrp|18069|2022|PDM|297.60|99|0.00|SKILLED NURSING CARE|
20|FH_F113524_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F85772_0_0|SrvcGrp|84180|2022|PDM|2991.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS|
20|FH_F147321_24523_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128753_32501_0|SrvcGrp|73483|2022|PCT|0.64|99|0.00|AETNA SUBACUTE III|
20|FH_F35475_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|618180-OPGH-LABS QW MOD|
20|FH_F94643_90501_0|SrvcGrp|86837|2022|PDM|25.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F67419_0_0|SrvcGrp|42974|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139947_43209_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F89851_83854_0|SrvcGrp|58368|2022|PDM|16032.00|99|0.00|MS DRG 030 ONLY|
20|FH_F125656_92868_0|SrvcGrp|17015|2022|PDM|12.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F73768_0_0|CSTM-ALL|CSTM-00|2020|PDM|4200.00|99|0.00|HCPCS E0784 MOD OT|
20|FH_F129966_18017_0|SrvcGrp|108484|2022|PDM|842.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F149582_01534_0|SrvcGrp|115401|2022|PCT|1.00|99|0.00|COVID-19 VACCINE COMBINATION - ELI LILLY|
20|FH_F123745_0_0|SrvcGrp|67065|2022|PDM|9500.00|99|0.00|CERVICAL SURGERY|
20|FH_F38676_0_0|SrvcGrp|17624|2022|PCT|0.75|99|0.00|IMPLANTS|
20|FH_F136376_0_0|SrvcGrp|73842|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149269_73120_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|993.00|99|0.00|AEG 7 (NO REV)|
20|FH_F114173_18901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98280_31015_0|SrvcGrp|95800|2022|PCT|1.10|99|0.00|SPEECH THERAPY|
20|FH_F38584_0_0|SrvcGrp|17067|2022|PDM|719.00|99|0.00|ASPG II|
20|FH_F145583_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F139715_0_0|SrvcGrp|99073|2022|PDM|1.42|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F148347_0_0|SrvcGrp|78283|2022|PDM|4831.20|99|0.00|CPT 49505|
20|FH_F41155_0_0|SrvcGrp|12790|2022|PCT|0.70|99|0.00|TISSUE PLASMINOGEN ACTIVATOR|
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AEG 2 (NO REV)|
20|FH_F149160_02180_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F35774_33573_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F103109_33462_0|SrvcGrp|89417|2022|PDM|365.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F130182_0_0|SrvcGrp|111515|2022|PDM|79.00|99|0.00|INJECT R VENTR/ATRIAL ANGIO|
20|FH_F72842_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F39819_0_0|SrvcGrp|31202|2022|PDM|7190.00|99|0.00|NY DRG 088 ONLY|
20|FH_F129328_33311_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|1247.13|99|0.00|AEG 3 (NO REV)|
20|FH_F40189_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F128982_44221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148340_28269_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135237_31015_0|SrvcGrp|48396|2022|PDM|150.00|99|0.00|OT SERVICES|
20|FH_F93702_63128_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66222_0_0|SrvcGrp|45784|2022|PDM|160.85|99|0.00|NUTRITIONAL SERVICES (RD)|
20|FH_F102302_0_0|SrvcGrp|98581|2022|PDM|29900.00|99|0.00|FUSION OF SACROILIAC JOINT|
20|FH_F87031_0_0|SrvcGrp|72992|2022|PDM|695.00|99|0.00|AEG 2|
20|FH_F145568_0_0|SrvcGrp|108484|2022|PDM|660.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F123473_65109_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F135764_0_0|SrvcGrp|73601|2022|PDM|1350.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
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_F66410_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F145508_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F62614_0_0|SrvcGrp|46424|2022|PDM|30.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F117147_0_0|SrvcGrp|87077|2022|PDM|148.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|953.22|99|0.00|AEG 4 (NO REV)|
20|FH_F72003_0_0|SrvcGrp|49071|2022|PCT|1.00|99|0.00|DME|
20|FH_F148419_01453_0|SrvcGrp|113171|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F148542_43517_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92833_0_0|SrvcGrp|26275|2022|PDM|2215.00|99|0.00|CPT 29826|
20|FH_F37751_0_0|SrvcGrp|471|2022|PDM|1142.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1673.00|99|0.00|AEG 8 (NO REV)|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|176.15|99|0.00|ASPG 118|
20|FH_F117733_91362_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101104_0_0|SrvcGrp|90339|2022|PDM|125.00|99|0.00|SKILLED NURSING RN|
20|FH_F120434_34761_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F37751_0_0|SrvcGrp|27692|2022|PCT|1.00|99|0.00|LABORATORY|
20|FH_F49354_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F34706_0_0|SrvcGrp|14938|2022|PDM|1688.00|99|0.00|PROGRESSIVE TELEMETRY|
20|FH_F111540_16823_0|SrvcGrp|91392|2022|PDM|210.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AF)|
20|FH_F134447_12883_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F150464_15746_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F37567_0_0|SrvcGrp|26002|2022|PDM|250.00|99|0.00|C-ARM AND LASER|
20|FH_F127960_85205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F87577_80016_0|SrvcGrp|73461|2022|PDM|7949.00|99|0.00|AETNA NICU IV|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.13|99|0.00|5780852_USTN_LAB|
20|FH_F67192_0_0|SrvcGrp|15363|2022|PCT|0.52|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F117965_60714_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117962_17603_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F112865_46135_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F63301_0_0|SrvcGrp|42976|2022|PDM|130.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC|
20|FH_F55113_0_0|SrvcGrp|10400|2022|PDM|1500.00|99|0.00|IP SURGERY|
20|FH_F141217_0_0|SrvcGrp|89404|2022|PDM|9500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F139298_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 7 (NO REV)|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|238.10|99|0.00|ASPG 113|
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_F149652_37212_0|SrvcGrp|114008|2022|PDM|485.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F38702_0_0|SrvcGrp|112054|2022|PDM|65.00|99|0.00|COVID-19 ANTIBODY|
20|FH_F129812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F88280_0_0|SrvcGrp|112751|2022|PDM|11535.00|99|0.00|MS DRG 521-522 ONLY|
20|FH_F31381_0_0|SrvcGrp|72|2022|PDM|200.00|99|0.00|NEWBORN NURSERY|
20|FH_F117132_0_0|SrvcGrp|107320|2022|PDM|2101.00|99|0.00|REPAIR RETINAL DETACHMENT|
20|FH_F133028_08021_0|SrvcGrp|109330|2022|PCT|1.20|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F113324_17055_0|SrvcGrp|105210|2022|PDM|673.00|99|0.00|SKILLED CARE LEVEL 1 AND 2|
20|FH_F133006_48067_0|SrvcGrp|90854|2022|PDM|550.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F36576_0_0|SrvcGrp|333|2022|PCT|0.90|99|0.00|HOSPICE SVCS|
20|FH_F44795_0_0|SrvcGrp|11072|2022|PDM|80.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F95360_08720_0|SrvcGrp|471|2022|PDM|530.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F128917_57212_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F71268_0_0|SrvcGrp|9947|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F148639_0_0|SrvcGrp|38364|2022|PDM|3400.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F98640_0_0|SrvcGrp|109016|2022|PDM|1818.00|99|0.00|REMOVAL OF ADENOIDS|
20|FH_F41804_0_0|SrvcGrp|115|2022|PDM|464.00|99|0.00|SKILLED NURSING CARE|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF|
20|FH_F127204_44420_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F117875_70601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113261_38464_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F123922_84102_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F109343_0_0|SrvcGrp|84198|2022|PDM|520.00|99|0.00|AETNA MATERNITY TRANSFER|
20|FH_F66630_0_0|SrvcGrp|46903|2022|PDM|625.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F92276_32308_0|SrvcGrp|82981|2022|PCT|0.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F130021_77904_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F40043_0_0|SrvcGrp|33265|2022|PDM|1586.00|99|0.00|GA ASPG V|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PDM|1808.51|99|0.00|ASPG V|
20|FH_F107800_34609_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124017_0_0|SrvcGrp|31674|2022|PDM|4500.00|99|0.00|NEUROSTIMULATOR|
20|FH_F120306_16424_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132779_0_0|SrvcGrp|15|2022|PDM|2415.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F91663_19901_0|SrvcGrp|73700|2022|PDM|55.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F115685_64064_0|SrvcGrp|86843|2022|PDM|55.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F149888_68506_0|SrvcGrp|65403|2022|PDM|2238.00|99|0.00|CPT 42830|
20|FH_F90798_0_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130503_98102_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149888_68506_0|SrvcGrp|84927|2022|PDM|3886.00|99|0.00|OP SURGERY|
20|FH_F131965_0_0|SrvcGrp|83522|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F77762_0_0|SrvcGrp|42974|2022|PDM|135.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F38357_0_0|SrvcGrp|17419|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F38526_0_0|SrvcGrp|43|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F132779_0_0|CSTM-ALL|CSTM-00|2020|PDM|2415.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93902_04043_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F151146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145758_20745_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73013_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALEGENT HH - DME|
20|FH_F141410_13045_0|SrvcGrp|112224|2022|PDM|110.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F56136_0_0|SrvcGrp|17378|2022|PCT|0.92|99|0.00|CAPD TRAINING|
20|FH_F44774_0_0|SrvcGrp|32404|2022|PCT|1.20|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL (RADIOLOGY)|
20|FH_F148480_03079_0|CSTM-ALL|CSTM-00|2020|PDM|1338.75|99|0.00|AEG 2 (NO REV)|
20|FH_F116760_68512_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F125949_66534_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F102302_0_0|SrvcGrp|58755|2022|PDM|8900.00|99|0.00|INJECTION PROC FOR JOINT|
20|FH_F135173_06519_0|SrvcGrp|106248|2022|PDM|524.00|99|0.00|PARTIAL HOSP PSYCH|
20|FH_F38798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|DME - MOD 53|
20|FH_F38392_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MOD TC|
20|FH_F121177_33407_0|SrvcGrp|90040|2022|PDM|280.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F116115_14437_0|SrvcGrp|89024|2022|PDM|76.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F56276_0_0|SrvcGrp|26776|2022|PDM|58.00|99|0.00|CPT 90804|
20|FH_F78762_0_0|SrvcGrp|23703|2022|PCT|0.71|99|0.00|IP/OP TRAUMA|
20|FH_F131420_29693_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F131420_29693_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116203_63901_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F40525_0_0|SrvcGrp|32994|2022|PDM|850.00|99|0.00|MOD SU- MRI|
20|FH_F71070_0_0|SrvcGrp|68102|2022|PCT|1.05|99|0.00|IMPLANTS W/ SURGERIES|
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OTHER DIAGNOSTIC - RONL/HSOH|
20|FH_F121164_61761_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F106822_0_0|SrvcGrp|100248|2022|PDM|57.00|99|0.00|REMOVAL OF SKIN TAGS|
20|FH_F112272_0_0|SrvcGrp|73601|2022|PDM|1456.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F133534_33483_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116027_17745_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F71848_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115109_20032_0|SrvcGrp|73601|2022|PDM|1954.99|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F128973_44256_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F127946_32514_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92964_0_0|SrvcGrp|16|2022|PDM|1375.00|99|0.00|ACUTE REHABILITATION|
20|FH_F132559_0_0|SrvcGrp|106265|2022|PDM|2800.00|99|0.00|NSL/SINS NDSC TOTAL|
20|FH_F41021_0_0|SrvcGrp|17067|2022|PDM|2416.00|99|0.00|ASPG II|
20|FH_F56136_0_0|SrvcGrp|22820|2022|PCT|0.92|99|0.00|DIALYSIS|
20|FH_F124050_75089_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PDM|30.00|99|0.00|HOME HEALTH AIDE MOD TF|
20|FH_F121523_33406_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 2 (NO REV)|
20|FH_F82696_16335_0|SrvcGrp|76013|2022|PDM|1373.00|99|0.00|EMERGENCY ROOM SVCS LEVEL VI|
20|FH_F86872_15215_0|SrvcGrp|14947|2022|PDM|100.00|99|0.00|HOME INFUSION|
20|FH_F62579_0_0|SrvcGrp|20480|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F38560_0_0|SrvcGrp|29555|2022|PDM|16500.00|99|0.00|ADULT AICD IMPLANT W/THORACOTOMY|
20|FH_F130656_04401_0|SrvcGrp|114916|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F130765_34113_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F130908_32708_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130911_06001_0|SrvcGrp|471|2022|PDM|656.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146474_78572_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|PROCRIT/ERYTHROPOIETIN (EPOETIN)|
20|FH_F110471_02215_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F112863_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F146400_71860_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127080_77520_0|SrvcGrp|46903|2022|PDM|624.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F78385_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F117555_72802_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F132289_89145_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132667_62025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F123158_0_0|SrvcGrp|77444|2022|PDM|970.00|99|0.00|VASECTOMY|
20|FH_F73542_0_0|SrvcGrp|70999|2022|PDM|26.00|99|0.00|AMBULANCE - WHEELCHAIR VAN|
20|FH_F138532_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F101840_76054_0|SrvcGrp|34473|2022|PDM|30562.00|99|0.00|MS DRG 040 ONLY|
20|FH_F41441_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F97042_64804_0|SrvcGrp|73559|2022|PDM|12503.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F106600_99202_0|SrvcGrp|86747|2022|PCT|1.05|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F122388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F33099_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142011_02859_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121306_32207_0|SrvcGrp|84897|2022|PCT|1.07|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F40056_0_0|SrvcGrp|30062|2022|PDM|4320.00|99|0.00|MULTIPLE BIRTH NORMAL DELIVERY|
20|FH_F117901_27526_0|SrvcGrp|473|2022|PDM|415.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F38700_0_0|SrvcGrp|19108|2022|PCT|0.80|99|0.00|MS DRG 619|
20|FH_F69242_0_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133018_84037_0|SrvcGrp|48398|2022|PDM|85.50|99|0.00|PT SERVICES|
20|FH_F150001_33064_0|SrvcGrp|86841|2022|PDM|53.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PDM|2770.00|99|0.00|AEG 5  (NO REV)|
20|FH_F117335_0_0|SrvcGrp|73006|2022|PDM|1284.00|99|0.00|AEG 9|
20|FH_F93421_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91061_63043_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F57372_0_0|SrvcGrp|45883|2022|PDM|110.00|99|0.00|OT|
20|FH_F117087_0_0|SrvcGrp|107190|2022|PDM|1153.00|99|0.00|EARDRUM REVISION|
20|FH_F144429_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F50372_0_0|SrvcGrp|46591|2022|PDM|140.00|99|0.00|CPT 99213|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD KM)|
20|FH_F72865_93501_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|GENERAL ACUTE CARE|
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|1202.36|99|0.00|ASPG IV|
20|FH_F102561_75146_0|SrvcGrp|88697|2022|PCT|0.00|99|0.00|DRUGS|
20|FH_F39558_0_0|SrvcGrp|17069|2022|PDM|595.00|99|0.00|ASPG III|
20|FH_F121335_0_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F136606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130636_78572_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130652_51101_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148644_06890_0|SrvcGrp|46885|2022|PDM|3131.00|99|0.00|REPAIR BROW DEFECT|
20|FH_F151086_60649_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151151_76504_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121946_43209_0|SrvcGrp|73842|2022|PDM|173.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
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|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136377_75240_0|SrvcGrp|89417|2022|PDM|420.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F136378_07104_0|SrvcGrp|89149|2022|PDM|210.00|99|0.00|OP INTENSIVE|
20|FH_F136414_54548_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F136487_71269_0|SrvcGrp|86722|2022|PDM|240.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F118152_20151_0|SrvcGrp|86828|2022|PDM|70.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F120444_84037_0|SrvcGrp|89337|2022|PDM|950.00|99|0.00|DETOXIFICATION|
20|FH_F120444_84037_0|SrvcGrp|87317|2022|PDM|850.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F120490_64133_0|SrvcGrp|46605|2022|PDM|55.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F120475_81052_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F134047_32628_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142393_33142_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117552_0_0|SrvcGrp|108518|2022|PDM|6000.00|99|0.00|IMPLANT PAT ACTIVE HT RECORD|
20|FH_F66765_0_0|SrvcGrp|3810|2022|PDM|148.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F138584_30912_0|SrvcGrp|113389|2022|PDM|1225.00|99|0.00|REMOVAL OF FACE BONE LESION|
20|FH_F140343_89052_0|SrvcGrp|10577|2022|PDM|30.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F140367_70510_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F140844_48083_0|SrvcGrp|90338|2022|PDM|96.00|99|0.00|SKILLED NURSING RN (HCFA)|
20|FH_F148699_19403_0|SrvcGrp|108484|2022|PDM|815.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F149610_76543_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151603_27609_0|SrvcGrp|77021|2022|PDM|6500.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F119023_91406_0|SrvcGrp|86844|2022|PDM|35.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F119004_06850_0|SrvcGrp|42550|2022|PDM|2273.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F119067_94080_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F118943_64506_0|SrvcGrp|14893|2022|PDM|42.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F80366_0_0|SrvcGrp|77260|2022|PCT|0.94|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F147725_06002_0|SrvcGrp|92197|2022|PDM|3614.00|99|0.00|CORRECTION OF BUNION|
20|FH_F129427_92262_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129483_77030_0|SrvcGrp|22593|2022|PDM|40.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F117219_77515_0|SrvcGrp|93919|2022|PDM|500.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F137898_46540_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F137938_29036_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|877.00|99|0.00|AEG 5  (NO REV)|
20|FH_F111046_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128804_0_0|SrvcGrp|106265|2022|PDM|4263.00|99|0.00|NSL/SINS NDSC TOTAL|
20|FH_F47552_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|987.00|99|0.00|AEG 2 (NO REV)|
20|FH_F47575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F56274_0_0|CSTM-ALL|CSTM-00|2020|PDM|155.00|99|0.00|PEDIATRIC SPEECH THERAPY|
20|FH_F116809_0_0|SrvcGrp|79594|2022|PDM|461.00|99|0.00|CPT 45380|
20|FH_F39895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1423.13|99|0.00|DELAWARE VALLEY- ASC 901|
20|FH_F66408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F33624_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F110000_0_0|SrvcGrp|33826|2022|PDM|1536.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 4|
20|FH_F111840_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87201_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INFUSION- IV SERVICES|
20|FH_F113143_0_0|SrvcGrp|73008|2022|PDM|536.00|99|0.00|AEG 10|
20|FH_F113784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116143_0_0|SrvcGrp|76579|2022|PCT|1.00|99|0.00|IMPLANTS W/ HCPC|
20|FH_F142312_62301_0|SrvcGrp|46903|2022|PDM|425.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F142447_72758_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142448_15701_0|SrvcGrp|24750|2022|PDM|45.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F39209_0_0|SrvcGrp|471|2022|PDM|1250.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PDM|904.39|99|0.00|ASPG V|
20|FH_F88933_0_0|SrvcGrp|17324|2022|PDM|3939.00|99|0.00|ARTHROSCOPIC KNEE REPAIR|
20|FH_F114389_50131_0|SrvcGrp|98997|2022|PDM|117.09|99|0.00|HYDRATION THERAPY 3 LITER (HCFA)|
20|FH_F141343_62047_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F72085_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|1495.00|99|0.00|ASPG VII|
20|FH_F37703_0_0|SrvcGrp|3327|2022|PDM|143.00|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125134_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F134809_0_0|SrvcGrp|87536|2022|PDM|210.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F133694_89117_0|SrvcGrp|27969|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE|
20|FH_F98042_10468_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F114666_30342_0|SrvcGrp|98497|2022|PDM|6500.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F114684_80547_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139662_51106_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114985_32073_0|SrvcGrp|52953|2022|PDM|23.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F81832_13827_0|SrvcGrp|73701|2022|PDM|39.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F127448_0_0|SrvcGrp|72996|2022|PDM|1000.00|99|0.00|AEG 4|
20|FH_F134791_98034_0|SrvcGrp|73742|2022|PCT|0.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F136796_24016_0|SrvcGrp|84910|2022|PDM|2907.56|99|0.00|ENDOSCOPY|
20|FH_F136796_24016_0|SrvcGrp|33984|2022|PDM|2180.67|99|0.00|HAMMERTOE CORRECTION|
20|FH_F136828_32405_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F136913_68803_0|SrvcGrp|93121|2022|PCT|2.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F136914_64081_0|SrvcGrp|106314|2022|PDM|603.00|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F131529_0_0|SrvcGrp|95441|2022|PDM|100.00|99|0.00|HOSPICE OR HOME CARE|
20|FH_F141170_0_0|SrvcGrp|58636|2022|PDM|15015.00|99|0.00|CPT 62362|
20|FH_F34498_0_0|SrvcGrp|16705|2022|PDM|1348.00|99|0.00|ULTRAFILTRATION|
20|FH_F116199_75042_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F147400_77707_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147468_20877_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F41489_0_0|SrvcGrp|350|2022|PDM|1000.00|99|0.00|SURGICAL CARE|
20|FH_F42176_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F42654_0_0|SrvcGrp|10545|2022|PDM|90.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F42715_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 4 (NO REV)|
20|FH_F97261_06098_0|SrvcGrp|73485|2022|PDM|4387.00|99|0.00|AETNA REHAB|
20|FH_F134826_19067_0|SrvcGrp|90644|2022|PDM|135.00|99|0.00|AETNA MEDICATION ASSISTED TRTMT MAINTENANCE INJECTION (HCFA)|
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_F137906_0_0|SrvcGrp|95660|2022|PDM|475.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F46433_0_0|SrvcGrp|17015|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F150939_0_0|SrvcGrp|100275|2022|PDM|127.25|99|0.00|MENINGOCOCCL POLYSACCHRID VA|
20|FH_F150939_0_0|SrvcGrp|110158|2022|PDM|72.61|99|0.00|INCISION|
20|FH_F138784_32216_0|SrvcGrp|3178|2022|PDM|1043.00|99|0.00|ACUTE PSYCH|
20|FH_F138876_25302_0|SrvcGrp|14893|2022|PDM|32.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F138685_18017_0|SrvcGrp|113450|2022|PDM|547.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH/CD|
20|FH_F67167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F83792_0_0|SrvcGrp|78377|2022|PDM|683.00|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|2006 MEDICARE ASPG X|
20|FH_F91641_0_0|SrvcGrp|78285|2022|PDM|1976.76|99|0.00|CPT 58671|
20|FH_F114326_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F122137_75633_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F135431_33414_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F135438_29030_0|SrvcGrp|89417|2022|PDM|430.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F135572_89106_0|SrvcGrp|29075|2022|PCT|1.00|99|0.00|HYDRATION THERAPY|
20|FH_F135609_37027_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F120719_27540_0|CSTM-ALL|CSTM-00|2020|PDM|8292.00|99|0.00|AEG 8 (NO REV)|
20|FH_F146113_26719_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 10 (NO REV)|
20|FH_F118253_89052_0|SrvcGrp|73842|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F88744_71103_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|AETNA OP CHEMOTHERAPY DRUG|
20|FH_F135670_01749_0|SrvcGrp|111528|2022|PDM|75.00|99|0.00|PICC LINE INSERTION (HCFA)|
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|329.00|99|0.00|AEG 9 (NO REV)|
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|2395.70|99|0.00|AEG 10 (NO REV)|
20|FH_F127418_0_0|SrvcGrp|90343|2022|PDM|36330.72|99|0.00|CERVICE CORPECTOMY 1 LEVEL|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1026.30|99|0.00|HAPA WPA-NWPA 2012-13 ASC 801 W/O REV|
20|FH_F110501_07652_0|SrvcGrp|89417|2022|PDM|621.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F90232_15126_0|SrvcGrp|16750|2022|PDM|102.90|99|0.00|HOME INFUSION THERAPY|
20|FH_F79863_0_0|SrvcGrp|50602|2022|PDM|90.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F133585_0_0|SrvcGrp|109469|2022|PDM|433.00|99|0.00|INS CATH ABD/L-EXT ART 3RD|
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|3982.00|99|0.00|AEG 5  (NO REV)|
20|FH_F122948_23947_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135623_53115_0|SrvcGrp|95440|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F119810_31525_0|SrvcGrp|57968|2022|PDM|32.12|99|0.00|CONTINUOUS HOMECARE|
20|FH_F139678_25601_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F150165_06032_0|SrvcGrp|96539|2022|PDM|4244.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F109577_0_0|SrvcGrp|103611|2022|PDM|123.00|99|0.00|DIABETIC MGMT PROGRAM - GROUP|
20|FH_F70208_0_0|SrvcGrp|537|2022|PCT|0.75|99|0.00|OBSERVATION SERVICES|
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|952.00|99|0.00|AEG 6 (NO REV)|
20|FH_F112023_12866_0|SrvcGrp|73605|2022|PDM|1935.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F132883_31602_0|SrvcGrp|86827|2022|PDM|30.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F37698_0_0|SrvcGrp|27168|2022|PCT|0.50|99|0.00|DRUGS/IMPANTS/PROSTHETICS/ORTHOTICS|
20|FH_F85353_16407_0|SrvcGrp|63852|2022|PDM|429.01|99|0.00|HAPA WPA-NWPA 2012-13 ASC 225|
20|FH_F133928_19713_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119227_01752_0|SrvcGrp|22593|2022|PDM|38.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F127908_60640_0|SrvcGrp|9866|2022|PCT|0.80|99|0.00|IP OBSERVATION SVCS|
20|FH_F103220_0_0|SrvcGrp|111777|2022|PDM|3960.00|99|0.00|INT HRHC TRANAL DARTLZJ 2+|
20|FH_F130763_0_0|SrvcGrp|78093|2022|PDM|4714.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F49914_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F83995_16748_0|SrvcGrp|82622|2022|PDM|318.00|99|0.00|ER SETTING W/ OP SURGERY LEVEL I|
20|FH_F114415_16509_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70883_0_0|SrvcGrp|12401|2022|PDM|82.00|99|0.00|RN VISIT|
20|FH_F134611_04103_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F123633_70506_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F112665_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F141337_60077_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F125870_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F145781_0_0|SrvcGrp|114309|2022|PDM|1400.00|99|0.00|EXPLORE/TREAT EYE SOCKET|
20|FH_F90334_23323_0|SrvcGrp|472|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F113428_19446_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F80224_0_0|SrvcGrp|26690|2022|PCT|0.76|99|0.00|MS DRG 215 ONLY|
20|FH_F120670_0_0|SrvcGrp|88024|2022|PDM|6500.00|99|0.00|REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION|
20|FH_F120299_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F126360_22485_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143742_60410_0|SrvcGrp|10910|2022|PCT|0.61|99|0.00|URGENT CARE|
20|FH_F85995_64111_0|SrvcGrp|46605|2022|PDM|150.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|ASPG X|
20|FH_F133972_27103_0|SrvcGrp|86844|2022|PDM|35.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F136037_0_0|SrvcGrp|73842|2022|PDM|233.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F150165_06032_0|SrvcGrp|83817|2022|PDM|5994.00|99|0.00|LAPAROSCOPY LYSIS ADHESIONS|
20|FH_F116506_0_0|SrvcGrp|75487|2022|PDM|825.00|99|0.00|AEG 5|
20|FH_F127094_61802_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F146559_71901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F45120_0_0|SrvcGrp|13880|2022|PCT|0.21|99|0.00|IMPLANTS|
20|FH_F72543_0_0|SrvcGrp|68987|2022|PDM|108.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F122532_46385_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F85393_0_0|SrvcGrp|42972|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|83.25|99|0.00|HAPA WPA-NWPA 2012-13 ASC 243 W/O REV|
20|FH_F105145_75075_0|SrvcGrp|72998|2022|PDM|4849.00|99|0.00|AEG 5|
20|FH_F115788_02904_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115870_98225_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F80513_0_0|SrvcGrp|3029|2022|PDM|445.00|99|0.00|NEWBORN NURSERY|
20|FH_F146672_47424_0|SrvcGrp|46903|2022|PDM|595.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F116088_46410_0|SrvcGrp|73841|2022|PDM|346.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F133583_77074_0|SrvcGrp|90388|2022|PDM|933.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F133478_40165_0|SrvcGrp|90004|2022|PDM|20408.00|99|0.00|MS DRG ONLY|
20|FH_F133494_90023_0|SrvcGrp|106164|2022|PCT|1.40|99|0.00|AETNA ALL DRUGS OR DRUG AGENTS|
20|FH_F130657_04614_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F133491_74012_0|SrvcGrp|89781|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F116464_13088_0|SrvcGrp|104075|2022|PCT|1.05|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F140629_0_0|SrvcGrp|82113|2022|PDM|2497.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F121743_70005_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F33785_0_0|SrvcGrp|14453|2022|PDM|5200.00|99|0.00|LITHOTRIPSY SVCS|
20|FH_F75205_0_0|SrvcGrp|45967|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132689_18436_0|SrvcGrp|90854|2022|PDM|896.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F111301_33122_0|SrvcGrp|88978|2022|PDM|4119.00|99|0.00|VAGINAL DELIVERY|
20|FH_F134315_89106_0|SrvcGrp|24750|2022|PCT|1.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F134315_89106_0|SrvcGrp|22592|2022|PCT|1.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F134930_0_0|SrvcGrp|17100|2022|PCT|0.00|99|0.00|SKILLED NURSING|
20|FH_F131000_0_0|SrvcGrp|100920|2022|PDM|4776.00|99|0.00|SPINE PRO DEVICE|
20|FH_F112082_30720_0|SrvcGrp|95582|2022|PCT|1.10|99|0.00|OP SERVICES AMFS(H) DEFAULT|
20|FH_F87557_33309_0|SrvcGrp|26869|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F125745_66025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141035_0_0|SrvcGrp|98006|2022|PDM|7129.00|99|0.00|PHALANGEAL SHAFT FRACTURE|
20|FH_F102222_19720_0|SrvcGrp|86841|2022|PDM|84.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F98626_29118_0|SrvcGrp|88977|2022|PDM|8925.00|99|0.00|C-SECTION DELIVERY|
20|FH_F101320_26062_0|SrvcGrp|13929|2022|PDM|18.00|99|0.00|GROWTH HORMONE|
20|FH_F62765_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62579_0_0|SrvcGrp|34146|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F62579_0_0|SrvcGrp|22594|2022|PDM|80.00|99|0.00|IMIGLUCERASE|
20|FH_F62974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F143650_0_0|SrvcGrp|26276|2022|PDM|1800.00|99|0.00|CPT 29819|
20|FH_F80776_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F138289_76273_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135660_77061_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F79923_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F100782_0_0|SrvcGrp|105098|2022|PDM|233.40|99|0.00|WINDBER MEDICAL CNTR ASC 143|
20|FH_F51318_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|ASPG VI - FH SW CUSTOM GROUPERS|
20|FH_F100782_0_0|SrvcGrp|108216|2022|PDM|859.25|99|0.00|MIDFACE FLAP|
20|FH_F75862_0_0|SrvcGrp|22954|2022|PDM|154.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 640|
20|FH_F116753_0_0|SrvcGrp|12535|2022|PDM|7465.00|99|0.00|LAPAROSCOPIC HYSTERECTOMY|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|156.82|99|0.00|HAPA WPA-NWPA 2012-13 ASC 240 W/O REV|
20|FH_F92893_75110_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119227_01752_0|SrvcGrp|10577|2022|PDM|38.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F143567_62207_0|SrvcGrp|61956|2022|PDM|138.00|99|0.00|DIABETIC MANAGEMENT|
20|FH_F119379_0_0|SrvcGrp|92014|2022|PDM|1428.00|99|0.00|PHALANGEAL SHAFT FRACTURE|
20|FH_F129548_44130_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F130770_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
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_F59872_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|ASPG II|
20|FH_F134324_26354_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F144228_0_0|SrvcGrp|64735|2022|PDM|936.00|99|0.00|CPT 43235|
20|FH_F132883_31602_0|SrvcGrp|86851|2022|PDM|20.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F109577_0_0|SrvcGrp|29464|2022|PDM|135.00|99|0.00|HOME HEALTH VISIT NEWBORN CARE|
20|FH_F96160_32207_0|SrvcGrp|86832|2022|PDM|5.62|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F71748_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F49853_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F81852_0_0|SrvcGrp|15477|2022|PDM|20.00|99|0.00|PHYSICAL THERAPY SVCS INITIAL EVAL|
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|865.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F138024_40509_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F110420_60649_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134208_21502_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83754_0_0|SrvcGrp|22822|2022|PCT|0.86|99|0.00|CPAP|
20|FH_F129638_0_0|SrvcGrp|15326|2022|PDM|1350.00|99|0.00|ER LEVEL IV|
20|FH_F109367_32751_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|PARTIAL HOSPITALIZATION PSYCHIATRIC|
20|FH_F145686_52591_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.00|99|0.00|AEG 2 (NO REV)|
20|FH_F121225_98902_0|SrvcGrp|74147|2022|PCT|0.85|99|0.00|INFUSION S-CODE PER MONTH|
20|FH_F111986_0_0|SrvcGrp|104115|2022|PDM|1236.00|99|0.00|DESTRUCTION, ANAL LESION(S)|
20|FH_F79245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109242_18466_0|SrvcGrp|90635|2022|PDM|108.00|99|0.00|AETNA PSYTX PT & FAMILY 60 MINUTES|
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F150165_06032_0|SrvcGrp|101527|2022|PDM|1480.00|99|0.00|HYSTEROSCOPY LYSIS|
20|FH_F138951_41101_0|SrvcGrp|86846|2022|PDM|45.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F117300_0_0|SrvcGrp|67068|2022|PDM|7853.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F114510_33445_0|SrvcGrp|73842|2022|PDM|177.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F116806_0_0|SrvcGrp|107044|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MANDIBLE/MAXILLA-PARTIAL ENDOSTEAL IMPLANT|
20|FH_F123850_0_0|SrvcGrp|89781|2022|PDM|198.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 5  (NO REV)|
20|FH_F114527_39047_0|SrvcGrp|90854|2022|PDM|833.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F111566_75093_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F111584_07002_0|SrvcGrp|58705|2022|PDM|144.00|99|0.00|EVALUATION & MANAGEMENT NEW PATIENT (HCFA)|
20|FH_F119795_0_0|SrvcGrp|77021|2022|PDM|5202.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F86851_0_0|SrvcGrp|84963|2022|PDM|520.00|99|0.00|CPT 43215|
20|FH_F87411_0_0|SrvcGrp|85681|2022|PDM|309.00|99|0.00|SLEEP STUDY (MOD TC)|
20|FH_F87474_0_0|SrvcGrp|17139|2022|PDM|616.00|99|0.00|HOSPICE CARE|
20|FH_F123752_44502_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F123784_03264_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F58252_0_0|SrvcGrp|48394|2022|PDM|8.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F136374_34461_0|SrvcGrp|46903|2022|PDM|637.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F136386_30901_0|SrvcGrp|113001|2022|PCT|1.80|99|0.00|ULTRASOUNDS|
20|FH_F118178_37909_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F137147_75006_0|SrvcGrp|88155|2022|PDM|23370.00|99|0.00|REVISE KNEECAP WITH IMPLANT|
20|FH_F137147_75006_0|CSTM-ALL|CSTM-00|2020|PDM|6090.00|99|0.00|AEG 7 (NO REV)|
20|FH_F137242_52722_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142313_14788_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142741_03264_0|SrvcGrp|74668|2022|PDM|1046.50|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F53732_0_0|SrvcGrp|41464|2022|PDM|60.00|99|0.00|REPAIR OF INFUSION DEVICE|
20|FH_F73403_0_0|SrvcGrp|43431|2022|PDM|45.00|99|0.00|LPN|
20|FH_F138469_70433_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|HSS ASC|
20|FH_F132733_0_0|SrvcGrp|3409|2022|PDM|595.00|99|0.00|NEWBORN NURSERY|
20|FH_F132733_0_0|SrvcGrp|58|2022|PDM|9184.00|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140343_89052_0|SrvcGrp|26869|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F140567_46350_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS|
20|FH_F140890_30906_0|SrvcGrp|90854|2022|PDM|966.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F149501_34471_0|SrvcGrp|114102|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F149640_50022_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118932_07652_0|SrvcGrp|73006|2022|PDM|6365.00|99|0.00|AEG 9|
20|FH_F92852_0_0|SrvcGrp|38907|2022|PDM|1320.00|99|0.00|CPT 66170 - FISTULIZATION OF SCLERA FOR GLAUCOMA|
20|FH_F129483_77030_0|SrvcGrp|86829|2022|PDM|5.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F117105_77619_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F137270_82901_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|505.00|99|0.00|AEG 2 (NO REV)|
20|FH_F38948_0_0|SrvcGrp|30191|2022|PDM|1899.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F112263_0_0|SrvcGrp|36591|2022|PDM|7150.00|99|0.00|CPT 63685|
20|FH_F38630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|100% 2007 MEDICARE TN DME  MOD NU|
20|FH_F151099_86429_0|SrvcGrp|74668|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151121_60455_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151155_26508_0|SrvcGrp|113324|2022|PDM|2303.00|99|0.00|MED ASSIST TX INJECT|
20|FH_F151159_46322_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151201_90020_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)|
20|FH_F114968_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35212_0_0|SrvcGrp|9830|2022|PDM|85.50|99|0.00|OT SVCS|
20|FH_F113726_61520_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F66688_0_0|SrvcGrp|46482|2022|PDM|128.00|99|0.00|S9083 PER VISIT|
20|FH_F77067_0_0|SrvcGrp|16|2022|PDM|1288.00|99|0.00|ACUTE REHABILITATION|
20|FH_F114916_30309_0|SrvcGrp|90365|2022|PDM|3000.00|99|0.00|REPAIR METACARPAL FRACTURE|
20|FH_F142448_15701_0|SrvcGrp|22592|2022|PDM|54.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC|
20|FH_F134317_0_0|SrvcGrp|80259|2022|PDM|500.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F138929_0_0|SrvcGrp|55071|2022|PDM|3520.00|99|0.00|ARTHROSCOPY SHOULDER|
20|FH_F132627_0_0|SrvcGrp|27968|2022|PDM|80.58|99|0.00|SKILLED NURSING LPN|
20|FH_F132627_0_0|SrvcGrp|27969|2022|PDM|52.02|99|0.00|HOME HEALTH AIDE|
20|FH_F133002_0_0|SrvcGrp|73000|2022|PDM|1041.00|99|0.00|AEG 6|
20|FH_F130274_63033_0|SrvcGrp|46605|2022|PDM|70.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F88933_0_0|SrvcGrp|38016|2022|PDM|2251.00|99|0.00|ROTATOR CUFF REPAIR|
20|FH_F93252_0_0|SrvcGrp|86426|2022|PDM|2500.00|99|0.00|REMOVE INT/EXT HEM GROUP 2|
20|FH_F114389_50131_0|SrvcGrp|105623|2022|PDM|5.90|99|0.00|NUTRITIONALLY COMPLETE ENTERAL FORMULA (MOD NU)|
20|FH_F124180_0_0|SrvcGrp|72990|2022|PDM|795.00|99|0.00|AEG 1|
20|FH_F149899_0_0|SrvcGrp|109199|2022|PDM|950.00|99|0.00|GI ENDOSCOPY/COLONOSCOPY|
20|FH_F132348_16214_0|SrvcGrp|46605|2022|PDM|116.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F37546_0_0|SrvcGrp|15403|2022|PDM|191.75|99|0.00|SPEECH THERAPY SVCS INITIAL EVAL|
20|FH_F41885_0_0|SrvcGrp|3029|2022|PDM|220.00|99|0.00|NEWBORN NURSERY|
20|FH_F49937_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F130909_33025_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F124234_33410_0|SrvcGrp|75419|2022|PDM|900.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F124613_64735_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124687_64024_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F127995_84010_0|SrvcGrp|86836|2022|PDM|10.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F127995_84010_0|SrvcGrp|86834|2022|PDM|10.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F67882_0_0|SrvcGrp|21801|2022|PDM|2750.00|99|0.00|ICU|
20|FH_F98042_10468_0|SrvcGrp|88977|2022|PDM|9316.00|99|0.00|C-SECTION DELIVERY|
20|FH_F136589_72601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114985_32073_0|SrvcGrp|22529|2022|PDM|387.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|3144.00|99|0.00|AEG 6 (NO REV)|
20|FH_F88744_71103_0|SrvcGrp|73461|2022|PDM|2749.00|99|0.00|AETNA NICU IV|
20|FH_F109577_0_0|SrvcGrp|91214|2022|PDM|123.00|99|0.00|MED NUTRITION|
20|FH_F34145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F41135_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|510.00|99|0.00|AEG 3 (NO REV)|
20|FH_F112827_26452_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127943_68939_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114409_18447_0|SrvcGrp|73701|2022|PDM|31.50|99|0.00|AETNA - SKILLED NURSING|
20|FH_F134508_14072_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122672_44089_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F71829_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85211_0_0|SrvcGrp|40002|2022|PDM|12100.00|99|0.00|TOTAL HIP|
20|FH_F85211_0_0|SrvcGrp|49544|2022|PDM|11000.00|99|0.00|ARTHROPLASTY|
20|FH_F85257_0_0|SrvcGrp|220|2022|PCT|0.55|99|0.00|INTRAOCULAR LENSES|
20|FH_F98780_35022_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F101100_50314_0|SrvcGrp|97922|2022|PDM|9623.00|99|0.00|PARTIAL HYSTERECTOMY|
20|FH_F115909_38133_0|SrvcGrp|73842|2022|PDM|194.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F63625_0_0|SrvcGrp|1259|2022|PDM|5145.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F146812_50401_0|SrvcGrp|114014|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F131671_72301_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131697_33444_0|SrvcGrp|83800|2022|PDM|4100.00|99|0.00|VBAC DELIVERY|
20|FH_F133581_84790_0|CSTM-ALL|CSTM-00|2020|PDM|844.05|99|0.00|AEG 3 (NO REV)|
20|FH_F132250_12550_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F132293_50595_0|SrvcGrp|75506|2022|PCT|0.90|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F132028_68776_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133471_47901_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F130657_04614_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 9 (NO REV)|
20|FH_F133574_91607_0|SrvcGrp|87077|2022|PDM|160.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F138347_77701_0|SrvcGrp|75442|2022|PDM|569.00|99|0.00|OBSERVATION - REV 762|
20|FH_F138424_83402_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139172_40207_0|SrvcGrp|90854|2022|PDM|836.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F139547_42343_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150746_31210_0|SrvcGrp|57968|2022|PDM|52.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F128672_30274_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97640_37043_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F97603_77901_0|SrvcGrp|73559|2022|PDM|7670.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F148667_0_0|SrvcGrp|82113|2022|PDM|2856.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 5  (NO REV)|
20|FH_F40690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ACTIVASE/ALTEPLASE|
20|FH_F147082_02359_0|CSTM-ALL|CSTM-00|2020|PDM|473.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F101441_0_0|SrvcGrp|84442|2022|PDM|10266.00|99|0.00|REVISION KNEE|
20|FH_F44279_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98820_81401_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F129297_97828_0|SrvcGrp|11108|2022|PDM|1330.00|99|0.00|NEWBORN NURSERY|
20|FH_F110732_31513_0|SrvcGrp|73006|2022|PDM|2497.00|99|0.00|AEG 9|
20|FH_F124514_21215_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F40991_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|2185.00|99|0.00|AEG 5  (NO REV)|
20|FH_F151043_71901_0|SrvcGrp|10365|2022|PDM|400.00|99|0.00|CPT CODE 99285|
20|FH_F73923_0_0|SrvcGrp|71220|2022|PDM|647.00|99|0.00|SIGMOIDOSCOPY  CPT 45334|
20|FH_F137748_95231_0|SrvcGrp|104363|2022|PCT|1.00|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|1426.00|99|0.00|AEG 3 (NO REV)|
20|FH_F143564_0_0|SrvcGrp|82298|2022|PDM|23083.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY|
20|FH_F50498_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F67280_0_0|SrvcGrp|44106|2022|PDM|54.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F150982_0_0|SrvcGrp|87677|2022|PDM|2080.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F124334_68022_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90817_0_0|SrvcGrp|91037|2022|PDM|2068.00|99|0.00|LAP HERNIORRHAPY (HCFA)|
20|FH_F94502_0_0|SrvcGrp|59291|2022|PDM|406.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F134846_06437_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147209_60202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|VERTICAL PLUS MRI MOD AW|
20|FH_F116437_0_0|SrvcGrp|38909|2022|PDM|1757.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F138017_73129_0|SrvcGrp|113306|2022|PDM|6883.00|99|0.00|HYSTEROSCOPY|
20|FH_F37960_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F109251_62269_0|SrvcGrp|88621|2022|PDM|78.03|99|0.00|SKILLED NURSING LPN|
20|FH_F120040_72703_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F41463_0_0|SrvcGrp|34415|2022|PDM|259.94|99|0.00|DME|
20|FH_F134732_0_0|SrvcGrp|109137|2022|PDM|2248.00|99|0.00|AV FISTULA REVISION|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|376.42|99|0.00|SALLY BALIN,999182,ASC 102|
20|FH_F110841_53012_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER NUKC|
20|FH_F102525_73134_0|SrvcGrp|28213|2022|PDM|17000.00|99|0.00|MS DRG 472 ONLY|
20|FH_F137788_72632_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F90817_0_0|SrvcGrp|53703|2022|PDM|2256.00|99|0.00|REVISE AQUEOUS SHUNT TO EXTRAOCULAR RESIVOIR|
20|FH_F122282_30080_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F38123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER QW|
20|FH_F148553_85016_0|SrvcGrp|115468|2022|PDM|2850.00|99|0.00|CORONARY ARTERY ANGIO S&I|
20|FH_F148553_85016_0|SrvcGrp|115473|2022|PDM|2907.00|99|0.00|RIGHT & LEFT HEART ART/VENTRICLE ANGIO|
20|FH_F115631_65201_0|SrvcGrp|58638|2022|PDM|3177.00|99|0.00|CPT 63688|
20|FH_F116199_75042_0|SrvcGrp|73842|2022|PDM|172.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F116233_33612_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F147414_92656_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F41463_0_0|SrvcGrp|24751|2022|PDM|81.00|99|0.00|INTERMITTENT ANTICOAGULANT THERAPY|
20|FH_F42708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F118792_63379_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS|
20|FH_F84611_30281_0|SrvcGrp|73008|2022|PDM|3643.00|99|0.00|AEG 10|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F40800_0_0|SrvcGrp|3029|2022|PDM|250.00|99|0.00|NEWBORN NURSERY|
20|FH_F123445_0_0|SrvcGrp|94781|2022|PDM|194.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F48348_61605_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F48772_66044_0|SrvcGrp|29347|2022|PDM|70.00|99|0.00|HOME HEALTH AIDE|
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|741.00|99|0.00|AEG 4 (NO REV)|
20|FH_F104802_0_0|SrvcGrp|14165|2022|PDM|350.00|99|0.00|PARTIAL HOSP PSYCH/CD|
20|FH_F36541_0_0|SrvcGrp|9774|2022|PDM|2645.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F77625_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150939_0_0|SrvcGrp|100246|2022|PCT|0.00|99|0.00|STREP A ASSAY W/ OPTIC|
20|FH_F150939_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114853_0_0|SrvcGrp|89842|2022|PDM|7699.00|99|0.00|LUMBAR|
20|FH_F42985_0_0|CSTM-ALL|CSTM-00|2020|PDM|360.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113585_20155_0|SrvcGrp|88621|2022|PDM|125.00|99|0.00|SKILLED NURSING LPN|
20|FH_F138787_32258_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F138876_25302_0|SrvcGrp|13929|2022|PDM|15.00|99|0.00|GROWTH HORMONE|
20|FH_F78265_0_0|SrvcGrp|12401|2022|PDM|114.00|99|0.00|RN VISIT|
20|FH_F113390_0_0|SrvcGrp|105245|2022|PDM|880.00|99|0.00|CREATE EARDRUM OPENING|
20|FH_F83152_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F113527_31023_0|SrvcGrp|75495|2022|PCT|0.80|99|0.00|AEG 9|
20|FH_F151503_30067_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 2 (NO REV)|
20|FH_F135583_17331_0|SrvcGrp|109384|2022|PDM|2313.00|99|0.00|CAT SCAN W/ ER SVCS|
20|FH_F91764_93710_0|SrvcGrp|75444|2022|PDM|15015.00|99|0.00|MS DRG 742-743 ONLY|
20|FH_F91764_93710_0|SrvcGrp|112762|2022|PCT|2.19|99|0.00|INFECTIOUS AGENT ANTIGEN DETECTION|
20|FH_F119885_13753_0|SrvcGrp|473|2022|PDM|285.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F100880_67735_0|SrvcGrp|53770|2022|PDM|783.00|99|0.00|ECT|
20|FH_F130996_34110_0|SrvcGrp|58993|2022|PDM|6750.00|99|0.00|DISKECTOMY|
20|FH_F111292_33136_0|SrvcGrp|72994|2022|PDM|4001.00|99|0.00|AEG 3|
20|FH_F40838_0_0|SrvcGrp|33410|2022|PDM|1400.00|99|0.00|ACUTE IP SURGICAL SERVICES|
20|FH_F45793_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39925_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F41780_0_0|SrvcGrp|31187|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF (DME)|
20|FH_F131000_0_0|SrvcGrp|78096|2022|PDM|3608.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F132328_0_0|SrvcGrp|103835|2022|PDM|2123.00|99|0.00|AETNA REMOVE BLADDER STONE|
20|FH_F141035_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F140102_0_0|SrvcGrp|104226|2022|PDM|105.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F129240_10028_0|SrvcGrp|86844|2022|PDM|50.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F102960_50613_0|CSTM-ALL|CSTM-00|2020|PDM|5578.00|99|0.00|AEG 10 (NO REV)|
20|FH_F102064_63565_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143542_0_0|SrvcGrp|114442|2022|PDM|12049.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F77462_0_0|SrvcGrp|43958|2022|PDM|110.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F148482_20136_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148492_28027_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115315_43011_0|SrvcGrp|94735|2022|PCT|1.00|99|0.00|AFLURIA VACC IM (>=3 YRS)|
20|FH_F90811_0_0|SrvcGrp|86462|2022|PDM|1500.00|99|0.00|AREOLA RECONSTRUCTION|
20|FH_F125672_92663_0|SrvcGrp|75442|2022|PDM|677.83|99|0.00|OBSERVATION - REV 762|
20|FH_F149840_80002_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|NON-ANESTHESIOLOGY (HANE) (HSMI) (SAMD)|
20|FH_F128445_85704_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F150480_14043_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F144388_19904_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F34109_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS|
20|FH_F132999_19901_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128605_20910_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|AEG 2 (NO REV)|
20|FH_F150527_33844_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|212.24|99|0.00|HAPA WPA-NWPA 2012-13 ASC 128 W/O REV|
20|FH_F117559_08619_0|SrvcGrp|114540|2022|PDM|40.00|99|0.00|ADM SARS COV2 10MCG TRS-SUCR 2|
20|FH_F43078_0_0|SrvcGrp|22954|2022|PDM|140.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F97565_83301_0|SrvcGrp|73601|2022|PDM|9234.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
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|400.85|99|0.00|ASPG 105|
20|FH_F119007_0_0|SrvcGrp|98326|2022|PDM|2721.00|99|0.00|PERQ LAMOT/LAM LUMBAR|
20|FH_F133018_84037_0|SrvcGrp|16750|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F102188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97541_33021_0|SrvcGrp|73461|2022|PDM|10642.00|99|0.00|AETNA NICU IV|
20|FH_F96102_33884_0|SrvcGrp|77012|2022|PCT|1.00|99|0.00|PT OT ST|
20|FH_F124928_04210_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F94222_62269_0|SrvcGrp|90898|2022|PDM|62.17|99|0.00|TREATMENT OF SPEECH|
20|FH_F85091_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F90698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F94643_90501_0|SrvcGrp|17016|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F114206_37203_0|SrvcGrp|86779|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F128753_32501_0|SrvcGrp|83678|2022|PCT|0.64|99|0.00|AETNA THERAPY|
20|FH_F35987_0_0|SrvcGrp|38|2022|PDM|3608.00|99|0.00|NORMAL DELIVERY|
20|FH_F113545_11201_0|SrvcGrp|86749|2022|PCT|1.02|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F89674_18640_0|SrvcGrp|46605|2022|PDM|68.25|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F149662_85015_0|SrvcGrp|108910|2022|PDM|9267.00|99|0.00|REVISE HIP ARTHROP|
20|FH_F86717_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146859_0_0|CSTM-ALL|CSTM-00|2020|PDM|1791.00|99|0.00|AEG 7 (NO REV)|
20|FH_F93392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129970_34986_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F128753_32501_0|SrvcGrp|93924|2022|PCT|0.64|99|0.00|AETNA MEDICAL SERVICES|
20|FH_F124381_27610_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F150913_70068_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.00|99|0.00|ASPG VI|
20|FH_F143348_16214_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F93287_0_0|CSTM-ALL|CSTM-00|2020|PDM|395.00|99|0.00|AEG 1 (NO REV)|
20|FH_F125249_0_0|SrvcGrp|89404|2022|PDM|16500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F101540_0_0|SrvcGrp|75545|2022|PDM|327.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F131090_44622_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131173_17043_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F49051_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132394_15317_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116698_07470_0|SrvcGrp|86849|2022|PDM|39.90|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F116698_07470_0|SrvcGrp|24754|2022|PDM|21.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F120927_28645_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F51276_0_0|SrvcGrp|34389|2022|PDM|150.00|99|0.00|SPEECH THERAPY|
20|FH_F33925_0_0|SrvcGrp|15775|2022|PDM|5000.00|99|0.00|CARDIAC CATH|
20|FH_F150280_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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F46258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|B CODES (MOD RR) - WALGREENS|
20|FH_F48133_0_0|SrvcGrp|42871|2022|PDM|40.12|99|0.00|SPEECH THERAPY VISIT|
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F148259_99163_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36822_0_0|SrvcGrp|18136|2022|PDM|11814.00|99|0.00|MS DRG 245|
20|FH_F130512_40205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109246_10018_0|SrvcGrp|104186|2022|PDM|12.50|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F43436_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90840_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OTHER OP  SERV MOD TC|
20|FH_F39545_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F141517_73034_0|SrvcGrp|89149|2022|PDM|181.38|99|0.00|OP INTENSIVE|
20|FH_F37884_0_0|SrvcGrp|13620|2022|PDM|750.00|99|0.00|SLEEP STUDIES|
20|FH_F135178_84049_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F82931_18847_0|SrvcGrp|13681|2022|PDM|311.13|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 2 (NO REV)|
20|FH_F60072_0_0|SrvcGrp|9444|2022|PCT|1.00|99|0.00|AMBULANCE SERVICES|
20|FH_F125249_0_0|SrvcGrp|104111|2022|PDM|900.00|99|0.00|EXCISE WRIST TENDON SHEATH|
20|FH_F143528_0_0|SrvcGrp|67279|2022|PDM|10500.00|99|0.00|CERVICAL SURGERY|
20|FH_F134996_83467_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|3023.00|99|0.00|AEG 5  (NO REV)|
20|FH_F37753_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|520.00|99|0.00|AEG 2 (NO REV)|
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|683.00|99|0.00|AEG 1 (NO REV)|
20|FH_F151146_0_0|CSTM-ALL|CSTM-00|2020|PDM|1363.00|99|0.00|AEG 3 (NO REV)|
20|FH_F128159_45356_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131254_92211_0|SrvcGrp|14949|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F129305_45614_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F129400_32726_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/MOD AV  (TN)|
20|FH_F143528_0_0|SrvcGrp|15473|2022|PDM|4076.10|99|0.00|CPT CODE 42820|
20|FH_F38798_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|NEBULIZER (DME) (MOD NU)|
20|FH_F37587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148265_06067_0|SrvcGrp|99073|2022|PCT|1.14|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F145803_19061_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F46612_0_0|SrvcGrp|10410|2022|PDM|83.00|99|0.00|SKILLED NURSING CARE|
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100761_02539_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F109343_0_0|SrvcGrp|103605|2022|PCT|0.00|99|0.00|BIRTHING CENTER|
20|FH_F127550_43026_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F93902_04043_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F129404_33461_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35388_0_0|SrvcGrp|9911|2022|PCT|0.65|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F149140_07522_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 3 (NO REV)|
20|FH_F137847_0_0|SrvcGrp|106048|2022|PDM|725.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F150024_08079_0|SrvcGrp|77021|2022|PDM|3500.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F141802_17042_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F142967_65065_0|SrvcGrp|98372|2022|PCT|1.00|99|0.00|SPEECH EVALUATION|
20|FH_F101840_76054_0|SrvcGrp|21206|2022|PDM|6608.00|99|0.00|MS DRG 713 ONLY|
20|FH_F43296_0_0|SrvcGrp|16684|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F126666_44053_0|SrvcGrp|105374|2022|PDM|88.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MIN|
20|FH_F148886_60621_0|SrvcGrp|105465|2022|PCT|1.35|99|0.00|AETNA THERAPIES|
20|FH_F69648_0_0|SrvcGrp|46605|2022|PDM|11.25|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F100740_15206_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F71926_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SPEECH THERAPY|
20|FH_F138532_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD AU|
20|FH_F51438_0_0|SrvcGrp|22019|2022|PCT|0.65|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F44607_0_0|SrvcGrp|38807|2022|PDM|2500.00|99|0.00|ACUTE SURGICAL SERVICES|
20|FH_F126733_83713_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F139607_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|1512.00|99|0.00|AEG 9 (NO REV)|
20|FH_F109642_80501_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F128421_27016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F87334_16507_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F81151_16801_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133018_84037_0|SrvcGrp|14948|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F147988_78759_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F33788_0_0|SrvcGrp|12674|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|5885.00|99|0.00|AEG 8 (NO REV)|
20|FH_F38865_0_0|SrvcGrp|3364|2022|PCT|0.75|99|0.00|IMPLANTS|
20|FH_F130556_33764_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141870_85224_0|SrvcGrp|86833|2022|PDM|25.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F139298_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F106540_26330_0|SrvcGrp|72990|2022|PDM|1519.00|99|0.00|AEG 1|
20|FH_F43330_0_0|SrvcGrp|15520|2022|PDM|30.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|2265.00|99|0.00|AEG 8 (NO REV)|
20|FH_F119825_0_0|SrvcGrp|104229|2022|PDM|100.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F95980_20016_0|SrvcGrp|70381|2022|PDM|311.00|99|0.00|PSYCH PARTIAL HOSP (FULL & PARTIAL DAY) PER VISIT|
20|FH_F40728_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91262_77036_0|SrvcGrp|48396|2022|PDM|90.00|99|0.00|OT SERVICES|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|283.45|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1601 W/O REV|
20|FH_F117885_81506_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F55375_0_0|SrvcGrp|17067|2022|PDM|1649.00|99|0.00|ASPG II|
20|FH_F133018_84037_0|SrvcGrp|48396|2022|PDM|85.50|99|0.00|OT SERVICES|
20|FH_F133396_72301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F39706_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F109624_15401_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F75643_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F144508_44107_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC|
20|FH_F134830_0_0|SrvcGrp|92502|2022|PDM|975.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F111540_16823_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.25|99|0.00|ASPG 228|
20|FH_F132900_06074_0|SrvcGrp|90397|2022|PDM|441.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F133533_33901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F69123_0_0|SrvcGrp|29826|2022|PCT|1.00|99|0.00|AWP  J & Q CODES|
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|431.00|99|0.00|AEG 1 (NO REV)|
20|FH_F133474_0_0|SrvcGrp|112884|2022|PDM|20.00|99|0.00|ADD'L SUPPLIES, MATERIALS, STAFF; PUBLIC HEALTH EMERGENCY|
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|783.00|99|0.00|ASPG II|
20|FH_F149840_80002_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|BONE MARROW W/BIOPSY (HBMW) (HBIO)|
20|FH_F57592_0_0|SrvcGrp|8950|2022|PDM|5000.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F132934_63005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F141833_31707_0|SrvcGrp|13262|2022|PDM|11.25|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F42494_0_0|SrvcGrp|3029|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F69123_0_0|SrvcGrp|29462|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE - MOD TF|
20|FH_F87577_80016_0|SrvcGrp|9517|2022|PDM|327.00|99|0.00|MAMMOGRAPHY|
20|FH_F133397_23233_0|SrvcGrp|66225|2022|PDM|146.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F150948_0_0|SrvcGrp|113857|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES|
20|FH_F80855_0_0|SrvcGrp|78093|2022|PDM|1100.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F119437_0_0|SrvcGrp|88160|2022|PDM|4750.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F113146_15001_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F139553_30084_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150719_30012_0|SrvcGrp|115845|2022|PCT|1.10|99|0.00|PALLIATIVE SERVICES|
20|FH_F150820_83843_0|CSTM-ALL|CSTM-00|2020|PDM|4136.00|99|0.00|AEG 7 (NO REV)|
20|FH_F150839_03833_0|SrvcGrp|48385|2022|PDM|170.00|99|0.00|SPEECH THERAPY|
20|FH_F150841_84757_0|SrvcGrp|75419|2022|PDM|880.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F150882_84041_0|SrvcGrp|86851|2022|PDM|47.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F150882_84041_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F151202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F114171_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F90213_30084_0|SrvcGrp|3809|2022|PDM|602.14|99|0.00|HOSPICE 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_F150459_08021_0|SrvcGrp|104229|2022|PDM|126.50|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|1433.00|99|0.00|AEG 9 (NO REV)|
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F146266_0_0|SrvcGrp|85792|2022|PDM|4200.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F147343_17011_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F110804_11373_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F40979_0_0|SrvcGrp|10361|2022|PDM|80.00|99|0.00|CPT CODE 99281|
20|FH_F90196_10467_0|SrvcGrp|52953|2022|PDM|83.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F134968_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F150999_20678_0|SrvcGrp|111929|2022|PDM|15.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F38742_0_0|SrvcGrp|19742|2022|PDM|80.00|99|0.00|MID-LINE INSERTION|
20|FH_F127418_0_0|SrvcGrp|89840|2022|PDM|26026.88|99|0.00|THORAX SPINE FUSION|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD UE KE RATE|
20|FH_F135263_0_0|SrvcGrp|112740|2022|PDM|900.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117576_21207_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F114207_35243_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42746_0_0|SrvcGrp|15403|2022|PDM|55.00|99|0.00|SPEECH THERAPY SVCS INITIAL EVAL|
20|FH_F41374_0_0|SrvcGrp|1306|2022|PDM|250.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F35446_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|REHABILITATION DAY PROGRAM|
20|FH_F112045_90301_0|SrvcGrp|83423|2022|PDM|8379.00|99|0.00|LAPROSCOPIC CHOLECYSTECTOMY|
20|FH_F147143_18706_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139147_0_0|SrvcGrp|59840|2022|PDM|3713.00|99|0.00|TYMPANOSTOMY|
20|FH_F148859_0_0|SrvcGrp|103992|2022|PDM|1353.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F35088_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|MULTIPLE BIRTH|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MS DRG 001-002 HEART TRANSPLANT|
20|FH_F139877_32615_0|SrvcGrp|113244|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 3 TRGT (HCFA)|
20|FH_F41155_0_0|SrvcGrp|12231|2022|PCT|0.70|99|0.00|TPA|
20|FH_F76285_0_0|SrvcGrp|48645|2022|PDM|126.00|99|0.00|OP SKILLED NURSING|
20|FH_F123377_0_0|SrvcGrp|63|2022|PDM|1794.00|99|0.00|SUBACUTE CARE|
20|FH_F38753_0_0|SrvcGrp|1168|2022|PDM|28.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F50398_0_0|SrvcGrp|44820|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F151019_14094_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F112956_0_0|SrvcGrp|75481|2022|PDM|536.00|99|0.00|AEG 2|
20|FH_F110726_19720_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F124433_77338_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F137986_0_0|SrvcGrp|71666|2022|PDM|3000.00|99|0.00|CPT 63655|
20|FH_F47558_0_0|SrvcGrp|43269|2022|PDM|35.00|99|0.00|CATHETER REPAIR|
20|FH_F50493_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124309_24112_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124703_65711_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F76826_0_0|SrvcGrp|16429|2022|PDM|63.00|99|0.00|OBSERVATION SVCS|
20|FH_F36683_0_0|SrvcGrp|18154|2022|PDM|11149.00|99|0.00|MS DRG 251|
20|FH_F128743_57252_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F34882_0_0|CSTM-ALL|CSTM-00|2020|PDM|1011.00|99|0.00|ACUTE PSYCH|
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|MULT FAM BEHAV TREAT GUIDE (HCFA)|
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|3496.00|99|0.00|AEG 6 (NO REV)|
20|FH_F134916_16421_0|SrvcGrp|13595|2022|PDM|244.88|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F150419_64119_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132254_40207_0|SrvcGrp|26869|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F43485_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|OP SVCS|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|113.00|99|0.00|MIDLINE INSERTION KIT|
20|FH_F124470_90025_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F32825_0_0|SrvcGrp|18559|2022|PCT|0.65|99|0.00|MS DRG 743|
20|FH_F35416_0_0|SrvcGrp|15967|2022|PDM|3420.00|99|0.00|ICU|
20|FH_F99420_91326_0|SrvcGrp|11000|2022|PCT|0.85|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F149003_62208_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F35167_0_0|SrvcGrp|24|2022|PCT|0.65|99|0.00|CARDIAC CATH|
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|931.00|99|0.00|ASPG III|
20|FH_F137788_72632_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F40899_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F92299_62016_0|SrvcGrp|79099|2022|PDM|1450.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F144831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129237_72833_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131028_49735_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112794_01040_0|SrvcGrp|94737|2022|PCT|1.00|99|0.00|FLUVIRIN VACC IM (>=3 YRS)|
20|FH_F134846_06437_0|SrvcGrp|471|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F145567_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F114416_0_0|SrvcGrp|63119|2022|PDM|31.00|99|0.00|BASIC HOME HOSPICE CARE|
20|FH_F139878_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140097_19145_0|SrvcGrp|89417|2022|PDM|370.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F140170_15301_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143214_92506_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F143347_16001_0|SrvcGrp|73842|2022|PDM|281.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F62892_0_0|SrvcGrp|58848|2022|PDM|500.00|99|0.00|HOSPICE GENERAL CARE|
20|FH_F122687_0_0|SrvcGrp|109186|2022|PDM|12020.00|99|0.00|NECK/SPINE SURGERY|
20|FH_F127205_44125_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F135175_45121_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F90852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113546_0_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F110925_01104_0|SrvcGrp|82821|2022|PDM|37.00|99|0.00|INJECTION, IMMUNE GLOBULIN (BIVIGAM)|
20|FH_F86752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|67066|2022|PDM|8368.00|99|0.00|CERVICAL SURGERY|
20|FH_F44198_0_0|SrvcGrp|13595|2022|PDM|357.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F143748_02904_0|SrvcGrp|75545|2022|PDM|250.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129305_45614_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F62892_0_0|SrvcGrp|44423|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE (VISIT LVL)|
20|FH_F123278_20850_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F130032_72034_0|SrvcGrp|3178|2022|PDM|896.00|99|0.00|ACUTE PSYCH|
20|FH_F109346_0_0|SrvcGrp|359|2022|PDM|550.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F111288_0_0|SrvcGrp|67064|2022|PDM|862.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F44495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141001_24739_0|SrvcGrp|113642|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|479.00|99|0.00|AEG 10 (NO REV)|
20|FH_F135187_80229_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|2398.00|99|0.00|AEG 4 (NO REV)|
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PDM|2049.00|99|0.00|AEG 4 (NO REV)|
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|1275.00|99|0.00|AEG 9 (NO REV)|
20|FH_F37679_0_0|SrvcGrp|17006|2022|PDM|61.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS|
20|FH_F119384_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F93791_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_F120647_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F150699_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F142073_0_0|SrvcGrp|92416|2022|PDM|5980.00|99|0.00|CERVICAL LAMINOTOMY|
20|FH_F31519_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS|
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.00|99|0.00|AEG 3 (NO REV)|
20|FH_F72930_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F69322_0_0|SrvcGrp|166|2022|PDM|760.00|99|0.00|CD (ADULT) - DETOXIFICATION|
20|FH_F93332_0_0|SrvcGrp|93062|2022|PDM|3090.00|99|0.00|PERQ CERVICOTHORACIC INJECTION (HCFA)|
20|FH_F37884_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD KN|
20|FH_F73013_0_0|SrvcGrp|15527|2022|PDM|26.15|99|0.00|HYDRATION THERAPY|
20|FH_F124017_0_0|SrvcGrp|109674|2022|PDM|3500.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY|
20|FH_F115985_0_0|SrvcGrp|15557|2022|PDM|444.00|99|0.00|VENTILATOR|
20|FH_F116392_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|OP SVCS|
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F145748_30084_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120952_25303_0|SrvcGrp|111242|2022|PDM|110.00|99|0.00|PT ASSISTANT (HCFA)|
20|FH_F33712_0_0|SrvcGrp|10964|2022|PDM|1500.00|99|0.00|ACUTE IP MED/SURG SVCS|
20|FH_F110925_01104_0|SrvcGrp|86140|2022|PDM|191.88|99|0.00|AETNA ALGLUCOSIDASE|
20|FH_F64160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F89778_0_0|SrvcGrp|88820|2022|PDM|1470.32|99|0.00|CPT 24359|
20|FH_F78003_0_0|SrvcGrp|35964|2022|PDM|45.00|99|0.00|SPEECH THERAPY|
20|FH_F132544_0_0|SrvcGrp|97362|2022|PDM|8007.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F119444_72903_0|SrvcGrp|73841|2022|PDM|386.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F119413_95123_0|SrvcGrp|108484|2022|PDM|1100.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F39640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|DME - MOD 53|
20|FH_F67265_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|PEDIATRIC PSYCHIATRIC SERVICES|
20|FH_F46196_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F41392_0_0|CSTM-ALL|CSTM-00|2020|PDM|774.00|99|0.00|ASPG IV|
20|FH_F47433_0_0|SrvcGrp|30623|2022|PDM|10660.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F150001_33064_0|SrvcGrp|86839|2022|PDM|26.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F149841_73114_0|SrvcGrp|108484|2022|PDM|483.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 9 (NO REV)|
20|FH_F133018_84037_0|SrvcGrp|88621|2022|PDM|60.75|99|0.00|SKILLED NURSING LPN|
20|FH_F67861_0_0|SrvcGrp|3418|2022|PDM|1650.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F38249_0_0|SrvcGrp|18120|2022|PCT|0.95|99|0.00|MS DRG 003|
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 10 (NO REV)|
20|FH_F125255_34769_0|SrvcGrp|73841|2022|PDM|200.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F38914_0_0|SrvcGrp|115|2022|PDM|420.00|99|0.00|SKILLED NURSING CARE|
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.00|99|0.00|ASPG IX|
20|FH_F100786_24740_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F36579_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F117087_0_0|SrvcGrp|107184|2022|PDM|2494.00|99|0.00|REVISE MIDDLE EAR BONE|
20|FH_F92677_08003_0|SrvcGrp|24761|2022|PDM|52.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD AU)|
20|FH_F49354_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|152.00|99|0.00|HAPA EPA ASC 25|
20|FH_F145937_75240_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|3600.00|99|0.00|AEG 9 (NO REV)|
20|FH_F127327_27401_0|SrvcGrp|73601|2022|PDM|2036.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F111809_93003_0|SrvcGrp|114115|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F49637_0_0|SrvcGrp|45545|2022|PDM|11025.00|99|0.00|MS DRG 407 ONLY|
20|FH_F128246_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142014_33170_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|1287.50|99|0.00|AEG 2 (NO REV)|
20|FH_F51438_0_0|SrvcGrp|3327|2022|PDM|175.00|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|264.00|99|0.00|HAPA EPA ASC 35|
20|FH_F146320_27610_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97561_30030_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100682_97401_0|SrvcGrp|73485|2022|PDM|3948.00|99|0.00|AETNA REHAB|
20|FH_F133287_40215_0|SrvcGrp|99362|2022|PDM|151.00|99|0.00|DX MAMMO INCL CAD BI|
20|FH_F101840_76054_0|SrvcGrp|97473|2022|PDM|8207.00|99|0.00|EXPLORE PARATHYROID GLANDS|
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117838_12901_0|SrvcGrp|76501|2022|PDM|250.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F150164_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36908_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F106580_33321_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F111780_38603_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135651_0_0|SrvcGrp|93736|2022|PDM|128.00|99|0.00|URGENT CARE|
20|FH_F128919_48075_0|SrvcGrp|83857|2022|PDM|550.00|99|0.00|IP HOSPICE SVCS|
20|FH_F126911_62301_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125176_20785_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F144020_15401_0|SrvcGrp|109057|2022|PCT|0.93|99|0.00|CARDIAC STUDIES|
20|FH_F80855_0_0|SrvcGrp|78098|2022|PDM|1100.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F67560_0_0|SrvcGrp|17067|2022|PCT|0.83|99|0.00|ASPG II|
20|FH_F97564_52246_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F128130_10027_0|CSTM-ALL|CSTM-00|2020|PDM|6174.00|99|0.00|AEG 5  (NO REV)|
20|FH_F123545_44512_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F32936_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133472_27607_0|SrvcGrp|75419|2022|PDM|1006.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F44612_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|IMPLANTS|
20|FH_F132503_73086_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F148599_98034_0|CSTM-ALL|CSTM-00|2020|PCT|2.62|99|0.00|HSS APC G  PROCEDURE NOT ON FS OR W/O WEIGHT|
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 484|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|122.22|99|0.00|ASPG 122|
20|FH_F116825_0_0|SrvcGrp|471|2022|PDM|1219.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F142822_63437_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67265_0_0|CSTM-ALL|CSTM-00|2020|PDM|267.00|99|0.00|INTENSIVE OP SUBSTANCE ABUSE PROGRAM|
20|FH_F42520_0_0|SrvcGrp|26010|2022|PDM|52.00|99|0.00|CPT CODES 00100-01999|
20|FH_F87155_04105_0|SrvcGrp|24752|2022|PDM|18.91|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F102561_75146_0|SrvcGrp|73463|2022|PDM|1000.00|99|0.00|AETNA NICU II|
20|FH_F118363_30305_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124608_0_0|SrvcGrp|92820|2022|PDM|2747.00|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY|
20|FH_F111546_84010_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117756_75402_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F148886_60621_0|SrvcGrp|96063|2022|PDM|30502.00|99|0.00|AETNA PTCA|
20|FH_F39844_0_0|SrvcGrp|941|2022|PDM|1485.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F150948_0_0|SrvcGrp|113854|2022|PDM|4740.00|99|0.00|REMOVE/REINSER SPINE FIXATION DEVICE|
20|FH_F32281_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|1585.00|99|0.00|AEG 7 (NO REV)|
20|FH_F144769_0_0|SrvcGrp|104458|2022|PDM|4928.00|99|0.00|MATERNITY CARE (VAGINAL DELIVERY)|
20|FH_F150532_16801_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117855_62246_0|SrvcGrp|48385|2022|PDM|61.00|99|0.00|SPEECH THERAPY|
20|FH_F127994_19301_0|SrvcGrp|86723|2022|PDM|324.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119206_35007_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150949_0_0|SrvcGrp|88157|2022|PDM|10950.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F149781_37404_0|SrvcGrp|89983|2022|PDM|3146.00|99|0.00|KNEE ARTHROSCOPY / SURGERY|
20|FH_F67861_0_0|SrvcGrp|27271|2022|PDM|17600.00|99|0.00|GASTRIC BYPASS|
20|FH_F106580_33321_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F122648_0_0|SrvcGrp|107187|2022|PDM|1306.00|99|0.00|REVISE TWO EYE MUSCLES|
20|FH_F148644_06890_0|SrvcGrp|70746|2022|PDM|3908.00|99|0.00|CPT 28292|
20|FH_F148644_06890_0|SrvcGrp|72121|2022|PDM|3794.00|99|0.00|ARTHOSCOPY|
20|FH_F148721_67205_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151141_24014_0|CSTM-ALL|CSTM-00|2020|PDM|1433.00|99|0.00|AEG 3 (NO REV)|
20|FH_F151144_35801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151223_73077_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121385_89102_0|SrvcGrp|109219|2022|PDM|10944.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|1690.00|99|0.00|AEG 8 (NO REV)|
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_F136467_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123595_70546_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F123763_80130_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F134253_48879_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136372_19046_0|SrvcGrp|73842|2022|PDM|186.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136377_75240_0|SrvcGrp|73841|2022|PDM|420.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F132349_66111_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132473_38018_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116802_41224_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116904_17543_0|SrvcGrp|472|2022|PDM|477.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116913_77024_0|SrvcGrp|100499|2022|PDM|520.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F120974_27607_0|SrvcGrp|472|2022|PDM|723.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120977_50510_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F46732_0_0|SrvcGrp|12702|2022|PDM|72.00|99|0.00|RN, INTERMITTENT VISIT|
20|FH_F70493_0_0|SrvcGrp|67283|2022|PDM|57.00|99|0.00|PT SUBSEQUENT VISIT 97799|
20|FH_F59732_0_0|SrvcGrp|50046|2022|PDM|150.00|99|0.00|PHOTOTHERAPY VISIT|
20|FH_F59732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F35271_0_0|SrvcGrp|19973|2022|PDM|550.00|99|0.00|CAT SCAN|
20|FH_F117783_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F62915_0_0|SrvcGrp|42870|2022|PDM|208.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F89475_71202_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F97102_83501_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F71282_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|IMPLANTS|
20|FH_F93055_34601_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE|
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|827.00|99|0.00|AEG 4 (NO REV)|
20|FH_F116760_68512_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F135236_02840_0|CSTM-ALL|CSTM-00|2020|PCT|1.01|99|0.00|OP SVCS|
20|FH_F74242_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F34513_0_0|SrvcGrp|9861|2022|PDM|1232.00|99|0.00|ACUTE REHABILITATION|
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PDM|2450.00|99|0.00|AEG 7 (NO REV)|
20|FH_F32935_0_0|SrvcGrp|3069|2022|PCT|0.35|99|0.00|IMPLANTS|
20|FH_F141517_73034_0|SrvcGrp|73841|2022|PDM|398.18|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F43858_0_0|SrvcGrp|37406|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F91994_0_0|SrvcGrp|16719|2022|PCT|1.15|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F130747_0_0|SrvcGrp|88596|2022|PDM|5202.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE|
20|FH_F94942_0_0|SrvcGrp|114518|2022|PDM|3500.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 6 (NO REV)|
20|FH_F41776_0_0|CSTM-ALL|CSTM-00|2020|PDM|4410.00|99|0.00|ASPG VIII|
20|FH_F84215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|2730.00|99|0.00|AEG 9 (NO REV)|
20|FH_F34112_0_0|SrvcGrp|16|2022|PDM|975.00|99|0.00|ACUTE REHABILITATION|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2004 NATIONAL RBRVS CPT F/S|
20|FH_F135077_60014_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F90840_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|874.00|99|0.00|AEG 1 (NO REV)|
20|FH_F116955_16801_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F139515_0_0|SrvcGrp|88487|2022|PDM|7236.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F148122_49435_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F148255_72703_0|SrvcGrp|86827|2022|PDM|57.75|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F38591_0_0|SrvcGrp|29062|2022|PCT|1.00|99|0.00|AMBULATORY SERVICES|
20|FH_F141794_50548_0|SrvcGrp|103913|2022|PCT|0.75|99|0.00|OP DIALYSIS|
20|FH_F94942_0_0|SrvcGrp|75497|2022|PDM|924.94|99|0.00|AEG 10|
20|FH_F37679_0_0|SrvcGrp|26849|2022|PDM|30.50|99|0.00|HOME INFUSION THERAPY (MOD SH)|
20|FH_F128878_11203_0|SrvcGrp|91397|2022|PDM|95.00|99|0.00|AETNA PSYCH PT & FAMILY 45MINS (MOD HO)|
20|FH_F116093_47327_0|SrvcGrp|73841|2022|PDM|346.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F128307_43219_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145546_52732_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F31253_0_0|SrvcGrp|115|2022|PDM|600.00|99|0.00|SKILLED NURSING CARE|
20|FH_F148239_74012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71346_0_0|SrvcGrp|3810|2022|PDM|127.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F39138_0_0|SrvcGrp|360|2022|PDM|765.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F86319_16365_0|SrvcGrp|82037|2022|PDM|2212.00|99|0.00|AETNA ICU|
20|FH_F135236_02840_0|SrvcGrp|112678|2022|PDM|132.70|99|0.00|COVID-19 SPECIMEN COLLECT|
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)|
20|FH_F82931_18847_0|SrvcGrp|10419|2022|PDM|554.00|99|0.00|SKILLED NURSING CARE|
20|FH_F92276_32308_0|SrvcGrp|20908|2022|PDM|34619.00|99|0.00|MS DRG 247 ONLY|
20|FH_F123302_33407_0|SrvcGrp|73841|2022|PDM|332.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F62915_0_0|SrvcGrp|22954|2022|PDM|305.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F143971_34986_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F123898_45121_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F73013_0_0|SrvcGrp|46609|2022|PDM|182.86|99|0.00|RESPIRATORY THERAPY CARE HOME VISIT|
20|FH_F147941_06023_0|SrvcGrp|112225|2022|PDM|25.67|99|0.00|COVID-19 SPECIMEN COLLECTION|
20|FH_F100761_02539_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F110967_0_0|SrvcGrp|84721|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F62892_0_0|SrvcGrp|10544|2022|PDM|73.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F112374_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49042_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC|
20|FH_F62892_0_0|SrvcGrp|58847|2022|PDM|125.00|99|0.00|HOSPICE RESPITE 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_F130134_08724_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
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_F94643_90501_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40501_0_0|SrvcGrp|3449|2022|PDM|600.00|99|0.00|ELECTRO CONVULSIVE THERAPY|
20|FH_F40644_0_0|SrvcGrp|471|2022|PDM|832.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F97183_25304_0|SrvcGrp|90854|2022|PDM|1804.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F140295_0_0|SrvcGrp|97730|2022|PDM|12200.00|99|0.00|REVERSE HIP JOINT|
20|FH_F124749_90211_0|SrvcGrp|67684|2022|PDM|363.00|99|0.00|PSYCH VISIT|
20|FH_F43486_0_0|SrvcGrp|4109|2022|PDM|1551.00|99|0.00|ACUTE PSYCH|
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_F137731_92262_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F37536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129966_18017_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149662_85015_0|SrvcGrp|115731|2022|PDM|7630.00|99|0.00|ANKLE JOINT RECONSTRUCT|
20|FH_F149601_64111_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138987_0_0|SrvcGrp|65720|2022|PDM|134.00|99|0.00|RESPITE CARE|
20|FH_F130939_40353_0|SrvcGrp|86722|2022|PDM|184.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F134936_01020_0|SrvcGrp|48385|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F114207_35243_0|SrvcGrp|86841|2022|PDM|80.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F97082_90012_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F131224_0_0|SrvcGrp|87077|2022|PDM|170.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F138018_17313_0|SrvcGrp|65621|2022|PDM|125.00|99|0.00|RN NURSING|
20|FH_F114206_37203_0|SrvcGrp|86828|2022|PDM|70.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138417_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35751_34613_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F138662_78624_0|SrvcGrp|73842|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139810_60938_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143249_89801_0|SrvcGrp|22589|2022|PDM|25.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F143536_47546_0|SrvcGrp|100265|2022|PCT|1.00|99|0.00|CHEMISTRY|
20|FH_F123185_0_0|SrvcGrp|72996|2022|PDM|707.00|99|0.00|AEG 4|
20|FH_F102920_0_0|SrvcGrp|73002|2022|PDM|1679.00|99|0.00|AEG 7|
20|FH_F102224_0_0|SrvcGrp|101282|2022|PDM|11000.00|99|0.00|REVISE HIP JOINT COMPONENT|
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 5  (NO REV)|
20|FH_F114931_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|368.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F132534_18407_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120862_87108_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F44438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1406.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F49895_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F99960_0_0|SrvcGrp|11669|2022|PDM|2180.00|99|0.00|OP SURG|
20|FH_F39819_0_0|SrvcGrp|31215|2022|PDM|14469.00|99|0.00|NY DRG 541 ONLY|
20|FH_F129679_20850_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147941_06023_0|SrvcGrp|2067|2022|PDM|1629.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F148265_06067_0|SrvcGrp|27330|2022|PDM|1668.00|99|0.00|CPT 27096|
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.18|99|0.00|AEG 10 (NO REV)|
20|FH_F72051_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147941_06023_0|SrvcGrp|46768|2022|PDM|242.00|99|0.00|CPT CODE 90847 PER VISIT|
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|403.00|99|0.00|AEG 1 (NO REV)|
20|FH_F135236_02840_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114970_28403_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F90872_0_0|SrvcGrp|34831|2022|PDM|1949.00|99|0.00|HEMODIALYSIS - ULTRAFILTRATION|
20|FH_F143783_0_0|SrvcGrp|114101|2022|PDM|105.00|99|0.00|HOSPICE CARE IN HOSPICE FACIILITY (HCFA)|
20|FH_F148265_06067_0|SrvcGrp|115354|2022|PDM|14571.00|99|0.00|RECONSTRUCT ELBOW JOINT|
20|FH_F37756_0_0|SrvcGrp|18932|2022|PDM|4631.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806|
20|FH_F120251_21122_0|SrvcGrp|89337|2022|PDM|1700.00|99|0.00|DETOXIFICATION|
20|FH_F77822_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120876_85250_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ACUTE PSYCH|
20|FH_F147941_06023_0|CSTM-ALL|CSTM-00|2020|PDM|16513.00|99|0.00|AEG 7 (NO REV)|
20|FH_F40043_0_0|SrvcGrp|33263|2022|PDM|1082.00|99|0.00|GA ASPG III|
20|FH_F149980_0_0|SrvcGrp|115796|2022|PDM|696.00|99|0.00|SURGICAL COLONOSCOPY|
20|FH_F143786_78746_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129231_30060_0|CSTM-ALL|CSTM-00|2020|PDM|1044.00|99|0.00|AEG 6 (NO REV)|
20|FH_F130051_31707_0|CSTM-ALL|CSTM-00|2020|PDM|2806.00|99|0.00|AEG 2 (NO REV)|
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F131254_92211_0|SrvcGrp|14945|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F44582_0_0|SrvcGrp|13152|2022|PDM|7000.00|99|0.00|RADIO FREQUENCY ABLATION|
20|FH_F71905_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1890.00|99|0.00|AEG 7 (NO REV)|
20|FH_F31825_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)|
20|FH_F93332_0_0|SrvcGrp|93075|2022|PDM|2295.00|99|0.00|APPLY SPINE PROSTH DEVICE (HCFA)|
20|FH_F136510_0_0|SrvcGrp|74670|2022|PCT|0.00|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F130523_04605_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F103100_47150_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F99720_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F136414_54548_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136426_19006_0|SrvcGrp|2067|2022|PDM|823.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F118156_19446_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F118232_24970_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE|
20|FH_F134147_19342_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134167_10032_0|SrvcGrp|27969|2022|PDM|28.09|99|0.00|HOME HEALTH AIDE|
20|FH_F137247_40160_0|SrvcGrp|86722|2022|PDM|156.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F142406_78840_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142547_70002_0|SrvcGrp|22593|2022|PDM|25.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F97582_46307_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F139456_47501_0|SrvcGrp|10944|2022|PCT|0.80|99|0.00|EMERGENCY ROOM|
20|FH_F140343_89052_0|SrvcGrp|22593|2022|PDM|30.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F140407_63841_0|SrvcGrp|109057|2022|PCT|0.75|99|0.00|CARDIAC STUDIES|
20|FH_F140496_38627_0|SrvcGrp|89337|2022|PDM|970.00|99|0.00|DETOXIFICATION|
20|FH_F140615_73013_0|SrvcGrp|73806|2022|PDM|794.00|99|0.00|AETNA ER|
20|FH_F140688_98405_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140747_34461_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122067_0_0|SrvcGrp|46906|2022|PDM|1430.00|99|0.00|CORNEAL TISSUE|
20|FH_F120152_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F145762_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F151603_27609_0|SrvcGrp|84939|2022|PDM|12244.90|99|0.00|SHOULDER JOINT|
20|FH_F151608_30236_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 4 (NO REV)|
20|FH_F119004_06850_0|SrvcGrp|85966|2022|PDM|2273.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F119090_91502_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F119018_47802_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F92636_90230_0|SrvcGrp|88834|2022|PDM|89.25|99|0.00|SKILLED NURSING SERVICES (15 MINS)|
20|FH_F109885_35473_0|SrvcGrp|86747|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F91913_0_0|SrvcGrp|72996|2022|PDM|630.00|99|0.00|AEG 4|
20|FH_F91913_0_0|SrvcGrp|72994|2022|PDM|510.00|99|0.00|AEG 3|
20|FH_F117295_70006_0|SrvcGrp|48398|2022|PDM|105.00|99|0.00|PT SERVICES|
20|FH_F129438_08234_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F129477_70403_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117218_32025_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91472_96001_0|SrvcGrp|20752|2022|PDM|56138.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F130035_0_0|SrvcGrp|108042|2022|PDM|473.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)|
20|FH_F109513_0_0|SrvcGrp|90420|2022|PDM|4000.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F109513_0_0|SrvcGrp|90431|2022|PDM|2500.00|99|0.00|HAND PROCEDURES|
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|1179.00|99|0.00|AEG 10 (NO REV)|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2504030 MOD QW (HCFA)|
20|FH_F72662_0_0|SrvcGrp|33414|2022|PDM|200.00|99|0.00|SNF VENTILATOR SUPPORT|
20|FH_F82933_0_0|CSTM-ALL|CSTM-00|2020|PDM|7470.02|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F91873_12723_0|SrvcGrp|91218|2022|PDM|1820.00|99|0.00|HYPERBARIC OXYGEN|
20|FH_F97780_43614_0|SrvcGrp|73659|2022|PDM|11247.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F117299_0_0|SrvcGrp|107500|2022|PDM|976.00|99|0.00|AETNA - CYSTOSCOPY AND TREATMENT|
20|FH_F74562_0_0|SrvcGrp|269|2022|PCT|0.80|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F113143_0_0|SrvcGrp|72994|2022|PDM|536.00|99|0.00|AEG 3|
20|FH_F113784_0_0|SrvcGrp|44042|2022|PDM|60.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|897.00|99|0.00|AEG 3 (NO REV)|
20|FH_F88885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|HSS ASC INVOICE|
20|FH_F142318_21218_0|SrvcGrp|74668|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PDM|3348.00|99|0.00|AEG 4 (NO REV)|
20|FH_F103961_63017_0|SrvcGrp|74546|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AEG 6 (NO REV)|
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 9 (NO REV)|
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133178_0_0|SrvcGrp|112209|2022|PDM|1255.00|99|0.00|DESTROY VAGINAL LESIONS COMPLEX|
20|FH_F138929_0_0|SrvcGrp|35668|2022|PDM|3520.00|99|0.00|CPT 29824|
20|FH_F141207_0_0|SrvcGrp|63297|2022|PDM|185.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F95282_77975_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT HH|
20|FH_F114002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77944_0_0|CSTM-ALL|CSTM-00|2020|PDM|6827.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F124059_64055_0|SrvcGrp|88620|2022|PDM|83.00|99|0.00|SKILLED NURSING RN|
20|FH_F146989_80204_0|SrvcGrp|109330|2022|PCT|1.52|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F38233_0_0|SrvcGrp|10648|2022|PDM|2.00|99|0.00|HOME INFUSION|
20|FH_F41035_0_0|SrvcGrp|54962|2022|PDM|1200.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)|
20|FH_F41885_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH|
20|FH_F92493_0_0|SrvcGrp|89989|2022|PDM|6239.20|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F100703_0_0|SrvcGrp|112025|2022|PDM|8034.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F98380_43055_0|SrvcGrp|88978|2022|PDM|5192.00|99|0.00|VAGINAL DELIVERY|
20|FH_F129549_01238_0|SrvcGrp|93098|2022|PDM|177.45|99|0.00|HOSPICE CARE|
20|FH_F124611_64804_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F124613_64735_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124663_65608_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F127995_84010_0|SrvcGrp|86842|2022|PDM|25.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F88254_33411_0|SrvcGrp|13929|2022|PDM|10.00|99|0.00|GROWTH HORMONE|
20|FH_F115043_77954_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F72183_0_0|SrvcGrp|66226|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F115771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100790_10512_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F71625_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PDM|830.55|99|0.00|AEG 4 (NO REV)|
20|FH_F72183_0_0|SrvcGrp|9774|2022|PDM|1500.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F82714_18848_0|SrvcGrp|73499|2022|PDM|736.00|99|0.00|AETNA ER LEVEL II|
20|FH_F129653_0_0|SrvcGrp|72992|2022|PDM|1235.00|99|0.00|AEG 2|
20|FH_F148259_99163_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F78922_0_0|SrvcGrp|76041|2022|PDM|400.00|99|0.00|DIALYSIS|
20|FH_F44582_0_0|SrvcGrp|21826|2022|PDM|7000.00|99|0.00|PTCA (MS DRG ONLY)|
20|FH_F100660_56303_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F48215_0_0|SrvcGrp|12401|2022|PDM|85.50|99|0.00|RN VISIT|
20|FH_F127564_66002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F77484_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|GENERAL ACUTE CARE|
20|FH_F143768_34785_0|SrvcGrp|113911|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F91622_0_0|SrvcGrp|80260|2022|PCT|0.00|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F128272_60640_0|SrvcGrp|86121|2022|PCT|0.85|99|0.00|AETNA GAMUNEX-C|
20|FH_F93332_0_0|SrvcGrp|88492|2022|PDM|2096.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F145545_01602_0|SrvcGrp|88905|2022|PDM|1167.00|99|0.00|PSYCHIATRIC CARE (AGE 0-17)|
20|FH_F42160_0_0|SrvcGrp|88|2022|PDM|4665.00|99|0.00|OP LITHOTRIPSY|
20|FH_F125899_07645_0|SrvcGrp|90356|2022|PCT|1.93|99|0.00|OP DIALYSIS|
20|FH_F65159_0_0|SrvcGrp|3950|2022|PDM|5106.99|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F122725_32216_0|SrvcGrp|104815|2022|PDM|102.00|99|0.00|NEUROBEHAVIORAL STATUS EXAM|
20|FH_F86872_15215_0|SrvcGrp|26868|2022|PDM|45.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F37970_0_0|SrvcGrp|27692|2022|PCT|1.00|99|0.00|LABORATORY|
20|FH_F37117_0_0|SrvcGrp|45685|2022|PDM|70.00|99|0.00|PT/OT/ST|
20|FH_F121303_15501_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 10 (NO REV)|
20|FH_F139780_75605_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F85353_16407_0|CSTM-ALL|CSTM-00|2020|PCT|1.55|99|0.00|HAPA WPA/NWPA 2018 LAB 100%|
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_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F119509_0_0|SrvcGrp|59163|2022|PCT|0.29|99|0.00|OP SURGICAL ANCILLARY SERVICES|
20|FH_F144808_0_0|SrvcGrp|104042|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F131127_0_0|SrvcGrp|111746|2022|PDM|6556.00|99|0.00|REVISE BREAST RECONSTRUCTION|
20|FH_F146124_06112_0|CSTM-ALL|CSTM-00|2020|PDM|6233.00|99|0.00|AEG 4 (NO REV)|
20|FH_F125260_0_0|SrvcGrp|46605|2022|PDM|221.86|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F110509_71351_0|SrvcGrp|75505|2022|PCT|1.25|99|0.00|CARDIAC STUDIES|
20|FH_F124369_0_0|SrvcGrp|92366|2022|PDM|13090.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F110425_01752_0|SrvcGrp|46605|2022|PDM|180.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F121225_98902_0|SrvcGrp|22593|2022|PCT|0.85|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F114404_73044_0|SrvcGrp|75545|2022|PDM|305.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F85353_16407_0|SrvcGrp|63860|2022|PDM|365.07|99|0.00|HAPA WPA-NWPA 2012-13 ASC 117|
20|FH_F100782_0_0|SrvcGrp|105152|2022|PDM|417.32|99|0.00|WINDBER MEDICAL CNTR ASC 312|
20|FH_F99161_0_0|SrvcGrp|75495|2022|PDM|2817.00|99|0.00|AEG 9|
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|AEG 10 (NO REV)|
20|FH_F117300_0_0|SrvcGrp|98494|2022|PDM|7853.00|99|0.00|ARTHRODESIS PRE-SACRAL|
20|FH_F110509_71351_0|SrvcGrp|73004|2022|PDM|4600.00|99|0.00|AEG 8|
20|FH_F147984_63664_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139565_0_0|SrvcGrp|109758|2022|PDM|11475.00|99|0.00|COLLAGEN CROSSLINKING CORNEA|
20|FH_F128825_45211_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134669_17403_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F118123_67226_0|SrvcGrp|43567|2022|PDM|83.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F63312_0_0|SrvcGrp|10541|2022|PDM|79.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F147959_33573_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149304_64137_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116806_0_0|SrvcGrp|107039|2022|PDM|1923.16|99|0.00|REPAIR DENTAL RIDGE FRACTURE|
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|1103.00|99|0.00|AEG 6 (NO REV)|
20|FH_F81698_10457_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112408_0_0|SrvcGrp|75545|2022|PDM|245.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F136359_0_0|SrvcGrp|67065|2022|PDM|18120.00|99|0.00|CERVICAL SURGERY|
20|FH_F119864_63141_0|SrvcGrp|88621|2022|PDM|105.00|99|0.00|SKILLED NURSING LPN|
20|FH_F120608_19901_0|SrvcGrp|48385|2022|PDM|136.50|99|0.00|SPEECH THERAPY|
20|FH_F122930_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119379_0_0|SrvcGrp|100079|2022|PDM|1428.00|99|0.00|RECONSTRUCT ULNA/RADIOLULNAR|
20|FH_F111031_30252_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F127616_17403_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126403_77304_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117206_0_0|SrvcGrp|90606|2022|PDM|1485.00|99|0.00|INSERT LENS PROSTHESIS|
20|FH_F114683_0_0|SrvcGrp|73000|2022|PDM|1947.00|99|0.00|AEG 6|
20|FH_F63456_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121303_15501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|822.00|99|0.00|AEG 5  (NO REV)|
20|FH_F126354_91321_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F127995_84010_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F114666_30342_0|SrvcGrp|90420|2022|PDM|5000.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F138310_60461_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PDM|52.48|99|0.00|NEUROPSYCHOLOGICAL TESTING|
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.88|99|0.00|2005 ASPG GROUPER X|
20|FH_F119725_0_0|SrvcGrp|13597|2022|PDM|217.22|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F122638_59715_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135715_32073_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112371_19047_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F112465_28401_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F113713_17013_0|SrvcGrp|105373|2022|PDM|55.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MIN (HCFA)|
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 7 (NO REV)|
20|FH_F149543_0_0|SrvcGrp|108082|2022|PDM|25.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|WELLPATH PROPIETARY ASC VI|
20|FH_F115152_77058_0|SrvcGrp|90854|2022|PDM|656.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F147446_76844_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147519_52627_0|CSTM-ALL|CSTM-00|2020|PDM|3956.51|99|0.00|AEG 4 (NO REV)|
20|FH_F147699_83704_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F41809_0_0|SrvcGrp|3029|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F41433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42581_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F98622_45005_0|SrvcGrp|73602|2022|PDM|6768.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F103241_06002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43136_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1020.00|99|0.00|ACUTE PSYCH / CHEMICAL DEPENDENCY|
20|FH_F102881_0_0|SrvcGrp|89939|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F134826_19067_0|SrvcGrp|90639|2022|PDM|125.00|99|0.00|AETNA MEDICATION ASSISTED TREATEMENT UNDER 30 MINS|
20|FH_F151139_0_0|SrvcGrp|12869|2022|PDM|155.00|99|0.00|AIR AMBULANCE|
20|FH_F46433_0_0|SrvcGrp|17002|2022|PDM|180.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS|
20|FH_F133579_0_0|SrvcGrp|28548|2022|PDM|2175.00|99|0.00|VITRECTOMY|
20|FH_F98361_12065_0|SrvcGrp|88977|2022|PDM|4862.00|99|0.00|C-SECTION DELIVERY|
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|962.00|99|0.00|AEG 10 (NO REV)|
20|FH_F48836_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F52872_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F113585_20155_0|SrvcGrp|86831|2022|PDM|4.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F138774_74133_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F31309_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|753.44|99|0.00|AEG 4 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|681.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1202 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|415.93|99|0.00|HAPA WPA-NWPA 2012-13 ASC 218 W/O REV|
20|FH_F75185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F151304_31520_0|CSTM-ALL|CSTM-00|2020|PDM|1088.00|99|0.00|AEG 6 (NO REV)|
20|FH_F151405_65109_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151440_84095_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132262_60062_0|SrvcGrp|100859|2022|PDM|336.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F122024_75751_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122114_91364_0|SrvcGrp|114008|2022|PDM|525.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F135388_48601_0|SrvcGrp|106291|2022|PDM|416.38|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F97142_94535_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F135924_02906_0|CSTM-ALL|CSTM-00|2020|PDM|6886.40|99|0.00|INPATIENT PSYCHIATRIC CARE >17 YRS|
20|FH_F135924_02906_0|SrvcGrp|103913|2022|PCT|1.03|99|0.00|OP DIALYSIS|
20|FH_F135951_34711_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135973_66606_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F131132_44077_0|SrvcGrp|97968|2022|PDM|1139.00|99|0.00|CT SCAN|
20|FH_F116431_76104_0|SrvcGrp|941|2022|PDM|1639.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F140629_0_0|SrvcGrp|78283|2022|PDM|1302.00|99|0.00|CPT 49505|
20|FH_F33015_0_0|SrvcGrp|3087|2022|PDM|515.00|99|0.00|CD - DETOX|
20|FH_F101644_75116_0|SrvcGrp|73700|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F121704_90405_0|SrvcGrp|74668|2022|PDM|550.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121761_44130_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|1607.00|99|0.00|AEG 9 (NO REV)|
20|FH_F134264_67226_0|SrvcGrp|89149|2022|PDM|180.00|99|0.00|OP INTENSIVE|
20|FH_F134322_98001_0|SrvcGrp|91740|2022|PCT|1.00|99|0.00|VANCOMYCIN HCL INJECT 500MG|
20|FH_F131000_0_0|SrvcGrp|41334|2022|PDM|15086.00|99|0.00|TOTAL KNEE|
20|FH_F131000_0_0|SrvcGrp|65403|2022|PDM|2971.00|99|0.00|CPT 42830|
20|FH_F141035_0_0|SrvcGrp|112150|2022|PDM|3052.00|99|0.00|DRAINAGE OF FINGER ABSCESS|
20|FH_F129240_10028_0|SrvcGrp|29075|2022|PDM|35.00|99|0.00|HYDRATION THERAPY|
20|FH_F129240_10028_0|SrvcGrp|86832|2022|PDM|5.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F98300_30236_0|SrvcGrp|75441|2022|PDM|1094.00|99|0.00|OBSERVATION - REV 760|
20|FH_F63195_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62579_0_0|SrvcGrp|21920|2022|PDM|70.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 484|
20|FH_F128278_21401_0|SrvcGrp|106048|2022|PDM|911.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F138951_41101_0|SrvcGrp|22389|2022|PDM|15.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F42799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126354_91321_0|SrvcGrp|75442|2022|PDM|720.00|99|0.00|OBSERVATION - REV 762|
20|FH_F134668_08003_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F96721_99504_0|SrvcGrp|88977|2022|PDM|7976.00|99|0.00|C-SECTION DELIVERY|
20|FH_F133727_33511_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F147502_0_0|SrvcGrp|82222|2022|PDM|150.00|99|0.00|HOSPICE CARE|
20|FH_F134331_61021_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F117206_0_0|SrvcGrp|72992|2022|PDM|560.00|99|0.00|AEG 2|
20|FH_F127849_43920_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F149365_77642_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F59872_0_0|CSTM-ALL|CSTM-00|2020|PDM|5200.00|99|0.00|ASPG IX|
20|FH_F90232_15126_0|SrvcGrp|75301|2022|PCT|1.05|99|0.00|AWP J CODES|
20|FH_F88744_71103_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F85097_0_0|SrvcGrp|13168|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F150304_16146_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.87|99|0.00|HAPA WPA-NWPA 2012-13 ASC 601 W/O REV|
20|FH_F112468_0_0|SrvcGrp|73006|2022|PDM|1153.00|99|0.00|AEG 9|
20|FH_F130017_02302_0|SrvcGrp|113463|2022|PCT|0.00|99|0.00|LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F149159_53220_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F96160_32207_0|SrvcGrp|22593|2022|PDM|68.65|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F139443_37705_0|SrvcGrp|73605|2022|PDM|950.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F133887_17013_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F150310_07035_0|SrvcGrp|74668|2022|PDM|287.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F134488_14086_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122425_75082_0|SrvcGrp|472|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F72963_0_0|SrvcGrp|30623|2022|PDM|7550.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F72963_0_0|SrvcGrp|55426|2022|PCT|0.50|99|0.00|OBSERVATION|
20|FH_F74583_0_0|SrvcGrp|48396|2022|PDM|14.00|99|0.00|OT SERVICES|
20|FH_F105145_75075_0|SrvcGrp|11663|2022|PCT|1.15|99|0.00|IMPLANTS|
20|FH_F66427_0_0|SrvcGrp|24598|2022|PDM|2370.00|99|0.00|MS DRG 945-946 ONLY|
20|FH_F72971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F80513_0_0|SrvcGrp|87308|2022|PDM|19882.00|99|0.00|MSDRG 271 ONLY|
20|FH_F120811_53525_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F31843_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F116056_73018_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F131698_01862_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132851_44805_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133176_32751_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133491_74012_0|SrvcGrp|97702|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|1156.00|99|0.00|AEG 3 (NO REV)|
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|2384.00|99|0.00|AEG 9 (NO REV)|
20|FH_F36646_0_0|SrvcGrp|23620|2022|PDM|42.00|99|0.00|PT OT ST|
20|FH_F89778_0_0|SrvcGrp|27344|2022|PDM|2107.64|99|0.00|OP SURGERY (CPT 42821)|
20|FH_F32995_0_0|SrvcGrp|12118|2022|PDM|575.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F46832_0_0|SrvcGrp|26868|2022|PDM|71.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|3951.00|99|0.00|AEG 9 (NO REV)|
20|FH_F136487_71269_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136952_78218_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F138892_46341_0|SrvcGrp|74668|2022|PDM|154.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F142470_32935_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142548_66614_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|ASPG V|
20|FH_F66765_0_0|SrvcGrp|42763|2022|PDM|100.00|99|0.00|SKILLED NURSING CARE VISIT|
20|FH_F138548_24090_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F77782_66061_0|SrvcGrp|15783|2022|PDM|6175.00|99|0.00|LITHOTRIPSY - MULTIPLE OR BILATERAL|
20|FH_F140343_89052_0|SrvcGrp|86836|2022|PDM|10.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F140765_30315_0|SrvcGrp|113302|2022|PDM|40.00|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - ASTRAZENECA|
20|FH_F140875_63363_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120152_0_0|SrvcGrp|36591|2022|PDM|22000.00|99|0.00|CPT 63685|
20|FH_F109885_35473_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F109982_33592_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F76144_0_0|SrvcGrp|16732|2022|PDM|2353.48|99|0.00|HYSTEROSCOPY ABLATION|
20|FH_F129477_70403_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F101945_0_0|SrvcGrp|98402|2022|PDM|2261.00|99|0.00|RHINO INCL MJR SEPTAL RPR|
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 2 (NO REV)|
20|FH_F118473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109652_0_0|SrvcGrp|78823|2022|PCT|0.57|99|0.00|EMERGENCY ROOM LEVEL 4|
20|FH_F109907_0_0|SrvcGrp|27968|2022|PDM|31.21|99|0.00|SKILLED NURSING LPN|
20|FH_F109821_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F91472_96001_0|SrvcGrp|111618|2022|PCT|0.40|99|0.00|REVISION UPPER EXTREMITY SHOULDER REPLACEMENT|
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|1172.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|946.00|99|0.00|AEG 6 (NO REV)|
20|FH_F95880_02726_0|SrvcGrp|90491|2022|PDM|226.00|99|0.00|EVALUATE SPEECH PRODUCTION|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PDM|1886.00|99|0.00|ASPG VIII|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|119.64|99|0.00|HAPA WPA-NWPA 2012-13 ASC 315 W/O REV|
20|FH_F44225_0_0|SrvcGrp|22461|2022|PCT|0.90|99|0.00|INPATIENT HOSPICE SVCS|
20|FH_F148881_33018_0|SrvcGrp|105023|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY EVALUATION (HCFA)|
20|FH_F148780_70739_0|SrvcGrp|113132|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F109273_77339_0|SrvcGrp|87317|2022|PDM|862.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F77585_0_0|SrvcGrp|3259|2022|PDM|495.00|99|0.00|ACUTE REHABILITATION|
20|FH_F149362_19446_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F49914_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|3137.00|99|0.00|AEG 7 (NO REV)|
20|FH_F120670_0_0|SrvcGrp|108911|2022|PDM|5500.00|99|0.00|DISK SURGERY/LAMINECTOMY|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|591.65|99|0.00|HAPA WPA-NWPA 2012-13 ASC 212 W/O REV|
20|FH_F88171_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F132822_95125_0|SrvcGrp|46605|2022|PDM|130.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F92598_21236_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97861_62223_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F81483_0_0|SrvcGrp|40303|2022|PDM|677.00|99|0.00|CVTY ENHANCED ASPG 1|
20|FH_F114510_33445_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
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_F100782_0_0|SrvcGrp|105136|2022|PDM|253.70|99|0.00|WINDBER MEDICAL CNTR ASC 241|
20|FH_F81698_10457_0|SrvcGrp|86831|2022|PDM|3.15|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F100782_0_0|SrvcGrp|105169|2022|PDM|2500.15|99|0.00|WINDBER MEDICAL CNTR ASC 909|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|251.27|99|0.00|HAPA WPA-NWPA 2012-13 ASC 229 W/O REV|
20|FH_F150160_01301_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F132969_84003_0|SrvcGrp|48385|2022|PDM|84.50|99|0.00|SPEECH THERAPY|
20|FH_F111704_30044_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F139678_25601_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133727_33511_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F111908_07677_0|SrvcGrp|100765|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F100782_0_0|SrvcGrp|105156|2022|PDM|227.05|99|0.00|WINDBER MEDICAL CNTR ASC 316|
20|FH_F113368_37752_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F132883_31602_0|SrvcGrp|14945|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F132969_84003_0|SrvcGrp|86833|2022|PDM|10.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F93122_01854_0|SrvcGrp|43524|2022|PDM|149.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F109264_33431_0|SrvcGrp|89149|2022|PDM|210.00|99|0.00|OP INTENSIVE|
20|FH_F63312_0_0|SrvcGrp|10540|2022|PDM|37.00|99|0.00|HOME HEALTH AIDE|
20|FH_F72584_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150241_60714_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119627_27288_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F79824_0_0|SrvcGrp|83317|2022|PCT|0.48|99|0.00|RADIOLOGY|
20|FH_F150242_60025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122130_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F89219_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MT NITTANY GH RAD|
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|546.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F134347_60630_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114683_0_0|SrvcGrp|73002|2022|PDM|2239.00|99|0.00|AEG 7|
20|FH_F90574_22560_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F114800_68510_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F90501_71101_0|SrvcGrp|75485|2022|PDM|3300.00|99|0.00|AEG 4|
20|FH_F145675_33761_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111986_0_0|CSTM-ALL|CSTM-00|2020|PDM|3399.00|99|0.00|LAP VENT/ABD HERNIA REPAIR|
20|FH_F149151_75248_0|SrvcGrp|74668|2022|PDM|365.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138050_52301_0|SrvcGrp|112734|2022|PCT|0.00|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F149139_07522_0|SrvcGrp|113232|2022|PDM|42.13|99|0.00|COVID-19 SARS-COV-2 ANTB QUANTITATIVE|
20|FH_F134608_18017_0|SrvcGrp|112597|2022|PDM|125.00|99|0.00|ULTRASOUND|
20|FH_F126308_44515_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F146207_73139_0|SrvcGrp|104226|2022|PDM|134.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F139722_30022_0|SrvcGrp|92502|2022|PDM|1025.23|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F146369_0_0|SrvcGrp|73605|2022|PDM|1000.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F81377_0_0|SrvcGrp|70073|2022|PDM|2604.00|99|0.00|LAPAROSCOPY CPT 49650|
20|FH_F147962_85008_0|CSTM-ALL|CSTM-00|2020|PDM|3721.00|99|0.00|AEG 6 (NO REV)|
20|FH_F149302_75032_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F115430_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT|
20|FH_F119383_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F113453_80020_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F132969_84003_0|SrvcGrp|86825|2022|PDM|50.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F63312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130329_64114_0|SrvcGrp|86829|2022|PDM|37.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F124369_0_0|SrvcGrp|109068|2022|PDM|2544.30|99|0.00|PARTIAL REMOVAL OF FOOT BONE|
20|FH_F134601_94010_0|SrvcGrp|93337|2022|PDM|536.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|2628.24|99|0.00|HAPA WPA-NWPA 2012-13 ASC 14 W/O REV|
20|FH_F133808_73401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F119379_0_0|SrvcGrp|92011|2022|PDM|672.00|99|0.00|REMOVAL OF IMPLANT|
20|FH_F125328_0_0|SrvcGrp|79595|2022|PDM|2535.00|99|0.00|CPT 45385|
20|FH_F118042_33401_0|SrvcGrp|89337|2022|PDM|700.00|99|0.00|DETOXIFICATION|
20|FH_F85098_33486_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F81698_10457_0|SrvcGrp|86841|2022|PDM|84.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F36552_0_0|SrvcGrp|18179|2022|PDM|8005.00|99|0.00|MS DRG 258|
20|FH_F119379_0_0|SrvcGrp|88596|2022|PDM|1428.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE|
20|FH_F52754_0_0|SrvcGrp|12512|2022|PDM|1260.00|99|0.00|ACUTE REHABILITATION|
20|FH_F151054_06473_0|SrvcGrp|100246|2022|PCT|1.00|99|0.00|STREP A ASSAY W/ OPTIC|
20|FH_F121897_28144_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F121897_28144_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121976_44505_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F121985_46256_0|SrvcGrp|106309|2022|PCT|1.00|99|0.00|AETNA DRUG TESTS|
20|FH_F122006_66839_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129130_92562_0|SrvcGrp|13187|2022|PCT|0.46|99|0.00|INTRAOCULAR LENSES|
20|FH_F35212_0_0|SrvcGrp|10410|2022|PDM|42.25|99|0.00|SKILLED NURSING CARE|
20|FH_F35212_0_0|SrvcGrp|13703|2022|PDM|26.75|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|353.72|99|0.00|DELAWARE VALLEY- ASC 211|
20|FH_F71543_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91873_12723_0|SrvcGrp|3178|2022|PDM|1495.00|99|0.00|ACUTE PSYCH|
20|FH_F97660_29401_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F117399_0_0|SrvcGrp|105357|2022|PDM|400.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F87054_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|DEVICE INSERTION|
20|FH_F113784_0_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F114916_30309_0|SrvcGrp|97741|2022|PDM|18500.00|99|0.00|REVISE KNEE|
20|FH_F100640_48097_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
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|643.29|99|0.00|ASPG III|
20|FH_F133178_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F135491_0_0|SrvcGrp|112756|2022|PDM|892.00|99|0.00|EYELID REVISION|
20|FH_F141207_0_0|SrvcGrp|89781|2022|PDM|485.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 7 (NO REV)|
20|FH_F94786_07974_0|SrvcGrp|41460|2022|PDM|21.00|99|0.00|ENTERAL THERAPY - UNSPECIFIED|
20|FH_F134270_0_0|SrvcGrp|13697|2022|PCT|0.00|99|0.00|PROSTHETICS, ORTHOTICS, IOLS|
20|FH_F141018_70125_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F40370_0_0|SrvcGrp|109|2022|PDM|695.00|99|0.00|CD - DETOX|
20|FH_F124180_0_0|SrvcGrp|109740|2022|PDM|2490.00|99|0.00|SINUS ENDO W/ BALLOON DILATION|
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_F122170_60120_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F124081_64154_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|ASPG VI|
20|FH_F37546_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38233_0_0|SrvcGrp|22018|2022|PDM|40.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F40603_0_0|SrvcGrp|3404|2022|PDM|65.00|99|0.00|CPT 99211|
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE|
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|1640.10|99|0.00|AEG 4 (NO REV)|
20|FH_F132864_71101_0|SrvcGrp|20293|2022|PDM|25859.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY|
20|FH_F132864_71101_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F124178_01604_0|SrvcGrp|87281|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA|
20|FH_F124593_07033_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F129761_43920_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127995_84010_0|SrvcGrp|27969|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE|
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F87856_0_0|SrvcGrp|86463|2022|PDM|1000.00|99|0.00|FRACTURE NASAL INFERIOR|
20|FH_F90653_0_0|SrvcGrp|25695|2022|PDM|1300.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F136544_06426_0|SrvcGrp|472|2022|PDM|555.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F113809_47302_0|SrvcGrp|73842|2022|PDM|155.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F100664_03104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42923_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.30|99|0.00|OP SVCS|
20|FH_F42980_0_0|SrvcGrp|50206|2022|PDM|125.00|99|0.00|CPT 99215|
20|FH_F43862_0_0|SrvcGrp|27769|2022|PDM|25.00|99|0.00|SKILLED LPN HOURLY|
20|FH_F134690_46237_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134694_94945_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F134817_30339_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F135719_45502_0|SrvcGrp|12491|2022|PCT|0.40|99|0.00|PACEMAKER|
20|FH_F136778_62034_0|SrvcGrp|107900|2022|PDM|5114.00|99|0.00|AETNA ALC/DRUG AB W/O REHAB W/O MC|
20|FH_F136778_62034_0|CSTM-ALL|CSTM-00|2020|PDM|852.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F31996_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F77234_0_0|SrvcGrp|17079|2022|PDM|2803.00|99|0.00|ASPG VIII|
20|FH_F115144_71373_0|SrvcGrp|67944|2022|PDM|510.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F115210_21043_0|SrvcGrp|79593|2022|PDM|716.00|99|0.00|CPT 45378|
20|FH_F116393_07002_0|SrvcGrp|89752|2022|PDM|140.00|99|0.00|CINE/VIDEO X-RAY THROAT/ESO|
20|FH_F116393_07002_0|SrvcGrp|45582|2022|PDM|7.65|99|0.00|CPT 85610|
20|FH_F147519_52627_0|SrvcGrp|114917|2022|PCT|0.00|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F147702_75240_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F147404_37863_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147700_21401_0|CSTM-ALL|CSTM-00|2020|PDM|492.31|99|0.00|AEG 1 (NO REV)|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|CHELATION THERAPY (MOD SH)|
20|FH_F42654_0_0|SrvcGrp|11798|2022|PDM|80.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F32739_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F118792_63379_0|SrvcGrp|102140|2022|PCT|0.74|99|0.00|OBSERVATION W/ SURGERY|
20|FH_F98621_41042_0|SrvcGrp|73643|2022|PDM|1721.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F100780_24153_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F103004_75840_0|SrvcGrp|3932|2022|PDM|3750.00|99|0.00|LITHOTRIPSY|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F111986_0_0|SrvcGrp|104111|2022|PDM|1854.00|99|0.00|EXCISE WRIST TENDON SHEATH|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|943.65|99|0.00|HAPA WPA-NWPA 2012-13 ASC 403 W/O REV|
20|FH_F112023_12866_0|SrvcGrp|103618|2022|PDM|3329.00|99|0.00|C-SECTION DELIVERY (MOM)|
20|FH_F130329_64114_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F130770_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS ASC|
20|FH_F48092_0_0|SrvcGrp|41368|2022|PDM|1400.00|99|0.00|TELEMETRY|
20|FH_F86101_76063_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F118123_67226_0|SrvcGrp|26868|2022|PDM|25.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F109266_33319_0|SrvcGrp|86753|2022|PCT|1.25|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F119864_63141_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.00|99|0.00|ASPG V - FH SW CUSTOM GROUPERS|
20|FH_F69606_0_0|SrvcGrp|64098|2022|PDM|1670.50|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 9|
20|FH_F122463_17109_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F122522_54024_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F72768_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|100% OF AWP DRUGS UPDATE QUARTLIE|
20|FH_F85257_0_0|SrvcGrp|131|2022|PCT|0.55|99|0.00|PACEMAKER DEVICE|
20|FH_F105145_75075_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F115872_06052_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131964_89120_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133269_78624_0|SrvcGrp|89149|2022|PDM|195.00|99|0.00|OP INTENSIVE|
20|FH_F133401_33404_0|SrvcGrp|111930|2022|PDM|20.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F133478_40165_0|SrvcGrp|11663|2022|PCT|0.28|99|0.00|IMPLANTS|
20|FH_F132815_39429_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133047_74012_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133402_10007_0|SrvcGrp|88857|2022|PDM|55.00|99|0.00|THERAPEUTIC ACTIVITIES|
20|FH_F139148_70006_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139209_22556_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F139560_78216_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150839_03833_0|SrvcGrp|73742|2022|PDM|9.36|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F132254_40207_0|SrvcGrp|43568|2022|PDM|140.00|99|0.00|SKILLED NURSING - RN|
20|FH_F122377_91007_0|SrvcGrp|4003|2022|PDM|2708.00|99|0.00|CPT CODE 99291- CRITICAL CARE|
20|FH_F150982_0_0|SrvcGrp|45583|2022|PDM|2392.00|99|0.00|CPT 65730|
20|FH_F134676_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F40498_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
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_F71108_0_0|SrvcGrp|21363|2022|PDM|8000.00|99|0.00|MS DRG 766 ONLY REPLACEMENT CODES 785, 788|
20|FH_F36663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S MOD KN (CPD 1364768)|
20|FH_F35771_32578_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132732_0_0|SrvcGrp|51672|2022|PDM|4229.00|99|0.00|MS DRG 286-287 ONLY|
20|FH_F147218_48026_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131371_0_0|SrvcGrp|84442|2022|PDM|17000.00|99|0.00|REVISION KNEE|
20|FH_F110783_93013_0|SrvcGrp|47183|2022|PDM|90.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F41463_0_0|SrvcGrp|34304|2022|PCT|0.60|99|0.00|SUPPIES MOD NU|
20|FH_F36403_0_0|SrvcGrp|473|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120040_72703_0|SrvcGrp|16069|2022|PDM|914.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F141278_80218_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F98623_97006_0|SrvcGrp|73603|2022|PDM|8420.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F132254_40207_0|SrvcGrp|14944|2022|PDM|8.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F37864_0_0|CSTM-ALL|CSTM-00|2020|PDM|1237.03|99|0.00|ASPG VII|
20|FH_F97603_77901_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|1479.00|99|0.00|AEG 9 (NO REV)|
20|FH_F132711_0_0|SrvcGrp|73485|2022|PDM|970.00|99|0.00|AETNA REHAB|
20|FH_F137719_28269_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142327_0_0|SrvcGrp|48380|2022|PDM|1000.00|99|0.00|CARVE OUT V2788|
20|FH_F80834_0_0|SrvcGrp|16|2022|PDM|2516.00|99|0.00|ACUTE REHABILITATION|
20|FH_F54056_0_0|SrvcGrp|12403|2022|PDM|788.55|99|0.00|CONTINUOUS HOMECARE|
20|FH_F114206_37203_0|SrvcGrp|26868|2022|PDM|35.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F114585_11501_0|SrvcGrp|86723|2022|PDM|294.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F120100_98390_0|SrvcGrp|89337|2022|PDM|1601.00|99|0.00|DETOXIFICATION|
20|FH_F37341_0_0|SrvcGrp|26016|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F110783_93013_0|SrvcGrp|29076|2022|PDM|35.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F150924_90029_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F126116_0_0|SrvcGrp|109505|2022|PDM|14747.00|99|0.00|REMV & REPLC PM GEN MULT LEADS|
20|FH_F110841_53012_0|SrvcGrp|104173|2022|PCT|2.00|99|0.00|IMMUNIZATIONS AND INJECTIONS|
20|FH_F90817_0_0|SrvcGrp|46890|2022|PDM|2256.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F130581_40356_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146859_0_0|SrvcGrp|82689|2022|PDM|2077.00|99|0.00|SCOPE PLANTAR FASCIOTOMY|
20|FH_F132818_24701_0|SrvcGrp|537|2022|PCT|0.88|99|0.00|OBSERVATION SERVICES|
20|FH_F134919_02155_0|SrvcGrp|88621|2022|PDM|102.50|99|0.00|SKILLED NURSING LPN|
20|FH_F124695_33401_0|SrvcGrp|105017|2022|PDM|769.00|99|0.00|RESIDENTIAL TREATMENT (13-17 YRS)|
20|FH_F128397_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F140007_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F40431_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F134265_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F118446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F39346_0_0|CSTM-ALL|CSTM-00|2020|PDM|12698.00|99|0.00|MS DRG 238 ONLY|
20|FH_F134087_0_0|SrvcGrp|84318|2022|PDM|5410.00|99|0.00|SPINE INFUSION|
20|FH_F35381_0_0|SrvcGrp|360|2022|PDM|1450.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F113226_30025_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|412.00|99|0.00|AEG 1 (NO REV)|
20|FH_F98361_12065_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F120612_23314_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F41013_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F132268_07060_0|SrvcGrp|99459|2022|PDM|84.78|99|0.00|PHYSICAL THERAPY EVALUATION|
20|FH_F144968_18702_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123184_20906_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135453_70726_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F135973_66606_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136192_33016_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F131228_01826_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS|
20|FH_F131520_19144_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131265_84106_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F116431_76104_0|SrvcGrp|74403|2022|PCT|0.80|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F104800_0_0|SrvcGrp|13990|2022|PCT|0.50|99|0.00|PACEMAKER|
20|FH_F31819_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33785_0_0|SrvcGrp|360|2022|PDM|900.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPT CARE OF MUNCY FH -AW|
20|FH_F38268_0_0|SrvcGrp|12401|2022|PDM|93.50|99|0.00|RN VISIT|
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_F111301_33122_0|SrvcGrp|99363|2022|PDM|73.00|99|0.00|SCR MAMMO BI INCL CAD|
20|FH_F116275_0_0|SrvcGrp|103550|2022|PDM|420.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F48581_0_0|SrvcGrp|15132|2022|PDM|1500.00|99|0.00|ACUTE IP MEDICAL SVCS|
20|FH_F51272_0_0|SrvcGrp|4109|2022|PDM|1200.00|99|0.00|ACUTE PSYCH|
20|FH_F131000_0_0|SrvcGrp|64517|2022|PDM|5202.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F132328_0_0|SrvcGrp|92364|2022|PDM|10595.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F102902_33764_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F129240_10028_0|SrvcGrp|17016|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F96960_35404_0|SrvcGrp|73601|2022|PDM|7183.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F102960_50613_0|SrvcGrp|13422|2022|PDM|721.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F101320_26062_0|SrvcGrp|17014|2022|PDM|66.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F119538_60959_0|SrvcGrp|75545|2022|PDM|309.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F92792_0_0|SrvcGrp|46890|2022|PDM|2200.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F42935_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PDM|7797.00|99|0.00|HYSTERECTOMY SERVICES|
20|FH_F109625_27330_0|SrvcGrp|74403|2022|PCT|0.77|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F150001_33064_0|SrvcGrp|86837|2022|PDM|11.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F72859_0_0|SrvcGrp|11791|2022|PDM|130.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F127432_18015_0|SrvcGrp|79699|2022|PCT|0.38|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F72859_0_0|SrvcGrp|15512|2022|PDM|5.62|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F133018_84037_0|SrvcGrp|22593|2022|PDM|25.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F40030_0_0|SrvcGrp|12342|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F147982_65706_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118456_30012_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F31093_0_0|CSTM-ALL|CSTM-00|2020|PDM|1055.00|99|0.00|ASPG II|
20|FH_F63250_0_0|SrvcGrp|46118|2022|PDM|72.00|99|0.00|NUTRITNAL CNSLNG/DIABETES EDU|
20|FH_F101754_63141_0|SrvcGrp|97981|2022|PDM|88.68|99|0.00|DIAG ANALYSIS COCHLEAR IMPLANT|
20|FH_F37491_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F128120_76513_0|SrvcGrp|75754|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F150020_70601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132224_89119_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F101754_63141_0|SrvcGrp|97978|2022|PDM|21.31|99|0.00|HEARING AID CHECK OWN AID|
20|FH_F94165_0_0|SrvcGrp|73602|2022|PCT|0.85|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F120803_38606_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F128120_76513_0|SrvcGrp|73605|2022|PDM|815.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F50221_0_0|SrvcGrp|45148|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F40895_0_0|SrvcGrp|17000|2022|PCT|0.65|99|0.00|OUTPATIENT SURGERY|
20|FH_F37567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150951_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F132547_39180_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134497_47126_0|SrvcGrp|86723|2022|PDM|375.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F125342_78754_0|SrvcGrp|75419|2022|PDM|436.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F146267_78626_0|SrvcGrp|75419|2022|PDM|422.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F111780_38603_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141940_50023_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|AEG 10 (NO REV)|
20|FH_F117906_91606_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F117762_0_0|SrvcGrp|89989|2022|PDM|3640.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F134797_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129562_38668_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_F136592_0_0|SrvcGrp|107794|2022|PDM|3880.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F124976_0_0|SrvcGrp|89149|2022|PDM|247.00|99|0.00|OP INTENSIVE|
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|AEG 4 (NO REV)|
20|FH_F37081_0_0|SrvcGrp|3029|2022|PDM|712.00|99|0.00|NEWBORN NURSERY|
20|FH_F120332_0_0|SrvcGrp|23683|2022|PCT|0.00|99|0.00|SKILLED NURSING RN|
20|FH_F90817_0_0|SrvcGrp|91021|2022|PDM|855.00|99|0.00|PROBE NASOLACRIMAL DUCT (HCFA)|
20|FH_F46433_0_0|SrvcGrp|17004|2022|PDM|73.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS|
20|FH_F132149_60624_0|SrvcGrp|86722|2022|PDM|235.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F149459_06615_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F124316_28112_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124467_27529_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F98001_27603_0|SrvcGrp|73461|2022|PDM|8799.00|99|0.00|AETNA NICU IV|
20|FH_F44476_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1206.40|99|0.00|AEG 5  (NO REV)|
20|FH_F91978_34471_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141156_04401_0|CSTM-ALL|CSTM-00|2020|PDM|1359.00|99|0.00|AEG 7 (NO REV)|
20|FH_F147422_84121_0|SrvcGrp|46903|2022|PDM|550.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132849_0_0|SrvcGrp|97|2022|PDM|5581.00|99|0.00|C-SECTION|
20|FH_F97880_63501_0|SrvcGrp|73602|2022|PDM|1750.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F90232_15126_0|SrvcGrp|14948|2022|PDM|113.40|99|0.00|HOME INFUSION THERAPY|
20|FH_F149160_02180_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149601_64111_0|SrvcGrp|81765|2022|PCT|1.00|99|0.00|AETNA OP RADIOLOGY (RAD)|
20|FH_F124719_64093_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F140094_16125_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143348_16214_0|SrvcGrp|114099|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F143348_16214_0|SrvcGrp|75506|2022|PCT|0.89|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F143351_21157_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143536_47546_0|SrvcGrp|100260|2022|PCT|1.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (OVER 30.0 CM)|
20|FH_F103060_0_0|SrvcGrp|98497|2022|PDM|8323.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F130951_15237_0|SrvcGrp|97507|2022|PDM|115.00|99|0.00|AETNA HOSPICE|
20|FH_F151740_77504_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F47600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD TC|
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|520.00|99|0.00|ASPG I|
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|2443.47|99|0.00|ASPG VII|
20|FH_F120839_19380_0|SrvcGrp|86722|2022|PDM|170.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F116698_07470_0|SrvcGrp|73742|2022|PDM|7.35|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F119992_67062_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F120895_19460_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120974_27607_0|SrvcGrp|60|2022|PDM|3149.00|99|0.00|NEWBORN NURSERY - LEVEL II|
20|FH_F120974_27607_0|SrvcGrp|74005|2022|PDM|4884.00|99|0.00|AETNA PET|
20|FH_F36274_0_0|SrvcGrp|12263|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F33925_0_0|SrvcGrp|18822|2022|PDM|22990.00|99|0.00|MS DRG 223|
20|FH_F33925_0_0|SrvcGrp|10944|2022|PDM|400.00|99|0.00|EMERGENCY ROOM|
20|FH_F35133_0_0|SrvcGrp|360|2022|PDM|1300.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F35685_0_0|SrvcGrp|10939|2022|PDM|2536.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F36372_0_0|SrvcGrp|15517|2022|PDM|54.00|99|0.00|HYDRATION THERAPY|
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|518.42|99|0.00|ASPG III|
20|FH_F150200_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F36439_0_0|SrvcGrp|23005|2022|PDM|650.00|99|0.00|V5256|
20|FH_F88753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F59732_0_0|SrvcGrp|50162|2022|PDM|61.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 12 HRS|
20|FH_F116760_68512_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F93881_15009_0|SrvcGrp|10944|2022|PDM|626.00|99|0.00|EMERGENCY ROOM|
20|FH_F148179_48065_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148222_18603_0|SrvcGrp|88778|2022|PDM|62.00|99|0.00|PHYSICAL THERAPY|
20|FH_F110925_01104_0|SrvcGrp|88621|2022|PDM|94.56|99|0.00|SKILLED NURSING LPN|
20|FH_F86752_0_0|SrvcGrp|75493|2022|PDM|1516.00|99|0.00|AEG 8|
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|1245.00|99|0.00|AEG 4 (NO REV)|
20|FH_F124026_53188_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F149859_60005_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149888_68506_0|SrvcGrp|98347|2022|PDM|5252.00|99|0.00|HIP ARTHROSCOPY / SURGERY|
20|FH_F39339_0_0|SrvcGrp|3409|2022|PDM|405.00|99|0.00|NEWBORN NURSERY|
20|FH_F130747_0_0|SrvcGrp|88157|2022|PDM|26010.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F37863_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CRESCENT ANESTHESIA - FH- NON-ANES CODES|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|431.16|99|0.00|HAPA WPA-NWPA 2012-13 ASC 204 W/O REV|
20|FH_F109601_0_0|SrvcGrp|75491|2022|PDM|1096.00|99|0.00|AEG 7|
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|1236.00|99|0.00|AEG 5  (NO REV)|
20|FH_F47641_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F115050_77995_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F130146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124017_0_0|SrvcGrp|105524|2022|PDM|4500.00|99|0.00|INSJ BIOMECHANICAL DEVICE|
20|FH_F121492_87111_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141427_22003_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F102302_0_0|SrvcGrp|96349|2022|PDM|29900.00|99|0.00|NECK SPINE FUSE|
20|FH_F91622_0_0|SrvcGrp|73609|2022|PDM|5252.00|99|0.00|AETNA MATERNITY CARE (NORMAL DELIVERY)|
20|FH_F34658_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.00|99|0.00|OP SVCS|
20|FH_F37679_0_0|SrvcGrp|26850|2022|PDM|15.25|99|0.00|HOME INFUSION THERAPY (SJ)|
20|FH_F131254_92211_0|SrvcGrp|24750|2022|PDM|35.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F140427_0_0|SrvcGrp|113637|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 642|
20|FH_F91835_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93880_95476_0|SrvcGrp|73603|2022|PDM|2534.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F131267_48846_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123278_20850_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F130527_66044_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F151408_0_0|CSTM-ALL|CSTM-00|2020|PDM|37.00|99|0.00|AEG 6 (NO REV)|
20|FH_F56972_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1345.00|99|0.00|AEG 5  (NO REV)|
20|FH_F120059_0_0|SrvcGrp|108115|2022|PDM|2500.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F112272_0_0|SrvcGrp|73485|2022|PDM|832.00|99|0.00|AETNA REHAB|
20|FH_F135236_02840_0|SrvcGrp|111929|2022|PDM|48.70|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F149442_0_0|SrvcGrp|111927|2022|PDM|95.00|99|0.00|COVID-19 NON CDC|
20|FH_F115063_78550_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F94662_0_0|SrvcGrp|47411|2022|PDM|199.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F33642_0_0|SrvcGrp|13360|2022|PDM|750.00|99|0.00|EMERGENCY ROOM SVCS LEVEL II|
20|FH_F125028_19061_0|SrvcGrp|86849|2022|PDM|63.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F115464_0_0|CSTM-ALL|CSTM-00|2020|PDM|1756.00|99|0.00|AEG 9 (NO REV)|
20|FH_F42905_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F150026_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F132138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135236_02840_0|SrvcGrp|73497|2022|PDM|1446.80|99|0.00|AETNA ER LEVEL IV|
20|FH_F55054_0_0|SrvcGrp|51276|2022|PCT|0.70|99|0.00|TRANSPLANT|
20|FH_F37937_0_0|SrvcGrp|27724|2022|PDM|100.00|99|0.00|SKILLED RN VISIT|
20|FH_F126585_45039_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F139515_0_0|SrvcGrp|113572|2022|PDM|1473.00|99|0.00|EXCISION OF NECK LESION - (3 CM)|
20|FH_F76171_0_0|CSTM-ALL|CSTM-00|2020|PDM|14.00|99|0.00|RN HOURLY|
20|FH_F130747_0_0|SrvcGrp|93071|2022|PDM|8843.00|99|0.00|POSTERIOR SEGMENTAL INSTRU|
20|FH_F131228_01826_0|CSTM-ALL|CSTM-00|2020|PDM|4557.51|99|0.00|AEG 9 (NO REV)|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|373.31|99|0.00|HAPA WPA-NWPA 2012-13 ASC 101 W/O REV|
20|FH_F123276_20737_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F38363_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F37679_0_0|SrvcGrp|26866|2022|PDM|15.25|99|0.00|CORTICOSTEROID THERAPY (MOD SJ)|
20|FH_F120285_32960_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F129766_48236_0|SrvcGrp|111385|2022|PCT|1.00|99|0.00|PATHOLOGY|
20|FH_F93720_12303_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F39855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F130985_0_0|SrvcGrp|33659|2022|PDM|400.00|99|0.00|DIALYSIS SERVICES|
20|FH_F73985_0_0|SrvcGrp|33131|2022|PCT|1.00|99|0.00|AIR AMBULANCE SVCS|
20|FH_F115737_78660_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F50879_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.20|99|0.00|OP SVCS|
20|FH_F141410_13045_0|SrvcGrp|79786|2022|PCT|0.90|99|0.00|SLEEP STUDIES|
20|FH_F39760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.35|99|0.00|HEARING AIDS|
20|FH_F39619_0_0|SrvcGrp|3029|2022|PDM|371.00|99|0.00|NEWBORN NURSERY|
20|FH_F37679_0_0|SrvcGrp|17008|2022|PDM|61.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS|
20|FH_F32471_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|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_F143903_06249_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F148600_30328_0|CSTM-ALL|CSTM-00|2020|PDM|710.00|99|0.00|AEG 10 (NO REV)|
20|FH_F92276_32308_0|SrvcGrp|20902|2022|PDM|27825.00|99|0.00|MS DRG 249 ONLY|
20|FH_F64440_0_0|SrvcGrp|61896|2022|PDM|115.00|99|0.00|OP PT/OT|
20|FH_F116923_85259_0|SrvcGrp|93337|2022|PDM|477.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F140910_53005_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148255_72703_0|SrvcGrp|24754|2022|PDM|10.50|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F34138_0_0|SrvcGrp|26001|2022|PDM|132.40|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F52393_0_0|SrvcGrp|49105|2022|PDM|2400.00|99|0.00|HEARING AID|
20|FH_F49338_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 7 DUBUQUE ENDOSCOPY CENTER (NO REV)|
20|FH_F55212_0_0|SrvcGrp|46414|2022|PDM|52.00|99|0.00|INTERACTIVE GROUP PSYCHOTHERAPY|
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1122.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132544_0_0|SrvcGrp|97259|2022|PDM|7850.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F119526_60435_0|SrvcGrp|471|2022|PDM|993.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F46914_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37751_0_0|SrvcGrp|472|2022|PDM|1045.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F146121_71857_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|79041|2022|PDM|689.99|99|0.00|MON VALLEY ASC 310|
20|FH_F97566_79902_0|SrvcGrp|73603|2022|PDM|10163.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|867.00|99|0.00|AEG 10 (NO REV)|
20|FH_F128246_0_0|SrvcGrp|104723|2022|PDM|726.00|99|0.00|REPAIR EYELID DEFECT|
20|FH_F142081_54929_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F40073_0_0|SrvcGrp|17065|2022|PDM|1053.00|99|0.00|ASPG I|
20|FH_F43239_0_0|SrvcGrp|109123|2022|PDM|325.00|99|0.00|CHILD AND ADOLESCENT|
20|FH_F135431_33414_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135583_17331_0|SrvcGrp|23259|2022|PDM|3588.00|99|0.00|MS DRG 789-795 ONLY NEONATAL|
20|FH_F135851_25414_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136040_75080_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F136042_90066_0|SrvcGrp|112394|2022|PDM|750.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F136086_63701_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136183_72756_0|SrvcGrp|74668|2022|PDM|500.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119885_13753_0|SrvcGrp|76501|2022|PDM|250.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F130996_34110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131374_08009_0|SrvcGrp|89269|2022|PCT|1.10|99|0.00|PSYTX PT/FAMILY 45 MINUTES|
20|FH_F116464_13088_0|SrvcGrp|91065|2022|PDM|90.00|99|0.00|PSYCHIATRIC CPT 90853 (HCFA)|
20|FH_F38843_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|NEWBORN NURSERY|
20|FH_F101200_19020_0|SrvcGrp|52952|2022|PCT|1.15|99|0.00|PSYCHIATRIC CPT 90847|
20|FH_F121428_40202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F121719_63122_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121763_07202_0|SrvcGrp|105465|2022|PCT|8.78|99|0.00|AETNA THERAPIES|
20|FH_F121796_68355_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F101182_07863_0|SrvcGrp|87910|2022|PCT|1.00|99|0.00|VANCOMYCIN HCL INJECT 500MG|
20|FH_F111880_50003_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|1255.05|99|0.00|2005 ASPG GROUPER VII|
20|FH_F132328_0_0|SrvcGrp|27261|2022|PDM|11257.00|99|0.00|CPT 27446|
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.08|99|0.00|AEG 2 (NO REV)|
20|FH_F112146_87102_0|SrvcGrp|73605|2022|PDM|910.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F124892_32535_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128185_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F62579_0_0|SrvcGrp|10580|2022|PDM|55.00|99|0.00|HYDRATION THERAPY - 3 LITERS|
20|FH_F38411_0_0|SrvcGrp|19516|2022|PCT|0.80|99|0.00|MS DRG 799|
20|FH_F130662_07032_0|SrvcGrp|111556|2022|PDM|80.00|99|0.00|GROUP PSYCHOTHERAPY (HCFA)|
20|FH_F130678_50220_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146470_68025_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F48092_0_0|SrvcGrp|471|2022|PDM|1100.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F51039_0_0|SrvcGrp|56203|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY|
20|FH_F127545_45227_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F120603_66112_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F122942_89512_0|SrvcGrp|90040|2022|PDM|500.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F143742_60410_0|SrvcGrp|941|2022|PDM|1890.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F120697_68526_0|SrvcGrp|73842|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F107702_01053_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112004_15401_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F138736_77038_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145604_14850_0|SrvcGrp|103739|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F114509_10010_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F151300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148668_33177_0|SrvcGrp|85963|2022|PDM|75.00|99|0.00|SELF CARE MANGEMENT TRAINING|
20|FH_F59872_0_0|SrvcGrp|10906|2022|PDM|895.00|99|0.00|EMERGENCY ROOM LEVEL IV|
20|FH_F134234_49525_0|SrvcGrp|73841|2022|PDM|330.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F145641_06902_0|SrvcGrp|98347|2022|PDM|5813.00|99|0.00|HIP ARTHROSCOPY / SURGERY|
20|FH_F120930_0_0|SrvcGrp|96564|2022|PDM|3000.00|99|0.00|EXTENSIVE HYSTERCTOMY|
20|FH_F141874_0_0|SrvcGrp|14494|2022|PDM|1271.47|99|0.00|CONTINUOUS HOMECARE|
20|FH_F31714_0_0|SrvcGrp|2077|2022|PDM|26200.00|99|0.00|DRG 515 CV SURG CARDIAC DEFIBRILLATOR|
20|FH_F143067_0_0|SrvcGrp|114010|2022|PDM|735.00|99|0.00|HEMODIALYSIS PROC, OP OR HOME|
20|FH_F126354_91321_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F133957_84121_0|SrvcGrp|23683|2022|PDM|42.25|99|0.00|SKILLED NURSING RN|
20|FH_F48588_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112060_07514_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F100782_0_0|SrvcGrp|108213|2022|PDM|560.00|99|0.00|PLACEMENT XTN|
20|FH_F148927_0_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F120448_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144248_0_0|SrvcGrp|62740|2022|PDM|5738.00|99|0.00|SURGERY CARVE OUTS|
20|FH_F149150_75407_0|SrvcGrp|75419|2022|PDM|575.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F123157_0_0|SrvcGrp|75485|2022|PDM|600.00|99|0.00|AEG 4|
20|FH_F38790_0_0|SrvcGrp|109|2022|PDM|695.00|99|0.00|CD - DETOX|
20|FH_F113435_19027_0|SrvcGrp|89149|2022|PDM|165.00|99|0.00|OP INTENSIVE|
20|FH_F81698_10457_0|SrvcGrp|86852|2022|PDM|31.50|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F137610_0_0|SrvcGrp|86723|2022|PDM|381.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F121639_06830_0|SrvcGrp|472|2022|PDM|830.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F142376_0_0|SrvcGrp|113976|2022|PDM|28.00|99|0.00|ANALYZE SPINE INFUSION PUMP|
20|FH_F126267_24219_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|1607.57|99|0.00|ASPG IX|
20|FH_F49552_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ST. CHARLES PARISH MRA|
20|FH_F145642_15108_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F114509_10010_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F85995_64111_0|SrvcGrp|48396|2022|PDM|136.00|99|0.00|OT SERVICES|
20|FH_F121685_75093_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1676.00|99|0.00|ASPG VII|
20|FH_F44075_0_0|SrvcGrp|13297|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F135982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121177_33407_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F102302_0_0|SrvcGrp|96351|2022|PDM|29900.00|99|0.00|SPINE PROSTHESIS DEVICE|
20|FH_F125927_75093_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F93741_85006_0|SrvcGrp|33363|2022|PCT|1.00|99|0.00|J CODES|
20|FH_F86332_75081_0|SrvcGrp|16298|2022|PDM|65.00|99|0.00|HOME ADMNSTRTN DRUG THERAPY - AEROSOLIZED|
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F41178_0_0|SrvcGrp|1306|2022|PDM|324.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F148200_26554_0|SrvcGrp|112510|2022|PCT|1.50|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F74342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AWP OR ASP+6|
20|FH_F110925_01104_0|SrvcGrp|86142|2022|PDM|34.50|99|0.00|AETNA ABATACEPT INJ|
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PDM|1265.00|99|0.00|ASPG V|
20|FH_F37945_0_0|SrvcGrp|9937|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F100790_10512_0|SrvcGrp|73605|2022|PDM|2830.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F137239_0_0|SrvcGrp|73605|2022|PDM|995.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F129367_89117_0|SrvcGrp|106048|2022|PDM|1047.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F56152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|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_F46941_0_0|SrvcGrp|10528|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F117044_37352_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F110925_01104_0|SrvcGrp|86162|2022|PDM|2.00|99|0.00|AETNA TOBRAMYC SULF|
20|FH_F125249_0_0|SrvcGrp|90361|2022|PDM|2000.00|99|0.00|REPAIR FRACTURE RADIUS/ULNA|
20|FH_F148480_03079_0|CSTM-ALL|CSTM-00|2020|PDM|2388.75|99|0.00|AEG 5  (NO REV)|
20|FH_F72830_0_0|SrvcGrp|14404|2022|PCT|0.40|99|0.00|HOME HEALTH CARE MEDICAL SUPPLIES|
20|FH_F107800_34609_0|CSTM-ALL|CSTM-00|2020|PDM|398.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F151523_86333_0|SrvcGrp|75419|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F130807_20721_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145815_30540_0|SrvcGrp|112727|2022|PDM|45.23|99|0.00|COVID-19 IA NFCT AB SARS COV 2|
20|FH_F137087_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F118057_47906_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|2340.00|99|0.00|AEG 3 (NO REV)|
20|FH_F72183_0_0|SrvcGrp|21354|2022|PDM|3000.00|99|0.00|MS DRG 250-251 ONLY|
20|FH_F147941_06023_0|SrvcGrp|72984|2022|PDM|371.00|99|0.00|CHEMOTHERAPY|
20|FH_F121183_75093_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F103100_47150_0|SrvcGrp|98444|2022|PCT|1.00|99|0.00|INJECTIBLES/DRUGS|
20|FH_F51120_0_0|SrvcGrp|12403|2022|PDM|39.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F130682_0_0|SrvcGrp|110204|2022|PDM|4980.00|99|0.00|UNLISTED PROC, MIDDLE EAR|
20|FH_F49543_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F149888_68506_0|CSTM-ALL|CSTM-00|2020|PDM|2791.00|99|0.00|AEG 7 (NO REV)|
20|FH_F148123_91301_0|SrvcGrp|75419|2022|PDM|545.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148200_26554_0|SrvcGrp|49682|2022|PCT|2.70|99|0.00|HSS DRG GROUPED|
20|FH_F60275_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142332_0_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F130725_33020_0|SrvcGrp|89149|2022|PDM|285.00|99|0.00|OP INTENSIVE|
20|FH_F150165_06032_0|SrvcGrp|104387|2022|PDM|4286.00|99|0.00|REMOVAL OF BONE FOR GRAFT|
20|FH_F71685_0_0|SrvcGrp|28270|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1873.00|99|0.00|AEG 2 (NO REV)|
20|FH_F51039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1143.00|99|0.00|AMPUTATION|
20|FH_F120539_89029_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F143560_03079_0|SrvcGrp|115129|2022|PDM|811.45|99|0.00|MRI/MRA W/ AND W/O CONTRAST|
20|FH_F92477_0_0|SrvcGrp|11199|2022|PDM|525.00|99|0.00|HYPERBARIC CHAMBER|
20|FH_F96160_32207_0|SrvcGrp|74147|2022|PDM|5.62|99|0.00|INFUSION S-CODE PER MONTH|
20|FH_F121476_0_0|SrvcGrp|108844|2022|PDM|7041.00|99|0.00|CARDIAC EVENT RECORDER|
20|FH_F101041_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F90496_13159_0|SrvcGrp|90040|2022|PDM|233.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F81835_0_0|SrvcGrp|75326|2022|PDM|77.46|99|0.00|SLEEP STUDY CPT 95801|
20|FH_F70603_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|1700.00|99|0.00|AEG 9 (NO REV)|
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|AEG 5  (NO REV)|
20|FH_F138024_40509_0|SrvcGrp|73842|2022|PDM|170.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F145817_88101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148600_30328_0|SrvcGrp|59705|2022|PDM|2750.00|99|0.00|SEPTOPLASTY|
20|FH_F75087_0_0|SrvcGrp|56464|2022|PDM|8700.00|99|0.00|CPT 55873|
20|FH_F128816_43537_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F145686_52591_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F139780_75605_0|SrvcGrp|48396|2022|PDM|105.00|99|0.00|OT SERVICES|
20|FH_F119227_01752_0|SrvcGrp|21920|2022|PDM|38.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F100680_43130_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F132899_01002_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F146120_45040_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112023_12866_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132883_31602_0|SrvcGrp|24761|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|3750.00|99|0.00|C-SECTION|
20|FH_F150222_98026_0|SrvcGrp|3178|2022|PDM|675.00|99|0.00|ACUTE PSYCH|
20|FH_F145641_06902_0|SrvcGrp|92368|2022|PDM|3588.00|99|0.00|REPAIR OF LEG TENDON|
20|FH_F134593_60007_0|SrvcGrp|29077|2022|PDM|190.00|99|0.00|HOME TRANSFUSION|
20|FH_F120437_85202_0|SrvcGrp|99040|2022|PDM|69.79|99|0.00|ANTIBIOTIC Q4H (HCFA)|
20|FH_F102561_75146_0|SrvcGrp|81859|2022|PDM|3189.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F75706_0_0|SrvcGrp|72981|2022|PDM|264.00|99|0.00|RESIDENTIAL SKILLED NURSING|
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F103360_68845_0|SrvcGrp|31707|2022|PDM|31050.00|99|0.00|MS DRG 793 ONLY|
20|FH_F126868_60451_0|SrvcGrp|89149|2022|PDM|208.00|99|0.00|OP INTENSIVE|
20|FH_F132601_92677_0|SrvcGrp|87317|2022|PDM|1600.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F44134_0_0|SrvcGrp|41333|2022|PDM|4862.00|99|0.00|LITHO MOD 51|
20|FH_F126626_80906_0|SrvcGrp|86723|2022|PDM|484.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|1986.24|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F44795_0_0|SrvcGrp|11068|2022|PDM|80.00|99|0.00|PT SVCS|
20|FH_F123181_75057_0|SrvcGrp|471|2022|PDM|800.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F87155_04105_0|SrvcGrp|29077|2022|PDM|18.91|99|0.00|HOME TRANSFUSION|
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|1499.00|99|0.00|AEG 5  (NO REV)|
20|FH_F142770_51546_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133006_48067_0|SrvcGrp|73842|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F49354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PDM|4174.00|99|0.00|AEG 9 (NO REV)|
20|FH_F141627_43725_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F72648_0_0|SrvcGrp|44244|2022|PDM|340.00|99|0.00|HEMODIALYSIS - HOME TRAINING|
20|FH_F87155_04105_0|SrvcGrp|22593|2022|PDM|57.78|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F97060_66534_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F40728_0_0|CSTM-ALL|CSTM-00|2020|PDM|801.00|99|0.00|ASPG III|
20|FH_F100784_59923_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS|
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|ASPG X|
20|FH_F118788_91355_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC INVOICE|
20|FH_F141411_0_0|SrvcGrp|113760|2022|PDM|5000.00|99|0.00|WOUND OR LESION REPAIR|
20|FH_F55113_0_0|SrvcGrp|31074|2022|PDM|475.00|99|0.00|MS DRG 795 ONLY|
20|FH_F117372_07442_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F128648_44256_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F119206_35007_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F89932_10940_0|SrvcGrp|29761|2022|PDM|130.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F97061_85012_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128468_37087_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F80952_45669_0|CSTM-ALL|CSTM-00|2020|PDM|1647.83|99|0.00|AEG 7 (NO REV)|
20|FH_F46196_0_0|SrvcGrp|31191|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF (DME)|
20|FH_F78205_0_0|SrvcGrp|14187|2022|PDM|1202.26|99|0.00|MRI|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|683.17|99|0.00|ASPG 301|
20|FH_F91155_16105_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F91255_19401_0|SrvcGrp|74580|2022|PCT|1.00|99|0.00|AETNA IP IMPLANTS|
20|FH_F67861_0_0|SrvcGrp|73979|2022|PDM|13200.00|99|0.00|IP SLEEVE GASTRECTOMY|
20|FH_F126935_33615_0|SrvcGrp|114093|2022|PDM|455.00|99|0.00|PARTIAL HOSPITAL SUBSTANCE ABUSE|
20|FH_F146220_72112_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132543_79549_0|SrvcGrp|73485|2022|PDM|400.00|99|0.00|AETNA REHAB|
20|FH_F115889_0_0|SrvcGrp|73000|2022|PDM|1311.00|99|0.00|AEG 6|
20|FH_F115329_79424_0|SrvcGrp|89149|2022|PDM|250.00|99|0.00|OP INTENSIVE|
20|FH_F139566_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132737_0_0|SrvcGrp|107734|2022|PDM|3742.00|99|0.00|VAGINAL DELIVERY|
20|FH_F117733_91362_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F97622_75051_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|OP SVCS|
20|FH_F89932_10940_0|SrvcGrp|85145|2022|PDM|127.00|99|0.00|PT/OT/ST|
20|FH_F92676_15063_0|SrvcGrp|14240|2022|PDM|365.00|99|0.00|EMERGENCY ROOM SVCS LEVEL II|
20|FH_F115312_78550_0|SrvcGrp|86723|2022|PDM|455.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F106243_92780_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72865_93501_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F72980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133380_46254_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F124608_0_0|SrvcGrp|89842|2022|PDM|8160.00|99|0.00|LUMBAR|
20|FH_F81494_0_0|SrvcGrp|12981|2022|PDM|2875.00|99|0.00|ICU|
20|FH_F101840_76054_0|SrvcGrp|47002|2022|PDM|8207.00|99|0.00|MS DRG 625 ONLY|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F120746_29621_0|SrvcGrp|57968|2022|PDM|30.26|99|0.00|CONTINUOUS HOMECARE|
20|FH_F38700_0_0|SrvcGrp|18886|2022|PCT|0.80|99|0.00|MS DRG 234|
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_F150903_45805_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142991_43920_0|SrvcGrp|13597|2022|PDM|233.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F105921_80014_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F97061_85012_0|SrvcGrp|88978|2022|PDM|6542.00|99|0.00|VAGINAL DELIVERY|
20|FH_F97141_93933_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F126975_43551_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F117613_08221_0|SrvcGrp|473|2022|PDM|300.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F41596_0_0|SrvcGrp|13551|2022|PDM|440.00|99|0.00|NEWBORN NURSERY|
20|FH_F37553_0_0|SrvcGrp|26799|2022|PDM|70.00|99|0.00|CPT 70030|
20|FH_F118373_21205_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F44607_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F103281_32086_0|CSTM-ALL|CSTM-00|2020|PDM|3437.00|99|0.00|AEG 5  (NO REV)|
20|FH_F151061_02720_0|SrvcGrp|113171|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F151179_84074_0|SrvcGrp|73004|2022|PDM|1470.00|99|0.00|AEG 8|
20|FH_F87117_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136467_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|2705.00|99|0.00|AEG 6 (NO REV)|
20|FH_F58856_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F64999_0_0|CSTM-ALL|CSTM-00|2020|PDM|1437.00|99|0.00|ASPG VII|
20|FH_F136373_17055_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F136373_17055_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134011_84102_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F137238_70056_0|SrvcGrp|73842|2022|PDM|253.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114092_83350_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F114092_83350_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F53732_0_0|SrvcGrp|22589|2022|PDM|75.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F138471_84663_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138584_30912_0|SrvcGrp|113412|2022|PDM|650.00|99|0.00|MANDIBULAR FRACTURE TREATMENT|
20|FH_F138967_67208_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140407_63841_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F140750_89119_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F79691_30014_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F80284_16354_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HAPA WPA/NWPA 2014 RAD 100%|
20|FH_F80754_31601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149377_22102_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149659_79912_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119065_92029_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F119067_94080_0|SrvcGrp|73701|2022|PDM|55.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F126853_19053_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109983_98607_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F147725_06002_0|SrvcGrp|33984|2022|PDM|3894.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F129477_70403_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F117217_80304_0|SrvcGrp|89022|2022|PDM|33.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F117218_32025_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F109652_0_0|SrvcGrp|30623|2022|PDM|5961.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138543_60130_0|SrvcGrp|73842|2022|PDM|243.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F83997_0_0|SrvcGrp|471|2022|PDM|484.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F83997_0_0|SrvcGrp|75545|2022|PDM|363.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F130978_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F143450_0_0|SrvcGrp|113568|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1406.00|99|0.00|AEG 9 (NO REV)|
20|FH_F65761_0_0|SrvcGrp|43429|2022|PDM|169.74|99|0.00|RN HOURLY, HIGH TECH PEDS|
20|FH_F76172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F98040_89406_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F117525_0_0|SrvcGrp|73004|2022|PDM|1400.00|99|0.00|AEG 8|
20|FH_F33421_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.10|99|0.00|OP SVCS|
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|487.96|99|0.00|AETNA POLYSOMNOGRAPHY|
20|FH_F130439_85014_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131494_0_0|SrvcGrp|101820|2022|PDM|578.00|99|0.00|HYSTEROSCOPY RESECT SEPTUM|
20|FH_F52516_0_0|SrvcGrp|3327|2022|PDM|139.76|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F134317_0_0|SrvcGrp|87536|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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_F114386_07090_0|SrvcGrp|73700|2022|PDM|57.92|99|0.00|AETNA - SKILLED NURSING|
20|FH_F77944_0_0|SrvcGrp|75319|2022|PCT|0.28|99|0.00|HIGH COST DRUGS EXCLUDE ER/URGENT CARE|
20|FH_F146807_28655_0|SrvcGrp|75506|2022|PCT|0.85|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F147081_02130_0|SrvcGrp|90388|2022|PDM|504.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F91998_0_0|SrvcGrp|91892|2022|PDM|8500.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F92493_0_0|SrvcGrp|88157|2022|PDM|22098.62|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F55453_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98380_43055_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124663_65608_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1088.00|99|0.00|AEG 6 (NO REV)|
20|FH_F132439_0_0|SrvcGrp|92501|2022|PDM|163.24|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F133399_72211_0|SrvcGrp|3178|2022|PDM|896.00|99|0.00|ACUTE PSYCH|
20|FH_F55694_0_0|SrvcGrp|360|2022|PDM|744.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F126073_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F136611_43764_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114645_34952_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F114666_30342_0|SrvcGrp|92009|2022|PDM|3000.00|99|0.00|CARPAL SCAPHOID FRACTURE|
20|FH_F138716_20151_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148553_85016_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F43418_0_0|SrvcGrp|40820|2022|PDM|1280.00|99|0.00|ICU/CCU|
20|FH_F136778_62034_0|CSTM-ALL|CSTM-00|2020|PDM|3686.00|99|0.00|AEG 4 (NO REV)|
20|FH_F119888_0_0|SrvcGrp|2067|2022|PDM|715.98|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F115206_80923_0|SrvcGrp|89417|2022|PDM|463.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F115210_21043_0|SrvcGrp|11673|2022|PDM|3077.00|99|0.00|CPT 29888|
20|FH_F116365_11417_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F116393_07002_0|SrvcGrp|111279|2022|PDM|13.11|99|0.00|AUTOMAT HEMOGRAM-COMPLET DIF|
20|FH_F147701_31093_0|CSTM-ALL|CSTM-00|2020|PDM|6059.00|99|0.00|AEG 7 (NO REV)|
20|FH_F147725_06002_0|SrvcGrp|99163|2022|PDM|14061.00|99|0.00|CPT 27703|
20|FH_F42402_0_0|SrvcGrp|12146|2022|PDM|1700.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F42581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F98621_41042_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F103004_75840_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F76824_0_0|SrvcGrp|47342|2022|PDM|100.00|99|0.00|SKN HOURLY|
20|FH_F47999_0_0|SrvcGrp|43988|2022|PDM|121.00|99|0.00|RN VISIT|
20|FH_F113025_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 5  (NO REV)|
20|FH_F114853_0_0|SrvcGrp|98497|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|WILLS COMM SURG SVC ASC 3|
20|FH_F113585_20155_0|SrvcGrp|95582|2022|PCT|1.00|99|0.00|OP SERVICES AMFS(H) DEFAULT|
20|FH_F138700_76802_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F90184_0_0|SrvcGrp|89669|2022|PCT|1.00|99|0.00|IMPLANTS HCPCS|
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1051.84|99|0.00|AEG 2 (NO REV)|
20|FH_F32886_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F113885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|337.81|99|0.00|HAPA WPA-NWPA 2012-13 ASC 113 W/O REV|
20|FH_F151303_50703_0|SrvcGrp|74668|2022|PDM|184.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151303_50703_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F132258_45404_0|SrvcGrp|24754|2022|PDM|11.93|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F145148_60162_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135352_32225_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135590_84066_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F91764_93710_0|SrvcGrp|114606|2022|PDM|25745.00|99|0.00|MAJOR JOINT REPLACEMENT (MS DRG 469/521)|
20|FH_F135787_60108_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135924_02906_0|SrvcGrp|88678|2022|PDM|3251.40|99|0.00|ACUTE REHAB I|
20|FH_F135972_18509_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F135979_66451_0|SrvcGrp|66264|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F136165_60637_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131228_01826_0|SrvcGrp|113741|2022|PCT|1.28|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F131132_44077_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F116397_33404_0|SrvcGrp|86828|2022|PDM|105.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F116468_49660_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F127399_0_0|SrvcGrp|89404|2022|PDM|14045.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
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|92007|2022|PDM|5202.00|99|0.00|PROXIMAL HUMERAL|
20|FH_F127399_0_0|SrvcGrp|73008|2022|PDM|1873.00|99|0.00|AEG 10|
20|FH_F121823_46234_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121854_28613_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F146125_0_0|SrvcGrp|78283|2022|PDM|3194.00|99|0.00|CPT 49505|
20|FH_F35357_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F38013_0_0|SrvcGrp|13627|2022|PDM|178.00|99|0.00|SLEEP STUDY|
20|FH_F67425_0_0|SrvcGrp|16|2022|PDM|1565.00|99|0.00|ACUTE REHABILITATION|
20|FH_F111363_33169_0|SrvcGrp|81406|2022|PDM|8.00|99|0.00|URINALYSIS|
20|FH_F134264_67226_0|SrvcGrp|46903|2022|PDM|550.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F47906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.80|99|0.00|AEG 5  (NO REV)|
20|FH_F42026_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F116430_0_0|SrvcGrp|55084|2022|PDM|2440.00|99|0.00|CPT 52648|
20|FH_F116430_0_0|SrvcGrp|106708|2022|PDM|2403.00|99|0.00|OTHER ENT SURGERY|
20|FH_F131000_0_0|SrvcGrp|82113|2022|PDM|3343.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F87496_17055_0|SrvcGrp|81950|2022|PCT|1.00|99|0.00|AETNA LABORATORY|
20|FH_F87501_32055_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F87557_33309_0|SrvcGrp|86829|2022|PDM|30.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F87557_33309_0|SrvcGrp|86523|2022|PCT|1.00|99|0.00|AETNA DRUGS/AGENTS/INJ DRUG|
20|FH_F123036_0_0|SrvcGrp|96353|2022|PDM|19500.00|99|0.00|RECONSTRUCT ANKLE JOINT|
20|FH_F148884_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102862_30606_0|SrvcGrp|26684|2022|PDM|55457.20|99|0.00|MS DRG 454 ONLY|
20|FH_F148101_33462_0|SrvcGrp|89024|2022|PDM|80.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F62579_0_0|SrvcGrp|16750|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F62579_0_0|SrvcGrp|14945|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|111.77|99|0.00|HAPA WPA-NWPA 2012-13 ASC 139 W/O REV|
20|FH_F79863_0_0|SrvcGrp|71162|2022|PDM|55.00|99|0.00|CATHERER CARE|
20|FH_F52713_0_0|SrvcGrp|9984|2022|PDM|247.00|99|0.00|URGENT CARE|
20|FH_F150165_06032_0|SrvcGrp|111954|2022|PDM|2204.00|99|0.00|MALE GENITAL PROCEDURES|
20|FH_F127090_45601_0|SrvcGrp|46605|2022|PDM|92.25|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F92652_76531_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127641_08103_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F97861_62223_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F143567_62207_0|SrvcGrp|48396|2022|PDM|140.00|99|0.00|OT SERVICES|
20|FH_F85353_16407_0|SrvcGrp|3388|2022|PDM|980.00|99|0.00|SUBACUTE CARE|
20|FH_F85132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F143631_52248_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|935.00|99|0.00|AEG 6 (NO REV)|
20|FH_F110902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117208_0_0|SrvcGrp|107357|2022|PDM|4015.00|99|0.00|HYOID MYOTOMY AND SUSPENSION|
20|FH_F138302_15701_0|SrvcGrp|53987|2022|PDM|40.00|99|0.00|PHOTOTHERAPY|
20|FH_F138589_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F149148_15330_0|SrvcGrp|48385|2022|PDM|91.00|99|0.00|SPEECH THERAPY|
20|FH_F54532_0_0|SrvcGrp|22985|2022|PDM|1130.00|99|0.00|GERIATRIC PSYCH SERVICES|
20|FH_F138292_60914_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145781_0_0|SrvcGrp|114303|2022|PDM|2200.00|99|0.00|PARTIAL REMOVAL COLLARBONE|
20|FH_F147962_85008_0|SrvcGrp|73806|2022|PDM|325.00|99|0.00|AETNA ER|
20|FH_F121225_98902_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|592.74|99|0.00|HAPA WPA-NWPA 2012-13 ASC 211 W/O REV|
20|FH_F112468_0_0|SrvcGrp|73004|2022|PDM|1114.00|99|0.00|AEG 8|
20|FH_F150165_06032_0|SrvcGrp|88824|2022|PDM|4244.00|99|0.00|CPT 69631|
20|FH_F96160_32207_0|SrvcGrp|86843|2022|PDM|61.90|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F51039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1143.00|99|0.00|STROKE REHAB|
20|FH_F118803_0_0|SrvcGrp|107792|2022|PDM|5632.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F110260_27546_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F145940_71730_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149244_85201_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133808_73401_0|SrvcGrp|66265|2022|PDM|81.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F120583_43219_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F119125_0_0|SrvcGrp|10708|2022|PDM|200.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F148600_30328_0|SrvcGrp|106063|2022|PDM|3933.00|99|0.00|REVISE MIDDLE EAR & MASTOID|
20|FH_F88698_18951_0|SrvcGrp|43524|2022|PDM|152.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F112065_20852_0|SrvcGrp|48398|2022|PDM|130.00|99|0.00|PT SERVICES|
20|FH_F136359_0_0|SrvcGrp|103236|2022|PDM|8100.00|99|0.00|AETNA INSJ STABLJ DEV|
20|FH_F110604_0_0|SrvcGrp|58638|2022|PDM|2310.00|99|0.00|CPT 63688|
20|FH_F145641_06902_0|SrvcGrp|100661|2022|PDM|5814.00|99|0.00|AETNA OP SURGERY|
20|FH_F145593_92660_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F90391_33774_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150165_06032_0|SrvcGrp|41547|2022|PDM|5994.00|99|0.00|OP LAPAROSCOPIC HYSTERECTOMY|
20|FH_F129509_0_0|SrvcGrp|74039|2022|PDM|3767.00|99|0.00|LAMINECTOMY|
20|FH_F121603_46761_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F89219_0_0|SrvcGrp|13222|2022|PDM|523.00|99|0.00|CPT CODE 99281|
20|FH_F142894_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F134208_21502_0|SrvcGrp|36591|2022|PDM|3500.00|99|0.00|CPT 63685|
20|FH_F85353_16407_0|SrvcGrp|63846|2022|PDM|446.41|99|0.00|HAPA WPA-NWPA 2012-13 ASC 109|
20|FH_F135670_01749_0|SrvcGrp|17013|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F133805_83401_0|SrvcGrp|90707|2022|PDM|122.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.61|99|0.00|HAPA WPA-NWPA 2012-13 ASC 126 W/O REV|
20|FH_F97840_54729_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|1141.00|99|0.00|AEG 7 (NO REV)|
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|2408.00|99|0.00|AEG 7 (NO REV)|
20|FH_F133747_80634_0|SrvcGrp|93007|2022|PDM|600.00|99|0.00|AETNA IP BH OBSERVATION|
20|FH_F113322_38119_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F127545_45227_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F145642_15108_0|SrvcGrp|86852|2022|PDM|30.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F110604_0_0|SrvcGrp|93807|2022|PDM|6715.50|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F130763_0_0|SrvcGrp|63466|2022|PDM|4714.00|99|0.00|CPT 52005|
20|FH_F112041_19020_0|SrvcGrp|76501|2022|PDM|304.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F138589_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_F111701_33330_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88274_0_0|SrvcGrp|75479|2022|PDM|600.00|99|0.00|AEG 1|
20|FH_F109577_0_0|SrvcGrp|87399|2022|PDM|135.00|99|0.00|CPT 99502 (HCFA)|
20|FH_F116806_0_0|SrvcGrp|107070|2022|PDM|1923.16|99|0.00|REPAIR SALIVARY DUCT|
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|1888.20|99|0.00|AEG 3 (NO REV)|
20|FH_F127486_06776_0|SrvcGrp|95660|2022|PDM|706.65|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F130468_0_0|SrvcGrp|93433|2022|PDM|11086.40|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F130763_0_0|SrvcGrp|91880|2022|PDM|9514.00|99|0.00|OSSEOINTEGRATED IMPLANT|
20|FH_F116806_0_0|SrvcGrp|107064|2022|PDM|1923.16|99|0.00|RECONSTRUCT CLEFT PALATE|
20|FH_F132883_31602_0|SrvcGrp|29023|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F95631_33705_0|SrvcGrp|73605|2022|PDM|3491.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F127418_0_0|SrvcGrp|110762|2022|PDM|40295.78|99|0.00|LUMBAR VERTEBRAL CORPECTOMY|
20|FH_F109242_18466_0|SrvcGrp|102982|2022|PDM|131.00|99|0.00|PSYTX WPT W E/M 60 MIN|
20|FH_F54592_0_0|SrvcGrp|14947|2022|PDM|65.00|99|0.00|HOME INFUSION|
20|FH_F54592_0_0|SrvcGrp|17009|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|2007 MEDICARE ASPG II|
20|FH_F87053_0_0|SrvcGrp|72996|2022|PDM|1020.00|99|0.00|AEG 4|
20|FH_F70684_0_0|SrvcGrp|42973|2022|PDM|126.53|99|0.00|SPEECH  THERAPIST|
20|FH_F101100_50314_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F105145_75075_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F132883_31602_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F95440_0_0|SrvcGrp|93725|2022|PDM|4600.00|99|0.00|IMPLANT SPINE INFUSION PMP25|
20|FH_F130501_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145641_06902_0|SrvcGrp|113168|2022|PDM|5626.00|99|0.00|REMOVAL OF KNEECAP BURSA|
20|FH_F96160_32207_0|SrvcGrp|22389|2022|PDM|25.89|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F89219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|MT NITTANY ASC 9|
20|FH_F136318_0_0|SrvcGrp|46903|2022|PDM|796.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F109273_77339_0|SrvcGrp|89337|2022|PDM|862.00|99|0.00|DETOXIFICATION|
20|FH_F127579_44321_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F87571_0_0|SrvcGrp|10905|2022|PDM|550.00|99|0.00|EMERGENCY ROOM LEVEL III|
20|FH_F134331_61021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121601_47446_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F134608_18017_0|SrvcGrp|85820|2022|PDM|130.00|99|0.00|RH IG, FULL DOSE, IM|
20|FH_F150299_22046_0|SrvcGrp|23683|2022|PDM|42.00|99|0.00|SKILLED NURSING RN|
20|FH_F133808_73401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F81852_0_0|CSTM-ALL|CSTM-00|2020|PDM|1779.00|99|0.00|ASPG IX|
20|FH_F134205_33410_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F50053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F125657_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|381.11|99|0.00|CPT 95805 (W/MOD TC)|
20|FH_F69708_0_0|SrvcGrp|42827|2022|PDM|117.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F80224_0_0|CSTM-ALL|CSTM-00|2020|PDM|1403.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F119227_01752_0|SrvcGrp|86850|2022|PDM|38.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F50657_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F70804_0_0|SrvcGrp|20000|2022|PDM|228.40|99|0.00|CATHETER CARE SUPPLIES|
20|FH_F50657_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F122553_92705_0|SrvcGrp|105350|2022|PDM|360.00|99|0.00|AETNA PARTIAL HOSPITALIZATION|
20|FH_F86435_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F84712_0_0|SrvcGrp|82884|2022|PDM|695.00|99|0.00|AETNA IP/OP BH OBSERVATION (BHOBSALL)|
20|FH_F85894_0_0|SrvcGrp|537|2022|PCT|0.77|99|0.00|OBSERVATION SERVICES|
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|2343.00|99|0.00|2007 MEDICARE ASPG IX|
20|FH_F115907_12206_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F146805_45662_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120795_27514_0|SrvcGrp|16|2022|PDM|3037.00|99|0.00|ACUTE REHABILITATION|
20|FH_F120795_27514_0|CSTM-ALL|CSTM-00|2020|PDM|12574.00|99|0.00|AEG 6 (NO REV)|
20|FH_F115956_06516_0|SrvcGrp|76501|2022|PDM|275.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F133583_77074_0|SrvcGrp|73842|2022|PDM|234.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132088_34981_0|SrvcGrp|86723|2022|PDM|387.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F131430_17566_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133700_92808_0|SrvcGrp|112393|2022|PDM|700.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F132678_19090_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111580_77004_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F35404_0_0|SrvcGrp|12047|2022|PCT|0.55|99|0.00|CPT CODES 80000-89999, 36415 (LAB)|
20|FH_F89736_0_0|SrvcGrp|111962|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F115487_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
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_F123792_90803_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F123820_91316_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F132810_0_0|SrvcGrp|10577|2022|PDM|35.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F58856_0_0|SrvcGrp|28162|2022|PDM|38520.00|99|0.00|MS DRG 217 ONLY|
20|FH_F69968_0_0|SrvcGrp|55662|2022|PCT|0.51|99|0.00|EMERGENCY ROOM LEVEL IV, V & CRITICAL CARE W/SURG|
20|FH_F136426_19006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118236_25901_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|GENERAL ACUTE CARE|
20|FH_F93178_73448_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|GENERAL ACUTE CARE|
20|FH_F137237_33304_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F138019_79705_0|SrvcGrp|86722|2022|PDM|231.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F138627_82901_0|SrvcGrp|86779|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F138627_82901_0|SrvcGrp|99040|2022|PDM|125.00|99|0.00|ANTIBIOTIC Q4H (HCFA)|
20|FH_F126567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126759_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F114865_77488_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F138735_50583_0|SrvcGrp|112967|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F140568_46506_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140615_73013_0|CSTM-ALL|CSTM-00|2020|PDM|1346.00|99|0.00|AEG 8 (NO REV)|
20|FH_F140730_84106_0|SrvcGrp|80920|2022|PDM|474.00|99|0.00|HOSPICE SERVICES|
20|FH_F140750_89119_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F140765_30315_0|SrvcGrp|113299|2022|PDM|40.00|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - MODERNA|
20|FH_F79724_32501_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120152_0_0|SrvcGrp|108350|2022|PDM|16500.00|99|0.00|REPAIR OF DURAL/CSF LEAK|
20|FH_F149514_99701_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149561_76667_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151606_64772_0|SrvcGrp|74668|2022|PDM|218.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119023_91406_0|SrvcGrp|86845|2022|PDM|35.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F119046_74012_0|SrvcGrp|89344|2022|PDM|325.00|99|0.00|HYPERBARIC OXYGEN|
20|FH_F133847_21702_0|SrvcGrp|38006|2022|PDM|1400.00|99|0.00|CPT CODE 59426|
20|FH_F63312_0_0|SrvcGrp|12403|2022|PDM|24.50|99|0.00|CONTINUOUS HOMECARE|
20|FH_F149362_19446_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138447_22041_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F96160_32207_0|SrvcGrp|86839|2022|PDM|68.65|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F43861_0_0|SrvcGrp|30961|2022|PDM|12.50|99|0.00|HOME HEALTH AIDE|
20|FH_F138026_46143_0|SrvcGrp|73841|2022|PDM|386.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F132883_31602_0|SrvcGrp|22592|2022|PDM|20.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F150239_75569_0|SrvcGrp|24761|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F111031_30252_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134326_14094_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|NURSING CARE MOD TE|
20|FH_F148600_30328_0|SrvcGrp|77582|2022|PDM|3520.00|99|0.00|CPT 31255|
20|FH_F121687_04401_0|SrvcGrp|83902|2022|PCT|1.38|99|0.00|STICK ASSAY OF BLOOD GLUCOSE|
20|FH_F149021_44514_0|SrvcGrp|115564|2022|PDM|775.28|99|0.00|SURGICAL SERVICES|
20|FH_F110542_10035_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F87775_15106_0|SrvcGrp|22384|2022|PDM|90.00|99|0.00|HOME VISIT PRENATAL|
20|FH_F121603_46761_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F109273_77339_0|SrvcGrp|73842|2022|PDM|220.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F126341_27284_0|SrvcGrp|63156|2022|PCT|0.54|99|0.00|IMMUNE GLOBULIN INTRAVENOUS|
20|FH_F150165_06032_0|SrvcGrp|80617|2022|PDM|12731.00|99|0.00|ARTHOPLASTY|
20|FH_F134249_05060_0|SrvcGrp|78421|2022|PDM|2792.00|99|0.00|VAGINAL DELIVERY|
20|FH_F145594_02809_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F50703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120425_11106_0|SrvcGrp|90643|2022|PDM|20.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F110311_17078_0|SrvcGrp|103939|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F150165_06032_0|SrvcGrp|113882|2022|PDM|2270.00|99|0.00|PENIS PLASTIC SURGERY|
20|FH_F124369_0_0|SrvcGrp|107983|2022|PDM|11220.00|99|0.00|PART REMOVAL OF ANKLE/HEEL|
20|FH_F70208_0_0|CSTM-ALL|CSTM-00|2020|PDM|449.00|99|0.00|ASPG I|
20|FH_F96201_01824_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F70863_0_0|SrvcGrp|14629|2022|PDM|146.00|99|0.00|RN VISIT|
20|FH_F51138_0_0|SrvcGrp|22954|2022|PDM|157.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F134494_33612_0|SrvcGrp|46903|2022|PDM|790.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F122551_75605_0|SrvcGrp|89417|2022|PDM|445.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F84454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCES|
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|73463|2022|PDM|2208.00|99|0.00|AETNA NICU II|
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|119.63|99|0.00|HAPA WPA-NWPA 2012-13 ASC 314 W/O REV|
20|FH_F101100_50314_0|SrvcGrp|97902|2022|PDM|13945.00|99|0.00|REMOVAL OF SPLEEN TOTAL|
20|FH_F105145_75075_0|SrvcGrp|75505|2022|PCT|0.00|99|0.00|CARDIAC STUDIES|
20|FH_F66427_0_0|SrvcGrp|47427|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F146422_80210_0|SrvcGrp|114583|2022|PCT|1.00|99|0.00|OP THERAPY SERVICE|
20|FH_F146806_33157_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120775_28805_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120795_27514_0|SrvcGrp|33789|2022|PDM|3496.00|99|0.00|MS DRG 880-887 ONLY|
20|FH_F120805_92672_0|SrvcGrp|87317|2022|PDM|1250.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F125698_44070_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131711_25550_0|SrvcGrp|537|2022|PCT|0.88|99|0.00|OBSERVATION SERVICES|
20|FH_F131737_15025_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F133569_17202_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139128_49503_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F150745_03301_0|SrvcGrp|43569|2022|PDM|164.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F150765_05001_0|SrvcGrp|88621|2022|PDM|135.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150882_84041_0|SrvcGrp|33722|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F132160_0_0|SrvcGrp|46886|2022|PDM|4590.00|99|0.00|REMOVAL OF EYELID LESION|
20|FH_F111080_18103_0|SrvcGrp|89149|2022|PDM|161.00|99|0.00|OP INTENSIVE|
20|FH_F116575_0_0|SrvcGrp|94989|2022|PDM|1525.00|99|0.00|SINUS ENDO W/ BALLOON DILATION|
20|FH_F40979_0_0|SrvcGrp|10365|2022|PDM|500.00|99|0.00|CPT CODE 99285|
20|FH_F124452_31322_0|SrvcGrp|73701|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F149516_65233_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F148963_56301_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F111246_80027_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F125656_92868_0|SrvcGrp|19742|2022|PDM|75.00|99|0.00|MID-LINE INSERTION|
20|FH_F44255_0_0|SrvcGrp|1306|2022|PDM|265.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F150943_15537_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F108180_29526_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F139970_16142_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137772_27320_0|SrvcGrp|22954|2022|PDM|175.95|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F151003_33162_0|SrvcGrp|74668|2022|PDM|232.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114676_91911_0|SrvcGrp|86722|2022|PDM|270.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F101685_0_0|SrvcGrp|72992|2022|PDM|550.00|99|0.00|AEG 2|
20|FH_F34983_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS|
20|FH_F37364_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|MULTIPLE BIRTH|
20|FH_F124492_30040_0|SrvcGrp|113244|2022|PDM|156.89|99|0.00|COVID-19 NFCT DS VIR RESP RNA 3 TRGT (HCFA)|
20|FH_F138018_17313_0|SrvcGrp|28630|2022|PDM|251.00|99|0.00|HOME INFUSION SKILLED NURSING|
20|FH_F126977_34990_0|SrvcGrp|87077|2022|PDM|139.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F97084_91911_0|SrvcGrp|88978|2022|PDM|9467.00|99|0.00|VAGINAL DELIVERY|
20|FH_F124492_30040_0|SrvcGrp|111928|2022|PDM|56.44|99|0.00|COVID-19 BARTONELLA|
20|FH_F139785_92629_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F94330_43220_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138018_17313_0|SrvcGrp|29077|2022|PDM|41.10|99|0.00|HOME TRANSFUSION|
20|FH_F119355_0_0|SrvcGrp|105427|2022|PDM|50.00|99|0.00|AETNA OBSERVATIONS BEHAVIORAL 30 MINS|
20|FH_F34853_0_0|SrvcGrp|9936|2022|PDM|170.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F35446_0_0|CSTM-ALL|CSTM-00|2020|PDM|117.00|99|0.00|INTENSIVE PSYCH SVCS|
20|FH_F111122_63376_0|SrvcGrp|46605|2022|PDM|81.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F81951_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F74670_0_0|SrvcGrp|46724|2022|PDM|95.00|99|0.00|WORK HARDENING|
20|FH_F134869_08854_0|SrvcGrp|89149|2022|PDM|270.00|99|0.00|OP INTENSIVE|
20|FH_F136887_0_0|SrvcGrp|40002|2022|PDM|14057.00|99|0.00|TOTAL HIP|
20|FH_F81312_0_0|SrvcGrp|12889|2022|PCT|0.65|99|0.00|RADIOLOGY|
20|FH_F125656_92868_0|SrvcGrp|22593|2022|PDM|30.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F76285_0_0|SrvcGrp|52803|2022|PDM|172.00|99|0.00|OT SVCS INITIAL EVAL 97003 VISIT LEVEL|
20|FH_F137789_48146_0|SrvcGrp|48396|2022|PDM|90.00|99|0.00|OT SERVICES|
20|FH_F39443_0_0|SrvcGrp|30291|2022|PDM|407.00|99|0.00|HAPA WPA ASC 103|
20|FH_F137902_0_0|SrvcGrp|73841|2022|PDM|269.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F134847_0_0|SrvcGrp|63471|2022|PDM|8824.00|99|0.00|CPT 64590|
20|FH_F130309_17044_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F147159_62615_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120332_0_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD OUTLIER|
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124548_12414_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F149023_44122_0|SrvcGrp|112960|2022|PDM|12618.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F39082_0_0|SrvcGrp|18278|2022|PDM|13141.00|99|0.00|MS DRG 460|
20|FH_F147330_34761_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50078_0_0|CSTM-ALL|CSTM-00|2020|PDM|95.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F137748_95231_0|SrvcGrp|73498|2022|PDM|1026.00|99|0.00|AETNA ER LEVEL III|
20|FH_F35174_0_0|SrvcGrp|8968|2022|PDM|4822.00|99|0.00|NICU LEVEL III & IV|
20|FH_F103109_33462_0|SrvcGrp|86723|2022|PDM|365.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F132132_77040_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129588_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|AEG 2 (NO REV)|
20|FH_F141334_66401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F117762_0_0|SrvcGrp|80617|2022|PDM|14560.00|99|0.00|ARTHOPLASTY|
20|FH_F150459_08021_0|SrvcGrp|23683|2022|PDM|47.59|99|0.00|SKILLED NURSING RN|
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 4 (NO REV)|
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|2530.00|99|0.00|AEG 5  (NO REV)|
20|FH_F128821_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F116806_0_0|SrvcGrp|107105|2022|PDM|887.26|99|0.00|CONTOUR OF FACE BONE LESION|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PDM|737.00|99|0.00|ASPG II|
20|FH_F122841_0_0|SrvcGrp|112136|2022|PDM|2235.00|99|0.00|XCAPSL CTRC RMVL CPLX W/ECP|
20|FH_F150982_0_0|SrvcGrp|76602|2022|PDM|1382.00|99|0.00|CPT 25000|
20|FH_F139247_77657_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F89616_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.10|99|0.00|GENERAL ACUTE CARE|
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|1801.00|99|0.00|AEG 2 (NO REV)|
20|FH_F139870_71075_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139950_76240_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F143536_47546_0|SrvcGrp|68241|2022|PCT|1.00|99|0.00|DESTRUCTION WARTS - 2ND - 4TH LESIONS|
20|FH_F95800_0_0|SrvcGrp|87679|2022|PDM|884.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F102542_0_0|SrvcGrp|10393|2022|PDM|1550.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F103060_0_0|SrvcGrp|98496|2022|PDM|8323.00|99|0.00|ARTHRODESIS POSTERIOR ATLAS|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|HERNIA PROCEDURES|
20|FH_F131067_57105_0|SrvcGrp|104400|2022|PCT|1.70|99|0.00|RADIOLOGY SERVICES|
20|FH_F49458_0_0|SrvcGrp|45570|2022|PDM|170.96|99|0.00|NON SILICONE BREAST FORM|
20|FH_F120208_20109_0|SrvcGrp|87077|2022|PDM|156.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F136267_73703_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F132407_62035_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116698_07470_0|SrvcGrp|48396|2022|PDM|52.50|99|0.00|OT SERVICES|
20|FH_F143467_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
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|31134|2022|PDM|1040.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F67505_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F59732_0_0|SrvcGrp|17003|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS|
20|FH_F35259_0_0|SrvcGrp|4109|2022|PDM|1391.00|99|0.00|ACUTE PSYCH|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD KM) - CPD 1963706|
20|FH_F141519_51566_0|SrvcGrp|75506|2022|PCT|0.95|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F137067_0_0|SrvcGrp|100011|2022|PDM|6884.00|99|0.00|ANKLE ARTHROSCOPY|
20|FH_F118373_21205_0|SrvcGrp|107760|2022|PDM|3224.00|99|0.00|PEDS/DLX|
20|FH_F82753_18840_0|SrvcGrp|13118|2022|PCT|0.64|99|0.00|TRAUMA CARE|
20|FH_F33471_0_0|SrvcGrp|13476|2022|PCT|0.90|99|0.00|TRAUMA CARE|
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG IX|
20|FH_F129387_33991_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F66427_0_0|SrvcGrp|34557|2022|PDM|5820.00|99|0.00|MS DRG 894-897 ONLY CHEM DEP|
20|FH_F75842_0_0|SrvcGrp|46530|2022|PDM|266.83|99|0.00|EMERGENCY ROOM LEVEL 1|
20|FH_F75842_0_0|SrvcGrp|107496|2022|PDM|21379.24|99|0.00|ATHERECTOMY PROCEDURES|
20|FH_F146796_43334_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146848_73072_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F63124_0_0|SrvcGrp|42972|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE|
20|FH_F131757_06320_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131904_18915_0|SrvcGrp|88620|2022|PDM|116.00|99|0.00|SKILLED NURSING RN|
20|FH_F132197_67437_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133491_74012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133700_92808_0|SrvcGrp|23587|2022|PDM|1600.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F139148_70006_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F139172_40207_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F139391_30127_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139673_63011_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F139707_84010_0|SrvcGrp|114716|2022|PDM|3148.00|99|0.00|LAPAROSCOPY SERVICES|
20|FH_F150745_03301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139150_75206_0|SrvcGrp|66264|2022|PDM|89.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F115483_62002_0|SrvcGrp|105811|2022|PDM|10132.00|99|0.00|CARDIAC ANGIOPLASTY|
20|FH_F35557_0_0|SrvcGrp|11785|2022|PDM|28.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F69811_0_0|CSTM-ALL|CSTM-00|2020|PCT|51.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132254_40207_0|SrvcGrp|19742|2022|PDM|80.00|99|0.00|MID-LINE INSERTION|
20|FH_F38123_0_0|SrvcGrp|31191|2022|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER UEKF (DME)|
20|FH_F119352_0_0|SrvcGrp|26470|2022|PDM|200.00|99|0.00|SELF DIALYSIS TRAINING CAPD|
20|FH_F122333_67010_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F99920_63141_0|SrvcGrp|87799|2022|PDM|110.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F132008_85226_0|SrvcGrp|111915|2022|PCT|0.80|99|0.00|GR24 SEALED LEADACID BATTERY|
20|FH_F139167_42240_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F124441_0_0|SrvcGrp|92365|2022|PDM|13300.00|99|0.00|FUSION OF SACROILIAC JOINT|
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|1775.00|99|0.00|AEG 7 (NO REV)|
20|FH_F119376_0_0|SrvcGrp|73006|2022|PDM|1607.00|99|0.00|AEG 9|
20|FH_F134707_0_0|SrvcGrp|78403|2022|PDM|0.15|99|0.00|AETNA MED RECORD|
20|FH_F98880_50158_0|SrvcGrp|73485|2022|PDM|3492.00|99|0.00|AETNA REHAB|
20|FH_F67424_0_0|SrvcGrp|471|2022|PDM|480.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F47902_0_0|SrvcGrp|29957|2022|PCT|1.00|99|0.00|DME MOD AW|
20|FH_F149160_02180_0|SrvcGrp|115400|2022|PCT|1.00|99|0.00|COVID-19 VACCINE - REGENERON|
20|FH_F116332_0_0|SrvcGrp|705|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F123745_0_0|SrvcGrp|88164|2022|PDM|9500.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F73643_0_0|SrvcGrp|57968|2022|PDM|32.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F37198_0_0|SrvcGrp|69664|2022|PCT|0.75|99|0.00|PTCA / CARDIAC CATH|
20|FH_F123745_0_0|SrvcGrp|41334|2022|PDM|16500.00|99|0.00|TOTAL KNEE|
20|FH_F110783_93013_0|SrvcGrp|16750|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138017_73129_0|SrvcGrp|35921|2022|PDM|13768.00|99|0.00|BARIATRIC SURGERY|
20|FH_F124695_33401_0|SrvcGrp|90854|2022|PDM|746.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F97280_20018_0|SrvcGrp|73603|2022|PDM|7969.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F143564_0_0|SrvcGrp|92419|2022|PDM|3850.00|99|0.00|LAPAROSCOPY|
20|FH_F89851_83854_0|SrvcGrp|31020|2022|PDM|18814.00|99|0.00|MS DRG 470 ONLY|
20|FH_F37864_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|(LAB) OCN F/S PRICING: ALL|
20|FH_F75243_0_0|SrvcGrp|12290|2022|PDM|418.00|99|0.00|DETOXIFICATION|
20|FH_F151005_17044_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134936_01020_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47902_0_0|SrvcGrp|43845|2022|PCT|1.00|99|0.00|DME MOD UEKE|
20|FH_F140295_0_0|SrvcGrp|75002|2022|PDM|4260.00|99|0.00|ARTHOSCOPY|
20|FH_F117762_0_0|SrvcGrp|11673|2022|PDM|5511.00|99|0.00|CPT 29888|
20|FH_F132126_08037_0|SrvcGrp|108484|2022|PDM|672.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F41802_0_0|SrvcGrp|45262|2022|PDM|150.00|99|0.00|HORMONE INJECTION THERAPY (MOD SD)|
20|FH_F147080_02446_0|SrvcGrp|88819|2022|PDM|504.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F132849_0_0|SrvcGrp|38|2022|PDM|3189.00|99|0.00|NORMAL DELIVERY|
20|FH_F128988_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F75404_0_0|SrvcGrp|64500|2022|PDM|50.00|99|0.00|OUTPATIENT THERAPY SVCS|
20|FH_F114848_50533_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147347_70806_0|SrvcGrp|105410|2022|PDM|30.00|99|0.00|AETNA SUBOXONE ADMIN|
20|FH_F111038_62960_0|SrvcGrp|75506|2022|PCT|0.84|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F147200_61944_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F128753_32501_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|OP SVCS|
20|FH_F40104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127418_0_0|SrvcGrp|67072|2022|PDM|15190.28|99|0.00|CPT 22845|
20|FH_F39443_0_0|SrvcGrp|30349|2022|PDM|339.00|99|0.00|HAPA WPA ASC 305|
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1535.00|99|0.00|AEG 8 (NO REV)|
20|FH_F73803_0_0|CSTM-ALL|CSTM-00|2020|PDM|479.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F119442_72205_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111044_0_0|SrvcGrp|88600|2022|PDM|1648.00|99|0.00|WRIST ARTHROS DIAG W/WO BIO|
20|FH_F129297_97828_0|SrvcGrp|36204|2022|PCT|0.00|99|0.00|ACUTE PSYCH|
20|FH_F124470_90025_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F131555_66213_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147315_33603_0|SrvcGrp|92760|2022|PCT|1.15|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F51572_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F151400_0_0|SrvcGrp|97279|2022|PDM|1500.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY|
20|FH_F133215_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F138882_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F134287_0_0|SrvcGrp|112539|2022|PDM|15000.00|99|0.00|HIP REPLACEMENT|
20|FH_F33855_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36366_0_0|SrvcGrp|13621|2022|PDM|783.00|99|0.00|SLEEP STUDIES|
20|FH_F130146_0_0|SrvcGrp|108443|2022|PDM|400.00|99|0.00|HEMODIALYSIS W/ TRAINING|
20|FH_F149862_76051_0|SrvcGrp|75419|2022|PDM|392.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148480_03079_0|SrvcGrp|115406|2022|PDM|5812.00|99|0.00|SPINE SERVICES GROUP 2|
20|FH_F32935_0_0|CSTM-ALL|CSTM-00|2020|PDM|968.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110925_01104_0|SrvcGrp|63156|2022|PDM|34.50|99|0.00|IMMUNE GLOBULIN INTRAVENOUS|
20|FH_F126033_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123372_0_0|SrvcGrp|20752|2022|PDM|2367.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F149666_33460_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149865_95624_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F63433_0_0|SrvcGrp|17065|2022|PDM|750.00|99|0.00|ASPG I|
20|FH_F113682_0_0|SrvcGrp|45183|2022|PDM|247.23|99|0.00|PHYSICAL THERAPY|
20|FH_F115669_07652_0|SrvcGrp|93337|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F135006_63353_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F115674_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F120306_16424_0|SrvcGrp|90854|2022|PDM|625.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F148255_72703_0|SrvcGrp|17015|2022|PDM|10.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F129658_77043_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F150462_30458_0|SrvcGrp|26867|2022|PDM|50.00|99|0.00|ANTI-EMETICS INFUSION THERAPY|
20|FH_F128073_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F90197_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|99|0.00|OP SVCS|
20|FH_F114963_62062_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|OP SVCS|
20|FH_F121547_46805_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123507_63869_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127710_44139_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125074_18104_0|SrvcGrp|88621|2022|PDM|113.40|99|0.00|SKILLED NURSING LPN|
20|FH_F87595_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|OP SVCS|
20|FH_F115103_31405_0|SrvcGrp|73559|2022|PDM|1866.70|99|0.00|AETNA INTENSIVE CARE|
20|FH_F146803_0_0|SrvcGrp|114755|2022|PDM|3200.00|99|0.00|PROSTATE PROCEDURES|
20|FH_F93136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|979.00|99|0.00|AEG 5  (NO REV)|
20|FH_F148500_50129_0|SrvcGrp|112064|2022|PCT|0.80|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F36669_0_0|SrvcGrp|3327|2022|PDM|136.71|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PDM|1090.39|99|0.00|AEG 2 (NO REV)|
20|FH_F120308_07901_0|SrvcGrp|90854|2022|PDM|1095.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F143974_28204_0|SrvcGrp|75419|2022|PDM|380.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|968.00|99|0.00|AEG 5  (NO REV)|
20|FH_F127816_44112_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149839_80002_0|SrvcGrp|48394|2022|PDM|75.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F137716_66204_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|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134876_0_0|SrvcGrp|83099|2022|PDM|54.00|99|0.00|HOSPICE SVCS|
20|FH_F68160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F125249_0_0|SrvcGrp|92007|2022|PDM|2000.00|99|0.00|PROXIMAL HUMERAL|
20|FH_F84215_0_0|SrvcGrp|73002|2022|PDM|1233.00|99|0.00|AEG 7|
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|609.00|99|0.00|AEG 2 (NO REV)|
20|FH_F139551_0_0|SrvcGrp|85792|2022|PDM|5000.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F148543_71103_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F123895_52722_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F63307_0_0|SrvcGrp|473|2022|PDM|475.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F65159_0_0|CSTM-ALL|CSTM-00|2020|PDM|3356.00|99|0.00|ASPG X|
20|FH_F122725_32216_0|SrvcGrp|72379|2022|PDM|94.00|99|0.00|SPEECH THERAPY|
20|FH_F86872_15215_0|SrvcGrp|86844|2022|PDM|67.50|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F86872_15215_0|SrvcGrp|47183|2022|PDM|117.50|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F43250_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.30|99|0.00|HSS APC GROUPED|
20|FH_F89736_0_0|SrvcGrp|12674|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F89736_0_0|SrvcGrp|82137|2022|PCT|0.78|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F32287_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F61773_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|OP SVCS|
20|FH_F119526_60435_0|SrvcGrp|75545|2022|PDM|496.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F148554_85016_0|SrvcGrp|115440|2022|PDM|1317.00|99|0.00|REPOSITION PACING DEFIB LEA|
20|FH_F111813_08080_0|SrvcGrp|104475|2022|PCT|1.00|99|0.00|INJ FILGRASTIM EXCL BIOSIMIL|
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|496.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F117793_90405_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70606_0_0|SrvcGrp|474|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F132279_63775_0|SrvcGrp|74469|2022|PCT|0.50|99|0.00|AETNA CHEMOTHERAPY|
20|FH_F118517_33316_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F48929_0_0|SrvcGrp|3809|2022|PDM|713.00|99|0.00|HOSPICE CARE|
20|FH_F139587_0_0|SrvcGrp|98062|2022|PDM|452.08|99|0.00|HOSPICE INPATIENT RESPITE CARE PER DIEM|
20|FH_F116806_0_0|SrvcGrp|107104|2022|PDM|887.26|99|0.00|ARTHROTOMY TEMPOROMANDIBULAR JOINT|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|VERTICAL PLUS MRI MOD AV|
20|FH_F149609_78624_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143249_89801_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F143529_84737_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143536_47546_0|SrvcGrp|82737|2022|PCT|0.00|99|0.00|URINALYSIS|
20|FH_F35345_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F101709_0_0|SrvcGrp|96352|2022|PDM|6584.00|99|0.00|ANKLE JOINT|
20|FH_F120240_37013_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136280_54915_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132491_34287_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120799_92651_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F116683_64730_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F116915_30308_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F119843_14103_0|SrvcGrp|472|2022|PDM|335.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120866_51652_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120974_27607_0|SrvcGrp|31655|2022|PCT|0.76|99|0.00|TRACHEOSTOMY (MS DRG)|
20|FH_F120974_27607_0|SrvcGrp|108565|2022|PCT|0.71|99|0.00|PT OT ST|
20|FH_F113563_70560_0|SrvcGrp|104557|2022|PCT|1.00|99|0.00|SYNVISC OR SYNVISC-ONE|
20|FH_F113649_01752_0|SrvcGrp|112058|2022|PDM|45.00|99|0.00|INFLECTRA|
20|FH_F113649_01752_0|SrvcGrp|26868|2022|PDM|45.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F113649_01752_0|SrvcGrp|86847|2022|PDM|45.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F33925_0_0|SrvcGrp|18827|2022|PDM|22990.00|99|0.00|MS DRG 224|
20|FH_F36372_0_0|SrvcGrp|10565|2022|PDM|140.00|99|0.00|HOME INFUSION|
20|FH_F39272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39355_0_0|SrvcGrp|16141|2022|PCT|1.05|99|0.00|PACEMAKER|
20|FH_F45332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F70493_0_0|SrvcGrp|67285|2022|PDM|57.00|99|0.00|ST SUBSEQUENT VISIT 92507|
20|FH_F37292_0_0|SrvcGrp|9460|2022|PDM|1434.00|99|0.00|ACUTE REHABILITATION|
20|FH_F88114_32205_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|OCN F/S PRICING: ALL|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1318.66|99|0.00|HAPA WPA-NWPA 2012-13 ASC 903 W/O REV|
20|FH_F34351_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128272_60640_0|SrvcGrp|86845|2022|PDM|50.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F91622_0_0|CSTM-ALL|CSTM-00|2020|PDM|2482.00|99|0.00|AEG 6 (NO REV) ANTHONY MED CTR|
20|FH_F124017_0_0|SrvcGrp|96350|2022|PDM|12800.00|99|0.00|SHOULDER JOINT|
20|FH_F87716_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1195.00|99|0.00|AEG 4 (NO REV)|
20|FH_F143297_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F139173_0_0|SrvcGrp|80920|2022|PDM|911.62|99|0.00|HOSPICE SERVICES|
20|FH_F130025_0_0|SrvcGrp|592|2022|PDM|461.00|99|0.00|SUB-ACUTE CARE|
20|FH_F149868_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121547_46805_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F86518_20721_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125011_74467_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F135171_22601_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 417-419|
20|FH_F118072_38133_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F102302_0_0|SrvcGrp|98599|2022|PDM|10850.00|99|0.00|LAMINECTOMY W/FACE-THORACIC|
20|FH_F127375_28621_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F31814_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116269_92627_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F130682_0_0|SrvcGrp|59840|2022|PDM|2900.00|99|0.00|TYMPANOSTOMY|
20|FH_F118086_66604_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F71070_0_0|SrvcGrp|3932|2022|PDM|4400.00|99|0.00|LITHOTRIPSY|
20|FH_F82931_18847_0|SrvcGrp|13422|2022|PDM|233.35|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F38798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|DME - MOD RR|
20|FH_F130807_20721_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F120294_46322_0|SrvcGrp|105267|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F109472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F120693_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|AETNA THERAPIES|
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|3774.00|99|0.00|AEG 9 (NO REV)|
20|FH_F89563_29407_0|SrvcGrp|90491|2022|PCT|1.00|99|0.00|EVALUATE SPEECH PRODUCTION|
20|FH_F56136_0_0|SrvcGrp|3069|2022|PCT|0.67|99|0.00|IMPLANTS|
20|FH_F129255_34952_0|SrvcGrp|73842|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F94942_0_0|SrvcGrp|73006|2022|PDM|1807.63|99|0.00|AEG 9|
20|FH_F137367_89139_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F128272_60640_0|SrvcGrp|26869|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F131190_21042_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F111288_0_0|SrvcGrp|92366|2022|PDM|6016.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F135236_02840_0|SrvcGrp|73841|2022|PDM|1061.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F93114_85016_0|SrvcGrp|48385|2022|PDM|151.00|99|0.00|SPEECH THERAPY|
20|FH_F121149_76021_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F88199_0_0|SrvcGrp|48385|2022|PDM|82.50|99|0.00|SPEECH THERAPY|
20|FH_F130916_33701_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143743_26501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|673.00|99|0.00|AEG 5  (NO REV)|
20|FH_F129221_84325_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|170.66|99|0.00|ASPG 222|
20|FH_F117372_07442_0|SrvcGrp|86722|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F128893_0_0|SrvcGrp|95660|2022|PDM|600.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F40256_0_0|SrvcGrp|3029|2022|PDM|200.00|99|0.00|NEWBORN NURSERY|
20|FH_F111809_93003_0|SrvcGrp|113740|2022|PCT|5.69|99|0.00|LABORATORY SERVICES|
20|FH_F101923_98104_0|SrvcGrp|78504|2022|PCT|0.73|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F147995_67037_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F134487_14843_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116825_0_0|SrvcGrp|74381|2022|PDM|33.13|99|0.00|PHYSICAL THERAPY|
20|FH_F100880_67735_0|SrvcGrp|44285|2022|PDM|140.00|99|0.00|THERAPY SERVICES|
20|FH_F43141_0_0|SrvcGrp|36975|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY|
20|FH_F50472_0_0|SrvcGrp|46722|2022|PDM|50.00|99|0.00|PHYSICAL PERFORMACE TEST|
20|FH_F122970_97222_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F126666_44053_0|SrvcGrp|87437|2022|PDM|83.00|99|0.00|AETNA PSYCH DIAGNOSITC EVALUATION (MOD TD)|
20|FH_F115274_15235_0|SrvcGrp|89781|2022|PDM|140.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1347.70|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F80955_0_0|SrvcGrp|471|2022|PDM|468.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1156.00|99|0.00|COVENTRY ENHANCED GROUPER 6 MOD 50|
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_F97061_85012_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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90955_06053_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA - ANCD ( HOME HEALTH)|
20|FH_F81657_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100788_01420_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F97581_60141_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F133535_32110_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
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_F117512_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 3 (NO REV)|
20|FH_F128349_43082_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F149781_37404_0|SrvcGrp|11663|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F150579_16652_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F144324_67467_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100785_54660_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35368_0_0|SrvcGrp|56743|2022|PDM|6879.00|99|0.00|PTC ANGIOPLASTY|
20|FH_F91220_32064_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F144869_15701_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117795_36272_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140472_0_0|SrvcGrp|10393|2022|PDM|1335.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F147800_0_0|SrvcGrp|53065|2022|PDM|1210.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF|
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|816.00|99|0.00|AEG 4 (NO REV)|
20|FH_F97103_53295_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F128442_57430_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118542_60188_0|SrvcGrp|24745|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F132722_71373_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F57372_0_0|SrvcGrp|45882|2022|PDM|110.00|99|0.00|PT|
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129176_48098_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142067_45211_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F136393_0_0|SrvcGrp|88482|2022|PDM|2000.00|99|0.00|AETNA REMOVE PULSE GENERATOR|
20|FH_F125348_84660_0|SrvcGrp|75442|2022|PDM|803.00|99|0.00|OBSERVATION - REV 762|
20|FH_F117827_75235_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F101840_76054_0|SrvcGrp|73004|2022|PDM|2832.00|99|0.00|AEG 8|
20|FH_F101811_64116_0|SrvcGrp|99427|2022|PDM|55.00|99|0.00|SKILLED NURSING RN|
20|FH_F44097_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|ACUTE PSYCH|
20|FH_F63618_0_0|CSTM-ALL|CSTM-00|2020|PDM|45000.00|99|0.00|CV SURGERY|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33285_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71484_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87579_33707_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131699_08210_0|SrvcGrp|48396|2022|PDM|154.35|99|0.00|OT SERVICES|
20|FH_F132338_18901_0|SrvcGrp|46903|2022|PDM|570.76|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F117335_0_0|SrvcGrp|114518|2022|PDM|1326.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F59274_0_0|SrvcGrp|3810|2022|PDM|132.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F113291_37055_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|1263.00|99|0.00|AEG 8 (NO REV)|
20|FH_F87297_17044_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|GENERAL ACUTE CARE|
20|FH_F150884_75503_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F83031_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F72859_0_0|SrvcGrp|15505|2022|PDM|270.67|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F67265_0_0|CSTM-ALL|CSTM-00|2020|PDM|830.00|99|0.00|ADULT PSYCHIATRIC SERVICES|
20|FH_F88491_71301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1457.00|99|0.00|AEG 5  (NO REV)|
20|FH_F136300_67206_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136386_30901_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136475_89119_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F120489_63552_0|SrvcGrp|75489|2022|PCT|0.75|99|0.00|AEG 6|
20|FH_F120489_63552_0|SrvcGrp|79802|2022|PDM|142.00|99|0.00|AETNA CHEMOTHERAPY|
20|FH_F120475_81052_0|SrvcGrp|33902|2022|PDM|350.00|99|0.00|DIALYSIS SERVICES|
20|FH_F93292_62234_0|SrvcGrp|48396|2022|PDM|86.00|99|0.00|OT SERVICES|
20|FH_F93358_63084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134011_84102_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F137147_75006_0|SrvcGrp|77021|2022|PDM|9875.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F137147_75006_0|SrvcGrp|103306|2022|PDM|4477.00|99|0.00|AETNA LAPAROSCOPY SERVICES|
20|FH_F137231_25550_0|SrvcGrp|88621|2022|PDM|91.00|99|0.00|SKILLED NURSING LPN|
20|FH_F142448_15701_0|SrvcGrp|29155|2022|PDM|178.89|99|0.00|HOSPICE SVCS|
20|FH_F97582_46307_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F97602_40121_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F138627_82901_0|SrvcGrp|14893|2022|PDM|40.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F140568_46506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F140890_30906_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F120152_0_0|SrvcGrp|85792|2022|PDM|5500.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F151603_27609_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 8 (NO REV)|
20|FH_F119023_91406_0|SrvcGrp|29023|2022|PDM|56.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F119046_74012_0|SrvcGrp|73601|2022|PDM|1600.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F119065_92029_0|SrvcGrp|74668|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F92506_07666_0|SrvcGrp|72984|2022|PDM|1260.00|99|0.00|CHEMOTHERAPY|
20|FH_F94581_0_0|SrvcGrp|472|2022|PDM|552.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117270_32073_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F147725_06002_0|SrvcGrp|100065|2022|PDM|3850.00|99|0.00|DEEP ANT OR POSTER TIBIAL|
20|FH_F147879_93309_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147882_44056_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129483_77030_0|SrvcGrp|86845|2022|PDM|35.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F69324_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137334_90405_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F137927_52241_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38699_0_0|SrvcGrp|64758|2022|PCT|0.80|99|0.00|HCPCS|
20|FH_F109652_0_0|SrvcGrp|42625|2022|PDM|1004.00|99|0.00|BEHAVIORAL HEALTH GENERAL|
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|AEG 3 (NO REV)|
20|FH_F111046_0_0|SrvcGrp|13595|2022|PDM|595.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F110720_0_0|SrvcGrp|72992|2022|PDM|1486.00|99|0.00|AEG 2|
20|FH_F124890_76119_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114567_43235_0|SrvcGrp|86749|2022|PCT|0.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 10 (NO REV)|
20|FH_F137359_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|623.00|99|0.00|AEG 10 (NO REV)|
20|FH_F38321_0_0|SrvcGrp|28552|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F38321_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110160_0_0|SrvcGrp|103302|2022|PDM|1000.00|99|0.00|ARTHROSCOPY|
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|35490.00|99|0.00|MSDRG 231-232 CORONARY BYPASS|
20|FH_F151081_85225_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F151155_26508_0|SrvcGrp|113343|2022|PDM|106.00|99|0.00|TAKE HOME BUPRENORPHINE (HCFA)|
20|FH_F113588_0_0|SrvcGrp|26001|2022|PDM|93.03|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F113139_0_0|SrvcGrp|104925|2022|PDM|5300.00|99|0.00|PRQ CARDIAC ANGIOPLAST 1 ART-CONCUR|
20|FH_F115884_0_0|SrvcGrp|29353|2022|PDM|111.00|99|0.00|HOSPICE SVCS|
20|FH_F51814_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F40081_0_0|SrvcGrp|11975|2022|PDM|600.00|99|0.00|ELECTRO CONVULSIVE THERAPY|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|422.71|99|0.00|DELAWARE VALLEY- ASC 302|
20|FH_F91832_06106_0|SrvcGrp|88620|2022|PDM|89.25|99|0.00|SKILLED NURSING RN|
20|FH_F109484_0_0|SrvcGrp|72998|2022|PDM|717.00|99|0.00|AEG 5|
20|FH_F114866_77706_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F100620_37027_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F104840_32565_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|3295.00|99|0.00|ENLARGE BREAST|
20|FH_F119581_0_0|SrvcGrp|108077|2022|PDM|2329.00|99|0.00|ARTERIOVENOUS ANASTOMOSIS|
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 10 (NO REV)|
20|FH_F95282_77975_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
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|112158|2022|PDM|2057.62|99|0.00|EXCISE THIGH TENDON & FASCIA|
20|FH_F130297_41042_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141036_02347_0|SrvcGrp|113726|2022|PCT|1.00|99|0.00|STREP A ASSAY W/ OPTIC|
20|FH_F93252_0_0|SrvcGrp|93016|2022|PDM|2500.00|99|0.00|HIP ARTHRO W/ FEMOROPLASTY|
20|FH_F92212_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|PDM|465.00|99|0.00|PHENYLEPHRINE KETOROLAC|
20|FH_F124180_0_0|SrvcGrp|73002|2022|PDM|2700.00|99|0.00|AEG 7|
20|FH_F148488_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F88733_0_0|SrvcGrp|87537|2022|PDM|525.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F124060_76040_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124129_33603_0|SrvcGrp|90643|2022|PDM|22.02|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F74102_0_0|SrvcGrp|26001|2022|PDM|164.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F38233_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAFS FS 100  NO MOD|
20|FH_F38688_0_0|SrvcGrp|68580|2022|PCT|1.00|99|0.00|IMMUNIZATIONS|
20|FH_F91998_0_0|SrvcGrp|72996|2022|PDM|679.00|99|0.00|AEG 4|
20|FH_F124225_92506_0|SrvcGrp|108484|2022|PDM|800.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 4 (NO REV)|
20|FH_F131888_71852_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136568_92562_0|SrvcGrp|108484|2022|PDM|725.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F136693_17754_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136734_46410_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F114666_30342_0|SrvcGrp|99173|2022|PDM|13500.00|99|0.00|HIP ARTHRO ACETABULOPLASTY|
20|FH_F114666_30342_0|SrvcGrp|88162|2022|PDM|3000.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F113787_31909_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F138327_39402_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F100664_03104_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F148424_01440_0|SrvcGrp|115401|2022|PCT|1.00|99|0.00|COVID-19 VACCINE COMBINATION - ELI LILLY|
20|FH_F119725_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148553_85016_0|SrvcGrp|115436|2022|PDM|3060.00|99|0.00|INSERT HEART PM VENTRICULAR|
20|FH_F136796_24016_0|SrvcGrp|96543|2022|PDM|2388.36|99|0.00|REVISION OF CALF TENDON|
20|FH_F136930_73114_0|SrvcGrp|12634|2022|PCT|1.48|99|0.00|RADIOLOGY SVCS|
20|FH_F132809_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|1045.00|99|0.00|AEG 10 (NO REV)|
20|FH_F34604_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54572_0_0|SrvcGrp|16|2022|PDM|1000.00|99|0.00|ACUTE REHABILITATION|
20|FH_F115631_65201_0|SrvcGrp|26279|2022|PDM|3177.00|99|0.00|CPT 29884|
20|FH_F115708_15317_0|SrvcGrp|472|2022|PDM|473.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F147699_83704_0|SrvcGrp|108484|2022|PDM|659.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|405.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F120888_63823_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F120895_19460_0|SrvcGrp|75545|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F120966_60707_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F125287_92374_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
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|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F51276_0_0|SrvcGrp|28638|2022|PDM|21.66|99|0.00|HOME INFUSION THERAPY (MOD SJ)|
20|FH_F51276_0_0|SrvcGrp|26617|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F33925_0_0|SrvcGrp|10391|2022|PDM|1300.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F103241_06002_0|SrvcGrp|471|2022|PDM|738.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138350_0_0|SrvcGrp|113277|2022|PDM|2122.00|99|0.00|AETNA ARTHROSCOPY SURGERY|
20|FH_F100681_73104_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F150663_0_0|SrvcGrp|74668|2022|PDM|227.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PDM|404.00|99|0.00|AEG 1 (NO REV)|
20|FH_F95221_0_0|SrvcGrp|73004|2022|PDM|1066.00|99|0.00|AEG 8|
20|FH_F111601_15203_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PDM|565.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F48692_0_0|SrvcGrp|33484|2022|PCT|1.00|99|0.00|THERAPY SERVICES|
20|FH_F49033_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F144848_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F120683_80238_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150939_0_0|SrvcGrp|85259|2022|PCT|0.00|99|0.00|PERIODIC REEVALUATION|
20|FH_F43575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F48836_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138634_33125_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F113390_0_0|SrvcGrp|59841|2022|PDM|1673.10|99|0.00|SUBMUCOUS RESECTION|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1506.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 906 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.28|99|0.00|HAPA WPA-NWPA 2012-13 ASC 235 W/O REV|
20|FH_F102063_0_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F151420_60654_0|SrvcGrp|34606|2022|PDM|3476.00|99|0.00|CPT 29827|
20|FH_F132205_45342_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132258_45404_0|SrvcGrp|16750|2022|PDM|80.56|99|0.00|HOME INFUSION THERAPY|
20|FH_F132258_45404_0|SrvcGrp|86836|2022|PDM|11.93|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F132258_45404_0|SrvcGrp|86829|2022|PDM|34.98|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F132268_07060_0|SrvcGrp|83057|2022|PDM|38.70|99|0.00|AETNA THERAPEUTIC EXERCISES|
20|FH_F145068_63084_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128181_62690_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135435_06067_0|SrvcGrp|471|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F97142_94535_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F135809_50501_0|SrvcGrp|107861|2022|PCT|0.60|99|0.00|AMFS(H) DEFAULT|
20|FH_F135836_60804_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116463_76501_0|SrvcGrp|87317|2022|PDM|500.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F121763_07202_0|SrvcGrp|72994|2022|PDM|1800.00|99|0.00|AEG 3|
20|FH_F121871_65401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F131407_07607_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F129967_18915_0|SrvcGrp|90040|2022|PDM|525.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F111291_52501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111301_33122_0|CSTM-ALL|CSTM-00|2020|PDM|1987.00|99|0.00|AETNA OP PET SCANS (PET)|
20|FH_F34864_0_0|CSTM-ALL|CSTM-00|2020|PDM|962.00|99|0.00|ASPG I|
20|FH_F101442_0_0|SrvcGrp|98458|2022|PDM|2393.85|99|0.00|RESECT FOOT|
20|FH_F111853_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116430_0_0|SrvcGrp|106712|2022|PDM|10609.00|99|0.00|JOINT & HIP SURGERY|
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130249_62034_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141035_0_0|SrvcGrp|113711|2022|PDM|6016.00|99|0.00|REMOVE MUSCLE FOREIGN BODY|
20|FH_F98300_30236_0|SrvcGrp|95621|2022|PDM|6346.00|99|0.00|AETNA AEG 7 W/O CARDIAC CATH|
20|FH_F102960_50613_0|SrvcGrp|3259|2022|PDM|1241.00|99|0.00|ACUTE REHABILITATION|
20|FH_F148061_11223_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F131612_0_0|SrvcGrp|91629|2022|PDM|105.45|99|0.00|SKILLED NURSE SERVICES 15 MINS|
20|FH_F38560_0_0|SrvcGrp|29547|2022|PDM|3500.00|99|0.00|OP KIDNEY LITHOTRIPSY W/O STENT|
20|FH_F130721_04769_0|SrvcGrp|114504|2022|PCT|4.24|99|0.00|LABORATORY SERVICES|
20|FH_F130901_68970_0|SrvcGrp|103913|2022|PCT|0.98|99|0.00|OP DIALYSIS|
20|FH_F126157_34210_0|SrvcGrp|89417|2022|PDM|389.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F79863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F59872_0_0|SrvcGrp|45884|2022|PDM|90.00|99|0.00|ST|
20|FH_F146117_0_0|SrvcGrp|86233|2022|PDM|2804.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F119110_91773_0|SrvcGrp|29347|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F100063_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F121476_0_0|SrvcGrp|88265|2022|PDM|6950.00|99|0.00|CONNECTIVE TISSUE|
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|2353.00|99|0.00|AEG 5  (NO REV)|
20|FH_F134359_36904_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134593_60007_0|SrvcGrp|115523|2022|PCT|0.85|99|0.00|OXLUMO/LUMASIRAN INJECTION|
20|FH_F31714_0_0|SrvcGrp|3479|2022|PDM|7500.00|99|0.00|DRG 124 CIR DISOR W/ CC W/ COMP DX|
20|FH_F87571_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F133724_84041_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F112082_30720_0|SrvcGrp|29023|2022|PDM|152.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F120719_27540_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 5  (NO REV)|
20|FH_F109405_73106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120930_0_0|SrvcGrp|27316|2022|PDM|2000.00|99|0.00|TONSILS & ADENOIDS (42820)|
20|FH_F135670_01749_0|SrvcGrp|98991|2022|PDM|31.00|99|0.00|HYDRATION THERAPY 1 LITER (HCFA)|
20|FH_F143563_32828_0|SrvcGrp|114975|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F125328_0_0|SrvcGrp|72998|2022|PDM|889.00|99|0.00|AEG 5|
20|FH_F117206_0_0|SrvcGrp|73002|2022|PDM|1417.00|99|0.00|AEG 7|
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|AEG 6 (NO REV)|
20|FH_F110423_33401_0|SrvcGrp|73842|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121225_98902_0|SrvcGrp|34146|2022|PDM|201.60|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F145598_23462_0|SrvcGrp|113706|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F96160_32207_0|SrvcGrp|24753|2022|PDM|25.89|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F134568_12946_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|1245.00|99|0.00|AEG 6 (NO REV)|
20|FH_F119110_91773_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F132925_84041_0|SrvcGrp|471|2022|PDM|675.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149341_39194_0|SrvcGrp|92501|2022|PDM|515.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F142376_0_0|SrvcGrp|105524|2022|PDM|3254.00|99|0.00|INSJ BIOMECHANICAL DEVICE|
20|FH_F49914_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F83978_66739_0|SrvcGrp|72996|2022|PDM|938.00|99|0.00|AEG 4|
20|FH_F134668_08003_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133876_27405_0|SrvcGrp|89417|2022|PDM|479.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F37877_0_0|CSTM-ALL|CSTM-00|2020|PDM|878.00|99|0.00|ASPG VI|
20|FH_F109264_33431_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F129509_0_0|SrvcGrp|88164|2022|PDM|5125.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F132969_84003_0|SrvcGrp|14948|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F100680_43130_0|SrvcGrp|73485|2022|PDM|2921.00|99|0.00|AETNA REHAB|
20|FH_F114506_15946_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100782_0_0|SrvcGrp|105089|2022|PDM|369.14|99|0.00|WINDBER MEDICAL CNTR ASC 134|
20|FH_F110420_60649_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F142376_0_0|SrvcGrp|98565|2022|PDM|17545.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F51039_0_0|SrvcGrp|63636|2022|PDM|100.00|99|0.00|OT|
20|FH_F146103_63851_0|SrvcGrp|73601|2022|PDM|1139.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F130763_0_0|SrvcGrp|83839|2022|PDM|6660.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F130763_0_0|SrvcGrp|44066|2022|PDM|5823.00|99|0.00|CPT 57288|
20|FH_F111882_51560_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132883_31602_0|SrvcGrp|17013|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F110302_15931_0|SrvcGrp|48385|2022|PDM|95.67|99|0.00|SPEECH THERAPY|
20|FH_F122130_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F138951_41101_0|SrvcGrp|86832|2022|PDM|3.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F79923_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F52713_0_0|SrvcGrp|20077|2022|PDM|64398.00|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR|
20|FH_F114525_72401_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F149261_75457_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134208_21502_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)|
20|FH_F54592_0_0|SrvcGrp|22954|2022|PDM|150.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F54592_0_0|SrvcGrp|27043|2022|PDM|18.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS (MOD SJ)|
20|FH_F122520_46383_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F122552_03103_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F86252_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85894_0_0|SrvcGrp|17075|2022|PDM|2078.00|99|0.00|ASPG VI|
20|FH_F102200_06416_0|SrvcGrp|22589|2022|PDM|45.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F115909_38133_0|SrvcGrp|72602|2022|PDM|553.00|99|0.00|ECT|
20|FH_F75842_0_0|SrvcGrp|46504|2022|PDM|6600.27|99|0.00|MS DRG 215-241,245, 250-265 CARDIAC /CCU SURGERY|
20|FH_F146668_30189_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|AEG 8 (NO REV)|
20|FH_F146795_44122_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146796_43334_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146881_83661_0|SrvcGrp|80920|2022|PDM|650.00|99|0.00|HOSPICE SERVICES|
20|FH_F120795_27514_0|SrvcGrp|77305|2022|PCT|0.57|99|0.00|DIAGNOSTIC DRUGS|
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F90817_0_0|SrvcGrp|91030|2022|PDM|2350.00|99|0.00|CORNEAL TISSUE (HCFA)|
20|FH_F128375_03909_0|CSTM-ALL|CSTM-00|2020|PDM|651.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F119203_0_0|SrvcGrp|103551|2022|PDM|186.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|1056.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F32963_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|OP SVCS|
20|FH_F137713_50025_0|SrvcGrp|111995|2022|PCT|0.90|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F132254_40207_0|SrvcGrp|86854|2022|PDM|50.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F33649_0_0|SrvcGrp|109|2022|PDM|625.00|99|0.00|CD - DETOX|
20|FH_F136843_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F140292_06902_0|SrvcGrp|75545|2022|PDM|425.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F125113_0_0|SrvcGrp|93740|2022|PDM|2000.00|99|0.00|REVISE/REMOVE NEURO RECEIVER|
20|FH_F116554_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150459_08021_0|SrvcGrp|29155|2022|PDM|133.00|99|0.00|HOSPICE SVCS|
20|FH_F130939_40353_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97100_23462_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F149559_60012_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35475_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|618180-OPGH-LABS|
20|FH_F41802_0_0|SrvcGrp|64603|2022|PDM|200.00|99|0.00|HOME INFUSION THERAPY(MOD KD)|
20|FH_F100663_56537_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|153.53|99|0.00|SALLY BALIN,999182,ASC 117|
20|FH_F36683_0_0|SrvcGrp|18868|2022|PDM|26758.00|99|0.00|MS DRG 231|
20|FH_F42395_0_0|SrvcGrp|38|2022|PDM|2016.00|99|0.00|NORMAL DELIVERY|
20|FH_F50398_0_0|SrvcGrp|33164|2022|PDM|315.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F39756_0_0|SrvcGrp|31076|2022|PDM|82.50|99|0.00|PROPHYLAXIS ADULT/CHILD - HCPCS D0110, D1120|
20|FH_F131942_50833_0|SrvcGrp|48398|2022|PDM|120.00|99|0.00|PT SERVICES|
20|FH_F47902_0_0|SrvcGrp|43847|2022|PCT|1.00|99|0.00|DME POS FACILITY MOD 53|
20|FH_F40564_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F91996_33805_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F35452_0_0|SrvcGrp|9911|2022|PCT|0.85|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F35987_0_0|SrvcGrp|22148|2022|PDM|261.00|99|0.00|PSYCH PARTIAL HOSP (FULL DAY)|
20|FH_F150946_75783_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150953_74953_0|SrvcGrp|115031|2022|PCT|0.77|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F137986_0_0|SrvcGrp|26274|2022|PDM|1436.00|99|0.00|CPT 29877|
20|FH_F146266_0_0|SrvcGrp|11673|2022|PDM|4785.00|99|0.00|CPT 29888|
20|FH_F147315_33603_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116753_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA) - HCFA|
20|FH_F126785_0_0|SrvcGrp|58618|2022|PCT|0.49|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F48695_0_0|SrvcGrp|473|2022|PDM|1400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F115483_62002_0|SrvcGrp|73485|2022|PDM|1782.00|99|0.00|AETNA REHAB|
20|FH_F81456_0_0|SrvcGrp|79238|2022|PDM|700.00|99|0.00|TRANSFER|
20|FH_F36202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F35738_33180_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F124714_64081_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)|
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|AEG 10 (NO REV)|
20|FH_F94643_90501_0|SrvcGrp|21920|2022|PDM|55.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F137748_95231_0|SrvcGrp|13187|2022|PCT|0.50|99|0.00|INTRAOCULAR LENSES|
20|FH_F122425_75082_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F111857_68005_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F150982_0_0|SrvcGrp|92010|2022|PDM|1382.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE|
20|FH_F97623_38008_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124486_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F123570_0_0|SrvcGrp|72992|2022|PDM|630.85|99|0.00|AEG 2|
20|FH_F151043_71901_0|SrvcGrp|10364|2022|PDM|350.00|99|0.00|CPT CODE 99284|
20|FH_F126781_92630_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131525_32159_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F126554_0_0|SrvcGrp|104484|2022|PDM|39.00|99|0.00|THER/PROPH/DIAG IV INF ADDON|
20|FH_F124487_89502_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F109251_62269_0|SrvcGrp|103229|2022|PDM|92.60|99|0.00|APPLY MULTLAY COMPRS UPR ARM|
20|FH_F131292_37650_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|538.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F119004_06850_0|CSTM-ALL|CSTM-00|2020|PDM|572.00|99|0.00|AEG 1 (NO REV)|
20|FH_F118943_64506_0|SrvcGrp|27968|2022|PDM|37.00|99|0.00|SKILLED NURSING LPN|
20|FH_F92506_07666_0|SrvcGrp|82369|2022|PCT|2.47|99|0.00|AETNA LABORATORY|
20|FH_F109884_36117_0|SrvcGrp|46903|2022|PDM|637.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F109982_33592_0|SrvcGrp|58509|2022|PDM|246.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F76144_0_0|SrvcGrp|35500|2022|PDM|1737.96|99|0.00|OP SURGERY|
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|985.00|99|0.00|AEG 5  (NO REV)|
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|2242.90|99|0.00|AETNA GLENNVILLE 2016 AEG 10|
20|FH_F147725_06002_0|SrvcGrp|104008|2022|PDM|5624.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS|
20|FH_F147928_11751_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F147932_78613_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F129434_98271_0|SrvcGrp|108484|2022|PDM|1273.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F117108_37841_0|SrvcGrp|73485|2022|PDM|2000.00|99|0.00|AETNA REHAB|
20|FH_F137814_61820_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F34371_0_0|SrvcGrp|10543|2022|PDM|100.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F38699_0_0|SrvcGrp|69399|2022|PCT|1.05|99|0.00|PREVENTATIVE CODES|
20|FH_F111593_0_0|SrvcGrp|104448|2022|PDM|7500.00|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE|
20|FH_F110720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91472_96001_0|SrvcGrp|102419|2022|PDM|6500.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F124754_84403_0|SrvcGrp|87131|2022|PDM|457.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F138732_60016_0|SrvcGrp|73842|2022|PDM|214.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130978_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|510.00|99|0.00|AEG 3 (NO REV)|
20|FH_F109513_0_0|SrvcGrp|73006|2022|PDM|1954.00|99|0.00|AEG 9|
20|FH_F95880_02726_0|SrvcGrp|88857|2022|PDM|37.75|99|0.00|THERAPEUTIC ACTIVITIES|
20|FH_F148880_26807_0|SrvcGrp|88620|2022|PDM|135.00|99|0.00|SKILLED NURSING RN|
20|FH_F151047_20860_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151282_46402_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F121326_60957_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)|
20|FH_F115884_0_0|SrvcGrp|94780|2022|PDM|111.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F91832_06106_0|SrvcGrp|48385|2022|PDM|89.25|99|0.00|SPEECH THERAPY|
20|FH_F106822_0_0|SrvcGrp|100271|2022|PDM|14.10|99|0.00|IIV3 VACC NO PRSV 0.5 ML IM|
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|69.55|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F86911_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F86911_0_0|SrvcGrp|86337|2022|PDM|55.00|99|0.00|CHEMOTHERAPY IV PUSH|
20|FH_F87201_0_0|SrvcGrp|12403|2022|PDM|40.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F113143_0_0|SrvcGrp|12664|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F142321_29401_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F112163_0_0|SrvcGrp|104621|2022|PDM|920.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY|
20|FH_F105440_46383_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119581_0_0|SrvcGrp|107793|2022|PDM|7638.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F41516_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F132988_0_0|SrvcGrp|27330|2022|PDM|771.00|99|0.00|CPT 27096|
20|FH_F133002_0_0|SrvcGrp|88154|2022|PDM|1716.00|99|0.00|LASER TREATMENT OLD RETINA|
20|FH_F114389_50131_0|SrvcGrp|26867|2022|PDM|102.25|99|0.00|ANTI-EMETICS INFUSION THERAPY|
20|FH_F45976_0_0|SrvcGrp|35982|2022|PDM|52.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F124059_64055_0|SrvcGrp|24744|2022|PDM|83.00|99|0.00|PICC LINE INSERTION|
20|FH_F146797_44906_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146922_68108_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43832_0_0|SrvcGrp|26798|2022|PDM|93.00|99|0.00|LICENSED PRACTICAL NURSE|
20|FH_F64819_0_0|SrvcGrp|59163|2022|PCT|0.55|99|0.00|OP SURGICAL ANCILLARY SERVICES|
20|FH_F91998_0_0|SrvcGrp|72990|2022|PDM|360.00|99|0.00|AEG 1|
20|FH_F92493_0_0|SrvcGrp|92363|2022|PDM|12999.53|99|0.00|OSTEOCHONDRAL ALLOGRAFT KNEE|
20|FH_F132864_71101_0|SrvcGrp|58380|2022|PDM|17292.00|99|0.00|MS DRG 239 ONLY|
20|FH_F150910_0_0|SrvcGrp|113857|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES|
20|FH_F130611_41143_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139758_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114666_30342_0|SrvcGrp|89860|2022|PDM|3200.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F114684_80547_0|SrvcGrp|104442|2022|PDM|99.50|99|0.00|AETNA OFFICE/OP VISIT EST (HCFA)|
20|FH_F113809_47302_0|SrvcGrp|105409|2022|PDM|70.00|99|0.00|AETNA PHARMACOLOGIC MANAGEMENT|
20|FH_F138779_62703_0|SrvcGrp|90854|2022|PDM|994.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F138267_75087_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139708_54880_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122674_94904_0|SrvcGrp|705|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F117026_17961_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F136786_25302_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136930_73114_0|SrvcGrp|72990|2022|PDM|3578.00|99|0.00|AEG 1|
20|FH_F112444_07102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F141170_0_0|SrvcGrp|103594|2022|PDM|6000.00|99|0.00|INTRACRANIAL ART|
20|FH_F38826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F115210_21043_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AEG 6 (NO REV)|
20|FH_F115631_65201_0|SrvcGrp|82112|2022|PDM|3177.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F115631_65201_0|SrvcGrp|88820|2022|PDM|1297.00|99|0.00|CPT 24359|
20|FH_F115723_78363_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F116281_19013_0|SrvcGrp|92760|2022|PCT|1.03|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131357_17545_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|AEG 8 (NO REV)|
20|FH_F73985_0_0|SrvcGrp|26216|2022|PDM|7118.00|99|0.00|ARTHROSCOPY|
20|FH_F128883_89521_0|SrvcGrp|29347|2022|PDM|26.25|99|0.00|HOME HEALTH AIDE|
20|FH_F114980_78061_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130747_0_0|SrvcGrp|16289|2022|PDM|2809.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F78922_0_0|SrvcGrp|42871|2022|PDM|95.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F41201_0_0|SrvcGrp|762|2022|PDM|5125.00|99|0.00|AIR AMBULANCE SVCS|
20|FH_F69764_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.20|99|0.00|GENERAL ACUTE CARE|
20|FH_F109180_18015_0|SrvcGrp|102980|2022|PDM|131.00|99|0.00|PSYTX WPT W E/M 30 MIN|
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|1236.00|99|0.00|AEG 6 (NO REV)|
20|FH_F110925_01104_0|SrvcGrp|21920|2022|PDM|59.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F110236_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89563_29407_0|SrvcGrp|94739|2022|PCT|1.00|99|0.00|NOS FLU VACC IM (>=3 YRS)|
20|FH_F124899_45246_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F128272_60640_0|SrvcGrp|86831|2022|PDM|9.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F131357_17545_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F92276_32308_0|SrvcGrp|73602|2022|PDM|761.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F123293_18087_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|528.83|99|0.00|ASPG I|
20|FH_F136790_0_0|CSTM-ALL|CSTM-00|2020|PDM|154.00|99|0.00|CPT 99201|
20|FH_F124660_0_0|SrvcGrp|73008|2022|PDM|847.00|99|0.00|AEG 10|
20|FH_F123895_52722_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F54614_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143820_28405_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F149740_33912_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F139515_0_0|SrvcGrp|88161|2022|PDM|8549.00|99|0.00|LAMINECTOMY W/FACE-THORACIC|
20|FH_F100320_0_0|SrvcGrp|75485|2022|PDM|674.00|99|0.00|AEG 4|
20|FH_F132051_74464_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F102302_0_0|SrvcGrp|98609|2022|PDM|29900.00|99|0.00|POSTERIOR SEGMENTAL INSTRU|
20|FH_F55212_0_0|SrvcGrp|51063|2022|PDM|121.00|99|0.00|SUBSEQUENT HOSPITAL CARE|
20|FH_F113815_0_0|SrvcGrp|73004|2022|PDM|233.00|99|0.00|AEG 8|
20|FH_F88639_80204_0|SrvcGrp|75491|2022|PDM|10245.25|99|0.00|AEG 7|
20|FH_F148552_68114_0|CSTM-ALL|CSTM-00|2020|PDM|2108.00|99|0.00|AEG 7 (NO REV)|
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_F95360_08720_0|SrvcGrp|94044|2022|PCT|1.00|99|0.00|VINBLASTINE SULFATE INJ|
20|FH_F106580_33321_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F106660_26554_0|SrvcGrp|88620|2022|PDM|90.00|99|0.00|SKILLED NURSING RN|
20|FH_F139176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS|
20|FH_F90955_06053_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F106660_26554_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129535_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F132289_89145_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|405.78|99|0.00|HAPA WPA-NWPA 2012-13 ASC 217 W/O REV|
20|FH_F101840_76054_0|SrvcGrp|81571|2022|PDM|6260.00|99|0.00|NASAL ENDOSCOPY W/ SINUS OSTIA DILATION|
20|FH_F141935_76033_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136507_0_0|SrvcGrp|80920|2022|PDM|525.00|99|0.00|HOSPICE SERVICES|
20|FH_F148039_92629_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F54552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144037_63141_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F117346_75093_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F147998_07030_0|SrvcGrp|74668|2022|PDM|1046.50|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F91155_16105_0|SrvcGrp|72992|2022|PDM|954.00|99|0.00|AEG 2|
20|FH_F66403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F115431_32821_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F148900_0_0|SrvcGrp|58634|2022|PDM|7680.00|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F94300_0_0|SrvcGrp|705|2022|PCT|1.03|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F128421_27016_0|SrvcGrp|109707|2022|PCT|0.80|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F38508_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F80955_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120746_29621_0|SrvcGrp|101562|2022|PCT|1.00|99|0.00|HOSPICE/PHYSICIAN|
20|FH_F62513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1947.61|99|0.00|ASPG V|
20|FH_F129303_33139_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130553_18640_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F150464_15746_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F97621_75801_0|SrvcGrp|73461|2022|PDM|8694.00|99|0.00|AETNA NICU IV|
20|FH_F146217_0_0|SrvcGrp|95660|2022|PDM|913.07|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F133351_84003_0|SrvcGrp|471|2022|PDM|630.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133154_27401_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F132722_71373_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F38352_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F67803_0_0|SrvcGrp|42828|2022|PDM|120.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F128349_43082_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F40154_0_0|SrvcGrp|13248|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F127412_15301_0|SrvcGrp|114518|2022|PDM|3000.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F42807_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|ACUTE PSYCH|
20|FH_F72859_0_0|SrvcGrp|9263|2022|PDM|119.74|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F107400_0_0|SrvcGrp|27969|2022|PDM|23.00|99|0.00|HOME HEALTH AIDE|
20|FH_F118672_29036_0|CSTM-ALL|CSTM-00|2020|PDM|4887.00|99|0.00|AEG 7 (NO REV)|
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F133307_14580_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F33246_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F133490_90650_0|CSTM-ALL|CSTM-00|2020|PDM|1867.00|99|0.00|AEG 2 (NO REV)|
20|FH_F117885_81506_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD NU|
20|FH_F143848_0_0|SrvcGrp|73606|2022|PDM|1963.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F130626_42345_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|ASPG VIII|
20|FH_F120773_77706_0|SrvcGrp|104079|2022|PCT|1.03|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F92677_08003_0|SrvcGrp|21456|2022|PDM|651.00|99|0.00|SLEEP STUDIES|
20|FH_F39723_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (HCFA)|
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 1 (NO REV)|
20|FH_F144011_60616_0|SrvcGrp|3378|2022|PCT|0.45|99|0.00|OBSERVATION SVCS|
20|FH_F133396_72301_0|SrvcGrp|46903|2022|PDM|583.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F150559_60018_0|SrvcGrp|88621|2022|PDM|115.00|99|0.00|SKILLED NURSING LPN|
20|FH_F111401_29425_0|SrvcGrp|48385|2022|PDM|120.00|99|0.00|SPEECH THERAPY|
20|FH_F100741_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F34843_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92531_0_0|SrvcGrp|92196|2022|PDM|11275.00|99|0.00|TOTAL JOINTS - KNEE/HIP SURGERY|
20|FH_F132224_89119_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F132999_19901_0|SrvcGrp|23683|2022|PDM|42.00|99|0.00|SKILLED NURSING RN|
20|FH_F126815_02118_0|SrvcGrp|109219|2022|PCT|0.55|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F144869_15701_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD NU)|
20|FH_F133271_72204_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F37600_0_0|SrvcGrp|14559|2022|PDM|5.00|99|0.00|AMBULANCE SVCS MILEAGE|
20|FH_F144789_48304_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46196_0_0|SrvcGrp|31186|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC (DME)|
20|FH_F66480_0_0|SrvcGrp|9828|2022|PDM|82.00|99|0.00|HOME HEALTH AIDE|
20|FH_F71947_15227_0|CSTM-ALL|CSTM-00|2020|PDM|340.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133467_03301_0|SrvcGrp|75419|2022|PDM|1250.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F118542_60188_0|SrvcGrp|27969|2022|PDM|24.00|99|0.00|HOME HEALTH AIDE|
20|FH_F74463_0_0|SrvcGrp|36591|2022|PDM|1000.00|99|0.00|CPT 63685|
20|FH_F134497_47126_0|SrvcGrp|73841|2022|PDM|375.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F144211_30012_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F90811_0_0|SrvcGrp|90428|2022|PDM|4500.00|99|0.00|INSERT SPINE FIXATION DEVICE|
20|FH_F92677_08003_0|SrvcGrp|86848|2022|PDM|52.50|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F42377_0_0|CSTM-ALL|CSTM-00|2020|PDM|552.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147995_67037_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F115405_06010_0|SrvcGrp|86722|2022|PDM|165.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F88818_0_0|SrvcGrp|87840|2022|PDM|320.00|99|0.00|AEG 1 W/O 11442, 12051|
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|1312.00|99|0.00|AEG 3 (NO REV)|
20|FH_F115431_32821_0|SrvcGrp|12659|2022|PDM|688.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F121016_32607_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139172_40207_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F150771_44512_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150820_83843_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F127553_44321_0|SrvcGrp|93098|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F49739_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F97640_37043_0|SrvcGrp|88977|2022|PDM|7514.00|99|0.00|C-SECTION DELIVERY|
20|FH_F124719_64093_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|1262.00|99|0.00|AEG 8 (NO REV)|
20|FH_F74622_0_0|SrvcGrp|14271|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F117615_30525_0|SrvcGrp|72984|2022|PCT|0.85|99|0.00|CHEMOTHERAPY|
20|FH_F97881_38703_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F34853_0_0|SrvcGrp|18791|2022|PDM|95515.00|99|0.00|MS DRG 215|
20|FH_F120100_98390_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131415_73071_0|SrvcGrp|49682|2022|PCT|1.30|99|0.00|HSS DRG GROUPED|
20|FH_F132008_85226_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F50612_0_0|CSTM-ALL|CSTM-00|2020|PDM|572.00|99|0.00|SKILLED NURSING|
20|FH_F115982_0_0|SrvcGrp|11673|2022|PDM|2000.00|99|0.00|CPT 29888|
20|FH_F139927_0_0|SrvcGrp|76501|2022|PDM|523.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F97881_38703_0|SrvcGrp|90854|2022|PDM|1476.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F147183_17701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115483_62002_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F147172_76086_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|4666.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY|
20|FH_F147372_0_0|SrvcGrp|46903|2022|PDM|825.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F127086_62246_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149083_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|IMPLANTS|
20|FH_F147183_17701_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F35475_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|618180-OPGH-080107-DME-MOD NU|
20|FH_F42444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F41814_0_0|SrvcGrp|9774|2022|PDM|2093.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F103781_0_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F132571_24739_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149721_76522_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39051_0_0|SrvcGrp|11663|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1157.64|99|0.00|HAPA WPA-NWPA 2012-13 ASC 8 W/O REV|
20|FH_F80952_45669_0|CSTM-ALL|CSTM-00|2020|PDM|1451.15|99|0.00|GENERAL ACUTE CARE|
20|FH_F132543_79549_0|SrvcGrp|109220|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F43018_0_0|SrvcGrp|12342|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F62601_0_0|SrvcGrp|48394|2022|PDM|7.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F41596_0_0|SrvcGrp|65|2022|PCT|0.85|99|0.00|OBSTETRICAL CARE|
20|FH_F58096_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150904_22306_0|SrvcGrp|48396|2022|PDM|139.00|99|0.00|OT SERVICES|
20|FH_F118647_21811_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|399.29|99|0.00|HAPA WPA-NWPA 2012-13 ASC 218 W/O REV|
20|FH_F135651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123373_0_0|SrvcGrp|10667|2022|PDM|657.00|99|0.00|BOARDER BABY SVCS|
20|FH_F128349_43082_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F100666_81301_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 2 (NO REV)|
20|FH_F133021_00910_0|SrvcGrp|75506|2022|PCT|1.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F94165_0_0|SrvcGrp|73461|2022|PCT|0.85|99|0.00|AETNA NICU IV|
20|FH_F120437_85202_0|SrvcGrp|99000|2022|PDM|106.93|99|0.00|HYDRATION THERAPY OVER 3 LITER (HCFA)|
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_F132693_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F87173_15136_0|SrvcGrp|46424|2022|PDM|104.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F150001_33064_0|SrvcGrp|17013|2022|PDM|26.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F119100_66086_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F36917_0_0|SrvcGrp|10951|2022|PDM|105.00|99|0.00|PARTIAL HOSPITALIZATION PSYCH/CD|
20|FH_F57396_0_0|SrvcGrp|46584|2022|PDM|100.00|99|0.00|CPT 99203|
20|FH_F151154_91761_0|SrvcGrp|29347|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F151155_26508_0|SrvcGrp|105708|2022|PDM|140.00|99|0.00|OFFICE/OUTPATIENT VISIT NEW (HCFA)|
20|FH_F151155_26508_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151201_90020_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F151221_71857_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F121329_33015_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F123848_03257_0|SrvcGrp|48385|2022|PDM|166.00|99|0.00|SPEECH THERAPY|
20|FH_F136386_30901_0|SrvcGrp|89337|2022|PDM|895.00|99|0.00|DETOXIFICATION|
20|FH_F136390_46321_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F93360_64730_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F134126_11554_0|SrvcGrp|11663|2022|PCT|0.45|99|0.00|IMPLANTS|
20|FH_F138746_60174_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142307_74066_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142742_44112_0|SrvcGrp|73605|2022|PDM|1000.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F78402_15905_0|SrvcGrp|11258|2022|PCT|0.62|99|0.00|DRUGS|
20|FH_F139456_47501_0|SrvcGrp|11442|2022|PDM|689.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F140338_40475_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149600_18901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149647_92651_0|SrvcGrp|74668|2022|PDM|325.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151603_27609_0|SrvcGrp|11663|2022|PCT|1.03|99|0.00|IMPLANTS|
20|FH_F118943_64506_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F92506_07666_0|SrvcGrp|15122|2022|PDM|5000.00|99|0.00|CARDIAC CATH LAB SVCS|
20|FH_F129838_17555_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109983_98607_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F49039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F52832_0_0|SrvcGrp|75699|2022|PCT|1.10|99|0.00|DME|
20|FH_F117267_07728_0|SrvcGrp|75505|2022|PCT|5.28|99|0.00|CARDIAC STUDIES|
20|FH_F117270_32073_0|SrvcGrp|90631|2022|PCT|1.08|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F147725_06002_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|AEG 6 (NO REV)|
20|FH_F129427_92262_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F117102_39355_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F117153_34113_0|SrvcGrp|86722|2022|PDM|171.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F117189_60085_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117126_12801_0|SrvcGrp|79561|2022|PDM|7145.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F117240_37334_0|SrvcGrp|10364|2022|PDM|1275.00|99|0.00|CPT CODE 99284|
20|FH_F124438_0_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F137980_03101_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F109652_0_0|SrvcGrp|23853|2022|PCT|0.00|99|0.00|CLINIC VISITS|
20|FH_F69364_0_0|CSTM-ALL|CSTM-00|2020|PDM|1160.00|99|0.00|ASPG III|
20|FH_F145348_0_0|CSTM-ALL|CSTM-00|2020|PDM|2724.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31525_0_0|SrvcGrp|65|2022|PDM|4135.00|99|0.00|OBSTETRICAL CARE|
20|FH_F37333_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|RS 580 CT CODES|
20|FH_F37823_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F116343_33701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147446_76844_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147586_44124_0|CSTM-ALL|CSTM-00|2020|PDM|1407.00|99|0.00|AEG 5  (NO REV)|
20|FH_F41663_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41809_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F42539_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F98622_45005_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F98625_08103_0|SrvcGrp|73559|2022|PDM|9588.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F111190_30512_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|AETNA HIGH COST DRUGS|
20|FH_F38476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128031_0_0|SrvcGrp|110950|2022|PDM|2065.00|99|0.00|ARTHROSCOPIC PROCEDURES|
20|FH_F128031_0_0|SrvcGrp|73008|2022|PDM|820.00|99|0.00|AEG 10|
20|FH_F136429_0_0|SrvcGrp|79583|2022|PDM|710.50|99|0.00|CPT 45381|
20|FH_F142087_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_F129850_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F133107_73071_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F113246_72687_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F42095_0_0|SrvcGrp|11798|2022|PDM|75.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 9 (NO REV)|
20|FH_F129912_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|1671.00|99|0.00|AEG 2 (NO REV)|
20|FH_F39825_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39988_0_0|SrvcGrp|13551|2022|PDM|549.00|99|0.00|NEWBORN NURSERY|
20|FH_F138687_77477_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F138876_25302_0|SrvcGrp|86779|2022|PDM|55.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F138936_01040_0|SrvcGrp|105465|2022|PDM|139.00|99|0.00|AETNA THERAPIES|
20|FH_F138970_62920_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|AEG 8 (NO REV)|
20|FH_F151307_63127_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132258_45404_0|SrvcGrp|17015|2022|PDM|11.93|99|0.00|HOME INFUSION THERAPY|
20|FH_F132268_07060_0|SrvcGrp|104305|2022|PCT|0.95|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F145528_76501_0|SrvcGrp|88620|2022|PDM|111.00|99|0.00|SKILLED NURSING RN|
20|FH_F135457_67214_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135979_66451_0|SrvcGrp|29346|2022|PDM|50.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F136130_10029_0|SrvcGrp|84559|2022|PCT|1.05|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F131132_44077_0|CSTM-ALL|CSTM-00|2020|PDM|4994.00|99|0.00|AEG 8 (NO REV)|
20|FH_F116397_33404_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116404_20191_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F116431_76104_0|SrvcGrp|10393|2022|PDM|2076.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F131361_18235_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121719_63122_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121796_68355_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F43274_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F111292_33136_0|SrvcGrp|88142|2022|PDM|268.00|99|0.00|AETNA ULTRASOUND BREAST(S)|
20|FH_F111301_33122_0|SrvcGrp|82755|2022|PDM|47.00|99|0.00|ASSAY BLOOD MAGNESIUM|
20|FH_F111385_33308_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F134257_62681_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|891.00|99|0.00|AEG 10 (NO REV)|
20|FH_F40174_0_0|SrvcGrp|30935|2022|PDM|60.00|99|0.00|PT & OT|
20|FH_F145587_0_0|SrvcGrp|33984|2022|PDM|1262.70|99|0.00|HAMMERTOE CORRECTION|
20|FH_F34864_0_0|SrvcGrp|9510|2022|PDM|468.00|99|0.00|SKILLED NURSING CARE|
20|FH_F51272_0_0|SrvcGrp|47585|2022|PDM|28000.00|99|0.00|STEREOTACTIC RADIOSURGERY|
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|1769.00|99|0.00|AEG 10 (NO REV)|
20|FH_F132328_0_0|SrvcGrp|35669|2022|PDM|1561.00|99|0.00|CPT 63650|
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)|
20|FH_F31504_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112092_46845_0|SrvcGrp|90497|2022|PCT|1.00|99|0.00|FLUZONE VACC 3 YRS & > IM|
20|FH_F87557_33309_0|SrvcGrp|86838|2022|PDM|10.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F125054_16365_0|SrvcGrp|48385|2022|PDM|108.00|99|0.00|SPEECH THERAPY|
20|FH_F125253_15601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98626_29118_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F98300_30236_0|SrvcGrp|75487|2022|PDM|5665.00|99|0.00|AEG 5|
20|FH_F132090_60915_0|CSTM-ALL|CSTM-00|2020|PDM|1255.80|99|0.00|AEG 2 (NO REV)|
20|FH_F148419_01453_0|SrvcGrp|115386|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F148498_75028_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54552_0_0|SrvcGrp|10538|2022|PDM|90.00|99|0.00|NURSING CARE|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HYDRATION THERAPY|
20|FH_F128919_48075_0|SrvcGrp|82222|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F144728_33541_0|SrvcGrp|92501|2022|PDM|393.44|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F97103_53295_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F100665_07939_0|SrvcGrp|73643|2022|PDM|1625.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F133546_61611_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F97564_52246_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F148900_0_0|SrvcGrp|103236|2022|PDM|19580.00|99|0.00|AETNA INSJ STABLJ DEV|
20|FH_F148494_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC|
20|FH_F101923_98104_0|SrvcGrp|89183|2022|PCT|3.17|99|0.00|MRI OF THE SPINAL CANAL|
20|FH_F113726_61520_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|1141.00|99|0.00|AEG 7 (NO REV)|
20|FH_F97660_29401_0|SrvcGrp|88977|2022|PDM|10644.00|99|0.00|C-SECTION DELIVERY|
20|FH_F97660_29401_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F97720_70084_0|SrvcGrp|88977|2022|PDM|3542.00|99|0.00|C-SECTION DELIVERY|
20|FH_F109484_0_0|SrvcGrp|73002|2022|PDM|995.00|99|0.00|AEG 7|
20|FH_F35499_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86911_0_0|SrvcGrp|44712|2022|PDM|90.00|99|0.00|OT SVCS|
20|FH_F87054_0_0|SrvcGrp|72992|2022|PDM|893.00|99|0.00|AEG 2|
20|FH_F112163_0_0|SrvcGrp|97507|2022|PDM|948.00|99|0.00|AETNA HOSPICE|
20|FH_F105381_66845_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130439_85014_0|SrvcGrp|108484|2022|PDM|557.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F119435_0_0|SrvcGrp|107879|2022|PDM|4300.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 4 (NO REV)|
20|FH_F116485_17033_0|SrvcGrp|114754|2022|PDM|303.85|99|0.00|EDUCATIONALLY BEHAVIORAL SUPPORTS LEVEL 3|
20|FH_F132627_0_0|SrvcGrp|14948|2022|PDM|291.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132988_0_0|SrvcGrp|100001|2022|PDM|20208.13|99|0.00|WRIST REPLACEMNT TOT WRIST|
20|FH_F128027_0_0|SrvcGrp|64723|2022|PDM|1260.00|99|0.00|CPT 45380|
20|FH_F50415_0_0|SrvcGrp|44707|2022|PDM|40.00|99|0.00|NURSING CARE|
20|FH_F114389_50131_0|SrvcGrp|86843|2022|PDM|130.65|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F49487_0_0|SrvcGrp|38757|2022|PDM|20.00|99|0.00|NUTRITION PRODUCTS VIA SYRINGE|
20|FH_F146715_34240_0|SrvcGrp|16|2022|PDM|1108.00|99|0.00|ACUTE REHABILITATION|
20|FH_F146990_80206_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F48752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85154_0_0|SrvcGrp|472|2022|PDM|468.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F92493_0_0|SrvcGrp|35672|2022|PDM|3640.56|99|0.00|CPT 23412|
20|FH_F100703_0_0|SrvcGrp|19920|2022|PDM|3535.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F132864_71101_0|SrvcGrp|75506|2022|PCT|2.37|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F124628_33064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121799_0_0|SrvcGrp|80918|2022|PDM|110.00|99|0.00|RESPITE CARE|
20|FH_F128613_68111_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F127995_84010_0|SrvcGrp|86829|2022|PDM|20.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F72416_0_0|SrvcGrp|34551|2022|PDM|825.00|99|0.00|SUB ACUTE / REHAB - LEVEL I|
20|FH_F98042_10468_0|SrvcGrp|88978|2022|PDM|8913.00|99|0.00|VAGINAL DELIVERY|
20|FH_F136701_45150_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114629_19131_0|SrvcGrp|105820|2022|PDM|1241.00|99|0.00|IP PSYCH EATING DISORDERS|
20|FH_F119725_0_0|SrvcGrp|13422|2022|PDM|260.67|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F135720_90025_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F135763_20678_0|SrvcGrp|89337|2022|PDM|1825.00|99|0.00|DETOXIFICATION|
20|FH_F136778_62034_0|SrvcGrp|76744|2022|PCT|0.71|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F112444_07102_0|SrvcGrp|49682|2022|PCT|1.70|99|0.00|HSS DRG GROUPED|
20|FH_F38331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|GENERAL ACUTE CARE|
20|FH_F38331_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1086154 REG W MED CTR LAB|
20|FH_F115206_80923_0|SrvcGrp|87441|2022|PDM|859.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F115210_21043_0|SrvcGrp|85000|2022|PDM|716.00|99|0.00|CPT 45384|
20|FH_F147444_32839_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F147584_37664_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|76.00|99|0.00|TPN ONE LITER (MOD SH)|
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_F41832_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CARILION IV THERAPY|
20|FH_F120531_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F62582_81650_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F104802_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34477_0_0|SrvcGrp|3809|2022|PDM|480.00|99|0.00|HOSPICE CARE|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TRC VACV 28 FS|
20|FH_F113025_0_0|SrvcGrp|104719|2022|PDM|815.00|99|0.00|RELIEVE INNER EYE PRESSURE|
20|FH_F38135_0_0|CSTM-ALL|CSTM-00|2020|PDM|1323.00|99|0.00|ACUTE ADULT MEDICAL SVCS|
20|FH_F113154_70359_0|SrvcGrp|105055|2022|PDM|1500.00|99|0.00|DESTRUCTION BY NEUROLYTIC AGENT|
20|FH_F113178_44035_0|SrvcGrp|75762|2022|PDM|469.00|99|0.00|AMBULATORY DETOX REHAB|
20|FH_F133536_0_0|SrvcGrp|98006|2022|PDM|3300.00|99|0.00|PHALANGEAL SHAFT FRACTURE|
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|1526.00|99|0.00|AEG 10 (NO REV)|
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PDM|1566.40|99|0.00|AEG 8 (NO REV)|
20|FH_F120630_33161_0|SrvcGrp|86723|2022|PDM|394.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F62609_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F138787_32258_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F57953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F89580_0_0|SrvcGrp|12724|2022|PDM|4920.00|99|0.00|ONCOLOGY CARE|
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|ASPG I|
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|3161.78|99|0.00|AEG 9 (NO REV)|
20|FH_F92188_0_0|CSTM-ALL|CSTM-00|2020|PDM|542.00|99|0.00|AEG 1 (NO REV)|
20|FH_F151342_90272_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151420_60654_0|CSTM-ALL|CSTM-00|2020|PDM|1302.00|99|0.00|AEG 4 (NO REV)|
20|FH_F122119_62675_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36492_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F135583_17331_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F39477_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150001_33064_0|SrvcGrp|86845|2022|PDM|26.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F37778_0_0|SrvcGrp|27313|2022|PDM|1749.00|99|0.00|LAPAROSCOPY (49650, 58660-58673)|
20|FH_F132285_89103_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F46876_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.50|99|0.00|OP SVCS|
20|FH_F133291_33563_0|SrvcGrp|73841|2022|PDM|435.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F72648_0_0|SrvcGrp|68641|2022|PDM|300.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F140690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F143027_16504_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102561_75146_0|SrvcGrp|76602|2022|PDM|3990.00|99|0.00|CPT 25000|
20|FH_F133380_46254_0|SrvcGrp|3178|2022|PDM|900.00|99|0.00|ACUTE PSYCH|
20|FH_F125049_44131_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F88956_0_0|SrvcGrp|75497|2022|PDM|3196.00|99|0.00|AEG 10|
20|FH_F122648_0_0|SrvcGrp|109176|2022|PDM|1739.00|99|0.00|EYE SERVICES|
20|FH_F71067_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F146217_0_0|SrvcGrp|104230|2022|PDM|141.22|99|0.00|RESPITE CARE (HCFA)|
20|FH_F127191_44720_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F111809_93003_0|SrvcGrp|11259|2022|PCT|0.67|99|0.00|DRUGS|
20|FH_F115330_34113_0|SrvcGrp|93337|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F89112_16509_0|SrvcGrp|64101|2022|PDM|2735.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 8|
20|FH_F142970_43055_0|SrvcGrp|13262|2022|PDM|5.10|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F87155_04105_0|SrvcGrp|29075|2022|PDM|57.78|99|0.00|HYDRATION THERAPY|
20|FH_F119220_75068_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F44135_0_0|SrvcGrp|11798|2022|PDM|95.00|99|0.00|HOME INFUSION NURSING 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_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|83.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION MOD HO (HCFA)|
20|FH_F107400_0_0|SrvcGrp|88621|2022|PDM|120.00|99|0.00|SKILLED NURSING LPN|
20|FH_F33311_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128325_19904_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133458_18929_0|SrvcGrp|74668|2022|PDM|900.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F100740_15206_0|CSTM-ALL|CSTM-00|2020|PCT|0.28|99|0.00|OP SVCS|
20|FH_F91155_16105_0|SrvcGrp|74663|2022|PDM|676.00|99|0.00|AETNA SLEEP STUDIES|
20|FH_F88512_0_0|SrvcGrp|36503|2022|PDM|6330.10|99|0.00|MS DRG 286 287 INPATIENT CARDIAC CATH|
20|FH_F44700_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F120437_85202_0|SrvcGrp|48398|2022|PDM|182.34|99|0.00|PT SERVICES|
20|FH_F118819_76226_0|SrvcGrp|90854|2022|PDM|876.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F44992_0_0|SrvcGrp|13472|2022|PDM|1650.00|99|0.00|ICU/CCU|
20|FH_F111520_81601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F67639_0_0|SrvcGrp|14614|2022|PDM|2800.00|99|0.00|LITHOTRIPSY|
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|2571.00|99|0.00|AEG 8 (NO REV)|
20|FH_F46196_0_0|SrvcGrp|31188|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC (DME)|
20|FH_F37641_0_0|CSTM-ALL|CSTM-00|2020|PDM|395.00|99|0.00|ASPG I|
20|FH_F47479_0_0|SrvcGrp|38327|2022|PCT|1.00|99|0.00|HILLCREST IV THERAPY DRUGS|
20|FH_F150020_70601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F31530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|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_F56792_0_0|CSTM-ALL|CSTM-00|2020|PDM|2398.00|99|0.00|ASPG IX WITH MOD SG|
20|FH_F123545_44512_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F45915_0_0|SrvcGrp|33165|2022|PDM|550.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F89011_75006_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F128418_88260_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F99720_0_0|SrvcGrp|72998|2022|PDM|2241.00|99|0.00|AEG 5|
20|FH_F117911_86403_0|SrvcGrp|88621|2022|PDM|122.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150020_70601_0|CSTM-ALL|CSTM-00|2020|PCT|0.17|99|0.00|OP SVCS|
20|FH_F132900_06074_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F103360_68845_0|SrvcGrp|98241|2022|PDM|9134.00|99|0.00|INCISION OF HIP TENDON|
20|FH_F98921_64503_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F133018_84037_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F145941_64119_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120817_53051_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F71145_0_0|SrvcGrp|44247|2022|PDM|165.00|99|0.00|CAPD TRAINING|
20|FH_F72940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F149781_37404_0|SrvcGrp|77021|2022|PDM|4244.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F147997_92620_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F88512_0_0|SrvcGrp|115591|2022|PDM|10889.63|99|0.00|CARDIAC STENT PLACEMENT|
20|FH_F97560_23249_0|SrvcGrp|73605|2022|PDM|4049.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F39558_0_0|SrvcGrp|17081|2022|PDM|1563.00|99|0.00|ASPG IX|
20|FH_F150538_90056_0|SrvcGrp|74668|2022|PDM|424.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F43974_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|ACUTE PSYCH|
20|FH_F89851_83854_0|SrvcGrp|89958|2022|PDM|4388.00|99|0.00|ARTHROSCOPY SERVICES|
20|FH_F81313_0_0|SrvcGrp|44106|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F63250_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139208_30309_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F139666_26175_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F150701_33437_0|CSTM-ALL|CSTM-00|2020|PCT|1.75|99|0.00|HSS ASC|
20|FH_F91700_15601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135964_33805_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100765_73735_0|SrvcGrp|73605|2022|PDM|3461.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F131463_19096_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F130620_18940_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116431_76104_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F151143_0_0|SrvcGrp|100959|2022|PDM|7500.00|99|0.00|AMB SRVC CONVNTION AIR TRANSPORT 1 WAY|
20|FH_F111292_33136_0|SrvcGrp|75506|2022|PCT|0.86|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F111394_46012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|6500.00|99|0.00|AEG 7 (NO REV)|
20|FH_F148243_0_0|SrvcGrp|79589|2022|PDM|650.00|99|0.00|UPPER GI|
20|FH_F36344_0_0|SrvcGrp|15402|2022|PDM|40.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F51272_0_0|SrvcGrp|12670|2022|PCT|0.50|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1747.00|99|0.00|AEG 9 (NO REV)|
20|FH_F132328_0_0|SrvcGrp|67119|2022|PDM|14566.00|99|0.00|ARTHODESIS|
20|FH_F87501_32055_0|SrvcGrp|57968|2022|PDM|36.73|99|0.00|CONTINUOUS HOMECARE|
20|FH_F87501_32055_0|SrvcGrp|80285|2022|PDM|148.30|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F87532_32110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F102282_06795_0|SrvcGrp|94781|2022|PDM|153.62|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F102325_62691_0|SrvcGrp|90340|2022|PDM|45.00|99|0.00|SKILLED NURSING LPN|
20|FH_F130027_76201_0|SrvcGrp|73842|2022|PDM|177.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148079_06512_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F60112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F62579_0_0|SrvcGrp|14949|2022|PDM|80.00|99|0.00|HOME INFUSION|
20|FH_F130725_33020_0|SrvcGrp|89417|2022|PDM|570.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F130841_49315_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F100982_75601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128235_62626_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_F127529_43230_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F90232_15126_0|SrvcGrp|24754|2022|PDM|14.18|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F146207_73139_0|SrvcGrp|84185|2022|PDM|134.00|99|0.00|RESPITE CARE|
20|FH_F93219_26354_0|SrvcGrp|48398|2022|PDM|99.00|99|0.00|PT SERVICES|
20|FH_F143579_43160_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F121476_0_0|SrvcGrp|111252|2022|PDM|645.00|99|0.00|CATHETER|
20|FH_F148927_0_0|SrvcGrp|23585|2022|PCT|0.47|99|0.00|IMPLANTS|
20|FH_F137587_0_0|SrvcGrp|112172|2022|PDM|311.00|99|0.00|CAPD/CCPD TRAINING W/ TREATMENT|
20|FH_F133875_80027_0|SrvcGrp|106048|2022|PDM|1188.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F90594_63304_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F145594_02809_0|SrvcGrp|75545|2022|PDM|250.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F134614_84651_0|SrvcGrp|75419|2022|PDM|600.00|99|0.00|OP PARTIAL HOSPITALIZATION|
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_F142376_0_0|SrvcGrp|11663|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F122130_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F149219_01966_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
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_F81698_10457_0|SrvcGrp|14944|2022|PDM|3.15|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F83978_66739_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F83978_66739_0|SrvcGrp|73004|2022|PDM|1804.00|99|0.00|AEG 8|
20|FH_F117208_0_0|SrvcGrp|77582|2022|PDM|3410.00|99|0.00|CPT 31255|
20|FH_F85652_98034_0|SrvcGrp|31707|2022|PDM|4046.00|99|0.00|MS DRG 793 ONLY|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98021_07012_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F111681_62702_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F118803_0_0|SrvcGrp|107883|2022|PDM|1705.04|99|0.00|SEC ART THROMBECTOMY ADD-ON|
20|FH_F121476_0_0|SrvcGrp|108829|2022|PDM|2081.00|99|0.00|NEUROMEND NERVE WRAP|
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|4748.00|99|0.00|AEG 9 (NO REV)|
20|FH_F145604_14850_0|SrvcGrp|31973|2022|PDM|35.00|99|0.00|HOME THERAPY|
20|FH_F130763_0_0|SrvcGrp|88491|2022|PDM|7319.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F135670_01749_0|SrvcGrp|86844|2022|PDM|42.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F133892_60076_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100782_0_0|SrvcGrp|105112|2022|PDM|771.02|99|0.00|WINDBER MEDICAL CNTR ASC 217|
20|FH_F71445_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132883_31602_0|SrvcGrp|22589|2022|PDM|20.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F127486_06776_0|SrvcGrp|88621|2022|PDM|109.20|99|0.00|SKILLED NURSING LPN|
20|FH_F109577_0_0|SrvcGrp|93338|2022|PDM|123.00|99|0.00|AETNA MED NUTRITION SEBSEQUENT|
20|FH_F83113_0_0|SrvcGrp|8962|2022|PDM|50.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F126003_79403_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F132922_91302_0|SrvcGrp|86722|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F122947_29532_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36753_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD NU|
20|FH_F110470_98335_0|SrvcGrp|92937|2022|PDM|120.00|99|0.00|INTENSIVE OP PSYCH (HCFA)|
20|FH_F144848_0_0|SrvcGrp|98360|2022|PDM|3700.00|99|0.00|AETNA LAMINECTOMY W/FACE-LUMBAR|
20|FH_F134608_18017_0|SrvcGrp|89674|2022|PDM|110.00|99|0.00|US EXAM PG UTERUS REPEAT|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|154.24|99|0.00|HAPA WPA-NWPA 2012-13 ASC 235 W/O REV|
20|FH_F150745_03301_0|SrvcGrp|88621|2022|PDM|132.00|99|0.00|SKILLED NURSING LPN|
20|FH_F67419_0_0|SrvcGrp|42975|2022|PDM|80.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F112306_81428_0|SrvcGrp|104329|2022|PCT|1.00|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F119897_78229_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|951.00|99|0.00|AEG 10 (NO REV)|
20|FH_F97880_63501_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F120157_93103_0|SrvcGrp|90854|2022|PDM|550.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F149662_85015_0|SrvcGrp|104363|2022|PCT|0.00|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F127364_26241_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149030_37919_0|CSTM-ALL|CSTM-00|2020|PDM|2085.75|99|0.00|AEG 4 (NO REV)|
20|FH_F37003_0_0|SrvcGrp|2799|2022|PDM|100.00|99|0.00|URGENT CARE|
20|FH_F49300_0_0|SrvcGrp|43958|2022|PDM|90.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F128375_03909_0|SrvcGrp|73842|2022|PDM|213.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F117762_0_0|SrvcGrp|88162|2022|PDM|4992.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F131068_43055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149160_02180_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F111044_0_0|SrvcGrp|26278|2022|PDM|2266.00|99|0.00|CPT 29881|
20|FH_F35475_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|618180-OPGH-RADIOLOGY|
20|FH_F131152_33403_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F109251_62269_0|SrvcGrp|27968|2022|PDM|48.90|99|0.00|SKILLED NURSING LPN|
20|FH_F111086_29501_0|SrvcGrp|93919|2022|PDM|644.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F124719_64093_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F114206_37203_0|SrvcGrp|105302|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJECTION DRUGS|
20|FH_F73442_0_0|SrvcGrp|44106|2022|PDM|50.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F34918_0_0|SrvcGrp|439|2022|PDM|3094.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F127324_0_0|SrvcGrp|106666|2022|PDM|14830.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F98020_50138_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F139877_32615_0|SrvcGrp|113235|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2&INF A&B&RSV AMP PRB|
20|FH_F129966_18017_0|SrvcGrp|73841|2022|PDM|324.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 9 (NO REV)|
20|FH_F116332_0_0|SrvcGrp|26275|2022|PDM|5419.00|99|0.00|CPT 29826|
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F98900_42001_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F149516_65233_0|SrvcGrp|46903|2022|PDM|483.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F35452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|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_F124441_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F140576_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128741_92879_0|SrvcGrp|53862|2022|PDM|190.69|99|0.00|HOME THERAPY VISITS|
20|FH_F125656_92868_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F90182_80443_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F116806_0_0|SrvcGrp|107118|2022|PDM|887.26|99|0.00|EXCIS TONGUE LESION W/LOCAL FLP|
20|FH_F134936_01020_0|SrvcGrp|88620|2022|PDM|115.00|99|0.00|SKILLED NURSING RN|
20|FH_F36036_0_0|SrvcGrp|22090|2022|PDM|60.00|99|0.00|HCPCS S9211|
20|FH_F111857_68005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151010_85007_0|SrvcGrp|73605|2022|PDM|1050.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F40490_0_0|SrvcGrp|10111|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F97260_06111_0|SrvcGrp|88978|2022|PDM|6625.00|99|0.00|VAGINAL DELIVERY|
20|FH_F134869_08854_0|SrvcGrp|90662|2022|PDM|149.00|99|0.00|EVALUATION AND MANAGEMENT CPT 99214|
20|FH_F90213_30084_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F138271_75040_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F149030_37919_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|335.00|99|0.00|AEG 10 (NO REV)|
20|FH_F116549_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PDM|911.69|99|0.00|ASPG IV|
20|FH_F36554_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ASPG IV|
20|FH_F117023_0_0|SrvcGrp|73004|2022|PDM|1603.00|99|0.00|AEG 8|
20|FH_F151043_71901_0|SrvcGrp|115534|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F130023_0_0|SrvcGrp|16|2022|PDM|1004.00|99|0.00|ACUTE REHABILITATION|
20|FH_F52278_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137719_28269_0|SrvcGrp|87317|2022|PDM|1176.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F97082_90012_0|SrvcGrp|73656|2022|PDM|607.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F105142_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS|
20|FH_F35557_0_0|SrvcGrp|11802|2022|PDM|120.00|99|0.00|HOME INFUSION|
20|FH_F139442_60143_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117762_0_0|SrvcGrp|97730|2022|PDM|14560.00|99|0.00|REVERSE HIP JOINT|
20|FH_F130661_04441_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F117799_0_0|SrvcGrp|27261|2022|PDM|11935.00|99|0.00|CPT 27446|
20|FH_F34777_0_0|SrvcGrp|31640|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F139913_33407_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143249_89801_0|SrvcGrp|14949|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F143536_47546_0|SrvcGrp|100263|2022|PCT|1.00|99|0.00|DESTRUCT LESION, 15 OR MORE|
20|FH_F101752_0_0|SrvcGrp|80245|2022|PCT|0.00|99|0.00|AETNA STEP DOWN/TELEMETRY|
20|FH_F102224_0_0|SrvcGrp|40002|2022|PDM|11000.00|99|0.00|TOTAL HIP|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD NU|
20|FH_F49286_0_0|SrvcGrp|29303|2022|PDM|115.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F49329_0_0|SrvcGrp|45011|2022|PDM|49.00|99|0.00|HOME HEALTH AIDE|
20|FH_F114844_17061_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|AEG 5  (NO REV)|
20|FH_F111908_07677_0|SrvcGrp|87902|2022|PCT|1.00|99|0.00|CEFTRIAXON SOD PER 250MG/8MX|
20|FH_F69708_0_0|SrvcGrp|42828|2022|PDM|117.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F141447_0_0|SrvcGrp|12664|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F150165_06032_0|SrvcGrp|77447|2022|PDM|1772.00|99|0.00|ENDOSCOPIC INJECTION|
20|FH_F130329_64114_0|SrvcGrp|111528|2022|PDM|83.00|99|0.00|PICC LINE INSERTION (HCFA)|
20|FH_F125328_0_0|SrvcGrp|72992|2022|PDM|482.00|99|0.00|AEG 2|
20|FH_F87012_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F96160_32207_0|SrvcGrp|29076|2022|PDM|68.65|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F126157_34210_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149199_73005_0|SrvcGrp|72984|2022|PCT|0.55|99|0.00|CHEMOTHERAPY|
20|FH_F111681_62702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|131.59|99|0.00|HAPA WPA-NWPA 2012-13 ASC 242 W/O REV|
20|FH_F143568_85006_0|SrvcGrp|21456|2022|PCT|2.23|99|0.00|SLEEP STUDIES|
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F133867_84075_0|SrvcGrp|92138|2022|PDM|85.50|99|0.00|SKILLED NURSING RN|
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 10 (NO REV)|
20|FH_F120719_27540_0|SrvcGrp|44564|2022|PDM|938.00|99|0.00|NEWBORN NURSERY|
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|999.00|99|0.00|AEG 7 (NO REV)|
20|FH_F133972_27103_0|SrvcGrp|29023|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F141347_52807_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F126267_24219_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138050_52301_0|SrvcGrp|537|2022|PCT|0.49|99|0.00|OBSERVATION SERVICES|
20|FH_F112665_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F97041_71603_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138302_15701_0|SrvcGrp|26868|2022|PDM|25.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F132969_84003_0|SrvcGrp|27968|2022|PDM|26.75|99|0.00|SKILLED NURSING LPN|
20|FH_F127529_43230_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F123644_0_0|SrvcGrp|89417|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132952_34994_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F52713_0_0|SrvcGrp|20096|2022|PDM|91221.00|99|0.00|MS DRG 222-223 ONLY|
20|FH_F70883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F134667_19110_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F100782_0_0|SrvcGrp|108217|2022|PDM|2254.00|99|0.00|EVASC RPR DPLMNT|
20|FH_F113428_19446_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132690_87571_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F90496_13159_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F134488_14086_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F134508_14072_0|SrvcGrp|471|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134528_63670_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134494_33612_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F122532_46385_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F85393_0_0|SrvcGrp|88621|2022|PDM|70.00|99|0.00|SKILLED NURSING LPN|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|264.36|99|0.00|HAPA WPA-NWPA 2012-13 ASC 117 W/O REV|
20|FH_F66782_0_0|SrvcGrp|29345|2022|PDM|35.00|99|0.00|SKILLED NURSING - LPN - MOD TE|
20|FH_F146499_72206_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146763_76109_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120805_92672_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F66705_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F133401_33404_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133219_89119_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139487_60076_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F139547_42343_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F139707_84010_0|SrvcGrp|11000|2022|PCT|0.45|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F150802_15401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150839_03833_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150841_84757_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124466_32724_0|SrvcGrp|89149|2022|PDM|165.00|99|0.00|OP INTENSIVE|
20|FH_F90817_0_0|SrvcGrp|90359|2022|PDM|2096.00|99|0.00|REPAIR SHOULDER CAPSULE|
20|FH_F111035_30535_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS|
20|FH_F124714_64081_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F35990_0_0|SrvcGrp|70921|2022|PDM|39526.00|99|0.00|CV SURGERY|
20|FH_F47902_0_0|SrvcGrp|29955|2022|PCT|1.00|99|0.00|DME MOD AU|
20|FH_F141511_0_0|SrvcGrp|73559|2022|PDM|1585.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F39443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F124749_90211_0|SrvcGrp|106248|2022|PDM|384.00|99|0.00|PARTIAL HOSP PSYCH|
20|FH_F140990_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111266_30339_0|SrvcGrp|86832|2022|PDM|3.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F128543_44413_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F40899_0_0|SrvcGrp|31191|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF (DME)|
20|FH_F39443_0_0|SrvcGrp|30331|2022|PDM|323.00|99|0.00|HAPA WPA ASC 215|
20|FH_F136887_0_0|SrvcGrp|112978|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F90199_24083_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F116806_0_0|SrvcGrp|107133|2022|PDM|887.26|99|0.00|GUM GRAFT|
20|FH_F111086_29501_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F37764_0_0|SrvcGrp|27579|2022|PDM|60.00|99|0.00|RESPIRATORY THERAPY INITIAL VISIT|
20|FH_F128753_32501_0|SrvcGrp|78377|2022|PCT|0.64|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F114207_35243_0|SrvcGrp|86835|2022|PDM|15.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F116575_0_0|SrvcGrp|88824|2022|PDM|2500.00|99|0.00|CPT 69631|
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_F151025_11230_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F98860_96706_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F137729_19703_0|SrvcGrp|89149|2022|PDM|191.00|99|0.00|OP INTENSIVE|
20|FH_F131331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 10 (NO REV)|
20|FH_F132153_06450_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40497_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F123745_0_0|SrvcGrp|93071|2022|PDM|3600.00|99|0.00|POSTERIOR SEGMENTAL INSTRU|
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37339_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148008_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F140233_35216_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F143347_16001_0|SrvcGrp|79862|2022|PDM|6798.00|99|0.00|ANGIOPLASTY|
20|FH_F143348_16214_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F143351_21157_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F143488_84770_0|CSTM-ALL|CSTM-00|2020|PDM|1326.00|99|0.00|AEG 6 (NO REV)|
20|FH_F143533_30013_0|SrvcGrp|86710|2022|PDM|124.00|99|0.00|NON INVASIVE VASCULAR STUDY|
20|FH_F143536_47546_0|SrvcGrp|101744|2022|PCT|1.00|99|0.00|IM ADMIN EACH ADDL COMPONENT|
20|FH_F101709_0_0|SrvcGrp|34606|2022|PDM|3045.00|99|0.00|CPT 29827|
20|FH_F131040_47715_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49037_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F136249_01913_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132418_84042_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150200_0_0|SrvcGrp|36591|2022|PDM|4590.00|99|0.00|CPT 63685|
20|FH_F150280_0_0|SrvcGrp|78067|2022|PCT|0.60|99|0.00|SUBACUTE CARE|
20|FH_F32292_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|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_F125760_67039_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125249_0_0|SrvcGrp|100059|2022|PDM|1200.00|99|0.00|REPAIR ULNA FRACTURE|
20|FH_F135149_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F90492_0_0|SrvcGrp|43524|2022|PDM|215.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F90714_0_0|SrvcGrp|73008|2022|PDM|555.00|99|0.00|AEG 10|
20|FH_F124899_45246_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F151562_26003_0|SrvcGrp|95661|2022|PDM|110.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F44774_0_0|SrvcGrp|32406|2022|PCT|1.20|99|0.00|OCN F/S PRICING: MODIFIER TC (RADIOLOGY)|
20|FH_F116245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F75722_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93880_95476_0|SrvcGrp|73485|2022|PDM|5939.00|99|0.00|AETNA REHAB|
20|FH_F120249_43215_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F120352_52556_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F118079_37642_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F38526_0_0|SrvcGrp|12969|2022|PDM|619.00|99|0.00|NEWBORN NURSERY|
20|FH_F92276_32308_0|SrvcGrp|39522|2022|PDM|82136.00|99|0.00|MS DRG 216-218 ONLY|
20|FH_F110925_01104_0|SrvcGrp|85820|2022|PDM|94.94|99|0.00|RH IG, FULL DOSE, IM|
20|FH_F137239_0_0|SrvcGrp|86722|2022|PDM|235.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F126730_84737_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F139515_0_0|SrvcGrp|36591|2022|PDM|22394.00|99|0.00|CPT 63685|
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|ASPG IX|
20|FH_F93881_15009_0|SrvcGrp|87107|2022|PDM|89.00|99|0.00|X-RAY EXAM OF KNEE|
20|FH_F118056_29464_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F66412_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F44582_0_0|SrvcGrp|38827|2022|PCT|0.70|99|0.00|PACEMAKER / AICD WITHOUT ACUTE INFARCTION|
20|FH_F110161_31329_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|BLOOD PRODUCTS W/TOB 210-28Z|
20|FH_F33642_0_0|SrvcGrp|15399|2022|PCT|0.60|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F127946_32514_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F69749_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F33712_0_0|SrvcGrp|13692|2022|PDM|6000.00|99|0.00|OP CARDIAC CATH|
20|FH_F54732_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137366_87505_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145550_62034_0|SrvcGrp|104838|2022|PDM|130.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F129011_15857_0|SrvcGrp|107741|2022|PCT|1.00|99|0.00|PNEUMOCCOCCAL VANCCINE|
20|FH_F93791_0_0|SrvcGrp|36591|2022|PDM|1260.00|99|0.00|CPT 63685|
20|FH_F115075_77833_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F43167_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|PARTIAL HOSPITALIZATION (<=17 YRS)|
20|FH_F131228_01826_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136690_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F148666_34205_0|SrvcGrp|108484|2022|PDM|650.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F148892_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F128272_60640_0|SrvcGrp|86852|2022|PDM|50.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|477.62|99|0.00|AEG 1 (NO REV)|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PDM|481.00|99|0.00|ASPG I F/S - BDSS|
20|FH_F92129_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|AEG 2 (NO REV)|
20|FH_F67280_0_0|SrvcGrp|44107|2022|PDM|54.00|99|0.00|SPEECH THERAPY|
20|FH_F35387_0_0|SrvcGrp|16|2022|PDM|1178.00|99|0.00|ACUTE REHABILITATION|
20|FH_F36165_0_0|SrvcGrp|22387|2022|PDM|90.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F138987_0_0|SrvcGrp|97507|2022|PDM|665.00|99|0.00|AETNA HOSPICE|
20|FH_F148181_0_0|SrvcGrp|93098|2022|PDM|155.00|99|0.00|HOSPICE CARE|
20|FH_F41617_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F75489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F137732_08690_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F80834_0_0|SrvcGrp|43871|2022|PDM|1481.00|99|0.00|NEWBORN NURSERY|
20|FH_F113826_51445_0|SrvcGrp|471|2022|PDM|530.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F145543_0_0|SrvcGrp|113197|2022|PDM|931.00|99|0.00|FISTULIZATION OF SCLERA|
20|FH_F139247_77657_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F34882_0_0|SrvcGrp|18920|2022|PDM|4794.42|99|0.00|MS DRG 766 REPLACEMENT CODES 785, 788|
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122330_75771_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F94643_90501_0|SrvcGrp|86836|2022|PDM|15.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F114090_19023_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40899_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F115483_62002_0|SrvcGrp|73461|2022|PDM|1672.00|99|0.00|AETNA NICU IV|
20|FH_F120099_86305_0|SrvcGrp|46903|2022|PDM|1208.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F36150_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F110732_31513_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F40490_0_0|CSTM-ALL|CSTM-00|2020|PDM|5766.00|99|0.00|MS DRG 765-766 ONLY C-SECTION|
20|FH_F35387_0_0|SrvcGrp|11083|2022|PDM|1117.00|99|0.00|NORMAL DELIVERY (MOTHER ONLY)|
20|FH_F113957_73554_0|SrvcGrp|75506|2022|PCT|1.25|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F43244_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F111035_30535_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|GENERAL ACUTE CARE|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|229.00|99|0.00|HAPA EPA ASC 31|
20|FH_F90232_15126_0|SrvcGrp|86853|2022|PDM|47.25|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F147060_32025_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD RR|
20|FH_F124383_39056_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124435_03882_0|SrvcGrp|90854|2022|PDM|784.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F130661_04441_0|SrvcGrp|75506|2022|PCT|0.86|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F124441_0_0|SrvcGrp|36591|2022|PDM|30400.00|99|0.00|CPT 63685|
20|FH_F130202_68003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36992_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F37081_0_0|SrvcGrp|177|2022|PDM|2345.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F149602_07109_0|SrvcGrp|111926|2022|PDM|35.92|99|0.00|COVID-19 LAB TESTING|
20|FH_F74465_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F102525_73134_0|SrvcGrp|72994|2022|PDM|1163.00|99|0.00|AEG 3|
20|FH_F112754_98057_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)|
20|FH_F116806_0_0|SrvcGrp|107094|2022|PDM|973.15|99|0.00|REMOVAL OF SKIN LESION|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|617.00|99|0.00|AEG 1 (NO REV)|
20|FH_F32825_0_0|SrvcGrp|701|2022|PDM|1748.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F146859_0_0|SrvcGrp|114014|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F97260_06111_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F129340_43212_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F47212_0_0|SrvcGrp|44430|2022|PDM|105.00|99|0.00|SPEECH THERAPY SVCS (VISIT LVL)|
20|FH_F72788_0_0|CSTM-ALL|CSTM-00|2020|PDM|1541.00|99|0.00|ACUTE PSYCH|
20|FH_F33566_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F137789_48146_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131392_17004_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138987_0_0|SrvcGrp|63297|2022|PDM|122.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F140289_52246_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149579_95815_0|SrvcGrp|115680|2022|PDM|66.63|99|0.00|PSYCHIATRIC COLLABORATIVE CARE 1ST SBSQ (HCFA)|
20|FH_F149582_01534_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F149400_83301_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F147225_48093_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IP MULTI ROOM COMPARISON|
20|FH_F147347_70806_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F40104_0_0|SrvcGrp|9830|2022|PDM|107.71|99|0.00|OT SVCS|
20|FH_F114825_32789_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F129682_07034_0|SrvcGrp|88621|2022|PDM|105.00|99|0.00|SKILLED NURSING LPN|
20|FH_F108680_0_0|SrvcGrp|88494|2022|PDM|3850.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F140036_07702_0|SrvcGrp|73842|2022|PDM|249.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F143488_84770_0|SrvcGrp|90606|2022|PDM|1327.00|99|0.00|INSERT LENS PROSTHESIS|
20|FH_F67147_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103060_0_0|SrvcGrp|35669|2022|PDM|5202.00|99|0.00|CPT 63650|
20|FH_F102224_0_0|SrvcGrp|101114|2022|PDM|9900.00|99|0.00|ARTHOPLASTY|
20|FH_F102224_0_0|SrvcGrp|88161|2022|PDM|6000.00|99|0.00|LAMINECTOMY W/FACE-THORACIC|
20|FH_F151743_20001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132419_84042_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F120747_19129_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116698_07470_0|SrvcGrp|86834|2022|PDM|21.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F120187_76522_0|SrvcGrp|108411|2022|PCT|1.00|99|0.00|OP SVCS AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F132424_75062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132419_84042_0|SrvcGrp|58509|2022|PDM|456.78|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F120747_19129_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112687_30474_0|SrvcGrp|48394|2022|PDM|69.30|99|0.00|SKILLED NURSING SERVICES|
20|FH_F116609_35801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119843_14103_0|SrvcGrp|76501|2022|PDM|250.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F120866_51652_0|SrvcGrp|76501|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F118792_63379_0|SrvcGrp|73606|2022|PDM|726.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F84394_17402_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F51276_0_0|SrvcGrp|10577|2022|PDM|80.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F142454_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F143467_0_0|SrvcGrp|104008|2022|PDM|4753.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS|
20|FH_F47539_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F100742_00616_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F59732_0_0|SrvcGrp|17016|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F102302_0_0|SrvcGrp|98587|2022|PDM|14750.00|99|0.00|IMPLNT SPINAL CANAL CATHETER|
20|FH_F111288_0_0|SrvcGrp|88065|2022|PDM|29362.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F149980_0_0|SrvcGrp|94899|2022|PDM|2954.00|99|0.00|VITRECTOMY|
20|FH_F93880_95476_0|SrvcGrp|90356|2022|PCT|0.00|99|0.00|OP DIALYSIS|
20|FH_F38591_0_0|SrvcGrp|72|2022|PDM|534.00|99|0.00|NEWBORN NURSERY|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2004 NATIONAL RBRVS HCPCS F/S|
20|FH_F127262_68064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F61332_0_0|SrvcGrp|14609|2022|PCT|0.65|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F92993_0_0|SrvcGrp|86476|2022|PDM|41.57|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F62892_0_0|SrvcGrp|22387|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F147941_06023_0|SrvcGrp|110566|2022|PCT|0.00|99|0.00|AETNA NICU II|
20|FH_F40834_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CV SURGERY (MS DRG)|
20|FH_F133099_66801_0|SrvcGrp|85759|2022|PCT|0.00|99|0.00|DETOXIFICATION|
20|FH_F126678_44870_0|SrvcGrp|87799|2022|PDM|130.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|AEG 2 (NO REV)|
20|FH_F37679_0_0|SrvcGrp|27061|2022|PDM|9.75|99|0.00|HYDRATION THERAPY - 3+ LITERS (MOD SJ)|
20|FH_F39349_0_0|SrvcGrp|3029|2022|PDM|367.00|99|0.00|NEWBORN NURSERY|
20|FH_F110925_01104_0|SrvcGrp|17015|2022|PDM|19.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F82173_72712_0|SrvcGrp|96461|2022|PDM|285.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F121535_60018_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F72842_0_0|SrvcGrp|3029|2022|PDM|789.00|99|0.00|NEWBORN NURSERY|
20|FH_F50214_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD AU) - PMRS|
20|FH_F83451_0_0|SrvcGrp|88492|2022|PDM|1906.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F148265_06067_0|SrvcGrp|98267|2022|PDM|22174.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F143968_94520_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129268_54220_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149859_60005_0|SrvcGrp|108484|2022|PDM|496.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131236_84041_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F77504_0_0|SrvcGrp|592|2022|PDM|400.00|99|0.00|SUB-ACUTE CARE|
20|FH_F137451_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78285_0_0|SrvcGrp|9830|2022|PDM|50.00|99|0.00|OT SVCS|
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|1231.00|99|0.00|AEG 3 (NO REV)|
20|FH_F88254_33411_0|SrvcGrp|86779|2022|PDM|112.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP DIALYSIS|
20|FH_F139719_0_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F86319_16365_0|SrvcGrp|111924|2022|PDM|6195.00|99|0.00|C-SECTION DELIVERY INCLUDES NEWBORN|
20|FH_F38526_0_0|SrvcGrp|675|2022|PDM|1770.00|99|0.00|PEDIATRIC INPATIENT SVCS|
20|FH_F117082_66216_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PDM|1046.08|99|0.00|ASPG VII|
20|FH_F72850_0_0|CSTM-ALL|CSTM-00|2020|PDM|1541.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F87254_0_0|SrvcGrp|80063|2022|PDM|1100.00|99|0.00|HEMORRHOIDECTOMY|
20|FH_F100762_51104_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F89475_71202_0|SrvcGrp|73806|2022|PDM|469.00|99|0.00|AETNA ER|
20|FH_F39940_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100660_56303_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F117783_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F131357_17545_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F128307_43219_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F126939_32405_0|SrvcGrp|89149|2022|PDM|195.00|99|0.00|OP INTENSIVE|
20|FH_F120910_63021_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F62719_0_0|SrvcGrp|14494|2022|PDM|40.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F45632_0_0|SrvcGrp|41487|2022|PDM|34.00|99|0.00|INFUSION PUMP|
20|FH_F129231_30060_0|CSTM-ALL|CSTM-00|2020|PDM|1255.00|99|0.00|AEG 8 (NO REV)|
20|FH_F44582_0_0|SrvcGrp|13292|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHYSICIAN CLINIC VISIT NATL F/S (MOD RR)|
20|FH_F141587_40242_0|SrvcGrp|3178|2022|PDM|820.00|99|0.00|ACUTE PSYCH|
20|FH_F60812_0_0|SrvcGrp|44012|2022|PDM|3751.00|99|0.00|RESIDENTIAL REHABILITATION|
20|FH_F120856_78247_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F147211_0_0|SrvcGrp|110537|2022|PDM|439.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
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_F39075_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.60|99|0.00|OP SVCS|
20|FH_F127567_44070_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F120352_52556_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F109980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148255_72703_0|SrvcGrp|14944|2022|PDM|3.15|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F143969_71129_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F31056_0_0|SrvcGrp|941|2022|PDM|3195.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F120362_23321_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F115685_64064_0|SrvcGrp|86830|2022|PDM|3.80|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F100320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129656_15005_0|SrvcGrp|17015|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F130024_78229_0|SrvcGrp|472|2022|PDM|516.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F82235_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148122_49435_0|SrvcGrp|109036|2022|PDM|550.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F137573_33764_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F37679_0_0|SrvcGrp|27063|2022|PDM|15.25|99|0.00|HOME INFUSION THERAPY|
20|FH_F140893_19720_0|SrvcGrp|46605|2022|PDM|113.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F140913_63017_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
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_F134287_0_0|SrvcGrp|112538|2022|PDM|15000.00|99|0.00|KNEE REPLACEMENT|
20|FH_F145755_08050_0|SrvcGrp|113995|2022|PCT|1.00|99|0.00|IMMUNIZATION ADMINISTRATION|
20|FH_F125516_50574_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F39339_0_0|SrvcGrp|361|2022|PDM|2025.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F122687_0_0|SrvcGrp|88162|2022|PDM|8742.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F121183_75093_0|SrvcGrp|90854|2022|PDM|884.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F41776_0_0|SrvcGrp|16|2022|PDM|992.00|99|0.00|ACUTE REHABILITATION|
20|FH_F128232_70374_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148323_84070_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F137067_0_0|SrvcGrp|93724|2022|PDM|2625.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F135005_06460_0|SrvcGrp|29347|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F74026_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1343.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|2284.00|99|0.00|AEG 9 (NO REV)|
20|FH_F147941_06023_0|SrvcGrp|73524|2022|PDM|247.00|99|0.00|PHYSICAL THERAPY|
20|FH_F34691_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F130916_33701_0|SrvcGrp|46903|2022|PDM|177.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F34112_0_0|SrvcGrp|9926|2022|PDM|5675.00|99|0.00|DIRECTIONAL CORONARY ATHERECTOMY|
20|FH_F105680_0_0|SrvcGrp|75495|2022|PDM|1920.00|99|0.00|AEG 9|
20|FH_F141587_40242_0|SrvcGrp|12659|2022|PDM|643.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F150980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148440_16506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F115737_78660_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F33500_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|15473|2022|PDM|3028.00|99|0.00|CPT CODE 42820|
20|FH_F38034_0_0|SrvcGrp|27881|2022|PDM|4171.00|99|0.00|ANGIOPLASTY|
20|FH_F63276_0_0|SrvcGrp|42825|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F130598_73601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93413_0_0|SrvcGrp|76094|2022|PDM|138.02|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F125138_63663_0|SrvcGrp|22596|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1086.00|99|0.00|AEG 7 (NO REV)|
20|FH_F118057_47906_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F38867_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|GENERAL ACUTE CARE|
20|FH_F37884_0_0|SrvcGrp|12044|2022|PDM|750.00|99|0.00|SLEEP STUDIES|
20|FH_F31253_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F149886_68112_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118050_77565_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F102302_0_0|SrvcGrp|98608|2022|PDM|1817.00|99|0.00|REVISE ULNAR NERVE AT WRIST|
20|FH_F87619_0_0|SrvcGrp|72992|2022|PDM|561.00|99|0.00|AEG 2|
20|FH_F125813_66030_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.75|99|0.00|ASPG VI|
20|FH_F149863_68127_0|SrvcGrp|108484|2022|PDM|483.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|1407.00|99|0.00|AEG 5  (NO REV)|
20|FH_F37679_0_0|SrvcGrp|26848|2022|PDM|15.25|99|0.00|ANTI-HEMOPHILIC (MOD SJ)|
20|FH_F121467_75165_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F118072_38133_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F101021_0_0|SrvcGrp|93100|2022|PDM|140.00|99|0.00|RESPITE CARE|
20|FH_F135081_63080_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F66687_0_0|SrvcGrp|20900|2022|PDM|48868.00|99|0.00|MS DRG 248 ONLY|
20|FH_F93332_0_0|SrvcGrp|93094|2022|PDM|7025.00|99|0.00|CORPECTOMY (HCFA)|
20|FH_F124783_92408_0|SrvcGrp|75419|2022|PDM|642.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F109240_21201_0|SrvcGrp|102984|2022|PDM|184.00|99|0.00|RADIATION THERAPY PLANNING|
20|FH_F137558_36116_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123533_63825_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F103902_89118_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37679_0_0|SrvcGrp|10580|2022|PDM|37.50|99|0.00|HYDRATION THERAPY - 3 LITERS|
20|FH_F131995_04730_0|SrvcGrp|23683|2022|PDM|63.00|99|0.00|SKILLED NURSING RN|
20|FH_F143743_26501_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F120059_0_0|SrvcGrp|108114|2022|PDM|2300.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F137943_0_0|SrvcGrp|79794|2022|PDM|1660.00|99|0.00|EYE/OCULAR ADNEXA SURGERY|
20|FH_F116327_75701_0|SrvcGrp|87317|2022|PDM|500.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F122898_63011_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F86872_15215_0|SrvcGrp|14893|2022|PDM|58.75|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)|
20|FH_F62579_0_0|SrvcGrp|17302|2022|PDM|55.00|99|0.00|HYDRATION THERAPY - 3+ LITERS|
20|FH_F130841_49315_0|SrvcGrp|65720|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F130897_03103_0|SrvcGrp|111633|2022|PDM|228.00|99|0.00|ALCOHOL & DRUG SERVICE|
20|FH_F129300_54541_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110466_06870_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F145641_06902_0|SrvcGrp|114234|2022|PDM|3253.00|99|0.00|EXC HAND LES SC < 1.5 CM|
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)|
20|FH_F85651_33549_0|SrvcGrp|83799|2022|PDM|2970.00|99|0.00|VAGINAL DELIVERY-NO ANTEPARTUM|
20|FH_F59872_0_0|CSTM-ALL|CSTM-00|2020|PDM|2250.00|99|0.00|ASPG IV|
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|964.00|99|0.00|AEG 7 (NO REV)|
20|FH_F138050_52301_0|SrvcGrp|73499|2022|PDM|910.00|99|0.00|AETNA ER LEVEL II|
20|FH_F39378_0_0|SrvcGrp|17419|2022|PDM|120.00|99|0.00|SPEECH THERAPY|
20|FH_F134619_14304_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F50657_0_0|SrvcGrp|31187|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF (DME)|
20|FH_F112668_0_0|SrvcGrp|82138|2022|PDM|535.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F132727_61108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F121597_30315_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143711_78405_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F112649_63764_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114415_16509_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133972_27103_0|SrvcGrp|16750|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132747_60174_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121476_0_0|SrvcGrp|108838|2022|PDM|192.00|99|0.00|INTEGRA BMWD|
20|FH_F149342_72204_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F89551_0_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F145604_14850_0|SrvcGrp|10577|2022|PDM|70.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F119573_95864_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130468_0_0|SrvcGrp|111435|2022|PDM|9919.40|99|0.00|ATRAUMATIC DISLOC WITH ANES|
20|FH_F48313_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132747_60174_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72785_0_0|SrvcGrp|30623|2022|PDM|11457.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F121628_19533_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F93359_63084_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F125513_40071_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132969_84003_0|SrvcGrp|24761|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F149021_44514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117206_0_0|SrvcGrp|88740|2022|PDM|2884.00|99|0.00|SP BONE ALGRFT|
20|FH_F132969_84003_0|SrvcGrp|29023|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F144248_0_0|SrvcGrp|77507|2022|PCT|1.04|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F121684_74447_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F150299_22046_0|SrvcGrp|66265|2022|PDM|84.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F116653_0_0|SrvcGrp|106655|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F111731_47802_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F49853_0_0|SrvcGrp|473|2022|PDM|370.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120417_63124_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 10 (NO REV)|
20|FH_F118088_71261_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F117300_0_0|SrvcGrp|54943|2022|PDM|2945.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F111882_51560_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F133749_84604_0|SrvcGrp|112452|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F120735_40012_0|SrvcGrp|86722|2022|PDM|171.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F35042_0_0|SrvcGrp|3987|2022|PCT|0.80|99|0.00|TRAUMA CARE|
20|FH_F146650_29690_0|SrvcGrp|115478|2022|PDM|711.00|99|0.00|RESIDENTIAL TREATMENT W/O AUTISM|
20|FH_F120425_11106_0|SrvcGrp|89024|2022|PDM|76.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F112082_30720_0|SrvcGrp|24750|2022|PDM|76.22|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F132969_84003_0|SrvcGrp|86850|2022|PDM|25.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F126354_91321_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F46290_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1318.00|99|0.00|AEG 4 (NO REV)|
20|FH_F142376_0_0|SrvcGrp|98569|2022|PDM|7405.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F144248_0_0|SrvcGrp|109764|2022|PDM|4590.00|99|0.00|REPAIR EYELID DEFECT|
20|FH_F146579_99202_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC|
20|FH_F117300_0_0|SrvcGrp|98498|2022|PDM|7360.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC|
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|1038.00|99|0.00|AEG 10 (NO REV)|
20|FH_F112908_0_0|SrvcGrp|27969|2022|PDM|13.00|99|0.00|HOME HEALTH AIDE|
20|FH_F97102_83501_0|SrvcGrp|88977|2022|PDM|6795.00|99|0.00|C-SECTION DELIVERY|
20|FH_F131254_92211_0|SrvcGrp|17015|2022|PDM|12.50|99|0.00|HOME INFUSION THERAPY|
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_F40332_0_0|SrvcGrp|9795|2022|PDM|825.00|99|0.00|SUBACUTE REHAB|
20|FH_F139515_0_0|SrvcGrp|109956|2022|PDM|10197.00|99|0.00|INSERT SPINE FIXATION DEVICE|
20|FH_F43171_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|ADULT PSYCH RESIDENT TREATMENT- IP|
20|FH_F124788_0_0|SrvcGrp|72998|2022|PDM|717.00|99|0.00|AEG 5|
20|FH_F139551_0_0|SrvcGrp|88065|2022|PDM|13750.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F123844_0_0|SrvcGrp|90707|2022|PDM|190.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F38526_0_0|SrvcGrp|51|2022|PDM|12500.00|99|0.00|KNEE REPLACEMENT|
20|FH_F38473_0_0|SrvcGrp|27968|2022|PDM|41.00|99|0.00|SKILLED NURSING LPN|
20|FH_F140929_67206_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126002_11946_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F140427_0_0|SrvcGrp|96380|2022|PDM|2500.00|99|0.00|AETNA INS/REP SUBQ DEFIBRILLATOR|
20|FH_F139515_0_0|SrvcGrp|88162|2022|PDM|8196.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F148265_06067_0|CSTM-ALL|CSTM-00|2020|PDM|1054.00|99|0.00|AEG 1 (NO REV)|
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|2216.00|99|0.00|AEG 7 (NO REV)|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OTHER OP  SERV|
20|FH_F137943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F128002_27260_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_F147941_06023_0|SrvcGrp|13422|2022|PDM|753.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F40043_0_0|SrvcGrp|13686|2022|PDM|1920.00|99|0.00|ACUTE IP SURG SVCS|
20|FH_F93881_15009_0|SrvcGrp|38247|2022|PDM|559.00|99|0.00|SLEEP STUDIES|
20|FH_F148325_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116065_06708_0|SrvcGrp|472|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F62694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F63235_0_0|SrvcGrp|73004|2022|PDM|2722.00|99|0.00|AEG 8|
20|FH_F142332_0_0|SrvcGrp|88620|2022|PDM|118.00|99|0.00|SKILLED NURSING RN|
20|FH_F101757_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS|
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145561_80210_0|SrvcGrp|89337|2022|PDM|2474.50|99|0.00|DETOXIFICATION|
20|FH_F85353_16407_0|SrvcGrp|63904|2022|PDM|147.67|99|0.00|HAPA WPA-NWPA 2012-13 ASC 138|
20|FH_F135626_20176_0|SrvcGrp|73605|2022|PDM|1080.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F35009_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F145641_06902_0|SrvcGrp|82108|2022|PDM|6619.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F62919_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F97840_54729_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146663_25311_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143566_98264_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132925_84041_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117245_0_0|SrvcGrp|73006|2022|PDM|2210.00|99|0.00|AEG 9|
20|FH_F125260_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|PDM|2700.00|99|0.00|AEG 10 (NO REV)|
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150239_75569_0|SrvcGrp|14892|2022|PCT|1.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F111986_0_0|SrvcGrp|104118|2022|PDM|3605.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F130763_0_0|SrvcGrp|89989|2022|PDM|4914.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F85652_98034_0|SrvcGrp|112490|2022|PDM|22300.00|99|0.00|BARIATRIC PROCEDURES|
20|FH_F95631_33705_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F127157_43614_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F146650_29690_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F125133_20601_0|SrvcGrp|27968|2022|PDM|63.65|99|0.00|SKILLED NURSING LPN|
20|FH_F142376_0_0|SrvcGrp|112515|2022|PDM|2805.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F139380_33062_0|SrvcGrp|86722|2022|PDM|237.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F134593_60007_0|SrvcGrp|112585|2022|PCT|0.85|99|0.00|GOLODIRSEN INJ|
20|FH_F135663_24401_0|SrvcGrp|29347|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE|
20|FH_F100782_0_0|SrvcGrp|105127|2022|PDM|513.75|99|0.00|WINDBER MEDICAL CNTR ASC 232|
20|FH_F126555_44906_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F85353_16407_0|SrvcGrp|63849|2022|PDM|440.87|99|0.00|HAPA WPA-NWPA 2012-13 ASC 16|
20|FH_F110509_71351_0|SrvcGrp|79797|2022|PCT|0.55|99|0.00|AETNA PTCA|
20|FH_F120715_83440_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F98021_07012_0|CSTM-ALL|CSTM-00|2020|PCT|0.39|99|0.00|OP SVCS|
20|FH_F149660_0_0|SrvcGrp|115763|2022|PDM|12.00|99|0.00|NON-EMERGENCY TRANSPORTATION|
20|FH_F119227_01752_0|SrvcGrp|24745|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F133585_0_0|SrvcGrp|105285|2022|PDM|768.00|99|0.00|TEMPORAL ARTERY|
20|FH_F134993_75034_0|SrvcGrp|89417|2022|PDM|380.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F149241_30161_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149345_45044_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F85353_16407_0|SrvcGrp|63843|2022|PDM|446.17|99|0.00|HAPA WPA-NWPA 2012-13 ASC 308|
20|FH_F138302_15701_0|SrvcGrp|17016|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F127950_45150_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125135_60008_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111986_0_0|SrvcGrp|94904|2022|PDM|2472.00|99|0.00|REPAIR/REVISE WRIST JOINT|
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|AEG 4 (NO REV)|
20|FH_F70863_0_0|SrvcGrp|9830|2022|PDM|161.00|99|0.00|OT SVCS|
20|FH_F130327_03867_0|SrvcGrp|88621|2022|PDM|123.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150165_06032_0|SrvcGrp|106265|2022|PDM|6047.00|99|0.00|NSL/SINS NDSC TOTAL|
20|FH_F120719_27540_0|SrvcGrp|108564|2022|PDM|1126.00|99|0.00|OUTPATIENT HOSPICE|
20|FH_F144808_0_0|SrvcGrp|36591|2022|PDM|4812.00|99|0.00|CPT 63685|
20|FH_F146657_01105_0|SrvcGrp|114677|2022|PDM|43.56|99|0.00|CRISIS INTERV SERV (MOD HO)|
20|FH_F80594_0_0|SrvcGrp|76501|2022|PDM|278.25|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F35966_0_0|SrvcGrp|16899|2022|PDM|275.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F126555_44906_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F110402_74361_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F145942_72019_0|SrvcGrp|108484|2022|PDM|504.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F83754_0_0|SrvcGrp|21818|2022|PCT|0.86|99|0.00|DIAGNOSTIC CARDIAC CATH|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|179.77|99|0.00|HAPA WPA-NWPA 2012-13 ASC 129 W/O REV|
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|16823.00|99|0.00|MS DRG 469-470|
20|FH_F85353_16407_0|SrvcGrp|63809|2022|PDM|613.76|99|0.00|HAPA WPA-NWPA 2012-13 ASC 203|
20|FH_F109405_73106_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F149517_0_0|SrvcGrp|95661|2022|PDM|678.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F149241_30161_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132969_84003_0|SrvcGrp|46605|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F146039_89511_0|SrvcGrp|29346|2022|PDM|40.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F128791_57201_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F79824_0_0|SrvcGrp|17077|2022|PDM|3477.00|99|0.00|ASPG VII|
20|FH_F127343_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F116727_0_0|SrvcGrp|103236|2022|PDM|5000.00|99|0.00|AETNA INSJ STABLJ DEV|
20|FH_F120484_31419_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124829_75231_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|1675.00|99|0.00|ASPG VIII - FH SW CUSTOM GROUPERS|
20|FH_F134488_14086_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F84932_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.20|99|0.00|GENERAL ACUTE CARE|
20|FH_F71964_0_0|SrvcGrp|68861|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F98800_85021_0|SrvcGrp|73601|2022|PDM|6240.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F98800_85021_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F100907_85206_0|SrvcGrp|92760|2022|PCT|0.95|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115814_53235_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F75842_0_0|SrvcGrp|73867|2022|PDM|3583.58|99|0.00|NORMAL DELIVERY|
20|FH_F120522_53549_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120805_92672_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F131665_50129_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131737_15025_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F131989_66030_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133544_78227_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F133491_74012_0|SrvcGrp|80920|2022|PDM|550.00|99|0.00|HOSPICE SERVICES|
20|FH_F134822_06513_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134828_30531_0|SrvcGrp|112663|2022|PDM|35.00|99|0.00|XRAY EXAM OF WRIST|
20|FH_F86851_0_0|SrvcGrp|84994|2022|PDM|324.00|99|0.00|CPT 45321|
20|FH_F90354_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|749.66|99|0.00|AETNA SLEEP STUDIES W/O MOD 26 & TC|
20|FH_F88398_15601_0|SrvcGrp|46605|2022|PDM|83.65|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|191.14|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)|
20|FH_F87474_0_0|SrvcGrp|12401|2022|PDM|66.00|99|0.00|RN VISIT|
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|2640.00|99|0.00|AEG 9 (NO REV)|
20|FH_F138588_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F43417_0_0|SrvcGrp|31134|2022|PDM|1040.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F46832_0_0|SrvcGrp|14948|2022|PDM|140.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F48292_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123784_03264_0|SrvcGrp|88620|2022|PDM|157.00|99|0.00|SKILLED NURSING RN|
20|FH_F121250_47401_0|SrvcGrp|89149|2022|PDM|187.00|99|0.00|OP INTENSIVE|
20|FH_F67901_0_0|SrvcGrp|14948|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F136386_30901_0|SrvcGrp|73605|2022|PDM|895.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F136390_46321_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F120489_63552_0|SrvcGrp|75497|2022|PCT|0.75|99|0.00|AEG 10|
20|FH_F93292_62234_0|SrvcGrp|45307|2022|PDM|5.00|99|0.00|ADMIN OF INFLUENZA VIRUS VACCINE|
20|FH_F136952_78218_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F139751_84065_0|SrvcGrp|75754|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142690_31774_0|SrvcGrp|13929|2022|PDM|40.00|99|0.00|GROWTH HORMONE|
20|FH_F142690_31774_0|SrvcGrp|82773|2022|PDM|150.00|99|0.00|POST NATAL ASSESSMENT W/ NEWBORN|
20|FH_F104340_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F97600_46151_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F138584_30912_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139267_30253_0|SrvcGrp|113175|2022|PDM|18.63|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - MODERNA|
20|FH_F137530_0_0|SrvcGrp|107877|2022|PDM|1298.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F149584_77045_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151608_30236_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F119065_92029_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F109982_33592_0|SrvcGrp|46903|2022|PDM|465.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F147725_06002_0|SrvcGrp|88599|2022|PDM|3848.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F147925_06457_0|SrvcGrp|115487|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F129483_77030_0|SrvcGrp|22592|2022|PDM|40.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F117153_34113_0|SrvcGrp|86723|2022|PDM|350.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F117218_32025_0|SrvcGrp|3178|2022|PDM|796.00|99|0.00|ACUTE PSYCH|
20|FH_F117126_12801_0|SrvcGrp|10362|2022|PDM|675.00|99|0.00|CPT CODE 99282|
20|FH_F137276_83127_0|SrvcGrp|29346|2022|PDM|26.75|99|0.00|SKILLED NURSING- LPN|
20|FH_F137887_33756_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F137891_23451_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40127_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS|
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148866_84123_0|SrvcGrp|471|2022|PDM|608.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F151054_06473_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F151154_91761_0|SrvcGrp|88620|2022|PDM|130.00|99|0.00|SKILLED NURSING RN|
20|FH_F151221_71857_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121329_33015_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121999_67002_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|354.21|99|0.00|DELAWARE VALLEY- ASC 210|
20|FH_F110381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39366_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F114916_30309_0|SrvcGrp|105636|2022|PDM|3750.00|99|0.00|REALIGNMENT OF KNEE|
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|846.00|99|0.00|AEG 5  (NO REV)|
20|FH_F43860_0_0|SrvcGrp|37405|2022|PDM|90.00|99|0.00|OT SVCS|
20|FH_F131412_0_0|SrvcGrp|82222|2022|PDM|34.91|99|0.00|HOSPICE CARE|
20|FH_F135491_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F138929_0_0|SrvcGrp|97730|2022|PDM|17600.00|99|0.00|REVERSE HIP JOINT|
20|FH_F134270_0_0|SrvcGrp|89404|2022|PDM|19000.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 2 (NO REV)|
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|444.00|99|0.00|AEG 2 (NO REV)|
20|FH_F124180_0_0|SrvcGrp|22949|2022|PDM|3860.00|99|0.00|CPT CODE 42825|
20|FH_F124927_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F147081_02130_0|CSTM-ALL|CSTM-00|2020|PDM|473.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F39398_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F39753_0_0|CSTM-ALL|CSTM-00|2020|PDM|1702.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F40643_0_0|SrvcGrp|11663|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F92493_0_0|SrvcGrp|89404|2022|PDM|20798.09|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F100703_0_0|SrvcGrp|93741|2022|PDM|7876.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY|
20|FH_F129549_01238_0|SrvcGrp|106904|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F128360_0_0|SrvcGrp|58638|2022|PDM|3000.00|99|0.00|CPT 63688|
20|FH_F133694_89117_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F136623_01830_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136658_50401_0|SrvcGrp|108484|2022|PDM|420.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F136674_16335_0|CSTM-ALL|CSTM-00|2020|PCT|3.00|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F139556_85006_0|SrvcGrp|92760|2022|PCT|1.08|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PDM|22.09|99|0.00|INTERVENE HLTH/BEHAVE INDIV|
20|FH_F148553_85016_0|SrvcGrp|115440|2022|PDM|1343.00|99|0.00|REPOSITION PACING DEFIB LEA|
20|FH_F122608_84123_0|SrvcGrp|32189|2022|PDM|112.00|99|0.00|RESPITE CARE|
20|FH_F122689_92009_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F135722_33461_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|WELLPATH PROPIETARY ASC VII|
20|FH_F115210_21043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116393_07002_0|SrvcGrp|111280|2022|PDM|9.83|99|0.00|C-REACTIVE PROTEIN|
20|FH_F116393_07002_0|SrvcGrp|86323|2022|PCT|1.25|99|0.00|OTORHINOLARYNGOLOGIC SERVICES|
20|FH_F147479_75077_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147586_44124_0|SrvcGrp|16732|2022|PDM|2293.00|99|0.00|HYSTEROSCOPY ABLATION|
20|FH_F147414_92656_0|SrvcGrp|75419|2022|PDM|600.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F41798_0_0|SrvcGrp|109|2022|PDM|468.00|99|0.00|CD - DETOX|
20|FH_F42399_0_0|SrvcGrp|33166|2022|PDM|423.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F42694_0_0|SrvcGrp|9828|2022|PDM|54.00|99|0.00|HOME HEALTH AIDE|
20|FH_F125479_17501_0|SrvcGrp|52953|2022|PDM|96.09|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F125287_92374_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F38980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F102947_44084_0|SrvcGrp|93919|2022|PDM|434.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PDM|619.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F54612_07631_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|2315.25|99|0.00|AEG 9 (NO REV)|
20|FH_F128341_41139_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F131235_36049_0|SrvcGrp|75419|2022|PDM|605.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F109963_0_0|SrvcGrp|72992|2022|PDM|497.00|99|0.00|AEG 2|
20|FH_F46433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F113025_0_0|SrvcGrp|104720|2022|PDM|485.00|99|0.00|BLEPHAROPLASTY UPPER EYELID|
20|FH_F134087_0_0|SrvcGrp|67068|2022|PDM|10220.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F113178_44035_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F100101_24018_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113585_20155_0|SrvcGrp|86825|2022|PDM|75.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F138680_53005_0|SrvcGrp|86723|2022|PDM|405.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F86294_0_0|SrvcGrp|84721|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F67359_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F107580_77018_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63862|2022|PDM|358.19|99|0.00|HAPA WPA-NWPA 2012-13 ASC 227|
20|FH_F130763_0_0|SrvcGrp|106264|2022|PDM|6043.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION|
20|FH_F132193_0_0|SrvcGrp|21978|2022|PDM|150.00|99|0.00|CPT 77003|
20|FH_F85652_98034_0|CSTM-ALL|CSTM-00|2020|PCT|2.62|99|0.00|AETNA - APC GROUPER G|
20|FH_F139873_0_0|SrvcGrp|26274|2022|PDM|2215.00|99|0.00|CPT 29877|
20|FH_F150239_75569_0|SrvcGrp|17013|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F133892_60076_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F93122_01854_0|SrvcGrp|75191|2022|PDM|413.00|99|0.00|AETNA OP ELECTRO SHOCK|
20|FH_F51393_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|106% OF ASP DRUGS/IMMUN UPDATE QUARTERLY|
20|FH_F37963_0_0|SrvcGrp|14210|2022|PDM|200.00|99|0.00|PSYCH INTENSIVE OUTPATIENT|
20|FH_F116506_0_0|SrvcGrp|75497|2022|PDM|375.00|99|0.00|AEG 10|
20|FH_F138302_15701_0|SrvcGrp|43567|2022|PDM|50.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F54592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F122459_15221_0|SrvcGrp|472|2022|PDM|390.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F122470_78229_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F32427_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
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_F105361_80104_0|SrvcGrp|58623|2022|PDM|588.00|99|0.00|C T SCANS|
20|FH_F146671_72205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115979_46107_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131737_15025_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F133133_32433_0|SrvcGrp|3178|2022|PDM|500.00|99|0.00|ACUTE PSYCH|
20|FH_F133153_44113_0|SrvcGrp|90854|2022|PDM|452.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F133219_89119_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F134827_32218_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PDM|1146.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 7 W/O REV|
20|FH_F67303_0_0|SrvcGrp|9518|2022|PCT|0.75|99|0.00|EMERGENCY ROOM|
20|FH_F86872_15215_0|SrvcGrp|86827|2022|PDM|90.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F86991_15122_0|SrvcGrp|82570|2022|PDM|900.00|99|0.00|REVISION EYELID/EXCESS SKIN|
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F32994_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F36397_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|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_F114064_0_0|SrvcGrp|102419|2022|PDM|2205.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PDM|1422.00|99|0.00|AEG 7 (NO REV)|
20|FH_F87480_0_0|SrvcGrp|78713|2022|PDM|2500.00|99|0.00|AETNA SPINAL STIMULATOR|
20|FH_F46832_0_0|SrvcGrp|24762|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F123741_20850_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F132810_0_0|SrvcGrp|112058|2022|PCT|1.29|99|0.00|INFLECTRA|
20|FH_F67901_0_0|SrvcGrp|28933|2022|PCT|1.00|99|0.00|OCN F/S PRICING:  (A & K CODES ONLY)|
20|FH_F136373_17055_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F136386_30901_0|SrvcGrp|20926|2022|PDM|68250.00|99|0.00|MS DRG 235 ONLY|
20|FH_F118236_25901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F120444_84037_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F134122_45255_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137236_17603_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F142547_70002_0|SrvcGrp|86840|2022|PDM|25.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F142707_02891_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138545_39503_0|SrvcGrp|3178|2022|PDM|1141.00|99|0.00|ACUTE PSYCH|
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 4 (NO REV)|
20|FH_F134654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78402_15905_0|SrvcGrp|13199|2022|PDM|5767.00|99|0.00|TRAUMA CARE|
20|FH_F114650_17104_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC|
20|FH_F149600_18901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F35925_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F129483_77030_0|SrvcGrp|29075|2022|PDM|35.00|99|0.00|HYDRATION THERAPY|
20|FH_F129514_79605_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117093_40041_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F117221_23434_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|AEG 4 (NO REV)|
20|FH_F137887_33756_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137905_91364_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F38948_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 248-251 PTCA|
20|FH_F109652_0_0|SrvcGrp|20096|2022|PDM|62484.00|99|0.00|MS DRG 222-223 ONLY|
20|FH_F109652_0_0|SrvcGrp|21354|2022|PDM|17704.00|99|0.00|MS DRG 250-251 ONLY|
20|FH_F91472_96001_0|SrvcGrp|103706|2022|PCT|0.40|99|0.00|CARDIAC SEPTAL DEFECT REPAIR W/ PROSTHESIS|
20|FH_F127326_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148720_0_0|SrvcGrp|15423|2022|PDM|115.00|99|0.00|ENGERIX-B HEPATITIS B|
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_F121338_37756_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F113744_80301_0|SrvcGrp|109894|2022|PDM|485.13|99|0.00|BEHAVIORAL HEALTH|
20|FH_F69651_0_0|SrvcGrp|22387|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F77763_0_0|SrvcGrp|10540|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F110000_0_0|SrvcGrp|10721|2022|PDM|636.00|99|0.00|PAIN MANAGEMENT|
20|FH_F91873_12723_0|SrvcGrp|16|2022|PDM|2500.00|99|0.00|ACUTE REHABILITATION|
20|FH_F109627_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|OCN F/S PRICING: ALL|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.25|99|0.00|HAPA WPA-NWPA 2012-13 ASC 704 W/O REV|
20|FH_F72606_0_0|SrvcGrp|73360|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F72606_0_0|SrvcGrp|15158|2022|PDM|700.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F97142_94535_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135799_99114_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135930_02879_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136133_77707_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131463_19096_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F116461_77536_0|SrvcGrp|89412|2022|PDM|150.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F116527_70443_0|SrvcGrp|72996|2022|PDM|1200.00|99|0.00|AEG 4|
20|FH_F127399_0_0|SrvcGrp|88163|2022|PDM|7283.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F127399_0_0|SrvcGrp|92368|2022|PDM|1665.00|99|0.00|REPAIR OF LEG TENDON|
20|FH_F121808_70390_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F44754_0_0|SrvcGrp|10540|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F69205_0_0|SrvcGrp|15385|2022|PDM|172.80|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F132689_18436_0|SrvcGrp|46903|2022|PDM|739.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F133668_63128_0|SrvcGrp|74668|2022|PDM|235.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F141651_0_0|SrvcGrp|89853|2022|PDM|2200.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG|
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|891.00|99|0.00|AEG 4 (NO REV)|
20|FH_F47906_0_0|SrvcGrp|43845|2022|PCT|1.00|99|0.00|DME MOD UEKE|
20|FH_F96960_35404_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F132347_01605_0|SrvcGrp|95221|2022|PDM|110.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F148061_11223_0|SrvcGrp|66264|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F72544_0_0|CSTM-ALL|CSTM-00|2020|PDM|5364.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119491_19904_0|SrvcGrp|48394|2022|PDM|36.75|99|0.00|SKILLED NURSING SERVICES|
20|FH_F126762_91311_0|SrvcGrp|27968|2022|PDM|50.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132613_84601_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|3153.00|99|0.00|ASPG IX|
20|FH_F142011_02859_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F103281_32086_0|SrvcGrp|79786|2022|PDM|1594.00|99|0.00|SLEEP STUDIES|
20|FH_F87295_40351_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|2912.00|99|0.00|MS DRG 216-221, 231-234 CV SURGERY|
20|FH_F117795_36272_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F142047_21853_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119437_0_0|SrvcGrp|75491|2022|PDM|2225.00|99|0.00|AEG 7|
20|FH_F113257_19034_0|SrvcGrp|76501|2022|PDM|304.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F150021_02725_0|SrvcGrp|115394|2022|PCT|1.00|99|0.00|DRUGS|
20|FH_F119226_07746_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F101922_98055_0|SrvcGrp|89939|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD 26) - BDSS|
20|FH_F149821_21202_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F54552_0_0|SrvcGrp|34388|2022|PDM|150.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F130573_02882_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F144109_63376_0|SrvcGrp|2067|2022|PCT|0.98|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F146320_27610_0|SrvcGrp|107794|2022|PDM|6212.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F63618_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|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_F43014_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97041_71603_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F97622_75051_0|SrvcGrp|73643|2022|PDM|2505.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F121306_32207_0|SrvcGrp|86635|2022|PCT|1.07|99|0.00|DME|
20|FH_F51438_0_0|SrvcGrp|22020|2022|PCT|0.65|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F42420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F67683_0_0|SrvcGrp|46903|2022|PDM|400.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD NU/KE)|
20|FH_F132613_84601_0|SrvcGrp|75419|2022|PDM|600.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F51548_0_0|SrvcGrp|10545|2022|PDM|125.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F127188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132446_19063_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F43974_0_0|CSTM-ALL|CSTM-00|2020|PDM|65.00|99|0.00|OP SVCS|
20|FH_F62560_0_0|SrvcGrp|3378|2022|PDM|1500.00|99|0.00|OBSERVATION SVCS|
20|FH_F130652_51101_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
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_F145988_06105_0|SrvcGrp|10365|2022|PDM|4120.00|99|0.00|CPT CODE 99285|
20|FH_F138532_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F120437_85202_0|SrvcGrp|86828|2022|PDM|183.46|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F35176_0_0|SrvcGrp|9828|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE|
20|FH_F45214_71103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F72859_0_0|SrvcGrp|15502|2022|PDM|150.57|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F119229_90804_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F124928_04210_0|SrvcGrp|73524|2022|PDM|154.22|99|0.00|PHYSICAL THERAPY|
20|FH_F40851_0_0|SrvcGrp|33351|2022|PDM|5392.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F51129_0_0|SrvcGrp|12846|2022|PCT|0.55|99|0.00|PHARMACY SVCS|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL|
20|FH_F122646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116159_0_0|SrvcGrp|114443|2022|PDM|3245.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F111442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111840_0_0|SrvcGrp|75495|2022|PDM|1288.00|99|0.00|AEG 9|
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 6 (NO REV)|
20|FH_F115264_0_0|CSTM-ALL|CSTM-00|2020|PDM|928.00|99|0.00|OLD MOULTRIE SURGERY GROUPER 4|
20|FH_F115895_0_0|SrvcGrp|93432|2022|PDM|9548.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F44195_0_0|CSTM-ALL|CSTM-00|2020|PDM|156.00|99|0.00|CD RESIDENTIAL TREATMENT|
20|FH_F94786_07974_0|SrvcGrp|26869|2022|PDM|36.75|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F95282_77975_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95282_77975_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F132627_0_0|SrvcGrp|24750|2022|PDM|43.86|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F134270_0_0|SrvcGrp|34606|2022|PDM|8000.00|99|0.00|CPT 29827|
20|FH_F137067_0_0|SrvcGrp|88163|2022|PDM|21000.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F141070_64093_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F49487_0_0|SrvcGrp|27540|2022|PDM|90.00|99|0.00|NUTRITIONAL ASSESSMENT (FOLLOW UP)|
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|ASPG X|
20|FH_F149899_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.00|99|0.00|AEG 1 (NO REV)|
20|FH_F46333_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|HIGH-COST DRUGS|
20|FH_F38983_0_0|SrvcGrp|97|2022|PDM|4500.00|99|0.00|C-SECTION|
20|FH_F100703_0_0|SrvcGrp|93740|2022|PDM|8034.00|99|0.00|REVISE/REMOVE NEURO RECEIVER|
20|FH_F124212_33407_0|SrvcGrp|108484|2022|PDM|680.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F124613_64735_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F124653_64062_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F124671_64844_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134809_0_0|SrvcGrp|79720|2022|PDM|892.00|99|0.00|ACUTE REHAB II|
20|FH_F150226_0_0|SrvcGrp|84284|2022|PDM|248.94|99|0.00|AMBULANCE SVC NEONATAL EMERG TRANSPORT|
20|FH_F130611_41143_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F63185_0_0|SrvcGrp|46350|2022|PDM|30.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
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_F114684_80547_0|SrvcGrp|104443|2022|PDM|149.00|99|0.00|AETNA OFFICE/OP VISIT EST (HCFA)|
20|FH_F81893_23114_0|SrvcGrp|87537|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F122689_92009_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F134674_06473_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F113713_17013_0|SrvcGrp|91396|2022|PDM|65.00|99|0.00|AETNA GROUP PSYCHOTHERAPY (MOD HO)|
20|FH_F141170_0_0|SrvcGrp|103587|2022|PDM|6000.00|99|0.00|THORACIC AORTA|
20|FH_F149543_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F49005_0_0|SrvcGrp|45334|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE|
20|FH_F147311_37421_0|SrvcGrp|98701|2022|PDM|360.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F147519_52627_0|SrvcGrp|15788|2022|PDM|93.70|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F147526_32216_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147586_44124_0|SrvcGrp|705|2022|PCT|0.44|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F147586_44124_0|SrvcGrp|58671|2022|PDM|991.00|99|0.00|ASC CARVE OUT 64721|
20|FH_F147725_06002_0|SrvcGrp|91880|2022|PDM|10000.00|99|0.00|OSSEOINTEGRATED IMPLANT|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD UEKF RATE|
20|FH_F100780_24153_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.00|99|0.00|AEG 2 (NO REV)|
20|FH_F97261_06098_0|SrvcGrp|73605|2022|PDM|4158.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F91937_0_0|SrvcGrp|57968|2022|PDM|31.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F150939_0_0|SrvcGrp|100271|2022|PDM|14.10|99|0.00|IIV3 VACC NO PRSV 0.5 ML IM|
20|FH_F43867_0_0|SrvcGrp|30961|2022|PDM|12.50|99|0.00|HOME HEALTH AIDE|
20|FH_F110233_0_0|SrvcGrp|92825|2022|PCT|0.94|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1602 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|103.45|99|0.00|HAPA WPA-NWPA 2012-13 ASC 242 W/O REV|
20|FH_F72606_0_0|SrvcGrp|30661|2022|PDM|9525.00|99|0.00|LITHOTRIPSY SVCS|
20|FH_F102063_0_0|SrvcGrp|48398|2022|PDM|140.00|99|0.00|PT SERVICES|
20|FH_F151420_60654_0|SrvcGrp|77021|2022|PDM|5164.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F122087_62684_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122140_66064_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122140_66064_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145528_76501_0|SrvcGrp|88781|2022|PDM|98.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F135376_83440_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135431_33414_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135608_19348_0|SrvcGrp|108484|2022|PDM|574.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F135911_32256_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136217_63112_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119892_47586_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100880_67735_0|SrvcGrp|73006|2022|PDM|3881.00|99|0.00|AEG 9|
20|FH_F129456_30809_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130584_32812_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116397_33404_0|SrvcGrp|86843|2022|PDM|43.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F116404_20191_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F121707_85745_0|SrvcGrp|104079|2022|PCT|1.25|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F129329_07039_0|SrvcGrp|89417|2022|PDM|345.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F111363_33169_0|SrvcGrp|107505|2022|PDM|158.00|99|0.00|X-RAY EXAM CHEST SINGLE VIEW|
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG VIII|
20|FH_F132720_0_0|SrvcGrp|51672|2022|PDM|7160.00|99|0.00|MS DRG 286-287 ONLY|
20|FH_F132720_0_0|SrvcGrp|40820|2022|PDM|3088.00|99|0.00|ICU/CCU|
20|FH_F137633_85202_0|SrvcGrp|106054|2022|PCT|1.70|99|0.00|DME|
20|FH_F141129_0_0|SrvcGrp|72784|2022|PDM|55.00|99|0.00|MEDICAL SOCIAL WORKER - VISIT LEVEL|
20|FH_F116327_75701_0|SrvcGrp|104075|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F65444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F41992_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90691_0_0|SrvcGrp|73004|2022|PDM|1055.00|99|0.00|AEG 8|
20|FH_F71905_0_0|SrvcGrp|59427|2022|PDM|75.00|99|0.00|OT|
20|FH_F135055_63016_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130747_0_0|SrvcGrp|95559|2022|PDM|26010.00|99|0.00|HIP JOINT|
20|FH_F93881_15009_0|SrvcGrp|74444|2022|PDM|150.00|99|0.00|CARDIAC TESTING|
20|FH_F50218_0_0|SrvcGrp|10542|2022|PDM|120.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F139515_0_0|SrvcGrp|81571|2022|PDM|2926.00|99|0.00|NASAL ENDOSCOPY W/ SINUS OSTIA DILATION|
20|FH_F66687_0_0|SrvcGrp|19846|2022|PDM|41677.00|99|0.00|MS DRG 249 ONLY|
20|FH_F149799_33484_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F82931_18847_0|SrvcGrp|13262|2022|PDM|6.58|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F128159_45356_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F116093_47327_0|SrvcGrp|73842|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F89475_71202_0|SrvcGrp|131|2022|PCT|0.65|99|0.00|PACEMAKER DEVICE|
20|FH_F93136_0_0|SrvcGrp|72994|2022|PDM|510.00|99|0.00|AEG 3|
20|FH_F120155_63114_0|SrvcGrp|84897|2022|PCT|0.75|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F145537_02061_0|SrvcGrp|88819|2022|PDM|504.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F32618_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146803_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS|
20|FH_F37756_0_0|SrvcGrp|1168|2022|PDM|937.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F115018_78410_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F125652_66743_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110925_01104_0|SrvcGrp|86165|2022|PDM|1.67|99|0.00|AETNA TRIAMCINOL HEXA|
20|FH_F122898_63011_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119795_0_0|SrvcGrp|54962|2022|PDM|4474.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)|
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|591.00|99|0.00|AEG 1 (NO REV)|
20|FH_F117485_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|1650.00|99|0.00|AEG 8 (NO REV)|
20|FH_F148425_01507_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148482_20136_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148554_85016_0|SrvcGrp|115472|2022|PDM|2965.00|99|0.00|LEFT HEART ARTERY/VENTRICLE ANGIO|
20|FH_F145901_45205_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93375_0_0|SrvcGrp|72990|2022|PDM|349.00|99|0.00|AEG 1|
20|FH_F82813_0_0|SrvcGrp|72994|2022|PDM|793.00|99|0.00|AEG 3|
20|FH_F148493_38008_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F69071_0_0|SrvcGrp|13262|2022|PDM|12.27|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F144468_45236_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F97882_32407_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97103_53295_0|SrvcGrp|73602|2022|PDM|3265.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F117446_31322_0|SrvcGrp|57968|2022|PDM|30.67|99|0.00|CONTINUOUS HOMECARE|
20|FH_F43164_0_0|CSTM-ALL|CSTM-00|2020|PDM|464.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F44607_0_0|SrvcGrp|17073|2022|PDM|3000.00|99|0.00|ASPG V|
20|FH_F41429_0_0|SrvcGrp|110|2022|PDM|392.00|99|0.00|CD - REHABILITATION|
20|FH_F151522_72712_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113324_17055_0|SrvcGrp|105211|2022|PDM|980.00|99|0.00|SKILLED CARE LEVEL 3|
20|FH_F146376_53188_0|SrvcGrp|75419|2022|PDM|1031.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F139301_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150602_59718_0|SrvcGrp|66265|2022|PDM|98.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F117087_0_0|SrvcGrp|90822|2022|PDM|2093.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY|
20|FH_F100665_07939_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F127325_0_0|SrvcGrp|72994|2022|PDM|488.00|99|0.00|AEG 3|
20|FH_F136407_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F55375_0_0|SrvcGrp|9939|2022|PDM|2300.00|99|0.00|ACUTE MEDICAL SVCS|
20|FH_F128349_43082_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F119775_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|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F146217_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126702_33139_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F69242_0_0|SrvcGrp|27968|2022|PDM|27.50|99|0.00|SKILLED NURSING LPN|
20|FH_F150602_59718_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|113.00|99|0.00|FAMILY PSYTX W PT 50 MINS|
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.37|99|0.00|COVENTRY ENHANCED DEFAULT 10021-69990|
20|FH_F34361_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS|
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|6269.00|99|0.00|AEG 9 (NO REV)|
20|FH_F98921_64503_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F63618_0_0|SrvcGrp|12787|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F88511_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38700_0_0|SrvcGrp|3271|2022|PDM|3195.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F141612_19605_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|1855.71|99|0.00|ASPG VIII|
20|FH_F34706_0_0|SrvcGrp|14341|2022|PDM|9838.00|99|0.00|DRG 197 ONLY - CHOLECYSTECTOMY XCPT LAPARO W/O C.D.E. W CC|
20|FH_F147995_67037_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F119229_90804_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F90032_15234_0|SrvcGrp|75545|2022|PDM|330.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F134830_0_0|SrvcGrp|57968|2022|PDM|55.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F145988_06105_0|SrvcGrp|74581|2022|PCT|0.69|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F45977_0_0|SrvcGrp|11072|2022|PDM|100.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F148904_85255_0|SrvcGrp|98701|2022|PDM|412.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 491|
20|FH_F67265_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F127422_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|DEVICE INSERTION|
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|5941.00|99|0.00|OSSEOINTEGRATED IMPLANT|
20|FH_F120434_34761_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118550_21133_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133367_40065_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F33311_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F141217_0_0|SrvcGrp|41334|2022|PDM|9500.00|99|0.00|TOTAL KNEE|
20|FH_F142775_72801_0|SrvcGrp|46903|2022|PDM|626.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F36756_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD KF|
20|FH_F107140_0_0|SrvcGrp|92518|2022|PDM|75.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F111417_33613_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F134490_62801_0|SrvcGrp|16301|2022|PDM|2715.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F132487_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F133397_23233_0|SrvcGrp|16|2022|PDM|2550.00|99|0.00|ACUTE REHABILITATION|
20|FH_F150479_53223_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F132551_39194_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42494_0_0|SrvcGrp|9515|2022|PCT|1.30|99|0.00|OP LAB SVCS|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F82572_0_0|SrvcGrp|47994|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F45977_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|966.14|99|0.00|ASPG VII|
20|FH_F141807_33020_0|SrvcGrp|98701|2022|PDM|335.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F72523_0_0|SrvcGrp|3809|2022|PDM|755.55|99|0.00|HOSPICE CARE|
20|FH_F71268_0_0|SrvcGrp|9826|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F117006_0_0|SrvcGrp|57967|2022|PDM|148.79|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F117891_19034_0|SrvcGrp|48398|2022|PDM|126.00|99|0.00|PT SERVICES|
20|FH_F137353_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1344.94|99|0.00|HAPA WPA-NWPA 2012-13 ASC 908 W/O REV|
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1275.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F133427_48811_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F33581_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.00|99|0.00|NEWBORN NURSERY - LEVEL I|
20|FH_F31824_0_0|SrvcGrp|439|2022|PDM|1000.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F42343_0_0|CSTM-ALL|CSTM-00|2020|PDM|255.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|767.00|99|0.00|AEG 2 (NO REV)|
20|FH_F88223_0_0|SrvcGrp|46605|2022|PDM|88.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
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_F125049_44131_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F101840_76054_0|SrvcGrp|26682|2022|PDM|23371.00|99|0.00|MS DRG 453 ONLY|
20|FH_F67265_0_0|CSTM-ALL|CSTM-00|2020|PDM|1075.00|99|0.00|IP DEVELOPMENTAL DISORDERS|
20|FH_F33832_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F101840_76054_0|SrvcGrp|63459|2022|PDM|6608.00|99|0.00|CPT 52601|
20|FH_F150062_92501_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F145854_37015_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F138236_0_0|SrvcGrp|104228|2022|PDM|105.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F81373_64064_0|SrvcGrp|360|2022|PDM|7522.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F129535_0_0|SrvcGrp|75487|2022|PDM|685.00|99|0.00|AEG 5|
20|FH_F148644_06890_0|CSTM-ALL|CSTM-00|2020|PDM|3688.00|99|0.00|AEG 9 (NO REV)|
20|FH_F88632_33950_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F123752_44502_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F123784_03264_0|SrvcGrp|48398|2022|PDM|166.00|99|0.00|PT SERVICES|
20|FH_F126770_43050_0|SrvcGrp|65720|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F38238_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F58856_0_0|SrvcGrp|22402|2022|PDM|1280.00|99|0.00|ASPG II (REV CODE + CPT/HCPCS)|
20|FH_F69968_0_0|SrvcGrp|29830|2022|PDM|6685.29|99|0.00|PERCUT NEEDLE INSERTION|
20|FH_F118152_20151_0|SrvcGrp|17014|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118156_19446_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120475_81052_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F137033_87108_0|SrvcGrp|110585|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION I|
20|FH_F138108_47130_0|SrvcGrp|89417|2022|PDM|391.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F142330_43701_0|SrvcGrp|74668|2022|PDM|203.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F142527_89109_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F142691_30328_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97582_46307_0|CSTM-ALL|CSTM-00|2020|PCT|0.39|99|0.00|OP SVCS|
20|FH_F138607_02760_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F138627_82901_0|SrvcGrp|86840|2022|PDM|85.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F140407_63841_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F146933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148739_47129_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F87334_16507_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125368_24153_0|SrvcGrp|108484|2022|PDM|785.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F40267_0_0|SrvcGrp|17075|2022|PDM|966.00|99|0.00|ASPG VI|
20|FH_F44724_0_0|SrvcGrp|33166|2022|PDM|515.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|6000.00|99|0.00|AETNA OP AICD 33249|
20|FH_F151518_60506_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117756_75402_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117895_28170_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147995_67037_0|SrvcGrp|115250|2022|PCT|2.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F97561_30030_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F120437_85202_0|SrvcGrp|86846|2022|PDM|159.82|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F38939_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS|
20|FH_F134487_14843_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F115274_15235_0|SrvcGrp|93098|2022|PDM|140.00|99|0.00|HOSPICE CARE|
20|FH_F144990_44708_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141930_72032_0|SrvcGrp|113834|2022|PDM|1654.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F39180_0_0|SrvcGrp|12116|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F115431_32821_0|SrvcGrp|89417|2022|PDM|397.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|531.00|99|0.00|AEG 1 (NO REV)|
20|FH_F133473_21702_0|SrvcGrp|29346|2022|PDM|58.35|99|0.00|SKILLED NURSING- LPN|
20|FH_F150530_63031_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F144508_44107_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F49617_0_0|SrvcGrp|43|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F148925_61531_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87620_80014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F148041_41017_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141217_0_0|SrvcGrp|73610|2022|PCT|0.97|99|0.00|AETNA IMPLANTS|
20|FH_F132224_89119_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F91634_0_0|SrvcGrp|44461|2022|PDM|17486.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F49637_0_0|SrvcGrp|45884|2022|PDM|72.00|99|0.00|ST|
20|FH_F56793_0_0|SrvcGrp|44427|2022|PDM|130.00|99|0.00|PHYSICAL THERAPY SVCS (VISIT LVL)|
20|FH_F92854_63028_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F51123_0_0|SrvcGrp|15385|2022|PDM|141.75|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F132571_24739_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F139547_42343_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150768_03054_0|SrvcGrp|95661|2022|PDM|718.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F150880_90036_0|SrvcGrp|46903|2022|PDM|750.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F120144_77031_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F128988_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F69183_0_0|SrvcGrp|31074|2022|PDM|350.00|99|0.00|MS DRG 795 ONLY|
20|FH_F150442_28451_0|CSTM-ALL|CSTM-00|2020|PDM|4500.00|99|0.00|AEG 6 (NO REV)|
20|FH_F47902_0_0|SrvcGrp|43838|2022|PCT|1.00|99|0.00|DME MOD NUKE|
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PDM|3100.00|99|0.00|AEG 4 (NO REV)|
20|FH_F44279_0_0|SrvcGrp|38439|2022|PDM|200.00|99|0.00|DIAGNOSTIC TESTING|
20|FH_F124441_0_0|SrvcGrp|88491|2022|PDM|6175.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F134867_32068_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F102365_0_0|SrvcGrp|471|2022|PDM|582.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138018_17313_0|SrvcGrp|21920|2022|PDM|103.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F124441_0_0|SrvcGrp|85778|2022|PDM|3040.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F148967_04254_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149582_01534_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F35416_0_0|SrvcGrp|35010|2022|PDM|6900.00|99|0.00|MS DRG 242-251 ONLY|
20|FH_F90196_10467_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PDM|2215.00|99|0.00|AEG 7 (NO REV)|
20|FH_F133223_0_0|SrvcGrp|112224|2022|PDM|95.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F129562_38668_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35410_0_0|SrvcGrp|20508|2022|PCT|0.65|99|0.00|CPT 99506|
20|FH_F148859_0_0|SrvcGrp|115512|2022|PDM|2081.00|99|0.00|CYSTOURETHRO|
20|FH_F91076_0_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F147170_53051_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42538_0_0|SrvcGrp|3809|2022|PDM|657.00|99|0.00|HOSPICE CARE|
20|FH_F150953_74953_0|SrvcGrp|3378|2022|PCT|0.83|99|0.00|OBSERVATION SVCS|
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|887.26|99|0.00|FIXATION OF TONGUE|
20|FH_F39443_0_0|SrvcGrp|30514|2022|PCT|0.45|99|0.00|JEFFERSON IMPLANTS|
20|FH_F113545_11201_0|SrvcGrp|89417|2022|PDM|330.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F119897_78229_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|387.74|99|0.00|SALLY BALIN,999182,ASC 101|
20|FH_F120207_0_0|SrvcGrp|47142|2022|PDM|2705.04|99|0.00|CPT 49650|
20|FH_F38080_0_0|SrvcGrp|15347|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F148959_77375_0|SrvcGrp|3178|2022|PDM|875.00|99|0.00|ACUTE PSYCH|
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 1 (NO REV)|
20|FH_F139974_37214_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43236_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F126116_0_0|SrvcGrp|103643|2022|PDM|7179.00|99|0.00|AETNA FEM/POPL REVASE W/ STENT|
20|FH_F134847_0_0|SrvcGrp|14614|2022|PDM|4722.00|99|0.00|LITHOTRIPSY|
20|FH_F119064_01581_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F118955_48239_0|SrvcGrp|90854|2022|PDM|680.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F38332_0_0|SrvcGrp|18881|2022|PDM|42216.00|99|0.00|MS DRG 233|
20|FH_F39466_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F117267_07728_0|SrvcGrp|107305|2022|PCT|5.58|99|0.00|LABORATORY SERVICES|
20|FH_F129491_90245_0|SrvcGrp|74668|2022|PDM|575.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129507_70002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117218_32025_0|SrvcGrp|73841|2022|PDM|382.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F117126_12801_0|SrvcGrp|3178|2022|PDM|1900.00|99|0.00|ACUTE PSYCH|
20|FH_F137333_51012_0|SrvcGrp|113080|2022|PDM|537.00|99|0.00|RESIDENTIAL TREATMENT PSYCH & CD (19-64 YRS)|
20|FH_F110342_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130619_0_0|CSTM-ALL|CSTM-00|2020|PDM|2113.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91067_0_0|SrvcGrp|73006|2022|PDM|1648.00|99|0.00|AEG 9|
20|FH_F69364_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151160_61350_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40536_0_0|SrvcGrp|32969|2022|PCT|1.00|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|144.13|99|0.00|DELAWARE VALLEY- ASC 118|
20|FH_F97740_01605_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117001_0_0|SrvcGrp|80658|2022|PCT|0.25|99|0.00|UPGRADED HEARING AID|
20|FH_F79025_0_0|SrvcGrp|33166|2022|PDM|750.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F80711_0_0|SrvcGrp|42825|2022|PDM|39.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F87201_0_0|SrvcGrp|26001|2022|PDM|175.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F114916_30309_0|SrvcGrp|100068|2022|PDM|9000.00|99|0.00|REPAIR DEGENERATED KNEECAP|
20|FH_F114916_30309_0|SrvcGrp|90343|2022|PDM|5000.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL|
20|FH_F115875_0_0|SrvcGrp|94479|2022|PDM|412.00|99|0.00|AETNA SCAN PROC CRANIAL EXTRA|
20|FH_F113130_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1|
20|FH_F115208_0_0|SrvcGrp|106184|2022|PDM|2546.00|99|0.00|REVISE MIDDLE EAR & MASTOID|
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|1295.00|99|0.00|AEG 4 (NO REV)|
20|FH_F133376_33414_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F33807_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F41516_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|1208.00|99|0.00|AEG 8 (NO REV)|
20|FH_F141207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132988_0_0|SrvcGrp|112141|2022|PDM|4493.01|99|0.00|HAND TENDON RECONSTRUCTION|
20|FH_F144828_0_0|SrvcGrp|114195|2022|PDM|1320.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F118786_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F119214_0_0|SrvcGrp|83677|2022|PDM|1500.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F114389_50131_0|SrvcGrp|65621|2022|PDM|85.53|99|0.00|RN NURSING|
20|FH_F114389_50131_0|SrvcGrp|29077|2022|PDM|490.42|99|0.00|HOME TRANSFUSION|
20|FH_F45312_0_0|SrvcGrp|8|2022|PCT|0.88|99|0.00|BURN INTENSIVE CARE|
20|FH_F72085_0_0|SrvcGrp|44250|2022|PDM|420.00|99|0.00|CCPD TRAINING|
20|FH_F92600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122194_66104_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F64441_0_0|SrvcGrp|3810|2022|PDM|147.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F100000_45417_0|SrvcGrp|87537|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F130909_33025_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F60365_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BONE MARROW TRANSPLANT|
20|FH_F97040_31901_0|SrvcGrp|73559|2022|PDM|9208.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114666_30342_0|SrvcGrp|88163|2022|PDM|6500.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F114792_48849_0|SrvcGrp|89149|2022|PDM|187.00|99|0.00|OP INTENSIVE|
20|FH_F113809_47302_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137933_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 3 (NO REV)|
20|FH_F144039_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.88|99|0.00|2005 ASPG GROUPER IV|
20|FH_F127448_0_0|SrvcGrp|72992|2022|PDM|710.00|99|0.00|AEG 2|
20|FH_F43779_0_0|SrvcGrp|360|2022|PDM|1128.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F134675_60134_0|SrvcGrp|89417|2022|PDM|391.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F134727_30650_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 5  (NO REV)|
20|FH_F136778_62034_0|SrvcGrp|3178|2022|PDM|1599.00|99|0.00|ACUTE PSYCH|
20|FH_F136930_73114_0|SrvcGrp|23458|2022|PDM|124.00|99|0.00|URGENT CARE SERVICES|
20|FH_F149248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38331_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1086154 REG W MED CTR LAB W/MOD 26|
20|FH_F46752_0_0|SrvcGrp|46802|2022|PDM|100.00|99|0.00|IV SERVICES|
20|FH_F147586_44124_0|SrvcGrp|41335|2022|PDM|16500.00|99|0.00|TOTAL HIP|
20|FH_F147586_44124_0|SrvcGrp|27316|2022|PDM|2934.00|99|0.00|TONSILS & ADENOIDS (42820)|
20|FH_F147620_67119_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147620_67119_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147725_06002_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|37.50|99|0.00|STEROID THERAPY (MOD SH)|
20|FH_F113649_01752_0|SrvcGrp|86849|2022|PDM|55.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F118792_63379_0|SrvcGrp|36204|2022|PCT|0.00|99|0.00|ACUTE PSYCH|
20|FH_F118792_63379_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION|
20|FH_F98622_45005_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F102948_43606_0|SrvcGrp|75749|2022|PDM|431.00|99|0.00|AMBULATORY DETOX REHAB|
20|FH_F56753_15086_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F70762_90805_0|SrvcGrp|67780|2022|PDM|635.00|99|0.00|DETOX|
20|FH_F148344_0_0|SrvcGrp|89337|2022|PDM|918.00|99|0.00|DETOXIFICATION|
20|FH_F35410_0_0|SrvcGrp|20479|2022|PCT|0.65|99|0.00|PARENTERAL NUTRITION|
20|FH_F131418_75215_0|SrvcGrp|90397|2022|PDM|195.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F39443_0_0|SrvcGrp|30513|2022|PCT|0.45|99|0.00|JEFFERSON INTRAOCULAR LENS|
20|FH_F149582_01534_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 10 (NO REV)|
20|FH_F133223_0_0|SrvcGrp|112225|2022|PDM|23.00|99|0.00|COVID-19 SPECIMEN COLLECTION|
20|FH_F127553_44321_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F147160_80260_0|SrvcGrp|91065|2022|PDM|153.00|99|0.00|PSYCHIATRIC CPT 90853 (HCFA)|
20|FH_F114848_50533_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F131371_0_0|SrvcGrp|111809|2022|PDM|7367.00|99|0.00|APPLY BONE FIXATION DEVICE|
20|FH_F138478_0_0|SrvcGrp|109501|2022|PDM|1892.62|99|0.00|REPAIR LEAD PACE-DEFIB DUAL|
20|FH_F35751_34613_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110783_93013_0|SrvcGrp|86825|2022|PDM|75.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F94303_0_0|SrvcGrp|73004|2022|PDM|2251.00|99|0.00|AEG 8|
20|FH_F97280_20018_0|SrvcGrp|73601|2022|PDM|8601.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F41155_0_0|SrvcGrp|701|2022|PDM|1717.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F130182_0_0|SrvcGrp|109446|2022|PDM|1457.00|99|0.00|R&L HRT CATH W/ VENTRICLGRPHY|
20|FH_F149046_53022_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|45630.00|99|0.00|MSDRG 226-227 CV SURG CARDIAC DEFIBRILLATOR|
20|FH_F147170_53051_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F141278_80218_0|SrvcGrp|110884|2022|PCT|1.24|99|0.00|ANTEPARTUM|
20|FH_F115705_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111266_30339_0|SrvcGrp|86835|2022|PDM|10.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F143230_33026_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F143410_77845_0|SrvcGrp|75419|2022|PDM|445.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F32623_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F102224_0_0|SrvcGrp|96839|2022|PDM|5000.00|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F130951_15237_0|SrvcGrp|65720|2022|PDM|115.00|99|0.00|RESPITE CARE|
20|FH_F47036_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120799_92651_0|SrvcGrp|74668|2022|PDM|550.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F73011_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116698_07470_0|SrvcGrp|86829|2022|PDM|68.25|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F120921_75835_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F126970_45601_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F125012_64658_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F84394_17402_0|SrvcGrp|114228|2022|PDM|14659.00|99|0.00|JOINT REPLACEMENT-HIP|
20|FH_F37200_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REGIONAL HEALTH SVCS OF HOWARD-DME|
20|FH_F40755_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MRI/CT MOD TC|
20|FH_F49895_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRBA|
20|FH_F52753_0_0|SrvcGrp|49206|2022|PDM|1700.00|99|0.00|CORNEAL TRANSPLANTS|
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|970.00|99|0.00|ASPG V|
20|FH_F59732_0_0|SrvcGrp|27969|2022|PDM|54.00|99|0.00|HOME HEALTH AIDE|
20|FH_F61292_0_0|SrvcGrp|31038|2022|PDM|32286.00|99|0.00|MS DRG 233-234 ONLY|
20|FH_F39992_0_0|SrvcGrp|26001|2022|PDM|93.00|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_F131277_29340_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)|
20|FH_F55532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F143786_78746_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F44020_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126678_44870_0|SrvcGrp|30609|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F136684_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F34138_0_0|SrvcGrp|22954|2022|PDM|127.23|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F83451_0_0|SrvcGrp|81570|2022|PDM|1705.00|99|0.00|PERCUTANEOUS ANNULOPLASTY|
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_F135069_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)|
20|FH_F117344_75062_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F127564_66002_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125249_0_0|SrvcGrp|94689|2022|PDM|1700.00|99|0.00|SHOULDER ARTHROSCOPY DX|
20|FH_F149839_80002_0|SrvcGrp|48398|2022|PDM|135.00|99|0.00|PT SERVICES|
20|FH_F38677_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116115_14437_0|SrvcGrp|86722|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F149866_07401_0|SrvcGrp|472|2022|PDM|404.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
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_F148255_72703_0|SrvcGrp|86834|2022|PDM|10.50|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F115050_77995_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148341_21222_0|SrvcGrp|74668|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F102302_0_0|SrvcGrp|64761|2022|PDM|10850.00|99|0.00|DISCECTOMY|
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_F36154_0_0|SrvcGrp|701|2022|PDM|2027.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F92034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132092_0_0|SrvcGrp|83521|2022|PDM|169.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F135165_15728_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
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_F132720_0_0|CSTM-ALL|CSTM-00|2020|PDM|2059.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41780_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F43895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F112152_34994_0|SrvcGrp|89149|2022|PDM|191.00|99|0.00|OP INTENSIVE|
20|FH_F126853_19053_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F128549_44224_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F129240_10028_0|SrvcGrp|86833|2022|PDM|25.00|99|0.00|HCPCS S9560 (HCFA)|
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|CSTM-ALL|CSTM-00|2020|PDM|1113.00|99|0.00|AEG 5  (NO REV)|
20|FH_F148554_85016_0|SrvcGrp|108170|2022|PDM|3252.00|99|0.00|ILIAC REVASC W/ STENT|
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1970.00|99|0.00|AEG 3 (NO REV)|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD UE KF"|
20|FH_F132118_92240_0|SrvcGrp|90854|2022|PDM|850.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F42807_0_0|SrvcGrp|12840|2022|PCT|0.75|99|0.00|PACEMAKER|
20|FH_F120437_85202_0|SrvcGrp|53987|2022|PCT|1.12|99|0.00|PHOTOTHERAPY|
20|FH_F40943_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|1359.00|99|0.00|HAPA EPA ASC 56|
20|FH_F83053_0_0|SrvcGrp|77180|2022|PCT|0.53|99|0.00|AETNA UNGROUPABLE AEG|
20|FH_F133021_00910_0|SrvcGrp|79099|2022|PDM|1280.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
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_F72859_0_0|SrvcGrp|12076|2022|PDM|100.00|99|0.00|HOME THERAPY|
20|FH_F136407_0_0|SrvcGrp|15473|2022|PDM|3960.00|99|0.00|CPT CODE 42820|
20|FH_F144769_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|OP SVCS|
20|FH_F92792_0_0|SrvcGrp|28547|2022|PDM|2200.00|99|0.00|VITRECTOMY|
20|FH_F125212_76301_0|SrvcGrp|89417|2022|PDM|350.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F92676_15063_0|SrvcGrp|78922|2022|PDM|5355.66|99|0.00|MON VALLEY ASC 14|
20|FH_F111813_08080_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F33629_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F46192_0_0|SrvcGrp|12674|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKE|
20|FH_F126868_60451_0|SrvcGrp|86722|2022|PDM|208.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F145842_37172_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135711_61401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132594_78229_0|SrvcGrp|46605|2022|PDM|105.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F120411_14541_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F35346_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F91255_19401_0|SrvcGrp|90390|2022|PDM|1100.00|99|0.00|ACUTE PSYCH 65-99 YRS|
20|FH_F112853_22408_0|SrvcGrp|73701|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F72865_93501_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F139825_0_0|SrvcGrp|109760|2022|PDM|6885.00|99|0.00|TRANSLUM DIL EYE CANAL|
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F128279_77043_0|SrvcGrp|86723|2022|PDM|370.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F120089_0_0|SrvcGrp|75485|2022|PDM|629.00|99|0.00|AEG 4|
20|FH_F103540_24740_0|SrvcGrp|16|2022|PDM|975.00|99|0.00|ACUTE REHABILITATION|
20|FH_F133367_40065_0|SrvcGrp|88978|2022|PDM|3967.00|99|0.00|VAGINAL DELIVERY|
20|FH_F106580_33321_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120825_66204_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F70487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F111461_32607_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133155_0_0|SrvcGrp|30609|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F118542_60188_0|SrvcGrp|103739|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F67424_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117756_75402_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143057_15767_0|SrvcGrp|113204|2022|PDM|28.28|99|0.00|MENTAL HEALTH ASSESSMENT|
20|FH_F87577_80016_0|SrvcGrp|10927|2022|PDM|1404.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F145884_72113_0|SrvcGrp|75419|2022|PDM|392.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F116825_0_0|SrvcGrp|11258|2022|PCT|0.45|99|0.00|DRUGS|
20|FH_F109606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33241_0_0|SrvcGrp|9808|2022|PDM|5000.00|99|0.00|PTCA WITH STENT|
20|FH_F41181_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER QW|
20|FH_F37641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1520.00|99|0.00|ASPG IX|
20|FH_F46255_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F134490_62801_0|SrvcGrp|83641|2022|PDM|4895.00|99|0.00|CPT 29889|
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F118462_21740_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F79231_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148599_98034_0|SrvcGrp|73499|2022|PDM|741.00|99|0.00|AETNA ER LEVEL II|
20|FH_F138054_0_0|SrvcGrp|88620|2022|PDM|161.00|99|0.00|SKILLED NURSING RN|
20|FH_F133021_00910_0|SrvcGrp|112358|2022|PDM|1300.00|99|0.00|STEREOTACTIC BX|
20|FH_F133493_90255_0|SrvcGrp|81779|2022|PCT|1.40|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F32509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F37562_0_0|SrvcGrp|24289|2022|PDM|65.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F128564_43235_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F105921_80014_0|SrvcGrp|46104|2022|PDM|90.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F127412_15301_0|SrvcGrp|42550|2022|PDM|1025.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F137366_87505_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F75307_0_0|SrvcGrp|22954|2022|PDM|154.10|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F143900_63303_0|SrvcGrp|46903|2022|PDM|522.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|AEG 7 (NO REV)|
20|FH_F44582_0_0|SrvcGrp|13293|2022|PCT|0.65|99|0.00|HIGH-COST DRUGS|
20|FH_F141427_22003_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132579_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148497_32162_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F83251_32751_0|SrvcGrp|471|2022|PDM|446.25|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F141470_71913_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F106822_0_0|SrvcGrp|100262|2022|PDM|57.00|99|0.00|TREAT DEHISCENCE W/ PACKING|
20|FH_F72664_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39339_0_0|SrvcGrp|360|2022|PDM|1795.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F97500_32025_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F78603_0_0|SrvcGrp|20898|2022|PDM|31355.80|99|0.00|MS DRG 246 ONLY|
20|FH_F112568_0_0|SrvcGrp|104230|2022|PDM|240.60|99|0.00|RESPITE CARE (HCFA)|
20|FH_F109645_0_0|SrvcGrp|34356|2022|PDM|85.00|99|0.00|T1001|
20|FH_F110925_01104_0|SrvcGrp|14948|2022|PDM|400.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F72664_0_0|SrvcGrp|90558|2022|PDM|90.00|99|0.00|RN VISIT|
20|FH_F56293_0_0|SrvcGrp|52842|2022|PDM|380.00|99|0.00|GI PROCEDURE GROUP A|
20|FH_F149479_0_0|SrvcGrp|105820|2022|PDM|1500.00|99|0.00|IP PSYCH EATING DISORDERS|
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|2228.00|99|0.00|AEG 7 (NO REV)|
20|FH_F65559_0_0|CSTM-ALL|CSTM-00|2020|PDM|2395.00|99|0.00|ACUTE IP REHAB LEVEL A|
20|FH_F93136_0_0|SrvcGrp|72992|2022|PDM|446.00|99|0.00|AEG 2|
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG I|
20|FH_F120001_0_0|SrvcGrp|87536|2022|PDM|204.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F137611_30909_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F102302_0_0|SrvcGrp|98591|2022|PDM|10850.00|99|0.00|LAMINECTOMY OF SPINAL CORD|
20|FH_F92091_0_0|SrvcGrp|73002|2022|PDM|3149.00|99|0.00|AEG 7|
20|FH_F82714_18848_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F39992_0_0|SrvcGrp|12264|2022|PDM|60.75|99|0.00|DIETICIAN OR LPN SERVICES|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S AZ - GLOBAL|
20|FH_F82931_18847_0|SrvcGrp|13683|2022|PDM|534.75|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F38389_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141354_63556_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93094_21227_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F98922_40351_0|SrvcGrp|73559|2022|PDM|7047.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F40472_0_0|SrvcGrp|15403|2022|PDM|70.00|99|0.00|SPEECH THERAPY SVCS INITIAL EVAL|
20|FH_F93881_15009_0|SrvcGrp|35669|2022|PDM|8311.00|99|0.00|CPT 63650|
20|FH_F148221_06477_0|SrvcGrp|46104|2022|PDM|105.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F150982_0_0|SrvcGrp|92409|2022|PDM|5284.00|99|0.00|PERQ CERVICOTHORACIC INJECT|
20|FH_F44774_0_0|SrvcGrp|32403|2022|PCT|1.20|99|0.00|OCN F/S PRICING: POS FACILITY MOD TC (RADIOLOGY)|
20|FH_F127375_28621_0|SrvcGrp|12280|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F111263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F108762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.79|99|0.00|ASPG IV|
20|FH_F122725_32216_0|CSTM-ALL|CSTM-00|2020|PDM|30.00|99|0.00|MANUAL BODY MUSCLE TESTING|
20|FH_F86872_15215_0|SrvcGrp|86832|2022|PDM|10.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|170.18|99|0.00|SLEEP STUDY CPT 95800|
20|FH_F62977_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F63129_0_0|SrvcGrp|46604|2022|PDM|25.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F63235_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F130721_04769_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC) (HCFA)|
20|FH_F108160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134353_84123_0|SrvcGrp|83522|2022|PDM|103.95|99|0.00|RESPITE CARE|
20|FH_F134593_60007_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F133747_80634_0|SrvcGrp|75522|2022|PDM|360.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD|
20|FH_F93906_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F145880_80303_0|SrvcGrp|74668|2022|PDM|254.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F150142_76018_0|SrvcGrp|109330|2022|PCT|1.03|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F51115_0_0|SrvcGrp|42826|2022|PDM|108.24|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F127934_62274_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F87775_15106_0|SrvcGrp|26869|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F133880_06488_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91171_0_0|SrvcGrp|90822|2022|PDM|783.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY|
20|FH_F83035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|381.33|99|0.00|HAPA WPA-NWPA 2012-13 ASC 102 W/O REV|
20|FH_F124159_92506_0|SrvcGrp|89149|2022|PDM|265.00|99|0.00|OP INTENSIVE|
20|FH_F125133_20601_0|SrvcGrp|110074|2022|PDM|26.52|99|0.00|ALGINATE DRSG >16 <=48 SQ IN|
20|FH_F70208_0_0|SrvcGrp|4109|2022|PDM|825.00|99|0.00|ACUTE PSYCH|
20|FH_F134595_06226_0|SrvcGrp|472|2022|PDM|588.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F79824_0_0|SrvcGrp|17067|2022|PDM|1521.00|99|0.00|ASPG II|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|300.61|99|0.00|ELECTROENCEPHALOGRAM (MOD TC)|
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|1013.00|99|0.00|AEG 10 (NO REV)|
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|AEG 6 (NO REV)|
20|FH_F133478_40165_0|SrvcGrp|20914|2022|PDM|59402.00|99|0.00|MS DRG 233 ONLY|
20|FH_F131212_63017_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F133700_92808_0|SrvcGrp|87317|2022|PDM|970.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F133700_92808_0|SrvcGrp|112394|2022|PDM|750.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F111601_15203_0|SrvcGrp|89417|2022|PDM|330.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F111662_80601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113025_0_0|SrvcGrp|75495|2022|PDM|1404.00|99|0.00|AEG 9|
20|FH_F32370_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|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_F150939_0_0|SrvcGrp|100244|2022|PCT|0.00|99|0.00|CHYLMD TRACH|
20|FH_F80511_0_0|SrvcGrp|16429|2022|PCT|0.60|99|0.00|OBSERVATION SVCS|
20|FH_F38955_0_0|SrvcGrp|1137|2022|PDM|603.71|99|0.00|ELECTRO CONVULSIVE THERAPY|
20|FH_F113585_20155_0|SrvcGrp|29023|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138876_25302_0|SrvcGrp|21920|2022|PDM|40.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F138992_72703_0|SrvcGrp|23279|2022|PDM|372.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F89580_0_0|SrvcGrp|86663|2022|PDM|5869.00|99|0.00|AETNA MEDICAL/SURGICAL|
20|FH_F151479_75605_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151503_30067_0|SrvcGrp|96539|2022|PDM|5995.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F151511_14094_0|SrvcGrp|10362|2022|PDM|372.00|99|0.00|CPT CODE 99282|
20|FH_F145408_43920_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F128115_52001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97501_31501_0|SrvcGrp|90854|2022|PDM|2467.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|954.00|99|0.00|ASPG I|
20|FH_F135389_43123_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F135485_20171_0|SrvcGrp|88620|2022|PDM|84.00|99|0.00|SKILLED NURSING RN|
20|FH_F91764_93710_0|SrvcGrp|43485|2022|PDM|18668.00|99|0.00|MS DRG'S 453-455|
20|FH_F136226_28638_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119892_47586_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F131463_19096_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F130996_34110_0|SrvcGrp|92415|2022|PDM|7000.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F130756_04901_0|SrvcGrp|114916|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F131407_07607_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F39507_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|OP SVCS|
20|FH_F101665_10027_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F121763_07202_0|SrvcGrp|90573|2022|PDM|115.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|590.00|99|0.00|AEG 1 (NO REV)|
20|FH_F42347_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111301_33122_0|SrvcGrp|82745|2022|PDM|95.00|99|0.00|CULT BACT NO URINE/BLD/STOOL|
20|FH_F116275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43137_0_0|SrvcGrp|36970|2022|PDM|60.00|99|0.00|INFUSION THERAPY|
20|FH_F114569_0_0|SrvcGrp|105719|2022|PDM|26.46|99|0.00|AETHA ALCOHOL/SUBS INTERV 15-30 MINS (MOD GT)(HCFA)|
20|FH_F87557_33309_0|SrvcGrp|14945|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F127713_30012_0|SrvcGrp|27968|2022|PDM|47.50|99|0.00|SKILLED NURSING LPN|
20|FH_F96560_17972_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F129240_10028_0|SrvcGrp|111025|2022|PCT|0.83|99|0.00|SUPPLIES|
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1916.00|99|0.00|AEG 6 (NO REV)|
20|FH_F134202_0_0|CSTM-ALL|CSTM-00|2020|PDM|1008.00|99|0.00|AEG 6 (NO REV)|
20|FH_F63249_0_0|SrvcGrp|57650|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SVCS MOD GO|
20|FH_F38411_0_0|SrvcGrp|20077|2022|PCT|0.80|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR|
20|FH_F103821_0_0|SrvcGrp|471|2022|PDM|703.31|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130721_04769_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 9 (NO REV)|
20|FH_F130901_68970_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|OP SVCS|
20|FH_F100782_0_0|SrvcGrp|97579|2022|PDM|887.92|99|0.00|WINDBER MEDICAL CNTR ASC 206|
20|FH_F150179_23124_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119379_0_0|SrvcGrp|94904|2022|PDM|1428.00|99|0.00|REPAIR/REVISE WRIST JOINT|
20|FH_F145642_15108_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149247_02760_0|SrvcGrp|87077|2022|PDM|145.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|2228.00|99|0.00|AEG 8 (NO REV)|
20|FH_F83754_0_0|SrvcGrp|919|2022|PDM|13824.00|99|0.00|OP URGENT CARE|
20|FH_F118088_71261_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F146420_18940_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134593_60007_0|SrvcGrp|29075|2022|PDM|34.00|99|0.00|HYDRATION THERAPY|
20|FH_F127282_98004_0|SrvcGrp|23587|2022|PDM|808.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F150239_75569_0|SrvcGrp|14947|2022|PCT|1.00|99|0.00|HOME INFUSION|
20|FH_F87775_15106_0|SrvcGrp|17015|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|1020.00|99|0.00|ASPG III|
20|FH_F85214_70360_0|SrvcGrp|79458|2022|PDM|0.11|99|0.00|MED RECORD COPY|
20|FH_F135670_01749_0|SrvcGrp|112764|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJECTION DRUGS|
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|1327.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132925_84041_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F135670_01749_0|SrvcGrp|14948|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F110453_0_0|SrvcGrp|72990|2022|PDM|358.00|99|0.00|AEG 1|
20|FH_F138147_18018_0|SrvcGrp|113204|2022|PDM|28.88|99|0.00|MENTAL HEALTH ASSESSMENT|
20|FH_F92652_76531_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F87775_15106_0|SrvcGrp|24750|2022|PDM|50.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|409.32|99|0.00|HAPA WPA-NWPA 2012-13 ASC 212 W/O REV|
20|FH_F112665_0_0|SrvcGrp|54943|2022|PDM|2887.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F133972_27103_0|SrvcGrp|24754|2022|PDM|30.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F50583_0_0|SrvcGrp|474|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F100063_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F131100_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 1 (NO REV)|
20|FH_F145641_06902_0|SrvcGrp|96819|2022|PDM|1890.00|99|0.00|DESTROY L/S FACET JNT ADDL|
20|FH_F121597_30315_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F138047_77027_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F110268_02891_0|SrvcGrp|86722|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F90232_15126_0|SrvcGrp|24752|2022|PDM|14.18|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F31714_0_0|SrvcGrp|9936|2022|PCT|0.75|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F130329_64114_0|SrvcGrp|86831|2022|PDM|4.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F134615_38478_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F116753_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F130763_0_0|SrvcGrp|67065|2022|PDM|15683.00|99|0.00|CERVICAL SURGERY|
20|FH_F51393_0_0|SrvcGrp|3809|2022|PDM|757.00|99|0.00|HOSPICE CARE|
20|FH_F145641_06902_0|SrvcGrp|76604|2022|PDM|5433.00|99|0.00|CPT 25447|
20|FH_F96160_32207_0|SrvcGrp|14944|2022|PDM|5.62|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F134593_60007_0|SrvcGrp|14947|2022|PDM|32.00|99|0.00|HOME INFUSION|
20|FH_F134627_74030_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F109364_52349_0|SrvcGrp|48396|2022|PDM|184.00|99|0.00|OT SERVICES|
20|FH_F114606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F96721_99504_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F88744_71103_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F88744_71103_0|SrvcGrp|20912|2022|PDM|23508.00|99|0.00|MS DRG 236 ONLY|
20|FH_F134174_63141_0|SrvcGrp|112533|2022|PDM|400.00|99|0.00|SLEEP STUDIES CPT 95806 W/MODIFIER TC (CMS-1500)|
20|FH_F134350_46601_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F70883_0_0|SrvcGrp|26001|2022|PDM|175.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F118957_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F138289_76273_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F37910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|NEWBORN NURSERY - LEVEL I|
20|FH_F145883_71106_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F126188_59404_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119227_01752_0|SrvcGrp|22389|2022|PDM|18.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F119732_37660_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F91633_33907_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F119783_46360_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F36753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
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_F111695_30286_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36552_0_0|SrvcGrp|18873|2022|PDM|37915.00|99|0.00|MS DRG 232|
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|944.29|99|0.00|ASPG VIII|
20|FH_F135666_37601_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F132952_34994_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90501_71101_0|SrvcGrp|90555|2022|PDM|2500.00|99|0.00|AEG 10 W/O CARDIAC STUDIES|
20|FH_F90501_71101_0|SrvcGrp|75479|2022|PDM|1300.00|99|0.00|AEG 1|
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_F93122_01854_0|SrvcGrp|92937|2022|PDM|149.00|99|0.00|INTENSIVE OP PSYCH (HCFA)|
20|FH_F109242_18466_0|SrvcGrp|69075|2022|PDM|70.34|99|0.00|CPT 99213|
20|FH_F134489_90305_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F85911_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.50|99|0.00|SKILLED NURSING|
20|FH_F86836_0_0|SrvcGrp|9460|2022|PDM|3200.00|99|0.00|ACUTE REHABILITATION|
20|FH_F72963_0_0|SrvcGrp|17069|2022|PDM|3748.00|99|0.00|ASPG III|
20|FH_F105143_26062_0|SrvcGrp|90356|2022|PCT|0.70|99|0.00|OP DIALYSIS|
20|FH_F105145_75075_0|SrvcGrp|98003|2022|PDM|12350.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F105145_75075_0|SrvcGrp|72990|2022|PDM|2500.00|99|0.00|AEG 1|
20|FH_F146499_72206_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146667_37110_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F146881_83661_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F131674_72501_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131711_25550_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F131737_15025_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F132928_64114_0|SrvcGrp|88778|2022|PDM|147.60|99|0.00|PHYSICAL THERAPY|
20|FH_F133050_78216_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F111841_85212_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134828_30531_0|SrvcGrp|89215|2022|PDM|35.00|99|0.00|X-RAY EXAM OF FINGER(S)|
20|FH_F129975_0_0|SrvcGrp|111385|2022|PCT|1.40|99|0.00|PATHOLOGY|
20|FH_F51538_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151559_0_0|SrvcGrp|116055|2022|PDM|800.00|99|0.00|SAME DAY NEWBORN DISCHARGE|
20|FH_F67300_0_0|SrvcGrp|9518|2022|PCT|0.75|99|0.00|EMERGENCY ROOM|
20|FH_F69968_0_0|SrvcGrp|17075|2022|PDM|2143.92|99|0.00|ASPG VI|
20|FH_F136475_89119_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F120444_84037_0|SrvcGrp|46903|2022|PDM|750.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F120490_64133_0|SrvcGrp|86849|2022|PDM|25.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F142403_65201_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142273_51012_0|SrvcGrp|90356|2022|PCT|0.84|99|0.00|OP DIALYSIS|
20|FH_F142547_70002_0|SrvcGrp|86836|2022|PDM|10.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F142690_31774_0|SrvcGrp|17015|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142730_20646_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97582_46307_0|SrvcGrp|90854|2022|PDM|2104.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F138584_30912_0|SrvcGrp|113373|2022|PDM|1900.00|99|0.00|RECONSTRUCT MIDFACE LEFORT 2|
20|FH_F138584_30912_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 6 (NO REV)|
20|FH_F140468_46825_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118955_48239_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F118932_07652_0|SrvcGrp|75399|2022|PDM|0.25|99|0.00|MED RECORD COPY|
20|FH_F109883_35007_0|SrvcGrp|46903|2022|PDM|637.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F147932_78613_0|SrvcGrp|75419|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F129467_45449_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F79305_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F117093_40041_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F137270_82901_0|SrvcGrp|29347|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE|
20|FH_F137930_51546_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F90733_63080_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F90838_16146_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F109513_0_0|SrvcGrp|76604|2022|PDM|1800.00|99|0.00|CPT 25447|
20|FH_F151079_17011_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113866_0_0|SrvcGrp|47411|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F129468_15010_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F101387_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F97720_70084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F97780_43614_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85674_0_0|SrvcGrp|83880|2022|PDM|52.17|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F39366_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115204_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F114916_30309_0|CSTM-ALL|CSTM-00|2020|PDM|1664.00|99|0.00|AEG 7 (NO REV)|
20|FH_F112704_0_0|SrvcGrp|35669|2022|PDM|5500.00|99|0.00|CPT 63650|
20|FH_F112064_0_0|SrvcGrp|103904|2022|PCT|0.00|99|0.00|HOSPICE INPT RESPITE CARE|
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_F138929_0_0|SrvcGrp|16289|2022|PDM|1457.50|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F132988_0_0|SrvcGrp|100069|2022|PDM|4493.01|99|0.00|REVISE LOWER LEG TENDON|
20|FH_F42948_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141014_29732_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114002_0_0|SrvcGrp|42976|2022|PDM|70.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F122174_16511_0|SrvcGrp|471|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146985_12205_0|SrvcGrp|73700|2022|PDM|42.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F39398_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SURGERY|
20|FH_F34546_0_0|SrvcGrp|177|2022|PDM|1100.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F42466_0_0|SrvcGrp|32633|2022|PDM|477.00|99|0.00|SKILLED NURSING|
20|FH_F91898_0_0|SrvcGrp|361|2022|PDM|6780.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|14813.00|99|0.00|AEG 8 (NO REV)|
20|FH_F92493_0_0|SrvcGrp|80617|2022|PDM|12999.53|99|0.00|ARTHOPLASTY|
20|FH_F97040_31901_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F63185_0_0|SrvcGrp|48398|2022|PDM|30.00|99|0.00|PT SERVICES|
20|FH_F66388_0_0|SrvcGrp|474|2022|PDM|290.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F71443_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|425.00|99|0.00|AEG 1 (NO REV)|
20|FH_F32525_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F136671_73110_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F114666_30342_0|SrvcGrp|35667|2022|PDM|1430.00|99|0.00|CPT 20680|
20|FH_F114705_77018_0|SrvcGrp|73841|2022|PDM|325.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F114792_48849_0|SrvcGrp|89417|2022|PDM|660.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F113791_32055_0|SrvcGrp|80449|2022|PDM|1910.00|99|0.00|PET SCAN|
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|1740.27|99|0.00|2005 ASPG GROUPER VII|
20|FH_F43421_0_0|SrvcGrp|37015|2022|PDM|524.00|99|0.00|CHILD & ADOLESCENT PSYCH|
20|FH_F134727_30650_0|CSTM-ALL|CSTM-00|2020|PDM|2801.00|99|0.00|AEG 10 W/O CARDIAC CATHERTERIZATION (NO REV)|
20|FH_F135719_45502_0|SrvcGrp|28120|2022|PDM|36060.30|99|0.00|MS DRG 467 ONLY|
20|FH_F136778_62034_0|SrvcGrp|111482|2022|PCT|0.71|99|0.00|CARDIAC STUDIES|
20|FH_F136796_24016_0|SrvcGrp|35670|2022|PDM|7788.11|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F136828_32405_0|SrvcGrp|106048|2022|PDM|905.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F149543_0_0|SrvcGrp|111468|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F49016_0_0|SrvcGrp|10906|2022|PCT|0.60|99|0.00|EMERGENCY ROOM LEVEL IV|
20|FH_F116393_07002_0|SrvcGrp|81487|2022|PDM|284.00|99|0.00|NON INVASIVE VASCULAR STUDY|
20|FH_F147394_14031_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|28.50|99|0.00|HYDRATION TWO LITER (MOD SH)|
20|FH_F41663_0_0|SrvcGrp|360|2022|PDM|900.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F42024_0_0|SrvcGrp|35560|2022|PCT|0.74|99|0.00|PHARMACY SVCS|
20|FH_F124219_0_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F147990_64701_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 4 (NO REV)|
20|FH_F130468_0_0|SrvcGrp|97732|2022|PDM|9919.40|99|0.00|TREAT THIGH FRACTURE 1|
20|FH_F147962_85008_0|SrvcGrp|75798|2022|PDM|490.00|99|0.00|EMERGENCY ROOM LEVEL 2|
20|FH_F109267_12202_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F97840_54729_0|SrvcGrp|73601|2022|PDM|7953.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F90232_15126_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F126341_27284_0|SrvcGrp|86840|2022|PDM|40.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F128833_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F139169_0_0|SrvcGrp|86505|2022|PDM|650.00|99|0.00|DENTAL SURGERY|
20|FH_F134613_08852_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F145641_06902_0|SrvcGrp|41325|2022|PDM|6673.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F127529_43230_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F90574_22560_0|SrvcGrp|33165|2022|PDM|315.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F145942_72019_0|SrvcGrp|75419|2022|PDM|356.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F149340_19136_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145642_15108_0|SrvcGrp|26868|2022|PDM|30.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F110580_71106_0|CSTM-ALL|CSTM-00|2020|PDM|1123.00|99|0.00|AEG 6 (NO REV)|
20|FH_F83380_0_0|SrvcGrp|27767|2022|PDM|52.50|99|0.00|SKILLED IV NURSING HOURLY|
20|FH_F120719_27540_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F111986_0_0|SrvcGrp|77461|2022|PDM|3296.00|99|0.00|CPT 52356|
20|FH_F43197_0_0|SrvcGrp|11113|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME|
20|FH_F138047_77027_0|SrvcGrp|66264|2022|PDM|89.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F109267_12202_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F150259_15668_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F87571_0_0|SrvcGrp|22106|2022|PDM|650.00|99|0.00|CAT SCAN|
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|474.00|99|0.00|AEG 2 (NO REV)|
20|FH_F147962_85008_0|SrvcGrp|114288|2022|PCT|0.00|99|0.00|PROFESSIONAL FEES (NON-CLINICAL)|
20|FH_F134353_84123_0|SrvcGrp|97507|2022|PDM|94.50|99|0.00|AETNA HOSPICE|
20|FH_F138026_46143_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F51393_0_0|SrvcGrp|42830|2022|PDM|64.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F128379_0_0|SrvcGrp|67069|2022|PDM|7553.00|99|0.00|CPT 22634|
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|2601.00|99|0.00|AEG 5  (NO REV)|
20|FH_F70804_0_0|SrvcGrp|22954|2022|PDM|191.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F125133_20601_0|SrvcGrp|110076|2022|PDM|26.52|99|0.00|HYDROGEL DRSG GEL FILLER|
20|FH_F126360_22485_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112908_0_0|SrvcGrp|88620|2022|PDM|87.00|99|0.00|SKILLED NURSING RN|
20|FH_F87541_0_0|SrvcGrp|73006|2022|PDM|1615.00|99|0.00|AEG 9|
20|FH_F118123_67226_0|SrvcGrp|48385|2022|PDM|83.00|99|0.00|SPEECH THERAPY|
20|FH_F119379_0_0|SrvcGrp|100075|2022|PDM|1428.00|99|0.00|REVISION OF RADIUS|
20|FH_F111702_07652_0|SrvcGrp|96400|2022|PCT|1.00|99|0.00|INTERFERON ALFACON|
20|FH_F134608_18017_0|SrvcGrp|103513|2022|PDM|250.00|99|0.00|VAGINA EXAMINATION & BIOPSY|
20|FH_F119613_90035_0|SrvcGrp|89337|2022|PDM|970.00|99|0.00|DETOXIFICATION|
20|FH_F109577_0_0|SrvcGrp|103616|2022|PDM|123.00|99|0.00|DIABETIC MANAGEMENT TRN INDIV/GROUP|
20|FH_F87775_15106_0|SrvcGrp|17013|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F149305_76036_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145604_14850_0|SrvcGrp|43567|2022|PDM|48.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F134593_60007_0|SrvcGrp|17013|2022|PDM|48.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134492_85201_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F84712_0_0|SrvcGrp|82740|2022|PDM|203.00|99|0.00|US EXAM PG UTERUS COMPL|
20|FH_F85314_0_0|SrvcGrp|73610|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F105103_39652_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F105143_26062_0|SrvcGrp|49682|2022|PCT|2.00|99|0.00|HSS DRG GROUPED|
20|FH_F146654_80524_0|SrvcGrp|74668|2022|PDM|412.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F146763_76109_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120528_60559_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125014_67301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127656_06068_0|SrvcGrp|93098|2022|PDM|161.70|99|0.00|HOSPICE CARE|
20|FH_F131738_72143_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133583_77074_0|SrvcGrp|72602|2022|PDM|933.00|99|0.00|ECT|
20|FH_F132928_64114_0|SrvcGrp|23683|2022|PDM|84.35|99|0.00|SKILLED NURSING RN|
20|FH_F139444_32966_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139666_26175_0|SrvcGrp|75507|2022|PCT|0.94|99|0.00|CHEMOTHERAPY|
20|FH_F150859_14620_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150881_52722_0|SrvcGrp|75419|2022|PDM|553.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PDM|3918.75|99|0.00|AEG 8 (NO REV)|
20|FH_F39162_0_0|SrvcGrp|25688|2022|PDM|300.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 9 (NO REV)|
20|FH_F111189_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F42294_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|ASPG III|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F122649_0_0|SrvcGrp|97703|2022|PDM|112.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F37312_0_0|SrvcGrp|25940|2022|PDM|99.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|2155.00|99|0.00|AEG 4 (NO REV)|
20|FH_F98623_97006_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F100783_03431_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F122953_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F39346_0_0|SrvcGrp|30546|2022|PDM|21518.00|99|0.00|MS DRG 246-247 ONLY|
20|FH_F146760_0_0|SrvcGrp|108082|2022|PDM|25.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|2350.00|99|0.00|AEG 5  (NO REV)|
20|FH_F35404_0_0|SrvcGrp|9938|2022|PDM|120.00|99|0.00|SPEECH THERAPY|
20|FH_F113154_70359_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F141937_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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F48295_0_0|SrvcGrp|44428|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SVCS (VISIT LVL)|
20|FH_F138687_77477_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F138936_01040_0|SrvcGrp|113561|2022|PCT|1.00|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F138685_18017_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F67167_0_0|SrvcGrp|8950|2022|PDM|4955.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|266.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 310 W/O REV|
20|FH_F93138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102063_0_0|SrvcGrp|48385|2022|PDM|140.00|99|0.00|SPEECH THERAPY|
20|FH_F151426_90028_0|SrvcGrp|46903|2022|PDM|740.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F151427_04106_0|SrvcGrp|112493|2022|PDM|364.93|99|0.00|CHEMOTHERAPY ADMINISTRATION  (HCFA)|
20|FH_F151440_84095_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F144948_83704_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135800_28731_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135924_02906_0|SrvcGrp|89417|2022|PDM|1061.10|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F130547_85712_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F131112_99163_0|SrvcGrp|89149|2022|PDM|159.00|99|0.00|OP INTENSIVE|
20|FH_F116463_76501_0|SrvcGrp|86723|2022|PDM|324.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F116464_13088_0|SrvcGrp|52953|2022|PDM|90.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F127399_0_0|SrvcGrp|110679|2022|PDM|5202.00|99|0.00|REPAIR HUMERUS FRACTURE|
20|FH_F140629_0_0|SrvcGrp|78286|2022|PDM|78286.00|99|0.00|CPT 49322|
20|FH_F32938_0_0|SrvcGrp|9978|2022|PDM|1485.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS|
20|FH_F101644_75116_0|SrvcGrp|73701|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F121444_47720_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F121743_70005_0|SrvcGrp|75419|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F35357_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|ACUTE PSYCH|
20|FH_F111363_33169_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS|
20|FH_F148243_0_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F48581_0_0|SrvcGrp|9774|2022|PDM|1600.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F116430_0_0|SrvcGrp|106706|2022|PDM|2122.00|99|0.00|PAIN STIM SURGERY|
20|FH_F131000_0_0|SrvcGrp|35668|2022|PDM|3343.00|99|0.00|CPT 29824|
20|FH_F132328_0_0|SrvcGrp|28551|2022|PDM|4110.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F127713_30012_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F129240_10028_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F72544_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F119449_84032_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119491_19904_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F138283_0_0|SrvcGrp|46118|2022|PDM|112.00|99|0.00|NUTRITNAL CNSLNG/DIABETES EDU|
20|FH_F148644_06890_0|SrvcGrp|16732|2022|PDM|6175.00|99|0.00|HYSTEROSCOPY ABLATION|
20|FH_F33537_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|SKILLED NURSING CARE|
20|FH_F81485_0_0|CSTM-ALL|CSTM-00|2020|PDM|2307.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148921_91356_0|SrvcGrp|74668|2022|PDM|340.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F87173_15136_0|SrvcGrp|79720|2022|PDM|1231.00|99|0.00|ACUTE REHAB II|
20|FH_F47479_0_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150559_60018_0|SrvcGrp|88620|2022|PDM|130.00|99|0.00|SKILLED NURSING RN|
20|FH_F97042_64804_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F121009_76180_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F92677_08003_0|SrvcGrp|92101|2022|PDM|58.80|99|0.00|AETNA SUCTION PUMP PORTABLE HOME MODEL|
20|FH_F46357_0_0|SrvcGrp|41336|2022|PDM|3300.00|99|0.00|VAGINAL HYSTERECTOMY|
20|FH_F117272_24333_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F111582_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136752_0_0|CSTM-ALL|CSTM-00|2020|PDM|416.00|99|0.00|AEG 1 (NO REV)|
20|FH_F72226_65804_0|SrvcGrp|48762|2022|PDM|851.00|99|0.00|MSDRG 949 950|
20|FH_F45214_71103_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|117.00|99|0.00|HAPA EPA ASC 20|
20|FH_F94300_0_0|SrvcGrp|11673|2022|PDM|3360.00|99|0.00|CPT 29888|
20|FH_F38700_0_0|SrvcGrp|18253|2022|PCT|0.80|99|0.00|MS DRG 287|
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|AEG 9 (NO REV)|
20|FH_F132566_38751_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148639_0_0|SrvcGrp|63471|2022|PDM|5000.00|99|0.00|CPT 64590|
20|FH_F43411_0_0|SrvcGrp|20305|2022|PCT|0.75|99|0.00|BARIATRIC SURGERY|
20|FH_F34353_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126815_02118_0|CSTM-ALL|CSTM-00|2020|PDM|2651.34|99|0.00|AEG 8 (NO REV)|
20|FH_F109840_62832_0|SrvcGrp|537|2022|PCT|0.80|99|0.00|OBSERVATION SERVICES|
20|FH_F97180_14604_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F82715_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F31107_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F150529_08037_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113586_0_0|SrvcGrp|75489|2022|PDM|1224.00|99|0.00|AEG 6|
20|FH_F87155_04105_0|SrvcGrp|85817|2022|PCT|1.13|99|0.00|INFUSION AND INJECTABLE DRUGS|
20|FH_F44350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F132285_89103_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F122245_0_0|SrvcGrp|82571|2022|PDM|1500.00|99|0.00|PERCUTANEOUS IMPLANT OF NEURO ELECTRODES|
20|FH_F142770_51546_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F72859_0_0|SrvcGrp|11795|2022|PDM|21.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F87592_85614_0|SrvcGrp|79099|2022|PDM|1167.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F112587_37058_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|99.00|99|0.00|HAPA EPA ASC 17|
20|FH_F147995_67037_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F111809_93003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F133474_0_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F146253_60419_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97560_23249_0|SrvcGrp|88977|2022|PDM|6133.00|99|0.00|C-SECTION DELIVERY|
20|FH_F148639_0_0|SrvcGrp|92010|2022|PDM|1131.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE|
20|FH_F100682_97401_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F117794_06473_0|SrvcGrp|471|2022|PDM|819.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F45977_0_0|SrvcGrp|11074|2022|PDM|100.00|99|0.00|NURSING CARE|
20|FH_F118034_60645_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121168_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F113131_19013_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F133350_39532_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F45977_0_0|SrvcGrp|40417|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD UE KC|
20|FH_F150948_0_0|CSTM-ALL|CSTM-00|2020|PDM|9000.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL|
20|FH_F92676_15063_0|SrvcGrp|79000|2022|PDM|1225.76|99|0.00|MON VALLEY ASC 405|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD RR/KC)|
20|FH_F133021_00910_0|SrvcGrp|112308|2022|PDM|3500.00|99|0.00|PTA TRASLUMINAL BALLOON|
20|FH_F143187_52565_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148662_01583_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F149721_76522_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F36973_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|REFERENCE LABS MOD 26%|
20|FH_F132785_17961_0|SrvcGrp|705|2022|PCT|0.11|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F31542_0_0|SrvcGrp|411|2022|PDM|3600.00|99|0.00|OP CARDIAC CATH|
20|FH_F97622_75051_0|SrvcGrp|73559|2022|PDM|13936.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F71323_68114_0|SrvcGrp|35501|2022|PDM|2800.00|99|0.00|MS DRG 195 ONLY|
20|FH_F148361_68779_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38700_0_0|SrvcGrp|65|2022|PDM|2641.00|99|0.00|OBSTETRICAL CARE|
20|FH_F49354_0_0|SrvcGrp|32390|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKE (DME)|
20|FH_F112865_46135_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F97621_75801_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148639_0_0|SrvcGrp|63467|2022|PDM|2159.00|99|0.00|CPT 64585|
20|FH_F102721_38118_0|SrvcGrp|2738|2022|PCT|0.37|99|0.00|IMPLANTS|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F113287_72501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142028_45714_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148920_40207_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124928_04210_0|SrvcGrp|24739|2022|PDM|149.67|99|0.00|RESPITE CARE|
20|FH_F92677_08003_0|SrvcGrp|92092|2022|PDM|157.30|99|0.00|AETNA STATIONARY COMPRESSED GAS OX|
20|FH_F132118_92240_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F115383_80734_0|SrvcGrp|93291|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA ESRD USE|
20|FH_F103360_68845_0|CSTM-ALL|CSTM-00|2020|PDM|10272.00|99|0.00|AEG 8 (NO REV)|
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|2303.00|99|0.00|AEG 9 (NO REV)|
20|FH_F149401_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F35051_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS|
20|FH_F148555_0_0|SrvcGrp|115502|2022|PDM|1288.00|99|0.00|INTRACARDIAC ECG (ICE)|
20|FH_F117087_0_0|SrvcGrp|107181|2022|PDM|2494.00|99|0.00|REVISE MIDDLE EAR & MASTOID|
20|FH_F63250_0_0|SrvcGrp|23683|2022|PDM|33.00|99|0.00|SKILLED NURSING RN|
20|FH_F120605_0_0|SrvcGrp|73000|2022|PDM|1330.00|99|0.00|AEG 6|
20|FH_F40906_0_0|SrvcGrp|25282|2022|PDM|5.83|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F146159_89102_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148430_06278_0|SrvcGrp|112678|2022|PCT|1.00|99|0.00|COVID-19 SPECIMEN COLLECT|
20|FH_F139487_60076_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F137986_0_0|SrvcGrp|74039|2022|PDM|3000.00|99|0.00|LAMINECTOMY|
20|FH_F124695_33401_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F129966_18017_0|CSTM-ALL|CSTM-00|2020|PDM|501.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F100663_56537_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F98940_70506_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F41363_0_0|CSTM-ALL|CSTM-00|2020|PDM|1796.00|99|0.00|ASPG IX|
20|FH_F141156_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130182_0_0|SrvcGrp|111519|2022|PDM|364.00|99|0.00|STAB PHLEBECT VV 1 EXT; >20|
20|FH_F50461_0_0|SrvcGrp|30401|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F35678_0_0|SrvcGrp|18154|2022|PDM|11300.00|99|0.00|MS DRG 251|
20|FH_F124526_05301_0|SrvcGrp|109359|2022|PDM|619.00|99|0.00|RESIDENTIAL TREATMENT (<= 17 YRS)|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F84433_0_0|SrvcGrp|48398|2022|PDM|114.00|99|0.00|PT SERVICES|
20|FH_F147227_48302_0|SrvcGrp|92501|2022|PDM|187.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F117762_0_0|SrvcGrp|99173|2022|PDM|5144.00|99|0.00|HIP ARTHRO ACETABULOPLASTY|
20|FH_F111266_30339_0|SrvcGrp|17016|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1071.00|99|0.00|HAPA EPA ASC 8|
20|FH_F36943_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD KF|
20|FH_F147217_33781_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F124281_44286_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34399_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|1687.00|99|0.00|AEG 7 (NO REV)|
20|FH_F150520_0_0|CSTM-ALL|CSTM-00|2020|PDM|529.00|99|0.00|AEG 1 (NO REV)|
20|FH_F148008_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147231_49440_0|SrvcGrp|92502|2022|PDM|804.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F91996_33805_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47819_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F137728_47203_0|SrvcGrp|108484|2022|PDM|721.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F112794_01040_0|SrvcGrp|94742|2022|PCT|1.00|99|0.00|FLUVIRIN VACC IM (>=3 YRS)|
20|FH_F149579_95815_0|SrvcGrp|115688|2022|PDM|51.29|99|0.00|PHYSIOLOGIC MONITORING REM 1ST 20 MINS (HCFA)|
20|FH_F94643_90501_0|SrvcGrp|86842|2022|PDM|54.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F129757_0_0|SrvcGrp|14510|2022|PDM|1300.00|99|0.00|SKILLED NURSING|
20|FH_F40899_0_0|SrvcGrp|31186|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC (DME)|
20|FH_F98020_50138_0|SrvcGrp|73603|2022|PDM|4164.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F151042_60659_0|SrvcGrp|66265|2022|PDM|98.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F123570_0_0|SrvcGrp|73008|2022|PDM|721.38|99|0.00|AEG 10|
20|FH_F150952_85008_0|SrvcGrp|74668|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F75207_0_0|SrvcGrp|59357|2022|PDM|140.00|99|0.00|CAPD TRAINING|
20|FH_F112306_81428_0|SrvcGrp|472|2022|PDM|446.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F137789_48146_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F37152_0_0|SrvcGrp|80|2022|PDM|1500.00|99|0.00|ACUTE PSYCH|
20|FH_F49338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40624_0_0|SrvcGrp|39245|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS (CARDIAC)|
20|FH_F138478_0_0|SrvcGrp|77290|2022|PDM|283.51|99|0.00|AETNA REMV TUNNLD CVC W/O SUBQ PORT|
20|FH_F36737_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F33632_52349_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F150921_21620_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F84433_0_0|SrvcGrp|82773|2022|PDM|107.00|99|0.00|POST NATAL ASSESSMENT W/ NEWBORN|
20|FH_F97082_90012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F114188_15205_0|SrvcGrp|48398|2022|PDM|99.34|99|0.00|PT SERVICES|
20|FH_F97880_63501_0|SrvcGrp|90854|2022|PDM|2467.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|908.00|99|0.00|AEG 3 (NO REV)|
20|FH_F128988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124514_21215_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F129183_24084_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F115483_62002_0|SrvcGrp|73806|2022|PDM|1194.00|99|0.00|AETNA ER|
20|FH_F131385_76457_0|SrvcGrp|89337|2022|PDM|820.00|99|0.00|DETOXIFICATION|
20|FH_F56232_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IMMUNIZATIONS|
20|FH_F90232_15126_0|SrvcGrp|73700|2022|PDM|36.75|99|0.00|AETNA - SKILLED NURSING|
20|FH_F129599_17078_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F66760_0_0|SrvcGrp|54670|2022|PDM|2500.00|99|0.00|NORMAL DELIVERY|
20|FH_F35765_32547_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|GENERAL ACUTE CARE|
20|FH_F147532_0_0|SrvcGrp|83519|2022|PDM|144.84|99|0.00|HOSPICE CARE (ALL OTHER)|
20|FH_F37934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F32825_0_0|SrvcGrp|8950|2022|PDM|1316.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F150459_08021_0|SrvcGrp|92501|2022|PDM|133.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F149049_28401_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 9 (NO REV)|
20|FH_F92498_07442_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F141327_65566_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124687_64024_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F124322_64131_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F151699_01752_0|SrvcGrp|86850|2022|PDM|50.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 8 (NO REV)|
20|FH_F128155_62249_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139785_92629_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F116753_0_0|SrvcGrp|106777|2022|PDM|7465.00|99|0.00|GASTROPLASTY|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1158.55|99|0.00|SALLY BALIN,999182,ASC 701|
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 7 (NO REV)|
20|FH_F146986_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120144_77031_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F98880_50158_0|SrvcGrp|73605|2022|PDM|2994.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F97603_77901_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|1614.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F149582_01534_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F130654_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F50461_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F40495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F97280_20018_0|SrvcGrp|73461|2022|PDM|9773.00|99|0.00|AETNA NICU IV|
20|FH_F140036_07702_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F143533_30013_0|SrvcGrp|92760|2022|PCT|1.16|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F75803_0_0|SrvcGrp|4109|2022|PDM|801.00|99|0.00|ACUTE PSYCH|
20|FH_F32838_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F114931_0_0|SrvcGrp|35921|2022|PDM|5200.00|99|0.00|BARIATRIC SURGERY|
20|FH_F131093_49690_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F151745_27312_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F47600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F120191_91360_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F116698_07470_0|SrvcGrp|106998|2022|PCT|1.05|99|0.00|ALL DRUGS, INJ, NUTRI SOLUTIONS|
20|FH_F116698_07470_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100742_00616_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F50137_0_0|SrvcGrp|28992|2022|PDM|120.00|99|0.00|RN HI-TECH VISIT|
20|FH_F86332_75081_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41665_0_0|SrvcGrp|32405|2022|PCT|0.65|99|0.00|OCN F/S PRICING: MODIFIER 26 (RADIOLOGY)|
20|FH_F148265_06067_0|SrvcGrp|74039|2022|PDM|12934.00|99|0.00|LAMINECTOMY|
20|FH_F121466_84057_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F145757_65101_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F114975_78596_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F35581_0_0|SrvcGrp|61209|2022|PCT|1.20|99|0.00|OP LAB SERVICES|
20|FH_F36433_0_0|SrvcGrp|24|2022|PDM|2812.00|99|0.00|CARDIAC CATH|
20|FH_F90157_0_0|SrvcGrp|79720|2022|PDM|1243.00|99|0.00|ACUTE REHAB II|
20|FH_F93881_15009_0|SrvcGrp|87100|2022|PDM|6.00|99|0.00|ECH TRANSESOPHAGEA|
20|FH_F123278_20850_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F145803_19061_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F92276_32308_0|SrvcGrp|73601|2022|PDM|4961.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F125969_73112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151408_0_0|CSTM-ALL|CSTM-00|2020|PDM|896.00|99|0.00|AEG 2 (NO REV)|
20|FH_F125927_75093_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F106822_0_0|SrvcGrp|100255|2022|PDM|57.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (OVER 30.0 CM)|
20|FH_F36171_0_0|SrvcGrp|13298|2022|PCT|0.95|99|0.00|LABORATORY|
20|FH_F73847_0_0|SrvcGrp|44330|2022|PDM|124.00|99|0.00|NEGATIVE PRESSURE WOUND THERAPY|
20|FH_F116269_92627_0|SrvcGrp|89149|2022|PDM|350.00|99|0.00|OP INTENSIVE|
20|FH_F56136_0_0|CSTM-ALL|CSTM-00|2020|PDM|2073.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42360_0_0|SrvcGrp|35953|2022|PCT|1.50|99|0.00|OTHER DIAGNOSTIC TESTING|
20|FH_F111288_0_0|SrvcGrp|11673|2022|PDM|8312.00|99|0.00|CPT 29888|
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1240.28|99|0.00|ASPG VII|
20|FH_F75307_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F93742_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148265_06067_0|CSTM-ALL|CSTM-00|2020|PDM|4512.00|99|0.00|AEG 6 (NO REV)|
20|FH_F133207_0_0|SrvcGrp|41334|2022|PDM|15065.00|99|0.00|TOTAL KNEE|
20|FH_F98922_40351_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F41776_0_0|CSTM-ALL|CSTM-00|2020|PDM|1323.00|99|0.00|ASPG I|
20|FH_F32336_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.50|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_F113546_0_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F77404_0_0|SrvcGrp|3809|2022|PDM|615.00|99|0.00|HOSPICE CARE|
20|FH_F135219_68506_0|SrvcGrp|113909|2022|PCT|1.00|99|0.00|COVID-19 DIAGNOSTIC|
20|FH_F126523_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F127209_45365_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F130025_0_0|SrvcGrp|111476|2022|PDM|279.00|99|0.00|WOUND CARE|
20|FH_F76171_0_0|SrvcGrp|73302|2022|PDM|225.00|99|0.00|SPEECH THERAPY RE-EVALUATION|
20|FH_F100762_51104_0|SrvcGrp|73559|2022|PDM|6795.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F125890_43054_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F148343_70810_0|SrvcGrp|79720|2022|PDM|1100.00|99|0.00|ACUTE REHAB II|
20|FH_F135010_46342_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150462_30458_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123894_60927_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|2992.00|99|0.00|AEG 8 (NO REV)|
20|FH_F120349_38774_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F97104_53545_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F149859_60005_0|SrvcGrp|74668|2022|PDM|204.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F99960_0_0|SrvcGrp|26273|2022|PDM|1174.00|99|0.00|CPT 29880|
20|FH_F93132_73134_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F114918_78748_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54513_0_0|SrvcGrp|10542|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F132125_0_0|SrvcGrp|76501|2022|PDM|750.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F93881_15009_0|SrvcGrp|24714|2022|PCT|0.40|99|0.00|INTRAOCULAR LENS|
20|FH_F100460_0_0|SrvcGrp|19991|2022|PDM|20428.00|99|0.00|NERVOUS SYSTEM SERVICES|
20|FH_F34487_0_0|SrvcGrp|13890|2022|PCT|1.00|99|0.00|PHYSICIAN CLINIC VISIT NATL F/S (GLOBAL)|
20|FH_F130747_0_0|SrvcGrp|33986|2022|PDM|3121.00|99|0.00|CPT 26055|
20|FH_F131190_21042_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F92659_0_0|SrvcGrp|86034|2022|PDM|1485.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F72784_0_0|SrvcGrp|4109|2022|PDM|787.40|99|0.00|ACUTE PSYCH|
20|FH_F91622_0_0|SrvcGrp|3029|2022|PDM|683.00|99|0.00|NEWBORN NURSERY|
20|FH_F38034_0_0|SrvcGrp|38|2022|PDM|2264.00|99|0.00|NORMAL DELIVERY|
20|FH_F129627_06037_0|SrvcGrp|106904|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F149886_68112_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121566_91360_0|SrvcGrp|75419|2022|PDM|1014.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F62892_0_0|SrvcGrp|10540|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F41600_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F124270_46256_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F124441_0_0|SrvcGrp|58638|2022|PDM|3325.00|99|0.00|CPT 63688|
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 5  (NO REV)|
20|FH_F37361_0_0|SrvcGrp|8962|2022|PDM|88.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F134916_16421_0|SrvcGrp|13422|2022|PDM|232.96|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PDM|319.00|99|0.00|CPT CODE 99283|
20|FH_F97100_23462_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F36079_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SHEEPLESS NIGHTS MOD AU|
20|FH_F41699_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F50461_0_0|SrvcGrp|9826|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F66760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125214_12428_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F114848_50533_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F56472_0_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132160_0_0|SrvcGrp|109763|2022|PDM|2869.00|99|0.00|TREAT EYELID LESION|
20|FH_F128029_48154_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F76124_0_0|SrvcGrp|474|2022|PDM|260.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F126147_45241_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36743_0_0|SrvcGrp|38|2022|PDM|2100.00|99|0.00|NORMAL DELIVERY|
20|FH_F149536_76642_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143564_0_0|SrvcGrp|35921|2022|PDM|12484.00|99|0.00|BARIATRIC SURGERY|
20|FH_F129562_38668_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110727_34994_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F124703_65711_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F35452_0_0|SrvcGrp|9511|2022|PDM|1600.00|99|0.00|OBSERVATION SVCS|
20|FH_F35678_0_0|SrvcGrp|18212|2022|PDM|11300.00|99|0.00|MS DRG 280|
20|FH_F150982_0_0|SrvcGrp|33977|2022|PDM|1981.00|99|0.00|CPT 59820|
20|FH_F33566_0_0|CSTM-ALL|CSTM-00|2020|PDM|434.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F122841_0_0|SrvcGrp|42428|2022|PDM|208.00|99|0.00|OP SURGERY CPT 65855|
20|FH_F147418_0_0|SrvcGrp|115024|2022|PDM|7000.00|99|0.00|NECK SPINE FUSE|
20|FH_F151019_14094_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138662_78624_0|SrvcGrp|89149|2022|PDM|210.00|99|0.00|OP INTENSIVE|
20|FH_F75404_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113524_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F125214_12428_0|SrvcGrp|11108|2022|PCT|0.00|99|0.00|NEWBORN NURSERY|
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 3 (NO REV)|
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|2818.00|99|0.00|AEG 4 (NO REV)|
20|FH_F125656_92868_0|SrvcGrp|86853|2022|PDM|35.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F140608_0_0|SrvcGrp|88621|2022|PDM|120.00|99|0.00|SKILLED NURSING LPN|
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|793.00|99|0.00|AEG 5  (NO REV)|
20|FH_F128550_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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149512_62550_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90223_0_0|SrvcGrp|88826|2022|PDM|95.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F35990_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.00|99|0.00|ACUTE PSYCH|
20|FH_F137713_50025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F127292_85705_0|SrvcGrp|87317|2022|PDM|600.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F78023_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F146288_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.39|99|0.00|OP SVCS|
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|1026.00|99|0.00|AEG 1 (NO REV)|
20|FH_F151041_60647_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F114585_11501_0|SrvcGrp|86722|2022|PDM|168.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F119442_72205_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F97640_37043_0|SrvcGrp|73559|2022|PDM|11767.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|2544.00|99|0.00|AEG 9 (NO REV)|
20|FH_F127464_15106_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150339_75035_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124322_64131_0|SrvcGrp|26869|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F124322_64131_0|SrvcGrp|22593|2022|PDM|25.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F111044_0_0|SrvcGrp|35668|2022|PDM|2060.00|99|0.00|CPT 29824|
20|FH_F35452_0_0|SrvcGrp|9795|2022|PDM|690.00|99|0.00|SUBACUTE REHAB|
20|FH_F124322_64131_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F143347_16001_0|SrvcGrp|111931|2022|PDM|35.91|99|0.00|COVID-19 CDC TESTING LAB|
20|FH_F143347_16001_0|CSTM-ALL|CSTM-00|2020|PDM|2931.00|99|0.00|AEG 4 (NO REV)|
20|FH_F143367_81003_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F48057_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101700_0_0|SrvcGrp|93740|2022|PDM|1250.00|99|0.00|REVISE/REMOVE NEURO RECEIVER|
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 2 (NO REV)|
20|FH_F102224_0_0|SrvcGrp|93730|2022|PDM|2640.00|99|0.00|INJ PERIPHERAL NERVE|
20|FH_F130918_01606_0|SrvcGrp|113930|2022|PDM|232.00|99|0.00|INTENSIVE OUTPATIENT (>=18 YRS)|
20|FH_F131107_43140_0|SrvcGrp|90707|2022|PDM|130.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F151761_20019_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120208_20109_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F114914_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120050_92626_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F120887_78750_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F126438_50029_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F40502_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F40207_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113649_01752_0|SrvcGrp|86844|2022|PDM|67.50|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F84394_17402_0|SrvcGrp|114225|2022|PDM|14659.00|99|0.00|UPPER EXTREMITY|
20|FH_F51276_0_0|SrvcGrp|9543|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F35685_0_0|SrvcGrp|9518|2022|PDM|607.00|99|0.00|EMERGENCY ROOM|
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1449.00|99|0.00|AEG 9 (NO REV)|
20|FH_F149959_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F37578_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42367_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100742_00616_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F59732_0_0|SrvcGrp|29677|2022|PDM|140.00|99|0.00|HOME INFUSION NURSING SVCS MOD SD|
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|643.00|99|0.00|AEG 4 (NO REV)|
20|FH_F113410_0_0|SrvcGrp|105250|2022|PDM|2416.00|99|0.00|SINUS ENDOSCOPY|
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F84215_0_0|SrvcGrp|26273|2022|PDM|1181.00|99|0.00|CPT 29880|
20|FH_F124788_0_0|SrvcGrp|72990|2022|PDM|333.00|99|0.00|AEG 1|
20|FH_F135165_15728_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F132125_0_0|SrvcGrp|473|2022|PDM|850.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F141471_0_0|SrvcGrp|109488|2022|PDM|5760.00|99|0.00|VASC EMBOLIZE/OCCLUDE ARTERY|
20|FH_F69965_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F113410_0_0|SrvcGrp|99174|2022|PDM|1996.00|99|0.00|CPT 30140|
20|FH_F150462_30458_0|SrvcGrp|17007|2022|PDM|50.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS|
20|FH_F128902_53105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
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_F45632_0_0|SrvcGrp|3809|2022|PDM|694.00|99|0.00|HOSPICE CARE|
20|FH_F82235_0_0|SrvcGrp|73000|2022|PDM|908.60|99|0.00|AEG 6|
20|FH_F128190_45342_0|SrvcGrp|104874|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117010_10549_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121118_06479_0|SrvcGrp|76501|2022|PDM|280.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F83520_18704_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F115763_16433_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149869_03253_0|SrvcGrp|48394|2022|PDM|57.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F129231_30060_0|CSTM-ALL|CSTM-00|2020|PDM|644.00|99|0.00|AEG 10 (NO REV)|
20|FH_F110132_23451_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F38151_0_0|SrvcGrp|97|2022|PDM|4368.00|99|0.00|C-SECTION|
20|FH_F118194_50841_0|SrvcGrp|86833|2022|PDM|33.51|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F129536_0_0|SrvcGrp|92084|2022|PDM|1793.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F137067_0_0|SrvcGrp|70749|2022|PDM|3150.00|99|0.00|CPT 29823|
20|FH_F102184_0_0|SrvcGrp|89842|2022|PDM|7699.00|99|0.00|LUMBAR|
20|FH_F143970_92656_0|SrvcGrp|87317|2022|PDM|1265.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F85295_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F120349_38774_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F145538_34997_0|CSTM-ALL|CSTM-00|2020|PDM|621.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F132051_74464_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F141567_80128_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135172_33157_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F77463_0_0|SrvcGrp|33165|2022|PDM|325.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F32471_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93741_85006_0|SrvcGrp|78579|2022|PDM|1409.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F137495_36701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37440_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ACTIVASE/ALTEPLASE|
20|FH_F128363_60062_0|SrvcGrp|89417|2022|PDM|438.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F143528_0_0|SrvcGrp|35669|2022|PDM|3150.00|99|0.00|CPT 63650|
20|FH_F113410_0_0|SrvcGrp|26281|2022|PDM|3992.00|99|0.00|CPT 58353|
20|FH_F128371_40207_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F47963_0_0|SrvcGrp|24289|2022|PDM|55.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S AZ/NV - MOD KN|
20|FH_F148352_74637_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F115119_10003_0|SrvcGrp|104079|2022|PCT|1.03|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F149523_0_0|SrvcGrp|101102|2022|PDM|15000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F63182_0_0|CSTM-ALL|CSTM-00|2020|PDM|1038.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31597_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141587_40242_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F132092_0_0|SrvcGrp|94781|2022|PDM|169.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F132282_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143969_71129_0|CSTM-ALL|CSTM-00|2020|PDM|310.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F82931_18847_0|CSTM-ALL|CSTM-00|2020|PDM|1551.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100320_0_0|SrvcGrp|75479|2022|PDM|356.00|99|0.00|AEG 1|
20|FH_F70984_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|645.00|99|0.00|AEG 6 (NO REV)|
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1397.11|99|0.00|AEG 8 (NO REV)|
20|FH_F38528_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC STUDIES|
20|FH_F143870_19134_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F32369_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69965_0_0|SrvcGrp|66360|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F148166_0_0|SrvcGrp|14494|2022|PDM|56.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F128869_45458_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122694_33334_0|SrvcGrp|89417|2022|PDM|383.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F86872_15215_0|SrvcGrp|86849|2022|PDM|55.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F89736_0_0|SrvcGrp|114930|2022|PDM|19905.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F86851_0_0|SrvcGrp|84976|2022|PDM|555.00|99|0.00|CPT 44361|
20|FH_F89372_0_0|SrvcGrp|3378|2022|PCT|0.61|99|0.00|OBSERVATION SVCS|
20|FH_F89778_0_0|SrvcGrp|26278|2022|PDM|1215.74|99|0.00|CPT 29881|
20|FH_F77462_0_0|SrvcGrp|15385|2022|PDM|55.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F140373_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F148554_85016_0|SrvcGrp|108173|2022|PDM|4323.00|99|0.00|FEM/POPL REVASC STNT & ATHER|
20|FH_F144588_60090_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PDM|1129.00|99|0.00|AEG 3 (NO REV)|
20|FH_F45176_0_0|SrvcGrp|39608|2022|PDM|2500.00|99|0.00|CATARACT SURGERY|
20|FH_F115330_34113_0|SrvcGrp|73841|2022|PDM|300.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F134447_12883_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F72750_0_0|SrvcGrp|11301|2022|PDM|850.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1446.01|99|0.00|HAPA WPA-NWPA 2012-13 ASC 906 W/O REV|
20|FH_F65619_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F142027_37217_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103360_68845_0|SrvcGrp|31705|2022|PDM|31050.00|99|0.00|MS DRG 791 ONLY|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|HAPA EPA ASC 8|
20|FH_F150899_17243_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F97543_33542_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F125023_45246_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43774_0_0|SrvcGrp|9830|2022|PDM|115.00|99|0.00|OT SVCS|
20|FH_F87577_80016_0|CSTM-ALL|CSTM-00|2020|PDM|8275.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120437_85202_0|SrvcGrp|27969|2022|PDM|43.73|99|0.00|HOME HEALTH AIDE|
20|FH_F107082_21015_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F148925_61531_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F132991_84790_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F133455_60110_0|SrvcGrp|66264|2022|PDM|103.97|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F133395_98801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148599_98034_0|CSTM-ALL|CSTM-00|2020|PCT|2.36|99|0.00|HSS APC Y PROCEDURE NOT ON FS OR W/O WEIGHT|
20|FH_F142818_34209_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.18|99|0.00|HAPA WPA-NWPA 2012-13 ASC 205 W/O REV|
20|FH_F148003_34285_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116828_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F35506_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120437_85202_0|SrvcGrp|88806|2022|PDM|185.71|99|0.00|TOTAL PARENTERAL NUTRITION; < 3 LITERS (HCFA)|
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 8 (NO REV)|
20|FH_F125255_34769_0|SrvcGrp|89417|2022|PDM|200.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F148886_60621_0|SrvcGrp|111930|2022|PCT|1.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F149781_37404_0|SrvcGrp|100919|2022|PDM|4738.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F34706_0_0|SrvcGrp|10059|2022|PDM|7716.00|99|0.00|DRG 124 ONLY CIRCULATORY DISORDERS W/CARDIAC CATH COMPLEX DX|
20|FH_F49354_0_0|SrvcGrp|31188|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC (DME)|
20|FH_F35408_0_0|SrvcGrp|47587|2022|PDM|5.35|99|0.00|ADDITIONAL MILEAGE|
20|FH_F115431_32821_0|SrvcGrp|16069|2022|PDM|675.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F150911_75979_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F106640_78642_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148886_60621_0|SrvcGrp|89297|2022|PDM|830.00|99|0.00|INPATIENT DETOXIFICATION SERVICES|
20|FH_F133214_75024_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F149781_37404_0|SrvcGrp|89842|2022|PDM|8837.00|99|0.00|LUMBAR|
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_F136507_0_0|SrvcGrp|83522|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148639_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F125660_46706_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F111802_22003_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F75743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F109561_97216_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F57592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|OP SVCS|
20|FH_F72226_65804_0|SrvcGrp|31653|2022|PDM|3052.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III (MS DRG)|
20|FH_F42557_0_0|SrvcGrp|12682|2022|PDM|135.00|99|0.00|GROUP THERAPY|
20|FH_F39535_0_0|SrvcGrp|72|2022|PDM|684.00|99|0.00|NEWBORN NURSERY|
20|FH_F120406_84047_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142822_63437_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148886_60621_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F141657_85715_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.00|99|0.00|AEG 1 (NO REV)|
20|FH_F94300_0_0|SrvcGrp|93605|2022|PDM|1050.00|99|0.00|CERVICAL SURGERY(HCFA)|
20|FH_F43027_0_0|SrvcGrp|33166|2022|PDM|450.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F135005_06460_0|SrvcGrp|48385|2022|PDM|89.00|99|0.00|SPEECH THERAPY|
20|FH_F38380_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F75307_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73010_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149939_91942_0|SrvcGrp|90040|2022|PDM|522.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F33612_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37679_0_0|SrvcGrp|17016|2022|PDM|61.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129305_45614_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F118910_0_0|SrvcGrp|63297|2022|PDM|126.18|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F115081_37185_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F110263_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F44582_0_0|SrvcGrp|9838|2022|PDM|2800.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F119795_0_0|SrvcGrp|90376|2022|PDM|20453.00|99|0.00|REVISION OF KNEE JOINTLANT|
20|FH_F84446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCES|
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV)|
20|FH_F148431_60523_0|SrvcGrp|95661|2022|PDM|105.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F148432_01585_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117901_27526_0|SrvcGrp|94736|2022|PCT|1.10|99|0.00|FLULAVAL VACC IM (>=3 YRS)|
20|FH_F117717_68410_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F41438_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146258_90004_0|SrvcGrp|3178|2022|PDM|1327.00|99|0.00|ACUTE PSYCH|
20|FH_F44312_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F88223_0_0|SrvcGrp|48396|2022|PDM|88.00|99|0.00|OT SERVICES|
20|FH_F128893_0_0|SrvcGrp|63297|2022|PDM|150.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F132272_16127_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|GENERAL ACUTE CARE|
20|FH_F148919_32806_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42159_0_0|SrvcGrp|22461|2022|PCT|0.95|99|0.00|INPATIENT HOSPICE SVCS|
20|FH_F142782_16201_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129644_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F133131_30253_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142947_76043_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133021_00910_0|SrvcGrp|112278|2022|PDM|10000.00|99|0.00|TRANSLUMINAL STENT PLACEMENT|
20|FH_F139825_0_0|SrvcGrp|82570|2022|PDM|4590.00|99|0.00|REVISION EYELID/EXCESS SKIN|
20|FH_F92677_08003_0|SrvcGrp|14893|2022|PDM|46.20|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F50372_0_0|SrvcGrp|46592|2022|PDM|190.00|99|0.00|CPT 99214|
20|FH_F83113_0_0|SrvcGrp|62154|2022|PDM|66.00|99|0.00|PICC LINES|
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_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER QW|
20|FH_F97882_32407_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F92531_0_0|SrvcGrp|92193|2022|PDM|2199.00|99|0.00|CORRECTION OF BUNION - INCISION METATARSAL|
20|FH_F145988_06105_0|SrvcGrp|80297|2022|PDM|28480.00|99|0.00|AETNA PERCUTANEOUS CORONARY ANGIOPLASTY|
20|FH_F91262_77036_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F98921_64503_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F109625_27330_0|SrvcGrp|78850|2022|PCT|0.00|99|0.00|VENIPUNCTURE|
20|FH_F111813_08080_0|SrvcGrp|472|2022|PDM|390.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F113326_80014_0|SrvcGrp|471|2022|PDM|541.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F98620_43920_0|SrvcGrp|73461|2022|PDM|9647.00|99|0.00|AETNA NICU IV|
20|FH_F101840_76054_0|SrvcGrp|97488|2022|PDM|1321.00|99|0.00|ENDOSCOPY BILE DUCT/PANCREAS|
20|FH_F117895_28170_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92676_15063_0|SrvcGrp|78924|2022|PDM|4185.50|99|0.00|MON VALLEY ASC 9|
20|FH_F100786_24740_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F97564_52246_0|SrvcGrp|73659|2022|PDM|11966.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F33182_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F109669_28376_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133478_40165_0|CSTM-ALL|CSTM-00|2020|PDM|2417.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 3 (NO REV)|
20|FH_F132992_04662_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F130616_43615_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150948_0_0|SrvcGrp|108093|2022|PDM|10950.00|99|0.00|REVISE HIP ARTHROPLASTY|
20|FH_F120390_91316_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F66839_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAPA OHIO FS LAB & RAD|
20|FH_F72750_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|OP SVCS|
20|FH_F145870_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F117275_16936_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F132528_64014_0|SrvcGrp|46605|2022|PDM|127.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F88512_0_0|SrvcGrp|29830|2022|PDM|10889.63|99|0.00|PERCUT NEEDLE INSERTION|
20|FH_F88512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.46|99|0.00|OP SVCS|
20|FH_F144528_48081_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111437_33305_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F51129_0_0|SrvcGrp|361|2022|PCT|0.75|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|3621.00|99|0.00|IMPLANTS|
20|FH_F133455_60110_0|SrvcGrp|46605|2022|PDM|118.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F128130_10027_0|SrvcGrp|110235|2022|PDM|1004.00|99|0.00|IP 3D RENDERING W/ INTERPRETA|
20|FH_F134434_30607_0|SrvcGrp|74668|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F127011_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101754_63141_0|SrvcGrp|97975|2022|PDM|35.45|99|0.00|AUDIOMETRY AIR & BONE|
20|FH_F72859_0_0|SrvcGrp|15499|2022|PDM|20.64|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PDM|434.91|99|0.00|AEG 1 (NO REV)|
20|FH_F39721_0_0|SrvcGrp|24651|2022|PDM|210.00|99|0.00|HEMODIALYSIS - HOME TRAINING|
20|FH_F149665_65689_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F46196_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F40994_0_0|SrvcGrp|350|2022|PDM|950.00|99|0.00|SURGICAL CARE|
20|FH_F79003_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133550_90630_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31184_0_0|SrvcGrp|18795|2022|PDM|42800.00|99|0.00|MS DRG 216|
20|FH_F143197_34957_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F127163_74437_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F103360_68845_0|SrvcGrp|97715|2022|PCT|2.00|99|0.00|AETNA ALL DRUGS AGENTS|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|170.34|99|0.00|ASPG 119|
20|FH_F151145_39365_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151226_33155_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F121946_43209_0|SrvcGrp|89149|2022|PDM|173.00|99|0.00|OP INTENSIVE|
20|FH_F130066_84107_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F38238_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F136372_19046_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136394_78240_0|SrvcGrp|73842|2022|PDM|380.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136536_46075_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134008_11221_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F134011_84102_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F134047_32628_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F114092_83350_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F114092_83350_0|SrvcGrp|105465|2022|PCT|1.00|99|0.00|AETNA THERAPIES|
20|FH_F142273_51012_0|SrvcGrp|79699|2022|PCT|0.84|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F142547_70002_0|SrvcGrp|86849|2022|PDM|25.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F142547_70002_0|SrvcGrp|17016|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F83831_0_0|SrvcGrp|20000|2022|PDM|165.00|99|0.00|CATHETER CARE SUPPLIES|
20|FH_F97602_40121_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F140343_89052_0|SrvcGrp|86840|2022|PDM|30.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F140760_07003_0|SrvcGrp|89149|2022|PDM|160.00|99|0.00|OP INTENSIVE|
20|FH_F140830_70056_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120152_0_0|SrvcGrp|92010|2022|PDM|2420.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE|
20|FH_F149659_79912_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151603_27609_0|SrvcGrp|88065|2022|PDM|22907.12|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F119067_94080_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118932_07652_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F39623_0_0|SrvcGrp|24447|2022|PDM|1600.00|99|0.00|OB GLOBAL|
20|FH_F80366_0_0|SrvcGrp|73008|2022|PCT|0.94|99|0.00|AEG 10|
20|FH_F147725_06002_0|SrvcGrp|28548|2022|PDM|5192.00|99|0.00|VITRECTOMY|
20|FH_F147726_18017_0|CSTM-ALL|CSTM-00|2020|PDM|1194.00|99|0.00|AEG 7 (NO REV)|
20|FH_F129514_79605_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F137898_46540_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35210_0_0|SrvcGrp|997|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F109821_0_0|SrvcGrp|58542|2022|PDM|4080.00|99|0.00|BARIATRIC SURGERY|
20|FH_F124754_84403_0|SrvcGrp|74611|2022|PDM|150.00|99|0.00|AETNA FOLLOW UP VISIT CPT 90837|
20|FH_F80084_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|ADOLESCENT PSYCH PARTIAL HOSP|
20|FH_F110000_0_0|SrvcGrp|14414|2022|PDM|792.00|99|0.00|NEWBORN NURSERY|
20|FH_F91832_06106_0|SrvcGrp|48396|2022|PDM|89.25|99|0.00|OT SERVICES|
20|FH_F97761_04072_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F77067_0_0|SrvcGrp|30976|2022|PCT|0.65|99|0.00|MS DRG 005-006 ONLY - LIVER TRANSPLANT|
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|156.60|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)|
20|FH_F114916_30309_0|SrvcGrp|70749|2022|PDM|2500.00|99|0.00|CPT 29823|
20|FH_F142318_21218_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F142318_21218_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F115895_0_0|SrvcGrp|88492|2022|PDM|4774.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F130439_85014_0|SrvcGrp|89417|2022|PDM|446.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F40783_0_0|SrvcGrp|26901|2022|PDM|988.00|99|0.00|VENTILATOR REHAB SERVICES|
20|FH_F110212_17013_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F125910_0_0|SrvcGrp|82981|2022|PDM|113.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F135491_0_0|SrvcGrp|111136|2022|PCT|1.21|99|0.00|PHENYLEPHRINE KETOROLAC INJECTION|
20|FH_F136132_0_0|SrvcGrp|111932|2022|PDM|51.31|99|0.00|COVID-19 NON-CDC TESTING LAB|
20|FH_F138929_0_0|SrvcGrp|26273|2022|PDM|3300.00|99|0.00|CPT 29880|
20|FH_F146125_0_0|SrvcGrp|114014|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F132627_0_0|SrvcGrp|10580|2022|PDM|64.26|99|0.00|HYDRATION THERAPY - 3 LITERS|
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.00|99|0.00|AEG 10 (NO REV)|
20|FH_F141336_16947_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F64180_0_0|SrvcGrp|3327|2022|PDM|155.00|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F124180_0_0|SrvcGrp|68800|2022|PDM|2863.50|99|0.00|REPAIR OF RETINAL DETACHMENT|
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 6 (NO REV)|
20|FH_F140500_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F146894_73505_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124234_33410_0|SrvcGrp|108484|2022|PDM|1200.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F130556_33764_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|204.00|99|0.00|CD - ADULT FULL DAY|
20|FH_F145664_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.62|99|0.00|OP SVCS|
20|FH_F133261_78041_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F133390_07626_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F127284_84403_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F118540_32064_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F72024_0_0|SrvcGrp|1168|2022|PDM|640.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F128707_72601_0|SrvcGrp|106655|2022|PCT|1.00|99|0.00|PARSABIV|
20|FH_F146108_66762_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F88956_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134434_30607_0|SrvcGrp|89412|2022|PDM|410.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|HOME INF- REV 640 MOD SJ|
20|FH_F130632_44145_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F31944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.13|99|0.00|5780852_USTN_XR_NOMOD|
20|FH_F69063_0_0|SrvcGrp|47764|2022|PDM|120.00|99|0.00|HOSPICE CARE/ IN HOME S9126 VISIT LEVEL|
20|FH_F97622_75051_0|SrvcGrp|88977|2022|PDM|6246.00|99|0.00|C-SECTION DELIVERY|
20|FH_F117087_0_0|SrvcGrp|98402|2022|PDM|2494.00|99|0.00|RHINO INCL MJR SEPTAL RPR|
20|FH_F97103_53295_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150949_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F39627_0_0|SrvcGrp|30712|2022|PDM|12500.00|99|0.00|BRACHYTHERAPY SVCS|
20|FH_F94165_0_0|SrvcGrp|78377|2022|PCT|0.85|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F142038_45152_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F55113_0_0|SrvcGrp|51267|2022|PDM|34080.00|99|0.00|CARDIOVASCULAR SURGERY|
20|FH_F118376_46052_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F101840_76054_0|SrvcGrp|73008|2022|PDM|1809.00|99|0.00|AEG 10|
20|FH_F135714_01922_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133458_18929_0|SrvcGrp|108484|2022|PDM|1550.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F149841_73114_0|SrvcGrp|74668|2022|PDM|166.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F146360_66502_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F68944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F111809_93003_0|CSTM-ALL|CSTM-00|2020|PDM|9703.00|99|0.00|AEG 6 (NO REV)|
20|FH_F38407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MOD 26|
20|FH_F41436_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F105842_70433_0|SrvcGrp|73601|2022|PDM|1470.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F118544_21550_0|SrvcGrp|471|2022|PDM|808.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F150524_64106_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|DEVICE INSERTION|
20|FH_F149179_0_0|SrvcGrp|115613|2022|PDM|4488.00|99|0.00|ARTHROS, SYNOVECT, SURG|
20|FH_F123783_03860_0|SrvcGrp|46104|2022|PDM|154.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F132810_0_0|SrvcGrp|86845|2022|PDM|35.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F69968_0_0|SrvcGrp|31769|2022|PDM|15193.82|99|0.00|CARDIAC ABLATION|
20|FH_F120490_64133_0|SrvcGrp|88620|2022|PDM|83.00|99|0.00|SKILLED NURSING RN|
20|FH_F134066_33881_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134126_11554_0|SrvcGrp|74581|2022|PCT|0.45|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F137147_75006_0|SrvcGrp|26686|2022|PDM|78750.00|99|0.00|MS DRG 455 ONLY|
20|FH_F137232_28210_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F114979_77979_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F142393_33142_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142742_44112_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F117552_0_0|SrvcGrp|73002|2022|PDM|1196.00|99|0.00|AEG 7|
20|FH_F53732_0_0|SrvcGrp|24744|2022|PDM|115.00|99|0.00|PICC LINE INSERTION|
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|1194.00|99|0.00|ASPG VII|
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 5  (NO REV)|
20|FH_F138471_84663_0|SrvcGrp|46605|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F138584_30912_0|SrvcGrp|113402|2022|PDM|850.00|99|0.00|MANDIBULAR FRACTURE TREATMENT|
20|FH_F149663_45219_0|SrvcGrp|11673|2022|PDM|2511.00|99|0.00|CPT 29888|
20|FH_F151604_44266_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F119003_78070_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119023_91406_0|SrvcGrp|86831|2022|PDM|7.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F117261_43543_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F117267_07728_0|SrvcGrp|82138|2022|PDM|5000.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F117371_77059_0|SrvcGrp|86723|2022|PDM|375.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F147725_06002_0|CSTM-ALL|CSTM-00|2020|PDM|2965.00|99|0.00|AEG 7 (NO REV)|
20|FH_F147725_06002_0|CSTM-ALL|CSTM-00|2020|PDM|2496.00|99|0.00|AEG 8 (NO REV)|
20|FH_F147801_90703_0|CSTM-ALL|CSTM-00|2020|PDM|1082.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F147861_45239_0|SrvcGrp|90854|2022|PDM|824.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F117221_23434_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F112446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91472_96001_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F47452_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151063_44094_0|SrvcGrp|73605|2022|PDM|950.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F97720_70084_0|SrvcGrp|73656|2022|PDM|548.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F97721_01053_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
20|FH_F124567_33144_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124679_64052_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F129143_68739_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100520_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87856_0_0|SrvcGrp|64517|2022|PDM|2332.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F136544_06426_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114629_19131_0|SrvcGrp|113276|2022|PCT|1.14|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F114666_30342_0|SrvcGrp|100039|2022|PDM|5000.00|99|0.00|REPAIR OF HEEL FRACTURE|
20|FH_F114666_30342_0|SrvcGrp|75002|2022|PDM|4500.00|99|0.00|ARTHOSCOPY|
20|FH_F127448_0_0|SrvcGrp|107878|2022|PDM|2150.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F137447_0_0|SrvcGrp|106294|2022|PDM|270.41|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F134694_94945_0|SrvcGrp|89412|2022|PDM|500.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F134727_30650_0|CSTM-ALL|CSTM-00|2020|PDM|962.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F136807_43220_0|SrvcGrp|88621|2022|PDM|82.00|99|0.00|SKILLED NURSING LPN|
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F147299_02072_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F42156_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76286_16038_0|SrvcGrp|10503|2022|PDM|53.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F118446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134828_30531_0|SrvcGrp|113099|2022|PDM|15.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB (NCFA)|
20|FH_F39346_0_0|SrvcGrp|29710|2022|PDM|13203.00|99|0.00|OTHER CARDIAC PACEMKR MS DRG 243-244 ONLY|
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|1578.35|99|0.00|AEG 2 (NO REV)|
20|FH_F117820_0_0|SrvcGrp|89783|2022|PDM|62.60|99|0.00|RESPITE CARE (HCFA)|
20|FH_F150939_0_0|SrvcGrp|100249|2022|PDM|12.00|99|0.00|REMOVAL OF SKIN TAGS|
20|FH_F150939_0_0|SrvcGrp|108435|2022|PDM|21.64|99|0.00|AETNA IMMUNIZATION|
20|FH_F47605_0_0|SrvcGrp|33165|2022|PDM|835.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F54552_0_0|SrvcGrp|27046|2022|PDM|33.50|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS (MOD SH)|
20|FH_F54552_0_0|SrvcGrp|29023|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138680_53005_0|SrvcGrp|73842|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138784_32216_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138876_25302_0|SrvcGrp|86830|2022|PDM|50.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F138936_01040_0|CSTM-ALL|CSTM-00|2020|PDM|3193.00|99|0.00|AEG 8 (NO REV)|
20|FH_F57953_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F67167_0_0|SrvcGrp|31981|2022|PCT|0.65|99|0.00|HIGH COST DRUGS|
20|FH_F72606_0_0|SrvcGrp|20752|2022|PDM|18000.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|AEG 10 (NO REV)|
20|FH_F93138_0_0|SrvcGrp|82981|2022|PDM|105.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F151340_30040_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F151405_65109_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151501_30265_0|SrvcGrp|109787|2022|PDM|950.00|99|0.00|EXC FOOT/TOE TUM SC < 1.5 CM|
20|FH_F132258_45404_0|SrvcGrp|86846|2022|PDM|34.98|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F132268_07060_0|SrvcGrp|94741|2022|PDM|58.94|99|0.00|FLULAVAL VACC IM (>=3 YRS)|
20|FH_F122119_62675_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145528_76501_0|SrvcGrp|46605|2022|PDM|117.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F128115_52001_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|3498.00|99|0.00|ASPG VII|
20|FH_F135473_33759_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135772_61364_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135979_66451_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F129131_27519_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131265_84106_0|SrvcGrp|73605|2022|PDM|1079.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F131132_44077_0|SrvcGrp|81779|2022|PCT|0.49|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F116447_21601_0|SrvcGrp|57968|2022|PDM|34.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F34686_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|IMPLANTS|
20|FH_F130766_04967_0|SrvcGrp|81779|2022|PCT|4.24|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F69583_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F36479_0_0|SrvcGrp|16|2022|PDM|803.00|99|0.00|ACUTE REHABILITATION|
20|FH_F121763_07202_0|SrvcGrp|72998|2022|PDM|1800.00|99|0.00|AEG 5|
20|FH_F133711_46131_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F111292_33136_0|SrvcGrp|82746|2022|PDM|106.00|99|0.00|CULT BACT BLD AEROIC ISOLA|
20|FH_F145587_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F145587_0_0|SrvcGrp|82112|2022|PDM|1262.70|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1795.00|99|0.00|ASPG V|
20|FH_F131000_0_0|SrvcGrp|106266|2022|PDM|5114.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT|
20|FH_F132328_0_0|SrvcGrp|72121|2022|PDM|3381.00|99|0.00|ARTHOSCOPY|
20|FH_F101904_17057_0|SrvcGrp|42622|2022|PCT|0.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F129220_18445_0|SrvcGrp|108040|2022|PDM|964.00|99|0.00|INPATIENT PSYCH|
20|FH_F63275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130821_85712_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130908_32708_0|SrvcGrp|73841|2022|PDM|415.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F149147_66221_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F54532_0_0|SrvcGrp|14165|2022|PDM|487.00|99|0.00|PARTIAL HOSP PSYCH/CD|
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 9 (NO REV)|
20|FH_F146039_89511_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F31714_0_0|SrvcGrp|2868|2022|PDM|34500.00|99|0.00|DRG 536 CARDIAC DEFIBRULATOR IMPLANTS|
20|FH_F114916_30309_0|SrvcGrp|84318|2022|PDM|3500.00|99|0.00|SPINE INFUSION|
20|FH_F114916_30309_0|SrvcGrp|67069|2022|PDM|3000.00|99|0.00|CPT 22634|
20|FH_F111885_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|1539.00|99|0.00|AEG 9 (NO REV)|
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 9 (NO REV)|
20|FH_F94786_07974_0|SrvcGrp|92184|2022|PDM|21.00|99|0.00|HCPCS S9340 (HCFA)|
20|FH_F132988_0_0|SrvcGrp|41335|2022|PDM|17000.00|99|0.00|TOTAL HIP|
20|FH_F43612_0_0|SrvcGrp|13811|2022|PDM|250.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F47694_0_0|SrvcGrp|40222|2022|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141070_64093_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141070_64093_0|SrvcGrp|23683|2022|PDM|46.00|99|0.00|SKILLED NURSING RN|
20|FH_F141036_02347_0|SrvcGrp|111935|2022|PCT|1.00|99|0.00|COVID-19 SPECIMEN COLLECTING ANY SOURCE|
20|FH_F93252_0_0|SrvcGrp|87679|2022|PDM|1500.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F114389_50131_0|SrvcGrp|92100|2022|PDM|31.50|99|0.00|AETNA NEUBULIZER WITH COMPRESSOR|
20|FH_F49487_0_0|SrvcGrp|10623|2022|PDM|32.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F69504_0_0|SrvcGrp|48385|2022|PDM|23.00|99|0.00|SPEECH THERAPY|
20|FH_F139295_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS|
20|FH_F39753_0_0|SrvcGrp|97|2022|PDM|5472.00|99|0.00|C-SECTION|
20|FH_F91898_0_0|CSTM-ALL|CSTM-00|2020|PDM|13099.00|99|0.00|AEG 6 (NO REV)|
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|1640.10|99|0.00|AEG 10 (NO REV)|
20|FH_F98380_43055_0|SrvcGrp|73559|2022|PDM|9613.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F124586_14850_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F87856_0_0|SrvcGrp|83837|2022|PDM|2332.00|99|0.00|EXCISION EXCESSIVE SKIN|
20|FH_F136746_63116_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114792_48849_0|SrvcGrp|109330|2022|PCT|1.34|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PDM|78.00|99|0.00|BIOFEEDBACK PERI/URO/RECTAL|
20|FH_F43447_0_0|CSTM-ALL|CSTM-00|2020|PDM|4500.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F117069_15236_0|SrvcGrp|48385|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F134693_92270_0|SrvcGrp|112675|2022|PDM|1000.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F134791_98034_0|SrvcGrp|90648|2022|PDM|296.00|99|0.00|PSYTX PT/FAMILY 45 MINUTES (HCFA)|
20|FH_F135747_76208_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F136786_25302_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F113713_17013_0|SrvcGrp|105370|2022|PDM|45.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MINS(HCFA)|
20|FH_F131529_0_0|SrvcGrp|83519|2022|PDM|100.00|99|0.00|HOSPICE CARE (ALL OTHER)|
20|FH_F34349_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49016_0_0|SrvcGrp|33089|2022|PDM|975.00|99|0.00|SUBACUTE CARE|
20|FH_F115723_78363_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116365_11417_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F147519_52627_0|CSTM-ALL|CSTM-00|2020|PDM|5693.90|99|0.00|AEG 8 (NO REV)|
20|FH_F147580_75110_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147445_76844_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
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_F116907_75093_0|SrvcGrp|23587|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F126243_32132_0|SrvcGrp|89417|2022|PDM|447.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F126884_28379_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F36274_0_0|SrvcGrp|8962|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F68835_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F103004_75840_0|SrvcGrp|73485|2022|PDM|811.00|99|0.00|AETNA REHAB|
20|FH_F39140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140007_0_0|SrvcGrp|97039|2022|PDM|3470.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F41605_0_0|SrvcGrp|38|2022|PDM|2704.00|99|0.00|NORMAL DELIVERY|
20|FH_F48772_66044_0|SrvcGrp|65720|2022|PCT|0.00|99|0.00|RESPITE CARE|
20|FH_F120112_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F97261_06098_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F98161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111601_15203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|3100.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F82234_0_0|SrvcGrp|80098|2022|PDM|857.79|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE|
20|FH_F46433_0_0|SrvcGrp|24750|2022|PDM|60.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F46433_0_0|SrvcGrp|40824|2022|PDM|50.00|99|0.00|DELIVERY/SERVICE (HIGH RISK)|
20|FH_F113025_0_0|SrvcGrp|75497|2022|PDM|752.00|99|0.00|AEG 10|
20|FH_F133132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F150939_0_0|SrvcGrp|100263|2022|PDM|59.00|99|0.00|DESTRUCT LESION, 15 OR MORE|
20|FH_F72445_0_0|SrvcGrp|26253|2022|PDM|38.00|99|0.00|LIPIDS|
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F48836_0_0|SrvcGrp|28919|2022|PDM|34.00|99|0.00|CPT 97750|
20|FH_F138907_01040_0|SrvcGrp|95661|2022|PDM|170.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F138936_01040_0|SrvcGrp|3378|2022|PDM|1854.00|99|0.00|OBSERVATION SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|529.10|99|0.00|HAPA WPA-NWPA 2012-13 ASC 203 W/O REV|
20|FH_F151380_90701_0|SrvcGrp|110811|2022|PDM|256.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F151412_71909_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151503_30067_0|SrvcGrp|100017|2022|PDM|14114.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F151514_35242_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132163_17601_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F132258_45404_0|SrvcGrp|46605|2022|PDM|85.86|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F122137_75633_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122152_70123_0|SrvcGrp|92502|2022|PDM|657.93|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F145562_70458_0|SrvcGrp|86835|2022|PDM|10.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F120930_0_0|SrvcGrp|90367|2022|PDM|2200.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F129509_0_0|SrvcGrp|111327|2022|PDM|1128.00|99|0.00|REVISION OF SCIATIC NERVE|
20|FH_F121650_60153_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F49552_0_0|SrvcGrp|20900|2022|PDM|3825.00|99|0.00|MS DRG 248 ONLY|
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|2090.00|99|0.00|AEG 7 (NO REV)|
20|FH_F124785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F86131_28215_0|SrvcGrp|471|2022|PDM|472.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F56772_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114527_39047_0|SrvcGrp|89417|2022|PDM|477.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F112082_30720_0|SrvcGrp|17015|2022|PDM|53.15|99|0.00|HOME INFUSION THERAPY|
20|FH_F134234_49525_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110470_98335_0|SrvcGrp|91399|2022|PDM|75.00|99|0.00|AETNA PSYCH PT & FAMILY 45MINS (MOD AJ)|
20|FH_F143650_0_0|SrvcGrp|33984|2022|PDM|1800.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F132147_33183_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F127918_45640_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85995_64111_0|SrvcGrp|48385|2022|PDM|136.00|99|0.00|SPEECH THERAPY|
20|FH_F85118_40403_0|SrvcGrp|73656|2022|PDM|577.50|99|0.00|AETNA HOSPICE SVCS|
20|FH_F145604_14850_0|SrvcGrp|14945|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F96800_32308_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|977.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F145641_06902_0|SrvcGrp|116098|2022|PDM|15000.00|99|0.00|TRML DSTRJ IOS BVN EA ADDL|
20|FH_F59872_0_0|CSTM-ALL|CSTM-00|2020|PDM|2995.00|99|0.00|ASPG VI|
20|FH_F130364_01331_0|SrvcGrp|10365|2022|PDM|882.00|99|0.00|CPT CODE 99285|
20|FH_F144228_0_0|SrvcGrp|19922|2022|PDM|5858.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F127849_43920_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F87712_15017_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F149245_78576_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135657_27612_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133913_61008_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110343_38139_0|SrvcGrp|86648|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F121597_30315_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F134656_02852_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133775_83401_0|SrvcGrp|88621|2022|PDM|140.00|99|0.00|SKILLED NURSING LPN|
20|FH_F148267_0_0|SrvcGrp|92502|2022|PDM|683.95|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F31714_0_0|SrvcGrp|2975|2022|PDM|4300.00|99|0.00|DRG 500 BACK & NECK PROCEDURE EXCEPT SPINAL FUSION W/O CC|
20|FH_F138191_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139565_0_0|SrvcGrp|84279|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|228.01|99|0.00|HAPA WPA-NWPA 2012-13 ASC 124 W/O REV|
20|FH_F112060_07514_0|SrvcGrp|96403|2022|PCT|1.00|99|0.00|CIPROFLOXACIN IV|
20|FH_F127090_45601_0|SrvcGrp|88620|2022|PDM|91.02|99|0.00|SKILLED NURSING RN|
20|FH_F149270_98004_0|SrvcGrp|115622|2022|PCT|0.70|99|0.00|VIRTUAL LOW INTENSITY OP PROGRAM (MOD GT)|
20|FH_F133972_27103_0|SrvcGrp|111526|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F135670_01749_0|SrvcGrp|24761|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118135_38109_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F134609_33458_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F135656_74820_0|SrvcGrp|106048|2022|PDM|428.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F90232_15126_0|SrvcGrp|48398|2022|PDM|94.50|99|0.00|PT SERVICES|
20|FH_F85213_02840_0|SrvcGrp|73499|2022|PDM|554.60|99|0.00|AETNA ER LEVEL II|
20|FH_F31595_0_0|SrvcGrp|10410|2022|PDM|85.00|99|0.00|SKILLED NURSING CARE|
20|FH_F133749_84604_0|SrvcGrp|112471|2022|PDM|50.00|99|0.00|HOME VISIT PRENATAL|
20|FH_F110522_13501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F90232_15126_0|SrvcGrp|86831|2022|PDM|4.20|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F143742_60410_0|SrvcGrp|73601|2022|PDM|1900.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F135666_37601_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F143568_85006_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121603_46761_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD KM"|
20|FH_F120930_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F139297_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F72543_0_0|SrvcGrp|46110|2022|PDM|56.70|99|0.00|HI-TECH NURSING (ADDITIONAL HOUR)|
20|FH_F134496_66062_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F134431_92647_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F134537_03060_0|SrvcGrp|89149|2022|PDM|196.00|99|0.00|OP INTENSIVE|
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 4 (NO REV)|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.38|99|0.00|HAPA WPA-NWPA 2012-13 ASC 227 W/O REV|
20|FH_F70607_0_0|SrvcGrp|17140|2022|PDM|150.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F85211_0_0|SrvcGrp|72996|2022|PDM|864.60|99|0.00|AEG 4|
20|FH_F101100_50314_0|SrvcGrp|97925|2022|PDM|4565.00|99|0.00|REMOVAL OF OVERY/TUBE|
20|FH_F105145_75075_0|SrvcGrp|34609|2022|PDM|16200.00|99|0.00|PODIATRIC PROCEDURE CPT 28080|
20|FH_F146522_74133_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146812_50401_0|CSTM-ALL|CSTM-00|2020|PDM|4446.18|99|0.00|AEG 10 (NO REV)|
20|FH_F126783_80021_0|SrvcGrp|104079|2022|PCT|0.70|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F116023_10027_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F111566_75093_0|SrvcGrp|12840|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F122152_70123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F130671_42701_0|SrvcGrp|46903|2022|PDM|541.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F135924_02906_0|SrvcGrp|74059|2022|PDM|3543.30|99|0.00|AETNA CC FOR ER SERVICE CPT 99291|
20|FH_F136022_64759_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F129131_27519_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130933_47129_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F131265_84106_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131407_07607_0|SrvcGrp|86854|2022|PDM|30.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F116463_76501_0|SrvcGrp|93919|2022|PDM|431.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F130766_04967_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AETNA OP CT SCANS (CTSCAN) - HCFA|
20|FH_F121411_33063_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F121763_07202_0|SrvcGrp|107674|2022|PCT|7.99|99|0.00|AETNA RADIOLOGY|
20|FH_F146909_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F69205_0_0|SrvcGrp|10517|2022|PDM|74.04|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F132689_18436_0|SrvcGrp|73842|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111303_19087_0|SrvcGrp|73841|2022|PDM|375.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F111363_33169_0|CSTM-ALL|CSTM-00|2020|PDM|13768.00|99|0.00|AETNA ANGIOPLASTY|
20|FH_F131000_0_0|SrvcGrp|106265|2022|PDM|5114.00|99|0.00|NSL/SINS NDSC TOTAL|
20|FH_F118651_0_0|SrvcGrp|101520|2022|PDM|4959.71|99|0.00|T1H W/T/O (<250G)|
20|FH_F123036_0_0|SrvcGrp|96349|2022|PDM|17500.00|99|0.00|NECK SPINE FUSE|
20|FH_F102325_62691_0|SrvcGrp|73523|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F102325_62691_0|SrvcGrp|26160|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F98300_30236_0|SrvcGrp|88978|2022|PDM|4472.00|99|0.00|VAGINAL DELIVERY|
20|FH_F62697_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63275_0_0|SrvcGrp|3809|2022|PDM|585.88|99|0.00|HOSPICE CARE|
20|FH_F38411_0_0|SrvcGrp|19530|2022|PCT|0.80|99|0.00|MS DRG 809|
20|FH_F130721_04769_0|SrvcGrp|81779|2022|PCT|4.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F109282_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|867.44|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1202 W/O REV|
20|FH_F83995_16748_0|SrvcGrp|26001|2022|PDM|123.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F130329_64114_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_F134249_05060_0|SrvcGrp|78420|2022|PDM|4550.00|99|0.00|INTERIM LABOR|
20|FH_F139722_30022_0|SrvcGrp|14494|2022|PDM|58.62|99|0.00|CONTINUOUS HOMECARE|
20|FH_F116806_0_0|SrvcGrp|107025|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MANDIBLE W/ TRANSOSTEAL BONE PLATE|
20|FH_F138286_50014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149305_76036_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149364_19335_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F145641_06902_0|SrvcGrp|98462|2022|PDM|3802.00|99|0.00|REVISON OF FOOT|
20|FH_F121687_04401_0|SrvcGrp|108918|2022|PCT|1.38|99|0.00|CHEMOTHERAPY ADMINISTRATION|
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F73228_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150221_63131_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F130327_03867_0|SrvcGrp|48398|2022|PDM|163.00|99|0.00|PT SERVICES|
20|FH_F127642_07047_0|SrvcGrp|72992|2022|PDM|1228.00|99|0.00|AEG 2|
20|FH_F133801_87107_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F143545_78723_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147962_85008_0|SrvcGrp|3378|2022|PDM|2800.00|99|0.00|OBSERVATION SVCS|
20|FH_F33496_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F132147_33183_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F110541_99336_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F112712_63005_0|SrvcGrp|65621|2022|PCT|1.00|99|0.00|RN NURSING|
20|FH_F149105_66215_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112665_0_0|SrvcGrp|88159|2022|PDM|7215.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F133207_0_0|SrvcGrp|14614|2022|PDM|3809.00|99|0.00|LITHOTRIPSY|
20|FH_F81377_0_0|SrvcGrp|70074|2022|PDM|2604.00|99|0.00|LAPAROSCOPY CPT 49651|
20|FH_F138736_77038_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
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_F121225_98902_0|SrvcGrp|24753|2022|PCT|0.85|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F121476_0_0|SrvcGrp|108828|2022|PDM|1153.00|99|0.00|NEURAGEN NERVE GUIDE|
20|FH_F150143_27320_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F124369_0_0|SrvcGrp|103331|2022|PDM|17765.00|99|0.00|REVISION OF LOWER LEG TENDON|
20|FH_F50334_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90316_17701_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135614_83642_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110346_38501_0|SrvcGrp|86747|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F145880_80303_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130364_01331_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)|
20|FH_F86052_15063_0|SrvcGrp|75545|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F121476_0_0|SrvcGrp|108864|2022|PDM|889.00|99|0.00|MATERIAL FOR VOCAL CORD MED|
20|FH_F150302_30114_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133947_93950_0|SrvcGrp|73842|2022|PDM|292.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114444_19602_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|AETNA PSYTX W/PT 45 MIN MOD HO (HCFA)|
20|FH_F120720_24541_0|SrvcGrp|48396|2022|PDM|70.00|99|0.00|OT SERVICES|
20|FH_F110881_63125_0|SrvcGrp|75545|2022|PDM|330.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F83978_66739_0|SrvcGrp|110428|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F135623_53115_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|3025.00|99|0.00|AEG 6 (NO REV)|
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1443.00|99|0.00|AEG 7 (NO REV)|
20|FH_F124146_46321_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F113457_17011_0|SrvcGrp|48385|2022|PDM|88.00|99|0.00|SPEECH THERAPY|
20|FH_F117245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86033_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149359_33301_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OCN F/S PRICING: ALL|
20|FH_F116126_0_0|SrvcGrp|26001|2022|PDM|133.35|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F132969_84003_0|SrvcGrp|87799|2022|PDM|93.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F87775_15106_0|SrvcGrp|53144|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F134174_63141_0|SrvcGrp|42723|2022|PDM|400.00|99|0.00|SLEEP STUDIES CPT 95806 W/MODIFIER TC|
20|FH_F126194_61111_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134608_18017_0|SrvcGrp|112609|2022|PDM|200.00|99|0.00|EXAMINATION OF VAGINA|
20|FH_F130329_64114_0|SrvcGrp|111529|2022|PDM|83.00|99|0.00|MID-LINE INSERTION (HCFA)|
20|FH_F150162_39402_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90391_33774_0|SrvcGrp|472|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130017_02302_0|SrvcGrp|88678|2022|PCT|0.00|99|0.00|ACUTE REHAB I|
20|FH_F43863_0_0|SrvcGrp|27725|2022|PDM|40.00|99|0.00|SKILLED RN HOURLY|
20|FH_F111732_33771_0|SrvcGrp|104468|2022|PDM|950.00|99|0.00|ANTEPARTUM CARE ONLY (4-6 VISITS)|
20|FH_F50013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F133770_34601_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120737_45877_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F147962_85008_0|CSTM-ALL|CSTM-00|2020|PDM|1955.00|99|0.00|AEG 10 (NO REV)|
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150165_06032_0|SrvcGrp|35669|2022|PDM|3034.00|99|0.00|CPT 63650|
20|FH_F69606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117344_75062_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F122553_92705_0|SrvcGrp|54142|2022|PDM|197.00|99|0.00|OP INTENSIVE SERVICES|
20|FH_F32762_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85894_0_0|SrvcGrp|17071|2022|PDM|1549.00|99|0.00|ASPG IV|
20|FH_F85894_0_0|SrvcGrp|4003|2022|PDM|1629.00|99|0.00|CPT CODE 99291- CRITICAL CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|147.23|99|0.00|HAPA WPA-NWPA 2012-13 ASC 132 W/O REV|
20|FH_F68887_0_0|SrvcGrp|44106|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F79644_0_0|SrvcGrp|89733|2022|PDM|907.00|99|0.00|ER SVCS|
20|FH_F105145_75075_0|SrvcGrp|41335|2022|PDM|24731.00|99|0.00|TOTAL HIP|
20|FH_F115909_38133_0|SrvcGrp|93919|2022|PDM|649.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F131930_46205_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133652_50310_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132276_33179_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150662_20901_0|SrvcGrp|46104|2022|PDM|135.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F150801_19380_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97880_63501_0|SrvcGrp|73485|2022|PDM|1669.00|99|0.00|AETNA REHAB|
20|FH_F150339_75035_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150979_44060_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F98020_50138_0|SrvcGrp|73605|2022|PDM|2103.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F114206_37203_0|SrvcGrp|86830|2022|PDM|4.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F150982_0_0|SrvcGrp|104256|2022|PDM|1382.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F120157_93103_0|SrvcGrp|105819|2022|PDM|1200.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F134869_08854_0|SrvcGrp|104443|2022|PDM|149.00|99|0.00|AETNA OFFICE/OP VISIT EST (HCFA)|
20|FH_F93254_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124714_64081_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F35557_0_0|SrvcGrp|16303|2022|PDM|48.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132039_92008_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|1224.00|99|0.00|AEG 8 (NO REV)|
20|FH_F137748_95231_0|CSTM-ALL|CSTM-00|2020|PDM|4203.00|99|0.00|AEG 6 (NO REV)|
20|FH_F94643_90501_0|SrvcGrp|14944|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F98001_27603_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG V|
20|FH_F40624_0_0|SrvcGrp|23477|2022|PDM|8810.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F36299_0_0|SrvcGrp|13088|2022|PCT|0.75|99|0.00|ER 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_F35987_0_0|SrvcGrp|360|2022|PDM|1461.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F146266_0_0|SrvcGrp|88820|2022|PDM|1920.00|99|0.00|CPT 24359|
20|FH_F150944_18052_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134874_80120_0|SrvcGrp|104440|2022|PDM|25.00|99|0.00|AETNA DRUG TEST PRSMV DIR OPT OBS|
20|FH_F127418_0_0|SrvcGrp|110764|2022|PDM|18957.29|99|0.00|REPAIR OF DURAL FLUID LEAK W/ LAMI|
20|FH_F132160_0_0|SrvcGrp|95819|2022|PDM|6885.00|99|0.00|GONIOTOMY|
20|FH_F114848_50533_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1269.00|99|0.00|AEG 6 (NO REV)|
20|FH_F151699_01752_0|SrvcGrp|22592|2022|PDM|60.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F132254_40207_0|SrvcGrp|86852|2022|PDM|50.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F113765_0_0|SrvcGrp|45924|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F138228_76208_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98820_81401_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS|
20|FH_F149023_44122_0|CSTM-ALL|CSTM-00|2020|PDM|1454.00|99|0.00|AEG 3 (NO REV)|
20|FH_F120157_93103_0|SrvcGrp|103669|2022|PDM|475.00|99|0.00|AETNA PARTIAL HOSP (HCFA)|
20|FH_F112045_90301_0|SrvcGrp|11259|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV)|
20|FH_F110726_19720_0|SrvcGrp|3178|2022|PDM|1004.00|99|0.00|ACUTE PSYCH|
20|FH_F112306_81428_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134916_16421_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41463_0_0|SrvcGrp|35465|2022|PDM|42.50|99|0.00|OXYGEN RENTAL (E0439 + E0434)|
20|FH_F124364_38611_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37304_0_0|SrvcGrp|17046|2022|PDM|87.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|2443.00|99|0.00|ASPG IX|
20|FH_F148667_0_0|SrvcGrp|26278|2022|PDM|2856.00|99|0.00|CPT 29881|
20|FH_F84532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F143668_0_0|SrvcGrp|115710|2022|PDM|450.00|99|0.00|PNEUMATIC COMPRESSOR SEGMEN (MOD UE)|
20|FH_F90232_15126_0|SrvcGrp|86779|2022|PDM|113.40|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F35779_32514_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|GENERAL ACUTE CARE|
20|FH_F120207_0_0|SrvcGrp|108191|2022|PDM|2813.20|99|0.00|ILIAC REVASC|
20|FH_F35387_0_0|SrvcGrp|360|2022|PDM|1234.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F148940_44077_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97640_37043_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F35452_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.00|99|0.00|ASPG I|
20|FH_F132235_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F91953_99508_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149582_01534_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150940_92708_0|SrvcGrp|74668|2022|PDM|413.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114207_35243_0|SrvcGrp|17015|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116332_0_0|SrvcGrp|35921|2022|PDM|12178.00|99|0.00|BARIATRIC SURGERY|
20|FH_F120154_77498_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F36952_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F84015_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F47902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD 26|
20|FH_F47212_0_0|SrvcGrp|43568|2022|PDM|90.00|99|0.00|SKILLED NURSING - RN|
20|FH_F128198_34208_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F124441_0_0|SrvcGrp|59841|2022|PDM|1615.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F137731_92262_0|SrvcGrp|89412|2022|PDM|500.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F67764_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97480_08204_0|SrvcGrp|73605|2022|PDM|2084.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|712.00|99|0.00|AEG 5  (NO REV)|
20|FH_F150982_0_0|SrvcGrp|77444|2022|PDM|1652.00|99|0.00|VASECTOMY|
20|FH_F124287_43160_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151699_01752_0|SrvcGrp|86837|2022|PDM|225.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F40346_0_0|SrvcGrp|3029|2022|PDM|350.00|99|0.00|NEWBORN NURSERY|
20|FH_F151000_20707_0|SrvcGrp|82981|2022|PDM|166.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F151202_0_0|SrvcGrp|74668|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148965_62025_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140295_0_0|SrvcGrp|82114|2022|PDM|4110.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F151699_01752_0|SrvcGrp|29077|2022|PDM|225.00|99|0.00|HOME TRANSFUSION|
20|FH_F132254_40207_0|SrvcGrp|16750|2022|PDM|110.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F128741_92879_0|SrvcGrp|48394|2022|PDM|95.86|99|0.00|SKILLED NURSING SERVICES|
20|FH_F124487_89502_0|SrvcGrp|27968|2022|PDM|55.00|99|0.00|SKILLED NURSING LPN|
20|FH_F140127_64131_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F114931_0_0|SrvcGrp|78283|2022|PDM|3200.00|99|0.00|CPT 49505|
20|FH_F151720_03301_0|SrvcGrp|107667|2022|PDM|625.00|99|0.00|AETNA PARTIAL HOSP EATING DIS FULL DAY|
20|FH_F48224_0_0|SrvcGrp|62741|2022|PDM|1472.00|99|0.00|SURGICAL CARVEOUTS|
20|FH_F120190_92624_0|SrvcGrp|75419|2022|PDM|600.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F132431_79606_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F132480_92054_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132419_84042_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F120799_92651_0|SrvcGrp|73605|2022|PDM|1250.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F116739_78501_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F36439_0_0|SrvcGrp|23006|2022|PDM|650.00|99|0.00|V5255|
20|FH_F59732_0_0|SrvcGrp|24751|2022|PDM|80.00|99|0.00|INTERMITTENT ANTICOAGULANT THERAPY|
20|FH_F89475_71202_0|SrvcGrp|114504|2022|PCT|1.98|99|0.00|LABORATORY SERVICES|
20|FH_F120215_92064_0|SrvcGrp|46903|2022|PDM|556.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F120308_07901_0|SrvcGrp|86722|2022|PDM|249.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F89475_71202_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F127205_44125_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F128878_11203_0|SrvcGrp|111180|2022|PDM|140.00|99|0.00|PSYTX W PT W E/M 45 MINS (MOD AF)|
20|FH_F129653_0_0|SrvcGrp|89842|2022|PDM|4000.00|99|0.00|LUMBAR|
20|FH_F32056_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F130747_0_0|SrvcGrp|78096|2022|PDM|5202.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F38025_0_0|SrvcGrp|25155|2022|PDM|60.00|99|0.00|PT/OT/ST|
20|FH_F99960_0_0|SrvcGrp|88147|2022|PDM|1760.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA|
20|FH_F82753_18840_0|SrvcGrp|112224|2022|PDM|110.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F47963_0_0|SrvcGrp|26035|2022|PDM|27.50|99|0.00|HOME HEALTH THERAPY VISITS|
20|FH_F150462_30458_0|SrvcGrp|47183|2022|PDM|105.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F129627_06037_0|SrvcGrp|88620|2022|PDM|111.00|99|0.00|SKILLED NURSING RN|
20|FH_F139667_84078_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150765_05001_0|SrvcGrp|27969|2022|PDM|34.00|99|0.00|HOME HEALTH AIDE|
20|FH_F150769_02302_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150770_43113_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|791.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F40904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|16062.00|99|0.00|MS DRG 238|
20|FH_F117799_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
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_F122841_0_0|SrvcGrp|85966|2022|PDM|1772.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F98360_11554_0|SrvcGrp|73461|2022|PDM|11173.00|99|0.00|AETNA NICU IV|
20|FH_F114676_91911_0|SrvcGrp|86748|2022|PCT|1.20|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD KM"|
20|FH_F147215_48105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137730_46563_0|SrvcGrp|73842|2022|PDM|206.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124270_46256_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35779_32514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F40899_0_0|SrvcGrp|31188|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC (DME)|
20|FH_F102525_73134_0|CSTM-ALL|CSTM-00|2020|PDM|15260.00|99|0.00|MS DRG 490 ONLY|
20|FH_F130661_04441_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 10 (NO REV)|
20|FH_F147174_75231_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97100_23462_0|SrvcGrp|73559|2022|PDM|12544.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F149601_64111_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 4 (NO REV)|
20|FH_F50398_0_0|SrvcGrp|33165|2022|PDM|405.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F150982_0_0|SrvcGrp|46885|2022|PDM|2202.00|99|0.00|REPAIR BROW DEFECT|
20|FH_F147218_48026_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71064_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|OCN F/S PRICING: ALL (SOURCE BB)|
20|FH_F132056_32080_0|SrvcGrp|46903|2022|PDM|650.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F137789_48146_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F131449_19073_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F35369_0_0|SrvcGrp|24|2022|PDM|3500.00|99|0.00|CARDIAC CATH|
20|FH_F69183_0_0|SrvcGrp|10905|2022|PCT|0.50|99|0.00|EMERGENCY ROOM LEVEL III|
20|FH_F98022_89015_0|SrvcGrp|73602|2022|PDM|2268.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F94621_07728_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F138018_17313_0|SrvcGrp|26867|2022|PDM|105.00|99|0.00|ANTI-EMETICS INFUSION THERAPY|
20|FH_F47424_0_0|SrvcGrp|42782|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F40653_0_0|SrvcGrp|33151|2022|PCT|0.90|99|0.00|BONE MARROW TRANSPLANT|
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|1254.00|99|0.00|AEG 10 (NO REV)|
20|FH_F125214_12428_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 10 (NO REV)|
20|FH_F150982_0_0|SrvcGrp|83640|2022|PDM|2202.00|99|0.00|CPT 29887|
20|FH_F149579_95815_0|SrvcGrp|115671|2022|PDM|49.85|99|0.00|CARE MGMT BH (HCFA)|
20|FH_F123570_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F128369_72901_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137732_08690_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F47558_0_0|SrvcGrp|40406|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD AW|
20|FH_F134871_28205_0|SrvcGrp|89149|2022|PDM|239.00|99|0.00|OP INTENSIVE|
20|FH_F67419_0_0|SrvcGrp|29463|2022|PDM|25.00|99|0.00|HOSPICE PAIN MANAGEMENT KIT|
20|FH_F98900_42001_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F147146_06117_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120099_86305_0|SrvcGrp|104079|2022|PCT|1.30|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F124695_33401_0|SrvcGrp|113927|2022|PDM|529.00|99|0.00|PARTIAL HOSPITAL (13-17 YRS)|
20|FH_F111266_30339_0|SrvcGrp|86852|2022|PDM|30.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F133569_17202_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F130970_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F69811_0_0|CSTM-ALL|CSTM-00|2020|PCT|51.00|99|0.00|OP SVCS|
20|FH_F84058_0_0|SrvcGrp|13597|2022|PDM|209.56|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F147180_19050_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F47902_0_0|SrvcGrp|43840|2022|PCT|1.00|99|0.00|DME MOD NUKL|
20|FH_F139847_66205_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F136493_0_0|SrvcGrp|83521|2022|PDM|166.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F142587_0_0|SrvcGrp|22596|2022|PDM|177.81|99|0.00|HOSPICE CARE|
20|FH_F40527_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|SPINAL CORD REHABILITATION|
20|FH_F44255_0_0|CSTM-ALL|CSTM-00|2020|PDM|212.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F39443_0_0|SrvcGrp|30370|2022|PDM|1161.00|99|0.00|HAPA WPA ASC 13|
20|FH_F127258_79912_0|SrvcGrp|3178|2022|PDM|822.00|99|0.00|ACUTE PSYCH|
20|FH_F134847_0_0|SrvcGrp|92405|2022|PDM|4345.00|99|0.00|PERQ LUMBOSACRAL INJECTION|
20|FH_F147237_40006_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F38364_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F116583_0_0|SrvcGrp|95661|2022|PDM|150.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F84532_0_0|SrvcGrp|13187|2022|PCT|0.31|99|0.00|INTRAOCULAR LENSES|
20|FH_F33632_52349_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147332_19406_0|SrvcGrp|87077|2022|PDM|205.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F35174_0_0|SrvcGrp|6|2022|PCT|0.71|99|0.00|OP SURGERY|
20|FH_F140210_60643_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F126153_44663_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
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_F125663_66614_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 3 (NO REV)|
20|FH_F128333_71001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111288_0_0|SrvcGrp|70749|2022|PDM|2849.00|99|0.00|CPT 29823|
20|FH_F93132_73134_0|CSTM-ALL|CSTM-00|2020|PDM|80.00|99|0.00|SKILLED NURSING SERVICES (15 MINS)|
20|FH_F39273_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F124955_98225_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130051_31707_0|CSTM-ALL|CSTM-00|2020|PDM|3928.00|99|0.00|AEG 3 (NO REV)|
20|FH_F78603_0_0|SrvcGrp|177|2022|PDM|3689.05|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F139173_0_0|SrvcGrp|29347|2022|PDM|95.00|99|0.00|HOME HEALTH AIDE|
20|FH_F150982_0_0|SrvcGrp|88147|2022|PDM|4184.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA|
20|FH_F69322_0_0|CSTM-ALL|CSTM-00|2020|PDM|402.00|99|0.00|CHILD PSYCH PARTIAL HOSP|
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 1 (NO REV)|
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|1548.00|99|0.00|AEG 7 (NO REV)|
20|FH_F120294_46322_0|SrvcGrp|48394|2022|PDM|32.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F149888_68506_0|SrvcGrp|98268|2022|PDM|5252.00|99|0.00|HIP ARTHROSCOPY DX|
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126489_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F68943_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|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_F69423_0_0|SrvcGrp|16732|2022|PDM|2965.00|99|0.00|HYSTEROSCOPY ABLATION|
20|FH_F82931_18847_0|SrvcGrp|100961|2022|PDM|342.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY|
20|FH_F36366_0_0|SrvcGrp|13627|2022|PDM|246.00|99|0.00|SLEEP STUDY|
20|FH_F150699_0_0|SrvcGrp|76023|2022|PDM|38065.00|99|0.00|OP AICD 33249|
20|FH_F82753_18840_0|SrvcGrp|80524|2022|PDM|34145.00|99|0.00|INFLATABLE PENILE PROSTHESIS|
20|FH_F73985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F151146_0_0|CSTM-ALL|CSTM-00|2020|PDM|1648.00|99|0.00|HERNIA REPAIR|
20|FH_F125983_82301_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F110023_33936_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|GENERAL ACUTE CARE|
20|FH_F31798_0_0|SrvcGrp|10427|2022|PCT|0.85|99|0.00|TRAUMA CARE|
20|FH_F39819_0_0|SrvcGrp|16|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION|
20|FH_F138010_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F125011_74467_0|SrvcGrp|85990|2022|PDM|2415.00|99|0.00|CPT 45560|
20|FH_F92091_0_0|SrvcGrp|89979|2022|PDM|6000.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F116923_85259_0|SrvcGrp|73842|2022|PDM|313.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F38377_0_0|SrvcGrp|24288|2022|PDM|105.00|99|0.00|SKILLED NURSING WOUND CARE|
20|FH_F139515_0_0|SrvcGrp|82109|2022|PDM|1626.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F109240_21201_0|SrvcGrp|89689|2022|PDM|333.00|99|0.00|ECHO GUIDANCE RADIOTHERAPY|
20|FH_F115985_0_0|SrvcGrp|73601|2022|PDM|1585.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F39138_0_0|SrvcGrp|18145|2022|PDM|14374.00|99|0.00|MS DRG 248|
20|FH_F118086_66604_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F42360_0_0|SrvcGrp|35954|2022|PCT|1.50|99|0.00|RADIOLOGY (PET, CT, MRI)|
20|FH_F141129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F130204_40807_0|SrvcGrp|73842|2022|PDM|184.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49653_0_0|SrvcGrp|22993|2022|PDM|2160.00|99|0.00|NICU LEVEL III & IV|
20|FH_F145550_62034_0|SrvcGrp|48385|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F37651_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD KF|
20|FH_F101711_0_0|SrvcGrp|46605|2022|PDM|75.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|432.00|99|0.00|AEG 2 (NO REV)|
20|FH_F117044_37352_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117378_16148_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97102_83501_0|SrvcGrp|73559|2022|PDM|14184.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F116955_16801_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F93881_15009_0|SrvcGrp|87126|2022|PCT|0.00|99|0.00|GLOBAL STRESS THALLIUM TESTING DENIAL|
20|FH_F89475_71202_0|SrvcGrp|99072|2022|PDM|3374.00|99|0.00|AETNA MATERNITY DELIVERY|
20|FH_F111288_0_0|SrvcGrp|67072|2022|PDM|4364.00|99|0.00|CPT 22845|
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F124048_47304_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F65159_0_0|CSTM-ALL|CSTM-00|2020|PDM|5107.00|99|0.00|TEMPLE LAP AND ARTH CARVEOUTS|
20|FH_F122688_19904_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F86914_19605_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F87092_60101_0|SrvcGrp|13990|2022|PCT|1.03|99|0.00|PACEMAKER|
20|FH_F148345_0_0|CSTM-ALL|CSTM-00|2020|PDM|908.00|99|0.00|AEG 3 (NO REV)|
20|FH_F32994_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OBSERVATION SVCS|
20|FH_F72544_0_0|SrvcGrp|13199|2022|PDM|6613.00|99|0.00|TRAUMA CARE|
20|FH_F77462_0_0|SrvcGrp|42974|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F119491_19904_0|SrvcGrp|48398|2022|PDM|84.00|99|0.00|PT SERVICES|
20|FH_F92676_15063_0|SrvcGrp|79081|2022|PDM|268.14|99|0.00|MON VALLEY ASC 316|
20|FH_F112854_53225_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F91937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F51438_0_0|SrvcGrp|10903|2022|PDM|150.00|99|0.00|EMERGENCY ROOM LEVEL I|
20|FH_F45436_0_0|SrvcGrp|12702|2022|PDM|65.00|99|0.00|RN, INTERMITTENT VISIT|
20|FH_F125019_67665_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F143249_89801_0|SrvcGrp|34566|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F75305_0_0|SrvcGrp|16|2022|PDM|1967.00|99|0.00|ACUTE REHABILITATION|
20|FH_F131040_47715_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47600_0_0|SrvcGrp|43320|2022|PDM|350.00|99|0.00|CT SCANS|
20|FH_F132416_92270_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116698_07470_0|SrvcGrp|14948|2022|PDM|36.75|99|0.00|HOME INFUSION THERAPY|
20|FH_F120050_92626_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F120887_78750_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120971_60714_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F33925_0_0|SrvcGrp|18834|2022|PDM|22990.00|99|0.00|MS DRG 225|
20|FH_F149679_0_0|SrvcGrp|13422|2022|PDM|188.89|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F46354_0_0|SrvcGrp|38925|2022|PCT|1.10|99|0.00|HCPC IMPLANTS|
20|FH_F59732_0_0|SrvcGrp|26868|2022|PDM|80.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F61292_0_0|SrvcGrp|20900|2022|PDM|14535.00|99|0.00|MS DRG 248 ONLY|
20|FH_F93920_0_0|SrvcGrp|75505|2022|PCT|0.75|99|0.00|CARDIAC STUDIES|
20|FH_F131902_46402_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139551_0_0|SrvcGrp|35672|2022|PDM|4531.00|99|0.00|CPT 23412|
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PDM|599.00|99|0.00|AEG 1 (NO REV)|
20|FH_F125983_82301_0|SrvcGrp|87131|2022|PDM|457.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F40661_0_0|CSTM-ALL|CSTM-00|2020|PDM|245.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F66501_0_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F112708_0_0|SrvcGrp|99981|2022|PDM|2223.00|99|0.00|LAPAROSCOPY SERVICES|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F110925_01104_0|SrvcGrp|86154|2022|PDM|11.86|99|0.00|AETNA EPOPROSTENOL|
20|FH_F149919_85390_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F82696_16335_0|SrvcGrp|58649|2022|PDM|191.00|99|0.00|INTENSIVE OUTPATIENT|
20|FH_F145758_20745_0|SrvcGrp|67065|2022|PDM|2244.00|99|0.00|CERVICAL SURGERY|
20|FH_F129650_49417_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143528_0_0|SrvcGrp|90369|2022|PDM|1518.30|99|0.00|PROBE NASOLACRIMAL DUCT|
20|FH_F135231_90265_0|SrvcGrp|89149|2022|PDM|625.00|99|0.00|OP INTENSIVE|
20|FH_F128896_53209_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F93881_15009_0|SrvcGrp|75479|2022|PDM|1047.00|99|0.00|AEG 1|
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)|
20|FH_F130523_04605_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|AEG 5  (NO REV)|
20|FH_F122687_0_0|SrvcGrp|89979|2022|PDM|13413.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F137367_89139_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F127209_45365_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F126926_32250_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F125118_99201_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F131948_23226_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116747_0_0|SrvcGrp|27968|2022|PCT|0.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135236_02840_0|SrvcGrp|111926|2022|PDM|203.10|99|0.00|COVID-19 LAB TESTING|
20|FH_F81172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F122433_0_0|SrvcGrp|72996|2022|PDM|630.00|99|0.00|AEG 4|
20|FH_F118366_17110_0|SrvcGrp|90707|2022|PDM|95.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F39273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD UE|
20|FH_F129666_71901_0|SrvcGrp|46605|2022|PDM|179.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|397.24|99|0.00|HAPA WPA-NWPA 2012-13 ASC 304 W/O REV|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|ASPG X|
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|ASPG X|
20|FH_F110236_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90492_0_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F42706_0_0|SrvcGrp|473|2022|PDM|470.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F88212_20151_0|SrvcGrp|46605|2022|PDM|90.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F76171_0_0|SrvcGrp|48631|2022|PDM|154.00|99|0.00|OCCUPATIONAL THERAPY SVCS RE-EVAL|
20|FH_F82753_18840_0|SrvcGrp|80498|2022|PDM|15046.00|99|0.00|TRANSCATHETER PLACEMENT|
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.00|99|0.00|AEG 7 (NO REV)|
20|FH_F38357_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F145537_02061_0|SrvcGrp|90854|2022|PDM|896.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F141590_90049_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F86332_75081_0|SrvcGrp|10649|2022|PDM|10.00|99|0.00|HOME INFUSION|
20|FH_F137239_0_0|SrvcGrp|73842|2022|PDM|235.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F150460_48334_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134287_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.45|99|0.00|HSS ASC|
20|FH_F123384_72076_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F56276_0_0|SrvcGrp|52950|2022|PDM|109.00|99|0.00|PSYCHIATRIC CPT 90818|
20|FH_F120059_0_0|SrvcGrp|108120|2022|PDM|1650.00|99|0.00|REPL TUNNLD CNTRL CVC W/O PORT/PUMP|
20|FH_F97000_24201_0|SrvcGrp|72300|2022|PDM|371.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F39476_0_0|SrvcGrp|41408|2022|PDM|2700.00|99|0.00|ANGIO + CARDIAC CATH W/ICD9|
20|FH_F40472_0_0|SrvcGrp|28068|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139515_0_0|SrvcGrp|33987|2022|PDM|1625.00|99|0.00|CPT 57522|
20|FH_F52854_0_0|SrvcGrp|17065|2022|PDM|852.00|99|0.00|ASPG I|
20|FH_F77983_0_0|SrvcGrp|56522|2022|PCT|1.00|99|0.00|SURGICAL PATHOLOGY LEVEL IV|
20|FH_F116024_13203_0|SrvcGrp|87317|2022|PDM|461.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F148599_98034_0|SrvcGrp|73498|2022|PDM|1026.00|99|0.00|AETNA ER LEVEL III|
20|FH_F38702_0_0|SrvcGrp|111932|2022|PDM|87.00|99|0.00|COVID-19 NON-CDC TESTING LAB|
20|FH_F144318_32696_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F90811_0_0|SrvcGrp|90424|2022|PDM|2500.00|99|0.00|ANKLE ARTHROSCOPY SURGERY|
20|FH_F51548_0_0|SrvcGrp|22387|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F113287_72501_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145988_06105_0|SrvcGrp|114462|2022|PCT|1.19|99|0.00|CHEMO DRUGS|
20|FH_F128144_45697_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F38865_0_0|SrvcGrp|1306|2022|PDM|340.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F117372_07442_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F96261_0_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F117335_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F146217_0_0|SrvcGrp|84185|2022|PDM|141.22|99|0.00|RESPITE CARE|
20|FH_F102561_75146_0|SrvcGrp|53065|2022|PDM|4520.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F119825_0_0|SrvcGrp|104230|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F74187_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F44257_0_0|SrvcGrp|17019|2022|PDM|1854.00|99|0.00|ICU/CCU|
20|FH_F86293_0_0|SrvcGrp|44064|2022|PDM|1995.00|99|0.00|CPT 52351|
20|FH_F106540_26330_0|SrvcGrp|79786|2022|PDM|1492.00|99|0.00|SLEEP STUDIES|
20|FH_F127191_44720_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F89015_74017_0|SrvcGrp|48645|2022|PDM|110.00|99|0.00|OP SKILLED NURSING|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|115.22|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)|
20|FH_F132420_84660_0|SrvcGrp|58509|2022|PDM|456.78|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PDM|2063.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123012_27703_0|SrvcGrp|74668|2022|PDM|500.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|ASPG I|
20|FH_F34706_0_0|SrvcGrp|2868|2022|PDM|47476.00|99|0.00|DRG 536 CARDIAC DEFIBRULATOR IMPLANTS|
20|FH_F91155_16105_0|SrvcGrp|74661|2022|PDM|243.00|99|0.00|AETNA SLEEP STUDIES|
20|FH_F96261_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT HH|
20|FH_F106400_02905_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F40465_0_0|SrvcGrp|32607|2022|PCT|0.75|99|0.00|JOINT REPLACEMENT PROCEDURES|
20|FH_F106660_26554_0|SrvcGrp|46605|2022|PDM|90.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F101840_76054_0|SrvcGrp|72994|2022|PDM|1464.00|99|0.00|AEG 3|
20|FH_F92677_08003_0|SrvcGrp|22593|2022|PDM|63.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F133251_89521_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|ASPG X|
20|FH_F141870_85224_0|SrvcGrp|29075|2022|PDM|35.00|99|0.00|HYDRATION THERAPY|
20|FH_F35411_0_0|SrvcGrp|13160|2022|PDM|204.00|99|0.00|PSYCH/CD INTENSIVE CARE SVCS|
20|FH_F137240_0_0|SrvcGrp|361|2022|PDM|4037.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F133021_00910_0|SrvcGrp|112288|2022|PDM|3000.00|99|0.00|INTRA-AORTIC BALLOON|
20|FH_F55113_0_0|SrvcGrp|51276|2022|PCT|0.70|99|0.00|TRANSPLANT|
20|FH_F117087_0_0|SrvcGrp|14320|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F71271_0_0|SrvcGrp|68262|2022|PDM|12.00|99|0.00|SPEECH THERAPY|
20|FH_F87155_04105_0|SrvcGrp|48398|2022|PDM|94.56|99|0.00|PT SERVICES|
20|FH_F125540_19462_0|SrvcGrp|91957|2022|PDM|175.00|99|0.00|INTENSIVE OUTPATIENT (>=18 YRS)|
20|FH_F43411_0_0|SrvcGrp|360|2022|PDM|2385.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F119206_35007_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F102561_75146_0|SrvcGrp|67065|2022|PDM|24273.00|99|0.00|CERVICAL SURGERY|
20|FH_F128120_76513_0|SrvcGrp|105819|2022|PDM|1139.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F43719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F44134_0_0|SrvcGrp|14614|2022|PDM|4400.00|99|0.00|LITHOTRIPSY|
20|FH_F43018_0_0|SrvcGrp|8950|2022|PDM|3530.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F133018_84037_0|SrvcGrp|65621|2022|PDM|30.00|99|0.00|RN NURSING|
20|FH_F41596_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F100785_54660_0|SrvcGrp|73643|2022|PDM|1750.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F101840_76054_0|SrvcGrp|73496|2022|PDM|1391.00|99|0.00|AETNA ER LEVEL V|
20|FH_F126666_44053_0|SrvcGrp|91394|2022|PDM|83.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD HO)|
20|FH_F146360_66502_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F106400_02905_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129535_0_0|SrvcGrp|86426|2022|PDM|600.00|99|0.00|REMOVE INT/EXT HEM GROUP 2|
20|FH_F133118_33143_0|SrvcGrp|89417|2022|PDM|457.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F87577_80016_0|SrvcGrp|10430|2022|PDM|12314.00|99|0.00|DIAGNOSTIC CARDIAC CATH|
20|FH_F133028_08021_0|SrvcGrp|91065|2022|PDM|108.00|99|0.00|PSYCHIATRIC CPT 90853 (HCFA)|
20|FH_F148021_80907_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100666_81301_0|SrvcGrp|73643|2022|PDM|1681.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F141804_70503_0|SrvcGrp|96699|2022|PDM|148.79|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F117575_0_0|SrvcGrp|76243|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F148907_01810_0|SrvcGrp|98701|2022|PDM|290.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER KL|
20|FH_F109812_37043_0|SrvcGrp|86749|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F86091_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS|
20|FH_F44383_0_0|CSTM-ALL|CSTM-00|2020|PDM|82.50|99|0.00|OP SVCS|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|HAPA EPA ASC 30|
20|FH_F118456_30012_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F136002_0_0|SrvcGrp|88620|2022|PDM|86.70|99|0.00|SKILLED NURSING RN|
20|FH_F148740_93230_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F88254_33411_0|SrvcGrp|22589|2022|PDM|30.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F33642_0_0|SrvcGrp|10964|2022|PDM|1500.00|99|0.00|ACUTE IP MED/SURG SVCS|
20|FH_F90958_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40063_0_0|SrvcGrp|361|2022|PDM|3160.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F131128_0_0|SrvcGrp|89980|2022|PDM|4774.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F37593_0_0|SrvcGrp|64260|2022|PDM|113.96|99|0.00|OP SVCS|
20|FH_F78922_0_0|SrvcGrp|16|2022|PDM|950.00|99|0.00|ACUTE REHABILITATION|
20|FH_F123407_04605_0|SrvcGrp|89149|2022|PDM|170.00|99|0.00|OP INTENSIVE|
20|FH_F69807_0_0|CSTM-ALL|CSTM-00|2020|PCT|56.56|99|0.00|OP SVCS|
20|FH_F89563_29407_0|SrvcGrp|90492|2022|PCT|1.00|99|0.00|BEHAVRAL QUALIT ANALYS VOICE|
20|FH_F133671_89102_0|SrvcGrp|27968|2022|PDM|35.00|99|0.00|SKILLED NURSING LPN|
20|FH_F148324_93101_0|SrvcGrp|89337|2022|PDM|1275.00|99|0.00|DETOXIFICATION|
20|FH_F102302_0_0|SrvcGrp|11043|2022|PDM|1817.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F134995_37055_0|SrvcGrp|73605|2022|PDM|1029.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F148179_48065_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F121164_61761_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F129367_89117_0|SrvcGrp|89417|2022|PDM|483.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|949.00|99|0.00|AEG 8 (NO REV)|
20|FH_F116327_75701_0|SrvcGrp|46903|2022|PDM|431.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F116327_75701_0|SrvcGrp|86723|2022|PDM|324.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F150761_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F110263_0_0|SrvcGrp|41334|2022|PDM|12703.00|99|0.00|TOTAL KNEE|
20|FH_F82931_18847_0|SrvcGrp|72780|2022|PDM|59.37|99|0.00|HOME HEALTH AIDE - VISIT LEVEL|
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 8 (NO REV)|
20|FH_F92276_32308_0|CSTM-ALL|CSTM-00|2020|PDM|893.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F31957_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149889_39759_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S AZ/NV - MOD KF|
20|FH_F31798_0_0|SrvcGrp|13294|2022|PDM|473.00|99|0.00|MRI|
20|FH_F145537_02061_0|CSTM-ALL|CSTM-00|2020|PDM|473.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F148265_06067_0|SrvcGrp|88156|2022|PDM|26839.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F141507_0_0|SrvcGrp|46890|2022|PDM|4000.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F129367_89117_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148255_72703_0|SrvcGrp|24753|2022|PDM|10.50|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|482.00|99|0.00|ASPG X|
20|FH_F145508_0_0|SrvcGrp|84185|2022|PDM|181.21|99|0.00|RESPITE CARE|
20|FH_F88639_80204_0|SrvcGrp|73500|2022|PDM|701.92|99|0.00|AETNA ER LEVEL I|
20|FH_F111594_0_0|SrvcGrp|41334|2022|PDM|7215.00|99|0.00|TOTAL KNEE|
20|FH_F137951_0_0|SrvcGrp|88487|2022|PDM|3000.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F145937_75240_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F137896_0_0|CSTM-ALL|CSTM-00|2020|PDM|173.80|99|0.00|SINGLE PORT O2 CONCENTRATOR (MOD RR) (HCFA)|
20|FH_F141870_85224_0|SrvcGrp|43568|2022|PDM|100.00|99|0.00|SKILLED NURSING - RN|
20|FH_F45435_0_0|SrvcGrp|8962|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F149652_37212_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149781_37404_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F100785_54660_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117717_68410_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F123538_21206_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116988_0_0|SrvcGrp|75485|2022|PDM|840.00|99|0.00|AEG 4|
20|FH_F133490_90650_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F138054_0_0|SrvcGrp|42972|2022|PDM|66.63|99|0.00|HOME HEALTH AIDE|
20|FH_F111540_16823_0|SrvcGrp|104431|2022|PDM|30.47|99|0.00|AETNA OFFICE OUTPATIENT VISIT VST (MOD AF)(HCFA)|
20|FH_F117756_75402_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F144728_33541_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122338_0_0|SrvcGrp|72990|2022|PDM|1485.00|99|0.00|AEG 1|
20|FH_F39995_0_0|SrvcGrp|115|2022|PDM|525.00|99|0.00|SKILLED NURSING CARE|
20|FH_F145937_75240_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150120_93619_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115330_34113_0|SrvcGrp|100160|2022|PDM|700.00|99|0.00|AETN IP PSYCH EATING DISORDERS|
20|FH_F33103_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS|
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42340_0_0|SrvcGrp|31189|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF (DME)|
20|FH_F109846_16502_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35173_0_0|SrvcGrp|997|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.53|99|0.00|ASPG 6|
20|FH_F33664_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|GENERAL ACUTE CARE|
20|FH_F132729_0_0|CSTM-ALL|CSTM-00|2020|PDM|2059.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1420.00|99|0.00|AEG 10 (NO REV)|
20|FH_F44607_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F143202_32114_0|SrvcGrp|113276|2022|PCT|1.15|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148639_0_0|SrvcGrp|115486|2022|PDM|4260.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F119437_0_0|SrvcGrp|67072|2022|PDM|4750.00|99|0.00|CPT 22845|
20|FH_F150024_08079_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|AEG 1 (NO REV)|
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136393_0_0|SrvcGrp|112883|2022|PDM|8000.00|99|0.00|FEM/POPL REVAS W/ATHER|
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|ASPG II|
20|FH_F35308_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD QW) - BDSS|
20|FH_F150220_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F47495_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F62577_0_0|SrvcGrp|58458|2022|PDM|1408.00|99|0.00|ASPG V|
20|FH_F64999_0_0|CSTM-ALL|CSTM-00|2020|PDM|1399.00|99|0.00|ASPG VIII|
20|FH_F118236_25901_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS|
20|FH_F120456_67117_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F120489_63552_0|SrvcGrp|91177|2022|PDM|1540.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F93292_62234_0|SrvcGrp|88620|2022|PDM|92.00|99|0.00|SKILLED NURSING RN|
20|FH_F93358_63084_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F134011_84102_0|SrvcGrp|48394|2022|PDM|43.20|99|0.00|SKILLED NURSING SERVICES|
20|FH_F134126_11554_0|SrvcGrp|12280|2022|PCT|0.45|99|0.00|IMPLANTS|
20|FH_F125053_0_0|SrvcGrp|73008|2022|PDM|360.00|99|0.00|AEG 10|
20|FH_F149580_98198_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151562_26003_0|SrvcGrp|113620|2022|PDM|520.00|99|0.00|HOSPICE CARE|
20|FH_F151603_27609_0|SrvcGrp|89842|2022|PDM|15492.86|99|0.00|LUMBAR|
20|FH_F119021_03060_0|SrvcGrp|89149|2022|PDM|230.00|99|0.00|OP INTENSIVE|
20|FH_F118932_07652_0|SrvcGrp|106251|2022|PCT|1.50|99|0.00|LABORATORY SERVICES|
20|FH_F118943_64506_0|SrvcGrp|22589|2022|PDM|34.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F38332_0_0|SrvcGrp|18811|2022|PDM|42216.00|99|0.00|MS DRG 220|
20|FH_F38332_0_0|SrvcGrp|88|2022|PDM|6032.00|99|0.00|OP LITHOTRIPSY|
20|FH_F39623_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147928_11751_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F129427_92262_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F117107_33704_0|SrvcGrp|54670|2022|PDM|4750.00|99|0.00|NORMAL DELIVERY|
20|FH_F137270_82901_0|SrvcGrp|29346|2022|PDM|26.75|99|0.00|SKILLED NURSING- LPN|
20|FH_F90613_05001_0|SrvcGrp|89417|2022|PDM|498.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F90880_15108_0|SrvcGrp|91069|2022|PCT|1.50|99|0.00|AETNA HARVONI IV (MOD TC)|
20|FH_F91472_96001_0|SrvcGrp|103744|2022|PCT|0.40|99|0.00|TOTAL SHOULDER REPLACEMENT|
20|FH_F128804_0_0|SrvcGrp|106264|2022|PDM|5170.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION|
20|FH_F139433_37115_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F147363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F31783_0_0|SrvcGrp|21354|2022|PDM|10606.00|99|0.00|MS DRG 250-251 ONLY|
20|FH_F56274_0_0|CSTM-ALL|CSTM-00|2020|PDM|155.00|99|0.00|PEDIATRIC OCCUPATIONAL THERAPY|
20|FH_F151061_02720_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F151144_35801_0|SrvcGrp|95107|2022|PDM|1273.10|99|0.00|INTRAOCULAR LENS PROSTHESIS|
20|FH_F151152_19150_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114931_0_0|SrvcGrp|105758|2022|PDM|1850.00|99|0.00|I & D PERIANAL ABSCESS|
20|FH_F34963_0_0|SrvcGrp|3810|2022|PDM|140.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F39895_0_0|CSTM-ALL|CSTM-00|2020|PDM|1027.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F117525_0_0|SrvcGrp|73008|2022|PDM|1300.00|99|0.00|AEG 10|
20|FH_F143828_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.00|99|0.00|AEG 1 (NO REV)|
20|FH_F91873_12723_0|SrvcGrp|89144|2022|PDM|1095.00|99|0.00|UPPER GI ENDOSCOPY|
20|FH_F106822_0_0|SrvcGrp|100247|2022|PDM|24.30|99|0.00|NASAL FLU VACCINE|
20|FH_F72049_0_0|SrvcGrp|17139|2022|PDM|704.00|99|0.00|HOSPICE CARE|
20|FH_F77067_0_0|SrvcGrp|941|2022|PDM|2964.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F87054_0_0|SrvcGrp|72990|2022|PDM|604.00|99|0.00|AEG 1|
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 2 (NO REV)|
20|FH_F142315_33701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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_F102041_35010_0|SrvcGrp|88620|2022|PDM|125.00|99|0.00|SKILLED NURSING RN|
20|FH_F33807_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F145784_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F95341_08701_0|SrvcGrp|72379|2022|PCT|0.80|99|0.00|SPEECH THERAPY|
20|FH_F131608_0_0|SrvcGrp|83857|2022|PDM|640.15|99|0.00|IP HOSPICE SVCS|
20|FH_F72162_0_0|SrvcGrp|43567|2022|PDM|114.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F118786_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.33|99|0.00|OP SVCS|
20|FH_F72204_0_0|SrvcGrp|43569|2022|PDM|40.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.85|99|0.00|ASPG II|
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_F119266_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F132351_19342_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146882_84532_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F92493_0_0|SrvcGrp|11669|2022|PDM|2989.14|99|0.00|OP SURG|
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|1073.00|99|0.00|AEG 2 (NO REV)|
20|FH_F98380_43055_0|SrvcGrp|73605|2022|PDM|3423.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F124611_64804_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124671_64844_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F150226_0_0|SrvcGrp|13597|2022|PDM|166.11|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F127995_84010_0|SrvcGrp|46605|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F98101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F137248_0_0|SrvcGrp|96939|2022|PDM|4058.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F139758_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F136665_80004_0|SrvcGrp|115055|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F136674_16335_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F114666_30342_0|SrvcGrp|102481|2022|PDM|2000.00|99|0.00|CPT 29898|
20|FH_F114666_30342_0|SrvcGrp|105639|2022|PDM|1500.00|99|0.00|INCISION OF ACHILLES TENDON|
20|FH_F68944_0_0|SrvcGrp|3409|2022|PDM|893.00|99|0.00|NEWBORN NURSERY|
20|FH_F150602_59718_0|SrvcGrp|27969|2022|PDM|23.00|99|0.00|HOME HEALTH AIDE|
20|FH_F92636_90230_0|SrvcGrp|48396|2022|PDM|89.25|99|0.00|OT SERVICES|
20|FH_F97581_60141_0|SrvcGrp|73559|2022|PDM|12352.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F124928_04210_0|SrvcGrp|87396|2022|PDM|95.31|99|0.00|HCPCS G0155 (HCFA)|
20|FH_F123317_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101840_76054_0|SrvcGrp|28119|2022|PDM|17529.00|99|0.00|MS DRG 466 ONLY|
20|FH_F119079_41018_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F127204_44420_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F150948_0_0|SrvcGrp|88164|2022|PDM|10500.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F42340_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F150119_34205_0|SrvcGrp|115724|2022|PCT|1.00|99|0.00|COVID VACCINE ADMINISTRATION|
20|FH_F87297_17044_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F92676_15063_0|SrvcGrp|79075|2022|PDM|310.72|99|0.00|MON VALLEY ASC 241|
20|FH_F39082_0_0|SrvcGrp|12969|2022|PDM|460.00|99|0.00|NEWBORN NURSERY|
20|FH_F133467_03301_0|SrvcGrp|108484|2022|PDM|1550.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|ASPG III|
20|FH_F139779_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|PHARMACY SVCS|
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|1124.00|99|0.00|AEG 7 (NO REV)|
20|FH_F70026_0_0|SrvcGrp|3810|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|2011 DALLAS TX LAB|
20|FH_F149781_37404_0|SrvcGrp|92364|2022|PDM|9888.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F133530_11237_0|SrvcGrp|79786|2022|PCT|2.20|99|0.00|SLEEP STUDIES|
20|FH_F142027_37217_0|SrvcGrp|88620|2022|PDM|125.00|99|0.00|SKILLED NURSING RN|
20|FH_F50440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133490_90650_0|SrvcGrp|79786|2022|PCT|0.00|99|0.00|SLEEP STUDIES|
20|FH_F115431_32821_0|SrvcGrp|3178|2022|PDM|906.00|99|0.00|ACUTE PSYCH|
20|FH_F128648_44256_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92677_08003_0|SrvcGrp|92102|2022|PDM|210.00|99|0.00|AETNA APNEA MONITOR|
20|FH_F33629_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144990_44708_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117366_33162_0|SrvcGrp|83800|2022|PDM|3900.00|99|0.00|VBAC DELIVERY|
20|FH_F135466_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147998_07030_0|SrvcGrp|89337|2022|PDM|2474.50|99|0.00|DETOXIFICATION|
20|FH_F114519_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117009_0_0|SrvcGrp|107270|2022|PDM|1337.00|99|0.00|INSERT AQUEOUS DRAIN DEVICE|
20|FH_F144011_60616_0|CSTM-ALL|CSTM-00|2020|PDM|4486.00|99|0.00|AEG 6 (NO REV)|
20|FH_F148865_0_0|SrvcGrp|65720|2022|PDM|145.00|99|0.00|RESPITE CARE|
20|FH_F67639_0_0|SrvcGrp|63462|2022|PDM|1025.00|99|0.00|CPT 64595|
20|FH_F123595_70546_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F67901_0_0|SrvcGrp|64134|2022|PDM|31.31|99|0.00|PUMP ANALYSIS W/O REPROGRAMMING|
20|FH_F90314_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F136347_30328_0|SrvcGrp|89337|2022|PDM|1122.00|99|0.00|DETOXIFICATION|
20|FH_F118152_20151_0|SrvcGrp|10577|2022|PDM|45.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F118170_18901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120489_63552_0|SrvcGrp|8950|2022|PDM|1474.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F134008_11221_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F137030_46256_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137242_52722_0|SrvcGrp|89417|2022|PDM|417.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F142430_38863_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142511_78597_0|SrvcGrp|108484|2022|PDM|669.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F142690_31774_0|SrvcGrp|19742|2022|PDM|215.00|99|0.00|MID-LINE INSERTION|
20|FH_F122009_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F138627_82901_0|SrvcGrp|86829|2022|PDM|50.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F139267_30253_0|SrvcGrp|73485|2022|PDM|1430.00|99|0.00|AETNA REHAB|
20|FH_F140609_16063_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140615_73013_0|SrvcGrp|105465|2022|PCT|1.20|99|0.00|AETNA THERAPIES|
20|FH_F140875_63363_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F80284_16354_0|SrvcGrp|16|2022|PDM|879.00|99|0.00|ACUTE REHABILITATION|
20|FH_F146933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132738_0_0|SrvcGrp|110|2022|PDM|846.00|99|0.00|CD - REHABILITATION|
20|FH_F149649_80104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118959_44830_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F92506_07666_0|SrvcGrp|73523|2022|PDM|228.80|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F109885_35473_0|SrvcGrp|93919|2022|PDM|637.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F115452_15235_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F117295_70006_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F147861_45239_0|SrvcGrp|74668|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129483_77030_0|SrvcGrp|24750|2022|PDM|40.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F117123_68025_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F119555_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F137930_51546_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72943_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35210_0_0|SrvcGrp|60098|2022|PCT|0.65|99|0.00|PACEMAKER IMPLANTATION - MS DRG ONLY|
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|2090.00|99|0.00|AEG 10 (NO REV)|
20|FH_F138055_16146_0|SrvcGrp|86723|2022|PDM|300.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PDM|107.37|99|0.00|NEUROPSYCHOLOGICAL TESTING|
20|FH_F144039_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F148553_85016_0|SrvcGrp|115452|2022|PDM|3500.00|99|0.00|INSERT PULSE GEN W/ MULTI LEADS|
20|FH_F42837_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136772_89109_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F136786_25302_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F136830_22003_0|SrvcGrp|73842|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F113713_17013_0|SrvcGrp|105560|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F141170_0_0|SrvcGrp|88065|2022|PDM|13500.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F39622_0_0|SrvcGrp|97|2022|PDM|2100.00|99|0.00|C-SECTION|
20|FH_F115210_21043_0|CSTM-ALL|CSTM-00|2020|PDM|690.00|99|0.00|AEG 2 (NO REV)|
20|FH_F115210_21043_0|CSTM-ALL|CSTM-00|2020|PDM|504.00|99|0.00|AEG 1 (NO REV)|
20|FH_F115567_91711_0|SrvcGrp|86648|2022|PCT|1.25|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F116339_41064_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP|
20|FH_F116835_94538_0|SrvcGrp|114317|2022|PDM|120.00|99|0.00|PSYCL/NRPSYC TST AUTO RESULT|
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|2205.00|99|0.00|AEG 7 (NO REV)|
20|FH_F82894_0_0|SrvcGrp|80098|2022|PDM|31.60|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE|
20|FH_F113649_01752_0|SrvcGrp|116047|2022|PCT|0.97|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F84411_32063_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
20|FH_F36472_0_0|SrvcGrp|131|2022|PCT|0.73|99|0.00|PACEMAKER DEVICE|
20|FH_F39272_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F39621_0_0|SrvcGrp|9263|2022|PDM|235.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F140007_0_0|SrvcGrp|96354|2022|PDM|7887.00|99|0.00|REMOVAL OF ANKLE JOINT|
20|FH_F100681_73104_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F48772_66044_0|SrvcGrp|63297|2022|PDM|118.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|2585.00|99|0.00|AEG 7 (NO REV)|
20|FH_F131235_36049_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F92516_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|3190.00|99|0.00|AEG 4 (NO REV)|
20|FH_F111584_07002_0|SrvcGrp|86723|2022|PDM|338.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F111604_16505_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F135891_0_0|SrvcGrp|30089|2022|PDM|450.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F51938_0_0|SrvcGrp|471|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F113178_44035_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F113178_44035_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F133579_0_0|SrvcGrp|45583|2022|PDM|2551.00|99|0.00|CPT 65730|
20|FH_F72986_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|OP SVCS|
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)|
20|FH_F136410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F38949_0_0|CSTM-ALL|CSTM-00|2020|PDM|1355.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39504_0_0|SrvcGrp|21791|2022|PDM|55.00|99|0.00|PT/OT/ST|
20|FH_F39839_0_0|CSTM-ALL|CSTM-00|2020|PDM|1112.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54552_0_0|SrvcGrp|17005|2022|PDM|67.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS|
20|FH_F113585_20155_0|SrvcGrp|48394|2022|PDM|46.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F138879_17837_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F143832_0_0|SrvcGrp|106799|2022|PDM|5060.10|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 601 W/O REV|
20|FH_F113527_31023_0|SrvcGrp|78377|2022|PDM|992.00|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F113527_31023_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F122089_68010_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F145528_76501_0|SrvcGrp|88779|2022|PDM|101.00|99|0.00|PHYSICAL THERAPY|
20|FH_F91700_15601_0|SrvcGrp|472|2022|PDM|340.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F91764_93710_0|SrvcGrp|113220|2022|PCT|2.12|99|0.00|COVID-19 NFCT DS 22 TRGT SARS-COV-2|
20|FH_F135800_28731_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129456_30809_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F130756_04901_0|SrvcGrp|111930|2022|PCT|1.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F131265_84106_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F116467_13031_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F36701_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F127399_0_0|SrvcGrp|72994|2022|PDM|2081.00|99|0.00|AEG 3|
20|FH_F101556_81004_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F121763_07202_0|SrvcGrp|73006|2022|PDM|2838.00|99|0.00|AEG 9|
20|FH_F33791_0_0|SrvcGrp|10393|2022|PDM|1750.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F36341_0_0|SrvcGrp|9911|2022|PCT|0.50|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPT CARE OF MUNCY FH -KN|
20|FH_F42347_0_0|SrvcGrp|31190|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC (DME)|
20|FH_F101182_07863_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F111301_33122_0|SrvcGrp|99362|2022|PDM|158.00|99|0.00|DX MAMMO INCL CAD BI|
20|FH_F111301_33122_0|SrvcGrp|104285|2022|PDM|62.00|99|0.00|DRUG SCREEN|
20|FH_F134315_89106_0|SrvcGrp|24745|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F140987_0_0|SrvcGrp|93431|2022|PDM|3750.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F117486_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148243_0_0|SrvcGrp|58638|2022|PDM|1500.00|99|0.00|CPT 63688|
20|FH_F36476_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION|
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)|
20|FH_F138051_75069_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F91067_0_0|SrvcGrp|72998|2022|PDM|884.00|99|0.00|AEG 5|
20|FH_F38807_0_0|SrvcGrp|29719|2022|PCT|0.45|99|0.00|IMPLANTS|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|505.52|99|0.00|DELAWARE VALLEY- ASC 2|
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)|
20|FH_F111001_0_0|CSTM-ALL|CSTM-00|2020|PDM|11.00|99|0.00|RESPITE CARE (MOD TE)|
20|FH_F39727_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151663_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F117001_0_0|SrvcGrp|49103|2022|PDM|400.00|99|0.00|HEARING AID|
20|FH_F71863_0_0|SrvcGrp|9830|2022|PDM|104.50|99|0.00|OT SVCS|
20|FH_F80711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1244.00|99|0.00|AEG 6 (NO REV)|
20|FH_F114916_30309_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114916_30309_0|SrvcGrp|84307|2022|PDM|2140.00|99|0.00|TENDON REPAIR|
20|FH_F135491_0_0|SrvcGrp|42550|2022|PDM|1143.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F138929_0_0|SrvcGrp|100014|2022|PDM|5005.00|99|0.00|REPAIR RADIUS OR ULNA|
20|FH_F94786_07974_0|SrvcGrp|41457|2022|PDM|1.94|99|0.00|ENTERAL FORMULA - PEDIATRICS (HYDROLYZED)|
20|FH_F132627_0_0|SrvcGrp|21711|2022|PDM|220.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F134270_0_0|SrvcGrp|88065|2022|PDM|14000.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137067_0_0|SrvcGrp|95559|2022|PDM|28875.00|99|0.00|HIP JOINT|
20|FH_F47694_0_0|SrvcGrp|3577|2022|PDM|615.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F62252_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141147_02571_0|SrvcGrp|113577|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.00|99|0.00|AEG 2 (NO REV)|
20|FH_F93252_0_0|SrvcGrp|93012|2022|PDM|1500.00|99|0.00|GASTROENTEROLOGY PROCEDURES|
20|FH_F126345_0_0|SrvcGrp|72994|2022|PDM|694.00|99|0.00|AEG 3|
20|FH_F141336_16947_0|SrvcGrp|112223|2022|PDM|110.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F40370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F39549_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72085_0_0|SrvcGrp|44244|2022|PDM|420.00|99|0.00|HEMODIALYSIS - HOME TRAINING|
20|FH_F81731_0_0|SrvcGrp|79720|2022|PDM|810.00|99|0.00|ACUTE REHAB II|
20|FH_F115971_0_0|CSTM-ALL|CSTM-00|2020|PDM|2060.00|99|0.00|DEVICE INSERTION|
20|FH_F147085_92780_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F39910_0_0|CSTM-ALL|CSTM-00|2020|PDM|1034.00|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_F132864_71101_0|SrvcGrp|103618|2022|PDM|5265.00|99|0.00|C-SECTION DELIVERY (MOM)|
20|FH_F124564_78411_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124671_64844_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F147899_0_0|SrvcGrp|115221|2022|PDM|1790.00|99|0.00|UPPR GI OPTICL ENDOMICRSCOPY (HCFA)|
20|FH_F131101_45840_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F131848_83651_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|2939.00|99|0.00|AEG 7 (NO REV)|
20|FH_F136708_06443_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F136741_60523_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138696_64772_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114985_32073_0|SrvcGrp|104802|2022|PDM|32.00|99|0.00|PROSTHETIC TRAINING|
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134670_95628_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136820_65483_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112268_19087_0|SrvcGrp|46605|2022|PDM|84.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F112378_60505_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112378_60505_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F141170_0_0|SrvcGrp|110761|2022|PDM|1000.00|99|0.00|SPINAL OSTEREOTACTIC|
20|FH_F115144_71373_0|SrvcGrp|82037|2022|PDM|1632.00|99|0.00|AETNA ICU|
20|FH_F115728_78404_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F147522_64114_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147586_44124_0|SrvcGrp|107984|2022|PDM|1634.00|99|0.00|PARTIAL REMOVAL OF HEEL|
20|FH_F147540_54871_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F41663_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F41749_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|EATING DISORDER PARTIAL DAY - ADOLESCENT|
20|FH_F42153_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|DEPAUL MS DRGS|
20|FH_F98625_08103_0|SrvcGrp|73643|2022|PDM|2351.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F102947_44084_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F33381_0_0|SrvcGrp|361|2022|PDM|2511.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F40634_0_0|SrvcGrp|33412|2022|PCT|1.00|99|0.00|TRANSPORTATION SERVICES|
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|AEG 1 (NO REV)|
20|FH_F91975_0_0|SrvcGrp|91860|2022|PDM|611.00|99|0.00|ENDOSCOPY PROCEDURES|
20|FH_F35216_0_0|SrvcGrp|12904|2022|PDM|850.00|99|0.00|MRI|
20|FH_F36049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F133536_0_0|SrvcGrp|36591|2022|PDM|8250.00|99|0.00|CPT 63685|
20|FH_F150939_0_0|SrvcGrp|101411|2022|PDM|58.00|99|0.00|NEW PATIENT OFFICE VISIT|
20|FH_F138681_39301_0|SrvcGrp|12659|2022|PDM|733.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F138787_32258_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138857_90025_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F138936_01040_0|CSTM-ALL|CSTM-00|2020|PDM|1885.00|99|0.00|AEG 2 (NO REV)|
20|FH_F127713_30012_0|SrvcGrp|23683|2022|PDM|92.50|99|0.00|SKILLED NURSING RN|
20|FH_F127713_30012_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F126023_70748_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128695_50049_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F132090_60915_0|SrvcGrp|96353|2022|PDM|9500.00|99|0.00|RECONSTRUCT ANKLE JOINT|
20|FH_F132347_01605_0|SrvcGrp|66265|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F148101_33462_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F60292_0_0|SrvcGrp|32652|2022|PDM|500.00|99|0.00|SKILLED NURSING CARE|
20|FH_F130662_07032_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130755_04401_0|SrvcGrp|114016|2022|PCT|0.93|99|0.00|OBSERVATION W/SURGERY|
20|FH_F130821_85712_0|SrvcGrp|93267|2022|PDM|0.36|99|0.00|INJECTION|
20|FH_F130901_68970_0|SrvcGrp|75506|2022|PCT|0.98|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F143771_0_0|SrvcGrp|113620|2022|PDM|139.00|99|0.00|HOSPICE CARE|
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|AEG 2 (NO REV)|
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|2175.00|99|0.00|AEG 4 (NO REV)|
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|977.00|99|0.00|AEG 8 (NO REV)|
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_F85442_27573_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|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_F34182_0_0|SrvcGrp|18107|2022|PDM|2729.00|99|0.00|MS DRG 236|
20|FH_F146543_89511_0|SrvcGrp|104186|2022|PDM|10.00|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1488.00|99|0.00|AEG 10 (NO REV)|
20|FH_F95623_84015_0|SrvcGrp|94780|2022|PDM|90.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F77585_0_0|SrvcGrp|9861|2022|PDM|585.00|99|0.00|ACUTE REHABILITATION|
20|FH_F149031_80525_0|SrvcGrp|46903|2022|PDM|750.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F111908_07677_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100782_0_0|SrvcGrp|105093|2022|PDM|304.44|99|0.00|WINDBER MEDICAL CNTR ASC 138|
20|FH_F134593_60007_0|SrvcGrp|12994|2022|PCT|0.84|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F84132_48026_0|SrvcGrp|82461|2022|PCT|1.00|99|0.00|AETNA INJECTIONS|
20|FH_F89219_0_0|SrvcGrp|112738|2022|PDM|36011.00|99|0.00|MSDRG 521 ONLY|
20|FH_F85651_33549_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F133922_70563_0|SrvcGrp|104799|2022|PDM|366.31|99|0.00|ELECTROENCEPHALOGRAM|
20|FH_F127598_43232_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F87541_0_0|SrvcGrp|85538|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F146103_63851_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F133774_06062_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F51479_0_0|SrvcGrp|47965|2022|PDM|325.00|99|0.00|DIALYSIS TREATMENT|
20|FH_F149051_01605_0|SrvcGrp|84897|2022|PCT|1.07|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F145561_80210_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F85353_16407_0|SrvcGrp|63921|2022|PDM|91.83|99|0.00|HAPA WPA-NWPA 2012-13 ASC 246|
20|FH_F95631_33705_0|SrvcGrp|90854|2022|PDM|3491.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F115616_0_0|SrvcGrp|67065|2022|PDM|3121.00|99|0.00|CERVICAL SURGERY|
20|FH_F138418_51201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F84593_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F124789_44514_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F110309_63301_0|SrvcGrp|104049|2022|PDM|422.00|99|0.00|RENAL DIALYSIS|
20|FH_F142376_0_0|SrvcGrp|80139|2022|PDM|24151.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F143669_78577_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149362_19446_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133585_0_0|SrvcGrp|108075|2022|PDM|3092.00|99|0.00|AV FUSION / UPPER ARM VEIN|
20|FH_F127908_60640_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|507.00|99|0.00|AEG 2 (NO REV)|
20|FH_F133869_19947_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F116806_0_0|SrvcGrp|107062|2022|PDM|1923.16|99|0.00|RECONSTRUCT CLEFT PALATE|
20|FH_F130763_0_0|SrvcGrp|99174|2022|PDM|3189.00|99|0.00|CPT 30140|
20|FH_F143571_0_0|SrvcGrp|89822|2022|PDM|153.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F83380_0_0|SrvcGrp|44712|2022|PDM|105.00|99|0.00|OT SVCS|
20|FH_F113322_38119_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F134249_05060_0|SrvcGrp|3483|2022|PDM|4920.00|99|0.00|CPT CODE 59400|
20|FH_F145641_06902_0|SrvcGrp|82113|2022|PDM|4783.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F139780_75605_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F120539_89029_0|SrvcGrp|23683|2022|PDM|60.00|99|0.00|SKILLED NURSING RN|
20|FH_F143687_70461_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121225_98902_0|SrvcGrp|22588|2022|PCT|0.85|99|0.00|CHEMOTHERAPY|
20|FH_F128379_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149102_33433_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43199_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85118_40403_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F134593_60007_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132609_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F135670_01749_0|SrvcGrp|22389|2022|PDM|12.50|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F110404_17821_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F119110_91773_0|SrvcGrp|73701|2022|PDM|55.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F148547_01908_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F112908_0_0|SrvcGrp|88621|2022|PDM|87.00|99|0.00|SKILLED NURSING LPN|
20|FH_F90496_13159_0|SrvcGrp|43524|2022|PDM|140.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F85212_71075_0|SrvcGrp|80262|2022|PCT|0.00|99|0.00|AETNA MATERNITY DELIVERY|
20|FH_F52713_0_0|SrvcGrp|70439|2022|PDM|5000.00|99|0.00|EMERGENCY ROOM WITH SURGERY|
20|FH_F149151_75248_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|559.87|99|0.00|HAPA WPA-NWPA 2012-13 ASC 215 W/O REV|
20|FH_F54592_0_0|SrvcGrp|26850|2022|PDM|21.66|99|0.00|HOME INFUSION THERAPY (SJ)|
20|FH_F134536_48080_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122552_03103_0|SrvcGrp|108484|2022|PDM|450.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F122672_44089_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F84932_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.20|99|0.00|OP SVCS|
20|FH_F86375_0_0|SrvcGrp|47411|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F105143_26062_0|SrvcGrp|72992|2022|PDM|4419.00|99|0.00|AEG 2|
20|FH_F105145_75075_0|SrvcGrp|98264|2022|PDM|14203.00|99|0.00|REVISION OF URINARY TRACT|
20|FH_F115784_06831_0|SrvcGrp|472|2022|PDM|691.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F146702_70508_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120795_27514_0|SrvcGrp|114917|2022|PCT|0.71|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F125440_04043_0|SrvcGrp|100520|2022|PDM|268.00|99|0.00|INTENSIVE OP EATING DISORDERS|
20|FH_F126359_24228_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47140_0_0|SrvcGrp|28737|2022|PDM|161.53|99|0.00|SLEEP STUDIES CPT 95810 W/MODIFIER 26|
20|FH_F116040_24637_0|SrvcGrp|86839|2022|PDM|30.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F139159_76011_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F139487_60076_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139560_78216_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135093_0_0|SrvcGrp|79720|2022|PDM|1104.00|99|0.00|ACUTE REHAB II|
20|FH_F109251_62269_0|SrvcGrp|46605|2022|PDM|91.56|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F116583_0_0|SrvcGrp|104230|2022|PDM|150.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F35432_0_0|SrvcGrp|8950|2022|PDM|1518.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F131028_49735_0|SrvcGrp|95661|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F151699_01752_0|SrvcGrp|86848|2022|PDM|45.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F98820_81401_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F137719_28269_0|SrvcGrp|73063|2022|PDM|751.00|99|0.00|OBSERVATION SERVICES|
20|FH_F122425_75082_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F149662_85015_0|CSTM-ALL|CSTM-00|2020|PDM|2150.00|99|0.00|AEG 4 (NO REV)|
20|FH_F151699_01752_0|SrvcGrp|86854|2022|PDM|69.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|103.00|99|0.00|SALLY BALIN,999182,ASC 123|
20|FH_F76826_0_0|SrvcGrp|69646|2022|PDM|749.00|99|0.00|ECHOCARDIOGRAPHY|
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|AEG 1 (NO REV)|
20|FH_F124413_30067_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|363.37|99|0.00|SALLY BALIN,999182,ASC 103|
20|FH_F31225_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F111122_63376_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F124441_0_0|SrvcGrp|27261|2022|PDM|12825.00|99|0.00|CPT 27446|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|95.00|99|0.00|HAPA EPA ASC 15|
20|FH_F35088_0_0|SrvcGrp|12543|2022|PCT|0.70|99|0.00|LAPAROSCOPIC HYSTERECTOMY|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|COVENTRY ENHANCED GROUPER 3 MOD 50|
20|FH_F40690_0_0|SrvcGrp|21868|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F120057_0_0|SrvcGrp|72994|2022|PDM|612.00|99|0.00|AEG 3|
20|FH_F98001_27603_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F81951_0_0|SrvcGrp|17766|2022|PDM|50.00|99|0.00|HOME HEALTH - PT/OT/ST|
20|FH_F52092_0_0|SrvcGrp|9828|2022|PDM|44.00|99|0.00|HOME HEALTH AIDE|
20|FH_F140093_33467_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|2383.00|99|0.00|AEG 8 (NO REV)|
20|FH_F149160_02180_0|SrvcGrp|115383|2022|PCT|1.00|99|0.00|COVID-19 INFUSION ADMINISTRATION - REGENERON|
20|FH_F111723_0_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F124470_90025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138018_17313_0|SrvcGrp|24753|2022|PDM|41.72|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F35557_0_0|SrvcGrp|10645|2022|PDM|175.00|99|0.00|PICC LINE INSERTION KIT|
20|FH_F128741_92879_0|SrvcGrp|23683|2022|PDM|90.65|99|0.00|SKILLED NURSING RN|
20|FH_F128741_92879_0|SrvcGrp|88620|2022|PDM|186.39|99|0.00|SKILLED NURSING RN|
20|FH_F101441_0_0|SrvcGrp|97199|2022|PDM|7946.00|99|0.00|THORAX SPINE DISK SURGERY|
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F47424_0_0|SrvcGrp|22954|2022|PDM|164.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F117711_73080_0|SrvcGrp|102419|2022|PDM|4200.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F37304_0_0|SrvcGrp|9858|2022|PDM|474.00|99|0.00|SKILLED NURSING CARE|
20|FH_F142370_0_0|SrvcGrp|113177|2022|PDM|16.94|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - ASTRAZENECA|
20|FH_F117626_0_0|SrvcGrp|35669|2022|PDM|5200.00|99|0.00|CPT 63650|
20|FH_F116583_0_0|SrvcGrp|106950|2022|PDM|650.00|99|0.00|HOSPICE IN INPT PSYCH|
20|FH_F136806_0_0|SrvcGrp|112953|2022|PDM|10609.00|99|0.00|INSRT PULSE GEN W/ DUAL LEADS|
20|FH_F124492_30040_0|SrvcGrp|113229|2022|PDM|156.89|99|0.00|COVID-19 NFCT DS VIR RESP RNA 4 TRGT (HCFA)|
20|FH_F114206_37203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114206_37203_0|SrvcGrp|65621|2022|PCT|1.00|99|0.00|RN NURSING|
20|FH_F37960_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F119310_20850_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134933_73505_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F131331_0_0|SrvcGrp|104228|2022|PDM|55.66|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F141250_95062_0|SrvcGrp|73842|2022|PDM|206.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148999_46218_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129340_43212_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F150961_89169_0|SrvcGrp|88779|2022|PDM|81.00|99|0.00|PHYSICAL THERAPY|
20|FH_F134732_0_0|SrvcGrp|108075|2022|PDM|2248.00|99|0.00|AV FUSION / UPPER ARM VEIN|
20|FH_F36743_0_0|SrvcGrp|360|2022|PDM|2200.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F149582_01534_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|2743.00|99|0.00|AEG 4 (NO REV)|
20|FH_F122267_62656_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F132132_77040_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F150399_53045_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130813_85014_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147227_48302_0|SrvcGrp|57968|2022|PDM|43.24|99|0.00|CONTINUOUS HOMECARE|
20|FH_F127292_85705_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F138018_17313_0|SrvcGrp|17015|2022|PDM|41.72|99|0.00|HOME INFUSION THERAPY|
20|FH_F110783_93013_0|SrvcGrp|86832|2022|PDM|7.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F47212_0_0|SrvcGrp|42912|2022|PDM|6.00|99|0.00|CATHETER CARE-SINGLE LUMEN|
20|FH_F146266_0_0|SrvcGrp|69964|2022|PDM|5500.00|99|0.00|CPT 23120|
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_F132254_40207_0|SrvcGrp|26868|2022|PDM|50.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F73442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35781_33133_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F127830_63703_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35757_34652_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|AEG 2 (NO REV)|
20|FH_F84532_0_0|SrvcGrp|72996|2022|PDM|1746.00|99|0.00|AEG 4|
20|FH_F147146_06117_0|SrvcGrp|75545|2022|PDM|434.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F97184_26101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F36150_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|ACUTE PSYCH|
20|FH_F37304_0_0|SrvcGrp|3224|2022|PDM|474.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F125182_0_0|SrvcGrp|79590|2022|PDM|1884.00|99|0.00|CPT 43248|
20|FH_F138228_76208_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F89640_98133_0|SrvcGrp|83537|2022|PDM|1513.00|99|0.00|AETNA DENEGERATIVE NERVOUS SYSTEM|
20|FH_F117737_75001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F105142_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F112045_90301_0|SrvcGrp|88977|2022|PDM|3200.00|99|0.00|C-SECTION DELIVERY|
20|FH_F148959_77375_0|SrvcGrp|75419|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F140295_0_0|SrvcGrp|113629|2022|PDM|8755.00|99|0.00|RECONSTRUCT ELBOW JOINT|
20|FH_F138410_19130_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F151639_90034_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116575_0_0|SrvcGrp|94479|2022|PDM|1250.00|99|0.00|AETNA SCAN PROC CRANIAL EXTRA|
20|FH_F124466_32724_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F150920_19490_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F86551_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F115705_0_0|SrvcGrp|57968|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F119795_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F149023_44122_0|CSTM-ALL|CSTM-00|2020|PDM|2042.00|99|0.00|AEG 5  (NO REV)|
20|FH_F39443_0_0|SrvcGrp|30406|2022|PCT|0.45|99|0.00|JEFFERSON SUPPLIES/DEVICES|
20|FH_F56232_0_0|CSTM-ALL|CSTM-00|2020|PDM|1005.08|99|0.00|ASPG III|
20|FH_F130023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148939_62650_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151042_60659_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F98840_31021_0|SrvcGrp|73605|2022|PDM|2201.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F117762_0_0|SrvcGrp|99169|2022|PDM|1976.00|99|0.00|CPT 28200|
20|FH_F89616_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.70|99|0.00|OP SVCS|
20|FH_F119897_78229_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F39211_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F112045_90301_0|SrvcGrp|10944|2022|PCT|0.40|99|0.00|EMERGENCY ROOM|
20|FH_F137719_28269_0|SrvcGrp|74668|2022|PDM|295.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F150313_78666_0|SrvcGrp|75419|2022|PDM|425.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F140032_60550_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143231_11101_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F140552_0_0|CSTM-ALL|CSTM-00|2020|PCT|36000.00|99|0.00|TIMELY FILING|
20|FH_F131173_17043_0|SrvcGrp|65720|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F151719_02138_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F151785_03104_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F120225_29644_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F132390_60018_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132530_38930_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116546_78723_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F116546_78723_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F119913_31545_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119918_38201_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F130044_0_0|SrvcGrp|111422|2022|PCT|6.90|99|0.00|PHYSICAL MEDICINE|
20|FH_F146859_0_0|SrvcGrp|44460|2022|PDM|3649.00|99|0.00|IMPLANTATION OF NEUROSTIMULATOR ELECTRODES|
20|FH_F35245_0_0|SrvcGrp|9936|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F130661_04441_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|OP SVCS|
20|FH_F101685_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40593_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36382_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F36133_70072_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F42979_0_0|SrvcGrp|3404|2022|PDM|32.00|99|0.00|CPT 99211|
20|FH_F133087_61107_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F40899_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F132732_0_0|SrvcGrp|360|2022|PDM|1844.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F138018_17313_0|SrvcGrp|24761|2022|PDM|82.20|99|0.00|HOME INFUSION THERAPY|
20|FH_F124316_28112_0|SrvcGrp|33165|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|1765.00|99|0.00|AEG 9 (NO REV)|
20|FH_F111086_29501_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F141247_18902_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133087_61107_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|2546.00|99|0.00|AEG 5  (NO REV)|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD UE KE"|
20|FH_F128500_37215_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131241_54154_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89640_98133_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140295_0_0|SrvcGrp|35670|2022|PDM|6668.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F81312_0_0|SrvcGrp|59291|2022|PCT|1.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F35245_0_0|SrvcGrp|13241|2022|PDM|70.00|99|0.00|SPEECH THERAPY|
20|FH_F145674_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.62|99|0.00|OP SVCS|
20|FH_F115982_0_0|SrvcGrp|83641|2022|PDM|2750.00|99|0.00|CPT 29889|
20|FH_F139822_30338_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F84061_0_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F133247_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F101752_0_0|SrvcGrp|11108|2022|PDM|712.00|99|0.00|NEWBORN NURSERY|
20|FH_F103060_0_0|SrvcGrp|72990|2022|PDM|1248.00|99|0.00|AEG 1|
20|FH_F101360_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT|
20|FH_F115208_0_0|SrvcGrp|57864|2022|PDM|1273.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F151764_03801_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F49329_0_0|SrvcGrp|44709|2022|PDM|179.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F120187_76522_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F136249_01913_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112687_30474_0|SrvcGrp|48385|2022|PDM|169.40|99|0.00|SPEECH THERAPY|
20|FH_F39567_0_0|SrvcGrp|43|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F49895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F78165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F71364_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40834_0_0|SrvcGrp|33370|2022|PDM|2146.00|99|0.00|MULTIPLE BIRTH - NICU LEVEL III|
20|FH_F118373_21205_0|SrvcGrp|22077|2022|PDM|2940.00|99|0.00|RESIDENTIAL TREATMENT SVCS|
20|FH_F99100_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_F97102_83501_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F42312_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148265_06067_0|CSTM-ALL|CSTM-00|2020|PDM|2303.00|99|0.00|AEG 10 (NO REV)|
20|FH_F46094_0_0|SrvcGrp|27766|2022|PDM|90.00|99|0.00|SKILLED IV NURSING VISIT|
20|FH_F44020_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F141129_0_0|SrvcGrp|29137|2022|PDM|11.00|99|0.00|HOME HEALTH AIDE|
20|FH_F135262_02148_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|792.00|99|0.00|AEG 5  (NO REV)|
20|FH_F118194_50841_0|SrvcGrp|48394|2022|PDM|110.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F127205_44125_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F148255_72703_0|SrvcGrp|86829|2022|PDM|31.50|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F89475_71202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F111288_0_0|SrvcGrp|109003|2022|PCT|0.40|99|0.00|LAPAROSCOPE PROC, STOM|
20|FH_F118703_0_0|SrvcGrp|72990|2022|PDM|380.00|99|0.00|AEG 1|
20|FH_F91078_0_0|SrvcGrp|89149|2022|PDM|170.00|99|0.00|OP INTENSIVE|
20|FH_F37679_0_0|SrvcGrp|27139|2022|PDM|3.75|99|0.00|INTERFERON INJECTION THERAPY (MOD SJ)|
20|FH_F39278_0_0|SrvcGrp|72782|2022|PDM|166.00|99|0.00|OT SVCS - VISIT LEVEL|
20|FH_F140910_53005_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F120172_92653_0|SrvcGrp|89417|2022|PDM|495.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F110061_0_0|SrvcGrp|44461|2022|PDM|20000.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F89563_29407_0|SrvcGrp|103322|2022|PCT|1.00|99|0.00|PT EVAL MOD COMPLEX 30 MIN|
20|FH_F135065_08043_0|SrvcGrp|73849|2022|PDM|700.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F145815_30540_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F115046_77964_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F68160_0_0|SrvcGrp|10431|2022|PDM|47.00|99|0.00|SPEECH THERAPY|
20|FH_F35344_0_0|SrvcGrp|72|2022|PDM|500.00|99|0.00|NEWBORN NURSERY|
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)|
20|FH_F124388_0_0|SrvcGrp|103966|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F119992_67062_0|SrvcGrp|471|2022|PDM|680.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F126054_30022_0|SrvcGrp|90631|2022|PDM|210.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F113649_01752_0|SrvcGrp|22593|2022|PDM|75.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F84394_17402_0|SrvcGrp|73806|2022|PDM|686.00|99|0.00|AETNA ER|
20|FH_F37200_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REGIONAL HEALTH SVCS OF HOWARD-DME-MOD KF|
20|FH_F38431_0_0|SrvcGrp|23008|2022|PDM|1300.00|99|0.00|V5253|
20|FH_F92276_32308_0|SrvcGrp|87305|2022|PDM|52700.00|99|0.00|MSDRG 268 ONLY|
20|FH_F143817_71322_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130840_21738_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F128580_0_0|SrvcGrp|108075|2022|PDM|2248.00|99|0.00|AV FUSION / UPPER ARM VEIN|
20|FH_F31688_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F136756_0_0|SrvcGrp|73000|2022|PDM|1170.40|99|0.00|AEG 6|
20|FH_F120175_19606_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F132735_97068_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F143976_80504_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1314.00|99|0.00|AEG 8 (NO REV)|
20|FH_F83793_77477_0|SrvcGrp|16526|2022|PDM|180.00|99|0.00|DIALYSIS|
20|FH_F135171_22601_0|SrvcGrp|89149|2022|PDM|190.00|99|0.00|OP INTENSIVE|
20|FH_F115112_48035_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC|
20|FH_F123282_03222_0|SrvcGrp|23683|2022|PDM|68.00|99|0.00|SKILLED NURSING RN|
20|FH_F82931_18847_0|SrvcGrp|23259|2022|PDM|737.00|99|0.00|MS DRG 789-795 ONLY NEONATAL|
20|FH_F150780_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46941_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE|
20|FH_F91622_0_0|SrvcGrp|3934|2022|PDM|212.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS|
20|FH_F110132_23451_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F122433_0_0|SrvcGrp|71666|2022|PDM|1385.00|99|0.00|CPT 63655|
20|FH_F126585_45039_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD TC|
20|FH_F137943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 8 (NO REV)|
20|FH_F40043_0_0|SrvcGrp|31848|2022|PCT|0.76|99|0.00|MS DRG'S %BC SOUTHERN REGIOANL MED CTR|
20|FH_F127550_43026_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128973_44256_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F145815_30540_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F149866_07401_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122536_0_0|CSTM-ALL|CSTM-00|2020|PDM|9490.00|99|0.00|ASPG IX|
20|FH_F83257_32404_0|SrvcGrp|75545|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F123481_90049_0|SrvcGrp|89417|2022|PDM|700.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F129656_15005_0|SrvcGrp|23683|2022|PDM|30.00|99|0.00|SKILLED NURSING RN|
20|FH_F37733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143768_34785_0|SrvcGrp|114018|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F55054_0_0|SrvcGrp|51274|2022|PDM|455.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F148258_66062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137617_84112_0|SrvcGrp|113128|2022|PCT|0.73|99|0.00|TRANSPLANT|
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|5250.00|99|0.00|AEG 7 (NO REV)|
20|FH_F139515_0_0|SrvcGrp|83640|2022|PDM|3425.00|99|0.00|CPT 29887|
20|FH_F146287_0_0|CSTM-ALL|CSTM-00|2020|PDM|2617.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124017_0_0|SrvcGrp|109672|2022|PDM|5200.00|99|0.00|LAMINOPLASTY, CERVICAL|
20|FH_F147941_06023_0|CSTM-ALL|CSTM-00|2020|PDM|6661.00|99|0.00|AETNA OP PET SCANS (PET)|
20|FH_F151524_84121_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|1825.00|99|0.00|AEG 8 (NO REV)|
20|FH_F139173_0_0|SrvcGrp|48385|2022|PDM|192.00|99|0.00|SPEECH THERAPY|
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1077.00|99|0.00|AEG 8 (NO REV)|
20|FH_F41776_0_0|CSTM-ALL|CSTM-00|2020|PDM|3197.00|99|0.00|ASPG X|
20|FH_F124388_0_0|SrvcGrp|63463|2022|PDM|1254.00|99|0.00|CPT 52204|
20|FH_F123276_20737_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139551_0_0|SrvcGrp|78282|2022|PDM|4100.00|99|0.00|CPT 47563|
20|FH_F73985_0_0|SrvcGrp|17073|2022|PDM|2541.00|99|0.00|ASPG V|
20|FH_F91663_19901_0|SrvcGrp|43567|2022|PDM|125.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F100660_56303_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F125048_94583_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F128139_62650_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137067_0_0|SrvcGrp|103329|2022|PDM|18900.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN|
20|FH_F125249_0_0|SrvcGrp|90422|2022|PDM|2000.00|99|0.00|REPAIR GRAFT RADIUS OR ULNA|
20|FH_F110220_0_0|SrvcGrp|103928|2022|PDM|91.78|99|0.00|SLEEP STUDY UNATTENDED ANALYSIS(HCFA)|
20|FH_F63190_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|2887.00|99|0.00|AEG 9 (NO REV)|
20|FH_F151526_28208_0|CSTM-ALL|CSTM-00|2020|PDM|1823.00|99|0.00|AEG 8 (NO REV)|
20|FH_F122687_0_0|SrvcGrp|27261|2022|PDM|11474.00|99|0.00|CPT 27446|
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1428.57|99|0.00|AEG 7 (NO REV)|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F40499_0_0|SrvcGrp|32643|2022|PCT|1.00|99|0.00|INFUSION THERAPY|
20|FH_F89563_29407_0|SrvcGrp|94737|2022|PCT|1.00|99|0.00|FLUVIRIN VACC IM (>=3 YRS)|
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|327.00|99|0.00|AEG 1 (NO REV)|
20|FH_F149799_33484_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F60019_0_0|SrvcGrp|9861|2022|PDM|1845.00|99|0.00|ACUTE REHABILITATION|
20|FH_F140907_28601_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92276_32308_0|SrvcGrp|39870|2022|PDM|29216.00|99|0.00|MS DRG 619-621 ONLY|
20|FH_F93114_85016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38377_0_0|SrvcGrp|10542|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F77504_0_0|SrvcGrp|16|2022|PDM|650.00|99|0.00|ACUTE REHABILITATION|
20|FH_F70645_0_0|SrvcGrp|9938|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F84215_0_0|SrvcGrp|82570|2022|PDM|961.00|99|0.00|REVISION EYELID/EXCESS SKIN|
20|FH_F94261_0_0|SrvcGrp|27969|2022|PDM|18.90|99|0.00|HOME HEALTH AIDE|
20|FH_F102184_0_0|SrvcGrp|98494|2022|PDM|7699.00|99|0.00|ARTHRODESIS PRE-SACRAL|
20|FH_F39992_0_0|SrvcGrp|8962|2022|PDM|82.50|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F148170_04005_0|SrvcGrp|13595|2022|PCT|2.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 226-227 CV SURG CARDIAC DEFIBRILLATOR|
20|FH_F125676_02892_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142073_0_0|SrvcGrp|92413|2022|PDM|5980.00|99|0.00|SPINAL CRD DECOMP->2 THORAC|
20|FH_F148266_45419_0|SrvcGrp|46890|2022|PDM|1730.33|99|0.00|IMPLANT EYE SHUNT|
20|FH_F131357_17545_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F75307_0_0|SrvcGrp|23683|2022|PDM|33.00|99|0.00|SKILLED NURSING RN|
20|FH_F120352_52556_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F123407_04605_0|SrvcGrp|73842|2022|PDM|170.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
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_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|608.00|99|0.00|AEG 1 (NO REV)|
20|FH_F37679_0_0|SrvcGrp|19741|2022|PDM|100.00|99|0.00|PICC LINE INSERT|
20|FH_F128151_62568_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122687_0_0|SrvcGrp|33984|2022|PDM|2185.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F131177_44122_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135173_06519_0|SrvcGrp|67684|2022|PDM|195.00|99|0.00|PSYCH VISIT|
20|FH_F69423_0_0|SrvcGrp|26281|2022|PDM|2601.00|99|0.00|CPT 58353|
20|FH_F63433_0_0|SrvcGrp|17000|2022|PCT|0.70|99|0.00|OUTPATIENT SURGERY|
20|FH_F116237_43235_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F143528_0_0|SrvcGrp|88599|2022|PDM|3439.80|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F129231_30060_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72830_0_0|SrvcGrp|15326|2022|PDM|900.00|99|0.00|ER LEVEL IV|
20|FH_F148265_06067_0|SrvcGrp|97895|2022|PDM|18479.00|99|0.00|REVISE KNEE 2|
20|FH_F127072_30458_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F133207_0_0|SrvcGrp|11673|2022|PDM|6161.00|99|0.00|CPT 29888|
20|FH_F83793_77477_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116341_12180_0|SrvcGrp|104076|2022|PCT|1.05|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F129766_48236_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F146260_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.20|99|0.00|OP SVCS|
20|FH_F40043_0_0|SrvcGrp|12772|2022|PDM|1395.00|99|0.00|ACUTE REHABILITATION|
20|FH_F122687_0_0|SrvcGrp|77021|2022|PDM|8742.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F69423_0_0|SrvcGrp|35734|2022|PDM|1665.00|99|0.00|CPT 29874 29877 29880-29881 29884 29888|
20|FH_F82871_33160_0|SrvcGrp|76501|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F125927_75093_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F116731_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F63494_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93132_73134_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 8 (NO REV)|
20|FH_F150982_0_0|SrvcGrp|78096|2022|PDM|3854.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 4 (NO REV)|
20|FH_F123276_20737_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F31340_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F71070_0_0|SrvcGrp|68054|2022|PDM|1800.00|99|0.00|CPT 52332|
20|FH_F141588_60062_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F78048_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F37679_0_0|SrvcGrp|27054|2022|PDM|16.75|99|0.00|HYDRATION THERAPY - 1 LITER (MOD SH)|
20|FH_F88391_0_0|SrvcGrp|3809|2022|PDM|603.09|99|0.00|HOSPICE CARE|
20|FH_F141587_40242_0|SrvcGrp|89417|2022|PDM|372.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F38591_0_0|SrvcGrp|11853|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F133671_89102_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F92276_32308_0|SrvcGrp|73806|2022|PDM|1475.00|99|0.00|AETNA ER|
20|FH_F40834_0_0|SrvcGrp|361|2022|PDM|2146.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F107800_34609_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F145550_62034_0|SrvcGrp|27969|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F124026_53188_0|SrvcGrp|87317|2022|PDM|799.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F138450_0_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F74602_0_0|SrvcGrp|45882|2022|PDM|120.00|99|0.00|PT|
20|FH_F119495_34711_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F128545_29569_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 9 (NO REV)|
20|FH_F150539_48374_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F146212_57108_0|CSTM-ALL|CSTM-00|2020|PDM|756.00|99|0.00|AEG 1 (NO REV)|
20|FH_F146376_53188_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F42803_0_0|SrvcGrp|13551|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F117807_86426_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100665_07939_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F137353_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92644_06053_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97560_23249_0|SrvcGrp|73643|2022|PDM|1027.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F69648_0_0|SrvcGrp|66265|2022|PDM|4.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F118194_50841_0|SrvcGrp|29023|2022|PDM|178.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F115669_07652_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67984_0_0|SrvcGrp|64202|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F122905_41018_0|SrvcGrp|75240|2022|PDM|732.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F34096_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F74602_0_0|SrvcGrp|11301|2022|PDM|900.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F88639_80204_0|SrvcGrp|87995|2022|PDM|204.37|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F63129_0_0|SrvcGrp|48397|2022|PDM|30.00|99|0.00|PT SERVICES|
20|FH_F130662_07032_0|SrvcGrp|90632|2022|PDM|265.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F85652_98034_0|SrvcGrp|20902|2022|PDM|35538.00|99|0.00|MS DRG 249 ONLY|
20|FH_F130123_24171_0|SrvcGrp|95221|2022|PDM|120.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F96780_0_0|SrvcGrp|42429|2022|PDM|516.00|99|0.00|OP SURGERY CPT 66761|
20|FH_F129638_0_0|SrvcGrp|537|2022|PCT|0.55|99|0.00|OBSERVATION SERVICES|
20|FH_F134170_33410_0|SrvcGrp|73842|2022|PDM|189.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F70208_0_0|SrvcGrp|588|2022|PDM|2530.00|99|0.00|CORONARY CARE UNIT|
20|FH_F114823_15701_0|SrvcGrp|73842|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F36381_0_0|SrvcGrp|22984|2022|PDM|200.00|99|0.00|BLOOD TRANSFUSION|
20|FH_F146520_80435_0|SrvcGrp|114600|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F43861_0_0|SrvcGrp|37404|2022|PDM|90.00|99|0.00|PT SVCS|
20|FH_F89219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|MT NITTANY ASC 8|
20|FH_F133818_01027_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F111882_51560_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F123623_03246_0|SrvcGrp|109279|2022|PCT|1.00|99|0.00|PLATE PHERES LEUKOREDU IRRAD|
20|FH_F112060_07514_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53|
20|FH_F114444_19602_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F114409_18447_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134601_94010_0|SrvcGrp|100499|2022|PDM|859.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F113325_80004_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F85995_64111_0|SrvcGrp|53987|2022|PCT|1.00|99|0.00|PHOTOTHERAPY|
20|FH_F121476_0_0|SrvcGrp|108848|2022|PDM|14493.00|99|0.00|PENILE PROSTHESIS|
20|FH_F149364_19335_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150302_30114_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F110504_37027_0|SrvcGrp|73842|2022|PDM|304.47|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F81698_10457_0|SrvcGrp|29076|2022|PDM|31.50|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F134604_64050_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119542_45417_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F145921_73139_0|SrvcGrp|46605|2022|PDM|97.85|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F142376_0_0|SrvcGrp|98603|2022|PDM|4219.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F93190_26456_0|SrvcGrp|73700|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F149219_01966_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F149106_07042_0|SrvcGrp|70064|2022|PDM|3518.00|99|0.00|CPT 19125|
20|FH_F133847_21702_0|SrvcGrp|38007|2022|PDM|750.00|99|0.00|CPT CODE 59425|
20|FH_F138302_15701_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F150130_70359_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F125515_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F117206_0_0|SrvcGrp|38364|2022|PDM|1500.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100782_0_0|SrvcGrp|105106|2022|PDM|131.92|99|0.00|WINDBER MEDICAL CNTR ASC 151|
20|FH_F110504_37027_0|SrvcGrp|73841|2022|PDM|555.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F127199_0_0|SrvcGrp|93098|2022|PDM|114.00|99|0.00|HOSPICE CARE|
20|FH_F146666_75154_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110311_17078_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F32212_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F117896_0_0|SrvcGrp|92501|2022|PDM|125.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F85651_33549_0|SrvcGrp|38006|2022|PDM|1540.00|99|0.00|CPT CODE 59426|
20|FH_F124711_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 6 (NO REV)|
20|FH_F130123_24171_0|SrvcGrp|65720|2022|PDM|120.00|99|0.00|RESPITE CARE|
20|FH_F149151_75248_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2383.00|99|0.00|AEG 5  (NO REV)|
20|FH_F126056_29824_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134650_07921_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42258_0_0|SrvcGrp|360|2022|PDM|900.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F134593_60007_0|SrvcGrp|86779|2022|PDM|110.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F71445_0_0|SrvcGrp|68382|2022|PDM|75.00|99|0.00|SOCIAL WORKER|
20|FH_F135622_34471_0|SrvcGrp|89417|2022|PDM|450.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F114527_39047_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F149061_44122_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: BREAKOUT|
20|FH_F134593_60007_0|SrvcGrp|86837|2022|PDM|190.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F32737_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1401.40|99|0.00|HAPA WPA-NWPA 2012-13 ASC 902 W/O REV|
20|FH_F37698_0_0|SrvcGrp|20801|2022|PCT|0.85|99|0.00|HOME HEALTH|
20|FH_F120719_27540_0|SrvcGrp|10361|2022|PDM|318.00|99|0.00|CPT CODE 99281|
20|FH_F118123_67226_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F150165_06032_0|SrvcGrp|101820|2022|PDM|1480.00|99|0.00|HYSTEROSCOPY RESECT SEPTUM|
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|4815.00|99|0.00|AEG 7 (NO REV)|
20|FH_F120549_19087_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F70603_0_0|SrvcGrp|52842|2022|PDM|265.00|99|0.00|GI PROCEDURE GROUP A|
20|FH_F117206_0_0|SrvcGrp|79588|2022|PDM|824.00|99|0.00|CPT 43235|
20|FH_F63114_0_0|SrvcGrp|48393|2022|PDM|7.50|99|0.00|SKILLED NURSING SERVICES (PER HOUR)|
20|FH_F121225_98902_0|SrvcGrp|108701|2022|PDM|281.40|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F126043_30339_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F45692_0_0|CSTM-ALL|CSTM-00|2020|PCT|49.16|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_F86953_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|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_F105145_75075_0|SrvcGrp|101882|2022|PDM|4500.00|99|0.00|AETNA AEG 4 WITHOUT CARVEOUT SURG|
20|FH_F115893_08002_0|SrvcGrp|74614|2022|PDM|730.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F75842_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.46|99|0.00|OP SVCS|
20|FH_F146796_43334_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120778_43351_0|SrvcGrp|107861|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F63124_0_0|SrvcGrp|44430|2022|PDM|145.00|99|0.00|SPEECH THERAPY SVCS (VISIT LVL)|
20|FH_F131959_31709_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131451_61455_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133583_77074_0|SrvcGrp|89337|2022|PDM|916.00|99|0.00|DETOXIFICATION|
20|FH_F132937_88201_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F132928_64114_0|SrvcGrp|111551|2022|PDM|147.60|99|0.00|NUTRITIONAL COUNSELING DIET (HCFA)|
20|FH_F132088_34981_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F111603_19529_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F134827_32218_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149179_0_0|SrvcGrp|115607|2022|PDM|3589.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F123784_03264_0|SrvcGrp|43569|2022|PDM|157.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F132810_0_0|SrvcGrp|26869|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F132810_0_0|SrvcGrp|14949|2022|PDM|90.00|99|0.00|HOME INFUSION|
20|FH_F64999_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102623_0_0|SrvcGrp|94499|2022|PDM|420.00|99|0.00|PERITONEAL/CAPD/CCPD|
20|FH_F136394_78240_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F136430_46710_0|SrvcGrp|472|2022|PDM|714.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F118154_17042_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120456_67117_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134062_32308_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134070_20017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134126_11554_0|CSTM-ALL|CSTM-00|2020|PDM|2468.00|99|0.00|AEG 4 (NO REV)|
20|FH_F137237_33304_0|SrvcGrp|89417|2022|PDM|420.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F114092_83350_0|SrvcGrp|104231|2022|PCT|0.00|99|0.00|AETNA IP DETOX|
20|FH_F142491_06033_0|SrvcGrp|29155|2022|PDM|160.00|99|0.00|HOSPICE SVCS|
20|FH_F142393_33142_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142530_60148_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F142667_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138308_50036_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F140548_60527_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F80284_16354_0|SrvcGrp|64106|2022|PDM|777.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 12|
20|FH_F122067_0_0|SrvcGrp|42550|2022|PDM|1540.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F149530_80014_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119018_47802_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F38332_0_0|SrvcGrp|997|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F38332_0_0|SrvcGrp|18803|2022|PDM|42216.00|99|0.00|MS DRG 218|
20|FH_F39466_0_0|SrvcGrp|3934|2022|PDM|231.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS|
20|FH_F117214_84020_0|SrvcGrp|87317|2022|PDM|1100.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F117126_12801_0|SrvcGrp|83824|2022|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES|
20|FH_F107480_0_0|SrvcGrp|75497|2022|PDM|500.00|99|0.00|AEG 10|
20|FH_F90876_18447_0|SrvcGrp|73701|2022|PDM|22.05|99|0.00|AETNA - SKILLED NURSING|
20|FH_F90880_15108_0|SrvcGrp|90481|2022|PCT|1.00|99|0.00|FLULAVAL VACC 3 YRS & > IM|
20|FH_F90880_15108_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F91472_96001_0|SrvcGrp|103757|2022|PCT|0.40|99|0.00|REVISION KNEE REPLACEMENT|
20|FH_F114567_43235_0|SrvcGrp|86748|2022|PCT|0.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F139350_70056_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129487_0_0|SrvcGrp|14614|2022|PDM|2800.00|99|0.00|LITHOTRIPSY|
20|FH_F147340_0_0|SrvcGrp|68641|2022|PDM|1141.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F151259_16505_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129468_15010_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F129130_92562_0|SrvcGrp|105465|2022|PCT|4.06|99|0.00|AETNA THERAPIES|
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|527.00|99|0.00|AEG 3 (NO REV)|
20|FH_F37328_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F37823_0_0|SrvcGrp|14886|2022|PCT|0.80|99|0.00|TRANSPORTATION|
20|FH_F142070_0_0|SrvcGrp|107748|2022|PDM|700.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F106822_0_0|SrvcGrp|100266|2022|PDM|7.07|99|0.00|TB INTRADERMAL TEST|
20|FH_F111001_0_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F116323_0_0|SrvcGrp|26002|2022|PDM|322.00|99|0.00|C-ARM AND LASER|
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|610.00|99|0.00|AEG 3 (NO REV)|
20|FH_F118363_30305_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F133474_0_0|SrvcGrp|111930|2022|PDM|15.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F43245_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132279_63775_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F125660_46706_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F80855_0_0|SrvcGrp|34606|2022|PDM|2200.00|99|0.00|CPT 29827|
20|FH_F132837_64118_0|SrvcGrp|73601|2022|PDM|2122.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F142027_37217_0|SrvcGrp|48396|2022|PDM|140.00|99|0.00|OT SERVICES|
20|FH_F92676_15063_0|SrvcGrp|79059|2022|PDM|454.31|99|0.00|MON VALLEY ASC 313|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|394.78|99|0.00|HAPA WPA-NWPA 2012-13 ASC 105 W/O REV|
20|FH_F113403_62274_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F128657_19008_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F41785_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F147996_21014_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133478_40165_0|SrvcGrp|85260|2022|PDM|74.00|99|0.00|INITIAL EVALUATION|
20|FH_F115330_34113_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F99720_0_0|SrvcGrp|104741|2022|PDM|4096.00|99|0.00|HIP ARTHRO W/ LABRAL REPAIR|
20|FH_F33106_0_0|SrvcGrp|3967|2022|PCT|0.80|99|0.00|UNGROUPABLE INPATIENT|
20|FH_F121016_32607_0|SrvcGrp|104470|2022|PDM|1000.00|99|0.00|ANTEPARTUM CARE ONLY (7 OR MORE VISITS)|
20|FH_F125033_93305_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F36993_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD 53|
20|FH_F139301_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F33664_0_0|CSTM-ALL|CSTM-00|2020|PDM|843.00|99|0.00|NEWBORN NURSERY - BABY ONLY|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|OP SVCS|
20|FH_F123583_72756_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F128559_43524_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F144020_15401_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133527_68025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F133477_90247_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F74163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F132601_92677_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F46552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F128912_44313_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F69104_0_0|SrvcGrp|17073|2022|PDM|1456.70|99|0.00|ASPG V|
20|FH_F87155_04105_0|SrvcGrp|73700|2022|PDM|50.43|99|0.00|AETNA - SKILLED NURSING|
20|FH_F103281_32086_0|SrvcGrp|73499|2022|PDM|500.00|99|0.00|AETNA ER LEVEL II|
20|FH_F139825_0_0|SrvcGrp|114443|2022|PDM|10178.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F92676_15063_0|SrvcGrp|78973|2022|PDM|1428.06|99|0.00|MON VALLEY ASC 2|
20|FH_F129175_0_0|SrvcGrp|105640|2022|PDM|285.03|99|0.00|NJX INTERLAMINAR CRV/THRC|
20|FH_F150907_17543_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F87615_80033_0|SrvcGrp|52953|2022|PDM|70.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F99720_0_0|SrvcGrp|88491|2022|PDM|3277.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F125672_92663_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41392_0_0|CSTM-ALL|CSTM-00|2020|PDM|605.00|99|0.00|ASPG III|
20|FH_F44342_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118027_28801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F38410_0_0|SrvcGrp|28631|2022|PDM|73.00|99|0.00|LPN VISIT|
20|FH_F34706_0_0|SrvcGrp|1175|2022|PDM|45874.00|99|0.00|DRG 106 CORONARY BYPASS|
20|FH_F120406_84047_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F129801_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F128246_0_0|SrvcGrp|85880|2022|PDM|726.00|99|0.00|CPT 66850|
20|FH_F137638_0_0|CSTM-ALL|CSTM-00|2020|PDM|1538.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS|
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_F144368_48315_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F134497_47126_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F92677_08003_0|SrvcGrp|92099|2022|PDM|113.40|99|0.00|AETNA HUMIDIFIER DURABLE FOR EXTE|
20|FH_F44992_0_0|CSTM-ALL|CSTM-00|2020|PDM|1233.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F132543_79549_0|SrvcGrp|73603|2022|PDM|850.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F93375_0_0|SrvcGrp|73006|2022|PDM|1405.00|99|0.00|AEG 9|
20|FH_F100740_15206_0|SrvcGrp|73559|2022|PDM|7006.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F124608_0_0|SrvcGrp|27261|2022|PDM|7344.00|99|0.00|CPT 27446|
20|FH_F97566_79902_0|SrvcGrp|73643|2022|PDM|1050.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F47234_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F40851_0_0|SrvcGrp|3378|2022|PDM|1452.00|99|0.00|OBSERVATION SVCS|
20|FH_F125215_78130_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|963.00|99|0.00|AEG 6 (NO REV)|
20|FH_F133172_66066_0|SrvcGrp|107861|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F97700_0_0|SrvcGrp|33166|2022|PDM|550.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F44540_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121335_0_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F40599_0_0|SrvcGrp|24|2022|PDM|3852.00|99|0.00|CARDIAC CATH|
20|FH_F111885_0_0|CSTM-ALL|CSTM-00|2020|PDM|1144.00|99|0.00|AEG 1 (NO REV)|
20|FH_F111862_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F113305_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F115875_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F113541_0_0|SrvcGrp|104948|2022|PDM|1955.00|99|0.00|MASTECTOMY FOR GYNECOMASTIA|
20|FH_F120617_0_0|CSTM-ALL|CSTM-00|2020|PDM|2113.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33856_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 6 (NO REV)|
20|FH_F131047_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F132988_0_0|SrvcGrp|100064|2022|PDM|4493.01|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|557.00|99|0.00|AEG 1 (NO REV)|
20|FH_F137067_0_0|SrvcGrp|88156|2022|PDM|21000.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F128027_0_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F72162_0_0|SrvcGrp|46424|2022|PDM|135.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F141070_64093_0|SrvcGrp|48398|2022|PDM|127.00|99|0.00|PT SERVICES|
20|FH_F72204_0_0|SrvcGrp|42972|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F114365_73162_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114389_50131_0|SrvcGrp|98082|2022|PDM|160.95|99|0.00|HIT ANTIBIOTIC Q3H DIEM (HCFA)|
20|FH_F124180_0_0|SrvcGrp|86037|2022|PDM|6672.50|99|0.00|REVISE CORNEA WITH IMPLANT|
20|FH_F124180_0_0|SrvcGrp|73006|2022|PDM|2500.00|99|0.00|AEG 9|
20|FH_F146794_79601_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F34652_0_0|SrvcGrp|20054|2022|PDM|912.00|99|0.00|MS DRG 792 & REV 172 TRANSITIONAL NURSERY|
20|FH_F49937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F98380_43055_0|SrvcGrp|90854|2022|PDM|3423.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F124613_64735_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124628_33064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124653_64062_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F136611_43764_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114764_78214_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F144039_0_0|SrvcGrp|84278|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F144039_0_0|SrvcGrp|45583|2022|PDM|9754.00|99|0.00|CPT 65730|
20|FH_F148424_01440_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122610_73139_0|SrvcGrp|82523|2022|PCT|0.50|99|0.00|AETNA NUCLEAR MEDICINE|
20|FH_F122872_67208_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134687_14226_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F136913_68803_0|SrvcGrp|73499|2022|PDM|1105.00|99|0.00|AETNA ER LEVEL II|
20|FH_F136913_68803_0|SrvcGrp|105465|2022|PCT|0.75|99|0.00|AETNA THERAPIES|
20|FH_F141170_0_0|SrvcGrp|88487|2022|PDM|4880.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F141170_0_0|SrvcGrp|103586|2022|PDM|2390.00|99|0.00|REMOVE SPINE INFUSION|
20|FH_F115631_65201_0|SrvcGrp|102481|2022|PDM|3177.00|99|0.00|CPT 29898|
20|FH_F115723_78363_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F116343_33701_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F116383_63026_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F116173_40217_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F147299_02072_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F147519_52627_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F147586_44124_0|SrvcGrp|93433|2022|PDM|16500.00|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F147586_44124_0|SrvcGrp|26273|2022|PDM|1634.00|99|0.00|CPT 29880|
20|FH_F147699_83704_0|SrvcGrp|74668|2022|PDM|254.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147414_92656_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147500_32720_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
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_F100783_03431_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F34048_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 8 (NO REV)|
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 2 (NO REV)|
20|FH_F39346_0_0|SrvcGrp|21358|2022|PDM|9558.00|99|0.00|MS DRG 258-259 ONLY|
20|FH_F35404_0_0|SrvcGrp|10927|2022|PDM|1200.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F113178_44035_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133536_0_0|SrvcGrp|107779|2022|PDM|3215.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F133579_0_0|SrvcGrp|93807|2022|PDM|3248.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F80511_0_0|SrvcGrp|76321|2022|PCT|0.60|99|0.00|AETNA ALL INPATIENT SERVICES|
20|FH_F54552_0_0|SrvcGrp|27047|2022|PDM|22.33|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS (MOD SJ)|
20|FH_F113585_20155_0|SrvcGrp|15402|2022|PDM|45.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F113585_20155_0|SrvcGrp|86832|2022|PDM|3.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F138936_01040_0|SrvcGrp|109707|2022|PDM|4635.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F106500_0_0|CSTM-ALL|CSTM-00|2020|PDM|508.00|99|0.00|CPT 95810 (W/MOD TC)|
20|FH_F113390_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_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1049.43|99|0.00|AEG 7 (NO REV)|
20|FH_F83475_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151514_35242_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 9 (NO REV)|
20|FH_F132163_17601_0|SrvcGrp|86642|2022|PDM|100.00|99|0.00|AETNA PSYCH DIAG EVAL W/MED SRVC (MOD TD)|
20|FH_F97501_31501_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F135453_70726_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F135584_10977_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130933_47129_0|SrvcGrp|90854|2022|PDM|780.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F116447_21601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116461_77536_0|SrvcGrp|90040|2022|PDM|150.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F127399_0_0|SrvcGrp|92822|2022|PDM|3121.00|99|0.00|REPAIR OF RUPTURED TENDON|
20|FH_F140629_0_0|SrvcGrp|113666|2022|PDM|2497.00|99|0.00|LAPAROSCOPY|
20|FH_F42347_0_0|SrvcGrp|31189|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF (DME)|
20|FH_F42347_0_0|SrvcGrp|17419|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F132947_45342_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F129329_07039_0|SrvcGrp|109330|2022|PCT|1.08|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F111390_32960_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111880_50003_0|SrvcGrp|91294|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F132328_0_0|SrvcGrp|88158|2022|PDM|6097.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|790.00|99|0.00|AEG 6 (NO REV)|
20|FH_F118651_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_F140102_0_0|SrvcGrp|82223|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F102222_19720_0|SrvcGrp|86850|2022|PDM|31.50|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F134797_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F119417_78212_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F109404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148555_0_0|SrvcGrp|28399|2022|PDM|3090.00|99|0.00|CPT CODE 93620|
20|FH_F44607_0_0|SrvcGrp|19973|2022|PDM|650.00|99|0.00|CAT SCAN|
20|FH_F123078_19119_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94300_0_0|SrvcGrp|93433|2022|PDM|4200.00|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F150949_0_0|SrvcGrp|108094|2022|PDM|10950.00|99|0.00|REVISE KNEE|
20|FH_F60101_0_0|SrvcGrp|42825|2022|PDM|48.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F44795_0_0|SrvcGrp|37767|2022|PDM|25.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F126935_33615_0|CSTM-ALL|CSTM-00|2020|PDM|1318.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS|
20|FH_F133487_24293_0|SrvcGrp|46605|2022|PDM|125.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F62816_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F74084_15206_0|SrvcGrp|13985|2022|PDM|52.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|ASPG IV|
20|FH_F134467_84321_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118391_77040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133480_85374_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F145937_75240_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F97563_83201_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1157.41|99|0.00|HAPA WPA-NWPA 2012-13 ASC 13 W/O REV|
20|FH_F117368_68114_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F74947_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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_F54552_0_0|SrvcGrp|34389|2022|PDM|150.00|99|0.00|SPEECH THERAPY|
20|FH_F127558_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.55|99|0.00|HSS ASC|
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 2 (NO REV)|
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|408.00|99|0.00|AEG 1 (NO REV)|
20|FH_F97141_93933_0|SrvcGrp|88978|2022|PDM|8044.00|99|0.00|VAGINAL DELIVERY|
20|FH_F50495_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|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_F118544_21550_0|SrvcGrp|75545|2022|PDM|343.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F117901_27526_0|SrvcGrp|105316|2022|PCT|1.10|99|0.00|HIGH COST DRUGS|
20|FH_F124608_0_0|SrvcGrp|100919|2022|PDM|8160.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|1605.00|99|0.00|ASPG VIII|
20|FH_F49663_0_0|SrvcGrp|24289|2022|PDM|40.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F43774_0_0|SrvcGrp|12401|2022|PDM|110.00|99|0.00|RN VISIT|
20|FH_F128325_19904_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F120803_38606_0|SrvcGrp|107861|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F71323_68114_0|SrvcGrp|35204|2022|PDM|2901.00|99|0.00|MS DRG 100 ONLY|
20|FH_F97566_79902_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F73785_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128893_0_0|SrvcGrp|89781|2022|PDM|160.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F133397_23233_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133477_90247_0|CSTM-ALL|CSTM-00|2020|PDM|4092.00|99|0.00|AEG 10 (NO REV)|
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|4750.00|99|0.00|REPAIR UMBIL HERNIA|
20|FH_F117945_78957_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F103106_04101_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F133270_77025_0|SrvcGrp|86723|2022|PDM|375.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F35875_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|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_F31184_0_0|SrvcGrp|361|2022|PDM|1100.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F132543_79549_0|SrvcGrp|73602|2022|PDM|500.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F43210_0_0|CSTM-ALL|CSTM-00|2020|PDM|194.00|99|0.00|SKILLED NURSING CARE|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD 26|
20|FH_F150023_75002_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F93592_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F92677_08003_0|SrvcGrp|29076|2022|PDM|63.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F95482_0_0|SrvcGrp|86919|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F34706_0_0|SrvcGrp|14960|2022|PDM|22994.00|99|0.00|DRG 569 MJR SM/LG BOWEL PRO W/CC W/MJR GASTRO DX|
20|FH_F132032_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F95360_08720_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|2780.00|99|0.00|AEG 3 (NO REV)|
20|FH_F148890_45133_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150949_0_0|SrvcGrp|84939|2022|PDM|10500.00|99|0.00|SHOULDER JOINT|
20|FH_F97566_79902_0|SrvcGrp|73659|2022|PDM|7835.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F98640_0_0|SrvcGrp|109017|2022|PDM|1818.00|99|0.00|REMOVAL OF ADENOIDS|
20|FH_F128299_44134_0|SrvcGrp|95661|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F150024_08079_0|SrvcGrp|88163|2022|PDM|4000.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F147997_92620_0|SrvcGrp|74668|2022|PDM|1660.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PDM|691.00|99|0.00|OCD RESIDENTIAL|
20|FH_F52733_0_0|SrvcGrp|43567|2022|PDM|85.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F107400_0_0|SrvcGrp|46605|2022|PDM|125.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F150908_38570_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109561_97216_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.00|99|0.00|COVENTRY ENHANCED GROUPER 2 MOD 50|
20|FH_F50420_0_0|SrvcGrp|33164|2022|PDM|315.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F90935_29073_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109840_62832_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F60254_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37042_0_0|SrvcGrp|17077|2022|PDM|1587.00|99|0.00|ASPG VII|
20|FH_F119096_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)|
20|FH_F148900_0_0|SrvcGrp|87677|2022|PDM|1293.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F133493_90255_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F68831_0_0|SrvcGrp|26001|2022|PDM|154.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F102561_75146_0|SrvcGrp|73483|2022|PDM|900.00|99|0.00|AETNA SUBACUTE III|
20|FH_F101811_64116_0|SrvcGrp|99440|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F147995_67037_0|CSTM-ALL|CSTM-00|2020|PDM|4116.00|99|0.00|AEG 8 (NO REV)|
20|FH_F111403_37167_0|SrvcGrp|73842|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F83294_0_0|SrvcGrp|42974|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F97560_23249_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F147800_0_0|SrvcGrp|36591|2022|PDM|48400.00|99|0.00|CPT 63685|
20|FH_F44350_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|ACUTE PSYCH|
20|FH_F50372_0_0|SrvcGrp|46587|2022|PDM|50.00|99|0.00|CPT 99211|
20|FH_F122648_0_0|SrvcGrp|92547|2022|PDM|817.00|99|0.00|SKIN FULL GRAFT PROCEDURE|
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|1075.00|99|0.00|AEG 6 (NO REV)|
20|FH_F139487_60076_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F139560_78216_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150882_84041_0|SrvcGrp|86834|2022|PDM|19.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F149273_0_0|SrvcGrp|115613|2022|PDM|4578.00|99|0.00|ARTHROS, SYNOVECT, SURG|
20|FH_F33632_52349_0|SrvcGrp|91437|2022|PDM|345.42|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F147315_33603_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC|
20|FH_F123745_0_0|SrvcGrp|93641|2022|PDM|4500.00|99|0.00|KNEE ARTHROSCOPIC SURGERY|
20|FH_F38007_0_0|SrvcGrp|15|2022|PDM|3385.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F36766_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|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_F147310_77036_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138018_17313_0|SrvcGrp|10578|2022|PDM|103.00|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F137767_01841_0|SrvcGrp|28213|2022|PDM|33033.00|99|0.00|MS DRG 472 ONLY|
20|FH_F127292_85705_0|SrvcGrp|75419|2022|PDM|425.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F36590_0_0|SrvcGrp|115|2022|PDM|616.00|99|0.00|SKILLED NURSING CARE|
20|FH_F46433_0_0|SrvcGrp|14945|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F113869_40215_0|SrvcGrp|73842|2022|PDM|169.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F141270_89103_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|2958.00|99|0.00|AEG 8 (NO REV)|
20|FH_F86714_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F66760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F68460_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F141267_0_0|SrvcGrp|104230|2022|PDM|90.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F117762_0_0|SrvcGrp|59705|2022|PDM|1352.00|99|0.00|SEPTOPLASTY|
20|FH_F149602_07109_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
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_F147083_46304_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142370_0_0|SrvcGrp|113541|2022|PDM|51.31|99|0.00|COVID-19 AMP PRB|
20|FH_F124976_0_0|SrvcGrp|89417|2022|PDM|531.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F33435_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128197_84123_0|SrvcGrp|95661|2022|PDM|112.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F74825_0_0|SrvcGrp|44883|2022|PDM|18.00|99|0.00|RT/PT/ST/OT|
20|FH_F140608_0_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F94426_47403_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F92498_07442_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F92153_74017_0|SrvcGrp|79699|2022|PCT|0.58|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PDM|7330.00|99|0.00|AEG 7 (NO REV)|
20|FH_F113869_40215_0|SrvcGrp|46903|2022|PDM|503.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F117581_21211_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134819_0_0|SrvcGrp|96979|2022|PDM|2481.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F40653_0_0|SrvcGrp|3029|2022|PDM|410.00|99|0.00|NEWBORN NURSERY|
20|FH_F89851_83854_0|SrvcGrp|27980|2022|PDM|50389.00|99|0.00|MS DRG 326 ONLY|
20|FH_F114207_35243_0|SrvcGrp|24745|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F78023_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F120848_20912_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F50078_0_0|SrvcGrp|42975|2022|PDM|70.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 2 (NO REV)|
20|FH_F146647_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F111723_0_0|SrvcGrp|89149|2022|PDM|178.00|99|0.00|OP INTENSIVE|
20|FH_F36036_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F151043_71901_0|SrvcGrp|104363|2022|PCT|1.00|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F139877_32615_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126256_24293_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|52.00|99|0.00|HAPA EPA ASC 11|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|679.00|99|0.00|ASPG II|
20|FH_F149003_62208_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146859_0_0|SrvcGrp|83624|2022|PDM|3824.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F134847_0_0|SrvcGrp|44066|2022|PDM|4751.00|99|0.00|CPT 57288|
20|FH_F137363_0_0|SrvcGrp|96385|2022|PDM|4500.00|99|0.00|AETNA IMPLANT DEFIBRILLATOR|
20|FH_F41273_0_0|SrvcGrp|13052|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F131261_19111_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F140990_0_0|SrvcGrp|107748|2022|PDM|575.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F42352_0_0|SrvcGrp|1121|2022|PCT|0.65|99|0.00|OP PTCA ANGIOPLASTY|
20|FH_F147147_50265_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|1182.75|99|0.00|AEG 2 (NO REV)|
20|FH_F130661_04441_0|SrvcGrp|107806|2022|PCT|2.25|99|0.00|CHEMOTHERAPY/ALL OTHER DRUGS|
20|FH_F124486_0_0|SrvcGrp|84123|2022|PDM|1803.00|99|0.00|INSERT ANT SEGMENT DRAIN EXT|
20|FH_F33504_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66405_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F35416_0_0|SrvcGrp|15969|2022|PCT|0.80|99|0.00|ORGAN TRANSPLANT/PROCUREMENT|
20|FH_F151699_01752_0|SrvcGrp|24744|2022|PDM|90.00|99|0.00|PICC LINE INSERTION|
20|FH_F47037_0_0|SrvcGrp|14080|2022|PDM|92.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F113957_73554_0|CSTM-ALL|CSTM-00|2020|PDM|1837.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F84532_0_0|SrvcGrp|11663|2022|PCT|0.31|99|0.00|IMPLANTS|
20|FH_F50078_0_0|SrvcGrp|1168|2022|PDM|28.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F143249_89801_0|SrvcGrp|29346|2022|PDM|40.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F143347_16001_0|SrvcGrp|18008|2022|PCT|2.00|99|0.00|DOPPLER FLOW TESTING|
20|FH_F63234_0_0|SrvcGrp|45726|2022|PCT|1.00|99|0.00|OCN F/S: LAB GLOBAL|
20|FH_F84631_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F102224_0_0|SrvcGrp|96779|2022|PDM|2300.00|99|0.00|SPINE OSTEOTOMY POST LUMBAR|
20|FH_F131067_57105_0|CSTM-ALL|CSTM-00|2020|PDM|3073.00|99|0.00|AEG 2 (NO REV)|
20|FH_F131067_57105_0|SrvcGrp|104030|2022|PDM|121.00|99|0.00|PT/OT/ST|
20|FH_F82375_28601_0|SrvcGrp|73700|2022|PDM|87.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F49051_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F49329_0_0|SrvcGrp|44984|2022|PDM|140.00|99|0.00|DIETICIAN VISIT - IP|
20|FH_F132480_92054_0|SrvcGrp|75419|2022|PDM|700.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F132530_38930_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116579_45822_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113563_70560_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 6 (NO REV)|
20|FH_F36132_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP MAFS  MOD RR|
20|FH_F147211_0_0|SrvcGrp|42623|2022|PDM|718.00|99|0.00|SUBACUTE - LEVEL III|
20|FH_F50137_0_0|SrvcGrp|46240|2022|PDM|120.00|99|0.00|HOME VISIT STOMA/COLOSTOMY/CYSTOSTOMY CARE|
20|FH_F135066_02908_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_F148322_93060_0|SrvcGrp|108484|2022|PDM|670.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F92513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113410_0_0|SrvcGrp|105259|2022|PDM|814.00|99|0.00|COLONOSCOPY AND BIOPSY|
20|FH_F141390_19007_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F66687_0_0|SrvcGrp|69924|2022|PDM|24486.00|99|0.00|PTCA W/O STENT|
20|FH_F121800_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F78603_0_0|SrvcGrp|21102|2022|PDM|80041.16|99|0.00|MS DRG 219 ONLY|
20|FH_F39391_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)|
20|FH_F128973_44256_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F92091_0_0|SrvcGrp|67065|2022|PDM|7650.00|99|0.00|CERVICAL SURGERY|
20|FH_F82753_18840_0|SrvcGrp|58755|2022|PDM|7908.00|99|0.00|INJECTION PROC FOR JOINT|
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133099_66801_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
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_F69703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F125249_0_0|SrvcGrp|100039|2022|PDM|1400.00|99|0.00|REPAIR OF HEEL FRACTURE|
20|FH_F139515_0_0|SrvcGrp|90062|2022|PDM|8549.00|99|0.00|TRANSPEDICULAR PROCEDURE|
20|FH_F91622_0_0|SrvcGrp|762|2022|PCT|1.00|99|0.00|AIR AMBULANCE SVCS|
20|FH_F45632_0_0|SrvcGrp|41494|2022|PDM|43.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F39886_0_0|CSTM-ALL|CSTM-00|2020|PDM|1272.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148260_0_0|SrvcGrp|33965|2022|PDM|13643.00|99|0.00|CPT 58552|
20|FH_F117906_91606_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F148023_34471_0|SrvcGrp|115180|2022|PCT|1.00|99|0.00|COVID-19 VACCINES AND ADMINSTRATION|
20|FH_F101840_76054_0|SrvcGrp|20908|2022|PDM|16477.00|99|0.00|MS DRG 247 ONLY|
20|FH_F148003_34285_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117027_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F148704_66219_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|919.00|99|0.00|AEG 7 (NO REV)|
20|FH_F46832_0_0|SrvcGrp|24752|2022|PDM|25.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F102623_0_0|SrvcGrp|94500|2022|PDM|180.00|99|0.00|PERITONEAL/CAPD/CCPD|
20|FH_F118152_20151_0|SrvcGrp|17013|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118152_20151_0|SrvcGrp|26868|2022|PDM|40.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F93180_73772_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F134011_84102_0|SrvcGrp|86842|2022|PDM|25.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F137147_75006_0|SrvcGrp|21359|2022|PDM|553287.00|99|0.00|MS DRG 460 ONLY|
20|FH_F53732_0_0|SrvcGrp|19742|2022|PDM|115.00|99|0.00|MID-LINE INSERTION|
20|FH_F97601_67218_0|SrvcGrp|73656|2022|PDM|586.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F97602_40121_0|SrvcGrp|88978|2022|PDM|5155.00|99|0.00|VAGINAL DELIVERY|
20|FH_F77782_66061_0|SrvcGrp|360|2022|PDM|803.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F114650_17104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F140760_07003_0|SrvcGrp|89417|2022|PDM|291.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F140889_33071_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F79724_32501_0|SrvcGrp|76501|2022|PDM|278.25|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F149701_0_0|SrvcGrp|87537|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F119023_91406_0|SrvcGrp|86840|2022|PDM|35.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F119026_36274_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F92475_15931_0|SrvcGrp|92760|2022|PCT|1.06|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92506_07666_0|SrvcGrp|705|2022|PCT|0.42|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F117295_70006_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F117107_33704_0|SrvcGrp|88337|2022|PCT|1.00|99|0.00|VENIPUNCTURE|
20|FH_F137276_83127_0|SrvcGrp|48398|2022|PDM|85.50|99|0.00|PT SERVICES|
20|FH_F104700_0_0|SrvcGrp|72994|2022|PDM|1245.00|99|0.00|AEG 3|
20|FH_F110720_0_0|SrvcGrp|38015|2022|PDM|7322.00|99|0.00|ARTHRODESIS|
20|FH_F91472_96001_0|SrvcGrp|58515|2022|PCT|0.40|99|0.00|OP PTCA|
20|FH_F73022_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.75|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F110160_0_0|SrvcGrp|73000|2022|PDM|1115.00|99|0.00|AEG 6|
20|FH_F121338_37756_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F114931_0_0|SrvcGrp|38364|2022|PDM|3200.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F114931_0_0|SrvcGrp|104618|2022|PDM|1850.00|99|0.00|EXCISION OF ANAL LESION(S)|
20|FH_F38564_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F40230_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|285.09|99|0.00|DELAWARE VALLEY- ASC 305|
20|FH_F72662_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110000_0_0|SrvcGrp|73440|2022|PDM|4793.00|99|0.00|PTCA|
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PDM|2687.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F77067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1160.00|99|0.00|ACUTE PSYCH|
20|FH_F113143_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91258_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F114916_30309_0|SrvcGrp|89860|2022|PDM|3200.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F115208_0_0|SrvcGrp|22948|2022|PDM|2228.00|99|0.00|CPT CODE 42830|
20|FH_F100640_48097_0|SrvcGrp|73601|2022|PDM|5129.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F103780_64804_0|CSTM-ALL|CSTM-00|2020|PDM|3086.00|99|0.00|AEG 8 (NO REV)|
20|FH_F130460_33166_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|1099.41|99|0.00|AEG 7 (NO REV)|
20|FH_F119535_0_0|SrvcGrp|45882|2022|PDM|90.00|99|0.00|PT|
20|FH_F36584_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD KM|
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|33824|2022|PDM|421.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 2|
20|FH_F126600_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F141207_0_0|SrvcGrp|83857|2022|PDM|995.00|99|0.00|IP HOSPICE SVCS|
20|FH_F132988_0_0|SrvcGrp|41334|2022|PDM|17000.00|99|0.00|TOTAL KNEE|
20|FH_F132988_0_0|SrvcGrp|105631|2022|PDM|1154.35|99|0.00|REMOVE BONE FIXATION DEVICE|
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1520.00|99|0.00|AEG 6 (NO REV)|
20|FH_F114345_27597_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114389_50131_0|SrvcGrp|84897|2022|PCT|1.61|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|970.00|99|0.00|AEG 8 (NO REV)|
20|FH_F39066_0_0|SrvcGrp|38|2022|PDM|2650.00|99|0.00|NORMAL DELIVERY|
20|FH_F39066_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F127972_68061_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F98380_43055_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F150959_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F132037_66002_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F76544_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F92599_0_0|SrvcGrp|75485|2022|PDM|906.00|99|0.00|AEG 4|
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PDM|953.00|99|0.00|AEG 4 (NO REV)|
20|FH_F136734_46410_0|SrvcGrp|88621|2022|PDM|75.00|99|0.00|SKILLED NURSING LPN|
20|FH_F114638_25309_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F114985_32073_0|SrvcGrp|98688|2022|PDM|23.00|99|0.00|GROUP THERAPY 2 OR MORE|
20|FH_F100664_03104_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F115079_62062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94662_0_0|SrvcGrp|73656|2022|PDM|726.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 471-473 CERVICAL FUSION|
20|FH_F89475_71202_0|SrvcGrp|17100|2022|PDM|866.00|99|0.00|SKILLED NURSING|
20|FH_F129603_34769_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143974_28204_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F123302_33407_0|SrvcGrp|89337|2022|PDM|789.00|99|0.00|DETOXIFICATION|
20|FH_F90874_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116747_0_0|SrvcGrp|46605|2022|PDM|91.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F52854_0_0|SrvcGrp|9510|2022|PDM|724.00|99|0.00|SKILLED NURSING CARE|
20|FH_F131228_01826_0|CSTM-ALL|CSTM-00|2020|PDM|5349.12|99|0.00|AEG 8 (NO REV)|
20|FH_F134894_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.81|99|0.00|HSS ASC|
20|FH_F78048_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130588_41171_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110925_01104_0|SrvcGrp|17016|2022|PDM|70.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F131286_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F130716_76013_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F116923_85259_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F120672_0_0|SrvcGrp|75506|2022|PCT|0.87|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F125913_66762_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150982_0_0|SrvcGrp|36991|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F72183_0_0|SrvcGrp|69122|2022|PDM|105.00|99|0.00|HOME HEALTH|
20|FH_F93332_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F141519_51566_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F51520_0_0|SrvcGrp|42828|2022|PDM|150.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F77404_0_0|SrvcGrp|57968|2022|PDM|34.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F32732_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141410_13045_0|SrvcGrp|12837|2022|PCT|0.39|99|0.00|INTRAOCULAR LENSES|
20|FH_F148219_33161_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)|
20|FH_F38798_0_0|SrvcGrp|29679|2022|PDM|110.00|99|0.00|SKILLED NURSING NON IV RELATED- MOD TJ|
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_F138020_20016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83592_17837_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148255_72703_0|SrvcGrp|86838|2022|PDM|10.50|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73985_0_0|SrvcGrp|100765|2022|PDM|65.17|99|0.00|PT/OT/ST|
20|FH_F120308_07901_0|SrvcGrp|109330|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F39863_0_0|CSTM-ALL|CSTM-00|2020|PDM|2278.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90818_0_0|SrvcGrp|89883|2022|PDM|3625.00|99|0.00|AETNA TREAT HUMERUS FRACTURE|
20|FH_F133232_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F41201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|TRAUMA CARE|
20|FH_F31936_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|946.23|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1301 W/O REV|
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|1317.00|99|0.00|AEG 5  (NO REV)|
20|FH_F115079_62062_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131128_0_0|SrvcGrp|90426|2022|PDM|2334.00|99|0.00|SHOULDER ARTHROSCOPY SURGERY|
20|FH_F34022_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131236_84041_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F135173_06519_0|SrvcGrp|105350|2022|PDM|465.00|99|0.00|AETNA PARTIAL HOSPITALIZATION|
20|FH_F40149_0_0|SrvcGrp|701|2022|PDM|1678.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F118910_0_0|SrvcGrp|65720|2022|PDM|113.30|99|0.00|RESPITE CARE|
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129587_27360_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141795_89509_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG V|
20|FH_F112508_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86518_20721_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F82753_18840_0|SrvcGrp|111929|2022|PDM|7.70|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F124899_45246_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PDM|6714.00|99|0.00|ASPG IX|
20|FH_F116093_47327_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F145815_30540_0|SrvcGrp|112884|2022|PDM|20.00|99|0.00|ADD'L SUPPLIES, MATERIALS, STAFF; PUBLIC HEALTH EMERGENCY|
20|FH_F125249_0_0|SrvcGrp|108260|2022|PDM|1000.00|99|0.00|AETNA FIXATION OF KNEE JOINT|
20|FH_F143908_52233_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F109645_0_0|SrvcGrp|103387|2022|PDM|85.00|99|0.00|NURSING ASSESSMENT/EVAL (HCFA)|
20|FH_F141587_40242_0|SrvcGrp|88819|2022|PDM|643.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PDM|1999.19|99|0.00|ASPG VI|
20|FH_F72830_0_0|SrvcGrp|70041|2022|PDM|1100.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 1|
20|FH_F36154_0_0|CSTM-ALL|CSTM-00|2020|PDM|1553.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|DEVICE INSERTION|
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PDM|1793.00|99|0.00|AEG 7 (NO REV)|
20|FH_F148265_06067_0|SrvcGrp|11673|2022|PDM|5723.00|99|0.00|CPT 29888|
20|FH_F127281_68516_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133099_66801_0|SrvcGrp|81779|2022|PCT|0.80|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F86917_61108_0|SrvcGrp|80317|2022|PDM|115.50|99|0.00|RESPITE CARE|
20|FH_F148553_85016_0|SrvcGrp|115476|2022|PDM|3227.00|99|0.00|PERC D-E COR REVASC T CABG S|
20|FH_F122689_92009_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|THER CGM RECIEIVER/MONITOR|
20|FH_F134734_90068_0|SrvcGrp|106048|2022|PDM|1100.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F134734_90068_0|SrvcGrp|108484|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F136930_73114_0|SrvcGrp|46903|2022|PDM|515.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F112410_46112_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F112416_71449_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F113708_32025_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141170_0_0|SrvcGrp|58638|2022|PDM|3740.00|99|0.00|CPT 63688|
20|FH_F42169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F74283_0_0|SrvcGrp|68140|2022|PDM|35.00|99|0.00|HOME HEALTH AID|
20|FH_F115210_21043_0|SrvcGrp|97741|2022|PDM|10000.00|99|0.00|REVISE KNEE|
20|FH_F115567_91711_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115631_65201_0|SrvcGrp|93069|2022|PDM|3177.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F147299_02072_0|SrvcGrp|88621|2022|PDM|114.00|99|0.00|SKILLED NURSING LPN|
20|FH_F147420_89032_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_F42551_0_0|CSTM-ALL|CSTM-00|2020|PDM|3465.00|99|0.00|CD SVCS (ADULT)|
20|FH_F42622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F116915_30308_0|SrvcGrp|33165|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F82691_0_0|SrvcGrp|33166|2022|PDM|420.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F120927_28645_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F40502_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39028_0_0|SrvcGrp|30196|2022|PCT|1.00|99|0.00|MOD 53|
20|FH_F39028_0_0|SrvcGrp|25349|2022|PCT|1.00|99|0.00|ALL VALID CODES W/ TC MOD|
20|FH_F44438_0_0|SrvcGrp|997|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F36472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ACUTE PSYCH|
20|FH_F43007_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|CD SVCS|
20|FH_F98625_08103_0|SrvcGrp|73605|2022|PDM|4023.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F103004_75840_0|SrvcGrp|73601|2022|PDM|1534.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 9 (NO REV)|
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1420.00|99|0.00|AEG 10 (NO REV)|
20|FH_F41605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F70762_90805_0|SrvcGrp|17276|2022|PDM|380.00|99|0.00|ACUTE REHABILITATION - ADULT|
20|FH_F106980_0_0|SrvcGrp|73002|2022|PDM|1250.00|99|0.00|AEG 7|
20|FH_F139887_0_0|SrvcGrp|113589|2022|PDM|1848.00|99|0.00|REMOVAL OF TOE|
20|FH_F133491_74012_0|SrvcGrp|97506|2022|PDM|130.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F131702_17022_0|SrvcGrp|43567|2022|PDM|117.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F132678_19090_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134828_30531_0|SrvcGrp|87106|2022|PDM|38.00|99|0.00|X-RAY EXAM OF HAND|
20|FH_F34477_0_0|SrvcGrp|14230|2022|PDM|661.00|99|0.00|SKILLED NURSING CARE|
20|FH_F62680_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F113154_70359_0|SrvcGrp|105056|2022|PDM|950.00|99|0.00|DESTRUCTION BY NEUROLYTIC AGENT|
20|FH_F135351_0_0|SrvcGrp|92408|2022|PDM|3630.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F48295_0_0|SrvcGrp|44423|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE (VISIT LVL)|
20|FH_F50459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F138876_25302_0|SrvcGrp|86853|2022|PDM|15.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F138876_25302_0|SrvcGrp|86838|2022|PDM|15.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F138876_25302_0|SrvcGrp|86831|2022|PDM|4.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F138936_01040_0|CSTM-ALL|CSTM-00|2020|PDM|2894.00|99|0.00|AEG 5  (NO REV)|
20|FH_F92188_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|357.00|99|0.00|AEG 1 (NO REV)|
20|FH_F151420_60654_0|SrvcGrp|88147|2022|PDM|3098.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA|
20|FH_F132268_07060_0|SrvcGrp|471|2022|PDM|439.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F145148_60162_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F128181_62690_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135440_32561_0|SrvcGrp|73841|2022|PDM|450.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F135583_17331_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F91735_92653_0|SrvcGrp|90707|2022|PDM|94.50|99|0.00|AETNA HOSPICE CARE|
20|FH_F91764_93710_0|SrvcGrp|43487|2022|PDM|26153.00|99|0.00|MS DRG'S 471-473|
20|FH_F91764_93710_0|SrvcGrp|114615|2022|PDM|27965.00|99|0.00|SPINAL PROCEDURES|
20|FH_F135916_33614_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F130670_32204_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130756_04901_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F127399_0_0|CSTM-ALL|CSTM-00|2020|PDM|3537.00|99|0.00|LAP INC HERNIA REPAIR|
20|FH_F121740_98119_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121854_28613_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121871_65401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131407_07607_0|SrvcGrp|86829|2022|PDM|30.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F129329_07039_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F129967_18915_0|SrvcGrp|89149|2022|PDM|194.00|99|0.00|OP INTENSIVE|
20|FH_F111292_33136_0|SrvcGrp|12840|2022|PCT|0.63|99|0.00|PACEMAKER|
20|FH_F69202_0_0|SrvcGrp|20252|2022|PDM|40000.00|99|0.00|MS DRG 224-225 ONLY|
20|FH_F145587_0_0|SrvcGrp|83643|2022|PDM|3607.84|99|0.00|CPT 29885|
20|FH_F33081_0_0|SrvcGrp|40645|2022|PCT|0.70|99|0.00|OTHER DIAGNOSTIC TESTING|
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132328_0_0|SrvcGrp|88492|2022|PDM|5202.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|2015.71|99|0.00|AEG 7 (NO REV)|
20|FH_F88639_80204_0|SrvcGrp|73806|2022|PDM|1517.24|99|0.00|AETNA ER|
20|FH_F63249_0_0|SrvcGrp|59414|2022|PDM|95.00|99|0.00|PHYSICAL THERAPY SVCS EXCLD MOD GP|
20|FH_F135840_0_0|SrvcGrp|75495|2022|PDM|1406.00|99|0.00|AEG 9|
20|FH_F114409_18447_0|SrvcGrp|48385|2022|PDM|110.25|99|0.00|SPEECH THERAPY|
20|FH_F37877_0_0|CSTM-ALL|CSTM-00|2020|PDM|538.00|99|0.00|ASPG III|
20|FH_F124173_66215_0|SrvcGrp|14893|2022|PDM|42.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F96160_32207_0|SrvcGrp|84897|2022|PCT|1.14|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F132969_84003_0|SrvcGrp|53746|2022|PDM|93.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F133207_0_0|SrvcGrp|99174|2022|PDM|2577.00|99|0.00|CPT 30140|
20|FH_F110541_99336_0|SrvcGrp|89149|2022|PDM|135.00|99|0.00|OP INTENSIVE|
20|FH_F43861_0_0|SrvcGrp|30955|2022|PDM|115.00|99|0.00|SKILLED RN VISIT|
20|FH_F120670_0_0|SrvcGrp|27261|2022|PDM|10750.00|99|0.00|CPT 27446|
20|FH_F133207_0_0|SrvcGrp|82107|2022|PDM|3527.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F146049_60462_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126506_68118_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F150160_01301_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F149199_73005_0|CSTM-ALL|CSTM-00|2020|PDM|922.00|99|0.00|AEG 2 (NO REV)|
20|FH_F51934_0_0|SrvcGrp|46350|2022|PDM|100.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F36753_0_0|SrvcGrp|23965|2022|PDM|70.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F85311_18702_0|SrvcGrp|3809|2022|PDM|462.00|99|0.00|HOSPICE CARE|
20|FH_F100782_0_0|SrvcGrp|97519|2022|PDM|1182.48|99|0.00|WINDBER MEDICAL CNTR ASC 12|
20|FH_F127486_06776_0|SrvcGrp|95661|2022|PDM|166.95|99|0.00|RESPITE CARE (HCFA)|
20|FH_F52713_0_0|SrvcGrp|9511|2022|PCT|0.60|99|0.00|OBSERVATION SVCS|
20|FH_F91633_33907_0|SrvcGrp|76501|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F149341_39194_0|SrvcGrp|22596|2022|PDM|190.00|99|0.00|HOSPICE CARE|
20|FH_F75862_0_0|SrvcGrp|3809|2022|PDM|681.00|99|0.00|HOSPICE CARE|
20|FH_F119783_46360_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F124371_0_0|SrvcGrp|13597|2022|PDM|181.13|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|205.00|99|0.00|IP ADULT PARTIAL HOSPITALIZATION (CD)|
20|FH_F117206_0_0|SrvcGrp|42550|2022|PDM|1442.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F125181_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|1518.00|99|0.00|ASPG VIII|
20|FH_F100782_0_0|SrvcGrp|97525|2022|PDM|780.12|99|0.00|WINDBER MEDICAL CNTR ASC 102|
20|FH_F111986_0_0|SrvcGrp|39909|2022|PDM|1545.00|99|0.00|PARTIAL MASTECTOMY|
20|FH_F100782_0_0|SrvcGrp|97684|2022|PDM|2656.19|99|0.00|WINDBER MEDICAL CNTR ASC 906|
20|FH_F95631_33705_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F123623_03246_0|SrvcGrp|109285|2022|PCT|1.00|99|0.00|ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ|
20|FH_F88698_18951_0|SrvcGrp|86723|2022|PDM|247.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F124161_95932_0|SrvcGrp|79786|2022|PCT|1.56|99|0.00|SLEEP STUDIES|
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PDM|513.00|99|0.00|AEG 2 (NO REV)|
20|FH_F114851_15301_0|SrvcGrp|42784|2022|PDM|54.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F88057_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111731_47802_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F79623_0_0|SrvcGrp|72990|2022|PDM|2250.00|99|0.00|AEG 1|
20|FH_F117831_0_0|SrvcGrp|88494|2022|PDM|3200.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F125244_0_0|SrvcGrp|110097|2022|PDM|4500.00|99|0.00|SUSPENSION OF UTERUS|
20|FH_F132958_79903_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F113453_80020_0|SrvcGrp|104336|2022|PCT|1.00|99|0.00|DENOSUMAB INJECTION|
20|FH_F145677_34208_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F47717_0_0|SrvcGrp|3205|2022|PDM|1248.00|99|0.00|ACUTE REHAB|
20|FH_F134488_14086_0|SrvcGrp|471|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117344_75062_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F101847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F86315_0_0|SrvcGrp|28243|2022|PCT|0.50|99|0.00|SUPPLIES AND DEVICES|
20|FH_F102200_06416_0|SrvcGrp|86851|2022|PDM|45.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F102200_06416_0|SrvcGrp|29075|2022|PDM|40.00|99|0.00|HYDRATION THERAPY|
20|FH_F102200_06416_0|SrvcGrp|13929|2022|PCT|1.00|99|0.00|GROWTH HORMONE|
20|FH_F105361_80104_0|SrvcGrp|919|2022|PDM|238.00|99|0.00|OP URGENT CARE|
20|FH_F75842_0_0|SrvcGrp|17071|2022|PDM|2262.53|99|0.00|ASPG IV|
20|FH_F146422_80210_0|SrvcGrp|73845|2022|PDM|750.00|99|0.00|AETNA OB BEHAVIOR HEALTH - REV 914|
20|FH_F146667_37110_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F146702_70508_0|SrvcGrp|16|2022|PDM|907.20|99|0.00|ACUTE REHABILITATION|
20|FH_F146848_73072_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F115952_44484_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F131677_50009_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139887_0_0|SrvcGrp|113590|2022|PDM|1848.00|99|0.00|PART REMOVAL OF METATARSAL|
20|FH_F133478_40165_0|SrvcGrp|20898|2022|PDM|22239.00|99|0.00|MS DRG 246 ONLY|
20|FH_F133494_90023_0|CSTM-ALL|CSTM-00|2020|PDM|2857.00|99|0.00|AEG 4 (NO REV)|
20|FH_F133007_76010_0|SrvcGrp|102239|2022|PDM|100.00|99|0.00|AETNA METHADONE MAINTENANCE|
20|FH_F111602_17102_0|SrvcGrp|89149|2022|PDM|161.00|99|0.00|OP INTENSIVE|
20|FH_F111603_19529_0|SrvcGrp|73841|2022|PDM|330.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F148346_0_0|SrvcGrp|73849|2022|PDM|878.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F46832_0_0|SrvcGrp|24758|2022|PDM|60.00|99|0.00|HOME INJECTABLE THERAPY|
20|FH_F123783_03860_0|SrvcGrp|88621|2022|PDM|125.00|99|0.00|SKILLED NURSING LPN|
20|FH_F123733_70714_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F126527_0_0|SrvcGrp|80918|2022|PDM|110.00|99|0.00|RESPITE CARE|
20|FH_F132810_0_0|SrvcGrp|24750|2022|PDM|40.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F132810_0_0|SrvcGrp|29075|2022|PDM|35.00|99|0.00|HYDRATION THERAPY|
20|FH_F69968_0_0|SrvcGrp|40820|2022|PDM|2612.76|99|0.00|ICU/CCU|
20|FH_F115166_0_0|SrvcGrp|89149|2022|PDM|165.00|99|0.00|OP INTENSIVE|
20|FH_F118156_19446_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F134156_32174_0|SrvcGrp|89417|2022|PDM|484.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F137068_81147_0|SrvcGrp|112812|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER|
20|FH_F137068_81147_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F137147_75006_0|SrvcGrp|98267|2022|PDM|23370.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F114264_51449_0|SrvcGrp|79699|2022|PCT|0.83|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F142508_29108_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142530_60148_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F53732_0_0|SrvcGrp|41461|2022|PDM|60.00|99|0.00|ROUTINE SERVICE - INFUSION DEVICE|
20|FH_F97600_46151_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97601_67218_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F138584_30912_0|SrvcGrp|87045|2022|PCT|1.00|99|0.00|AETNA BIOPSY OF LIP|
20|FH_F125053_0_0|SrvcGrp|85000|2022|PDM|2410.50|99|0.00|CPT 45384|
20|FH_F140488_07039_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140488_07039_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140582_46514_0|CSTM-ALL|CSTM-00|2020|PCT|2.40|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F140687_98001_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|GENERAL ACUTE CARE|
20|FH_F140733_45005_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F140841_07410_0|SrvcGrp|104434|2022|PCT|1.00|99|0.00|TRANSPORTATION SERVICES|
20|FH_F149701_0_0|SrvcGrp|87536|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F118955_48239_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F92506_07666_0|SrvcGrp|22596|2022|PDM|256.16|99|0.00|HOSPICE CARE|
20|FH_F129511_44044_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F137276_83127_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F137817_17050_0|SrvcGrp|89417|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F110308_0_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F90880_15108_0|SrvcGrp|91064|2022|PCT|1.50|99|0.00|AETNA DAPTOMYCIN INJECTION (MOD TC)|
20|FH_F91472_96001_0|SrvcGrp|11259|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F124923_23518_0|SrvcGrp|48394|2022|PDM|34.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F139817_75119_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130978_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F142007_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC|
20|FH_F95880_02726_0|SrvcGrp|94740|2022|PDM|56.65|99|0.00|AFLURIA VACC IM (>=3 YRS)|
20|FH_F121385_89102_0|CSTM-ALL|CSTM-00|2020|PDM|2084.00|99|0.00|AEG 1 (NO REV) WITHOUT BONE TESTING/BLADDER PROC|
20|FH_F121404_32216_0|SrvcGrp|84897|2022|PCT|1.05|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F121936_17543_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115543_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_F57854_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|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_F98041_10027_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|946.00|99|0.00|AEG 6 (NO REV)|
20|FH_F77923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F31563_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F39057_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113143_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F114916_30309_0|SrvcGrp|100039|2022|PDM|5000.00|99|0.00|REPAIR OF HEEL FRACTURE|
20|FH_F114916_30309_0|SrvcGrp|91567|2022|PDM|1400.00|99|0.00|REPAIR OF KNEECAP TENDON|
20|FH_F112163_0_0|SrvcGrp|75399|2022|PDM|0.15|99|0.00|MED RECORD COPY|
20|FH_F115208_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F105362_44601_0|SrvcGrp|58509|2022|PDM|400.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F105440_46383_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F113541_0_0|SrvcGrp|104947|2022|PDM|1955.00|99|0.00|EXCISION ADDL BREAST LESION|
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37294_0_0|SrvcGrp|20825|2022|PCT|0.80|99|0.00|HEART TRANSPLANT|
20|FH_F40397_0_0|CSTM-ALL|CSTM-00|2020|PDM|170.00|99|0.00|PSYCH FULL DAY TREATMENT|
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138929_0_0|SrvcGrp|77021|2022|PDM|6600.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F132627_0_0|SrvcGrp|17005|2022|PDM|80.58|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS|
20|FH_F87482_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F141047_23661_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141070_64093_0|SrvcGrp|48396|2022|PDM|127.00|99|0.00|OT SERVICES|
20|FH_F141147_02571_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1623.00|99|0.00|ASPG V|
20|FH_F114389_50131_0|SrvcGrp|17003|2022|PDM|132.55|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS|
20|FH_F141336_16947_0|CSTM-ALL|CSTM-00|2020|PDM|2119.00|99|0.00|AEG 7 (NO REV)|
20|FH_F137897_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F124058_61081_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124116_79410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F66411_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PDM|1875.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F112129_62220_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F87557_33309_0|SrvcGrp|14949|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F87557_33309_0|SrvcGrp|86827|2022|PDM|55.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F87557_33309_0|SrvcGrp|86833|2022|PDM|10.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F125253_15601_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129485_34741_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128549_44224_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F130721_04769_0|SrvcGrp|111930|2022|PCT|1.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F74509_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146657_01105_0|SrvcGrp|114657|2022|PDM|22.21|99|0.00|CLINIC SERVICE|
20|FH_F134662_54853_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F114683_0_0|SrvcGrp|72998|2022|PDM|1746.00|99|0.00|AEG 5|
20|FH_F138418_51201_0|SrvcGrp|537|2022|PCT|0.90|99|0.00|OBSERVATION SERVICES|
20|FH_F117437_0_0|SrvcGrp|82222|2022|PDM|180.00|99|0.00|HOSPICE CARE|
20|FH_F92598_21236_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F138147_18018_0|SrvcGrp|86722|2022|PDM|127.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F149102_33433_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F39378_0_0|SrvcGrp|16746|2022|PDM|120.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F110501_07652_0|SrvcGrp|73842|2022|PDM|339.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F90501_71101_0|SrvcGrp|82369|2022|PCT|2.00|99|0.00|AETNA LABORATORY|
20|FH_F134191_75025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133869_19947_0|SrvcGrp|16069|2022|PDM|695.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F138259_36606_0|SrvcGrp|92760|2022|PCT|0.80|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36552_0_0|SrvcGrp|18217|2022|PDM|5720.00|99|0.00|MS DRG 281|
20|FH_F133868_40202_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F114432_75035_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F70448_0_0|SrvcGrp|67283|2022|PDM|57.00|99|0.00|PT SUBSEQUENT VISIT 97799|
20|FH_F83978_66739_0|SrvcGrp|72984|2022|PCT|0.00|99|0.00|CHEMOTHERAPY|
20|FH_F133747_80634_0|SrvcGrp|103383|2022|PDM|600.00|99|0.00|BEHAVIORAL HEALTH OBSERVATION|
20|FH_F95623_84015_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F119864_63141_0|SrvcGrp|48385|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F50577_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127091_62016_0|SrvcGrp|27968|2022|PCT|0.00|99|0.00|SKILLED NURSING LPN|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|220.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1602 W/O REV|
20|FH_F138047_77027_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132740_46250_0|SrvcGrp|88620|2022|PDM|90.00|99|0.00|SKILLED NURSING RN|
20|FH_F34182_0_0|SrvcGrp|16|2022|PDM|2278.00|99|0.00|ACUTE REHABILITATION|
20|FH_F88744_71103_0|SrvcGrp|34168|2022|PCT|0.75|99|0.00|BURN SERVICES MS DRG|
20|FH_F100680_43130_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F133870_60618_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110580_71106_0|CSTM-ALL|CSTM-00|2020|PDM|1305.00|99|0.00|AEG 7 (NO REV)|
20|FH_F124371_0_0|SrvcGrp|106294|2022|PDM|344.16|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F134667_19110_0|SrvcGrp|73841|2022|PDM|430.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|2356.00|99|0.00|AEG 9 (NO REV)|
20|FH_F149151_75248_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F89219_0_0|SrvcGrp|107756|2022|PDM|10460.00|99|0.00|NORMAL DELIVERY|
20|FH_F146103_63851_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)|
20|FH_F145781_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F85764_33308_0|SrvcGrp|75545|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F124743_0_0|SrvcGrp|82222|2022|PDM|125.00|99|0.00|HOSPICE CARE|
20|FH_F126188_59404_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F83754_0_0|SrvcGrp|17379|2022|PCT|0.86|99|0.00|CCPD TRAINING|
20|FH_F51559_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134972_84117_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F126043_30339_0|SrvcGrp|58509|2022|PDM|295.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F148600_30328_0|CSTM-ALL|CSTM-00|2020|PDM|1354.00|99|0.00|AEG 8 (NO REV)|
20|FH_F98021_07012_0|SrvcGrp|88977|2022|PDM|6469.00|99|0.00|C-SECTION DELIVERY|
20|FH_F114824_44484_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F149048_77090_0|SrvcGrp|94879|2022|PDM|145.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F110509_71351_0|SrvcGrp|73501|2022|PCT|0.50|99|0.00|AETNA OBSERVATION|
20|FH_F110509_71351_0|SrvcGrp|79786|2022|PDM|1000.00|99|0.00|SLEEP STUDIES|
20|FH_F145739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136359_0_0|SrvcGrp|63471|2022|PDM|8410.00|99|0.00|CPT 64590|
20|FH_F123623_03246_0|SrvcGrp|109296|2022|PCT|1.00|99|0.00|TRANSFUSION MEDICINE|
20|FH_F150165_06032_0|CSTM-ALL|CSTM-00|2020|PDM|2440.00|99|0.00|AEG 5  (NO REV)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|337.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 123 W/O REV|
20|FH_F120555_68405_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F133724_84041_0|SrvcGrp|95220|2022|PDM|474.00|99|0.00|HOSPICE CARE PROVIDED IN HOSPICE FACILITY (HCFA)|
20|FH_F130770_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F121476_0_0|SrvcGrp|108821|2022|PDM|156.00|99|0.00|GRAFTJACKET|
20|FH_F146160_52803_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F59872_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|ASPG III|
20|FH_F96780_0_0|SrvcGrp|28550|2022|PDM|1761.00|99|0.00|VITRECTOMY|
20|FH_F79863_0_0|SrvcGrp|74079|2022|PDM|255.00|99|0.00|HOME INFUSION|
20|FH_F143674_34208_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F92493_0_0|SrvcGrp|88155|2022|PDM|12999.53|99|0.00|REVISE KNEECAP WITH IMPLANT|
20|FH_F100703_0_0|SrvcGrp|97279|2022|PDM|7876.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY|
20|FH_F124178_01604_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F55694_0_0|SrvcGrp|19846|2022|PDM|20847.00|99|0.00|MS DRG 249 ONLY|
20|FH_F71443_0_0|SrvcGrp|68640|2022|PDM|4.00|99|0.00|THERAPY|
20|FH_F127604_0_0|SrvcGrp|82981|2022|PDM|180.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F136570_32084_0|SrvcGrp|89417|2022|PDM|325.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F114629_19131_0|SrvcGrp|105705|2022|PDM|378.00|99|0.00|AETNA TERANIAL MAGN STIM REDETEMINE (HCFA)|
20|FH_F134727_30650_0|SrvcGrp|103965|2022|PCT|1.10|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F134817_30339_0|SrvcGrp|27969|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F135747_76208_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F112371_19047_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41540_0_0|SrvcGrp|33827|2022|PDM|1290.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 5|
20|FH_F103004_75840_0|SrvcGrp|131|2022|PCT|0.88|99|0.00|PACEMAKER DEVICE|
20|FH_F34048_0_0|SrvcGrp|6|2022|PCT|0.77|99|0.00|OP SURGERY|
20|FH_F140007_0_0|SrvcGrp|97239|2022|PDM|8045.00|99|0.00|DISKECTOMY CERVICAL SINGLE|
20|FH_F38808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97261_06098_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F150939_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150939_0_0|SrvcGrp|100277|2022|PDM|59.71|99|0.00|HEPB VACCINE ADULT|
20|FH_F36854_0_0|SrvcGrp|701|2022|PDM|3160.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F113585_20155_0|SrvcGrp|86847|2022|PDM|60.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F138857_90025_0|SrvcGrp|79280|2022|PDM|1200.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F138685_18017_0|CSTM-ALL|CSTM-00|2020|PDM|468.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F67167_0_0|SrvcGrp|3188|2022|PDM|1091.00|99|0.00|NEWBORN NURSERY|
20|FH_F83792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F118986_0_0|SrvcGrp|75487|2022|PDM|1028.89|99|0.00|AEG 5|
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F113390_0_0|CSTM-ALL|CSTM-00|2020|PDM|3135.00|99|0.00|AEG 8 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.66|99|0.00|HAPA WPA-NWPA 2012-13 ASC 703 W/O REV|
20|FH_F113527_31023_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F151427_04106_0|SrvcGrp|100866|2022|PDM|364.93|99|0.00|CHEMOTHERAPY ADMINISTRATION|
20|FH_F151501_30265_0|SrvcGrp|116014|2022|PDM|1565.00|99|0.00|EXE FOOT/TOE TUM SC <1.5 CM|
20|FH_F145251_45107_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135453_70726_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F135465_80023_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F135489_70508_0|SrvcGrp|31700|2022|PDM|800.00|99|0.00|CD DETOX|
20|FH_F135583_17331_0|SrvcGrp|10667|2022|PDM|1947.00|99|0.00|BOARDER BABY SVCS|
20|FH_F135607_21613_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136042_90066_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F136110_83330_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131463_19096_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F116468_49660_0|SrvcGrp|73841|2022|PDM|380.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F130766_04967_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F140629_0_0|SrvcGrp|88599|2022|PDM|1372.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F121713_84747_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F46918_0_0|SrvcGrp|10545|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F127992_34952_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F111292_33136_0|SrvcGrp|73559|2022|PDM|6211.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F134264_67226_0|SrvcGrp|90854|2022|PDM|831.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F134322_98001_0|SrvcGrp|112550|2022|PCT|1.00|99|0.00|MEROPENEM INJECTION|
20|FH_F132328_0_0|SrvcGrp|111959|2022|PDM|2383.00|99|0.00|ELBOW ARTHROSCOPY|
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F112152_34994_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F87500_16823_0|SrvcGrp|48398|2022|PDM|104.00|99|0.00|PT SERVICES|
20|FH_F102222_19720_0|SrvcGrp|14893|2022|PDM|26.25|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F102282_06795_0|SrvcGrp|48385|2022|PDM|103.74|99|0.00|SPEECH THERAPY|
20|FH_F129240_10028_0|SrvcGrp|86837|2022|PDM|25.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F96960_35404_0|SrvcGrp|73485|2022|PDM|2794.00|99|0.00|AETNA REHAB|
20|FH_F102960_50613_0|CSTM-ALL|CSTM-00|2020|PDM|3167.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132090_60915_0|SrvcGrp|84442|2022|PDM|9500.00|99|0.00|REVISION KNEE|
20|FH_F148100_22406_0|SrvcGrp|73700|2022|PDM|42.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F148119_30165_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|GENERAL ACUTE CARE|
20|FH_F111594_0_0|SrvcGrp|88163|2022|PDM|5296.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|4057.00|99|0.00|AEG 7 (NO REV)|
20|FH_F134797_0_0|SrvcGrp|12664|2022|PCT|0.34|99|0.00|IMPLANTS|
20|FH_F137951_0_0|SrvcGrp|54943|2022|PDM|3131.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F149884_68516_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80855_0_0|SrvcGrp|73004|2022|PDM|1100.00|99|0.00|AEG 8|
20|FH_F92676_15063_0|SrvcGrp|79073|2022|PDM|323.03|99|0.00|MON VALLEY ASC 240|
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F65359_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F88956_0_0|SrvcGrp|73603|2022|PDM|2602.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F122646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F128144_45697_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134647_35244_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F90574_22560_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F85340_98195_0|CSTM-ALL|CSTM-00|2020|PDM|303.00|99|0.00|AETNA - APC GROUPER P|
20|FH_F114525_72401_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F126308_44515_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2456.00|99|0.00|AEG 7 (NO REV)|
20|FH_F71866_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132883_31602_0|SrvcGrp|14948|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F79824_0_0|SrvcGrp|17652|2022|PDM|725.00|99|0.00|SKILLED NURSING CARE|
20|FH_F54592_0_0|SrvcGrp|17004|2022|PDM|54.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS|
20|FH_F73024_0_0|SrvcGrp|48398|2022|PDM|30.00|99|0.00|PT SERVICES|
20|FH_F134488_14086_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F122470_78229_0|SrvcGrp|107288|2022|PCT|1.00|99|0.00|INJ INTERFERON BETA|
20|FH_F122520_46383_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F122526_22203_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
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|88101|2022|PDM|51.00|99|0.00|DRUG SCREEN SINGLE|
20|FH_F85012_0_0|SrvcGrp|16|2022|PDM|945.00|99|0.00|ACUTE REHABILITATION|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|86.90|99|0.00|HAPA WPA-NWPA 2012-13 ASC 242 W/O REV|
20|FH_F98800_85021_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F101084_15459_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F105145_75075_0|SrvcGrp|73004|2022|PDM|6926.00|99|0.00|AEG 8|
20|FH_F105361_80104_0|SrvcGrp|12809|2022|PCT|0.49|99|0.00|RADIATION THERAPY SVCS|
20|FH_F80513_0_0|SrvcGrp|19846|2022|PDM|14061.00|99|0.00|MS DRG 249 ONLY|
20|FH_F146795_44122_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120522_53549_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F120774_14070_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F120795_27514_0|CSTM-ALL|CSTM-00|2020|PDM|4880.00|99|0.00|AEG 1 (NO REV)|
20|FH_F115950_08648_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116055_59804_0|SrvcGrp|106554|2022|PDM|1000.00|99|0.00|CT SCAN|
20|FH_F131674_72501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139188_29169_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139666_26175_0|SrvcGrp|113186|2022|PCT|0.94|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F139680_76006_0|SrvcGrp|73842|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139707_84010_0|SrvcGrp|114740|2022|PDM|5163.00|99|0.00|ENT PROCEDURES|
20|FH_F139150_75206_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F151407_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F146266_0_0|SrvcGrp|26275|2022|PDM|3450.00|99|0.00|CPT 29826|
20|FH_F107840_07006_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F117617_80439_0|SrvcGrp|95762|2022|PDM|165.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F120435_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F150442_28451_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 3 (NO REV)|
20|FH_F50100_0_0|SrvcGrp|46112|2022|PDM|55.32|99|0.00|MATERNAL/CHILD HEALTH (ADDITIONAL HOUR)|
20|FH_F89851_83854_0|SrvcGrp|38664|2022|PDM|12942.00|99|0.00|MS DRG 328 ONLY|
20|FH_F110783_93013_0|SrvcGrp|116239|2022|PDM|89.00|99|0.00|RITUXIMAB INJECTION 10 MG|
20|FH_F116575_0_0|SrvcGrp|88823|2022|PDM|1250.00|99|0.00|REPAIR OF EARDRUM|
20|FH_F136806_0_0|SrvcGrp|94883|2022|PDM|1380.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F138478_0_0|SrvcGrp|109504|2022|PDM|6793.71|99|0.00|REMV & REPLC PM GEN DUAL LEAD|
20|FH_F138995_0_0|SrvcGrp|91940|2022|PDM|886.00|99|0.00|TYMPANIC MEMBRANE REPAIR|
20|FH_F34853_0_0|SrvcGrp|8968|2022|PDM|3383.00|99|0.00|NICU LEVEL III & IV|
20|FH_F97084_91911_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F93961_0_0|SrvcGrp|91861|2022|PDM|452.00|99|0.00|COLONOSCOPY PROCEDURES|
20|FH_F132033_60134_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35757_34652_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149642_95678_0|SrvcGrp|108484|2022|PDM|800.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F74663_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97082_90012_0|CSTM-ALL|CSTM-00|2020|PCT|0.46|99|0.00|OP SVCS|
20|FH_F128753_32501_0|SrvcGrp|90356|2022|PCT|0.64|99|0.00|OP DIALYSIS|
20|FH_F69249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|2173.00|99|0.00|AEG 3 (NO REV)|
20|FH_F141247_18902_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F140349_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F147332_19406_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F108680_0_0|SrvcGrp|96799|2022|PDM|1595.00|99|0.00|DESTROY C/TH FACET JNT ADDL|
20|FH_F142327_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1195.00|99|0.00|AEG 8 (NO REV)|
20|FH_F35446_0_0|SrvcGrp|16|2022|PDM|893.00|99|0.00|ACUTE REHABILITATION|
20|FH_F108260_63141_0|SrvcGrp|48394|2022|PDM|70.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F117711_73080_0|SrvcGrp|73004|2022|PDM|1260.00|99|0.00|AEG 8|
20|FH_F36943_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD TC|
20|FH_F37364_0_0|SrvcGrp|9863|2022|PDM|2000.00|99|0.00|INTENSIVE CARE/CORONARY CARE UNIT|
20|FH_F49338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F94303_0_0|SrvcGrp|72996|2022|PDM|1624.00|99|0.00|AEG 4|
20|FH_F39443_0_0|SrvcGrp|30338|2022|PDM|140.00|99|0.00|HAPA WPA ASC 222|
20|FH_F97603_77901_0|SrvcGrp|73659|2022|PDM|5411.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F34706_0_0|SrvcGrp|10126|2022|PDM|5834.00|99|0.00|DRG 015 NONSPECIFIC CRBRVSCLR & PRECRBRL OCCLSN W/O INFRCTN|
20|FH_F34706_0_0|SrvcGrp|11212|2022|PDM|14872.00|99|0.00|DRG 556 PERCUTANEUS CV PX W/NON DRUG ELUTING STENT W/O MC DX|
20|FH_F148021_80907_0|SrvcGrp|88779|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F35575_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|691.00|99|0.00|AEG 2 (NO REV)|
20|FH_F97140_91730_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F92531_0_0|SrvcGrp|67066|2022|PDM|4510.00|99|0.00|CERVICAL SURGERY|
20|FH_F121016_32607_0|SrvcGrp|104469|2022|PDM|3150.00|99|0.00|VBAC DELIVERY|
20|FH_F103106_04101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118647_21811_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120825_66204_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F133447_53120_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKE|
20|FH_F67639_0_0|SrvcGrp|27402|2022|PDM|1800.00|99|0.00|LASER PROCEDURES|
20|FH_F130563_85122_0|SrvcGrp|87077|2022|PDM|143.50|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F130606_41144_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141612_19605_0|SrvcGrp|12659|2022|PDM|927.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F145960_33414_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F123872_75006_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F128299_44134_0|SrvcGrp|95660|2022|PDM|550.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F142028_45714_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117885_81506_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F96261_0_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F55375_0_0|SrvcGrp|51469|2022|PDM|140.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F41438_0_0|SrvcGrp|22954|2022|PDM|140.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F41181_0_0|SrvcGrp|13551|2022|PDM|468.00|99|0.00|NEWBORN NURSERY|
20|FH_F132289_89145_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F95980_20016_0|SrvcGrp|86648|2022|PCT|1.05|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F141657_85715_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F100740_15206_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F145864_65084_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141910_70809_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|985.00|99|0.00|AEG 8 (NO REV)|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD KM"|
20|FH_F127994_19301_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F111467_33761_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123091_92627_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F90935_29073_0|SrvcGrp|43523|2022|PDM|120.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F37778_0_0|SrvcGrp|27311|2022|PDM|1749.00|99|0.00|EXCISION PAROTID GLAND/LESION|
20|FH_F148019_54311_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F92677_08003_0|SrvcGrp|24744|2022|PDM|113.40|99|0.00|PICC LINE INSERTION|
20|FH_F45199_0_0|CSTM-ALL|CSTM-00|2020|PDM|1504.00|99|0.00|ASPG IX|
20|FH_F129176_48098_0|SrvcGrp|83857|2022|PDM|550.00|99|0.00|IP HOSPICE SVCS|
20|FH_F42807_0_0|SrvcGrp|115|2022|PDM|468.00|99|0.00|SKILLED NURSING CARE|
20|FH_F89851_83854_0|SrvcGrp|88903|2022|PDM|11800.00|99|0.00|MS DRG 581 ONLY|
20|FH_F39859_0_0|SrvcGrp|12287|2022|PCT|0.60|99|0.00|IP PET SCAN|
20|FH_F88956_0_0|SrvcGrp|75481|2022|PDM|1433.00|99|0.00|AEG 2|
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|ASPG VIII|
20|FH_F93375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39180_0_0|SrvcGrp|361|2022|PDM|1783.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F113326_80014_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F39723_0_0|SrvcGrp|11798|2022|PDM|105.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F150524_64106_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88223_0_0|SrvcGrp|29347|2022|PDM|19.80|99|0.00|HOME HEALTH AIDE|
20|FH_F128279_77043_0|SrvcGrp|89149|2022|PDM|160.00|99|0.00|OP INTENSIVE|
20|FH_F101754_63141_0|SrvcGrp|97979|2022|PDM|20.27|99|0.00|ELECTRO HEARING AID TEST ONE|
20|FH_F97041_71603_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146244_76028_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F63417_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER RRKE|
20|FH_F37640_0_0|CSTM-ALL|CSTM-00|2020|PDM|1129.00|99|0.00|ASPG VII|
20|FH_F42159_0_0|SrvcGrp|12118|2022|PCT|0.95|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F146220_72112_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92677_08003_0|SrvcGrp|86854|2022|PDM|84.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F133006_48067_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F125049_44131_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F130656_04401_0|SrvcGrp|111928|2022|PCT|1.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F111809_93003_0|SrvcGrp|75506|2022|PCT|9.35|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F132837_64118_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F39180_0_0|SrvcGrp|97|2022|PDM|1896.00|99|0.00|C-SECTION|
20|FH_F38425_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118542_60188_0|SrvcGrp|73742|2022|PCT|1.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F141411_0_0|SrvcGrp|113758|2022|PDM|4500.00|99|0.00|DEBRIDEMENT OF SKIN|
20|FH_F125266_44515_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F45435_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKE|
20|FH_F56232_0_0|CSTM-ALL|CSTM-00|2020|PDM|1359.61|99|0.00|ASPG V|
20|FH_F138018_17313_0|SrvcGrp|17004|2022|PDM|103.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS|
20|FH_F117583_21208_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|3545.00|99|0.00|AEG 6 (NO REV)|
20|FH_F130581_40356_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F36382_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36454_0_0|SrvcGrp|16719|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|3380.00|99|0.00|ASPG VI|
20|FH_F150982_0_0|SrvcGrp|101527|2022|PDM|1930.00|99|0.00|HYSTEROSCOPY LYSIS|
20|FH_F126914_44136_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F40490_0_0|SrvcGrp|12406|2022|PCT|0.59|99|0.00|DRUGS|
20|FH_F73768_0_0|SrvcGrp|71106|2022|PDM|12.00|99|0.00|DISPOSABLE SENSOR|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|292.86|99|0.00|SALLY BALIN,999182,ASC 214|
20|FH_F35735_33870_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F34882_0_0|SrvcGrp|3409|2022|PDM|590.00|99|0.00|NEWBORN NURSERY|
20|FH_F149512_62550_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F47902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F84433_0_0|SrvcGrp|43567|2022|PDM|107.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F129237_72833_0|SrvcGrp|109029|2022|PCT|0.88|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F35557_0_0|SrvcGrp|11790|2022|PDM|52.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F137767_01841_0|SrvcGrp|73659|2022|PDM|3925.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F103180_85283_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F148940_44077_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F34983_0_0|CSTM-ALL|CSTM-00|2020|PDM|1234.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F136493_0_0|SrvcGrp|65720|2022|PDM|166.00|99|0.00|RESPITE CARE|
20|FH_F39287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134847_0_0|SrvcGrp|83641|2022|PDM|5926.00|99|0.00|CPT 29889|
20|FH_F149000_07701_0|SrvcGrp|115559|2022|PCT|1.00|99|0.00|OPIOID TREATMENT|
20|FH_F131548_32003_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F128197_84123_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F124441_0_0|SrvcGrp|88162|2022|PDM|5700.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F146266_0_0|SrvcGrp|100042|2022|PDM|8573.00|99|0.00|REPAIR HUMERUS FRACTURE II|
20|FH_F90455_0_0|SrvcGrp|3810|2022|PDM|151.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|77.92|99|0.00|SALLY BALIN,999182,ASC 125|
20|FH_F36883_0_0|SrvcGrp|73652|2022|PDM|312.50|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F92278_01440_0|SrvcGrp|43524|2022|PDM|140.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F37304_0_0|SrvcGrp|3409|2022|PDM|379.00|99|0.00|NEWBORN NURSERY|
20|FH_F42979_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F110963_30535_0|SrvcGrp|78403|2022|PDM|0.25|99|0.00|AETNA MED RECORD|
20|FH_F128924_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47573_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127418_0_0|SrvcGrp|108350|2022|PDM|18957.29|99|0.00|REPAIR OF DURAL/CSF LEAK|
20|FH_F110725_48047_0|SrvcGrp|89149|2022|PDM|150.00|99|0.00|OP INTENSIVE|
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|2126.00|99|0.00|AEG 8 (NO REV)|
20|FH_F140231_60540_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139810_60938_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143488_84770_0|CSTM-ALL|CSTM-00|2020|PDM|1563.00|99|0.00|AEG 8 (NO REV)|
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1286.00|99|0.00|AEG 9 (NO REV)|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|HERNIA REPAIR W/ MESH|
20|FH_F130918_01606_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F131107_43140_0|SrvcGrp|94780|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F151746_20032_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F82375_28601_0|SrvcGrp|88621|2022|PDM|184.00|99|0.00|SKILLED NURSING LPN|
20|FH_F47600_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1068.00|99|0.00|GA RETINA SURG CTR ASC 26|
20|FH_F49286_0_0|SrvcGrp|10517|2022|PDM|8.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F132353_66423_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F112679_85711_0|SrvcGrp|48385|2022|PDM|117.00|99|0.00|SPEECH THERAPY|
20|FH_F116633_37217_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F39567_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION|
20|FH_F39567_0_0|SrvcGrp|6|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F50137_0_0|SrvcGrp|14081|2022|PDM|120.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|2684.00|99|0.00|AEG 6 (NO REV)|
20|FH_F34550_0_0|SrvcGrp|38|2022|PDM|2184.00|99|0.00|NORMAL DELIVERY|
20|FH_F128272_60640_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F121490_86314_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F46359_0_0|SrvcGrp|10410|2022|PDM|79.00|99|0.00|SKILLED NURSING CARE|
20|FH_F39138_0_0|SrvcGrp|18247|2022|PDM|7674.00|99|0.00|MS DRG 286|
20|FH_F37173_0_0|SrvcGrp|23387|2022|PDM|70.00|99|0.00|PT/OT/ST|
20|FH_F130452_48801_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F34710_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35271_0_0|SrvcGrp|14187|2022|PDM|850.00|99|0.00|MRI|
20|FH_F122687_0_0|SrvcGrp|88163|2022|PDM|12020.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F110925_01104_0|SrvcGrp|86155|2022|PDM|0.26|99|0.00|AETNA MEDROXYPROGESTERONE|
20|FH_F72850_0_0|SrvcGrp|3418|2022|PCT|0.66|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F127325_0_0|SrvcGrp|72992|2022|PDM|427.00|99|0.00|AEG 2|
20|FH_F102561_75146_0|SrvcGrp|73602|2022|PDM|850.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F72750_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F149880_33150_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F38425_0_0|SrvcGrp|10545|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F119437_0_0|SrvcGrp|89848|2022|PDM|4000.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F112853_22408_0|SrvcGrp|98482|2022|PDM|50.00|99|0.00|PHOTOTHERAPY (HCFA)|
20|FH_F117346_75093_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F87615_80033_0|SrvcGrp|102980|2022|PDM|134.00|99|0.00|PSYTX WPT W E/M 30 MIN|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1362.00|99|0.00|COVENTRY ENHANCED GROUPER 8 MOD 50|
20|FH_F111461_32607_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F49354_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F79902_0_0|SrvcGrp|33011|2022|PCT|1.00|99|0.00|HIGH COST DRUGS/PHARMACEUTICALS|
20|FH_F139428_65270_0|SrvcGrp|29346|2022|PDM|30.90|99|0.00|SKILLED NURSING- LPN|
20|FH_F150820_83843_0|SrvcGrp|11673|2022|PDM|4000.00|99|0.00|CPT 29888|
20|FH_F150882_84041_0|SrvcGrp|86835|2022|PDM|19.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F132008_85226_0|SrvcGrp|107247|2022|PCT|0.80|99|0.00|ULTRALIGHTWEIGHT WHEELCHAIR|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|1333.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F119376_0_0|SrvcGrp|108114|2022|PDM|2500.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F108680_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F114585_11501_0|SrvcGrp|104080|2022|PCT|1.03|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F117737_75001_0|CSTM-ALL|CSTM-00|2020|PCT|1.65|99|0.00|HSS ASC|
20|FH_F124749_90211_0|SrvcGrp|90573|2022|PDM|363.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F71468_0_0|SrvcGrp|10544|2022|PDM|70.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F67419_0_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F40490_0_0|SrvcGrp|10107|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F42016_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50220_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F127324_0_0|SrvcGrp|93962|2022|PDM|11480.00|99|0.00|NEURO STIMULATOR|
20|FH_F134847_0_0|SrvcGrp|92408|2022|PDM|5836.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|2944.00|99|0.00|AEG 7 (NO REV)|
20|FH_F35416_0_0|SrvcGrp|147|2022|PCT|0.80|99|0.00|HOME HEALTH CARE|
20|FH_F133677_15601_0|SrvcGrp|14494|2022|PDM|28.41|99|0.00|CONTINUOUS HOMECARE|
20|FH_F109160_63129_0|SrvcGrp|73842|2022|PDM|203.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130182_0_0|SrvcGrp|104921|2022|PDM|104.00|99|0.00|HEART FLOW RESERVE MEASURE-CONCUR|
20|FH_F38172_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|GA STANDARD CT CODES|
20|FH_F111044_0_0|SrvcGrp|78282|2022|PDM|3296.00|99|0.00|CPT 47563|
20|FH_F114568_08097_0|SrvcGrp|105047|2022|PDM|145.00|99|0.00|AETNA PSYCH DIAG EVAL W/ MED SVCS (HCFA)|
20|FH_F139910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114676_91911_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F90199_24083_0|SrvcGrp|33165|2022|PDM|315.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F131028_49735_0|SrvcGrp|83857|2022|PDM|550.00|99|0.00|IP HOSPICE SVCS|
20|FH_F148347_0_0|SrvcGrp|116282|2022|PDM|4252.00|99|0.00|HERNIA|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|ASPG IV|
20|FH_F113869_40215_0|SrvcGrp|73841|2022|PDM|355.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F136779_0_0|SrvcGrp|19922|2022|PDM|3463.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F128770_57313_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110725_48047_0|SrvcGrp|89417|2022|PDM|350.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F36715_0_0|SrvcGrp|20576|2022|PDM|13000.00|99|0.00|MS DRG 619-621 BARIATRIC SURGERY|
20|FH_F76382_0_0|SrvcGrp|472|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133632_0_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F149459_06615_0|SrvcGrp|48396|2022|PDM|121.00|99|0.00|OT SERVICES|
20|FH_F98880_50158_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F138217_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F149579_95815_0|SrvcGrp|115665|2022|PDM|5.83|99|0.00|BRIEF EMOTIONAL BH (HCFA)|
20|FH_F148347_0_0|SrvcGrp|79594|2022|PDM|2338.00|99|0.00|CPT 45380|
20|FH_F115982_0_0|SrvcGrp|72996|2022|PDM|791.00|99|0.00|AEG 4|
20|FH_F114206_37203_0|SrvcGrp|86825|2022|PDM|60.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F148859_0_0|SrvcGrp|22780|2022|PDM|1974.00|99|0.00|CPT 55875|
20|FH_F36338_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F118907_0_0|SrvcGrp|107722|2022|PDM|603.56|99|0.00|SLEEP STUDIES|
20|FH_F116806_0_0|SrvcGrp|107095|2022|PDM|973.15|99|0.00|COMPLEX  WOUND DRAINAGE|
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|32123.00|99|0.00|MS DRG 233-234 CORONARY BYPASS|
20|FH_F90223_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F146204_0_0|SrvcGrp|67989|2022|PDM|2376.00|99|0.00|CPT 49320|
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1705.00|99|0.00|AEG 6 (NO REV)|
20|FH_F147201_48234_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67419_0_0|SrvcGrp|42973|2022|PDM|80.00|99|0.00|SPEECH  THERAPIST|
20|FH_F114568_08097_0|SrvcGrp|105685|2022|PDM|175.00|99|0.00|INTENSIVE OUTPATIENT 13-17 YRS|
20|FH_F36594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138017_73129_0|SrvcGrp|113083|2022|PDM|315.00|99|0.00|CT SCAN|
20|FH_F110732_31513_0|SrvcGrp|705|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F114332_19973_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS|
20|FH_F98280_31015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132849_0_0|SrvcGrp|32541|2022|PDM|36675.00|99|0.00|MS DRG 231-236 ONLY|
20|FH_F150922_02452_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F56472_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|1886.00|99|0.00|AEG 10 (NO REV)|
20|FH_F102184_0_0|SrvcGrp|88158|2022|PDM|7215.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F125011_74467_0|SrvcGrp|47532|2022|PDM|3730.00|99|0.00|TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE|
20|FH_F118311_35211_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F141592_80233_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F148182_23324_0|SrvcGrp|88620|2022|PDM|84.00|99|0.00|SKILLED NURSING RN|
20|FH_F106020_0_0|SrvcGrp|35669|2022|PDM|2311.00|99|0.00|CPT 63650|
20|FH_F125249_0_0|SrvcGrp|33971|2022|PDM|1700.00|99|0.00|CPT 25652|
20|FH_F91891_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F91622_0_0|CSTM-ALL|CSTM-00|2020|PDM|702.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F43858_0_0|SrvcGrp|35468|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F135165_15728_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F129968_98004_0|SrvcGrp|89417|2022|PDM|585.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F72850_0_0|SrvcGrp|3271|2022|PDM|5244.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F75084_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F71848_0_0|SrvcGrp|56522|2022|PDM|191.35|99|0.00|SURGICAL PATHOLOGY LEVEL IV|
20|FH_F130747_0_0|SrvcGrp|92820|2022|PDM|5202.00|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY|
20|FH_F93424_53578_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F38034_0_0|SrvcGrp|10024|2022|PDM|3634.00|99|0.00|ICU/CCU|
20|FH_F78285_0_0|SrvcGrp|9829|2022|PDM|50.00|99|0.00|PT SVCS|
20|FH_F126844_44333_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F123943_84041_0|SrvcGrp|80918|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F92760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117504_31088_0|SrvcGrp|57968|2022|PDM|32.66|99|0.00|CONTINUOUS HOMECARE|
20|FH_F129400_32726_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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_F129653_0_0|SrvcGrp|67065|2022|PDM|4000.00|99|0.00|CERVICAL SURGERY|
20|FH_F137367_89139_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39819_0_0|SrvcGrp|31229|2022|PDM|5396.00|99|0.00|NY DRG 167 ONLY|
20|FH_F125516_50574_0|SrvcGrp|537|2022|PCT|0.90|99|0.00|OBSERVATION SERVICES|
20|FH_F123844_0_0|SrvcGrp|63297|2022|PDM|190.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F58692_0_0|SrvcGrp|3066|2022|PCT|0.50|99|0.00|HIGH-COST DRUGS|
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|1971.00|99|0.00|AEG 6 (NO REV)|
20|FH_F45169_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145535_92708_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F38528_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F143973_28040_0|SrvcGrp|74668|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F141507_0_0|SrvcGrp|109760|2022|PDM|3150.00|99|0.00|TRANSLUM DIL EYE CANAL|
20|FH_F130424_41102_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143928_21061_0|SrvcGrp|73742|2022|PCT|1.05|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F93881_15009_0|SrvcGrp|81403|2022|PDM|37.00|99|0.00|COMPREHEN METABOLIC PANEL|
20|FH_F137718_80107_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F148170_04005_0|SrvcGrp|13681|2022|PCT|2.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F102184_0_0|SrvcGrp|71666|2022|PDM|6737.00|99|0.00|CPT 63655|
20|FH_F37605_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77883_0_0|CSTM-ALL|CSTM-00|2020|PDM|462.83|99|0.00|ENHANCED TELE-MONITORING|
20|FH_F115685_64064_0|SrvcGrp|86841|2022|PDM|125.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F65680_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F135078_73119_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128108_49505_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120294_46322_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|803.00|99|0.00|AEG 1 (NO REV)|
20|FH_F148255_72703_0|SrvcGrp|14949|2022|PDM|47.25|99|0.00|HOME INFUSION|
20|FH_F128363_60062_0|SrvcGrp|86722|2022|PDM|248.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F139551_0_0|SrvcGrp|34606|2022|PDM|5000.00|99|0.00|CPT 29827|
20|FH_F137946_0_0|SrvcGrp|113232|2022|PDM|42.13|99|0.00|COVID-19 SARS-COV-2 ANTB QUANTITATIVE|
20|FH_F129792_80309_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115010_20105_0|SrvcGrp|22528|2022|PDM|460.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F148319_37042_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F128272_60640_0|SrvcGrp|86847|2022|PDM|50.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F130466_53916_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62719_0_0|SrvcGrp|44712|2022|PDM|108.00|99|0.00|OT SVCS|
20|FH_F93920_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|AETNA OP LABORATORY|
20|FH_F38473_0_0|SrvcGrp|10615|2022|PDM|120.00|99|0.00|HOME HEALTH AIDE|
20|FH_F100662_27534_0|SrvcGrp|73485|2022|PDM|3401.00|99|0.00|AETNA REHAB|
20|FH_F121495_92009_0|SrvcGrp|46903|2022|PDM|1250.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F110925_01104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT HH|
20|FH_F143528_0_0|SrvcGrp|88163|2022|PDM|10500.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F100761_02539_0|SrvcGrp|73659|2022|PDM|6163.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F150982_0_0|SrvcGrp|11673|2022|PDM|3854.00|99|0.00|CPT 29888|
20|FH_F116024_13203_0|SrvcGrp|89022|2022|PDM|30.90|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F125949_66534_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131965_0_0|SrvcGrp|97507|2022|PDM|100.00|99|0.00|AETNA HOSPICE|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHYSICIAN CLINIC VISIT NATL F/S (MOD UE)|
20|FH_F138215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82696_16335_0|SrvcGrp|38247|2022|PCT|1.00|99|0.00|SLEEP STUDIES|
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PDM|5962.00|99|0.00|AEG 7 (NO REV)|
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 9 (NO REV)|
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|3978.00|99|0.00|AEG 8 (NO REV)|
20|FH_F146859_0_0|SrvcGrp|16472|2022|PDM|1791.00|99|0.00|HAND PROCEDURE|
20|FH_F117023_0_0|SrvcGrp|72992|2022|PDM|735.00|99|0.00|AEG 2|
20|FH_F31547_0_0|SrvcGrp|12834|2022|PCT|0.88|99|0.00|EMERGENCY ROOM|
20|FH_F35770_33511_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F149645_92708_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F117645_90034_0|SrvcGrp|107574|2022|PCT|1.10|99|0.00|AETNA OUTPATIENT THERAPY|
20|FH_F140094_16125_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F140137_15235_0|SrvcGrp|26001|2022|PDM|131.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F143536_47546_0|SrvcGrp|85259|2022|PCT|0.00|99|0.00|PERIODIC REEVALUATION|
20|FH_F101700_0_0|SrvcGrp|104588|2022|PDM|362.31|99|0.00|EPIDURAL OR SUBARACHNOID; CERVICAL OR THORACIC|
20|FH_F103140_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|ACUTE REHAB II|
20|FH_F103481_0_0|SrvcGrp|471|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F131093_49690_0|SrvcGrp|94781|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F131173_17043_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F136299_75218_0|SrvcGrp|112835|2022|PCT|1.80|99|0.00|CHEMOTHERAPY|
20|FH_F132480_92054_0|SrvcGrp|46903|2022|PDM|428.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132480_92054_0|SrvcGrp|109798|2022|PCT|1.25|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F116683_64730_0|SrvcGrp|90479|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F119993_71913_0|SrvcGrp|79720|2022|PDM|1125.00|99|0.00|ACUTE REHAB II|
20|FH_F120974_27607_0|SrvcGrp|10363|2022|PDM|955.00|99|0.00|CPT CODE 99283|
20|FH_F113563_70560_0|SrvcGrp|87123|2022|PDM|950.00|99|0.00|DESTROY LUMB/SAC FACET JNT|
20|FH_F41535_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY|
20|FH_F38831_0_0|SrvcGrp|439|2022|PDM|1772.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F40517_0_0|SrvcGrp|13722|2022|PDM|165.20|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE|
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F45332_0_0|SrvcGrp|14412|2022|PDM|480.00|99|0.00|HOSPICE CARE|
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|746.97|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F66420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F50137_0_0|SrvcGrp|10541|2022|PDM|115.00|99|0.00|PHYSICAL THERAPY SVCS|
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|2401.00|99|0.00|ASPG V - FH SW CUSTOM GROUPERS|
20|FH_F118194_50841_0|SrvcGrp|108268|2022|PCT|1.00|99|0.00|DME (MOD NU)|
20|FH_F34138_0_0|SrvcGrp|3809|2022|PDM|567.07|99|0.00|HOSPICE CARE|
20|FH_F90874_0_0|SrvcGrp|29429|2022|PDM|1988.00|99|0.00|ULTRA FILTRATION|
20|FH_F124388_0_0|SrvcGrp|87421|2022|PDM|1254.00|99|0.00|CYSTOURETHROSCOPY|
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116955_16801_0|SrvcGrp|48385|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKL|
20|FH_F129656_15005_0|SrvcGrp|24744|2022|PDM|80.00|99|0.00|PICC LINE INSERTION|
20|FH_F133207_0_0|SrvcGrp|73610|2022|PCT|0.00|99|0.00|AETNA IMPLANTS|
20|FH_F151539_64014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F125899_07645_0|SrvcGrp|110280|2022|PDM|7775.00|99|0.00|SURGICAL MSDRG|
20|FH_F143819_29485_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F39943_0_0|SrvcGrp|439|2022|PDM|1850.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F38982_0_0|SrvcGrp|72|2022|PDM|377.00|99|0.00|NEWBORN NURSERY|
20|FH_F148221_06477_0|SrvcGrp|48396|2022|PDM|105.00|99|0.00|OT SERVICES|
20|FH_F87254_0_0|SrvcGrp|44068|2022|PDM|1100.00|99|0.00|CPT 52332|
20|FH_F139173_0_0|SrvcGrp|48394|2022|PDM|95.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F70645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F129656_15005_0|SrvcGrp|19742|2022|PDM|80.00|99|0.00|MID-LINE INSERTION|
20|FH_F130523_04605_0|SrvcGrp|79699|2022|PCT|0.84|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F130747_0_0|SrvcGrp|111587|2022|PDM|6763.00|99|0.00|CPTR-ASST DIR MS PX|
20|FH_F110166_32757_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149939_91942_0|SrvcGrp|90854|2022|PDM|1100.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F34496_0_0|SrvcGrp|12350|2022|PDM|798.00|99|0.00|BOARDER BABY SERVICES|
20|FH_F100962_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117010_10549_0|SrvcGrp|86746|2022|PCT|1.05|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F145755_08050_0|SrvcGrp|113994|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F129305_45614_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F131236_84041_0|SrvcGrp|90707|2022|PDM|93.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F72369_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F92392_0_0|SrvcGrp|74581|2022|PCT|0.50|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F117378_16148_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F148254_89503_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F37651_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD AU|
20|FH_F90714_0_0|SrvcGrp|72996|2022|PDM|710.00|99|0.00|AEG 4|
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148265_06067_0|SrvcGrp|88163|2022|PDM|16023.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F37330_0_0|SrvcGrp|26142|2022|PDM|1920.00|99|0.00|PET SCAN|
20|FH_F90691_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F149720_81212_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F90654_0_0|SrvcGrp|25695|2022|PDM|1300.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F149888_68506_0|SrvcGrp|11673|2022|PDM|6124.00|99|0.00|CPT 29888|
20|FH_F128883_89521_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F130682_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F122687_0_0|SrvcGrp|100041|2022|PDM|4371.00|99|0.00|REPAIR HUMERUS FRACTURE I|
20|FH_F126523_0_0|SrvcGrp|73000|2022|PDM|1135.00|99|0.00|AEG 6|
20|FH_F100762_51104_0|SrvcGrp|73605|2022|PDM|2382.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F117010_10549_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131176_28712_0|SrvcGrp|109036|2022|PDM|955.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F137507_62901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F52854_0_0|SrvcGrp|16435|2022|PDM|5366.00|99|0.00|CERVICAL FUSION - ANTERIOR TECHNIQUE|
20|FH_F127152_50636_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125890_43054_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F130977_0_0|SrvcGrp|3142|2022|PDM|1695.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F135066_02908_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S AZ/NV - MOD KM|
20|FH_F35259_0_0|SrvcGrp|3499|2022|PCT|0.68|99|0.00|IMPLANTS|
20|FH_F114963_62062_0|SrvcGrp|82773|2022|PDM|184.00|99|0.00|POST NATAL ASSESSMENT W/ NEWBORN|
20|FH_F130747_0_0|SrvcGrp|41325|2022|PDM|4682.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F97540_32114_0|SrvcGrp|73559|2022|PDM|30071.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F148255_72703_0|SrvcGrp|86839|2022|PDM|31.50|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F44218_0_0|SrvcGrp|10951|2022|PDM|350.00|99|0.00|PARTIAL HOSPITALIZATION PSYCH/CD|
20|FH_F113410_0_0|SrvcGrp|89982|2022|PDM|2942.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY|
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 4 (NO REV)|
20|FH_F112272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128982_44221_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F149780_00783_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F100762_51104_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F82871_33160_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F145545_01602_0|SrvcGrp|113928|2022|PDM|354.00|99|0.00|PARTIAL HOSPITAL (>=18 YRS)|
20|FH_F150462_30458_0|SrvcGrp|17011|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
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_F123488_65559_0|SrvcGrp|472|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F110220_0_0|SrvcGrp|93688|2022|PDM|739.82|99|0.00|POLYSOMNOGRAPHY (HCFA)|
20|FH_F141794_50548_0|SrvcGrp|75506|2022|PCT|0.75|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F102302_0_0|SrvcGrp|98597|2022|PDM|10850.00|99|0.00|CERVICAL LAMINOTOMY|
20|FH_F73729_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40519_0_0|SrvcGrp|32647|2022|PCT|1.50|99|0.00|OTHER DIAGNOSTIC TESTING - CPT/GLOBAL|
20|FH_F126489_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F48192_0_0|SrvcGrp|592|2022|PDM|550.00|99|0.00|SUB-ACUTE CARE|
20|FH_F110043_33308_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F97540_32114_0|SrvcGrp|73601|2022|PDM|19774.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F63095_0_0|SrvcGrp|9518|2022|PCT|0.65|99|0.00|EMERGENCY ROOM|
20|FH_F63419_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F86872_15215_0|SrvcGrp|112058|2022|PDM|45.00|99|0.00|INFLECTRA|
20|FH_F86851_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F62579_0_0|SrvcGrp|24762|2022|PDM|150.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F117887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|PEDIATRIC CV SURGERY (MS DRG)|
20|FH_F72102_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130656_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 9 (NO REV)|
20|FH_F134619_14304_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F110541_99336_0|SrvcGrp|73842|2022|PDM|135.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|1290.00|99|0.00|AEG 8 (NO REV)|
20|FH_F117437_0_0|SrvcGrp|83857|2022|PDM|761.00|99|0.00|IP HOSPICE SVCS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|416.66|99|0.00|HAPA WPA-NWPA 2012-13 ASC 209 W/O REV|
20|FH_F134610_33426_0|SrvcGrp|109798|2022|PCT|1.10|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F83995_16748_0|SrvcGrp|82626|2022|PDM|862.00|99|0.00|ER SETTING W/ OP SURGERY LEVEL V|
20|FH_F149263_0_0|SrvcGrp|115606|2022|PDM|4900.00|99|0.00|REVISE CERV ARTIFIC DISC|
20|FH_F127638_44720_0|SrvcGrp|94780|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F130468_0_0|SrvcGrp|27261|2022|PDM|12602.50|99|0.00|CPT 27446|
20|FH_F133922_70563_0|SrvcGrp|42722|2022|PDM|69.65|99|0.00|SLEEP STUDIES CPT 95806 W/MODIFIER 26|
20|FH_F117208_0_0|SrvcGrp|106264|2022|PDM|4015.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION|
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|990.00|99|0.00|AEG 7 (NO REV)|
20|FH_F118123_67226_0|SrvcGrp|14947|2022|PDM|5.00|99|0.00|HOME INFUSION|
20|FH_F70162_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F125139_84096_0|SrvcGrp|108484|2022|PDM|950.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F88672_0_0|SrvcGrp|35669|2022|PDM|3992.00|99|0.00|CPT 63650|
20|FH_F87012_0_0|SrvcGrp|72996|2022|PDM|1074.86|99|0.00|AEG 4|
20|FH_F103220_0_0|SrvcGrp|81904|2022|PDM|13750.00|99|0.00|LAP PARASOPHAG HERNIA REPAIR|
20|FH_F145641_06902_0|SrvcGrp|97895|2022|PDM|20500.00|99|0.00|REVISE KNEE 2|
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|688.00|99|0.00|AEG 4 (NO REV)|
20|FH_F150145_20124_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F97041_71603_0|SrvcGrp|73559|2022|PDM|7063.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F90232_15126_0|SrvcGrp|24761|2022|PDM|51.45|99|0.00|HOME INFUSION THERAPY|
20|FH_F85652_98034_0|CSTM-ALL|CSTM-00|2020|PCT|2.36|99|0.00|AETNA - APC GROUPER Y|
20|FH_F126550_43085_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F117437_0_0|SrvcGrp|104229|2022|PDM|180.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F79245_0_0|SrvcGrp|66480|2022|PDM|75.00|99|0.00|RN VISIT|
20|FH_F81838_0_0|SrvcGrp|12401|2022|PDM|88.00|99|0.00|RN VISIT|
20|FH_F116473_0_0|SrvcGrp|84309|2022|PDM|1900.00|99|0.00|KNEE SURGERY|
20|FH_F150140_28714_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|152.48|99|0.00|HAPA WPA-NWPA 2012-13 ASC 241 W/O REV|
20|FH_F87775_15106_0|SrvcGrp|75301|2022|PCT|1.00|99|0.00|AWP J CODES|
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|676.00|99|0.00|AEG 3 (NO REV)|
20|FH_F51124_0_0|SrvcGrp|10618|2022|PDM|122.50|99|0.00|CPT CODE 99344|
20|FH_F133943_01606_0|SrvcGrp|93268|2022|PCT|1.00|99|0.00|LOVENOX/ENOXAPARIN|
20|FH_F75087_0_0|SrvcGrp|72287|2022|PDM|1400.00|99|0.00|URETHRAL PROCEDURES|
20|FH_F145708_89030_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F141829_0_0|SrvcGrp|13597|2022|PDM|247.28|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|561.30|99|0.00|AETNA POLYSOMNOGRAPHY|
20|FH_F85212_71075_0|SrvcGrp|73000|2022|PDM|1240.00|99|0.00|AEG 6|
20|FH_F133585_0_0|SrvcGrp|107792|2022|PDM|8416.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F118123_67226_0|SrvcGrp|17016|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134947_14227_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133747_80634_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F110580_71106_0|SrvcGrp|16467|2022|PDM|710.00|99|0.00|LASER PROCEDURES|
20|FH_F126042_97005_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F77943_0_0|SrvcGrp|89937|2022|PDM|73781.47|99|0.00|MS DRG 273-274 ONLY|
20|FH_F80172_0_0|SrvcGrp|10577|2022|PCT|0.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F85212_71075_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133753_84015_0|SrvcGrp|86660|2022|PDM|71.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F99161_0_0|SrvcGrp|75497|2022|PDM|700.00|99|0.00|AEG 10|
20|FH_F72785_0_0|SrvcGrp|29817|2022|PDM|5841.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F134601_94010_0|SrvcGrp|105819|2022|PDM|1466.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F113484_43015_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F72584_0_0|SrvcGrp|44131|2022|PDM|140.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F83991_52172_0|SrvcGrp|113166|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F145714_44135_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F54592_0_0|SrvcGrp|28637|2022|PDM|32.50|99|0.00|HOME INFUSION THERAPY (MOD SH)|
20|FH_F71103_0_0|SrvcGrp|42784|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F101063_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129101_27006_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|92.18|99|0.00|HAPA WPA-NWPA 2012-13 ASC 142 W/O REV|
20|FH_F70607_0_0|SrvcGrp|9832|2022|PDM|126.53|99|0.00|ST SVCS|
20|FH_F70684_0_0|SrvcGrp|29345|2022|PDM|52.73|99|0.00|SKILLED NURSING - LPN - MOD TE|
20|FH_F72963_0_0|SrvcGrp|69999|2022|PDM|5000.00|99|0.00|DAVINCI|
20|FH_F75963_0_0|SrvcGrp|73139|2022|PDM|18.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F105143_26062_0|SrvcGrp|16429|2022|PCT|0.70|99|0.00|OBSERVATION SVCS|
20|FH_F105145_75075_0|SrvcGrp|11853|2022|PCT|1.15|99|0.00|DRUGS|
20|FH_F146783_76048_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116040_24637_0|SrvcGrp|86844|2022|PDM|30.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F131737_15025_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F132150_66083_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133544_78227_0|SrvcGrp|87077|2022|PDM|135.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F133700_92808_0|SrvcGrp|58509|2022|PDM|410.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F134826_19067_0|SrvcGrp|52953|2022|PDM|45.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F123847_24012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137231_25550_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137232_28210_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138583_60644_0|SrvcGrp|86722|2022|PDM|234.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F140329_78570_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140647_66210_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F140765_30315_0|SrvcGrp|113232|2022|PDM|45.13|99|0.00|COVID-19 SARS-COV-2 ANTB QUANTITATIVE|
20|FH_F140867_56345_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F79691_30014_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F120152_0_0|SrvcGrp|67065|2022|PDM|16500.00|99|0.00|CERVICAL SURGERY|
20|FH_F119130_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119021_03060_0|SrvcGrp|89417|2022|PDM|350.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F118932_07652_0|SrvcGrp|72990|2022|PDM|1273.00|99|0.00|AEG 1|
20|FH_F38332_0_0|SrvcGrp|18148|2022|PDM|12064.00|99|0.00|MS DRG 249|
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|853.60|99|0.00|AETNA GLENNVILLE 2016 AEG 3|
20|FH_F147741_80012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147931_29732_0|SrvcGrp|46903|2022|PDM|602.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F129448_43235_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F50578_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F117221_23434_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F137818_31602_0|SrvcGrp|89412|2022|PDM|342.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F109652_0_0|SrvcGrp|72990|2022|PDM|1551.00|99|0.00|AEG 1|
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1108.00|99|0.00|AEG 6 (NO REV)|
20|FH_F138543_60130_0|SrvcGrp|86723|2022|PDM|379.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F110160_0_0|SrvcGrp|72992|2022|PDM|696.00|99|0.00|AEG 2|
20|FH_F151063_44094_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F151160_61350_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117001_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87054_0_0|SrvcGrp|84933|2022|PDM|2100.00|99|0.00|TRANSLUMINAL DILATION OF CANAL|
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142321_29401_0|SrvcGrp|87131|2022|PDM|505.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F117623_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|FAMILY ADAPTIVE BH TREATMENT W/O PATIENT (HCFA)|
20|FH_F44358_0_0|CSTM-ALL|CSTM-00|2020|PDM|597.00|99|0.00|ACUTE PSYCH|
20|FH_F110205_64012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135491_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F141207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F94786_07974_0|SrvcGrp|37385|2022|PDM|1.05|99|0.00|AMINO ACIDS|
20|FH_F95341_08701_0|SrvcGrp|90490|2022|PCT|0.80|99|0.00|EVALUATION OF SPEECH FLUENCY|
20|FH_F133002_0_0|SrvcGrp|72990|2022|PDM|422.00|99|0.00|AEG 1|
20|FH_F42161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F120901_0_0|SrvcGrp|92821|2022|PDM|4682.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR|
20|FH_F141147_02571_0|SrvcGrp|113041|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F75542_0_0|SrvcGrp|1168|2022|PDM|35.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F114389_50131_0|SrvcGrp|98926|2022|PDM|93.83|99|0.00|HIT INTERMIT PAIN MGMT (HCFA)|
20|FH_F141336_16947_0|SrvcGrp|10107|2022|PCT|0.39|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F141336_16947_0|SrvcGrp|109057|2022|PCT|0.55|99|0.00|CARDIAC STUDIES|
20|FH_F115971_0_0|SrvcGrp|73002|2022|PDM|1087.00|99|0.00|AEG 7|
20|FH_F132348_16214_0|SrvcGrp|110782|2022|PCT|1.05|99|0.00|ROUTINE VENIPUNCTURE|
20|FH_F43832_0_0|SrvcGrp|10410|2022|PDM|74.00|99|0.00|SKILLED NURSING CARE|
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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|CSTM-ALL|CSTM-00|2020|PDM|8772.00|99|0.00|AEG 3 (NO REV)|
20|FH_F41633_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F132864_71101_0|SrvcGrp|10391|2022|PDM|2274.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F124178_01604_0|SrvcGrp|109722|2022|PCT|1.00|99|0.00|DALTEPARIN SODIUM PER 2500IU|
20|FH_F132973_28054_0|SrvcGrp|89149|2022|PDM|138.00|99|0.00|OP INTENSIVE|
20|FH_F132592_68305_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|OP SVCS|
20|FH_F87856_0_0|SrvcGrp|83835|2022|PDM|2114.00|99|0.00|REPLACE TISSUE EXPANDER|
20|FH_F122638_59715_0|SrvcGrp|705|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F134690_46237_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F134770_14420_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F135722_33461_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F140505_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F136913_68803_0|SrvcGrp|109057|2022|PCT|0.70|99|0.00|CARDIAC STUDIES|
20|FH_F112371_19047_0|SrvcGrp|87119|2022|PDM|8193.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F46752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F115210_21043_0|SrvcGrp|47142|2022|PDM|2652.00|99|0.00|CPT 49650|
20|FH_F115631_65201_0|SrvcGrp|106253|2022|PDM|3177.00|99|0.00|INSERT SPINE FIXATION DEVICE|
20|FH_F147519_52627_0|SrvcGrp|114944|2022|PCT|2.20|99|0.00|ALL OTHER DRUGS|
20|FH_F43007_0_0|CSTM-ALL|CSTM-00|2020|PDM|191.00|99|0.00|CD DAY TREATMENT|
20|FH_F100783_03431_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F140007_0_0|SrvcGrp|97319|2022|PDM|7887.00|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|3996.00|99|0.00|AEG 7 (NO REV)|
20|FH_F47693_16148_0|SrvcGrp|81879|2022|PCT|1.00|99|0.00|LABORATORY W/ REV/HCPC|
20|FH_F132772_0_0|SrvcGrp|112094|2022|PDM|465.00|99|0.00|DIALYSIS ULTRAFILTRATION|
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135891_0_0|SrvcGrp|79720|2022|PDM|1000.00|99|0.00|ACUTE REHAB II|
20|FH_F34477_0_0|SrvcGrp|63743|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F39346_0_0|SrvcGrp|2738|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F117199_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140511_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F35381_0_0|SrvcGrp|24|2022|PDM|1759.00|99|0.00|CARDIAC CATH|
20|FH_F98361_12065_0|SrvcGrp|73605|2022|PDM|2696.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F82357_0_0|SrvcGrp|26253|2022|PDM|33.00|99|0.00|LIPIDS|
20|FH_F41013_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F54552_0_0|SrvcGrp|24748|2022|PDM|85.00|99|0.00|CORTICOSTEROID THERAPY|
20|FH_F113585_20155_0|SrvcGrp|86853|2022|PDM|50.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F138670_53045_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138747_53158_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F138880_92392_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F138907_01040_0|SrvcGrp|43567|2022|PDM|103.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F138936_01040_0|SrvcGrp|24714|2022|PCT|0.47|99|0.00|INTRAOCULAR LENS|
20|FH_F133891_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F113390_0_0|SrvcGrp|105244|2022|PDM|880.00|99|0.00|INCISION OF EARDRUM|
20|FH_F151339_72758_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132238_27615_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132268_07060_0|SrvcGrp|75545|2022|PDM|439.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F122119_62675_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F135583_17331_0|SrvcGrp|73483|2022|PDM|1721.00|99|0.00|AETNA SUBACUTE III|
20|FH_F91735_92653_0|SrvcGrp|73524|2022|PDM|110.25|99|0.00|PHYSICAL THERAPY|
20|FH_F135920_32211_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135924_02906_0|SrvcGrp|73498|2022|PDM|1446.80|99|0.00|AETNA ER LEVEL III|
20|FH_F136153_62960_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130996_34110_0|SrvcGrp|110096|2022|PDM|6000.00|99|0.00|LAPAROSCOPY SURGICAL COLPOPE|
20|FH_F131361_18235_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F130766_04967_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F140629_0_0|SrvcGrp|113676|2022|PDM|2497.00|99|0.00|LAPARO ABLATE LIVER CRYOSURG|
20|FH_F121428_40202_0|SrvcGrp|108633|2022|PDM|3637.00|99|0.00|ICU/BURN CARE|
20|FH_F149271_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67923_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F33785_0_0|SrvcGrp|13390|2022|PDM|350.00|99|0.00|DIALYSIS SVCS|
20|FH_F72743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F111301_33122_0|SrvcGrp|105465|2022|PDM|128.00|99|0.00|AETNA THERAPIES|
20|FH_F111303_19087_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F111363_33169_0|SrvcGrp|88977|2022|PDM|6682.00|99|0.00|C-SECTION DELIVERY|
20|FH_F111363_33169_0|SrvcGrp|82749|2022|PDM|60.00|99|0.00|AUTOMAT HEMOGRAM COMPLET DIF|
20|FH_F111363_33169_0|SrvcGrp|82762|2022|PDM|24.00|99|0.00|URINALYSIS AUTO W/ SCOPE|
20|FH_F134256_36117_0|SrvcGrp|57967|2022|PDM|150.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F58494_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36344_0_0|SrvcGrp|10567|2022|PDM|160.00|99|0.00|HOME INFUSION|
20|FH_F132328_0_0|SrvcGrp|15473|2022|PDM|2451.00|99|0.00|CPT CODE 42820|
20|FH_F72666_0_0|CSTM-ALL|CSTM-00|2020|PDM|1425.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114569_0_0|SrvcGrp|105717|2022|PDM|18.38|99|0.00|AETHA BRIEF ALCOHOL MISUSE COUNSEL (MOD GT)(HCFA)|
20|FH_F112166_72143_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F102222_19720_0|SrvcGrp|86825|2022|PDM|57.75|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F102222_19720_0|SrvcGrp|86853|2022|PDM|31.50|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F102325_62691_0|SrvcGrp|53144|2022|PDM|45.00|99|0.00|SPEECH THERAPY|
20|FH_F102325_62691_0|SrvcGrp|19742|2022|PDM|30.00|99|0.00|MID-LINE INSERTION|
20|FH_F129194_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102940_35034_0|SrvcGrp|46605|2022|PDM|125.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132544_0_0|SrvcGrp|96959|2022|PDM|3454.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F119289_43040_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F119491_19904_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148379_89129_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|23540.00|99|0.00|DRG 127 ONLY|
20|FH_F116988_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F137896_0_0|CSTM-ALL|CSTM-00|2020|PDM|87.97|99|0.00|CPAP (MOD RR) - HCFA|
20|FH_F127197_23111_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|913.50|99|0.00|AEG 10 (NO REV)|
20|FH_F133455_60110_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F97541_33021_0|SrvcGrp|73485|2022|PDM|3456.00|99|0.00|AETNA REHAB|
20|FH_F113326_80014_0|SrvcGrp|472|2022|PDM|433.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F115431_32821_0|SrvcGrp|73841|2022|PDM|397.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F117335_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PDM|9639.00|99|0.00|MSDRG 246-251 ANGIOPLASTY|
20|FH_F43330_0_0|CSTM-ALL|CSTM-00|2020|PDM|26.00|99|0.00|NURSING CARE MOD TE|
20|FH_F144109_63376_0|SrvcGrp|13683|2022|PCT|1.17|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F126589_62881_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146227_66210_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F49354_0_0|SrvcGrp|43318|2022|PDM|550.00|99|0.00|MRI|
20|FH_F141910_70809_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KL|
20|FH_F101840_76054_0|SrvcGrp|2741|2022|PCT|1.50|99|0.00|DRUGS|
20|FH_F150001_33064_0|SrvcGrp|86844|2022|PDM|26.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F117385_48091_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|987.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F39844_0_0|SrvcGrp|701|2022|PDM|1432.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F34706_0_0|SrvcGrp|2917|2022|PDM|23252.00|99|0.00|DRG 075 MAJOR CHEST PROCEDURES|
20|FH_F109815_52241_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111421_32216_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F55375_0_0|SrvcGrp|51474|2022|PDM|140.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F67205_0_0|SrvcGrp|16|2022|PDM|1856.00|99|0.00|ACUTE REHABILITATION|
20|FH_F122245_0_0|SrvcGrp|73002|2022|PDM|1174.00|99|0.00|AEG 7|
20|FH_F133154_27401_0|SrvcGrp|89149|2022|PDM|210.00|99|0.00|OP INTENSIVE|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|77.00|99|0.00|OFFICE / OP VISIT EAST (HCFA)|
20|FH_F132400_79106_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F48929_0_0|SrvcGrp|22954|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F141627_43725_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37886_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD RR|
20|FH_F86098_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F44701_0_0|SrvcGrp|38908|2022|PDM|750.00|99|0.00|CPT 67025 - INJECTION OF VITREOUS SUBSTITUTE|
20|FH_F49663_0_0|SrvcGrp|27579|2022|PDM|85.00|99|0.00|RESPIRATORY THERAPY INITIAL VISIT|
20|FH_F101562_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F141611_43113_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F101104_0_0|SrvcGrp|14892|2022|PDM|175.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F34706_0_0|SrvcGrp|14937|2022|PDM|2066.00|99|0.00|ICU/CCU|
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F145288_45345_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97543_33542_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|73.00|99|0.00|HAPA EPA ASC 12|
20|FH_F128246_0_0|SrvcGrp|111037|2022|PDM|588.00|99|0.00|REPAIR OF ECTROPION|
20|FH_F146373_66092_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122245_0_0|SrvcGrp|72990|2022|PDM|393.00|99|0.00|AEG 1|
20|FH_F117385_48091_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F101851_78024_0|SrvcGrp|43523|2022|PDM|185.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F126815_02118_0|SrvcGrp|79458|2022|PDM|0.25|99|0.00|MED RECORD COPY|
20|FH_F92676_15063_0|SrvcGrp|79097|2022|PDM|2060.35|99|0.00|MON VALLEY ASC 505|
20|FH_F115330_34113_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F150024_08079_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F47479_0_0|SrvcGrp|14893|2022|PDM|47.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F144011_60616_0|SrvcGrp|75399|2022|PDM|1.00|99|0.00|MED RECORD COPY|
20|FH_F145842_37172_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136751_0_0|SrvcGrp|88157|2022|PDM|20500.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F106540_26330_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|2011 DALLAS TX RAD|
20|FH_F147800_0_0|SrvcGrp|115146|2022|PDM|206.00|99|0.00|CHEMODENERV MUSC NECK DYSTON|
20|FH_F119206_35007_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F45176_0_0|SrvcGrp|39605|2022|PDM|2250.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F149781_37404_0|CSTM-ALL|CSTM-00|2020|PDM|2981.00|99|0.00|AEG 8 (NO REV)|
20|FH_F133535_32110_0|SrvcGrp|89417|2022|PDM|389.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F71644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F118542_60188_0|SrvcGrp|16750|2022|PDM|145.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F141790_85374_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F90811_0_0|SrvcGrp|90421|2022|PDM|4000.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F148494_0_0|SrvcGrp|114176|2022|PDM|6000.00|99|0.00|SPINE PROCEDURES|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC|
20|FH_F118845_71111_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F126666_44053_0|SrvcGrp|75754|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133135_48235_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35368_0_0|SrvcGrp|38|2022|PDM|1400.00|99|0.00|NORMAL DELIVERY|
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133470_97068_0|SrvcGrp|112072|2022|PDM|1550.00|99|0.00|RESIDENITAL TREATMENT EATING DISORDER (AGE 0-17)|
20|FH_F40465_0_0|SrvcGrp|9863|2022|PDM|2439.00|99|0.00|INTENSIVE CARE/CORONARY CARE UNIT|
20|FH_F130596_50273_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F98921_64503_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F145881_46011_0|SrvcGrp|108484|2022|PDM|645.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F81485_0_0|SrvcGrp|79638|2022|PCT|2.00|99|0.00|2014 WMS CHRISTIAN ASSOC RAD W/ OBS OR SURG|
20|FH_F143087_97411_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133291_33563_0|SrvcGrp|90854|2022|PDM|820.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F141872_20707_0|SrvcGrp|3178|2022|PDM|997.00|99|0.00|ACUTE PSYCH|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|ASPG IV|
20|FH_F148721_67205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151060_02493_0|SrvcGrp|90854|2022|PDM|800.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F150861_92592_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150881_52722_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37342_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F45798_0_0|SrvcGrp|10179|2022|PDM|16600.00|99|0.00|DRG 216 BIOPSIES MUSCU & CON TISSUE|
20|FH_F98280_31015_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F112755_43215_0|SrvcGrp|76501|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F139576_0_0|SrvcGrp|96919|2022|PDM|2448.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F32494_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F131942_50833_0|SrvcGrp|27968|2022|PDM|50.00|99|0.00|SKILLED NURSING LPN|
20|FH_F137789_48146_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F71064_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|OCN F/S PRICING: ALL (SOURCE AA W/REDUCTIONS)|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|20144.00|99|0.00|MS DRG 252-254 CV SURGERY|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SAINT ALEXIUS FH MOD KM|
20|FH_F130371_0_0|SrvcGrp|76321|2022|PCT|0.92|99|0.00|AETNA ALL INPATIENT SERVICES|
20|FH_F84556_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F134891_45885_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138017_73129_0|SrvcGrp|79786|2022|PCT|1.57|99|0.00|SLEEP STUDIES|
20|FH_F50078_0_0|SrvcGrp|43958|2022|PDM|70.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F35744_32177_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|GENERAL ACUTE CARE|
20|FH_F140295_0_0|SrvcGrp|99067|2022|PDM|7704.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F148967_04254_0|SrvcGrp|74668|2022|PDM|195.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1559.10|99|0.00|SALLY BALIN,999182,ASC 901|
20|FH_F109221_15084_0|SrvcGrp|73700|2022|PDM|35.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F149602_07109_0|SrvcGrp|113223|2022|PDM|42.13|99|0.00|COVID-19 ANTIBODY SARS-COV-2 TITER(S)|
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 4 (NO REV)|
20|FH_F83871_0_0|CSTM-ALL|CSTM-00|2020|PDM|426.00|99|0.00|AEG 1 (NO REV)|
20|FH_F59312_0_0|SrvcGrp|473|2022|PDM|303.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F115483_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|AEG 3 (NO REV)|
20|FH_F143564_0_0|SrvcGrp|107757|2022|PDM|2900.00|99|0.00|LAP PARAESOPH HER RPR W/ MESH|
20|FH_F150982_0_0|SrvcGrp|84313|2022|PDM|1802.00|99|0.00|TENDON REPAIR|
20|FH_F137729_19703_0|SrvcGrp|46903|2022|PDM|541.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F34777_0_0|CSTM-ALL|CSTM-00|2020|PDM|355.00|99|0.00|CD SERVICES|
20|FH_F148960_13045_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F90232_15126_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150922_02452_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132944_06480_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F68460_0_0|SrvcGrp|3178|2022|PDM|887.00|99|0.00|ACUTE PSYCH|
20|FH_F89674_18640_0|SrvcGrp|23681|2022|PDM|57.75|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F124896_43220_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F115982_0_0|SrvcGrp|73002|2022|PDM|1282.00|99|0.00|AEG 7|
20|FH_F52092_0_0|SrvcGrp|9899|2022|PDM|127.00|99|0.00|HOSPICE SERVICES|
20|FH_F148999_46218_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151699_01752_0|SrvcGrp|86830|2022|PDM|100.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F129682_07034_0|SrvcGrp|48396|2022|PDM|105.00|99|0.00|OT SERVICES|
20|FH_F102525_73134_0|SrvcGrp|72990|2022|PDM|760.00|99|0.00|AEG 1|
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP DIALYSIS|
20|FH_F31547_0_0|SrvcGrp|63|2022|PDM|450.00|99|0.00|SUBACUTE CARE|
20|FH_F32221_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34675_0_0|SrvcGrp|17107|2022|PCT|1.10|99|0.00|COCHLEAR IMPLANT DEVICE|
20|FH_F35369_0_0|SrvcGrp|16109|2022|PCT|1.15|99|0.00|IMPLANTS|
20|FH_F119352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F129588_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147082_02359_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94303_0_0|SrvcGrp|72992|2022|PDM|1154.00|99|0.00|AEG 2|
20|FH_F141156_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151661_78526_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147080_02446_0|SrvcGrp|16069|2022|PDM|504.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|3447.00|99|0.00|AEG 6 (NO REV)|
20|FH_F149582_01534_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F116437_0_0|SrvcGrp|88149|2022|PDM|1757.00|99|0.00|RELEASE OF EYE FLUID|
20|FH_F37267_0_0|SrvcGrp|3809|2022|PDM|483.00|99|0.00|HOSPICE CARE|
20|FH_F134847_0_0|SrvcGrp|49205|2022|PDM|3486.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|2033.00|99|0.00|AEG 7 (NO REV)|
20|FH_F111122_63376_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F75606_0_0|SrvcGrp|12791|2022|PCT|0.64|99|0.00|PROSTHETICS/IMPLANTS/DEVICES|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|20749.00|99|0.00|MS DRG 246-247, 249 PTCA W/STENT|
20|FH_F131387_76001_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F35410_0_0|SrvcGrp|20480|2022|PCT|0.65|99|0.00|HOME INFUSION THERAPY|
20|FH_F123745_0_0|SrvcGrp|85790|2022|PDM|6800.00|99|0.00|TREATMENT OF FRACTURE|
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|724.00|99|0.00|AEG 4 (NO REV)|
20|FH_F36683_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149379_53213_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|1001.00|99|0.00|AEG 7 (NO REV)|
20|FH_F150441_76132_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|829.03|99|0.00|AEG 6 (NO REV)|
20|FH_F131555_66213_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137767_01841_0|SrvcGrp|88977|2022|PDM|7500.00|99|0.00|C-SECTION DELIVERY|
20|FH_F147181_27514_0|SrvcGrp|82981|2022|PDM|140.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PDM|2768.00|99|0.00|AEG 9 (NO REV)|
20|FH_F35557_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1414794 AM HOME PAT DME MOD RR|
20|FH_F143427_30442_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC|
20|FH_F143529_84737_0|SrvcGrp|73701|2022|PDM|26.75|99|0.00|AETNA - SKILLED NURSING|
20|FH_F103060_0_0|SrvcGrp|73006|2022|PDM|3121.00|99|0.00|AEG 9|
20|FH_F116645_71457_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F120866_51652_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120862_87108_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F118879_93063_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F84611_30281_0|SrvcGrp|72984|2022|PCT|0.73|99|0.00|CHEMOTHERAPY|
20|FH_F36132_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP MAFS  MOD NU|
20|FH_F38004_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE|
20|FH_F45332_0_0|SrvcGrp|37906|2022|PDM|135.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F100742_00616_0|SrvcGrp|73643|2022|PDM|759.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F49029_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F78945_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F102302_0_0|SrvcGrp|98589|2022|PDM|14300.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F151408_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|AEG 8 (NO REV)|
20|FH_F130747_0_0|SrvcGrp|26278|2022|PDM|5202.00|99|0.00|CPT 29881|
20|FH_F78922_0_0|SrvcGrp|76047|2022|PCT|0.20|99|0.00|ULTRAFILTRATION|
20|FH_F130850_67401_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F148324_93101_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F52393_0_0|SrvcGrp|49108|2022|PDM|2400.00|99|0.00|HEARING AID|
20|FH_F143528_0_0|SrvcGrp|92415|2022|PDM|5250.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F72830_0_0|SrvcGrp|70044|2022|PDM|2500.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 4|
20|FH_F129627_06037_0|SrvcGrp|43568|2022|PDM|111.00|99|0.00|SKILLED NURSING - RN|
20|FH_F149885_68502_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F47359_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F125011_74467_0|SrvcGrp|110026|2022|PDM|2600.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F90818_0_0|SrvcGrp|59840|2022|PDM|2500.00|99|0.00|TYMPANOSTOMY|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG VI|
20|FH_F97500_32025_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|PDM|434.50|99|0.00|AEG 1 (NO REV)|
20|FH_F130523_04605_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|AEG 7 (NO REV)|
20|FH_F135056_06401_0|SrvcGrp|58718|2022|PDM|180.25|99|0.00|CPT CODE 99285|
20|FH_F56972_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F39041_0_0|CSTM-ALL|CSTM-00|2020|PDM|2054.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31643_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124783_92408_0|SrvcGrp|74668|2022|PDM|375.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F126926_32250_0|SrvcGrp|73841|2022|PDM|902.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F125473_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F33513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|DME F/S (MOD KN) - MHAC|
20|FH_F140907_28601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F93881_15009_0|SrvcGrp|81405|2022|PDM|30.00|99|0.00|URINALYSIS W/ MICROSCPY|
20|FH_F56136_0_0|SrvcGrp|24600|2022|PCT|0.92|99|0.00|CAPD TRAINING|
20|FH_F92091_0_0|SrvcGrp|72994|2022|PDM|2100.00|99|0.00|AEG 3|
20|FH_F88199_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130157_84049_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149939_91942_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149140_07522_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F147941_06023_0|SrvcGrp|113275|2022|PDM|100.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT|
20|FH_F51074_0_0|SrvcGrp|3409|2022|PDM|392.00|99|0.00|NEWBORN NURSERY|
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41491_0_0|SrvcGrp|97|2022|PDM|2864.00|99|0.00|C-SECTION|
20|FH_F148255_72703_0|SrvcGrp|86835|2022|PDM|10.50|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F39694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MS DRG UNGROUPABLE INPATIENT|
20|FH_F123844_0_0|SrvcGrp|104228|2022|PDM|194.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F89779_0_0|SrvcGrp|72994|2022|PDM|2700.00|99|0.00|AEG 3|
20|FH_F135216_64064_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148265_06067_0|SrvcGrp|88155|2022|PDM|13060.00|99|0.00|REVISE KNEECAP WITH IMPLANT|
20|FH_F65681_0_0|SrvcGrp|473|2022|PDM|355.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F130207_33458_0|SrvcGrp|89417|2022|PDM|499.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F93384_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124388_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F117784_0_0|SrvcGrp|2067|2022|PDM|488.38|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PDM|3800.00|99|0.00|AEG 8 (NO REV)|
20|FH_F72704_0_0|SrvcGrp|33166|2022|PDM|475.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F73985_0_0|SrvcGrp|17065|2022|PDM|1179.00|99|0.00|ASPG I|
20|FH_F148254_89503_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F140427_0_0|SrvcGrp|91959|2022|PDM|2500.00|99|0.00|INSERT PULSE GENERATOR|
20|FH_F120371_63136_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128878_11203_0|SrvcGrp|90397|2022|PDM|350.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F139551_0_0|SrvcGrp|37317|2022|PDM|4500.00|99|0.00|LITHOTRIPSY|
20|FH_F148222_18603_0|SrvcGrp|48398|2022|PDM|107.00|99|0.00|PT SERVICES|
20|FH_F62700_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F45632_0_0|SrvcGrp|41496|2022|PDM|57.00|99|0.00|OT SVCS|
20|FH_F135211_63119_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F33712_0_0|SrvcGrp|15368|2022|PCT|0.60|99|0.00|CPT CODES 70000-79999 (RAD)|
20|FH_F132190_0_0|SrvcGrp|101839|2022|PDM|2500.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F151526_28208_0|SrvcGrp|107877|2022|PDM|954.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F149047_0_0|SrvcGrp|87077|2022|PDM|135.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F115772_26250_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143969_71129_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142073_0_0|SrvcGrp|88158|2022|PDM|5980.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|2188.72|99|0.00|AEG 6 (NO REV)|
20|FH_F128333_71001_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F92012_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.20|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_F49338_0_0|SrvcGrp|32388|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKE (DME)|
20|FH_F126678_44870_0|SrvcGrp|94781|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F89453_75069_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101564_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.00|99|0.00|OP SVCS|
20|FH_F39349_0_0|CSTM-ALL|CSTM-00|2020|PDM|285.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F43446_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F133534_33483_0|SrvcGrp|86723|2022|PDM|394.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 3 (NO REV)|
20|FH_F92276_32308_0|SrvcGrp|22781|2022|PDM|32025.00|99|0.00|MS DRG 244 ONLY|
20|FH_F130512_40205_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143746_85006_0|SrvcGrp|3178|2022|PDM|1185.00|99|0.00|ACUTE PSYCH|
20|FH_F118194_50841_0|SrvcGrp|86842|2022|PDM|90.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F126153_44663_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F151542_32224_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F129968_98004_0|SrvcGrp|46903|2022|PDM|1668.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F111835_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)|
20|FH_F67261_0_0|SrvcGrp|10362|2022|PDM|250.00|99|0.00|CPT CODE 99282|
20|FH_F141590_90049_0|SrvcGrp|74668|2022|PDM|509.37|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F123265_68154_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F69971_0_0|SrvcGrp|24951|2022|PDM|329.00|99|0.00|ESOPHOGEAL MOTILITY STUDY|
20|FH_F122893_29135_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F87092_60101_0|SrvcGrp|85718|2022|PCT|1.00|99|0.00|DRUGS|
20|FH_F143539_0_0|SrvcGrp|82570|2022|PDM|4285.00|99|0.00|REVISION EYELID/EXCESS SKIN|
20|FH_F113815_0_0|SrvcGrp|73000|2022|PDM|233.00|99|0.00|AEG 6|
20|FH_F129888_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140035_0_0|SrvcGrp|46424|2022|PDM|211.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F97042_64804_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F126762_91311_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F36542_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F150020_70601_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|3425.00|99|0.00|AEG 4 (NO REV)|
20|FH_F113146_15001_0|SrvcGrp|105014|2022|PDM|503.00|99|0.00|AETNA IP DETOXIFICATION SERVICES (13-999 YRS)|
20|FH_F137638_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1838.81|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F34706_0_0|SrvcGrp|11191|2022|PDM|32074.00|99|0.00|DRG 551 PERMANENT CARDIAC PACEMAKER|
20|FH_F149781_37404_0|SrvcGrp|67065|2022|PDM|9124.00|99|0.00|CERVICAL SURGERY|
20|FH_F98640_0_0|SrvcGrp|27316|2022|PDM|1818.00|99|0.00|TONSILS & ADENOIDS (42820)|
20|FH_F114310_0_0|SrvcGrp|105491|2022|PDM|2050.00|99|0.00|KNEE ARTHROCOPY PROCEDURES|
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F99720_0_0|SrvcGrp|104740|2022|PDM|3584.00|99|0.00|HIP ARTHRO W/FEMOROPLASTY|
20|FH_F98600_91730_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|79080|2022|PDM|268.14|99|0.00|MON VALLEY ASC 242|
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1431.00|99|0.00|AEG 8 (NO REV)|
20|FH_F92676_15063_0|SrvcGrp|78969|2022|PDM|1767.61|99|0.00|MON VALLEY ASC 1202|
20|FH_F77025_0_0|SrvcGrp|34342|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F125660_46706_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F46196_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_F150024_08079_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F150024_08079_0|SrvcGrp|86505|2022|PDM|2300.00|99|0.00|DENTAL SURGERY|
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F123181_75057_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F132420_84660_0|SrvcGrp|74668|2022|PDM|375.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115313_11216_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F113264_71860_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F88956_0_0|SrvcGrp|86720|2022|PCT|0.50|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F101853_77840_0|SrvcGrp|87317|2022|PDM|770.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F67148_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F69648_0_0|SrvcGrp|48398|2022|PDM|11.25|99|0.00|PT SERVICES|
20|FH_F102561_75146_0|CSTM-ALL|CSTM-00|2020|PDM|3100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40812_0_0|CSTM-ALL|CSTM-00|2020|PDM|613.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F124608_0_0|SrvcGrp|109833|2022|PDM|8160.00|99|0.00|REPLACE ELBOW JOINT|
20|FH_F142008_74301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133478_40165_0|CSTM-ALL|CSTM-00|2020|PDM|2332.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 9 (NO REV)|
20|FH_F120437_85202_0|SrvcGrp|86845|2022|PDM|76.51|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F97160_77436_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F150907_17543_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150951_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F91155_16105_0|SrvcGrp|73608|2022|PDM|4631.00|99|0.00|AETNA MATERNITY CARE (C-SECTION)|
20|FH_F46352_0_0|SrvcGrp|11080|2022|PDM|158.00|99|0.00|NURSING CARE|
20|FH_F38425_0_0|SrvcGrp|10542|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F111444_33401_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F50297_0_0|SrvcGrp|42976|2022|PDM|82.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F40645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|PSYCHIATRIC EATING DISORDERS|
20|FH_F117512_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F95661_27217_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F124505_0_0|SrvcGrp|80537|2022|PDM|323.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 1|
20|FH_F129175_0_0|SrvcGrp|35669|2022|PDM|4561.00|99|0.00|CPT 63650|
20|FH_F42779_0_0|SrvcGrp|701|2022|PDM|2250.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F87155_04105_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125352_90034_0|SrvcGrp|87317|2022|PDM|1100.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F143027_16504_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38016_0_0|SrvcGrp|115|2022|PDM|487.00|99|0.00|SKILLED NURSING CARE|
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|504.00|99|0.00|AEG 1 (NO REV)|
20|FH_F72523_0_0|SrvcGrp|22954|2022|PDM|170.66|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F118672_29036_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F121306_32207_0|SrvcGrp|84559|2022|PCT|1.07|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F68944_0_0|SrvcGrp|23477|2022|PDM|4819.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F133477_90247_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F101840_76054_0|SrvcGrp|31030|2022|PDM|15880.00|99|0.00|MS DRG 507 ONLY|
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34550_0_0|CSTM-ALL|CSTM-00|2020|PDM|27251.00|99|0.00|MSDRG 216-238 CV SURGERY|
20|FH_F124802_72301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40499_0_0|SrvcGrp|592|2022|PDM|741.00|99|0.00|SUB-ACUTE CARE|
20|FH_F40321_0_0|CSTM-ALL|CSTM-00|2020|PDM|1428.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132190_0_0|SrvcGrp|85198|2022|PDM|3000.00|99|0.00|AETNA KNEE ARTHROSCOPY|
20|FH_F38341_0_0|SrvcGrp|17419|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F63182_0_0|SrvcGrp|9811|2022|PDM|435.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F115047_78526_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F128883_89521_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F86872_15215_0|SrvcGrp|86847|2022|PDM|45.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F138667_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|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_F74602_0_0|SrvcGrp|11306|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F89340_0_0|SrvcGrp|63462|2022|PDM|1210.00|99|0.00|CPT 64595|
20|FH_F63249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130725_33020_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130897_03103_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F50583_0_0|SrvcGrp|473|2022|PDM|800.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F119227_01752_0|SrvcGrp|17015|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F117382_0_0|SrvcGrp|105357|2022|PDM|400.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111942_92647_0|SrvcGrp|66264|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F112631_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F125928_0_0|SrvcGrp|106300|2022|PDM|289.81|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F90500_32446_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE|
20|FH_F145562_70458_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121225_98902_0|SrvcGrp|10577|2022|PDM|61.50|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F89176_0_0|CSTM-ALL|CSTM-00|2020|PDM|928.00|99|0.00|ASPG IV|
20|FH_F142376_0_0|SrvcGrp|93740|2022|PDM|2640.00|99|0.00|REVISE/REMOVE NEURO RECEIVER|
20|FH_F114683_0_0|SrvcGrp|79420|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F36753_0_0|SrvcGrp|23963|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F127545_45227_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F139578_70433_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F125260_0_0|SrvcGrp|88620|2022|PDM|185.10|99|0.00|SKILLED NURSING RN|
20|FH_F149339_44147_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F126341_27284_0|SrvcGrp|22389|2022|PCT|1.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F114844_17061_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|PDM|2346.00|99|0.00|AEG 6 (NO REV)|
20|FH_F100782_0_0|SrvcGrp|11659|2022|PDM|2298.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F145641_06902_0|SrvcGrp|90420|2022|PDM|6509.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1533.87|99|0.00|HAPA WPA-NWPA 2012-13 ASC 8 W/O REV|
20|FH_F124161_95932_0|SrvcGrp|16429|2022|PCT|0.00|99|0.00|OBSERVATION SVCS|
20|FH_F85777_77030_0|SrvcGrp|73659|2022|PDM|6670.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F149148_15330_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133207_0_0|SrvcGrp|26273|2022|PDM|3529.00|99|0.00|CPT 29880|
20|FH_F110237_94501_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|924.00|99|0.00|AEG 4 (NO REV)|
20|FH_F130327_03867_0|SrvcGrp|48396|2022|PDM|166.00|99|0.00|OT SERVICES|
20|FH_F36552_0_0|SrvcGrp|18241|2022|PDM|7845.00|99|0.00|MS DRG 285|
20|FH_F147981_60035_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147502_0_0|SrvcGrp|80918|2022|PDM|150.00|99|0.00|RESPITE CARE|
20|FH_F34852_0_0|SrvcGrp|97|2022|PDM|5000.00|99|0.00|C-SECTION|
20|FH_F90496_13159_0|SrvcGrp|43523|2022|PDM|140.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F133870_60618_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119110_91773_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120559_29108_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F114444_19602_0|SrvcGrp|86871|2022|PDM|45.00|99|0.00|AETNA PSYTX PT & FAMILY 30 MINS (MOD TD)(HCFA)|
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_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1318.00|99|0.00|AEG 5  (NO REV)|
20|FH_F116753_0_0|CSTM-ALL|CSTM-00|2020|PDM|1077.00|99|0.00|AEG 1 (NO REV)|
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|827.40|99|0.00|ASPG IV|
20|FH_F116124_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F120930_0_0|SrvcGrp|27261|2022|PDM|6500.00|99|0.00|CPT 27446|
20|FH_F135614_83642_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124161_95932_0|SrvcGrp|3499|2022|PCT|0.81|99|0.00|IMPLANTS|
20|FH_F93076_85016_0|CSTM-ALL|CSTM-00|2020|PCT|0.38|99|0.00|OP SVCS|
20|FH_F85213_02840_0|CSTM-ALL|CSTM-00|2020|PDM|2731.50|99|0.00|INPATIENT PSYCHIATRIC CARE <18 YRS|
20|FH_F110906_54481_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS|
20|FH_F149106_07042_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|AEG 2 (NO REV)|
20|FH_F85132_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|ACUTE REHAB II|
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|320.00|99|0.00|AEG 1 (NO REV)|
20|FH_F116806_0_0|SrvcGrp|107054|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MOUTH|
20|FH_F133972_27103_0|SrvcGrp|112488|2022|PDM|328.00|99|0.00|TX/PRO/DX INJ NEW DRUG ADDON|
20|FH_F121225_98902_0|SrvcGrp|106792|2022|PDM|236.25|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F139678_25601_0|SrvcGrp|90397|2022|PDM|300.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F149319_07670_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F114444_19602_0|SrvcGrp|105372|2022|PDM|55.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MIN|
20|FH_F120930_0_0|SrvcGrp|104008|2022|PDM|2500.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS|
20|FH_F150303_19150_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70208_0_0|SrvcGrp|42784|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F145640_32503_0|CSTM-ALL|CSTM-00|2020|PCT|1.45|99|0.00|HSS ASC|
20|FH_F139512_77550_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F126341_27284_0|SrvcGrp|104216|2022|PCT|1.15|99|0.00|HYQVIA 100MG IMMUNEGLOBULIN|
20|FH_F130364_01331_0|SrvcGrp|73483|2022|PDM|1800.00|99|0.00|AETNA SUBACUTE III|
20|FH_F54592_0_0|SrvcGrp|22387|2022|PDM|150.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F54592_0_0|CSTM-ALL|CSTM-00|2020|PDM|80.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F122459_15221_0|SrvcGrp|471|2022|PDM|476.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F122553_92705_0|SrvcGrp|67684|2022|PDM|197.00|99|0.00|PSYCH VISIT|
20|FH_F85553_0_0|SrvcGrp|14243|2022|PDM|530.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F86658_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F84175_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F105303_15136_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F75842_0_0|SrvcGrp|73871|2022|PDM|26400.00|99|0.00|BARIATRIC SURGERY|
20|FH_F146783_76048_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146881_83661_0|SrvcGrp|29346|2022|PDM|60.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F115972_92675_0|SrvcGrp|86749|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F132971_77063_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133133_32433_0|SrvcGrp|46903|2022|PDM|545.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132234_97703_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|HSS ASC|
20|FH_F32958_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F63552_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2010 B CODES (GLOBAL)|
20|FH_F123820_91316_0|SrvcGrp|87131|2022|PDM|900.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F151559_0_0|SrvcGrp|78420|2022|PDM|625.00|99|0.00|INTERIM LABOR|
20|FH_F58252_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F58856_0_0|SrvcGrp|50169|2022|PDM|32300.00|99|0.00|MSDRG 227 ONLY|
20|FH_F71923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F107200_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F136371_29720_0|SrvcGrp|73841|2022|PDM|426.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F136386_30901_0|SrvcGrp|107756|2022|PDM|7900.00|99|0.00|NORMAL DELIVERY|
20|FH_F93292_62234_0|SrvcGrp|90494|2022|PDM|13.02|99|0.00|AFLURIA VACC 3 YRS & > IM|
20|FH_F134011_84102_0|SrvcGrp|86838|2022|PDM|10.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F134075_78230_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F114092_83350_0|SrvcGrp|88977|2022|PDM|5401.00|99|0.00|C-SECTION DELIVERY|
20|FH_F114979_77979_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F142527_89109_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F142527_89109_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142547_70002_0|SrvcGrp|86825|2022|PDM|50.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F142727_21222_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117552_0_0|SrvcGrp|103645|2022|PDM|9500.00|99|0.00|AETNA TIB/ PER REVASE W/ STENT|
20|FH_F53732_0_0|SrvcGrp|17011|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138469_70433_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F138584_30912_0|SrvcGrp|113390|2022|PDM|1200.00|99|0.00|MANDIBLE OSTEOTOMY|
20|FH_F77782_66061_0|SrvcGrp|29817|2022|PDM|4120.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F139267_30253_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F140615_73013_0|SrvcGrp|113186|2022|PCT|1.10|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F140733_45005_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: BREAKOUT|
20|FH_F137530_0_0|SrvcGrp|108194|2022|PDM|3117.00|99|0.00|INSERT TUN IP CATH PERC|
20|FH_F119067_94080_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|688.00|99|0.00|ACUTE PSYCH|
20|FH_F109982_33592_0|CSTM-ALL|CSTM-00|2020|PDM|403.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F109983_98607_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F49039_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F129434_98271_0|SrvcGrp|46903|2022|PDM|1273.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F129524_48104_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F117105_77619_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F117123_68025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137901_60089_0|SrvcGrp|112868|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F46273_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109652_0_0|SrvcGrp|89937|2022|PDM|17704.00|99|0.00|MS DRG 273-274 ONLY|
20|FH_F112526_0_0|SrvcGrp|90477|2022|PDM|105.00|99|0.00|HOSPICE|
20|FH_F91472_96001_0|SrvcGrp|83426|2022|PCT|0.40|99|0.00|HEART REPLACEMENT/REPAIR PROCEDURES|
20|FH_F130676_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112817_37027_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F148720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73022_0_0|SrvcGrp|25535|2022|PDM|1400.00|99|0.00|ICU|
20|FH_F129487_0_0|SrvcGrp|73004|2022|PDM|2598.00|99|0.00|AEG 8|
20|FH_F135315_0_0|SrvcGrp|46482|2022|PDM|185.00|99|0.00|S9083 PER VISIT|
20|FH_F151122_10462_0|SrvcGrp|48398|2022|PDM|137.00|99|0.00|PT SERVICES|
20|FH_F151140_33134_0|CSTM-ALL|CSTM-00|2020|PCT|1.12|99|0.00|HSS ASC INVOICE|
20|FH_F151145_39365_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151155_26508_0|SrvcGrp|113328|2022|PDM|559.00|99|0.00|MED TX REMOVE IMPLANT|
20|FH_F151155_26508_0|SrvcGrp|104440|2022|PDM|20.60|99|0.00|AETNA DRUG TEST PRSMV DIR OPT OBS|
20|FH_F151282_46402_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F122007_30701_0|SrvcGrp|92501|2022|PDM|149.80|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|149.05|99|0.00|DELAWARE VALLEY- ASC 117|
20|FH_F66711_0_0|SrvcGrp|44392|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F98041_10027_0|SrvcGrp|73601|2022|PDM|6155.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F143828_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F106822_0_0|SrvcGrp|100268|2022|PDM|13.07|99|0.00|ADENOVIRUS ASSAY W/ OPTIC|
20|FH_F106822_0_0|SrvcGrp|100285|2022|PDM|3.00|99|0.00|IMMUN ADMIN ORAL/NASAL (HCFA)|
20|FH_F111001_0_0|CSTM-ALL|CSTM-00|2020|PDM|11.00|99|0.00|LVN HOURLY|
20|FH_F90173_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F114916_30309_0|SrvcGrp|89989|2022|PDM|3500.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F142448_15701_0|SrvcGrp|21920|2022|PDM|35.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F112967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119581_0_0|SrvcGrp|108190|2022|PDM|2334.00|99|0.00|ARTERY-VEIN GRAFT|
20|FH_F100401_15317_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F33856_0_0|SrvcGrp|38|2022|PDM|2000.00|99|0.00|NORMAL DELIVERY|
20|FH_F37294_0_0|SrvcGrp|108|2022|PCT|0.80|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN|
20|FH_F129597_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F94786_07974_0|SrvcGrp|42384|2022|PDM|47.25|99|0.00|ENTERAL ADDITIVE (B4088)|
20|FH_F131047_0_0|SrvcGrp|105690|2022|PCT|0.57|99|0.00|LABORATORY SERVICES|
20|FH_F131087_0_0|SrvcGrp|72992|2022|PDM|700.00|99|0.00|AEG 2|
20|FH_F132627_0_0|SrvcGrp|13929|2022|PDM|43.86|99|0.00|GROWTH HORMONE|
20|FH_F130274_63033_0|SrvcGrp|48385|2022|PDM|70.00|99|0.00|SPEECH THERAPY|
20|FH_F118909_0_0|SrvcGrp|89781|2022|PDM|123.60|99|0.00|RESPITE CARE (HCFA)|
20|FH_F114345_27597_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F141343_62047_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F49487_0_0|SrvcGrp|10517|2022|PDM|12.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F77662_0_0|SrvcGrp|75545|2022|PDM|370.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F83115_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|18000.00|99|0.00|TIMELY FILING|
20|FH_F124059_64055_0|SrvcGrp|16750|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F124059_64055_0|SrvcGrp|105706|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F34523_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|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|103570|2022|PDM|910.00|99|0.00|ARTHROSCOPIC FRACTURE|
20|FH_F89582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124177_59254_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124584_28204_0|SrvcGrp|73841|2022|PDM|477.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F87856_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F114629_19131_0|SrvcGrp|109036|2022|PDM|548.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F113787_31909_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F146040_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F122832_61938_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F43862_0_0|SrvcGrp|37403|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F117069_15236_0|SrvcGrp|48396|2022|PDM|90.00|99|0.00|OT SERVICES|
20|FH_F117075_68847_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F136831_78728_0|SrvcGrp|89417|2022|PDM|420.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F136913_68803_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F136930_73114_0|SrvcGrp|73006|2022|PDM|11295.00|99|0.00|AEG 9|
20|FH_F112411_28207_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115154_45069_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115210_21043_0|CSTM-ALL|CSTM-00|2020|PDM|2016.00|99|0.00|AEG 9 (NO REV)|
20|FH_F115608_24171_0|SrvcGrp|82138|2022|PCT|1.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F115728_78404_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F116393_07002_0|SrvcGrp|106509|2022|PDM|17.48|99|0.00|HGB-A1C|
20|FH_F147311_37421_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F147446_76844_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131235_36049_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F38805_0_0|SrvcGrp|29716|2022|PDM|975.00|99|0.00|LABOR ROOM/DELIVERY 4 OR MORE HRS/TRANSFERRED|
20|FH_F137906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|3733.94|99|0.00|AEG 8 (NO REV)|
20|FH_F39098_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F41013_0_0|SrvcGrp|31189|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF (DME)|
20|FH_F138687_77477_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F89580_0_0|SrvcGrp|16718|2022|PCT|0.46|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|2777.50|99|0.00|AEG 9 (NO REV)|
20|FH_F151320_15145_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151404_71655_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132268_07060_0|SrvcGrp|106536|2022|PDM|19.76|99|0.00|GROUP THERAPEUTIC PROCEDURES|
20|FH_F122085_70360_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|GENERAL ACUTE CARE|
20|FH_F145248_19477_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145528_76501_0|SrvcGrp|29346|2022|PDM|48.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F135440_32561_0|SrvcGrp|86722|2022|PDM|195.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F135583_17331_0|SrvcGrp|75506|2022|PCT|0.82|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F135608_19348_0|SrvcGrp|12514|2022|PDM|574.00|99|0.00|TRANSITIONAL LIVING CENTER|
20|FH_F97142_94535_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F136009_76051_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100880_67735_0|SrvcGrp|73004|2022|PDM|3451.00|99|0.00|AEG 8|
20|FH_F130996_34110_0|SrvcGrp|97741|2022|PDM|17000.00|99|0.00|REVISE KNEE|
20|FH_F121740_98119_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F121808_70390_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F121873_54303_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F36596_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F63881_0_0|SrvcGrp|59353|2022|PDM|325.00|99|0.00|HEMODIALYSIS - HOME TRAINING|
20|FH_F72586_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAPA OHIO FS LAB & RAD|
20|FH_F129967_18915_0|SrvcGrp|86722|2022|PDM|194.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F111292_33136_0|SrvcGrp|104283|2022|PDM|6719.00|99|0.00|GASTRIC SLEEVE WITH HERNIA REPAIR|
20|FH_F148243_0_0|SrvcGrp|58636|2022|PDM|13000.00|99|0.00|CPT 62362|
20|FH_F33390_0_0|SrvcGrp|12299|2022|PCT|0.75|99|0.00|PROSTHETICS/IMPLANTS/DEVICES|
20|FH_F69806_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.18|99|0.00|OP SVCS|
20|FH_F36344_0_0|SrvcGrp|10564|2022|PDM|120.00|99|0.00|HOME INFUSION|
20|FH_F116430_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F131000_0_0|SrvcGrp|108267|2022|PCT|0.00|99|0.00|AETNA IMAGING|
20|FH_F132328_0_0|SrvcGrp|107544|2022|PDM|9270.00|99|0.00|ILIAC REVASC W/ STENT|
20|FH_F132328_0_0|SrvcGrp|33966|2022|PDM|2049.00|99|0.00|CPT 29866|
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|AEG 8 (NO REV)|
20|FH_F112092_46845_0|SrvcGrp|90483|2022|PCT|1.00|99|0.00|FLUZONE VACC 3 YRS & > IM|
20|FH_F112135_80910_0|SrvcGrp|73485|2022|PDM|1297.00|99|0.00|AETNA REHAB|
20|FH_F87557_33309_0|SrvcGrp|13929|2022|PDM|10.00|99|0.00|GROWTH HORMONE|
20|FH_F123036_0_0|SrvcGrp|15052|2022|PCT|0.60|99|0.00|RADIOLOGY SVCS|
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PDM|2187.00|99|0.00|AEG 7 (NO REV)|
20|FH_F140102_0_0|SrvcGrp|82222|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F102222_19720_0|SrvcGrp|86833|2022|PDM|10.50|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F98626_29118_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F98626_29118_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F129240_10028_0|SrvcGrp|14948|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129240_10028_0|SrvcGrp|14945|2022|PDM|5.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F102960_50613_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS|
20|FH_F103780_64804_0|SrvcGrp|107733|2022|PDM|7043.00|99|0.00|CESAREAN SECTION|
20|FH_F132090_60915_0|SrvcGrp|94566|2022|PDM|6085.00|99|0.00|TREATMENT OF FRACTURE|
20|FH_F132544_0_0|SrvcGrp|97179|2022|PDM|7850.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON|
20|FH_F137951_0_0|SrvcGrp|98003|2022|PDM|4203.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F43652_0_0|SrvcGrp|37502|2022|PDM|6654.35|99|0.00|OBSTETRICAL GLOBAL VAGINAL DELIVERY|
20|FH_F92676_15063_0|SrvcGrp|78962|2022|PDM|2235.11|99|0.00|MON VALLEY ASC 502|
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|1068.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F41275_0_0|SrvcGrp|34041|2022|PDM|625.00|99|0.00|ACUTE PSYCH|
20|FH_F117875_70601_0|SrvcGrp|16|2022|PDM|1204.00|99|0.00|ACUTE REHABILITATION|
20|FH_F92677_08003_0|SrvcGrp|29075|2022|PDM|63.00|99|0.00|HYDRATION THERAPY|
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 6 (NO REV)|
20|FH_F128246_0_0|SrvcGrp|16427|2022|PDM|907.00|99|0.00|OP SURGERY|
20|FH_F50974_0_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F119096_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 10 (NO REV)|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F141930_72032_0|CSTM-ALL|CSTM-00|2020|PDM|633.00|99|0.00|AEG 2 (NO REV)|
20|FH_F91220_32064_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|GENERAL ACUTE CARE|
20|FH_F101104_0_0|SrvcGrp|27969|2022|PDM|61.00|99|0.00|HOME HEALTH AIDE|
20|FH_F128707_72601_0|SrvcGrp|107479|2022|PCT|1.00|99|0.00|CINACALCET ORAL (FOR ESRD ON DIALYSIS|
20|FH_F43330_0_0|SrvcGrp|11073|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F111540_16823_0|SrvcGrp|104432|2022|PDM|30.47|99|0.00|AETNA OFFICE OUTPATIENT VISIT VST (MOD AF)|
20|FH_F114310_0_0|SrvcGrp|105489|2022|PDM|2050.00|99|0.00|SHOULDER ARTHOSCOPY PROCEDURES|
20|FH_F45199_0_0|CSTM-ALL|CSTM-00|2020|PDM|1097.00|99|0.00|ASPG VIII|
20|FH_F101754_63141_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38396_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F124505_0_0|SrvcGrp|80541|2022|PDM|698.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 5|
20|FH_F118964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F78205_0_0|SrvcGrp|17071|2022|PDM|1748.74|99|0.00|ASPG IV|
20|FH_F117891_19034_0|SrvcGrp|48394|2022|PDM|63.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F146121_71857_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37569_0_0|SrvcGrp|26746|2022|PDM|35.00|99|0.00|BAYRHOD/WINRHOSDF/RHO D IMMUNE GLOB|
20|FH_F129364_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
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_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.51|99|0.00|AEG 3 (NO REV)|
20|FH_F142810_77087_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|3400.00|99|0.00|AEG 9 (NO REV)|
20|FH_F150951_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F146217_0_0|SrvcGrp|80918|2022|PDM|423.55|99|0.00|RESPITE CARE|
20|FH_F103281_32086_0|CSTM-ALL|CSTM-00|2020|PDM|3008.00|99|0.00|AEG 4 (NO REV)|
20|FH_F111461_32607_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
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_F141927_71901_0|CSTM-ALL|CSTM-00|2020|PDM|471.00|99|0.00|AEG 1 (NO REV)|
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|3126.00|99|0.00|AEG 7 (NO REV)|
20|FH_F51129_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133478_40165_0|SrvcGrp|107807|2022|PCT|0.54|99|0.00|LABORATORY SERVICES|
20|FH_F149661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141654_15217_0|SrvcGrp|88621|2022|PDM|97.85|99|0.00|SKILLED NURSING LPN|
20|FH_F129596_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F113291_37055_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F89932_10940_0|SrvcGrp|75505|2022|PCT|2.92|99|0.00|CARDIAC STUDIES|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|960.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 601 W/O REV|
20|FH_F142888_77095_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F91155_16105_0|SrvcGrp|73483|2022|PDM|724.00|99|0.00|AETNA SUBACUTE III|
20|FH_F50974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F144769_0_0|SrvcGrp|73559|2022|PDM|3390.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F120841_16201_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121168_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|926.00|99|0.00|AEG 4 (NO REV)|
20|FH_F148494_0_0|SrvcGrp|96353|2022|PDM|16400.00|99|0.00|RECONSTRUCT ANKLE JOINT|
20|FH_F102561_75146_0|SrvcGrp|82037|2022|PDM|3600.00|99|0.00|AETNA ICU|
20|FH_F68974_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117087_0_0|SrvcGrp|107166|2022|PDM|2494.00|99|0.00|RHINOPLASTY|
20|FH_F149581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F62560_0_0|SrvcGrp|12787|2022|PCT|0.25|99|0.00|IMPLANTS|
20|FH_F126666_44053_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F123872_75006_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F137896_0_0|SrvcGrp|105616|2022|PDM|87.97|99|0.00|CPAP DEVICE (MOD RR)|
20|FH_F40994_0_0|SrvcGrp|701|2022|PDM|1600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F113306_33458_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128089_57385_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100682_97401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F39417_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GI DX LAB & RAD CARVEOUTS MOD TC|
20|FH_F49637_0_0|CSTM-ALL|CSTM-00|2020|PDM|4043.00|99|0.00|OK SURGICAL HOSPITAL CVTY ENHANCED GROUPER 9|
20|FH_F126815_02118_0|SrvcGrp|109220|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F31928_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F133270_77025_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F92677_08003_0|SrvcGrp|86852|2022|PDM|63.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F141890_64865_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116428_0_0|SrvcGrp|57967|2022|PDM|148.79|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|523.00|99|0.00|AEG 3 (NO REV)|
20|FH_F94165_0_0|SrvcGrp|73806|2022|PCT|0.85|99|0.00|AETNA ER|
20|FH_F98640_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F149781_37404_0|SrvcGrp|100006|2022|PDM|6386.00|99|0.00|RECONSTRUCT ELBOW MED LIGMNT|
20|FH_F133155_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F149781_37404_0|SrvcGrp|11673|2022|PDM|4774.00|99|0.00|CPT 29888|
20|FH_F109882_36695_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F128312_45230_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F145877_0_0|SrvcGrp|11606|2022|PDM|1450.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)|
20|FH_F139680_76006_0|SrvcGrp|86723|2022|PDM|473.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F150769_02302_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F150800_44256_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150801_19380_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
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_F134869_08854_0|SrvcGrp|42625|2022|PDM|311.00|99|0.00|BEHAVIORAL HEALTH GENERAL|
20|FH_F142785_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F120057_0_0|SrvcGrp|108077|2022|PDM|1698.78|99|0.00|ARTERIOVENOUS ANASTOMOSIS|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F71108_0_0|SrvcGrp|45678|2022|PCT|0.70|99|0.00|HIGH COST DRUGS|
20|FH_F97623_38008_0|SrvcGrp|73603|2022|PDM|3521.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F130919_33314_0|SrvcGrp|73841|2022|PDM|467.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F147160_80260_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138662_78624_0|SrvcGrp|89417|2022|PDM|350.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F120083_13501_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130919_33314_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149582_01534_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F36903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F108680_0_0|SrvcGrp|102726|2022|PCT|0.00|99|0.00|DESTROY CERV/THOR FACET JNT|
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|35315.00|99|0.00|MS DRGS 233-236 CV SURGERY|
20|FH_F124044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124727_0_0|SrvcGrp|108041|2022|PDM|425.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F147347_70806_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F114207_35243_0|SrvcGrp|17016|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F147418_0_0|SrvcGrp|11000|2022|PCT|0.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F127324_0_0|SrvcGrp|110674|2022|PDM|11480.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F112956_0_0|SrvcGrp|75497|2022|PDM|363.00|99|0.00|AEG 10|
20|FH_F120040_72703_0|SrvcGrp|88819|2022|PDM|914.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F124760_34997_0|SrvcGrp|72602|2022|PDM|716.00|99|0.00|ECT|
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F101083_0_0|SrvcGrp|73008|2022|PDM|997.00|99|0.00|AEG 10|
20|FH_F50078_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F37960_0_0|CSTM-ALL|CSTM-00|2020|PDM|1010.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151039_16749_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149004_67025_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F73768_0_0|SrvcGrp|46983|2022|PDM|23.77|99|0.00|HOME SUPPLIES (A4221)|
20|FH_F110121_0_0|SrvcGrp|72994|2022|PDM|1943.00|99|0.00|AEG 3|
20|FH_F138017_73129_0|SrvcGrp|35669|2022|PDM|5775.00|99|0.00|CPT 63650|
20|FH_F92716_0_0|SrvcGrp|82301|2022|PDM|274.00|99|0.00|HEMORRHOIDECTOMY|
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|2705.04|99|0.00|LAP VENT/ABD HERN PROC COMP|
20|FH_F132254_40207_0|SrvcGrp|21920|2022|PDM|50.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F111122_63376_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110785_10040_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F109247_73102_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F37198_0_0|SrvcGrp|66459|2022|PDM|1000.00|99|0.00|CT SCAN|
20|FH_F151008_92625_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F39772_0_0|SrvcGrp|877|2022|PDM|424.00|99|0.00|BOARDER BABY SVCS|
20|FH_F97640_37043_0|SrvcGrp|73605|2022|PDM|2898.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F149023_44122_0|SrvcGrp|115112|2022|PDM|24700.00|99|0.00|THORACIC DISKECTOMY|
20|FH_F147224_48026_0|SrvcGrp|42622|2022|PDM|638.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F69123_0_0|SrvcGrp|42973|2022|PDM|90.00|99|0.00|SPEECH  THERAPIST|
20|FH_F101685_0_0|SrvcGrp|73000|2022|PDM|962.00|99|0.00|AEG 6|
20|FH_F137730_46563_0|SrvcGrp|3178|2022|PDM|999.00|99|0.00|ACUTE PSYCH|
20|FH_F32825_0_0|SrvcGrp|705|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F139147_0_0|SrvcGrp|65403|2022|PDM|5305.00|99|0.00|CPT 42830|
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|2203.00|99|0.00|AEG 9 (NO REV)|
20|FH_F84833_17109_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F94621_07728_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 6 (NO REV)|
20|FH_F132056_32080_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
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_F134933_73505_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97080_85122_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F149602_07109_0|SrvcGrp|113220|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS 22 TRGT SARS-COV-2|
20|FH_F132160_0_0|SrvcGrp|109764|2022|PDM|4590.00|99|0.00|REPAIR EYELID DEFECT|
20|FH_F98801_93274_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132149_60624_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|2550.00|99|0.00|ASPG IV|
20|FH_F46284_0_0|SrvcGrp|10410|2022|PDM|79.00|99|0.00|SKILLED NURSING CARE|
20|FH_F98022_89015_0|SrvcGrp|73601|2022|PDM|9106.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F37864_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|1675.00|99|0.00|AEG 3 (NO REV)|
20|FH_F115483_62002_0|SrvcGrp|112978|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F37422_0_0|SrvcGrp|474|2022|PDM|190.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F50078_0_0|SrvcGrp|14893|2022|PDM|47.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F132149_60624_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F34777_0_0|CSTM-ALL|CSTM-00|2020|PDM|355.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F137748_95231_0|CSTM-ALL|CSTM-00|2020|PDM|2608.00|99|0.00|AEG 3 (NO REV)|
20|FH_F94643_90501_0|SrvcGrp|86838|2022|PDM|25.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F81312_0_0|SrvcGrp|537|2022|PCT|0.65|99|0.00|OBSERVATION SERVICES|
20|FH_F110824_83221_0|SrvcGrp|75506|2022|PCT|0.85|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F127636_06030_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F124441_0_0|SrvcGrp|106265|2022|PDM|3325.00|99|0.00|NSL/SINS NDSC TOTAL|
20|FH_F129237_72833_0|SrvcGrp|79699|2022|PCT|0.88|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F150928_62521_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F66405_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F98001_27603_0|SrvcGrp|73601|2022|PDM|15043.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F151001_80501_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F116575_0_0|SrvcGrp|65403|2022|PDM|2500.00|99|0.00|CPT 42830|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|JERS LAB RENTAL|
20|FH_F140231_60540_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F143348_16214_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F143536_47546_0|SrvcGrp|25383|2022|PCT|0.00|99|0.00|MEDICINE SERVICES|
20|FH_F75903_0_0|SrvcGrp|25038|2022|PDM|831.14|99|0.00|SLEEP STUDIES|
20|FH_F101709_0_0|SrvcGrp|54943|2022|PDM|2985.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F103060_0_0|SrvcGrp|98498|2022|PDM|7803.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC|
20|FH_F102224_0_0|SrvcGrp|87679|2022|PDM|2080.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F151785_03104_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F47056_0_0|SrvcGrp|26001|2022|PDM|110.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F47600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53|
20|FH_F47952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F49552_0_0|SrvcGrp|28531|2022|PDM|6.42|99|0.00|AMBULANCE MILEAGE|
20|FH_F132418_84042_0|SrvcGrp|58509|2022|PDM|456.78|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F132431_79606_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F116913_77024_0|SrvcGrp|106263|2022|PDM|460.00|99|0.00|AETNA PARTIAL HOSP PSYCH|
20|FH_F116918_06488_0|SrvcGrp|473|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|1995.00|99|0.00|AEG 5  (NO REV)|
20|FH_F120974_27607_0|SrvcGrp|75943|2022|PDM|6209.00|99|0.00|AETNA INPATIENT SURGICAL CARE|
20|FH_F38289_0_0|CSTM-ALL|CSTM-00|2020|PDM|210.83|99|0.00|CENTER FOR SPINE CARE RAD|
20|FH_F51276_0_0|SrvcGrp|27045|2022|PDM|20.33|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS (MOD SJ)|
20|FH_F149679_0_0|SrvcGrp|106317|2022|PDM|1118.17|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F150200_0_0|SrvcGrp|74039|2022|PDM|4776.00|99|0.00|LAMINECTOMY|
20|FH_F46258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F59732_0_0|SrvcGrp|17009|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F72842_0_0|SrvcGrp|3271|2022|PDM|5244.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F34546_0_0|SrvcGrp|38|2022|PDM|1100.00|99|0.00|NORMAL DELIVERY|
20|FH_F131002_40977_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148222_18603_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F122687_0_0|SrvcGrp|58671|2022|PDM|1311.00|99|0.00|ASC CARVE OUT 64721|
20|FH_F137615_16335_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F123276_20737_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F110925_01104_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148265_06067_0|SrvcGrp|113851|2022|PDM|21728.00|99|0.00|ARTHRDSIS LAT MINI DISKECT|
20|FH_F135219_68506_0|SrvcGrp|115534|2022|PCT|1.18|99|0.00|LABORATORY SERVICES|
20|FH_F115109_20032_0|SrvcGrp|10391|2022|PDM|1821.08|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F126581_45638_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F110263_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F131254_92211_0|SrvcGrp|10577|2022|PDM|35.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F122433_0_0|SrvcGrp|92759|2022|PCT|0.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME,MOD_53|
20|FH_F148265_06067_0|SrvcGrp|83640|2022|PDM|4828.00|99|0.00|CPT 29887|
20|FH_F82714_18848_0|SrvcGrp|113185|2022|PCT|4.61|99|0.00|RADIOLOGY SERVICES|
20|FH_F39863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|OP SVCS|
20|FH_F146803_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F147941_06023_0|SrvcGrp|109217|2022|PDM|145.00|99|0.00|PSYCH/NEUROPSYCH TEST 1ST 30 MINUTES|
20|FH_F39479_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148262_17901_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
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_F118910_0_0|SrvcGrp|89781|2022|PDM|113.30|99|0.00|RESPITE CARE (HCFA)|
20|FH_F32612_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93332_0_0|SrvcGrp|89860|2022|PDM|7416.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F149980_0_0|SrvcGrp|115798|2022|PDM|1000.00|99|0.00|TREATMENT OF RETINA|
20|FH_F95200_16201_0|SrvcGrp|3388|2022|PDM|1348.00|99|0.00|SUBACUTE CARE|
20|FH_F92034_0_0|SrvcGrp|73000|2022|PDM|1088.00|99|0.00|AEG 6|
20|FH_F145758_20745_0|SrvcGrp|58634|2022|PDM|3060.00|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F135236_02840_0|SrvcGrp|105809|2022|PCT|1.01|99|0.00|PT OT ST|
20|FH_F82235_0_0|SrvcGrp|73008|2022|PDM|693.00|99|0.00|AEG 10|
20|FH_F148319_37042_0|SrvcGrp|82981|2022|PDM|140.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F148480_03079_0|SrvcGrp|115403|2022|PDM|3966.00|99|0.00|NEURO/SPINE|
20|FH_F123957_84321_0|SrvcGrp|73605|2022|PDM|957.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F79542_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.40|99|0.00|OP SVCS|
20|FH_F122687_0_0|SrvcGrp|100014|2022|PDM|3825.00|99|0.00|REPAIR RADIUS OR ULNA|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD NU/KF) - CPD 1963706|
20|FH_F37077_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126581_45638_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F92091_0_0|SrvcGrp|89980|2022|PDM|3800.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F47963_0_0|SrvcGrp|26017|2022|PDM|99.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F78928_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 4 (NO REV)|
20|FH_F120279_98005_0|SrvcGrp|75419|2022|PDM|550.00|99|0.00|OP PARTIAL HOSPITALIZATION|
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_F130013_16509_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F91622_0_0|CSTM-ALL|CSTM-00|2020|PDM|3130.00|99|0.00|AEG 9 (NO REV) ANTHONY MED CTR|
20|FH_F131763_06002_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F91876_0_0|SrvcGrp|83646|2022|PDM|2345.00|99|0.00|CPT 31276|
20|FH_F93534_45690_0|SrvcGrp|57968|2022|PDM|31.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F92655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F62915_0_0|SrvcGrp|3809|2022|PDM|1103.00|99|0.00|HOSPICE CARE|
20|FH_F38526_0_0|SrvcGrp|453|2022|PDM|520.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F128272_60640_0|SrvcGrp|14893|2022|PDM|85.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F127255_03104_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F85475_0_0|SrvcGrp|46482|2022|PDM|143.00|99|0.00|S9083 PER VISIT|
20|FH_F122687_0_0|SrvcGrp|82109|2022|PDM|1311.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F112508_0_0|SrvcGrp|10393|2022|PDM|1560.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F49653_0_0|SrvcGrp|17739|2022|PDM|2160.00|99|0.00|ICU/CCU|
20|FH_F38867_0_0|SrvcGrp|453|2022|PDM|250.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F135219_68506_0|CSTM-ALL|CSTM-00|2020|PDM|1561.80|99|0.00|AEG 1 (NO REV)|
20|FH_F93538_87124_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F142710_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F67261_0_0|SrvcGrp|10364|2022|PDM|500.00|99|0.00|CPT CODE 99284|
20|FH_F128272_60640_0|SrvcGrp|86840|2022|PDM|40.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F76402_0_0|CSTM-ALL|CSTM-00|2020|PCT|56650.00|99|0.00|HOME HEMO TRAINING|
20|FH_F137067_0_0|SrvcGrp|35668|2022|PDM|4305.00|99|0.00|CPT 29824|
20|FH_F93094_21227_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F131254_92211_0|SrvcGrp|17016|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F38090_0_0|SrvcGrp|15|2022|PDM|2055.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F100660_56303_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F34899_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|721.80|99|0.00|HAPA WPA-NWPA 2012-13 ASC 502 W/O REV|
20|FH_F111288_0_0|SrvcGrp|67279|2022|PDM|18884.00|99|0.00|CERVICAL SURGERY|
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_F128446_0_0|SrvcGrp|87077|2022|PDM|161.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F123902_19140_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE|
20|FH_F128176_24201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149888_68506_0|CSTM-ALL|CSTM-00|2020|PDM|2791.00|99|0.00|AEG 10 (NO REV)|
20|FH_F86654_33073_0|SrvcGrp|85100|2022|PDM|415.00|99|0.00|WIG, ANY TYPE|
20|FH_F84778_0_0|SrvcGrp|73006|2022|PDM|2205.00|99|0.00|AEG 9|
20|FH_F63095_0_0|SrvcGrp|29121|2022|PCT|0.65|99|0.00|LABORATORY|
20|FH_F55212_0_0|SrvcGrp|51066|2022|PDM|215.00|99|0.00|HOSP DISCHARGE DAY MGMT MORE THAN 30 MINS|
20|FH_F89736_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|AETNA OVERNIGHT STAYS|
20|FH_F139689_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87474_0_0|SrvcGrp|9828|2022|PDM|39.00|99|0.00|HOME HEALTH AIDE|
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ASPG III|
20|FH_F63229_0_0|SrvcGrp|44247|2022|PDM|385.00|99|0.00|CAPD TRAINING|
20|FH_F149268_74820_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132599_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|510.00|99|0.00|AEG 1 (NO REV)|
20|FH_F31714_0_0|SrvcGrp|11182|2022|PDM|32200.00|99|0.00|DRG 547 CORONARY BYP W/CARDIAC CATH W/DIAGNOSIS|
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|356.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F133801_87107_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F79743_0_0|CSTM-ALL|CSTM-00|2020|PDM|4872.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F109387_35630_0|SrvcGrp|86747|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F109577_0_0|SrvcGrp|53144|2022|PDM|133.00|99|0.00|SPEECH THERAPY|
20|FH_F127157_43614_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133749_84604_0|SrvcGrp|46691|2022|PDM|17.50|99|0.00|HOME HEALTH AID SERVICES|
20|FH_F133103_0_0|SrvcGrp|112098|2022|PCT|2.00|99|0.00|COVID-19 CODES|
20|FH_F119567_04072_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119657_39111_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F150165_06032_0|SrvcGrp|11663|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F100782_0_0|SrvcGrp|105120|2022|PDM|695.12|99|0.00|WINDBER MEDICAL CNTR ASC 225|
20|FH_F120719_27540_0|SrvcGrp|39871|2022|PCT|0.76|99|0.00|MS DRG 619-621 ONLY OTLR|
20|FH_F143620_81504_0|SrvcGrp|88621|2022|PDM|105.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150165_06032_0|SrvcGrp|27347|2022|PDM|2016.00|99|0.00|CPT 58558|
20|FH_F139578_70433_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119650_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130763_0_0|SrvcGrp|84180|2022|PDM|4716.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS|
20|FH_F50657_0_0|SrvcGrp|31191|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF (DME)|
20|FH_F110980_53566_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146372_28681_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149106_07042_0|SrvcGrp|38795|2022|PDM|6564.00|99|0.00|MASTECTOMY, SIMPLE, COMPLETE|
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1706.01|99|0.00|AEG 7 (NO REV)|
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F150179_23124_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F83113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: ALL|
20|FH_F51039_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|2010 LABORATORY (MOD TC)|
20|FH_F68844_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|TRANSPLANT MSDRG ONLY|
20|FH_F118384_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F90438_08873_0|SrvcGrp|43523|2022|PDM|177.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.00|99|0.00|ASPG IV- MOD 50|
20|FH_F149345_45044_0|SrvcGrp|110126|2022|PDM|522.50|99|0.00|DIALYSIS|
20|FH_F117208_0_0|SrvcGrp|83646|2022|PDM|4015.00|99|0.00|CPT 31276|
20|FH_F122948_23947_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132802_68022_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F133947_93950_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F143566_98264_0|SrvcGrp|115337|2022|PDM|1300.00|99|0.00|VAGINAL DELIVERY|
20|FH_F149051_01605_0|SrvcGrp|86635|2022|PCT|1.07|99|0.00|DME|
20|FH_F145642_15108_0|SrvcGrp|86838|2022|PDM|10.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F138056_64055_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F134895_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F127589_45459_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149259_64050_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138024_40509_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F145839_45244_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133748_77081_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133753_84015_0|SrvcGrp|76501|2022|PDM|260.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F145558_43950_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126063_43078_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F122930_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F138047_77027_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F71345_0_0|SrvcGrp|26001|2022|PDM|163.81|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.00|99|0.00|ASPG IV|
20|FH_F128379_0_0|SrvcGrp|12491|2022|PCT|1.05|99|0.00|PACEMAKER|
20|FH_F143335_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F133585_0_0|SrvcGrp|74670|2022|PCT|0.00|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F79623_0_0|SrvcGrp|75497|2022|PCT|0.53|99|0.00|AEG 10|
20|FH_F96721_99504_0|SrvcGrp|73603|2022|PDM|7969.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F134650_07921_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F119590_29607_0|SrvcGrp|104364|2022|PCT|1.20|99|0.00|DIAGNOSTIC RADIOLOGY SERVICES|
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|1795.00|99|0.00|AEG 6 (NO REV)|
20|FH_F144808_0_0|SrvcGrp|88163|2022|PDM|7699.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F130763_0_0|SrvcGrp|27316|2022|PDM|3258.00|99|0.00|TONSILS & ADENOIDS (42820)|
20|FH_F137530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139443_37705_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F123623_03246_0|SrvcGrp|109277|2022|PCT|1.00|99|0.00|RBC LEUKOCYTES REDUCED|
20|FH_F112023_12866_0|SrvcGrp|79099|2022|PDM|4375.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F122930_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|PHENYLEPHRINE KETOROLAC|
20|FH_F149199_73005_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F111732_33771_0|SrvcGrp|91992|2022|PDM|1900.00|99|0.00|VAGINAL DELIVERY ONLY (HCFA)|
20|FH_F149141_27262_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F113276_38506_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|4675.00|99|0.00|AEG 8 (NO REV)|
20|FH_F111349_0_0|SrvcGrp|93274|2022|PDM|329.00|99|0.00|SKILLED CARE LEVEL I AND II|
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PDM|2048.00|99|0.00|AEG 7 (NO REV)|
20|FH_F145642_15108_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING-OP W/O HOME INFUSION|
20|FH_F111704_30044_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134495_84321_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122552_03103_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F85001_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115788_02904_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F115870_98225_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F115907_12206_0|SrvcGrp|46903|2022|PDM|302.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F47140_0_0|SrvcGrp|13621|2022|PDM|563.56|99|0.00|SLEEP STUDIES|
20|FH_F115966_16801_0|SrvcGrp|48398|2022|PDM|125.00|99|0.00|PT SERVICES|
20|FH_F116040_24637_0|SrvcGrp|17016|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116056_73018_0|SrvcGrp|88621|2022|PDM|75.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133581_84790_0|SrvcGrp|110820|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F132851_44805_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133398_43204_0|SrvcGrp|89417|2022|PDM|287.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F133478_40165_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132191_66757_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130657_04614_0|SrvcGrp|72984|2022|PCT|0.86|99|0.00|CHEMOTHERAPY|
20|FH_F111601_15203_0|SrvcGrp|90854|2022|PDM|634.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F111603_19529_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F88115_0_0|SrvcGrp|22528|2022|PDM|402.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F123792_90803_0|SrvcGrp|100520|2022|PDM|492.00|99|0.00|INTENSIVE OP EATING DISORDERS|
20|FH_F123784_03264_0|SrvcGrp|46104|2022|PDM|154.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F62577_0_0|SrvcGrp|58462|2022|PDM|2615.00|99|0.00|ASPG IX|
20|FH_F62577_0_0|SrvcGrp|58461|2022|PDM|1951.00|99|0.00|ASPG VIII|
20|FH_F69968_0_0|SrvcGrp|17065|2022|PDM|884.42|99|0.00|ASPG I|
20|FH_F134011_84102_0|SrvcGrp|86828|2022|PDM|10.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F134057_32570_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137033_87108_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F142314_19102_0|SrvcGrp|110812|2022|PDM|189.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F53732_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F97600_46151_0|SrvcGrp|73603|2022|PDM|10135.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F97600_46151_0|SrvcGrp|73485|2022|PDM|1803.00|99|0.00|AETNA REHAB|
20|FH_F140343_89052_0|SrvcGrp|29023|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F140407_63841_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F140493_67107_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1715.00|99|0.00|AEG 9 (NO REV)|
20|FH_F151579_19802_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118943_64506_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F92551_18508_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|GENERAL ACUTE CARE|
20|FH_F66835_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40110_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F117211_15143_0|SrvcGrp|27968|2022|PDM|33.00|99|0.00|SKILLED NURSING LPN|
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|377.00|99|0.00|AEG 10 (NO REV)|
20|FH_F137930_51546_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F35210_0_0|SrvcGrp|72|2022|PDM|744.00|99|0.00|NEWBORN NURSERY|
20|FH_F110342_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|1888.00|99|0.00|ASPG X|
20|FH_F109513_0_0|SrvcGrp|90439|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY SURGERY|
20|FH_F58272_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO|
20|FH_F129130_92562_0|SrvcGrp|12837|2022|PCT|0.46|99|0.00|INTRAOCULAR LENSES|
20|FH_F129130_92562_0|SrvcGrp|111293|2022|PDM|5833.12|99|0.00|CATHETER PLACEMENT|
20|FH_F40144_0_0|SrvcGrp|958|2022|PDM|1114.00|99|0.00|VENTILATOR SERVICES|
20|FH_F69651_0_0|SrvcGrp|24739|2022|PDM|35.00|99|0.00|RESPITE CARE|
20|FH_F91873_12723_0|SrvcGrp|86582|2022|PDM|6395.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F97780_43614_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|3250.00|99|0.00|AEG 9 (NO REV)|
20|FH_F111442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F73025_0_0|SrvcGrp|48385|2022|PDM|30.00|99|0.00|SPEECH THERAPY|
20|FH_F74562_0_0|SrvcGrp|3029|2022|PDM|295.00|99|0.00|NEWBORN NURSERY|
20|FH_F113143_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114866_77706_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F142427_36607_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F113385_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F105480_19940_0|SrvcGrp|472|2022|PDM|395.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130400_26505_0|SrvcGrp|75506|2022|PCT|0.74|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1431.00|99|0.00|AEG 5  (NO REV)|
20|FH_F110212_17013_0|SrvcGrp|89149|2022|PDM|196.00|99|0.00|OP INTENSIVE|
20|FH_F145784_0_0|SrvcGrp|104249|2022|PDM|3500.00|99|0.00|FULL GRAFT PROCEDURE|
20|FH_F94740_32904_0|SrvcGrp|22954|2022|PDM|128.38|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F132988_0_0|SrvcGrp|92408|2022|PDM|4493.01|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F132988_0_0|SrvcGrp|92820|2022|PDM|4493.01|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY|
20|FH_F58932_0_0|SrvcGrp|12516|2022|PDM|290.00|99|0.00|DAY HOSPITAL PARTIAL|
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116664_0_0|SrvcGrp|103550|2022|PDM|1265.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F114389_50131_0|SrvcGrp|24754|2022|PDM|30.30|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F55812_0_0|SrvcGrp|10542|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F64819_0_0|SrvcGrp|21108|2022|PDM|8284.00|99|0.00|MS DRG 243 ONLY|
20|FH_F34546_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F38688_0_0|SrvcGrp|11033|2022|PCT|1.00|99|0.00|OP REFERENCE LAB|
20|FH_F39561_0_0|SrvcGrp|3810|2022|PDM|122.47|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F100703_0_0|SrvcGrp|96354|2022|PDM|7876.00|99|0.00|REMOVAL OF ANKLE JOINT|
20|FH_F132864_71101_0|SrvcGrp|39522|2022|PDM|44579.00|99|0.00|MS DRG 216-218 ONLY|
20|FH_F131101_45840_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 10 (NO REV)|
20|FH_F116572_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F135327_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F136544_06426_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136569_16506_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F114666_30342_0|SrvcGrp|82108|2022|PDM|2000.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F144039_0_0|SrvcGrp|109763|2022|PDM|2869.00|99|0.00|TREAT EYELID LESION|
20|FH_F148553_85016_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F148553_85016_0|SrvcGrp|115465|2022|PDM|5422.00|99|0.00|TIB/PER REVASC W/ STENT|
20|FH_F43135_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|SPINAL CORD REHABILITATION|
20|FH_F43859_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F134791_98034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135762_70001_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F136828_32405_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136930_73114_0|SrvcGrp|13778|2022|PDM|1042.00|99|0.00|PSYCH/CD|
20|FH_F112371_19047_0|CSTM-ALL|CSTM-00|2020|PDM|3186.00|99|0.00|AEG 7 (NO REV)|
20|FH_F38826_0_0|SrvcGrp|701|2022|PDM|2600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F74283_0_0|CSTM-ALL|CSTM-00|2020|PDM|11.00|99|0.00|VACCINE ADMINISTRATION|
20|FH_F115567_91711_0|SrvcGrp|93338|2022|PDM|30.73|99|0.00|AETNA MED NUTRITION SEBSEQUENT|
20|FH_F115631_65201_0|SrvcGrp|80617|2022|PDM|10551.00|99|0.00|ARTHOPLASTY|
20|FH_F116199_75042_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F116393_07002_0|SrvcGrp|111284|2022|PDM|6.56|99|0.00|SEDIMENTATION RATE|
20|FH_F41540_0_0|SrvcGrp|33831|2022|PDM|1840.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 9|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD UEKC|
20|FH_F98622_45005_0|SrvcGrp|88978|2022|PDM|11122.00|99|0.00|VAGINAL DELIVERY|
20|FH_F100780_24153_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F40634_0_0|SrvcGrp|115|2022|PDM|530.00|99|0.00|SKILLED NURSING CARE|
20|FH_F128430_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102881_0_0|SrvcGrp|98721|2022|PCT|0.00|99|0.00|AETNA IMPLANTS DENIAL|
20|FH_F109963_0_0|SrvcGrp|73008|2022|PDM|615.00|99|0.00|AEG 10|
20|FH_F34477_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DURABLE MEDICAL EQUIPMENT (DME) W/MOD UE - WINN|
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_F35708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|TRC VACV 28 FS %|
20|FH_F51938_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F46433_0_0|SrvcGrp|10578|2022|PDM|57.00|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F113178_44035_0|SrvcGrp|97959|2022|PDM|125.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F133536_0_0|SrvcGrp|105430|2022|PDM|9500.00|99|0.00|AETNA ARTHRODESIS INTERNAL TECH|
20|FH_F135351_0_0|SrvcGrp|88487|2022|PDM|3630.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F139916_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F117820_0_0|SrvcGrp|29353|2022|PDM|62.60|99|0.00|HOSPICE SVCS|
20|FH_F54552_0_0|SrvcGrp|27042|2022|PDM|27.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS(MOD SH)|
20|FH_F133021_00910_0|SrvcGrp|112311|2022|PDM|1600.00|99|0.00|DSA INTERVENTIONAL DIAGNOSTIC|
20|FH_F146258_90004_0|SrvcGrp|112076|2022|PCT|0.60|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F119226_07746_0|SrvcGrp|73605|2022|PDM|833.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F142973_62448_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143684_0_0|SrvcGrp|35669|2022|PDM|8323.00|99|0.00|CPT 63650|
20|FH_F130649_98055_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F31824_0_0|SrvcGrp|13243|2022|PDM|1600.00|99|0.00|OP SURG|
20|FH_F132991_84790_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138467_32216_0|SrvcGrp|73842|2022|PDM|695.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139129_70508_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|HSS ASC|
20|FH_F139388_33407_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150719_30012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
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_F147237_40006_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F52278_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97620_75904_0|SrvcGrp|73602|2022|PDM|1493.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.00|99|0.00|AEG 9 (NO REV)|
20|FH_F124759_34108_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F101441_0_0|SrvcGrp|113615|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F111246_80027_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F111040_30033_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132860_0_0|SrvcGrp|361|2022|PDM|1605.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|911.00|99|0.00|AEG 10 (NO REV)|
20|FH_F137767_01841_0|SrvcGrp|86700|2022|PDM|235.00|99|0.00|ECHO TRANSESOPHAGEAL 2|
20|FH_F47558_0_0|SrvcGrp|40412|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD RR KC|
20|FH_F32384_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.50|99|0.00|OP SVCS|
20|FH_F127418_0_0|SrvcGrp|88162|2022|PDM|7980.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PDM|1230.00|99|0.00|ASPG IX|
20|FH_F97260_06111_0|SrvcGrp|88977|2022|PDM|6625.00|99|0.00|C-SECTION DELIVERY|
20|FH_F119203_0_0|SrvcGrp|103550|2022|PDM|435.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F71108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F39772_0_0|SrvcGrp|537|2022|PCT|0.80|99|0.00|OBSERVATION SERVICES|
20|FH_F124722_66067_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130997_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F35416_0_0|SrvcGrp|8950|2022|PDM|3252.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F149373_0_0|SrvcGrp|110811|2022|PDM|302.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F139877_32615_0|SrvcGrp|113250|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2&INF A&B&RSV AMP PRB (HCFA)|
20|FH_F36663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S MOD AV (CPD 1364768)|
20|FH_F37335_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148181_0_0|SrvcGrp|95661|2022|PDM|837.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F148883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F116642_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F37777_0_0|SrvcGrp|25346|2022|PDM|30.00|99|0.00|PT|
20|FH_F124749_90211_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129307_54174_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|1263.00|99|0.00|ASPG VI|
20|FH_F37081_0_0|SrvcGrp|18838|2022|PDM|42693.00|99|0.00|MS DRG 226|
20|FH_F71064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|2753.00|99|0.00|HERNIA PROCEDURES|
20|FH_F32825_0_0|SrvcGrp|18370|2022|PCT|0.70|99|0.00|MS DRG 481|
20|FH_F39443_0_0|SrvcGrp|30319|2022|PDM|552.00|99|0.00|HAPA WPA ASC 203|
20|FH_F128386_60124_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F129111_43084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110732_31513_0|SrvcGrp|75506|2022|PCT|0.60|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F149160_02180_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 10 (NO REV)|
20|FH_F110783_93013_0|SrvcGrp|17016|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F139970_16142_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128369_72901_0|SrvcGrp|89149|2022|PDM|159.00|99|0.00|OP INTENSIVE|
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)|
20|FH_F69183_0_0|SrvcGrp|31377|2022|PCT|0.50|99|0.00|EMERGENCY ROOM LEVEL V|
20|FH_F110785_10040_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F126785_0_0|SrvcGrp|14509|2022|PDM|995.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F119897_78229_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F125081_15218_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F36133_70072_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F137986_0_0|SrvcGrp|77021|2022|PDM|3000.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F102525_73134_0|SrvcGrp|31916|2022|PDM|15000.00|99|0.00|MS DRG 473 ONLY|
20|FH_F125419_44110_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35771_32578_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F124316_28112_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F143351_21157_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F143413_75061_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143536_47546_0|SrvcGrp|100280|2022|PCT|1.00|99|0.00|NEBULIZER ADMINISTRATION SET|
20|FH_F115208_0_0|SrvcGrp|91382|2022|PDM|1485.00|99|0.00|REMOVAL OF TONSILS|
20|FH_F114931_0_0|SrvcGrp|104113|2022|PDM|3200.00|99|0.00|REMOVE ANAL FIST COMPLEX|
20|FH_F131067_57105_0|CSTM-ALL|CSTM-00|2020|PDM|6849.00|99|0.00|AEG 7 "NO REV" WITHOUT CARVE OUT SURG|
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1692.73|99|0.00|AEG 5  (NO REV)|
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)|
20|FH_F151320_15145_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151503_30067_0|SrvcGrp|116014|2022|PDM|1565.00|99|0.00|EXE FOOT/TOE TUM SC <1.5 CM|
20|FH_F151514_35242_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132258_45404_0|SrvcGrp|14893|2022|PDM|42.72|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F132268_07060_0|CSTM-ALL|CSTM-00|2020|PDM|30.72|99|0.00|COGNITIVE SKILLS DEVELOPMENT|
20|FH_F132268_07060_0|SrvcGrp|85963|2022|PDM|38.87|99|0.00|SELF CARE MANGEMENT TRAINING|
20|FH_F122106_60035_0|SrvcGrp|89149|2022|PDM|201.00|99|0.00|OP INTENSIVE|
20|FH_F122148_62664_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F144928_02703_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F144968_18702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135447_53226_0|SrvcGrp|3483|2022|PDM|4625.00|99|0.00|CPT CODE 59400|
20|FH_F135584_10977_0|SrvcGrp|104464|2022|PDM|2800.00|99|0.00|VAGINAL DELIVERY (W/ OR W/O EPISIOTOMY)|
20|FH_F131132_44077_0|SrvcGrp|109707|2022|PDM|7517.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F116431_76104_0|SrvcGrp|86919|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F116468_49660_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F121707_85745_0|SrvcGrp|46903|2022|PDM|1115.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F121761_44130_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F44113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F46918_0_0|SrvcGrp|10407|2022|PDM|55.00|99|0.00|HOME INFUSION|
20|FH_F130817_18103_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130817_18103_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 4 (NO REV)|
20|FH_F111292_33136_0|SrvcGrp|81402|2022|PDM|105.00|99|0.00|METABOLIC PANEL|
20|FH_F134315_89106_0|SrvcGrp|13929|2022|PCT|1.00|99|0.00|GROWTH HORMONE|
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|846.00|99|0.00|ASPG VIII|
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PDM|1909.00|99|0.00|AEG 5  (NO REV)|
20|FH_F102862_30606_0|SrvcGrp|31928|2022|PDM|64786.40|99|0.00|MS DRG 456 ONLY|
20|FH_F102905_85541_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F102960_50613_0|SrvcGrp|83960|2022|PCT|0.65|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F66642_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.30|99|0.00|GENERAL ACUTE CARE|
20|FH_F73626_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F148545_84047_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F133427_48811_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F112853_22408_0|SrvcGrp|73524|2022|PCT|1.05|99|0.00|PHYSICAL THERAPY|
20|FH_F117885_81506_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F97621_75801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123181_75057_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F45977_0_0|SrvcGrp|40418|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD UE|
20|FH_F132934_63005_0|SrvcGrp|92579|2022|PDM|3909.00|99|0.00|PEDIATRIC SURGICAL CARE (<= 17 YRS)|
20|FH_F102561_75146_0|SrvcGrp|82242|2022|PCT|2.00|99|0.00|AETNA PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY|
20|FH_F133271_72204_0|SrvcGrp|89417|2022|PDM|420.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F130553_18640_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F85314_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F150899_17243_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F76662_0_0|SrvcGrp|3810|2022|PDM|178.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F115406_79902_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118379_32079_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F119076_41001_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133516_44004_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F117559_08619_0|SrvcGrp|114538|2022|PDM|40.00|99|0.00|ADM SARS COV2 50MCG / 0.25ML BST|
20|FH_F103400_33426_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F90935_29073_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F150001_33064_0|SrvcGrp|13929|2022|PDM|11.00|99|0.00|GROWTH HORMONE|
20|FH_F141870_85224_0|SrvcGrp|86838|2022|PDM|25.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F71323_68114_0|SrvcGrp|112053|2022|PCT|1.00|99|0.00|COVID-19 IMMUNOASSAY|
20|FH_F35278_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F119291_0_0|SrvcGrp|108041|2022|PDM|435.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F128299_44134_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F81771_0_0|SrvcGrp|22954|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F147995_67037_0|CSTM-ALL|CSTM-00|2020|PDM|4397.00|99|0.00|AEG 9 (NO REV)|
20|FH_F150948_0_0|SrvcGrp|113856|2022|PDM|10000.00|99|0.00|SPINE PROCEDURES|
20|FH_F102188_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101246_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100784_59923_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41461_0_0|SrvcGrp|439|2022|PDM|1350.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F37035_0_0|SrvcGrp|33824|2022|PDM|564.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 2|
20|FH_F128246_0_0|SrvcGrp|111045|2022|PDM|726.00|99|0.00|LASER SURGERY EYE STRANDS|
20|FH_F82378_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F97542_32960_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU KE"|
20|FH_F133021_00910_0|CSTM-ALL|CSTM-00|2020|PDM|4500.00|99|0.00|MATERNITY DELIVERY|
20|FH_F109846_16502_0|SrvcGrp|472|2022|PDM|447.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F45977_0_0|SrvcGrp|11080|2022|PDM|100.00|99|0.00|NURSING CARE|
20|FH_F146229_60031_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F118542_60188_0|SrvcGrp|107697|2022|PCT|1.00|99|0.00|AETNA ALL DRUGS AGENTS INJ|
20|FH_F43774_0_0|SrvcGrp|9832|2022|PDM|115.00|99|0.00|ST SVCS|
20|FH_F133021_00910_0|SrvcGrp|11259|2022|PCT|1.00|99|0.00|DRUGS|
20|FH_F40591_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F150059_54494_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147800_0_0|SrvcGrp|113716|2022|PDM|880.00|99|0.00|NJX AA / STR AXILLARY NERVE|
20|FH_F129535_0_0|SrvcGrp|85000|2022|PDM|550.00|99|0.00|CPT 45384|
20|FH_F149840_80002_0|SrvcGrp|80920|2022|PDM|618.00|99|0.00|HOSPICE SERVICES|
20|FH_F71947_15227_0|SrvcGrp|29611|2022|PDM|195.00|99|0.00|VENTILATOR SUPPORT|
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|AEG 2 (NO REV)|
20|FH_F118698_32054_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F148556_13206_0|SrvcGrp|17006|2022|PDM|40.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS|
20|FH_F129659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102361_44024_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150021_02725_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132737_0_0|SrvcGrp|47427|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F42494_0_0|SrvcGrp|1171|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F146212_57108_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 6 (NO REV)|
20|FH_F97182_21502_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F34263_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80855_0_0|SrvcGrp|65403|2022|PDM|1100.00|99|0.00|CPT 42830|
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_F150531_16148_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117891_19034_0|SrvcGrp|88621|2022|PDM|110.25|99|0.00|SKILLED NURSING LPN|
20|FH_F149781_37404_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133397_23233_0|SrvcGrp|66226|2022|PDM|146.00|99|0.00|SPEECH THERAPY|
20|FH_F33199_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F43018_0_0|SrvcGrp|36812|2022|PDM|4515.00|99|0.00|ACUTE IP MEDICAL SVCS - ONE DAY STAY|
20|FH_F127197_23111_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148644_06890_0|SrvcGrp|82114|2022|PDM|3823.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F40191_0_0|SrvcGrp|8950|2022|PDM|2386.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F123784_03264_0|SrvcGrp|48394|2022|PDM|58.14|99|0.00|SKILLED NURSING SERVICES|
20|FH_F132810_0_0|SrvcGrp|111528|2022|PDM|80.00|99|0.00|PICC LINE INSERTION (HCFA)|
20|FH_F93177_73044_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F134126_11554_0|CSTM-ALL|CSTM-00|2020|PDM|2726.00|99|0.00|AEG 5  (NO REV)|
20|FH_F137147_75006_0|SrvcGrp|98003|2022|PDM|10374.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F137231_25550_0|SrvcGrp|48398|2022|PDM|92.00|99|0.00|PT SERVICES|
20|FH_F138108_47130_0|SrvcGrp|89149|2022|PDM|221.00|99|0.00|OP INTENSIVE|
20|FH_F142413_61342_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F142547_70002_0|SrvcGrp|86843|2022|PDM|33.60|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|756.00|99|0.00|ASPG IV|
20|FH_F138545_39503_0|SrvcGrp|89149|2022|PDM|202.00|99|0.00|OP INTENSIVE|
20|FH_F138561_08034_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125408_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F140343_89052_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F140468_46825_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140844_48083_0|SrvcGrp|87401|2022|PDM|39.00|99|0.00|HCPCS G0156 (HCFA)|
20|FH_F140844_48083_0|SrvcGrp|87393|2022|PDM|129.00|99|0.00|HCPCS G0151 (HCFA)|
20|FH_F149441_28401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149647_92651_0|SrvcGrp|46903|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F109885_35473_0|SrvcGrp|73841|2022|PDM|542.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F109920_39180_0|SrvcGrp|75491|2022|PDM|1485.00|99|0.00|AEG 7|
20|FH_F91913_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117255_68520_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147725_06002_0|SrvcGrp|114443|2022|PDM|4651.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F147725_06002_0|SrvcGrp|90157|2022|PDM|2756.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F147725_06002_0|CSTM-ALL|CSTM-00|2020|PDM|2231.00|99|0.00|AEG 3 (NO REV)|
20|FH_F147879_93309_0|SrvcGrp|27968|2022|PDM|77.50|99|0.00|SKILLED NURSING LPN|
20|FH_F117240_37334_0|SrvcGrp|941|2022|PDM|2000.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F114145_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F137905_91364_0|SrvcGrp|75442|2022|PDM|750.00|99|0.00|OBSERVATION - REV 762|
20|FH_F37680_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110342_0_0|SrvcGrp|73004|2022|PDM|2200.00|99|0.00|AEG 8|
20|FH_F110342_0_0|SrvcGrp|102419|2022|PDM|2200.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F129941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|GENERAL ACUTE CARE|
20|FH_F121976_44505_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F35212_0_0|SrvcGrp|12856|2022|PDM|42.25|99|0.00|NURSING CARE|
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.00|99|0.00|ASPG III|
20|FH_F97721_01053_0|SrvcGrp|73602|2022|PDM|3772.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F111840_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F76583_0_0|SrvcGrp|73850|2022|PCT|1.00|99|0.00|SLEEP STUDY|
20|FH_F87054_0_0|SrvcGrp|73000|2022|PDM|1301.00|99|0.00|AEG 6|
20|FH_F87201_0_0|SrvcGrp|47183|2022|PDM|110.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F114916_30309_0|SrvcGrp|90063|2022|PDM|2500.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F142321_29401_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F105581_19053_0|SrvcGrp|23683|2022|PCT|0.00|99|0.00|SKILLED NURSING RN|
20|FH_F133376_33414_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37294_0_0|SrvcGrp|72|2022|PDM|562.00|99|0.00|NEWBORN NURSERY|
20|FH_F131173_17043_0|SrvcGrp|63297|2022|PDM|130.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F151785_03104_0|SrvcGrp|473|2022|PDM|391.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|1074.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F136247_28804_0|SrvcGrp|89149|2022|PDM|310.76|99|0.00|OP INTENSIVE|
20|FH_F132394_15317_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132418_84042_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F116684_30701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120971_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F36274_0_0|SrvcGrp|9828|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE|
20|FH_F142454_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|AEG 3 (NO REV)|
20|FH_F143467_0_0|SrvcGrp|41327|2022|PDM|1424.00|99|0.00|OP SURGERY CPT 28308|
20|FH_F71704_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F71070_0_0|SrvcGrp|68053|2022|PDM|1500.00|99|0.00|CPT 52234|
20|FH_F40272_0_0|SrvcGrp|13551|2022|PDM|400.00|99|0.00|NEWBORN NURSERY|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|HOME INF- REV 640 MOD SH|
20|FH_F141507_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2007 DME (TN) DBL MODIFIERS - RR/KF|
20|FH_F38034_0_0|SrvcGrp|11259|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F148700_0_0|SrvcGrp|109036|2022|PDM|1015.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F52854_0_0|SrvcGrp|17069|2022|PDM|1313.00|99|0.00|ASPG III|
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|ASPG I|
20|FH_F47733_0_0|SrvcGrp|43564|2022|PDM|55.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F115046_77964_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F123384_72076_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135897_0_0|SrvcGrp|85906|2022|PDM|792.00|99|0.00|CPT 66710|
20|FH_F141527_36830_0|SrvcGrp|86829|2022|PDM|21.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F137067_0_0|SrvcGrp|92412|2022|PDM|5250.00|99|0.00|SPINAL CRD DECOMP->2 CERVIC|
20|FH_F34112_0_0|SrvcGrp|97|2022|PDM|3400.00|99|0.00|C-SECTION|
20|FH_F128580_0_0|SrvcGrp|111139|2022|PDM|2248.00|99|0.00|ARTERY-VEIN GRAFT|
20|FH_F130204_40807_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135081_63080_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F34513_0_0|SrvcGrp|12211|2022|PDM|811.00|99|0.00|ACUTE PHYSICAL REHAB|
20|FH_F39273_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F34454_0_0|SrvcGrp|13703|2022|PDM|26.75|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F125810_67301_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143820_28405_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F147941_06023_0|SrvcGrp|27969|2022|PDM|75.00|99|0.00|HOME HEALTH AIDE|
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|558.00|99|0.00|AEG 1 (NO REV)|
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|506.59|99|0.00|ASPG X|
20|FH_F38366_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121523_33406_0|SrvcGrp|75442|2022|PDM|624.00|99|0.00|OBSERVATION - REV 762|
20|FH_F148255_72703_0|SrvcGrp|86849|2022|PDM|31.50|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F39819_0_0|SrvcGrp|31238|2022|PDM|5301.00|99|0.00|NY DRG 813 ONLY|
20|FH_F102020_0_0|SrvcGrp|26001|2022|PDM|214.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|38959.00|99|0.00|MSDRG 231-232 CORONARY BYPASS|
20|FH_F151146_0_0|CSTM-ALL|CSTM-00|2020|PDM|1647.00|99|0.00|AEG 4 (NO REV)|
20|FH_F129064_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|OCN F/S PRICING: ALL (HCFA) INPATIENT|
20|FH_F147919_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F36154_0_0|SrvcGrp|97|2022|PDM|4025.00|99|0.00|C-SECTION|
20|FH_F85291_0_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|957.00|99|0.00|AEG 8 (NO REV)|
20|FH_F88254_33411_0|SrvcGrp|14948|2022|PDM|112.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116269_92627_0|SrvcGrp|86747|2022|PCT|1.15|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F125011_74467_0|SrvcGrp|73002|2022|PDM|2730.00|99|0.00|AEG 7|
20|FH_F135151_61874_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F115019_78414_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F87538_0_0|SrvcGrp|42826|2022|PDM|108.00|99|0.00|PHYSICAL THERAPY VISIT|
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_F83635_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.60|99|0.00|OP SVCS|
20|FH_F136790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116061_80110_0|SrvcGrp|73842|2022|PDM|290.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F125512_85295_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F42706_0_0|SrvcGrp|36414|2022|PDM|400.00|99|0.00|OP DIALYSIS|
20|FH_F124050_75089_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F105221_01757_0|SrvcGrp|27969|2022|PDM|18.90|99|0.00|HOME HEALTH AIDE|
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41491_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PDM|966.14|99|0.00|ASPG VII|
20|FH_F130527_66044_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143900_63303_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F151146_0_0|SrvcGrp|16301|2022|PDM|2575.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F40834_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|944.00|99|0.00|AEG 6 (NO REV)|
20|FH_F118050_77565_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F93881_15009_0|SrvcGrp|76661|2022|PDM|74.00|99|0.00|CPT 73610|
20|FH_F126523_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F57372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|COVENTRY NISC 2018|
20|FH_F100682_97401_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F81494_0_0|SrvcGrp|3029|2022|PDM|861.00|99|0.00|NEWBORN NURSERY|
20|FH_F42779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F118027_28801_0|SrvcGrp|89417|2022|PDM|461.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F126626_80906_0|SrvcGrp|89149|2022|PDM|271.00|99|0.00|OP INTENSIVE|
20|FH_F145924_36695_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F115312_78550_0|SrvcGrp|12659|2022|PDM|845.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F103360_68845_0|SrvcGrp|81779|2022|PCT|7.50|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F146141_77598_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PDM|867.00|99|0.00|MSDRG 894-897 CHEMICAL DEPENDENCY|
20|FH_F72686_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F149840_80002_0|SrvcGrp|94780|2022|PDM|144.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F88512_0_0|SrvcGrp|29816|2022|PCT|0.53|99|0.00|IMPLANTS/PROSTHETICS/DRUGS|
20|FH_F103281_32086_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F148021_80907_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F141807_33020_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F78682_0_0|SrvcGrp|14614|2022|PDM|3500.00|99|0.00|LITHOTRIPSY|
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F97622_75051_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F140502_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS|
20|FH_F89932_10940_0|SrvcGrp|31707|2022|PDM|1430.00|99|0.00|MS DRG 793 ONLY|
20|FH_F91152_60061_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F122245_0_0|SrvcGrp|72994|2022|PDM|650.00|99|0.00|AEG 3|
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|777.00|99|0.00|AEG 4 (NO REV)|
20|FH_F43917_0_0|SrvcGrp|59696|2022|PDM|380.00|99|0.00|CODE 95811 WITH MOD 81|
20|FH_F141940_50023_0|CSTM-ALL|CSTM-00|2020|PDM|6533.10|99|0.00|AEG 9 (NO REV)|
20|FH_F111426_63640_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F103400_33426_0|SrvcGrp|89417|2022|PDM|409.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F150534_08879_0|SrvcGrp|104434|2022|PCT|1.00|99|0.00|TRANSPORTATION SERVICES|
20|FH_F57592_0_0|SrvcGrp|21104|2022|PDM|57500.00|99|0.00|MS DRG 220 ONLY|
20|FH_F133493_90255_0|CSTM-ALL|CSTM-00|2020|PDM|5555.00|99|0.00|AEG 8 (NO REV)|
20|FH_F117132_0_0|SrvcGrp|84932|2022|PDM|2070.00|99|0.00|VITRECTOMY|
20|FH_F146061_24502_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123373_0_0|SrvcGrp|16|2022|PDM|1711.00|99|0.00|ACUTE REHABILITATION|
20|FH_F117368_68114_0|SrvcGrp|471|2022|PDM|530.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117550_0_0|SrvcGrp|99459|2022|PDM|46.00|99|0.00|PHYSICAL THERAPY EVALUATION|
20|FH_F130553_18640_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F112632_66207_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97061_85012_0|SrvcGrp|73601|2022|PDM|8338.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F146211_68144_0|CSTM-ALL|CSTM-00|2020|PDM|6886.00|99|0.00|AEG 8 (NO REV)|
20|FH_F76284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F42779_0_0|SrvcGrp|537|2022|PDM|1865.00|99|0.00|OBSERVATION SERVICES|
20|FH_F69063_0_0|SrvcGrp|27968|2022|PDM|27.50|99|0.00|SKILLED NURSING LPN|
20|FH_F115315_43011_0|SrvcGrp|94742|2022|PCT|1.00|99|0.00|FLUVIRIN VACC IM (>=3 YRS)|
20|FH_F138977_64468_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138742_33125_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139700_42104_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150620_53402_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150768_03054_0|SrvcGrp|84185|2022|PDM|208.00|99|0.00|RESPITE CARE|
20|FH_F150839_03833_0|SrvcGrp|95661|2022|PDM|704.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F92299_62016_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F150442_28451_0|SrvcGrp|98326|2022|PDM|8500.00|99|0.00|PERQ LAMOT/LAM LUMBAR|
20|FH_F127487_60169_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F138478_0_0|SrvcGrp|113283|2022|PDM|1341.77|99|0.00|REPOS PREV IMPLTBL SUBQ DFB|
20|FH_F35755_34950_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PDM|665.00|99|0.00|ASPG 1 PIEDMONT OUTPATIENT SURGERY CENTER|
20|FH_F117762_0_0|SrvcGrp|99175|2022|PDM|3120.00|99|0.00|CPT 31200|
20|FH_F133087_61107_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F38860_0_0|SrvcGrp|16777|2022|PCT|1.00|99|0.00|ORGAN ACQUISITION|
20|FH_F137767_01841_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129030_21204_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126717_66103_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F73262_0_0|SrvcGrp|62998|2022|PDM|400.00|99|0.00|CAT SCAN|
20|FH_F37536_0_0|CSTM-ALL|CSTM-00|2020|PDM|707.00|99|0.00|STEREOTACTIC LOCALIZATION W/ BIOPSY|
20|FH_F90223_0_0|SrvcGrp|88816|2022|PDM|75.00|99|0.00|HOME VISIT (HCFA)|
20|FH_F119897_78229_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97223_94028_0|SrvcGrp|472|2022|PDM|560.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F37198_0_0|SrvcGrp|13402|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F119376_0_0|SrvcGrp|106799|2022|PDM|6000.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 6 (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_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F130939_40353_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F114173_18901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128190_45342_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F100790_10512_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F115121_32250_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F117783_0_0|SrvcGrp|78045|2022|PCT|1.00|99|0.00|AETNA AMNIOTIC MEMBRANE|
20|FH_F128878_11203_0|SrvcGrp|105375|2022|PDM|101.65|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MIN (HCFA)|
20|FH_F39391_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F101711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118249_0_0|SrvcGrp|108064|2022|PDM|4300.00|99|0.00|IMPLANT NEUROELECTRODES 29|
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|555.00|99|0.00|AEG 3 (NO REV)|
20|FH_F139719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125323_43213_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F100762_51104_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F151543_95630_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F126939_32405_0|SrvcGrp|90854|2022|PDM|800.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F123885_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F137067_0_0|SrvcGrp|88160|2022|PDM|5250.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F40046_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|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_F142073_0_0|SrvcGrp|95559|2022|PDM|11900.00|99|0.00|HIP JOINT|
20|FH_F139515_0_0|SrvcGrp|78283|2022|PDM|2395.00|99|0.00|CPT 49505|
20|FH_F38034_0_0|SrvcGrp|409|2022|PCT|0.85|99|0.00|ER SVCS|
20|FH_F93881_15009_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F82173_72712_0|SrvcGrp|116076|2022|PDM|13112.00|99|0.00|KNEE/HIP/SHOULDER SURGERY|
20|FH_F63307_0_0|SrvcGrp|474|2022|PDM|310.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F122725_32216_0|SrvcGrp|90486|2022|PDM|35.00|99|0.00|ORTHOTIC MANAGEMENT|
20|FH_F130841_49315_0|SrvcGrp|94781|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F98002_27103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F98002_27103_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F145562_70458_0|SrvcGrp|86847|2022|PDM|25.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F127545_45227_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F145983_45213_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F85212_71075_0|SrvcGrp|73606|2022|PDM|800.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F50657_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F93076_85016_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110589_70809_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F80172_0_0|SrvcGrp|13159|2022|PDM|59.78|99|0.00|HOME INFUSION THERAPY|
20|FH_F83978_66739_0|SrvcGrp|73002|2022|PDM|1680.00|99|0.00|AEG 7|
20|FH_F127090_45601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139767_15217_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F110604_0_0|SrvcGrp|87679|2022|PDM|1100.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F127725_63017_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|1196.00|99|0.00|AEG 3 (NO REV)|
20|FH_F146590_77449_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F50657_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F144228_0_0|SrvcGrp|114148|2022|PDM|1982.00|99|0.00|CONTROL THROAT BLEEDING|
20|FH_F97840_54729_0|SrvcGrp|88978|2022|PDM|7005.00|99|0.00|VAGINAL DELIVERY|
20|FH_F58713_0_0|SrvcGrp|15473|2022|PDM|1171.00|99|0.00|CPT CODE 42820|
20|FH_F120719_27540_0|SrvcGrp|19973|2022|PDM|579.00|99|0.00|CAT SCAN|
20|FH_F110420_60649_0|SrvcGrp|72996|2022|PDM|725.00|99|0.00|AEG 4|
20|FH_F85353_16407_0|SrvcGrp|63912|2022|PDM|120.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 316|
20|FH_F137530_0_0|SrvcGrp|107792|2022|PDM|14301.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F66991_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F119810_31525_0|SrvcGrp|101562|2022|PCT|1.00|99|0.00|HOSPICE/PHYSICIAN|
20|FH_F145641_06902_0|SrvcGrp|89404|2022|PDM|21013.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F80172_0_0|SrvcGrp|22593|2022|PCT|0.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F146005_67037_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F110921_53014_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F85353_16407_0|SrvcGrp|63779|2022|PDM|1373.22|99|0.00|HAPA WPA-NWPA 2012-13 ASC 703|
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1838.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F81563_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116806_0_0|SrvcGrp|107014|2022|PDM|1923.16|99|0.00|REDUCTION OF FOREHEAD|
20|FH_F121601_47446_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|161.56|99|0.00|HAPA WPA-NWPA 2012-13 ASC 139 W/O REV|
20|FH_F133749_84604_0|SrvcGrp|91623|2022|PDM|239.49|99|0.00|PHOTOTHERAPY|
20|FH_F127579_44321_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 619-621|
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|1292.20|99|0.00|ASPG VIII|
20|FH_F127957_89521_0|SrvcGrp|79280|2022|PDM|585.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F133724_84041_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110506_98901_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F136207_0_0|SrvcGrp|78579|2022|PDM|1668.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
20|FH_F83754_0_0|SrvcGrp|16|2022|PDM|2212.00|99|0.00|ACUTE REHABILITATION|
20|FH_F48092_0_0|SrvcGrp|23130|2022|PDM|22.00|99|0.00|1:1 SUPERVISION|
20|FH_F92652_76531_0|SrvcGrp|92760|2022|PCT|0.95|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F52713_0_0|SrvcGrp|36768|2022|PCT|0.60|99|0.00|OTHER DIAGNOSTIC TESTING|
20|FH_F126198_44236_0|SrvcGrp|3178|2022|PDM|870.00|99|0.00|ACUTE PSYCH|
20|FH_F100782_0_0|SrvcGrp|105131|2022|PDM|328.54|99|0.00|WINDBER MEDICAL CNTR ASC 236|
20|FH_F119937_0_0|SrvcGrp|80920|2022|PDM|500.00|99|0.00|HOSPICE SERVICES|
20|FH_F39898_0_0|SrvcGrp|26001|2022|PDM|171.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F111986_0_0|SrvcGrp|87421|2022|PDM|1133.00|99|0.00|CYSTOURETHROSCOPY|
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1213.00|99|0.00|AEG 6 (NO REV)|
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|1422.00|99|0.00|ASPG VI|
20|FH_F130329_64114_0|SrvcGrp|47183|2022|PDM|83.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F70331_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 6 (NO REV)|
20|FH_F133749_84604_0|SrvcGrp|112427|2022|PDM|25.00|99|0.00|PAIN MGMT HOME INFUSION THERAPY (HCFA)|
20|FH_F138047_77027_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F144808_0_0|SrvcGrp|89840|2022|PDM|7699.00|99|0.00|THORAX SPINE FUSION|
20|FH_F70863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F120727_54301_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145983_45213_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141347_52807_0|SrvcGrp|73841|2022|PDM|406.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138447_22041_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F70208_0_0|SrvcGrp|16|2022|PDM|825.00|99|0.00|ACUTE REHABILITATION|
20|FH_F80172_0_0|SrvcGrp|12073|2022|PDM|10.86|99|0.00|HOME INFUSION THERAPY|
20|FH_F134170_33410_0|SrvcGrp|89149|2022|PDM|189.00|99|0.00|OP INTENSIVE|
20|FH_F71647_0_0|SrvcGrp|592|2022|PDM|550.00|99|0.00|SUB-ACUTE CARE|
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.40|99|0.00|AEG 4 (NO REV)|
20|FH_F117531_0_0|SrvcGrp|68641|2022|PDM|700.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F43199_0_0|SrvcGrp|12263|2022|PDM|26.25|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F38966_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122526_22203_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F70607_0_0|SrvcGrp|9829|2022|PDM|115.99|99|0.00|PT SVCS|
20|FH_F74583_0_0|SrvcGrp|42975|2022|PDM|56.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F98780_35022_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101100_50314_0|SrvcGrp|93069|2022|PDM|19551.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F101100_50314_0|SrvcGrp|41334|2022|PDM|18695.00|99|0.00|TOTAL KNEE|
20|FH_F101100_50314_0|SrvcGrp|96559|2022|PDM|5515.00|99|0.00|TOTAL HYSTERCECTOMY|
20|FH_F80513_0_0|SrvcGrp|33087|2022|PCT|0.74|99|0.00|ROBOTIC ASSISTED SURGERY|
20|FH_F146654_80524_0|SrvcGrp|87131|2022|PDM|481.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F120528_60559_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F125698_44070_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116040_24637_0|SrvcGrp|86834|2022|PDM|10.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F132954_32066_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133688_44504_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130657_04614_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 2 (NO REV)|
20|FH_F131490_29909_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111561_10002_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F111566_75093_0|SrvcGrp|705|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F134828_30531_0|SrvcGrp|89205|2022|PDM|34.00|99|0.00|X-RAY EXAM OF ELBOW|
20|FH_F134828_30531_0|SrvcGrp|100288|2022|PDM|167.00|99|0.00|NEW PATIENT OFF/OP VISIT (HCFA)|
20|FH_F135891_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F33389_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122911_92240_0|SrvcGrp|89337|2022|PDM|1100.00|99|0.00|DETOXIFICATION|
20|FH_F141031_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114064_0_0|SrvcGrp|72992|2022|PDM|563.00|99|0.00|AEG 2|
20|FH_F89778_0_0|SrvcGrp|33967|2022|PDM|2135.54|99|0.00|CPT 47562|
20|FH_F88639_80204_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F128378_0_0|SrvcGrp|83857|2022|PDM|580.00|99|0.00|IP HOSPICE SVCS|
20|FH_F84894_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136314_19013_0|SrvcGrp|108484|2022|PDM|673.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F136367_72210_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136371_29720_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136383_98118_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136386_30901_0|SrvcGrp|73485|2022|PDM|1155.00|99|0.00|AETNA REHAB|
20|FH_F136426_19006_0|SrvcGrp|106300|2022|PDM|247.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F137232_28210_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION|
20|FH_F142527_89109_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F142741_03264_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F53732_0_0|SrvcGrp|17003|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS|
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|652.00|99|0.00|AEG 2 (NO REV)|
20|FH_F75549_96101_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F125053_0_0|SrvcGrp|78286|2022|PDM|8280.00|99|0.00|CPT 49322|
20|FH_F140338_40475_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140343_89052_0|SrvcGrp|86829|2022|PDM|30.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F140572_46526_0|CSTM-ALL|CSTM-00|2020|PCT|0.81|99|0.00|GENERAL ACUTE CARE|
20|FH_F140750_89119_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F140765_30315_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148699_19403_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149580_98198_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118959_44830_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F119003_78070_0|SrvcGrp|73063|2022|PDM|722.00|99|0.00|OBSERVATION SERVICES|
20|FH_F118932_07652_0|SrvcGrp|72998|2022|PDM|3819.00|99|0.00|AEG 5|
20|FH_F41481_0_0|SrvcGrp|17077|2022|PDM|1092.00|99|0.00|ASPG VII|
20|FH_F129448_43235_0|SrvcGrp|29347|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F117126_12801_0|CSTM-ALL|CSTM-00|2020|PDM|4060.00|99|0.00|AEG 4 (NO REV)|
20|FH_F117240_37334_0|SrvcGrp|36204|2022|PCT|0.00|99|0.00|ACUTE PSYCH|
20|FH_F137812_12118_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F109652_0_0|SrvcGrp|78788|2022|PDM|10656.00|99|0.00|PERMANENT PACEMAKER|
20|FH_F110720_0_0|SrvcGrp|97239|2022|PDM|4882.00|99|0.00|DISKECTOMY CERVICAL SINGLE|
20|FH_F121949_80246_0|SrvcGrp|86648|2022|PCT|1.05|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.47|99|0.00|DELAWARE VALLEY- ASC 701|
20|FH_F98041_10027_0|SrvcGrp|73461|2022|PDM|15357.00|99|0.00|AETNA NICU IV|
20|FH_F110000_0_0|SrvcGrp|33823|2022|PDM|820.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG I|
20|FH_F110381_0_0|SrvcGrp|103972|2022|PDM|5872.00|99|0.00|AETNA NECK & SPINE SURGERY INCLUDING|
20|FH_F91873_12723_0|SrvcGrp|75506|2022|PCT|2.92|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F106822_0_0|SrvcGrp|100277|2022|PDM|59.71|99|0.00|HEPB VACCINE ADULT|
20|FH_F117001_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|HEARING AID, CROS, IN THE EA|
20|FH_F87201_0_0|SrvcGrp|75241|2022|PDM|35.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F114916_30309_0|SrvcGrp|90420|2022|PDM|5000.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F114916_30309_0|SrvcGrp|85778|2022|PDM|3000.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F142448_15701_0|SrvcGrp|24745|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F115045_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115208_0_0|SrvcGrp|106175|2022|PDM|2546.00|99|0.00|EXCISE PAROTID GLAND/LESION|
20|FH_F105588_15228_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F113541_0_0|SrvcGrp|86462|2022|PDM|1956.00|99|0.00|AREOLA RECONSTRUCTION|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|665.00|99|0.00|AEG 1 (NO REV)|
20|FH_F136793_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.03|99|0.00|ASPG I|
20|FH_F138929_0_0|SrvcGrp|92009|2022|PDM|4620.00|99|0.00|CARPAL SCAPHOID FRACTURE|
20|FH_F132627_0_0|SrvcGrp|81858|2022|PDM|43.86|99|0.00|LPN SERVICES|
20|FH_F132988_0_0|SrvcGrp|27315|2022|PDM|4493.01|99|0.00|TENDON REPAIR|
20|FH_F118909_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141336_16947_0|CSTM-ALL|CSTM-00|2020|PDM|1207.00|99|0.00|AEG 1 (NO REV)|
20|FH_F119603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 6 (NO REV)|
20|FH_F42932_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122198_20708_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F146715_34240_0|SrvcGrp|30089|2022|PDM|415.00|99|0.00|HEMODIALYSIS SERVICES|
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_F91752_0_0|SrvcGrp|11442|2022|PDM|514.15|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F91898_0_0|SrvcGrp|14048|2022|PCT|0.95|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN|
20|FH_F91998_0_0|SrvcGrp|90435|2022|PDM|5300.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|3214.00|99|0.00|AEG 6 (NO REV)|
20|FH_F127995_84010_0|SrvcGrp|26869|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F128188_0_0|SrvcGrp|471|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F136657_70806_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F113791_32055_0|SrvcGrp|105398|2022|PCT|1.20|99|0.00|MAMMOGRAPHY|
20|FH_F138055_16146_0|SrvcGrp|89149|2022|PDM|191.00|99|0.00|OP INTENSIVE|
20|FH_F81832_13827_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F144039_0_0|SrvcGrp|84280|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F148424_01440_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F43693_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136796_24016_0|SrvcGrp|103541|2022|PDM|7788.12|99|0.00|REMOVE SPINE ELTRD PERQ ARAY|
20|FH_F136796_24016_0|SrvcGrp|67065|2022|PDM|5396.49|99|0.00|CERVICAL SURGERY|
20|FH_F113713_17013_0|CSTM-ALL|CSTM-00|2020|PDM|85.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION MOD HO (HCFA)|
20|FH_F38826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|DRG 124-125 CARDIAC CATH|
20|FH_F115152_77058_0|SrvcGrp|74668|2022|PDM|206.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F116383_63026_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F116345_78626_0|SrvcGrp|46903|2022|PDM|510.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F147331_90045_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F147443_06469_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147586_44124_0|SrvcGrp|82109|2022|PDM|991.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F41463_0_0|SrvcGrp|10580|2022|PDM|57.00|99|0.00|HYDRATION THERAPY - 3 LITERS|
20|FH_F41832_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CARILION ANTI-INFECTIVE IV THERAPY|
20|FH_F98621_41042_0|SrvcGrp|73605|2022|PDM|2714.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F98624_15701_0|SrvcGrp|88977|2022|PDM|6795.00|99|0.00|C-SECTION DELIVERY|
20|FH_F103004_75840_0|SrvcGrp|72996|2022|PDM|882.00|99|0.00|AEG 4|
20|FH_F36704_0_0|SrvcGrp|9503|2022|PDM|1350.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 4 (NO REV)|
20|FH_F66922_66211_0|SrvcGrp|88342|2022|PCT|0.55|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F130302_0_0|SrvcGrp|73004|2022|PDM|2251.00|99|0.00|AEG 8|
20|FH_F98161_0_0|SrvcGrp|72990|2022|PDM|383.00|99|0.00|AEG 1|
20|FH_F104802_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114853_0_0|SrvcGrp|11673|2022|PDM|4812.00|99|0.00|CPT 29888|
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|2409.00|99|0.00|AEG 7 (NO REV)|
20|FH_F54552_0_0|SrvcGrp|22594|2022|PDM|80.00|99|0.00|IMIGLUCERASE|
20|FH_F138876_25302_0|SrvcGrp|22592|2022|PDM|40.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F138973_45036_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134317_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135491_0_0|SrvcGrp|78046|2022|PCT|1.21|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F143898_0_0|SrvcGrp|92501|2022|PDM|160.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F132988_0_0|SrvcGrp|112160|2022|PDM|1766.05|99|0.00|DRAIN SHOULDER LESION|
20|FH_F137067_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F42161_0_0|SrvcGrp|12146|2022|PDM|1700.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F119214_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F114389_50131_0|SrvcGrp|10578|2022|PDM|102.96|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F149719_0_0|SrvcGrp|107750|2022|PDM|25.00|99|0.00|TRAINING INCL A TREATMENT|
20|FH_F124180_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F39351_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F81731_0_0|SrvcGrp|92605|2022|PDM|412.00|99|0.00|SUB-ACUTE CARE LEVEL II|
20|FH_F132348_16214_0|SrvcGrp|73700|2022|PDM|47.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F122174_16511_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124058_61081_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F124129_33603_0|SrvcGrp|69072|2022|PDM|149.00|99|0.00|CPT 99205|
20|FH_F44224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F48752_0_0|SrvcGrp|42870|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F39066_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION|
20|FH_F41035_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F129549_01238_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129549_01238_0|SrvcGrp|30609|2022|PDM|43.16|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F124227_01230_0|SrvcGrp|472|2022|PDM|515.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F124636_85008_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124663_65608_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136603_60654_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136622_60062_0|SrvcGrp|86722|2022|PDM|349.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F113913_70065_0|SrvcGrp|76501|2022|PDM|360.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F138779_62703_0|SrvcGrp|73841|2022|PDM|378.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138527_64506_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F114985_32073_0|SrvcGrp|102983|2022|PDM|33.00|99|0.00|MULTIPLE FAMILY GROUP PSYTX|
20|FH_F100664_03104_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F119725_0_0|SrvcGrp|106300|2022|PDM|347.56|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F148553_85016_0|SrvcGrp|115461|2022|PDM|1317.00|99|0.00|INSERT/REPLACE SUBQ DEFIB|
20|FH_F136778_62034_0|SrvcGrp|941|2022|PDM|3475.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F136189_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F112371_19047_0|SrvcGrp|82369|2022|PCT|1.00|99|0.00|AETNA LABORATORY|
20|FH_F64900_0_0|CSTM-ALL|CSTM-00|2020|PDM|80.00|99|0.00|OP SVCS|
20|FH_F77234_0_0|SrvcGrp|17071|2022|PDM|1822.00|99|0.00|ASPG IV|
20|FH_F115157_06851_0|SrvcGrp|89149|2022|PDM|189.75|99|0.00|OP INTENSIVE|
20|FH_F115631_65201_0|SrvcGrp|26277|2022|PDM|3177.00|99|0.00|CPT 29874|
20|FH_F115631_65201_0|SrvcGrp|74039|2022|PDM|3177.00|99|0.00|LAMINECTOMY|
20|FH_F115733_33012_0|SrvcGrp|89149|2022|PDM|179.00|99|0.00|OP INTENSIVE|
20|FH_F147331_90045_0|SrvcGrp|88621|2022|PDM|168.00|99|0.00|SKILLED NURSING LPN|
20|FH_F41809_0_0|SrvcGrp|97|2022|PDM|2400.00|99|0.00|C-SECTION|
20|FH_F42153_0_0|SrvcGrp|361|2022|PDM|2311.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F116835_94538_0|SrvcGrp|107157|2022|PDM|1597.00|99|0.00|AETNA IP DETOXIFICATION SERVICES (18-150 YRS)|
20|FH_F120050_92626_0|SrvcGrp|46903|2022|PDM|850.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F120050_92626_0|SrvcGrp|75442|2022|PDM|770.00|99|0.00|OBSERVATION - REV 762|
20|FH_F126970_45601_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F113649_01752_0|SrvcGrp|24745|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F118917_33317_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F36274_0_0|SrvcGrp|10410|2022|PDM|45.00|99|0.00|SKILLED NURSING CARE|
20|FH_F36372_0_0|SrvcGrp|10646|2022|PDM|110.00|99|0.00|MIDLINE INSERTION KIT|
20|FH_F100783_03431_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128031_0_0|SrvcGrp|110952|2022|PDM|9680.00|99|0.00|SPINAL FUSION|
20|FH_F40431_0_0|SrvcGrp|3140|2022|PCT|0.50|99|0.00|PHARMACY SERVICES|
20|FH_F131324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148490_80231_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F132250_12550_0|CSTM-ALL|CSTM-00|2020|PDM|109.14|99|0.00|FAMILY PSYTX W PT 50 MINS (HCFA)|
20|FH_F133478_40165_0|SrvcGrp|90502|2022|PDM|44474.00|99|0.00|MSDRG 268, 270 ONLY|
20|FH_F133133_32433_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132131_33060_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F131430_17566_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F133574_91607_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F111584_07002_0|SrvcGrp|90631|2022|PDM|276.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F111847_70301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134823_33135_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F35216_0_0|SrvcGrp|10651|2022|PCT|0.75|99|0.00|SPEECH THERAPY|
20|FH_F144988_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|2587.00|99|0.00|AEG 10 (NO REV)|
20|FH_F133536_0_0|SrvcGrp|90061|2022|PDM|20350.00|99|0.00|AETNA RECONSTRUCT SHOULDER JOINT|
20|FH_F120635_22903_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F41989_0_0|SrvcGrp|109|2022|PDM|630.00|99|0.00|CD - DETOX|
20|FH_F138687_77477_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F138907_01040_0|SrvcGrp|74802|2022|PDM|12.91|99|0.00|AETNA CPT 36415|
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 3 (NO REV)|
20|FH_F72606_0_0|SrvcGrp|46731|2022|PCT|0.85|99|0.00|NITRIC OXIDE THERAPY|
20|FH_F132251_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132258_45404_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122069_75935_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123184_20906_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F135432_16335_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F135607_21613_0|SrvcGrp|108484|2022|PDM|1550.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F135607_21613_0|SrvcGrp|74668|2022|PDM|900.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F91764_93710_0|SrvcGrp|20752|2022|PDM|15784.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F135929_02919_0|CSTM-ALL|CSTM-00|2020|PCT|1.02|99|0.00|OP SVCS|
20|FH_F119892_47586_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F133468_74873_0|SrvcGrp|108484|2022|PDM|1550.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 9 (NO REV)|
20|FH_F32228_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F38686_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F101644_75116_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F121707_85745_0|SrvcGrp|89337|2022|PDM|1250.00|99|0.00|DETOXIFICATION|
20|FH_F79570_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F46918_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|LPN HI TECH - HOURLY|
20|FH_F128370_76132_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F127926_62832_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F128201_33334_0|SrvcGrp|89417|2022|PDM|230.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F129967_18915_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134264_67226_0|SrvcGrp|73842|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F134322_98001_0|SrvcGrp|112552|2022|PCT|1.00|99|0.00|STREPTOMYCIN INJECTION|
20|FH_F145587_0_0|SrvcGrp|26274|2022|PDM|1262.70|99|0.00|CPT 29877|
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54272_0_0|SrvcGrp|18120|2022|PDM|148104.00|99|0.00|MS DRG 003|
20|FH_F101442_0_0|SrvcGrp|98463|2022|PDM|1347.69|99|0.00|CORRECTION OF BUNION|
20|FH_F43895_0_0|SrvcGrp|45882|2022|PDM|125.00|99|0.00|PT|
20|FH_F72666_0_0|SrvcGrp|69681|2022|PDM|1680.00|99|0.00|TERTIARY ORTHOPEDIC PROCEDURES MS DRG ONLY|
20|FH_F112138_80120_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87500_16823_0|SrvcGrp|85602|2022|PCT|1.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F125054_16365_0|SrvcGrp|27968|2022|PDM|53.06|99|0.00|SKILLED NURSING LPN|
20|FH_F102222_19720_0|SrvcGrp|86835|2022|PDM|10.50|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F130027_76201_0|SrvcGrp|89337|2022|PDM|834.00|99|0.00|DETOXIFICATION|
20|FH_F102960_50613_0|SrvcGrp|92958|2022|PCT|3.13|99|0.00|SLEEP STUDIES|
20|FH_F132090_60915_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132854_77379_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143542_0_0|SrvcGrp|84279|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F132544_0_0|SrvcGrp|16692|2022|PDM|3454.00|99|0.00|KNEE SCOPE|
20|FH_F148554_85016_0|SrvcGrp|115475|2022|PDM|4320.00|99|0.00|PERC D-E COR STENT ATHER S|
20|FH_F46173_0_0|SrvcGrp|29971|2022|PDM|675.00|99|0.00|DIALYSIS|
20|FH_F149860_80112_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120841_16201_0|SrvcGrp|73841|2022|PDM|180.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F69123_0_0|SrvcGrp|46642|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- ALL|
20|FH_F146224_84321_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117380_60020_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F117555_72802_0|SrvcGrp|89417|2022|PDM|401.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F75245_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F132400_79106_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F126934_72064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150539_48374_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F125266_44515_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F35408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133478_40165_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 10 (NO REV)|
20|FH_F100740_15206_0|SrvcGrp|73659|2022|PDM|5117.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F148599_98034_0|CSTM-ALL|CSTM-00|2020|PCT|2.36|99|0.00|HSS APC F PROCEDURE NOT ON FS OR W/O WEIGHT|
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_F81373_64064_0|SrvcGrp|86440|2022|PDM|2257.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F117450_63131_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F130573_02882_0|SrvcGrp|111551|2022|PDM|125.00|99|0.00|NUTRITIONAL COUNSELING DIET (HCFA)|
20|FH_F31944_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F132785_17961_0|SrvcGrp|110428|2022|PCT|4.95|99|0.00|LABORATORY SERVICES|
20|FH_F133287_40215_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130563_85122_0|SrvcGrp|113762|2022|PCT|1.00|99|0.00|AMFS CARVE-OUT BILLED W/ HCPC S9083|
20|FH_F124983_44514_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117993_32054_0|SrvcGrp|107767|2022|PCT|1.10|99|0.00|AETNA OP SERVICES AMFS(H) DEFAULT (POS 72)|
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 2|
20|FH_F143054_26147_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F88818_0_0|SrvcGrp|75487|2022|PDM|650.00|99|0.00|AEG 5|
20|FH_F120089_0_0|SrvcGrp|75491|2022|PDM|995.00|99|0.00|AEG 7|
20|FH_F105842_70433_0|SrvcGrp|79458|2022|PDM|0.10|99|0.00|MED RECORD COPY|
20|FH_F149781_37404_0|CSTM-ALL|CSTM-00|2020|PDM|2965.00|99|0.00|AEG 7 (NO REV)|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 581|
20|FH_F128438_87410_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143202_32114_0|SrvcGrp|89417|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F31093_0_0|SrvcGrp|26893|2022|PCT|0.55|99|0.00|PROSTHETICS/ORTHOTICS/IMPLANTS|
20|FH_F87615_80033_0|SrvcGrp|75240|2022|PDM|1065.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F117838_12901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F58574_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|384.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 107 W/O REV|
20|FH_F131699_08210_0|SrvcGrp|48394|2022|PDM|60.33|99|0.00|SKILLED NURSING SERVICES|
20|FH_F150908_38570_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F38848_0_0|SrvcGrp|97|2022|PDM|4500.00|99|0.00|C-SECTION|
20|FH_F117717_68410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150001_33064_0|SrvcGrp|86833|2022|PDM|11.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F133490_90650_0|SrvcGrp|73842|2022|PDM|292.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F44855_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|VIENNA MEDICAL DRUGS|
20|FH_F132543_79549_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F113306_33458_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119400_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145988_06105_0|CSTM-ALL|CSTM-00|2020|PDM|5634.00|99|0.00|AEG 3 (NO REV)|
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|AEG 8 (NO REV)|
20|FH_F33182_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97542_32960_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F92676_15063_0|SrvcGrp|67739|2022|PCT|1.00|99|0.00|HAPA WPA-APLIGRAPH DRUGS W/ SURGERY|
20|FH_F142084_82009_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (BREAKOUT)|
20|FH_F69104_0_0|SrvcGrp|17077|2022|PDM|1993.96|99|0.00|ASPG VII|
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41785_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|DUAL DIAGNOSIS|
20|FH_F67192_0_0|SrvcGrp|25535|2022|PDM|2914.00|99|0.00|ICU|
20|FH_F146211_68144_0|SrvcGrp|93730|2022|PDM|979.00|99|0.00|INJ PERIPHERAL NERVE|
20|FH_F143200_91602_0|SrvcGrp|75419|2022|PDM|2100.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F126808_15005_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125215_78130_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97182_21502_0|SrvcGrp|73603|2022|PDM|9281.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F92676_15063_0|SrvcGrp|14243|2022|PDM|898.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F45513_0_0|SrvcGrp|41333|2022|PDM|4200.00|99|0.00|LITHO MOD 51|
20|FH_F125541_07825_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F50974_0_0|SrvcGrp|42973|2022|PDM|70.00|99|0.00|SPEECH  THERAPIST|
20|FH_F33634_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|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_F128564_43235_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40906_0_0|SrvcGrp|13681|2022|PDM|278.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F69063_0_0|SrvcGrp|42973|2022|PDM|95.00|99|0.00|SPEECH  THERAPIST|
20|FH_F115383_80734_0|SrvcGrp|472|2022|PDM|433.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F95661_27217_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148021_80907_0|SrvcGrp|53144|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F97566_79902_0|SrvcGrp|73559|2022|PDM|11111.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F141747_20688_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F42332_0_0|SrvcGrp|33237|2022|PCT|0.70|99|0.00|AMBULATORY SURG W/LAPAROSCOPIC|
20|FH_F144011_60616_0|SrvcGrp|9815|2022|PDM|1045.00|99|0.00|ACUTE PSYCHIATRIC|
20|FH_F145881_46011_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F97560_23249_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F33241_0_0|SrvcGrp|88|2022|PDM|4500.00|99|0.00|OP LITHOTRIPSY|
20|FH_F43296_0_0|SrvcGrp|18932|2022|PDM|1370.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806|
20|FH_F31093_0_0|SrvcGrp|3138|2022|PDM|450.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F32869_0_0|SrvcGrp|9774|2022|PDM|1500.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F139553_30084_0|SrvcGrp|42784|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F150882_84041_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38986_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138478_0_0|SrvcGrp|109492|2022|PDM|6572.12|99|0.00|INSERT HEART PM ATRIAL|
20|FH_F90455_0_0|SrvcGrp|45924|2022|PDM|58.00|99|0.00|HOME HEALTH AIDE|
20|FH_F120848_20912_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F60296_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|MSDRG 789-793 NICU|
20|FH_F111857_68005_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F94643_90501_0|SrvcGrp|26869|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F110783_93013_0|SrvcGrp|86846|2022|PDM|35.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F141287_14830_0|SrvcGrp|111928|2022|PDM|56.44|99|0.00|COVID-19 BARTONELLA|
20|FH_F138016_19808_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F125081_15218_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F116437_0_0|SrvcGrp|87387|2022|PDM|1757.00|99|0.00|REMOVE EYE IMPLANT MATERIAL|
20|FH_F124514_21215_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F122264_75972_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F35452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1904.00|99|0.00|ASPG VII|
20|FH_F42165_0_0|SrvcGrp|12146|2022|PDM|1700.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|4125.00|99|0.00|ASPG X|
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|3060.00|99|0.00|AEG 9 (NO REV)|
20|FH_F149522_83221_0|SrvcGrp|104229|2022|PDM|130.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F41802_0_0|SrvcGrp|44124|2022|PDM|0.92|99|0.00|HIGH COST DRUGS J0696|
20|FH_F147231_49440_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132254_40207_0|SrvcGrp|86843|2022|PDM|50.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F86714_0_0|SrvcGrp|45541|2022|PDM|177.61|99|0.00|SPEECH THERAPY|
20|FH_F116437_0_0|SrvcGrp|106767|2022|PDM|1757.00|99|0.00|REPAIR RETINAL DETACHMENT|
20|FH_F111266_30339_0|SrvcGrp|22589|2022|PDM|25.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F138410_19130_0|SrvcGrp|113174|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - PFIZER|
20|FH_F137986_0_0|SrvcGrp|98003|2022|PDM|4203.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149030_37919_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F35736_34952_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|GENERAL ACUTE CARE|
20|FH_F129599_17078_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35432_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS|
20|FH_F113869_40215_0|SrvcGrp|89149|2022|PDM|169.00|99|0.00|OP INTENSIVE|
20|FH_F97101_98003_0|SrvcGrp|73643|2022|PDM|1061.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F146266_0_0|SrvcGrp|27261|2022|PDM|10705.00|99|0.00|CPT 27446|
20|FH_F93961_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|AEG 6 (NO REV)|
20|FH_F140608_0_0|SrvcGrp|48396|2022|PDM|134.00|99|0.00|OT SERVICES|
20|FH_F146568_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F128191_28642_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F113869_40215_0|SrvcGrp|89417|2022|PDM|355.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F41374_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F149536_76642_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114676_91911_0|SrvcGrp|89149|2022|PDM|270.00|99|0.00|OP INTENSIVE|
20|FH_F148926_28803_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F33632_52349_0|SrvcGrp|72602|2022|PDM|770.58|99|0.00|ECT|
20|FH_F48855_0_0|SrvcGrp|76207|2022|PDM|70.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN|
20|FH_F150925_33936_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131558_63028_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F108260_63141_0|SrvcGrp|46605|2022|PDM|83.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F35775_32055_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|GENERAL ACUTE CARE|
20|FH_F149662_85015_0|SrvcGrp|115735|2022|PDM|6200.00|99|0.00|SPINE DISKECTOMIES|
20|FH_F110821_31513_0|SrvcGrp|92760|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37364_0_0|SrvcGrp|131|2022|PCT|0.70|99|0.00|PACEMAKER DEVICE|
20|FH_F147228_49441_0|SrvcGrp|57967|2022|PDM|204.17|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F149049_28401_0|SrvcGrp|13557|2022|PCT|1.10|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F140295_0_0|SrvcGrp|35672|2022|PDM|6715.00|99|0.00|CPT 23412|
20|FH_F56652_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|632.82|99|0.00|AEG 4 (NO REV)|
20|FH_F124492_30040_0|SrvcGrp|113239|2022|PDM|82.50|99|0.00|COVID-19 AMP PRB HGH THRUPUT (HCFA)|
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 2 (NO REV)|
20|FH_F150459_08021_0|SrvcGrp|80920|2022|PDM|635.00|99|0.00|HOSPICE SERVICES|
20|FH_F35088_0_0|SrvcGrp|268|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER|
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|931.00|99|0.00|ASPG VI- GNADEN HUETTEN|
20|FH_F114951_20002_0|SrvcGrp|79458|2022|PDM|0.25|99|0.00|MED RECORD COPY|
20|FH_F129174_20910_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124759_34108_0|SrvcGrp|89149|2022|PDM|180.00|99|0.00|OP INTENSIVE|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|26.00|99|0.00|ENBREL THERAPY (MOD SD/SC/SH)|
20|FH_F131187_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PDM|2497.00|99|0.00|DEVICE INSERTION|
20|FH_F36743_0_0|SrvcGrp|6|2022|PCT|0.79|99|0.00|OP SURGERY|
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37493_0_0|SrvcGrp|72|2022|PDM|649.00|99|0.00|NEWBORN NURSERY|
20|FH_F132160_0_0|SrvcGrp|109348|2022|PDM|2869.00|99|0.00|EXCISION OF LESION OF EYELID|
20|FH_F137729_19703_0|SrvcGrp|73842|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F35987_0_0|SrvcGrp|941|2022|PDM|2749.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1561.00|99|0.00|AEG 1 (NO REV)|
20|FH_F35567_0_0|SrvcGrp|21014|2022|PDM|690.00|99|0.00|MRI SERVICES|
20|FH_F37960_0_0|SrvcGrp|359|2022|PDM|1010.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F139792_26034_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140147_34785_0|CSTM-ALL|CSTM-00|2020|PCT|1.34|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F140027_61031_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F140087_62864_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140233_35216_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 10 (NO REV)|
20|FH_F143536_47546_0|SrvcGrp|94299|2022|PCT|1.00|99|0.00|NEW PT OFFICE VISIT|
20|FH_F71747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F101709_0_0|SrvcGrp|73004|2022|PDM|2746.00|99|0.00|AEG 8|
20|FH_F103060_0_0|SrvcGrp|54943|2022|PDM|3121.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F103481_0_0|SrvcGrp|99239|2022|PCT|1.00|99|0.00|INJECTIONS|
20|FH_F102224_0_0|SrvcGrp|92409|2022|PDM|2400.00|99|0.00|PERQ CERVICOTHORACIC INJECT|
20|FH_F130918_01606_0|SrvcGrp|113928|2022|PDM|438.00|99|0.00|PARTIAL HOSPITAL (>=18 YRS)|
20|FH_F131067_57105_0|SrvcGrp|73498|2022|PDM|1649.00|99|0.00|AETNA ER LEVEL III|
20|FH_F48476_0_0|SrvcGrp|43955|2022|PDM|85.00|99|0.00|NURSING CARE|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD RR/KF)|
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|792.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F136299_75218_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132431_79606_0|SrvcGrp|46482|2022|PDM|125.00|99|0.00|S9083 PER VISIT|
20|FH_F116698_07470_0|SrvcGrp|15402|2022|PDM|55.12|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F116699_46347_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F116915_30308_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119929_70364_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F120971_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125350_81050_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F113649_01752_0|SrvcGrp|17014|2022|PDM|47.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F113649_01752_0|SrvcGrp|86836|2022|PDM|15.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F51276_0_0|SrvcGrp|16750|2022|PDM|135.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|387.00|99|0.00|AEG 1 (NO REV)|
20|FH_F105221_01757_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG X|
20|FH_F67504_0_0|SrvcGrp|43893|2022|PDM|93.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F36595_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F83672_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F118271_46052_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F89563_29407_0|SrvcGrp|90488|2022|PCT|1.00|99|0.00|ORAL FUNCTION THERAPY|
20|FH_F131267_48846_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F31959_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36681_0_0|SrvcGrp|15473|2022|PDM|968.00|99|0.00|CPT CODE 42820|
20|FH_F125973_63830_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148255_72703_0|SrvcGrp|65621|2022|PDM|31.50|99|0.00|RN NURSING|
20|FH_F34438_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F135219_68506_0|SrvcGrp|13807|2022|PCT|0.00|99|0.00|OBSERVATION SVCS|
20|FH_F72830_0_0|SrvcGrp|10675|2022|PDM|2500.00|99|0.00|ICU/CCU|
20|FH_F100660_56303_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|970.00|99|0.00|AEG 4 (NO REV)|
20|FH_F56972_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F122687_0_0|SrvcGrp|63471|2022|PDM|8742.00|99|0.00|CPT 64590|
20|FH_F118311_35211_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F102302_0_0|SrvcGrp|97099|2022|PDM|10850.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F139515_0_0|SrvcGrp|92415|2022|PDM|8549.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F37679_0_0|SrvcGrp|27081|2022|PDM|25.00|99|0.00|PICC LINE INSERTION (MID-LINE) (MOD SJ)|
20|FH_F115019_78414_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F69766_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAPA OHIO FS LAB & RAD|
20|FH_F120296_97223_0|SrvcGrp|84559|2022|PCT|0.70|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|1144.00|99|0.00|ASPG VIII|
20|FH_F101201_0_0|SrvcGrp|73849|2022|PDM|275.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F143973_28040_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40063_0_0|SrvcGrp|9838|2022|PDM|2460.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F93136_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F93881_15009_0|SrvcGrp|74666|2022|PDM|26.00|99|0.00|AETNA PHYSICIAN SERVICES|
20|FH_F43858_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F142073_0_0|SrvcGrp|89860|2022|PDM|5980.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F122240_0_0|SrvcGrp|108043|2022|PDM|164.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F149859_60005_0|SrvcGrp|46903|2022|PDM|496.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F40063_0_0|SrvcGrp|16318|2022|PCT|1.00|99|0.00|AIR AMBULANCE SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|349.38|99|0.00|HAPA WPA-NWPA 2012-13 ASC 218 W/O REV|
20|FH_F149888_68506_0|CSTM-ALL|CSTM-00|2020|PDM|736.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132190_0_0|SrvcGrp|44461|2022|PDM|2600.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F71625_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63556_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148356_18104_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F88254_33411_0|SrvcGrp|10577|2022|PDM|30.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F124017_0_0|SrvcGrp|85198|2022|PDM|8000.00|99|0.00|AETNA KNEE ARTHROSCOPY|
20|FH_F120279_98005_0|SrvcGrp|108484|2022|PDM|750.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)|
20|FH_F143793_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|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_F83253_33511_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35202_0_0|SrvcGrp|12401|2022|PDM|84.00|99|0.00|RN VISIT|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|OP SVCS|
20|FH_F37753_0_0|SrvcGrp|27265|2022|PDM|52.00|99|0.00|THERAPY VISITS|
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ASPG IV|
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126439_92627_0|SrvcGrp|73605|2022|PDM|1100.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F35388_0_0|SrvcGrp|919|2022|PDM|100.00|99|0.00|OP URGENT CARE|
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|1855.00|99|0.00|AEG 7 (NO REV)|
20|FH_F131995_04730_0|SrvcGrp|48398|2022|PDM|142.00|99|0.00|PT SERVICES|
20|FH_F126784_80809_0|SrvcGrp|108061|2022|PCT|0.70|99|0.00|OP THERAPY SERVICES|
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|890.00|99|0.00|AEG 2 (NO REV)|
20|FH_F131207_19947_0|SrvcGrp|104796|2022|PDM|132.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F128863_57701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141527_36830_0|SrvcGrp|86837|2022|PDM|11.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F135236_02840_0|SrvcGrp|115518|2022|PCT|1.01|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|479.00|99|0.00|AEG 3 (NO REV)|
20|FH_F129334_43016_0|SrvcGrp|48396|2022|PDM|123.00|99|0.00|OT SERVICES|
20|FH_F93332_0_0|SrvcGrp|93076|2022|PDM|2096.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT (HCFA)|
20|FH_F42736_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87254_0_0|SrvcGrp|104614|2022|PDM|800.00|99|0.00|BIOPSY OF RECTUM|
20|FH_F83255_32025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F140651_0_0|CSTM-ALL|CSTM-00|2020|PDM|2552.00|99|0.00|AEG 5  (NO REV)|
20|FH_F135211_63119_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F33728_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F137574_68130_0|SrvcGrp|13238|2022|PCT|1.00|99|0.00|VENIPUNCTURE|
20|FH_F116923_85259_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F110925_01104_0|SrvcGrp|65621|2022|PDM|53.00|99|0.00|RN NURSING|
20|FH_F129657_77479_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F38967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134999_89106_0|SrvcGrp|14892|2022|PDM|80.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F110161_31329_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F33513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|DME F/S (MOD UE) - MHAC|
20|FH_F63249_0_0|SrvcGrp|23683|2022|PDM|30.00|99|0.00|SKILLED NURSING RN|
20|FH_F130805_17404_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)|
20|FH_F149106_07042_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 10 (NO REV)|
20|FH_F126975_43551_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144228_0_0|SrvcGrp|64737|2022|PDM|894.00|99|0.00|CPT 43202|
20|FH_F133749_84604_0|SrvcGrp|46604|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133920_64057_0|SrvcGrp|48396|2022|PDM|123.00|99|0.00|OT SERVICES|
20|FH_F100680_43130_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113345_25301_0|SrvcGrp|102419|2022|PCT|0.70|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F146293_0_0|CSTM-ALL|CSTM-00|2020|PDM|2617.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110580_71106_0|CSTM-ALL|CSTM-00|2020|PDM|440.00|99|0.00|AEG 1 (NO REV)|
20|FH_F90332_07060_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F88744_71103_0|SrvcGrp|20914|2022|PDM|30680.00|99|0.00|MS DRG 233 ONLY|
20|FH_F145604_14850_0|SrvcGrp|29077|2022|PDM|25.00|99|0.00|HOME TRANSFUSION|
20|FH_F85353_16407_0|SrvcGrp|63888|2022|PDM|208.02|99|0.00|HAPA WPA-NWPA 2012-13 ASC 234|
20|FH_F132747_60174_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F88744_71103_0|CSTM-ALL|CSTM-00|2020|PDM|2081.00|99|0.00|AEG 10 (NO REV)|
20|FH_F119379_0_0|SrvcGrp|107848|2022|PDM|764.00|99|0.00|REVISE MEDIAN NERVE AT WRIST|
20|FH_F133972_27103_0|SrvcGrp|112486|2022|PDM|230.00|99|0.00|HYDRATION IV INFUSION, INIT (HCFA)|
20|FH_F79923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F146124_06112_0|SrvcGrp|114467|2022|PDM|782.00|99|0.00|ADD'L RX SERVICES|
20|FH_F149199_73005_0|SrvcGrp|3378|2022|PCT|0.88|99|0.00|OBSERVATION SVCS|
20|FH_F132716_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145604_14850_0|SrvcGrp|14947|2022|PDM|40.00|99|0.00|HOME INFUSION|
20|FH_F145597_78644_0|SrvcGrp|87317|2022|PDM|670.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F81698_10457_0|SrvcGrp|21920|2022|PDM|31.50|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F139678_25601_0|SrvcGrp|89149|2022|PDM|160.00|99|0.00|OP INTENSIVE|
20|FH_F133801_87107_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|271.73|99|0.00|HAPA WPA-NWPA 2012-13 ASC 227 W/O REV|
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_F134593_60007_0|SrvcGrp|112061|2022|PCT|0.85|99|0.00|ICATIBANT|
20|FH_F148799_50125_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F85442_27573_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS|
20|FH_F117206_0_0|SrvcGrp|90604|2022|PDM|1485.00|99|0.00|EXTRACTION OF LENS|
20|FH_F111064_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133207_0_0|SrvcGrp|26274|2022|PDM|3529.00|99|0.00|CPT 29877|
20|FH_F73228_0_0|SrvcGrp|17065|2022|PDM|2295.00|99|0.00|ASPG I|
20|FH_F93122_01854_0|SrvcGrp|46903|2022|PDM|446.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F127642_07047_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F110346_38501_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127091_62016_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F110465_30328_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F134328_13088_0|SrvcGrp|473|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F125870_0_0|SrvcGrp|72996|2022|PDM|1295.00|99|0.00|AEG 4|
20|FH_F149061_44122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144248_0_0|SrvcGrp|95819|2022|PDM|6885.00|99|0.00|GONIOTOMY|
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|3329.00|99|0.00|AEG 8 (NO REV)|
20|FH_F52713_0_0|CSTM-ALL|CSTM-00|2020|PDM|5000.00|99|0.00|OP SVCS|
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 9 (NO REV)|
20|FH_F111702_07652_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120299_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132883_31602_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142376_0_0|SrvcGrp|108265|2022|PDM|2310.00|99|0.00|AETNA INSJ BIOMECHANICAL DEVICE|
20|FH_F59872_0_0|SrvcGrp|10904|2022|PDM|515.00|99|0.00|EMERGENCY ROOM LEVEL II|
20|FH_F128833_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F113484_43015_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132822_95125_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F92598_21236_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS COMPREHENSIVE|
20|FH_F134593_60007_0|SrvcGrp|29023|2022|PDM|47.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|ASPG II|
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|2072.00|99|0.00|AEG 6 (NO REV)|
20|FH_F145604_14850_0|SrvcGrp|114246|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F80172_0_0|SrvcGrp|77223|2022|PDM|182.00|99|0.00|AETNA HOME INFUSION - S5520|
20|FH_F149301_44122_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|2423.00|99|0.00|AEG 6 (NO REV)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|55.65|99|0.00|HAPA WPA-NWPA 2012-13 ASC 10 W/O REV|
20|FH_F113435_19027_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F134247_66049_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133895_61530_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124146_46321_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F143576_43812_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F149321_44691_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F84712_0_0|SrvcGrp|12787|2022|PCT|0.63|99|0.00|IMPLANTS|
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)|
20|FH_F75963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F105145_75075_0|SrvcGrp|37984|2022|PDM|15300.00|99|0.00|LUMBAR INJECTIONS PROCEDURE|
20|FH_F105340_13502_0|SrvcGrp|100580|2022|PCT|1.00|99|0.00|AETNA MEDICAL AND SURGICAL SUPPLIES|
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F63625_0_0|SrvcGrp|14079|2022|PCT|0.68|99|0.00|RADIOACTIVE SEED|
20|FH_F80513_0_0|SrvcGrp|28121|2022|PDM|24603.00|99|0.00|MS DRG 469 ONLY|
20|FH_F146668_30189_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F146881_83661_0|SrvcGrp|88620|2022|PDM|150.00|99|0.00|SKILLED NURSING RN|
20|FH_F120795_27514_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS|
20|FH_F120805_92672_0|SrvcGrp|108484|2022|PDM|1250.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F116023_10027_0|SrvcGrp|86722|2022|PDM|100.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F131747_80108_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|IP/OP MBPR SERVICES|
20|FH_F133415_90066_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|TRC VACV 28 FS % MOD RR|
20|FH_F47999_0_0|SrvcGrp|12403|2022|PDM|33.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F86991_15122_0|SrvcGrp|85853|2022|PDM|515.00|99|0.00|AEG 2|
20|FH_F148345_0_0|SrvcGrp|99073|2022|PDM|1.48|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F89372_0_0|SrvcGrp|79678|2022|PCT|0.71|99|0.00|BURN SERVICES|
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|558.00|99|0.00|AEG 1 (NO REV)|
20|FH_F88545_78734_0|SrvcGrp|11283|2022|PDM|140.00|99|0.00|HYPERBARIC CHAMBER|
20|FH_F148346_0_0|SrvcGrp|108484|2022|PDM|1191.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F123856_54963_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123741_20850_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
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_F115166_0_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F136347_30328_0|SrvcGrp|112394|2022|PDM|505.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F118152_20151_0|SrvcGrp|86779|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F118170_18901_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F118186_97070_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F93178_73448_0|SrvcGrp|78504|2022|PCT|0.71|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F134160_19006_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134167_10032_0|SrvcGrp|27968|2022|PDM|40.57|99|0.00|SKILLED NURSING LPN|
20|FH_F137238_70056_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F53732_0_0|SrvcGrp|22954|2022|PDM|147.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F138627_82901_0|SrvcGrp|86830|2022|PDM|50.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F78267_18702_0|SrvcGrp|47183|2022|PDM|105.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F139267_30253_0|SrvcGrp|113551|2022|PDM|82.50|99|0.00|COVID-19 AMP PRB HGH THRUPUT|
20|FH_F138583_60644_0|SrvcGrp|89417|2022|PDM|364.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F140548_60527_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140730_84106_0|SrvcGrp|113662|2022|PDM|615.00|99|0.00|HOSPICE ROUT HOME CARE-DIEM|
20|FH_F79724_32501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120152_0_0|SrvcGrp|101800|2022|PDM|2420.00|99|0.00|SKELETAL FIXATION|
20|FH_F151562_26003_0|SrvcGrp|83857|2022|PDM|520.00|99|0.00|IP HOSPICE SVCS|
20|FH_F118926_30135_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F38332_0_0|SrvcGrp|18169|2022|PDM|12064.00|99|0.00|MS DRG 255|
20|FH_F147725_06002_0|SrvcGrp|89988|2022|PDM|3948.00|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F147941_06023_0|SrvcGrp|82243|2022|PDM|1092.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F94061_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117107_33704_0|SrvcGrp|104467|2022|PDM|750.00|99|0.00|ANTEPARTUM CARE ONLY (4-6 VISITS)|
20|FH_F117217_80304_0|SrvcGrp|89024|2022|PDM|94.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F117126_12801_0|CSTM-ALL|CSTM-00|2020|PDM|2625.00|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F137276_83127_0|SrvcGrp|23683|2022|PDM|42.25|99|0.00|SKILLED NURSING RN|
20|FH_F137333_51012_0|SrvcGrp|73842|2022|PDM|204.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137930_51546_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F110720_0_0|SrvcGrp|96354|2022|PDM|2653.00|99|0.00|REMOVAL OF ANKLE JOINT|
20|FH_F90880_15108_0|SrvcGrp|90482|2022|PCT|1.00|99|0.00|FLUVIRIN VACC 3 YRS & > IM|
20|FH_F124890_76119_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138732_60016_0|SrvcGrp|75754|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F109513_0_0|SrvcGrp|85022|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_F151099_86429_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F151144_35801_0|SrvcGrp|109762|2022|PDM|915.43|99|0.00|REMOVE EYELID LESION(S)|
20|FH_F151154_91761_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F121329_33015_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F121897_28144_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129468_15010_0|SrvcGrp|86722|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F82933_0_0|SrvcGrp|68061|2022|PDM|994.32|99|0.00|NICU|
20|FH_F82933_0_0|CSTM-ALL|CSTM-00|2020|PDM|8786.43|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F97721_01053_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F111207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F72690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|PROFESSIONAL FEES ON CMS1500|
20|FH_F77067_0_0|SrvcGrp|361|2022|PDM|2446.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
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|OP SVCS|
20|FH_F111862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F114063_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F113130_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F105581_19053_0|SrvcGrp|29346|2022|PCT|0.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F130400_26505_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS|
20|FH_F119581_0_0|SrvcGrp|107792|2022|PDM|4774.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F102041_35010_0|SrvcGrp|88621|2022|PDM|125.00|99|0.00|SKILLED NURSING LPN|
20|FH_F110212_17013_0|SrvcGrp|73842|2022|PDM|196.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|517.00|99|0.00|AEG 2 (NO REV)|
20|FH_F138929_0_0|SrvcGrp|104112|2022|PDM|4400.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F132627_0_0|SrvcGrp|17016|2022|PDM|80.58|99|0.00|HOME INFUSION THERAPY|
20|FH_F132739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS|
20|FH_F114389_50131_0|SrvcGrp|92904|2022|PDM|859.61|99|0.00|RAD W/BACKUP NON INV INTRFC (MOD RR)|
20|FH_F124059_64055_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F62624_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F34652_0_0|SrvcGrp|38|2022|PDM|4737.00|99|0.00|NORMAL DELIVERY|
20|FH_F92493_0_0|SrvcGrp|92360|2022|PDM|12999.53|99|0.00|REMOVAL OF HIP PROSTHESIS|
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132867_83318_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129973_48030_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F124653_64062_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F132973_28054_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PDM|1431.00|99|0.00|AEG 7 (NO REV)|
20|FH_F136570_32084_0|SrvcGrp|73605|2022|PDM|725.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F136658_50401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114666_30342_0|SrvcGrp|90063|2022|PDM|2500.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F138310_60461_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F138855_84067_0|SrvcGrp|74668|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F122588_53073_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112187_98272_0|SrvcGrp|109057|2022|PCT|0.81|99|0.00|CARDIAC STUDIES|
20|FH_F37847_0_0|SrvcGrp|9828|2022|PDM|44.00|99|0.00|HOME HEALTH AIDE|
20|FH_F49016_0_0|SrvcGrp|42825|2022|PDM|28.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PDM|1740.00|99|0.00|ASPG VIII|
20|FH_F115206_80923_0|SrvcGrp|16069|2022|PDM|859.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F115728_78404_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F147305_90755_0|SrvcGrp|88620|2022|PDM|137.00|99|0.00|SKILLED NURSING RN|
20|FH_F147500_32720_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41695_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F102984_80026_0|SrvcGrp|16|2022|PDM|1172.00|99|0.00|ACUTE REHABILITATION|
20|FH_F103004_75840_0|SrvcGrp|100559|2022|PDM|579.00|99|0.00|AETNA OP CT SCAN W/ OBS|
20|FH_F103004_75840_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F109279_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F133579_0_0|SrvcGrp|46906|2022|PDM|2551.00|99|0.00|CORNEAL TISSUE|
20|FH_F82357_0_0|SrvcGrp|10648|2022|PDM|6.00|99|0.00|HOME INFUSION|
20|FH_F48836_0_0|SrvcGrp|31190|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC (DME)|
20|FH_F57953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F77933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1024.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 708 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|89.55|99|0.00|HAPA WPA-NWPA 2012-13 ASC 144 W/O REV|
20|FH_F102063_0_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F151340_30040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151501_30265_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F132268_07060_0|SrvcGrp|104303|2022|PCT|0.95|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F145251_45107_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135495_33145_0|SrvcGrp|73841|2022|PDM|401.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F97141_93933_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F135799_99114_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135929_02919_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136070_46410_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131407_07607_0|SrvcGrp|24745|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F92188_0_0|CSTM-ALL|CSTM-00|2020|PDM|726.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|429.69|99|0.00|HAPA WPA-NWPA 2012-13 ASC 103 W/O REV|
20|FH_F151501_30265_0|SrvcGrp|100044|2022|PDM|6496.00|99|0.00|INCISION OF HEEL BONE|
20|FH_F132258_45404_0|SrvcGrp|21920|2022|PDM|34.98|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F132268_07060_0|SrvcGrp|104964|2022|PCT|0.95|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F104420_52208_0|SrvcGrp|92760|2022|PCT|3.18|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132054_30339_0|SrvcGrp|80918|2022|PDM|132.00|99|0.00|RESPITE CARE|
20|FH_F135350_60014_0|SrvcGrp|88620|2022|PDM|115.00|99|0.00|SKILLED NURSING RN|
20|FH_F135583_17331_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F136110_83330_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136226_28638_0|SrvcGrp|3809|2022|PDM|699.00|99|0.00|HOSPICE CARE|
20|FH_F131132_44077_0|SrvcGrp|111768|2022|PCT|0.59|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F133468_74873_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F101644_75116_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F101644_75116_0|SrvcGrp|48396|2022|PDM|107.50|99|0.00|OT SERVICES|
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|3100.00|99|0.00|REPAIR UMBIL HERNIA|
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|1119.00|99|0.00|AEG 10 (NO REV)|
20|FH_F121425_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F148243_0_0|SrvcGrp|71221|2022|PDM|879.00|99|0.00|EGD W/BALLOON DIALATION CPT 43249|
20|FH_F101442_0_0|SrvcGrp|98457|2022|PDM|1503.05|99|0.00|TREAT FOOT BONE LESION|
20|FH_F116430_0_0|SrvcGrp|106707|2022|PDM|1655.00|99|0.00|OTHER UROLOGY SURGERY|
20|FH_F132328_0_0|SrvcGrp|93059|2022|PDM|5202.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.92|99|0.00|AEG 9 (NO REV)|
20|FH_F112187_98272_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F87532_32110_0|SrvcGrp|76501|2022|PDM|278.25|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F102325_62691_0|SrvcGrp|29023|2022|PDM|64.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F102905_85541_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F102960_50613_0|CSTM-ALL|CSTM-00|2020|PDM|3751.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132877_06105_0|SrvcGrp|75545|2022|PDM|437.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|1088.00|99|0.00|AEG 6 (NO REV)|
20|FH_F148101_33462_0|SrvcGrp|89023|2022|PDM|80.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F63275_0_0|SrvcGrp|26001|2022|PDM|138.62|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F100982_75601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128278_21401_0|SrvcGrp|73842|2022|PDM|246.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F98002_27103_0|SrvcGrp|73602|2022|PDM|1986.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F98002_27103_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F48353_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F148429_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118123_67226_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F145641_06902_0|CSTM-ALL|CSTM-00|2020|PDM|642.00|99|0.00|AEG 10 (NO REV)|
20|FH_F118123_67226_0|SrvcGrp|53987|2022|PDM|50.00|99|0.00|PHOTOTHERAPY|
20|FH_F118146_33062_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F147962_85008_0|SrvcGrp|75506|2022|PCT|1.25|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F127157_43614_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F149151_75248_0|SrvcGrp|75419|2022|PDM|575.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F146124_06112_0|SrvcGrp|114464|2022|PCT|2.65|99|0.00|PT DRUGS|
20|FH_F145739_0_0|SrvcGrp|111630|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F124162_73127_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F79824_0_0|SrvcGrp|29110|2022|PCT|0.48|99|0.00|DIALYSIS|
20|FH_F134593_60007_0|SrvcGrp|86852|2022|PDM|48.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F93173_73401_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148521_0_0|CSTM-ALL|CSTM-00|2020|PDM|326.55|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1|
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2175.00|99|0.00|AEG 4 (NO REV)|
20|FH_F126003_79403_0|SrvcGrp|87317|2022|PDM|975.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 6 (NO REV)|
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1498.00|99|0.00|AEG 3 (NO REV)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|343.87|99|0.00|HAPA WPA-NWPA 2012-13 ASC 231 W/O REV|
20|FH_F133867_84075_0|SrvcGrp|46604|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F125135_60008_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33163_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F79824_0_0|SrvcGrp|17075|2022|PDM|2825.00|99|0.00|ASPG VI|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC|
20|FH_F80594_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F110604_0_0|SrvcGrp|113145|2022|PDM|1485.00|99|0.00|WRIST ARHROSCOPY|
20|FH_F83978_66739_0|SrvcGrp|537|2022|PDM|1036.00|99|0.00|OBSERVATION SERVICES|
20|FH_F114527_39047_0|SrvcGrp|67684|2022|PDM|196.00|99|0.00|PSYCH VISIT|
20|FH_F33269_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134608_18017_0|SrvcGrp|108125|2022|PCT|1.00|99|0.00|INDUCED ABORTION BY DILATION/CURETTAGE|
20|FH_F82591_0_0|SrvcGrp|79562|2022|PCT|0.35|99|0.00|AETNA AMBULATORY SURGERY|
20|FH_F120670_0_0|SrvcGrp|67065|2022|PDM|19000.00|99|0.00|CERVICAL SURGERY|
20|FH_F113345_25301_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F122942_89512_0|SrvcGrp|107483|2022|PCT|1.35|99|0.00|OP THERAPY SERVICE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.17|99|0.00|HAPA WPA-NWPA 2012-13 ASC 8 W/O REV|
20|FH_F149439_0_0|SrvcGrp|13722|2022|PDM|190.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE|
20|FH_F146207_73139_0|SrvcGrp|80920|2022|PDM|567.00|99|0.00|HOSPICE SERVICES|
20|FH_F63398_0_0|SrvcGrp|3259|2022|PDM|575.00|99|0.00|ACUTE REHABILITATION|
20|FH_F71064_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37385_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS|
20|FH_F36554_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ASPG X|
20|FH_F128091_37129_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F110785_10040_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F143668_0_0|SrvcGrp|114072|2022|PDM|2250.00|99|0.00|PNEUMATIC COMPRESSION DEVICE (MOD NU)|
20|FH_F90232_15126_0|SrvcGrp|73742|2022|PDM|6.30|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F36903_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KEITH RATHBOON PT HCPC MOD KM|
20|FH_F147222_49544_0|SrvcGrp|42623|2022|PDM|539.00|99|0.00|SUBACUTE - LEVEL III|
20|FH_F111266_30339_0|SrvcGrp|86841|2022|PDM|80.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F56712_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98900_42001_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F123745_0_0|SrvcGrp|33986|2022|PDM|2500.00|99|0.00|CPT 26055|
20|FH_F108460_32746_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37361_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147303_70508_0|SrvcGrp|48385|2022|PDM|89.00|99|0.00|SPEECH THERAPY|
20|FH_F94643_90501_0|SrvcGrp|43568|2022|PDM|90.00|99|0.00|SKILLED NURSING - RN|
20|FH_F138007_24314_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F122377_91007_0|SrvcGrp|103618|2022|PDM|10584.00|99|0.00|C-SECTION DELIVERY (MOM)|
20|FH_F112956_0_0|SrvcGrp|105030|2022|PDM|735.00|99|0.00|AETNA SURGICAL CARVEOUT|
20|FH_F150982_0_0|SrvcGrp|42550|2022|PDM|1382.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F50078_0_0|SrvcGrp|47764|2022|PDM|70.00|99|0.00|HOSPICE CARE/ IN HOME S9126 VISIT LEVEL|
20|FH_F39443_0_0|SrvcGrp|30295|2022|PDM|323.00|99|0.00|HAPA WPA ASC 107|
20|FH_F146266_0_0|SrvcGrp|58638|2022|PDM|1095.00|99|0.00|CPT 63688|
20|FH_F42426_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F150922_02452_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F127291_86426_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F137902_0_0|SrvcGrp|73842|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F41802_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|ALTERNACARE INF THERAPY-  MOD SJ|
20|FH_F113826_51445_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F147299_02072_0|SrvcGrp|23683|2022|PDM|55.50|99|0.00|SKILLED NURSING RN|
20|FH_F47573_0_0|SrvcGrp|42824|2022|PDM|140.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F110121_0_0|SrvcGrp|72992|2022|PDM|1155.00|99|0.00|AEG 2|
20|FH_F129773_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F36826_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPEN MRI OF LEE CT SCANS (RENTAL)|
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)|
20|FH_F49300_0_0|SrvcGrp|43956|2022|PDM|52.00|99|0.00|NURSING CARE|
20|FH_F35452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|OP SVCS|
20|FH_F50461_0_0|SrvcGrp|20147|2022|PDM|201471.00|99|0.00|LIVER TRANSPLANT|
20|FH_F134603_0_0|SrvcGrp|79561|2022|PDM|4700.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F113524_0_0|SrvcGrp|105220|2022|PDM|7000.00|99|0.00|SPINAL DECOMPRESSION|
20|FH_F148839_0_0|SrvcGrp|114443|2022|PDM|3246.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F123745_0_0|CSTM-ALL|CSTM-00|2020|PDM|5100.00|99|0.00|AEG 6 (NO REV)|
20|FH_F45798_0_0|SrvcGrp|2981|2022|PDM|15600.00|99|0.00|DRG 520 CERVICAL SPINAL FUSION W/O CC|
20|FH_F143348_16214_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F143488_84770_0|SrvcGrp|85966|2022|PDM|1563.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F131067_57105_0|CSTM-ALL|CSTM-00|2020|PDM|5685.00|99|0.00|AEG 6 (NO REV)|
20|FH_F47952_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE|
20|FH_F136299_75218_0|SrvcGrp|109707|2022|PDM|7287.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F132353_66423_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132427_33853_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F31600_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126054_30022_0|SrvcGrp|93338|2022|PDM|25.00|99|0.00|AETNA MED NUTRITION SEBSEQUENT|
20|FH_F113649_01752_0|SrvcGrp|86850|2022|PDM|50.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F118815_61021_0|SrvcGrp|86753|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F39266_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F56833_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F42715_0_0|SrvcGrp|473|2022|PDM|374.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F150102_0_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F38242_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|IMPLANTS|
20|FH_F138296_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F59732_0_0|SrvcGrp|17015|2022|PDM|19.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F61292_0_0|SrvcGrp|12154|2022|PDM|6724.00|99|0.00|LITHOTRIPSY|
20|FH_F78603_0_0|SrvcGrp|29127|2022|PDM|22015.17|99|0.00|MSDRG 265 ONLY|
20|FH_F145545_01602_0|SrvcGrp|91070|2022|PDM|284.00|99|0.00|AETNA MH CRISIS INTERVENTION (HCFA)|
20|FH_F129683_45255_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F139551_0_0|SrvcGrp|82112|2022|PDM|2537.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F135173_06519_0|SrvcGrp|90573|2022|PDM|223.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F143903_06249_0|SrvcGrp|89412|2022|PDM|300.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F38389_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F120001_0_0|SrvcGrp|73485|2022|PDM|873.00|99|0.00|AETNA REHAB|
20|FH_F66501_0_0|CSTM-ALL|CSTM-00|2020|PDM|47.00|99|0.00|HOME INFUSION NURSING SERVICES MOD SD|
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_F115047_78526_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F72183_0_0|SrvcGrp|30156|2022|PCT|1.80|99|0.00|OTHER DIAGNOSTIC TESTING MOD 26|
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F33712_0_0|SrvcGrp|10946|2022|PCT|0.75|99|0.00|EMERGENCY ROOM|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|73.56|99|0.00|AETNA SLEEP STUDY CPT 95801|
20|FH_F116404_20191_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F116431_76104_0|SrvcGrp|86582|2022|PCT|0.80|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PDM|480.00|99|0.00|AEG 1 (NO REV)|
20|FH_F140629_0_0|SrvcGrp|82112|2022|PDM|2497.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F121425_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F43274_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33785_0_0|SrvcGrp|3448|2022|PDM|850.00|99|0.00|MRI|
20|FH_F42347_0_0|SrvcGrp|31187|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF (DME)|
20|FH_F128353_22191_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F111341_80501_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F111363_33169_0|SrvcGrp|82761|2022|PDM|39.00|99|0.00|AUTOMATED WITHOUT MICRO|
20|FH_F87153_0_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F116275_0_0|SrvcGrp|103551|2022|PDM|180.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F148243_0_0|SrvcGrp|79594|2022|PDM|770.00|99|0.00|CPT 45380|
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_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|614.72|99|0.00|AEG 3 (NO REV)|
20|FH_F112129_62220_0|SrvcGrp|89417|2022|PDM|317.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F96340_23704_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F130027_76201_0|SrvcGrp|86722|2022|PDM|177.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F96960_35404_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F101320_26062_0|SrvcGrp|14947|2022|PDM|30.00|99|0.00|HOME INFUSION|
20|FH_F132834_63640_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119491_19904_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F148552_68114_0|CSTM-ALL|CSTM-00|2020|PDM|2950.57|99|0.00|AEG 9 (NO REV)|
20|FH_F117855_62246_0|SrvcGrp|48394|2022|PDM|26.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F146159_89102_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F128699_0_0|SrvcGrp|82222|2022|PDM|90.00|99|0.00|HOSPICE CARE|
20|FH_F87592_85614_0|SrvcGrp|85537|2022|PCT|1.00|99|0.00|ALL DRUGS|
20|FH_F125672_92663_0|SrvcGrp|74668|2022|PDM|1500.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F89932_10940_0|SrvcGrp|78450|2022|PDM|2365.00|99|0.00|AETNA ARTHROSCOPY|
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_F44607_0_0|SrvcGrp|14187|2022|PDM|750.00|99|0.00|MRI|
20|FH_F39859_0_0|SrvcGrp|37255|2022|PCT|0.50|99|0.00|HIGH COST DRUGS|
20|FH_F132886_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148579_17057_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F124957_60473_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146320_27610_0|CSTM-ALL|CSTM-00|2020|PDM|1118.30|99|0.00|AEG 5  (NO REV)|
20|FH_F117555_72802_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F150024_08079_0|CSTM-ALL|CSTM-00|2020|PDM|2213.00|99|0.00|AEG 3 (NO REV)|
20|FH_F63250_0_0|SrvcGrp|57650|2022|PDM|77.00|99|0.00|OCCUPATIONAL THERAPY SVCS MOD GO|
20|FH_F34984_0_0|CSTM-ALL|CSTM-00|2020|PDM|55.00|99|0.00|5781263-GA-PT/OT/ST-CPT|
20|FH_F65899_0_0|SrvcGrp|20814|2022|PCT|0.65|99|0.00|MS DRG 001-002 ONLY - HEART TRANSPLANT|
20|FH_F112905_62088_0|CSTM-ALL|CSTM-00|2020|PDM|3132.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129175_0_0|SrvcGrp|27330|2022|PDM|290.47|99|0.00|CPT 27096|
20|FH_F127994_19301_0|SrvcGrp|89417|2022|PDM|324.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F118391_77040_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134497_47126_0|SrvcGrp|89149|2022|PDM|170.00|99|0.00|OP INTENSIVE|
20|FH_F65899_0_0|SrvcGrp|31592|2022|PCT|0.65|99|0.00|MS DRG 004 ONLY|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD RR/KE)|
20|FH_F102681_34237_0|SrvcGrp|72994|2022|PDM|453.00|99|0.00|AEG 3|
20|FH_F117745_15801_0|SrvcGrp|471|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F58574_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP|
20|FH_F132279_63775_0|SrvcGrp|105604|2022|PCT|0.50|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F128605_20910_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F100880_67735_0|SrvcGrp|72992|2022|PDM|1344.00|99|0.00|AEG 2|
20|FH_F112936_32081_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141927_71901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112836_06040_0|SrvcGrp|473|2022|PDM|502.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F103360_68845_0|SrvcGrp|73496|2022|PDM|4140.00|99|0.00|AETNA ER LEVEL V|
20|FH_F146211_68144_0|SrvcGrp|90421|2022|PDM|6230.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F133490_90650_0|SrvcGrp|110428|2022|PCT|1.40|99|0.00|LABORATORY SERVICES|
20|FH_F133397_23233_0|SrvcGrp|12962|2022|PDM|166.00|99|0.00|DME|
20|FH_F41739_0_0|SrvcGrp|9571|2022|PDM|39590.00|99|0.00|DRG 550 ONLY|
20|FH_F146375_06751_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132999_19901_0|SrvcGrp|48396|2022|PDM|89.00|99|0.00|OT SERVICES|
20|FH_F44314_0_0|SrvcGrp|33166|2022|PDM|450.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F71162_0_0|SrvcGrp|42828|2022|PDM|57.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F92677_08003_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 238|
20|FH_F37567_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F40350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F37468_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87592_85614_0|SrvcGrp|76619|2022|PCT|1.00|99|0.00|THERAPY|
20|FH_F134490_62801_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F101840_76054_0|SrvcGrp|997|2022|PCT|0.32|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F90811_0_0|SrvcGrp|90430|2022|PDM|2500.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F97181_33143_0|SrvcGrp|43523|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F88512_0_0|SrvcGrp|13123|2022|PDM|1147.34|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F133546_61611_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141833_31707_0|SrvcGrp|107353|2022|PDM|1000.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)|
20|FH_F142814_16511_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143007_60640_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141612_19605_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F77787_0_0|SrvcGrp|26179|2022|PDM|114.00|99|0.00|OT|
20|FH_F117793_90405_0|SrvcGrp|89337|2022|PDM|1150.00|99|0.00|DETOXIFICATION|
20|FH_F92677_08003_0|SrvcGrp|92100|2022|PDM|147.00|99|0.00|AETNA NEUBULIZER WITH COMPRESSOR|
20|FH_F41785_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F111802_22003_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F132331_89107_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F68124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F51129_0_0|CSTM-ALL|CSTM-00|2020|PDM|6000.00|99|0.00|ONCOLOGY|
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|AEG 1 (NO REV)|
20|FH_F59274_0_0|SrvcGrp|48399|2022|PDM|34.00|99|0.00|SPEECH THERAPY|
20|FH_F98620_43920_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F92636_90230_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133155_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F100786_24740_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F128120_76513_0|SrvcGrp|74668|2022|PDM|204.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|2350.00|99|0.00|ASPG IX|
20|FH_F33113_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS|
20|FH_F120290_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 6 (NO REV)|
20|FH_F149781_37404_0|CSTM-ALL|CSTM-00|2020|PDM|1991.00|99|0.00|AEG 4 (NO REV)|
20|FH_F63417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F44334_0_0|SrvcGrp|12045|2022|PDM|302.07|99|0.00|SLEEP STUDIES|
20|FH_F119775_0_0|SrvcGrp|72992|2022|PDM|496.00|99|0.00|AEG 2|
20|FH_F149940_02645_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F43953_0_0|SrvcGrp|361|2022|PDM|2354.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F134830_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F107140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63301_0_0|SrvcGrp|3810|2022|PDM|135.11|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F134490_62801_0|CSTM-ALL|CSTM-00|2020|PDM|1641.00|99|0.00|AEG 6 (NO REV)|
20|FH_F129007_21532_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39844_0_0|SrvcGrp|11000|2022|PCT|0.70|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F125033_93305_0|SrvcGrp|73841|2022|PDM|450.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F40465_0_0|SrvcGrp|762|2022|PCT|0.75|99|0.00|AIR AMBULANCE SVCS|
20|FH_F115289_90057_0|SrvcGrp|86753|2022|PCT|1.15|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F110400_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111482_33020_0|SrvcGrp|72379|2022|PDM|147.75|99|0.00|SPEECH THERAPY|
20|FH_F151157_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|AEG 10 (NO REV) W/ GASTROESOPHOGEAL|
20|FH_F118672_29036_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F146211_68144_0|SrvcGrp|86233|2022|PDM|18689.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F47319_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118534_07652_0|SrvcGrp|74668|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129801_0_0|CSTM-ALL|CSTM-00|2020|PDM|17.50|99|0.00|OCN F/S PRICING: ALL|
20|FH_F117550_0_0|SrvcGrp|104815|2022|PDM|192.00|99|0.00|NEUROBEHAVIORAL STATUS EXAM|
20|FH_F41396_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146361_66215_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F55113_0_0|SrvcGrp|20752|2022|PDM|27035.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F72542_0_0|SrvcGrp|12122|2022|PCT|0.80|99|0.00|GAMMA KNIFE|
20|FH_F113287_72501_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117508_90232_0|SrvcGrp|75522|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD|
20|FH_F148644_06890_0|SrvcGrp|46887|2022|PDM|5410.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F139666_26175_0|SrvcGrp|79699|2022|PCT|0.94|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F150764_33919_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F150768_03054_0|SrvcGrp|82222|2022|PDM|212.00|99|0.00|HOSPICE CARE|
20|FH_F97280_20018_0|SrvcGrp|90854|2022|PDM|3236.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F151607_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS|
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
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_F149049_28401_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 1 (NO REV)|
20|FH_F35475_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|618180-OPGH-CHEMO|
20|FH_F38123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F147082_02359_0|SrvcGrp|108484|2022|PDM|473.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F146266_0_0|SrvcGrp|100041|2022|PDM|8573.00|99|0.00|REPAIR HUMERUS FRACTURE I|
20|FH_F117626_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F122393_76020_0|SrvcGrp|90854|2022|PDM|800.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F116100_0_0|SrvcGrp|76094|2022|PDM|148.79|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F110732_31513_0|SrvcGrp|73841|2022|PDM|694.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F114332_19973_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138995_0_0|SrvcGrp|88599|2022|PDM|1895.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F90232_15126_0|SrvcGrp|86828|2022|PDM|94.50|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD NU KC RATE|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|74.00|99|0.00|HAPA EPA ASC 13|
20|FH_F131558_63028_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148181_0_0|SrvcGrp|94780|2022|PDM|155.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F97081_21122_0|SrvcGrp|35005|2022|PCT|1.00|99|0.00|HOSPICE PHYSICIAN SERVICES|
20|FH_F117711_73080_0|SrvcGrp|75505|2022|PCT|1.55|99|0.00|CARDIAC STUDIES|
20|FH_F103180_85283_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F122271_79416_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97881_38703_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F127467_44202_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F117574_49022_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145920_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F131387_76001_0|SrvcGrp|89417|2022|PDM|414.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|ANTIBIOTIC THERAPY Q24 (MOD SH)|
20|FH_F134732_0_0|SrvcGrp|108078|2022|PDM|1306.00|99|0.00|ARTERY-VEIN FUSION|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SAINT ALEXIUS FH MOD RR|
20|FH_F149459_06615_0|SrvcGrp|27969|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F145563_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F147222_49544_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ST CLAIRS S CODES|
20|FH_F149023_44122_0|SrvcGrp|11673|2022|PDM|6190.00|99|0.00|CPT 29888|
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|741.17|99|0.00|ASPG III|
20|FH_F145863_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149273_0_0|SrvcGrp|27343|2022|PDM|3641.00|99|0.00|OP SURGERY (CPT 25607 - 25609)|
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 9 (NO REV)|
20|FH_F109251_62269_0|SrvcGrp|104877|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F149020_78653_0|SrvcGrp|74668|2022|PDM|220.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149400_83301_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F137731_92262_0|SrvcGrp|114093|2022|PDM|510.00|99|0.00|PARTIAL HOSPITAL SUBSTANCE ABUSE|
20|FH_F97260_06111_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F131498_0_0|SrvcGrp|95441|2022|PDM|100.00|99|0.00|HOSPICE OR HOME CARE|
20|FH_F98020_50138_0|SrvcGrp|90854|2022|PDM|2103.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F145543_0_0|CSTM-ALL|CSTM-00|2020|PDM|931.00|99|0.00|AEG 7 (NO REV)|
20|FH_F40799_0_0|CSTM-ALL|CSTM-00|2020|PDM|2250.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116437_0_0|SrvcGrp|84122|2022|PCT|1.10|99|0.00|VASCULAR GRAFT MATERIAL SYN|
20|FH_F35369_0_0|SrvcGrp|12714|2022|PDM|13000.00|99|0.00|BRACHIOTHERAPY|
20|FH_F119940_60126_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F131389_33169_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F149662_85015_0|SrvcGrp|115730|2022|PDM|4930.00|99|0.00|LAMINOTOMIES/LAMINECTOMIES|
20|FH_F146266_0_0|SrvcGrp|98497|2022|PDM|15190.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F147219_48207_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36222_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F117799_0_0|SrvcGrp|67279|2022|PDM|10609.00|99|0.00|CERVICAL SURGERY|
20|FH_F114207_35243_0|SrvcGrp|86831|2022|PDM|4.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F116753_0_0|SrvcGrp|73603|2022|PDM|1977.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|26.50|99|0.00|GROWTH HORMONE THERAPY (MOD KP/SH)|
20|FH_F131028_49735_0|SrvcGrp|33722|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|1499.00|99|0.00|AEG 5  (NO REV)|
20|FH_F84015_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128197_84123_0|SrvcGrp|46605|2022|PDM|99.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F113957_73554_0|SrvcGrp|102419|2022|PDM|4200.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F139309_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F149648_89148_0|SrvcGrp|66264|2022|PDM|120.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F132160_0_0|SrvcGrp|42429|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 66761|
20|FH_F90232_15126_0|SrvcGrp|24745|2022|PDM|56.70|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F39450_0_0|SrvcGrp|72|2022|PDM|259.00|99|0.00|NEWBORN NURSERY|
20|FH_F145674_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.62|99|0.00|GENERAL ACUTE CARE|
20|FH_F110783_93013_0|SrvcGrp|14947|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F130182_0_0|SrvcGrp|109455|2022|PDM|104.00|99|0.00|HEART FLOW RESERVE MEASURE|
20|FH_F128753_32501_0|SrvcGrp|75485|2022|PCT|0.64|99|0.00|AEG 4|
20|FH_F125782_66763_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|100% 2007 MEDICARE DME TN  MOD TC|
20|FH_F140094_16125_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143412_70503_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F143447_53204_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143454_94550_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149700_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120747_19129_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118815_61021_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F93948_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F45332_0_0|SrvcGrp|37902|2022|PDM|95.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F45832_0_0|SrvcGrp|41384|2022|PCT|0.72|99|0.00|OP SURGERY|
20|FH_F57093_0_0|SrvcGrp|3259|2022|PDM|652.00|99|0.00|ACUTE REHABILITATION|
20|FH_F61292_0_0|SrvcGrp|12587|2022|PDM|8720.00|99|0.00|PTCA W/ STENT|
20|FH_F61292_0_0|SrvcGrp|9511|2022|PDM|2168.00|99|0.00|OBSERVATION SVCS|
20|FH_F89475_71202_0|CSTM-ALL|CSTM-00|2020|PDM|578.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F135219_68506_0|CSTM-ALL|CSTM-00|2020|PDM|5617.19|99|0.00|AEG 7 (NO REV)|
20|FH_F148184_29527_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|AEG 3 (NO REV)|
20|FH_F137460_42103_0|SrvcGrp|86722|2022|PDM|153.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F86319_16365_0|SrvcGrp|90854|2022|PDM|1185.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F106822_0_0|SrvcGrp|100261|2022|PDM|57.00|99|0.00|TREAT WOUND DEHISCENCE|
20|FH_F36822_0_0|CSTM-ALL|CSTM-00|2020|PDM|11814.00|99|0.00|MS DRG 242-244 PACEMAKER IMPLANT|
20|FH_F118050_77565_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F120952_25303_0|SrvcGrp|48398|2022|PDM|130.00|99|0.00|PT SERVICES|
20|FH_F124965_0_0|SrvcGrp|72998|2022|PDM|1300.00|99|0.00|AEG 5|
20|FH_F141527_36830_0|SrvcGrp|86849|2022|PDM|26.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F34854_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143528_0_0|SrvcGrp|35668|2022|PDM|4305.00|99|0.00|CPT 29824|
20|FH_F141509_07058_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F70984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F125011_74467_0|SrvcGrp|82689|2022|PDM|2100.00|99|0.00|SCOPE PLANTAR FASCIOTOMY|
20|FH_F137633_85202_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|838.00|99|0.00|AEG 1 (NO REV)|
20|FH_F149523_0_0|SrvcGrp|101114|2022|PDM|15000.00|99|0.00|ARTHOPLASTY|
20|FH_F145551_04106_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|2117.50|99|0.00|AEG 5  (NO REV)|
20|FH_F83253_33511_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131254_92211_0|SrvcGrp|24754|2022|PDM|12.50|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F92276_32308_0|SrvcGrp|20898|2022|PDM|40530.00|99|0.00|MS DRG 246 ONLY|
20|FH_F39992_0_0|SrvcGrp|12263|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F130747_0_0|SrvcGrp|92416|2022|PDM|8843.00|99|0.00|CERVICAL LAMINOTOMY|
20|FH_F123320_43558_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|581.11|99|0.00|AEG 4 (NO REV)|
20|FH_F100660_56303_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F126439_92627_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130317_0_0|SrvcGrp|95665|2022|PDM|2276.20|99|0.00|ACUTE REHABILITATION/COMPLEX MEDICAL CARE|
20|FH_F145800_22003_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F115739_78722_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F123957_84321_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD TC|
20|FH_F33451_0_0|CSTM-ALL|CSTM-00|2020|PDM|2237.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131254_92211_0|SrvcGrp|86838|2022|PDM|12.50|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F43260_0_0|SrvcGrp|1306|2022|PDM|250.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F70104_0_0|SrvcGrp|48385|2022|PDM|12.00|99|0.00|SPEECH THERAPY|
20|FH_F137630_24266_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F100790_10512_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129782_0_0|CSTM-ALL|CSTM-00|2020|PDM|981.00|99|0.00|AEG 5  (NO REV)|
20|FH_F143388_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F132190_0_0|SrvcGrp|11043|2022|PDM|2500.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F123957_84321_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F143388_0_0|SrvcGrp|33722|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F117783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F115739_78722_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F102302_0_0|SrvcGrp|80137|2022|PDM|14750.00|99|0.00|IMPLANT SPINAL INFUSION|
20|FH_F107800_34609_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F98801_93274_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F120338_83226_0|SrvcGrp|74668|2022|PDM|480.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F135092_46410_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F71144_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F115018_78410_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130747_0_0|SrvcGrp|85792|2022|PDM|6763.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F136756_0_0|SrvcGrp|73004|2022|PDM|1377.20|99|0.00|AEG 8|
20|FH_F116269_92627_0|SrvcGrp|90854|2022|PDM|1200.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F145552_86301_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F123488_65559_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118057_47906_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F130503_98102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F91663_19901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F86332_75081_0|SrvcGrp|11785|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F40032_0_0|SrvcGrp|110|2022|PDM|375.00|99|0.00|CD - REHABILITATION|
20|FH_F125028_19061_0|SrvcGrp|16750|2022|PDM|114.45|99|0.00|HOME INFUSION THERAPY|
20|FH_F129643_33176_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F94367_15601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F120876_85250_0|SrvcGrp|87131|2022|PDM|502.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 9 (NO REV)|
20|FH_F126585_45039_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F120285_32960_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F123505_64468_0|SrvcGrp|75545|2022|PDM|327.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F123507_63869_0|SrvcGrp|472|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F93332_0_0|SrvcGrp|93093|2022|PDM|3090.00|99|0.00|REVISE ULNAR NERVE ELBOW (HCFA)|
20|FH_F123915_0_0|SrvcGrp|93098|2022|PDM|190.00|99|0.00|HOSPICE CARE|
20|FH_F101406_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS|
20|FH_F102302_0_0|SrvcGrp|68742|2022|PDM|14300.00|99|0.00|CRANIAL DEVICE INSERTION/REPLACEMENT|
20|FH_F40255_0_0|CSTM-ALL|CSTM-00|2020|PDM|1136.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF|
20|FH_F33513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS|
20|FH_F121488_77478_0|SrvcGrp|46903|2022|PDM|900.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F141588_60062_0|SrvcGrp|73841|2022|PDM|710.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F60836_0_0|SrvcGrp|13368|2022|PDM|711.34|99|0.00|OP SURGERY|
20|FH_F63129_0_0|SrvcGrp|48395|2022|PDM|30.00|99|0.00|OT SERVICES|
20|FH_F130656_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 7 (NO REV)|
20|FH_F112004_15401_0|SrvcGrp|27969|2022|PCT|0.00|99|0.00|HOME HEALTH AIDE|
20|FH_F116806_0_0|SrvcGrp|107058|2022|PDM|1923.16|99|0.00|PARTIAL REMOVAL OF TONGUE|
20|FH_F80814_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE|
20|FH_F146372_28681_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149241_30161_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F121639_06830_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123609_28451_0|SrvcGrp|89149|2022|PDM|222.00|99|0.00|OP INTENSIVE|
20|FH_F127642_07047_0|SrvcGrp|91357|2022|PDM|85.31|99|0.00|ASA CODES & CPT4 CODE|
20|FH_F51393_0_0|SrvcGrp|22954|2022|PDM|170.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F118252_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F127849_43920_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F89645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F145791_67205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F52713_0_0|SrvcGrp|49064|2022|PCT|0.65|99|0.00|OP BRACHYTHERAPY|
20|FH_F126341_27284_0|SrvcGrp|14945|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F146113_26719_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130763_0_0|SrvcGrp|100065|2022|PDM|3450.00|99|0.00|DEEP ANT OR POSTER TIBIAL|
20|FH_F111349_0_0|SrvcGrp|73482|2022|PDM|934.00|99|0.00|AETNA SUBACUTE IV|
20|FH_F120549_19087_0|SrvcGrp|108521|2022|PCT|1.00|99|0.00|FEMALE GENITAL SYSTEM|
20|FH_F111908_07677_0|SrvcGrp|104475|2022|PCT|1.00|99|0.00|INJ FILGRASTIM EXCL BIOSIMIL|
20|FH_F100782_0_0|SrvcGrp|105118|2022|PDM|704.00|99|0.00|WINDBER MEDICAL CNTR ASC 223|
20|FH_F138739_21157_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F118123_67226_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F126308_44515_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149051_01605_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126225_23413_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F126341_27284_0|SrvcGrp|29075|2022|PDM|35.00|99|0.00|HYDRATION THERAPY|
20|FH_F134593_60007_0|SrvcGrp|86845|2022|PDM|48.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F133585_0_0|SrvcGrp|68546|2022|PDM|1786.00|99|0.00|CPT 36558|
20|FH_F138147_18018_0|CSTM-ALL|CSTM-00|2020|PDM|292.00|99|0.00|PSYCHIATRIST LEVEL AUTISM (MOD AF)|
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 6 (NO REV)|
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|95559|2022|PDM|6500.00|99|0.00|HIP JOINT|
20|FH_F127075_64772_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89219_0_0|SrvcGrp|57382|2022|PDM|59744.00|99|0.00|MS DRG 456-458 ONLY|
20|FH_F127282_98004_0|SrvcGrp|100859|2022|PDM|328.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F119554_16506_0|SrvcGrp|471|2022|PDM|476.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F143620_81504_0|SrvcGrp|27968|2022|PDM|52.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135670_01749_0|SrvcGrp|24753|2022|PDM|12.50|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F120719_27540_0|SrvcGrp|12110|2022|PDM|6497.00|99|0.00|CARDIAC CATH LAB OP SVCS|
20|FH_F126043_30339_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F91777_29577_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135623_53115_0|SrvcGrp|97507|2022|PDM|100.00|99|0.00|AETNA HOSPICE|
20|FH_F40294_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|ACUTE PSYCH|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1992.02|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1402 W/O REV|
20|FH_F130763_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F31714_0_0|SrvcGrp|9808|2022|PDM|8000.00|99|0.00|PTCA WITH STENT|
20|FH_F134234_49525_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F117206_0_0|SrvcGrp|85966|2022|PDM|1485.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F81698_10457_0|SrvcGrp|86827|2022|PDM|57.75|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F133877_84117_0|SrvcGrp|80918|2022|PDM|93.00|99|0.00|RESPITE CARE|
20|FH_F135663_24401_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|289.97|99|0.00|HAPA WPA-NWPA 2012-13 ASC 126 W/O REV|
20|FH_F110420_60649_0|SrvcGrp|72994|2022|PDM|587.00|99|0.00|AEG 3|
20|FH_F145677_34208_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAMPTON ROADS GAST MOD 26|
20|FH_F85097_0_0|SrvcGrp|14242|2022|PDM|603.00|99|0.00|EMERGENCY ROOM SVCS LEVEL IV|
20|FH_F89219_0_0|SrvcGrp|106229|2022|PCT|1.00|99|0.00|OP MRI/CT SCAN W/ ER|
20|FH_F134610_33426_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F79824_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F150239_75569_0|SrvcGrp|22389|2022|PCT|1.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F121225_98902_0|SrvcGrp|34868|2022|PDM|281.40|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F38790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|MSDRG 246-251 ANGIOPLASTY|
20|FH_F138908_84010_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146666_75154_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F70883_0_0|SrvcGrp|20000|2022|PDM|209.00|99|0.00|CATHETER CARE SUPPLIES|
20|FH_F95623_84015_0|SrvcGrp|74546|2022|PDM|425.00|99|0.00|HOSPICE SERVICES|
20|FH_F110465_30328_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F121684_74447_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133749_84604_0|SrvcGrp|112450|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|1043.00|99|0.00|AEG 8 (NO REV)|
20|FH_F121476_0_0|SrvcGrp|108822|2022|PDM|1723.00|99|0.00|NEUROMATRIX NERVE CUFF|
20|FH_F143567_62207_0|SrvcGrp|48398|2022|PDM|135.00|99|0.00|PT SERVICES|
20|FH_F54592_0_0|SrvcGrp|22594|2022|PDM|80.00|99|0.00|IMIGLUCERASE|
20|FH_F54592_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|LIPIDS|
20|FH_F122532_46385_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F84712_0_0|SrvcGrp|73604|2022|PDM|662.00|99|0.00|AETNA DETOXIFICATION|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|115.50|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1501 W/O REV|
20|FH_F105361_80104_0|SrvcGrp|36991|2022|PCT|0.49|99|0.00|IMPLANTS|
20|FH_F115786_57701_0|SrvcGrp|73701|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F66427_0_0|SrvcGrp|29817|2022|PDM|6939.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F120805_92672_0|SrvcGrp|46903|2022|PDM|1250.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F51136_0_0|SrvcGrp|3142|2022|PDM|1775.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F116040_24637_0|SrvcGrp|86845|2022|PDM|30.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F133592_63957_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133658_60053_0|SrvcGrp|27969|2022|PDM|34.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132293_50595_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F132671_60123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132964_06484_0|SrvcGrp|75545|2022|PDM|525.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F133402_10007_0|SrvcGrp|38582|2022|PDM|42.00|99|0.00|THERAPY|
20|FH_F133448_44094_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111604_16505_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F76824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146760_0_0|SrvcGrp|111468|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F122898_63011_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|PDM|900.00|99|0.00|AEG 4 (NO REV)|
20|FH_F88639_80204_0|SrvcGrp|74059|2022|PDM|584.22|99|0.00|AETNA CC FOR ER SERVICE CPT 99291|
20|FH_F117465_0_0|SrvcGrp|75485|2022|PDM|1500.00|99|0.00|AEG 4|
20|FH_F132810_0_0|SrvcGrp|21920|2022|PDM|60.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F67901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|LINTRATHECAL  IV SERVICES MOD SJ|
20|FH_F120490_64133_0|SrvcGrp|27968|2022|PDM|37.00|99|0.00|SKILLED NURSING LPN|
20|FH_F93132_73134_0|SrvcGrp|43569|2022|PDM|60.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F137033_87108_0|SrvcGrp|78579|2022|PDM|1236.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
20|FH_F137238_70056_0|SrvcGrp|73841|2022|PDM|409.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F139559_21001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138955_43420_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142406_78840_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142530_60148_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F142707_02891_0|SrvcGrp|75545|2022|PDM|250.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F53732_0_0|SrvcGrp|29677|2022|PDM|140.00|99|0.00|HOME INFUSION NURSING SVCS MOD SD|
20|FH_F138542_40324_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F114865_77488_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F140573_46517_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F120152_0_0|SrvcGrp|89848|2022|PDM|19800.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F149377_22102_0|CSTM-ALL|CSTM-00|2020|PDM|1321.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS|
20|FH_F149514_99701_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151601_89118_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F151603_27609_0|CSTM-ALL|CSTM-00|2020|PDM|4285.71|99|0.00|AEG 7 (NO REV)|
20|FH_F38332_0_0|SrvcGrp|19112|2022|PDM|15759.00|99|0.00|MS DRG 620|
20|FH_F109886_36303_0|SrvcGrp|87317|2022|PDM|637.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F115452_15235_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F147725_06002_0|SrvcGrp|104003|2022|PDM|3100.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES|
20|FH_F129514_79605_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F137817_17050_0|SrvcGrp|73842|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137829_62948_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137934_51054_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109652_0_0|SrvcGrp|360|2022|PDM|683.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F110308_0_0|SrvcGrp|72996|2022|PDM|700.00|99|0.00|AEG 4|
20|FH_F90880_15108_0|SrvcGrp|90480|2022|PCT|1.00|99|0.00|AFLURIA VACC 3 YRS & > IM|
20|FH_F124801_67110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114567_43235_0|SrvcGrp|43924|2022|PDM|1000.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F151063_44094_0|SrvcGrp|86723|2022|PDM|401.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F151063_44094_0|SrvcGrp|89417|2022|PDM|401.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|463.96|99|0.00|DELAWARE VALLEY- ASC 202|
20|FH_F65761_0_0|SrvcGrp|42828|2022|PDM|175.05|99|0.00|SPEECH THERAPY VISIT|
20|FH_F76172_0_0|SrvcGrp|45148|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F142070_0_0|SrvcGrp|107749|2022|PDM|300.00|99|0.00|CAPD/CCPD|
20|FH_F72845_0_0|SrvcGrp|30623|2022|PDM|11907.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F72845_0_0|CSTM-ALL|CSTM-00|2020|PDM|1541.00|99|0.00|ACUTE PSYCH|
20|FH_F74562_0_0|SrvcGrp|97|2022|PDM|4200.00|99|0.00|C-SECTION|
20|FH_F88456_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F142319_19403_0|SrvcGrp|3178|2022|PDM|972.00|99|0.00|ACUTE PSYCH|
20|FH_F142321_29401_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F142334_33186_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|3169.00|99|0.00|AEG 10 (NO REV)|
20|FH_F100640_48097_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F113392_0_0|SrvcGrp|104257|2022|PDM|1650.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F113392_0_0|SrvcGrp|105201|2022|PDM|1650.00|99|0.00|MUSCLE FLAP|
20|FH_F119435_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F42512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|HEARING AIDS|
20|FH_F94786_07974_0|SrvcGrp|14947|2022|PDM|31.50|99|0.00|HOME INFUSION|
20|FH_F132988_0_0|SrvcGrp|107778|2022|PDM|12296.59|99|0.00|ARTHROSCOPIC FRACTURE TX|
20|FH_F136832_0_0|SrvcGrp|110585|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION I|
20|FH_F118909_0_0|SrvcGrp|95661|2022|PDM|123.60|99|0.00|RESPITE CARE (HCFA)|
20|FH_F114386_07090_0|SrvcGrp|88621|2022|PDM|78.35|99|0.00|SKILLED NURSING LPN|
20|FH_F49812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122184_65674_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146894_73505_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36318_0_0|SrvcGrp|177|2022|PDM|2052.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F91998_0_0|SrvcGrp|91891|2022|PDM|1075.00|99|0.00|REMOVAL OF LOOSE BODY|
20|FH_F124663_65608_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F134809_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127932_32117_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F87856_0_0|SrvcGrp|75497|2022|PDM|891.00|99|0.00|AEG 10|
20|FH_F137248_0_0|SrvcGrp|113066|2022|PDM|2393.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F129103_17545_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98042_10468_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F114666_30342_0|SrvcGrp|100068|2022|PDM|9000.00|99|0.00|REPAIR DEGENERATED KNEECAP|
20|FH_F138981_85123_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F81832_13827_0|SrvcGrp|12403|2022|PDM|46.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F137933_0_0|SrvcGrp|113159|2022|PDM|3500.00|99|0.00|KIDNEY ENDOSCOPY & TREATMENT|
20|FH_F148424_01440_0|SrvcGrp|115384|2022|PCT|1.00|99|0.00|COVID-19 INFUSION ADMINISTRATION COMBINATION - ELI LILLY|
20|FH_F148553_85016_0|SrvcGrp|115435|2022|PDM|3121.00|99|0.00|INSERT HEART PM ATRIAL|
20|FH_F122740_71038_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43833_0_0|SrvcGrp|11121|2022|PDM|75.00|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F134770_14420_0|SrvcGrp|76501|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F112187_98272_0|SrvcGrp|79786|2022|PCT|0.81|99|0.00|SLEEP STUDIES|
20|FH_F39622_0_0|SrvcGrp|2741|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F77234_0_0|SrvcGrp|33312|2022|PDM|2075.00|99|0.00|CPT 42820|
20|FH_F115631_65201_0|SrvcGrp|35669|2022|PDM|3177.00|99|0.00|CPT 63650|
20|FH_F41426_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F41832_0_0|SrvcGrp|24029|2022|PDM|55.00|99|0.00|RN HOURLY|
20|FH_F41832_0_0|SrvcGrp|58736|2022|PDM|125.00|99|0.00|HOME PEDIATRIC THERAPY|
20|FH_F42176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F136429_0_0|SrvcGrp|79590|2022|PDM|679.00|99|0.00|CPT 43248|
20|FH_F139236_0_0|SrvcGrp|11259|2022|PCT|0.26|99|0.00|DRUGS|
20|FH_F150663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F128341_41139_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F54552_0_0|SrvcGrp|17012|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F67167_0_0|SrvcGrp|26595|2022|PDM|1124.00|99|0.00|ACUTE PSYCHIATRIC|
20|FH_F78265_0_0|SrvcGrp|3069|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F106500_0_0|SrvcGrp|10391|2022|PDM|1510.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151379_21045_0|SrvcGrp|73000|2022|PDM|949.00|99|0.00|AEG 6|
20|FH_F151503_30067_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 5  (NO REV)|
20|FH_F151516_63023_0|SrvcGrp|90854|2022|PDM|950.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F135427_19610_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F135432_16335_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135489_70508_0|SrvcGrp|30089|2022|PDM|400.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F135608_19348_0|SrvcGrp|90854|2022|PDM|727.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F135836_60804_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135978_06851_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130670_32204_0|SrvcGrp|108484|2022|PDM|546.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F131520_19144_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131265_84106_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F116527_70443_0|SrvcGrp|72984|2022|PCT|1.00|99|0.00|CHEMOTHERAPY|
20|FH_F31955_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101200_19020_0|SrvcGrp|89269|2022|PCT|1.15|99|0.00|PSYTX PT/FAMILY 45 MINUTES|
20|FH_F129967_18915_0|SrvcGrp|104429|2022|PDM|44.89|99|0.00|AETNA OFFICE OUTPATIENT VISIT EST (MOD AF)|
20|FH_F111292_33136_0|SrvcGrp|82753|2022|PDM|71.00|99|0.00|TROPONIN QUANT|
20|FH_F134322_98001_0|SrvcGrp|109292|2022|PCT|1.00|99|0.00|HEPB VACC 4 DOSE IMMUNSUP IM|
20|FH_F39178_0_0|SrvcGrp|65|2022|PDM|1685.00|99|0.00|OBSTETRICAL CARE|
20|FH_F39796_0_0|SrvcGrp|1259|2022|PDM|1522.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F132720_0_0|SrvcGrp|3409|2022|PDM|600.00|99|0.00|NEWBORN NURSERY|
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|ASPG VI|
20|FH_F67502_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|1688.96|99|0.00|2005 ASPG GROUPER IX|
20|FH_F147941_06023_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION|
20|FH_F55634_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F124788_0_0|SrvcGrp|73008|2022|PDM|333.00|99|0.00|AEG 10|
20|FH_F93563_98499_0|SrvcGrp|89149|2022|PDM|105.00|99|0.00|OP INTENSIVE|
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F47152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|GENERAL ACUTE CARE|
20|FH_F137574_68130_0|SrvcGrp|90340|2022|PCT|1.00|99|0.00|SKILLED NURSING LPN|
20|FH_F49338_0_0|SrvcGrp|33643|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F116093_47327_0|SrvcGrp|93919|2022|PDM|508.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F69108_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115685_64064_0|SrvcGrp|88828|2022|PDM|14.80|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F32784_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F115109_20032_0|SrvcGrp|30089|2022|PDM|455.27|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F135239_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|100.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F32114_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F39170_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130681_15701_0|SrvcGrp|14657|2022|PDM|2006.00|99|0.00|MENTAL HEALTH / DETOX|
20|FH_F145748_30084_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129397_17847_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F90872_0_0|SrvcGrp|82498|2022|PDM|835.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS|
20|FH_F130024_78229_0|SrvcGrp|92760|2022|PCT|1.02|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|746.00|99|0.00|AEG 3 (NO REV)|
20|FH_F128276_66441_0|SrvcGrp|73842|2022|PDM|132.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F46612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 10 (NO REV)|
20|FH_F131236_84041_0|SrvcGrp|95661|2022|PDM|93.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F129536_0_0|SrvcGrp|108385|2022|PCT|1.00|99|0.00|AQUEOUS SHUNT|
20|FH_F93791_0_0|SrvcGrp|93596|2022|PDM|4200.00|99|0.00|SHOULDER JOINT(HCFA)|
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1071.40|99|0.00|ASPG 8- PROGRESSIVE SURG|
20|FH_F141707_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1325.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F37679_0_0|SrvcGrp|22590|2022|PDM|61.00|99|0.00|PAIN MANAGAMENT - INTERMITTENT|
20|FH_F36135_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91034_0_0|SrvcGrp|82981|2022|PDM|128.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F128190_45342_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F40026_0_0|SrvcGrp|229|2022|PCT|0.73|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)|
20|FH_F91994_0_0|SrvcGrp|73000|2022|PDM|2400.00|99|0.00|AEG 6|
20|FH_F136195_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F113410_0_0|SrvcGrp|100065|2022|PDM|2942.00|99|0.00|DEEP ANT OR POSTER TIBIAL|
20|FH_F100662_27534_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F131357_17545_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F118121_46001_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F145748_30084_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145815_30540_0|SrvcGrp|100860|2022|PDM|106.00|99|0.00|OFFICE/OUTPATIENT VISIT NEW|
20|FH_F143528_0_0|SrvcGrp|83641|2022|PDM|8865.15|99|0.00|CPT 29889|
20|FH_F137457_32216_0|SrvcGrp|94880|2022|PDM|135.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F123844_0_0|SrvcGrp|89781|2022|PDM|190.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F116115_14437_0|SrvcGrp|90644|2022|PDM|20.00|99|0.00|AETNA MEDICATION ASSISTED TRTMT MAINTENANCE INJECTION (HCFA)|
20|FH_F123282_03222_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F31861_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F105221_01757_0|SrvcGrp|23683|2022|PDM|36.75|99|0.00|SKILLED NURSING RN|
20|FH_F143834_06511_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F148266_45419_0|SrvcGrp|95819|2022|PDM|1730.33|99|0.00|GONIOTOMY|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHYSICIAN CLINIC VISIT NATL F/S (MOD TC)|
20|FH_F38380_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F63556_0_0|SrvcGrp|10400|2022|PDM|4000.00|99|0.00|IP SURGERY|
20|FH_F109260_0_0|SrvcGrp|41334|2022|PDM|23339.80|99|0.00|TOTAL KNEE|
20|FH_F55054_0_0|SrvcGrp|51263|2022|PDM|4544.00|99|0.00|ANGIOPLASTY|
20|FH_F122725_32216_0|SrvcGrp|89500|2022|PDM|182.00|99|0.00|SPEECH SOUND LANGUAGE|
20|FH_F130156_98198_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F50635_0_0|SrvcGrp|9811|2022|PDM|395.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F145508_0_0|SrvcGrp|82223|2022|PDM|181.21|99|0.00|HOSPICE 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_F87219_0_0|SrvcGrp|83884|2022|PDM|107.13|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)|
20|FH_F63249_0_0|SrvcGrp|52782|2022|PDM|42.00|99|0.00|VENIPUNCTURE PER VISIT|
20|FH_F38560_0_0|SrvcGrp|29542|2022|PDM|15200.00|99|0.00|PEDIATRIC VALVE REPAIR/REPLACE (MS DRG)|
20|FH_F130721_04769_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 5  (NO REV)|
20|FH_F130801_57717_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149102_33433_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146657_01105_0|SrvcGrp|114672|2022|PDM|116.93|99|0.00|BEHAV HEALTH DAY TRT (MOD U2)|
20|FH_F52713_0_0|SrvcGrp|9529|2022|PDM|790.00|99|0.00|HOSPICE SVCS|
20|FH_F130327_03867_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111023_13905_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135610_06451_0|SrvcGrp|80918|2022|PDM|119.00|99|0.00|RESPITE CARE|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD KL"|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.96|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1406 W/O REV|
20|FH_F130763_0_0|SrvcGrp|82107|2022|PDM|4391.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F119125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117206_0_0|SrvcGrp|79590|2022|PDM|721.00|99|0.00|CPT 43248|
20|FH_F50875_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119227_01752_0|SrvcGrp|29075|2022|PDM|35.00|99|0.00|HYDRATION THERAPY|
20|FH_F146103_63851_0|SrvcGrp|79699|2022|PCT|0.75|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F112041_19020_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133585_0_0|SrvcGrp|77292|2022|PDM|424.00|99|0.00|AETNA REMV TUNNLD CVAD W/SUBQ PORT|
20|FH_F109244_19808_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121225_98902_0|SrvcGrp|108754|2022|PCT|0.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F129440_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANESTHESIOLOGIST/CRNA (HAN4)|
20|FH_F34182_0_0|SrvcGrp|20096|2022|PDM|2729.00|99|0.00|MS DRG 222-223 ONLY|
20|FH_F145675_33761_0|SrvcGrp|48385|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F146540_78013_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149139_07522_0|SrvcGrp|113224|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS DNA&RNA 21 SARSCOV2|
20|FH_F100782_0_0|SrvcGrp|35164|2022|PDM|2298.00|99|0.00|NICU LEVEL II OR III|
20|FH_F143650_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F77082_0_0|SrvcGrp|24598|2022|PDM|2793.00|99|0.00|MS DRG 945-946 ONLY|
20|FH_F133887_17013_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F134223_83617_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121687_04401_0|SrvcGrp|57604|2022|PCT|1.38|99|0.00|IMMUNIZATION ADMINISTRATION|
20|FH_F130468_0_0|SrvcGrp|111433|2022|PDM|10503.00|99|0.00|REMOVAL OF HIP PROSTHESIS|
20|FH_F35966_0_0|SrvcGrp|16996|2022|PDM|55.00|99|0.00|AMBULANCE RESPONSE/TREATMENT - NO TRANSPORT|
20|FH_F132822_95125_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F109387_35630_0|SrvcGrp|86749|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F145926_45243_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|271.73|99|0.00|HAPA WPA-NWPA 2012-13 ASC 118 W/O REV|
20|FH_F141210_0_0|SrvcGrp|93432|2022|PDM|14057.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F145579_67226_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35128_0_0|SrvcGrp|15074|2022|PDM|75.00|99|0.00|PHYSICAL/OCCUPATIONAL/SPEECH THERAPY|
20|FH_F134494_33612_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F122434_40207_0|SrvcGrp|109330|2022|PCT|1.03|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|242.46|99|0.00|HAPA WPA-NWPA 2012-13 ASC 121 W/O REV|
20|FH_F101100_50314_0|SrvcGrp|97913|2022|PDM|20655.00|99|0.00|COLOSTOMY|
20|FH_F77665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146668_30189_0|SrvcGrp|98466|2022|PDM|4850.00|99|0.00|PARTIAL REMOVAL OF FOOT BONE|
20|FH_F146716_46733_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F47140_0_0|SrvcGrp|28731|2022|PDM|75.38|99|0.00|SLEEP STUDIES CPT 95807 W/MODIFIER 26|
20|FH_F47140_0_0|SrvcGrp|28736|2022|PDM|558.11|99|0.00|SLEEP STUDIES CPT 95810 W/MODIFIER TC|
20|FH_F116114_37033_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F131711_25550_0|SrvcGrp|91177|2022|PDM|1090.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F133583_77074_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F139188_29169_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F35990_0_0|CSTM-ALL|CSTM-00|2020|PDM|1718.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F133677_15601_0|SrvcGrp|88620|2022|PDM|107.00|99|0.00|SKILLED NURSING RN|
20|FH_F131356_19131_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124760_34997_0|SrvcGrp|73842|2022|PDM|206.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F90201_15650_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F117737_75001_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F137902_0_0|SrvcGrp|3178|2022|PDM|1000.00|99|0.00|ACUTE PSYCH|
20|FH_F110963_30535_0|SrvcGrp|88620|2022|PDM|170.00|99|0.00|SKILLED NURSING RN|
20|FH_F128821_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F36683_0_0|SrvcGrp|72|2022|PDM|328.00|99|0.00|NEWBORN NURSERY|
20|FH_F36743_0_0|SrvcGrp|2741|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F150439_03110_0|SrvcGrp|74668|2022|PDM|290.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F38753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F35678_0_0|SrvcGrp|18253|2022|PDM|6357.00|99|0.00|MS DRG 287|
20|FH_F67419_0_0|SrvcGrp|43567|2022|PDM|80.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F114568_08097_0|SrvcGrp|105681|2022|PDM|186.00|99|0.00|INTENSIVE OUTPATIENT >=18 YRS (HCFA)|
20|FH_F84532_0_0|SrvcGrp|73000|2022|PDM|2017.00|99|0.00|AEG 6|
20|FH_F40653_0_0|CSTM-ALL|CSTM-00|2020|PDM|410.00|99|0.00|MULTIPLE BIRTH|
20|FH_F136843_0_0|SrvcGrp|107749|2022|PDM|164.00|99|0.00|CAPD/CCPD|
20|FH_F111038_62960_0|SrvcGrp|103503|2022|PCT|0.84|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F108180_29526_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132818_24701_0|SrvcGrp|36204|2022|PDM|1078.00|99|0.00|ACUTE PSYCH|
20|FH_F52278_0_0|CSTM-ALL|CSTM-00|2020|PDM|765.00|99|0.00|ASPG X|
20|FH_F148891_44432_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F108680_0_0|SrvcGrp|93069|2022|PDM|11000.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1732.00|99|0.00|AEG 7 (NO REV)|
20|FH_F45113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36343_0_0|SrvcGrp|10648|2022|PDM|4.00|99|0.00|HOME INFUSION|
20|FH_F147166_03444_0|SrvcGrp|46903|2022|PDM|1550.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F130017_02302_0|SrvcGrp|53153|2022|PDM|14273.00|99|0.00|MS DRG 261 ONLY|
20|FH_F79824_0_0|SrvcGrp|17083|2022|PDM|2173.00|99|0.00|ASPG X|
20|FH_F126198_44236_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F98021_07012_0|SrvcGrp|73601|2022|PDM|5645.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F127914_28602_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112073_65020_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100782_0_0|SrvcGrp|97527|2022|PDM|745.87|99|0.00|WINDBER MEDICAL CNTR ASC 104|
20|FH_F125110_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|GENERAL ACUTE CARE|
20|FH_F109387_35630_0|SrvcGrp|86648|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F121225_98902_0|SrvcGrp|108707|2022|PCT|0.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F110580_71106_0|SrvcGrp|103993|2022|PDM|710.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F90501_71101_0|SrvcGrp|72984|2022|PCT|1.00|99|0.00|CHEMOTHERAPY|
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|2407.00|99|0.00|ASPG IX|
20|FH_F79824_0_0|SrvcGrp|9518|2022|PCT|0.57|99|0.00|EMERGENCY ROOM|
20|FH_F119575_0_0|SrvcGrp|108081|2022|PDM|186.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F127090_45601_0|SrvcGrp|74147|2022|PDM|59.16|99|0.00|INFUSION S-CODE PER MONTH|
20|FH_F85353_16407_0|SrvcGrp|63768|2022|PDM|1747.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 906|
20|FH_F85353_16407_0|SrvcGrp|63817|2022|PDM|546.22|99|0.00|HAPA WPA-NWPA 2012-13 ASC 210|
20|FH_F32657_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121255_76132_0|SrvcGrp|90854|2022|PDM|884.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F62352_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F111882_51560_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F43199_0_0|SrvcGrp|8962|2022|PDM|131.25|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F149199_73005_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F125328_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F111681_62702_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F118042_33401_0|SrvcGrp|89149|2022|PDM|375.00|99|0.00|OP INTENSIVE|
20|FH_F80455_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F144808_0_0|SrvcGrp|88160|2022|PDM|7215.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F146064_17331_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120720_24541_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130364_01331_0|SrvcGrp|73602|2022|PDM|2030.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|467.50|99|0.00|HAPA WPA-NWPA 2012-13 ASC 201 W/O REV|
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|1850.00|99|0.00|AEG 9 (NO REV)|
20|FH_F116806_0_0|SrvcGrp|107023|2022|PDM|1923.16|99|0.00|LOWER JAW BONE GRAFT|
20|FH_F87012_0_0|SrvcGrp|85637|2022|PDM|1362.31|99|0.00|ESOPHAGOGASTRODUODENOSCOPY|
20|FH_F133585_0_0|SrvcGrp|112381|2022|PDM|1092.00|99|0.00|NJX NONCMPND SCLRSNT 1 VEIN|
20|FH_F96780_0_0|SrvcGrp|87386|2022|PDM|1613.00|99|0.00|AMNIOTIC MEMBRANE TRANSPLANTATION|
20|FH_F132889_63740_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145921_73139_0|SrvcGrp|23683|2022|PDM|41.20|99|0.00|SKILLED NURSING RN|
20|FH_F111986_0_0|SrvcGrp|35669|2022|PDM|2575.00|99|0.00|CPT 63650|
20|FH_F85353_16407_0|SrvcGrp|63810|2022|PDM|613.74|99|0.00|HAPA WPA-NWPA 2012-13 ASC 303|
20|FH_F91171_0_0|SrvcGrp|79101|2022|PDM|783.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F63114_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112665_0_0|SrvcGrp|98498|2022|PDM|7215.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC|
20|FH_F146103_63851_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|465.60|99|0.00|HAPA WPA-NWPA 2012-13 ASC 303 W/O REV|
20|FH_F132883_31602_0|SrvcGrp|86838|2022|PDM|10.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F133207_0_0|SrvcGrp|84181|2022|PDM|3192.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS|
20|FH_F143742_60410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112023_12866_0|SrvcGrp|83824|2022|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES|
20|FH_F135666_37601_0|SrvcGrp|29347|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE|
20|FH_F139512_77550_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F85353_16407_0|SrvcGrp|63780|2022|PDM|1373.22|99|0.00|HAPA WPA-NWPA 2012-13 ASC 3|
20|FH_F120291_0_0|SrvcGrp|108431|2022|PDM|1084.00|99|0.00|HOSPICE SERVICES|
20|FH_F79245_0_0|SrvcGrp|59428|2022|PDM|75.00|99|0.00|ST|
20|FH_F36552_0_0|SrvcGrp|18886|2022|PDM|28250.00|99|0.00|MS DRG 234|
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|1359.00|99|0.00|AEG 5  (NO REV)|
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|4087.60|99|0.00|AEG 8 (NO REV)|
20|FH_F149148_15330_0|SrvcGrp|48398|2022|PDM|91.00|99|0.00|PT SERVICES|
20|FH_F43679_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120719_27540_0|SrvcGrp|10363|2022|PDM|955.00|99|0.00|CPT CODE 99283|
20|FH_F89574_0_0|SrvcGrp|73485|2022|PDM|840.00|99|0.00|AETNA REHAB|
20|FH_F125124_0_0|SrvcGrp|72992|2022|PDM|482.00|99|0.00|AEG 2|
20|FH_F85353_16407_0|SrvcGrp|63812|2022|PDM|578.33|99|0.00|HAPA WPA-NWPA 2012-13 ASC 205|
20|FH_F100782_0_0|SrvcGrp|105124|2022|PDM|559.39|99|0.00|WINDBER MEDICAL CNTR ASC 229|
20|FH_F96721_99504_0|SrvcGrp|73659|2022|PDM|13813.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F72543_0_0|SrvcGrp|46107|2022|PDM|108.00|99|0.00|SKILLED NURSING|
20|FH_F134492_85201_0|SrvcGrp|89337|2022|PDM|1167.00|99|0.00|DETOXIFICATION|
20|FH_F84712_0_0|SrvcGrp|82803|2022|PDM|3911.00|99|0.00|IP CARDIAC CATHETERIZATION|
20|FH_F87053_0_0|SrvcGrp|73000|2022|PDM|1320.00|99|0.00|AEG 6|
20|FH_F68626_0_0|SrvcGrp|3142|2022|PDM|1695.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F105145_75075_0|SrvcGrp|33984|2022|PDM|16200.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F115907_12206_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F131675_71753_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141327_65566_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 6 (NO REV)|
20|FH_F90151_24382_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F151619_73505_0|SrvcGrp|75489|2022|PDM|954.00|99|0.00|AEG 6|
20|FH_F66760_0_0|SrvcGrp|63457|2022|PDM|125.00|99|0.00|ULTRASOUND|
20|FH_F128375_03909_0|SrvcGrp|90397|2022|PDM|615.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F74845_0_0|SrvcGrp|13293|2022|PCT|1.15|99|0.00|HIGH-COST DRUGS|
20|FH_F139147_0_0|SrvcGrp|112978|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F149529_68102_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F114585_11501_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F126147_45241_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F86714_0_0|SrvcGrp|45539|2022|PDM|177.61|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|1024.00|99|0.00|AEG 7 (NO REV)|
20|FH_F149539_06032_0|SrvcGrp|46605|2022|PDM|241.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F94585_19040_0|SrvcGrp|473|2022|PDM|561.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F39443_0_0|SrvcGrp|13364|2022|PDM|675.00|99|0.00|EMERGENCY ROOM SVCS LEVEL VI|
20|FH_F143668_0_0|SrvcGrp|114068|2022|PDM|280.00|99|0.00|SEGMENTAL PNEUMATIC (MOD NU)|
20|FH_F124322_64131_0|SrvcGrp|14948|2022|PDM|125.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F117762_0_0|SrvcGrp|89860|2022|PDM|4992.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F127553_44321_0|SrvcGrp|94781|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F92032_32308_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149516_65233_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F43076_0_0|SrvcGrp|27726|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F40627_0_0|SrvcGrp|8968|2022|PDM|3335.00|99|0.00|NICU LEVEL III & IV|
20|FH_F137986_0_0|SrvcGrp|35668|2022|PDM|1436.00|99|0.00|CPT 29824|
20|FH_F40899_0_0|SrvcGrp|17419|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F150940_92708_0|SrvcGrp|75419|2022|PDM|583.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F36634_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|ACUTE PSYCH|
20|FH_F109251_62269_0|SrvcGrp|103226|2022|PDM|92.60|99|0.00|APPLY MULTLAY COMPRS UPR LEG|
20|FH_F35716_0_0|SrvcGrp|12403|2022|PDM|26.25|99|0.00|CONTINUOUS HOMECARE|
20|FH_F89851_83854_0|SrvcGrp|28119|2022|PDM|43651.00|99|0.00|MS DRG 466 ONLY|
20|FH_F35735_33870_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|GENERAL ACUTE CARE|
20|FH_F128375_03909_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F120083_13501_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F35776_33063_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F139907_42266_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151755_03303_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS|
20|FH_F132387_60465_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132467_33825_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116683_64730_0|SrvcGrp|94736|2022|PCT|1.00|99|0.00|FLULAVAL VACC IM (>=3 YRS)|
20|FH_F116698_07470_0|SrvcGrp|10577|2022|PDM|39.90|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F37578_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|SCHCP MRI MRA 550|
20|FH_F40091_0_0|SrvcGrp|17067|2022|PDM|1419.00|99|0.00|ASPG II|
20|FH_F40755_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138296_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50137_0_0|SrvcGrp|45327|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F59732_0_0|SrvcGrp|17011|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F150462_30458_0|SrvcGrp|112596|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116024_13203_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F127441_45822_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F143790_83440_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 10 (NO REV)|
20|FH_F139515_0_0|SrvcGrp|78911|2022|PDM|2850.00|99|0.00|LAPARO HERNIA REPAIR RECUR|
20|FH_F137573_33764_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F123372_0_0|SrvcGrp|9537|2022|PDM|3249.00|99|0.00|CARDIAC CARE UNIT|
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|555.95|99|0.00|ASPG II|
20|FH_F87031_0_0|SrvcGrp|73004|2022|PDM|1512.00|99|0.00|AEG 8|
20|FH_F135236_02840_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F64440_0_0|SrvcGrp|108692|2022|PDM|1195.00|99|0.00|MRI/MRA W/ & W/O CONTRAST|
20|FH_F126784_80809_0|SrvcGrp|87317|2022|PDM|1595.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F132779_0_0|SrvcGrp|112238|2022|PDM|16096.00|99|0.00|KNEE AND JOINT SERVICES|
20|FH_F32056_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115685_64064_0|SrvcGrp|86840|2022|PDM|75.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F136510_0_0|SrvcGrp|84279|2022|PDM|3882.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F67504_0_0|SrvcGrp|3259|2022|PDM|926.00|99|0.00|ACUTE REHABILITATION|
20|FH_F137574_68130_0|SrvcGrp|29464|2022|PCT|1.00|99|0.00|HOME HEALTH VISIT NEWBORN CARE|
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_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|376.76|99|0.00|HAPA WPA-NWPA 2012-13 ASC 306 W/O REV|
20|FH_F115018_78410_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F133207_0_0|SrvcGrp|112220|2022|PDM|6684.00|99|0.00|TREATMENT OF FRACTURE|
20|FH_F130985_0_0|SrvcGrp|3142|2022|PDM|1695.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F122433_0_0|SrvcGrp|72990|2022|PDM|350.00|99|0.00|AEG 1|
20|FH_F130889_68818_0|SrvcGrp|79699|2022|PCT|0.96|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F123278_20850_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F137940_0_0|SrvcGrp|13597|2022|PDM|183.28|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F65200_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN|
20|FH_F136510_0_0|SrvcGrp|45583|2022|PDM|3882.00|99|0.00|CPT 65730|
20|FH_F123896_68114_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F110925_01104_0|SrvcGrp|43567|2022|PDM|94.56|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F143969_71129_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F145803_19061_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35259_0_0|SrvcGrp|30619|2022|PCT|0.66|99|0.00|GAMMA KNIFE|
20|FH_F32996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F145546_52732_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F87618_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|TRANSPLANT SVCS|
20|FH_F89563_29407_0|SrvcGrp|94740|2022|PCT|1.00|99|0.00|AFLURIA VACC IM (>=3 YRS)|
20|FH_F109581_0_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F93114_85016_0|SrvcGrp|27969|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F39479_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34112_0_0|SrvcGrp|24|2022|PDM|4700.00|99|0.00|CARDIAC CATH|
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|506.59|99|0.00|ASPG III|
20|FH_F109601_0_0|SrvcGrp|75497|2022|PDM|624.00|99|0.00|AEG 10|
20|FH_F79427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1113.00|99|0.00|ASPG IV|
20|FH_F128272_60640_0|SrvcGrp|26868|2022|PDM|50.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F70163_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F136690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F87538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128887_57225_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150699_0_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F62915_0_0|SrvcGrp|58766|2022|PCT|1.00|99|0.00|OCN F/S PRICING: HCPCS POS FAC (HCFA)|
20|FH_F92618_0_0|SrvcGrp|75399|2022|PDM|0.12|99|0.00|MED RECORD COPY|
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)|
20|FH_F137067_0_0|SrvcGrp|109965|2022|PDM|5250.00|99|0.00|THORAX SPINE DISK SURGERY|
20|FH_F137487_74447_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F125254_30306_0|SrvcGrp|89149|2022|PDM|252.00|99|0.00|OP INTENSIVE|
20|FH_F132559_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F39819_0_0|SrvcGrp|31219|2022|PDM|7016.00|99|0.00|NY DRG 138 ONLY|
20|FH_F131236_84041_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F122433_0_0|SrvcGrp|109084|2022|PDM|1200.00|99|0.00|NERVOUS SYSTEM|
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 8 (NO REV)|
20|FH_F62915_0_0|SrvcGrp|58800|2022|PCT|1.87|99|0.00|OCN F/S SURGERY (HCFA) POS FAC (MOD 53) GLOBAL|
20|FH_F135219_68506_0|SrvcGrp|111934|2022|PCT|1.00|99|0.00|COVID-19 NUCLEIC ACID|
20|FH_F128276_66441_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130977_0_0|SrvcGrp|13188|2022|PCT|0.30|99|0.00|DRUGS|
20|FH_F38088_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|636.00|99|0.00|AEG 10 (NO REV)|
20|FH_F94102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|OP SVCS|
20|FH_F136510_0_0|SrvcGrp|90566|2022|PDM|2142.00|99|0.00|REMOVE EYE IMPLANT MATERIAL|
20|FH_F112508_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F42722_0_0|SrvcGrp|29093|2022|PDM|72.00|99|0.00|PT / OT / ST|
20|FH_F84778_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125028_19061_0|SrvcGrp|86834|2022|PDM|15.75|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F125899_07645_0|SrvcGrp|73004|2022|PDM|7718.00|99|0.00|AEG 8|
20|FH_F93332_0_0|SrvcGrp|93079|2022|PDM|7416.00|99|0.00|ARTHODESIS (HCFA)|
20|FH_F77883_0_0|SrvcGrp|114565|2022|PDM|175.45|99|0.00|SKILLED NURSING|
20|FH_F125011_74467_0|SrvcGrp|537|2022|PCT|0.63|99|0.00|OBSERVATION SERVICES|
20|FH_F133224_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD UE/KC) - CPD 1963706|
20|FH_F131228_01826_0|SrvcGrp|20898|2022|PDM|36657.97|99|0.00|MS DRG 246 ONLY|
20|FH_F39286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F148169_33138_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F143820_28405_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F135237_31015_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F36366_0_0|SrvcGrp|22921|2022|PDM|632.00|99|0.00|CPT 95808 MOD TC|
20|FH_F93332_0_0|SrvcGrp|93070|2022|PDM|2295.00|99|0.00|POSTERIOR NON-SEGMENTAL INST (HFCA)|
20|FH_F99960_0_0|SrvcGrp|92676|2022|PCT|0.00|99|0.00|IMAGING ENHANCED SUBSTANCE|
20|FH_F38738_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37733_0_0|SrvcGrp|9466|2022|PDM|450.00|99|0.00|SKILLED NURSING - LEVEL IV|
20|FH_F123501_64831_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F122725_32216_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F122898_63011_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F86696_16063_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F86696_16063_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118555_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F119795_0_0|SrvcGrp|27310|2022|PDM|3106.00|99|0.00|ENDOSCOPIC PLANTAR FASCIOTOMY|
20|FH_F86851_0_0|SrvcGrp|84995|2022|PDM|598.00|99|0.00|CPT 45333|
20|FH_F77462_0_0|SrvcGrp|46729|2022|PDM|35.00|99|0.00|RESPITE CARE|
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1590.00|99|0.00|AEG 7 (NO REV)|
20|FH_F129688_74066_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F100785_54660_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F39723_0_0|SrvcGrp|30944|2022|PDM|95.00|99|0.00|HOME PEDIATRIC THERAPY VISITS|
20|FH_F133490_90650_0|SrvcGrp|111288|2022|PCT|1.40|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F113264_71860_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1201.00|99|0.00|AEG 7 (NO REV)|
20|FH_F128144_45697_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F142907_60640_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F44023_0_0|SrvcGrp|38422|2022|PCT|0.69|99|0.00|INTERLUKEN II & DRUGS (OP))|
20|FH_F123078_19119_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141654_15217_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88280_0_0|SrvcGrp|59163|2022|PCT|0.55|99|0.00|OP SURGICAL ANCILLARY SERVICES|
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|ACUTE REHABILITATION|
20|FH_F123039_44147_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150539_48374_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114310_0_0|SrvcGrp|94883|2022|PDM|1275.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F144011_60616_0|CSTM-ALL|CSTM-00|2020|PDM|3574.00|99|0.00|AEG 4 (NO REV)|
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F55375_0_0|SrvcGrp|10904|2022|PDM|1350.00|99|0.00|EMERGENCY ROOM LEVEL II|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S - BDSS|
20|FH_F37475_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127994_19301_0|SrvcGrp|86722|2022|PDM|220.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F71323_68114_0|SrvcGrp|37352|2022|PDM|3006.00|99|0.00|MS DRG 152-153 ONLY|
20|FH_F109812_37043_0|SrvcGrp|86753|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F125266_44515_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F89851_83854_0|SrvcGrp|80838|2022|PDM|16310.00|99|0.00|MSDRG 519 ONLY|
20|FH_F67285_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F103781_0_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F51658_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F118363_30305_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F78682_0_0|SrvcGrp|66168|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F117794_06473_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F102561_75146_0|SrvcGrp|98008|2022|PDM|375.00|99|0.00|DEBRIDEMENT OPEN WOUND|
20|FH_F101923_98104_0|SrvcGrp|80456|2022|PDM|64165.00|99|0.00|GAMMA KNIFE|
20|FH_F145964_10993_0|SrvcGrp|106472|2022|PDM|63.00|99|0.00|CARDIAC REHAB|
20|FH_F92676_15063_0|SrvcGrp|79054|2022|PDM|529.51|99|0.00|MON VALLEY ASC 129|
20|FH_F97140_91730_0|SrvcGrp|73485|2022|PDM|6725.00|99|0.00|AETNA REHAB|
20|FH_F36118_0_0|SrvcGrp|12401|2022|PDM|88.00|99|0.00|RN VISIT|
20|FH_F142970_43055_0|SrvcGrp|106314|2022|PDM|525.00|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|AEG 6 (NO REV)|
20|FH_F133416_87402_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PDM|644.00|99|0.00|ASPG I|
20|FH_F146258_90004_0|SrvcGrp|90854|2022|PDM|1310.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F141852_78102_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F107140_0_0|SrvcGrp|15850|2022|PDM|130.00|99|0.00|HOSPICE SVCS|
20|FH_F72859_0_0|SrvcGrp|1168|2022|PDM|665.79|99|0.00|CONTINUOUS HOMECARE|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KD|
20|FH_F132224_89119_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F117559_08619_0|SrvcGrp|103552|2022|PDM|158.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F95482_0_0|SrvcGrp|86582|2022|PDM|1217.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F111809_93003_0|SrvcGrp|10361|2022|PDM|2089.00|99|0.00|CPT CODE 99281|
20|FH_F87155_04105_0|SrvcGrp|22589|2022|PDM|57.78|99|0.00|CHEMOTHERAPY NOC|
20|FH_F117087_0_0|SrvcGrp|107176|2022|PDM|2494.00|99|0.00|REMOVE EAR LESION|
20|FH_F118698_32054_0|CSTM-ALL|CSTM-00|2020|PCT|2.10|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F63244_0_0|SrvcGrp|33165|2022|PDM|370.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F40331_0_0|CSTM-ALL|CSTM-00|2020|PDM|1573.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146211_68144_0|SrvcGrp|72121|2022|PDM|6180.00|99|0.00|ARTHOSCOPY|
20|FH_F133455_60110_0|SrvcGrp|23683|2022|PDM|58.35|99|0.00|SKILLED NURSING RN|
20|FH_F120430_32177_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - OP|
20|FH_F123039_44147_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F36002_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134490_62801_0|SrvcGrp|104714|2022|PDM|2605.00|99|0.00|REPAIR OF  TENDON(S)|
20|FH_F144789_48304_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133478_40165_0|SrvcGrp|92958|2022|PCT|0.54|99|0.00|SLEEP STUDIES|
20|FH_F39723_0_0|SrvcGrp|30950|2022|PDM|90.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F102900_44883_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F99720_0_0|SrvcGrp|73002|2022|PDM|3110.00|99|0.00|AEG 7|
20|FH_F89932_10940_0|SrvcGrp|86582|2022|PDM|6395.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F92636_90230_0|SrvcGrp|48385|2022|PDM|89.25|99|0.00|SPEECH THERAPY|
20|FH_F110240_0_0|CSTM-ALL|CSTM-00|2020|PDM|716.00|99|0.00|AEG 2 (NO REV)|
20|FH_F136751_0_0|SrvcGrp|88162|2022|PDM|9500.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F149861_85225_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F124608_0_0|SrvcGrp|109911|2022|PDM|6630.00|99|0.00|WRIST REPLACEMENT|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD AW|
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F39517_0_0|SrvcGrp|941|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F133533_33901_0|SrvcGrp|73842|2022|PDM|187.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F123324_0_0|SrvcGrp|63|2022|PDM|1711.00|99|0.00|SUBACUTE CARE|
20|FH_F148644_06890_0|SrvcGrp|26278|2022|PDM|3712.00|99|0.00|CPT 29881|
20|FH_F89340_0_0|SrvcGrp|29830|2022|PDM|1936.00|99|0.00|PERCUT NEEDLE INSERTION|
20|FH_F89372_0_0|SrvcGrp|79099|2022|PDM|5789.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F89495_0_0|SrvcGrp|83806|2022|PDM|1530.00|99|0.00|JAW ARTHROSCOPY/TMJ SURGERY|
20|FH_F90354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87474_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|106% OF ASP DRUGS/IMMUN UPDATE QUARTERLY|
20|FH_F145690_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F32709_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F131860_38834_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133581_84790_0|CSTM-ALL|CSTM-00|2020|PDM|737.03|99|0.00|AEG 2 (NO REV)|
20|FH_F139289_0_0|SrvcGrp|113492|2022|PDM|195.36|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F134839_60942_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE|
20|FH_F87480_0_0|SrvcGrp|86235|2022|PDM|1000.00|99|0.00|AETHA HAND SURGERY|
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123783_03860_0|SrvcGrp|48398|2022|PDM|163.00|99|0.00|PT SERVICES|
20|FH_F123741_20850_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121250_47401_0|SrvcGrp|46903|2022|PDM|984.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F64999_0_0|CSTM-ALL|CSTM-00|2020|PDM|644.00|99|0.00|ASPG II|
20|FH_F117465_0_0|SrvcGrp|96353|2022|PDM|9000.00|99|0.00|RECONSTRUCT ANKLE JOINT|
20|FH_F136374_34461_0|CSTM-ALL|CSTM-00|2020|PDM|637.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F136386_30901_0|SrvcGrp|113011|2022|PDM|500.00|99|0.00|CAT SCAN W/ER|
20|FH_F93292_62234_0|SrvcGrp|73701|2022|PDM|85.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F93292_62234_0|SrvcGrp|46605|2022|PDM|86.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F134167_10032_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F137242_52722_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F139107_61024_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|2295.00|99|0.00|AEG 9 (NO REV)|
20|FH_F56832_0_0|SrvcGrp|177|2022|PDM|1700.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F138471_84663_0|SrvcGrp|48396|2022|PDM|85.50|99|0.00|OT SERVICES|
20|FH_F138584_30912_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|AEG 1 (NO REV)|
20|FH_F138607_02760_0|SrvcGrp|108418|2022|PDM|18.00|99|0.00|MANUAL BREAST PUMP (MOD NU)|
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 6 (NO REV)|
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 2 (NO REV)|
20|FH_F119046_74012_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F92506_07666_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F109920_39180_0|SrvcGrp|75497|2022|PDM|990.00|99|0.00|AEG 10|
20|FH_F129438_08234_0|SrvcGrp|89412|2022|PDM|475.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F129483_77030_0|SrvcGrp|86850|2022|PDM|35.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F129483_77030_0|SrvcGrp|24761|2022|PDM|5.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F117107_33704_0|SrvcGrp|104469|2022|PDM|4750.00|99|0.00|VBAC DELIVERY|
20|FH_F117218_32025_0|SrvcGrp|73842|2022|PDM|186.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137806_83702_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F109632_0_0|SrvcGrp|87536|2022|PDM|464.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F91472_96001_0|SrvcGrp|12664|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F124757_45750_0|SrvcGrp|78403|2022|PDM|0.25|99|0.00|AETNA MED RECORD|
20|FH_F139820_75657_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F95880_02726_0|SrvcGrp|72379|2022|PDM|76.33|99|0.00|SPEECH THERAPY|
20|FH_F151141_24014_0|CSTM-ALL|CSTM-00|2020|PDM|2380.00|99|0.00|AEG 8 (NO REV)|
20|FH_F151223_73077_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121329_33015_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F130066_84107_0|SrvcGrp|46903|2022|PDM|650.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F110381_0_0|SrvcGrp|89942|2022|PDM|10335.00|99|0.00|PERCUTANEOUS INTRADISCAL|
20|FH_F91873_12723_0|SrvcGrp|75999|2022|PDM|355.00|99|0.00|OP URGENT CARE|
20|FH_F97660_29401_0|SrvcGrp|88978|2022|PDM|10312.00|99|0.00|VAGINAL DELIVERY|
20|FH_F117001_0_0|SrvcGrp|106600|2022|PDM|650.00|99|0.00|HEARING AID, DIGIT, MON, ITC|
20|FH_F87201_0_0|SrvcGrp|29462|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE - MOD TF|
20|FH_F87201_0_0|SrvcGrp|42974|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F110448_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F104840_32565_0|SrvcGrp|75481|2022|PCT|0.69|99|0.00|AEG 2|
20|FH_F105588_15228_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F105591_17601_0|SrvcGrp|73004|2022|PDM|1842.00|99|0.00|AEG 8|
20|FH_F102041_35010_0|SrvcGrp|48385|2022|PDM|145.00|99|0.00|SPEECH THERAPY|
20|FH_F43717_0_0|SrvcGrp|350|2022|PDM|918.00|99|0.00|SURGICAL CARE|
20|FH_F44195_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F129254_0_0|CSTM-ALL|CSTM-00|2020|PDM|1227.30|99|0.00|ASPG VIII|
20|FH_F94740_32904_0|SrvcGrp|12403|2022|PDM|31.22|99|0.00|CONTINUOUS HOMECARE|
20|FH_F72204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|INFUSION THERAPY (MOD SH)|
20|FH_F40333_0_0|SrvcGrp|9774|2022|PDM|2000.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PDM|611.00|99|0.00|ASPG I|
20|FH_F49812_0_0|SrvcGrp|45868|2022|PDM|20.00|99|0.00|CPT 92567|
20|FH_F146844_78582_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146922_68108_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146993_66020_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F34652_0_0|SrvcGrp|43|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F36667_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39066_0_0|SrvcGrp|701|2022|PDM|1800.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F124233_92648_0|SrvcGrp|75419|2022|PDM|900.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F124575_33351_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124663_65608_0|SrvcGrp|75545|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F121799_0_0|SrvcGrp|82223|2022|PDM|103.00|99|0.00|HOSPICE CARE|
20|FH_F64779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F69685_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F136658_50401_0|SrvcGrp|74668|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F122638_59715_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC|
20|FH_F42980_0_0|SrvcGrp|50205|2022|PDM|125.00|99|0.00|CPT 99211|
20|FH_F123647_66441_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F123848_03257_0|SrvcGrp|43567|2022|PDM|160.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F123741_20850_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F126770_43050_0|SrvcGrp|93098|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F47495_0_0|SrvcGrp|18076|2022|PCT|0.50|99|0.00|MRI|
20|FH_F136481_61350_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134075_78230_0|SrvcGrp|48396|2022|PDM|125.00|99|0.00|OT SERVICES|
20|FH_F142527_89109_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F142690_31774_0|SrvcGrp|26869|2022|PDM|55.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F138607_02760_0|SrvcGrp|114134|2022|PDM|450.00|99|0.00|EXTERNAL TRANSMITTER (MOD NU)|
20|FH_F138627_82901_0|SrvcGrp|98978|2022|PDM|150.00|99|0.00|TPN ONE LITER PER DAY (HCFA)|
20|FH_F139267_30253_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140332_19041_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F80284_16354_0|SrvcGrp|111927|2022|PDM|15.31|99|0.00|COVID-19 NON CDC|
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|1760.00|99|0.00|AEG 4 (NO REV)|
20|FH_F149531_80237_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F118943_64506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109920_39180_0|SrvcGrp|78579|2022|PDM|1375.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
20|FH_F92852_0_0|SrvcGrp|28547|2022|PDM|2200.00|99|0.00|VITRECTOMY|
20|FH_F117102_39355_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137905_91364_0|SrvcGrp|46903|2022|PDM|1300.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F137937_20032_0|SrvcGrp|3178|2022|PDM|1591.00|99|0.00|ACUTE PSYCH|
20|FH_F137938_29036_0|SrvcGrp|31704|2022|PDM|4623.00|99|0.00|MS DRG 790 ONLY|
20|FH_F35210_0_0|SrvcGrp|418|2022|PCT|0.70|99|0.00|LAPAROSCOPIC HYSTERECTOMY|
20|FH_F109652_0_0|SrvcGrp|15480|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F109821_0_0|SrvcGrp|103082|2022|PDM|714.00|99|0.00|GASTROENTEROLOGY|
20|FH_F91472_96001_0|SrvcGrp|103735|2022|PDM|16413.00|99|0.00|ANGIOPLASTY|
20|FH_F124754_84403_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1792.00|99|0.00|AEG 9 (NO REV)|
20|FH_F47452_0_0|SrvcGrp|33643|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F50446_0_0|SrvcGrp|45148|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F151054_06473_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F151058_18064_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151086_60649_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151144_35801_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F151144_35801_0|SrvcGrp|46885|2022|PDM|915.43|99|0.00|REPAIR BROW DEFECT|
20|FH_F113866_0_0|SrvcGrp|89822|2022|PDM|100.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F101387_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|GENERAL ACUTE CARE|
20|FH_F114267_0_0|SrvcGrp|36591|2022|PDM|2500.00|99|0.00|CPT 63685|
20|FH_F97721_01053_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F33530_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|BURN SERVICES|
20|FH_F117299_0_0|SrvcGrp|68053|2022|PDM|1701.00|99|0.00|CPT 52234|
20|FH_F117299_0_0|CSTM-ALL|CSTM-00|2020|PDM|1688.00|99|0.00|AEG 6 (NO REV)|
20|FH_F73231_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INFUSION REV CODE 949|
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_F114916_30309_0|SrvcGrp|27261|2022|PDM|10500.00|99|0.00|CPT 27446|
20|FH_F142319_19403_0|SrvcGrp|108484|2022|PDM|629.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F111925_0_0|SrvcGrp|88154|2022|PDM|1602.00|99|0.00|LASER TREATMENT OLD RETINA|
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|AEG 10 (NO REV)|
20|FH_F130439_85014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F102041_35010_0|SrvcGrp|48394|2022|PDM|84.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F33856_0_0|SrvcGrp|701|2022|PDM|1400.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F55694_0_0|SrvcGrp|39245|2022|PCT|0.59|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS (CARDIAC)|
20|FH_F132988_0_0|SrvcGrp|105634|2022|PDM|4493.01|99|0.00|KNEE JOINT LINING|
20|FH_F132988_0_0|SrvcGrp|89946|2022|PDM|4493.01|99|0.00|REPAIR OF KNEE LIGAMENT|
20|FH_F88933_0_0|SrvcGrp|112912|2022|PDM|10609.00|99|0.00|REMOVAL OF PACEMAKER|
20|FH_F88933_0_0|SrvcGrp|87523|2022|PDM|3939.00|99|0.00|AETNA KNEE RECONSTRUCTION|
20|FH_F141036_02347_0|SrvcGrp|112812|2022|PCT|1.00|99|0.00|COVID-19 LAB TRANSFER|
20|FH_F50415_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 642|
20|FH_F93252_0_0|SrvcGrp|93027|2022|PDM|8000.00|99|0.00|TOTAL SHOULDER REPLACEMENT|
20|FH_F114389_50131_0|SrvcGrp|26868|2022|PDM|130.65|99|0.00|DIURETIC IV THERAPY|
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|628.00|99|0.00|AEG 4 (NO REV)|
20|FH_F100703_0_0|SrvcGrp|97239|2022|PDM|7876.00|99|0.00|DISKECTOMY CERVICAL SINGLE|
20|FH_F124237_95023_0|SrvcGrp|108484|2022|PDM|1200.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F124417_85364_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124663_65608_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136590_71263_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F114629_19131_0|SrvcGrp|16069|2022|PDM|986.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F114666_30342_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|AEG 3 (NO REV)|
20|FH_F114764_78214_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138310_60461_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F129913_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F122610_73139_0|SrvcGrp|62210|2022|PDM|121.00|99|0.00|MAMMOGRAPHY - VISIT LEVEL|
20|FH_F42917_0_0|SrvcGrp|4109|2022|PDM|825.00|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_F43352_0_0|CSTM-ALL|CSTM-00|2020|PDM|1590.00|99|0.00|WELLPATH PROPIETARY ASC VII|
20|FH_F135719_45502_0|CSTM-ALL|CSTM-00|2020|PDM|657.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F136799_75061_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39622_0_0|SrvcGrp|3037|2022|PDM|6115.00|99|0.00|LITHOTRIPSY|
20|FH_F42169_0_0|SrvcGrp|20801|2022|PCT|0.85|99|0.00|HOME HEALTH|
20|FH_F115210_21043_0|SrvcGrp|93432|2022|PDM|11000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F115733_33012_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F116393_07002_0|SrvcGrp|106514|2022|PDM|17.48|99|0.00|ASSAY IGA/IGD/IGG/IGM EACH|
20|FH_F147466_18355_0|SrvcGrp|108484|2022|PDM|850.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F147527_60645_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147620_67119_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F41171_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F42153_0_0|SrvcGrp|3029|2022|PDM|578.00|99|0.00|NEWBORN NURSERY|
20|FH_F42522_0_0|SrvcGrp|36145|2022|PDM|16538.00|99|0.00|OP CARDIAC SERVICES|
20|FH_F116907_75093_0|SrvcGrp|106263|2022|PDM|460.00|99|0.00|AETNA PARTIAL HOSP PSYCH|
20|FH_F119921_83213_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F120927_28645_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F120974_27607_0|SrvcGrp|103913|2022|PCT|0.71|99|0.00|OP DIALYSIS|
20|FH_F126438_50029_0|SrvcGrp|87317|2022|PDM|888.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F127033_54501_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F31150_0_0|SrvcGrp|9863|2022|PDM|1400.00|99|0.00|INTENSIVE CARE/CORONARY CARE UNIT|
20|FH_F51276_0_0|SrvcGrp|14947|2022|PDM|65.00|99|0.00|HOME INFUSION|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|22990.00|99|0.00|MS DRG 242-245 OTHER PERMANENT CARDIAC PACEMAKER IMP W/O|
20|FH_F35685_0_0|SrvcGrp|1174|2022|PDM|35280.00|99|0.00|DRG 105 CARDIAC VALVE PX & OTHER MJR CARDIOTHORACIC PX W/CC|
20|FH_F35685_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F40517_0_0|SrvcGrp|3809|2022|PDM|729.81|99|0.00|HOSPICE CARE|
20|FH_F42423_0_0|SrvcGrp|36273|2022|PDM|284.50|99|0.00|INTRAOCULAR LENS|
20|FH_F67820_15009_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F132772_0_0|SrvcGrp|112095|2022|PDM|217.00|99|0.00|DIALYSIS|
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|1149.00|99|0.00|AEG 6 (NO REV)|
20|FH_F139887_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F133478_40165_0|SrvcGrp|112337|2022|PCT|0.54|99|0.00|DIGIT REPLANTATION|
20|FH_F133133_32433_0|SrvcGrp|105425|2022|PDM|28.17|99|0.00|AETNA EXPOSURE ADAPTIVE BH TREATMENT 60 MINS|
20|FH_F133047_74012_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F133494_90023_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.60|99|0.00|AEG 4 (NO REV)|
20|FH_F34477_0_0|SrvcGrp|16494|2022|PDM|425.00|99|0.00|MULTIPLE SLEEP LATENCY|
20|FH_F134087_0_0|SrvcGrp|89860|2022|PDM|5410.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F133579_0_0|SrvcGrp|28551|2022|PDM|2205.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F141837_0_0|SrvcGrp|13597|2022|PDM|300.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F117820_0_0|SrvcGrp|24739|2022|PDM|82.34|99|0.00|RESPITE CARE|
20|FH_F114853_0_0|SrvcGrp|67068|2022|PDM|7699.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|1281.00|99|0.00|AEG 8 (NO REV)|
20|FH_F138770_75142_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138787_32258_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F138880_92392_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139115_32504_0|SrvcGrp|82981|2022|PDM|144.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F39018_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118986_0_0|SrvcGrp|75481|2022|PDM|640.76|99|0.00|AEG 2|
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|270.34|99|0.00|HAPA WPA-NWPA 2012-13 ASC 231 W/O REV|
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|4199.00|99|0.00|AEG 5  (NO REV)|
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PDM|1519.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F84139_0_0|SrvcGrp|12682|2022|PDM|140.00|99|0.00|GROUP THERAPY|
20|FH_F151341_75904_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151503_30067_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F132258_45404_0|SrvcGrp|23683|2022|PDM|40.28|99|0.00|SKILLED NURSING RN|
20|FH_F132268_07060_0|SrvcGrp|89500|2022|PDM|236.00|99|0.00|SPEECH SOUND LANGUAGE|
20|FH_F145208_63640_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136153_62960_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F129456_30809_0|SrvcGrp|113849|2022|PCT|1.00|99|0.00|INFECTIOUS ANTIGEN DETECTION N GONORRHOEAE DNA AMP PROB|
20|FH_F130584_32812_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131132_44077_0|SrvcGrp|110428|2022|PCT|1.25|99|0.00|LABORATORY SERVICES|
20|FH_F116397_33404_0|SrvcGrp|17015|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116464_13088_0|SrvcGrp|104078|2022|PCT|1.05|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F128104_57702_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F101661_08879_0|SrvcGrp|93919|2022|PDM|624.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F121713_84747_0|SrvcGrp|108484|2022|PDM|800.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F121796_68355_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F111291_52501_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F111363_33169_0|SrvcGrp|63457|2022|PDM|219.00|99|0.00|ULTRASOUND|
20|FH_F111383_62233_0|SrvcGrp|103913|2022|PCT|0.88|99|0.00|OP DIALYSIS|
20|FH_F134315_89106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43693_0_0|SrvcGrp|16420|2022|PDM|340.00|99|0.00|PSYCH RESIDENTIAL TREATMENT|
20|FH_F134733_19460_0|SrvcGrp|58509|2022|PDM|502.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F134735_91362_0|SrvcGrp|105350|2022|PDM|560.00|99|0.00|AETNA PARTIAL HOSPITALIZATION|
20|FH_F134770_14420_0|SrvcGrp|471|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F58153_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F115144_71373_0|SrvcGrp|105888|2022|PDM|153.00|99|0.00|WOUND CARE|
20|FH_F115157_06851_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F115263_47129_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F116365_11417_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F116393_07002_0|SrvcGrp|106510|2022|PDM|147.00|99|0.00|THERAPEUTIC SERVICES|
20|FH_F41540_0_0|SrvcGrp|11000|2022|PCT|0.26|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F41809_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|ACUTE PSYCH|
20|FH_F100780_24153_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F118446_0_0|SrvcGrp|82222|2022|PDM|150.00|99|0.00|HOSPICE CARE|
20|FH_F131235_36049_0|SrvcGrp|74668|2022|PDM|385.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F92871_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|2328.70|99|0.00|AEG 9 (NO REV)|
20|FH_F102641_0_0|SrvcGrp|72998|2022|PDM|1250.00|99|0.00|AEG 5|
20|FH_F149267_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
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_F148645_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F113154_70359_0|SrvcGrp|104935|2022|PCT|1.00|99|0.00|DRUG ADMIN|
20|FH_F133579_0_0|SrvcGrp|96839|2022|PDM|3248.00|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F82357_0_0|SrvcGrp|26001|2022|PDM|138.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F150939_0_0|SrvcGrp|25385|2022|PDM|80.00|99|0.00|CPT 10060|
20|FH_F38949_0_0|SrvcGrp|411|2022|PDM|3614.00|99|0.00|OP CARDIAC CATH|
20|FH_F138674_75149_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138880_92392_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F81823_0_0|SrvcGrp|79952|2022|PDM|11.00|99|0.00|INFLUENZA ADMINISTRATION|
20|FH_F81823_0_0|SrvcGrp|57968|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1209.21|99|0.00|HAPA WPA-NWPA 2012-13 ASC 702 W/O REV|
20|FH_F151302_80227_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F151425_19111_0|SrvcGrp|82981|2022|PDM|145.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F151503_30067_0|SrvcGrp|41327|2022|PDM|2090.00|99|0.00|OP SURGERY CPT 28308|
20|FH_F151503_30067_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 4 (NO REV)|
20|FH_F151516_63023_0|SrvcGrp|75419|2022|PDM|410.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F40073_0_0|SrvcGrp|17081|2022|PCT|0.70|99|0.00|ASPG IX|
20|FH_F40334_0_0|SrvcGrp|65|2022|PDM|2333.00|99|0.00|OBSTETRICAL CARE|
20|FH_F135438_29030_0|SrvcGrp|46903|2022|PDM|764.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F135969_33904_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135976_67401_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136067_67037_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100880_67735_0|SrvcGrp|12345|2022|PCT|0.84|99|0.00|OP TRAUMA|
20|FH_F116397_33404_0|SrvcGrp|86840|2022|PDM|40.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F116397_33404_0|SrvcGrp|90338|2022|PDM|68.00|99|0.00|SKILLED NURSING RN (HCFA)|
20|FH_F140629_0_0|SrvcGrp|79101|2022|PDM|1372.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F33556_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F121411_33063_0|SrvcGrp|89149|2022|PDM|170.00|99|0.00|OP INTENSIVE|
20|FH_F121428_40202_0|SrvcGrp|75505|2022|PCT|0.33|99|0.00|CARDIAC STUDIES|
20|FH_F146125_0_0|SrvcGrp|101520|2022|PDM|3150.00|99|0.00|T1H W/T/O (<250G)|
20|FH_F146125_0_0|SrvcGrp|105701|2022|PDM|2405.00|99|0.00|REPAIR OF VAGINA|
20|FH_F32168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42098_0_0|SrvcGrp|28286|2022|PDM|35.00|99|0.00|IV NURSE EA ADD HR  99602 MOD SD|
20|FH_F42347_0_0|SrvcGrp|28919|2022|PDM|34.00|99|0.00|CPT 97750|
20|FH_F134315_89106_0|SrvcGrp|112551|2022|PCT|1.00|99|0.00|ALL OUTPATIENT DRUGS (C, J, Q & S CODES)|
20|FH_F141651_0_0|SrvcGrp|113813|2022|PDM|2200.00|99|0.00|REMOVAL OF NOSE POLYPS|
20|FH_F36344_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|720223_LABS_MOD QW|
20|FH_F116430_0_0|SrvcGrp|37317|2022|PDM|3713.00|99|0.00|LITHOTRIPSY|
20|FH_F132328_0_0|SrvcGrp|97465|2022|PDM|2123.00|99|0.00|REMOVE PROSTATE REGROWTH|
20|FH_F87500_16823_0|SrvcGrp|73485|2022|PDM|1231.00|99|0.00|AETNA REHAB|
20|FH_F129240_10028_0|SrvcGrp|86847|2022|PDM|40.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F101620_47401_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F101620_47401_0|SrvcGrp|46903|2022|PDM|639.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F143542_0_0|SrvcGrp|42550|2022|PDM|5738.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F111594_0_0|SrvcGrp|67279|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY|
20|FH_F119347_27540_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148379_89129_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F35454_0_0|SrvcGrp|16512|2022|PDM|4.00|99|0.00|CPT 81002|
20|FH_F128246_0_0|SrvcGrp|111039|2022|PDM|726.00|99|0.00|REPAIR OF ENTROPION|
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131699_08210_0|SrvcGrp|23683|2022|PDM|72.38|99|0.00|SKILLED NURSING RN|
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1054.90|99|0.00|AEG 4 (NO REV)|
20|FH_F123085_21921_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F101840_76054_0|SrvcGrp|22781|2022|PDM|17445.00|99|0.00|MS DRG 244 ONLY|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|466.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F101922_98055_0|SrvcGrp|80679|2022|PCT|2.79|99|0.00|AETNA RADIOLOGY|
20|FH_F54552_0_0|SrvcGrp|24934|2022|PDM|75.00|99|0.00|NUTRITIONAL ASSESSMENT (INITIAL)|
20|FH_F133493_90255_0|SrvcGrp|106164|2022|PCT|1.40|99|0.00|AETNA ALL DRUGS OR DRUG AGENTS|
20|FH_F96280_06340_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F128381_61342_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F101320_26062_0|SrvcGrp|48396|2022|PDM|108.00|99|0.00|OT SERVICES|
20|FH_F148100_22406_0|SrvcGrp|48396|2022|PDM|84.00|99|0.00|OT SERVICES|
20|FH_F63129_0_0|SrvcGrp|48393|2022|PDM|8.50|99|0.00|SKILLED NURSING SERVICES (PER HOUR)|
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|ACUTE PSYCH|
20|FH_F130801_57717_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F32073_0_0|SrvcGrp|3259|2022|PDM|1103.00|99|0.00|ACUTE REHABILITATION|
20|FH_F35805_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F145562_70458_0|SrvcGrp|86849|2022|PDM|25.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F109577_0_0|SrvcGrp|87393|2022|PDM|135.00|99|0.00|HCPCS G0151 (HCFA)|
20|FH_F130763_0_0|SrvcGrp|83646|2022|PDM|4367.00|99|0.00|CPT 31276|
20|FH_F130017_02302_0|SrvcGrp|73603|2022|PDM|2594.51|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F89574_0_0|SrvcGrp|73606|2022|PDM|525.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F123633_70506_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F127900_63080_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111702_07652_0|SrvcGrp|96401|2022|PCT|1.00|99|0.00|ACYELOVIR INJECTION|
20|FH_F150165_06032_0|SrvcGrp|89988|2022|PDM|3872.00|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|579.80|99|0.00|2005 ASPG GROUPER II|
20|FH_F88744_71103_0|CSTM-ALL|CSTM-00|2020|PDM|984.00|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F52713_0_0|SrvcGrp|70440|2022|PDM|1700.00|99|0.00|TCU|
20|FH_F120930_0_0|SrvcGrp|97895|2022|PDM|4000.00|99|0.00|REVISE KNEE 2|
20|FH_F114404_73044_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109405_73106_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F87812_33919_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F45317_0_0|CSTM-ALL|CSTM-00|2020|PCT|35.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50703_0_0|SrvcGrp|46963|2022|PDM|40.00|99|0.00|RN SERVICES (CPT 99602)|
20|FH_F119213_66209_0|SrvcGrp|98372|2022|PCT|1.00|99|0.00|SPEECH EVALUATION|
20|FH_F121816_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148644_06890_0|SrvcGrp|115480|2022|PDM|2200.00|99|0.00|REMOVE VAGINA LESION|
20|FH_F119864_63141_0|SrvcGrp|29347|2022|PDM|22.50|99|0.00|HOME HEALTH AIDE|
20|FH_F85353_16407_0|SrvcGrp|63920|2022|PDM|102.02|99|0.00|HAPA WPA-NWPA 2012-13 ASC 145|
20|FH_F114823_15701_0|SrvcGrp|86722|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F143669_78577_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F85353_16407_0|SrvcGrp|63919|2022|PDM|102.91|99|0.00|HAPA WPA-NWPA 2012-13 ASC 245|
20|FH_F52956_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|ZERO ALLOWABLE - INPATIENT SERVICES|
20|FH_F149364_19335_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F121303_15501_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144808_0_0|SrvcGrp|88158|2022|PDM|7215.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F143560_03079_0|SrvcGrp|115127|2022|PDM|376.91|99|0.00|CT W/ CONTRAST|
20|FH_F63312_0_0|SrvcGrp|16302|2022|PDM|42.00|99|0.00|VENIPUNCTURE|
20|FH_F119125_0_0|SrvcGrp|8960|2022|PDM|200.00|99|0.00|SPEECH THERAPY|
20|FH_F148600_30328_0|SrvcGrp|88824|2022|PDM|3933.00|99|0.00|CPT 69631|
20|FH_F133801_87107_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F125513_40071_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F119227_01752_0|SrvcGrp|86854|2022|PDM|75.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F125259_0_0|SrvcGrp|108119|2022|PDM|1300.00|99|0.00|ARTERY-VEIN FUSION|
20|FH_F124161_95932_0|SrvcGrp|10391|2022|PDM|3381.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F110465_30328_0|SrvcGrp|73841|2022|PDM|539.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 5  (NO REV)|
20|FH_F139207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146543_89511_0|SrvcGrp|90854|2022|PDM|1061.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|3455.00|99|0.00|AEG 9 (NO REV)|
20|FH_F126085_76002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86094_16748_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F36753_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD AV|
20|FH_F121225_98902_0|SrvcGrp|29023|2022|PDM|190.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|181.15|99|0.00|HAPA WPA-NWPA 2012-13 ASC 136 W/O REV|
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|885.00|99|0.00|AEG 6 (NO REV)|
20|FH_F150165_06032_0|SrvcGrp|67066|2022|PDM|17900.00|99|0.00|CERVICAL SURGERY|
20|FH_F60112_0_0|SrvcGrp|471|2022|PDM|608.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117245_0_0|SrvcGrp|72998|2022|PDM|1183.00|99|0.00|AEG 5|
20|FH_F51039_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|2010 LABORATORY (MOD 26)|
20|FH_F137362_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83380_0_0|SrvcGrp|43270|2022|PDM|50.00|99|0.00|CATHETER REPAIR|
20|FH_F119613_90035_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F118088_71261_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F72431_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134496_66062_0|SrvcGrp|75419|2022|PDM|258.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F122552_03103_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F122553_92705_0|SrvcGrp|106248|2022|PDM|467.00|99|0.00|PARTIAL HOSP PSYCH|
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F85055_0_0|SrvcGrp|73000|2022|PDM|950.00|99|0.00|AEG 6|
20|FH_F85553_0_0|SrvcGrp|59159|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F87815_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70684_0_0|SrvcGrp|42975|2022|PDM|115.99|99|0.00|PHYSICAL THERAPIST|
20|FH_F75963_0_0|SrvcGrp|46424|2022|PDM|18.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F79644_0_0|SrvcGrp|89734|2022|PDM|616.00|99|0.00|ER SVCS|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|78.00|99|0.00|PSYTX W PT 60 MINS (HCFA)|
20|FH_F40297_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|NEWBORN NURSERY|
20|FH_F44258_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133474_0_0|SrvcGrp|111929|2022|PDM|15.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F144011_60616_0|SrvcGrp|39824|2022|PDM|353.00|99|0.00|ER SERVICES LEVEL 1 & 2|
20|FH_F117993_32054_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|AETNA MCARE2 OCN F/S PRICING (POS 72)|
20|FH_F97560_23249_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|366.00|99|0.00|ASPG I|
20|FH_F143487_0_0|CSTM-ALL|CSTM-00|2020|PDM|674.00|99|0.00|AEG 1 (NO REV)|
20|FH_F37035_0_0|SrvcGrp|33829|2022|PDM|1259.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 7|
20|FH_F72859_0_0|SrvcGrp|15516|2022|PDM|70.00|99|0.00|HYDRATION THERAPY|
20|FH_F88956_0_0|SrvcGrp|73461|2022|PDM|2869.00|99|0.00|AETNA NICU IV|
20|FH_F83294_0_0|SrvcGrp|10545|2022|PDM|85.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F128349_43082_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F80855_0_0|SrvcGrp|27348|2022|PDM|2625.00|99|0.00|OP SURGERY (CPT 58662)|
20|FH_F87455_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|85.97|99|0.00|HAPA WPA-NWPA 2012-13 ASC 317 W/O REV|
20|FH_F122958_45014_0|SrvcGrp|104079|2022|PCT|1.50|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F68831_0_0|SrvcGrp|8962|2022|PDM|99.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F133478_40165_0|SrvcGrp|105465|2022|PDM|72.00|99|0.00|AETNA THERAPIES|
20|FH_F97541_33021_0|SrvcGrp|88978|2022|PDM|7618.00|99|0.00|VAGINAL DELIVERY|
20|FH_F133006_48067_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F144048_91324_0|SrvcGrp|108484|2022|PDM|2835.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F44646_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128472_53129_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F106420_18510_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F148906_79336_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123181_75057_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F72750_0_0|SrvcGrp|220|2022|PCT|0.40|99|0.00|INTRAOCULAR LENSES|
20|FH_F101840_76054_0|SrvcGrp|73002|2022|PDM|2855.00|99|0.00|AEG 7|
20|FH_F92677_08003_0|SrvcGrp|92189|2022|PDM|408.45|99|0.00|CPT 95808  (HCFA)|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|471.41|99|0.00|ASPG 304|
20|FH_F144011_60616_0|SrvcGrp|114127|2022|PCT|0.45|99|0.00|CRITICAL CARE FOR ER SERVICES|
20|FH_F97561_30030_0|SrvcGrp|73601|2022|PDM|7953.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F106243_92780_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F89932_10940_0|SrvcGrp|73006|2022|PDM|3565.00|99|0.00|AEG 9|
20|FH_F145988_06105_0|SrvcGrp|114468|2022|PCT|2.49|99|0.00|RADIOLOGY|
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 7 (NO REV)|
20|FH_F41173_0_0|CSTM-ALL|CSTM-00|2020|PDM|364.00|99|0.00|CD ADOLESCENT RESIDENTIAL TREATMENT|
20|FH_F71323_68114_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F67265_0_0|CSTM-ALL|CSTM-00|2020|PDM|830.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F141849_76053_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD TC|
20|FH_F136751_0_0|SrvcGrp|78096|2022|PDM|7500.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F146250_67601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147800_0_0|SrvcGrp|98103|2022|PDM|83.00|99|0.00|INJECTION TRIGGER POINTS >3|
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|1291.00|99|0.00|AEG 5  (NO REV)|
20|FH_F89015_74017_0|SrvcGrp|87394|2022|PDM|110.00|99|0.00|HCPCS G0152 (HCFA)|
20|FH_F40267_0_0|SrvcGrp|23190|2022|PCT|0.75|99|0.00|AICD (MS DRG ONLY)|
20|FH_F49044_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F56793_0_0|SrvcGrp|26253|2022|PDM|4.95|99|0.00|LIPIDS|
20|FH_F89015_74017_0|SrvcGrp|73524|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY|
20|FH_F97622_75051_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F126663_91423_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F143200_91602_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F106540_26330_0|CSTM-ALL|CSTM-00|2020|PDM|2926.00|99|0.00|AETNA OP PET SCANS (PET)|
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|AEG 5  (NO REV)|
20|FH_F116828_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F67861_0_0|SrvcGrp|24807|2022|PCT|0.60|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F101922_98055_0|SrvcGrp|72992|2022|PDM|2900.00|99|0.00|AEG 2|
20|FH_F126560_43606_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PDM|3520.00|99|0.00|AEG 6 (NO REV)|
20|FH_F100665_07939_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F42168_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS|
20|FH_F126560_43606_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|ASPG X|
20|FH_F150884_75503_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97201_15068_0|SrvcGrp|48394|2022|PDM|33.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F132503_73086_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F33659_0_0|SrvcGrp|15387|2022|PDM|95.00|99|0.00|RN VISIT|
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2835.00|99|0.00|AEG 7 (NO REV)|
20|FH_F89233_0_0|SrvcGrp|12837|2022|PCT|0.76|99|0.00|INTRAOCULAR LENSES|
20|FH_F146377_85007_0|SrvcGrp|90854|2022|PDM|860.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F91255_19401_0|CSTM-ALL|CSTM-00|2020|PDM|2247.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119007_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F102561_75146_0|SrvcGrp|73006|2022|PDM|4560.00|99|0.00|AEG 9|
20|FH_F80185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F105145_75075_0|SrvcGrp|27261|2022|PDM|24731.00|99|0.00|CPT 27446|
20|FH_F115909_38133_0|SrvcGrp|86747|2022|PCT|1.05|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F77665_0_0|SrvcGrp|29303|2022|PDM|15.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F120522_53549_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|1582.00|99|0.00|AEG 10 (NO REV)|
20|FH_F115979_46107_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F133658_60053_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132213_17543_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133249_33603_0|SrvcGrp|90854|2022|PDM|806.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F133249_33603_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138347_77701_0|SrvcGrp|87131|2022|PDM|333.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F139172_40207_0|SrvcGrp|88819|2022|PDM|643.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F139175_98229_0|SrvcGrp|74668|2022|PDM|135.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139428_65270_0|SrvcGrp|88621|2022|PDM|87.55|99|0.00|SKILLED NURSING LPN|
20|FH_F150659_84604_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150662_20901_0|SrvcGrp|46605|2022|PDM|153.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F150769_02302_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F110963_30535_0|SrvcGrp|46605|2022|PDM|170.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F35410_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GASTROSTOMY TUBE|
20|FH_F129811_53573_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89674_18640_0|SrvcGrp|29464|2022|PDM|57.75|99|0.00|HOME HEALTH VISIT NEWBORN CARE|
20|FH_F109247_73102_0|SrvcGrp|89149|2022|PDM|147.00|99|0.00|OP INTENSIVE|
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 4 (NO REV)|
20|FH_F101441_0_0|SrvcGrp|96979|2022|PDM|3497.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F111044_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F138018_17313_0|SrvcGrp|10580|2022|PDM|103.00|99|0.00|HYDRATION THERAPY - 3 LITERS|
20|FH_F124270_46256_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F120057_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F114090_19023_0|SrvcGrp|76501|2022|PDM|304.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F122333_67010_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128543_44413_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126554_0_0|SrvcGrp|35669|2022|PDM|4400.00|99|0.00|CPT 63650|
20|FH_F110725_48047_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F85091_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|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_F132126_08037_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F36750_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F46433_0_0|SrvcGrp|14371|2022|PDM|20.00|99|0.00|DISPOSABLE DRUG DELIVERY|
20|FH_F149023_44122_0|SrvcGrp|35669|2022|PDM|6923.00|99|0.00|CPT 63650|
20|FH_F116806_0_0|SrvcGrp|107132|2022|PDM|887.26|99|0.00|EXCIS TONGUE LESION POSTR 1/3|
20|FH_F125656_92868_0|SrvcGrp|17013|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PDM|2615.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F43081_0_0|CSTM-ALL|CSTM-00|2020|PDM|144.00|99|0.00|PSYCHIATRIC RESIDENTIAL TREATMENT|
20|FH_F134874_80120_0|SrvcGrp|73842|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F107922_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F147226_48154_0|SrvcGrp|110537|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F134819_0_0|SrvcGrp|106178|2022|PDM|1773.00|99|0.00|REMOVAL TONSILS AND ADENOIDS|
20|FH_F40627_0_0|CSTM-ALL|CSTM-00|2020|PDM|3420.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|476.61|99|0.00|SALLY BALIN,999182,ASC 204|
20|FH_F141034_0_0|SrvcGrp|109080|2022|PDM|25.00|99|0.00|DIALYSIS TRAINING|
20|FH_F84433_0_0|SrvcGrp|48631|2022|PDM|93.36|99|0.00|OCCUPATIONAL THERAPY SVCS RE-EVAL|
20|FH_F92716_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F130661_04441_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 4 (NO REV)|
20|FH_F128924_0_0|SrvcGrp|29428|2022|PDM|424.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT|
20|FH_F71468_0_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F40490_0_0|SrvcGrp|941|2022|PDM|3625.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F127418_0_0|SrvcGrp|89844|2022|PDM|26798.82|99|0.00|REINSERT SPINAL FIXATION|
20|FH_F36594_0_0|SrvcGrp|12264|2022|PDM|80.00|99|0.00|DIETICIAN OR LPN SERVICES|
20|FH_F124322_64131_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F97603_77901_0|SrvcGrp|73603|2022|PDM|3798.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F140295_0_0|SrvcGrp|95559|2022|PDM|11845.00|99|0.00|HIP JOINT|
20|FH_F147224_48026_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F31087_0_0|SrvcGrp|9263|2022|PDM|132.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F114188_15205_0|SrvcGrp|46605|2022|PDM|138.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F114206_37203_0|SrvcGrp|86834|2022|PDM|15.00|99|0.00|HCPCS S9559 (HCFA)|
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_F110727_34994_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|490.00|99|0.00|AEG 2 (NO REV)|
20|FH_F98022_89015_0|SrvcGrp|88977|2022|PDM|7647.00|99|0.00|C-SECTION DELIVERY|
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PDM|2116.40|99|0.00|AEG 9 (NO REV)|
20|FH_F91076_0_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F124484_83837_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F40554_0_0|SrvcGrp|38|2022|PDM|1200.00|99|0.00|NORMAL DELIVERY|
20|FH_F71644_0_0|SrvcGrp|1306|2022|PDM|342.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F134490_62801_0|SrvcGrp|104715|2022|PDM|2605.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY|
20|FH_F101922_98055_0|SrvcGrp|73006|2022|PDM|4700.00|99|0.00|AEG 9|
20|FH_F40645_0_0|SrvcGrp|15634|2022|PDM|245.00|99|0.00|OP PARTIAL PSYCH|
20|FH_F117835_14551_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39516_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116428_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42159_0_0|SrvcGrp|20801|2022|PCT|0.95|99|0.00|HOME HEALTH|
20|FH_F126812_44137_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97061_85012_0|SrvcGrp|73603|2022|PDM|8401.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F91152_60061_0|SrvcGrp|89417|2022|PDM|362.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F132934_63005_0|SrvcGrp|109057|2022|PCT|0.71|99|0.00|CARDIAC STUDIES|
20|FH_F129644_0_0|SrvcGrp|103550|2022|PDM|400.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F141747_20688_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F99720_0_0|SrvcGrp|104737|2022|PDM|2867.00|99|0.00|RELIEVE SPINAL CORD PRESSURE|
20|FH_F148740_93230_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148863_33021_0|SrvcGrp|87317|2022|PDM|1114.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F138742_33125_0|SrvcGrp|73841|2022|PDM|225.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F139677_77087_0|SrvcGrp|89417|2022|PDM|395.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F150741_81506_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150768_03054_0|SrvcGrp|48398|2022|PDM|167.00|99|0.00|PT SERVICES|
20|FH_F139163_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F130044_0_0|SrvcGrp|111480|2022|PDM|185.00|99|0.00|HYSTERECTOMY|
20|FH_F100540_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F32825_0_0|SrvcGrp|38|2022|PDM|2374.00|99|0.00|NORMAL DELIVERY|
20|FH_F149023_44122_0|SrvcGrp|115576|2022|PDM|4550.00|99|0.00|LAMINOTOMY/SPINE SURGERY|
20|FH_F134410_46807_0|SrvcGrp|75419|2022|PDM|1250.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F150953_74953_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F137732_08690_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F117576_21207_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F98022_89015_0|SrvcGrp|90854|2022|PDM|1961.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F75724_0_0|SrvcGrp|33165|2022|PDM|398.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F35987_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F111266_30339_0|SrvcGrp|26868|2022|PDM|30.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F40979_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F90196_10467_0|SrvcGrp|43524|2022|PDM|125.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F93254_0_0|SrvcGrp|26001|2022|PDM|125.55|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F125656_92868_0|SrvcGrp|14949|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F76222_0_0|CSTM-ALL|CSTM-00|2020|PDM|3822.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35458_0_0|SrvcGrp|8968|2022|PDM|2300.00|99|0.00|NICU LEVEL III & IV|
20|FH_F35769_32765_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149522_83221_0|SrvcGrp|84185|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F148181_0_0|SrvcGrp|80918|2022|PDM|837.00|99|0.00|RESPITE CARE|
20|FH_F124526_05301_0|SrvcGrp|73841|2022|PDM|530.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F150359_30106_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|1607.00|99|0.00|COVENTRY ENHANCED GROUPER 7 MOD 50|
20|FH_F75547_0_0|SrvcGrp|16277|2022|PCT|0.50|99|0.00|HIGH COST DRUGS|
20|FH_F143050_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F84058_0_0|SrvcGrp|82450|2022|PDM|633.03|99|0.00|ADVANCED LIFE SUPPORT LEVEL II|
20|FH_F36883_0_0|SrvcGrp|70399|2022|PDM|260.00|99|0.00|PSYCHIATIC/PSYCHOLOGIC SERVICE|
20|FH_F130757_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|GENERAL ACUTE CARE|
20|FH_F150913_70068_0|SrvcGrp|82981|2022|PDM|175.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F117762_0_0|SrvcGrp|89982|2022|PDM|3620.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY|
20|FH_F149662_85015_0|SrvcGrp|115737|2022|PDM|8750.00|99|0.00|TOTAL KNEE ARTHROPLASTY/REVISION|
20|FH_F134707_0_0|SrvcGrp|79561|2022|PDM|4430.50|99|0.00|AETNA CARDIAC CATH|
20|FH_F137797_70123_0|SrvcGrp|48385|2022|PDM|124.00|99|0.00|SPEECH THERAPY|
20|FH_F111266_30339_0|SrvcGrp|86834|2022|PDM|10.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F37187_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136806_0_0|SrvcGrp|107441|2022|PDM|2652.00|99|0.00|AETNA CYSTOSCOPY PROSTATIC IMPLANTS|
20|FH_F110666_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F98860_96706_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F34399_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|OP SVCS|
20|FH_F35174_0_0|SrvcGrp|20744|2022|PCT|0.75|99|0.00|MS DRG 242 ONLY|
20|FH_F59312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F84058_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PDM|1575.00|99|0.00|ASPG 3 PIEDMONT OUTPATIENT SURGERY CENTER|
20|FH_F91938_70121_0|SrvcGrp|57968|2022|PDM|30.99|99|0.00|CONTINUOUS HOMECARE|
20|FH_F134847_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F80834_0_0|SrvcGrp|23279|2022|PDM|1218.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
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_F120100_98390_0|SrvcGrp|104079|2022|PCT|1.30|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F40490_0_0|SrvcGrp|361|2022|PDM|3625.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F147342_08012_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F149160_02180_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F42979_0_0|CSTM-ALL|CSTM-00|2020|PDM|610.00|99|0.00|ACUTE PSYCH|
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|4950.00|99|0.00|AEG 8 (NO REV)|
20|FH_F41320_0_0|SrvcGrp|439|2022|PDM|1050.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F41457_0_0|SrvcGrp|13085|2022|PDM|1100.00|99|0.00|OBSERVATION SVCS|
20|FH_F143412_70503_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F143488_84770_0|CSTM-ALL|CSTM-00|2020|PDM|838.00|99|0.00|AEG 3 (NO REV)|
20|FH_F75803_0_0|SrvcGrp|23259|2022|PDM|676.00|99|0.00|MS DRG 789-795 ONLY NEONATAL|
20|FH_F103000_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F101391_0_0|SrvcGrp|112098|2022|PCT|2.00|99|0.00|COVID-19 CODES|
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151719_02138_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F120233_24368_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116552_70001_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F116698_07470_0|SrvcGrp|24750|2022|PDM|39.90|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F116699_46347_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F46732_0_0|SrvcGrp|3809|2022|PDM|619.00|99|0.00|HOSPICE CARE|
20|FH_F51554_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F73013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F120374_0_0|SrvcGrp|107749|2022|PDM|164.00|99|0.00|CAPD/CCPD|
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|782.10|99|0.00|ASPG 5- PROGRESSIVE SURG|
20|FH_F118271_46052_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143928_21061_0|SrvcGrp|23683|2022|PDM|58.00|99|0.00|SKILLED NURSING RN|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD 53|
20|FH_F130747_0_0|SrvcGrp|26273|2022|PDM|5202.00|99|0.00|CPT 29880|
20|FH_F66481_0_0|SrvcGrp|42976|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F93279_0_0|SrvcGrp|87297|2022|PCT|0.00|99|0.00|HCPCS CODES|
20|FH_F121113_33613_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
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_F79007_0_0|CSTM-ALL|CSTM-00|2020|PCT|49.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128343_48035_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120910_63021_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F122433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38798_0_0|SrvcGrp|10540|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE|
20|FH_F135236_02840_0|SrvcGrp|112727|2022|PDM|255.90|99|0.00|COVID-19 IA NFCT AB SARS COV 2|
20|FH_F135237_31015_0|SrvcGrp|29347|2022|PCT|0.00|99|0.00|HOME HEALTH AIDE|
20|FH_F84778_0_0|SrvcGrp|72996|2022|PDM|1890.00|99|0.00|AEG 4|
20|FH_F39801_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F92276_32308_0|SrvcGrp|20900|2022|PDM|35280.00|99|0.00|MS DRG 248 ONLY|
20|FH_F35271_0_0|SrvcGrp|9978|2022|PDM|1100.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS|
20|FH_F125025_67401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F69423_0_0|SrvcGrp|35733|2022|PDM|2965.00|99|0.00|CPT 29819 29826|
20|FH_F130157_84049_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F109180_18015_0|SrvcGrp|98041|2022|PDM|8.16|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F82931_18847_0|SrvcGrp|9793|2022|PDM|591.00|99|0.00|NEWBORN NURSERY|
20|FH_F114930_71101_0|SrvcGrp|268|2022|PDM|510.00|99|0.00|HYPERBARIC CHAMBER|
20|FH_F135779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F34546_0_0|SrvcGrp|14230|2022|PDM|400.00|99|0.00|SKILLED NURSING CARE|
20|FH_F129324_24701_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|2526.00|99|0.00|AEG 10 (NO REV)|
20|FH_F124788_0_0|SrvcGrp|73000|2022|PDM|826.00|99|0.00|AEG 6|
20|FH_F90362_0_0|SrvcGrp|89947|2022|PDM|1667.00|99|0.00|LIGAMENT REPAIR KNEE|
20|FH_F116049_0_0|SrvcGrp|80285|2022|PDM|148.79|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F78165_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F34408_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129627_06037_0|SrvcGrp|23683|2022|PDM|54.00|99|0.00|SKILLED NURSING RN|
20|FH_F102020_0_0|SrvcGrp|9828|2022|PDM|75.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132190_0_0|SrvcGrp|109618|2022|PDM|2600.00|99|0.00|IMPLANT NEUROELECTRODES 29|
20|FH_F56276_0_0|SrvcGrp|52243|2022|PDM|135.00|99|0.00|METH MAINTENANCE|
20|FH_F71346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143948_44870_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134994_33162_0|SrvcGrp|73841|2022|PDM|419.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F40304_0_0|SrvcGrp|11312|2022|PCT|0.50|99|0.00|IMPLANTS/PROSHETICS/ORTHOTICS/DRUGS|
20|FH_F149885_68502_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F63433_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (BREAKOUT)|
20|FH_F40049_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F151225_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F96902_0_0|SrvcGrp|89781|2022|PDM|165.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F141588_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
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_F89475_71202_0|SrvcGrp|87052|2022|PCT|0.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F35928_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135259_21090_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110263_0_0|SrvcGrp|84939|2022|PDM|13084.00|99|0.00|SHOULDER JOINT|
20|FH_F110002_16901_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|GENERAL ACUTE CARE|
20|FH_F139551_0_0|SrvcGrp|97895|2022|PDM|17500.00|99|0.00|REVISE KNEE 2|
20|FH_F42429_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F92129_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F67121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F36998_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47733_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% L CODES MOD KM|
20|FH_F147176_17701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141249_17103_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148667_0_0|SrvcGrp|90420|2022|PDM|2791.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F98840_31021_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F39443_0_0|SrvcGrp|30292|2022|PDM|403.00|99|0.00|HAPA WPA ASC 104|
20|FH_F97603_77901_0|SrvcGrp|73605|2022|PDM|1958.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F141270_89103_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F150443_77536_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47037_0_0|SrvcGrp|12403|2022|PDM|24.50|99|0.00|CONTINUOUS HOMECARE|
20|FH_F147306_70115_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37081_0_0|SrvcGrp|18130|2022|PDM|20200.00|99|0.00|MS DRG 243|
20|FH_F101441_0_0|SrvcGrp|96899|2022|PDM|7946.00|99|0.00|LUMBAR ARTIF DISCECTOMY|
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 4 (NO REV)|
20|FH_F144651_0_0|CSTM-ALL|CSTM-00|2020|PDM|10000.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL|
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.00|99|0.00|AEG 1 (NO REV)|
20|FH_F100663_56537_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)|
20|FH_F146266_0_0|SrvcGrp|67066|2022|PDM|17754.00|99|0.00|CERVICAL SURGERY|
20|FH_F143412_70503_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143427_30442_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F75903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101709_0_0|SrvcGrp|82107|2022|PDM|2865.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|REPAIR UMBIL HERNIA|
20|FH_F151720_03301_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F151744_60914_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F82375_28601_0|SrvcGrp|88620|2022|PDM|184.00|99|0.00|SKILLED NURSING RN|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD AW|
20|FH_F47952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F47969_0_0|SrvcGrp|26001|2022|PDM|90.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|1289.00|99|0.00|ASPG VI- MOD 50|
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|2756.36|99|0.00|ASPG IX|
20|FH_F132371_19083_0|SrvcGrp|46605|2022|PDM|102.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F120747_19129_0|SrvcGrp|473|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F116698_07470_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 INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118879_93063_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F128517_57301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38387_0_0|SrvcGrp|3809|2022|PDM|573.00|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_F93805_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116021_60714_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F123533_63825_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128272_60640_0|SrvcGrp|86848|2022|PDM|50.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F38341_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F145535_92708_0|SrvcGrp|75419|2022|PDM|543.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148260_0_0|SrvcGrp|27346|2022|PDM|9480.00|99|0.00|REPAIR BLADDER DEFECT|
20|FH_F140967_20735_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137716_66204_0|SrvcGrp|75545|2022|PDM|448.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F38875_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|RAD MOD 26|
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F131254_92211_0|SrvcGrp|24745|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F35631_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137557_33437_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131228_01826_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143834_06511_0|SrvcGrp|89412|2022|PDM|300.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F63556_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129658_77043_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F37756_0_0|SrvcGrp|3449|2022|PDM|992.00|99|0.00|ELECTRO CONVULSIVE THERAPY|
20|FH_F107782_0_0|SrvcGrp|22780|2022|PDM|2600.00|99|0.00|CPT 55875|
20|FH_F39617_0_0|SrvcGrp|997|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F127205_44125_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F102020_0_0|SrvcGrp|3809|2022|PDM|802.00|99|0.00|HOSPICE CARE|
20|FH_F98920_46526_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F141591_92630_0|SrvcGrp|46903|2022|PDM|695.25|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F129683_45255_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F79704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39273_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F42905_0_0|SrvcGrp|115|2022|PDM|300.00|99|0.00|SKILLED NURSING CARE|
20|FH_F86319_16365_0|SrvcGrp|3378|2022|PCT|0.63|99|0.00|OBSERVATION SVCS|
20|FH_F31798_0_0|CSTM-ALL|CSTM-00|2020|PDM|1840.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F99960_0_0|SrvcGrp|73004|2022|PDM|1534.00|99|0.00|AEG 8|
20|FH_F149140_07522_0|SrvcGrp|113227|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 3 TRGT|
20|FH_F135066_02908_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F141468_75160_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129011_15857_0|SrvcGrp|29347|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE|
20|FH_F39819_0_0|SrvcGrp|31256|2022|PDM|9794.00|99|0.00|NY DRG 122 ONLY|
20|FH_F64140_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|OCN F/S PRICING: ALL|
20|FH_F122911_92240_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F87092_60101_0|SrvcGrp|72996|2022|PDM|2835.00|99|0.00|AEG 4|
20|FH_F86851_0_0|SrvcGrp|71219|2022|PDM|676.00|99|0.00|COLONOSCOPY CPT 45382|
20|FH_F132544_0_0|SrvcGrp|93741|2022|PDM|7850.00|99|0.00|REVISE SPINE ELECTRODE PERCUTANEOUS ARRAY|
20|FH_F148425_01507_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148501_21550_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F40030_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F35176_0_0|SrvcGrp|9829|2022|PDM|85.50|99|0.00|PT SVCS|
20|FH_F144408_21617_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118785_33315_0|SrvcGrp|106048|2022|PDM|1275.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F38865_0_0|SrvcGrp|63|2022|PCT|0.65|99|0.00|SUBACUTE CARE|
20|FH_F38770_0_0|SrvcGrp|20071|2022|PDM|990.00|99|0.00|MS DRG 945-946|
20|FH_F45436_0_0|SrvcGrp|8962|2022|PDM|170.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F128296_37167_0|SrvcGrp|111048|2022|PDM|230.00|99|0.00|ALCOHOL & DRUG SERVICES|
20|FH_F133480_85374_0|SrvcGrp|3178|2022|PDM|1167.00|99|0.00|ACUTE PSYCH|
20|FH_F40786_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|ACUTE PSYCH|
20|FH_F112905_62088_0|SrvcGrp|85040|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F50974_0_0|SrvcGrp|42976|2022|PDM|70.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F113792_0_0|SrvcGrp|44042|2022|PDM|70.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F69084_0_0|SrvcGrp|37202|2022|PDM|742.00|99|0.00|ENDOSCOPY|
20|FH_F34706_0_0|CSTM-ALL|CSTM-00|2020|PDM|51480.00|99|0.00|DRG 104 ONLY CARDIAC VALVE PROCEDURE W/CARDIAC CATH|
20|FH_F150065_16001_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149781_37404_0|SrvcGrp|107361|2022|PDM|4326.00|99|0.00|SECOND LEVEL CER DISKECTOMY|
20|FH_F128472_53129_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124928_04210_0|SrvcGrp|53145|2022|PDM|95.31|99|0.00|SOCIAL WORKER|
20|FH_F133467_03301_0|SrvcGrp|46903|2022|PDM|1550.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F37724_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.50|99|0.00|OP SVCS|
20|FH_F144011_60616_0|CSTM-ALL|CSTM-00|2020|PDM|2576.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132737_0_0|SrvcGrp|51672|2022|PDM|6804.00|99|0.00|MS DRG 286-287 ONLY|
20|FH_F148639_0_0|SrvcGrp|63462|2022|PDM|2642.00|99|0.00|CPT 64595|
20|FH_F133052_33462_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F125050_33765_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F92676_15063_0|SrvcGrp|79003|2022|PDM|1091.78|99|0.00|MON VALLEY ASC 104|
20|FH_F148900_0_0|SrvcGrp|90976|2022|PDM|668.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT|
20|FH_F150001_33064_0|SrvcGrp|94093|2022|PCT|1.05|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F133495_70301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123091_92627_0|SrvcGrp|75419|2022|PDM|900.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F125570_66104_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146320_27610_0|SrvcGrp|114590|2022|PDM|3452.00|99|0.00|AV FUSION/UPPR ARM VEIN|
20|FH_F133550_90630_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F49554_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F133477_90247_0|CSTM-ALL|CSTM-00|2020|PDM|2335.00|99|0.00|AEG 3 (NO REV)|
20|FH_F129688_74066_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150541_37922_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115327_45320_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F43433_0_0|SrvcGrp|32441|2022|PDM|4853.00|99|0.00|JACKSON MADISON HOSP ASPG 5|
20|FH_F145988_06105_0|SrvcGrp|12840|2022|PCT|0.50|99|0.00|PACEMAKER|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|408.19|99|0.00|HAPA WPA-NWPA 2012-13 ASC 406 W/O REV|
20|FH_F97140_91730_0|SrvcGrp|73605|2022|PDM|2398.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 6 (NO REV)|
20|FH_F59274_0_0|SrvcGrp|46350|2022|PDM|32.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F40851_0_0|SrvcGrp|14404|2022|PCT|0.50|99|0.00|HOME HEALTH CARE MEDICAL SUPPLIES|
20|FH_F117906_91606_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F94300_0_0|SrvcGrp|93604|2022|PDM|3360.00|99|0.00|KNEE ARTHO/ANT CRUCIATE LIG REPAIR(HCFA)|
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|AEG 10 (NO REV)|
20|FH_F134467_84321_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F49044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F111520_81601_0|SrvcGrp|75545|2022|PDM|309.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F146370_19355_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133907_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90955_06053_0|SrvcGrp|88621|2022|PDM|73.50|99|0.00|SKILLED NURSING LPN|
20|FH_F150001_33064_0|SrvcGrp|16750|2022|PDM|53.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F97060_66534_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133427_48811_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F90955_06053_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117962_17603_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150463_50701_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 10 (NO REV)|
20|FH_F128299_44134_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F67639_0_0|SrvcGrp|38364|2022|PDM|3371.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F38865_0_0|CSTM-ALL|CSTM-00|2020|PDM|320.00|99|0.00|CD DAY TREATMENT|
20|FH_F97041_71603_0|SrvcGrp|90854|2022|PDM|1629.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F41814_0_0|SrvcGrp|11023|2022|PDM|3827.00|99|0.00|NORMAL DELIVERY|
20|FH_F68040_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142041_44846_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F112092_46845_0|SrvcGrp|90480|2022|PCT|1.00|99|0.00|AFLURIA VACC 3 YRS & > IM|
20|FH_F112152_34994_0|SrvcGrp|87317|2022|PDM|796.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F128549_44224_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130120_75862_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F102862_30606_0|SrvcGrp|26672|2022|PDM|22070.80|99|0.00|MS DRG 462 ONLY|
20|FH_F129240_10028_0|SrvcGrp|86834|2022|PDM|15.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F129220_18445_0|SrvcGrp|69075|2022|PDM|72.00|99|0.00|CPT 99213|
20|FH_F98300_30236_0|SrvcGrp|88977|2022|PDM|5515.00|99|0.00|C-SECTION DELIVERY|
20|FH_F102960_50613_0|SrvcGrp|13262|2022|PDM|17.01|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F143542_0_0|SrvcGrp|109759|2022|PDM|5738.00|99|0.00|REMOVAL CORNEAL EPITHELIUM|
20|FH_F148100_22406_0|SrvcGrp|88620|2022|PDM|84.00|99|0.00|SKILLED NURSING RN|
20|FH_F119448_07083_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148419_01453_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1160.84|99|0.00|HAPA WPA-NWPA 2012-13 ASC 702 W/O REV|
20|FH_F129965_0_0|SrvcGrp|71083|2022|PCT|1.10|99|0.00|RADIOLOGY SERVICES|
20|FH_F132118_92240_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F71323_68114_0|SrvcGrp|16901|2022|PDM|13.00|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F88818_0_0|SrvcGrp|75495|2022|PDM|600.00|99|0.00|AEG 9|
20|FH_F60101_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|106% OF ASP DRUGS/IMMUN UPDATE QUARTERLY|
20|FH_F37641_0_0|SrvcGrp|69399|2022|PCT|1.15|99|0.00|PREVENTATIVE CODES|
20|FH_F106640_78642_0|SrvcGrp|108484|2022|PDM|757.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139594_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F119437_0_0|SrvcGrp|93057|2022|PDM|4750.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F40176_0_0|SrvcGrp|32014|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE|
20|FH_F36118_0_0|SrvcGrp|3810|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F92676_15063_0|SrvcGrp|78928|2022|PDM|4069.02|99|0.00|MON VALLEY ASC 903|
20|FH_F148872_45723_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115274_15235_0|SrvcGrp|94781|2022|PDM|140.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F37641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1099.00|99|0.00|ASPG VIII|
20|FH_F150900_19104_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144068_17901_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132571_24739_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F102561_75146_0|SrvcGrp|2738|2022|PCT|1.15|99|0.00|IMPLANTS|
20|FH_F91155_16105_0|SrvcGrp|23681|2022|PDM|102.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F47857_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|CHEMICAL DEPENDENCY - ADOLESCENT|
20|FH_F136407_0_0|SrvcGrp|59841|2022|PDM|2310.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F88223_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F134447_12883_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F142775_72801_0|SrvcGrp|108484|2022|PDM|626.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F55375_0_0|SrvcGrp|12118|2022|PDM|475.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F134467_84321_0|SrvcGrp|472|2022|PDM|377.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F41456_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145988_06105_0|SrvcGrp|73804|2022|PDM|29469.00|99|0.00|AETNA MSDRG 620 ONLY|
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|760.00|99|0.00|ASPG II|
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.00|99|0.00|AEG 10 (NO REV)|
20|FH_F97103_53295_0|SrvcGrp|73656|2022|PDM|594.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F127181_64155_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101754_63141_0|SrvcGrp|97982|2022|PDM|89.57|99|0.00|EVALUATION OF AUDITORY REHAB|
20|FH_F129688_74066_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|272.48|99|0.00|HAPA WPA-NWPA 2012-13 ASC 230 W/O REV|
20|FH_F128893_0_0|SrvcGrp|89783|2022|PDM|150.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F92676_15063_0|SrvcGrp|79029|2022|PDM|800.38|99|0.00|MON VALLEY ASC 118|
20|FH_F135714_01922_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|534.00|99|0.00|AEG 1 (NO REV)|
20|FH_F106540_26330_0|SrvcGrp|102399|2022|PCT|0.50|99|0.00|HIGH COST DRUGS W/TRAUMA|
20|FH_F148890_45133_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39082_0_0|SrvcGrp|359|2022|PDM|460.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F50297_0_0|SrvcGrp|42975|2022|PDM|82.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F51438_0_0|SrvcGrp|1306|2022|PDM|525.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F113288_38104_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F110240_0_0|SrvcGrp|79594|2022|PDM|743.00|99|0.00|CPT 45380|
20|FH_F100665_07939_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F56793_0_0|SrvcGrp|24762|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F45176_0_0|CSTM-ALL|CSTM-00|2020|PDM|2032.00|99|0.00|ASPG VII|
20|FH_F89015_74017_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F37641_0_0|CSTM-ALL|CSTM-00|2020|PDM|579.00|99|0.00|ASPG III|
20|FH_F39640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F124608_0_0|SrvcGrp|97730|2022|PDM|7650.00|99|0.00|REVERSE HIP JOINT|
20|FH_F97562_29803_0|SrvcGrp|73656|2022|PDM|529.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F142970_43055_0|SrvcGrp|13683|2022|PDM|525.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F143194_19973_0|SrvcGrp|102239|2022|PDM|95.00|99|0.00|AETNA METHADONE MAINTENANCE|
20|FH_F50372_0_0|SrvcGrp|46586|2022|PDM|225.00|99|0.00|CPT 99205|
20|FH_F87577_80016_0|SrvcGrp|17553|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46196_0_0|SrvcGrp|16746|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)|
20|FH_F128089_57385_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F126935_33615_0|SrvcGrp|109036|2022|PDM|905.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F148002_78209_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97042_64804_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148639_0_0|SrvcGrp|71666|2022|PDM|6105.00|99|0.00|CPT 63655|
20|FH_F41456_0_0|SrvcGrp|26001|2022|PDM|145.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F97560_23249_0|SrvcGrp|73601|2022|PDM|14082.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F132331_89107_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133490_90650_0|SrvcGrp|13187|2022|PCT|0.25|99|0.00|INTRAOCULAR LENSES|
20|FH_F67803_0_0|SrvcGrp|24029|2022|PDM|55.00|99|0.00|RN HOURLY|
20|FH_F103281_32086_0|SrvcGrp|73500|2022|PDM|500.00|99|0.00|AETNA ER LEVEL I|
20|FH_F34480_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137950_0_0|SrvcGrp|78403|2022|PDM|0.05|99|0.00|AETNA MED RECORD|
20|FH_F92676_15063_0|SrvcGrp|79083|2022|PDM|256.90|99|0.00|MON VALLEY ASC 243|
20|FH_F97541_33021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F40765_0_0|CSTM-ALL|CSTM-00|2020|PDM|583.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F117807_86426_0|SrvcGrp|48394|2022|PDM|58.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F133490_90650_0|CSTM-ALL|CSTM-00|2020|PDM|4092.00|99|0.00|AEG 10 (NO REV)|
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F40980_0_0|SrvcGrp|15|2022|PDM|5826.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F121016_32607_0|SrvcGrp|3483|2022|PDM|3150.00|99|0.00|CPT CODE 59400|
20|FH_F119825_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F111520_81601_0|SrvcGrp|91294|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F102361_44024_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150524_64106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88956_0_0|SrvcGrp|78377|2022|PDM|1185.00|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F113586_0_0|SrvcGrp|75483|2022|PDM|1277.00|99|0.00|AEG 3|
20|FH_F101104_0_0|SrvcGrp|19742|2022|PDM|200.00|99|0.00|MID-LINE INSERTION|
20|FH_F133627_89113_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F111540_16823_0|SrvcGrp|104419|2022|PDM|112.00|99|0.00|OFFICE/OUTPATIENT VISIT EST (MOD AF)|
20|FH_F47248_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121250_47401_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F132810_0_0|SrvcGrp|14944|2022|PDM|8.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F58856_0_0|SrvcGrp|28161|2022|PDM|40000.00|99|0.00|MS DRG 216 ONLY|
20|FH_F58856_0_0|SrvcGrp|20914|2022|PDM|36875.00|99|0.00|MS DRG 233 ONLY|
20|FH_F67901_0_0|SrvcGrp|24762|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F69968_0_0|CSTM-ALL|CSTM-00|2020|PDM|2545.62|99|0.00|MS DRG BAPTIST MEM HOSP SURGICAL|
20|FH_F134255_01201_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F134126_11554_0|SrvcGrp|74982|2022|PDM|1953.00|99|0.00|AETNA REHABILITATION MSDRG 945-946|
20|FH_F137068_81147_0|SrvcGrp|111934|2022|PDM|51.31|99|0.00|COVID-19 NUCLEIC ACID|
20|FH_F137147_75006_0|SrvcGrp|84939|2022|PDM|16650.00|99|0.00|SHOULDER JOINT|
20|FH_F137247_40160_0|SrvcGrp|89417|2022|PDM|271.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F142207_62237_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142690_31774_0|SrvcGrp|22589|2022|PDM|139.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F123489_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F83831_0_0|SrvcGrp|13606|2022|PDM|33.00|99|0.00|HOME INFUSION|
20|FH_F138607_02760_0|CSTM-ALL|CSTM-00|2020|PDM|220.00|99|0.00|THER CGM RECEIVER/MONITOR (MOD NU)|
20|FH_F137287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140335_70435_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140615_73013_0|SrvcGrp|104363|2022|PCT|1.10|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F140846_48207_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149653_19702_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F118914_43015_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39466_0_0|SrvcGrp|12290|2022|PDM|735.00|99|0.00|DETOXIFICATION|
20|FH_F130800_06078_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147879_93309_0|SrvcGrp|88620|2022|PDM|165.00|99|0.00|SKILLED NURSING RN|
20|FH_F40213_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F117214_84020_0|SrvcGrp|46903|2022|PDM|1100.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F38221_0_0|SrvcGrp|6|2022|PCT|0.83|99|0.00|OP SURGERY|
20|FH_F109652_0_0|SrvcGrp|471|2022|PDM|1055.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F109652_0_0|SrvcGrp|78850|2022|PCT|0.00|99|0.00|VENIPUNCTURE|
20|FH_F124923_23518_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F109513_0_0|SrvcGrp|73002|2022|PDM|1413.00|99|0.00|AEG 7|
20|FH_F110160_0_0|SrvcGrp|73002|2022|PDM|1332.00|99|0.00|AEG 7|
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 8 (NO REV)|
20|FH_F82199_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148867_20191_0|SrvcGrp|48398|2022|PDM|128.00|99|0.00|PT SERVICES|
20|FH_F151059_60435_0|SrvcGrp|23683|2022|PDM|60.00|99|0.00|SKILLED NURSING RN|
20|FH_F121385_89102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121970_92653_0|SrvcGrp|73841|2022|PDM|500.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F37823_0_0|SrvcGrp|27539|2022|PDM|4700.00|99|0.00|C-SECTION|
20|FH_F39581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F113726_61520_0|SrvcGrp|75545|2022|PDM|275.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|823.00|99|0.00|AEG 5  (NO REV)|
20|FH_F97721_01053_0|SrvcGrp|73601|2022|PDM|9298.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F97780_43614_0|SrvcGrp|73559|2022|PDM|21703.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F144528_48081_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118541_15222_0|SrvcGrp|104464|2022|PDM|3309.00|99|0.00|VAGINAL DELIVERY (W/ OR W/O EPISIOTOMY)|
20|FH_F150559_60018_0|SrvcGrp|66265|2022|PDM|132.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F47433_0_0|SrvcGrp|29817|2022|PDM|6810.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F43953_0_0|SrvcGrp|10675|2022|PDM|4586.00|99|0.00|ICU/CCU|
20|FH_F103360_68845_0|CSTM-ALL|CSTM-00|2020|PDM|9134.00|99|0.00|AEG 9 (NO REV)|
20|FH_F132999_19901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88223_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141728_71203_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101840_76054_0|SrvcGrp|97469|2022|PDM|8207.00|99|0.00|REMOVAL OF THYROID|
20|FH_F139587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F44079_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.06|99|0.00|100% ASP NEBRASKA|
20|FH_F44855_0_0|SrvcGrp|30206|2022|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F33165_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123096_28210_0|SrvcGrp|75419|2022|PDM|850.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F73684_0_0|SrvcGrp|1306|2022|PDM|450.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F33019_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F56793_0_0|SrvcGrp|42974|2022|PDM|130.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F139825_0_0|SrvcGrp|114442|2022|PDM|11276.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F39995_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F146211_68144_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119493_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F145864_65084_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|1987.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PDM|937.15|99|0.00|AEG 5  (NO REV)|
20|FH_F142776_65338_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148886_60621_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133021_00910_0|SrvcGrp|108172|2022|PDM|7500.00|99|0.00|AETNA FEM/POPL REVASE W/ATHER|
20|FH_F97160_77436_0|SrvcGrp|86723|2022|PDM|584.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F92677_08003_0|SrvcGrp|86844|2022|PDM|63.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F136751_0_0|SrvcGrp|33967|2022|PDM|5200.00|99|0.00|CPT 47562|
20|FH_F128648_44256_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F120605_0_0|SrvcGrp|72998|2022|PDM|1145.00|99|0.00|AEG 5|
20|FH_F148863_33021_0|SrvcGrp|89337|2022|PDM|1221.00|99|0.00|DETOXIFICATION|
20|FH_F139590_98908_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139666_26175_0|SrvcGrp|113579|2022|PCT|0.94|99|0.00|RADIOLOGY SERVICES|
20|FH_F139673_63011_0|SrvcGrp|66264|2022|PDM|80.75|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F139707_84010_0|SrvcGrp|114708|2022|PDM|7542.00|99|0.00|VASCULAR PROCEDURE|
20|FH_F150746_31210_0|SrvcGrp|57967|2022|PDM|166.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F150765_05001_0|SrvcGrp|88620|2022|PDM|167.00|99|0.00|SKILLED NURSING RN|
20|FH_F138710_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139048_0_0|SrvcGrp|93762|2022|PDM|1815.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F134916_16421_0|SrvcGrp|106300|2022|PDM|247.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F113524_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F124467_27529_0|SrvcGrp|89417|2022|PDM|419.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F114294_18235_0|CSTM-ALL|CSTM-00|2020|PCT|0.20|99|0.00|OP SVCS|
20|FH_F110783_93013_0|SrvcGrp|14944|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F35097_16508_0|SrvcGrp|99619|2022|PDM|22.00|99|0.00|PHYSICAL THERAPY SVCS INITIAL EVAL|
20|FH_F148963_56301_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F36385_0_0|CSTM-ALL|CSTM-00|2020|PDM|4374.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35174_0_0|SrvcGrp|10671|2022|PCT|0.75|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F94621_07728_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120104_97223_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F111040_30033_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F138417_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AETNA DME|
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|366.00|99|0.00|AEG 1 (NO REV)|
20|FH_F35369_0_0|SrvcGrp|13004|2022|PCT|0.65|99|0.00|OP SURGERY|
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146204_0_0|SrvcGrp|33987|2022|PDM|1500.00|99|0.00|CPT 57522|
20|FH_F110972_30512_0|SrvcGrp|90101|2022|PDM|0.25|99|0.00|AETNA MED RECORD COPY|
20|FH_F149662_85015_0|SrvcGrp|115727|2022|PDM|8600.00|99|0.00|ARTHRODESIS/SPINAL FUSION|
20|FH_F151699_01752_0|SrvcGrp|116018|2022|PCT|0.97|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F98360_11554_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F141330_65075_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124322_64131_0|SrvcGrp|26868|2022|PDM|25.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F124487_89502_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47902_0_0|SrvcGrp|43842|2022|PCT|1.00|99|0.00|DME MOD RRKE|
20|FH_F123745_0_0|SrvcGrp|109188|2022|PDM|7500.00|99|0.00|TIBIAL RODDING|
20|FH_F92498_07442_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F146765_0_0|SrvcGrp|33722|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F147303_70508_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F98840_31021_0|SrvcGrp|73659|2022|PDM|4903.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F100540_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F38475_0_0|SrvcGrp|28628|2022|PDM|102.00|99|0.00|SKILLED NURSING|
20|FH_F35174_0_0|SrvcGrp|3140|2022|PCT|0.75|99|0.00|PHARMACY SERVICES|
20|FH_F106822_0_0|SrvcGrp|73362|2022|PDM|7.95|99|0.00|VACCINE SERVICES|
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F69785_0_0|SrvcGrp|42976|2022|PDM|80.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F73231_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INFUSION REV CODE 649|
20|FH_F87054_0_0|SrvcGrp|79561|2022|PDM|1313.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F88456_0_0|SrvcGrp|77452|2022|PDM|13871.00|99|0.00|CPT 54405|
20|FH_F115808_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|2595.00|99|0.00|AEG 4 (NO REV)|
20|FH_F136132_0_0|SrvcGrp|111931|2022|PDM|35.91|99|0.00|COVID-19 CDC TESTING LAB|
20|FH_F132627_0_0|SrvcGrp|23683|2022|PDM|133.00|99|0.00|SKILLED NURSING RN|
20|FH_F132627_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132988_0_0|SrvcGrp|108351|2022|PDM|13432.78|99|0.00|REPAIR RADIUS FRACTURE|
20|FH_F132988_0_0|SrvcGrp|100040|2022|PDM|8647.09|99|0.00|REPAIR HUMERUS FRACTURE|
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|3230.00|99|0.00|AEG 5  (NO REV)|
20|FH_F93252_0_0|SrvcGrp|93031|2022|PDM|5000.00|99|0.00|SPINAL FUSION|
20|FH_F126345_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F114389_50131_0|SrvcGrp|86832|2022|PDM|12.31|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F114389_50131_0|SrvcGrp|17008|2022|PDM|284.03|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS|
20|FH_F114389_50131_0|SrvcGrp|86841|2022|PDM|447.35|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F132348_16214_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122181_66538_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124060_76040_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F146715_34240_0|SrvcGrp|98372|2022|PCT|1.00|99|0.00|SPEECH EVALUATION|
20|FH_F146844_78582_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F64819_0_0|SrvcGrp|74543|2022|PCT|1.75|99|0.00|MRI/CT SCAN|
20|FH_F69923_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F34546_0_0|SrvcGrp|6|2022|PDM|2200.00|99|0.00|OP SURGERY|
20|FH_F42363_0_0|SrvcGrp|35950|2022|PDM|400.00|99|0.00|CD DETOX|
20|FH_F98380_43055_0|SrvcGrp|73485|2022|PDM|3550.00|99|0.00|AETNA REHAB|
20|FH_F124173_66215_0|SrvcGrp|108547|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ. DRUGS|
20|FH_F124235_92840_0|SrvcGrp|74668|2022|PDM|700.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124414_92653_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124414_92653_0|SrvcGrp|108484|2022|PDM|550.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F127995_84010_0|SrvcGrp|86847|2022|PDM|25.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F127995_84010_0|SrvcGrp|86840|2022|PDM|22.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F52614_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F87856_0_0|SrvcGrp|84180|2022|PDM|4000.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS|
20|FH_F137248_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F136658_50401_0|SrvcGrp|75754|2022|PCT|1.30|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F114792_48849_0|SrvcGrp|16069|2022|PDM|695.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F113830_96002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F114985_32073_0|SrvcGrp|104806|2022|PDM|84.00|99|0.00|PSYCHOANALYSIS|
20|FH_F136276_0_0|SrvcGrp|87077|2022|PDM|163.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F132595_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F122680_53511_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43421_0_0|CSTM-ALL|CSTM-00|2020|PDM|66.00|99|0.00|CD SVCS (ADULT)|
20|FH_F117085_40207_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134735_91362_0|SrvcGrp|110194|2022|PDM|325.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F136796_24016_0|SrvcGrp|84939|2022|PDM|2440.83|99|0.00|SHOULDER JOINT|
20|FH_F136796_24016_0|CSTM-ALL|CSTM-00|2020|PDM|1768.00|99|0.00|AEG 10 (NO REV)|
20|FH_F136828_32405_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F54572_0_0|SrvcGrp|8950|2022|PDM|1730.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F77234_0_0|SrvcGrp|17069|2022|PDM|1971.00|99|0.00|ASPG III|
20|FH_F115154_45069_0|SrvcGrp|109330|2022|PCT|1.03|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F115631_65201_0|SrvcGrp|73610|2022|PCT|0.40|99|0.00|AETNA IMPLANTS|
20|FH_F41463_0_0|SrvcGrp|10577|2022|PDM|80.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F40919_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F42694_0_0|SrvcGrp|12401|2022|PDM|96.00|99|0.00|RN VISIT|
20|FH_F116802_41224_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F125479_17501_0|SrvcGrp|67684|2022|PDM|186.00|99|0.00|PSYCH VISIT|
20|FH_F51276_0_0|SrvcGrp|15596|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
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_F36372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|100% AWP CPT|
20|FH_F39266_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111143_28659_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS|
20|FH_F111300_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F136429_0_0|SrvcGrp|79594|2022|PDM|700.00|99|0.00|CPT 45380|
20|FH_F134265_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133107_73071_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F92516_0_0|SrvcGrp|72992|2022|PDM|475.00|99|0.00|AEG 2|
20|FH_F132928_64114_0|SrvcGrp|46605|2022|PDM|162.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133401_33404_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133478_40165_0|SrvcGrp|74581|2022|PCT|0.28|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F131212_63017_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133491_74012_0|SrvcGrp|94781|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F131702_17022_0|SrvcGrp|88621|2022|PDM|128.00|99|0.00|SKILLED NURSING LPN|
20|FH_F111601_15203_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F146760_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F47999_0_0|SrvcGrp|42825|2022|PDM|52.80|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F113178_44035_0|SrvcGrp|79305|2022|PDM|125.00|99|0.00|AETNA ALCOHOL AND/OR DRUG SERVICES|
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1760.00|99|0.00|AEG 5  (NO REV)|
20|FH_F133579_0_0|SrvcGrp|84280|2022|PDM|2551.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F141837_0_0|SrvcGrp|106294|2022|PDM|750.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
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|36669|2022|PDM|10.00|99|0.00|IMMUNIZATION ADMIN|
20|FH_F36261_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36854_0_0|SrvcGrp|413|2022|PCT|0.75|99|0.00|TRANSPLANT SVCS|
20|FH_F41989_0_0|SrvcGrp|3934|2022|PDM|179.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS|
20|FH_F43867_0_0|SrvcGrp|30958|2022|PDM|65.00|99|0.00|SKILLED LPN VISIT|
20|FH_F113585_20155_0|SrvcGrp|86834|2022|PDM|15.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F138747_53158_0|SrvcGrp|113429|2022|PCT|1.55|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F138907_01040_0|SrvcGrp|83857|2022|PDM|710.00|99|0.00|IP HOSPICE SVCS|
20|FH_F78265_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F113885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119888_0_0|SrvcGrp|106291|2022|PDM|264.36|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F113390_0_0|SrvcGrp|65403|2022|PDM|2200.00|99|0.00|CPT 42830|
20|FH_F143832_0_0|SrvcGrp|108174|2022|PDM|2405.06|99|0.00|TIB/PER REVASC W/TLA|
20|FH_F151321_92626_0|SrvcGrp|108484|2022|PDM|650.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F151503_30067_0|SrvcGrp|89988|2022|PDM|2090.00|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F132258_45404_0|SrvcGrp|27968|2022|PDM|30.74|99|0.00|SKILLED NURSING LPN|
20|FH_F122038_34606_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F122069_75935_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F144928_02703_0|SrvcGrp|46903|2022|PDM|473.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F135427_19610_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F40568_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135805_98225_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135972_18509_0|SrvcGrp|472|2022|PDM|497.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F136174_89146_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F116464_13088_0|SrvcGrp|89022|2022|PDM|42.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F140629_0_0|SrvcGrp|113682|2022|PDM|2497.00|99|0.00|LAPARO URETHRAL SUSPENSION|
20|FH_F121813_75701_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 3 (NO REV)|
20|FH_F33791_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F38013_0_0|SrvcGrp|13620|2022|PDM|759.00|99|0.00|SLEEP STUDIES|
20|FH_F129329_07039_0|SrvcGrp|86723|2022|PDM|345.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F111292_33136_0|SrvcGrp|107506|2022|PDM|231.00|99|0.00|X-RAY EXAM CHEST TWO VIEWS|
20|FH_F111385_33308_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134290_67209_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F47906_0_0|SrvcGrp|23235|2022|PCT|1.00|99|0.00|DME (GLOBAL)|
20|FH_F87153_0_0|CSTM-ALL|CSTM-00|2020|PDM|54.08|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F148243_0_0|SrvcGrp|33982|2022|PDM|1450.00|99|0.00|CPT 28296|
20|FH_F33081_0_0|SrvcGrp|10927|2022|PDM|1000.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F39796_0_0|SrvcGrp|43285|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F51272_0_0|SrvcGrp|47597|2022|PCT|0.75|99|0.00|HOME HEALTH SERVICES|
20|FH_F101442_0_0|SrvcGrp|70746|2022|PDM|1494.63|99|0.00|CPT 28292|
20|FH_F114569_0_0|SrvcGrp|105718|2022|PDM|12.94|99|0.00|AETHA DEPRESSION SCREEN ANNUAL (MOD GT)(HCFA)|
20|FH_F88831_84123_0|SrvcGrp|80317|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F128695_50049_0|SrvcGrp|48398|2022|PDM|140.00|99|0.00|PT SERVICES|
20|FH_F129194_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102960_50613_0|SrvcGrp|10363|2022|PDM|1080.00|99|0.00|CPT CODE 99283|
20|FH_F143542_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.06|99|0.00|ASPG V|
20|FH_F63235_0_0|SrvcGrp|72998|2022|PDM|2005.00|99|0.00|AEG 5|
20|FH_F38560_0_0|SrvcGrp|97|2022|PDM|3900.00|99|0.00|C-SECTION|
20|FH_F130821_85712_0|SrvcGrp|96163|2022|PDM|1.72|99|0.00|TIGECYCLINE INJECTION|
20|FH_F80594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F120735_40012_0|SrvcGrp|46903|2022|PDM|496.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F92598_21236_0|SrvcGrp|27969|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE|
20|FH_F85340_98195_0|CSTM-ALL|CSTM-00|2020|PCT|2.18|99|0.00|AETNA - APC GROUPER B|
20|FH_F150304_16146_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F70863_0_0|SrvcGrp|14500|2022|PDM|34.00|99|0.00|STATIONARY/AMBULATORY/DISPOSAL PUMPS|
20|FH_F138951_41101_0|SrvcGrp|19742|2022|PDM|60.00|99|0.00|MID-LINE INSERTION|
20|FH_F112631_0_0|SrvcGrp|72994|2022|PDM|658.00|99|0.00|AEG 3|
20|FH_F143571_0_0|SrvcGrp|65720|2022|PDM|153.00|99|0.00|RESPITE CARE|
20|FH_F132958_79903_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2420.00|99|0.00|AEG 7 (NO REV)|
20|FH_F145641_06902_0|SrvcGrp|116019|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|OP ADOLESCENT PSYCHIATRIC PARTIAL HOSP.|
20|FH_F135900_0_0|SrvcGrp|73485|2022|PDM|900.00|99|0.00|AETNA REHAB|
20|FH_F133815_46526_0|SrvcGrp|3483|2022|PDM|2800.00|99|0.00|CPT CODE 59400|
20|FH_F119732_37660_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F110509_71351_0|SrvcGrp|99075|2022|PCT|1.50|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F123851_03235_0|SrvcGrp|104874|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138951_41101_0|SrvcGrp|86845|2022|PDM|40.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|AEG 8 (NO REV)|
20|FH_F146039_89511_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F149320_82609_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F114432_75035_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124369_0_0|SrvcGrp|107986|2022|PDM|6545.00|99|0.00|REMOVAL OF FOOT LESION|
20|FH_F145759_18452_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F85133_85251_0|SrvcGrp|48394|2022|PDM|59.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F134229_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.45|99|0.00|HSS ASC|
20|FH_F144248_0_0|SrvcGrp|109759|2022|PDM|5738.00|99|0.00|REMOVAL CORNEAL EPITHELIUM|
20|FH_F111030_05641_0|SrvcGrp|76501|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F111986_0_0|SrvcGrp|104113|2022|PDM|1236.00|99|0.00|REMOVE ANAL FIST COMPLEX|
20|FH_F85353_16407_0|SrvcGrp|63899|2022|PDM|165.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 238|
20|FH_F146663_25311_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134568_12946_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 10 (NO REV)|
20|FH_F130763_0_0|SrvcGrp|26278|2022|PDM|3450.00|99|0.00|CPT 29881|
20|FH_F79763_0_0|SrvcGrp|66481|2022|PDM|110.00|99|0.00|SOCIAL WORKER|
20|FH_F84132_48026_0|SrvcGrp|73610|2022|PCT|0.90|99|0.00|AETNA IMPLANTS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1302.78|99|0.00|HAPA WPA-NWPA 2012-13 ASC 708 W/O REV|
20|FH_F130166_65065_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F96721_99504_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|AEG 6 (NO REV)|
20|FH_F121628_19533_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F130364_01331_0|SrvcGrp|88978|2022|PDM|3904.00|99|0.00|VAGINAL DELIVERY|
20|FH_F127529_43230_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F139658_02893_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134620_73112_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F85353_16407_0|SrvcGrp|63758|2022|PDM|1873.14|99|0.00|HAPA WPA-NWPA 2012-13 ASC 9|
20|FH_F110509_71351_0|SrvcGrp|104166|2022|PCT|0.00|99|0.00|AETNA ALL DRUGS AGENTS|
20|FH_F126341_27284_0|SrvcGrp|86124|2022|PCT|0.50|99|0.00|AETNA OCTAGAM INJ|
20|FH_F41962_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F138447_22041_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116473_0_0|SrvcGrp|106717|2022|PDM|2000.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F81852_0_0|CSTM-ALL|CSTM-00|2020|PDM|662.00|99|0.00|ASPG X|
20|FH_F93076_85016_0|SrvcGrp|92158|2022|PCT|1.00|99|0.00|PALIVIZUMAB PER 50MG|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F138348_04096_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120539_89029_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F70863_0_0|SrvcGrp|14372|2022|PDM|25.00|99|0.00|AMBULATORY INFUSION PUMP|
20|FH_F135670_01749_0|SrvcGrp|86854|2022|PDM|60.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F133724_84041_0|SrvcGrp|73700|2022|PDM|42.25|99|0.00|AETNA - SKILLED NURSING|
20|FH_F109387_35630_0|SrvcGrp|87317|2022|PDM|637.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F143067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F95623_84015_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121476_0_0|SrvcGrp|111251|2022|PDM|1050.00|99|0.00|LEVONORGESTREL|
20|FH_F133749_84604_0|SrvcGrp|112455|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F118123_67226_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F118123_67226_0|SrvcGrp|24750|2022|PDM|10.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|676.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F145642_15108_0|SrvcGrp|86827|2022|PDM|55.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F121640_75062_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F112665_0_0|SrvcGrp|78096|2022|PDM|2887.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F110503_10016_0|SrvcGrp|89149|2022|PDM|339.00|99|0.00|OP INTENSIVE|
20|FH_F126244_43567_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F122930_0_0|SrvcGrp|72998|2022|PDM|1797.00|99|0.00|AEG 5|
20|FH_F31595_0_0|SrvcGrp|12855|2022|PCT|0.93|99|0.00|OP SURGERY|
20|FH_F138302_15701_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F143715_33161_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130364_01331_0|CSTM-ALL|CSTM-00|2020|PDM|2660.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132958_79903_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F147962_85008_0|SrvcGrp|109057|2022|PCT|1.35|99|0.00|CARDIAC STUDIES|
20|FH_F146100_17403_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|572.60|99|0.00|AEG 3 (NO REV)|
20|FH_F95623_84015_0|SrvcGrp|88834|2022|PDM|85.00|99|0.00|SKILLED NURSING SERVICES (15 MINS)|
20|FH_F150165_06032_0|SrvcGrp|89860|2022|PDM|8137.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F85012_0_0|SrvcGrp|13928|2022|PCT|0.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.00|99|0.00|2007 MEDICARE ASPG IV|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.65|99|0.00|HAPA WPA-NWPA 2012-13 ASC 146 W/O REV|
20|FH_F98800_85021_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F101100_50314_0|SrvcGrp|97732|2022|PDM|8487.00|99|0.00|TREAT THIGH FRACTURE 1|
20|FH_F105145_75075_0|SrvcGrp|101888|2022|PDM|6000.00|99|0.00|AETNA AEG 10 WITHOUT CARVEOUT SURG|
20|FH_F115788_02904_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115811_33410_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F66782_0_0|SrvcGrp|44042|2022|PDM|70.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F77665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146668_30189_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120805_92672_0|SrvcGrp|74668|2022|PDM|550.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F127656_06068_0|SrvcGrp|29347|2022|PDM|34.28|99|0.00|HOME HEALTH AIDE|
20|FH_F127656_06068_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F127656_06068_0|SrvcGrp|48398|2022|PDM|109.20|99|0.00|PT SERVICES|
20|FH_F66705_0_0|SrvcGrp|44392|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F131904_18915_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133590_33064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F133658_60053_0|SrvcGrp|48394|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F133658_60053_0|SrvcGrp|48398|2022|PDM|125.00|99|0.00|PT SERVICES|
20|FH_F139430_63017_0|SrvcGrp|48385|2022|PDM|101.00|99|0.00|SPEECH THERAPY|
20|FH_F139441_91324_0|SrvcGrp|75522|2022|PDM|2835.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD|
20|FH_F139649_40108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150882_84041_0|SrvcGrp|86848|2022|PDM|47.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|113.00|99|0.00|HAPA EPA ASC 19|
20|FH_F38584_0_0|SrvcGrp|17075|2022|PDM|1334.00|99|0.00|ASPG VI|
20|FH_F98001_27603_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F131325_48170_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F75793_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|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_F73923_0_0|SrvcGrp|71221|2022|PDM|670.00|99|0.00|EGD W/BALLOON DIALATION CPT 43249|
20|FH_F124514_21215_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F90817_0_0|SrvcGrp|91035|2022|PDM|2096.00|99|0.00|REPAIR OF TENDON(S) (HCFA)|
20|FH_F139227_33162_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F110821_31513_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39944_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|TRAUMA CARE|
20|FH_F67419_0_0|SrvcGrp|42976|2022|PDM|80.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F137561_43935_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|TRAUMA CARE|
20|FH_F137363_0_0|SrvcGrp|104639|2022|PDM|4500.00|99|0.00|REMOVE & REPLACE PM GEN SINGL|
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40653_0_0|SrvcGrp|361|2022|PDM|1270.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F39443_0_0|SrvcGrp|30333|2022|PDM|300.00|99|0.00|HAPA WPA ASC 217|
20|FH_F134869_08854_0|SrvcGrp|89267|2022|PDM|110.00|99|0.00|PSYTX PT/FAMILY 30 MINUTES|
20|FH_F147234_19010_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F128770_57313_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126116_0_0|SrvcGrp|101527|2022|PDM|982.00|99|0.00|HYSTEROSCOPY LYSIS|
20|FH_F141249_17103_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F36435_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS|
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97080_85122_0|SrvcGrp|88977|2022|PDM|6927.00|99|0.00|C-SECTION DELIVERY|
20|FH_F147339_08837_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 5  (NO REV)|
20|FH_F149400_83301_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F150459_08021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90232_15126_0|SrvcGrp|14893|2022|PDM|34.65|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F148347_0_0|SrvcGrp|82118|2022|PDM|5569.30|99|0.00|LAPAROSCOPY ESOPHAGUS|
20|FH_F114207_35243_0|SrvcGrp|17014|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F38123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F130654_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F109762_0_0|SrvcGrp|73002|2022|PDM|995.00|99|0.00|AEG 7|
20|FH_F127965_32204_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41463_0_0|SrvcGrp|35464|2022|PDM|42.50|99|0.00|OXYGEN RENTAL (E0424 + E0431)|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|100% 2007 MEDICARE TN DME MOD KF|
20|FH_F146859_0_0|SrvcGrp|114857|2022|PDM|2187.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F35758_33710_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AEG 10 (NO REV)|
20|FH_F36715_0_0|SrvcGrp|15122|2022|PCT|0.80|99|0.00|CARDIAC CATH LAB SVCS|
20|FH_F117615_30525_0|SrvcGrp|75999|2022|PDM|150.00|99|0.00|OP URGENT CARE|
20|FH_F137627_78382_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|AEG 7 (NO REV)|
20|FH_F122377_91007_0|SrvcGrp|109117|2022|PDM|29225.00|99|0.00|LITHOTRIPSY|
20|FH_F115269_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F126717_66103_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124760_34997_0|SrvcGrp|89417|2022|PDM|435.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F90817_0_0|SrvcGrp|91042|2022|PDM|1574.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC (HCFA)|
20|FH_F147080_02446_0|SrvcGrp|72602|2022|PDM|504.00|99|0.00|ECT|
20|FH_F150442_28451_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F125214_12428_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F99420_91326_0|SrvcGrp|3989|2022|PCT|0.76|99|0.00|EMERGENCY ROOM SERVICES|
20|FH_F67132_0_0|CSTM-ALL|CSTM-00|2020|PCT|44.50|99|0.00|OP SVCS|
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F127553_44321_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F99380_90503_0|SrvcGrp|90628|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F151619_73505_0|SrvcGrp|75485|2022|PDM|728.00|99|0.00|AEG 4|
20|FH_F147225_48093_0|SrvcGrp|42623|2022|PDM|528.00|99|0.00|SUBACUTE - LEVEL III|
20|FH_F140215_93301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127965_32204_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F50100_0_0|SrvcGrp|46117|2022|PDM|30.43|99|0.00|HOME HEALTH AIDE (PER HOUR)|
20|FH_F69183_0_0|SrvcGrp|10903|2022|PCT|0.50|99|0.00|EMERGENCY ROOM LEVEL I|
20|FH_F42775_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F148859_0_0|SrvcGrp|68056|2022|PDM|791.00|99|0.00|CPT 55700|
20|FH_F85437_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F45856_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134870_97015_0|SrvcGrp|107861|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F108680_0_0|SrvcGrp|36591|2022|PDM|28600.00|99|0.00|CPT 63685|
20|FH_F133087_61107_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140147_34785_0|CSTM-ALL|CSTM-00|2020|PCT|1.34|99|0.00|HSS ASC|
20|FH_F140248_42420_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139810_60938_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143230_33026_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F143488_84770_0|SrvcGrp|62740|2022|PDM|1327.00|99|0.00|SURGERY CARVE OUTS|
20|FH_F32125_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F140552_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
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_F123185_0_0|SrvcGrp|78045|2022|PCT|1.00|99|0.00|AETNA AMNIOTIC MEMBRANE|
20|FH_F103060_0_0|SrvcGrp|72994|2022|PDM|2263.00|99|0.00|AEG 3|
20|FH_F130914_51103_0|SrvcGrp|109798|2022|PCT|1.30|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F46893_0_0|SrvcGrp|9854|2022|PDM|424.00|99|0.00|HOSPICE|
20|FH_F120190_92624_0|SrvcGrp|46903|2022|PDM|825.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132417_38119_0|SrvcGrp|74668|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132433_34952_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F112687_30474_0|SrvcGrp|92760|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116698_07470_0|SrvcGrp|29464|2022|PCT|1.05|99|0.00|HOME HEALTH VISIT NEWBORN CARE|
20|FH_F143988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F46732_0_0|SrvcGrp|91722|2022|PDM|148.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT|
20|FH_F130682_0_0|SrvcGrp|65625|2022|PDM|4980.00|99|0.00|CPT 30520|
20|FH_F123953_84003_0|SrvcGrp|89337|2022|PDM|1013.00|99|0.00|DETOXIFICATION|
20|FH_F82235_0_0|SrvcGrp|73006|2022|PDM|1472.90|99|0.00|AEG 9|
20|FH_F44177_0_0|SrvcGrp|20752|2022|PDM|16200.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F34100_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82714_18848_0|CSTM-ALL|CSTM-00|2020|PDM|904.00|99|0.00|AEG 2 (NO REV)|
20|FH_F128307_43219_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F129792_80309_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F139551_0_0|SrvcGrp|97730|2022|PDM|16500.00|99|0.00|REVERSE HIP JOINT|
20|FH_F93055_34601_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130350_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F34513_0_0|SrvcGrp|12179|2022|PCT|1.00|99|0.00|CPT CODES 70000-79999 (RAD)|
20|FH_F116760_68512_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F143768_34785_0|SrvcGrp|84117|2022|PCT|1.00|99|0.00|TELEHEALTH SERVICES|
20|FH_F145544_93536_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F125421_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.00|99|0.00|AEG 3 (NO REV)|
20|FH_F84778_0_0|SrvcGrp|73002|2022|PDM|1927.00|99|0.00|AEG 7|
20|FH_F88451_0_0|SrvcGrp|14404|2022|PCT|0.60|99|0.00|HOME HEALTH CARE MEDICAL SUPPLIES|
20|FH_F41932_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F86456_79761_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F52854_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F148486_03110_0|SrvcGrp|471|2022|PDM|652.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F116115_14437_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F32135_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AEG 7 (NO REV)|
20|FH_F110132_23451_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT HH|
20|FH_F135207_76053_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F148265_06067_0|SrvcGrp|89860|2022|PDM|12467.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F82931_18847_0|SrvcGrp|2067|2022|PDM|631.98|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F88254_33411_0|SrvcGrp|31973|2022|PDM|10.00|99|0.00|HOME THERAPY|
20|FH_F102302_0_0|SrvcGrp|98561|2022|PDM|39100.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F35259_0_0|SrvcGrp|24|2022|PDM|8759.00|99|0.00|CARDIAC CATH|
20|FH_F115050_77995_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129627_06037_0|SrvcGrp|94780|2022|PDM|165.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|1517.00|99|0.00|AEG 6 (NO REV)|
20|FH_F128272_60640_0|SrvcGrp|86827|2022|PDM|100.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F120338_83226_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|2346.00|99|0.00|AEG 6 (NO REV)|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|OP SVCS|
20|FH_F79007_0_0|CSTM-ALL|CSTM-00|2020|PCT|49.00|99|0.00|OP SVCS|
20|FH_F44177_0_0|SrvcGrp|12359|2022|PDM|1786.00|99|0.00|TELEMETRY SVCS|
20|FH_F115043_77954_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F149888_68506_0|SrvcGrp|84929|2022|PDM|4946.00|99|0.00|OP SURGERY|
20|FH_F131902_46402_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F89563_29407_0|SrvcGrp|83057|2022|PCT|1.00|99|0.00|AETNA THERAPEUTIC EXERCISES|
20|FH_F135236_02840_0|CSTM-ALL|CSTM-00|2020|PDM|6886.40|99|0.00|INPATIENT DETOX SERVICES >17 YRS|
20|FH_F72830_0_0|SrvcGrp|70050|2022|PDM|3300.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 10|
20|FH_F118194_50841_0|SrvcGrp|103381|2022|PDM|240.00|99|0.00|HOME INFUSTION THERAPY, PICC LINE, INCLUDING SUPPLIES|
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 8 (NO REV)|
20|FH_F125138_63663_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F135092_46410_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F93920_0_0|SrvcGrp|72984|2022|PCT|0.75|99|0.00|CHEMOTHERAPY|
20|FH_F34413_0_0|SrvcGrp|3277|2022|PDM|200.00|99|0.00|SKILLED NURSING CARE|
20|FH_F130747_0_0|SrvcGrp|92821|2022|PDM|5202.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD QW|
20|FH_F92276_32308_0|SrvcGrp|79099|2022|PDM|3300.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|917.00|99|0.00|AEG 5  (NO REV)|
20|FH_F79485_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131236_84041_0|SrvcGrp|27968|2022|PDM|29.40|99|0.00|SKILLED NURSING LPN|
20|FH_F110166_32757_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123943_84041_0|SrvcGrp|97506|2022|PDM|90.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F100460_0_0|SrvcGrp|87526|2022|PDM|58366.00|99|0.00|AETNA PERMANENT NEUROSTIMULATOR|
20|FH_F135260_18655_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F115063_78550_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117784_0_0|SrvcGrp|13262|2022|PDM|2.88|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F141527_36830_0|SrvcGrp|47183|2022|PDM|63.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F134999_89106_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129168_43050_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145758_20745_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F151541_01436_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F130936_06107_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129969_33908_0|SrvcGrp|3178|2022|PDM|900.00|99|0.00|ACUTE PSYCH|
20|FH_F91617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129000_21017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F122687_0_0|SrvcGrp|27310|2022|PDM|2732.00|99|0.00|ENDOSCOPIC PLANTAR FASCIOTOMY|
20|FH_F110925_01104_0|SrvcGrp|24744|2022|PDM|220.00|99|0.00|PICC LINE INSERTION|
20|FH_F135267_19002_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F148480_03079_0|CSTM-ALL|CSTM-00|2020|PDM|866.25|99|0.00|AEG 1 (NO REV)|
20|FH_F149140_07522_0|SrvcGrp|113235|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2&INF A&B&RSV AMP PRB|
20|FH_F116952_01020_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120371_63136_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F41178_0_0|SrvcGrp|13811|2022|PDM|324.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F111288_0_0|SrvcGrp|82298|2022|PDM|25500.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY|
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)|
20|FH_F148265_06067_0|SrvcGrp|93069|2022|PDM|7554.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|1219.00|99|0.00|AEG 8 (NO REV)|
20|FH_F82696_16335_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|HAPA WPA 2013 4TH QTR INJ 100%|
20|FH_F128159_45356_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F125890_43054_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F135056_06401_0|SrvcGrp|86722|2022|PDM|165.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F66687_0_0|SrvcGrp|20744|2022|PCT|0.85|99|0.00|MS DRG 242 ONLY|
20|FH_F37863_0_0|CSTM-ALL|CSTM-00|2020|PDM|21.00|99|0.00|ANESTHESIA SERVICES - CRNA|
20|FH_F136510_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F128496_46936_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F86696_16063_0|SrvcGrp|48385|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F86872_15215_0|SrvcGrp|14945|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F86991_15122_0|SrvcGrp|39608|2022|PDM|1254.00|99|0.00|CATARACT SURGERY|
20|FH_F111594_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F132544_0_0|SrvcGrp|16694|2022|PDM|3523.00|99|0.00|KNEE SCOPE, CHONDROPLASTY|
20|FH_F148482_20136_0|CSTM-ALL|CSTM-00|2020|PDM|595.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F148545_84047_0|SrvcGrp|73701|2022|PDM|26.75|99|0.00|AETNA - SKILLED NURSING|
20|FH_F139470_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120437_85202_0|SrvcGrp|73742|2022|PCT|1.12|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F132612_0_0|SrvcGrp|705|2022|PCT|0.67|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F71145_0_0|SrvcGrp|44250|2022|PDM|165.00|99|0.00|CCPD TRAINING|
20|FH_F100661_63640_0|SrvcGrp|73559|2022|PDM|7796.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F34706_0_0|SrvcGrp|10175|2022|PDM|7350.00|99|0.00|DRG 198 CHOLY EXCEPT LAPAR W/O COMMON DUCT EXPLORTN W/O CC|
20|FH_F40203_0_0|SrvcGrp|248|2022|PDM|800.00|99|0.00|PEDIATRIC REHABILITATION|
20|FH_F141833_31707_0|SrvcGrp|106294|2022|PDM|750.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F139594_0_0|SrvcGrp|108893|2022|PDM|700.00|99|0.00|IMPLANTABLE TISSUE MARKER|
20|FH_F118845_71111_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F127432_18015_0|SrvcGrp|103913|2022|PCT|0.38|99|0.00|OP DIALYSIS|
20|FH_F90935_29073_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F77787_0_0|SrvcGrp|3499|2022|PCT|0.31|99|0.00|IMPLANTS|
20|FH_F149841_73114_0|SrvcGrp|46903|2022|PDM|483.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F41804_0_0|CSTM-ALL|CSTM-00|2020|PDM|1082.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91634_0_0|SrvcGrp|108340|2022|PCT|0.00|99|0.00|IMPLANT NEURORECEIVER 23|
20|FH_F82715_0_0|SrvcGrp|80658|2022|PCT|0.25|99|0.00|UPGRADED HEARING AID|
20|FH_F87155_04105_0|SrvcGrp|14945|2022|PDM|12.61|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F38725_0_0|CSTM-ALL|CSTM-00|2020|PDM|786.00|99|0.00|ASPG IV|
20|FH_F130108_0_0|SrvcGrp|3029|2022|PDM|500.00|99|0.00|NEWBORN NURSERY|
20|FH_F41396_0_0|SrvcGrp|34274|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC (DME)|
20|FH_F150530_63031_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111546_84010_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119775_0_0|SrvcGrp|73004|2022|PDM|931.00|99|0.00|AEG 8|
20|FH_F146257_83713_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F44813_0_0|CSTM-ALL|CSTM-00|2020|PDM|205.00|99|0.00|PSYCHIATRIC DAY TREATMENT PROGRAM|
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|1898.97|99|0.00|ASPG VII|
20|FH_F149881_03038_0|SrvcGrp|472|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F136002_0_0|SrvcGrp|112811|2022|PDM|86.70|99|0.00|LPN CARE|
20|FH_F83031_0_0|SrvcGrp|44707|2022|PDM|105.00|99|0.00|NURSING CARE|
20|FH_F148639_0_0|SrvcGrp|90063|2022|PDM|2994.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F119437_0_0|SrvcGrp|88163|2022|PDM|4000.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F133473_21702_0|SrvcGrp|88620|2022|PDM|163.38|99|0.00|SKILLED NURSING RN|
20|FH_F42719_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.60|99|0.00|OP SVCS|
20|FH_F38161_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|FLORIDA GLOBAL MRI CARVEOUT CODES|
20|FH_F150039_34236_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1179.23|99|0.00|HAPA WPA-NWPA 2012-13 ASC 701 W/O REV|
20|FH_F150909_70032_0|SrvcGrp|113911|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME INFUSION|
20|FH_F142776_65338_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F49637_0_0|SrvcGrp|20071|2022|PDM|550.00|99|0.00|MS DRG 945-946|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PICC LINE INSERTION NURSING|
20|FH_F146320_27610_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|AEG 1 (NO REV)|
20|FH_F69242_0_0|SrvcGrp|36068|2022|PDM|55.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F76586_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|HOME HEALTH|
20|FH_F44016_0_0|SrvcGrp|36642|2022|PDM|1338.00|99|0.00|EMERGENCY CRITICAL CARE|
20|FH_F127412_15301_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 4 W/O EYE SURGERY (NO REV)|
20|FH_F115505_21014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39255_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|AEG 10 (NO REV)|
20|FH_F131699_08210_0|SrvcGrp|46605|2022|PDM|154.35|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F136751_0_0|SrvcGrp|97895|2022|PDM|20500.00|99|0.00|REVISE KNEE 2|
20|FH_F139789_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F114310_0_0|SrvcGrp|16289|2022|PDM|1085.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|963.00|99|0.00|ACUTE PSYCH|
20|FH_F132331_89107_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F148494_0_0|SrvcGrp|101114|2022|PDM|15000.00|99|0.00|ARTHOPLASTY|
20|FH_F148556_13206_0|SrvcGrp|29075|2022|PDM|31.00|99|0.00|HYDRATION THERAPY|
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_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC|
20|FH_F141913_65560_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|557.70|99|0.00|AEG 1 (NO REV)|
20|FH_F128089_57385_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131315_0_0|SrvcGrp|87077|2022|PDM|148.50|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F115315_43011_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1724.00|99|0.00|AEG 2 (NO REV)|
20|FH_F120707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|GENERAL ACUTE CARE|
20|FH_F125352_90034_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F42807_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|NUCLEAR MEDICINE / PROSTATE SEED IMPLANTS|
20|FH_F123144_0_0|SrvcGrp|73002|2022|PDM|1017.00|99|0.00|AEG 7|
20|FH_F148872_45723_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_F37640_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|ASPG IV|
20|FH_F33497_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72686_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F120437_85202_0|SrvcGrp|10579|2022|PDM|101.29|99|0.00|HYDRATION THERAPY - 2 LITERS|
20|FH_F126935_33615_0|SrvcGrp|108484|2022|PDM|641.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F97041_71603_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F92677_08003_0|SrvcGrp|29023|2022|PDM|84.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F141804_70503_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F50420_0_0|SrvcGrp|45148|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|681.09|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F113146_15001_0|SrvcGrp|86722|2022|PDM|168.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F118004_74133_0|SrvcGrp|16|2022|PDM|1135.00|99|0.00|ACUTE REHABILITATION|
20|FH_F116440_0_0|SrvcGrp|79720|2022|PDM|1000.00|99|0.00|ACUTE REHAB II|
20|FH_F52112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F49637_0_0|SrvcGrp|31028|2022|PDM|7035.00|99|0.00|MS DRG 489 ONLY|
20|FH_F38663_0_0|SrvcGrp|15075|2022|PDM|125.00|99|0.00|PICC LINE INSERTION NURSING|
20|FH_F140583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133019_23236_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F145865_78130_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F34998_0_0|SrvcGrp|65|2022|PDM|1450.00|99|0.00|OBSTETRICAL CARE|
20|FH_F48475_0_0|SrvcGrp|14230|2022|PDM|418.00|99|0.00|SKILLED NURSING CARE|
20|FH_F36350_0_0|SrvcGrp|3069|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F142789_34104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1397.11|99|0.00|AEG 8 (NO REV)|
20|FH_F120658_0_0|CSTM-ALL|CSTM-00|2020|PDM|2113.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117559_08619_0|SrvcGrp|104054|2022|PDM|20.00|99|0.00|INFLUENZA VACCINE - PRESERVATIVE FREE|
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|1487.07|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|1483.72|99|0.00|AEG 8 (NO REV)|
20|FH_F89778_0_0|SrvcGrp|35668|2022|PDM|2455.44|99|0.00|CPT 29824|
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|66.37|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F151559_0_0|SrvcGrp|116054|2022|PDM|800.00|99|0.00|SAME DAY NEWBORN DISCHARGE|
20|FH_F58252_0_0|SrvcGrp|46605|2022|PDM|35.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F58856_0_0|SrvcGrp|28164|2022|PDM|43750.00|99|0.00|MS DRG 224 ONLY|
20|FH_F58856_0_0|SrvcGrp|9529|2022|PDM|1100.00|99|0.00|HOSPICE SVCS|
20|FH_F136386_30901_0|SrvcGrp|21350|2022|PDM|15750.00|99|0.00|MS DRG 287 ONLY|
20|FH_F136487_71269_0|SrvcGrp|86723|2022|PDM|470.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F120489_63552_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134011_84102_0|SrvcGrp|17014|2022|PDM|22.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F137047_73120_0|SrvcGrp|78579|2022|PDM|1236.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
20|FH_F137147_75006_0|SrvcGrp|10365|2022|PDM|2100.00|99|0.00|CPT CODE 99285|
20|FH_F137232_28210_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137237_33304_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F142320_07747_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F142470_32935_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F142390_20866_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142690_31774_0|SrvcGrp|48385|2022|PDM|145.00|99|0.00|SPEECH THERAPY|
20|FH_F138607_02760_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F138627_82901_0|SrvcGrp|88805|2022|PDM|225.00|99|0.00|TOTAL PARENTERAL NUTRITION; > 3 LITERS (HCFA)|
20|FH_F125053_0_0|SrvcGrp|110066|2022|PDM|768.00|99|0.00|ANOSCOPY CONTROL BLEEDING|
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1445.19|99|0.00|2006 MEDICARE ASPG X|
20|FH_F140343_89052_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F140407_63841_0|SrvcGrp|113633|2022|PDM|715.00|99|0.00|HOSPICE CARE|
20|FH_F140407_63841_0|SrvcGrp|112225|2022|PDM|23.46|99|0.00|COVID-19 SPECIMEN COLLECTION|
20|FH_F140553_37205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F140570_46996_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|OP SVCS|
20|FH_F140615_73013_0|CSTM-ALL|CSTM-00|2020|PDM|989.00|99|0.00|AEG 1 (NO REV)|
20|FH_F140760_07003_0|SrvcGrp|90397|2022|PDM|372.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F80284_16354_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F149377_22102_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F151600_17866_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119023_91406_0|SrvcGrp|86850|2022|PDM|35.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F70665_0_0|SrvcGrp|42828|2022|PDM|68.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F80366_0_0|SrvcGrp|537|2022|PCT|0.94|99|0.00|OBSERVATION SERVICES|
20|FH_F147799_18052_0|SrvcGrp|48396|2022|PDM|116.42|99|0.00|OT SERVICES|
20|FH_F129504_02871_0|SrvcGrp|95661|2022|PDM|170.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F117219_77515_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137333_51012_0|SrvcGrp|113077|2022|PDM|608.00|99|0.00|RESIDENTIAL TREATMENT (12-18 YRS)|
20|FH_F109652_0_0|SrvcGrp|27877|2022|PDM|192.00|99|0.00|ULTRASOUND|
20|FH_F109907_0_0|SrvcGrp|23683|2022|PDM|36.41|99|0.00|SKILLED NURSING RN|
20|FH_F109513_0_0|SrvcGrp|84180|2022|PDM|2800.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS|
20|FH_F148760_12953_0|SrvcGrp|46605|2022|PDM|147.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F151179_84074_0|SrvcGrp|72994|2022|PDM|945.00|99|0.00|AEG 3|
20|FH_F110381_0_0|SrvcGrp|103971|2022|PDM|2332.00|99|0.00|AETNA KNEE ARTHROSCOPY & REPAIR|
20|FH_F110381_0_0|SrvcGrp|72994|2022|PDM|1034.00|99|0.00|AEG 3|
20|FH_F117525_0_0|SrvcGrp|72996|2022|PDM|1035.00|99|0.00|AEG 4|
20|FH_F91873_12723_0|SrvcGrp|11258|2022|PCT|0.68|99|0.00|DRUGS|
20|FH_F91873_12723_0|SrvcGrp|90177|2022|PCT|2.92|99|0.00|AETNA HOSPITAL OP DIALYSIS|
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|1271.00|99|0.00|AEG 1 (NO REV)|
20|FH_F87197_0_0|SrvcGrp|92605|2022|PDM|414.00|99|0.00|SUB-ACUTE CARE LEVEL II|
20|FH_F113784_0_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F115150_0_0|SrvcGrp|103929|2022|PDM|155.55|99|0.00|SLEEP STUDY UNATTENDED RESPIRATORY EFFORT(HCFA)|
20|FH_F142288_44714_0|SrvcGrp|74668|2022|PDM|232.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115208_0_0|SrvcGrp|22915|2022|PDM|2228.00|99|0.00|CPT CODE 42820|
20|FH_F40082_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV)|
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|3180.00|99|0.00|AETNA AEG 6 WITHOUT 66985-66986|
20|FH_F43717_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|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_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 4 (NO REV)|
20|FH_F143898_0_0|SrvcGrp|57967|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F94786_07974_0|SrvcGrp|91685|2022|PDM|787.50|99|0.00|HOME VENT|
20|FH_F94786_07974_0|SrvcGrp|86825|2022|PDM|73.50|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F94786_07974_0|SrvcGrp|22593|2022|PDM|36.75|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F131047_0_0|SrvcGrp|14610|2022|PCT|0.57|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F129785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130274_63033_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141336_16947_0|SrvcGrp|112224|2022|PDM|110.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F124180_0_0|SrvcGrp|109734|2022|PDM|3475.50|99|0.00|OCULR RECNSTR;LMBL STEM CELL|
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 7 (NO REV)|
20|FH_F55812_0_0|SrvcGrp|15850|2022|PDM|110.00|99|0.00|HOSPICE SVCS|
20|FH_F115971_0_0|SrvcGrp|73000|2022|PDM|927.00|99|0.00|AEG 6|
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PDM|1004.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F37703_0_0|SrvcGrp|15873|2022|PDM|31.00|99|0.00|HOSPICE SERVICE - CONTINUOUS HOME CARE|
20|FH_F38983_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124584_28204_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135327_0_0|SrvcGrp|84285|2022|PDM|2600.00|99|0.00|REVISE CORNEA WITH IMPLANT|
20|FH_F148553_85016_0|SrvcGrp|108170|2022|PDM|3383.00|99|0.00|ILIAC REVASC W/ STENT|
20|FH_F122643_72501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122879_39564_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F43913_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F134770_14420_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F69623_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAPA WPA/NWPA 2012 RAD 100%|
20|FH_F115631_65201_0|SrvcGrp|11673|2022|PDM|3177.00|99|0.00|CPT 29888|
20|FH_F116343_33701_0|SrvcGrp|92760|2022|PCT|1.08|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147331_90045_0|SrvcGrp|48394|2022|PDM|79.56|99|0.00|SKILLED NURSING SERVICES|
20|FH_F42153_0_0|SrvcGrp|47250|2022|PDM|867.00|99|0.00|MS DRG 876, 880-887 ONLY|
20|FH_F120921_75835_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F126435_77459_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113649_01752_0|SrvcGrp|86841|2022|PDM|119.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F113649_01752_0|SrvcGrp|14949|2022|PDM|120.00|99|0.00|HOME INFUSION|
20|FH_F33925_0_0|SrvcGrp|15783|2022|PDM|3658.00|99|0.00|LITHOTRIPSY - MULTIPLE OR BILATERAL|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1512.00|99|0.00|ASPG III|
20|FH_F38831_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GOOD SHEPHERD RADIOLOGY|
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.40|99|0.00|ASPG IV|
20|FH_F40800_0_0|SrvcGrp|177|2022|PDM|950.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F41433_0_0|SrvcGrp|34280|2022|PDM|25.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F42715_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F131208_0_0|SrvcGrp|13262|2022|PDM|13.20|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F132131_33060_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131702_17022_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F111841_85212_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F134828_30531_0|SrvcGrp|89080|2022|PDM|43.00|99|0.00|X-RAY EXAM OF NECK SPINE|
20|FH_F34477_0_0|SrvcGrp|63740|2022|PDM|100.00|99|0.00|RN VISIT|
20|FH_F33295_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113025_0_0|SrvcGrp|75491|2022|PDM|1043.00|99|0.00|AEG 7|
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|3448.39|99|0.00|AEG 6 (NO REV)|
20|FH_F35381_0_0|CSTM-ALL|CSTM-00|2020|PDM|1491.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143509_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F150939_0_0|SrvcGrp|100264|2022|PDM|24.00|99|0.00|REMOVE IMPACTED EAR WAX|
20|FH_F66569_0_0|SrvcGrp|62361|2022|PDM|85.00|99|0.00|SPEECH THERAPY EVAL AND RE-EVAL|
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_F49832_0_0|SrvcGrp|42824|2022|PDM|90.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F50459_0_0|SrvcGrp|43893|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F54552_0_0|SrvcGrp|17006|2022|PDM|61.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS|
20|FH_F113585_20155_0|SrvcGrp|29077|2022|PCT|1.00|99|0.00|HOME TRANSFUSION|
20|FH_F138730_22602_0|SrvcGrp|78419|2022|PDM|2500.00|99|0.00|VBAC DELIVERY|
20|FH_F138807_32207_0|SrvcGrp|66264|2022|PDM|137.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F138876_25302_0|SrvcGrp|24761|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F119544_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151420_60654_0|CSTM-ALL|CSTM-00|2020|PDM|1744.00|99|0.00|AEG 6 (NO REV)|
20|FH_F122116_60942_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122168_66214_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135427_19610_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97142_94535_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F136130_10029_0|SrvcGrp|85017|2022|PCT|1.05|99|0.00|DME|
20|FH_F116397_33404_0|SrvcGrp|86845|2022|PDM|40.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F116468_49660_0|SrvcGrp|90854|2022|PDM|760.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F130766_04967_0|SrvcGrp|113925|2022|PCT|0.88|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F121700_60938_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPTION CARE OF MUNCY FH MOD-26|
20|FH_F111292_33136_0|SrvcGrp|73008|2022|PDM|5737.00|99|0.00|AEG 10|
20|FH_F111301_33122_0|SrvcGrp|88142|2022|PDM|268.00|99|0.00|AETNA ULTRASOUND BREAST(S)|
20|FH_F111301_33122_0|SrvcGrp|73002|2022|PDM|2483.00|99|0.00|AEG 7|
20|FH_F47906_0_0|SrvcGrp|29961|2022|PCT|1.00|99|0.00|DME MOD QW|
20|FH_F41780_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F96340_23704_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F129419_27407_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102222_19720_0|SrvcGrp|86854|2022|PDM|31.50|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F102228_08846_0|SrvcGrp|86746|2022|PCT|1.05|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F102322_32233_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F102862_30606_0|SrvcGrp|73559|2022|PDM|1760.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F130658_44484_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F130805_17404_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130895_07726_0|SrvcGrp|73842|2022|PDM|182.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|591.00|99|0.00|AEG 2 (NO REV)|
20|FH_F136207_0_0|SrvcGrp|73559|2022|PDM|1989.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F123610_60018_0|SrvcGrp|100499|2022|PDM|662.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F57453_0_0|SrvcGrp|57606|2022|PCT|1.00|99|0.00|RADIOLOGY|
20|FH_F76022_0_0|SrvcGrp|11259|2022|PCT|0.85|99|0.00|DRUGS|
20|FH_F121476_0_0|SrvcGrp|108846|2022|PDM|1595.00|99|0.00|URINARY INCON REPAIR DEVICE|
20|FH_F119227_01752_0|SrvcGrp|86837|2022|PDM|18.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F134611_04103_0|SrvcGrp|75419|2022|PDM|1575.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F119227_01752_0|SrvcGrp|86842|2022|PDM|35.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F145791_67205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114526_33401_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F141210_0_0|SrvcGrp|78283|2022|PDM|5305.00|99|0.00|CPT 49505|
20|FH_F145641_06902_0|SrvcGrp|114238|2022|PDM|3709.00|99|0.00|TREATMENT OF ANKLE FRACTURE|
20|FH_F51613_0_0|SrvcGrp|3449|2022|PDM|848.00|99|0.00|ELECTRO CONVULSIVE THERAPY|
20|FH_F125328_0_0|SrvcGrp|73008|2022|PDM|360.00|99|0.00|AEG 10|
20|FH_F133585_0_0|SrvcGrp|112389|2022|PDM|151.00|99|0.00|CPT 75774 (HCFA)|
20|FH_F130364_01331_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F133747_80634_0|SrvcGrp|89317|2022|PCT|0.92|99|0.00|AETNA SLEEP STUDIES|
20|FH_F80594_0_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109367_32751_0|SrvcGrp|100499|2022|PDM|900.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F133749_84604_0|SrvcGrp|112478|2022|PDM|50.00|99|0.00|POST NATAL ASSESSMENT W/ NEWBORN|
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|2619.00|99|0.00|AEG 4 (NO REV)|
20|FH_F119227_01752_0|SrvcGrp|17016|2022|PDM|38.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F121603_46761_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|538.00|99|0.00|AEG 3 (NO REV)|
20|FH_F36552_0_0|SrvcGrp|18815|2022|PDM|29295.00|99|0.00|MS DRG 221|
20|FH_F73864_0_0|SrvcGrp|48396|2022|PDM|12.00|99|0.00|OT SERVICES|
20|FH_F144848_0_0|SrvcGrp|97319|2022|PDM|18043.00|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F150144_39452_0|SrvcGrp|46903|2022|PDM|670.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F136780_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1322.00|99|0.00|ASPG VI|
20|FH_F111986_0_0|SrvcGrp|63459|2022|PDM|1854.00|99|0.00|CPT 52601|
20|FH_F145675_33761_0|SrvcGrp|48396|2022|PDM|90.00|99|0.00|OT SERVICES|
20|FH_F119937_0_0|SrvcGrp|82223|2022|PDM|127.00|99|0.00|HOSPICE CARE|
20|FH_F143650_0_0|SrvcGrp|73000|2022|PDM|2900.00|99|0.00|AEG 6|
20|FH_F130017_02302_0|SrvcGrp|88977|2022|PDM|12377.73|99|0.00|C-SECTION DELIVERY|
20|FH_F145554_53066_0|SrvcGrp|46903|2022|PDM|880.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F144248_0_0|SrvcGrp|109758|2022|PDM|11475.00|99|0.00|COLLAGEN CROSSLINKING CORNEA|
20|FH_F43197_0_0|SrvcGrp|11068|2022|PDM|80.00|99|0.00|PT SVCS|
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1508.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.57|99|0.00|HAPA WPA-NWPA 2012-13 ASC 112 W/O REV|
20|FH_F119999_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F39418_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|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_F134168_70526_0|SrvcGrp|87077|2022|PDM|115.00|99|0.00|AETNA 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_F114444_19602_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F95440_0_0|SrvcGrp|93807|2022|PDM|6000.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F147962_85008_0|SrvcGrp|115273|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2887.00|99|0.00|AEG 9 (NO REV)|
20|FH_F110302_15931_0|SrvcGrp|48398|2022|PDM|95.67|99|0.00|PT SERVICES|
20|FH_F143563_32828_0|SrvcGrp|113911|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F52805_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F95631_33705_0|CSTM-ALL|CSTM-00|2020|PCT|0.36|99|0.00|OP SVCS|
20|FH_F144248_0_0|SrvcGrp|95107|2022|PDM|5738.00|99|0.00|INTRAOCULAR LENS PROSTHESIS|
20|FH_F51258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F135657_27612_0|SrvcGrp|73842|2022|PDM|198.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F143628_32810_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124173_66215_0|SrvcGrp|13929|2022|PDM|10.00|99|0.00|GROWTH HORMONE|
20|FH_F133877_84117_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110309_63301_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147959_33573_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72543_0_0|SrvcGrp|69021|2022|PDM|108.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F134489_90305_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F50074_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|OP SVCS|
20|FH_F84652_0_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F68626_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F70684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS|
20|FH_F72768_0_0|SrvcGrp|14893|2022|PDM|35.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F118699_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F105143_26062_0|SrvcGrp|72994|2022|PDM|5223.00|99|0.00|AEG 3|
20|FH_F115784_06831_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146805_45662_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115950_08648_0|SrvcGrp|86749|2022|PCT|1.05|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F116040_24637_0|SrvcGrp|21920|2022|PDM|30.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F133658_60053_0|SrvcGrp|66265|2022|PDM|106.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F132971_77063_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F139550_75219_0|SrvcGrp|100520|2022|PDM|392.00|99|0.00|INTENSIVE OP EATING DISORDERS|
20|FH_F150839_03833_0|SrvcGrp|46104|2022|PDM|164.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F138017_73129_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F149602_07109_0|SrvcGrp|113228|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 4 TRGT|
20|FH_F123570_0_0|SrvcGrp|61096|2022|PCT|1.18|99|0.00|IMPLANTS|
20|FH_F35678_0_0|SrvcGrp|18239|2022|PDM|16952.00|99|0.00|MS DRG 031|
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1927.00|99|0.00|AEG 8 W/O 66982, 66984|
20|FH_F134916_16421_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35750_0_0|SrvcGrp|12787|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F75207_0_0|SrvcGrp|47999|2022|PDM|120.00|99|0.00|CAPD SUPPLEMENT DAY|
20|FH_F147215_48105_0|SrvcGrp|42623|2022|PDM|539.00|99|0.00|SUBACUTE - LEVEL III|
20|FH_F137363_0_0|SrvcGrp|110358|2022|PDM|1854.00|99|0.00|ARTHROSCOPY|
20|FH_F111246_80027_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|1391.00|99|0.00|AEG 10 (NO REV)|
20|FH_F69183_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|ASPG II - FH SW CUSTOM GROUPERS|
20|FH_F92300_37303_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F149273_0_0|SrvcGrp|75181|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F141287_14830_0|SrvcGrp|113740|2022|PCT|4.87|99|0.00|LABORATORY SERVICES|
20|FH_F38584_0_0|SrvcGrp|17081|2022|PDM|2156.00|99|0.00|ASPG IX|
20|FH_F37304_0_0|SrvcGrp|12037|2022|PDM|10018.00|99|0.00|PTCA W/STENT|
20|FH_F123386_0_0|SrvcGrp|12918|2022|PDM|2300.00|99|0.00|GYNECOLOGICAL MED/SURG|
20|FH_F142694_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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F147229_60523_0|SrvcGrp|57967|2022|PDM|204.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F150922_02452_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.65|99|0.00|SALLY BALIN,999182,ASC 309|
20|FH_F42944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36883_0_0|SrvcGrp|75505|2022|PCT|0.52|99|0.00|CARDIAC STUDIES|
20|FH_F123726_0_0|SrvcGrp|79420|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F134847_0_0|SrvcGrp|88494|2022|PDM|8756.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F125182_0_0|SrvcGrp|72990|2022|PDM|360.00|99|0.00|AEG 1|
20|FH_F117023_0_0|SrvcGrp|84939|2022|PDM|5000.00|99|0.00|SHOULDER JOINT|
20|FH_F142327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138018_17313_0|SrvcGrp|22389|2022|PDM|41.72|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F41317_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F124691_78003_0|SrvcGrp|87317|2022|PDM|1400.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F130836_53406_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132944_06480_0|SrvcGrp|472|2022|PDM|560.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F110732_31513_0|SrvcGrp|103966|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F112794_01040_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F148347_0_0|SrvcGrp|107757|2022|PDM|5063.00|99|0.00|LAP PARAESOPH HER RPR W/ MESH|
20|FH_F90232_15126_0|SrvcGrp|22592|2022|PDM|56.70|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F151158_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F84058_0_0|SrvcGrp|82447|2022|PDM|276.23|99|0.00|AMBULANCE SVC ADV LIFE SUPPORT NON-EMER|
20|FH_F94643_90501_0|SrvcGrp|86832|2022|PDM|9.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F76588_0_0|SrvcGrp|53144|2022|PDM|18.00|99|0.00|SPEECH THERAPY|
20|FH_F35737_34741_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F122260_98034_0|SrvcGrp|78420|2022|PDM|700.00|99|0.00|INTERIM LABOR|
20|FH_F114951_20002_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|758.00|99|0.00|AEG 6 (NO REV)|
20|FH_F140349_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PDM|1275.00|99|0.00|ASPG VIII|
20|FH_F114171_0_0|SrvcGrp|91759|2022|PCT|1.00|99|0.00|OCULAR IMPLANT|
20|FH_F90232_15126_0|SrvcGrp|29076|2022|PDM|56.70|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F131187_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F122377_91007_0|SrvcGrp|105465|2022|PCT|2.89|99|0.00|AETNA THERAPIES|
20|FH_F92299_62016_0|SrvcGrp|72992|2022|PCT|0.75|99|0.00|AEG 2|
20|FH_F36202_0_0|SrvcGrp|147|2022|PCT|0.80|99|0.00|HOME HEALTH CARE|
20|FH_F151699_01752_0|SrvcGrp|22389|2022|PDM|15.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F92153_74017_0|SrvcGrp|78504|2022|PCT|0.58|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F37304_0_0|SrvcGrp|12886|2022|PDM|126.00|99|0.00|HOSPICE SVCS (HOME CARE)|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD RRKF|
20|FH_F150925_33936_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F118220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125081_15218_0|SrvcGrp|95661|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F117023_0_0|SrvcGrp|27261|2022|PDM|5000.00|99|0.00|CPT 27446|
20|FH_F45226_0_0|SrvcGrp|11080|2022|PDM|80.00|99|0.00|NURSING CARE|
20|FH_F147422_84121_0|SrvcGrp|73063|2022|PDM|803.00|99|0.00|OBSERVATION SERVICES|
20|FH_F143412_70503_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F101709_0_0|SrvcGrp|73000|2022|PDM|2617.00|99|0.00|AEG 6|
20|FH_F102920_0_0|SrvcGrp|73000|2022|PDM|1394.00|99|0.00|AEG 6|
20|FH_F102522_0_0|SrvcGrp|98692|2022|PDM|37.08|99|0.00|ORTHOPEDIC SHOE|
20|FH_F115208_0_0|SrvcGrp|64723|2022|PDM|716.00|99|0.00|CPT 45380|
20|FH_F151785_03104_0|SrvcGrp|471|2022|PDM|652.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F49286_0_0|SrvcGrp|10623|2022|PDM|125.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F132496_17512_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132416_92270_0|SrvcGrp|108484|2022|PDM|585.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F112712_63005_0|SrvcGrp|24752|2022|PCT|1.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2767.00|99|0.00|AEG 9 (NO REV)|
20|FH_F37200_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MIDWEST RADIOLOGICAL MOD KM|
20|FH_F49895_0_0|SrvcGrp|36807|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER QW (DME)|
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_F79645_0_0|SrvcGrp|9882|2022|PCT|0.70|99|0.00|SUPPLIES|
20|FH_F112568_0_0|SrvcGrp|80920|2022|PDM|1047.73|99|0.00|HOSPICE SERVICES|
20|FH_F92091_0_0|SrvcGrp|89987|2022|PDM|1350.00|99|0.00|CORRECTION OF BUNION|
20|FH_F148122_49435_0|SrvcGrp|75419|2022|PDM|350.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|513.00|99|0.00|ASPG 1 HEARTLAND HEALTHCARE|
20|FH_F121090_07848_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F125899_07645_0|SrvcGrp|72990|2022|PDM|4190.00|99|0.00|AEG 1|
20|FH_F75804_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F149140_07522_0|SrvcGrp|113223|2022|PDM|42.13|99|0.00|COVID-19 ANTIBODY SARS-COV-2 TITER(S)|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|394.96|99|0.00|HAPA WPA-NWPA 2012-13 ASC 211 W/O REV|
20|FH_F151526_28208_0|CSTM-ALL|CSTM-00|2020|PDM|12338.00|99|0.00|PERCUTANEOUS AVF|
20|FH_F118373_21205_0|SrvcGrp|113450|2022|PDM|4806.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH/CD|
20|FH_F110086_21742_0|CSTM-ALL|CSTM-00|2020|PDM|751.00|99|0.00|AEG 3 (NO REV)|
20|FH_F137067_0_0|SrvcGrp|88494|2022|PDM|6300.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|456.00|99|0.00|AEG 2 (NO REV)|
20|FH_F127375_28621_0|SrvcGrp|73499|2022|PDM|550.00|99|0.00|AETNA ER LEVEL II|
20|FH_F132190_0_0|SrvcGrp|80139|2022|PDM|2600.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1360.00|99|0.00|AEG 5  (NO REV)|
20|FH_F47152_0_0|SrvcGrp|39544|2022|PDM|145000.00|99|0.00|MS DRG 005-006 LIVER TRANSPLANT - CADAVER DONOR|
20|FH_F148480_03079_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71070_0_0|SrvcGrp|22780|2022|PDM|3000.00|99|0.00|CPT 55875|
20|FH_F134995_37055_0|SrvcGrp|108484|2022|PDM|782.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F37756_0_0|SrvcGrp|16623|2022|PCT|0.70|99|0.00|OBSERVATION SVCS|
20|FH_F135072_65712_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F145550_62034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116108_0_0|SrvcGrp|22954|2022|PDM|148.79|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F137487_74447_0|CSTM-ALL|CSTM-00|2020|PCT|0.21|99|0.00|OP SVCS|
20|FH_F128272_60640_0|SrvcGrp|86825|2022|PDM|80.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F139515_0_0|SrvcGrp|105284|2022|PDM|1380.00|99|0.00|REMOVAL OF PILONIDAL LESION|
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|2725.00|99|0.00|AEG 4 (NO REV)|
20|FH_F148222_18603_0|SrvcGrp|88781|2022|PDM|62.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F37647_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F141527_36830_0|SrvcGrp|19742|2022|PDM|53.00|99|0.00|MID-LINE INSERTION|
20|FH_F39821_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40063_0_0|SrvcGrp|31771|2022|PDM|7835.00|99|0.00|MS DRG 417-419 ONLY  LAP CHOLE|
20|FH_F126730_84737_0|SrvcGrp|108484|2022|PDM|1050.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F143870_19134_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32114_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90362_0_0|SrvcGrp|72998|2022|PDM|821.00|99|0.00|AEG 5|
20|FH_F72183_0_0|SrvcGrp|29838|2022|PDM|1600.00|99|0.00|ARTHROSCOPY|
20|FH_F113410_0_0|SrvcGrp|105253|2022|PDM|1996.00|99|0.00|REMOVAL/TRANSPLANT TENDON|
20|FH_F93880_95476_0|SrvcGrp|73602|2022|PDM|500.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F33712_0_0|SrvcGrp|18197|2022|PCT|0.75|99|0.00|MS DRG 025|
20|FH_F42105_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|1333.00|99|0.00|AEG 6 (NO REV)|
20|FH_F32108_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F89475_71202_0|CSTM-ALL|CSTM-00|2020|PDM|1933.00|99|0.00|AEG 4 (NO REV)|
20|FH_F143528_0_0|SrvcGrp|88157|2022|PDM|14700.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F52854_0_0|CSTM-ALL|CSTM-00|2020|PDM|101.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F98801_93274_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1600.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F92276_32308_0|SrvcGrp|73842|2022|PDM|227.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120195_28403_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137067_0_0|SrvcGrp|102481|2022|PDM|2625.00|99|0.00|CPT 29898|
20|FH_F130145_98043_0|SrvcGrp|107749|2022|PDM|306.00|99|0.00|CAPD/CCPD|
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|2387.00|99|0.00|AEG 9 (NO REV)|
20|FH_F90700_0_0|SrvcGrp|3809|2022|PDM|1637.00|99|0.00|HOSPICE CARE|
20|FH_F132559_0_0|SrvcGrp|65625|2022|PDM|1635.00|99|0.00|CPT 30520|
20|FH_F148265_06067_0|SrvcGrp|96543|2022|PDM|2812.00|99|0.00|REVISION OF CALF TENDON|
20|FH_F99960_0_0|SrvcGrp|27348|2022|PDM|1760.00|99|0.00|OP SURGERY (CPT 58662)|
20|FH_F117113_0_0|SrvcGrp|75545|2022|PDM|367.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F38982_0_0|SrvcGrp|941|2022|PDM|2391.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F109343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F88451_0_0|SrvcGrp|60057|2022|PDM|126.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F37679_0_0|SrvcGrp|22593|2022|PDM|61.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F40427_0_0|SrvcGrp|3499|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F130630_0_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F122687_0_0|SrvcGrp|104008|2022|PDM|3278.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS|
20|FH_F141507_0_0|SrvcGrp|114518|2022|PDM|5000.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F63190_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137067_0_0|SrvcGrp|67066|2022|PDM|16800.00|99|0.00|CERVICAL SURGERY|
20|FH_F130157_84049_0|SrvcGrp|108484|2022|PDM|1300.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F35271_0_0|SrvcGrp|3099|2022|PDM|3500.00|99|0.00|OP SURGERY|
20|FH_F118194_50841_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129231_30060_0|SrvcGrp|68281|2022|PDM|1754.00|99|0.00|CPT 67041|
20|FH_F101711_0_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F109645_0_0|SrvcGrp|103683|2022|PDM|88.00|99|0.00|SPEECH THERAPY (HCFA)|
20|FH_F141527_36830_0|SrvcGrp|86843|2022|PDM|35.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|1036.00|99|0.00|AEG 6 (NO REV)|
20|FH_F124899_45246_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F36366_0_0|CSTM-ALL|CSTM-00|2020|PDM|868.00|99|0.00|CPT 95811 (W/MOD TC)|
20|FH_F145538_34997_0|SrvcGrp|87317|2022|PDM|796.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F77504_0_0|SrvcGrp|8|2022|PDM|1600.00|99|0.00|BURN INTENSIVE CARE|
20|FH_F38377_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CHILDREN'S MERCY INFUSION SERVICES|
20|FH_F39170_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CT MRI MOD 26|
20|FH_F87092_60101_0|SrvcGrp|85622|2022|PDM|9450.00|99|0.00|SPINAL CORD PROCEDURES|
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)|
20|FH_F143539_0_0|SrvcGrp|42550|2022|PDM|6642.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F148492_28027_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148561_17022_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 5  (NO REV)|
20|FH_F45974_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46372_0_0|SrvcGrp|3499|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F133493_90255_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F37611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100682_97401_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F38061_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|NE REG SUR CTR ARTHROSCOPY FH|
20|FH_F36521_0_0|SrvcGrp|177|2022|PDM|950.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F128950_53538_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117550_0_0|SrvcGrp|89502|2022|PDM|28.00|99|0.00|NEUROMUSCULAR REEDUCATION|
20|FH_F133029_61264_0|SrvcGrp|73841|2022|PDM|500.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F76284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|79017|2022|PDM|985.12|99|0.00|MON VALLEY ASC 16|
20|FH_F92676_15063_0|SrvcGrp|79045|2022|PDM|660.18|99|0.00|MON VALLEY ASC 233|
20|FH_F132285_89103_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F120437_85202_0|SrvcGrp|24761|2022|PDM|90.04|99|0.00|HOME INFUSION THERAPY|
20|FH_F150949_0_0|SrvcGrp|113851|2022|PDM|10500.00|99|0.00|ARTHRDSIS LAT MINI DISKECT|
20|FH_F126815_02118_0|SrvcGrp|107542|2022|PCT|0.55|99|0.00|RADIOLOGY|
20|FH_F92676_15063_0|SrvcGrp|79060|2022|PDM|454.31|99|0.00|MON VALLEY ASC 132|
20|FH_F142994_54313_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F127217_29650_0|SrvcGrp|112868|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F57396_0_0|SrvcGrp|53745|2022|PDM|15.00|99|0.00|IMMUNIZATIONS CPT 90657-90658|
20|FH_F97563_83201_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F97566_79902_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F82813_0_0|SrvcGrp|72990|2022|PDM|477.00|99|0.00|AEG 1|
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1923.35|99|0.00|AEG 9 (NO REV)|
20|FH_F101754_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128762_78231_0|SrvcGrp|111199|2022|PDM|3000.00|99|0.00|INTRAOPERATIVE NEUROPHYSIOLOGY MONITORING|
20|FH_F128707_72601_0|SrvcGrp|111172|2022|PDM|550.00|99|0.00|HEMODIALYSIS|
20|FH_F149999_33150_0|SrvcGrp|75419|2022|PDM|510.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F145328_90301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132566_38751_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F92676_15063_0|SrvcGrp|78952|2022|PDM|2985.50|99|0.00|MON VALLEY ASC 706|
20|FH_F69122_0_0|SrvcGrp|65622|2022|PDM|1589.00|99|0.00|REV CODE 724 & CPT CODE 59409|
20|FH_F46352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F35408_0_0|SrvcGrp|20870|2022|PDM|275.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) PARAMEDIC INTERCEPT|
20|FH_F87596_33609_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F148494_0_0|SrvcGrp|114174|2022|PDM|6600.00|99|0.00|REMOVE/REINSER SPINE FIXATION DEVICE|
20|FH_F94165_0_0|SrvcGrp|83677|2022|PCT|0.85|99|0.00|AETNA CARDIAC CATH|
20|FH_F44700_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142847_07003_0|SrvcGrp|113993|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F125352_90034_0|SrvcGrp|73605|2022|PDM|970.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F130593_48103_0|SrvcGrp|82223|2022|PDM|140.00|99|0.00|HOSPICE CARE|
20|FH_F119079_41018_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132338_18901_0|SrvcGrp|89412|2022|PDM|332.51|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F144368_48315_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100740_15206_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F133396_72301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F40980_0_0|SrvcGrp|12661|2022|PDM|5826.00|99|0.00|INTENSIVE CARE/CORONARY CARE UNIT|
20|FH_F39859_0_0|SrvcGrp|10927|2022|PDM|700.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F148861_18706_0|SrvcGrp|75419|2022|PDM|591.22|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F74463_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F77787_0_0|SrvcGrp|15052|2022|PCT|0.65|99|0.00|RADIOLOGY SVCS|
20|FH_F149721_76522_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67861_0_0|SrvcGrp|24805|2022|PCT|0.60|99|0.00|NUCLEAR MEDICINE|
20|FH_F117559_08619_0|SrvcGrp|90497|2022|PDM|11.00|99|0.00|FLUZONE VACC 3 YRS & > IM|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD UE)|
20|FH_F132690_87571_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F33096_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143168_60563_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|133.73|99|0.00|ASPG 224|
20|FH_F39723_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (HCFA)|
20|FH_F132080_0_0|SrvcGrp|65720|2022|PDM|169.00|99|0.00|RESPITE CARE|
20|FH_F51438_0_0|SrvcGrp|47689|2022|PDM|120.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F126806_44125_0|SrvcGrp|95661|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F36286_0_0|SrvcGrp|11606|2022|PDM|646.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)|
20|FH_F132528_64014_0|SrvcGrp|14893|2022|PDM|60.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F149513_0_0|SrvcGrp|11442|2022|PDM|994.20|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139825_0_0|SrvcGrp|109769|2022|PDM|2433.00|99|0.00|COVER EYE W/ MEMBRANE SUTURE INCIDENTAL CODES|
20|FH_F150479_53223_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92676_15063_0|SrvcGrp|58974|2022|PDM|5187.00|99|0.00|OP CARDIAC CATH|
20|FH_F88512_0_0|SrvcGrp|42726|2022|PDM|24749.14|99|0.00|CYBER KNIFE|
20|FH_F123324_0_0|CSTM-ALL|CSTM-00|2020|PDM|1711.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F65899_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F129688_74066_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F139607_0_0|SrvcGrp|113463|2022|PDM|6610.00|99|0.00|LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F97581_60141_0|SrvcGrp|73601|2022|PDM|9364.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F117087_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F92792_0_0|SrvcGrp|46887|2022|PDM|2200.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F128312_45230_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F100786_24740_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|763.09|99|0.00|HAPA WPA-NWPA 2012-13 ASC 504 W/O REV|
20|FH_F81485_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F146262_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|OP SVCS|
20|FH_F120753_61701_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F67192_0_0|SrvcGrp|12290|2022|PDM|820.00|99|0.00|DETOXIFICATION|
20|FH_F150949_0_0|SrvcGrp|108093|2022|PDM|10950.00|99|0.00|REVISE HIP ARTHROPLASTY|
20|FH_F43433_0_0|SrvcGrp|32437|2022|PDM|1231.00|99|0.00|JACKSON MADISON HOSP ASPG I|
20|FH_F147982_65706_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133478_40165_0|SrvcGrp|76095|2022|PCT|0.56|99|0.00|AETNA OBSERVATION SERVICES W/ER|
20|FH_F32533_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F141967_89509_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F44312_0_0|CSTM-ALL|CSTM-00|2020|PDM|240.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F106660_26554_0|SrvcGrp|48396|2022|PDM|90.00|99|0.00|OT SERVICES|
20|FH_F89495_0_0|SrvcGrp|73002|2022|PDM|1032.00|99|0.00|AEG 7|
20|FH_F87915_0_0|SrvcGrp|3405|2022|PDM|154.00|99|0.00|CPT 99212|
20|FH_F123792_90803_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F63316_0_0|SrvcGrp|47184|2022|PDM|131.11|99|0.00|SKILLED NURSING RN|
20|FH_F69968_0_0|SrvcGrp|46526|2022|PDM|15193.82|99|0.00|OP AICD|
20|FH_F71628_0_0|SrvcGrp|46424|2022|PDM|15.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F136383_98118_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136386_30901_0|SrvcGrp|21102|2022|PDM|89250.00|99|0.00|MS DRG 219 ONLY|
20|FH_F120490_64133_0|SrvcGrp|73742|2022|PDM|3.50|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F120475_81052_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INJECTION, PEGFILGRASTIM 6MG|
20|FH_F134126_11554_0|CSTM-ALL|CSTM-00|2020|PDM|1666.00|99|0.00|AEG 2 (NO REV)|
20|FH_F134160_19006_0|SrvcGrp|106291|2022|PDM|271.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F134167_10032_0|SrvcGrp|88621|2022|PDM|98.83|99|0.00|SKILLED NURSING LPN|
20|FH_F136967_63877_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F137048_60714_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F137209_60515_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117552_0_0|SrvcGrp|107544|2022|PDM|6000.00|99|0.00|ILIAC REVASC W/ STENT|
20|FH_F101389_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F138584_30912_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 3 (NO REV)|
20|FH_F125053_0_0|SrvcGrp|72996|2022|PDM|680.00|99|0.00|AEG 4|
20|FH_F139267_30253_0|SrvcGrp|113548|2022|PDM|156.89|99|0.00|COVID-19 NFCT DS VIR RESP RNA 4 TRGT|
20|FH_F140343_89052_0|SrvcGrp|16750|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F149663_45219_0|CSTM-ALL|CSTM-00|2020|PDM|662.00|99|0.00|AEG 1 (NO REV)|
20|FH_F119018_47802_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F67239_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|EXCELLENT SURG OBS SERVICES|
20|FH_F92852_0_0|SrvcGrp|46890|2022|PDM|2200.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F147929_03820_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F129504_02871_0|SrvcGrp|48398|2022|PDM|111.00|99|0.00|PT SERVICES|
20|FH_F129511_44044_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F117126_12801_0|SrvcGrp|73560|2022|PDM|1765.00|99|0.00|AETNA SLEEP STUDIES|
20|FH_F137335_08096_0|SrvcGrp|86722|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F104700_0_0|SrvcGrp|73002|2022|PDM|1245.00|99|0.00|AEG 7|
20|FH_F109907_0_0|SrvcGrp|48394|2022|PDM|54.10|99|0.00|SKILLED NURSING SERVICES|
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90735_94070_0|SrvcGrp|90289|2022|PDM|0.01|99|0.00|MED GENETICS & GENETIC COUNSELING|
20|FH_F124891_29935_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F128804_0_0|SrvcGrp|83646|2022|PDM|3520.00|99|0.00|CPT 31276|
20|FH_F114630_48205_0|SrvcGrp|73841|2022|PDM|290.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|662.00|99|0.00|AEG 4 (NO REV)|
20|FH_F151060_02493_0|SrvcGrp|79280|2022|PDM|440.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F151122_10462_0|SrvcGrp|29346|2022|PDM|32.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F121329_33015_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F66711_0_0|SrvcGrp|62538|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F98040_89406_0|SrvcGrp|73605|2022|PDM|2103.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F106822_0_0|SrvcGrp|36668|2022|PDM|186.25|99|0.00|ZOSTER (SHINGLES VACCINE)|
20|FH_F117442_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F72690_0_0|SrvcGrp|43525|2022|PDM|300.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC|
20|FH_F72845_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F116043_0_0|SrvcGrp|73656|2022|PDM|475.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F79426_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113392_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F43860_0_0|SrvcGrp|37403|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F44358_0_0|CSTM-ALL|CSTM-00|2020|PDM|597.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131412_0_0|SrvcGrp|80918|2022|PDM|149.80|99|0.00|RESPITE CARE|
20|FH_F94786_07974_0|SrvcGrp|86828|2022|PDM|36.75|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F94786_07974_0|SrvcGrp|24750|2022|PDM|36.75|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F94786_07974_0|SrvcGrp|14945|2022|PDM|10.50|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F131608_0_0|SrvcGrp|63297|2022|PDM|165.42|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F132988_0_0|SrvcGrp|109131|2022|PDM|11531.54|99|0.00|RECONSTRUCTION, KNEE|
20|FH_F133002_0_0|SrvcGrp|28551|2022|PDM|1716.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F118909_0_0|SrvcGrp|94780|2022|PDM|133.90|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F81393_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.50|99|0.00|AEG 3 (NO REV)|
20|FH_F114389_50131_0|SrvcGrp|105629|2022|PDM|346.46|99|0.00|WALKING BOOT (MOD NU)|
20|FH_F125946_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119603_0_0|SrvcGrp|87077|2022|PDM|185.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F77944_0_0|SrvcGrp|10393|2022|PDM|8264.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F122198_20708_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147039_06374_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147081_02130_0|SrvcGrp|16069|2022|PDM|504.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|ASPG V|
20|FH_F124234_33410_0|SrvcGrp|108061|2022|PDM|300.00|99|0.00|OP THERAPY SERVICES|
20|FH_F124234_33410_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97040_31901_0|SrvcGrp|73659|2022|PDM|7089.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F90653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F136623_01830_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137447_0_0|SrvcGrp|106300|2022|PDM|234.69|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F134770_14420_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F135722_33461_0|SrvcGrp|89149|2022|PDM|145.00|99|0.00|OP INTENSIVE|
20|FH_F135761_70127_0|SrvcGrp|74668|2022|PDM|900.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136778_62034_0|SrvcGrp|3378|2022|PCT|0.71|99|0.00|OBSERVATION SVCS|
20|FH_F112268_19087_0|SrvcGrp|73700|2022|PDM|36.75|99|0.00|AETNA - SKILLED NURSING|
20|FH_F112505_51503_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F49005_0_0|SrvcGrp|45335|2022|PDM|70.00|99|0.00|DIETICIAN VISIT - OP|
20|FH_F41678_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41798_0_0|CSTM-ALL|CSTM-00|2020|PDM|380.00|99|0.00|ACUTE PSYCH|
20|FH_F116802_41224_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120050_92626_0|SrvcGrp|74668|2022|PDM|375.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F113649_01752_0|SrvcGrp|86831|2022|PDM|10.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F36420_0_0|SrvcGrp|177|2022|PDM|1600.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F37353_0_0|SrvcGrp|61209|2022|PCT|1.20|99|0.00|OP LAB SERVICES|
20|FH_F39028_0_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F39028_0_0|SrvcGrp|25351|2022|PCT|1.00|99|0.00|ALL VALID CODES GLOBAL|
20|FH_F36132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F36372_0_0|SrvcGrp|12071|2022|PDM|28.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F98624_15701_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F100783_03431_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F103004_75840_0|SrvcGrp|80679|2022|PCT|0.80|99|0.00|AETNA RADIOLOGY|
20|FH_F70444_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40431_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|NEUROREHABILITATION IP SVCS|
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 3 (NO REV)|
20|FH_F97261_06098_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F132131_33060_0|SrvcGrp|89149|2022|PDM|180.00|99|0.00|OP INTENSIVE|
20|FH_F111847_70301_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F145721_0_0|SrvcGrp|82222|2022|PDM|135.00|99|0.00|HOSPICE CARE|
20|FH_F68322_0_0|SrvcGrp|17069|2022|PDM|900.00|99|0.00|ASPG III|
20|FH_F134087_0_0|SrvcGrp|112554|2022|PDM|3607.00|99|0.00|HEMICRT INTRCLRY ALGRFT PRTL|
20|FH_F139916_0_0|SrvcGrp|73841|2022|PDM|468.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F77625_0_0|SrvcGrp|42826|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F120639_73078_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F150939_0_0|SrvcGrp|97972|2022|PDM|7.80|99|0.00|TYMPANOMETRY IMPEDANCE TEST|
20|FH_F66569_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F115185_0_0|SrvcGrp|82981|2022|PDM|157.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F41013_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F138887_71822_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138936_01040_0|SrvcGrp|104804|2022|PDM|350.00|99|0.00|PSYTX CRISIS INITIAL 60 MIN|
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|852.41|99|0.00|AEG 2 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|794.89|99|0.00|HAPA WPA-NWPA 2012-13 ASC 504 W/O REV|
20|FH_F91933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151501_30265_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 7 (NO REV)|
20|FH_F151510_15928_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122076_17543_0|SrvcGrp|76501|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F133119_46545_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36492_0_0|SrvcGrp|73002|2022|PDM|1706.00|99|0.00|AEG 7|
20|FH_F40073_0_0|SrvcGrp|17077|2022|PCT|0.70|99|0.00|ASPG VII|
20|FH_F135355_73112_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F97143_80012_0|SrvcGrp|73656|2022|PDM|871.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F135972_18509_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135979_66451_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F136019_63044_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136217_63112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100765_73735_0|SrvcGrp|73643|2022|PDM|2650.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F130933_47129_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F116447_21601_0|SrvcGrp|57967|2022|PDM|166.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F116461_77536_0|SrvcGrp|104078|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F116468_49660_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F140629_0_0|SrvcGrp|90822|2022|PDM|1372.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY|
20|FH_F33725_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F121428_40202_0|SrvcGrp|73605|2022|PDM|1054.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPT CARE OF MUNCY FH -AU|
20|FH_F131407_07607_0|SrvcGrp|86832|2022|PDM|3.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F111301_33122_0|SrvcGrp|88977|2022|PDM|6682.00|99|0.00|C-SECTION DELIVERY|
20|FH_F117486_0_0|SrvcGrp|105357|2022|PDM|400.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F118482_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|PDM|717.00|99|0.00|AEG 4 (NO REV)|
20|FH_F75806_0_0|SrvcGrp|10541|2022|PDM|216.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F132328_0_0|SrvcGrp|90797|2022|PDM|3974.00|99|0.00|INSERT SPINAL INFUSION DEV16|
20|FH_F112129_62220_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|2525.00|99|0.00|AEG 6 (NO REV)|
20|FH_F102325_62691_0|SrvcGrp|24750|2022|PDM|80.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F102862_30606_0|SrvcGrp|58368|2022|PDM|12328.00|99|0.00|MS DRG 030 ONLY|
20|FH_F102960_50613_0|CSTM-ALL|CSTM-00|2020|PDM|6718.00|99|0.00|AEG 8 (NO REV)|
20|FH_F62579_0_0|SrvcGrp|17003|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS|
20|FH_F130662_07032_0|SrvcGrp|104796|2022|PDM|265.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F130755_04401_0|SrvcGrp|94040|2022|PCT|0.93|99|0.00|OBSERVATION SERVICES FOR ER SERVICES|
20|FH_F50494_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134217_46725_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F51258_0_0|SrvcGrp|43283|2022|PDM|81.00|99|0.00|PHYSICAL THERAPY|
20|FH_F85213_02840_0|CSTM-ALL|CSTM-00|2020|PDM|2731.50|99|0.00|INPATIENT DETOX SERVICES <18 YRS|
20|FH_F52713_0_0|SrvcGrp|8968|2022|PDM|5000.00|99|0.00|NICU LEVEL III & IV|
20|FH_F146470_68025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F127343_0_0|SrvcGrp|110673|2022|PDM|14830.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F145781_0_0|SrvcGrp|114311|2022|PDM|1500.00|99|0.00|REVISE/GRAFT EYELID LINING|
20|FH_F90501_71101_0|SrvcGrp|75487|2022|PDM|3450.00|99|0.00|AEG 5|
20|FH_F79863_0_0|SrvcGrp|77238|2022|PDM|22.00|99|0.00|AETNA HOME INFUSION S9537|
20|FH_F150161_63361_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116806_0_0|SrvcGrp|107021|2022|PDM|1923.16|99|0.00|OSTEOPLASTY FACIAL-REDUCT|
20|FH_F149439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|2729.00|99|0.00|MSDRG 231-232 CORONARY BYPASS|
20|FH_F134208_21502_0|SrvcGrp|35669|2022|PDM|3000.00|99|0.00|CPT 63650|
20|FH_F133801_87107_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F141167_0_0|SrvcGrp|107749|2022|PDM|214.00|99|0.00|CAPD/CCPD|
20|FH_F121255_76132_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F145593_92660_0|SrvcGrp|109798|2022|PCT|1.20|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F114526_33401_0|SrvcGrp|86723|2022|PDM|401.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F51124_0_0|SrvcGrp|40582|2022|PDM|250.00|99|0.00|HOSPICE SVCS|
20|FH_F80613_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F124159_92506_0|SrvcGrp|86723|2022|PDM|472.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F110580_71106_0|SrvcGrp|47531|2022|PDM|680.00|99|0.00|LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS, LG|
20|FH_F81861_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.45|99|0.00|LABS - SOUTHWOODS 100%|
20|FH_F111744_32514_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F133938_53143_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F80224_0_0|SrvcGrp|997|2022|PCT|0.76|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F80613_0_0|SrvcGrp|10542|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F117300_0_0|SrvcGrp|98500|2022|PDM|7360.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F36616_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F149150_75407_0|SrvcGrp|87317|2022|PDM|1000.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|375.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 120 W/O REV|
20|FH_F126003_79403_0|SrvcGrp|89337|2022|PDM|975.00|99|0.00|DETOXIFICATION|
20|FH_F138050_52301_0|CSTM-ALL|CSTM-00|2020|PDM|5599.00|99|0.00|AEG 10 (NO REV)|
20|FH_F145593_92660_0|SrvcGrp|111348|2022|PCT|1.20|99|0.00|OP THERAPY SERVICES|
20|FH_F149660_0_0|SrvcGrp|14557|2022|PDM|44.00|99|0.00|AMBULANCE SVCS - WHEELCHAIR VAN|
20|FH_F110311_17078_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|945.00|99|0.00|ASPG IV - FH SW CUSTOM GROUPERS|
20|FH_F120608_19901_0|SrvcGrp|48396|2022|PDM|136.50|99|0.00|OT SERVICES|
20|FH_F139747_06241_0|SrvcGrp|471|2022|PDM|530.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F83754_0_0|SrvcGrp|22819|2022|PCT|0.86|99|0.00|PTCA|
20|FH_F134608_18017_0|SrvcGrp|108133|2022|PDM|650.00|99|0.00|INDUCED ABORTION BY DILATION AND EVACUATION (HCFA)|
20|FH_F100782_0_0|SrvcGrp|97683|2022|PDM|2731.03|99|0.00|WINDBER MEDICAL CNTR ASC 905|
20|FH_F95440_0_0|SrvcGrp|93726|2022|PDM|3000.00|99|0.00|REMOVE SPINAL CANAL CATHET18|
20|FH_F149319_07670_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F135626_20176_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F147502_0_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F110302_15931_0|SrvcGrp|23683|2022|PDM|42.77|99|0.00|SKILLED NURSING RN|
20|FH_F119810_31525_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F111031_30252_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51124_0_0|SrvcGrp|29303|2022|PDM|120.75|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F112060_07514_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F90391_33774_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F132958_79903_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F74024_0_0|SrvcGrp|71284|2022|PCT|1.00|99|0.00|MRI CODES -ORTHO & SPINE CTR--PT & MRI|
20|FH_F133485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F54592_0_0|SrvcGrp|49286|2022|PDM|60.00|99|0.00|REPAIR OF INFUSION DEVICE|
20|FH_F134495_84321_0|SrvcGrp|43567|2022|PDM|50.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F122526_22203_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F34422_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|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_F102200_06416_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F115788_02904_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F115909_38133_0|SrvcGrp|86749|2022|PCT|1.05|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F68442_0_0|SrvcGrp|43893|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F80513_0_0|SrvcGrp|87309|2022|PDM|19882.00|99|0.00|MSDRG 272 ONLY|
20|FH_F146655_80226_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F120775_28805_0|SrvcGrp|89417|2022|PDM|372.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F127656_06068_0|SrvcGrp|89781|2022|PDM|159.60|99|0.00|RESPITE CARE (HCFA)|
20|FH_F127656_06068_0|SrvcGrp|48396|2022|PDM|109.20|99|0.00|OT SERVICES|
20|FH_F115952_44484_0|SrvcGrp|73842|2022|PDM|138.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F116040_24637_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F138487_85297_0|SrvcGrp|75419|2022|PDM|465.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F138424_83402_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139209_22556_0|SrvcGrp|112891|2022|PCT|1.00|99|0.00|RSV DNA/MA AMP PROBE|
20|FH_F139597_07009_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150741_81506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150802_15401_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F110841_53012_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130661_04441_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 2 (NO REV)|
20|FH_F147237_40006_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F97100_23462_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F124322_64131_0|SrvcGrp|22592|2022|PDM|22.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F124381_27610_0|SrvcGrp|89149|2022|PDM|193.00|99|0.00|OP INTENSIVE|
20|FH_F51572_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.80|99|0.00|OP SVCS|
20|FH_F98360_11554_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F36590_0_0|CSTM-ALL|CSTM-00|2020|PDM|1199.00|99|0.00|GENERAL ACUTE CARE|
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_F98880_50158_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F150947_37660_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F38999_0_0|SrvcGrp|361|2022|PDM|2484.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F31547_0_0|SrvcGrp|12685|2022|PDM|11.58|99|0.00|PROCRIT/ERYTHROPOIETIN (EPOETIN)|
20|FH_F97880_63501_0|SrvcGrp|73659|2022|PDM|10844.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F138018_17313_0|SrvcGrp|16559|2022|PDM|16.68|99|0.00|HOME INFUSION THERAPY|
20|FH_F119897_78229_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117617_80439_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F102163_0_0|SrvcGrp|42622|2022|PCT|0.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F130182_0_0|SrvcGrp|109448|2022|PDM|1457.00|99|0.00|CORONARY ART/GRFT ANGIO S&I|
20|FH_F137986_0_0|SrvcGrp|84939|2022|PDM|12000.00|99|0.00|SHOULDER JOINT|
20|FH_F47212_0_0|SrvcGrp|42913|2022|PDM|8.00|99|0.00|CATHETER CARE-DOUBLE LUMEN|
20|FH_F112754_98057_0|SrvcGrp|90340|2022|PDM|263.87|99|0.00|SKILLED NURSING LPN|
20|FH_F84058_0_0|SrvcGrp|82452|2022|PDM|210.05|99|0.00|AMBULANCE SVC NEONATAL EMERG TRANSPORT|
20|FH_F147237_40006_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F117762_0_0|SrvcGrp|99164|2022|PDM|7280.00|99|0.00|CPT 22846|
20|FH_F123745_0_0|SrvcGrp|109528|2022|PDM|7500.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F140140_07722_0|SrvcGrp|22529|2022|PCT|0.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F132849_0_0|SrvcGrp|112113|2022|PDM|8770.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F75724_0_0|SrvcGrp|73043|2022|PCT|1.00|99|0.00|HIGH COST PHARMACEUTICALS|
20|FH_F110661_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F137748_95231_0|SrvcGrp|73497|2022|PDM|1857.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F134871_28205_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F132254_40207_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F35765_32547_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS|
20|FH_F138987_0_0|SrvcGrp|83521|2022|PDM|126.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
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_F134603_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F127553_44321_0|SrvcGrp|89781|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F134900_72450_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136382_0_0|SrvcGrp|112892|2022|PDM|1600.00|99|0.00|ESOPHAGOSCOPY|
20|FH_F42449_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F124976_0_0|SrvcGrp|16069|2022|PDM|651.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F151010_85007_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F90196_10467_0|SrvcGrp|86746|2022|PCT|1.05|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F94643_90501_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97603_77901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33719_0_0|CSTM-ALL|CSTM-00|2020|PDM|344.00|99|0.00|PSYCHIATRIC RESIDENTIAL TREATMENT|
20|FH_F150982_0_0|SrvcGrp|77582|2022|PDM|2753.00|99|0.00|CPT 31255|
20|FH_F142587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1714.00|99|0.00|AEG 8 (NO REV)|
20|FH_F134707_0_0|SrvcGrp|11663|2022|PCT|0.44|99|0.00|IMPLANTS|
20|FH_F131392_17004_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F120057_0_0|SrvcGrp|72996|2022|PDM|756.00|99|0.00|AEG 4|
20|FH_F150932_15143_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147418_0_0|SrvcGrp|115022|2022|PDM|7000.00|99|0.00|CARDIOLOGY|
20|FH_F132109_66762_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132163_17601_0|SrvcGrp|74694|2022|PDM|1103.00|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F114308_70601_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F119442_72205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F137627_78382_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PDM|1563.00|99|0.00|ASPG IV|
20|FH_F39849_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|OP SVCS|
20|FH_F126299_20176_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|CARECENTRIX AWP - 12% (MANUAL REVIEW)|
20|FH_F125182_0_0|SrvcGrp|79595|2022|PDM|2535.00|99|0.00|CPT 45385|
20|FH_F84833_17109_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F139967_37205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136779_0_0|SrvcGrp|112920|2022|PDM|2218.00|99|0.00|SHOULDER ARTHOSCOPY PROCEDURES|
20|FH_F90455_0_0|SrvcGrp|48396|2022|PDM|140.00|99|0.00|OT SERVICES|
20|FH_F36683_0_0|SrvcGrp|8968|2022|PDM|2077.00|99|0.00|NICU LEVEL III & IV|
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|2939.00|99|0.00|AEG 8 (NO REV)|
20|FH_F148859_0_0|SrvcGrp|115537|2022|PDM|788.00|99|0.00|SUSPENSION OF TESTIS|
20|FH_F126502_0_0|SrvcGrp|82981|2022|PDM|133.95|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F40104_0_0|SrvcGrp|9829|2022|PDM|107.71|99|0.00|PT SVCS|
20|FH_F136779_0_0|SrvcGrp|99073|2022|PDM|1.39|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F124441_0_0|SrvcGrp|67069|2022|PDM|5225.00|99|0.00|CPT 22634|
20|FH_F149579_95815_0|SrvcGrp|111987|2022|PDM|12.31|99|0.00|VIRTUAL CHECK-IN|
20|FH_F147339_08837_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 2 (NO REV)|
20|FH_F42979_0_0|SrvcGrp|26351|2022|PDM|74.00|99|0.00|CPT 90805|
20|FH_F140127_64131_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140233_35216_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)|
20|FH_F143529_84737_0|SrvcGrp|80920|2022|PDM|474.00|99|0.00|HOSPICE SERVICES|
20|FH_F71747_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82779_0_0|SrvcGrp|68362|2022|PDM|1058.00|99|0.00|COVENTRY ENHANCED GROUPER 10 WITH REV CODES|
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|AEG 10 (NO REV)|
20|FH_F125249_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|PDM|493.00|99|0.00|AEG 1 (NO REV)|
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)|
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 10 (NO REV)|
20|FH_F130917_48658_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151753_03104_0|SrvcGrp|471|2022|PDM|652.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F47128_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F47600_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F136299_75218_0|CSTM-ALL|CSTM-00|2020|PDM|10300.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132417_38119_0|SrvcGrp|108484|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F132419_84042_0|SrvcGrp|87317|2022|PDM|460.43|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F116756_77477_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|651.63|99|0.00|ASPG III|
20|FH_F135219_68506_0|CSTM-ALL|CSTM-00|2020|PDM|2809.23|99|0.00|AEG 2 (NO REV)|
20|FH_F143900_63303_0|SrvcGrp|74668|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F98920_46526_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F140575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41458_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129294_53925_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139551_0_0|SrvcGrp|89861|2022|PDM|5769.00|99|0.00|LUMBAR LAMINOTOMY|
20|FH_F123921_89128_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F39740_0_0|SrvcGrp|20906|2022|PDM|11612.00|99|0.00|MS DRG 243-244 ONLY CARDIAC PACEMAKER|
20|FH_F40063_0_0|SrvcGrp|13739|2022|PDM|12831.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F70984_0_0|SrvcGrp|10989|2022|PDM|1800.00|99|0.00|ENDOSCOPIC LIGATION|
20|FH_F34513_0_0|SrvcGrp|12496|2022|PDM|811.00|99|0.00|ACUTE REHABILITATION|
20|FH_F147941_06023_0|SrvcGrp|10363|2022|PDM|1155.00|99|0.00|CPT CODE 99283|
20|FH_F136510_0_0|SrvcGrp|46906|2022|PDM|3882.00|99|0.00|CORNEAL TISSUE|
20|FH_F113682_0_0|SrvcGrp|29915|2022|PDM|641.70|99|0.00|SUBACUTE CARE|
20|FH_F135175_45121_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F35476_0_0|SrvcGrp|3810|2022|PDM|158.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F35513_0_0|SrvcGrp|16495|2022|PDM|850.00|99|0.00|POLYSOMNOGRAPHY|
20|FH_F117044_37352_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149869_03253_0|SrvcGrp|48398|2022|PDM|166.00|99|0.00|PT SERVICES|
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 3 (NO REV)|
20|FH_F119824_0_0|SrvcGrp|108043|2022|PDM|164.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F38798_0_0|SrvcGrp|12957|2022|PCT|0.90|99|0.00|DME|
20|FH_F151540_17055_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143829_74066_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79746_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101021_0_0|SrvcGrp|93099|2022|PDM|550.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY|
20|FH_F73985_0_0|SrvcGrp|537|2022|PDM|199.00|99|0.00|OBSERVATION SERVICES|
20|FH_F141390_19007_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135221_62691_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F40043_0_0|SrvcGrp|3069|2022|PCT|0.76|99|0.00|IMPLANTS|
20|FH_F71848_0_0|SrvcGrp|68780|2022|PDM|108.15|99|0.00|SPECIAL STAINS GROUP 2|
20|FH_F34513_0_0|SrvcGrp|9795|2022|PDM|520.00|99|0.00|SUBACUTE REHAB|
20|FH_F123844_0_0|SrvcGrp|87799|2022|PDM|198.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F77925_0_0|SrvcGrp|360|2022|PDM|5400.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F43154_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F110925_01104_0|SrvcGrp|43568|2022|PDM|106.00|99|0.00|SKILLED NURSING - RN|
20|FH_F135235_01830_0|SrvcGrp|46903|2022|PDM|969.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F90691_0_0|SrvcGrp|73000|2022|PDM|892.00|99|0.00|AEG 6|
20|FH_F94862_0_0|SrvcGrp|73002|2022|PDM|1000.00|99|0.00|AEG 7|
20|FH_F123372_0_0|SrvcGrp|77348|2022|PDM|6557.00|99|0.00|CARDIAC CATH|
20|FH_F121467_75165_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F87254_0_0|SrvcGrp|42472|2022|PDM|2200.00|99|0.00|CPT 58670|
20|FH_F74092_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129556_65233_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/MOD RR  (TN)|
20|FH_F131254_92211_0|SrvcGrp|86839|2022|PDM|35.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F109581_0_0|SrvcGrp|75485|2022|PDM|716.00|99|0.00|AEG 4|
20|FH_F120693_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F140931_24014_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117082_66216_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|1523.00|99|0.00|AEG 8 (NO REV)|
20|FH_F72369_0_0|SrvcGrp|25748|2022|PDM|45.00|99|0.00|OCULAR PROSTHESIS, RESURFACING|
20|FH_F129231_30060_0|CSTM-ALL|CSTM-00|2020|PDM|2596.00|99|0.00|DEVICE INSERTION|
20|FH_F129231_30060_0|SrvcGrp|104719|2022|PDM|1754.00|99|0.00|RELIEVE INNER EYE PRESSURE|
20|FH_F129627_06037_0|SrvcGrp|89781|2022|PDM|163.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|ASPG II|
20|FH_F38151_0_0|SrvcGrp|997|2022|PCT|0.85|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F128276_66441_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F33782_0_0|SrvcGrp|12157|2022|PDM|100.00|99|0.00|RN VISIT|
20|FH_F70104_0_0|SrvcGrp|48396|2022|PDM|12.00|99|0.00|OT SERVICES|
20|FH_F137067_0_0|SrvcGrp|82720|2022|PDM|3491.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F149869_03253_0|SrvcGrp|88620|2022|PDM|154.00|99|0.00|SKILLED NURSING RN|
20|FH_F149888_68506_0|CSTM-ALL|CSTM-00|2020|PDM|1432.00|99|0.00|AEG 3 (NO REV)|
20|FH_F98801_93274_0|SrvcGrp|73485|2022|PDM|5622.00|99|0.00|AETNA REHAB|
20|FH_F125652_66743_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110925_01104_0|SrvcGrp|86128|2022|PDM|0.83|99|0.00|AETNA FACTOR VIII PER IU|
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)|
20|FH_F143793_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34022_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|98003|2022|PDM|5200.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F145537_02061_0|SrvcGrp|90397|2022|PDM|284.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F110925_01104_0|SrvcGrp|86153|2022|PDM|60.43|99|0.00|TREPROSTINIL INJECTION|
20|FH_F151526_28208_0|CSTM-ALL|CSTM-00|2020|PDM|1863.00|99|0.00|AEG 7 (NO REV)|
20|FH_F143976_80504_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130747_0_0|SrvcGrp|88065|2022|PDM|24970.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F55794_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F115079_62062_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F91284_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F127890_44857_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137067_0_0|SrvcGrp|89860|2022|PDM|7350.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F65159_0_0|CSTM-ALL|CSTM-00|2020|PDM|4525.00|99|0.00|ASPG VIII|
20|FH_F122905_41018_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F86696_16063_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F86872_15215_0|SrvcGrp|86831|2022|PDM|10.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|3105.00|99|0.00|AEG 10 (NO REV)|
20|FH_F38696_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77462_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40060_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37567_0_0|CSTM-ALL|CSTM-00|2020|PDM|41.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F68363_0_0|SrvcGrp|3403|2022|PDM|137.00|99|0.00|CPT 99203|
20|FH_F32729_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|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_F36146_0_0|SrvcGrp|14221|2022|PCT|0.40|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F38016_0_0|SrvcGrp|97|2022|PDM|3461.00|99|0.00|C-SECTION|
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F129175_0_0|SrvcGrp|93730|2022|PDM|135.58|99|0.00|INJ PERIPHERAL NERVE|
20|FH_F123545_44512_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F128893_0_0|SrvcGrp|95661|2022|PDM|150.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F133112_70433_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F146135_87112_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F91635_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.10|99|0.00|OP SVCS|
20|FH_F118819_76226_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F103360_68845_0|SrvcGrp|72984|2022|PCT|7.50|99|0.00|CHEMOTHERAPY|
20|FH_F118550_21133_0|SrvcGrp|75545|2022|PDM|343.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F148919_32806_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117911_86403_0|SrvcGrp|29347|2022|PDM|28.00|99|0.00|HOME HEALTH AIDE|
20|FH_F97182_21502_0|SrvcGrp|73605|2022|PDM|1797.00|99|0.00|AETNA ACUTE PSYCH|
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_F45436_0_0|SrvcGrp|12263|2022|PDM|27.50|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F41696_0_0|SrvcGrp|109|2022|PDM|540.00|99|0.00|CD - DETOX|
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|2300.00|99|0.00|AEG 6 (NO REV)|
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|6000.00|99|0.00|AEG 7 (NO REV)|
20|FH_F101923_98104_0|SrvcGrp|89057|2022|PCT|3.17|99|0.00|MRI OF BRAIN W/O & W/ CONTRA|
20|FH_F49354_0_0|SrvcGrp|31187|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF (DME)|
20|FH_F115889_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F38089_0_0|SrvcGrp|701|2022|PDM|1985.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F148019_54311_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111789_25301_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F87155_04105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F90921_77702_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F117829_45227_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F92676_15063_0|SrvcGrp|78977|2022|PDM|1371.43|99|0.00|MON VALLEY ASC 203|
20|FH_F115324_78852_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F117970_15963_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35408_0_0|SrvcGrp|19609|2022|PDM|39.00|99|0.00|NONEMERGENCY TRANSPORTATION, WHEELCHAIR VAN|
20|FH_F119095_08536_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F111809_93003_0|CSTM-ALL|CSTM-00|2020|PDM|7815.00|99|0.00|AEG 4 (NO REV)|
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.70|99|0.00|AEG 7 (NO REV)|
20|FH_F126934_72064_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F144011_60616_0|SrvcGrp|75507|2022|PCT|0.45|99|0.00|CHEMOTHERAPY|
20|FH_F103360_68845_0|SrvcGrp|31074|2022|PDM|1863.00|99|0.00|MS DRG 795 ONLY|
20|FH_F116988_0_0|SrvcGrp|75489|2022|PDM|1103.00|99|0.00|AEG 6|
20|FH_F89932_10940_0|SrvcGrp|919|2022|PDM|355.00|99|0.00|OP URGENT CARE|
20|FH_F107400_0_0|SrvcGrp|73701|2022|PDM|43.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC STUDIES|
20|FH_F38079_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128130_10027_0|SrvcGrp|110280|2022|PDM|7775.00|99|0.00|SURGICAL MSDRG|
20|FH_F101840_76054_0|SrvcGrp|89815|2022|PDM|9722.00|99|0.00|MS DRG 506 ONLY|
20|FH_F39546_0_0|CSTM-ALL|CSTM-00|2020|PDM|1435.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F64659_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|EMERGENCY ROOM|
20|FH_F142755_33916_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117380_60020_0|SrvcGrp|73842|2022|PDM|214.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F92677_08003_0|SrvcGrp|92090|2022|PDM|224.70|99|0.00|AETNA OXY & WATER VAPOR W/O HEATER|
20|FH_F113586_0_0|SrvcGrp|75485|2022|PDM|1379.00|99|0.00|AEG 4|
20|FH_F85444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F87592_85614_0|SrvcGrp|82369|2022|PCT|1.00|99|0.00|AETNA LABORATORY|
20|FH_F145988_06105_0|SrvcGrp|111932|2022|PCT|1.47|99|0.00|COVID-19 NON-CDC TESTING LAB|
20|FH_F92677_08003_0|SrvcGrp|10577|2022|PDM|52.50|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F33241_0_0|CSTM-ALL|CSTM-00|2020|PDM|3153.00|99|0.00|ASPG IX|
20|FH_F91212_62864_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F34706_0_0|SrvcGrp|2944|2022|PDM|6023.00|99|0.00|DRG 359 UTERINE & ADNEXA PROC|
20|FH_F111522_81067_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1393.70|99|0.00|AEG 6 (NO REV)|
20|FH_F102721_38118_0|SrvcGrp|10944|2022|PDM|366.00|99|0.00|EMERGENCY ROOM|
20|FH_F149820_75040_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F90811_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F120829_85283_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F127325_0_0|SrvcGrp|72998|2022|PDM|687.00|99|0.00|AEG 5|
20|FH_F142043_45503_0|SrvcGrp|90854|2022|PDM|827.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F49027_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING|
20|FH_F46196_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F87436_0_0|SrvcGrp|59159|2022|PCT|0.62|99|0.00|OP SURGERY|
20|FH_F127412_15301_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 8 (NO REV)|
20|FH_F148900_0_0|CSTM-ALL|CSTM-00|2020|PDM|732.16|99|0.00|AEG 3 (NO REV)|
20|FH_F36993_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD KF|
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1657.00|99|0.00|REMOVAL OF TISSUE FOR GRAFT|
20|FH_F97560_23249_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|OP SVCS|
20|FH_F87577_80016_0|SrvcGrp|98725|2022|PDM|7544.00|99|0.00|AETNA MATERNITY DELIVERY|
20|FH_F148644_06890_0|SrvcGrp|33987|2022|PDM|3090.00|99|0.00|CPT 57522|
20|FH_F148346_0_0|SrvcGrp|43525|2022|PDM|627.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC|
20|FH_F46832_0_0|SrvcGrp|17003|2022|PDM|200.00|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS|
20|FH_F123847_24012_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F63316_0_0|SrvcGrp|17140|2022|PDM|172.94|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F69968_0_0|SrvcGrp|42726|2022|PDM|15193.82|99|0.00|CYBER KNIFE|
20|FH_F136299_75218_0|SrvcGrp|105465|2022|PDM|221.00|99|0.00|AETNA THERAPIES|
20|FH_F136348_32092_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136394_78240_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F136423_61254_0|SrvcGrp|86722|2022|PDM|222.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F136430_46710_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120489_63552_0|SrvcGrp|75506|2022|PCT|0.75|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F120490_64133_0|SrvcGrp|86842|2022|PDM|25.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F134126_11554_0|SrvcGrp|76076|2022|PDM|2036.00|99|0.00|AETNA NEWBORN LOWER LEVEL|
20|FH_F134126_11554_0|SrvcGrp|13422|2022|PDM|402.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F134150_01801_0|SrvcGrp|90160|2022|PDM|770.00|99|0.00|AETNA INPATIENT DETOX (>= 18 YEARS OF AGE)|
20|FH_F134160_19006_0|SrvcGrp|106317|2022|PDM|823.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F137033_87108_0|SrvcGrp|73559|2022|PDM|1545.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F137147_75006_0|CSTM-ALL|CSTM-00|2020|PDM|5775.00|99|0.00|AEG 6 (NO REV)|
20|FH_F137267_62906_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139751_84065_0|SrvcGrp|46903|2022|PDM|1300.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F53732_0_0|SrvcGrp|14949|2022|PDM|80.00|99|0.00|HOME INFUSION|
20|FH_F53732_0_0|SrvcGrp|24758|2022|PDM|19.00|99|0.00|HOME INJECTABLE THERAPY|
20|FH_F97600_46151_0|SrvcGrp|73659|2022|PDM|14664.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F138627_82901_0|SrvcGrp|86831|2022|PDM|12.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F140844_48083_0|SrvcGrp|87395|2022|PDM|129.00|99|0.00|HCPCS G0153 (HCFA)|
20|FH_F140868_63103_0|SrvcGrp|113502|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F80754_31601_0|CSTM-ALL|CSTM-00|2020|PDM|166.46|99|0.00|AETNA DGITAL SCREENING MAMMOGRAM BILATERAL|
20|FH_F140209_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F149579_95815_0|SrvcGrp|89337|2022|PDM|1375.00|99|0.00|DETOXIFICATION|
20|FH_F118932_07652_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F91913_0_0|SrvcGrp|72990|2022|PDM|333.00|99|0.00|AEG 1|
20|FH_F117301_01887_0|SrvcGrp|78180|2022|PDM|875.00|99|0.00|AETNA RESIDENTIAL TREATMENT|
20|FH_F147941_06023_0|SrvcGrp|106305|2022|PDM|1629.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F50578_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117240_37334_0|SrvcGrp|88977|2022|PDM|4200.00|99|0.00|C-SECTION DELIVERY|
20|FH_F137812_12118_0|SrvcGrp|90643|2022|PDM|22.75|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F137937_20032_0|SrvcGrp|112967|2022|PCT|2.32|99|0.00|LABORATORY SERVICES|
20|FH_F35210_0_0|SrvcGrp|43|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F37878_0_0|SrvcGrp|10545|2022|PDM|85.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F90613_05001_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F91472_96001_0|SrvcGrp|103712|2022|PCT|0.40|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F83997_0_0|SrvcGrp|472|2022|PDM|385.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1431.00|99|0.00|AEG 8 (NO REV)|
20|FH_F93512_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F151050_17015_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122013_75503_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110927_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|OP SVCS|
20|FH_F38564_0_0|SrvcGrp|17140|2022|PDM|134.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2501000 MOD QW (HCFA)|
20|FH_F113738_27006_0|SrvcGrp|46605|2022|PDM|130.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F110000_0_0|SrvcGrp|33832|2022|PCT|0.70|99|0.00|KANSAS ENHANCED GROUPERS ASPG 10|
20|FH_F91873_12723_0|SrvcGrp|72992|2022|PDM|2118.00|99|0.00|AEG 2|
20|FH_F151045_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F69785_0_0|SrvcGrp|42975|2022|PDM|83.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F36710_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F113143_0_0|SrvcGrp|102419|2022|PDM|4410.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F110448_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113130_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F103880_85014_0|SrvcGrp|73700|2022|PDM|35.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F131494_0_0|SrvcGrp|68000|2022|PDM|814.00|99|0.00|CPT 58561|
20|FH_F33856_0_0|SrvcGrp|97|2022|PDM|3000.00|99|0.00|C-SECTION|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER 53|
20|FH_F110205_64012_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F143898_0_0|SrvcGrp|104229|2022|PDM|100.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F132627_0_0|SrvcGrp|29023|2022|PDM|80.58|99|0.00|HOME INFUSION THERAPY|
20|FH_F132627_0_0|SrvcGrp|44430|2022|PDM|144.00|99|0.00|SPEECH THERAPY SVCS (VISIT LVL)|
20|FH_F114345_27597_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F114389_50131_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114389_50131_0|SrvcGrp|17002|2022|PDM|419.42|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS|
20|FH_F141336_16947_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F43665_0_0|CSTM-ALL|CSTM-00|2020|PDM|892.00|99|0.00|BRAIN INJURY REHAB|
20|FH_F115971_0_0|SrvcGrp|106322|2022|PDM|1494.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F122198_20708_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124082_78526_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F146715_34240_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62767_0_0|SrvcGrp|110234|2022|PCT|1.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F64441_0_0|SrvcGrp|1168|2022|PDM|640.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F37901_0_0|SrvcGrp|27171|2022|PDM|45.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F38047_0_0|SrvcGrp|65|2022|PDM|2418.00|99|0.00|OBSTETRICAL CARE|
20|FH_F39066_0_0|SrvcGrp|115|2022|PDM|500.00|99|0.00|SKILLED NURSING CARE|
20|FH_F124611_64804_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F118848_0_0|SrvcGrp|42550|2022|PDM|3000.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F147899_0_0|SrvcGrp|113170|2022|PDM|1790.00|99|0.00|UPPER GI OPTIC ENDOMICROSCOPY|
20|FH_F150910_0_0|SrvcGrp|108094|2022|PDM|10950.00|99|0.00|REVISE KNEE|
20|FH_F127995_84010_0|SrvcGrp|27968|2022|PDM|26.75|99|0.00|SKILLED NURSING LPN|
20|FH_F127995_84010_0|SrvcGrp|14944|2022|PDM|2.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F133694_89117_0|SrvcGrp|46605|2022|PDM|135.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133399_72211_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F63185_0_0|SrvcGrp|48396|2022|PDM|30.00|99|0.00|OT SERVICES|
20|FH_F66388_0_0|SrvcGrp|44107|2022|PDM|48.00|99|0.00|SPEECH THERAPY|
20|FH_F136596_72117_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136667_23603_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F136708_06443_0|SrvcGrp|87317|2022|PDM|1289.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F136708_06443_0|SrvcGrp|52953|2022|PDM|42.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F136708_06443_0|SrvcGrp|113303|2022|PCT|1.10|99|0.00|OP THERAPY SERVICES|
20|FH_F114666_30342_0|SrvcGrp|11673|2022|PDM|1760.00|99|0.00|CPT 29888|
20|FH_F114684_80547_0|SrvcGrp|105709|2022|PDM|187.00|99|0.00|OFFICE/OUTPATIENT VISIT NEW (HCFA)|
20|FH_F138527_64506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|1407.00|99|0.00|AEG 1 (NO REV)|
20|FH_F144039_0_0|SrvcGrp|109348|2022|PDM|2869.00|99|0.00|EXCISION OF LESION OF EYELID|
20|FH_F43653_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|SPINAL CORD REHABILITATION|
20|FH_F136829_29615_0|SrvcGrp|89417|2022|PDM|986.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F112444_07102_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F113713_17013_0|SrvcGrp|91399|2022|PDM|75.00|99|0.00|AETNA PSYCH PT & FAMILY 45MINS (MOD AJ)|
20|FH_F115625_63110_0|SrvcGrp|73485|2022|PDM|1008.00|99|0.00|AETNA REHAB|
20|FH_F116393_07002_0|SrvcGrp|15788|2022|PDM|230.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F147380_78520_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147439_84003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD UE|
20|FH_F113649_01752_0|SrvcGrp|19742|2022|PDM|90.00|99|0.00|MID-LINE INSERTION|
20|FH_F118950_33312_0|SrvcGrp|107483|2022|PCT|1.10|99|0.00|OP THERAPY SERVICE|
20|FH_F36420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|BRACHY SEED IMPLANT|
20|FH_F112705_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40345_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F98624_15701_0|SrvcGrp|73603|2022|PDM|9293.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F98625_08103_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|MSDRG 233-234 CORONARY BYPASS|
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PDM|6786.00|99|0.00|AEG 9 (NO REV)|
20|FH_F133494_90023_0|CSTM-ALL|CSTM-00|2020|PDM|4106.00|99|0.00|AEG 6 (NO REV)|
20|FH_F133700_92808_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F111581_77401_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|GENERAL ACUTE CARE|
20|FH_F134828_30531_0|SrvcGrp|112659|2022|PDM|46.00|99|0.00|XRAY EXAM OF LOWER SPINE|
20|FH_F134368_0_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|5750.00|99|0.00|MS DRG 490 ONLY|
20|FH_F72404_0_0|SrvcGrp|98362|2022|PDM|1851.00|99|0.00|AETNA LASER COAGULATION OF PROSTATE|
20|FH_F133579_0_0|SrvcGrp|104003|2022|PDM|1749.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES|
20|FH_F138491_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F38949_0_0|SrvcGrp|115|2022|PDM|585.00|99|0.00|SKILLED NURSING CARE|
20|FH_F39633_0_0|SrvcGrp|31323|2022|PDM|1169.00|99|0.00|DREYER AMB SURGERY - ASPG IV|
20|FH_F41013_0_0|SrvcGrp|31187|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF (DME)|
20|FH_F54552_0_0|SrvcGrp|49022|2022|PDM|80.00|99|0.00|NURSING VISIT W/INFUSION THERAPY|
20|FH_F113585_20155_0|SrvcGrp|86833|2022|PDM|15.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F138658_75022_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138807_32207_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F138936_01040_0|SrvcGrp|103913|2022|PCT|0.00|99|0.00|OP DIALYSIS|
20|FH_F57953_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F113885_0_0|SrvcGrp|3809|2022|PDM|721.60|99|0.00|HOSPICE CARE|
20|FH_F88893_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1526.45|99|0.00|HAPA WPA-NWPA 2012-13 ASC 905 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|103.45|99|0.00|HAPA WPA-NWPA 2012-13 ASC 316 W/O REV|
20|FH_F84751_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PDM|2140.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F40073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F135388_48601_0|SrvcGrp|13597|2022|PDM|322.53|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F135607_21613_0|SrvcGrp|75419|2022|PDM|1250.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F136186_46307_0|SrvcGrp|48396|2022|PDM|120.00|99|0.00|OT SERVICES|
20|FH_F119892_47586_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131334_60062_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130756_04901_0|SrvcGrp|111926|2022|PCT|1.00|99|0.00|COVID-19 LAB TESTING|
20|FH_F131265_84106_0|SrvcGrp|87317|2022|PDM|1079.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F41457_0_0|SrvcGrp|29121|2022|PCT|0.62|99|0.00|LABORATORY|
20|FH_F148860_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97623_38008_0|SrvcGrp|73605|2022|PDM|2466.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F120332_0_0|SrvcGrp|29346|2022|PCT|0.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F103180_85283_0|SrvcGrp|46424|2022|PDM|95.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F33719_0_0|SrvcGrp|360|2022|PDM|1234.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F150912_19344_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F72788_0_0|SrvcGrp|3418|2022|PCT|0.66|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F148926_28803_0|SrvcGrp|75419|2022|PDM|410.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F98360_11554_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F52092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F39443_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAPA WPA INJECTABLES 106%|
20|FH_F97280_20018_0|SrvcGrp|88978|2022|PDM|6448.00|99|0.00|VAGINAL DELIVERY|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|33122.00|99|0.00|MS DRGS 216-221 CARDIAC VALVE|
20|FH_F128987_65737_0|SrvcGrp|108081|2022|PDM|215.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F116753_0_0|SrvcGrp|38246|2022|PDM|905.00|99|0.00|SLEEP STUDIES|
20|FH_F40667_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|GENERAL ACUTE CARE|
20|FH_F133223_0_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F149459_06615_0|SrvcGrp|66264|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F124441_0_0|SrvcGrp|109834|2022|PDM|3040.00|99|0.00|REPAIR HUMERUS FRACTURE|
20|FH_F149608_19116_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110732_31513_0|SrvcGrp|83824|2022|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES|
20|FH_F147330_34761_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112045_90301_0|SrvcGrp|16|2022|PDM|2857.00|99|0.00|ACUTE REHABILITATION|
20|FH_F37864_0_0|CSTM-ALL|CSTM-00|2020|PDM|1021.76|99|0.00|ASPG VI|
20|FH_F99420_91326_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP LABORATORY|
20|FH_F117583_21208_0|SrvcGrp|473|2022|PDM|380.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F114416_0_0|SrvcGrp|90707|2022|PDM|120.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F150919_17603_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F35557_0_0|SrvcGrp|10571|2022|PDM|48.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138017_73129_0|SrvcGrp|55084|2022|PDM|6539.00|99|0.00|CPT 52648|
20|FH_F143347_16001_0|SrvcGrp|113637|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F75305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG UNGROUPABLE INPATIENT|
20|FH_F120512_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F101380_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F130951_15237_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131067_57105_0|CSTM-ALL|CSTM-00|2020|PDM|2290.00|99|0.00|AEG 1 (NO REV)|
20|FH_F46893_0_0|SrvcGrp|9510|2022|PDM|424.00|99|0.00|SKILLED NURSING CARE|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1761.00|99|0.00|GA RETINA SURG CTR ASC 35|
20|FH_F120171_33770_0|SrvcGrp|46903|2022|PDM|663.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F120171_33770_0|SrvcGrp|86722|2022|PDM|207.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F120190_92624_0|SrvcGrp|108484|2022|PDM|825.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F132479_90290_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F116698_07470_0|SrvcGrp|86845|2022|PDM|39.90|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F120974_27607_0|SrvcGrp|76768|2022|PCT|0.76|99|0.00|MS DRG 001-002 ONLY|
20|FH_F126438_50029_0|SrvcGrp|108484|2022|PDM|650.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F125479_17501_0|SrvcGrp|90854|2022|PDM|903.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F51276_0_0|SrvcGrp|17002|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS|
20|FH_F70493_0_0|SrvcGrp|11258|2022|PCT|0.35|99|0.00|DRUGS|
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS|
20|FH_F63095_0_0|SrvcGrp|16536|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F63432_0_0|SrvcGrp|4109|2022|PCT|0.76|99|0.00|ACUTE PSYCH|
20|FH_F137427_89146_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F124018_75067_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F89453_75069_0|SrvcGrp|26160|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F33642_0_0|SrvcGrp|15369|2022|PCT|0.60|99|0.00|LABORATORY|
20|FH_F125890_43054_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F91994_0_0|SrvcGrp|72996|2022|PDM|1760.00|99|0.00|AEG 4|
20|FH_F121149_76021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131254_92211_0|SrvcGrp|86832|2022|PDM|7.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F79645_0_0|SrvcGrp|62258|2022|PDM|85.00|99|0.00|PHYSICAL THERAY EVAL/RE-EVAL|
20|FH_F71070_0_0|SrvcGrp|68052|2022|PDM|1200.00|99|0.00|CPT 52204|
20|FH_F79427_0_0|SrvcGrp|65421|2022|PCT|1.00|99|0.00|HAPA SEPA-- IMPLANTS|
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|889.00|99|0.00|AEG 10 (NO REV)|
20|FH_F72947_0_0|SrvcGrp|15052|2022|PCT|1.00|99|0.00|RADIOLOGY SVCS|
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 10 (NO REV)|
20|FH_F32336_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F36433_0_0|CSTM-ALL|CSTM-00|2020|PDM|486.00|99|0.00|ACUTE PSYCH|
20|FH_F32156_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|ACUTE PSYCH|
20|FH_F77463_0_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F114916_30309_0|SrvcGrp|53065|2022|PDM|675.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F143976_80504_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F94862_0_0|SrvcGrp|72990|2022|PDM|480.00|99|0.00|AEG 1|
20|FH_F125940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F116397_33404_0|SrvcGrp|86849|2022|PDM|43.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F116397_33404_0|SrvcGrp|17016|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116527_70443_0|SrvcGrp|17100|2022|PDM|750.00|99|0.00|SKILLED NURSING|
20|FH_F116527_70443_0|SrvcGrp|537|2022|PDM|350.00|99|0.00|OBSERVATION SERVICES|
20|FH_F127399_0_0|SrvcGrp|84181|2022|PDM|2185.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS|
20|FH_F36258_0_0|SrvcGrp|22562|2022|PDM|45.00|99|0.00|SPEECH THERAPY|
20|FH_F121428_40202_0|SrvcGrp|88977|2022|PDM|1746.00|99|0.00|C-SECTION DELIVERY|
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|2838.00|99|0.00|ASPG IX|
20|FH_F42347_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F111292_33136_0|SrvcGrp|104284|2022|PDM|12208.00|99|0.00|GASTRIC SLEEVE|
20|FH_F140987_0_0|SrvcGrp|99163|2022|PDM|3750.00|99|0.00|CPT 27703|
20|FH_F141651_0_0|SrvcGrp|77582|2022|PDM|2310.00|99|0.00|CPT 31255|
20|FH_F47906_0_0|SrvcGrp|29956|2022|PCT|1.00|99|0.00|DME MOD AV|
20|FH_F89360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: ALL|
20|FH_F148243_0_0|SrvcGrp|98470|2022|PDM|1450.00|99|0.00|AMPUTATION TOE|
20|FH_F41780_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F112082_30720_0|SrvcGrp|14949|2022|PDM|183.00|99|0.00|HOME INFUSION|
20|FH_F87557_33309_0|SrvcGrp|86845|2022|PDM|30.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|2973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F62579_0_0|SrvcGrp|24761|2022|PDM|42.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F100782_0_0|SrvcGrp|97656|2022|PDM|1373.76|99|0.00|WINDBER MEDICAL CNTR ASC 401|
20|FH_F114683_0_0|SrvcGrp|27261|2022|PDM|5595.00|99|0.00|CPT 27446|
20|FH_F146064_17331_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F88274_0_0|SrvcGrp|75497|2022|PDM|650.00|99|0.00|AEG 10|
20|FH_F91171_0_0|CSTM-ALL|CSTM-00|2020|PDM|1212.00|99|0.00|AEG 9 (NO REV)|
20|FH_F83754_0_0|SrvcGrp|12659|2022|PCT|0.84|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134234_49525_0|SrvcGrp|58509|2022|PDM|240.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F67963_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F109364_52349_0|SrvcGrp|48394|2022|PDM|77.04|99|0.00|SKILLED NURSING SERVICES|
20|FH_F145584_15010_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F83978_66739_0|SrvcGrp|109057|2022|PCT|1.00|99|0.00|CARDIAC STUDIES|
20|FH_F146579_99202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149021_44514_0|CSTM-ALL|CSTM-00|2020|PDM|902.00|99|0.00|AEG 6 (NO REV)|
20|FH_F133943_01606_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109242_18466_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F145642_15108_0|SrvcGrp|17016|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F121303_15501_0|SrvcGrp|113176|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - MODERNA|
20|FH_F62853_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F112023_12866_0|SrvcGrp|79804|2022|PDM|4375.00|99|0.00|AETNA MEDICAL/SURGICAL|
20|FH_F83978_66739_0|SrvcGrp|73000|2022|PDM|1548.00|99|0.00|AEG 6|
20|FH_F123851_03235_0|SrvcGrp|48394|2022|PDM|58.14|99|0.00|SKILLED NURSING SERVICES|
20|FH_F149319_07670_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 5  (NO REV)|
20|FH_F121225_98902_0|SrvcGrp|80679|2022|PCT|0.85|99|0.00|AETNA RADIOLOGY|
20|FH_F116753_0_0|CSTM-ALL|CSTM-00|2020|PDM|1552.00|99|0.00|AEG 3 (NO REV)|
20|FH_F118252_32216_0|SrvcGrp|87317|2022|PDM|1150.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F109267_12202_0|SrvcGrp|89149|2022|PDM|85.00|99|0.00|OP INTENSIVE|
20|FH_F145604_14850_0|SrvcGrp|86854|2022|PDM|85.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132883_31602_0|SrvcGrp|26868|2022|PDM|20.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F52713_0_0|SrvcGrp|42785|2022|PDM|240.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F121225_98902_0|SrvcGrp|17016|2022|PCT|0.85|99|0.00|HOME INFUSION THERAPY|
20|FH_F134207_19116_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144808_0_0|SrvcGrp|88157|2022|PDM|7215.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F93190_26456_0|SrvcGrp|46605|2022|PDM|90.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F49913_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F130763_0_0|CSTM-ALL|CSTM-00|2020|PDM|4169.00|99|0.00|AEG 9 (NO REV)|
20|FH_F51124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F79743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130329_64114_0|SrvcGrp|86838|2022|PDM|10.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F149299_43351_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116806_0_0|SrvcGrp|107013|2022|PDM|1923.16|99|0.00|AUGMENTATION LOWER JAW BONE|
20|FH_F150160_01301_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F117300_0_0|SrvcGrp|88163|2022|PDM|5402.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F85212_71075_0|SrvcGrp|72996|2022|PDM|941.00|99|0.00|AEG 4|
20|FH_F33047_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139873_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F50657_0_0|SrvcGrp|32386|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKL (DME)|
20|FH_F109364_52349_0|SrvcGrp|46605|2022|PDM|201.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133207_0_0|SrvcGrp|106265|2022|PDM|5293.00|99|0.00|NSL/SINS NDSC TOTAL|
20|FH_F129440_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|NON-ANESTHESIOLOGIST/CRNA (HAN3)|
20|FH_F138050_52301_0|SrvcGrp|75506|2022|PCT|1.36|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F52754_0_0|SrvcGrp|29986|2022|PDM|450.00|99|0.00|REHAB THERAPY|
20|FH_F31714_0_0|SrvcGrp|9984|2022|PDM|225.00|99|0.00|URGENT CARE|
20|FH_F133868_40202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F139565_0_0|SrvcGrp|42550|2022|PDM|5738.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F109400_80026_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F85213_02840_0|CSTM-ALL|CSTM-00|2020|PDM|6886.40|99|0.00|INPATIENT DETOX SERVICES >17 YRS|
20|FH_F130329_64114_0|SrvcGrp|46605|2022|PDM|50.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1388.89|99|0.00|AEG 6 (NO REV)|
20|FH_F120583_43219_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F90416_73013_0|SrvcGrp|73700|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F125139_84096_0|SrvcGrp|46903|2022|PDM|950.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F124369_0_0|SrvcGrp|27310|2022|PDM|2113.10|99|0.00|ENDOSCOPIC PLANTAR FASCIOTOMY|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.75|99|0.00|HAPA WPA-NWPA 2012-13 ASC 201 W/O REV|
20|FH_F109405_73106_0|SrvcGrp|86722|2022|PDM|120.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F126904_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F150165_06032_0|CSTM-ALL|CSTM-00|2020|PDM|4350.00|99|0.00|AEG 9 (NO REV)|
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 6 (NO REV)|
20|FH_F125328_0_0|SrvcGrp|68000|2022|PDM|8718.00|99|0.00|CPT 58561|
20|FH_F134331_61021_0|SrvcGrp|48396|2022|PDM|150.00|99|0.00|OT SERVICES|
20|FH_F120719_27540_0|SrvcGrp|103913|2022|PCT|0.71|99|0.00|OP DIALYSIS|
20|FH_F125133_20601_0|SrvcGrp|110073|2022|PDM|31.83|99|0.00|CONTACT LAYER >48 SQ IN|
20|FH_F85212_71075_0|SrvcGrp|75443|2022|PDM|650.00|99|0.00|OBSERVATION - REV 769|
20|FH_F136359_0_0|SrvcGrp|46890|2022|PDM|5225.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F54592_0_0|SrvcGrp|41460|2022|PDM|20.00|99|0.00|ENTERAL THERAPY - UNSPECIFIED|
20|FH_F47717_0_0|SrvcGrp|4109|2022|PDM|692.00|99|0.00|ACUTE PSYCH|
20|FH_F134489_90305_0|SrvcGrp|89412|2022|PDM|450.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F134489_90305_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F129101_27006_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F85055_0_0|SrvcGrp|76579|2022|PCT|1.00|99|0.00|IMPLANTS W/ HCPC|
20|FH_F85211_0_0|SrvcGrp|72998|2022|PDM|984.50|99|0.00|AEG 5|
20|FH_F101100_50314_0|SrvcGrp|97900|2022|PDM|12617.00|99|0.00|AMPUTATION LOWER LEG 2|
20|FH_F77665_0_0|SrvcGrp|74860|2022|PDM|6.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F146671_72205_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127656_06068_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47140_0_0|SrvcGrp|12044|2022|PDM|719.64|99|0.00|SLEEP STUDIES|
20|FH_F116040_24637_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F132928_64114_0|SrvcGrp|102159|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F138702_43614_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139156_30060_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143201_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F150313_78666_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F94585_19040_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137627_78382_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F101083_0_0|SrvcGrp|85980|2022|PDM|1575.00|99|0.00|CPT 58670|
20|FH_F150953_74953_0|SrvcGrp|74694|2022|PDM|1870.00|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F130309_17044_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F98860_96706_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F127291_86426_0|SrvcGrp|99064|2022|PCT|1.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F149020_78653_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F35750_0_0|SrvcGrp|18120|2022|PCT|0.65|99|0.00|MS DRG 003|
20|FH_F116753_0_0|SrvcGrp|73605|2022|PDM|986.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F133677_15601_0|SrvcGrp|48396|2022|PDM|107.00|99|0.00|OT SERVICES|
20|FH_F149662_85015_0|SrvcGrp|112966|2022|PCT|1.10|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|682.50|99|0.00|AEG 3 (NO REV)|
20|FH_F151022_17016_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|AEG 6 (NO REV)|
20|FH_F148980_18603_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147210_70633_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F92092_74055_0|SrvcGrp|78504|2022|PCT|0.52|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F139565_0_0|SrvcGrp|42429|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 66761|
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 10 (NO REV)|
20|FH_F33719_0_0|SrvcGrp|91|2022|PCT|0.70|99|0.00|KIDNEY TRANSPLANT|
20|FH_F123570_0_0|SrvcGrp|37317|2022|PDM|3914.00|99|0.00|LITHOTRIPSY|
20|FH_F50100_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F151022_17016_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145920_0_0|SrvcGrp|114014|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F98860_96706_0|SrvcGrp|90854|2022|PDM|3326.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F117581_21211_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F134916_16421_0|SrvcGrp|13262|2022|PDM|4.54|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F137363_0_0|SrvcGrp|84720|2022|PCT|0.00|99|0.00|AETNA LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F149648_89148_0|SrvcGrp|48396|2022|PDM|135.00|99|0.00|OT SERVICES|
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)|
20|FH_F149662_85015_0|CSTM-ALL|CSTM-00|2020|PDM|2720.00|99|0.00|AEG 6 (NO REV)|
20|FH_F41033_0_0|SrvcGrp|17067|2022|PDM|491.00|99|0.00|ASPG II|
20|FH_F151029_52241_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131325_48170_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147321_24523_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126977_34990_0|SrvcGrp|113911|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F98880_50158_0|SrvcGrp|73559|2022|PDM|8385.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F90151_24382_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147229_60523_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116753_0_0|SrvcGrp|74792|2022|PDM|1250.00|99|0.00|POLYSOMNOGRAPHY|
20|FH_F40564_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ACUTE PSYCH|
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|3318.00|99|0.00|AEG 8 (NO REV)|
20|FH_F147342_08012_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128366_32901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37094_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.90|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_F34319_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F114503_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|109.00|99|0.00|HAPA EPA ASC 18|
20|FH_F117583_21208_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122392_78207_0|SrvcGrp|89149|2022|PDM|202.00|99|0.00|OP INTENSIVE|
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|AEG 9 (NO REV)|
20|FH_F75243_0_0|SrvcGrp|12591|2022|PDM|123.00|99|0.00|CD FULL DAY|
20|FH_F147142_33870_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F37364_0_0|SrvcGrp|97|2022|PDM|6500.00|99|0.00|C-SECTION|
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41802_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F132818_24701_0|SrvcGrp|75506|2022|PCT|0.88|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F129970_34986_0|SrvcGrp|46903|2022|PDM|588.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F122841_0_0|SrvcGrp|90599|2022|PDM|1349.00|99|0.00|REMOVAL OF LENS LESION|
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)|
20|FH_F94643_90501_0|SrvcGrp|24752|2022|PDM|25.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F137788_72632_0|SrvcGrp|103913|2022|PCT|1.00|99|0.00|OP DIALYSIS|
20|FH_F137797_70123_0|SrvcGrp|48398|2022|PDM|121.00|99|0.00|PT SERVICES|
20|FH_F110121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131111_33304_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110732_31513_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|CHEMOTHERAPY AND ALL OTHER DRUGS|
20|FH_F142370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138995_0_0|SrvcGrp|91422|2022|PDM|1199.00|99|0.00|REMOVAL OF ADENOIDS|
20|FH_F150383_29853_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|1241.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132096_89118_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F39443_0_0|SrvcGrp|30313|2022|PDM|98.00|99|0.00|HAPA WPA ASC 122|
20|FH_F140248_42420_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F102943_0_0|SrvcGrp|79577|2022|PDM|1044.65|99|0.00|CPT 43244|
20|FH_F49329_0_0|SrvcGrp|45334|2022|PDM|49.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132418_84042_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112712_63005_0|SrvcGrp|29077|2022|PCT|1.00|99|0.00|HOME TRANSFUSION|
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1124.00|99|0.00|AEG 2 (NO REV)|
20|FH_F50137_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F59732_0_0|SrvcGrp|22594|2022|PDM|80.00|99|0.00|IMIGLUCERASE|
20|FH_F137984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F98801_93274_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F131190_21042_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F87254_0_0|SrvcGrp|68543|2022|PDM|1300.00|99|0.00|CPT 36561|
20|FH_F125011_74467_0|SrvcGrp|110024|2022|PDM|9000.00|99|0.00|ATTACH BLADDER/URETHRA|
20|FH_F93332_0_0|SrvcGrp|93064|2022|PDM|7416.00|99|0.00|LUMBAR ARTIF DISKECTOMY (HCFA)|
20|FH_F115064_78582_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F114930_71101_0|SrvcGrp|73485|2022|PDM|816.00|99|0.00|AETNA REHAB|
20|FH_F66501_0_0|SrvcGrp|10543|2022|PDM|70.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F149866_07401_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F109000_0_0|SrvcGrp|11663|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F37937_0_0|SrvcGrp|11085|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F59093_0_0|SrvcGrp|42976|2022|PDM|85.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F40525_0_0|SrvcGrp|50222|2022|PDM|600.00|99|0.00|COLONOSCOPY MOD SU|
20|FH_F135211_63119_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97104_53545_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F137067_0_0|SrvcGrp|88161|2022|PDM|5250.00|99|0.00|LAMINECTOMY W/FACE-THORACIC|
20|FH_F110102_0_0|SrvcGrp|95779|2022|PDM|150.00|99|0.00|HOSPICE CARE|
20|FH_F38798_0_0|SrvcGrp|10646|2022|PDM|80.00|99|0.00|MIDLINE INSERTION KIT|
20|FH_F116059_62959_0|SrvcGrp|75966|2022|PCT|1.00|99|0.00|RADIOLOGY|
20|FH_F121113_33613_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.00|99|0.00|AEG 10 (NO REV)|
20|FH_F38090_0_0|SrvcGrp|147|2022|PDM|101.00|99|0.00|HOME HEALTH CARE|
20|FH_F123400_04605_0|SrvcGrp|104996|2022|PDM|141.00|99|0.00|AETNA CRISIS INTERVENTION MENTAL HEALTH FOLLOW UP|
20|FH_F33233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F120059_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 9 (NO REV)|
20|FH_F128272_60640_0|SrvcGrp|24745|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F37679_0_0|SrvcGrp|26859|2022|PDM|30.50|99|0.00|DIURETIC IV THERAPY (MOD SH)|
20|FH_F40834_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F109601_0_0|SrvcGrp|75495|2022|PDM|1467.00|99|0.00|AEG 9|
20|FH_F37659_0_0|SrvcGrp|14088|2022|PDM|600.00|99|0.00|ELECTRO CONVULSIVE THERAPY|
20|FH_F145536_90265_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127165_32112_0|SrvcGrp|73842|2022|PDM|231.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F82173_72712_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F68966_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F70104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.35|99|0.00|OP SVCS|
20|FH_F51520_0_0|SrvcGrp|42826|2022|PDM|150.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F148260_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F125028_19061_0|SrvcGrp|29075|2022|PDM|57.75|99|0.00|HYDRATION THERAPY|
20|FH_F78603_0_0|SrvcGrp|26036|2022|PCT|0.73|99|0.00|DRUGS|
20|FH_F42521_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F31218_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F141355_63134_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F123302_33407_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148420_33437_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|HSS ASC|
20|FH_F125028_19061_0|SrvcGrp|29077|2022|PDM|210.00|99|0.00|HOME TRANSFUSION|
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 2 (NO REV)|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|389.19|99|0.00|HAPA WPA-NWPA 2012-13 ASC 405 W/O REV|
20|FH_F139515_0_0|SrvcGrp|27348|2022|PDM|2150.00|99|0.00|OP SURGERY (CPT 58662)|
20|FH_F137573_33764_0|SrvcGrp|73842|2022|PDM|202.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F113410_0_0|SrvcGrp|104760|2022|PDM|3887.00|99|0.00|VAGINAL HYSTERECTOMY|
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 2 (NO REV)|
20|FH_F62892_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137087_0_0|SrvcGrp|113022|2022|PDM|20000.00|99|0.00|HIP SERVICES|
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AEG 3 (NO REV)|
20|FH_F147941_06023_0|SrvcGrp|114470|2022|PCT|1.00|99|0.00|INFUSIONS|
20|FH_F121533_26241_0|SrvcGrp|66562|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F93424_53578_0|SrvcGrp|86746|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F71867_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F101386_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|OP SVCS|
20|FH_F130807_20721_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F56276_0_0|SrvcGrp|26777|2022|PDM|85.00|99|0.00|CPT 90806|
20|FH_F39022_0_0|SrvcGrp|13849|2022|PCT|0.80|99|0.00|LITHOTRIPSY|
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|1213.48|99|0.00|2005 ASPG GROUPER VIII|
20|FH_F128272_60640_0|SrvcGrp|22593|2022|PDM|40.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F115019_78414_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136490_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F133215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148182_23324_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F52854_0_0|SrvcGrp|16442|2022|PDM|5366.00|99|0.00|LAPAROSCOPIC ASSISTED VAGINAL HYSTERECTOMY|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38792_0_0|CSTM-ALL|CSTM-00|2020|PDM|379.00|99|0.00|BETHANY MED CTR ESOPHAGOSCOPY MOD SU|
20|FH_F110925_01104_0|SrvcGrp|86148|2022|PDM|900.00|99|0.00|AETNA PEGLOTICASE INJ|
20|FH_F93332_0_0|SrvcGrp|88164|2022|PDM|7416.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F145568_0_0|SrvcGrp|46903|2022|PDM|660.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F138636_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F129305_45614_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F126242_32796_0|SrvcGrp|89337|2022|PDM|928.00|99|0.00|DETOXIFICATION|
20|FH_F75307_0_0|SrvcGrp|26001|2022|PDM|159.74|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F141410_13045_0|SrvcGrp|75999|2022|PCT|0.00|99|0.00|OP URGENT CARE|
20|FH_F116341_12180_0|SrvcGrp|91065|2022|PDM|90.00|99|0.00|PSYCHIATRIC CPT 90853 (HCFA)|
20|FH_F41178_0_0|SrvcGrp|110|2022|PDM|581.00|99|0.00|CD - REHABILITATION|
20|FH_F134994_33162_0|SrvcGrp|73842|2022|PDM|224.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F98920_46526_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
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_F122433_0_0|SrvcGrp|36591|2022|PDM|1500.00|99|0.00|CPT 63685|
20|FH_F118910_0_0|SrvcGrp|80918|2022|PDM|113.30|99|0.00|RESPITE CARE|
20|FH_F134236_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41776_0_0|CSTM-ALL|CSTM-00|2020|PDM|937.00|99|0.00|ACUTE PSYCH|
20|FH_F37659_0_0|SrvcGrp|26987|2022|PDM|54901.00|99|0.00|BMT AUTOLOGOUS TRANSPLANT|
20|FH_F124048_47304_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F122725_32216_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|MANUAL BODY MUSCLE TESTING|
20|FH_F122694_33334_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F86991_15122_0|SrvcGrp|42551|2022|PDM|350.00|99|0.00|OP SURGERY|
20|FH_F55212_0_0|SrvcGrp|3390|2022|PDM|130.00|99|0.00|CPT 90801|
20|FH_F86851_0_0|SrvcGrp|84985|2022|PDM|676.00|99|0.00|CPT 44391|
20|FH_F69347_0_0|SrvcGrp|44768|2022|PDM|11770.00|99|0.00|PORTLAND ADVENTIST ASPG VII|
20|FH_F119347_27540_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148425_01507_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F148495_03038_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F39268_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123872_75006_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118704_0_0|SrvcGrp|107745|2022|PDM|1519.00|99|0.00|DIALYSIS ULTRAFILTRATION|
20|FH_F40734_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144011_60616_0|SrvcGrp|30623|2022|PDM|8520.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|302.12|99|0.00|HAPA WPA-NWPA 2012-13 ASC 117 W/O REV|
20|FH_F73230_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125352_90034_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|1462.00|99|0.00|AEG 10 (NO REV)|
20|FH_F33581_0_0|SrvcGrp|941|2022|PDM|3240.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|688.00|99|0.00|HAPA EPA ASC 4|
20|FH_F146132_76801_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100741_0_0|SrvcGrp|72994|2022|PDM|703.00|99|0.00|AEG 3|
20|FH_F97182_21502_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F101923_98104_0|SrvcGrp|16429|2022|PDM|68.00|99|0.00|OBSERVATION SVCS|
20|FH_F145842_37172_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F36207_0_0|SrvcGrp|16996|2022|PDM|55.00|99|0.00|AMBULANCE RESPONSE/TREATMENT - NO TRANSPORT|
20|FH_F100741_0_0|SrvcGrp|72992|2022|PDM|616.00|99|0.00|AEG 2|
20|FH_F120437_85202_0|SrvcGrp|82822|2022|PDM|11.42|99|0.00|INJECTION, IMMUNE GLOBULIN (HIZENTRA)|
20|FH_F44701_0_0|SrvcGrp|38909|2022|PDM|1410.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F119437_0_0|SrvcGrp|75493|2022|PDM|2400.00|99|0.00|AEG 8|
20|FH_F40994_0_0|SrvcGrp|3029|2022|PDM|220.00|99|0.00|NEWBORN NURSERY|
20|FH_F150525_16056_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F70026_0_0|SrvcGrp|17139|2022|PDM|705.00|99|0.00|HOSPICE CARE|
20|FH_F133397_23233_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146116_34233_0|SrvcGrp|14494|2022|PDM|1150.63|99|0.00|CONTINUOUS HOMECARE|
20|FH_F133167_82930_0|SrvcGrp|471|2022|PDM|725.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F150001_33064_0|SrvcGrp|31973|2022|PDM|11.00|99|0.00|HOME THERAPY|
20|FH_F146376_53188_0|SrvcGrp|74668|2022|PDM|744.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F92676_15063_0|SrvcGrp|78983|2022|PDM|1244.55|99|0.00|MON VALLEY ASC 208|
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|226.22|99|0.00|HAPA WPA-NWPA 2012-13 ASC 15 W/O REV|
20|FH_F57834_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F103360_68845_0|CSTM-ALL|CSTM-00|2020|PDM|6676.00|99|0.00|AEG 3 (NO REV)|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F126735_38018_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F92676_15063_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|HAPA WPA/NWPA 2018 LAB 100%|
20|FH_F42803_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F122958_45014_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F132446_19063_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37565_0_0|SrvcGrp|23387|2022|PDM|52.00|99|0.00|PT/OT/ST|
20|FH_F112953_06066_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142990_06488_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F124928_04210_0|SrvcGrp|95661|2022|PDM|149.67|99|0.00|RESPITE CARE (HCFA)|
20|FH_F94165_0_0|SrvcGrp|73483|2022|PCT|0.85|99|0.00|AETNA SUBACUTE III|
20|FH_F142927_52402_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150949_0_0|SrvcGrp|67068|2022|PDM|10500.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F142904_50322_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133350_39532_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F41392_0_0|SrvcGrp|68580|2022|PCT|1.00|99|0.00|IMMUNIZATIONS|
20|FH_F133018_84037_0|SrvcGrp|24761|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F43433_0_0|SrvcGrp|36515|2022|PCT|0.50|99|0.00|HIGH COST DRUGS|
20|FH_F41181_0_0|CSTM-ALL|CSTM-00|2020|PDM|728.00|99|0.00|ACUTE PSYCH|
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117794_06473_0|SrvcGrp|472|2022|PDM|701.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F84591_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130596_50273_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F44414_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46192_0_0|SrvcGrp|10111|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F128485_44667_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F39844_0_0|SrvcGrp|360|2022|PDM|796.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F137240_0_0|SrvcGrp|8950|2022|PDM|5912.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F130573_02882_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F121009_76180_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F113288_38104_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119079_41018_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F126666_44053_0|SrvcGrp|91397|2022|PDM|68.00|99|0.00|AETNA PSYCH PT & FAMILY 45MINS (MOD HO)|
20|FH_F132794_40324_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F43443_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89851_83854_0|CSTM-ALL|CSTM-00|2020|PDM|7227.00|99|0.00|AEG 9 (NO REV)|
20|FH_F132900_06074_0|SrvcGrp|91070|2022|PDM|441.00|99|0.00|AETNA MH CRISIS INTERVENTION (HCFA)|
20|FH_F88956_0_0|SrvcGrp|39870|2022|PDM|20302.00|99|0.00|MS DRG 619-621 ONLY|
20|FH_F120437_85202_0|SrvcGrp|29023|2022|PDM|90.04|99|0.00|HOME INFUSION THERAPY|
20|FH_F114024_0_0|SrvcGrp|75493|2022|PDM|1001.00|99|0.00|AEG 8|
20|FH_F38630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|100% 2007 MEDICARE DME TN|
20|FH_F46196_0_0|SrvcGrp|31187|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF (DME)|
20|FH_F100661_63640_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124608_0_0|SrvcGrp|36591|2022|PDM|4080.00|99|0.00|CPT 63685|
20|FH_F57834_0_0|SrvcGrp|11577|2022|PDM|420.00|99|0.00|DIALYSIS|
20|FH_F122958_45014_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125660_46706_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F39546_0_0|SrvcGrp|30806|2022|PCT|1.05|99|0.00|SKIN GRAFT|
20|FH_F34706_0_0|SrvcGrp|2814|2022|PDM|4690.00|99|0.00|DRG 119 VEIN LIGATION & STRIPPING|
20|FH_F34303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F102822_84065_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F120032_0_0|SrvcGrp|79593|2022|PDM|580.00|99|0.00|CPT 45378|
20|FH_F115406_79902_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F100666_81301_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|760.00|99|0.00|AEG 2 (NO REV)|
20|FH_F117087_0_0|SrvcGrp|107186|2022|PDM|2494.00|99|0.00|EXPLORE INNER EAR|
20|FH_F106540_26330_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F148556_13206_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148760_12953_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F89778_0_0|SrvcGrp|63461|2022|PDM|1178.04|99|0.00|CPT 52235|
20|FH_F88639_80204_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F118783_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F123792_90803_0|SrvcGrp|109330|2022|PCT|1.30|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F132810_0_0|SrvcGrp|98966|2022|PDM|60.00|99|0.00|HIT ENZYME REPLACE (HCFA)|
20|FH_F58856_0_0|SrvcGrp|22408|2022|PDM|3875.00|99|0.00|ASPG VIII (REV CODE + CPT)|
20|FH_F67901_0_0|SrvcGrp|24761|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F136386_30901_0|SrvcGrp|107733|2022|PDM|11865.00|99|0.00|CESAREAN SECTION|
20|FH_F118244_30040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F134150_01801_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137036_60504_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F114178_19083_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114092_83350_0|SrvcGrp|537|2022|PCT|0.45|99|0.00|OBSERVATION SERVICES|
20|FH_F142473_07663_0|SrvcGrp|23683|2022|PDM|56.18|99|0.00|SKILLED NURSING RN|
20|FH_F83831_0_0|SrvcGrp|10648|2022|PDM|6.00|99|0.00|HOME INFUSION|
20|FH_F138627_82901_0|SrvcGrp|86854|2022|PDM|85.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F139456_47501_0|SrvcGrp|14494|2022|PDM|861.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F140343_89052_0|SrvcGrp|86839|2022|PDM|30.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F140687_98001_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140867_56345_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140888_75119_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151610_77304_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118789_92211_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F38332_0_0|SrvcGrp|18116|2022|PDM|12064.00|99|0.00|MS DRG 239|
20|FH_F147725_06002_0|CSTM-ALL|CSTM-00|2020|PDM|2668.00|99|0.00|AEG 5 (NO REV) W/O MIDDLE EAR PROCEDURES|
20|FH_F147803_33952_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117102_39355_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F137270_82901_0|SrvcGrp|46605|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F109632_0_0|SrvcGrp|43740|2022|PDM|900.00|99|0.00|REHABILITATION - PRIVATE|
20|FH_F111046_0_0|SrvcGrp|13422|2022|PDM|436.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F90613_05001_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F91472_96001_0|SrvcGrp|103754|2022|PCT|0.40|99|0.00|ORIF OF TIBIA/FIBULA W/INTERNAL FIXATION|
20|FH_F139820_75657_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F109513_0_0|SrvcGrp|90433|2022|PDM|1500.00|99|0.00|HAND PROCEDURES|
20|FH_F47452_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F148864_81303_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F151079_17011_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121347_29401_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE|
20|FH_F121404_32216_0|SrvcGrp|108774|2022|PDM|1300.00|99|0.00|RAD W/O BACKUP NON-INV INTFC (MOD NU) (HCFA)|
20|FH_F121970_92653_0|SrvcGrp|89417|2022|PDM|500.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F114931_0_0|SrvcGrp|105762|2022|PDM|1850.00|99|0.00|REMOVE BY LIGAT INT HEM GRP|
20|FH_F129468_15010_0|SrvcGrp|73842|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129130_92562_0|SrvcGrp|111449|2022|PDM|8465.21|99|0.00|ELECTROPHYSIOLOGY EVALUATION (01- DAYS)|
20|FH_F129130_92562_0|CSTM-ALL|CSTM-00|2020|PDM|11277.57|99|0.00|AEG 6 (NO REV) W/O LAPAROSCOPIC/HYSTEROSCOPIC|
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|589.00|99|0.00|ASPG III|
20|FH_F113744_80301_0|SrvcGrp|43924|2022|PDM|971.29|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F97761_04072_0|SrvcGrp|88977|2022|PDM|6795.00|99|0.00|C-SECTION DELIVERY|
20|FH_F106822_0_0|SrvcGrp|100272|2022|PDM|9.50|99|0.00|IIV3 VACCINE SPLT 0.25 ML IM|
20|FH_F117299_0_0|SrvcGrp|107499|2022|PDM|996.00|99|0.00|AETNA - DESTRUCTION, PENIS LESION|
20|FH_F87054_0_0|SrvcGrp|73006|2022|PDM|2109.00|99|0.00|AEG 9|
20|FH_F114916_30309_0|SrvcGrp|88740|2022|PDM|2500.00|99|0.00|SP BONE ALGRFT|
20|FH_F142447_72758_0|SrvcGrp|110126|2022|PDM|532.00|99|0.00|DIALYSIS|
20|FH_F138751_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94786_07974_0|SrvcGrp|86852|2022|PDM|36.75|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F132988_0_0|SrvcGrp|100013|2022|PDM|4493.01|99|0.00|REPAIR/GRAFT ACHILLES TENDON|
20|FH_F132988_0_0|SrvcGrp|87679|2022|PDM|1279.81|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F136818_0_0|SrvcGrp|112936|2022|PDM|3000.00|99|0.00|SURGICAL SERVICES|
20|FH_F58932_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F43665_0_0|SrvcGrp|16|2022|PDM|761.00|99|0.00|ACUTE REHABILITATION|
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 5  (NO REV)|
20|FH_F76782_0_0|SrvcGrp|26001|2022|PDM|160.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F124059_64055_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F74102_0_0|SrvcGrp|11073|2022|PDM|95.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F36318_0_0|SrvcGrp|22801|2022|PCT|0.85|99|0.00|HEART VALVE & CABG|
20|FH_F36318_0_0|SrvcGrp|9518|2022|PCT|0.45|99|0.00|EMERGENCY ROOM|
20|FH_F91752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92493_0_0|SrvcGrp|90420|2022|PDM|6500.34|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|1893.10|99|0.00|AEG 6 (NO REV)|
20|FH_F93232_0_0|SrvcGrp|42784|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F132864_71101_0|SrvcGrp|73602|2022|PDM|481.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F124414_92653_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|AEG 10 (NO REV)|
20|FH_F150910_0_0|SrvcGrp|113853|2022|PDM|3000.00|99|0.00|CARDIAC CATHERIZATION INCL INJECTIONS|
20|FH_F127995_84010_0|SrvcGrp|86848|2022|PDM|25.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F87856_0_0|SrvcGrp|75489|2022|PDM|1080.00|99|0.00|AEG 6|
20|FH_F136355_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F100787_69162_0|SrvcGrp|73643|2022|PDM|2603.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F114629_19131_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F114705_77018_0|SrvcGrp|46903|2022|PDM|450.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 10 (NO REV)|
20|FH_F117195_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F148553_85016_0|SrvcGrp|80496|2022|PDM|2029.00|99|0.00|INSERTION OF PULSE GENERATOR|
20|FH_F148553_85016_0|SrvcGrp|115467|2022|PDM|1457.00|99|0.00|RIGHT HEART CATH|
20|FH_F132595_0_0|SrvcGrp|107733|2022|PDM|5800.00|99|0.00|CESAREAN SECTION|
20|FH_F135748_60455_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135762_70001_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F136778_62034_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS|
20|FH_F136796_24016_0|SrvcGrp|55071|2022|PDM|2440.83|99|0.00|ARTHROSCOPY SHOULDER|
20|FH_F136930_73114_0|SrvcGrp|11259|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F112371_19047_0|SrvcGrp|47530|2022|PDM|2426.00|99|0.00|LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS|
20|FH_F112505_51503_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F34498_0_0|SrvcGrp|16703|2022|PDM|1348.00|99|0.00|HEMO/HOME DIALYSIS SVCS|
20|FH_F63317_0_0|SrvcGrp|26179|2022|PDM|60.00|99|0.00|OT|
20|FH_F147462_84741_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F147468_20877_0|SrvcGrp|75419|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F147540_54871_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F42153_0_0|SrvcGrp|31771|2022|PCT|0.80|99|0.00|MS DRG 417-419 ONLY  LAP CHOLE|
20|FH_F116756_77477_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|456.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F119998_39823_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120866_51652_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120887_78750_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F113649_01752_0|SrvcGrp|86828|2022|PDM|120.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F51276_0_0|SrvcGrp|27047|2022|PDM|22.33|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS (MOD SJ)|
20|FH_F42715_0_0|SrvcGrp|474|2022|PDM|302.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F43156_0_0|SrvcGrp|526|2022|PDM|1100.00|99|0.00|CARDIAC CARE UNIT|
20|FH_F131208_0_0|SrvcGrp|13597|2022|PDM|315.70|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F40431_0_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|CVA (STROKE)|
20|FH_F123445_0_0|SrvcGrp|65720|2022|PDM|194.00|99|0.00|RESPITE CARE|
20|FH_F138350_0_0|SrvcGrp|112556|2022|PDM|2122.00|99|0.00|REPAIR OF TENDON(S)|
20|FH_F71183_29601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|1922.00|99|0.00|AEG 9 (NO REV)|
20|FH_F104802_0_0|SrvcGrp|15157|2022|PDM|80.00|99|0.00|INDIVIDUAL THERAPY|
20|FH_F109963_0_0|SrvcGrp|73002|2022|PDM|1117.00|99|0.00|AEG 7|
20|FH_F132928_64114_0|SrvcGrp|88621|2022|PDM|157.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132293_50595_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133219_89119_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F135891_0_0|SrvcGrp|73483|2022|PDM|500.00|99|0.00|AETNA SUBACUTE III|
20|FH_F81152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F113178_44035_0|SrvcGrp|43525|2022|PDM|280.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC|
20|FH_F120683_80238_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F150939_0_0|SrvcGrp|110583|2022|PDM|32.91|99|0.00|REMOVAL PROCEDURES ON EYE|
20|FH_F54552_0_0|SrvcGrp|24747|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138876_25302_0|SrvcGrp|26869|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F138936_01040_0|SrvcGrp|112677|2022|PCT|1.00|99|0.00|COVID-19 SPEC COLL SNF/LAB|
20|FH_F138936_01040_0|SrvcGrp|113166|2022|PCT|1.03|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F138992_72703_0|SrvcGrp|105465|2022|PDM|144.00|99|0.00|AETNA THERAPIES|
20|FH_F57953_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F106500_0_0|CSTM-ALL|CSTM-00|2020|PDM|549.00|99|0.00|AETNA POLYSOMNOGRAPHY|
20|FH_F119544_0_0|SrvcGrp|108041|2022|PDM|500.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F119888_0_0|SrvcGrp|106294|2022|PDM|418.57|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F151426_90028_0|SrvcGrp|90854|2022|PDM|1100.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F151427_04106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151503_30067_0|SrvcGrp|84307|2022|PDM|5996.00|99|0.00|TENDON REPAIR|
20|FH_F132258_45404_0|SrvcGrp|48398|2022|PDM|85.86|99|0.00|PT SERVICES|
20|FH_F135493_07514_0|SrvcGrp|108484|2022|PDM|424.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F135983_22030_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136164_63965_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136216_27526_0|CSTM-ALL|CSTM-00|2020|PCT|1.45|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119892_47586_0|SrvcGrp|95661|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F119892_47586_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F100765_73735_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F100880_67735_0|SrvcGrp|89891|2022|PDM|4130.00|99|0.00|MEDICAL CARE|
20|FH_F130933_47129_0|SrvcGrp|89417|2022|PDM|310.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F130996_34110_0|SrvcGrp|41335|2022|PDM|17000.00|99|0.00|TOTAL HIP|
20|FH_F116397_33404_0|SrvcGrp|22389|2022|PDM|15.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F131361_18235_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F127399_0_0|SrvcGrp|41334|2022|PDM|14045.00|99|0.00|TOTAL KNEE|
20|FH_F140629_0_0|SrvcGrp|33724|2022|PDM|2497.00|99|0.00|ARTHROSCOPY|
20|FH_F32168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F111301_33122_0|SrvcGrp|72984|2022|PCT|0.84|99|0.00|CHEMOTHERAPY|
20|FH_F134256_36117_0|SrvcGrp|57966|2022|PDM|900.00|99|0.00|HOSPICE CARE|
20|FH_F69202_0_0|SrvcGrp|9510|2022|PDM|900.00|99|0.00|SKILLED NURSING CARE|
20|FH_F33081_0_0|SrvcGrp|88|2022|PDM|3800.00|99|0.00|OP LITHOTRIPSY|
20|FH_F54272_0_0|SrvcGrp|51784|2022|PCT|0.45|99|0.00|OP PHARMACY|
20|FH_F132328_0_0|SrvcGrp|89404|2022|PDM|13213.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F132328_0_0|SrvcGrp|33982|2022|PDM|2289.00|99|0.00|CPT 28296|
20|FH_F132328_0_0|SrvcGrp|111958|2022|PDM|1821.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F102282_06795_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD DEFAULT HH|
20|FH_F98300_30236_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101320_26062_0|SrvcGrp|29075|2022|PDM|48.00|99|0.00|HYDRATION THERAPY|
20|FH_F130841_49315_0|SrvcGrp|97705|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F49598_0_0|SrvcGrp|9939|2022|PDM|1157.00|99|0.00|ACUTE MEDICAL SVCS|
20|FH_F109367_32751_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133972_27103_0|SrvcGrp|111529|2022|PDM|60.00|99|0.00|MID-LINE INSERTION (HCFA)|
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|1073.80|99|0.00|2005 ASPG GROUPER VI|
20|FH_F114824_44484_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F116506_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1064.11|99|0.00|HAPA WPA-NWPA 2012-13 ASC 702 W/O REV|
20|FH_F149660_0_0|SrvcGrp|34625|2022|PDM|25.00|99|0.00|NON EMERGENCY TRANSPORT|
20|FH_F126003_79403_0|SrvcGrp|86723|2022|PDM|597.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PDM|708.00|99|0.00|ASPG X|
20|FH_F118123_67226_0|SrvcGrp|24761|2022|PDM|37.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F114444_19602_0|SrvcGrp|106470|2022|PDM|72.00|99|0.00|AETNA OFFICE OUTPATIENT VISIT EST (MOD TD)|
20|FH_F87775_15106_0|SrvcGrp|17016|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F70883_0_0|SrvcGrp|3809|2022|PDM|780.00|99|0.00|HOSPICE CARE|
20|FH_F69647_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F138024_40509_0|SrvcGrp|89149|2022|PDM|170.00|99|0.00|OP INTENSIVE|
20|FH_F85652_98034_0|CSTM-ALL|CSTM-00|2020|PCT|2.30|99|0.00|AETNA - APC GROUPER M|
20|FH_F127529_43230_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139767_15217_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125124_0_0|SrvcGrp|73006|2022|PDM|1547.00|99|0.00|AEG 9|
20|FH_F133868_40202_0|SrvcGrp|108484|2022|PDM|446.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139569_15063_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130763_0_0|SrvcGrp|89861|2022|PDM|7319.00|99|0.00|LUMBAR LAMINOTOMY|
20|FH_F126348_23824_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144248_0_0|SrvcGrp|84279|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F148547_01908_0|SrvcGrp|115394|2022|PCT|1.00|99|0.00|DRUGS|
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|3802.00|99|0.00|AEG 5  (NO REV)|
20|FH_F111912_30720_0|SrvcGrp|75399|2022|PDM|0.15|99|0.00|MED RECORD COPY|
20|FH_F109273_77339_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F143624_73069_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150144_39452_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F34535_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118270_30606_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F110604_0_0|SrvcGrp|103586|2022|PDM|6050.00|99|0.00|REMOVE SPINE INFUSION|
20|FH_F90501_71101_0|SrvcGrp|83678|2022|PCT|2.00|99|0.00|AETNA THERAPY|
20|FH_F150130_70359_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F121684_74447_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111908_07677_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112908_0_0|SrvcGrp|48394|2022|PDM|26.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F109244_19808_0|SrvcGrp|91065|2022|PDM|60.00|99|0.00|PSYCHIATRIC CPT 90853 (HCFA)|
20|FH_F138147_18018_0|SrvcGrp|113205|2022|PDM|31.28|99|0.00|MULTISYSTEMIC THERAPY (HCFA)|
20|FH_F124161_95932_0|SrvcGrp|72996|2022|PDM|3641.00|99|0.00|AEG 4|
20|FH_F79863_0_0|SrvcGrp|77226|2022|PDM|90.00|99|0.00|AETNA HOME INFUSION S9336|
20|FH_F85213_02840_0|SrvcGrp|74059|2022|PDM|3543.30|99|0.00|AETNA CC FOR ER SERVICE CPT 99291|
20|FH_F130364_01331_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 3 (NO REV)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|131.59|99|0.00|HAPA WPA-NWPA 2012-13 ASC 316 W/O REV|
20|FH_F148547_01908_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F38790_0_0|SrvcGrp|3029|2022|PDM|562.00|99|0.00|NEWBORN NURSERY|
20|FH_F70208_0_0|SrvcGrp|9518|2022|PCT|0.75|99|0.00|EMERGENCY ROOM|
20|FH_F70863_0_0|SrvcGrp|17139|2022|PDM|1029.00|99|0.00|HOSPICE CARE|
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|477.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F85272_77375_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F127895_31516_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124162_73127_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F126443_77089_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F72828_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F132883_31602_0|SrvcGrp|86841|2022|PDM|20.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F125124_0_0|SrvcGrp|79583|2022|PDM|2028.00|99|0.00|CPT 45381|
20|FH_F81457_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130364_01331_0|CSTM-ALL|CSTM-00|2020|PDM|2468.00|99|0.00|AEG 10 (NO REV)|
20|FH_F97840_54729_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
20|FH_F149888_68506_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F147941_06023_0|CSTM-ALL|CSTM-00|2020|PDM|4775.00|99|0.00|AEG 2 (NO REV)|
20|FH_F100761_02539_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F115967_60123_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F62681_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F127567_44070_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141527_36830_0|SrvcGrp|86842|2022|PDM|26.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F70104_0_0|SrvcGrp|46605|2022|PDM|12.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F137591_33411_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122433_0_0|SrvcGrp|93724|2022|PDM|800.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F139551_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F56136_0_0|SrvcGrp|12290|2022|PDM|1004.00|99|0.00|DETOXIFICATION|
20|FH_F45175_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54513_0_0|SrvcGrp|10540|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F92091_0_0|SrvcGrp|89983|2022|PDM|4000.00|99|0.00|KNEE ARTHROSCOPY / SURGERY|
20|FH_F38798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|DME - MOD TC|
20|FH_F128371_40207_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F40615_0_0|SrvcGrp|38|2022|PDM|1690.00|99|0.00|NORMAL DELIVERY|
20|FH_F38526_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|ACUTE IP SVCS ONE DAY STAY|
20|FH_F145545_01602_0|SrvcGrp|12659|2022|PDM|504.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F131190_21042_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93332_0_0|SrvcGrp|93082|2022|PDM|7416.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR (HCFA)|
20|FH_F129404_33461_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148892_0_0|SrvcGrp|58634|2022|PDM|7680.00|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F130850_67401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120155_63114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140967_20735_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78603_0_0|SrvcGrp|21106|2022|PDM|29807.41|99|0.00|MS DRG 250 ONLY|
20|FH_F41519_0_0|SrvcGrp|97|2022|PDM|3000.00|99|0.00|C-SECTION|
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_F37756_0_0|SrvcGrp|19512|2022|PDM|2095.00|99|0.00|MS DRG 794|
20|FH_F131228_01826_0|SrvcGrp|16429|2022|PDM|2107.00|99|0.00|OBSERVATION SVCS|
20|FH_F129683_45255_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F126581_45638_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F122687_0_0|SrvcGrp|26433|2022|PDM|3825.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F97540_32114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141527_36830_0|SrvcGrp|10577|2022|PDM|26.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F143834_06511_0|SrvcGrp|58509|2022|PDM|300.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F115685_64064_0|SrvcGrp|86836|2022|PDM|20.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F84778_0_0|SrvcGrp|73000|2022|PDM|1759.00|99|0.00|AEG 6|
20|FH_F149879_80045_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
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_F101021_0_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F70984_0_0|CSTM-ALL|CSTM-00|2020|PDM|1660.00|99|0.00|COVENTRY ENHANCED GROUPER 8 GA NO CRESCENT|
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F120251_21122_0|SrvcGrp|75419|2022|PDM|900.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F83592_17837_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90362_0_0|SrvcGrp|87558|2022|PDM|1948.00|99|0.00|SPINE SURGERY PROCEDURES|
20|FH_F93282_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS SNF PART B DRUGS|
20|FH_F123895_52722_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F56136_0_0|SrvcGrp|20299|2022|PCT|0.85|99|0.00|MS DRG 228-230 ONLY OTHER CARDIOTHORACIC PROC|
20|FH_F113410_0_0|SrvcGrp|63472|2022|PDM|2364.00|99|0.00|CPT 64581|
20|FH_F148265_06067_0|SrvcGrp|86233|2022|PDM|19172.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F134876_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F123511_64076_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F148170_04005_0|SrvcGrp|13597|2022|PDM|447.57|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F116092_83254_0|SrvcGrp|75506|2022|PCT|0.92|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F52393_0_0|SrvcGrp|49110|2022|PDM|3200.00|99|0.00|HEARING AID|
20|FH_F115047_78526_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F46094_0_0|SrvcGrp|34280|2022|PDM|25.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F77883_0_0|SrvcGrp|74925|2022|PDM|206.66|99|0.00|PHYSICAL THERAPY|
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|512.00|99|0.00|AEG 1 (NO REV)|
20|FH_F100762_51104_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F141587_40242_0|SrvcGrp|86722|2022|PDM|209.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F137943_0_0|SrvcGrp|79792|2022|PDM|1660.00|99|0.00|EYE/OCULAR ADNEXA SURGERY|
20|FH_F127882_62812_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129969_33908_0|SrvcGrp|88819|2022|PDM|625.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F32770_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 9 (NO REV)|
20|FH_F93880_95476_0|SrvcGrp|73002|2022|PDM|6002.00|99|0.00|AEG 7|
20|FH_F37679_0_0|SrvcGrp|24751|2022|PDM|15.00|99|0.00|INTERMITTENT ANTICOAGULANT THERAPY|
20|FH_F67984_0_0|SrvcGrp|17139|2022|PDM|540.00|99|0.00|HOSPICE CARE|
20|FH_F62579_0_0|SrvcGrp|13929|2022|PDM|19.00|99|0.00|GROWTH HORMONE|
20|FH_F38411_0_0|SrvcGrp|19731|2022|PCT|0.80|99|0.00|MS DRG 469-470 ONLY|
20|FH_F98002_27103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85651_33549_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133747_80634_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F90332_07060_0|SrvcGrp|75545|2022|PDM|378.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F132801_0_0|SrvcGrp|112034|2022|PCT|0.57|99|0.00|IMPLANTS/PROSTHETIC|
20|FH_F135610_06451_0|SrvcGrp|104229|2022|PDM|128.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F71345_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54592_0_0|SrvcGrp|14944|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F42138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134492_85201_0|SrvcGrp|46903|2022|PDM|615.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F84712_0_0|SrvcGrp|73462|2022|PDM|4415.00|99|0.00|AETNA NICU III|
20|FH_F84712_0_0|SrvcGrp|82756|2022|PDM|65.00|99|0.00|ASSAY BLOOD LIPASE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|247.81|99|0.00|HAPA WPA-NWPA 2012-13 ASC 120 W/O REV|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.70|99|0.00|HAPA WPA-NWPA 2012-13 ASC 141 W/O REV|
20|FH_F85211_0_0|SrvcGrp|84161|2022|PDM|2079.00|99|0.00|AETNA ARTHROSCOPY SVCS|
20|FH_F98780_35022_0|SrvcGrp|90854|2022|PDM|2180.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F102200_06416_0|SrvcGrp|86833|2022|PDM|15.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F75842_0_0|SrvcGrp|13123|2022|PDM|991.11|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F146667_37110_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F146812_50401_0|SrvcGrp|40003|2022|PDM|11500.00|99|0.00|TOTAL KNEE|
20|FH_F120795_27514_0|SrvcGrp|82523|2022|PCT|0.57|99|0.00|AETNA NUCLEAR MEDICINE|
20|FH_F116063_43220_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F133589_54722_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139394_07424_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139553_30084_0|SrvcGrp|42782|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F139560_78216_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122282_30080_0|SrvcGrp|75419|2022|PDM|430.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F131261_19111_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F116332_0_0|SrvcGrp|27918|2022|PDM|5361.00|99|0.00|CPT 23410, 23412|
20|FH_F137363_0_0|SrvcGrp|14614|2022|PDM|3090.00|99|0.00|LITHOTRIPSY|
20|FH_F62703_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PDM|1168.00|99|0.00|ASPG VIII|
20|FH_F47558_0_0|SrvcGrp|40413|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD RR KF|
20|FH_F40739_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45226_0_0|SrvcGrp|15529|2022|PDM|80.00|99|0.00|NURSING - MIDLINE INSERTION|
20|FH_F149273_0_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F147361_19806_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115982_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|1840.00|99|0.00|AEG 3 (NO REV)|
20|FH_F36743_0_0|SrvcGrp|997|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F39443_0_0|SrvcGrp|30141|2022|PDM|1310.00|99|0.00|PARTIAL MASTECTOMY|
20|FH_F92299_62016_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F119316_27104_0|SrvcGrp|89149|2022|PDM|275.00|99|0.00|OP INTENSIVE|
20|FH_F116100_0_0|SrvcGrp|26001|2022|PDM|133.35|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F120332_0_0|SrvcGrp|87799|2022|PDM|112.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F134847_0_0|SrvcGrp|89856|2022|PDM|5129.00|99|0.00|LAMIN EXCIS EXTRADURAL LUMB|
20|FH_F120332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130371_0_0|SrvcGrp|75506|2022|PCT|0.92|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F130023_0_0|SrvcGrp|11283|2022|PDM|580.00|99|0.00|HYPERBARIC CHAMBER|
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|461.00|99|0.00|AEG 2 (NO REV)|
20|FH_F137627_78382_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F35458_0_0|SrvcGrp|12804|2022|PDM|2300.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F142370_0_0|SrvcGrp|73483|2022|PDM|770.00|99|0.00|AETNA SUBACUTE III|
20|FH_F147223_49444_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110963_30535_0|SrvcGrp|48398|2022|PDM|170.00|99|0.00|PT SERVICES|
20|FH_F110785_10040_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F132123_91360_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F98001_27603_0|SrvcGrp|73602|2022|PDM|2866.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F129682_07034_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F124514_21215_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F35732_32308_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F138387_02886_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130661_04441_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC) (HCFA)|
20|FH_F89640_98133_0|CSTM-ALL|CSTM-00|2020|PDM|111.00|99|0.00|AETNA - APC GROUPER P|
20|FH_F116753_0_0|SrvcGrp|21458|2022|PDM|1268.00|99|0.00|SLEEP STUDIES|
20|FH_F148008_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112956_0_0|SrvcGrp|75491|2022|PDM|1087.00|99|0.00|AEG 7|
20|FH_F40550_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40624_0_0|SrvcGrp|16|2022|PDM|965.00|99|0.00|ACUTE REHABILITATION|
20|FH_F40653_0_0|SrvcGrp|97|2022|PDM|5150.00|99|0.00|C-SECTION|
20|FH_F37777_0_0|SrvcGrp|36231|2022|PDM|500.00|99|0.00|SUB ACUTE|
20|FH_F139967_37205_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141270_89103_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F149645_92708_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F45226_0_0|SrvcGrp|11074|2022|PDM|80.00|99|0.00|NURSING CARE|
20|FH_F128197_84123_0|SrvcGrp|89781|2022|PDM|112.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F138478_0_0|SrvcGrp|11663|2022|PCT|0.63|99|0.00|IMPLANTS|
20|FH_F122377_91007_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS|
20|FH_F129297_97828_0|SrvcGrp|10391|2022|PDM|3150.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F39756_0_0|SrvcGrp|31077|2022|PDM|110.00|99|0.00|TOPICAL APPLICATION OF FLUORIDE (PROPHYLAXIS NOT INCLUDED)|
20|FH_F73643_0_0|SrvcGrp|26001|2022|PDM|140.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F76382_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F112727_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F104640_21204_0|SrvcGrp|92760|2022|PCT|1.05|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139877_32615_0|SrvcGrp|113239|2022|PDM|75.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT (HCFA)|
20|FH_F149655_78539_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38475_0_0|SrvcGrp|15846|2022|PDM|47.00|99|0.00|HOME VISIT|
20|FH_F137798_0_0|SrvcGrp|29155|2022|PDM|743.00|99|0.00|HOSPICE SVCS|
20|FH_F39443_0_0|SrvcGrp|30142|2022|PDM|1750.00|99|0.00|KNEE ARTHOSCOPY|
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|1611.00|99|0.00|AEG 1 (NO REV)|
20|FH_F72883_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F124452_31322_0|SrvcGrp|88620|2022|PDM|130.00|99|0.00|SKILLED NURSING RN|
20|FH_F97603_77901_0|SrvcGrp|73485|2022|PDM|3756.00|99|0.00|AETNA REHAB|
20|FH_F37078_0_0|SrvcGrp|473|2022|PDM|286.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F103180_85283_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90817_0_0|SrvcGrp|10986|2022|PDM|2914.00|99|0.00|ARTHROSCOPIC KNEE REPAIR|
20|FH_F122841_0_0|SrvcGrp|87385|2022|PDM|2063.00|99|0.00|PARTIAL REMOVAL OF EYE FLUID|
20|FH_F98360_11554_0|SrvcGrp|73601|2022|PDM|8719.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F144831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F122377_91007_0|SrvcGrp|109114|2022|PDM|81477.00|99|0.00|CARDIOVASCULAR SURGERY|
20|FH_F50078_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HILLCREST IV THERAPY|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.00|99|0.00|ASPG V|
20|FH_F133087_61107_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F112045_90301_0|SrvcGrp|103701|2022|PDM|8820.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F139823_32250_0|SrvcGrp|89417|2022|PDM|453.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F143454_94550_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|762.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F103140_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F101540_0_0|SrvcGrp|472|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F102920_0_0|SrvcGrp|96799|2022|PDM|2026.00|99|0.00|DESTROY C/TH FACET JNT ADDL|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD NU KE|
20|FH_F132371_19083_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112679_85711_0|SrvcGrp|23683|2022|PDM|55.00|99|0.00|SKILLED NURSING RN|
20|FH_F116698_07470_0|SrvcGrp|46605|2022|PDM|52.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F45832_0_0|SrvcGrp|9520|2022|PCT|0.72|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F49954_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|323.00|99|0.00|AEG 1 (NO REV)|
20|FH_F148666_34205_0|SrvcGrp|89024|2022|PDM|74.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F78343_0_0|SrvcGrp|30094|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY|
20|FH_F91663_19901_0|SrvcGrp|48398|2022|PDM|125.00|99|0.00|PT SERVICES|
20|FH_F137616_48823_0|SrvcGrp|3259|2022|PDM|1450.00|99|0.00|ACUTE REHABILITATION|
20|FH_F150982_0_0|SrvcGrp|93071|2022|PDM|3854.00|99|0.00|POSTERIOR SEGMENTAL INSTRU|
20|FH_F129656_15005_0|SrvcGrp|10577|2022|PDM|45.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F143902_41018_0|SrvcGrp|46903|2022|PDM|546.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F129221_84325_0|SrvcGrp|108484|2022|PDM|1425.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115768_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F131965_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139173_0_0|SrvcGrp|88621|2022|PDM|164.00|99|0.00|SKILLED NURSING LPN|
20|FH_F88694_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F118311_35211_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|2060.45|99|0.00|AEG 6 (NO REV)|
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|1122.00|99|0.00|AEG 7 (NO REV)|
20|FH_F147941_06023_0|CSTM-ALL|CSTM-00|2020|PDM|8610.00|99|0.00|AEG 3 (NO REV)|
20|FH_F82753_18840_0|SrvcGrp|2738|2022|PCT|0.39|99|0.00|IMPLANTS|
20|FH_F132190_0_0|SrvcGrp|109364|2022|PDM|2600.00|99|0.00|REMOVAL OF BONE FOR GRAFT|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD KM|
20|FH_F132374_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62915_0_0|SrvcGrp|58797|2022|PCT|1.64|99|0.00|OCN F/S RAD/LAB/MED CPT (HCFA) (MOD 26 TC QW) GLOBAL|
20|FH_F110004_75149_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F33471_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F127072_30458_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F149759_63122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31111_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F142073_0_0|SrvcGrp|26278|2022|PDM|1500.00|99|0.00|CPT 29881|
20|FH_F129666_71901_0|SrvcGrp|27969|2022|PDM|33.00|99|0.00|HOME HEALTH AIDE|
20|FH_F127550_43026_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F143528_0_0|SrvcGrp|107170|2022|PDM|4076.10|99|0.00|EXCISION OF NECK CYST|
20|FH_F129268_54220_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148266_45419_0|CSTM-ALL|CSTM-00|2020|PDM|1124.00|99|0.00|AEG 6 (NO REV)|
20|FH_F123529_31021_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F101386_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150759_0_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F91622_0_0|SrvcGrp|91527|2022|PDM|11156.00|99|0.00|SPINAL FUSION|
20|FH_F128272_60640_0|SrvcGrp|22389|2022|PDM|25.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD AV) - CPD 1963706|
20|FH_F120902_64085_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F56972_0_0|SrvcGrp|23401|2022|PDM|18.00|99|0.00|RT/PT/ST/OT|
20|FH_F141001_24739_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100790_10512_0|SrvcGrp|73601|2022|PDM|6233.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F129105_21713_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F93136_0_0|SrvcGrp|72990|2022|PDM|333.00|99|0.00|AEG 1|
20|FH_F52854_0_0|SrvcGrp|592|2022|PDM|1300.00|99|0.00|SUB-ACUTE CARE|
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|611.00|99|0.00|AEG 4 (NO REV)|
20|FH_F92971_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135264_40272_0|SrvcGrp|75419|2022|PDM|414.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F89453_75069_0|SrvcGrp|53144|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F129262_33813_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F37996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141795_89509_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F151541_01436_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F149404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F33513_0_0|SrvcGrp|34869|2022|PCT|0.77|99|0.00|DIETICIAN|
20|FH_F130523_04605_0|SrvcGrp|81779|2022|PCT|4.24|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F143888_32205_0|SrvcGrp|114112|2022|PDM|23.46|99|0.00|COVID-19 SPECIMEN COLLECT|
20|FH_F39857_0_0|SrvcGrp|38|2022|PDM|4472.00|99|0.00|NORMAL DELIVERY|
20|FH_F129683_45255_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F62892_0_0|SrvcGrp|10545|2022|PDM|95.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F135236_02840_0|SrvcGrp|116099|2022|PCT|1.01|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.24|99|0.00|AEG 2 (NO REV)|
20|FH_F148265_06067_0|SrvcGrp|88157|2022|PDM|20231.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F37945_0_0|CSTM-ALL|CSTM-00|2020|PDM|723.00|99|0.00|ASPG II|
20|FH_F115046_77964_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|2900.00|99|0.00|ASPG VII|
20|FH_F130767_67133_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141387_63108_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124738_0_0|SrvcGrp|72998|2022|PDM|710.00|99|0.00|AEG 5|
20|FH_F94145_34994_0|SrvcGrp|92760|2022|PCT|0.95|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40525_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F128881_70601_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116923_85259_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F94665_0_0|SrvcGrp|21803|2022|PDM|5562.00|99|0.00|LITHOTRIPSY|
20|FH_F141802_17042_0|SrvcGrp|24598|2022|PDM|3346.00|99|0.00|MS DRG 945-946 ONLY|
20|FH_F40912_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|OP SVCS|
20|FH_F129627_06037_0|SrvcGrp|89783|2022|PDM|165.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F132768_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|995.00|99|0.00|AEG 7 (NO REV)|
20|FH_F128190_45342_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F117010_10549_0|SrvcGrp|86648|2022|PCT|1.05|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F120352_52556_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F145568_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F86851_0_0|SrvcGrp|84980|2022|PDM|520.00|99|0.00|CPT 44373|
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 4 (NO REV)|
20|FH_F148641_92505_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC|
20|FH_F42453_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F38376_0_0|SrvcGrp|3810|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F92676_15063_0|SrvcGrp|78997|2022|PDM|1123.18|99|0.00|MON VALLEY ASC 102|
20|FH_F66906_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142014_33170_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142931_60644_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F36118_0_0|SrvcGrp|8962|2022|PDM|102.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F150001_33064_0|SrvcGrp|29076|2022|PDM|26.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F149940_02645_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F146211_68144_0|SrvcGrp|11673|2022|PDM|5250.00|99|0.00|CPT 29888|
20|FH_F142749_15212_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F62982_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F45199_0_0|CSTM-ALL|CSTM-00|2020|PDM|573.00|99|0.00|ASPG III|
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|960.00|99|0.00|AEG 4 (NO REV)|
20|FH_F146208_76643_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72523_0_0|SrvcGrp|26001|2022|PDM|173.90|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F117829_45227_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F112854_53225_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149867_62901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F106100_26651_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|876.37|99|0.00|ASPG 4|
20|FH_F142900_32792_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121016_32607_0|SrvcGrp|79238|2022|PDM|2300.00|99|0.00|TRANSFER|
20|FH_F121306_32207_0|SrvcGrp|108756|2022|PCT|1.07|99|0.00|DME|
20|FH_F56793_0_0|SrvcGrp|42973|2022|PDM|130.00|99|0.00|SPEECH  THERAPIST|
20|FH_F141870_85224_0|SrvcGrp|14893|2022|PDM|45.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F120437_85202_0|SrvcGrp|88620|2022|PDM|181.20|99|0.00|SKILLED NURSING RN|
20|FH_F62292_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118708_33455_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD RR|
20|FH_F89011_75006_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F97060_66534_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133535_32110_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F143053_89501_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F44601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|GENERAL ACUTE CARE|
20|FH_F134447_12883_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F97563_83201_0|SrvcGrp|73605|2022|PDM|2483.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F112165_0_0|SrvcGrp|86088|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F134487_14843_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
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_F117087_0_0|SrvcGrp|88824|2022|PDM|2494.00|99|0.00|CPT 69631|
20|FH_F148599_98034_0|SrvcGrp|31916|2022|PDM|35351.00|99|0.00|MS DRG 473 ONLY|
20|FH_F39051_0_0|SrvcGrp|24716|2022|PDM|4000.00|99|0.00|OP SURGERY|
20|FH_F133257_72088_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F45513_0_0|SrvcGrp|41335|2022|PDM|3400.00|99|0.00|TOTAL HIP|
20|FH_F68842_0_0|SrvcGrp|12157|2022|PDM|123.00|99|0.00|RN VISIT|
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117380_60020_0|SrvcGrp|86722|2022|PDM|214.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F43018_0_0|SrvcGrp|13811|2022|PDM|304.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F70026_0_0|SrvcGrp|17140|2022|PDM|160.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F78682_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72024_0_0|SrvcGrp|42782|2022|PDM|68.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F54832_0_0|SrvcGrp|10111|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F130656_04401_0|SrvcGrp|111927|2022|PCT|1.00|99|0.00|COVID-19 NON CDC|
20|FH_F122958_45014_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133533_33901_0|SrvcGrp|89149|2022|PDM|187.00|99|0.00|OP INTENSIVE|
20|FH_F118845_71111_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F129965_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|RADIOLOGY W/MOD 26|
20|FH_F87620_80014_0|SrvcGrp|110202|2022|PDM|181.00|99|0.00|X-RAY|
20|FH_F150001_33064_0|SrvcGrp|24750|2022|PDM|11.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F125540_19462_0|SrvcGrp|101679|2022|PDM|30.60|99|0.00|OP SUBOXONE ADMINISTRATION (HCFA)|
20|FH_F112848_06032_0|SrvcGrp|472|2022|PDM|699.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F132420_84660_0|SrvcGrp|89412|2022|PDM|456.78|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F123181_75057_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|901.00|99|0.00|AEG 5  (NO REV)|
20|FH_F101922_98055_0|SrvcGrp|72996|2022|PDM|3750.00|99|0.00|AEG 4|
20|FH_F34706_0_0|SrvcGrp|10091|2022|PDM|60518.00|99|0.00|DRG 535 ONLY|
20|FH_F119007_0_0|SrvcGrp|103236|2022|PDM|11876.00|99|0.00|AETNA INSJ STABLJ DEV|
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|611.00|99|0.00|AEG 4 (NO REV)|
20|FH_F72859_0_0|SrvcGrp|3810|2022|PDM|114.08|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F112853_22408_0|SrvcGrp|53144|2022|PCT|1.05|99|0.00|SPEECH THERAPY|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME HEALTH THERAPY VISITS OP|
20|FH_F40056_0_0|SrvcGrp|97|2022|PDM|5400.00|99|0.00|C-SECTION|
20|FH_F92677_08003_0|SrvcGrp|86845|2022|PDM|63.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F132647_60067_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125368_24153_0|SrvcGrp|46903|2022|PDM|785.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F41785_0_0|SrvcGrp|17419|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F126666_44053_0|SrvcGrp|91779|2022|PDM|47.00|99|0.00|AETNA GROUP THERAPY (MOD AH)(HCFA)|
20|FH_F126733_83713_0|SrvcGrp|75442|2022|PDM|722.00|99|0.00|OBSERVATION - REV 762|
20|FH_F68842_0_0|SrvcGrp|12160|2022|PDM|41.00|99|0.00|HOME HEALTH AID|
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|1160.00|99|0.00|AEG 5  (NO REV)|
20|FH_F36579_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALLIED MED-MOD AU|
20|FH_F47834_0_0|SrvcGrp|30158|2022|PCT|1.10|99|0.00|LABORATORY MOD 26|
20|FH_F36286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130108_0_0|SrvcGrp|12406|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F115315_43011_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F132837_64118_0|SrvcGrp|30089|2022|PDM|500.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F100682_97401_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F118785_33315_0|SrvcGrp|86722|2022|PDM|450.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F92673_44041_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F91198_46714_0|SrvcGrp|89417|2022|PDM|287.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F134150_01801_0|SrvcGrp|88905|2022|PDM|927.00|99|0.00|PSYCHIATRIC CARE (AGE 0-17)|
20|FH_F137238_70056_0|SrvcGrp|89417|2022|PDM|409.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F137246_66064_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142403_65201_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F53732_0_0|SrvcGrp|27969|2022|PDM|54.00|99|0.00|HOME HEALTH AIDE|
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 3 (NO REV)|
20|FH_F134654_0_0|SrvcGrp|110063|2022|PDM|22.43|99|0.00|MULTIPLE FAMILY ADAPTIVE BH TREATMENT 15 MINS|
20|FH_F140473_30518_0|SrvcGrp|80920|2022|PDM|1025.00|99|0.00|HOSPICE SERVICES|
20|FH_F119011_08701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119023_91406_0|SrvcGrp|86843|2022|PDM|50.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F118943_64506_0|SrvcGrp|24761|2022|PDM|37.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F38332_0_0|SrvcGrp|18815|2022|PDM|42216.00|99|0.00|MS DRG 221|
20|FH_F109883_35007_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F109920_39180_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109920_39180_0|SrvcGrp|92760|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F66835_0_0|SrvcGrp|14210|2022|PDM|245.00|99|0.00|PSYCH INTENSIVE OUTPATIENT|
20|FH_F129441_19134_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129501_67831_0|SrvcGrp|75506|2022|PCT|1.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F117091_28144_0|SrvcGrp|73842|2022|PDM|138.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F117093_40041_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117105_77619_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117221_23434_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F137329_81224_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137329_81224_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F119555_0_0|SrvcGrp|473|2022|PDM|2710.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F78894_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F109652_0_0|SrvcGrp|78800|2022|PCT|0.00|99|0.00|VENIPUNCTURE|
20|FH_F109652_0_0|SrvcGrp|29702|2022|PDM|17704.00|99|0.00|CV SURGERY MS DRG 260-262 ONLY|
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|1020.00|99|0.00|AEG 6 (NO REV)|
20|FH_F110720_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F90833_62821_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|2861.00|99|0.00|AEG 8 (NO REV)|
20|FH_F119285_0_0|SrvcGrp|106235|2022|PDM|3050.00|99|0.00|CYPASS|
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|1552.00|99|0.00|AEG 9 (NO REV)|
20|FH_F110160_0_0|SrvcGrp|103301|2022|PDM|1500.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F151083_66223_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151152_19150_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
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|237.44|99|0.00|DELAWARE VALLEY- ASC 110|
20|FH_F98041_10027_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F110103_0_0|SrvcGrp|73485|2022|PDM|850.00|99|0.00|AETNA REHAB|
20|FH_F91873_12723_0|SrvcGrp|10944|2022|PDM|1135.00|99|0.00|EMERGENCY ROOM|
20|FH_F97740_01605_0|SrvcGrp|73461|2022|PDM|18248.00|99|0.00|AETNA NICU IV|
20|FH_F117001_0_0|SrvcGrp|106597|2022|PDM|1600.00|99|0.00|HEARING AID, PROG, BIN, CIC|
20|FH_F77067_0_0|SrvcGrp|26690|2022|PCT|0.65|99|0.00|MS DRG 215 ONLY|
20|FH_F85039_0_0|SrvcGrp|75491|2022|PDM|1095.00|99|0.00|AEG 7|
20|FH_F115264_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|768.00|99|0.00|AEG 3 (NO REV)|
20|FH_F114916_30309_0|SrvcGrp|104008|2022|PDM|3500.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS|
20|FH_F115208_0_0|SrvcGrp|106174|2022|PDM|2016.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F99541_0_0|CSTM-ALL|CSTM-00|2020|PCT|47.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|3606.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER QW|
20|FH_F134317_0_0|SrvcGrp|30089|2022|PDM|450.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F94740_32904_0|SrvcGrp|26001|2022|PDM|132.39|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F132627_0_0|SrvcGrp|29898|2022|PDM|139.00|99|0.00|RN VISIT|
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|926.00|99|0.00|AEG 5  (NO REV)|
20|FH_F118909_0_0|SrvcGrp|80918|2022|PDM|123.60|99|0.00|RESPITE CARE|
20|FH_F114389_50131_0|SrvcGrp|85017|2022|PCT|1.61|99|0.00|DME|
20|FH_F141353_26452_0|SrvcGrp|103658|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|1379.00|99|0.00|AEG 6 (NO REV)|
20|FH_F119266_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124059_64055_0|SrvcGrp|48398|2022|PDM|83.00|99|0.00|PT SERVICES|
20|FH_F124082_78526_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F43832_0_0|SrvcGrp|37790|2022|PCT|0.50|99|0.00|MEDICAL SUPPLIES|
20|FH_F91998_0_0|SrvcGrp|72994|2022|PDM|552.00|99|0.00|AEG 3|
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|2398.00|99|0.00|AEG 8 (NO REV)|
20|FH_F130036_43232_0|SrvcGrp|90854|2022|PDM|816.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F87856_0_0|SrvcGrp|75495|2022|PDM|1739.00|99|0.00|AEG 9|
20|FH_F136746_63116_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114638_25309_0|SrvcGrp|537|2022|PCT|0.75|99|0.00|OBSERVATION SERVICES|
20|FH_F114666_30342_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|AEG 2 (NO REV)|
20|FH_F138456_33543_0|SrvcGrp|89337|2022|PDM|987.00|99|0.00|DETOXIFICATION|
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148553_85016_0|SrvcGrp|115448|2022|PDM|2500.00|99|0.00|REMOVE & REPLACE PM GEN SINGLE|
20|FH_F134675_60134_0|SrvcGrp|86722|2022|PDM|252.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F134727_30650_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134735_91362_0|SrvcGrp|100519|2022|PDM|325.00|99|0.00|INTENSIVE OUTPATIENT|
20|FH_F136778_62034_0|SrvcGrp|105465|2022|PDM|75.00|99|0.00|AETNA THERAPIES|
20|FH_F136930_73114_0|SrvcGrp|108724|2022|PDM|376.00|99|0.00|MENTAL HEALTH PARTIAL HOSP|
20|FH_F112465_28401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|WELLPATH PROPRIETARY ASC NON-GROUPED|
20|FH_F115708_15317_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147348_19406_0|SrvcGrp|74668|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F42754_0_0|SrvcGrp|110|2022|PDM|350.00|99|0.00|CD - REHABILITATION|
20|FH_F116918_06488_0|SrvcGrp|472|2022|PDM|610.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F82771_0_0|SrvcGrp|35669|2022|PDM|1575.00|99|0.00|CPT 63650|
20|FH_F118815_61021_0|SrvcGrp|86749|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F35133_0_0|CSTM-ALL|CSTM-00|2020|PDM|28200.00|99|0.00|MSDRG 228-230|
20|FH_F35685_0_0|SrvcGrp|9521|2022|PDM|3307.00|99|0.00|LITHOTRIPSY|
20|FH_F41934_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ASPG III - CPD 1281588|
20|FH_F98624_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98625_08103_0|SrvcGrp|73601|2022|PDM|7312.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F103004_75840_0|SrvcGrp|84720|2022|PCT|0.00|99|0.00|AETNA LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F111186_15213_0|SrvcGrp|108484|2022|PDM|1141.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F40474_0_0|CSTM-ALL|CSTM-00|2020|PDM|605.00|99|0.00|MRI/MRA CARVEOUTS|
20|FH_F139236_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F91975_0_0|SrvcGrp|91861|2022|PDM|452.00|99|0.00|COLONOSCOPY PROCEDURES|
20|FH_F109963_0_0|SrvcGrp|72994|2022|PDM|615.00|99|0.00|AEG 3|
20|FH_F111847_70301_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG VIII|
20|FH_F113025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F94101_0_0|CSTM-ALL|CSTM-00|2020|PCT|52.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134087_0_0|SrvcGrp|92410|2022|PDM|5771.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|1906.00|99|0.00|AEG 6 (NO REV)|
20|FH_F141004_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F98361_12065_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F37850_0_0|SrvcGrp|941|2022|PDM|2163.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F37850_0_0|CSTM-ALL|CSTM-00|2020|PDM|1622.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114853_0_0|SrvcGrp|88157|2022|PDM|7215.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F117509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138684_44484_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|ASPG V|
20|FH_F91641_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F106500_0_0|SrvcGrp|101501|2022|PDM|96.41|99|0.00|PT/OT/ST|
20|FH_F135027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 9 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1177.50|99|0.00|HAPA WPA-NWPA 2012-13 ASC 801 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|862.31|99|0.00|HAPA WPA-NWPA 2012-13 ASC 501 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|844.63|99|0.00|HAPA WPA-NWPA 2012-13 ASC 12 W/O REV|
20|FH_F121219_0_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151340_30040_0|CSTM-ALL|CSTM-00|2020|PDM|1490.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132202_67490_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123194_97222_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F132054_30339_0|SrvcGrp|63297|2022|PDM|128.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F135434_64424_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135453_70726_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F135485_20171_0|SrvcGrp|29347|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F135572_89106_0|SrvcGrp|26869|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F135960_33141_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136174_89146_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F130996_34110_0|SrvcGrp|67068|2022|PDM|16000.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F127399_0_0|CSTM-ALL|CSTM-00|2020|PDM|3537.00|99|0.00|LAP INC HERN REPAIR COMP|
20|FH_F127399_0_0|SrvcGrp|72996|2022|PDM|2393.00|99|0.00|AEG 4|
20|FH_F42098_0_0|SrvcGrp|11074|2022|PDM|55.00|99|0.00|NURSING CARE|
20|FH_F111341_80501_0|SrvcGrp|33659|2022|PDM|361.00|99|0.00|DIALYSIS SERVICES|
20|FH_F134315_89106_0|SrvcGrp|17016|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134315_89106_0|SrvcGrp|14949|2022|PCT|1.00|99|0.00|HOME INFUSION|
20|FH_F134322_98001_0|SrvcGrp|112549|2022|PCT|1.00|99|0.00|LEVOFLAXACIN INJECTION|
20|FH_F141651_0_0|SrvcGrp|90822|2022|PDM|2200.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY|
20|FH_F69202_0_0|SrvcGrp|9937|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F115943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148243_0_0|SrvcGrp|36608|2022|PDM|234.00|99|0.00|SIGMOIDOSCOPY|
20|FH_F78889_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.00|99|0.00|OP SVCS|
20|FH_F41780_0_0|SrvcGrp|35102|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY|
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|AEG 4 (NO REV)|
20|FH_F132073_0_0|SrvcGrp|57965|2022|PDM|131.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F141035_0_0|SrvcGrp|82109|2022|PDM|4359.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F102862_30606_0|SrvcGrp|31927|2022|PDM|48465.60|99|0.00|MS DRG 457 ONLY|
20|FH_F96960_35404_0|SrvcGrp|73605|2022|PDM|2103.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F101320_26062_0|SrvcGrp|26868|2022|PDM|60.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F148101_33462_0|SrvcGrp|58509|2022|PDM|850.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F62579_0_0|SrvcGrp|17009|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F38411_0_0|SrvcGrp|20071|2022|PDM|950.00|99|0.00|MS DRG 945-946|
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)|
20|FH_F130755_04401_0|SrvcGrp|104363|2022|PCT|0.93|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|908.00|99|0.00|AEG 3 (NO REV)|
20|FH_F132969_84003_0|SrvcGrp|14949|2022|PDM|10.00|99|0.00|HOME INFUSION|
20|FH_F138047_77027_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F109405_73106_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F110541_99336_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|154.24|99|0.00|HAPA WPA-NWPA 2012-13 ASC 132 W/O REV|
20|FH_F134611_04103_0|SrvcGrp|46903|2022|PDM|2047.50|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F90416_73013_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F130017_02302_0|SrvcGrp|20900|2022|PDM|30005.48|99|0.00|MS DRG 248 ONLY|
20|FH_F150223_30720_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F125407_68756_0|SrvcGrp|109057|2022|PCT|0.98|99|0.00|CARDIAC STUDIES|
20|FH_F128379_0_0|SrvcGrp|89848|2022|PDM|7553.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F131100_0_0|SrvcGrp|98105|2022|PDM|57.00|99|0.00|DRAIN INJ JOINT/BURSA W/O U|
20|FH_F122243_30655_0|SrvcGrp|73605|2022|PDM|875.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F89219_0_0|SrvcGrp|27028|2022|PDM|7473.00|99|0.00|OBSERVATION SERVICES|
20|FH_F143669_78577_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F144228_0_0|SrvcGrp|114145|2022|PDM|7161.00|99|0.00|RHINOPLASTY|
20|FH_F51039_0_0|SrvcGrp|3259|2022|PDM|1112.00|99|0.00|ACUTE REHABILITATION|
20|FH_F112665_0_0|SrvcGrp|67065|2022|PDM|7699.00|99|0.00|CERVICAL SURGERY|
20|FH_F85214_70360_0|SrvcGrp|73559|2022|PDM|1680.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F121476_0_0|SrvcGrp|78045|2022|PDM|1064.00|99|0.00|AETNA AMNIOTIC MEMBRANE|
20|FH_F149048_77090_0|SrvcGrp|74668|2022|PDM|226.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F92598_21236_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F107702_01053_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130763_0_0|SrvcGrp|85792|2022|PDM|5165.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F132740_46250_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F130364_01331_0|SrvcGrp|73601|2022|PDM|2763.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F129509_0_0|SrvcGrp|92416|2022|PDM|3767.00|99|0.00|CERVICAL LAMINOTOMY|
20|FH_F141829_0_0|SrvcGrp|106294|2022|PDM|295.57|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD TC|
20|FH_F91777_29577_0|SrvcGrp|53145|2022|PCT|1.00|99|0.00|SOCIAL WORKER|
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1035.20|99|0.00|AEG 7 (NO REV)|
20|FH_F126525_0_0|SrvcGrp|107749|2022|PDM|175.00|99|0.00|CAPD/CCPD|
20|FH_F138147_18018_0|SrvcGrp|113194|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F98021_07012_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F100782_0_0|SrvcGrp|97682|2022|PDM|2767.81|99|0.00|WINDBER MEDICAL CNTR ASC 904|
20|FH_F132740_46250_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F111882_51560_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119227_01752_0|SrvcGrp|86825|2022|PDM|65.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F119590_29607_0|SrvcGrp|92760|2022|PCT|1.20|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142376_0_0|SrvcGrp|113970|2022|PDM|1459.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN|
20|FH_F145604_14850_0|SrvcGrp|86845|2022|PDM|75.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F31714_0_0|SrvcGrp|9938|2022|PCT|0.75|99|0.00|SPEECH THERAPY|
20|FH_F139240_81055_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|GENERAL ACUTE CARE|
20|FH_F100782_0_0|SrvcGrp|97693|2022|PDM|2696.45|99|0.00|WINDBER MEDICAL CNTR ASC 1401|
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|790.00|99|0.00|AEG 5  (NO REV)|
20|FH_F138050_52301_0|SrvcGrp|15386|2022|PDM|50.00|99|0.00|CLINIC VISIT|
20|FH_F128833_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F130017_02302_0|SrvcGrp|81779|2022|PCT|1.33|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F149304_64137_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123157_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F121687_04401_0|SrvcGrp|108921|2022|PCT|1.38|99|0.00|THER/PROPH/DIAG INJ, IV PUSH|
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138951_41101_0|SrvcGrp|86854|2022|PDM|50.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 8 (NO REV)|
20|FH_F111986_0_0|CSTM-ALL|CSTM-00|2020|PDM|2060.00|99|0.00|REPAIR UMBIL HERNIA|
20|FH_F146520_80435_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133972_27103_0|SrvcGrp|86843|2022|PDM|35.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F85353_16407_0|SrvcGrp|63792|2022|PDM|1011.38|99|0.00|HAPA WPA-NWPA 2012-13 ASC 5|
20|FH_F34852_0_0|SrvcGrp|3224|2022|PDM|750.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F126443_77089_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|2925.00|99|0.00|AEG 8 (NO REV)|
20|FH_F126089_62420_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|PDM|855.00|99|0.00|AEG 1 (NO REV)|
20|FH_F133916_66090_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F80613_0_0|SrvcGrp|10537|2022|PDM|55.00|99|0.00|NURSING CARE|
20|FH_F125260_0_0|SrvcGrp|88621|2022|PDM|185.10|99|0.00|SKILLED NURSING LPN|
20|FH_F121685_75093_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120697_68526_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F143650_0_0|SrvcGrp|72121|2022|PDM|2800.00|99|0.00|ARTHOSCOPY|
20|FH_F54592_0_0|SrvcGrp|24751|2022|PDM|80.00|99|0.00|INTERMITTENT ANTICOAGULANT THERAPY|
20|FH_F73084_0_0|SrvcGrp|68986|2022|PDM|72.00|99|0.00|PT VISIT|
20|FH_F42138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129101_27006_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F115890_75067_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F146793_44236_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146793_44236_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120795_27514_0|SrvcGrp|14187|2022|PDM|1986.00|99|0.00|MRI|
20|FH_F116023_10027_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F116040_24637_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F116056_73018_0|SrvcGrp|73700|2022|PDM|47.50|99|0.00|AETNA - SKILLED NURSING|
20|FH_F133581_84790_0|CSTM-ALL|CSTM-00|2020|PDM|551.67|99|0.00|AEG 1 (NO REV)|
20|FH_F133398_43204_0|SrvcGrp|46903|2022|PDM|420.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F133335_84790_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F139707_84010_0|SrvcGrp|90342|2022|PCT|0.00|99|0.00|SUPPLIES|
20|FH_F150861_92592_0|SrvcGrp|46903|2022|PDM|750.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F138852_75228_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116332_0_0|SrvcGrp|87844|2022|PDM|5202.00|99|0.00|LAPARASCOPY - GASTRIC|
20|FH_F117617_80439_0|SrvcGrp|48398|2022|PDM|150.00|99|0.00|PT SERVICES|
20|FH_F138987_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F34882_0_0|SrvcGrp|361|2022|PDM|2134.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F114207_35243_0|SrvcGrp|86840|2022|PDM|35.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F40644_0_0|SrvcGrp|12280|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F145599_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F46433_0_0|SrvcGrp|40826|2022|PDM|20.00|99|0.00|DISPOSABLE DRUG DELIVERY SYSTEM|
20|FH_F130309_17044_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F147237_40006_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F148351_33012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47573_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129340_43212_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F134797_0_0|SrvcGrp|112679|2022|PDM|1100.00|99|0.00|TRIGGER FINGER RELEASE|
20|FH_F134732_0_0|SrvcGrp|107877|2022|PDM|522.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|16792.00|99|0.00|MS DRG 490|
20|FH_F124486_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F39912_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|ER SVCS|
20|FH_F38976_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35217_0_0|CSTM-ALL|CSTM-00|2020|PDM|1678.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138017_73129_0|SrvcGrp|10365|2022|PDM|1376.00|99|0.00|CPT CODE 99285|
20|FH_F76262_0_0|SrvcGrp|25804|2022|PDM|525.00|99|0.00|ENDOSCOPY|
20|FH_F140295_0_0|SrvcGrp|96839|2022|PDM|4008.00|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F129682_07034_0|SrvcGrp|27969|2022|PDM|22.50|99|0.00|HOME HEALTH AIDE|
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|979.69|99|0.00|AEG 8 (NO REV)|
20|FH_F141228_23181_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117617_80439_0|SrvcGrp|107586|2022|PDM|165.00|99|0.00|HOSPICE/HH CARE IN ASSISTED LIVING FAC|
20|FH_F35769_32765_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|GENERAL ACUTE CARE|
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|2720.00|99|0.00|AEG 8 (NO REV)|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|53.00|99|0.00|SYNAGIS DISPENSING FEE|
20|FH_F146765_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
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_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|527.00|99|0.00|AEG 3 (NO REV)|
20|FH_F94303_0_0|SrvcGrp|72998|2022|PDM|1892.00|99|0.00|AEG 5|
20|FH_F39756_0_0|SrvcGrp|31083|2022|PDM|412.50|99|0.00|DENTAL PROCEDURES - CHILD|
20|FH_F116583_0_0|SrvcGrp|104842|2022|PDM|650.00|99|0.00|HOSPICE CARE PROVIDED IP HOSPICE FAC (HCFA)|
20|FH_F144831_0_0|SrvcGrp|104033|2022|PCT|1.00|99|0.00|OP SERVICES W/O HH|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F37864_0_0|CSTM-ALL|CSTM-00|2020|PDM|554.14|99|0.00|ASPG II|
20|FH_F126554_0_0|SrvcGrp|92408|2022|PDM|3300.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|776.00|99|0.00|AEG 2 (NO REV)|
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 4 (NO REV)|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F147339_08837_0|SrvcGrp|88065|2022|PDM|3000.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F136541_0_0|SrvcGrp|112813|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER|
20|FH_F37487_0_0|SrvcGrp|16615|2022|PDM|74.00|99|0.00|RN VISIT|
20|FH_F139565_0_0|SrvcGrp|109765|2022|PDM|1721.00|99|0.00|CLOSURE OF LACRIMAL PUNCTUM|
20|FH_F34882_0_0|SrvcGrp|18932|2022|PDM|4133.50|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806|
20|FH_F35557_0_0|SrvcGrp|11800|2022|PDM|24.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F124441_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F108260_63141_0|SrvcGrp|102159|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F149602_07109_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F111044_0_0|SrvcGrp|82720|2022|PDM|1648.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F117762_0_0|SrvcGrp|99166|2022|PDM|2184.00|99|0.00|CPT 63005|
20|FH_F135263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125656_92868_0|SrvcGrp|86845|2022|PDM|35.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F144651_0_0|SrvcGrp|98561|2022|PDM|12000.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F147082_02359_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F112755_43215_0|SrvcGrp|473|2022|PDM|340.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F110783_93013_0|SrvcGrp|86843|2022|PDM|50.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F127079_33026_0|SrvcGrp|100520|2022|PDM|280.00|99|0.00|INTENSIVE OP EATING DISORDERS|
20|FH_F35967_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97101_98003_0|SrvcGrp|73605|2022|PDM|3263.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F97081_21122_0|SrvcGrp|57968|2022|PDM|33.29|99|0.00|CONTINUOUS HOMECARE|
20|FH_F139565_0_0|SrvcGrp|46886|2022|PDM|4590.00|99|0.00|REMOVAL OF EYELID LESION|
20|FH_F147359_54911_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136947_0_0|SrvcGrp|106317|2022|PDM|800.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F97420_75052_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F35678_0_0|SrvcGrp|18275|2022|PDM|8476.00|99|0.00|MS DRG 037|
20|FH_F112128_63017_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F119355_0_0|SrvcGrp|107561|2022|PDM|90.00|99|0.00|EXPOSURE ADAPTIVE BH TREATMENT 60 MINS (HCFA)|
20|FH_F139877_32615_0|SrvcGrp|111926|2022|PDM|35.92|99|0.00|COVID-19 LAB TESTING|
20|FH_F131591_67203_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147226_48154_0|SrvcGrp|42622|2022|PDM|625.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD AU|
20|FH_F101083_0_0|SrvcGrp|86582|2022|PDM|4200.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|HOME HEALTH MOD TD|
20|FH_F148940_44077_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36554_0_0|SrvcGrp|65859|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F147214_48162_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IP MULTI ROOM COMPARISON|
20|FH_F94643_90501_0|SrvcGrp|15402|2022|PDM|45.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F98022_89015_0|SrvcGrp|73559|2022|PDM|12766.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F76285_0_0|CSTM-ALL|CSTM-00|2020|PDM|11.00|99|0.00|LVN HIGH TECH HOURLY|
20|FH_F38475_0_0|SrvcGrp|10407|2022|PDM|55.00|99|0.00|HOME INFUSION|
20|FH_F136592_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.00|99|0.00|AEG 10 (NO REV)|
20|FH_F143249_89801_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F84631_0_0|SrvcGrp|3950|2022|PDM|3050.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F102224_0_0|SrvcGrp|99067|2022|PDM|2300.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F131153_66203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46893_0_0|SrvcGrp|537|2022|PCT|0.70|99|0.00|OBSERVATION SERVICES|
20|FH_F48473_0_0|SrvcGrp|12401|2022|PDM|93.50|99|0.00|RN VISIT|
20|FH_F48785_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F132417_38119_0|SrvcGrp|75754|2022|PCT|1.15|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F132480_92054_0|SrvcGrp|108484|2022|PDM|428.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F120747_19129_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F112712_63005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112712_63005_0|SrvcGrp|22589|2022|PCT|1.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F143467_0_0|SrvcGrp|90357|2022|PDM|3140.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F39238_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F46732_0_0|SrvcGrp|39524|2022|PDM|240.00|99|0.00|BILIRUBIN TEST|
20|FH_F57093_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128883_89521_0|SrvcGrp|29346|2022|PDM|52.50|99|0.00|SKILLED NURSING- LPN|
20|FH_F151525_30349_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F82931_18847_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BARNES KASSON LAB|
20|FH_F40421_0_0|SrvcGrp|3458|2022|PDM|1400.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149780_00783_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F40709_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.00|99|0.00|ASPG IX|
20|FH_F132190_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|697.00|99|0.00|AEG 3 (NO REV)|
20|FH_F63433_0_0|SrvcGrp|17075|2022|PDM|1096.85|99|0.00|ASPG VI|
20|FH_F132779_0_0|SrvcGrp|112236|2022|PDM|16096.00|99|0.00|KNEE AND JOINT REPLACEMENT|
20|FH_F84135_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F116341_12180_0|SrvcGrp|52953|2022|PDM|90.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1266.39|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1403 W/O REV|
20|FH_F89563_29407_0|SrvcGrp|94741|2022|PCT|1.00|99|0.00|FLULAVAL VACC IM (>=3 YRS)|
20|FH_F148342_80621_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F124017_0_0|SrvcGrp|109666|2022|PDM|4100.00|99|0.00|INSJ STABLJ DEV W/DCMPRN|
20|FH_F149523_0_0|SrvcGrp|96350|2022|PDM|15000.00|99|0.00|SHOULDER JOINT|
20|FH_F142073_0_0|SrvcGrp|67066|2022|PDM|11900.00|99|0.00|CERVICAL SURGERY|
20|FH_F39339_0_0|SrvcGrp|3259|2022|PDM|1010.00|99|0.00|ACUTE REHABILITATION|
20|FH_F90714_0_0|SrvcGrp|72990|2022|PDM|354.00|99|0.00|AEG 1|
20|FH_F141410_13045_0|SrvcGrp|111926|2022|PDM|39.51|99|0.00|COVID-19 LAB TESTING|
20|FH_F85295_0_0|SrvcGrp|75937|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENTS|
20|FH_F130452_48801_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F66409_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F125949_66534_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39101_0_0|CSTM-ALL|CSTM-00|2020|PDM|49800.00|99|0.00|MSDRG 231-232 CORONARY BYPASS|
20|FH_F122433_0_0|SrvcGrp|73004|2022|PDM|973.00|99|0.00|AEG 8|
20|FH_F128237_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F132768_0_0|SrvcGrp|22528|2022|PDM|950.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|703.00|99|0.00|AEG 5  (NO REV)|
20|FH_F141510_95123_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F135065_08043_0|SrvcGrp|90631|2022|PDM|350.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F121523_33406_0|SrvcGrp|9866|2022|PCT|0.44|99|0.00|IP OBSERVATION SVCS|
20|FH_F87254_0_0|SrvcGrp|27402|2022|PDM|1100.00|99|0.00|LASER PROCEDURES|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|667.71|99|0.00|HAPA WPA-NWPA 2012-13 ASC 504 W/O REV|
20|FH_F125254_30306_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F62773_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F120279_98005_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F141567_80128_0|SrvcGrp|12957|2022|PCT|1.00|99|0.00|DME|
20|FH_F77925_0_0|SrvcGrp|3358|2022|PDM|9100.00|99|0.00|CV SURGERY|
20|FH_F90492_0_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F131961_06040_0|SrvcGrp|472|2022|PDM|494.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F123512_64089_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F38526_0_0|CSTM-ALL|CSTM-00|2020|PDM|1170.00|99|0.00|ACUTE PSYCH|
20|FH_F129354_19152_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122433_0_0|SrvcGrp|109087|2022|PDM|1379.00|99|0.00|AEG 9 W/O PERCUTANEOUS VERTEBROPLASTY|
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.73|99|0.00|ASPG III|
20|FH_F116747_0_0|SrvcGrp|48396|2022|PDM|91.00|99|0.00|OT SERVICES|
20|FH_F35513_0_0|SrvcGrp|16496|2022|PDM|900.00|99|0.00|POLYSOMNOGRAPHY - CPAP|
20|FH_F151526_28208_0|SrvcGrp|107884|2022|PDM|3771.00|99|0.00|TRLUML BALO ANGIOP 1ST ART|
20|FH_F118910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117504_31088_0|SrvcGrp|101562|2022|PCT|1.00|99|0.00|HOSPICE/PHYSICIAN|
20|FH_F130061_84097_0|SrvcGrp|109798|2022|PCT|1.20|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F126002_11946_0|SrvcGrp|75754|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F37863_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|ANESTHESIA SERVICES - OBSTETRIC - CRNA|
20|FH_F36263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|GENERAL ACUTE CARE|
20|FH_F71945_0_0|SrvcGrp|63|2022|PDM|880.00|99|0.00|SUBACUTE CARE|
20|FH_F38090_0_0|SrvcGrp|38|2022|PDM|3477.00|99|0.00|NORMAL DELIVERY|
20|FH_F141527_36830_0|SrvcGrp|112596|2022|PCT|1.05|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36433_0_0|CSTM-ALL|CSTM-00|2020|PDM|486.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD AU|
20|FH_F90853_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137614_17602_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F41776_0_0|SrvcGrp|19512|2022|PDM|2095.00|99|0.00|MS DRG 794|
20|FH_F141527_36830_0|SrvcGrp|17014|2022|PDM|26.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F66501_0_0|SrvcGrp|3809|2022|PDM|573.00|99|0.00|HOSPICE CARE|
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|737.00|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_F44582_0_0|CSTM-ALL|CSTM-00|2020|PDM|2150.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F123895_52722_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F90818_0_0|SrvcGrp|82107|2022|PDM|6500.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|3415.00|99|0.00|AEG 9 (NO REV)|
20|FH_F92276_32308_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS|
20|FH_F89475_71202_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F40661_0_0|SrvcGrp|110|2022|PDM|432.00|99|0.00|CD - REHABILITATION|
20|FH_F136684_0_0|CSTM-ALL|CSTM-00|2020|PDM|917.00|99|0.00|AEG 6 (NO REV)|
20|FH_F148265_06067_0|CSTM-ALL|CSTM-00|2020|PDM|3932.00|99|0.00|AEG 5 (NO REV) W/O CORRECTION HALLUX VALGUS|
20|FH_F141169_0_0|SrvcGrp|73610|2022|PCT|0.00|99|0.00|AETNA IMPLANTS|
20|FH_F145758_20745_0|CSTM-ALL|CSTM-00|2020|PDM|556.61|99|0.00|AEG 2 (NO REV)|
20|FH_F140762_0_0|SrvcGrp|113697|2022|PDM|1723.00|99|0.00|TRANSLUM DIL EYE CANAL|
20|FH_F93791_0_0|SrvcGrp|93597|2022|PDM|4200.00|99|0.00|REVISE RECONSTRUCT SHOULDER JOINT(HCFA)|
20|FH_F141212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F65159_0_0|SrvcGrp|4109|2022|PDM|1364.00|99|0.00|ACUTE PSYCH|
20|FH_F65159_0_0|SrvcGrp|9518|2022|PCT|1.00|99|0.00|EMERGENCY ROOM|
20|FH_F122725_32216_0|SrvcGrp|104803|2022|PDM|156.00|99|0.00|SPINAL FLUID TAP DIAGNO 5|
20|FH_F122905_41018_0|SrvcGrp|109256|2022|PCT|1.00|99|0.00|OP THERAPY SERVICE W/O ELECTROCONVULSIVE THERAPY|
20|FH_F86872_15215_0|SrvcGrp|86836|2022|PDM|15.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F57073_0_0|SrvcGrp|72|2022|PDM|267.00|99|0.00|NEWBORN NURSERY|
20|FH_F145508_0_0|SrvcGrp|95660|2022|PDM|956.15|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F77462_0_0|SrvcGrp|42975|2022|PDM|110.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F132544_0_0|SrvcGrp|93740|2022|PDM|7850.00|99|0.00|REVISE/REMOVE NEURO RECEIVER|
20|FH_F119413_95123_0|SrvcGrp|46903|2022|PDM|1100.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F33088_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97140_91730_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F126975_43551_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F97560_23249_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F47679_0_0|SrvcGrp|42785|2022|PDM|40.12|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|704.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132331_89107_0|SrvcGrp|27968|2022|PDM|35.00|99|0.00|SKILLED NURSING LPN|
20|FH_F71929_15090_0|SrvcGrp|10503|2022|PDM|47.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F51438_0_0|SrvcGrp|1168|2022|PDM|794.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F143199_33403_0|SrvcGrp|74668|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F100661_63640_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F132992_04662_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133333_74132_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|GENERAL ACUTE CARE|
20|FH_F130553_18640_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F89011_75006_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F90921_77702_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F125672_92663_0|SrvcGrp|89269|2022|PDM|420.00|99|0.00|PSYTX PT/FAMILY 45 MINUTES|
20|FH_F127960_85205_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F103281_32086_0|SrvcGrp|87995|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F33581_0_0|SrvcGrp|14533|2022|PDM|3240.00|99|0.00|CORONARY CARE UNIT|
20|FH_F40331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F123085_21921_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F52032_0_0|SrvcGrp|13928|2022|PDM|500.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F102561_75146_0|SrvcGrp|98011|2022|PDM|825.00|99|0.00|DEBRIDEMENT-MUSCLE AND/OR FASCIA|
20|FH_F115289_90057_0|SrvcGrp|73842|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130108_0_0|SrvcGrp|9510|2022|PDM|575.00|99|0.00|SKILLED NURSING CARE|
20|FH_F146211_68144_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133469_33404_0|SrvcGrp|75419|2022|PDM|600.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F38630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|100% 2007 MEDICARE TN DME MOD  AV|
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142782_16201_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F60101_0_0|SrvcGrp|42826|2022|PDM|68.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F133287_40215_0|SrvcGrp|103610|2022|PDM|749.00|99|0.00|DIABETIC MGMT PROGRAM - GROUP|
20|FH_F128130_10027_0|CSTM-ALL|CSTM-00|2020|PDM|6836.00|99|0.00|AEG 10 (NO REV)|
20|FH_F129175_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT|
20|FH_F123538_21206_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F149861_85225_0|SrvcGrp|46903|2022|PDM|483.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F128130_10027_0|SrvcGrp|537|2022|PDM|3308.00|99|0.00|OBSERVATION SERVICES|
20|FH_F115405_06010_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F43774_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148900_0_0|SrvcGrp|36591|2022|PDM|38367.00|99|0.00|CPT 63685|
20|FH_F101840_76054_0|SrvcGrp|73485|2022|PDM|811.00|99|0.00|AETNA REHAB|
20|FH_F144288_46322_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F150539_48374_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F78205_0_0|SrvcGrp|17075|2022|PDM|2407.77|99|0.00|ASPG VI|
20|FH_F97622_75051_0|SrvcGrp|73603|2022|PDM|5319.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F80859_65616_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139825_0_0|SrvcGrp|84280|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F149940_02645_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F57592_0_0|SrvcGrp|26666|2022|PDM|33000.00|99|0.00|MS DRG 482 ONLY|
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|13000.00|99|0.00|MS DRG 253-254 CV SURGERY|
20|FH_F72686_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F87620_80014_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F68947_0_0|SrvcGrp|59841|2022|PDM|5367.60|99|0.00|SUBMUCOUS RESECTION|
20|FH_F101853_77840_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112165_0_0|SrvcGrp|72990|2022|PDM|995.00|99|0.00|AEG 1|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PDM|1222.00|99|0.00|ASPG IV|
20|FH_F120788_0_0|SrvcGrp|107748|2022|PDM|400.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F36576_0_0|SrvcGrp|1171|2022|PCT|0.85|99|0.00|IMPLANTS|
20|FH_F121168_0_0|SrvcGrp|97507|2022|PDM|100.00|99|0.00|AETNA HOSPICE|
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|12000.00|99|0.00|MS DRG 619-621|
20|FH_F141790_85374_0|SrvcGrp|113811|2022|PDM|3025.00|99|0.00|TIS TRNFR ADDL 30 SQ CM|
20|FH_F35454_0_0|SrvcGrp|16859|2022|PDM|30.00|99|0.00|FLU TEST|
20|FH_F92677_08003_0|SrvcGrp|82823|2022|PCT|0.86|99|0.00|UNCLASSIFIED BIOLOGIC|
20|FH_F43719_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113287_72501_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F31944_0_0|SrvcGrp|13385|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|538.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F149779_0_0|SrvcGrp|14188|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F132331_89107_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117450_63131_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F109526_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F141217_0_0|SrvcGrp|86233|2022|PDM|9500.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|972.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F135708_61401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F69104_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|WEOC MRI MOD TC|
20|FH_F103360_68845_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150062_92501_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.00|99|0.00|AEG 2 (NO REV)|
20|FH_F88818_0_0|SrvcGrp|75491|2022|PDM|943.00|99|0.00|AEG 7|
20|FH_F89363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|GENERAL ACUTE CARE|
20|FH_F87474_0_0|SrvcGrp|13606|2022|PDM|33.00|99|0.00|HOME INFUSION|
20|FH_F87915_0_0|SrvcGrp|3403|2022|PDM|154.00|99|0.00|CPT 99203|
20|FH_F46832_0_0|SrvcGrp|17006|2022|PDM|80.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS|
20|FH_F58856_0_0|SrvcGrp|16|2022|PDM|1100.00|99|0.00|ACUTE REHABILITATION|
20|FH_F69968_0_0|SrvcGrp|46523|2022|PDM|15193.82|99|0.00|MASTECTOMY|
20|FH_F120490_64133_0|SrvcGrp|88621|2022|PDM|73.00|99|0.00|SKILLED NURSING LPN|
20|FH_F134126_11554_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137068_81147_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137147_75006_0|SrvcGrp|113045|2022|PDM|33668.00|99|0.00|MS DRG 351 ONLY|
20|FH_F137231_25550_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F142267_78240_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F53732_0_0|SrvcGrp|26617|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F66765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F83831_0_0|SrvcGrp|12403|2022|PDM|770.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F138542_40324_0|SrvcGrp|86723|2022|PDM|363.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F138584_30912_0|SrvcGrp|113420|2022|PDM|440.00|99|0.00|EXCISION OF LESION OR TUMOR|
20|FH_F126567_0_0|SrvcGrp|107747|2022|PDM|1200.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F78267_18702_0|SrvcGrp|29087|2022|PDM|50.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F140582_46514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140612_60070_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F119023_91406_0|SrvcGrp|29077|2022|PDM|12.50|99|0.00|HOME TRANSFUSION|
20|FH_F38332_0_0|SrvcGrp|18873|2022|PDM|42216.00|99|0.00|MS DRG 232|
20|FH_F92506_07666_0|SrvcGrp|74670|2022|PCT|0.42|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F117270_32073_0|SrvcGrp|73842|2022|PDM|185.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147861_45239_0|SrvcGrp|75419|2022|PDM|425.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F147861_45239_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F147931_29732_0|SrvcGrp|108484|2022|PDM|590.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F129450_17201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129491_90245_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129504_02871_0|SrvcGrp|106904|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F117102_39355_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117217_80304_0|SrvcGrp|90040|2022|PDM|355.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F117219_77515_0|SrvcGrp|73841|2022|PDM|375.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F137937_20032_0|CSTM-ALL|CSTM-00|2020|PCT|2.39|99|0.00|AETNA - APC GROUPER P|
20|FH_F34371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109652_0_0|SrvcGrp|9539|2022|PDM|249.00|99|0.00|SUBACUTE CARE|
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|751.00|99|0.00|AEG 4 (NO REV)|
20|FH_F90880_15108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90880_15108_0|SrvcGrp|86323|2022|PCT|1.00|99|0.00|OTORHINOLARYNGOLOGIC SERVICES|
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F52152_0_0|CSTM-ALL|CSTM-00|2020|PDM|3120.00|99|0.00|ACUTE IP SVCS ONE DAY STAY|
20|FH_F32848_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F132736_0_0|SrvcGrp|3409|2022|PDM|600.00|99|0.00|NEWBORN NURSERY|
20|FH_F72928_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151199_77511_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129130_92562_0|SrvcGrp|10363|2022|PDM|1465.05|99|0.00|CPT CODE 99283|
20|FH_F36386_0_0|SrvcGrp|1168|2022|PDM|25.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F37190_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86911_0_0|SrvcGrp|44711|2022|PDM|105.00|99|0.00|PT SVCS|
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|638.00|99|0.00|AEG 2 (NO REV)|
20|FH_F113143_0_0|SrvcGrp|72996|2022|PDM|662.00|99|0.00|AEG 4|
20|FH_F114916_30309_0|SrvcGrp|33984|2022|PDM|1430.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F115208_0_0|SrvcGrp|57863|2022|PDM|2016.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F104840_32565_0|SrvcGrp|81340|2022|PCT|0.69|99|0.00|AETNA LABORATORY|
20|FH_F123774_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F132627_0_0|SrvcGrp|53502|2022|PDM|144.00|99|0.00|DIETICIAN|
20|FH_F132988_0_0|SrvcGrp|38352|2022|PDM|6093.66|99|0.00|FOOT MUSCLOSKELETAL PROCEDURE|
20|FH_F134027_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F128880_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43536_0_0|CSTM-ALL|CSTM-00|2020|PDM|2613.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|CHILD PSYCHIATRIC|
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|628.00|99|0.00|AEG 10 (NO REV)|
20|FH_F122198_20708_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F146994_74462_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|2010.00|99|0.00|ASPG IX|
20|FH_F42363_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|CD INTENSIVE OUTPATIENT SVCS|
20|FH_F87816_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F132864_71101_0|SrvcGrp|99068|2022|PDM|40498.00|99|0.00|MS DRG 228-229 ONLY OTHER CARDIOTHORACIC PROC|
20|FH_F89273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113845_32746_0|SrvcGrp|105439|2022|PDM|275.00|99|0.00|AETNA TERANIAL MAGN STIM TX DELI|
20|FH_F122872_67208_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F136930_73114_0|SrvcGrp|68403|2022|PDM|1238.00|99|0.00|EMERGENCY ROOM SERVICES|
20|FH_F113713_17013_0|SrvcGrp|86645|2022|PDM|75.00|99|0.00|AETNA PSYTX PT & FAM 45 MINS (MOD TD)|
20|FH_F131529_0_0|SrvcGrp|80317|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F141170_0_0|SrvcGrp|71666|2022|PDM|16000.00|99|0.00|CPT 63655|
20|FH_F115631_65201_0|SrvcGrp|88162|2022|PDM|3177.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F116343_33701_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F116233_33612_0|SrvcGrp|86723|2022|PDM|312.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F147305_90755_0|SrvcGrp|48394|2022|PDM|59.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F147700_21401_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F147700_21401_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|AEG 4 (NO REV)|
20|FH_F41463_0_0|SrvcGrp|17005|2022|PDM|80.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD RR KC RATES|
20|FH_F119993_71913_0|SrvcGrp|16|2022|PDM|1067.00|99|0.00|ACUTE REHABILITATION|
20|FH_F120862_87108_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113595_29527_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F36132_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP MAFS  MOD KN|
20|FH_F69245_84047_0|SrvcGrp|46903|2022|PDM|562.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F133107_73071_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F131235_36049_0|SrvcGrp|58509|2022|PDM|622.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F91975_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG IX|
20|FH_F51938_0_0|SrvcGrp|43893|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F113025_0_0|SrvcGrp|104963|2022|PDM|752.00|99|0.00|AEG 5 W/O CPT 15823|
20|FH_F83951_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|99|0.00|OP SVCS|
20|FH_F134087_0_0|SrvcGrp|67065|2022|PDM|6712.00|99|0.00|CERVICAL SURGERY|
20|FH_F151399_0_0|SrvcGrp|107351|2022|PDM|11724.00|99|0.00|AMB SRVC CONVNTION AIR TRANSPORT 1 WAY (HCFA)|
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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133579_0_0|SrvcGrp|35669|2022|PDM|3248.00|99|0.00|CPT 63650|
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AEG 3 (NO REV)|
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|2336.00|99|0.00|AEG 5  (NO REV)|
20|FH_F52772_0_0|SrvcGrp|474|2022|PDM|385.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F138700_76802_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138857_90025_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F87595_0_0|SrvcGrp|13724|2022|PCT|0.49|99|0.00|PHARMACY SVCS|
20|FH_F129768_0_0|SrvcGrp|35982|2022|PDM|37.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F147941_06023_0|SrvcGrp|109057|2022|PCT|5.00|99|0.00|CARDIAC STUDIES|
20|FH_F37945_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2007 LAB/RAD/OTHER DIAG TESTING F/S (MOD 26) - CPD 1365022|
20|FH_F93881_15009_0|SrvcGrp|75497|2022|PDM|1210.00|99|0.00|AEG 10|
20|FH_F110061_0_0|SrvcGrp|75491|2022|PDM|1054.00|99|0.00|AEG 7|
20|FH_F51074_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F40255_0_0|SrvcGrp|473|2022|PDM|838.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F136756_0_0|SrvcGrp|72996|2022|PDM|917.40|99|0.00|AEG 4|
20|FH_F39479_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F116955_16801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132372_0_0|SrvcGrp|87077|2022|PDM|193.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F137573_33764_0|SrvcGrp|58509|2022|PDM|372.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F116024_13203_0|SrvcGrp|86722|2022|PDM|148.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F109601_0_0|SrvcGrp|75489|2022|PDM|916.00|99|0.00|AEG 6|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OMNICARE IV SERVICES GH|
20|FH_F150699_0_0|SrvcGrp|109505|2022|PDM|21573.00|99|0.00|REMV & REPLC PM GEN MULT LEADS|
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 5  (NO REV)|
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1185.47|99|0.00|AEG 6 (NO REV)|
20|FH_F124050_75089_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F125011_74467_0|SrvcGrp|107542|2022|PCT|0.63|99|0.00|RADIOLOGY|
20|FH_F128272_60640_0|SrvcGrp|17014|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F141567_80128_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F49653_0_0|CSTM-ALL|CSTM-00|2020|PDM|4730.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F38967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F56112_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F143790_83440_0|SrvcGrp|113939|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)|
20|FH_F116269_92627_0|SrvcGrp|46903|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F39212_0_0|SrvcGrp|30447|2022|PCT|1.00|99|0.00|AMBULANCE|
20|FH_F38982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1573.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148355_37601_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115121_32250_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F129088_68763_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_F116269_92627_0|SrvcGrp|73841|2022|PDM|500.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F90492_0_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F149819_75067_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|2825.00|99|0.00|AEG 8 (NO REV)|
20|FH_F60112_0_0|SrvcGrp|42826|2022|PDM|85.50|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F100982_75601_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120727_54301_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F56512_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|SKILLED NURSING|
20|FH_F111732_33771_0|SrvcGrp|63458|2022|PDM|1400.00|99|0.00|ANTEPARTUM VISITS 7 OR MORE|
20|FH_F145584_15010_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F83054_0_0|SrvcGrp|10505|2022|PDM|106.00|99|0.00|CPT CODE 97001 PHYSICAL THERAPY INITIAL EVALUATION|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1289.00|99|0.00|ASPG VI- MOD 50|
20|FH_F50657_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F103320_0_0|SrvcGrp|73008|2022|PDM|1015.00|99|0.00|AEG 10|
20|FH_F93122_01854_0|SrvcGrp|86638|2022|PDM|896.00|99|0.00|AETNA IP PSYCHIATRIC (>=18 YRS)|
20|FH_F97840_54729_0|SrvcGrp|88977|2022|PDM|6795.00|99|0.00|C-SECTION DELIVERY|
20|FH_F122248_33441_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133749_84604_0|SrvcGrp|112461|2022|PDM|2.00|99|0.00|HOME INFUSION THERAPY SINGLE LUMEN (HCFA)|
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 8 (NO REV)|
20|FH_F85315_15217_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112791_0_0|SrvcGrp|73008|2022|PDM|535.00|99|0.00|AEG 10|
20|FH_F82591_0_0|SrvcGrp|75479|2022|PDM|1102.50|99|0.00|AEG 1|
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PDM|8465.00|99|0.00|2007 MEDICARE ASPG V|
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125024_66523_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F81698_10457_0|SrvcGrp|24750|2022|PDM|31.50|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F123157_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F49552_0_0|SrvcGrp|17083|2022|PDM|747.47|99|0.00|ASPG X|
20|FH_F90453_65203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97861_62223_0|SrvcGrp|88977|2022|PDM|6795.00|99|0.00|C-SECTION DELIVERY|
20|FH_F79824_0_0|SrvcGrp|17073|2022|PDM|2391.00|99|0.00|ASPG V|
20|FH_F149345_45044_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F120603_66112_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F127616_17403_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149061_44122_0|SrvcGrp|41563|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F130017_02302_0|SrvcGrp|88978|2022|PDM|10226.81|99|0.00|VAGINAL DELIVERY|
20|FH_F118042_33401_0|SrvcGrp|106722|2022|PDM|700.00|99|0.00|IP REHAB|
20|FH_F49552_0_0|SrvcGrp|9521|2022|PDM|3216.00|99|0.00|LITHOTRIPSY|
20|FH_F139565_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F109405_73106_0|SrvcGrp|79280|2022|PDM|400.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F31714_0_0|SrvcGrp|16|2022|PDM|600.00|99|0.00|ACUTE REHABILITATION|
20|FH_F111908_07677_0|SrvcGrp|96400|2022|PCT|1.00|99|0.00|INTERFERON ALFACON|
20|FH_F43861_0_0|SrvcGrp|37403|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F134608_18017_0|SrvcGrp|112608|2022|PDM|160.00|99|0.00|ANESTHESIA FOR INDUCED ABORT (HCFA)|
20|FH_F114409_18447_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F126099_34237_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113424_60626_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132728_0_0|SrvcGrp|58|2022|PDM|9668.00|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F138302_15701_0|SrvcGrp|24750|2022|PDM|10.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F132899_01002_0|SrvcGrp|90397|2022|PDM|441.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F112665_0_0|SrvcGrp|98499|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F69712_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F133207_0_0|SrvcGrp|87055|2022|PDM|3809.00|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION|
20|FH_F146049_60462_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143650_0_0|SrvcGrp|35921|2022|PDM|4000.00|99|0.00|BARIATRIC SURGERY|
20|FH_F83754_0_0|SrvcGrp|52742|2022|PCT|0.86|99|0.00|LAMINECTOMY|
20|FH_F124371_0_0|SrvcGrp|106317|2022|PDM|588.69|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F145702_22192_0|SrvcGrp|48396|2022|PDM|84.00|99|0.00|OT SERVICES|
20|FH_F83380_0_0|SrvcGrp|43266|2022|PDM|120.00|99|0.00|MIDLINE INSERTION KIT|
20|FH_F119783_46360_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F112023_12866_0|SrvcGrp|104365|2022|PCT|0.54|99|0.00|RADIOLOGY SERVICES|
20|FH_F85492_0_0|SrvcGrp|22528|2022|PCT|0.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F138302_15701_0|SrvcGrp|24761|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F123638_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F71445_0_0|SrvcGrp|68380|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F125259_0_0|SrvcGrp|110098|2022|PDM|1750.00|99|0.00|AV FISTULA EXCISION|
20|FH_F149079_70809_0|SrvcGrp|45751|2022|PDM|100.00|99|0.00|INDIVIDUAL THERAPY|
20|FH_F136359_0_0|SrvcGrp|112853|2022|PDM|6275.00|99|0.00|SPINAL SERVICES|
20|FH_F85353_16407_0|SrvcGrp|63827|2022|PDM|515.52|99|0.00|HAPA WPA-NWPA 2012-13 ASC 101|
20|FH_F130763_0_0|SrvcGrp|84182|2022|PDM|3947.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE|
20|FH_F130017_02302_0|SrvcGrp|114563|2022|PCT|1.22|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|1346.00|99|0.00|AEG 4 (NO REV)|
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 4 (NO REV)|
20|FH_F127641_08103_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F83995_16748_0|SrvcGrp|59159|2022|PCT|0.82|99|0.00|OP SURGERY|
20|FH_F148799_50125_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133920_64057_0|SrvcGrp|48398|2022|PDM|123.00|99|0.00|PT SERVICES|
20|FH_F96780_0_0|SrvcGrp|42428|2022|PDM|518.00|99|0.00|OP SURGERY CPT 65855|
20|FH_F123609_28451_0|SrvcGrp|73842|2022|PDM|222.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120715_83440_0|SrvcGrp|537|2022|PCT|0.96|99|0.00|OBSERVATION SERVICES|
20|FH_F122930_0_0|SrvcGrp|87386|2022|PDM|3592.00|99|0.00|AMNIOTIC MEMBRANE TRANSPLANTATION|
20|FH_F138047_77027_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F150165_06032_0|SrvcGrp|106266|2022|PDM|6100.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT|
20|FH_F135900_0_0|SrvcGrp|87536|2022|PDM|300.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F31524_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1680.00|99|0.00|ASPG IX - FH SW CUSTOM GROUPERS|
20|FH_F134362_32535_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F85995_64111_0|SrvcGrp|43569|2022|PDM|136.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F144808_0_0|SrvcGrp|98498|2022|PDM|7215.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC|
20|FH_F149263_0_0|SrvcGrp|99073|2022|PDM|1.39|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F145641_06902_0|SrvcGrp|114239|2022|PDM|4360.00|99|0.00|DECOMPRESSION FASCIOTOMY|
20|FH_F145681_38301_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133485_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F113368_37752_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F127199_0_0|SrvcGrp|94780|2022|PDM|114.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F151300_0_0|CSTM-ALL|CSTM-00|2020|PDM|352.00|99|0.00|AETNA SURGERY DEFAULT WITHOUT GROUPER 1|
20|FH_F144228_0_0|SrvcGrp|16668|2022|PDM|5543.00|99|0.00|OPEN TX OF BIMALLIOLAR ANKLE FX W/FIX|
20|FH_F130763_0_0|SrvcGrp|77582|2022|PDM|4367.00|99|0.00|CPT 31255|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|105.49|99|0.00|HAPA WPA-NWPA 2012-13 ASC 241 W/O REV|
20|FH_F148927_0_0|SrvcGrp|24714|2022|PCT|0.47|99|0.00|INTRAOCULAR LENS|
20|FH_F71005_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117206_0_0|SrvcGrp|82307|2022|PDM|618.00|99|0.00|COLORECTAL CANCER SCREENING|
20|FH_F148922_32073_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92893_75110_0|SrvcGrp|73656|2022|PDM|400.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F149268_74820_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F146124_06112_0|SrvcGrp|114468|2022|PCT|1.18|99|0.00|RADIOLOGY|
20|FH_F120719_27540_0|SrvcGrp|10365|2022|PDM|2289.00|99|0.00|CPT CODE 99285|
20|FH_F129638_0_0|SrvcGrp|15324|2022|PDM|300.00|99|0.00|ER LEVEL II|
20|FH_F84712_0_0|SrvcGrp|82750|2022|PDM|26.00|99|0.00|CHORIONIC GONADOTROPIN ASSAY|
20|FH_F85055_0_0|SrvcGrp|73006|2022|PDM|1050.00|99|0.00|AEG 9|
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.00|99|0.00|2007 MEDICARE ASPG X|
20|FH_F72768_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98780_35022_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F105361_80104_0|SrvcGrp|73461|2022|PDM|6320.00|99|0.00|AETNA NICU IV|
20|FH_F115786_57701_0|SrvcGrp|29347|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F115907_12206_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F73967_0_0|SrvcGrp|3809|2022|PDM|643.00|99|0.00|HOSPICE CARE|
20|FH_F75842_0_0|SrvcGrp|11970|2022|PDM|129.13|99|0.00|LABOR/DELIVERY CHECK|
20|FH_F146655_80226_0|SrvcGrp|75419|2022|PDM|740.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F43199_0_0|SrvcGrp|9829|2022|PDM|131.25|99|0.00|PT SVCS|
20|FH_F129509_0_0|SrvcGrp|89860|2022|PDM|3767.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F150146_95401_0|SrvcGrp|89337|2022|PDM|1184.00|99|0.00|DETOXIFICATION|
20|FH_F112649_63764_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F134169_08831_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F124369_0_0|SrvcGrp|104114|2022|PDM|9350.00|99|0.00|INCISION OF FOOT FASCIA|
20|FH_F134353_84123_0|SrvcGrp|97703|2022|PDM|94.50|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F127642_07047_0|SrvcGrp|72998|2022|PDM|2118.00|99|0.00|AEG 5|
20|FH_F143715_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143562_76665_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|1210.00|99|0.00|AEG 1 (NO REV)|
20|FH_F139443_37705_0|SrvcGrp|108799|2022|PCT|1.20|99|0.00|OP THERAPY SERVICE|
20|FH_F149341_39194_0|SrvcGrp|57968|2022|PDM|56.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F149300_53158_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111031_30252_0|SrvcGrp|76094|2022|PDM|153.97|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F130763_0_0|SrvcGrp|106267|2022|PDM|6043.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL|
20|FH_F79824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F84191_16001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134607_80222_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F111681_62702_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F125870_0_0|SrvcGrp|104003|2022|PDM|3095.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES|
20|FH_F79743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F121476_0_0|SrvcGrp|108854|2022|PDM|525.00|99|0.00|OSSICULA IMPLANT|
20|FH_F114444_19602_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F111027_32817_0|SrvcGrp|46903|2022|PDM|975.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F134593_60007_0|SrvcGrp|86829|2022|PDM|45.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F130123_24171_0|SrvcGrp|29346|2022|PDM|45.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F121476_0_0|SrvcGrp|58659|2022|PDM|4408.00|99|0.00|PROSTHETIC IMPLANTS|
20|FH_F41608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F71103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113645_0_0|SrvcGrp|103551|2022|PDM|557.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F122532_46385_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F86552_0_0|SrvcGrp|36591|2022|PDM|26000.00|99|0.00|CPT 63685|
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 9 (NO REV)|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|223.61|99|0.00|HAPA WPA-NWPA 2012-13 ASC 232 W/O REV|
20|FH_F72963_0_0|SrvcGrp|11259|2022|PCT|0.44|99|0.00|DRUGS|
20|FH_F78344_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F115811_33410_0|SrvcGrp|105046|2022|PCT|0.00|99|0.00|AETNA RES TREATMENT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F115909_38133_0|SrvcGrp|86648|2022|PCT|1.05|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F75842_0_0|SrvcGrp|104422|2022|PDM|9406.88|99|0.00|AETNA CARDIAC STENT PLACEMENT|
20|FH_F146668_30189_0|SrvcGrp|99171|2022|PDM|8500.00|99|0.00|CPT 28485|
20|FH_F146499_72206_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146667_37110_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F146667_37110_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F120795_27514_0|SrvcGrp|45622|2022|PCT|0.00|99|0.00|SUBACUTE|
20|FH_F115972_92675_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133581_84790_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F146622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133398_43204_0|SrvcGrp|90854|2022|PDM|623.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F111563_02116_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 3 (NO REV)|
20|FH_F46832_0_0|SrvcGrp|26869|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F119729_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F69968_0_0|SrvcGrp|46525|2022|PDM|15193.82|99|0.00|PACEMAKER|
20|FH_F136430_46710_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F93177_73044_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F134011_84102_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134159_80228_0|SrvcGrp|89337|2022|PDM|1050.00|99|0.00|DETOXIFICATION|
20|FH_F137036_60504_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F142373_78727_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142741_03264_0|SrvcGrp|46903|2022|PDM|2047.50|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F142742_44112_0|SrvcGrp|89337|2022|PDM|950.00|99|0.00|DETOXIFICATION|
20|FH_F117552_0_0|SrvcGrp|88739|2022|PDM|2200.00|99|0.00|IMPLANT SPINAL CANAL|
20|FH_F97582_46307_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F97600_46151_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F138607_02760_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138607_02760_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125053_0_0|SrvcGrp|79583|2022|PDM|2028.00|99|0.00|CPT 45381|
20|FH_F140616_43338_0|SrvcGrp|113166|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F140867_56345_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F140893_19720_0|SrvcGrp|53987|2022|PDM|47.20|99|0.00|PHOTOTHERAPY|
20|FH_F132738_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F149511_62626_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149527_62859_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149640_50022_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119026_36274_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F109885_35473_0|SrvcGrp|86648|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F70665_0_0|SrvcGrp|42827|2022|PDM|68.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F80366_0_0|SrvcGrp|73002|2022|PCT|0.94|99|0.00|AEG 7|
20|FH_F117325_19342_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F147939_61611_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117108_37841_0|SrvcGrp|10393|2022|PDM|2000.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F101161_0_0|SrvcGrp|20260|2022|PDM|2671.00|99|0.00|ER LEVEL V|
20|FH_F137938_29036_0|SrvcGrp|109057|2022|PCT|0.68|99|0.00|CARDIAC STUDIES|
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 2 (NO REV)|
20|FH_F40983_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129487_0_0|SrvcGrp|33984|2022|PDM|2369.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F145348_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.42|99|0.00|OP SVCS|
20|FH_F147340_0_0|SrvcGrp|82498|2022|PDM|651.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS|
20|FH_F50446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F95880_02726_0|SrvcGrp|85963|2022|PDM|37.36|99|0.00|SELF CARE MANGEMENT TRAINING|
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)|
20|FH_F36386_0_0|SrvcGrp|3810|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F113741_63303_0|SrvcGrp|42971|2022|PDM|86.70|99|0.00|SKN RN|
20|FH_F61493_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F98040_89406_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116323_0_0|SrvcGrp|97462|2022|PDM|24747.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F71863_0_0|SrvcGrp|8962|2022|PDM|104.50|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F73231_0_0|SrvcGrp|44712|2022|PDM|115.99|99|0.00|OT SVCS|
20|FH_F80711_0_0|SrvcGrp|42831|2022|PDM|39.00|99|0.00|DIETICIAN VISIT|
20|FH_F142315_33701_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1576.00|99|0.00|AEG 7 (NO REV)|
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F104840_32565_0|SrvcGrp|73601|2022|PCT|0.69|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF|
20|FH_F135491_0_0|SrvcGrp|84278|2022|PDM|1980.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F131047_0_0|SrvcGrp|13293|2022|PCT|0.60|99|0.00|HIGH-COST DRUGS|
20|FH_F132627_0_0|SrvcGrp|14944|2022|PDM|18.36|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F132988_0_0|SrvcGrp|96839|2022|PDM|24603.00|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F132988_0_0|SrvcGrp|100000|2022|PDM|19032.77|99|0.00|RECONSTRUCT WRIST DIST ULNA|
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1066.00|99|0.00|AEG 6 (NO REV)|
20|FH_F114389_50131_0|SrvcGrp|98966|2022|PDM|102.25|99|0.00|HIT ENZYME REPLACE (HCFA)|
20|FH_F43536_0_0|SrvcGrp|38|2022|PDM|4354.00|99|0.00|NORMAL DELIVERY|
20|FH_F45976_0_0|SrvcGrp|12492|2022|PCT|1.05|99|0.00|PROSTHETICS|
20|FH_F132351_19342_0|SrvcGrp|85017|2022|PCT|1.05|99|0.00|DME|
20|FH_F124059_64055_0|SrvcGrp|17014|2022|PDM|22.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F124140_15214_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F62624_0_0|SrvcGrp|51672|2022|PDM|5440.00|99|0.00|MS DRG 286-287 ONLY|
20|FH_F85154_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92493_0_0|SrvcGrp|41334|2022|PDM|20798.09|99|0.00|TOTAL KNEE|
20|FH_F129549_01238_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124173_66215_0|SrvcGrp|14947|2022|PDM|5.00|99|0.00|HOME INFUSION|
20|FH_F124613_64735_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150910_0_0|SrvcGrp|93432|2022|PDM|10500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F136746_63116_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F113787_31909_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F138247_76201_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F81893_23114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1078.00|99|0.00|AEG 2 (NO REV)|
20|FH_F122689_92009_0|SrvcGrp|108902|2022|PDM|16.00|99|0.00|HOME BLOOD GLUCOSE MONITOR|
20|FH_F122689_92009_0|SrvcGrp|71107|2022|PDM|525.00|99|0.00|HCPCS A9277|
20|FH_F43246_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43613_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F117085_40207_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134791_98034_0|SrvcGrp|26160|2022|PDM|119.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F135720_90025_0|SrvcGrp|109036|2022|PDM|874.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F136778_62034_0|SrvcGrp|9517|2022|PDM|117.00|99|0.00|MAMMOGRAPHY|
20|FH_F136796_24016_0|CSTM-ALL|CSTM-00|2020|PDM|2457.26|99|0.00|AEG 7 (NO REV)|
20|FH_F136927_45690_0|SrvcGrp|48394|2022|PDM|32.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F113713_17013_0|SrvcGrp|91781|2022|PDM|65.00|99|0.00|AETNA GROUP THERAPY (MOD TD)(HCFA)|
20|FH_F115631_65201_0|SrvcGrp|88487|2022|PDM|3177.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F116393_07002_0|SrvcGrp|111271|2022|PDM|37.15|99|0.00|X-RAY EXAM OF ABDOMEN|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|BLOOD TRANSFUSION (MOD SH)|
20|FH_F41663_0_0|SrvcGrp|3029|2022|PDM|325.00|99|0.00|NEWBORN NURSERY|
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PDM|619.00|99|0.00|ACUTE PSYCH|
20|FH_F138197_0_0|SrvcGrp|90567|2022|PDM|880.00|99|0.00|CILIARY BODY DESTRUCTION|
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|2350.00|99|0.00|AEG 5  (NO REV)|
20|FH_F128341_41139_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F98161_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|581.93|99|0.00|2005 ASPG GROUPER III|
20|FH_F137906_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F62680_0_0|SrvcGrp|58602|2022|PCT|1.00|99|0.00|DRUGS - J-CODES AND Q-CODES|
20|FH_F71502_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134087_0_0|SrvcGrp|99161|2022|PDM|10455.00|99|0.00|CPT 27138|
20|FH_F35404_0_0|SrvcGrp|12195|2022|PDM|150.00|99|0.00|OBSERVATION SVCS|
20|FH_F113154_70359_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F113180_23507_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120528_60559_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120811_53525_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F47140_0_0|SrvcGrp|13626|2022|PDM|462.88|99|0.00|SLEEP STUDIES|
20|FH_F131747_80108_0|SrvcGrp|111899|2022|PDM|2400.00|99|0.00|OB C-SECTION|
20|FH_F131904_18915_0|SrvcGrp|53987|2022|PDM|232.00|99|0.00|PHOTOTHERAPY|
20|FH_F130657_04614_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132575_38635_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111601_15203_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F134823_33135_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F35216_0_0|SrvcGrp|17849|2022|PDM|1375.00|99|0.00|ICU / CCU|
20|FH_F117199_0_0|CSTM-ALL|CSTM-00|2020|PDM|947.39|99|0.00|AEG 2 (NO REV)|
20|FH_F68322_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F86991_15122_0|SrvcGrp|85483|2022|PDM|1900.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F57073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1393.00|99|0.00|SPECIALTY REHABILITATION|
20|FH_F58112_0_0|CSTM-ALL|CSTM-00|2020|PDM|1620.00|99|0.00|GENERAL ACUTE CARE|
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|CSTM-ALL|CSTM-00|2020|PDM|477.00|99|0.00|AEG 1 (NO REV)|
20|FH_F89372_0_0|SrvcGrp|8968|2022|PDM|5606.00|99|0.00|NICU LEVEL III & IV|
20|FH_F88639_80204_0|SrvcGrp|75481|2022|PDM|3756.77|99|0.00|AEG 2|
20|FH_F139690_0_0|SrvcGrp|112094|2022|PDM|500.00|99|0.00|DIALYSIS ULTRAFILTRATION|
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F117465_0_0|SrvcGrp|75483|2022|PDM|1200.00|99|0.00|AEG 3|
20|FH_F132810_0_0|SrvcGrp|17014|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F107200_0_0|SrvcGrp|42472|2022|PDM|2705.00|99|0.00|CPT 58670|
20|FH_F134253_48879_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136386_30901_0|SrvcGrp|112997|2022|PDM|11550.00|99|0.00|MS DRG 683 ONLY|
20|FH_F118193_06241_0|CSTM-ALL|CSTM-00|2020|PDM|86.47|99|0.00|AETNA FAMILY ADAPTIVE BH TREATMENT W/O PATIENT|
20|FH_F93363_63123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134011_84102_0|SrvcGrp|86831|2022|PDM|3.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F114092_83350_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F142406_78840_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F53732_0_0|SrvcGrp|34388|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F138545_39503_0|SrvcGrp|73842|2022|PDM|209.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138627_82901_0|SrvcGrp|37386|2022|PDM|1.84|99|0.00|AMINO ACIDS|
20|FH_F140335_70435_0|SrvcGrp|113132|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F140647_66210_0|SrvcGrp|86722|2022|PDM|510.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F140837_34947_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147799_18052_0|SrvcGrp|88621|2022|PDM|109.57|99|0.00|SKILLED NURSING LPN|
20|FH_F129511_44044_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F129524_48104_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137814_61820_0|SrvcGrp|89149|2022|PDM|250.00|99|0.00|OP INTENSIVE|
20|FH_F112080_0_0|SrvcGrp|72994|2022|PDM|739.00|99|0.00|AEG 3|
20|FH_F90735_94070_0|SrvcGrp|90288|2022|PDM|32.50|99|0.00|TAY-SACHS ENZYME CARRIER SCREENING|
20|FH_F91472_96001_0|SrvcGrp|104593|2022|PDM|16302.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F91472_96001_0|SrvcGrp|103701|2022|PDM|14871.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1929.00|99|0.00|ASPG VII|
20|FH_F151142_35406_0|CSTM-ALL|CSTM-00|2020|PDM|1398.00|99|0.00|AEG 5  (NO REV)|
20|FH_F151159_46322_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F121329_33015_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121329_33015_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113866_0_0|SrvcGrp|90478|2022|PDM|100.00|99|0.00|HOSPICE|
20|FH_F129130_92562_0|SrvcGrp|73483|2022|PDM|2660.00|99|0.00|AETNA SUBACUTE III|
20|FH_F129130_92562_0|SrvcGrp|103913|2022|PCT|4.64|99|0.00|OP DIALYSIS|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1127.79|99|0.00|DELAWARE VALLEY- ASC 7|
20|FH_F77763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82933_0_0|CSTM-ALL|CSTM-00|2020|PDM|9117.38|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F98040_89406_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F106822_0_0|SrvcGrp|22380|2022|PDM|44.95|99|0.00|CPT CODE 94060|
20|FH_F88616_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114916_30309_0|SrvcGrp|92821|2022|PDM|13500.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR|
20|FH_F112967_0_0|SrvcGrp|90707|2022|PDM|115.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F105591_17601_0|SrvcGrp|72994|2022|PDM|961.00|99|0.00|AEG 3|
20|FH_F105700_08865_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|GENERAL ACUTE CARE|
20|FH_F102041_35010_0|SrvcGrp|27969|2022|PDM|42.00|99|0.00|HOME HEALTH AIDE|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY POS FACILITY MOD TC|
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1726.00|99|0.00|AEG 9 (NO REV)|
20|FH_F138929_0_0|SrvcGrp|67065|2022|PDM|14850.00|99|0.00|CERVICAL SURGERY|
20|FH_F132627_0_0|SrvcGrp|89621|2022|PDM|347.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F132627_0_0|SrvcGrp|44427|2022|PDM|144.00|99|0.00|PHYSICAL THERAPY SVCS (VISIT LVL)|
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|2457.00|99|0.00|AEG 5  (NO REV)|
20|FH_F49812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F105320_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F85655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE|
20|FH_F91998_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F132864_71101_0|SrvcGrp|73559|2022|PDM|3038.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F124222_92625_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F124225_92506_0|SrvcGrp|75419|2022|PDM|600.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F134612_0_0|SrvcGrp|106799|2022|PDM|10000.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F135351_0_0|SrvcGrp|67065|2022|PDM|9900.00|99|0.00|CERVICAL SURGERY|
20|FH_F150939_0_0|SrvcGrp|22379|2022|PDM|24.00|99|0.00|CPT CODE 94010|
20|FH_F66569_0_0|SrvcGrp|471|2022|PDM|570.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F54552_0_0|SrvcGrp|10527|2022|PDM|115.00|99|0.00|HOSPICE SVCS|
20|FH_F113585_20155_0|SrvcGrp|24744|2022|PDM|80.00|99|0.00|PICC LINE INSERTION|
20|FH_F138807_32207_0|SrvcGrp|73700|2022|PDM|58.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F138936_01040_0|CSTM-ALL|CSTM-00|2020|PDM|1803.00|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F117715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1412.25|99|0.00|AEG 9 (NO REV)|
20|FH_F151382_30501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151404_71655_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122032_32413_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F123191_15012_0|SrvcGrp|46605|2022|PDM|91.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F91764_93710_0|SrvcGrp|26672|2022|PDM|32542.00|99|0.00|MS DRG 462 ONLY|
20|FH_F135924_02906_0|SrvcGrp|113560|2022|PCT|1.03|99|0.00|OBSERVATION W/ ER|
20|FH_F130756_04901_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 4 (NO REV)|
20|FH_F131132_44077_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116397_33404_0|SrvcGrp|86838|2022|PDM|15.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F116431_76104_0|SrvcGrp|79786|2022|PCT|1.00|99|0.00|SLEEP STUDIES|
20|FH_F140629_0_0|SrvcGrp|113670|2022|PDM|2497.00|99|0.00|LYMPH NODE BIOP LAPAROSCOPY|
20|FH_F42347_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111880_50003_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134322_98001_0|SrvcGrp|91739|2022|PCT|1.00|99|0.00|CEFTAZIDIME PER 500MG/12MX|
20|FH_F141651_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F47906_0_0|SrvcGrp|29959|2022|PCT|1.00|99|0.00|DME MOD KM|
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|1124.00|99|0.00|AEG 8 (NO REV)|
20|FH_F101442_0_0|SrvcGrp|98464|2022|PDM|1295.50|99|0.00|RELEASE OF MIDFOOT JOINT|
20|FH_F87557_33309_0|SrvcGrp|14892|2022|PDM|60.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F87557_33309_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F127713_30012_0|SrvcGrp|42404|2022|PCT|1.00|99|0.00|VENIPUNCTURE|
20|FH_F103780_64804_0|SrvcGrp|107734|2022|PDM|4253.00|99|0.00|VAGINAL DELIVERY|
20|FH_F148120_22903_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148079_06512_0|SrvcGrp|23683|2022|PDM|61.80|99|0.00|SKILLED NURSING RN|
20|FH_F148545_84047_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F148644_06890_0|SrvcGrp|84280|2022|PDM|7426.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F73304_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|ASPG I|
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_F117745_15801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148009_71322_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|138.80|99|0.00|ASPG 121|
20|FH_F133021_00910_0|SrvcGrp|112355|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F111522_81067_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F72823_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F148921_91356_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F126666_44053_0|SrvcGrp|102979|2022|PDM|116.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AH)|
20|FH_F49354_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F38848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F113287_72501_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F128512_37087_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F42159_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F89233_0_0|SrvcGrp|997|2022|PCT|0.76|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F35080_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F145328_90301_0|SrvcGrp|113334|2022|PDM|175.00|99|0.00|MED ASSIST TX NO DRUG|
20|FH_F119437_0_0|SrvcGrp|88491|2022|PDM|4750.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F145988_06105_0|SrvcGrp|89652|2022|PDM|21465.00|99|0.00|CYBERKNIFE|
20|FH_F88956_0_0|SrvcGrp|20297|2022|PDM|42447.00|99|0.00|MS DRG 219-221 ONLY CARDIAC VALVE PROC|
20|FH_F101840_76054_0|SrvcGrp|106763|2022|PCT|1.50|99|0.00|LABORATORY SERVICES|
20|FH_F97621_75801_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F83053_0_0|SrvcGrp|72992|2022|PDM|2190.00|99|0.00|AEG 2|
20|FH_F130615_95350_0|SrvcGrp|73842|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F40718_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F106600_99202_0|SrvcGrp|86749|2022|PCT|1.05|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F111316_0_0|SrvcGrp|89417|2022|PDM|400.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F133270_77025_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F150559_60018_0|SrvcGrp|66264|2022|PDM|132.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F32729_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|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_F149940_02645_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117275_16936_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F86293_0_0|SrvcGrp|84704|2022|PDM|1995.00|99|0.00|CYSTOURETHROSCOPY W/ REMOVAL OF FOREIGN BODY|
20|FH_F142008_74301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126666_44053_0|SrvcGrp|91392|2022|PDM|169.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AF)|
20|FH_F47345_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.90|99|0.00|OP SVCS|
20|FH_F49637_0_0|SrvcGrp|45762|2022|PDM|5000.00|99|0.00|NEUROSTIMULATOR PERM|
20|FH_F133493_90255_0|CSTM-ALL|CSTM-00|2020|PDM|2857.00|99|0.00|AEG 4 (NO REV)|
20|FH_F101923_98104_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F40895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42984_0_0|SrvcGrp|109|2022|PDM|584.00|99|0.00|CD - DETOX|
20|FH_F68842_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F83031_0_0|SrvcGrp|43270|2022|PDM|50.00|99|0.00|CATHETER REPAIR|
20|FH_F122970_97222_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125256_77365_0|SrvcGrp|86722|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ASPG VII|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|169.72|99|0.00|HAPA WPA-NWPA 2012-13 ASC 131 W/O REV|
20|FH_F117380_60020_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F102361_44024_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39627_0_0|SrvcGrp|9927|2022|PDM|3100.00|99|0.00|ROOM & BOARD STERILE ENVIRONMENT|
20|FH_F97140_91730_0|SrvcGrp|88978|2022|PDM|9076.00|99|0.00|VAGINAL DELIVERY|
20|FH_F37568_0_0|SrvcGrp|14404|2022|PCT|0.60|99|0.00|HOME HEALTH CARE MEDICAL SUPPLIES|
20|FH_F134490_62801_0|SrvcGrp|104716|2022|PDM|1317.00|99|0.00|REMOVAL OF LOOSE BODY|
20|FH_F148556_13206_0|SrvcGrp|17002|2022|PDM|95.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS|
20|FH_F145862_66209_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F91155_16105_0|SrvcGrp|73461|2022|PDM|2263.00|99|0.00|AETNA NICU IV|
20|FH_F81485_0_0|SrvcGrp|11108|2022|PDM|1768.00|99|0.00|NEWBORN NURSERY|
20|FH_F92792_0_0|SrvcGrp|38907|2022|PDM|1320.00|99|0.00|CPT 66170 - FISTULIZATION OF SCLERA FOR GLAUCOMA|
20|FH_F97543_33542_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132503_73086_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F41976_0_0|SrvcGrp|45537|2022|PDM|360.00|99|0.00|COLORECTAL CANCER SCREENING|
20|FH_F47345_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F59274_0_0|SrvcGrp|48385|2022|PDM|34.00|99|0.00|SPEECH THERAPY|
20|FH_F97560_23249_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F144449_04619_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111426_63640_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F68888_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F50694_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97140_91730_0|SrvcGrp|73656|2022|PDM|382.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F101811_64116_0|SrvcGrp|99420|2022|PDM|20.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F128699_0_0|SrvcGrp|83857|2022|PDM|450.00|99|0.00|IP HOSPICE SVCS|
20|FH_F39995_0_0|SrvcGrp|72|2022|PDM|375.00|99|0.00|NEWBORN NURSERY|
20|FH_F94300_0_0|SrvcGrp|67066|2022|PDM|1050.00|99|0.00|CERVICAL SURGERY|
20|FH_F66541_0_0|CSTM-ALL|CSTM-00|2020|PCT|13500.00|99|0.00|PERITONEAL DIALYSIS|
20|FH_F133477_90247_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F87362_15746_0|SrvcGrp|472|2022|PDM|385.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F126815_02118_0|SrvcGrp|108986|2022|PCT|1.18|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|AEG 5  (NO REV)|
20|FH_F81763_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|509.13|99|0.00|CPT 95811 (W/MOD TC)|
20|FH_F38845_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38700_0_0|SrvcGrp|18127|2022|PCT|0.80|99|0.00|MS DRG 242|
20|FH_F118542_60188_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F101754_63141_0|CSTM-ALL|CSTM-00|2020|PDM|85.32|99|0.00|AUDITORY EVOKED POTENTIALS|
20|FH_F132571_24739_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F122958_45014_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F102561_75146_0|SrvcGrp|72990|2022|PDM|1300.00|99|0.00|AEG 1|
20|FH_F139188_29169_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139454_32839_0|CSTM-ALL|CSTM-00|2020|PCT|1.45|99|0.00|HSS ASC|
20|FH_F138852_75228_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150931_65201_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F102525_73134_0|SrvcGrp|14871|2022|PDM|51000.00|99|0.00|DRG 454 ONLY|
20|FH_F147347_70806_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F147339_08837_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 3 (NO REV)|
20|FH_F124487_89502_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F148326_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F110783_93013_0|SrvcGrp|17013|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F47836_0_0|SrvcGrp|44142|2022|PDM|1750.00|99|0.00|CPT  31541, 42825, 42830, 60280|
20|FH_F120848_20912_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F35446_0_0|SrvcGrp|97|2022|PDM|1815.00|99|0.00|C-SECTION|
20|FH_F109251_62269_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40627_0_0|SrvcGrp|9774|2022|PDM|3780.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F130939_40353_0|SrvcGrp|73842|2022|PDM|184.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147142_33870_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134916_16421_0|SrvcGrp|106317|2022|PDM|823.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|12714.00|99|0.00|MS DRGS 258-262 PACEMAKER REVISION OR REPLACEMENT|
20|FH_F117576_21207_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124389_84115_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F102525_73134_0|SrvcGrp|705|2022|PCT|0.35|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F149585_46012_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146266_0_0|SrvcGrp|92416|2022|PDM|5971.00|99|0.00|CERVICAL LAMINOTOMY|
20|FH_F112045_90301_0|SrvcGrp|90854|2022|PDM|2708.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F149160_02180_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149539_06032_0|SrvcGrp|106792|2022|PDM|234.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1575124_CPT_ MOD TC|
20|FH_F76826_0_0|SrvcGrp|60623|2022|PCT|1.00|99|0.00|(HIGH COST DRUGS) OCN F/S PRICING: ALL|
20|FH_F139576_0_0|SrvcGrp|81418|2022|PDM|5441.00|99|0.00|AETNA LAPARO CHOLECYSTECOMY|
20|FH_F37764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|O2 SOLUTIONS MOD NU|
20|FH_F149602_07109_0|SrvcGrp|113230|2022|PDM|42.13|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 SCR|
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39211_0_0|SrvcGrp|30206|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F73442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149023_44122_0|SrvcGrp|107367|2022|PDM|19369.00|99|0.00|INSERTION OF INTERVERTEBRAL BIOMECHANICAL DEVICE(S)|
20|FH_F35776_33063_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|GENERAL ACUTE CARE|
20|FH_F38372_0_0|SrvcGrp|110|2022|PDM|325.00|99|0.00|CD - REHABILITATION|
20|FH_F35847_0_0|SrvcGrp|12047|2022|PCT|0.66|99|0.00|CPT CODES 80000-89999, 36415 (LAB)|
20|FH_F138410_19130_0|SrvcGrp|113175|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - MODERNA|
20|FH_F116753_0_0|SrvcGrp|21456|2022|PDM|1250.00|99|0.00|SLEEP STUDIES|
20|FH_F147140_89103_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35255_98310_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 5  (NO REV)|
20|FH_F122371_83276_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F92413_07631_0|SrvcGrp|46605|2022|PDM|112.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F85437_0_0|SrvcGrp|472|2022|PDM|386.40|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150982_0_0|SrvcGrp|105637|2022|PDM|2202.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F110193_70444_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F34777_0_0|SrvcGrp|16197|2022|PDM|593.00|99|0.00|NEWBORN NURSERY|
20|FH_F36594_0_0|SrvcGrp|8962|2022|PDM|102.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F117615_30525_0|SrvcGrp|75495|2022|PCT|0.85|99|0.00|AEG 9|
20|FH_F41377_0_0|SrvcGrp|177|2022|PDM|950.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F35742_33407_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|GENERAL ACUTE CARE|
20|FH_F98801_93274_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F116753_0_0|SrvcGrp|92189|2022|PDM|953.00|99|0.00|CPT 95808  (HCFA)|
20|FH_F147221_49442_0|SrvcGrp|42622|2022|PDM|638.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F129340_43212_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F35174_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 238 ONLY|
20|FH_F111122_63376_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F43324_0_0|SrvcGrp|30551|2022|PDM|115.00|99|0.00|EARLY INTERVENTION PHYSICAL THERAPY|
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_F125656_92868_0|SrvcGrp|86835|2022|PDM|12.50|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F147060_32025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|2835.00|99|0.00|AEG 9 (NO REV)|
20|FH_F142228_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.70|99|0.00|OP SVCS|
20|FH_F146859_0_0|SrvcGrp|114839|2022|PDM|2118.00|99|0.00|FOOT CONTRACTURE|
20|FH_F139912_04101_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F140167_16101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140090_37221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140027_61031_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143454_94550_0|SrvcGrp|114036|2022|PDM|114.00|99|0.00|DEMONSTRATION OF HOME INR MONITORING (MOD NU)|
20|FH_F72749_0_0|SrvcGrp|30623|2022|PDM|3901.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|REPAIR VENTRAL HERNIA INI BLOCK|
20|FH_F47600_0_0|SrvcGrp|33643|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD KN|
20|FH_F132418_84042_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F116739_78501_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F116835_94538_0|SrvcGrp|89149|2022|PDM|382.00|99|0.00|OP INTENSIVE|
20|FH_F120050_92626_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125648_67005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F44584_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84611_30281_0|SrvcGrp|73601|2022|PDM|2839.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F51276_0_0|SrvcGrp|29023|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F51276_0_0|SrvcGrp|22389|2022|PDM|19.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F40600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1631.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143467_0_0|SrvcGrp|114046|2022|PCT|0.00|99|0.00|PROSTHETICS/ORTHOPEDICS|
20|FH_F145268_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F40091_0_0|SrvcGrp|17079|2022|PCT|0.70|99|0.00|ASPG VIII|
20|FH_F40755_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|RAD MOD TC|
20|FH_F59732_0_0|SrvcGrp|10578|2022|PDM|40.00|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F59732_0_0|SrvcGrp|17302|2022|PDM|55.00|99|0.00|HYDRATION THERAPY - 3+ LITERS|
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|45882|2022|PDM|105.00|99|0.00|PT|
20|FH_F110220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F56276_0_0|SrvcGrp|52953|2022|PDM|63.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F38360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F117378_16148_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F141470_71913_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113985_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F33782_0_0|SrvcGrp|14114|2022|PDM|75.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F122687_0_0|SrvcGrp|97741|2022|PDM|14205.00|99|0.00|REVISE KNEE|
20|FH_F137067_0_0|SrvcGrp|88162|2022|PDM|6983.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F129105_21713_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33712_0_0|SrvcGrp|15355|2022|PCT|0.60|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)|
20|FH_F43167_0_0|SrvcGrp|12290|2022|PDM|450.00|99|0.00|DETOXIFICATION|
20|FH_F73013_0_0|SrvcGrp|42972|2022|PDM|104.50|99|0.00|HOME HEALTH AIDE|
20|FH_F123953_84003_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F122687_0_0|SrvcGrp|105401|2022|PDM|12381.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F131228_01826_0|SrvcGrp|12280|2022|PCT|1.11|99|0.00|IMPLANTS|
20|FH_F130520_43947_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97102_83501_0|SrvcGrp|73461|2022|PDM|10888.00|99|0.00|AETNA NICU IV|
20|FH_F88199_0_0|SrvcGrp|48396|2022|PDM|82.50|99|0.00|OT SERVICES|
20|FH_F143873_33407_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F73985_0_0|SrvcGrp|14414|2022|PDM|817.00|99|0.00|NEWBORN NURSERY|
20|FH_F83253_33511_0|SrvcGrp|471|2022|PDM|446.25|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F116203_63901_0|SrvcGrp|73700|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F126002_11946_0|SrvcGrp|87317|2022|PDM|605.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F115674_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F121488_77478_0|SrvcGrp|75419|2022|PDM|550.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F51520_0_0|SrvcGrp|43429|2022|PDM|145.00|99|0.00|RN HOURLY, HIGH TECH PEDS|
20|FH_F129115_85716_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F37679_0_0|SrvcGrp|14945|2022|PDM|8.50|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F141001_24739_0|SrvcGrp|91631|2022|PCT|1.00|99|0.00|OFFICE VISIT|
20|FH_F141510_95123_0|SrvcGrp|100520|2022|PDM|525.00|99|0.00|INTENSIVE OP EATING DISORDERS|
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|1041.52|99|0.00|AEG 7 (NO REV)|
20|FH_F116647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|677.00|99|0.00|AEG 3 (NO REV)|
20|FH_F149888_68506_0|SrvcGrp|84926|2022|PDM|3769.00|99|0.00|OP SURGERY|
20|FH_F86412_32258_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125810_67301_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129262_33813_0|SrvcGrp|105685|2022|PDM|212.00|99|0.00|INTENSIVE OUTPATIENT 13-17 YRS|
20|FH_F43513_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F120322_60016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116327_75701_0|SrvcGrp|89149|2022|PDM|192.00|99|0.00|OP INTENSIVE|
20|FH_F125693_92660_0|SrvcGrp|110161|2022|PDM|250.00|99|0.00|OP THERAPY SERVICES|
20|FH_F40099_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F37173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116024_13203_0|SrvcGrp|89149|2022|PDM|148.00|99|0.00|OP INTENSIVE|
20|FH_F77903_0_0|SrvcGrp|131|2022|PCT|0.60|99|0.00|PACEMAKER DEVICE|
20|FH_F90852_0_0|SrvcGrp|10393|2022|PDM|1627.50|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ASPG II|
20|FH_F124965_0_0|SrvcGrp|73000|2022|PDM|1400.00|99|0.00|AEG 6|
20|FH_F145815_30540_0|SrvcGrp|113236|2022|PDM|41.38|99|0.00|COVID-19 SARS-COV-2 W/ OPTIC|
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|602.00|99|0.00|AEG 2 (NO REV)|
20|FH_F40066_0_0|SrvcGrp|24703|2022|PDM|675.00|99|0.00|NEWBORN NURSERY|
20|FH_F109180_18015_0|SrvcGrp|46903|2022|PDM|533.00|99|0.00|RESIDENTIAL TREATMENT|
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_F149740_33912_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F36081_0_0|SrvcGrp|22136|2022|PDM|303.00|99|0.00|CT SCAN|
20|FH_F123272_54901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130032_72034_0|SrvcGrp|90854|2022|PDM|896.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F37945_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2007 LAB/RAD/OTHER DIAG TESTING F/S (GLOBAL) - CPD 1365022|
20|FH_F111288_0_0|SrvcGrp|81904|2022|PDM|22542.00|99|0.00|LAP PARASOPHAG HERNIA REPAIR|
20|FH_F150982_0_0|SrvcGrp|36591|2022|PDM|8320.00|99|0.00|CPT 63685|
20|FH_F141527_36830_0|SrvcGrp|29076|2022|PDM|26.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F34854_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|ACUTE PSYCH|
20|FH_F31882_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35259_0_0|SrvcGrp|3029|2022|PDM|923.00|99|0.00|NEWBORN NURSERY|
20|FH_F32286_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F129683_45255_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F40089_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132051_74464_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F145755_08050_0|SrvcGrp|111928|2022|PCT|1.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F97500_32025_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F117784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39138_0_0|SrvcGrp|26893|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS/IMPLANTS|
20|FH_F137588_33852_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116760_68512_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F129643_33176_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38377_0_0|SrvcGrp|14081|2022|PDM|115.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F151541_01436_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130038_08021_0|SrvcGrp|89149|2022|PDM|205.00|99|0.00|OP INTENSIVE|
20|FH_F41776_0_0|SrvcGrp|16623|2022|PCT|0.30|99|0.00|OBSERVATION SVCS|
20|FH_F122905_41018_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F87092_60101_0|SrvcGrp|72990|2022|PDM|1328.00|99|0.00|AEG 1|
20|FH_F89340_0_0|SrvcGrp|55084|2022|PDM|2200.00|99|0.00|CPT 52648|
20|FH_F88398_15601_0|SrvcGrp|73701|2022|PDM|38.46|99|0.00|AETNA - SKILLED NURSING|
20|FH_F124613_64735_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F129103_17545_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136657_70806_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F114792_48849_0|SrvcGrp|73842|2022|PDM|187.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138779_62703_0|SrvcGrp|3178|2022|PDM|1024.00|99|0.00|ACUTE PSYCH|
20|FH_F138779_62703_0|SrvcGrp|86722|2022|PDM|233.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F100664_03104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F43779_0_0|SrvcGrp|903|2022|PCT|0.75|99|0.00|PTC ANGIOPLASTY|
20|FH_F43779_0_0|SrvcGrp|9863|2022|PDM|2887.00|99|0.00|INTENSIVE CARE/CORONARY CARE UNIT|
20|FH_F117085_40207_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F117069_15236_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136772_89109_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F136778_62034_0|SrvcGrp|112965|2022|PDM|9247.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F112371_19047_0|SrvcGrp|10391|2022|PDM|1685.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F113713_17013_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|AETNA PSYTX W/PT 45 MIN MOD HO (HCFA)|
20|FH_F69623_0_0|SrvcGrp|10503|2022|PDM|47.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F115210_21043_0|SrvcGrp|97730|2022|PDM|10000.00|99|0.00|REVERSE HIP JOINT|
20|FH_F115266_66736_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F115631_65201_0|SrvcGrp|35668|2022|PDM|3177.00|99|0.00|CPT 29824|
20|FH_F115733_33012_0|SrvcGrp|3178|2022|PDM|735.00|99|0.00|ACUTE PSYCH|
20|FH_F147586_44124_0|SrvcGrp|26278|2022|PDM|1634.00|99|0.00|CPT 29881|
20|FH_F147586_44124_0|SrvcGrp|98459|2022|PDM|1294.00|99|0.00|RESECT FOOT TOE TUMOR|
20|FH_F147586_44124_0|SrvcGrp|104255|2022|PDM|1065.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F33925_0_0|SrvcGrp|15779|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F36132_0_0|SrvcGrp|22077|2022|PDM|810.00|99|0.00|RESIDENTIAL TREATMENT SVCS|
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103004_75840_0|SrvcGrp|73806|2022|PDM|500.00|99|0.00|AETNA ER|
20|FH_F124444_0_0|SrvcGrp|87077|2022|PDM|130.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F140007_0_0|SrvcGrp|97019|2022|PDM|4290.00|99|0.00|ARTHROSCOPY BICEPS TENODESIS|
20|FH_F62582_81650_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS|
20|FH_F120112_0_0|SrvcGrp|95661|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F113180_23507_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F133579_0_0|SrvcGrp|46887|2022|PDM|2205.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F150939_0_0|SrvcGrp|100242|2022|PCT|0.00|99|0.00|ANTIBODY|
20|FH_F46672_0_0|SrvcGrp|9828|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE|
20|FH_F40535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F54552_0_0|SrvcGrp|17302|2022|PDM|55.00|99|0.00|HYDRATION THERAPY - 3+ LITERS|
20|FH_F112947_47303_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F113585_20155_0|SrvcGrp|86854|2022|PDM|80.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F113585_20155_0|SrvcGrp|13929|2022|PDM|15.00|99|0.00|GROWTH HORMONE|
20|FH_F138770_75142_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138856_48092_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F138936_01040_0|CSTM-ALL|CSTM-00|2020|PDM|2575.00|99|0.00|AEG 6 (NO REV)|
20|FH_F100904_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F106500_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117715_0_0|SrvcGrp|75483|2022|PDM|747.00|99|0.00|AEG 3|
20|FH_F72606_0_0|SrvcGrp|3646|2022|PDM|9525.00|99|0.00|ELECTROPHYSIOLOGY|
20|FH_F122069_75935_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135495_33145_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135978_06851_0|SrvcGrp|112784|2022|PDM|254.00|99|0.00|PARTIAL HOSPITALIZATION  (>=19 YRS)|
20|FH_F136081_71742_0|SrvcGrp|537|2022|PCT|0.60|99|0.00|OBSERVATION SERVICES|
20|FH_F136127_15658_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130620_18940_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116397_33404_0|SrvcGrp|17014|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116397_33404_0|SrvcGrp|90339|2022|PDM|68.00|99|0.00|SKILLED NURSING RN|
20|FH_F116464_13088_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F140629_0_0|SrvcGrp|98526|2022|PDM|1016.00|99|0.00|CYSTOURETHROSCOPY|
20|FH_F32938_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|OP SVCS|
20|FH_F121407_73701_0|SrvcGrp|1943|2022|PDM|1413.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F121763_07202_0|SrvcGrp|102980|2022|PDM|61.00|99|0.00|PSYTX WPT W E/M 30 MIN|
20|FH_F146909_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72586_0_0|CSTM-ALL|CSTM-00|2020|PDM|340.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128370_76132_0|SrvcGrp|86723|2022|PDM|375.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F128353_22191_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F32371_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F44396_0_0|CSTM-ALL|CSTM-00|2020|PDM|359.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51272_0_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS|
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|82107|2022|PDM|1800.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F130120_75862_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102325_62691_0|SrvcGrp|29077|2022|PDM|65.00|99|0.00|HOME TRANSFUSION|
20|FH_F129240_10028_0|SrvcGrp|86853|2022|PDM|40.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F129234_78245_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101320_26062_0|SrvcGrp|14949|2022|PDM|138.00|99|0.00|HOME INFUSION|
20|FH_F39543_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F119507_92627_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F138283_0_0|SrvcGrp|53144|2022|PDM|107.00|99|0.00|SPEECH THERAPY|
20|FH_F148498_75028_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37567_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ASPG II|
20|FH_F119226_07746_0|SrvcGrp|75442|2022|PDM|574.00|99|0.00|OBSERVATION - REV 762|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|377.00|99|0.00|HAPA EPA ASC 44|
20|FH_F34706_0_0|SrvcGrp|12212|2022|PDM|915.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)|
20|FH_F98620_43920_0|SrvcGrp|73485|2022|PDM|2301.00|99|0.00|AETNA REHAB|
20|FH_F142782_16201_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117346_75093_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F67192_0_0|SrvcGrp|62963|2022|PCT|0.52|99|0.00|SURGICAL|
20|FH_F67639_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148639_0_0|SrvcGrp|87677|2022|PDM|1770.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F133261_78041_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F51129_0_0|SrvcGrp|30063|2022|PCT|0.55|99|0.00|HIGH COST DRUGS|
20|FH_F63250_0_0|SrvcGrp|59414|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY SVCS EXCLD MOD GP|
20|FH_F128657_19008_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F102561_75146_0|SrvcGrp|79589|2022|PDM|4961.00|99|0.00|UPPER GI|
20|FH_F91198_46714_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133006_48067_0|SrvcGrp|108484|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F136393_0_0|SrvcGrp|11306|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F97181_33143_0|SrvcGrp|89149|2022|PDM|300.00|99|0.00|OP INTENSIVE|
20|FH_F128445_85704_0|SrvcGrp|75419|2022|PDM|577.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F87436_0_0|SrvcGrp|16429|2022|PCT|0.62|99|0.00|OBSERVATION SVCS|
20|FH_F89015_74017_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|HCPCS G0154 (HCFA)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|408.19|99|0.00|HAPA WPA-NWPA 2012-13 ASC 216 W/O REV|
20|FH_F38865_0_0|SrvcGrp|3259|2022|PDM|1035.00|99|0.00|ACUTE REHABILITATION|
20|FH_F67379_0_0|SrvcGrp|941|2022|PDM|2119.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F91635_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.30|99|0.00|GENERAL ACUTE CARE|
20|FH_F55375_0_0|SrvcGrp|17081|2022|PDM|12500.00|99|0.00|ASPG IX|
20|FH_F148886_60621_0|SrvcGrp|114462|2022|PCT|1.35|99|0.00|CHEMO DRUGS|
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 5  (NO REV)|
20|FH_F134467_84321_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP|
20|FH_F42557_0_0|SrvcGrp|3087|2022|PDM|586.00|99|0.00|CD - DETOX|
20|FH_F145907_03867_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|1413.00|99|0.00|AEG 7 (NO REV)|
20|FH_F105921_80014_0|SrvcGrp|43569|2022|PDM|90.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|119.64|99|0.00|HAPA WPA-NWPA 2012-13 ASC 240 W/O REV|
20|FH_F141890_64865_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F112853_22408_0|SrvcGrp|91281|2022|PDM|0.42|99|0.00|ENTERAL AND PARENTERAL THERAPY|
20|FH_F117895_28170_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F146135_87112_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F106700_02906_0|SrvcGrp|81340|2022|PCT|2.20|99|0.00|AETNA LABORATORY|
20|FH_F118496_92627_0|SrvcGrp|73842|2022|PDM|315.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136751_0_0|SrvcGrp|112581|2022|PDM|4535.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F133447_53120_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F97141_93933_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|373.25|99|0.00|HAPA WPA-NWPA 2012-13 ASC 221 W/O REV|
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 4 (NO REV)|
20|FH_F148639_0_0|SrvcGrp|33986|2022|PDM|1163.00|99|0.00|CPT 26055|
20|FH_F143993_07621_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109812_37043_0|SrvcGrp|89417|2022|PDM|542.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F144668_62526_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F94165_0_0|SrvcGrp|85570|2022|PCT|0.85|99|0.00|AETNA HOSPITAL OP DIALYSIS|
20|FH_F97541_33021_0|SrvcGrp|73659|2022|PDM|6882.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.00|99|0.00|ASPG VII|
20|FH_F120763_60957_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132934_63005_0|SrvcGrp|92577|2022|PDM|3429.00|99|0.00|PEDIATRIC MEDICAL CARE (=< 17 YRS)|
20|FH_F130861_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95661_27217_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F97622_75051_0|SrvcGrp|73659|2022|PDM|9830.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F148556_13206_0|SrvcGrp|21711|2022|PDM|90.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F144008_11413_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F146105_76016_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F65359_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42444_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82813_0_0|SrvcGrp|73006|2022|PDM|2026.00|99|0.00|AEG 9|
20|FH_F118363_30305_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.30|99|0.00|AEG 8 (NO REV)|
20|FH_F34706_0_0|SrvcGrp|9948|2022|PDM|47705.00|99|0.00|DRG 528 INTRACRANIAL VASCULAR PROC|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/MOD KF (CO)|
20|FH_F50974_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INFUSION THERAPY AND SERVICES|
20|FH_F142041_44846_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F132729_0_0|SrvcGrp|360|2022|PDM|2059.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F117550_0_0|SrvcGrp|87536|2022|PDM|200.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 10 (NO REV)|
20|FH_F92676_15063_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F120437_85202_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146320_27610_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|246.25|99|0.00|ASPG 308|
20|FH_F132886_0_0|SrvcGrp|106294|2022|PDM|412.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F109404_0_0|SrvcGrp|17000|2022|PCT|1.25|99|0.00|OUTPATIENT SURGERY|
20|FH_F133427_48811_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146135_87112_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F56792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1525.00|99|0.00|ASPG V WITH MOD SG|
20|FH_F118027_28801_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F141767_62312_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F91262_77036_0|SrvcGrp|48385|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F92752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89932_10940_0|SrvcGrp|74670|2022|PCT|0.45|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F135714_01922_0|SrvcGrp|82222|2022|PDM|145.00|99|0.00|HOSPICE CARE|
20|FH_F139667_84078_0|SrvcGrp|100663|2022|PDM|474.00|99|0.00|HOSPICE IP CARE|
20|FH_F139676_76901_0|SrvcGrp|73842|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139677_77087_0|SrvcGrp|46903|2022|PDM|590.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F139679_75050_0|SrvcGrp|89337|2022|PDM|935.00|99|0.00|DETOXIFICATION|
20|FH_F150882_84041_0|SrvcGrp|88621|2022|PDM|105.00|99|0.00|SKILLED NURSING LPN|
20|FH_F148667_0_0|SrvcGrp|100066|2022|PDM|2856.00|99|0.00|REPAIR RADIUS FRACTURE|
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|424.00|99|0.00|AEG 1 (NO REV)|
20|FH_F131574_64131_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|1608.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132732_0_0|SrvcGrp|3409|2022|PDM|614.00|99|0.00|NEWBORN NURSERY|
20|FH_F86551_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|462.00|99|0.00|HAPA EPA ASC 52|
20|FH_F131385_76457_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F76826_0_0|SrvcGrp|16448|2022|PDM|849.00|99|0.00|AIR AMBULANCE|
20|FH_F69183_0_0|SrvcGrp|10906|2022|PCT|0.50|99|0.00|EMERGENCY ROOM LEVEL IV|
20|FH_F41463_0_0|SrvcGrp|34391|2022|PDM|71.55|99|0.00|CPT CODE 94760 MOD NU|
20|FH_F131387_76001_0|SrvcGrp|89149|2022|PDM|202.00|99|0.00|OP INTENSIVE|
20|FH_F39772_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (HCFA)|
20|FH_F124759_34108_0|SrvcGrp|73842|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124719_64093_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|1121.00|99|0.00|AEG 8 (NO REV)|
20|FH_F117576_21207_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F138017_73129_0|SrvcGrp|113304|2022|PDM|8523.00|99|0.00|COLPOPEXY|
20|FH_F150922_02452_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F84433_0_0|SrvcGrp|43569|2022|PDM|107.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F35736_34952_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F50415_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F127830_63703_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126914_44136_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F119316_27104_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F101441_0_0|SrvcGrp|96939|2022|PDM|4238.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F74844_0_0|SrvcGrp|42870|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F117583_21208_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F138987_0_0|SrvcGrp|90707|2022|PDM|117.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124380_83406_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F35781_33133_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F147303_70508_0|SrvcGrp|46605|2022|PDM|89.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F130654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F93961_0_0|SrvcGrp|91858|2022|PDM|611.00|99|0.00|SIGMOIDOSCOPY CODE W/ ULTRASOUND|
20|FH_F94643_90501_0|SrvcGrp|86779|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F129340_43212_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F128753_32501_0|SrvcGrp|75495|2022|PCT|0.64|99|0.00|AEG 9|
20|FH_F41320_0_0|SrvcGrp|9916|2022|PDM|830.00|99|0.00|OBSERVATION SVCS|
20|FH_F37341_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|ASPG IV|
20|FH_F98840_31021_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F110121_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|369.00|99|0.00|AEG 1 (NO REV)|
20|FH_F56472_0_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F102525_73134_0|SrvcGrp|75443|2022|PDM|1050.00|99|0.00|OBSERVATION - REV 769|
20|FH_F112794_01040_0|SrvcGrp|94740|2022|PCT|1.00|99|0.00|AFLURIA VACC IM (>=3 YRS)|
20|FH_F148702_32606_0|SrvcGrp|90854|2022|PDM|875.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F132008_85226_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F76588_0_0|SrvcGrp|73523|2022|PDM|18.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F36328_0_0|CSTM-ALL|CSTM-00|2020|PDM|885.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36992_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD KN|
20|FH_F97260_06111_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F125113_0_0|SrvcGrp|80139|2022|PDM|14707.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F112045_90301_0|SrvcGrp|82137|2022|PCT|0.40|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F140233_35216_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 6 (NO REV)|
20|FH_F139950_76240_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F143347_16001_0|SrvcGrp|79865|2022|PDM|16993.00|99|0.00|ANGIO W/STENT + ARTHERECTOMY|
20|FH_F87411_0_0|SrvcGrp|85683|2022|PDM|107.79|99|0.00|POLYSOM (MOD 26)|
20|FH_F62579_0_0|SrvcGrp|24750|2022|PDM|80.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F131612_0_0|SrvcGrp|107865|2022|PCT|1.00|99|0.00|AETNA INJECTABLES (J CODES)|
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|2861.00|99|0.00|AEG 9 (NO REV)|
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|344.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132609_0_0|SrvcGrp|413|2022|PCT|0.72|99|0.00|TRANSPLANT SVCS|
20|FH_F120603_66112_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F145641_06902_0|SrvcGrp|83640|2022|PDM|4902.00|99|0.00|CPT 29887|
20|FH_F83113_0_0|SrvcGrp|9228|2022|PDM|50.00|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F148927_0_0|SrvcGrp|16719|2022|PCT|0.47|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F120670_0_0|SrvcGrp|84939|2022|PDM|16000.00|99|0.00|SHOULDER JOINT|
20|FH_F126354_91321_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F112041_19020_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F134593_60007_0|SrvcGrp|86833|2022|PDM|12.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F148267_0_0|SrvcGrp|92501|2022|PDM|162.59|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F87919_01950_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121628_19533_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120670_0_0|SrvcGrp|108910|2022|PDM|16000.00|99|0.00|REVISE HIP ARTHROP|
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PDM|5377.00|99|0.00|2007 MEDICARE ASPG II|
20|FH_F120425_11106_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F110470_98335_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150145_20124_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F70208_0_0|SrvcGrp|30623|2022|PDM|3542.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F133972_27103_0|SrvcGrp|112492|2022|PDM|230.00|99|0.00|INSRT NON-TUNNL CNTRL CVC (HCFA)|
20|FH_F79743_0_0|SrvcGrp|13293|2022|PCT|0.60|99|0.00|HIGH-COST DRUGS|
20|FH_F111027_32817_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F120719_27540_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS|
20|FH_F63318_0_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|DBPT PT-OT-ST|
20|FH_F132899_01002_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|174.90|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1501 W/O REV|
20|FH_F118265_46268_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F142930_0_0|SrvcGrp|33722|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F126550_43085_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F134208_21502_0|SrvcGrp|63471|2022|PDM|3000.00|99|0.00|CPT 64590|
20|FH_F133811_29615_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F81861_0_0|SrvcGrp|64098|2022|PDM|3213.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 9|
20|FH_F150161_63361_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F129509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110509_71351_0|SrvcGrp|84186|2022|PCT|0.00|99|0.00|LITHOTRIPSY ESWL|
20|FH_F146120_45040_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149263_0_0|SrvcGrp|115609|2022|PDM|3589.00|99|0.00|ANKLE FRACTURE REPAIR|
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_F133747_80634_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|GENERAL ACUTE CARE|
20|FH_F145562_70458_0|SrvcGrp|86829|2022|PDM|20.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F125513_40071_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F89323_63033_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126341_27284_0|SrvcGrp|24744|2022|PCT|1.00|99|0.00|PICC LINE INSERTION|
20|FH_F120930_0_0|SrvcGrp|35672|2022|PDM|3000.00|99|0.00|CPT 23412|
20|FH_F133749_84604_0|SrvcGrp|112429|2022|PDM|25.00|99|0.00|TOCOLYTIC INFUSION THERAPY (HCFA)|
20|FH_F143708_19031_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F127071_82435_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F138348_04096_0|SrvcGrp|73605|2022|PDM|950.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F90501_71101_0|SrvcGrp|75481|2022|PDM|2500.00|99|0.00|AEG 2|
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|1724.18|99|0.00|AEG 10 (NO REV)|
20|FH_F85353_16407_0|SrvcGrp|63837|2022|PDM|477.02|99|0.00|HAPA WPA-NWPA 2012-13 ASC 105|
20|FH_F135670_01749_0|SrvcGrp|14945|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F150239_75569_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150311_18106_0|SrvcGrp|113773|2022|PCT|1.00|99|0.00|TELEMEDICINE (MOD 95, GT)|
20|FH_F134947_14227_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146207_73139_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F83995_16748_0|CSTM-ALL|CSTM-00|2020|PCT|2.25|99|0.00|HAPA WPA/NWPA 2018 RAD 100%|
20|FH_F118803_0_0|SrvcGrp|107877|2022|PDM|349.70|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F50583_0_0|SrvcGrp|472|2022|PDM|1000.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F100782_0_0|SrvcGrp|105105|2022|PDM|159.83|99|0.00|WINDBER MEDICAL CNTR ASC 150|
20|FH_F146559_71901_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|PDM|1320.00|99|0.00|AEG 5  (NO REV)|
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F121225_98902_0|SrvcGrp|34173|2022|PDM|281.40|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F138050_52301_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS|
20|FH_F119227_01752_0|SrvcGrp|14947|2022|PDM|60.00|99|0.00|HOME INFUSION|
20|FH_F145555_72204_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116473_0_0|SrvcGrp|90063|2022|PDM|2200.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F85652_98034_0|SrvcGrp|16|2022|PDM|3312.00|99|0.00|ACUTE REHABILITATION|
20|FH_F134174_63141_0|CSTM-ALL|CSTM-00|2020|PDM|620.00|99|0.00|CPT 95810 (W/MOD TC)|
20|FH_F111986_0_0|SrvcGrp|72996|2022|PDM|1030.00|99|0.00|AEG 4|
20|FH_F122948_23947_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143413_75061_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143451_50635_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143488_84770_0|CSTM-ALL|CSTM-00|2020|PDM|549.00|99|0.00|AEG 1 (NO REV)|
20|FH_F133247_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|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_F101709_0_0|SrvcGrp|84442|2022|PDM|10691.00|99|0.00|REVISION KNEE|
20|FH_F131067_57105_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1168.00|99|0.00|GA RETINA SURG CTR ASC 27|
20|FH_F47952_0_0|SrvcGrp|10527|2022|PDM|120.00|99|0.00|HOSPICE SVCS|
20|FH_F48476_0_0|SrvcGrp|42046|2022|PDM|595.00|99|0.00|HOSPICE CARE|
20|FH_F136250_73026_0|SrvcGrp|89149|2022|PDM|330.00|99|0.00|OP INTENSIVE|
20|FH_F120856_78247_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120927_28645_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118874_29926_0|SrvcGrp|73605|2022|PDM|1000.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F118950_33312_0|SrvcGrp|73605|2022|PDM|1275.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F118792_63379_0|SrvcGrp|537|2022|PCT|0.74|99|0.00|OBSERVATION SERVICES|
20|FH_F84611_30281_0|SrvcGrp|82648|2022|PDM|7637.00|99|0.00|ERCP LITHOTRIPSY|
20|FH_F84611_30281_0|SrvcGrp|73262|2022|PCT|0.73|99|0.00|AETNA OP OBSERVATION W/ER|
20|FH_F48915_0_0|SrvcGrp|44789|2022|PDM|60.00|99|0.00|SPEECH THERAPY|
20|FH_F51276_0_0|SrvcGrp|16559|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 5  (NO REV)|
20|FH_F39567_0_0|SrvcGrp|10|2022|PDM|4050.00|99|0.00|ANGIOPLASTY|
20|FH_F145536_90265_0|SrvcGrp|75419|2022|PDM|2660.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F145815_30540_0|SrvcGrp|113232|2022|PDM|42.13|99|0.00|COVID-19 SARS-COV-2 ANTB QUANTITATIVE|
20|FH_F123278_20850_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F128401_44615_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F130503_98102_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131190_21042_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F110263_0_0|SrvcGrp|115581|2022|PDM|7354.00|99|0.00|CYSTOURETHROSCOPY/URETEROSCO (HCFA)|
20|FH_F118373_21205_0|SrvcGrp|107759|2022|PDM|3129.00|99|0.00|MED-SUR-GY/DLX|
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 6 (NO REV)|
20|FH_F40834_0_0|SrvcGrp|413|2022|PCT|0.85|99|0.00|TRANSPLANT SVCS|
20|FH_F93332_0_0|SrvcGrp|93081|2022|PDM|7725.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY (HCFA)|
20|FH_F140988_22041_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F141607_27021_0|SrvcGrp|66265|2022|PDM|120.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F78603_0_0|SrvcGrp|54973|2022|PDM|58795.27|99|0.00|MS DRG 225 ONLY|
20|FH_F40043_0_0|SrvcGrp|30654|2022|PCT|0.76|99|0.00|OP LITHOTRIPSY|
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 6 (NO REV)|
20|FH_F51192_0_0|SrvcGrp|33165|2022|PDM|450.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F37650_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS|
20|FH_F127165_32112_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F141590_90049_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F35476_0_0|SrvcGrp|20293|2022|PDM|30000.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY|
20|FH_F37945_0_0|SrvcGrp|10927|2022|PDM|389.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F77404_0_0|SrvcGrp|26001|2022|PDM|142.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F32727_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F37679_0_0|SrvcGrp|27060|2022|PDM|19.50|99|0.00|HYDRATION THERAPY - 3+ LITERS (MOD SH)|
20|FH_F34546_0_0|SrvcGrp|701|2022|PDM|1250.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F135052_18702_0|SrvcGrp|76501|2022|PDM|291.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F35388_0_0|SrvcGrp|9774|2022|PDM|1835.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145545_01602_0|CSTM-ALL|CSTM-00|2020|PDM|473.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F123385_03561_0|SrvcGrp|48394|2022|PDM|57.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F135771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73142_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149866_07401_0|SrvcGrp|471|2022|PDM|412.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F120248_77008_0|SrvcGrp|90040|2022|PDM|250.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F75307_0_0|SrvcGrp|27969|2022|PDM|44.00|99|0.00|HOME HEALTH AIDE|
20|FH_F93332_0_0|SrvcGrp|87448|2022|PDM|4120.00|99|0.00|AETNA KYPHOPLASTY (2015 HIPPA)|
20|FH_F46612_0_0|SrvcGrp|24639|2022|PDM|154.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F91876_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F69322_0_0|CSTM-ALL|CSTM-00|2020|PDM|881.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F139241_0_0|SrvcGrp|77584|2022|PDM|765.00|99|0.00|DIAGNOSTIC COLONOSCOPY|
20|FH_F77883_0_0|SrvcGrp|74924|2022|PDM|63.50|99|0.00|HOME HEALTH AID VISIT/LNA|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F36366_0_0|SrvcGrp|13620|2022|PDM|1094.00|99|0.00|SLEEP STUDIES|
20|FH_F124660_0_0|SrvcGrp|73006|2022|PDM|1575.00|99|0.00|AEG 9|
20|FH_F143829_74066_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143903_06249_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F115064_78582_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F84778_0_0|SrvcGrp|72990|2022|PDM|1155.00|99|0.00|AEG 1|
20|FH_F142073_0_0|SrvcGrp|34606|2022|PDM|2400.00|99|0.00|CPT 29827|
20|FH_F33642_0_0|SrvcGrp|13363|2022|PCT|0.75|99|0.00|EMERGENCY ROOM SVCS LEVEL V|
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|4235.00|99|0.00|LAP VENT/ABD HERN PROC COMP|
20|FH_F151526_28208_0|SrvcGrp|109135|2022|PDM|4143.00|99|0.00|AV FISTULA EXCISION|
20|FH_F35599_0_0|SrvcGrp|20847|2022|PDM|825.00|99|0.00|ABORTION 15 WEEKS|
20|FH_F127032_33573_0|SrvcGrp|57966|2022|PDM|699.64|99|0.00|HOSPICE CARE|
20|FH_F55054_0_0|CSTM-ALL|CSTM-00|2020|PDM|4415.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F31111_0_0|SrvcGrp|112479|2022|PDM|65.00|99|0.00|COVID-19 ANTIBODY (HCFA)|
20|FH_F121427_0_0|SrvcGrp|108081|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F131236_84041_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F100790_10512_0|SrvcGrp|73659|2022|PDM|5785.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F77042_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F148440_16506_0|SrvcGrp|38909|2022|PDM|2700.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|S CODES|
20|FH_F150079_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F42360_0_0|SrvcGrp|36515|2022|PCT|0.60|99|0.00|HIGH COST DRUGS|
20|FH_F141427_22003_0|SrvcGrp|29347|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|9173.00|99|0.00|AEG 4 (NO REV)|
20|FH_F33899_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F121539_27511_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143971_34986_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F91900_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F121800_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F137495_36701_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F34413_0_0|SrvcGrp|177|2022|PDM|1000.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F93332_0_0|SrvcGrp|67073|2022|PDM|2295.00|99|0.00|CPT 22851|
20|FH_F120952_25303_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F135078_73119_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32621_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139515_0_0|SrvcGrp|88492|2022|PDM|2122.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F115057_15601_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F126153_44663_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F123331_45373_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F114916_30309_0|CSTM-ALL|CSTM-00|2020|PDM|572.00|99|0.00|AEG 1 (NO REV)|
20|FH_F55054_0_0|SrvcGrp|360|2022|PDM|2465.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F148483_94087_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1192.99|99|0.00|AEG 2 (NO REV)|
20|FH_F120249_43215_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124608_0_0|SrvcGrp|82107|2022|PDM|2550.00|99|0.00|SHOULDER ARTHROSCOPY|
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_F130721_04769_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 4 (NO REV)|
20|FH_F130898_06405_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138056_64055_0|SrvcGrp|27968|2022|PDM|44.00|99|0.00|SKILLED NURSING LPN|
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|AEG 4 (NO REV)|
20|FH_F85353_16407_0|SrvcGrp|63794|2022|PDM|992.99|99|0.00|HAPA WPA-NWPA 2012-13 ASC 502|
20|FH_F81838_0_0|SrvcGrp|9828|2022|PDM|39.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132609_0_0|SrvcGrp|58|2022|PCT|0.67|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F35966_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145604_14850_0|SrvcGrp|22592|2022|PDM|70.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD UE KC"|
20|FH_F110425_01752_0|SrvcGrp|48385|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F90501_71101_0|SrvcGrp|10944|2022|PDM|550.00|99|0.00|EMERGENCY ROOM|
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1415.00|99|0.00|ASPG VII - FH SW CUSTOM GROUPERS|
20|FH_F77082_0_0|SrvcGrp|21040|2022|PCT|0.80|99|0.00|MS DRG 652 ONLY - KIDNEY TRANSPLANT|
20|FH_F113465_28204_0|SrvcGrp|105361|2022|PCT|1.00|99|0.00|HOSPICE/PHYSICIAN|
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 7 (NO REV)|
20|FH_F150542_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F143581_02130_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F85097_0_0|SrvcGrp|14243|2022|PDM|806.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F120719_27540_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F45120_0_0|SrvcGrp|30457|2022|PCT|0.21|99|0.00|DRUGS|
20|FH_F67887_0_0|SrvcGrp|42828|2022|PDM|100.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F128379_0_0|SrvcGrp|89842|2022|PDM|14306.00|99|0.00|LUMBAR|
20|FH_F149051_01605_0|SrvcGrp|85017|2022|PCT|1.07|99|0.00|DME|
20|FH_F145604_14850_0|SrvcGrp|17016|2022|PDM|70.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F127579_44321_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F110642_17901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112060_07514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119783_46360_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F81563_0_0|CSTM-ALL|CSTM-00|2020|PDM|546.43|99|0.00|AEG 1 (NO REV)|
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|1742.00|99|0.00|AEG 9 (NO REV)|
20|FH_F126391_24651_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110470_98335_0|SrvcGrp|91394|2022|PDM|90.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD HO)|
20|FH_F121225_98902_0|SrvcGrp|108916|2022|PCT|0.00|99|0.00|HOSPICE IP/OP RESPITE CARE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.98|99|0.00|HAPA WPA-NWPA 2012-13 ASC 401 W/O REV|
20|FH_F133868_40202_0|SrvcGrp|89412|2022|PDM|258.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F136591_0_0|SrvcGrp|3178|2022|PDM|798.78|99|0.00|ACUTE PSYCH|
20|FH_F133749_84604_0|SrvcGrp|112467|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY SUPPLIES (HCFA)|
20|FH_F118123_67226_0|SrvcGrp|22589|2022|PDM|34.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F111986_0_0|SrvcGrp|87055|2022|PDM|1442.00|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION|
20|FH_F77943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F123646_91350_0|SrvcGrp|23587|2022|PDM|638.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F69708_0_0|SrvcGrp|42830|2022|PDM|92.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F149319_07670_0|SrvcGrp|75545|2022|PDM|397.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F110660_85741_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F112065_20852_0|SrvcGrp|46605|2022|PDM|130.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F134608_18017_0|SrvcGrp|112599|2022|PDM|16.00|99|0.00|BLOOD YPING RH|
20|FH_F120670_0_0|SrvcGrp|99167|2022|PDM|6000.00|99|0.00|CPT 63057|
20|FH_F46113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F90496_13159_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F129633_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F111702_07652_0|SrvcGrp|96402|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA|
20|FH_F110247_08865_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132609_0_0|CSTM-ALL|CSTM-00|2020|PDM|1952.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|MT NITTANY ASC 5|
20|FH_F90416_73013_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F49853_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F100782_0_0|SrvcGrp|97585|2022|PDM|841.01|99|0.00|WINDBER MEDICAL CNTR ASC 212|
20|FH_F85212_71075_0|SrvcGrp|72992|2022|PDM|666.00|99|0.00|AEG 2|
20|FH_F119657_39111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113764_0_0|SrvcGrp|42824|2022|PDM|80.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|1904.00|99|0.00|AEG 10 (NO REV)|
20|FH_F50657_0_0|SrvcGrp|32390|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKE (DME)|
20|FH_F76022_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F81861_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.25|99|0.00|HAPA OHIO 2014 NISC 100%|
20|FH_F83113_0_0|SrvcGrp|9874|2022|PDM|39.00|99|0.00|DIETICIAN|
20|FH_F112023_12866_0|SrvcGrp|73498|2022|PDM|972.00|99|0.00|AETNA ER LEVEL III|
20|FH_F114409_18447_0|SrvcGrp|95779|2022|PDM|29.00|99|0.00|HOSPICE CARE|
20|FH_F71273_0_0|SrvcGrp|63|2022|PDM|1282.00|99|0.00|SUBACUTE CARE|
20|FH_F112668_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|713.00|99|0.00|AEG 4 (NO REV)|
20|FH_F126114_31788_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F58396_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INFUSION SERVICE|
20|FH_F150130_70359_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127080_77520_0|SrvcGrp|86723|2022|PDM|468.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F114526_33401_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F145640_32503_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129101_27006_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|336.41|99|0.00|HAPA WPA-NWPA 2012-13 ASC 106 W/O REV|
20|FH_F80185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102142_80014_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT INTEGRITY HH|
20|FH_F115903_43560_0|SrvcGrp|73842|2022|PDM|421.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F63625_0_0|SrvcGrp|33793|2022|PDM|16464.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F66427_0_0|SrvcGrp|3971|2022|PDM|243.00|99|0.00|SKILLED NURSING CARE|
20|FH_F146846_73139_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120522_53549_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F131737_15025_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F133558_87111_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133544_78227_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F133494_90023_0|CSTM-ALL|CSTM-00|2020|PDM|4830.00|99|0.00|AEG 7 (NO REV)|
20|FH_F111563_02116_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F46433_0_0|SrvcGrp|17011|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F46433_0_0|SrvcGrp|24752|2022|PDM|25.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F113025_0_0|SrvcGrp|104723|2022|PDM|719.00|99|0.00|REPAIR EYELID DEFECT|
20|FH_F113025_0_0|SrvcGrp|104722|2022|PDM|458.00|99|0.00|REPAIR EYELID DEFECT|
20|FH_F119594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F122911_92240_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F86157_75090_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F86851_0_0|SrvcGrp|79589|2022|PDM|520.00|99|0.00|UPPER GI|
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137057_0_0|SrvcGrp|104745|2022|PDM|165.00|99|0.00|HOSPICE|
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|966.14|99|0.00|ASPG VII|
20|FH_F46832_0_0|SrvcGrp|24751|2022|PDM|60.00|99|0.00|INTERMITTENT ANTICOAGULANT THERAPY|
20|FH_F46832_0_0|SrvcGrp|14893|2022|PDM|60.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F69968_0_0|SrvcGrp|46518|2022|PDM|6685.29|99|0.00|ELECTROPHYSIOLOGY STUDIES|
20|FH_F115166_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F136542_02446_0|SrvcGrp|111639|2022|PDM|354.00|99|0.00|PARTIAL HOSPITALIZATION (>=18) (HCFA)|
20|FH_F118201_35126_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F134008_11221_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F136952_78218_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F137068_81147_0|SrvcGrp|111931|2022|PDM|35.91|99|0.00|COVID-19 CDC TESTING LAB|
20|FH_F137147_75006_0|SrvcGrp|89984|2022|PDM|22134.00|99|0.00|LAMINECTOMY W/FACE-LUMBAR|
20|FH_F114092_83350_0|SrvcGrp|72984|2022|PCT|0.00|99|0.00|CHEMOTHERAPY|
20|FH_F142330_43701_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142727_21222_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142741_03264_0|SrvcGrp|108484|2022|PDM|2047.50|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F97602_40121_0|SrvcGrp|73602|2022|PDM|2160.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F138471_84663_0|SrvcGrp|48385|2022|PDM|84.50|99|0.00|SPEECH THERAPY|
20|FH_F78404_16646_0|SrvcGrp|11336|2022|PCT|0.34|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F140730_84106_0|SrvcGrp|104230|2022|PDM|93.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F140734_71105_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC|
20|FH_F140750_89119_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F140765_30315_0|SrvcGrp|112727|2022|PDM|45.23|99|0.00|COVID-19 IA NFCT AB SARS COV 2|
20|FH_F120152_0_0|SrvcGrp|27315|2022|PDM|3300.00|99|0.00|TENDON REPAIR|
20|FH_F148739_47129_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F149441_28401_0|SrvcGrp|74668|2022|PDM|206.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149639_96822_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151603_27609_0|CSTM-ALL|CSTM-00|2020|PDM|1676.00|99|0.00|AEG 6 (NO REV)|
20|FH_F119023_91406_0|SrvcGrp|107994|2022|PCT|1.00|99|0.00|ALL OP DRUG (C, Q, S CODES)|
20|FH_F63054_0_0|SrvcGrp|20074|2022|PDM|400.00|99|0.00|HYPERBARIC CHAMBER|
20|FH_F147744_33614_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC|
20|FH_F117190_84020_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117240_37334_0|SrvcGrp|1943|2022|PDM|1000.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F128804_0_0|SrvcGrp|13990|2022|PCT|1.05|99|0.00|PACEMAKER|
20|FH_F95880_02726_0|SrvcGrp|104301|2022|PCT|0.95|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F151086_60649_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151144_35801_0|SrvcGrp|88149|2022|PDM|1273.10|99|0.00|RELEASE OF EYE FLUID|
20|FH_F151159_46322_0|SrvcGrp|66265|2022|PDM|97.75|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F114968_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129130_92562_0|SrvcGrp|73461|2022|PDM|5813.32|99|0.00|AETNA NICU IV|
20|FH_F129130_92562_0|SrvcGrp|23279|2022|PDM|708.56|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|578.07|99|0.00|DELAWARE VALLEY- ASC 3|
20|FH_F65761_0_0|SrvcGrp|42825|2022|PDM|63.65|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F77763_0_0|SrvcGrp|3810|2022|PDM|105.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F91873_12723_0|SrvcGrp|89142|2022|PDM|14665.00|99|0.00|ELECTROPHYSIOLOGY STUDIES|
20|FH_F56252_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F117299_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F86911_0_0|SrvcGrp|44707|2022|PDM|50.00|99|0.00|NURSING CARE|
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|1089.00|99|0.00|AEG 8 (NO REV)|
20|FH_F104840_32565_0|SrvcGrp|75489|2022|PCT|0.69|99|0.00|AEG 6|
20|FH_F105480_19940_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129597_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F138929_0_0|SrvcGrp|87677|2022|PDM|1457.50|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F143898_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|GENERAL ACUTE CARE|
20|FH_F144828_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_F124180_0_0|SrvcGrp|86033|2022|PDM|3500.00|99|0.00|CPT 67107|
20|FH_F147039_06374_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147059_28806_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F62624_0_0|SrvcGrp|58516|2022|PDM|5445.00|99|0.00|OP CARDIAC CATH|
20|FH_F36318_0_0|CSTM-ALL|CSTM-00|2020|PDM|1954.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F42363_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|OP SVCS|
20|FH_F91998_0_0|SrvcGrp|90427|2022|PDM|6500.00|99|0.00|CERVICAL SPINAL FUSION|
20|FH_F98380_43055_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F124636_85008_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127995_84010_0|SrvcGrp|17013|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F97083_90670_0|SrvcGrp|73603|2022|PDM|7969.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F97040_31901_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F132973_28054_0|SrvcGrp|73841|2022|PDM|204.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|1292.00|99|0.00|ASPG I|
20|FH_F89273_0_0|SrvcGrp|88269|2022|PDM|400.00|99|0.00|RETINAL TAMPONADE DEVICE|
20|FH_F136607_68632_0|SrvcGrp|112064|2022|PCT|0.97|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F136611_43764_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F114666_30342_0|SrvcGrp|105634|2022|PDM|10000.00|99|0.00|KNEE JOINT LINING|
20|FH_F113847_20910_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F113870_10536_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F138981_85123_0|SrvcGrp|108484|2022|PDM|500.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F43444_0_0|SrvcGrp|37018|2022|PDM|275.00|99|0.00|BOARDER BABY|
20|FH_F43779_0_0|SrvcGrp|16|2022|PDM|1071.00|99|0.00|ACUTE REHABILITATION|
20|FH_F135715_32073_0|CSTM-ALL|CSTM-00|2020|PCT|0.20|99|0.00|OP SVCS|
20|FH_F112378_60505_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F34498_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F49016_0_0|SrvcGrp|9978|2022|PDM|1250.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS|
20|FH_F147522_64114_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F42024_0_0|SrvcGrp|9938|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F36132_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP MAFS  MOD 53|
20|FH_F36372_0_0|SrvcGrp|11802|2022|PDM|120.00|99|0.00|HOME INFUSION|
20|FH_F36418_0_0|SrvcGrp|13123|2022|PCT|1.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F39266_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F43156_0_0|SrvcGrp|12834|2022|PDM|280.00|99|0.00|EMERGENCY ROOM|
20|FH_F98625_08103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111186_15213_0|SrvcGrp|86722|2022|PDM|314.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F123445_0_0|SrvcGrp|95661|2022|PDM|706.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F109963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150239_75569_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F100782_0_0|SrvcGrp|105292|2022|PDM|187.75|99|0.00|WINDBER MEDICAL CNTR ASC 244|
20|FH_F143567_62207_0|SrvcGrp|47183|2022|PDM|140.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F126348_23824_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F112468_0_0|SrvcGrp|73008|2022|PDM|796.00|99|0.00|AEG 10|
20|FH_F146207_73139_0|SrvcGrp|29155|2022|PDM|134.00|99|0.00|HOSPICE SVCS|
20|FH_F116657_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F134249_05060_0|SrvcGrp|79238|2022|PDM|4550.00|99|0.00|TRANSFER|
20|FH_F120408_0_0|SrvcGrp|100499|2022|PDM|691.79|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F145641_06902_0|SrvcGrp|93432|2022|PDM|17610.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F116806_0_0|SrvcGrp|107040|2022|PDM|1923.16|99|0.00|PERCUTANEOUS OF MANDIBULAR FRACTURE W/ EXTERNAL FIXATION|
20|FH_F133972_27103_0|SrvcGrp|17014|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F111027_32817_0|SrvcGrp|108484|2022|PDM|975.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F63297_0_0|SrvcGrp|59427|2022|PDM|75.00|99|0.00|OT|
20|FH_F38889_0_0|SrvcGrp|72|2022|PDM|368.00|99|0.00|NEWBORN NURSERY|
20|FH_F122425_75082_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F70607_0_0|SrvcGrp|65605|2022|PDM|143.00|99|0.00|HOSPICE|
20|FH_F70684_0_0|SrvcGrp|43569|2022|PDM|105.45|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F85257_0_0|SrvcGrp|997|2022|PCT|0.55|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F100907_85206_0|SrvcGrp|79720|2022|PDM|1157.00|99|0.00|ACUTE REHAB II|
20|FH_F101100_50314_0|SrvcGrp|3178|2022|PDM|1264.00|99|0.00|ACUTE PSYCH|
20|FH_F101100_50314_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA - APC GROUPER G|
20|FH_F105145_75075_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F115903_43560_0|SrvcGrp|89417|2022|PDM|820.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F66782_0_0|SrvcGrp|43569|2022|PDM|40.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F77665_0_0|SrvcGrp|10615|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE|
20|FH_F127656_06068_0|SrvcGrp|65720|2022|PDM|159.60|99|0.00|RESPITE CARE|
20|FH_F116023_10027_0|SrvcGrp|73842|2022|PDM|100.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131741_19037_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133667_83642_0|SrvcGrp|106048|2022|PDM|1030.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F131212_63017_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F130657_04614_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 6 (NO REV)|
20|FH_F111584_07002_0|SrvcGrp|104441|2022|PDM|51.38|99|0.00|AETNA DRUG TEST PRSMV DIR OPT OBS (HCFA)|
20|FH_F134828_30531_0|SrvcGrp|112660|2022|PDM|38.00|99|0.00|XRAY EXAM OF SHOULDER (HCFA)|
20|FH_F134828_30531_0|SrvcGrp|91445|2022|PDM|37.00|99|0.00|RADIOLOGIC FOOT EXAM (HCFA)|
20|FH_F132810_0_0|SrvcGrp|22592|2022|PDM|40.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F136536_46075_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134011_84102_0|SrvcGrp|95660|2022|PDM|112.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F134156_32174_0|SrvcGrp|86722|2022|PDM|229.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F142690_31774_0|SrvcGrp|29075|2022|PDM|85.00|99|0.00|HYDRATION THERAPY|
20|FH_F142690_31774_0|SrvcGrp|48396|2022|PDM|145.00|99|0.00|OT SERVICES|
20|FH_F142737_77703_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142742_44112_0|SrvcGrp|74668|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138512_62236_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140407_63841_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F140573_46517_0|SrvcGrp|94064|2022|PDM|300.00|99|0.00|OP BEHAVIORAL OBSERVATION|
20|FH_F140760_07003_0|SrvcGrp|86722|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F140761_33172_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F80062_27612_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F119021_03060_0|SrvcGrp|73842|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F38332_0_0|SrvcGrp|18886|2022|PDM|42216.00|99|0.00|MS DRG 234|
20|FH_F117267_07728_0|SrvcGrp|107410|2022|PDM|1184.00|99|0.00|CARDIAC PROCEDURES|
20|FH_F117377_71303_0|SrvcGrp|92502|2022|PDM|551.11|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F129434_98271_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F129504_02871_0|SrvcGrp|90707|2022|PDM|170.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F137276_83127_0|SrvcGrp|88621|2022|PDM|60.75|99|0.00|SKILLED NURSING LPN|
20|FH_F119555_0_0|SrvcGrp|474|2022|PDM|2710.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F137898_46540_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F137938_29036_0|SrvcGrp|65161|2022|PDM|2933.00|99|0.00|NEWBORN HIGHER LEVEL|
20|FH_F38699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F110720_0_0|SrvcGrp|104098|2022|PDM|4669.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F90735_94070_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F129892_0_0|SrvcGrp|11673|2022|PDM|1495.00|99|0.00|CPT 29888|
20|FH_F95880_02726_0|SrvcGrp|94739|2022|PDM|56.65|99|0.00|NOS FLU VACC IM (>=3 YRS)|
20|FH_F151141_24014_0|SrvcGrp|107792|2022|PDM|6350.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F121385_89102_0|SrvcGrp|73603|2022|PDM|4300.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F39895_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|ACUTE PSYCH|
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F91873_12723_0|SrvcGrp|13130|2022|PDM|1815.00|99|0.00|TRAUMA EMERGENCY ROOM SVCS|
20|FH_F97720_70084_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F116323_0_0|SrvcGrp|106668|2022|PDM|25737.00|99|0.00|AETNA LUMBAR SPINE FUSION|
20|FH_F72690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F73231_0_0|SrvcGrp|11113|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME|
20|FH_F36854_0_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|ACUTE PSYCH|
20|FH_F110940_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F129912_0_0|CSTM-ALL|CSTM-00|2020|PDM|775.00|99|0.00|AEG 2 (NO REV)|
20|FH_F40088_0_0|SrvcGrp|177|2022|PDM|1060.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F54552_0_0|SrvcGrp|22590|2022|PDM|80.00|99|0.00|PAIN MANAGAMENT - INTERMITTENT|
20|FH_F54552_0_0|SrvcGrp|17016|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138784_32216_0|SrvcGrp|12659|2022|PDM|777.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F138936_01040_0|SrvcGrp|16069|2022|PDM|1082.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F57953_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F113390_0_0|SrvcGrp|105238|2022|PDM|1320.00|99|0.00|INCISION OF TONGUE FOLD|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1614.78|99|0.00|HAPA WPA-NWPA 2012-13 ASC 9 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.10|99|0.00|HAPA WPA-NWPA 2012-13 ASC 124 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|167.18|99|0.00|HAPA WPA-NWPA 2012-13 ASC 133 W/O REV|
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|2684.00|99|0.00|AEG 2 (NO REV)|
20|FH_F151420_60654_0|SrvcGrp|67989|2022|PDM|2528.00|99|0.00|CPT 49320|
20|FH_F151501_30265_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F132262_60062_0|SrvcGrp|100499|2022|PDM|785.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F144948_83704_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97501_31501_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F42554_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|OP SVCS|
20|FH_F91766_25401_0|SrvcGrp|48398|2022|PDM|120.75|99|0.00|PT SERVICES|
20|FH_F135924_02906_0|SrvcGrp|109057|2022|PCT|1.03|99|0.00|CARDIAC STUDIES|
20|FH_F136042_90066_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136247_28804_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131463_19096_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F131112_99163_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116397_33404_0|SrvcGrp|24745|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F116527_70443_0|SrvcGrp|104400|2022|PCT|1.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F116468_49660_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F101200_19020_0|SrvcGrp|52951|2022|PCT|1.15|99|0.00|PSYCHIATRIC CPT 90846|
20|FH_F101681_46123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121466_84057_0|SrvcGrp|89337|2022|PDM|800.00|99|0.00|DETOXIFICATION|
20|FH_F121761_44130_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F128353_22191_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F133668_63128_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F111292_33136_0|SrvcGrp|82762|2022|PDM|24.00|99|0.00|URINALYSIS AUTO W/ SCOPE|
20|FH_F111301_33122_0|SrvcGrp|72990|2022|PDM|1048.00|99|0.00|AEG 1|
20|FH_F134288_33919_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC INVOICE|
20|FH_F87153_0_0|CSTM-ALL|CSTM-00|2020|PDM|39.88|99|0.00|AETNA SLEEP STUDIES (MOD TC)|
20|FH_F33390_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F34532_0_0|SrvcGrp|13631|2022|PDM|65.00|99|0.00|CPT 99213|
20|FH_F51272_0_0|SrvcGrp|47590|2022|PDM|12000.00|99|0.00|LITHOTRIPSY|
20|FH_F131000_0_0|SrvcGrp|99167|2022|PDM|4994.00|99|0.00|CPT 63057|
20|FH_F132073_0_0|SrvcGrp|57966|2022|PDM|556.00|99|0.00|HOSPICE CARE|
20|FH_F132328_0_0|SrvcGrp|26276|2022|PDM|1800.00|99|0.00|CPT 29819|
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|2006 MEDICARE ASPG IV|
20|FH_F141035_0_0|SrvcGrp|113718|2022|PDM|4029.00|99|0.00|TENDON EXCISION PALM / FINGER|
20|FH_F141035_0_0|SrvcGrp|104111|2022|PDM|3932.00|99|0.00|EXCISE WRIST TENDON SHEATH|
20|FH_F102862_30606_0|SrvcGrp|28078|2022|PDM|21160.00|99|0.00|MS DRG 029 ONLY|
20|FH_F102960_50613_0|SrvcGrp|110135|2022|PDM|851.00|99|0.00|RESIDENTIAL PSYCHIATRIC TREATMENT|
20|FH_F101320_26062_0|SrvcGrp|19742|2022|PDM|108.00|99|0.00|MID-LINE INSERTION|
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 1 (NO REV)|
20|FH_F66642_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.30|99|0.00|OP SVCS|
20|FH_F148431_60523_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F65899_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F116825_0_0|SrvcGrp|74383|2022|PDM|33.13|99|0.00|SPEECH THERAPY|
20|FH_F41814_0_0|SrvcGrp|9226|2022|PCT|0.45|99|0.00|MED/SURG OTHER SUPPLIES/DEVICES|
20|FH_F141967_89509_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F126030_29835_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112587_37058_0|SrvcGrp|104302|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F148925_61531_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92833_0_0|SrvcGrp|84279|2022|PDM|2992.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F97565_83301_0|SrvcGrp|73656|2022|PDM|586.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F71667_0_0|SrvcGrp|10681|2022|PDM|182.00|99|0.00|INTENSIVE  SVCS|
20|FH_F150948_0_0|SrvcGrp|113853|2022|PDM|3000.00|99|0.00|CARDIAC CATHERIZATION INCL INJECTIONS|
20|FH_F34706_0_0|SrvcGrp|12047|2022|PCT|1.00|99|0.00|CPT CODES 80000-89999, 36415 (LAB)|
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|1662.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|AEG 7 (NO REV)|
20|FH_F134430_86301_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150001_33064_0|SrvcGrp|10577|2022|PDM|26.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F150559_60018_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|2611.00|99|0.00|AEG 1 (NO REV)|
20|FH_F38425_0_0|SrvcGrp|10540|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE|
20|FH_F126663_91423_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F50472_0_0|SrvcGrp|46723|2022|PDM|130.00|99|0.00|WORK HARDENING|
20|FH_F120550_91355_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44701_0_0|SrvcGrp|13297|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F112165_0_0|SrvcGrp|72996|2022|PDM|3200.00|99|0.00|AEG 4|
20|FH_F148556_13206_0|SrvcGrp|16750|2022|PDM|90.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F40154_0_0|SrvcGrp|12280|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F141935_76033_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132503_73086_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F139825_0_0|SrvcGrp|42429|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 66761|
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|767.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F144022_32118_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|PDM|97.00|99|0.00|HAPA EPA ASC 16|
20|FH_F117875_70601_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F149864_32905_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133003_49012_0|SrvcGrp|86723|2022|PDM|360.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F67861_0_0|SrvcGrp|3029|2022|PDM|880.00|99|0.00|NEWBORN NURSERY|
20|FH_F148865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F126735_38018_0|SrvcGrp|75419|2022|PDM|800.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F149401_0_0|SrvcGrp|109036|2022|PDM|601.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "GLOBAL"|
20|FH_F113146_15001_0|SrvcGrp|90632|2022|PDM|162.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F136393_0_0|SrvcGrp|109501|2022|PDM|2000.00|99|0.00|REPAIR LEAD PACE-DEFIB DUAL|
20|FH_F43411_0_0|SrvcGrp|18932|2022|PDM|3865.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806|
20|FH_F92677_08003_0|SrvcGrp|86828|2022|PDM|151.20|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F118468_21502_0|SrvcGrp|472|2022|PDM|549.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F67424_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F127412_15301_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F97560_23249_0|SrvcGrp|73559|2022|PDM|18630.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F97562_29803_0|SrvcGrp|73559|2022|PDM|13686.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F37568_0_0|SrvcGrp|26017|2022|PDM|90.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F56332_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111467_33761_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 10 (NO REV)|
20|FH_F126666_44053_0|SrvcGrp|104414|2022|PDM|169.00|99|0.00|PSYCH DIAGNOSTIC EVALUATION (HCFA)(MOD AF)|
20|FH_F133490_90650_0|SrvcGrp|110820|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F88280_0_0|SrvcGrp|21108|2022|PDM|9053.00|99|0.00|MS DRG 243 ONLY|
20|FH_F117559_08619_0|SrvcGrp|74422|2022|PDM|15.00|99|0.00|IMMUNIZATION ADMIN|
20|FH_F147800_0_0|SrvcGrp|89862|2022|PDM|275.00|99|0.00|FLUOROSCOPIC GUIDANCE|
20|FH_F125471_34471_0|SrvcGrp|73842|2022|PDM|235.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F97042_64804_0|SrvcGrp|88978|2022|PDM|3764.00|99|0.00|VAGINAL DELIVERY|
20|FH_F44724_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|430.85|99|0.00|ASPG II|
20|FH_F150001_33064_0|SrvcGrp|22593|2022|PDM|26.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F120550_91355_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133490_90650_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F35477_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150602_59718_0|SrvcGrp|104228|2022|PDM|153.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F126806_44125_0|SrvcGrp|89781|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F78205_0_0|SrvcGrp|17065|2022|PDM|789.28|99|0.00|ASPG I|
20|FH_F141731_92590_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F139679_75050_0|SrvcGrp|108484|2022|PDM|770.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139707_84010_0|SrvcGrp|116275|2022|PDM|8880.00|99|0.00|BARIATRIC PROCEDURES|
20|FH_F150745_03301_0|SrvcGrp|104230|2022|PDM|212.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F150799_44041_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150841_84757_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F139150_75206_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F38007_0_0|SrvcGrp|361|2022|PDM|3195.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F68460_0_0|SrvcGrp|87317|2022|PDM|813.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F117617_80439_0|SrvcGrp|107587|2022|PDM|165.00|99|0.00|HOSPICE/HH CARE IN ASSISTED LIVING FAC (HCFA)|
20|FH_F90232_15126_0|SrvcGrp|43569|2022|PDM|91.35|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F39772_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (HCFA)|
20|FH_F38007_0_0|SrvcGrp|8950|2022|PDM|3385.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F39756_0_0|SrvcGrp|31523|2022|PDM|1185.80|99|0.00|CUMBERLAND SURGERY CTR - ASPG VII|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|26.50|99|0.00|BIOLOGICAL RESPONSE MODIFIERS THERAPY (MOD KP/SH)|
20|FH_F107922_0_0|SrvcGrp|471|2022|PDM|575.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F40590_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130661_04441_0|SrvcGrp|75505|2022|PCT|0.86|99|0.00|CARDIAC STUDIES|
20|FH_F67924_0_0|SrvcGrp|24029|2022|PDM|55.00|99|0.00|RN HOURLY|
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|AEG 3 (NO REV)|
20|FH_F148667_0_0|SrvcGrp|35668|2022|PDM|2856.00|99|0.00|CPT 29824|
20|FH_F124441_0_0|SrvcGrp|26278|2022|PDM|2375.00|99|0.00|CPT 29881|
20|FH_F39151_0_0|SrvcGrp|30225|2022|PDM|200.00|99|0.00|NEWBORN NURSERY|
20|FH_F117905_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F56652_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F110805_45227_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F92280_15090_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|1751.00|99|0.00|AEG 6 (NO REV)|
20|FH_F110783_93013_0|SrvcGrp|24745|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F119897_78229_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F39202_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39211_0_0|SrvcGrp|28847|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PDM|1316.00|99|0.00|ASPG IV|
20|FH_F150928_62521_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F35369_0_0|SrvcGrp|10|2022|PDM|3500.00|99|0.00|ANGIOPLASTY|
20|FH_F149160_02180_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F114188_15205_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F111857_68005_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F110783_93013_0|SrvcGrp|14948|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG X|
20|FH_F103180_85283_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F114206_37203_0|SrvcGrp|86845|2022|PDM|35.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F110666_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123745_0_0|SrvcGrp|27918|2022|PDM|8500.00|99|0.00|CPT 23410, 23412|
20|FH_F40627_0_0|SrvcGrp|11920|2022|PCT|0.70|99|0.00|PHARMACY SVCS|
20|FH_F131495_77407_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F97184_26101_0|SrvcGrp|73659|2022|PDM|7468.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F113545_11201_0|SrvcGrp|73842|2022|PDM|240.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F116806_0_0|SrvcGrp|107079|2022|PDM|1923.16|99|0.00|REPAIR PALATE|
20|FH_F116806_0_0|SrvcGrp|93642|2022|PDM|949.60|99|0.00|BIOPSY REMOVAL LYMPH NODES|
20|FH_F54952_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
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|CSTM-ALL|CSTM-00|2020|PDM|1825.00|99|0.00|AEG 6 (NO REV)|
20|FH_F35792_33175_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F124316_28112_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36202_0_0|SrvcGrp|2738|2022|PCT|0.75|99|0.00|IMPLANTS|
20|FH_F150924_90029_0|SrvcGrp|75419|2022|PDM|545.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F125182_0_0|SrvcGrp|79579|2022|PDM|3315.00|99|0.00|CPT 43251|
20|FH_F134603_0_0|SrvcGrp|78403|2022|PDM|0.15|99|0.00|AETNA MED RECORD|
20|FH_F137798_0_0|SrvcGrp|80918|2022|PDM|140.00|99|0.00|RESPITE CARE|
20|FH_F110732_31513_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112128_63017_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F119897_78229_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F137902_0_0|SrvcGrp|89149|2022|PDM|161.00|99|0.00|OP INTENSIVE|
20|FH_F139668_42701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F98900_42001_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F112823_0_0|SrvcGrp|42550|2022|PDM|2155.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F151661_78526_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|PDM|383.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PDM|756.00|99|0.00|ASPG IV|
20|FH_F149001_37055_0|SrvcGrp|57967|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F35446_0_0|SrvcGrp|701|2022|PDM|2076.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F109247_73102_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F97280_20018_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F146266_0_0|SrvcGrp|27315|2022|PDM|2450.00|99|0.00|TENDON REPAIR|
20|FH_F134868_32504_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F126502_0_0|SrvcGrp|87077|2022|PDM|133.95|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F140036_07702_0|SrvcGrp|89417|2022|PDM|355.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F72749_0_0|SrvcGrp|30707|2022|PDM|1213.00|99|0.00|MS DRG 789-793 ONLY|
20|FH_F75305_0_0|SrvcGrp|45087|2022|PDM|2441.00|99|0.00|LICENSED NICU|
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|474.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F101755_0_0|CSTM-ALL|CSTM-00|2020|PCT|52.00|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_F102224_0_0|SrvcGrp|74039|2022|PDM|6000.00|99|0.00|LAMINECTOMY|
20|FH_F151720_03301_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F151748_20037_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|1532.94|99|0.00|ASPG IV|
20|FH_F132419_84042_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F120799_92651_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F116698_07470_0|SrvcGrp|86827|2022|PDM|78.75|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F119918_38201_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120871_14068_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F120856_78247_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120966_60707_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F113649_01752_0|SrvcGrp|111742|2022|PCT|1.00|99|0.00|ADULT ENTERAL FORMULA|
20|FH_F118792_63379_0|SrvcGrp|12787|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F84611_30281_0|SrvcGrp|72992|2022|PDM|1555.00|99|0.00|AEG 2|
20|FH_F147211_0_0|SrvcGrp|108622|2022|PDM|585.00|99|0.00|SUB ACUTE CARE LEVEL II|
20|FH_F49895_0_0|SrvcGrp|31187|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF (DME)|
20|FH_F49895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER QW|
20|FH_F46258_0_0|SrvcGrp|14892|2022|PDM|100.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F61292_0_0|SrvcGrp|44564|2022|PDM|523.00|99|0.00|NEWBORN NURSERY|
20|FH_F78928_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F129367_89117_0|SrvcGrp|89149|2022|PDM|247.00|99|0.00|OP INTENSIVE|
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PDM|3800.00|99|0.00|AEG 9 (NO REV)|
20|FH_F140893_19720_0|SrvcGrp|88621|2022|PDM|125.00|99|0.00|SKILLED NURSING LPN|
20|FH_F145758_20745_0|SrvcGrp|58638|2022|PDM|1836.00|99|0.00|CPT 63688|
20|FH_F143971_34986_0|SrvcGrp|108484|2022|PDM|650.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F85039_0_0|SrvcGrp|75483|2022|PDM|561.00|99|0.00|AEG 3|
20|FH_F112163_0_0|SrvcGrp|47411|2022|PDM|229.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F112967_0_0|SrvcGrp|24739|2022|PDM|115.00|99|0.00|RESPITE CARE|
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41539_0_0|SrvcGrp|28818|2022|PCT|0.45|99|0.00|SUPPLIES AND DEVICES|
20|FH_F95282_77975_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F132988_0_0|SrvcGrp|90417|2022|PDM|4493.01|99|0.00|TREATMENT OF JOINT|
20|FH_F133002_0_0|SrvcGrp|72992|2022|PDM|562.00|99|0.00|AEG 2|
20|FH_F136818_0_0|SrvcGrp|112937|2022|PDM|2155.00|99|0.00|SURGICAL SERVICES|
20|FH_F50415_0_0|SrvcGrp|44704|2022|PDM|80.00|99|0.00|NURSING CARE|
20|FH_F114389_50131_0|SrvcGrp|21711|2022|PDM|337.29|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F114389_50131_0|SrvcGrp|46605|2022|PDM|203.55|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F124180_0_0|SrvcGrp|73000|2022|PDM|1700.00|99|0.00|AEG 6|
20|FH_F131505_0_0|SrvcGrp|89869|2022|PDM|410.00|99|0.00|SPONTANEOUS ABORTION|
20|FH_F88733_0_0|SrvcGrp|87536|2022|PDM|315.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F124059_64055_0|SrvcGrp|14948|2022|PDM|125.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F124136_75860_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146922_68108_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F101164_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62624_0_0|SrvcGrp|58518|2022|PDM|6500.00|99|0.00|MS DRG 691 - 694 ONLY - LITHROTRIPSY|
20|FH_F91898_0_0|SrvcGrp|116022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F91998_0_0|SrvcGrp|90061|2022|PDM|8500.00|99|0.00|AETNA RECONSTRUCT SHOULDER JOINT|
20|FH_F124417_85364_0|SrvcGrp|108818|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F124636_85008_0|SrvcGrp|108061|2022|PCT|1.25|99|0.00|OP THERAPY SERVICES|
20|FH_F127995_84010_0|SrvcGrp|73742|2022|PDM|4.41|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F97040_31901_0|SrvcGrp|73605|2022|PDM|2103.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F97040_31901_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F76163_0_0|SrvcGrp|22954|2022|PDM|146.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F114666_30342_0|SrvcGrp|11663|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F114666_30342_0|SrvcGrp|99161|2022|PDM|18000.00|99|0.00|CPT 27138|
20|FH_F114666_30342_0|SrvcGrp|84318|2022|PDM|3500.00|99|0.00|SPINE INFUSION|
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.66|99|0.00|2005 ASPG GROUPER II|
20|FH_F132721_0_0|SrvcGrp|40820|2022|PDM|3088.00|99|0.00|ICU/CCU|
20|FH_F122571_53555_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122638_59715_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F43653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F43779_0_0|SrvcGrp|361|2022|PDM|2887.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F134674_06473_0|SrvcGrp|74668|2022|PDM|137.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136796_24016_0|SrvcGrp|58993|2022|PDM|5396.49|99|0.00|DISKECTOMY|
20|FH_F136828_32405_0|SrvcGrp|3178|2022|PDM|905.00|99|0.00|ACUTE PSYCH|
20|FH_F116393_07002_0|SrvcGrp|106515|2022|PDM|19.67|99|0.00|PROT ELEC-PHORE FRACTIONATI|
20|FH_F116393_07002_0|SrvcGrp|90488|2022|PDM|119.00|99|0.00|ORAL FUNCTION THERAPY|
20|FH_F147700_21401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147414_92656_0|SrvcGrp|73605|2022|PDM|1400.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F41540_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111201_25301_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|GENERAL ACUTE CARE|
20|FH_F33381_0_0|SrvcGrp|2741|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|1021.00|99|0.00|AEG 8 (NO REV)|
20|FH_F140007_0_0|SrvcGrp|64761|2022|PDM|7887.00|99|0.00|DISCECTOMY|
20|FH_F37626_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AEG 2 (NO REV)|
20|FH_F34626_0_0|SrvcGrp|42975|2022|PDM|95.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F86660_0_0|SrvcGrp|12491|2022|PCT|0.55|99|0.00|PACEMAKER|
20|FH_F134087_0_0|SrvcGrp|88492|2022|PDM|2195.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F98361_12065_0|SrvcGrp|88978|2022|PDM|4930.00|99|0.00|VAGINAL DELIVERY|
20|FH_F41013_0_0|SrvcGrp|16746|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F139016_47460_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F78265_0_0|CSTM-ALL|CSTM-00|2020|PDM|2348.00|99|0.00|ASPG V|
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F106500_0_0|CSTM-ALL|CSTM-00|2020|PDM|544.00|99|0.00|CPT 95811 (W/MOD TC)|
20|FH_F113390_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F151507_32327_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132258_45404_0|SrvcGrp|73742|2022|PCT|1.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F132268_07060_0|SrvcGrp|90492|2022|PDM|236.00|99|0.00|BEHAVRAL QUALIT ANALYS VOICE|
20|FH_F145068_63084_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135447_53226_0|SrvcGrp|104470|2022|PDM|1125.00|99|0.00|ANTEPARTUM CARE ONLY (7 OR MORE VISITS)|
20|FH_F135587_37334_0|SrvcGrp|104762|2022|PCT|1.00|99|0.00|AETNA HIGH COST DRUGS|
20|FH_F97142_94535_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F135920_32211_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135924_02906_0|SrvcGrp|105809|2022|PCT|1.03|99|0.00|PT OT ST|
20|FH_F135969_33904_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130996_34110_0|SrvcGrp|88157|2022|PDM|17000.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F130756_04901_0|SrvcGrp|73806|2022|PCT|0.89|99|0.00|AETNA ER|
20|FH_F34709_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F121743_70005_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F69205_0_0|SrvcGrp|36971|2022|PDM|184.02|99|0.00|MISC INFUSION THERAPY|
20|FH_F128201_33334_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130817_18103_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 3 (NO REV)|
20|FH_F111292_33136_0|SrvcGrp|12491|2022|PCT|0.63|99|0.00|PACEMAKER|
20|FH_F135294_64093_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|818.00|99|0.00|AEG 4 (NO REV)|
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_F93332_0_0|SrvcGrp|89857|2022|PDM|6386.00|99|0.00|REMOVAL OF SPINAL LAMINA|
20|FH_F84816_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.70|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_F72887_0_0|SrvcGrp|61516|2022|PDM|51.00|99|0.00|THERAPY PER VISIT|
20|FH_F82714_18848_0|SrvcGrp|471|2022|PDM|1061.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F102302_0_0|SrvcGrp|97179|2022|PDM|10850.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PDM|4190.00|99|0.00|MS DRG 775|
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.60|99|0.00|ASPG V|
20|FH_F66412_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F125028_19061_0|SrvcGrp|26869|2022|PDM|52.50|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F127152_50636_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149886_68112_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148200_26554_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F141801_80534_0|SrvcGrp|73841|2022|PDM|525.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F126844_44333_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F127877_43560_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133099_66801_0|SrvcGrp|87052|2022|PCT|0.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F141527_36830_0|SrvcGrp|86840|2022|PDM|26.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F41887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 315-316 OTHER CIRCULATORY SYS DIAG|
20|FH_F66465_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|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_F123302_33407_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
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_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 10 (NO REV)|
20|FH_F125690_67211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143891_19808_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F72842_0_0|CSTM-ALL|CSTM-00|2020|PDM|3564.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148201_82716_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: BREAKOUT|
20|FH_F137943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 10 (NO REV)|
20|FH_F94942_0_0|SrvcGrp|72996|2022|PDM|929.06|99|0.00|AEG 4|
20|FH_F110925_01104_0|SrvcGrp|22592|2022|PDM|59.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F125864_78748_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143528_0_0|SrvcGrp|88158|2022|PDM|4359.60|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F149866_07401_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F38034_0_0|SrvcGrp|27883|2022|PCT|0.90|99|0.00|ELECTROPHYSIOLOGY|
20|FH_F33513_0_0|SrvcGrp|189|2022|PCT|0.60|99|0.00|DURABLE MEDICAL EQUIPMENT|
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|2123.43|99|0.00|ASPG VII|
20|FH_F45632_0_0|SrvcGrp|41485|2022|PDM|25.00|99|0.00|CADD SYSTEM|
20|FH_F120296_97223_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125993_64850_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37587_0_0|SrvcGrp|3483|2022|PDM|2950.00|99|0.00|CPT CODE 59400|
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|1057.00|99|0.00|AEG 7 (NO REV)|
20|FH_F33513_0_0|SrvcGrp|34866|2022|PCT|0.77|99|0.00|HOME HEALTH - PT/OT/ST|
20|FH_F51520_0_0|SrvcGrp|45784|2022|PDM|160.00|99|0.00|NUTRITIONAL SERVICES (RD)|
20|FH_F148489_0_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F116731_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|1758.00|99|0.00|AEG 8 (NO REV)|
20|FH_F87254_0_0|SrvcGrp|78285|2022|PDM|2200.00|99|0.00|CPT 58671|
20|FH_F126033_15301_0|SrvcGrp|48396|2022|PDM|90.46|99|0.00|OT SERVICES|
20|FH_F121547_46805_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F83533_70433_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110061_0_0|SrvcGrp|75481|2022|PDM|473.00|99|0.00|AEG 2|
20|FH_F148200_26554_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133099_66801_0|SrvcGrp|88977|2022|PCT|0.80|99|0.00|C-SECTION DELIVERY|
20|FH_F48215_0_0|SrvcGrp|12856|2022|PDM|42.25|99|0.00|NURSING CARE|
20|FH_F32772_0_0|SrvcGrp|3378|2022|PCT|0.95|99|0.00|OBSERVATION SVCS|
20|FH_F42429_0_0|CSTM-ALL|CSTM-00|2020|PDM|5702.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127036_43724_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F119760_0_0|SrvcGrp|63297|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F127998_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F93880_95476_0|SrvcGrp|73006|2022|PDM|6612.00|99|0.00|AEG 9|
20|FH_F36366_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116760_68512_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F33181_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ANGIOPLASTY|
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F117113_0_0|SrvcGrp|472|2022|PDM|367.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 1 (NO REV)|
20|FH_F125074_18104_0|SrvcGrp|48398|2022|PDM|118.65|99|0.00|PT SERVICES|
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|786.00|99|0.00|AEG 4 (NO REV)|
20|FH_F102500_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148266_45419_0|CSTM-ALL|CSTM-00|2020|PDM|1390.00|99|0.00|AEG 7 (NO REV)|
20|FH_F92091_0_0|SrvcGrp|72992|2022|PDM|1090.00|99|0.00|AEG 2|
20|FH_F148892_0_0|SrvcGrp|115145|2022|PDM|668.00|99|0.00|NJX AA&/STRD PUDENDAL NERVE|
20|FH_F93132_73134_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135259_21090_0|SrvcGrp|46903|2022|PDM|969.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F114977_78550_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F63186_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130715_98503_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120930_0_0|SrvcGrp|96543|2022|PDM|2500.00|99|0.00|REVISION OF CALF TENDON|
20|FH_F126308_44515_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F146657_01105_0|SrvcGrp|114680|2022|PDM|64.63|99|0.00|ALCOHOL AND/OR DRUG OUTREACH (MOD HT)|
20|FH_F96780_0_0|SrvcGrp|46890|2022|PDM|1605.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F79923_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F113368_37752_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118088_71261_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F133775_83401_0|SrvcGrp|48385|2022|PDM|140.00|99|0.00|SPEECH THERAPY|
20|FH_F121476_0_0|SrvcGrp|36273|2022|PDM|299.00|99|0.00|INTRAOCULAR LENS|
20|FH_F85652_98034_0|SrvcGrp|29757|2022|PDM|34843.00|99|0.00|MS DRG 251 ONLY|
20|FH_F112665_0_0|SrvcGrp|67068|2022|PDM|7699.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F97861_62223_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F68849_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F100782_0_0|SrvcGrp|105113|2022|PDM|769.95|99|0.00|WINDBER MEDICAL CNTR ASC 218|
20|FH_F123325_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F117437_0_0|SrvcGrp|104230|2022|PDM|180.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F149199_73005_0|SrvcGrp|109057|2022|PCT|0.55|99|0.00|CARDIAC STUDIES|
20|FH_F149340_19136_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125259_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F121650_60153_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124173_66215_0|SrvcGrp|14948|2022|PDM|125.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F70208_0_0|CSTM-ALL|CSTM-00|2020|PDM|602.00|99|0.00|ASPG II|
20|FH_F70448_0_0|SrvcGrp|59122|2022|PDM|138.00|99|0.00|VENTILATOR SUPPORT|
20|FH_F41660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SURGERY|
20|FH_F52713_0_0|SrvcGrp|38980|2022|PDM|29283.00|99|0.00|MSDRG 246-249 ONLY|
20|FH_F69712_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133869_19947_0|SrvcGrp|109798|2022|PCT|1.03|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F119613_90035_0|SrvcGrp|46903|2022|PDM|1050.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132969_84003_0|SrvcGrp|86841|2022|PDM|50.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F81563_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA AMBULATORY SURGERY (NO REV)|
20|FH_F124369_0_0|SrvcGrp|104008|2022|PDM|7480.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS|
20|FH_F134353_84123_0|SrvcGrp|95660|2022|PDM|531.30|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F145641_06902_0|CSTM-ALL|CSTM-00|2020|PDM|949.00|99|0.00|AEG 3 (NO REV)|
20|FH_F146471_63110_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134992_34112_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133875_80027_0|SrvcGrp|89417|2022|PDM|549.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F116806_0_0|SrvcGrp|83843|2022|PDM|1923.16|99|0.00|CLOSED TREATMENT OF MANDIBULAR FRACTURE|
20|FH_F91171_0_0|SrvcGrp|77582|2022|PDM|1242.00|99|0.00|CPT 31255|
20|FH_F69845_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F120715_83440_0|CSTM-ALL|CSTM-00|2020|PCT|0.96|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_F50053_0_0|SrvcGrp|10111|2022|PCT|1.20|99|0.00|IMPLANTS|
20|FH_F127545_45227_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F134587_64114_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133775_83401_0|SrvcGrp|46605|2022|PDM|197.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F143650_0_0|SrvcGrp|109974|2022|PDM|1800.00|99|0.00|ELBOW ARTHROSCOPY / SURGERY|
20|FH_F122942_89512_0|SrvcGrp|73842|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F145562_70458_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F110309_63301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F139299_0_0|SrvcGrp|108484|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F149106_07042_0|CSTM-ALL|CSTM-00|2020|PDM|1037.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132899_01002_0|SrvcGrp|90347|2022|PDM|958.00|99|0.00|AETNA RESIDENTIAL EATING DISORDERS >=18 YRS|
20|FH_F127486_06776_0|SrvcGrp|88620|2022|PDM|109.20|99|0.00|SKILLED NURSING RN|
20|FH_F150242_60025_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|338.61|99|0.00|HAPA WPA-NWPA 2012-13 ASC 310 W/O REV|
20|FH_F92893_75110_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143576_43812_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F116806_0_0|SrvcGrp|107024|2022|PDM|1923.16|99|0.00|ARTHROPLASTY W/ ALLOGRAFT|
20|FH_F124161_95932_0|SrvcGrp|8950|2022|PDM|3537.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F120425_11106_0|SrvcGrp|86648|2022|PCT|1.02|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|5500.00|99|0.00|AEG 7 (NO REV)|
20|FH_F145604_14850_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F124369_0_0|SrvcGrp|35667|2022|PDM|2750.00|99|0.00|CPT 20680|
20|FH_F76022_0_0|SrvcGrp|73283|2022|PCT|0.85|99|0.00|OP GAMMA KNIFE|
20|FH_F96721_99504_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F150239_75569_0|SrvcGrp|16750|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142376_0_0|SrvcGrp|87123|2022|PDM|1159.00|99|0.00|DESTROY LUMB/SAC FACET JNT|
20|FH_F63297_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F84912_0_0|SrvcGrp|3403|2022|PDM|100.23|99|0.00|CPT 99203|
20|FH_F84935_0_0|SrvcGrp|44858|2022|PDM|702.00|99|0.00|DAY TREATMENT|
20|FH_F74583_0_0|SrvcGrp|42976|2022|PDM|56.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F111301_33122_0|SrvcGrp|14614|2022|PDM|6396.00|99|0.00|LITHOTRIPSY|
20|FH_F134260_02155_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134312_76301_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F32703_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33081_0_0|SrvcGrp|11258|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F101442_0_0|SrvcGrp|36873|2022|PDM|3252.48|99|0.00|HAMMERTOE|
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|552.00|99|0.00|AEG 1 (NO REV)|
20|FH_F131000_0_0|SrvcGrp|77582|2022|PDM|3343.00|99|0.00|CPT 31255|
20|FH_F102126_0_0|CSTM-ALL|CSTM-00|2020|PDM|414.00|99|0.00|AEG 1 (NO REV)|
20|FH_F112187_98272_0|CSTM-ALL|CSTM-00|2020|PDM|9870.00|99|0.00|AEG 9 (NO REV)|
20|FH_F102960_50613_0|SrvcGrp|73842|2022|PDM|566.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F102940_35034_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD HOME HEALTH|
20|FH_F89932_10940_0|SrvcGrp|73605|2022|PDM|1495.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F150001_33064_0|SrvcGrp|86830|2022|PDM|3.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141767_62312_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F34706_0_0|SrvcGrp|14018|2022|PDM|24710.00|99|0.00|DRG 001 ONLY CRANIOTOMY W/CC|
20|FH_F37641_0_0|CSTM-ALL|CSTM-00|2020|PDM|814.00|99|0.00|ASPG V|
20|FH_F122262_0_0|CSTM-ALL|CSTM-00|2020|PDM|2990.00|99|0.00|AEG 4 (NO REV)|
20|FH_F118373_21205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46473_0_0|SrvcGrp|14997|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F123078_19119_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119104_44870_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F133291_33563_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F111403_37167_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F128299_44134_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F146320_27610_0|CSTM-ALL|CSTM-00|2020|PDM|14391.00|99|0.00|AVF USE MAGNETIC/ART/VEN|
20|FH_F141871_33024_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F132555_39466_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133006_48067_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F101923_98104_0|SrvcGrp|27615|2022|PCT|3.17|99|0.00|AETNA DRUGS|
20|FH_F146320_27610_0|CSTM-ALL|CSTM-00|2020|PDM|1518.40|99|0.00|AEG 8 (NO REV)|
20|FH_F120406_84047_0|SrvcGrp|74668|2022|PDM|325.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132992_04662_0|SrvcGrp|48398|2022|PDM|89.00|99|0.00|PT SERVICES|
20|FH_F89015_74017_0|SrvcGrp|26160|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD TC|
20|FH_F34706_0_0|SrvcGrp|13673|2022|PDM|7922.00|99|0.00|DRG 358 ONLY|
20|FH_F145917_37604_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|444.79|99|0.00|HAPA WPA-NWPA 2012-13 ASC 405 W/O REV|
20|FH_F143197_34957_0|SrvcGrp|108484|2022|PDM|630.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|589.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F142038_45152_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F142994_54313_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F42494_0_0|SrvcGrp|13085|2022|PCT|0.85|99|0.00|OBSERVATION 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_F146320_27610_0|SrvcGrp|114589|2022|PDM|3142.00|99|0.00|TRLUML BALO ANGIOP 1ST ART|
20|FH_F44607_0_0|SrvcGrp|26179|2022|PDM|95.00|99|0.00|OT|
20|FH_F80859_65616_0|SrvcGrp|48947|2022|PCT|0.73|99|0.00|MSDRG 880-887,894-897,945-946|
20|FH_F119128_93619_0|SrvcGrp|46903|2022|PDM|950.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F88512_0_0|SrvcGrp|11970|2022|PDM|149.49|99|0.00|LABOR/DELIVERY CHECK|
20|FH_F112836_06040_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|2686.00|99|0.00|AEG 7 (NO REV)|
20|FH_F133490_90650_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F36101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95980_20016_0|SrvcGrp|86753|2022|PCT|1.05|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F90935_29073_0|SrvcGrp|89149|2022|PDM|120.00|99|0.00|OP INTENSIVE|
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ASPG I|
20|FH_F67763_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127994_19301_0|SrvcGrp|91065|2022|PDM|90.00|99|0.00|PSYCHIATRIC CPT 90853 (HCFA)|
20|FH_F80859_65616_0|SrvcGrp|78684|2022|PCT|0.00|99|0.00|AETNA INTRACARDIAC CATHETER|
20|FH_F111791_33308_0|SrvcGrp|29532|2022|PCT|1.00|99|0.00|LABORATORY|
20|FH_F51545_0_0|SrvcGrp|43429|2022|PDM|145.00|99|0.00|RN HOURLY, HIGH TECH PEDS|
20|FH_F118027_28801_0|SrvcGrp|73842|2022|PDM|231.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F97621_75801_0|SrvcGrp|73602|2022|PDM|3060.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F117728_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132279_63775_0|SrvcGrp|112040|2022|PCT|0.50|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F142970_43055_0|SrvcGrp|100961|2022|PCT|0.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY|
20|FH_F133333_74132_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS|
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1490.00|99|0.00|AEG 8 (NO REV)|
20|FH_F107400_0_0|SrvcGrp|48396|2022|PDM|140.00|99|0.00|OT SERVICES|
20|FH_F38770_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F142011_02859_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133517_49221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124954_17055_0|SrvcGrp|106294|2022|PDM|369.29|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F141807_33020_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F105361_80104_0|SrvcGrp|53770|2022|PDM|783.00|99|0.00|ECT|
20|FH_F105361_80104_0|SrvcGrp|13627|2022|PDM|404.00|99|0.00|SLEEP STUDY|
20|FH_F76028_0_0|SrvcGrp|43431|2022|PDM|45.00|99|0.00|LPN|
20|FH_F146582_75146_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146812_50401_0|CSTM-ALL|CSTM-00|2020|PDM|3264.00|99|0.00|AEG 8 (NO REV)|
20|FH_F116056_73018_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F131738_72143_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131706_72404_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133581_84790_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132937_88201_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F133494_90023_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F111563_02116_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F111566_75093_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F111829_32257_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F51938_0_0|SrvcGrp|43892|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 14 W/O REV|
20|FH_F130156_98198_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F86991_15122_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F119795_0_0|SrvcGrp|11673|2022|PDM|7263.00|99|0.00|CPT 29888|
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F62614_0_0|SrvcGrp|48397|2022|PDM|30.00|99|0.00|PT SERVICES|
20|FH_F74602_0_0|CSTM-ALL|CSTM-00|2020|PDM|1815.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F86851_0_0|SrvcGrp|84984|2022|PDM|607.00|99|0.00|CPT 44389|
20|FH_F86851_0_0|SrvcGrp|79594|2022|PDM|607.00|99|0.00|CPT 45380|
20|FH_F128378_0_0|SrvcGrp|82223|2022|PDM|160.00|99|0.00|HOSPICE CARE|
20|FH_F63316_0_0|SrvcGrp|47186|2022|PDM|151.03|99|0.00|SPEECH THERPY|
20|FH_F134255_01201_0|SrvcGrp|112542|2022|PDM|13.80|99|0.00|METHADONE TREATMENT|
20|FH_F136386_30901_0|SrvcGrp|58393|2022|PDM|78750.00|99|0.00|MS DRG 293 ONLY|
20|FH_F136390_46321_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F136426_19006_0|SrvcGrp|13681|2022|PDM|247.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F136491_08068_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136491_08068_0|SrvcGrp|73842|2022|PDM|202.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F118195_44039_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F134011_84102_0|SrvcGrp|58588|2022|PDM|50.00|99|0.00|INFUSION|
20|FH_F137231_25550_0|SrvcGrp|27968|2022|PDM|45.00|99|0.00|SKILLED NURSING LPN|
20|FH_F137237_33304_0|SrvcGrp|46903|2022|PDM|605.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F137241_07481_0|SrvcGrp|115589|2022|PDM|466.00|99|0.00|CRISIS INTERVENTION|
20|FH_F137247_40160_0|SrvcGrp|73605|2022|PDM|588.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F137249_30046_0|SrvcGrp|113059|2022|PDM|495.00|99|0.00|RESPITE CARE|
20|FH_F142547_70002_0|SrvcGrp|26868|2022|PDM|25.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F142547_70002_0|SrvcGrp|24752|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F138627_82901_0|SrvcGrp|86846|2022|PDM|85.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F138627_82901_0|SrvcGrp|86833|2022|PDM|10.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F140493_67107_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109885_35473_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F117371_77059_0|SrvcGrp|72602|2022|PDM|795.00|99|0.00|ECT|
20|FH_F147725_06002_0|SrvcGrp|84910|2022|PDM|4400.00|99|0.00|ENDOSCOPY|
20|FH_F147901_95008_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F129474_92701_0|SrvcGrp|87317|2022|PDM|1200.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F129511_44044_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F117091_28144_0|SrvcGrp|89149|2022|PDM|138.00|99|0.00|OP INTENSIVE|
20|FH_F109652_0_0|SrvcGrp|472|2022|PDM|870.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|417.00|99|0.00|AEG 1 (NO REV)|
20|FH_F90880_15108_0|SrvcGrp|91068|2022|PCT|1.50|99|0.00|AETNA CASPOFUNGIN ACETATE (MOD TC)|
20|FH_F129487_0_0|SrvcGrp|73000|2022|PDM|2205.00|99|0.00|AEG 6|
20|FH_F147340_0_0|SrvcGrp|29428|2022|PDM|1519.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT|
20|FH_F151121_60455_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151122_10462_0|SrvcGrp|48396|2022|PDM|137.00|99|0.00|OT SERVICES|
20|FH_F151122_10462_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151142_35406_0|CSTM-ALL|CSTM-00|2020|PDM|1188.00|99|0.00|AEG 10 (NO REV)|
20|FH_F151153_77591_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F33744_0_0|SrvcGrp|72|2022|PDM|435.00|99|0.00|NEWBORN NURSERY|
20|FH_F110000_0_0|SrvcGrp|11151|2022|PDM|2813.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F110000_0_0|SrvcGrp|75061|2022|PDM|4793.00|99|0.00|CARDIAC CATH|
20|FH_F117442_0_0|SrvcGrp|92501|2022|PDM|133.35|99|0.00|HOSPICE IP RESPITE 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|11109|2022|PDM|104.50|99|0.00|SKILLED NURSING CARE|
20|FH_F115150_0_0|SrvcGrp|92190|2022|PDM|557.63|99|0.00|CPT 95810  (HCFA)|
20|FH_F142344_16693_0|SrvcGrp|74668|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F112967_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F103780_64804_0|CSTM-ALL|CSTM-00|2020|PDM|2651.00|99|0.00|AEG 5  (NO REV)|
20|FH_F47773_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_F114389_50131_0|SrvcGrp|17004|2022|PDM|115.07|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS|
20|FH_F114389_50131_0|SrvcGrp|43569|2022|PDM|244.27|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F118180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124081_64154_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F64819_0_0|SrvcGrp|10523|2022|PDM|435.00|99|0.00|EMERGENCY ROOM|
20|FH_F42363_0_0|SrvcGrp|35951|2022|PDM|275.00|99|0.00|CD REHABILITATION|
20|FH_F132864_71101_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F124178_01604_0|SrvcGrp|109720|2022|PCT|1.00|99|0.00|FOUNDAPARINUX SODIUM|
20|FH_F124188_29621_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124235_92840_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F124246_71655_0|SrvcGrp|87317|2022|PDM|650.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F124564_78411_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131101_45840_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F72390_0_0|SrvcGrp|27316|2022|PDM|3553.00|99|0.00|TONSILS & ADENOIDS (42820)|
20|FH_F43786_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F137248_0_0|SrvcGrp|19921|2022|PDM|4058.00|99|0.00|ARTHROSCOPICALLY LIGAMENT REPAIR|
20|FH_F136689_45044_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113937_15301_0|SrvcGrp|88620|2022|PDM|91.00|99|0.00|SKILLED NURSING RN|
20|FH_F138716_20151_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F81893_23114_0|SrvcGrp|79723|2022|PCT|1.18|99|0.00|AETNA DME L-CODES|
20|FH_F148553_85016_0|CSTM-ALL|CSTM-00|2020|PDM|1571.00|99|0.00|AEG 9 (NO REV)|
20|FH_F127448_0_0|SrvcGrp|72998|2022|PDM|1100.00|99|0.00|AEG 5|
20|FH_F122606_53818_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122635_06410_0|SrvcGrp|46605|2022|PDM|118.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F43352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F43412_0_0|SrvcGrp|37266|2022|PDM|600.00|99|0.00|ADULT REHABILITATION FULL DAY|
20|FH_F43862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F43953_0_0|SrvcGrp|38421|2022|PCT|0.70|99|0.00|INTERLUKEN II & DRUGS (IP)|
20|FH_F134690_46237_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F134733_19460_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F134735_91362_0|SrvcGrp|23587|2022|PDM|777.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F135761_70127_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136796_24016_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F136796_24016_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F136913_68803_0|SrvcGrp|112967|2022|PCT|7.50|99|0.00|LABORATORY SERVICES|
20|FH_F77234_0_0|SrvcGrp|33311|2022|PDM|1383.00|99|0.00|CPT 62284|
20|FH_F115210_21043_0|SrvcGrp|89404|2022|PDM|8200.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F147362_33137_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147701_31093_0|CSTM-ALL|CSTM-00|2020|PDM|5411.00|99|0.00|AEG 6 (NO REV)|
20|FH_F41489_0_0|SrvcGrp|3029|2022|PDM|450.00|99|0.00|NEWBORN NURSERY|
20|FH_F42396_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD RRKF|
20|FH_F34311_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F39967_0_0|SrvcGrp|705|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F41433_0_0|SrvcGrp|11442|2022|PDM|623.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F98625_08103_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128031_0_0|SrvcGrp|110951|2022|PDM|18700.00|99|0.00|SHOULDER REPLACEMENT|
20|FH_F39541_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F130302_0_0|SrvcGrp|103737|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F97261_06098_0|SrvcGrp|73461|2022|PDM|11269.00|99|0.00|AETNA NICU IV|
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG IX|
20|FH_F113181_72202_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134612_0_0|SrvcGrp|108166|2022|PDM|1500.00|99|0.00|ESTABLISH ACCESS TO AORTA|
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|66482|2022|PDM|35.00|99|0.00|HOME HEALTH AID|
20|FH_F54552_0_0|SrvcGrp|29087|2022|PDM|45.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F113585_20155_0|SrvcGrp|19742|2022|PDM|75.00|99|0.00|MID-LINE INSERTION|
20|FH_F138936_01040_0|SrvcGrp|45751|2022|PDM|350.00|99|0.00|INDIVIDUAL THERAPY|
20|FH_F57953_0_0|SrvcGrp|31189|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF (DME)|
20|FH_F57953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL|
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|942.00|99|0.00|2006 MEDICARE ASPG IV|
20|FH_F72606_0_0|SrvcGrp|3418|2022|PDM|4500.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F151420_60654_0|SrvcGrp|112583|2022|PDM|2233.00|99|0.00|LAPAROSCOPY|
20|FH_F151420_60654_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151511_14094_0|SrvcGrp|91177|2022|PDM|935.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F135489_70508_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F91735_92653_0|SrvcGrp|80920|2022|PDM|472.50|99|0.00|HOSPICE SERVICES|
20|FH_F136183_72756_0|SrvcGrp|75419|2022|PDM|650.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F100880_67735_0|SrvcGrp|79099|2022|PDM|4130.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F130766_04967_0|SrvcGrp|112064|2022|PCT|0.88|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F127399_0_0|SrvcGrp|90420|2022|PDM|2809.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F140629_0_0|SrvcGrp|27402|2022|PDM|3512.00|99|0.00|LASER PROCEDURES|
20|FH_F121761_44130_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|GENERAL ACUTE CARE|
20|FH_F132689_18436_0|SrvcGrp|108484|2022|PDM|739.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F111292_33136_0|SrvcGrp|82764|2022|PDM|64.00|99|0.00|HEPATIC FUNCTION PANEL|
20|FH_F111301_33122_0|SrvcGrp|82737|2022|PDM|41.00|99|0.00|URINALYSIS|
20|FH_F111880_50003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145587_0_0|SrvcGrp|28547|2022|PDM|1779.93|99|0.00|VITRECTOMY|
20|FH_F33081_0_0|SrvcGrp|12179|2022|PCT|0.70|99|0.00|CPT CODES 70000-79999 (RAD)|
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 3 (NO REV)|
20|FH_F87592_85614_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F68161_0_0|SrvcGrp|705|2022|PCT|0.55|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F35408_0_0|SrvcGrp|16996|2022|PDM|55.00|99|0.00|AMBULANCE RESPONSE/TREATMENT - NO TRANSPORT|
20|FH_F115330_34113_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F100661_63640_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F126762_91311_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 649|
20|FH_F80859_65616_0|SrvcGrp|48762|2022|PDM|851.00|99|0.00|MSDRG 949 950|
20|FH_F42340_0_0|SrvcGrp|31191|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF (DME)|
20|FH_F91155_16105_0|SrvcGrp|42404|2022|PDM|8.11|99|0.00|VENIPUNCTURE|
20|FH_F128492_49010_0|SrvcGrp|82222|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F126911_62301_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F126676_43537_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F36383_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS|
20|FH_F120838_01603_0|SrvcGrp|90854|2022|PDM|825.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F123085_21921_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F51438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|OP SVCS|
20|FH_F97563_83201_0|SrvcGrp|73485|2022|PDM|3389.00|99|0.00|AETNA REHAB|
20|FH_F42248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F148644_06890_0|SrvcGrp|33982|2022|PDM|3794.00|99|0.00|CPT 28296|
20|FH_F151048_15122_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138742_33125_0|SrvcGrp|75754|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F139430_63017_0|SrvcGrp|48394|2022|PDM|30.90|99|0.00|SKILLED NURSING SERVICES|
20|FH_F139673_63011_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F150765_05001_0|SrvcGrp|43569|2022|PDM|161.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F150881_52722_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F150882_84041_0|SrvcGrp|86840|2022|PDM|47.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F110193_70444_0|SrvcGrp|87317|2022|PDM|898.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F126785_0_0|SrvcGrp|22106|2022|PDM|1338.00|99|0.00|CAT SCAN|
20|FH_F137797_70123_0|SrvcGrp|88620|2022|PDM|119.00|99|0.00|SKILLED NURSING RN|
20|FH_F97623_38008_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F141287_14830_0|SrvcGrp|12491|2022|PCT|0.39|99|0.00|PACEMAKER|
20|FH_F125656_92868_0|SrvcGrp|29076|2022|PDM|35.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F37444_0_0|SrvcGrp|16618|2022|PCT|0.72|99|0.00|ST SVCS|
20|FH_F116583_0_0|SrvcGrp|106929|2022|PDM|150.00|99|0.00|HOSPICE IN LT NON-SNF (HCFA)|
20|FH_F97082_90012_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F35987_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F120848_20912_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F139877_32615_0|SrvcGrp|113234|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2 & INF A&B AMP PRB|
20|FH_F98820_81401_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F126398_77090_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34918_0_0|CSTM-ALL|CSTM-00|2020|PDM|2391.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F122377_91007_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F111044_0_0|SrvcGrp|26274|2022|PDM|2266.00|99|0.00|CPT 29877|
20|FH_F131371_0_0|SrvcGrp|96350|2022|PDM|17000.00|99|0.00|SHOULDER JOINT|
20|FH_F140143_24874_0|SrvcGrp|100961|2022|PDM|233.93|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY|
20|FH_F46433_0_0|SrvcGrp|40827|2022|PDM|1.79|99|0.00|STERILE WATER SALINE|
20|FH_F56054_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F37304_0_0|SrvcGrp|10510|2022|PDM|147.00|99|0.00|CPT CODE 90945|
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|878.00|99|0.00|AEG 2 (NO REV)|
20|FH_F137986_0_0|SrvcGrp|27315|2022|PDM|3223.00|99|0.00|TENDON REPAIR|
20|FH_F149001_37055_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126914_44136_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35056_0_0|SrvcGrp|10387|2022|PDM|3200.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F145920_0_0|SrvcGrp|79595|2022|PDM|1970.00|99|0.00|CPT 45385|
20|FH_F90817_0_0|SrvcGrp|90998|2022|PDM|7520.00|99|0.00|RECONSTRUCT SHOULDER JOINT (HCFA)|
20|FH_F124691_78003_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1259.00|99|0.00|AEG 5  (NO REV)|
20|FH_F147341_19720_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1260.00|99|0.00|AEG 9 (NO REV)|
20|FH_F40624_0_0|SrvcGrp|3409|2022|PDM|400.00|99|0.00|NEWBORN NURSERY|
20|FH_F131471_67203_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F97080_85122_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F136382_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F126933_33174_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149379_53213_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147304_75965_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124441_0_0|SrvcGrp|77461|2022|PDM|2375.00|99|0.00|CPT 52356|
20|FH_F116332_0_0|SrvcGrp|27261|2022|PDM|16079.00|99|0.00|CPT 27446|
20|FH_F140608_0_0|SrvcGrp|23683|2022|PDM|122.00|99|0.00|SKILLED NURSING RN|
20|FH_F37536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138017_73129_0|SrvcGrp|105465|2022|PCT|1.26|99|0.00|AETNA THERAPIES|
20|FH_F114206_37203_0|SrvcGrp|29075|2022|PDM|30.00|99|0.00|HYDRATION THERAPY|
20|FH_F76826_0_0|SrvcGrp|74447|2022|PDM|83.00|99|0.00|RADIOACTIVE DYE|
20|FH_F36620_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138452_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F132235_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F96280_06340_0|SrvcGrp|89412|2022|PDM|419.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F141035_0_0|SrvcGrp|33986|2022|PDM|3932.00|99|0.00|CPT 26055|
20|FH_F123036_0_0|SrvcGrp|109249|2022|PDM|6051.00|99|0.00|RADIOFQ TRSMTR FOR IMPLT NEU|
20|FH_F129220_18445_0|SrvcGrp|46903|2022|PDM|565.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F143542_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|520.47|99|0.00|2005 ASPG GROUPER I|
20|FH_F119289_43040_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F119347_27540_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119444_72903_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F119500_01570_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148561_17022_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F90811_0_0|SrvcGrp|90429|2022|PDM|2700.00|99|0.00|REPAIR WRIST BONE FRACTURE|
20|FH_F111809_93003_0|SrvcGrp|31125|2022|PDM|13072.00|99|0.00|MS DRG 789-794 ONLY SICK BABY|
20|FH_F52733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133552_77006_0|SrvcGrp|109330|2022|PCT|1.06|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F47433_0_0|SrvcGrp|3418|2022|PDM|2610.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F100666_81301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE NO MOD|
20|FH_F38407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MOD NU|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|443.36|99|0.00|HAPA WPA-NWPA 2012-13 ASC 214 W/O REV|
20|FH_F68479_0_0|SrvcGrp|29611|2022|PDM|217.00|99|0.00|VENTILATOR SUPPORT|
20|FH_F42238_0_0|SrvcGrp|35713|2022|PCT|0.85|99|0.00|J CODES|
20|FH_F132503_73086_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F88512_0_0|SrvcGrp|46504|2022|PDM|7640.63|99|0.00|MS DRG 215-241,245, 250-265 CARDIAC /CCU SURGERY|
20|FH_F38394_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119076_41001_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F120788_0_0|SrvcGrp|108546|2022|PDM|171.00|99|0.00|PERITONEAL TREATMENTS W/ PATIENT TRAINING|
20|FH_F141411_0_0|SrvcGrp|78403|2022|PDM|0.25|99|0.00|AETNA MED RECORD|
20|FH_F117132_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F127432_18015_0|CSTM-ALL|CSTM-00|2020|PCT|0.38|99|0.00|OP SVCS|
20|FH_F133493_90255_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F92531_0_0|SrvcGrp|86919|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F103281_32086_0|SrvcGrp|81779|2022|PDM|2100.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F97562_29803_0|SrvcGrp|88978|2022|PDM|5780.00|99|0.00|VAGINAL DELIVERY|
20|FH_F67136_0_0|SrvcGrp|8968|2022|PDM|10674.00|99|0.00|NICU LEVEL III & IV|
20|FH_F89932_10940_0|SrvcGrp|31704|2022|PDM|3450.00|99|0.00|MS DRG 790 ONLY|
20|FH_F145988_06105_0|SrvcGrp|44461|2022|PDM|47745.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F108660_63775_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41739_0_0|SrvcGrp|14951|2022|PDM|31672.00|99|0.00|DRG 123 ONLY - CIRCULATORY DISORDERS|
20|FH_F117807_86426_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F43539_0_0|SrvcGrp|38021|2022|PDM|65.00|99|0.00|PHYSICAL THERAPY|
20|FH_F43330_0_0|CSTM-ALL|CSTM-00|2020|PDM|30.00|99|0.00|HOME HEALTH MOD TD|
20|FH_F32090_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F120437_85202_0|SrvcGrp|10580|2022|PDM|101.29|99|0.00|HYDRATION THERAPY - 3 LITERS|
20|FH_F69610_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92792_0_0|SrvcGrp|53703|2022|PDM|1320.00|99|0.00|REVISE AQUEOUS SHUNT TO EXTRAOCULAR RESIVOIR|
20|FH_F115405_06010_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F38249_0_0|SrvcGrp|34168|2022|PCT|0.95|99|0.00|BURN SERVICES MS DRG|
20|FH_F114310_0_0|SrvcGrp|11673|2022|PDM|2600.00|99|0.00|CPT 29888|
20|FH_F60101_0_0|SrvcGrp|17140|2022|PDM|180.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F144011_60616_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F39433_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F68479_0_0|SrvcGrp|64639|2022|PDM|60.00|99|0.00|ST 92507|
20|FH_F141754_21703_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119076_41001_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F146320_27610_0|SrvcGrp|107792|2022|PDM|9394.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F92676_15063_0|SrvcGrp|79076|2022|PDM|329.96|99|0.00|MON VALLEY ASC 139|
20|FH_F119079_41018_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F44601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|OP SVCS|
20|FH_F128325_19904_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F133271_72204_0|SrvcGrp|73842|2022|PDM|235.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F117970_15963_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F139607_0_0|SrvcGrp|53703|2022|PDM|1191.00|99|0.00|REVISE AQUEOUS SHUNT TO EXTRAOCULAR RESIVOIR|
20|FH_F117275_16936_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F38161_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MOD TC|
20|FH_F145988_06105_0|SrvcGrp|112051|2022|PCT|1.47|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F106540_26330_0|SrvcGrp|11336|2022|PCT|0.50|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F52293_0_0|SrvcGrp|44430|2022|PDM|115.00|99|0.00|SPEECH THERAPY SVCS (VISIT LVL)|
20|FH_F89932_10940_0|SrvcGrp|11663|2022|PCT|0.45|99|0.00|IMPLANTS|
20|FH_F31204_0_0|SrvcGrp|109|2022|PDM|692.00|99|0.00|CD - DETOX|
20|FH_F120954_0_0|SrvcGrp|108542|2022|PDM|281.40|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F148904_85255_0|SrvcGrp|75419|2022|PDM|721.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F119229_90804_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F39443_0_0|SrvcGrp|30318|2022|PDM|564.00|99|0.00|HAPA WPA ASC 202|
20|FH_F122277_98045_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F75944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|INTRAOCULAR LENS|
20|FH_F34336_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122264_75972_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F100663_56537_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F93268_0_0|SrvcGrp|472|2022|PDM|522.75|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F97082_90012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98623_97006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F116753_0_0|SrvcGrp|97968|2022|PDM|1473.00|99|0.00|CT SCAN|
20|FH_F119203_0_0|SrvcGrp|108021|2022|PDM|435.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F90055_33805_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128008_27302_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38742_0_0|SrvcGrp|29462|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE - MOD TF|
20|FH_F124760_34997_0|SrvcGrp|88819|2022|PDM|716.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|AEG 1 (NO REV)|
20|FH_F134738_0_0|SrvcGrp|78403|2022|PDM|0.25|99|0.00|AETNA MED RECORD|
20|FH_F149049_28401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47902_0_0|SrvcGrp|29956|2022|PCT|1.00|99|0.00|DME MOD AV|
20|FH_F148326_0_0|SrvcGrp|35670|2022|PDM|12735.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F139822_30338_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F143214_92506_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: BREAKOUT|
20|FH_F143227_50312_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143536_47546_0|SrvcGrp|97972|2022|PCT|1.00|99|0.00|TYMPANOMETRY IMPEDANCE TEST|
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1483.00|99|0.00|AEG 9 (NO REV)|
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1656.00|99|0.00|AEG 6 (NO REV)|
20|FH_F101709_0_0|SrvcGrp|96353|2022|PDM|8441.00|99|0.00|RECONSTRUCT ANKLE JOINT|
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 5  (NO REV)|
20|FH_F131067_57105_0|SrvcGrp|102419|2022|PDM|4338.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F131107_43140_0|SrvcGrp|63297|2022|PDM|130.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F131107_43140_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F48937_0_0|SrvcGrp|10518|2022|PDM|65.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT|
20|FH_F112711_80909_0|SrvcGrp|104545|2022|PCT|1.00|99|0.00|AETNA CARVEOUT DRUGS|
20|FH_F116698_07470_0|SrvcGrp|29076|2022|PDM|39.90|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F116698_07470_0|SrvcGrp|86841|2022|PDM|99.75|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F116756_77477_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F116913_77024_0|SrvcGrp|23587|2022|PDM|700.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F119993_71913_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120974_27607_0|CSTM-ALL|CSTM-00|2020|PDM|3837.00|99|0.00|AEG 1 (NO REV)|
20|FH_F120974_27607_0|SrvcGrp|108564|2022|PDM|1126.00|99|0.00|OUTPATIENT HOSPICE|
20|FH_F84611_30281_0|SrvcGrp|82633|2022|PDM|10597.00|99|0.00|FUSION OF SPINE|
20|FH_F147211_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F150200_0_0|SrvcGrp|88163|2022|PDM|9690.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F40649_0_0|SrvcGrp|6|2022|PCT|0.83|99|0.00|OP SURGERY|
20|FH_F61292_0_0|SrvcGrp|14187|2022|PDM|959.00|99|0.00|MRI|
20|FH_F143814_18062_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F109180_18015_0|SrvcGrp|102983|2022|PDM|113.00|99|0.00|MULTIPLE FAMILY GROUP PSYTX|
20|FH_F148255_72703_0|SrvcGrp|14947|2022|PDM|31.50|99|0.00|HOME INFUSION|
20|FH_F116136_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39731_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148265_06067_0|SrvcGrp|67068|2022|PDM|16023.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F40149_0_0|CSTM-ALL|CSTM-00|2020|PDM|1406.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100962_0_0|SrvcGrp|72996|2022|PDM|1020.00|99|0.00|AEG 4|
20|FH_F37945_0_0|SrvcGrp|675|2022|PDM|880.00|99|0.00|PEDIATRIC INPATIENT SVCS|
20|FH_F116984_28092_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129666_71901_0|SrvcGrp|27968|2022|PDM|55.00|99|0.00|SKILLED NURSING LPN|
20|FH_F41776_0_0|SrvcGrp|17140|2022|PDM|276.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F126422_77375_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123473_65109_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110925_01104_0|SrvcGrp|85818|2022|PDM|67.79|99|0.00|ENTERAL NUTRITION INFUSION (MOD RR)|
20|FH_F39819_0_0|SrvcGrp|31242|2022|PDM|5299.00|99|0.00|NY DRG 494 ONLY|
20|FH_F141795_89509_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|696.00|99|0.00|AEG 4 (NO REV)|
20|FH_F129766_48236_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|RADIOLOGY W/MOD 26|
20|FH_F39531_0_0|SrvcGrp|177|2022|PDM|2200.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93538_87124_0|SrvcGrp|91214|2022|PDM|54.12|99|0.00|MED NUTRITION|
20|FH_F102184_0_0|SrvcGrp|89840|2022|PDM|7699.00|99|0.00|THORAX SPINE FUSION|
20|FH_F143528_0_0|SrvcGrp|89848|2022|PDM|10500.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 3 (NO REV)|
20|FH_F131357_17545_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F72704_0_0|SrvcGrp|43893|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F125482_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F41053_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|ACUTE PSYCH|
20|FH_F63141_0_0|SrvcGrp|33812|2022|PDM|370.00|99|0.00|IOP / MENTAL HEALTH / SUBSTANCE ABUSE|
20|FH_F37679_0_0|SrvcGrp|27127|2022|PDM|3.75|99|0.00|ANTI-EMETICS INJECTION THERAPY (MOD SJ)|
20|FH_F140893_19720_0|SrvcGrp|46104|2022|PDM|167.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F45392_0_0|SrvcGrp|10400|2022|PDM|1500.00|99|0.00|IP SURGERY|
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_F36521_0_0|SrvcGrp|38|2022|PDM|1600.00|99|0.00|NORMAL DELIVERY|
20|FH_F40331_0_0|SrvcGrp|125|2022|PDM|1811.00|99|0.00|HEMATOLOGY/ONCOLOGY UNIT|
20|FH_F42343_0_0|CSTM-ALL|CSTM-00|2020|PDM|517.00|99|0.00|ACUTE PSYCH|
20|FH_F148886_60621_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F150001_33064_0|SrvcGrp|86829|2022|PDM|21.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F87362_15746_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKL|
20|FH_F148599_98034_0|SrvcGrp|73500|2022|PDM|416.00|99|0.00|AETNA ER LEVEL I|
20|FH_F44607_0_0|SrvcGrp|25346|2022|PDM|95.00|99|0.00|PT|
20|FH_F146211_68144_0|SrvcGrp|113903|2022|PDM|41.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F92676_15063_0|SrvcGrp|78995|2022|PDM|1151.92|99|0.00|MON VALLEY ASC 101|
20|FH_F128912_44313_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F111791_33308_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128615_78520_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F148599_98034_0|SrvcGrp|31704|2022|PDM|3910.00|99|0.00|MS DRG 790 ONLY|
20|FH_F139172_40207_0|SrvcGrp|73841|2022|PDM|372.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F139208_30309_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139368_57043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150745_03301_0|SrvcGrp|33722|2022|PDM|44.88|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F150802_15401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150928_62521_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147140_89103_0|SrvcGrp|66264|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|965.00|99|0.00|ASPG VI|
20|FH_F90223_0_0|SrvcGrp|88827|2022|PDM|5.80|99|0.00|HOME INFUSION (HCFA)|
20|FH_F94643_90501_0|SrvcGrp|13929|2022|PDM|25.00|99|0.00|GROWTH HORMONE|
20|FH_F69183_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|ASPG IX - FH SW CUSTOM GROUPERS|
20|FH_F40762_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F131954_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.76|99|0.00|HSS ASC|
20|FH_F122277_98045_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F97280_20018_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F147303_70508_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F139927_0_0|SrvcGrp|33165|2022|PDM|589.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F137713_50025_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F50220_0_0|SrvcGrp|33164|2022|PDM|315.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F97080_85122_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F151619_73505_0|SrvcGrp|75497|2022|PDM|728.00|99|0.00|AEG 10|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SAINT ALEXIUS FH MOD AV|
20|FH_F134603_0_0|SrvcGrp|12491|2022|PCT|0.44|99|0.00|PACEMAKER|
20|FH_F130328_0_0|SrvcGrp|104230|2022|PDM|198.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F127553_44321_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F132254_40207_0|SrvcGrp|63156|2022|PCT|0.85|99|0.00|IMMUNE GLOBULIN INTRAVENOUS|
20|FH_F91259_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39772_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (HCFA)|
20|FH_F35384_0_0|SrvcGrp|15361|2022|PDM|3351.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F147167_75605_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F122394_75979_0|SrvcGrp|86723|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F81312_0_0|SrvcGrp|12342|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F150941_68124_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F124452_31322_0|SrvcGrp|48398|2022|PDM|130.00|99|0.00|PT SERVICES|
20|FH_F147143_18706_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97080_85122_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F124739_64429_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F119946_36109_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F130970_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124291_44122_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F117583_21208_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F147080_02446_0|SrvcGrp|12659|2022|PDM|504.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F109251_62269_0|SrvcGrp|23683|2022|PDM|36.41|99|0.00|SKILLED NURSING RN|
20|FH_F98020_50138_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F137627_78382_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F35416_0_0|SrvcGrp|16|2022|PDM|1386.00|99|0.00|ACUTE REHABILITATION|
20|FH_F110783_93013_0|SrvcGrp|86841|2022|PDM|100.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F149003_62208_0|SrvcGrp|88779|2022|PDM|86.52|99|0.00|PHYSICAL THERAPY|
20|FH_F114332_19973_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F67419_0_0|CSTM-ALL|CSTM-00|2020|PDM|80.00|99|0.00|SKILLED NURSING - RN|
20|FH_F143564_0_0|SrvcGrp|87842|2022|PDM|12000.00|99|0.00|LAPAROSCOPY - GASTRIC|
20|FH_F128753_32501_0|SrvcGrp|75479|2022|PCT|0.64|99|0.00|AEG 1|
20|FH_F146261_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|908.00|99|0.00|AEG 5  (NO REV)|
20|FH_F35069_0_0|CSTM-ALL|CSTM-00|2020|PDM|118.00|99|0.00|OP URGENT CARE|
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 3 (NO REV)|
20|FH_F149030_37919_0|CSTM-ALL|CSTM-00|2020|PDM|2678.00|99|0.00|AEG 7 (NO REV) W/O ANAL SURGERY|
20|FH_F151699_01752_0|SrvcGrp|14947|2022|PDM|100.00|99|0.00|HOME INFUSION|
20|FH_F141592_80233_0|SrvcGrp|10364|2022|PDM|2163.00|99|0.00|CPT CODE 99284|
20|FH_F148323_84070_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F40099_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER UEKC|
20|FH_F38034_0_0|SrvcGrp|16|2022|PDM|2030.00|99|0.00|ACUTE REHABILITATION|
20|FH_F124763_61821_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143902_41018_0|SrvcGrp|3178|2022|PDM|852.00|99|0.00|ACUTE PSYCH|
20|FH_F38709_0_0|SrvcGrp|3418|2022|PDM|1751.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F41665_0_0|SrvcGrp|32406|2022|PCT|0.65|99|0.00|OCN F/S PRICING: MODIFIER TC (RADIOLOGY)|
20|FH_F125011_74467_0|SrvcGrp|42784|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F98920_46526_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F38526_0_0|SrvcGrp|290|2022|PDM|5900.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F93881_15009_0|SrvcGrp|80266|2022|PDM|25.00|99|0.00|THERAPEUTIC EXERCISES|
20|FH_F135237_31015_0|SrvcGrp|48394|2022|PDM|75.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F37679_0_0|SrvcGrp|24750|2022|PDM|15.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F125899_07645_0|SrvcGrp|73008|2022|PDM|6836.00|99|0.00|AEG 10|
20|FH_F129000_21017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31433_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|TAKE HOME DRUGS|
20|FH_F137547_32750_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38320_0_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F83520_18704_0|SrvcGrp|472|2022|PDM|390.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F135307_73142_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F44177_0_0|SrvcGrp|23477|2022|PDM|2333.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F124738_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F129650_49417_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F35259_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|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_F33181_0_0|CSTM-ALL|CSTM-00|2020|PDM|17000.00|99|0.00|CORONARY BYPASS SURGERY|
20|FH_F33601_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F149980_0_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F150699_0_0|SrvcGrp|109502|2022|PDM|22004.00|99|0.00|INSERT PULSE GEN MULT LEADS|
20|FH_F148221_06477_0|SrvcGrp|29347|2022|PDM|27.00|99|0.00|HOME HEALTH AIDE|
20|FH_F118194_50841_0|SrvcGrp|17015|2022|PDM|36.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F135065_08043_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F130013_16509_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F137457_32216_0|SrvcGrp|94879|2022|PDM|135.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F124738_0_0|SrvcGrp|72992|2022|PDM|440.00|99|0.00|AEG 2|
20|FH_F35476_0_0|SrvcGrp|997|2022|PCT|0.83|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F135219_68506_0|CSTM-ALL|CSTM-00|2020|PDM|4739.39|99|0.00|AEG 5  (NO REV)|
20|FH_F34413_0_0|SrvcGrp|11336|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F97104_53545_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F116021_60714_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125935_44024_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F43858_0_0|SrvcGrp|30961|2022|PDM|12.50|99|0.00|HOME HEALTH AIDE|
20|FH_F63464_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114930_71101_0|SrvcGrp|73601|2022|PDM|1530.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F32772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|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_F93880_95476_0|SrvcGrp|82369|2022|PCT|1.42|99|0.00|AETNA LABORATORY|
20|FH_F78363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111852_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F145545_01602_0|SrvcGrp|74668|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120714_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.60|99|0.00|OP SVCS|
20|FH_F130024_78229_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131190_21042_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F31840_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127988_85258_0|SrvcGrp|74668|2022|PDM|213.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F145748_30084_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F39760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123466_93420_0|SrvcGrp|9866|2022|PDM|925.00|99|0.00|IP OBSERVATION SVCS|
20|FH_F79746_0_0|SrvcGrp|53987|2022|PCT|1.00|99|0.00|PHOTOTHERAPY|
20|FH_F139515_0_0|SrvcGrp|100919|2022|PDM|13596.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F90840_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F67984_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|1640.00|99|0.00|AEG 4 (NO REV)|
20|FH_F74602_0_0|SrvcGrp|71902|2022|PDM|48505.00|99|0.00|STEM CELL TRANSPLANT|
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.64|99|0.00|AEG 3 (NO REV)|
20|FH_F89778_0_0|SrvcGrp|79561|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F87411_0_0|SrvcGrp|85677|2022|PDM|749.30|99|0.00|POLYSOM (MOD TC)|
20|FH_F130898_06405_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130908_32708_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F129300_54541_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128278_21401_0|SrvcGrp|58509|2022|PDM|435.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F135622_34471_0|SrvcGrp|73841|2022|PDM|450.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F132728_0_0|SrvcGrp|3409|2022|PDM|600.00|99|0.00|NEWBORN NURSERY|
20|FH_F133747_80634_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS|
20|FH_F133747_80634_0|SrvcGrp|73806|2022|PCT|0.92|99|0.00|AETNA ER|
20|FH_F112045_90301_0|SrvcGrp|11108|2022|PDM|2849.00|99|0.00|NEWBORN NURSERY|
20|FH_F151039_16749_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124364_38611_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F37422_0_0|SrvcGrp|472|2022|PDM|320.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F69123_0_0|SrvcGrp|47183|2022|PDM|80.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)|
20|FH_F71362_0_0|SrvcGrp|3810|2022|PDM|105.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F150982_0_0|SrvcGrp|104555|2022|PDM|2211.00|99|0.00|HYSTEROSCOPY REMOVE FB|
20|FH_F120848_20912_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92300_37303_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147303_70508_0|SrvcGrp|88620|2022|PDM|89.00|99|0.00|SKILLED NURSING RN|
20|FH_F137790_62568_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F149273_0_0|SrvcGrp|115611|2022|PDM|7283.00|99|0.00|CATH DIALYSIS CIRCUIT|
20|FH_F37304_0_0|SrvcGrp|10509|2022|PDM|252.00|99|0.00|CPT CODE 90937|
20|FH_F124492_30040_0|SrvcGrp|113251|2022|PDM|45.52|99|0.00|COVID-19 SARS-COV-2 W/ OPTIC (HCFA)|
20|FH_F140187_61061_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143347_16001_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F143536_47546_0|SrvcGrp|100271|2022|PCT|1.00|99|0.00|IIV3 VACC NO PRSV 0.5 ML IM|
20|FH_F131067_57105_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F131067_57105_0|SrvcGrp|103913|2022|PCT|1.70|99|0.00|OP DIALYSIS|
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|1099.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F120862_87108_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120921_75835_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113563_70560_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F118792_63379_0|SrvcGrp|92553|2022|PCT|0.74|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43698_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40063_0_0|SrvcGrp|29512|2022|PDM|2503.00|99|0.00|PEDIATRIC SURGICAL SVCS|
20|FH_F148259_99163_0|SrvcGrp|106311|2022|PCT|1.00|99|0.00|VBAC DELIVERY|
20|FH_F126523_0_0|SrvcGrp|72996|2022|PDM|935.00|99|0.00|AEG 4|
20|FH_F82753_18840_0|SrvcGrp|113740|2022|PCT|3.50|99|0.00|LABORATORY SERVICES|
20|FH_F37679_0_0|SrvcGrp|27133|2022|PDM|3.75|99|0.00|GROWTH HORMONE (MOD SJ)|
20|FH_F116188_72211_0|SrvcGrp|86723|2022|PDM|468.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F39617_0_0|SrvcGrp|13551|2022|PDM|318.00|99|0.00|NEWBORN NURSERY|
20|FH_F132779_0_0|SrvcGrp|361|2022|PDM|2758.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F102184_0_0|SrvcGrp|88160|2022|PDM|7215.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F38357_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F137633_85202_0|SrvcGrp|92760|2022|PCT|1.70|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38277_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F125849_67052_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148258_66062_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F86332_75081_0|SrvcGrp|15527|2022|PDM|30.00|99|0.00|HYDRATION THERAPY|
20|FH_F81172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F93332_0_0|SrvcGrp|93067|2022|PDM|7416.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F32014_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F66630_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|INTENSIVE OP EATING DISORDERS|
20|FH_F148266_45419_0|SrvcGrp|114442|2022|PDM|3200.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F127816_44112_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F42105_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F123512_64089_0|SrvcGrp|472|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F46612_0_0|SrvcGrp|22954|2022|PDM|310.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F33407_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121925_0_0|SrvcGrp|84974|2022|PDM|797.69|99|0.00|CPT 43255|
20|FH_F129231_30060_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F128863_57701_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131228_01826_0|SrvcGrp|88977|2022|PDM|10978.99|99|0.00|C-SECTION DELIVERY|
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 9 (NO REV)|
20|FH_F149442_0_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F128859_57702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143773_30350_0|SrvcGrp|87077|2022|PDM|143.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F93980_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS SNF PPS|
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F51520_0_0|SrvcGrp|42824|2022|PDM|135.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F72850_0_0|CSTM-ALL|CSTM-00|2020|PDM|3564.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F133099_66801_0|SrvcGrp|10391|2022|PCT|0.80|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F123512_64089_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115103_31405_0|SrvcGrp|73483|2022|PDM|992.20|99|0.00|AETNA SUBACUTE III|
20|FH_F125935_44024_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F93136_0_0|SrvcGrp|72996|2022|PDM|630.00|99|0.00|AEG 4|
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_F117783_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.00|99|0.00|AEG 1 (NO REV)|
20|FH_F44495_0_0|SrvcGrp|9828|2022|PDM|49.00|99|0.00|HOME HEALTH AIDE|
20|FH_F109277_0_0|SrvcGrp|9861|2022|PDM|1597.00|99|0.00|ACUTE REHABILITATION|
20|FH_F115103_31405_0|SrvcGrp|73601|2022|PDM|1576.30|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F120718_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.30|99|0.00|OP SVCS|
20|FH_F120719_27540_0|SrvcGrp|82523|2022|PCT|0.46|99|0.00|AETNA NUCLEAR MEDICINE|
20|FH_F49552_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ST CHARLES LAB|
20|FH_F50654_0_0|SrvcGrp|46887|2022|PCT|1.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F138348_04096_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132922_91302_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F146124_06112_0|SrvcGrp|79786|2022|PDM|3135.00|99|0.00|SLEEP STUDIES|
20|FH_F146113_26719_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143561_16001_0|SrvcGrp|27968|2022|PDM|27.00|99|0.00|SKILLED NURSING LPN|
20|FH_F63312_0_0|SrvcGrp|26001|2022|PDM|110.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 10 (NO REV)|
20|FH_F130123_24171_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F36552_0_0|SrvcGrp|18803|2022|PDM|37410.00|99|0.00|MS DRG 218|
20|FH_F150311_18106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F49552_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|ST CHARLES MRI|
20|FH_F85213_02840_0|SrvcGrp|111475|2022|PDM|2119.90|99|0.00|TRAUMA TEAM LEVEL 1|
20|FH_F45200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F70804_0_0|SrvcGrp|9874|2022|PDM|54.00|99|0.00|DIETICIAN|
20|FH_F97840_54729_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F87775_15106_0|SrvcGrp|29023|2022|PDM|90.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118127_30078_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F34229_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F133815_46526_0|SrvcGrp|88337|2022|PCT|0.00|99|0.00|VENIPUNCTURE|
20|FH_F114432_75035_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118803_0_0|SrvcGrp|107879|2022|PDM|2601.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F44278_0_0|SrvcGrp|177|2022|PDM|2100.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F149304_64137_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144808_0_0|SrvcGrp|98500|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F133815_46526_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113435_19027_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F149517_0_0|SrvcGrp|87799|2022|PDM|198.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F117206_0_0|SrvcGrp|84999|2022|PDM|721.00|99|0.00|CPT 45379|
20|FH_F124371_0_0|SrvcGrp|13422|2022|PDM|217.36|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F145641_06902_0|SrvcGrp|88162|2022|PDM|11173.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F48092_0_0|SrvcGrp|14110|2022|PDM|28.75|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F138736_77038_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F112023_12866_0|SrvcGrp|997|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F70208_0_0|SrvcGrp|10939|2022|PDM|2530.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F36552_0_0|SrvcGrp|313|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|108.49|99|0.00|HAPA WPA-NWPA 2012-13 ASC 315 W/O REV|
20|FH_F31595_0_0|SrvcGrp|8962|2022|PDM|85.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F150165_06032_0|SrvcGrp|100045|2022|PDM|4668.00|99|0.00|REVISION OF FOOT TENDON|
20|FH_F134350_46601_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F93179_73460_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|GENERAL ACUTE CARE|
20|FH_F128825_45211_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F123850_0_0|SrvcGrp|87799|2022|PDM|190.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F117300_0_0|SrvcGrp|34606|2022|PDM|2945.00|99|0.00|CPT 29827|
20|FH_F123633_70506_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116959_0_0|SrvcGrp|96999|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F50952_0_0|SrvcGrp|15122|2022|PCT|0.80|99|0.00|CARDIAC CATH LAB SVCS|
20|FH_F124369_0_0|SrvcGrp|84307|2022|PDM|12155.00|99|0.00|TENDON REPAIR|
20|FH_F138507_62208_0|SrvcGrp|29347|2022|PDM|21.21|99|0.00|HOME HEALTH AIDE|
20|FH_F119125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F145781_0_0|SrvcGrp|114310|2022|PDM|1400.00|99|0.00|INSERT EYE SOCKET IMPLT|
20|FH_F112665_0_0|SrvcGrp|35669|2022|PDM|4812.00|99|0.00|CPT 63650|
20|FH_F120384_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F129548_44130_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F112023_12866_0|SrvcGrp|79561|2022|PDM|6049.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F120417_63124_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 8 (NO REV)|
20|FH_F138210_60540_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F132776_43614_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|OP SVCS|
20|FH_F67887_0_0|SrvcGrp|42825|2022|PDM|44.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F100782_0_0|SrvcGrp|105128|2022|PDM|489.62|99|0.00|WINDBER MEDICAL CNTR ASC 233|
20|FH_F130364_01331_0|SrvcGrp|89149|2022|PDM|250.00|99|0.00|OP INTENSIVE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1782.04|99|0.00|HAPA WPA-NWPA 2012-13 ASC 908 W/O REV|
20|FH_F31714_0_0|SrvcGrp|13490|2022|PDM|6600.00|99|0.00|DRG 499 ONLY|
20|FH_F126341_27284_0|SrvcGrp|86122|2022|PDM|42.00|99|0.00|AETNA GAMMAGARD LIQUID INJ|
20|FH_F54592_0_0|SrvcGrp|49285|2022|PDM|90.00|99|0.00|DELIVERY/NURSING (HIGH RISK)|
20|FH_F134494_33612_0|SrvcGrp|86722|2022|PDM|243.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F84712_0_0|SrvcGrp|73002|2022|PDM|4920.00|99|0.00|AEG 7|
20|FH_F76063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98800_85021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F100907_85206_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F105145_75075_0|SrvcGrp|93431|2022|PDM|28320.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F105145_75075_0|SrvcGrp|76602|2022|PDM|5460.00|99|0.00|CPT 25000|
20|FH_F115872_06052_0|SrvcGrp|471|2022|PDM|725.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146783_76048_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F47140_0_0|SrvcGrp|28735|2022|PDM|441.25|99|0.00|SLEEP STUDIES CPT 95808 W/MODIFIER TC|
20|FH_F91622_0_0|SrvcGrp|25518|2022|PDM|6752.00|99|0.00|LAPAROSCOPY SURGICAL CHOLECYSTECTOMY|
20|FH_F125899_07645_0|SrvcGrp|75505|2022|PCT|4.41|99|0.00|CARDIAC STUDIES|
20|FH_F34550_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MS DRG 619-621|
20|FH_F130747_0_0|SrvcGrp|97730|2022|PDM|26010.00|99|0.00|REVERSE HIP JOINT|
20|FH_F128079_67456_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F126939_32405_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F143821_60559_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F66687_0_0|SrvcGrp|29757|2022|PDM|26191.00|99|0.00|MS DRG 251 ONLY|
20|FH_F39270_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F112272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130466_53916_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129135_68756_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F79904_0_0|SrvcGrp|76094|2022|PDM|118.14|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F142073_0_0|SrvcGrp|99167|2022|PDM|5980.00|99|0.00|CPT 63057|
20|FH_F123276_20737_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F63514_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102302_0_0|SrvcGrp|98570|2022|PDM|29900.00|99|0.00|INSERT SPINE FIXATION DEVICE|
20|FH_F137946_0_0|SrvcGrp|113246|2022|PDM|105.33|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 TITER (HCFA)|
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|1523.00|99|0.00|AEG 7 (NO REV)|
20|FH_F102500_0_0|SrvcGrp|72996|2022|PDM|982.00|99|0.00|AEG 4|
20|FH_F129656_15005_0|SrvcGrp|73742|2022|PDM|40.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F91663_19901_0|SrvcGrp|46104|2022|PDM|125.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F100790_10512_0|SrvcGrp|73559|2022|PDM|6449.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F142252_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130527_66044_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F70984_0_0|SrvcGrp|38013|2022|PDM|2800.00|99|0.00|HYSTEROSCOPY|
20|FH_F124660_0_0|SrvcGrp|73000|2022|PDM|964.00|99|0.00|AEG 6|
20|FH_F126939_32405_0|SrvcGrp|86722|2022|PDM|195.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F135092_46410_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F40499_0_0|SrvcGrp|32639|2022|PCT|1.00|99|0.00|POTOMAC CTR SPECIALITY DME (MOD RR)|
20|FH_F75307_0_0|SrvcGrp|59415|2022|PDM|105.00|99|0.00|OCCUPATIONAL THERAPY SVCS EXCLD MOD GO|
20|FH_F135173_06519_0|SrvcGrp|100859|2022|PDM|223.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F92618_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110086_21742_0|CSTM-ALL|CSTM-00|2020|PDM|1213.00|99|0.00|AEG 6 (NO REV)|
20|FH_F111288_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|1500.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F33712_0_0|SrvcGrp|13715|2022|PCT|0.60|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F149868_0_0|SrvcGrp|65720|2022|PDM|194.00|99|0.00|RESPITE CARE|
20|FH_F120349_38774_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.93|99|0.00|ASPG II|
20|FH_F89563_29407_0|SrvcGrp|72379|2022|PCT|1.00|99|0.00|SPEECH THERAPY|
20|FH_F137366_87505_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F123957_84321_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F122725_32216_0|CSTM-ALL|CSTM-00|2020|PDM|24.05|99|0.00|PRE-TRANSPLANT ENVIRONMENTAL ASSESSMENT|
20|FH_F130895_07726_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F126114_31788_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119227_01752_0|SrvcGrp|86845|2022|PDM|38.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F150281_76309_0|SrvcGrp|108484|2022|PDM|613.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F125513_40071_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F134324_26354_0|SrvcGrp|74584|2022|PCT|0.84|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F138050_52301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F150160_01301_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PDM|1880.00|99|0.00|AEG 9 (NO REV)|
20|FH_F134611_04103_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|63.54|99|0.00|HAPA WPA-NWPA 2012-13 ASC 146 W/O REV|
20|FH_F145562_70458_0|SrvcGrp|112596|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138951_41101_0|SrvcGrp|31973|2022|PDM|15.00|99|0.00|HOME THERAPY|
20|FH_F95631_33705_0|SrvcGrp|88978|2022|PDM|6314.00|99|0.00|VAGINAL DELIVERY|
20|FH_F144808_0_0|SrvcGrp|71666|2022|PDM|4812.00|99|0.00|CPT 63655|
20|FH_F89219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|MT NITTANY ASC 7|
20|FH_F51476_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109364_52349_0|SrvcGrp|48385|2022|PDM|201.00|99|0.00|SPEECH THERAPY|
20|FH_F150305_18848_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114525_72401_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F125259_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_F145562_70458_0|SrvcGrp|86854|2022|PDM|25.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|224.87|99|0.00|HAPA WPA-NWPA 2012-13 ASC 131 W/O REV|
20|FH_F91777_29577_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F99161_0_0|SrvcGrp|75491|2022|PDM|1806.00|99|0.00|AEG 7|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.82|99|0.00|HAPA WPA-NWPA 2012-13 ASC 301 W/O REV|
20|FH_F135670_01749_0|SrvcGrp|14944|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F77943_0_0|SrvcGrp|20297|2022|PDM|79409.73|99|0.00|MS DRG 219-221 ONLY CARDIAC VALVE PROC|
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F83754_0_0|SrvcGrp|22811|2022|PCT|0.86|99|0.00|TRAUMA CARE|
20|FH_F116040_24637_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP WITHOUT CPT 99601|
20|FH_F116040_24637_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F131628_26505_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F132293_50595_0|SrvcGrp|109220|2022|PCT|0.10|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F133478_40165_0|SrvcGrp|112340|2022|PCT|0.54|99|0.00|REPAIR BLOOD VESSEL LESION|
20|FH_F132815_39429_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133494_90023_0|SrvcGrp|75506|2022|PCT|0.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F133494_90023_0|SrvcGrp|103913|2022|PCT|0.00|99|0.00|OP DIALYSIS|
20|FH_F133007_76010_0|SrvcGrp|89149|2022|PDM|180.00|99|0.00|OP INTENSIVE|
20|FH_F111605_80524_0|SrvcGrp|472|2022|PDM|433.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134826_19067_0|SrvcGrp|90647|2022|PDM|100.00|99|0.00|PSYTX PT/FAMILY 30 MINUTES (HCFA)|
20|FH_F134826_19067_0|SrvcGrp|52952|2022|PDM|175.00|99|0.00|PSYCHIATRIC CPT 90847|
20|FH_F132016_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F105301_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46832_0_0|SrvcGrp|10579|2022|PDM|65.00|99|0.00|HYDRATION THERAPY - 2 LITERS|
20|FH_F123820_91316_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132810_0_0|SrvcGrp|86844|2022|PDM|60.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F58856_0_0|SrvcGrp|22406|2022|PDM|3350.00|99|0.00|ASPG VI (REV CODE + CPT)|
20|FH_F136358_06070_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136532_54874_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F118186_97070_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F120489_63552_0|SrvcGrp|105809|2022|PCT|0.75|99|0.00|PT OT ST|
20|FH_F134011_84102_0|SrvcGrp|24750|2022|PDM|10.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F142547_70002_0|SrvcGrp|14949|2022|PDM|10.00|99|0.00|HOME INFUSION|
20|FH_F142547_70002_0|SrvcGrp|43568|2022|PDM|60.00|99|0.00|SKILLED NURSING - RN|
20|FH_F53732_0_0|SrvcGrp|17013|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138627_82901_0|SrvcGrp|41454|2022|PDM|1.58|99|0.00|ENTERAL FORMULA - PEDIATRICS|
20|FH_F140616_43338_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F128270_0_0|SrvcGrp|471|2022|PDM|725.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F118959_44830_0|SrvcGrp|75545|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F119011_08701_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F119023_91406_0|SrvcGrp|86851|2022|PDM|35.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F119023_91406_0|SrvcGrp|86849|2022|PDM|50.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F92593_21031_0|SrvcGrp|57968|2022|PDM|34.95|99|0.00|CONTINUOUS HOMECARE|
20|FH_F117371_77059_0|SrvcGrp|89337|2022|PDM|750.00|99|0.00|DETOXIFICATION|
20|FH_F147725_06002_0|SrvcGrp|33982|2022|PDM|3068.00|99|0.00|CPT 28296|
20|FH_F147744_33614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147861_45239_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F147921_19083_0|SrvcGrp|75419|2022|PDM|370.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F117093_40041_0|SrvcGrp|107267|2022|PDM|280.00|99|0.00|HEMODIALYSIS|
20|FH_F117107_33704_0|SrvcGrp|106990|2022|PCT|1.00|99|0.00|RHOGAM INJECTION|
20|FH_F117154_43017_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F137814_61820_0|SrvcGrp|46903|2022|PDM|575.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F101945_0_0|SrvcGrp|54943|2022|PDM|2726.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F109652_0_0|SrvcGrp|15789|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F112080_0_0|SrvcGrp|73004|2022|PDM|1410.00|99|0.00|AEG 8|
20|FH_F91472_96001_0|SrvcGrp|74579|2022|PCT|0.75|99|0.00|TRAUMA SERVICES|
20|FH_F85757_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121910_27104_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114968_0_0|SrvcGrp|79458|2022|PDM|0.25|99|0.00|MED RECORD COPY|
20|FH_F115884_0_0|SrvcGrp|89783|2022|PDM|111.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F34963_0_0|SrvcGrp|16304|2022|PDM|580.00|99|0.00|HOSPICE CARE|
20|FH_F110000_0_0|SrvcGrp|16|2022|PDM|1406.00|99|0.00|ACUTE REHABILITATION|
20|FH_F110381_0_0|SrvcGrp|73002|2022|PDM|2438.00|99|0.00|AEG 7|
20|FH_F91873_12723_0|SrvcGrp|73002|2022|PDM|3701.00|99|0.00|AEG 7|
20|FH_F91873_12723_0|SrvcGrp|74668|2022|PDM|360.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F97660_29401_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F116323_0_0|SrvcGrp|11663|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F115150_0_0|SrvcGrp|92188|2022|PDM|350.17|99|0.00|CPT 95805  (HCFA)|
20|FH_F116043_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F103780_64804_0|CSTM-ALL|CSTM-00|2020|PDM|1786.00|99|0.00|AEG 3 (NO REV)|
20|FH_F117623_0_0|CSTM-ALL|CSTM-00|2020|PDM|27.00|99|0.00|EXPOSE BEHAV ASSESS ADDL|
20|FH_F138929_0_0|SrvcGrp|35666|2022|PDM|1375.00|99|0.00|CPT 23700|
20|FH_F132988_0_0|SrvcGrp|112164|2022|PDM|11979.18|99|0.00|REPAIR OF HUMERUS|
20|FH_F137067_0_0|SrvcGrp|103236|2022|PDM|18900.00|99|0.00|AETNA INSJ STABLJ DEV|
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1426.19|99|0.00|ASPG IV|
20|FH_F93252_0_0|SrvcGrp|93018|2022|PDM|7000.00|99|0.00|PARTIAL KNEE REPLACEMENT|
20|FH_F114389_50131_0|SrvcGrp|21920|2022|PDM|130.65|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F124180_0_0|SrvcGrp|22948|2022|PDM|1800.00|99|0.00|CPT CODE 42830|
20|FH_F146974_19709_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124417_85364_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124414_92653_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F124611_64804_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147899_0_0|CSTM-ALL|CSTM-00|2020|PDM|443.00|99|0.00|AEG 1 (NO REV)|
20|FH_F133694_89117_0|SrvcGrp|88799|2022|PDM|115.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F130796_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117202_0_0|SrvcGrp|82981|2022|PDM|100.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F133207_0_0|SrvcGrp|100067|2022|PDM|3360.00|99|0.00|ANKLE ARTHROSCOPY SURGERY|
20|FH_F137567_0_0|SrvcGrp|87077|2022|PDM|105.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F124792_44515_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150223_30720_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150299_22046_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F112060_07514_0|SrvcGrp|87910|2022|PCT|1.00|99|0.00|VANCOMYCIN HCL INJECT 500MG|
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|2133.00|99|0.00|AEG 4 (NO REV)|
20|FH_F148905_85390_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F49476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149245_78576_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|1660.00|99|0.00|AEG 8 (NO REV)|
20|FH_F85353_16407_0|SrvcGrp|63854|2022|PDM|400.33|99|0.00|HAPA WPA-NWPA 2012-13 ASC 407|
20|FH_F111882_51560_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|2249.33|99|0.00|AEG 9 (NO REV)|
20|FH_F138348_04096_0|SrvcGrp|46903|2022|PDM|800.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132969_84003_0|SrvcGrp|26868|2022|PDM|25.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F126341_27284_0|SrvcGrp|26868|2022|PCT|1.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F121225_98902_0|SrvcGrp|73488|2022|PCT|0.85|99|0.00|AETNA HOSPITAL OP DIALYSIS|
20|FH_F150225_03051_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147980_0_0|SrvcGrp|80920|2022|PDM|450.00|99|0.00|HOSPICE SERVICES|
20|FH_F120417_63124_0|CSTM-ALL|CSTM-00|2020|PDM|602.00|99|0.00|AEG 3 (NO REV)|
20|FH_F150165_06032_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F139565_0_0|SrvcGrp|114443|2022|PDM|10328.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F144228_0_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F127090_45601_0|SrvcGrp|73700|2022|PDM|45.51|99|0.00|AETNA - SKILLED NURSING|
20|FH_F147980_0_0|SrvcGrp|104229|2022|PDM|95.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F146117_0_0|SrvcGrp|84939|2022|PDM|3118.00|99|0.00|SHOULDER JOINT|
20|FH_F133875_80027_0|SrvcGrp|72602|2022|PDM|1067.00|99|0.00|ECT|
20|FH_F144848_0_0|SrvcGrp|97299|2022|PDM|2437.00|99|0.00|REMOVE SPINE ELTRD PLATE|
20|FH_F128379_0_0|SrvcGrp|100920|2022|PDM|3319.00|99|0.00|SPINE PRO DEVICE|
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|205.00|99|0.00|OP ADULT PARTIAL HOSPITALIZATION (CD)|
20|FH_F138951_41101_0|SrvcGrp|86843|2022|PDM|45.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1083.18|99|0.00|HAPA WPA-NWPA 2012-13 ASC 7 W/O REV|
20|FH_F124161_95932_0|SrvcGrp|90854|2022|PDM|2066.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F134362_32535_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|PDM|2780.00|99|0.00|AEG 3 (NO REV)|
20|FH_F127589_45459_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F114415_16509_0|SrvcGrp|75545|2022|PDM|330.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F146461_75428_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136359_0_0|SrvcGrp|28549|2022|PDM|4400.00|99|0.00|VITRECTOMY|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|438.74|99|0.00|HAPA WPA-NWPA 2012-13 ASC 205 W/O REV|
20|FH_F133774_06062_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126550_43085_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F122948_23947_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150225_03051_0|SrvcGrp|82981|2022|PDM|135.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F111986_0_0|SrvcGrp|89982|2022|PDM|3605.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY|
20|FH_F93359_63084_0|SrvcGrp|92807|2022|PDM|430.00|99|0.00|AETNA RESIDENTIAL TREATMENT PYCH & CD (AGE 13-17)|
20|FH_F120727_54301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133749_84604_0|SrvcGrp|112409|2022|PDM|30.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F143742_60410_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F126348_23824_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54592_0_0|SrvcGrp|24748|2022|PDM|85.00|99|0.00|CORTICOSTEROID THERAPY|
20|FH_F85257_0_0|SrvcGrp|3066|2022|PCT|0.55|99|0.00|HIGH-COST DRUGS|
20|FH_F101100_50314_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115814_53235_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F115872_06052_0|SrvcGrp|76501|2022|PDM|368.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F115936_75093_0|SrvcGrp|89417|2022|PDM|475.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146783_76048_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115950_08648_0|SrvcGrp|86746|2022|PCT|1.05|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F115972_92675_0|SrvcGrp|89417|2022|PDM|500.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F116088_46410_0|SrvcGrp|73842|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133558_87111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133007_76010_0|SrvcGrp|89024|2022|PDM|80.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F131430_17566_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131212_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111601_15203_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F111666_06517_0|SrvcGrp|108484|2022|PDM|515.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F134826_19067_0|SrvcGrp|90643|2022|PDM|135.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F39346_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|ACUTE PSYCH|
20|FH_F35381_0_0|SrvcGrp|16777|2022|PCT|1.00|99|0.00|ORGAN ACQUISITION|
20|FH_F89372_0_0|SrvcGrp|109120|2022|PDM|30240.00|99|0.00|GASTRIC BYPASS|
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|997.00|99|0.00|AEG 4 (NO REV)|
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|37.51|99|0.00|AETNA SLEEP STUDIES (MOD TC)|
20|FH_F129103_17545_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100787_69162_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F114645_34952_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F114985_32073_0|SrvcGrp|90491|2022|PDM|86.00|99|0.00|EVALUATE SPEECH PRODUCTION|
20|FH_F137447_0_0|SrvcGrp|106317|2022|PDM|500.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F122610_73139_0|SrvcGrp|109156|2022|PDM|1346.00|99|0.00|NUCLEAR MEDICINE|
20|FH_F43862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F134675_60134_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F134770_14420_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F136778_62034_0|SrvcGrp|12491|2022|PCT|0.25|99|0.00|PACEMAKER|
20|FH_F136824_08034_0|SrvcGrp|74668|2022|PDM|254.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|1620.00|99|0.00|WELLPATH PROPIETARY ASC VIII|
20|FH_F115210_21043_0|SrvcGrp|26274|2022|PDM|2122.00|99|0.00|CPT 29877|
20|FH_F115631_65201_0|SrvcGrp|98947|2022|PDM|7575.00|99|0.00|HIT EXTERNAL (HCFA)|
20|FH_F147299_02072_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F147439_84003_0|SrvcGrp|76501|2022|PDM|260.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F147539_68359_0|SrvcGrp|75506|2022|PCT|0.98|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F147394_14031_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42433_0_0|SrvcGrp|474|2022|PDM|220.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F98622_45005_0|SrvcGrp|73656|2022|PDM|629.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F103004_75840_0|SrvcGrp|73000|2022|PDM|1156.00|99|0.00|AEG 6|
20|FH_F40634_0_0|SrvcGrp|97|2022|PDM|2917.00|99|0.00|C-SECTION|
20|FH_F140007_0_0|SrvcGrp|16669|2022|PDM|3470.00|99|0.00|ACROMINOPLASTY OF SHOULDER|
20|FH_F140007_0_0|SrvcGrp|97079|2022|PDM|3470.00|99|0.00|MENISCUS REPAIR, MED OR LAT|
20|FH_F66922_66211_0|CSTM-ALL|CSTM-00|2020|PDM|1685.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132772_0_0|SrvcGrp|112096|2022|PDM|284.00|99|0.00|DIALYSIS|
20|FH_F148490_80231_0|SrvcGrp|109330|2022|PCT|1.03|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PDM|2106.00|99|0.00|AEG 10 (NO REV)|
20|FH_F133107_73071_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F95101_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F132545_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F113154_70359_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 4 (NO REV)|
20|FH_F113250_71901_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F135351_0_0|SrvcGrp|103813|2022|PDM|891.00|99|0.00|SPINE INJECTION|
20|FH_F117820_0_0|SrvcGrp|90707|2022|PDM|105.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F82357_0_0|SrvcGrp|62154|2022|PDM|66.00|99|0.00|PICC LINES|
20|FH_F35929_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129248_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F129248_0_0|SrvcGrp|14614|2022|PDM|3000.00|99|0.00|LITHOTRIPSY|
20|FH_F111951_80111_0|SrvcGrp|471|2022|PDM|557.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138774_74133_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138876_25302_0|SrvcGrp|86839|2022|PDM|40.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F138936_01040_0|SrvcGrp|92958|2022|PCT|1.40|99|0.00|SLEEP STUDIES|
20|FH_F77933_0_0|SrvcGrp|48630|2022|PDM|57.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|1462.99|99|0.00|AEG 5  (NO REV)|
20|FH_F151319_64040_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151420_60654_0|CSTM-ALL|CSTM-00|2020|PDM|2081.00|99|0.00|AEG 9 (NO REV)|
20|FH_F151479_75605_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151501_30265_0|SrvcGrp|104008|2022|PDM|5709.00|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS|
20|FH_F132268_07060_0|SrvcGrp|94743|2022|PDM|58.94|99|0.00|FLUZONE VACC IM (>=3 YRS)|
20|FH_F144928_02703_0|SrvcGrp|90397|2022|PDM|284.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F123193_33431_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F36492_0_0|SrvcGrp|72992|2022|PDM|764.00|99|0.00|AEG 2|
20|FH_F135407_62320_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135427_19610_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F135494_10941_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F135495_33145_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F135973_66606_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136180_92253_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F119885_13753_0|SrvcGrp|472|2022|PDM|335.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F131228_01826_0|SrvcGrp|10362|2022|PDM|457.93|99|0.00|CPT CODE 99282|
20|FH_F131407_07607_0|SrvcGrp|86848|2022|PDM|30.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F121803_66502_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F128201_33334_0|SrvcGrp|46903|2022|PDM|460.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F128201_33334_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F111301_33122_0|SrvcGrp|104283|2022|PDM|6719.00|99|0.00|GASTRIC SLEEVE WITH HERNIA REPAIR|
20|FH_F134315_89106_0|SrvcGrp|24761|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG VI|
20|FH_F51272_0_0|SrvcGrp|47588|2022|PDM|12000.00|99|0.00|LITHOTRIPSY|
20|FH_F131000_0_0|SrvcGrp|78098|2022|PDM|2494.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|2159.00|99|0.00|AEG 4 (NO REV)|
20|FH_F132328_0_0|SrvcGrp|41334|2022|PDM|14566.00|99|0.00|TOTAL KNEE|
20|FH_F43895_0_0|SrvcGrp|45883|2022|PDM|125.00|99|0.00|OT|
20|FH_F72666_0_0|SrvcGrp|69679|2022|PDM|4614.00|99|0.00|AICD MS DRG ONLY|
20|FH_F105421_0_0|SrvcGrp|67684|2022|PDM|215.00|99|0.00|PSYCH VISIT|
20|FH_F87532_32110_0|SrvcGrp|471|2022|PDM|472.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F87474_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F123848_03257_0|SrvcGrp|46605|2022|PDM|163.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F93363_63123_0|SrvcGrp|88621|2022|PDM|45.00|99|0.00|SKILLED NURSING LPN|
20|FH_F134126_11554_0|CSTM-ALL|CSTM-00|2020|PDM|1837.00|99|0.00|AEG 10 (NO REV)|
20|FH_F137036_60504_0|SrvcGrp|88620|2022|PDM|115.00|99|0.00|SKILLED NURSING RN|
20|FH_F142413_61342_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142547_70002_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138545_39503_0|SrvcGrp|90388|2022|PDM|718.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F74264_15301_0|SrvcGrp|81879|2022|PCT|1.00|99|0.00|LABORATORY W/ REV/HCPC|
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 1 (NO REV)|
20|FH_F77782_66061_0|SrvcGrp|30623|2022|PDM|7081.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F139267_30253_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139456_47501_0|SrvcGrp|9263|2022|PDM|155.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F140343_89052_0|SrvcGrp|19742|2022|PDM|55.00|99|0.00|MID-LINE INSERTION|
20|FH_F140760_07003_0|SrvcGrp|73841|2022|PDM|291.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F79724_32501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120152_0_0|SrvcGrp|92009|2022|PDM|4400.00|99|0.00|CARPAL SCAPHOID FRACTURE|
20|FH_F149600_18901_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119021_03060_0|SrvcGrp|86747|2022|PCT|1.06|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F92551_18508_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117261_43543_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F129427_92262_0|SrvcGrp|111348|2022|PCT|1.50|99|0.00|OP THERAPY SERVICES|
20|FH_F117240_37334_0|SrvcGrp|16|2022|PDM|1250.00|99|0.00|ACUTE REHABILITATION|
20|FH_F137927_52241_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F109652_0_0|SrvcGrp|78804|2022|PDM|9566.00|99|0.00|MEDICAL BACK PROBLEMS MSDRG ONLY|
20|FH_F109652_0_0|SrvcGrp|73610|2022|PCT|0.24|99|0.00|AETNA IMPLANTS|
20|FH_F109821_0_0|SrvcGrp|78701|2022|PDM|1530.00|99|0.00|AETNA REPAIRING HERN PREMIE REDUC|
20|FH_F124754_84403_0|SrvcGrp|75442|2022|PDM|803.00|99|0.00|OBSERVATION - REV 762|
20|FH_F124891_29935_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124954_17055_0|SrvcGrp|106297|2022|PDM|204.13|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F33821_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73022_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.75|99|0.00|HSS APC GROUPED|
20|FH_F151056_17821_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F121385_89102_0|SrvcGrp|73602|2022|PDM|1564.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F121976_44505_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115884_0_0|SrvcGrp|9529|2022|PDM|515.00|99|0.00|HOSPICE SVCS|
20|FH_F115884_0_0|SrvcGrp|89822|2022|PDM|111.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F115884_0_0|SrvcGrp|90707|2022|PDM|111.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F129130_92562_0|SrvcGrp|109057|2022|PCT|4.22|99|0.00|CARDIAC STUDIES|
20|FH_F73163_0_0|CSTM-ALL|CSTM-00|2020|PDM|2278.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67999_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117525_0_0|SrvcGrp|72998|2022|PDM|1185.00|99|0.00|AEG 5|
20|FH_F91873_12723_0|SrvcGrp|78448|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F97780_43614_0|SrvcGrp|73601|2022|PDM|11286.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F106822_0_0|SrvcGrp|82757|2022|PDM|5.45|99|0.00|ASSAY BLOOD CREATININE|
20|FH_F106822_0_0|SrvcGrp|100275|2022|PDM|125.60|99|0.00|MENINGOCOCCL POLYSACCHRID VA|
20|FH_F106822_0_0|SrvcGrp|100283|2022|PDM|7.95|99|0.00|SINGLE IMMUNIZATION ADMIN (HCFA)|
20|FH_F88616_0_0|CSTM-ALL|CSTM-00|2020|PDM|775.00|99|0.00|AEG 1 (NO REV)|
20|FH_F112967_0_0|SrvcGrp|80317|2022|PDM|115.00|99|0.00|RESPITE CARE|
20|FH_F115208_0_0|SrvcGrp|98364|2022|PDM|1591.00|99|0.00|AETNA NASAL/SINUS ENDO W/MAXILLARY ANTROSTOMY|
20|FH_F100640_48097_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F104840_32565_0|SrvcGrp|93924|2022|PCT|0.69|99|0.00|AETNA MEDICAL SERVICES|
20|FH_F133016_67114_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134317_0_0|SrvcGrp|73485|2022|PDM|950.00|99|0.00|AETNA REHAB|
20|FH_F143898_0_0|SrvcGrp|84185|2022|PDM|160.00|99|0.00|RESPITE CARE|
20|FH_F132627_0_0|SrvcGrp|17006|2022|PDM|80.58|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS|
20|FH_F132988_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 8 (NO REV)|
20|FH_F82432_0_0|SrvcGrp|80918|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F116664_0_0|SrvcGrp|103551|2022|PDM|542.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F114389_50131_0|SrvcGrp|98929|2022|PDM|93.83|99|0.00|HIT PAIN IMP PUMP (HCFA)|
20|FH_F114389_50131_0|SrvcGrp|48398|2022|PDM|170.42|99|0.00|PT SERVICES|
20|FH_F141336_16947_0|SrvcGrp|12491|2022|PCT|0.39|99|0.00|PACEMAKER|
20|FH_F149719_0_0|SrvcGrp|108043|2022|PDM|236.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F147017_35976_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F100703_0_0|SrvcGrp|96353|2022|PDM|8034.00|99|0.00|RECONSTRUCT ANKLE JOINT|
20|FH_F124235_92840_0|SrvcGrp|104079|2022|PCT|1.50|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F124663_65608_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130036_43232_0|SrvcGrp|72602|2022|PDM|867.00|99|0.00|ECT|
20|FH_F131656_51401_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F76163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136607_68632_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|GENERAL ACUTE CARE|
20|FH_F136624_15025_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|GENERAL ACUTE CARE|
20|FH_F114666_30342_0|SrvcGrp|53065|2022|PDM|675.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F138562_46703_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136698_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F148100_22406_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132212_0_0|SrvcGrp|89783|2022|PDM|90.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F148482_20136_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F148545_84047_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101754_63141_0|SrvcGrp|97983|2022|PDM|21.48|99|0.00|EVALUATION OF AUDITORY REHAB|
20|FH_F75245_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.80|99|0.00|OP SVCS|
20|FH_F129364_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38770_0_0|SrvcGrp|3029|2022|PDM|502.00|99|0.00|NEWBORN NURSERY|
20|FH_F142078_73110_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F51129_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|BURN CARE SERVICES|
20|FH_F121016_32607_0|SrvcGrp|13238|2022|PCT|1.00|99|0.00|VENIPUNCTURE|
20|FH_F145901_45205_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133530_11237_0|SrvcGrp|3273|2022|PCT|0.45|99|0.00|IMPLANTS|
20|FH_F149581_0_0|SrvcGrp|73485|2022|PDM|1008.00|99|0.00|AETNA REHAB|
20|FH_F145818_77573_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124608_0_0|SrvcGrp|67065|2022|PDM|5916.00|99|0.00|CERVICAL SURGERY|
20|FH_F33554_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125009_17042_0|SrvcGrp|89149|2022|PDM|206.00|99|0.00|OP INTENSIVE|
20|FH_F125256_77365_0|SrvcGrp|108484|2022|PDM|480.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F118542_60188_0|SrvcGrp|26868|2022|PDM|57.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F137896_0_0|SrvcGrp|107864|2022|PCT|1.00|99|0.00|AETNA INJECTABLES (A & B CODES)|
20|FH_F126868_60451_0|SrvcGrp|86723|2022|PDM|395.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F38039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126942_39540_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F120407_84070_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD NU/KL)|
20|FH_F49027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F58972_0_0|CSTM-ALL|CSTM-00|2020|PDM|2328.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F96120_67207_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37909_0_0|SrvcGrp|15477|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS INITIAL EVAL|
20|FH_F44795_0_0|SrvcGrp|30955|2022|PDM|80.00|99|0.00|SKILLED RN VISIT|
20|FH_F142084_82009_0|SrvcGrp|41563|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2368.00|99|0.00|AEG 8 (NO REV)|
20|FH_F115274_15235_0|SrvcGrp|95660|2022|PDM|575.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1737.00|99|0.00|AEG 9 (NO REV)|
20|FH_F117821_90049_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F41739_0_0|SrvcGrp|13551|2022|PDM|642.00|99|0.00|NEWBORN NURSERY|
20|FH_F66480_0_0|SrvcGrp|39524|2022|PDM|25.00|99|0.00|BILIRUBIN TEST|
20|FH_F100666_81301_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F102721_38118_0|SrvcGrp|75506|2022|PCT|0.40|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F97564_52246_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
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_F133627_89113_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F92676_15063_0|SrvcGrp|79088|2022|PDM|227.97|99|0.00|MON VALLEY ASC 145|
20|FH_F142084_82009_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: BREAKOUT|
20|FH_F116324_0_0|SrvcGrp|75479|2022|PDM|385.00|99|0.00|AEG 1|
20|FH_F38663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128279_77043_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F68363_0_0|SrvcGrp|13640|2022|PDM|80.00|99|0.00|CPT 99202|
20|FH_F119559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F134448_66203_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F113146_15001_0|SrvcGrp|86648|2022|PCT|1.05|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F35013_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|OP SVCS|
20|FH_F31184_0_0|SrvcGrp|18868|2022|PDM|39500.00|99|0.00|MS DRG 231|
20|FH_F132224_89119_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F144769_0_0|SrvcGrp|11258|2022|PCT|0.21|99|0.00|DRUGS|
20|FH_F118964_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.00|99|0.00|AEG 2 (NO REV)|
20|FH_F126815_02118_0|CSTM-ALL|CSTM-00|2020|PDM|2469.81|99|0.00|AEG 9 (NO REV)|
20|FH_F117816_0_0|SrvcGrp|92501|2022|PDM|133.35|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F34706_0_0|SrvcGrp|3581|2022|PDM|17389.00|99|0.00|DRG 111 MAJOR CV PROC W/O CC|
20|FH_F132338_18901_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F31093_0_0|CSTM-ALL|CSTM-00|2020|PDM|2353.00|99|0.00|ASPG VII|
20|FH_F148865_0_0|SrvcGrp|30609|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F97563_83201_0|SrvcGrp|88978|2022|PDM|7704.00|99|0.00|VAGINAL DELIVERY|
20|FH_F132487_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F42377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F40542_0_0|SrvcGrp|32649|2022|PCT|1.50|99|0.00|OTHER DIAGNOSTIC TESTING - CPT/MOD TC|
20|FH_F80855_0_0|SrvcGrp|73008|2022|PDM|825.00|99|0.00|AEG 10|
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_F73542_0_0|SrvcGrp|71039|2022|PCT|1.00|99|0.00|CMS AMBULANCE MS (00512-00) SUPER RURAL GROUND MILEAGE|
20|FH_F34688_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F124928_04210_0|SrvcGrp|97507|2022|PDM|144.58|99|0.00|AETNA HOSPICE|
20|FH_F119437_0_0|SrvcGrp|67069|2022|PDM|4750.00|99|0.00|CPT 22634|
20|FH_F38016_0_0|SrvcGrp|361|2022|PDM|784.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F128421_27016_0|SrvcGrp|73485|2022|PCT|0.80|99|0.00|AETNA REHAB|
20|FH_F117559_08619_0|SrvcGrp|64580|2022|PDM|264.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F80955_0_0|SrvcGrp|75545|2022|PDM|352.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F81832_13827_0|SrvcGrp|73700|2022|PDM|49.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F122606_53818_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F42837_0_0|SrvcGrp|13627|2022|PDM|225.00|99|0.00|SLEEP STUDY|
20|FH_F134735_91362_0|SrvcGrp|9811|2022|PDM|648.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F135719_45502_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|AETNA LAB SERVICES|
20|FH_F135748_60455_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136796_24016_0|SrvcGrp|94883|2022|PDM|2907.56|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F113713_17013_0|SrvcGrp|104415|2022|PDM|190.00|99|0.00|PSYCH DIAGNOSTIC (HCFA)(MOD AF)|
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|2222.00|99|0.00|AEG 9 (NO REV)|
20|FH_F121402_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|OP SVCS|
20|FH_F74283_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147420_89032_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F41463_0_0|SrvcGrp|10579|2022|PDM|57.00|99|0.00|HYDRATION THERAPY - 2 LITERS|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD MS OR  MOD RR/MS RATE|
20|FH_F38831_0_0|SrvcGrp|10419|2022|PDM|1442.00|99|0.00|SKILLED NURSING CARE|
20|FH_F100780_24153_0|SrvcGrp|90854|2022|PDM|2552.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F103004_75840_0|SrvcGrp|73606|2022|PDM|579.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F62582_81650_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|GENERAL ACUTE CARE|
20|FH_F130302_0_0|SrvcGrp|73000|2022|PDM|2251.00|99|0.00|AEG 6|
20|FH_F141211_0_0|SrvcGrp|11306|2022|PCT|0.45|99|0.00|IMPLANTS|
20|FH_F133107_73071_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F120630_33161_0|SrvcGrp|73841|2022|PDM|394.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F37850_0_0|SrvcGrp|27566|2022|PCT|0.68|99|0.00|CV SURGERY|
20|FH_F39633_0_0|SrvcGrp|17067|2022|PDM|828.00|99|0.00|ASPG II|
20|FH_F41013_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F139012_78516_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138685_18017_0|SrvcGrp|89022|2022|PDM|35.11|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F96321_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149242_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|513.29|99|0.00|HAPA WPA-NWPA 2012-13 ASC 204 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|470.19|99|0.00|HAPA WPA-NWPA 2012-13 ASC 211 W/O REV|
20|FH_F84159_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151303_50703_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F151304_31520_0|CSTM-ALL|CSTM-00|2020|PDM|1282.00|99|0.00|AEG 8 (NO REV)|
20|FH_F151306_21030_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151320_15145_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151426_90028_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151501_30265_0|SrvcGrp|100067|2022|PDM|2090.00|99|0.00|ANKLE ARTHROSCOPY SURGERY|
20|FH_F132258_45404_0|SrvcGrp|48385|2022|PDM|85.86|99|0.00|SPEECH THERAPY|
20|FH_F36492_0_0|SrvcGrp|72996|2022|PDM|1080.00|99|0.00|AEG 4|
20|FH_F97142_94535_0|SrvcGrp|73601|2022|PDM|11799.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F100765_73735_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F116431_76104_0|SrvcGrp|73841|2022|PDM|350.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F116527_70443_0|SrvcGrp|99072|2022|PDM|1061.00|99|0.00|AETNA MATERNITY DELIVERY|
20|FH_F121813_75701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F33685_0_0|CSTM-ALL|CSTM-00|2020|PDM|1830.00|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_F42347_0_0|SrvcGrp|16746|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F43237_0_0|SrvcGrp|40820|2022|PDM|1400.00|99|0.00|ICU/CCU|
20|FH_F44113_0_0|SrvcGrp|20801|2022|PCT|0.80|99|0.00|HOME HEALTH|
20|FH_F127926_62832_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129967_18915_0|SrvcGrp|89417|2022|PDM|277.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F111301_33122_0|SrvcGrp|72994|2022|PDM|1559.00|99|0.00|AEG 3|
20|FH_F134263_15628_0|SrvcGrp|104796|2022|PDM|145.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F132720_0_0|SrvcGrp|3078|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.00|99|0.00|ASPG IX|
20|FH_F132328_0_0|SrvcGrp|88599|2022|PDM|4734.00|99|0.00|ENDOSCOPY MAXILLARY SINUS|
20|FH_F132328_0_0|SrvcGrp|85785|2022|PDM|2049.00|99|0.00|ARTHROSCOPY|
20|FH_F87534_19464_0|SrvcGrp|85601|2022|PCT|1.45|99|0.00|PT/OT REHAB SERV|
20|FH_F148120_22903_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72544_0_0|SrvcGrp|8968|2022|PDM|5364.00|99|0.00|NICU LEVEL III & IV|
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PDM|2278.00|99|0.00|AEG 5  (NO REV)|
20|FH_F138283_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148432_01585_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F42984_0_0|SrvcGrp|110|2022|PDM|557.00|99|0.00|CD - REHABILITATION|
20|FH_F101840_76054_0|SrvcGrp|29757|2022|PDM|15935.00|99|0.00|MS DRG 251 ONLY|
20|FH_F44334_0_0|SrvcGrp|13621|2022|PDM|470.99|99|0.00|SLEEP STUDIES|
20|FH_F144888_15370_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F129175_0_0|SrvcGrp|87679|2022|PDM|555.83|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F110240_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F45199_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.45|99|0.00|OCN F/S PRICING: ALL|
20|FH_F92676_15063_0|SrvcGrp|14244|2022|PDM|898.00|99|0.00|EMERGENCY ROOM SVCS LEVEL VI|
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 5  (NO REV)|
20|FH_F134490_62801_0|CSTM-ALL|CSTM-00|2020|PDM|890.00|99|0.00|AEG 2 (NO REV)|
20|FH_F101943_17701_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F68121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F141927_71901_0|CSTM-ALL|CSTM-00|2020|PDM|1414.00|99|0.00|AEG 7 (NO REV)|
20|FH_F123039_44147_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144048_91324_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F89851_83854_0|SrvcGrp|73805|2022|PDM|13900.00|99|0.00|AETNA MSDRG 621 ONLY|
20|FH_F138611_0_0|SrvcGrp|99161|2022|PDM|14894.00|99|0.00|CPT 27138|
20|FH_F36973_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REFERENCE LABS MOD QW|
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_F136417_0_0|SrvcGrp|87077|2022|PDM|232.20|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F142169_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F71723_16502_0|SrvcGrp|81879|2022|PCT|1.00|99|0.00|LABORATORY W/ REV/HCPC|
20|FH_F101840_76054_0|SrvcGrp|73497|2022|PDM|1391.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F149840_80002_0|SrvcGrp|65720|2022|PDM|144.00|99|0.00|RESPITE CARE|
20|FH_F42779_0_0|SrvcGrp|36516|2022|PDM|521.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 8 (NO REV)|
20|FH_F113146_15001_0|SrvcGrp|105017|2022|PDM|503.00|99|0.00|RESIDENTIAL TREATMENT (13-17 YRS)|
20|FH_F126650_68105_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143684_0_0|SrvcGrp|103329|2022|PDM|9833.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN|
20|FH_F148900_0_0|SrvcGrp|115145|2022|PDM|668.00|99|0.00|NJX AA&/STRD PUDENDAL NERVE|
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)|
20|FH_F111520_81601_0|SrvcGrp|104329|2022|PCT|1.00|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|WV HH  S CODES MOD 53|
20|FH_F127325_0_0|SrvcGrp|73000|2022|PDM|794.00|99|0.00|AEG 6|
20|FH_F40659_0_0|SrvcGrp|33164|2022|PDM|275.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F138702_43614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139172_40207_0|SrvcGrp|73842|2022|PDM|209.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139327_62220_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|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_F97260_06111_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F149459_06615_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F122371_83276_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|OP SVCS|
20|FH_F141021_0_0|SrvcGrp|109812|2022|PDM|640.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F136947_0_0|SrvcGrp|106300|2022|PDM|450.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F137288_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|434.24|99|0.00|SALLY BALIN,999182,ASC 405|
20|FH_F90055_33805_0|SrvcGrp|75545|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F114207_35243_0|SrvcGrp|86842|2022|PDM|30.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F139227_33162_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F107922_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148347_0_0|SrvcGrp|109799|2022|PDM|2018.55|99|0.00|REPAIR OF RECTUM|
20|FH_F115483_62002_0|SrvcGrp|73602|2022|PDM|965.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F90232_15126_0|SrvcGrp|86846|2022|PDM|56.70|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F146266_0_0|SrvcGrp|114329|2022|PDM|3396.00|99|0.00|BIOPSY FINGER JOINT LINING|
20|FH_F134846_06437_0|SrvcGrp|75545|2022|PDM|495.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F134869_08854_0|SrvcGrp|89417|2022|PDM|477.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|933.00|99|0.00|AEG 6 (NO REV)|
20|FH_F149023_44122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111266_30339_0|SrvcGrp|86853|2022|PDM|30.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F128197_84123_0|SrvcGrp|88620|2022|PDM|103.00|99|0.00|SKILLED NURSING RN|
20|FH_F147140_89103_0|SrvcGrp|73700|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F35088_0_0|SrvcGrp|290|2022|PCT|0.65|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F117617_80439_0|SrvcGrp|107591|2022|PDM|165.00|99|0.00|HOSPICE CARE PROV SKILLED NURSING FAC (HCFA)|
20|FH_F36485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% 2007 MEDICARE TN DME MOD KF|
20|FH_F31547_0_0|SrvcGrp|12690|2022|PDM|13.13|99|0.00|CALCITRIOL|
20|FH_F127553_44321_0|SrvcGrp|80920|2022|PDM|550.00|99|0.00|HOSPICE SERVICES|
20|FH_F131389_33169_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112754_98057_0|SrvcGrp|73523|2022|PDM|263.87|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F47902_0_0|SrvcGrp|29963|2022|PCT|1.00|99|0.00|DME MOD UE|
20|FH_F149699_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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126116_0_0|SrvcGrp|27347|2022|PDM|1125.00|99|0.00|CPT 58558|
20|FH_F132254_40207_0|SrvcGrp|86850|2022|PDM|50.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F98001_27603_0|SrvcGrp|73603|2022|PDM|7022.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F37342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|VERTICAL PLUS MRI MOD KM|
20|FH_F127464_15106_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F122260_98034_0|SrvcGrp|79238|2022|PDM|700.00|99|0.00|TRANSFER|
20|FH_F35416_0_0|SrvcGrp|72|2022|PDM|780.00|99|0.00|NEWBORN NURSERY|
20|FH_F73803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F119897_78229_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148859_0_0|SrvcGrp|89657|2022|PDM|23.46|99|0.00|RADIATION TREATMENT DEVICES|
20|FH_F36462_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|2801.00|99|0.00|AEG 10 (NO REV)|
20|FH_F128543_44413_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F130023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97184_26101_0|SrvcGrp|73559|2022|PDM|8668.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 9 (NO REV)|
20|FH_F141612_19605_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F74883_0_0|SrvcGrp|72042|2022|PDM|110.00|99|0.00|OFFICE VISIT|
20|FH_F118667_95131_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F117009_0_0|SrvcGrp|114581|2022|PDM|2368.00|99|0.00|INSERT ANT SEGMENT DRAIN IN|
20|FH_F119437_0_0|SrvcGrp|67064|2022|PDM|4750.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F109566_28601_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F40388_0_0|SrvcGrp|7|2022|PDM|335.00|99|0.00|NEONATAL INTENSIVE|
20|FH_F128699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45176_0_0|SrvcGrp|39603|2022|PDM|2800.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F38410_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|LPN HI TECH - HOURLY|
20|FH_F133129_45863_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F111401_29425_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F38725_0_0|CSTM-ALL|CSTM-00|2020|PDM|1181.00|99|0.00|ASPG VII|
20|FH_F148009_71322_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F52293_0_0|SrvcGrp|11920|2022|PCT|0.90|99|0.00|PHARMACY SVCS|
20|FH_F92676_15063_0|SrvcGrp|78963|2022|PDM|2227.27|99|0.00|MON VALLEY ASC 503|
20|FH_F127412_15301_0|SrvcGrp|46906|2022|PDM|1640.00|99|0.00|CORNEAL TISSUE|
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|1828.00|99|0.00|ASPG VII|
20|FH_F128349_43082_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133005_32726_0|SrvcGrp|83801|2022|PDM|1700.00|99|0.00|INTERIM LABOR FACILITY GLOBA|
20|FH_F139825_0_0|SrvcGrp|109348|2022|PDM|2869.00|99|0.00|EXCISION OF LESION OF EYELID|
20|FH_F147997_92620_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F41181_0_0|SrvcGrp|11663|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F146121_71857_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F49044_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING|
20|FH_F38939_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31184_0_0|SrvcGrp|18889|2022|PDM|21500.00|99|0.00|MS DRG 235|
20|FH_F118540_32064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117559_08619_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100666_81301_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F37751_0_0|SrvcGrp|27695|2022|PCT|1.00|99|0.00|TRANSPORTATION|
20|FH_F101922_98055_0|SrvcGrp|92825|2022|PDM|4700.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F119602_0_0|SrvcGrp|35669|2022|PDM|5200.00|99|0.00|CPT 63650|
20|FH_F133287_40215_0|SrvcGrp|13750|2022|PCT|0.00|99|0.00|DRUGS INCIDENT TO RADIOLOGY|
20|FH_F117006_0_0|SrvcGrp|92501|2022|PDM|133.35|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F119096_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 2 (NO REV)|
20|FH_F68865_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F118845_71111_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F95641_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F69104_0_0|SrvcGrp|17081|2022|PDM|1273.92|99|0.00|ASPG IX|
20|FH_F103360_68845_0|SrvcGrp|69646|2022|PDM|2044.00|99|0.00|ECHOCARDIOGRAPHY|
20|FH_F40442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F129535_0_0|SrvcGrp|91989|2022|PDM|550.00|99|0.00|COLONOSCOPY LESION REMOVAL|
20|FH_F102361_44024_0|SrvcGrp|73483|2022|PDM|831.00|99|0.00|AETNA SUBACUTE III|
20|FH_F150062_92501_0|SrvcGrp|58509|2022|PDM|530.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F34005_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142891_54022_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142991_43920_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|427.00|99|0.00|HAPA EPA ASC 47|
20|FH_F119076_41001_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F65899_0_0|SrvcGrp|30976|2022|PCT|0.65|99|0.00|MS DRG 005-006 ONLY - LIVER TRANSPLANT|
20|FH_F57592_0_0|SrvcGrp|28162|2022|PDM|72000.00|99|0.00|MS DRG 217 ONLY|
20|FH_F148556_13206_0|SrvcGrp|24745|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F133148_71446_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113264_71860_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F118004_74133_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F130108_0_0|SrvcGrp|10946|2022|PCT|0.75|99|0.00|EMERGENCY ROOM|
20|FH_F34706_0_0|SrvcGrp|3585|2022|PDM|13156.00|99|0.00|DRG 118 CARDIAC PACE DEV REPLACEMNT|
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|CHILD PSYCH|
20|FH_F92676_15063_0|SrvcGrp|110105|2022|PCT|2.43|99|0.00|RAD SERVICES WITH SURGERY|
20|FH_F31204_0_0|SrvcGrp|13811|2022|PDM|275.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F83031_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|HOME HEALTH AIDE MOD TF|
20|FH_F36761_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F117450_63131_0|SrvcGrp|88621|2022|PDM|112.00|99|0.00|SKILLED NURSING LPN|
20|FH_F119128_93619_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F128144_45697_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F142770_51546_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1428.00|99|0.00|AEG 9 (NO REV)|
20|FH_F125222_83211_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F101922_98055_0|SrvcGrp|75505|2022|PCT|0.63|99|0.00|CARDIAC STUDIES|
20|FH_F125033_93305_0|SrvcGrp|86723|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F120803_38606_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F46192_0_0|SrvcGrp|9889|2022|PDM|868.00|99|0.00|NICU LEVEL I & II|
20|FH_F128605_20910_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F125216_66755_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150531_16148_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111857_68005_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F139167_42240_0|SrvcGrp|46903|2022|PDM|608.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F114848_50533_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117615_30525_0|SrvcGrp|75489|2022|PCT|0.85|99|0.00|AEG 6|
20|FH_F148347_0_0|SrvcGrp|87842|2022|PDM|14056.00|99|0.00|LAPAROSCOPY - GASTRIC|
20|FH_F101441_0_0|SrvcGrp|96353|2022|PDM|8105.00|99|0.00|RECONSTRUCT ANKLE JOINT|
20|FH_F114206_37203_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122377_91007_0|SrvcGrp|75506|2022|PCT|2.89|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F149023_44122_0|CSTM-ALL|CSTM-00|2020|PDM|2837.00|99|0.00|AEG 7 (NO REV)|
20|FH_F117645_90034_0|SrvcGrp|34923|2022|PDM|1150.00|99|0.00|ACUTE PSYCH|
20|FH_F128197_84123_0|SrvcGrp|48396|2022|PDM|103.00|99|0.00|OT SERVICES|
20|FH_F140233_35216_0|SrvcGrp|103532|2022|PDM|8000.00|99|0.00|NECK SPINE FUSE & REMOVE|
20|FH_F143207_72301_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143533_30013_0|SrvcGrp|99361|2022|PDM|201.00|99|0.00|DX MAMMO INCL CAD UNI|
20|FH_F112448_0_0|SrvcGrp|3142|2022|PDM|1775.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F103060_0_0|SrvcGrp|95559|2022|PDM|7803.00|99|0.00|HIP JOINT|
20|FH_F131107_43140_0|SrvcGrp|80920|2022|PDM|550.00|99|0.00|HOSPICE SERVICES|
20|FH_F47600_0_0|SrvcGrp|31191|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF (DME)|
20|FH_F48459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132418_84042_0|SrvcGrp|74668|2022|PDM|325.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132515_19382_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F112712_63005_0|SrvcGrp|14948|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116766_06460_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F116918_06488_0|SrvcGrp|471|2022|PDM|630.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F120856_78247_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F120887_78750_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F120974_27607_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F113563_70560_0|SrvcGrp|105056|2022|PDM|950.00|99|0.00|DESTRUCTION BY NEUROLYTIC AGENT|
20|FH_F84611_30281_0|SrvcGrp|20752|2022|PDM|21507.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F130152_48025_0|SrvcGrp|57967|2022|PCT|1.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F40560_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143467_0_0|SrvcGrp|35667|2022|PDM|1067.00|99|0.00|CPT 20680|
20|FH_F149679_0_0|SrvcGrp|13681|2022|PDM|172.33|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F59732_0_0|SrvcGrp|17002|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS|
20|FH_F63464_0_0|SrvcGrp|16746|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F123918_76012_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F148348_16803_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F67504_0_0|SrvcGrp|49862|2022|PDM|93.00|99|0.00|SPEECH THERAPY|
20|FH_F143948_44870_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130747_0_0|SrvcGrp|88160|2022|PDM|8843.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F143809_62401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145742_64862_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148440_16506_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 1 (NO REV)|
20|FH_F135236_02840_0|CSTM-ALL|CSTM-00|2020|PDM|2731.50|99|0.00|INPATIENT DETOX SERVICES <18 YRS|
20|FH_F71945_0_0|SrvcGrp|537|2022|PCT|0.65|99|0.00|OBSERVATION SERVICES|
20|FH_F108762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F78603_0_0|SrvcGrp|22781|2022|PDM|19987.07|99|0.00|MS DRG 244 ONLY|
20|FH_F40026_0_0|CSTM-ALL|CSTM-00|2020|PDM|919.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110004_75149_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F112568_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F90362_0_0|SrvcGrp|16289|2022|PDM|1485.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F92034_0_0|SrvcGrp|73004|2022|PDM|1282.00|99|0.00|AEG 8|
20|FH_F94662_0_0|SrvcGrp|93098|2022|PDM|199.00|99|0.00|HOSPICE CARE|
20|FH_F93902_04043_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F118121_46001_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125138_63663_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F150936_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F52854_0_0|SrvcGrp|919|2022|PDM|189.00|99|0.00|OP URGENT CARE|
20|FH_F109240_21201_0|SrvcGrp|102991|2022|PDM|208.00|99|0.00|RADIATION TX MANAGEMENT, X5|
20|FH_F66412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148265_06067_0|SrvcGrp|89988|2022|PDM|4773.00|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F34454_0_0|SrvcGrp|12856|2022|PDM|42.25|99|0.00|NURSING CARE|
20|FH_F123915_0_0|SrvcGrp|80918|2022|PDM|678.00|99|0.00|RESPITE CARE|
20|FH_F137457_32216_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112374_0_0|SrvcGrp|8950|2022|PDM|1456.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F127584_45219_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F109581_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F39662_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F34315_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82931_18847_0|SrvcGrp|13597|2022|PDM|194.46|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F149086_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101246_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|OP SVCS|
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|438.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132779_0_0|SrvcGrp|32539|2022|PDM|42703.00|99|0.00|MS DRG 222-227 ONLY|
20|FH_F44073_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F102302_0_0|SrvcGrp|98360|2022|PDM|10850.00|99|0.00|AETNA LAMINECTOMY W/FACE-LUMBAR|
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|2625.00|99|0.00|AEG 8 (NO REV)|
20|FH_F115674_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)|
20|FH_F116960_91505_0|SrvcGrp|110811|2022|PDM|371.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 3 (NO REV)|
20|FH_F148440_16506_0|SrvcGrp|115397|2022|PDM|2908.00|99|0.00|ENDOLASER|
20|FH_F38709_0_0|SrvcGrp|1267|2022|PCT|0.80|99|0.00|STEM CELL TRANSPLANT|
20|FH_F36822_0_0|SrvcGrp|3069|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F119824_0_0|SrvcGrp|108151|2022|PDM|164.00|99|0.00|CAPD/CCPD INCLUDES TRAINING|
20|FH_F132579_0_0|SrvcGrp|22596|2022|PDM|150.00|99|0.00|HOSPICE CARE|
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F127710_44139_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117783_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F63433_0_0|SrvcGrp|17073|2022|PDM|945.56|99|0.00|ASPG V|
20|FH_F139551_0_0|SrvcGrp|88157|2022|PDM|16500.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F89563_29407_0|SrvcGrp|90479|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F92091_0_0|SrvcGrp|89984|2022|PDM|7800.00|99|0.00|LAMINECTOMY W/FACE-LUMBAR|
20|FH_F59333_0_0|SrvcGrp|22954|2022|PDM|135.11|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F125746_45331_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137943_0_0|SrvcGrp|68283|2022|PDM|1700.00|99|0.00|CPT 67043|
20|FH_F88451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78709_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|NON SURGERY CODES|
20|FH_F102500_0_0|SrvcGrp|72998|2022|PDM|1116.00|99|0.00|AEG 5|
20|FH_F39273_0_0|SrvcGrp|28847|2022|PDM|65.00|99|0.00|PHYSICAL THERAPY|
20|FH_F140427_0_0|SrvcGrp|104921|2022|PDM|400.00|99|0.00|HEART FLOW RESERVE MEASURE-CONCUR|
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|521.00|99|0.00|AEG 10 (NO REV)|
20|FH_F114963_62062_0|SrvcGrp|88621|2022|PDM|99.81|99|0.00|SKILLED NURSING LPN|
20|FH_F72887_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_F109260_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148480_03079_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F141590_90049_0|SrvcGrp|75419|2022|PDM|724.62|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F123505_64468_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|435.00|99|0.00|ASPG I|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/MOD KM  (TN)|
20|FH_F125983_82301_0|SrvcGrp|87317|2022|PDM|957.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F126678_44870_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F122911_92240_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F136846_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F119795_0_0|SrvcGrp|35667|2022|PDM|3019.00|99|0.00|CPT 20680|
20|FH_F87474_0_0|SrvcGrp|9830|2022|PDM|50.00|99|0.00|OT SVCS|
20|FH_F62579_0_0|SrvcGrp|17001|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F130656_04401_0|SrvcGrp|104363|2022|PCT|0.89|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F130665_67202_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F130721_04769_0|SrvcGrp|112727|2022|PCT|1.00|99|0.00|COVID-19 IA NFCT AB SARS COV 2|
20|FH_F130914_51103_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F31181_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|451.69|99|0.00|HAPA WPA-NWPA 2012-13 ASC 204 W/O REV|
20|FH_F124161_95932_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F149050_22844_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F95631_33705_0|SrvcGrp|73643|2022|PDM|2209.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F145593_92660_0|SrvcGrp|75419|2022|PDM|900.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F116806_0_0|SrvcGrp|107030|2022|PDM|1923.16|99|0.00|REVISE EYE SOCKETS|
20|FH_F132922_91302_0|SrvcGrp|89149|2022|PDM|350.00|99|0.00|OP INTENSIVE|
20|FH_F126550_43085_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F111702_07652_0|SrvcGrp|75545|2022|PDM|390.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|601.53|99|0.00|HAPA WPA-NWPA 2012-13 ASC 404 W/O REV|
20|FH_F90416_73013_0|SrvcGrp|73701|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F130763_0_0|SrvcGrp|99163|2022|PDM|11056.00|99|0.00|CPT 27703|
20|FH_F69942_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F127545_45227_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F83035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F111908_07677_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F93122_01854_0|SrvcGrp|43523|2022|PDM|172.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F121225_98902_0|SrvcGrp|75506|2022|PCT|0.85|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F120719_27540_0|SrvcGrp|473|2022|PDM|593.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F39378_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F119732_37660_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F93333_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F150299_22046_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F150306_51566_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F83995_16748_0|SrvcGrp|76010|2022|PDM|698.00|99|0.00|EMERGENCY ROOM SVCS LEVEL III|
20|FH_F116124_0_0|SrvcGrp|17000|2022|PCT|1.00|99|0.00|OUTPATIENT SURGERY|
20|FH_F126555_44906_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F117245_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F95440_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|PDM|868.00|99|0.00|AEG 1 (NO REV)|
20|FH_F90574_22560_0|SrvcGrp|472|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F100785_54660_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F37611_0_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AEG 10 (NO REV)|
20|FH_F117275_16936_0|SrvcGrp|86723|2022|PDM|285.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F118379_32079_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F44607_0_0|SrvcGrp|17077|2022|PDM|3400.00|99|0.00|ASPG VII|
20|FH_F127217_29650_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F49049_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING|
20|FH_F148900_0_0|SrvcGrp|88487|2022|PDM|4704.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F133327_0_0|SrvcGrp|87077|2022|PDM|150.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC|
20|FH_F49035_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F91080_67212_0|SrvcGrp|3520|2022|PDM|487.00|99|0.00|DIALYSIS SVCS|
20|FH_F132992_04662_0|SrvcGrp|29347|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F97621_75801_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F102561_75146_0|SrvcGrp|98014|2022|PDM|4520.00|99|0.00|THERAPEUTIC INJECTION|
20|FH_F145988_06105_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139294_33406_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150769_02302_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148667_0_0|SrvcGrp|100063|2022|PDM|2856.00|99|0.00|REPAIR FOOT DISLOCATION|
20|FH_F36992_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD RR|
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|548.00|99|0.00|AEG 1 (NO REV)|
20|FH_F98360_11554_0|SrvcGrp|73643|2022|PDM|1002.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F112045_90301_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F141278_80218_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F35728_34209_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F109247_73102_0|SrvcGrp|73842|2022|PDM|147.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137728_47203_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128029_48154_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F76826_0_0|SrvcGrp|74443|2022|PDM|331.00|99|0.00|CARDIAC TESTING|
20|FH_F35804_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F98820_81401_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F97620_75904_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F146266_0_0|SrvcGrp|82113|2022|PDM|2150.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F148883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F74845_0_0|SrvcGrp|115|2022|PCT|0.85|99|0.00|SKILLED NURSING CARE|
20|FH_F36803_0_0|SrvcGrp|97|2022|PDM|4025.00|99|0.00|C-SECTION|
20|FH_F31547_0_0|SrvcGrp|26950|2022|PDM|72.93|99|0.00|PHYSICAL THERAPY|
20|FH_F149023_44122_0|SrvcGrp|58636|2022|PDM|21707.00|99|0.00|CPT 62362|
20|FH_F131356_19131_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F120057_0_0|SrvcGrp|108078|2022|PDM|1257.61|99|0.00|ARTERY-VEIN FUSION|
20|FH_F90223_0_0|SrvcGrp|88807|2022|PDM|130.00|99|0.00|TOTAL PARENTERAL NUTRITION; < 2 LITERS (HCFA)|
20|FH_F40644_0_0|SrvcGrp|3095|2022|PDM|1164.00|99|0.00|ROOM AND BOARD PRIVATE|
20|FH_F81272_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147225_48093_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147304_75965_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101685_0_0|SrvcGrp|72996|2022|PDM|784.00|99|0.00|AEG 4|
20|FH_F39360_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F113826_51445_0|SrvcGrp|75545|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F140143_24874_0|SrvcGrp|106314|2022|PDM|499.11|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F38007_0_0|SrvcGrp|360|2022|PDM|2155.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F146859_0_0|SrvcGrp|114901|2022|PDM|2320.00|99|0.00|TRANSPLANT HAND TENDON|
20|FH_F132512_0_0|SrvcGrp|73841|2022|PDM|714.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F102620_0_0|SrvcGrp|37542|2022|PDM|569.25|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F149379_53213_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|5962.00|99|0.00|AEG 8 (NO REV)|
20|FH_F41457_0_0|SrvcGrp|34344|2022|PDM|500.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F124318_29020_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35446_0_0|CSTM-ALL|CSTM-00|2020|PDM|690.00|99|0.00|ACUTE PSYCH|
20|FH_F35557_0_0|SrvcGrp|10583|2022|PDM|52.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F36743_0_0|SrvcGrp|2797|2022|PDM|2040.00|99|0.00|POST INTENSIVE CARE UNIT|
20|FH_F149023_44122_0|SrvcGrp|115578|2022|PDM|14300.00|99|0.00|SHOULDER, PELVIS AND HIP SURGERY|
20|FH_F150442_28451_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F99380_90503_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F34983_0_0|SrvcGrp|97|2022|PDM|1530.00|99|0.00|C-SECTION|
20|FH_F120057_0_0|SrvcGrp|108076|2022|PDM|1698.78|99|0.00|AV FUSION / FOREARM VEIN|
20|FH_F40346_0_0|SrvcGrp|21805|2022|PCT|0.75|99|0.00|PT/OT/ST|
20|FH_F149030_37919_0|SrvcGrp|82298|2022|PDM|8500.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY|
20|FH_F128753_32501_0|SrvcGrp|81340|2022|PCT|0.64|99|0.00|AETNA LABORATORY|
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_F137797_70123_0|SrvcGrp|27969|2022|PDM|30.46|99|0.00|HOME HEALTH AIDE|
20|FH_F134936_01020_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F141287_14830_0|SrvcGrp|12280|2022|PCT|0.39|99|0.00|IMPLANTS|
20|FH_F94643_90501_0|SrvcGrp|29075|2022|PDM|30.00|99|0.00|HYDRATION THERAPY|
20|FH_F109247_73102_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F115982_0_0|SrvcGrp|35669|2022|PDM|2425.00|99|0.00|CPT 63650|
20|FH_F147532_0_0|SrvcGrp|89783|2022|PDM|717.20|99|0.00|RESPITE CARE (HCFA)|
20|FH_F87775_15106_0|SrvcGrp|14892|2022|PDM|75.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F128379_0_0|SrvcGrp|88492|2022|PDM|2861.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PDM|494.00|99|0.00|AEG 3 (NO REV)|
20|FH_F124161_95932_0|SrvcGrp|107542|2022|PCT|2.08|99|0.00|RADIOLOGY|
20|FH_F120930_0_0|SrvcGrp|93432|2022|PDM|4000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F132883_31602_0|SrvcGrp|86845|2022|PDM|20.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F110302_15931_0|SrvcGrp|46605|2022|PDM|95.67|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F122942_89512_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|683.00|99|0.00|AEG 3 (NO REV)|
20|FH_F116207_0_0|SrvcGrp|102419|2022|PCT|0.49|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F32222_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|338.47|99|0.00|HAPA WPA-NWPA 2012-13 ASC 222 W/O REV|
20|FH_F150165_06032_0|SrvcGrp|104003|2022|PDM|3100.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES|
20|FH_F70883_0_0|SrvcGrp|10649|2022|PDM|8.00|99|0.00|HOME INFUSION|
20|FH_F124829_75231_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143677_62301_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS ASC|
20|FH_F112023_12866_0|SrvcGrp|14048|2022|PDM|6094.00|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN|
20|FH_F138507_62208_0|SrvcGrp|29346|2022|PDM|30.90|99|0.00|SKILLED NURSING- LPN|
20|FH_F130763_0_0|SrvcGrp|99073|2022|PDM|1.45|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F118270_30606_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F110268_02891_0|SrvcGrp|90643|2022|PDM|25.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F143581_02130_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F85353_16407_0|SrvcGrp|63774|2022|PDM|1424.90|99|0.00|HAPA WPA-NWPA 2012-13 ASC 701|
20|FH_F149439_0_0|SrvcGrp|11442|2022|PDM|980.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F118144_33418_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146100_17403_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150223_30720_0|SrvcGrp|115724|2022|PCT|1.00|99|0.00|COVID VACCINE ADMINISTRATION|
20|FH_F111731_47802_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F139380_33062_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|814.00|99|0.00|AEG 10 (NO REV)|
20|FH_F148541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F143581_02130_0|SrvcGrp|104965|2022|PCT|1.00|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F111701_33330_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117300_0_0|SrvcGrp|71666|2022|PDM|6872.00|99|0.00|CPT 63655|
20|FH_F128828_44122_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F114432_75035_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F134655_14221_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F93359_63084_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F63114_0_0|SrvcGrp|46605|2022|PDM|25.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F110344_37421_0|SrvcGrp|86753|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F136037_0_0|SrvcGrp|73841|2022|PDM|416.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F121225_98902_0|SrvcGrp|22591|2022|PDM|200.00|99|0.00|IMPLANTED PUMP|
20|FH_F42690_0_0|SrvcGrp|115|2022|PDM|120.00|99|0.00|SKILLED NURSING CARE|
20|FH_F138213_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134492_85201_0|SrvcGrp|108484|2022|PDM|615.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F33068_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F102200_06416_0|SrvcGrp|29077|2022|PDM|225.00|99|0.00|HOME TRANSFUSION|
20|FH_F102200_06416_0|SrvcGrp|86825|2022|PDM|90.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F105145_75075_0|SrvcGrp|12280|2022|PCT|1.15|99|0.00|IMPLANTS|
20|FH_F115890_75067_0|SrvcGrp|89412|2022|PDM|350.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F76028_0_0|SrvcGrp|45967|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE|
20|FH_F146466_21620_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146793_44236_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120795_27514_0|SrvcGrp|115926|2022|PCT|2.81|99|0.00|RADIOLOGY SERVICES|
20|FH_F131964_89120_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F133569_17202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133581_84790_0|SrvcGrp|41334|2022|PDM|5000.00|99|0.00|TOTAL KNEE|
20|FH_F132293_50595_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F111561_10002_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F134828_30531_0|SrvcGrp|89227|2022|PDM|35.00|99|0.00|X-RAY EXAM OF KNEE|
20|FH_F32995_0_0|SrvcGrp|88|2022|PDM|5000.00|99|0.00|OP LITHOTRIPSY|
20|FH_F46832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|HOME INFUSION (ANTIBIOTIC, ANTIVIRAL, ANTIFUNGAL)|
20|FH_F46832_0_0|SrvcGrp|40828|2022|PDM|70.00|99|0.00|CONTINUOUS INSULIN INFUSION THERAPY|
20|FH_F123739_61820_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F126527_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F58252_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F134254_33462_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F134011_84102_0|SrvcGrp|97507|2022|PDM|112.00|99|0.00|AETNA HOSPICE|
20|FH_F134088_32209_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134159_80228_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F137147_75006_0|SrvcGrp|90365|2022|PDM|10374.00|99|0.00|REPAIR METACARPAL FRACTURE|
20|FH_F137246_66064_0|SrvcGrp|89149|2022|PDM|190.00|99|0.00|OP INTENSIVE|
20|FH_F142548_66614_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F53732_0_0|SrvcGrp|47411|2022|PDM|115.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F97601_67218_0|SrvcGrp|73659|2022|PDM|7774.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F140295_0_0|SrvcGrp|99161|2022|PDM|12200.00|99|0.00|CPT 27138|
20|FH_F101280_63111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F72788_0_0|CSTM-ALL|CSTM-00|2020|PDM|3564.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F99380_90503_0|SrvcGrp|13724|2022|PCT|0.85|99|0.00|PHARMACY SVCS|
20|FH_F50078_0_0|SrvcGrp|47463|2022|PDM|70.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F148960_13045_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F147360_06415_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
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_F98001_27603_0|SrvcGrp|90854|2022|PDM|2514.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F138017_73129_0|SrvcGrp|12491|2022|PCT|0.33|99|0.00|PACEMAKER|
20|FH_F138417_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F37335_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139990_71418_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F139877_32615_0|SrvcGrp|113238|2022|PDM|51.31|99|0.00|COVID-19 LAB TEST NON-CDC (HCFA)|
20|FH_F131187_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F111320_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 3 (NO REV)|
20|FH_F140167_16101_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143307_72223_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F84061_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101391_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS|
20|FH_F130917_48658_0|SrvcGrp|82222|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F151741_15090_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD NU/KE)|
20|FH_F120191_91360_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F120747_19129_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F112679_85711_0|SrvcGrp|88621|2022|PDM|113.00|99|0.00|SKILLED NURSING LPN|
20|FH_F50240_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116683_64730_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F116698_07470_0|SrvcGrp|17015|2022|PDM|21.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F119992_67062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120050_92626_0|SrvcGrp|87131|2022|PDM|700.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F120885_66224_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120921_75835_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120977_50510_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F125436_60506_0|SrvcGrp|86722|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F113563_70560_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F113563_70560_0|CSTM-ALL|CSTM-00|2020|PDM|773.00|99|0.00|AEG 2 (NO REV)|
20|FH_F41535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F51276_0_0|SrvcGrp|49022|2022|PDM|80.00|99|0.00|NURSING VISIT W/INFUSION THERAPY|
20|FH_F143467_0_0|SrvcGrp|114045|2022|PDM|3140.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F149679_0_0|SrvcGrp|13262|2022|PDM|3.68|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F39567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|TRAUMA CARE|
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|ASPG II|
20|FH_F61292_0_0|SrvcGrp|19973|2022|PDM|756.00|99|0.00|CAT SCAN|
20|FH_F109000_0_0|SrvcGrp|101114|2022|PDM|9592.00|99|0.00|ARTHOPLASTY|
20|FH_F39138_0_0|SrvcGrp|1121|2022|PDM|4915.00|99|0.00|OP PTCA ANGIOPLASTY|
20|FH_F88254_33411_0|SrvcGrp|86825|2022|PDM|60.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F143780_33873_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F93424_53578_0|SrvcGrp|86748|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F72183_0_0|SrvcGrp|12117|2022|PDM|850.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S AZ/NV - MOD AW|
20|FH_F77484_0_0|SrvcGrp|78378|2022|PCT|0.62|99|0.00|IMPLANTS|
20|FH_F52854_0_0|CSTM-ALL|CSTM-00|2020|PDM|4245.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY|
20|FH_F125028_19061_0|SrvcGrp|10577|2022|PDM|52.50|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F133671_89102_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F77762_0_0|SrvcGrp|23683|2022|PDM|55.00|99|0.00|SKILLED NURSING RN|
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F125693_92660_0|SrvcGrp|110160|2022|PDM|350.00|99|0.00|OP THERAPY SERVICES|
20|FH_F131577_89148_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F139551_0_0|SrvcGrp|77461|2022|PDM|2650.00|99|0.00|CPT 52356|
20|FH_F37651_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD AW|
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|1635.00|99|0.00|AEG 8 (NO REV)|
20|FH_F82235_0_0|SrvcGrp|72992|2022|PDM|490.60|99|0.00|AEG 2|
20|FH_F64519_0_0|SrvcGrp|87537|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F124050_75089_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F91900_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F54513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F130747_0_0|SrvcGrp|88740|2022|PDM|6763.00|99|0.00|SP BONE ALGRFT|
20|FH_F59093_0_0|SrvcGrp|42972|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F115046_77964_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F149939_91942_0|SrvcGrp|114093|2022|PDM|522.00|99|0.00|PARTIAL HOSPITAL SUBSTANCE ABUSE|
20|FH_F128232_70374_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41178_0_0|CSTM-ALL|CSTM-00|2020|PDM|646.00|99|0.00|ACUTE PSYCH|
20|FH_F122533_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F48215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139456_47501_0|SrvcGrp|73063|2022|PCT|0.80|99|0.00|OBSERVATION SERVICES|
20|FH_F140343_89052_0|SrvcGrp|14947|2022|PDM|30.00|99|0.00|HOME INFUSION|
20|FH_F140687_98001_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F140760_07003_0|SrvcGrp|73842|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151606_64772_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F119023_91406_0|SrvcGrp|24753|2022|PDM|12.50|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F109884_36117_0|SrvcGrp|86747|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F147799_18052_0|SrvcGrp|46104|2022|PDM|109.57|99|0.00|HOME VISIT - PRENATAL|
20|FH_F129511_44044_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F117182_68127_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F38699_0_0|SrvcGrp|17069|2022|PDM|605.00|99|0.00|ASPG III|
20|FH_F109652_0_0|SrvcGrp|73008|2022|PDM|2734.00|99|0.00|AEG 10|
20|FH_F91472_96001_0|SrvcGrp|91198|2022|PDM|90945.00|99|0.00|NEUROSURGERY|
20|FH_F91067_0_0|SrvcGrp|73004|2022|PDM|1202.00|99|0.00|AEG 8|
20|FH_F148720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38321_0_0|SrvcGrp|474|2022|PDM|285.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F151155_26508_0|SrvcGrp|113351|2022|PDM|104.00|99|0.00|OFF BASE OPIOID TX ADD 30 MIN (HCFA)|
20|FH_F151279_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121326_60957_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113866_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F112844_0_0|SrvcGrp|80317|2022|PDM|115.00|99|0.00|RESPITE CARE|
20|FH_F129130_92562_0|SrvcGrp|113463|2022|PCT|0.00|99|0.00|LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F97721_01053_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|OP SVCS|
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|3650.00|99|0.00|AEG 10 (NO REV)|
20|FH_F78243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F142321_29401_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F103780_64804_0|CSTM-ALL|CSTM-00|2020|PDM|2536.00|99|0.00|AEG 6 (NO REV)|
20|FH_F105581_19053_0|SrvcGrp|48396|2022|PDM|130.00|99|0.00|OT SERVICES|
20|FH_F131047_0_0|SrvcGrp|29294|2022|PDM|2206.00|99|0.00|ACUTE REHAB|
20|FH_F141036_02347_0|SrvcGrp|113724|2022|PCT|1.00|99|0.00|INFLUENZA DNA AMP PROBE|
20|FH_F126345_0_0|SrvcGrp|73002|2022|PDM|1360.00|99|0.00|AEG 7|
20|FH_F114389_50131_0|SrvcGrp|16750|2022|PDM|447.35|99|0.00|HOME INFUSION THERAPY|
20|FH_F114389_50131_0|SrvcGrp|48396|2022|PDM|170.42|99|0.00|OT SERVICES|
20|FH_F136735_0_0|CSTM-ALL|CSTM-00|2020|PDM|1769.00|99|0.00|AEG 4 (NO REV)|
20|FH_F146794_79601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146901_78006_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F62624_0_0|SrvcGrp|21784|2022|PDM|7800.00|99|0.00|PACEMAKER|
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F38233_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAFS FS 100  MOD TC CPT ONLY|
20|FH_F91752_0_0|SrvcGrp|80285|2022|PDM|133.40|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F92493_0_0|SrvcGrp|26273|2022|PDM|3119.66|99|0.00|CPT 29880|
20|FH_F45518_0_0|CSTM-ALL|CSTM-00|2020|PCT|52.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F133674_30350_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AETNA IP LABORATORY|
20|FH_F129549_01238_0|SrvcGrp|48385|2022|PDM|107.62|99|0.00|SPEECH THERAPY|
20|FH_F124233_92648_0|SrvcGrp|108484|2022|PDM|1200.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F124234_33410_0|SrvcGrp|87317|2022|PDM|1200.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F124234_33410_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|AEG 3 (NO REV)|
20|FH_F127995_84010_0|SrvcGrp|26868|2022|PDM|25.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F87856_0_0|SrvcGrp|78878|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F114666_30342_0|SrvcGrp|92819|2022|PDM|13500.00|99|0.00|HIP ARTHOSCOPY|
20|FH_F138052_19462_0|SrvcGrp|91065|2022|PDM|113.00|99|0.00|PSYCHIATRIC CPT 90853 (HCFA)|
20|FH_F139556_85006_0|SrvcGrp|74794|2022|PCT|1.89|99|0.00|SLEEP STUDY|
20|FH_F114985_32073_0|SrvcGrp|29080|2022|PDM|328.00|99|0.00|SLEEP STUDIES|
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|2705.00|99|0.00|AEG 5  (NO REV)|
20|FH_F127448_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F43833_0_0|SrvcGrp|10419|2022|PDM|450.00|99|0.00|SKILLED NURSING CARE|
20|FH_F134746_83318_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136914_64081_0|SrvcGrp|75545|2022|PDM|425.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F62922_0_0|SrvcGrp|23587|2022|PDM|475.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F115266_66736_0|SrvcGrp|73842|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115631_65201_0|SrvcGrp|26280|2022|PDM|1141.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F147539_68359_0|SrvcGrp|74403|2022|PCT|0.98|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F147559_70433_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147528_72114_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42342_0_0|SrvcGrp|26798|2022|PDM|78.75|99|0.00|LICENSED PRACTICAL NURSE|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- NO MODIFIERS|
20|FH_F98621_41042_0|SrvcGrp|90854|2022|PDM|2714.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F140007_0_0|SrvcGrp|97299|2022|PDM|8045.00|99|0.00|REMOVE SPINE ELTRD PLATE|
20|FH_F138350_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F148344_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F76824_0_0|SrvcGrp|29898|2022|PDM|90.00|99|0.00|RN VISIT|
20|FH_F114151_0_0|SrvcGrp|95441|2022|PDM|90.00|99|0.00|HOSPICE OR HOME CARE|
20|FH_F33295_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F133579_0_0|SrvcGrp|93724|2022|PDM|3248.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F144548_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137366_87505_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F93094_21227_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114916_30309_0|SrvcGrp|16289|2022|PDM|1000.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F141607_27021_0|SrvcGrp|48398|2022|PDM|135.00|99|0.00|PT SERVICES|
20|FH_F50218_0_0|SrvcGrp|28629|2022|PDM|105.00|99|0.00|HIGH TECH SKILLED NURSING|
20|FH_F148266_45419_0|SrvcGrp|114518|2022|PDM|2508.08|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F34413_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F37659_0_0|SrvcGrp|13236|2022|PDM|2305.00|99|0.00|ICU/CCU|
20|FH_F40709_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|ASPG VI|
20|FH_F137490_62226_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141507_0_0|SrvcGrp|111136|2022|PDM|200.00|99|0.00|PHENYLEPHRINE KETOROLAC INJECTION|
20|FH_F37590_0_0|SrvcGrp|9830|2022|PDM|84.00|99|0.00|OT SVCS|
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|1039.00|99|0.00|ASPG IV|
20|FH_F137943_0_0|SrvcGrp|68282|2022|PDM|1700.00|99|0.00|CPT 67042|
20|FH_F43663_0_0|SrvcGrp|3577|2022|PDM|221.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F139515_0_0|SrvcGrp|92414|2022|PDM|8549.00|99|0.00|SPINAL CRD DECOMP->2 LUMBAR|
20|FH_F141801_80534_0|SrvcGrp|16069|2022|PDM|1000.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|737.00|99|0.00|AEG 5  (NO REV)|
20|FH_F117484_15601_0|SrvcGrp|76501|2022|PDM|415.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F123915_0_0|SrvcGrp|80920|2022|PDM|692.00|99|0.00|HOSPICE SERVICES|
20|FH_F125849_67052_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37945_0_0|SrvcGrp|10365|2022|PDM|652.00|99|0.00|CPT CODE 99285|
20|FH_F145544_93536_0|SrvcGrp|46903|2022|PDM|1200.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F35581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F120952_25303_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F51358_0_0|SrvcGrp|45924|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE|
20|FH_F129782_0_0|CSTM-ALL|CSTM-00|2020|PDM|698.00|99|0.00|AEG 3 (NO REV)|
20|FH_F110086_21742_0|SrvcGrp|75182|2022|PCT|1.02|99|0.00|AETNA IMPLANTS|
20|FH_F135897_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86412_32258_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F150462_30458_0|SrvcGrp|21920|2022|PDM|50.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F123276_20737_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F97440_0_0|SrvcGrp|82603|2022|PCT|5.50|99|0.00|AETNA HUMAN IG IM|
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|1758.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F125983_82301_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F89475_71202_0|SrvcGrp|114917|2022|PCT|0.65|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F32802_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|ASPG V|
20|FH_F40709_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|99|0.00|ASPG V|
20|FH_F62579_0_0|SrvcGrp|23683|2022|PDM|125.00|99|0.00|SKILLED NURSING RN|
20|FH_F130656_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 3 (NO REV)|
20|FH_F130755_04401_0|SrvcGrp|106251|2022|PCT|4.24|99|0.00|LABORATORY SERVICES|
20|FH_F130775_61701_0|SrvcGrp|73841|2022|PDM|346.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F31101_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85651_33549_0|SrvcGrp|92760|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F87571_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F98021_07012_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F80172_0_0|SrvcGrp|16541|2022|PDM|70.64|99|0.00|ANTI-SPASMOTIC THERAPY|
20|FH_F36552_0_0|SrvcGrp|18194|2022|PDM|6685.00|99|0.00|MS DRG 262|
20|FH_F118135_38109_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F119213_66209_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118144_33418_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F110302_15931_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F148600_30328_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132801_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS|
20|FH_F133895_61530_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F133207_0_0|SrvcGrp|111602|2022|PDM|2464.00|99|0.00|LARYNGOSCOPY|
20|FH_F79923_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F113457_17011_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F71345_0_0|SrvcGrp|22954|2022|PDM|163.48|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F31714_0_0|SrvcGrp|44453|2022|PDM|425.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F145604_14850_0|SrvcGrp|24744|2022|PDM|80.00|99|0.00|PICC LINE INSERTION|
20|FH_F146200_70815_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F96160_32207_0|SrvcGrp|86838|2022|PDM|25.89|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F114683_0_0|SrvcGrp|88340|2022|PDM|2298.00|99|0.00|SPINAL FUSION|
20|FH_F129638_0_0|SrvcGrp|75506|2022|PCT|0.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F133818_01027_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F98021_07012_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F85213_02840_0|SrvcGrp|73497|2022|PDM|1446.80|99|0.00|AETNA ER LEVEL IV|
20|FH_F125244_0_0|SrvcGrp|83817|2022|PDM|5500.00|99|0.00|LAPAROSCOPY LYSIS ADHESIONS|
20|FH_F32165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80172_0_0|SrvcGrp|10583|2022|PDM|93.47|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F145641_06902_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F43199_0_0|SrvcGrp|12157|2022|PDM|131.25|99|0.00|RN VISIT|
20|FH_F84973_46733_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149343_44134_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133972_27103_0|SrvcGrp|29077|2022|PDM|45.00|99|0.00|HOME TRANSFUSION|
20|FH_F53573_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|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_F117715_0_0|SrvcGrp|68048|2022|PDM|5234.92|99|0.00|CPT 64581|
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|3102.72|99|0.00|AVF BY TISSUE W THERMAL E|
20|FH_F132258_45404_0|SrvcGrp|48396|2022|PDM|85.86|99|0.00|OT SERVICES|
20|FH_F132268_07060_0|SrvcGrp|104304|2022|PCT|0.95|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122038_34606_0|SrvcGrp|108484|2022|PDM|615.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F145468_60615_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145528_76501_0|SrvcGrp|88621|2022|PDM|98.00|99|0.00|SKILLED NURSING LPN|
20|FH_F97501_31501_0|SrvcGrp|73602|2022|PDM|5078.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F135388_48601_0|SrvcGrp|106300|2022|PDM|469.47|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F91764_93710_0|SrvcGrp|73806|2022|PDM|1189.00|99|0.00|AETNA ER|
20|FH_F119886_25504_0|SrvcGrp|111241|2022|PDM|110.00|99|0.00|PT ASSISTANT|
20|FH_F131344_61832_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F32803_0_0|SrvcGrp|411|2022|PCT|0.65|99|0.00|OP CARDIAC CATH|
20|FH_F43237_0_0|SrvcGrp|31134|2022|PDM|2315.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F111292_33136_0|CSTM-ALL|CSTM-00|2020|PDM|2107.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F145587_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
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|88495|2022|PDM|3153.00|99|0.00|AETNA PERCUTANEOUS INTRADISCAL|
20|FH_F72666_0_0|SrvcGrp|40682|2022|PCT|0.75|99|0.00|LITHOTRIPSY|
20|FH_F118651_0_0|SrvcGrp|107871|2022|PDM|3182.70|99|0.00|AETNA EXC ABD TUM 5 CM OR LESS|
20|FH_F87534_19464_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F88831_84123_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F98626_29118_0|SrvcGrp|73643|2022|PDM|899.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F102862_30606_0|SrvcGrp|99060|2022|PDM|5897.20|99|0.00|AETNA MS DRG 053 ONLY|
20|FH_F130027_76201_0|SrvcGrp|73841|2022|PDM|344.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F69347_0_0|SrvcGrp|44762|2022|PDM|2996.00|99|0.00|PORTLAND ADVENTIST ASPG I|
20|FH_F119347_27540_0|SrvcGrp|72379|2022|PCT|0.98|99|0.00|SPEECH THERAPY|
20|FH_F148431_60523_0|SrvcGrp|104228|2022|PDM|105.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F48787_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS|
20|FH_F134467_84321_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F40256_0_0|SrvcGrp|10632|2022|PCT|0.90|99|0.00|OP MRI|
20|FH_F150559_60018_0|SrvcGrp|29347|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F44795_0_0|SrvcGrp|11069|2022|PDM|80.00|99|0.00|OT SVCS|
20|FH_F148920_40207_0|SrvcGrp|114161|2022|PCT|1.00|99|0.00|DRUGS|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|1370.00|99|0.00|HAPA EPA ASC 55|
20|FH_F141860_60610_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148861_18706_0|SrvcGrp|46903|2022|PDM|956.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F103360_68845_0|SrvcGrp|97912|2022|PDM|9134.00|99|0.00|ILEOSTOMY OR JEJUNOSTOMY|
20|FH_F133516_44004_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115485_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F109242_18466_0|SrvcGrp|3178|2022|PDM|872.00|99|0.00|ACUTE PSYCH|
20|FH_F125019_67665_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37491_0_0|SrvcGrp|12591|2022|PDM|135.00|99|0.00|CD FULL DAY|
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|2052.00|99|0.00|ACUTE PSYCH|
20|FH_F121304_61520_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F44724_0_0|SrvcGrp|26775|2022|PDM|48.00|99|0.00|OT|
20|FH_F112936_32081_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MBPR 5281|
20|FH_F43433_0_0|SrvcGrp|32447|2022|PDM|4902.00|99|0.00|JACKSON MADISON HOSP ASPG 11|
20|FH_F132338_18901_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|160.49|99|0.00|HAPA WPA-NWPA 2012-13 ASC 133 W/O REV|
20|FH_F124966_60559_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|997.39|99|0.00|ASPG 5|
20|FH_F146362_76048_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142043_45503_0|SrvcGrp|46903|2022|PDM|649.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F50372_0_0|SrvcGrp|46588|2022|PDM|80.00|99|0.00|CPT 99212|
20|FH_F71323_68114_0|SrvcGrp|19607|2022|PDM|1423.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F36450_0_0|SrvcGrp|22967|2022|PDM|4150.00|99|0.00|LITHOTRIPSY|
20|FH_F92677_08003_0|SrvcGrp|37385|2022|PDM|3.41|99|0.00|AMINO ACIDS|
20|FH_F133412_84129_0|SrvcGrp|76501|2022|PDM|260.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F117346_75093_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F145988_06105_0|SrvcGrp|114561|2022|PCT|0.69|99|0.00|BLOOD STORAGE|
20|FH_F44952_0_0|SrvcGrp|3809|2022|PDM|601.02|99|0.00|HOSPICE CARE|
20|FH_F46492_0_0|CSTM-ALL|CSTM-00|2020|PDM|2460.00|99|0.00|ASPG IX|
20|FH_F42340_0_0|SrvcGrp|31187|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF (DME)|
20|FH_F40812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F136751_0_0|SrvcGrp|95559|2022|PDM|20500.00|99|0.00|HIP JOINT|
20|FH_F92676_15063_0|SrvcGrp|78976|2022|PDM|1389.96|99|0.00|MON VALLEY ASC 202|
20|FH_F133214_75024_0|SrvcGrp|110811|2022|PDM|297.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F133124_33837_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F146257_83713_0|SrvcGrp|108484|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F47834_0_0|SrvcGrp|20482|2022|PCT|1.10|99|0.00|RADIOLOGY SVCS TC MOD|
20|FH_F126867_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97542_32960_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F38376_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F145604_14850_0|SrvcGrp|21920|2022|PDM|75.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F138908_84010_0|SrvcGrp|75545|2022|PDM|390.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F130763_0_0|SrvcGrp|33985|2022|PDM|3299.00|99|0.00|CPT 19120|
20|FH_F88744_71103_0|SrvcGrp|79786|2022|PCT|2.48|99|0.00|SLEEP STUDIES|
20|FH_F130123_24171_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F120425_11106_0|SrvcGrp|89149|2022|PDM|215.00|99|0.00|OP INTENSIVE|
20|FH_F127642_07047_0|SrvcGrp|73004|2022|PDM|2697.00|99|0.00|AEG 8|
20|FH_F110343_38139_0|SrvcGrp|86747|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F110506_98901_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F134191_75025_0|SrvcGrp|87077|2022|PDM|180.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F150160_01301_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F149079_70809_0|SrvcGrp|8950|2022|PDM|1576.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F32214_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119588_0_0|SrvcGrp|102419|2022|PDM|707.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F85097_0_0|CSTM-ALL|CSTM-00|2020|PDM|4026.00|99|0.00|OP SVCS|
20|FH_F133769_20783_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|438.15|99|0.00|HAPA WPA-NWPA 2012-13 ASC 206 W/O REV|
20|FH_F145694_84770_0|SrvcGrp|46903|2022|PDM|1500.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F83978_66739_0|SrvcGrp|104363|2022|PCT|0.00|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F149517_0_0|SrvcGrp|65720|2022|PDM|194.00|99|0.00|RESPITE CARE|
20|FH_F69708_0_0|SrvcGrp|42826|2022|PDM|117.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F150227_63301_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F121225_98902_0|SrvcGrp|19742|2022|PDM|112.50|99|0.00|MID-LINE INSERTION|
20|FH_F134669_17403_0|SrvcGrp|86723|2022|PDM|370.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F149517_0_0|SrvcGrp|80920|2022|PDM|692.00|99|0.00|HOSPICE SERVICES|
20|FH_F50334_0_0|SrvcGrp|3809|2022|PDM|540.00|99|0.00|HOSPICE CARE|
20|FH_F127486_06776_0|SrvcGrp|80918|2022|PDM|166.95|99|0.00|RESPITE CARE|
20|FH_F137587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F80613_0_0|SrvcGrp|10543|2022|PDM|95.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F52452_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112908_0_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F90232_15126_0|SrvcGrp|46605|2022|PDM|89.25|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F100782_0_0|SrvcGrp|105115|2022|PDM|754.74|99|0.00|WINDBER MEDICAL CNTR ASC 220|
20|FH_F54592_0_0|SrvcGrp|20480|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F85691_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F101100_50314_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA - APC GROUPER L|
20|FH_F101100_50314_0|SrvcGrp|97918|2022|PDM|11034.00|99|0.00|REMOVAL OF GALLBLADER|
20|FH_F102200_06416_0|SrvcGrp|47183|2022|PDM|117.50|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F146796_43334_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115952_44484_0|SrvcGrp|86722|2022|PDM|138.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F116040_24637_0|SrvcGrp|24745|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F116040_24637_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F131698_01862_0|SrvcGrp|27968|2022|PDM|25.00|99|0.00|SKILLED NURSING LPN|
20|FH_F131904_18915_0|SrvcGrp|48396|2022|PDM|123.00|99|0.00|OT SERVICES|
20|FH_F132928_64114_0|SrvcGrp|27968|2022|PDM|84.35|99|0.00|SKILLED NURSING LPN|
20|FH_F131430_17566_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134822_06513_0|SrvcGrp|471|2022|PDM|558.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 4 (NO REV)|
20|FH_F116443_0_0|SrvcGrp|106798|2022|PDM|4100.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F57073_0_0|SrvcGrp|3273|2022|PCT|0.75|99|0.00|IMPLANTS|
20|FH_F143539_0_0|SrvcGrp|84934|2022|PDM|6427.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F87411_0_0|SrvcGrp|83881|2022|PDM|43.49|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F87480_0_0|SrvcGrp|84939|2022|PDM|7500.00|99|0.00|SHOULDER JOINT|
20|FH_F39977_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F46832_0_0|SrvcGrp|21920|2022|PDM|70.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F123752_44502_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F123809_26155_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136422_29180_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE|
20|FH_F120520_54401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134011_84102_0|SrvcGrp|97703|2022|PDM|112.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F134126_11554_0|SrvcGrp|106292|2022|PDM|402.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1|
20|FH_F114979_77979_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F142527_89109_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F142547_70002_0|SrvcGrp|21920|2022|PDM|25.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F117552_0_0|SrvcGrp|36591|2022|PDM|21500.00|99|0.00|CPT 63685|
20|FH_F62683_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138541_54840_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F138558_60107_0|SrvcGrp|89149|2022|PDM|243.00|99|0.00|OP INTENSIVE|
20|FH_F140668_68745_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140833_19454_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148679_57328_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122067_0_0|SrvcGrp|108980|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151603_27609_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F118789_92211_0|SrvcGrp|87131|2022|PDM|411.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F119023_91406_0|SrvcGrp|86848|2022|PDM|35.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PDM|12064.00|99|0.00|MS DRG 238|
20|FH_F41739_0_0|SrvcGrp|28088|2022|PCT|1.00|99|0.00|ORGAN ACQUISITION|
20|FH_F101840_76054_0|SrvcGrp|73459|2022|PDM|19719.00|99|0.00|AETNA OR PROCEDURE FOR OBESITY MSDRG 619 ONLY|
20|FH_F144288_46322_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149940_02645_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146212_57108_0|CSTM-ALL|CSTM-00|2020|PDM|2920.00|99|0.00|AEG 9 (NO REV)|
20|FH_F146376_53188_0|SrvcGrp|108484|2022|PDM|2061.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F119437_0_0|SrvcGrp|75485|2022|PDM|1625.00|99|0.00|AEG 4|
20|FH_F147992_63452_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118790_98640_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F109625_27330_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|GENERAL ACUTE CARE|
20|FH_F57592_0_0|SrvcGrp|34557|2022|PDM|2200.00|99|0.00|MS DRG 894-897 ONLY CHEM DEP|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|216.56|99|0.00|HAPA WPA-NWPA 2012-13 ASC 127 W/O REV|
20|FH_F116145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141870_85224_0|SrvcGrp|86125|2022|PCT|0.83|99|0.00|AETNA FLEBOGAMMA INJ|
20|FH_F91155_16105_0|SrvcGrp|83877|2022|PCT|1.00|99|0.00|AETNA SLEEP STUDIES|
20|FH_F101811_64116_0|SrvcGrp|99499|2022|PDM|115.00|99|0.00|PT SERVICES|
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_F146258_90004_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F148886_60621_0|SrvcGrp|111926|2022|PCT|1.00|99|0.00|COVID-19 LAB TESTING|
20|FH_F134544_03874_0|SrvcGrp|73842|2022|PDM|169.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130596_50273_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120817_53051_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F142831_08053_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER UEBA|
20|FH_F150906_0_0|SrvcGrp|115901|2022|PDM|983.00|99|0.00|HOSPICE IN SNF|
20|FH_F67560_0_0|SrvcGrp|17077|2022|PCT|0.83|99|0.00|ASPG VII|
20|FH_F148886_60621_0|SrvcGrp|111929|2022|PCT|1.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F143848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F127132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124526_05301_0|SrvcGrp|86638|2022|PDM|1222.00|99|0.00|AETNA IP PSYCHIATRIC (>=18 YRS)|
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F131274_48322_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F47836_0_0|SrvcGrp|56242|2022|PDM|5000.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F116332_0_0|SrvcGrp|115364|2022|PDM|8144.00|99|0.00|NPS SURG DILAT EUST TUBE UNI|
20|FH_F90172_81301_0|SrvcGrp|89498|2022|PCT|1.00|99|0.00|AIR AND GROUND AMBULANCE|
20|FH_F147080_02446_0|SrvcGrp|114167|2022|PDM|398.00|99|0.00|PARTIAL HOSPITAL (0-17 YRS)|
20|FH_F122364_67203_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130309_17044_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F84433_0_0|SrvcGrp|46424|2022|PDM|110.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F111266_30339_0|SrvcGrp|86829|2022|PDM|30.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F99920_63141_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114206_37203_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F144831_0_0|SrvcGrp|88620|2022|PDM|105.45|99|0.00|SKILLED NURSING RN|
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_F150459_08021_0|SrvcGrp|27969|2022|PDM|33.00|99|0.00|HOME HEALTH AIDE|
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|AEG 4 (NO REV)|
20|FH_F76285_0_0|SrvcGrp|48381|2022|PDM|250.00|99|0.00|ST SVCS INITIAL EVAL 92506 VISIT LEVEL|
20|FH_F46284_0_0|SrvcGrp|42762|2022|PDM|158.00|99|0.00|NURSING CARE|
20|FH_F124719_64093_0|SrvcGrp|75545|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F134797_0_0|SrvcGrp|73002|2022|PDM|1332.00|99|0.00|AEG 7|
20|FH_F90199_24083_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139576_0_0|SrvcGrp|19922|2022|PDM|2497.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F37444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132056_32080_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F131371_0_0|SrvcGrp|101114|2022|PDM|17000.00|99|0.00|ARTHOPLASTY|
20|FH_F137986_0_0|SrvcGrp|92408|2022|PDM|3000.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|3008.00|99|0.00|LAPAROSCOPY CHOLECYSTECTOMY|
20|FH_F36554_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|ASPG II|
20|FH_F38172_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|GA STANDARD THERAPY CODES|
20|FH_F50461_0_0|SrvcGrp|46903|2022|PDM|480.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F150913_70068_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151019_14094_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PDM|738.03|99|0.00|ASPG III|
20|FH_F145920_0_0|SrvcGrp|78283|2022|PDM|3433.00|99|0.00|CPT 49505|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|243.91|99|0.00|SALLY BALIN,999182,ASC 111|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.00|99|0.00|HAPA EPA ASC 49|
20|FH_F149043_72021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134819_0_0|SrvcGrp|16692|2022|PDM|1561.00|99|0.00|KNEE SCOPE|
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|1057.00|99|0.00|AEG 7 (NO REV)|
20|FH_F37777_0_0|SrvcGrp|26180|2022|PDM|30.00|99|0.00|ST|
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|571.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F148964_30101_0|SrvcGrp|90040|2022|PDM|360.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F111266_30339_0|SrvcGrp|24744|2022|PDM|55.00|99|0.00|PICC LINE INSERTION|
20|FH_F128197_84123_0|SrvcGrp|23683|2022|PDM|51.50|99|0.00|SKILLED NURSING RN|
20|FH_F117232_83221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F117371_77059_0|SrvcGrp|16069|2022|PDM|795.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F117190_84020_0|SrvcGrp|107284|2022|PDM|600.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F117217_80304_0|SrvcGrp|90644|2022|PDM|27.00|99|0.00|AETNA MEDICATION ASSISTED TRTMT MAINTENANCE INJECTION (HCFA)|
20|FH_F110342_0_0|SrvcGrp|73002|2022|PDM|2200.00|99|0.00|AEG 7|
20|FH_F109513_0_0|SrvcGrp|99161|2022|PDM|10000.00|99|0.00|CPT 27138|
20|FH_F129487_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F129487_0_0|SrvcGrp|73008|2022|PDM|917.00|99|0.00|AEG 10|
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|2075.00|99|0.00|AEG 8 (NO REV)|
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 4 (NO REV)|
20|FH_F148879_33018_0|SrvcGrp|472|2022|PDM|505.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F151120_71901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151144_35801_0|SrvcGrp|105285|2022|PDM|662.17|99|0.00|TEMPORAL ARTERY|
20|FH_F151155_26508_0|SrvcGrp|69075|2022|PDM|92.70|99|0.00|CPT 99213|
20|FH_F146785_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F35212_0_0|SrvcGrp|9828|2022|PDM|36.00|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_F109951_0_0|CSTM-ALL|CSTM-00|2020|PDM|2920.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F91873_12723_0|SrvcGrp|705|2022|PCT|0.68|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F97660_29401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111207_0_0|SrvcGrp|104337|2022|PCT|0.70|99|0.00|DIALYSIS|
20|FH_F80711_0_0|SrvcGrp|42829|2022|PDM|60.00|99|0.00|RESPIRATORY THERAPY VISIT|
20|FH_F86911_0_0|CSTM-ALL|CSTM-00|2020|PDM|38.00|99|0.00|NURSING CARE MOD TE|
20|FH_F88456_0_0|SrvcGrp|87421|2022|PDM|952.00|99|0.00|CYSTOURETHROSCOPY|
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|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115045_0_0|SrvcGrp|92324|2022|PCT|0.00|99|0.00|VBAC DELIVERY|
20|FH_F130439_85014_0|SrvcGrp|73841|2022|PDM|446.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F112064_0_0|SrvcGrp|103902|2022|PDM|641.00|99|0.00|GENERAL INPATIENT CARE|
20|FH_F113541_0_0|SrvcGrp|99073|2022|PDM|1.35|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F94786_07974_0|SrvcGrp|22589|2022|PDM|52.50|99|0.00|CHEMOTHERAPY NOC|
20|FH_F95282_77975_0|SrvcGrp|73700|2022|PDM|35.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F95341_08701_0|SrvcGrp|90479|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F136818_0_0|SrvcGrp|112938|2022|PDM|2000.00|99|0.00|SURGICAL SERVICES|
20|FH_F114386_07090_0|SrvcGrp|29347|2022|PDM|17.64|99|0.00|HOME HEALTH AIDE|
20|FH_F136735_0_0|SrvcGrp|73008|2022|PDM|1248.00|99|0.00|AEG 10|
20|FH_F124180_0_0|SrvcGrp|91382|2022|PDM|1800.00|99|0.00|REMOVAL OF TONSILS|
20|FH_F124059_64055_0|SrvcGrp|106790|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ. DRUGS|
20|FH_F146906_60445_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|ASPG VIII|
20|FH_F64819_0_0|SrvcGrp|19731|2022|PDM|10556.00|99|0.00|MS DRG 469-470 ONLY|
20|FH_F132864_71101_0|CSTM-ALL|CSTM-00|2020|PDM|2289.00|99|0.00|AEG 10 (NO REV)|
20|FH_F66439_0_0|CSTM-ALL|CSTM-00|2020|PCT|56.00|99|0.00|OP SURGERY|
20|FH_F127995_84010_0|SrvcGrp|14947|2022|PDM|3.00|99|0.00|HOME INFUSION|
20|FH_F75662_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAPA OHIO FS LAB & RAD|
20|FH_F114638_25309_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|AETNA ACUTE FACILITY TRANSFER (<=48 HRS)|
20|FH_F114645_34952_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F114666_30342_0|SrvcGrp|88491|2022|PDM|5200.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F113785_35763_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140827_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F144039_0_0|SrvcGrp|109769|2022|PCT|0.00|99|0.00|COVER EYE W/ MEMBRANE SUTURE INCIDENTAL CODES|
20|FH_F132595_0_0|SrvcGrp|107734|2022|PDM|4058.00|99|0.00|VAGINAL DELIVERY|
20|FH_F122610_73139_0|SrvcGrp|73000|2022|PDM|7147.00|99|0.00|AEG 6|
20|FH_F43169_0_0|SrvcGrp|37016|2022|PDM|60.00|99|0.00|PT/OT/ST|
20|FH_F43295_0_0|SrvcGrp|40820|2022|PDM|1499.00|99|0.00|ICU/CCU|
20|FH_F134693_92270_0|SrvcGrp|89337|2022|PDM|1550.00|99|0.00|DETOXIFICATION|
20|FH_F134742_52806_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134796_70001_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134817_30339_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F135720_90025_0|SrvcGrp|98701|2022|PDM|514.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F135752_98290_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136828_32405_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F46938_0_0|SrvcGrp|10527|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F63317_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41171_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41675_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F41832_0_0|SrvcGrp|34173|2022|PDM|160.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F39080_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F39355_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F98624_15701_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F100780_24153_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F124710_0_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F128031_0_0|SrvcGrp|73004|2022|PDM|1583.00|99|0.00|AEG 8|
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PDM|4205.00|99|0.00|AEG 6 (NO REV)|
20|FH_F53573_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42942_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS APC GROUPED|
20|FH_F43867_0_0|SrvcGrp|37405|2022|PDM|90.00|99|0.00|OT SVCS|
20|FH_F138907_01040_0|SrvcGrp|65720|2022|PDM|170.00|99|0.00|RESPITE CARE|
20|FH_F81823_0_0|SrvcGrp|3809|2022|PDM|540.00|99|0.00|HOSPICE CARE|
20|FH_F116753_0_0|SrvcGrp|106771|2022|PDM|905.00|99|0.00|SLEEP STUDIES (HCFA)|
20|FH_F99420_91326_0|SrvcGrp|90628|2022|PCT|0.75|99|0.00|OP SURGERY|
20|FH_F149651_90046_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F101441_0_0|SrvcGrp|97219|2022|PDM|8105.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON|
20|FH_F122377_91007_0|SrvcGrp|109219|2022|PDM|10145.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F111266_30339_0|SrvcGrp|22592|2022|PDM|30.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F127467_44202_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F39443_0_0|SrvcGrp|30329|2022|PDM|339.00|99|0.00|HAPA WPA ASC 213|
20|FH_F37341_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|ASPG VIII|
20|FH_F124687_64024_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111857_68005_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|1420.00|99|0.00|AEG 3 (NO REV)|
20|FH_F47212_0_0|SrvcGrp|46963|2022|PDM|45.00|99|0.00|RN SERVICES (CPT 99602)|
20|FH_F147223_49444_0|SrvcGrp|42622|2022|PDM|638.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F124492_30040_0|SrvcGrp|113238|2022|PDM|56.44|99|0.00|COVID-19 LAB TEST NON-CDC (HCFA)|
20|FH_F43113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129765_43015_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL|
20|FH_F114585_11501_0|SrvcGrp|104075|2022|PCT|1.03|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F143231_11101_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F143529_84737_0|SrvcGrp|89783|2022|PDM|93.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F72749_0_0|SrvcGrp|29817|2022|PDM|3901.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F101752_0_0|SrvcGrp|74584|2022|PCT|0.90|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|258.00|99|0.00|GA RETINA SURG CTR ASC 9|
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120196_33161_0|SrvcGrp|90854|2022|PDM|986.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F112670_47150_0|SrvcGrp|104302|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F112679_85711_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD HOME HEALTH|
20|FH_F116915_30308_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F119591_75034_0|SrvcGrp|89149|2022|PDM|209.00|99|0.00|OP INTENSIVE|
20|FH_F126970_45601_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F32573_0_0|CSTM-ALL|CSTM-00|2020|PCT|43.00|99|0.00|OP SVCS|
20|FH_F51276_0_0|SrvcGrp|29087|2022|PDM|45.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F40600_0_0|SrvcGrp|6|2022|PDM|2633.00|99|0.00|OP SURGERY|
20|FH_F71704_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F57093_0_0|SrvcGrp|80|2022|PDM|652.00|99|0.00|ACUTE PSYCH|
20|FH_F59992_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F61292_0_0|SrvcGrp|9978|2022|PDM|2168.00|99|0.00|ACUTE INPATIENT MEDICAL SVCS|
20|FH_F148222_18603_0|SrvcGrp|23683|2022|PDM|51.00|99|0.00|SKILLED NURSING RN|
20|FH_F112325_0_0|SrvcGrp|95441|2022|PDM|100.00|99|0.00|HOSPICE OR HOME CARE|
20|FH_F40525_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
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_F110363_0_0|SrvcGrp|103948|2022|PDM|168.00|99|0.00|HOSPICE IN LT/NON-SKILLED NF|
20|FH_F113410_0_0|SrvcGrp|27344|2022|PDM|2101.00|99|0.00|OP SURGERY (CPT 42821)|
20|FH_F34112_0_0|SrvcGrp|708|2022|PDM|4025.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F91876_0_0|SrvcGrp|28549|2022|PDM|2100.00|99|0.00|VITRECTOMY|
20|FH_F129023_15501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38798_0_0|SrvcGrp|13606|2022|PDM|65.00|99|0.00|HOME INFUSION|
20|FH_F137067_0_0|SrvcGrp|26275|2022|PDM|3150.00|99|0.00|CPT 29826|
20|FH_F147941_06023_0|SrvcGrp|92502|2022|PDM|3118.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F38798_0_0|SrvcGrp|17818|2022|PDM|110.00|99|0.00|S9123 WITH TF MOD|
20|FH_F147941_06023_0|SrvcGrp|73841|2022|PDM|835.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F37679_0_0|SrvcGrp|26853|2022|PDM|30.50|99|0.00|CHELATION THERAPY (MOD SH)|
20|FH_F126784_80809_0|SrvcGrp|89337|2022|PDM|1995.00|99|0.00|DETOXIFICATION|
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 8 (NO REV)|
20|FH_F129964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F141588_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F118121_46001_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F129328_33311_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F148348_16803_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|2126.43|99|0.00|ASPG IX|
20|FH_F39857_0_0|SrvcGrp|1021|2022|PCT|0.75|99|0.00|VENTILATOR EQUIPMENT|
20|FH_F115740_78957_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F78165_0_0|SrvcGrp|30095|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F100790_10512_0|SrvcGrp|73643|2022|PDM|2004.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F138533_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F70984_0_0|SrvcGrp|67991|2022|PDM|1600.00|99|0.00|CPT 59150|
20|FH_F129135_68756_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F52653_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F92276_32308_0|SrvcGrp|109057|2022|PDM|1260.00|99|0.00|CARDIAC STUDIES|
20|FH_F138450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS|
20|FH_F32604_0_0|SrvcGrp|10540|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132190_0_0|SrvcGrp|16692|2022|PDM|2500.00|99|0.00|KNEE SCOPE|
20|FH_F127890_44857_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136490_0_0|CSTM-ALL|CSTM-00|2020|PDM|1360.00|99|0.00|AEG 7 (NO REV)|
20|FH_F42951_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F32786_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|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_F127207_0_0|SrvcGrp|104226|2022|PDM|90.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F125206_0_0|SrvcGrp|705|2022|PCT|0.55|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F151420_60654_0|SrvcGrp|70749|2022|PDM|3098.00|99|0.00|CPT 29823|
20|FH_F151503_30067_0|SrvcGrp|100048|2022|PDM|6622.00|99|0.00|INCISE/GRAFT MIDFOOT BONES|
20|FH_F122038_34606_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F123191_15012_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F97501_31501_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F135384_28714_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135438_29030_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F135924_02906_0|SrvcGrp|12659|2022|PDM|439.50|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F136247_28804_0|SrvcGrp|75522|2022|PCT|0.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD|
20|FH_F100763_24202_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F100848_17202_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F131228_01826_0|SrvcGrp|74444|2022|PDM|65.30|99|0.00|CARDIAC TESTING|
20|FH_F131265_84106_0|SrvcGrp|73063|2022|PDM|894.00|99|0.00|OBSERVATION SERVICES|
20|FH_F116397_33404_0|SrvcGrp|86833|2022|PDM|15.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F116431_76104_0|SrvcGrp|88819|2022|PDM|656.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F116447_21601_0|SrvcGrp|92501|2022|PDM|143.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F116461_77536_0|SrvcGrp|58509|2022|PDM|150.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F116463_76501_0|SrvcGrp|89412|2022|PDM|150.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F140629_0_0|SrvcGrp|113690|2022|PDM|2497.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F140629_0_0|SrvcGrp|41546|2022|PDM|2497.00|99|0.00|LAPAROSCOPIC APPENDECTOMY|
20|FH_F121761_44130_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F33785_0_0|SrvcGrp|24|2022|PDM|2800.00|99|0.00|CARDIAC CATH|
20|FH_F111301_33122_0|SrvcGrp|10944|2022|PDM|1060.00|99|0.00|EMERGENCY ROOM|
20|FH_F134256_36117_0|SrvcGrp|107861|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F134263_15628_0|SrvcGrp|46903|2022|PDM|637.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F134263_15628_0|SrvcGrp|89417|2022|PDM|352.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F40838_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|ASPG V|
20|FH_F33081_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34864_0_0|SrvcGrp|17368|2022|PDM|8320.00|99|0.00|PTCA W/O STENT|
20|FH_F132915_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F43895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112082_30720_0|SrvcGrp|89474|2022|PCT|1.10|99|0.00|ALL DRUGS/AGENTS/ INJ DRUG|
20|FH_F87557_33309_0|SrvcGrp|86850|2022|PDM|30.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F129240_10028_0|SrvcGrp|21920|2022|PDM|50.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F132090_60915_0|SrvcGrp|16472|2022|PDM|989.00|99|0.00|HAND PROCEDURE|
20|FH_F72544_0_0|SrvcGrp|12287|2022|PCT|0.70|99|0.00|IP PET SCAN|
20|FH_F84446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F119315_70663_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F148644_06890_0|SrvcGrp|90418|2022|PDM|7825.00|99|0.00|ENLARGE BREAST WITH IMPLANT|
20|FH_F109840_62832_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F87155_04105_0|SrvcGrp|14947|2022|PDM|37.82|99|0.00|HOME INFUSION|
20|FH_F38725_0_0|SrvcGrp|64758|2022|PCT|0.80|99|0.00|HCPCS|
20|FH_F123144_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F44607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|340.00|99|0.00|HAPA EPA ASC 40|
20|FH_F64943_0_0|SrvcGrp|17274|2022|PDM|697.00|99|0.00|CHEMICAL DEPENDENCY - ADULT|
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|1415.00|99|0.00|AEG 4 (NO REV)|
20|FH_F87559_0_0|SrvcGrp|86480|2022|PDM|79.14|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)|
20|FH_F122338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45436_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F97541_33021_0|SrvcGrp|73602|2022|PDM|1724.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F81373_64064_0|SrvcGrp|90356|2022|PCT|0.66|99|0.00|OP DIALYSIS|
20|FH_F133287_40215_0|CSTM-ALL|CSTM-00|2020|PDM|1788.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 3 (NO REV)|
20|FH_F87334_16507_0|SrvcGrp|85601|2022|PCT|1.45|99|0.00|PT/OT REHAB SERV|
20|FH_F144048_91324_0|SrvcGrp|87317|2022|PDM|2835.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F133517_49221_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F148886_60621_0|SrvcGrp|88977|2022|PDM|1282.00|99|0.00|C-SECTION DELIVERY|
20|FH_F105760_98104_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F148886_60621_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F87155_04105_0|SrvcGrp|16750|2022|PDM|101.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F146285_76109_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F111791_33308_0|SrvcGrp|99090|2022|PCT|1.00|99|0.00|AETNA DRUGS|
20|FH_F63618_0_0|SrvcGrp|43871|2022|PDM|800.00|99|0.00|NEWBORN NURSERY|
20|FH_F146267_78626_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130330_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142907_60640_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132737_0_0|SrvcGrp|941|2022|PDM|3912.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F143194_19973_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F128787_60302_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F67202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F106600_99202_0|SrvcGrp|86746|2022|PCT|1.05|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F100665_07939_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F78682_0_0|CSTM-ALL|CSTM-00|2020|PDM|1659.86|99|0.00|ASPG VIII|
20|FH_F146105_76016_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F69108_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F32512_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F107800_34609_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F33322_0_0|SrvcGrp|10427|2022|PCT|0.90|99|0.00|TRAUMA CARE|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKE|
20|FH_F31822_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115109_20032_0|SrvcGrp|88678|2022|PCT|0.00|99|0.00|ACUTE REHAB I|
20|FH_F141801_80534_0|SrvcGrp|88819|2022|PDM|1000.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F122433_0_0|SrvcGrp|67073|2022|PDM|1100.00|99|0.00|CPT 22851|
20|FH_F136790_0_0|SrvcGrp|13631|2022|PDM|154.00|99|0.00|CPT 99213|
20|FH_F88254_33411_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F135069_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F138416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|1884.00|99|0.00|AEG 9 (NO REV)|
20|FH_F71364_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|HOSPICE SERVICES|
20|FH_F136092_0_0|SrvcGrp|97507|2022|PDM|105.00|99|0.00|AETNA HOSPICE|
20|FH_F128333_71001_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F123276_20737_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F102500_0_0|SrvcGrp|98687|2022|PDM|2088.00|99|0.00|PARTIAL EXCISION THYROID|
20|FH_F39022_0_0|SrvcGrp|10400|2022|PDM|2610.00|99|0.00|IP SURGERY|
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1854.00|99|0.00|AEG 9 (NO REV)|
20|FH_F93741_85006_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION|
20|FH_F135311_33146_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|3926.00|99|0.00|AEG 3 (NO REV)|
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PDM|1182.00|99|0.00|AEG 4 (NO REV)|
20|FH_F115019_78414_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F91994_0_0|SrvcGrp|73004|2022|PDM|3152.00|99|0.00|AEG 8|
20|FH_F113253_72206_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128902_53105_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F36822_0_0|CSTM-ALL|CSTM-00|2020|PDM|1823.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F75307_0_0|SrvcGrp|12403|2022|PDM|35.20|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_F139515_0_0|SrvcGrp|113571|2022|PDM|1380.00|99|0.00|REMOVAL OF PILONIDAL LESION|
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_F148139_48328_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC STUDIES|
20|FH_F134999_89106_0|SrvcGrp|112551|2022|PCT|1.00|99|0.00|ALL OUTPATIENT DRUGS (C, J, Q & S CODES)|
20|FH_F137574_68130_0|SrvcGrp|53987|2022|PCT|1.00|99|0.00|PHOTOTHERAPY|
20|FH_F128139_62650_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116960_91505_0|SrvcGrp|86648|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F41519_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH|
20|FH_F148265_06067_0|SrvcGrp|88740|2022|PDM|5817.00|99|0.00|SP BONE ALGRFT|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER QW|
20|FH_F134999_89106_0|SrvcGrp|14893|2022|PDM|47.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F135175_45121_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F148169_33138_0|SrvcGrp|114102|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|63459|2022|PDM|3303.00|99|0.00|CPT 52601|
20|FH_F39041_0_0|CSTM-ALL|CSTM-00|2020|PDM|4439.00|99|0.00|MS DRG 774-775 NORMAL DELIVERY|
20|FH_F97104_53545_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|1851.00|99|0.00|AEG 6 (NO REV)|
20|FH_F114064_0_0|SrvcGrp|72996|2022|PDM|1200.00|99|0.00|AEG 4|
20|FH_F89778_0_0|SrvcGrp|88821|2022|PDM|1135.88|99|0.00|CPT 31536|
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87480_0_0|SrvcGrp|86237|2022|PDM|1800.00|99|0.00|AETNA PODIATRY PROCEDURES|
20|FH_F60112_0_0|SrvcGrp|42827|2022|PDM|85.50|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F62579_0_0|SrvcGrp|50165|2022|PDM|88.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 4 HRS|
20|FH_F130841_49315_0|SrvcGrp|33722|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F87333_0_0|SrvcGrp|13990|2022|PCT|0.84|99|0.00|PACEMAKER|
20|FH_F146124_06112_0|SrvcGrp|73063|2022|PCT|0.00|99|0.00|OBSERVATION SERVICES|
20|FH_F139380_33062_0|SrvcGrp|89149|2022|PDM|237.00|99|0.00|OP INTENSIVE|
20|FH_F132728_0_0|CSTM-ALL|CSTM-00|2020|PDM|2059.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134611_04103_0|SrvcGrp|109798|2022|PCT|1.10|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F93122_01854_0|SrvcGrp|93038|2022|PDM|334.00|99|0.00|AETNA PARTIAL HOSPITALIZATION (<18 YRS)|
20|FH_F127933_62863_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150165_06032_0|SrvcGrp|115164|2022|PDM|4500.00|99|0.00|MIDDLE EAR PROCEDURES|
20|FH_F114526_33401_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F70208_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|106% OF ASP DRUGS/IMMUN UPDATE QUARTERLY|
20|FH_F33063_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F96780_0_0|SrvcGrp|88154|2022|PDM|1761.00|99|0.00|LASER TREATMENT OLD RETINA|
20|FH_F129509_0_0|SrvcGrp|93063|2022|PDM|6445.00|99|0.00|LUMBAR ARTIF DISKECTOMY|
20|FH_F96160_32207_0|SrvcGrp|86836|2022|PDM|25.89|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F127529_43230_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F83035_0_0|SrvcGrp|3809|2022|PDM|531.22|99|0.00|HOSPICE CARE|
20|FH_F132969_84003_0|SrvcGrp|86834|2022|PDM|10.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F85213_02840_0|SrvcGrp|73498|2022|PDM|1446.80|99|0.00|AETNA ER LEVEL III|
20|FH_F68868_0_0|SrvcGrp|27761|2022|PDM|2836.00|99|0.00|ICU/CCU|
20|FH_F81313_0_0|SrvcGrp|79177|2022|PDM|48.00|99|0.00|SPEECH THERAPY|
20|FH_F141807_33020_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117450_63131_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F43433_0_0|SrvcGrp|37309|2022|PDM|1150.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F117272_24333_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 5  (NO REV)|
20|FH_F103281_32086_0|SrvcGrp|84839|2022|PDM|7000.00|99|0.00|AETNA LAPAROSCOPY|
20|FH_F143054_26147_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F111421_32216_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F43433_0_0|SrvcGrp|12343|2022|PDM|2500.00|99|0.00|PET SCAN|
20|FH_F117945_78957_0|SrvcGrp|73842|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F76662_0_0|SrvcGrp|11442|2022|PDM|737.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F32965_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F74305_0_0|SrvcGrp|15473|2022|PDM|789.00|99|0.00|CPT CODE 42820|
20|FH_F133627_89113_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F119070_0_0|SrvcGrp|104098|2022|PDM|4100.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F125255_34769_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|360.30|99|0.00|HAPA WPA-NWPA 2012-13 ASC 224 W/O REV|
20|FH_F146121_71857_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120437_85202_0|SrvcGrp|22389|2022|PDM|33.77|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F128774_53140_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F97061_85012_0|SrvcGrp|73643|2022|PDM|1131.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F39689_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101840_76054_0|SrvcGrp|21359|2022|PDM|20449.00|99|0.00|MS DRG 460 ONLY|
20|FH_F90811_0_0|SrvcGrp|84180|2022|PDM|2800.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS|
20|FH_F72859_0_0|SrvcGrp|15503|2022|PDM|194.56|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F91255_19401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F147800_0_0|SrvcGrp|98104|2022|PDM|55.00|99|0.00|INJ SINGLE/MX TRIGGER POINT1|
20|FH_F101104_0_0|SrvcGrp|53145|2022|PDM|195.00|99|0.00|SOCIAL WORKER|
20|FH_F132991_84790_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116828_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149605_0_0|SrvcGrp|89822|2022|PDM|153.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|296.44|99|0.00|HAPA WPA-NWPA 2012-13 ASC 309 W/O REV|
20|FH_F101754_63141_0|SrvcGrp|97988|2022|PCT|0.87|99|0.00|COCH IMP EXT PROC/CONTR RPLC|
20|FH_F148021_80907_0|SrvcGrp|88781|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F144017_33873_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F42779_0_0|SrvcGrp|3409|2022|PDM|741.00|99|0.00|NEWBORN NURSERY|
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127412_15301_0|SrvcGrp|87387|2022|PDM|905.00|99|0.00|REMOVE EYE IMPLANT MATERIAL|
20|FH_F113291_37055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|79052|2022|PDM|573.06|99|0.00|MON VALLEY ASC 312|
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.48|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F33099_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F145877_0_0|SrvcGrp|3142|2022|PDM|1695.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F139172_40207_0|CSTM-ALL|CSTM-00|2020|PDM|596.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F139553_30084_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F139707_84010_0|CSTM-ALL|CSTM-00|2020|PDM|2359.00|99|0.00|AEG 5  (NO REV)|
20|FH_F150800_44256_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139150_75206_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 8 (NO REV)|
20|FH_F125081_15218_0|SrvcGrp|87799|2022|PDM|130.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F35716_0_0|SrvcGrp|3809|2022|PDM|483.00|99|0.00|HOSPICE CARE|
20|FH_F71468_0_0|SrvcGrp|3809|2022|PDM|573.00|99|0.00|HOSPICE CARE|
20|FH_F126147_45241_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F139048_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|772.50|99|0.00|AEG 4 (NO REV)|
20|FH_F94621_07728_0|SrvcGrp|75545|2022|PDM|260.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F97881_38703_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117583_21208_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F97623_38008_0|SrvcGrp|73602|2022|PDM|1567.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F111723_0_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F144029_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134394_92101_0|SrvcGrp|109613|2022|PDM|525.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION (>=18 YRS)|
20|FH_F76262_0_0|SrvcGrp|25805|2022|PDM|750.00|99|0.00|COLONOSCOPY|
20|FH_F97183_25304_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F49338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53|
20|FH_F120157_93103_0|SrvcGrp|90573|2022|PDM|275.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F89640_98133_0|CSTM-ALL|CSTM-00|2020|PCT|1.11|99|0.00|AETNA - APC GROUPER F|
20|FH_F137731_92262_0|SrvcGrp|90040|2022|PDM|500.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F35730_0_0|SrvcGrp|11323|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F138995_0_0|SrvcGrp|90157|2022|PDM|1100.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F140093_33467_0|SrvcGrp|108484|2022|PDM|901.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F124329_37874_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114432_75035_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120291_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100782_0_0|SrvcGrp|97583|2022|PDM|852.41|99|0.00|WINDBER MEDICAL CNTR ASC 210|
20|FH_F79623_0_0|SrvcGrp|73006|2022|PDM|7959.00|99|0.00|AEG 9|
20|FH_F119732_37660_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.31|99|0.00|HAPA WPA-NWPA 2012-13 ASC 117 W/O REV|
20|FH_F148661_45429_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134229_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138736_77038_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150144_39452_0|SrvcGrp|89337|2022|PDM|1120.00|99|0.00|DETOXIFICATION|
20|FH_F128148_0_0|SrvcGrp|29898|2022|PDM|135.00|99|0.00|RN VISIT|
20|FH_F116753_0_0|SrvcGrp|70073|2022|PDM|7465.00|99|0.00|LAPAROSCOPY CPT 49650|
20|FH_F150305_18848_0|SrvcGrp|13222|2022|PDM|37.40|99|0.00|CPT CODE 99281|
20|FH_F132969_84003_0|SrvcGrp|13929|2022|PDM|10.00|99|0.00|GROWTH HORMONE|
20|FH_F130329_64114_0|SrvcGrp|111527|2022|PDM|125.00|99|0.00|HOME INFUSION (HCFA)|
20|FH_F112665_0_0|SrvcGrp|88164|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F118123_67226_0|SrvcGrp|17014|2022|PDM|22.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F110404_17821_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F81852_0_0|CSTM-ALL|CSTM-00|2020|PDM|592.00|99|0.00|ASPG II|
20|FH_F143650_0_0|SrvcGrp|26277|2022|PDM|1800.00|99|0.00|CPT 29874|
20|FH_F124159_92506_0|SrvcGrp|73841|2022|PDM|472.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F149528_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F100680_43130_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F114510_33445_0|SrvcGrp|89149|2022|PDM|177.00|99|0.00|OP INTENSIVE|
20|FH_F139780_75605_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F83534_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133749_84604_0|SrvcGrp|112439|2022|PDM|25.00|99|0.00|ANIT-HEMOPHILIC FACTORS (HCFA)|
20|FH_F142376_0_0|SrvcGrp|87122|2022|PDM|1159.00|99|0.00|DESTROY CERV/THOR FACET JNT|
20|FH_F87712_15017_0|CSTM-ALL|CSTM-00|2020|PCT|1.26|99|0.00|HSS ASC|
20|FH_F70208_0_0|SrvcGrp|59445|2022|PDM|525.00|99|0.00|MRI|
20|FH_F112060_07514_0|SrvcGrp|87911|2022|PCT|1.00|99|0.00|CYCLOSPORINE ORAL 100MG|
20|FH_F134168_70526_0|SrvcGrp|113132|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F114407_19002_0|SrvcGrp|48398|2022|PDM|84.00|99|0.00|PT SERVICES|
20|FH_F135663_24401_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F100063_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F129509_0_0|SrvcGrp|73002|2022|PDM|1380.00|99|0.00|AEG 7|
20|FH_F50475_0_0|SrvcGrp|36991|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F73084_0_0|SrvcGrp|46117|2022|PDM|24.00|99|0.00|HOME HEALTH AIDE (PER HOUR)|
20|FH_F72262_0_0|SrvcGrp|8950|2022|PDM|1750.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F122470_78229_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122551_75605_0|SrvcGrp|86723|2022|PDM|445.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F86375_0_0|SrvcGrp|82222|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F72963_0_0|SrvcGrp|20072|2022|PDM|1360.00|99|0.00|MS DRG 880-887, 894-897|
20|FH_F105143_26062_0|SrvcGrp|102345|2022|PCT|0.70|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F105361_80104_0|SrvcGrp|73601|2022|PDM|5095.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F115934_70605_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F80513_0_0|SrvcGrp|31020|2022|PDM|14628.00|99|0.00|MS DRG 470 ONLY|
20|FH_F146668_30189_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|AEG 7 (NO REV)|
20|FH_F146667_37110_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146673_19085_0|SrvcGrp|98701|2022|PDM|417.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F115956_06516_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116040_24637_0|SrvcGrp|86779|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F132845_63841_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133133_32433_0|SrvcGrp|110041|2022|PDM|19.00|99|0.00|BEHAVIOR TREATMENT|
20|FH_F130657_04614_0|SrvcGrp|537|2022|PCT|0.86|99|0.00|OBSERVATION SERVICES|
20|FH_F111662_80601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INJECTION, PEGFILGRASTIM 6MG|
20|FH_F136467_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123752_44502_0|SrvcGrp|109459|2022|PDM|280.00|99|0.00|HEMODIALYSIS|
20|FH_F136399_70445_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136542_02446_0|CSTM-ALL|CSTM-00|2020|PDM|398.00|99|0.00|PARTIAL HOSPITALIZATION (<=17 YRS)|
20|FH_F134011_84102_0|SrvcGrp|24739|2022|PDM|112.00|99|0.00|RESPITE CARE|
20|FH_F134066_33881_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137030_46256_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F142530_60148_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F142654_73034_0|CSTM-ALL|CSTM-00|2020|PCT|0.13|99|0.00|OP SVCS|
20|FH_F142707_02891_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F53732_0_0|SrvcGrp|15596|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138308_50036_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140750_89119_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140761_33172_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F140893_19720_0|SrvcGrp|93734|2022|PCT|1.11|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F80284_16354_0|SrvcGrp|30623|2022|PDM|4839.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F148699_19403_0|SrvcGrp|46903|2022|PDM|815.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F119021_03060_0|SrvcGrp|86749|2022|PCT|1.06|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F92506_07666_0|SrvcGrp|42404|2022|PDM|11.95|99|0.00|VENIPUNCTURE|
20|FH_F109884_36117_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F115452_15235_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117232_83221_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F147725_06002_0|SrvcGrp|70746|2022|PDM|4218.00|99|0.00|CPT 28292|
20|FH_F147799_18052_0|SrvcGrp|73742|2022|PCT|1.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F147879_93309_0|SrvcGrp|88621|2022|PDM|155.00|99|0.00|SKILLED NURSING LPN|
20|FH_F117107_33704_0|SrvcGrp|104470|2022|PDM|1400.00|99|0.00|ANTEPARTUM CARE ONLY (7 OR MORE VISITS)|
20|FH_F117219_77515_0|SrvcGrp|89417|2022|PDM|375.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F117218_32025_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F117123_68025_0|CSTM-ALL|CSTM-00|2020|PCT|0.21|99|0.00|OP SVCS|
20|FH_F137937_20032_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F109821_0_0|SrvcGrp|102260|2022|PDM|10000.00|99|0.00|AETNA TOTAL JOINT REPLACEMENT|
20|FH_F111593_0_0|SrvcGrp|87026|2022|PDM|1870.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|380.00|99|0.00|AEG 1 (NO REV)|
20|FH_F151099_86429_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151144_35801_0|CSTM-ALL|CSTM-00|2020|PDM|451.00|99|0.00|AEG 1 (NO REV)|
20|FH_F151284_72703_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F121960_75503_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121999_67002_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|LAP VENT/ABD HERN PROC COMP|
20|FH_F116143_0_0|SrvcGrp|73004|2022|PDM|1425.00|99|0.00|AEG 8|
20|FH_F114916_30309_0|SrvcGrp|89848|2022|PDM|5000.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PDM|3348.00|99|0.00|AEG 8 (NO REV)|
20|FH_F112704_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.80|99|0.00|AEG 1 (NO REV)|
20|FH_F104840_32565_0|SrvcGrp|73461|2022|PCT|0.69|99|0.00|AETNA NICU IV|
20|FH_F112453_0_0|SrvcGrp|80317|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F119435_0_0|SrvcGrp|107877|2022|PDM|543.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F133376_33414_0|SrvcGrp|73842|2022|PDM|194.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F52516_0_0|SrvcGrp|3810|2022|PDM|135.11|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F94786_07974_0|SrvcGrp|86844|2022|PDM|36.75|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F132627_0_0|SrvcGrp|24752|2022|PDM|43.86|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 7 (NO REV)|
20|FH_F42933_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118962_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F49487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F77944_0_0|CSTM-ALL|CSTM-00|2020|PDM|6046.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F122184_65674_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F92493_0_0|SrvcGrp|92362|2022|PDM|12999.53|99|0.00|AUTOLOG CHONDROCYTE IMP KNEE|
20|FH_F100703_0_0|SrvcGrp|96919|2022|PDM|4284.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F72416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.41|99|0.00|GENERAL ACUTE CARE|
20|FH_F123620_0_0|SrvcGrp|13595|2022|PDM|285.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F136568_92562_0|SrvcGrp|89149|2022|PDM|365.00|99|0.00|OP INTENSIVE|
20|FH_F113809_47302_0|SrvcGrp|73841|2022|PDM|272.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138981_85123_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F81832_13827_0|SrvcGrp|48385|2022|PDM|184.00|99|0.00|SPEECH THERAPY|
20|FH_F148487_28210_0|SrvcGrp|74668|2022|PDM|320.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F144039_0_0|SrvcGrp|109767|2022|PCT|0.00|99|0.00|COVER EYE W/ MEMBRANE INCIDENTAL CODES|
20|FH_F122610_73139_0|SrvcGrp|68403|2022|PDM|1238.00|99|0.00|EMERGENCY ROOM SERVICES|
20|FH_F134791_98034_0|SrvcGrp|107859|2022|PCT|1.41|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F135762_70001_0|SrvcGrp|75419|2022|PDM|1250.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F136778_62034_0|SrvcGrp|79800|2022|PCT|0.71|99|0.00|AETNA SLEEP STUDIES|
20|FH_F136824_08034_0|SrvcGrp|16069|2022|PDM|898.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F112187_98272_0|SrvcGrp|81765|2022|PCT|0.81|99|0.00|AETNA OP RADIOLOGY (RAD)|
20|FH_F112505_51503_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116199_75042_0|SrvcGrp|89149|2022|PDM|172.00|99|0.00|OP INTENSIVE|
20|FH_F147725_06002_0|SrvcGrp|36864|2022|PDM|14061.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F41675_0_0|SrvcGrp|30661|2022|PDM|1575.00|99|0.00|LITHOTRIPSY SVCS|
20|FH_F42399_0_0|SrvcGrp|471|2022|PDM|618.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F42754_0_0|CSTM-ALL|CSTM-00|2020|PDM|143.00|99|0.00|CD DAY TREATMENT|
20|FH_F100780_24153_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F111190_30512_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F141211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97261_06098_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_F71165_0_0|CSTM-ALL|CSTM-00|2020|PDM|1675.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F52872_0_0|SrvcGrp|49622|2022|PDM|1066.00|99|0.00|WILLS COMM SURG SVC UNGROUPED|
20|FH_F111951_80111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138879_17837_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|APC OVERRIDES|
20|FH_F138936_01040_0|SrvcGrp|108724|2022|PDM|489.00|99|0.00|MENTAL HEALTH PARTIAL HOSP|
20|FH_F138992_72703_0|SrvcGrp|111322|2022|PDM|1965.00|99|0.00|OBSERVATION SERVICES|
20|FH_F83792_0_0|SrvcGrp|80123|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F89580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.46|99|0.00|IP DIAPHRAGMATIC PACEMAKER IMP|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|221.09|99|0.00|HAPA WPA-NWPA 2012-13 ASC 128 W/O REV|
20|FH_F72606_0_0|SrvcGrp|30477|2022|PDM|4300.00|99|0.00|IMCU / DOU|
20|FH_F124542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84297_0_0|SrvcGrp|79420|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F151514_35242_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130671_42701_0|SrvcGrp|108484|2022|PDM|541.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F97501_31501_0|SrvcGrp|73559|2022|PDM|12613.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F43239_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F135507_02859_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135911_32256_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135979_66451_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F130584_32812_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F121823_46234_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F33785_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F101182_07863_0|SrvcGrp|96400|2022|PCT|1.00|99|0.00|INTERFERON ALFACON|
20|FH_F111363_33169_0|SrvcGrp|73605|2022|PDM|1020.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F111363_33169_0|SrvcGrp|110234|2022|PCT|0.84|99|0.00|RADIOLOGY SERVICES|
20|FH_F36344_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|720223_LABS_NO MOD|
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112092_46845_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F87534_19464_0|SrvcGrp|79720|2022|PDM|1231.00|99|0.00|ACUTE REHAB II|
20|FH_F87557_33309_0|SrvcGrp|29076|2022|PDM|30.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F88831_84123_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F141035_0_0|SrvcGrp|113714|2022|PDM|7129.00|99|0.00|RELEASE PALM CONTRACTURE|
20|FH_F140102_0_0|SrvcGrp|80918|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F102228_08846_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132090_60915_0|SrvcGrp|40002|2022|PDM|9500.00|99|0.00|TOTAL HIP|
20|FH_F148100_22406_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F148100_22406_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F148425_01507_0|SrvcGrp|115386|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F148425_01507_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148485_13021_0|SrvcGrp|104186|2022|PDM|12.00|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F148641_92505_0|SrvcGrp|46903|2022|PDM|750.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F144011_60616_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|952.00|99|0.00|AEG 10 (NO REV)|
20|FH_F121012_29732_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132992_04662_0|SrvcGrp|88621|2022|PDM|79.00|99|0.00|SKILLED NURSING LPN|
20|FH_F38702_0_0|SrvcGrp|112105|2022|PDM|87.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HCFA)|
20|FH_F146254_83651_0|SrvcGrp|74668|2022|PDM|236.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132587_57105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46473_0_0|SrvcGrp|11151|2022|PDM|2771.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F49035_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC|
20|FH_F125033_93305_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F49637_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|OK SURGICAL HOSPITAL CVTY ENHANCED GROUPER 10|
20|FH_F42557_0_0|CSTM-ALL|CSTM-00|2020|PDM|360.00|99|0.00|CD - ADOLESCENT PARTIAL HOSPITAL|
20|FH_F80592_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|911.00|99|0.00|HAPA EPA ASC 6|
20|FH_F69071_0_0|SrvcGrp|13422|2022|PDM|374.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F40591_0_0|SrvcGrp|8968|2022|PDM|4025.00|99|0.00|NICU LEVEL III & IV|
20|FH_F57592_0_0|SrvcGrp|9517|2022|PDM|250.00|99|0.00|MAMMOGRAPHY|
20|FH_F100740_15206_0|SrvcGrp|73485|2022|PDM|3014.00|99|0.00|AETNA REHAB|
20|FH_F100740_15206_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F33241_0_0|SrvcGrp|9911|2022|PDM|3500.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F119079_41018_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F102561_75146_0|SrvcGrp|98003|2022|PDM|10038.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F129965_0_0|SrvcGrp|111412|2022|PCT|1.00|99|0.00|OB SERVICES|
20|FH_F141910_70809_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F31446_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.00|99|0.00|CD SVCS (ADULT)|
20|FH_F132420_84660_0|SrvcGrp|108484|2022|PDM|1120.36|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F115889_0_0|SrvcGrp|73002|2022|PDM|1434.00|99|0.00|AEG 7|
20|FH_F147997_92620_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146212_57108_0|CSTM-ALL|CSTM-00|2020|PDM|1669.17|99|0.00|AEG 4 (NO REV)|
20|FH_F45202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F38848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F42340_0_0|SrvcGrp|31190|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC (DME)|
20|FH_F124608_0_0|SrvcGrp|41334|2022|PDM|7956.00|99|0.00|TOTAL KNEE|
20|FH_F145964_10993_0|SrvcGrp|15357|2022|PCT|1.00|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F33070_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125540_19462_0|CSTM-ALL|CSTM-00|2020|PDM|190.00|99|0.00|INTENSIVE OUTPATIENT (<=17 YRS)|
20|FH_F150500_85253_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F130330_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111423_34952_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F96120_67207_0|SrvcGrp|43524|2022|PDM|150.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F125049_44131_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER QW|
20|FH_F144308_44512_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F91155_16105_0|SrvcGrp|46424|2022|PDM|94.58|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F146320_27610_0|CSTM-ALL|CSTM-00|2020|PDM|1288.30|99|0.00|AEG 6 (NO REV)|
20|FH_F117901_27526_0|SrvcGrp|90484|2022|PCT|1.10|99|0.00|NOS FLU VACC 3 YRS & > IM|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|53.00|99|0.00|ANCILLARY DRUG THERAPY|
20|FH_F33649_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|1683.00|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_F114206_37203_0|SrvcGrp|86843|2022|PDM|35.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F130309_17044_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F147327_19010_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F127464_15106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138662_78624_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130182_0_0|SrvcGrp|97895|2022|PDM|8323.00|99|0.00|REVISE KNEE 2|
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 7 (NO REV)|
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|1199.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F148902_40509_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F76222_0_0|SrvcGrp|3458|2022|PDM|2188.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F37487_0_0|SrvcGrp|16620|2022|PDM|80.00|99|0.00|PT SVCS|
20|FH_F134847_0_0|SrvcGrp|77021|2022|PDM|5429.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F94643_90501_0|SrvcGrp|14945|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F136806_0_0|SrvcGrp|112946|2022|PDM|7597.00|99|0.00|ILIAC REVASC W/ STENT|
20|FH_F130654_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OBSERVATION SERVICES|
20|FH_F124486_0_0|SrvcGrp|46890|2022|PDM|1803.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|AEG 5  (NO REV)|
20|FH_F116753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|821.00|99|0.00|AEG 6 (NO REV)|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|3552.00|99|0.00|ASPG VII|
20|FH_F137721_80737_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37361_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F132254_40207_0|SrvcGrp|86846|2022|PDM|50.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F136592_0_0|SrvcGrp|68546|2022|PDM|1240.00|99|0.00|CPT 36558|
20|FH_F137748_95231_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F97640_37043_0|SrvcGrp|73603|2022|PDM|3802.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F39443_0_0|SrvcGrp|30327|2022|PDM|421.00|99|0.00|HAPA WPA ASC 211|
20|FH_F37058_0_0|SrvcGrp|23387|2022|PDM|80.00|99|0.00|PT/OT/ST|
20|FH_F99920_63141_0|SrvcGrp|83522|2022|PDM|110.00|99|0.00|RESPITE CARE|
20|FH_F97084_91911_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F124486_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F117762_0_0|SrvcGrp|88160|2022|PDM|4992.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F139591_72401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40527_0_0|SrvcGrp|16|2022|PDM|850.00|99|0.00|ACUTE REHABILITATION|
20|FH_F139950_76240_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143210_72211_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143210_72211_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143231_11101_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F143413_75061_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143536_47546_0|SrvcGrp|100261|2022|PCT|1.00|99|0.00|TREAT WOUND DEHISCENCE|
20|FH_F143536_47546_0|SrvcGrp|100279|2022|PCT|1.00|99|0.00|ALBUTEROL NON-COMPOUNDED|
20|FH_F103060_0_0|SrvcGrp|67068|2022|PDM|8323.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F103060_0_0|SrvcGrp|88160|2022|PDM|7803.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F114931_0_0|SrvcGrp|82298|2022|PDM|19000.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY|
20|FH_F116698_07470_0|SrvcGrp|53987|2022|PDM|136.50|99|0.00|PHOTOTHERAPY|
20|FH_F120853_61201_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120921_75835_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120974_27607_0|SrvcGrp|10393|2022|PDM|5521.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F120974_27607_0|SrvcGrp|14187|2022|PDM|961.00|99|0.00|MRI|
20|FH_F113563_70560_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118879_93063_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F84394_17402_0|CSTM-ALL|CSTM-00|2020|PDM|1474.00|99|0.00|AEG 1 (NO REV)|
20|FH_F46354_0_0|CSTM-ALL|CSTM-00|2020|PDM|346.92|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F56092_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS|
20|FH_F47884_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F49954_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_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|79377|2022|PCT|0.49|99|0.00|UNGROUPABLE ASPG + REV CODES|
20|FH_F89475_71202_0|SrvcGrp|20926|2022|PDM|25544.00|99|0.00|MS DRG 235 ONLY|
20|FH_F148263_30830_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140247_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F110925_01104_0|SrvcGrp|29076|2022|PDM|57.78|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F143780_33873_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F145590_45242_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F40115_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F127584_45219_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F124899_45246_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F33712_0_0|SrvcGrp|3029|2022|PDM|500.00|99|0.00|NEWBORN NURSERY|
20|FH_F93136_0_0|SrvcGrp|73008|2022|PDM|630.00|99|0.00|AEG 10|
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|2049.00|99|0.00|ASPG VII - IOWA|
20|FH_F33106_0_0|SrvcGrp|409|2022|PCT|0.80|99|0.00|ER SVCS|
20|FH_F35263_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F97061_85012_0|SrvcGrp|73485|2022|PDM|5020.00|99|0.00|AETNA REHAB|
20|FH_F49354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F112853_22408_0|SrvcGrp|41454|2022|PDM|0.60|99|0.00|ENTERAL FORMULA - PEDIATRICS|
20|FH_F35019_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112905_62088_0|SrvcGrp|3208|2022|PDM|2917.00|99|0.00|SUBACUTE CARE|
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1009.00|99|0.00|AEG 8 (NO REV)|
20|FH_F103540_24740_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147995_67037_0|SrvcGrp|75442|2022|PDM|1425.00|99|0.00|OBSERVATION - REV 762|
20|FH_F92854_63028_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138236_0_0|SrvcGrp|73656|2022|PDM|550.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F117872_33462_0|SrvcGrp|89417|2022|PDM|477.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F114519_0_0|SrvcGrp|73004|2022|PDM|1560.00|99|0.00|AEG 8|
20|FH_F148740_93230_0|SrvcGrp|58509|2022|PDM|501.56|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F151053_17602_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150760_44833_0|SrvcGrp|48398|2022|PDM|150.00|99|0.00|PT SERVICES|
20|FH_F116806_0_0|SrvcGrp|107112|2022|PCT|0.50|99|0.00|DENTAL SERVICES UNDER ANESTHESIA|
20|FH_F101861_19567_0|SrvcGrp|86728|2022|PCT|1.00|99|0.00|RHOGAM INJECTION|
20|FH_F40530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F90817_0_0|SrvcGrp|91017|2022|PDM|1692.00|99|0.00|NASAL/SINUS ENDOSCOPY (HCFA)|
20|FH_F98900_42001_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F117615_30525_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F35778_33321_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138410_19130_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F100965_25276_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127418_0_0|SrvcGrp|96799|2022|PDM|6691.56|99|0.00|DESTROY C/TH FACET JNT ADDL|
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)|
20|FH_F40530_0_0|SrvcGrp|701|2022|PDM|2156.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F90817_0_0|SrvcGrp|90999|2022|PDM|2162.00|99|0.00|REPAIR FRACTURE OF ULNA (HCFA)|
20|FH_F125081_15218_0|SrvcGrp|90707|2022|PDM|130.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F39443_0_0|SrvcGrp|30288|2022|PDM|448.00|99|0.00|HAPA WPA ASC 1|
20|FH_F114207_35243_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F112754_98057_0|SrvcGrp|73524|2022|PDM|263.87|99|0.00|PHYSICAL THERAPY|
20|FH_F124526_05301_0|SrvcGrp|73842|2022|PDM|284.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|144.00|99|0.00|HAPA EPA ASC 24|
20|FH_F115483_62002_0|SrvcGrp|112965|2022|PDM|7320.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F37370_0_0|SrvcGrp|22136|2022|PDM|303.00|99|0.00|CT SCAN|
20|FH_F144651_0_0|SrvcGrp|114173|2022|PDM|3000.00|99|0.00|CARDIAC CATHERIZATION INCL INJECTIONS|
20|FH_F120040_72703_0|SrvcGrp|87317|2022|PDM|902.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F139177_0_0|SrvcGrp|11259|2022|PCT|0.26|99|0.00|DRUGS|
20|FH_F73803_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F37198_0_0|SrvcGrp|9510|2022|PCT|0.75|99|0.00|SKILLED NURSING CARE|
20|FH_F132008_85226_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139877_32615_0|SrvcGrp|113237|2022|PDM|35.92|99|0.00|COVID-19 NCOV DIAGNOSTIC P (HCFA)|
20|FH_F140289_52246_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149043_72021_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150520_0_0|CSTM-ALL|CSTM-00|2020|PDM|727.00|99|0.00|AEG 2 (NO REV)|
20|FH_F127467_44202_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F126554_0_0|SrvcGrp|49443|2022|PDM|121.00|99|0.00|INFUSION THERAPY|
20|FH_F124739_64429_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109515_15301_0|SrvcGrp|3809|2022|PDM|764.00|99|0.00|HOSPICE CARE|
20|FH_F120057_0_0|SrvcGrp|107793|2022|PDM|6000.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F36343_0_0|SrvcGrp|11798|2022|PDM|100.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F47558_0_0|SrvcGrp|40411|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD RR KE|
20|FH_F148859_0_0|SrvcGrp|115511|2022|PDM|788.00|99|0.00|BLADDER STONE REMOVAL|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD AV|
20|FH_F138387_02886_0|SrvcGrp|113269|2022|PDM|115.00|99|0.00|HOME OCCUPATIONAL THERAPY|
20|FH_F137772_27320_0|SrvcGrp|26001|2022|PDM|195.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|691.00|99|0.00|AEG 1 (NO REV)|
20|FH_F35452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1895.00|99|0.00|ASPG VIII|
20|FH_F117762_0_0|SrvcGrp|83641|2022|PDM|1872.00|99|0.00|CPT 29889|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|6.00|99|0.00|GROSHONG SINGLE LUMEN CATHETER CARE (MOD SH)|
20|FH_F76222_0_0|SrvcGrp|3029|2022|PDM|1254.00|99|0.00|NEWBORN NURSERY|
20|FH_F92032_32308_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F147339_08837_0|SrvcGrp|67065|2022|PDM|3500.00|99|0.00|CERVICAL SURGERY|
20|FH_F97101_98003_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F129297_97828_0|SrvcGrp|106811|2022|PCT|0.00|99|0.00|IP DETOXIFICATION|
20|FH_F84433_0_0|SrvcGrp|73742|2022|PDM|11.14|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F117023_0_0|SrvcGrp|72998|2022|PDM|1180.00|99|0.00|AEG 5|
20|FH_F139877_32615_0|SrvcGrp|112224|2022|PDM|75.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F37312_0_0|SrvcGrp|26035|2022|PDM|27.50|99|0.00|HOME HEALTH THERAPY VISITS|
20|FH_F126933_33174_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F125656_92868_0|SrvcGrp|86834|2022|PDM|12.50|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F94862_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F131992_62832_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147941_06023_0|SrvcGrp|10364|2022|PDM|1358.00|99|0.00|CPT CODE 99284|
20|FH_F150699_0_0|SrvcGrp|109503|2022|PDM|3383.00|99|0.00|REPOSITION L VENTRIC LEAD|
20|FH_F145536_90265_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F126678_44870_0|SrvcGrp|90707|2022|PDM|130.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F39385_0_0|SrvcGrp|27726|2022|PCT|0.65|99|0.00|OP SURGERY|
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145536_90265_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F42160_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125249_0_0|SrvcGrp|90360|2022|PDM|1200.00|99|0.00|REPAIR FRACTURE OF ULNA|
20|FH_F37651_0_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|DBPT PT-OT-ST|
20|FH_F37679_0_0|SrvcGrp|17302|2022|PDM|39.00|99|0.00|HYDRATION THERAPY - 3+ LITERS|
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)|
20|FH_F33513_0_0|SrvcGrp|34867|2022|PCT|0.77|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F145550_62034_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115019_78414_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F85115_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126439_92627_0|SrvcGrp|87317|2022|PDM|1100.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F129969_33908_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F56136_0_0|SrvcGrp|13472|2022|PDM|3345.00|99|0.00|ICU/CCU|
20|FH_F66687_0_0|SrvcGrp|29755|2022|PCT|0.85|99|0.00|MS DRG 245 ONLY|
20|FH_F141407_76226_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F116061_80110_0|SrvcGrp|104077|2022|PCT|1.40|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F125899_07645_0|SrvcGrp|73002|2022|PDM|7166.00|99|0.00|AEG 7|
20|FH_F35599_0_0|SrvcGrp|20848|2022|PDM|625.00|99|0.00|ABORTION UP TO 11 WEEKS|
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1059.00|99|0.00|AEG 8 (NO REV)|
20|FH_F140967_20735_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125210_32901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F34454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83493_21220_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F83451_0_0|SrvcGrp|81568|2022|PDM|1575.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F109645_0_0|SrvcGrp|87397|2022|PDM|90.00|99|0.00|CPT 99500 (HCFA)|
20|FH_F151526_28208_0|SrvcGrp|103638|2022|PDM|10702.00|99|0.00|AETNA OPEN/PERQ PLACE STENT 1ST|
20|FH_F118194_50841_0|SrvcGrp|82773|2022|PDM|272.00|99|0.00|POST NATAL ASSESSMENT W/ NEWBORN|
20|FH_F135897_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F87716_0_0|CSTM-ALL|CSTM-00|2020|PDM|1751.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135219_68506_0|SrvcGrp|105465|2022|PCT|1.18|99|0.00|AETNA THERAPIES|
20|FH_F63444_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|OP SVCS|
20|FH_F137347_26003_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION|
20|FH_F82696_16335_0|SrvcGrp|76012|2022|PDM|1373.00|99|0.00|EMERGENCY ROOM SVCS LEVEL V|
20|FH_F129653_0_0|SrvcGrp|73004|2022|PDM|2405.00|99|0.00|AEG 8|
20|FH_F139551_0_0|SrvcGrp|88740|2022|PDM|4574.00|99|0.00|SP BONE ALGRFT|
20|FH_F40272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38961_0_0|SrvcGrp|27830|2022|PDM|42.00|99|0.00|THERAPY|
20|FH_F93881_15009_0|SrvcGrp|74441|2022|PDM|3.00|99|0.00|CARDIAC TESTING|
20|FH_F125011_74467_0|SrvcGrp|110025|2022|PDM|3150.00|99|0.00|TONSIL AND ADENOIDECTOMY|
20|FH_F63432_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|GENERAL ACUTE CARE|
20|FH_F40063_0_0|SrvcGrp|26595|2022|PDM|806.00|99|0.00|ACUTE PSYCHIATRIC|
20|FH_F139515_0_0|SrvcGrp|84939|2022|PDM|10686.00|99|0.00|SHOULDER JOINT|
20|FH_F129666_71901_0|SrvcGrp|88621|2022|PDM|155.00|99|0.00|SKILLED NURSING LPN|
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_F88212_20151_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F93620_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137352_43912_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F82695_15014_0|SrvcGrp|472|2022|PDM|368.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130681_15701_0|SrvcGrp|112039|2022|PCT|1.45|99|0.00|URGENT CARE TELEMEDICINE ESTABLISHED PATIENT (MOD GT)|
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|847.00|99|0.00|AEG 3 (NO REV)|
20|FH_F89475_71202_0|CSTM-ALL|CSTM-00|2020|PDM|1566.00|99|0.00|AEG 3 (NO REV)|
20|FH_F128159_45356_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F44582_0_0|SrvcGrp|38826|2022|PCT|0.70|99|0.00|ELECTROPHYSIOLOGY STUDIES|
20|FH_F123400_04605_0|SrvcGrp|73842|2022|PDM|170.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148254_89503_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F42706_0_0|CSTM-ALL|CSTM-00|2020|PDM|712.21|99|0.00|ASPG V|
20|FH_F38798_0_0|SrvcGrp|29677|2022|PDM|110.00|99|0.00|HOME INFUSION NURSING SVCS MOD SD|
20|FH_F93553_65065_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F77862_0_0|SrvcGrp|29898|2022|PDM|105.78|99|0.00|RN VISIT|
20|FH_F38360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F141527_36830_0|SrvcGrp|24750|2022|PDM|11.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F135261_33144_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F91994_0_0|SrvcGrp|72998|2022|PDM|1800.00|99|0.00|AEG 5|
20|FH_F149868_0_0|SrvcGrp|33722|2022|PDM|43.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F121113_33613_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F127205_44125_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F125935_44024_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F47963_0_0|SrvcGrp|24286|2022|PDM|27.50|99|0.00|SKILLED NURSING CARE|
20|FH_F35557_0_0|SrvcGrp|17014|2022|PDM|28.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F137986_0_0|SrvcGrp|11673|2022|PDM|4326.00|99|0.00|CPT 29888|
20|FH_F131387_76001_0|SrvcGrp|73841|2022|PDM|414.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F114188_15205_0|SrvcGrp|73700|2022|PDM|38.63|99|0.00|AETNA - SKILLED NURSING|
20|FH_F114206_37203_0|SrvcGrp|24750|2022|PDM|35.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|2375.00|99|0.00|AEG 5  (NO REV)|
20|FH_F147166_03444_0|SrvcGrp|114985|2022|PCT|0.65|99|0.00|LABORATORY|
20|FH_F39443_0_0|SrvcGrp|30346|2022|PDM|503.00|99|0.00|HAPA WPA ASC 302|
20|FH_F114207_35243_0|SrvcGrp|86837|2022|PDM|15.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F139823_32250_0|SrvcGrp|86722|2022|PDM|246.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F143249_89801_0|SrvcGrp|31973|2022|PDM|10.00|99|0.00|HOME THERAPY|
20|FH_F143348_16214_0|SrvcGrp|3378|2022|PCT|0.89|99|0.00|OBSERVATION SVCS|
20|FH_F32617_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F102224_0_0|SrvcGrp|88493|2022|PDM|2120.00|99|0.00|AETNA VERTEBROPLASTY ADDL INJECT|
20|FH_F151748_20037_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|189.00|99|0.00|GA RETINA SURG CTR ASC 4|
20|FH_F132417_38119_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F132479_90290_0|SrvcGrp|75442|2022|PDM|906.00|99|0.00|OBSERVATION - REV 762|
20|FH_F116698_07470_0|SrvcGrp|86842|2022|PDM|31.50|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F82691_0_0|SrvcGrp|44106|2022|PDM|48.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F119591_75034_0|SrvcGrp|86723|2022|PDM|429.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F120887_78750_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120974_27607_0|SrvcGrp|114917|2022|PCT|0.71|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F120966_60707_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F44438_0_0|SrvcGrp|3856|2022|PDM|1676.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F51276_0_0|SrvcGrp|21920|2022|PDM|70.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F51276_0_0|SrvcGrp|24761|2022|PDM|42.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F35685_0_0|SrvcGrp|10091|2022|PDM|50715.00|99|0.00|DRG 535 ONLY|
20|FH_F40345_0_0|SrvcGrp|30941|2022|PDM|309.00|99|0.00|NEWBORN NURSERY|
20|FH_F36676_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|DME MOD 26|
20|FH_F38076_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F110263_0_0|SrvcGrp|63471|2022|PDM|22051.00|99|0.00|CPT 64590|
20|FH_F129653_0_0|SrvcGrp|99073|2022|PDM|1.32|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F127564_66002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130134_08724_0|SrvcGrp|109921|2022|PDM|425.00|99|0.00|RESIDENTIAL TREATMENT (13-17 YRS)|
20|FH_F63153_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|99|0.00|OP SVCS|
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|944.00|99|0.00|AEG 1 (NO REV)|
20|FH_F135207_76053_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F122687_0_0|SrvcGrp|74039|2022|PDM|8742.00|99|0.00|LAMINECTOMY|
20|FH_F71364_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|AMBULANCE SVCS|
20|FH_F37679_0_0|SrvcGrp|27073|2022|PDM|2.13|99|0.00|HOME INFUSION - DOUBLE / TRIPLE LUMEN (MOD SJ)|
20|FH_F147941_06023_0|SrvcGrp|73665|2022|PCT|1.38|99|0.00|OTHER OP DRUGS|
20|FH_F92276_32308_0|SrvcGrp|3378|2022|PDM|3675.00|99|0.00|OBSERVATION SVCS|
20|FH_F92276_32308_0|CSTM-ALL|CSTM-00|2020|PDM|8269.00|99|0.00|AEG 2 (NO REV)|
20|FH_F125028_19061_0|SrvcGrp|22589|2022|PDM|63.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|2117.50|99|0.00|AEG 10 (NO REV)|
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121492_87111_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F137067_0_0|SrvcGrp|72121|2022|PDM|7350.00|99|0.00|ARTHOSCOPY|
20|FH_F143989_19090_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F148892_0_0|SrvcGrp|53065|2022|PDM|668.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F38526_0_0|SrvcGrp|16|2022|PDM|1125.00|99|0.00|ACUTE REHABILITATION|
20|FH_F139551_0_0|SrvcGrp|87844|2022|PDM|5382.00|99|0.00|LAPARASCOPY - GASTRIC|
20|FH_F129782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F149863_68127_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130747_0_0|SrvcGrp|72121|2022|PDM|5202.00|99|0.00|ARTHOSCOPY|
20|FH_F41053_0_0|SrvcGrp|453|2022|PDM|281.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KL|
20|FH_F49299_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143970_92656_0|SrvcGrp|46903|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F148160_29732_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|2220.00|99|0.00|WELLPATH ASC IX|
20|FH_F117010_10549_0|SrvcGrp|86753|2022|PCT|1.05|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F128906_48423_0|SrvcGrp|83857|2022|PDM|550.00|99|0.00|IP HOSPICE SVCS|
20|FH_F99320_0_0|CSTM-ALL|CSTM-00|2020|PCT|46.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131228_01826_0|SrvcGrp|73483|2022|PDM|1720.13|99|0.00|AETNA SUBACUTE III|
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93881_15009_0|SrvcGrp|29081|2022|PDM|448.00|99|0.00|SLEEP STUDIES|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1735.63|99|0.00|HAPA WPA-NWPA 2012-13 ASC 14 W/O REV|
20|FH_F130497_33321_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F38526_0_0|SrvcGrp|701|2022|PDM|2400.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F122687_0_0|SrvcGrp|88494|2022|PDM|5464.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F131254_92211_0|SrvcGrp|14944|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F87716_0_0|SrvcGrp|37260|2022|PDM|5305.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F140893_19720_0|SrvcGrp|43569|2022|PDM|167.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F137558_36116_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143821_60559_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F115057_15601_0|SrvcGrp|109330|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F113410_0_0|SrvcGrp|104006|2022|PDM|7549.00|99|0.00|LAPS ABLATION UTERINE FIBROIDS|
20|FH_F130747_0_0|SrvcGrp|93069|2022|PDM|8843.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F118249_0_0|SrvcGrp|108066|2022|PDM|21000.00|99|0.00|IMPLANT NEUROELECTRODES 23|
20|FH_F140427_0_0|SrvcGrp|104922|2022|PDM|400.00|99|0.00|ENDOLUMINL IVUS OCT C 1ST-CONCUR|
20|FH_F49092_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.20|99|0.00|OP SVCS|
20|FH_F143528_0_0|SrvcGrp|104008|2022|PDM|3452.40|99|0.00|CORRECTION HALUX RIDGUS W IMPLANTS|
20|FH_F129766_48236_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F128237_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|2331.00|99|0.00|AEG 8 (NO REV)|
20|FH_F89779_0_0|SrvcGrp|73008|2022|PDM|1500.00|99|0.00|AEG 10|
20|FH_F135840_0_0|SrvcGrp|75497|2022|PDM|350.00|99|0.00|AEG 10|
20|FH_F130665_67202_0|SrvcGrp|109330|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130711_06716_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130755_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|AEG 4 (NO REV)|
20|FH_F31064_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138024_40509_0|SrvcGrp|73841|2022|PDM|290.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F34182_0_0|SrvcGrp|18791|2022|PDM|10805.00|99|0.00|MS DRG 215|
20|FH_F127071_82435_0|SrvcGrp|74668|2022|PDM|800.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121303_15501_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F134171_72301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F73583_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAPA OHIO FS LAB & RAD|
20|FH_F145641_06902_0|SrvcGrp|33986|2022|PDM|3204.00|99|0.00|CPT 26055|
20|FH_F51364_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS|
20|FH_F138418_51201_0|SrvcGrp|112064|2022|PCT|0.90|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F132952_34994_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121628_19533_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F81861_0_0|SrvcGrp|64103|2022|PDM|1998.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 6|
20|FH_F85353_16407_0|SrvcGrp|63824|2022|PDM|535.73|99|0.00|HAPA WPA-NWPA 2012-13 ASC 214|
20|FH_F68844_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|BOARDER BABY SVCS|
20|FH_F125407_68756_0|SrvcGrp|75506|2022|PCT|0.98|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F43199_0_0|SrvcGrp|12702|2022|PDM|68.25|99|0.00|RN, INTERMITTENT VISIT|
20|FH_F79863_0_0|SrvcGrp|77232|2022|PDM|90.00|99|0.00|AETNA HOME INFUSION S9349|
20|FH_F150165_06032_0|SrvcGrp|113887|2022|PDM|1720.00|99|0.00|REIMPLANT URETER IN BLADDER|
20|FH_F126308_44515_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132922_91302_0|SrvcGrp|90040|2022|PDM|500.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F139723_30066_0|SrvcGrp|113166|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|2911.70|99|0.00|AEG 10 (NO REV)|
20|FH_F135670_01749_0|SrvcGrp|111527|2022|PDM|45.00|99|0.00|HOME INFUSION (HCFA)|
20|FH_F111986_0_0|SrvcGrp|90420|2022|PDM|3605.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F70208_0_0|CSTM-ALL|CSTM-00|2020|PDM|967.00|99|0.00|ASPG V|
20|FH_F51500_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F148549_60523_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63864|2022|PDM|347.13|99|0.00|HAPA WPA-NWPA 2012-13 ASC 119|
20|FH_F132606_0_0|SrvcGrp|80617|2022|PDM|3537.36|99|0.00|ARTHOPLASTY|
20|FH_F83995_16748_0|SrvcGrp|10538|2022|PDM|25.00|99|0.00|NURSING CARE|
20|FH_F110471_02215_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F123638_0_0|SrvcGrp|108041|2022|PDM|927.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F111957_30024_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F127090_45601_0|SrvcGrp|21920|2022|PDM|48.96|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F117382_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134324_26354_0|SrvcGrp|109057|2022|PCT|0.84|99|0.00|CARDIAC STUDIES|
20|FH_F126063_43078_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F76022_0_0|SrvcGrp|4109|2022|PDM|1040.00|99|0.00|ACUTE PSYCH|
20|FH_F138050_52301_0|SrvcGrp|103383|2022|PDM|572.00|99|0.00|BEHAVIORAL HEALTH OBSERVATION|
20|FH_F150147_24541_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F112073_65020_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129638_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F80172_0_0|SrvcGrp|77510|2022|PDM|70.64|99|0.00|AETNA HOME INFUSION MEDICATION|
20|FH_F133972_27103_0|SrvcGrp|112485|2022|PCT|1.00|99|0.00|ALL DRUGS|
20|FH_F110604_0_0|SrvcGrp|90978|2022|PDM|1100.00|99|0.00|INJECTION CERVICAL OR THORACIC TRANSFORAMINAL EPIDURAL|
20|FH_F127529_43230_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PDM|501.00|99|0.00|ASPG II|
20|FH_F111908_07677_0|SrvcGrp|472|2022|PDM|390.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|91.04|99|0.00|HAPA WPA-NWPA 2012-13 ASC 242 W/O REV|
20|FH_F80172_0_0|SrvcGrp|22591|2022|PDM|17.39|99|0.00|IMPLANTED PUMP|
20|FH_F128828_44122_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|2300.00|99|0.00|AEG 6 (NO REV)|
20|FH_F119613_90035_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F89219_0_0|SrvcGrp|20898|2022|PDM|44811.00|99|0.00|MS DRG 246 ONLY|
20|FH_F148668_33177_0|SrvcGrp|472|2022|PDM|505.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150165_06032_0|SrvcGrp|110703|2022|PDM|4848.00|99|0.00|INSERTION OF HEART ELECTRODE|
20|FH_F90232_15126_0|SrvcGrp|14947|2022|PDM|122.85|99|0.00|HOME INFUSION|
20|FH_F112712_63005_0|SrvcGrp|85763|2022|PCT|0.84|99|0.00|ELELYSO|
20|FH_F117401_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F114444_19602_0|SrvcGrp|105370|2022|PDM|45.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MINS(HCFA)|
20|FH_F33639_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|1188.00|99|0.00|AEG 5  (NO REV)|
20|FH_F31111_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F130487_98004_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41776_0_0|CSTM-ALL|CSTM-00|2020|PDM|2811.00|99|0.00|ASPG V|
20|FH_F40834_0_0|SrvcGrp|33366|2022|PDM|787.00|99|0.00|MULTIPLE BIRTH - NICU LEVEL I|
20|FH_F148219_33161_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124026_53188_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F129408_48034_0|SrvcGrp|83857|2022|PDM|550.00|99|0.00|IP HOSPICE SVCS|
20|FH_F122240_0_0|SrvcGrp|108153|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F82173_72712_0|SrvcGrp|16|2022|PDM|2677.00|99|0.00|ACUTE REHABILITATION|
20|FH_F130021_77904_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145537_02061_0|SrvcGrp|88905|2022|PDM|1167.00|99|0.00|PSYCHIATRIC CARE (AGE 0-17)|
20|FH_F72830_0_0|SrvcGrp|20260|2022|PDM|1100.00|99|0.00|ER LEVEL V|
20|FH_F35405_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134939_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.20|99|0.00|GENERAL ACUTE CARE|
20|FH_F123895_52722_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F125817_78613_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110226_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143528_0_0|SrvcGrp|86463|2022|PDM|1914.15|99|0.00|FRACTURE NASAL INFERIOR|
20|FH_F118050_77565_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F91994_0_0|SrvcGrp|44064|2022|PDM|1368.00|99|0.00|CPT 52351|
20|FH_F137457_32216_0|SrvcGrp|12659|2022|PDM|802.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F125028_19061_0|SrvcGrp|17013|2022|PDM|63.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F82955_34266_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F37647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123282_03222_0|SrvcGrp|73742|2022|PDM|8.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F122725_32216_0|SrvcGrp|102982|2022|PDM|104.00|99|0.00|PSYTX WPT W E/M 60 MIN|
20|FH_F86872_15215_0|SrvcGrp|86839|2022|PDM|75.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F33271_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139689_0_0|SrvcGrp|107747|2022|PDM|533.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F113815_0_0|SrvcGrp|72994|2022|PDM|233.00|99|0.00|AEG 3|
20|FH_F88633_32570_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS|
20|FH_F88639_80204_0|SrvcGrp|75506|2022|PCT|1.84|99|0.00|VASCULAR DIAGNOSTIC 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_F62579_0_0|SrvcGrp|41460|2022|PDM|20.00|99|0.00|ENTERAL THERAPY - UNSPECIFIED|
20|FH_F62579_0_0|SrvcGrp|22590|2022|PDM|80.00|99|0.00|PAIN MANAGAMENT - INTERMITTENT|
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ASPG X|
20|FH_F130755_04401_0|SrvcGrp|75505|2022|PCT|0.93|99|0.00|CARDIAC STUDIES|
20|FH_F128235_62626_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125020_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146590_77449_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F116126_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121303_15501_0|SrvcGrp|113175|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - MODERNA|
20|FH_F51015_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|OP SVCS|
20|FH_F45120_0_0|SrvcGrp|29988|2022|PCT|0.21|99|0.00|INTRAOCULAR LENSES|
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)|
20|FH_F120291_0_0|SrvcGrp|108433|2022|PDM|1084.00|99|0.00|HOSPICE SERVICES|
20|FH_F73583_0_0|SrvcGrp|13985|2022|PDM|47.00|99|0.00|OCCUPATIONAL THERAPY|
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_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|405.61|99|0.00|HAPA WPA-NWPA 2012-13 ASC 116 W/O REV|
20|FH_F117208_0_0|SrvcGrp|15473|2022|PDM|3410.00|99|0.00|CPT CODE 42820|
20|FH_F142376_0_0|SrvcGrp|113978|2022|PDM|462.00|99|0.00|NJX AA&/STRD GNCLR NRV BRNCH|
20|FH_F149044_60463_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F85353_16407_0|SrvcGrp|63876|2022|PDM|300.56|99|0.00|HAPA WPA-NWPA 2012-13 ASC 124|
20|FH_F31369_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146103_63851_0|SrvcGrp|88978|2022|PDM|1800.00|99|0.00|VAGINAL DELIVERY|
20|FH_F71647_0_0|SrvcGrp|474|2022|PDM|225.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F120719_27540_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F132899_01002_0|SrvcGrp|88905|2022|PDM|1068.00|99|0.00|PSYCHIATRIC CARE (AGE 0-17)|
20|FH_F90574_22560_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F130017_02302_0|CSTM-ALL|CSTM-00|2020|PDM|4125.54|99|0.00|AEG 5  (NO REV)|
20|FH_F120417_63124_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F130763_0_0|SrvcGrp|27344|2022|PDM|3258.00|99|0.00|OP SURGERY (CPT 42821)|
20|FH_F110343_38139_0|SrvcGrp|86749|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F117206_0_0|SrvcGrp|88487|2022|PDM|1000.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F149021_44514_0|CSTM-ALL|CSTM-00|2020|PDM|380.00|99|0.00|AEG 1 (NO REV)|
20|FH_F149050_22844_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD UE KC"|
20|FH_F95440_0_0|SrvcGrp|73006|2022|PDM|2884.00|99|0.00|AEG 9|
20|FH_F119573_95864_0|SrvcGrp|113194|2022|PCT|1.15|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133972_27103_0|SrvcGrp|112487|2022|PDM|328.00|99|0.00|TX/PRO/DX INJ NEW DRUG ADDON (HCFA)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|78.07|99|0.00|HAPA WPA-NWPA 2012-13 ASC 245 W/O REV|
20|FH_F135657_27612_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F126882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F95631_33705_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114683_0_0|SrvcGrp|80617|2022|PDM|6530.00|99|0.00|ARTHOPLASTY|
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|1405.00|99|0.00|AEG 1 (NO REV)|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU KC"|
20|FH_F133788_74006_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134174_63141_0|CSTM-ALL|CSTM-00|2020|PDM|620.00|99|0.00|CPT 95810 (W/MOD TC) (CMS-1500)|
20|FH_F132969_84003_0|SrvcGrp|106681|2022|PDM|615.00|99|0.00|CONTINUOUS HOSPICE CARE (HCFA)|
20|FH_F120608_19901_0|SrvcGrp|29347|2022|PDM|28.24|99|0.00|HOME HEALTH AIDE|
20|FH_F127090_45601_0|SrvcGrp|110782|2022|PDM|5.00|99|0.00|ROUTINE VENIPUNCTURE|
20|FH_F72543_0_0|SrvcGrp|46112|2022|PDM|50.67|99|0.00|MATERNAL/CHILD HEALTH (ADDITIONAL HOUR)|
20|FH_F122475_37659_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122553_92705_0|SrvcGrp|79280|2022|PDM|522.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F84712_0_0|SrvcGrp|88782|2022|PCT|0.84|99|0.00|TRAUMA/BURN CARE|
20|FH_F84755_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85894_0_0|SrvcGrp|10362|2022|PDM|196.00|99|0.00|CPT CODE 99282|
20|FH_F102200_06416_0|SrvcGrp|86852|2022|PDM|60.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F105143_26062_0|SrvcGrp|73497|2022|PDM|1240.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|538.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F146668_30189_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 4 (NO REV)|
20|FH_F146702_70508_0|SrvcGrp|87536|2022|PDM|340.20|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F146805_45662_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120795_27514_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F115972_92675_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132931_57350_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133398_43204_0|SrvcGrp|73842|2022|PDM|155.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132167_06040_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132928_64114_0|SrvcGrp|48385|2022|PDM|157.00|99|0.00|SPEECH THERAPY|
20|FH_F132293_50595_0|SrvcGrp|103913|2022|PCT|0.90|99|0.00|OP DIALYSIS|
20|FH_F133478_40165_0|SrvcGrp|12280|2022|PCT|0.28|99|0.00|IMPLANTS|
20|FH_F132191_66757_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130657_04614_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 3 (NO REV)|
20|FH_F117199_0_0|SrvcGrp|92597|2022|PDM|1813.93|99|0.00|GI PEGFILGRASTIM|
20|FH_F150939_0_0|SrvcGrp|82737|2022|PCT|0.00|99|0.00|URINALYSIS|
20|FH_F87092_60101_0|SrvcGrp|73002|2022|PDM|3780.00|99|0.00|AEG 7|
20|FH_F125485_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|OP SVCS|
20|FH_F89340_0_0|SrvcGrp|38364|2022|PDM|3300.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F32995_0_0|SrvcGrp|411|2022|PDM|4000.00|99|0.00|OP CARDIAC CATH|
20|FH_F123733_70714_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132810_0_0|SrvcGrp|17016|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132810_0_0|SrvcGrp|86839|2022|PDM|60.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1405.00|99|0.00|AEG 6 (NO REV)|
20|FH_F117465_0_0|SrvcGrp|98580|2022|PDM|6000.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F136378_07104_0|SrvcGrp|73841|2022|PDM|370.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F136423_61254_0|SrvcGrp|89149|2022|PDM|222.00|99|0.00|OP INTENSIVE|
20|FH_F136487_71269_0|SrvcGrp|46903|2022|PDM|625.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F136491_08068_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F118152_20151_0|SrvcGrp|86847|2022|PDM|45.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F93363_63123_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F134011_84102_0|SrvcGrp|14947|2022|PDM|3.00|99|0.00|HOME INFUSION|
20|FH_F137033_87108_0|SrvcGrp|73601|2022|PDM|1350.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F137247_40160_0|SrvcGrp|86723|2022|PDM|271.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F114264_51449_0|SrvcGrp|75506|2022|PCT|0.83|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F114979_77979_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142448_15701_0|SrvcGrp|16750|2022|PDM|85.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142207_62237_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142667_63017_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138607_02760_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 5  (NO REV)|
20|FH_F119023_91406_0|SrvcGrp|14947|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F119090_91502_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F50519_0_0|SrvcGrp|46765|2022|PDM|85.00|99|0.00|CPT CODE 90801 PER VISIT|
20|FH_F66835_0_0|SrvcGrp|12591|2022|PDM|245.00|99|0.00|CD FULL DAY|
20|FH_F110308_0_0|SrvcGrp|73008|2022|PDM|150.00|99|0.00|AEG 10|
20|FH_F107926_0_0|SrvcGrp|86034|2022|PDM|1875.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F70005_0_0|CSTM-ALL|CSTM-00|2020|PDM|2166.00|99|0.00|AEG 7 (NO REV)|
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|3216.00|99|0.00|DEVICE INSERTION|
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PDM|1213.00|99|0.00|AEG 7 (NO REV)|
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147340_0_0|SrvcGrp|34831|2022|PDM|1519.00|99|0.00|HEMODIALYSIS - ULTRAFILTRATION|
20|FH_F31537_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F148880_26807_0|SrvcGrp|48398|2022|PDM|162.00|99|0.00|PT SERVICES|
20|FH_F151099_86429_0|SrvcGrp|3178|2022|PDM|1075.00|99|0.00|ACUTE PSYCH|
20|FH_F151223_73077_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121989_43026_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F38807_0_0|SrvcGrp|17079|2022|PDM|973.00|99|0.00|ASPG VIII|
20|FH_F39895_0_0|SrvcGrp|177|2022|PDM|1298.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F65761_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F110000_0_0|SrvcGrp|29289|2022|PCT|1.00|99|0.00|KS FS 1698 RAD GLOBAL|
20|FH_F73231_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F87054_0_0|SrvcGrp|84932|2022|PDM|2111.00|99|0.00|VITRECTOMY|
20|FH_F142321_29401_0|SrvcGrp|75419|2022|PDM|501.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F138951_41101_0|SrvcGrp|86837|2022|PDM|150.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F85353_16407_0|SrvcGrp|63841|2022|PDM|458.66|99|0.00|HAPA WPA-NWPA 2012-13 ASC 220|
20|FH_F120583_43219_0|SrvcGrp|73701|2022|PDM|35.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F110423_33401_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130329_64114_0|SrvcGrp|43569|2022|PDM|42.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F120384_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F129440_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOSPICE (UHSP)|
20|FH_F135617_52001_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133877_84117_0|SrvcGrp|97703|2022|PDM|93.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F111942_92647_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F63398_0_0|SrvcGrp|1306|2022|PDM|300.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F79743_0_0|SrvcGrp|14187|2022|PCT|0.57|99|0.00|MRI|
20|FH_F149321_44691_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145604_14850_0|SrvcGrp|86849|2022|PDM|70.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F121225_98902_0|SrvcGrp|24750|2022|PCT|0.85|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F133957_84121_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F71669_0_0|SrvcGrp|13778|2022|PDM|754.00|99|0.00|PSYCH/CD|
20|FH_F136318_0_0|SrvcGrp|108484|2022|PDM|796.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F122930_0_0|SrvcGrp|106235|2022|PDM|3463.00|99|0.00|CYPASS|
20|FH_F135622_34471_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F31714_0_0|SrvcGrp|10946|2022|PDM|478.00|99|0.00|EMERGENCY ROOM|
20|FH_F114510_33445_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC|
20|FH_F52713_0_0|SrvcGrp|42782|2022|PDM|240.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F127090_45601_0|SrvcGrp|29075|2022|PDM|40.80|99|0.00|HYDRATION THERAPY|
20|FH_F128833_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F85415_27612_0|SrvcGrp|48394|2022|PDM|31.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F120719_27540_0|SrvcGrp|74005|2022|PDM|4884.00|99|0.00|AETNA PET|
20|FH_F90232_15126_0|SrvcGrp|86834|2022|PDM|14.18|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F125657_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134618_14892_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F143545_78723_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63312_0_0|SrvcGrp|18024|2022|PDM|65.00|99|0.00|NUTRITNAL CNSLNG/DIABETES EDU|
20|FH_F95440_0_0|SrvcGrp|72998|2022|PDM|2730.00|99|0.00|AEG 5|
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54592_0_0|SrvcGrp|33165|2022|PDM|545.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F113645_0_0|SrvcGrp|103552|2022|PDM|1325.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F134489_90305_0|SrvcGrp|73842|2022|PDM|315.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F134508_14072_0|SrvcGrp|76501|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F134451_63670_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|1072.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F70607_0_0|SrvcGrp|12401|2022|PDM|105.45|99|0.00|RN VISIT|
20|FH_F118699_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|AEG 4 (NO REV)|
20|FH_F105145_75075_0|SrvcGrp|98268|2022|PDM|14300.00|99|0.00|HIP ARTHROSCOPY DX|
20|FH_F105145_75075_0|SrvcGrp|33985|2022|PDM|6693.00|99|0.00|CPT 19120|
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F80513_0_0|SrvcGrp|53154|2022|PDM|1483.00|99|0.00|ACUTE MED/SURG SERVICES|
20|FH_F120528_60559_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F127656_06068_0|SrvcGrp|43567|2022|PDM|115.50|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|OP ADULT PSYCHIATRIC PARTIAL HOSP|
20|FH_F115952_44484_0|SrvcGrp|86746|2022|PCT|1.05|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F133583_77074_0|SrvcGrp|86722|2022|PDM|234.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F133471_47901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F46832_0_0|SrvcGrp|16559|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F123763_80130_0|SrvcGrp|73842|2022|PDM|240.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F123820_91316_0|SrvcGrp|75442|2022|PDM|900.00|99|0.00|OBSERVATION - REV 762|
20|FH_F39869_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS|
20|FH_F136386_30901_0|SrvcGrp|20912|2022|PDM|47250.00|99|0.00|MS DRG 236 ONLY|
20|FH_F134147_19342_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137167_71635_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137167_71635_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138108_47130_0|SrvcGrp|73841|2022|PDM|391.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F142448_15701_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F138584_30912_0|SrvcGrp|113400|2022|PDM|900.00|99|0.00|REMOVE JAW JOINT CARTILAGE|
20|FH_F149531_80237_0|SrvcGrp|75419|2022|PDM|515.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F149583_98930_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F149644_91367_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149663_45219_0|CSTM-ALL|CSTM-00|2020|PDM|3821.30|99|0.00|AEG 9 (NO REV)|
20|FH_F119023_91406_0|SrvcGrp|86837|2022|PDM|12.50|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F119023_91406_0|SrvcGrp|86828|2022|PDM|45.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F119023_91406_0|SrvcGrp|19742|2022|PDM|75.00|99|0.00|MID-LINE INSERTION|
20|FH_F147725_06002_0|SrvcGrp|88824|2022|PDM|4000.00|99|0.00|CPT 69631|
20|FH_F69324_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F137815_15501_0|SrvcGrp|86722|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F101945_0_0|SrvcGrp|98404|2022|PDM|2081.00|99|0.00|ARTHROSCOPIC FRACTURE TX|
20|FH_F90876_18447_0|SrvcGrp|63297|2022|PDM|110.25|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F124801_67110_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119838_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F123774_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102041_35010_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F43694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F55694_0_0|SrvcGrp|31038|2022|PDM|40140.00|99|0.00|MS DRG 233-234 ONLY|
20|FH_F116485_17033_0|SrvcGrp|110062|2022|PDM|31.83|99|0.00|FAMILY ADAPTIVE BH TREATMENT 15 MINS|
20|FH_F132988_0_0|SrvcGrp|109834|2022|PDM|4493.01|99|0.00|REPAIR HUMERUS FRACTURE|
20|FH_F132988_0_0|SrvcGrp|100068|2022|PDM|4493.01|99|0.00|REPAIR DEGENERATED KNEECAP|
20|FH_F144828_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F78447_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1406.00|99|0.00|AEG 9 (NO REV)|
20|FH_F137897_0_0|SrvcGrp|107864|2022|PCT|1.00|99|0.00|AETNA INJECTABLES (A & B CODES)|
20|FH_F92212_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|700.00|99|0.00|AEG 10 (NO REV)|
20|FH_F83231_0_0|SrvcGrp|15488|2022|PDM|400.00|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)|
20|FH_F124082_78526_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F146895_28751_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F72863_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F129549_01238_0|SrvcGrp|23683|2022|PDM|55.30|99|0.00|SKILLED NURSING RN|
20|FH_F124178_01604_0|SrvcGrp|76501|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F124227_01230_0|SrvcGrp|471|2022|PDM|624.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F97040_31901_0|SrvcGrp|90854|2022|PDM|2103.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 8 (NO REV)|
20|FH_F136567_94578_0|SrvcGrp|46903|2022|PDM|769.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F136650_72543_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F81832_13827_0|SrvcGrp|43569|2022|PDM|105.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F144039_0_0|SrvcGrp|109766|2022|PDM|2869.00|99|0.00|COVER EYE W/ MEMBRANE|
20|FH_F122610_73139_0|SrvcGrp|13778|2022|PDM|1042.00|99|0.00|PSYCH/CD|
20|FH_F122675_07055_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS APC GROUPED|
20|FH_F42954_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F43693_0_0|SrvcGrp|1306|2022|PDM|257.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F43833_0_0|SrvcGrp|35083|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F134670_95628_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134697_32566_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F134760_32202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136786_25302_0|SrvcGrp|29347|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F136820_65483_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136930_73114_0|SrvcGrp|108818|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F63317_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115206_80923_0|SrvcGrp|12659|2022|PDM|859.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F115631_65201_0|SrvcGrp|72121|2022|PDM|3177.00|99|0.00|ARTHOSCOPY|
20|FH_F116199_75042_0|SrvcGrp|73841|2022|PDM|355.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F116393_07002_0|SrvcGrp|12496|2022|PDM|1502.00|99|0.00|ACUTE REHABILITATION|
20|FH_F41801_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|CHILD PSYCHIATRIC|
20|FH_F42748_0_0|SrvcGrp|109|2022|PDM|650.00|99|0.00|CD - DETOX|
20|FH_F42837_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD AU|
20|FH_F100783_03431_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F109963_0_0|SrvcGrp|72990|2022|PDM|333.00|99|0.00|AEG 1|
20|FH_F133536_0_0|SrvcGrp|41325|2022|PDM|1682.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F139916_0_0|SrvcGrp|86723|2022|PDM|453.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F98361_12065_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F46672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46672_0_0|SrvcGrp|38695|2022|PDM|70.00|99|0.00|DIETICIAN VISIT|
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|871.30|99|0.00|2005 ASPG GROUPER IV|
20|FH_F39825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F138687_77477_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F57953_0_0|SrvcGrp|54243|2022|PDM|500.00|99|0.00|MRI|
20|FH_F91641_0_0|SrvcGrp|91461|2022|PDM|2705.04|99|0.00|INTRAOCULAR LENS PROSTHESIS|
20|FH_F106500_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114326_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|472.90|99|0.00|HAPA WPA-NWPA 2012-13 ASC 304 W/O REV|
20|FH_F72606_0_0|SrvcGrp|50362|2022|PDM|2500.00|99|0.00|ACUTE PSYCH|
20|FH_F132268_07060_0|SrvcGrp|89503|2022|PDM|31.61|99|0.00|GAIT TRAINING THERAPY|
20|FH_F122119_62675_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144989_07701_0|SrvcGrp|53145|2022|PCT|1.00|99|0.00|SOCIAL WORKER|
20|FH_F135376_83440_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135388_48601_0|SrvcGrp|107353|2022|PDM|754.04|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)|
20|FH_F135587_37334_0|SrvcGrp|473|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F135590_84066_0|SrvcGrp|471|2022|PDM|478.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F135608_19348_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F91764_93710_0|SrvcGrp|113227|2022|PCT|2.12|99|0.00|COVID-19 NFCT DS VIR RESP RNA 3 TRGT|
20|FH_F135943_76051_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136042_90066_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F131132_44077_0|SrvcGrp|17100|2022|PDM|1186.00|99|0.00|SKILLED NURSING|
20|FH_F116464_13088_0|SrvcGrp|73842|2022|PDM|135.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F116527_70443_0|SrvcGrp|73606|2022|PDM|750.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F133468_74873_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F138543_60130_0|SrvcGrp|108484|2022|PDM|561.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139350_70056_0|SrvcGrp|82981|2022|PDM|183.73|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F79443_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135315_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F56274_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F49444_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151060_02493_0|SrvcGrp|108484|2022|PDM|440.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F151142_35406_0|CSTM-ALL|CSTM-00|2020|PDM|851.00|99|0.00|AEG 3 (NO REV)|
20|FH_F151144_35801_0|SrvcGrp|92545|2022|PDM|915.43|99|0.00|FOLLOW-UP SURGERY OF EYE|
20|FH_F115990_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|742.00|99|0.00|AEG 5  (NO REV)|
20|FH_F37823_0_0|SrvcGrp|27446|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2504030 GLOBAL (HCFA)|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|267.97|99|0.00|DELAWARE VALLEY- ASC 214|
20|FH_F66711_0_0|SrvcGrp|43428|2022|PDM|25.00|99|0.00|RN HOURLY|
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|586.00|99|0.00|AEG 3 (NO REV)|
20|FH_F91818_02828_0|SrvcGrp|108484|2022|PDM|388.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F116323_0_0|SrvcGrp|35669|2022|PDM|12868.00|99|0.00|CPT 63650|
20|FH_F34317_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|IMPLANTS|
20|FH_F117299_0_0|SrvcGrp|104021|2022|PDM|2809.00|99|0.00|CYSTOSCOPY PROSTATIC IMP 1-3|
20|FH_F71365_0_0|SrvcGrp|66482|2022|PDM|35.00|99|0.00|HOME HEALTH AID|
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114916_30309_0|SrvcGrp|105634|2022|PDM|10000.00|99|0.00|KNEE JOINT LINING|
20|FH_F114916_30309_0|SrvcGrp|92369|2022|PDM|2800.00|99|0.00|REPAIR OF ANKLE LIGAMENTS|
20|FH_F103880_85014_0|SrvcGrp|73701|2022|PDM|25.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F117623_0_0|CSTM-ALL|CSTM-00|2020|PDM|27.00|99|0.00|EXPOSE BEHAV TREATMENT ADDL|
20|FH_F33856_0_0|SrvcGrp|117|2022|PCT|0.85|99|0.00|OP LAPAROSCOPIC SVCS|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER KD|
20|FH_F126600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141207_0_0|SrvcGrp|95661|2022|PDM|485.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F143457_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F132988_0_0|SrvcGrp|100012|2022|PDM|4493.01|99|0.00|REPAIR SHOULDER CAPSULE|
20|FH_F132988_0_0|SrvcGrp|92368|2022|PDM|2057.62|99|0.00|REPAIR OF LEG TENDON|
20|FH_F88933_0_0|SrvcGrp|87524|2022|PDM|5065.00|99|0.00|AETNA HIP ARTHOSCOPY|
20|FH_F88933_0_0|SrvcGrp|87525|2022|PDM|5065.00|99|0.00|AETNA NEUROSTIMULATOR TRIAL|
20|FH_F126345_0_0|SrvcGrp|101524|2022|PDM|1480.00|99|0.00|MISSED ABORTION SECOND TRIMESTER|
20|FH_F114365_73162_0|SrvcGrp|76501|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F114389_50131_0|SrvcGrp|88825|2022|PDM|48.28|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F69504_0_0|SrvcGrp|48398|2022|PDM|23.00|99|0.00|PT SERVICES|
20|FH_F124180_0_0|SrvcGrp|57864|2022|PDM|1900.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F124129_33603_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124140_15214_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146794_79601_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146715_34240_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
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_F124222_92625_0|SrvcGrp|75419|2022|PDM|900.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F150910_0_0|SrvcGrp|67068|2022|PDM|10500.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F136614_43512_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136658_50401_0|SrvcGrp|75419|2022|PDM|325.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F122610_73139_0|SrvcGrp|72930|2022|PDM|2316.00|99|0.00|PET SCANS|
20|FH_F43653_0_0|CSTM-ALL|CSTM-00|2020|PDM|845.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134727_30650_0|SrvcGrp|103913|2022|PCT|1.43|99|0.00|OP DIALYSIS|
20|FH_F134791_98034_0|SrvcGrp|48385|2022|PDM|283.00|99|0.00|SPEECH THERAPY|
20|FH_F136778_62034_0|CSTM-ALL|CSTM-00|2020|PDM|3095.00|99|0.00|AEG 3 (NO REV)|
20|FH_F136914_64081_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113713_17013_0|SrvcGrp|86871|2022|PDM|45.00|99|0.00|AETNA PSYTX PT & FAMILY 30 MINS (MOD TD)(HCFA)|
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|577.50|99|0.00|AEG 1 (NO REV)|
20|FH_F39622_0_0|SrvcGrp|49|2022|PDM|12500.00|99|0.00|HIP REPLACEMENT|
20|FH_F43503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F43503_0_0|SrvcGrp|38|2022|PDM|2369.00|99|0.00|NORMAL DELIVERY|
20|FH_F46752_0_0|SrvcGrp|41601|2022|PCT|1.15|99|0.00|IMMUNE GLOBULIN|
20|FH_F115145_83201_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116383_63026_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F147519_52627_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147519_52627_0|SrvcGrp|73605|2022|PDM|981.14|99|0.00|AETNA ACUTE PSYCH|
20|FH_F147519_52627_0|CSTM-ALL|CSTM-00|2020|PDM|1202.72|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F147394_14031_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F147725_06002_0|SrvcGrp|86233|2022|PDM|14061.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F42153_0_0|SrvcGrp|16|2022|PDM|1127.00|99|0.00|ACUTE REHABILITATION|
20|FH_F42694_0_0|SrvcGrp|26180|2022|PDM|80.00|99|0.00|ST|
20|FH_F66880_25301_0|CSTM-ALL|CSTM-00|2020|PDM|1731.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91975_0_0|SrvcGrp|91862|2022|PDM|452.00|99|0.00|COLONOSCOPY PROCEDURES 2|
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PDM|3946.00|99|0.00|AEG 9 (NO REV)|
20|FH_F31754_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134087_0_0|SrvcGrp|11669|2022|PDM|2064.00|99|0.00|OP SURG|
20|FH_F120612_23314_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F37850_0_0|SrvcGrp|27568|2022|PCT|0.65|99|0.00|BLOOD PRODUCTS|
20|FH_F80511_0_0|SrvcGrp|74603|2022|PCT|0.57|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)|
20|FH_F54552_0_0|SrvcGrp|17002|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS|
20|FH_F113585_20155_0|SrvcGrp|14948|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138879_17837_0|CSTM-ALL|CSTM-00|2020|PCT|4.85|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F138936_01040_0|SrvcGrp|109220|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F138665_53186_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|1443.00|99|0.00|2006 MEDICARE ASPG VII|
20|FH_F119544_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|532.51|99|0.00|AEG 2 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|254.70|99|0.00|HAPA WPA-NWPA 2012-13 ASC 233 W/O REV|
20|FH_F151427_04106_0|SrvcGrp|109019|2022|PCT|1.00|99|0.00|RADIOLOGY|
20|FH_F151503_30067_0|SrvcGrp|109792|2022|PDM|4606.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F151503_30067_0|SrvcGrp|98523|2022|PDM|2090.00|99|0.00|CAPSULOTOMY|
20|FH_F151511_14094_0|CSTM-ALL|CSTM-00|2020|PDM|3062.21|99|0.00|AEG 7 (NO REV)|
20|FH_F132163_17601_0|SrvcGrp|100859|2022|PDM|223.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F132258_45404_0|SrvcGrp|88620|2022|PDM|85.86|99|0.00|SKILLED NURSING RN|
20|FH_F135489_70508_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135572_89106_0|SrvcGrp|14944|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F135572_89106_0|SrvcGrp|24761|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F135584_10977_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F91764_93710_0|CSTM-ALL|CSTM-00|2020|PDM|5600.00|99|0.00|AEG 6 (NO REV)|
20|FH_F135924_02906_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F136031_62220_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100880_67735_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130547_85712_0|SrvcGrp|93269|2022|PDM|6.93|99|0.00|LINEZOLID INJECTION|
20|FH_F116431_76104_0|SrvcGrp|88877|2022|PDM|3736.00|99|0.00|AETNA MATERNITY CARE (C-SECTION)|
20|FH_F116527_70443_0|SrvcGrp|72998|2022|PDM|1300.00|99|0.00|AEG 5|
20|FH_F121701_70420_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F121763_07202_0|SrvcGrp|108724|2022|PDM|193.00|99|0.00|MENTAL HEALTH PARTIAL HOSP|
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|1170.00|99|0.00|AEG 8 (NO REV)|
20|FH_F75205_0_0|SrvcGrp|45966|2022|PDM|140.00|99|0.00|SOCIAL WORKER|
20|FH_F111301_33122_0|SrvcGrp|110428|2022|PCT|0.84|99|0.00|LABORATORY SERVICES|
20|FH_F111880_50003_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F141651_0_0|SrvcGrp|91880|2022|PDM|4400.00|99|0.00|OSSEOINTEGRATED IMPLANT|
20|FH_F141651_0_0|SrvcGrp|84910|2022|PDM|3850.00|99|0.00|ENDOSCOPY|
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|816.00|99|0.00|AEG 5  (NO REV)|
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|459.00|99|0.00|ASPG III|
20|FH_F51272_0_0|SrvcGrp|47583|2022|PCT|0.75|99|0.00|HOSPICE SVCS|
20|FH_F131000_0_0|SrvcGrp|39909|2022|PDM|2494.00|99|0.00|PARTIAL MASTECTOMY|
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PDM|2643.00|99|0.00|AEG 7 (NO REV)|
20|FH_F112092_46845_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F112166_72143_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F87557_33309_0|SrvcGrp|19742|2022|PDM|55.00|99|0.00|MID-LINE INSERTION|
20|FH_F126853_19053_0|SrvcGrp|27968|2022|PDM|25.00|99|0.00|SKILLED NURSING LPN|
20|FH_F130206_78209_0|SrvcGrp|90854|2022|PDM|721.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F129240_10028_0|SrvcGrp|24750|2022|PDM|40.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F129151_43950_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132791_44122_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134202_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS|
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|1361.00|99|0.00|AEG 1 (NO REV)|
20|FH_F119413_95123_0|SrvcGrp|74668|2022|PDM|550.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148548_37909_0|CSTM-ALL|CSTM-00|2020|PDM|2772.00|99|0.00|AEG 7 (NO REV)|
20|FH_F118004_74133_0|SrvcGrp|92760|2022|PCT|1.38|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|1954.00|99|0.00|AEG 9 (NO REV)|
20|FH_F144668_62526_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148662_01583_0|SrvcGrp|104328|2022|PCT|0.85|99|0.00|PRESCRIPTION DRUG|
20|FH_F126815_02118_0|SrvcGrp|105465|2022|PCT|0.55|99|0.00|AETNA THERAPIES|
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_F120390_91316_0|SrvcGrp|75419|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1307.00|99|0.00|AEG 6 (NO REV)|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER RRKC|
20|FH_F122970_97222_0|SrvcGrp|104079|2022|PCT|1.25|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F87596_33609_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F38161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117872_33462_0|SrvcGrp|23587|2022|PDM|727.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F141827_80003_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F95482_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F71929_15090_0|SrvcGrp|81878|2022|PCT|1.00|99|0.00|RADIOLOGY W/ REV/HCPC|
20|FH_F118004_74133_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F43018_0_0|SrvcGrp|11201|2022|PDM|4515.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F133142_19076_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132934_63005_0|SrvcGrp|31974|2022|PCT|0.70|99|0.00|CRANIOTOMY MS DRG 023-027, 955 ONLY|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149028_0_0|SrvcGrp|82981|2022|PDM|158.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F120707_0_0|SrvcGrp|103913|2022|PCT|0.89|99|0.00|OP DIALYSIS|
20|FH_F37566_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69063_0_0|SrvcGrp|43955|2022|PDM|90.00|99|0.00|NURSING CARE|
20|FH_F126626_80906_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F45977_0_0|SrvcGrp|41103|2022|PDM|80.00|99|0.00|NURSING CARE|
20|FH_F97542_32960_0|SrvcGrp|73461|2022|PDM|7803.00|99|0.00|AETNA NICU IV|
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|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_F115274_15235_0|SrvcGrp|87799|2022|PDM|135.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F115315_43011_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117875_70601_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128893_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F34706_0_0|SrvcGrp|2117|2022|PDM|8752.00|99|0.00|DRG 122 CIRCULATORY DISORDER W/ACUTE MYOCARDIAL INFARCTION|
20|FH_F148060_01001_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F76662_0_0|SrvcGrp|59426|2022|PDM|85.00|99|0.00|PT|
20|FH_F148907_01810_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F119007_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F126858_43113_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F133287_40215_0|SrvcGrp|73605|2022|PDM|947.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F78385_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139607_0_0|SrvcGrp|81571|2022|PDM|2381.00|99|0.00|NASAL ENDOSCOPY W/ SINUS OSTIA DILATION|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F113324_17055_0|SrvcGrp|105265|2022|PDM|765.00|99|0.00|HEMODIALYSIS|
20|FH_F133009_19038_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F97562_29803_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F133327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 5  (NO REV)|
20|FH_F144769_0_0|SrvcGrp|74586|2022|PCT|0.21|99|0.00|AETNA OP HIGH COST DRUGS|
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 3 (NO REV)|
20|FH_F81151_16801_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F135714_01922_0|SrvcGrp|84185|2022|PDM|145.00|99|0.00|RESPITE CARE|
20|FH_F128605_20910_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F67639_0_0|SrvcGrp|63465|2022|PDM|800.00|99|0.00|CPT 52214|
20|FH_F146221_72560_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149840_80002_0|SrvcGrp|90341|2022|PDM|125.00|99|0.00|SKILLED NURSING LPN (HCFA)|
20|FH_F144528_48081_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|1688.00|99|0.00|AEG 9 (NO REV)|
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97201_15068_0|SrvcGrp|46605|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F32686_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F141411_0_0|SrvcGrp|33985|2022|PDM|10000.00|99|0.00|CPT 19120|
20|FH_F38725_0_0|CSTM-ALL|CSTM-00|2020|PDM|1159.00|99|0.00|ASPG VIII|
20|FH_F113264_71860_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F125415_64701_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F91255_19401_0|SrvcGrp|10944|2022|PDM|845.00|99|0.00|EMERGENCY ROOM|
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|OP SVCS|
20|FH_F132543_79549_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS|
20|FH_F128246_0_0|SrvcGrp|79795|2022|PDM|1176.00|99|0.00|EYE/OCULAR ADNEXA SURGERY|
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117087_0_0|SrvcGrp|107179|2022|PDM|2494.00|99|0.00|REPAIR EARDRUM STRUCTURES|
20|FH_F97201_15068_0|SrvcGrp|48396|2022|PDM|82.50|99|0.00|OT SERVICES|
20|FH_F119437_0_0|SrvcGrp|75481|2022|PDM|1200.00|99|0.00|AEG 2|
20|FH_F132080_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133473_21702_0|SrvcGrp|23683|2022|PDM|58.35|99|0.00|SKILLED NURSING RN|
20|FH_F133021_00910_0|SrvcGrp|112274|2022|PCT|1.00|99|0.00|RADIOLOGY|
20|FH_F101853_77840_0|SrvcGrp|43524|2022|PDM|185.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F89112_16509_0|SrvcGrp|81779|2022|PCT|1.85|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F35176_0_0|SrvcGrp|9827|2022|PDM|85.50|99|0.00|RN INTERMITTENT VISIT|
20|FH_F68719_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37554_0_0|SrvcGrp|27005|2022|PDM|700.00|99|0.00|MRI W/CONTRAST|
20|FH_F149979_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|133.93|99|0.00|HAPA WPA-NWPA 2012-13 ASC 239 W/O REV|
20|FH_F148760_12953_0|SrvcGrp|88621|2022|PDM|137.00|99|0.00|SKILLED NURSING LPN|
20|FH_F148761_33311_0|SrvcGrp|9539|2022|PDM|360.00|99|0.00|SUBACUTE CARE|
20|FH_F139444_32966_0|SrvcGrp|46903|2022|PDM|800.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F150739_44060_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150769_02302_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F94643_90501_0|SrvcGrp|22589|2022|PDM|50.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F74844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128715_71201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F108260_63141_0|SrvcGrp|48385|2022|PDM|83.00|99|0.00|SPEECH THERAPY|
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.00|99|0.00|AEG 2 (NO REV)|
20|FH_F151000_20707_0|SrvcGrp|111929|2022|PDM|15.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F39443_0_0|SrvcGrp|12253|2022|PDM|2750.00|99|0.00|LAPAROSCOPIC APPENDECTOMY|
20|FH_F150931_65201_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38742_0_0|SrvcGrp|28931|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MOD RR (A & K CODES)|
20|FH_F136592_0_0|SrvcGrp|107878|2022|PDM|1990.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F133087_61107_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F38742_0_0|SrvcGrp|23683|2022|PDM|90.00|99|0.00|SKILLED NURSING RN|
20|FH_F141267_0_0|SrvcGrp|104229|2022|PDM|172.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F37267_0_0|SrvcGrp|26001|2022|PDM|94.50|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F111040_30033_0|CSTM-ALL|CSTM-00|2020|PDM|4818.00|99|0.00|AETNA PATIENT TRANSFER  (<48 HRS)|
20|FH_F147082_02359_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F90455_0_0|SrvcGrp|9263|2022|PDM|151.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F147422_84121_0|SrvcGrp|74668|2022|PDM|244.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F109251_62269_0|SrvcGrp|48398|2022|PDM|91.56|99|0.00|PT SERVICES|
20|FH_F131449_19073_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124714_64081_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138017_73129_0|SrvcGrp|10364|2022|PDM|1376.00|99|0.00|CPT CODE 99284|
20|FH_F132818_24701_0|SrvcGrp|67944|2022|PDM|348.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F40899_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F139990_71418_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F44279_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F90817_0_0|SrvcGrp|91032|2022|PDM|2256.00|99|0.00|AQUEOUS SHUNT EYE W/GRAFT (HCFA)|
20|FH_F36170_0_0|SrvcGrp|12290|2022|PDM|618.00|99|0.00|DETOXIFICATION|
20|FH_F114188_15205_0|SrvcGrp|48394|2022|PDM|49.67|99|0.00|SKILLED NURSING SERVICES|
20|FH_F137986_0_0|SrvcGrp|113167|2022|PDM|1436.00|99|0.00|PERCUTANEOUS SKELETAL FIX|
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|984.00|99|0.00|AEG 6 (NO REV)|
20|FH_F111266_30339_0|SrvcGrp|86843|2022|PDM|25.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F141511_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F99380_90503_0|SrvcGrp|11000|2022|PCT|0.85|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F145567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F110963_30535_0|SrvcGrp|48394|2022|PDM|84.96|99|0.00|SKILLED NURSING SERVICES|
20|FH_F110783_93013_0|SrvcGrp|86828|2022|PDM|45.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F97184_26101_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F40899_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F41802_0_0|SrvcGrp|22018|2022|PDM|40.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F97260_06111_0|SrvcGrp|73602|2022|PDM|2496.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD UEKF RATE|
20|FH_F124470_90025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F139967_37205_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124433_77338_0|SrvcGrp|73841|2022|PDM|435.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F112794_01040_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F151699_01752_0|SrvcGrp|111742|2022|PCT|1.00|99|0.00|ADULT ENTERAL FORMULA|
20|FH_F99920_63141_0|SrvcGrp|93098|2022|PDM|110.00|99|0.00|HOSPICE CARE|
20|FH_F116806_0_0|SrvcGrp|107089|2022|PDM|1149.97|99|0.00|ARTHROSCOPY TEMPOROMANDIBULAR JOINT|
20|FH_F35765_32547_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F35768_32827_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS|
20|FH_F146266_0_0|SrvcGrp|67065|2022|PDM|17971.00|99|0.00|CERVICAL SURGERY|
20|FH_F35475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F48695_0_0|SrvcGrp|474|2022|PDM|1230.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F128977_0_0|SrvcGrp|82981|2022|PDM|265.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F149579_95815_0|SrvcGrp|115678|2022|PDM|82.27|99|0.00|CHRONIC CARE MGMT STAFF 1ST 30 MINS (HCFA)|
20|FH_F124287_43160_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109515_15301_0|SrvcGrp|73605|2022|PDM|1167.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F36343_0_0|SrvcGrp|10567|2022|PDM|106.25|99|0.00|HOME INFUSION|
20|FH_F124316_28112_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150982_0_0|SrvcGrp|33965|2022|PDM|2527.00|99|0.00|CPT 58552|
20|FH_F131392_17004_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|869.00|99|0.00|AEG 10 (NO REV)|
20|FH_F38999_0_0|SrvcGrp|9533|2022|PDM|1811.00|99|0.00|ONCOLOGY|
20|FH_F148926_28803_0|SrvcGrp|74668|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|593.83|99|0.00|SALLY BALIN,999182,ASC 301|
20|FH_F118907_0_0|SrvcGrp|107897|2022|PDM|508.10|99|0.00|SLEEP STUDIES (HCFA)|
20|FH_F110724_33064_0|SrvcGrp|104144|2022|PDM|165.00|99|0.00|INTENSIVE CHEMICAL DEPENDENCY PROGRAM|
20|FH_F136541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|OP SVCS|
20|FH_F125656_92868_0|SrvcGrp|14947|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F40530_0_0|SrvcGrp|1171|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F132160_0_0|SrvcGrp|84279|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F139878_33161_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143347_16001_0|SrvcGrp|79999|2022|PCT|2.00|99|0.00|AETNA ECHO EXAM|
20|FH_F143348_16214_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F143351_21157_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F143407_75021_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143471_02895_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143488_84770_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F143536_47546_0|SrvcGrp|100273|2022|PCT|1.00|99|0.00|MEASLES MUMPS&RUBELLA VAC LI|
20|FH_F90559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F93740_0_0|SrvcGrp|91593|2022|PDM|4800.00|99|0.00|PACEMAKER/ACID|
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|521.00|99|0.00|AEG 10 (NO REV)|
20|FH_F102522_0_0|SrvcGrp|98691|2022|PDM|115.36|99|0.00|ADDITION TO LOWER EXTREMITY|
20|FH_F131067_57105_0|SrvcGrp|75506|2022|PCT|1.70|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F47600_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F116698_07470_0|SrvcGrp|86847|2022|PDM|39.90|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F116698_07470_0|SrvcGrp|29077|2022|PDM|210.00|99|0.00|HOME TRANSFUSION|
20|FH_F116699_46347_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F116756_77477_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F83292_0_0|SrvcGrp|69525|2022|PCT|4.00|99|0.00|BARNESVILLE CARDIO DX @ 100% W/ OP SURG|
20|FH_F120895_19460_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120921_75835_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F120961_66615_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F120974_27607_0|SrvcGrp|473|2022|PDM|605.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F113649_01752_0|SrvcGrp|86840|2022|PDM|47.50|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F84411_32063_0|SrvcGrp|131|2022|PCT|0.69|99|0.00|PACEMAKER DEVICE|
20|FH_F39266_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F40517_0_0|SrvcGrp|3327|2022|PDM|167.24|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F146284_0_0|CSTM-ALL|CSTM-00|2020|PDM|2617.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38431_0_0|SrvcGrp|23014|2022|PDM|650.00|99|0.00|V5245|
20|FH_F47130_0_0|SrvcGrp|3142|2022|PDM|2270.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F137457_32216_0|SrvcGrp|89417|2022|PDM|471.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F55532_0_0|SrvcGrp|3259|2022|PDM|950.00|99|0.00|ACUTE REHABILITATION|
20|FH_F130514_33316_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91622_0_0|SrvcGrp|8950|2022|PDM|2900.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 6 (NO REV)|
20|FH_F37756_0_0|SrvcGrp|18920|2022|PDM|5237.00|99|0.00|MS DRG 766 REPLACEMENT CODES 785, 788|
20|FH_F128878_11203_0|SrvcGrp|91070|2022|PDM|350.00|99|0.00|AETNA MH CRISIS INTERVENTION (HCFA)|
20|FH_F116188_72211_0|SrvcGrp|89417|2022|PDM|468.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F143528_0_0|SrvcGrp|11663|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.97|99|0.00|CPT 95810 (W/MOD TC)|
20|FH_F66687_0_0|SrvcGrp|62294|2022|PDM|31557.00|99|0.00|TRANSLUMINAL STENT PLACEMENT|
20|FH_F110925_01104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148356_18104_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F66481_0_0|SrvcGrp|42971|2022|PDM|95.00|99|0.00|SKN RN|
20|FH_F128401_44615_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F38357_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F93332_0_0|SrvcGrp|93078|2022|PDM|7416.00|99|0.00|CERVICAL ARTHRODESIS (HCFA)|
20|FH_F123473_65109_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148166_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F78603_0_0|SrvcGrp|21108|2022|PDM|25793.82|99|0.00|MS DRG 243 ONLY|
20|FH_F124026_53188_0|SrvcGrp|46903|2022|PDM|756.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F56152_0_0|SrvcGrp|3066|2022|PCT|0.50|99|0.00|HIGH-COST DRUGS|
20|FH_F128276_66441_0|SrvcGrp|90854|2022|PDM|320.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F72765_0_0|SrvcGrp|12118|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F86752_0_0|SrvcGrp|75491|2022|PDM|1283.00|99|0.00|AEG 7|
20|FH_F124899_45246_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F136756_0_0|SrvcGrp|112978|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F116311_02657_0|SrvcGrp|106722|2022|PDM|792.00|99|0.00|IP REHAB|
20|FH_F41021_0_0|SrvcGrp|17071|2022|PDM|3412.00|99|0.00|ASPG IV|
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.00|99|0.00|ASPG VII|
20|FH_F131254_92211_0|SrvcGrp|16750|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F90654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F125028_19061_0|SrvcGrp|17014|2022|PDM|63.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F135897_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)|
20|FH_F135173_06519_0|SrvcGrp|79280|2022|PDM|714.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F33451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F118050_77565_0|SrvcGrp|86723|2022|PDM|375.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F129653_0_0|SrvcGrp|109220|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
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_F151562_26003_0|SrvcGrp|80918|2022|PDM|110.00|99|0.00|RESPITE CARE|
20|FH_F40834_0_0|SrvcGrp|359|2022|PDM|787.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F117378_16148_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F125966_68776_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147164_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.90|99|0.00|OP SVCS|
20|FH_F114963_62062_0|SrvcGrp|48398|2022|PDM|131.00|99|0.00|PT SERVICES|
20|FH_F109581_0_0|SrvcGrp|75483|2022|PDM|975.00|99|0.00|AEG 3|
20|FH_F86332_75081_0|SrvcGrp|84343|2022|PCT|1.00|99|0.00|AETNA DRUGS/AGENTS/INJ DRUG|
20|FH_F116341_12180_0|CSTM-ALL|CSTM-00|2020|PDM|173.00|99|0.00|NEW PATIENT VISIT|
20|FH_F110102_0_0|SrvcGrp|104132|2022|PDM|650.00|99|0.00|INPATIENT PSYCH|
20|FH_F37659_0_0|SrvcGrp|8950|2022|PDM|2305.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F73847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F77066_0_0|SrvcGrp|13367|2022|PDM|1500.00|99|0.00|ICU/CCU|
20|FH_F141587_40242_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F56136_0_0|SrvcGrp|43939|2022|PCT|0.92|99|0.00|SLEEP STUDIES|
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|10000.00|99|0.00|BRACHYTHERAPY SVCS|
20|FH_F122433_0_0|SrvcGrp|77461|2022|PDM|1350.00|99|0.00|CPT 52356|
20|FH_F134876_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F42999_0_0|SrvcGrp|10542|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151539_64014_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F122725_32216_0|SrvcGrp|104802|2022|PDM|32.00|99|0.00|PROSTHETIC TRAINING|
20|FH_F57073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG CV SURGERY|
20|FH_F143539_0_0|SrvcGrp|95819|2022|PDM|6427.00|99|0.00|GONIOTOMY|
20|FH_F143539_0_0|SrvcGrp|109760|2022|PDM|6427.00|99|0.00|TRANSLUM DIL EYE CANAL|
20|FH_F119795_0_0|SrvcGrp|92820|2022|PDM|7263.00|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY|
20|FH_F86851_0_0|SrvcGrp|84975|2022|PDM|495.00|99|0.00|CPT 44360|
20|FH_F89340_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F89495_0_0|SrvcGrp|16719|2022|PCT|0.45|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F130901_68970_0|SrvcGrp|109057|2022|PCT|0.98|99|0.00|CARDIAC STUDIES|
20|FH_F81861_0_0|SrvcGrp|64102|2022|PDM|2073.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 13|
20|FH_F49996_0_0|SrvcGrp|30076|2022|PCT|1.00|99|0.00|IMPLANTS, PROSTHETICS, OR SUPPLIES|
20|FH_F48588_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F85651_33549_0|SrvcGrp|66261|2022|PCT|1.10|99|0.00|E&M AND PREVENTIVE CODES|
20|FH_F127343_0_0|SrvcGrp|110675|2022|PDM|11480.00|99|0.00|NERVOUS SYSTEM|
20|FH_F132716_60062_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F85212_71075_0|SrvcGrp|73601|2022|PDM|1900.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F110503_10016_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F87812_33919_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138951_41101_0|SrvcGrp|86853|2022|PDM|15.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F133957_84121_0|SrvcGrp|30609|2022|PDM|630.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F133943_01606_0|SrvcGrp|87910|2022|PCT|1.00|99|0.00|VANCOMYCIN HCL INJECT 500MG|
20|FH_F138050_52301_0|CSTM-ALL|CSTM-00|2020|PDM|1536.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118123_67226_0|SrvcGrp|73701|2022|PDM|37.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F143620_81504_0|SrvcGrp|48398|2022|PDM|120.00|99|0.00|PT SERVICES|
20|FH_F127148_63011_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113276_38506_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F116473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|AEG 5  (NO REV)|
20|FH_F138951_41101_0|SrvcGrp|29075|2022|PDM|35.00|99|0.00|HYDRATION THERAPY|
20|FH_F87571_0_0|SrvcGrp|3178|2022|PDM|550.00|99|0.00|ACUTE PSYCH|
20|FH_F149139_07522_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F110305_70403_0|SrvcGrp|26001|2022|PDM|155.37|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F150141_63103_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F145667_01905_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F120930_0_0|SrvcGrp|78096|2022|PDM|2000.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F51613_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132822_95125_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F135670_01749_0|SrvcGrp|86837|2022|PDM|12.50|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F85995_64111_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS DEFAULT SHAWNEE MISSION|
20|FH_F86112_63501_0|SrvcGrp|76257|2022|PCT|0.47|99|0.00|CARDIAC STUDIES|
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|671.00|99|0.00|AEG 1 (NO REV)|
20|FH_F134593_60007_0|SrvcGrp|86838|2022|PDM|12.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|3501.00|99|0.00|AEG 4 (NO REV)|
20|FH_F149339_44147_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135670_01749_0|SrvcGrp|99037|2022|PDM|48.00|99|0.00|ANTIBIOTIC Q6H (HCFA)|
20|FH_F79863_0_0|SrvcGrp|77224|2022|PDM|130.00|99|0.00|AETNA HOME INFUSION S5521|
20|FH_F87775_15106_0|SrvcGrp|24745|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F134347_60630_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133585_0_0|SrvcGrp|112385|2022|PDM|51.00|99|0.00|US GUID VASC ACSS SITE PERM|
20|FH_F120408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F148439_0_0|SrvcGrp|73485|2022|PDM|1500.00|99|0.00|AETNA REHAB|
20|FH_F95631_33705_0|SrvcGrp|73559|2022|PDM|16267.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F148546_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|2105.00|99|0.00|AEG 7 (NO REV)|
20|FH_F147962_85008_0|SrvcGrp|115651|2022|PDM|5571.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F138951_41101_0|SrvcGrp|17015|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138250_64145_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133801_87107_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118123_67226_0|SrvcGrp|43569|2022|PDM|42.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F79743_0_0|CSTM-ALL|CSTM-00|2020|PDM|1629.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F132883_31602_0|SrvcGrp|86839|2022|PDM|20.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F132883_31602_0|SrvcGrp|112132|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F127090_45601_0|SrvcGrp|53987|2022|PCT|1.00|99|0.00|PHOTOTHERAPY|
20|FH_F149245_78576_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145604_14850_0|SrvcGrp|86843|2022|PDM|85.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F119829_83221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149259_64050_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111986_0_0|SrvcGrp|92369|2022|PDM|1854.00|99|0.00|REPAIR OF ANKLE LIGAMENTS|
20|FH_F132707_83716_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|1850.00|99|0.00|AEG 3 (NO REV)|
20|FH_F145641_06902_0|SrvcGrp|96543|2022|PDM|3697.00|99|0.00|REVISION OF CALF TENDON|
20|FH_F120555_68405_0|SrvcGrp|471|2022|PDM|530.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F73084_0_0|SrvcGrp|68988|2022|PDM|72.00|99|0.00|ST VISIT|
20|FH_F134492_85201_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F122526_22203_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F84712_0_0|SrvcGrp|82761|2022|PDM|32.00|99|0.00|AUTOMATED WITHOUT MICRO|
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 7 (NO REV)|
20|FH_F86836_0_0|SrvcGrp|11258|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|171.60|99|0.00|HAPA WPA-NWPA 2012-13 ASC 129 W/O REV|
20|FH_F78344_0_0|SrvcGrp|26001|2022|PDM|175.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F101100_50314_0|SrvcGrp|98021|2022|PCT|1.15|99|0.00|AETNA OP AMFS DEFAULT W/O REV 901,905-906,944-945|
20|FH_F115903_43560_0|SrvcGrp|89149|2022|PDM|421.00|99|0.00|OP INTENSIVE|
20|FH_F80513_0_0|SrvcGrp|21106|2022|PDM|23487.00|99|0.00|MS DRG 250 ONLY|
20|FH_F146522_74133_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146812_50401_0|SrvcGrp|87527|2022|PDM|11500.00|99|0.00|AETNA RECONSTRUCT SHOULDER JOINT|
20|FH_F120795_27514_0|SrvcGrp|361|2022|PDM|4797.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F126376_23936_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F115952_44484_0|SrvcGrp|98319|2022|PDM|426.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY (HCFA)|
20|FH_F116040_24637_0|SrvcGrp|26869|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F131757_06320_0|SrvcGrp|472|2022|PDM|756.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F131904_18915_0|SrvcGrp|29346|2022|PDM|51.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F131904_18915_0|SrvcGrp|43569|2022|PDM|112.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F133408_01095_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F133402_10007_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132575_38635_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149179_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F123809_26155_0|SrvcGrp|92825|2022|PCT|0.72|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F132810_0_0|SrvcGrp|86840|2022|PDM|60.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F69968_0_0|SrvcGrp|17083|2022|PDM|2245.79|99|0.00|ASPG X|
20|FH_F107200_0_0|SrvcGrp|30076|2022|PCT|1.00|99|0.00|IMPLANTS, PROSTHETICS, OR SUPPLIES|
20|FH_F134255_01201_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136386_30901_0|SrvcGrp|87311|2022|PDM|36750.00|99|0.00|MSDRG 274 ONLY|
20|FH_F136426_19006_0|SrvcGrp|13683|2022|PDM|624.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F118156_19446_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118236_25901_0|SrvcGrp|102580|2022|PCT|0.76|99|0.00|OP DIALYSIS|
20|FH_F137238_70056_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F142547_70002_0|SrvcGrp|86850|2022|PDM|25.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F97602_40121_0|SrvcGrp|73656|2022|PDM|968.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F125053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140633_17901_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|HSS ASC|
20|FH_F119065_92029_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F92551_18508_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F109883_35007_0|SrvcGrp|86748|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F76144_0_0|SrvcGrp|14614|2022|PDM|7531.15|99|0.00|LITHOTRIPSY|
20|FH_F119555_0_0|CSTM-ALL|CSTM-00|2020|PDM|2830.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137829_62948_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F109821_0_0|SrvcGrp|13557|2022|PCT|1.02|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F107926_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F90735_94070_0|SrvcGrp|90291|2022|PDM|45.00|99|0.00|MOPATH PROCEDURE LEVEL 2|
20|FH_F90880_15108_0|SrvcGrp|10506|2022|PCT|1.00|99|0.00|CPT CODE 97003 OCCUPATIONAL THERAPY INITIAL EVALUATION|
20|FH_F129500_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|769.00|99|0.00|AEG 4 (NO REV)|
20|FH_F151085_15905_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151087_60548_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151155_26508_0|SrvcGrp|46903|2022|PDM|699.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F151179_84074_0|SrvcGrp|110820|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F121960_75503_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122006_66839_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F32066_0_0|SrvcGrp|30426|2022|PCT|0.68|99|0.00|CARVE OUT MS DRG PROCEDURES|
20|FH_F62867_0_0|SrvcGrp|1306|2022|PDM|300.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F76172_0_0|SrvcGrp|33165|2022|PDM|405.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F82933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F110000_0_0|SrvcGrp|30623|2022|PDM|5272.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F91832_06106_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F91873_12723_0|SrvcGrp|73000|2022|PDM|3082.00|99|0.00|AEG 6|
20|FH_F88456_0_0|SrvcGrp|87054|2022|PDM|2801.00|99|0.00|CYSTOSCOPY CHEMODENERVATION|
20|FH_F113794_0_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F105623_77901_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F119581_0_0|SrvcGrp|107794|2022|PDM|4668.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 3 (NO REV)|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F94786_07974_0|SrvcGrp|41451|2022|PDM|0.36|99|0.00|ENTERAL FORMULA - CALORICALLY DENSE|
20|FH_F95341_08701_0|SrvcGrp|90489|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F132988_0_0|SrvcGrp|72121|2022|PDM|4493.01|99|0.00|ARTHOSCOPY|
20|FH_F141014_29732_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1009.45|99|0.00|ASPG II|
20|FH_F114389_50131_0|SrvcGrp|105613|2022|PDM|296.82|99|0.00|FULL FACE MASK (MOD NU)|
20|FH_F141336_16947_0|SrvcGrp|113465|2022|PCT|1.10|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PDM|2460.00|99|0.00|ASPG IX|
20|FH_F46333_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F45312_0_0|SrvcGrp|39773|2022|PCT|0.75|99|0.00|KIDNEY TRANSPLANT|
20|FH_F146985_12205_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F92493_0_0|SrvcGrp|16289|2022|PDM|1949.64|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F132864_71101_0|SrvcGrp|79786|2022|PCT|2.48|99|0.00|SLEEP STUDIES|
20|FH_F130909_33025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124234_33410_0|SrvcGrp|75442|2022|PDM|900.00|99|0.00|OBSERVATION - REV 762|
20|FH_F131101_45840_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F64779_0_0|SrvcGrp|42827|2022|PDM|163.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F89273_0_0|SrvcGrp|78046|2022|PDM|795.00|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F92599_0_0|SrvcGrp|75495|2022|PDM|1926.00|99|0.00|AEG 9|
20|FH_F132890_87544_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F114645_34952_0|SrvcGrp|58509|2022|PDM|315.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F138052_19462_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F148553_85016_0|SrvcGrp|108175|2022|PDM|5337.00|99|0.00|TIB/PER REVASC W/TLA|
20|FH_F122643_72501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F42943_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43613_0_0|SrvcGrp|6|2022|PCT|0.85|99|0.00|OP SURGERY|
20|FH_F135752_98290_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136930_73114_0|SrvcGrp|72930|2022|PDM|2316.00|99|0.00|PET SCANS|
20|FH_F113713_17013_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115608_24171_0|SrvcGrp|17100|2022|PDM|1450.00|99|0.00|SKILLED NURSING|
20|FH_F147700_21401_0|SrvcGrp|113695|2022|PDM|1175.00|99|0.00|COLONOSCOPY W/ RESECTION|
20|FH_F41463_0_0|SrvcGrp|27969|2022|PDM|29.40|99|0.00|HOME HEALTH AIDE|
20|FH_F42024_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F98622_45005_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F102948_43606_0|SrvcGrp|43523|2022|PDM|168.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F140007_0_0|SrvcGrp|12309|2022|PDM|8045.00|99|0.00|MICRODISKETOMY|
20|FH_F54612_07631_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F70762_90805_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|ADULT INTENSIVE OP CHEMICAL DEPENDENCY|
20|FH_F70844_15317_0|SrvcGrp|13985|2022|PDM|47.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F132772_0_0|SrvcGrp|112097|2022|PDM|191.00|99|0.00|DIALYSIS|
20|FH_F43872_0_0|SrvcGrp|472|2022|PDM|359.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102641_0_0|SrvcGrp|87677|2022|PDM|2026.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F102641_0_0|SrvcGrp|72996|2022|PDM|1098.00|99|0.00|AEG 4|
20|FH_F68322_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119262_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F151399_0_0|SrvcGrp|100960|2022|PDM|82.20|99|0.00|FIXED WING AIR MILEAGE|
20|FH_F66569_0_0|SrvcGrp|62258|2022|PDM|85.00|99|0.00|PHYSICAL THERAY EVAL/RE-EVAL|
20|FH_F41013_0_0|SrvcGrp|31190|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC (DME)|
20|FH_F138680_53005_0|SrvcGrp|90854|2022|PDM|904.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F138707_44138_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138992_72703_0|SrvcGrp|113464|2022|PCT|1.22|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F57953_0_0|SrvcGrp|32383|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KL (DME)|
20|FH_F67167_0_0|SrvcGrp|16815|2022|PDM|7042.00|99|0.00|ICU|
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_F84297_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F113527_31023_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132258_45404_0|SrvcGrp|14949|2022|PDM|43.00|99|0.00|HOME INFUSION|
20|FH_F132268_07060_0|SrvcGrp|38582|2022|PDM|31.80|99|0.00|THERAPY|
20|FH_F122116_60942_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135427_19610_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F135453_70726_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F135978_06851_0|SrvcGrp|112507|2022|PDM|459.00|99|0.00|PARTIAL HOSPITALIZATION (0-18 YRS)|
20|FH_F136012_60625_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136110_83330_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100763_24202_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F100763_24202_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F130996_34110_0|SrvcGrp|67066|2022|PDM|14000.00|99|0.00|CERVICAL SURGERY|
20|FH_F116488_79925_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F127399_0_0|SrvcGrp|72990|2022|PDM|936.00|99|0.00|AEG 1|
20|FH_F101200_19020_0|SrvcGrp|86746|2022|PCT|1.05|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F121428_40202_0|SrvcGrp|106269|2022|PCT|0.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F121763_07202_0|SrvcGrp|102981|2022|PDM|94.00|99|0.00|PSYTX WPT W E/M 45 MIN|
20|FH_F121808_70390_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F34177_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.30|99|0.00|GENERAL ACUTE CARE|
20|FH_F72586_0_0|SrvcGrp|33414|2022|PDM|125.00|99|0.00|SNF VENTILATOR SUPPORT|
20|FH_F111292_33136_0|SrvcGrp|73000|2022|PDM|6520.00|99|0.00|AEG 6|
20|FH_F141651_0_0|SrvcGrp|111552|2022|PDM|2200.00|99|0.00|REMOVAL OF INTRANASAL LESION|
20|FH_F69202_0_0|SrvcGrp|41367|2022|PDM|19800.00|99|0.00|MS DRG 242-244 ONLY|
20|FH_F132328_0_0|SrvcGrp|37984|2022|PDM|1498.00|99|0.00|LUMBAR INJECTIONS PROCEDURE|
20|FH_F114569_0_0|SrvcGrp|105677|2022|PCT|1.00|99|0.00|AETNA BH TELEMEDICINE/OP THERAPY SVCS (MOD GT/AH)|
20|FH_F102862_30606_0|SrvcGrp|28120|2022|PDM|23616.40|99|0.00|MS DRG 467 ONLY|
20|FH_F102862_30606_0|SrvcGrp|80838|2022|PDM|12765.00|99|0.00|MSDRG 519 ONLY|
20|FH_F97221_29406_0|SrvcGrp|92760|2022|PCT|1.05|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F98300_30236_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134202_0_0|SrvcGrp|63471|2022|PDM|3150.00|99|0.00|CPT 64590|
20|FH_F143648_0_0|SrvcGrp|113888|2022|PDM|1008.00|99|0.00|SURGERY FOR VULVA LESION|
20|FH_F63396_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148431_60523_0|SrvcGrp|33722|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F148644_06890_0|SrvcGrp|83839|2022|PDM|9775.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F133367_40065_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F125212_76301_0|SrvcGrp|89149|2022|PDM|181.00|99|0.00|OP INTENSIVE|
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|794.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 3|
20|FH_F92676_15063_0|SrvcGrp|78989|2022|PDM|1207.84|99|0.00|MON VALLEY ASC 212|
20|FH_F149860_80112_0|SrvcGrp|74668|2022|PDM|166.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F141947_63367_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118517_33316_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F117838_12901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120605_0_0|SrvcGrp|73008|2022|PDM|815.00|99|0.00|AEG 10|
20|FH_F74264_15301_0|SrvcGrp|33414|2022|PDM|125.00|99|0.00|SNF VENTILATOR SUPPORT|
20|FH_F150001_33064_0|SrvcGrp|14948|2022|PDM|26.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F112165_0_0|SrvcGrp|73006|2022|PDM|2600.00|99|0.00|AEG 9|
20|FH_F118667_95131_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F43917_0_0|SrvcGrp|12784|2022|PDM|45.00|99|0.00|PULMONARY REHAB|
20|FH_F149884_68516_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F46357_0_0|SrvcGrp|26216|2022|PDM|1750.00|99|0.00|ARTHROSCOPY|
20|FH_F87577_80016_0|CSTM-ALL|CSTM-00|2020|PDM|2739.00|99|0.00|TCU|
20|FH_F38410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148599_98034_0|SrvcGrp|10365|2022|PDM|2512.00|99|0.00|CPT CODE 99285|
20|FH_F52112_0_0|SrvcGrp|3932|2022|PDM|5700.00|99|0.00|LITHOTRIPSY|
20|FH_F133552_77006_0|SrvcGrp|89417|2022|PDM|435.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F141987_02859_0|SrvcGrp|75545|2022|PDM|250.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F112865_46135_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F126935_33615_0|SrvcGrp|98701|2022|PDM|294.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F91194_33511_0|SrvcGrp|86728|2022|PCT|1.00|99|0.00|RHOGAM INJECTION|
20|FH_F116440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150949_0_0|SrvcGrp|89404|2022|PDM|10950.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F144769_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|ANGIOPLASTY|
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 3 (NO REV)|
20|FH_F117901_27526_0|SrvcGrp|92760|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F44660_0_0|SrvcGrp|3029|2022|PDM|325.00|99|0.00|NEWBORN NURSERY|
20|FH_F148599_98034_0|SrvcGrp|20902|2022|PDM|35538.00|99|0.00|MS DRG 249 ONLY|
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F100741_0_0|SrvcGrp|73002|2022|PDM|1373.00|99|0.00|AEG 7|
20|FH_F72750_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F126806_44125_0|SrvcGrp|93098|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F44079_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INTERIM HOURLY RATES|
20|FH_F36756_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD UE|
20|FH_F124928_04210_0|SrvcGrp|87394|2022|PDM|148.86|99|0.00|HCPCS G0152 (HCFA)|
20|FH_F98620_43920_0|SrvcGrp|73656|2022|PDM|1039.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|ASPG III|
20|FH_F127412_15301_0|SrvcGrp|78045|2022|PCT|1.00|99|0.00|AETNA AMNIOTIC MEMBRANE|
20|FH_F150600_44270_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125415_64701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40591_0_0|SrvcGrp|9774|2022|PDM|4025.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F133493_90255_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|917.00|99|0.00|AEG 6 (NO REV)|
20|FH_F126911_62301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117550_0_0|SrvcGrp|106536|2022|PDM|22.40|99|0.00|GROUP THERAPEUTIC PROCEDURES|
20|FH_F150120_93619_0|SrvcGrp|74668|2022|PDM|339.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.13|99|0.00|5780852_USTN_LAB_MODQW|
20|FH_F31542_0_0|SrvcGrp|9793|2022|PDM|250.00|99|0.00|NEWBORN NURSERY|
20|FH_F62175_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62596_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F108700_63857_0|SrvcGrp|23683|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PICC LINE INSERTION KIT|
20|FH_F115405_06010_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F146217_0_0|SrvcGrp|80920|2022|PDM|913.07|99|0.00|HOSPICE SERVICES|
20|FH_F133473_21702_0|SrvcGrp|46605|2022|PDM|233.40|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F135714_01922_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F74305_0_0|CSTM-ALL|CSTM-00|2020|PDM|789.00|99|0.00|ASPG V|
20|FH_F118544_21550_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145864_65084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91155_16105_0|SrvcGrp|46605|2022|PDM|102.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F92644_06053_0|SrvcGrp|76501|2022|PDM|284.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F38700_0_0|SrvcGrp|18148|2022|PCT|0.80|99|0.00|MS DRG 249|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|WV HH CATH CARE|
20|FH_F149881_03038_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F57592_0_0|CSTM-ALL|CSTM-00|2020|PDM|10000.00|99|0.00|ACUTE IP SVCS ONE DAY STAY|
20|FH_F47834_0_0|SrvcGrp|13526|2022|PCT|1.10|99|0.00|CPT CODES 80000-89999 - (LAB)|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|OP SVCS|
20|FH_F38352_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F87436_0_0|SrvcGrp|3388|2022|PDM|659.00|99|0.00|SUBACUTE CARE|
20|FH_F118790_98640_0|SrvcGrp|108484|2022|PDM|1377.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F101923_98104_0|SrvcGrp|79699|2022|PCT|0.73|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F106241_93309_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F117807_86426_0|SrvcGrp|88621|2022|PDM|122.00|99|0.00|SKILLED NURSING LPN|
20|FH_F38700_0_0|SrvcGrp|18868|2022|PCT|0.80|99|0.00|MS DRG 231|
20|FH_F100741_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F78167_0_0|SrvcGrp|30095|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F150540_63401_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F111789_25301_0|SrvcGrp|131|2022|PCT|0.65|99|0.00|PACEMAKER DEVICE|
20|FH_F32325_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|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_F74264_15301_0|SrvcGrp|10503|2022|PDM|55.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F120032_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146211_68144_0|SrvcGrp|10361|2022|PDM|255.00|99|0.00|CPT CODE 99281|
20|FH_F133172_66066_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148761_33311_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139527_15642_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139676_76901_0|SrvcGrp|108484|2022|PDM|425.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F150745_03301_0|SrvcGrp|23683|2022|PDM|82.19|99|0.00|SKILLED NURSING RN|
20|FH_F150768_03054_0|SrvcGrp|82223|2022|PDM|204.00|99|0.00|HOSPICE CARE|
20|FH_F150820_83843_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150882_84041_0|SrvcGrp|46605|2022|PDM|109.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F111272_74012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139150_75206_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F109251_62269_0|SrvcGrp|103222|2022|PDM|2.18|99|0.00|TUBULAR DRESSING|
20|FH_F140990_0_0|SrvcGrp|108042|2022|PDM|575.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F146266_0_0|SrvcGrp|92014|2022|PDM|2485.00|99|0.00|PHALANGEAL SHAFT FRACTURE|
20|FH_F124487_89502_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PDM|1213.00|99|0.00|ASPG I|
20|FH_F134394_92101_0|SrvcGrp|91957|2022|PDM|360.00|99|0.00|INTENSIVE OUTPATIENT (>=18 YRS)|
20|FH_F131387_76001_0|SrvcGrp|3178|2022|PDM|875.00|99|0.00|ACUTE PSYCH|
20|FH_F39443_0_0|SrvcGrp|30316|2022|PDM|601.00|99|0.00|HAPA WPA ASC 2|
20|FH_F110729_15068_0|SrvcGrp|46903|2022|PDM|572.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F149083_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116806_0_0|SrvcGrp|107102|2022|PDM|887.26|99|0.00|EXCISION OF MOUTH LESION|
20|FH_F90455_0_0|SrvcGrp|48398|2022|PDM|140.00|99|0.00|PT SERVICES|
20|FH_F32825_0_0|SrvcGrp|18366|2022|PCT|0.70|99|0.00|MS DRG 480|
20|FH_F42145_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|551.91|99|0.00|AEG 1 (NO REV)|
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127467_44202_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F137288_0_0|SrvcGrp|113071|2022|PDM|600.00|99|0.00|FULL DAY OP THERAPY|
20|FH_F149662_85015_0|SrvcGrp|115733|2022|PDM|3564.00|99|0.00|KNEE LIGAMENT REPAIR|
20|FH_F143564_0_0|SrvcGrp|115351|2022|PDM|1050.00|99|0.00|GASTRIC RESTRICTIVE PROCEDURE|
20|FH_F149602_07109_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F108260_63141_0|SrvcGrp|27969|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F90817_0_0|SrvcGrp|90368|2022|PDM|1151.00|99|0.00|REMOVAL OF TEAR SAC|
20|FH_F141278_80218_0|SrvcGrp|110885|2022|PCT|1.24|99|0.00|ANTEPARTUM|
20|FH_F143668_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134916_16421_0|SrvcGrp|13683|2022|PDM|624.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F146266_0_0|SrvcGrp|88162|2022|PDM|5911.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F34985_0_0|SrvcGrp|12342|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F113957_73554_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39443_0_0|SrvcGrp|30512|2022|PCT|1.02|99|0.00|JEFFERSON PACEMAKER|
20|FH_F122277_98045_0|SrvcGrp|75545|2022|PDM|366.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F111080_18103_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F98623_97006_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F147200_61944_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146266_0_0|SrvcGrp|89857|2022|PDM|7892.00|99|0.00|REMOVAL OF SPINAL LAMINA|
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|967.00|99|0.00|AEG 8 (NO REV)|
20|FH_F122377_91007_0|SrvcGrp|107758|2022|PCT|0.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F139167_42240_0|SrvcGrp|86722|2022|PDM|213.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
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_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|783.00|99|0.00|HAPA EPA ASC 5|
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92155_74437_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F34882_0_0|SrvcGrp|360|2022|PDM|1629.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F129030_21204_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F100663_56537_0|SrvcGrp|90854|2022|PDM|2264.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F40624_0_0|SrvcGrp|361|2022|PDM|875.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F64839_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149030_37919_0|SrvcGrp|25518|2022|PDM|3500.97|99|0.00|LAPAROSCOPY SURGICAL CHOLECYSTECTOMY|
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 3 (NO REV)|
20|FH_F150927_64836_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140140_07722_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F108080_77081_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137719_28269_0|SrvcGrp|75419|2022|PDM|550.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F39082_0_0|SrvcGrp|131|2022|PCT|0.65|99|0.00|PACEMAKER DEVICE|
20|FH_F149529_68102_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F41273_0_0|SrvcGrp|11336|2022|PCT|0.70|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F147359_54911_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40627_0_0|CSTM-ALL|CSTM-00|2020|PDM|5520.00|99|0.00|MSDRG 246-251 ANGIOPLASTY|
20|FH_F132254_40207_0|SrvcGrp|86841|2022|PDM|110.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F114585_11501_0|SrvcGrp|89412|2022|PDM|400.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)|
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F140295_0_0|SrvcGrp|67279|2022|PDM|7951.00|99|0.00|CERVICAL SURGERY|
20|FH_F147339_08837_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 6 (NO REV)|
20|FH_F139928_37228_0|SrvcGrp|73841|2022|PDM|550.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F143249_89801_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F143488_84770_0|SrvcGrp|53703|2022|PDM|788.00|99|0.00|REVISE AQUEOUS SHUNT TO EXTRAOCULAR RESIVOIR|
20|FH_F72749_0_0|SrvcGrp|14210|2022|PDM|328.00|99|0.00|PSYCH INTENSIVE OUTPATIENT|
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|463.61|99|0.00|AEG 1 (NO REV)|
20|FH_F103060_0_0|SrvcGrp|98494|2022|PDM|8323.00|99|0.00|ARTHRODESIS PRE-SACRAL|
20|FH_F115208_0_0|SrvcGrp|64718|2022|PDM|716.00|99|0.00|CPT 45384|
20|FH_F151754_71943_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151762_17042_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F136247_28804_0|CSTM-ALL|CSTM-00|2020|PCT|0.33|99|0.00|OP SVCS|
20|FH_F132419_84042_0|SrvcGrp|46903|2022|PDM|1120.36|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F112712_63005_0|SrvcGrp|24754|2022|PCT|1.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F116552_70001_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F116756_77477_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|1680.00|99|0.00|AEG 3 (NO REV)|
20|FH_F120887_78750_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F40207_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F118792_63379_0|SrvcGrp|92440|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F51276_0_0|SrvcGrp|14948|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F93000_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37200_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REGIONAL HEALTH SVCS OF HOWARD-DME-MOD AW|
20|FH_F66961_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F100742_00616_0|SrvcGrp|73559|2022|PDM|3084.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F61292_0_0|SrvcGrp|12543|2022|PDM|5726.00|99|0.00|LAPAROSCOPIC HYSTERECTOMY|
20|FH_F89475_71202_0|SrvcGrp|79786|2022|PCT|2.25|99|0.00|SLEEP STUDIES|
20|FH_F132130_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F129221_84325_0|SrvcGrp|75419|2022|PDM|1050.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F94665_0_0|SrvcGrp|22383|2022|PCT|1.00|99|0.00|SUPPLIES|
20|FH_F90654_0_0|SrvcGrp|47260|2022|PCT|0.70|99|0.00|IMPLANTS 274-276, 278  LINE LEVEL|
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_F127328_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125693_92660_0|SrvcGrp|110163|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F141407_76226_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148255_72703_0|SrvcGrp|29076|2022|PDM|31.50|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)|
20|FH_F121090_07848_0|SrvcGrp|73842|2022|PDM|235.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F135081_63080_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139515_0_0|SrvcGrp|41334|2022|PDM|11330.00|99|0.00|TOTAL KNEE|
20|FH_F93881_15009_0|SrvcGrp|22379|2022|PDM|74.00|99|0.00|CPT CODE 94010|
20|FH_F116952_01020_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123529_31021_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116115_14437_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F66687_0_0|SrvcGrp|29702|2022|PCT|0.85|99|0.00|CV SURGERY MS DRG 260-262 ONLY|
20|FH_F73733_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S NV - MOD UE|
20|FH_F51733_0_0|SrvcGrp|44430|2022|PDM|105.00|99|0.00|SPEECH THERAPY SVCS (VISIT LVL)|
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_F123331_45373_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F129567_60616_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
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_F129656_15005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120952_25303_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150982_0_0|SrvcGrp|82108|2022|PDM|3303.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F37937_0_0|SrvcGrp|27766|2022|PDM|100.00|99|0.00|SKILLED IV NURSING VISIT|
20|FH_F141527_36830_0|SrvcGrp|24745|2022|PDM|26.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F135231_90265_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F93880_95476_0|SrvcGrp|93799|2022|PCT|0.30|99|0.00|TENECTEPLASE INJECTION|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: GLOBAL|
20|FH_F135151_61874_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126153_44663_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F130751_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC|
20|FH_F82714_18848_0|SrvcGrp|220|2022|PCT|0.39|99|0.00|INTRAOCULAR LENSES|
20|FH_F124017_0_0|SrvcGrp|64761|2022|PDM|5200.00|99|0.00|DISCECTOMY|
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|2355.00|99|0.00|AEG 9 (NO REV)|
20|FH_F39819_0_0|SrvcGrp|31225|2022|PDM|6264.00|99|0.00|NY DRG 141 ONLY|
20|FH_F82173_72712_0|SrvcGrp|84720|2022|PCT|0.00|99|0.00|AETNA LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F77822_0_0|SrvcGrp|471|2022|PDM|598.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F102500_0_0|SrvcGrp|45583|2022|PDM|1863.00|99|0.00|CPT 65730|
20|FH_F135219_68506_0|SrvcGrp|115513|2022|PDM|22295.52|99|0.00|SHOULDER JOINT RECONSTRUCTION|
20|FH_F34496_0_0|SrvcGrp|16634|2022|PDM|16466.63|99|0.00|CRYOBLATION|
20|FH_F94102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|GENERAL ACUTE CARE|
20|FH_F118194_50841_0|SrvcGrp|43567|2022|PDM|250.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F123488_65559_0|SrvcGrp|75545|2022|PDM|327.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F86332_75081_0|SrvcGrp|16541|2022|PDM|65.00|99|0.00|ANTI-SPASMOTIC THERAPY|
20|FH_F72051_0_0|SrvcGrp|66482|2022|PDM|35.00|99|0.00|HOME HEALTH AID|
20|FH_F38867_0_0|CSTM-ALL|CSTM-00|2020|PDM|365.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F115737_78660_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121183_75093_0|SrvcGrp|89149|2022|PDM|225.00|99|0.00|OP INTENSIVE|
20|FH_F137457_32216_0|SrvcGrp|108484|2022|PDM|766.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F130145_98043_0|SrvcGrp|108042|2022|PDM|715.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F143783_0_0|SrvcGrp|80920|2022|PDM|105.00|99|0.00|HOSPICE SERVICES|
20|FH_F125028_19061_0|SrvcGrp|86779|2022|PDM|126.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F146569_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147994_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F34691_0_0|SrvcGrp|17146|2022|PDM|1081.00|99|0.00|MRI|
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ASPG I|
20|FH_F137574_68130_0|SrvcGrp|27968|2022|PCT|1.00|99|0.00|SKILLED NURSING LPN|
20|FH_F146661_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.43|99|0.00|HSS ASC|
20|FH_F103902_89118_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F110004_75149_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F82931_18847_0|SrvcGrp|72781|2022|PDM|121.03|99|0.00|PT SVCS - VISIT LEVEL|
20|FH_F147941_06023_0|SrvcGrp|74608|2022|PDM|241.00|99|0.00|AETNA FOLLOW UP VISIT CPT 90833|
20|FH_F149523_0_0|SrvcGrp|98564|2022|PDM|15000.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F148320_02130_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37679_0_0|SrvcGrp|27057|2022|PDM|8.75|99|0.00|HYDRATION THERAPY - 2 LITERS (MOD SJ)|
20|FH_F71047_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F69322_0_0|CSTM-ALL|CSTM-00|2020|PDM|321.00|99|0.00|CD ADULT PARTIAL HOSPITALIZATION|
20|FH_F109980_0_0|SrvcGrp|73559|2022|PDM|1500.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F130134_08724_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137972_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)|
20|FH_F143530_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F135239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F63419_0_0|SrvcGrp|80|2022|PDM|712.00|99|0.00|ACUTE PSYCH|
20|FH_F64140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F67984_0_0|SrvcGrp|59425|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE|
20|FH_F67984_0_0|SrvcGrp|14494|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|72.73|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F88492_70601_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F88639_80204_0|SrvcGrp|113789|2022|PDM|567.10|99|0.00|CAT SCAN|
20|FH_F87480_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|1867.63|99|0.00|ASPG IX|
20|FH_F62691_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62579_0_0|SrvcGrp|14948|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F130725_33020_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149079_70809_0|SrvcGrp|105737|2022|PDM|1326.00|99|0.00|INPATIENT PSYCHIATRIC|
20|FH_F112665_0_0|SrvcGrp|88160|2022|PDM|7215.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F114800_68510_0|SrvcGrp|88621|2022|PDM|91.00|99|0.00|SKILLED NURSING LPN|
20|FH_F103220_0_0|SrvcGrp|99144|2022|PDM|2310.00|99|0.00|BIOPSY OR EXC AXILLARY|
20|FH_F124369_0_0|SrvcGrp|109787|2022|PDM|1815.00|99|0.00|EXC FOOT/TOE TUM SC < 1.5 CM|
20|FH_F85353_16407_0|SrvcGrp|63863|2022|PDM|358.19|99|0.00|HAPA WPA-NWPA 2012-13 ASC 118|
20|FH_F133808_73401_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F83380_0_0|SrvcGrp|43269|2022|PDM|35.00|99|0.00|CATHETER REPAIR|
20|FH_F133972_27103_0|SrvcGrp|13929|2022|PDM|30.00|99|0.00|GROWTH HORMONE|
20|FH_F70804_0_0|SrvcGrp|14372|2022|PDM|30.46|99|0.00|AMBULATORY INFUSION PUMP|
20|FH_F132883_31602_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F110302_15931_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121603_46761_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
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_F146120_45040_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117300_0_0|SrvcGrp|67065|2022|PDM|7853.00|99|0.00|CERVICAL SURGERY|
20|FH_F133585_0_0|SrvcGrp|109429|2022|PDM|105.00|99|0.00|INTRVASC US NONCORONARY ADDL|
20|FH_F130017_02302_0|SrvcGrp|75506|2022|PCT|1.11|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F31714_0_0|SrvcGrp|9937|2022|PCT|0.75|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|1178.00|99|0.00|AEG 1 (NO REV)|
20|FH_F130763_0_0|SrvcGrp|83642|2022|PDM|3450.00|99|0.00|CPT 29883|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1080.96|99|0.00|HAPA WPA-NWPA 2012-13 ASC 701 W/O REV|
20|FH_F128825_45211_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F145641_06902_0|SrvcGrp|77021|2022|PDM|11452.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F125259_0_0|SrvcGrp|108116|2022|PDM|1750.00|99|0.00|AV FUSION / UPPER ARM VEIN|
20|FH_F90453_65203_0|SrvcGrp|73485|2022|PDM|941.00|99|0.00|AETNA REHAB|
20|FH_F136591_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|GENERAL ACUTE CARE|
20|FH_F143687_70461_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F142376_0_0|SrvcGrp|98588|2022|PDM|3511.00|99|0.00|REMOVE SPINE INFUSION DEVI16|
20|FH_F71273_0_0|SrvcGrp|29815|2022|PDM|4323.00|99|0.00|MS DRG 003-004, 207-208 ONLY|
20|FH_F145598_23462_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110420_60649_0|SrvcGrp|73002|2022|PDM|1144.00|99|0.00|AEG 7|
20|FH_F130763_0_0|SrvcGrp|44067|2022|PDM|4714.00|99|0.00|CPT 52240|
20|FH_F149081_63028_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132606_0_0|SrvcGrp|26275|2022|PDM|1305.00|99|0.00|CPT 29826|
20|FH_F130501_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F84593_0_0|SrvcGrp|472|2022|PDM|367.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F147962_85008_0|SrvcGrp|72984|2022|PCT|1.35|99|0.00|CHEMOTHERAPY|
20|FH_F145642_15108_0|SrvcGrp|86848|2022|PDM|30.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|1417.00|99|0.00|AEG 2 (NO REV)|
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1706.01|99|0.00|AEG 10 (NO REV)|
20|FH_F112665_0_0|SrvcGrp|27261|2022|PDM|8661.00|99|0.00|CPT 27446|
20|FH_F145641_06902_0|SrvcGrp|88158|2022|PDM|11173.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F150165_06032_0|SrvcGrp|75282|2022|PDM|1480.00|99|0.00|DIAGNOSTIC HYSTEROSCOPY|
20|FH_F130468_0_0|SrvcGrp|11663|2022|PCT|1.15|99|0.00|IMPLANTS|
20|FH_F79763_0_0|SrvcGrp|59426|2022|PDM|90.00|99|0.00|PT|
20|FH_F121628_19533_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133585_0_0|SrvcGrp|89701|2022|PDM|230.00|99|0.00|ARTERY X-RAYS ARM/LEG|
20|FH_F35966_0_0|SrvcGrp|19607|2022|PDM|750.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F121603_46761_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133585_0_0|SrvcGrp|107882|2022|PDM|289.00|99|0.00|DIALYSIS CIRCUIT EMBOLJ|
20|FH_F37877_0_0|CSTM-ALL|CSTM-00|2020|PDM|756.00|99|0.00|ASPG V|
20|FH_F71345_0_0|SrvcGrp|12403|2022|PDM|37.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|819.00|99|0.00|2005 ASPG GROUPER IV|
20|FH_F110604_0_0|SrvcGrp|88317|2022|PDM|1100.00|99|0.00|TESTING EBN 1.6 R4 2015|
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|1338.00|99|0.00|AEG 4 (NO REV)|
20|FH_F130364_01331_0|SrvcGrp|10362|2022|PDM|364.00|99|0.00|CPT CODE 99282|
20|FH_F116207_0_0|SrvcGrp|104911|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F42690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F54592_0_0|SrvcGrp|22590|2022|PDM|80.00|99|0.00|PAIN MANAGAMENT - INTERMITTENT|
20|FH_F134495_84321_0|SrvcGrp|23683|2022|PDM|42.25|99|0.00|SKILLED NURSING RN|
20|FH_F122470_78229_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F84712_0_0|SrvcGrp|82764|2022|PDM|52.00|99|0.00|HEPATIC FUNCTION PANEL|
20|FH_F84175_0_0|SrvcGrp|471|2022|PDM|703.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F102200_06416_0|SrvcGrp|14945|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F105143_26062_0|SrvcGrp|102343|2022|PDM|1240.00|99|0.00|ER LEVEL IV W/ SURGERY|
20|FH_F115786_57701_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F115865_78621_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F115784_06831_0|SrvcGrp|471|2022|PDM|725.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F75842_0_0|SrvcGrp|73862|2022|PDM|10371.17|99|0.00|LITHOTRIPSY/CHOLECYSECTOMY|
20|FH_F146881_83661_0|SrvcGrp|104226|2022|PDM|140.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F120528_60559_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F115966_16801_0|SrvcGrp|29347|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F116114_37033_0|SrvcGrp|105819|2022|PDM|944.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F131711_25550_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F132971_77063_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129310_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133574_91607_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111580_77004_0|SrvcGrp|13187|2022|PCT|1.10|99|0.00|INTRAOCULAR LENSES|
20|FH_F134828_30531_0|SrvcGrp|30379|2022|PCT|1.05|99|0.00|LABORATORY SERVICES|
20|FH_F139690_0_0|SrvcGrp|107749|2022|PDM|214.00|99|0.00|CAPD/CCPD|
20|FH_F46832_0_0|SrvcGrp|24746|2022|PDM|85.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F123818_43452_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F58856_0_0|SrvcGrp|17967|2022|PDM|3125.00|99|0.00|ICU / CCU|
20|FH_F64999_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136371_29720_0|SrvcGrp|89417|2022|PDM|426.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F120490_64133_0|SrvcGrp|86851|2022|PDM|25.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F134011_84102_0|SrvcGrp|86850|2022|PDM|25.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F137232_28210_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137249_30046_0|SrvcGrp|73951|2022|PDM|1089.00|99|0.00|HOSPICE SERVICES|
20|FH_F142390_20866_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142547_70002_0|SrvcGrp|86846|2022|PDM|25.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F142690_31774_0|SrvcGrp|106904|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F117552_0_0|SrvcGrp|73004|2022|PDM|1178.00|99|0.00|AEG 8|
20|FH_F138627_82901_0|SrvcGrp|21919|2022|PDM|45.00|99|0.00|NASOGASTRIC TUBING|
20|FH_F138627_82901_0|SrvcGrp|98923|2022|PDM|95.00|99|0.00|HIT CONT PAIN MGMT (HCFA)|
20|FH_F75549_96101_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F132733_0_0|SrvcGrp|107734|2022|PDM|4593.00|99|0.00|VAGINAL DELIVERY|
20|FH_F78404_16646_0|SrvcGrp|11258|2022|PCT|0.62|99|0.00|DRUGS|
20|FH_F140407_63841_0|SrvcGrp|75506|2022|PCT|0.75|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F140569_46975_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140209_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 8 (NO REV)|
20|FH_F119130_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F149375_26101_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149501_34471_0|SrvcGrp|115602|2022|PCT|1.00|99|0.00|TELEMEDICINE|
20|FH_F118943_64506_0|SrvcGrp|22593|2022|PDM|25.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F109886_36303_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F109886_36303_0|SrvcGrp|86746|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F76144_0_0|SrvcGrp|35668|2022|PDM|3186.25|99|0.00|CPT 29824|
20|FH_F117267_07728_0|SrvcGrp|22810|2022|PDM|9000.00|99|0.00|MATERNITY|
20|FH_F147879_93309_0|SrvcGrp|66264|2022|PDM|130.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F147879_93309_0|SrvcGrp|66265|2022|PDM|130.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F147926_19063_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F117189_60085_0|SrvcGrp|74668|2022|PDM|219.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111593_0_0|SrvcGrp|72990|2022|PDM|841.50|99|0.00|AEG 1|
20|FH_F90735_94070_0|SrvcGrp|90285|2022|PDM|32.50|99|0.00|FAMILIAL DYSATONOMIA|
20|FH_F124757_45750_0|SrvcGrp|88217|2022|PDM|0.25|99|0.00|AETNA MED RECORD COPY ADMIN|
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|715.00|99|0.00|AEG 1 (NO REV)|
20|FH_F139287_33544_0|CSTM-ALL|CSTM-00|2020|PCT|1.26|99|0.00|HSS ASC|
20|FH_F129487_0_0|SrvcGrp|73006|2022|PDM|3613.00|99|0.00|AEG 9|
20|FH_F129487_0_0|SrvcGrp|41327|2022|PDM|2369.00|99|0.00|OP SURGERY CPT 28308|
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|1440.00|99|0.00|AEG 5  (NO REV)|
20|FH_F56274_0_0|SrvcGrp|17139|2022|PDM|711.00|99|0.00|HOSPICE CARE|
20|FH_F151061_02720_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F129130_92562_0|SrvcGrp|60098|2022|PDM|27416.00|99|0.00|PACEMAKER IMPLANTATION - MS DRG ONLY|
20|FH_F129130_92562_0|SrvcGrp|82381|2022|PDM|19601.06|99|0.00|BRACHYTHERAPY|
20|FH_F37823_0_0|SrvcGrp|21752|2022|PDM|50.00|99|0.00|CPT CODES 00100-01999|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|278.74|99|0.00|DELAWARE VALLEY- ASC 106|
20|FH_F106822_0_0|SrvcGrp|100265|2022|PDM|3.01|99|0.00|CHEMISTRY|
20|FH_F72923_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F77067_0_0|SrvcGrp|360|2022|PDM|1868.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F105581_19053_0|SrvcGrp|88621|2022|PDM|120.00|99|0.00|SKILLED NURSING LPN|
20|FH_F105591_17601_0|SrvcGrp|73008|2022|PCT|0.00|99|0.00|AEG 10|
20|FH_F42744_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110212_17013_0|SrvcGrp|109330|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F75542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93252_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F114389_50131_0|SrvcGrp|86848|2022|PDM|130.65|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F114389_50131_0|SrvcGrp|17302|2022|PDM|80.47|99|0.00|HYDRATION THERAPY - 3+ LITERS|
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F45976_0_0|SrvcGrp|17077|2022|PDM|1438.00|99|0.00|ASPG VII|
20|FH_F77944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.43|99|0.00|IMPLANTS/PROSTHETICS/DEVICES EXCLUDE ER/URGENT CARE|
20|FH_F146901_78006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146912_90025_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F64819_0_0|SrvcGrp|13185|2022|PDM|1753.00|99|0.00|ICU/CCU|
20|FH_F34546_0_0|SrvcGrp|9518|2022|PCT|0.90|99|0.00|EMERGENCY ROOM|
20|FH_F39066_0_0|SrvcGrp|13811|2022|PDM|200.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F49943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F91898_0_0|SrvcGrp|91754|2022|PDM|10138.00|99|0.00|AETNA SURGICAL MSDRG AND INTENSIVE CARE|
20|FH_F124237_95023_0|SrvcGrp|74668|2022|PDM|700.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124687_64024_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F147899_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132247_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136603_60654_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136603_60654_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114684_80547_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139556_85006_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122872_67208_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F134674_06473_0|SrvcGrp|89412|2022|PDM|210.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F134727_30650_0|SrvcGrp|11663|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F136189_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F136930_73114_0|SrvcGrp|109154|2022|PDM|219.00|99|0.00|INTENSIVE OP MENTAL HEALTH & CHEMICAL DEP|
20|FH_F115567_91711_0|SrvcGrp|91214|2022|PDM|35.21|99|0.00|MED NUTRITION|
20|FH_F115631_65201_0|CSTM-ALL|CSTM-00|2020|PDM|814.00|99|0.00|AEG 2 (NO REV)|
20|FH_F116199_75042_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F116393_07002_0|SrvcGrp|89082|2022|PDM|103.00|99|0.00|X-RAY EXAM OF NECK SPINE|
20|FH_F147311_37421_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147701_31093_0|CSTM-ALL|CSTM-00|2020|PDM|6710.00|99|0.00|AEG 8 (NO REV)|
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|737.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F100783_03431_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F102950_86040_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|GENERAL ACUTE CARE|
20|FH_F38476_0_0|SrvcGrp|10541|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|1035.00|99|0.00|AEG 7 (NO REV)|
20|FH_F138197_0_0|CSTM-ALL|CSTM-00|2020|PDM|1720.95|99|0.00|AEG 7 (NO REV)|
20|FH_F118446_0_0|SrvcGrp|80918|2022|PDM|150.00|99|0.00|RESPITE CARE|
20|FH_F97261_06098_0|SrvcGrp|88977|2022|PDM|6602.00|99|0.00|C-SECTION DELIVERY|
20|FH_F97261_06098_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
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|35669|2022|PDM|3500.00|99|0.00|CPT 63650|
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|1246.30|99|0.00|AEG 5  (NO REV)|
20|FH_F35216_0_0|SrvcGrp|18165|2022|PDM|11750.00|99|0.00|MS DRG 254|
20|FH_F39346_0_0|SrvcGrp|29600|2022|PDM|7737.00|99|0.00|MS DRG 263 ONLY|
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|755.07|99|0.00|ASPG X|
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F148645_0_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F133536_0_0|SrvcGrp|100980|2022|PDM|1100.00|99|0.00|NERVOUS SYSTEM|
20|FH_F117509_0_0|SrvcGrp|104226|2022|PDM|148.79|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1345.68|99|0.00|2005 ASPG GROUPER VIII|
20|FH_F39988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F52772_0_0|SrvcGrp|472|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F113585_20155_0|SrvcGrp|29076|2022|PCT|1.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F138907_01040_0|SrvcGrp|92518|2022|PDM|103.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F37644_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|PT SERVICES|
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|732.00|99|0.00|AEG 5  (NO REV)|
20|FH_F151508_60435_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145408_43920_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130671_42701_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F135371_61032_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|OP SVCS|
20|FH_F97143_80012_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F91766_25401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136150_73068_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136174_89146_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F130756_04901_0|SrvcGrp|104363|2022|PCT|0.89|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F116461_77536_0|SrvcGrp|104080|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F116527_70443_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121823_46234_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F38268_0_0|SrvcGrp|10410|2022|PDM|44.00|99|0.00|SKILLED NURSING CARE|
20|FH_F129967_18915_0|SrvcGrp|106468|2022|PDM|38.15|99|0.00|AETNA OFFICE OUTPATIENT VISIT EST (MOD TD)|
20|FH_F111301_33122_0|SrvcGrp|79904|2022|PDM|5258.00|99|0.00|HEART GROUP I MSDRG ONLY|
20|FH_F111390_32960_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134322_98001_0|SrvcGrp|112564|2022|PCT|1.00|99|0.00|IIV3 VACCINE|
20|FH_F134322_98001_0|SrvcGrp|108043|2022|PDM|471.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F141651_0_0|SrvcGrp|12664|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F148243_0_0|SrvcGrp|36591|2022|PDM|26000.00|99|0.00|CPT 63685|
20|FH_F148243_0_0|SrvcGrp|79595|2022|PDM|770.00|99|0.00|CPT 45385|
20|FH_F34532_0_0|SrvcGrp|17051|2022|PDM|1100.00|99|0.00|TELEMETRY|
20|FH_F132720_0_0|SrvcGrp|16|2022|PDM|1611.00|99|0.00|ACUTE REHABILITATION|
20|FH_F112086_33713_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F102282_06795_0|SrvcGrp|46605|2022|PDM|103.74|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F129326_02026_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F101852_78758_0|SrvcGrp|73849|2022|PDM|465.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F101320_26062_0|SrvcGrp|65621|2022|PDM|30.00|99|0.00|RN NURSING|
20|FH_F132972_78589_0|SrvcGrp|73842|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119321_71040_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148548_37909_0|CSTM-ALL|CSTM-00|2020|PDM|4411.00|99|0.00|AEG 9 (NO REV)|
20|FH_F100661_63640_0|CSTM-ALL|CSTM-00|2020|PCT|0.38|99|0.00|OP SVCS|
20|FH_F81494_0_0|SrvcGrp|3069|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F82813_0_0|SrvcGrp|73008|2022|PDM|694.00|99|0.00|AEG 10|
20|FH_F150883_14727_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F88818_0_0|SrvcGrp|87822|2022|PDM|2170.00|99|0.00|SUSPENSION OF BREAST|
20|FH_F103360_68845_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F112836_06040_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150949_0_0|SrvcGrp|93432|2022|PDM|10500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F87615_80033_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F71145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127412_15301_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 10 (NO REV)|
20|FH_F133490_90650_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F36579_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALLIED MED-MOD 53|
20|FH_F40914_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133477_90247_0|SrvcGrp|105465|2022|PCT|1.40|99|0.00|AETNA THERAPIES|
20|FH_F93375_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F132667_62025_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132224_89119_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PDM|33063.00|99|0.00|DRG 531/532 ONLY|
20|FH_F111456_33884_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150062_92501_0|SrvcGrp|108484|2022|PDM|725.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F148009_71322_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100784_59923_0|SrvcGrp|73601|2022|PDM|7907.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F80952_45669_0|CSTM-ALL|CSTM-00|2020|PDM|550.73|99|0.00|AEG 1 (NO REV)|
20|FH_F132543_79549_0|SrvcGrp|109057|2022|PCT|1.30|99|0.00|CARDIAC STUDIES|
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|3300.00|99|0.00|AEG 5  (NO REV)|
20|FH_F45436_0_0|SrvcGrp|12401|2022|PDM|130.00|99|0.00|RN VISIT|
20|FH_F63250_0_0|SrvcGrp|57649|2022|PDM|77.00|99|0.00|PHYSICAL THERAPY SVCS MOD GP|
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_F148430_06278_0|SrvcGrp|100246|2022|PCT|1.00|99|0.00|STREP A ASSAY W/ OPTIC|
20|FH_F126942_39540_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125368_24153_0|SrvcGrp|74668|2022|PDM|195.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F102188_0_0|SrvcGrp|3809|2022|PDM|544.72|99|0.00|HOSPICE CARE|
20|FH_F72859_0_0|SrvcGrp|10410|2022|PDM|25.00|99|0.00|SKILLED NURSING CARE|
20|FH_F150600_44270_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38352_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F145988_06105_0|SrvcGrp|31793|2022|PDM|41930.00|99|0.00|PACEMAKER IMPLANT|
20|FH_F88956_0_0|SrvcGrp|75479|2022|PDM|1065.00|99|0.00|AEG 1|
20|FH_F97541_33021_0|SrvcGrp|73605|2022|PDM|2986.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F102721_38118_0|SrvcGrp|80|2022|PDM|550.00|99|0.00|ACUTE PSYCH|
20|FH_F88280_0_0|SrvcGrp|107733|2022|PDM|5701.00|99|0.00|CESAREAN SECTION|
20|FH_F141754_21703_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132080_0_0|SrvcGrp|80918|2022|PDM|169.00|99|0.00|RESPITE CARE|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD KN"|
20|FH_F37751_0_0|SrvcGrp|27696|2022|PCT|1.00|99|0.00|DIALYSIS|
20|FH_F44023_0_0|CSTM-ALL|CSTM-00|2020|PDM|2236.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132591_75146_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F111437_33305_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F103281_32086_0|SrvcGrp|76259|2022|PDM|2100.00|99|0.00|OP DIALYSIS|
20|FH_F126666_44053_0|SrvcGrp|86870|2022|PDM|67.00|99|0.00|AETNA OFFICE OP VISIT EST (MOD TD) (HCFA)|
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|79089|2022|PDM|205.19|99|0.00|MON VALLEY ASC 246|
20|FH_F82813_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F148886_60621_0|SrvcGrp|115359|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F133350_39532_0|SrvcGrp|75419|2022|PDM|1250.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F113146_15001_0|SrvcGrp|73841|2022|PDM|251.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F47479_0_0|SrvcGrp|47764|2022|PDM|70.00|99|0.00|HOSPICE CARE/ IN HOME S9126 VISIT LEVEL|
20|FH_F34706_0_0|SrvcGrp|13643|2022|PDM|2780.00|99|0.00|DRG 372 NORMAL DELIVERY (MOTHER ONLY)|
20|FH_F89932_10940_0|SrvcGrp|72994|2022|PDM|2236.00|99|0.00|AEG 3|
20|FH_F70606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133552_77006_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F142970_43055_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F72980_0_0|SrvcGrp|13422|2022|PDM|272.43|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F50221_0_0|SrvcGrp|33166|2022|PDM|515.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F100661_63640_0|SrvcGrp|90854|2022|PDM|2393.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F146179_37687_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150883_14727_0|SrvcGrp|11606|2022|PDM|1992.94|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)|
20|FH_F121009_76180_0|SrvcGrp|107288|2022|PCT|1.00|99|0.00|INJ INTERFERON BETA|
20|FH_F91262_77036_0|SrvcGrp|73701|2022|PDM|43.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F47727_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F149867_62901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133540_72687_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148556_13206_0|SrvcGrp|22591|2022|PDM|35.00|99|0.00|IMPLANTED PUMP|
20|FH_F35176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47433_0_0|SrvcGrp|42424|2022|PDM|4700.00|99|0.00|ANGIOPLASTY|
20|FH_F39995_0_0|SrvcGrp|38|2022|PDM|2100.00|99|0.00|NORMAL DELIVERY|
20|FH_F65899_0_0|SrvcGrp|26690|2022|PCT|0.65|99|0.00|MS DRG 215 ONLY|
20|FH_F62596_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F31928_0_0|SrvcGrp|13115|2022|PCT|0.95|99|0.00|MRI/CT SCAN|
20|FH_F97566_79902_0|SrvcGrp|73485|2022|PDM|4120.00|99|0.00|AETNA REHAB|
20|FH_F115448_80031_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|1443.00|99|0.00|ASPG VII|
20|FH_F117132_0_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F37188_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|OP SVCS|
20|FH_F144011_60616_0|SrvcGrp|113637|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F46492_0_0|SrvcGrp|12995|2022|PDM|485.00|99|0.00|DIALYSIS|
20|FH_F144748_19707_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F31093_0_0|SrvcGrp|537|2022|PDM|1100.00|99|0.00|OBSERVATION SERVICES|
20|FH_F119220_75068_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F115315_43011_0|SrvcGrp|94739|2022|PCT|1.00|99|0.00|NOS FLU VACC IM (>=3 YRS)|
20|FH_F35346_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143848_0_0|SrvcGrp|79720|2022|PDM|2776.00|99|0.00|ACUTE REHAB II|
20|FH_F150700_90028_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F146204_0_0|SrvcGrp|110349|2022|PDM|1922.00|99|0.00|REOPEN FALLOPIAN TUBE|
20|FH_F131376_66215_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F31990_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150932_15143_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132153_06450_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139565_0_0|SrvcGrp|109346|2022|PDM|4590.00|99|0.00|EXCISION OF CHALAZION DIFFERENT LIDS|
20|FH_F99420_91326_0|SrvcGrp|90627|2022|PCT|0.00|99|0.00|FH WEST PROVIDENCE ST JOSEPH OP LAB DRAW (ZERO REIMBURSE)|
20|FH_F90196_10467_0|SrvcGrp|89019|2022|PDM|83.00|99|0.00|GROUP PSYCHOTHERAPY|
20|FH_F137732_08690_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143668_0_0|SrvcGrp|114062|2022|PDM|370.00|99|0.00|SEGMENTAL PNEUMATIC TRUNK (MOD NU)|
20|FH_F147142_33870_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128753_32501_0|SrvcGrp|73485|2022|PCT|0.64|99|0.00|AETNA REHAB|
20|FH_F66405_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F148859_0_0|SrvcGrp|108395|2022|PDM|263.00|99|0.00|SET RADIATION THERAPY FIELD|
20|FH_F97880_63501_0|SrvcGrp|73601|2022|PDM|10903.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109470_15370_0|SrvcGrp|88377|2022|PDM|1167.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F73442_0_0|SrvcGrp|44105|2022|PDM|50.00|99|0.00|PHYSICAL THERAPY|
20|FH_F120099_86305_0|SrvcGrp|74668|2022|PDM|778.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137728_47203_0|SrvcGrp|74694|2022|PDM|721.00|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F35752_33470_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110824_83221_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F73803_0_0|SrvcGrp|11033|2022|PCT|1.00|99|0.00|OP REFERENCE LAB|
20|FH_F149273_0_0|SrvcGrp|99073|2022|PDM|1.36|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F146266_0_0|SrvcGrp|80617|2022|PDM|21515.00|99|0.00|ARTHOPLASTY|
20|FH_F119652_0_0|SrvcGrp|82037|2022|PDM|1600.00|99|0.00|AETNA ICU|
20|FH_F124288_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148980_18603_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35557_0_0|CSTM-ALL|CSTM-00|2020|PDM|29.00|99|0.00|PARENTERAL NUTRITION|
20|FH_F113524_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F114207_35243_0|SrvcGrp|86830|2022|PDM|4.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F38584_0_0|SrvcGrp|17083|2022|PDM|822.00|99|0.00|ASPG X|
20|FH_F92300_37303_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124380_83406_0|SrvcGrp|73842|2022|PDM|228.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120083_13501_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|1560.00|99|0.00|AEG 10 (NO REV)|
20|FH_F47037_0_0|SrvcGrp|10542|2022|PDM|92.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F113869_40215_0|SrvcGrp|90854|2022|PDM|735.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F50612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97101_98003_0|CSTM-ALL|CSTM-00|2020|PCT|0.36|99|0.00|OP SVCS|
20|FH_F31547_0_0|SrvcGrp|537|2022|PCT|0.88|99|0.00|OBSERVATION SERVICES|
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|1866.00|99|0.00|AEG 10 (NO REV)|
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|1345.00|99|0.00|AEG 9 (NO REV)|
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|SOCIAL SKILLS TRAINING GROUP (HCFA)|
20|FH_F128741_92879_0|SrvcGrp|46617|2022|PDM|119.83|99|0.00|SKILLED NURSING HOME VISIT OR PROCEDURE|
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|716.00|99|0.00|AEG 1 (NO REV)|
20|FH_F148962_08109_0|SrvcGrp|74668|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124270_46256_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F35557_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1414794 AM HOME PAT DME BASE|
20|FH_F115483_62002_0|SrvcGrp|82981|2022|PDM|220.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F84433_0_0|SrvcGrp|44884|2022|PDM|93.36|99|0.00|PT SVCS INITIAL EVAL 97001 VISIT LEVEL|
20|FH_F138478_0_0|SrvcGrp|113287|2022|PCT|0.63|99|0.00|TOTAL JOINTS|
20|FH_F36743_0_0|SrvcGrp|359|2022|PDM|2100.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F40917_0_0|SrvcGrp|110|2022|PDM|483.00|99|0.00|CD - REHABILITATION|
20|FH_F110972_30512_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F141267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127464_15106_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132254_40207_0|SrvcGrp|86840|2022|PDM|40.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F143668_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|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F74670_0_0|SrvcGrp|11577|2022|PDM|440.00|99|0.00|DIALYSIS|
20|FH_F97084_91911_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F123745_0_0|SrvcGrp|92358|2022|PDM|16500.00|99|0.00|REMOVAL OF KNEE PROSTHESIS|
20|FH_F66405_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120100_98390_0|SrvcGrp|75419|2022|PDM|978.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF|
20|FH_F139878_33161_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139912_04101_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F140032_60550_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130918_01606_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F151743_20001_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120190_92624_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F132419_84042_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F33223_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F109848_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116552_70001_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F119918_38201_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F125479_17501_0|SrvcGrp|106248|2022|PDM|499.00|99|0.00|PARTIAL HOSP PSYCH|
20|FH_F40207_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP ARTHROSCOPIC KNEE SURGERY|
20|FH_F46158_0_0|SrvcGrp|17081|2022|PCT|0.65|99|0.00|ASPG IX|
20|FH_F93000_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F141861_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 6 (NO REV)|
20|FH_F142454_0_0|SrvcGrp|95110|2022|PDM|1000.00|99|0.00|DIABETIC RETINOPATHY|
20|FH_F149780_00783_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F91994_0_0|SrvcGrp|63472|2022|PDM|4800.00|99|0.00|CPT 64581|
20|FH_F151146_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131216_31901_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135249_73114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|83835|2022|PDM|5506.00|99|0.00|REPLACE TISSUE EXPANDER|
20|FH_F125983_82301_0|SrvcGrp|75419|2022|PDM|475.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F39740_0_0|SrvcGrp|20908|2022|PDM|12752.00|99|0.00|MS DRG 247 ONLY|
20|FH_F150982_0_0|SrvcGrp|104112|2022|PDM|5200.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F143580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145756_03801_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F39138_0_0|SrvcGrp|18140|2022|PDM|15967.00|99|0.00|MS DRG 246|
20|FH_F84215_0_0|SrvcGrp|37317|2022|PDM|4015.00|99|0.00|LITHOTRIPSY|
20|FH_F146940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127036_43724_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143928_21061_0|SrvcGrp|29346|2022|PDM|51.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F135220_21532_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136510_0_0|SrvcGrp|90603|2022|PDM|3882.00|99|0.00|EXTRACTION OF LENS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|2066.23|99|0.00|HAPA WPA-NWPA 2012-13 ASC 14 W/O REV|
20|FH_F125011_74467_0|SrvcGrp|72994|2022|PDM|1365.00|99|0.00|AEG 3|
20|FH_F131603_53051_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123486_61764_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F32156_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46001_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F39041_0_0|SrvcGrp|413|2022|PCT|0.75|99|0.00|TRANSPLANT SVCS|
20|FH_F140931_24014_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F50184_0_0|SrvcGrp|43785|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F78603_0_0|CSTM-ALL|CSTM-00|2020|PDM|3132.85|99|0.00|ACUTE IP MED SVCS|
20|FH_F148122_49435_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F42706_0_0|SrvcGrp|13854|2022|PDM|760.00|99|0.00|HYPERBARIC CHAMBER|
20|FH_F31736_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126465_37190_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F54513_0_0|SrvcGrp|11442|2022|PDM|475.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F133207_0_0|SrvcGrp|67066|2022|PDM|16353.00|99|0.00|CERVICAL SURGERY|
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PDM|1039.00|99|0.00|ASPG X|
20|FH_F47152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F125820_66436_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130032_72034_0|SrvcGrp|105421|2022|PDM|265.00|99|0.00|AETNA TERANIAL MAGN STIM TX PLAN|
20|FH_F84215_0_0|SrvcGrp|72998|2022|PDM|877.00|99|0.00|AEG 5|
20|FH_F87254_0_0|SrvcGrp|44064|2022|PDM|1100.00|99|0.00|CPT 52351|
20|FH_F118194_50841_0|SrvcGrp|86843|2022|PDM|145.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F126883_78621_0|SrvcGrp|86722|2022|PDM|195.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F71665_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F130807_20721_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120215_92064_0|SrvcGrp|73605|2022|PDM|970.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F121495_92009_0|SrvcGrp|74668|2022|PDM|550.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F93424_53578_0|SrvcGrp|43524|2022|PDM|239.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F150462_30458_0|SrvcGrp|17001|2022|PDM|100.00|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F131420_29693_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F32260_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F75425_0_0|SrvcGrp|33165|2022|PDM|550.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F128132_69361_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F71047_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148343_70810_0|SrvcGrp|16|2022|PDM|950.00|99|0.00|ACUTE REHABILITATION|
20|FH_F118194_50841_0|SrvcGrp|17016|2022|PDM|240.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F137946_0_0|SrvcGrp|113245|2022|PDM|42.13|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 SCR (HCFA)|
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|1510.00|99|0.00|AEG 8 (NO REV)|
20|FH_F128190_45342_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F35476_0_0|SrvcGrp|20299|2022|PDM|34498.00|99|0.00|MS DRG 228-230 ONLY OTHER CARDIOTHORACIC PROC|
20|FH_F128307_43219_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F132374_0_0|SrvcGrp|97467|2022|PDM|3627.06|99|0.00|PARTIAL EXCISION THYROID|
20|FH_F121495_92009_0|SrvcGrp|89337|2022|PDM|1250.00|99|0.00|DETOXIFICATION|
20|FH_F150462_30458_0|SrvcGrp|10578|2022|PDM|50.00|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F133207_0_0|SrvcGrp|36864|2022|PDM|14001.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F82753_18840_0|SrvcGrp|73500|2022|PDM|623.00|99|0.00|AETNA ER LEVEL I|
20|FH_F136092_0_0|SrvcGrp|93098|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F128159_45356_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F89475_71202_0|SrvcGrp|9866|2022|PDM|2008.00|99|0.00|IP OBSERVATION SVCS|
20|FH_F31244_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F97440_0_0|SrvcGrp|75746|2022|PCT|5.50|99|0.00|AETNA PT AND CHIRO|
20|FH_F124017_0_0|SrvcGrp|109667|2022|PDM|7000.00|99|0.00|ARTHRODESIS, ANT INTER TECH|
20|FH_F117082_66216_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|418.79|99|0.00|HAPA WPA-NWPA 2012-13 ASC 206 W/O REV|
20|FH_F120876_85250_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F148266_45419_0|SrvcGrp|38907|2022|PDM|967.19|99|0.00|CPT 66170 - FISTULIZATION OF SCLERA FOR GLAUCOMA|
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ASPG IV|
20|FH_F145542_70503_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F72704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F82871_33160_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F66222_0_0|SrvcGrp|48005|2022|PDM|220.43|99|0.00|HOME HEALTH AIDE|
20|FH_F127584_45219_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|GENERAL ACUTE CARE|
20|FH_F89475_71202_0|SrvcGrp|114613|2022|PCT|2.00|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|13245.00|99|0.00|MS DRG 238|
20|FH_F115049_78539_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F123385_03561_0|SrvcGrp|27969|2022|PDM|29.56|99|0.00|HOME HEALTH AIDE|
20|FH_F143819_29485_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F143900_63303_0|SrvcGrp|108484|2022|PDM|522.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F143968_94520_0|SrvcGrp|90854|2022|PDM|1300.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F129231_30060_0|SrvcGrp|111258|2022|PDM|1789.00|99|0.00|REPAIR RETINAL DETACH CPLX (MOD LT)|
20|FH_F121490_86314_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F141592_80233_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118884_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|987.00|99|0.00|AEG 3 (NO REV)|
20|FH_F145542_70503_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F148320_02130_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F128228_40047_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F86851_0_0|SrvcGrp|84988|2022|PDM|324.00|99|0.00|CPT 45305|
20|FH_F89372_0_0|SrvcGrp|15386|2022|PCT|0.00|99|0.00|CLINIC VISIT|
20|FH_F89495_0_0|SrvcGrp|88538|2022|PDM|1875.00|99|0.00|RETINAL PROCEDURES|
20|FH_F87474_0_0|SrvcGrp|9874|2022|PDM|39.00|99|0.00|DIETICIAN|
20|FH_F62579_0_0|SrvcGrp|29677|2022|PDM|140.00|99|0.00|HOME INFUSION NURSING SVCS MOD SD|
20|FH_F62579_0_0|CSTM-ALL|CSTM-00|2020|PDM|80.00|99|0.00|HOME INFUSION NURSING SERVICES MOD SD|
20|FH_F38411_0_0|SrvcGrp|28989|2022|PCT|0.90|99|0.00|AIR AMBULANCE|
20|FH_F125139_84096_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F150225_03051_0|SrvcGrp|87077|2022|PDM|135.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F134208_21502_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F96160_32207_0|SrvcGrp|82846|2022|PCT|1.14|99|0.00|AETNA DME|
20|FH_F32594_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F133943_01606_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148600_30328_0|SrvcGrp|99073|2022|PCT|1.10|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F83995_16748_0|SrvcGrp|76033|2022|PDM|300.00|99|0.00|EMERGENCY ROOM|
20|FH_F114404_73044_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63821|2022|PDM|539.56|99|0.00|HAPA WPA-NWPA 2012-13 ASC 212|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU KF"|
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|2688.00|99|0.00|AEG 7 (NO REV)|
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|2090.00|99|0.00|AEG 4 (NO REV)|
20|FH_F88698_18951_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136359_0_0|SrvcGrp|103329|2022|PDM|8100.00|99|0.00|INSJ STABLJ DEV W/ DCMPRN|
20|FH_F133877_84117_0|SrvcGrp|83522|2022|PDM|93.00|99|0.00|RESPITE CARE|
20|FH_F60041_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114606_0_0|SrvcGrp|80317|2022|PDM|131.76|99|0.00|RESPITE CARE|
20|FH_F77082_0_0|SrvcGrp|360|2022|PDM|2060.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F123851_03235_0|SrvcGrp|43569|2022|PDM|154.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F77943_0_0|SrvcGrp|71860|2022|PCT|0.70|99|0.00|PERCUTANEOUS PROCEDURES|
20|FH_F70863_0_0|SrvcGrp|14371|2022|PDM|15.00|99|0.00|DISPOSABLE DRUG DELIVERY|
20|FH_F79743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F111744_32514_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F130763_0_0|SrvcGrp|87055|2022|PDM|4717.00|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION|
20|FH_F103320_0_0|SrvcGrp|113695|2022|PDM|2197.00|99|0.00|COLONOSCOPY W/ RESECTION|
20|FH_F119937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135670_01749_0|SrvcGrp|17016|2022|PDM|42.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129440_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANESTHESIOLOGIST/CRNA (HAN5)|
20|FH_F83380_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INTERIM INFUSION REV CODE 649|
20|FH_F51934_0_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F133957_84121_0|SrvcGrp|48385|2022|PDM|84.50|99|0.00|SPEECH THERAPY|
20|FH_F110184_0_0|SrvcGrp|8950|2022|PDM|1400.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F141167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132707_83716_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|798.20|99|0.00|AEG 2 (NO REV)|
20|FH_F100782_0_0|SrvcGrp|105153|2022|PDM|402.10|99|0.00|WINDBER MEDICAL CNTR ASC 313|
20|FH_F95623_84015_0|SrvcGrp|53746|2022|PDM|90.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F116806_0_0|SrvcGrp|107028|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MANDIBLE/MAXILLA-COMPLETE ENDOSTEAL IMPLAN|
20|FH_F138050_52301_0|CSTM-ALL|CSTM-00|2020|PDM|8287.00|99|0.00|AEG 9 (NO REV)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.46|99|0.00|HAPA WPA-NWPA 2012-13 ASC 225 W/O REV|
20|FH_F127849_43920_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F97840_54729_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|321.40|99|0.00|ASPG I|
20|FH_F134647_35244_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132889_63740_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F69708_0_0|SrvcGrp|14372|2022|PDM|44.00|99|0.00|AMBULATORY INFUSION PUMP|
20|FH_F150165_06032_0|SrvcGrp|35670|2022|PDM|4583.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F69708_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F74024_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F39902_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F85214_70360_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117300_0_0|SrvcGrp|88158|2022|PDM|7360.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F130017_02302_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145714_44135_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F61072_0_0|SrvcGrp|42827|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F37698_0_0|SrvcGrp|9527|2022|PDM|1200.00|99|0.00|NORMAL DELIVERY|
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150165_06032_0|CSTM-ALL|CSTM-00|2020|PDM|2069.00|99|0.00|AEG 3 (NO REV)|
20|FH_F37910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F139723_30066_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50703_0_0|CSTM-ALL|CSTM-00|2020|PDM|475.00|99|0.00|REMICAIDE INFUSION (W/MOD SD)|
20|FH_F132969_84003_0|SrvcGrp|24750|2022|PDM|10.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F123638_0_0|SrvcGrp|108546|2022|PDM|417.00|99|0.00|PERITONEAL TREATMENTS W/ PATIENT TRAINING|
20|FH_F85764_33308_0|SrvcGrp|471|2022|PDM|446.25|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F110507_33462_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133585_0_0|SrvcGrp|77280|2022|PDM|1786.00|99|0.00|AETNA REPL TUNNLD CNTRL CVAD W/SUB|
20|FH_F93371_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F31714_0_0|SrvcGrp|12047|2022|PCT|2.00|99|0.00|CPT CODES 80000-89999, 36415 (LAB)|
20|FH_F112408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136207_0_0|SrvcGrp|30089|2022|PDM|450.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F146657_01105_0|SrvcGrp|114658|2022|PDM|16.15|99|0.00|SPECIALIZED CHILDCARE|
20|FH_F150599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145641_06902_0|SrvcGrp|88491|2022|PDM|3869.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F81698_10457_0|SrvcGrp|24744|2022|PDM|57.75|99|0.00|PICC LINE INSERTION|
20|FH_F63398_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149031_80525_0|SrvcGrp|108484|2022|PDM|750.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F138302_15701_0|SrvcGrp|88621|2022|PDM|60.00|99|0.00|SKILLED NURSING LPN|
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|4590.00|99|0.00|AEG 6 (NO REV)|
20|FH_F150144_39452_0|SrvcGrp|74668|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F124371_0_0|SrvcGrp|13683|2022|PDM|498.38|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F145604_14850_0|SrvcGrp|16750|2022|PDM|165.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F130763_0_0|SrvcGrp|77461|2022|PDM|4020.00|99|0.00|CPT 52356|
20|FH_F54592_0_0|SrvcGrp|17002|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS|
20|FH_F69606_0_0|SrvcGrp|64104|2022|PDM|894.40|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 5|
20|FH_F122470_78229_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F122553_92705_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F85553_0_0|SrvcGrp|14242|2022|PDM|398.00|99|0.00|EMERGENCY ROOM SVCS LEVEL IV|
20|FH_F70607_0_0|SrvcGrp|12023|2022|PDM|150.00|99|0.00|HOSPICE RESPITE SERVICES|
20|FH_F75184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F105340_13502_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115870_98225_0|SrvcGrp|89149|2022|PDM|180.00|99|0.00|OP INTENSIVE|
20|FH_F63625_0_0|SrvcGrp|39579|2022|PCT|0.60|99|0.00|TPA|
20|FH_F75842_0_0|SrvcGrp|46522|2022|PDM|21379.24|99|0.00|TOTAL KNEE|
20|FH_F146812_50401_0|CSTM-ALL|CSTM-00|2020|PDM|2133.00|99|0.00|AEG 4 (NO REV)|
20|FH_F131860_38834_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133592_63957_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133478_40165_0|SrvcGrp|22781|2022|PDM|21685.00|99|0.00|MS DRG 244 ONLY|
20|FH_F111584_07002_0|SrvcGrp|86648|2022|PCT|1.16|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F111604_16505_0|SrvcGrp|73841|2022|PDM|330.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|3329.00|99|0.00|AEG 7 (NO REV)|
20|FH_F123752_44502_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F132810_0_0|SrvcGrp|86837|2022|PDM|25.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F150220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2994.00|99|0.00|AEG 7 (NO REV)|
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_F107200_0_0|SrvcGrp|101527|2022|PDM|2289.00|99|0.00|HYSTEROSCOPY LYSIS|
20|FH_F136411_67031_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118152_20151_0|SrvcGrp|86832|2022|PDM|3.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F118170_18901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120489_63552_0|SrvcGrp|537|2022|PCT|0.75|99|0.00|OBSERVATION SERVICES|
20|FH_F134011_84102_0|SrvcGrp|103382|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY (PICC) NURSING SVCS ONLY (UP TO 2 HRS)|
20|FH_F134011_84102_0|SrvcGrp|86851|2022|PDM|25.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F137036_60504_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F137237_33304_0|SrvcGrp|86722|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F114092_83350_0|SrvcGrp|10393|2022|PDM|4700.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F138019_79705_0|SrvcGrp|90854|2022|PDM|777.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F142547_70002_0|SrvcGrp|86852|2022|PDM|22.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F142727_21222_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F51276_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|HOME NURSING / SPECIALIZED NURSING|
20|FH_F97566_79902_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F97582_46307_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F138512_62236_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138584_30912_0|SrvcGrp|113416|2022|PDM|550.00|99|0.00|EXCISION OF BONE FACIAL|
20|FH_F140612_60070_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140760_07003_0|SrvcGrp|91070|2022|PDM|372.00|99|0.00|AETNA MH CRISIS INTERVENTION (HCFA)|
20|FH_F120152_0_0|SrvcGrp|108348|2022|PDM|2750.00|99|0.00|TREAT FRACTURE RADIUS/ULNA|
20|FH_F151601_89118_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F151603_27609_0|SrvcGrp|41335|2022|PDM|12885.26|99|0.00|TOTAL HIP|
20|FH_F118943_64506_0|SrvcGrp|107697|2022|PCT|1.00|99|0.00|AETNA ALL DRUGS AGENTS INJ|
20|FH_F118943_64506_0|SrvcGrp|103739|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F83931_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F38332_0_0|SrvcGrp|18107|2022|PDM|42216.00|99|0.00|MS DRG 236|
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|2242.90|99|0.00|AETNA GLENNVILLE 2016 AEG 9|
20|FH_F117371_77059_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F117154_43017_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F117217_80304_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1128.00|99|0.00|AEG 7 (NO REV)|
20|FH_F115868_0_0|SrvcGrp|80317|2022|PDM|135.00|99|0.00|RESPITE CARE|
20|FH_F38699_0_0|SrvcGrp|17079|2022|PDM|1159.00|99|0.00|ASPG VIII|
20|FH_F91472_96001_0|SrvcGrp|73483|2022|PDM|3593.00|99|0.00|AETNA SUBACUTE III|
20|FH_F91067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
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_F95880_02726_0|SrvcGrp|94744|2022|PDM|56.65|99|0.00|NOS FLU VACC IM (>=3 YRS)|
20|FH_F151063_44094_0|SrvcGrp|89149|2022|PDM|220.00|99|0.00|OP INTENSIVE|
20|FH_F151155_26508_0|SrvcGrp|113335|2022|PDM|200.00|99|0.00|MED ASSIST TX NO DRUG (HFCA)|
20|FH_F121976_44505_0|SrvcGrp|73842|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F113139_0_0|SrvcGrp|104922|2022|PDM|400.00|99|0.00|ENDOLUMINL IVUS OCT C 1ST-CONCUR|
20|FH_F129130_92562_0|SrvcGrp|73559|2022|PDM|6086.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F31525_0_0|CSTM-ALL|CSTM-00|2020|PDM|1745.00|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_F85002_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|IMPLANTS|
20|FH_F73231_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INFUSION REV CODE 642|
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F114916_30309_0|SrvcGrp|95559|2022|PDM|18000.00|99|0.00|HIP JOINT|
20|FH_F142448_15701_0|SrvcGrp|10577|2022|PDM|45.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F105591_17601_0|SrvcGrp|105399|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_F136793_0_0|CSTM-ALL|CSTM-00|2020|PDM|974.00|99|0.00|AEG 6 (NO REV)|
20|FH_F138929_0_0|SrvcGrp|75002|2022|PDM|5005.00|99|0.00|ARTHOSCOPY|
20|FH_F138929_0_0|SrvcGrp|82108|2022|PDM|3520.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F94786_07974_0|SrvcGrp|24752|2022|PDM|15.75|99|0.00|HORMONE INJECTION THERAPY|
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|98007|2022|PDM|2057.62|99|0.00|FINGER/THUMB AMPUTATION|
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|429.00|99|0.00|AEG 1 (NO REV)|
20|FH_F128027_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F141050_46410_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141127_62286_0|SrvcGrp|90076|2022|PCT|0.80|99|0.00|CARDIC CATH PROCEDURES|
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F114389_50131_0|SrvcGrp|105614|2022|PDM|474.38|99|0.00|HEATED HUMIDIFIER (MOD NU)|
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_F129849_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F124060_76040_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F146674_70778_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F146972_17931_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146906_60445_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146907_24521_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F45518_0_0|CSTM-ALL|CSTM-00|2020|PCT|52.50|99|0.00|OP SVCS|
20|FH_F132864_71101_0|SrvcGrp|105465|2022|PCT|2.15|99|0.00|AETNA THERAPIES|
20|FH_F124233_92648_0|SrvcGrp|46903|2022|PDM|1200.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F125824_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F146290_0_0|CSTM-ALL|CSTM-00|2020|PDM|2617.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136624_15025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F136689_45044_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F113787_31909_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP|
20|FH_F42980_0_0|SrvcGrp|50203|2022|PDM|125.00|99|0.00|CPT 99214|
20|FH_F136796_24016_0|SrvcGrp|58773|2022|PDM|2440.83|99|0.00|ARTHROSCOPY KNEE|
20|FH_F136913_68803_0|SrvcGrp|112966|2022|PCT|2.00|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F113713_17013_0|SrvcGrp|105372|2022|PDM|55.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MIN|
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1265.00|99|0.00|AEG 5  (NO REV)|
20|FH_F38826_0_0|SrvcGrp|23342|2022|PCT|0.80|99|0.00|TRAUMA CARE|
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F116393_07002_0|SrvcGrp|106517|2022|PDM|9.83|99|0.00|C-REACTIVE PROTEIN|
20|FH_F147439_84003_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147586_44124_0|SrvcGrp|36591|2022|PDM|29309.00|99|0.00|CPT 63685|
20|FH_F147501_52655_0|SrvcGrp|42623|2022|PCT|0.90|99|0.00|SUBACUTE - LEVEL III|
20|FH_F100783_03431_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F103004_75840_0|SrvcGrp|88977|2022|PDM|3250.00|99|0.00|C-SECTION DELIVERY|
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|526.00|99|0.00|AEG 1 (NO REV)|
20|FH_F47693_16148_0|SrvcGrp|10503|2022|PDM|47.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F141471_0_0|SrvcGrp|107876|2022|PDM|2012.00|99|0.00|MECH REMV PERICATH MATL SEP|
20|FH_F133107_73071_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|795.00|99|0.00|AEG 5  (NO REV)|
20|FH_F39346_0_0|SrvcGrp|439|2022|PDM|1500.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F111292_33136_0|SrvcGrp|3378|2022|PDM|3384.00|99|0.00|OBSERVATION SVCS|
20|FH_F111292_33136_0|SrvcGrp|45582|2022|PDM|40.00|99|0.00|CPT 85610|
20|FH_F134260_02155_0|SrvcGrp|86722|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F141651_0_0|SrvcGrp|98402|2022|PDM|3850.00|99|0.00|RHINO INCL MJR SEPTAL RPR|
20|FH_F116275_0_0|SrvcGrp|105356|2022|PCT|0.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD - INCL CODES|
20|FH_F44336_0_0|SrvcGrp|170|2022|PDM|354.00|99|0.00|CD (ADOLESCENT) - REHAB|
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1665.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132328_0_0|SrvcGrp|99155|2022|PDM|2049.00|99|0.00|WRST ARTHROS SURG|
20|FH_F72666_0_0|SrvcGrp|69689|2022|PCT|0.75|99|0.00|OP GAMMA KNIFE|
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)|
20|FH_F102222_19720_0|SrvcGrp|86840|2022|PDM|31.50|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F130027_76201_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F102960_50613_0|SrvcGrp|78504|2022|PCT|0.65|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F119245_19010_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F119289_43040_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F119315_70663_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148419_01453_0|SrvcGrp|115383|2022|PCT|1.00|99|0.00|COVID-19 INFUSION ADMINISTRATION - REGENERON|
20|FH_F148554_85016_0|SrvcGrp|115435|2022|PDM|3000.00|99|0.00|INSERT HEART PM ATRIAL|
20|FH_F120089_0_0|SrvcGrp|75497|2022|PDM|718.00|99|0.00|AEG 10|
20|FH_F125660_46706_0|SrvcGrp|471|2022|PDM|520.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F150001_33064_0|SrvcGrp|86849|2022|PDM|26.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F113403_62274_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F117835_14551_0|SrvcGrp|76501|2022|PDM|250.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F132837_64118_0|SrvcGrp|73559|2022|PDM|2122.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F42453_0_0|CSTM-ALL|CSTM-00|2020|PDM|775.00|99|0.00|SPINAL CORD REHABILITATION|
20|FH_F72940_0_0|SrvcGrp|9438|2022|PCT|0.85|99|0.00|TRAUMA CARE|
20|FH_F120725_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.37|99|0.00|OP SVCS|
20|FH_F87436_0_0|SrvcGrp|105466|2022|PDM|1042.00|99|0.00|ACUTE PSYCH/CD|
20|FH_F121168_0_0|SrvcGrp|94781|2022|PDM|100.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F63301_0_0|SrvcGrp|17140|2022|PDM|139.76|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F87615_80033_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS|
20|FH_F120089_0_0|SrvcGrp|75479|2022|PDM|330.00|99|0.00|AEG 1|
20|FH_F117717_68410_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F91155_16105_0|SrvcGrp|86610|2022|PDM|8.11|99|0.00|ROUTINE VENIPUNCTURE|
20|FH_F147800_0_0|SrvcGrp|115149|2022|PDM|132.00|99|0.00|NJX AA&/STRD II IH NERVES|
20|FH_F87173_15136_0|SrvcGrp|81950|2022|PCT|1.00|99|0.00|AETNA LABORATORY|
20|FH_F117855_62246_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F90811_0_0|SrvcGrp|90434|2022|PDM|2000.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F111809_93003_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F64659_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F97140_91730_0|SrvcGrp|73559|2022|PDM|9676.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F37562_0_0|SrvcGrp|24286|2022|PDM|32.50|99|0.00|SKILLED NURSING CARE|
20|FH_F72648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102822_84065_0|SrvcGrp|27969|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|AEG 4 (NO REV)|
20|FH_F113291_37055_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149781_37404_0|SrvcGrp|72121|2022|PDM|4500.00|99|0.00|ARTHOSCOPY|
20|FH_F83294_0_0|SrvcGrp|22387|2022|PDM|85.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1329.00|99|0.00|AEG 8 (NO REV)|
20|FH_F43330_0_0|SrvcGrp|11068|2022|PDM|90.00|99|0.00|PT SVCS|
20|FH_F72065_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|PDM|677.00|99|0.00|AEG 2 (NO REV)|
20|FH_F117745_15801_0|SrvcGrp|472|2022|PDM|320.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117756_75402_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F141807_33020_0|CSTM-ALL|CSTM-00|2020|PDM|1236.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS|
20|FH_F39995_0_0|SrvcGrp|177|2022|PDM|1100.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F146320_27610_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117385_48091_0|SrvcGrp|23587|2022|PDM|380.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F49637_0_0|CSTM-ALL|CSTM-00|2020|PDM|1328.00|99|0.00|OK SURGICAL HOSPITAL CVTY ENHANCED GROUPER 2|
20|FH_F112852_73112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126666_44053_0|SrvcGrp|105369|2022|PDM|39.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MINS|
20|FH_F117346_75093_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F147800_0_0|SrvcGrp|115144|2022|PDM|660.00|99|0.00|NJX AA&/STRD NTRCOST NRV 1|
20|FH_F150000_30152_0|SrvcGrp|94299|2022|PCT|1.60|99|0.00|NEW PT OFFICE VISIT|
20|FH_F128127_57028_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38725_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|OCN F/S PRICING: ALL|
20|FH_F75706_0_0|SrvcGrp|42828|2022|PDM|50.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F123545_44512_0|SrvcGrp|105265|2022|PDM|280.00|99|0.00|HEMODIALYSIS|
20|FH_F146159_89102_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F88512_0_0|SrvcGrp|46502|2022|PDM|7640.63|99|0.00|MS DRG 215-241,245, 250-265 CARDIAC SURGERY|
20|FH_F88512_0_0|SrvcGrp|46518|2022|PDM|10889.63|99|0.00|ELECTROPHYSIOLOGY STUDIES|
20|FH_F37035_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CEDAR OAKS, RENTAL, SURGERY|
20|FH_F144769_0_0|SrvcGrp|329|2022|PDM|21560.00|99|0.00|DRG 288 GASTROPLASTY PROCEDURE OBESITY|
20|FH_F119229_90804_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F150122_75020_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144468_45236_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132837_64118_0|SrvcGrp|78579|2022|PDM|1997.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKE|
20|FH_F45974_0_0|SrvcGrp|17000|2022|PCT|0.75|99|0.00|OUTPATIENT SURGERY|
20|FH_F40030_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ACUTE PSYCH|
20|FH_F101840_76054_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F117838_12901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142822_63437_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F81373_64064_0|SrvcGrp|8950|2022|PDM|4814.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F117450_63131_0|SrvcGrp|48385|2022|PDM|114.00|99|0.00|SPEECH THERAPY|
20|FH_F123012_27703_0|SrvcGrp|108484|2022|PDM|1250.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F103360_68845_0|SrvcGrp|24598|2022|PDM|1501.00|99|0.00|MS DRG 945-946 ONLY|
20|FH_F150024_08079_0|SrvcGrp|67072|2022|PDM|750.00|99|0.00|CPT 22845|
20|FH_F112832_06776_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44135_0_0|SrvcGrp|15850|2022|PDM|70.00|99|0.00|HOSPICE SVCS|
20|FH_F126806_44125_0|SrvcGrp|65720|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|2065.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F133021_00910_0|SrvcGrp|112269|2022|PDM|8000.00|99|0.00|PTCA ROT ABLATOR|
20|FH_F87173_15136_0|SrvcGrp|85602|2022|PCT|1.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F115889_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT|
20|FH_F97103_53295_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F142776_65338_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150768_03054_0|SrvcGrp|104226|2022|PDM|208.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 2 (NO REV)|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|VERTICAL PLUS MRI NO MOD|
20|FH_F34777_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F86714_0_0|SrvcGrp|32995|2022|PDM|199.13|99|0.00|PHYSICAL THERAPY SVCS INITIAL EVAL|
20|FH_F52278_0_0|SrvcGrp|30401|2022|PCT|1.10|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F97081_21122_0|SrvcGrp|96699|2022|PDM|158.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F124514_21215_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F67281_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|85785|2022|PDM|2202.00|99|0.00|ARTHROSCOPY|
20|FH_F120144_77031_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F116583_0_0|SrvcGrp|106934|2022|PDM|150.00|99|0.00|HOSPICE/HH PLACE NOS (HCFA)|
20|FH_F84833_17109_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|12.00|99|0.00|HICKMAN/BROVIAC LUMEN CATH CARE|
20|FH_F129256_89146_0|SrvcGrp|73842|2022|PDM|306.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F47558_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F111266_30339_0|SrvcGrp|14948|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F144651_0_0|SrvcGrp|114174|2022|PDM|6600.00|99|0.00|REMOVE/REINSER SPINE FIXATION DEVICE|
20|FH_F149399_17013_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116549_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149003_62208_0|SrvcGrp|46605|2022|PDM|89.61|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F149582_01534_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147209_60202_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129765_43015_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F115483_62002_0|SrvcGrp|109057|2022|PCT|0.60|99|0.00|CARDIAC STUDIES|
20|FH_F116583_0_0|SrvcGrp|104229|2022|PDM|150.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F102525_73134_0|SrvcGrp|26682|2022|PDM|80000.00|99|0.00|MS DRG 453 ONLY|
20|FH_F147083_46304_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F36165_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INFUSION|
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|1755.00|99|0.00|AEG 2 (NO REV)|
20|FH_F128839_0_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F90223_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F41463_0_0|SrvcGrp|35716|2022|PDM|165.00|99|0.00|OXYGEN RENTAL (E0424 ONLY)|
20|FH_F74670_0_0|SrvcGrp|46723|2022|PDM|180.00|99|0.00|WORK HARDENING|
20|FH_F110121_0_0|SrvcGrp|72990|2022|PDM|788.00|99|0.00|AEG 1|
20|FH_F149000_07701_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F128375_03909_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140295_0_0|SrvcGrp|88159|2022|PDM|8169.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F108460_32746_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132818_24701_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F133569_17202_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F98880_50158_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F134847_0_0|SrvcGrp|88160|2022|PDM|6110.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F128755_62702_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150938_02062_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F113869_40215_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F110783_93013_0|SrvcGrp|86829|2022|PDM|35.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F36343_0_0|SrvcGrp|22400|2022|PDM|15.00|99|0.00|A4250|
20|FH_F127553_44321_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F140576_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F90817_0_0|SrvcGrp|54962|2022|PDM|2096.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)|
20|FH_F130182_0_0|SrvcGrp|27261|2022|PDM|8323.00|99|0.00|CPT 27446|
20|FH_F147361_19806_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F94621_07728_0|SrvcGrp|91294|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F117617_80439_0|SrvcGrp|107590|2022|PDM|165.00|99|0.00|HOSPICE CARE PROV SKILLED NURSING FAC|
20|FH_F150982_0_0|SrvcGrp|90365|2022|PDM|1976.00|99|0.00|REPAIR METACARPAL FRACTURE|
20|FH_F149515_66002_0|SrvcGrp|75419|2022|PDM|392.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F150928_62521_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97084_91911_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 2 (NO REV)|
20|FH_F93172_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F148959_77375_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F114332_19973_0|SrvcGrp|82846|2022|PCT|1.05|99|0.00|AETNA DME|
20|FH_F150442_28451_0|SrvcGrp|41334|2022|PDM|7000.00|99|0.00|TOTAL KNEE|
20|FH_F143850_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F97184_26101_0|SrvcGrp|73605|2022|PDM|1797.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F149579_95815_0|SrvcGrp|115694|2022|PDM|161.17|99|0.00|PSYCHIATRIC COLLABORATIVE CARE MGMT 1ST (MOD AH)(HCFA)|
20|FH_F137748_95231_0|CSTM-ALL|CSTM-00|2020|PDM|1595.00|99|0.00|AEG 1 (NO REV)|
20|FH_F124492_30040_0|SrvcGrp|113228|2022|PDM|156.89|99|0.00|COVID-19 NFCT DS VIR RESP RNA 4 TRGT|
20|FH_F71468_0_0|SrvcGrp|15071|2022|PDM|145.00|99|0.00|PHOTOTHERAPY (BILIRUBIN)|
20|FH_F146266_0_0|SrvcGrp|92010|2022|PDM|1900.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE|
20|FH_F93740_0_0|SrvcGrp|73008|2022|PDM|500.00|99|0.00|AEG 10|
20|FH_F115208_0_0|SrvcGrp|79794|2022|PDM|1485.00|99|0.00|EYE/OCULAR ADNEXA SURGERY|
20|FH_F115208_0_0|SrvcGrp|22914|2022|PDM|955.00|99|0.00|CPT CODE 69436|
20|FH_F130951_15237_0|SrvcGrp|93098|2022|PDM|115.00|99|0.00|HOSPICE CARE|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|941.00|99|0.00|GA RETINA SURG CTR ASC 21|
20|FH_F120921_75835_0|SrvcGrp|471|2022|PDM|555.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F125479_17501_0|SrvcGrp|103669|2022|PDM|499.00|99|0.00|AETNA PARTIAL HOSP (HCFA)|
20|FH_F84611_30281_0|SrvcGrp|82073|2022|PCT|0.73|99|0.00|RADIOTHERAPY|
20|FH_F36274_0_0|SrvcGrp|12401|2022|PDM|90.00|99|0.00|RN VISIT|
20|FH_F142454_0_0|SrvcGrp|42550|2022|PDM|1400.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F143467_0_0|SrvcGrp|92366|2022|PDM|3140.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F147005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F150200_0_0|SrvcGrp|77021|2022|PDM|4590.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F38431_0_0|SrvcGrp|23011|2022|PDM|1600.00|99|0.00|V5250|
20|FH_F59732_0_0|SrvcGrp|50166|2022|PDM|95.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 3 HRS|
20|FH_F59732_0_0|SrvcGrp|24750|2022|PDM|80.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F59732_0_0|SrvcGrp|22592|2022|PDM|80.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F34550_0_0|CSTM-ALL|CSTM-00|2020|PDM|3406.00|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F145545_01602_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHYSICIAN CLINIC VISIT NATL F/S (MOD 53)|
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F36154_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CV SURGERY|
20|FH_F90362_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|REMOVAL OF TISSUE FOR GRAFT|
20|FH_F82753_18840_0|SrvcGrp|105465|2022|PCT|0.87|99|0.00|AETNA THERAPIES|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|ASPG IV|
20|FH_F138020_20016_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148262_17901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120215_92064_0|SrvcGrp|89337|2022|PDM|1300.00|99|0.00|DETOXIFICATION|
20|FH_F147941_06023_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F79645_0_0|SrvcGrp|62259|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F92659_0_0|SrvcGrp|23936|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F128970_54729_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143783_0_0|SrvcGrp|97705|2022|PDM|105.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F147941_06023_0|SrvcGrp|105465|2022|PDM|378.00|99|0.00|AETNA THERAPIES|
20|FH_F43118_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F126585_45039_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F130889_68818_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F40043_0_0|SrvcGrp|8|2022|PDM|2792.00|99|0.00|BURN INTENSIVE CARE|
20|FH_F109645_0_0|SrvcGrp|91677|2022|PDM|88.00|99|0.00|AETNA SKILLED NURSE IN HOME HEALTH SETTING|
20|FH_F125710_02860_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|732.38|99|0.00|HAPA WPA-NWPA 2012-13 ASC 5 W/O REV|
20|FH_F139241_0_0|SrvcGrp|12491|2022|PCT|0.55|99|0.00|PACEMAKER|
20|FH_F129231_30060_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92411_0_0|SrvcGrp|76094|2022|PDM|131.46|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F149859_60005_0|SrvcGrp|90854|2022|PDM|735.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F82955_34266_0|CSTM-ALL|CSTM-00|2020|PCT|1.38|99|0.00|(JCODES-IMMUN) OCN F/S PRICING: ALL|
20|FH_F123265_68154_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138450_0_0|SrvcGrp|111928|2022|PDM|51.30|99|0.00|COVID-19 BARTONELLA|
20|FH_F115046_77964_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F148486_03110_0|SrvcGrp|472|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F125890_43054_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F100790_10512_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F137946_0_0|SrvcGrp|82981|2022|PDM|140.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|1459.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F66422_0_0|SrvcGrp|474|2022|PDM|290.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F101021_0_0|SrvcGrp|90707|2022|PDM|83.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|1298.00|99|0.00|AEG 9 (NO REV)|
20|FH_F44582_0_0|SrvcGrp|13880|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F92276_32308_0|CSTM-ALL|CSTM-00|2020|PDM|14333.00|99|0.00|AEG 5  (NO REV)|
20|FH_F94461_63090_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143783_0_0|SrvcGrp|97507|2022|PDM|105.00|99|0.00|AETNA HOSPICE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1075.56|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1404 W/O REV|
20|FH_F115685_64064_0|SrvcGrp|86837|2022|PDM|20.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F93534_45690_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123265_68154_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F46612_0_0|SrvcGrp|26742|2022|PDM|154.00|99|0.00|PT|
20|FH_F133207_0_0|SrvcGrp|67065|2022|PDM|16353.00|99|0.00|CERVICAL SURGERY|
20|FH_F33850_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS|
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.00|99|0.00|AEG 2 (NO REV)|
20|FH_F72051_0_0|SrvcGrp|66481|2022|PDM|75.00|99|0.00|SOCIAL WORKER|
20|FH_F137574_68130_0|SrvcGrp|53145|2022|PCT|1.00|99|0.00|SOCIAL WORKER|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|ASPG VII|
20|FH_F94403_0_0|SrvcGrp|44461|2022|PDM|7150.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F88199_0_0|SrvcGrp|27969|2022|PDM|19.80|99|0.00|HOME HEALTH AIDE|
20|FH_F83672_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41021_0_0|SrvcGrp|17077|2022|PDM|6738.00|99|0.00|ASPG VII|
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|ASPG X|
20|FH_F139173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F123302_33407_0|SrvcGrp|87317|2022|PDM|789.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F40840_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS|
20|FH_F40304_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|OP SVCS|
20|FH_F148258_66062_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F102184_0_0|SrvcGrp|58993|2022|PDM|7215.00|99|0.00|DISKECTOMY|
20|FH_F101021_0_0|SrvcGrp|94781|2022|PDM|83.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|1065.00|99|0.00|AEG 4 (NO REV)|
20|FH_F62719_0_0|SrvcGrp|44713|2022|PDM|108.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F110226_0_0|CSTM-ALL|CSTM-00|2020|PCT|62.00|99|0.00|OP SVCS|
20|FH_F92276_32308_0|SrvcGrp|114020|2022|PCT|2.98|99|0.00|LABORATORY SERVICES|
20|FH_F125249_0_0|SrvcGrp|100076|2022|PDM|1200.00|99|0.00|FUSION OF HAND BONES|
20|FH_F89475_71202_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F127375_28621_0|SrvcGrp|79699|2022|PCT|0.69|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F100762_51104_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F120059_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F116161_28112_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116269_92627_0|SrvcGrp|86648|2022|PCT|1.15|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F41178_0_0|CSTM-ALL|CSTM-00|2020|PDM|451.00|99|0.00|PSYCHIATRIC RESIDENTIAL TREATMENT|
20|FH_F130747_0_0|SrvcGrp|26274|2022|PDM|5202.00|99|0.00|CPT 29877|
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|1743.00|99|0.00|AEG 9 (NO REV)|
20|FH_F42999_0_0|SrvcGrp|46463|2022|PDM|75.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F137427_89146_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F93332_0_0|SrvcGrp|93084|2022|PDM|6386.00|99|0.00|LOW BACK DISK SURGERY (HCFA)|
20|FH_F128358_46072_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F63514_0_0|SrvcGrp|1168|2022|PDM|32.96|99|0.00|CONTINUOUS HOMECARE|
20|FH_F70510_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F44582_0_0|SrvcGrp|39123|2022|PCT|0.70|99|0.00|CARDIAC ABLATION|
20|FH_F122694_33334_0|SrvcGrp|88819|2022|PDM|716.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|ASPG V|
20|FH_F131612_0_0|SrvcGrp|107864|2022|PCT|1.00|99|0.00|AETNA INJECTABLES (A & B CODES)|
20|FH_F38411_0_0|SrvcGrp|19262|2022|PCT|0.80|99|0.00|MS DRG 652|
20|FH_F142332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132606_0_0|SrvcGrp|26274|2022|PDM|1305.00|99|0.00|CPT 29877|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|100.93|99|0.00|ACTIGRAPHY TESTING (MOD TC)|
20|FH_F34678_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138457_0_0|CSTM-ALL|CSTM-00|2020|PDM|573.00|99|0.00|AEG 1 (NO REV)|
20|FH_F83754_0_0|SrvcGrp|20299|2022|PCT|0.81|99|0.00|MS DRG 228-230 ONLY OTHER CARDIOTHORACIC PROC|
20|FH_F124146_46321_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F110541_99336_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|19400.00|99|0.00|DRG 110 ONLY MAJOR CARDIOVASCULAR PROCEDURE W/CC|
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|6270.00|99|0.00|AEG 8 (NO REV)|
20|FH_F36753_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD AU|
20|FH_F143067_0_0|SrvcGrp|114009|2022|PDM|420.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F147502_0_0|SrvcGrp|95660|2022|PDM|575.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F39898_0_0|SrvcGrp|12403|2022|PDM|45.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F121699_73703_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F49476_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F130329_64114_0|SrvcGrp|110782|2022|PDM|3.50|99|0.00|ROUTINE VENIPUNCTURE|
20|FH_F116806_0_0|SrvcGrp|107038|2022|PDM|1923.16|99|0.00|REPAIR EYE SOCKET FRACTURE|
20|FH_F125259_0_0|SrvcGrp|106799|2022|PDM|4000.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1013.60|99|0.00|HAPA WPA-NWPA 2012-13 ASC 706 W/O REV|
20|FH_F150239_75569_0|SrvcGrp|29076|2022|PCT|1.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F145742_64862_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 2 (NO REV)|
20|FH_F150165_06032_0|SrvcGrp|85778|2022|PDM|4774.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F85995_64111_0|SrvcGrp|27969|2022|PDM|45.34|99|0.00|HOME HEALTH AIDE|
20|FH_F83978_66739_0|SrvcGrp|27100|2022|PCT|0.00|99|0.00|EMERGENCY ROOM|
20|FH_F70863_0_0|SrvcGrp|3810|2022|PDM|205.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F124369_0_0|SrvcGrp|108095|2022|PDM|1815.00|99|0.00|PARTIAL REMOVAL FOOT FASCIA|
20|FH_F84191_16001_0|SrvcGrp|472|2022|PDM|368.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F112665_0_0|SrvcGrp|41334|2022|PDM|7215.00|99|0.00|TOTAL KNEE|
20|FH_F90232_15126_0|SrvcGrp|17015|2022|PDM|14.18|99|0.00|HOME INFUSION THERAPY|
20|FH_F138350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1399.00|99|0.00|AEG 7 (NO REV)|
20|FH_F139716_50208_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132822_95125_0|SrvcGrp|48385|2022|PDM|130.00|99|0.00|SPEECH THERAPY|
20|FH_F149147_66221_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F109405_73106_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F96160_32207_0|SrvcGrp|29077|2022|PDM|25.89|99|0.00|HOME TRANSFUSION|
20|FH_F130763_0_0|SrvcGrp|83643|2022|PDM|3450.00|99|0.00|CPT 29885|
20|FH_F138056_64055_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F95440_0_0|SrvcGrp|72990|2022|PDM|711.00|99|0.00|AEG 1|
20|FH_F110503_10016_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
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_F125328_0_0|SrvcGrp|79583|2022|PDM|2028.00|99|0.00|CPT 45381|
20|FH_F146595_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F120719_27540_0|SrvcGrp|74586|2022|PCT|0.46|99|0.00|AETNA OP HIGH COST DRUGS|
20|FH_F122947_29532_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150311_18106_0|SrvcGrp|114012|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2420.00|99|0.00|AEG 10 (NO REV)|
20|FH_F70205_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F150239_75569_0|SrvcGrp|21920|2022|PCT|1.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F85652_98034_0|SrvcGrp|31916|2022|PDM|35351.00|99|0.00|MS DRG 473 ONLY|
20|FH_F146124_06112_0|CSTM-ALL|CSTM-00|2020|PDM|9616.00|99|0.00|AEG 6 (NO REV)|
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)|
20|FH_F133947_93950_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F58396_0_0|SrvcGrp|3810|2022|PDM|180.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F119379_0_0|SrvcGrp|107827|2022|PDM|1428.00|99|0.00|EXPLORE/TREAT WRIST JOINT|
20|FH_F111986_0_0|SrvcGrp|83835|2022|PDM|2472.00|99|0.00|REPLACE TISSUE EXPANDER|
20|FH_F138021_0_0|SrvcGrp|113084|2022|PCT|0.00|99|0.00|CARDIAC CATH NOT REIMBURSED|
20|FH_F79863_0_0|SrvcGrp|77244|2022|PDM|19.00|99|0.00|AETNA HIT ENTERAL PUMP DIEM|
20|FH_F150241_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147980_0_0|SrvcGrp|29155|2022|PDM|95.00|99|0.00|HOSPICE SVCS|
20|FH_F48997_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F119383_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F42626_0_0|SrvcGrp|3029|2022|PDM|244.00|99|0.00|NEWBORN NURSERY|
20|FH_F85353_16407_0|SrvcGrp|63907|2022|PDM|143.01|99|0.00|HAPA WPA-NWPA 2012-13 ASC 240|
20|FH_F120930_0_0|SrvcGrp|11306|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F150311_18106_0|SrvcGrp|114102|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F130329_64114_0|SrvcGrp|86839|2022|PDM|25.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F54592_0_0|SrvcGrp|10578|2022|PDM|40.00|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F41474_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F122522_54024_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F122532_46385_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122552_03103_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F86375_0_0|SrvcGrp|82223|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F105145_75075_0|SrvcGrp|33982|2022|PDM|27000.00|99|0.00|CPT 28296|
20|FH_F76028_0_0|SrvcGrp|43428|2022|PDM|60.00|99|0.00|RN HOURLY|
20|FH_F63124_0_0|SrvcGrp|42975|2022|PDM|145.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F115952_44484_0|SrvcGrp|73841|2022|PDM|208.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F133249_33603_0|SrvcGrp|46903|2022|PDM|743.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F133710_21811_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F114064_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.52|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F149179_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F46832_0_0|SrvcGrp|24754|2022|PDM|25.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F136474_95742_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F118152_20151_0|SrvcGrp|24752|2022|PDM|15.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F118193_06241_0|SrvcGrp|105425|2022|PDM|64.11|99|0.00|AETNA EXPOSURE ADAPTIVE BH TREATMENT 60 MINS|
20|FH_F120456_67117_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134126_11554_0|SrvcGrp|78403|2022|PDM|0.25|99|0.00|AETNA MED RECORD|
20|FH_F137048_60714_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F137048_60714_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F137236_17603_0|SrvcGrp|113048|2022|PDM|1251.00|99|0.00|IP PSYCH ADULT INTENSIVE UNIT|
20|FH_F142313_14788_0|SrvcGrp|46903|2022|PDM|151.53|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F142547_70002_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|1181.00|99|0.00|AEG 6 (NO REV)|
20|FH_F97582_46307_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138542_40324_0|SrvcGrp|73841|2022|PDM|363.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138542_40324_0|SrvcGrp|89149|2022|PDM|171.00|99|0.00|OP INTENSIVE|
20|FH_F140765_30315_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140844_48083_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F80754_31601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149663_45219_0|CSTM-ALL|CSTM-00|2020|PDM|928.03|99|0.00|AEG 2 (NO REV)|
20|FH_F151608_30236_0|CSTM-ALL|CSTM-00|2020|PDM|1466.00|99|0.00|AEG 8 (NO REV)|
20|FH_F151610_77304_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119021_03060_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126853_19053_0|SrvcGrp|48385|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F117267_07728_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F137818_31602_0|SrvcGrp|89149|2022|PDM|262.00|99|0.00|OP INTENSIVE|
20|FH_F38948_0_0|SrvcGrp|16|2022|PDM|1108.00|99|0.00|ACUTE REHABILITATION|
20|FH_F39893_0_0|SrvcGrp|16|2022|PDM|600.00|99|0.00|ACUTE REHABILITATION|
20|FH_F104700_0_0|SrvcGrp|72990|2022|PDM|1245.00|99|0.00|AEG 1|
20|FH_F109652_0_0|SrvcGrp|78846|2022|PDM|5892.00|99|0.00|RADIATION TREATMENT DELIVERY|
20|FH_F110308_0_0|SrvcGrp|73002|2022|PDM|800.00|99|0.00|AEG 7|
20|FH_F109821_0_0|SrvcGrp|76847|2022|PDM|1836.00|99|0.00|AETNA ARTHROSCOPY|
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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F95880_02726_0|SrvcGrp|90490|2022|PDM|226.00|99|0.00|EVALUATION OF SPEECH FLUENCY|
20|FH_F148864_81303_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F148866_84123_0|SrvcGrp|473|2022|PDM|318.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F151058_18064_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151144_35801_0|SrvcGrp|115969|2022|PDM|915.43|99|0.00|EYELID RECONSTRUCTION|
20|FH_F151155_26508_0|SrvcGrp|75419|2022|PDM|383.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F112844_0_0|SrvcGrp|74546|2022|PDM|545.00|99|0.00|HOSPICE SERVICES|
20|FH_F37823_0_0|SrvcGrp|4109|2022|PDM|600.00|99|0.00|ACUTE PSYCH|
20|FH_F65761_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F98040_89406_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F110000_0_0|SrvcGrp|40484|2022|PCT|1.00|99|0.00|OP CARDIOLOGY MOD TC|
20|FH_F97720_70084_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F97721_01053_0|SrvcGrp|73659|2022|PDM|9030.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F111840_0_0|SrvcGrp|75481|2022|PDM|446.00|99|0.00|AEG 2|
20|FH_F69785_0_0|SrvcGrp|88621|2022|PDM|60.00|99|0.00|SKILLED NURSING LPN|
20|FH_F114916_30309_0|SrvcGrp|67066|2022|PDM|3500.00|99|0.00|CERVICAL SURGERY|
20|FH_F105588_15228_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41539_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132988_0_0|SrvcGrp|100014|2022|PDM|6217.57|99|0.00|REPAIR RADIUS OR ULNA|
20|FH_F132988_0_0|SrvcGrp|90421|2022|PDM|5994.26|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_F42161_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|SrvcGrp|29817|2022|PDM|2000.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F114386_07090_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114389_50131_0|SrvcGrp|92094|2022|PDM|316.91|99|0.00|AETNA STATIONARY LIQUID OXYGEN SYSTEM|
20|FH_F50163_0_0|SrvcGrp|3449|2022|PDM|375.00|99|0.00|ELECTRO CONVULSIVE THERAPY|
20|FH_F77944_0_0|SrvcGrp|12670|2022|PCT|0.43|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F100703_0_0|SrvcGrp|96349|2022|PDM|8034.00|99|0.00|NECK SPINE FUSE|
20|FH_F100000_45417_0|SrvcGrp|92760|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124233_92648_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124663_65608_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124687_64024_0|SrvcGrp|75545|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F118848_0_0|SrvcGrp|28551|2022|PDM|4100.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 1 (NO REV)|
20|FH_F32834_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114666_30342_0|SrvcGrp|89848|2022|PDM|5000.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F139087_47586_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F114985_32073_0|SrvcGrp|105749|2022|PDM|43.00|99|0.00|ORTHC/PROSTC MGMT SBSQ ENC|
20|FH_F148553_85016_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|AEG 3 (NO REV)|
20|FH_F122591_84010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122610_73139_0|SrvcGrp|108724|2022|PDM|376.00|99|0.00|MENTAL HEALTH PARTIAL HOSP|
20|FH_F43418_0_0|SrvcGrp|9539|2022|PDM|300.00|99|0.00|SUBACUTE CARE|
20|FH_F43693_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|ACUTE PSYCH|
20|FH_F136796_24016_0|CSTM-ALL|CSTM-00|2020|PDM|1258.61|99|0.00|AEG 3 (NO REV)|
20|FH_F136914_64081_0|SrvcGrp|13422|2022|PDM|325.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F74283_0_0|SrvcGrp|1168|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F115631_65201_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F116233_33612_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F147500_32720_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41463_0_0|SrvcGrp|34356|2022|PDM|138.60|99|0.00|T1001|
20|FH_F41835_0_0|SrvcGrp|16|2022|PDM|630.00|99|0.00|ACUTE REHABILITATION|
20|FH_F42422_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40600_0_0|SrvcGrp|12491|2022|PCT|0.70|99|0.00|PACEMAKER|
20|FH_F41934_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|ASPG II - CPD 1281588|
20|FH_F100780_24153_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F41605_0_0|CSTM-ALL|CSTM-00|2020|PDM|1298.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54055_70006_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS|
20|FH_F140873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|987.00|99|0.00|AEG 8 (NO REV)|
20|FH_F106980_0_0|SrvcGrp|73004|2022|PDM|1225.00|99|0.00|AEG 8|
20|FH_F113178_44035_0|SrvcGrp|105526|2022|PDM|280.00|99|0.00|AETNA PARTIAL HOSP|
20|FH_F133536_0_0|SrvcGrp|69969|2022|PDM|2100.00|99|0.00|CPT 28285, 28292, 28296|
20|FH_F141937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F48295_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F138856_48092_0|SrvcGrp|3178|2022|PDM|800.00|99|0.00|ACUTE PSYCH|
20|FH_F89580_0_0|SrvcGrp|85040|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F109949_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|440.15|99|0.00|HAPA WPA-NWPA 2012-13 ASC 215 W/O REV|
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|2665.00|99|0.00|AEG 9 (NO REV)|
20|FH_F151306_21030_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151501_30265_0|SrvcGrp|89989|2022|PDM|6666.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F151503_30067_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132262_60062_0|SrvcGrp|113276|2022|PCT|1.15|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130671_42701_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135388_48601_0|SrvcGrp|2067|2022|PDM|908.21|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F135427_19610_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F135583_17331_0|SrvcGrp|103913|2022|PCT|0.82|99|0.00|OP DIALYSIS|
20|FH_F135590_84066_0|SrvcGrp|75545|2022|PDM|334.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F135607_21613_0|SrvcGrp|46903|2022|PDM|1550.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F130933_47129_0|SrvcGrp|73841|2022|PDM|310.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F116397_33404_0|SrvcGrp|21920|2022|PDM|40.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F121731_20164_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPT CARE OF MUNCY FH -RR|
20|FH_F42347_0_0|SrvcGrp|31186|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC (DME)|
20|FH_F46918_0_0|SrvcGrp|10541|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F131407_07607_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP WITHOUT CPT 99601|
20|FH_F132947_45342_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111292_33136_0|SrvcGrp|10944|2022|PDM|1648.00|99|0.00|EMERGENCY ROOM|
20|FH_F111301_33122_0|SrvcGrp|82738|2022|PDM|14.00|99|0.00|NON-AUTOMATED WITHOUT MICRO|
20|FH_F141651_0_0|SrvcGrp|89884|2022|PDM|1100.00|99|0.00|AETNA ABLATE TURBINATE SUBMUC|
20|FH_F33390_0_0|SrvcGrp|14886|2022|PCT|0.75|99|0.00|TRANSPORTATION|
20|FH_F39796_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|PDM|562.57|99|0.00|2005 ASPG GROUPER II|
20|FH_F131000_0_0|SrvcGrp|77461|2022|PDM|3077.00|99|0.00|CPT 52356|
20|FH_F131000_0_0|SrvcGrp|59705|2022|PDM|2441.00|99|0.00|SEPTOPLASTY|
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123036_0_0|SrvcGrp|105319|2022|PDM|21704.00|99|0.00|IMPLT NROSTM PLS GEN DUA REC|
20|FH_F98300_30236_0|SrvcGrp|73485|2022|PDM|1797.00|99|0.00|AETNA REHAB|
20|FH_F102960_50613_0|SrvcGrp|89149|2022|PDM|566.00|99|0.00|OP INTENSIVE|
20|FH_F77462_0_0|SrvcGrp|43957|2022|PDM|60.00|99|0.00|HOME HEALTH AIDE|
20|FH_F148554_85016_0|SrvcGrp|115466|2022|PDM|3060.00|99|0.00|PRQ CARD STENT W/ ANGIO 1 VS|
20|FH_F39517_0_0|SrvcGrp|360|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F41392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD KN) - BDSS|
20|FH_F145862_66209_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|79047|2022|PDM|648.00|99|0.00|MON VALLEY ASC 1602|
20|FH_F71644_0_0|SrvcGrp|38797|2022|PDM|342.00|99|0.00|PSYCHIATRIC PARTIAL HOSPITALIZATION - IP|
20|FH_F118667_95131_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F125352_90034_0|SrvcGrp|75442|2022|PDM|770.00|99|0.00|OBSERVATION - REV 762|
20|FH_F37562_0_0|SrvcGrp|14402|2022|PDM|52.00|99|0.00|HOME HEALTH AIDE|
20|FH_F123085_21921_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133477_90247_0|SrvcGrp|12491|2022|PCT|0.25|99|0.00|PACEMAKER|
20|FH_F117875_70601_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117900_19118_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F68944_0_0|SrvcGrp|9947|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F150559_60018_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F95482_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111502_33331_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124608_0_0|SrvcGrp|47142|2022|PDM|3138.00|99|0.00|CPT 49650|
20|FH_F92677_08003_0|SrvcGrp|29489|2022|PDM|249.90|99|0.00|DIGESTIVE TRACT ACCESS DEVICES|
20|FH_F71882_15228_0|SrvcGrp|81878|2022|PCT|1.00|99|0.00|RADIOLOGY W/ REV/HCPC|
20|FH_F147800_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_F150532_16801_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F111813_08080_0|SrvcGrp|75545|2022|PDM|390.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F111540_16823_0|SrvcGrp|104417|2022|PDM|134.00|99|0.00|OFFICE/OUTPATIENT VISIT EST (MOD AF)|
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_F123539_65265_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F68479_0_0|SrvcGrp|34025|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (LAB)|
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 8 (NO REV)|
20|FH_F31049_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F55375_0_0|SrvcGrp|17083|2022|PCT|0.73|99|0.00|ASPG X|
20|FH_F45977_0_0|SrvcGrp|39704|2022|PCT|1.00|99|0.00|KS FS 3247 (A&E CODES)- W MOD MS OR MOD RR AND MS|
20|FH_F97061_85012_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F142947_76043_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F91061_63043_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F125467_67206_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111522_81067_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F63899_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43953_0_0|SrvcGrp|26595|2022|PDM|1343.00|99|0.00|ACUTE PSYCHIATRIC|
20|FH_F148555_0_0|SrvcGrp|115449|2022|PDM|3090.00|99|0.00|REMOVE & REPLACE PM GEN DUAL LEAD|
20|FH_F148886_60621_0|SrvcGrp|29127|2022|PDM|11319.00|99|0.00|MSDRG 265 ONLY|
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1468.00|99|0.00|ASPG VI|
20|FH_F63618_0_0|SrvcGrp|8|2022|PDM|6000.00|99|0.00|BURN INTENSIVE CARE|
20|FH_F141835_78676_0|SrvcGrp|90854|2022|PDM|940.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F141870_85224_0|SrvcGrp|17016|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129535_0_0|SrvcGrp|79589|2022|PDM|550.00|99|0.00|UPPER GI|
20|FH_F89112_16509_0|SrvcGrp|537|2022|PCT|0.60|99|0.00|OBSERVATION SERVICES|
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F151751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1377.00|99|0.00|AEG 4 (NO REV)|
20|FH_F97541_33021_0|SrvcGrp|73559|2022|PDM|10492.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F50615_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F56792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|ASPG X WITH MOD SG|
20|FH_F111812_11222_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F133517_49221_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F133627_89113_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F91155_16105_0|SrvcGrp|48398|2022|PDM|102.00|99|0.00|PT SERVICES|
20|FH_F80855_0_0|SrvcGrp|47142|2022|PDM|2625.00|99|0.00|CPT 49650|
20|FH_F36350_0_0|SrvcGrp|72|2022|PDM|384.00|99|0.00|NEWBORN NURSERY|
20|FH_F142900_32792_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142994_54313_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F41261_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F56793_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F130553_18640_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117275_16936_0|SrvcGrp|93919|2022|PDM|480.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F117380_60020_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F37568_0_0|SrvcGrp|14402|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F51548_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F126849_67337_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 4 (NO REV)|
20|FH_F149821_21202_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F93375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92676_15063_0|SrvcGrp|78979|2022|PDM|1330.44|99|0.00|MON VALLEY ASC 204|
20|FH_F123538_21206_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F103360_68845_0|CSTM-ALL|CSTM-00|2020|PDM|2044.00|99|0.00|AEG 1 (NO REV)|
20|FH_F92676_15063_0|SrvcGrp|79079|2022|PDM|284.44|99|0.00|MON VALLEY ASC 142|
20|FH_F69122_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87436_0_0|SrvcGrp|27453|2022|PCT|0.62|99|0.00|EMERGENCY ROOM|
20|FH_F125176_20785_0|SrvcGrp|107267|2022|PDM|280.00|99|0.00|HEMODIALYSIS|
20|FH_F42238_0_0|CSTM-ALL|CSTM-00|2020|PDM|2962.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97141_93933_0|SrvcGrp|73559|2022|PDM|19091.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F41739_0_0|SrvcGrp|34764|2022|PCT|1.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|1083.00|99|0.00|AEG 10 (NO REV)|
20|FH_F83053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F91194_33511_0|SrvcGrp|83799|2022|PDM|2700.00|99|0.00|VAGINAL DELIVERY-NO ANTEPARTUM|
20|FH_F31446_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79231_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
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_F138611_0_0|CSTM-ALL|CSTM-00|2020|PDM|2429.00|99|0.00|AEG 2 (NO REV)|
20|FH_F112862_46176_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD KN|
20|FH_F139175_98229_0|SrvcGrp|75754|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F139441_91324_0|SrvcGrp|73605|2022|PDM|2835.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F139666_26175_0|SrvcGrp|105809|2022|PCT|0.94|99|0.00|PT OT ST|
20|FH_F139679_75050_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F150768_03054_0|SrvcGrp|48394|2022|PDM|67.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F150820_83843_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F115483_62002_0|SrvcGrp|73603|2022|PDM|1363.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|22500.00|99|0.00|OT SERVICES|
20|FH_F140990_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134394_92101_0|SrvcGrp|111639|2022|PDM|525.00|99|0.00|PARTIAL HOSPITALIZATION (>=18) (HCFA)|
20|FH_F114951_20002_0|SrvcGrp|81839|2022|PDM|50.00|99|0.00|AETNA MEDICAL RECORD|
20|FH_F123386_0_0|SrvcGrp|3178|2022|PDM|650.00|99|0.00|ACUTE PSYCH|
20|FH_F80834_0_0|SrvcGrp|27831|2022|PDM|10593.00|99|0.00|MS DRG 003-004 ONLY|
20|FH_F90223_0_0|SrvcGrp|88811|2022|PDM|27.50|99|0.00|HOME PHARMACY SERVICES (MOD SH) (HCFA)|
20|FH_F35999_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F128029_48154_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 3 (NO REV)|
20|FH_F147160_80260_0|SrvcGrp|90040|2022|PDM|374.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F146859_0_0|SrvcGrp|93740|2022|PDM|3867.00|99|0.00|REVISE/REMOVE NEURO RECEIVER|
20|FH_F35384_0_0|SrvcGrp|360|2022|PDM|1234.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F151659_17013_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132878_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F133569_17202_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F36992_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD KF|
20|FH_F97260_06111_0|SrvcGrp|73605|2022|PDM|3233.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F136947_0_0|SrvcGrp|13262|2022|PDM|12.00|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 4 (NO REV)|
20|FH_F117615_30525_0|SrvcGrp|16429|2022|PCT|0.80|99|0.00|OBSERVATION SVCS|
20|FH_F43293_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134407_63801_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F97300_47501_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F40736_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F147183_17701_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128008_27302_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137986_0_0|SrvcGrp|80063|2022|PDM|1228.00|99|0.00|HEMORRHOIDECTOMY|
20|FH_F92454_0_0|SrvcGrp|14188|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F126933_33174_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F40624_0_0|SrvcGrp|25934|2022|PDM|649.00|99|0.00|SKILLED NURSING|
20|FH_F147181_27514_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F123570_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F132254_40207_0|SrvcGrp|86825|2022|PDM|80.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F50415_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|HOME INF- REV 640 MOD SH|
20|FH_F117711_73080_0|SrvcGrp|72992|2022|PDM|840.00|99|0.00|AEG 2|
20|FH_F36992_0_0|SrvcGrp|28919|2022|PDM|34.00|99|0.00|CPT 97750|
20|FH_F69183_0_0|CSTM-ALL|CSTM-00|2020|PDM|2350.00|99|0.00|ASPG VII - FH SW CUSTOM GROUPERS|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1575124_HCPCS_  MOD KM|
20|FH_F127291_86426_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132143_66111_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120100_98390_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F36590_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F117762_0_0|SrvcGrp|67119|2022|PDM|7800.00|99|0.00|ARTHODESIS|
20|FH_F97082_90012_0|SrvcGrp|88977|2022|PDM|8719.00|99|0.00|C-SECTION DELIVERY|
20|FH_F102620_0_0|CSTM-ALL|CSTM-00|2020|PDM|496.80|99|0.00|OP OBSERVATION <=23 HRS|
20|FH_F145543_0_0|SrvcGrp|113195|2022|PDM|770.00|99|0.00|REINFORCE/GRAFT EYE WALL|
20|FH_F138932_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132160_0_0|SrvcGrp|114442|2022|PDM|12049.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F102365_0_0|SrvcGrp|75545|2022|PDM|340.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F38873_66434_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149240_0_0|SrvcGrp|82223|2022|PDM|144.84|99|0.00|HOSPICE CARE|
20|FH_F124548_12414_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
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_F130331_0_0|SrvcGrp|57965|2022|PDM|150.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F130182_0_0|SrvcGrp|98267|2022|PDM|8323.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F146266_0_0|SrvcGrp|109833|2022|PDM|17338.00|99|0.00|REPLACE ELBOW JOINT|
20|FH_F97080_85122_0|SrvcGrp|73461|2022|PDM|7573.00|99|0.00|AETNA NICU IV|
20|FH_F151041_60647_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150982_0_0|SrvcGrp|98404|2022|PDM|2202.00|99|0.00|ARTHROSCOPIC FRACTURE TX|
20|FH_F134397_27513_0|SrvcGrp|89149|2022|PDM|234.00|99|0.00|OP INTENSIVE|
20|FH_F146859_0_0|SrvcGrp|114848|2022|PDM|1791.00|99|0.00|REMOVAL OF IMPLANT|
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136947_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124759_34108_0|SrvcGrp|106249|2022|PDM|345.00|99|0.00|PARTIAL HOSP SUBSTANCE ABUSE|
20|FH_F35387_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F149004_67025_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117581_21211_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120040_72703_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F140295_0_0|SrvcGrp|88340|2022|PDM|8111.00|99|0.00|SPINAL FUSION|
20|FH_F137902_0_0|SrvcGrp|86722|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F140233_35216_0|SrvcGrp|113625|2022|PDM|4800.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F143488_84770_0|SrvcGrp|11663|2022|PCT|1.02|99|0.00|IMPLANTS|
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103060_0_0|SrvcGrp|73002|2022|PDM|2601.00|99|0.00|AEG 7|
20|FH_F103481_0_0|SrvcGrp|75545|2022|PDM|327.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F102224_0_0|SrvcGrp|58638|2022|PDM|4000.00|99|0.00|CPT 63688|
20|FH_F131104_98007_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD KF|
20|FH_F48937_0_0|SrvcGrp|10545|2022|PDM|65.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F48937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|2756.36|99|0.00|ASPG X|
20|FH_F112711_80909_0|SrvcGrp|471|2022|PDM|541.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F116739_78501_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F116835_94538_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F82771_0_0|CSTM-ALL|CSTM-00|2020|PDM|893.00|99|0.00|AEG 10 (NO REV)|
20|FH_F125436_60506_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F127033_54501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118879_93063_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F84394_17402_0|SrvcGrp|67072|2022|PDM|11961.00|99|0.00|CPT 22845|
20|FH_F91392_63105_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F47884_0_0|SrvcGrp|11336|2022|PCT|0.50|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F57093_0_0|SrvcGrp|3934|2022|PDM|170.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS|
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 9 (NO REV)|
20|FH_F148348_16803_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87031_0_0|SrvcGrp|73002|2022|PDM|1551.00|99|0.00|AEG 7|
20|FH_F40332_0_0|SrvcGrp|19973|2022|PCT|0.70|99|0.00|CAT SCAN|
20|FH_F128973_44256_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F62915_0_0|SrvcGrp|12403|2022|PDM|1179.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F128288_57058_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40415_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113410_0_0|SrvcGrp|65350|2022|PDM|3572.00|99|0.00|KNEE ARTHRO/ANTER|
20|FH_F72546_0_0|SrvcGrp|11336|2022|PCT|0.35|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F55054_0_0|SrvcGrp|361|2022|PDM|3115.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F91739_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|142.10|99|0.00|CPT 95811 (W/MOD 26)|
20|FH_F110161_31329_0|CSTM-ALL|CSTM-00|2020|PCT|0.67|99|0.00|OP SVCS|
20|FH_F150314_0_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F82714_18848_0|SrvcGrp|472|2022|PDM|722.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F135239_0_0|SrvcGrp|22596|2022|PDM|192.50|99|0.00|HOSPICE CARE|
20|FH_F130747_0_0|SrvcGrp|92366|2022|PDM|4682.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F137940_0_0|SrvcGrp|106294|2022|PDM|348.22|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F72766_0_0|SrvcGrp|21975|2022|PDM|1575.00|99|0.00|INPATIENT SERVICES|
20|FH_F150936_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F78162_0_0|SrvcGrp|29977|2022|PDM|53.00|99|0.00|WOUND CARE CANISTER SET|
20|FH_F129679_20850_0|SrvcGrp|63379|2022|PDM|170.00|99|0.00|CARDIAC REHABILITATION|
20|FH_F129828_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|969.00|99|0.00|AEG 3 (NO REV)|
20|FH_F143971_34986_0|SrvcGrp|75419|2022|PDM|430.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148265_06067_0|SrvcGrp|100054|2022|PDM|4578.00|99|0.00|REPAIR OF FEMUR FRACTURE|
20|FH_F131992_62832_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131228_01826_0|SrvcGrp|20075|2022|PDM|14695.39|99|0.00|MS DRG 286 ONLY|
20|FH_F93413_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130061_84097_0|SrvcGrp|108484|2022|PDM|1300.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F65103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F67101_0_0|SrvcGrp|69521|2022|PCT|1.00|99|0.00|BONEMARROW SEARCH TESTING AND ACQUISITION|
20|FH_F87254_0_0|SrvcGrp|104618|2022|PDM|850.00|99|0.00|EXCISION OF ANAL LESION(S)|
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 5  (NO REV)|
20|FH_F116237_43235_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F40032_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F87716_0_0|SrvcGrp|16|2022|PDM|933.00|99|0.00|ACUTE REHABILITATION|
20|FH_F141527_36830_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD OCN F/S PRICING-OP W/O HOME INFUSION|
20|FH_F123276_20737_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F122687_0_0|SrvcGrp|95560|2022|PDM|2185.00|99|0.00|REMOVAL OF SHOULDER BONE|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG IX|
20|FH_F137087_0_0|SrvcGrp|35670|2022|PDM|28000.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|742.00|99|0.00|AEG 3 (NO REV)|
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|ASPG II|
20|FH_F125011_74467_0|SrvcGrp|75506|2022|PCT|0.63|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F135231_90265_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F132559_0_0|SrvcGrp|105233|2022|PDM|3100.00|99|0.00|REMOVAL OF THYROID|
20|FH_F82197_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F128401_44615_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F91900_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F149980_0_0|SrvcGrp|115795|2022|PDM|696.00|99|0.00|UPPR GI ENDOSCOPY DIAGNOSIS|
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2487.00|99|0.00|AEG 7 (NO REV)|
20|FH_F130747_0_0|SrvcGrp|89860|2022|PDM|8843.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F38417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110923_54768_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F137239_0_0|SrvcGrp|73841|2022|PDM|451.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F137457_32216_0|SrvcGrp|89149|2022|PDM|259.00|99|0.00|OP INTENSIVE|
20|FH_F38383_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F121492_87111_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F145545_01602_0|SrvcGrp|108484|2022|PDM|473.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F47733_0_0|SrvcGrp|43563|2022|PDM|55.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F51358_0_0|SrvcGrp|45948|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F110925_01104_0|SrvcGrp|86122|2022|PDM|41.00|99|0.00|AETNA GAMMAGARD LIQUID INJ|
20|FH_F118271_46052_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44177_0_0|SrvcGrp|30133|2022|PDM|6634.00|99|0.00|LASER SURGERY|
20|FH_F90492_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F39866_0_0|SrvcGrp|6|2022|PDM|1825.00|99|0.00|OP SURGERY|
20|FH_F37659_0_0|SrvcGrp|4109|2022|PDM|700.00|99|0.00|ACUTE PSYCH|
20|FH_F97104_53545_0|SrvcGrp|73602|2022|PDM|3772.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1082.00|99|0.00|ASPG VI|
20|FH_F42822_0_0|SrvcGrp|33252|2022|PDM|567.00|99|0.00|CD (CHILD) - DETOX|
20|FH_F110925_01104_0|SrvcGrp|29347|2022|PDM|31.52|99|0.00|HOME HEALTH AIDE|
20|FH_F102302_0_0|SrvcGrp|98605|2022|PDM|2550.00|99|0.00|TREAT TRIGEMINAL NERVE|
20|FH_F93534_45690_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F110925_01104_0|SrvcGrp|14949|2022|PDM|100.00|99|0.00|HOME INFUSION|
20|FH_F110263_0_0|SrvcGrp|93595|2022|PDM|13477.00|99|0.00|ARTHROPLASTY(HCFA)|
20|FH_F110043_33308_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|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_F112508_0_0|SrvcGrp|8950|2022|PDM|1456.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F56136_0_0|SrvcGrp|16362|2022|PCT|0.92|99|0.00|CCPD TRAINING|
20|FH_F150982_0_0|SrvcGrp|42472|2022|PDM|4184.00|99|0.00|CPT 58670|
20|FH_F37679_0_0|SrvcGrp|17015|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F40421_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F72842_0_0|SrvcGrp|29817|2022|PDM|5389.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F72830_0_0|SrvcGrp|70047|2022|PDM|2900.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 7|
20|FH_F131228_01826_0|SrvcGrp|88978|2022|PDM|7263.71|99|0.00|VAGINAL DELIVERY|
20|FH_F148356_18104_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F131236_84041_0|SrvcGrp|65720|2022|PDM|93.00|99|0.00|RESPITE CARE|
20|FH_F63095_0_0|SrvcGrp|59290|2022|PDM|862.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F122725_32216_0|SrvcGrp|90488|2022|PDM|79.00|99|0.00|ORAL FUNCTION THERAPY|
20|FH_F62920_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F50462_0_0|SrvcGrp|44427|2022|PDM|140.00|99|0.00|PHYSICAL THERAPY SVCS (VISIT LVL)|
20|FH_F96721_99504_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119864_63141_0|SrvcGrp|66265|2022|PDM|89.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F134208_21502_0|SrvcGrp|112537|2022|PDM|835.00|99|0.00|REMOVE SPINAL CORD LESION|
20|FH_F149082_33406_0|SrvcGrp|115587|2022|PCT|1.00|99|0.00|COVID-19 VACCINES AND ADMINSTRATION|
20|FH_F51855_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F149268_74820_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F132840_65201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145641_06902_0|SrvcGrp|100074|2022|PDM|6461.00|99|0.00|REPAIR SHOULDER CAPSULE|
20|FH_F74024_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F133492_0_0|SrvcGrp|84974|2022|PDM|1809.00|99|0.00|CPT 43255|
20|FH_F133867_84075_0|SrvcGrp|46693|2022|PDM|26.75|99|0.00|LPN NURSING SERVICES|
20|FH_F150239_75569_0|SrvcGrp|24750|2022|PCT|1.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|932.10|99|0.00|2005 ASPG GROUPER V|
20|FH_F123157_0_0|SrvcGrp|75487|2022|PDM|650.00|99|0.00|AEG 5|
20|FH_F141874_0_0|SrvcGrp|92502|2022|PDM|854.25|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|2096.00|99|0.00|AEG 3 (NO REV)|
20|FH_F124369_0_0|SrvcGrp|98466|2022|PDM|8415.00|99|0.00|PARTIAL REMOVAL OF FOOT BONE|
20|FH_F149263_0_0|SrvcGrp|75181|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F83995_16748_0|CSTM-ALL|CSTM-00|2020|PDM|2462.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134174_63141_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|CPT 95805 (W/MOD TC) (CMS-1500)|
20|FH_F84132_48026_0|SrvcGrp|72994|2022|PDM|700.00|99|0.00|AEG 3|
20|FH_F121225_98902_0|SrvcGrp|22389|2022|PCT|0.85|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F142376_0_0|SrvcGrp|98560|2022|PDM|18590.00|99|0.00|LUMBAR|
20|FH_F84191_16001_0|SrvcGrp|471|2022|PDM|462.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130123_24171_0|SrvcGrp|94781|2022|PDM|145.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F80613_0_0|SrvcGrp|63119|2022|PDM|45.00|99|0.00|BASIC HOME HOSPICE CARE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|699.50|99|0.00|HAPA WPA-NWPA 2012-13 ASC 504 W/O REV|
20|FH_F109577_0_0|SrvcGrp|93339|2022|PDM|123.00|99|0.00|AETNA MED NUTRITION GROUP|
20|FH_F130763_0_0|SrvcGrp|41334|2022|PDM|15683.00|99|0.00|TOTAL KNEE|
20|FH_F149139_07522_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133801_87107_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F138302_15701_0|SrvcGrp|48398|2022|PDM|65.00|99|0.00|PT SERVICES|
20|FH_F145839_45244_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137587_0_0|SrvcGrp|111448|2022|PDM|691.00|99|0.00|HOME HEMODIALYSIS TRAINING & TREATMENT|
20|FH_F89323_63033_0|SrvcGrp|88247|2022|PCT|1.00|99|0.00|CAT SCAN|
20|FH_F149102_33433_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|1070.00|99|0.00|AEG 8 (NO REV)|
20|FH_F119627_27288_0|SrvcGrp|102419|2022|PCT|0.75|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F112082_30720_0|SrvcGrp|29347|2022|PDM|53.35|99|0.00|HOME HEALTH AIDE|
20|FH_F114444_19602_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|2585.00|99|0.00|AEG 7 (NO REV)|
20|FH_F123623_03246_0|SrvcGrp|109294|2022|PCT|1.00|99|0.00|ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ|
20|FH_F73228_0_0|SrvcGrp|11000|2022|PCT|0.55|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F130364_01331_0|SrvcGrp|10391|2022|PDM|2400.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F136359_0_0|SrvcGrp|35672|2022|PDM|6025.00|99|0.00|CPT 23412|
20|FH_F145675_33761_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|1405.00|99|0.00|AEG 6 (NO REV)|
20|FH_F143650_0_0|SrvcGrp|12491|2022|PCT|0.50|99|0.00|PACEMAKER|
20|FH_F124369_0_0|SrvcGrp|100045|2022|PDM|4400.00|99|0.00|REVISION OF FOOT TENDON|
20|FH_F132740_46250_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|568.00|99|0.00|AEG 2 (NO REV)|
20|FH_F119937_0_0|SrvcGrp|65720|2022|PDM|65.00|99|0.00|RESPITE CARE|
20|FH_F114525_72401_0|SrvcGrp|89417|2022|PDM|325.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F89760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F127642_07047_0|SrvcGrp|72996|2022|PDM|1940.00|99|0.00|AEG 4|
20|FH_F126341_27284_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121476_0_0|SrvcGrp|108843|2022|PDM|4086.00|99|0.00|LEAD CORONARY VENOUS|
20|FH_F110470_98335_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F114509_10010_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F42258_0_0|SrvcGrp|3409|2022|PDM|350.00|99|0.00|NEWBORN NURSERY|
20|FH_F133969_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138507_62208_0|SrvcGrp|23683|2022|PDM|47.74|99|0.00|SKILLED NURSING RN|
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|AEG 7 (NO REV)|
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.46|99|0.00|ASPG II|
20|FH_F68849_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33063_0_0|SrvcGrp|3577|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F95440_0_0|SrvcGrp|63471|2022|PDM|5400.00|99|0.00|CPT 64590|
20|FH_F38790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.77|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F128379_0_0|SrvcGrp|93071|2022|PDM|7553.00|99|0.00|POSTERIOR SEGMENTAL INSTRU|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1465.11|99|0.00|HAPA WPA-NWPA 2012-13 ASC 706 W/O REV|
20|FH_F135627_77070_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F143742_60410_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|OP SVCS|
20|FH_F134508_14072_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F84712_0_0|SrvcGrp|73806|2022|PCT|0.66|99|0.00|AETNA ER|
20|FH_F86315_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F105145_75075_0|SrvcGrp|88697|2022|PCT|0.00|99|0.00|DRUGS|
20|FH_F115865_78621_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F68442_0_0|SrvcGrp|43892|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F146655_80226_0|SrvcGrp|73063|2022|PDM|693.00|99|0.00|OBSERVATION SERVICES|
20|FH_F120795_27514_0|SrvcGrp|44564|2022|PDM|1284.00|99|0.00|NEWBORN NURSERY|
20|FH_F120795_27514_0|SrvcGrp|92958|2022|PCT|0.71|99|0.00|SLEEP STUDIES|
20|FH_F125014_67301_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133478_40165_0|SrvcGrp|20908|2022|PDM|21619.00|99|0.00|MS DRG 247 ONLY|
20|FH_F133494_90023_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133491_74012_0|SrvcGrp|95661|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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_F113025_0_0|SrvcGrp|104724|2022|PDM|765.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F50635_0_0|SrvcGrp|3259|2022|PDM|610.00|99|0.00|ACUTE REHABILITATION|
20|FH_F119795_0_0|SrvcGrp|35668|2022|PDM|5202.00|99|0.00|CPT 29824|
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|2459.00|99|0.00|AEG 6 (NO REV)|
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 10 (NO REV)|
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|608.96|99|0.00|ASPG IV|
20|FH_F132810_0_0|SrvcGrp|86830|2022|PDM|8.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F126770_43050_0|SrvcGrp|95661|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F107200_0_0|SrvcGrp|33965|2022|PDM|5202.00|99|0.00|CPT 58552|
20|FH_F136386_30901_0|SrvcGrp|87306|2022|PDM|48300.00|99|0.00|MSDRG 269 ONLY|
20|FH_F118232_24970_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
20|FH_F120441_33065_0|SrvcGrp|74668|2022|PDM|718.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F134011_84102_0|SrvcGrp|48396|2022|PDM|103.00|99|0.00|OT SERVICES|
20|FH_F137040_76011_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137147_75006_0|SrvcGrp|74581|2022|PCT|0.32|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F137147_75006_0|SrvcGrp|21116|2022|PDM|33668.00|99|0.00|MS DRG 350 ONLY|
20|FH_F137147_75006_0|SrvcGrp|98266|2022|PDM|23370.00|99|0.00|REVISE KNEECAP|
20|FH_F142377_14626_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142207_62237_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F66765_0_0|SrvcGrp|17140|2022|PDM|152.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F78267_18702_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F140387_72202_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140765_30315_0|SrvcGrp|113234|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2 & INF A&B AMP PRB|
20|FH_F149561_76667_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151603_27609_0|SrvcGrp|27261|2022|PDM|16326.53|99|0.00|CPT 27446|
20|FH_F119003_78070_0|SrvcGrp|106048|2022|PDM|768.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F118914_43015_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F36915_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130800_06078_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F49039_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC|
20|FH_F76144_0_0|CSTM-ALL|CSTM-00|2020|PDM|2092.78|99|0.00|ASPG VI F/S - BDSS|
20|FH_F117267_07728_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F147726_18017_0|CSTM-ALL|CSTM-00|2020|PDM|756.00|99|0.00|AEG 4 (NO REV)|
20|FH_F129434_98271_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129467_45449_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F53094_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117098_20186_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117102_39355_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117108_37841_0|SrvcGrp|10391|2022|PDM|2000.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F117153_34113_0|SrvcGrp|73842|2022|PDM|171.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F34371_0_0|SrvcGrp|10544|2022|PDM|90.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F37878_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111593_0_0|SrvcGrp|73008|2022|PDM|3135.00|99|0.00|AEG 10|
20|FH_F124893_40311_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124923_23518_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F31783_0_0|CSTM-ALL|CSTM-00|2020|PDM|25250.00|99|0.00|MSDRG 228-230|
20|FH_F151053_17602_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151054_06473_0|SrvcGrp|100245|2022|PCT|1.00|99|0.00|INFLUENZA ASSAY W/ OPTIC|
20|FH_F151060_02493_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F151083_66223_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151179_84074_0|SrvcGrp|73006|2022|PDM|1785.00|99|0.00|AEG 9|
20|FH_F35212_0_0|SrvcGrp|9829|2022|PDM|85.50|99|0.00|PT SVCS|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2501000/2504030 MOD 53 (HCFA)|
20|FH_F63462_0_0|SrvcGrp|40826|2022|PDM|250.00|99|0.00|DISPOSABLE DRUG DELIVERY SYSTEM|
20|FH_F110381_0_0|SrvcGrp|100006|2022|PDM|2014.00|99|0.00|RECONSTRUCT ELBOW MED LIGMNT|
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PDM|3098.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F97660_29401_0|SrvcGrp|73602|2022|PDM|3084.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F133990_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.00|99|0.00|AEG 8 (NO REV)|
20|FH_F86911_0_0|SrvcGrp|72960|2022|PDM|90.00|99|0.00|REVENUE 642 AND HCPCS S5522|
20|FH_F87197_0_0|SrvcGrp|92604|2022|PDM|299.00|99|0.00|SUB-ACUTE CARE LEVEL I|
20|FH_F87201_0_0|SrvcGrp|75242|2022|PDM|50.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F113784_0_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F142427_36607_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113537_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|GENERAL ACUTE CARE|
20|FH_F105588_15228_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 10 (NO REV)|
20|FH_F133016_67114_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136473_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F94786_07974_0|SrvcGrp|86841|2022|PDM|91.87|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F132988_0_0|SrvcGrp|112169|2022|PDM|4493.01|99|0.00|REPAIR WRIST DISLOCATION|
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|867.00|99|0.00|AEG 6 (NO REV)|
20|FH_F114389_50131_0|CSTM-ALL|CSTM-00|2020|PDM|98.46|99|0.00|DURABLE MEDICAL EQUIPMENT (DME) (MOD RR)|
20|FH_F114389_50131_0|SrvcGrp|10579|2022|PDM|120.72|99|0.00|HYDRATION THERAPY - 2 LITERS|
20|FH_F62624_0_0|SrvcGrp|229|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT SCAN)|
20|FH_F34652_0_0|SrvcGrp|997|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F34652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F92493_0_0|SrvcGrp|26278|2022|PDM|1949.64|99|0.00|CPT 29881|
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1612.60|99|0.00|AEG 8 (NO REV)|
20|FH_F127995_84010_0|SrvcGrp|10577|2022|PDM|25.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F97040_31901_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F67888_0_0|SrvcGrp|26001|2022|PDM|142.05|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F133697_63129_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F136596_72117_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136614_43512_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136622_60062_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F114783_70810_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113870_10536_0|SrvcGrp|73605|2022|PDM|1044.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F114985_32073_0|SrvcGrp|104805|2022|PDM|61.00|99|0.00|PSYTX CRISIS EA ADDL 30 MIN|
20|FH_F100664_03104_0|SrvcGrp|73559|2022|PDM|8465.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F100664_03104_0|SrvcGrp|73643|2022|PDM|2201.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F117195_0_0|SrvcGrp|66561|2022|PCT|0.90|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F122610_73139_0|SrvcGrp|12634|2022|PCT|1.48|99|0.00|RADIOLOGY 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_F135719_45502_0|SrvcGrp|11663|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F135763_20678_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F136930_73114_0|SrvcGrp|72219|2022|PCT|1.48|99|0.00|LABORATORY|
20|FH_F112268_19087_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F112416_71449_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F141170_0_0|SrvcGrp|67065|2022|PDM|16400.00|99|0.00|CERVICAL SURGERY|
20|FH_F116173_40217_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116393_07002_0|SrvcGrp|106511|2022|PDM|146.00|99|0.00|ASSESSMENT OF APHASIA|
20|FH_F147519_52627_0|SrvcGrp|110542|2022|PDM|453.09|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F42279_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F102984_80026_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F140007_0_0|SrvcGrp|84442|2022|PDM|9990.00|99|0.00|REVISION KNEE|
20|FH_F142087_0_0|SrvcGrp|98497|2022|PDM|12000.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F135351_0_0|SrvcGrp|89404|2022|PDM|16500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F72445_0_0|SrvcGrp|9830|2022|PDM|60.00|99|0.00|OT SVCS|
20|FH_F136410_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AETNA AMBULATORY SURGERY (NO REV)|
20|FH_F113585_20155_0|SrvcGrp|86828|2022|PDM|90.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F138627_82901_0|SrvcGrp|43568|2022|PDM|75.00|99|0.00|SKILLED NURSING - RN|
20|FH_F57953_0_0|SrvcGrp|54244|2022|PDM|350.00|99|0.00|CT SCANS|
20|FH_F89580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.61|99|0.00|OP SVCS|
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|465.99|99|0.00|HAPA WPA-NWPA 2012-13 ASC 212 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|384.84|99|0.00|HAPA WPA-NWPA 2012-13 ASC 109 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F91933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138685_18017_0|SrvcGrp|113364|2022|PDM|83.04|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F138407_60025_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138665_53186_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F96321_0_0|SrvcGrp|108769|2022|PDM|1044.65|99|0.00|UPPER GI ENDOSCOPY/LIGATION|
20|FH_F113527_31023_0|SrvcGrp|75497|2022|PCT|0.80|99|0.00|AEG 10|
20|FH_F132163_17601_0|SrvcGrp|103669|2022|PDM|527.00|99|0.00|AETNA PARTIAL HOSP (HCFA)|
20|FH_F132258_45404_0|SrvcGrp|86827|2022|PDM|71.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F135440_32561_0|SrvcGrp|89149|2022|PDM|195.00|99|0.00|OP INTENSIVE|
20|FH_F135507_02859_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135583_17331_0|SrvcGrp|114925|2022|PCT|0.82|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F130847_53098_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131132_44077_0|CSTM-ALL|CSTM-00|2020|PDM|3171.00|99|0.00|AEG 4 (NO REV)|
20|FH_F131407_07607_0|SrvcGrp|29076|2022|PDM|30.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F116464_13088_0|SrvcGrp|89024|2022|PDM|83.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F127399_0_0|SrvcGrp|110676|2022|PDM|2913.00|99|0.00|LAPAROSCOPIC TREAT OF ECTOP|
20|FH_F121428_40202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146125_0_0|SrvcGrp|64517|2022|PDM|2030.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F42098_0_0|SrvcGrp|11796|2022|PDM|65.00|99|0.00|DIETICIAN|
20|FH_F42347_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F134264_67226_0|SrvcGrp|73841|2022|PDM|428.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F134315_89106_0|SrvcGrp|21920|2022|PCT|1.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F131000_0_0|SrvcGrp|83646|2022|PDM|3343.00|99|0.00|CPT 31276|
20|FH_F132328_0_0|SrvcGrp|88161|2022|PDM|6097.00|99|0.00|LAMINECTOMY W/FACE-THORACIC|
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)|
20|FH_F96340_23704_0|SrvcGrp|46903|2022|PDM|492.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F141035_0_0|SrvcGrp|90365|2022|PDM|7008.00|99|0.00|REPAIR METACARPAL FRACTURE|
20|FH_F128185_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F102222_19720_0|SrvcGrp|43568|2022|PDM|63.00|99|0.00|SKILLED NURSING - RN|
20|FH_F129234_78245_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143542_0_0|SrvcGrp|109758|2022|PDM|11475.00|99|0.00|COLLAGEN CROSSLINKING CORNEA|
20|FH_F131173_17043_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|493.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F36274_0_0|SrvcGrp|9830|2022|PDM|90.00|99|0.00|OT SVCS|
20|FH_F117378_16148_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78048_0_0|SrvcGrp|35964|2022|PDM|45.00|99|0.00|SPEECH THERAPY|
20|FH_F141410_13045_0|SrvcGrp|111927|2022|PDM|56.44|99|0.00|COVID-19 NON CDC|
20|FH_F32996_0_0|SrvcGrp|1943|2022|PDM|3240.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F116059_62959_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88254_33411_0|SrvcGrp|17013|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F135219_68506_0|SrvcGrp|75506|2022|PCT|1.18|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F121149_76021_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F68843_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100984_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F123898_45121_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F89453_75069_0|SrvcGrp|73524|2022|PDM|95.00|99|0.00|PHYSICAL THERAPY|
20|FH_F65159_0_0|CSTM-ALL|CSTM-00|2020|PDM|1459.00|99|0.00|ASPG I|
20|FH_F130765_34113_0|CSTM-ALL|CSTM-00|2020|PCT|0.20|99|0.00|OP SVCS|
20|FH_F145641_06902_0|SrvcGrp|100012|2022|PDM|5814.00|99|0.00|REPAIR SHOULDER CAPSULE|
20|FH_F31595_0_0|SrvcGrp|12401|2022|PDM|85.00|99|0.00|RN VISIT|
20|FH_F31248_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F150241_60714_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143567_62207_0|SrvcGrp|46605|2022|PDM|135.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F77943_0_0|SrvcGrp|51643|2022|PCT|0.70|99|0.00|LABORATORY|
20|FH_F144848_0_0|SrvcGrp|114179|2022|PDM|3866.00|99|0.00|ABLATE BONE TUMOR(S) PERQ|
20|FH_F134614_84651_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F144848_0_0|SrvcGrp|104163|2022|PDM|4575.00|99|0.00|KYPHOPLASTY|
20|FH_F150140_28714_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F54592_0_0|SrvcGrp|17014|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F84935_0_0|SrvcGrp|79099|2022|PCT|0.90|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F105143_26062_0|SrvcGrp|73496|2022|PDM|1470.00|99|0.00|AETNA ER LEVEL V|
20|FH_F146793_44236_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111662_80601_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F111823_32539_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F121250_47401_0|SrvcGrp|108484|2022|PDM|984.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F53732_0_0|SrvcGrp|10580|2022|PDM|55.00|99|0.00|HYDRATION THERAPY - 3 LITERS|
20|FH_F97602_40121_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F140615_73013_0|SrvcGrp|113624|2022|PDM|5251.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F109513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142067_45211_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151222_72958_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F32093_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130460_33166_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|2075.00|99|0.00|AEG 4 (NO REV)|
20|FH_F114389_50131_0|SrvcGrp|24747|2022|PDM|102.25|99|0.00|HOME INFUSION THERAPY|
20|FH_F67882_0_0|SrvcGrp|13880|2022|PCT|0.75|99|0.00|IMPLANTS|
20|FH_F67379_0_0|SrvcGrp|9774|2022|PDM|2119.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F118785_33315_0|SrvcGrp|107483|2022|PCT|1.10|99|0.00|OP THERAPY SERVICE|
20|FH_F151380_90701_0|SrvcGrp|114093|2022|PDM|506.00|99|0.00|PARTIAL HOSPITAL SUBSTANCE ABUSE|
20|FH_F151405_65109_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151427_04106_0|SrvcGrp|108447|2022|PDM|300.40|99|0.00|INFUSION THERAPY (HCFA)|
20|FH_F151510_15928_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132258_45404_0|SrvcGrp|112042|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUG|
20|FH_F37809_0_0|SrvcGrp|27397|2022|PDM|5830.00|99|0.00|OP SURGERY|
20|FH_F135350_60014_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F135372_73089_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135439_33825_0|SrvcGrp|108484|2022|PDM|549.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F135483_53226_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F135584_10977_0|SrvcGrp|78420|2022|PDM|2800.00|99|0.00|INTERIM LABOR|
20|FH_F135972_18509_0|SrvcGrp|473|2022|PDM|402.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F136183_72756_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F130547_85712_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116397_33404_0|SrvcGrp|24750|2022|PDM|43.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F116397_33404_0|SrvcGrp|86835|2022|PDM|15.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F116397_33404_0|SrvcGrp|86829|2022|PDM|4.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F116455_26003_0|SrvcGrp|75545|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F116463_76501_0|SrvcGrp|46903|2022|PDM|431.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1302.00|99|0.00|REPAIR UMBIL HERNIA|
20|FH_F36479_0_0|SrvcGrp|23170|2022|PDM|2295.00|99|0.00|CV SURGERY|
20|FH_F121444_47720_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121719_63122_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F131407_07607_0|SrvcGrp|14948|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F131407_07607_0|SrvcGrp|86830|2022|PDM|30.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F127992_34952_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111292_33136_0|SrvcGrp|66517|2022|PCT|0.00|99|0.00|NICU|
20|FH_F111363_33169_0|SrvcGrp|99361|2022|PDM|73.00|99|0.00|DX MAMMO INCL CAD UNI|
20|FH_F111385_33308_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F134264_67226_0|SrvcGrp|108484|2022|PDM|550.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F40838_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F87153_0_0|SrvcGrp|83880|2022|PDM|50.80|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F51272_0_0|SrvcGrp|16|2022|PDM|2800.00|99|0.00|ACUTE REHABILITATION|
20|FH_F72666_0_0|SrvcGrp|26994|2022|PDM|591.00|99|0.00|SKILLED NURSING|
20|FH_F87501_32055_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F102862_30606_0|SrvcGrp|21359|2022|PDM|27278.00|99|0.00|MS DRG 460 ONLY|
20|FH_F129194_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143648_0_0|SrvcGrp|17327|2022|PDM|6000.00|99|0.00|HYSTEROSCOPY|
20|FH_F148101_33462_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F143249_89801_0|SrvcGrp|10577|2022|PDM|30.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F123185_0_0|SrvcGrp|73004|2022|PDM|1209.00|99|0.00|AEG 8|
20|FH_F150025_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F129241_54409_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130747_0_0|SrvcGrp|88491|2022|PDM|8843.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F82955_34266_0|SrvcGrp|82138|2022|PCT|0.66|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|AEG 1 (NO REV)|
20|FH_F150982_0_0|SrvcGrp|86460|2022|PDM|6606.00|99|0.00|REVISE BREAST RECONSTRUCTION|
20|FH_F38526_0_0|SrvcGrp|15762|2022|PCT|0.90|99|0.00|TRAUMA|
20|FH_F139515_0_0|SrvcGrp|71666|2022|PDM|15299.00|99|0.00|CPT 63655|
20|FH_F67121_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F126523_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|1912.00|99|0.00|AEG 8 (NO REV)|
20|FH_F129782_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F151562_26003_0|SrvcGrp|82222|2022|PDM|103.00|99|0.00|HOSPICE CARE|
20|FH_F129096_77833_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128274_81501_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130805_17404_0|SrvcGrp|77507|2022|PCT|2.05|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|130.52|99|0.00|AETNA SLEEP STUDIES|
20|FH_F121628_19533_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F134593_60007_0|SrvcGrp|86828|2022|PDM|110.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F49552_0_0|SrvcGrp|10675|2022|PDM|1340.00|99|0.00|ICU/CCU|
20|FH_F114683_0_0|SrvcGrp|89981|2022|PDM|1645.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY|
20|FH_F134613_08852_0|SrvcGrp|109798|2022|PCT|1.10|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F110541_99336_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F134495_84321_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134495_84321_0|SrvcGrp|46104|2022|PDM|50.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F44638_0_0|SrvcGrp|196|2022|PDM|590.00|99|0.00|CD (ADOLESCENT) - DETOX|
20|FH_F134823_33135_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F107200_0_0|SrvcGrp|33977|2022|PDM|1665.00|99|0.00|CPT 59820|
20|FH_F136386_30901_0|SrvcGrp|28164|2022|PDM|89250.00|99|0.00|MS DRG 224 ONLY|
20|FH_F122009_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F117270_32073_0|SrvcGrp|89149|2022|PDM|185.00|99|0.00|OP INTENSIVE|
20|FH_F90791_79106_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F129892_0_0|CSTM-ALL|CSTM-00|2020|PDM|843.00|99|0.00|AEG 4 (NO REV)|
20|FH_F102760_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|ENTERAL & PARENTERAL THERAPY|
20|FH_F121404_32216_0|SrvcGrp|105614|2022|PDM|173.00|99|0.00|HEATED HUMIDIFIER (MOD NU)|
20|FH_F117399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F87201_0_0|SrvcGrp|42971|2022|PDM|100.00|99|0.00|SKN RN|
20|FH_F141336_16947_0|CSTM-ALL|CSTM-00|2020|PDM|1243.00|99|0.00|AEG 2 (NO REV)|
20|FH_F137897_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F147059_28806_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F71105_0_0|SrvcGrp|32153|2022|PDM|70.00|99|0.00|PT/OT/ST|
20|FH_F148379_89129_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F148419_01453_0|SrvcGrp|107288|2022|PCT|1.00|99|0.00|INJ INTERFERON BETA|
20|FH_F146374_84102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149820_75040_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137896_0_0|SrvcGrp|91629|2022|PDM|105.45|99|0.00|SKILLED NURSE SERVICES 15 MINS|
20|FH_F133490_90650_0|SrvcGrp|11663|2022|PCT|0.25|99|0.00|IMPLANTS|
20|FH_F133631_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F145988_06105_0|CSTM-ALL|CSTM-00|2020|PDM|7252.00|99|0.00|AEG 5  (NO REV)|
20|FH_F47834_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F63516_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F40465_0_0|SrvcGrp|3607|2022|PCT|0.75|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F92677_08003_0|SrvcGrp|92809|2022|PDM|12.60|99|0.00|ENTERAL FEEDING SUPPLY KIT PUMP (HCFA)|
20|FH_F141654_15217_0|SrvcGrp|91214|2022|PDM|76.49|99|0.00|MED NUTRITION|
20|FH_F43953_0_0|SrvcGrp|38444|2022|PCT|0.70|99|0.00|MEDICAL/SURGICAL SUPPLIES|
20|FH_F55375_0_0|SrvcGrp|30623|2022|PDM|4800.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F147166_03444_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F84833_17109_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F150921_21620_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F147361_19806_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)|
20|FH_F127189_49503_0|SrvcGrp|83857|2022|PDM|550.00|99|0.00|IP HOSPICE SVCS|
20|FH_F128715_71201_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS|
20|FH_F124691_78003_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|4107.00|99|0.00|AEG 7 (NO REV)|
20|FH_F150339_75035_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120977_50510_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F66687_0_0|SrvcGrp|21104|2022|PDM|92780.00|99|0.00|MS DRG 220 ONLY|
20|FH_F31540_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F100320_0_0|SrvcGrp|86582|2022|PDM|1700.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F116245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82235_0_0|SrvcGrp|73002|2022|PDM|1094.50|99|0.00|AEG 7|
20|FH_F137946_0_0|SrvcGrp|113236|2022|PDM|41.38|99|0.00|COVID-19 SARS-COV-2 W/ OPTIC|
20|FH_F125011_74467_0|SrvcGrp|73004|2022|PDM|2940.00|99|0.00|AEG 8|
20|FH_F130747_0_0|SrvcGrp|100010|2022|PDM|4682.00|99|0.00|KNEE RECONSTRUCTION|
20|FH_F138578_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F115103_31405_0|SrvcGrp|30089|2022|PDM|496.10|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F72830_0_0|SrvcGrp|70043|2022|PDM|2000.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 3|
20|FH_F139551_0_0|SrvcGrp|35921|2022|PDM|7700.00|99|0.00|BARIATRIC SURGERY|
20|FH_F122725_32216_0|SrvcGrp|52951|2022|PDM|97.00|99|0.00|PSYCHIATRIC CPT 90846|
20|FH_F38952_0_0|SrvcGrp|29906|2022|PCT|0.90|99|0.00|MORRISON COMM HOSP PROFESSIONAL SVCS|
20|FH_F134618_14892_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133749_84604_0|SrvcGrp|112423|2022|PDM|25.00|99|0.00|DIURETIC IV THERAPY (HCFA)|
20|FH_F124743_0_0|SrvcGrp|30609|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F138050_52301_0|SrvcGrp|89317|2022|PCT|1.36|99|0.00|AETNA SLEEP STUDIES|
20|FH_F32073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1516.00|99|0.00|SPINAL CORD REHABILITATION|
20|FH_F123616_30117_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F118270_30606_0|CSTM-ALL|CSTM-00|2020|PDM|156.23|99|0.00|HOSPICE ROUTINE HOME CARE (DAYS 0-60)|
20|FH_F143742_60410_0|SrvcGrp|73606|2022|PDM|1733.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F34477_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DURABLE MEDICAL EQUIPMENT (DME) W/MOD UR - WINN|
20|FH_F37772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137147_75006_0|SrvcGrp|31020|2022|PDM|28367.00|99|0.00|MS DRG 470 ONLY|
20|FH_F114178_19083_0|SrvcGrp|472|2022|PDM|386.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F91913_0_0|SrvcGrp|73002|2022|PDM|995.00|99|0.00|AEG 7|
20|FH_F147725_06002_0|SrvcGrp|90822|2022|PDM|3875.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY|
20|FH_F39893_0_0|SrvcGrp|526|2022|PDM|1500.00|99|0.00|CARDIAC CARE UNIT|
20|FH_F83231_0_0|SrvcGrp|18076|2022|PDM|600.00|99|0.00|MRI|
20|FH_F124414_92653_0|SrvcGrp|89337|2022|PDM|970.00|99|0.00|DETOXIFICATION|
20|FH_F116097_0_0|SrvcGrp|26001|2022|PDM|133.35|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F124233_92648_0|SrvcGrp|87317|2022|PDM|1200.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1090.00|99|0.00|AEG 5  (NO REV)|
20|FH_F137729_19703_0|SrvcGrp|86722|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F141267_0_0|SrvcGrp|103911|2022|PDM|939.00|99|0.00|HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY|
20|FH_F147360_06415_0|SrvcGrp|111928|2022|PCT|1.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F148702_32606_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F41155_0_0|SrvcGrp|24585|2022|PDM|468.00|99|0.00|SKILLED NURSING|
20|FH_F134900_72450_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F37764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F132418_84042_0|SrvcGrp|46903|2022|PDM|1120.36|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F83292_0_0|SrvcGrp|69523|2022|PCT|4.00|99|0.00|BARNESVILLE  PHARMACY @ 100% W/ OP SURG|
20|FH_F83292_0_0|CSTM-ALL|CSTM-00|2020|PCT|5.00|99|0.00|BARNESVILLE  RAD @ 100%|
20|FH_F120974_27607_0|SrvcGrp|92958|2022|PCT|0.71|99|0.00|SLEEP STUDIES|
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|1728.00|99|0.00|AEG 5  (NO REV)|
20|FH_F37611_0_0|SrvcGrp|473|2022|PDM|325.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F114519_0_0|SrvcGrp|72992|2022|PDM|862.00|99|0.00|AEG 2|
20|FH_F44607_0_0|SrvcGrp|17067|2022|PDM|1700.00|99|0.00|ASPG II|
20|FH_F133021_00910_0|SrvcGrp|10944|2022|PDM|350.00|99|0.00|EMERGENCY ROOM|
20|FH_F64940_0_0|SrvcGrp|17139|2022|PDM|605.00|99|0.00|HOSPICE CARE|
20|FH_F51438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95980_20016_0|SrvcGrp|87317|2022|PDM|813.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F138977_64468_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139666_26175_0|SrvcGrp|79786|2022|PCT|0.94|99|0.00|SLEEP STUDIES|
20|FH_F124492_30040_0|SrvcGrp|113235|2022|PDM|156.89|99|0.00|COVID-19 SARSCOV2&INF A&B&RSV AMP PRB|
20|FH_F113545_11201_0|SrvcGrp|46903|2022|PDM|510.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F146204_0_0|SrvcGrp|67994|2022|PDM|1500.00|99|0.00|CPT 58120|
20|FH_F146904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F110732_31513_0|SrvcGrp|73002|2022|PDM|2085.00|99|0.00|AEG 7|
20|FH_F94621_07728_0|SrvcGrp|94044|2022|PCT|1.00|99|0.00|VINBLASTINE SULFATE INJ|
20|FH_F123745_0_0|SrvcGrp|35666|2022|PDM|2500.00|99|0.00|CPT 23700|
20|FH_F149399_17013_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122277_98045_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F102224_0_0|SrvcGrp|67065|2022|PDM|4500.00|99|0.00|CERVICAL SURGERY|
20|FH_F131093_49690_0|SrvcGrp|83857|2022|PDM|550.00|99|0.00|IP HOSPICE SVCS|
20|FH_F132371_19083_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F89779_0_0|SrvcGrp|67065|2022|PDM|11000.00|99|0.00|CERVICAL SURGERY|
20|FH_F129782_0_0|SrvcGrp|99063|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F109040_0_0|SrvcGrp|29428|2022|PDM|420.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT|
20|FH_F148549_60523_0|SrvcGrp|27968|2022|PDM|50.00|99|0.00|SKILLED NURSING LPN|
20|FH_F122433_0_0|SrvcGrp|72992|2022|PDM|625.00|99|0.00|AEG 2|
20|FH_F145550_62034_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F51520_0_0|SrvcGrp|42825|2022|PDM|65.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F71002_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117044_37352_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125118_99201_0|SrvcGrp|110038|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F135236_02840_0|SrvcGrp|12659|2022|PDM|439.50|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
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_F125864_78748_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115464_0_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F93279_0_0|CSTM-ALL|CSTM-00|2020|PDM|1126.00|99|0.00|AEG 9 (NO REV)|
20|FH_F124788_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F44198_0_0|SrvcGrp|2067|2022|PDM|566.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F123372_0_0|CSTM-ALL|CSTM-00|2020|PDM|837.00|99|0.00|CD ADULT REHAB|
20|FH_F120583_43219_0|SrvcGrp|48385|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F149005_16830_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31714_0_0|SrvcGrp|411|2022|PDM|3000.00|99|0.00|OP CARDIAC CATH|
20|FH_F134353_84123_0|SrvcGrp|80918|2022|PDM|693.00|99|0.00|RESPITE CARE|
20|FH_F125928_0_0|SrvcGrp|106317|2022|PDM|588.69|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F44278_0_0|SrvcGrp|3224|2022|PCT|0.85|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F84712_0_0|SrvcGrp|82747|2022|PDM|52.00|99|0.00|THROMBOPLASTIN TIME PARTIAL|
20|FH_F75184_0_0|CSTM-ALL|CSTM-00|2020|PDM|865.60|99|0.00|DIALYSIS|
20|FH_F105145_75075_0|SrvcGrp|98265|2022|PDM|12750.00|99|0.00|SURGICAL PREPARATION OR CREA|
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130800_06078_0|SrvcGrp|472|2022|PDM|585.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F109885_35473_0|SrvcGrp|87317|2022|PDM|637.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F117295_70006_0|SrvcGrp|46605|2022|PDM|105.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F137806_83702_0|SrvcGrp|73842|2022|PDM|235.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136735_0_0|SrvcGrp|112933|2022|PDM|150.00|99|0.00|EPILATION SURGERY|
20|FH_F119447_64081_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F103880_85014_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F69694_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|1854.00|99|0.00|AEG 4 (NO REV)|
20|FH_F133397_23233_0|SrvcGrp|104355|2022|PCT|1.18|99|0.00|ORTHOTIC PROCEDURES|
20|FH_F115324_78852_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118486_95060_0|SrvcGrp|86723|2022|PDM|550.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F72859_0_0|SrvcGrp|12856|2022|PDM|85.00|99|0.00|NURSING CARE|
20|FH_F150541_37922_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143197_34957_0|SrvcGrp|74668|2022|PDM|195.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|3163.00|99|0.00|AEG 3 (NO REV)|
20|FH_F107140_0_0|SrvcGrp|48396|2022|PDM|65.00|99|0.00|OT SERVICES|
20|FH_F119104_44870_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135714_01922_0|SrvcGrp|104228|2022|PDM|145.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F88223_0_0|SrvcGrp|73701|2022|PDM|27.50|99|0.00|AETNA - SKILLED NURSING|
20|FH_F120099_86305_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F119946_36109_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F140295_0_0|SrvcGrp|72121|2022|PDM|4164.00|99|0.00|ARTHOSCOPY|
20|FH_F98840_31021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32825_0_0|SrvcGrp|12674|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F35557_0_0|SrvcGrp|10572|2022|PDM|28.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F114294_18235_0|CSTM-ALL|CSTM-00|2020|PCT|1.59|99|0.00|HSS APC GROUPED|
20|FH_F150981_33140_0|SrvcGrp|115602|2022|PCT|1.00|99|0.00|TELEMEDICINE|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PDM|994.80|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 13 W/O REV|
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 7 (NO REV)|
20|FH_F134598_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F135351_0_0|SrvcGrp|110571|2022|PDM|897.00|99|0.00|NERVE BLOCK INJECTION 8|
20|FH_F138491_0_0|SrvcGrp|87799|2022|PDM|85.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F100101_24018_0|SrvcGrp|75545|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F120639_73078_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F150939_0_0|SrvcGrp|53786|2022|PDM|12.00|99|0.00|BREATHING DEVICE|
20|FH_F114853_0_0|SrvcGrp|98495|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F41013_0_0|SrvcGrp|29021|2022|PCT|1.00|99|0.00|DME AND SUPPLIES|
20|FH_F138697_53219_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138730_22602_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138876_25302_0|SrvcGrp|86842|2022|PDM|35.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F139115_32504_0|SrvcGrp|87077|2022|PDM|144.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F138387_02886_0|SrvcGrp|93360|2022|PDM|43.00|99|0.00|HOME HEALTH AIDE|
20|FH_F57953_0_0|SrvcGrp|32385|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKE (DME)|
20|FH_F67167_0_0|SrvcGrp|16634|2022|PDM|22473.00|99|0.00|CRYOBLATION|
20|FH_F78265_0_0|SrvcGrp|75344|2022|PDM|9632.00|99|0.00|PTCA|
20|FH_F89580_0_0|SrvcGrp|16719|2022|PCT|0.46|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F37738_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1105.46|99|0.00|HAPA WPA-NWPA 2012-13 ASC 707 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|124.63|99|0.00|HAPA WPA-NWPA 2012-13 ASC 315 W/O REV|
20|FH_F151302_80227_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F151319_64040_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145248_19477_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F97501_31501_0|SrvcGrp|73601|2022|PDM|8719.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F136012_60625_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136019_63044_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136026_66062_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119886_25504_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F130933_47129_0|SrvcGrp|89149|2022|PDM|160.00|99|0.00|OP INTENSIVE|
20|FH_F130756_04901_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 10 (NO REV)|
20|FH_F116431_76104_0|SrvcGrp|78403|2022|PDM|0.25|99|0.00|AETNA MED RECORD|
20|FH_F140629_0_0|SrvcGrp|113678|2022|PDM|2497.00|99|0.00|BILIARY LAPAROSCOPY|
20|FH_F121704_90405_0|SrvcGrp|75419|2022|PDM|1100.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F43237_0_0|CSTM-ALL|CSTM-00|2020|PDM|2315.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111363_33169_0|SrvcGrp|99363|2022|PDM|73.00|99|0.00|SCR MAMMO BI INCL CAD|
20|FH_F47906_0_0|SrvcGrp|43922|2022|PCT|1.00|99|0.00|DME MOD KL|
20|FH_F47906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53|
20|FH_F34864_0_0|CSTM-ALL|CSTM-00|2020|PDM|2735.00|99|0.00|ASPG VIII|
20|FH_F39925_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH|
20|FH_F131000_0_0|SrvcGrp|26273|2022|PDM|3343.00|99|0.00|CPT 29880|
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|111602|2022|PDM|2335.00|99|0.00|LARYNGOSCOPY|
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PDM|1394.00|99|0.00|AEG 3 (NO REV)|
20|FH_F133994_0_0|SrvcGrp|82981|2022|PDM|145.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F112166_72143_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F141035_0_0|SrvcGrp|76604|2022|PDM|7008.00|99|0.00|CPT 25447|
20|FH_F101852_78758_0|SrvcGrp|43524|2022|PDM|185.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F101852_78758_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F101320_26062_0|SrvcGrp|24745|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F56472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102943_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F132387_60465_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112679_85711_0|SrvcGrp|27968|2022|PDM|50.00|99|0.00|SKILLED NURSING LPN|
20|FH_F116869_15146_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120974_27607_0|SrvcGrp|116131|2022|PCT|0.71|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F84394_17402_0|CSTM-ALL|CSTM-00|2020|PDM|4539.00|99|0.00|AEG 7 (NO REV)|
20|FH_F46373_0_0|SrvcGrp|977|2022|PCT|0.84|99|0.00|RADIOLOGY SVCS|
20|FH_F84215_0_0|SrvcGrp|72996|2022|PDM|767.00|99|0.00|AEG 4|
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1941.56|99|0.00|AEG 9 (NO REV)|
20|FH_F139551_0_0|SrvcGrp|87055|2022|PDM|2625.00|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION|
20|FH_F129656_15005_0|SrvcGrp|27968|2022|PDM|20.00|99|0.00|SKILLED NURSING LPN|
20|FH_F44218_0_0|SrvcGrp|37542|2022|PDM|500.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F148265_06067_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F82753_18840_0|SrvcGrp|3803|2022|PCT|0.64|99|0.00|TRAUMA CARE|
20|FH_F128906_48423_0|SrvcGrp|82223|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F82173_72712_0|SrvcGrp|131|2022|PCT|0.53|99|0.00|PACEMAKER DEVICE|
20|FH_F40046_0_0|SrvcGrp|30089|2022|PCT|0.60|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F125074_18104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39339_0_0|SrvcGrp|413|2022|PCT|0.75|99|0.00|TRANSPLANT SVCS|
20|FH_F141590_90049_0|SrvcGrp|89337|2022|PDM|1347.89|99|0.00|DETOXIFICATION|
20|FH_F130821_85712_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145562_70458_0|SrvcGrp|86825|2022|PDM|50.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F119864_63141_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137573_33764_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143786_78746_0|SrvcGrp|74668|2022|PDM|281.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115075_77833_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F92091_0_0|SrvcGrp|89989|2022|PDM|4000.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2652.00|99|0.00|AEG 8 (NO REV)|
20|FH_F32612_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F112272_0_0|SrvcGrp|82037|2022|PDM|1560.00|99|0.00|AETNA ICU|
20|FH_F141802_17042_0|SrvcGrp|113156|2022|PDM|12967.00|99|0.00|PATIENT TRANSFER  (<=48 HRS)|
20|FH_F130214_30144_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F115049_78539_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F77903_0_0|SrvcGrp|19973|2022|PDM|2500.00|99|0.00|CAT SCAN|
20|FH_F136790_0_0|SrvcGrp|3406|2022|PDM|647.00|99|0.00|CPT 99214|
20|FH_F144808_0_0|CSTM-ALL|CSTM-00|2020|PDM|2888.00|99|0.00|AEG 9 (NO REV)|
20|FH_F71445_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124159_92506_0|SrvcGrp|89337|2022|PDM|943.00|99|0.00|DETOXIFICATION|
20|FH_F138147_18018_0|CSTM-ALL|CSTM-00|2020|PDM|292.00|99|0.00|PSYCHIATRIST LEVEL AUTISM (MOD AF) (HCFA)|
20|FH_F150140_28714_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132131_33060_0|SrvcGrp|90854|2022|PDM|475.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F132733_0_0|SrvcGrp|51672|2022|PDM|6804.00|99|0.00|MS DRG 286-287 ONLY|
20|FH_F140844_48083_0|SrvcGrp|73523|2022|PDM|129.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F119285_0_0|SrvcGrp|87391|2022|PDM|1751.00|99|0.00|REAPIR RETINAL DETACHMENT|
20|FH_F114918_78748_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F117887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42258_0_0|SrvcGrp|588|2022|PDM|1400.00|99|0.00|CORONARY CARE UNIT|
20|FH_F100782_0_0|SrvcGrp|105121|2022|PDM|679.93|99|0.00|WINDBER MEDICAL CNTR ASC 226|
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)|
20|FH_F81861_0_0|SrvcGrp|64099|2022|PDM|2500.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 14|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|ASPG I- MOD 50|
20|FH_F120670_0_0|SrvcGrp|108933|2022|PDM|2850.00|99|0.00|ARTHROSCOPY|
20|FH_F145642_15108_0|SrvcGrp|86846|2022|PDM|30.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F138149_24112_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F134489_90305_0|SrvcGrp|58509|2022|PDM|450.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F101100_50314_0|SrvcGrp|97914|2022|PDM|4318.00|99|0.00|REVISION OF COLOSTOMY|
20|FH_F131430_17566_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F46832_0_0|SrvcGrp|40825|2022|PDM|60.00|99|0.00|HOME THERAPY - PERITONEAL DIALYSIS|
20|FH_F123848_03257_0|SrvcGrp|48398|2022|PDM|163.00|99|0.00|PT SERVICES|
20|FH_F136426_19006_0|SrvcGrp|106314|2022|PDM|624.00|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F134156_32174_0|SrvcGrp|89337|2022|PDM|858.00|99|0.00|DETOXIFICATION|
20|FH_F140765_30315_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F147926_19063_0|SrvcGrp|74668|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PDM|739.00|99|0.00|AEG 3 (NO REV)|
20|FH_F128360_0_0|SrvcGrp|35669|2022|PDM|5200.00|99|0.00|CPT 63650|
20|FH_F137951_0_0|SrvcGrp|77021|2022|PDM|3000.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F49046_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F115405_06010_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F71926_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SOCIAL WORKER|
20|FH_F115273_15132_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148430_06278_0|SrvcGrp|111926|2022|PCT|1.00|99|0.00|COVID-19 LAB TESTING|
20|FH_F101840_76054_0|SrvcGrp|10391|2022|PDM|2957.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F126815_02118_0|CSTM-ALL|CSTM-00|2020|PDM|2470.59|99|0.00|AEG 6 (NO REV)|
20|FH_F134430_86301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139209_22556_0|SrvcGrp|88246|2022|PCT|1.00|99|0.00|INFLUENZA DNA AMP PROBE|
20|FH_F130941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F97881_38703_0|SrvcGrp|88977|2022|PDM|4390.00|99|0.00|C-SECTION DELIVERY|
20|FH_F40899_0_0|SrvcGrp|28847|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY|
20|FH_F40627_0_0|CSTM-ALL|CSTM-00|2020|PDM|5715.00|99|0.00|MS DRG 417-419|
20|FH_F136382_0_0|SrvcGrp|12664|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F50657_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|676.00|99|0.00|AEG 10 (NO REV)|
20|FH_F105143_26062_0|SrvcGrp|20071|2022|PDM|1200.00|99|0.00|MS DRG 945-946|
20|FH_F62577_0_0|SrvcGrp|58455|2022|PDM|786.00|99|0.00|ASPG II|
20|FH_F137242_52722_0|SrvcGrp|73842|2022|PDM|218.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F125053_0_0|SrvcGrp|79594|2022|PDM|2259.00|99|0.00|CPT 45380|
20|FH_F140335_70435_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148739_47129_0|SrvcGrp|112323|2022|PDM|400.00|99|0.00|LABORATORY|
20|FH_F109920_39180_0|SrvcGrp|75487|2022|PDM|1155.00|99|0.00|AEG 5|
20|FH_F117267_07728_0|SrvcGrp|10944|2022|PDM|2790.00|99|0.00|EMERGENCY ROOM|
20|FH_F137934_51054_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F104840_32565_0|SrvcGrp|75495|2022|PCT|0.69|99|0.00|AEG 9|
20|FH_F35448_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F41035_0_0|SrvcGrp|77582|2022|PDM|850.00|99|0.00|CPT 31255|
20|FH_F100703_0_0|SrvcGrp|64761|2022|PDM|7876.00|99|0.00|DISCECTOMY|
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 10 (NO REV)|
20|FH_F112632_66207_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130861_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F40785_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115273_15132_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143529_84737_0|SrvcGrp|106116|2022|PDM|615.00|99|0.00|HOSPICE ROUT HOME CARE-DIEM|
20|FH_F101806_0_0|SrvcGrp|75489|2022|PDM|920.00|99|0.00|AEG 6|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|AETNA CPT 49560|
20|FH_F125350_81050_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37756_0_0|SrvcGrp|9936|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F125249_0_0|SrvcGrp|90417|2022|PDM|1200.00|99|0.00|TREATMENT OF JOINT|
20|FH_F149866_07401_0|SrvcGrp|115642|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F80283_0_0|SrvcGrp|22954|2022|PDM|209.81|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F148221_06477_0|SrvcGrp|94780|2022|PDM|168.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
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_F141470_71913_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149140_07522_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F33851_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F128276_66441_0|SrvcGrp|73841|2022|PDM|198.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F111180_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F41350_0_0|CSTM-ALL|CSTM-00|2020|PDM|802.00|99|0.00|ASPG III|
20|FH_F122694_33334_0|SrvcGrp|105440|2022|PDM|210.00|99|0.00|AETNA TERANIAL MAGN STIM REDETEMINE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|282.28|99|0.00|HAPA WPA-NWPA 2012-13 ASC 115 W/O REV|
20|FH_F81563_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F70303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127080_77520_0|SrvcGrp|89149|2022|PDM|224.00|99|0.00|OP INTENSIVE|
20|FH_F109577_0_0|SrvcGrp|27540|2022|PDM|123.00|99|0.00|NUTRITIONAL ASSESSMENT (FOLLOW UP)|
20|FH_F110346_38501_0|SrvcGrp|86749|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F66427_0_0|SrvcGrp|36231|2022|PDM|1020.00|99|0.00|SUB ACUTE|
20|FH_F146702_70508_0|SrvcGrp|17100|2022|PDM|510.30|99|0.00|SKILLED NURSING|
20|FH_F131711_25550_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F131741_19037_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F70083_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F136481_61350_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118186_97070_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132118_92240_0|SrvcGrp|73842|2022|PDM|259.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151179_84074_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F109277_0_0|SrvcGrp|9494|2022|PDM|865.00|99|0.00|SUBACUTE CARE|
20|FH_F102302_0_0|SrvcGrp|97139|2022|PDM|10850.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F38560_0_0|SrvcGrp|29533|2022|PDM|5500.00|99|0.00|ADULT AICD IMPLANTATION|
20|FH_F130017_02302_0|SrvcGrp|19846|2022|PDM|30005.48|99|0.00|MS DRG 249 ONLY|
20|FH_F100680_43130_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F92598_21236_0|SrvcGrp|46605|2022|PDM|125.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F118144_33418_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138289_76273_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120930_0_0|SrvcGrp|96541|2022|PDM|3000.00|99|0.00|EXTENSIVE HYSTERCTOMY|
20|FH_F115936_75093_0|SrvcGrp|86723|2022|PDM|475.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F120795_27514_0|CSTM-ALL|CSTM-00|2020|PDM|9648.00|99|0.00|AEG 4 (NO REV)|
20|FH_F133007_76010_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F46433_0_0|SrvcGrp|32704|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F87480_0_0|SrvcGrp|27261|2022|PDM|6500.00|99|0.00|CPT 27446|
20|FH_F69968_0_0|SrvcGrp|14174|2022|PDM|1071.96|99|0.00|MRI|
20|FH_F67306_0_0|SrvcGrp|9518|2022|PCT|0.75|99|0.00|EMERGENCY ROOM|
20|FH_F138471_84663_0|SrvcGrp|73700|2022|PDM|42.25|99|0.00|AETNA - SKILLED NURSING|
20|FH_F120152_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 2 (NO REV)|
20|FH_F147927_19083_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F101945_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F137898_46540_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F38948_0_0|SrvcGrp|177|2022|PDM|2769.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F34963_0_0|SrvcGrp|1168|2022|PDM|140.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|1020.00|99|0.00|AEG 7 (NO REV)|
20|FH_F77944_0_0|SrvcGrp|33789|2022|PDM|1581.00|99|0.00|MS DRG 880-887 ONLY|
20|FH_F150884_75503_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F51482_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139825_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F143191_17512_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150000_30152_0|SrvcGrp|115801|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F147800_0_0|SrvcGrp|98105|2022|PDM|110.00|99|0.00|DRAIN INJ JOINT/BURSA W/O U|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|165.00|99|0.00|HAPA EPA ASC 27|
20|FH_F47037_0_0|SrvcGrp|10538|2022|PDM|25.00|99|0.00|NURSING CARE|
20|FH_F117799_0_0|SrvcGrp|77021|2022|PDM|4244.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F90232_15126_0|SrvcGrp|21920|2022|PDM|56.70|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F148181_0_0|SrvcGrp|30609|2022|PDM|48.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F103180_85283_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F116040_24637_0|SrvcGrp|86853|2022|PDM|30.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F134826_19067_0|SrvcGrp|90635|2022|PDM|150.00|99|0.00|AETNA PSYTX PT & FAMILY 60 MINUTES|
20|FH_F93360_64730_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F140612_60070_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137973_24457_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|1168.00|99|0.00|ASPG IV|
20|FH_F76085_0_0|SrvcGrp|73179|2022|PDM|50.00|99|0.00|PT/OT/ST|
20|FH_F110420_60649_0|SrvcGrp|73006|2022|PDM|1540.00|99|0.00|AEG 9|
20|FH_F145983_45213_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145642_15108_0|SrvcGrp|86825|2022|PDM|55.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F114444_19602_0|SrvcGrp|86643|2022|PDM|45.00|99|0.00|AETNA PSYTX PT & FAMILY 30 MINS (MOD TD)|
20|FH_F125928_0_0|SrvcGrp|106297|2022|PDM|181.13|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F130826_0_0|CSTM-ALL|CSTM-00|2020|PDM|812.00|99|0.00|AEG 5  (NO REV)|
20|FH_F116114_37033_0|SrvcGrp|90573|2022|PDM|239.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F133335_84790_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|789.00|99|0.00|ASPG VI|
20|FH_F109501_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE|
20|FH_F88639_80204_0|SrvcGrp|15386|2022|PCT|0.00|99|0.00|CLINIC VISIT|
20|FH_F35308_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD AW) - BDSS|
20|FH_F120489_63552_0|SrvcGrp|941|2022|PDM|471.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F137054_22041_0|SrvcGrp|14494|2022|PDM|40.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F80284_16354_0|SrvcGrp|64103|2022|PDM|1031.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 6|
20|FH_F80284_16354_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F149540_64083_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37545_0_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|OP SVCS|
20|FH_F147725_06002_0|SrvcGrp|89853|2022|PDM|3700.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG|
20|FH_F147725_06002_0|SrvcGrp|86463|2022|PDM|2866.00|99|0.00|FRACTURE NASAL INFERIOR|
20|FH_F134447_12883_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F121970_92653_0|SrvcGrp|89149|2022|PDM|350.00|99|0.00|OP INTENSIVE|
20|FH_F106822_0_0|SrvcGrp|94882|2022|PDM|12.70|99|0.00|FLU VIRUS VACC-SPLIT 3 YRS & ABOVE|
20|FH_F136793_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F40728_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149721_76522_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146254_83651_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F128299_44134_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F115312_78550_0|SrvcGrp|94880|2022|PDM|87.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F136812_0_0|SrvcGrp|108443|2022|PDM|500.00|99|0.00|HEMODIALYSIS W/ TRAINING|
20|FH_F120788_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132338_18901_0|SrvcGrp|75419|2022|PDM|475.99|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F139294_33406_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139597_07009_0|SrvcGrp|471|2022|PDM|700.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F131415_73071_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F36743_0_0|SrvcGrp|675|2022|PDM|1770.00|99|0.00|PEDIATRIC INPATIENT SVCS|
20|FH_F132056_32080_0|SrvcGrp|73842|2022|PDM|208.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F36165_0_0|SrvcGrp|17015|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|978.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F44644_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|AEG 1 (NO REV)|
20|FH_F108080_77081_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
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_F87993_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT|
20|FH_F48476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116633_37217_0|SrvcGrp|88621|2022|PDM|120.00|99|0.00|SKILLED NURSING LPN|
20|FH_F119591_75034_0|SrvcGrp|73842|2022|PDM|209.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F39866_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F110166_32757_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F55054_0_0|SrvcGrp|51269|2022|PDM|28000.00|99|0.00|GAMMA|
20|FH_F93593_33414_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F115046_77964_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F137633_85202_0|SrvcGrp|92761|2022|PCT|1.70|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135236_02840_0|CSTM-ALL|CSTM-00|2020|PDM|6886.40|99|0.00|INPATIENT PSYCHIATRIC CARE >17 YRS|
20|FH_F39273_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F63249_0_0|SrvcGrp|59415|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPY SVCS EXCLD MOD GO|
20|FH_F38560_0_0|CSTM-ALL|CSTM-00|2020|PDM|18000.00|99|0.00|ADULT CV SURGERY (MS DRG)|
20|FH_F148659_28134_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120719_27540_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F36381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114483_47905_0|SrvcGrp|25004|2022|PDM|460.00|99|0.00|DIALYSIS SVCS|
20|FH_F134609_33458_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147502_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F113457_17011_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F110521_98034_0|SrvcGrp|89149|2022|PDM|191.00|99|0.00|OP INTENSIVE|
20|FH_F95623_84015_0|SrvcGrp|90707|2022|PDM|90.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F134593_60007_0|SrvcGrp|22389|2022|PDM|12.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F150144_39452_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F141447_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124369_0_0|SrvcGrp|96543|2022|PDM|2750.00|99|0.00|REVISION OF CALF TENDON|
20|FH_F102200_06416_0|SrvcGrp|24750|2022|PDM|45.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F115966_16801_0|SrvcGrp|46605|2022|PDM|125.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F51674_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134087_0_0|SrvcGrp|80617|2022|PDM|10455.00|99|0.00|ARTHOPLASTY|
20|FH_F37365_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118986_0_0|SrvcGrp|75489|2022|PDM|1206.66|99|0.00|AEG 6|
20|FH_F151379_21045_0|SrvcGrp|72990|2022|PDM|437.00|99|0.00|AEG 1|
20|FH_F151427_04106_0|SrvcGrp|49443|2022|PDM|300.40|99|0.00|INFUSION THERAPY|
20|FH_F151501_30265_0|SrvcGrp|98523|2022|PDM|2090.00|99|0.00|CAPSULOTOMY|
20|FH_F132258_45404_0|SrvcGrp|86837|2022|PDM|11.93|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F132258_45404_0|SrvcGrp|22389|2022|PDM|11.93|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F132262_60062_0|CSTM-ALL|CSTM-00|2020|PDM|1232.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS|
20|FH_F36492_0_0|SrvcGrp|73000|2022|PDM|1428.00|99|0.00|AEG 6|
20|FH_F36555_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F40571_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43239_0_0|SrvcGrp|40820|2022|PDM|1400.00|99|0.00|ICU/CCU|
20|FH_F135834_74434_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135851_25414_0|SrvcGrp|89149|2022|PDM|180.00|99|0.00|OP INTENSIVE|
20|FH_F135973_66606_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119892_47586_0|SrvcGrp|48396|2022|PDM|90.00|99|0.00|OT SERVICES|
20|FH_F100763_24202_0|SrvcGrp|73659|2022|PDM|4297.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F130620_18940_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F131132_44077_0|SrvcGrp|73496|2022|PDM|2274.00|99|0.00|AETNA ER LEVEL V|
20|FH_F116397_33404_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F116404_20191_0|SrvcGrp|29347|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F121824_92675_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F111292_33136_0|SrvcGrp|73004|2022|PDM|7736.00|99|0.00|AEG 8|
20|FH_F111390_32960_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50336_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|ASPG IV|
20|FH_F41780_0_0|SrvcGrp|16746|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F40598_0_0|SrvcGrp|701|2022|PDM|1450.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F31504_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F96280_06340_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129240_10028_0|SrvcGrp|86825|2022|PDM|60.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F101852_78758_0|SrvcGrp|89417|2022|PDM|465.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F102960_50613_0|SrvcGrp|73841|2022|PDM|566.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F143648_0_0|SrvcGrp|114092|2022|PDM|1960.00|99|0.00|DRAINAGE OF VULVA ABSCESS|
20|FH_F46258_0_0|CSTM-ALL|CSTM-00|2020|PDM|78.20|99|0.00|WALGREENS CPAP (MOD RR) - UB|
20|FH_F151146_0_0|SrvcGrp|82641|2022|PDM|6180.00|99|0.00|AETNA LAPROSCOPY|
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125883_78748_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148892_0_0|SrvcGrp|36591|2022|PDM|38367.00|99|0.00|CPT 63685|
20|FH_F120349_38774_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F129656_15005_0|SrvcGrp|48394|2022|PDM|34.22|99|0.00|SKILLED NURSING SERVICES|
20|FH_F31798_0_0|SrvcGrp|903|2022|PCT|0.75|99|0.00|PTC ANGIOPLASTY|
20|FH_F74026_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|OP SVCS|
20|FH_F110925_01104_0|SrvcGrp|48396|2022|PDM|94.56|99|0.00|OT SERVICES|
20|FH_F93881_15009_0|SrvcGrp|105415|2022|PCT|1.85|99|0.00|LABORATORY SERVICES|
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|3080.00|99|0.00|AEG 6 (NO REV)|
20|FH_F148265_06067_0|SrvcGrp|99162|2022|PDM|11280.00|99|0.00|CPT 24366|
20|FH_F125870_0_0|SrvcGrp|28549|2022|PDM|2445.00|99|0.00|VITRECTOMY|
20|FH_F145714_44135_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144248_0_0|SrvcGrp|109346|2022|PDM|4590.00|99|0.00|EXCISION OF CHALAZION DIFFERENT LIDS|
20|FH_F112082_30720_0|SrvcGrp|29076|2022|PDM|89.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F116806_0_0|SrvcGrp|65402|2022|PDM|1923.16|99|0.00|CPT 42145|
20|FH_F39532_0_0|CSTM-ALL|CSTM-00|2020|PDM|210.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F79863_0_0|SrvcGrp|43572|2022|PDM|90.00|99|0.00|PICC-LINE INSERTION|
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PDM|603.00|99|0.00|AEG 3 (NO REV)|
20|FH_F134609_33458_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F113465_28204_0|SrvcGrp|3809|2022|PDM|661.13|99|0.00|HOSPICE CARE|
20|FH_F150165_06032_0|SrvcGrp|27261|2022|PDM|9270.00|99|0.00|CPT 27446|
20|FH_F125124_0_0|SrvcGrp|110066|2022|PDM|768.00|99|0.00|ANOSCOPY CONTROL BLEEDING|
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 9 (NO REV)|
20|FH_F145940_71730_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F76028_0_0|SrvcGrp|45965|2022|PDM|120.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F120522_53549_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F125816_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118178_37909_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149663_45219_0|SrvcGrp|705|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F117098_20186_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F33821_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F117623_0_0|CSTM-ALL|CSTM-00|2020|PDM|27.00|99|0.00|GROUP BEHAVIOR TREATMENT (HCFA)|
20|FH_F93252_0_0|SrvcGrp|93026|2022|PDM|2700.00|99|0.00|ROTATOR CUFF REPAIR|
20|FH_F114389_50131_0|SrvcGrp|22389|2022|PDM|30.30|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F141353_26452_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|GENERAL ACUTE CARE|
20|FH_F32402_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|422.54|99|0.00|HAPA WPA-NWPA 2012-13 ASC 215 W/O REV|
20|FH_F148556_13206_0|SrvcGrp|46802|2022|PDM|120.00|99|0.00|IV SERVICES|
20|FH_F109625_27330_0|SrvcGrp|105438|2022|PCT|0.00|99|0.00|CONTRAST AGENT|
20|FH_F39304_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F133068_75965_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142321_29401_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F141336_16947_0|SrvcGrp|73606|2022|PDM|325.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F124173_66215_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111594_0_0|SrvcGrp|67068|2022|PDM|7699.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F35368_0_0|SrvcGrp|12234|2022|PDM|1433.00|99|0.00|PACEMAKER REPLACEMENT PX|
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|839.00|99|0.00|AEG 10 (NO REV)|
20|FH_F42557_0_0|SrvcGrp|15159|2022|PDM|215.00|99|0.00|INITIAL EVALUATION|
20|FH_F112853_22408_0|SrvcGrp|41457|2022|PCT|1.00|99|0.00|ENTERAL FORMULA - PEDIATRICS (HYDROLYZED)|
20|FH_F101811_64116_0|SrvcGrp|99437|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F133118_33143_0|SrvcGrp|86723|2022|PDM|457.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F41392_0_0|CSTM-ALL|CSTM-00|2020|PDM|1589.00|99|0.00|ASPG IX|
20|FH_F129111_43084_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149539_06032_0|SrvcGrp|48398|2022|PDM|180.00|99|0.00|PT SERVICES|
20|FH_F124294_66614_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149662_85015_0|SrvcGrp|105465|2022|PCT|1.00|99|0.00|AETNA THERAPIES|
20|FH_F114206_37203_0|SrvcGrp|86831|2022|PDM|4.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F137767_01841_0|SrvcGrp|105465|2022|PCT|0.78|99|0.00|AETNA THERAPIES|
20|FH_F134916_16421_0|SrvcGrp|106291|2022|PDM|232.96|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F36165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111086_29501_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F138017_73129_0|SrvcGrp|103913|2022|PCT|1.57|99|0.00|OP DIALYSIS|
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1738.00|99|0.00|AEG 8 (NO REV)|
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147941_06023_0|SrvcGrp|13595|2022|PDM|1186.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F125028_19061_0|SrvcGrp|86846|2022|PDM|36.75|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F123501_64831_0|SrvcGrp|75545|2022|PDM|327.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F37945_0_0|SrvcGrp|23281|2022|PDM|382.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PDM|5843.00|99|0.00|MS DRG 765|
20|FH_F143898_0_0|SrvcGrp|104226|2022|PDM|100.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F132988_0_0|SrvcGrp|84313|2022|PDM|2057.62|99|0.00|TENDON REPAIR|
20|FH_F130573_02882_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F33165_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F141791_22572_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F117855_62246_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F81494_0_0|SrvcGrp|3809|2022|PDM|933.00|99|0.00|HOSPICE CARE|
20|FH_F117289_01028_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126666_44053_0|SrvcGrp|86868|2022|PDM|68.00|99|0.00|AETNA PSYTX PT & FAM 45 MINS (MOD TD)(HCFA)|
20|FH_F44019_0_0|SrvcGrp|474|2022|PDM|285.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F109840_62832_0|SrvcGrp|75506|2022|PCT|0.80|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F117508_90232_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126975_43551_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F117340_68144_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147800_0_0|SrvcGrp|96781|2022|PDM|99.00|99|0.00|INJECTION FOR NERVE BLOCK 5|
20|FH_F132999_19901_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125182_0_0|SrvcGrp|73002|2022|PDM|1077.00|99|0.00|AEG 7|
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
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|80617|2022|PDM|5500.00|99|0.00|ARTHOPLASTY|
20|FH_F110828_32757_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F47036_0_0|SrvcGrp|10527|2022|PDM|103.00|99|0.00|HOSPICE SVCS|
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100660_56303_0|SrvcGrp|73605|2022|PDM|2447.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F77504_0_0|SrvcGrp|10013|2022|PDM|350.00|99|0.00|NEWBORN NURSERY|
20|FH_F67121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F109277_0_0|SrvcGrp|102100|2022|PDM|141.00|99|0.00|X-RAY/OTHER|
20|FH_F65200_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP|
20|FH_F129096_77833_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|AEG 5  (NO REV)|
20|FH_F37366_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F149079_70809_0|SrvcGrp|16|2022|PDM|816.00|99|0.00|ACUTE REHABILITATION|
20|FH_F138047_77027_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F110344_37421_0|SrvcGrp|86748|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F150165_06032_0|SrvcGrp|113883|2022|PDM|2140.00|99|0.00|ORCHIOPEXY|
20|FH_F150239_75569_0|SrvcGrp|19742|2022|PCT|1.00|99|0.00|MID-LINE INSERTION|
20|FH_F111731_47802_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|415.00|99|0.00|AEG 1 (NO REV)|
20|FH_F110466_06870_0|SrvcGrp|86723|2022|PDM|512.53|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F118196_0_0|SrvcGrp|73004|2022|PDM|1201.00|99|0.00|AEG 8|
20|FH_F146376_53188_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133268_63703_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F93275_0_0|SrvcGrp|13187|2022|PCT|1.05|99|0.00|INTRAOCULAR LENSES|
20|FH_F67639_0_0|SrvcGrp|27346|2022|PDM|1600.00|99|0.00|REPAIR BLADDER DEFECT|
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PDM|4252.00|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F151000_20707_0|SrvcGrp|105323|2022|PCT|1.00|99|0.00|ESTABLISH PATIENT OFF/OP VST|
20|FH_F131239_54615_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114310_0_0|SrvcGrp|105488|2022|PDM|2050.00|99|0.00|SHOULDER ANDOSCOPY PROCEDURES|
20|FH_F39721_0_0|SrvcGrp|17379|2022|PDM|210.00|99|0.00|CCPD TRAINING|
20|FH_F146362_76048_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123324_0_0|SrvcGrp|22899|2022|PDM|2914.00|99|0.00|ICU|
20|FH_F141750_77515_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_F146211_68144_0|CSTM-ALL|CSTM-00|2020|PDM|3230.00|99|0.00|AEG 3 (NO REV)|
20|FH_F130140_68845_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F50484_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130661_04441_0|SrvcGrp|94040|2022|PCT|0.86|99|0.00|OBSERVATION SERVICES FOR ER SERVICES|
20|FH_F117762_0_0|SrvcGrp|41334|2022|PDM|14560.00|99|0.00|TOTAL KNEE|
20|FH_F139927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|GENERAL ACUTE CARE|
20|FH_F94585_19040_0|SrvcGrp|42622|2022|PCT|0.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F147220_49417_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG VI|
20|FH_F98022_89015_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F149273_0_0|SrvcGrp|115610|2022|PDM|4578.00|99|0.00|VENTRAL HERN INIT REPAIR|
20|FH_F150323_68847_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_F151699_01752_0|SrvcGrp|13929|2022|PCT|1.00|99|0.00|GROWTH HORMONE|
20|FH_F143249_89801_0|SrvcGrp|48385|2022|PDM|120.00|99|0.00|SPEECH THERAPY|
20|FH_F38526_0_0|CSTM-ALL|CSTM-00|2020|PDM|3900.00|99|0.00|CV SURGERY (MS DRG 215-238)|
20|FH_F135237_31015_0|SrvcGrp|29346|2022|PCT|0.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F33642_0_0|SrvcGrp|15351|2022|PDM|6500.00|99|0.00|PTCA ANGIOPLASTY|
20|FH_F116960_91505_0|SrvcGrp|86747|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F116176_0_0|SrvcGrp|104745|2022|PDM|148.79|99|0.00|HOSPICE|
20|FH_F64519_0_0|SrvcGrp|16|2022|PDM|1454.00|99|0.00|ACUTE REHABILITATION|
20|FH_F83251_32751_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40358_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F111826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F129656_15005_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F148265_06067_0|CSTM-ALL|CSTM-00|2020|PDM|3400.00|99|0.00|AEG 7 (NO REV)|
20|FH_F37970_0_0|SrvcGrp|27697|2022|PDM|125.00|99|0.00|THERAPY VISIT|
20|FH_F142332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|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_F144808_0_0|SrvcGrp|35669|2022|PDM|4812.00|99|0.00|CPT 63650|
20|FH_F128825_45211_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F110470_98335_0|SrvcGrp|46903|2022|PDM|300.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F96160_32207_0|SrvcGrp|86850|2022|PDM|68.65|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F111986_0_0|SrvcGrp|58636|2022|PDM|2575.00|99|0.00|CPT 62362|
20|FH_F93176_73750_0|SrvcGrp|78504|2022|PCT|0.80|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F130017_02302_0|SrvcGrp|73483|2022|PDM|1797.02|99|0.00|AETNA SUBACUTE III|
20|FH_F116806_0_0|SrvcGrp|107045|2022|PDM|1923.16|99|0.00|RECONSTUCTION OF CHIN|
20|FH_F134826_19067_0|SrvcGrp|90040|2022|PDM|350.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|2188.00|99|0.00|AEG 8 (NO REV)|
20|FH_F142267_78240_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F142530_60148_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F138558_60107_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F126567_0_0|SrvcGrp|107750|2022|PDM|1250.00|99|0.00|TRAINING INCL A TREATMENT|
20|FH_F149659_79912_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151608_30236_0|SrvcGrp|85778|2022|PDM|7812.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F115895_0_0|SrvcGrp|97741|2022|PDM|7002.00|99|0.00|REVISE KNEE|
20|FH_F105591_17601_0|SrvcGrp|48160|2022|PCT|1.00|99|0.00|BOTULINUM TOXIN TYPE A, PER UNIT|
20|FH_F72162_0_0|SrvcGrp|48396|2022|PDM|135.00|99|0.00|OT SERVICES|
20|FH_F41539_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|526.00|99|0.00|AEG 4 (NO REV)|
20|FH_F117471_19111_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F80532_0_0|SrvcGrp|12403|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F151520_44134_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F144008_11413_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F45513_0_0|SrvcGrp|14614|2022|PDM|3800.00|99|0.00|LITHOTRIPSY|
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|857.00|99|0.00|AEG 2 (NO REV)|
20|FH_F109882_36695_0|SrvcGrp|86747|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F132160_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F142370_0_0|SrvcGrp|73601|2022|PDM|1430.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F89640_98133_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|AETNA - APC GROUPER L|
20|FH_F110729_15068_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F141511_0_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION|
20|FH_F78023_0_0|SrvcGrp|35964|2022|PDM|45.00|99|0.00|SPEECH THERAPY|
20|FH_F148347_0_0|SrvcGrp|92417|2022|PDM|14056.00|99|0.00|LAPAROSCOPY|
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|665.00|99|0.00|AEG 2 (NO REV)|
20|FH_F49037_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD UE/KE)|
20|FH_F120888_63823_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F34691_0_0|SrvcGrp|13188|2022|PCT|0.75|99|0.00|DRUGS|
20|FH_F123943_84041_0|SrvcGrp|97702|2022|PDM|90.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F88633_32570_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|GENERAL ACUTE CARE|
20|FH_F114092_83350_0|SrvcGrp|36204|2022|PCT|0.00|99|0.00|ACUTE PSYCH|
20|FH_F137310_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140407_63841_0|SrvcGrp|113300|2022|PDM|28.39|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - MODERNA|
20|FH_F140553_37205_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149530_80014_0|SrvcGrp|104186|2022|PDM|13.00|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F129053_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F143450_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F142344_16693_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F63185_0_0|SrvcGrp|48397|2022|PDM|30.00|99|0.00|PT SERVICES|
20|FH_F133403_0_0|SrvcGrp|82981|2022|PDM|156.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 3 (NO REV)|
20|FH_F95282_77975_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F34706_0_0|SrvcGrp|9553|2022|PDM|14329.00|99|0.00|DRG 530 VENTRICULAR SHUNT PROCEDURES W/O CC|
20|FH_F145988_06105_0|SrvcGrp|58507|2022|PDM|18942.00|99|0.00|CYBER KNIFE|
20|FH_F118704_0_0|SrvcGrp|107750|2022|PDM|1550.00|99|0.00|TRAINING INCL A TREATMENT|
20|FH_F142673_0_0|CSTM-ALL|CSTM-00|2020|PDM|1296.00|99|0.00|AEG 2 (NO REV)|
20|FH_F133474_0_0|SrvcGrp|112676|2022|PDM|42.13|99|0.00|COVID-19 SARS-COV-2 ANTIBODY|
20|FH_F113131_19013_0|SrvcGrp|89149|2022|PDM|161.00|99|0.00|OP INTENSIVE|
20|FH_F96120_67207_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F150908_38570_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F107140_0_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F110783_93013_0|SrvcGrp|116238|2022|PCT|1.00|99|0.00|DRUGS (C, J, Q & S CODES)|
20|FH_F119316_27104_0|SrvcGrp|73605|2022|PDM|1047.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F44132_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138478_0_0|SrvcGrp|109505|2022|PDM|10507.16|99|0.00|REMV & REPLC PM GEN MULT LEADS|
20|FH_F131327_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F109221_15084_0|SrvcGrp|27969|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F110725_48047_0|SrvcGrp|9500|2022|PDM|1300.00|99|0.00|PSYCH INTENSIVE CARE UNIT|
20|FH_F67419_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|INFUSION- IV SERVICES (MOD SH)|
20|FH_F127553_44321_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F138478_0_0|SrvcGrp|109494|2022|PDM|6955.89|99|0.00|INSRT HEART PM ATRIAL & VENT|
20|FH_F124492_30040_0|SrvcGrp|113236|2022|PDM|45.52|99|0.00|COVID-19 SARS-COV-2 W/ OPTIC|
20|FH_F120856_78247_0|SrvcGrp|471|2022|PDM|555.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F84274_46805_0|CSTM-ALL|CSTM-00|2020|PCT|1.09|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F78343_0_0|SrvcGrp|30095|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F113546_0_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F138010_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F149939_91942_0|SrvcGrp|74668|2022|PDM|302.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130157_84049_0|SrvcGrp|73063|2022|PDM|770.00|99|0.00|OBSERVATION SERVICES|
20|FH_F38320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37651_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD 53|
20|FH_F64559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F90232_15126_0|SrvcGrp|14944|2022|PDM|3.15|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F146103_63851_0|SrvcGrp|112064|2022|PCT|0.75|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F44278_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F138250_64145_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F100782_0_0|SrvcGrp|97676|2022|PDM|2087.92|99|0.00|WINDBER MEDICAL CNTR ASC 705|
20|FH_F36552_0_0|SrvcGrp|2738|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F109360_32514_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F134609_33458_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F37910_0_0|SrvcGrp|16|2022|PCT|0.85|99|0.00|ACUTE REHABILITATION|
20|FH_F111030_05641_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F75842_0_0|SrvcGrp|42726|2022|PDM|21379.24|99|0.00|CYBER KNIFE|
20|FH_F134826_19067_0|SrvcGrp|89267|2022|PDM|100.00|99|0.00|PSYTX PT/FAMILY 30 MINUTES|
20|FH_F63316_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F64999_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|ASPG IV|
20|FH_F142210_61356_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F56832_0_0|SrvcGrp|2020|2022|PCT|0.75|99|0.00|PROFESSIONAL SVCS|
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.00|99|0.00|ASPG II|
20|FH_F140343_89052_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F118818_19808_0|SrvcGrp|89149|2022|PDM|150.00|99|0.00|OP INTENSIVE|
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|AEG 6 (NO REV)|
20|FH_F71905_0_0|SrvcGrp|66482|2022|PDM|35.00|99|0.00|HOME HEALTH AID|
20|FH_F145538_34997_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F129334_43016_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F85353_16407_0|SrvcGrp|63895|2022|PDM|191.84|99|0.00|HAPA WPA-NWPA 2012-13 ASC 133|
20|FH_F147962_85008_0|SrvcGrp|73489|2022|PDM|3500.00|99|0.00|AETNA TRAUMA|
20|FH_F70208_0_0|SrvcGrp|11259|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F119613_90035_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F147962_85008_0|CSTM-ALL|CSTM-00|2020|PDM|2685.00|99|0.00|AEG 3 (NO REV)|
20|FH_F83754_0_0|SrvcGrp|30504|2022|PCT|0.86|99|0.00|CCPD TRAINING|
20|FH_F133769_20783_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120719_27540_0|SrvcGrp|107733|2022|PDM|4682.00|99|0.00|CESAREAN SECTION|
20|FH_F123616_30117_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129666_71901_0|SrvcGrp|66264|2022|PDM|155.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F109645_0_0|SrvcGrp|91678|2022|PDM|88.00|99|0.00|AETNA SKILLED NURSE IN HOME HEALTH SETTING (HCFA)|
20|FH_F128878_11203_0|SrvcGrp|111176|2022|PDM|141.51|99|0.00|CRISIS INTERVENTION MENTAL|
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|AEG 2 (NO REV)|
20|FH_F149442_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|785.00|99|0.00|ASPG II|
20|FH_F39273_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F115967_60123_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F55032_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|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_F149150_75407_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128791_57201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132969_84003_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F121476_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F71445_0_0|SrvcGrp|68381|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F132969_84003_0|SrvcGrp|86849|2022|PDM|25.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F38966_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F98800_85021_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F105145_75075_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F134032_19611_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138108_47130_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F138607_02760_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F140407_63841_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F151601_89118_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F111593_0_0|SrvcGrp|98526|2022|PDM|2640.00|99|0.00|CYSTOURETHROSCOPY|
20|FH_F121385_89102_0|CSTM-ALL|CSTM-00|2020|PDM|4431.00|99|0.00|AEG 4 (NO REV)|
20|FH_F123372_0_0|SrvcGrp|11259|2022|PCT|0.52|99|0.00|DRUGS|
20|FH_F129367_89117_0|SrvcGrp|73842|2022|PDM|247.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F66501_0_0|SrvcGrp|15071|2022|PDM|145.00|99|0.00|PHOTOTHERAPY (BILIRUBIN)|
20|FH_F112468_0_0|SrvcGrp|72994|2022|PDM|658.00|99|0.00|AEG 3|
20|FH_F146421_72758_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F93219_26354_0|SrvcGrp|48396|2022|PDM|99.00|99|0.00|OT SERVICES|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1119.00|99|0.00|ASPG V- MOD 50|
20|FH_F110311_17078_0|SrvcGrp|103941|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F145675_33761_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F133770_34601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134509_14075_0|SrvcGrp|471|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132088_34981_0|SrvcGrp|46903|2022|PDM|603.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F119795_0_0|SrvcGrp|53065|2022|PDM|1685.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F138746_60174_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151054_06473_0|SrvcGrp|114471|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F114916_30309_0|SrvcGrp|26278|2022|PDM|1445.00|99|0.00|CPT 29881|
20|FH_F113541_0_0|SrvcGrp|84183|2022|PDM|2580.00|99|0.00|AETNA SURGERY OF BREAST CAPSULE|
20|FH_F128027_0_0|SrvcGrp|64719|2022|PDM|1120.00|99|0.00|CPT 45382|
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|1090.00|99|0.00|ASPG V|
20|FH_F132864_71101_0|SrvcGrp|110581|2022|PCT|0.00|99|0.00|INPATIENT DETOXIFICATION SERVICES|
20|FH_F149605_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38410_0_0|SrvcGrp|10541|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F36450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113792_0_0|SrvcGrp|42971|2022|PDM|85.00|99|0.00|SKN RN|
20|FH_F70324_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97581_60141_0|SrvcGrp|73656|2022|PDM|1088.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F40980_0_0|SrvcGrp|361|2022|PDM|5826.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F34705_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102062_35447_0|SrvcGrp|46605|2022|PDM|145.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F128605_20910_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148041_41017_0|SrvcGrp|472|2022|PDM|689.52|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150839_03833_0|SrvcGrp|33722|2022|PDM|44.88|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F149662_85015_0|CSTM-ALL|CSTM-00|2020|PDM|610.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|4780.00|99|0.00|ASPG IX|
20|FH_F148347_0_0|SrvcGrp|35664|2022|PDM|3111.50|99|0.00|VNUS CLOSURE|
20|FH_F127487_60169_0|SrvcGrp|27968|2022|PDM|25.00|99|0.00|SKILLED NURSING LPN|
20|FH_F125656_92868_0|SrvcGrp|86825|2022|PDM|75.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F41457_0_0|CSTM-ALL|CSTM-00|2020|PDM|58.00|99|0.00|EXTRA AMBULANCE ATTENDANT|
20|FH_F111086_29501_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F94303_0_0|SrvcGrp|78504|2022|PDM|4800.00|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F97082_90012_0|SrvcGrp|73603|2022|PDM|5625.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F117023_0_0|SrvcGrp|89404|2022|PDM|5500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F147080_02446_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|1189.00|99|0.00|AEG 5  (NO REV)|
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1384.00|99|0.00|AEG 2 (NO REV)|
20|FH_F96160_32207_0|SrvcGrp|108456|2022|PCT|1.07|99|0.00|ALL DRUGS/AGENTS/INJ DRUGS|
20|FH_F113484_43015_0|SrvcGrp|104302|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F149517_0_0|SrvcGrp|80918|2022|PDM|692.00|99|0.00|RESPITE CARE|
20|FH_F146881_83661_0|SrvcGrp|84185|2022|PDM|140.00|99|0.00|RESPITE CARE|
20|FH_F133478_40165_0|SrvcGrp|84186|2022|PCT|0.00|99|0.00|LITHOTRIPSY ESWL|
20|FH_F133408_01095_0|SrvcGrp|113234|2022|PCT|1.00|99|0.00|COVID-19 SARSCOV2 & INF A&B AMP PRB|
20|FH_F133253_62226_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F35216_0_0|SrvcGrp|21122|2022|PDM|16500.00|99|0.00|MS DRG 459 ONLY|
20|FH_F123741_20850_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F120152_0_0|SrvcGrp|108347|2022|PDM|5500.00|99|0.00|REPAIR OF KNEE FRACTURE|
20|FH_F149701_0_0|SrvcGrp|16|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION|
20|FH_F109821_0_0|SrvcGrp|78713|2022|PDM|2550.00|99|0.00|AETNA SPINAL STIMULATOR|
20|FH_F109821_0_0|SrvcGrp|103059|2022|PDM|1530.00|99|0.00|NASAL ENDOSCOPY|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|1633.00|99|0.00|AEG 7 (NO REV)|
20|FH_F113741_63303_0|SrvcGrp|88620|2022|PDM|86.70|99|0.00|SKILLED NURSING RN|
20|FH_F79025_0_0|SrvcGrp|471|2022|PDM|945.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F88885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F94786_07974_0|SrvcGrp|94106|2022|PCT|1.05|99|0.00|ALL DRUGS/AGENTS/INJ DRUG|
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PDM|1914.00|99|0.00|AEG 9 (NO REV)|
20|FH_F122198_20708_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147085_92780_0|SrvcGrp|74668|2022|PDM|415.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F45372_0_0|SrvcGrp|38797|2022|PDM|255.00|99|0.00|PSYCHIATRIC PARTIAL HOSPITALIZATION - IP|
20|FH_F124663_65608_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 10 (NO REV)|
20|FH_F91152_60061_0|SrvcGrp|89149|2022|PDM|205.00|99|0.00|OP INTENSIVE|
20|FH_F144429_04401_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F36576_0_0|SrvcGrp|38|2022|PDM|2840.00|99|0.00|NORMAL DELIVERY|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F67379_0_0|SrvcGrp|20900|2022|PDM|11300.00|99|0.00|MS DRG 248 ONLY|
20|FH_F146108_66762_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119229_90804_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F151521_45882_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD KL)|
20|FH_F36207_0_0|SrvcGrp|16899|2022|PDM|275.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F126116_0_0|SrvcGrp|41334|2022|PDM|13500.00|99|0.00|TOTAL KNEE|
20|FH_F47902_0_0|SrvcGrp|29958|2022|PCT|1.00|99|0.00|DME MOD KF|
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|ASPG II|
20|FH_F63033_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127418_0_0|SrvcGrp|93059|2022|PDM|3823.90|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F117605_85260_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F109247_73102_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F110804_11373_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F150982_0_0|SrvcGrp|103967|2022|PDM|1981.00|99|0.00|TRANSURETHRAL INCISION OF PR|
20|FH_F137767_01841_0|SrvcGrp|10944|2022|PDM|950.00|99|0.00|EMERGENCY ROOM|
20|FH_F130182_0_0|SrvcGrp|109449|2022|PDM|1457.00|99|0.00|R HRT CORONARY ARTERY ANGIO|
20|FH_F138410_19130_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F123185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132419_84042_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F39028_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116093_47327_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131177_44122_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F110925_01104_0|SrvcGrp|40690|2022|PDM|3.90|99|0.00|ENTERAL FEEDING SUPPLY KIT, BOLUS|
20|FH_F71546_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F125893_78245_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82753_18840_0|SrvcGrp|80523|2022|PDM|33150.00|99|0.00|PENILE PROSTHESIS IMPLANTATION|
20|FH_F100662_27534_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F93881_15009_0|SrvcGrp|23585|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F121385_89102_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110000_0_0|SrvcGrp|36991|2022|PCT|0.85|99|0.00|IMPLANTS|
20|FH_F88933_0_0|SrvcGrp|82289|2022|PDM|5065.00|99|0.00|KYPHOPLASTY|
20|FH_F34652_0_0|CSTM-ALL|CSTM-00|2020|PDM|1843.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87822_0_0|SrvcGrp|25688|2022|PDM|481.95|99|0.00|HOME HEMODIALYSIS|
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1291.00|99|0.00|AEG 6 (NO REV)|
20|FH_F148419_01453_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|COVID-19 INFUSION ADMIN - ELI LILLY|
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|1791.00|99|0.00|AEG 8 (NO REV)|
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PDM|740.56|99|0.00|AEG 10 (NO REV)|
20|FH_F87620_80014_0|SrvcGrp|110201|2022|PDM|291.00|99|0.00|MAMMOGRAPHY|
20|FH_F149880_33150_0|SrvcGrp|108484|2022|PDM|830.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F133021_00910_0|SrvcGrp|112295|2022|PDM|400.00|99|0.00|CARDIOVERSION|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|246.25|99|0.00|ASPG 112|
20|FH_F150820_83843_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 1 (NO REV)|
20|FH_F33303_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149645_92708_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148539_33548_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F98360_11554_0|SrvcGrp|73602|2022|PDM|4675.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F147231_49440_0|SrvcGrp|53144|2022|PDM|43.31|99|0.00|SPEECH THERAPY|
20|FH_F143564_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 5  (NO REV)|
20|FH_F138018_17313_0|SrvcGrp|24748|2022|PDM|103.00|99|0.00|CORTICOSTEROID THERAPY|
20|FH_F99920_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114090_19023_0|SrvcGrp|472|2022|PDM|477.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F35174_0_0|SrvcGrp|20898|2022|PCT|0.75|99|0.00|MS DRG 246 ONLY|
20|FH_F49552_0_0|SrvcGrp|45647|2022|PDM|86.00|99|0.00|MAMMOGRAM|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|HAPA WPA/NWPA 2017 NISC 100%|
20|FH_F78344_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F101100_50314_0|CSTM-ALL|CSTM-00|2020|PCT|1.26|99|0.00|AETNA - APC GROUPER A|
20|FH_F120522_53549_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 6 (NO REV)|
20|FH_F147939_61611_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151155_26508_0|SrvcGrp|90854|2022|PDM|929.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F144429_04401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141870_85224_0|SrvcGrp|29023|2022|PDM|60.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F43330_0_0|SrvcGrp|11069|2022|PDM|90.00|99|0.00|OT SVCS|
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PDM|35439.00|99|0.00|CORONARY VALVE PROCEDURE (MS DRG)|
20|FH_F120406_84047_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F125103_0_0|SrvcGrp|110070|2022|PDM|550.00|99|0.00|HEMODIALYSIS PHYSICIAN EVALUATION|
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PDM|735.85|99|0.00|AEG 4 (NO REV)|
20|FH_F139673_63011_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F141247_18902_0|SrvcGrp|75419|2022|PDM|424.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148519_83201_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F146266_0_0|SrvcGrp|100017|2022|PDM|11917.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F132860_0_0|CSTM-ALL|CSTM-00|2020|PDM|1910.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114207_35243_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151042_60659_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F122390_29550_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113545_11201_0|SrvcGrp|86723|2022|PDM|330.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|460.82|99|0.00|SALLY BALIN,999182,ASC 206|
20|FH_F131325_48170_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35567_0_0|SrvcGrp|21045|2022|PDM|450.00|99|0.00|CT SERVICES|
20|FH_F111603_19529_0|SrvcGrp|73842|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120444_84037_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137051_64096_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138545_39503_0|SrvcGrp|72602|2022|PDM|694.00|99|0.00|ECT|
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F76172_0_0|SrvcGrp|33164|2022|PDM|315.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F141336_16947_0|SrvcGrp|471|2022|PDM|1336.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|2146.10|99|0.00|AEG 7 (NO REV)|
20|FH_F146290_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.41|99|0.00|OP SVCS|
20|FH_F146790_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F120437_85202_0|SrvcGrp|86849|2022|PDM|76.51|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F44855_0_0|SrvcGrp|30198|2022|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F86173_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.77|99|0.00|OP SVCS|
20|FH_F38865_0_0|SrvcGrp|997|2022|PCT|0.75|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F97141_93933_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133487_24293_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F85444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F125475_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F81485_0_0|SrvcGrp|3178|2022|PDM|1017.00|99|0.00|ACUTE PSYCH|
20|FH_F127163_74437_0|SrvcGrp|108484|2022|PDM|520.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F93561_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F78385_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117340_68144_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 10 (NO REV)|
20|FH_F71929_15090_0|SrvcGrp|33414|2022|PDM|195.00|99|0.00|SNF VENTILATOR SUPPORT|
20|FH_F148865_0_0|SrvcGrp|82222|2022|PDM|140.00|99|0.00|HOSPICE CARE|
20|FH_F139547_42343_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_F37304_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SAINT ALEXIUS FH MOD KF|
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|CARDIAC STUDIES|
20|FH_F134847_0_0|SrvcGrp|112647|2022|PDM|2684.00|99|0.00|JOINT ARTHROSCOPY|
20|FH_F119376_0_0|SrvcGrp|108120|2022|PDM|1115.00|99|0.00|REPL TUNNLD CNTRL CVC W/O PORT/PUMP|
20|FH_F128191_28642_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 4 (NO REV)|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|CPT CODE 99291|
20|FH_F119897_78229_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F139990_71418_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127258_79912_0|SrvcGrp|86723|2022|PDM|412.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F143249_89801_0|SrvcGrp|29347|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F49895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53|
20|FH_F93384_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F128878_11203_0|CSTM-ALL|CSTM-00|2020|PDM|95.00|99|0.00|AETNA PSYTX W/PT 45 MIN MOD HO (HCFA)|
20|FH_F77925_0_0|SrvcGrp|16|2022|PDM|4968.00|99|0.00|ACUTE REHABILITATION|
20|FH_F123282_03222_0|SrvcGrp|88620|2022|PDM|136.00|99|0.00|SKILLED NURSING RN|
20|FH_F149086_0_0|SrvcGrp|82223|2022|PDM|169.00|99|0.00|HOSPICE CARE|
20|FH_F115685_64064_0|SrvcGrp|86849|2022|PDM|75.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F137457_32216_0|SrvcGrp|73842|2022|PDM|268.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F110263_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|475.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|579.00|99|0.00|AEG 1 (NO REV)|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120888_63823_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F126054_30022_0|SrvcGrp|100499|2022|PDM|840.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F50873_0_0|SrvcGrp|42826|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F114977_78550_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F129231_30060_0|CSTM-ALL|CSTM-00|2020|PDM|2508.00|99|0.00|INSERT ANT SEGMENT DRAIN|
20|FH_F91321_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F118050_77565_0|SrvcGrp|89417|2022|PDM|375.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F120280_64701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F123943_84041_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124048_47304_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129328_33311_0|SrvcGrp|73841|2022|PDM|385.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F122649_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F93332_0_0|SrvcGrp|77021|2022|PDM|7725.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F40709_0_0|CSTM-ALL|CSTM-00|2020|PDM|870.00|99|0.00|ASPG IV|
20|FH_F132609_0_0|SrvcGrp|81036|2022|PCT|0.77|99|0.00|ANGIOPLASTY|
20|FH_F143631_52248_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88744_71103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F116806_0_0|SrvcGrp|107063|2022|PDM|1923.16|99|0.00|RECONSTRUCT CLEFT PALATE|
20|FH_F124958_49307_0|SrvcGrp|83235|2022|PCT|1.40|99|0.00|AMBULATORY SURGERY|
20|FH_F80172_0_0|SrvcGrp|13155|2022|PDM|149.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134327_12853_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F52713_0_0|SrvcGrp|14552|2022|PDM|9103.00|99|0.00|LITHOTRIPSY|
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|10805.00|99|0.00|MS DRG 242 PERMANENT CARDIAC PACEMAKER|
20|FH_F126443_77089_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150227_63301_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F149301_44122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133749_84604_0|SrvcGrp|112432|2022|PDM|33.60|99|0.00|CHEMOTHERAPY|
20|FH_F89219_0_0|SrvcGrp|87311|2022|PDM|34850.00|99|0.00|MSDRG 274 ONLY|
20|FH_F134331_61021_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F44607_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F86293_0_0|SrvcGrp|82112|2022|PDM|2714.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F134434_30607_0|SrvcGrp|108484|2022|PDM|700.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F121335_0_0|CSTM-ALL|CSTM-00|2020|PDM|3689.00|99|0.00|AEG 4 (NO REV)|
20|FH_F111540_16823_0|SrvcGrp|70642|2022|PDM|12.55|99|0.00|CONSULTANT THERAPIST|
20|FH_F148861_18706_0|SrvcGrp|87317|2022|PDM|984.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F69023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F106540_26330_0|SrvcGrp|42784|2022|PDM|119.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F67424_0_0|SrvcGrp|472|2022|PDM|405.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F80859_65616_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|OP SVCS|
20|FH_F92278_01440_0|SrvcGrp|89149|2022|PDM|140.00|99|0.00|OP INTENSIVE|
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|1379.00|99|0.00|AEG 6 (NO REV)|
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|AEG 3 (NO REV)|
20|FH_F149001_37055_0|SrvcGrp|92501|2022|PDM|160.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F114090_19023_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F42979_0_0|SrvcGrp|3394|2022|PDM|96.00|99|0.00|CPT 90808|
20|FH_F90232_15126_0|SrvcGrp|22589|2022|PDM|61.95|99|0.00|CHEMOTHERAPY NOC|
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PDM|4237.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F132099_67487_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143989_19090_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F140427_0_0|SrvcGrp|113635|2022|PDM|900.00|99|0.00|ENDO CHOLANGIOPANCREATOGRAPH|
20|FH_F121084_13114_0|SrvcGrp|90632|2022|PDM|135.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F145815_30540_0|SrvcGrp|113227|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 3 TRGT|
20|FH_F85353_16407_0|SrvcGrp|63847|2022|PDM|445.28|99|0.00|HAPA WPA-NWPA 2012-13 ASC 110|
20|FH_F150165_06032_0|SrvcGrp|41334|2022|PDM|12731.00|99|0.00|TOTAL KNEE|
20|FH_F130329_64114_0|SrvcGrp|86841|2022|PDM|50.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F87571_0_0|SrvcGrp|45883|2022|PDM|85.00|99|0.00|OT|
20|FH_F85353_16407_0|CSTM-ALL|CSTM-00|2020|PDM|2225.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79863_0_0|SrvcGrp|77243|2022|PDM|16.00|99|0.00|AETNA HIT ENTERAL GRAV DIEM|
20|FH_F85212_71075_0|SrvcGrp|73559|2022|PDM|2000.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1343.28|99|0.00|HAPA WPA-NWPA 2012-13 ASC 905 W/O REV|
20|FH_F90438_08873_0|SrvcGrp|89149|2022|PDM|177.00|99|0.00|OP INTENSIVE|
20|FH_F121476_0_0|SrvcGrp|88269|2022|PDM|729.00|99|0.00|RETINAL TAMPONADE DEVICE|
20|FH_F57073_0_0|SrvcGrp|944|2022|PDM|12480.00|99|0.00|BARIATRIC SVCS|
20|FH_F145508_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128378_0_0|SrvcGrp|29155|2022|PDM|160.00|99|0.00|HOSPICE SVCS|
20|FH_F46832_0_0|SrvcGrp|22593|2022|PDM|35.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F136315_98144_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136347_30328_0|SrvcGrp|87131|2022|PDM|467.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F93175_73438_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F151601_89118_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F34975_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F69364_0_0|CSTM-ALL|CSTM-00|2020|PDM|981.00|99|0.00|ASPG II|
20|FH_F56274_0_0|SrvcGrp|27969|2022|PDM|65.00|99|0.00|HOME HEALTH AIDE|
20|FH_F148760_12953_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41463_0_0|SrvcGrp|35108|2022|PCT|0.92|99|0.00|CARECENTRIX AWP - 8%|
20|FH_F112823_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F78009_0_0|SrvcGrp|30095|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F117802_0_0|SrvcGrp|107624|2022|PDM|441.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F146204_0_0|SrvcGrp|73495|2022|PDM|2376.00|99|0.00|AETNA MYOMECTOMY|
20|FH_F146204_0_0|SrvcGrp|101524|2022|PDM|1500.00|99|0.00|MISSED ABORTION SECOND TRIMESTER|
20|FH_F147183_17701_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F147361_19806_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115483_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|AEG 8 (NO REV)|
20|FH_F37230_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F119591_75034_0|SrvcGrp|89417|2022|PDM|429.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F145758_20745_0|SrvcGrp|35669|2022|PDM|3060.00|99|0.00|CPT 63650|
20|FH_F128343_48035_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131254_92211_0|SrvcGrp|86852|2022|PDM|35.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F72407_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SURGERY|
20|FH_F120253_44646_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148265_06067_0|SrvcGrp|88487|2022|PDM|7361.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F109180_18015_0|SrvcGrp|52952|2022|PDM|113.00|99|0.00|PSYCHIATRIC CPT 90847|
20|FH_F142073_0_0|SrvcGrp|41334|2022|PDM|11900.00|99|0.00|TOTAL KNEE|
20|FH_F131228_01826_0|CSTM-ALL|CSTM-00|2020|PDM|2256.50|99|0.00|AEG 1 (NO REV)|
20|FH_F148166_0_0|SrvcGrp|22596|2022|PDM|190.00|99|0.00|HOSPICE CARE|
20|FH_F104520_0_0|SrvcGrp|73656|2022|PDM|450.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F125249_0_0|SrvcGrp|108252|2022|PDM|1800.00|99|0.00|AETNA REPAIR DISLOCATION/FRACTURE|
20|FH_F135077_60014_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F83978_66739_0|SrvcGrp|110873|2022|PDM|13961.00|99|0.00|CERVICAL ARTIFICIAL|
20|FH_F126341_27284_0|SrvcGrp|86121|2022|PDM|41.50|99|0.00|AETNA GAMUNEX-C|
20|FH_F138240_64114_0|SrvcGrp|46605|2022|PDM|122.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F143650_0_0|SrvcGrp|105658|2022|PDM|2800.00|99|0.00|REPAIR FRACTURE OF RADIUS|
20|FH_F120719_27540_0|CSTM-ALL|CSTM-00|2020|PDM|10686.00|99|0.00|AEG 7 (NO REV)|
20|FH_F125328_0_0|SrvcGrp|104555|2022|PDM|9427.50|99|0.00|HYSTEROSCOPY REMOVE FB|
20|FH_F134611_04103_0|SrvcGrp|3178|2022|PDM|1240.00|99|0.00|ACUTE PSYCH|
20|FH_F125328_0_0|SrvcGrp|88147|2022|PDM|15798.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA|
20|FH_F51115_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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F54592_0_0|SrvcGrp|24745|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F63701_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137167_71635_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138471_84663_0|SrvcGrp|89781|2022|PDM|93.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F86815_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|AEG 2 (NO REV)|
20|FH_F137980_03101_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F95880_02726_0|SrvcGrp|90487|2022|PDM|30.78|99|0.00|WHEELCHAIR MANAGEMENT|
20|FH_F151056_17821_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40081_0_0|SrvcGrp|31832|2022|PDM|600.00|99|0.00|PSYCHIATRIC EATING DISORDERS|
20|FH_F114389_50131_0|SrvcGrp|99000|2022|PDM|80.47|99|0.00|HYDRATION THERAPY OVER 3 LITER (HCFA)|
20|FH_F131282_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F120171_33770_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F39138_0_0|SrvcGrp|88|2022|PDM|4368.00|99|0.00|OP LITHOTRIPSY|
20|FH_F123272_54901_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F49653_0_0|SrvcGrp|9916|2022|PCT|0.54|99|0.00|OBSERVATION SVCS|
20|FH_F148244_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40421_0_0|SrvcGrp|10400|2022|PDM|2300.00|99|0.00|IP SURGERY|
20|FH_F129328_33311_0|SrvcGrp|89149|2022|PDM|187.00|99|0.00|OP INTENSIVE|
20|FH_F115020_67301_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F37756_0_0|SrvcGrp|11442|2022|PDM|827.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F72183_0_0|SrvcGrp|30157|2022|PCT|1.80|99|0.00|LABORATORY|
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|4042.50|99|0.00|AEG 7 (NO REV)|
20|FH_F84816_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F35276_0_0|SrvcGrp|16732|2022|PDM|1625.00|99|0.00|HYSTEROSCOPY ABLATION|
20|FH_F63246_0_0|SrvcGrp|59410|2022|PCT|1.10|99|0.00|PROSTHETICS|
20|FH_F130725_33020_0|SrvcGrp|87317|2022|PDM|952.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F141829_0_0|SrvcGrp|106300|2022|PDM|256.53|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.51|99|0.00|HAPA WPA-NWPA 2012-13 ASC 401 W/O REV|
20|FH_F43197_0_0|SrvcGrp|27767|2022|PDM|40.00|99|0.00|SKILLED IV NURSING HOURLY|
20|FH_F110521_98034_0|SrvcGrp|46903|2022|PDM|477.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F133920_64057_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132270_33414_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138188_54901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F78402_15905_0|SrvcGrp|34034|2022|PCT|0.00|99|0.00|BLOOD PRODUCTS|
20|FH_F149375_26101_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149659_79912_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118914_43015_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F118914_43015_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F92506_07666_0|SrvcGrp|73501|2022|PCT|0.62|99|0.00|AETNA OBSERVATION|
20|FH_F109951_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F111840_0_0|SrvcGrp|75483|2022|PDM|510.00|99|0.00|AEG 3|
20|FH_F72049_0_0|SrvcGrp|1168|2022|PDM|39.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F114386_07090_0|SrvcGrp|73701|2022|PDM|45.42|99|0.00|AETNA - SKILLED NURSING|
20|FH_F148425_01507_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124608_0_0|SrvcGrp|33967|2022|PDM|3138.00|99|0.00|CPT 47562|
20|FH_F133287_40215_0|SrvcGrp|85260|2022|PDM|74.00|99|0.00|INITIAL EVALUATION|
20|FH_F133367_40065_0|SrvcGrp|88977|2022|PDM|6333.00|99|0.00|C-SECTION DELIVERY|
20|FH_F133552_77006_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F81373_64064_0|SrvcGrp|75505|2022|PCT|0.66|99|0.00|CARDIAC STUDIES|
20|FH_F39756_0_0|SrvcGrp|31517|2022|PDM|396.00|99|0.00|CUMBERLAND SURGERY CTR-ASPG I|
20|FH_F39355_0_0|SrvcGrp|16719|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F43156_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|SUB-ACUTE PHYSICAL REHAB|
20|FH_F103004_75840_0|SrvcGrp|72984|2022|PCT|1.00|99|0.00|CHEMOTHERAPY|
20|FH_F136987_0_0|SrvcGrp|78579|2022|PDM|1632.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
20|FH_F151002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 10 (NO REV)|
20|FH_F131609_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F113787_31909_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F139372_34698_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F43793_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F135719_45502_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F136778_62034_0|SrvcGrp|19318|2022|PDM|3302.00|99|0.00|MS DRG 894|
20|FH_F136796_24016_0|SrvcGrp|109834|2022|PDM|2440.83|99|0.00|REPAIR HUMERUS FRACTURE|
20|FH_F141170_0_0|SrvcGrp|92410|2022|PDM|8000.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F54572_0_0|SrvcGrp|12118|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F115567_91711_0|SrvcGrp|86748|2022|PCT|1.25|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F41463_0_0|SrvcGrp|34389|2022|PDM|134.40|99|0.00|SPEECH THERAPY|
20|FH_F41489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F41663_0_0|SrvcGrp|9774|2022|PDM|2300.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F42024_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ACUTE PSYCH|
20|FH_F42522_0_0|SrvcGrp|10364|2022|PCT|0.60|99|0.00|CPT CODE 99284|
20|FH_F86293_0_0|SrvcGrp|26273|2022|PDM|2714.00|99|0.00|CPT 29880|
20|FH_F80855_0_0|SrvcGrp|26278|2022|PDM|1200.00|99|0.00|CPT 29881|
20|FH_F133351_84003_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F83053_0_0|SrvcGrp|73004|2022|PDM|4756.00|99|0.00|AEG 8|
20|FH_F117962_17603_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F42355_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|OP SVCS|
20|FH_F37640_0_0|SrvcGrp|11033|2022|PCT|1.00|99|0.00|OP REFERENCE LAB|
20|FH_F141872_20707_0|SrvcGrp|110811|2022|PDM|170.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F66545_0_0|SrvcGrp|61817|2022|PDM|110.00|99|0.00|PT SVCS|
20|FH_F138017_73129_0|SrvcGrp|78093|2022|PDM|6196.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F125656_92868_0|SrvcGrp|86827|2022|PDM|75.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F113181_72202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132199_0_0|CSTM-ALL|CSTM-00|2020|PDM|1392.85|99|0.00|OP SVCS|
20|FH_F138491_0_0|SrvcGrp|95660|2022|PDM|400.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F39825_0_0|SrvcGrp|43|2022|PCT|0.75|99|0.00|IMPLANTS|
20|FH_F50459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F52872_0_0|CSTM-ALL|CSTM-00|2020|PDM|1779.00|99|0.00|WILLS COMM SURG SVC ASC 7|
20|FH_F138684_44484_0|SrvcGrp|46903|2022|PDM|450.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F138876_25302_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F138996_68104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138685_18017_0|SrvcGrp|86723|2022|PDM|291.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|491.00|99|0.00|AEG 2 (NO REV)|
20|FH_F68341_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F119888_0_0|SrvcGrp|106314|2022|PDM|605.83|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 3 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|463.33|99|0.00|HAPA WPA-NWPA 2012-13 ASC 213 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|134.73|99|0.00|HAPA WPA-NWPA 2012-13 ASC 137 W/O REV|
20|FH_F151503_30067_0|SrvcGrp|12664|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F132258_45404_0|SrvcGrp|86839|2022|PDM|30.74|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F135447_53226_0|SrvcGrp|104467|2022|PDM|562.00|99|0.00|ANTEPARTUM CARE ONLY (4-6 VISITS)|
20|FH_F135575_50597_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135607_21613_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F91735_92653_0|SrvcGrp|87393|2022|PDM|110.25|99|0.00|HCPCS G0151 (HCFA)|
20|FH_F135787_60108_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135792_60143_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F130756_04901_0|SrvcGrp|112676|2022|PCT|1.00|99|0.00|COVID-19 SARS-COV-2 ANTIBODY|
20|FH_F147163_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F130766_04967_0|SrvcGrp|79699|2022|PCT|0.88|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F116370_0_0|SrvcGrp|103550|2022|PDM|400.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F140629_0_0|SrvcGrp|83648|2022|PDM|2497.00|99|0.00|CPT 47570|
20|FH_F121763_07202_0|SrvcGrp|73002|2022|PDM|2838.00|99|0.00|AEG 7|
20|FH_F121796_68355_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|2109.00|99|0.00|ASPG VII|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPTION CARE OF MUNCY FH MOD-SJ|
20|FH_F46918_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129967_18915_0|SrvcGrp|89412|2022|PDM|525.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F111292_33136_0|SrvcGrp|86921|2022|PDM|18075.00|99|0.00|GAMMA KNIFE|
20|FH_F111301_33122_0|SrvcGrp|82751|2022|PDM|26.00|99|0.00|GONADOTROIN CHORINIC (HCG) QUANTITATIVE|
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|904.39|99|0.00|2005 ASPG GROUPER V|
20|FH_F132328_0_0|SrvcGrp|107778|2022|PDM|2143.00|99|0.00|ARTHROSCOPIC FRACTURE TX|
20|FH_F132328_0_0|SrvcGrp|66307|2022|PDM|1259.00|99|0.00|CPT 53020|
20|FH_F112152_34994_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128549_44224_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123036_0_0|SrvcGrp|108847|2022|PDM|14429.00|99|0.00|IMPLT NROSTM PLS GEN SNG NON|
20|FH_F102282_06795_0|SrvcGrp|65720|2022|PDM|151.62|99|0.00|RESPITE CARE|
20|FH_F129240_10028_0|SrvcGrp|86838|2022|PDM|25.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F103109_33462_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F143542_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|AEG 1 (NO REV)|
20|FH_F51276_0_0|SrvcGrp|17015|2022|PDM|19.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F51276_0_0|SrvcGrp|34146|2022|PDM|150.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F113957_73554_0|SrvcGrp|103658|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F132419_84042_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F41776_0_0|CSTM-ALL|CSTM-00|2020|PDM|5843.00|99|0.00|MS DRG 765|
20|FH_F52854_0_0|SrvcGrp|31577|2022|PDM|8459.00|99|0.00|ANGIOPLASTY|
20|FH_F151562_26003_0|SrvcGrp|104226|2022|PDM|103.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F150699_0_0|SrvcGrp|112881|2022|PDM|3988.00|99|0.00|REMOVE PACEMAKER SYSTEM|
20|FH_F118194_50841_0|SrvcGrp|86835|2022|PDM|33.51|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F37539_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|ACUTE PSYCH|
20|FH_F148203_60190_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35344_0_0|CSTM-ALL|CSTM-00|2020|PDM|1412.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F83520_18704_0|SrvcGrp|471|2022|PDM|468.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F129656_15005_0|SrvcGrp|17016|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F136092_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F121524_87111_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113453_80020_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133972_27103_0|SrvcGrp|22593|2022|PDM|35.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F118123_67226_0|SrvcGrp|73700|2022|PDM|42.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F93076_85016_0|SrvcGrp|82242|2022|PCT|1.00|99|0.00|AETNA PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY|
20|FH_F85894_0_0|SrvcGrp|17067|2022|PDM|1095.00|99|0.00|ASPG II|
20|FH_F133176_32751_0|SrvcGrp|89149|2022|PDM|232.00|99|0.00|OP INTENSIVE|
20|FH_F32994_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42255_0_0|SrvcGrp|26421|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F118201_35126_0|CSTM-ALL|CSTM-00|2020|PDM|148.51|99|0.00|HOSPICE ROUTINE HOME CARE (DAYS 0-60)|
20|FH_F137147_75006_0|SrvcGrp|10363|2022|PDM|787.00|99|0.00|CPT CODE 99283|
20|FH_F137241_07481_0|SrvcGrp|75419|2022|PDM|376.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F140867_56345_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F117255_68520_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109513_0_0|SrvcGrp|90427|2022|PDM|6500.00|99|0.00|CERVICAL SPINAL FUSION|
20|FH_F148644_06890_0|CSTM-ALL|CSTM-00|2020|PDM|3417.00|99|0.00|AEG 7 (NO REV)|
20|FH_F122198_20708_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F128360_0_0|SrvcGrp|36591|2022|PDM|3500.00|99|0.00|CPT 63685|
20|FH_F147995_67037_0|SrvcGrp|73499|2022|PDM|291.00|99|0.00|AETNA ER LEVEL II|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|99.31|99|0.00|HAPA WPA-NWPA 2012-13 ASC 242 W/O REV|
20|FH_F145964_10993_0|SrvcGrp|73483|2022|PDM|1060.00|99|0.00|AETNA SUBACUTE III|
20|FH_F97566_79902_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F143191_17512_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F42494_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142755_33916_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100880_67735_0|SrvcGrp|72994|2022|PDM|1568.00|99|0.00|AEG 3|
20|FH_F146401_76401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142907_60640_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F92676_15063_0|SrvcGrp|79050|2022|PDM|590.88|99|0.00|MON VALLEY ASC 126|
20|FH_F123091_92627_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149243_64114_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118541_15222_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147302_33573_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F47836_0_0|SrvcGrp|44144|2022|PDM|2000.00|99|0.00|CPT 42440|
20|FH_F127418_0_0|SrvcGrp|90973|2022|PDM|7387.19|99|0.00|CERVICAL OR THORACIC INJECTION|
20|FH_F101844_0_0|SrvcGrp|98325|2022|PDM|8943.00|99|0.00|TTE W/DOPPLER COMPLETE|
20|FH_F138478_0_0|SrvcGrp|107878|2022|PDM|1905.93|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F111266_30339_0|SrvcGrp|17013|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F110722_19966_0|SrvcGrp|472|2022|PDM|430.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F149459_06615_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F93791_0_0|SrvcGrp|88354|2022|PDM|1260.00|99|0.00|CPT 63685 (HCFA)|
20|FH_F111288_0_0|SrvcGrp|77021|2022|PDM|5832.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F33509_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F116327_75701_0|SrvcGrp|104080|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F136510_0_0|SrvcGrp|109251|2022|PDM|2142.00|99|0.00|CILIARY BODY DESTRUCTION|
20|FH_F151408_0_0|CSTM-ALL|CSTM-00|2020|PDM|694.00|99|0.00|AEG 1 (NO REV)|
20|FH_F82955_34266_0|SrvcGrp|79306|2022|PCT|0.66|99|0.00|AETNA RADIOLOGY (CPT AND HCPCS)|
20|FH_F86412_32258_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110161_31329_0|SrvcGrp|92607|2022|PDM|660.00|99|0.00|SUB-ACUTE CARE LEVEL IV|
20|FH_F44774_0_0|SrvcGrp|39076|2022|PDM|800.00|99|0.00|MRI|
20|FH_F37443_0_0|SrvcGrp|3029|2022|PDM|780.00|99|0.00|NEWBORN NURSERY|
20|FH_F115685_64064_0|SrvcGrp|104091|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SN & CHEMO (HCFA)|
20|FH_F122725_32216_0|SrvcGrp|104796|2022|PDM|139.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
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_F130752_43701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F93190_26456_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES|
20|FH_F121225_98902_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F145819_03431_0|SrvcGrp|473|2022|PDM|391.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F124369_0_0|CSTM-ALL|CSTM-00|2020|PDM|2544.00|99|0.00|AEG 4 (NO REV)|
20|FH_F50703_0_0|SrvcGrp|46989|2022|PDM|35.00|99|0.00|LIPIDS|
20|FH_F136359_0_0|SrvcGrp|26275|2022|PDM|3915.00|99|0.00|CPT 29826|
20|FH_F98780_35022_0|SrvcGrp|73485|2022|PDM|2603.00|99|0.00|AETNA REHAB|
20|FH_F98800_85021_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F77665_0_0|SrvcGrp|15385|2022|PDM|60.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F146881_83661_0|SrvcGrp|48385|2022|PDM|150.00|99|0.00|SPEECH THERAPY|
20|FH_F133494_90023_0|SrvcGrp|13187|2022|PCT|0.25|99|0.00|INTRAOCULAR LENSES|
20|FH_F58252_0_0|SrvcGrp|46350|2022|PDM|31.25|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F114092_83350_0|SrvcGrp|112406|2022|PDM|4000.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F120152_0_0|SrvcGrp|67072|2022|PDM|16500.00|99|0.00|CPT 22845|
20|FH_F119003_78070_0|SrvcGrp|73605|2022|PDM|768.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F92506_07666_0|SrvcGrp|53145|2022|PDM|228.80|99|0.00|SOCIAL WORKER|
20|FH_F80731_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117131_45209_0|SrvcGrp|113276|2022|PCT|1.15|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F124828_74074_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129487_0_0|SrvcGrp|72990|2022|PDM|900.00|99|0.00|AEG 1|
20|FH_F63436_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117087_0_0|SrvcGrp|84910|2022|PDM|2093.00|99|0.00|ENDOSCOPY|
20|FH_F121976_44505_0|SrvcGrp|89417|2022|PDM|450.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F114916_30309_0|SrvcGrp|105638|2022|PDM|13500.00|99|0.00|HIP ARTHROSCOPY|
20|FH_F132627_0_0|SrvcGrp|26871|2022|PDM|80.58|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3 HRS|
20|FH_F124611_64804_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F55694_0_0|SrvcGrp|11336|2022|PCT|0.59|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F120437_85202_0|SrvcGrp|10577|2022|PDM|76.51|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F64180_0_0|SrvcGrp|1168|2022|PDM|640.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F92493_0_0|CSTM-ALL|CSTM-00|2020|PDM|821.21|99|0.00|AEG 1 (NO REV)|
20|FH_F128657_19008_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F44607_0_0|SrvcGrp|30017|2022|PCT|0.80|99|0.00|ER SERVICES|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|136.72|99|0.00|HAPA WPA-NWPA 2012-13 ASC 314 W/O REV|
20|FH_F145884_72113_0|SrvcGrp|108484|2022|PDM|524.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|439.51|99|0.00|HAPA WPA-NWPA 2012-13 ASC 305 W/O REV|
20|FH_F128912_44313_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F100741_0_0|SrvcGrp|88436|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F147210_70633_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117762_0_0|SrvcGrp|88164|2022|PDM|9360.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F144651_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.53|99|0.00|HSS ASC|
20|FH_F41155_0_0|CSTM-ALL|CSTM-00|2020|PDM|962.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F119993_71913_0|SrvcGrp|22528|2022|PDM|474.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F39274_0_0|SrvcGrp|22954|2022|PDM|300.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F117216_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC|
20|FH_F129627_06037_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139515_0_0|SrvcGrp|63471|2022|PDM|8549.00|99|0.00|CPT 64590|
20|FH_F130682_0_0|SrvcGrp|111552|2022|PDM|4980.00|99|0.00|REMOVAL OF INTRANASAL LESION|
20|FH_F131612_0_0|SrvcGrp|110173|2022|PCT|1.00|99|0.00|INJECTABLES (Q CODES)|
20|FH_F100782_0_0|SrvcGrp|105144|2022|PDM|882.45|99|0.00|WINDBER MEDICAL CNTR ASC 304|
20|FH_F47370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113325_80004_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INJECTION, PEGFILGRASTIM 6MG|
20|FH_F146474_78572_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F51124_0_0|SrvcGrp|11796|2022|PDM|115.00|99|0.00|DIETICIAN|
20|FH_F119227_01752_0|SrvcGrp|86829|2022|PDM|70.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F100782_0_0|SrvcGrp|97669|2022|PDM|1307.97|99|0.00|WINDBER MEDICAL CNTR ASC 506|
20|FH_F120484_31419_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F51393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F110223_31750_0|SrvcGrp|79099|2022|PCT|0.90|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F116806_0_0|SrvcGrp|107051|2022|PDM|1923.16|99|0.00|REPAIR CLEFT LIP|
20|FH_F63625_0_0|SrvcGrp|60128|2022|PDM|2620.00|99|0.00|GERIATRIC PSYCH SERVICES|
20|FH_F134828_30531_0|SrvcGrp|112674|2022|PDM|34.00|99|0.00|XRAY EXAM OF FOOT|
20|FH_F32995_0_0|SrvcGrp|14546|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F123784_03264_0|SrvcGrp|23683|2022|PDM|77.00|99|0.00|SKILLED NURSING RN|
20|FH_F134011_84102_0|SrvcGrp|13929|2022|PDM|10.00|99|0.00|GROWTH HORMONE|
20|FH_F134126_11554_0|SrvcGrp|13683|2022|PDM|770.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F97600_46151_0|SrvcGrp|90854|2022|PDM|2132.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F140889_33071_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F40402_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F151144_35801_0|SrvcGrp|109928|2022|PDM|915.43|99|0.00|REPAIR OF ENTROPIAN SUTURE|
20|FH_F62892_0_0|SrvcGrp|10537|2022|PDM|55.00|99|0.00|NURSING CARE|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S AZ - MOD UE|
20|FH_F118079_37642_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143617_49412_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F85212_71075_0|SrvcGrp|76522|2022|PCT|0.00|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F127282_98004_0|SrvcGrp|100499|2022|PDM|683.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F35442_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127849_43920_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146103_63851_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F124369_0_0|SrvcGrp|38352|2022|PDM|4400.00|99|0.00|FOOT MUSCLOSKELETAL PROCEDURE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|193.31|99|0.00|HAPA WPA-NWPA 2012-13 ASC 311 W/O REV|
20|FH_F131904_18915_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133583_77074_0|SrvcGrp|94880|2022|PDM|152.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F62680_0_0|SrvcGrp|11113|2022|PDM|135.00|99|0.00|HOSPICE CARE/ IN HOME|
20|FH_F86851_0_0|SrvcGrp|84983|2022|PDM|451.00|99|0.00|CPT 44386|
20|FH_F40191_0_0|SrvcGrp|177|2022|PDM|2036.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F136489_25428_0|SrvcGrp|89023|2022|PDM|80.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F134126_11554_0|SrvcGrp|92958|2022|PCT|0.00|99|0.00|SLEEP STUDIES|
20|FH_F142547_70002_0|SrvcGrp|26869|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F53732_0_0|SrvcGrp|17002|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 3 LITERS|
20|FH_F148780_70739_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE|
20|FH_F87197_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F141336_16947_0|SrvcGrp|73498|2022|PDM|991.00|99|0.00|AETNA ER LEVEL III|
20|FH_F83115_0_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F124136_75860_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146794_79601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46903_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OP SVCS|
20|FH_F127972_68061_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132864_71101_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F132544_0_0|SrvcGrp|96353|2022|PDM|8007.00|99|0.00|RECONSTRUCT ANKLE JOINT|
20|FH_F134487_14843_0|SrvcGrp|471|2022|PDM|750.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133018_84037_0|SrvcGrp|26869|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F44992_0_0|SrvcGrp|16|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION|
20|FH_F147800_0_0|SrvcGrp|98102|2022|PDM|99.00|99|0.00|DRAIN INJ JOING/BURSA W/US|
20|FH_F48032_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F68831_0_0|SrvcGrp|9829|2022|PDM|99.00|99|0.00|PT SVCS|
20|FH_F117275_16936_0|SrvcGrp|89417|2022|PDM|285.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F40465_0_0|SrvcGrp|65|2022|PDM|1560.00|99|0.00|OBSTETRICAL CARE|
20|FH_F133021_00910_0|SrvcGrp|112273|2022|PCT|1.10|99|0.00|THERAPEUTIC APHERESIS|
20|FH_F34706_0_0|SrvcGrp|11223|2022|PDM|22294.00|99|0.00|DRG 558 PERC CV PX W/DRUG-ELUTING STENT W/O MAJOR CV DX|
20|FH_F120665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.39|99|0.00|OP SVCS|
20|FH_F101751_25302_0|SrvcGrp|79238|2022|PDM|1680.00|99|0.00|TRANSFER|
20|FH_F141947_63367_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F72226_65804_0|SrvcGrp|108937|2022|PCT|0.68|99|0.00|AMBULANCE|
20|FH_F63101_0_0|CSTM-ALL|CSTM-00|2020|PDM|3201.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126147_45241_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F147303_70508_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134936_01020_0|SrvcGrp|48398|2022|PDM|125.00|99|0.00|PT SERVICES|
20|FH_F71468_0_0|SrvcGrp|62224|2022|PCT|1.00|99|0.00|IV THERAPY DRUGS|
20|FH_F42395_0_0|CSTM-ALL|CSTM-00|2020|PDM|902.00|99|0.00|GENERAL ACUTE CARE|
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_F122520_46383_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120528_60559_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F132810_0_0|SrvcGrp|17015|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F140343_89052_0|SrvcGrp|86850|2022|PDM|30.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F140730_84106_0|SrvcGrp|29155|2022|PDM|93.00|99|0.00|HOSPICE SVCS|
20|FH_F140888_75119_0|SrvcGrp|86722|2022|PDM|194.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F149649_80104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124954_17055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151049_18702_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F142448_15701_0|SrvcGrp|17013|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F148554_85016_0|SrvcGrp|114206|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F145862_66209_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F81494_0_0|SrvcGrp|26001|2022|PDM|186.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F144020_15401_0|SrvcGrp|112722|2022|PCT|0.93|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F150904_22306_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F55375_0_0|SrvcGrp|17077|2022|PDM|8000.00|99|0.00|ASPG VII|
20|FH_F130573_02882_0|SrvcGrp|72672|2022|PDM|125.00|99|0.00|DIETICIAN PHONE CONSULT|
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|830.00|99|0.00|ASPG III|
20|FH_F141648_60050_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146258_90004_0|SrvcGrp|109036|2022|PCT|0.60|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F141731_92590_0|SrvcGrp|89412|2022|PDM|463.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F117756_75402_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F66541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117762_0_0|SrvcGrp|87062|2022|PDM|1144.00|99|0.00|REVISE ULNAR NERVE AT ELBOW|
20|FH_F39443_0_0|SrvcGrp|13362|2022|PDM|340.00|99|0.00|EMERGENCY ROOM SVCS LEVEL IV|
20|FH_F134933_73505_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F127553_44321_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F148519_83201_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F136779_0_0|SrvcGrp|112924|2022|PDM|3546.00|99|0.00|IMPLNT SPINAL CANAL CATH|
20|FH_F127467_44202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114916_30309_0|SrvcGrp|26274|2022|PDM|1350.00|99|0.00|CPT 29877|
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|3713.00|99|0.00|AEG 5  (NO REV)|
20|FH_F105591_17601_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F132988_0_0|SrvcGrp|112159|2022|PDM|2057.62|99|0.00|TREAT LOWER LEG BONE LESION|
20|FH_F133002_0_0|SrvcGrp|73008|2022|PDM|562.00|99|0.00|AEG 10|
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F105320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137951_0_0|SrvcGrp|35668|2022|PDM|1436.00|99|0.00|CPT 29824|
20|FH_F40851_0_0|SrvcGrp|177|2022|PDM|3160.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F115324_78852_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F118645_19103_0|SrvcGrp|75545|2022|PDM|321.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F66648_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.90|99|0.00|OP SVCS|
20|FH_F144068_17901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43411_0_0|SrvcGrp|16|2022|PDM|1270.00|99|0.00|ACUTE REHABILITATION|
20|FH_F131699_08210_0|SrvcGrp|88620|2022|PDM|154.35|99|0.00|SKILLED NURSING RN|
20|FH_F145877_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.29|99|0.00|GENERAL ACUTE CARE|
20|FH_F130636_78572_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F101104_0_0|SrvcGrp|14949|2022|PDM|200.00|99|0.00|HOME INFUSION|
20|FH_F144851_60123_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 10 (NO REV)|
20|FH_F110732_31513_0|SrvcGrp|10393|2022|PDM|1833.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F112089_0_0|CSTM-ALL|CSTM-00|2020|PDM|1866.00|99|0.00|AEG 6 (NO REV)|
20|FH_F110732_31513_0|SrvcGrp|76059|2022|PDM|168.00|99|0.00|AETNA OP BRIDGE APPOINTMENT|
20|FH_F47600_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F112711_80909_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129334_43016_0|SrvcGrp|46605|2022|PDM|138.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F143989_19090_0|CSTM-ALL|CSTM-00|2020|PCT|1.43|99|0.00|HSS ASC|
20|FH_F116061_80110_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F83293_0_0|SrvcGrp|24598|2022|PDM|1413.00|99|0.00|MS DRG 945-946 ONLY|
20|FH_F145748_30084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125249_0_0|SrvcGrp|70746|2022|PDM|1000.00|99|0.00|CPT 28292|
20|FH_F46874_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG X|
20|FH_F125883_78748_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F107800_34609_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F90840_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F141370_20866_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F116955_16801_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|387.33|99|0.00|HAPA WPA-NWPA 2012-13 ASC 215 W/O REV|
20|FH_F98021_07012_0|SrvcGrp|73461|2022|PDM|7306.00|99|0.00|AETNA NICU IV|
20|FH_F39378_0_0|SrvcGrp|28919|2022|PDM|34.00|99|0.00|CPT 97750|
20|FH_F145641_06902_0|SrvcGrp|90417|2022|PDM|3697.00|99|0.00|TREATMENT OF JOINT|
20|FH_F127412_15301_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 3 (NO REV)|
20|FH_F97541_33021_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F44334_0_0|SrvcGrp|12044|2022|PDM|772.30|99|0.00|SLEEP STUDIES|
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F133467_03301_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F138742_33125_0|SrvcGrp|73842|2022|PDM|120.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F146286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|OP SVCS|
20|FH_F148020_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|PDM|2612.50|99|0.00|AEG 6 (NO REV)|
20|FH_F94303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134732_0_0|SrvcGrp|107878|2022|PDM|2003.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F149662_85015_0|SrvcGrp|115736|2022|PDM|6100.00|99|0.00|SPINE DISCKETOMIES|
20|FH_F132155_66209_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F108680_0_0|SrvcGrp|89842|2022|PDM|19800.00|99|0.00|LUMBAR|
20|FH_F122841_0_0|CSTM-ALL|CSTM-00|2020|PDM|1607.00|99|0.00|AEG 5 W/O CARVEOUTS|
20|FH_F134847_0_0|SrvcGrp|36865|2022|PDM|5429.00|99|0.00|NUCLEOPLASTY|
20|FH_F75903_0_0|SrvcGrp|44583|2022|PDM|475.00|99|0.00|COLORECTAL CANCER SCREENING - G0121 W/MOD SG|
20|FH_F103481_0_0|SrvcGrp|472|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F84394_17402_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F98920_46526_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F56276_0_0|SrvcGrp|52952|2022|PDM|88.00|99|0.00|PSYCHIATRIC CPT 90847|
20|FH_F143873_33407_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129969_33908_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F115018_78410_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F145815_30540_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F93881_15009_0|SrvcGrp|22378|2022|PDM|74.00|99|0.00|CPT CODE 93000|
20|FH_F109343_0_0|SrvcGrp|359|2022|PDM|550.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F77404_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_F39819_0_0|SrvcGrp|31223|2022|PDM|5172.00|99|0.00|NY DRG 371 ONLY|
20|FH_F69703_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F129228_72432_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121084_13114_0|SrvcGrp|86722|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F96721_99504_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F122930_0_0|SrvcGrp|95819|2022|PDM|3898.00|99|0.00|GONIOTOMY|
20|FH_F145885_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|PDM|741.17|99|0.00|ASPG X|
20|FH_F148859_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124389_84115_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F134916_16421_0|SrvcGrp|100961|2022|PDM|336.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY|
20|FH_F99380_90503_0|SrvcGrp|11336|2022|PCT|0.85|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F147339_08837_0|SrvcGrp|35669|2022|PDM|3500.00|99|0.00|CPT 63650|
20|FH_F113957_73554_0|SrvcGrp|73008|2022|PDM|1365.00|99|0.00|AEG 10|
20|FH_F143536_47546_0|SrvcGrp|100266|2022|PCT|1.00|99|0.00|TB INTRADERMAL TEST|
20|FH_F132473_38018_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143968_94520_0|SrvcGrp|75419|2022|PDM|550.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F35202_0_0|SrvcGrp|12264|2022|PDM|59.85|99|0.00|DIETICIAN OR LPN SERVICES|
20|FH_F116700_11787_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F116269_92627_0|SrvcGrp|86748|2022|PCT|1.15|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F51733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F145588_75081_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F118194_50841_0|SrvcGrp|89621|2022|PDM|250.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F72784_0_0|SrvcGrp|3271|2022|PDM|3262.11|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F38411_0_0|SrvcGrp|13715|2022|PCT|0.80|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F119110_91773_0|SrvcGrp|48398|2022|PDM|120.00|99|0.00|PT SERVICES|
20|FH_F127725_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136359_0_0|SrvcGrp|28551|2022|PDM|3850.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F138047_77027_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F87712_15017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F83754_0_0|SrvcGrp|76947|2022|PDM|1662.00|99|0.00|SKILLED NURSING|
20|FH_F125244_0_0|SrvcGrp|104006|2022|PDM|6500.00|99|0.00|LAPS ABLATION UTERINE FIBROIDS|
20|FH_F102200_06416_0|SrvcGrp|26868|2022|PDM|45.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F134822_06513_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 5  (NO REV)|
20|FH_F58856_0_0|CSTM-ALL|CSTM-00|2020|PDM|31750.00|99|0.00|MS DRG 230 ONLY|
20|FH_F129501_67831_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117091_28144_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F39303_0_0|SrvcGrp|997|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F112263_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS|
20|FH_F148867_20191_0|SrvcGrp|29347|2022|PDM|24.00|99|0.00|HOME HEALTH AIDE|
20|FH_F151659_17013_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110783_93013_0|SrvcGrp|19742|2022|PDM|75.00|99|0.00|MID-LINE INSERTION|
20|FH_F127132_0_0|SrvcGrp|108043|2022|PDM|171.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F41033_0_0|SrvcGrp|17073|2022|PDM|789.00|99|0.00|ASPG V|
20|FH_F98022_89015_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124703_65711_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143451_50635_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115208_0_0|SrvcGrp|77490|2022|PDM|1485.00|99|0.00|AETNA SEPTOPLASTY|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD KN|
20|FH_F91876_0_0|SrvcGrp|73004|2022|PDM|2612.00|99|0.00|AEG 8|
20|FH_F93881_15009_0|SrvcGrp|87110|2022|PDM|744.00|99|0.00|CONTRAST X-RAY LOWER SPINE|
20|FH_F40304_0_0|SrvcGrp|3660|2022|PDM|575.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)|
20|FH_F135248_84651_0|SrvcGrp|473|2022|PDM|318.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F34735_0_0|SrvcGrp|20775|2022|PCT|0.75|99|0.00|MS DRG 306 CARDI CONGENI & VALV W/CC|
20|FH_F139515_0_0|SrvcGrp|112212|2022|PDM|2781.00|99|0.00|VAGINAL PROLAPSE REPAIR|
20|FH_F66630_0_0|SrvcGrp|31702|2022|PDM|200.00|99|0.00|INTENSIVE OUTPATIENT|
20|FH_F65159_0_0|SrvcGrp|31381|2022|PDM|26264.00|99|0.00|CYBER KNIFE|
20|FH_F56772_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F123644_0_0|SrvcGrp|73842|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133749_84604_0|SrvcGrp|112433|2022|PDM|33.60|99|0.00|CHEMOTHERAPY (HCFA)|
20|FH_F146520_80435_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F37698_0_0|SrvcGrp|9793|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F86052_15063_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116753_0_0|SrvcGrp|106128|2022|PCT|2.55|99|0.00|LABORATORY SERVICES|
20|FH_F130763_0_0|SrvcGrp|65625|2022|PDM|3189.00|99|0.00|CPT 30520|
20|FH_F72584_0_0|SrvcGrp|42825|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F90594_63304_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F69606_0_0|SrvcGrp|64099|2022|PDM|1300.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 14|
20|FH_F115909_38133_0|SrvcGrp|3178|2022|PDM|1054.00|99|0.00|ACUTE PSYCH|
20|FH_F120795_27514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F133025_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F114389_50131_0|SrvcGrp|24761|2022|PDM|84.26|99|0.00|HOME INFUSION THERAPY|
20|FH_F64441_0_0|SrvcGrp|17139|2022|PDM|643.00|99|0.00|HOSPICE CARE|
20|FH_F124928_04210_0|SrvcGrp|53746|2022|PDM|149.67|99|0.00|RESPITE CARE (HCFA)|
20|FH_F88956_0_0|SrvcGrp|73601|2022|PDM|3039.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F111791_33308_0|SrvcGrp|73065|2022|PCT|1.00|99|0.00|AETNA OP RADIOLOGY|
20|FH_F116869_15146_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F132190_0_0|SrvcGrp|96979|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F127209_45365_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F40615_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|78282|2022|PDM|4368.00|99|0.00|CPT 47563|
20|FH_F129683_45255_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F137719_28269_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F122333_67010_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F91392_63105_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39567_0_0|SrvcGrp|91|2022|PCT|1.00|99|0.00|KIDNEY TRANSPLANT|
20|FH_F47884_0_0|CSTM-ALL|CSTM-00|2020|PDM|1474.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148254_89503_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F121090_07848_0|SrvcGrp|91065|2022|PDM|51.25|99|0.00|PSYCHIATRIC CPT 90853 (HCFA)|
20|FH_F138416_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|RESPITE CARE|
20|FH_F124050_75089_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F141549_33403_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F123302_33407_0|SrvcGrp|108484|2022|PDM|644.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F148239_74012_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116311_02657_0|SrvcGrp|89149|2022|PDM|210.00|99|0.00|OP INTENSIVE|
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|570.00|99|0.00|AEG 2 (NO REV)|
20|FH_F116268_19064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79746_0_0|SrvcGrp|24290|2022|PDM|154.00|99|0.00|HOME HEALTH THERAPY VISITS|
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 2 (NO REV)|
20|FH_F93881_15009_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97721_01053_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F114916_30309_0|SrvcGrp|78403|2022|PDM|0.25|99|0.00|AETNA MED RECORD|
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|1247.00|99|0.00|AEG 8 (NO REV)|
20|FH_F138929_0_0|SrvcGrp|41334|2022|PDM|17600.00|99|0.00|TOTAL KNEE|
20|FH_F132988_0_0|SrvcGrp|88163|2022|PDM|8647.09|99|0.00|LUMBAR SPINE FUSION|
20|FH_F141070_64093_0|SrvcGrp|88620|2022|PDM|127.00|99|0.00|SKILLED NURSING RN|
20|FH_F113146_15001_0|SrvcGrp|86723|2022|PDM|251.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F89851_83854_0|SrvcGrp|73804|2022|PDM|16703.00|99|0.00|AETNA MSDRG 620 ONLY|
20|FH_F89851_83854_0|SrvcGrp|79786|2022|PCT|2.00|99|0.00|SLEEP STUDIES|
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|1172.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F144388_19904_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103440_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|69.31|99|0.00|HAPA WPA-NWPA 2012-13 ASC 146 W/O REV|
20|FH_F91155_16105_0|SrvcGrp|73008|2022|PDM|1013.00|99|0.00|AEG 10|
20|FH_F40340_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133329_40202_0|SrvcGrp|87536|2022|PDM|381.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F65899_0_0|SrvcGrp|12787|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F150800_44256_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150953_74953_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F42979_0_0|SrvcGrp|3399|2022|PDM|79.00|99|0.00|CPT 90862|
20|FH_F111266_30339_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132254_40207_0|SrvcGrp|14947|2022|PDM|13.00|99|0.00|HOME INFUSION|
20|FH_F147222_49544_0|SrvcGrp|110537|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F134847_0_0|SrvcGrp|88740|2022|PDM|3793.00|99|0.00|SP BONE ALGRFT|
20|FH_F117576_21207_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39443_0_0|SrvcGrp|13359|2022|PDM|105.00|99|0.00|EMERGENCY ROOM SVCS LEVEL I|
20|FH_F97300_47501_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F37003_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SURGERY|
20|FH_F141267_0_0|SrvcGrp|113620|2022|PDM|550.00|99|0.00|HOSPICE CARE|
20|FH_F132446_19063_0|SrvcGrp|74802|2022|PDM|6.00|99|0.00|AETNA CPT 36415|
20|FH_F116904_17543_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149759_63122_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1230.08|99|0.00|HAPA WPA-NWPA 2012-13 ASC 907 W/O REV|
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|2409.00|99|0.00|AEG 7 (NO REV)|
20|FH_F150982_0_0|SrvcGrp|88164|2022|PDM|9909.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F89475_71202_0|CSTM-ALL|CSTM-00|2020|PDM|990.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F94102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97102_83501_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS|
20|FH_F47963_0_0|SrvcGrp|26160|2022|PDM|16.50|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F38867_0_0|SrvcGrp|72|2022|PCT|0.92|99|0.00|NEWBORN NURSERY|
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|873.94|99|0.00|AEG 10 (NO REV)|
20|FH_F110509_71351_0|SrvcGrp|103717|2022|PCT|0.55|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F145675_33761_0|SrvcGrp|46605|2022|PDM|90.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F34273_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F147962_85008_0|SrvcGrp|81779|2022|PCT|1.25|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F147962_85008_0|SrvcGrp|75797|2022|PDM|2000.00|99|0.00|EMERGENCY ROOM LEVEL 4|
20|FH_F134188_83201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130017_02302_0|SrvcGrp|20744|2022|PDM|31792.22|99|0.00|MS DRG 242 ONLY|
20|FH_F143631_52248_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F141217_0_0|CSTM-ALL|CSTM-00|2020|PDM|1748.00|99|0.00|AEG 6 (NO REV)|
20|FH_F44134_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.37|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F146141_77598_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145901_45205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F72226_65804_0|SrvcGrp|75506|2022|PCT|0.56|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F117906_91606_0|SrvcGrp|73701|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F128349_43082_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|857.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 11|
20|FH_F63301_0_0|SrvcGrp|46224|2022|PDM|115.00|99|0.00|NUTRITIONAL ASSESSMENT (INITIAL) VISIT OP|
20|FH_F131449_19073_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F135263_0_0|SrvcGrp|112741|2022|PDM|900.00|99|0.00|TOTAL KNEE ARTHROPLASTY|
20|FH_F124467_27529_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150961_89169_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|6998.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F97603_77901_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F137719_28269_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F36594_0_0|SrvcGrp|12401|2022|PDM|88.00|99|0.00|RN VISIT|
20|FH_F145543_0_0|SrvcGrp|114208|2022|PDM|931.00|99|0.00|REPAIR OF BROW PTOSIS|
20|FH_F78009_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F148839_0_0|CSTM-ALL|CSTM-00|2020|PDM|513.00|99|0.00|AEG 3 (NO REV)|
20|FH_F37267_0_0|SrvcGrp|12401|2022|PDM|85.50|99|0.00|RN VISIT|
20|FH_F138478_0_0|SrvcGrp|91959|2022|PDM|17567.26|99|0.00|INSERT PULSE GENERATOR|
20|FH_F84394_17402_0|SrvcGrp|105465|2022|PCT|1.52|99|0.00|AETNA THERAPIES|
20|FH_F81183_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F129064_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|OCN F/S PRICING: ALL|
20|FH_F143976_80504_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124254_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83520_18704_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149660_0_0|SrvcGrp|2067|2022|PDM|1119.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F142376_0_0|SrvcGrp|80137|2022|PDM|20408.00|99|0.00|IMPLANT SPINAL INFUSION|
20|FH_F118088_71261_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)|
20|FH_F42577_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|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_F75087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|COVENTRY ENHANCED DEFAULT 10021-69990|
20|FH_F139569_15063_0|SrvcGrp|113637|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F145659_29646_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126056_29824_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133969_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F134492_85201_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F146808_44641_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150060_0_0|SrvcGrp|89337|2022|PDM|1000.00|99|0.00|DETOXIFICATION|
20|FH_F148699_19403_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F149561_76667_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92634_08244_0|SrvcGrp|10944|2022|PCT|0.70|99|0.00|EMERGENCY ROOM|
20|FH_F109883_35007_0|SrvcGrp|86753|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F94581_0_0|SrvcGrp|471|2022|PDM|676.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F47452_0_0|SrvcGrp|42823|2022|PCT|0.45|99|0.00|DME|
20|FH_F130371_0_0|SrvcGrp|90882|2022|PCT|0.92|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F101640_32218_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F35847_0_0|SrvcGrp|12596|2022|PCT|0.66|99|0.00|OP RADIOLOGY|
20|FH_F114207_35243_0|SrvcGrp|86838|2022|PDM|15.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F99920_63141_0|SrvcGrp|94781|2022|PDM|110.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|1096.00|99|0.00|ASPG VIII- GNADEN HUETTEN|
20|FH_F112306_81428_0|SrvcGrp|75545|2022|PDM|361.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F116698_07470_0|SrvcGrp|86832|2022|PDM|10.50|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F60273_0_0|SrvcGrp|56462|2022|PDM|4515.84|99|0.00|CPT 53850|
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|514.00|99|0.00|AEG 2 (NO REV)|
20|FH_F88451_0_0|SrvcGrp|56603|2022|PDM|70.00|99|0.00|HOME HEALTH AIDE|
20|FH_F89563_29407_0|SrvcGrp|86323|2022|PCT|1.00|99|0.00|OTORHINOLARYNGOLOGIC SERVICES|
20|FH_F120876_85250_0|SrvcGrp|104079|2022|PCT|1.30|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F126883_78621_0|SrvcGrp|89337|2022|PDM|800.00|99|0.00|DETOXIFICATION|
20|FH_F100762_51104_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F52393_0_0|SrvcGrp|49112|2022|PDM|1800.00|99|0.00|HEARING AID|
20|FH_F135066_02908_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126033_15301_0|SrvcGrp|23683|2022|PDM|43.08|99|0.00|SKILLED NURSING RN|
20|FH_F62579_0_0|SrvcGrp|14947|2022|PDM|65.00|99|0.00|HOME INFUSION|
20|FH_F130805_17404_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)|
20|FH_F125244_0_0|SrvcGrp|41546|2022|PDM|5000.00|99|0.00|LAPAROSCOPIC APPENDECTOMY|
20|FH_F146590_77449_0|SrvcGrp|111241|2022|PDM|98.00|99|0.00|PT ASSISTANT|
20|FH_F116806_0_0|SrvcGrp|107020|2022|PDM|1923.16|99|0.00|OSTEOPLASTY FACIAL-AUGMENT|
20|FH_F145641_06902_0|SrvcGrp|74039|2022|PDM|15759.00|99|0.00|LAMINECTOMY|
20|FH_F145604_14850_0|SrvcGrp|86829|2022|PDM|30.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F116849_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110420_60649_0|SrvcGrp|88977|2022|PDM|3200.00|99|0.00|C-SECTION DELIVERY|
20|FH_F43863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F80613_0_0|SrvcGrp|10545|2022|PDM|95.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F134208_21502_0|CSTM-ALL|CSTM-00|2020|PDM|634.00|99|0.00|AEG 3 (NO REV)|
20|FH_F146839_17601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F47140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133047_74012_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F34477_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DURABLE MEDICAL EQUIPMENT (DME) W/MOD KN - WINN|
20|FH_F142448_15701_0|SrvcGrp|14949|2022|PDM|80.00|99|0.00|HOME INFUSION|
20|FH_F133753_84015_0|SrvcGrp|473|2022|PDM|318.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F88744_71103_0|SrvcGrp|73659|2022|PDM|2274.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F133207_0_0|SrvcGrp|106267|2022|PDM|5293.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL|
20|FH_F70208_0_0|SrvcGrp|42785|2022|PDM|85.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F132937_88201_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F46832_0_0|SrvcGrp|22594|2022|PDM|60.00|99|0.00|IMIGLUCERASE|
20|FH_F123595_70546_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123847_24012_0|SrvcGrp|75545|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F40347_0_0|SrvcGrp|12235|2022|PDM|1450.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F120456_67117_0|SrvcGrp|75545|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|1445.19|99|0.00|2006 MEDICARE ASPG VII|
20|FH_F138583_60644_0|SrvcGrp|73842|2022|PDM|234.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F140493_67107_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40899_0_0|SrvcGrp|31190|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC (DME)|
20|FH_F149023_44122_0|SrvcGrp|67279|2022|PDM|13039.00|99|0.00|CERVICAL SURGERY|
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|1446.00|99|0.00|AEG 7 (NO REV)|
20|FH_F90817_0_0|SrvcGrp|91011|2022|PDM|2280.00|99|0.00|SHOULDER ARTHROSCOPY/SURGERY (HCFA)|
20|FH_F151407_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F147234_19010_0|SrvcGrp|74668|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114207_35243_0|SrvcGrp|86849|2022|PDM|35.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F116869_15146_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F119843_14103_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130523_04605_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|AEG 4 (NO REV)|
20|FH_F118194_50841_0|SrvcGrp|86836|2022|PDM|36.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F110925_01104_0|SrvcGrp|86139|2022|PDM|516.25|99|0.00|IDURSULFASE INJECTIONS|
20|FH_F120899_72758_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125913_66762_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128402_80233_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F130747_0_0|SrvcGrp|11673|2022|PDM|5202.00|99|0.00|CPT 29888|
20|FH_F133175_0_0|SrvcGrp|46482|2022|PDM|175.00|99|0.00|S9083 PER VISIT|
20|FH_F114444_19602_0|SrvcGrp|86647|2022|PDM|62.00|99|0.00|AETNA OFFICE OP VISIT EST (MOD TD)|
20|FH_F110309_63301_0|SrvcGrp|3142|2022|PDM|1733.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F124917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145694_84770_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F137587_0_0|SrvcGrp|108043|2022|PDM|297.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F132969_84003_0|SrvcGrp|86853|2022|PDM|10.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F101100_50314_0|SrvcGrp|84939|2022|PDM|22154.00|99|0.00|SHOULDER JOINT|
20|FH_F131989_66030_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133569_17202_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F117465_0_0|SrvcGrp|75489|2022|PDM|1400.00|99|0.00|AEG 6|
20|FH_F69968_0_0|SrvcGrp|46532|2022|PDM|456.11|99|0.00|EMERGENCY ROOM LEVEL 3|
20|FH_F142741_03264_0|SrvcGrp|75419|2022|PDM|1575.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F132733_0_0|SrvcGrp|33793|2022|PDM|12757.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F109632_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F74562_0_0|SrvcGrp|16|2022|PDM|940.00|99|0.00|ACUTE REHABILITATION|
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F89932_10940_0|SrvcGrp|82369|2022|PCT|1.60|99|0.00|AETNA LABORATORY|
20|FH_F120437_85202_0|SrvcGrp|29076|2022|PDM|76.51|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F132419_84042_0|SrvcGrp|74668|2022|PDM|325.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F84611_30281_0|SrvcGrp|10986|2022|PDM|7538.00|99|0.00|ARTHROSCOPIC KNEE REPAIR|
20|FH_F43118_0_0|SrvcGrp|36839|2022|PDM|13800.00|99|0.00|PTCA|
20|FH_F32486_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137591_33411_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F124050_75089_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F116188_72211_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F33479_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|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_F42312_0_0|SrvcGrp|35796|2022|PCT|0.90|99|0.00|AZT ZIDOVUDINE|
20|FH_F76146_0_0|SrvcGrp|68362|2022|PDM|985.00|99|0.00|COVENTRY ENHANCED GROUPER 10 WITH REV CODES|
20|FH_F132899_01002_0|SrvcGrp|90349|2022|PDM|1264.00|99|0.00|AETNA RESIDENTIAL PSYCHIATRIC  EATING DISORDERS >=18 YRS|
20|FH_F145642_15108_0|SrvcGrp|86828|2022|PDM|45.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F114683_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138240_64114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134590_53223_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F148885_23226_0|SrvcGrp|92502|2022|PDM|795.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F102200_06416_0|SrvcGrp|86853|2022|PDM|45.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F80513_0_0|SrvcGrp|16162|2022|PDM|2003.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F133478_40165_0|SrvcGrp|3932|2022|PDM|7607.00|99|0.00|LITHOTRIPSY|
20|FH_F93363_63123_0|SrvcGrp|93820|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F137812_12118_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137937_20032_0|CSTM-ALL|CSTM-00|2020|PCT|2.32|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F98041_10027_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F40370_0_0|SrvcGrp|110|2022|PDM|674.00|99|0.00|CD - REHABILITATION|
20|FH_F88733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F68622_0_0|SrvcGrp|10708|2022|PCT|0.80|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F37042_0_0|SrvcGrp|17065|2022|PDM|531.00|99|0.00|ASPG I|
20|FH_F56832_0_0|SrvcGrp|65|2022|PDM|1200.00|99|0.00|OBSTETRICAL CARE|
20|FH_F140730_84106_0|SrvcGrp|84185|2022|PDM|93.00|99|0.00|RESPITE CARE|
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1274.00|99|0.00|AEG 7 (NO REV)|
20|FH_F137818_31602_0|SrvcGrp|89417|2022|PDM|486.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F148644_06890_0|SrvcGrp|26273|2022|PDM|3604.00|99|0.00|CPT 29880|
20|FH_F151155_26508_0|SrvcGrp|104443|2022|PDM|137.00|99|0.00|AETNA OFFICE/OP VISIT EST (HCFA)|
20|FH_F106822_0_0|SrvcGrp|100278|2022|PDM|0.29|99|0.00|INJ DEXAMETHASONE ACETATE|
20|FH_F86911_0_0|SrvcGrp|43263|2022|PDM|3.80|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F112064_0_0|SrvcGrp|103903|2022|PDM|161.07|99|0.00|HOSPICE IN SNF|
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AEG 6 (NO REV)|
20|FH_F146844_78582_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147059_28806_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F87822_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F124235_92840_0|SrvcGrp|87317|2022|PDM|1200.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F44606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89851_83854_0|SrvcGrp|88902|2022|PDM|11709.00|99|0.00|MS DRG 502 ONLY|
20|FH_F133251_89521_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133018_84037_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F126672_0_0|SrvcGrp|28549|2022|PDM|1752.00|99|0.00|VITRECTOMY|
20|FH_F48224_0_0|SrvcGrp|72992|2022|PDM|528.00|99|0.00|AEG 2|
20|FH_F126970_45601_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F61292_0_0|SrvcGrp|20293|2022|PDM|31050.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY|
20|FH_F131228_01826_0|SrvcGrp|73601|2022|PDM|4149.05|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F116341_12180_0|SrvcGrp|90017|2022|PDM|83.00|99|0.00|AETNA PHARMACOLOGIC MANAGEMENT SUBOXONE (HCFA)|
20|FH_F86332_75081_0|SrvcGrp|47183|2022|PDM|160.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F121547_46805_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F83198_44125_0|SrvcGrp|26470|2022|PDM|126.00|99|0.00|SELF DIALYSIS TRAINING CAPD|
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|1304.00|99|0.00|AEG 7 (NO REV)|
20|FH_F41665_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPEN MRI OF NAPLES MRI/CT MOD TC|
20|FH_F82173_72712_0|CSTM-ALL|CSTM-00|2020|PDM|2668.00|99|0.00|AEG 3 (NO REV)|
20|FH_F109400_80026_0|SrvcGrp|88620|2022|PDM|98.00|99|0.00|SKILLED NURSING RN|
20|FH_F126343_07018_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112908_0_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F126417_77338_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119646_65804_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121225_98902_0|SrvcGrp|14944|2022|PCT|0.85|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F111986_0_0|SrvcGrp|72990|2022|PDM|477.00|99|0.00|AEG 1|
20|FH_F119588_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149149_32937_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125440_04043_0|SrvcGrp|23587|2022|PDM|546.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|595.00|99|0.00|ASPG IV|
20|FH_F134160_19006_0|SrvcGrp|13683|2022|PDM|624.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F139559_21001_0|SrvcGrp|82981|2022|PDM|154.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F129483_77030_0|SrvcGrp|86849|2022|PDM|40.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F111593_0_0|SrvcGrp|72992|2022|PDM|1980.00|99|0.00|AEG 2|
20|FH_F90613_05001_0|SrvcGrp|73849|2022|PDM|498.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F72845_0_0|SrvcGrp|3271|2022|PDM|6010.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F124082_78526_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F144188_76502_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F47679_0_0|CSTM-ALL|CSTM-00|2020|PDM|560.00|99|0.00|SKILLED NURSING|
20|FH_F111526_32226_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F67265_0_0|SrvcGrp|453|2022|PDM|472.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F116828_0_0|SrvcGrp|82222|2022|PDM|148.79|99|0.00|HOSPICE CARE|
20|FH_F81313_0_0|SrvcGrp|33166|2022|PDM|450.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F124749_90211_0|SrvcGrp|100499|2022|PDM|768.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F40855_0_0|CSTM-ALL|CSTM-00|2020|PDM|478.00|99|0.00|ACUTE PSYCH|
20|FH_F151002_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F48772_66044_0|SrvcGrp|80920|2022|PDM|528.00|99|0.00|HOSPICE SERVICES|
20|FH_F148665_65270_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC|
20|FH_F106980_0_0|SrvcGrp|72996|2022|PDM|925.00|99|0.00|AEG 4|
20|FH_F138630_72616_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138052_19462_0|SrvcGrp|90632|2022|PDM|162.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F100664_03104_0|SrvcGrp|90854|2022|PDM|2669.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F148553_85016_0|SrvcGrp|108177|2022|PDM|2139.00|99|0.00|TRLUML BALO ANGIOP 1ST VEIN|
20|FH_F122606_53818_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122727_64030_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122740_71038_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F122675_07055_0|CSTM-ALL|CSTM-00|2020|PCT|0.22|99|0.00|OP SVCS|
20|FH_F42906_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42943_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F134691_33445_0|SrvcGrp|46903|2022|PDM|2047.50|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F135722_33461_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149543_0_0|SrvcGrp|107749|2022|PDM|182.00|99|0.00|CAPD/CCPD|
20|FH_F74283_0_0|SrvcGrp|3810|2022|PDM|75.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F115144_71373_0|SrvcGrp|92582|2022|PDM|459.00|99|0.00|DIALYSIS SERVICES|
20|FH_F115210_21043_0|SrvcGrp|97895|2022|PDM|10000.00|99|0.00|REVISE KNEE 2|
20|FH_F115210_21043_0|SrvcGrp|78284|2022|PDM|1485.00|99|0.00|CPT 46200|
20|FH_F115244_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147586_44124_0|SrvcGrp|58636|2022|PDM|17365.00|99|0.00|CPT 62362|
20|FH_F147540_54871_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|38.00|99|0.00|PAIN MANAGEMENT THERAPY IV/SQ (MOD SH)|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD RR KE RATES|
20|FH_F132503_73086_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F92792_0_0|SrvcGrp|28550|2022|PDM|2200.00|99|0.00|VITRECTOMY|
20|FH_F113315_72205_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F49354_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEBA|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER NUKL|
20|FH_F115312_78550_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F128421_27016_0|SrvcGrp|73559|2022|PCT|0.80|99|0.00|AETNA INTENSIVE CARE|
20|FH_F124928_04210_0|SrvcGrp|90338|2022|PDM|132.30|99|0.00|SKILLED NURSING RN (HCFA)|
20|FH_F120437_85202_0|SrvcGrp|17003|2022|PDM|185.71|99|0.00|TOTAL PARENTERAL NUTRITION;MORE THAN 3 LITERS|
20|FH_F148662_01583_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F130563_85122_0|SrvcGrp|82981|2022|PDM|143.50|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F88956_0_0|SrvcGrp|75485|2022|PDM|2022.00|99|0.00|AEG 4|
20|FH_F90955_06053_0|SrvcGrp|27969|2022|PDM|18.90|99|0.00|HOME HEALTH AIDE|
20|FH_F111809_93003_0|SrvcGrp|104542|2022|PDM|41202.00|99|0.00|CRYOABLATION LIVER TUMORS|
20|FH_F150882_84041_0|SrvcGrp|100664|2022|PDM|650.00|99|0.00|HOSPICE IP CARE (HCFA)|
20|FH_F34777_0_0|SrvcGrp|109|2022|PDM|816.00|99|0.00|CD - DETOX|
20|FH_F122248_33441_0|SrvcGrp|74668|2022|PDM|900.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AEG 2 (NO REV)|
20|FH_F114571_34613_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F132860_0_0|SrvcGrp|38|2022|PDM|3127.00|99|0.00|NORMAL DELIVERY|
20|FH_F35753_33770_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F112796_63703_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36992_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD NU|
20|FH_F39443_0_0|SrvcGrp|30363|2022|PDM|1337.00|99|0.00|HAPA WPA ASC 701|
20|FH_F117820_0_0|SrvcGrp|74546|2022|PDM|499.00|99|0.00|HOSPICE SERVICES|
20|FH_F91594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F114853_0_0|SrvcGrp|35670|2022|PDM|7699.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F54552_0_0|SrvcGrp|28637|2022|PDM|32.50|99|0.00|HOME INFUSION THERAPY (MOD SH)|
20|FH_F138936_01040_0|SrvcGrp|112224|2022|PCT|1.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F57953_0_0|SrvcGrp|36808|2022|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53  (DME)|
20|FH_F67167_0_0|SrvcGrp|177|2022|PDM|3180.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PDM|814.00|99|0.00|ASPG IV|
20|FH_F88893_0_0|SrvcGrp|79588|2022|PDM|528.00|99|0.00|CPT 43235|
20|FH_F151342_90272_0|SrvcGrp|75419|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F151514_35242_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132258_45404_0|SrvcGrp|110823|2022|PCT|1.00|99|0.00|OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F145468_60615_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F133608_33602_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42492_0_0|SrvcGrp|33363|2022|PCT|0.85|99|0.00|J CODES|
20|FH_F135410_30013_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135434_64424_0|SrvcGrp|10391|2022|PDM|1273.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F135572_89106_0|SrvcGrp|17015|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F97142_94535_0|SrvcGrp|73656|2022|PDM|555.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F91764_93710_0|SrvcGrp|114613|2022|PCT|1.00|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F116404_20191_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F116404_20191_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F116461_77536_0|SrvcGrp|98319|2022|PDM|431.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY (HCFA)|
20|FH_F116488_79925_0|SrvcGrp|66264|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F127399_0_0|SrvcGrp|104112|2022|PDM|2497.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F140629_0_0|SrvcGrp|113665|2022|PDM|2497.00|99|0.00|LAPAROSCOPY|
20|FH_F121444_47720_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121823_46234_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F127992_34952_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F111292_33136_0|SrvcGrp|110234|2022|PCT|0.86|99|0.00|RADIOLOGY SERVICES|
20|FH_F111301_33122_0|SrvcGrp|82747|2022|PDM|64.00|99|0.00|THROMBOPLASTIN TIME PARTIAL|
20|FH_F134263_15628_0|SrvcGrp|89149|2022|PDM|215.00|99|0.00|OP INTENSIVE|
20|FH_F134322_98001_0|SrvcGrp|112546|2022|PCT|1.00|99|0.00|CEFOTAXIME SODIUM INJECTION|
20|FH_F65882_0_0|SrvcGrp|42830|2022|PDM|54.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F43137_0_0|SrvcGrp|16746|2022|PDM|50.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F43137_0_0|SrvcGrp|10431|2022|PDM|50.00|99|0.00|SPEECH THERAPY|
20|FH_F75806_0_0|SrvcGrp|10542|2022|PDM|216.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F131000_0_0|SrvcGrp|27261|2022|PDM|13265.00|99|0.00|CPT 27446|
20|FH_F132328_0_0|SrvcGrp|88596|2022|PDM|1746.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE|
20|FH_F132328_0_0|SrvcGrp|96819|2022|PDM|1746.00|99|0.00|DESTROY L/S FACET JNT ADDL|
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|382.00|99|0.00|2006 MEDICARE ASPG I|
20|FH_F68043_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114569_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130206_78209_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F123036_0_0|SrvcGrp|98584|2022|PDM|13393.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F98626_29118_0|SrvcGrp|73461|2022|PDM|7570.00|99|0.00|AETNA NICU IV|
20|FH_F102862_30606_0|SrvcGrp|28119|2022|PDM|34610.40|99|0.00|MS DRG 466 ONLY|
20|FH_F129240_10028_0|SrvcGrp|86836|2022|PDM|25.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F98300_30236_0|SrvcGrp|79099|2022|PDM|2814.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F132834_63640_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD NU/KC)|
20|FH_F61292_0_0|SrvcGrp|11000|2022|PCT|0.44|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
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_F116341_12180_0|SrvcGrp|86722|2022|PDM|135.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F82753_18840_0|SrvcGrp|73497|2022|PDM|1197.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F120155_63114_0|SrvcGrp|84559|2022|PCT|0.75|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|563.00|99|0.00|AEG 10 (NO REV)|
20|FH_F42019_0_0|SrvcGrp|701|2022|PDM|1600.00|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_F99960_0_0|SrvcGrp|55071|2022|PDM|1174.00|99|0.00|ARTHROSCOPY SHOULDER|
20|FH_F135207_76053_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F93534_45690_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F78603_0_0|SrvcGrp|54975|2022|PDM|62640.58|99|0.00|MS DRG 223 ONLY|
20|FH_F76146_0_0|SrvcGrp|68188|2022|PDM|1103.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 4|
20|FH_F35042_0_0|SrvcGrp|701|2022|PDM|2514.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F119227_01752_0|SrvcGrp|86832|2022|PDM|15.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F126431_77338_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120484_31419_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F128148_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133972_27103_0|SrvcGrp|86854|2022|PDM|45.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F120484_31419_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F133909_19805_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150242_60025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89219_0_0|SrvcGrp|13227|2022|PDM|1423.00|99|0.00|CPT CODE 99283|
20|FH_F110302_15931_0|SrvcGrp|103942|2022|PDM|11.26|99|0.00|HHC PT MAINT EA 15 MIN|
20|FH_F146422_80210_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F127656_06068_0|SrvcGrp|89783|2022|PDM|161.70|99|0.00|RESPITE CARE (HCFA)|
20|FH_F133219_89119_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F74602_0_0|CSTM-ALL|CSTM-00|2020|PDM|2245.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F114064_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F123848_03257_0|SrvcGrp|53987|2022|PDM|75.00|99|0.00|PHOTOTHERAPY|
20|FH_F137147_75006_0|SrvcGrp|31926|2022|PDM|39721.00|99|0.00|MS DRG 458 ONLY|
20|FH_F138735_50583_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F129483_77030_0|SrvcGrp|86840|2022|PDM|40.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F151054_06473_0|SrvcGrp|112678|2022|PCT|1.00|99|0.00|COVID-19 SPECIMEN COLLECT|
20|FH_F121404_32216_0|SrvcGrp|108782|2022|PDM|51.64|99|0.00|CONT AIRWAY PRESSURE DEVICE (MOD KH, KI, KJ, KX, RR) (HCFA)|
20|FH_F87054_0_0|SrvcGrp|705|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F116043_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F146715_34240_0|SrvcGrp|104193|2022|PCT|1.00|99|0.00|PHYSICAL THERAPY|
20|FH_F124212_33407_0|SrvcGrp|87131|2022|PDM|290.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F124653_64062_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148703_33853_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1241.00|99|0.00|AEG 2 (NO REV)|
20|FH_F128492_49010_0|SrvcGrp|83857|2022|PDM|550.00|99|0.00|IP HOSPICE SVCS|
20|FH_F47479_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|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_F97042_64804_0|SrvcGrp|90854|2022|PDM|1773.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F148556_13206_0|SrvcGrp|17011|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F146211_68144_0|SrvcGrp|109057|2022|PCT|1.20|99|0.00|CARDIAC STUDIES|
20|FH_F91262_77036_0|SrvcGrp|46605|2022|PDM|90.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F123144_0_0|SrvcGrp|73000|2022|PDM|855.00|99|0.00|AEG 6|
20|FH_F35567_0_0|SrvcGrp|21044|2022|PDM|690.00|99|0.00|MRI SERVICES|
20|FH_F55693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111266_30339_0|SrvcGrp|86828|2022|PDM|45.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F39944_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1799.00|99|0.00|AEG 9 (NO REV)|
20|FH_F149002_80014_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F137561_43935_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS APC GROUPED|
20|FH_F116908_33461_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|78911|2022|PDM|4404.00|99|0.00|LAPARO HERNIA REPAIR RECUR|
20|FH_F74647_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139303_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F125516_50574_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F32060_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F48998_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F125249_0_0|SrvcGrp|27315|2022|PDM|3300.00|99|0.00|TENDON REPAIR|
20|FH_F118057_47906_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F143530_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40134_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F125244_0_0|SrvcGrp|73495|2022|PDM|5000.00|99|0.00|AETNA MYOMECTOMY|
20|FH_F109624_15401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40267_0_0|SrvcGrp|17069|2022|PDM|640.00|99|0.00|ASPG III|
20|FH_F44612_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F141887_65605_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F49637_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|LAB F/S W/MOD QW OK SURG HOSP|
20|FH_F88512_0_0|SrvcGrp|46509|2022|PDM|1146.50|99|0.00|MSDRG  880-887 ONLY & REV ACUTE PSYCHIATRIC|
20|FH_F130108_0_0|SrvcGrp|111492|2022|PCT|0.60|99|0.00|RADIATION ONCOLOGY|
20|FH_F117366_33162_0|SrvcGrp|38007|2022|PDM|500.00|99|0.00|CPT CODE 59425|
20|FH_F148861_18706_0|SrvcGrp|89337|2022|PDM|1061.00|99|0.00|DETOXIFICATION|
20|FH_F119206_35007_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F139679_75050_0|SrvcGrp|87317|2022|PDM|770.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F98625_08103_0|SrvcGrp|73602|2022|PDM|7595.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F128031_0_0|SrvcGrp|73002|2022|PDM|1256.00|99|0.00|AEG 7|
20|FH_F39939_0_0|SrvcGrp|10701|2022|PDM|2620.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F131324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120112_0_0|SrvcGrp|94781|2022|PDM|94.50|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F97261_06098_0|SrvcGrp|90854|2022|PDM|4158.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F104802_0_0|SrvcGrp|23587|2022|PDM|425.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F98042_10468_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F114666_30342_0|SrvcGrp|58993|2022|PDM|5200.00|99|0.00|DISKECTOMY|
20|FH_F114666_30342_0|SrvcGrp|26278|2022|PDM|1445.00|99|0.00|CPT 29881|
20|FH_F113845_32746_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F113870_10536_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114985_32073_0|SrvcGrp|104798|2022|PDM|68.00|99|0.00|ORAL SPEECH DEVICE EVALUATION|
20|FH_F133210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117195_0_0|SrvcGrp|36144|2022|PCT|0.59|99|0.00|OP SURGERY|
20|FH_F148553_85016_0|SrvcGrp|115462|2022|PDM|1224.00|99|0.00|INSERT SUBQ IMPLANTABLE DEFIB ELECTRODE|
20|FH_F146043_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F43862_0_0|SrvcGrp|30955|2022|PDM|115.00|99|0.00|SKILLED RN VISIT|
20|FH_F134691_33445_0|SrvcGrp|74668|2022|PDM|1046.50|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F135747_76208_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 III|
20|FH_F115567_91711_0|SrvcGrp|86746|2022|PCT|1.25|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F147699_83704_0|SrvcGrp|90854|2022|PDM|1167.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F41254_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42024_0_0|SrvcGrp|35499|2022|PCT|0.79|99|0.00|OP SURGERY|
20|FH_F49617_0_0|SrvcGrp|12964|2022|PDM|950.00|99|0.00|CD - DETOX|
20|FH_F72065_0_0|SrvcGrp|3810|2022|PDM|193.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|1082.00|99|0.00|HAPA EPA ASC 54|
20|FH_F123158_0_0|SrvcGrp|29830|2022|PDM|1375.00|99|0.00|PERCUT NEEDLE INSERTION|
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|3337.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F118785_33315_0|SrvcGrp|107948|2022|PDM|650.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC|
20|FH_F119070_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F39859_0_0|SrvcGrp|10365|2022|PDM|1880.00|99|0.00|CPT CODE 99285|
20|FH_F133021_00910_0|SrvcGrp|112310|2022|PDM|800.00|99|0.00|DRAINAGE|
20|FH_F41739_0_0|SrvcGrp|29745|2022|PDM|19581.00|99|0.00|DRG 002 ONLY CRANIOTOMY W/O CC|
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1687.00|99|0.00|ASPG V|
20|FH_F138424_83402_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F97603_77901_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F124452_31322_0|SrvcGrp|73700|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F136395_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F39912_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138478_0_0|SrvcGrp|76023|2022|PDM|23759.57|99|0.00|OP AICD 33249|
20|FH_F91772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98900_42001_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS|
20|FH_F50220_0_0|SrvcGrp|43785|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F124441_0_0|SrvcGrp|89842|2022|PDM|11400.00|99|0.00|LUMBAR|
20|FH_F133536_0_0|SrvcGrp|69981|2022|PDM|2802.00|99|0.00|CPT 24358|
20|FH_F141837_0_0|SrvcGrp|13262|2022|PDM|11.25|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F114853_0_0|SrvcGrp|78096|2022|PDM|2887.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F42244_0_0|SrvcGrp|88|2022|PCT|0.70|99|0.00|OP LITHOTRIPSY|
20|FH_F113585_20155_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F138681_39301_0|SrvcGrp|86723|2022|PDM|423.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F138707_44138_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138784_32216_0|SrvcGrp|73842|2022|PDM|253.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138685_18017_0|CSTM-ALL|CSTM-00|2020|PDM|547.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F86377_0_0|SrvcGrp|57968|2022|PDM|28.73|99|0.00|CONTINUOUS HOMECARE|
20|FH_F89580_0_0|SrvcGrp|16141|2022|PCT|0.46|99|0.00|PACEMAKER|
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|270.34|99|0.00|HAPA WPA-NWPA 2012-13 ASC 122 W/O REV|
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|351.21|99|0.00|AEG 1 (NO REV)|
20|FH_F122035_84020_0|SrvcGrp|89417|2022|PDM|478.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F135493_07514_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F135583_17331_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F91764_93710_0|SrvcGrp|111926|2022|PCT|2.19|99|0.00|COVID-19 LAB TESTING|
20|FH_F135799_99114_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135834_74434_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136192_33016_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F131407_07607_0|SrvcGrp|86837|2022|PDM|10.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F116501_17801_0|SrvcGrp|471|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F131361_18235_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127399_0_0|SrvcGrp|72120|2022|PDM|2913.00|99|0.00|TENOTOMY|
20|FH_F140629_0_0|SrvcGrp|113672|2022|PDM|2497.00|99|0.00|SPLENECTOMY LAPAROSCOPY|
20|FH_F121428_40202_0|SrvcGrp|88978|2022|PDM|1746.00|99|0.00|VAGINAL DELIVERY|
20|FH_F130817_18103_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132689_18436_0|SrvcGrp|73841|2022|PDM|479.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F101182_07863_0|SrvcGrp|96402|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA|
20|FH_F111363_33169_0|SrvcGrp|12290|2022|PDM|1020.00|99|0.00|DETOXIFICATION|
20|FH_F40174_0_0|SrvcGrp|28068|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.33|99|0.00|AEG 3 (NO REV)|
20|FH_F40423_0_0|SrvcGrp|32551|2022|PDM|5500.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F131000_0_0|SrvcGrp|59841|2022|PDM|2441.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F132328_0_0|SrvcGrp|92365|2022|PDM|11257.00|99|0.00|FUSION OF SACROILIAC JOINT|
20|FH_F72666_0_0|SrvcGrp|69685|2022|PCT|0.75|99|0.00|OP ANGIOPLASTY|
20|FH_F118651_0_0|SrvcGrp|83817|2022|PDM|2652.25|99|0.00|LAPAROSCOPY LYSIS ADHESIONS|
20|FH_F129240_10028_0|SrvcGrp|86852|2022|PDM|40.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F129240_10028_0|SrvcGrp|86828|2022|PDM|70.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F129220_18445_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F128381_61342_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102940_35034_0|SrvcGrp|27968|2022|PDM|37.50|99|0.00|SKILLED NURSING LPN|
20|FH_F143542_0_0|SrvcGrp|109760|2022|PDM|6885.00|99|0.00|TRANSLUM DIL EYE CANAL|
20|FH_F148061_11223_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F138651_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F46258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|ENTERAL AND PARENTERAL THERAPY|
20|FH_F82931_18847_0|SrvcGrp|103816|2022|PCT|1.00|99|0.00|AMBULANCE SERVICES OP DEFAULT|
20|FH_F131952_06002_0|SrvcGrp|75545|2022|PDM|391.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F131228_01826_0|SrvcGrp|73602|2022|PDM|935.43|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F125074_18104_0|SrvcGrp|46605|2022|PDM|113.40|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F100790_10512_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F138654_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150699_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122687_0_0|SrvcGrp|105632|2022|PDM|2185.00|99|0.00|AMPUTATION OF TOE|
20|FH_F116237_43235_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F94261_0_0|SrvcGrp|23683|2022|PDM|36.75|99|0.00|SKILLED NURSING RN|
20|FH_F145542_70503_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F122694_33334_0|SrvcGrp|105421|2022|PDM|243.00|99|0.00|AETNA TERANIAL MAGN STIM TX PLAN|
20|FH_F43197_0_0|SrvcGrp|11090|2022|PDM|80.00|99|0.00|NURSING CARE|
20|FH_F134191_75025_0|SrvcGrp|112529|2022|PDM|40.00|99|0.00|TELEHEALTH SERVICES|
20|FH_F136359_0_0|SrvcGrp|89989|2022|PDM|5500.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|323.98|99|0.00|HAPA WPA-NWPA 2012-13 ASC 125 W/O REV|
20|FH_F150239_75569_0|SrvcGrp|14945|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
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_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD AV"|
20|FH_F81861_0_0|SrvcGrp|32623|2022|PDM|3650.00|99|0.00|OP LITHOTRIPSY|
20|FH_F74583_0_0|SrvcGrp|46605|2022|PDM|14.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F87915_0_0|SrvcGrp|13632|2022|PDM|1187.00|99|0.00|CPT 99215|
20|FH_F58252_0_0|SrvcGrp|48396|2022|PDM|31.25|99|0.00|OT SERVICES|
20|FH_F69968_0_0|SrvcGrp|67259|2022|PDM|870.53|99|0.00|SKILLED NURSING|
20|FH_F138955_43420_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F53732_0_0|SrvcGrp|24745|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F140338_40475_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
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_F92506_07666_0|SrvcGrp|33789|2022|PDM|1155.00|99|0.00|MS DRG 880-887 ONLY|
20|FH_F67880_0_0|SrvcGrp|13292|2022|PCT|0.75|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F121329_33015_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F115884_0_0|SrvcGrp|63297|2022|PDM|111.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F135491_0_0|SrvcGrp|112757|2022|PCT|1.21|99|0.00|DEXAMETHASONE 9% INJECTION|
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148432_01585_0|SrvcGrp|104328|2022|PCT|0.85|99|0.00|PRESCRIPTION DRUG|
20|FH_F150001_33064_0|SrvcGrp|86835|2022|PDM|11.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F138611_0_0|SrvcGrp|27261|2022|PDM|14894.00|99|0.00|CPT 27446|
20|FH_F70343_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|1487.00|99|0.00|AEG 6 (NO REV)|
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.00|99|0.00|AEG 1 (NO REV)|
20|FH_F76662_0_0|SrvcGrp|59428|2022|PDM|85.00|99|0.00|ST|
20|FH_F71984_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.81|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|78988|2022|PDM|1218.73|99|0.00|MON VALLEY ASC 211|
20|FH_F141896_61462_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46196_0_0|SrvcGrp|31189|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF (DME)|
20|FH_F146135_87112_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F133018_84037_0|SrvcGrp|29076|2022|PDM|25.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F136382_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 10 (NO REV)|
20|FH_F150442_28451_0|SrvcGrp|11673|2022|PDM|4500.00|99|0.00|CPT 29888|
20|FH_F75793_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124975_63366_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|964.00|99|0.00|AEG 7 (NO REV)|
20|FH_F116346_0_0|SrvcGrp|103551|2022|PDM|186.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F117762_0_0|SrvcGrp|84939|2022|PDM|14560.00|99|0.00|SHOULDER JOINT|
20|FH_F142454_0_0|SrvcGrp|42551|2022|PDM|832.00|99|0.00|OP SURGERY|
20|FH_F130500_33317_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F110102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72890_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F92276_32308_0|SrvcGrp|113925|2022|PCT|0.00|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRMS|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PDM|4500.00|99|0.00|OP SVCS|
20|FH_F129653_0_0|SrvcGrp|90974|2022|PDM|2000.00|99|0.00|CERVICAL OR THORACIC INJECTION W/ IMAGING GUIDANCE|
20|FH_F123464_63841_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F62719_0_0|SrvcGrp|59289|2022|PDM|113.40|99|0.00|INITIAL SPECIALTY NURSING (MOD TG)|
20|FH_F124788_0_0|SrvcGrp|72992|2022|PDM|446.00|99|0.00|AEG 2|
20|FH_F130656_04401_0|SrvcGrp|73063|2022|PCT|0.89|99|0.00|OBSERVATION SERVICES|
20|FH_F77943_0_0|SrvcGrp|87308|2022|PDM|73781.47|99|0.00|MSDRG 271 ONLY|
20|FH_F124161_95932_0|SrvcGrp|72990|2022|PDM|1925.00|99|0.00|AEG 1|
20|FH_F51934_0_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F146016_34108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145562_70458_0|SrvcGrp|86831|2022|PDM|3.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F149048_77090_0|SrvcGrp|16069|2022|PDM|960.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F114415_16509_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146881_83661_0|SrvcGrp|104230|2022|PDM|140.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F137147_75006_0|SrvcGrp|23279|2022|PDM|525.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F142448_15701_0|SrvcGrp|80918|2022|PDM|445.85|99|0.00|RESPITE CARE|
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|2050.00|99|0.00|AEG 8 (NO REV)|
20|FH_F140343_89052_0|SrvcGrp|86851|2022|PDM|30.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F117182_68127_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F147340_0_0|SrvcGrp|106655|2022|PCT|0.50|99|0.00|PARSABIV|
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1145.83|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F113866_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103961_63017_0|SrvcGrp|100100|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT(HCFA)|
20|FH_F45312_0_0|SrvcGrp|15663|2022|PCT|0.88|99|0.00|TRAUMA CARE|
20|FH_F100703_0_0|SrvcGrp|16692|2022|PDM|3535.00|99|0.00|KNEE SCOPE|
20|FH_F112943_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 10 (NO REV)|
20|FH_F113143_0_0|SrvcGrp|72990|2022|PDM|350.00|99|0.00|AEG 1|
20|FH_F94786_07974_0|SrvcGrp|86831|2022|PDM|10.50|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F132988_0_0|SrvcGrp|112139|2022|PDM|11865.23|99|0.00|REPAIR OF TIBIA FRACTURE|
20|FH_F69104_0_0|SrvcGrp|58671|2022|PDM|1329.31|99|0.00|ASC CARVE OUT 64721|
20|FH_F127560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128127_57028_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F101853_77840_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135714_01922_0|SrvcGrp|95660|2022|PDM|650.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F148555_0_0|SrvcGrp|108183|2022|PDM|4635.00|99|0.00|REMOVE & REPLACEMENT PULSE|
20|FH_F46286_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67192_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F119007_0_0|SrvcGrp|96799|2022|PDM|393.00|99|0.00|DESTROY C/TH FACET JNT ADDL|
20|FH_F75202_0_0|SrvcGrp|9939|2022|PDM|1061.00|99|0.00|ACUTE MEDICAL SVCS|
20|FH_F101751_25302_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F110725_48047_0|SrvcGrp|88377|2022|PDM|770.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F97084_91911_0|SrvcGrp|73485|2022|PDM|7755.00|99|0.00|AETNA REHAB|
20|FH_F116753_0_0|SrvcGrp|73485|2022|PDM|1552.00|99|0.00|AETNA REHAB|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|MRI & CT DIAGNOSTICS MRI/MRA|
20|FH_F120057_0_0|SrvcGrp|72990|2022|PDM|400.00|99|0.00|AEG 1|
20|FH_F124487_89502_0|SrvcGrp|48385|2022|PDM|120.00|99|0.00|SPEECH THERAPY|
20|FH_F133677_15601_0|SrvcGrp|29347|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F119998_39823_0|SrvcGrp|73483|2022|PDM|825.00|99|0.00|AETNA SUBACUTE III|
20|FH_F150025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
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_F38151_0_0|SrvcGrp|701|2022|PDM|2113.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F120253_44646_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F93538_87124_0|SrvcGrp|86648|2022|PCT|1.15|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F67309_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36822_0_0|SrvcGrp|3271|2022|PDM|2106.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F142332_0_0|SrvcGrp|73524|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY|
20|FH_F112082_30720_0|SrvcGrp|26868|2022|PDM|74.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F139299_0_0|SrvcGrp|89417|2022|PDM|435.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F50952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|3850.00|99|0.00|AEG 7 (NO REV)|
20|FH_F92477_0_0|SrvcGrp|30089|2022|PDM|420.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F143628_32810_0|SrvcGrp|114114|2022|PDM|70.00|99|0.00|MISC SUPPLY ACCESSORY IMP VAD (MOD NU)(HCFA)|
20|FH_F138302_15701_0|SrvcGrp|23683|2022|PDM|30.00|99|0.00|SKILLED NURSING RN|
20|FH_F44299_0_0|SrvcGrp|10540|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F86658_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|693.00|99|0.00|AEG 2 (NO REV)|
20|FH_F68251_0_0|SrvcGrp|44131|2022|PDM|80.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F150536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120743_44116_0|SrvcGrp|107861|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F149027_60402_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136359_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F110420_60649_0|SrvcGrp|92825|2022|PDM|2800.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F134170_33410_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130017_02302_0|SrvcGrp|22781|2022|PDM|32904.95|99|0.00|MS DRG 244 ONLY|
20|FH_F138210_60540_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146471_63110_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F49914_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101100_50314_0|SrvcGrp|88157|2022|PDM|17561.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F80513_0_0|SrvcGrp|53149|2022|PDM|14427.00|99|0.00|MS DRG 064 ONLY|
20|FH_F137147_75006_0|SrvcGrp|26672|2022|PDM|30439.00|99|0.00|MS DRG 462 ONLY|
20|FH_F137905_91364_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F141036_02347_0|SrvcGrp|113577|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F137897_0_0|SrvcGrp|111643|2022|PDM|1625.00|99|0.00|HOME VENTILATOR (MOD RR)|
20|FH_F66711_0_0|SrvcGrp|62539|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F114389_50131_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F78167_0_0|SrvcGrp|30094|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY|
20|FH_F133006_48067_0|SrvcGrp|89149|2022|PDM|160.00|99|0.00|OP INTENSIVE|
20|FH_F141930_72032_0|CSTM-ALL|CSTM-00|2020|PDM|1654.00|99|0.00|AEG 9 (NO REV)|
20|FH_F97543_33542_0|SrvcGrp|73461|2022|PDM|6747.00|99|0.00|AETNA NICU IV|
20|FH_F40465_0_0|SrvcGrp|10043|2022|PDM|27000.00|99|0.00|DRG 107 ONLY CRNRY BYPASS (DRG 547-548)|
20|FH_F125296_18337_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124854_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146139_37604_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100880_67735_0|SrvcGrp|27938|2022|PDM|165.00|99|0.00|MAMMOGRAPHY|
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_F150662_20901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147333_18704_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F107980_08005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F98840_31021_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F124526_05301_0|SrvcGrp|17275|2022|PDM|619.00|99|0.00|CHEMICAL DEPENDENCY - YOUTH|
20|FH_F132149_60624_0|SrvcGrp|73841|2022|PDM|418.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F147330_34761_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146765_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F101709_0_0|SrvcGrp|72121|2022|PDM|3045.00|99|0.00|ARTHOSCOPY|
20|FH_F84411_32063_0|SrvcGrp|997|2022|PCT|0.69|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|1612.60|99|0.00|AEG 8 (NO REV)|
20|FH_F93948_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F61292_0_0|SrvcGrp|20075|2022|PDM|8746.00|99|0.00|MS DRG 286 ONLY|
20|FH_F93055_34601_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
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_F129968_98004_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F48215_0_0|SrvcGrp|9832|2022|PDM|84.50|99|0.00|ST SVCS|
20|FH_F35259_0_0|SrvcGrp|23703|2022|PCT|0.55|99|0.00|IP/OP TRAUMA|
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|4157.00|99|0.00|AEG 4 (NO REV)|
20|FH_F116024_13203_0|SrvcGrp|90040|2022|PDM|290.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F143388_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F100761_02539_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F138450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F83754_0_0|SrvcGrp|17378|2022|PCT|0.86|99|0.00|CAPD TRAINING|
20|FH_F72584_0_0|SrvcGrp|10410|2022|PDM|60.00|99|0.00|SKILLED NURSING CARE|
20|FH_F119509_0_0|SrvcGrp|81779|2022|PCT|1.25|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F139240_81055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|601.53|99|0.00|HAPA WPA-NWPA 2012-13 ASC 304 W/O REV|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC|
20|FH_F86452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1253.00|99|0.00|2007 MEDICARE ASPG V|
20|FH_F133133_32433_0|SrvcGrp|108484|2022|PDM|545.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F133219_89119_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F119795_0_0|SrvcGrp|92821|2022|PDM|7263.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR|
20|FH_F137147_75006_0|SrvcGrp|34606|2022|PDM|26762.00|99|0.00|CPT 29827|
20|FH_F142690_31774_0|SrvcGrp|24754|2022|PDM|40.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F109886_36303_0|SrvcGrp|86648|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F137891_23451_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F95880_02726_0|SrvcGrp|90486|2022|PDM|40.81|99|0.00|ORTHOTIC MANAGEMENT|
20|FH_F119437_0_0|SrvcGrp|89860|2022|PDM|4750.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F121338_37756_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F130066_84107_0|SrvcGrp|87571|2022|PDM|75.00|99|0.00|CPT 90834 W/REV 914|
20|FH_F139515_0_0|SrvcGrp|59705|2022|PDM|2060.00|99|0.00|SEPTOPLASTY|
20|FH_F130681_15701_0|SrvcGrp|111989|2022|PCT|1.45|99|0.00|TELEPHONE E&M SERVICES ESTABLISHED PATIENT|
20|FH_F123895_52722_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F129587_27360_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132559_0_0|SrvcGrp|65403|2022|PDM|1635.00|99|0.00|CPT 42830|
20|FH_F130747_0_0|SrvcGrp|70749|2022|PDM|5202.00|99|0.00|CPT 29823|
20|FH_F123945_19111_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
20|FH_F113041_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118088_71261_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F134618_14892_0|SrvcGrp|473|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F125133_20601_0|SrvcGrp|107859|2022|PCT|1.17|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F139299_0_0|SrvcGrp|86722|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F110425_01752_0|SrvcGrp|48396|2022|PDM|125.00|99|0.00|OT SERVICES|
20|FH_F133972_27103_0|SrvcGrp|86831|2022|PDM|4.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F79743_0_0|CSTM-ALL|CSTM-00|2020|PDM|2184.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F110509_71351_0|SrvcGrp|97968|2022|PDM|500.00|99|0.00|CT SCAN|
20|FH_F133478_40165_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F89372_0_0|SrvcGrp|9866|2022|PDM|5789.00|99|0.00|IP OBSERVATION SVCS|
20|FH_F97602_40121_0|SrvcGrp|88977|2022|PDM|4882.00|99|0.00|C-SECTION DELIVERY|
20|FH_F138967_67208_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140387_72202_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129483_77030_0|SrvcGrp|14944|2022|PDM|5.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F70005_0_0|SrvcGrp|17000|2022|PDM|1100.00|99|0.00|OUTPATIENT SURGERY|
20|FH_F114916_30309_0|SrvcGrp|104112|2022|PDM|3000.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F142318_21218_0|SrvcGrp|58509|2022|PDM|205.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F105440_46383_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F132988_0_0|SrvcGrp|90363|2022|PDM|6024.30|99|0.00|REVISE/IMPLANT FINGER JOINT|
20|FH_F39753_0_0|SrvcGrp|3273|2022|PCT|0.85|99|0.00|IMPLANTS|
20|FH_F148485_13021_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142047_21853_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|415.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F36118_0_0|SrvcGrp|3327|2022|PDM|90.00|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F44435_0_0|CSTM-ALL|CSTM-00|2020|PDM|2165.00|99|0.00|AEG 5  (NO REV)|
20|FH_F149940_02645_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|631.00|99|0.00|AEG 10 (NO REV)|
20|FH_F148556_13206_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F98623_97006_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 9 (NO REV)|
20|FH_F41457_0_0|SrvcGrp|13592|2022|PDM|2750.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F45226_0_0|SrvcGrp|15531|2022|PDM|80.00|99|0.00|NURSING - PICC INSERTION|
20|FH_F56813_0_0|SrvcGrp|18007|2022|PDM|171.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F149151_75248_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F105145_75075_0|SrvcGrp|64517|2022|PDM|13600.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F132810_0_0|SrvcGrp|14948|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|832.00|99|0.00|AEG 3 (NO REV)|
20|FH_F140730_84106_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119090_91502_0|SrvcGrp|73701|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F109982_33592_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F112817_37027_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F33982_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F77944_0_0|SrvcGrp|36802|2022|PDM|102366.00|99|0.00|MS DRG 215-238, 258-262  ONLY CV SURGERY|
20|FH_F150910_0_0|SrvcGrp|108093|2022|PDM|10950.00|99|0.00|REVISE HIP ARTHROPLASTY|
20|FH_F127995_84010_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133561_70364_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42355_0_0|SrvcGrp|109|2022|PDM|420.00|99|0.00|CD - DETOX|
20|FH_F92677_08003_0|SrvcGrp|92097|2022|PDM|612.15|99|0.00|AETNA HOME VENT NON-INVASIVE INTERFACE|
20|FH_F34653_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.20|99|0.00|OP SVCS|
20|FH_F145328_90301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133469_33404_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F68121_0_0|SrvcGrp|64321|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F123181_75057_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F139607_0_0|SrvcGrp|11663|2022|PCT|0.30|99|0.00|IMPLANTS|
20|FH_F133003_49012_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F146324_70810_0|SrvcGrp|96699|2022|PDM|155.60|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F115889_0_0|SrvcGrp|72998|2022|PDM|1148.00|99|0.00|AEG 5|
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F134869_08854_0|SrvcGrp|90632|2022|PDM|239.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PDM|3628.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|1890.00|99|0.00|AEG 7 (NO REV)|
20|FH_F147303_70508_0|SrvcGrp|48398|2022|PDM|89.00|99|0.00|PT SERVICES|
20|FH_F35410_0_0|SrvcGrp|10407|2022|PDM|43.00|99|0.00|HOME INFUSION|
20|FH_F120157_93103_0|SrvcGrp|79280|2022|PDM|550.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F129297_97828_0|SrvcGrp|10393|2022|PDM|3350.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F150920_19490_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41363_0_0|CSTM-ALL|CSTM-00|2020|PDM|1102.00|99|0.00|ASPG VI|
20|FH_F112755_43215_0|SrvcGrp|92760|2022|PCT|1.15|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128197_84123_0|SrvcGrp|110993|2022|PDM|632.50|99|0.00|HOSPICE (HCFA)|
20|FH_F122390_29550_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143210_72211_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131107_43140_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F113595_29527_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F59992_0_0|SrvcGrp|54670|2022|PDM|4200.00|99|0.00|NORMAL DELIVERY|
20|FH_F72764_0_0|SrvcGrp|12118|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F100660_56303_0|SrvcGrp|90854|2022|PDM|2447.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F145758_20745_0|SrvcGrp|93807|2022|PDM|2550.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F93881_15009_0|SrvcGrp|93729|2022|PDM|126.00|99|0.00|X-RAY EXAM OF HIP|
20|FH_F139551_0_0|SrvcGrp|35668|2022|PDM|2537.00|99|0.00|CPT 29824|
20|FH_F115990_0_0|SrvcGrp|72992|2022|PDM|750.00|99|0.00|AEG 2|
20|FH_F87117_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F118661_0_0|SrvcGrp|107852|2022|PDM|1090.00|99|0.00|AETNA AMBULATORY SURGERY W/O AEG 1 & 2 AND DIGESTIVE/PROF SV|
20|FH_F110000_0_0|SrvcGrp|30502|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F74562_0_0|SrvcGrp|29900|2022|PCT|0.80|99|0.00|TRANSPLANT SVCS|
20|FH_F88933_0_0|SrvcGrp|87520|2022|PDM|2814.00|99|0.00|AETNA ARTHROSCOPY PROCEDURES|
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ASPG I|
20|FH_F148644_06890_0|SrvcGrp|28547|2022|PDM|5572.00|99|0.00|VITRECTOMY|
20|FH_F61494_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F135708_61401_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|300.00|99|0.00|ALBERMARLE GASTRO ENDO MOD SU|
20|FH_F38845_0_0|SrvcGrp|10639|2022|PDM|500.00|99|0.00|CT SCAN|
20|FH_F136728_0_0|SrvcGrp|87077|2022|PDM|195.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F146211_68144_0|SrvcGrp|100040|2022|PDM|5230.00|99|0.00|REPAIR HUMERUS FRACTURE|
20|FH_F117725_38036_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F89932_10940_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F35454_0_0|SrvcGrp|67039|2022|PDM|65.00|99|0.00|EVAL & MANAGEMENT SVCS|
20|FH_F115312_78550_0|SrvcGrp|16069|2022|PDM|845.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F114308_70601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F72883_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98623_97006_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F90196_10467_0|SrvcGrp|86748|2022|PCT|1.05|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|1499.00|99|0.00|AEG 5  (NO REV)|
20|FH_F120100_98390_0|SrvcGrp|87131|2022|PDM|834.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F42655_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127189_49503_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F108680_0_0|SrvcGrp|102722|2022|PDM|5720.00|99|0.00|LAMINECTOMY W/ FACETECTOMY|
20|FH_F122416_72364_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.00|99|0.00|AEG 1 (NO REV)|
20|FH_F47812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38090_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F63458_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F123922_84102_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146569_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F123280_67002_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125028_19061_0|SrvcGrp|86854|2022|PDM|105.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F130920_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F100320_0_0|SrvcGrp|75481|2022|PDM|477.00|99|0.00|AEG 2|
20|FH_F135232_34471_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC INVOICE|
20|FH_F93920_0_0|SrvcGrp|72994|2022|PDM|2500.00|99|0.00|AEG 3|
20|FH_F141802_17042_0|SrvcGrp|80259|2022|PDM|2870.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F49552_0_0|SrvcGrp|17073|2022|PDM|852.45|99|0.00|ASPG V|
20|FH_F31369_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F77082_0_0|SrvcGrp|3029|2022|PDM|1242.00|99|0.00|NEWBORN NURSERY|
20|FH_F124369_0_0|SrvcGrp|109790|2022|PDM|11220.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F134191_75025_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F134223_83617_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F127918_45640_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F83995_16748_0|SrvcGrp|82623|2022|PDM|318.00|99|0.00|ER SETTING W/ OP SURGERY LEVEL II|
20|FH_F145781_0_0|SrvcGrp|114305|2022|PDM|2000.00|99|0.00|OSTEOCHONDRAL ALLOGRAFT KNEE|
20|FH_F47834_0_0|CSTM-ALL|CSTM-00|2020|PDM|2289.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY|
20|FH_F145907_03867_0|SrvcGrp|473|2022|PDM|391.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F78205_0_0|CSTM-ALL|CSTM-00|2020|PDM|19297.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F146211_68144_0|SrvcGrp|41334|2022|PDM|14687.00|99|0.00|TOTAL KNEE|
20|FH_F147995_67037_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F87155_04105_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ENTERAL SUPPLIES|
20|FH_F117335_0_0|SrvcGrp|72994|2022|PDM|668.00|99|0.00|AEG 3|
20|FH_F64940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|99174|2022|PDM|1927.00|99|0.00|CPT 30140|
20|FH_F37341_0_0|CSTM-ALL|CSTM-00|2020|PDM|1220.00|99|0.00|ASPG VII|
20|FH_F149582_01534_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|COVID-19 INFUSION ADMIN - ELI LILLY|
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|AEG 1 (NO REV)|
20|FH_F86714_0_0|SrvcGrp|24028|2022|PDM|150.70|99|0.00|LICENSED PRACTICAL NURSE|
20|FH_F98020_50138_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F44132_0_0|SrvcGrp|33164|2022|PDM|325.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F124435_03882_0|SrvcGrp|86722|2022|PDM|182.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F132008_85226_0|SrvcGrp|111913|2022|PCT|0.80|99|0.00|WHEELCHAIR ACCESSORY POWER LEG ELEVATION|
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F131415_73071_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136299_75218_0|CSTM-ALL|CSTM-00|2020|PDM|4017.00|99|0.00|AEG 10 (NO REV)|
20|FH_F76402_0_0|CSTM-ALL|CSTM-00|2020|PCT|24411.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F149140_07522_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F110925_01104_0|SrvcGrp|86125|2022|PDM|41.00|99|0.00|AETNA FLEBOGAMMA INJ|
20|FH_F85291_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|1535.00|99|0.00|AEG 8 (NO REV)|
20|FH_F118194_50841_0|SrvcGrp|22389|2022|PDM|33.51|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F94662_0_0|SrvcGrp|24739|2022|PDM|199.00|99|0.00|RESPITE CARE|
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|1257.00|99|0.00|AEG 8 (NO REV)|
20|FH_F130154_33607_0|CSTM-ALL|CSTM-00|2020|PCT|1.70|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F118057_47906_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F125328_0_0|SrvcGrp|79593|2022|PDM|1962.00|99|0.00|CPT 45378|
20|FH_F42366_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100782_0_0|SrvcGrp|105161|2022|PDM|857.48|99|0.00|WINDBER MEDICAL CNTR ASC 406|
20|FH_F150165_06032_0|SrvcGrp|78093|2022|PDM|4300.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|1961.00|99|0.00|AEG 9 (NO REV)|
20|FH_F38790_0_0|SrvcGrp|65|2022|PDM|750.00|99|0.00|OBSTETRICAL CARE|
20|FH_F112065_20852_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120417_63124_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149319_07670_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122520_46383_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F98780_35022_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F89778_0_0|SrvcGrp|33987|2022|PDM|1043.18|99|0.00|CPT 57522|
20|FH_F78403_15552_0|SrvcGrp|34034|2022|PCT|0.00|99|0.00|BLOOD PRODUCTS|
20|FH_F120152_0_0|SrvcGrp|82109|2022|PDM|4400.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F38000_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85713_0_0|SrvcGrp|25688|2022|PDM|421.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F147930_21244_0|SrvcGrp|75419|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F117211_15143_0|SrvcGrp|29347|2022|PDM|33.00|99|0.00|HOME HEALTH AIDE|
20|FH_F110720_0_0|SrvcGrp|96939|2022|PDM|4882.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F124893_40311_0|SrvcGrp|88621|2022|PDM|88.00|99|0.00|SKILLED NURSING LPN|
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|687.00|99|0.00|AEG 3 (NO REV)|
20|FH_F121887_53144_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F132988_0_0|SrvcGrp|100059|2022|PDM|5817.50|99|0.00|REPAIR ULNA FRACTURE|
20|FH_F32198_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90811_0_0|SrvcGrp|90433|2022|PDM|1500.00|99|0.00|HAND PROCEDURES|
20|FH_F136507_0_0|SrvcGrp|97507|2022|PDM|120.00|99|0.00|AETNA HOSPICE|
20|FH_F111791_33308_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43210_0_0|CSTM-ALL|CSTM-00|2020|PDM|847.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89112_16509_0|SrvcGrp|99619|2022|PDM|39.00|99|0.00|PHYSICAL THERAPY SVCS INITIAL EVAL|
20|FH_F140175_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100784_59923_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|306.12|99|0.00|HAPA WPA-NWPA 2012-13 ASC 116 W/O REV|
20|FH_F98620_43920_0|SrvcGrp|73605|2022|PDM|2351.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F120437_85202_0|SrvcGrp|86852|2022|PDM|78.78|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F89112_16509_0|SrvcGrp|10363|2022|PDM|439.00|99|0.00|CPT CODE 99283|
20|FH_F39266_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F39272_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F142087_0_0|SrvcGrp|67068|2022|PDM|15000.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F134192_0_0|SrvcGrp|104098|2022|PDM|4100.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 10 (NO REV)|
20|FH_F123083_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 8 (NO REV)|
20|FH_F98042_10468_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F136570_32084_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F136624_15025_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114666_30342_0|SrvcGrp|89988|2022|PDM|1000.00|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F114678_78745_0|SrvcGrp|3178|2022|PDM|932.00|99|0.00|ACUTE PSYCH|
20|FH_F138630_72616_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F43135_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|HEAD INJURY REHABILITATION|
20|FH_F43444_0_0|CSTM-ALL|CSTM-00|2020|PDM|940.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134674_06473_0|SrvcGrp|58509|2022|PDM|210.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F134687_14226_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136799_75061_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112371_19047_0|CSTM-ALL|CSTM-00|2020|PDM|1152.00|99|0.00|AEG 2 (NO REV)|
20|FH_F131529_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F115631_65201_0|SrvcGrp|26274|2022|PDM|3177.00|99|0.00|CPT 29877|
20|FH_F147519_52627_0|SrvcGrp|104363|2022|PCT|0.89|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F147586_44124_0|SrvcGrp|115113|2022|PDM|1634.00|99|0.00|FOOT TENDON SHEATH EXCISE|
20|FH_F147621_74338_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F42399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD UE KE RATE|
20|FH_F42748_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136751_0_0|SrvcGrp|34606|2022|PDM|7500.00|99|0.00|CPT 29827|
20|FH_F120844_66061_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F71644_0_0|SrvcGrp|20154|2022|PDM|210283.00|99|0.00|DOUBLE LUNG TRANSPLANT INCLUDING PHYSICIAN FEES|
20|FH_F40388_0_0|SrvcGrp|109|2022|PDM|550.00|99|0.00|CD - DETOX|
20|FH_F119220_75068_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F139707_84010_0|SrvcGrp|116281|2022|PDM|12507.00|99|0.00|VASCULAR PROCEDURES|
20|FH_F149030_37919_0|SrvcGrp|86460|2022|PDM|5304.50|99|0.00|REVISE BREAST RECONSTRUCTION|
20|FH_F36225_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33566_0_0|SrvcGrp|39522|2022|PDM|63672.00|99|0.00|MS DRG 216-218 ONLY|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1575124_HCPCS_  MOD AV|
20|FH_F122394_75979_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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 CMS 1500 (HCFA)|
20|FH_F98940_70506_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F84413_0_0|SrvcGrp|28787|2022|PDM|25.00|99|0.00|CPT CODE 90993|
20|FH_F120057_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F35452_0_0|CSTM-ALL|CSTM-00|2020|PDM|854.00|99|0.00|ASPG II|
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|3245.00|99|0.00|MS DRG 774-775 NORMAL DELIVERY|
20|FH_F35404_0_0|SrvcGrp|9936|2022|PDM|120.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 3 (NO REV)|
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F117820_0_0|SrvcGrp|93098|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F36854_0_0|CSTM-ALL|CSTM-00|2020|PDM|4050.00|99|0.00|CV SURGERY (MS DRG)|
20|FH_F37850_0_0|SrvcGrp|22661|2022|PCT|0.68|99|0.00|ANGIOPLASTY|
20|FH_F66569_0_0|SrvcGrp|62261|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F114853_0_0|SrvcGrp|88164|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F118173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54552_0_0|SrvcGrp|17008|2022|PDM|88.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS|
20|FH_F138936_01040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F91641_0_0|SrvcGrp|65623|2022|PDM|4785.84|99|0.00|HYSTEROSCOPY|
20|FH_F118986_0_0|SrvcGrp|75485|2022|PDM|903.37|99|0.00|AEG 4|
20|FH_F75185_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|664.45|99|0.00|AEG 4 (NO REV)|
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|2578.00|99|0.00|AEG 6 (NO REV)|
20|FH_F151420_60654_0|SrvcGrp|112584|2022|PDM|1827.00|99|0.00|PARTIAL TOE REMOVAL|
20|FH_F151501_30265_0|SrvcGrp|96543|2022|PDM|2090.00|99|0.00|REVISION OF CALF TENDON|
20|FH_F151510_15928_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132262_60062_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F145208_63640_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145531_61614_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F97501_31501_0|SrvcGrp|73485|2022|PDM|3158.00|99|0.00|AETNA REHAB|
20|FH_F43239_0_0|SrvcGrp|109124|2022|PDM|250.00|99|0.00|SKILLED NURSING CARE|
20|FH_F135372_73089_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135410_30013_0|SrvcGrp|107861|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F135493_07514_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136107_63801_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136174_89146_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F100765_73735_0|SrvcGrp|73485|2022|PDM|3006.00|99|0.00|AETNA REHAB|
20|FH_F130620_18940_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F116527_70443_0|SrvcGrp|106811|2022|PCT|0.00|99|0.00|IP DETOXIFICATION|
20|FH_F130766_04967_0|SrvcGrp|73806|2022|PCT|0.88|99|0.00|AETNA ER|
20|FH_F32938_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ACUTE PSYCH|
20|FH_F121763_07202_0|SrvcGrp|72992|2022|PDM|1800.00|99|0.00|AEG 2|
20|FH_F121813_75701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146125_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|588.00|99|0.00|CHEMICAL DEPENDENCY|
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_F69205_0_0|SrvcGrp|10518|2022|PDM|180.51|99|0.00|ENTEROSTOMAL VISIT F/U VISIT|
20|FH_F111292_33136_0|SrvcGrp|73601|2022|PDM|6098.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F111301_33122_0|SrvcGrp|73601|2022|PDM|2965.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F111301_33122_0|SrvcGrp|111183|2022|PDM|12178.00|99|0.00|GASTRIC SLEEVE|
20|FH_F111394_46012_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|1413.45|99|0.00|AEG 7 (NO REV)|
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|491.00|99|0.00|ASPG II|
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.22|99|0.00|AEG 5  (NO REV)|
20|FH_F112086_33713_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F123036_0_0|SrvcGrp|101279|2022|PDM|17500.00|99|0.00|ADDL NECK SPINE FUSION|
20|FH_F128185_0_0|CSTM-ALL|CSTM-00|2020|PDM|1062.00|99|0.00|AEG 6 (NO REV)|
20|FH_F143536_47546_0|SrvcGrp|100269|2022|PCT|1.00|99|0.00|HEPA VACCINE ADULT IM|
20|FH_F36274_0_0|SrvcGrp|12264|2022|PDM|70.00|99|0.00|DIETICIAN OR LPN SERVICES|
20|FH_F50535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49895_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F141802_17042_0|SrvcGrp|115655|2022|PCT|0.68|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F63141_0_0|SrvcGrp|1306|2022|PDM|725.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F141591_92630_0|SrvcGrp|73841|2022|PDM|489.25|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F105221_01757_0|SrvcGrp|48385|2022|PDM|84.00|99|0.00|SPEECH THERAPY|
20|FH_F151225_0_0|SrvcGrp|10527|2022|PDM|208.00|99|0.00|HOSPICE SVCS|
20|FH_F92659_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|PDM|494.00|99|0.00|AEG 3 (NO REV)|
20|FH_F135005_06460_0|SrvcGrp|46605|2022|PDM|89.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F141387_63108_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148265_06067_0|SrvcGrp|33984|2022|PDM|2700.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F72766_0_0|SrvcGrp|8950|2022|PDM|1730.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F141801_80534_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F126439_92627_0|SrvcGrp|87131|2022|PDM|440.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F120906_65542_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F89475_71202_0|SrvcGrp|114925|2022|PDM|5239.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F130707_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|1990.00|99|0.00|ASPG VII|
20|FH_F128795_57469_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150165_06032_0|SrvcGrp|100044|2022|PDM|3700.00|99|0.00|INCISION OF HEEL BONE|
20|FH_F116806_0_0|SrvcGrp|90796|2022|PDM|1923.16|99|0.00|RHINOPLASTY SECONDARY - MINOR|
20|FH_F122243_30655_0|SrvcGrp|74668|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F127486_06776_0|SrvcGrp|80920|2022|PDM|706.65|99|0.00|HOSPICE SERVICES|
20|FH_F145642_15108_0|SrvcGrp|86833|2022|PDM|10.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F147980_0_0|SrvcGrp|82223|2022|PDM|95.00|99|0.00|HOSPICE CARE|
20|FH_F143581_02130_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F54592_0_0|SrvcGrp|8961|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F134152_70563_0|SrvcGrp|82981|2022|PDM|115.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F114092_83350_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F77782_66061_0|SrvcGrp|21357|2022|PCT|0.80|99|0.00|MS DRG 260-262 ONLY|
20|FH_F140496_38627_0|SrvcGrp|87317|2022|PDM|970.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F109953_75234_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F90876_18447_0|SrvcGrp|87798|2022|PDM|110.25|99|0.00|HOSPICE CARE (ALL OTHER)(HCFA)|
20|FH_F109513_0_0|SrvcGrp|84181|2022|PDM|2700.00|99|0.00|AETNA IMMEDIATE BREAST PROSTHESIS|
20|FH_F121970_92653_0|SrvcGrp|86648|2022|PCT|1.15|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F97780_43614_0|SrvcGrp|88978|2022|PDM|7277.00|99|0.00|VAGINAL DELIVERY|
20|FH_F86911_0_0|SrvcGrp|85657|2022|PDM|8.00|99|0.00|VIA BOLUS|
20|FH_F72204_0_0|SrvcGrp|42971|2022|PDM|85.00|99|0.00|SKN RN|
20|FH_F124222_92625_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F73705_0_0|SrvcGrp|10393|2022|PDM|1825.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F133477_90247_0|SrvcGrp|103913|2022|PCT|0.00|99|0.00|OP DIALYSIS|
20|FH_F38630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|100% 2007 MEDICARE DME  TN MOD KN|
20|FH_F87592_85614_0|SrvcGrp|75506|2022|PCT|1.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F44855_0_0|SrvcGrp|27579|2022|PDM|60.00|99|0.00|RESPIRATORY THERAPY INITIAL VISIT|
20|FH_F148639_0_0|SrvcGrp|11673|2022|PDM|3084.00|99|0.00|CPT 29888|
20|FH_F139347_06471_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F90817_0_0|SrvcGrp|90378|2022|PDM|2280.00|99|0.00|JAW ARTHROSCOPY/TMJ SURG|
20|FH_F137748_95231_0|SrvcGrp|31074|2022|PDM|780.00|99|0.00|MS DRG 795 ONLY|
20|FH_F40521_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F138662_78624_0|SrvcGrp|86722|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F136493_0_0|SrvcGrp|83522|2022|PDM|166.00|99|0.00|RESPITE CARE|
20|FH_F47600_0_0|SrvcGrp|36808|2022|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53  (DME)|
20|FH_F112712_63005_0|SrvcGrp|14949|2022|PCT|1.00|99|0.00|HOME INFUSION|
20|FH_F149523_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F90654_0_0|SrvcGrp|58764|2022|PCT|0.70|99|0.00|PHYSICIANS FEES|
20|FH_F120945_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|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_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|4110.00|99|0.00|AEG 5  (NO REV)|
20|FH_F40438_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F99100_0_0|SrvcGrp|37984|2022|PDM|566.50|99|0.00|LUMBAR INJECTIONS PROCEDURE|
20|FH_F76303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92276_32308_0|SrvcGrp|73606|2022|PDM|1259.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F149263_0_0|SrvcGrp|115608|2022|PDM|5100.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F131630_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F39378_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F145601_32159_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100782_0_0|SrvcGrp|97514|2022|PDM|2232.52|99|0.00|WINDBER MEDICAL CNTR ASC 7|
20|FH_F146124_06112_0|CSTM-ALL|CSTM-00|2020|PDM|7274.00|99|0.00|AEG 9 (NO REV)|
20|FH_F111986_0_0|SrvcGrp|73002|2022|PDM|1725.00|99|0.00|AEG 7|
20|FH_F133922_70563_0|SrvcGrp|29080|2022|PDM|380.19|99|0.00|SLEEP STUDIES|
20|FH_F132609_0_0|SrvcGrp|705|2022|PCT|0.67|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F34182_0_0|SrvcGrp|13397|2022|PCT|0.78|99|0.00|IMPLANTS|
20|FH_F72086_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120417_63124_0|CSTM-ALL|CSTM-00|2020|PDM|846.00|99|0.00|AEG 5  (NO REV)|
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|959.00|99|0.00|ASPG IV|
20|FH_F131959_31709_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F89372_0_0|SrvcGrp|113447|2022|PDM|10547.00|99|0.00|CARDIAC SURGERY|
20|FH_F140868_63103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151601_89118_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F117107_33704_0|SrvcGrp|104468|2022|PDM|750.00|99|0.00|ANTEPARTUM CARE ONLY (4-6 VISITS)|
20|FH_F121404_32216_0|SrvcGrp|92760|2022|PCT|1.05|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F51814_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|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_F114866_77706_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F141336_16947_0|SrvcGrp|113739|2022|PCT|1.65|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F132348_16214_0|SrvcGrp|100982|2022|PCT|1.05|99|0.00|AETNA OP SVCS HH AMFS DEFAULT|
20|FH_F38688_0_0|SrvcGrp|21342|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F42466_0_0|CSTM-ALL|CSTM-00|2020|PDM|902.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|3600.00|99|0.00|AEG 4 (NO REV)|
20|FH_F35216_0_0|SrvcGrp|18273|2022|PDM|13645.00|99|0.00|MS DRG 459|
20|FH_F87474_0_0|SrvcGrp|17140|2022|PDM|138.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F123741_20850_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120489_63552_0|SrvcGrp|79786|2022|PCT|0.75|99|0.00|SLEEP STUDIES|
20|FH_F134156_32174_0|SrvcGrp|108484|2022|PDM|739.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F124754_84403_0|SrvcGrp|75419|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|4854.00|99|0.00|AEG 9 (NO REV)|
20|FH_F143772_75225_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F151526_28208_0|SrvcGrp|111139|2022|PDM|4143.00|99|0.00|ARTERY-VEIN GRAFT|
20|FH_F97500_32025_0|SrvcGrp|73603|2022|PDM|9587.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F150982_0_0|SrvcGrp|54943|2022|PDM|3303.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHYSICIAN CLINIC VISIT NATL F/S (MOD 26)|
20|FH_F115737_78660_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39493_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F112631_0_0|SrvcGrp|72992|2022|PDM|637.00|99|0.00|AEG 2|
20|FH_F148661_45429_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F100782_0_0|SrvcGrp|105171|2022|PDM|2377.36|99|0.00|WINDBER MEDICAL CNTR ASC 911|
20|FH_F131630_0_0|SrvcGrp|34342|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F118803_0_0|SrvcGrp|103640|2022|PDM|5555.43|99|0.00|AETNA OPEN/PERQ PLACE STENT SAME|
20|FH_F110604_0_0|SrvcGrp|82110|2022|PDM|1485.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC|
20|FH_F119227_01752_0|SrvcGrp|22589|2022|PDM|60.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F120608_19901_0|SrvcGrp|93734|2022|PCT|1.05|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F128828_44122_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F119864_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111986_0_0|SrvcGrp|39906|2022|PDM|2163.00|99|0.00|MASTECTOMY, SIMPLE, COMPLETE|
20|FH_F132922_91302_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F84712_0_0|SrvcGrp|81341|2022|PCT|0.63|99|0.00|AETNA CHEMOTHERAPY DRUGS|
20|FH_F105145_75075_0|SrvcGrp|79593|2022|PDM|4000.00|99|0.00|CPT 45378|
20|FH_F115870_98225_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F111584_07002_0|SrvcGrp|104442|2022|PDM|116.00|99|0.00|AETNA OFFICE/OP VISIT EST (HCFA)|
20|FH_F111662_80601_0|SrvcGrp|104336|2022|PCT|1.00|99|0.00|DENOSUMAB INJECTION|
20|FH_F87092_60101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89778_0_0|SrvcGrp|88824|2022|PDM|2107.64|99|0.00|CPT 69631|
20|FH_F114092_83350_0|SrvcGrp|79099|2022|PDM|7700.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F149530_80014_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F114968_0_0|SrvcGrp|471|2022|PDM|856.98|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132988_0_0|SrvcGrp|112144|2022|PDM|4493.01|99|0.00|FUSION OF KNUCKLE WITH GRAFT|
20|FH_F133002_0_0|SrvcGrp|28547|2022|PDM|1716.00|99|0.00|VITRECTOMY|
20|FH_F37546_0_0|SrvcGrp|10431|2022|PDM|91.00|99|0.00|SPEECH THERAPY|
20|FH_F92599_0_0|SrvcGrp|75497|2022|PDM|733.00|99|0.00|AEG 10|
20|FH_F148419_01453_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F142749_15212_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50974_0_0|SrvcGrp|42975|2022|PDM|70.00|99|0.00|PHYSICAL THERAPIST|
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_F117954_17961_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F74305_0_0|SrvcGrp|15472|2022|PDM|366.00|99|0.00|CPT CODE 62284|
20|FH_F43333_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F97622_75051_0|SrvcGrp|88978|2022|PDM|6816.00|99|0.00|VAGINAL DELIVERY|
20|FH_F117555_72802_0|SrvcGrp|46903|2022|PDM|520.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F43164_0_0|SrvcGrp|37007|2022|PDM|876.00|99|0.00|VENTILATOR DEPENDENT CARE|
20|FH_F88818_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F118540_32064_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F35368_0_0|SrvcGrp|97|2022|PDM|2750.00|99|0.00|C-SECTION|
20|FH_F141927_71901_0|CSTM-ALL|CSTM-00|2020|PDM|633.00|99|0.00|AEG 2 (NO REV)|
20|FH_F144748_19707_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40542_0_0|SrvcGrp|32646|2022|PCT|1.50|99|0.00|RADIOLOGY - CPT/MOD TC|
20|FH_F33634_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133493_90255_0|SrvcGrp|75506|2022|PCT|0.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F97480_08204_0|SrvcGrp|73485|2022|PDM|2497.00|99|0.00|AETNA REHAB|
20|FH_F146266_0_0|SrvcGrp|98003|2022|PDM|2365.00|99|0.00|BIMALLEOLAR ANKLE FRACTURE|
20|FH_F50100_0_0|SrvcGrp|46109|2022|PDM|110.64|99|0.00|HI-TECH NURSING (1 HOUR)|
20|FH_F124492_30040_0|SrvcGrp|82981|2022|PDM|152.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F35410_0_0|SrvcGrp|20292|2022|PCT|0.65|99|0.00|UNLISTED J-CODES|
20|FH_F110728_13069_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F124719_64093_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122425_75082_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F151009_07649_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F128543_44413_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|1060.00|99|0.00|ASPG IV|
20|FH_F42138_0_0|SrvcGrp|9263|2022|PDM|125.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F134494_33612_0|SrvcGrp|86723|2022|PDM|508.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F66782_0_0|SrvcGrp|29744|2022|PDM|40.00|99|0.00|SKILLED NURSING CARE - MOD TD|
20|FH_F89372_0_0|SrvcGrp|20752|2022|PDM|31090.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F132810_0_0|SrvcGrp|86851|2022|PDM|40.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F136475_89119_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F142267_78240_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149377_22102_0|SrvcGrp|114008|2022|PDM|510.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F118926_30135_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129504_02871_0|SrvcGrp|89781|2022|PDM|163.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F91472_96001_0|SrvcGrp|111617|2022|PCT|0.40|99|0.00|CARDIAC STENT IMPLANT NON-DRUG ELUTING|
20|FH_F124923_23518_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|5136.00|99|0.00|AEG 9 (NO REV)|
20|FH_F100401_15317_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F85154_0_0|SrvcGrp|471|2022|PDM|562.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130036_43232_0|SrvcGrp|74668|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F109812_37043_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F117733_91362_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F67302_0_0|SrvcGrp|9518|2022|PCT|0.75|99|0.00|EMERGENCY ROOM|
20|FH_F83113_0_0|SrvcGrp|26001|2022|PDM|138.00|99|0.00|HOSPICE RESPITE SVCS|
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_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F51658_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F63137_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|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_F88956_0_0|SrvcGrp|20293|2022|PDM|40692.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY|
20|FH_F139447_40336_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F99380_90503_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F150323_68847_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139877_32615_0|SrvcGrp|113229|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 4 TRGT (HCFA)|
20|FH_F125214_12428_0|SrvcGrp|42784|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|434.24|99|0.00|SALLY BALIN,999182,ASC 303|
20|FH_F36403_0_0|SrvcGrp|3259|2022|PDM|300.00|99|0.00|ACUTE REHABILITATION|
20|FH_F93254_0_0|SrvcGrp|57968|2022|PDM|29.52|99|0.00|CONTINUOUS HOMECARE|
20|FH_F134900_72450_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PDM|2111.00|99|0.00|AEG 8 (NO REV)|
20|FH_F147181_27514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124526_05301_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F143249_89801_0|SrvcGrp|29023|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F59732_0_0|SrvcGrp|15402|2022|PDM|75.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F123915_0_0|SrvcGrp|94781|2022|PDM|194.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F123885_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F137067_0_0|SrvcGrp|109966|2022|PDM|5250.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON|
20|FH_F88220_63664_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F33233_0_0|SrvcGrp|14955|2022|PDM|132.30|99|0.00|PT/OT/ST|
20|FH_F39540_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F98040_89406_0|SrvcGrp|73559|2022|PDM|11497.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F100703_0_0|SrvcGrp|97119|2022|PDM|8034.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F127995_84010_0|SrvcGrp|24744|2022|PDM|50.00|99|0.00|PICC LINE INSERTION|
20|FH_F38407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F33800_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F35454_0_0|SrvcGrp|16851|2022|PDM|24.00|99|0.00|FINGER SPLINT|
20|FH_F146324_70810_0|SrvcGrp|92502|2022|PDM|683.95|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F146380_85203_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|298.42|99|0.00|ASPG 110|
20|FH_F150760_44833_0|SrvcGrp|48394|2022|PCT|1.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F119203_0_0|SrvcGrp|108020|2022|PDM|186.00|99|0.00|PERITONEAL DIALYSIS - CCPD/CAPD|
20|FH_F149522_83221_0|SrvcGrp|66265|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F128490_88240_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110121_0_0|SrvcGrp|73002|2022|PDM|3885.00|99|0.00|AEG 7|
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 1 (NO REV)|
20|FH_F131331_0_0|SrvcGrp|104229|2022|PDM|165.42|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110785_10040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F38246_66606_0|SrvcGrp|67921|2022|PDM|459.00|99|0.00|DIALYSIS|
20|FH_F93237_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136382_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F140087_62864_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151755_03303_0|SrvcGrp|472|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F40589_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123407_04605_0|SrvcGrp|105656|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F43663_0_0|CSTM-ALL|CSTM-00|2020|PDM|729.00|99|0.00|ACUTE PSYCH|
20|FH_F73985_0_0|SrvcGrp|17079|2022|PDM|3484.00|99|0.00|ASPG VIII|
20|FH_F114963_62062_0|SrvcGrp|27969|2022|PDM|31.52|99|0.00|HOME HEALTH AIDE|
20|FH_F37679_0_0|SrvcGrp|27058|2022|PDM|18.75|99|0.00|HYDRATION THERAPY - 3 LITERS (MOD SH)|
20|FH_F100662_27534_0|SrvcGrp|73643|2022|PDM|3006.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PDM|6740.00|99|0.00|2007 MEDICARE ASPG III|
20|FH_F70883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F85133_85251_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142894_0_0|SrvcGrp|33722|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F143674_34208_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F134619_14304_0|SrvcGrp|76501|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F97840_54729_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F120583_43219_0|SrvcGrp|74802|2022|PCT|1.00|99|0.00|AETNA CPT 36415|
20|FH_F126244_43567_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123616_30117_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111813_08080_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F141612_19605_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F34057_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F133021_00910_0|SrvcGrp|112315|2022|PDM|650.00|99|0.00|BIOPSY|
20|FH_F49354_0_0|SrvcGrp|43320|2022|PDM|350.00|99|0.00|CT SCANS|
20|FH_F148493_38008_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F102561_75146_0|SrvcGrp|73496|2022|PDM|2750.00|99|0.00|AETNA ER LEVEL V|
20|FH_F40599_0_0|SrvcGrp|10927|2022|PDM|360.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F137896_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|OCN F/S PRICING: ALL|
20|FH_F150760_44833_0|SrvcGrp|88621|2022|PDM|150.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150322_68301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101441_0_0|SrvcGrp|97159|2022|PDM|8105.00|99|0.00|TRANSPEDICULAR, 1 SEG, LUMBAR|
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_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|139.00|99|0.00|HAPA EPA ASC 22|
20|FH_F147220_49417_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IP MULTI ROOM COMPARISON|
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 4 (NO REV)|
20|FH_F136592_0_0|SrvcGrp|107885|2022|PDM|1990.00|99|0.00|TRLUML BALO ANGIOP 1ST VEIN|
20|FH_F143454_94550_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F48057_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F151744_60914_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F33712_0_0|SrvcGrp|9936|2022|PCT|0.75|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F132735_97068_0|SrvcGrp|112073|2022|PDM|1375.00|99|0.00|RESIDENITAL TREATMENT EATING DISORDER (AGE 18-99)|
20|FH_F120872_74120_0|SrvcGrp|73605|2022|PDM|745.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F123400_04605_0|SrvcGrp|104084|2022|PDM|521.00|99|0.00|RESIDENTIAL ADULT CD(<= 17 YRS)|
20|FH_F100660_56303_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F31798_0_0|SrvcGrp|360|2022|PCT|0.85|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F129576_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130204_40807_0|SrvcGrp|90040|2022|PDM|336.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F122898_63011_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F130841_49315_0|SrvcGrp|83521|2022|PDM|130.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F127157_43614_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F132969_84003_0|SrvcGrp|17016|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F85353_16407_0|SrvcGrp|63789|2022|PDM|1188.07|99|0.00|HAPA WPA-NWPA 2012-13 ASC 708|
20|FH_F144248_0_0|SrvcGrp|109769|2022|PDM|2433.00|99|0.00|COVER EYE W/ MEMBRANE SUTURE INCIDENTAL CODES|
20|FH_F85353_16407_0|SrvcGrp|63828|2022|PDM|510.57|99|0.00|HAPA WPA-NWPA 2012-13 ASC 215|
20|FH_F63312_0_0|SrvcGrp|10527|2022|PDM|103.00|99|0.00|HOSPICE SVCS|
20|FH_F144248_0_0|SrvcGrp|45583|2022|PDM|9754.00|99|0.00|CPT 65730|
20|FH_F85055_0_0|SrvcGrp|72998|2022|PDM|1500.00|99|0.00|AEG 5|
20|FH_F133494_90023_0|SrvcGrp|75505|2022|PCT|0.00|99|0.00|CARDIAC STUDIES|
20|FH_F119795_0_0|CSTM-ALL|CSTM-00|2020|PDM|1345.00|99|0.00|AEG 3 (NO REV)|
20|FH_F74602_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F120489_63552_0|SrvcGrp|73483|2022|PDM|643.00|99|0.00|AETNA SUBACUTE III|
20|FH_F134075_78230_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137007_43160_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F142547_70002_0|SrvcGrp|86841|2022|PDM|50.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|3300.00|99|0.00|AEG 7 (NO REV)|
20|FH_F128753_32501_0|SrvcGrp|88397|2022|PCT|0.64|99|0.00|AETNA MATERNITY DELIVERY|
20|FH_F120154_77498_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F36554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|ASPG VIII|
20|FH_F138017_73129_0|CSTM-ALL|CSTM-00|2020|PDM|3802.00|99|0.00|AEG 9 (NO REV)|
20|FH_F36594_0_0|SrvcGrp|11442|2022|PDM|600.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F92299_62016_0|SrvcGrp|72994|2022|PCT|0.75|99|0.00|AEG 3|
20|FH_F120888_63823_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F84611_30281_0|SrvcGrp|82635|2022|PDM|17934.00|99|0.00|TRANSLUMINAL ANGIOPLASTY|
20|FH_F46258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F42019_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F73847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143928_21061_0|SrvcGrp|48398|2022|PDM|131.00|99|0.00|PT SERVICES|
20|FH_F128272_60640_0|SrvcGrp|86779|2022|PDM|125.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F116203_63901_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F143948_44870_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F70510_0_0|SrvcGrp|17140|2022|PDM|145.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F40519_0_0|SrvcGrp|472|2022|PDM|355.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F127032_33573_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F89799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88254_33411_0|SrvcGrp|24744|2022|PDM|60.00|99|0.00|PICC LINE INSERTION|
20|FH_F63318_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F133922_70563_0|SrvcGrp|92837|2022|PDM|98.94|99|0.00|SLEEP STUDY|
20|FH_F134331_61021_0|SrvcGrp|46605|2022|PDM|150.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F130123_24171_0|SrvcGrp|94780|2022|PDM|145.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F110580_71106_0|SrvcGrp|3932|2022|PDM|3500.00|99|0.00|LITHOTRIPSY|
20|FH_F128828_44122_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F87571_0_0|SrvcGrp|10393|2022|PDM|1760.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F119573_95864_0|SrvcGrp|98701|2022|PDM|489.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F150259_15668_0|SrvcGrp|76501|2022|PDM|260.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F72963_0_0|SrvcGrp|17079|2022|PDM|5364.00|99|0.00|ASPG VIII|
20|FH_F98800_85021_0|CSTM-ALL|CSTM-00|2020|PCT|0.29|99|0.00|OP SVCS|
20|FH_F146605_72205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128334_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130657_04614_0|SrvcGrp|103717|2022|PCT|0.86|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F111823_32539_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120520_54401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F139382_49202_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142448_15701_0|SrvcGrp|84185|2022|PDM|445.85|99|0.00|RESPITE CARE|
20|FH_F140473_30518_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151144_35801_0|SrvcGrp|114443|2022|PDM|2589.70|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|1840.00|99|0.00|AEG 9 (NO REV)|
20|FH_F103780_64804_0|SrvcGrp|10944|2022|PDM|1207.00|99|0.00|EMERGENCY ROOM|
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|1001.09|99|0.00|AEG 5  (NO REV)|
20|FH_F131505_0_0|SrvcGrp|67994|2022|PDM|299.00|99|0.00|CPT 58120|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1004.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F146212_57108_0|CSTM-ALL|CSTM-00|2020|PDM|1019.00|99|0.00|AEG 2 (NO REV)|
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_F120747_19129_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F59732_0_0|SrvcGrp|17012|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F127205_44125_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39385_0_0|SrvcGrp|22106|2022|PDM|1193.00|99|0.00|CAT SCAN|
20|FH_F133671_89102_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F35259_0_0|SrvcGrp|20089|2022|PDM|12214.00|99|0.00|ANGIOPLASTY|
20|FH_F148255_72703_0|SrvcGrp|86843|2022|PDM|26.25|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F37590_0_0|SrvcGrp|25850|2022|PDM|42.00|99|0.00|RN HOURLY HOME CARE|
20|FH_F148320_02130_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F129627_06037_0|SrvcGrp|63297|2022|PDM|165.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F88391_0_0|SrvcGrp|26001|2022|PDM|140.81|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F141527_36830_0|SrvcGrp|86852|2022|PDM|23.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F150699_0_0|SrvcGrp|109497|2022|PDM|3383.00|99|0.00|REPOSITION PACING-DEFIB LEA|
20|FH_F127642_07047_0|SrvcGrp|73006|2022|PDM|2918.00|99|0.00|AEG 9|
20|FH_F90332_07060_0|SrvcGrp|471|2022|PDM|481.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F38567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F93190_26456_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132931_57350_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F74602_0_0|SrvcGrp|1306|2022|PDM|365.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F77782_66061_0|SrvcGrp|47444|2022|PCT|0.80|99|0.00|MS DRG 283-285 ONLY|
20|FH_F109982_33592_0|SrvcGrp|93919|2022|PDM|465.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F91198_46714_0|SrvcGrp|78180|2022|PDM|496.00|99|0.00|AETNA RESIDENTIAL TREATMENT|
20|FH_F119581_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F146807_28655_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F115289_90057_0|SrvcGrp|86747|2022|PCT|1.15|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F144588_60090_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F146116_34233_0|SrvcGrp|22596|2022|PDM|169.47|99|0.00|HOSPICE CARE|
20|FH_F137240_0_0|CSTM-ALL|CSTM-00|2020|PDM|3163.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102062_35447_0|SrvcGrp|48396|2022|PDM|145.00|99|0.00|OT SERVICES|
20|FH_F123091_92627_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F102681_34237_0|SrvcGrp|73000|2022|PDM|892.00|99|0.00|AEG 6|
20|FH_F39996_0_0|SrvcGrp|16|2022|PDM|450.00|99|0.00|ACUTE REHABILITATION|
20|FH_F40517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102948_43606_0|CSTM-ALL|CSTM-00|2020|PDM|516.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|746.00|99|0.00|AEG 5  (NO REV)|
20|FH_F48772_66044_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F142087_0_0|SrvcGrp|80617|2022|PDM|15000.00|99|0.00|ARTHOPLASTY|
20|FH_F75787_85137_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F110604_0_0|SrvcGrp|58636|2022|PDM|20900.00|99|0.00|CPT 62362|
20|FH_F110604_0_0|SrvcGrp|90798|2022|PDM|18150.00|99|0.00|IMPLANT SPINE INFUSION PUMP19|
20|FH_F136569_16506_0|SrvcGrp|3044|2022|PDM|637.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F136650_72543_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F114666_30342_0|SrvcGrp|26274|2022|PDM|1350.00|99|0.00|CPT 29877|
20|FH_F114705_77018_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F113845_32746_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F122610_73139_0|SrvcGrp|23458|2022|PDM|124.00|99|0.00|URGENT CARE SERVICES|
20|FH_F42940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F43295_0_0|SrvcGrp|18932|2022|PDM|2442.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806|
20|FH_F135747_76208_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F136796_24016_0|CSTM-ALL|CSTM-00|2020|PDM|1766.48|99|0.00|AEG 5  (NO REV)|
20|FH_F136547_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141170_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
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_F115263_47129_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F115608_24171_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS|
20|FH_F147526_32216_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F147586_44124_0|CSTM-ALL|CSTM-00|2020|PDM|2109.00|99|0.00|AEG 8 (NO REV)|
20|FH_F41652_0_0|CSTM-ALL|CSTM-00|2020|PDM|324.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42024_0_0|SrvcGrp|10944|2022|PCT|0.79|99|0.00|EMERGENCY ROOM|
20|FH_F38865_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F118612_21502_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129688_74066_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.35|99|0.00|POLYSOMNOGRAPHY|
20|FH_F33385_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F97181_33143_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F33788_0_0|SrvcGrp|10111|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F128929_33030_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F101802_17201_0|SrvcGrp|48398|2022|PDM|134.00|99|0.00|PT SERVICES|
20|FH_F147995_67037_0|SrvcGrp|79786|2022|PCT|1.00|99|0.00|SLEEP STUDIES|
20|FH_F67136_0_0|SrvcGrp|62720|2022|PDM|8427.00|99|0.00|CARDIAC MSDRG ONLY|
20|FH_F147800_0_0|SrvcGrp|93724|2022|PDM|1650.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F133018_84037_0|SrvcGrp|53987|2022|PDM|239.49|99|0.00|PHOTOTHERAPY|
20|FH_F148865_0_0|SrvcGrp|80918|2022|PDM|140.00|99|0.00|RESPITE CARE|
20|FH_F132118_92240_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|94.32|99|0.00|HAPA WPA-NWPA 2012-13 ASC 244 W/O REV|
20|FH_F84532_0_0|SrvcGrp|82806|2022|PDM|1178.00|99|0.00|PAIN MANAGEMENT CARVEOUTS|
20|FH_F98940_70506_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F132039_92008_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F138453_74135_0|SrvcGrp|86723|2022|PDM|424.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F132160_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|650.00|99|0.00|ENT SURG CTR -CVTY ENHANCED GROUP 1|
20|FH_F112794_01040_0|SrvcGrp|94744|2022|PCT|1.00|99|0.00|NOS FLU VACC IM (>=3 YRS)|
20|FH_F113957_73554_0|SrvcGrp|75505|2022|PCT|1.25|99|0.00|CARDIAC STUDIES|
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 2 (NO REV)|
20|FH_F113181_72202_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120635_22903_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F120657_54220_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150939_0_0|SrvcGrp|111060|2022|PDM|20.53|99|0.00|TOXOIDS VACCINES|
20|FH_F138730_22602_0|SrvcGrp|79237|2022|PDM|2500.00|99|0.00|VBAC DELIVERY|
20|FH_F138807_32207_0|SrvcGrp|48394|2022|PDM|53.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F139016_47460_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138685_18017_0|SrvcGrp|90854|2022|PDM|599.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F31890_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F117715_0_0|SrvcGrp|75491|2022|PDM|1048.00|99|0.00|AEG 7|
20|FH_F127207_0_0|SrvcGrp|82223|2022|PDM|90.00|99|0.00|HOSPICE CARE|
20|FH_F127207_0_0|SrvcGrp|104230|2022|PDM|90.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PDM|3085.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F151302_80227_0|SrvcGrp|90854|2022|PDM|1100.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F151307_63127_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151420_60654_0|SrvcGrp|104039|2022|PDM|1896.00|99|0.00|CORRECTION HALLUX VALGUS|
20|FH_F145468_60615_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F123191_15012_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F36492_0_0|SrvcGrp|73004|2022|PDM|1681.00|99|0.00|AEG 8|
20|FH_F135438_29030_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F91764_93710_0|CSTM-ALL|CSTM-00|2020|PDM|5313.00|99|0.00|AEG 5  (NO REV)|
20|FH_F131374_08009_0|SrvcGrp|104796|2022|PDM|175.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F131132_44077_0|SrvcGrp|63471|2022|PDM|29131.00|99|0.00|CPT 64590|
20|FH_F121407_73701_0|SrvcGrp|3078|2022|PCT|0.39|99|0.00|DRUGS|
20|FH_F121763_07202_0|SrvcGrp|107806|2022|PCT|4.00|99|0.00|CHEMOTHERAPY/ALL OTHER DRUGS|
20|FH_F121854_28613_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146125_0_0|CSTM-ALL|CSTM-00|2020|PDM|1414.00|99|0.00|AEG 6 (NO REV)|
20|FH_F111291_52501_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140987_0_0|SrvcGrp|88157|2022|PDM|4000.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.53|99|0.00|AEG 2 (NO REV)|
20|FH_F41780_0_0|SrvcGrp|31190|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC (DME)|
20|FH_F131000_0_0|SrvcGrp|88159|2022|PDM|6155.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F72666_0_0|SrvcGrp|360|2022|PDM|866.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1199.30|99|0.00|AEG 7 (NO REV)|
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F87534_19464_0|SrvcGrp|48398|2022|PDM|104.00|99|0.00|PT SERVICES|
20|FH_F96340_23704_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F129141_21221_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141035_0_0|SrvcGrp|113712|2022|PDM|7008.00|99|0.00|REMOVE WRIST JOINT LINING|
20|FH_F102222_19720_0|SrvcGrp|93273|2022|PCT|1.05|99|0.00|AETNA DRUGS/AGENTS/INJ DRUG|
20|FH_F102902_33764_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143542_0_0|SrvcGrp|95107|2022|PDM|5738.00|99|0.00|INTRAOCULAR LENS PROSTHESIS|
20|FH_F82375_28601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120971_60714_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F52753_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|ASPG X|
20|FH_F102302_0_0|SrvcGrp|98573|2022|PDM|29900.00|99|0.00|DISKECTOMY THORACIC SINGLE|
20|FH_F124017_0_0|SrvcGrp|109671|2022|PDM|5200.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F141607_27021_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F46359_0_0|SrvcGrp|24639|2022|PDM|147.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F31908_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93119_0_0|SrvcGrp|471|2022|PDM|834.45|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F115109_20032_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F44582_0_0|SrvcGrp|360|2022|PDM|2800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F126439_92627_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F148440_16506_0|CSTM-ALL|CSTM-00|2020|PDM|784.00|99|0.00|AEG 4 (NO REV)|
20|FH_F55054_0_0|SrvcGrp|10400|2022|PDM|1430.00|99|0.00|IP SURGERY|
20|FH_F37945_0_0|CSTM-ALL|CSTM-00|2020|PDM|891.00|99|0.00|ASPG III|
20|FH_F64440_0_0|SrvcGrp|33843|2022|PDM|129.00|99|0.00|CPT CODE 94762|
20|FH_F141567_80128_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F71346_0_0|SrvcGrp|1168|2022|PDM|31.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F121090_07848_0|SrvcGrp|89337|2022|PDM|792.00|99|0.00|DETOXIFICATION|
20|FH_F43663_0_0|SrvcGrp|52|2022|PCT|0.65|99|0.00|RESIDENTIAL TREATMENT SVCS|
20|FH_F115049_78539_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F66409_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F97540_32114_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F131234_32207_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F116092_83254_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F122694_33334_0|SrvcGrp|46903|2022|PDM|563.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F50654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126360_22485_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139297_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93359_63084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|148.75|99|0.00|HAPA WPA-NWPA 2012-13 ASC 236 W/O REV|
20|FH_F85353_16407_0|SrvcGrp|42504|2022|PDM|60.00|99|0.00|ALTEPLASE W/ER|
20|FH_F117831_0_0|SrvcGrp|101320|2022|PDM|1000.00|99|0.00|PARAVERTEBRAL FACET JOINT NERVE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|623.39|99|0.00|HAPA WPA-NWPA 2012-13 ASC 207 W/O REV|
20|FH_F134614_84651_0|SrvcGrp|74668|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F121225_98902_0|SrvcGrp|22589|2022|PDM|120.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F52672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|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_F115811_33410_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111584_07002_0|SrvcGrp|89412|2022|PDM|386.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F134087_0_0|SrvcGrp|100001|2022|PDM|10455.00|99|0.00|WRIST REPLACEMNT TOT WRIST|
20|FH_F137147_75006_0|SrvcGrp|58417|2022|PDM|33668.00|99|0.00|MS DRG 355 ONLY|
20|FH_F43201_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F136779_0_0|CSTM-ALL|CSTM-00|2020|PDM|869.00|99|0.00|AEG 10 (NO REV)|
20|FH_F35446_0_0|SrvcGrp|38|2022|PDM|1464.00|99|0.00|NORMAL DELIVERY|
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1203.00|99|0.00|ASPG X|
20|FH_F147213_48609_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35387_0_0|SrvcGrp|14414|2022|PDM|467.00|99|0.00|NEWBORN NURSERY|
20|FH_F98623_97006_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F150982_0_0|SrvcGrp|104257|2022|PDM|1382.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F40853_0_0|SrvcGrp|97|2022|PDM|4000.00|99|0.00|C-SECTION|
20|FH_F43244_0_0|CSTM-ALL|CSTM-00|2020|PDM|2141.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37081_0_0|SrvcGrp|18278|2022|PDM|17669.00|99|0.00|MS DRG 460|
20|FH_F148205_75149_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149868_0_0|SrvcGrp|90478|2022|PDM|190.00|99|0.00|HOSPICE|
20|FH_F116237_43235_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F91622_0_0|SrvcGrp|10365|2022|PDM|1725.00|99|0.00|CPT CODE 99285|
20|FH_F93741_85006_0|SrvcGrp|11199|2022|PDM|490.00|99|0.00|HYPERBARIC CHAMBER|
20|FH_F109281_0_0|CSTM-ALL|CSTM-00|2020|PDM|1610.00|99|0.00|AEG 6 (NO REV)|
20|FH_F115075_77833_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131254_92211_0|SrvcGrp|86825|2022|PDM|75.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F122687_0_0|SrvcGrp|85778|2022|PDM|3825.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F128970_54729_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F93332_0_0|SrvcGrp|83821|2022|PDM|1906.00|99|0.00|ALLOGRAFT SPINE SURG|
20|FH_F129768_0_0|SrvcGrp|111414|2022|PCT|6.50|99|0.00|MEDICINE CODES|
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_F114823_15701_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F137530_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F85353_16407_0|SrvcGrp|63775|2022|PDM|1402.69|99|0.00|HAPA WPA-NWPA 2012-13 ASC 702|
20|FH_F150222_98026_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F49575_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145641_06902_0|SrvcGrp|110767|2022|PDM|2178.00|99|0.00|2ND LEVEL INJ PARAVERT F JNT L/S|
20|FH_F133950_06029_0|SrvcGrp|87077|2022|PDM|151.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F138056_64055_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F133950_06029_0|SrvcGrp|112370|2022|PCT|1.00|99|0.00|RABIES VACCINE|
20|FH_F143650_0_0|SrvcGrp|80617|2022|PDM|4100.00|99|0.00|ARTHOPLASTY|
20|FH_F110580_71106_0|CSTM-ALL|CSTM-00|2020|PDM|653.00|99|0.00|AEG 2 (NO REV)|
20|FH_F102200_06416_0|SrvcGrp|86846|2022|PDM|50.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F134828_30531_0|SrvcGrp|112654|2022|PDM|57.00|99|0.00|XRAY EXAM OF THORAX SPINE (HCFA)|
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F136372_19046_0|SrvcGrp|89149|2022|PDM|186.00|99|0.00|OP INTENSIVE|
20|FH_F114092_83350_0|SrvcGrp|111928|2022|PDM|80.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F38807_0_0|SrvcGrp|17083|2022|PDM|510.00|99|0.00|ASPG X|
20|FH_F72390_0_0|SrvcGrp|27155|2022|PCT|1.00|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F128605_20910_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F132285_89103_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|3200.00|99|0.00|AREOLA RECONSTRUCTION|
20|FH_F120974_27607_0|CSTM-ALL|CSTM-00|2020|PDM|9706.00|99|0.00|AEG 6 (NO REV)|
20|FH_F61292_0_0|CSTM-ALL|CSTM-00|2020|PDM|1117.00|99|0.00|ASPG I - FH SW CUSTOM GROUPERS|
20|FH_F111206_63011_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37001_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F38051_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F116115_14437_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F131216_31901_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F116203_63901_0|SrvcGrp|48394|2022|PDM|70.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1849.00|99|0.00|AEG 8 (NO REV)|
20|FH_F129231_30060_0|SrvcGrp|106216|2022|PDM|1754.00|99|0.00|CORNEAL TRANSPLANT ENDOTHELIAL|
20|FH_F135779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F121149_76021_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143873_33407_0|SrvcGrp|109036|2022|PDM|820.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F124965_0_0|SrvcGrp|73006|2022|PDM|1500.00|99|0.00|AEG 9|
20|FH_F116311_02657_0|SrvcGrp|58509|2022|PDM|372.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F135178_84049_0|SrvcGrp|74668|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148121_21734_0|SrvcGrp|74668|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F80283_0_0|SrvcGrp|3809|2022|PDM|938.18|99|0.00|HOSPICE CARE|
20|FH_F120349_38774_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F130514_33316_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124796_37641_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37679_0_0|SrvcGrp|26844|2022|PDM|15.25|99|0.00|CONTINUOUS ANTICOAGULANT THERAPY (MOD SJ)|
20|FH_F116998_17701_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F62719_0_0|SrvcGrp|44709|2022|PDM|108.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F151523_86333_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F109242_18466_0|SrvcGrp|102980|2022|PDM|131.00|99|0.00|PSYTX WPT W E/M 30 MIN|
20|FH_F110906_54481_0|SrvcGrp|104173|2022|PCT|2.00|99|0.00|IMMUNIZATIONS AND INJECTIONS|
20|FH_F46857_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F95440_0_0|SrvcGrp|73000|2022|PDM|2755.00|99|0.00|AEG 6|
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|813.00|99|0.00|AEG 5  (NO REV)|
20|FH_F127814_63103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F139658_02893_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119110_91773_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F110580_71106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134494_33612_0|SrvcGrp|89149|2022|PDM|243.00|99|0.00|OP INTENSIVE|
20|FH_F133494_90023_0|SrvcGrp|111928|2022|PDM|100.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F60276_0_0|CSTM-ALL|CSTM-00|2020|PDM|314.00|99|0.00|ASPG I|
20|FH_F69968_0_0|SrvcGrp|20984|2022|PDM|468.84|99|0.00|MSDRG 795 & REV CODES 170-172 NORMAL NEWBORN|
20|FH_F136299_75218_0|SrvcGrp|104363|2022|PCT|1.75|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F136390_46321_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F120489_63552_0|SrvcGrp|73496|2022|PDM|2854.00|99|0.00|AETNA ER LEVEL V|
20|FH_F134088_32209_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F53732_0_0|SrvcGrp|34389|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F138548_24090_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|813.00|99|0.00|AEG 5  (NO REV)|
20|FH_F100640_48097_0|SrvcGrp|90854|2022|PDM|2488.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY POS FACILITY MOD 53|
20|FH_F43860_0_0|SrvcGrp|27769|2022|PDM|25.00|99|0.00|SKILLED LPN HOURLY|
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128027_0_0|SrvcGrp|64735|2022|PDM|1050.00|99|0.00|CPT 43235|
20|FH_F114389_50131_0|SrvcGrp|86853|2022|PDM|83.32|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|858.00|99|0.00|AEG 10 (NO REV)|
20|FH_F101922_98055_0|SrvcGrp|72994|2022|PDM|3400.00|99|0.00|AEG 3|
20|FH_F49046_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F51548_0_0|SrvcGrp|10541|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F118517_33316_0|SrvcGrp|89149|2022|PDM|215.00|99|0.00|OP INTENSIVE|
20|FH_F48935_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F126663_91423_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F49354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD TC|
20|FH_F72859_0_0|SrvcGrp|15515|2022|PDM|50.00|99|0.00|HYDRATION THERAPY|
20|FH_F123324_0_0|SrvcGrp|3178|2022|PDM|837.00|99|0.00|ACUTE PSYCH|
20|FH_F123583_72756_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F138054_0_0|SrvcGrp|48398|2022|PDM|144.00|99|0.00|PT SERVICES|
20|FH_F132612_0_0|SrvcGrp|360|2022|PDM|1520.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F45174_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F133490_90650_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F144471_19805_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F45977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F147998_07030_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F36372_0_0|SrvcGrp|11797|2022|PDM|54.00|99|0.00|HYDRATION THERAPY - 3+ LITERS|
20|FH_F39080_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F103241_06002_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39939_0_0|SrvcGrp|9774|2022|PDM|2940.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F47693_16148_0|SrvcGrp|13985|2022|PDM|47.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F48772_66044_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F111661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135235_01830_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F124371_0_0|SrvcGrp|106300|2022|PDM|289.81|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F117831_0_0|CSTM-ALL|CSTM-00|2020|PDM|683.00|99|0.00|AEG 3 (NO REV)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|105.49|99|0.00|HAPA WPA-NWPA 2012-13 ASC 141 W/O REV|
20|FH_F127638_44720_0|SrvcGrp|97702|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F121476_0_0|SrvcGrp|78046|2022|PDM|1360.00|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F109577_0_0|SrvcGrp|80716|2022|PDM|123.00|99|0.00|AETNA G0109|
20|FH_F129101_27006_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F85894_0_0|SrvcGrp|17073|2022|PDM|1769.00|99|0.00|ASPG V|
20|FH_F102641_0_0|SrvcGrp|72992|2022|PDM|753.00|99|0.00|AEG 2|
20|FH_F140450_18104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PDM|962.50|99|0.00|AEG 10 (NO REV)|
20|FH_F147930_21244_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F57372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F114916_30309_0|SrvcGrp|34606|2022|PDM|2500.00|99|0.00|CPT 29827|
20|FH_F136832_0_0|SrvcGrp|73559|2022|PDM|1836.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F55812_0_0|SrvcGrp|10543|2022|PDM|70.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F132864_71101_0|SrvcGrp|31038|2022|PDM|30680.00|99|0.00|MS DRG 233-234 ONLY|
20|FH_F63185_0_0|SrvcGrp|48385|2022|PDM|30.00|99|0.00|SPEECH THERAPY|
20|FH_F137951_0_0|SrvcGrp|79578|2022|PDM|1458.00|99|0.00|CPT 43246|
20|FH_F148548_37909_0|CSTM-ALL|CSTM-00|2020|PDM|1550.00|99|0.00|AEG 4 (NO REV)|
20|FH_F117720_23323_0|SrvcGrp|76501|2022|PDM|278.25|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F35615_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F95980_20016_0|SrvcGrp|86749|2022|PCT|1.05|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F133469_33404_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F133005_32726_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F101840_76054_0|SrvcGrp|73605|2022|PDM|603.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F92977_64067_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F32325_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117970_15963_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122262_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F38410_0_0|SrvcGrp|10545|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F148886_60621_0|CSTM-ALL|CSTM-00|2020|PDM|688.00|99|0.00|AEG 1 (NO REV)|
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|GENERAL ACUTE CARE|
20|FH_F101802_17201_0|SrvcGrp|46605|2022|PDM|150.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F150862_75082_0|SrvcGrp|75419|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F33632_52349_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F125656_92868_0|SrvcGrp|14945|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F149400_83301_0|SrvcGrp|23683|2022|PDM|35.00|99|0.00|SKILLED NURSING RN|
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|1075.00|99|0.00|AEG 8 (NO REV)|
20|FH_F97184_26101_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
20|FH_F34130_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36734_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124492_30040_0|SrvcGrp|113249|2022|PDM|156.89|99|0.00|COVID-19 SARSCOV2 & INF A&B AMP PRB (HCFA)|
20|FH_F114951_20002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F110727_34994_0|SrvcGrp|73841|2022|PDM|442.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F76285_0_0|SrvcGrp|48382|2022|PDM|172.00|99|0.00|CPT 92507|
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39443_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAPA WPA RAD  FS 90224 125%|
20|FH_F143536_47546_0|SrvcGrp|100240|2022|PCT|0.00|99|0.00|CHEMISTRY|
20|FH_F49051_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F115046_77964_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F39819_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ACUTE PSYCH|
20|FH_F41021_0_0|SrvcGrp|11000|2022|PCT|0.55|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F93538_87124_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129231_30060_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F150982_0_0|SrvcGrp|88493|2022|PDM|5284.00|99|0.00|AETNA VERTEBROPLASTY ADDL INJECT|
20|FH_F39170_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|RAD MOD 26|
20|FH_F127036_43724_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F130207_33458_0|SrvcGrp|73841|2022|PDM|499.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F96902_0_0|SrvcGrp|94780|2022|PDM|165.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F151541_01436_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F77925_0_0|SrvcGrp|9911|2022|PCT|0.74|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F37970_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F132883_31602_0|SrvcGrp|14947|2022|PDM|30.00|99|0.00|HOME INFUSION|
20|FH_F74024_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F135666_37601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F42366_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|EMERGENCY ROOM|
20|FH_F100782_0_0|SrvcGrp|105143|2022|PDM|953.09|99|0.00|WINDBER MEDICAL CNTR ASC 302|
20|FH_F145601_32159_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F85118_40403_0|SrvcGrp|63297|2022|PDM|131.25|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU"|
20|FH_F116443_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118170_18901_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F142087_0_0|SrvcGrp|113853|2022|PDM|3000.00|99|0.00|CARDIAC CATHERIZATION INCL INJECTIONS|
20|FH_F130302_0_0|SrvcGrp|83379|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F140873_0_0|SrvcGrp|80918|2022|PDM|145.00|99|0.00|RESPITE CARE|
20|FH_F92516_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98042_10468_0|SrvcGrp|73602|2022|PDM|3772.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F114666_30342_0|SrvcGrp|93433|2022|PDM|16500.00|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F113787_31909_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139027_18407_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F81832_13827_0|SrvcGrp|48396|2022|PDM|184.00|99|0.00|OT SERVICES|
20|FH_F144039_0_0|SrvcGrp|62740|2022|PDM|5738.00|99|0.00|SURGERY CARVE OUTS|
20|FH_F132721_0_0|SrvcGrp|107734|2022|PDM|4476.00|99|0.00|VAGINAL DELIVERY|
20|FH_F43249_0_0|SrvcGrp|18932|2022|PDM|4043.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806|
20|FH_F43693_0_0|CSTM-ALL|CSTM-00|2020|PDM|490.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F43779_0_0|SrvcGrp|14260|2022|PCT|1.00|99|0.00|NITRIC OXIDE|
20|FH_F136769_37142_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136772_89109_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)|
20|FH_F49005_0_0|SrvcGrp|45552|2022|PDM|75.00|99|0.00|SKILLED NURSING (ADDITIONAL HOURS)|
20|FH_F115206_80923_0|SrvcGrp|73842|2022|PDM|258.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115210_21043_0|SrvcGrp|70749|2022|PDM|2652.00|99|0.00|CPT 29823|
20|FH_F147541_44805_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F41463_0_0|SrvcGrp|10578|2022|PDM|57.00|99|0.00|HYDRATION THERAPY - 1 LITER|
20|FH_F41835_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148552_68114_0|CSTM-ALL|CSTM-00|2020|PDM|1109.43|99|0.00|AEG 2 (NO REV)|
20|FH_F100786_24740_0|SrvcGrp|73643|2022|PDM|1228.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F128130_10027_0|SrvcGrp|75507|2022|PCT|0.73|99|0.00|CHEMOTHERAPY|
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|663.00|99|0.00|AEG 3 (NO REV)|
20|FH_F148886_60621_0|SrvcGrp|115538|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F68622_0_0|SrvcGrp|13928|2022|PCT|0.80|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F100665_07939_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F127960_85205_0|SrvcGrp|73842|2022|PDM|186.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138467_32216_0|SrvcGrp|89149|2022|PDM|695.00|99|0.00|OP INTENSIVE|
20|FH_F35750_0_0|SrvcGrp|18920|2022|PDM|4704.48|99|0.00|MS DRG 766 REPLACEMENT CODES 785, 788|
20|FH_F89674_18640_0|SrvcGrp|27968|2022|PDM|26.25|99|0.00|SKILLED NURSING LPN|
20|FH_F40899_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F124334_68022_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122263_37072_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F31547_0_0|SrvcGrp|12698|2022|PCT|1.00|99|0.00|BLOOD SERVICES|
20|FH_F122396_90024_0|SrvcGrp|46903|2022|PDM|1254.60|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F33649_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F131356_19131_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133536_0_0|SrvcGrp|65350|2022|PDM|4950.00|99|0.00|KNEE ARTHRO/ANTER|
20|FH_F133536_0_0|SrvcGrp|100660|2022|PDM|1100.00|99|0.00|AETNA SURGERY|
20|FH_F139238_0_0|SrvcGrp|11663|2022|PCT|0.32|99|0.00|IMPLANTS|
20|FH_F72445_0_0|SrvcGrp|26001|2022|PDM|160.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F138876_25302_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138907_01040_0|SrvcGrp|14893|2022|PDM|45.17|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F86377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F33316_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|613.75|99|0.00|HAPA WPA-NWPA 2012-13 ASC 301 W/O REV|
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|1055.00|99|0.00|AEG 8 (NO REV)|
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151443_34741_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F132268_07060_0|SrvcGrp|90493|2022|PDM|14.28|99|0.00|ELEC STIM OTHER THAN WOUND|
20|FH_F144989_07701_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135427_19610_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F135584_10977_0|SrvcGrp|79238|2022|PDM|2800.00|99|0.00|TRANSFER|
20|FH_F91735_92653_0|SrvcGrp|53144|2022|PDM|110.25|99|0.00|SPEECH THERAPY|
20|FH_F135976_67401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136038_33018_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F119892_47586_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F100765_73735_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F131228_01826_0|SrvcGrp|81779|2022|PCT|2.84|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F116431_76104_0|SrvcGrp|15182|2022|PCT|0.80|99|0.00|ER SVCS|
20|FH_F116527_70443_0|SrvcGrp|73002|2022|PDM|1500.00|99|0.00|AEG 7|
20|FH_F36458_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130766_04967_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|AEG 9 (NO REV)|
20|FH_F101718_50702_0|SrvcGrp|92760|2022|PCT|2.16|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121428_40202_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F53416_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F38013_0_0|SrvcGrp|13626|2022|PDM|449.00|99|0.00|SLEEP STUDIES|
20|FH_F75205_0_0|SrvcGrp|43431|2022|PDM|45.00|99|0.00|LPN|
20|FH_F40174_0_0|SrvcGrp|15403|2022|PDM|70.00|99|0.00|SPEECH THERAPY SVCS INITIAL EVAL|
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|957.00|99|0.00|AEG 6 (NO REV)|
20|FH_F44396_0_0|SrvcGrp|1306|2022|PDM|260.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F41780_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F42272_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.00|99|0.00|ASPG II|
20|FH_F116430_0_0|SrvcGrp|77445|2022|PDM|2042.00|99|0.00|REMOVAL OF HYDROCELE|
20|FH_F132328_0_0|SrvcGrp|79589|2022|PDM|1500.00|99|0.00|UPPER GI|
20|FH_F68043_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F87557_33309_0|SrvcGrp|86847|2022|PDM|30.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F128549_44224_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F102325_62691_0|SrvcGrp|73524|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY|
20|FH_F132972_78589_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F143542_0_0|SrvcGrp|92549|2022|PDM|5738.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F51276_0_0|SrvcGrp|10579|2022|PDM|50.00|99|0.00|HYDRATION THERAPY - 2 LITERS|
20|FH_F138018_17313_0|SrvcGrp|24759|2022|PDM|45.21|99|0.00|HOME IRRIGATION THERAPY|
20|FH_F84394_17402_0|CSTM-ALL|CSTM-00|2020|PDM|4453.00|99|0.00|AEG 5  (NO REV)|
20|FH_F150200_0_0|SrvcGrp|27400|2022|PDM|2865.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F149839_80002_0|SrvcGrp|80918|2022|PDM|142.00|99|0.00|RESPITE CARE|
20|FH_F39920_0_0|SrvcGrp|65|2022|PDM|1450.00|99|0.00|OBSTETRICAL CARE|
20|FH_F130138_02915_0|SrvcGrp|101260|2022|PCT|0.96|99|0.00|RESIDENTIAL TREATMENT CHEMICAL DEPENDENCY|
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|AEG 6 (NO REV)|
20|FH_F37679_0_0|SrvcGrp|27131|2022|PDM|3.75|99|0.00|HORMONE INJECTION THERAPY (MOD SJ)|
20|FH_F35748_0_0|SrvcGrp|16746|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F103902_89118_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F99441_0_0|SrvcGrp|111136|2022|PDM|477.00|99|0.00|PHENYLEPHRINE KETOROLAC INJECTION|
20|FH_F132579_0_0|SrvcGrp|92502|2022|PDM|900.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F77943_0_0|SrvcGrp|20096|2022|PDM|90606.00|99|0.00|MS DRG 222-223 ONLY|
20|FH_F36936_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F52713_0_0|SrvcGrp|14562|2022|PCT|0.60|99|0.00|OUTPATIENT SURGERY|
20|FH_F126341_27284_0|SrvcGrp|86127|2022|PDM|1.17|99|0.00|AETNA FACTOR IX RECOMBINANT|
20|FH_F146369_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F72785_0_0|CSTM-ALL|CSTM-00|2020|PDM|1748.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F109387_35630_0|SrvcGrp|86746|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 7 (NO REV)|
20|FH_F146400_71860_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133972_27103_0|SrvcGrp|86842|2022|PDM|30.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F143566_98264_0|SrvcGrp|83801|2022|PDM|900.00|99|0.00|INTERIM LABOR FACILITY GLOBA|
20|FH_F127665_44124_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125244_0_0|SrvcGrp|26002|2022|PDM|200.00|99|0.00|C-ARM AND LASER|
20|FH_F113645_0_0|SrvcGrp|106655|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F68887_0_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F76028_0_0|SrvcGrp|62539|2022|PDM|130.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F133589_54722_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132810_0_0|SrvcGrp|86834|2022|PDM|15.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F136423_61254_0|SrvcGrp|73842|2022|PDM|222.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F118178_37909_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F118198_38119_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113392_0_0|SrvcGrp|92541|2022|PDM|1650.00|99|0.00|MUSCLE FLAP|
20|FH_F43860_0_0|SrvcGrp|30958|2022|PDM|65.00|99|0.00|SKILLED LPN VISIT|
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_F114365_73162_0|SrvcGrp|473|2022|PDM|343.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F147085_92780_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F92493_0_0|SrvcGrp|54943|2022|PDM|3250.17|99|0.00|REPAIR OF SLAP LESION|
20|FH_F38725_0_0|CSTM-ALL|CSTM-00|2020|PDM|851.00|99|0.00|ASPG V|
20|FH_F118379_32079_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F148903_51101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120437_85202_0|SrvcGrp|17016|2022|PDM|108.05|99|0.00|HOME INFUSION THERAPY|
20|FH_F36579_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALLIED MED-MOD AW|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 020-022|
20|FH_F150882_84041_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F140295_0_0|SrvcGrp|88163|2022|PDM|13023.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|22500.00|99|0.00|SPEECH THERAPY|
20|FH_F118220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132416_92270_0|SrvcGrp|110811|2022|PDM|490.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|1738.00|99|0.00|AEG 4 (NO REV)|
20|FH_F125254_30306_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F141527_36830_0|SrvcGrp|86854|2022|PDM|26.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F98801_93274_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31244_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125249_0_0|SrvcGrp|90063|2022|PDM|1400.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F54513_0_0|SrvcGrp|22387|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F129547_35476_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F148169_33138_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121090_07848_0|SrvcGrp|46903|2022|PDM|737.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F145593_92660_0|SrvcGrp|89337|2022|PDM|1600.00|99|0.00|DETOXIFICATION|
20|FH_F135840_0_0|SrvcGrp|75485|2022|PDM|662.00|99|0.00|AEG 4|
20|FH_F130662_07032_0|SrvcGrp|105047|2022|PDM|265.00|99|0.00|AETNA PSYCH DIAG EVAL W/ MED SVCS (HCFA)|
20|FH_F129440_0_0|SrvcGrp|108056|2022|PCT|1.00|99|0.00|PHYSICAL THERAPY (UB)|
20|FH_F129509_0_0|SrvcGrp|111325|2022|PDM|3767.00|99|0.00|SPINAL CORD DECOMPRESS-CERVICAL|
20|FH_F87775_15106_0|SrvcGrp|29077|2022|PDM|200.00|99|0.00|HOME TRANSFUSION|
20|FH_F52713_0_0|SrvcGrp|23477|2022|PDM|15233.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F126555_44906_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F137147_75006_0|SrvcGrp|21114|2022|PDM|33668.00|99|0.00|MS DRG 353 ONLY|
20|FH_F147925_06457_0|SrvcGrp|87077|2022|PDM|163.01|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F131412_0_0|SrvcGrp|83857|2022|PDM|640.15|99|0.00|IP HOSPICE SVCS|
20|FH_F78447_0_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F49487_0_0|SrvcGrp|38758|2022|PDM|20.00|99|0.00|NUTRITION PRODUCTS VIA GRAVITY|
20|FH_F101922_98055_0|SrvcGrp|73000|2022|PDM|4500.00|99|0.00|AEG 6|
20|FH_F92531_0_0|SrvcGrp|92195|2022|PDM|11275.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F118459_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F72085_0_0|SrvcGrp|44247|2022|PDM|420.00|99|0.00|CAPD TRAINING|
20|FH_F124564_78411_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F44607_0_0|SrvcGrp|17069|2022|PDM|1900.00|99|0.00|ASPG III|
20|FH_F132601_92677_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F150164_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F149781_37404_0|SrvcGrp|67279|2022|PDM|9124.00|99|0.00|CERVICAL SURGERY|
20|FH_F67182_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141790_85374_0|SrvcGrp|98265|2022|PDM|1473.00|99|0.00|SURGICAL PREPARATION OR CREA|
20|FH_F33241_0_0|SrvcGrp|9936|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F101802_17201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40851_0_0|CSTM-ALL|CSTM-00|2020|PDM|2464.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F48935_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F119437_0_0|SrvcGrp|75479|2022|PDM|850.00|99|0.00|AEG 1|
20|FH_F137798_0_0|SrvcGrp|82222|2022|PDM|128.00|99|0.00|HOSPICE CARE|
20|FH_F35387_0_0|SrvcGrp|11086|2022|PDM|1178.00|99|0.00|CSECT (MOTHER ONLY)|
20|FH_F137767_01841_0|SrvcGrp|86699|2022|PDM|895.00|99|0.00|ECHO TRANSESOPHAGEAL 6|
20|FH_F78185_0_0|SrvcGrp|75299|2022|PDM|39.00|99|0.00|ENTERAL NUTRITION|
20|FH_F97640_37043_0|SrvcGrp|88978|2022|PDM|7429.00|99|0.00|VAGINAL DELIVERY|
20|FH_F105142_0_0|CSTM-ALL|CSTM-00|2020|PDM|632.82|99|0.00|AEG 10 (NO REV)|
20|FH_F47600_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F47969_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F116595_92506_0|SrvcGrp|86747|2022|PCT|1.15|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F120856_78247_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F82173_72712_0|CSTM-ALL|CSTM-00|2020|PDM|1944.00|99|0.00|AEG 2 (NO REV)|
20|FH_F37215_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32200_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131236_84041_0|SrvcGrp|23683|2022|PDM|46.50|99|0.00|SKILLED NURSING RN|
20|FH_F118057_47906_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F132190_0_0|SrvcGrp|109621|2022|PDM|1900.00|99|0.00|PERQ CERVICOTHORACIC INJECTION|
20|FH_F123276_20737_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40525_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F97540_32114_0|SrvcGrp|73659|2022|PDM|19724.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F88199_0_0|SrvcGrp|23683|2022|PDM|38.50|99|0.00|SKILLED NURSING RN|
20|FH_F139515_0_0|SrvcGrp|79593|2022|PDM|711.00|99|0.00|CPT 45378|
20|FH_F123276_20737_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F78603_0_0|SrvcGrp|50169|2022|PDM|49781.36|99|0.00|MSDRG 227 ONLY|
20|FH_F79863_0_0|SrvcGrp|77236|2022|PDM|90.00|99|0.00|AETNA HOME INFUSION S9338|
20|FH_F148546_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135610_06451_0|SrvcGrp|82222|2022|PDM|89.12|99|0.00|HOSPICE CARE|
20|FH_F126341_27284_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|207.37|99|0.00|HAPA WPA-NWPA 2012-13 ASC 15 W/O REV|
20|FH_F88491_71301_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F123735_32708_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132810_0_0|SrvcGrp|113259|2022|PCT|1.09|99|0.00|ALL DRUGS/AGENTS/INJ DRUGS|
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|37.00|99|0.00|AEG 3 (NO REV)|
20|FH_F140343_89052_0|SrvcGrp|17013|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F112080_0_0|SrvcGrp|72996|2022|PDM|914.00|99|0.00|AEG 4|
20|FH_F69364_0_0|CSTM-ALL|CSTM-00|2020|PDM|775.00|99|0.00|ASPG I|
20|FH_F50420_0_0|SrvcGrp|28074|2022|PCT|0.90|99|0.00|HIGH COST PHARMACEUTICALS|
20|FH_F52854_0_0|SrvcGrp|14494|2022|PDM|35.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F78603_0_0|SrvcGrp|65|2022|PDM|2867.32|99|0.00|OBSTETRICAL CARE|
20|FH_F133671_89102_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F137611_30909_0|SrvcGrp|86722|2022|PDM|176.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F116093_47327_0|SrvcGrp|89417|2022|PDM|346.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F141802_17042_0|SrvcGrp|113083|2022|PDM|1001.00|99|0.00|CT SCAN|
20|FH_F52854_0_0|SrvcGrp|9506|2022|PDM|2598.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F127598_43232_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F120608_19901_0|SrvcGrp|88620|2022|PDM|136.50|99|0.00|SKILLED NURSING RN|
20|FH_F127486_06776_0|SrvcGrp|93098|2022|PDM|161.70|99|0.00|HOSPICE CARE|
20|FH_F125124_0_0|SrvcGrp|67989|2022|PDM|2370.00|99|0.00|CPT 49320|
20|FH_F144291_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143568_85006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130329_64114_0|SrvcGrp|73701|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F99161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114851_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|86.90|99|0.00|HAPA WPA-NWPA 2012-13 ASC 316 W/O REV|
20|FH_F70607_0_0|SrvcGrp|9828|2022|PDM|47.45|99|0.00|HOME HEALTH AIDE|
20|FH_F134002_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F38805_0_0|SrvcGrp|29714|2022|PDM|2000.00|99|0.00|DELIVERY|
20|FH_F58856_0_0|SrvcGrp|9939|2022|PDM|1725.00|99|0.00|ACUTE MEDICAL SVCS|
20|FH_F85213_02840_0|SrvcGrp|111927|2022|PDM|290.30|99|0.00|COVID-19 NON CDC|
20|FH_F127908_60640_0|SrvcGrp|87995|2022|PCT|1.40|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F110268_02891_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F150536_0_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F112065_20852_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120475_81052_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F149639_96822_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117153_34113_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F151221_71857_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114389_50131_0|SrvcGrp|20480|2022|PDM|102.25|99|0.00|HOME INFUSION THERAPY|
20|FH_F132864_71101_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F148554_85016_0|SrvcGrp|115455|2022|PDM|1250.00|99|0.00|REMOVE PACEMAKER ELECTRODE|
20|FH_F114389_50131_0|SrvcGrp|48394|2022|PDM|99.41|99|0.00|SKILLED NURSING SERVICES|
20|FH_F141336_16947_0|CSTM-ALL|CSTM-00|2020|PDM|2183.00|99|0.00|AEG 9 (NO REV)|
20|FH_F117794_06473_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141930_72032_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.47|99|0.00|CPT 95810 (W/MOD 26)|
20|FH_F120437_85202_0|SrvcGrp|26868|2022|PDM|76.51|99|0.00|DIURETIC IV THERAPY|
20|FH_F143684_0_0|SrvcGrp|35670|2022|PDM|31212.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F143684_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F74264_15301_0|SrvcGrp|13985|2022|PDM|55.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F132612_0_0|SrvcGrp|58|2022|PCT|0.66|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F125352_90034_0|SrvcGrp|87131|2022|PDM|411.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F150001_33064_0|SrvcGrp|86851|2022|PDM|26.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F132420_84660_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F133493_90255_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F51123_0_0|SrvcGrp|26160|2022|PDM|38.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F89932_10940_0|SrvcGrp|73488|2022|PCT|2.92|99|0.00|AETNA HOSPITAL OP DIALYSIS|
20|FH_F90811_0_0|SrvcGrp|90376|2022|PDM|10000.00|99|0.00|REVISION OF KNEE JOINTLANT|
20|FH_F112754_98057_0|SrvcGrp|88779|2022|PDM|232.13|99|0.00|PHYSICAL THERAPY|
20|FH_F141275_07004_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|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F149160_02180_0|SrvcGrp|115401|2022|PCT|1.00|99|0.00|COVID-19 VACCINE COMBINATION - ELI LILLY|
20|FH_F132694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90232_15126_0|SrvcGrp|27969|2022|PDM|26.25|99|0.00|HOME HEALTH AIDE|
20|FH_F138018_17313_0|SrvcGrp|14944|2022|PDM|8.22|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F127487_60169_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F102943_0_0|CSTM-ALL|CSTM-00|2020|PDM|1017.00|99|0.00|AEG 7 (NO REV)|
20|FH_F102224_0_0|SrvcGrp|101103|2022|PDM|10450.00|99|0.00|REVIS SHOULDER JOINT|
20|FH_F102224_0_0|SrvcGrp|67068|2022|PDM|5514.95|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F116552_70001_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F119992_67062_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F120876_85250_0|CSTM-ALL|CSTM-00|2020|PDM|1131.00|99|0.00|ABH IP OBSERVATION >=24 HOURS|
20|FH_F73662_0_0|SrvcGrp|15473|2022|PDM|1183.00|99|0.00|CPT CODE 42820|
20|FH_F128580_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F149866_07401_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F52854_0_0|SrvcGrp|31576|2022|PDM|7379.00|99|0.00|LITHOTRIPSY|
20|FH_F32799_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122725_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63235_0_0|SrvcGrp|29718|2022|PCT|0.40|99|0.00|SUPPLIES/DEVICES/IMPLANTABLES|
20|FH_F88744_71103_0|SrvcGrp|73606|2022|PDM|797.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|299.75|99|0.00|HAPA WPA-NWPA 2012-13 ASC 15 W/O REV|
20|FH_F63312_0_0|SrvcGrp|12157|2022|PDM|85.00|99|0.00|RN VISIT|
20|FH_F143650_0_0|SrvcGrp|41325|2022|PDM|2800.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F51258_0_0|SrvcGrp|12496|2022|PDM|753.00|99|0.00|ACUTE REHABILITATION|
20|FH_F133478_40165_0|SrvcGrp|73559|2022|PDM|3311.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F32362_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F55212_0_0|SrvcGrp|9493|2022|PDM|69.00|99|0.00|CPT 90804|
20|FH_F117102_39355_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F51016_0_0|SrvcGrp|33165|2022|PDM|405.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F125011_74467_0|SrvcGrp|68047|2022|PDM|2940.00|99|0.00|CPT 64585|
20|FH_F78162_0_0|SrvcGrp|17753|2022|PDM|160.00|99|0.00|NEGATIVE  PRESSURE WOUND THERAPY ELEC PUMP|
20|FH_F123921_89128_0|SrvcGrp|108061|2022|PCT|1.50|99|0.00|OP THERAPY SERVICES|
20|FH_F148255_72703_0|SrvcGrp|19742|2022|PDM|57.75|99|0.00|MID-LINE INSERTION|
20|FH_F120308_07901_0|SrvcGrp|73605|2022|PDM|1154.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F116984_28092_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41313_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F147941_06023_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F110061_0_0|SrvcGrp|75479|2022|PDM|352.00|99|0.00|AEG 1|
20|FH_F130017_02302_0|SrvcGrp|109894|2022|PDM|345.36|99|0.00|BEHAVIORAL HEALTH|
20|FH_F118123_67226_0|SrvcGrp|65621|2022|PDM|42.00|99|0.00|RN NURSING|
20|FH_F145604_14850_0|SrvcGrp|86841|2022|PDM|165.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F121476_0_0|SrvcGrp|108893|2022|PDM|1232.00|99|0.00|IMPLANTABLE TISSUE MARKER|
20|FH_F119783_46360_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F114444_19602_0|SrvcGrp|104415|2022|PDM|190.00|99|0.00|PSYCH DIAGNOSTIC (HCFA)(MOD AF)|
20|FH_F138908_84010_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136542_02446_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F93187_08043_0|SrvcGrp|473|2022|PDM|441.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F137237_33304_0|SrvcGrp|108484|2022|PDM|605.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F97582_46307_0|SrvcGrp|73485|2022|PDM|3697.00|99|0.00|AETNA REHAB|
20|FH_F119026_36274_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F121404_32216_0|SrvcGrp|84559|2022|PCT|1.05|99|0.00|AETNA ENTERAL & PARENTERAL|
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_F114916_30309_0|SrvcGrp|67119|2022|PDM|1800.00|99|0.00|ARTHODESIS|
20|FH_F100703_0_0|SrvcGrp|97219|2022|PDM|7876.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON|
20|FH_F87856_0_0|SrvcGrp|83838|2022|PDM|1693.00|99|0.00|SUSPENSION OF BREAST|
20|FH_F33664_0_0|SrvcGrp|6|2022|PCT|0.91|99|0.00|OP SURGERY|
20|FH_F107180_80723_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130652_51101_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F87577_80016_0|SrvcGrp|31778|2022|PDM|13838.00|99|0.00|MS DRG 246-247, 249 ONLY  PTCA W/STENT|
20|FH_F150059_54494_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146211_68144_0|SrvcGrp|100059|2022|PDM|6473.00|99|0.00|REPAIR ULNA FRACTURE|
20|FH_F43140_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97622_75051_0|SrvcGrp|90854|2022|PDM|4557.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F134430_86301_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F43433_0_0|SrvcGrp|31112|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F117368_68114_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F139673_63011_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F145543_0_0|SrvcGrp|104723|2022|PDM|931.00|99|0.00|REPAIR EYELID DEFECT|
20|FH_F101685_0_0|SrvcGrp|73004|2022|PDM|1205.00|99|0.00|AEG 8|
20|FH_F147181_27514_0|SrvcGrp|113359|2022|PCT|1.00|99|0.00|COVID-19 SARSCOV & INF VIR A&B AG IA|
20|FH_F40690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|PSYCHIATRIC OP SVCS|
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 5  (NO REV)|
20|FH_F55876_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F147220_49417_0|SrvcGrp|110537|2022|PDM|392.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F118252_32216_0|SrvcGrp|89149|2022|PDM|423.00|99|0.00|OP INTENSIVE|
20|FH_F113470_74010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116040_24637_0|SrvcGrp|86835|2022|PDM|10.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F134151_17509_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142690_31774_0|SrvcGrp|43567|2022|PDM|150.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F140765_30315_0|SrvcGrp|92760|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118914_43015_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F109885_35473_0|SrvcGrp|89417|2022|PDM|542.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F117267_07728_0|SrvcGrp|79786|2022|PCT|5.13|99|0.00|SLEEP STUDIES|
20|FH_F112817_37027_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F113738_27006_0|SrvcGrp|88621|2022|PDM|130.00|99|0.00|SKILLED NURSING LPN|
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|1569.00|99|0.00|AEG 8 (NO REV)|
20|FH_F119535_0_0|SrvcGrp|45883|2022|PDM|90.00|99|0.00|OT|
20|FH_F67882_0_0|SrvcGrp|13778|2022|PDM|946.00|99|0.00|PSYCH/CD|
20|FH_F92599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F138283_0_0|SrvcGrp|90339|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F101922_98055_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F124928_04210_0|SrvcGrp|94781|2022|PDM|144.58|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F125266_44515_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F39477_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|79013|2022|PDM|1005.02|99|0.00|MON VALLEY ASC 222|
20|FH_F137240_0_0|SrvcGrp|66479|2022|PDM|46000.00|99|0.00|GAMMA KNIFE|
20|FH_F148599_98034_0|SrvcGrp|81656|2022|PCT|0.51|99|0.00|MS DRG 789 ONLY|
20|FH_F57956_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|OP SVCS|
20|FH_F133490_90650_0|SrvcGrp|10944|2022|PDM|1159.00|99|0.00|EMERGENCY ROOM|
20|FH_F63250_0_0|SrvcGrp|43567|2022|PDM|105.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|290.40|99|0.00|HAPA WPA-NWPA 2012-13 ASC 119 W/O REV|
20|FH_F132080_0_0|SrvcGrp|93098|2022|PDM|169.00|99|0.00|HOSPICE CARE|
20|FH_F55375_0_0|SrvcGrp|51475|2022|PCT|0.65|99|0.00|HIGH COST DRUGS|
20|FH_F37536_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F146266_0_0|SrvcGrp|95560|2022|PDM|5250.00|99|0.00|REMOVAL OF SHOULDER BONE|
20|FH_F35924_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132149_60624_0|SrvcGrp|73842|2022|PDM|235.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120144_77031_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F150912_19344_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F115982_0_0|SrvcGrp|26432|2022|PDM|1800.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F101752_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F37590_0_0|SrvcGrp|12401|2022|PDM|84.00|99|0.00|RN VISIT|
20|FH_F141567_80128_0|SrvcGrp|92141|2022|PDM|38.00|99|0.00|ANETHESIA SERVICES|
20|FH_F148265_06067_0|SrvcGrp|89848|2022|PDM|14571.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F110925_01104_0|SrvcGrp|86164|2022|PDM|3.37|99|0.00|AETNA BIVALIRUDIN|
20|FH_F125011_74467_0|SrvcGrp|3273|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F151155_26508_0|SrvcGrp|104441|2022|PDM|22.00|99|0.00|AETNA DRUG TEST PRSMV DIR OPT OBS (HCFA)|
20|FH_F117299_0_0|SrvcGrp|47529|2022|PDM|976.00|99|0.00|CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY|
20|FH_F141353_26452_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124059_64055_0|SrvcGrp|53987|2022|PDM|50.00|99|0.00|PHOTOTHERAPY|
20|FH_F113705_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79902_0_0|SrvcGrp|537|2022|PDM|85.00|99|0.00|OBSERVATION SERVICES|
20|FH_F128144_45697_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKE|
20|FH_F98921_64503_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F49354_0_0|SrvcGrp|32383|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KL (DME)|
20|FH_F142990_06488_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49776_0_0|SrvcGrp|22954|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F120829_85283_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F126815_02118_0|SrvcGrp|10944|2022|PDM|1091.13|99|0.00|EMERGENCY ROOM|
20|FH_F143194_19973_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97543_33542_0|SrvcGrp|88978|2022|PDM|6280.00|99|0.00|VAGINAL DELIVERY|
20|FH_F133287_40215_0|SrvcGrp|12290|2022|PDM|947.00|99|0.00|DETOXIFICATION|
20|FH_F47234_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137767_01841_0|CSTM-ALL|CSTM-00|2020|PDM|1625.00|99|0.00|AEG 1 (NO REV)|
20|FH_F37081_0_0|SrvcGrp|18273|2022|PDM|17669.00|99|0.00|MS DRG 459|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F150224_0_0|SrvcGrp|92502|2022|PDM|650.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F35847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F143529_84737_0|SrvcGrp|46605|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F93287_0_0|CSTM-ALL|CSTM-00|2020|PDM|395.00|99|0.00|AEG 10 (NO REV)|
20|FH_F112670_47150_0|SrvcGrp|75545|2022|PDM|313.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F61292_0_0|SrvcGrp|45883|2022|PDM|105.00|99|0.00|OT|
20|FH_F148220_70578_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148480_03079_0|CSTM-ALL|CSTM-00|2020|PDM|2257.50|99|0.00|AEG 6 (NO REV) W/O INTRAOCULAR LENS PROCEDURES|
20|FH_F148440_16506_0|SrvcGrp|115396|2022|PDM|4084.00|99|0.00|EYE INCISION|
20|FH_F124050_75089_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F58514_0_0|SrvcGrp|44302|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) PT MOD GP|
20|FH_F126242_32796_0|SrvcGrp|89149|2022|PDM|265.00|99|0.00|OP INTENSIVE|
20|FH_F44495_0_0|SrvcGrp|38695|2022|PDM|140.00|99|0.00|DIETICIAN VISIT|
20|FH_F149523_0_0|SrvcGrp|113843|2022|PDM|15500.00|99|0.00|REVISE KNEE|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF|
20|FH_F42019_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH|
20|FH_F92091_0_0|SrvcGrp|26274|2022|PDM|3500.00|99|0.00|CPT 29877|
20|FH_F38377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F54513_0_0|SrvcGrp|10544|2022|PDM|110.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F60072_0_0|SrvcGrp|10393|2022|PDM|4000.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F151526_28208_0|CSTM-ALL|CSTM-00|2020|PDM|1546.00|99|0.00|AEG 6 (NO REV)|
20|FH_F130841_49315_0|SrvcGrp|63297|2022|PDM|130.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F70804_0_0|SrvcGrp|29893|2022|PDM|69.23|99|0.00|ST|
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|1102.00|99|0.00|AEG 8 (NO REV)|
20|FH_F135670_01749_0|SrvcGrp|24750|2022|PDM|42.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F145604_14850_0|SrvcGrp|22593|2022|PDM|75.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F112004_15401_0|SrvcGrp|48385|2022|PDM|145.00|99|0.00|SPEECH THERAPY|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|429.70|99|0.00|HAPA WPA-NWPA 2012-13 ASC 113 W/O REV|
20|FH_F128379_0_0|SrvcGrp|67068|2022|PDM|14306.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F109264_33431_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F128508_37210_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133009_19038_0|SrvcGrp|46605|2022|PDM|107.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F147800_0_0|SrvcGrp|100923|2022|PDM|990.00|99|0.00|DRUGS|
20|FH_F131282_0_0|SrvcGrp|111373|2022|PDM|465.00|99|0.00|PHENYLEPHRINE KETOROLAC INJECTION|
20|FH_F128418_88260_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|597.44|99|0.00|ASPG 201|
20|FH_F124928_04210_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125033_93305_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F124294_66614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124441_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
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_F122377_91007_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F138018_17313_0|SrvcGrp|24751|2022|PDM|41.10|99|0.00|INTERMITTENT ANTICOAGULANT THERAPY|
20|FH_F116583_0_0|SrvcGrp|84185|2022|PDM|150.00|99|0.00|RESPITE CARE|
20|FH_F137748_95231_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F92276_32308_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F148352_74637_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F109180_18015_0|SrvcGrp|69075|2022|PDM|70.34|99|0.00|CPT 99213|
20|FH_F148121_21734_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F75307_0_0|SrvcGrp|43567|2022|PDM|105.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F94402_0_0|CSTM-ALL|CSTM-00|2020|PDM|605.00|99|0.00|AEG 1 (NO REV)|
20|FH_F141355_63134_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79704_0_0|SrvcGrp|10527|2022|PDM|160.00|99|0.00|HOSPICE SVCS|
20|FH_F38982_0_0|SrvcGrp|360|2022|PDM|1573.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F141355_63134_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120349_38774_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F119213_66209_0|SrvcGrp|75545|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F124173_66215_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F138739_21157_0|SrvcGrp|89149|2022|PDM|174.00|99|0.00|OP INTENSIVE|
20|FH_F142376_0_0|SrvcGrp|113982|2022|PDM|7069.00|99|0.00|SPINAL CORD DECOMPRESS|
20|FH_F111903_26241_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS|
20|FH_F133749_84604_0|SrvcGrp|83521|2022|PDM|94.50|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F146016_34108_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134495_84321_0|SrvcGrp|46605|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F122470_78229_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F133398_43204_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F142508_29108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119003_78070_0|SrvcGrp|89417|2022|PDM|368.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F109951_0_0|SrvcGrp|12491|2022|PCT|0.45|99|0.00|PACEMAKER|
20|FH_F129758_54405_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F88933_0_0|SrvcGrp|87526|2022|PDM|5402.00|99|0.00|AETNA PERMANENT NEUROSTIMULATOR|
20|FH_F132348_16214_0|SrvcGrp|95660|2022|PDM|446.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F97083_90670_0|SrvcGrp|73605|2022|PDM|2162.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F150480_14043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F141772_80124_0|SrvcGrp|92141|2022|PDM|55.00|99|0.00|ANETHESIA SERVICES|
20|FH_F69123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|INFUSION- IV SERVICES (MOD SH)|
20|FH_F92676_15063_0|SrvcGrp|79063|2022|PDM|433.32|99|0.00|MON VALLEY ASC 133|
20|FH_F117368_68114_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|1995.00|99|0.00|AEG 2 (NO REV)|
20|FH_F64943_0_0|SrvcGrp|61637|2022|PDM|480.00|99|0.00|CRISIS EVALUATION|
20|FH_F142779_64083_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150768_03054_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150770_43113_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119442_72205_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F117714_94301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F140295_0_0|SrvcGrp|70749|2022|PDM|3395.00|99|0.00|CPT 29823|
20|FH_F146256_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72484_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|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_F124441_0_0|SrvcGrp|109145|2022|PDM|14250.00|99|0.00|ARTIFICIAL DISC|
20|FH_F124487_89502_0|SrvcGrp|23683|2022|PDM|60.00|99|0.00|SKILLED NURSING RN|
20|FH_F122393_76020_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F125036_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F70684_0_0|SrvcGrp|29463|2022|PDM|25.00|99|0.00|HOSPICE PAIN MANAGEMENT KIT|
20|FH_F105361_80104_0|CSTM-ALL|CSTM-00|2020|PDM|588.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA) W/OUT ER|
20|FH_F136399_70445_0|SrvcGrp|16|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION|
20|FH_F137147_75006_0|SrvcGrp|75506|2022|PCT|0.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F137147_75006_0|SrvcGrp|72984|2022|PCT|0.00|99|0.00|CHEMOTHERAPY|
20|FH_F137905_91364_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F113586_0_0|SrvcGrp|104402|2022|PCT|0.00|99|0.00|IMAGING ENHANCE SUBSTANCE|
20|FH_F111437_33305_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|913.00|99|0.00|ASPG X|
20|FH_F126975_43551_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132543_79549_0|SrvcGrp|73606|2022|PDM|3000.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F89233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F148906_79336_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144471_19805_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F42352_0_0|SrvcGrp|72|2022|PDM|460.00|99|0.00|NEWBORN NURSERY|
20|FH_F41785_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F44813_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103360_68845_0|SrvcGrp|81656|2022|PDM|12938.00|99|0.00|MS DRG 789 ONLY|
20|FH_F125176_20785_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F31944_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F128988_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F149001_37055_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F72788_0_0|SrvcGrp|3029|2022|PDM|789.00|99|0.00|NEWBORN NURSERY|
20|FH_F67419_0_0|SrvcGrp|47411|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F36343_0_0|SrvcGrp|17139|2022|PDM|513.00|99|0.00|HOSPICE CARE|
20|FH_F110732_31513_0|SrvcGrp|72980|2022|PCT|0.60|99|0.00|AETNA LABORATORY|
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|AEG 2 (NO REV)|
20|FH_F126438_50029_0|SrvcGrp|73605|2022|PDM|888.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F70493_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|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_F40661_0_0|CSTM-ALL|CSTM-00|2020|PDM|541.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F33513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|DME F/S (MOD AU) - MHAC|
20|FH_F138488_0_0|CSTM-ALL|CSTM-00|2020|PDM|661.00|99|0.00|AEG 2 (NO REV)|
20|FH_F113906_0_0|SrvcGrp|72994|2022|PDM|665.00|99|0.00|AEG 3|
20|FH_F113726_61520_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|3025.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F72162_0_0|SrvcGrp|47183|2022|PDM|135.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F129549_01238_0|SrvcGrp|89781|2022|PDM|177.45|99|0.00|RESPITE CARE (HCFA)|
20|FH_F148554_85016_0|SrvcGrp|22552|2022|PDM|4474.00|99|0.00|REMOVAL PERMANENT PACEMAKER|
20|FH_F117821_90049_0|SrvcGrp|93337|2022|PDM|468.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F97622_75051_0|SrvcGrp|73605|2022|PDM|4557.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F97560_23249_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F101840_76054_0|SrvcGrp|16506|2022|PDM|6608.00|99|0.00|CPT 52647|
20|FH_F125266_44515_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F136752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147993_65622_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39723_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (HCFA)|
20|FH_F69750_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F67379_0_0|SrvcGrp|20075|2022|PDM|6357.00|99|0.00|MS DRG 286 ONLY|
20|FH_F139584_10281_0|SrvcGrp|113773|2022|PCT|1.00|99|0.00|TELEMEDICINE (MOD 95, GT)|
20|FH_F47037_0_0|SrvcGrp|14081|2022|PDM|92.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|AEG 7 (NO REV)|
20|FH_F122392_78207_0|SrvcGrp|89417|2022|PDM|424.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F149023_44122_0|SrvcGrp|88163|2022|PDM|13226.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F33566_0_0|CSTM-ALL|CSTM-00|2020|PDM|1379.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66649_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.90|99|0.00|OP SVCS|
20|FH_F120796_33548_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F50240_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F116869_15146_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F72784_0_0|SrvcGrp|44564|2022|PDM|590.55|99|0.00|NEWBORN NURSERY|
20|FH_F37756_0_0|SrvcGrp|53562|2022|PDM|7277.00|99|0.00|DIAGNOSTIC CARDIAC CATH|
20|FH_F110109_32901_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC|
20|FH_F38159_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143900_63303_0|SrvcGrp|90854|2022|PDM|620.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
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_F38900_0_0|SrvcGrp|2738|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F82695_15014_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD RR/KC) - CPD 1963706|
20|FH_F129653_0_0|SrvcGrp|107361|2022|PDM|4000.00|99|0.00|SECOND LEVEL CER DISKECTOMY|
20|FH_F122649_0_0|SrvcGrp|47411|2022|PDM|112.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F50218_0_0|SrvcGrp|15070|2022|PDM|120.00|99|0.00|HOME HEALTH (NEWBORN CARE)|
20|FH_F88254_33411_0|SrvcGrp|29075|2022|PDM|30.00|99|0.00|HYDRATION THERAPY|
20|FH_F105221_01757_0|SrvcGrp|48398|2022|PDM|84.00|99|0.00|PT SERVICES|
20|FH_F129679_20850_0|SrvcGrp|92760|2022|PCT|1.68|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120279_98005_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40709_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139240_81055_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F83754_0_0|SrvcGrp|22820|2022|PCT|0.86|99|0.00|DIALYSIS|
20|FH_F77082_0_0|SrvcGrp|41367|2022|PDM|61837.00|99|0.00|MS DRG 242-244 ONLY|
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 3 (NO REV)|
20|FH_F109630_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|348.65|99|0.00|HAPA WPA-NWPA 2012-13 ASC 107 W/O REV|
20|FH_F43863_0_0|SrvcGrp|30955|2022|PDM|115.00|99|0.00|SKILLED RN VISIT|
20|FH_F117210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136359_0_0|SrvcGrp|112854|2022|PDM|8890.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F115315_43011_0|SrvcGrp|94738|2022|PCT|1.00|99|0.00|FLUZONE VACC IM (>=3 YRS)|
20|FH_F42140_0_0|SrvcGrp|27536|2022|PDM|495.00|99|0.00|HAPA EPA ASC 57 UNGROUPED|
20|FH_F139779_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F66712_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142970_43055_0|SrvcGrp|106300|2022|PDM|280.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F113271_72205_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97042_64804_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F102561_75146_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F144569_71055_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F88512_0_0|SrvcGrp|46526|2022|PDM|24749.14|99|0.00|OP AICD|
20|FH_F119229_90804_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F41739_0_0|SrvcGrp|34808|2022|PDM|27499.00|99|0.00|DRG 003 ONLY CRANIOTOMY|
20|FH_F41670_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88280_0_0|SrvcGrp|22781|2022|PDM|12553.00|99|0.00|MS DRG 244 ONLY|
20|FH_F67419_0_0|SrvcGrp|28933|2022|PCT|1.00|99|0.00|OCN F/S PRICING:  (A & K CODES ONLY)|
20|FH_F39082_0_0|SrvcGrp|2738|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F149662_85015_0|SrvcGrp|93433|2022|PDM|8317.00|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F36435_0_0|SrvcGrp|12594|2022|PCT|1.00|99|0.00|LABORATORY|
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F35384_0_0|SrvcGrp|14414|2022|PDM|467.00|99|0.00|NEWBORN NURSERY|
20|FH_F37364_0_0|SrvcGrp|26204|2022|PDM|700.00|99|0.00|SUB-ACUTE SKILLED NURSING CARE|
20|FH_F136779_0_0|SrvcGrp|104021|2022|PDM|2652.00|99|0.00|CYSTOSCOPY PROSTATIC IMP 1-3|
20|FH_F137748_95231_0|CSTM-ALL|CSTM-00|2020|PDM|3696.00|99|0.00|AEG 10 (NO REV)|
20|FH_F143347_16001_0|SrvcGrp|112812|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER|
20|FH_F98480_0_0|CSTM-ALL|CSTM-00|2020|PDM|579.00|99|0.00|AEG 3 (NO REV)|
20|FH_F115443_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)|
20|FH_F120240_37013_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116698_07470_0|SrvcGrp|34566|2022|PDM|39.90|99|0.00|HOME INFUSION THERAPY|
20|FH_F33925_0_0|SrvcGrp|13217|2022|PCT|0.60|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F66420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135231_90265_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F118194_50841_0|SrvcGrp|86854|2022|PDM|178.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F143973_28040_0|CSTM-ALL|CSTM-00|2020|PDM|640.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F131228_01826_0|SrvcGrp|73559|2022|PDM|5353.72|99|0.00|AETNA INTENSIVE CARE|
20|FH_F123620_0_0|SrvcGrp|2067|2022|PDM|823.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F131507_64154_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133052_33462_0|SrvcGrp|90854|2022|PDM|899.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F111589_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F50974_0_0|CSTM-ALL|CSTM-00|2020|PDM|20.00|99|0.00|ANTIBIOTIC THERAPY Q12 (MOD SH)|
20|FH_F102561_75146_0|SrvcGrp|72994|2022|PDM|2000.00|99|0.00|AEG 3|
20|FH_F120437_85202_0|SrvcGrp|99037|2022|PDM|52.90|99|0.00|ANTIBIOTIC Q6H (HCFA)|
20|FH_F103400_33426_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 6 (NO REV)|
20|FH_F144572_34203_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38700_0_0|SrvcGrp|18288|2022|PCT|0.80|99|0.00|MS DRG 462|
20|FH_F97882_32407_0|SrvcGrp|88977|2022|PDM|8043.00|99|0.00|C-SECTION DELIVERY|
20|FH_F139553_30084_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F151699_01752_0|SrvcGrp|24750|2022|PDM|45.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F147146_06117_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F91799_15010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140295_0_0|SrvcGrp|85792|2022|PDM|4749.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F151007_90048_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129757_0_0|SrvcGrp|471|2022|PDM|1600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F73803_0_0|CSTM-ALL|CSTM-00|2020|PDM|358.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F31087_0_0|SrvcGrp|3809|2022|PDM|586.00|99|0.00|HOSPICE CARE|
20|FH_F116806_0_0|SrvcGrp|107135|2022|PDM|836.56|99|0.00|AURICULAR PROSTHESIS|
20|FH_F124492_30040_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151005_17044_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F72749_0_0|SrvcGrp|30708|2022|PDM|1162.00|99|0.00|SKILLED NURSING FACILITY|
20|FH_F101806_0_0|SrvcGrp|13990|2022|PCT|1.05|99|0.00|PACEMAKER|
20|FH_F116609_35801_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113563_70560_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|AEG 10 (NO REV)|
20|FH_F118874_29926_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F40649_0_0|SrvcGrp|65|2022|PDM|1621.00|99|0.00|OBSTETRICAL CARE|
20|FH_F67339_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116311_02657_0|CSTM-ALL|CSTM-00|2020|PDM|379.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F39551_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS|
20|FH_F115736_77459_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F91622_0_0|CSTM-ALL|CSTM-00|2020|PDM|1627.00|99|0.00|AEG 3 (NO REV) ANTHONY MED CTR|
20|FH_F71686_0_0|SrvcGrp|38452|2022|PCT|0.75|99|0.00|DAY SURGERY SERVICES|
20|FH_F32604_0_0|SrvcGrp|10543|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F100662_27534_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F129657_77479_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39428_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F90362_0_0|SrvcGrp|72990|2022|PDM|389.00|99|0.00|AEG 1|
20|FH_F79800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F94942_0_0|SrvcGrp|94363|2022|PDM|1638.73|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F121149_76021_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F97242_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F90157_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER RRKC|
20|FH_F116279_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|OP SVCS|
20|FH_F145550_62034_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F100962_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F133928_19713_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F80224_0_0|CSTM-ALL|CSTM-00|2020|PDM|2623.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F130329_64114_0|SrvcGrp|86851|2022|PDM|25.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F128379_0_0|SrvcGrp|88163|2022|PDM|14306.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F123623_03246_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54592_0_0|SrvcGrp|27045|2022|PDM|20.33|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 12HRS (MOD SJ)|
20|FH_F133707_73072_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F131212_63017_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F134831_17331_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136542_02446_0|SrvcGrp|73842|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F61813_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F47733_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% L CODES MOD NU|
20|FH_F117113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109926_0_0|SrvcGrp|84121|2022|PCT|1.00|99|0.00|OCULAR IMPLANTS|
20|FH_F90362_0_0|SrvcGrp|78448|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F38792_0_0|CSTM-ALL|CSTM-00|2020|PDM|508.00|99|0.00|BETHANY MED CTR COLONSCOPY MOD SU|
20|FH_F128333_71001_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F110580_71106_0|SrvcGrp|68053|2022|PDM|680.00|99|0.00|CPT 52234|
20|FH_F126341_27284_0|SrvcGrp|29076|2022|PCT|1.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F134608_18017_0|SrvcGrp|90643|2022|PDM|35.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F120384_0_0|SrvcGrp|108180|2022|PDM|400.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F135670_01749_0|SrvcGrp|86846|2022|PDM|35.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F138050_52301_0|SrvcGrp|73606|2022|PDM|968.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F124161_95932_0|SrvcGrp|3178|2022|PDM|2066.00|99|0.00|ACUTE PSYCH|
20|FH_F93190_26456_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37045_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|901.30|99|0.00|HAPA WPA-NWPA 2012-13 ASC 708 W/O REV|
20|FH_F79743_0_0|SrvcGrp|12126|2022|PCT|0.57|99|0.00|OP PET SCAN|
20|FH_F124958_49307_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124173_66215_0|SrvcGrp|17016|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134609_33458_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F121603_46761_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F111563_02116_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F145721_0_0|SrvcGrp|110926|2022|PDM|413.00|99|0.00|IP HOSPICE RESPITE CARE|
20|FH_F34626_0_0|SrvcGrp|59726|2022|PDM|95.00|99|0.00|RN VISIT HOME HEALTH|
20|FH_F136496_61832_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120424_03060_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120489_63552_0|SrvcGrp|31931|2022|PDM|643.00|99|0.00|SKILLED NURSING CARE|
20|FH_F53732_0_0|SrvcGrp|13929|2022|PDM|19.00|99|0.00|GROWTH HORMONE|
20|FH_F120152_0_0|SrvcGrp|107984|2022|PDM|4950.00|99|0.00|PARTIAL REMOVAL OF HEEL|
20|FH_F149522_83221_0|SrvcGrp|104228|2022|PDM|130.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F36803_0_0|SrvcGrp|38|2022|PDM|2500.00|99|0.00|NORMAL DELIVERY|
20|FH_F125113_0_0|SrvcGrp|44461|2022|PDM|23707.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F35750_0_0|SrvcGrp|17548|2022|PCT|0.60|99|0.00|HIGH COST DRUGS|
20|FH_F117615_30525_0|SrvcGrp|107598|2022|PDM|619.00|99|0.00|CT SCAN|
20|FH_F97300_47501_0|SrvcGrp|92760|2022|PCT|2.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35847_0_0|SrvcGrp|3066|2022|PCT|0.66|99|0.00|HIGH-COST DRUGS|
20|FH_F113563_70560_0|CSTM-ALL|CSTM-00|2020|PDM|895.00|99|0.00|AEG 3 (NO REV)|
20|FH_F84394_17402_0|SrvcGrp|114229|2022|PDM|18338.00|99|0.00|NECK SPINE FUSION|
20|FH_F100742_00616_0|SrvcGrp|73659|2022|PDM|2118.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F149866_07401_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F145800_22003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97242_0_0|SrvcGrp|76501|2022|PDM|235.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F122687_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F129603_34769_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F121564_35080_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F120337_85004_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F149863_68127_0|SrvcGrp|75419|2022|PDM|392.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F36822_0_0|SrvcGrp|9826|2022|PCT|0.50|99|0.00|OP SURGERY|
20|FH_F130914_51103_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F111986_0_0|SrvcGrp|68543|2022|PDM|1854.00|99|0.00|CPT 36561|
20|FH_F110604_0_0|SrvcGrp|58634|2022|PDM|6050.00|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F129548_44130_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1401.92|99|0.00|HAPA WPA-NWPA 2012-13 ASC 4 W/O REV|
20|FH_F87796_63376_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122941_62702_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F136037_0_0|SrvcGrp|86723|2022|PDM|416.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F105145_75075_0|SrvcGrp|33979|2022|PDM|24731.00|99|0.00|CPT 27440|
20|FH_F137906_0_0|SrvcGrp|95661|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F137147_75006_0|CSTM-ALL|CSTM-00|2020|PDM|5091.00|99|0.00|AEG 5  (NO REV)|
20|FH_F80062_27612_0|SrvcGrp|471|2022|PDM|472.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149580_98198_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F109652_0_0|SrvcGrp|73000|2022|PDM|3300.00|99|0.00|AEG 6|
20|FH_F114389_50131_0|SrvcGrp|86851|2022|PDM|130.65|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F51438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|ASPG II|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|457.00|99|0.00|HAPA EPA ASC 51|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD AV)|
20|FH_F116533_33619_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F149679_0_0|SrvcGrp|13597|2022|PDM|166.11|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F47884_0_0|CSTM-ALL|CSTM-00|2020|PDM|741.00|99|0.00|ACUTE PSYCH|
20|FH_F130504_33756_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 2 (NO REV)|
20|FH_F128186_43230_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F129666_71901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F143834_06511_0|SrvcGrp|74668|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F78887_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F134287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F100660_56303_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F109264_33431_0|SrvcGrp|73841|2022|PDM|443.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F116753_0_0|CSTM-ALL|CSTM-00|2020|PDM|3320.00|99|0.00|AEG 8 (NO REV)|
20|FH_F138240_64114_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F121476_0_0|SrvcGrp|111249|2022|PDM|575.00|99|0.00|LEVONORGESTREL|
20|FH_F125928_0_0|SrvcGrp|13262|2022|PDM|6.47|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F111605_80524_0|SrvcGrp|93291|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA ESRD USE|
20|FH_F138542_40324_0|SrvcGrp|86722|2022|PDM|171.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F129483_77030_0|SrvcGrp|22589|2022|PDM|35.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F124893_40311_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F148761_33311_0|SrvcGrp|79720|2022|PDM|1100.00|99|0.00|ACUTE REHAB II|
20|FH_F141151_75150_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124637_77080_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F145988_06105_0|SrvcGrp|16065|2022|PCT|0.69|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F128512_37087_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146211_68144_0|SrvcGrp|113628|2022|PDM|6180.00|99|0.00|REVISE KNUCKLE JOINT|
20|FH_F49354_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F72542_0_0|SrvcGrp|9537|2022|PDM|1400.00|99|0.00|CARDIAC CARE UNIT|
20|FH_F111540_16823_0|SrvcGrp|98040|2022|PDM|10.75|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F146659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113326_80014_0|SrvcGrp|93291|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA ESRD USE|
20|FH_F148555_0_0|SrvcGrp|115448|2022|PDM|3090.00|99|0.00|REMOVE & REPLACE PM GEN SINGLE|
20|FH_F40728_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG VI|
20|FH_F150739_44060_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150880_90036_0|SrvcGrp|108484|2022|PDM|750.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F67419_0_0|SrvcGrp|29744|2022|PDM|40.00|99|0.00|SKILLED NURSING CARE - MOD TD|
20|FH_F34400_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98622_45005_0|SrvcGrp|73601|2022|PDM|14346.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F98624_15701_0|SrvcGrp|88978|2022|PDM|7023.00|99|0.00|VAGINAL DELIVERY|
20|FH_F36704_0_0|SrvcGrp|9911|2022|PDM|350.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F124444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140007_0_0|SrvcGrp|112025|2022|PDM|8045.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F100681_73104_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
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_F114666_30342_0|SrvcGrp|67068|2022|PDM|13000.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F113937_15301_0|SrvcGrp|88621|2022|PDM|91.00|99|0.00|SKILLED NURSING LPN|
20|FH_F139652_42211_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS|
20|FH_F148424_01440_0|SrvcGrp|115383|2022|PCT|1.00|99|0.00|COVID-19 INFUSION ADMINISTRATION - REGENERON|
20|FH_F148553_85016_0|SrvcGrp|115463|2022|PDM|2295.00|99|0.00|INSERT SUBQ CAR RHYTHM MONITOR|
20|FH_F122664_07005_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F43779_0_0|SrvcGrp|413|2022|PCT|0.80|99|0.00|TRANSPLANT SVCS|
20|FH_F134791_98034_0|SrvcGrp|89269|2022|PDM|296.00|99|0.00|PSYTX PT/FAMILY 45 MINUTES|
20|FH_F136778_62034_0|SrvcGrp|112941|2022|PDM|9356.00|99|0.00|ALCOHOL/DRUG ABUSE W/O REHAB W/ MCC|
20|FH_F136829_29615_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F112411_28207_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49005_0_0|SrvcGrp|44982|2022|PDM|125.00|99|0.00|MEDICAL SOCIAL WORKER VISIT - IP|
20|FH_F115144_71373_0|SrvcGrp|45752|2022|PDM|66.00|99|0.00|GROUP THERAPY|
20|FH_F115631_65201_0|SrvcGrp|88494|2022|PDM|3177.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F115728_78404_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116393_07002_0|SrvcGrp|106508|2022|PDM|37.15|99|0.00|X-RAY EXAM OF ABDOMEN|
20|FH_F147586_44124_0|SrvcGrp|33984|2022|PDM|1634.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F147725_06002_0|SrvcGrp|106266|2022|PDM|6100.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT|
20|FH_F133550_90630_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F38663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133052_33462_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149344_0_0|SrvcGrp|13422|2022|PDM|188.89|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F141913_65560_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38700_0_0|SrvcGrp|18151|2022|PCT|0.80|99|0.00|MS DRG 250|
20|FH_F150039_34236_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141217_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F33282_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.00|99|0.00|OP SVCS|
20|FH_F39721_0_0|SrvcGrp|25688|2022|PDM|355.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F117366_33162_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149542_89169_0|SrvcGrp|75419|2022|PDM|455.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F33719_0_0|SrvcGrp|8968|2022|PDM|1830.00|99|0.00|NICU LEVEL III & IV|
20|FH_F74424_0_0|SrvcGrp|48003|2022|PDM|371.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F115269_0_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F120144_77031_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|1041.55|99|0.00|ASPG V|
20|FH_F139951_92870_0|SrvcGrp|75419|2022|PDM|650.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F134087_0_0|SrvcGrp|109143|2022|PDM|3312.00|99|0.00|SPINAL INSTRUMENTATION|
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.00|99|0.00|AEG 6 (NO REV)|
20|FH_F98361_12065_0|SrvcGrp|90854|2022|PDM|2696.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F38846_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F80511_0_0|SrvcGrp|75639|2022|PDM|781.00|99|0.00|AETNA IP DETOX SERVICES|
20|FH_F110940_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F48836_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F48836_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F54552_0_0|SrvcGrp|17007|2022|PDM|74.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS|
20|FH_F138730_22602_0|SrvcGrp|104464|2022|PDM|2500.00|99|0.00|VAGINAL DELIVERY (W/ OR W/O EPISIOTOMY)|
20|FH_F151379_21045_0|SrvcGrp|72996|2022|PDM|724.00|99|0.00|AEG 4|
20|FH_F122035_84020_0|SrvcGrp|73841|2022|PDM|478.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F144991_43607_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|2703.00|99|0.00|ASPG IV|
20|FH_F40571_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F91764_93710_0|SrvcGrp|72984|2022|PCT|1.00|99|0.00|CHEMOTHERAPY|
20|FH_F135925_32548_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135964_33805_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F116397_33404_0|SrvcGrp|86846|2022|PDM|40.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F116431_76104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116461_77536_0|SrvcGrp|73841|2022|PDM|324.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F131682_50109_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140629_0_0|SrvcGrp|113667|2022|PDM|2497.00|99|0.00|ESOPHAGUS LAPAROSCOPY|
20|FH_F140629_0_0|SrvcGrp|98404|2022|PDM|2497.00|99|0.00|ARTHROSCOPIC FRACTURE TX|
20|FH_F101558_80443_0|SrvcGrp|89498|2022|PCT|1.00|99|0.00|AIR AND GROUND AMBULANCE|
20|FH_F151143_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134315_89106_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP WITHOUT CPT 99601|
20|FH_F134315_89106_0|SrvcGrp|47183|2022|PDM|80.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1917.00|99|0.00|ASPG VI|
20|FH_F114569_0_0|SrvcGrp|105541|2022|PDM|12.94|99|0.00|AETHA DEPRESSION SCREEN ANNUAL (MOD GT)|
20|FH_F140102_0_0|SrvcGrp|104228|2022|PDM|105.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F98300_30236_0|SrvcGrp|75505|2022|PCT|2.00|99|0.00|CARDIAC STUDIES|
20|FH_F96960_35404_0|SrvcGrp|90854|2022|PDM|2103.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F102960_50613_0|SrvcGrp|72602|2022|PDM|1190.00|99|0.00|ECT|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1408.00|99|0.00|GA RETINA SURG CTR ASC 29|
20|FH_F136299_75218_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F120948_53188_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F120977_50510_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F143528_0_0|SrvcGrp|88065|2022|PDM|9208.50|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F35202_0_0|SrvcGrp|9829|2022|PDM|84.00|99|0.00|PT SVCS|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F63444_0_0|SrvcGrp|3934|2022|PDM|250.00|99|0.00|INTENSIVE ADULT DUAL DIAGNOSIS|
20|FH_F49852_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F116049_0_0|SrvcGrp|26001|2022|PDM|133.35|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F82714_18848_0|SrvcGrp|111930|2022|PDM|14.30|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F139515_0_0|SrvcGrp|89848|2022|PDM|9289.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F71070_0_0|SrvcGrp|47544|2022|PDM|2600.00|99|0.00|PERCUTANEOUS IMPLANT OF NEUROSTIMULATOR ELECTRODES|
20|FH_F151523_86333_0|SrvcGrp|74668|2022|PDM|240.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F70303_0_0|SrvcGrp|11442|2022|PDM|948.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121601_47446_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F88935_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F105145_75075_0|SrvcGrp|88147|2022|PDM|9500.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA|
20|FH_F133461_61277_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F126104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136348_32092_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132733_0_0|SrvcGrp|413|2022|PCT|0.74|99|0.00|TRANSPLANT SVCS|
20|FH_F112844_0_0|SrvcGrp|90477|2022|PDM|115.00|99|0.00|HOSPICE|
20|FH_F77067_0_0|SrvcGrp|20814|2022|PCT|0.65|99|0.00|MS DRG 001-002 ONLY - HEART TRANSPLANT|
20|FH_F113794_0_0|SrvcGrp|42971|2022|PDM|85.00|99|0.00|SKN RN|
20|FH_F103961_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141036_02347_0|SrvcGrp|112813|2022|PCT|1.00|99|0.00|COVID-19 LAB TRANSFER|
20|FH_F146253_60419_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F101840_76054_0|SrvcGrp|97467|2022|PDM|8207.00|99|0.00|PARTIAL EXCISION THYROID|
20|FH_F117087_0_0|SrvcGrp|94989|2022|PDM|2093.00|99|0.00|SINUS ENDO W/ BALLOON DILATION|
20|FH_F139607_0_0|SrvcGrp|76847|2022|PDM|1613.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F32614_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F103781_0_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F111401_29425_0|SrvcGrp|73701|2022|PDM|49.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F144068_17901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88956_0_0|SrvcGrp|75487|2022|PDM|2299.00|99|0.00|AEG 5|
20|FH_F120767_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F147339_08837_0|SrvcGrp|88160|2022|PDM|3500.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F101280_63111_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F46433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|HOME INFUSION (ANTIBIOTIC, ANTIVIRAL, ANTIFUNGAL)|
20|FH_F31486_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|353.00|99|0.00|HAPA EPA ASC 42|
20|FH_F117576_21207_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F110963_30535_0|SrvcGrp|23683|2022|PDM|103.00|99|0.00|SKILLED NURSING RN|
20|FH_F33632_52349_0|SrvcGrp|88819|2022|PDM|770.58|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F146859_0_0|SrvcGrp|106166|2022|PDM|3345.00|99|0.00|REPAIR WRIST JOINT(S)|
20|FH_F114206_37203_0|SrvcGrp|29076|2022|PDM|35.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F143347_16001_0|SrvcGrp|111932|2022|PDM|51.31|99|0.00|COVID-19 NON-CDC TESTING LAB|
20|FH_F47884_0_0|SrvcGrp|11259|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F66501_0_0|CSTM-ALL|CSTM-00|2020|PDM|95.00|99|0.00|HOME INFUSION NURSING SVCS MOD SD|
20|FH_F42999_0_0|SrvcGrp|10541|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F89563_29407_0|SrvcGrp|90486|2022|PCT|1.00|99|0.00|ORTHOTIC MANAGEMENT|
20|FH_F123512_64089_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F77862_0_0|SrvcGrp|34865|2022|PDM|46.28|99|0.00|HOME HEALTH AIDE|
20|FH_F110925_01104_0|SrvcGrp|86134|2022|PDM|161.02|99|0.00|AETNA INJECTION|
20|FH_F125254_30306_0|SrvcGrp|73842|2022|PDM|252.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F144808_0_0|SrvcGrp|34606|2022|PDM|2888.00|99|0.00|CPT 29827|
20|FH_F134087_0_0|SrvcGrp|74039|2022|PDM|6011.00|99|0.00|LAMINECTOMY|
20|FH_F145690_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F149441_28401_0|SrvcGrp|75419|2022|PDM|577.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F109652_0_0|SrvcGrp|87997|2022|PDM|627.00|99|0.00|AETNA CHEMOTHERAPY|
20|FH_F107926_0_0|SrvcGrp|68280|2022|PDM|1875.00|99|0.00|CPT 67040|
20|FH_F51016_0_0|SrvcGrp|11258|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F115895_0_0|SrvcGrp|67068|2022|PDM|7532.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F141050_46410_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F114389_50131_0|SrvcGrp|86850|2022|PDM|130.65|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F74102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117450_63131_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F111403_37167_0|SrvcGrp|87317|2022|PDM|1058.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F132934_63005_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F39604_0_0|SrvcGrp|16321|2022|PDM|28.00|99|0.00|DIALYSIS TRAINING|
20|FH_F91155_16105_0|SrvcGrp|72990|2022|PDM|806.00|99|0.00|AEG 1|
20|FH_F92677_08003_0|SrvcGrp|17015|2022|PDM|18.90|99|0.00|HOME INFUSION THERAPY|
20|FH_F120437_85202_0|SrvcGrp|108451|2022|PDM|476.42|99|0.00|GAMMA GLOBULIN  INTRAM>10 CC|
20|FH_F137638_0_0|SrvcGrp|90854|2022|PDM|928.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F100788_01420_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F128755_62702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137288_0_0|SrvcGrp|113072|2022|PDM|300.00|99|0.00|HALF DAY OP THERAPY|
20|FH_F97280_20018_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F98022_89015_0|SrvcGrp|73605|2022|PDM|1961.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F147080_02446_0|SrvcGrp|90388|2022|PDM|504.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F104640_21204_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113545_11201_0|SrvcGrp|73841|2022|PDM|330.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F149662_85015_0|CSTM-ALL|CSTM-00|2020|PDM|1030.00|99|0.00|AEG 1 (NO REV)|
20|FH_F31087_0_0|SrvcGrp|10518|2022|PDM|98.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT|
20|FH_F35728_34209_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F116806_0_0|SrvcGrp|44144|2022|PDM|1923.16|99|0.00|CPT 42440|
20|FH_F43324_0_0|SrvcGrp|30553|2022|PDM|115.00|99|0.00|EARLY INTERVENTION SPEECH THERAPY|
20|FH_F41457_0_0|SrvcGrp|34346|2022|PDM|2750.00|99|0.00|OP SURGERY|
20|FH_F134427_64014_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F129297_97828_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION|
20|FH_F151699_01752_0|SrvcGrp|86843|2022|PDM|45.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F35927_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F40644_0_0|SrvcGrp|11663|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F132690_87571_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F80513_0_0|SrvcGrp|9838|2022|PDM|1670.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F128334_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133408_01095_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126527_0_0|SrvcGrp|83857|2022|PDM|500.00|99|0.00|IP HOSPICE SVCS|
20|FH_F134156_32174_0|SrvcGrp|87317|2022|PDM|858.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F121472_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F140343_89052_0|SrvcGrp|24745|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F119023_91406_0|SrvcGrp|24761|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118932_07652_0|SrvcGrp|73004|2022|PDM|5453.00|99|0.00|AEG 8|
20|FH_F151054_06473_0|SrvcGrp|88246|2022|PCT|1.00|99|0.00|INFLUENZA DNA AMP PROBE|
20|FH_F120901_0_0|SrvcGrp|58638|2022|PDM|4682.00|99|0.00|CPT 63688|
20|FH_F147010_82930_0|SrvcGrp|81779|2022|PCT|1.75|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F105320_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOSPICE CARE|
20|FH_F100703_0_0|SrvcGrp|96939|2022|PDM|4284.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F132544_0_0|SrvcGrp|101107|2022|PDM|7850.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F132722_71373_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F86394_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146258_90004_0|SrvcGrp|98701|2022|PCT|0.60|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F133530_11237_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F113586_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124928_04210_0|SrvcGrp|80920|2022|PDM|643.69|99|0.00|HOSPICE SERVICES|
20|FH_F63244_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126868_60451_0|SrvcGrp|89417|2022|PDM|395.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F102525_73134_0|CSTM-ALL|CSTM-00|2020|PDM|8000.00|99|0.00|MS DRG 491 ONLY|
20|FH_F50498_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125081_15218_0|SrvcGrp|24739|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|VERTICAL PLUS MRI OP SERVICES|
20|FH_F137788_72632_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F112712_63005_0|SrvcGrp|22593|2022|PCT|1.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F145758_20745_0|SrvcGrp|77021|2022|PDM|1632.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F130204_40807_0|SrvcGrp|89417|2022|PDM|381.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F62915_0_0|SrvcGrp|58798|2022|PCT|1.64|99|0.00|OCN F/S RADIOLOGY (HCFA) POS FAC (MOD 26 TC) GLOBAL|
20|FH_F125867_78748_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145550_62034_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F48418_0_0|CSTM-ALL|CSTM-00|2020|PDM|130.00|99|0.00|OP SVCS|
20|FH_F151400_0_0|SrvcGrp|97319|2022|PDM|6700.00|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F120155_63114_0|SrvcGrp|85017|2022|PCT|0.75|99|0.00|DME|
20|FH_F133534_33483_0|SrvcGrp|89149|2022|PDM|189.00|99|0.00|OP INTENSIVE|
20|FH_F126242_32796_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F49299_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F90362_0_0|SrvcGrp|73002|2022|PDM|1139.00|99|0.00|AEG 7|
20|FH_F110102_0_0|SrvcGrp|104334|2022|PDM|150.00|99|0.00|IP HOSPICE HOME CARE|
20|FH_F93902_04043_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F83293_0_0|SrvcGrp|47250|2022|PDM|1296.00|99|0.00|MS DRG 876, 880-887 ONLY|
20|FH_F127032_33573_0|SrvcGrp|101562|2022|PCT|1.00|99|0.00|HOSPICE/PHYSICIAN|
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|WELLPATH ASC VII|
20|FH_F110925_01104_0|SrvcGrp|86137|2022|PDM|358.00|99|0.00|AETNA VELAGLUCERASE|
20|FH_F38411_0_0|SrvcGrp|19460|2022|PCT|0.80|99|0.00|MS DRG 917|
20|FH_F141337_60077_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F103320_0_0|SrvcGrp|72990|2022|PDM|536.00|99|0.00|AEG 1|
20|FH_F133749_84604_0|SrvcGrp|112460|2022|PDM|2.00|99|0.00|HOME INFUSION THERAPY SINGLE LUMEN|
20|FH_F127725_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F81698_10457_0|SrvcGrp|22593|2022|PDM|31.50|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F110507_33462_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F111732_33771_0|SrvcGrp|3483|2022|PDM|4750.00|99|0.00|CPT CODE 59400|
20|FH_F122532_46385_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F111584_07002_0|SrvcGrp|90040|2022|PDM|386.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F89778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1558.00|99|0.00|AEG 7 (NO REV)|
20|FH_F139382_49202_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35210_0_0|SrvcGrp|115|2022|PDM|1227.00|99|0.00|SKILLED NURSING CARE|
20|FH_F116753_0_0|SrvcGrp|12787|2022|PCT|0.46|99|0.00|IMPLANTS|
20|FH_F149023_44122_0|SrvcGrp|88493|2022|PDM|2275.00|99|0.00|AETNA VERTEBROPLASTY ADDL INJECT|
20|FH_F50078_0_0|SrvcGrp|42976|2022|PDM|70.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F150399_53045_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F132126_08037_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F143412_70503_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F136247_28804_0|SrvcGrp|89412|2022|PDM|329.02|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F31736_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|2625.00|99|0.00|AEG 9 (NO REV)|
20|FH_F52393_0_0|SrvcGrp|49111|2022|PDM|4600.00|99|0.00|HEARING AID|
20|FH_F38709_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41053_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|1808.00|99|0.00|ASPG IX|
20|FH_F115685_64064_0|SrvcGrp|86835|2022|PDM|20.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OBSERVATION SERVICES|
20|FH_F121090_07848_0|SrvcGrp|90632|2022|PDM|149.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150165_06032_0|SrvcGrp|114443|2022|PDM|4562.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F40850_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F118265_46268_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143615_92612_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F134656_02852_0|SrvcGrp|473|2022|PDM|300.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|860.81|99|0.00|ASPG V|
20|FH_F149322_19023_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145921_73139_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F84935_0_0|SrvcGrp|16429|2022|PCT|0.90|99|0.00|OBSERVATION SVCS|
20|FH_F111602_17102_0|SrvcGrp|73842|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F105301_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F124754_84403_0|SrvcGrp|73605|2022|PDM|1028.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F148720_0_0|SrvcGrp|79618|2022|PDM|325.00|99|0.00|CPT CODE 90945 (HCFA)|
20|FH_F147340_0_0|SrvcGrp|105470|2022|PDM|1550.00|99|0.00|TRAINING INCL A TREATMENT|
20|FH_F117087_0_0|CSTM-ALL|CSTM-00|2020|PDM|773.00|99|0.00|AEG 1 (NO REV)|
20|FH_F129535_0_0|SrvcGrp|77292|2022|PDM|450.00|99|0.00|AETNA REMV TUNNLD CVAD W/SUBQ PORT|
20|FH_F151086_60649_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F116323_0_0|SrvcGrp|106669|2022|PDM|24089.00|99|0.00|AETNA POSTERIOR CERVICAL FUSION|
20|FH_F103961_63017_0|SrvcGrp|80318|2022|PDM|105.00|99|0.00|HOSPICE CARE (ALL OTHER)|
20|FH_F85154_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F71443_0_0|CSTM-ALL|CSTM-00|2020|PDM|12.00|99|0.00|SKILLED NURSING|
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|1276.00|99|0.00|AEG 9 (NO REV)|
20|FH_F134487_14843_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F34998_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F81373_64064_0|SrvcGrp|80|2022|PDM|702.00|99|0.00|ACUTE PSYCH|
20|FH_F115431_32821_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F150519_92626_0|SrvcGrp|114008|2022|PDM|600.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F126666_44053_0|SrvcGrp|91391|2022|PDM|56.00|99|0.00|AETNA GROUP PSYCHOTHERAPY (MOD AF)|
20|FH_F131093_49690_0|SrvcGrp|97704|2022|PDM|130.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F47128_0_0|SrvcGrp|3982|2022|PDM|2121.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F120050_92626_0|SrvcGrp|87317|2022|PDM|1175.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F142454_0_0|SrvcGrp|113940|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F38431_0_0|SrvcGrp|23004|2022|PDM|650.00|99|0.00|V5257|
20|FH_F46732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F145550_62034_0|SrvcGrp|84185|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F42999_0_0|SrvcGrp|10545|2022|PDM|70.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F126465_37190_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F32502_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133178_0_0|SrvcGrp|112208|2022|PDM|94.00|99|0.00|DESTROY VAGINAL LESIONS SIMPLE|
20|FH_F124585_33070_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F117906_91606_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F132080_0_0|SrvcGrp|97705|2022|PDM|169.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F132900_06074_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F141654_15217_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F149881_03038_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F133142_19076_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126930_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F71162_0_0|CSTM-ALL|CSTM-00|2020|PDM|440.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43164_0_0|SrvcGrp|16|2022|PDM|773.00|99|0.00|ACUTE REHABILITATION|
20|FH_F141802_17042_0|SrvcGrp|92958|2022|PCT|0.68|99|0.00|SLEEP STUDIES|
20|FH_F118540_32064_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|42.52|99|0.00|DELAWARE VALLEY- ASC 224|
20|FH_F70711_0_0|SrvcGrp|17806|2022|PDM|4406.00|99|0.00|CPT 28890|
20|FH_F121304_61520_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151639_90034_0|SrvcGrp|46903|2022|PDM|770.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F124452_31322_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F35452_0_0|CSTM-ALL|CSTM-00|2020|PDM|1375.00|99|0.00|ASPG V|
20|FH_F119008_0_0|SrvcGrp|83857|2022|PDM|475.00|99|0.00|IP HOSPICE SVCS|
20|FH_F72788_0_0|SrvcGrp|3271|2022|PDM|5244.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F116575_0_0|SrvcGrp|90822|2022|PDM|1800.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY|
20|FH_F134916_16421_0|SrvcGrp|106294|2022|PDM|244.88|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F107980_08005_0|SrvcGrp|89417|2022|PDM|288.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F150521_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F110783_93013_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING-OP W/O HOME INFUSION|
20|FH_F134874_80120_0|SrvcGrp|89149|2022|PDM|180.00|99|0.00|OP INTENSIVE|
20|FH_F148882_20814_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|HSS ASC|
20|FH_F39476_0_0|SrvcGrp|10939|2022|PDM|1701.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F137588_33852_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F115736_77459_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F32034_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F131236_84041_0|SrvcGrp|80920|2022|PDM|93.00|99|0.00|HOSPICE SERVICES|
20|FH_F86319_16365_0|SrvcGrp|75506|2022|PCT|0.63|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F145815_30540_0|SrvcGrp|113299|2022|PDM|16.94|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - MODERNA|
20|FH_F91622_0_0|SrvcGrp|91424|2022|PDM|9125.00|99|0.00|BRACHYTHERAPY|
20|FH_F86872_15215_0|SrvcGrp|86838|2022|PDM|15.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F150165_06032_0|SrvcGrp|41336|2022|PDM|4570.00|99|0.00|VAGINAL HYSTERECTOMY|
20|FH_F132952_34994_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125133_20601_0|SrvcGrp|88620|2022|PDM|196.00|99|0.00|SKILLED NURSING RN|
20|FH_F121700_60938_0|SrvcGrp|89337|2022|PDM|1000.00|99|0.00|DETOXIFICATION|
20|FH_F85353_16407_0|SrvcGrp|3950|2022|PDM|4793.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F118123_67226_0|SrvcGrp|46104|2022|PDM|50.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F99161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150001_33064_0|SrvcGrp|29077|2022|PDM|11.00|99|0.00|HOME TRANSFUSION|
20|FH_F118667_95131_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F145865_78130_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F88818_0_0|SrvcGrp|87817|2022|PDM|300.00|99|0.00|REMOVAL OF SKIN LESION|
20|FH_F38977_0_0|SrvcGrp|65|2022|PDM|1667.00|99|0.00|OBSTETRICAL CARE|
20|FH_F125212_76301_0|SrvcGrp|108484|2022|PDM|430.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F45977_0_0|SrvcGrp|11068|2022|PDM|100.00|99|0.00|PT SVCS|
20|FH_F132528_64014_0|SrvcGrp|47183|2022|PDM|127.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F147997_92620_0|SrvcGrp|108484|2022|PDM|3300.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F150768_03054_0|SrvcGrp|80920|2022|PDM|805.00|99|0.00|HOSPICE SERVICES|
20|FH_F149160_02180_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F147360_06415_0|SrvcGrp|111927|2022|PCT|1.00|99|0.00|COVID-19 NON CDC|
20|FH_F116332_0_0|SrvcGrp|111810|2022|PDM|16409.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F132436_33144_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116533_33619_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F33559_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F149980_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F129653_0_0|SrvcGrp|53065|2022|PDM|2000.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F37679_0_0|SrvcGrp|32704|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F148483_94087_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F93557_15147_0|SrvcGrp|75545|2022|PDM|340.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F39479_0_0|SrvcGrp|30551|2022|PDM|85.00|99|0.00|EARLY INTERVENTION PHYSICAL THERAPY|
20|FH_F149523_0_0|SrvcGrp|98560|2022|PDM|15000.00|99|0.00|LUMBAR|
20|FH_F87254_0_0|SrvcGrp|73004|2022|PDM|1640.00|99|0.00|AEG 8|
20|FH_F41776_0_0|SrvcGrp|18932|2022|PDM|4631.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806|
20|FH_F130821_85712_0|SrvcGrp|87914|2022|PDM|12.13|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F109577_0_0|SrvcGrp|103614|2022|PDM|123.00|99|0.00|MED NUTRITION - GROUP|
20|FH_F114527_39047_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130763_0_0|SrvcGrp|88492|2022|PDM|5823.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F100782_0_0|SrvcGrp|105160|2022|PDM|1089.13|99|0.00|WINDBER MEDICAL CNTR ASC 405|
20|FH_F87571_0_0|SrvcGrp|22809|2022|PDM|1250.00|99|0.00|INPATIENT SURGICAL|
20|FH_F150219_38578_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|2860.00|99|0.00|AEG 8 (NO REV)|
20|FH_F145708_89030_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F146559_71901_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120539_89029_0|SrvcGrp|29347|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F149199_73005_0|SrvcGrp|113463|2022|PCT|0.00|99|0.00|LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F81852_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HAPA WPA/NWPA 2014 LABS 100%|
20|FH_F98780_35022_0|SrvcGrp|73601|2022|PDM|4955.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F105143_26062_0|SrvcGrp|91437|2022|PDM|441.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F80513_0_0|SrvcGrp|69801|2022|PCT|0.74|99|0.00|OP SURGERY|
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|818.13|99|0.00|2005 ASPG GROUPER V|
20|FH_F93360_64730_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F140343_89052_0|SrvcGrp|14893|2022|PDM|47.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F140343_89052_0|SrvcGrp|24750|2022|PDM|30.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F124893_40311_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F135653_0_0|SrvcGrp|40003|2022|PDM|14000.00|99|0.00|TOTAL KNEE|
20|FH_F34914_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HRHO 1038716 SLEEP STUDIES|
20|FH_F111044_0_0|SrvcGrp|104170|2022|PDM|1648.00|99|0.00|AETNA ARTHROSCOPY SURGERY|
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 7 (NO REV)|
20|FH_F134843_83638_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F49300_0_0|SrvcGrp|42976|2022|PDM|100.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F98022_89015_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F134847_0_0|SrvcGrp|35669|2022|PDM|4536.00|99|0.00|CPT 63650|
20|FH_F137748_95231_0|SrvcGrp|104567|2022|PDM|20000.00|99|0.00|TRAUMA|
20|FH_F40530_0_0|SrvcGrp|13551|2022|PDM|440.00|99|0.00|NEWBORN NURSERY|
20|FH_F91996_33805_0|SrvcGrp|3809|2022|PDM|588.21|99|0.00|HOSPICE CARE|
20|FH_F128543_44413_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F111246_80027_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119946_36109_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120248_77008_0|SrvcGrp|89412|2022|PDM|250.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F65440_0_0|CSTM-ALL|CSTM-00|2020|PDM|1267.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F84215_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F35259_0_0|SrvcGrp|23|2022|PCT|0.68|99|0.00|BONE MARROW TRANSPLANT|
20|FH_F40525_0_0|SrvcGrp|32992|2022|PDM|475.00|99|0.00|CT SCANS|
20|FH_F71386_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141527_36830_0|SrvcGrp|86844|2022|PDM|26.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F142611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123466_93420_0|SrvcGrp|73605|2022|PDM|1200.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F39278_0_0|SrvcGrp|9828|2022|PDM|105.00|99|0.00|HOME HEALTH AIDE|
20|FH_F122893_29135_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130662_07032_0|SrvcGrp|89417|2022|PDM|325.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F130841_49315_0|SrvcGrp|97506|2022|PDM|130.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F146160_52803_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F93743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|608.96|99|0.00|ASPG IV|
20|FH_F63312_0_0|SrvcGrp|22387|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F111695_30286_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F80186_0_0|CSTM-ALL|CSTM-00|2020|PDM|407.00|99|0.00|AEG 1 (NO REV)|
20|FH_F143571_0_0|SrvcGrp|113451|2022|PDM|87.23|99|0.00|HOSPICE CARE|
20|FH_F80186_0_0|CSTM-ALL|CSTM-00|2020|PDM|518.10|99|0.00|AEG 10 (NO REV)|
20|FH_F144248_0_0|SrvcGrp|42428|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 65855|
20|FH_F143289_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|472.28|99|0.00|HAPA WPA-NWPA 2012-13 ASC 224 W/O REV|
20|FH_F102200_06416_0|SrvcGrp|29076|2022|PCT|1.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F147725_06002_0|SrvcGrp|94989|2022|PDM|4576.00|99|0.00|SINUS ENDO W/ BALLOON DILATION|
20|FH_F147725_06002_0|SrvcGrp|79101|2022|PDM|4000.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F129483_77030_0|SrvcGrp|111026|2022|PCT|0.83|99|0.00|SUPPLIES|
20|FH_F77763_0_0|SrvcGrp|100947|2022|PDM|85.00|99|0.00|HOME HEALTH RN SERVICE|
20|FH_F51478_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F64819_0_0|CSTM-ALL|CSTM-00|2020|PDM|1483.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100703_0_0|SrvcGrp|97099|2022|PDM|8034.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F119507_92627_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F67379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F140036_07702_0|CSTM-ALL|CSTM-00|2020|PDM|876.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F119913_31545_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119760_0_0|SrvcGrp|93098|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F148400_33401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F83793_77477_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F151542_32224_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F116760_68512_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F39855_0_0|CSTM-ALL|CSTM-00|2020|PDM|1091.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145535_92708_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F98920_46526_0|SrvcGrp|73559|2022|PDM|7284.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32935_0_0|SrvcGrp|13390|2022|PCT|0.60|99|0.00|DIALYSIS SVCS|
20|FH_F86101_76063_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F111288_0_0|SrvcGrp|113481|2022|PDM|8670.00|99|0.00|LAPAROSCOPY|
20|FH_F121084_13114_0|SrvcGrp|90631|2022|PDM|135.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F34550_0_0|SrvcGrp|701|2022|PDM|1533.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F38982_0_0|SrvcGrp|65|2022|PDM|1762.00|99|0.00|OBSTETRICAL CARE|
20|FH_F109282_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F69647_0_0|SrvcGrp|17067|2022|PDM|785.00|99|0.00|ASPG II|
20|FH_F75087_0_0|SrvcGrp|27346|2022|PDM|4000.00|99|0.00|REPAIR BLADDER DEFECT|
20|FH_F110542_10035_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F46290_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|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_F86131_28215_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F110542_10035_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F100782_0_0|SrvcGrp|105092|2022|PDM|317.13|99|0.00|WINDBER MEDICAL CNTR ASC 137|
20|FH_F121225_98902_0|SrvcGrp|24745|2022|PDM|200.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F132883_31602_0|SrvcGrp|86843|2022|PDM|20.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F130468_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121639_06830_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112665_0_0|SrvcGrp|88163|2022|PDM|5296.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F146605_72205_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134831_17331_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|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_F86851_0_0|SrvcGrp|85000|2022|PDM|788.00|99|0.00|CPT 45384|
20|FH_F136399_70445_0|SrvcGrp|78579|2022|PDM|1300.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
20|FH_F136426_19006_0|SrvcGrp|13597|2022|PDM|238.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F134150_01801_0|SrvcGrp|91957|2022|PDM|188.00|99|0.00|INTENSIVE OUTPATIENT (>=18 YRS)|
20|FH_F138892_46341_0|SrvcGrp|86648|2022|PCT|1.13|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F109920_39180_0|SrvcGrp|11663|2022|PCT|0.33|99|0.00|IMPLANTS|
20|FH_F110342_0_0|SrvcGrp|73006|2022|PDM|2886.00|99|0.00|AEG 9|
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.00|99|0.00|AEG 2 (NO REV)|
20|FH_F148761_33311_0|SrvcGrp|73485|2022|PDM|950.00|99|0.00|AETNA REHAB|
20|FH_F151061_02720_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F113744_80301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 9 (NO REV)|
20|FH_F114389_50131_0|SrvcGrp|105607|2022|PDM|64.61|99|0.00|TUBING (MOD NU)|
20|FH_F49487_0_0|SrvcGrp|15596|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F126975_43551_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F106822_0_0|SrvcGrp|101411|2022|PDM|45.00|99|0.00|NEW PATIENT OFFICE VISIT|
20|FH_F32316_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1286.00|99|0.00|AEG 7 (NO REV)|
20|FH_F114389_50131_0|SrvcGrp|86838|2022|PDM|31.24|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F57114_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS|
20|FH_F124613_64735_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F132973_28054_0|SrvcGrp|73842|2022|PDM|138.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F31093_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|RAD F/S - SPCE|
20|FH_F127327_27401_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F44097_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F137639_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.32|99|0.00|OP SVCS|
20|FH_F123373_0_0|SrvcGrp|22899|2022|PDM|2914.00|99|0.00|ICU|
20|FH_F125212_76301_0|SrvcGrp|86722|2022|PDM|181.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F128929_33030_0|SrvcGrp|89417|2022|PDM|412.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F37778_0_0|SrvcGrp|27308|2022|PDM|1749.00|99|0.00|TYMPANOPLASTY|
20|FH_F128564_43235_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F89851_83854_0|SrvcGrp|80679|2022|PCT|1.80|99|0.00|AETNA RADIOLOGY|
20|FH_F139444_32966_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139677_77087_0|SrvcGrp|73842|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119946_36109_0|SrvcGrp|76501|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F92278_01440_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F130723_0_0|SrvcGrp|86505|2022|PDM|1500.00|99|0.00|DENTAL SURGERY|
20|FH_F147418_0_0|CSTM-ALL|CSTM-00|2020|PDM|2840.00|99|0.00|AEG 6 (NO REV)|
20|FH_F137902_0_0|SrvcGrp|89417|2022|PDM|269.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F38475_0_0|SrvcGrp|10543|2022|PDM|110.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F120099_86305_0|SrvcGrp|87317|2022|PDM|1221.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F98480_0_0|SrvcGrp|95799|2022|PDM|953.00|99|0.00|ESOPHAGUS ENDOSCOPY REPAIR|
20|FH_F120191_91360_0|SrvcGrp|74668|2022|PDM|500.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120921_75835_0|SrvcGrp|472|2022|PDM|475.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F38526_0_0|SrvcGrp|23929|2022|PCT|0.65|99|0.00|HIGH COST DRUGS|
20|FH_F121090_07848_0|SrvcGrp|90631|2022|PDM|149.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F116092_83254_0|SrvcGrp|73501|2022|PCT|0.92|99|0.00|AETNA OBSERVATION|
20|FH_F145545_01602_0|SrvcGrp|90397|2022|PDM|284.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|3125.00|99|0.00|REPAIR UMBILICAL HERNIA (>5 YRS)|
20|FH_F34454_0_0|SrvcGrp|12263|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F150699_0_0|SrvcGrp|109494|2022|PDM|12296.00|99|0.00|INSRT HEART PM ATRIAL & VENT|
20|FH_F94862_0_0|SrvcGrp|72998|2022|PDM|800.00|99|0.00|AEG 5|
20|FH_F42905_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149819_75067_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125943_66071_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120939_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F126033_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126844_44333_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120248_77008_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F129653_0_0|SrvcGrp|41334|2022|PDM|4000.00|99|0.00|TOTAL KNEE|
20|FH_F139274_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)|
20|FH_F65159_0_0|SrvcGrp|29921|2022|PDM|5108.00|99|0.00|PTCA|
20|FH_F130905_60187_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143568_85006_0|SrvcGrp|71951|2022|PCT|2.23|99|0.00|HOME SLEEP TEST|
20|FH_F133877_84117_0|SrvcGrp|80920|2022|PDM|93.00|99|0.00|HOSPICE SERVICES|
20|FH_F120484_31419_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150147_24541_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|2990.00|99|0.00|AEG 4 (NO REV)|
20|FH_F132802_68022_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F85098_33486_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F96160_32207_0|SrvcGrp|86852|2022|PDM|68.65|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F49598_0_0|SrvcGrp|33793|2022|PDM|3183.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F133658_60053_0|SrvcGrp|48396|2022|PDM|125.00|99|0.00|OT SERVICES|
20|FH_F86851_0_0|SrvcGrp|84993|2022|PDM|324.00|99|0.00|CPT 45320|
20|FH_F134011_84102_0|SrvcGrp|24761|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F137236_17603_0|SrvcGrp|105047|2022|PDM|175.00|99|0.00|AETNA PSYCH DIAG EVAL W/ MED SVCS (HCFA)|
20|FH_F86319_16365_0|SrvcGrp|73601|2022|PDM|2279.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F135235_01830_0|SrvcGrp|75419|2022|PDM|625.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F125676_02892_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|682.00|99|0.00|AEG 3 (NO REV)|
20|FH_F80613_0_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F122947_29532_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38790_0_0|SrvcGrp|439|2022|PDM|1177.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F85353_16407_0|SrvcGrp|63834|2022|PDM|490.32|99|0.00|HAPA WPA-NWPA 2012-13 ASC 217|
20|FH_F93359_63084_0|SrvcGrp|92799|2022|PDM|418.00|99|0.00|AETNA RESIDENTIAL TREATMENT PYCH & CD (AGE 18-150)|
20|FH_F110562_33409_0|SrvcGrp|89417|2022|PDM|955.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F149339_44147_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F109405_73106_0|SrvcGrp|45751|2022|PDM|80.00|99|0.00|INDIVIDUAL THERAPY|
20|FH_F122520_46383_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F71964_0_0|SrvcGrp|68864|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F133050_78216_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F65239_0_0|SrvcGrp|61357|2022|PDM|1202.00|99|0.00|SURGICAL CARVEOUTS|
20|FH_F149501_34471_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117301_01887_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F107926_0_0|SrvcGrp|68283|2022|PDM|1875.00|99|0.00|CPT 67043|
20|FH_F142007_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151154_91761_0|SrvcGrp|48394|2022|PDM|60.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F69651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F91873_12723_0|SrvcGrp|89145|2022|PDM|9740.00|99|0.00|BARIATRIC SURGERY|
20|FH_F42744_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|PSYCHIATRIC RESIDENTIAL TREATMENT|
20|FH_F113541_0_0|SrvcGrp|39906|2022|PDM|1955.00|99|0.00|MASTECTOMY, SIMPLE, COMPLETE|
20|FH_F119435_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 9 (NO REV)|
20|FH_F94786_07974_0|SrvcGrp|24744|2022|PDM|73.50|99|0.00|PICC LINE INSERTION|
20|FH_F132988_0_0|SrvcGrp|35670|2022|PDM|36969.87|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F101851_78024_0|SrvcGrp|89417|2022|PDM|465.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F63618_0_0|SrvcGrp|60112|2022|PDM|6000.00|99|0.00|ICU/CCU 200-203, 208-213, 219|
20|FH_F92676_15063_0|SrvcGrp|79048|2022|PDM|610.80|99|0.00|MON VALLEY ASC 15|
20|FH_F111809_93003_0|SrvcGrp|78682|2022|PDM|37178.00|99|0.00|AETNA PERCUTANEOUS CORONARY ANGIOPLASTY|
20|FH_F81494_0_0|SrvcGrp|63|2022|PDM|1006.00|99|0.00|SUBACUTE CARE|
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F106880_80528_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 9 (NO REV)|
20|FH_F142673_0_0|CSTM-ALL|CSTM-00|2020|PDM|1017.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F134487_14843_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F37553_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|RS 580 CT CODES|
20|FH_F133124_33837_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F131495_77407_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151699_01752_0|SrvcGrp|47183|2022|PDM|117.50|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F120119_0_0|SrvcGrp|106235|2022|PDM|2971.00|99|0.00|CYPASS|
20|FH_F132694_0_0|SrvcGrp|13724|2022|PCT|0.49|99|0.00|PHARMACY SVCS|
20|FH_F40526_0_0|CSTM-ALL|CSTM-00|2020|PDM|1335.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146716_46733_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111603_19529_0|SrvcGrp|93919|2022|PDM|520.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F96182_0_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F118171_00674_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137815_15501_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F111361_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F73022_0_0|SrvcGrp|43506|2022|PCT|0.50|99|0.00|OP LAB|
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F98380_43055_0|SrvcGrp|88977|2022|PDM|5192.00|99|0.00|C-SECTION DELIVERY|
20|FH_F123533_63825_0|SrvcGrp|75545|2022|PDM|327.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F61332_0_0|SrvcGrp|14610|2022|PCT|0.65|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F82696_16335_0|SrvcGrp|87939|2022|PCT|0.00|99|0.00|SELF ADMINISTERED DRUGS|
20|FH_F116161_28112_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F148255_72703_0|SrvcGrp|24752|2022|PDM|10.50|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F131267_48846_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124965_0_0|SrvcGrp|72992|2022|PDM|760.00|99|0.00|AEG 2|
20|FH_F123902_19140_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
20|FH_F123501_64831_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F123895_52722_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F55872_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149603_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|OP SVCS|
20|FH_F110604_0_0|SrvcGrp|87677|2022|PDM|1100.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F133585_0_0|SrvcGrp|78760|2022|PDM|580.00|99|0.00|AETNA PTCA REVASC W/STENT AND ATHERECTOMY|
20|FH_F146124_06112_0|SrvcGrp|73485|2022|PDM|2643.00|99|0.00|AETNA REHAB|
20|FH_F146881_83661_0|SrvcGrp|82223|2022|PDM|140.00|99|0.00|HOSPICE CARE|
20|FH_F126376_23936_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F46433_0_0|SrvcGrp|22593|2022|PDM|35.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F121250_47401_0|SrvcGrp|73842|2022|PDM|187.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F126527_0_0|SrvcGrp|29155|2022|PDM|110.00|99|0.00|HOSPICE SVCS|
20|FH_F132810_0_0|SrvcGrp|22589|2022|PDM|35.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F140753_75038_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F137329_81224_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|727.00|99|0.00|AEG 4 (NO REV)|
20|FH_F72204_0_0|SrvcGrp|29462|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE - MOD TF|
20|FH_F75542_0_0|SrvcGrp|17139|2022|PDM|644.00|99|0.00|HOSPICE CARE|
20|FH_F124116_79410_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146797_44906_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146715_34240_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F147010_82930_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F149861_85225_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F68888_0_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F128421_27016_0|SrvcGrp|103913|2022|PCT|0.80|99|0.00|OP DIALYSIS|
20|FH_F39417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|ASPG X|
20|FH_F145964_10993_0|SrvcGrp|92760|2022|PCT|1.47|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136751_0_0|SrvcGrp|98266|2022|PDM|20500.00|99|0.00|REVISE KNEECAP|
20|FH_F146257_83713_0|SrvcGrp|74668|2022|PDM|236.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F40980_0_0|SrvcGrp|360|2022|PDM|5274.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F150526_16335_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133412_84129_0|SrvcGrp|472|2022|PDM|377.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F115383_80734_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INJECTION, PEGFILGRASTIM 6MG|
20|FH_F118468_21502_0|SrvcGrp|75545|2022|PDM|343.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F120437_85202_0|SrvcGrp|17007|2022|PDM|52.90|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS|
20|FH_F80952_45669_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OUTPATIENT CODES/SURGERY CARVE OUTS - TGSC|
20|FH_F41181_0_0|SrvcGrp|38|2022|PDM|3432.00|99|0.00|NORMAL DELIVERY|
20|FH_F120437_85202_0|SrvcGrp|88805|2022|PDM|185.71|99|0.00|TOTAL PARENTERAL NUTRITION; > 3 LITERS (HCFA)|
20|FH_F150659_84604_0|SrvcGrp|75419|2022|PDM|925.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F35685_0_0|CSTM-ALL|CSTM-00|2020|PDM|1929.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F36034_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F43156_0_0|SrvcGrp|675|2022|PDM|800.00|99|0.00|PEDIATRIC INPATIENT SVCS|
20|FH_F103004_75840_0|SrvcGrp|93180|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F123445_0_0|SrvcGrp|80920|2022|PDM|692.00|99|0.00|HOSPICE SERVICES|
20|FH_F140873_0_0|SrvcGrp|104226|2022|PDM|152.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F130796_0_0|SrvcGrp|82981|2022|PDM|110.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F127604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F136546_33176_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136569_16506_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136665_80004_0|SrvcGrp|82981|2022|PDM|190.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F114638_25309_0|SrvcGrp|111995|2022|PCT|0.75|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F138207_63017_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PDM|24.05|99|0.00|PRE-TRANSPLANT ENVIRONMENTAL ASSESSMENT|
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|AEG 1 (NO REV)|
20|FH_F148553_85016_0|CSTM-ALL|CSTM-00|2020|PDM|515.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132595_0_0|SrvcGrp|3078|2022|PCT|0.57|99|0.00|DRUGS|
20|FH_F43862_0_0|SrvcGrp|37406|2022|PDM|90.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F134727_30650_0|SrvcGrp|12280|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F135761_70127_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F106963_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F136829_29615_0|SrvcGrp|86723|2022|PDM|986.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F136913_68803_0|SrvcGrp|12491|2022|PCT|1.15|99|0.00|PACEMAKER|
20|FH_F112465_28401_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F115266_66736_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115631_65201_0|SrvcGrp|102480|2022|PDM|3177.00|99|0.00|CPT 29897|
20|FH_F147305_90755_0|SrvcGrp|66265|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F147725_06002_0|SrvcGrp|106264|2022|PDM|6450.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION|
20|FH_F67888_0_0|SrvcGrp|64636|2022|PDM|33.75|99|0.00|HOSPICE CONTINUOUS HOME CARE|
20|FH_F108700_63857_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F101923_98104_0|SrvcGrp|82684|2022|PCT|0.82|99|0.00|AETNA TRAUMA|
20|FH_F98600_91730_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F145988_06105_0|SrvcGrp|3378|2022|PDM|7861.00|99|0.00|OBSERVATION SVCS|
20|FH_F100785_54660_0|SrvcGrp|73601|2022|PDM|5745.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F87620_80014_0|SrvcGrp|92760|2022|PCT|1.06|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F101840_76054_0|SrvcGrp|2738|2022|PCT|0.32|99|0.00|IMPLANTS|
20|FH_F117795_36272_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER NUKE|
20|FH_F143197_34957_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132543_79549_0|SrvcGrp|73461|2022|PDM|1000.00|99|0.00|AETNA NICU IV|
20|FH_F101943_17701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F34706_0_0|SrvcGrp|1174|2022|PDM|41127.00|99|0.00|DRG 105 CARDIAC VALVE PX & OTHER MJR CARDIOTHORACIC PX W/CC|
20|FH_F116437_0_0|SrvcGrp|106768|2022|PDM|906.00|99|0.00|TREATMENT OF RETINAL LESION|
20|FH_F76285_0_0|SrvcGrp|73301|2022|PDM|73.00|99|0.00|PHYSICAL THERAPY HOURLY|
20|FH_F36620_0_0|SrvcGrp|19984|2022|PDM|50.00|99|0.00|THERAPY|
20|FH_F111266_30339_0|SrvcGrp|29076|2022|PDM|30.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F92092_74055_0|SrvcGrp|79699|2022|PCT|0.52|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F125656_92868_0|SrvcGrp|22389|2022|PDM|12.50|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F37444_0_0|SrvcGrp|9934|2022|PDM|1100.00|99|0.00|GENERAL ACUTE CARE W/VENTILATOR SVCS|
20|FH_F97620_75904_0|SrvcGrp|73643|2022|PDM|1325.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F134410_46807_0|SrvcGrp|74668|2022|PDM|900.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F69183_0_0|CSTM-ALL|CSTM-00|2020|PDM|2420.00|99|0.00|ASPG VIII - FH SW CUSTOM GROUPERS|
20|FH_F46284_0_0|SrvcGrp|26742|2022|PDM|147.00|99|0.00|PT|
20|FH_F139951_92870_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1502.00|99|0.00|GA RETINA SURG CTR ASC 32|
20|FH_F116698_07470_0|SrvcGrp|86779|2022|PDM|36.75|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F116698_07470_0|SrvcGrp|48398|2022|PDM|52.50|99|0.00|PT SERVICES|
20|FH_F51276_0_0|SrvcGrp|47662|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY|
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|AEG 3 (NO REV)|
20|FH_F48998_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F151541_01436_0|SrvcGrp|115999|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUG|
20|FH_F115954_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|1451.00|99|0.00|AEG 3 (NO REV)|
20|FH_F115103_31405_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F103100_47150_0|SrvcGrp|73004|2022|PDM|1870.00|99|0.00|AEG 8|
20|FH_F142312_62301_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F114345_27597_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148492_28027_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 5  (NO REV)|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD TC|
20|FH_F143684_0_0|SrvcGrp|103236|2022|PDM|12393.00|99|0.00|AETNA INSJ STABLJ DEV|
20|FH_F97562_29803_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F135708_61401_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118785_33315_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F45199_0_0|SrvcGrp|69699|2022|PCT|1.15|99|0.00|OCN F/S PRICING: LAB CPT CODES 80047-86999|
20|FH_F141668_47978_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F128929_33030_0|SrvcGrp|86723|2022|PDM|412.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F132543_79549_0|SrvcGrp|73483|2022|PDM|750.00|99|0.00|AETNA SUBACUTE III|
20|FH_F41173_0_0|CSTM-ALL|CSTM-00|2020|PDM|364.00|99|0.00|ADOL PSYCH RESIDENTIAL CARE|
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|784.00|99|0.00|AEG 5  (NO REV)|
20|FH_F116346_0_0|SrvcGrp|103550|2022|PDM|435.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F126256_24293_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141155_34952_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC|
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|2443.00|99|0.00|ASPG VIII|
20|FH_F150945_15904_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F75404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150922_02452_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F98022_89015_0|SrvcGrp|73643|2022|PDM|1427.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F101540_0_0|SrvcGrp|96201|2022|PDM|48.00|99|0.00|PT/OT/ST|
20|FH_F132399_66801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112712_63005_0|SrvcGrp|22389|2022|PCT|1.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F116683_64730_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F84611_30281_0|SrvcGrp|29817|2022|PDM|4940.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F61292_0_0|SrvcGrp|20902|2022|PDM|14535.00|99|0.00|MS DRG 249 ONLY|
20|FH_F92618_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36767_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F115121_32250_0|SrvcGrp|46903|2022|PDM|1265.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F32289_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS|
20|FH_F116760_68512_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F88451_0_0|SrvcGrp|43283|2022|PDM|126.00|99|0.00|PHYSICAL THERAPY|
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)|
20|FH_F75862_0_0|SrvcGrp|26001|2022|PDM|156.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F111030_05641_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103122_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F128828_44122_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146122_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143566_98264_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F111605_80524_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F88639_80204_0|SrvcGrp|78180|2022|PDM|818.55|99|0.00|AETNA RESIDENTIAL TREATMENT|
20|FH_F87915_0_0|SrvcGrp|3406|2022|PDM|647.00|99|0.00|CPT 99214|
20|FH_F42255_0_0|CSTM-ALL|CSTM-00|2020|PDM|802.00|99|0.00|ASPG VI|
20|FH_F142430_38863_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117552_0_0|SrvcGrp|58636|2022|PDM|13000.00|99|0.00|CPT 62362|
20|FH_F147941_06023_0|SrvcGrp|111925|2022|PDM|12500.00|99|0.00|VAGINAL DELIVERY INCLUDES NEWBORN|
20|FH_F148644_06890_0|SrvcGrp|26274|2022|PDM|3712.00|99|0.00|CPT 29877|
20|FH_F38807_0_0|SrvcGrp|17067|2022|PDM|446.00|99|0.00|ASPG II|
20|FH_F97761_04072_0|SrvcGrp|73461|2022|PDM|9773.00|99|0.00|AETNA NICU IV|
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|815.00|99|0.00|AEG 4 (NO REV)|
20|FH_F45976_0_0|SrvcGrp|3378|2022|PDM|34.00|99|0.00|OBSERVATION SVCS|
20|FH_F129549_01238_0|SrvcGrp|46605|2022|PDM|107.62|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F125134_0_0|SrvcGrp|110068|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F148548_37909_0|SrvcGrp|115410|2022|PCT|0.00|99|0.00|IMPLANT NEUROELECTRODES INCIDENTAL CODES|
20|FH_F148599_98034_0|CSTM-ALL|CSTM-00|2020|PCT|2.92|99|0.00|HSS APC B PROCEDURE NOT ON FS OR W/O WEIGHT|
20|FH_F102062_35447_0|SrvcGrp|48394|2022|PDM|84.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F41263_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F115315_43011_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F81373_64064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F120437_85202_0|SrvcGrp|17013|2022|PDM|76.51|99|0.00|HOME INFUSION THERAPY|
20|FH_F115315_43011_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132729_0_0|SrvcGrp|16|2022|PDM|1611.00|99|0.00|ACUTE REHABILITATION|
20|FH_F112836_06040_0|SrvcGrp|471|2022|PDM|725.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F145988_06105_0|SrvcGrp|114485|2022|PDM|41340.00|99|0.00|OPERATIVE ABLATION/INTRACARDIAC CATHETER ABLATION|
20|FH_F97565_83301_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F38865_0_0|SrvcGrp|13811|2022|PDM|340.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F117027_0_0|CSTM-ALL|CSTM-00|2020|PDM|1012.00|99|0.00|AEG 9 (NO REV)|
20|FH_F102947_44084_0|SrvcGrp|43524|2022|PDM|168.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F102984_80026_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|GENERAL ACUTE CARE|
20|FH_F38476_0_0|SrvcGrp|10615|2022|PDM|120.00|99|0.00|HOME HEALTH AIDE|
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1574.00|99|0.00|AEG 7 (NO REV)|
20|FH_F48772_66044_0|SrvcGrp|48394|2022|PDM|100.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F118446_0_0|SrvcGrp|82223|2022|PDM|150.00|99|0.00|HOSPICE CARE|
20|FH_F133660_53225_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133697_63129_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136568_92562_0|SrvcGrp|73841|2022|PDM|525.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F136570_32084_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F114727_44512_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F113787_31909_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F138284_98052_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F148553_85016_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 1 (NO REV)|
20|FH_F122610_73139_0|SrvcGrp|73002|2022|PDM|7994.00|99|0.00|AEG 7|
20|FH_F134687_14226_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F134727_30650_0|SrvcGrp|109057|2022|PCT|1.43|99|0.00|CARDIAC STUDIES|
20|FH_F136772_89109_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F112371_19047_0|SrvcGrp|89239|2022|PCT|1.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F112485_61032_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F113713_17013_0|SrvcGrp|91392|2022|PDM|190.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AF)|
20|FH_F115154_45069_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F116345_78626_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F42342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F42694_0_0|SrvcGrp|25346|2022|PDM|85.00|99|0.00|PT|
20|FH_F97564_52246_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128912_44313_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F38410_0_0|SrvcGrp|10542|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F67379_0_0|SrvcGrp|21350|2022|PDM|6357.00|99|0.00|MS DRG 287 ONLY|
20|FH_F133351_84003_0|SrvcGrp|472|2022|PDM|508.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD TC) - BDSS|
20|FH_F40372_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144429_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134490_62801_0|CSTM-ALL|CSTM-00|2020|PDM|1921.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132553_65340_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F92676_15063_0|SrvcGrp|79087|2022|PDM|229.94|99|0.00|MON VALLEY ASC 245|
20|FH_F32524_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.25|99|0.00|GENERAL ACUTE CARE|
20|FH_F117872_33462_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132934_63005_0|SrvcGrp|26690|2022|PDM|100000.00|99|0.00|MS DRG 215 ONLY|
20|FH_F123373_0_0|SrvcGrp|9537|2022|PDM|3249.00|99|0.00|CARDIAC CARE UNIT|
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)|
20|FH_F41818_0_0|SrvcGrp|30941|2022|PDM|408.00|99|0.00|NEWBORN NURSERY|
20|FH_F42024_0_0|SrvcGrp|9936|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F42539_0_0|SrvcGrp|26001|2022|PDM|145.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F117795_36272_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148021_80907_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F145988_06105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F148040_90631_0|SrvcGrp|90040|2022|PDM|500.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F72823_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F150839_03833_0|SrvcGrp|88620|2022|PDM|170.00|99|0.00|SKILLED NURSING RN|
20|FH_F147143_18706_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F32693_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F115483_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F147339_08837_0|SrvcGrp|36591|2022|PDM|3750.00|99|0.00|CPT 63685|
20|FH_F124514_21215_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F97300_47501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F90817_0_0|SrvcGrp|91000|2022|PDM|2914.00|99|0.00|REPAIR FRACTURE RADIUS/ULNA (HCFA)|
20|FH_F124759_34108_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116575_0_0|SrvcGrp|106264|2022|PDM|2537.92|99|0.00|NSL/SINS NDSC W/ SINS DILATION|
20|FH_F122377_91007_0|SrvcGrp|103617|2022|PDM|10584.00|99|0.00|NORMAL DELIVERY (MOM)|
20|FH_F40346_0_0|SrvcGrp|9911|2022|PCT|0.75|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F37708_0_0|SrvcGrp|13640|2022|PDM|90.00|99|0.00|CPT 99202|
20|FH_F115982_0_0|SrvcGrp|41334|2022|PDM|6625.00|99|0.00|TOTAL KNEE|
20|FH_F113178_44035_0|SrvcGrp|73843|2022|PDM|125.00|99|0.00|AETNA INTENSIVE OUTPATIENT - REV 906|
20|FH_F135351_0_0|SrvcGrp|74039|2022|PDM|7370.00|99|0.00|LAMINECTOMY|
20|FH_F91594_0_0|SrvcGrp|537|2022|PCT|0.85|99|0.00|OBSERVATION SERVICES|
20|FH_F120630_33161_0|SrvcGrp|89417|2022|PDM|394.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F150939_0_0|SrvcGrp|100278|2022|PDM|0.29|99|0.00|INJ DEXAMETHASONE ACETATE|
20|FH_F41013_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F54552_0_0|SrvcGrp|14949|2022|PDM|80.00|99|0.00|HOME INFUSION|
20|FH_F138777_43140_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|473.48|99|0.00|HAPA WPA-NWPA 2012-13 ASC 210 W/O REV|
20|FH_F72606_0_0|SrvcGrp|15663|2022|PCT|0.85|99|0.00|TRAUMA CARE|
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113527_31023_0|SrvcGrp|10393|2022|PDM|1857.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F151503_30067_0|SrvcGrp|85778|2022|PDM|6152.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F151503_30067_0|SrvcGrp|98466|2022|PDM|2090.00|99|0.00|PARTIAL REMOVAL OF FOOT BONE|
20|FH_F132258_45404_0|SrvcGrp|29075|2022|PDM|31.80|99|0.00|HYDRATION THERAPY|
20|FH_F122114_91364_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F123194_97222_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F104420_52208_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132054_30339_0|SrvcGrp|90707|2022|PDM|128.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F135389_43123_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F135608_19348_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F135930_02879_0|CSTM-ALL|CSTM-00|2020|PCT|1.02|99|0.00|OP SVCS|
20|FH_F136031_62220_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F100763_24202_0|SrvcGrp|73485|2022|PDM|2638.00|99|0.00|AETNA REHAB|
20|FH_F129456_30809_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130564_74834_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131344_61832_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116463_76501_0|SrvcGrp|90040|2022|PDM|150.00|99|0.00|AETNA AMBULATORY DETOX ALCOHOL & DRUG REHAB (HCFA)|
20|FH_F140629_0_0|SrvcGrp|77448|2022|PDM|1016.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F121428_40202_0|SrvcGrp|103913|2022|PCT|0.33|99|0.00|OP DIALYSIS|
20|FH_F121701_70420_0|SrvcGrp|108484|2022|PDM|800.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F101182_07863_0|SrvcGrp|96399|2022|PCT|1.00|99|0.00|FOUNDAPARINUX SODIUM|
20|FH_F111301_33122_0|SrvcGrp|78687|2022|PDM|205.00|99|0.00|AETNA DUAL ENERGY X-RAY ABSORBTION|
20|FH_F34864_0_0|SrvcGrp|12587|2022|PDM|8320.00|99|0.00|PTCA W/ STENT|
20|FH_F40423_0_0|CSTM-ALL|CSTM-00|2020|PDM|985.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F56573_0_0|SrvcGrp|13627|2022|PCT|0.00|99|0.00|SLEEP STUDY|
20|FH_F116430_0_0|SrvcGrp|11673|2022|PDM|2705.00|99|0.00|CPT 29888|
20|FH_F132328_0_0|SrvcGrp|104171|2022|PDM|2049.00|99|0.00|AETNA ARTHROSCOPY SURGERY SYNOVECT|
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)|
20|FH_F141035_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|889.00|99|0.00|AEG 2 (NO REV)|
20|FH_F102282_06795_0|SrvcGrp|27969|2022|PDM|33.21|99|0.00|HOME HEALTH AIDE|
20|FH_F129240_10028_0|SrvcGrp|24744|2022|PDM|60.00|99|0.00|PICC LINE INSERTION|
20|FH_F129220_18445_0|SrvcGrp|110063|2022|PDM|23.70|99|0.00|MULTIPLE FAMILY ADAPTIVE BH TREATMENT 15 MINS|
20|FH_F101320_26062_0|SrvcGrp|98002|2022|PCT|1.00|99|0.00|AETNA DRUGS/AGENTS/INJ DRUG|
20|FH_F84611_30281_0|SrvcGrp|10944|2022|PCT|0.73|99|0.00|EMERGENCY ROOM|
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121467_75165_0|SrvcGrp|108484|2022|PDM|800.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F147941_06023_0|SrvcGrp|10391|2022|PDM|8200.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F139551_0_0|SrvcGrp|26275|2022|PDM|3042.00|99|0.00|CPT 29826|
20|FH_F124017_0_0|SrvcGrp|109669|2022|PDM|4500.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F123278_20850_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F37945_0_0|CSTM-ALL|CSTM-00|2020|PDM|3526.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F148200_26554_0|SrvcGrp|115031|2022|PCT|0.75|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F115771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32996_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F151408_0_0|CSTM-ALL|CSTM-00|2020|PDM|37.00|99|0.00|AEG 5  (NO REV)|
20|FH_F93880_95476_0|SrvcGrp|74584|2022|PCT|0.00|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F49338_0_0|SrvcGrp|31186|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC (DME)|
20|FH_F38798_0_0|SrvcGrp|14892|2022|PDM|110.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F150982_0_0|SrvcGrp|74039|2022|PDM|6607.00|99|0.00|LAMINECTOMY|
20|FH_F35259_0_0|SrvcGrp|65820|2022|PCT|0.37|99|0.00|OP PHARMACEUTICALS|
20|FH_F58052_0_0|SrvcGrp|26732|2022|PDM|720.00|99|0.00|CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE|
20|FH_F51039_0_0|SrvcGrp|45884|2022|PDM|100.00|99|0.00|ST|
20|FH_F127849_43920_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149219_01966_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F109387_35630_0|SrvcGrp|93919|2022|PDM|637.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F145601_32159_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F96160_32207_0|SrvcGrp|17013|2022|PDM|68.65|99|0.00|HOME INFUSION THERAPY|
20|FH_F49552_0_0|CSTM-ALL|CSTM-00|2020|PDM|348.00|99|0.00|ST. CHARLES PARISH CT|
20|FH_F127638_44720_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111732_33771_0|SrvcGrp|86729|2022|PCT|1.00|99|0.00|COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE|
20|FH_F118363_30305_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F92677_08003_0|SrvcGrp|73380|2022|PDM|320.25|99|0.00|CPT 95805|
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|765.00|99|0.00|AEG 3 (NO REV)|
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1538.00|99|0.00|AEG 1 (NO REV)|
20|FH_F71162_0_0|SrvcGrp|64200|2022|PCT|1.00|99|0.00|RAD AND LAB|
20|FH_F127191_44720_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F133552_77006_0|SrvcGrp|86723|2022|PDM|435.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F116988_0_0|SrvcGrp|75493|2022|PDM|1297.00|99|0.00|AEG 8|
20|FH_F150659_84604_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|746.00|99|0.00|AEG 4 (NO REV)|
20|FH_F35369_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F133223_0_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F34882_0_0|CSTM-ALL|CSTM-00|2020|PDM|6574.16|99|0.00|MS DRG 765|
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PDM|7929.00|99|0.00|AEG 9 (NO REV)|
20|FH_F134797_0_0|SrvcGrp|72990|2022|PDM|412.00|99|0.00|AEG 1|
20|FH_F150931_65201_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.28|99|0.00|SALLY BALIN,999182,ASC 217|
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|516.00|99|0.00|AEG 1 (NO REV)|
20|FH_F124714_64081_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F151660_77074_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131173_17043_0|SrvcGrp|29346|2022|PDM|44.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F47245_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113649_01752_0|SrvcGrp|17015|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F94367_15601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F77232_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F131236_84041_0|SrvcGrp|88621|2022|PDM|66.80|99|0.00|SKILLED NURSING LPN|
20|FH_F109180_18015_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F121149_76021_0|SrvcGrp|472|2022|PDM|475.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F125254_30306_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|415.00|99|0.00|AEG 1 (NO REV)|
20|FH_F93332_0_0|SrvcGrp|93077|2022|PDM|4120.00|99|0.00|AETNA KYPHOPLASTY (HCFA)|
20|FH_F89475_71202_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F77463_0_0|SrvcGrp|44122|2022|PDM|500.00|99|0.00|SUB-ACUTE REHB - LEVEL  V|
20|FH_F149106_07042_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145641_06902_0|SrvcGrp|92820|2022|PDM|5412.00|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY|
20|FH_F138951_41101_0|SrvcGrp|17014|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134168_70526_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F134610_33426_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F147990_64701_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F126343_07018_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F133492_0_0|SrvcGrp|72992|2022|PDM|927.00|99|0.00|AEG 2|
20|FH_F113470_74010_0|SrvcGrp|472|2022|PDM|445.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F111027_32817_0|SrvcGrp|89149|2022|PDM|264.00|99|0.00|OP INTENSIVE|
20|FH_F125135_60008_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F32305_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F136424_34470_0|SrvcGrp|73842|2022|PDM|198.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F137036_60504_0|SrvcGrp|112744|2022|PCT|0.00|99|0.00|HOME HEALTH PROSPECTIVE PAYMENT SYSTEM (HHRG)|
20|FH_F137047_73120_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97601_67218_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|1320.00|99|0.00|AEG 7 (NO REV)|
20|FH_F117126_12801_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124433_77338_0|SrvcGrp|89417|2022|PDM|435.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F35088_0_0|SrvcGrp|3102|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F136887_0_0|SrvcGrp|112965|2022|PDM|4894.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F124316_28112_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F131942_50833_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142370_0_0|SrvcGrp|113552|2022|PDM|75.00|99|0.00|COVID-19 TEST NON-CDC HGH THRU|
20|FH_F140499_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|OP SVCS|
20|FH_F130641_40205_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F101380_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131067_57105_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F143928_21061_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F50218_0_0|SrvcGrp|46248|2022|PDM|60.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F133099_66801_0|SrvcGrp|10393|2022|PCT|0.80|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F130717_85006_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127209_45365_0|SrvcGrp|105267|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120248_77008_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F122687_0_0|SrvcGrp|41325|2022|PDM|3825.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F145757_65101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112568_0_0|SrvcGrp|104841|2022|PDM|1047.73|99|0.00|HOSPICE CARE PROVIDED IP HOSPICE FAC|
20|FH_F124018_75067_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F135072_65712_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128278_21401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130017_02302_0|SrvcGrp|55194|2022|PDM|17230.28|99|0.00|MS DRG 258 ONLY|
20|FH_F133207_0_0|SrvcGrp|89853|2022|PDM|3529.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG|
20|FH_F135656_74820_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F77082_0_0|SrvcGrp|32560|2022|PCT|0.95|99|0.00|BURN SERVICES (MS DRG)|
20|FH_F127486_06776_0|SrvcGrp|43567|2022|PDM|115.50|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F144248_0_0|SrvcGrp|114442|2022|PDM|12049.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F68844_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|1433.00|99|0.00|AEG 9 (NO REV)|
20|FH_F90438_08873_0|SrvcGrp|73849|2022|PDM|284.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F120709_64116_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F87374_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F133569_17202_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F46433_0_0|SrvcGrp|22590|2022|PDM|80.00|99|0.00|PAIN MANAGAMENT - INTERMITTENT|
20|FH_F86851_0_0|SrvcGrp|71220|2022|PDM|469.00|99|0.00|SIGMOIDOSCOPY  CPT 45334|
20|FH_F123784_03264_0|SrvcGrp|73742|2022|PDM|8.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F96182_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F114865_77488_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F140571_46514_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149540_64083_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119023_91406_0|SrvcGrp|86779|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F129434_98271_0|SrvcGrp|74668|2022|PDM|440.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F117098_20186_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F39893_0_0|SrvcGrp|360|2022|PDM|600.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F97720_70084_0|SrvcGrp|90854|2022|PDM|2199.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F105581_19053_0|SrvcGrp|46605|2022|PDM|130.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F69504_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|901.00|99|0.00|AEG 10 (NO REV)|
20|FH_F124663_65608_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F48224_0_0|SrvcGrp|72996|2022|PDM|746.00|99|0.00|AEG 4|
20|FH_F39028_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|2047.00|99|0.00|AEG 1 (NO REV)|
20|FH_F37200_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REGIONAL HEALTH SVCS OF HOWARD-DME-MOD NU|
20|FH_F50137_0_0|SrvcGrp|46237|2022|PDM|105.00|99|0.00|SKILLED NURSING HOME VISIT OR PROCEDURE|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F137366_87505_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F134993_75034_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F59333_0_0|SrvcGrp|3809|2022|PDM|601.02|99|0.00|HOSPICE CARE|
20|FH_F93332_0_0|SrvcGrp|93059|2022|PDM|2096.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PDM|836.00|99|0.00|AEG 4 (NO REV)|
20|FH_F125569_71220_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F137239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137716_66204_0|SrvcGrp|471|2022|PDM|448.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F90362_0_0|SrvcGrp|89942|2022|PDM|1948.00|99|0.00|PERCUTANEOUS INTRADISCAL|
20|FH_F127205_44125_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F145815_30540_0|SrvcGrp|113222|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS 22 TRGT SARS-COV-2|
20|FH_F71345_0_0|SrvcGrp|9830|2022|PDM|105.37|99|0.00|OT SVCS|
20|FH_F113428_19446_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F146586_71602_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F116753_0_0|SrvcGrp|106781|2022|PDM|5599.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F77044_0_0|SrvcGrp|74142|2022|PCT|0.50|99|0.00|INFUSION S-CODES (MOD SH)|
20|FH_F133207_0_0|SrvcGrp|59840|2022|PDM|2241.00|99|0.00|TYMPANOSTOMY|
20|FH_F150146_95401_0|SrvcGrp|46903|2022|PDM|678.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F34398_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F116753_0_0|SrvcGrp|101118|2022|PDM|7465.00|99|0.00|ARTHROSCOPY REPAIR|
20|FH_F149439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F81838_0_0|SrvcGrp|14371|2022|PDM|17.00|99|0.00|DISPOSABLE DRUG DELIVERY|
20|FH_F150303_19150_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F144291_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F134174_63141_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|CPT 95805 (W/MOD TC)|
20|FH_F110343_38139_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129509_0_0|SrvcGrp|73063|2022|PDM|610.00|99|0.00|OBSERVATION SERVICES|
20|FH_F146672_47424_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136532_54874_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142491_06033_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140343_89052_0|SrvcGrp|21920|2022|PDM|30.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F140668_68745_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149663_45219_0|SrvcGrp|41334|2022|PDM|15965.00|99|0.00|TOTAL KNEE|
20|FH_F151603_27609_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 2 (NO REV)|
20|FH_F119021_03060_0|SrvcGrp|86722|2022|PDM|230.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F147940_33626_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|1290.00|99|0.00|AEG 8 (NO REV)|
20|FH_F37328_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|SOUTH CARE CT|
20|FH_F37823_0_0|SrvcGrp|27448|2022|PCT|0.80|99|0.00|AMBULANCE SVCS|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|931.22|99|0.00|DELAWARE VALLEY- ASC 6|
20|FH_F110381_0_0|SrvcGrp|73008|2022|PDM|1272.00|99|0.00|AEG 10|
20|FH_F136818_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 9 (NO REV)|
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132864_71101_0|SrvcGrp|109057|2022|PCT|2.25|99|0.00|CARDIAC STUDIES|
20|FH_F76544_0_0|CSTM-ALL|CSTM-00|2020|PDM|1529.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148501_21550_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38352_0_0|SrvcGrp|17419|2022|PDM|70.00|99|0.00|SPEECH THERAPY|
20|FH_F132528_64014_0|SrvcGrp|88621|2022|PDM|127.00|99|0.00|SKILLED NURSING LPN|
20|FH_F125043_53545_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118456_30012_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128648_44256_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F100665_07939_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F51548_0_0|SrvcGrp|10544|2022|PDM|73.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F31827_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|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_F128657_19008_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F92648_90248_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125266_44515_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F44272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132934_63005_0|SrvcGrp|73602|2022|PDM|1026.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F34109_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115327_45320_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F133271_72204_0|SrvcGrp|73841|2022|PDM|420.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F117009_0_0|SrvcGrp|28551|2022|PDM|2348.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PDM|1347.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F120437_85202_0|SrvcGrp|17004|2022|PDM|39.39|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS|
20|FH_F141654_15217_0|SrvcGrp|46605|2022|PDM|128.75|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F149781_37404_0|SrvcGrp|78096|2022|PDM|4774.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F109606_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|AEG 1 (NO REV)|
20|FH_F150882_84041_0|SrvcGrp|82773|2022|PDM|105.00|99|0.00|POST NATAL ASSESSMENT W/ NEWBORN|
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|578.00|99|0.00|AEG 2 (NO REV)|
20|FH_F42177_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F100783_03431_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F102948_43606_0|SrvcGrp|73849|2022|PDM|356.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F33381_0_0|SrvcGrp|941|2022|PDM|2871.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F39140_0_0|SrvcGrp|13631|2022|PDM|110.00|99|0.00|CPT 99213|
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV)|
20|FH_F138981_85123_0|SrvcGrp|89149|2022|PDM|250.00|99|0.00|OP INTENSIVE|
20|FH_F100664_03104_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F148553_85016_0|SrvcGrp|115447|2022|PDM|1100.00|99|0.00|REPOSITION LEFT VENTRIC LEAD|
20|FH_F43696_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F134727_30650_0|CSTM-ALL|CSTM-00|2020|PDM|642.00|99|0.00|AEG 1 (NO REV)|
20|FH_F134735_91362_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136813_06518_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112248_53223_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112411_28207_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F112465_28401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112505_51503_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F113713_17013_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.00|99|0.00|AEG 8 (NO REV)|
20|FH_F138219_0_0|SrvcGrp|25688|2022|PDM|424.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F47233_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|WELLPATH PROPIETARY ASC IV|
20|FH_F116339_41064_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F116393_07002_0|SrvcGrp|90493|2022|PDM|18.94|99|0.00|ELEC STIM OTHER THAN WOUND|
20|FH_F116393_07002_0|SrvcGrp|111286|2022|PCT|1.00|99|0.00|THERAPY CODES|
20|FH_F147444_32839_0|SrvcGrp|92760|2022|PCT|1.20|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|76.00|99|0.00|TPN THREE LITER (MOD SH)|
20|FH_F42153_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F148548_37909_0|SrvcGrp|115409|2022|PCT|0.00|99|0.00|IMPLANT NEUROELECTRODES 29 INCIDENTAL CODES|
20|FH_F95482_0_0|SrvcGrp|92676|2022|PCT|0.00|99|0.00|IMAGING ENHANCED SUBSTANCE|
20|FH_F150559_60018_0|SrvcGrp|29346|2022|PDM|55.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F145845_37167_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122245_0_0|SrvcGrp|63459|2022|PDM|2000.00|99|0.00|CPT 52601|
20|FH_F145800_22003_0|SrvcGrp|46605|2022|PDM|84.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F130895_07726_0|SrvcGrp|73841|2022|PDM|278.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F149345_45044_0|SrvcGrp|16|2022|PDM|1579.00|99|0.00|ACUTE REHABILITATION|
20|FH_F147959_33573_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F85415_27612_0|SrvcGrp|48396|2022|PDM|78.75|99|0.00|OT SERVICES|
20|FH_F138951_41101_0|SrvcGrp|113446|2022|PCT|1.00|99|0.00|ALL DRUGS/AGENTS/INJECTION DRUGS|
20|FH_F119627_27288_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F123638_0_0|SrvcGrp|108042|2022|PDM|955.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F88698_18951_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F148600_30328_0|CSTM-ALL|CSTM-00|2020|PDM|1865.00|99|0.00|AEG 9 (NO REV)|
20|FH_F132802_68022_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F134593_60007_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F139472_06902_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F85553_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|JONES MEMORIAL HOSPITAL NY LAB|
20|FH_F120795_27514_0|CSTM-ALL|CSTM-00|2020|PDM|13969.00|99|0.00|AEG 7 (NO REV)|
20|FH_F137167_71635_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138892_46341_0|SrvcGrp|75419|2022|PDM|259.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F142690_31774_0|SrvcGrp|24745|2022|PDM|103.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F97582_46307_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F140450_18104_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151154_91761_0|SrvcGrp|48396|2022|PDM|140.00|99|0.00|OT SERVICES|
20|FH_F39209_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F144828_0_0|SrvcGrp|114192|2022|PDM|2970.00|99|0.00|FLAPS AND GRAFTS PROCEDURES|
20|FH_F114389_50131_0|SrvcGrp|105630|2022|PCT|0.82|99|0.00|ENTERAL AND PARENTERAL THERAPY|
20|FH_F108780_54235_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133029_61264_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F50618_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121016_32607_0|SrvcGrp|74500|2022|PDM|150.00|99|0.00|CPT 76805|
20|FH_F141772_80124_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F63145_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F44048_0_0|CSTM-ALL|CSTM-00|2020|PDM|609.00|99|0.00|CHILD PSYCHIATRIC|
20|FH_F106540_26330_0|SrvcGrp|42785|2022|PDM|135.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F143200_91602_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F38780_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102561_75146_0|SrvcGrp|73461|2022|PDM|1800.00|99|0.00|AETNA NICU IV|
20|FH_F148886_60621_0|SrvcGrp|13807|2022|PDM|1490.00|99|0.00|OBSERVATION SVCS|
20|FH_F128559_43524_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F68479_0_0|SrvcGrp|28570|2022|PDM|60.00|99|0.00|CPT 92610|
20|FH_F69249_0_0|SrvcGrp|12787|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F117762_0_0|SrvcGrp|67068|2022|PDM|8840.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F132056_32080_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F39443_0_0|SrvcGrp|30301|2022|PDM|203.00|99|0.00|HAPA WPA ASC 113|
20|FH_F149662_85015_0|SrvcGrp|115732|2022|PDM|6535.00|99|0.00|VERTEBRAL BODY REMOVAL|
20|FH_F112794_01040_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F134869_08854_0|SrvcGrp|58509|2022|PDM|480.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F100540_0_0|SrvcGrp|72996|2022|PDM|1363.50|99|0.00|AEG 4|
20|FH_F122392_78207_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141267_0_0|SrvcGrp|83857|2022|PDM|939.00|99|0.00|IP HOSPICE SVCS|
20|FH_F125182_0_0|SrvcGrp|110066|2022|PDM|768.00|99|0.00|ANOSCOPY CONTROL BLEEDING|
20|FH_F132431_79606_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F114930_71101_0|SrvcGrp|105737|2022|PDM|1326.00|99|0.00|INPATIENT PSYCHIATRIC|
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37945_0_0|CSTM-ALL|CSTM-00|2020|PDM|3059.00|99|0.00|MS DRG 774-775 NORMAL DELIVERY|
20|FH_F110061_0_0|SrvcGrp|75493|2022|PDM|1034.00|99|0.00|AEG 8|
20|FH_F38363_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31594_0_0|SrvcGrp|72|2022|PDM|200.00|99|0.00|NEWBORN NURSERY|
20|FH_F38591_0_0|SrvcGrp|12840|2022|PCT|0.70|99|0.00|PACEMAKER|
20|FH_F32177_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149879_80045_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130013_16509_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F141507_0_0|SrvcGrp|95819|2022|PDM|1890.00|99|0.00|GONIOTOMY|
20|FH_F143820_28405_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F135779_0_0|SrvcGrp|73842|2022|PDM|217.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132092_0_0|SrvcGrp|83522|2022|PDM|169.00|99|0.00|RESPITE CARE|
20|FH_F67121_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F141167_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143687_70461_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121476_0_0|SrvcGrp|108858|2022|PDM|1492.00|99|0.00|CRYO PROBE/NEEDLE|
20|FH_F123638_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F132882_63857_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138302_15701_0|SrvcGrp|14948|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F49598_0_0|SrvcGrp|38244|2022|PDM|5092.00|99|0.00|CARDIAC CATH (WITH PTCA / ROTO / STENT)|
20|FH_F84712_0_0|SrvcGrp|83061|2022|PDM|14507.00|99|0.00|INTRACRANIAL EMBOLIZATION|
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|1582.00|99|0.00|AEG 4 (NO REV)|
20|FH_F115952_44484_0|SrvcGrp|93919|2022|PDM|426.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F129975_0_0|SrvcGrp|71083|2022|PDM|10.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1688.00|99|0.00|ASPG V|
20|FH_F149663_45219_0|CSTM-ALL|CSTM-00|2020|PDM|1655.00|99|0.00|AEG 5  (NO REV)|
20|FH_F151608_30236_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118818_19808_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F109652_0_0|SrvcGrp|78847|2022|PDM|5892.00|99|0.00|STEREOTACTIC BODY RADIATION THERAPY|
20|FH_F90791_79106_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F38023_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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92493_0_0|SrvcGrp|27261|2022|PDM|12999.53|99|0.00|CPT 27446|
20|FH_F102180_0_0|SrvcGrp|472|2022|PCT|0.84|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F95341_08701_0|SrvcGrp|94764|2022|PCT|1.00|99|0.00|NOS FLU VACC IM (>=3 YRS)|
20|FH_F137067_0_0|SrvcGrp|98267|2022|PDM|21000.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F62624_0_0|SrvcGrp|58515|2022|PDM|6465.00|99|0.00|OP PTCA|
20|FH_F92493_0_0|SrvcGrp|35668|2022|PDM|2989.14|99|0.00|CPT 29824|
20|FH_F124112_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F106540_26330_0|SrvcGrp|98448|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F126858_43113_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133474_0_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F132934_63005_0|SrvcGrp|30623|2022|PDM|11401.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F34696_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F123181_75057_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F142990_06488_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F67379_0_0|SrvcGrp|8950|2022|PDM|1696.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F87173_15136_0|SrvcGrp|73485|2022|PDM|1231.00|99|0.00|AETNA REHAB|
20|FH_F150944_18052_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114207_35243_0|SrvcGrp|75323|2022|PCT|1.00|99|0.00|DME|
20|FH_F40710_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|71.25|99|0.00|PIC LINE INSERTION KIT (MOD SD/SQ/SH)|
20|FH_F90223_0_0|SrvcGrp|88810|2022|PDM|40.00|99|0.00|HOME HEALTH VISIT (HCFA)|
20|FH_F149273_0_0|SrvcGrp|115614|2022|PDM|3978.00|99|0.00|LAMINOTOMY/LAMINECTOMY|
20|FH_F69183_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|ASPG IV - FH SW CUSTOM GROUPERS|
20|FH_F98840_31021_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F113957_73554_0|SrvcGrp|104363|2022|PCT|1.15|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F132732_0_0|SrvcGrp|361|2022|PDM|2696.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F47902_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|MRI|
20|FH_F35366_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F103481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126395_37043_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130492_66212_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128237_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130850_67401_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F126595_32308_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121488_77478_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F36280_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143891_19808_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131207_19947_0|SrvcGrp|69075|2022|PDM|70.00|99|0.00|CPT 99213|
20|FH_F135236_02840_0|SrvcGrp|73496|2022|PDM|1446.80|99|0.00|AETNA ER LEVEL V|
20|FH_F92993_0_0|SrvcGrp|86480|2022|PDM|68.79|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)|
20|FH_F35276_0_0|SrvcGrp|3932|2022|PDM|5200.00|99|0.00|LITHOTRIPSY|
20|FH_F60073_0_0|SrvcGrp|79720|2022|PDM|2400.00|99|0.00|ACUTE REHAB II|
20|FH_F132969_84003_0|SrvcGrp|14893|2022|PDM|30.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F134608_18017_0|SrvcGrp|112605|2022|PDM|80.00|99|0.00|INSERT CERVICAL DILATOR|
20|FH_F105600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|145.53|99|0.00|HAPA WPA-NWPA 2012-13 ASC 237 W/O REV|
20|FH_F97041_71603_0|SrvcGrp|73601|2022|PDM|7063.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F110311_17078_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F119272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112665_0_0|SrvcGrp|72121|2022|PDM|2887.00|99|0.00|ARTHOSCOPY|
20|FH_F133972_27103_0|SrvcGrp|29075|2022|PDM|30.00|99|0.00|HYDRATION THERAPY|
20|FH_F125515_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122552_03103_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115893_08002_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F131737_15025_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F131737_15025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F113025_0_0|SrvcGrp|104961|2022|PDM|535.00|99|0.00|AEG 3 W/O CPT 15822|
20|FH_F87480_0_0|SrvcGrp|82720|2022|PDM|1500.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F120489_63552_0|SrvcGrp|10393|2022|PDM|2000.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F142690_31774_0|SrvcGrp|17016|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F149644_91367_0|SrvcGrp|108484|2022|PDM|725.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F118932_07652_0|SrvcGrp|3178|2022|PDM|1273.00|99|0.00|ACUTE PSYCH|
20|FH_F38332_0_0|SrvcGrp|18133|2022|PDM|12064.00|99|0.00|MS DRG 244|
20|FH_F109513_0_0|SrvcGrp|90432|2022|PDM|2000.00|99|0.00|REMOVAL OF BREAST IMPLANT|
20|FH_F35103_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F128130_10027_0|CSTM-ALL|CSTM-00|2020|PDM|4741.00|99|0.00|AEG 2 (NO REV)|
20|FH_F88212_20151_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F145538_34997_0|SrvcGrp|46903|2022|PDM|621.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F148260_0_0|SrvcGrp|104753|2022|PDM|3322.00|99|0.00|PELVIC EXAMINATION|
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.00|99|0.00|CD RESIDENTIAL TREATMENT (ADULT)|
20|FH_F122725_32216_0|CSTM-ALL|CSTM-00|2020|PDM|30.00|99|0.00|MANUAL HAND MUSCLE TESTING|
20|FH_F89176_0_0|CSTM-ALL|CSTM-00|2020|PDM|812.00|99|0.00|ASPG III|
20|FH_F145561_80210_0|SrvcGrp|109798|2022|PCT|1.10|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F138026_46143_0|SrvcGrp|90854|2022|PDM|999.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F143579_43160_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F119227_01752_0|SrvcGrp|14945|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F97840_54729_0|SrvcGrp|73559|2022|PDM|10702.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F132863_65240_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120930_0_0|SrvcGrp|92820|2022|PDM|4500.00|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY|
20|FH_F118152_20151_0|SrvcGrp|22589|2022|PDM|50.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F120490_64133_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F134011_84102_0|SrvcGrp|14949|2022|PDM|10.00|99|0.00|HOME INFUSION|
20|FH_F151058_18064_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151155_26508_0|SrvcGrp|105709|2022|PDM|199.00|99|0.00|OFFICE/OUTPATIENT VISIT NEW (HCFA)|
20|FH_F37823_0_0|SrvcGrp|9518|2022|PCT|0.80|99|0.00|EMERGENCY ROOM|
20|FH_F112163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135491_0_0|SrvcGrp|112136|2022|PDM|2640.00|99|0.00|XCAPSL CTRC RMVL CPLX W/ECP|
20|FH_F124129_33603_0|CSTM-ALL|CSTM-00|2020|PDM|540.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F87856_0_0|SrvcGrp|75491|2022|PDM|1292.00|99|0.00|AEG 7|
20|FH_F137951_0_0|SrvcGrp|85778|2022|PDM|4138.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F89851_83854_0|CSTM-ALL|CSTM-00|2020|PDM|5162.00|99|0.00|AEG 6 (NO REV)|
20|FH_F90811_0_0|SrvcGrp|83839|2022|PDM|2800.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F39627_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F113792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124839_71360_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92676_15063_0|SrvcGrp|79058|2022|PDM|454.31|99|0.00|MON VALLEY ASC 235|
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|886.00|99|0.00|AEG 5  (NO REV)|
20|FH_F66839_0_0|SrvcGrp|10431|2022|PDM|49.00|99|0.00|SPEECH THERAPY|
20|FH_F117385_48091_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F140295_0_0|SrvcGrp|26273|2022|PDM|3525.00|99|0.00|CPT 29880|
20|FH_F37000_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F92716_0_0|SrvcGrp|72992|2022|PDM|529.00|99|0.00|AEG 2|
20|FH_F131942_50833_0|SrvcGrp|23683|2022|PDM|55.00|99|0.00|SKILLED NURSING RN|
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG III|
20|FH_F125656_92868_0|SrvcGrp|86838|2022|PDM|12.50|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F97603_77901_0|SrvcGrp|73461|2022|PDM|6840.00|99|0.00|AETNA NICU IV|
20|FH_F130179_62447_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148020_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F122520_46383_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F128334_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F133667_83642_0|SrvcGrp|89337|2022|PDM|1030.00|99|0.00|DETOXIFICATION|
20|FH_F133478_40165_0|SrvcGrp|112343|2022|PCT|0.54|99|0.00|ANGIOPLASTY/STENT PROCEDURES|
20|FH_F133494_90023_0|SrvcGrp|107595|2022|PCT|1.40|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F130657_04614_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|OP SVCS|
20|FH_F149024_0_0|CSTM-ALL|CSTM-00|2020|PDM|886.60|99|0.00|AEG 3 (NO REV)|
20|FH_F33535_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126527_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137147_75006_0|SrvcGrp|80617|2022|PDM|7862.00|99|0.00|ARTHOPLASTY|
20|FH_F142530_60148_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F101389_0_0|SrvcGrp|112098|2022|PCT|2.00|99|0.00|COVID-19 CODES|
20|FH_F139267_30253_0|SrvcGrp|113549|2022|PDM|39.51|99|0.00|COVID-19 DIAGNOSTIC|
20|FH_F140615_73013_0|SrvcGrp|75506|2022|PCT|1.35|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F147799_18052_0|SrvcGrp|53987|2022|PCT|1.00|99|0.00|PHOTOTHERAPY|
20|FH_F104700_0_0|SrvcGrp|73006|2022|PDM|1245.00|99|0.00|AEG 9|
20|FH_F50446_0_0|SrvcGrp|33166|2022|PDM|515.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F121960_75503_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119535_0_0|SrvcGrp|29930|2022|PDM|450.00|99|0.00|DIALYSIS|
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|1435.00|99|0.00|AEG 2 (NO REV)|
20|FH_F78447_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F82432_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F121426_0_0|SrvcGrp|14997|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F62624_0_0|SrvcGrp|11577|2022|PDM|600.00|99|0.00|DIALYSIS|
20|FH_F131507_64154_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|PCT|0.30|99|0.00|OP SVCS|
20|FH_F150900_19104_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111412_33777_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148861_18706_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F46372_0_0|SrvcGrp|34168|2022|PCT|0.85|99|0.00|BURN SERVICES MS DRG|
20|FH_F133018_84037_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F72859_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.23|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F33088_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F90811_0_0|SrvcGrp|90439|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY SURGERY|
20|FH_F40980_0_0|SrvcGrp|411|2022|PDM|9230.00|99|0.00|OP CARDIAC CATH|
20|FH_F79927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F149841_73114_0|SrvcGrp|90854|2022|PDM|567.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F80952_45669_0|SrvcGrp|2738|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F150499_32405_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80952_45669_0|CSTM-ALL|CSTM-00|2020|PDM|818.45|99|0.00|MRI|
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PDM|2100.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F144508_44107_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125256_77365_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F139565_0_0|SrvcGrp|109763|2022|PDM|2869.00|99|0.00|TREAT EYELID LESION|
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149373_0_0|SrvcGrp|23587|2022|PDM|750.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F97603_77901_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC|
20|FH_F111189_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F128543_44413_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110121_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F108680_0_0|SrvcGrp|58671|2022|PDM|1650.00|99|0.00|ASC CARVE OUT 64721|
20|FH_F107840_07006_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120747_19129_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F84611_30281_0|SrvcGrp|72994|2022|PDM|1877.00|99|0.00|AEG 3|
20|FH_F51276_0_0|SrvcGrp|27048|2022|PDM|37.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS(MOD SH)|
20|FH_F61332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123276_20737_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
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_F91994_0_0|SrvcGrp|63459|2022|PDM|1760.00|99|0.00|CPT 52601|
20|FH_F110212_17013_0|SrvcGrp|106048|2022|PDM|746.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F134027_0_0|SrvcGrp|76847|2022|PDM|2223.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F146922_68108_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128188_0_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F39604_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89932_10940_0|SrvcGrp|73004|2022|PDM|3565.00|99|0.00|AEG 8|
20|FH_F98620_43920_0|SrvcGrp|88978|2022|PDM|5221.00|99|0.00|VAGINAL DELIVERY|
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|2147.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125176_20785_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F91255_19401_0|SrvcGrp|82369|2022|PCT|1.25|99|0.00|AETNA LABORATORY|
20|FH_F88818_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97565_83301_0|SrvcGrp|88977|2022|PDM|6795.00|99|0.00|C-SECTION DELIVERY|
20|FH_F126679_62401_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143053_89501_0|SrvcGrp|110811|2022|PDM|212.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F120825_66204_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36750_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35416_0_0|SrvcGrp|70644|2022|PDM|50400.00|99|0.00|PEDIATRIC CARDIOVASCULAR SURGERY|
20|FH_F134432_85053_0|SrvcGrp|58509|2022|PDM|502.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F128197_84123_0|SrvcGrp|63119|2022|PDM|29.00|99|0.00|BASIC HOME HOSPICE CARE|
20|FH_F101441_0_0|SrvcGrp|97139|2022|PDM|8105.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1210.00|99|0.00|AEG 4 (NO REV)|
20|FH_F40593_0_0|SrvcGrp|473|2022|PDM|325.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F131093_49690_0|SrvcGrp|63297|2022|PDM|130.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F49478_0_0|CSTM-ALL|CSTM-00|2020|PDM|564.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|767.58|99|0.00|ASPG I|
20|FH_F116629_83467_0|SrvcGrp|75505|2022|PCT|0.82|99|0.00|CARDIAC STUDIES|
20|FH_F125885_78741_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123466_93420_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50218_0_0|SrvcGrp|10541|2022|PDM|120.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F93949_02720_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F126923_33612_0|SrvcGrp|80|2022|PDM|743.00|99|0.00|ACUTE PSYCH|
20|FH_F73985_0_0|SrvcGrp|71267|2022|PCT|0.66|99|0.00|EMERGENCY ROOM|
20|FH_F143790_83440_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F128125_68601_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F128973_44256_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F55054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F124788_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151539_64014_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F141587_40242_0|SrvcGrp|86723|2022|PDM|372.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F84132_48026_0|SrvcGrp|73000|2022|PDM|1159.00|99|0.00|AEG 6|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1401.92|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1 W/O REV|
20|FH_F70448_0_0|SrvcGrp|67285|2022|PDM|57.00|99|0.00|ST SUBSEQUENT VISIT 92507|
20|FH_F117368_68114_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F49637_0_0|SrvcGrp|39871|2022|PCT|0.60|99|0.00|MS DRG 619-621 ONLY OTLR|
20|FH_F111540_16823_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F94165_0_0|SrvcGrp|85757|2022|PCT|0.85|99|0.00|PT OT ST|
20|FH_F43411_0_0|SrvcGrp|37018|2022|PDM|480.00|99|0.00|BOARDER BABY|
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|277.09|99|0.00|HAPA WPA-NWPA 2012-13 ASC 229 W/O REV|
20|FH_F139824_24801_0|SrvcGrp|104338|2022|PCT|0.95|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F132160_0_0|SrvcGrp|109794|2022|PDM|11475.00|99|0.00|COLLAGEN CROSSLINKING CORNEA|
20|FH_F46433_0_0|SrvcGrp|14947|2022|PDM|25.00|99|0.00|HOME INFUSION|
20|FH_F139970_16142_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F94100_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.00|99|0.00|OP SVCS|
20|FH_F132818_24701_0|SrvcGrp|111960|2022|PCT|0.88|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F90223_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|(JCODES-IMMUN) OCN F/S PRICING: ALL|
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PDM|948.00|99|0.00|AEG 8 (NO REV)|
20|FH_F130044_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|MRI/RAD PROF COMPONENT (MOD 26)|
20|FH_F97480_08204_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F131371_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|557.00|99|0.00|AEG 2 (NO REV)|
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_F135219_68506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F123400_04605_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F66501_0_0|SrvcGrp|26001|2022|PDM|134.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F125074_18104_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F56136_0_0|SrvcGrp|3224|2022|PCT|0.92|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F86872_15215_0|SrvcGrp|86853|2022|PDM|45.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F38411_0_0|SrvcGrp|19532|2022|PCT|0.80|99|0.00|MS DRG 810|
20|FH_F136359_0_0|SrvcGrp|83644|2022|PDM|5780.00|99|0.00|CPT 30465|
20|FH_F69766_0_0|SrvcGrp|33414|2022|PDM|125.00|99|0.00|SNF VENTILATOR SUPPORT|
20|FH_F139569_15063_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119650_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|950.00|99|0.00|AEG 3 (NO REV)|
20|FH_F115872_06052_0|SrvcGrp|473|2022|PDM|502.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F76028_0_0|SrvcGrp|62538|2022|PDM|130.00|99|0.00|PHYSICAL THERAPY|
20|FH_F133658_60053_0|SrvcGrp|27968|2022|PDM|60.00|99|0.00|SKILLED NURSING LPN|
20|FH_F68972_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118152_20151_0|SrvcGrp|86836|2022|PDM|15.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F134126_11554_0|SrvcGrp|705|2022|PCT|0.45|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F137048_60714_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F139751_84065_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97601_67218_0|SrvcGrp|73602|2022|PDM|3772.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F138471_84663_0|SrvcGrp|95660|2022|PDM|474.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F150982_0_0|SrvcGrp|82109|2022|PDM|1101.00|99|0.00|REVISE ULNAR NERVE ELBOW|
20|FH_F76222_0_0|SrvcGrp|6|2022|PCT|0.77|99|0.00|OP SURGERY|
20|FH_F134396_80045_0|SrvcGrp|86723|2022|PDM|460.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F140295_0_0|SrvcGrp|77021|2022|PDM|7257.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F132732_0_0|SrvcGrp|33793|2022|PDM|6734.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F99380_90503_0|SrvcGrp|11920|2022|PCT|0.85|99|0.00|PHARMACY SVCS|
20|FH_F40446_0_0|SrvcGrp|439|2022|PDM|1300.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F36165_0_0|SrvcGrp|22385|2022|PDM|105.00|99|0.00|CPT 59025|
20|FH_F138995_0_0|SrvcGrp|77582|2022|PDM|1175.00|99|0.00|CPT 31255|
20|FH_F151008_92625_0|SrvcGrp|74668|2022|PDM|365.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F102920_0_0|SrvcGrp|91528|2022|PDM|1295.00|99|0.00|SPINAL CORD IMPLANT|
20|FH_F39567_0_0|SrvcGrp|97|2022|PDM|1000.00|99|0.00|C-SECTION|
20|FH_F127165_32112_0|SrvcGrp|89149|2022|PDM|231.00|99|0.00|OP INTENSIVE|
20|FH_F141001_24739_0|SrvcGrp|112091|2022|PCT|1.00|99|0.00|URGENT CARE TELEMEDICINE|
20|FH_F111288_0_0|SrvcGrp|27261|2022|PDM|21868.00|99|0.00|CPT 27446|
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|2370.00|99|0.00|ASPG 9 HEARTLAND HEALTHCARE|
20|FH_F38798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|DME - OSTOMY|
20|FH_F142710_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112568_0_0|SrvcGrp|104840|2022|PDM|240.60|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F129536_0_0|SrvcGrp|84935|2022|PDM|900.00|99|0.00|REPAIR IRIS AND CILIARY BODY|
20|FH_F123276_20737_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F122688_19904_0|SrvcGrp|472|2022|PDM|620.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F51364_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31714_0_0|SrvcGrp|14196|2022|PCT|0.74|99|0.00|TRAUMA CARE|
20|FH_F131996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1079.00|99|0.00|AEG 8 (NO REV)|
20|FH_F119227_01752_0|SrvcGrp|14948|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F112060_07514_0|SrvcGrp|472|2022|PDM|390.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F145708_89030_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F90232_15126_0|SrvcGrp|86830|2022|PDM|122.85|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F145642_15108_0|SrvcGrp|65621|2022|PDM|25.00|99|0.00|RN NURSING|
20|FH_F59872_0_0|SrvcGrp|29991|2022|PCT|0.50|99|0.00|SUPPLIES|
20|FH_F134328_13088_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F83978_66739_0|SrvcGrp|81779|2022|PCT|1.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F132815_39429_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136299_75218_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F140753_75038_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F147882_44056_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97740_01605_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS|
20|FH_F70484_0_0|CSTM-ALL|CSTM-00|2020|PCT|53.80|99|0.00|OP SVCS|
20|FH_F105623_77901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT HH|
20|FH_F113541_0_0|SrvcGrp|84180|2022|PDM|6662.00|99|0.00|AETNA DELAYED BREAST PROSTHESIS|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1625.00|99|0.00|EXTENDED RECOVERY/OBSERVATION (16-23 HRS)|
20|FH_F137897_0_0|SrvcGrp|91629|2022|PDM|105.45|99|0.00|SKILLED NURSE SERVICES 15 MINS|
20|FH_F119256_63031_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146217_0_0|SrvcGrp|95661|2022|PDM|423.55|99|0.00|RESPITE CARE (HCFA)|
20|FH_F146360_66502_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38016_0_0|SrvcGrp|360|2022|PDM|541.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F125660_46706_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F97564_52246_0|SrvcGrp|73559|2022|PDM|13191.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F118027_28801_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F35446_0_0|SrvcGrp|43|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F116753_0_0|SrvcGrp|90854|2022|PDM|986.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F125207_32904_0|SrvcGrp|103821|2022|PCT|0.80|99|0.00|DME CODES|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|VERTICAL PLUS MRI MOD 53|
20|FH_F92278_01440_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F133536_0_0|SrvcGrp|71666|2022|PDM|8250.00|99|0.00|CPT 63655|
20|FH_F77625_0_0|SrvcGrp|42828|2022|PDM|90.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F47605_0_0|SrvcGrp|33166|2022|PDM|975.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F119544_0_0|SrvcGrp|108180|2022|PDM|500.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F96321_0_0|CSTM-ALL|CSTM-00|2020|PDM|463.61|99|0.00|AEG 1 (NO REV)|
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F139750_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F113527_31023_0|SrvcGrp|88397|2022|PDM|1528.00|99|0.00|AETNA MATERNITY DELIVERY|
20|FH_F36492_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F135372_73089_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135432_16335_0|SrvcGrp|27969|2022|PDM|17.11|99|0.00|HOME HEALTH AIDE|
20|FH_F135439_33825_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135447_53226_0|SrvcGrp|13238|2022|PCT|1.00|99|0.00|VENIPUNCTURE|
20|FH_F135924_02906_0|SrvcGrp|111929|2022|PDM|48.70|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F116461_77536_0|SrvcGrp|89417|2022|PDM|324.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F116527_70443_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F34119_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F140629_0_0|SrvcGrp|37317|2022|PDM|3512.00|99|0.00|LITHOTRIPSY|
20|FH_F121466_84057_0|SrvcGrp|75442|2022|PDM|570.00|99|0.00|OBSERVATION - REV 762|
20|FH_F44113_0_0|SrvcGrp|12119|2022|PCT|0.90|99|0.00|EMERGENCY ROOM|
20|FH_F65959_0_0|SrvcGrp|45884|2022|PDM|110.00|99|0.00|ST|
20|FH_F111292_33136_0|CSTM-ALL|CSTM-00|2020|PDM|18075.00|99|0.00|HIGH GASTRIC BYPASS|
20|FH_F111341_80501_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111383_62233_0|SrvcGrp|105804|2022|PCT|0.88|99|0.00|URGENT CARE|
20|FH_F47906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F131000_0_0|SrvcGrp|88491|2022|PDM|6155.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F132328_0_0|SrvcGrp|67068|2022|PDM|17219.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F41339_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87557_33309_0|SrvcGrp|24744|2022|PDM|55.00|99|0.00|PICC LINE INSERTION|
20|FH_F101904_17057_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102325_62691_0|SrvcGrp|14949|2022|PDM|60.00|99|0.00|HOME INFUSION|
20|FH_F129240_10028_0|SrvcGrp|86840|2022|PDM|40.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F102960_50613_0|SrvcGrp|89417|2022|PDM|566.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F132834_63640_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F51276_0_0|SrvcGrp|27969|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE|
20|FH_F125081_15218_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F36343_0_0|SrvcGrp|11802|2022|PDM|106.25|99|0.00|HOME INFUSION|
20|FH_F48459_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN|
20|FH_F126939_32405_0|SrvcGrp|86723|2022|PDM|360.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F86654_33073_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING W/O WIG|
20|FH_F132051_74464_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132779_0_0|SrvcGrp|3499|2022|PCT|0.59|99|0.00|IMPLANTS|
20|FH_F90818_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 2 (NO REV)|
20|FH_F64519_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135219_68506_0|SrvcGrp|74670|2022|PCT|0.60|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F72546_0_0|SrvcGrp|17652|2022|PDM|591.00|99|0.00|SKILLED NURSING CARE|
20|FH_F150982_0_0|SrvcGrp|100919|2022|PDM|3303.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F41350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1303.00|99|0.00|ASPG VI|
20|FH_F110263_0_0|SrvcGrp|80617|2022|PDM|13084.00|99|0.00|ARTHOPLASTY|
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG X|
20|FH_F36918_0_0|SrvcGrp|19923|2022|PDM|1625.00|99|0.00|HYSTEROSCOPY|
20|FH_F122725_32216_0|SrvcGrp|79586|2022|PDM|201.00|99|0.00|CPT 43200|
20|FH_F38411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F130721_04769_0|SrvcGrp|114917|2022|PCT|0.89|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F149219_01966_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F147502_0_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F110589_70809_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F57453_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|MT NITTANY ASC 1|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.22|99|0.00|HAPA WPA-NWPA 2012-13 ASC 144 W/O REV|
20|FH_F105145_75075_0|SrvcGrp|41325|2022|PDM|24687.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F116040_24637_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97602_40121_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F151201_90020_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|2450.00|99|0.00|AEG 5  (NO REV)|
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|672.00|99|0.00|AEG 2 (NO REV)|
20|FH_F124593_07033_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F140373_0_0|SrvcGrp|108914|2022|PDM|2789.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F34480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F133490_90650_0|SrvcGrp|537|2022|PDM|2273.00|99|0.00|OBSERVATION SERVICES|
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|OP SVCS|
20|FH_F97561_30030_0|SrvcGrp|88978|2022|PDM|5262.00|99|0.00|VAGINAL DELIVERY|
20|FH_F49637_0_0|SrvcGrp|12787|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F103060_0_0|SrvcGrp|67279|2022|PDM|8323.00|99|0.00|CERVICAL SURGERY|
20|FH_F116739_78501_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F120871_14068_0|SrvcGrp|89417|2022|PDM|500.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F61292_0_0|SrvcGrp|39522|2022|PDM|47554.00|99|0.00|MS DRG 216-218 ONLY|
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1242.00|99|0.00|AEG 5  (NO REV)|
20|FH_F31370_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F116341_12180_0|SrvcGrp|104078|2022|PCT|1.05|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F135236_02840_0|SrvcGrp|74059|2022|PDM|3543.30|99|0.00|AETNA CC FOR ER SERVICE CPT 99291|
20|FH_F93791_0_0|SrvcGrp|93601|2022|PDM|4200.00|99|0.00|REVISON OF KNEE JOINT(HCFA)|
20|FH_F143908_52233_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145550_62034_0|SrvcGrp|29155|2022|PDM|130.00|99|0.00|HOSPICE SVCS|
20|FH_F127851_68106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49299_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F142073_0_0|SrvcGrp|33984|2022|PDM|1000.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F66501_0_0|SrvcGrp|42404|2022|PDM|29.00|99|0.00|VENIPUNCTURE|
20|FH_F112082_30720_0|SrvcGrp|14947|2022|PDM|157.00|99|0.00|HOME INFUSION|
20|FH_F139723_30066_0|SrvcGrp|78177|2022|PCT|1.00|99|0.00|AETNA INJECTABLE DRUGS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1862.69|99|0.00|HAPA WPA-NWPA 2012-13 ASC 907 W/O REV|
20|FH_F143650_0_0|SrvcGrp|73008|2022|PDM|1700.00|99|0.00|AEG 10|
20|FH_F85314_0_0|CSTM-ALL|CSTM-00|2020|PDM|409.00|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_F117301_01887_0|SrvcGrp|107284|2022|PDM|525.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F142318_21218_0|SrvcGrp|102239|2022|PDM|105.00|99|0.00|AETNA METHADONE MAINTENANCE|
20|FH_F123774_0_0|SrvcGrp|72990|2022|PDM|485.00|99|0.00|AEG 1|
20|FH_F49487_0_0|SrvcGrp|29402|2022|PDM|30.00|99|0.00|HOME HEALTH THERAPY VISITS OP|
20|FH_F55812_0_0|SrvcGrp|22387|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F149344_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F122245_0_0|SrvcGrp|73004|2022|PDM|1148.00|99|0.00|AEG 8|
20|FH_F132612_0_0|SrvcGrp|112077|2022|PDM|49727.00|99|0.00|CV SURGERY|
20|FH_F49637_0_0|CSTM-ALL|CSTM-00|2020|PDM|809.00|99|0.00|OK SURGICAL HOSPITAL CVTY ENHANCED GROUPER 1|
20|FH_F128130_10027_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F71323_68114_0|SrvcGrp|112054|2022|PCT|1.00|99|0.00|COVID-19 ANTIBODY|
20|FH_F148555_0_0|SrvcGrp|115453|2022|PDM|3502.00|99|0.00|REMOVAL OF PM GENERATOR|
20|FH_F113426_0_0|CSTM-ALL|CSTM-00|2020|PDM|877.00|99|0.00|AEG 3 (NO REV)|
20|FH_F141930_72032_0|CSTM-ALL|CSTM-00|2020|PDM|1193.00|99|0.00|AEG 6 (NO REV)|
20|FH_F92676_15063_0|SrvcGrp|79005|2022|PDM|1065.90|99|0.00|MON VALLEY ASC 105|
20|FH_F40906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144008_11413_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F120665_0_0|CSTM-ALL|CSTM-00|2020|PDM|2113.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128246_0_0|SrvcGrp|111044|2022|PDM|378.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F38387_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111101_97123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124444_0_0|SrvcGrp|82981|2022|PDM|130.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F51113_15501_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F54612_07631_0|SrvcGrp|1228|2022|PCT|1.00|99|0.00|MOBILE INTENSIVE CARE UNIT|
20|FH_F114666_30342_0|SrvcGrp|54943|2022|PDM|2500.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F113910_16508_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F138052_19462_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F138981_85123_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F81893_23114_0|CSTM-ALL|CSTM-00|2020|PCT|1.41|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F122739_43558_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F122839_37122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134817_30339_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136796_24016_0|SrvcGrp|84318|2022|PDM|5396.49|99|0.00|SPINE INFUSION|
20|FH_F136913_68803_0|SrvcGrp|112064|2022|PCT|0.70|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F136927_45690_0|SrvcGrp|46605|2022|PDM|83.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F112371_19047_0|SrvcGrp|12248|2022|PDM|3695.00|99|0.00|BUNIONECTOMY|
20|FH_F74283_0_0|SrvcGrp|42782|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F115181_78602_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F115210_21043_0|SrvcGrp|27261|2022|PDM|8200.00|99|0.00|CPT 27446|
20|FH_F115267_67156_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F147420_89032_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147586_44124_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43330_0_0|SrvcGrp|28622|2022|PDM|40.00|99|0.00|NURSING CARE|
20|FH_F57592_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|FORM H MOD 26|
20|FH_F71882_15228_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40267_0_0|SrvcGrp|17083|2022|PCT|0.80|99|0.00|ASPG X|
20|FH_F149652_37212_0|SrvcGrp|98701|2022|PDM|404.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F147800_0_0|SrvcGrp|87677|2022|PDM|1650.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F97621_75801_0|SrvcGrp|88977|2022|PDM|8791.00|99|0.00|C-SECTION DELIVERY|
20|FH_F144532_19606_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37562_0_0|SrvcGrp|25941|2022|PDM|117.00|99|0.00|PHYSICAL THERAPY|
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|767.00|99|0.00|AEG 3 (NO REV)|
20|FH_F71468_0_0|SrvcGrp|36068|2022|PDM|47.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F147227_48302_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146266_0_0|SrvcGrp|88491|2022|PDM|5600.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F123158_0_0|SrvcGrp|84704|2022|PDM|960.00|99|0.00|CYSTOURETHROSCOPY W/ REMOVAL OF FOREIGN BODY|
20|FH_F150949_0_0|SrvcGrp|113853|2022|PDM|3000.00|99|0.00|CARDIAC CATHERIZATION INCL INJECTIONS|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PDM|52.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F139707_84010_0|SrvcGrp|116279|2022|PDM|6922.00|99|0.00|ORTHOPEDIC/PODIATRY|
20|FH_F128924_0_0|SrvcGrp|111217|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY IPD/CAPD/CCPD NO ESRD|
20|FH_F98940_70506_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F98940_70506_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F138478_0_0|SrvcGrp|109510|2022|PDM|1736.59|99|0.00|REMOVE PACEMAKER ELECTRODE|
20|FH_F97084_91911_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F113116_23847_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148999_46218_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116437_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F134819_0_0|SrvcGrp|17955|2022|PDM|2128.00|99|0.00|HYSTEROSCOPY|
20|FH_F137713_50025_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F36299_0_0|SrvcGrp|72|2022|PDM|530.00|99|0.00|NEWBORN NURSERY|
20|FH_F36683_0_0|SrvcGrp|656|2022|PCT|0.65|99|0.00|DEFINITIVE OBSERVATION UNIT|
20|FH_F112794_01040_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F139912_04101_0|SrvcGrp|73842|2022|PDM|185.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F143249_89801_0|SrvcGrp|26868|2022|PDM|30.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F143249_89801_0|SrvcGrp|48398|2022|PDM|120.00|99|0.00|PT SERVICES|
20|FH_F120856_78247_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118950_33312_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F125011_74467_0|SrvcGrp|110028|2022|PDM|3460.00|99|0.00|INTERSTIM INSERTION REMOVAL|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD KN) - PMRS|
20|FH_F90691_0_0|SrvcGrp|72994|2022|PDM|570.00|99|0.00|AEG 3|
20|FH_F143833_63703_0|SrvcGrp|3178|2022|PDM|977.00|99|0.00|ACUTE PSYCH|
20|FH_F129766_48236_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL|
20|FH_F91994_0_0|SrvcGrp|72992|2022|PDM|750.00|99|0.00|AEG 2|
20|FH_F33712_0_0|SrvcGrp|361|2022|PDM|900.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F42706_0_0|SrvcGrp|8950|2022|PDM|1300.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F121303_15501_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F138256_68803_0|CSTM-ALL|CSTM-00|2020|PCT|1.48|99|0.00|HSS ASC|
20|FH_F150148_71901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116806_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|1434.00|99|0.00|ASPG V|
20|FH_F100782_0_0|SrvcGrp|105074|2022|PDM|582.22|99|0.00|WINDBER MEDICAL CNTR ASC 119|
20|FH_F123851_03235_0|SrvcGrp|43567|2022|PDM|160.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F118123_67226_0|SrvcGrp|24752|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F115870_98225_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F133478_40165_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F67303_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F137047_73120_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F140612_60070_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118959_44830_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F147801_90703_0|SrvcGrp|94880|2022|PDM|159.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F117126_12801_0|SrvcGrp|81779|2022|PCT|2.15|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F109652_0_0|SrvcGrp|44564|2022|PDM|529.00|99|0.00|NEWBORN NURSERY|
20|FH_F107480_0_0|SrvcGrp|75479|2022|PDM|500.00|99|0.00|AEG 1|
20|FH_F90833_62821_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130035_0_0|SrvcGrp|108082|2022|PDM|37.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F32232_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F109513_0_0|SrvcGrp|90422|2022|PDM|3500.00|99|0.00|REPAIR GRAFT RADIUS OR ULNA|
20|FH_F94786_07974_0|SrvcGrp|14948|2022|PDM|36.75|99|0.00|HOME INFUSION THERAPY|
20|FH_F73727_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121426_0_0|SrvcGrp|11151|2022|PDM|2771.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F146807_28655_0|SrvcGrp|109057|2022|PCT|0.85|99|0.00|CARDIAC STUDIES|
20|FH_F147081_02130_0|SrvcGrp|17698|2022|PDM|1104.00|99|0.00|ACUTE PSYCH (>=18 YRS)|
20|FH_F33896_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F92493_0_0|SrvcGrp|92367|2022|PDM|2601.06|99|0.00|TRANSPLANT HAND TENDON|
20|FH_F124267_29671_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F105591_17601_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F94786_07974_0|SrvcGrp|86849|2022|PDM|36.75|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F127995_84010_0|SrvcGrp|48398|2022|PDM|85.50|99|0.00|PT SERVICES|
20|FH_F117891_19034_0|SrvcGrp|73701|2022|PDM|26.25|99|0.00|AETNA - SKILLED NURSING|
20|FH_F33241_0_0|SrvcGrp|3420|2022|PDM|4000.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F147995_67037_0|SrvcGrp|114925|2022|PDM|10000.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F142947_76043_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128130_10027_0|SrvcGrp|110238|2022|PDM|1384.00|99|0.00|CAT SCAN|
20|FH_F74264_15301_0|CSTM-ALL|CSTM-00|2020|PDM|340.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86293_0_0|SrvcGrp|41327|2022|PDM|1995.00|99|0.00|OP SURGERY CPT 28308|
20|FH_F91255_19401_0|SrvcGrp|83798|2022|PCT|1.25|99|0.00|AETNA RADIOLOGY SERVICES|
20|FH_F88956_0_0|SrvcGrp|10391|2022|PDM|2533.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F91152_60061_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F72542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F37494_0_0|CSTM-ALL|CSTM-00|2020|PDM|851.20|99|0.00|ASPG II|
20|FH_F40457_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F133018_84037_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F38007_0_0|SrvcGrp|27887|2022|PCT|0.88|99|0.00|BONE MARROW TRANSPLANT|
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1799.00|99|0.00|AEG 9 (NO REV)|
20|FH_F114568_08097_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134847_0_0|SrvcGrp|84318|2022|PDM|9503.00|99|0.00|SPINE INFUSION|
20|FH_F130813_85014_0|SrvcGrp|109798|2022|PCT|1.25|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 2 (NO REV)|
20|FH_F35557_0_0|SrvcGrp|10407|2022|PDM|40.00|99|0.00|HOME INFUSION|
20|FH_F39443_0_0|SrvcGrp|30143|2022|PDM|1470.00|99|0.00|SEPTUM REPAIR|
20|FH_F113178_44035_0|SrvcGrp|75761|2022|PDM|469.00|99|0.00|AMBULATORY DETOX REHAB|
20|FH_F133579_0_0|SrvcGrp|92659|2022|PDM|2205.00|99|0.00|REPAIR OF RETINAL DETACHMENT|
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150939_0_0|SrvcGrp|105327|2022|PDM|2.98|99|0.00|METHILPREDNISO ACET 80MG/2MX|
20|FH_F114853_0_0|SrvcGrp|88491|2022|PDM|7215.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F38949_0_0|SrvcGrp|28227|2022|PDM|8504.00|99|0.00|ANGIOPLASTY|
20|FH_F48295_0_0|SrvcGrp|36068|2022|PDM|45.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F113585_20155_0|SrvcGrp|22593|2022|PCT|1.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F113585_20155_0|SrvcGrp|86843|2022|PDM|50.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F138670_53045_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138770_75142_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138876_25302_0|SrvcGrp|31973|2022|PDM|15.00|99|0.00|HOME THERAPY|
20|FH_F138996_68104_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1126.46|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1301 W/O REV|
20|FH_F151420_60654_0|SrvcGrp|29532|2022|PCT|1.00|99|0.00|LABORATORY|
20|FH_F151427_04106_0|SrvcGrp|116007|2022|PDM|66.25|99|0.00|HYDRATE IV INFUSION ADD ON (HCFA)|
20|FH_F36492_0_0|SrvcGrp|72994|2022|PDM|874.00|99|0.00|AEG 3|
20|FH_F135572_89106_0|SrvcGrp|24750|2022|PCT|1.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F135572_89106_0|SrvcGrp|47183|2022|PDM|80.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F135763_20678_0|SrvcGrp|74668|2022|PDM|900.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F135763_20678_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F135800_28731_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131463_19096_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F130547_85712_0|SrvcGrp|472|2022|PDM|403.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116431_76104_0|SrvcGrp|16276|2022|PCT|0.85|99|0.00|HIGH COST DRUGS|
20|FH_F140629_0_0|SrvcGrp|26280|2022|PDM|2497.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F140629_0_0|SrvcGrp|83646|2022|PDM|1372.00|99|0.00|CPT 31276|
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|SrvcGrp|44064|2022|PDM|1016.00|99|0.00|CPT 52351|
20|FH_F32938_0_0|SrvcGrp|9774|2022|PDM|1800.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F101681_46123_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F121761_44130_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F121763_07202_0|SrvcGrp|89269|2022|PDM|90.00|99|0.00|PSYTX PT/FAMILY 45 MINUTES|
20|FH_F121796_68355_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F42098_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|PROFESSIONAL PHARMACY|
20|FH_F42347_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F111363_33169_0|SrvcGrp|110428|2022|PCT|0.84|99|0.00|LABORATORY SERVICES|
20|FH_F111880_50003_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F141651_0_0|SrvcGrp|59841|2022|PDM|2200.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F65882_0_0|SrvcGrp|42827|2022|PDM|54.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F31375_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F33081_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F39925_0_0|SrvcGrp|3029|2022|PDM|250.00|99|0.00|NEWBORN NURSERY|
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|2006 MEDICARE ASPG III|
20|FH_F118651_0_0|SrvcGrp|41547|2022|PDM|4376.21|99|0.00|OP LAPAROSCOPIC HYSTERECTOMY|
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)|
20|FH_F87500_16823_0|SrvcGrp|81950|2022|PCT|1.00|99|0.00|AETNA LABORATORY|
20|FH_F129485_34741_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|3042.00|99|0.00|AEG 10 (NO REV)|
20|FH_F140102_0_0|SrvcGrp|104230|2022|PDM|105.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F102222_19720_0|SrvcGrp|86834|2022|PDM|10.50|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F102228_08846_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F102960_50613_0|CSTM-ALL|CSTM-00|2020|PDM|4078.00|99|0.00|AEG 3 (NO REV)|
20|FH_F101320_26062_0|SrvcGrp|24752|2022|PDM|18.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F103780_64804_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F51276_0_0|SrvcGrp|41460|2022|PDM|20.00|99|0.00|ENTERAL THERAPY - UNSPECIFIED|
20|FH_F51276_0_0|SrvcGrp|17016|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F143529_84737_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|320.00|99|0.00|GA RETINA SURG CTR ASC 11|
20|FH_F33233_0_0|SrvcGrp|696|2022|PDM|0.50|99|0.00|BLOOD PLASMA/TRANSPORTATION|
20|FH_F143783_0_0|SrvcGrp|97703|2022|PDM|105.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F87031_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F100962_0_0|SrvcGrp|73008|2022|PDM|832.00|99|0.00|AEG 10|
20|FH_F41491_0_0|CSTM-ALL|CSTM-00|2020|PDM|902.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63877|2022|PDM|295.45|99|0.00|HAPA WPA-NWPA 2012-13 ASC 233|
20|FH_F132969_84003_0|SrvcGrp|10577|2022|PDM|25.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F85353_16407_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F112668_0_0|SrvcGrp|73004|2022|PDM|1102.00|99|0.00|AEG 8|
20|FH_F110344_37421_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130330_0_0|SrvcGrp|82981|2022|PDM|114.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 10 (NO REV)|
20|FH_F128246_0_0|SrvcGrp|79792|2022|PDM|1176.00|99|0.00|EYE/OCULAR ADNEXA SURGERY|
20|FH_F83113_0_0|SrvcGrp|22954|2022|PDM|138.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F141327_65566_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124322_64131_0|SrvcGrp|47183|2022|PDM|83.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F113116_23847_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147172_76086_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138018_17313_0|SrvcGrp|15596|2022|PDM|12.32|99|0.00|HOME INFUSION THERAPY|
20|FH_F33719_0_0|SrvcGrp|14414|2022|PDM|467.00|99|0.00|NEWBORN NURSERY|
20|FH_F149602_07109_0|SrvcGrp|113227|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 3 TRGT|
20|FH_F101640_32218_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 4 (NO REV)|
20|FH_F89851_83854_0|SrvcGrp|26664|2022|PDM|17370.00|99|0.00|MS DRG 481 ONLY|
20|FH_F84611_30281_0|SrvcGrp|76379|2022|PDM|35004.00|99|0.00|OP GAMMA KNIFE|
20|FH_F49954_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC|
20|FH_F110263_0_0|SrvcGrp|77461|2022|PDM|7140.00|99|0.00|CPT 52356|
20|FH_F88199_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_F32758_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|2250.00|99|0.00|REPAIR VENTRAL HERNIA INI BLOCK|
20|FH_F82235_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F114963_62062_0|SrvcGrp|43567|2022|PDM|184.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F83253_33511_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F116188_72211_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F91622_0_0|SrvcGrp|3499|2022|PCT|0.59|99|0.00|IMPLANTS|
20|FH_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER KL|
20|FH_F142710_0_0|SrvcGrp|84185|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F110925_01104_0|SrvcGrp|40699|2022|PDM|6.83|99|0.00|ENTERAL FEEDING SUPPLY KIT, PUMP|
20|FH_F86872_15215_0|SrvcGrp|86842|2022|PDM|40.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F145641_06902_0|SrvcGrp|105640|2022|PDM|1051.00|99|0.00|NJX INTERLAMINAR CRV/THRC|
20|FH_F117206_0_0|SrvcGrp|82310|2022|PDM|600.00|99|0.00|COLORECTAL CANCER SCREENING|
20|FH_F125259_0_0|SrvcGrp|108118|2022|PDM|1750.00|99|0.00|ARTERIOVENOUS ANASTOMOSIS|
20|FH_F100782_0_0|SrvcGrp|105109|2022|PDM|858.76|99|0.00|WINDBER MEDICAL CNTR ASC 209|
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV)|
20|FH_F83995_16748_0|SrvcGrp|10527|2022|PDM|123.00|99|0.00|HOSPICE SVCS|
20|FH_F134226_66533_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126324_20176_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101084_15459_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102623_0_0|SrvcGrp|26472|2022|PDM|420.00|99|0.00|HEMODIALYSIS|
20|FH_F136404_06410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118152_20151_0|SrvcGrp|86849|2022|PDM|40.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F148761_33311_0|SrvcGrp|90898|2022|PDM|75.00|99|0.00|TREATMENT OF SPEECH|
20|FH_F132190_0_0|SrvcGrp|99073|2022|PDM|1.25|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F58592_0_0|CSTM-ALL|CSTM-00|2020|PDM|525.00|99|0.00|OP SURGERY (MOD SG)|
20|FH_F32484_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F38798_0_0|SrvcGrp|10541|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F126581_45638_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122893_29135_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F63129_0_0|SrvcGrp|46424|2022|PDM|25.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|927.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F146579_99202_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F125549_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|4300.00|99|0.00|AEG 9 (NO REV)|
20|FH_F126076_75231_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134593_60007_0|SrvcGrp|86136|2022|PCT|0.85|99|0.00|AETNA LUMIZYME INJ|
20|FH_F146200_70815_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35442_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F80513_0_0|SrvcGrp|87307|2022|PDM|21718.00|99|0.00|MSDRG 270 ONLY|
20|FH_F115966_16801_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111605_80524_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F34477_0_0|SrvcGrp|63742|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F136542_02446_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137530_0_0|SrvcGrp|107794|2022|PDM|9466.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F118932_07652_0|SrvcGrp|79786|2022|PDM|2652.00|99|0.00|SLEEP STUDIES|
20|FH_F32728_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
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_F100703_0_0|SrvcGrp|96979|2022|PDM|3466.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F55694_0_0|SrvcGrp|11000|2022|PCT|0.59|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F104963_15146_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136751_0_0|SrvcGrp|98497|2022|PDM|16000.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F97103_53295_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142769_21204_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F71926_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHYSICAL THERAPY|
20|FH_F32965_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|OP SVCS|
20|FH_F148899_44041_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118486_95060_0|SrvcGrp|89149|2022|PDM|330.00|99|0.00|OP INTENSIVE|
20|FH_F133540_72687_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F50420_0_0|SrvcGrp|33165|2022|PDM|405.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F150760_44833_0|SrvcGrp|29346|2022|PDM|25.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F110783_93013_0|SrvcGrp|24761|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F92299_62016_0|SrvcGrp|72998|2022|PCT|0.75|99|0.00|AEG 5|
20|FH_F69183_0_0|SrvcGrp|22020|2022|PCT|0.50|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F130309_17044_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F128392_01026_0|SrvcGrp|75442|2022|PDM|800.00|99|0.00|OBSERVATION - REV 762|
20|FH_F141156_04401_0|CSTM-ALL|CSTM-00|2020|PDM|946.00|99|0.00|AEG 5  (NO REV)|
20|FH_F76124_0_0|SrvcGrp|56483|2022|PDM|71.00|99|0.00|PT/OT/ST|
20|FH_F134847_0_0|SrvcGrp|28549|2022|PDM|3496.00|99|0.00|VITRECTOMY|
20|FH_F132153_06450_0|SrvcGrp|472|2022|PDM|495.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|ASPG X|
20|FH_F134869_08854_0|SrvcGrp|90647|2022|PDM|110.00|99|0.00|PSYTX PT/FAMILY 30 MINUTES (HCFA)|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|351.69|99|0.00|SALLY BALIN,999182,ASC 104|
20|FH_F68844_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|AMBULANCE SERVICES|
20|FH_F66404_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F131757_06320_0|SrvcGrp|471|2022|PDM|888.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133569_17202_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F88545_78734_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F136952_78218_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F137236_17603_0|SrvcGrp|14615|2022|PDM|1365.00|99|0.00|PSYCH|
20|FH_F118914_43015_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F118943_64506_0|SrvcGrp|53987|2022|PDM|50.00|99|0.00|PHOTOTHERAPY|
20|FH_F129483_77030_0|SrvcGrp|24752|2022|PDM|25.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F109652_0_0|SrvcGrp|9517|2022|PDM|145.00|99|0.00|MAMMOGRAPHY|
20|FH_F73022_0_0|SrvcGrp|11259|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F148644_06890_0|SrvcGrp|70749|2022|PDM|3794.00|99|0.00|CPT 29823|
20|FH_F151155_26508_0|SrvcGrp|113326|2022|PDM|6782.00|99|0.00|MED ASSIST TX IMPLANT|
20|FH_F115884_0_0|SrvcGrp|90477|2022|PDM|111.00|99|0.00|HOSPICE|
20|FH_F98040_89406_0|SrvcGrp|90854|2022|PDM|2103.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F141050_46410_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F107400_0_0|SrvcGrp|73700|2022|PDM|60.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F128657_19008_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F38770_0_0|SrvcGrp|28001|2022|PDM|2596.00|99|0.00|MS DRG 207-208 ONLY|
20|FH_F138611_0_0|SrvcGrp|41334|2022|PDM|14894.00|99|0.00|TOTAL KNEE|
20|FH_F127105_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F100786_24740_0|SrvcGrp|73559|2022|PDM|6240.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F118379_32079_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F126819_43701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|1470.00|99|0.00|AEG 4 (NO REV)|
20|FH_F140175_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44607_0_0|SrvcGrp|38805|2022|PDM|2500.00|99|0.00|ACUTE MEDICAL SERVICES|
20|FH_F115315_43011_0|SrvcGrp|90489|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F126676_43537_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139607_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F132934_63005_0|SrvcGrp|92601|2022|PDM|124.00|99|0.00|INPATIENT DISCHARGE SERVICE|
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_F87155_04105_0|SrvcGrp|17013|2022|PDM|57.78|99|0.00|HOME INFUSION THERAPY|
20|FH_F150662_20901_0|SrvcGrp|43567|2022|PDM|135.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.00|99|0.00|HAPA EPA ASC 33|
20|FH_F98840_31021_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F47902_0_0|SrvcGrp|29954|2022|PCT|1.00|99|0.00|DME MOD 53|
20|FH_F139167_42240_0|SrvcGrp|86723|2022|PDM|379.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F38584_0_0|SrvcGrp|17073|2022|PDM|1156.00|99|0.00|ASPG V|
20|FH_F35410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|INFI- SH AND SJ  CODES|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89674_18640_0|SrvcGrp|22384|2022|PDM|57.75|99|0.00|HOME VISIT PRENATAL|
20|FH_F137363_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F143488_84770_0|CSTM-ALL|CSTM-00|2020|PDM|1034.00|99|0.00|AEG 4 (NO REV)|
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|AEG 10 (NO REV)|
20|FH_F117378_16148_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F77762_0_0|SrvcGrp|42975|2022|PDM|135.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F148169_33138_0|SrvcGrp|112677|2022|PDM|25.46|99|0.00|COVID-19 SPEC COLL SNF/LAB|
20|FH_F31540_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91575_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F125011_74467_0|SrvcGrp|42782|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F127441_45822_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F129130_92562_0|SrvcGrp|112831|2022|PDM|32556.25|99|0.00|ORTHOPEDIC SURGERY (0-3 DAYS)|
20|FH_F97761_04072_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F142319_19403_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F103780_64804_0|SrvcGrp|105465|2022|PCT|0.68|99|0.00|AETNA THERAPIES|
20|FH_F69504_0_0|SrvcGrp|48394|2022|PDM|7.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F132348_16214_0|SrvcGrp|63297|2022|PDM|95.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F91752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F128613_68111_0|SrvcGrp|86722|2022|PDM|196.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F38352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100880_67735_0|SrvcGrp|14096|2022|PCT|0.78|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1484.00|99|0.00|ASPG IV|
20|FH_F42984_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128615_78520_0|SrvcGrp|89337|2022|PDM|775.00|99|0.00|DETOXIFICATION|
20|FH_F123096_28210_0|SrvcGrp|74668|2022|PDM|500.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F95284_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91255_19401_0|CSTM-ALL|CSTM-00|2020|PDM|1873.00|99|0.00|AEG 3 (NO REV)|
20|FH_F117368_68114_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120407_84070_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F41785_0_0|SrvcGrp|28847|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY|
20|FH_F132279_63775_0|SrvcGrp|112047|2022|PCT|0.50|99|0.00|RADIOLOGY|
20|FH_F46856_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|OP SVCS|
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)|
20|FH_F150882_84041_0|SrvcGrp|86853|2022|PDM|47.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F97184_26101_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F131028_49735_0|SrvcGrp|97702|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F97184_26101_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F84535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F151023_77384_0|CSTM-ALL|CSTM-00|2020|PDM|1365.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS|
20|FH_F36663_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F98900_42001_0|SrvcGrp|73643|2022|PDM|2454.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PDM|1170.00|99|0.00|ACUTE PSYCH|
20|FH_F132056_32080_0|SrvcGrp|73841|2022|PDM|416.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F125207_32904_0|SrvcGrp|21915|2022|PCT|1.05|99|0.00|GASTROSTOMY TUBE|
20|FH_F97640_37043_0|SrvcGrp|73485|2022|PDM|2468.00|99|0.00|AETNA REHAB|
20|FH_F124435_03882_0|SrvcGrp|108484|2022|PDM|433.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F149608_19116_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F128583_45154_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F113649_01752_0|SrvcGrp|86848|2022|PDM|45.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F138649_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F102302_0_0|SrvcGrp|80136|2022|PDM|14750.00|99|0.00|IMPLANT SPINAL INFUSION|
20|FH_F141607_27021_0|SrvcGrp|88620|2022|PDM|130.00|99|0.00|SKILLED NURSING RN|
20|FH_F123921_89128_0|SrvcGrp|75419|2022|PDM|800.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F85353_16407_0|SrvcGrp|537|2022|PDM|94.00|99|0.00|OBSERVATION SERVICES|
20|FH_F150165_06032_0|SrvcGrp|115162|2022|PDM|5305.00|99|0.00|FOOT AND TOES REPAIR|
20|FH_F120930_0_0|SrvcGrp|65403|2022|PDM|2000.00|99|0.00|CPT 42830|
20|FH_F122942_89512_0|SrvcGrp|73605|2022|PDM|1200.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F143578_63033_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|HSS ASC|
20|FH_F31612_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.10|99|0.00|OP SVCS|
20|FH_F120735_40012_0|SrvcGrp|73841|2022|PDM|369.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|CHEMICAL DEPENDENCY - ADOLESCENT|
20|FH_F120058_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145937_75240_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119400_0_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F125660_46706_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F111520_81601_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F38865_0_0|SrvcGrp|360|2022|PDM|1860.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F127965_32204_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147315_33603_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|30.50|99|0.00|ARALAST THERAPY (MOD KP/SH)|
20|FH_F35678_0_0|SrvcGrp|18308|2022|PDM|16952.00|99|0.00|MS DRG 041|
20|FH_F98000_59102_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F120104_97223_0|SrvcGrp|90573|2022|PDM|225.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F132351_19342_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|AEG 10 (NO REV)|
20|FH_F113253_72206_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F141802_17042_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F145792_33612_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F44198_0_0|SrvcGrp|13422|2022|PDM|236.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F62719_0_0|SrvcGrp|3810|2022|PDM|168.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F147941_06023_0|SrvcGrp|74610|2022|PDM|453.00|99|0.00|AETNA FOLLOW UP VISIT CPT 90836|
20|FH_F112568_0_0|SrvcGrp|104844|2022|PDM|312.65|99|0.00|CLINICAL SOCIAL WORKER IN HOME|
20|FH_F104740_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F148500_50129_0|SrvcGrp|109057|2022|PCT|0.80|99|0.00|CARDIAC STUDIES|
20|FH_F139299_0_0|SrvcGrp|89149|2022|PDM|230.00|99|0.00|OP INTENSIVE|
20|FH_F134568_12946_0|SrvcGrp|76501|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|3121.00|99|0.00|AEG 9 (NO REV)|
20|FH_F130468_0_0|SrvcGrp|88219|2022|PDM|2847.40|99|0.00|ARTHROSCOPY KNEE/SURGICAL|
20|FH_F133867_84075_0|SrvcGrp|97705|2022|PDM|93.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|4305.00|99|0.00|AEG 8 (NO REV)|
20|FH_F150165_06032_0|SrvcGrp|78283|2022|PDM|2540.00|99|0.00|CPT 49505|
20|FH_F133749_84604_0|SrvcGrp|112435|2022|PDM|25.00|99|0.00|HYDRATION THERAPY (HCFA)|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|113.17|99|0.00|HAPA WPA-NWPA 2012-13 ASC 137 W/O REV|
20|FH_F68442_0_0|SrvcGrp|44131|2022|PDM|80.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F131964_89120_0|SrvcGrp|105353|2022|PDM|80.00|99|0.00|AETNA PT/OT|
20|FH_F43450_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89340_0_0|SrvcGrp|88137|2022|PDM|3850.00|99|0.00|PENILE PROSTHESIS|
20|FH_F69846_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F123818_43452_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F138471_84663_0|SrvcGrp|48398|2022|PDM|85.50|99|0.00|PT SERVICES|
20|FH_F118932_07652_0|SrvcGrp|105480|2022|PCT|2.50|99|0.00|RADIOLOGY SERVICES|
20|FH_F80366_0_0|SrvcGrp|73806|2022|PDM|414.00|99|0.00|AETNA ER|
20|FH_F117211_15143_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117240_37334_0|SrvcGrp|75489|2022|PDM|3000.00|99|0.00|AEG 6|
20|FH_F102760_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F148704_66219_0|SrvcGrp|110428|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F151144_35801_0|SrvcGrp|115966|2022|PDM|915.43|99|0.00|STRABISMUS SURGERY|
20|FH_F126116_0_0|SrvcGrp|89404|2022|PDM|13500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F138662_78624_0|SrvcGrp|108484|2022|PDM|500.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F138017_73129_0|SrvcGrp|16506|2022|PDM|6539.00|99|0.00|CPT 52647|
20|FH_F132008_85226_0|SrvcGrp|107243|2022|PCT|0.80|99|0.00|POWER WHEELCHAIR GROUP 3|
20|FH_F38584_0_0|SrvcGrp|17069|2022|PDM|822.00|99|0.00|ASPG III|
20|FH_F37081_0_0|SrvcGrp|18240|2022|PDM|37700.00|99|0.00|MS DRG 453|
20|FH_F49300_0_0|SrvcGrp|43955|2022|PDM|85.00|99|0.00|NURSING CARE|
20|FH_F151755_03303_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148162_29412_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F33513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|GENERAL ACUTE CARE|
20|FH_F125660_46706_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F61332_0_0|SrvcGrp|40222|2022|PCT|0.65|99|0.00|OP SVCS|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 640|
20|FH_F72546_0_0|SrvcGrp|114299|2022|PCT|1.20|99|0.00|OCN F/S PRICING: GLOBAL (RADIOLOGY) (HCFA)|
20|FH_F54974_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: ALL|
20|FH_F149780_00783_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F72664_0_0|SrvcGrp|68382|2022|PDM|75.00|99|0.00|SOCIAL WORKER|
20|FH_F77463_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109645_0_0|SrvcGrp|103782|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS (MOD GP) (HCFA)|
20|FH_F75307_0_0|SrvcGrp|3809|2022|PDM|605.00|99|0.00|HOSPICE CARE|
20|FH_F149739_77087_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116747_0_0|SrvcGrp|48385|2022|PDM|91.00|99|0.00|SPEECH THERAPY|
20|FH_F66687_0_0|SrvcGrp|69926|2022|PDM|2312.00|99|0.00|ELECTROPHSIOLOGY|
20|FH_F37945_0_0|SrvcGrp|16309|2022|PCT|0.50|99|0.00|HIGH COST DRUGS|
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2393.00|99|0.00|AEG 6 (NO REV)|
20|FH_F87775_15106_0|SrvcGrp|73523|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F133585_0_0|SrvcGrp|112384|2022|PDM|1786.00|99|0.00|REMOVE TUNNELED IP CATH|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|65.71|99|0.00|SLEEP EEG (MOD 26)|
20|FH_F120805_92672_0|SrvcGrp|75419|2022|PDM|725.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F116088_46410_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F133700_92808_0|SrvcGrp|73063|2022|PDM|765.00|99|0.00|OBSERVATION SERVICES|
20|FH_F51938_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F120490_64133_0|SrvcGrp|86841|2022|PDM|50.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F142449_62220_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F142715_32757_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128678_68048_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F76586_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F110103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111925_0_0|SrvcGrp|95108|2022|PDM|1602.00|99|0.00|RETINAL DETACHMENT|
20|FH_F124663_65608_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F135327_0_0|SrvcGrp|112736|2022|PDM|1080.00|99|0.00|VITRECTOMY|
20|FH_F133455_60110_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F101709_0_0|SrvcGrp|97363|2022|PDM|2865.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F84394_17402_0|SrvcGrp|81779|2022|PCT|0.82|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F59732_0_0|SrvcGrp|14948|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F115985_0_0|SrvcGrp|29930|2022|PDM|444.00|99|0.00|DIALYSIS|
20|FH_F44198_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127375_28621_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F116269_92627_0|SrvcGrp|86749|2022|PCT|1.15|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F49338_0_0|SrvcGrp|36808|2022|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53  (DME)|
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|1928.00|99|0.00|AEG 5  (NO REV)|
20|FH_F90362_0_0|SrvcGrp|84939|2022|PDM|11670.00|99|0.00|SHOULDER JOINT|
20|FH_F113325_80004_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F118803_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F133969_0_0|CSTM-ALL|CSTM-00|2020|PDM|707.33|99|0.00|AEG 4 (NO REV)|
20|FH_F77082_0_0|SrvcGrp|47252|2022|PDM|61837.00|99|0.00|MS DRG 216-237 ONLY|
20|FH_F88673_71105_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|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_F75963_0_0|SrvcGrp|73140|2022|PDM|18.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F101100_50314_0|SrvcGrp|97898|2022|PDM|6202.00|99|0.00|AMPUTATE LOWER LEG|
20|FH_F75842_0_0|SrvcGrp|29830|2022|PDM|9406.88|99|0.00|PERCUT NEEDLE INSERTION|
20|FH_F120795_27514_0|SrvcGrp|34557|2022|PDM|3281.00|99|0.00|MS DRG 894-897 ONLY CHEM DEP|
20|FH_F114092_83350_0|CSTM-ALL|CSTM-00|2020|PDM|8622.00|99|0.00|AEG 4 W/O ATRIAL/VENTRICULAR ELECTRODE (NO REV)|
20|FH_F142449_62220_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F142267_78240_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F139287_33544_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F151121_60455_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|587.00|99|0.00|AEG 1 (NO REV)|
20|FH_F135491_0_0|CSTM-ALL|CSTM-00|2020|PDM|957.00|99|0.00|AEG 6 (NO REV)|
20|FH_F124180_0_0|SrvcGrp|85898|2022|PDM|2700.00|99|0.00|CPT 67312|
20|FH_F77944_0_0|SrvcGrp|21805|2022|PDM|260.00|99|0.00|PT/OT/ST|
20|FH_F146896_78636_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87436_0_0|SrvcGrp|29804|2022|PDM|1042.00|99|0.00|DETOX|
20|FH_F117807_86426_0|SrvcGrp|29347|2022|PDM|28.00|99|0.00|HOME HEALTH AIDE|
20|FH_F133021_00910_0|SrvcGrp|112265|2022|PDM|17000.00|99|0.00|ENDOVASCULAR REPAIR OF THORACIC AORTA|
20|FH_F33428_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133397_23233_0|SrvcGrp|66224|2022|PDM|146.00|99|0.00|PHYSICAL THERAPY|
20|FH_F118667_95131_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40943_0_0|SrvcGrp|473|2022|PDM|318.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F129535_0_0|SrvcGrp|91569|2022|PDM|725.00|99|0.00|REMOVE HEMMORRHOIDS AND FISSURE|
20|FH_F139209_22556_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130023_0_0|SrvcGrp|79720|2022|PDM|1291.00|99|0.00|ACUTE REHAB II|
20|FH_F36472_0_0|SrvcGrp|944|2022|PCT|0.65|99|0.00|BARIATRIC SVCS|
20|FH_F42177_0_0|SrvcGrp|22461|2022|PCT|0.85|99|0.00|INPATIENT HOSPICE SVCS|
20|FH_F126339_0_0|SrvcGrp|87077|2022|PDM|115.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F111204_10023_0|SrvcGrp|98701|2022|PDM|340.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F140007_0_0|SrvcGrp|93740|2022|PDM|8045.00|99|0.00|REVISE/REMOVE NEURO RECEIVER|
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|2418.00|99|0.00|AEG 4 (NO REV)|
20|FH_F138197_0_0|SrvcGrp|80139|2022|PDM|4883.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F134192_0_0|CSTM-ALL|CSTM-00|2020|PDM|2425.00|99|0.00|AEG 6 (NO REV)|
20|FH_F92516_0_0|SrvcGrp|73000|2022|PDM|840.00|99|0.00|AEG 6|
20|FH_F109963_0_0|SrvcGrp|72998|2022|PDM|738.00|99|0.00|AEG 5|
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PDM|722.00|99|0.00|AEG 3 (NO REV)|
20|FH_F100787_69162_0|SrvcGrp|73601|2022|PDM|5190.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F136622_60062_0|SrvcGrp|73841|2022|PDM|656.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F114678_78745_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138055_16146_0|SrvcGrp|108484|2022|PDM|541.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F100664_03104_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F43249_0_0|SrvcGrp|31134|2022|PDM|2104.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F43779_0_0|CSTM-ALL|CSTM-00|2020|PDM|890.00|99|0.00|ACUTE PSYCH|
20|FH_F135761_70127_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F112371_19047_0|CSTM-ALL|CSTM-00|2020|PDM|1872.00|99|0.00|AEG 5  (NO REV)|
20|FH_F54572_0_0|SrvcGrp|29930|2022|PDM|400.00|99|0.00|DIALYSIS|
20|FH_F115631_65201_0|SrvcGrp|106254|2022|PDM|1141.00|99|0.00|UNLISTED PROCEDURE, HUMERUS OR EL|
20|FH_F115664_72758_0|SrvcGrp|78420|2022|PDM|623.00|99|0.00|INTERIM LABOR|
20|FH_F116199_75042_0|SrvcGrp|88819|2022|PDM|796.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F147443_06469_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|28.50|99|0.00|HYDRATION THREE LITER (MOD SH)|
20|FH_F41832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134797_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148554_85016_0|SrvcGrp|115453|2022|PDM|2040.00|99|0.00|REMOVAL OF PM GENERATOR|
20|FH_F42807_0_0|SrvcGrp|110|2022|PDM|728.00|99|0.00|CD - REHABILITATION|
20|FH_F128349_43082_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F123583_72756_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111522_81067_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INJECTION, PEGFILGRASTIM 6MG|
20|FH_F32167_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F139707_84010_0|SrvcGrp|84285|2022|PDM|11280.00|99|0.00|REVISE CORNEA WITH IMPLANT|
20|FH_F113765_0_0|SrvcGrp|88621|2022|PDM|60.00|99|0.00|SKILLED NURSING LPN|
20|FH_F92155_74437_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|GENERAL ACUTE CARE|
20|FH_F73442_0_0|SrvcGrp|44107|2022|PDM|50.00|99|0.00|SPEECH THERAPY|
20|FH_F135093_0_0|SrvcGrp|16|2022|PDM|890.00|99|0.00|ACUTE REHABILITATION|
20|FH_F134867_32068_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132512_0_0|SrvcGrp|89417|2022|PDM|714.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F134394_92101_0|SrvcGrp|105681|2022|PDM|360.00|99|0.00|INTENSIVE OUTPATIENT >=18 YRS (HCFA)|
20|FH_F137767_01841_0|SrvcGrp|9866|2022|PDM|3675.00|99|0.00|IP OBSERVATION SVCS|
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|2544.00|99|0.00|AEG 6 (NO REV)|
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|913.00|99|0.00|AEG 6 (NO REV)|
20|FH_F133536_0_0|SrvcGrp|100065|2022|PDM|1682.00|99|0.00|DEEP ANT OR POSTER TIBIAL|
20|FH_F133579_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F141004_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F80511_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F41213_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48295_0_0|SrvcGrp|42046|2022|PDM|595.00|99|0.00|HOSPICE CARE|
20|FH_F48693_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F138407_60025_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F81823_0_0|SrvcGrp|66482|2022|PDM|35.00|99|0.00|HOME HEALTH AID|
20|FH_F118986_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119888_0_0|SrvcGrp|13262|2022|PDM|7.45|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|537.89|99|0.00|AEG 10 (NO REV)|
20|FH_F151321_92626_0|SrvcGrp|75419|2022|PDM|475.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F151379_21045_0|SrvcGrp|73002|2022|PDM|1144.00|99|0.00|AEG 7|
20|FH_F151427_04106_0|SrvcGrp|104482|2022|PDM|248.00|99|0.00|HYDRATION IV INFUSION INIT|
20|FH_F132268_07060_0|SrvcGrp|90491|2022|PDM|236.00|99|0.00|EVALUATE SPEECH PRODUCTION|
20|FH_F122038_34606_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F145168_15601_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145408_43920_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F47212_0_0|SrvcGrp|80037|2022|PDM|30.00|99|0.00|IMMUNIZATION|
20|FH_F135572_89106_0|SrvcGrp|22593|2022|PCT|1.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F135575_50597_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97142_94535_0|SrvcGrp|73602|2022|PDM|5277.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F136012_60625_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136170_76132_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100848_17202_0|SrvcGrp|471|2022|PDM|442.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F100880_67735_0|SrvcGrp|89871|2022|PCT|0.98|99|0.00|GROUND TRANSPORTATION|
20|FH_F116447_21601_0|SrvcGrp|92502|2022|PDM|614.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F116463_76501_0|SrvcGrp|98319|2022|PDM|431.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY (HCFA)|
20|FH_F44113_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|PEDIATRIC IP SVCS|
20|FH_F69205_0_0|SrvcGrp|10623|2022|PDM|172.80|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F111292_33136_0|SrvcGrp|361|2022|PDM|6093.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F141651_0_0|SrvcGrp|113814|2022|PDM|3850.00|99|0.00|LYSIS INTRANASAL SYNECHIA|
20|FH_F89360_0_0|SrvcGrp|58932|2022|PCT|1.20|99|0.00|RAD GLOBAL|
20|FH_F54272_0_0|SrvcGrp|17291|2022|PDM|1135.00|99|0.00|PAIN MANAGEMENT|
20|FH_F116430_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|801.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132328_0_0|SrvcGrp|70749|2022|PDM|1800.00|99|0.00|CPT 29823|
20|FH_F112092_46845_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F136698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F98300_30236_0|SrvcGrp|72984|2022|PCT|2.00|99|0.00|CHEMOTHERAPY|
20|FH_F33925_0_0|SrvcGrp|8950|2022|PDM|1254.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|2812.00|99|0.00|ASPG VII|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1873.00|99|0.00|ASPG IV|
20|FH_F130813_85014_0|SrvcGrp|75419|2022|PDM|275.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F150359_30106_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F75803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1897.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151752_63017_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40091_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102184_0_0|SrvcGrp|67068|2022|PDM|7699.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F141527_36830_0|SrvcGrp|21920|2022|PDM|26.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F135249_73114_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F139515_0_0|SrvcGrp|90778|2022|PDM|2395.00|99|0.00|HEMIOPLASTY|
20|FH_F56112_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31111_0_0|SrvcGrp|111934|2022|PDM|87.00|99|0.00|COVID-19 NUCLEIC ACID|
20|FH_F114511_0_0|SrvcGrp|89337|2022|PDM|770.00|99|0.00|DETOXIFICATION|
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1294.00|99|0.00|ASPG VII|
20|FH_F149879_80045_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F141519_51566_0|SrvcGrp|109057|2022|PCT|0.95|99|0.00|CARDIAC STUDIES|
20|FH_F72183_0_0|SrvcGrp|51672|2022|PDM|2250.00|99|0.00|MS DRG 286-287 ONLY|
20|FH_F116203_63901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121539_27511_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F96902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145561_80210_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F148905_85390_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110420_60649_0|SrvcGrp|9511|2022|PCT|0.60|99|0.00|OBSERVATION SVCS|
20|FH_F85097_0_0|SrvcGrp|73201|2022|PCT|1.00|99|0.00|NORTH PHIL CT & MRI OCN F/S PRICING|
20|FH_F133972_27103_0|SrvcGrp|26868|2022|PDM|35.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F50703_0_0|SrvcGrp|43568|2022|PDM|75.00|99|0.00|SKILLED NURSING - RN|
20|FH_F91777_29577_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F87915_0_0|SrvcGrp|12043|2022|PDM|1187.00|99|0.00|CPT 99205|
20|FH_F42633_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|NEWBORN NURSERY|
20|FH_F69968_0_0|CSTM-ALL|CSTM-00|2020|PDM|15193.82|99|0.00|ARTHRECTOMY PROCEDURES|
20|FH_F136426_19006_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142448_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|100% DISCOUNT FROM BILLED CHARGES DEFAULT - IP/OP|
20|FH_F142390_20866_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F80366_0_0|SrvcGrp|72994|2022|PCT|0.94|99|0.00|AEG 3|
20|FH_F117240_37334_0|SrvcGrp|106251|2022|PCT|1.45|99|0.00|LABORATORY SERVICES|
20|FH_F137850_32826_0|SrvcGrp|89149|2022|PDM|211.00|99|0.00|OP INTENSIVE|
20|FH_F151083_66223_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F109248_0_0|SrvcGrp|103236|2022|PDM|3350.00|99|0.00|AETNA INSJ STABLJ DEV|
20|FH_F103281_32086_0|SrvcGrp|89922|2022|PDM|8700.00|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F128559_43524_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150948_0_0|SrvcGrp|113851|2022|PDM|10500.00|99|0.00|ARTHRDSIS LAT MINI DISKECT|
20|FH_F102561_75146_0|SrvcGrp|73462|2022|PDM|1300.00|99|0.00|AETNA NICU III|
20|FH_F115505_21014_0|SrvcGrp|76501|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F118034_60645_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F145960_33414_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147995_67037_0|SrvcGrp|115249|2022|PCT|1.75|99|0.00|LABORATORY SERVICES|
20|FH_F35411_0_0|SrvcGrp|9795|2022|PDM|997.00|99|0.00|SUBACUTE REHAB|
20|FH_F117340_68144_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F142769_21204_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133416_87402_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109574_62859_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER UEKE|
20|FH_F146141_77598_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1174.00|99|0.00|AEG 7 (NO REV)|
20|FH_F120089_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150882_84041_0|SrvcGrp|97703|2022|PDM|100.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F142785_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F109221_15084_0|SrvcGrp|48398|2022|PDM|88.00|99|0.00|PT SERVICES|
20|FH_F76588_0_0|SrvcGrp|53145|2022|PDM|18.00|99|0.00|SOCIAL WORKER|
20|FH_F134819_0_0|SrvcGrp|109741|2022|PDM|2128.00|99|0.00|SINUS ENDO W/ BALLOON DILATION|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.00|99|0.00|ANTIBIOTIC THERAPY Q4 (MOD SH)|
20|FH_F126116_0_0|SrvcGrp|84939|2022|PDM|13500.00|99|0.00|SHOULDER JOINT|
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_F124441_0_0|SrvcGrp|106264|2022|PDM|3800.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION|
20|FH_F137748_95231_0|SrvcGrp|537|2022|PDM|2000.00|99|0.00|OBSERVATION SERVICES|
20|FH_F95800_0_0|SrvcGrp|87677|2022|PDM|884.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F101700_0_0|SrvcGrp|98580|2022|PDM|2600.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F39028_0_0|SrvcGrp|29956|2022|PCT|1.00|99|0.00|DME MOD AV|
20|FH_F148167_43950_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F121118_06479_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F33899_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40418_0_0|SrvcGrp|13551|2022|PDM|500.00|99|0.00|NEWBORN NURSERY|
20|FH_F143790_83440_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 3 (NO REV)|
20|FH_F146642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98021_07012_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F90496_13159_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|1214.00|99|0.00|AEG 4 (NO REV)|
20|FH_F66406_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F110881_63125_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150165_06032_0|SrvcGrp|90822|2022|PDM|3991.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY|
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|ASPG VI - FH SW CUSTOM GROUPERS|
20|FH_F127486_06776_0|SrvcGrp|63297|2022|PDM|161.70|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F145642_15108_0|SrvcGrp|86841|2022|PDM|80.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F78344_0_0|SrvcGrp|75242|2022|PDM|50.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F133269_78624_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F132131_33060_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134826_19067_0|SrvcGrp|89269|2022|PDM|125.00|99|0.00|PSYTX PT/FAMILY 45 MINUTES|
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|1519.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F86851_0_0|SrvcGrp|84977|2022|PDM|651.00|99|0.00|CPT 44365|
20|FH_F138545_39503_0|SrvcGrp|16069|2022|PDM|694.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 4 (NO REV)|
20|FH_F129130_92562_0|SrvcGrp|115250|2022|PCT|4.83|99|0.00|RADIOLOGY SERVICES|
20|FH_F97720_70084_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F132627_0_0|SrvcGrp|10579|2022|PDM|64.26|99|0.00|HYDRATION THERAPY - 2 LITERS|
20|FH_F45977_0_0|SrvcGrp|11076|2022|PDM|100.00|99|0.00|NURSING CARE|
20|FH_F130400_26505_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131047_0_0|CSTM-ALL|CSTM-00|2020|PDM|3421.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|2211.07|99|0.00|ASPG VIII|
20|FH_F124414_92653_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36350_0_0|SrvcGrp|11606|2022|PDM|477.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)|
20|FH_F142027_37217_0|SrvcGrp|88621|2022|PDM|125.00|99|0.00|SKILLED NURSING LPN|
20|FH_F128554_87102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38725_0_0|SrvcGrp|69399|2022|PCT|1.00|99|0.00|PREVENTATIVE CODES|
20|FH_F122245_0_0|SrvcGrp|48160|2022|PDM|1741.70|99|0.00|BOTULINUM TOXIN TYPE A, PER UNIT|
20|FH_F45915_0_0|SrvcGrp|33164|2022|PDM|400.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148872_45723_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150528_78644_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F102062_35447_0|SrvcGrp|43567|2022|PDM|150.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F120954_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F36917_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139147_0_0|SrvcGrp|79588|2022|PDM|1804.00|99|0.00|CPT 43235|
20|FH_F126781_92630_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F75207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35781_33133_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD RR KE|
20|FH_F132349_66111_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43008_0_0|SrvcGrp|18932|2022|PDM|1500.00|99|0.00|MS DRG 774 REPLACEMENT MS DRG 805-806|
20|FH_F45832_0_0|SrvcGrp|30623|2022|PDM|9579.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F31111_0_0|SrvcGrp|112054|2022|PDM|65.00|99|0.00|COVID-19 ANTIBODY|
20|FH_F130204_40807_0|SrvcGrp|108484|2022|PDM|522.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F115049_78539_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F50873_0_0|SrvcGrp|42828|2022|PDM|75.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F145815_30540_0|SrvcGrp|113235|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2&INF A&B&RSV AMP PRB|
20|FH_F34413_0_0|SrvcGrp|16499|2022|PDM|1000.00|99|0.00|IP SURGICAL SVCS|
20|FH_F40270_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F125028_19061_0|SrvcGrp|24745|2022|PDM|36.75|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F85353_16407_0|SrvcGrp|63811|2022|PDM|595.41|99|0.00|HAPA WPA-NWPA 2012-13 ASC 204|
20|FH_F109244_19808_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG X|
20|FH_F150302_30114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88639_80204_0|SrvcGrp|89265|2022|PDM|328.68|99|0.00|AMBULATORY DETOX - ALCOHOL AND DRUG REHAB|
20|FH_F142449_62220_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F80284_16354_0|SrvcGrp|63|2022|PDM|587.00|99|0.00|SUBACUTE CARE|
20|FH_F137814_61820_0|SrvcGrp|112868|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|2090.00|99|0.00|AEG 3 (NO REV)|
20|FH_F145448_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)|
20|FH_F114931_0_0|SrvcGrp|78284|2022|PDM|1850.00|99|0.00|CPT 46200|
20|FH_F130066_84107_0|SrvcGrp|74668|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F142321_29401_0|SrvcGrp|46903|2022|PDM|731.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F113794_0_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F124180_0_0|SrvcGrp|109743|2022|PDM|1450.00|99|0.00|REPAIR OF EARDRUM|
20|FH_F141411_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 9 (NO REV)|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F41661_0_0|SrvcGrp|16|2022|PDM|630.00|99|0.00|ACUTE REHABILITATION|
20|FH_F101840_76054_0|SrvcGrp|23279|2022|PDM|464.00|99|0.00|EMERGENCY ROOM SVCS 99281-99282|
20|FH_F97541_33021_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F31204_0_0|SrvcGrp|2761|2022|PDM|210.00|99|0.00|CRISIS EVALUATION|
20|FH_F133287_40215_0|CSTM-ALL|CSTM-00|2020|PDM|2619.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 7 (NO REV)|
20|FH_F150001_33064_0|SrvcGrp|17016|2022|PDM|26.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F111809_93003_0|SrvcGrp|31074|2022|PDM|2200.00|99|0.00|MS DRG 795 ONLY|
20|FH_F112905_62088_0|SrvcGrp|75506|2022|PCT|0.81|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F139584_10281_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F31547_0_0|SrvcGrp|12401|2022|PDM|86.82|99|0.00|RN VISIT|
20|FH_F147231_49440_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37487_0_0|SrvcGrp|997|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F100663_56537_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49300_0_0|SrvcGrp|10527|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F140295_0_0|SrvcGrp|93432|2022|PDM|12200.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F76826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F143564_0_0|SrvcGrp|115352|2022|PCT|0.55|99|0.00|STOMACH PROCEDURE|
20|FH_F47996_0_0|CSTM-ALL|CSTM-00|2020|PCT|59.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F77903_0_0|SrvcGrp|2738|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F91622_0_0|SrvcGrp|91423|2022|PDM|134.00|99|0.00|PROFESSIONAL FEE|
20|FH_F52393_0_0|SrvcGrp|49123|2022|PDM|3200.00|99|0.00|HEARING AID|
20|FH_F141407_76226_0|SrvcGrp|23683|2022|PDM|48.00|99|0.00|SKILLED NURSING RN|
20|FH_F137946_0_0|SrvcGrp|113239|2022|PDM|100.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT (HCFA)|
20|FH_F48927_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125743_45640_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127091_62016_0|SrvcGrp|23683|2022|PCT|0.00|99|0.00|SKILLED NURSING RN|
20|FH_F116753_0_0|CSTM-ALL|CSTM-00|2020|PDM|4622.00|99|0.00|AEG 9 (NO REV)|
20|FH_F150165_06032_0|SrvcGrp|92407|2022|PDM|7490.00|99|0.00|REMOVAL & REPLACE PULSE GEN 2 LEAD|
20|FH_F143650_0_0|SrvcGrp|89883|2022|PDM|2500.00|99|0.00|AETNA TREAT HUMERUS FRACTURE|
20|FH_F79743_0_0|SrvcGrp|42529|2022|PDM|1517.00|99|0.00|NICU|
20|FH_F147981_60035_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132969_84003_0|SrvcGrp|86852|2022|PDM|22.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F119227_01752_0|SrvcGrp|86834|2022|PDM|18.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F70684_0_0|SrvcGrp|3069|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F126104_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126770_43050_0|SrvcGrp|63297|2022|PDM|130.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F73403_0_0|SrvcGrp|62538|2022|PDM|130.00|99|0.00|PHYSICAL THERAPY|
20|FH_F80284_16354_0|SrvcGrp|76011|2022|PDM|358.00|99|0.00|EMERGENCY ROOM SVCS LEVEL IV|
20|FH_F117371_77059_0|SrvcGrp|73841|2022|PDM|375.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F129438_08234_0|SrvcGrp|89417|2022|PDM|340.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 10 (NO REV)|
20|FH_F114567_43235_0|SrvcGrp|86746|2022|PCT|0.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F106822_0_0|SrvcGrp|53786|2022|PDM|17.20|99|0.00|BREATHING DEVICE|
20|FH_F76085_0_0|SrvcGrp|70819|2022|PCT|1.00|99|0.00|(HCPCS) OCN F/S PRICING: ALL|
20|FH_F42466_0_0|SrvcGrp|97|2022|PDM|2864.00|99|0.00|C-SECTION|
20|FH_F44341_0_0|SrvcGrp|109|2022|PDM|425.00|99|0.00|CD - DETOX|
20|FH_F127995_84010_0|SrvcGrp|106904|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F63185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139825_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 3 (NO REV)|
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 1 (NO REV)|
20|FH_F67195_0_0|CSTM-ALL|CSTM-00|2020|PDM|882.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PDM|2437.00|99|0.00|AEG 4 (NO REV)|
20|FH_F62513_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|PDM|1142.00|99|0.00|AEG 5  (NO REV)|
20|FH_F144017_33873_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111815_35904_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD KM) - BDSS|
20|FH_F102721_38118_0|SrvcGrp|72996|2022|PDM|1100.00|99|0.00|AEG 4|
20|FH_F39180_0_0|SrvcGrp|16|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION|
20|FH_F72859_0_0|SrvcGrp|473|2022|PDM|300.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F129176_48098_0|SrvcGrp|29155|2022|PDM|130.00|99|0.00|HOSPICE SVCS|
20|FH_F100661_63640_0|SrvcGrp|73643|2022|PDM|2418.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F150839_03833_0|SrvcGrp|115510|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F149019_34114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150932_15143_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150930_64485_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151043_71901_0|SrvcGrp|105465|2022|PDM|100.00|99|0.00|AETNA THERAPIES|
20|FH_F46258_0_0|SrvcGrp|15402|2022|PDM|50.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F148892_0_0|SrvcGrp|92409|2022|PDM|2133.00|99|0.00|PERQ CERVICOTHORACIC INJECT|
20|FH_F116327_75701_0|SrvcGrp|58509|2022|PDM|150.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F72850_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F38034_0_0|SrvcGrp|22976|2022|PCT|0.90|99|0.00|CPT CODES 93600-93660|
20|FH_F141590_90049_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F39886_0_0|SrvcGrp|115|2022|PDM|478.00|99|0.00|SKILLED NURSING CARE|
20|FH_F40255_0_0|SrvcGrp|3259|2022|PDM|1136.00|99|0.00|ACUTE REHABILITATION|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|POLYSOMNOGRAPHY|
20|FH_F128176_24201_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F63095_0_0|SrvcGrp|537|2022|PCT|0.65|99|0.00|OBSERVATION SERVICES|
20|FH_F130725_33020_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F90232_15126_0|SrvcGrp|17014|2022|PDM|56.70|99|0.00|HOME INFUSION THERAPY|
20|FH_F121303_15501_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F145921_73139_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1483.47|99|0.00|HAPA WPA-NWPA 2012-13 ASC 801 W/O REV|
20|FH_F43865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F93219_26354_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|213.00|99|0.00|IP ADOLESCENT PARTIAL HOSPITALIZATION (CD)|
20|FH_F55713_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85213_02840_0|SrvcGrp|73500|2022|PDM|249.50|99|0.00|AETNA ER LEVEL I|
20|FH_F57853_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.80|99|0.00|OP SVCS|
20|FH_F120727_54301_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F102200_06416_0|SrvcGrp|86838|2022|PDM|15.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F115872_06052_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F102641_0_0|SrvcGrp|96819|2022|PDM|2026.00|99|0.00|DESTROY L/S FACET JNT ADDL|
20|FH_F38183_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147939_61611_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148219_33161_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F89111_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F92091_0_0|SrvcGrp|73008|2022|PDM|2247.00|99|0.00|AEG 10|
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|616.38|99|0.00|AEG 2 (NO REV)|
20|FH_F132779_0_0|SrvcGrp|97|2022|PDM|8707.00|99|0.00|C-SECTION|
20|FH_F91777_29577_0|SrvcGrp|73700|2022|PDM|55.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F133747_80634_0|SrvcGrp|97440|2022|PCT|0.92|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F145880_80303_0|SrvcGrp|46903|2022|PDM|570.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F120735_40012_0|SrvcGrp|86723|2022|PDM|369.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F124743_0_0|SrvcGrp|82223|2022|PDM|125.00|99|0.00|HOSPICE CARE|
20|FH_F110309_63301_0|SrvcGrp|30733|2022|PDM|1553.00|99|0.00|SKILLED NURSING CARE|
20|FH_F143650_0_0|SrvcGrp|100008|2022|PDM|4000.00|99|0.00|RECONSTRUCT ELBOW LAT LIGMNT|
20|FH_F132954_32066_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133047_74012_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F140730_84106_0|SrvcGrp|33722|2022|PDM|26.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F119026_36274_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F38699_0_0|SrvcGrp|17075|2022|PDM|975.00|99|0.00|ASPG VI|
20|FH_F110720_0_0|SrvcGrp|94560|2022|PDM|4245.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F90880_15108_0|SrvcGrp|90486|2022|PCT|1.00|99|0.00|ORTHOTIC MANAGEMENT|
20|FH_F124923_23518_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F151153_77591_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38564_0_0|SrvcGrp|3810|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F89037_0_0|SrvcGrp|23585|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F114916_30309_0|SrvcGrp|92819|2022|PDM|13500.00|99|0.00|HIP ARTHOSCOPY|
20|FH_F123774_0_0|SrvcGrp|73002|2022|PDM|1222.00|99|0.00|AEG 7|
20|FH_F132988_0_0|SrvcGrp|112143|2022|PDM|4493.01|99|0.00|FUSION OF KNUCKLE|
20|FH_F114389_50131_0|SrvcGrp|99010|2022|PDM|115.07|99|0.00|ANTIBIOTIC Q24H (HCFA)|
20|FH_F91998_0_0|SrvcGrp|90376|2022|PDM|8500.00|99|0.00|REVISION OF KNEE JOINTLANT|
20|FH_F127995_84010_0|SrvcGrp|88620|2022|PDM|85.50|99|0.00|SKILLED NURSING RN|
20|FH_F133694_89117_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F137951_0_0|SrvcGrp|113169|2022|PDM|3130.00|99|0.00|REMOVAL OF KNEECAP|
20|FH_F133214_75024_0|SrvcGrp|109036|2022|PDM|1027.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F133287_40215_0|SrvcGrp|81779|2022|PCT|0.53|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F72859_0_0|SrvcGrp|10543|2022|PDM|96.54|99|0.00|SPEECH THERAPY SVCS|
20|FH_F133490_90650_0|SrvcGrp|106811|2022|PDM|1005.00|99|0.00|IP DETOXIFICATION|
20|FH_F116828_0_0|SrvcGrp|92502|2022|PDM|573.47|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F132737_0_0|SrvcGrp|361|2022|PDM|2933.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F97103_53295_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F51658_0_0|SrvcGrp|44427|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY SVCS (VISIT LVL)|
20|FH_F33003_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F146362_76048_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F136407_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.00|99|0.00|AEG 8 (NO REV)|
20|FH_F102365_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41463_0_0|SrvcGrp|34227|2022|PDM|52.00|99|0.00|ENBREL THERAPY|
20|FH_F74646_0_0|SrvcGrp|16|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION|
20|FH_F149579_95815_0|SrvcGrp|115661|2022|PDM|500.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F50461_0_0|SrvcGrp|11283|2022|PCT|0.75|99|0.00|HYPERBARIC CHAMBER|
20|FH_F133087_61107_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F139877_32615_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F112794_01040_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F42294_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|AEG 10 (NO REV)|
20|FH_F146667_37110_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F127656_06068_0|SrvcGrp|80918|2022|PDM|166.95|99|0.00|RESPITE CARE|
20|FH_F116040_24637_0|SrvcGrp|86849|2022|PDM|30.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F88639_80204_0|SrvcGrp|2738|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F134075_78230_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F137147_75006_0|SrvcGrp|98268|2022|PDM|13513.00|99|0.00|HIP ARTHROSCOPY DX|
20|FH_F140407_63841_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F149646_71129_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F151601_89118_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F45303_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CARDIAC CATH LAB SVCS|
20|FH_F114567_43235_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121980_66104_0|SrvcGrp|3178|2022|PDM|850.00|99|0.00|ACUTE PSYCH|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|285.09|99|0.00|DELAWARE VALLEY- ASC 105|
20|FH_F48357_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F86911_0_0|SrvcGrp|72941|2022|PDM|150.00|99|0.00|HOSPICE CARE IN HOME|
20|FH_F114916_30309_0|SrvcGrp|99161|2022|PDM|18000.00|99|0.00|CPT 27138|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1984.00|99|0.00|AEG 7 (NO REV)|
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|1494.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F36521_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH|
20|FH_F97581_60141_0|SrvcGrp|73485|2022|PDM|3856.00|99|0.00|AETNA REHAB|
20|FH_F132543_79549_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC|
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1021.00|99|0.00|AEG 6 (NO REV)|
20|FH_F136751_0_0|SrvcGrp|92821|2022|PDM|9200.00|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR|
20|FH_F67379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1024.00|99|0.00|ACUTE PSYCH|
20|FH_F32530_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F123012_27703_0|SrvcGrp|46903|2022|PDM|1250.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F42295_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100666_81301_0|SrvcGrp|73605|2022|PDM|2474.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F133287_40215_0|SrvcGrp|73496|2022|PDM|578.00|99|0.00|AETNA ER LEVEL V|
20|FH_F123181_75057_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|426.64|99|0.00|HAPA WPA-NWPA 2012-13 ASC 101 W/O REV|
20|FH_F49637_0_0|CSTM-ALL|CSTM-00|2020|PDM|1850.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER QW|
20|FH_F116324_0_0|SrvcGrp|75489|2022|PDM|550.00|99|0.00|AEG 6|
20|FH_F126666_44053_0|SrvcGrp|89417|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F150741_81506_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139353_67124_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148667_0_0|SrvcGrp|84939|2022|PDM|11000.00|99|0.00|SHOULDER JOINT|
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1585.00|99|0.00|AEG 7 (NO REV)|
20|FH_F109251_62269_0|SrvcGrp|88620|2022|PDM|90.51|99|0.00|SKILLED NURSING RN|
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132008_85226_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F101441_0_0|SrvcGrp|96351|2022|PDM|7946.00|99|0.00|SPINE PROSTHESIS DEVICE|
20|FH_F122377_91007_0|SrvcGrp|73496|2022|PDM|2719.00|99|0.00|AETNA ER LEVEL V|
20|FH_F40550_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F36743_0_0|SrvcGrp|49|2022|PDM|12500.00|99|0.00|HIP REPLACEMENT|
20|FH_F56232_0_0|CSTM-ALL|CSTM-00|2020|PDM|1428.27|99|0.00|ASPG VI|
20|FH_F135093_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F128197_84123_0|SrvcGrp|48394|2022|PDM|43.20|99|0.00|SKILLED NURSING SERVICES|
20|FH_F45332_0_0|SrvcGrp|3810|2022|PDM|135.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F49029_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PDM|1104.00|99|0.00|AEG 5  (NO REV)|
20|FH_F148255_72703_0|SrvcGrp|22589|2022|PDM|26.25|99|0.00|CHEMOTHERAPY NOC|
20|FH_F32935_0_0|SrvcGrp|14492|2022|PCT|0.35|99|0.00|DURABLE MEDICAL EQUIPMENT (DME)|
20|FH_F131190_21042_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|652.00|99|0.00|AEG 4 (NO REV)|
20|FH_F71543_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F135491_0_0|SrvcGrp|78045|2022|PCT|1.21|99|0.00|AETNA AMNIOTIC MEMBRANE|
20|FH_F132988_0_0|SrvcGrp|107835|2022|PDM|4279.06|99|0.00|NERVE REPAIR|
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 7 (NO REV)|
20|FH_F114389_50131_0|SrvcGrp|29076|2022|PDM|130.65|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F129549_01238_0|SrvcGrp|65720|2022|PDM|177.45|99|0.00|RESPITE CARE|
20|FH_F133003_49012_0|SrvcGrp|89149|2022|PDM|160.00|99|0.00|OP INTENSIVE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|99.31|99|0.00|HAPA WPA-NWPA 2012-13 ASC 143 W/O REV|
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_F87577_80016_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117132_0_0|SrvcGrp|84931|2022|PDM|2030.00|99|0.00|KERATOPLASTY|
20|FH_F63137_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|STANTON COUNTY LABS|
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PDM|365.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132960_0_0|SrvcGrp|93736|2022|PDM|90.00|99|0.00|URGENT CARE|
20|FH_F48998_0_0|SrvcGrp|44131|2022|PDM|18.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F143873_33407_0|SrvcGrp|114008|2022|PDM|380.00|99|0.00|PARTIAL HOSPITAL PSYCHIATRIC|
20|FH_F31178_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PDM|1045.00|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_F109267_12202_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144848_0_0|CSTM-ALL|CSTM-00|2020|PDM|905.00|99|0.00|AEG 6 (NO REV)|
20|FH_F85055_0_0|SrvcGrp|73002|2022|PDM|1625.00|99|0.00|AEG 7|
20|FH_F105361_80104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F132937_88201_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F88491_71301_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F149643_91367_0|SrvcGrp|46903|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F121338_37756_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F93413_0_0|SrvcGrp|26001|2022|PDM|123.70|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F149939_91942_0|SrvcGrp|89412|2022|PDM|522.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F132887_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145544_93536_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F122725_32216_0|SrvcGrp|90492|2022|PDM|82.00|99|0.00|BEHAVRAL QUALIT ANALYS VOICE|
20|FH_F122898_63011_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F130721_04769_0|SrvcGrp|111929|2022|PCT|1.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F130901_68970_0|CSTM-ALL|CSTM-00|2020|PCT|0.98|99|0.00|GENERAL ACUTE CARE|
20|FH_F130914_51103_0|SrvcGrp|75419|2022|PDM|470.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F49552_0_0|SrvcGrp|9522|2022|PDM|3216.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F113453_80020_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F77597_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F36753_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD 26|
20|FH_F146124_06112_0|SrvcGrp|114014|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F86052_15063_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F132716_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135626_20176_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F150165_06032_0|SrvcGrp|103515|2022|PDM|3358.00|99|0.00|VAGINAL HYSTERECTOMY|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1941.64|99|0.00|HAPA WPA-NWPA 2012-13 ASC 905 W/O REV|
20|FH_F44299_0_0|SrvcGrp|10543|2022|PDM|65.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F39346_0_0|SrvcGrp|21354|2022|PDM|11841.00|99|0.00|MS DRG 250-251 ONLY|
20|FH_F48692_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F43250_0_0|SrvcGrp|31134|2022|PDM|1400.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F123783_03860_0|SrvcGrp|48394|2022|PDM|57.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F69968_0_0|SrvcGrp|46502|2022|PDM|4690.70|99|0.00|MS DRG 215-241,245, 250-265 CARDIAC SURGERY|
20|FH_F120418_43015_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F120152_0_0|SrvcGrp|90420|2022|PDM|5500.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F119004_06850_0|CSTM-ALL|CSTM-00|2020|PDM|1636.00|99|0.00|AEG 8 (NO REV)|
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|404.00|99|0.00|AEG 1 (NO REV)|
20|FH_F144828_0_0|SrvcGrp|114200|2022|PDM|1176.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F124212_33407_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F132269_34202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F145988_06105_0|SrvcGrp|10107|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F130656_04401_0|SrvcGrp|111930|2022|PCT|1.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F122648_0_0|SrvcGrp|109174|2022|PDM|992.00|99|0.00|EYE SERVICES|
20|FH_F117795_36272_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_F139673_63011_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F35088_0_0|SrvcGrp|65|2022|PDM|2838.00|99|0.00|OBSTETRICAL CARE|
20|FH_F137721_80737_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F129297_97828_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130203_29601_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F42426_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122371_83276_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F40501_0_0|CSTM-ALL|CSTM-00|2020|PDM|263.00|99|0.00|OP PSYCHIATRIC TREATMENT (8-12 HRS)|
20|FH_F35728_34209_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F122526_22203_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F77665_0_0|SrvcGrp|10657|2022|PDM|50.00|99|0.00|CPT CODE 99350|
20|FH_F137127_72761_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117552_0_0|SrvcGrp|72998|2022|PDM|863.00|99|0.00|AEG 5|
20|FH_F78402_15905_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|HOME HEALTH|
20|FH_F149583_98930_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F91913_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F94740_32904_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F94786_07974_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72162_0_0|SrvcGrp|48398|2022|PDM|135.00|99|0.00|PT SERVICES|
20|FH_F124180_0_0|SrvcGrp|80139|2022|PDM|7314.50|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F146844_78582_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41456_0_0|SrvcGrp|22954|2022|PDM|140.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F108660_63775_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35596_0_0|SrvcGrp|61209|2022|PCT|1.20|99|0.00|OP LAB SERVICES|
20|FH_F111522_81067_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F111520_81601_0|SrvcGrp|472|2022|PDM|433.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F115273_15132_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F138995_0_0|SrvcGrp|36865|2022|PDM|4590.00|99|0.00|NUCLEOPLASTY|
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|1078.00|99|0.00|AEG 2 (NO REV)|
20|FH_F117023_0_0|SrvcGrp|73000|2022|PDM|1362.00|99|0.00|AEG 6|
20|FH_F34918_0_0|SrvcGrp|15044|2022|PCT|0.50|99|0.00|MED/SURG OTHER SUPPLIES/DEVICES|
20|FH_F122276_83252_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F40667_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F149585_46012_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115705_0_0|SrvcGrp|3809|2022|PDM|540.00|99|0.00|HOSPICE CARE|
20|FH_F84532_0_0|SrvcGrp|42550|2022|PDM|3694.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F97184_26101_0|SrvcGrp|88978|2022|PDM|5728.00|99|0.00|VAGINAL DELIVERY|
20|FH_F147140_89103_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F122248_33441_0|SrvcGrp|75442|2022|PDM|520.00|99|0.00|OBSERVATION - REV 762|
20|FH_F140134_52732_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132407_62035_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F101201_0_0|SrvcGrp|43525|2022|PDM|275.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC|
20|FH_F141515_50010_0|SrvcGrp|89417|2022|PDM|412.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F123953_84003_0|SrvcGrp|75442|2022|PDM|894.00|99|0.00|OBSERVATION - REV 762|
20|FH_F120215_92064_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F110470_98335_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION MOD HO (HCFA)|
20|FH_F120930_0_0|SrvcGrp|92369|2022|PDM|2500.00|99|0.00|REPAIR OF ANKLE LIGAMENTS|
20|FH_F149247_02760_0|SrvcGrp|114256|2022|PCT|1.00|99|0.00|COVID-19 TESTING/LAB/ADMIN|
20|FH_F34852_0_0|SrvcGrp|3066|2022|PCT|0.70|99|0.00|HIGH-COST DRUGS|
20|FH_F143560_03079_0|SrvcGrp|115125|2022|PDM|646.13|99|0.00|CT HEART W/ 3D IMAGE|
20|FH_F130329_64114_0|SrvcGrp|86834|2022|PDM|10.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F150161_63361_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F145722_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149099_23901_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149301_44122_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150001_33064_0|SrvcGrp|21920|2022|PDM|26.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F148886_60621_0|SrvcGrp|99068|2022|PDM|29048.00|99|0.00|MS DRG 228-229 ONLY OTHER CARDIOTHORACIC PROC|
20|FH_F39838_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS|
20|FH_F133478_40165_0|CSTM-ALL|CSTM-00|2020|PDM|1563.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 2 (NO REV)|
20|FH_F125266_44515_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F51548_0_0|SrvcGrp|10543|2022|PDM|125.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F92676_15063_0|SrvcGrp|79023|2022|PDM|875.61|99|0.00|MON VALLEY ASC 113|
20|FH_F39558_0_0|SrvcGrp|17075|2022|PDM|969.00|99|0.00|ASPG VI|
20|FH_F117335_0_0|SrvcGrp|72996|2022|PDM|759.00|99|0.00|AEG 4|
20|FH_F67192_0_0|SrvcGrp|16|2022|PDM|1711.00|99|0.00|ACUTE REHABILITATION|
20|FH_F139667_84078_0|SrvcGrp|88620|2022|PDM|101.00|99|0.00|SKILLED NURSING RN|
20|FH_F139707_84010_0|CSTM-ALL|CSTM-00|2020|PDM|2137.00|99|0.00|AEG 4 (NO REV)|
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F37230_0_0|SrvcGrp|15391|2022|PDM|117.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F124470_90025_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F39443_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAPA WPA NISC FS 32814 140%|
20|FH_F35755_34950_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F111044_0_0|SrvcGrp|88596|2022|PDM|1648.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE|
20|FH_F149085_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|395.00|99|0.00|AEG 1 (NO REV)|
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93377_0_0|SrvcGrp|80317|2022|PDM|120.00|99|0.00|RESPITE CARE|
20|FH_F122277_98045_0|SrvcGrp|471|2022|PDM|533.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F124467_27529_0|SrvcGrp|112868|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F32523_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F93740_0_0|SrvcGrp|44664|2022|PDM|1700.00|99|0.00|CPT 93505|
20|FH_F150026_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F92120_0_0|SrvcGrp|89978|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132190_0_0|SrvcGrp|109622|2022|PDM|6000.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F55532_0_0|SrvcGrp|9914|2022|PDM|850.00|99|0.00|PEDIATRIC REHABILITATION|
20|FH_F129656_15005_0|SrvcGrp|26869|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F105593_0_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F130755_04401_0|SrvcGrp|79699|2022|PCT|0.93|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F142894_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111027_32817_0|SrvcGrp|89417|2022|PDM|484.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F110345_37919_0|SrvcGrp|86753|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F81861_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124146_46321_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F148186_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126308_44515_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F135663_24401_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|108.49|99|0.00|HAPA WPA-NWPA 2012-13 ASC 240 W/O REV|
20|FH_F83995_16748_0|SrvcGrp|76034|2022|PDM|813.00|99|0.00|EMERGENCY ROOM|
20|FH_F122564_53809_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|189.49|99|0.00|HAPA WPA-NWPA 2012-13 ASC 127 W/O REV|
20|FH_F123820_91316_0|SrvcGrp|46903|2022|PDM|1200.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66430_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35678_0_0|SrvcGrp|18145|2022|PDM|11300.00|99|0.00|MS DRG 248|
20|FH_F111044_0_0|SrvcGrp|11673|2022|PDM|3090.00|99|0.00|CPT 29888|
20|FH_F36225_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F36343_0_0|SrvcGrp|15385|2022|PDM|90.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F40581_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151027_16652_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F40346_0_0|SrvcGrp|12179|2022|PCT|0.75|99|0.00|CPT CODES 70000-79999 (RAD)|
20|FH_F84433_0_0|SrvcGrp|48396|2022|PDM|116.00|99|0.00|OT SERVICES|
20|FH_F36663_0_0|SrvcGrp|469|2022|PDM|1320.00|99|0.00|VENTILATOR REHABILITATION|
20|FH_F139824_24801_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110729_15068_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F32509_0_0|SrvcGrp|14271|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.55|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1302 W/O REV|
20|FH_F84778_0_0|SrvcGrp|72992|2022|PDM|1260.00|99|0.00|AEG 2|
20|FH_F143968_94520_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F110161_31329_0|SrvcGrp|104131|2022|PCT|1.00|99|0.00|THERAPY W/TOB 230-28Z|
20|FH_F93881_15009_0|SrvcGrp|107506|2022|PDM|119.00|99|0.00|X-RAY EXAM CHEST TWO VIEWS|
20|FH_F101711_0_0|SrvcGrp|48398|2022|PDM|75.00|99|0.00|PT SERVICES|
20|FH_F131420_29693_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F151526_28208_0|SrvcGrp|107878|2022|PDM|3771.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F40661_0_0|CSTM-ALL|CSTM-00|2020|PDM|245.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1405 W/O REV|
20|FH_F127072_30458_0|SrvcGrp|46903|2022|PDM|710.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F117484_15601_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|538.00|99|0.00|AEG 10 (NO REV)|
20|FH_F112650_85016_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F148885_23226_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120123_0_0|SrvcGrp|30089|2022|PDM|400.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F130923_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F120778_43351_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F133170_50501_0|SrvcGrp|46903|2022|PDM|443.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F111581_77401_0|SrvcGrp|13187|2022|PCT|1.10|99|0.00|INTRAOCULAR LENSES|
20|FH_F118555_0_0|CSTM-ALL|CSTM-00|2020|PDM|315.00|99|0.00|AEG 1 (NO REV)|
20|FH_F141031_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136367_72210_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138627_82901_0|SrvcGrp|99031|2022|PDM|95.00|99|0.00|ANTIBIOTIC Q12H (HCFA)|
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128804_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
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_F151159_46322_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F114968_0_0|SrvcGrp|81839|2022|PDM|50.00|99|0.00|AETNA MEDICAL RECORD|
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|1006.00|99|0.00|AEG 8 (NO REV)|
20|FH_F40391_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146989_80204_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F119095_08536_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F40465_0_0|SrvcGrp|24703|2022|PDM|491.00|99|0.00|NEWBORN NURSERY|
20|FH_F150602_59718_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132479_90290_0|SrvcGrp|108484|2022|PDM|1250.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F131190_21042_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F125703_02907_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F116311_02657_0|SrvcGrp|89417|2022|PDM|445.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F102302_0_0|SrvcGrp|98580|2022|PDM|29900.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F50218_0_0|SrvcGrp|10543|2022|PDM|120.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F34138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148255_72703_0|SrvcGrp|22592|2022|PDM|31.50|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F125938_0_0|SrvcGrp|16|2022|PCT|0.75|99|0.00|ACUTE REHABILITATION|
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|2194.50|99|0.00|AEG 3 (NO REV)|
20|FH_F137946_0_0|SrvcGrp|113243|2022|PDM|42.28|99|0.00|COVID-19 SVNT SARSCOV2 ELISA PLSM SRM (HCFA)|
20|FH_F54652_0_0|SrvcGrp|50922|2022|PDM|349.79|99|0.00|SPINE CARE DELAWARE CARVE OUT|
20|FH_F112004_15401_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F85652_98034_0|SrvcGrp|112914|2022|PDM|36519.00|99|0.00|MAJOR JOINT REPLACEMENT (MS DRG 470/522)|
20|FH_F125124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134365_60084_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146124_06112_0|CSTM-ALL|CSTM-00|2020|PDM|6613.00|99|0.00|AEG 8 (NO REV)|
20|FH_F145742_64862_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.01|99|0.00|GENERAL ACUTE CARE|
20|FH_F116506_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100782_0_0|SrvcGrp|97520|2022|PDM|1577.05|99|0.00|WINDBER MEDICAL CNTR ASC 13|
20|FH_F149079_70809_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F101100_50314_0|SrvcGrp|97899|2022|PDM|18508.00|99|0.00|AMPUTATION LOWER LEG|
20|FH_F146479_20782_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146848_73072_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111605_80524_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F58252_0_0|SrvcGrp|48395|2022|PDM|31.25|99|0.00|OT SERVICES|
20|FH_F58856_0_0|SrvcGrp|20075|2022|PDM|9200.00|99|0.00|MS DRG 286 ONLY|
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|1597.00|99|0.00|ASPG IX|
20|FH_F138471_84663_0|SrvcGrp|63119|2022|PDM|26.00|99|0.00|BASIC HOME HOSPICE CARE|
20|FH_F110342_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F148761_33311_0|SrvcGrp|72379|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F148780_70739_0|SrvcGrp|114012|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F71549_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F114267_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F141336_16947_0|SrvcGrp|705|2022|PCT|0.39|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F91152_60061_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142967_65065_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130599_41472_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38089_0_0|CSTM-ALL|CSTM-00|2020|PDM|32604.00|99|0.00|CORONARY BYPASS SURGERY|
20|FH_F149840_80002_0|SrvcGrp|63297|2022|PDM|144.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F37909_0_0|SrvcGrp|27736|2022|PDM|60.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F146229_60031_0|SrvcGrp|108484|2022|PDM|660.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139444_32966_0|SrvcGrp|73605|2022|PDM|950.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F150620_53402_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F36132_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP MAFS|
20|FH_F38387_0_0|SrvcGrp|22954|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F39272_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F38476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111300_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|1350.00|99|0.00|AEG 9 (NO REV)|
20|FH_F100906_0_0|SrvcGrp|97460|2022|PDM|6000.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F100906_0_0|SrvcGrp|73004|2022|PDM|2203.00|99|0.00|AEG 8|
20|FH_F113910_16508_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132595_0_0|SrvcGrp|72|2022|PDM|676.00|99|0.00|NEWBORN NURSERY|
20|FH_F122832_61938_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122689_92009_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F134770_14420_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F136796_24016_0|SrvcGrp|103543|2022|PDM|6749.71|99|0.00|REMOVE SPINAL CANAL CATHE|
20|FH_F136796_24016_0|SrvcGrp|35672|2022|PDM|3388.52|99|0.00|CPT 23412|
20|FH_F112411_28207_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F77234_0_0|SrvcGrp|17067|2022|PDM|1856.00|99|0.00|ASPG II|
20|FH_F115631_65201_0|SrvcGrp|88740|2022|PDM|1141.00|99|0.00|SP BONE ALGRFT|
20|FH_F116393_07002_0|SrvcGrp|9861|2022|PDM|1753.00|99|0.00|ACUTE REHABILITATION|
20|FH_F147519_52627_0|SrvcGrp|89417|2022|PDM|342.71|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F41540_0_0|SrvcGrp|33830|2022|PDM|1710.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 8|
20|FH_F136608_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F148899_44041_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F66480_0_0|CSTM-ALL|CSTM-00|2020|PDM|157.00|99|0.00|HOME HEALTH PRIVATE DUTY NURSING - RN|
20|FH_F35408_0_0|SrvcGrp|16896|2022|PDM|475.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F37565_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F105760_98104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F135179_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F77787_0_0|SrvcGrp|13085|2022|PDM|1494.00|99|0.00|OBSERVATION SVCS|
20|FH_F139159_76011_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151004_87121_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F75788_0_0|CSTM-ALL|CSTM-00|2020|PCT|64.90|99|0.00|OP SVCS|
20|FH_F137788_72632_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F41363_0_0|CSTM-ALL|CSTM-00|2020|PDM|598.00|99|0.00|ASPG II|
20|FH_F37864_0_0|CSTM-ALL|CSTM-00|2020|PDM|1665.51|99|0.00|ASPG IX|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF|
20|FH_F85437_0_0|SrvcGrp|471|2022|PDM|496.65|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|6055.60|99|0.00|AEG 9 (NO REV)|
20|FH_F124714_64081_0|SrvcGrp|75545|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F111080_18103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
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_F148645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33389_0_0|SrvcGrp|16|2022|PDM|1013.00|99|0.00|ACUTE REHABILITATION|
20|FH_F38037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133536_0_0|SrvcGrp|82114|2022|PDM|1700.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1101.00|99|0.00|AEG 8 (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|524.70|99|0.00|AEG 1 (NO REV)|
20|FH_F141004_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150939_0_0|SrvcGrp|100268|2022|PDM|9.00|99|0.00|ADENOVIRUS ASSAY W/ OPTIC|
20|FH_F150939_0_0|SrvcGrp|101744|2022|PDM|5.00|99|0.00|IM ADMIN EACH ADDL COMPONENT|
20|FH_F37850_0_0|SrvcGrp|65|2022|PCT|0.73|99|0.00|OBSTETRICAL CARE|
20|FH_F40715_0_0|CSTM-ALL|CSTM-00|2020|PDM|1312.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F113585_20155_0|SrvcGrp|86850|2022|PDM|50.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F138687_77477_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F138992_72703_0|SrvcGrp|112979|2022|PDM|1965.00|99|0.00|OBSERVATION W/ ER|
20|FH_F133478_40165_0|SrvcGrp|87109|2022|PDM|520.00|99|0.00|CAT SCAN OF FACE/JAW|
20|FH_F95641_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F32881_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87592_85614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F120745_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|GENERAL ACUTE CARE|
20|FH_F92833_0_0|SrvcGrp|26273|2022|PDM|2215.00|99|0.00|CPT 29880|
20|FH_F57592_0_0|SrvcGrp|20910|2022|PDM|61000.00|99|0.00|MS DRG 234 ONLY|
20|FH_F119220_75068_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F68363_0_0|SrvcGrp|3405|2022|PDM|80.00|99|0.00|CPT 99212|
20|FH_F133028_08021_0|SrvcGrp|103614|2022|PDM|16.00|99|0.00|MED NUTRITION - GROUP|
20|FH_F95980_20016_0|SrvcGrp|3178|2022|PDM|890.00|99|0.00|ACUTE PSYCH|
20|FH_F130553_18640_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F133009_19038_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F52293_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F138467_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F138487_85297_0|SrvcGrp|74668|2022|PDM|223.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138478_0_0|SrvcGrp|109499|2022|PDM|5938.22|99|0.00|INSERT 2 ELECTRODE PM-DEFIB|
20|FH_F112794_01040_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41320_0_0|CSTM-ALL|CSTM-00|2020|PDM|865.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133569_17202_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F151042_60659_0|SrvcGrp|29346|2022|PDM|45.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F40979_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F128924_0_0|SrvcGrp|111215|2022|PDM|182.00|99|0.00|CAPD/CCPD|
20|FH_F132160_0_0|SrvcGrp|109346|2022|PDM|4590.00|99|0.00|EXCISION OF CHALAZION DIFFERENT LIDS|
20|FH_F139591_72401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98020_50138_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F140087_62864_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F47600_0_0|SrvcGrp|32383|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KL (DME)|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119992_67062_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F125249_0_0|SrvcGrp|11673|2022|PDM|3200.00|99|0.00|CPT 29888|
20|FH_F43242_0_0|CSTM-ALL|CSTM-00|2020|PDM|1284.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148325_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131234_32207_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F39273_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F125074_18104_0|SrvcGrp|92501|2022|PDM|150.15|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F151155_26508_0|SrvcGrp|113344|2022|PDM|39.00|99|0.00|ADD 30 MINS COUNSEL|
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_F106822_0_0|SrvcGrp|100281|2022|PDM|7.95|99|0.00|IM ADMIN 1ST/ONLY COMPONENT (HCFA)|
20|FH_F124233_92648_0|SrvcGrp|108061|2022|PDM|300.00|99|0.00|OP THERAPY SERVICES|
20|FH_F127995_84010_0|SrvcGrp|17014|2022|PDM|22.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132544_0_0|SrvcGrp|96919|2022|PDM|4186.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F134797_0_0|SrvcGrp|112680|2022|PDM|1527.00|99|0.00|HAND FLEXOR TENDON REPAIR|
20|FH_F67192_0_0|SrvcGrp|30623|2022|PDM|6237.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F111813_08080_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141890_64865_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87171_32578_0|SrvcGrp|473|2022|PDM|367.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F123085_21921_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F45174_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|GENERAL ACUTE CARE|
20|FH_F139825_0_0|SrvcGrp|46886|2022|PDM|4590.00|99|0.00|REMOVAL OF EYELID LESION|
20|FH_F117072_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|3150.00|99|0.00|AEG 5  (NO REV)|
20|FH_F112853_22408_0|SrvcGrp|27969|2022|PCT|1.05|99|0.00|HOME HEALTH AIDE|
20|FH_F126868_60451_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F144471_19805_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92673_44041_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F126735_38018_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|AEG 10 (NO REV)|
20|FH_F143171_18411_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139700_42104_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|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_F97082_90012_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F131591_67203_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124270_46256_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE NO MOD|
20|FH_F125656_92868_0|SrvcGrp|22592|2022|PDM|35.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F89640_98133_0|CSTM-ALL|CSTM-00|2020|PCT|2.77|99|0.00|AETNA - APC GROUPER E|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|1088.00|99|0.00|ASPG V|
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|2365.00|99|0.00|AEG 5  (NO REV)|
20|FH_F122390_29550_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110783_93013_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|PDM|345.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) PARAMEDIC INTERCEPT|
20|FH_F134396_80045_0|SrvcGrp|73842|2022|PDM|316.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F36597_0_0|SrvcGrp|3932|2022|PDM|5200.00|99|0.00|LITHOTRIPSY|
20|FH_F134847_0_0|SrvcGrp|26275|2022|PDM|3585.00|99|0.00|CPT 29826|
20|FH_F68866_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F93094_21227_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F116327_75701_0|SrvcGrp|89412|2022|PDM|150.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F110925_01104_0|SrvcGrp|86127|2022|PDM|1.17|99|0.00|AETNA FACTOR IX RECOMBINANT|
20|FH_F40709_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.00|99|0.00|ASPG III|
20|FH_F129011_15857_0|SrvcGrp|53746|2022|PDM|230.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F38473_0_0|SrvcGrp|28631|2022|PDM|73.00|99|0.00|LPN VISIT|
20|FH_F62892_0_0|SrvcGrp|10538|2022|PDM|27.50|99|0.00|NURSING CARE|
20|FH_F38088_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ACUTE PSYCH|
20|FH_F130145_98043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|2483.00|99|0.00|AEG 8 (NO REV)|
20|FH_F125965_66720_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138951_41101_0|SrvcGrp|86833|2022|PDM|15.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F71445_0_0|SrvcGrp|68384|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY|
20|FH_F133585_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 5  (NO REV)|
20|FH_F150142_76018_0|SrvcGrp|91399|2022|PDM|90.00|99|0.00|AETNA PSYCH PT & FAMILY 45MINS (MOD AJ)|
20|FH_F143650_0_0|SrvcGrp|34606|2022|PDM|2800.00|99|0.00|CPT 29827|
20|FH_F149021_44514_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|AEG 5  (NO REV)|
20|FH_F51479_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F125682_46825_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123623_03246_0|SrvcGrp|109280|2022|PCT|1.00|99|0.00|RBC LEUKOREDUCED IRRADIATED|
20|FH_F92636_90230_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F65899_0_0|SrvcGrp|17548|2022|PCT|0.60|99|0.00|HIGH COST DRUGS|
20|FH_F121068_18036_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F87293_18702_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F150532_16801_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150820_83843_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151027_16652_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
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_F151000_20707_0|SrvcGrp|111930|2022|PDM|15.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD RR KF"|
20|FH_F122364_67203_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F132585_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114931_0_0|SrvcGrp|87844|2022|PDM|6039.00|99|0.00|LAPARASCOPY - GASTRIC|
20|FH_F116609_35801_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F113649_01752_0|SrvcGrp|86829|2022|PDM|50.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F84611_30281_0|SrvcGrp|73603|2022|PDM|2647.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F60273_0_0|CSTM-ALL|CSTM-00|2020|PDM|916.24|99|0.00|ASPG V|
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PDM|2300.00|99|0.00|AEG 7 (NO REV)|
20|FH_F145542_70503_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F38341_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F141471_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F137946_0_0|SrvcGrp|113223|2022|PDM|42.13|99|0.00|COVID-19 ANTIBODY SARS-COV-2 TITER(S)|
20|FH_F141550_33619_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F85212_71075_0|SrvcGrp|76484|2022|PCT|1.00|99|0.00|AETNA RADIOLOGY|
20|FH_F96160_32207_0|SrvcGrp|86848|2022|PDM|68.65|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F85353_16407_0|SrvcGrp|63845|2022|PDM|446.17|99|0.00|HAPA WPA-NWPA 2012-13 ASC 222|
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PDM|2652.00|99|0.00|AEG 7 (NO REV)|
20|FH_F145641_06902_0|SrvcGrp|85792|2022|PDM|2600.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F129509_0_0|SrvcGrp|72990|2022|PDM|612.00|99|0.00|AEG 1|
20|FH_F71103_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F105145_75075_0|SrvcGrp|76619|2022|PCT|1.50|99|0.00|THERAPY|
20|FH_F105340_13502_0|SrvcGrp|100776|2022|PCT|1.00|99|0.00|AETNA DRUGS ADMINISTERED OTHER THAN ORAL METHOD|
20|FH_F36541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129438_08234_0|SrvcGrp|73842|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114630_48205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
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_F128755_62702_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140143_24874_0|SrvcGrp|13595|2022|PDM|348.22|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F139947_43209_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|S CODES|
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PDM|1304.60|99|0.00|AEG 6 (NO REV)|
20|FH_F85772_0_0|SrvcGrp|84183|2022|PDM|1639.00|99|0.00|AETNA SURGERY OF BREAST CAPSULE|
20|FH_F136947_0_0|SrvcGrp|106294|2022|PDM|525.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F71468_0_0|SrvcGrp|26001|2022|PDM|134.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F137986_0_0|SrvcGrp|113170|2022|PDM|1458.00|99|0.00|UPPER GI OPTIC ENDOMICROSCOPY|
20|FH_F140143_24874_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140170_15301_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143410_77845_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
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_F151743_20001_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F49329_0_0|SrvcGrp|44982|2022|PDM|179.00|99|0.00|MEDICAL SOCIAL WORKER VISIT - IP|
20|FH_F116698_07470_0|SrvcGrp|24753|2022|PDM|21.00|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F118950_33312_0|SrvcGrp|73842|2022|PDM|450.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F100742_00616_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F110263_0_0|SrvcGrp|38364|2022|PDM|8659.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F82753_18840_0|SrvcGrp|113185|2022|PCT|4.93|99|0.00|RADIOLOGY SERVICES|
20|FH_F80083_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F116024_13203_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F90362_0_0|SrvcGrp|89943|2022|PDM|1299.00|99|0.00|NEUROSTIMULATOR TRIAL|
20|FH_F40043_0_0|SrvcGrp|33270|2022|PCT|0.76|99|0.00|GA ASPG X|
20|FH_F141794_50548_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F40519_0_0|SrvcGrp|32648|2022|PCT|1.50|99|0.00|OTHER DIAGNOSTIC TESTING - CPT/MOD 26|
20|FH_F126085_76002_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F127545_45227_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F99528_0_0|CSTM-ALL|CSTM-00|2020|PCT|48.00|99|0.00|OP SVCS|
20|FH_F97840_54729_0|SrvcGrp|73602|2022|PDM|3772.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F110311_17078_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F146039_89511_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F85212_71075_0|SrvcGrp|83678|2022|PCT|1.00|99|0.00|AETNA THERAPY|
20|FH_F54592_0_0|SrvcGrp|15071|2022|PDM|150.00|99|0.00|PHOTOTHERAPY (BILIRUBIN)|
20|FH_F72963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.27|99|0.00|GENERAL ACUTE CARE|
20|FH_F63124_0_0|SrvcGrp|45950|2022|PDM|145.00|99|0.00|SPEECH THERAPY|
20|FH_F134826_19067_0|SrvcGrp|90632|2022|PDM|250.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F123595_70546_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F123595_70546_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134167_10032_0|SrvcGrp|23683|2022|PDM|46.81|99|0.00|SKILLED NURSING RN|
20|FH_F137242_52722_0|SrvcGrp|73841|2022|PDM|417.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138627_82901_0|SrvcGrp|86839|2022|PDM|85.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F140312_77365_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F90613_05001_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F73542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS AMBULANCE TN (10302-35) SUPER-RURAL|
20|FH_F133674_30350_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129549_01238_0|SrvcGrp|48398|2022|PDM|107.62|99|0.00|PT SERVICES|
20|FH_F124237_95023_0|SrvcGrp|87317|2022|PDM|1200.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F132544_0_0|SrvcGrp|16693|2022|PDM|3523.00|99|0.00|KNEE SCOPE, MENISCECTOMY|
20|FH_F119374_62263_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117087_0_0|SrvcGrp|107167|2022|PDM|2494.00|99|0.00|RHINOPLASTY|
20|FH_F37562_0_0|SrvcGrp|26035|2022|PDM|32.50|99|0.00|HOME HEALTH THERAPY VISITS|
20|FH_F142822_63437_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F72065_0_0|SrvcGrp|1168|2022|PDM|47.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F38242_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88753_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|2946.00|99|0.00|AEG 6 (NO REV)|
20|FH_F123473_65109_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F145815_30540_0|SrvcGrp|111929|2022|PDM|8.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F114977_78550_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120368_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS|
20|FH_F129023_15501_0|SrvcGrp|471|2022|PDM|541.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F129594_02842_0|SrvcGrp|82981|2022|PDM|169.83|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F130138_02915_0|SrvcGrp|113276|2022|PCT|0.96|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130747_0_0|SrvcGrp|67072|2022|PDM|8843.00|99|0.00|CPT 22845|
20|FH_F141802_17042_0|CSTM-ALL|CSTM-00|2020|PCT|0.47|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F110262_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129679_20850_0|SrvcGrp|73485|2022|PDM|2147.00|99|0.00|AETNA REHAB|
20|FH_F133950_06029_0|SrvcGrp|112230|2022|PCT|1.00|99|0.00|CCIIV4 VACCINE IM CULT PRSV FREE 0.5 ML|
20|FH_F121476_0_0|SrvcGrp|108842|2022|PDM|7750.00|99|0.00|LEAD CARDIOVERTER DEFIBRILLATOR|
20|FH_F55713_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F133788_74006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120417_63124_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|1264.90|99|0.00|2005 ASPG GROUPER VIII|
20|FH_F118088_71261_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F136359_0_0|SrvcGrp|100043|2022|PDM|8600.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F85777_77030_0|SrvcGrp|73559|2022|PDM|6670.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F86375_0_0|SrvcGrp|80920|2022|PDM|504.00|99|0.00|HOSPICE SERVICES|
20|FH_F105145_75075_0|SrvcGrp|705|2022|PCT|1.15|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F73967_0_0|SrvcGrp|42785|2022|PDM|68.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F137951_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F140567_46350_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|GENERAL ACUTE CARE|
20|FH_F140747_34461_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149643_91367_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117261_43543_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F129501_67831_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148644_06890_0|SrvcGrp|101527|2022|PDM|4635.00|99|0.00|HYSTEROSCOPY LYSIS|
20|FH_F114931_0_0|SrvcGrp|63472|2022|PDM|3200.00|99|0.00|CPT 64581|
20|FH_F114002_0_0|SrvcGrp|42973|2022|PDM|65.00|99|0.00|SPEECH  THERAPIST|
20|FH_F69923_0_0|SrvcGrp|36514|2022|PCT|0.95|99|0.00|DRUGS|
20|FH_F148544_60439_0|SrvcGrp|46903|2022|PDM|1020.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F40542_0_0|SrvcGrp|592|2022|PDM|525.00|99|0.00|SUB-ACUTE CARE|
20|FH_F126806_44125_0|SrvcGrp|94780|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F36756_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD NU|
20|FH_F73542_0_0|SrvcGrp|70779|2022|PCT|1.00|99|0.00|CMS AMBULANCE TN (10302-35) SUPER-RURAL GROUND MILEAGE|
20|FH_F111415_33180_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F40785_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|OP SVCS|
20|FH_F111589_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F132338_18901_0|SrvcGrp|87317|2022|PDM|797.94|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F115330_34113_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F41456_0_0|SrvcGrp|34280|2022|PDM|25.00|99|0.00|HOSPICE PAIN MGMT COMFORT KIT|
20|FH_F145988_06105_0|SrvcGrp|10362|2022|PDM|1000.00|99|0.00|CPT CODE 99282|
20|FH_F126666_44053_0|SrvcGrp|105371|2022|PDM|116.00|99|0.00|PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F47857_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111540_16823_0|SrvcGrp|104418|2022|PDM|112.00|99|0.00|OFFICE/OUTPATIENT VISIT EST (HCFA)(MOD AF)|
20|FH_F122648_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F94300_0_0|SrvcGrp|27261|2022|PDM|4200.00|99|0.00|CPT 27446|
20|FH_F44334_0_0|SrvcGrp|13620|2022|PDM|802.59|99|0.00|SLEEP STUDIES|
20|FH_F39627_0_0|SrvcGrp|10421|2022|PDM|21000.00|99|0.00|GAMMA KNIFE|
20|FH_F139441_91324_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F102525_73134_0|SrvcGrp|72992|2022|PDM|1019.00|99|0.00|AEG 2|
20|FH_F40800_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F98622_45005_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128031_0_0|SrvcGrp|72998|2022|PDM|1001.00|99|0.00|AEG 5|
20|FH_F38708_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|MSDRG 880-887 PSYCHIATRIC|
20|FH_F100681_73104_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F76286_16038_0|SrvcGrp|73540|2022|PDM|78.00|99|0.00|SPEECH THERAPY|
20|FH_F131888_71852_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136568_92562_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136609_72601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136667_23603_0|SrvcGrp|89337|2022|PDM|929.00|99|0.00|DETOXIFICATION|
20|FH_F114764_78214_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138696_64772_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139027_18407_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148424_01440_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F136772_89109_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F136778_62034_0|SrvcGrp|44564|2022|PDM|641.00|99|0.00|NEWBORN NURSERY|
20|FH_F136930_73114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136930_73114_0|SrvcGrp|109155|2022|PDM|966.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)|
20|FH_F39622_0_0|SrvcGrp|23928|2022|PDM|5900.00|99|0.00|ABDOMINAL LAPAROSCOPIC PROCEDURES|
20|FH_F43503_0_0|SrvcGrp|701|2022|PDM|2369.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F147586_44124_0|CSTM-ALL|CSTM-00|2020|PDM|965.00|99|0.00|AEG 2 (NO REV) W/O HAND/FINGER INCISION|
20|FH_F41675_0_0|SrvcGrp|34666|2022|PDM|415.00|99|0.00|SUB ACUTE UNIT SERVICES|
20|FH_F42342_0_0|SrvcGrp|12702|2022|PDM|68.25|99|0.00|RN, INTERMITTENT VISIT|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F120829_85283_0|SrvcGrp|108061|2022|PCT|1.10|99|0.00|OP THERAPY SERVICES|
20|FH_F141896_61462_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133118_33143_0|SrvcGrp|73842|2022|PDM|218.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F92676_15063_0|SrvcGrp|78999|2022|PDM|1102.12|99|0.00|MON VALLEY ASC 216|
20|FH_F37491_0_0|SrvcGrp|12525|2022|PDM|83.00|99|0.00|NEUROPSYCHOLOGY ASSESMENT|
20|FH_F89932_10940_0|SrvcGrp|72992|2022|PDM|2118.00|99|0.00|AEG 2|
20|FH_F97581_60141_0|SrvcGrp|73643|2022|PDM|2062.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F32533_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113288_38104_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|WV HH  S CODES|
20|FH_F77787_0_0|SrvcGrp|57607|2022|PCT|0.65|99|0.00|LABORATORY/PATHOLOGY|
20|FH_F132732_0_0|SrvcGrp|107734|2022|PDM|3859.00|99|0.00|VAGINAL DELIVERY|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PDM|847.00|99|0.00|ASPG III|
20|FH_F134396_80045_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F149046_53022_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110783_93013_0|SrvcGrp|29023|2022|PDM|56.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F94303_0_0|SrvcGrp|73000|2022|PDM|2251.00|99|0.00|AEG 6|
20|FH_F114568_08097_0|SrvcGrp|91957|2022|PDM|186.00|99|0.00|INTENSIVE OUTPATIENT (>=18 YRS)|
20|FH_F116332_0_0|SrvcGrp|115367|2022|PDM|4123.00|99|0.00|SHOULDER LAPAROSCOPY|
20|FH_F35381_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|ACUTE GERIATRIC PSYCHIATRIC|
20|FH_F113154_70359_0|CSTM-ALL|CSTM-00|2020|PDM|773.00|99|0.00|AEG 2 (NO REV)|
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150939_0_0|SrvcGrp|105342|2022|PDM|5.38|99|0.00|METHILPREDNISO ACET 80MG/2MX|
20|FH_F150939_0_0|SrvcGrp|112229|2022|PDM|26.88|99|0.00|LAIV4 VACINE INTRANASAL|
20|FH_F138857_90025_0|SrvcGrp|87317|2022|PDM|1000.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F88893_0_0|SrvcGrp|87841|2022|PDM|11897.00|99|0.00|LAPAROSCOPE PROCEDURE - STOMACH|
20|FH_F90422_0_0|SrvcGrp|3810|2022|PDM|85.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F135027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151321_92626_0|SrvcGrp|74668|2022|PDM|325.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F151402_70508_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F144989_07701_0|SrvcGrp|107853|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|3074.00|99|0.00|ASPG VI|
20|FH_F135350_60014_0|SrvcGrp|112743|2022|PDM|22.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F117132_0_0|SrvcGrp|80784|2022|PDM|2189.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F39627_0_0|SrvcGrp|12674|2022|PCT|0.85|99|0.00|IMPLANTS|
20|FH_F92677_08003_0|SrvcGrp|47183|2022|PDM|94.50|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F37035_0_0|SrvcGrp|33831|2022|PDM|564.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 9|
20|FH_F142973_62448_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119220_75068_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
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_F139594_0_0|SrvcGrp|107441|2022|PDM|2754.00|99|0.00|AETNA CYSTOSCOPY PROSTATIC IMPLANTS|
20|FH_F139627_80537_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F150442_28451_0|CSTM-ALL|CSTM-00|2020|PDM|4350.00|99|0.00|AEG 9 (NO REV)|
20|FH_F132235_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148351_33012_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150382_80821_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147229_60523_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|1030.00|99|0.00|AEG 10 (NO REV)|
20|FH_F111723_0_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|1518.00|99|0.00|ASPG VIII- MOD 50|
20|FH_F38431_0_0|SrvcGrp|23005|2022|PDM|650.00|99|0.00|V5256|
20|FH_F59732_0_0|SrvcGrp|22389|2022|PDM|19.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F61292_0_0|SrvcGrp|108|2022|PCT|0.63|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN|
20|FH_F135207_76053_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F70984_0_0|CSTM-ALL|CSTM-00|2020|PDM|1224.00|99|0.00|COVENTRY ENHANCED GROUPER 5 GA NO CRESCENT|
20|FH_F86911_0_0|SrvcGrp|43269|2022|PDM|35.00|99|0.00|CATHETER REPAIR|
20|FH_F132348_16214_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F124082_78526_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F124177_59254_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS|
20|FH_F97563_83201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F117965_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133530_11237_0|SrvcGrp|82242|2022|PCT|1.76|99|0.00|AETNA PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY|
20|FH_F127432_18015_0|SrvcGrp|110428|2022|PCT|4.95|99|0.00|LABORATORY SERVICES|
20|FH_F101840_76054_0|SrvcGrp|47032|2022|PDM|12773.00|99|0.00|MS DRG 740 ONLY|
20|FH_F94165_0_0|SrvcGrp|80988|2022|PCT|0.85|99|0.00|AETNA MATERNITY DELIVERY|
20|FH_F133627_89113_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F115383_80734_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F100784_59923_0|SrvcGrp|73605|2022|PDM|3668.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F43018_0_0|SrvcGrp|16|2022|PDM|1550.00|99|0.00|ACUTE REHABILITATION|
20|FH_F128601_29340_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F106660_26554_0|SrvcGrp|73701|2022|PDM|35.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F136751_0_0|SrvcGrp|84939|2022|PDM|16000.00|99|0.00|SHOULDER JOINT|
20|FH_F113826_51445_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F141250_95062_0|SrvcGrp|89149|2022|PDM|206.00|99|0.00|OP INTENSIVE|
20|FH_F97620_75904_0|SrvcGrp|73601|2022|PDM|7131.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F137789_48146_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F35557_0_0|SrvcGrp|11789|2022|PDM|52.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F120974_27607_0|SrvcGrp|361|2022|PDM|3087.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F147661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118910_0_0|SrvcGrp|89783|2022|PDM|126.18|99|0.00|RESPITE CARE (HCFA)|
20|FH_F137943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125028_19061_0|SrvcGrp|86827|2022|PDM|94.50|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F74227_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F128358_46072_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146663_25311_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119227_01752_0|SrvcGrp|34566|2022|PDM|38.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F85097_0_0|SrvcGrp|13360|2022|PDM|301.00|99|0.00|EMERGENCY ROOM SVCS LEVEL II|
20|FH_F142376_0_0|SrvcGrp|58755|2022|PDM|6446.00|99|0.00|INJECTION PROC FOR JOINT|
20|FH_F120727_54301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F110425_01752_0|SrvcGrp|29347|2022|PDM|38.00|99|0.00|HOME HEALTH AIDE|
20|FH_F52713_0_0|SrvcGrp|28002|2022|PDM|28429.00|99|0.00|MS DRG 253-254 ONLY|
20|FH_F130364_01331_0|CSTM-ALL|CSTM-00|2020|PDM|2890.00|99|0.00|AEG 7 (NO REV)|
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132543_79549_0|SrvcGrp|73659|2022|PDM|1500.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F133333_74132_0|SrvcGrp|78504|2022|PCT|0.62|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F136507_0_0|SrvcGrp|83521|2022|PDM|120.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F144008_11413_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37537_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142027_37217_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F90811_0_0|SrvcGrp|76604|2022|PDM|1800.00|99|0.00|CPT 25447|
20|FH_F114951_20002_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_F149662_85015_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F124695_33401_0|SrvcGrp|113930|2022|PDM|279.00|99|0.00|INTENSIVE OUTPATIENT (>=18 YRS)|
20|FH_F138478_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F31166_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F126939_32405_0|SrvcGrp|46903|2022|PDM|625.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F124965_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F123844_0_0|SrvcGrp|104226|2022|PDM|194.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F148221_06477_0|SrvcGrp|65720|2022|PDM|168.00|99|0.00|RESPITE CARE|
20|FH_F40198_0_0|SrvcGrp|115|2022|PDM|233.00|99|0.00|SKILLED NURSING CARE|
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1900.00|99|0.00|AEG 4 (NO REV)|
20|FH_F55054_0_0|SrvcGrp|31074|2022|PDM|455.00|99|0.00|MS DRG 795 ONLY|
20|FH_F120248_77008_0|SrvcGrp|86723|2022|PDM|375.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F130061_84097_0|SrvcGrp|74668|2022|PDM|900.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147161_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117902_0_0|CSTM-ALL|CSTM-00|2020|PDM|1845.00|99|0.00|AEG 9 (NO REV)|
20|FH_F93332_0_0|SrvcGrp|88491|2022|PDM|7416.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F141794_50548_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F82393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F100782_0_0|SrvcGrp|97524|2022|PDM|786.46|99|0.00|WINDBER MEDICAL CNTR ASC 101|
20|FH_F128828_44122_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F84593_0_0|SrvcGrp|75545|2022|PDM|336.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F95440_0_0|SrvcGrp|36591|2022|PDM|5700.00|99|0.00|CPT 63685|
20|FH_F51500_0_0|SrvcGrp|23850|2022|PCT|0.91|99|0.00|AIR AMBULANCE SERVICES|
20|FH_F112668_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126267_24219_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F70684_0_0|SrvcGrp|29826|2022|PCT|1.00|99|0.00|AWP  J & Q CODES|
20|FH_F98780_35022_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F111662_80601_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F46832_0_0|SrvcGrp|26617|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134075_78230_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F137147_75006_0|SrvcGrp|98269|2022|PDM|7839.00|99|0.00|SHOULDER ARTHROSCOPY WITHOUT REPAIR|
20|FH_F62978_0_0|SrvcGrp|11000|2022|PCT|1.20|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F97601_67218_0|SrvcGrp|73461|2022|PDM|10878.00|99|0.00|AETNA NICU IV|
20|FH_F80284_16354_0|SrvcGrp|111929|2022|PDM|15.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F149649_80104_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F52832_0_0|SrvcGrp|44391|2022|PDM|250.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F129501_67831_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F117219_77515_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F130978_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36343_0_0|SrvcGrp|10541|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F129970_34986_0|SrvcGrp|86723|2022|PDM|473.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F151699_01752_0|SrvcGrp|17014|2022|PDM|47.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F137363_0_0|CSTM-ALL|CSTM-00|2020|PDM|772.50|99|0.00|AEG 10 (NO REV)|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|455.21|99|0.00|SALLY BALIN,999182,ASC 207|
20|FH_F150945_15904_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128839_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134843_83638_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131558_63028_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F38080_0_0|CSTM-ALL|CSTM-00|2020|PDM|1340.00|99|0.00|AEG 5  (NO REV)|
20|FH_F67419_0_0|SrvcGrp|29345|2022|PDM|35.00|99|0.00|SKILLED NURSING - LPN - MOD TE|
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|2922.00|99|0.00|AEG 6 (NO REV)|
20|FH_F116915_30308_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120977_50510_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F114977_78550_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F98922_40351_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F109180_18015_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F126678_44870_0|SrvcGrp|89781|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F94261_0_0|SrvcGrp|46605|2022|PDM|84.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F115667_16101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126900_61924_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F44218_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F51613_0_0|SrvcGrp|48212|2022|PDM|233.00|99|0.00|MENTAL HEALTH IOP|
20|FH_F85213_02840_0|CSTM-ALL|CSTM-00|2020|PDM|6886.40|99|0.00|INPATIENT PSYCHIATRIC CARE >17 YRS|
20|FH_F145641_06902_0|CSTM-ALL|CSTM-00|2020|PDM|1307.00|99|0.00|AEG 6 (NO REV)|
20|FH_F139565_0_0|SrvcGrp|84934|2022|PDM|6885.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F110268_02891_0|SrvcGrp|89024|2022|PDM|78.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F42258_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F71049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F150165_06032_0|SrvcGrp|113880|2022|PDM|2140.00|99|0.00|REVISION OF PENIS|
20|FH_F145942_72019_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120603_66112_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F110906_54481_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F88744_71103_0|CSTM-ALL|CSTM-00|2020|PDM|620.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F122553_92705_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F105361_80104_0|SrvcGrp|113848|2022|PCT|0.49|99|0.00|HIGH COST DRUGS|
20|FH_F133478_40165_0|SrvcGrp|21108|2022|PDM|25858.00|99|0.00|MS DRG 243 ONLY|
20|FH_F111829_32257_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F134087_0_0|SrvcGrp|88159|2022|PDM|5332.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F86851_0_0|SrvcGrp|84969|2022|PDM|520.00|99|0.00|CPT 43241|
20|FH_F136399_70445_0|SrvcGrp|8950|2022|PDM|1500.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F109652_0_0|SrvcGrp|32011|2022|PCT|0.57|99|0.00|TRAUMA CARE|
20|FH_F107480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|GENERAL ACUTE CARE|
20|FH_F45977_0_0|SrvcGrp|40410|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD NU|
20|FH_F151153_77591_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F69651_0_0|SrvcGrp|10537|2022|PDM|55.00|99|0.00|NURSING CARE|
20|FH_F106822_0_0|SrvcGrp|91631|2022|PDM|45.00|99|0.00|OFFICE VISIT|
20|FH_F43196_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132988_0_0|SrvcGrp|85792|2022|PDM|6359.65|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F132988_0_0|SrvcGrp|92369|2022|PDM|6323.70|99|0.00|REPAIR OF ANKLE LIGAMENTS|
20|FH_F114389_50131_0|SrvcGrp|105628|2022|PDM|710.55|99|0.00|POWER WHEELCHAIR (MOD RR)|
20|FH_F125824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127995_84010_0|SrvcGrp|24739|2022|PDM|107.00|99|0.00|RESPITE CARE|
20|FH_F97083_90670_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F55694_0_0|SrvcGrp|941|2022|PDM|3087.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PDM|1481.00|99|0.00|AEG 6 (NO REV)|
20|FH_F97182_21502_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F117891_19034_0|SrvcGrp|48385|2022|PDM|126.00|99|0.00|SPEECH THERAPY|
20|FH_F133550_90630_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F106540_26330_0|SrvcGrp|72992|2022|PDM|2161.00|99|0.00|AEG 2|
20|FH_F120605_0_0|SrvcGrp|108494|2022|PDM|1785.00|99|0.00|RPR I/HERN INIT REDUC >5 YR|
20|FH_F117786_71446_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|OP SVCS|
20|FH_F47036_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116908_33461_0|SrvcGrp|74615|2022|PDM|650.00|99|0.00|INTENSIVE OUTPATIENT|
20|FH_F126627_33155_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F61292_0_0|SrvcGrp|361|2022|PDM|2150.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F115020_67301_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F127711_0_0|SrvcGrp|63469|2022|PDM|1255.00|99|0.00|CPT 55700|
20|FH_F93880_95476_0|SrvcGrp|72990|2022|PDM|3764.00|99|0.00|AEG 1|
20|FH_F149862_76051_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
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_F120365_30043_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141590_90049_0|SrvcGrp|73605|2022|PDM|1347.89|99|0.00|AETNA ACUTE PSYCH|
20|FH_F38798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|KIDS HOME INFUSION THERAPY MOD SH|
20|FH_F110925_01104_0|SrvcGrp|88620|2022|PDM|94.56|99|0.00|SKILLED NURSING RN|
20|FH_F131207_19947_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F126043_30339_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F134593_60007_0|SrvcGrp|24744|2022|PDM|65.00|99|0.00|PICC LINE INSERTION|
20|FH_F134568_12946_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150139_71667_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F31714_0_0|SrvcGrp|9511|2022|PDM|2175.00|99|0.00|OBSERVATION SVCS|
20|FH_F145641_06902_0|SrvcGrp|88157|2022|PDM|21013.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F41594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138584_30912_0|SrvcGrp|113368|2022|PDM|2800.00|99|0.00|RECONSTRUCT MIDFACE LEFORT 3|
20|FH_F119023_91406_0|SrvcGrp|26869|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F112263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)|
20|FH_F33744_0_0|SrvcGrp|3069|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F116485_17033_0|SrvcGrp|110060|2022|PDM|18.57|99|0.00|GROUP BH TREATMENT 15 MINS|
20|FH_F93232_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137951_0_0|SrvcGrp|34606|2022|PDM|3223.00|99|0.00|CPT 29827|
20|FH_F147800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1099.00|99|0.00|AEG 7 (NO REV)|
20|FH_F133021_00910_0|SrvcGrp|112299|2022|PDM|450.00|99|0.00|LOCALIZATION DEVICE|
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|1680.00|99|0.00|ASPG IX|
20|FH_F98600_91730_0|SrvcGrp|73701|2022|PDM|25.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F44435_0_0|SrvcGrp|38585|2022|PDM|2600.00|99|0.00|OP SURGERY (CPT 49505, 49565)|
20|FH_F39521_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1180.00|99|0.00|AEG 6 (NO REV)|
20|FH_F66922_66211_0|SrvcGrp|90684|2022|PDM|2732.00|99|0.00|MS DRG 470 W/ICD|
20|FH_F100906_0_0|SrvcGrp|67072|2022|PDM|2000.00|99|0.00|CPT 22845|
20|FH_F109963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129529_45229_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136607_68632_0|SrvcGrp|537|2022|PCT|0.97|99|0.00|OBSERVATION SERVICES|
20|FH_F136686_43551_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F113830_96002_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F138630_72616_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139087_47586_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F144039_0_0|SrvcGrp|109759|2022|PDM|5738.00|99|0.00|REMOVAL CORNEAL EPITHELIUM|
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|1254.05|99|0.00|2005 ASPG GROUPER V|
20|FH_F132595_0_0|SrvcGrp|108|2022|PCT|0.75|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN|
20|FH_F122610_73139_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F43444_0_0|SrvcGrp|14056|2022|PDM|4000.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F135719_45502_0|SrvcGrp|16429|2022|PDM|1775.72|99|0.00|OBSERVATION SVCS|
20|FH_F63256_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F39622_0_0|SrvcGrp|290|2022|PDM|5900.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F115210_21043_0|SrvcGrp|78096|2022|PDM|3077.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F115608_24171_0|SrvcGrp|99190|2022|PCT|0.00|99|0.00|NORMAL DELIVERY|
20|FH_F147586_44124_0|SrvcGrp|90063|2022|PDM|3601.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F41463_0_0|SrvcGrp|17007|2022|PDM|80.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS|
20|FH_F42024_0_0|SrvcGrp|10927|2022|PDM|694.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F42342_0_0|SrvcGrp|12157|2022|PDM|131.25|99|0.00|RN VISIT|
20|FH_F133018_84037_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125368_24153_0|SrvcGrp|87317|2022|PDM|750.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F113146_15001_0|SrvcGrp|104186|2022|PDM|10.00|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F128299_44134_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F38089_0_0|SrvcGrp|3140|2022|PCT|0.70|99|0.00|PHARMACY SERVICES|
20|FH_F67379_0_0|SrvcGrp|13470|2022|PDM|1837.00|99|0.00|ACUTE SURGICAL SVCS|
20|FH_F133287_40215_0|CSTM-ALL|CSTM-00|2020|PDM|3329.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 9 (NO REV)|
20|FH_F36118_0_0|SrvcGrp|14412|2022|PDM|600.00|99|0.00|HOSPICE CARE|
20|FH_F117368_68114_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F42340_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F97541_33021_0|SrvcGrp|73656|2022|PDM|1076.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F146116_34233_0|SrvcGrp|92501|2022|PDM|373.33|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F67803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141896_61462_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138487_85297_0|SrvcGrp|16069|2022|PDM|1127.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F122377_91007_0|SrvcGrp|31771|2022|PDM|12518.00|99|0.00|MS DRG 417-419 ONLY  LAP CHOLE|
20|FH_F125214_12428_0|SrvcGrp|74581|2022|PCT|0.55|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F131356_19131_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F145920_0_0|SrvcGrp|47142|2022|PDM|3433.00|99|0.00|CPT 49650|
20|FH_F41155_0_0|SrvcGrp|3029|2022|PDM|239.00|99|0.00|NEWBORN NURSERY|
20|FH_F148347_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F47902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F140295_0_0|SrvcGrp|78096|2022|PDM|4635.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F149403_69210_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128008_27302_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150982_0_0|SrvcGrp|65625|2022|PDM|2147.00|99|0.00|CPT 30520|
20|FH_F144648_0_0|SrvcGrp|111468|2022|PDM|150.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F110940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F43867_0_0|SrvcGrp|27725|2022|PDM|40.00|99|0.00|SKILLED RN HOURLY|
20|FH_F54552_0_0|SrvcGrp|24751|2022|PDM|80.00|99|0.00|INTERMITTENT ANTICOAGULANT THERAPY|
20|FH_F113585_20155_0|SrvcGrp|86829|2022|PDM|30.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F138876_25302_0|SrvcGrp|86827|2022|PDM|60.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F138936_01040_0|SrvcGrp|111927|2022|PCT|1.00|99|0.00|COVID-19 NON CDC|
20|FH_F77933_0_0|SrvcGrp|63616|2022|PDM|57.00|99|0.00|OCCUPATIONAL THERAPY SVCS RE-EVAL|
20|FH_F91641_0_0|SrvcGrp|91458|2022|PDM|1872.72|99|0.00|OCULAR SURFACE RECONSTRUCTION|
20|FH_F133891_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F106500_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F114326_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1610.38|99|0.00|HAPA WPA-NWPA 2012-13 ASC 901 W/O REV|
20|FH_F102063_0_0|SrvcGrp|48396|2022|PDM|140.00|99|0.00|OT SERVICES|
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PDM|2976.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F151427_04106_0|SrvcGrp|90643|2022|PDM|109.38|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F132258_45404_0|SrvcGrp|24745|2022|PDM|34.98|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F132268_07060_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F144948_83704_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F97501_31501_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F40073_0_0|SrvcGrp|17073|2022|PCT|0.70|99|0.00|ASPG V|
20|FH_F135347_68784_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135372_73089_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135384_28714_0|SrvcGrp|92501|2022|PDM|195.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F135388_48601_0|SrvcGrp|13681|2022|PDM|469.47|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F135572_89106_0|SrvcGrp|13929|2022|PCT|1.00|99|0.00|GROWTH HORMONE|
20|FH_F91764_93710_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F136186_46307_0|SrvcGrp|48385|2022|PDM|120.00|99|0.00|SPEECH THERAPY|
20|FH_F131334_60062_0|SrvcGrp|92502|2022|PDM|475.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F131132_44077_0|SrvcGrp|73497|2022|PDM|1858.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F131407_07607_0|SrvcGrp|86843|2022|PDM|25.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F116397_33404_0|SrvcGrp|86842|2022|PDM|40.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F116467_13031_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F116501_17801_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36458_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F42098_0_0|SrvcGrp|11073|2022|PDM|55.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F129967_18915_0|SrvcGrp|58509|2022|PDM|525.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F111292_33136_0|SrvcGrp|705|2022|PCT|0.63|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F111383_62233_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F47906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F69202_0_0|SrvcGrp|9774|2022|PDM|3100.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F34532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F34864_0_0|SrvcGrp|9795|2022|PDM|1066.00|99|0.00|SUBACUTE REHAB|
20|FH_F41780_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F101442_0_0|SrvcGrp|33982|2022|PDM|1327.08|99|0.00|CPT 28296|
20|FH_F132328_0_0|SrvcGrp|89842|2022|PDM|14566.00|99|0.00|LUMBAR|
20|FH_F132328_0_0|SrvcGrp|27402|2022|PDM|3371.00|99|0.00|LASER PROCEDURES|
20|FH_F132328_0_0|SrvcGrp|88597|2022|PDM|2049.00|99|0.00|INTERNAL FIX FOR FRACT/INSTA|
20|FH_F96280_06340_0|SrvcGrp|89417|2022|PDM|430.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F102222_19720_0|SrvcGrp|86851|2022|PDM|31.50|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F102325_62691_0|SrvcGrp|29075|2022|PDM|50.00|99|0.00|HYDRATION THERAPY|
20|FH_F102862_30606_0|SrvcGrp|31916|2022|PDM|15566.40|99|0.00|MS DRG 473 ONLY|
20|FH_F101606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F118194_50841_0|SrvcGrp|26868|2022|PDM|145.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F92091_0_0|SrvcGrp|67279|2022|PDM|7650.00|99|0.00|CERVICAL SURGERY|
20|FH_F129011_15857_0|SrvcGrp|48385|2022|PDM|120.00|99|0.00|SPEECH THERAPY|
20|FH_F123950_19111_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121183_75093_0|SrvcGrp|73842|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114930_71101_0|SrvcGrp|103979|2022|PDM|1326.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F143888_32205_0|SrvcGrp|114012|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F135840_0_0|SrvcGrp|75483|2022|PDM|536.00|99|0.00|AEG 3|
20|FH_F138050_52301_0|SrvcGrp|58509|2022|PDM|398.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F118803_0_0|SrvcGrp|107793|2022|PDM|7547.69|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F51039_0_0|CSTM-ALL|CSTM-00|2020|PDM|1229.00|99|0.00|SPINAL CORD REHABILITATION|
20|FH_F88744_71103_0|SrvcGrp|109057|2022|PCT|2.78|99|0.00|CARDIAC STUDIES|
20|FH_F111957_30024_0|SrvcGrp|471|2022|PDM|980.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F85353_16407_0|SrvcGrp|63761|2022|PDM|1847.98|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1|
20|FH_F150159_06511_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F119272_0_0|SrvcGrp|87077|2022|PDM|156.06|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|762.00|99|0.00|AEG 5  (NO REV)|
20|FH_F80172_0_0|SrvcGrp|43571|2022|PDM|107.00|99|0.00|MID-LINE INSERTION|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|286.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 127 W/O REV|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|267.86|99|0.00|HAPA WPA-NWPA 2012-13 ASC 116 W/O REV|
20|FH_F40191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1616.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F40702_0_0|SrvcGrp|13640|2022|PDM|110.00|99|0.00|CPT 99202|
20|FH_F120475_81052_0|SrvcGrp|104329|2022|PCT|1.00|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F56832_0_0|SrvcGrp|9793|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F138583_60644_0|SrvcGrp|86723|2022|PDM|364.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F140332_19041_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119023_91406_0|SrvcGrp|10577|2022|PDM|35.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F119090_91502_0|SrvcGrp|73700|2022|PDM|55.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F117102_39355_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 10 (NO REV)|
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.00|99|0.00|AEG 3 (NO REV)|
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1780.00|99|0.00|ASPG VIII|
20|FH_F132351_19342_0|SrvcGrp|86635|2022|PCT|1.05|99|0.00|DME|
20|FH_F101702_0_0|SrvcGrp|111499|2022|PDM|3550.00|99|0.00|MOLECULAR PATHOLOGY|
20|FH_F101840_76054_0|SrvcGrp|97482|2022|PDM|6260.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F140472_0_0|SrvcGrp|15480|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F103281_32086_0|CSTM-ALL|CSTM-00|2020|PDM|5206.00|99|0.00|AEG 9 (NO REV)|
20|FH_F141612_19605_0|SrvcGrp|75419|2022|PDM|520.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F44135_0_0|SrvcGrp|33643|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F146211_68144_0|SrvcGrp|114504|2022|PCT|1.20|99|0.00|LABORATORY SERVICES|
20|FH_F71145_0_0|SrvcGrp|44246|2022|PDM|165.00|99|0.00|CAPD TRAINING|
20|FH_F40388_0_0|CSTM-ALL|CSTM-00|2020|PDM|407.00|99|0.00|ACUTE PSYCH|
20|FH_F38725_0_0|CSTM-ALL|CSTM-00|2020|PDM|657.00|99|0.00|ASPG II|
20|FH_F111809_93003_0|CSTM-ALL|CSTM-00|2020|PDM|11281.00|99|0.00|AEG 8 (NO REV)|
20|FH_F97542_32960_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150999_20678_0|SrvcGrp|105323|2022|PCT|1.00|99|0.00|ESTABLISH PATIENT OFF/OP VST|
20|FH_F124691_78003_0|SrvcGrp|46903|2022|PDM|1200.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F48617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90817_0_0|SrvcGrp|82720|2022|PDM|1607.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F52092_0_0|SrvcGrp|9829|2022|PDM|58.00|99|0.00|PT SVCS|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD AU"|
20|FH_F98000_59102_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F61292_0_0|SrvcGrp|20908|2022|PDM|14535.00|99|0.00|MS DRG 247 ONLY|
20|FH_F140427_0_0|SrvcGrp|113624|2022|PDM|2750.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F110925_01104_0|SrvcGrp|86166|2022|PDM|52.84|99|0.00|AETNA REGADENOSON INJ|
20|FH_F88451_0_0|SrvcGrp|43284|2022|PDM|126.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F31798_0_0|SrvcGrp|177|2022|PDM|3680.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F40834_0_0|SrvcGrp|675|2022|PDM|1517.00|99|0.00|PEDIATRIC INPATIENT SVCS|
20|FH_F134996_83467_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89475_71202_0|SrvcGrp|113275|2022|PDM|100.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT|
20|FH_F109645_0_0|SrvcGrp|87398|2022|PDM|95.00|99|0.00|CPT 99501 (HCFA)|
20|FH_F109343_0_0|SrvcGrp|103606|2022|PCT|0.00|99|0.00|NURSERY|
20|FH_F57032_0_0|SrvcGrp|53484|2022|PDM|9.00|99|0.00|CONTROL SOLUTION|
20|FH_F137943_0_0|SrvcGrp|104719|2022|PDM|3040.00|99|0.00|RELIEVE INNER EYE PRESSURE|
20|FH_F125927_75093_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|92820|2022|PDM|16516.00|99|0.00|HIP ARTHOSCOPY ACETABULOPLASTY|
20|FH_F149980_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AEG 5  (NO REV)|
20|FH_F143928_21061_0|SrvcGrp|29347|2022|PDM|26.00|99|0.00|HOME HEALTH AIDE|
20|FH_F131254_92211_0|SrvcGrp|86844|2022|PDM|35.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F123282_03222_0|SrvcGrp|48385|2022|PDM|144.00|99|0.00|SPEECH THERAPY|
20|FH_F42938_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137943_0_0|SrvcGrp|113195|2022|PDM|1660.00|99|0.00|REINFORCE/GRAFT EYE WALL|
20|FH_F70303_0_0|SrvcGrp|13722|2022|PDM|218.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE|
20|FH_F130662_07032_0|SrvcGrp|46903|2022|PDM|650.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F133748_77081_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F150124_44107_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120930_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|DEVICE INSERTION|
20|FH_F133972_27103_0|SrvcGrp|104482|2022|PDM|230.00|99|0.00|HYDRATION IV INFUSION INIT|
20|FH_F144808_0_0|SrvcGrp|72121|2022|PDM|2888.00|99|0.00|ARTHOSCOPY|
20|FH_F141901_0_0|CSTM-ALL|CSTM-00|2020|PDM|1194.57|99|0.00|ASPG VII|
20|FH_F85777_77030_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F54592_0_0|SrvcGrp|27051|2022|PDM|29.33|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS (MOD SJ)|
20|FH_F133574_91607_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F113815_0_0|SrvcGrp|72990|2022|PDM|426.00|99|0.00|AEG 1|
20|FH_F87474_0_0|SrvcGrp|20000|2022|PDM|165.00|99|0.00|CATHETER CARE SUPPLIES|
20|FH_F58856_0_0|SrvcGrp|28165|2022|PDM|32500.00|99|0.00|MS DRG 228 ONLY|
20|FH_F148739_47129_0|SrvcGrp|46903|2022|PDM|1550.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F109652_0_0|SrvcGrp|23477|2022|PDM|9895.00|99|0.00|MSDRG 286-287 ONLY CARDIAC CATH|
20|FH_F139820_75657_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F148900_0_0|SrvcGrp|45063|2022|PDM|668.00|99|0.00|CPT 64493  INJECTION CARVE OUT|
20|FH_F82933_0_0|SrvcGrp|34025|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (LAB)|
20|FH_F116323_0_0|SrvcGrp|88492|2022|PDM|24090.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F115208_0_0|SrvcGrp|106172|2022|PDM|2016.00|99|0.00|SINUS SURGICAL ENDOSCOPY|
20|FH_F33982_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130297_41042_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F147081_02130_0|SrvcGrp|88905|2022|PDM|1167.00|99|0.00|PSYCHIATRIC CARE (AGE 0-17)|
20|FH_F111594_0_0|SrvcGrp|78096|2022|PDM|2887.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F128130_10027_0|SrvcGrp|92958|2022|PCT|1.93|99|0.00|SLEEP STUDIES|
20|FH_F98041_10027_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F117001_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37568_0_0|SrvcGrp|24289|2022|PDM|50.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F51438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|ASPG IV|
20|FH_F89932_10940_0|CSTM-ALL|CSTM-00|2020|PDM|760.00|99|0.00|AETNA ENDOSCOPY (ENDO)|
20|FH_F132934_63005_0|SrvcGrp|83960|2022|PCT|0.71|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F117583_21208_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F151699_01752_0|SrvcGrp|24761|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F124703_65711_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146266_0_0|SrvcGrp|12664|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F47036_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F116684_30701_0|SrvcGrp|104847|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125482_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F131998_67401_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121090_07848_0|CSTM-ALL|CSTM-00|2020|PDM|702.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F87619_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118194_50841_0|SrvcGrp|14494|2022|PDM|968.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F140427_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46612_0_0|SrvcGrp|26001|2022|PDM|329.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F141707_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 3 (NO REV)|
20|FH_F134593_60007_0|SrvcGrp|24761|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F149322_19023_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F77044_0_0|SrvcGrp|74143|2022|PCT|0.33|99|0.00|INFUSION S-CODES (MOD SJ)|
20|FH_F149106_07042_0|SrvcGrp|84183|2022|PCT|1.00|99|0.00|AETNA SURGERY OF BREAST CAPSULE|
20|FH_F109242_18466_0|SrvcGrp|91398|2022|PDM|123.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AJ)|
20|FH_F87333_0_0|SrvcGrp|73008|2022|PDM|1087.28|99|0.00|AEG 10|
20|FH_F138951_41101_0|SrvcGrp|86830|2022|PDM|50.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F142547_70002_0|SrvcGrp|86829|2022|PDM|20.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F122009_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F117301_01887_0|SrvcGrp|75754|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148430_06278_0|SrvcGrp|111927|2022|PCT|1.00|99|0.00|COVID-19 NON CDC|
20|FH_F148644_06890_0|SrvcGrp|82107|2022|PDM|3794.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F138882_0_0|CSTM-ALL|CSTM-00|2020|PDM|1562.00|99|0.00|AEG 2 (NO REV)|
20|FH_F77822_0_0|SrvcGrp|472|2022|PDM|546.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F95021_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F83978_66739_0|SrvcGrp|131|2022|PCT|0.42|99|0.00|PACEMAKER DEVICE|
20|FH_F132147_33183_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F119213_66209_0|SrvcGrp|104193|2022|PCT|1.00|99|0.00|PHYSICAL THERAPY|
20|FH_F143560_03079_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129509_0_0|SrvcGrp|35669|2022|PDM|3280.00|99|0.00|CPT 63650|
20|FH_F77943_0_0|SrvcGrp|11336|2022|PCT|0.49|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F138951_41101_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F87812_33919_0|SrvcGrp|84559|2022|PCT|1.10|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F134667_19110_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F105361_80104_0|SrvcGrp|73006|2022|PDM|3881.00|99|0.00|AEG 9|
20|FH_F146668_30189_0|SrvcGrp|114612|2022|PDM|4850.00|99|0.00|REMOVAL OF FOOT FASCIA|
20|FH_F132815_39429_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111581_77401_0|SrvcGrp|104270|2022|PCT|1.50|99|0.00|CHEMOTHERAPY & ALL OTHER DRUGS|
20|FH_F89372_0_0|SrvcGrp|3078|2022|PCT|0.51|99|0.00|DRUGS|
20|FH_F123756_45324_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F65239_0_0|SrvcGrp|36591|2022|PDM|984.00|99|0.00|CPT 63685|
20|FH_F140488_07039_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F80284_16354_0|SrvcGrp|64113|2022|PDM|46.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 10|
20|FH_F137814_61820_0|SrvcGrp|73605|2022|PDM|961.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F111593_0_0|SrvcGrp|73006|2022|PDM|3822.50|99|0.00|AEG 9|
20|FH_F95880_02726_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151083_66223_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113741_63303_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37875_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F113143_0_0|SrvcGrp|73004|2022|PDM|1103.00|99|0.00|AEG 8|
20|FH_F103780_64804_0|SrvcGrp|116091|2022|PCT|0.68|99|0.00|CARDIAC CATH|
20|FH_F147014_33612_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132864_71101_0|CSTM-ALL|CSTM-00|2020|PDM|2924.00|99|0.00|AEG 7 (NO REV)|
20|FH_F112165_0_0|SrvcGrp|72998|2022|PDM|2350.00|99|0.00|AEG 5|
20|FH_F117909_92405_0|SrvcGrp|73701|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F118376_46052_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133049_19145_0|SrvcGrp|3178|2022|PDM|960.00|99|0.00|ACUTE PSYCH|
20|FH_F133029_61264_0|SrvcGrp|73842|2022|PDM|246.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F71723_16502_0|SrvcGrp|10503|2022|PDM|47.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F101922_98055_0|SrvcGrp|75506|2022|PCT|0.63|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F117885_81506_0|SrvcGrp|73701|2022|PDM|52.50|99|0.00|AETNA - SKILLED NURSING|
20|FH_F80859_65616_0|SrvcGrp|31653|2022|PDM|3052.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III (MS DRG)|
20|FH_F126735_38018_0|SrvcGrp|73605|2022|PDM|1000.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F139666_26175_0|SrvcGrp|113114|2022|PCT|0.94|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F150746_31210_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F74765_0_0|CSTM-ALL|CSTM-00|2020|PDM|401.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F94643_90501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98860_96706_0|SrvcGrp|73643|2022|PDM|2881.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F137731_92262_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149579_95815_0|SrvcGrp|115707|2022|PDM|128.25|99|0.00|PSYCHIATRIC COLLABORATIVE CARE MGMT SBSQ (MOD TD)|
20|FH_F125081_15218_0|SrvcGrp|89781|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F151660_77074_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F54056_0_0|SrvcGrp|3809|2022|PDM|601.02|99|0.00|HOSPICE CARE|
20|FH_F109247_73102_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F85211_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115907_12206_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F116040_24637_0|SrvcGrp|24750|2022|PDM|30.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F146760_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F107200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1457.00|99|0.00|AEG 8 (NO REV)|
20|FH_F137242_52722_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F140343_89052_0|SrvcGrp|86843|2022|PDM|25.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F151579_19802_0|SrvcGrp|82981|2022|PDM|135.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F92852_0_0|SrvcGrp|28551|2022|PDM|2200.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F121989_43026_0|SrvcGrp|74668|2022|PDM|264.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F110720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102041_35010_0|SrvcGrp|48398|2022|PDM|145.00|99|0.00|PT SERVICES|
20|FH_F134317_0_0|SrvcGrp|79720|2022|PDM|1000.00|99|0.00|ACUTE REHAB II|
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|2668.00|99|0.00|AEG 5  (NO REV)|
20|FH_F130652_51101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F144990_44708_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146258_90004_0|SrvcGrp|112844|2022|PDM|1634.00|99|0.00|IP PSYCHIATRIC EATING DISORDERS|
20|FH_F141807_33020_0|SrvcGrp|74668|2022|PDM|237.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133467_03301_0|SrvcGrp|74668|2022|PDM|900.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F37185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126666_44053_0|SrvcGrp|91750|2022|PDM|47.00|99|0.00|AETNA GROUP THERAPY (MOD AH)|
20|FH_F41670_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F123583_72756_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F46196_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F88355_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F133168_62035_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139294_33406_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 4 (NO REV)|
20|FH_F131415_73071_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F131942_50833_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F37189_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151699_01752_0|SrvcGrp|86852|2022|PDM|60.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F119316_27104_0|SrvcGrp|89417|2022|PDM|450.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|ASPG X|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU KC"|
20|FH_F120839_19380_0|SrvcGrp|89149|2022|PDM|170.00|99|0.00|OP INTENSIVE|
20|FH_F128883_89521_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F141794_50548_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F127711_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F151146_0_0|CSTM-ALL|CSTM-00|2020|PDM|2612.00|99|0.00|AEG 7 (NO REV)|
20|FH_F104941_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F38034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|IP ELECTROPHYSIOLOGY + ANGIO|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD AW|
20|FH_F33782_0_0|SrvcGrp|12160|2022|PDM|35.00|99|0.00|HOME HEALTH AID|
20|FH_F119535_0_0|SrvcGrp|48085|2022|PDM|90.00|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F42005_0_0|SrvcGrp|35149|2022|PDM|500.00|99|0.00|COLORECTAL CANCER SCREENING|
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|AEG 6 (NO REV)|
20|FH_F138054_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97041_71603_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F141967_89509_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F119229_90804_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F42332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F143171_18411_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F118541_15222_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125365_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F88956_0_0|SrvcGrp|75483|2022|PDM|1632.00|99|0.00|AEG 3|
20|FH_F144789_48304_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35368_0_0|SrvcGrp|12859|2022|PDM|5544.00|99|0.00|ELECTROPHYSIOLOGY|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME TRANSFUSION|
20|FH_F144494_62526_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150882_84041_0|SrvcGrp|73742|2022|PDM|4.41|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F124691_78003_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111038_62960_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F41377_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F69183_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122649_0_0|SrvcGrp|100664|2022|PDM|632.50|99|0.00|HOSPICE IP CARE (HCFA)|
20|FH_F31547_0_0|SrvcGrp|12263|2022|PDM|19.68|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F124291_44122_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F143536_47546_0|SrvcGrp|25385|2022|PCT|1.00|99|0.00|CPT 10060|
20|FH_F113649_01752_0|SrvcGrp|14945|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F146885_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F47733_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% L CODES MOD UE|
20|FH_F35202_0_0|SrvcGrp|9832|2022|PDM|84.00|99|0.00|ST SVCS|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|ASPG IV F/S - BDSS|
20|FH_F62695_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93902_04043_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F72546_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F56972_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F148342_80621_0|SrvcGrp|108484|2022|PDM|750.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F80083_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122687_0_0|SrvcGrp|41334|2022|PDM|11474.00|99|0.00|TOTAL KNEE|
20|FH_F130721_04769_0|SrvcGrp|75506|2022|PCT|0.89|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F148267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F96160_32207_0|SrvcGrp|14945|2022|PDM|6.76|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F133747_80634_0|SrvcGrp|20752|2022|PDM|16000.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F80172_0_0|SrvcGrp|16300|2022|PDM|284.00|99|0.00|HOME TRANSFUSION|
20|FH_F42577_0_0|CSTM-ALL|CSTM-00|2020|PDM|199.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F125013_85251_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F146179_37687_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148599_98034_0|SrvcGrp|104540|2022|PCT|2.00|99|0.00|LABORATORY SERVICES|
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F42420_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F81860_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.20|99|0.00|OP SVCS|
20|FH_F76382_0_0|SrvcGrp|43892|2022|PDM|110.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F35734_32405_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F84532_0_0|CSTM-ALL|CSTM-00|2020|PDM|5374.00|99|0.00|FRAGMENTING KIDNEY STONE PARTIAL TREATMENT|
20|FH_F148326_0_0|CSTM-ALL|CSTM-00|2020|PDM|3520.00|99|0.00|AEG 7 (NO REV)|
20|FH_F74845_0_0|SrvcGrp|3029|2022|PDM|524.00|99|0.00|NEWBORN NURSERY|
20|FH_F126914_44136_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F36597_0_0|SrvcGrp|19923|2022|PDM|1625.00|99|0.00|HYSTEROSCOPY|
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|2288.00|99|0.00|ASPG IX|
20|FH_F134870_97015_0|SrvcGrp|87329|2022|PCT|2.24|99|0.00|TUALITY HEALTH ALLIANCE MED/E&M|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|191.45|99|0.00|SALLY BALIN,999182,ASC 219|
20|FH_F116437_0_0|SrvcGrp|87759|2022|PDM|793.00|99|0.00|REINFORCE/GRAFT EYE WALL|
20|FH_F143347_16001_0|SrvcGrp|109057|2022|PCT|0.65|99|0.00|CARDIAC STUDIES|
20|FH_F48937_0_0|SrvcGrp|26160|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F119992_67062_0|SrvcGrp|75545|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F120887_78750_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132190_0_0|SrvcGrp|16694|2022|PDM|2500.00|99|0.00|KNEE SCOPE, CHONDROPLASTY|
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|AEG 9 (NO REV)|
20|FH_F139241_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|1262.00|99|0.00|AEG 5  (NO REV)|
20|FH_F137943_0_0|SrvcGrp|92548|2022|PDM|703.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F130747_0_0|SrvcGrp|89848|2022|PDM|32252.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F126153_44663_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F56276_0_0|SrvcGrp|26778|2022|PDM|72.00|99|0.00|CPT 90816|
20|FH_F74242_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F148666_34205_0|SrvcGrp|46903|2022|PDM|650.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 6 (NO REV)|
20|FH_F126341_27284_0|SrvcGrp|17015|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F114444_19602_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F111701_33330_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149106_07042_0|SrvcGrp|28557|2022|PDM|6728.00|99|0.00|CPT 19318|
20|FH_F134619_14304_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F148927_0_0|SrvcGrp|99073|2022|PCT|0.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F145641_06902_0|SrvcGrp|45063|2022|PDM|2178.00|99|0.00|CPT 64493  INJECTION CARVE OUT|
20|FH_F84855_0_0|CSTM-ALL|CSTM-00|2020|PDM|2309.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F68887_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F115811_33410_0|SrvcGrp|73842|2022|PDM|208.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F87480_0_0|CSTM-ALL|CSTM-00|2020|PDM|909.00|99|0.00|AEG 6 (NO REV)|
20|FH_F136386_30901_0|SrvcGrp|105528|2022|PDM|200.00|99|0.00|MAMMOGRAPHY UNILATERAL|
20|FH_F120152_0_0|SrvcGrp|89404|2022|PDM|24750.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F151609_17601_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111593_0_0|SrvcGrp|77449|2022|PDM|2915.00|99|0.00|CPT 52352|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F115483_62002_0|SrvcGrp|112966|2022|PCT|0.60|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F139353_67124_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149402_03301_0|SrvcGrp|16|2022|PDM|1170.00|99|0.00|ACUTE REHABILITATION|
20|FH_F148965_62025_0|SrvcGrp|79720|2022|PDM|1782.00|99|0.00|ACUTE REHAB II|
20|FH_F129297_97828_0|SrvcGrp|73601|2022|PCT|0.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F148008_0_0|SrvcGrp|472|2022|PDM|528.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F143368_33028_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143536_47546_0|SrvcGrp|101743|2022|PCT|1.00|99|0.00|IM ADMIN 1ST/ONLY COMPONENT|
20|FH_F151746_20032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136247_28804_0|SrvcGrp|73841|2022|PDM|460.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F120887_78750_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F92091_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F132051_74464_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F38526_0_0|SrvcGrp|2741|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F72183_0_0|SrvcGrp|60756|2022|PDM|1500.00|99|0.00|ASPG X - FH SW CUSTOM GROUPERS|
20|FH_F60072_0_0|SrvcGrp|941|2022|PDM|4225.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F39945_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F149140_07522_0|SrvcGrp|113224|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS DNA&RNA 21 SARSCOV2|
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PDM|1735.00|99|0.00|AEG 5  (NO REV)|
20|FH_F140427_0_0|SrvcGrp|88481|2022|PDM|2500.00|99|0.00|AETNA RMVL & RPLCMT DFB GEN MLT LEAD|
20|FH_F142611_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121183_75093_0|SrvcGrp|73841|2022|PDM|386.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F124018_75067_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F66687_0_0|SrvcGrp|54973|2022|PCT|0.85|99|0.00|MS DRG 225 ONLY|
20|FH_F125011_74467_0|SrvcGrp|42785|2022|PDM|75.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F137367_89139_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F120296_97223_0|SrvcGrp|86635|2022|PCT|0.70|99|0.00|DME|
20|FH_F110142_39056_0|SrvcGrp|103998|2022|PCT|1.00|99|0.00|HOSPICE/PHYSICIAN|
20|FH_F122725_32216_0|SrvcGrp|104798|2022|PDM|68.00|99|0.00|ORAL SPEECH DEVICE EVALUATION|
20|FH_F100782_0_0|SrvcGrp|105137|2022|PDM|227.05|99|0.00|WINDBER MEDICAL CNTR ASC 242|
20|FH_F125328_0_0|SrvcGrp|79594|2022|PDM|2259.00|99|0.00|CPT 45380|
20|FH_F111030_05641_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F45120_0_0|SrvcGrp|40403|2022|PDM|500.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|368.46|99|0.00|HAPA WPA-NWPA 2012-13 ASC 307 W/O REV|
20|FH_F118300_0_0|SrvcGrp|14494|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F120583_43219_0|SrvcGrp|46605|2022|PDM|90.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F79863_0_0|SrvcGrp|77240|2022|PDM|22.00|99|0.00|AETNA HOME INJECTABLE THERAPY|
20|FH_F133207_0_0|SrvcGrp|104108|2022|PDM|3192.00|99|0.00|EXCISION OF BREAST LESION ID|
20|FH_F126359_24228_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122009_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F139456_47501_0|SrvcGrp|22596|2022|PDM|155.00|99|0.00|HOSPICE CARE|
20|FH_F91472_96001_0|SrvcGrp|8950|2022|PDM|11115.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F39366_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F66411_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F97040_31901_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F119104_44870_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118517_33316_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F102721_38118_0|SrvcGrp|16173|2022|PDM|200.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F116699_46347_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F116915_30308_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)|
20|FH_F89734_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77862_0_0|SrvcGrp|3809|2022|PDM|623.54|99|0.00|HOSPICE CARE|
20|FH_F145588_75081_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F148170_04005_0|SrvcGrp|106314|2022|PDM|1230.82|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F39273_0_0|SrvcGrp|17419|2022|PDM|65.00|99|0.00|SPEECH THERAPY|
20|FH_F129656_15005_0|SrvcGrp|43569|2022|PDM|60.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F32772_0_0|SrvcGrp|79699|2022|PCT|0.95|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F148139_48328_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38411_0_0|SrvcGrp|15|2022|PDM|3450.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F123644_0_0|SrvcGrp|86723|2022|PDM|300.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F83995_16748_0|SrvcGrp|10540|2022|PDM|37.00|99|0.00|HOME HEALTH AIDE|
20|FH_F44278_0_0|SrvcGrp|29842|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F85213_02840_0|SrvcGrp|111930|2022|PDM|73.60|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F117300_0_0|SrvcGrp|88160|2022|PDM|7360.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F117300_0_0|SrvcGrp|98493|2022|PDM|7853.00|99|0.00|THORACIC|
20|FH_F86101_76063_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F115877_63556_0|SrvcGrp|74581|2022|PCT|0.51|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F131904_18915_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132954_32066_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134155_07016_0|SrvcGrp|112508|2022|PDM|267.00|99|0.00|INTENSIVE OUTPATIENT PSYCH (0-18 YRS)|
20|FH_F138584_30912_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109513_0_0|SrvcGrp|90417|2022|PDM|2700.00|99|0.00|TREATMENT OF JOINT|
20|FH_F110381_0_0|SrvcGrp|72998|2022|PDM|1537.00|99|0.00|AEG 5|
20|FH_F97740_01605_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F125946_0_0|SrvcGrp|92502|2022|PDM|1260.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F132544_0_0|SrvcGrp|96349|2022|PDM|7850.00|99|0.00|NECK SPINE FUSE|
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 5  (NO REV)|
20|FH_F129175_0_0|SrvcGrp|53066|2022|PDM|107.59|99|0.00|INJECTION(S), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL|
20|FH_F31530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|GENERAL ACUTE CARE|
20|FH_F111789_25301_0|SrvcGrp|103503|2022|PCT|0.77|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F51548_0_0|SrvcGrp|10542|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F37537_0_0|SrvcGrp|12343|2022|PDM|1920.00|99|0.00|PET SCAN|
20|FH_F118542_60188_0|SrvcGrp|14945|2022|PDM|6.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F33003_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35368_0_0|SrvcGrp|12221|2022|PDM|6699.00|99|0.00|ELECTROPHYSIOLOGY|
20|FH_F92752_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F97182_21502_0|SrvcGrp|73659|2022|PDM|5486.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F133478_40165_0|SrvcGrp|73497|2022|PDM|858.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.40|99|0.00|ASPG X|
20|FH_F100783_03431_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F33381_0_0|SrvcGrp|3029|2022|PDM|831.00|99|0.00|NEWBORN NURSERY|
20|FH_F140873_0_0|SrvcGrp|104228|2022|PDM|152.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F110604_0_0|SrvcGrp|88163|2022|PDM|18150.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F114638_25309_0|SrvcGrp|75506|2022|PCT|0.75|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PDM|5.20|99|0.00|INTERVENE HLTH/BEHAVE GROUP|
20|FH_F122689_92009_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F42837_0_0|SrvcGrp|13626|2022|PDM|605.00|99|0.00|SLEEP STUDIES|
20|FH_F42840_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F42897_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117075_68847_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136778_62034_0|CSTM-ALL|CSTM-00|2020|PDM|5493.00|99|0.00|AEG 7 (NO REV)|
20|FH_F136830_22003_0|SrvcGrp|89149|2022|PDM|205.00|99|0.00|OP INTENSIVE|
20|FH_F112378_60505_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
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_F115181_78602_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115266_66736_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F116383_63026_0|SrvcGrp|89417|2022|PDM|424.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F116393_07002_0|SrvcGrp|100267|2022|PDM|14.21|99|0.00|URINE BACTERIA CULTURE|
20|FH_F147299_02072_0|SrvcGrp|88620|2022|PDM|114.00|99|0.00|SKILLED NURSING RN|
20|FH_F147479_75077_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147519_52627_0|SrvcGrp|89297|2022|PDM|826.80|99|0.00|INPATIENT DETOXIFICATION SERVICES|
20|FH_F147580_75110_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41652_0_0|CSTM-ALL|CSTM-00|2020|PDM|212.00|99|0.00|CD PARTIAL HOSP (> 4 HOURS)|
20|FH_F42176_0_0|SrvcGrp|20801|2022|PCT|0.88|99|0.00|HOME HEALTH|
20|FH_F42250_0_0|CSTM-ALL|CSTM-00|2020|PCT|74.00|99|0.00|OP SVCS|
20|FH_F148554_85016_0|SrvcGrp|115464|2022|PDM|1399.00|99|0.00|REMOVE ENDOVAS VENA CAVA FILTER|
20|FH_F115431_32821_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F71667_0_0|SrvcGrp|1306|2022|PDM|342.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F87155_04105_0|SrvcGrp|26869|2022|PDM|57.78|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|MIDLINE INSERTION KIT|
20|FH_F128468_37087_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F101840_76054_0|SrvcGrp|80838|2022|PDM|20287.00|99|0.00|MSDRG 519 ONLY|
20|FH_F37778_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F34706_0_0|CSTM-ALL|CSTM-00|2020|PDM|20592.00|99|0.00|GAMMA KNIFE|
20|FH_F115312_78550_0|SrvcGrp|87441|2022|PDM|845.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F43953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F117872_33462_0|SrvcGrp|73841|2022|PDM|477.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F150948_0_0|SrvcGrp|67068|2022|PDM|10500.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F150019_19380_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147083_46304_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138017_73129_0|SrvcGrp|63459|2022|PDM|6539.00|99|0.00|CPT 52601|
20|FH_F124749_90211_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F31547_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F124749_90211_0|SrvcGrp|46903|2022|PDM|838.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F35416_0_0|SrvcGrp|411|2022|PCT|0.80|99|0.00|OP CARDIAC CATH|
20|FH_F133579_0_0|CSTM-ALL|CSTM-00|2020|PDM|1159.00|99|0.00|AEG 3 (NO REV)|
20|FH_F120688_68124_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36854_0_0|SrvcGrp|38|2022|PDM|5180.00|99|0.00|NORMAL DELIVERY|
20|FH_F72445_0_0|SrvcGrp|10649|2022|PDM|8.00|99|0.00|HOME INFUSION|
20|FH_F72445_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F49832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138777_43140_0|SrvcGrp|3178|2022|PDM|816.00|99|0.00|ACUTE PSYCH|
20|FH_F138907_01040_0|SrvcGrp|30609|2022|PDM|41.31|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F89580_0_0|SrvcGrp|43985|2022|PCT|0.44|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F127207_0_0|SrvcGrp|80317|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F143832_0_0|CSTM-ALL|CSTM-00|2020|PDM|2378.55|99|0.00|AEG 7 (NO REV)|
20|FH_F83621_0_0|SrvcGrp|77260|2022|PDM|3200.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F151307_63127_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151516_63023_0|SrvcGrp|108484|2022|PDM|765.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F122032_32413_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135389_43123_0|SrvcGrp|89417|2022|PDM|468.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F97143_80012_0|SrvcGrp|73602|2022|PDM|1974.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F91764_93710_0|SrvcGrp|113222|2022|PCT|2.19|99|0.00|COVID-19 NFCT DS 22 TRGT SARS-COV-2|
20|FH_F135893_74006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135924_02906_0|SrvcGrp|111475|2022|PDM|2119.90|99|0.00|TRAUMA TEAM LEVEL 1|
20|FH_F136180_92253_0|SrvcGrp|74668|2022|PDM|450.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F100880_67735_0|SrvcGrp|41335|2022|PDM|33000.00|99|0.00|TOTAL HIP|
20|FH_F116397_33404_0|SrvcGrp|24744|2022|PDM|65.00|99|0.00|PICC LINE INSERTION|
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PDM|918.00|99|0.00|AEG 3 (NO REV)|
20|FH_F121763_07202_0|SrvcGrp|109217|2022|PDM|47.00|99|0.00|PSYCH/NEUROPSYCH TEST 1ST 30 MINUTES|
20|FH_F131407_07607_0|SrvcGrp|86827|2022|PDM|55.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F134263_15628_0|SrvcGrp|73842|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1375.00|99|0.00|AEG 7 (NO REV)|
20|FH_F47906_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL|
20|FH_F148243_0_0|SrvcGrp|82300|2022|PDM|500.00|99|0.00|SIGMOIDOSCOPY|
20|FH_F131000_0_0|SrvcGrp|59840|2022|PDM|2123.00|99|0.00|TYMPANOSTOMY|
20|FH_F35783_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_F112105_24924_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|OP SVCS|
20|FH_F132347_01605_0|SrvcGrp|48394|2022|PDM|52.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|22990.00|99|0.00|MS DRG 242 PERMANENT CARDIAC PACEMAKER|
20|FH_F130841_49315_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F127343_0_0|CSTM-ALL|CSTM-00|2020|PDM|3520.00|99|0.00|AEG 9 (NO REV)|
20|FH_F131100_0_0|SrvcGrp|111435|2022|PDM|856.00|99|0.00|ATRAUMATIC DISLOC WITH ANES|
20|FH_F85133_85251_0|SrvcGrp|23683|2022|PDM|51.00|99|0.00|SKILLED NURSING RN|
20|FH_F112060_07514_0|SrvcGrp|96400|2022|PCT|1.00|99|0.00|INTERFERON ALFACON|
20|FH_F111986_0_0|SrvcGrp|16289|2022|PDM|1133.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F126063_43078_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133869_19947_0|SrvcGrp|88819|2022|PDM|695.25|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F127091_62016_0|SrvcGrp|112744|2022|PCT|0.00|99|0.00|HOME HEALTH PROSPECTIVE PAYMENT SYSTEM (HHRG)|
20|FH_F121303_15501_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F132606_0_0|SrvcGrp|27261|2022|PDM|3537.36|99|0.00|CPT 27446|
20|FH_F50657_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F146124_06112_0|SrvcGrp|80244|2022|PCT|0.00|99|0.00|AETNA ICU|
20|FH_F134156_32174_0|SrvcGrp|73841|2022|PDM|484.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F137007_43160_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F53732_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|PEDIATRIC SPEECH THERAPY|
20|FH_F119046_74012_0|SrvcGrp|73659|2022|PDM|1200.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F94786_07974_0|SrvcGrp|24745|2022|PDM|36.75|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F72085_0_0|SrvcGrp|43534|2022|PDM|392.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F147081_02130_0|SrvcGrp|72602|2022|PDM|504.00|99|0.00|ECT|
20|FH_F124178_01604_0|SrvcGrp|3923|2022|PCT|1.00|99|0.00|LOVENOX/ENOXAPARIN|
20|FH_F134770_14420_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F136930_73114_0|SrvcGrp|73002|2022|PDM|7994.00|99|0.00|AEG 7|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|332.14|99|0.00|HAPA WPA-NWPA 2012-13 ASC 220 W/O REV|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|104.69|99|0.00|HAPA WPA-NWPA 2012-13 ASC 140 W/O REV|
20|FH_F35216_0_0|SrvcGrp|10944|2022|PCT|0.75|99|0.00|EMERGENCY ROOM|
20|FH_F136386_30901_0|CSTM-ALL|CSTM-00|2020|PCT|1.80|99|0.00|CHEMOTHERAPY AND OTHER DRUGS WITH ER SERVICES|
20|FH_F112817_37027_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F39085_0_0|SrvcGrp|115|2022|PDM|525.00|99|0.00|SKILLED NURSING CARE|
20|FH_F91873_12723_0|SrvcGrp|89143|2022|PCT|3.45|99|0.00|RADIATION TREATMENT DELIVERY|
20|FH_F116043_0_0|SrvcGrp|80317|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F77944_0_0|SrvcGrp|10639|2022|PDM|810.00|99|0.00|CT SCAN|
20|FH_F37901_0_0|SrvcGrp|27173|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F124611_64804_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F128360_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F72390_0_0|CSTM-ALL|CSTM-00|2020|PDM|3553.00|99|0.00|ASPG V|
20|FH_F138052_19462_0|SrvcGrp|90636|2022|PDM|117.00|99|0.00|AETNA PSYTX PT & FAMILY 60 MINUTES (HCFA)|
20|FH_F119825_0_0|SrvcGrp|95661|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F133287_40215_0|SrvcGrp|537|2022|PCT|0.53|99|0.00|OBSERVATION SERVICES|
20|FH_F151521_45882_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119008_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F50652_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|OP SVCS|
20|FH_F150883_14727_0|SrvcGrp|3378|2022|PCT|0.80|99|0.00|OBSERVATION SVCS|
20|FH_F63301_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101840_76054_0|SrvcGrp|97484|2022|PDM|1321.00|99|0.00|ENDO CHOLANGIOPANCREATOGRAPH|
20|FH_F38914_0_0|CSTM-ALL|CSTM-00|2020|PDM|1025.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148903_51101_0|SrvcGrp|88620|2022|PDM|128.00|99|0.00|SKILLED NURSING RN|
20|FH_F142891_54022_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151520_44134_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140093_33467_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F94330_43220_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F123570_0_0|SrvcGrp|73002|2022|PDM|1407.40|99|0.00|AEG 7|
20|FH_F140093_33467_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137748_95231_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS|
20|FH_F35416_0_0|SrvcGrp|15971|2022|PDM|6900.00|99|0.00|ELECTROPHYSIOLOGY|
20|FH_F114188_15205_0|SrvcGrp|46424|2022|PDM|99.34|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F90817_0_0|SrvcGrp|91040|2022|PDM|1692.00|99|0.00|REPAIR WRIST JOINT(S) (HCFA)|
20|FH_F151202_0_0|SrvcGrp|108484|2022|PDM|450.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F113180_23507_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138491_0_0|SrvcGrp|104226|2022|PDM|85.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F82357_0_0|SrvcGrp|13606|2022|PDM|33.00|99|0.00|HOME INFUSION|
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|1753.00|99|0.00|AEG 9 (NO REV)|
20|FH_F48836_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F54552_0_0|SrvcGrp|26867|2022|PDM|80.00|99|0.00|ANTI-EMETICS INFUSION THERAPY|
20|FH_F138658_75022_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F138857_90025_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F139012_78516_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F57953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD 26|
20|FH_F33067_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117715_0_0|SrvcGrp|75493|2022|PDM|1048.00|99|0.00|AEG 8|
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 10 (NO REV)|
20|FH_F143832_0_0|SrvcGrp|108172|2022|PDM|2405.06|99|0.00|AETNA FEM/POPL REVASE W/ATHER|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|448.53|99|0.00|HAPA WPA-NWPA 2012-13 ASC 306 W/O REV|
20|FH_F151427_04106_0|SrvcGrp|116010|2022|PDM|139.03|99|0.00|CHEMOTHERAPY ADMINISTRATION (HCFA)|
20|FH_F151514_35242_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132258_45404_0|SrvcGrp|10577|2022|PDM|34.98|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F132258_45404_0|SrvcGrp|86828|2022|PDM|43.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F97142_94535_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F91764_93710_0|SrvcGrp|112677|2022|PCT|2.19|99|0.00|COVID-19 SPEC COLL SNF/LAB|
20|FH_F135979_66451_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F136130_10029_0|SrvcGrp|82846|2022|PCT|1.05|99|0.00|AETNA DME|
20|FH_F131228_01826_0|SrvcGrp|74443|2022|PDM|233.57|99|0.00|CARDIAC TESTING|
20|FH_F130547_85712_0|SrvcGrp|96163|2022|PDM|1.72|99|0.00|TIGECYCLINE INJECTION|
20|FH_F116463_76501_0|SrvcGrp|58509|2022|PDM|150.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F41196_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121771_91405_0|SrvcGrp|108484|2022|PDM|1200.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F131407_07607_0|SrvcGrp|24761|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F128370_76132_0|SrvcGrp|108484|2022|PDM|580.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F111292_33136_0|SrvcGrp|110744|2022|PCT|2.00|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F111363_33169_0|SrvcGrp|45582|2022|PDM|40.00|99|0.00|CPT 85610|
20|FH_F134322_98001_0|SrvcGrp|10006|2022|PCT|1.00|99|0.00|NEBCIN/TOBRAMYCIN SULFATE|
20|FH_F111853_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118651_0_0|SrvcGrp|88147|2022|PDM|2652.25|99|0.00|LAPAROSCOPY REMOVE ADNEXA|
20|FH_F112129_62220_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88831_84123_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F98626_29118_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F129240_10028_0|SrvcGrp|14947|2022|PDM|5.00|99|0.00|HOME INFUSION|
20|FH_F129240_10028_0|SrvcGrp|111026|2022|PCT|0.83|99|0.00|SUPPLIES|
20|FH_F102960_50613_0|SrvcGrp|16429|2022|PDM|125.00|99|0.00|OBSERVATION SVCS|
20|FH_F132347_01605_0|SrvcGrp|46605|2022|PDM|147.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F134202_0_0|SrvcGrp|34606|2022|PDM|1890.00|99|0.00|CPT 29827|
20|FH_F79743_0_0|SrvcGrp|16|2022|PDM|1843.00|99|0.00|ACUTE REHABILITATION|
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150306_51566_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145604_14850_0|SrvcGrp|29076|2022|PDM|75.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F70448_0_0|CSTM-ALL|CSTM-00|2020|PDM|374.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136359_0_0|SrvcGrp|102481|2022|PDM|2895.00|99|0.00|CPT 29898|
20|FH_F134928_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F110311_17078_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122470_78229_0|SrvcGrp|76501|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F86452_0_0|SrvcGrp|15472|2022|PDM|583.00|99|0.00|CPT CODE 62284|
20|FH_F115909_38133_0|SrvcGrp|89149|2022|PDM|194.00|99|0.00|OP INTENSIVE|
20|FH_F139887_0_0|SrvcGrp|92197|2022|PDM|5973.00|99|0.00|CORRECTION OF BUNION|
20|FH_F133494_90023_0|SrvcGrp|79786|2022|PCT|0.00|99|0.00|SLEEP STUDIES|
20|FH_F134828_30531_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142491_06033_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|AETNA ANCD OCN F/S PRICING - OP|
20|FH_F147926_19063_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112080_0_0|SrvcGrp|73008|2022|PDM|914.00|99|0.00|AEG 10|
20|FH_F97761_04072_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32777_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110785_10040_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F149559_60012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F149662_85015_0|CSTM-ALL|CSTM-00|2020|PDM|2420.00|99|0.00|AEG 7 (NO REV)|
20|FH_F150442_28451_0|SrvcGrp|74039|2022|PDM|6000.00|99|0.00|LAMINECTOMY|
20|FH_F82375_28601_0|SrvcGrp|48396|2022|PDM|135.00|99|0.00|OT SERVICES|
20|FH_F39272_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F66059_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F49895_0_0|SrvcGrp|32385|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKE (DME)|
20|FH_F148265_06067_0|SrvcGrp|88160|2022|PDM|13550.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F52854_0_0|SrvcGrp|17067|2022|PDM|1136.00|99|0.00|ASPG II|
20|FH_F147941_06023_0|SrvcGrp|14614|2022|PDM|9882.00|99|0.00|LITHOTRIPSY|
20|FH_F32060_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143870_19134_0|SrvcGrp|86505|2022|PDM|2100.00|99|0.00|DENTAL SURGERY|
20|FH_F91622_0_0|SrvcGrp|91528|2022|PDM|8102.00|99|0.00|SPINAL CORD IMPLANT|
20|FH_F141471_0_0|SrvcGrp|113778|2022|PDM|5900.00|99|0.00|THROMBECTOMY|
20|FH_F74342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40661_0_0|SrvcGrp|109|2022|PDM|487.00|99|0.00|CD - DETOX|
20|FH_F40089_0_0|SrvcGrp|31949|2022|PDM|50.00|99|0.00|SPEECH THERAPY|
20|FH_F72944_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F37884_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F109484_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH|
20|FH_F123774_0_0|SrvcGrp|72992|2022|PDM|628.00|99|0.00|AEG 2|
20|FH_F132988_0_0|SrvcGrp|112152|2022|PDM|3144.78|99|0.00|NERVE PEDICLE TRANSFER|
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|747.00|99|0.00|AEG 3 (NO REV)|
20|FH_F124178_01604_0|SrvcGrp|109719|2022|PCT|1.00|99|0.00|CILAS SOD;IMIP PR 250MG/32MX|
20|FH_F129143_68739_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F66880_25301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F92833_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F42779_0_0|SrvcGrp|15158|2022|PDM|571.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F136401_0_0|SrvcGrp|87077|2022|PDM|154.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F150001_33064_0|SrvcGrp|86847|2022|PDM|26.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F132587_57105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150003_22630_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40943_0_0|SrvcGrp|471|2022|PDM|608.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F82215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|447.00|99|0.00|HAPA EPA ASC 50|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|709.44|99|0.00|ASPG 3|
20|FH_F38089_0_0|SrvcGrp|16|2022|PDM|1134.00|99|0.00|ACUTE REHABILITATION|
20|FH_F117720_23323_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132613_84601_0|SrvcGrp|46903|2022|PDM|800.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F38700_0_0|SrvcGrp|18133|2022|PCT|0.80|99|0.00|MS DRG 244|
20|FH_F74463_0_0|SrvcGrp|71667|2022|PDM|1100.00|99|0.00|SURGERY|
20|FH_F71465_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F138487_85297_0|SrvcGrp|88819|2022|PDM|1127.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F139576_0_0|CSTM-ALL|CSTM-00|2020|PDM|3732.00|99|0.00|AEG 9 (NO REV)|
20|FH_F120057_0_0|SrvcGrp|103503|2022|PDM|1700.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F150982_0_0|SrvcGrp|104258|2022|PDM|1382.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F124389_84115_0|SrvcGrp|12957|2022|PCT|1.00|99|0.00|DME|
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|1916.00|99|0.00|AEG 6 (NO REV)|
20|FH_F84631_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AMFS DEFAULT W/O HOME HEALTH|
20|FH_F33287_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90852_0_0|SrvcGrp|8950|2022|PDM|1470.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F93332_0_0|SrvcGrp|93072|2022|PDM|2295.00|99|0.00|POSTERIOR SEGMENTAL INSTRU (HCFA)|
20|FH_F91617_0_0|SrvcGrp|87077|2022|PDM|240.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F148184_29527_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137946_0_0|SrvcGrp|113224|2022|PDM|416.78|99|0.00|COVID-19 NFCT DS DNA&RNA 21 SARSCOV2|
20|FH_F39170_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF|
20|FH_F98801_93274_0|SrvcGrp|73643|2022|PDM|2405.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F77925_0_0|SrvcGrp|15763|2022|PCT|0.65|99|0.00|TRAUMA|
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126403_77304_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133972_27103_0|SrvcGrp|10577|2022|PDM|35.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F143611_84065_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114444_19602_0|CSTM-ALL|CSTM-00|2020|PDM|85.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION MOD AJ (HCFA)|
20|FH_F145640_32503_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F145781_0_0|SrvcGrp|99073|2022|PDM|1.28|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F123539_65265_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F119226_07746_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F43774_0_0|SrvcGrp|8962|2022|PDM|125.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F128127_57028_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121385_89102_0|SrvcGrp|109220|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F138387_02886_0|SrvcGrp|113270|2022|PDM|115.00|99|0.00|HOME PHYSICAL THERAPY|
20|FH_F141511_0_0|SrvcGrp|30089|2022|PDM|425.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F112045_90301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|3017.00|99|0.00|AEG 7 (NO REV)|
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 2 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|119.88|99|0.00|HAPA WPA-NWPA 2012-13 ASC 241 W/O REV|
20|FH_F151420_60654_0|SrvcGrp|104750|2022|PDM|2272.00|99|0.00|REPAIR BLADDER & VAGINA|
20|FH_F151501_30265_0|SrvcGrp|99172|2022|PDM|6913.00|99|0.00|CPT 28740|
20|FH_F151501_30265_0|SrvcGrp|92197|2022|PDM|6737.00|99|0.00|CORRECTION OF BUNION|
20|FH_F151501_30265_0|SrvcGrp|98466|2022|PDM|2090.00|99|0.00|PARTIAL REMOVAL OF FOOT BONE|
20|FH_F145168_15601_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135473_33759_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135572_89106_0|SrvcGrp|29077|2022|PCT|1.00|99|0.00|HOME TRANSFUSION|
20|FH_F97143_80012_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F135960_33141_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116431_76104_0|SrvcGrp|36505|2022|PCT|0.90|99|0.00|TRAUMA|
20|FH_F140629_0_0|SrvcGrp|26274|2022|PDM|2497.00|99|0.00|CPT 29877|
20|FH_F121444_47720_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F121761_44130_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F111292_33136_0|SrvcGrp|78807|2022|PDM|41268.00|99|0.00|AETNA CARDIAC VALVE & OTH MAJ CAR|
20|FH_F111301_33122_0|SrvcGrp|3378|2022|PDM|2942.00|99|0.00|OBSERVATION SVCS|
20|FH_F134315_89106_0|SrvcGrp|26868|2022|PCT|1.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F141651_0_0|SrvcGrp|91420|2022|PDM|2200.00|99|0.00|REMOVAL OF ADENOIDS|
20|FH_F89360_0_0|SrvcGrp|88431|2022|PDM|2810.00|99|0.00|C-SECTION|
20|FH_F43137_0_0|SrvcGrp|69121|2022|PDM|700.00|99|0.00|VENT LEVEL SNF|
20|FH_F39925_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F101442_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132328_0_0|SrvcGrp|90798|2022|PDM|3974.00|99|0.00|IMPLANT SPINE INFUSION PUMP19|
20|FH_F132328_0_0|SrvcGrp|44064|2022|PDM|2425.00|99|0.00|CPT 52351|
20|FH_F132328_0_0|SrvcGrp|33724|2022|PDM|1745.00|99|0.00|ARTHROSCOPY|
20|FH_F72666_0_0|SrvcGrp|69700|2022|PDM|26372.00|99|0.00|IP DEEP BRAIN STIMULATION|
20|FH_F112138_80120_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F87496_17055_0|SrvcGrp|48398|2022|PDM|104.00|99|0.00|PT SERVICES|
20|FH_F87500_16823_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F102222_19720_0|SrvcGrp|86838|2022|PDM|10.50|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F129234_78245_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F102960_50613_0|SrvcGrp|10361|2022|PDM|491.00|99|0.00|CPT CODE 99281|
20|FH_F148079_06512_0|SrvcGrp|88620|2022|PDM|103.00|99|0.00|SKILLED NURSING RN|
20|FH_F33925_0_0|SrvcGrp|15776|2022|PCT|0.70|99|0.00|CHEMOTHERAPY|
20|FH_F50475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
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_F117300_0_0|SrvcGrp|27261|2022|PDM|8835.00|99|0.00|CPT 27446|
20|FH_F52713_0_0|SrvcGrp|29702|2022|PDM|17942.00|99|0.00|CV SURGERY MS DRG 260-262 ONLY|
20|FH_F58396_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|106% OF ASP DRUGS/IMMUN UPDATE QUARTERLY|
20|FH_F110503_10016_0|SrvcGrp|86723|2022|PDM|621.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F85353_16407_0|SrvcGrp|42269|2022|PDM|4793.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F88744_71103_0|SrvcGrp|17100|2022|PDM|877.00|99|0.00|SKILLED NURSING|
20|FH_F146400_71860_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133126_48059_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131808_74525_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F46433_0_0|SrvcGrp|17012|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F136398_23502_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136536_46075_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118171_00674_0|CSTM-ALL|CSTM-00|2020|PDM|1379.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142741_03264_0|SrvcGrp|89337|2022|PDM|2474.50|99|0.00|DETOXIFICATION|
20|FH_F78404_16646_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS|
20|FH_F151608_30236_0|SrvcGrp|100048|2022|PDM|8920.00|99|0.00|INCISE/GRAFT MIDFOOT BONES|
20|FH_F129504_02871_0|SrvcGrp|29346|2022|PDM|54.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F117093_40041_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111840_0_0|SrvcGrp|75493|2022|PDM|1339.00|99|0.00|AEG 8|
20|FH_F68950_0_0|SrvcGrp|25518|2022|PDM|3472.88|99|0.00|LAPAROSCOPY SURGICAL CHOLECYSTECTOMY|
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|979.00|99|0.00|AEG 5  (NO REV)|
20|FH_F146674_70778_0|SrvcGrp|46903|2022|PDM|555.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F39910_0_0|SrvcGrp|360|2022|PDM|870.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F150910_0_0|SrvcGrp|41334|2022|PDM|10500.00|99|0.00|TOTAL KNEE|
20|FH_F137248_0_0|SrvcGrp|103569|2022|PDM|4058.00|99|0.00|REPAIR ANKLE FRACTURE|
20|FH_F114684_80547_0|SrvcGrp|105707|2022|PDM|102.00|99|0.00|OFFICE/OUTPATIENT VISIT NEW (HCFA)|
20|FH_F142087_0_0|SrvcGrp|89842|2022|PDM|15000.00|99|0.00|LUMBAR|
20|FH_F127656_06068_0|SrvcGrp|43568|2022|PDM|109.20|99|0.00|SKILLED NURSING - RN|
20|FH_F111566_75093_0|SrvcGrp|13187|2022|PCT|1.10|99|0.00|INTRAOCULAR LENSES|
20|FH_F82234_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123741_20850_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142430_38863_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142207_62237_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114650_17104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F117267_07728_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|1097.00|99|0.00|AEG 8 (NO REV)|
20|FH_F91873_12723_0|CSTM-ALL|CSTM-00|2020|PCT|2.92|99|0.00|OP SVCS|
20|FH_F146922_68108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39753_0_0|SrvcGrp|1245|2022|PCT|0.90|99|0.00|POSTERIOR LUMBAR FUSION|
20|FH_F100703_0_0|SrvcGrp|19922|2022|PDM|4200.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PDM|2513.00|99|0.00|AEG 3 (NO REV)|
20|FH_F146991_80918_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F42466_0_0|SrvcGrp|3029|2022|PDM|244.00|99|0.00|NEWBORN NURSERY|
20|FH_F124173_66215_0|SrvcGrp|105706|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F138456_33543_0|SrvcGrp|106048|2022|PDM|987.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F134733_19460_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147468_20877_0|SrvcGrp|74668|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F63281_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F135891_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136474_95742_0|SrvcGrp|90854|2022|PDM|1150.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F134011_84102_0|SrvcGrp|48385|2022|PDM|103.00|99|0.00|SPEECH THERAPY|
20|FH_F140888_75119_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F140893_19720_0|SrvcGrp|29347|2022|PDM|29.80|99|0.00|HOME HEALTH AIDE|
20|FH_F117221_23434_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112371_19047_0|SrvcGrp|13123|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F149861_85225_0|SrvcGrp|75419|2022|PDM|392.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F92531_0_0|SrvcGrp|92197|2022|PDM|2875.00|99|0.00|CORRECTION OF BUNION|
20|FH_F117335_0_0|SrvcGrp|72992|2022|PDM|557.00|99|0.00|AEG 2|
20|FH_F123158_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 3 (NO REV)|
20|FH_F39844_0_0|SrvcGrp|24|2022|PDM|3183.00|99|0.00|CARDIAC CATH|
20|FH_F128774_53140_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F107261_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F33581_0_0|SrvcGrp|24|2022|PCT|0.75|99|0.00|CARDIAC CATH|
20|FH_F97182_21502_0|SrvcGrp|88978|2022|PDM|7467.00|99|0.00|VAGINAL DELIVERY|
20|FH_F118488_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F63462_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F139428_65270_0|SrvcGrp|48396|2022|PDM|97.85|99|0.00|OT SERVICES|
20|FH_F139444_32966_0|SrvcGrp|75419|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F130331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F55693_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F37338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F43399_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F138478_0_0|SrvcGrp|113281|2022|PDM|5220.46|99|0.00|INSERT/REPLACE OF CARD ELECT|
20|FH_F132446_19063_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F140007_0_0|SrvcGrp|16693|2022|PDM|3470.00|99|0.00|KNEE SCOPE, MENISCECTOMY|
20|FH_F77862_0_0|SrvcGrp|45539|2022|PDM|105.78|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F133099_66801_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F124802_72301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|746.00|99|0.00|AEG 1 (NO REV)|
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100761_02539_0|SrvcGrp|73601|2022|PDM|6614.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F123963_0_0|CSTM-ALL|CSTM-00|2020|PDM|1699.23|99|0.00|AEG 5  (NO REV)|
20|FH_F143819_29485_0|SrvcGrp|74694|2022|PDM|739.00|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F124018_75067_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F130840_21738_0|SrvcGrp|112076|2022|PDM|1100.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F89563_29407_0|SrvcGrp|89500|2022|PCT|1.00|99|0.00|SPEECH SOUND LANGUAGE|
20|FH_F141548_33410_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|2025.96|99|0.00|AEG 9 (NO REV)|
20|FH_F90671_33701_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F100620_37027_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124687_64024_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F81832_13827_0|SrvcGrp|22954|2022|PDM|197.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F122689_92009_0|SrvcGrp|108905|2022|PDM|26.00|99|0.00|EXT AMB INSULIN DELIVERY SYS|
20|FH_F123445_0_0|SrvcGrp|95660|2022|PDM|692.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F128438_87410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101840_76054_0|SrvcGrp|47036|2022|PDM|7994.00|99|0.00|MS DRG 743 ONLY|
20|FH_F118674_29036_0|SrvcGrp|114102|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|1255.00|99|0.00|AEG 6 (NO REV)|
20|FH_F100786_24740_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F145862_66209_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F46357_0_0|SrvcGrp|41333|2022|PDM|4200.00|99|0.00|LITHO MOD 51|
20|FH_F117512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F98921_64503_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F151144_35801_0|CSTM-ALL|CSTM-00|2020|PDM|1812.00|99|0.00|AEG 9 (NO REV)|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|208.36|99|0.00|DELAWARE VALLEY- ASC 111|
20|FH_F35056_0_0|CSTM-ALL|CSTM-00|2020|PDM|3975.00|99|0.00|ASPG VIII|
20|FH_F149019_34114_0|SrvcGrp|115368|2022|PCT|1.00|99|0.00|COVID-19 VACCINES AND ADMINSTRATION|
20|FH_F150940_92708_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148839_0_0|SrvcGrp|109760|2022|PDM|1919.00|99|0.00|TRANSLUM DIL EYE CANAL|
20|FH_F108680_0_0|CSTM-ALL|CSTM-00|2020|PDM|647.00|99|0.00|AEG 2 (NO REV)|
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1832.00|99|0.00|AEG 8 (NO REV)|
20|FH_F33632_52349_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F37081_0_0|SrvcGrp|18366|2022|PDM|17440.00|99|0.00|MS DRG 480|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F127292_85705_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F151029_52241_0|SrvcGrp|87536|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F46284_0_0|SrvcGrp|9828|2022|PDM|63.00|99|0.00|HOME HEALTH AIDE|
20|FH_F114585_11501_0|SrvcGrp|104078|2022|PCT|1.03|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F146765_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F32150_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|110096|2022|PDM|2759.00|99|0.00|LAPAROSCOPY SURGICAL COLPOPE|
20|FH_F36743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|POST INTENSIVE CARE UNIT|
20|FH_F143536_47546_0|SrvcGrp|82744|2022|PCT|1.00|99|0.00|URINE CULTURE COLONY COUNT|
20|FH_F133247_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F102224_0_0|SrvcGrp|92405|2022|PDM|2400.00|99|0.00|PERQ LUMBOSACRAL INJECTION|
20|FH_F84611_30281_0|SrvcGrp|73000|2022|PDM|3168.00|99|0.00|AEG 6|
20|FH_F123302_33407_0|SrvcGrp|89417|2022|PDM|332.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F43513_0_0|CSTM-ALL|CSTM-00|2020|PCT|86.60|99|0.00|OP SVCS|
20|FH_F131228_01826_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F32373_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128272_60640_0|SrvcGrp|86837|2022|PDM|25.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F86416_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89778_0_0|SrvcGrp|27348|2022|PDM|2135.54|99|0.00|OP SURGERY (CPT 58662)|
20|FH_F112023_12866_0|SrvcGrp|72994|2022|PDM|3838.00|99|0.00|AEG 3|
20|FH_F143568_85006_0|SrvcGrp|21457|2022|PCT|2.23|99|0.00|CPT CODE 95811|
20|FH_F96201_01824_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F145594_02809_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132969_84003_0|SrvcGrp|105706|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F81457_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F116806_0_0|SrvcGrp|107009|2022|PDM|2047.31|99|0.00|REREVISE ORBITOFACIAL BONES|
20|FH_F134326_14094_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F115870_98225_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F97602_40121_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F50519_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|CPT CODE 96101 PER VISIT|
20|FH_F117240_37334_0|SrvcGrp|79786|2022|PCT|1.45|99|0.00|SLEEP STUDIES|
20|FH_F121329_33015_0|SrvcGrp|108803|2022|PDM|280.00|99|0.00|HEMODIALYSIS|
20|FH_F35212_0_0|SrvcGrp|9832|2022|PDM|84.50|99|0.00|ST SVCS|
20|FH_F130813_85014_0|SrvcGrp|46903|2022|PDM|428.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F139147_0_0|SrvcGrp|91422|2022|PDM|5305.00|99|0.00|REMOVAL OF ADENOIDS|
20|FH_F97101_98003_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110121_0_0|SrvcGrp|72998|2022|PDM|3360.00|99|0.00|AEG 5|
20|FH_F97280_20018_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F103180_85283_0|SrvcGrp|27969|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F35752_33470_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F102224_0_0|SrvcGrp|88160|2022|PDM|6000.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F150026_0_0|SrvcGrp|30609|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|33.93|99|0.00|AETNA SLEEP STUDIES (MOD TC)|
20|FH_F128401_44615_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F148170_04005_0|SrvcGrp|13422|2022|PDM|537.08|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F143784_16801_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|386.10|99|0.00|ASPG I|
20|FH_F51074_0_0|SrvcGrp|10667|2022|PDM|701.00|99|0.00|BOARDER BABY SVCS|
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|474.00|99|0.00|AEG 2 (NO REV)|
20|FH_F120249_43215_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1050.00|99|0.00|ASPG V|
20|FH_F86851_0_0|SrvcGrp|84966|2022|PDM|520.00|99|0.00|CPT 43220|
20|FH_F89219_0_0|SrvcGrp|23259|2022|PDM|2256.00|99|0.00|MS DRG 789-795 ONLY NEONATAL|
20|FH_F118310_60108_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F126904_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F110441_60062_0|SrvcGrp|89149|2022|PDM|280.88|99|0.00|OP INTENSIVE|
20|FH_F134326_14094_0|SrvcGrp|473|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F150165_06032_0|SrvcGrp|100069|2022|PDM|4161.00|99|0.00|REVISE LOWER LEG TENDON|
20|FH_F143681_61938_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F33535_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F46832_0_0|SrvcGrp|29076|2022|PDM|60.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F134011_84102_0|SrvcGrp|86829|2022|PDM|20.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F62732_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F137930_51546_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109652_0_0|SrvcGrp|12920|2022|PCT|0.57|99|0.00|EMERGENCY CRITICAL CARE|
20|FH_F143828_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AMBULATORY SURGERY W/O AEG 1|
20|FH_F73231_0_0|SrvcGrp|27767|2022|PDM|52.73|99|0.00|SKILLED IV NURSING HOURLY|
20|FH_F124586_14850_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F136622_60062_0|SrvcGrp|86723|2022|PDM|656.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|28.50|99|0.00|HYDRATION ONE LITER (MOD SH)|
20|FH_F148545_84047_0|SrvcGrp|48385|2022|PDM|84.50|99|0.00|SPEECH THERAPY|
20|FH_F116698_07470_0|SrvcGrp|14944|2022|PDM|10.50|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F120308_07901_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F125011_74467_0|SrvcGrp|110022|2022|PDM|10000.00|99|0.00|FUSION OF SACROILIAC JOINT|
20|FH_F82173_72712_0|SrvcGrp|16319|2022|PDM|1777.00|99|0.00|TRAUMA CARE|
20|FH_F120349_38774_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F116960_91505_0|SrvcGrp|110812|2022|PDM|361.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F135979_66451_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136247_28804_0|SrvcGrp|3178|2022|PCT|0.00|99|0.00|ACUTE PSYCH|
20|FH_F100848_17202_0|SrvcGrp|472|2022|PDM|364.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130933_47129_0|SrvcGrp|46903|2022|PDM|520.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F130996_34110_0|SrvcGrp|97895|2022|PDM|17000.00|99|0.00|REVISE KNEE 2|
20|FH_F140629_0_0|SrvcGrp|113684|2022|PDM|1302.00|99|0.00|RPR FEM HERNIA|
20|FH_F38843_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SURGERY|
20|FH_F101681_46123_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101718_50702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121731_20164_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F121771_91405_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121854_28613_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F130010_77384_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111291_52501_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F111363_33169_0|SrvcGrp|82748|2022|PDM|45.00|99|0.00|HEMO/PLATELET CNT AUTOMATED|
20|FH_F33081_0_0|SrvcGrp|14610|2022|PCT|0.70|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F101442_0_0|SrvcGrp|98460|2022|PDM|1909.05|99|0.00|AMPUTATION FOOT TRANSMETATARSAL|
20|FH_F131000_0_0|SrvcGrp|94989|2022|PDM|3343.00|99|0.00|SINUS ENDO W/ BALLOON DILATION|
20|FH_F132328_0_0|SrvcGrp|99174|2022|PDM|2289.00|99|0.00|CPT 30140|
20|FH_F132328_0_0|SrvcGrp|88739|2022|PDM|1706.00|99|0.00|IMPLANT SPINAL CANAL|
20|FH_F132915_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F32826_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F125253_15601_0|SrvcGrp|472|2022|PDM|459.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F102325_62691_0|SrvcGrp|22384|2022|PDM|60.00|99|0.00|HOME VISIT PRENATAL|
20|FH_F130027_76201_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F98300_30236_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F148061_11223_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F51276_0_0|SrvcGrp|49285|2022|PDM|90.00|99|0.00|DELIVERY/NURSING (HIGH RISK)|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138050_52301_0|SrvcGrp|42785|2022|PDM|140.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F51479_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112631_0_0|SrvcGrp|73000|2022|PDM|928.00|99|0.00|AEG 6|
20|FH_F134615_38478_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120719_27540_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|947.00|99|0.00|AEG 3 (NO REV)|
20|FH_F66427_0_0|SrvcGrp|11258|2022|PCT|0.80|99|0.00|DRUGS|
20|FH_F138607_02760_0|SrvcGrp|114135|2022|PDM|400.00|99|0.00|EXTERNAL RECEIVER (MOD NU)|
20|FH_F149646_71129_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F124115_77546_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124636_85008_0|SrvcGrp|75419|2022|PDM|600.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F147468_20877_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F84935_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F149527_62859_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147939_61611_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F38699_0_0|SrvcGrp|17065|2022|PDM|415.00|99|0.00|ASPG I|
20|FH_F91472_96001_0|SrvcGrp|73806|2022|PCT|0.60|99|0.00|AETNA ER|
20|FH_F39057_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F141036_02347_0|SrvcGrp|111931|2022|PCT|1.00|99|0.00|COVID-19 CDC TESTING LAB|
20|FH_F132351_19342_0|SrvcGrp|82846|2022|PCT|1.05|99|0.00|AETNA DME|
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|2678.00|99|0.00|AEG 5  (NO REV)|
20|FH_F124212_33407_0|SrvcGrp|75442|2022|PDM|465.00|99|0.00|OBSERVATION - REV 762|
20|FH_F127995_84010_0|SrvcGrp|14945|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F128974_70130_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F113937_15301_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F42001_0_0|CSTM-ALL|CSTM-00|2020|PDM|115.00|99|0.00|OP SVCS|
20|FH_F142087_0_0|SrvcGrp|113851|2022|PDM|15000.00|99|0.00|ARTHRDSIS LAT MINI DISKECT|
20|FH_F111594_0_0|SrvcGrp|35669|2022|PDM|4812.00|99|0.00|CPT 63650|
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AEG 8 (NO REV)|
20|FH_F133458_18929_0|SrvcGrp|90397|2022|PDM|1750.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F100661_63640_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F88512_0_0|SrvcGrp|46523|2022|PDM|24749.14|99|0.00|MASTECTOMY|
20|FH_F37573_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F117471_19111_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F97562_29803_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F44093_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F127422_0_0|SrvcGrp|73006|2022|PDM|1339.00|99|0.00|AEG 9|
20|FH_F32881_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F142043_45503_0|SrvcGrp|74668|2022|PDM|232.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F141804_70503_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F118542_60188_0|SrvcGrp|17016|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F121016_32607_0|SrvcGrp|106990|2022|PCT|1.00|99|0.00|RHOGAM INJECTION|
20|FH_F111815_35904_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F88956_0_0|SrvcGrp|75495|2022|PDM|3003.00|99|0.00|AEG 9|
20|FH_F138478_0_0|SrvcGrp|92406|2022|PDM|17355.00|99|0.00|REMOVAL & REPLACE PULSE GEN 1 LEAD|
20|FH_F132849_0_0|SrvcGrp|112130|2022|PDM|8770.00|99|0.00|HYSTERECTOMY|
20|FH_F127364_26241_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141247_18902_0|SrvcGrp|90643|2022|PDM|20.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F146266_0_0|SrvcGrp|26274|2022|PDM|2580.00|99|0.00|CPT 29877|
20|FH_F55694_0_0|SrvcGrp|27726|2022|PCT|0.54|99|0.00|OP SURGERY|
20|FH_F136607_68632_0|SrvcGrp|75506|2022|PCT|0.97|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F148424_01440_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F127412_15301_0|SrvcGrp|109251|2022|PDM|905.00|99|0.00|CILIARY BODY DESTRUCTION|
20|FH_F41456_0_0|SrvcGrp|12403|2022|PDM|34.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F127412_15301_0|SrvcGrp|110734|2022|PDM|1210.00|99|0.00|RECONSTRUCTION OF UPPER EYELID|
20|FH_F39180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F31542_0_0|SrvcGrp|12394|2022|PCT|1.00|99|0.00|PROSTHETICS/IMPLANTS/DEVICES|
20|FH_F150951_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F110240_0_0|SrvcGrp|91478|2022|PDM|743.00|99|0.00|COLONOSCOPY AND BIOPSY (HCFA)|
20|FH_F119079_41018_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F146212_57108_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F33113_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142084_82009_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F148644_06890_0|SrvcGrp|54943|2022|PDM|4025.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F115990_0_0|SrvcGrp|73000|2022|PDM|1250.00|99|0.00|AEG 6|
20|FH_F139430_63017_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F76826_0_0|SrvcGrp|74441|2022|PDM|677.00|99|0.00|CARDIAC TESTING|
20|FH_F148181_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150383_29853_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F52092_0_0|SrvcGrp|8962|2022|PDM|58.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F97880_63501_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F101083_0_0|SrvcGrp|86606|2022|PDM|1260.00|99|0.00|INTRAOCULAR LENS|
20|FH_F141330_65075_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140094_16125_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143488_84770_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116913_77024_0|SrvcGrp|93337|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F123511_64076_0|SrvcGrp|472|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130747_0_0|SrvcGrp|88492|2022|PDM|6763.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F33642_0_0|SrvcGrp|13362|2022|PCT|0.75|99|0.00|EMERGENCY ROOM SVCS LEVEL IV|
20|FH_F117783_0_0|SrvcGrp|107610|2022|PCT|1.00|99|0.00|REMOVE EYE/ATTACH IMPLANT|
20|FH_F72930_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37945_0_0|SrvcGrp|14187|2022|PDM|612.00|99|0.00|MRI|
20|FH_F130127_77071_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F113682_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137940_0_0|SrvcGrp|106291|2022|PDM|219.93|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F88254_33411_0|SrvcGrp|21920|2022|PDM|30.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F130588_41171_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F110180_0_0|SrvcGrp|21975|2022|PDM|1575.00|99|0.00|INPATIENT SERVICES|
20|FH_F87054_0_0|SrvcGrp|38907|2022|PDM|1260.00|99|0.00|CPT 66170 - FISTULIZATION OF SCLERA FOR GLAUCOMA|
20|FH_F142321_29401_0|SrvcGrp|87317|2022|PDM|1176.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F113392_0_0|CSTM-ALL|CSTM-00|2020|PDM|1074.36|99|0.00|AEG 8 (NO REV)|
20|FH_F64819_0_0|SrvcGrp|29817|2022|PDM|3941.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F100703_0_0|SrvcGrp|97319|2022|PDM|8034.00|99|0.00|REVISE SPINE ELTRD PLATE|
20|FH_F87856_0_0|SrvcGrp|75493|2022|PDM|1272.00|99|0.00|AEG 8|
20|FH_F136617_76118_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F115210_21043_0|SrvcGrp|80617|2022|PDM|11000.00|99|0.00|ARTHOPLASTY|
20|FH_F88956_0_0|SrvcGrp|76243|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F128246_0_0|SrvcGrp|111040|2022|PDM|726.00|99|0.00|REMOVE EYELID LINING LESION|
20|FH_F86655_0_0|SrvcGrp|85159|2022|PCT|0.00|99|0.00|CARDIAC CATH|
20|FH_F118698_32054_0|SrvcGrp|92759|2022|PCT|1.10|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F144628_21146_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130652_51101_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F92677_08003_0|SrvcGrp|24754|2022|PDM|15.75|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F130066_84107_0|SrvcGrp|73063|2022|PDM|700.00|99|0.00|OBSERVATION SERVICES|
20|FH_F150880_90036_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136779_0_0|SrvcGrp|112923|2022|PDM|2222.00|99|0.00|KNEE ARTHROSCOPY PROCEDURES|
20|FH_F34792_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F114848_50533_0|SrvcGrp|91294|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|6.00|99|0.00|IMPLANTABLE PORTS CATHETER CARE (MOD SD/SH)|
20|FH_F36485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% 2007 MEDICARE DME TN  MOD UE|
20|FH_F143249_89801_0|SrvcGrp|48396|2022|PDM|120.00|99|0.00|OT SERVICES|
20|FH_F72830_0_0|SrvcGrp|9817|2022|PDM|2115.00|99|0.00|OBSTETRICAL CARE|
20|FH_F118693_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F71068_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83257_32404_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120906_65542_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139515_0_0|SrvcGrp|106266|2022|PDM|4352.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT|
20|FH_F121533_26241_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F37937_0_0|SrvcGrp|27767|2022|PDM|45.00|99|0.00|SKILLED IV NURSING HOURLY|
20|FH_F138450_0_0|SrvcGrp|79699|2022|PCT|0.93|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F31940_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|ASPG VIII|
20|FH_F87333_0_0|SrvcGrp|73006|2022|PDM|2161.34|99|0.00|AEG 9|
20|FH_F117206_0_0|SrvcGrp|79589|2022|PDM|600.00|99|0.00|UPPER GI|
20|FH_F127579_44321_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F70090_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|TRAUMA CARE|
20|FH_F41932_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|928.59|99|0.00|HAPA WPA-NWPA 2012-13 ASC 707 W/O REV|
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.00|99|0.00|AEG 4 (NO REV)|
20|FH_F66630_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|EATING DISORDERS|
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|556.23|99|0.00|2005 ASPG GROUPER II|
20|FH_F125969_73112_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F93791_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 10 (NO REV)|
20|FH_F135219_68506_0|SrvcGrp|96350|2022|PDM|22295.52|99|0.00|SHOULDER JOINT|
20|FH_F35308_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD TC) - BDSS|
20|FH_F127642_07047_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F110470_98335_0|SrvcGrp|91397|2022|PDM|75.00|99|0.00|AETNA PSYCH PT & FAMILY 45MINS (MOD HO)|
20|FH_F89219_0_0|SrvcGrp|112748|2022|PDM|36011.00|99|0.00|MSDRG 522 ONLY|
20|FH_F143573_01610_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70804_0_0|SrvcGrp|3809|2022|PDM|852.69|99|0.00|HOSPICE CARE|
20|FH_F98021_07012_0|SrvcGrp|73643|2022|PDM|1246.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F119627_27288_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE|
20|FH_F133209_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F120930_0_0|SrvcGrp|26274|2022|PDM|2000.00|99|0.00|CPT 29877|
20|FH_F124369_0_0|SrvcGrp|99172|2022|PDM|17765.00|99|0.00|CPT 28740|
20|FH_F79623_0_0|SrvcGrp|73002|2022|PDM|6387.00|99|0.00|AEG 7|
20|FH_F118672_29036_0|SrvcGrp|114646|2022|PCT|5.04|99|0.00|DIAGNOSTIC RADIOLOGY SERVICES|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|ALL DRUGS/AGENTS/INJ DRUG|
20|FH_F128246_0_0|SrvcGrp|111036|2022|PDM|726.00|99|0.00|REPAIR ENTROPION|
20|FH_F149841_73114_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F38161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|FL VISTA RADIOLOGY MOD 26|
20|FH_F149884_68516_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133008_78382_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97560_23249_0|SrvcGrp|73602|2022|PDM|2866.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F102561_75146_0|SrvcGrp|84720|2022|PCT|0.00|99|0.00|AETNA LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F150839_03833_0|SrvcGrp|23683|2022|PDM|82.19|99|0.00|SKILLED NURSING RN|
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|AEG 1 (NO REV)|
20|FH_F35747_34223_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F128741_92879_0|SrvcGrp|47183|2022|PDM|186.39|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F42395_0_0|SrvcGrp|3029|2022|PDM|244.00|99|0.00|NEWBORN NURSERY|
20|FH_F128029_48154_0|SrvcGrp|82223|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F140295_0_0|SrvcGrp|88024|2022|PDM|7936.00|99|0.00|REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION|
20|FH_F138417_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|DME|
20|FH_F102341_0_0|SrvcGrp|184|2022|PDM|1982.00|99|0.00|MEDICAL INTENSIVE CARE|
20|FH_F126970_45601_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F39545_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78603_0_0|SrvcGrp|21104|2022|PDM|52610.43|99|0.00|MS DRG 220 ONLY|
20|FH_F39273_0_0|SrvcGrp|28919|2022|PDM|34.00|99|0.00|CPT 97750|
20|FH_F90654_0_0|SrvcGrp|11199|2022|PCT|0.70|99|0.00|HYPERBARIC CHAMBER|
20|FH_F148265_06067_0|CSTM-ALL|CSTM-00|2020|PDM|2771.00|99|0.00|AEG 3 (NO REV) ORTHO REVISION, REPAIR, SURGERY|
20|FH_F123282_03222_0|SrvcGrp|43567|2022|PDM|136.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F111222_15701_0|SrvcGrp|472|2022|PDM|507.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F128883_89521_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F137531_62959_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F67984_0_0|SrvcGrp|64201|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F139689_0_0|SrvcGrp|113580|2022|PDM|152.00|99|0.00|DIALYSIS PATIENT TRAINING|
20|FH_F88115_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F92893_75110_0|SrvcGrp|76531|2022|PDM|35.00|99|0.00|HOSPICE IN HOME|
20|FH_F34535_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F138302_15701_0|SrvcGrp|14893|2022|PDM|30.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F96160_32207_0|SrvcGrp|43568|2022|PDM|131.00|99|0.00|SKILLED NURSING - RN|
20|FH_F126550_43085_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F125139_84096_0|SrvcGrp|75442|2022|PDM|722.00|99|0.00|OBSERVATION - REV 762|
20|FH_F87333_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|PDM|563.20|99|0.00|AEG 10 (NO REV)|
20|FH_F132733_0_0|SrvcGrp|3078|2022|PCT|0.96|99|0.00|DRUGS|
20|FH_F121404_32216_0|SrvcGrp|85017|2022|PCT|1.05|99|0.00|DME|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|164.33|99|0.00|DELAWARE VALLEY- ASC 114|
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|3161.00|99|0.00|AEG 9 (NO REV)|
20|FH_F127418_0_0|SrvcGrp|110761|2022|PDM|8039.06|99|0.00|SPINAL OSTEREOTACTIC|
20|FH_F149020_78653_0|SrvcGrp|90854|2022|PDM|900.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F116437_0_0|SrvcGrp|46889|2022|PDM|1757.00|99|0.00|LASER TREATMENT OF RETINA|
20|FH_F134407_63801_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35744_32177_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F136779_0_0|SrvcGrp|112925|2022|PDM|5909.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F38753_0_0|SrvcGrp|17139|2022|PDM|573.00|99|0.00|HOSPICE CARE|
20|FH_F151699_01752_0|SrvcGrp|24754|2022|PDM|15.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F36299_0_0|SrvcGrp|13402|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F40885_0_0|SrvcGrp|26426|2022|PDM|850.00|99|0.00|CPT 95810  MOD TC|
20|FH_F132254_40207_0|SrvcGrp|86779|2022|PDM|125.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F132109_66762_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F98840_31021_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1074.00|99|0.00|AEG 8 (NO REV)|
20|FH_F135010_46342_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F126784_80809_0|SrvcGrp|87131|2022|PDM|1095.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F67101_0_0|SrvcGrp|112082|2022|PCT|1.00|99|0.00|CHILD DEVELOPMENT & REHAB|
20|FH_F122687_0_0|SrvcGrp|34606|2022|PDM|3825.00|99|0.00|CPT 29827|
20|FH_F99960_0_0|SrvcGrp|72990|2022|PDM|502.00|99|0.00|AEG 1|
20|FH_F40834_0_0|SrvcGrp|177|2022|PDM|1629.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F39349_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F37679_0_0|SrvcGrp|22389|2022|PDM|15.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F35476_0_0|SrvcGrp|3077|2022|PCT|0.83|99|0.00|IMPLANTS|
20|FH_F110925_01104_0|SrvcGrp|86133|2022|PDM|1.58|99|0.00|AETNA ANTI INHIBITOR|
20|FH_F151526_28208_0|CSTM-ALL|CSTM-00|2020|PDM|17270.00|99|0.00|AVF USE MAGNETIC/ART/VEN|
20|FH_F38411_0_0|SrvcGrp|29008|2022|PDM|1799.00|99|0.00|ACUTE MEDICAL SERVICES|
20|FH_F117437_0_0|SrvcGrp|104228|2022|PDM|180.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F130017_02302_0|CSTM-ALL|CSTM-00|2020|PDM|3836.10|99|0.00|AEG 9 (NO REV)|
20|FH_F145584_15010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109242_18466_0|SrvcGrp|102981|2022|PDM|131.00|99|0.00|PSYTX WPT W E/M 45 MIN|
20|FH_F96160_32207_0|SrvcGrp|24752|2022|PDM|25.89|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F120207_0_0|SrvcGrp|11663|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F110305_70403_0|SrvcGrp|57968|2022|PDM|827.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F134326_14094_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F112631_0_0|SrvcGrp|72990|2022|PDM|530.00|99|0.00|AEG 1|
20|FH_F111704_30044_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F71647_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F90334_23323_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F93292_62234_0|SrvcGrp|29347|2022|PDM|27.00|99|0.00|HOME HEALTH AIDE|
20|FH_F140612_60070_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40302_0_0|SrvcGrp|38|2022|PDM|3000.00|99|0.00|NORMAL DELIVERY|
20|FH_F124183_01109_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F124222_92625_0|SrvcGrp|78180|2022|PDM|1200.00|99|0.00|AETNA RESIDENTIAL TREATMENT|
20|FH_F150959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 5  (NO REV)|
20|FH_F147466_18355_0|SrvcGrp|46903|2022|PDM|850.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F42379_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|OP SVCS|
20|FH_F42837_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD KM|
20|FH_F148544_60439_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1020.00|99|0.00|GA RETINA SURG CTR ASC 24|
20|FH_F116698_07470_0|SrvcGrp|24761|2022|PDM|68.25|99|0.00|HOME INFUSION THERAPY|
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|1126.00|99|0.00|AEG 5  (NO REV)|
20|FH_F109180_18015_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F125011_74467_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F102500_0_0|SrvcGrp|84285|2022|PDM|2348.00|99|0.00|REVISE CORNEA WITH IMPLANT|
20|FH_F109538_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F75307_0_0|SrvcGrp|57650|2022|PDM|77.00|99|0.00|OCCUPATIONAL THERAPY SVCS MOD GO|
20|FH_F126153_44663_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129255_34952_0|CSTM-ALL|CSTM-00|2020|PDM|796.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F117902_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|500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F39393_0_0|SrvcGrp|17067|2022|PDM|600.00|99|0.00|ASPG II|
20|FH_F31714_0_0|SrvcGrp|88|2022|PDM|5500.00|99|0.00|OP LITHOTRIPSY|
20|FH_F111912_30720_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F85353_16407_0|SrvcGrp|63868|2022|PDM|331.22|99|0.00|HAPA WPA-NWPA 2012-13 ASC 229|
20|FH_F139512_77550_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F134595_06226_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148927_0_0|SrvcGrp|115557|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F127656_06068_0|SrvcGrp|29346|2022|PDM|52.43|99|0.00|SKILLED NURSING- LPN|
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|4355.19|99|0.00|AEG 7 (NO REV)|
20|FH_F120456_67117_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F93363_63123_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F142730_20646_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140652_92626_0|SrvcGrp|90854|2022|PDM|1200.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F148739_47129_0|SrvcGrp|75419|2022|PDM|1250.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F92636_90230_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129504_02871_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F90735_94070_0|SrvcGrp|90294|2022|PDM|32.50|99|0.00|ASPA GENE|
20|FH_F36401_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.90|99|0.00|OP SVCS|
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|39.86|99|0.00|AETNA SLEEP STUDIES (MOD TC)|
20|FH_F124653_64062_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F127995_84010_0|SrvcGrp|13929|2022|PDM|10.00|99|0.00|GROWTH HORMONE|
20|FH_F114666_30342_0|SrvcGrp|33986|2022|PDM|900.00|99|0.00|CPT 26055|
20|FH_F43249_0_0|SrvcGrp|15150|2022|PCT|0.54|99|0.00|DRUGS|
20|FH_F136786_25302_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F39543_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F128130_10027_0|SrvcGrp|78527|2022|PCT|6.84|99|0.00|RADIOLOGY|
20|FH_F77663_0_0|SrvcGrp|74859|2022|PDM|540.00|99|0.00|OBSERVATION|
20|FH_F92676_15063_0|SrvcGrp|79090|2022|PDM|187.14|99|0.00|MON VALLEY ASC 146|
20|FH_F133472_27607_0|SrvcGrp|74694|2022|PDM|1349.00|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F73705_0_0|SrvcGrp|56313|2022|PDM|125.00|99|0.00|HYPERBARIC THERAPY|
20|FH_F149840_80002_0|SrvcGrp|53144|2022|PDM|135.00|99|0.00|SPEECH THERAPY|
20|FH_F100680_43130_0|SrvcGrp|73605|2022|PDM|2397.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F112665_0_0|SrvcGrp|88491|2022|PDM|7215.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F109577_0_0|SrvcGrp|49743|2022|PDM|123.00|99|0.00|DIABETIC MANAGEMENT|
20|FH_F112004_15401_0|SrvcGrp|73701|2022|PCT|0.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F143650_0_0|SrvcGrp|72990|2022|PDM|700.00|99|0.00|AEG 1|
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2246.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 9|
20|FH_F87155_04105_0|SrvcGrp|43567|2022|PDM|94.56|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F150065_16001_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118728_33409_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F88956_0_0|SrvcGrp|21108|2022|PDM|11072.00|99|0.00|MS DRG 243 ONLY|
20|FH_F150906_0_0|SrvcGrp|115867|2022|PDM|161.00|99|0.00|HOSPICE  HOME CARE|
20|FH_F89932_10940_0|SrvcGrp|12491|2022|PCT|0.45|99|0.00|PACEMAKER|
20|FH_F33019_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139487_60076_0|SrvcGrp|29347|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F150839_03833_0|SrvcGrp|104230|2022|PDM|212.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F97260_06111_0|SrvcGrp|73656|2022|PDM|944.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F146765_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F112045_90301_0|SrvcGrp|80679|2022|PCT|2.26|99|0.00|AETNA RADIOLOGY|
20|FH_F101844_0_0|SrvcGrp|89842|2022|PDM|8943.00|99|0.00|LUMBAR|
20|FH_F148519_83201_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F143347_16001_0|CSTM-ALL|CSTM-00|2020|PDM|7326.00|99|0.00|AEG 9 (NO REV)|
20|FH_F143494_34474_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120225_29644_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37353_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F40600_0_0|SrvcGrp|38|2022|PDM|4574.00|99|0.00|NORMAL DELIVERY|
20|FH_F98621_41042_0|SrvcGrp|73461|2022|PDM|11170.00|99|0.00|AETNA NICU IV|
20|FH_F143988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F90362_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD KN|
20|FH_F148892_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F117378_16148_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F63141_0_0|SrvcGrp|38223|2022|PDM|1300.00|99|0.00|ADULT DETOX|
20|FH_F127567_44070_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F39917_0_0|SrvcGrp|13630|2022|PDM|120.00|99|0.00|CPT 99204|
20|FH_F110066_36608_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F149862_76051_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F36381_0_0|SrvcGrp|3259|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|156.82|99|0.00|HAPA WPA-NWPA 2012-13 ASC 140 W/O REV|
20|FH_F148521_0_0|SrvcGrp|47544|2022|PDM|4246.19|99|0.00|PERCUTANEOUS IMPLANT OF NEUROSTIMULATOR ELECTRODES|
20|FH_F116023_10027_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F132131_33060_0|SrvcGrp|73842|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F46832_0_0|SrvcGrp|17013|2022|PDM|72.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134155_07016_0|SrvcGrp|90574|2022|PDM|267.00|99|0.00|INTENSIVE OP CD (<=18 YRS) (HCFA)|
20|FH_F138584_30912_0|SrvcGrp|113409|2022|PDM|700.00|99|0.00|REPAIR DENTAL RIDGE FRACTURE|
20|FH_F41481_0_0|SrvcGrp|17073|2022|PDM|788.00|99|0.00|ASPG V|
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)|
20|FH_F150982_0_0|SrvcGrp|49205|2022|PDM|2392.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F148519_83201_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F37081_0_0|CSTM-ALL|CSTM-00|2020|PDM|51493.00|99|0.00|MSDRG 231-232 CORONARY BYPASS|
20|FH_F147180_19050_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147142_33870_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F98624_15701_0|SrvcGrp|73601|2022|PDM|8338.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F110621_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F32123_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|OP SVCS|
20|FH_F128869_45458_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116700_11787_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F126585_45039_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F139580_0_0|SrvcGrp|108043|2022|PDM|182.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F38341_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F145800_22003_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F40043_0_0|SrvcGrp|33268|2022|PCT|0.76|99|0.00|GA ASPG VIII|
20|FH_F131220_08062_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|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_F137087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148355_37601_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F149780_00783_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F109264_33431_0|SrvcGrp|93919|2022|PDM|665.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F100782_0_0|SrvcGrp|108215|2022|PDM|350.00|99|0.00|PERQ ACCESS|
20|FH_F129273_57783_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109400_80026_0|SrvcGrp|43569|2022|PDM|50.64|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F48092_0_0|SrvcGrp|33166|2022|PDM|1000.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F127090_45601_0|SrvcGrp|26868|2022|PDM|49.98|99|0.00|DIURETIC IV THERAPY|
20|FH_F146795_44122_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F134126_11554_0|SrvcGrp|13262|2022|PDM|5.16|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F140887_43338_0|SrvcGrp|107861|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F128270_0_0|SrvcGrp|76501|2022|PDM|380.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F87201_0_0|SrvcGrp|42972|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F39209_0_0|SrvcGrp|29459|2022|PDM|600.00|99|0.00|MRI/CT/PET SCAN|
20|FH_F93252_0_0|SrvcGrp|93025|2022|PDM|4000.00|99|0.00|OSTEOCHONDRAL DEFECTS SURGERIES|
20|FH_F121426_0_0|CSTM-ALL|CSTM-00|2020|PDM|1828.00|99|0.00|ASPG VII|
20|FH_F62624_0_0|SrvcGrp|31539|2022|PCT|1.07|99|0.00|IMPLANTS|
20|FH_F124636_85008_0|SrvcGrp|104079|2022|PCT|1.25|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F136914_64081_0|SrvcGrp|106317|2022|PDM|609.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F113713_17013_0|SrvcGrp|73842|2022|PDM|120.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119417_78212_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F103060_0_0|SrvcGrp|73004|2022|PDM|3017.00|99|0.00|AEG 8|
20|FH_F120796_33548_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F32928_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116552_70001_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F120866_51652_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F33322_0_0|SrvcGrp|8|2022|PCT|0.90|99|0.00|BURN INTENSIVE CARE|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|ACUTE PSYCH|
20|FH_F79704_0_0|SrvcGrp|76531|2022|PDM|32.61|99|0.00|HOSPICE IN HOME|
20|FH_F78603_0_0|SrvcGrp|20075|2022|PDM|19698.59|99|0.00|MS DRG 286 ONLY|
20|FH_F129011_15857_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148549_60523_0|SrvcGrp|48394|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F74602_0_0|SrvcGrp|45883|2022|PDM|120.00|99|0.00|OT|
20|FH_F133877_84117_0|SrvcGrp|106662|2022|PDM|26.00|99|0.00|CONTINUOUS HOSPICE CARE (HCFA)|
20|FH_F79863_0_0|SrvcGrp|77228|2022|PDM|90.00|99|0.00|AETNA HOME INFUSION S9355|
20|FH_F132922_91302_0|SrvcGrp|89417|2022|PDM|500.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F150281_76309_0|SrvcGrp|46903|2022|PDM|613.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F35221_0_0|SrvcGrp|38|2022|PDM|2600.00|99|0.00|NORMAL DELIVERY|
20|FH_F144248_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F49459_0_0|SrvcGrp|31702|2022|PDM|180.00|99|0.00|INTENSIVE OUTPATIENT|
20|FH_F124161_95932_0|SrvcGrp|72994|2022|PDM|2882.00|99|0.00|AEG 3|
20|FH_F49598_0_0|CSTM-ALL|CSTM-00|2020|PDM|3183.00|99|0.00|CV SURGERY (MS DRG)|
20|FH_F144248_0_0|SrvcGrp|114443|2022|PDM|10328.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F118384_0_0|SrvcGrp|107774|2022|PCT|1.00|99|0.00|INJECTABLES (J CODES)|
20|FH_F144228_0_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F133207_0_0|SrvcGrp|83646|2022|PDM|3529.00|99|0.00|CPT 31276|
20|FH_F51124_0_0|CSTM-ALL|CSTM-00|2020|PDM|146.00|99|0.00|HI TECH NURSING|
20|FH_F111732_33771_0|SrvcGrp|79238|2022|PDM|2300.00|99|0.00|TRANSFER|
20|FH_F87775_15106_0|SrvcGrp|10577|2022|PDM|50.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F72431_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F122470_78229_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120811_53525_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F135351_0_0|SrvcGrp|87677|2022|PDM|1199.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F136475_89119_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F126567_0_0|SrvcGrp|107745|2022|PDM|1200.00|99|0.00|DIALYSIS ULTRAFILTRATION|
20|FH_F78402_15905_0|SrvcGrp|75379|2022|PDM|2966.00|99|0.00|NICU MSDRG 790-793|
20|FH_F140407_63841_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F129504_02871_0|SrvcGrp|65720|2022|PDM|163.00|99|0.00|RESPITE CARE|
20|FH_F109652_0_0|SrvcGrp|50649|2022|PDM|19787.00|99|0.00|MS DRG 248 - 249 ONLY|
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|542.00|99|0.00|AEG 2 (NO REV)|
20|FH_F114916_30309_0|SrvcGrp|33982|2022|PDM|1760.00|99|0.00|CPT 28296|
20|FH_F142312_62301_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F135491_0_0|SrvcGrp|84279|2022|PDM|1980.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F124624_31792_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114666_30342_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F43833_0_0|SrvcGrp|537|2022|PCT|0.60|99|0.00|OBSERVATION SERVICES|
20|FH_F117085_40207_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F134691_33445_0|SrvcGrp|75419|2022|PDM|1575.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F147416_19095_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126679_62401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.13|99|0.00|5780852_USTN_XR_MOD26|
20|FH_F45977_0_0|SrvcGrp|40412|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD RR KC|
20|FH_F46357_0_0|CSTM-ALL|CSTM-00|2020|PDM|1269.70|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F117132_0_0|SrvcGrp|107321|2022|PDM|2000.00|99|0.00|FISTULIZATION AND TRANSLUMINAL DILATION|
20|FH_F98620_43920_0|SrvcGrp|73659|2022|PDM|7720.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F149840_80002_0|SrvcGrp|27968|2022|PDM|55.00|99|0.00|SKILLED NURSING LPN|
20|FH_F126030_29835_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128421_27016_0|SrvcGrp|79099|2022|PDM|900.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F148680_33311_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111826_0_0|SrvcGrp|72994|2022|PDM|990.00|99|0.00|AEG 3|
20|FH_F139689_0_0|SrvcGrp|108042|2022|PDM|541.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F130914_51103_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F149082_33406_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F85353_16407_0|SrvcGrp|63790|2022|PDM|1150.46|99|0.00|HAPA WPA-NWPA 2012-13 ASC 6|
20|FH_F100782_0_0|SrvcGrp|105082|2022|PDM|489.62|99|0.00|WINDBER MEDICAL CNTR ASC 127|
20|FH_F127529_43230_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F51124_0_0|SrvcGrp|22954|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F83031_0_0|SrvcGrp|44713|2022|PDM|105.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F40591_0_0|SrvcGrp|12359|2022|PDM|2944.00|99|0.00|TELEMETRY SVCS|
20|FH_F144109_63376_0|SrvcGrp|13422|2022|PCT|1.77|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F130682_0_0|SrvcGrp|106265|2022|PDM|9207.00|99|0.00|NSL/SINS NDSC TOTAL|
20|FH_F87474_0_0|SrvcGrp|10649|2022|PDM|8.00|99|0.00|HOME INFUSION|
20|FH_F62995_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F145742_64862_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F84132_48026_0|SrvcGrp|72998|2022|PDM|984.00|99|0.00|AEG 5|
20|FH_F135663_24401_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F77943_0_0|SrvcGrp|20077|2022|PDM|75720.24|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR|
20|FH_F138292_60914_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F113764_0_0|SrvcGrp|105472|2022|PCT|1.00|99|0.00|HHIVB|
20|FH_F126354_91321_0|SrvcGrp|87317|2022|PDM|860.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F133880_06488_0|SrvcGrp|472|2022|PDM|441.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F143579_43160_0|SrvcGrp|97968|2022|PDM|1250.00|99|0.00|CT SCAN|
20|FH_F143742_60410_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F114407_19002_0|SrvcGrp|88620|2022|PDM|84.00|99|0.00|SKILLED NURSING RN|
20|FH_F130166_65065_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134249_05060_0|SrvcGrp|55677|2022|PDM|2492.00|99|0.00|VAGINAL DELIVERY ONLY|
20|FH_F110509_71351_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F71342_0_0|SrvcGrp|15473|2022|PDM|1801.00|99|0.00|CPT CODE 42820|
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG V|
20|FH_F120490_64133_0|SrvcGrp|86838|2022|PDM|10.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F80711_0_0|SrvcGrp|42824|2022|PDM|60.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F132988_0_0|SrvcGrp|92821|2022|PDM|4493.01|99|0.00|HIP ARTHROSCOPY W/ LABRAL REPAIR|
20|FH_F124115_77546_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42837_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD UE|
20|FH_F119417_78212_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F148459_15241_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133021_00910_0|SrvcGrp|112332|2022|PDM|4000.00|99|0.00|CYSTOURETHROSCOPY|
20|FH_F101568_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86655_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.05|99|0.00|AEG 4 (NO REV)|
20|FH_F150024_08079_0|SrvcGrp|67065|2022|PDM|7300.00|99|0.00|CERVICAL SURGERY|
20|FH_F144109_63376_0|SrvcGrp|13681|2022|PCT|1.74|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F133095_30024_0|SrvcGrp|87077|2022|PDM|169.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F117335_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F90811_0_0|CSTM-ALL|CSTM-00|2020|PDM|643.50|99|0.00|AEG 2 (NO REV)|
20|FH_F145964_10993_0|SrvcGrp|104330|2022|PDM|1837.00|99|0.00|AETNA ACUTE REHAB II|
20|FH_F133490_90650_0|SrvcGrp|109057|2022|PCT|0.00|99|0.00|CARDIAC STUDIES|
20|FH_F147422_84121_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F120332_0_0|SrvcGrp|63297|2022|PDM|112.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F122260_98034_0|SrvcGrp|104464|2022|PDM|1100.00|99|0.00|VAGINAL DELIVERY (W/ OR W/O EPISIOTOMY)|
20|FH_F138018_17313_0|SrvcGrp|10579|2022|PDM|103.00|99|0.00|HYDRATION THERAPY - 2 LITERS|
20|FH_F151699_01752_0|SrvcGrp|86833|2022|PDM|15.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F137798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138302_15701_0|SrvcGrp|22592|2022|PDM|22.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F149603_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F145629_45243_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F54532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F134488_14086_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F84712_0_0|SrvcGrp|45582|2022|PDM|33.00|99|0.00|CPT 85610|
20|FH_F133126_48059_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140867_56345_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F117126_12801_0|CSTM-ALL|CSTM-00|2020|PDM|3150.00|99|0.00|AEG 2 (NO REV)|
20|FH_F137832_89118_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F137938_29036_0|SrvcGrp|75226|2022|PCT|0.00|99|0.00|AETNA URGENT CARE|
20|FH_F80711_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INFUSION SERVICE|
20|FH_F113794_0_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F138929_0_0|SrvcGrp|67068|2022|PDM|13750.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F132627_0_0|SrvcGrp|14949|2022|PDM|291.00|99|0.00|HOME INFUSION|
20|FH_F136569_16506_0|SrvcGrp|67944|2022|PDM|302.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F114985_32073_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F147466_18355_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PDM|516.00|99|0.00|AEG 1 (NO REV)|
20|FH_F133019_23236_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F34641_0_0|SrvcGrp|40222|2022|PDM|350.00|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_F44072_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|OP SVCS|
20|FH_F151058_18064_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151155_26508_0|SrvcGrp|113339|2022|PDM|140.00|99|0.00|PERIODIC ASSESSMENT (HCFA)|
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|823.00|99|0.00|ASPG II|
20|FH_F147306_70115_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F136779_0_0|SrvcGrp|104022|2022|PDM|3713.00|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE|
20|FH_F41155_0_0|SrvcGrp|38|2022|PDM|2081.00|99|0.00|NORMAL DELIVERY|
20|FH_F151010_85007_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136806_0_0|SrvcGrp|34606|2022|PDM|3463.00|99|0.00|CPT 29827|
20|FH_F101844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F46893_0_0|SrvcGrp|9513|2022|PCT|0.70|99|0.00|EMERGENCY ROOM SERVICES|
20|FH_F132417_38119_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F43156_0_0|SrvcGrp|16|2022|PDM|600.00|99|0.00|ACUTE REHABILITATION|
20|FH_F59732_0_0|SrvcGrp|26869|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F150980_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F128883_89521_0|SrvcGrp|88620|2022|PDM|115.00|99|0.00|SKILLED NURSING RN|
20|FH_F148500_50129_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F98922_40351_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120322_60016_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F37562_0_0|SrvcGrp|25938|2022|PDM|117.00|99|0.00|SOCIAL WORKER (MEDICAL)|
20|FH_F49776_0_0|SrvcGrp|42827|2022|PDM|102.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F127432_18015_0|SrvcGrp|705|2022|PCT|0.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F121980_66104_0|SrvcGrp|108484|2022|PDM|450.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F146859_0_0|SrvcGrp|114841|2022|PDM|1080.00|99|0.00|HANDS/FINGERS PROCEDURES|
20|FH_F128197_84123_0|SrvcGrp|94780|2022|PDM|112.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
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_F151043_71901_0|SrvcGrp|93436|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F35458_0_0|SrvcGrp|360|2022|PDM|550.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F37493_0_0|CSTM-ALL|CSTM-00|2020|PDM|4617.00|99|0.00|CV SURGERY|
20|FH_F119376_0_0|SrvcGrp|14162|2022|PDM|1500.00|99|0.00|VNUS CLOSURE|
20|FH_F84061_0_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132424_75062_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120921_75835_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F46158_0_0|SrvcGrp|17071|2022|PCT|0.65|99|0.00|ASPG IV|
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|1011.42|99|0.00|ASPG VII|
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PDM|954.50|99|0.00|AEG 5  (NO REV)|
20|FH_F47656_0_0|SrvcGrp|24703|2022|PDM|740.00|99|0.00|NEWBORN NURSERY|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD AV) - PMRS|
20|FH_F41200_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F127205_44125_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F122687_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F122687_0_0|SrvcGrp|36591|2022|PDM|13113.00|99|0.00|CPT 63685|
20|FH_F105680_0_0|SrvcGrp|75493|2022|PDM|1800.00|99|0.00|AEG 8|
20|FH_F60292_0_0|SrvcGrp|474|2022|PDM|300.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|CHEMICAL DEPENDENCY - ADOLESCENT|
20|FH_F85353_16407_0|CSTM-ALL|CSTM-00|2020|PCT|1.45|99|0.00|COVENTRY NISC 2018|
20|FH_F142376_0_0|SrvcGrp|112511|2022|PDM|2805.00|99|0.00|SP BONE ALGRFT STRUCT ADD-ON|
20|FH_F88640_32935_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|OP SVCS|
20|FH_F81483_0_0|SrvcGrp|40310|2022|PDM|2197.00|99|0.00|CVTY ENHANCED ASPG 8|
20|FH_F110509_71351_0|SrvcGrp|100765|2022|PCT|1.25|99|0.00|PT/OT/ST|
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|3069.00|99|0.00|AEG 7 (NO REV)|
20|FH_F110420_60649_0|SrvcGrp|82369|2022|PCT|1.05|99|0.00|AETNA LABORATORY|
20|FH_F105143_26062_0|SrvcGrp|103719|2022|PCT|2.50|99|0.00|RADIOLOGY SERVICES|
20|FH_F146773_78414_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120795_27514_0|SrvcGrp|110362|2022|PCT|0.93|99|0.00|BURN/TRAUMA SERVICES & ECMO|
20|FH_F61512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120441_33065_0|SrvcGrp|104079|2022|PCT|1.15|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F142207_62237_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F142547_70002_0|SrvcGrp|86838|2022|PDM|10.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F115208_0_0|SrvcGrp|104042|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F72162_0_0|SrvcGrp|61956|2022|PDM|135.00|99|0.00|DIABETIC MANAGEMENT|
20|FH_F146914_75032_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F48752_0_0|SrvcGrp|42869|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F135747_76208_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F112371_19047_0|SrvcGrp|81779|2022|PCT|1.00|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F115206_80923_0|SrvcGrp|73841|2022|PDM|463.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F98161_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|118.50|99|0.00|ASPG 312|
20|FH_F119128_93619_0|SrvcGrp|73842|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F146211_68144_0|SrvcGrp|113083|2022|PDM|245.00|99|0.00|CT SCAN|
20|FH_F51129_0_0|SrvcGrp|30064|2022|PDM|850.00|99|0.00|ELECTROCONVULSIVE THERAPY (ECT)|
20|FH_F106540_26330_0|SrvcGrp|9438|2022|PCT|0.50|99|0.00|TRAUMA CARE|
20|FH_F145907_03867_0|SrvcGrp|472|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F97543_33542_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F128421_27016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148644_06890_0|SrvcGrp|28551|2022|PDM|5572.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F151155_26508_0|SrvcGrp|113349|2022|PDM|512.00|99|0.00|OFF BASE OPIOID TX 60 MIN (HCFA)|
20|FH_F132113_85224_0|SrvcGrp|16|2022|PDM|1093.00|99|0.00|ACUTE REHABILITATION|
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134797_0_0|SrvcGrp|112681|2022|PDM|1265.00|99|0.00|HUMERUS AND ELBOW REPAIR|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|6.00|99|0.00|HICKMAN/BROVIAC TRIPLE LUMEN CATH CARE (MOD SD/SH)|
20|FH_F133677_15601_0|SrvcGrp|87799|2022|PDM|118.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F134603_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|3121.00|99|0.00|AEG 5  (NO REV)|
20|FH_F100540_0_0|SrvcGrp|73008|2022|PDM|909.00|99|0.00|AEG 10|
20|FH_F32141_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F35599_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132579_0_0|SrvcGrp|92501|2022|PDM|450.00|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F38380_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|COMPREHENSIVE DAY TREATMENT|
20|FH_F94403_0_0|CSTM-ALL|CSTM-00|2020|PDM|1410.00|99|0.00|AEG 8 (NO REV)|
20|FH_F102302_0_0|SrvcGrp|97239|2022|PDM|29900.00|99|0.00|DISKECTOMY CERVICAL SINGLE|
20|FH_F149780_00783_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92993_0_0|SrvcGrp|92838|2022|PDM|117.00|99|0.00|AETNA SLEEP STUDY (MOD TC)|
20|FH_F72765_0_0|SrvcGrp|32703|2022|PDM|1900.00|99|0.00|ICU|
20|FH_F148260_0_0|SrvcGrp|101519|2022|PDM|13643.00|99|0.00|T1H UTERUS (<250G)|
20|FH_F128272_60640_0|SrvcGrp|22592|2022|PDM|50.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F120352_52556_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F130468_0_0|SrvcGrp|99163|2022|PDM|5835.00|99|0.00|CPT 27703|
20|FH_F146471_63110_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120719_27540_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F149343_44134_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134593_60007_0|SrvcGrp|112586|2022|PCT|0.85|99|0.00|CERLIPONASE ALFA INJ|
20|FH_F100782_0_0|SrvcGrp|105175|2022|PDM|1517.58|99|0.00|WINDBER MEDICAL CNTR ASC 1301|
20|FH_F120683_80238_0|SrvcGrp|29346|2022|PDM|45.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F37850_0_0|SrvcGrp|360|2022|PDM|1190.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F39633_0_0|SrvcGrp|17083|2022|PDM|1169.00|99|0.00|ASPG X|
20|FH_F54552_0_0|SrvcGrp|11258|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F138936_01040_0|CSTM-ALL|CSTM-00|2020|PDM|2081.00|99|0.00|AEG 3 (NO REV)|
20|FH_F138936_01040_0|SrvcGrp|75507|2022|PDM|139.00|99|0.00|CHEMOTHERAPY|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1610.38|99|0.00|HAPA WPA-NWPA 2012-13 ASC 4 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 216 W/O REV|
20|FH_F91933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F83621_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|AEG 10 (NO REV)|
20|FH_F151379_21045_0|SrvcGrp|73008|2022|PDM|437.00|99|0.00|AEG 10|
20|FH_F151401_36607_0|SrvcGrp|73701|2022|PCT|0.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F122038_34606_0|SrvcGrp|73841|2022|PDM|415.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F122087_62684_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F123191_15012_0|SrvcGrp|48385|2022|PDM|91.00|99|0.00|SPEECH THERAPY|
20|FH_F91764_93710_0|SrvcGrp|3378|2022|PDM|1328.00|99|0.00|OBSERVATION SVCS|
20|FH_F136016_67209_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136019_63044_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136067_67037_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136070_46410_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136188_04005_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116461_77536_0|SrvcGrp|104076|2022|PCT|1.10|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F127399_0_0|SrvcGrp|73002|2022|PDM|3329.00|99|0.00|AEG 7|
20|FH_F121466_84057_0|SrvcGrp|75419|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F111363_33169_0|SrvcGrp|105465|2022|PDM|128.00|99|0.00|AETNA THERAPIES|
20|FH_F111383_62233_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F131000_0_0|SrvcGrp|27402|2022|PDM|3795.00|99|0.00|LASER PROCEDURES|
20|FH_F131000_0_0|SrvcGrp|82108|2022|PDM|3343.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F132328_0_0|SrvcGrp|78283|2022|PDM|2819.00|99|0.00|CPT 49505|
20|FH_F102126_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112092_46845_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F87534_19464_0|SrvcGrp|81950|2022|PCT|1.00|99|0.00|AETNA LABORATORY|
20|FH_F125054_16365_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F96280_06340_0|SrvcGrp|73841|2022|PDM|430.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F141035_0_0|SrvcGrp|92013|2022|PDM|7008.00|99|0.00|REPAIR OF COLLATERAL LIGAMENT|
20|FH_F98626_29118_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F111522_81067_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F126819_43701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87362_15746_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133021_00910_0|SrvcGrp|112354|2022|PDM|4000.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F52293_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F150905_01608_0|SrvcGrp|115860|2022|PDM|21.82|99|0.00|THERAPEUTIC BEHAV SERV (MOD HN) (0-21 YRS)|
20|FH_F126663_91423_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F146124_06112_0|SrvcGrp|72984|2022|PCT|0.74|99|0.00|CHEMOTHERAPY|
20|FH_F111986_0_0|SrvcGrp|41325|2022|PDM|2472.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F117206_0_0|SrvcGrp|11673|2022|PDM|2884.00|99|0.00|CPT 29888|
20|FH_F46857_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|2601.00|99|0.00|AEG 6 (NO REV)|
20|FH_F67887_0_0|SrvcGrp|12157|2022|PDM|114.00|99|0.00|RN VISIT|
20|FH_F54592_0_0|SrvcGrp|10527|2022|PDM|115.00|99|0.00|HOSPICE SVCS|
20|FH_F107360_0_0|SrvcGrp|30089|2022|PDM|467.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F38037_0_0|SrvcGrp|8962|2022|PDM|88.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F132810_0_0|SrvcGrp|86122|2022|PCT|1.19|99|0.00|AETNA GAMMAGARD LIQUID INJ|
20|FH_F136347_30328_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F142691_30328_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138627_82901_0|SrvcGrp|41457|2022|PDM|1.82|99|0.00|ENTERAL FORMULA - PEDIATRICS (HYDROLYZED)|
20|FH_F80062_27612_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F80284_16354_0|SrvcGrp|64098|2022|PDM|1656.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 9|
20|FH_F148739_47129_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F39352_0_0|SrvcGrp|30441|2022|PCT|0.85|99|0.00|HOME HEALTH CARE / HOSPICE|
20|FH_F109652_0_0|SrvcGrp|78805|2022|PDM|23955.00|99|0.00|MUSCULOSKELET SYSTEM MSDRG ONLY|
20|FH_F117623_0_0|CSTM-ALL|CSTM-00|2020|PDM|27.00|99|0.00|BEHAVIOR TREATMENT (HCFA)|
20|FH_F40397_0_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F94786_07974_0|SrvcGrp|86842|2022|PDM|31.50|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F123620_0_0|SrvcGrp|13422|2022|PDM|271.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F129529_45229_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116393_07002_0|SrvcGrp|111263|2022|PDM|76.49|99|0.00|X-RAY EXAM OF LOWER SPINE|
20|FH_F122434_40207_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F84712_0_0|SrvcGrp|82762|2022|PDM|19.00|99|0.00|URINALYSIS AUTO W/ SCOPE|
20|FH_F133658_60053_0|SrvcGrp|88620|2022|PDM|125.00|99|0.00|SKILLED NURSING RN|
20|FH_F117552_0_0|SrvcGrp|103643|2022|PDM|6000.00|99|0.00|AETNA FEM/POPL REVASE W/ STENT|
20|FH_F80205_33161_0|SrvcGrp|76501|2022|PDM|278.25|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F109883_35007_0|SrvcGrp|73841|2022|PDM|542.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F137980_03101_0|SrvcGrp|3178|2022|PDM|655.00|99|0.00|ACUTE PSYCH|
20|FH_F124180_0_0|SrvcGrp|68284|2022|PDM|3500.00|99|0.00|CPT 67113|
20|FH_F124246_71655_0|SrvcGrp|46903|2022|PDM|320.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F66388_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F38808_0_0|SrvcGrp|17081|2022|PDM|1473.00|99|0.00|ASPG IX|
20|FH_F102062_35447_0|SrvcGrp|88620|2022|PDM|125.00|99|0.00|SKILLED NURSING RN|
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117559_08619_0|SrvcGrp|105357|2022|PDM|617.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
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_F144851_60123_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F44660_0_0|SrvcGrp|9774|2022|PDM|2300.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F145818_77573_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151518_60506_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117087_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F41814_0_0|SrvcGrp|997|2022|PCT|0.45|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F46196_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F37751_0_0|SrvcGrp|473|2022|PDM|946.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F109842_28337_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139679_75050_0|SrvcGrp|86723|2022|PDM|473.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F47902_0_0|CSTM-ALL|CSTM-00|2020|PDM|350.00|99|0.00|CT|
20|FH_F90817_0_0|SrvcGrp|26274|2022|PDM|1574.00|99|0.00|CPT 29877|
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|675.00|99|0.00|AEG 3 (NO REV)|
20|FH_F150982_0_0|SrvcGrp|105632|2022|PDM|1976.00|99|0.00|AMPUTATION OF TOE|
20|FH_F43113_0_0|SrvcGrp|17766|2022|PDM|77.00|99|0.00|HOME HEALTH - PT/OT/ST|
20|FH_F147216_48307_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116806_0_0|SrvcGrp|107114|2022|PDM|887.26|99|0.00|PARTIAL EXCISION OF LIP|
20|FH_F138478_0_0|SrvcGrp|113285|2022|PDM|2066.18|99|0.00|HEMODIALYSIS|
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120191_91360_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F51276_0_0|SrvcGrp|10580|2022|PDM|55.00|99|0.00|HYDRATION THERAPY - 3 LITERS|
20|FH_F40649_0_0|SrvcGrp|13551|2022|PDM|535.00|99|0.00|NEWBORN NURSERY|
20|FH_F119760_0_0|SrvcGrp|97703|2022|PDM|105.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F89475_71202_0|SrvcGrp|72984|2022|PCT|2.15|99|0.00|CHEMOTHERAPY|
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|4994.00|99|0.00|AEG 7 (NO REV)|
20|FH_F137067_0_0|SrvcGrp|92411|2022|PDM|5250.00|99|0.00|RELIEVE SPINAL CORD PRESSURE|
20|FH_F41133_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F118373_21205_0|SrvcGrp|12030|2022|PDM|2940.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F116108_0_0|SrvcGrp|76531|2022|PDM|148.79|99|0.00|HOSPICE IN HOME|
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_F121564_35080_0|SrvcGrp|108484|2022|PDM|1365.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F122687_0_0|SrvcGrp|84307|2022|PDM|3825.00|99|0.00|TENDON REPAIR|
20|FH_F123512_64089_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F72928_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|OP SVCS|
20|FH_F98040_89406_0|SrvcGrp|73656|2022|PDM|586.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F151423_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114389_50131_0|SrvcGrp|105624|2022|PDM|17.73|99|0.00|ENTERAL FEEDING SUPPLY KIT (MOD NU)|
20|FH_F64441_0_0|SrvcGrp|17140|2022|PDM|155.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F77234_0_0|SrvcGrp|17081|2022|PDM|3876.00|99|0.00|ASPG IX|
20|FH_F42433_0_0|SrvcGrp|473|2022|PDM|295.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F148554_85016_0|SrvcGrp|115454|2022|PDM|1301.00|99|0.00|REMOVE PACEMAKER SYSTEM|
20|FH_F110971_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F133477_90247_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F55375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2011 TN DME (MOD RR)|
20|FH_F120837_33309_0|SrvcGrp|74694|2022|PDM|623.00|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F142807_67114_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133493_90255_0|CSTM-ALL|CSTM-00|2020|PDM|3462.00|99|0.00|AEG 5  (NO REV)|
20|FH_F70545_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F139166_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101840_76054_0|SrvcGrp|79786|2022|PCT|1.50|99|0.00|SLEEP STUDIES|
20|FH_F80855_0_0|SrvcGrp|44066|2022|PDM|1530.00|99|0.00|CPT 57288|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F123012_27703_0|SrvcGrp|104079|2022|PCT|1.15|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F141657_85715_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F142078_73110_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40799_0_0|SrvcGrp|3499|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F150953_74953_0|SrvcGrp|10364|2022|PDM|672.00|99|0.00|CPT CODE 99284|
20|FH_F127418_0_0|SrvcGrp|93730|2022|PDM|4195.19|99|0.00|INJ PERIPHERAL NERVE|
20|FH_F132254_40207_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F119652_0_0|SrvcGrp|93924|2022|PDM|1350.00|99|0.00|AETNA MEDICAL SERVICES|
20|FH_F117603_92210_0|SrvcGrp|3178|2022|PDM|1150.00|99|0.00|ACUTE PSYCH|
20|FH_F120057_0_0|SrvcGrp|73004|2022|PDM|1168.00|99|0.00|AEG 8|
20|FH_F107980_08005_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|38.50|99|0.00|REMODULIN THERAPY (MOD KP/HB/SH)|
20|FH_F143413_75061_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F101806_0_0|SrvcGrp|75182|2022|PCT|1.05|99|0.00|AETNA IMPLANTS|
20|FH_F48261_0_0|CSTM-ALL|CSTM-00|2020|PDM|2282.00|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_F62719_0_0|SrvcGrp|59292|2022|PDM|50.67|99|0.00|SUBSEQUENT MATERNAL/CHILD HEALTH|
20|FH_F93902_04043_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F123921_89128_0|SrvcGrp|104079|2022|PCT|1.50|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F71905_0_0|SrvcGrp|59428|2022|PDM|75.00|99|0.00|ST|
20|FH_F129404_33461_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F34691_0_0|SrvcGrp|11199|2022|PCT|0.75|99|0.00|HYPERBARIC CHAMBER|
20|FH_F82173_72712_0|SrvcGrp|112031|2022|PDM|9180.00|99|0.00|LAPAROSCOPIC HYSTERECTOMY|
20|FH_F110925_01104_0|SrvcGrp|41424|2022|PDM|1.16|99|0.00|ENTERAL FORMULA - BLENDERIZED|
20|FH_F125516_50574_0|SrvcGrp|103717|2022|PCT|0.90|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F39022_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|SKILLED NURSING|
20|FH_F63083_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133207_0_0|SrvcGrp|34606|2022|PDM|3883.00|99|0.00|CPT 29827|
20|FH_F110470_98335_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F79743_0_0|CSTM-ALL|CSTM-00|2020|PDM|4763.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F70448_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114800_68510_0|SrvcGrp|88620|2022|PDM|91.00|99|0.00|SKILLED NURSING RN|
20|FH_F146207_73139_0|SrvcGrp|104229|2022|PDM|134.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F71523_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118147_33801_0|SrvcGrp|73605|2022|PDM|876.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F110420_60649_0|SrvcGrp|73603|2022|PDM|750.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F42163_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OP SVCS|
20|FH_F133627_89113_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F89932_10940_0|SrvcGrp|16|2022|PDM|2500.00|99|0.00|ACUTE REHABILITATION|
20|FH_F133287_40215_0|SrvcGrp|28015|2022|PCT|0.55|99|0.00|MSDRG 466-470 ONLY MAJOR JOINT/LIMB PROC|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.27|99|0.00|DELAWARE VALLEY- ASC 310|
20|FH_F150525_16056_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|DEVICE INSERTION|
20|FH_F121880_54935_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139707_84010_0|SrvcGrp|114702|2022|PDM|6817.00|99|0.00|VASCULAR PROCEDURES|
20|FH_F112750_63379_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150981_33140_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|82720|2022|PDM|2228.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F138018_17313_0|SrvcGrp|26868|2022|PDM|105.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F31547_0_0|SrvcGrp|12691|2022|PDM|40.47|99|0.00|INRON DEXTRAN|
20|FH_F97260_06111_0|SrvcGrp|73603|2022|PDM|3711.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F136947_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|512.28|99|0.00|AEG 3 (NO REV)|
20|FH_F131107_43140_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP LABS - SFHT - (MOD QW)|
20|FH_F102947_44084_0|SrvcGrp|89337|2022|PDM|712.00|99|0.00|DETOXIFICATION|
20|FH_F66059_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32996_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.00|99|0.00|NEWBORN NURSERY - LEVEL I|
20|FH_F92659_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117504_31088_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F131168_33912_0|CSTM-ALL|CSTM-00|2020|PCT|1.09|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F123407_04605_0|SrvcGrp|104997|2022|PDM|141.00|99|0.00|AETNA CRISIS INTERVENTION MENTAL HEALTH FOLLOW UP (HCFA)|
20|FH_F128272_60640_0|SrvcGrp|86122|2022|PCT|0.85|99|0.00|AETNA GAMMAGARD LIQUID INJ|
20|FH_F145758_20745_0|SrvcGrp|93724|2022|PDM|816.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F130656_04401_0|SrvcGrp|75506|2022|PCT|0.89|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F136359_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F139722_30022_0|SrvcGrp|22596|2022|PDM|195.36|99|0.00|HOSPICE CARE|
20|FH_F99161_0_0|SrvcGrp|75483|2022|PDM|1250.00|99|0.00|AEG 3|
20|FH_F143669_78577_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F51934_0_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F119934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147962_85008_0|SrvcGrp|80|2022|PDM|1350.00|99|0.00|ACUTE PSYCH|
20|FH_F138147_18018_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F110509_71351_0|SrvcGrp|72996|2022|PDM|3005.00|99|0.00|AEG 4|
20|FH_F133585_0_0|SrvcGrp|112382|2022|PDM|183.00|99|0.00|INJECTION THERAPY OF VEINS|
20|FH_F139446_87106_0|SrvcGrp|75419|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F130126_33413_0|SrvcGrp|89337|2022|PDM|1353.00|99|0.00|DETOXIFICATION|
20|FH_F131737_15025_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F135351_0_0|SrvcGrp|58638|2022|PDM|2940.00|99|0.00|CPT 63688|
20|FH_F83937_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|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_F67901_0_0|SrvcGrp|43568|2022|PDM|80.00|99|0.00|SKILLED NURSING - RN|
20|FH_F69968_0_0|CSTM-ALL|CSTM-00|2020|PDM|2546.78|99|0.00|MS DRG 768, 774-775 NORMAL DELIVERY|
20|FH_F120489_63552_0|SrvcGrp|75491|2022|PCT|0.75|99|0.00|AEG 7|
20|FH_F138188_54901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149650_96819_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130035_0_0|SrvcGrp|109020|2022|PCT|0.90|99|0.00|PARSABIV INJECTION ETELCALCETIDE 0.1 MG|
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112453_0_0|SrvcGrp|65720|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F100000_45417_0|SrvcGrp|87536|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F124222_92625_0|SrvcGrp|87317|2022|PDM|1200.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F46752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116383_63026_0|SrvcGrp|89337|2022|PDM|875.00|99|0.00|DETOXIFICATION|
20|FH_F117335_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F78542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F143057_15767_0|SrvcGrp|75419|2022|PDM|370.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F127197_23111_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F111791_33308_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133535_32110_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F73304_0_0|SrvcGrp|38588|2022|PDM|52.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|ASPG IX|
20|FH_F136002_0_0|SrvcGrp|48394|2022|PDM|25.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F133009_19038_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F131471_67203_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F134568_12946_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F124161_95932_0|SrvcGrp|109707|2022|PDM|8323.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F127579_44321_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F87571_0_0|SrvcGrp|10903|2022|PDM|350.00|99|0.00|EMERGENCY ROOM LEVEL I|
20|FH_F128816_43537_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F134494_33612_0|SrvcGrp|73841|2022|PDM|508.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F79644_0_0|SrvcGrp|13807|2022|PCT|0.70|99|0.00|OBSERVATION SVCS|
20|FH_F101100_50314_0|SrvcGrp|97895|2022|PDM|22307.00|99|0.00|REVISE KNEE 2|
20|FH_F142547_70002_0|SrvcGrp|86779|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F79724_32501_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F80754_31601_0|CSTM-ALL|CSTM-00|2020|PDM|136.37|99|0.00|AETNA DIGITAL SCREENING MAMMOGRAM|
20|FH_F106960_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120901_0_0|SrvcGrp|12491|2022|PCT|0.40|99|0.00|PACEMAKER|
20|FH_F114389_50131_0|SrvcGrp|105616|2022|PDM|175.21|99|0.00|CPAP DEVICE (MOD RR)|
20|FH_F114727_44512_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115210_21043_0|SrvcGrp|93431|2022|PDM|11000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F113709_0_0|SrvcGrp|104351|2022|PDM|35.09|99|0.00|STREP A/DNA/AMP PROBE|
20|FH_F119444_72903_0|SrvcGrp|87317|2022|PDM|902.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F146258_90004_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|480.00|99|0.00|AEG 1 (NO REV)|
20|FH_F115315_43011_0|SrvcGrp|94737|2022|PCT|1.00|99|0.00|FLUVIRIN VACC IM (>=3 YRS)|
20|FH_F141657_85715_0|SrvcGrp|75419|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F143053_89501_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F141668_47978_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127412_15301_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 2 W/O EYE SURGERY (NO REV)|
20|FH_F101840_76054_0|SrvcGrp|26684|2022|PDM|23371.00|99|0.00|MS DRG 454 ONLY|
20|FH_F139172_40207_0|SrvcGrp|86723|2022|PDM|372.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F140143_24874_0|SrvcGrp|106300|2022|PDM|293.23|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F150938_02062_0|SrvcGrp|113171|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F125772_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|AEG 1 (NO REV)|
20|FH_F92154_74023_0|SrvcGrp|82137|2022|PCT|0.71|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F128506_77304_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150399_53045_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138410_19130_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F138478_0_0|SrvcGrp|113282|2022|PDM|5570.24|99|0.00|INSJ SUBQ IMPLTBL DFB ELCTR|
20|FH_F130925_34652_0|SrvcGrp|73841|2022|PDM|389.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F132480_92054_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F119929_70364_0|SrvcGrp|92502|2022|PDM|551.11|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F59732_0_0|SrvcGrp|20480|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F61292_0_0|SrvcGrp|31504|2022|PDM|23802.00|99|0.00|CYBER KNIFE|
20|FH_F138010_0_0|SrvcGrp|63119|2022|PDM|25.00|99|0.00|BASIC HOME HOSPICE CARE|
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F135299_61021_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130013_16509_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F132579_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89112_16509_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HAPA WPA/NWPA 2018 LAB 100%|
20|FH_F117725_38036_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132991_84790_0|SrvcGrp|48385|2022|PDM|84.50|99|0.00|SPEECH THERAPY|
20|FH_F90196_10467_0|SrvcGrp|89149|2022|PDM|125.00|99|0.00|OP INTENSIVE|
20|FH_F146266_0_0|SrvcGrp|16289|2022|PDM|2418.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F125113_0_0|SrvcGrp|108267|2022|PCT|0.00|99|0.00|AETNA IMAGING|
20|FH_F112750_63379_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143249_89801_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
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|GENERAL ACUTE CARE|
20|FH_F47600_0_0|SrvcGrp|36809|2022|PCT|1.00|99|0.00|OCN F/S PRICING:POS FACILITY  GLOBAL (DME)|
20|FH_F49286_0_0|SrvcGrp|45328|2022|PDM|8.00|99|0.00|HOME HEALTH AIDE SERVICES (15 MINS)|
20|FH_F116684_30701_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F116684_30701_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37679_0_0|SrvcGrp|27145|2022|PDM|3.75|99|0.00|HOME INJECTABLE THERAPY (MOD SJ)|
20|FH_F47359_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94942_0_0|SrvcGrp|72990|2022|PDM|448.05|99|0.00|AEG 1|
20|FH_F39760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40043_0_0|SrvcGrp|30458|2022|PCT|0.76|99|0.00|DRUGS|
20|FH_F143814_18062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40043_0_0|SrvcGrp|33267|2022|PCT|0.76|99|0.00|GA ASPG VII|
20|FH_F125323_43213_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F88451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87092_60101_0|SrvcGrp|23585|2022|PCT|1.03|99|0.00|IMPLANTS|
20|FH_F62754_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F87333_0_0|SrvcGrp|16719|2022|PCT|0.84|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F73125_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117300_0_0|SrvcGrp|67279|2022|PDM|7853.00|99|0.00|CERVICAL SURGERY|
20|FH_F133947_93950_0|SrvcGrp|46903|2022|PDM|679.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F39898_0_0|SrvcGrp|3809|2022|PDM|716.00|99|0.00|HOSPICE CARE|
20|FH_F124173_66215_0|SrvcGrp|53987|2022|PDM|50.00|99|0.00|PHOTOTHERAPY|
20|FH_F69606_0_0|SrvcGrp|64107|2022|PDM|635.70|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 3|
20|FH_F115979_46107_0|SrvcGrp|105581|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F137147_75006_0|SrvcGrp|79786|2022|PCT|0.00|99|0.00|SLEEP STUDIES|
20|FH_F53732_0_0|SrvcGrp|11442|2022|PDM|643.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F78402_15905_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119023_91406_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F109886_36303_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F129483_77030_0|SrvcGrp|86834|2022|PDM|15.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F117221_23434_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124671_64844_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F114726_45213_0|SrvcGrp|89417|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F138310_60461_0|SrvcGrp|48394|2022|PDM|48.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F42396_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|KS DME FS 3247- W/MOD NU|
20|FH_F128341_41139_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F116433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F57592_0_0|SrvcGrp|20968|2022|PDM|27500.00|99|0.00|MS DRG 480 ONLY|
20|FH_F125660_46706_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F63131_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F133155_0_0|SrvcGrp|83521|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F122970_97222_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F141867_62258_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F103281_32086_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F141731_92590_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F42779_0_0|SrvcGrp|474|2022|PDM|905.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F71926_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F40542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/MOD NU (TX)|
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|1366.41|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F38663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BURMANS APOTHECARY DME MOD UE|
20|FH_F132446_19063_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F31842_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90921_77702_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F35454_0_0|SrvcGrp|16849|2022|PDM|50.00|99|0.00|SPLINTER REMOVAL - FOOT|
20|FH_F107400_0_0|SrvcGrp|48385|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F44194_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148701_32708_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148721_67205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148760_12953_0|SrvcGrp|48396|2022|PDM|147.00|99|0.00|OT SERVICES|
20|FH_F151056_17821_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151144_35801_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 6 (NO REV)|
20|FH_F66408_0_0|SrvcGrp|33164|2022|PDM|350.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F139677_77087_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115483_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F149539_06032_0|SrvcGrp|27968|2022|PCT|0.00|99|0.00|SKILLED NURSING LPN|
20|FH_F147230_49505_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SUPPLEMENTAL. OCN F/S PRICING: ALL|
20|FH_F132160_0_0|CSTM-ALL|CSTM-00|2020|PDM|1078.00|99|0.00|AEG 2 (NO REV)|
20|FH_F40521_0_0|SrvcGrp|97|2022|PDM|4100.00|99|0.00|C-SECTION|
20|FH_F116753_0_0|SrvcGrp|106769|2022|PDM|7465.00|99|0.00|REVISION GASTROPLASTY|
20|FH_F128753_32501_0|SrvcGrp|73559|2022|PCT|0.64|99|0.00|AETNA INTENSIVE CARE|
20|FH_F140248_42420_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148519_83201_0|SrvcGrp|29346|2022|PDM|45.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F35678_0_0|SrvcGrp|18287|2022|PDM|8476.00|99|0.00|MS DRG 038|
20|FH_F120352_52556_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150982_0_0|SrvcGrp|64517|2022|PDM|6606.00|99|0.00|REDUCE MANMMAPLASTY|
20|FH_F39212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.91|99|0.00|OP SVCS|
20|FH_F132130_0_0|CSTM-ALL|CSTM-00|2020|PDM|948.00|99|0.00|AEG 8 (NO REV)|
20|FH_F95200_16201_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F91077_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151146_0_0|SrvcGrp|82298|2022|PDM|6000.00|99|0.00|AETNA LAP SLEEVE GASTRECTOMY|
20|FH_F128883_89521_0|SrvcGrp|23683|2022|PDM|57.50|99|0.00|SKILLED NURSING RN|
20|FH_F74602_0_0|SrvcGrp|31074|2022|PDM|495.00|99|0.00|MS DRG 795 ONLY|
20|FH_F109652_0_0|SrvcGrp|57382|2022|PDM|54092.00|99|0.00|MS DRG 456-458 ONLY|
20|FH_F98041_10027_0|SrvcGrp|73485|2022|PDM|5659.00|99|0.00|AETNA REHAB|
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139295_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147014_33612_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F49943_0_0|SrvcGrp|45949|2022|PDM|140.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F113845_32746_0|SrvcGrp|105427|2022|PDM|28.17|99|0.00|AETNA OBSERVATIONS BEHAVIORAL 30 MINS|
20|FH_F43859_0_0|SrvcGrp|27725|2022|PDM|40.00|99|0.00|SKILLED RN HOURLY|
20|FH_F134694_94945_0|SrvcGrp|108484|2022|PDM|1200.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F147466_18355_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|PHOENIX HH S CODES W/MOD SJ|
20|FH_F129850_0_0|SrvcGrp|111385|2022|PCT|1.00|99|0.00|PATHOLOGY|
20|FH_F138451_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148556_13206_0|SrvcGrp|24750|2022|PDM|35.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F146159_89102_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F117965_60714_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F126666_44053_0|CSTM-ALL|CSTM-00|2020|PDM|70.00|99|0.00|PSYTX W PT 30 MINS|
20|FH_F102188_0_0|SrvcGrp|22954|2022|PDM|139.71|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F144288_46322_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F40645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|EATING DISORDER|
20|FH_F117725_38036_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F43443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F139700_42104_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F93172_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F143050_0_0|SrvcGrp|113574|2022|PDM|31973.00|99|0.00|AMBULANCE AIR TRANSPORT (HCFA)|
20|FH_F35452_0_0|SrvcGrp|13604|2022|PCT|1.50|99|0.00|CARDIO DIAGNOSTIC (CPT CODES 90000-99999)|
20|FH_F149579_95815_0|SrvcGrp|115701|2022|PDM|128.25|99|0.00|PSYCHIATRIC COLLABORATIVE CARE MGMT SBSQ (MOD AF)|
20|FH_F35769_32765_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F113765_0_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F129237_72833_0|SrvcGrp|75506|2022|PCT|1.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F122386_70578_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F98020_50138_0|SrvcGrp|73559|2022|PDM|10788.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F146266_0_0|SrvcGrp|99166|2022|PDM|7892.00|99|0.00|CPT 63005|
20|FH_F143536_47546_0|SrvcGrp|100245|2022|PCT|0.00|99|0.00|INFLUENZA ASSAY W/ OPTIC|
20|FH_F47600_0_0|SrvcGrp|31190|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC (DME)|
20|FH_F33522_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F129255_34952_0|SrvcGrp|89417|2022|PDM|420.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F42019_0_0|SrvcGrp|97|2022|PDM|2600.00|99|0.00|C-SECTION|
20|FH_F38383_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|AUTOLOGUS BONE MARROW HARVEST|
20|FH_F121149_76021_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F87254_0_0|SrvcGrp|72998|2022|PDM|1040.00|99|0.00|AEG 5|
20|FH_F106822_0_0|SrvcGrp|100260|2022|PDM|57.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (OVER 30.0 CM)|
20|FH_F123529_31021_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD 26|
20|FH_F137087_0_0|SrvcGrp|41334|2022|PDM|23000.00|99|0.00|TOTAL KNEE|
20|FH_F79625_0_0|SrvcGrp|76501|2022|PDM|435.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F128272_60640_0|SrvcGrp|24752|2022|PDM|25.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F130810_54728_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F62579_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|PEDIATRIC SPEECH THERAPY|
20|FH_F62579_0_0|SrvcGrp|14944|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F40575_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129509_0_0|SrvcGrp|88161|2022|PDM|3767.00|99|0.00|LAMINECTOMY W/FACE-THORACIC|
20|FH_F114823_15701_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F100782_0_0|SrvcGrp|97578|2022|PDM|904.43|99|0.00|WINDBER MEDICAL CNTR ASC 205|
20|FH_F120670_0_0|SrvcGrp|88163|2022|PDM|19000.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F134593_60007_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145604_14850_0|SrvcGrp|17014|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F145983_45213_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F149106_07042_0|CSTM-ALL|CSTM-00|2020|PDM|2268.00|99|0.00|AEG 8 (NO REV)|
20|FH_F134328_13088_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F118042_33401_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F44992_0_0|SrvcGrp|20014|2022|PCT|1.10|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F102188_0_0|SrvcGrp|76531|2022|PDM|139.71|99|0.00|HOSPICE IN HOME|
20|FH_F128893_0_0|SrvcGrp|65720|2022|PDM|160.00|99|0.00|RESPITE CARE|
20|FH_F97041_71603_0|SrvcGrp|73656|2022|PDM|592.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F120799_92651_0|SrvcGrp|108484|2022|PDM|1250.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F120974_27607_0|SrvcGrp|115534|2022|PCT|2.81|99|0.00|LABORATORY SERVICES|
20|FH_F84442_79606_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F131208_0_0|SrvcGrp|106317|2022|PDM|786.50|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97440_0_0|SrvcGrp|32405|2022|PCT|1.60|99|0.00|OCN F/S PRICING: MODIFIER 26 (RADIOLOGY)|
20|FH_F124017_0_0|SrvcGrp|106145|2022|PDM|12800.00|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F89779_0_0|SrvcGrp|73004|2022|PDM|3000.00|99|0.00|AEG 8|
20|FH_F149739_77087_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143970_92656_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F148254_89503_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F78363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93791_0_0|SrvcGrp|84939|2022|PDM|4200.00|99|0.00|SHOULDER JOINT|
20|FH_F124903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130682_0_0|SrvcGrp|78097|2022|PDM|6068.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F148265_06067_0|SrvcGrp|41334|2022|PDM|21558.00|99|0.00|TOTAL KNEE|
20|FH_F151562_26003_0|SrvcGrp|29155|2022|PDM|103.00|99|0.00|HOSPICE SVCS|
20|FH_F130721_04769_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 2 (NO REV)|
20|FH_F85272_77375_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F114407_19002_0|SrvcGrp|73700|2022|PDM|36.75|99|0.00|AETNA - SKILLED NURSING|
20|FH_F133876_27405_0|SrvcGrp|73842|2022|PDM|221.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114853_0_0|SrvcGrp|98499|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F42244_0_0|CSTM-ALL|CSTM-00|2020|PDM|1009.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113585_20155_0|SrvcGrp|24752|2022|PCT|1.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F138784_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F138685_18017_0|SrvcGrp|86722|2022|PDM|177.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F88893_0_0|SrvcGrp|35921|2022|PDM|8667.00|99|0.00|BARIATRIC SURGERY|
20|FH_F151321_92626_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151419_07852_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151503_30067_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132202_67490_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122064_64633_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F122152_70123_0|CSTM-ALL|CSTM-00|2020|PDM|168.95|99|0.00|HOSPICE ROUTINE HOME CARE (DAYS 0-60)|
20|FH_F135800_28731_0|SrvcGrp|57968|2022|PDM|41.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F135988_75703_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136150_73068_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131132_44077_0|SrvcGrp|96363|2022|PDM|36414.00|99|0.00|AETNA INC FOR VAGUS N ELECT IMPT|
20|FH_F133468_74873_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F121407_73701_0|SrvcGrp|2738|2022|PCT|0.39|99|0.00|IMPLANTS|
20|FH_F46918_0_0|SrvcGrp|10543|2022|PDM|110.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F133668_63128_0|SrvcGrp|75419|2022|PDM|375.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F134315_89106_0|SrvcGrp|17013|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F87153_0_0|CSTM-ALL|CSTM-00|2020|PDM|109.58|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)|
20|FH_F41780_0_0|SrvcGrp|17419|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
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|67065|2022|PDM|10404.00|99|0.00|CERVICAL SURGERY|
20|FH_F132328_0_0|SrvcGrp|107099|2022|PDM|1446.00|99|0.00|TREATMENT OF NOSE FRACTURE|
20|FH_F112133_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F141035_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F141035_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|4094.00|99|0.00|AEG 9 (NO REV)|
20|FH_F132347_01605_0|SrvcGrp|29346|2022|PDM|61.77|99|0.00|SKILLED NURSING- LPN|
20|FH_F111809_93003_0|SrvcGrp|56464|2022|PDM|41182.00|99|0.00|CPT 55873|
20|FH_F117340_68144_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|1208.00|99|0.00|AEG 8 (NO REV)|
20|FH_F145941_64119_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138611_0_0|SrvcGrp|112225|2022|PDM|23.46|99|0.00|COVID-19 SPECIMEN COLLECTION|
20|FH_F43953_0_0|CSTM-ALL|CSTM-00|2020|PDM|2301.00|99|0.00|OBSERVATION SERVICES|
20|FH_F130656_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F114407_19002_0|SrvcGrp|48394|2022|PDM|36.75|99|0.00|SKILLED NURSING SERVICES|
20|FH_F133492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|3428.00|99|0.00|AEG 7 (NO REV)|
20|FH_F133867_84075_0|SrvcGrp|48395|2022|PDM|85.50|99|0.00|OT SERVICES|
20|FH_F126198_44236_0|SrvcGrp|105820|2022|PDM|870.00|99|0.00|IP PSYCH EATING DISORDERS|
20|FH_F129509_0_0|SrvcGrp|100919|2022|PDM|7175.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F63312_0_0|CSTM-ALL|CSTM-00|2020|PDM|10.00|99|0.00|TELEMANAGEMENT SERVICES|
20|FH_F63580_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1538.12|99|0.00|HAPA WPA-NWPA 2012-13 ASC 702 W/O REV|
20|FH_F38227_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124369_0_0|SrvcGrp|98467|2022|PDM|4290.00|99|0.00|REPAIR BIG TOE FRACTURE|
20|FH_F145597_78644_0|SrvcGrp|108484|2022|PDM|670.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F54592_0_0|SrvcGrp|27049|2022|PDM|24.66|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS (MOD SJ)|
20|FH_F54592_0_0|SrvcGrp|22389|2022|PDM|19.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F105143_26062_0|SrvcGrp|104380|2022|PCT|2.50|99|0.00|AETNA CT SCANS|
20|FH_F133491_74012_0|SrvcGrp|93098|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F136386_30901_0|SrvcGrp|31020|2022|PDM|36750.00|99|0.00|MS DRG 470 ONLY|
20|FH_F142690_31774_0|SrvcGrp|22592|2022|PDM|80.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F138584_30912_0|SrvcGrp|113399|2022|PDM|900.00|99|0.00|EXCISION OF JAW JOINT|
20|FH_F140343_89052_0|SrvcGrp|14948|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129448_43235_0|SrvcGrp|73701|2022|PDM|33.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F94643_90501_0|SrvcGrp|16750|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F150323_68847_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F114204_53191_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 4 (NO REV)|
20|FH_F37444_0_0|SrvcGrp|3611|2022|PCT|0.70|99|0.00|DURABLE MEDICAL EQUIPMENT|
20|FH_F37422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31547_0_0|SrvcGrp|12702|2022|PDM|43.41|99|0.00|RN, INTERMITTENT VISIT|
20|FH_F130951_15237_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120856_78247_0|SrvcGrp|472|2022|PDM|475.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F35685_0_0|SrvcGrp|3480|2022|PDM|6891.00|99|0.00|DRG 125 CIRCULATORY DISORDER W/ CC W/O COMP DX|
20|FH_F63095_0_0|SrvcGrp|13168|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|362.00|99|0.00|AEG 1 (NO REV)|
20|FH_F32780_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F131128_0_0|SrvcGrp|112718|2022|PDM|2334.00|99|0.00|KNEE ARTHROSCOPY / SURGERY|
20|FH_F126883_78621_0|SrvcGrp|73842|2022|PDM|195.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131254_92211_0|SrvcGrp|86853|2022|PDM|35.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F100320_0_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F93332_0_0|SrvcGrp|93058|2022|PDM|1906.00|99|0.00|SPINAL BONE AUTOGRAFT (HCFA)|
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F122725_32216_0|SrvcGrp|72300|2022|PDM|705.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F133811_29615_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138302_15701_0|SrvcGrp|24745|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116506_0_0|SrvcGrp|75485|2022|PDM|725.00|99|0.00|AEG 4|
20|FH_F125244_0_0|SrvcGrp|27347|2022|PDM|4000.00|99|0.00|CPT 58558|
20|FH_F119107_22601_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F130329_64114_0|SrvcGrp|86842|2022|PDM|25.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|1553.00|99|0.00|ASPG VII- MOD 50|
20|FH_F138021_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F130364_01331_0|SrvcGrp|106164|2022|PCT|0.40|99|0.00|AETNA ALL DRUGS OR DRUG AGENTS|
20|FH_F133494_90023_0|SrvcGrp|106261|2022|PDM|3212.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F134828_30531_0|SrvcGrp|89231|2022|PDM|36.00|99|0.00|X-RAY EXAM OF LOWER LEG|
20|FH_F116443_0_0|CSTM-ALL|CSTM-00|2020|PDM|2285.00|99|0.00|AEG 4 (NO REV)|
20|FH_F77782_66061_0|SrvcGrp|13368|2022|PCT|0.83|99|0.00|OP SURGERY|
20|FH_F140875_63363_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38332_0_0|SrvcGrp|18798|2022|PDM|42216.00|99|0.00|MS DRG 217|
20|FH_F132627_0_0|SrvcGrp|17008|2022|PDM|80.58|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS|
20|FH_F141036_02347_0|SrvcGrp|87077|2022|PDM|167.20|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|824.00|99|0.00|AEG 6 (NO REV)|
20|FH_F122184_65674_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F139556_85006_0|SrvcGrp|21458|2022|PCT|1.89|99|0.00|SLEEP STUDIES|
20|FH_F115048_78520_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F137951_0_0|SrvcGrp|35669|2022|PDM|3000.00|99|0.00|CPT 63650|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|1583.00|99|0.00|GA RETINA SURG CTR ASC 34|
20|FH_F39274_0_0|SrvcGrp|3809|2022|PDM|1058.00|99|0.00|HOSPICE CARE|
20|FH_F40634_0_0|SrvcGrp|39|2022|PCT|0.70|99|0.00|TISSUE PLASMINOGEN ACTIVATOR|
20|FH_F82753_18840_0|SrvcGrp|111927|2022|PDM|56.44|99|0.00|COVID-19 NON CDC|
20|FH_F120902_64085_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F90872_0_0|SrvcGrp|105470|2022|PDM|1986.00|99|0.00|TRAINING INCL A TREATMENT|
20|FH_F139173_0_0|SrvcGrp|97702|2022|PDM|172.09|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F101021_0_0|SrvcGrp|95220|2022|PDM|550.00|99|0.00|HOSPICE CARE PROVIDED IN HOSPICE FACILITY (HCFA)|
20|FH_F116092_83254_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|GENERAL ACUTE CARE|
20|FH_F132735_97068_0|SrvcGrp|74668|2022|PDM|700.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F91632_46360_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
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_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|791.00|99|0.00|AEG 5  (NO REV)|
20|FH_F115685_64064_0|SrvcGrp|98926|2022|PDM|75.00|99|0.00|HIT INTERMIT PAIN MGMT (HCFA)|
20|FH_F126070_0_0|SrvcGrp|72990|2022|PDM|466.00|99|0.00|AEG 1|
20|FH_F123533_63825_0|SrvcGrp|97365|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F92276_32308_0|SrvcGrp|106157|2022|PDM|1475.00|99|0.00|EMERGENCY W/ SURGERY|
20|FH_F92091_0_0|SrvcGrp|41335|2022|PDM|10000.00|99|0.00|TOTAL HIP|
20|FH_F63307_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F86851_0_0|SrvcGrp|79590|2022|PDM|520.00|99|0.00|CPT 43248|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL|
20|FH_F150165_06032_0|SrvcGrp|87055|2022|PDM|1870.00|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION|
20|FH_F149219_01966_0|SrvcGrp|115383|2022|PCT|1.00|99|0.00|COVID-19 INFUSION ADMINISTRATION - REGENERON|
20|FH_F136037_0_0|SrvcGrp|90854|2022|PDM|921.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F133972_27103_0|SrvcGrp|86849|2022|PDM|35.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F111702_07652_0|SrvcGrp|59795|2022|PCT|1.00|99|0.00|TPN|
20|FH_F148905_85390_0|SrvcGrp|108484|2022|PDM|1000.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F132690_87571_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F136414_54548_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134152_70563_0|SrvcGrp|113132|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F137040_76011_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_F38948_0_0|SrvcGrp|97|2022|PDM|2954.00|99|0.00|C-SECTION|
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|1280.00|99|0.00|AEG 9 (NO REV)|
20|FH_F117623_0_0|SrvcGrp|107561|2022|PDM|55.00|99|0.00|EXPOSURE ADAPTIVE BH TREATMENT 60 MINS (HCFA)|
20|FH_F136736_65483_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F148424_01440_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136831_78728_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F147586_44124_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F54592_0_0|SrvcGrp|26864|2022|PDM|23.33|99|0.00|MISC INFUSION THERAPY (MOD SJ)|
20|FH_F84712_0_0|SrvcGrp|82774|2022|PDM|13876.00|99|0.00|HIGH GASTRIC BYPASS ADDITIONAL|
20|FH_F105361_80104_0|SrvcGrp|97379|2022|PDM|1384.00|99|0.00|AETNA SLEEP STUDIES|
20|FH_F102641_0_0|SrvcGrp|72990|2022|PDM|561.00|99|0.00|AEG 1|
20|FH_F136348_32092_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109652_0_0|SrvcGrp|12659|2022|PDM|994.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F143450_0_0|SrvcGrp|114025|2022|PDM|706.00|99|0.00|ESOPH ENDOSCOPY W/DRAIN CYST|
20|FH_F58932_0_0|SrvcGrp|12515|2022|PDM|450.00|99|0.00|DAY HOSPITAL|
20|FH_F91752_0_0|SrvcGrp|80098|2022|PDM|28.11|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE|
20|FH_F124417_85364_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F114638_25309_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F81832_13827_0|SrvcGrp|73742|2022|PDM|9.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F38808_0_0|SrvcGrp|17069|2022|PDM|561.00|99|0.00|ASPG III|
20|FH_F110604_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F132544_0_0|SrvcGrp|84442|2022|PDM|8007.00|99|0.00|REVISION KNEE|
20|FH_F92935_0_0|CSTM-ALL|CSTM-00|2020|PDM|1753.00|99|0.00|AEG 9 (NO REV)|
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|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_F132999_19901_0|SrvcGrp|48398|2022|PDM|89.00|99|0.00|PT SERVICES|
20|FH_F85753_0_0|SrvcGrp|14412|2022|PDM|585.23|99|0.00|HOSPICE CARE|
20|FH_F44607_0_0|SrvcGrp|17081|2022|PDM|4000.00|99|0.00|ASPG IX|
20|FH_F38630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F148639_0_0|SrvcGrp|99159|2022|PDM|2467.00|99|0.00|KNEE ARTHROSCOPY/SURGICAL|
20|FH_F39604_0_0|SrvcGrp|16325|2022|PDM|571.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F119128_93619_0|SrvcGrp|89337|2022|PDM|1350.00|99|0.00|DETOXIFICATION|
20|FH_F146250_67601_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F115315_43011_0|SrvcGrp|94743|2022|PCT|1.00|99|0.00|FLUZONE VACC IM (>=3 YRS)|
20|FH_F119076_41001_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F67639_0_0|SrvcGrp|44067|2022|PDM|1025.00|99|0.00|CPT 52240|
20|FH_F148867_20191_0|SrvcGrp|46605|2022|PDM|124.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F151004_87121_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140295_0_0|SrvcGrp|92823|2022|PDM|4774.00|99|0.00|REVISE KNUCKLE WITH IMPLANT|
20|FH_F137748_95231_0|SrvcGrp|75506|2022|PCT|1.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F47558_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149662_85015_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|AEG 5  (NO REV)|
20|FH_F108680_0_0|SrvcGrp|35669|2022|PDM|6050.00|99|0.00|CPT 63650|
20|FH_F90817_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 6 (NO REV)|
20|FH_F125214_12428_0|SrvcGrp|73559|2022|PCT|0.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F149273_0_0|SrvcGrp|93641|2022|PDM|3450.00|99|0.00|KNEE ARTHROSCOPIC SURGERY|
20|FH_F115208_0_0|SrvcGrp|106170|2022|PDM|1485.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F131173_17043_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F116802_41224_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F59732_0_0|SrvcGrp|26617|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F110002_16901_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127072_30458_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F75483_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139515_0_0|SrvcGrp|38364|2022|PDM|8549.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F141410_13045_0|SrvcGrp|73496|2022|PDM|1401.00|99|0.00|AETNA ER LEVEL V|
20|FH_F149980_0_0|SrvcGrp|113697|2022|PDM|1921.00|99|0.00|TRANSLUM DIL EYE CANAL|
20|FH_F115736_77459_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F62691_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F55812_0_0|SrvcGrp|10537|2022|PDM|52.00|99|0.00|NURSING CARE|
20|FH_F100703_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F98042_10468_0|SrvcGrp|73559|2022|PDM|14153.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F100787_69162_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F138981_85123_0|SrvcGrp|73841|2022|PDM|400.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F148424_01440_0|SrvcGrp|115400|2022|PCT|1.00|99|0.00|COVID-19 VACCINE - REGENERON|
20|FH_F134689_60190_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134734_90068_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115625_63110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115631_65201_0|SrvcGrp|88065|2022|PDM|7846.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F147701_31093_0|CSTM-ALL|CSTM-00|2020|PDM|3463.00|99|0.00|AEG 3 (NO REV)|
20|FH_F128341_41139_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F119538_60959_0|SrvcGrp|471|2022|PDM|437.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F100661_63640_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F45121_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117793_90405_0|SrvcGrp|3178|2022|PDM|1150.00|99|0.00|ACUTE PSYCH|
20|FH_F117875_70601_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F97140_91730_0|SrvcGrp|73603|2022|PDM|3401.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F117745_15801_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41396_0_0|SrvcGrp|474|2022|PDM|185.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F107140_0_0|SrvcGrp|29347|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F103281_32086_0|SrvcGrp|74469|2022|PCT|0.51|99|0.00|AETNA CHEMOTHERAPY|
20|FH_F141870_85224_0|SrvcGrp|86848|2022|PDM|35.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F148702_32606_0|SrvcGrp|75419|2022|PDM|460.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F37764_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|O2 SOLUTIONS MOD RR|
20|FH_F111080_18103_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F34853_0_0|SrvcGrp|360|2022|PDM|2799.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F131067_57105_0|SrvcGrp|106251|2022|PCT|1.70|99|0.00|LABORATORY SERVICES|
20|FH_F116698_07470_0|SrvcGrp|22389|2022|PDM|21.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F84394_17402_0|SrvcGrp|67064|2022|PDM|11614.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F35133_0_0|SrvcGrp|16|2022|PDM|1100.00|99|0.00|ACUTE REHABILITATION|
20|FH_F50715_0_0|SrvcGrp|26001|2022|PDM|140.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F121524_87111_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F88199_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F39819_0_0|SrvcGrp|31252|2022|PDM|4409.00|99|0.00|NY DRG 142 ONLY|
20|FH_F84994_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F86332_75081_0|SrvcGrp|10582|2022|PDM|30.00|99|0.00|UNCLASSIFIED HOME INJECTABLES|
20|FH_F143888_32205_0|SrvcGrp|114102|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F116291_11570_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F138450_0_0|SrvcGrp|74403|2022|PCT|0.93|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F65719_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.00|99|0.00|AEG 1 (NO REV)|
20|FH_F128125_68601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87092_60101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135656_74820_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143711_78405_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119810_31525_0|SrvcGrp|92501|2022|PDM|140.46|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F120408_0_0|SrvcGrp|103669|2022|PDM|481.00|99|0.00|AETNA PARTIAL HOSP (HCFA)|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F88744_71103_0|SrvcGrp|73559|2022|PDM|2762.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F100782_0_0|SrvcGrp|15706|2022|PCT|0.65|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F49914_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC|
20|FH_F150165_06032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146657_01105_0|SrvcGrp|113276|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|633.33|99|0.00|HAPA WPA-NWPA 2012-13 ASC 206 W/O REV|
20|FH_F150306_51566_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132883_31602_0|SrvcGrp|86825|2022|PDM|30.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F127642_07047_0|SrvcGrp|73008|2022|PDM|1040.00|99|0.00|AEG 10|
20|FH_F110604_0_0|SrvcGrp|63472|2022|PDM|9176.00|99|0.00|CPT 64581|
20|FH_F89219_0_0|SrvcGrp|14657|2022|PDM|2410.00|99|0.00|MENTAL HEALTH / DETOX|
20|FH_F105361_80104_0|SrvcGrp|88792|2022|PDM|35170.00|99|0.00|ARTHRODESIS|
20|FH_F138558_60107_0|SrvcGrp|90854|2022|PDM|959.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F92475_15931_0|SrvcGrp|75545|2022|PDM|366.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F117267_07728_0|SrvcGrp|72984|2022|PCT|5.38|99|0.00|CHEMOTHERAPY|
20|FH_F117189_60085_0|SrvcGrp|3178|2022|PDM|945.00|99|0.00|ACUTE PSYCH|
20|FH_F141249_17103_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F131383_85006_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS ASC|
20|FH_F131383_85006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97300_47501_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F80834_0_0|SrvcGrp|63|2022|PDM|1562.00|99|0.00|SUBACUTE CARE|
20|FH_F132417_38119_0|SrvcGrp|90854|2022|PDM|950.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F116546_78723_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131128_0_0|SrvcGrp|90365|2022|PDM|3278.00|99|0.00|REPAIR METACARPAL FRACTURE|
20|FH_F82753_18840_0|SrvcGrp|79786|2022|PCT|0.87|99|0.00|SLEEP STUDIES|
20|FH_F122533_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101711_0_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F140581_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141515_50010_0|SrvcGrp|108484|2022|PDM|469.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F120001_0_0|SrvcGrp|73606|2022|PDM|306.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F140574_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129627_06037_0|SrvcGrp|65720|2022|PDM|163.00|99|0.00|RESPITE CARE|
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F39740_0_0|SrvcGrp|701|2022|PDM|3025.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F65159_0_0|SrvcGrp|63|2022|PDM|1604.00|99|0.00|SUBACUTE CARE|
20|FH_F122725_32216_0|SrvcGrp|89267|2022|PDM|61.00|99|0.00|PSYTX PT/FAMILY 30 MINUTES|
20|FH_F86851_0_0|SrvcGrp|79593|2022|PDM|547.00|99|0.00|CPT 45378|
20|FH_F35308_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD 53) - BDSS|
20|FH_F45052_0_0|SrvcGrp|9874|2022|PDM|100.00|99|0.00|DIETICIAN|
20|FH_F133922_70563_0|SrvcGrp|42724|2022|PDM|180.45|99|0.00|SLEEP STUDY|
20|FH_F138127_44857_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134208_21502_0|SrvcGrp|12664|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F145604_14850_0|SrvcGrp|86848|2022|PDM|70.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F131738_72143_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132591_75146_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F145937_75240_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121980_66104_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F148326_0_0|SrvcGrp|90436|2022|PDM|8000.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F149030_37919_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134427_64014_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140093_33467_0|SrvcGrp|46903|2022|PDM|901.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F35847_0_0|SrvcGrp|701|2022|PCT|0.63|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F127364_26241_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F129340_43212_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F148859_0_0|SrvcGrp|112616|2022|PDM|36.72|99|0.00|BRACHYTX 125|
20|FH_F110726_19720_0|SrvcGrp|87317|2022|PDM|721.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F136779_0_0|SrvcGrp|44461|2022|PDM|4593.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F125648_67005_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35271_0_0|SrvcGrp|16|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION|
20|FH_F148265_06067_0|SrvcGrp|88492|2022|PDM|7514.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1808.00|99|0.00|AEG 9 (NO REV)|
20|FH_F123312_54115_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135264_40272_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F128176_24201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F93881_15009_0|SrvcGrp|12526|2022|PDM|134.00|99|0.00|RADIOLOGY SVCS|
20|FH_F86872_15215_0|SrvcGrp|27615|2022|PDM|65.82|99|0.00|AETNA DRUGS|
20|FH_F143539_0_0|SrvcGrp|42551|2022|PDM|1607.00|99|0.00|OP SURGERY|
20|FH_F111908_07677_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F51124_0_0|SrvcGrp|10519|2022|PDM|141.75|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F121225_98902_0|SrvcGrp|108753|2022|PCT|0.00|99|0.00|PHYSICAL THERAPY|
20|FH_F130763_0_0|SrvcGrp|47142|2022|PDM|4077.00|99|0.00|CPT 49650|
20|FH_F110343_38139_0|SrvcGrp|86753|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|504.03|99|0.00|HAPA WPA-NWPA 2012-13 ASC 106 W/O REV|
20|FH_F119937_0_0|SrvcGrp|63297|2022|PDM|127.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F117208_0_0|SrvcGrp|79101|2022|PDM|3410.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F45214_71103_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F145884_72113_0|SrvcGrp|88819|2022|PDM|670.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F142229_0_0|CSTM-ALL|CSTM-00|2020|PCT|54.80|99|0.00|OP SVCS|
20|FH_F139594_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F133021_00910_0|SrvcGrp|112296|2022|PDM|1800.00|99|0.00|NEPHROSTOMY TUBE|
20|FH_F150022_32539_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC|
20|FH_F40738_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|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_F133028_08021_0|SrvcGrp|90631|2022|PDM|175.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F128421_27016_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F71271_0_0|SrvcGrp|66264|2022|PDM|8.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F66408_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F138467_32216_0|SrvcGrp|89417|2022|PDM|876.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F117711_73080_0|SrvcGrp|73008|2022|PDM|1050.00|99|0.00|AEG 10|
20|FH_F97184_26101_0|SrvcGrp|88977|2022|PDM|7572.00|99|0.00|C-SECTION DELIVERY|
20|FH_F90817_0_0|SrvcGrp|46906|2022|PDM|2350.00|99|0.00|CORNEAL TISSUE|
20|FH_F150931_65201_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F92151_74104_0|SrvcGrp|82137|2022|PCT|0.58|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F137729_19703_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F146266_0_0|SrvcGrp|103586|2022|PDM|5559.00|99|0.00|REMOVE SPINE INFUSION|
20|FH_F84394_17402_0|CSTM-ALL|CSTM-00|2020|PDM|4780.00|99|0.00|AEG 6 (NO REV)|
20|FH_F33925_0_0|SrvcGrp|14414|2022|PDM|355.00|99|0.00|NEWBORN NURSERY|
20|FH_F149523_0_0|SrvcGrp|114171|2022|PDM|1250.00|99|0.00|STENT PACEMT ANTE COROTID|
20|FH_F34496_0_0|SrvcGrp|361|2022|PDM|2478.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F115047_78526_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F79483_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|GENERAL ACUTE CARE|
20|FH_F141527_36830_0|SrvcGrp|86845|2022|PDM|26.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F133714_03570_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148862_85390_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136359_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 1 (NO REV)|
20|FH_F86103_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115892_83263_0|SrvcGrp|92761|2022|PCT|1.20|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133536_0_0|SrvcGrp|99154|2022|PDM|2100.00|99|0.00|ELBOW ARTHROSCOPY/SURGERY|
20|FH_F120520_54401_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F137147_75006_0|SrvcGrp|109057|2022|PCT|0.00|99|0.00|CARDIAC STUDIES|
20|FH_F142548_66614_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F83831_0_0|SrvcGrp|26001|2022|PDM|138.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F126567_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149540_64083_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117154_43017_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113866_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F147180_19050_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F35410_0_0|SrvcGrp|20001|2022|PDM|12.00|99|0.00|WOUND CARE SUPPLIES|
20|FH_F147327_19010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|946.00|99|0.00|ASPG IX|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TRC VACV 28 FS MOD AV|
20|FH_F68322_0_0|SrvcGrp|17067|2022|PDM|785.00|99|0.00|ASPG II|
20|FH_F136424_34470_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142547_70002_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F109513_0_0|SrvcGrp|67072|2022|PDM|4500.00|99|0.00|CPT 22845|
20|FH_F40397_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|PSYCH HALF DAY TREATMENT|
20|FH_F120901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87816_0_0|SrvcGrp|76421|2022|PDM|430.50|99|0.00|HEMODIALYSIS|
20|FH_F92599_0_0|SrvcGrp|75483|2022|PDM|733.00|99|0.00|AEG 3|
20|FH_F147443_06469_0|SrvcGrp|75545|2022|PDM|380.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F41692_0_0|CSTM-ALL|CSTM-00|2020|PCT|67.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144011_60616_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F116698_07470_0|SrvcGrp|86833|2022|PDM|21.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F120971_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
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_F140007_0_0|SrvcGrp|96899|2022|PDM|7887.00|99|0.00|LUMBAR ARTIF DISCECTOMY|
20|FH_F115771_0_0|SrvcGrp|87077|2022|PDM|155.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F123943_84041_0|SrvcGrp|90707|2022|PDM|90.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F77504_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F137717_13901_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F124017_0_0|SrvcGrp|98601|2022|PDM|5200.00|99|0.00|TRANSPEDICULAR 1 SEG THORACIC|
20|FH_F100460_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40255_0_0|SrvcGrp|1259|2022|PDM|1298.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F137067_0_0|SrvcGrp|99167|2022|PDM|5250.00|99|0.00|CPT 63057|
20|FH_F72830_0_0|SrvcGrp|70081|2022|PCT|0.40|99|0.00|LAB WITH REV CODE 300-319|
20|FH_F123468_63384_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123511_64076_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F148663_48601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114064_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130659_44410_0|SrvcGrp|12280|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F150165_06032_0|SrvcGrp|109493|2022|PDM|4392.00|99|0.00|INSERT HEART PM VENTRICULAR|
20|FH_F149272_64057_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134249_05060_0|SrvcGrp|54670|2022|PDM|4920.00|99|0.00|NORMAL DELIVERY|
20|FH_F144291_0_0|SrvcGrp|108082|2022|PDM|25.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F134472_84624_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F85393_0_0|SrvcGrp|88620|2022|PDM|75.00|99|0.00|SKILLED NURSING RN|
20|FH_F102200_06416_0|SrvcGrp|86779|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F134255_01201_0|SrvcGrp|73842|2022|PDM|110.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149663_45219_0|SrvcGrp|100006|2022|PDM|2074.42|99|0.00|RECONSTRUCT ELBOW MED LIGMNT|
20|FH_F91913_0_0|SrvcGrp|73006|2022|PDM|1339.00|99|0.00|AEG 9|
20|FH_F117126_12801_0|SrvcGrp|10361|2022|PDM|575.00|99|0.00|CPT CODE 99281|
20|FH_F101945_0_0|SrvcGrp|34605|2022|PDM|2185.00|99|0.00|CPT 28299|
20|FH_F91258_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92493_0_0|SrvcGrp|88163|2022|PDM|20241.10|99|0.00|LUMBAR SPINE FUSION|
20|FH_F133674_30350_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PDM|1126.00|99|0.00|ASPG VIII|
20|FH_F115631_65201_0|SrvcGrp|67279|2022|PDM|7575.00|99|0.00|CERVICAL SURGERY|
20|FH_F72544_0_0|SrvcGrp|63|2022|PDM|1685.00|99|0.00|SUBACUTE CARE|
20|FH_F120089_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F144011_60616_0|CSTM-ALL|CSTM-00|2020|PDM|6861.00|99|0.00|AEG 9 (NO REV)|
20|FH_F143202_32114_0|SrvcGrp|89149|2022|PDM|187.00|99|0.00|OP INTENSIVE|
20|FH_F149999_33150_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148639_0_0|SrvcGrp|88596|2022|PDM|1054.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE|
20|FH_F38016_0_0|SrvcGrp|16|2022|PDM|811.00|99|0.00|ACUTE REHABILITATION|
20|FH_F35176_0_0|SrvcGrp|12264|2022|PDM|60.75|99|0.00|DIETICIAN OR LPN SERVICES|
20|FH_F150001_33064_0|SrvcGrp|26868|2022|PDM|26.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F115383_80734_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_F111813_08080_0|SrvcGrp|87902|2022|PCT|1.00|99|0.00|CEFTRIAXON SOD PER 250MG/8MX|
20|FH_F39546_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F126663_91423_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F132331_89107_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F91255_19401_0|CSTM-ALL|CSTM-00|2020|PDM|5105.00|99|0.00|AEG 9 (NO REV)|
20|FH_F126942_39540_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148740_93230_0|SrvcGrp|74668|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148760_12953_0|SrvcGrp|27968|2022|PDM|42.00|99|0.00|SKILLED NURSING LPN|
20|FH_F97102_83501_0|SrvcGrp|73601|2022|PDM|11862.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F102184_0_0|SrvcGrp|41334|2022|PDM|7215.00|99|0.00|TOTAL KNEE|
20|FH_F139241_0_0|SrvcGrp|58671|2022|PDM|1257.00|99|0.00|ASC CARVE OUT 64721|
20|FH_F77883_0_0|SrvcGrp|74933|2022|PDM|48.44|99|0.00|HOMEMAKER|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|254.92|99|0.00|HAPA WPA-NWPA 2012-13 ASC 130 W/O REV|
20|FH_F132882_63857_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120608_19901_0|SrvcGrp|48394|2022|PDM|51.58|99|0.00|SKILLED NURSING SERVICES|
20|FH_F114800_68510_0|SrvcGrp|48396|2022|PDM|92.00|99|0.00|OT SERVICES|
20|FH_F118088_71261_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F100782_0_0|SrvcGrp|97666|2022|PDM|1552.61|99|0.00|WINDBER MEDICAL CNTR ASC 503|
20|FH_F122475_37659_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139147_0_0|SrvcGrp|112965|2022|PDM|4894.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F143447_53204_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|PDM|234.00|99|0.00|GA RETINA SURG CTR ASC 7|
20|FH_F120747_19129_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F84611_30281_0|SrvcGrp|75999|2022|PCT|0.73|99|0.00|OP URGENT CARE|
20|FH_F151002_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F127890_44857_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145550_62034_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F39943_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|ACUTE PSYCH|
20|FH_F148322_93060_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F38798_0_0|SrvcGrp|10644|2022|PDM|115.00|99|0.00|MIDLINE INSERTION NURSING|
20|FH_F139164_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|602.00|99|0.00|ASPG II|
20|FH_F135210_61080_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123160_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F118072_38133_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149666_33460_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|695.00|99|0.00|AEG 2 (NO REV)|
20|FH_F94665_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|1460.00|99|0.00|AEG 10 (NO REV)|
20|FH_F127638_44720_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133957_84121_0|SrvcGrp|46605|2022|PDM|82.50|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133585_0_0|SrvcGrp|89424|2022|PDM|245.00|99|0.00|ARTERY XRAYS ARMS/LEGS|
20|FH_F141447_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F146590_77449_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F134087_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F113246_72687_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F136399_70445_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F142491_06033_0|SrvcGrp|104226|2022|PDM|160.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F140747_34461_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147861_45239_0|SrvcGrp|3178|2022|PDM|927.00|99|0.00|ACUTE PSYCH|
20|FH_F38699_0_0|SrvcGrp|11033|2022|PCT|1.00|99|0.00|OP REFERENCE LAB|
20|FH_F82933_0_0|SrvcGrp|80926|2022|PDM|3315.42|99|0.00|SOUTHSIDE REG MED MSDRG GH|
20|FH_F122174_16511_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122181_66538_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F64819_0_0|SrvcGrp|20744|2022|PDM|6227.00|99|0.00|MS DRG 242 ONLY|
20|FH_F122200_0_0|SrvcGrp|82498|2022|PDM|305.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS|
20|FH_F41463_0_0|SrvcGrp|10505|2022|PDM|138.60|99|0.00|CPT CODE 97001 PHYSICAL THERAPY INITIAL EVALUATION|
20|FH_F70844_15317_0|SrvcGrp|10503|2022|PDM|47.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F138197_0_0|SrvcGrp|103236|2022|PDM|2495.00|99|0.00|AETNA INSJ STABLJ DEV|
20|FH_F143533_30013_0|SrvcGrp|104182|2022|PDM|63.00|99|0.00|TOMOSYNTHESIS, MAMMO SCREEN GLOBAL|
20|FH_F38431_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147941_06023_0|CSTM-ALL|CSTM-00|2020|PDM|2192.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F116390_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F106020_0_0|SrvcGrp|36591|2022|PDM|3152.00|99|0.00|CPT 63685|
20|FH_F118703_0_0|SrvcGrp|72994|2022|PDM|583.00|99|0.00|AEG 3|
20|FH_F109343_0_0|SrvcGrp|103604|2022|PCT|0.00|99|0.00|TRANSFER TO HOSPITAL|
20|FH_F118366_17110_0|SrvcGrp|93098|2022|PDM|95.00|99|0.00|HOSPICE CARE|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 283-285 CV SURGERY|
20|FH_F145542_70503_0|SrvcGrp|29347|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE|
20|FH_F40149_0_0|SrvcGrp|97|2022|PDM|3656.00|99|0.00|C-SECTION|
20|FH_F43260_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|OP SVCS|
20|FH_F121111_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82753_18840_0|SrvcGrp|80522|2022|PDM|17621.00|99|0.00|URINARY SPHINCTER OR SLING|
20|FH_F129300_54541_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125244_0_0|SrvcGrp|97921|2022|PDM|5500.00|99|0.00|MYOMECTOMY ABDOM METHOD|
20|FH_F117437_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F63312_0_0|SrvcGrp|10543|2022|PDM|79.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F112023_12866_0|SrvcGrp|73501|2022|PCT|0.70|99|0.00|AETNA OBSERVATION|
20|FH_F136390_46321_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F66765_0_0|SrvcGrp|1168|2022|PDM|36.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F116143_0_0|SrvcGrp|82138|2022|PDM|1050.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
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_F114386_07090_0|SrvcGrp|94119|2022|PCT|1.05|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|4305.00|99|0.00|AEG 9 (NO REV)|
20|FH_F147319_32763_0|SrvcGrp|113911|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F119256_63031_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F127191_44720_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F142176_98040_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F117802_0_0|SrvcGrp|29434|2022|PDM|469.00|99|0.00|HOME HEMODIALYSIS TRAINING & TREATMENT|
20|FH_F122245_0_0|SrvcGrp|107441|2022|PDM|6839.50|99|0.00|AETNA CYSTOSCOPY PROSTATIC IMPLANTS|
20|FH_F125660_46706_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F149665_65689_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141728_71203_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151518_60506_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F54552_0_0|SrvcGrp|49285|2022|PDM|90.00|99|0.00|DELIVERY/NURSING (HIGH RISK)|
20|FH_F35368_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F100880_67735_0|SrvcGrp|919|2022|PDM|238.00|99|0.00|OP URGENT CARE|
20|FH_F143200_91602_0|SrvcGrp|74668|2022|PDM|1660.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148644_06890_0|SrvcGrp|82113|2022|PDM|3823.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F109343_0_0|SrvcGrp|103264|2022|PDM|1650.00|99|0.00|TRANSFER TO HOSPITAL|
20|FH_F43250_0_0|SrvcGrp|9539|2022|PDM|650.00|99|0.00|SUBACUTE CARE|
20|FH_F89340_0_0|SrvcGrp|44068|2022|PDM|1023.00|99|0.00|CPT 52332|
20|FH_F46832_0_0|SrvcGrp|17007|2022|PDM|85.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS|
20|FH_F120930_0_0|SrvcGrp|93431|2022|PDM|5000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F146207_73139_0|SrvcGrp|95660|2022|PDM|567.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F69708_0_0|SrvcGrp|42831|2022|PDM|92.00|99|0.00|DIETICIAN VISIT|
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113457_17011_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F142930_0_0|SrvcGrp|113620|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F120930_0_0|SrvcGrp|90157|2022|PDM|2000.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F111704_30044_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89219_0_0|SrvcGrp|43485|2022|PDM|103058.00|99|0.00|MS DRG'S 453-455|
20|FH_F134593_60007_0|SrvcGrp|115520|2022|PCT|0.87|99|0.00|MOMETASONE FUROATE SINUS IMPLANT|
20|FH_F114606_0_0|SrvcGrp|74546|2022|PDM|608.17|99|0.00|HOSPICE SERVICES|
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|AEG 1 (NO REV)|
20|FH_F126484_30078_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F34182_0_0|SrvcGrp|20906|2022|PDM|10805.00|99|0.00|MS DRG 243-244 ONLY CARDIAC PACEMAKER|
20|FH_F133749_84604_0|SrvcGrp|112457|2022|PDM|50.00|99|0.00|PICC LINE INSERTION (HCFA)|
20|FH_F63625_0_0|SrvcGrp|12394|2022|PCT|0.60|99|0.00|PROSTHETICS/IMPLANTS/DEVICES|
20|FH_F131430_17566_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140335_70435_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F140760_07003_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F110000_0_0|SrvcGrp|37389|2022|PDM|4984.00|99|0.00|MS DRG 286-287 ONLY CARDIAC CATH|
20|FH_F116169_0_0|SrvcGrp|82498|2022|PDM|164.00|99|0.00|DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS|
20|FH_F128027_0_0|SrvcGrp|705|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F38233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124212_33407_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F124584_28204_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F134791_98034_0|SrvcGrp|114312|2022|PDM|296.00|99|0.00|PSY DX INTERVIEW (HCFA)|
20|FH_F115631_65201_0|SrvcGrp|92408|2022|PDM|3177.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F86434_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 10 (NO REV)|
20|FH_F113792_0_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F147995_67037_0|SrvcGrp|12664|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F144020_15401_0|SrvcGrp|75506|2022|PCT|0.93|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F42159_0_0|SrvcGrp|20534|2022|PCT|0.95|99|0.00|SKILLED NURSING|
20|FH_F127197_23111_0|SrvcGrp|48394|2022|PDM|34.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F135714_01922_0|SrvcGrp|29155|2022|PDM|145.00|99|0.00|HOSPICE SVCS|
20|FH_F118550_21133_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F111444_33401_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|398.89|99|0.00|DELAWARE VALLEY- ASC 303|
20|FH_F139175_98229_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139877_32615_0|SrvcGrp|113227|2022|PDM|142.63|99|0.00|COVID-19 NFCT DS VIR RESP RNA 3 TRGT|
20|FH_F63759_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131418_75215_0|SrvcGrp|91070|2022|PDM|195.00|99|0.00|AETNA MH CRISIS INTERVENTION (HCFA)|
20|FH_F147218_48026_0|SrvcGrp|108622|2022|PDM|453.00|99|0.00|SUB ACUTE CARE LEVEL II|
20|FH_F117617_80439_0|SrvcGrp|63297|2022|PDM|165.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F112746_33844_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F56472_0_0|SrvcGrp|36066|2022|PDM|40.00|99|0.00|NURSING CARE|
20|FH_F36683_0_0|SrvcGrp|18253|2022|PDM|3010.00|99|0.00|MS DRG 287|
20|FH_F139878_33161_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F126783_80021_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134598_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS|
20|FH_F140888_75119_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F67880_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|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_F95880_02726_0|SrvcGrp|94735|2022|PDM|56.65|99|0.00|AFLURIA VACC IM (>=3 YRS)|
20|FH_F142344_16693_0|SrvcGrp|90854|2022|PDM|727.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F100401_15317_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F138929_0_0|SrvcGrp|95559|2022|PDM|17600.00|99|0.00|HIP JOINT|
20|FH_F88933_0_0|SrvcGrp|49544|2022|PDM|11255.00|99|0.00|ARTHROPLASTY|
20|FH_F42300_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F146886_77378_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F41633_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135327_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F122839_37122_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92677_08003_0|SrvcGrp|17016|2022|PDM|63.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F118196_0_0|SrvcGrp|73000|2022|PDM|894.00|99|0.00|AEG 6|
20|FH_F81151_16801_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F106540_26330_0|SrvcGrp|73002|2022|PDM|4200.00|99|0.00|AEG 7|
20|FH_F145641_06902_0|SrvcGrp|99161|2022|PDM|20500.00|99|0.00|CPT 27138|
20|FH_F110423_33401_0|SrvcGrp|73841|2022|PDM|327.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F126188_59404_0|SrvcGrp|110371|2022|PDM|600.00|99|0.00|TRABECULOPLASTY (HCFA)|
20|FH_F114525_72401_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F81861_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|CT SCANS - SOUTHWOODS|
20|FH_F111986_0_0|SrvcGrp|33986|2022|PDM|927.00|99|0.00|CPT 26055|
20|FH_F105361_80104_0|SrvcGrp|72992|2022|PDM|1344.00|99|0.00|AEG 2|
20|FH_F33512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F137147_75006_0|SrvcGrp|89404|2022|PDM|23370.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F67239_0_0|SrvcGrp|63037|2022|PDM|313.00|99|0.00|IMPLANTABLE ACCESS CATHETERS|
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124173_66215_0|SrvcGrp|43569|2022|PDM|42.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F132721_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PDM|1516.00|99|0.00|AEG 9 (NO REV)|
20|FH_F115210_21043_0|SrvcGrp|26278|2022|PDM|2122.00|99|0.00|CPT 29881|
20|FH_F143194_19973_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F111809_93003_0|SrvcGrp|705|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F122245_0_0|SrvcGrp|87055|2022|PDM|650.00|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION|
20|FH_F122958_45014_0|SrvcGrp|108061|2022|PCT|1.50|99|0.00|OP THERAPY SERVICES|
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 10 (NO REV)|
20|FH_F127412_15301_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|AEG 1 (NO REV)|
20|FH_F42557_0_0|CSTM-ALL|CSTM-00|2020|PDM|458.00|99|0.00|ACUTE REHABILITATION - ADOLESCENT|
20|FH_F87173_15136_0|SrvcGrp|48385|2022|PDM|104.00|99|0.00|SPEECH THERAPY|
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 10 (NO REV)|
20|FH_F111526_32226_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F34672_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F51438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|ASPG V|
20|FH_F87222_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
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_F130901_68970_0|SrvcGrp|537|2022|PCT|0.98|99|0.00|OBSERVATION SERVICES|
20|FH_F150159_06511_0|SrvcGrp|110811|2022|PDM|195.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F126391_24651_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F63387_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F93179_73460_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124173_66215_0|SrvcGrp|21920|2022|PDM|25.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F54592_0_0|SrvcGrp|24762|2022|PDM|150.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F80284_16354_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HAPA WPA/NWPA 2014 CARDIO 100%|
20|FH_F83931_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92593_21031_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F114916_30309_0|SrvcGrp|77021|2022|PDM|5200.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F116485_17033_0|SrvcGrp|110064|2022|PDM|31.83|99|0.00|GROUP BH TREATMENT 15 MINS|
20|FH_F147017_35976_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124593_07033_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|3698.00|99|0.00|AEG 10 (NO REV)|
20|FH_F97261_06098_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F118363_30305_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133019_23236_0|SrvcGrp|48385|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F131433_0_0|SrvcGrp|82981|2022|PDM|149.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|2343.00|99|0.00|ASPG VII|
20|FH_F145328_90301_0|SrvcGrp|113342|2022|PDM|87.00|99|0.00|TAKE HOME BUPRENORPHINE|
20|FH_F151157_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133472_27607_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F122245_0_0|SrvcGrp|73006|2022|PDM|1580.00|99|0.00|AEG 9|
20|FH_F40144_0_0|SrvcGrp|31756|2022|PDM|975.00|99|0.00|BRAIN INJURY SERVICES|
20|FH_F102525_73134_0|SrvcGrp|82369|2022|PCT|1.00|99|0.00|AETNA LABORATORY|
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PDM|3549.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F134874_80120_0|SrvcGrp|86722|2022|PDM|180.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F46433_0_0|SrvcGrp|24761|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134869_08854_0|SrvcGrp|108370|2022|PDM|185.00|99|0.00|PSYTX W PT W E/M 45 MINS (HCFA)|
20|FH_F125124_0_0|SrvcGrp|73000|2022|PDM|905.00|99|0.00|AEG 6|
20|FH_F135670_01749_0|SrvcGrp|29077|2022|PDM|12.50|99|0.00|HOME TRANSFUSION|
20|FH_F77044_0_0|SrvcGrp|74144|2022|PCT|1.00|99|0.00|INFUSION B-CODES|
20|FH_F120425_11106_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F84552_0_0|SrvcGrp|471|2022|PDM|462.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F134489_90305_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F70684_0_0|SrvcGrp|14893|2022|PDM|52.73|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F101100_50314_0|SrvcGrp|16069|2022|PDM|804.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F102200_06416_0|SrvcGrp|17015|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F47140_0_0|SrvcGrp|28727|2022|PDM|86.87|99|0.00|SLEEP STUDIES CPT 95805 W/MODIFIER 26|
20|FH_F132937_88201_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133478_40165_0|SrvcGrp|21350|2022|PDM|9924.00|99|0.00|MS DRG 287 ONLY|
20|FH_F46832_0_0|SrvcGrp|13929|2022|PDM|35.00|99|0.00|GROWTH HORMONE|
20|FH_F125053_0_0|SrvcGrp|79593|2022|PDM|1962.00|99|0.00|CPT 45378|
20|FH_F137329_81224_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F33530_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|TRAUMA CARE|
20|FH_F124407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136647_43506_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148553_85016_0|SrvcGrp|115445|2022|PDM|1343.00|99|0.00|INSERT PACING LEAD & CONNECT|
20|FH_F43000_0_0|SrvcGrp|36742|2022|PDM|75.00|99|0.00|RN VISIT|
20|FH_F134694_94945_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F147619_72034_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F40448_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.00|99|0.00|SPINAL CORD REHABILITATION|
20|FH_F118542_60188_0|SrvcGrp|24761|2022|PDM|48.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F139607_0_0|SrvcGrp|705|2022|PCT|0.30|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F131282_0_0|SrvcGrp|92542|2022|PDM|817.00|99|0.00|REVISION OF EYELID|
20|FH_F65619_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128144_45697_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F89112_16509_0|SrvcGrp|72980|2022|PCT|1.50|99|0.00|AETNA LABORATORY|
20|FH_F151199_77511_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149160_02180_0|SrvcGrp|115386|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F125214_12428_0|SrvcGrp|10944|2022|PDM|936.00|99|0.00|EMERGENCY ROOM|
20|FH_F42929_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.70|99|0.00|OP SVCS|
20|FH_F36485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% 2007 MEDICARETN  DME  MOD RR|
20|FH_F115483_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|AEG 7 (NO REV)|
20|FH_F35678_0_0|SrvcGrp|13470|2022|PDM|1837.00|99|0.00|ACUTE SURGICAL SVCS|
20|FH_F128091_37129_0|SrvcGrp|74668|2022|PDM|450.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F143307_72223_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131107_43140_0|SrvcGrp|65720|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F136299_75218_0|CSTM-ALL|CSTM-00|2020|PDM|7210.00|99|0.00|AEG 6 (NO REV)|
20|FH_F132416_92270_0|SrvcGrp|79280|2022|PDM|585.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F36132_0_0|SrvcGrp|207|2022|PDM|515.00|99|0.00|OP REHAB PROGRAM|
20|FH_F143903_06249_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149839_80002_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F84778_0_0|SrvcGrp|73008|2022|PDM|1050.00|99|0.00|AEG 10|
20|FH_F39385_0_0|SrvcGrp|11259|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F93593_33414_0|SrvcGrp|70381|2022|PDM|339.00|99|0.00|PSYCH PARTIAL HOSP (FULL & PARTIAL DAY) PER VISIT|
20|FH_F130523_04605_0|SrvcGrp|107806|2022|PCT|2.25|99|0.00|CHEMOTHERAPY/ALL OTHER DRUGS|
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|1138.65|99|0.00|ASPG V|
20|FH_F40318_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F76171_0_0|SrvcGrp|48645|2022|PDM|126.00|99|0.00|OP SKILLED NURSING|
20|FH_F35513_0_0|SrvcGrp|11326|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY|
20|FH_F97000_24201_0|SrvcGrp|72299|2022|PDM|239.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F135005_06460_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F93413_0_0|SrvcGrp|3809|2022|PDM|531.96|99|0.00|HOSPICE CARE|
20|FH_F127882_62812_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97561_30030_0|SrvcGrp|73656|2022|PDM|605.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|964.00|99|0.00|AEG 7 (NO REV)|
20|FH_F136751_0_0|SrvcGrp|88163|2022|PDM|16000.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F151044_19606_0|SrvcGrp|74668|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139487_60076_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F139163_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111246_80027_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INJECTION, PEGFILGRASTIM 6MG|
20|FH_F110121_0_0|SrvcGrp|73004|2022|PDM|2625.00|99|0.00|AEG 8|
20|FH_F127079_33026_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F36720_0_0|SrvcGrp|14187|2022|PDM|825.00|99|0.00|MRI|
20|FH_F73485_0_0|SrvcGrp|48394|2022|PDM|7.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F132407_62035_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36274_0_0|SrvcGrp|9832|2022|PDM|90.00|99|0.00|ST SVCS|
20|FH_F33498_0_0|SrvcGrp|30379|2022|PCT|0.57|99|0.00|LABORATORY SERVICES|
20|FH_F140910_53005_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F143528_0_0|SrvcGrp|114086|2022|PDM|4861.50|99|0.00|CORRECTION HALLUX VALGUS|
20|FH_F93384_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F66879_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123468_63384_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F80067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131965_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F141129_0_0|SrvcGrp|113720|2022|PDM|25.00|99|0.00|VISIT/HOME SERVICE|
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135002_54971_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F89538_0_0|CSTM-ALL|CSTM-00|2020|PDM|1505.48|99|0.00|AEG 10 (NO REV)|
20|FH_F90438_08873_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F98021_07012_0|SrvcGrp|90854|2022|PDM|3070.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F39586_0_0|SrvcGrp|11442|2022|PDM|603.33|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F132899_01002_0|SrvcGrp|112085|2022|PDM|291.00|99|0.00|INTENSIVE OUTPATIENT EATING DISORDERS (>=18 YRS)|
20|FH_F93190_26456_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F120539_89029_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F146479_20782_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111666_06517_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F134828_30531_0|SrvcGrp|112651|2022|PDM|46.00|99|0.00|XRAY EXAM OF RIBS (HCFA)|
20|FH_F58856_0_0|SrvcGrp|20926|2022|PDM|30625.00|99|0.00|MS DRG 235 ONLY|
20|FH_F69968_0_0|SrvcGrp|46519|2022|PDM|6685.29|99|0.00|PTCA WITH STENT|
20|FH_F69968_0_0|SrvcGrp|46515|2022|PDM|6685.29|99|0.00|LAPAROSCOPIC VAGINAL HYSTERECTOMY|
20|FH_F139456_47501_0|SrvcGrp|113188|2022|PCT|1.35|99|0.00|LABORATORY SERVICES|
20|FH_F119023_91406_0|SrvcGrp|29075|2022|PDM|30.00|99|0.00|HYDRATION THERAPY|
20|FH_F147861_45239_0|SrvcGrp|88819|2022|PDM|900.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F147930_21244_0|SrvcGrp|74668|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|764.00|99|0.00|AEG 4 (NO REV)|
20|FH_F133002_0_0|SrvcGrp|72998|2022|PDM|816.10|99|0.00|AEG 5|
20|FH_F137067_0_0|SrvcGrp|27261|2022|PDM|21000.00|99|0.00|CPT 27446|
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|18900.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL|
20|FH_F114389_50131_0|SrvcGrp|86852|2022|PDM|130.65|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F64441_0_0|SrvcGrp|42785|2022|PDM|68.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F124222_92625_0|SrvcGrp|104079|2022|PCT|1.50|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F131848_83651_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139113_21804_0|SrvcGrp|87536|2022|PDM|336.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F68481_0_0|CSTM-ALL|CSTM-00|2020|PDM|1110.00|99|0.00|ASPG IV|
20|FH_F72003_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|240.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1602 W/O REV|
20|FH_F40718_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F49354_0_0|SrvcGrp|30207|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F141849_76053_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100786_24740_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F139450_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F151522_72712_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|HSS ASC|
20|FH_F67639_0_0|SrvcGrp|44068|2022|PDM|850.00|99|0.00|CPT 52332|
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|1245.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F36576_0_0|SrvcGrp|115|2022|PDM|642.00|99|0.00|SKILLED NURSING CARE|
20|FH_F37909_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151142_35406_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121329_33015_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F92299_62016_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117762_0_0|SrvcGrp|88065|2022|PDM|9360.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F139715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F93961_0_0|SrvcGrp|93751|2022|PDM|1654.00|99|0.00|ERCP STENT EXCHANGE W/DILATE|
20|FH_F138017_73129_0|SrvcGrp|97484|2022|PDM|6196.00|99|0.00|ENDO CHOLANGIOPANCREATOGRAPH|
20|FH_F151699_01752_0|SrvcGrp|29076|2022|PCT|1.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F116633_37217_0|SrvcGrp|29347|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F126581_45638_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125935_44024_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F129656_15005_0|SrvcGrp|26868|2022|PDM|35.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F32487_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F130588_41171_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50218_0_0|SrvcGrp|46237|2022|PDM|105.00|99|0.00|SKILLED NURSING HOME VISIT OR PROCEDURE|
20|FH_F125966_68776_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1617.87|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1401 W/O REV|
20|FH_F143928_21061_0|SrvcGrp|88620|2022|PDM|126.00|99|0.00|SKILLED NURSING RN|
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|840.00|99|0.00|AEG 1 (NO REV)|
20|FH_F87480_0_0|SrvcGrp|41334|2022|PDM|7500.00|99|0.00|TOTAL KNEE|
20|FH_F133808_73401_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F103320_0_0|SrvcGrp|72996|2022|PDM|923.00|99|0.00|AEG 4|
20|FH_F135900_0_0|SrvcGrp|30089|2022|PDM|450.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F50657_0_0|SrvcGrp|17419|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F124369_0_0|SrvcGrp|107008|2022|PDM|5610.00|99|0.00|REMOVAL OF BONE FOR GRAFT|
20|FH_F145642_15108_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F125244_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 2 (NO REV)|
20|FH_F138050_52301_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F62609_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117715_0_0|SrvcGrp|107640|2022|PDM|4748.88|99|0.00|REMOVAL OF KIDNEY STONE|
20|FH_F151427_04106_0|SrvcGrp|112486|2022|PDM|248.00|99|0.00|HYDRATION IV INFUSION, INIT (HCFA)|
20|FH_F122076_17543_0|SrvcGrp|42622|2022|PCT|0.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F145068_63084_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F91735_92653_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD OCN F/S PRICING - OP|
20|FH_F135772_61364_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135800_28731_0|SrvcGrp|3809|2022|PDM|699.00|99|0.00|HOSPICE CARE|
20|FH_F136041_87107_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F136133_77707_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136180_92253_0|SrvcGrp|46903|2022|PDM|1100.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F116461_77536_0|SrvcGrp|86723|2022|PDM|324.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F116464_13088_0|CSTM-ALL|CSTM-00|2020|PDM|173.00|99|0.00|NEW PATIENT OFF OP VISIT|
20|FH_F121743_70005_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F32803_0_0|SrvcGrp|3064|2022|PDM|1599.00|99|0.00|ICU/CCU|
20|FH_F34283_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69205_0_0|SrvcGrp|115426|2022|PDM|172.81|99|0.00|MATERNAL / CHILD HEALTH VISIT|
20|FH_F111390_32960_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148243_0_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F131000_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F131000_0_0|SrvcGrp|74039|2022|PDM|6450.00|99|0.00|LAMINECTOMY|
20|FH_F131000_0_0|SrvcGrp|70749|2022|PDM|3343.00|99|0.00|CPT 29823|
20|FH_F112092_46845_0|SrvcGrp|90482|2022|PCT|1.00|99|0.00|FLUVIRIN VACC 3 YRS & > IM|
20|FH_F87557_33309_0|SrvcGrp|86832|2022|PDM|3.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F130206_78209_0|SrvcGrp|46903|2022|PDM|489.25|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F82715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71723_16502_0|SrvcGrp|81878|2022|PCT|1.00|99|0.00|RADIOLOGY W/ REV/HCPC|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1130.40|99|0.00|HAPA WPA-NWPA 2012-13 ASC 801 W/O REV|
20|FH_F42340_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 7 (NO REV)|
20|FH_F40980_0_0|SrvcGrp|97|2022|PDM|17008.00|99|0.00|C-SECTION|
20|FH_F78385_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F113677_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147140_89103_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F47902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD TC|
20|FH_F119601_0_0|CSTM-ALL|CSTM-00|2020|PDM|2113.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F45226_0_0|SrvcGrp|37027|2022|PDM|80.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F137986_0_0|SrvcGrp|85792|2022|PDM|4490.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F35174_0_0|CSTM-ALL|CSTM-00|2020|PDM|1209.00|99|0.00|ACUTE PSYCH|
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|ASPG 4 SURGICAL EYE CENTER|
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89640_98133_0|CSTM-ALL|CSTM-00|2020|PCT|1.11|99|0.00|AETNA - APC GROUPER Y|
20|FH_F94643_90501_0|SrvcGrp|14949|2022|PDM|180.00|99|0.00|HOME INFUSION|
20|FH_F47812_0_0|SrvcGrp|42869|2022|PDM|40.12|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F135261_33144_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F147212_0_0|SrvcGrp|3327|2022|PDM|255.00|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F63422_0_0|SrvcGrp|3259|2022|PDM|428.00|99|0.00|ACUTE REHABILITATION|
20|FH_F72766_0_0|SrvcGrp|12118|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F116731_0_0|SrvcGrp|97506|2022|PDM|100.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F34706_0_0|SrvcGrp|13123|2022|PDM|561.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F118672_29036_0|CSTM-ALL|CSTM-00|2020|PDM|2366.00|99|0.00|AEG 3 (NO REV)|
20|FH_F103400_33426_0|SrvcGrp|43524|2022|PDM|228.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - SUBSTANCE ABUSE|
20|FH_F150524_64106_0|SrvcGrp|115639|2022|PCT|1.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD AU) - BDSS|
20|FH_F46357_0_0|SrvcGrp|41546|2022|PDM|3000.00|99|0.00|LAPAROSCOPIC APPENDECTOMY|
20|FH_F130108_0_0|SrvcGrp|15350|2022|PCT|0.75|99|0.00|TRAUMA ACTIVATION|
20|FH_F127553_44321_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114206_37203_0|SrvcGrp|13929|2022|PDM|15.00|99|0.00|GROWTH HORMONE|
20|FH_F139048_0_0|SrvcGrp|11306|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F142370_0_0|SrvcGrp|113176|2022|PDM|28.39|99|0.00|COVID-19 IMMUN ADMIN 2ND DOSE - MODERNA|
20|FH_F40917_0_0|SrvcGrp|109|2022|PDM|505.00|99|0.00|CD - DETOX|
20|FH_F36094_0_0|SrvcGrp|57482|2022|PDM|59.00|99|0.00|PT/OT/ST INITIAL VISIT|
20|FH_F117023_0_0|SrvcGrp|12491|2022|PCT|1.10|99|0.00|PACEMAKER|
20|FH_F35458_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG IV|
20|FH_F139565_0_0|SrvcGrp|109767|2022|PDM|2869.00|99|0.00|COVER EYE W/ MEMBRANE INCIDENTAL CODES|
20|FH_F132878_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F138017_73129_0|SrvcGrp|93751|2022|PDM|6196.00|99|0.00|ERCP STENT EXCHANGE W/DILATE|
20|FH_F56572_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F131261_19111_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F143214_92506_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102224_0_0|SrvcGrp|101102|2022|PDM|10450.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F148265_06067_0|SrvcGrp|88164|2022|PDM|17247.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F77042_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F109180_18015_0|SrvcGrp|91392|2022|PDM|214.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD AF)|
20|FH_F39101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F143903_06249_0|SrvcGrp|87317|2022|PDM|500.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F145758_20745_0|SrvcGrp|112537|2022|PDM|851.70|99|0.00|REMOVE SPINAL CORD LESION|
20|FH_F36789_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130751_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|6300.00|99|0.00|AEG 6 (NO REV)|
20|FH_F124050_75089_0|SrvcGrp|48385|2022|PDM|95.00|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_F71364_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F50654_0_0|SrvcGrp|46883|2022|PCT|1.00|99|0.00|REPAIR OF EYELID DEFECT|
20|FH_F133922_70563_0|SrvcGrp|21456|2022|PDM|658.14|99|0.00|SLEEP STUDIES|
20|FH_F97861_62223_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F130468_0_0|SrvcGrp|78403|2022|PDM|0.25|99|0.00|AETNA MED RECORD|
20|FH_F119379_0_0|SrvcGrp|98007|2022|PDM|1113.00|99|0.00|FINGER/THUMB AMPUTATION|
20|FH_F121225_98902_0|SrvcGrp|31973|2022|PCT|0.85|99|0.00|HOME THERAPY|
20|FH_F85340_98195_0|CSTM-ALL|CSTM-00|2020|PCT|2.83|99|0.00|AETNA - APC GROUPER M|
20|FH_F149106_07042_0|CSTM-ALL|CSTM-00|2020|PDM|2553.00|99|0.00|AEG 9 (NO REV)|
20|FH_F134002_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F132187_66111_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136314_19013_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F109920_39180_0|SrvcGrp|75479|2022|PDM|550.00|99|0.00|AEG 1|
20|FH_F129477_70403_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124438_0_0|SrvcGrp|82981|2022|PDM|140.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F109652_0_0|SrvcGrp|39823|2022|PDM|752.00|99|0.00|ER SERVICES LEVEL 3|
20|FH_F151500_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F41795_0_0|SrvcGrp|28068|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F141940_50023_0|CSTM-ALL|CSTM-00|2020|PDM|4773.56|99|0.00|AEG 8 (NO REV)|
20|FH_F133472_27607_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120437_85202_0|SrvcGrp|99034|2022|PDM|47.27|99|0.00|ANTIBIOTIC Q18H (HCFA)|
20|FH_F115890_75067_0|SrvcGrp|89417|2022|PDM|430.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F132150_66083_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133478_40165_0|SrvcGrp|29755|2022|PDM|31534.00|99|0.00|MS DRG 245 ONLY|
20|FH_F113025_0_0|SrvcGrp|104960|2022|PDM|349.00|99|0.00|AEG 1 W/O CPT 65820|
20|FH_F134126_11554_0|SrvcGrp|12840|2022|PCT|0.45|99|0.00|PACEMAKER|
20|FH_F114092_83350_0|SrvcGrp|103913|2022|PCT|0.00|99|0.00|OP DIALYSIS|
20|FH_F142691_30328_0|SrvcGrp|108484|2022|PDM|1244.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F109883_35007_0|SrvcGrp|89337|2022|PDM|881.00|99|0.00|DETOXIFICATION|
20|FH_F117325_19342_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F142312_62301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F94786_07974_0|SrvcGrp|86829|2022|PDM|31.50|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F132988_0_0|SrvcGrp|93731|2022|PDM|771.00|99|0.00|INJEC PROC FOR SACROILIAC JOINT|
20|FH_F114389_50131_0|SrvcGrp|24745|2022|PDM|130.65|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F132864_71101_0|SrvcGrp|13880|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F136734_46410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122872_67208_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35926_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F48772_66044_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
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_F123078_19119_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137240_0_0|SrvcGrp|26595|2022|PDM|1341.00|99|0.00|ACUTE PSYCHIATRIC|
20|FH_F134497_47126_0|SrvcGrp|90854|2022|PDM|910.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151285_72956_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150700_90028_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F150882_84041_0|SrvcGrp|112700|2022|PDM|315.00|99|0.00|RN HOME CARE (HCFA)|
20|FH_F35369_0_0|SrvcGrp|13292|2022|PCT|1.15|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F40346_0_0|SrvcGrp|9795|2022|PDM|975.00|99|0.00|SUBACUTE REHAB|
20|FH_F112956_0_0|SrvcGrp|75485|2022|PDM|688.00|99|0.00|AEG 4|
20|FH_F150359_30106_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119652_0_0|SrvcGrp|73601|2022|PDM|1450.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F98820_81401_0|SrvcGrp|73659|2022|PDM|5306.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F137767_01841_0|SrvcGrp|11258|2022|PCT|0.55|99|0.00|DRUGS|
20|FH_F151407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F139870_71075_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134667_19110_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F84712_0_0|SrvcGrp|87965|2022|PDM|10316.00|99|0.00|GASTRIC SLEEVE W/ HERINA REPAIR|
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F146672_47424_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F134612_0_0|SrvcGrp|108177|2022|PDM|2300.00|99|0.00|TRLUML BALO ANGIOP 1ST VEIN|
20|FH_F120489_63552_0|SrvcGrp|74586|2022|PCT|0.65|99|0.00|AETNA OP HIGH COST DRUGS|
20|FH_F120490_64133_0|SrvcGrp|106904|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F142547_70002_0|SrvcGrp|86832|2022|PDM|2.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F138571_65807_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138584_30912_0|SrvcGrp|113374|2022|PDM|1800.00|99|0.00|RECONSTRUCTION MIDFACE LEFORT I|
20|FH_F120152_0_0|SrvcGrp|101320|2022|PDM|1650.00|99|0.00|PARAVERTEBRAL FACET JOINT NERVE|
20|FH_F117154_43017_0|SrvcGrp|73842|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F101945_0_0|SrvcGrp|11669|2022|PDM|2726.00|99|0.00|OP SURG|
20|FH_F91472_96001_0|SrvcGrp|103711|2022|PCT|0.40|99|0.00|(AICD) LEAD ONLY IMPLANT/REPLACEMNT|
20|FH_F77067_0_0|SrvcGrp|31592|2022|PCT|0.65|99|0.00|MS DRG 004 ONLY|
20|FH_F133002_0_0|SrvcGrp|105604|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_F147010_82930_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136567_94578_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F122606_53818_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136778_62034_0|SrvcGrp|11663|2022|PCT|0.25|99|0.00|IMPLANTS|
20|FH_F115631_65201_0|SrvcGrp|69881|2022|PDM|1297.00|99|0.00|VASCULAR PROCEDURES|
20|FH_F144048_91324_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.35|99|0.00|POLYSOMNOGRAPHY W/O MOD 26 & TC|
20|FH_F133009_19038_0|SrvcGrp|48396|2022|PDM|107.00|99|0.00|OT SERVICES|
20|FH_F82813_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150905_01608_0|SrvcGrp|115861|2022|PDM|31.13|99|0.00|THERAPEUTIC BEHAV SERV (MOD HO) (0-21 YRS)|
20|FH_F117559_08619_0|SrvcGrp|109210|2022|PDM|20.00|99|0.00|CCIIV4 VACC ABX FREE IM|
20|FH_F144037_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132279_63775_0|SrvcGrp|111993|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F45392_0_0|SrvcGrp|3029|2022|PDM|325.00|99|0.00|NEWBORN NURSERY|
20|FH_F150766_33952_0|CSTM-ALL|CSTM-00|2020|PCT|0.30|99|0.00|OP SVCS|
20|FH_F150768_03054_0|SrvcGrp|80918|2022|PDM|690.00|99|0.00|RESPITE CARE|
20|FH_F39772_0_0|SrvcGrp|359|2022|PDM|424.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F97521_30824_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F98860_96706_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F110824_83221_0|SrvcGrp|11108|2022|PDM|712.00|99|0.00|NEWBORN NURSERY|
20|FH_F39443_0_0|SrvcGrp|30306|2022|PDM|144.00|99|0.00|HAPA WPA ASC 118|
20|FH_F131545_64057_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F93740_0_0|SrvcGrp|91581|2022|PDM|11500.00|99|0.00|RENAL DIAGNOSTIC|
20|FH_F49458_0_0|SrvcGrp|45567|2022|PDM|32.99|99|0.00|MASTECTOMY BRA|
20|FH_F141035_0_0|SrvcGrp|107845|2022|PDM|4417.00|99|0.00|REVISE FINGER/TOE NERVE|
20|FH_F123036_0_0|SrvcGrp|107347|2022|PDM|6334.00|99|0.00|IMPLT NEUROSTIM RADIOFQ REC|
20|FH_F128381_61342_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132972_78589_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|950.00|99|0.00|CD INTENSIVE OUTPATIENT SVCS|
20|FH_F32936_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F101840_76054_0|SrvcGrp|21122|2022|PDM|21910.00|99|0.00|MS DRG 459 ONLY|
20|FH_F97565_83301_0|SrvcGrp|73659|2022|PDM|9022.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F137530_0_0|SrvcGrp|107793|2022|PDM|23044.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F83995_16748_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HAPA WPA/NWPA 2018 LAB 100%|
20|FH_F134608_18017_0|SrvcGrp|103514|2022|PDM|110.00|99|0.00|ENDOMETRIAL SAMPLING BIOPSY|
20|FH_F31595_0_0|SrvcGrp|12856|2022|PDM|92.00|99|0.00|NURSING CARE|
20|FH_F148546_0_0|SrvcGrp|79720|2022|PDM|1000.00|99|0.00|ACUTE REHAB II|
20|FH_F124173_66215_0|SrvcGrp|29076|2022|PDM|25.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F134593_60007_0|SrvcGrp|14949|2022|PDM|110.00|99|0.00|HOME INFUSION|
20|FH_F145642_15108_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F133778_38119_0|SrvcGrp|22954|2022|PDM|94.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F87053_0_0|SrvcGrp|72992|2022|PDM|727.00|99|0.00|AEG 2|
20|FH_F133269_78624_0|SrvcGrp|73842|2022|PDM|195.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111847_70301_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|1042.00|99|0.00|AEG 3 (NO REV)|
20|FH_F91913_0_0|SrvcGrp|73004|2022|PDM|1200.00|99|0.00|AEG 8|
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117371_77059_0|SrvcGrp|88819|2022|PDM|795.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F139817_75119_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F95880_02726_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97761_04072_0|SrvcGrp|73602|2022|PDM|3772.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F68950_0_0|CSTM-ALL|CSTM-00|2020|PDM|753.62|99|0.00|ASPG I|
20|FH_F148553_85016_0|SrvcGrp|115450|2022|PDM|3121.00|99|0.00|REMOVE & REPLACE PM GEN MULTI LEADS|
20|FH_F122608_84123_0|SrvcGrp|76529|2022|PDM|112.00|99|0.00|HOSPICE RESPITE|
20|FH_F135747_76208_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|269.45|99|0.00|HAPA WPA-NWPA 2012-13 ASC 115 W/O REV|
20|FH_F146668_30189_0|SrvcGrp|113590|2022|PDM|4850.00|99|0.00|PART REMOVAL OF METATARSAL|
20|FH_F111601_15203_0|SrvcGrp|73841|2022|PDM|330.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F58252_0_0|SrvcGrp|48398|2022|PDM|31.25|99|0.00|PT SERVICES|
20|FH_F136536_46075_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F142333_28387_0|SrvcGrp|74668|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F97602_40121_0|SrvcGrp|73643|2022|PDM|853.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F148908_10710_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149378_44074_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F129504_02871_0|SrvcGrp|46104|2022|PDM|118.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F104840_32565_0|SrvcGrp|83677|2022|PCT|0.69|99|0.00|AETNA CARDIAC CATH|
20|FH_F117623_0_0|CSTM-ALL|CSTM-00|2020|PDM|115.00|99|0.00|BEHAVIORAL ID ASSESSMENT (HCFA)|
20|FH_F141050_46410_0|SrvcGrp|88621|2022|PDM|105.00|99|0.00|SKILLED NURSING LPN|
20|FH_F39549_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|NEWBORN NURSERY|
20|FH_F41035_0_0|SrvcGrp|107779|2022|PDM|910.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F91898_0_0|SrvcGrp|91753|2022|PDM|7500.00|99|0.00|AETNA MEDICAL MSDRG AND INTENSIVE CARE|
20|FH_F114792_48849_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136927_45690_0|SrvcGrp|29347|2022|PDM|16.50|99|0.00|HOME HEALTH AIDE|
20|FH_F148431_60523_0|SrvcGrp|104226|2022|PDM|105.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F133261_78041_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F97564_52246_0|SrvcGrp|90854|2022|PDM|2103.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F142991_43920_0|SrvcGrp|2067|2022|PDM|767.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F120089_0_0|SrvcGrp|75489|2022|PDM|840.00|99|0.00|AEG 6|
20|FH_F145328_90301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133510_26003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150880_90036_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F131371_0_0|SrvcGrp|108269|2022|PDM|17000.00|99|0.00|REVISE HIP JOINT COMPONENT|
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 8 (NO REV)|
20|FH_F148667_0_0|SrvcGrp|90365|2022|PDM|2856.00|99|0.00|REPAIR METACARPAL FRACTURE|
20|FH_F137748_95231_0|SrvcGrp|109057|2022|PCT|1.00|99|0.00|CARDIAC STUDIES|
20|FH_F36554_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132254_40207_0|SrvcGrp|86845|2022|PDM|50.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F97080_85122_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|OP SVCS|
20|FH_F92280_15090_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|HSS ASC|
20|FH_F124044_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F98000_59102_0|SrvcGrp|73656|2022|PDM|586.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F93740_0_0|SrvcGrp|91594|2022|PDM|7000.00|99|0.00|PACEMAKER/ACID INSERTION & LV PACING|
20|FH_F120871_14068_0|SrvcGrp|73842|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F126054_30022_0|SrvcGrp|91214|2022|PDM|30.00|99|0.00|MED NUTRITION|
20|FH_F109180_18015_0|SrvcGrp|91394|2022|PDM|123.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD HO)|
20|FH_F116024_13203_0|SrvcGrp|90643|2022|PDM|20.60|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F129754_0_0|CSTM-ALL|CSTM-00|2020|PDM|636.05|99|0.00|2005 ASPG GROUPER III|
20|FH_F60019_0_0|CSTM-ALL|CSTM-00|2020|PDM|1342.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133714_03570_0|SrvcGrp|472|2022|PDM|585.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F70984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119924_14070_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100742_00616_0|SrvcGrp|73485|2022|PDM|1437.00|99|0.00|AETNA REHAB|
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37937_0_0|SrvcGrp|11069|2022|PDM|100.00|99|0.00|OT SVCS|
20|FH_F116341_12180_0|SrvcGrp|89337|2022|PDM|607.00|99|0.00|DETOXIFICATION|
20|FH_F120294_46322_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116176_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F86332_75081_0|SrvcGrp|77223|2022|PDM|115.00|99|0.00|AETNA HOME INFUSION - S5520|
20|FH_F47963_0_0|SrvcGrp|14402|2022|PDM|44.00|99|0.00|HOME HEALTH AIDE|
20|FH_F100762_51104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130492_66212_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F94662_0_0|SrvcGrp|90478|2022|PDM|199.00|99|0.00|HOSPICE|
20|FH_F109240_21201_0|SrvcGrp|102987|2022|PDM|2055.00|99|0.00|PROTON TRMT, SIMPLE W/O COMP|
20|FH_F125935_44024_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F44701_0_0|CSTM-ALL|CSTM-00|2020|PDM|689.00|99|0.00|ASPG III|
20|FH_F91634_0_0|CSTM-ALL|CSTM-00|2020|PDM|636.00|99|0.00|AEG 2 (NO REV)|
20|FH_F47479_0_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F139676_76901_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F132711_0_0|SrvcGrp|104330|2022|PDM|1000.00|99|0.00|AETNA ACUTE REHAB II|
20|FH_F132849_0_0|SrvcGrp|3493|2022|PCT|0.63|99|0.00|PHARMACY SVCS|
20|FH_F37487_0_0|SrvcGrp|3611|2022|PCT|0.70|99|0.00|DURABLE MEDICAL EQUIPMENT|
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|493.00|99|0.00|AEG 2 (NO REV)|
20|FH_F127132_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F122377_91007_0|SrvcGrp|109057|2022|PCT|2.89|99|0.00|CARDIAC STUDIES|
20|FH_F37078_0_0|SrvcGrp|12496|2022|PDM|676.00|99|0.00|ACUTE REHABILITATION|
20|FH_F125695_52033_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111080_18103_0|SrvcGrp|86722|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F102948_43606_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F111186_15213_0|SrvcGrp|89149|2022|PDM|314.00|99|0.00|OP INTENSIVE|
20|FH_F143467_0_0|SrvcGrp|98524|2022|PDM|1424.00|99|0.00|EXCISION OF BONE CYST|
20|FH_F136490_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH|
20|FH_F90818_0_0|SrvcGrp|79595|2022|PDM|1625.00|99|0.00|CPT 45385|
20|FH_F41665_0_0|SrvcGrp|32402|2022|PCT|0.65|99|0.00|OCN F/S PRICING: POS FACILITY MOD 26 (RADIOLOGY)|
20|FH_F40043_0_0|CSTM-ALL|CSTM-00|2020|PDM|5990.00|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F147941_06023_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 246-247, 249 PTCA W/STENT|
20|FH_F149888_68506_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F100762_51104_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F38792_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F90874_0_0|SrvcGrp|94419|2022|PDM|843.00|99|0.00|PERITONEAL/CAPD/CCPD|
20|FH_F128402_80233_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128272_60640_0|SrvcGrp|29077|2022|PDM|25.00|99|0.00|HOME TRANSFUSION|
20|FH_F92091_0_0|SrvcGrp|89986|2022|PDM|1350.00|99|0.00|CORRECTION OF BUNION|
20|FH_F93557_15147_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F72183_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG IX - FH SW CUSTOM GROUPERS|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|LAB - RONL/HSOH|
20|FH_F86872_15215_0|SrvcGrp|22589|2022|PDM|45.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F135840_0_0|SrvcGrp|87186|2022|PDM|550.00|99|0.00|CPT 43242|
20|FH_F50703_0_0|SrvcGrp|27602|2022|PDM|943.38|99|0.00|SYNAGIS (100 MG)|
20|FH_F119379_0_0|SrvcGrp|107829|2022|PDM|1428.00|99|0.00|REMOVAL OF WRIST BONES|
20|FH_F143620_81504_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F148600_30328_0|SrvcGrp|83644|2022|PDM|4675.00|99|0.00|CPT 30465|
20|FH_F115616_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1030.00|99|0.00|AEG 2 (NO REV)|
20|FH_F122520_46383_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F115956_06516_0|SrvcGrp|471|2022|PDM|575.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F137334_90405_0|SrvcGrp|89149|2022|PDM|360.00|99|0.00|OP INTENSIVE|
20|FH_F97721_01053_0|SrvcGrp|88977|2022|PDM|6795.00|99|0.00|C-SECTION DELIVERY|
20|FH_F80711_0_0|SrvcGrp|42826|2022|PDM|60.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F119435_0_0|SrvcGrp|107793|2022|PDM|11795.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F119535_0_0|SrvcGrp|35058|2022|PDM|400.00|99|0.00|MRI - IP|
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_F131047_0_0|SrvcGrp|59656|2022|PCT|0.57|99|0.00|MAMMOGRAPHY|
20|FH_F72204_0_0|SrvcGrp|42974|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F73727_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F129549_01238_0|SrvcGrp|88621|2022|PDM|107.62|99|0.00|SKILLED NURSING LPN|
20|FH_F90653_0_0|SrvcGrp|47260|2022|PCT|0.70|99|0.00|IMPLANTS 274-276, 278  LINE LEVEL|
20|FH_F147586_44124_0|SrvcGrp|71666|2022|PDM|28000.00|99|0.00|CPT 63655|
20|FH_F147586_44124_0|SrvcGrp|107172|2022|PDM|2934.00|99|0.00|EXPLORE PARATHYROID GLANDS|
20|FH_F147414_92656_0|SrvcGrp|109798|2022|PCT|1.50|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F41809_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.00|99|0.00|AEG 6 (NO REV)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1503.41|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1402 W/O REV|
20|FH_F40554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F110240_0_0|SrvcGrp|91475|2022|PDM|743.00|99|0.00|UPPER GI ENDOSCOPY BIOPSY (HCFA)|
20|FH_F141870_85224_0|SrvcGrp|26868|2022|PDM|35.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F127412_15301_0|SrvcGrp|110733|2022|PDM|1640.00|99|0.00|VITREORETINAL SURGERIES|
20|FH_F119578_0_0|SrvcGrp|108081|2022|PDM|186.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKE|
20|FH_F51520_0_0|SrvcGrp|42830|2022|PDM|190.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F89563_29407_0|SrvcGrp|94738|2022|PCT|1.00|99|0.00|FLUZONE VACC IM (>=3 YRS)|
20|FH_F42938_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F31826_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143783_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F138873_0_0|CSTM-ALL|CSTM-00|2020|PDM|938.00|99|0.00|AEG 5  (NO REV)|
20|FH_F36584_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD KN|
20|FH_F136693_17754_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134760_32202_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F42837_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD AV|
20|FH_F132544_0_0|CSTM-ALL|CSTM-00|2020|PDM|1815.00|99|0.00|AEG 2 (NO REV)|
20|FH_F142779_64083_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117911_86403_0|SrvcGrp|48385|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37641_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F150024_08079_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F150024_08079_0|CSTM-ALL|CSTM-00|2020|PDM|832.00|99|0.00|AEG 10 (NO REV)|
20|FH_F102062_35447_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150530_63031_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88512_0_0|SrvcGrp|46505|2022|PCT|0.49|99|0.00|MS DRG 215-241,245, 250-265 CARDIAC /CCU SURG OTLR|
20|FH_F144471_19805_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146377_85007_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F89851_83854_0|SrvcGrp|82369|2022|PCT|1.80|99|0.00|AETNA LABORATORY|
20|FH_F148494_0_0|SrvcGrp|101280|2022|PDM|15500.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F38425_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|LPN HI TECH - HOURLY|
20|FH_F138054_0_0|SrvcGrp|48394|2022|PDM|67.63|99|0.00|SKILLED NURSING SERVICES|
20|FH_F68828_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|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_F149665_65689_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33199_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116145_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F114931_0_0|SrvcGrp|91568|2022|PDM|1850.00|99|0.00|REMOVE EXT HEM GROUPS = 2|
20|FH_F47659_0_0|SrvcGrp|941|2022|PCT|0.80|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F98820_81401_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F122276_83252_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F51276_0_0|SrvcGrp|24758|2022|PDM|19.00|99|0.00|HOME INJECTABLE THERAPY|
20|FH_F35685_0_0|SrvcGrp|6|2022|PCT|0.35|99|0.00|OP SURGERY|
20|FH_F109260_0_0|SrvcGrp|93433|2022|PDM|22278.90|99|0.00|PARTIAL HIP REPLACEMENT|
20|FH_F128401_44615_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40694_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|PROFESSIONAL SVCS|
20|FH_F32604_0_0|SrvcGrp|10545|2022|PDM|90.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F121533_26241_0|SrvcGrp|85017|2022|PCT|1.00|99|0.00|DME|
20|FH_F132735_97068_0|SrvcGrp|112076|2022|PDM|1100.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F109577_0_0|SrvcGrp|73523|2022|PDM|133.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|493.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 221 W/O REV|
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.24|99|0.00|AEG 2 (NO REV)|
20|FH_F89219_0_0|SrvcGrp|13228|2022|PDM|1423.00|99|0.00|CPT CODE 99284|
20|FH_F145708_89030_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134593_60007_0|SrvcGrp|21920|2022|PDM|48.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F141347_52807_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F99021_0_0|CSTM-ALL|CSTM-00|2020|PDM|829.00|99|0.00|AEG 6 (NO REV)|
20|FH_F145675_33761_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES|
20|FH_F103281_32086_0|CSTM-ALL|CSTM-00|2020|PDM|3818.00|99|0.00|AEG 8 (NO REV)|
20|FH_F44435_0_0|SrvcGrp|27347|2022|PDM|1850.00|99|0.00|CPT 58558|
20|FH_F117087_0_0|SrvcGrp|106267|2022|PDM|4185.00|99|0.00|NSL/SINS NDSC SPHN TISS RMVL|
20|FH_F148021_80907_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F73304_0_0|SrvcGrp|70339|2022|PDM|217.00|99|0.00|CHEMO ADMIN|
20|FH_F119602_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 7 (NO REV)|
20|FH_F47479_0_0|SrvcGrp|64716|2022|PDM|95.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F38848_0_0|SrvcGrp|10111|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F117550_0_0|SrvcGrp|72379|2022|PDM|37.60|99|0.00|SPEECH THERAPY|
20|FH_F106100_26651_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F43433_0_0|SrvcGrp|15326|2022|PCT|1.00|99|0.00|ER LEVEL IV|
20|FH_F42803_0_0|SrvcGrp|97|2022|PDM|1000.00|99|0.00|C-SECTION|
20|FH_F86855_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.90|99|0.00|OP SVCS|
20|FH_F40144_0_0|SrvcGrp|3016|2022|PCT|0.73|99|0.00|HEMODIALYSIS|
20|FH_F36943_0_0|CSTM-ALL|CSTM-00|2020|PDM|65.00|99|0.00|JAMES RIVER PT-OT-ST|
20|FH_F150520_0_0|CSTM-ALL|CSTM-00|2020|PDM|543.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
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_F40690_0_0|SrvcGrp|701|2022|PDM|1536.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F111042_99159_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F132512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F47600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120187_76522_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F33381_0_0|SrvcGrp|360|2022|PDM|1580.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F137457_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F91255_19401_0|SrvcGrp|73602|2022|PDM|2247.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F138611_0_0|SrvcGrp|97730|2022|PDM|14894.00|99|0.00|REVERSE HIP JOINT|
20|FH_F144011_60616_0|SrvcGrp|85652|2022|PDM|2091.00|99|0.00|MSDRG UNGROUPABLE 998-999|
20|FH_F39180_0_0|SrvcGrp|360|2022|PDM|1783.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F123324_0_0|SrvcGrp|16|2022|PDM|1711.00|99|0.00|ACUTE REHABILITATION|
20|FH_F120437_85202_0|SrvcGrp|103385|2022|PDM|181.20|99|0.00|MED NUTRITION, INDIV, INIT (HCFA)|
20|FH_F150841_84757_0|SrvcGrp|46903|2022|PDM|1300.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F124322_64131_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F39443_0_0|SrvcGrp|30348|2022|PDM|435.00|99|0.00|HAPA WPA ASC 304|
20|FH_F73342_0_0|SrvcGrp|21342|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD RR"|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|557.00|99|0.00|HAPA EPA ASC 3|
20|FH_F35730_0_0|SrvcGrp|11325|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F139167_42240_0|SrvcGrp|89149|2022|PDM|213.00|99|0.00|OP INTENSIVE|
20|FH_F148859_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F119376_0_0|SrvcGrp|73008|2022|PDM|612.00|99|0.00|AEG 10|
20|FH_F147422_84121_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F139824_24801_0|SrvcGrp|109057|2022|PCT|0.95|99|0.00|CARDIAC STUDIES|
20|FH_F149030_37919_0|CSTM-ALL|CSTM-00|2020|PDM|4243.60|99|0.00|AEG 8 (NO REV)|
20|FH_F89640_98133_0|CSTM-ALL|CSTM-00|2020|PCT|2.77|99|0.00|AETNA - APC GROUPER A|
20|FH_F90455_0_0|SrvcGrp|65645|2022|PDM|128.00|99|0.00|NURSING CARE IN HOME - S9123|
20|FH_F75944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|VERTICAL PLUS MRI MOD NU|
20|FH_F134676_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F122377_91007_0|SrvcGrp|36204|2022|PCT|0.00|99|0.00|ACUTE PSYCH|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|2126.00|99|0.00|ASPG IX|
20|FH_F151400_0_0|CSTM-ALL|CSTM-00|2020|PDM|2275.00|99|0.00|AEG 6 (NO REV)|
20|FH_F131234_32207_0|CSTM-ALL|CSTM-00|2020|PDM|896.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F70104_0_0|SrvcGrp|10540|2022|PDM|28.00|99|0.00|HOME HEALTH AIDE|
20|FH_F40182_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33851_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123505_64468_0|SrvcGrp|472|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F44582_0_0|SrvcGrp|30218|2022|PDM|6000.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F130747_0_0|SrvcGrp|103564|2022|PDM|5202.00|99|0.00|REPAIR FINGER TENDON|
20|FH_F121925_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F63095_0_0|CSTM-ALL|CSTM-00|2020|PDM|4310.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86991_15122_0|SrvcGrp|85486|2022|PDM|1900.00|99|0.00|VICTRECTOMY|
20|FH_F63235_0_0|SrvcGrp|72990|2022|PDM|931.00|99|0.00|AEG 1|
20|FH_F85213_02840_0|SrvcGrp|110427|2022|PDM|2119.90|99|0.00|TRAUMA TEAM LEVEL 1|
20|FH_F149219_01966_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F138050_52301_0|SrvcGrp|89417|2022|PDM|449.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F69708_0_0|SrvcGrp|14947|2022|PDM|118.00|99|0.00|HOME INFUSION|
20|FH_F145708_89030_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F110420_60649_0|SrvcGrp|103892|2022|PCT|1.06|99|0.00|AETNA CHEMO DRUGS|
20|FH_F93219_26354_0|SrvcGrp|48394|2022|PDM|16.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|1525.99|99|0.00|AEG 6 (NO REV)|
20|FH_F70883_0_0|SrvcGrp|9830|2022|PDM|66.00|99|0.00|OT SVCS|
20|FH_F130468_0_0|SrvcGrp|88157|2022|PDM|11776.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F32222_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143509_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F117225_0_0|CSTM-ALL|CSTM-00|2020|PDM|959.00|99|0.00|AEG 8 (NO REV)|
20|FH_F100161_17325_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120635_22903_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150939_0_0|SrvcGrp|100241|2022|PCT|0.00|99|0.00|IMMUNOLOGY|
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|1304.00|99|0.00|AEG 7 (NO REV)|
20|FH_F47605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F48295_0_0|SrvcGrp|44426|2022|PDM|52.00|99|0.00|NURSING CARE (VISIT LVL)|
20|FH_F138907_01040_0|SrvcGrp|80918|2022|PDM|170.00|99|0.00|RESPITE CARE|
20|FH_F138992_72703_0|CSTM-ALL|CSTM-00|2020|PDM|3501.00|99|0.00|AEG 8 (NO REV)|
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|ASPG III|
20|FH_F117715_0_0|SrvcGrp|75487|2022|PDM|1048.00|99|0.00|AEG 5|
20|FH_F151420_60654_0|SrvcGrp|27346|2022|PDM|2272.00|99|0.00|REPAIR BLADDER DEFECT|
20|FH_F151425_19111_0|SrvcGrp|114975|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F151501_30265_0|SrvcGrp|99169|2022|PDM|2090.00|99|0.00|CPT 28200|
20|FH_F132258_45404_0|SrvcGrp|14948|2022|PDM|43.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132258_45404_0|SrvcGrp|86831|2022|PDM|6.65|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F132268_07060_0|SrvcGrp|98009|2022|PDM|53.05|99|0.00|DEBRIDEMENT OPEN WOUND|
20|FH_F122038_34606_0|SrvcGrp|46903|2022|PDM|615.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F145528_76501_0|SrvcGrp|48394|2022|PDM|41.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F136003_19380_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136067_67037_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F100880_67735_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116397_33404_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F116467_13031_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128104_57702_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_F36479_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F101200_19020_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F143528_0_0|CSTM-ALL|CSTM-00|2020|PDM|2625.00|99|0.00|AEG 8 (NO REV)|
20|FH_F115020_67301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121118_06479_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148182_23324_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120362_23321_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F141527_36830_0|SrvcGrp|86846|2022|PDM|26.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F70104_0_0|SrvcGrp|66264|2022|PDM|4.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F47130_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|622.08|99|0.00|ASPG II|
20|FH_F149027_60402_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134604_64050_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133585_0_0|SrvcGrp|112383|2022|PDM|3092.00|99|0.00|INSERTION OF CANNULA|
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|644.00|99|0.00|AEG 4 (NO REV)|
20|FH_F84712_0_0|SrvcGrp|82752|2022|PDM|18.00|99|0.00|ASSAY BUN|
20|FH_F72963_0_0|SrvcGrp|20071|2022|PDM|1200.00|99|0.00|MS DRG 945-946|
20|FH_F111604_16505_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F134831_17331_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F70665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: ALL|
20|FH_F70665_0_0|SrvcGrp|3810|2022|PDM|180.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F151122_10462_0|SrvcGrp|46605|2022|PDM|121.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F151259_16505_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138745_29642_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150620_53402_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119376_0_0|SrvcGrp|72996|2022|PDM|756.00|99|0.00|AEG 4|
20|FH_F125182_0_0|SrvcGrp|79589|2022|PDM|1923.00|99|0.00|UPPER GI|
20|FH_F47037_0_0|SrvcGrp|10527|2022|PDM|103.00|99|0.00|HOSPICE SVCS|
20|FH_F39443_0_0|SrvcGrp|30364|2022|PDM|1319.00|99|0.00|HAPA WPA ASC 8|
20|FH_F112045_90301_0|SrvcGrp|20752|2022|PDM|28390.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|1726.00|99|0.00|AEG 9 (NO REV)|
20|FH_F110732_31513_0|SrvcGrp|72990|2022|PDM|696.00|99|0.00|AEG 1|
20|FH_F150982_0_0|SrvcGrp|101520|2022|PDM|2527.00|99|0.00|T1H W/T/O (<250G)|
20|FH_F140295_0_0|SrvcGrp|58634|2022|PDM|2157.00|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F132160_0_0|SrvcGrp|45583|2022|PDM|9754.00|99|0.00|CPT 65730|
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 3 (NO REV)|
20|FH_F140295_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|1111.00|99|0.00|AEG 8 (NO REV)|
20|FH_F50137_0_0|SrvcGrp|46249|2022|PDM|120.00|99|0.00|HOME VISIT STOMA/COLOSTOMY/CYSTOSTOMY CARE|
20|FH_F48315_0_0|CSTM-ALL|CSTM-00|2020|PDM|2149.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147941_06023_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F148892_0_0|SrvcGrp|103236|2022|PDM|19580.00|99|0.00|AETNA INSJ STABLJ DEV|
20|FH_F143528_0_0|SrvcGrp|107121|2022|PDM|1914.15|99|0.00|RECONSTRUCTION TONGUE FOLD|
20|FH_F123407_04605_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F77504_0_0|SrvcGrp|13854|2022|PDM|450.00|99|0.00|HYPERBARIC CHAMBER|
20|FH_F128159_45356_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F77722_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148205_75149_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38090_0_0|CSTM-ALL|CSTM-00|2020|PDM|1435.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128896_53209_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F127642_07047_0|SrvcGrp|33967|2022|PDM|3704.00|99|0.00|CPT 47562|
20|FH_F80224_0_0|SrvcGrp|360|2022|PDM|1543.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F121225_98902_0|SrvcGrp|45540|2022|PDM|201.60|99|0.00|PHYSICAL THERAPY|
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|328.00|99|0.00|AEG 10 (NO REV)|
20|FH_F150165_06032_0|SrvcGrp|11673|2022|PDM|3820.00|99|0.00|CPT 29888|
20|FH_F86836_0_0|SrvcGrp|1259|2022|PDM|4000.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F146466_21620_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133536_0_0|SrvcGrp|69967|2022|PDM|767.00|99|0.00|REMOVAL IMPLANTS|
20|FH_F136967_63877_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137147_75006_0|SrvcGrp|54924|2022|PDM|20475.00|99|0.00|MS DRG 493 ONLY|
20|FH_F125053_0_0|SrvcGrp|72998|2022|PDM|889.00|99|0.00|AEG 5|
20|FH_F139267_30253_0|SrvcGrp|113544|2022|PDM|45.52|99|0.00|COVID-19 SARS-COV-2 W/ OPTIC|
20|FH_F147725_06002_0|SrvcGrp|115167|2022|PDM|3557.00|99|0.00|MIDDLE EAR PROCEDURES|
20|FH_F131412_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146890_44115_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F117195_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS|
20|FH_F132544_0_0|SrvcGrp|97219|2022|PDM|8007.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON|
20|FH_F129535_0_0|SrvcGrp|75479|2022|PDM|315.00|99|0.00|AEG 1|
20|FH_F101806_0_0|SrvcGrp|75479|2022|PDM|368.00|99|0.00|AEG 1|
20|FH_F48224_0_0|SrvcGrp|72998|2022|PDM|848.00|99|0.00|AEG 5|
20|FH_F120866_51652_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F35685_0_0|SrvcGrp|4109|2022|PDM|1031.00|99|0.00|ACUTE PSYCH|
20|FH_F98625_08103_0|SrvcGrp|90854|2022|PDM|4023.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F34048_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100742_00616_0|SrvcGrp|73605|2022|PDM|1256.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F77762_0_0|SrvcGrp|43955|2022|PDM|120.00|99|0.00|NURSING CARE|
20|FH_F91332_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
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_F76171_0_0|CSTM-ALL|CSTM-00|2020|PDM|16.00|99|0.00|RN HIGH TECH HOURLY|
20|FH_F90818_0_0|SrvcGrp|89888|2022|PDM|4100.00|99|0.00|AETNA SUSPENSION OF TESTIS|
20|FH_F121444_47720_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121731_20164_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F121813_75701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F146125_0_0|SrvcGrp|86460|2022|PDM|2150.00|99|0.00|REVISE BREAST RECONSTRUCTION|
20|FH_F149271_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F36341_0_0|CSTM-ALL|CSTM-00|2020|PDM|945.00|99|0.00|ASPG II|
20|FH_F111301_33122_0|SrvcGrp|705|2022|PCT|0.63|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F111363_33169_0|SrvcGrp|99362|2022|PDM|158.00|99|0.00|DX MAMMO INCL CAD BI|
20|FH_F111383_62233_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F134257_62681_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140987_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 10 (NO REV)|
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_F145587_0_0|SrvcGrp|100661|2022|PDM|1262.70|99|0.00|AETNA OP SURGERY|
20|FH_F41780_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F131000_0_0|SrvcGrp|72121|2022|PDM|29806.00|99|0.00|ARTHOSCOPY|
20|FH_F87557_33309_0|SrvcGrp|24750|2022|PDM|30.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F123036_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129326_02026_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F101620_47401_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F103780_64804_0|SrvcGrp|11336|2022|PCT|0.69|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F93592_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 9 (NO REV)|
20|FH_F46196_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F123181_75057_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|AEG 2 (NO REV)|
20|FH_F128316_22192_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|807.00|99|0.00|AEG 3 (NO REV)|
20|FH_F133287_40215_0|SrvcGrp|99361|2022|PDM|151.00|99|0.00|DX MAMMO INCL CAD UNI|
20|FH_F135614_83642_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F32737_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93076_85016_0|SrvcGrp|75926|2022|PDM|649.37|99|0.00|OBSERVATION SERVICES|
20|FH_F85353_16407_0|SrvcGrp|63916|2022|PDM|113.97|99|0.00|HAPA WPA-NWPA 2012-13 ASC 244|
20|FH_F129509_0_0|SrvcGrp|72998|2022|PDM|1053.00|99|0.00|AEG 5|
20|FH_F138951_41101_0|SrvcGrp|24761|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F136359_0_0|SrvcGrp|77021|2022|PDM|6875.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F117627_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 3 (NO REV)|
20|FH_F146793_44236_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120811_53525_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F131706_72404_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132937_88201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F37772_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HEARING AIDS|
20|FH_F134087_0_0|SrvcGrp|41334|2022|PDM|10455.00|99|0.00|TOTAL KNEE|
20|FH_F134087_0_0|SrvcGrp|67064|2022|PDM|2195.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F62886_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|GENERAL ACUTE CARE|
20|FH_F53732_0_0|SrvcGrp|22588|2022|PDM|75.00|99|0.00|CHEMOTHERAPY|
20|FH_F140627_68651_0|SrvcGrp|75506|2022|PCT|0.96|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F142070_0_0|SrvcGrp|107747|2022|PDM|675.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F87201_0_0|SrvcGrp|42973|2022|PDM|100.00|99|0.00|SPEECH  THERAPIST|
20|FH_F135491_0_0|SrvcGrp|95819|2022|PDM|1956.00|99|0.00|GONIOTOMY|
20|FH_F132627_0_0|SrvcGrp|22593|2022|PDM|18.36|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F146674_70778_0|SrvcGrp|108484|2022|PDM|555.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F134687_14226_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F136914_64081_0|SrvcGrp|13595|2022|PDM|438.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F136914_64081_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F119888_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116383_63026_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F147331_90045_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F76286_16038_0|SrvcGrp|13985|2022|PDM|53.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F42397_0_0|CSTM-ALL|CSTM-00|2020|PDM|1288.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F69968_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (HCFA) INPATIENT|
20|FH_F142406_78840_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F51276_0_0|CSTM-ALL|CSTM-00|2020|PDM|80.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F138545_39503_0|SrvcGrp|89417|2022|PDM|733.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F129474_92701_0|SrvcGrp|108484|2022|PDM|1200.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F116043_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111925_0_0|SrvcGrp|28551|2022|PDM|1602.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F132627_0_0|SrvcGrp|78534|2022|PDM|0.35|99|0.00|AETNA MED RECORD|
20|FH_F114389_50131_0|SrvcGrp|105606|2022|PDM|8.50|99|0.00|DISPOSABLE FILTER (MOD NU)|
20|FH_F124414_92653_0|SrvcGrp|75419|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F138981_85123_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F136796_24016_0|SrvcGrp|82720|2022|PDM|2440.83|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F119444_72903_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F43652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133493_90255_0|SrvcGrp|12491|2022|PCT|0.25|99|0.00|PACEMAKER|
20|FH_F54552_0_0|SrvcGrp|17009|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132737_0_0|SrvcGrp|33793|2022|PDM|12757.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F77862_0_0|SrvcGrp|45540|2022|PDM|105.78|99|0.00|PHYSICAL THERAPY|
20|FH_F128333_71001_0|SrvcGrp|46605|2022|PDM|80.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|552.00|99|0.00|AEG 1 (NO REV)|
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)|
20|FH_F110925_01104_0|SrvcGrp|86138|2022|PDM|28.35|99|0.00|AETNA INJ LARONIDAS|
20|FH_F149720_81212_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F129782_0_0|SrvcGrp|45583|2022|PCT|1.00|99|0.00|CPT 65730|
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145508_0_0|SrvcGrp|29155|2022|PDM|181.21|99|0.00|HOSPICE SVCS|
20|FH_F87411_0_0|SrvcGrp|83880|2022|PDM|49.10|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F134218_20783_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|992.00|99|0.00|AEG 7 (NO REV)|
20|FH_F144808_0_0|SrvcGrp|41334|2022|PDM|7215.00|99|0.00|TOTAL KNEE|
20|FH_F126427_77082_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F103220_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F112004_15401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128825_45211_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F121303_15501_0|SrvcGrp|113177|2022|PCT|1.00|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - ASTRAZENECA|
20|FH_F150142_76018_0|SrvcGrp|91397|2022|PDM|90.00|99|0.00|AETNA PSYCH PT & FAMILY 45MINS (MOD HO)|
20|FH_F85995_64111_0|SrvcGrp|98663|2022|PDM|181.00|99|0.00|HOME VISIT NEW PATIENT|
20|FH_F110346_38501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F73967_0_0|SrvcGrp|12403|2022|PDM|640.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F146668_30189_0|CSTM-ALL|CSTM-00|2020|PDM|4500.00|99|0.00|AEG 9 (NO REV)|
20|FH_F123752_44502_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F118152_20151_0|SrvcGrp|86851|2022|PDM|35.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F109982_33592_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138543_60130_0|SrvcGrp|89149|2022|PDM|243.00|99|0.00|OP INTENSIVE|
20|FH_F40127_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F106822_0_0|SrvcGrp|100274|2022|PDM|40.50|99|0.00|TETANUS DIPHTHERIA TOXOI|
20|FH_F132988_0_0|SrvcGrp|104112|2022|PDM|5945.23|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F118909_0_0|SrvcGrp|97703|2022|PDM|123.60|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F81393_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F77944_0_0|SrvcGrp|16276|2022|PCT|0.28|99|0.00|HIGH COST DRUGS|
20|FH_F136667_23603_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114638_25309_0|SrvcGrp|73842|2022|PDM|193.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114666_30342_0|SrvcGrp|93069|2022|PDM|3424.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F40554_0_0|SrvcGrp|30941|2022|PDM|280.00|99|0.00|NEWBORN NURSERY|
20|FH_F69104_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|WEOC MRI|
20|FH_F126666_44053_0|SrvcGrp|86864|2022|PDM|83.00|99|0.00|AETNA PSYCH DIAGNOSITC EVALUATION (MOD TD)(HCFA)|
20|FH_F119530_0_0|SrvcGrp|75481|2022|PDM|725.00|99|0.00|AEG 2|
20|FH_F123872_75006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150949_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126769_43701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F64943_0_0|SrvcGrp|17275|2022|PDM|783.00|99|0.00|CHEMICAL DEPENDENCY - YOUTH|
20|FH_F117346_75093_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F112862_46176_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148761_33311_0|SrvcGrp|105022|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY EVALUATION (HCFA)|
20|FH_F122243_30655_0|SrvcGrp|89337|2022|PDM|875.00|99|0.00|DETOXIFICATION|
20|FH_F136037_0_0|SrvcGrp|89149|2022|PDM|233.00|99|0.00|OP INTENSIVE|
20|FH_F134655_14221_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F85353_16407_0|SrvcGrp|63897|2022|PDM|167.50|99|0.00|HAPA WPA-NWPA 2012-13 ASC 135|
20|FH_F111942_92647_0|SrvcGrp|66265|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F144228_0_0|SrvcGrp|64744|2022|PDM|926.00|99|0.00|CPT 45331|
20|FH_F110465_30328_0|SrvcGrp|86722|2022|PDM|297.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F85894_0_0|CSTM-ALL|CSTM-00|2020|PDM|1957.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101084_15459_0|SrvcGrp|75545|2022|PDM|340.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F126783_80021_0|SrvcGrp|87317|2022|PDM|1595.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F131853_24017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38805_0_0|SrvcGrp|29715|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F134087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140615_73013_0|SrvcGrp|72984|2022|PCT|1.35|99|0.00|CHEMOTHERAPY|
20|FH_F117214_84020_0|SrvcGrp|73605|2022|PDM|1100.00|99|0.00|AETNA ACUTE PSYCH|
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_F88933_0_0|SrvcGrp|87522|2022|PDM|3939.00|99|0.00|AETNA REPAIR OF KNEE LIGAMENT|
20|FH_F141336_16947_0|SrvcGrp|72984|2022|PDM|289.00|99|0.00|CHEMOTHERAPY|
20|FH_F124140_15214_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137447_0_0|SrvcGrp|106291|2022|PDM|257.25|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F43779_0_0|SrvcGrp|1121|2022|PCT|0.75|99|0.00|OP PTCA ANGIOPLASTY|
20|FH_F134672_44060_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F134693_92270_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F112371_19047_0|CSTM-ALL|CSTM-00|2020|PDM|2124.00|99|0.00|AEG 4 (NO REV)|
20|FH_F147443_06469_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F128031_0_0|SrvcGrp|110953|2022|PDM|4950.00|99|0.00|DECOMPRESSIONS & ADDITIONAL LEVEL FUSIONS|
20|FH_F133477_90247_0|CSTM-ALL|CSTM-00|2020|PDM|3462.00|99|0.00|AEG 5  (NO REV)|
20|FH_F81373_64064_0|CSTM-ALL|CSTM-00|2020|PDM|4814.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72980_0_0|SrvcGrp|13681|2022|PDM|363.25|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F69063_0_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F42159_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|255.55|99|0.00|HAPA WPA-NWPA 2012-13 ASC 310 W/O REV|
20|FH_F125023_45246_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97180_14604_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|566.76|99|0.00|ASPG 202|
20|FH_F114310_0_0|SrvcGrp|105490|2022|PDM|2050.00|99|0.00|KNEE ARTHROSCOPY PROCEDURES|
20|FH_F114974_0_0|SrvcGrp|83824|2022|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES|
20|FH_F117793_90405_0|SrvcGrp|74614|2022|PDM|550.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F126762_91311_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F129535_0_0|SrvcGrp|38364|2022|PDM|600.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F151141_24014_0|SrvcGrp|107794|2022|PDM|5465.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F31547_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.98|99|0.00|BIOFEEDBACK PERI/URO/RECTAL|
20|FH_F124383_39056_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F97084_91911_0|SrvcGrp|73601|2022|PDM|20200.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F150699_0_0|SrvcGrp|104635|2022|PDM|9727.00|99|0.00|INSERT PULSE GEN SNGL LEAD|
20|FH_F115081_37185_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F109320_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F78603_0_0|SrvcGrp|29755|2022|PDM|39699.86|99|0.00|MS DRG 245 ONLY|
20|FH_F145538_34997_0|SrvcGrp|108484|2022|PDM|621.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F67063_0_0|CSTM-ALL|CSTM-00|2020|PDM|1330.00|99|0.00|WELLPATH ASC VI|
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_F141802_17042_0|SrvcGrp|115664|2022|PDM|1051.00|99|0.00|CAT SCAN W/ER|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 649|
20|FH_F113682_0_0|SrvcGrp|17421|2022|PDM|497.81|99|0.00|INPATIENT MEDICAL|
20|FH_F126585_45039_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F123512_64089_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F126964_0_0|SrvcGrp|82981|2022|PDM|158.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F130908_32708_0|SrvcGrp|46903|2022|PDM|645.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F96780_0_0|SrvcGrp|38909|2022|PDM|1761.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F110223_31750_0|SrvcGrp|90101|2022|PDM|0.10|99|0.00|AETNA MED RECORD COPY|
20|FH_F42366_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|99|0.00|OP SVCS|
20|FH_F43197_0_0|SrvcGrp|11080|2022|PDM|80.00|99|0.00|NURSING CARE|
20|FH_F131613_0_0|SrvcGrp|79720|2022|PDM|1250.00|99|0.00|ACUTE REHAB II|
20|FH_F132925_84041_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F138056_64055_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F133972_27103_0|SrvcGrp|86852|2022|PDM|35.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F144848_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|2771.00|99|0.00|AEG 6 (NO REV)|
20|FH_F150939_0_0|SrvcGrp|100274|2022|PDM|40.50|99|0.00|TETANUS DIPHTHERIA TOXOI|
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|729.00|99|0.00|AEG 3 (NO REV)|
20|FH_F47462_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F48693_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F50459_0_0|SrvcGrp|43892|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F54552_0_0|SrvcGrp|24745|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F112947_47303_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113585_20155_0|SrvcGrp|14947|2022|PDM|5.00|99|0.00|HOME INFUSION|
20|FH_F113390_0_0|SrvcGrp|79586|2022|PDM|1320.00|99|0.00|CPT 43200|
20|FH_F143832_0_0|SrvcGrp|104098|2022|PDM|3102.72|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|AEG 5  (NO REV)|
20|FH_F84139_0_0|SrvcGrp|3259|2022|PDM|800.00|99|0.00|ACUTE REHABILITATION|
20|FH_F151441_98664_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151511_14094_0|CSTM-ALL|CSTM-00|2020|PDM|2931.99|99|0.00|AEG 9 (NO REV)|
20|FH_F151511_14094_0|CSTM-ALL|CSTM-00|2020|PDM|1373.93|99|0.00|AEG 2 (NO REV)|
20|FH_F122168_66214_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133119_46545_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135389_43123_0|SrvcGrp|108484|2022|PDM|677.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F97143_80012_0|SrvcGrp|73461|2022|PDM|14082.00|99|0.00|AETNA NICU IV|
20|FH_F135983_22030_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130756_04901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F116397_33404_0|SrvcGrp|29023|2022|PDM|47.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116464_13088_0|SrvcGrp|104080|2022|PCT|1.05|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F116527_70443_0|SrvcGrp|72992|2022|PDM|1000.00|99|0.00|AEG 2|
20|FH_F127399_0_0|SrvcGrp|88740|2022|PDM|2601.00|99|0.00|SP BONE ALGRFT|
20|FH_F121763_07202_0|SrvcGrp|90635|2022|PDM|101.00|99|0.00|AETNA PSYTX PT & FAMILY 60 MINUTES|
20|FH_F68309_0_0|CSTM-ALL|CSTM-00|2020|PDM|557.00|99|0.00|AEG 2 (NO REV)|
20|FH_F111292_33136_0|SrvcGrp|11663|2022|PCT|0.63|99|0.00|IMPLANTS|
20|FH_F47906_0_0|SrvcGrp|43841|2022|PCT|1.00|99|0.00|DME MOD RRKC|
20|FH_F115943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F43801_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F132328_0_0|SrvcGrp|11673|2022|PDM|3715.00|99|0.00|CPT 29888|
20|FH_F132328_0_0|CSTM-ALL|CSTM-00|2020|PDM|1701.00|99|0.00|AEG 4 (NO REV)|
20|FH_F72666_0_0|SrvcGrp|828|2022|PDM|7187.00|99|0.00|CARDIAC CATH ABLATIONS|
20|FH_F62092_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39121_0_0|SrvcGrp|34882|2022|PCT|1.00|99|0.00|IMPLANTS (HEART TRANSPLANT)|
20|FH_F120089_0_0|SrvcGrp|75495|2022|PDM|1440.00|99|0.00|AEG 9|
20|FH_F139825_0_0|SrvcGrp|109767|2022|PDM|2869.00|99|0.00|COVER EYE W/ MEMBRANE INCIDENTAL CODES|
20|FH_F36207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38016_0_0|SrvcGrp|18140|2022|PDM|3245.00|99|0.00|MS DRG 246|
20|FH_F72750_0_0|CSTM-ALL|CSTM-00|2020|PDM|1325.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F132541_39120_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133131_30253_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148761_33311_0|SrvcGrp|99460|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY EVALUATION|
20|FH_F139172_40207_0|SrvcGrp|16069|2022|PDM|643.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F150770_43113_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F40644_0_0|SrvcGrp|10107|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F127553_44321_0|SrvcGrp|95661|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F131292_37650_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F90817_0_0|SrvcGrp|91027|2022|PDM|2444.00|99|0.00|AETNA LAPAR HERNIA REPAIR (HCFA)|
20|FH_F115269_0_0|SrvcGrp|89417|2022|PDM|375.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F111857_68005_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F139928_37228_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 5  (NO REV)|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|66.50|99|0.00|HAPA WPA-NWPA 2012-13 ASC 246 W/O REV|
20|FH_F132868_43551_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F46832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|HOME INFUSION (HYDRATION THERAPY)|
20|FH_F142207_62237_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138575_66053_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F117153_34113_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F90791_79106_0|SrvcGrp|27969|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE|
20|FH_F129713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114389_50131_0|SrvcGrp|88828|2022|PDM|48.28|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F146807_28655_0|SrvcGrp|114014|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F91998_0_0|SrvcGrp|89946|2022|PDM|1750.00|99|0.00|REPAIR OF KNEE LIGAMENT|
20|FH_F119725_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136914_64081_0|SrvcGrp|48394|2022|PDM|48.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F147700_21401_0|CSTM-ALL|CSTM-00|2020|PDM|1359.00|99|0.00|AEG 8 (NO REV)|
20|FH_F124928_04210_0|SrvcGrp|94780|2022|PDM|144.58|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F57592_0_0|SrvcGrp|39871|2022|PCT|0.72|99|0.00|MS DRG 619-621 ONLY OTLR|
20|FH_F106540_26330_0|SrvcGrp|67279|2022|PDM|30308.00|99|0.00|CERVICAL SURGERY|
20|FH_F66541_0_0|CSTM-ALL|CSTM-00|2020|PCT|30000.00|99|0.00|HEMO/HOME DIALYSIS SVCS|
20|FH_F132934_63005_0|SrvcGrp|104569|2022|PDM|901.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F135708_61401_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|281.00|99|0.00|ADOLESCENT PSYCH FULL DAY (8-12 HRS)|
20|FH_F120437_85202_0|SrvcGrp|17008|2022|PDM|69.79|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS|
20|FH_F117087_0_0|SrvcGrp|106266|2022|PDM|4185.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT|
20|FH_F133350_39532_0|SrvcGrp|89337|2022|PDM|2000.00|99|0.00|DETOXIFICATION|
20|FH_F120154_77498_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F81456_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35167_0_0|SrvcGrp|290|2022|PDM|8993.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F75344_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F127143_68716_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PDM|1115.00|99|0.00|ASPG 8 SURGICAL EYE CENTER|
20|FH_F139877_32615_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F122649_0_0|SrvcGrp|80918|2022|PDM|112.00|99|0.00|RESPITE CARE|
20|FH_F139951_92870_0|SrvcGrp|111348|2022|PCT|1.30|99|0.00|OP THERAPY SERVICES|
20|FH_F125876_78254_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35259_0_0|SrvcGrp|30620|2022|PCT|0.66|99|0.00|CARDIAC ABLATIONS|
20|FH_F120248_77008_0|SrvcGrp|86722|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F125891_45219_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128445_85704_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F47857_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.00|99|0.00|CD DAY TREATMENT|
20|FH_F87155_04105_0|SrvcGrp|17016|2022|PDM|68.29|99|0.00|HOME INFUSION THERAPY|
20|FH_F44607_0_0|SrvcGrp|3066|2022|PCT|0.50|99|0.00|HIGH-COST DRUGS|
20|FH_F97041_71603_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F120437_85202_0|SrvcGrp|14947|2022|PDM|23.64|99|0.00|HOME INFUSION|
20|FH_F101840_76054_0|SrvcGrp|73006|2022|PDM|3842.00|99|0.00|AEG 9|
20|FH_F132601_92677_0|SrvcGrp|89337|2022|PDM|1800.00|99|0.00|DETOXIFICATION|
20|FH_F139666_26175_0|SrvcGrp|113577|2022|PCT|1.50|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F114848_50533_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F139694_42718_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146266_0_0|SrvcGrp|99167|2022|PDM|6571.00|99|0.00|CPT 63057|
20|FH_F74648_0_0|CSTM-ALL|CSTM-00|2020|PCT|44.00|99|0.00|OP SVCS|
20|FH_F76826_0_0|SrvcGrp|75121|2022|PDM|116.00|99|0.00|CARDIAC REHAB|
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|792.00|99|0.00|AEG 5  (NO REV)|
20|FH_F150323_68847_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131389_33169_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F111086_29501_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F139807_33064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48937_0_0|SrvcGrp|29303|2022|PDM|65.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F71268_0_0|SrvcGrp|60|2022|PDM|3200.00|99|0.00|NEWBORN NURSERY - LEVEL II|
20|FH_F83031_0_0|SrvcGrp|44704|2022|PDM|105.00|99|0.00|NURSING CARE|
20|FH_F72859_0_0|SrvcGrp|10582|2022|PDM|100.00|99|0.00|UNCLASSIFIED HOME INJECTABLES|
20|FH_F114931_0_0|SrvcGrp|78911|2022|PDM|3200.00|99|0.00|LAPARO HERNIA REPAIR RECUR|
20|FH_F37328_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|SOUTH CARE MRI|
20|FH_F41317_0_0|SrvcGrp|3029|2022|PDM|265.00|99|0.00|NEWBORN NURSERY|
20|FH_F36683_0_0|SrvcGrp|18247|2022|PDM|5017.00|99|0.00|MS DRG 286|
20|FH_F140143_24874_0|SrvcGrp|106291|2022|PDM|219.93|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|COVENTRY ENHANCED GROUPER 2 MOD 50|
20|FH_F45798_0_0|SrvcGrp|4109|2022|PDM|1224.00|99|0.00|ACUTE PSYCH|
20|FH_F117762_0_0|SrvcGrp|89856|2022|PDM|5720.00|99|0.00|LAMIN EXCIS EXTRADURAL LUMB|
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|180.00|99|0.00|AETNA BEHAVIORAL ID ASSESSMENT|
20|FH_F147237_40006_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151043_71901_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F48857_0_0|CSTM-ALL|CSTM-00|2020|PDM|110.00|99|0.00|OP SVCS|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|SKILLED NURSING SERVICES (15 MINS)|
20|FH_F120191_91360_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F132414_30571_0|SrvcGrp|46903|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F89563_29407_0|SrvcGrp|103325|2022|PCT|1.00|99|0.00|OT EVAL MOD COMPLEX 45 MIN|
20|FH_F131965_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101607_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)|
20|FH_F67121_0_0|SrvcGrp|44883|2022|PDM|18.00|99|0.00|RT/PT/ST/OT|
20|FH_F110925_01104_0|SrvcGrp|37385|2022|PDM|1.06|99|0.00|AMINO ACIDS|
20|FH_F151524_84121_0|SrvcGrp|90854|2022|PDM|896.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F151523_86333_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F37443_0_0|SrvcGrp|23929|2022|PCT|0.45|99|0.00|HIGH COST DRUGS|
20|FH_F128333_71001_0|SrvcGrp|27969|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE|
20|FH_F105581_19053_0|SrvcGrp|48385|2022|PDM|130.00|99|0.00|SPEECH THERAPY|
20|FH_F133376_33414_0|SrvcGrp|46903|2022|PDM|609.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132988_0_0|SrvcGrp|112155|2022|PDM|2057.62|99|0.00|PIN HAND DISLOCATION|
20|FH_F38233_0_0|SrvcGrp|474|2022|PDM|225.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F100703_0_0|SrvcGrp|97299|2022|PDM|7876.00|99|0.00|REMOVE SPINE ELTRD PLATE|
20|FH_F124628_33064_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97083_90670_0|CSTM-ALL|CSTM-00|2020|PCT|0.23|99|0.00|OP SVCS|
20|FH_F134760_32202_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136772_89109_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F113713_17013_0|SrvcGrp|86870|2022|PDM|62.00|99|0.00|AETNA OFFICE OP VISIT EST (MOD TD) (HCFA)|
20|FH_F146250_67601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46196_0_0|SrvcGrp|40696|2022|PDM|85.00|99|0.00|SPEECH THERAPY MOD 59|
20|FH_F150882_84041_0|SrvcGrp|48385|2022|PDM|109.00|99|0.00|SPEECH THERAPY|
20|FH_F90817_0_0|SrvcGrp|91019|2022|PDM|1692.00|99|0.00|EXPLORE/DRAIN EYE SOCKET (HCFA)|
20|FH_F36323_0_0|SrvcGrp|473|2022|PDM|395.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F117762_0_0|SrvcGrp|99161|2022|PDM|14560.00|99|0.00|CPT 27138|
20|FH_F102542_0_0|SrvcGrp|8950|2022|PDM|1450.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F51276_0_0|SrvcGrp|22588|2022|PDM|75.00|99|0.00|CHEMOTHERAPY|
20|FH_F72887_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F77762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F141795_89509_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F77883_0_0|SrvcGrp|113846|2022|PDM|220.65|99|0.00|HOSPICE|
20|FH_F132190_0_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F131190_21042_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F129653_0_0|SrvcGrp|73006|2022|PDM|3250.00|99|0.00|AEG 9|
20|FH_F139551_0_0|SrvcGrp|54943|2022|PDM|3921.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|ASPG IV|
20|FH_F115616_0_0|CSTM-ALL|CSTM-00|2020|PDM|1665.00|99|0.00|AEG 2 (NO REV)|
20|FH_F133877_84117_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F103320_0_0|SrvcGrp|73002|2022|PDM|1460.00|99|0.00|AEG 7|
20|FH_F126157_34210_0|SrvcGrp|73841|2022|PDM|389.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|113.91|99|0.00|HAPA WPA-NWPA 2012-13 ASC 317 W/O REV|
20|FH_F119379_0_0|SrvcGrp|107845|2022|PDM|764.00|99|0.00|REVISE FINGER/TOE NERVE|
20|FH_F71685_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MS DRG UNGROUPABLE INPATIENT|
20|FH_F103320_0_0|SrvcGrp|73006|2022|PDM|2158.00|99|0.00|AEG 9|
20|FH_F87577_80016_0|SrvcGrp|39870|2022|PDM|13838.00|99|0.00|MS DRG 619-621 ONLY|
20|FH_F106880_80528_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F115312_78550_0|SrvcGrp|89417|2022|PDM|455.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F146212_57108_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F65359_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SURGERY|
20|FH_F92648_90248_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133021_00910_0|SrvcGrp|13741|2022|PDM|500.00|99|0.00|GASTROINTESTINAL PROCEDURES|
20|FH_F41696_0_0|CSTM-ALL|CSTM-00|2020|PDM|268.00|99|0.00|CD DAY TREATMENT|
20|FH_F151200_10001_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F116806_0_0|CSTM-ALL|CSTM-00|2020|PDM|530.00|99|0.00|AEG 10 (NO REV)|
20|FH_F98880_50158_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F90817_0_0|SrvcGrp|91022|2022|PDM|1057.00|99|0.00|REVISE EXTERNAL EAR (HCFA)|
20|FH_F127418_0_0|SrvcGrp|89847|2022|PDM|14873.91|99|0.00|REMOVE SPINE FIXATION DEVICE|
20|FH_F73923_0_0|CSTM-ALL|CSTM-00|2020|PDM|383.00|99|0.00|AEG 1 (NO REV)|
20|FH_F124727_0_0|SrvcGrp|108180|2022|PDM|425.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F126884_28379_0|SrvcGrp|89149|2022|PDM|140.00|99|0.00|OP INTENSIVE|
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|685.00|99|0.00|AEG 4 (NO REV)|
20|FH_F41776_0_0|CSTM-ALL|CSTM-00|2020|PDM|6714.00|99|0.00|ASPG IX|
20|FH_F128190_45342_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F149047_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F73985_0_0|SrvcGrp|29817|2022|PDM|5315.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F147212_0_0|SrvcGrp|13722|2022|PDM|155.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE|
20|FH_F90818_0_0|SrvcGrp|89885|2022|PDM|4100.00|99|0.00|AETNA REPAIR HERNIA|
20|FH_F35344_0_0|SrvcGrp|9487|2022|PDM|6644.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F127567_44070_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F93880_95476_0|SrvcGrp|92825|2022|PCT|0.70|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F62773_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94942_0_0|SrvcGrp|73002|2022|PDM|1344.15|99|0.00|AEG 7|
20|FH_F139241_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F143829_74066_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F37330_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73985_0_0|SrvcGrp|17069|2022|PDM|1806.00|99|0.00|ASPG III|
20|FH_F139551_0_0|SrvcGrp|27402|2022|PDM|3927.00|99|0.00|LASER PROCEDURES|
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PDM|1377.00|99|0.00|AEG 8 (NO REV)|
20|FH_F142930_0_0|SrvcGrp|80920|2022|PDM|100.00|99|0.00|HOSPICE SERVICES|
20|FH_F68251_0_0|SrvcGrp|43892|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F150165_06032_0|SrvcGrp|65403|2022|PDM|2758.00|99|0.00|CPT 42830|
20|FH_F149304_64137_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F85995_64111_0|SrvcGrp|98662|2022|PDM|181.00|99|0.00|HOME VISIT NEW PATIENT|
20|FH_F116849_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F149148_15330_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F114941_0_0|SrvcGrp|82981|2022|PDM|124.84|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F110305_70403_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F84712_0_0|SrvcGrp|78180|2022|PDM|473.00|99|0.00|AETNA RESIDENTIAL TREATMENT|
20|FH_F115814_53235_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133536_0_0|CSTM-ALL|CSTM-00|2020|PDM|1420.00|99|0.00|AEG 4 (NO REV)|
20|FH_F142403_65201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77782_66061_0|SrvcGrp|47443|2022|PCT|0.80|99|0.00|MS DRG 280-282 ONLY|
20|FH_F139456_47501_0|SrvcGrp|105465|2022|PDM|150.00|99|0.00|AETNA THERAPIES|
20|FH_F117240_37334_0|SrvcGrp|105480|2022|PCT|1.45|99|0.00|RADIOLOGY SERVICES|
20|FH_F40127_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F110000_0_0|SrvcGrp|33827|2022|PDM|1749.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 5|
20|FH_F141336_16947_0|SrvcGrp|75506|2022|PCT|0.55|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F77944_0_0|SrvcGrp|21359|2022|PDM|39508.00|99|0.00|MS DRG 460 ONLY|
20|FH_F101702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F134734_90068_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F135747_76208_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F112268_19087_0|SrvcGrp|73701|2022|PDM|26.25|99|0.00|AETNA - SKILLED NURSING|
20|FH_F116199_75042_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F147362_33137_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119825_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F59274_0_0|SrvcGrp|17140|2022|PDM|140.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F113288_38104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128390_0_0|SrvcGrp|63297|2022|PDM|115.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F38700_0_0|SrvcGrp|18809|2022|PCT|0.80|99|0.00|MS DRG 219|
20|FH_F72859_0_0|SrvcGrp|15478|2022|PDM|117.63|99|0.00|OCCUPATIONAL THERAPY SVCS INITIAL EVAL|
20|FH_F142847_07003_0|SrvcGrp|113994|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F79584_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F118704_0_0|SrvcGrp|107747|2022|PDM|1141.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F103281_32086_0|CSTM-ALL|CSTM-00|2020|PDM|3528.00|99|0.00|AEG 6 (NO REV)|
20|FH_F121329_33015_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121338_37756_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F150719_30012_0|SrvcGrp|92502|2022|PDM|901.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F150760_44833_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147339_08837_0|SrvcGrp|77021|2022|PDM|3500.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F39082_0_0|CSTM-ALL|CSTM-00|2020|PDM|35043.00|99|0.00|MS DRG 231-232|
20|FH_F122396_90024_0|SrvcGrp|73605|2022|PDM|1428.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|393.25|99|0.00|AEG 1 (NO REV)|
20|FH_F37267_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F114206_37203_0|SrvcGrp|86837|2022|PDM|15.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F116698_07470_0|SrvcGrp|26868|2022|PDM|39.90|99|0.00|DIURETIC IV THERAPY|
20|FH_F131207_19947_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F126581_45638_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F132374_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F148700_0_0|SrvcGrp|98701|2022|PDM|611.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F116188_72211_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F131254_92211_0|SrvcGrp|86842|2022|PDM|30.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F127375_28621_0|SrvcGrp|73500|2022|PDM|419.00|99|0.00|AETNA ER LEVEL I|
20|FH_F83812_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40089_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F140988_22041_0|SrvcGrp|87077|2022|PDM|122.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F112092_46845_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F88831_84123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101620_47401_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F101320_26062_0|SrvcGrp|48398|2022|PDM|30.00|99|0.00|PT SERVICES|
20|FH_F148492_28027_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147995_67037_0|CSTM-ALL|CSTM-00|2020|PDM|3015.00|99|0.00|AEG 5  (NO REV)|
20|FH_F145884_72113_0|SrvcGrp|16069|2022|PDM|670.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F121168_0_0|SrvcGrp|97704|2022|PDM|100.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F141870_85224_0|SrvcGrp|86122|2022|PCT|0.68|99|0.00|AETNA GAMMAGARD LIQUID INJ|
20|FH_F120390_91316_0|SrvcGrp|46903|2022|PDM|1600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F33497_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F117450_63131_0|SrvcGrp|23683|2022|PDM|58.65|99|0.00|SKILLED NURSING RN|
20|FH_F114310_0_0|SrvcGrp|55071|2022|PDM|2050.00|99|0.00|ARTHROSCOPY SHOULDER|
20|FH_F37970_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.06|99|0.00|2008 Q1 AWP F/S|
20|FH_F66406_0_0|SrvcGrp|33166|2022|PDM|500.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F117531_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F114525_72401_0|SrvcGrp|46903|2022|PDM|500.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F71049_0_0|SrvcGrp|20072|2022|PDM|1345.00|99|0.00|MS DRG 880-887, 894-897|
20|FH_F146124_06112_0|SrvcGrp|74581|2022|PCT|0.32|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F111986_0_0|SrvcGrp|83839|2022|PDM|3811.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F129101_27006_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|322.44|99|0.00|HAPA WPA-NWPA 2012-13 ASC 110 W/O REV|
20|FH_F70684_0_0|SrvcGrp|47183|2022|PDM|105.45|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F75842_0_0|SrvcGrp|13774|2022|PDM|1224.93|99|0.00|SKILLED NURSING CARE|
20|FH_F58252_0_0|SrvcGrp|46424|2022|PDM|31.25|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F136544_06426_0|SrvcGrp|471|2022|PDM|655.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138108_47130_0|SrvcGrp|88905|2022|PDM|999.00|99|0.00|PSYCHIATRIC CARE (AGE 0-17)|
20|FH_F117552_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F117217_80304_0|SrvcGrp|74668|2022|PDM|270.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F110381_0_0|SrvcGrp|89981|2022|PDM|2332.00|99|0.00|SHOULDER ARTHROSCOPY / SURGERY|
20|FH_F111662_80601_0|SrvcGrp|472|2022|PDM|433.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F138545_39503_0|SrvcGrp|90854|2022|PDM|1102.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F80284_16354_0|SrvcGrp|76010|2022|PDM|328.00|99|0.00|EMERGENCY ROOM SVCS LEVEL III|
20|FH_F118943_64506_0|SrvcGrp|24745|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F70665_0_0|SrvcGrp|42829|2022|PDM|68.00|99|0.00|RESPIRATORY THERAPY VISIT|
20|FH_F147801_90703_0|SrvcGrp|89149|2022|PDM|329.00|99|0.00|OP INTENSIVE|
20|FH_F147839_33983_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124438_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_F145784_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 3 (NO REV)|
20|FH_F147586_44124_0|CSTM-ALL|CSTM-00|2020|PDM|1363.00|99|0.00|AEG 10 (NO REV)|
20|FH_F133474_0_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F38425_0_0|SrvcGrp|10407|2022|PDM|55.00|99|0.00|HOME INFUSION|
20|FH_F117795_36272_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133018_84037_0|SrvcGrp|43568|2022|PDM|60.00|99|0.00|SKILLED NURSING - RN|
20|FH_F36363_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F118025_60641_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F80952_45669_0|CSTM-ALL|CSTM-00|2020|PDM|844.68|99|0.00|AEG 3 (NO REV)|
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|523.00|99|0.00|AEG 10 (NO REV)|
20|FH_F68828_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135711_61401_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|84.43|99|0.00|HAPA WPA-NWPA 2012-13 ASC 145 W/O REV|
20|FH_F120437_85202_0|SrvcGrp|86834|2022|PDM|33.77|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F148886_60621_0|SrvcGrp|88978|2022|PDM|1531.00|99|0.00|VAGINAL DELIVERY|
20|FH_F147159_62615_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37181_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126116_0_0|SrvcGrp|107544|2022|PDM|6730.00|99|0.00|ILIAC REVASC W/ STENT|
20|FH_F31547_0_0|SrvcGrp|9832|2022|PDM|90.29|99|0.00|ST SVCS|
20|FH_F116753_0_0|SrvcGrp|103929|2022|PDM|299.00|99|0.00|SLEEP STUDY UNATTENDED RESPIRATORY EFFORT(HCFA)|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|364.00|99|0.00|HAPA EPA ASC 1|
20|FH_F90817_0_0|SrvcGrp|91012|2022|PDM|2280.00|99|0.00|ARTHROSCOPIC FRACTURE TX (HCFA)|
20|FH_F131356_19131_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150922_02452_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120851_66112_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120961_66615_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F77544_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F34241_0_0|SrvcGrp|184|2022|PDM|1450.00|99|0.00|MEDICAL INTENSIVE CARE|
20|FH_F116281_19013_0|SrvcGrp|33977|2022|PDM|515.00|99|0.00|CPT 59820|
20|FH_F44177_0_0|SrvcGrp|9774|2022|PDM|2030.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F38377_0_0|SrvcGrp|10644|2022|PDM|80.00|99|0.00|MIDLINE INSERTION NURSING|
20|FH_F82173_72712_0|SrvcGrp|2738|2022|PCT|0.53|99|0.00|IMPLANTS|
20|FH_F123466_93420_0|SrvcGrp|87317|2022|PDM|1200.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F39855_0_0|SrvcGrp|701|2022|PDM|1803.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F130523_04605_0|SrvcGrp|73806|2022|PCT|0.84|99|0.00|AETNA ER|
20|FH_F128108_49505_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102302_0_0|SrvcGrp|87119|2022|PDM|8250.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F38085_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143786_78746_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142332_0_0|SrvcGrp|73523|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F130725_33020_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149079_70809_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146543_89511_0|SrvcGrp|3178|2022|PDM|1061.00|99|0.00|ACUTE PSYCH|
20|FH_F133972_27103_0|SrvcGrp|86846|2022|PDM|30.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F117206_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F116473_0_0|SrvcGrp|11673|2022|PDM|2200.00|99|0.00|CPT 29888|
20|FH_F85651_33549_0|SrvcGrp|38007|2022|PDM|825.00|99|0.00|CPT CODE 59425|
20|FH_F117225_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F120639_73078_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F120688_68124_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F114853_0_0|SrvcGrp|89840|2022|PDM|7699.00|99|0.00|THORAX SPINE FUSION|
20|FH_F41989_0_0|CSTM-ALL|CSTM-00|2020|PDM|179.00|99|0.00|CD SVCS (ADULT)|
20|FH_F138774_74133_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138936_01040_0|SrvcGrp|67944|2022|PDM|489.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F138970_62920_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F73204_0_0|SrvcGrp|12403|2022|PDM|35.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F81823_0_0|SrvcGrp|66481|2022|PDM|75.00|99|0.00|SOCIAL WORKER|
20|FH_F89580_0_0|SrvcGrp|88423|2022|PCT|1.00|99|0.00|OP REFERENCE LABORATORY (MOD 90)|
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1560.60|99|0.00|AEG 4 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|383.86|99|0.00|HAPA WPA-NWPA 2012-13 ASC 110 W/O REV|
20|FH_F125206_0_0|CSTM-ALL|CSTM-00|2020|PDM|3157.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F151512_27587_0|SrvcGrp|90488|2022|PCT|1.06|99|0.00|ORAL FUNCTION THERAPY|
20|FH_F132268_07060_0|SrvcGrp|88857|2022|PDM|39.28|99|0.00|THERAPEUTIC ACTIVITIES|
20|FH_F122103_62548_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F42492_0_0|SrvcGrp|25004|2022|PDM|499.00|99|0.00|DIALYSIS SVCS|
20|FH_F135473_33759_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135583_17331_0|CSTM-ALL|CSTM-00|2020|PDM|6937.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135583_17331_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F91764_93710_0|CSTM-ALL|CSTM-00|2020|PDM|2470.00|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F135948_60471_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136150_73068_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F136186_46307_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131228_01826_0|SrvcGrp|86699|2022|PDM|620.16|99|0.00|ECHO TRANSESOPHAGEAL 6|
20|FH_F130547_85712_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116527_70443_0|SrvcGrp|102419|2022|PDM|1500.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F33725_0_0|SrvcGrp|13385|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F130817_18103_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_F39796_0_0|SrvcGrp|30380|2022|PDM|1283.00|99|0.00|MED/SURG|
20|FH_F94280_0_0|CSTM-ALL|CSTM-00|2020|PDM|1127.00|99|0.00|AEG 10 (NO REV)|
20|FH_F131000_0_0|SrvcGrp|26278|2022|PDM|3343.00|99|0.00|CPT 29881|
20|FH_F132328_0_0|SrvcGrp|103586|2022|PDM|1706.00|99|0.00|REMOVE SPINE INFUSION|
20|FH_F114569_0_0|SrvcGrp|105676|2022|PCT|1.00|99|0.00|AETNA BH TELEMEDICINE/OP THERAPY SVCS (MOD GT/AF)|
20|FH_F98300_30236_0|SrvcGrp|75483|2022|PDM|2964.00|99|0.00|AEG 3|
20|FH_F98300_30236_0|SrvcGrp|95600|2022|PDM|135.00|99|0.00|AETNA MAMMOGRAPHY|
20|FH_F119347_27540_0|SrvcGrp|90488|2022|PCT|0.91|99|0.00|ORAL FUNCTION THERAPY|
20|FH_F141750_77515_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F103400_33426_0|SrvcGrp|93919|2022|PDM|737.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F40994_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
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_F97543_33542_0|SrvcGrp|73656|2022|PDM|605.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F106243_92780_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F63229_0_0|SrvcGrp|44250|2022|PDM|385.00|99|0.00|CCPD TRAINING|
20|FH_F130805_17404_0|CSTM-ALL|CSTM-00|2020|PDM|567.00|99|0.00|AEG 10 (NO REV)|
20|FH_F125515_0_0|SrvcGrp|87077|2022|PDM|135.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F100680_43130_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F143624_73069_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F85353_16407_0|SrvcGrp|63818|2022|PDM|548.56|99|0.00|HAPA WPA-NWPA 2012-13 ASC 404|
20|FH_F100782_0_0|SrvcGrp|97513|2022|PDM|1812.63|99|0.00|WINDBER MEDICAL CNTR ASC 6|
20|FH_F128379_0_0|SrvcGrp|111058|2022|PDM|7210.00|99|0.00|SPINAL CORD DECOMPRESS|
20|FH_F118042_33401_0|SrvcGrp|89417|2022|PDM|475.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F147962_85008_0|SrvcGrp|103913|2022|PCT|1.35|99|0.00|OP DIALYSIS|
20|FH_F73228_0_0|SrvcGrp|17073|2022|PDM|4942.00|99|0.00|ASPG V|
20|FH_F126555_44906_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122930_0_0|SrvcGrp|73006|2022|PDM|4125.00|99|0.00|AEG 9|
20|FH_F85393_0_0|SrvcGrp|42973|2022|PDM|75.00|99|0.00|SPEECH  THERAPIST|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|223.18|99|0.00|HAPA WPA-NWPA 2012-13 ASC 123 W/O REV|
20|FH_F129310_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F142400_75090_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147801_90703_0|SrvcGrp|111119|2022|PDM|459.00|99|0.00|PARTIAL HOSP (>=65 YRS)|
20|FH_F114567_43235_0|SrvcGrp|86648|2022|PCT|0.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F95880_02726_0|SrvcGrp|75545|2022|PDM|439.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F115895_0_0|SrvcGrp|27261|2022|PDM|9548.00|99|0.00|CPT 27446|
20|FH_F45976_0_0|SrvcGrp|17071|2022|PDM|910.00|99|0.00|ASPG IV|
20|FH_F144021_0_0|SrvcGrp|107748|2022|PDM|475.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|1517.00|99|0.00|AEG 10 (NO REV)|
20|FH_F114976_78539_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F37659_0_0|SrvcGrp|13551|2022|PDM|549.00|99|0.00|NEWBORN NURSERY|
20|FH_F51192_0_0|SrvcGrp|44106|2022|PDM|55.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F72183_0_0|SrvcGrp|177|2022|PDM|1450.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F146287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.38|99|0.00|OP SVCS|
20|FH_F129011_15857_0|SrvcGrp|74902|2022|PCT|1.00|99|0.00|VACCINE SERVICES|
20|FH_F95900_0_0|CSTM-ALL|CSTM-00|2020|PDM|1517.00|99|0.00|AEG 9 (NO REV)|
20|FH_F72845_0_0|SrvcGrp|3418|2022|PCT|0.83|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F131759_06032_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146912_90025_0|SrvcGrp|113276|2022|PCT|1.15|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F71105_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F136622_60062_0|SrvcGrp|89149|2022|PDM|349.00|99|0.00|OP INTENSIVE|
20|FH_F117085_40207_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116233_33612_0|SrvcGrp|89412|2022|PDM|364.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F148554_85016_0|SrvcGrp|115462|2022|PDM|1200.00|99|0.00|INSERT SUBQ IMPLANTABLE DEFIB ELECTRODE|
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|853.00|99|0.00|AEG 3 (NO REV)|
20|FH_F148903_51101_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F59274_0_0|SrvcGrp|1168|2022|PDM|32.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F97565_83301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31093_0_0|CSTM-ALL|CSTM-00|2020|PDM|1973.00|99|0.00|ASPG VI|
20|FH_F119070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 2 (NO REV)|
20|FH_F111809_93003_0|SrvcGrp|79786|2022|PCT|9.35|99|0.00|SLEEP STUDIES|
20|FH_F140508_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F120435_0_0|SrvcGrp|105357|2022|PDM|400.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F37304_0_0|SrvcGrp|14629|2022|PDM|87.00|99|0.00|RN VISIT|
20|FH_F117762_0_0|SrvcGrp|99162|2022|PDM|12480.00|99|0.00|CPT 24366|
20|FH_F148859_0_0|SrvcGrp|115526|2022|PDM|780.00|99|0.00|CIRCUMCISION|
20|FH_F42367_0_0|CSTM-ALL|CSTM-00|2020|PCT|58.00|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_F44218_0_0|SrvcGrp|3577|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F139515_0_0|SrvcGrp|90798|2022|PDM|14420.00|99|0.00|IMPLANT SPINE INFUSION PUMP19|
20|FH_F141592_80233_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F109810_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|OP SVCS|
20|FH_F121495_92009_0|SrvcGrp|73605|2022|PDM|1250.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F92034_0_0|SrvcGrp|73006|2022|PDM|1765.00|99|0.00|AEG 9|
20|FH_F37651_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD TC|
20|FH_F39176_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141527_36830_0|SrvcGrp|14948|2022|PDM|26.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F43250_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.30|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F89340_0_0|SrvcGrp|63471|2022|PDM|1210.00|99|0.00|CPT 64590|
20|FH_F135900_0_0|SrvcGrp|73606|2022|PDM|500.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F136359_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F133972_27103_0|SrvcGrp|86836|2022|PDM|30.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F134659_83628_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD UE"|
20|FH_F110504_37027_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F36381_0_0|SrvcGrp|9861|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION|
20|FH_F117895_28170_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F71644_0_0|SrvcGrp|20040|2022|PDM|96129.00|99|0.00|SIMULTANEOUS PANCREAS KIDNEY TRANSPLANT|
20|FH_F37309_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|1752.00|99|0.00|AEG 6 (NO REV)|
20|FH_F42779_0_0|SrvcGrp|11009|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F125342_78754_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F150525_16056_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43147_0_0|SrvcGrp|109|2022|PDM|600.00|99|0.00|CD - DETOX|
20|FH_F118541_15222_0|SrvcGrp|92324|2022|PCT|1.00|99|0.00|VBAC DELIVERY|
20|FH_F83031_0_0|SrvcGrp|43266|2022|PDM|120.00|99|0.00|MIDLINE INSERTION KIT|
20|FH_F75724_0_0|SrvcGrp|33164|2022|PDM|362.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F101441_0_0|SrvcGrp|97279|2022|PDM|8105.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY|
20|FH_F35446_0_0|SrvcGrp|941|2022|PDM|2076.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F150982_0_0|SrvcGrp|28549|2022|PDM|2392.00|99|0.00|VITRECTOMY|
20|FH_F98900_42001_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F127553_44321_0|SrvcGrp|63297|2022|PDM|130.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F116806_0_0|SrvcGrp|90822|2022|PDM|1613.14|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY|
20|FH_F151699_01752_0|SrvcGrp|26253|2022|PDM|5.17|99|0.00|LIPIDS|
20|FH_F131471_67203_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F143533_30013_0|SrvcGrp|89366|2022|PDM|131.00|99|0.00|ULTRASOUND EXAM ABDO BACK WALL, COMPLETE|
20|FH_F120799_92651_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F114930_71101_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F151225_0_0|SrvcGrp|80317|2022|PDM|690.00|99|0.00|RESPITE CARE|
20|FH_F78048_0_0|SrvcGrp|473|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120215_92064_0|SrvcGrp|75442|2022|PDM|770.00|99|0.00|OBSERVATION - REV 762|
20|FH_F92276_32308_0|CSTM-ALL|CSTM-00|2020|PDM|14385.00|99|0.00|AEG 6 (NO REV)|
20|FH_F113410_0_0|SrvcGrp|54943|2022|PDM|2837.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|732.16|99|0.00|AEG 10 (NO REV)|
20|FH_F123488_65559_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F115121_32250_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F40603_0_0|SrvcGrp|13631|2022|PDM|140.00|99|0.00|CPT 99213|
20|FH_F41035_0_0|SrvcGrp|107785|2022|PDM|1076.00|99|0.00|AETNA AEG 8 W/O EYE/OCULAR SURGERY|
20|FH_F129761_43920_0|SrvcGrp|75323|2022|PCT|1.00|99|0.00|DME|
20|FH_F127995_84010_0|SrvcGrp|86851|2022|PDM|25.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F101702_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IMMUNOHISTOCHEMISTRY EACH AN|
20|FH_F138955_43420_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132738_0_0|SrvcGrp|15|2022|PDM|887.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F90613_05001_0|SrvcGrp|61040|2022|PDM|611.00|99|0.00|ADOLESCENT ACUTE RESIDENTIAL|
20|FH_F44172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
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_F75662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F113870_10536_0|SrvcGrp|73841|2022|PDM|385.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F140035_0_0|SrvcGrp|26160|2022|PDM|60.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F47433_0_0|SrvcGrp|9522|2022|PDM|3473.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F39640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|DME - MOD RR|
20|FH_F40599_0_0|SrvcGrp|17773|2022|PDM|2884.00|99|0.00|PET SCAN|
20|FH_F120437_85202_0|SrvcGrp|82821|2022|PDM|87.30|99|0.00|INJECTION, IMMUNE GLOBULIN (BIVIGAM)|
20|FH_F64943_0_0|SrvcGrp|61041|2022|PCT|0.80|99|0.00|TRANSCRANIAL MAGNETIC STIMULATION (TMS)|
20|FH_F137240_0_0|SrvcGrp|16|2022|PDM|1830.00|99|0.00|ACUTE REHABILITATION|
20|FH_F48475_0_0|SrvcGrp|103388|2022|PDM|19.80|99|0.00|PT/OT/ST|
20|FH_F151241_15139_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139667_84078_0|SrvcGrp|100664|2022|PDM|474.00|99|0.00|HOSPICE IP CARE (HCFA)|
20|FH_F97620_75904_0|SrvcGrp|73461|2022|PDM|7152.00|99|0.00|AETNA NICU IV|
20|FH_F146859_0_0|SrvcGrp|114854|2022|PDM|549.00|99|0.00|INJECT SPINE C/T|
20|FH_F137986_0_0|SrvcGrp|113168|2022|PDM|1479.00|99|0.00|REMOVAL OF KNEECAP BURSA|
20|FH_F138655_63873_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
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_F36992_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD 53|
20|FH_F143367_81003_0|SrvcGrp|13005|2022|PCT|0.90|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F103140_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AETNA PT EVALUATION|
20|FH_F115443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116552_70001_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F45832_0_0|SrvcGrp|360|2022|PDM|580.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F129928_80033_0|SrvcGrp|107861|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F151146_0_0|CSTM-ALL|CSTM-00|2020|PDM|3634.00|99|0.00|AEG 8 (NO REV)|
20|FH_F73013_0_0|SrvcGrp|10615|2022|PDM|117.56|99|0.00|HOME HEALTH AIDE|
20|FH_F71070_0_0|SrvcGrp|68048|2022|PDM|4100.00|99|0.00|CPT 64581|
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 7 (NO REV)|
20|FH_F115049_78539_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135290_60115_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114977_78550_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F73743_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145534_02155_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS|
20|FH_F122694_33334_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F104700_0_0|SrvcGrp|73000|2022|PDM|1130.00|99|0.00|AEG 6|
20|FH_F119838_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|662.00|99|0.00|AEG 4 (NO REV)|
20|FH_F134733_19460_0|SrvcGrp|112633|2022|PDM|550.00|99|0.00|ELECTRODE STIMULATION BRAIN-INITIAL|
20|FH_F113713_17013_0|SrvcGrp|106469|2022|PDM|72.00|99|0.00|AETNA OFFICE OUTPATIENT VISIT EST (MOD TD) (HCFA)|
20|FH_F147311_37421_0|SrvcGrp|89337|2022|PDM|750.00|99|0.00|DETOXIFICATION|
20|FH_F147420_89032_0|SrvcGrp|75419|2022|PDM|490.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F42130_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38425_0_0|SrvcGrp|10624|2022|PDM|68.00|99|0.00|CPT CODE 99347|
20|FH_F142897_07018_0|SrvcGrp|82981|2022|PDM|120.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F89015_74017_0|SrvcGrp|87401|2022|PDM|40.00|99|0.00|HCPCS G0156 (HCFA)|
20|FH_F41988_0_0|CSTM-ALL|CSTM-00|2020|PDM|198.00|99|0.00|PSYCHIATRIC PARTIAL HOSPITALIZATION|
20|FH_F44607_0_0|SrvcGrp|17075|2022|PDM|3100.00|99|0.00|ASPG VI|
20|FH_F113741_63303_0|SrvcGrp|48394|2022|PDM|25.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F84413_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151001_80501_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F149655_78539_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F132254_40207_0|SrvcGrp|17014|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F37493_0_0|SrvcGrp|16|2022|PDM|1254.00|99|0.00|ACUTE REHABILITATION|
20|FH_F35678_0_0|SrvcGrp|18151|2022|PDM|11300.00|99|0.00|MS DRG 250|
20|FH_F131371_0_0|SrvcGrp|109723|2022|PDM|15836.00|99|0.00|APPLICATION OF A MULTIPLAN|
20|FH_F143536_47546_0|SrvcGrp|100247|2022|PCT|1.00|99|0.00|NASAL FLU VACCINE|
20|FH_F131173_17043_0|SrvcGrp|94781|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F48396_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119924_14070_0|SrvcGrp|472|2022|PDM|335.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130497_33321_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90492_0_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F135065_08043_0|SrvcGrp|105047|2022|PDM|400.00|99|0.00|AETNA PSYCH DIAG EVAL W/ MED SVCS (HCFA)|
20|FH_F130479_67526_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F35476_0_0|CSTM-ALL|CSTM-00|2020|PDM|20000.00|99|0.00|MS DRG 243-244|
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|3526.00|99|0.00|AEG 9 (NO REV)|
20|FH_F128580_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F98801_93274_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F116108_0_0|SrvcGrp|26001|2022|PDM|133.35|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F118194_50841_0|SrvcGrp|86829|2022|PDM|93.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F148255_72703_0|SrvcGrp|47183|2022|PDM|63.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F70883_0_0|SrvcGrp|9828|2022|PDM|47.00|99|0.00|HOME HEALTH AIDE|
20|FH_F117206_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F49535_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F150259_15668_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F149320_82609_0|SrvcGrp|87077|2022|PDM|170.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F91061_63043_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F123085_21921_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F73705_0_0|CSTM-ALL|CSTM-00|2020|PDM|300.00|99|0.00|ASPG III|
20|FH_F147995_67037_0|CSTM-ALL|CSTM-00|2020|PDM|1341.00|99|0.00|AEG 1 (NO REV)|
20|FH_F72387_0_0|SrvcGrp|3087|2022|PDM|600.00|99|0.00|CD - DETOX|
20|FH_F101802_17201_0|SrvcGrp|88621|2022|PDM|134.00|99|0.00|SKILLED NURSING LPN|
20|FH_F146131_37160_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133477_90247_0|SrvcGrp|106164|2022|PCT|1.40|99|0.00|AETNA ALL DRUGS OR DRUG AGENTS|
20|FH_F119079_41018_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F126672_0_0|CSTM-ALL|CSTM-00|2020|PDM|906.00|99|0.00|AEG 8 (NO REV)|
20|FH_F111409_33761_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F151144_35801_0|CSTM-ALL|CSTM-00|2020|PDM|1324.00|99|0.00|AEG 8 (NO REV)|
20|FH_F121404_32216_0|SrvcGrp|108781|2022|PDM|51.64|99|0.00|CONT AIRWAY PRESSURE DEVICE (MOD KH, KI, KJ, KX, RR)|
20|FH_F150882_84041_0|SrvcGrp|86830|2022|PDM|24.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F138017_73129_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F118220_0_0|SrvcGrp|60779|2022|PDM|13.61|99|0.00|CPT 93270|
20|FH_F127292_85705_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F124896_43220_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PDM|162.00|99|0.00|NEBULIZER (DME) (MOD NU)|
20|FH_F39443_0_0|SrvcGrp|30368|2022|PDM|616.00|99|0.00|HAPA WPA ASC 11|
20|FH_F124703_65711_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F35174_0_0|SrvcGrp|20077|2022|PCT|0.75|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR|
20|FH_F129340_43212_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F139147_0_0|CSTM-ALL|CSTM-00|2020|PDM|2799.00|99|0.00|AEG 5  (NO REV)|
20|FH_F74845_0_0|SrvcGrp|24|2022|PCT|0.75|99|0.00|CARDIAC CATH|
20|FH_F139807_33064_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139913_33407_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F84411_32063_0|SrvcGrp|2746|2022|PCT|0.69|99|0.00|ORGAN ASSIST DEVICE|
20|FH_F145268_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86319_16365_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F100660_56303_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F117082_66216_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PDM|1107.06|99|0.00|ASPG II|
20|FH_F116960_91505_0|SrvcGrp|114093|2022|PDM|560.00|99|0.00|PARTIAL HOSPITAL SUBSTANCE ABUSE|
20|FH_F77504_0_0|SrvcGrp|33231|2022|PCT|1.00|99|0.00|TAKE HOME DRUGS|
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 6 (NO REV)|
20|FH_F39170_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GLOABAL RAD|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|515.22|99|0.00|HAPA WPA-NWPA 2012-13 ASC 302 W/O REV|
20|FH_F134994_33162_0|SrvcGrp|46903|2022|PDM|735.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|OP SVCS|
20|FH_F41350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F82173_72712_0|SrvcGrp|29817|2022|PDM|7045.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F91284_0_0|CSTM-ALL|CSTM-00|2020|PDM|1985.00|99|0.00|AEG 5  (NO REV)|
20|FH_F97540_32114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F129653_0_0|SrvcGrp|90976|2022|PDM|2000.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT|
20|FH_F133887_17013_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F36936_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|652.84|99|0.00|HAPA WPA-NWPA 2012-13 ASC 403 W/O REV|
20|FH_F120930_0_0|SrvcGrp|97741|2022|PDM|4000.00|99|0.00|REVISE KNEE|
20|FH_F150165_06032_0|SrvcGrp|33982|2022|PDM|2864.00|99|0.00|CPT 28296|
20|FH_F43199_0_0|SrvcGrp|26798|2022|PDM|78.75|99|0.00|LICENSED PRACTICAL NURSE|
20|FH_F149263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1561.00|99|0.00|AEG 1 (NO REV)|
20|FH_F91633_33907_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F135663_24401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F31714_0_0|CSTM-ALL|CSTM-00|2020|PDM|1946.00|99|0.00|ASPG VIII|
20|FH_F122526_22203_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F84134_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|GENERAL ACUTE CARE|
20|FH_F118152_20151_0|SrvcGrp|21920|2022|PDM|40.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F140765_30315_0|SrvcGrp|113223|2022|PDM|41.13|99|0.00|COVID-19 ANTIBODY SARS-COV-2 TITER(S)|
20|FH_F129504_02871_0|SrvcGrp|46605|2022|PDM|111.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F124270_46256_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F108180_29526_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F52092_0_0|SrvcGrp|9873|2022|PDM|58.00|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F97183_25304_0|SrvcGrp|73601|2022|PDM|12056.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F150943_15537_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PDM|432.00|99|0.00|AEG 2 (NO REV)|
20|FH_F129345_60623_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F70510_0_0|SrvcGrp|3810|2022|PDM|135.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F39286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F63433_0_0|SrvcGrp|58956|2022|PDM|1008.60|99|0.00|OBSERVATION SVCS|
20|FH_F125249_0_0|SrvcGrp|88162|2022|PDM|4000.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F140427_0_0|SrvcGrp|104316|2022|PDM|5300.00|99|0.00|PERC DRUG-EL COR STENT SING|
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|757.00|99|0.00|AEG 2 (NO REV)|
20|FH_F134656_02852_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F85214_70360_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124372_0_0|SrvcGrp|108043|2022|PDM|164.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F120549_19087_0|SrvcGrp|82138|2022|PCT|1.05|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F121603_46761_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F118147_33801_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F128379_0_0|SrvcGrp|67065|2022|PDM|14306.00|99|0.00|CERVICAL SURGERY|
20|FH_F134607_80222_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F70804_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: ALL|
20|FH_F146668_30189_0|SrvcGrp|113588|2022|PDM|2250.00|99|0.00|REMOVAL OF FOOT FOREIGN BODY|
20|FH_F115950_08648_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F34477_0_0|SrvcGrp|63744|2022|PDM|75.00|99|0.00|SOCIAL WORKER|
20|FH_F69968_0_0|SrvcGrp|46509|2022|PDM|703.84|99|0.00|MSDRG  880-887 ONLY & REV ACUTE PSYCHIATRIC|
20|FH_F136414_54548_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134155_07016_0|SrvcGrp|90550|2022|PDM|437.00|99|0.00|AETNA PARTIAL HOSPITALIZATION (<=18 YRS)|
20|FH_F142547_70002_0|SrvcGrp|16750|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F125053_0_0|SrvcGrp|82301|2022|PDM|2233.50|99|0.00|HEMORRHOIDECTOMY|
20|FH_F140615_73013_0|CSTM-ALL|CSTM-00|2020|PDM|2217.00|99|0.00|AEG 5  (NO REV)|
20|FH_F151054_06473_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121329_33015_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F150662_20901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132069_63128_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PDM|3499.00|99|0.00|AEG 5  (NO REV)|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD 26|
20|FH_F32236_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F36435_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OUTPATIENT DX W/MOD 26 - USMC DIRECT|
20|FH_F36594_0_0|SrvcGrp|9829|2022|PDM|102.00|99|0.00|PT SVCS|
20|FH_F150950_17522_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F98940_70506_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|OP SVCS|
20|FH_F98900_42001_0|SrvcGrp|73605|2022|PDM|2335.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F97620_75904_0|SrvcGrp|90854|2022|PDM|2744.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F123745_0_0|SrvcGrp|97730|2022|PDM|17000.00|99|0.00|REVERSE HIP JOINT|
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 7 (NO REV)|
20|FH_F124526_05301_0|SrvcGrp|90163|2022|PDM|1362.00|99|0.00|AETNA IP PSYCH CONSTANT OBS (<= 17 YEARS OF AGE)|
20|FH_F63033_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102224_0_0|SrvcGrp|36591|2022|PDM|7000.00|99|0.00|CPT 63685|
20|FH_F130157_84049_0|SrvcGrp|109798|2022|PCT|1.20|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F137557_33437_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128272_60640_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F39138_0_0|SrvcGrp|30092|2022|PDM|491.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F129656_15005_0|SrvcGrp|24745|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F92411_0_0|SrvcGrp|26001|2022|PDM|138.95|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F88096_0_0|SrvcGrp|86606|2022|PDM|1000.00|99|0.00|INTRAOCULAR LENS|
20|FH_F79863_0_0|SrvcGrp|49465|2022|PDM|22.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F126493_31501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139780_75605_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F144808_0_0|SrvcGrp|58993|2022|PDM|7215.00|99|0.00|DISKECTOMY|
20|FH_F131613_0_0|SrvcGrp|30089|2022|PDM|400.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F114407_19002_0|SrvcGrp|48385|2022|PDM|84.00|99|0.00|SPEECH THERAPY|
20|FH_F130763_0_0|SrvcGrp|16289|2022|PDM|2010.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F142894_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F132606_0_0|SrvcGrp|35668|2022|PDM|1305.00|99|0.00|CPT 29824|
20|FH_F146124_06112_0|CSTM-ALL|CSTM-00|2020|PDM|3555.00|99|0.00|AEG 1 (NO REV)|
20|FH_F33163_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109577_0_0|SrvcGrp|90339|2022|PDM|135.00|99|0.00|SKILLED NURSING RN|
20|FH_F35042_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|BURN SVCS|
20|FH_F87053_0_0|SrvcGrp|72998|2022|PDM|1166.00|99|0.00|AEG 5|
20|FH_F133249_33603_0|SrvcGrp|89149|2022|PDM|239.00|99|0.00|OP INTENSIVE|
20|FH_F134126_11554_0|SrvcGrp|79458|2022|PDM|0.25|99|0.00|MED RECORD COPY|
20|FH_F140496_38627_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F140765_30315_0|SrvcGrp|113701|2022|PDM|40.00|99|0.00|COVID-19 IMMUN ADMIN - JANSSEN|
20|FH_F137815_15501_0|SrvcGrp|73841|2022|PDM|350.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F137930_51546_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F114916_30309_0|SrvcGrp|63471|2022|PDM|6500.00|99|0.00|CPT 64590|
20|FH_F122198_20708_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124129_33603_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PDM|953.00|99|0.00|AEG 10 (NO REV)|
20|FH_F115631_65201_0|SrvcGrp|82110|2022|PDM|3177.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC|
20|FH_F149522_83221_0|SrvcGrp|66264|2022|PDM|95.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F37304_0_0|SrvcGrp|9840|2022|PDM|1578.00|99|0.00|ICU UNIT|
20|FH_F66961_0_0|SrvcGrp|76207|2022|PDM|60.00|99|0.00|SPEECH THERAPY (VISIT LVL) MOD GN|
20|FH_F70645_0_0|SrvcGrp|10708|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F127826_65583_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F148266_45419_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F89563_29407_0|SrvcGrp|87914|2022|PCT|1.50|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PDM|2650.00|99|0.00|AEG 3 (NO REV)|
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|965.00|99|0.00|AEG 3 (NO REV)|
20|FH_F124017_0_0|SrvcGrp|96349|2022|PDM|9000.00|99|0.00|NECK SPINE FUSE|
20|FH_F86696_16063_0|SrvcGrp|27969|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F130659_44410_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F119227_01752_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135670_01749_0|SrvcGrp|34566|2022|PDM|42.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F86101_76063_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F79644_0_0|SrvcGrp|89731|2022|PDM|1561.00|99|0.00|ER SVCS|
20|FH_F105361_80104_0|SrvcGrp|72994|2022|PDM|1568.00|99|0.00|AEG 3|
20|FH_F120811_53525_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132197_67437_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F68322_0_0|SrvcGrp|17071|2022|PDM|1100.00|99|0.00|ASPG IV|
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)|
20|FH_F123756_45324_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136314_19013_0|SrvcGrp|89149|2022|PDM|199.00|99|0.00|OP INTENSIVE|
20|FH_F53732_0_0|SrvcGrp|24754|2022|PDM|19.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F109920_39180_0|SrvcGrp|3208|2022|PDM|880.00|99|0.00|SUBACUTE CARE|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|339.18|99|0.00|DELAWARE VALLEY- ASC 104|
20|FH_F112045_90301_0|SrvcGrp|79797|2022|PCT|0.40|99|0.00|AETNA PTCA|
20|FH_F147172_76086_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67924_0_0|SrvcGrp|29137|2022|PDM|23.00|99|0.00|HOME HEALTH AIDE|
20|FH_F84532_0_0|SrvcGrp|73006|2022|PDM|6346.00|99|0.00|AEG 9|
20|FH_F98840_31021_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F124719_64093_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F143347_16001_0|SrvcGrp|72602|2022|PDM|607.00|99|0.00|ECT|
20|FH_F101806_0_0|SrvcGrp|75497|2022|PDM|696.60|99|0.00|AEG 10|
20|FH_F120866_51652_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F137946_0_0|SrvcGrp|113237|2022|PDM|35.92|99|0.00|COVID-19 NCOV DIAGNOSTIC P (HCFA)|
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_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|689.00|99|0.00|AEG 3 (NO REV)|
20|FH_F135779_0_0|SrvcGrp|89417|2022|PDM|467.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F110132_23451_0|SrvcGrp|27969|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F123511_64076_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F63481_0_0|SrvcGrp|26235|2022|PDM|900.00|99|0.00|SLEEP STUDIES|
20|FH_F145758_20745_0|CSTM-ALL|CSTM-00|2020|PDM|616.08|99|0.00|AEG 3 (NO REV)|
20|FH_F39339_0_0|CSTM-ALL|CSTM-00|2020|PDM|1605.00|99|0.00|C-SECTION|
20|FH_F131612_0_0|SrvcGrp|107770|2022|PCT|1.00|99|0.00|INJECTABLES (S CODES)|
20|FH_F145645_77089_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F110507_33462_0|SrvcGrp|89337|2022|PDM|760.00|99|0.00|DETOXIFICATION|
20|FH_F85213_02840_0|CSTM-ALL|CSTM-00|2020|PCT|1.03|99|0.00|OP SVCS|
20|FH_F110184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127900_63080_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134249_05060_0|SrvcGrp|104470|2022|PDM|1668.00|99|0.00|ANTEPARTUM CARE ONLY (7 OR MORE VISITS)|
20|FH_F42138_0_0|SrvcGrp|11442|2022|PDM|492.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F85911_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.50|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F146479_20782_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133398_43204_0|SrvcGrp|89149|2022|PDM|155.00|99|0.00|OP INTENSIVE|
20|FH_F134828_30531_0|SrvcGrp|112668|2022|PDM|46.00|99|0.00|XRAY EXAM HIP UNI 1 VIEW|
20|FH_F134612_0_0|SrvcGrp|111994|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F40702_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134160_19006_0|SrvcGrp|13262|2022|PDM|5.00|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F117552_0_0|SrvcGrp|103642|2022|PDM|6500.00|99|0.00|AETNA FEM/POPL REVASE W/ATHER|
20|FH_F140844_48083_0|SrvcGrp|23683|2022|PDM|65.00|99|0.00|SKILLED NURSING RN|
20|FH_F149646_71129_0|SrvcGrp|89337|2022|PDM|800.00|99|0.00|DETOXIFICATION|
20|FH_F107926_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 2 (NO REV)|
20|FH_F112453_0_0|SrvcGrp|63297|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F141336_16947_0|CSTM-ALL|CSTM-00|2020|PDM|1824.00|99|0.00|AEG 5  (NO REV)|
20|FH_F147899_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136674_16335_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114985_32073_0|SrvcGrp|90486|2022|PDM|35.00|99|0.00|ORTHOTIC MANAGEMENT|
20|FH_F148487_28210_0|SrvcGrp|108484|2022|PDM|727.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F119495_34711_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F148482_20136_0|SrvcGrp|23587|2022|PDM|595.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F84774_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132416_92270_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F131286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33220_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F116390_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.00|99|0.00|OP SVCS|
20|FH_F39479_0_0|SrvcGrp|30556|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F41540_0_0|SrvcGrp|33826|2022|PDM|1152.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 4|
20|FH_F148545_84047_0|SrvcGrp|48398|2022|PDM|85.50|99|0.00|PT SERVICES|
20|FH_F39255_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|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_F116913_77024_0|SrvcGrp|90573|2022|PDM|275.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F36472_0_0|SrvcGrp|23181|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F143036_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|45.00|99|0.00|LPN HI TECH - HOURLY|
20|FH_F133534_33483_0|SrvcGrp|108484|2022|PDM|609.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F123278_20850_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F126489_0_0|SrvcGrp|108042|2022|PDM|400.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F34854_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F122649_0_0|SrvcGrp|87799|2022|PDM|112.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F120322_60016_0|SrvcGrp|472|2022|PDM|714.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F123407_04605_0|SrvcGrp|86722|2022|PDM|170.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F102522_0_0|SrvcGrp|46703|2022|PDM|92.70|99|0.00|ORTHOTICS (L3000)|
20|FH_F143746_85006_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137460_42103_0|SrvcGrp|3178|2022|PDM|648.00|99|0.00|ACUTE PSYCH|
20|FH_F114064_0_0|SrvcGrp|73006|2022|PDM|1566.00|99|0.00|AEG 9|
20|FH_F89340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130721_04769_0|SrvcGrp|92958|2022|PCT|0.89|99|0.00|SLEEP STUDIES|
20|FH_F130841_49315_0|SrvcGrp|83857|2022|PDM|550.00|99|0.00|IP HOSPICE SVCS|
20|FH_F126990_0_0|SrvcGrp|110375|2022|PCT|1.00|99|0.00|PHYSICAL THERAPY (UB) SAME DOS|
20|FH_F145883_71106_0|SrvcGrp|74668|2022|PDM|266.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|2619.00|99|0.00|AEG 10 (NO REV)|
20|FH_F126089_62420_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100782_0_0|SrvcGrp|105154|2022|PDM|317.13|99|0.00|WINDBER MEDICAL CNTR ASC 314|
20|FH_F110442_98003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F79102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F126341_27284_0|SrvcGrp|24748|2022|PDM|35.00|99|0.00|CORTICOSTEROID THERAPY|
20|FH_F109360_32514_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F110521_98034_0|SrvcGrp|73841|2022|PDM|318.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F54592_0_0|SrvcGrp|24287|2022|PDM|60.00|99|0.00|IV PUMP MAINTENANCE|
20|FH_F115909_38133_0|SrvcGrp|86748|2022|PCT|1.05|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F116040_24637_0|SrvcGrp|10577|2022|PDM|30.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F133292_75042_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F133478_40165_0|SrvcGrp|54973|2022|PDM|63307.00|99|0.00|MS DRG 225 ONLY|
20|FH_F148645_0_0|SrvcGrp|99073|2022|PCT|0.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F136423_61254_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F142707_02891_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138561_08034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139456_47501_0|SrvcGrp|104363|2022|PCT|1.35|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F137850_32826_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F134270_0_0|CSTM-ALL|CSTM-00|2020|PDM|1975.00|99|0.00|AEG 3 (NO REV)|
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|1389.25|99|0.00|AEG 7 (NO REV)|
20|FH_F115631_65201_0|SrvcGrp|82114|2022|PDM|3177.00|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F41489_0_0|SrvcGrp|701|2022|PDM|1500.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F137951_0_0|SrvcGrp|26273|2022|PDM|1436.00|99|0.00|CPT 29880|
20|FH_F123872_75006_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117368_68114_0|SrvcGrp|76501|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F115431_32821_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|89.64|99|0.00|ASPG 125|
20|FH_F133487_24293_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F136728_0_0|SrvcGrp|82981|2022|PDM|195.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F136407_0_0|CSTM-ALL|CSTM-00|2020|PDM|638.00|99|0.00|AEG 1 (NO REV)|
20|FH_F136393_0_0|SrvcGrp|112879|2022|PDM|1760.00|99|0.00|L VENTRIC PACING LEAD ADD ON|
20|FH_F124954_17055_0|SrvcGrp|106314|2022|PDM|534.50|99|0.00|ADVANCED LIFE SUPPORT LEVEL 2 (ALS2) (HCFA)|
20|FH_F106540_26330_0|SrvcGrp|41334|2022|PDM|31744.00|99|0.00|TOTAL KNEE|
20|FH_F150164_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F112708_0_0|CSTM-ALL|CSTM-00|2020|PDM|1838.00|99|0.00|AEG 9 (NO REV)|
20|FH_F42706_0_0|SrvcGrp|3477|2022|PDM|145.00|99|0.00|CLINIC VISIT|
20|FH_F38847_0_0|SrvcGrp|97|2022|PDM|3200.00|99|0.00|C-SECTION|
20|FH_F39977_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130656_04401_0|SrvcGrp|109057|2022|PCT|0.89|99|0.00|CARDIAC STUDIES|
20|FH_F130891_41175_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127806_63044_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148668_33177_0|SrvcGrp|76501|2022|PDM|360.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1870.00|99|0.00|AEG 3 (NO REV)|
20|FH_F86094_16748_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|(IMMUN) OCN F/S PRICING: ALL|
20|FH_F129440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OFFICE VISIT W/MOD 25 & PREV MED (NO25, HPMN)|
20|FH_F89645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|GENERAL ACUTE CARE|
20|FH_F98021_07012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F143650_0_0|SrvcGrp|109973|2022|PDM|1800.00|99|0.00|ARTHROSCOPY / SURGERY|
20|FH_F121225_98902_0|SrvcGrp|34388|2022|PDM|201.60|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F132863_65240_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110425_01752_0|SrvcGrp|73700|2022|PDM|80.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F149579_95815_0|SrvcGrp|115699|2022|PDM|161.17|99|0.00|PSYCHIATRIC COLLABORATIVE CARE MGMT 1ST (MOD AJ)|
20|FH_F99420_91326_0|SrvcGrp|62017|2022|PCT|0.85|99|0.00|RADIOLOGY SERVICES|
20|FH_F135093_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F40490_0_0|SrvcGrp|3420|2022|PCT|0.58|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F33381_0_0|SrvcGrp|14999|2022|PCT|0.68|99|0.00|CARDIOVASCULAR SURGERY|
20|FH_F128982_44221_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F107800_34609_0|SrvcGrp|93919|2022|PDM|390.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F37440_0_0|CSTM-ALL|CSTM-00|2020|PDM|875.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118311_35211_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F135264_40272_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F78706_0_0|CSTM-ALL|CSTM-00|2020|PDM|2201.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% OF AWP DRUGS W/ DIRECT RATES|
20|FH_F56136_0_0|SrvcGrp|22817|2022|PCT|0.92|99|0.00|ARTHROSCOPIC  SURGERY|
20|FH_F87092_60101_0|SrvcGrp|24714|2022|PCT|1.03|99|0.00|INTRAOCULAR LENS|
20|FH_F139565_0_0|SrvcGrp|95107|2022|PDM|5738.00|99|0.00|INTRAOCULAR LENS PROSTHESIS|
20|FH_F132883_31602_0|SrvcGrp|16750|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F124711_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F47499_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148600_30328_0|CSTM-ALL|CSTM-00|2020|PDM|1386.00|99|0.00|AEG 7 (NO REV)|
20|FH_F85764_33308_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F96721_99504_0|SrvcGrp|90854|2022|PDM|2103.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F145921_73139_0|SrvcGrp|48398|2022|PDM|97.85|99|0.00|PT SERVICES|
20|FH_F100782_0_0|SrvcGrp|108209|2022|PDM|1400.00|99|0.00|DLYD PLACEMENT|
20|FH_F52713_0_0|SrvcGrp|360|2022|PDM|4000.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F132827_0_0|SrvcGrp|92502|2022|PDM|900.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F137287_0_0|SrvcGrp|113070|2022|PDM|1050.00|99|0.00|IP DAY HOSPITAL|
20|FH_F140473_30518_0|SrvcGrp|107861|2022|PCT|1.00|99|0.00|AMFS(H) DEFAULT|
20|FH_F132738_0_0|CSTM-ALL|CSTM-00|2020|PDM|566.00|99|0.00|CD RESIDENTIAL TREATMENT|
20|FH_F36318_0_0|SrvcGrp|701|2022|PDM|3589.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F132439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F34165_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138527_64506_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F115608_24171_0|SrvcGrp|73606|2022|PDM|1550.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F125660_46706_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F136286_73120_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120974_27607_0|SrvcGrp|471|2022|PDM|1010.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F41874_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F150025_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2221.00|99|0.00|AEG 2 (NO REV)|
20|FH_F63556_0_0|SrvcGrp|49062|2022|PDM|4000.00|99|0.00|CV SURGERY 216 - 234 MS DRG ONLY|
20|FH_F88114_32205_0|SrvcGrp|69690|2022|PCT|1.05|99|0.00|HOSPICE PHYSICIAN|
20|FH_F127415_45822_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F42019_0_0|SrvcGrp|177|2022|PDM|950.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F39479_0_0|SrvcGrp|29021|2022|PCT|1.00|99|0.00|DME AND SUPPLIES|
20|FH_F148260_0_0|SrvcGrp|67989|2022|PDM|4400.00|99|0.00|CPT 49320|
20|FH_F41776_0_0|SrvcGrp|11975|2022|PDM|992.00|99|0.00|ELECTRO CONVULSIVE THERAPY|
20|FH_F70165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128973_44256_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F52393_0_0|SrvcGrp|49104|2022|PDM|1750.00|99|0.00|HEARING AID|
20|FH_F49573_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|1315.48|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1402 W/O REV|
20|FH_F149862_76051_0|SrvcGrp|90854|2022|PDM|567.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124608_0_0|CSTM-ALL|CSTM-00|2020|PDM|1928.00|99|0.00|AEG 10 (NO REV)|
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|761.00|99|0.00|AEG 10 (NO REV)|
20|FH_F116923_85259_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F125969_73112_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F60232_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121225_98902_0|SrvcGrp|89297|2022|PDM|1500.00|99|0.00|INPATIENT DETOXIFICATION SERVICES|
20|FH_F127589_45459_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F138302_15701_0|SrvcGrp|14944|2022|PDM|2.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F122564_53809_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 8 (NO REV)|
20|FH_F146812_50401_0|SrvcGrp|40002|2022|PDM|11500.00|99|0.00|TOTAL HIP|
20|FH_F134011_84102_0|SrvcGrp|86843|2022|PDM|33.60|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F55255_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|1686.00|99|0.00|AEG 6 (NO REV)|
20|FH_F111207_0_0|SrvcGrp|471|2022|PDM|1800.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F49487_0_0|SrvcGrp|19742|2022|PDM|112.00|99|0.00|MID-LINE INSERTION|
20|FH_F109248_0_0|SrvcGrp|35670|2022|PDM|3350.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F147479_75077_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147500_32720_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F97261_06098_0|SrvcGrp|73643|2022|PDM|1153.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F144769_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67136_0_0|SrvcGrp|4109|2022|PDM|3371.00|99|0.00|ACUTE PSYCH|
20|FH_F115315_43011_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F150165_06032_0|SrvcGrp|33977|2022|PDM|2699.00|99|0.00|CPT 59820|
20|FH_F150222_98026_0|SrvcGrp|108484|2022|PDM|1000.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F109266_33319_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F138739_21157_0|SrvcGrp|73842|2022|PDM|174.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111732_33771_0|SrvcGrp|104490|2022|PDM|1900.00|99|0.00|VAGINAL DELIVERY (W/ OR W/O EPISIOTOMY)|
20|FH_F130657_04614_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 7 (NO REV)|
20|FH_F46433_0_0|SrvcGrp|40825|2022|PDM|60.00|99|0.00|HOME THERAPY - PERITONEAL DIALYSIS|
20|FH_F123818_43452_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F107200_0_0|SrvcGrp|73495|2022|PDM|5202.00|99|0.00|AETNA MYOMECTOMY|
20|FH_F117552_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149524_28806_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92593_21031_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1888.00|99|0.00|ASPG VIII|
20|FH_F98041_10027_0|SrvcGrp|88978|2022|PDM|8441.00|99|0.00|VAGINAL DELIVERY|
20|FH_F116143_0_0|SrvcGrp|106235|2022|PCT|1.00|99|0.00|CYPASS|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG IX|
20|FH_F87577_80016_0|SrvcGrp|93924|2022|PDM|8275.00|99|0.00|AETNA MEDICAL SERVICES|
20|FH_F100880_67735_0|SrvcGrp|12343|2022|PDM|3142.00|99|0.00|PET SCAN|
20|FH_F129303_33139_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43953_0_0|SrvcGrp|38002|2022|PDM|4123.00|99|0.00|SURGICAL DAY CARE|
20|FH_F74163_0_0|SrvcGrp|14112|2022|PDM|18.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1163.00|99|0.00|AEG 10 (NO REV)|
20|FH_F142789_34104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150023_75002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141791_22572_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35454_0_0|SrvcGrp|25392|2022|PDM|40.00|99|0.00|PATIENT VISIT LOW|
20|FH_F117581_21211_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F151699_01752_0|SrvcGrp|24745|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F74844_0_0|SrvcGrp|42869|2022|PDM|60.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F47558_0_0|SrvcGrp|43266|2022|PDM|120.00|99|0.00|MIDLINE INSERTION KIT|
20|FH_F143214_92506_0|SrvcGrp|41563|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F114509_10010_0|SrvcGrp|89412|2022|PDM|225.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F98780_35022_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F66782_0_0|SrvcGrp|42971|2022|PDM|80.00|99|0.00|SKN RN|
20|FH_F69968_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (HCFA) OUTPATIENT|
20|FH_F119023_91406_0|SrvcGrp|86825|2022|PDM|75.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F110212_17013_0|SrvcGrp|86722|2022|PDM|196.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F118909_0_0|SrvcGrp|97702|2022|PDM|133.90|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F77944_0_0|SrvcGrp|14747|2022|PCT|1.00|99|0.00|KIDNEY ACQUISITION|
20|FH_F133697_63129_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F136930_73114_0|SrvcGrp|73004|2022|PDM|8727.00|99|0.00|AEG 8|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|40.50|99|0.00|THROMBOLYTIC THERAPY (MOD SH)|
20|FH_F130626_42345_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F50221_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F98921_64503_0|SrvcGrp|73559|2022|PDM|7544.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F144449_04619_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F67639_0_0|CSTM-ALL|CSTM-00|2020|PDM|608.96|99|0.00|ASPG IV|
20|FH_F49027_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F103360_68845_0|SrvcGrp|83837|2022|PDM|9134.00|99|0.00|EXCISION EXCESSIVE SKIN|
20|FH_F91155_16105_0|SrvcGrp|44564|2022|PDM|521.00|99|0.00|NEWBORN NURSERY|
20|FH_F146374_84102_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149883_43920_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F41461_0_0|SrvcGrp|30941|2022|PDM|200.00|99|0.00|NEWBORN NURSERY|
20|FH_F44607_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|138.62|99|0.00|HAPA WPA-NWPA 2012-13 ASC 135 W/O REV|
20|FH_F132118_92240_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148662_01583_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146135_87112_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F132503_73086_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148644_06890_0|SrvcGrp|67994|2022|PDM|3869.00|99|0.00|CPT 58120|
20|FH_F139129_70508_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F139172_40207_0|SrvcGrp|89149|2022|PDM|209.00|99|0.00|OP INTENSIVE|
20|FH_F150521_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_F40727_0_0|SrvcGrp|31737|2022|PDM|48.00|99|0.00|ANESTHESIA SERVICES (CMS 1500)|
20|FH_F75207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150459_08021_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F37777_0_0|SrvcGrp|26179|2022|PDM|30.00|99|0.00|OT|
20|FH_F120100_98390_0|SrvcGrp|73605|2022|PDM|1221.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F122330_75771_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F116546_78723_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F120866_51652_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F127375_28621_0|SrvcGrp|10107|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F128232_70374_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83493_21220_0|SrvcGrp|77012|2022|PCT|1.05|99|0.00|PT OT ST|
20|FH_F138054_0_0|SrvcGrp|42971|2022|PDM|161.00|99|0.00|SKN RN|
20|FH_F138611_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F111812_11222_0|SrvcGrp|74668|2022|PDM|119.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F135261_33144_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F146885_0_0|SrvcGrp|108484|2022|PDM|650.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F143528_0_0|SrvcGrp|89842|2022|PDM|10500.00|99|0.00|LUMBAR|
20|FH_F72183_0_0|SrvcGrp|11301|2022|PDM|850.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|2395.00|99|0.00|REPAIR UMBIL HERNIA|
20|FH_F77232_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62579_0_0|SrvcGrp|24747|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138951_41101_0|SrvcGrp|86828|2022|PDM|55.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F93076_85016_0|CSTM-ALL|CSTM-00|2020|PDM|1154.43|99|0.00|GENERAL ACUTE CARE|
20|FH_F134650_07921_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F114509_10010_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F90232_15126_0|SrvcGrp|86832|2022|PDM|3.15|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F130123_24171_0|SrvcGrp|93098|2022|PDM|145.00|99|0.00|HOSPICE CARE|
20|FH_F51135_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|OP SVCS|
20|FH_F84712_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F63316_0_0|SrvcGrp|47187|2022|PDM|139.78|99|0.00|OCCUPATIONAL THERPY|
20|FH_F118818_19808_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F117105_77619_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F97761_04072_0|SrvcGrp|73643|2022|PDM|941.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|AEG 1 (NO REV)|
20|FH_F94786_07974_0|SrvcGrp|86854|2022|PDM|52.50|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F68950_0_0|SrvcGrp|27751|2022|PDM|2894.06|99|0.00|OP ARTHROSCOPY|
20|FH_F146800_74128_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F93232_0_0|SrvcGrp|42785|2022|PDM|45.00|99|0.00|SPEECH THERAPY  SRVCS|
20|FH_F132864_71101_0|SrvcGrp|114917|2022|PCT|0.65|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F114666_30342_0|SrvcGrp|41325|2022|PDM|2200.00|99|0.00|OP SURGERY CPT 24342|
20|FH_F37847_0_0|SrvcGrp|9832|2022|PDM|88.00|99|0.00|ST SVCS|
20|FH_F147700_21401_0|SrvcGrp|99073|2022|PCT|1.11|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2788.00|99|0.00|AEG 8 (NO REV)|
20|FH_F126663_91423_0|SrvcGrp|73700|2022|PDM|55.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F72859_0_0|SrvcGrp|15511|2022|PDM|3.93|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F113315_72205_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F114310_0_0|SrvcGrp|14614|2022|PDM|3500.00|99|0.00|LITHOTRIPSY|
20|FH_F44023_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS|
20|FH_F103400_33426_0|SrvcGrp|43523|2022|PDM|228.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F97061_85012_0|SrvcGrp|73602|2022|PDM|4738.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F100682_97401_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F87615_80033_0|SrvcGrp|89337|2022|PDM|2118.00|99|0.00|DETOXIFICATION|
20|FH_F148903_51101_0|SrvcGrp|73701|2022|PDM|61.80|99|0.00|AETNA - SKILLED NURSING|
20|FH_F91255_19401_0|SrvcGrp|74469|2022|PCT|0.40|99|0.00|AETNA CHEMOTHERAPY|
20|FH_F133021_00910_0|SrvcGrp|112263|2022|PDM|16000.00|99|0.00|THORACIC OF AORTA SURGERY|
20|FH_F130492_66212_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135610_06451_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|2020.00|99|0.00|AEG 7 (NO REV)|
20|FH_F149199_73005_0|SrvcGrp|34557|2022|PDM|468.00|99|0.00|MS DRG 894-897 ONLY CHEM DEP|
20|FH_F110346_38501_0|SrvcGrp|89417|2022|PDM|542.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F95631_33705_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F127849_43920_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F122520_46383_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F72963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.35|99|0.00|OP SVCS|
20|FH_F146846_73139_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34477_0_0|SrvcGrp|63739|2022|PDM|75.00|99|0.00|PHYSICAL THERAPY|
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.00|99|0.00|AEG 1 (NO REV)|
20|FH_F134255_01201_0|SrvcGrp|102239|2022|PDM|13.80|99|0.00|AETNA METHADONE MAINTENANCE|
20|FH_F138583_60644_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 4 (NO REV)|
20|FH_F116323_0_0|SrvcGrp|106670|2022|PDM|19303.00|99|0.00|AETNA ANTERIOR CERVICAL FUSION|
20|FH_F116169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PDM|2018.00|99|0.00|AEG 9 (NO REV)|
20|FH_F138929_0_0|SrvcGrp|82110|2022|PDM|3300.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC|
20|FH_F122198_20708_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134727_30650_0|CSTM-ALL|CSTM-00|2020|PDM|1923.00|99|0.00|AEG 8 (NO REV)|
20|FH_F149248_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 1 (NO REV)|
20|FH_F111551_32825_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F73502_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKE|
20|FH_F133470_97068_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F45513_0_0|CSTM-ALL|CSTM-00|2020|PDM|457.30|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F144588_60090_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F150529_08037_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128421_27016_0|SrvcGrp|75943|2022|PDM|1050.00|99|0.00|AETNA INPATIENT SURGICAL CARE|
20|FH_F150946_75783_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124698_45380_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120100_98390_0|SrvcGrp|74668|2022|PDM|778.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F114207_35243_0|SrvcGrp|26869|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F135466_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 10 (NO REV)|
20|FH_F73342_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F139668_42701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130309_17044_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F133632_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F37078_0_0|SrvcGrp|474|2022|PDM|234.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F118243_0_0|SrvcGrp|103551|2022|PDM|193.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F35475_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|618180-OPGH-080107-DME-MOD RR|
20|FH_F131093_49690_0|SrvcGrp|90707|2022|PDM|130.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F47792_0_0|SrvcGrp|43563|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F120050_92626_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F126395_37043_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F113985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148260_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130247_35045_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F147941_06023_0|SrvcGrp|113903|2022|PCT|3.75|99|0.00|RADIOLOGY SERVICES|
20|FH_F37756_0_0|SrvcGrp|16|2022|PDM|992.00|99|0.00|ACUTE REHABILITATION|
20|FH_F120374_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|1979.00|99|0.00|AEG 6 (NO REV)|
20|FH_F93880_95476_0|SrvcGrp|73004|2022|PDM|6104.00|99|0.00|AEG 8|
20|FH_F34100_0_0|SrvcGrp|16116|2022|PDM|90.00|99|0.00|PT/OT/ST|
20|FH_F133207_0_0|SrvcGrp|91880|2022|PDM|10081.00|99|0.00|OSSEOINTEGRATED IMPLANT|
20|FH_F113255_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151526_28208_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F39393_0_0|SrvcGrp|17065|2022|PDM|475.00|99|0.00|ASPG I|
20|FH_F121225_98902_0|SrvcGrp|73483|2022|PDM|1500.00|99|0.00|AETNA SUBACUTE III|
20|FH_F85212_71075_0|SrvcGrp|75505|2022|PCT|1.00|99|0.00|CARDIAC STUDIES|
20|FH_F90501_71101_0|SrvcGrp|75495|2022|PDM|4674.00|99|0.00|AEG 9|
20|FH_F129638_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F70883_0_0|SrvcGrp|14371|2022|PDM|13.00|99|0.00|DISPOSABLE DRUG DELIVERY|
20|FH_F114527_39047_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F150165_06032_0|SrvcGrp|28547|2022|PDM|3850.00|99|0.00|VITRECTOMY|
20|FH_F134667_19110_0|SrvcGrp|86723|2022|PDM|430.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F85213_02840_0|SrvcGrp|113560|2022|PCT|1.03|99|0.00|OBSERVATION W/ ER|
20|FH_F124792_44515_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150225_03051_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F120417_63124_0|SrvcGrp|108378|2022|PCT|1.00|99|0.00|THERASKIN|
20|FH_F77082_0_0|SrvcGrp|13476|2022|PCT|0.95|99|0.00|TRAUMA CARE|
20|FH_F92931_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84755_0_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F131867_37211_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F93360_64730_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F140407_63841_0|SrvcGrp|112727|2022|PDM|45.23|99|0.00|COVID-19 IA NFCT AB SARS COV 2|
20|FH_F140407_63841_0|SrvcGrp|112677|2022|PDM|23.46|99|0.00|COVID-19 SPEC COLL SNF/LAB|
20|FH_F139820_75657_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143450_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F56274_0_0|SrvcGrp|17140|2022|PDM|163.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F91818_02828_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F50415_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|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_F72085_0_0|SrvcGrp|64297|2022|PDM|314.00|99|0.00|CAPD|
20|FH_F90653_0_0|SrvcGrp|25696|2022|PDM|950.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F42980_0_0|SrvcGrp|50202|2022|PDM|125.00|99|0.00|OP OFFICE VISIT|
20|FH_F116345_78626_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F66880_25301_0|SrvcGrp|11151|2022|PDM|2075.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F40784_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134490_62801_0|CSTM-ALL|CSTM-00|2020|PDM|2661.00|99|0.00|AEG 9 (NO REV)|
20|FH_F144408_21617_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72523_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F102062_35447_0|SrvcGrp|27969|2022|PDM|42.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132279_63775_0|SrvcGrp|111992|2022|PCT|0.50|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F89932_10940_0|SrvcGrp|81779|2022|PCT|2.92|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F89173_0_0|CSTM-ALL|CSTM-00|2020|PDM|629.00|99|0.00|AEG 3 (NO REV)|
20|FH_F149864_32905_0|SrvcGrp|115779|2022|PDM|200.00|99|0.00|MEDICARE INTENSIVE OUTPATIENT|
20|FH_F144748_19707_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F92676_15063_0|SrvcGrp|79044|2022|PDM|671.59|99|0.00|MON VALLEY ASC 124|
20|FH_F117450_63131_0|SrvcGrp|66264|2022|PDM|97.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 2 (NO REV)|
20|FH_F111266_30339_0|SrvcGrp|10577|2022|PDM|30.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F137767_01841_0|SrvcGrp|113041|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F87711_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F144651_0_0|SrvcGrp|113840|2022|PDM|15500.00|99|0.00|REVISE HIP ARTHROPLASTY|
20|FH_F151009_07649_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84631_0_0|SrvcGrp|62390|2022|PDM|111.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F103060_0_0|SrvcGrp|98493|2022|PDM|8323.00|99|0.00|THORACIC|
20|FH_F141873_0_0|SrvcGrp|74694|2022|PDM|702.00|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F38377_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F95962_0_0|SrvcGrp|3208|2022|PDM|1378.00|99|0.00|SUBACUTE CARE|
20|FH_F44582_0_0|SrvcGrp|39102|2022|PDM|9000.00|99|0.00|PACEMAKER / AICD|
20|FH_F128155_62249_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|90157|2022|PDM|2532.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|198.52|99|0.00|HAPA WPA-NWPA 2012-13 ASC 127 W/O REV|
20|FH_F122470_78229_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133494_90023_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F133219_89119_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F149267_0_0|CSTM-ALL|CSTM-00|2020|PDM|764.00|99|0.00|AEG 2 (NO REV)|
20|FH_F129483_77030_0|SrvcGrp|86841|2022|PDM|110.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F138051_75069_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F33856_0_0|SrvcGrp|12886|2022|PCT|0.85|99|0.00|HOSPICE SVCS (HOME CARE)|
20|FH_F62624_0_0|SrvcGrp|58519|2022|PDM|19000.00|99|0.00|MS DRG 231-238 ONLY|
20|FH_F134689_60190_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F100681_73104_0|SrvcGrp|73485|2022|PDM|2662.00|99|0.00|AETNA REHAB|
20|FH_F132794_40324_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F127325_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F92972_0_0|SrvcGrp|82137|2022|PCT|0.63|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F68944_0_0|SrvcGrp|12154|2022|PCT|0.70|99|0.00|LITHOTRIPSY|
20|FH_F124954_17055_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148865_0_0|SrvcGrp|80920|2022|PDM|550.00|99|0.00|HOSPICE SERVICES|
20|FH_F146267_78626_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F139347_06471_0|SrvcGrp|472|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F130661_04441_0|CSTM-ALL|CSTM-00|2020|PDM|1167.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F49338_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD TC|
20|FH_F120848_20912_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137730_46563_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97640_37043_0|SrvcGrp|73602|2022|PDM|2610.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F137986_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 5  (NO REV)|
20|FH_F151699_01752_0|SrvcGrp|86839|2022|PDM|75.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F137788_72632_0|SrvcGrp|112064|2022|PCT|0.90|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F50398_0_0|SrvcGrp|28074|2022|PCT|0.90|99|0.00|HIGH COST PHARMACEUTICALS|
20|FH_F150322_68301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143207_72301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F102920_0_0|SrvcGrp|72990|2022|PDM|561.00|99|0.00|AEG 1|
20|FH_F49051_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING|
20|FH_F66687_0_0|SrvcGrp|20898|2022|PDM|58581.00|99|0.00|MS DRG 246 ONLY|
20|FH_F129408_48034_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F34691_0_0|SrvcGrp|9774|2022|PDM|1988.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F78022_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147941_06023_0|SrvcGrp|59145|2022|PCT|1.20|99|0.00|AIRFARE/CARGO TEAM ACCOMODATIONS|
20|FH_F145815_30540_0|SrvcGrp|113234|2022|PDM|142.63|99|0.00|COVID-19 SARSCOV2 & INF A&B AMP PRB|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|638.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F143007_60640_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F125660_46706_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F71667_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F82973_0_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F92676_15063_0|SrvcGrp|78982|2022|PDM|1270.31|99|0.00|MON VALLEY ASC 207|
20|FH_F38396_0_0|SrvcGrp|72|2022|PDM|200.00|99|0.00|NEWBORN NURSERY|
20|FH_F145988_06105_0|SrvcGrp|114506|2022|PDM|3851.00|99|0.00|SLEEP STUDIES|
20|FH_F97563_83201_0|SrvcGrp|90854|2022|PDM|2483.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F148880_26807_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F69183_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG III - FH SW CUSTOM GROUPERS|
20|FH_F140093_33467_0|SrvcGrp|75419|2022|PDM|541.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 5  (NO REV)|
20|FH_F124270_46256_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F111086_29501_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F110193_70444_0|SrvcGrp|86648|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F139227_33162_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97260_06111_0|SrvcGrp|73485|2022|PDM|4637.00|99|0.00|AETNA REHAB|
20|FH_F109221_15084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F100663_56537_0|SrvcGrp|73559|2022|PDM|6895.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F38831_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F61292_0_0|SrvcGrp|12590|2022|PDM|523.00|99|0.00|PSYCH PARTIAL HOSP - FULL DAY|
20|FH_F139551_0_0|SrvcGrp|88158|2022|PDM|5769.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F129627_06037_0|SrvcGrp|95661|2022|PDM|170.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F40193_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.30|99|0.00|GENERAL ACUTE CARE|
20|FH_F121495_92009_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F71185_0_0|SrvcGrp|14509|2022|PDM|948.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F82753_18840_0|SrvcGrp|997|2022|PCT|0.39|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F100761_02539_0|SrvcGrp|73559|2022|PDM|7255.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F93920_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS|
20|FH_F124660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F127882_62812_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
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_F131254_92211_0|SrvcGrp|24761|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F143948_44870_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F121547_46805_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F118194_50841_0|SrvcGrp|86830|2022|PDM|50.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F117784_0_0|SrvcGrp|13595|2022|PDM|155.47|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F143388_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F96721_99504_0|SrvcGrp|88978|2022|PDM|8092.00|99|0.00|VAGINAL DELIVERY|
20|FH_F132883_31602_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|145.15|99|0.00|CPT 95811 (W/MOD 26)|
20|FH_F89219_0_0|SrvcGrp|14560|2022|PDM|1423.00|99|0.00|ER|
20|FH_F127849_43920_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F138658_75022_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F138887_71822_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F57953_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|770.00|99|0.00|AEG 3 (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|463.33|99|0.00|HAPA WPA-NWPA 2012-13 ASC 405 W/O REV|
20|FH_F151501_30265_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151503_30067_0|SrvcGrp|96543|2022|PDM|2090.00|99|0.00|REVISION OF CALF TENDON|
20|FH_F151514_35242_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 1 (NO REV)|
20|FH_F122038_34606_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F135485_20171_0|SrvcGrp|46605|2022|PDM|84.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F135924_02906_0|SrvcGrp|116099|2022|PCT|1.03|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F136038_33018_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136183_72756_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119886_25504_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F116464_13088_0|SrvcGrp|87317|2022|PDM|478.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F121731_20164_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F121763_07202_0|SrvcGrp|90662|2022|PDM|74.00|99|0.00|EVALUATION AND MANAGEMENT CPT 99214|
20|FH_F51352_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F38013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|SAOF OP SERVICES MOD NU|
20|FH_F101182_07863_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F111301_33122_0|SrvcGrp|99361|2022|PDM|73.00|99|0.00|DX MAMMO INCL CAD UNI|
20|FH_F111390_32960_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F134322_98001_0|SrvcGrp|112567|2022|PCT|1.00|99|0.00|CEFEPIME INJECTION|
20|FH_F145587_0_0|SrvcGrp|38909|2022|PDM|1779.93|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F145587_0_0|SrvcGrp|83639|2022|PDM|1262.70|99|0.00|CPT 29886|
20|FH_F41780_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F132328_0_0|SrvcGrp|66305|2022|PDM|1259.00|99|0.00|CPT 53450|
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112129_62220_0|SrvcGrp|100859|2022|PDM|252.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F96340_23704_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F102228_08846_0|SrvcGrp|43523|2022|PDM|239.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F129240_10028_0|SrvcGrp|86849|2022|PDM|40.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F109562_32827_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
20|FH_F134497_47126_0|SrvcGrp|89417|2022|PDM|375.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F123158_0_0|SrvcGrp|63468|2022|PDM|850.00|99|0.00|CPT 52281|
20|FH_F40943_0_0|SrvcGrp|43283|2022|PDM|71.00|99|0.00|PHYSICAL THERAPY|
20|FH_F100741_0_0|SrvcGrp|72998|2022|PDM|1087.00|99|0.00|AEG 5|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F45176_0_0|SrvcGrp|39672|2022|PCT|1.05|99|0.00|IMPLANTABLES/PROS/ORTHO|
20|FH_F92676_15063_0|SrvcGrp|79007|2022|PDM|1038.06|99|0.00|MON VALLEY ASC 106|
20|FH_F37478_0_0|SrvcGrp|72|2022|PDM|522.00|99|0.00|NEWBORN NURSERY|
20|FH_F93190_26456_0|SrvcGrp|88620|2022|PDM|90.00|99|0.00|SKILLED NURSING RN|
20|FH_F118300_0_0|SrvcGrp|92501|2022|PDM|133.35|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F123609_28451_0|SrvcGrp|89417|2022|PDM|419.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F34229_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132969_84003_0|SrvcGrp|24744|2022|PDM|50.00|99|0.00|PICC LINE INSERTION|
20|FH_F144848_0_0|SrvcGrp|98584|2022|PDM|16065.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F80513_0_0|SrvcGrp|361|2022|PDM|2125.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F133219_89119_0|SrvcGrp|88620|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PDM|718.86|99|0.00|2005 ASPG GROUPER X|
20|FH_F80284_16354_0|SrvcGrp|64111|2022|PDM|260.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 16|
20|FH_F118932_07652_0|SrvcGrp|73008|2022|PDM|1273.00|99|0.00|AEG 10|
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|663.00|99|0.00|AEG 3 (NO REV)|
20|FH_F118909_0_0|SrvcGrp|95660|2022|PDM|566.50|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F64819_0_0|SrvcGrp|59159|2022|PCT|0.55|99|0.00|OP SURGERY|
20|FH_F75662_0_0|SrvcGrp|33414|2022|PDM|125.00|99|0.00|SNF VENTILATOR SUPPORT|
20|FH_F116199_75042_0|SrvcGrp|89417|2022|PDM|355.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F147702_75240_0|SrvcGrp|74668|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115490_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66782_0_0|SrvcGrp|29462|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE - MOD TF|
20|FH_F80513_0_0|SrvcGrp|14174|2022|PDM|1012.00|99|0.00|MRI|
20|FH_F140761_33172_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F109513_0_0|SrvcGrp|72990|2022|PDM|472.50|99|0.00|AEG 1|
20|FH_F114916_30309_0|SrvcGrp|88160|2022|PDM|5000.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F125163_0_0|SrvcGrp|108042|2022|PDM|1300.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER NUKF|
20|FH_F132420_84660_0|SrvcGrp|87317|2022|PDM|460.43|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F118708_33455_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 10 (NO REV)|
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_F133455_60110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97581_60141_0|SrvcGrp|73602|2022|PDM|2190.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F148899_44041_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144022_32118_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|ASPG X|
20|FH_F88220_63664_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F86851_0_0|SrvcGrp|84989|2022|PDM|324.00|99|0.00|CPT 45307|
20|FH_F86851_0_0|SrvcGrp|84991|2022|PDM|324.00|99|0.00|CPT 45309|
20|FH_F63246_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F52713_0_0|SrvcGrp|3950|2022|PDM|13958.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F145694_84770_0|SrvcGrp|112323|2022|PCT|1.25|99|0.00|LABORATORY|
20|FH_F35042_0_0|SrvcGrp|361|2022|PDM|2562.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F132922_91302_0|SrvcGrp|89412|2022|PDM|500.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F132969_84003_0|SrvcGrp|86844|2022|PDM|25.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F85353_16407_0|SrvcGrp|63819|2022|PDM|548.56|99|0.00|HAPA WPA-NWPA 2012-13 ASC 304|
20|FH_F121476_0_0|SrvcGrp|108826|2022|PDM|175.00|99|0.00|STENT NON-CORONARY|
20|FH_F48313_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F79763_0_0|SrvcGrp|66482|2022|PDM|35.00|99|0.00|HOME HEALTH AID|
20|FH_F129101_27006_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F101100_50314_0|SrvcGrp|97728|2022|PDM|477.00|99|0.00|AMBULATORY DETOX|
20|FH_F133408_01095_0|SrvcGrp|113235|2022|PCT|1.00|99|0.00|COVID-19 SARSCOV2&INF A&B&RSV AMP PRB|
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|566.00|99|0.00|AEG 3 (NO REV)|
20|FH_F47999_0_0|SrvcGrp|42830|2022|PDM|104.50|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F118154_17042_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F137209_60515_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|IP SVCS|
20|FH_F149501_34471_0|SrvcGrp|114012|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F137832_89118_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F73231_0_0|SrvcGrp|11157|2022|PDM|55.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F41539_0_0|SrvcGrp|33825|2022|PDM|482.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 3|
20|FH_F45976_0_0|SrvcGrp|17075|2022|PDM|1200.00|99|0.00|ASPG VI|
20|FH_F92493_0_0|SrvcGrp|88487|2022|PDM|9539.20|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F130611_41143_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116173_40217_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F102881_0_0|SrvcGrp|83960|2022|PCT|0.80|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F78003_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F87171_32578_0|SrvcGrp|76501|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F97621_75801_0|SrvcGrp|73656|2022|PDM|404.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F44048_0_0|CSTM-ALL|CSTM-00|2020|PDM|609.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39604_0_0|SrvcGrp|16526|2022|PDM|177.00|99|0.00|DIALYSIS|
20|FH_F100784_59923_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F117559_08619_0|SrvcGrp|15423|2022|PDM|115.00|99|0.00|ENGERIX-B HEPATITIS B|
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|1056.00|99|0.00|AEG 6 (NO REV)|
20|FH_F141791_22572_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118309_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F143190_46168_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|2310.00|99|0.00|AEG 8 (NO REV)|
20|FH_F133478_40165_0|SrvcGrp|28786|2022|PDM|491.00|99|0.00|CPT CODE 90937|
20|FH_F132991_84790_0|SrvcGrp|27969|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE|
20|FH_F133632_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 10 (NO REV)|
20|FH_F149582_01534_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F99281_81147_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F37708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F56054_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|1449.00|99|0.00|AEG 9 (NO REV)|
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 2 (NO REV)|
20|FH_F124364_38611_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F149019_34114_0|SrvcGrp|87077|2022|PDM|110.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F136806_0_0|SrvcGrp|106706|2022|PDM|2364.00|99|0.00|PAIN STIM SURGERY|
20|FH_F134247_66049_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F110509_71351_0|SrvcGrp|3932|2022|PDM|4000.00|99|0.00|LITHOTRIPSY|
20|FH_F133938_53143_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121225_98902_0|SrvcGrp|108917|2022|PCT|0.00|99|0.00|HOSPICE IP/OP RESPITE CARE|
20|FH_F105143_26062_0|CSTM-ALL|CSTM-00|2020|PCT|2.50|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F111580_77004_0|SrvcGrp|705|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F138491_0_0|SrvcGrp|104228|2022|PDM|85.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F142491_06033_0|SrvcGrp|33722|2022|PDM|48.93|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F119130_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F149649_80104_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F76144_0_0|SrvcGrp|58994|2022|PCT|0.00|99|0.00|LAMINOTOMY|
20|FH_F64441_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124611_64804_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|1173.00|99|0.00|AEG 5  (NO REV)|
20|FH_F76782_0_0|SrvcGrp|3809|2022|PDM|698.00|99|0.00|HOSPICE CARE|
20|FH_F132864_71101_0|SrvcGrp|114898|2022|PCT|2.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F115664_72758_0|SrvcGrp|55677|2022|PDM|1750.00|99|0.00|VAGINAL DELIVERY ONLY|
20|FH_F120437_85202_0|SrvcGrp|98997|2022|PDM|101.29|99|0.00|HYDRATION THERAPY 3 LITER (HCFA)|
20|FH_F139587_0_0|SrvcGrp|108899|2022|PDM|1025.00|99|0.00|HOSPICE INPATIENT RESPITE CARE|
20|FH_F55375_0_0|SrvcGrp|11336|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF|
20|FH_F42340_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|103.42|99|0.00|DELAWARE VALLEY- ASC 121|
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_F95980_20016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130182_0_0|SrvcGrp|109445|2022|PDM|1457.00|99|0.00|LEFT HRT CATH W/ VENTRCLGRPHY|
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|1745.00|99|0.00|AEG 7 (NO REV)|
20|FH_F39772_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (HCFA)|
20|FH_F131471_67203_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F147532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35743_34202_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|OP SVCS|
20|FH_F149559_60012_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150950_17522_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F56813_0_0|SrvcGrp|103731|2022|PDM|171.00|99|0.00|SPEECH THERAPY|
20|FH_F149522_83221_0|SrvcGrp|88620|2022|PDM|115.00|99|0.00|SKILLED NURSING RN|
20|FH_F93961_0_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F102542_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132433_34952_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F65719_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F37733_0_0|SrvcGrp|27218|2022|PDM|550.00|99|0.00|SKILLED NURSING - LEVEL V|
20|FH_F129683_45255_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F139551_0_0|SrvcGrp|88164|2022|PDM|12916.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F90700_0_0|SrvcGrp|12403|2022|PDM|2165.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F39973_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.00|99|0.00|OP SVCS|
20|FH_F40332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F37679_0_0|SrvcGrp|27069|2022|PDM|15.25|99|0.00|PAIN MANAGAMENT - INTERMITTENT (MOD SJ)|
20|FH_F110109_32901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|849.00|99|0.00|AEG 6 (NO REV)|
20|FH_F109260_0_0|CSTM-ALL|CSTM-00|2020|PDM|2671.13|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_F83451_0_0|SrvcGrp|112110|2022|PDM|1350.00|99|0.00|NSL / SINS NDSC TOTAL|
20|FH_F139515_0_0|SrvcGrp|39604|2022|PDM|2632.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F137333_51012_0|SrvcGrp|113078|2022|PDM|537.00|99|0.00|RESIDENTIAL TREATMENT (19-64 YRS)|
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F106822_0_0|SrvcGrp|100280|2022|PDM|1.47|99|0.00|NEBULIZER ADMINISTRATION SET|
20|FH_F39753_0_0|SrvcGrp|177|2022|PDM|2251.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F42913_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43779_0_0|SrvcGrp|941|2022|PDM|2887.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F136824_08034_0|SrvcGrp|90388|2022|PDM|898.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F136927_45690_0|SrvcGrp|23683|2022|PDM|41.00|99|0.00|SKILLED NURSING RN|
20|FH_F41463_0_0|SrvcGrp|17015|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F148599_98034_0|SrvcGrp|31706|2022|PDM|3640.00|99|0.00|MS DRG 792 ONLY|
20|FH_F134447_12883_0|SrvcGrp|76501|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F44435_0_0|SrvcGrp|38586|2022|PDM|1020.00|99|0.00|OP SURGERY (CPT 52332)|
20|FH_F133287_40215_0|CSTM-ALL|CSTM-00|2020|PDM|2565.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 8 (NO REV)|
20|FH_F71947_15227_0|SrvcGrp|10431|2022|PDM|47.00|99|0.00|SPEECH THERAPY|
20|FH_F141747_20688_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151223_73077_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92300_37303_0|SrvcGrp|88621|2022|PDM|105.00|99|0.00|SKILLED NURSING LPN|
20|FH_F64739_0_0|SrvcGrp|14494|2022|PDM|37.40|99|0.00|CONTINUOUS HOMECARE|
20|FH_F38742_0_0|SrvcGrp|28936|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MOD AW (A & K CODES)|
20|FH_F151699_01752_0|SrvcGrp|86849|2022|PDM|55.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F115483_62002_0|SrvcGrp|75506|2022|PCT|0.60|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F101844_0_0|SrvcGrp|89861|2022|PDM|8943.00|99|0.00|LUMBAR LAMINOTOMY|
20|FH_F89640_98133_0|SrvcGrp|92760|2022|PCT|2.77|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120157_93103_0|SrvcGrp|90572|2022|PDM|275.00|99|0.00|INTENSIVE OP PSYCH (HCFA)|
20|FH_F149273_0_0|SrvcGrp|115607|2022|PDM|3589.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F38007_0_0|SrvcGrp|9114|2022|PDM|3715.00|99|0.00|OTHER INTENSIVE CARE|
20|FH_F101083_0_0|SrvcGrp|72998|2022|PDM|1102.00|99|0.00|AEG 5|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|43415.00|99|0.00|MSDRG 228-230|
20|FH_F112448_0_0|SrvcGrp|11606|2022|PDM|1475.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)|
20|FH_F125249_0_0|SrvcGrp|84939|2022|PDM|14500.00|99|0.00|SHOULDER JOINT|
20|FH_F103060_0_0|SrvcGrp|27261|2022|PDM|9364.00|99|0.00|CPT 27446|
20|FH_F39272_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F106020_0_0|SrvcGrp|39904|2022|PDM|2022.00|99|0.00|ARTHROSCOPY OF KNEE|
20|FH_F87619_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F55874_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116341_12180_0|SrvcGrp|73842|2022|PDM|135.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131254_92211_0|SrvcGrp|86827|2022|PDM|75.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F135840_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F127642_07047_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135663_24401_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F143573_01610_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAMPTON ROADS GAST MOD 53|
20|FH_F146103_63851_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F100060_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 3 (NO REV)|
20|FH_F52956_0_0|SrvcGrp|36770|2022|PDM|151.82|99|0.00|PERITONEAL/CAPD/CCPD|
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|673.00|99|0.00|AEG 2 (NO REV)|
20|FH_F131613_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144808_0_0|SrvcGrp|98496|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR ATLAS|
20|FH_F111986_0_0|SrvcGrp|84910|2022|PDM|1854.00|99|0.00|ENDOSCOPY|
20|FH_F116956_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136367_72210_0|SrvcGrp|73841|2022|PDM|408.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F137147_75006_0|SrvcGrp|78282|2022|PDM|16380.00|99|0.00|CPT 47563|
20|FH_F142448_15701_0|SrvcGrp|31973|2022|PDM|25.00|99|0.00|HOME THERAPY|
20|FH_F101161_0_0|SrvcGrp|15324|2022|PDM|310.00|99|0.00|ER LEVEL II|
20|FH_F103880_85014_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F69504_0_0|SrvcGrp|46605|2022|PDM|11.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F109248_0_0|CSTM-ALL|CSTM-00|2020|PDM|670.00|99|0.00|AEG 2 (NO REV)|
20|FH_F146715_34240_0|SrvcGrp|10391|2022|PDM|1840.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F81893_23114_0|SrvcGrp|106753|2022|PDM|1309.00|99|0.00|MRI/MRA|
20|FH_F122608_84123_0|SrvcGrp|48385|2022|PDM|103.00|99|0.00|SPEECH THERAPY|
20|FH_F112371_19047_0|SrvcGrp|15645|2022|PDM|350.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F38826_0_0|SrvcGrp|359|2022|PCT|0.73|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F116383_63026_0|SrvcGrp|86723|2022|PDM|424.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F55113_0_0|SrvcGrp|361|2022|PDM|3270.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F130553_18640_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 3 (NO REV)|
20|FH_F101840_76054_0|SrvcGrp|72990|2022|PDM|957.00|99|0.00|AEG 1|
20|FH_F49776_0_0|SrvcGrp|42826|2022|PDM|102.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F100788_01420_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F111809_93003_0|SrvcGrp|111932|2022|PDM|51.31|99|0.00|COVID-19 NON-CDC TESTING LAB|
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|64454.00|99|0.00|MSDRG 231-232 CORONARY BYPASS|
20|FH_F123181_75057_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F87436_0_0|SrvcGrp|3178|2022|PDM|1380.00|99|0.00|ACUTE PSYCH|
20|FH_F146211_68144_0|SrvcGrp|10362|2022|PDM|306.00|99|0.00|CPT CODE 99282|
20|FH_F121338_37756_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F33566_0_0|SrvcGrp|701|2022|PDM|1750.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F76285_0_0|SrvcGrp|47991|2022|PDM|172.00|99|0.00|THERAPY SERVICES VISIT|
20|FH_F112956_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139755_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F122390_29550_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F108460_32746_0|SrvcGrp|89149|2022|PDM|165.00|99|0.00|OP INTENSIVE|
20|FH_F38246_66606_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124270_46256_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F82779_0_0|CSTM-ALL|CSTM-00|2020|PDM|375.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F116698_07470_0|SrvcGrp|22593|2022|PDM|39.90|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F120966_60707_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F61292_0_0|SrvcGrp|20898|2022|PDM|14535.00|99|0.00|MS DRG 246 ONLY|
20|FH_F52854_0_0|CSTM-ALL|CSTM-00|2020|PDM|2078.00|99|0.00|ACUTE MEDICAL & SURGICAL|
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_F125482_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143814_18062_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120910_63021_0|SrvcGrp|46903|2022|PDM|1323.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F73985_0_0|SrvcGrp|17081|2022|PDM|4744.00|99|0.00|ASPG IX|
20|FH_F125074_18104_0|SrvcGrp|29347|2022|PDM|27.98|99|0.00|HOME HEALTH AIDE|
20|FH_F60836_0_0|CSTM-ALL|CSTM-00|2020|PDM|464.46|99|0.00|ASPG I|
20|FH_F109387_35630_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F119227_01752_0|SrvcGrp|26869|2022|PDM|38.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F120425_11106_0|SrvcGrp|58509|2022|PDM|295.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F133749_84604_0|SrvcGrp|112444|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F119213_66209_0|SrvcGrp|89500|2022|PCT|1.00|99|0.00|SPEECH SOUND LANGUAGE|
20|FH_F90232_15126_0|SrvcGrp|14945|2022|PDM|4.20|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F41135_0_0|SrvcGrp|17075|2022|PDM|802.00|99|0.00|ASPG VI|
20|FH_F150160_01301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36854_0_0|CSTM-ALL|CSTM-00|2020|PDM|1842.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F138856_48092_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138876_25302_0|SrvcGrp|14945|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F138973_45036_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F132251_33161_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122168_66214_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F132054_30339_0|SrvcGrp|65720|2022|PDM|132.00|99|0.00|RESPITE CARE|
20|FH_F37809_0_0|CSTM-ALL|CSTM-00|2020|PDM|2915.00|99|0.00|ASPG V|
20|FH_F135385_38614_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135427_19610_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F135427_19610_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135431_33414_0|SrvcGrp|84897|2022|PCT|1.00|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F135447_53226_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135453_70726_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F135465_80023_0|SrvcGrp|92761|2022|PCT|1.10|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F135495_33145_0|SrvcGrp|89417|2022|PDM|401.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F135572_89106_0|SrvcGrp|14893|2022|PDM|47.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F91735_92653_0|SrvcGrp|63297|2022|PDM|94.50|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F91766_25401_0|SrvcGrp|27968|2022|PDM|26.25|99|0.00|SKILLED NURSING LPN|
20|FH_F135767_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135867_60625_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136188_04005_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119886_25504_0|SrvcGrp|73700|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F116397_33404_0|SrvcGrp|86851|2022|PDM|40.00|99|0.00|HCPCS S9363 (HCFA)|
20|FH_F140629_0_0|SrvcGrp|113686|2022|PDM|2497.00|99|0.00|ARTHROSCOPY TEMPORMANDIULAR JOINT|
20|FH_F140629_0_0|SrvcGrp|103570|2022|PDM|2497.00|99|0.00|ARTHROSCOPIC FRACTURE|
20|FH_F121428_40202_0|SrvcGrp|73602|2022|PDM|802.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F121428_40202_0|SrvcGrp|75506|2022|PCT|0.33|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F121713_84747_0|SrvcGrp|46903|2022|PDM|800.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|LUZERNE HOME INFUSION AWP|
20|FH_F101182_07863_0|SrvcGrp|75545|2022|PDM|425.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F133668_63128_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F111292_33136_0|SrvcGrp|73002|2022|PDM|7943.00|99|0.00|AEG 7|
20|FH_F111363_33169_0|CSTM-ALL|CSTM-00|2020|PDM|11518.00|99|0.00|HIGH GASTRIC BYPASS|
20|FH_F141651_0_0|SrvcGrp|59705|2022|PDM|2750.00|99|0.00|SEPTOPLASTY|
20|FH_F131000_0_0|SrvcGrp|100067|2022|PDM|3183.00|99|0.00|ANKLE ARTHROSCOPY SURGERY|
20|FH_F112082_30720_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F87557_33309_0|SrvcGrp|17014|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F102222_19720_0|SrvcGrp|86828|2022|PDM|47.25|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F102862_30606_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129240_10028_0|SrvcGrp|24761|2022|PDM|5.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F102960_50613_0|SrvcGrp|105480|2022|PCT|3.90|99|0.00|RADIOLOGY SERVICES|
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 10 (NO REV)|
20|FH_F117807_86426_0|SrvcGrp|88620|2022|PDM|122.00|99|0.00|SKILLED NURSING RN|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 9 (NO REV)|
20|FH_F55375_0_0|SrvcGrp|31074|2022|PDM|450.00|99|0.00|MS DRG 795 ONLY|
20|FH_F47834_0_0|SrvcGrp|11336|2022|PCT|0.65|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F112627_26062_0|SrvcGrp|473|2022|PDM|345.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F123589_52402_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63822|2022|PDM|537.46|99|0.00|HAPA WPA-NWPA 2012-13 ASC 405|
20|FH_F143617_49412_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87541_0_0|SrvcGrp|73000|2022|PDM|995.00|99|0.00|AEG 6|
20|FH_F121225_98902_0|SrvcGrp|14949|2022|PDM|112.50|99|0.00|HOME INFUSION|
20|FH_F113457_17011_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138951_41101_0|SrvcGrp|112596|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F79863_0_0|SrvcGrp|77229|2022|PDM|90.00|99|0.00|AETNA HOME INFUSION S9361|
20|FH_F85212_71075_0|SrvcGrp|73008|2022|PDM|941.00|99|0.00|AEG 10|
20|FH_F145604_14850_0|SrvcGrp|17013|2022|PDM|70.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F147990_64701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113276_38506_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146808_44641_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116040_24637_0|SrvcGrp|86841|2022|PDM|80.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F133579_0_0|SrvcGrp|14614|2022|PDM|4060.00|99|0.00|LITHOTRIPSY|
20|FH_F138168_63084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149650_96819_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137973_24457_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|1045.00|99|0.00|AEG 7 (NO REV)|
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F138456_33543_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F44299_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|PDM|2640.00|99|0.00|AEG 9 (NO REV)|
20|FH_F93292_62234_0|SrvcGrp|66265|2022|PDM|76.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F134008_11221_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F134150_01801_0|CSTM-ALL|CSTM-00|2020|PDM|220.00|99|0.00|INTENSIVE OUTPATIENT (<=17 YRS)|
20|FH_F137930_51546_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F90735_94070_0|SrvcGrp|90295|2022|PDM|32.50|99|0.00|BLM GENE|
20|FH_F86911_0_0|SrvcGrp|85658|2022|PDM|55.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F142447_72758_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|AEG 6 (NO REV)|
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|944.29|99|0.00|ASPG VIII|
20|FH_F89273_0_0|SrvcGrp|88244|2022|PDM|850.00|99|0.00|EYE SURGERY|
20|FH_F136823_63048_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114916_30309_0|SrvcGrp|105640|2022|PDM|1000.00|99|0.00|NJX INTERLAMINAR CRV/THRC|
20|FH_F120294_46322_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F37443_0_0|SrvcGrp|26366|2022|PCT|0.45|99|0.00|PROSTH/ORTHO/PACEMKR/INTRA LENS/IMPLNT/ROBOTIC SYS/SUPPLIES|
20|FH_F130747_0_0|SrvcGrp|100919|2022|PDM|8843.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F129567_60616_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93881_15009_0|SrvcGrp|21457|2022|PDM|1234.00|99|0.00|CPT CODE 95811|
20|FH_F124026_53188_0|SrvcGrp|75442|2022|PDM|436.00|99|0.00|OBSERVATION - REV 762|
20|FH_F121225_98902_0|SrvcGrp|29077|2022|PDM|200.00|99|0.00|HOME TRANSFUSION|
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|IP ADOLESCENT PSYCHIATRIC PARTIAL HOSP|
20|FH_F114683_0_0|SrvcGrp|11669|2022|PDM|2100.00|99|0.00|OP SURG|
20|FH_F144848_0_0|SrvcGrp|80139|2022|PDM|20928.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F125259_0_0|SrvcGrp|108117|2022|PDM|1750.00|99|0.00|AV FUSION / FOREARM VEIN|
20|FH_F108780_54235_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F43330_0_0|SrvcGrp|11072|2022|PDM|100.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F37285_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117794_06473_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35411_0_0|SrvcGrp|9263|2022|PDM|875.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F88956_0_0|SrvcGrp|19961|2022|PDM|44291.00|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA|
20|FH_F95360_08720_0|SrvcGrp|93291|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA ESRD USE|
20|FH_F133268_63703_0|SrvcGrp|111061|2022|PDM|13.20|99|0.00|TOXOIDS VACCINES|
20|FH_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|ASPG VI|
20|FH_F40591_0_0|CSTM-ALL|CSTM-00|2020|PDM|5175.00|99|0.00|MS DRG 417-419|
20|FH_F38089_0_0|SrvcGrp|537|2022|PCT|0.68|99|0.00|OBSERVATION SERVICES|
20|FH_F151204_24073_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F150802_15401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129764_48084_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116753_0_0|SrvcGrp|16475|2022|PDM|7465.00|99|0.00|BARIATRIC SURGERY|
20|FH_F112755_43215_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|ASPG X|
20|FH_F92431_80033_0|SrvcGrp|48385|2022|PDM|146.00|99|0.00|SPEECH THERAPY|
20|FH_F149400_83301_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F111266_30339_0|SrvcGrp|86848|2022|PDM|30.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F122392_78207_0|SrvcGrp|108484|2022|PDM|583.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F39443_0_0|SrvcGrp|30314|2022|PDM|90.00|99|0.00|HAPA WPA ASC 123|
20|FH_F120747_19129_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
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_F92392_0_0|SrvcGrp|73485|2022|PDM|3348.00|99|0.00|AETNA REHAB|
20|FH_F110263_0_0|SrvcGrp|88354|2022|PDM|28546.00|99|0.00|CPT 63685 (HCFA)|
20|FH_F50184_0_0|SrvcGrp|45148|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F92034_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F123259_54501_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1115.00|99|0.00|AEG 6 (NO REV)|
20|FH_F88115_0_0|SrvcGrp|79720|2022|PDM|965.00|99|0.00|ACUTE REHAB II|
20|FH_F128378_0_0|SrvcGrp|84185|2022|PDM|160.00|99|0.00|RESPITE CARE|
20|FH_F60112_0_0|SrvcGrp|43428|2022|PDM|42.25|99|0.00|RN HOURLY|
20|FH_F91777_29577_0|SrvcGrp|73701|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F72828_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F127589_45459_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F139512_77550_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138951_41101_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132191_66757_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118171_00674_0|SrvcGrp|11852|2022|PCT|1.30|99|0.00|IMPLANTS|
20|FH_F120489_63552_0|SrvcGrp|75483|2022|PCT|0.75|99|0.00|AEG 3|
20|FH_F137147_75006_0|SrvcGrp|33985|2022|PDM|5621.00|99|0.00|CPT 19120|
20|FH_F142373_78727_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117286_17202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137270_82901_0|SrvcGrp|88620|2022|PDM|85.50|99|0.00|SKILLED NURSING RN|
20|FH_F97640_37043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F132907_72949_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139167_42240_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|1197.00|99|0.00|AEG 6 (NO REV)|
20|FH_F151699_01752_0|SrvcGrp|17013|2022|PDM|55.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|100% 2007 MEDICARE TN DME  MOD NU|
20|FH_F130951_15237_0|SrvcGrp|97506|2022|PDM|115.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F49286_0_0|SrvcGrp|45327|2022|PDM|125.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F120927_28645_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F36418_0_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143467_0_0|SrvcGrp|92197|2022|PDM|4601.00|99|0.00|CORRECTION OF BUNION|
20|FH_F49895_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F45832_0_0|SrvcGrp|24899|2022|PCT|0.72|99|0.00|IMPLANTS|
20|FH_F63444_0_0|SrvcGrp|1306|2022|PDM|350.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F132779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F91876_0_0|SrvcGrp|77582|2022|PDM|2345.00|99|0.00|CPT 31255|
20|FH_F96902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
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_F78048_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F42722_0_0|SrvcGrp|28146|2022|PDM|401.00|99|0.00|SKILLED NURSING|
20|FH_F147500_32720_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F42494_0_0|SrvcGrp|177|2022|PDM|2100.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F126666_44053_0|SrvcGrp|86723|2022|PDM|300.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F41785_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F108780_54235_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F124966_60559_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97542_32960_0|SrvcGrp|73559|2022|PDM|9511.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F100666_81301_0|SrvcGrp|73485|2022|PDM|2572.00|99|0.00|AETNA REHAB|
20|FH_F93375_0_0|SrvcGrp|73002|2022|PDM|1044.00|99|0.00|AEG 7|
20|FH_F76864_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109762_0_0|SrvcGrp|72992|2022|PDM|500.00|99|0.00|AEG 2|
20|FH_F130152_48025_0|SrvcGrp|111512|2022|PCT|1.00|99|0.00|SKILLED NURSING|
20|FH_F124444_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F78162_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100790_10512_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F71945_0_0|CSTM-ALL|CSTM-00|2020|PDM|678.00|99|0.00|SKILLED NURSING|
20|FH_F130747_0_0|SrvcGrp|35668|2022|PDM|5202.00|99|0.00|CPT 29824|
20|FH_F37679_0_0|SrvcGrp|27138|2022|PDM|7.50|99|0.00|INTERFERON INJECTION THERAPY (MOD SH)|
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130747_0_0|SrvcGrp|93432|2022|PDM|19768.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F112325_0_0|SrvcGrp|80317|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F117079_01085_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137457_32216_0|SrvcGrp|73841|2022|PDM|471.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F130807_20721_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F38798_0_0|SrvcGrp|28978|2022|PDM|55.00|99|0.00|SKILLED NURSING NON IV RELATED- MOD TD|
20|FH_F39303_0_0|SrvcGrp|13551|2022|PDM|516.00|99|0.00|NEWBORN NURSERY|
20|FH_F103780_64804_0|SrvcGrp|74403|2022|PCT|0.68|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F103880_85014_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|764.00|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_F129529_45229_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134687_14226_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116393_07002_0|SrvcGrp|106525|2022|PCT|1.25|99|0.00|CANALITH REPOSITIONING PROC|
20|FH_F148554_85016_0|SrvcGrp|115465|2022|PDM|5422.00|99|0.00|TIB/PER REVASC W/ STENT|
20|FH_F110606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41429_0_0|SrvcGrp|109|2022|PDM|543.00|99|0.00|CD - DETOX|
20|FH_F122245_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F117945_78957_0|SrvcGrp|106048|2022|PDM|735.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F133455_60110_0|SrvcGrp|66265|2022|PDM|103.97|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F151122_10462_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F122006_66839_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F97101_98003_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F103109_33462_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139177_0_0|SrvcGrp|12491|2022|PCT|0.41|99|0.00|PACEMAKER|
20|FH_F148667_0_0|SrvcGrp|103570|2022|PDM|2856.00|99|0.00|ARTHROSCOPIC FRACTURE|
20|FH_F98860_96706_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F149579_95815_0|SrvcGrp|115668|2022|PDM|53.54|99|0.00|THERAPEUTIC MONITORING REM 1ST 20 MINS|
20|FH_F50100_0_0|SrvcGrp|46107|2022|PDM|103.73|99|0.00|SKILLED NURSING|
20|FH_F40690_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F143307_72223_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F39028_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ASP EXCLUSIONS|
20|FH_F40649_0_0|CSTM-ALL|CSTM-00|2020|PDM|1378.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90362_0_0|SrvcGrp|41335|2022|PDM|12731.00|99|0.00|TOTAL HIP|
20|FH_F137387_32605_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F109277_0_0|SrvcGrp|22529|2022|PDM|663.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F102184_0_0|SrvcGrp|54943|2022|PDM|2887.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F86712_60173_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|OCN F/S PRICING: ALL|
20|FH_F88096_0_0|SrvcGrp|11673|2022|PDM|2100.00|99|0.00|CPT 29888|
20|FH_F129509_0_0|SrvcGrp|109220|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F145852_67203_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130923_0_0|SrvcGrp|82222|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F145562_70458_0|SrvcGrp|86840|2022|PDM|25.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F87541_0_0|SrvcGrp|72990|2022|PDM|401.00|99|0.00|AEG 1|
20|FH_F125139_84096_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F96160_32207_0|SrvcGrp|86635|2022|PCT|1.07|99|0.00|DME|
20|FH_F107702_01053_0|SrvcGrp|471|2022|PDM|578.70|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F85213_02840_0|SrvcGrp|89417|2022|PDM|1061.10|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F79623_0_0|SrvcGrp|72998|2022|PDM|5262.00|99|0.00|AEG 5|
20|FH_F126225_23413_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146369_0_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|673.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 303 W/O REV|
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_F109264_33431_0|SrvcGrp|73842|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F69242_0_0|SrvcGrp|47764|2022|PDM|120.00|99|0.00|HOSPICE CARE/ IN HOME S9126 VISIT LEVEL|
20|FH_F148555_0_0|SrvcGrp|115435|2022|PDM|4326.00|99|0.00|INSERT HEART PM ATRIAL|
20|FH_F116440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87615_80033_0|SrvcGrp|89269|2022|PDM|140.00|99|0.00|PSYTX PT/FAMILY 45 MINUTES|
20|FH_F148265_06067_0|SrvcGrp|77021|2022|PDM|13060.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F99522_0_0|CSTM-ALL|CSTM-00|2020|PCT|47.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124161_95932_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F119379_0_0|CSTM-ALL|CSTM-00|2020|PDM|355.00|99|0.00|AEG 1 (NO REV)|
20|FH_F49459_0_0|SrvcGrp|80|2022|PDM|762.00|99|0.00|ACUTE PSYCH|
20|FH_F96160_32207_0|SrvcGrp|86835|2022|PDM|25.89|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F80224_0_0|SrvcGrp|701|2022|PDM|3667.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F114404_73044_0|SrvcGrp|471|2022|PDM|515.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F150161_63361_0|SrvcGrp|48394|2022|PDM|60.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F134208_21502_0|CSTM-ALL|CSTM-00|2020|PDM|756.00|99|0.00|AEG 4 (NO REV)|
20|FH_F110345_37919_0|SrvcGrp|86749|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F119262_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136491_08068_0|SrvcGrp|89149|2022|PDM|202.00|99|0.00|OP INTENSIVE|
20|FH_F78403_15552_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS|
20|FH_F139456_47501_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F51016_0_0|SrvcGrp|33164|2022|PDM|305.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F117623_0_0|CSTM-ALL|CSTM-00|2020|PDM|36.00|99|0.00|ADAPTIVE BEHAVIOR TREATMNT MODIFIED 30 MINS (HCFA)|
20|FH_F132988_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BIENVILLE MED CTR LABS/RADS|
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|ASPG IX|
20|FH_F56753_15086_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100906_0_0|SrvcGrp|72998|2022|PDM|1185.00|99|0.00|AEG 5|
20|FH_F101901_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|AEG 1 (NO REV)|
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1673.63|99|0.00|ASPG V|
20|FH_F136267_73703_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|2118.00|99|0.00|AEG 9 (NO REV)|
20|FH_F46732_0_0|SrvcGrp|26001|2022|PDM|142.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F111288_0_0|SrvcGrp|26273|2022|PDM|3569.00|99|0.00|CPT 29880|
20|FH_F110925_01104_0|SrvcGrp|86147|2022|PDM|365.06|99|0.00|ECALLANTIDE INJ|
20|FH_F148497_32162_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141471_0_0|SrvcGrp|107793|2022|PDM|9661.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F121149_76021_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F79483_0_0|SrvcGrp|89276|2022|PDM|435.00|99|0.00|PORTABLE SLEEP STUDY TYPE III|
20|FH_F145689_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|581.02|99|0.00|AETNA POLYSOMNOGRAPHY|
20|FH_F88639_80204_0|SrvcGrp|108282|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130721_04769_0|SrvcGrp|112064|2022|PCT|0.89|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F148924_44003_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119588_0_0|CSTM-ALL|CSTM-00|2020|PDM|373.00|99|0.00|AEG 1 (NO REV)|
20|FH_F119783_46360_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F146474_78572_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117208_0_0|SrvcGrp|83644|2022|PDM|4015.00|99|0.00|CPT 30465|
20|FH_F48034_0_0|SrvcGrp|39203|2022|PDM|250.00|99|0.00|HALF-DAY PARTIAL PSYCH|
20|FH_F123856_54963_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72162_0_0|SrvcGrp|42971|2022|PDM|135.00|99|0.00|SKN RN|
20|FH_F38081_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92493_0_0|SrvcGrp|82114|2022|PDM|2601.06|99|0.00|MENISCUS REPAIR MED OR LAT|
20|FH_F134734_90068_0|SrvcGrp|89337|2022|PDM|1100.00|99|0.00|DETOXIFICATION|
20|FH_F117733_91362_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F93275_0_0|SrvcGrp|705|2022|PCT|1.05|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F94165_0_0|SrvcGrp|74469|2022|PCT|0.85|99|0.00|AETNA CHEMOTHERAPY|
20|FH_F106600_99202_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F134487_14843_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F68121_0_0|SrvcGrp|64324|2022|PDM|100.00|99|0.00|BIOFEEDBACK|
20|FH_F87334_16507_0|SrvcGrp|48396|2022|PDM|104.00|99|0.00|OT SERVICES|
20|FH_F101840_76054_0|SrvcGrp|54924|2022|PDM|16124.00|99|0.00|MS DRG 493 ONLY|
20|FH_F119400_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F150980_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC|
20|FH_F130656_04401_0|SrvcGrp|114927|2022|PCT|2.25|99|0.00|CHEMOTHERAPY AND ALL OTHER DRUGS|
20|FH_F130656_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 10 (NO REV)|
20|FH_F79623_0_0|SrvcGrp|73486|2022|PCT|0.00|99|0.00|AETNA CONTRAST AGENT|
20|FH_F126555_44906_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F146423_28401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114506_15946_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126063_43078_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F126417_77338_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F146667_37110_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F133478_40165_0|SrvcGrp|21102|2022|PDM|66608.00|99|0.00|MS DRG 219 ONLY|
20|FH_F123735_32708_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F123856_54963_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67901_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|LINTRATHECAL IV SERVICES MOD SH|
20|FH_F142347_75140_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140833_19454_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F85757_0_0|SrvcGrp|84185|2022|PDM|105.00|99|0.00|RESPITE CARE|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PDM|835.00|99|0.00|ASPG V|
20|FH_F137951_0_0|SrvcGrp|26278|2022|PDM|1436.00|99|0.00|CPT 29881|
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|994.00|99|0.00|AEG 4 (NO REV)|
20|FH_F88223_0_0|SrvcGrp|73700|2022|PDM|38.50|99|0.00|AETNA - SKILLED NURSING|
20|FH_F90032_15234_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F34998_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F44607_0_0|SrvcGrp|17079|2022|PDM|3750.00|99|0.00|ASPG VIII|
20|FH_F97640_37043_0|SrvcGrp|90854|2022|PDM|2898.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F34853_0_0|SrvcGrp|16|2022|PDM|2100.00|99|0.00|ACUTE REHABILITATION|
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117576_21207_0|SrvcGrp|76501|2022|PDM|330.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F90817_0_0|SrvcGrp|90385|2022|PDM|1762.00|99|0.00|NASAL ENDOSCOPY SURGICAL|
20|FH_F126977_34990_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F42538_0_0|SrvcGrp|9483|2022|PDM|130.00|99|0.00|RESIDENTIAL HOSPICE SVCS|
20|FH_F112712_63005_0|SrvcGrp|19742|2022|PCT|1.00|99|0.00|MID-LINE INSERTION|
20|FH_F119591_75034_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
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_F120531_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|AEG 5  (NO REV)|
20|FH_F38431_0_0|SrvcGrp|23009|2022|PDM|1300.00|99|0.00|V5252|
20|FH_F148339_71303_0|SrvcGrp|74668|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F90818_0_0|SrvcGrp|11663|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F90691_0_0|SrvcGrp|72990|2022|PDM|382.00|99|0.00|AEG 1|
20|FH_F114918_78748_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F129324_24701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F115685_64064_0|SrvcGrp|98961|2022|PDM|75.00|99|0.00|HIT CONT ANTIMETIC (HCFA)|
20|FH_F130747_0_0|SrvcGrp|88159|2022|PDM|8843.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F37651_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD KM|
20|FH_F148259_99163_0|SrvcGrp|83801|2022|PDM|900.00|99|0.00|INTERIM LABOR FACILITY GLOBA|
20|FH_F100761_02539_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F85295_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148322_93060_0|SrvcGrp|46903|2022|PDM|670.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F90354_0_0|SrvcGrp|57968|2022|PDM|33.90|99|0.00|CONTINUOUS HOMECARE|
20|FH_F35308_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F130017_02302_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F114823_15701_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F79743_0_0|SrvcGrp|83557|2022|PCT|0.57|99|0.00|OP CARADIAC CATH|
20|FH_F110471_02215_0|SrvcGrp|98701|2022|PDM|299.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F149362_19446_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F35042_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|ACUTE PSYCH|
20|FH_F128825_45211_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|489.24|99|0.00|HAPA WPA-NWPA 2012-13 ASC 222 W/O REV|
20|FH_F41135_0_0|SrvcGrp|17083|2022|PDM|492.54|99|0.00|ASPG X|
20|FH_F150165_06032_0|SrvcGrp|88147|2022|PDM|3760.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA|
20|FH_F35216_0_0|CSTM-ALL|CSTM-00|2020|PDM|13500.00|99|0.00|MS DRG 242 PERMANENT CARDIAC PACEMAKER|
20|FH_F118152_20151_0|SrvcGrp|86854|2022|PDM|50.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F109920_39180_0|SrvcGrp|8950|2022|PDM|1540.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F125656_92868_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|762.00|99|0.00|AEG 3 (NO REV)|
20|FH_F149030_37919_0|CSTM-ALL|CSTM-00|2020|PDM|772.50|99|0.00|AEG 1 (NO REV)|
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|737.00|99|0.00|AEG 10 (NO REV)|
20|FH_F37444_0_0|SrvcGrp|3259|2022|PDM|900.00|99|0.00|ACUTE REHABILITATION|
20|FH_F147339_08837_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F34853_0_0|SrvcGrp|9938|2022|PDM|170.00|99|0.00|SPEECH THERAPY|
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|969.00|99|0.00|AEG 3 (NO REV)|
20|FH_F48224_0_0|SrvcGrp|73008|2022|PDM|746.00|99|0.00|AEG 10|
20|FH_F136289_73099_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F92276_32308_0|CSTM-ALL|CSTM-00|2020|PDM|735.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|1188.00|99|0.00|AEG 10 (NO REV)|
20|FH_F115739_78722_0|SrvcGrp|471|2022|PDM|537.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F107782_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F95021_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F89475_71202_0|SrvcGrp|3066|2022|PCT|0.65|99|0.00|HIGH-COST DRUGS|
20|FH_F118079_37642_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F109180_18015_0|SrvcGrp|89149|2022|PDM|225.00|99|0.00|OP INTENSIVE|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD UE) - PMRS|
20|FH_F119635_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 10 (NO REV)|
20|FH_F32073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1295.00|99|0.00|AMPUTATION|
20|FH_F143715_33161_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125328_0_0|SrvcGrp|27347|2022|PDM|12535.50|99|0.00|CPT 58558|
20|FH_F145645_77089_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133957_84121_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F124173_66215_0|SrvcGrp|22589|2022|PDM|34.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F81835_0_0|SrvcGrp|74663|2022|PDM|627.24|99|0.00|AETNA SLEEP STUDIES|
20|FH_F146650_29690_0|SrvcGrp|115402|2022|PDM|770.00|99|0.00|AUTISM RESIDENTIAL TREATMENT|
20|FH_F142548_66614_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140553_37205_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140844_48083_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137335_08096_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F109652_0_0|SrvcGrp|19961|2022|PDM|49803.00|99|0.00|MS DRG 231-232 ONLY CORONARY BYPASS W/ PTCA|
20|FH_F133028_08021_0|SrvcGrp|73842|2022|PDM|242.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F45513_0_0|SrvcGrp|41337|2022|PDM|3000.00|99|0.00|LAPAROSCOPIC PROCEDURES|
20|FH_F115405_06010_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F82813_0_0|SrvcGrp|72992|2022|PDM|694.00|99|0.00|AEG 2|
20|FH_F149581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F123091_92627_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F145877_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.29|99|0.00|OP SVCS|
20|FH_F37640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F150000_30152_0|SrvcGrp|91631|2022|PCT|1.60|99|0.00|OFFICE VISIT|
20|FH_F89015_74017_0|SrvcGrp|87395|2022|PDM|110.00|99|0.00|HCPCS G0153 (HCFA)|
20|FH_F151082_18020_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138487_85297_0|SrvcGrp|94880|2022|PDM|88.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F139209_22556_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F139666_26175_0|SrvcGrp|113608|2022|PCT|1.50|99|0.00|LABORATORY SERVICES|
20|FH_F150882_84041_0|SrvcGrp|36669|2022|PDM|10.50|99|0.00|IMMUNIZATION ADMIN|
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F35745_33952_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS|
20|FH_F150919_17603_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|2431.00|99|0.00|AEG 4 (NO REV)|
20|FH_F147082_02359_0|SrvcGrp|88819|2022|PDM|504.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F120144_77031_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F146266_0_0|SrvcGrp|41334|2022|PDM|14900.00|99|0.00|TOTAL KNEE|
20|FH_F143567_62207_0|SrvcGrp|48385|2022|PDM|135.00|99|0.00|SPEECH THERAPY|
20|FH_F127641_08103_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F105143_26062_0|SrvcGrp|72980|2022|PCT|2.50|99|0.00|AETNA LABORATORY|
20|FH_F142530_60148_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142690_31774_0|SrvcGrp|14948|2022|PDM|125.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F97602_40121_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F118932_07652_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F111001_0_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F100401_15317_0|SrvcGrp|75545|2022|PDM|340.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F138196_0_0|CSTM-ALL|CSTM-00|2020|PDM|766.00|99|0.00|AEG 4 (NO REV)|
20|FH_F131047_0_0|CSTM-ALL|CSTM-00|2020|PDM|2614.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F131505_0_0|SrvcGrp|75282|2022|PDM|265.00|99|0.00|DIAGNOSTIC HYSTEROSCOPY|
20|FH_F136570_32084_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F114985_32073_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F122610_73139_0|SrvcGrp|77305|2022|PCT|0.50|99|0.00|DIAGNOSTIC DRUGS|
20|FH_F115181_78602_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F106241_93309_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F72226_65804_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|OP SVCS|
20|FH_F148662_01583_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F142888_77095_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F37600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123373_0_0|SrvcGrp|3418|2022|PDM|2914.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F43433_0_0|SrvcGrp|32445|2022|PDM|7425.00|99|0.00|JACKSON MADISON HOSP ASPG 9|
20|FH_F42807_0_0|SrvcGrp|109|2022|PDM|780.00|99|0.00|CD - DETOX|
20|FH_F150882_84041_0|SrvcGrp|86839|2022|PDM|47.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F141034_0_0|SrvcGrp|107749|2022|PDM|171.00|99|0.00|CAPD/CCPD|
20|FH_F134968_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F116437_0_0|SrvcGrp|46888|2022|PDM|1757.00|99|0.00|VITRECTOMY|
20|FH_F117629_06514_0|SrvcGrp|473|2022|PDM|502.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F64799_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140007_0_0|SrvcGrp|97099|2022|PDM|8045.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F147211_0_0|SrvcGrp|42622|2022|PDM|791.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F130032_72034_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F100662_27534_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F32509_0_0|SrvcGrp|88|2022|PDM|12663.00|99|0.00|OP LITHOTRIPSY|
20|FH_F117082_66216_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138934_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 2 (NO REV)|
20|FH_F141527_36830_0|SrvcGrp|14944|2022|PDM|2.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F137367_89139_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F113410_0_0|SrvcGrp|79593|2022|PDM|683.00|99|0.00|CPT 45378|
20|FH_F131216_31901_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F47963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|S CODES MOD SH|
20|FH_F41776_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F88740_0_0|CSTM-ALL|CSTM-00|2020|PDM|1108.00|99|0.00|AEG 4 (NO REV)|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC|
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|2678.00|99|0.00|AEG 7 (NO REV)|
20|FH_F49027_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F151141_24014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121385_89102_0|CSTM-ALL|CSTM-00|2020|PDM|5469.00|99|0.00|AEG 6 (NO REV)|
20|FH_F116583_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F114207_35243_0|SrvcGrp|65621|2022|PCT|1.00|99|0.00|RN NURSING|
20|FH_F139565_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 10 (NO REV)|
20|FH_F132849_0_0|SrvcGrp|112131|2022|PDM|957.00|99|0.00|CAT SCAN|
20|FH_F87993_0_0|CSTM-ALL|CSTM-00|2020|PDM|1480.00|99|0.00|AEG 9 (NO REV)|
20|FH_F35847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F150961_89169_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110342_0_0|SrvcGrp|89404|2022|PDM|8323.20|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F142312_62301_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F114389_50131_0|SrvcGrp|29075|2022|PDM|80.47|99|0.00|HYDRATION THERAPY|
20|FH_F138779_62703_0|SrvcGrp|73842|2022|PDM|233.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F141170_0_0|SrvcGrp|92365|2022|PDM|10500.00|99|0.00|FUSION OF SACROILIAC JOINT|
20|FH_F115733_33012_0|SrvcGrp|73841|2022|PDM|368.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F142176_98040_0|SrvcGrp|73339|2022|PCT|0.85|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F151746_20032_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F46893_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F48476_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE|
20|FH_F48476_0_0|SrvcGrp|42974|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F82771_0_0|SrvcGrp|36591|2022|PDM|1575.00|99|0.00|CPT 63685|
20|FH_F35133_0_0|SrvcGrp|3029|2022|PDM|400.00|99|0.00|NEWBORN NURSERY|
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143746_85006_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F118910_0_0|SrvcGrp|80920|2022|PDM|540.75|99|0.00|HOSPICE SERVICES|
20|FH_F148440_16506_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F143580_0_0|SrvcGrp|13681|2022|PDM|425.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F141509_07058_0|SrvcGrp|104434|2022|PCT|1.00|99|0.00|TRANSPORTATION SERVICES|
20|FH_F69322_0_0|CSTM-ALL|CSTM-00|2020|PDM|362.00|99|0.00|ADOLESCENT PSYCH PARTIAL HOSP|
20|FH_F119795_0_0|SrvcGrp|35672|2022|PDM|4474.00|99|0.00|CPT 23412|
20|FH_F89778_0_0|SrvcGrp|90157|2022|PDM|1099.68|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F88545_78734_0|SrvcGrp|87536|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F126341_27284_0|SrvcGrp|86120|2022|PDM|0.95|99|0.00|AETNA HUMATE|
20|FH_F133972_27103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127814_63103_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F31714_0_0|SrvcGrp|3584|2022|PDM|7100.00|99|0.00|DRG 117 CARDIAC PACE REVISION|
20|FH_F100782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F133249_33603_0|SrvcGrp|73841|2022|PDM|419.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F133415_90066_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F43872_0_0|SrvcGrp|471|2022|PDM|579.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F46832_0_0|SrvcGrp|14892|2022|PDM|125.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F123601_30680_0|SrvcGrp|42784|2022|PDM|125.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F117465_0_0|SrvcGrp|107493|2022|PDM|3000.00|99|0.00|AETNA - ARTHROSCOPY OF JOINT|
20|FH_F76144_0_0|CSTM-ALL|CSTM-00|2020|PDM|1850.06|99|0.00|ASPG V F/S - BDSS|
20|FH_F147922_10031_0|SrvcGrp|104186|2022|PDM|12.00|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F129483_77030_0|SrvcGrp|19742|2022|PDM|60.00|99|0.00|MID-LINE INSERTION|
20|FH_F80731_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F71863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126345_0_0|SrvcGrp|89869|2022|PDM|1480.00|99|0.00|SPONTANEOUS ABORTION|
20|FH_F141349_26440_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|GENERAL ACUTE CARE|
20|FH_F124414_92653_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F114727_44512_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F119725_0_0|SrvcGrp|13595|2022|PDM|412.72|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F54572_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F115206_80923_0|SrvcGrp|106048|2022|PDM|1034.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F31985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F37346_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|OP SVCS|
20|FH_F105760_98104_0|SrvcGrp|84897|2022|PCT|1.26|99|0.00|DME PROSTHETICS AND ORTHOTICS|
20|FH_F102188_0_0|SrvcGrp|26001|2022|PDM|136.42|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F128657_19008_0|SrvcGrp|473|2022|PDM|402.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F128564_43235_0|SrvcGrp|94781|2022|PDM|138.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F144468_45236_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)|
20|FH_F145842_37172_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131190_21042_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F92659_0_0|SrvcGrp|92546|2022|PDM|652.00|99|0.00|SKIN FULL GRAFT PROCEDURE|
20|FH_F99100_0_0|SrvcGrp|96101|2022|PDM|669.80|99|0.00|PERCUTANEOUS INTRADISCAL (HCFA)|
20|FH_F145815_30540_0|SrvcGrp|113230|2022|PDM|42.13|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 SCR|
20|FH_F52452_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F112863_0_0|SrvcGrp|104258|2022|PDM|1141.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F48302_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F112665_0_0|SrvcGrp|13187|2022|PCT|1.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F88698_18951_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F86131_28215_0|SrvcGrp|472|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F114526_33401_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134249_05060_0|SrvcGrp|63458|2022|PDM|1668.00|99|0.00|ANTEPARTUM VISITS 7 OR MORE|
20|FH_F147987_65674_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124159_92506_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F150301_23236_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F85353_16407_0|SrvcGrp|63816|2022|PDM|549.23|99|0.00|HAPA WPA-NWPA 2012-13 ASC 209|
20|FH_F138353_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|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134160_19006_0|SrvcGrp|2067|2022|PDM|823.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F138584_30912_0|SrvcGrp|113415|2022|PDM|550.00|99|0.00|REPAIR DENTAL REIDGE FRACTURE|
20|FH_F147932_78613_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F35210_0_0|CSTM-ALL|CSTM-00|2020|PDM|1380.00|99|0.00|ACUTE GERIATRIC PSYCHIATRIC|
20|FH_F137248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.00|99|0.00|AEG 1 (NO REV)|
20|FH_F127448_0_0|SrvcGrp|72990|2022|PDM|600.00|99|0.00|AEG 1|
20|FH_F134770_14420_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F119538_60959_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F138283_0_0|SrvcGrp|34173|2022|PDM|115.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F35408_0_0|SrvcGrp|16899|2022|PDM|211.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F35727_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|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_F51658_0_0|SrvcGrp|46248|2022|PDM|90.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F151747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F144888_15370_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F41739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|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_F72648_0_0|SrvcGrp|64580|2022|PDM|240.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F148904_85255_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F55375_0_0|SrvcGrp|17608|2022|PDM|689.00|99|0.00|MENTAL HEALTH / DETOX|
20|FH_F139679_75050_0|SrvcGrp|89417|2022|PDM|473.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F98360_11554_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F69183_0_0|SrvcGrp|360|2022|PDM|800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F97081_21122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147181_27514_0|SrvcGrp|111926|2022|PCT|1.00|99|0.00|COVID-19 LAB TESTING|
20|FH_F149559_60012_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35097_16508_0|SrvcGrp|17755|2022|PDM|54.00|99|0.00|CANISTER DISPOSABLE USED WITH SUCTION PUMP|
20|FH_F151001_80501_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F116753_0_0|SrvcGrp|73483|2022|PDM|1552.00|99|0.00|AETNA SUBACUTE III|
20|FH_F132254_40207_0|SrvcGrp|14948|2022|PDM|125.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F107840_07006_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|1034.00|99|0.00|AEG 6 (NO REV)|
20|FH_F139810_60938_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F36132_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP MAFS  MOD UE|
20|FH_F138296_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|PHARMACY SVCS|
20|FH_F39278_0_0|SrvcGrp|12401|2022|PDM|159.00|99|0.00|RN VISIT|
20|FH_F72830_0_0|SrvcGrp|15324|2022|PDM|300.00|99|0.00|ER LEVEL II|
20|FH_F58292_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138020_20016_0|CSTM-ALL|CSTM-00|2020|PCT|2.70|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131254_92211_0|SrvcGrp|22593|2022|PDM|35.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F148260_0_0|CSTM-ALL|CSTM-00|2020|PDM|10850.00|99|0.00|AEG 7 (NO REV)|
20|FH_F92676_15063_0|SrvcGrp|78968|2022|PDM|1963.93|99|0.00|MON VALLEY ASC 402|
20|FH_F128120_76513_0|SrvcGrp|75419|2022|PDM|408.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F66403_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F44079_0_0|SrvcGrp|10544|2022|PDM|70.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F148867_20191_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121338_37756_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150879_75056_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F150882_84041_0|SrvcGrp|95660|2022|PDM|100.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F139814_24333_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F132160_0_0|SrvcGrp|109765|2022|PDM|1721.00|99|0.00|CLOSURE OF LACRIMAL PUNCTUM|
20|FH_F36435_0_0|SrvcGrp|13133|2022|PDM|55.00|99|0.00|PT/OT/ST|
20|FH_F114951_20002_0|SrvcGrp|8950|2022|PDM|1954.99|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F131551_68355_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143564_0_0|SrvcGrp|87841|2022|PDM|7500.00|99|0.00|LAPAROSCOPE PROCEDURE - STOMACH|
20|FH_F101441_0_0|SrvcGrp|97099|2022|PDM|8105.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F80974_0_0|SrvcGrp|33164|2022|PDM|250.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F132153_06450_0|SrvcGrp|471|2022|PDM|588.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146859_0_0|SrvcGrp|44461|2022|PDM|5913.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F80974_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F131028_49735_0|SrvcGrp|94780|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F110728_13069_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F39443_0_0|SrvcGrp|30310|2022|PDM|123.00|99|0.00|HAPA WPA ASC 120|
20|FH_F110783_93013_0|SrvcGrp|86842|2022|PDM|30.00|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F151785_03104_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F132416_92270_0|SrvcGrp|100499|2022|PDM|779.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F116633_37217_0|SrvcGrp|46605|2022|PDM|150.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F102948_43606_0|SrvcGrp|89337|2022|PDM|712.00|99|0.00|DETOXIFICATION|
20|FH_F67339_0_0|SrvcGrp|473|2022|PDM|1300.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F109601_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F110086_21742_0|SrvcGrp|103837|2022|PDM|600.00|99|0.00|AETNA DESTRUCTION PENIS LESION|
20|FH_F36366_0_0|SrvcGrp|12044|2022|PDM|998.00|99|0.00|SLEEP STUDIES|
20|FH_F72664_0_0|SrvcGrp|68383|2022|PDM|35.00|99|0.00|HOME HEALTH AID|
20|FH_F93920_0_0|SrvcGrp|73002|2022|PDM|7700.00|99|0.00|AEG 7|
20|FH_F33782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS|
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.55|99|0.00|ASPG V|
20|FH_F115464_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F119795_0_0|SrvcGrp|33986|2022|PDM|3019.00|99|0.00|CPT 26055|
20|FH_F106961_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138908_84010_0|SrvcGrp|472|2022|PDM|508.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F125133_20601_0|SrvcGrp|48394|2022|PDM|133.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F49037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F71070_0_0|SrvcGrp|16468|2022|PDM|3000.00|99|0.00|LASER PROCEDURES|
20|FH_F124050_75089_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F100762_51104_0|SrvcGrp|73643|2022|PDM|2637.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F31056_0_0|CSTM-ALL|CSTM-00|2020|PDM|867.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F51074_0_0|SrvcGrp|36991|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F129255_34952_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F129400_32726_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121113_33613_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F78603_0_0|SrvcGrp|28162|2022|PDM|69649.33|99|0.00|MS DRG 217 ONLY|
20|FH_F124796_37641_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109645_0_0|SrvcGrp|22384|2022|PDM|90.00|99|0.00|HOME VISIT PRENATAL|
20|FH_F62702_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F99960_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F149919_85390_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F121547_46805_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F128358_46072_0|SrvcGrp|471|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F143297_0_0|CSTM-ALL|CSTM-00|2020|PDM|2031.00|99|0.00|AEG 8 (NO REV)|
20|FH_F120253_44646_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F106961_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F149031_80525_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F51124_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F33063_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43199_0_0|SrvcGrp|9830|2022|PDM|131.25|99|0.00|OT SVCS|
20|FH_F125682_46825_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F85213_02840_0|SrvcGrp|109057|2022|PCT|1.03|99|0.00|CARDIAC STUDIES|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|TRC VACV 28 FS % MOD NU UE|
20|FH_F138584_30912_0|SrvcGrp|103920|2022|PCT|1.00|99|0.00|CYTOPATHOLOGY FLUIDS|
20|FH_F120152_0_0|SrvcGrp|100063|2022|PDM|2420.00|99|0.00|REPAIR FOOT DISLOCATION|
20|FH_F129427_92262_0|SrvcGrp|87317|2022|PDM|1200.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F137938_29036_0|SrvcGrp|30623|2022|PDM|12614.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F103880_85014_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F100401_15317_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114985_32073_0|SrvcGrp|90492|2022|PDM|82.00|99|0.00|BEHAVRAL QUALIT ANALYS VOICE|
20|FH_F113708_32025_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F147420_89032_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F111409_33761_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F120437_85202_0|SrvcGrp|24754|2022|PDM|33.77|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F133427_48811_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F142169_62002_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F87592_85614_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F133473_21702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F144709_48076_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117446_31322_0|SrvcGrp|92502|2022|PDM|565.35|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F148003_34285_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133148_71446_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149999_33150_0|SrvcGrp|90854|2022|PDM|900.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F121970_92653_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F150820_83843_0|CSTM-ALL|CSTM-00|2020|PDM|2376.50|99|0.00|AEG 5  (NO REV)|
20|FH_F114207_35243_0|SrvcGrp|86834|2022|PDM|15.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F141275_07004_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145920_0_0|SrvcGrp|79593|2022|PDM|1931.00|99|0.00|CPT 45378|
20|FH_F114206_37203_0|SrvcGrp|14948|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F132160_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F140233_35216_0|CSTM-ALL|CSTM-00|2020|PDM|2400.00|99|0.00|AEG 8 (NO REV)|
20|FH_F132418_84042_0|SrvcGrp|89412|2022|PDM|456.78|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F103100_47150_0|SrvcGrp|98445|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS/INJECTIBLES|
20|FH_F125693_92660_0|SrvcGrp|110162|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
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_F124026_53188_0|SrvcGrp|74668|2022|PDM|172.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F97104_53545_0|SrvcGrp|73656|2022|PDM|586.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F88114_32205_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35202_0_0|SrvcGrp|3810|2022|PDM|94.50|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F120308_07901_0|SrvcGrp|73842|2022|PDM|249.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F90818_0_0|SrvcGrp|83351|2022|PDM|4100.00|99|0.00|AETNA LAPAR ORCHIOPEXY|
20|FH_F77983_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TISSUE EXAM BY PATHOLOGIST (MOD TC)|
20|FH_F116291_11570_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F89778_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F130755_04401_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AETNA OP CT SCANS (CTSCAN) - HCFA|
20|FH_F110470_98335_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F143624_73069_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F119379_0_0|SrvcGrp|107841|2022|PDM|885.00|99|0.00|FORMATION OF SKIN PEDICLE|
20|FH_F111986_0_0|SrvcGrp|27345|2022|PDM|2060.00|99|0.00|OP SURGERY (CPT 49650)|
20|FH_F116753_0_0|SrvcGrp|106775|2022|PDM|5599.00|99|0.00|TIB/PER REVASC|
20|FH_F100782_0_0|SrvcGrp|105129|2022|PDM|483.31|99|0.00|WINDBER MEDICAL CNTR ASC 234|
20|FH_F114386_07090_0|SrvcGrp|48394|2022|PDM|35.28|99|0.00|SKILLED NURSING SERVICES|
20|FH_F150910_0_0|SrvcGrp|113851|2022|PDM|10500.00|99|0.00|ARTHRDSIS LAT MINI DISKECT|
20|FH_F136659_62821_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138310_60461_0|SrvcGrp|73701|2022|PDM|35.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F43123_0_0|CSTM-ALL|CSTM-00|2020|PDM|149.00|99|0.00|OP SVCS|
20|FH_F147725_06002_0|SrvcGrp|100017|2022|PDM|9800.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F133107_73071_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F148644_06890_0|SrvcGrp|114926|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F145884_72113_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F93421_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F32198_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F119291_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F32970_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F141852_78102_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41814_0_0|SrvcGrp|9510|2022|PDM|580.00|99|0.00|SKILLED NURSING CARE|
20|FH_F90955_06053_0|SrvcGrp|23683|2022|PDM|36.75|99|0.00|SKILLED NURSING RN|
20|FH_F118542_60188_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F147997_92620_0|SrvcGrp|75419|2022|PDM|2100.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148644_06890_0|SrvcGrp|33967|2022|PDM|4635.00|99|0.00|CPT 47562|
20|FH_F138007_24314_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117287_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F36343_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|930741-PHELPS REG-S CODES-SH/SJ MOD|
20|FH_F65100_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO|
20|FH_F140143_24874_0|SrvcGrp|13422|2022|PDM|219.93|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F36554_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|ASPG I|
20|FH_F130371_0_0|SrvcGrp|83960|2022|PCT|0.92|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F129966_18017_0|CSTM-ALL|CSTM-00|2020|PDM|842.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F35557_0_0|SrvcGrp|17016|2022|PDM|28.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F109221_15084_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD TRI CARE HOME HEALTH|
20|FH_F114951_20002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97080_85122_0|SrvcGrp|88978|2022|PDM|6763.00|99|0.00|VAGINAL DELIVERY|
20|FH_F136779_0_0|SrvcGrp|112928|2022|PDM|7957.00|99|0.00|ILIAC REVASC W/STENT|
20|FH_F41342_0_0|CSTM-ALL|CSTM-00|2020|PDM|625.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119946_36109_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139870_71075_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134568_12946_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F85212_71075_0|SrvcGrp|73002|2022|PDM|1486.00|99|0.00|AEG 7|
20|FH_F114444_19602_0|SrvcGrp|105374|2022|PDM|95.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MIN|
20|FH_F134537_03060_0|SrvcGrp|73841|2022|PDM|354.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F129101_27006_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F101100_50314_0|SrvcGrp|97729|2022|PDM|13669.00|99|0.00|BREAST RECONTRUCT|
20|FH_F133478_40165_0|SrvcGrp|12491|2022|PCT|0.28|99|0.00|PACEMAKER|
20|FH_F145188_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|AEG 2 (NO REV)|
20|FH_F46433_0_0|SrvcGrp|22594|2022|PDM|60.00|99|0.00|IMIGLUCERASE|
20|FH_F113178_44035_0|SrvcGrp|43526|2022|PDM|280.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - SUBSTANCE ABUSE|
20|FH_F118201_35126_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F142393_33142_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F137980_03101_0|SrvcGrp|113276|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142427_36607_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130297_41042_0|SrvcGrp|108153|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F146794_79601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47421_0_0|SrvcGrp|36991|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|2035.00|99|0.00|AEG 3 (NO REV)|
20|FH_F134814_62230_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F34498_0_0|SrvcGrp|12692|2022|PDM|573.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F41463_0_0|SrvcGrp|17013|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F126769_43701_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F49637_0_0|SrvcGrp|27976|2022|PDM|22907.00|99|0.00|MS DRG 329 ONLY|
20|FH_F117275_16936_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F145988_06105_0|CSTM-ALL|CSTM-00|2020|PDM|6613.00|99|0.00|AEG 8 (NO REV)|
20|FH_F144588_60090_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40084_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|GENERAL ACUTE CARE|
20|FH_F71644_0_0|SrvcGrp|20153|2022|PDM|180242.00|99|0.00|SINGLE LUNG TRANSPLANT|
20|FH_F151049_18702_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F109843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1980.00|99|0.00|AEG 10 (NO REV)|
20|FH_F124486_0_0|SrvcGrp|91032|2022|PDM|1803.00|99|0.00|AQUEOUS SHUNT EYE W/GRAFT (HCFA)|
20|FH_F76826_0_0|SrvcGrp|76010|2022|PDM|577.00|99|0.00|EMERGENCY ROOM SVCS LEVEL III|
20|FH_F146266_0_0|SrvcGrp|26432|2022|PDM|1840.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F33719_0_0|SrvcGrp|110|2022|PDM|500.00|99|0.00|CD - REHABILITATION|
20|FH_F89640_98133_0|CSTM-ALL|CSTM-00|2020|PCT|2.12|99|0.00|AETNA - APC GROUPER K|
20|FH_F97623_38008_0|SrvcGrp|73559|2022|PDM|6516.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F128753_32501_0|SrvcGrp|72984|2022|PCT|0.64|99|0.00|CHEMOTHERAPY|
20|FH_F37081_0_0|SrvcGrp|16|2022|PDM|1086.00|99|0.00|ACUTE REHABILITATION|
20|FH_F115705_0_0|SrvcGrp|22954|2022|PDM|130.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F119376_0_0|SrvcGrp|108115|2022|PDM|1969.74|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F118907_0_0|SrvcGrp|107720|2022|PDM|333.89|99|0.00|SLEEP STUDIES|
20|FH_F109221_15084_0|SrvcGrp|48385|2022|PDM|88.00|99|0.00|SPEECH THERAPY|
20|FH_F129839_63640_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD KN|
20|FH_F50218_0_0|SrvcGrp|42972|2022|PDM|32.00|99|0.00|HOME HEALTH AIDE|
20|FH_F151146_0_0|CSTM-ALL|CSTM-00|2020|PDM|3743.00|99|0.00|AEG 9 (NO REV)|
20|FH_F116955_16801_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F121547_46805_0|SrvcGrp|107288|2022|PCT|1.00|99|0.00|INJ INTERFERON BETA|
20|FH_F73662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137067_0_0|SrvcGrp|26278|2022|PDM|3491.00|99|0.00|CPT 29881|
20|FH_F63250_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F148430_06278_0|SrvcGrp|88246|2022|PCT|1.00|99|0.00|INFLUENZA DNA AMP PROBE|
20|FH_F40890_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F71323_68114_0|SrvcGrp|37354|2022|PDM|2970.00|99|0.00|MS DRG 343 ONLY|
20|FH_F44540_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|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_F92676_15063_0|SrvcGrp|78938|2022|PDM|3795.66|99|0.00|MON VALLEY ASC 907|
20|FH_F151144_35801_0|SrvcGrp|107187|2022|PDM|915.43|99|0.00|REVISE TWO EYE MUSCLES|
20|FH_F121949_80246_0|SrvcGrp|74668|2022|PDM|584.82|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F150839_03833_0|SrvcGrp|82223|2022|PDM|208.00|99|0.00|HOSPICE CARE|
20|FH_F117574_49022_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F50461_0_0|SrvcGrp|20155|2022|PDM|78105.00|99|0.00|MS DRG 010|
20|FH_F125772_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F111857_68005_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F125182_0_0|SrvcGrp|85000|2022|PDM|2410.50|99|0.00|CPT 45384|
20|FH_F149699_0_0|SrvcGrp|80098|2022|PDM|58.00|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE|
20|FH_F116575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F37777_0_0|SrvcGrp|36234|2022|PDM|300.00|99|0.00|JOINT REPLACEMENT/ ORTHO / GENERAL DAY TREATMENT|
20|FH_F124322_64131_0|SrvcGrp|43569|2022|PDM|42.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F139824_24801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F130937_98002_0|SrvcGrp|108484|2022|PDM|446.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F132353_66423_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126970_45601_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F40649_0_0|SrvcGrp|33148|2022|PDM|2260.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F54614_0_0|SrvcGrp|50907|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F101021_0_0|SrvcGrp|65720|2022|PDM|140.00|99|0.00|RESPITE CARE|
20|FH_F123320_43558_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F143530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148340_28269_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F124388_0_0|CSTM-ALL|CSTM-00|2020|PDM|1188.00|99|0.00|AEG 10 (NO REV)|
20|FH_F151541_01436_0|SrvcGrp|473|2022|PDM|413.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F129792_80309_0|SrvcGrp|111423|2022|PCT|1.16|99|0.00|DIAGNOSTIC RADIOLOGY SERVICES (MOD TC)|
20|FH_F151408_0_0|CSTM-ALL|CSTM-00|2020|PDM|36.00|99|0.00|AEG 10 (NO REV)|
20|FH_F52534_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34182_0_0|CSTM-ALL|CSTM-00|2020|PDM|8646.00|99|0.00|MS DRG 281-282 CIRCULATORY DISORDER|
20|FH_F150165_06032_0|SrvcGrp|109494|2022|PDM|4021.00|99|0.00|INSRT HEART PM ATRIAL & VENT|
20|FH_F110305_70403_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F85213_02840_0|SrvcGrp|115762|2022|PCT|1.03|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F145882_02368_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F110442_98003_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F145593_92660_0|SrvcGrp|75442|2022|PDM|710.00|99|0.00|OBSERVATION - REV 762|
20|FH_F51934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F98780_35022_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F105145_75075_0|SrvcGrp|73497|2022|PDM|1125.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F146668_30189_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F111604_16505_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F117465_0_0|SrvcGrp|101114|2022|PDM|10000.00|99|0.00|ARTHOPLASTY|
20|FH_F109982_33592_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F129438_08234_0|SrvcGrp|86722|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F99541_0_0|CSTM-ALL|CSTM-00|2020|PCT|47.00|99|0.00|OP SVCS|
20|FH_F131759_06032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131047_0_0|SrvcGrp|105702|2022|PCT|0.57|99|0.00|EMERGENCY ROOM SERVICE|
20|FH_F121799_0_0|SrvcGrp|84185|2022|PDM|24.50|99|0.00|RESPITE CARE|
20|FH_F147702_75240_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F101922_98055_0|SrvcGrp|73497|2022|PDM|2923.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F97565_83301_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F43774_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141747_20688_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97541_33021_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F81151_16801_0|SrvcGrp|75545|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F106540_26330_0|SrvcGrp|73004|2022|PDM|4468.00|99|0.00|AEG 8|
20|FH_F119229_90804_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F97542_32960_0|SrvcGrp|88977|2022|PDM|5738.00|99|0.00|C-SECTION DELIVERY|
20|FH_F37567_0_0|CSTM-ALL|CSTM-00|2020|PDM|1220.00|99|0.00|ASPG VII|
20|FH_F120743_44116_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139530_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F82357_0_0|SrvcGrp|14371|2022|PDM|17.00|99|0.00|DISPOSABLE DRUG DELIVERY|
20|FH_F91594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F120635_22903_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F46672_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F72445_0_0|SrvcGrp|12073|2022|PDM|52.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138857_90025_0|SrvcGrp|75419|2022|PDM|750.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F138876_25302_0|SrvcGrp|86847|2022|PDM|45.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F138880_92392_0|SrvcGrp|109798|2022|PCT|1.30|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F32589_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F151401_36607_0|SrvcGrp|27969|2022|PCT|0.00|99|0.00|HOME HEALTH AIDE|
20|FH_F151501_30265_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F151501_30265_0|SrvcGrp|96539|2022|PDM|5995.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F151501_30265_0|SrvcGrp|108095|2022|PDM|2090.00|99|0.00|PARTIAL REMOVAL FOOT FASCIA|
20|FH_F132258_45404_0|SrvcGrp|22592|2022|PDM|34.98|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F122076_17543_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43239_0_0|SrvcGrp|31134|2022|PDM|760.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F135434_64424_0|SrvcGrp|73606|2022|PDM|901.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F135485_20171_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97142_94535_0|SrvcGrp|73603|2022|PDM|22507.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F97142_94535_0|SrvcGrp|73485|2022|PDM|1353.00|99|0.00|AETNA REHAB|
20|FH_F91764_93710_0|CSTM-ALL|CSTM-00|2020|PDM|4534.00|99|0.00|AEG 4 (NO REV)|
20|FH_F91764_93710_0|SrvcGrp|89317|2022|PCT|1.00|99|0.00|AETNA SLEEP STUDIES|
20|FH_F135775_60614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135795_60016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136041_87107_0|SrvcGrp|86722|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F136150_73068_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136216_27526_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100765_73735_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F131463_19096_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F131566_60559_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116431_76104_0|SrvcGrp|86465|2022|PCT|1.50|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F116527_70443_0|SrvcGrp|73006|2022|PDM|1700.00|99|0.00|AEG 9|
20|FH_F131361_18235_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F130766_04967_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|AEG 8 (NO REV)|
20|FH_F140629_0_0|SrvcGrp|107778|2022|PDM|2497.00|99|0.00|ARTHROSCOPIC FRACTURE TX|
20|FH_F101644_75116_0|SrvcGrp|48398|2022|PDM|107.50|99|0.00|PT SERVICES|
20|FH_F121411_33063_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F121763_07202_0|SrvcGrp|10944|2022|PDM|684.00|99|0.00|EMERGENCY ROOM|
20|FH_F121771_91405_0|SrvcGrp|74668|2022|PDM|278.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F44113_0_0|SrvcGrp|177|2022|PDM|1400.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F128370_76132_0|SrvcGrp|23587|2022|PDM|625.00|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F128370_76132_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F111394_46012_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|580.00|99|0.00|AEG 3 (NO REV)|
20|FH_F48215_0_0|SrvcGrp|3809|2022|PDM|483.00|99|0.00|HOSPICE CARE|
20|FH_F36344_0_0|SrvcGrp|19984|2022|PDM|46.00|99|0.00|THERAPY|
20|FH_F116430_0_0|SrvcGrp|82720|2022|PDM|2175.00|99|0.00|WRIST ENDOSCOPY/SURGERY|
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|1925.00|99|0.00|AEG 6 (NO REV)|
20|FH_F132328_0_0|SrvcGrp|65625|2022|PDM|2563.00|99|0.00|CPT 30520|
20|FH_F109503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112995_0_0|SrvcGrp|90318|2022|PCT|1.10|99|0.00|IMPLANTS/PROSTHETICS|
20|FH_F87557_33309_0|SrvcGrp|86854|2022|PDM|30.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F102282_06795_0|SrvcGrp|23683|2022|PDM|49.81|99|0.00|SKILLED NURSING RN|
20|FH_F102322_32233_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F102325_62691_0|SrvcGrp|17016|2022|PDM|75.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F102862_30606_0|SrvcGrp|21122|2022|PDM|44781.00|99|0.00|MS DRG 459 ONLY|
20|FH_F143648_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F143648_0_0|SrvcGrp|16732|2022|PDM|8200.00|99|0.00|HYSTEROSCOPY ABLATION|
20|FH_F148079_06512_0|SrvcGrp|48394|2022|PDM|49.44|99|0.00|SKILLED NURSING SERVICES|
20|FH_F138283_0_0|SrvcGrp|63297|2022|PDM|113.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F101840_76054_0|SrvcGrp|73804|2022|PDM|19719.00|99|0.00|AETNA MSDRG 620 ONLY|
20|FH_F126560_43606_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F114519_0_0|SrvcGrp|73006|2022|PDM|1747.00|99|0.00|AEG 9|
20|FH_F104180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD KF|
20|FH_F146103_63851_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F126188_59404_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F134601_94010_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F85415_27612_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148644_06890_0|CSTM-ALL|CSTM-00|2020|PDM|1213.00|99|0.00|AEG 2 (NO REV)|
20|FH_F109630_0_0|CSTM-ALL|CSTM-00|2020|PDM|597.80|99|0.00|AEG 1 (NO REV)|
20|FH_F145697_52302_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F83035_0_0|SrvcGrp|26001|2022|PDM|126.33|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F145641_06902_0|SrvcGrp|96781|2022|PDM|769.00|99|0.00|INJECTION FOR NERVE BLOCK 5|
20|FH_F111809_93003_0|SrvcGrp|72984|2022|PCT|9.10|99|0.00|CHEMOTHERAPY|
20|FH_F116428_0_0|SrvcGrp|57968|2022|PDM|31.35|99|0.00|CONTINUOUS HOMECARE|
20|FH_F139487_60076_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F74845_0_0|SrvcGrp|360|2022|PCT|0.85|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F122336_67042_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F147303_70508_0|SrvcGrp|66265|2022|PDM|74.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F131471_67203_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F36720_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F120083_13501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150914_17350_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134410_46807_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|COVENTRY ENHANCED DEFAULT 10021-69990|
20|FH_F134847_0_0|SrvcGrp|84939|2022|PDM|14238.00|99|0.00|SHOULDER JOINT|
20|FH_F132419_84042_0|SrvcGrp|73605|2022|PDM|956.96|99|0.00|AETNA ACUTE PSYCH|
20|FH_F120977_50510_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F140007_0_0|SrvcGrp|97362|2022|PDM|8045.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F97500_32025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F40615_0_0|SrvcGrp|72|2022|PDM|416.00|99|0.00|NEWBORN NURSERY|
20|FH_F116760_68512_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|1242.00|99|0.00|AEG 7 (NO REV)|
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|1818.00|99|0.00|AEG 7 (NO REV)|
20|FH_F110263_0_0|SrvcGrp|35669|2022|PDM|9277.00|99|0.00|CPT 63650|
20|FH_F139515_0_0|SrvcGrp|37984|2022|PDM|1791.00|99|0.00|LUMBAR INJECTIONS PROCEDURE|
20|FH_F117783_0_0|SrvcGrp|106235|2022|PCT|1.00|99|0.00|CYPASS|
20|FH_F120902_64085_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F63514_0_0|SrvcGrp|17139|2022|PDM|627.34|99|0.00|HOSPICE CARE|
20|FH_F70531_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143528_0_0|SrvcGrp|88487|2022|PDM|4861.50|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F97000_24201_0|SrvcGrp|97965|2022|PCT|1.00|99|0.00|AETNA OP AMFS DEFAULT W/O REV 931-932|
20|FH_F86991_15122_0|SrvcGrp|73006|2022|PDM|1546.00|99|0.00|AEG 9|
20|FH_F60095_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F49535_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124162_73127_0|SrvcGrp|86722|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F150307_84111_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F70804_0_0|SrvcGrp|12403|2022|PDM|1065.85|99|0.00|CONTINUOUS HOMECARE|
20|FH_F125164_15206_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125105_67361_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141837_0_0|SrvcGrp|106317|2022|PDM|1275.00|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F138857_90025_0|SrvcGrp|73605|2022|PDM|970.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F89580_0_0|SrvcGrp|13903|2022|PDM|6485.00|99|0.00|PEDIATRIC IP SVCS|
20|FH_F91641_0_0|SrvcGrp|87201|2022|PDM|3121.20|99|0.00|AETNA HIGH COST SURGERY - CATARACT|
20|FH_F100904_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AEG 9 (NO REV)|
20|FH_F110233_0_0|SrvcGrp|74584|2022|PCT|0.94|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1566.05|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1402 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|472.90|99|0.00|HAPA WPA-NWPA 2012-13 ASC 404 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|127.30|99|0.00|HAPA WPA-NWPA 2012-13 ASC 139 W/O REV|
20|FH_F113527_31023_0|SrvcGrp|92940|2022|PDM|1114.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F151339_72758_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F151340_30040_0|CSTM-ALL|CSTM-00|2020|PDM|1070.00|99|0.00|AEG 5  (NO REV)|
20|FH_F151420_60654_0|SrvcGrp|11000|2022|PCT|0.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F151501_30265_0|CSTM-ALL|CSTM-00|2020|PDM|1466.00|99|0.00|AEG 8 (NO REV)|
20|FH_F122106_60035_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F36492_0_0|SrvcGrp|73006|2022|PDM|1428.00|99|0.00|AEG 9|
20|FH_F37809_0_0|SrvcGrp|27399|2022|PDM|5830.00|99|0.00|OP SURGERY|
20|FH_F135572_89106_0|SrvcGrp|17013|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F135572_89106_0|SrvcGrp|24752|2022|PCT|1.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F136003_19380_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119892_47586_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F119892_47586_0|SrvcGrp|106904|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F130547_85712_0|SrvcGrp|97365|2022|PDM|47.82|99|0.00|ERTAPENEM INJECTION|
20|FH_F130756_04901_0|SrvcGrp|105465|2022|PCT|0.89|99|0.00|AETNA THERAPIES|
20|FH_F131407_07607_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131407_07607_0|SrvcGrp|86845|2022|PDM|30.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F116397_33404_0|SrvcGrp|10577|2022|PDM|40.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F116397_33404_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F101741_16823_0|SrvcGrp|42622|2022|PCT|0.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F121701_70420_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F121743_70005_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F69205_0_0|SrvcGrp|11798|2022|PDM|204.20|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F111292_33136_0|SrvcGrp|82755|2022|PDM|47.00|99|0.00|ASSAY BLOOD MAGNESIUM|
20|FH_F111363_33169_0|SrvcGrp|73603|2022|PDM|2141.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F37209_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F33081_0_0|SrvcGrp|14300|2022|PDM|4035.00|99|0.00|LAPAROSCOPIC SUPRACERVICAL HYSTERECTOMY|
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|SrvcGrp|87055|2022|PDM|2123.00|99|0.00|CYSTOURETHROSCOPY W/STENT INSERTION|
20|FH_F112995_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139873_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F131702_17022_0|SrvcGrp|100982|2022|PCT|1.00|99|0.00|AETNA OP SVCS HH AMFS DEFAULT|
20|FH_F134087_0_0|SrvcGrp|67279|2022|PDM|9017.00|99|0.00|CERVICAL SURGERY|
20|FH_F92533_27810_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F85713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F109040_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F124679_64052_0|SrvcGrp|75545|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F43352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54612_07631_0|SrvcGrp|9829|2022|PDM|109.50|99|0.00|PT SVCS|
20|FH_F105361_80104_0|SrvcGrp|29816|2022|PCT|0.49|99|0.00|IMPLANTS/PROSTHETICS/DRUGS|
20|FH_F77665_0_0|SrvcGrp|27579|2022|PDM|65.00|99|0.00|RESPIRATORY THERAPY INITIAL VISIT|
20|FH_F146466_21620_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F63124_0_0|SrvcGrp|45944|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE SVCS|
20|FH_F51938_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F123739_61820_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120473_98055_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137187_64015_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114092_83350_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F129434_98271_0|SrvcGrp|87317|2022|PDM|1326.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F117093_40041_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F131379_0_0|SrvcGrp|108153|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PDM|517.00|99|0.00|ASPG II|
20|FH_F131608_0_0|SrvcGrp|80918|2022|PDM|149.80|99|0.00|RESPITE CARE|
20|FH_F132739_0_0|SrvcGrp|112034|2022|PCT|0.62|99|0.00|IMPLANTS/PROSTHETIC|
20|FH_F141336_16947_0|SrvcGrp|111930|2022|PDM|14.30|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F136772_89109_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F34888_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F81373_64064_0|SrvcGrp|29817|2022|PDM|5265.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F45977_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 649|
20|FH_F83294_0_0|SrvcGrp|42975|2022|PDM|85.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F106640_78642_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F139441_91324_0|SrvcGrp|75419|2022|PDM|2660.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F39443_0_0|SrvcGrp|30362|2022|PDM|1340.00|99|0.00|HAPA WPA ASC 7|
20|FH_F148347_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)|
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_F131261_19111_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F72702_0_0|CSTM-ALL|CSTM-00|2020|PDM|485.00|99|0.00|AEG 6 (NO REV)|
20|FH_F123745_0_0|SrvcGrp|109526|2022|PDM|7500.00|99|0.00|TREATMENT OF ANKLE FRACTURE|
20|FH_F124492_30040_0|SrvcGrp|113227|2022|PDM|156.89|99|0.00|COVID-19 NFCT DS VIR RESP RNA 3 TRGT|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD AV"|
20|FH_F47600_0_0|SrvcGrp|32388|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKE (DME)|
20|FH_F35685_0_0|SrvcGrp|1175|2022|PDM|44541.00|99|0.00|DRG 106 CORONARY BYPASS|
20|FH_F40517_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F34048_0_0|SrvcGrp|65861|2022|PCT|0.65|99|0.00|PHARMACY SERVICES|
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F71070_0_0|SrvcGrp|68055|2022|PDM|3000.00|99|0.00|CPT 52649|
20|FH_F45175_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F118072_38133_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147941_06023_0|SrvcGrp|14494|2022|PDM|85.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F123407_04605_0|SrvcGrp|104996|2022|PDM|141.00|99|0.00|AETNA CRISIS INTERVENTION MENTAL HEALTH FOLLOW UP|
20|FH_F120280_64701_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120308_07901_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F92120_0_0|CSTM-ALL|CSTM-00|2020|PDM|1362.00|99|0.00|AEG 5  (NO REV)|
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PDM|1858.00|99|0.00|AEG 8 (NO REV)|
20|FH_F99720_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F122928_39563_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F113541_0_0|SrvcGrp|90418|2022|PDM|6662.00|99|0.00|ENLARGE BREAST WITH IMPLANT|
20|FH_F146880_74105_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F37603_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53|
20|FH_F100703_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F132864_71101_0|SrvcGrp|73461|2022|PDM|3024.00|99|0.00|AETNA NICU IV|
20|FH_F126073_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|962.00|99|0.00|AEG 10 (NO REV)|
20|FH_F88355_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133455_60110_0|SrvcGrp|48396|2022|PDM|118.00|99|0.00|OT SERVICES|
20|FH_F98600_91730_0|SrvcGrp|73700|2022|PDM|35.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F56533_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114974_0_0|CSTM-ALL|CSTM-00|2020|PDM|1160.00|99|0.00|AEG 5  (NO REV)|
20|FH_F44072_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92673_44041_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F133009_19038_0|SrvcGrp|53987|2022|PDM|227.00|99|0.00|PHOTOTHERAPY|
20|FH_F133118_33143_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F113288_38104_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F87500_16823_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87532_32110_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F125054_16365_0|SrvcGrp|88620|2022|PDM|92.00|99|0.00|SKILLED NURSING RN|
20|FH_F132090_60915_0|SrvcGrp|108932|2022|PDM|2250.00|99|0.00|KNEE ARTHROSCOPY/SURGICAL|
20|FH_F148119_30165_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F119289_43040_0|SrvcGrp|105265|2022|PDM|280.00|99|0.00|HEMODIALYSIS|
20|FH_F143190_46168_0|SrvcGrp|90854|2022|PDM|1021.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F95641_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137950_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F148890_45133_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146254_83651_0|SrvcGrp|113276|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F89574_0_0|SrvcGrp|87537|2022|PDM|525.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F79824_0_0|SrvcGrp|29121|2022|PCT|0.48|99|0.00|LABORATORY|
20|FH_F130329_64114_0|SrvcGrp|86846|2022|PDM|25.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F112665_0_0|SrvcGrp|98497|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F102726_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|MAMMOGRAPHY|
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.04|99|0.00|AEG 5  (NO REV)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|237.90|99|0.00|HAPA WPA-NWPA 2012-13 ASC 231 W/O REV|
20|FH_F126114_31788_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127090_45601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126341_27284_0|SrvcGrp|14948|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F85651_33549_0|SrvcGrp|74500|2022|PDM|165.00|99|0.00|CPT 76805|
20|FH_F84712_0_0|SrvcGrp|16301|2022|PDM|6307.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F115903_43560_0|SrvcGrp|46903|2022|PDM|1038.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F51938_0_0|SrvcGrp|44131|2022|PDM|90.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F46433_0_0|SrvcGrp|17009|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134011_84102_0|SrvcGrp|80918|2022|PDM|112.00|99|0.00|RESPITE CARE|
20|FH_F129504_02871_0|SrvcGrp|48394|2022|PDM|71.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F137806_83702_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F105320_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F100703_0_0|CSTM-ALL|CSTM-00|2020|PDM|3571.00|99|0.00|AEG 8 (NO REV)|
20|FH_F113913_70065_0|SrvcGrp|473|2022|PDM|385.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F41540_0_0|SrvcGrp|33824|2022|PDM|866.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 2|
20|FH_F132845_63841_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140844_48083_0|SrvcGrp|87394|2022|PDM|129.00|99|0.00|HCPCS G0152 (HCFA)|
20|FH_F141036_02347_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F55812_0_0|SrvcGrp|14254|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F122174_16511_0|SrvcGrp|75545|2022|PDM|340.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F130036_43232_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F148554_85016_0|SrvcGrp|115460|2022|PDM|4422.00|99|0.00|REMOVE & REPLACE DEFIB GEN MULTI LEAD|
20|FH_F147800_0_0|SrvcGrp|90976|2022|PDM|1210.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F103281_32086_0|SrvcGrp|74586|2022|PCT|0.31|99|0.00|AETNA OP HIGH COST DRUGS|
20|FH_F40465_0_0|CSTM-ALL|CSTM-00|2020|PDM|33000.00|99|0.00|DRG 514 (535-536)|
20|FH_F143684_0_0|SrvcGrp|92408|2022|PDM|8323.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|449.30|99|0.00|ASPG 210|
20|FH_F147800_0_0|SrvcGrp|110570|2022|PDM|880.00|99|0.00|NERVE BLOCK INJECTION 7|
20|FH_F141870_85224_0|SrvcGrp|86846|2022|PDM|35.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F117909_92405_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F38663_0_0|SrvcGrp|27969|2022|PDM|13.00|99|0.00|HOME HEALTH AIDE|
20|FH_F47479_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HILLCREST IV THERAPY - MOD SH|
20|FH_F35737_34741_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|1927.00|99|0.00|AEG 7 (NO REV)|
20|FH_F145920_0_0|CSTM-ALL|CSTM-00|2020|PDM|1712.00|99|0.00|AEG 3 (NO REV)|
20|FH_F98360_11554_0|SrvcGrp|73605|2022|PDM|3706.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F128029_48154_0|SrvcGrp|84185|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F134732_0_0|SrvcGrp|74670|2022|PCT|0.00|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F143227_50312_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120187_76522_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132414_30571_0|SrvcGrp|75754|2022|PCT|1.15|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F82173_72712_0|SrvcGrp|81779|2022|PCT|2.25|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F126784_80809_0|SrvcGrp|73605|2022|PDM|2195.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG X|
20|FH_F151526_28208_0|SrvcGrp|107793|2022|PDM|18641.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F40410_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130716_76013_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137980_03101_0|SrvcGrp|90397|2022|PDM|360.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F38450_0_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F93252_0_0|SrvcGrp|93119|2022|PDM|2000.00|99|0.00|BREAST TISSUE REMOVAL OR REPAIR|
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|ASPG IV|
20|FH_F134809_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F49016_0_0|SrvcGrp|14187|2022|PDM|650.00|99|0.00|MRI|
20|FH_F148432_01585_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F109812_37043_0|SrvcGrp|86748|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F34641_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117385_48091_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F76662_0_0|SrvcGrp|66482|2022|PDM|35.00|99|0.00|HOME HEALTH AID|
20|FH_F132934_63005_0|SrvcGrp|9838|2022|PDM|3842.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F148981_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|AEG 1 (NO REV)|
20|FH_F150961_89169_0|SrvcGrp|115907|2022|PCT|1.00|99|0.00|OUTPATIENT AMFS(H) DEFAULT W/O OTHER SERVICES|
20|FH_F94303_0_0|SrvcGrp|72994|2022|PDM|1423.00|99|0.00|AEG 3|
20|FH_F110783_93013_0|SrvcGrp|86121|2022|PDM|52.40|99|0.00|AETNA GAMUNEX-C|
20|FH_F140295_0_0|SrvcGrp|106680|2022|PDM|13261.00|99|0.00|REVISION OF ANKLE JOINT|
20|FH_F151699_01752_0|SrvcGrp|14949|2022|PDM|120.00|99|0.00|HOME INFUSION|
20|FH_F143413_75061_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132416_92270_0|SrvcGrp|110812|2022|PDM|400.00|99|0.00|INTENSIVE OP PSYCH|
20|FH_F116546_78723_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F33925_0_0|SrvcGrp|20288|2022|PDM|2650.00|99|0.00|NORMAL DELIVERY|
20|FH_F131208_0_0|SrvcGrp|106291|2022|PDM|379.50|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F149839_80002_0|SrvcGrp|23683|2022|PDM|65.00|99|0.00|SKILLED NURSING RN|
20|FH_F128307_43219_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147941_06023_0|SrvcGrp|100272|2022|PCT|1.26|99|0.00|IIV3 VACCINE SPLT 0.25 ML IM|
20|FH_F131603_53051_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87619_0_0|SrvcGrp|73002|2022|PDM|1247.00|99|0.00|AEG 7|
20|FH_F151084_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F142710_0_0|SrvcGrp|82223|2022|PDM|105.00|99|0.00|HOSPICE CARE|
20|FH_F102302_0_0|SrvcGrp|98600|2022|PDM|10850.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F94261_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/MOD KN  (TN)|
20|FH_F116188_72211_0|SrvcGrp|89149|2022|PDM|207.00|99|0.00|OP INTENSIVE|
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|412.00|99|0.00|AEG 2 (NO REV)|
20|FH_F133749_84604_0|SrvcGrp|112414|2022|PDM|22.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F146400_71860_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123623_03246_0|SrvcGrp|109297|2022|PCT|1.00|99|0.00|IIV NO PRSV INCREASED AG IM|
20|FH_F125110_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 7 (NO REV)|
20|FH_F138050_52301_0|CSTM-ALL|CSTM-00|2020|PDM|6022.00|99|0.00|AEG 8 (NO REV)|
20|FH_F49572_0_0|SrvcGrp|43502|2022|PDM|300.00|99|0.00|NEWBORN NURSERY WITH MS DRG 795|
20|FH_F120737_45877_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F58396_0_0|SrvcGrp|1168|2022|PDM|803.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F83978_66739_0|SrvcGrp|110876|2022|PDM|1191.00|99|0.00|WRIST ENDOSCOPY|
20|FH_F123623_03246_0|SrvcGrp|109284|2022|PCT|1.00|99|0.00|ANTIHUMAN GLOBULIN TEST|
20|FH_F145959_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|HSS ASC|
20|FH_F123096_28210_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F146211_68144_0|CSTM-ALL|CSTM-00|2020|PDM|4973.00|99|0.00|AEG 5  (NO REV)|
20|FH_F51129_0_0|SrvcGrp|360|2022|PDM|2760.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F52733_0_0|SrvcGrp|43569|2022|PDM|85.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F128919_48075_0|SrvcGrp|33722|2022|PDM|30.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F150883_14727_0|SrvcGrp|25934|2022|PDM|585.00|99|0.00|SKILLED NURSING|
20|FH_F38394_0_0|SrvcGrp|17071|2022|PDM|1000.80|99|0.00|ASPG IV|
20|FH_F132285_89103_0|SrvcGrp|46605|2022|PDM|85.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F148866_84123_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121985_46256_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F115982_0_0|SrvcGrp|26278|2022|PDM|1350.00|99|0.00|CPT 29881|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PDM|12.00|99|0.00|PICC LINE CATH CARE|
20|FH_F119946_36109_0|SrvcGrp|472|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150938_02062_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F94621_07728_0|SrvcGrp|94045|2022|PCT|1.00|99|0.00|VINCRISTINE SULFATE 1MG/2 MX|
20|FH_F124703_65711_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F140137_15235_0|SrvcGrp|3809|2022|PDM|606.00|99|0.00|HOSPICE CARE|
20|FH_F140233_35216_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F93740_0_0|SrvcGrp|91588|2022|PDM|10000.00|99|0.00|DIAGNOSTIC ELECTROPHYSIOLOGY (EP) STUDY|
20|FH_F42177_0_0|SrvcGrp|20534|2022|PCT|0.85|99|0.00|SKILLED NURSING|
20|FH_F98625_08103_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F38341_0_0|SrvcGrp|16746|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F149523_0_0|SrvcGrp|98561|2022|PDM|12000.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F40709_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|ASPG II|
20|FH_F123885_60062_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125028_19061_0|SrvcGrp|29076|2022|PDM|63.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F40525_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD TC|
20|FH_F44582_0_0|SrvcGrp|9774|2022|PDM|3300.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F148440_16506_0|CSTM-ALL|CSTM-00|2020|PDM|1270.00|99|0.00|AEG 7 (NO REV)|
20|FH_F130512_40205_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137716_66204_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F39740_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F40661_0_0|SrvcGrp|588|2022|PDM|1786.00|99|0.00|CORONARY CARE UNIT|
20|FH_F40605_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|SPINAL CORD REHABILITATION|
20|FH_F89778_0_0|SrvcGrp|26273|2022|PDM|1215.74|99|0.00|CPT 29880|
20|FH_F88492_70601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F62974_0_0|SrvcGrp|3810|2022|PDM|98.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F143566_98264_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139169_0_0|SrvcGrp|58636|2022|PDM|6500.00|99|0.00|CPT 62362|
20|FH_F119213_66209_0|SrvcGrp|90490|2022|PCT|1.00|99|0.00|EVALUATION OF SPEECH FLUENCY|
20|FH_F127806_63044_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125133_20601_0|SrvcGrp|88621|2022|PDM|159.00|99|0.00|SKILLED NURSING LPN|
20|FH_F38700_0_0|SrvcGrp|18130|2022|PCT|0.80|99|0.00|MS DRG 243|
20|FH_F37035_0_0|SrvcGrp|33830|2022|PDM|1231.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 8|
20|FH_F111415_33180_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F40645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F101754_63141_0|SrvcGrp|97980|2022|PDM|43.34|99|0.00|ELECTRO HEARINGAID TEST BOTH|
20|FH_F34706_0_0|SrvcGrp|13615|2022|PDM|4462.00|99|0.00|DRG 370 CESAREAN SECTION MOTHER ONLY|
20|FH_F54552_0_0|SrvcGrp|27969|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE|
20|FH_F37553_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F142847_07003_0|SrvcGrp|113553|2022|PCT|1.00|99|0.00|COVID-19 DIAGNOSTIC|
20|FH_F150768_03054_0|SrvcGrp|43569|2022|PDM|164.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F139150_75206_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F114585_11501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111044_0_0|SrvcGrp|54962|2022|PDM|2987.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)|
20|FH_F98940_70506_0|SrvcGrp|73605|2022|PDM|1974.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F120057_0_0|SrvcGrp|72992|2022|PDM|535.00|99|0.00|AEG 2|
20|FH_F134819_0_0|SrvcGrp|22949|2022|PDM|1773.00|99|0.00|CPT CODE 42825|
20|FH_F35452_0_0|SrvcGrp|9774|2022|PDM|1950.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F130044_0_0|SrvcGrp|71083|2022|PDM|14.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F137788_72632_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F143307_72223_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F72749_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|MS DRG UNGROUPABLE INPATIENT|
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141873_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F128363_60062_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F128159_45356_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)|
20|FH_F39515_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F130527_66044_0|SrvcGrp|89149|2022|PDM|185.00|99|0.00|OP INTENSIVE|
20|FH_F117392_0_0|SrvcGrp|75481|2022|PDM|550.00|99|0.00|AEG 2|
20|FH_F83754_0_0|SrvcGrp|21354|2022|PCT|0.81|99|0.00|MS DRG 250-251 ONLY|
20|FH_F149159_53220_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F61072_0_0|SrvcGrp|42826|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F89219_0_0|SrvcGrp|15356|2022|PCT|0.33|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F112004_15401_0|SrvcGrp|73700|2022|PCT|0.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F133880_06488_0|SrvcGrp|471|2022|PDM|605.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138951_41101_0|SrvcGrp|29023|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F134171_72301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133647_32952_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F37491_0_0|SrvcGrp|26466|2022|PDM|90.00|99|0.00|INDIVIDUAL COUNSELING|
20|FH_F113146_15001_0|SrvcGrp|109358|2022|PDM|448.00|99|0.00|RESIDENTIAL TREATMENT (>= 18 YRS)|
20|FH_F145941_64119_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133478_40165_0|SrvcGrp|72984|2022|PDM|134.00|99|0.00|CHEMOTHERAPY|
20|FH_F40267_0_0|SrvcGrp|17081|2022|PCT|0.80|99|0.00|ASPG IX|
20|FH_F151061_02720_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F76172_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F150745_03301_0|SrvcGrp|73742|2022|PDM|9.18|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F150745_03301_0|SrvcGrp|46605|2022|PDM|167.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F130140_68845_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F128392_01026_0|SrvcGrp|108484|2022|PDM|1400.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F102525_73134_0|SrvcGrp|10944|2022|PDM|1200.00|99|0.00|EMERGENCY ROOM|
20|FH_F38475_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38246_66606_0|SrvcGrp|12512|2022|PDM|1136.00|99|0.00|ACUTE REHABILITATION|
20|FH_F110621_0_0|CSTM-ALL|CSTM-00|2020|PDM|868.00|99|0.00|AEG 6 (NO REV)|
20|FH_F130523_04605_0|SrvcGrp|104363|2022|PCT|0.84|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|21696.00|99|0.00|MSDRG 235-236 CORONARY BYPASS|
20|FH_F92276_32308_0|SrvcGrp|113166|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F56136_0_0|SrvcGrp|4109|2022|PDM|1004.00|99|0.00|ACUTE PSYCH|
20|FH_F125569_71220_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F64440_0_0|SrvcGrp|108690|2022|PDM|831.00|99|0.00|MRI/MRA W/O CONTRAST|
20|FH_F98801_93274_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F137547_32750_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F74307_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31594_0_0|SrvcGrp|16|2022|PDM|450.00|99|0.00|ACUTE REHABILITATION|
20|FH_F115737_78660_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F86872_15215_0|SrvcGrp|14948|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F89340_0_0|SrvcGrp|56464|2022|PDM|5720.00|99|0.00|CPT 55873|
20|FH_F120930_0_0|SrvcGrp|94989|2022|PDM|2200.00|99|0.00|SINUS ENDO W/ BALLOON DILATION|
20|FH_F49913_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC|
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|AEG 3 (NO REV)|
20|FH_F59872_0_0|SrvcGrp|19973|2022|PDM|695.00|99|0.00|CAT SCAN|
20|FH_F138507_62208_0|SrvcGrp|48394|2022|PDM|47.74|99|0.00|SKILLED NURSING SERVICES|
20|FH_F126904_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F120697_68526_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F31843_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40903_0_0|SrvcGrp|18071|2022|PDM|55.00|99|0.00|AMBULANCE RESPONSE/TREATMENT - NO TRANSPORT|
20|FH_F39346_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F119732_37660_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124369_0_0|SrvcGrp|33980|2022|PDM|7480.00|99|0.00|CPT 28298|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|65.71|99|0.00|ELECTROENCEPHALOGRAM (MOD 26)|
20|FH_F132276_33179_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F67901_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|LINTRATHECAL IV SERVICES|
20|FH_F137333_51012_0|SrvcGrp|90854|2022|PDM|827.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F109652_0_0|SrvcGrp|72602|2022|PDM|1004.00|99|0.00|ECT|
20|FH_F70005_0_0|SrvcGrp|13990|2022|PCT|0.55|99|0.00|PACEMAKER|
20|FH_F131379_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124613_64735_0|SrvcGrp|75545|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F136665_80004_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F45435_0_0|SrvcGrp|26798|2022|PDM|90.00|99|0.00|LICENSED PRACTICAL NURSE|
20|FH_F115273_15132_0|SrvcGrp|75323|2022|PCT|1.00|99|0.00|DME|
20|FH_F42807_0_0|SrvcGrp|13187|2022|PCT|0.75|99|0.00|INTRAOCULAR LENSES|
20|FH_F44135_0_0|SrvcGrp|24289|2022|PDM|70.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F32088_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97621_75801_0|SrvcGrp|73603|2022|PDM|8529.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F150164_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F97562_29803_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F141830_92592_0|SrvcGrp|46903|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F92792_0_0|SrvcGrp|92659|2022|PDM|880.00|99|0.00|REPAIR OF RETINAL DETACHMENT|
20|FH_F69023_0_0|CSTM-ALL|CSTM-00|2020|PDM|134.00|99|0.00|OP SVCS|
20|FH_F148644_06890_0|SrvcGrp|84279|2022|PDM|4562.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F150662_20901_0|SrvcGrp|48385|2022|PDM|149.00|99|0.00|SPEECH THERAPY|
20|FH_F31486_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146859_0_0|SrvcGrp|108292|2022|PDM|3531.00|99|0.00|AETNA ANKLE ARTHROSCOPY|
20|FH_F140215_93301_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HSS ASC|
20|FH_F37864_0_0|CSTM-ALL|CSTM-00|2020|PDM|1204.07|99|0.00|ASPG VIII|
20|FH_F107922_0_0|SrvcGrp|76501|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F150979_44060_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149536_76642_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F143536_47546_0|SrvcGrp|100250|2022|PCT|1.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (2.5 CM OR LESS)|
20|FH_F131173_17043_0|SrvcGrp|95660|2022|PDM|550.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F136250_73026_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116739_78501_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F113649_01752_0|SrvcGrp|86846|2022|PDM|50.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F100783_03431_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103004_75840_0|SrvcGrp|76619|2022|PCT|0.80|99|0.00|THERAPY|
20|FH_F36704_0_0|SrvcGrp|9793|2022|PDM|450.00|99|0.00|NEWBORN NURSERY|
20|FH_F137347_26003_0|SrvcGrp|8950|2022|PDM|1665.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F150699_0_0|SrvcGrp|95339|2022|PDM|12296.00|99|0.00|INSERT PACING LEAD & CONNECT|
20|FH_F37863_0_0|CSTM-ALL|CSTM-00|2020|PDM|42.00|99|0.00|CPT 00100-01999 MODIFIER AA OR QZ|
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F107782_0_0|CSTM-ALL|CSTM-00|2020|PDM|2450.00|99|0.00|AEG 9 (NO REV)|
20|FH_F128272_60640_0|SrvcGrp|17013|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F37292_0_0|SrvcGrp|9861|2022|PDM|1861.00|99|0.00|ACUTE REHABILITATION|
20|FH_F122687_0_0|SrvcGrp|100065|2022|PDM|3825.00|99|0.00|DEEP ANT OR POSTER TIBIAL|
20|FH_F145544_93536_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F63433_0_0|SrvcGrp|17077|2022|PDM|1312.24|99|0.00|ASPG VII|
20|FH_F91994_0_0|SrvcGrp|72994|2022|PDM|1200.00|99|0.00|AEG 3|
20|FH_F90818_0_0|SrvcGrp|78098|2022|PDM|3050.00|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F130662_07032_0|SrvcGrp|90854|2022|PDM|825.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F116806_0_0|SrvcGrp|107027|2022|PDM|1923.16|99|0.00|RECONSTRUCTION OF MANDIBLE/MAXILLA-COMPLETE SUBPERIOSTEAL IM|
20|FH_F48834_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130763_0_0|SrvcGrp|26273|2022|PDM|3450.00|99|0.00|CPT 29880|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1288.65|99|0.00|HAPA WPA-NWPA 2012-13 ASC 907 W/O REV|
20|FH_F114432_75035_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|2640.00|99|0.00|AEG 8 (NO REV)|
20|FH_F113457_17011_0|SrvcGrp|48398|2022|PDM|88.00|99|0.00|PT SERVICES|
20|FH_F150165_06032_0|SrvcGrp|99171|2022|PDM|3787.00|99|0.00|CPT 28485|
20|FH_F36854_0_0|SrvcGrp|97|2022|PDM|6955.00|99|0.00|C-SECTION|
20|FH_F80511_0_0|SrvcGrp|3191|2022|PCT|0.57|99|0.00|OP SURGERY|
20|FH_F38955_0_0|SrvcGrp|72|2022|PDM|628.44|99|0.00|NEWBORN NURSERY|
20|FH_F138680_53005_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F138777_43140_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138857_90025_0|SrvcGrp|87131|2022|PDM|610.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F138992_72703_0|CSTM-ALL|CSTM-00|2020|PDM|3289.00|99|0.00|AEG 7 (NO REV)|
20|FH_F73204_0_0|SrvcGrp|22954|2022|PDM|145.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F106500_0_0|SrvcGrp|30089|2022|PDM|428.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F150324_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1196.66|99|0.00|HAPA WPA-NWPA 2012-13 ASC 3 W/O REV|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|144.40|99|0.00|HAPA WPA-NWPA 2012-13 ASC 135 W/O REV|
20|FH_F83472_0_0|CSTM-ALL|CSTM-00|2020|PDM|870.48|99|0.00|AEG 6 (NO REV)|
20|FH_F151511_14094_0|CSTM-ALL|CSTM-00|2020|PCT|0.20|99|0.00|AEG 10 (NO REV)|
20|FH_F145528_76501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F42492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|OP SVCS|
20|FH_F135432_16335_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F82234_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|1896.00|99|0.00|AEG 4 (NO REV)|
20|FH_F136542_02446_0|SrvcGrp|108484|2022|PDM|473.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F120489_63552_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F138627_82901_0|SrvcGrp|68247|2022|PDM|15.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F117102_39355_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F37227_0_0|CSTM-ALL|CSTM-00|2020|PDM|385.00|99|0.00|ASPG I|
20|FH_F38986_0_0|SrvcGrp|701|2022|PDM|1742.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F122364_67203_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F102620_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114951_20002_0|SrvcGrp|88678|2022|PCT|0.00|99|0.00|ACUTE REHAB I|
20|FH_F94330_43220_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41463_0_0|SrvcGrp|34136|2022|PDM|77.00|99|0.00|REMODULIN THERAPY|
20|FH_F115269_0_0|SrvcGrp|90854|2022|PDM|750.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F112956_0_0|SrvcGrp|75489|2022|PDM|902.00|99|0.00|AEG 6|
20|FH_F37812_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME HEALTH|
20|FH_F125656_92868_0|SrvcGrp|86846|2022|PDM|35.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F117762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1239.00|99|0.00|AEG 6 (NO REV)|
20|FH_F35366_0_0|SrvcGrp|20256|2022|PDM|45.00|99|0.00|PT/OT/ST|
20|FH_F137986_0_0|SrvcGrp|70749|2022|PDM|1478.00|99|0.00|CPT 29823|
20|FH_F46158_0_0|SrvcGrp|17083|2022|PCT|0.65|99|0.00|ASPG X|
20|FH_F143467_0_0|CSTM-ALL|CSTM-00|2020|PDM|2439.80|99|0.00|AEG 9 (NO REV)|
20|FH_F71905_0_0|SrvcGrp|59426|2022|PDM|75.00|99|0.00|PT|
20|FH_F133671_89102_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F127165_32112_0|SrvcGrp|89417|2022|PDM|436.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F42722_0_0|SrvcGrp|28147|2022|PDM|506.00|99|0.00|SKILLED NURSING|
20|FH_F125028_19061_0|SrvcGrp|17016|2022|PDM|63.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F100662_27534_0|SrvcGrp|73559|2022|PDM|7406.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|1444.00|99|0.00|AEG 6 (NO REV)|
20|FH_F125323_43213_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121490_86314_0|SrvcGrp|75419|2022|PDM|525.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F77862_0_0|SrvcGrp|34868|2022|PDM|105.78|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F86872_15215_0|SrvcGrp|116047|2022|PCT|0.97|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F50462_0_0|SrvcGrp|44430|2022|PDM|140.00|99|0.00|SPEECH THERAPY SVCS (VISIT LVL)|
20|FH_F105593_0_0|SrvcGrp|88621|2022|PDM|70.00|99|0.00|SKILLED NURSING LPN|
20|FH_F85212_71075_0|SrvcGrp|80246|2022|PCT|0.00|99|0.00|AETNA NURSERY|
20|FH_F89176_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F110906_54481_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F143571_0_0|SrvcGrp|74546|2022|PDM|543.00|99|0.00|HOSPICE SERVICES|
20|FH_F133815_46526_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133947_93950_0|SrvcGrp|89417|2022|PDM|334.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|2063.00|99|0.00|AEG 8 (NO REV)|
20|FH_F145562_70458_0|SrvcGrp|86834|2022|PDM|10.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F150165_06032_0|SrvcGrp|35668|2022|PDM|2120.00|99|0.00|CPT 29824|
20|FH_F129101_27006_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F74583_0_0|SrvcGrp|48398|2022|PDM|14.00|99|0.00|PT SERVICES|
20|FH_F120795_27514_0|SrvcGrp|26690|2022|PCT|0.75|99|0.00|MS DRG 215 ONLY|
20|FH_F120489_63552_0|SrvcGrp|75487|2022|PCT|0.75|99|0.00|AEG 5|
20|FH_F115210_21043_0|SrvcGrp|92010|2022|PDM|1167.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE|
20|FH_F41738_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_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|2087.82|99|0.00|ASPG VI|
20|FH_F141873_0_0|SrvcGrp|108484|2022|PDM|702.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F49895_0_0|SrvcGrp|31186|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC (DME)|
20|FH_F38709_0_0|SrvcGrp|701|2022|PDM|1751.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F100984_0_0|CSTM-ALL|CSTM-00|2020|PDM|542.00|99|0.00|AEG 3 (NO REV)|
20|FH_F34899_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F148255_72703_0|SrvcGrp|86836|2022|PDM|10.50|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|1115.00|99|0.00|ASPG VI|
20|FH_F128159_45356_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F60812_0_0|SrvcGrp|3259|2022|PDM|3453.00|99|0.00|ACUTE REHABILITATION|
20|FH_F130850_67401_0|SrvcGrp|48394|2022|PDM|47.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F40689_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS|
20|FH_F137067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1092.00|99|0.00|AEG 10 (NO REV)|
20|FH_F38867_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.00|99|0.00|ACUTE PSYCH|
20|FH_F42722_0_0|SrvcGrp|28145|2022|PDM|330.00|99|0.00|SKILLED NURSING|
20|FH_F117644_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F148266_45419_0|SrvcGrp|53703|2022|PDM|967.19|99|0.00|REVISE AQUEOUS SHUNT TO EXTRAOCULAR RESIVOIR|
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F52534_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F87775_15106_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F130763_0_0|SrvcGrp|82113|2022|PDM|3450.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F133972_27103_0|SrvcGrp|24745|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F45120_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F120417_63124_0|CSTM-ALL|CSTM-00|2020|PDM|528.00|99|0.00|AEG 2 (NO REV)|
20|FH_F74024_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F42646_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ACUTE PSYCH|
20|FH_F128816_43537_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F88698_18951_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F137799_0_0|SrvcGrp|65720|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F134508_14072_0|SrvcGrp|473|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F48692_0_0|SrvcGrp|473|2022|PDM|310.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F140647_66210_0|SrvcGrp|73841|2022|PDM|1032.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F140791_20678_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F118914_43015_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F97660_29401_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F133178_0_0|SrvcGrp|89869|2022|PDM|1255.00|99|0.00|SPONTANEOUS ABORTION|
20|FH_F134270_0_0|SrvcGrp|11673|2022|PDM|10000.00|99|0.00|CPT 29888|
20|FH_F146937_27609_0|SrvcGrp|72379|2022|PCT|1.04|99|0.00|SPEECH THERAPY|
20|FH_F146903_72901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122879_39564_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136778_62034_0|SrvcGrp|73463|2022|PDM|812.00|99|0.00|AETNA NICU II|
20|FH_F37847_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115631_65201_0|SrvcGrp|36591|2022|PDM|3177.00|99|0.00|CPT 63685|
20|FH_F115490_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F135714_01922_0|SrvcGrp|33722|2022|PDM|40.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F134487_14843_0|SrvcGrp|473|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F128099_70403_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F124608_0_0|SrvcGrp|93067|2022|PDM|8160.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F149880_33150_0|SrvcGrp|74668|2022|PDM|290.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F100788_01420_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F33788_0_0|SrvcGrp|429|2022|PCT|0.70|99|0.00|OP LAPAROSCOPIC SURGERY|
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_F115685_64064_0|SrvcGrp|98936|2022|PDM|75.00|99|0.00|HIT CONT CHEMOTX (HCFA)|
20|FH_F46832_0_0|SrvcGrp|14949|2022|PDM|140.00|99|0.00|HOME INFUSION|
20|FH_F127486_06776_0|SrvcGrp|94780|2022|PDM|161.70|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F51393_0_0|SrvcGrp|42824|2022|PDM|80.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F134170_33410_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F134620_73112_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F127157_43614_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|535.78|99|0.00|HAPA WPA-NWPA 2012-13 ASC 104 W/O REV|
20|FH_F118123_67226_0|SrvcGrp|19742|2022|PDM|83.00|99|0.00|MID-LINE INSERTION|
20|FH_F146124_06112_0|SrvcGrp|110579|2022|PCT|0.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F38790_0_0|SrvcGrp|110|2022|PDM|430.00|99|0.00|CD - REHABILITATION|
20|FH_F133943_01606_0|SrvcGrp|76501|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F45120_0_0|SrvcGrp|30456|2022|PCT|0.21|99|0.00|DRUGS|
20|FH_F81698_10457_0|SrvcGrp|26868|2022|PDM|31.50|99|0.00|DIURETIC IV THERAPY|
20|FH_F114683_0_0|SrvcGrp|105732|2022|PDM|1910.00|99|0.00|SPINE SURGERY|
20|FH_F112082_30720_0|SrvcGrp|13929|2022|PDM|22.15|99|0.00|GROWTH HORMONE|
20|FH_F134507_0_0|SrvcGrp|27210|2022|PDM|1144.00|99|0.00|SKILLED NURSING LEVEL I|
20|FH_F133398_43204_0|SrvcGrp|73841|2022|PDM|287.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F137027_63960_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138627_82901_0|SrvcGrp|98997|2022|PDM|95.00|99|0.00|HYDRATION THERAPY 3 LITER (HCFA)|
20|FH_F129434_98271_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F93512_0_0|CSTM-ALL|CSTM-00|2020|PDM|753.00|99|0.00|AEG 5  (NO REV)|
20|FH_F48752_0_0|SrvcGrp|33166|2022|PDM|450.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F139306_08854_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F129913_0_0|CSTM-ALL|CSTM-00|2020|PDM|1444.69|99|0.00|2005 ASPG GROUPER VI|
20|FH_F146043_0_0|CSTM-ALL|CSTM-00|2020|PDM|1259.00|99|0.00|AEG 1 (NO REV)|
20|FH_F41798_0_0|CSTM-ALL|CSTM-00|2020|PDM|380.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132772_0_0|SrvcGrp|108041|2022|PDM|465.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F117485_0_0|CSTM-ALL|CSTM-00|2020|PDM|2344.00|99|0.00|AEG 9 (NO REV)|
20|FH_F92676_15063_0|SrvcGrp|79051|2022|PDM|584.72|99|0.00|MON VALLEY ASC 127|
20|FH_F120407_84070_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F97563_83201_0|SrvcGrp|73601|2022|PDM|12186.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F92676_15063_0|SrvcGrp|79071|2022|PDM|349.21|99|0.00|MON VALLEY ASC 137|
20|FH_F128279_77043_0|SrvcGrp|86722|2022|PDM|160.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F129472_0_0|CSTM-ALL|CSTM-00|2020|PDM|857.00|99|0.00|AEG 4 (NO REV)|
20|FH_F38407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MOD UE|
20|FH_F123324_0_0|CSTM-ALL|CSTM-00|2020|PDM|837.00|99|0.00|CD ADULT REHAB|
20|FH_F121985_46256_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|61350.00|99|0.00|MSDRG 231-232 CORONARY BYPASS|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|S CODES MOD SH|
20|FH_F47902_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL|
20|FH_F149648_89148_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F73128_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119897_78229_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F35217_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F127292_85705_0|SrvcGrp|108484|2022|PDM|600.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F149020_78653_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|VERTICAL PLUS MRI MOD AU|
20|FH_F41314_0_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110732_31513_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F140233_35216_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 2 (NO REV)|
20|FH_F110442_98003_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F88639_80204_0|SrvcGrp|114562|2022|PCT|2.27|99|0.00|ALL OTHER DRUGS|
20|FH_F88639_80204_0|SrvcGrp|3378|2022|PDM|5528.69|99|0.00|OBSERVATION SVCS|
20|FH_F118146_33062_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|OP SVCS|
20|FH_F146421_72758_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125124_0_0|SrvcGrp|82301|2022|PDM|2233.50|99|0.00|HEMORRHOIDECTOMY|
20|FH_F34182_0_0|SrvcGrp|12840|2022|PCT|0.78|99|0.00|PACEMAKER|
20|FH_F112665_0_0|SrvcGrp|11673|2022|PDM|4812.00|99|0.00|CPT 29888|
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 2 (NO REV)|
20|FH_F111702_07652_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F130123_24171_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD UE KF"|
20|FH_F118135_38109_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F85212_71075_0|SrvcGrp|72984|2022|PCT|0.00|99|0.00|CHEMOTHERAPY|
20|FH_F115907_12206_0|SrvcGrp|90644|2022|PDM|20.00|99|0.00|AETNA MEDICATION ASSISTED TRTMT MAINTENANCE INJECTION (HCFA)|
20|FH_F120795_27514_0|SrvcGrp|16319|2022|PDM|4936.00|99|0.00|TRAUMA CARE|
20|FH_F39869_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136398_23502_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F109930_73109_0|SrvcGrp|471|2022|PDM|555.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117154_43017_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F45795_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113541_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F131101_45840_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F113713_17013_0|SrvcGrp|105369|2022|PDM|45.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MINS|
20|FH_F147700_21401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69245_84047_0|SrvcGrp|89149|2022|PDM|143.00|99|0.00|OP INTENSIVE|
20|FH_F119447_64081_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119500_01570_0|SrvcGrp|471|2022|PDM|652.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F128296_37167_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|624.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F117230_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F90935_29073_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F38725_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101811_64116_0|SrvcGrp|99441|2022|PDM|115.00|99|0.00|SKILLED NURSING RN|
20|FH_F129391_17777_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39855_0_0|CSTM-ALL|CSTM-00|2020|PDM|646.00|99|0.00|ACUTE PSYCH|
20|FH_F40186_0_0|CSTM-ALL|CSTM-00|2020|PDM|470.00|99|0.00|CAROLINA DIGESTIVE COLONOSCOPY FH RATES|
20|FH_F38842_0_0|SrvcGrp|11301|2022|PDM|900.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F65159_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TEMPLE MRI CT PET|
20|FH_F40635_0_0|SrvcGrp|33080|2022|PDM|505.00|99|0.00|SKILLED NURSING|
20|FH_F148484_19462_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F111725_33066_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127343_0_0|SrvcGrp|93962|2022|PDM|11480.00|99|0.00|NEURO STIMULATOR|
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|1668.50|99|0.00|AEG 8 (NO REV)|
20|FH_F142930_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F125682_46825_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120603_66112_0|SrvcGrp|471|2022|PDM|610.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F121687_04401_0|SrvcGrp|108923|2022|PCT|1.38|99|0.00|CHEMOTHERAPY ADMINISTRATION|
20|FH_F127656_06068_0|SrvcGrp|48394|2022|PDM|69.91|99|0.00|SKILLED NURSING SERVICES|
20|FH_F71628_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120489_63552_0|SrvcGrp|88977|2022|PDM|4443.00|99|0.00|C-SECTION DELIVERY|
20|FH_F140343_89052_0|SrvcGrp|86837|2022|PDM|10.00|99|0.00|HCPCS S9538 (HCFA)|
20|FH_F117126_12801_0|SrvcGrp|537|2022|PDM|5175.00|99|0.00|OBSERVATION SERVICES|
20|FH_F47452_0_0|SrvcGrp|42822|2022|PDM|115.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F72049_0_0|SrvcGrp|17140|2022|PDM|160.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F132988_0_0|SrvcGrp|100006|2022|PDM|8647.09|99|0.00|RECONSTRUCT ELBOW MED LIGMNT|
20|FH_F82195_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F92212_0_0|CSTM-ALL|CSTM-00|2020|PDM|714.00|99|0.00|AEG 5  (NO REV)|
20|FH_F39351_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F54752_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F38688_0_0|SrvcGrp|17071|2022|PDM|1210.00|99|0.00|ASPG IV|
20|FH_F100703_0_0|SrvcGrp|96959|2022|PDM|3466.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F148553_85016_0|CSTM-ALL|CSTM-00|2020|PDM|744.00|99|0.00|AEG 4 (NO REV)|
20|FH_F128341_41139_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F119289_43040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F146320_27610_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F92676_15063_0|SrvcGrp|78954|2022|PDM|2865.36|99|0.00|MON VALLEY ASC 707|
20|FH_F150164_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F117855_62246_0|SrvcGrp|88620|2022|PDM|70.00|99|0.00|SKILLED NURSING RN|
20|FH_F127327_27401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F32424_0_0|CSTM-ALL|CSTM-00|2020|PCT|48.00|99|0.00|OP SVCS|
20|FH_F92792_0_0|SrvcGrp|46906|2022|PDM|2200.00|99|0.00|CORNEAL TISSUE|
20|FH_F143487_0_0|SrvcGrp|103861|2022|PDM|2060.00|99|0.00|GASTROESOPHOGEAL STUDY|
20|FH_F133493_90255_0|SrvcGrp|79786|2022|PCT|0.00|99|0.00|SLEEP STUDIES|
20|FH_F43018_0_0|SrvcGrp|16034|2022|PDM|489.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|1463.00|99|0.00|ASPG V|
20|FH_F39772_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (HCFA)|
20|FH_F137797_70123_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F96780_0_0|CSTM-ALL|CSTM-00|2020|PDM|1069.00|99|0.00|AEG 6 (NO REV)|
20|FH_F125139_84096_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F98800_85021_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136367_72210_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F114092_83350_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119023_91406_0|SrvcGrp|22592|2022|PDM|35.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F109886_36303_0|SrvcGrp|86748|2022|PCT|1.10|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F117240_37334_0|SrvcGrp|10391|2022|PDM|2000.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|1903.00|99|0.00|ASPG IX|
20|FH_F150947_37660_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F131152_33403_0|SrvcGrp|89149|2022|PDM|189.00|99|0.00|OP INTENSIVE|
20|FH_F111042_99159_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F50078_0_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F131072_26416_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.44|99|0.00|SALLY BALIN,999182,ASC 302|
20|FH_F150922_02452_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F31547_0_0|SrvcGrp|12693|2022|PDM|202.58|99|0.00|CAPD/CCPD TRAINING|
20|FH_F138710_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F143533_30013_0|SrvcGrp|99741|2022|PDM|133.00|99|0.00|ULTRASOUND BREAST UNILATERAL (HCFA)|
20|FH_F103481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|728.83|99|0.00|ASPG V|
20|FH_F40358_0_0|SrvcGrp|3029|2022|PDM|350.00|99|0.00|NEWBORN NURSERY|
20|FH_F92091_0_0|SrvcGrp|72996|2022|PDM|2725.00|99|0.00|AEG 4|
20|FH_F117484_15601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118373_21205_0|SrvcGrp|3259|2022|PDM|2776.00|99|0.00|ACUTE REHABILITATION|
20|FH_F148279_15009_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F95021_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F72306_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F125118_99201_0|SrvcGrp|74611|2022|PDM|500.00|99|0.00|AETNA FOLLOW UP VISIT CPT 90837|
20|FH_F147919_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F72183_0_0|SrvcGrp|8968|2022|PDM|1500.00|99|0.00|NICU LEVEL III & IV|
20|FH_F123064_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F124608_0_0|SrvcGrp|33987|2022|PDM|1224.00|99|0.00|CPT 57522|
20|FH_F49653_0_0|SrvcGrp|8950|2022|PDM|2588.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F114975_78596_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F124738_0_0|SrvcGrp|73008|2022|PDM|330.00|99|0.00|AEG 10|
20|FH_F78603_0_0|SrvcGrp|26690|2022|PDM|122076.18|99|0.00|MS DRG 215 ONLY|
20|FH_F143528_0_0|SrvcGrp|26275|2022|PDM|3150.00|99|0.00|CPT 29826|
20|FH_F118249_0_0|CSTM-ALL|CSTM-00|2020|PDM|438.00|99|0.00|AEG 10 (NO REV)|
20|FH_F149179_0_0|SrvcGrp|115605|2022|PDM|4900.00|99|0.00|NECK SPINE FUSE|
20|FH_F150165_06032_0|SrvcGrp|84307|2022|PDM|3236.00|99|0.00|TENDON REPAIR|
20|FH_F87541_0_0|SrvcGrp|72994|2022|PDM|615.00|99|0.00|AEG 3|
20|FH_F146657_01105_0|SrvcGrp|114670|2022|PDM|10.16|99|0.00|HLTH BHV IVNTJ GRP (MOD U2)|
20|FH_F126904_0_0|SrvcGrp|84185|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F119227_01752_0|SrvcGrp|86847|2022|PDM|38.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F129509_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F110881_63125_0|SrvcGrp|472|2022|PDM|427.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F111741_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS SNF PPS|
20|FH_F146881_83661_0|SrvcGrp|23683|2022|PDM|70.00|99|0.00|SKILLED NURSING RN|
20|FH_F133408_01095_0|SrvcGrp|82981|2022|PDM|140.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F123848_03257_0|SrvcGrp|88621|2022|PDM|121.00|99|0.00|SKILLED NURSING LPN|
20|FH_F121250_47401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F58252_0_0|SrvcGrp|48393|2022|PDM|8.50|99|0.00|SKILLED NURSING SERVICES (PER HOUR)|
20|FH_F136347_30328_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F120489_63552_0|SrvcGrp|79099|2022|PDM|1540.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F117552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137812_12118_0|SrvcGrp|113912|2022|PDM|26.79|99|0.00|CRISIS INTERV SERV 15 MINUTES|
20|FH_F114145_0_0|CSTM-ALL|CSTM-00|2020|PDM|1097.00|99|0.00|AEG 7 (NO REV)|
20|FH_F137982_68510_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F128804_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 4 (NO REV)|
20|FH_F72427_0_0|SrvcGrp|10639|2022|PDM|360.00|99|0.00|CT SCAN|
20|FH_F115208_0_0|SrvcGrp|106182|2022|PDM|2652.00|99|0.00|PARTIAL REMOVAL OF THYROID|
20|FH_F39561_0_0|SrvcGrp|11442|2022|PDM|550.12|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F124417_85364_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F127995_84010_0|SrvcGrp|86831|2022|PDM|3.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F130036_43232_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F128974_70130_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F100664_03104_0|SrvcGrp|73659|2022|PDM|7651.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F134693_92270_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134791_98034_0|SrvcGrp|48396|2022|PDM|283.00|99|0.00|OT SERVICES|
20|FH_F136778_62034_0|SrvcGrp|21256|2022|PCT|0.00|99|0.00|MS DRG 895 ONLY|
20|FH_F37987_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115210_21043_0|SrvcGrp|53065|2022|PDM|637.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, SINGLE LEVEL|
20|FH_F120112_0_0|SrvcGrp|94780|2022|PDM|94.50|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F102341_0_0|SrvcGrp|1259|2022|PDM|1742.00|99|0.00|INTERMEDIATE INTENSIVE CARE UNIT|
20|FH_F115974_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD UE"|
20|FH_F75087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120930_0_0|SrvcGrp|78093|2022|PDM|2200.00|99|0.00|AETNA NASAL ENDOSCOPY SURG|
20|FH_F32736_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117214_84020_0|SrvcGrp|74668|2022|PDM|450.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148720_0_0|SrvcGrp|103550|2022|PDM|325.00|99|0.00|HEMODIALYSIS SVCS|
20|FH_F97780_43614_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F105623_77901_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F141353_26452_0|SrvcGrp|12280|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F36318_0_0|SrvcGrp|22794|2022|PDM|3416.00|99|0.00|C-SECTION (MOTHER & BABY)|
20|FH_F124593_07033_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124687_64024_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122591_84010_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136772_89109_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F35926_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115210_21043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77462_0_0|SrvcGrp|42976|2022|PDM|135.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F111594_0_0|SrvcGrp|89842|2022|PDM|7699.00|99|0.00|LUMBAR|
20|FH_F138283_0_0|SrvcGrp|34389|2022|PDM|118.00|99|0.00|SPEECH THERAPY|
20|FH_F109812_37043_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|1466.00|99|0.00|AEG 9 (NO REV)|
20|FH_F146374_84102_0|SrvcGrp|83235|2022|PCT|0.60|99|0.00|AMBULATORY SURGERY|
20|FH_F88512_0_0|SrvcGrp|17065|2022|PDM|1440.56|99|0.00|ASPG I|
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|AEG 8 (NO REV)|
20|FH_F71644_0_0|SrvcGrp|20147|2022|PDM|201471.00|99|0.00|LIVER TRANSPLANT|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53|
20|FH_F73542_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS AMBULANCE MS (00512-00) RURAL|
20|FH_F95360_08720_0|SrvcGrp|472|2022|PDM|401.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F111426_63640_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112853_22408_0|SrvcGrp|73700|2022|PDM|55.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F148599_98034_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PACKAGE APC Q1 PAYMENT SAME DOS|
20|FH_F137798_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117762_0_0|SrvcGrp|33984|2022|PDM|1248.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F33632_52349_0|SrvcGrp|94062|2022|PDM|439.21|99|0.00|IP BEHAVIORAL OBSERVATION|
20|FH_F67424_0_0|SrvcGrp|63365|2022|PCT|1.00|99|0.00|DRUGS INVOICE|
20|FH_F146266_0_0|SrvcGrp|84307|2022|PDM|1725.00|99|0.00|TENDON REPAIR|
20|FH_F150982_0_0|CSTM-ALL|CSTM-00|2020|PDM|2643.00|99|0.00|AETNA CPT 49560|
20|FH_F132818_24701_0|SrvcGrp|67684|2022|PDM|161.00|99|0.00|PSYCH VISIT|
20|FH_F140127_64131_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140127_64131_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F51276_0_0|SrvcGrp|42322|2022|PDM|60.00|99|0.00|HOME THERAPY|
20|FH_F110132_23451_0|SrvcGrp|73701|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F38677_0_0|SrvcGrp|24651|2022|PDM|135.00|99|0.00|HEMODIALYSIS - HOME TRAINING|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME_MOD26|
20|FH_F62681_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F139173_0_0|SrvcGrp|88620|2022|PDM|176.00|99|0.00|SKILLED NURSING RN|
20|FH_F34241_0_0|SrvcGrp|3044|2022|PDM|1250.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F41776_0_0|SrvcGrp|31769|2022|PDM|9923.00|99|0.00|CARDIAC ABLATION|
20|FH_F120437_85202_0|SrvcGrp|48394|2022|PDM|86.10|99|0.00|SKILLED NURSING SERVICES|
20|FH_F36756_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD TC|
20|FH_F45977_0_0|SrvcGrp|40416|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD UE KE|
20|FH_F100880_67735_0|SrvcGrp|72998|2022|PDM|2218.00|99|0.00|AEG 5|
20|FH_F69651_0_0|SrvcGrp|58848|2022|PDM|525.00|99|0.00|HOSPICE GENERAL CARE|
20|FH_F139430_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150679_32534_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F92299_62016_0|SrvcGrp|72990|2022|PCT|0.75|99|0.00|AEG 1|
20|FH_F35751_34613_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F139576_0_0|SrvcGrp|19923|2022|PDM|2856.00|99|0.00|HYSTEROSCOPY|
20|FH_F144831_0_0|SrvcGrp|114181|2022|PDM|143.00|99|0.00|HOSPICE HOME HEALTH IN ASST LIVING (HCFA)|
20|FH_F111122_63376_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F124492_30040_0|SrvcGrp|112223|2022|PDM|82.50|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F74670_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F140170_15301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F48224_0_0|SrvcGrp|73000|2022|PDM|980.00|99|0.00|AEG 6|
20|FH_F82691_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F84611_30281_0|SrvcGrp|72990|2022|PDM|1169.00|99|0.00|AEG 1|
20|FH_F141410_13045_0|SrvcGrp|12280|2022|PCT|0.39|99|0.00|IMPLANTS|
20|FH_F125663_66614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137946_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F123278_20850_0|SrvcGrp|473|2022|PDM|375.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F60072_0_0|SrvcGrp|360|2022|PDM|1400.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F59093_0_0|SrvcGrp|42975|2022|PDM|85.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F125138_63663_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F128132_69361_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME - HCPCS/MOD KF  (TN)|
20|FH_F70805_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F121495_92009_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F103060_0_0|SrvcGrp|74039|2022|PDM|7803.00|99|0.00|LAMINECTOMY|
20|FH_F149479_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F127375_28621_0|SrvcGrp|75506|2022|PCT|0.69|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F110925_01104_0|SrvcGrp|19742|2022|PDM|140.00|99|0.00|MID-LINE INSERTION|
20|FH_F105221_01757_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143785_19713_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F58052_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F37679_0_0|SrvcGrp|26867|2022|PDM|61.00|99|0.00|ANTI-EMETICS INFUSION THERAPY|
20|FH_F130747_0_0|SrvcGrp|108260|2022|PDM|2601.00|99|0.00|AETNA FIXATION OF KNEE JOINT|
20|FH_F123486_61764_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F54513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F144021_0_0|SrvcGrp|108082|2022|PDM|25.76|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F149140_07522_0|SrvcGrp|113236|2022|PDM|41.38|99|0.00|COVID-19 SARS-COV-2 W/ OPTIC|
20|FH_F112665_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 1 (NO REV)|
20|FH_F85340_98195_0|SrvcGrp|73485|2022|PDM|1933.00|99|0.00|AETNA REHAB|
20|FH_F76146_0_0|SrvcGrp|68193|2022|PDM|2337.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 9|
20|FH_F136359_0_0|SrvcGrp|28547|2022|PDM|4000.00|99|0.00|VITRECTOMY|
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|3331.00|99|0.00|AEG 9 (NO REV)|
20|FH_F110268_02891_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F142376_0_0|CSTM-ALL|CSTM-00|2020|PDM|1122.00|99|0.00|AEG 3 (NO REV)|
20|FH_F130364_01331_0|CSTM-ALL|CSTM-00|2020|PDM|3100.00|99|0.00|AEG 9 (NO REV)|
20|FH_F72543_0_0|SrvcGrp|3809|2022|PDM|675.00|99|0.00|HOSPICE CARE|
20|FH_F111561_10002_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F111836_12901_0|SrvcGrp|89024|2022|PDM|98.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F132199_0_0|CSTM-ALL|CSTM-00|2020|PDM|1392.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F139711_16037_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F113392_0_0|SrvcGrp|105203|2022|PDM|1650.00|99|0.00|MUSCLE FLAP|
20|FH_F34328_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114764_78214_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F150763_0_0|CSTM-ALL|CSTM-00|2020|PDM|1923.00|99|0.00|AEG 3 (NO REV)|
20|FH_F32708_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F105842_70433_0|SrvcGrp|73559|2022|PDM|1627.50|99|0.00|AETNA INTENSIVE CARE|
20|FH_F146159_89102_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F135580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
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_F127325_0_0|SrvcGrp|34342|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F129688_74066_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|674.00|99|0.00|AEG 2 (NO REV)|
20|FH_F133467_03301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117366_33162_0|SrvcGrp|83801|2022|PDM|1600.00|99|0.00|INTERIM LABOR FACILITY GLOBA|
20|FH_F97042_64804_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F132092_0_0|SrvcGrp|97705|2022|PDM|169.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F88639_80204_0|SrvcGrp|75226|2022|PCT|0.00|99|0.00|AETNA URGENT CARE|
20|FH_F145697_52302_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134655_14221_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117437_0_0|SrvcGrp|84185|2022|PDM|180.00|99|0.00|RESPITE CARE|
20|FH_F40374_0_0|CSTM-ALL|CSTM-00|2020|PCT|57.00|99|0.00|OP SVCS|
20|FH_F114444_19602_0|SrvcGrp|98040|2022|PDM|12.08|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F130364_01331_0|SrvcGrp|75507|2022|PCT|1.75|99|0.00|CHEMOTHERAPY|
20|FH_F102726_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|2850.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132193_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 5  (NO REV)|
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|2150.00|99|0.00|AEG 3 (NO REV)|
20|FH_F38889_0_0|CSTM-ALL|CSTM-00|2020|PDM|1104.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134488_14086_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F35796_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.50|99|0.00|OP SVCS|
20|FH_F102200_06416_0|SrvcGrp|22389|2022|PDM|15.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F66782_0_0|SrvcGrp|42972|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F53732_0_0|SrvcGrp|28630|2022|PDM|140.00|99|0.00|HOME INFUSION SKILLED NURSING|
20|FH_F151608_30236_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F147801_90703_0|SrvcGrp|111117|2022|PDM|415.00|99|0.00|PARTIAL HOSP (18-64 YRS)|
20|FH_F137898_46540_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F90735_94070_0|SrvcGrp|90284|2022|PDM|32.50|99|0.00|TAY-SACHS DISEASE|
20|FH_F141336_16947_0|CSTM-ALL|CSTM-00|2020|PDM|2119.00|99|0.00|AEG 8 (NO REV)|
20|FH_F133674_30350_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F118848_0_0|SrvcGrp|47142|2022|PDM|4800.00|99|0.00|CPT 49650|
20|FH_F147619_72034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F56753_15086_0|SrvcGrp|10503|2022|PDM|53.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F140035_0_0|SrvcGrp|42971|2022|PDM|211.00|99|0.00|SKN RN|
20|FH_F148554_85016_0|SrvcGrp|115444|2022|PDM|1291.00|99|0.00|INSERT PULSE GEN MULT LEADS|
20|FH_F117009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1657.00|99|0.00|AEG 8 (NO REV)|
20|FH_F149605_0_0|SrvcGrp|90478|2022|PDM|153.00|99|0.00|HOSPICE|
20|FH_F132601_92677_0|SrvcGrp|74668|2022|PDM|278.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F128316_22192_0|SrvcGrp|48394|2022|PDM|34.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F81373_64064_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F129688_74066_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F41785_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F44225_0_0|SrvcGrp|38370|2022|PCT|0.90|99|0.00|HOME HEALTH SERVICES|
20|FH_F125703_02907_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100240_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F132883_31602_0|SrvcGrp|86840|2022|PDM|20.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F120670_0_0|SrvcGrp|100919|2022|PDM|6500.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F134608_18017_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F109367_32751_0|SrvcGrp|100859|2022|PDM|285.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F147990_64701_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118088_71261_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F100782_0_0|SrvcGrp|97641|2022|PDM|930.75|99|0.00|WINDBER MEDICAL CNTR ASC 303|
20|FH_F51479_0_0|SrvcGrp|47998|2022|PCT|1.06|99|0.00|DIALYSIS HIGH COST DRUGS|
20|FH_F85553_0_0|SrvcGrp|14244|2022|PDM|637.00|99|0.00|EMERGENCY ROOM SVCS LEVEL VI|
20|FH_F115893_08002_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F120444_84037_0|SrvcGrp|74668|2022|PDM|325.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F140447_84106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F92634_08244_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F137901_60089_0|SrvcGrp|86722|2022|PDM|222.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F85674_0_0|CSTM-ALL|CSTM-00|2020|PDM|86.07|99|0.00|AETNA SLEEP STUDY CPT 95801|
20|FH_F129046_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141134_84720_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F39956_0_0|SrvcGrp|705|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F124178_01604_0|SrvcGrp|471|2022|PDM|624.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41801_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F41832_0_0|SrvcGrp|58737|2022|PDM|110.00|99|0.00|HOME PEDIATRIC THERAPY|
20|FH_F42522_0_0|SrvcGrp|11259|2022|PCT|0.60|99|0.00|DRUGS|
20|FH_F146254_83651_0|SrvcGrp|114499|2022|PDM|3.29|99|0.00|NALTREXONE DEPOT FORM|
20|FH_F86293_0_0|SrvcGrp|33984|2022|PDM|2048.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F92676_15063_0|SrvcGrp|78937|2022|PDM|3904.23|99|0.00|MON VALLEY ASC 906|
20|FH_F92677_08003_0|SrvcGrp|21920|2022|PDM|63.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F103281_32086_0|CSTM-ALL|CSTM-00|2020|PDM|3010.00|99|0.00|AEG 10 (NO REV)|
20|FH_F126942_39540_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89932_10940_0|SrvcGrp|89146|2022|PDM|345.00|99|0.00|HOME SLEEP STUDIES|
20|FH_F147998_07030_0|SrvcGrp|75419|2022|PDM|1575.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F38352_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F144011_60616_0|SrvcGrp|12491|2022|PCT|0.43|99|0.00|PACEMAKER|
20|FH_F106600_99202_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F98640_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F122928_39563_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F37364_0_0|SrvcGrp|72|2022|PDM|700.00|99|0.00|NEWBORN NURSERY|
20|FH_F137986_0_0|SrvcGrp|67065|2022|PDM|3000.00|99|0.00|CERVICAL SURGERY|
20|FH_F146204_0_0|SrvcGrp|88147|2022|PDM|2376.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA|
20|FH_F37361_0_0|SrvcGrp|12401|2022|PDM|88.00|99|0.00|RN VISIT|
20|FH_F115269_0_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F124322_64131_0|SrvcGrp|16750|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F43081_0_0|CSTM-ALL|CSTM-00|2020|PDM|399.00|99|0.00|ACUTE PSYCH|
20|FH_F138995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1784.00|99|0.00|AEG 9 (NO REV)|
20|FH_F116806_0_0|SrvcGrp|107115|2022|PDM|887.26|99|0.00|PARTIAL EXCISION OF LIP|
20|FH_F132480_92054_0|SrvcGrp|87317|2022|PDM|795.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F132479_90290_0|SrvcGrp|89337|2022|PDM|1800.00|99|0.00|DETOXIFICATION|
20|FH_F120974_27607_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F118879_93063_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F118815_61021_0|SrvcGrp|86648|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F42423_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F88212_20151_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F126923_33612_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F82714_18848_0|SrvcGrp|105465|2022|PCT|0.72|99|0.00|AETNA THERAPIES|
20|FH_F126308_44515_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F50459_0_0|SrvcGrp|33164|2022|PDM|305.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F54552_0_0|SrvcGrp|27048|2022|PDM|37.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS(MOD SH)|
20|FH_F138658_75022_0|SrvcGrp|73842|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138876_25302_0|SrvcGrp|86833|2022|PDM|15.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F138893_98903_0|SrvcGrp|92760|2022|PCT|1.06|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F57953_0_0|SrvcGrp|30204|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN (DME)|
20|FH_F119544_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|421.21|99|0.00|HAPA WPA-NWPA 2012-13 ASC 104 W/O REV|
20|FH_F92474_0_0|CSTM-ALL|CSTM-00|2020|PDM|504.00|99|0.00|AEG 2 (NO REV)|
20|FH_F151320_15145_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151426_90028_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151511_14094_0|SrvcGrp|116016|2022|PCT|1.00|99|0.00|LABORATORY SERVICES|
20|FH_F122069_75935_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F135453_70726_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F136006_44709_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125528_81147_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F38016_0_0|SrvcGrp|18143|2022|PDM|3245.00|99|0.00|MS DRG 247|
20|FH_F63301_0_0|CSTM-ALL|CSTM-00|2020|PDM|135.00|99|0.00|PEDS PT SVCS (MOD TJ)|
20|FH_F76624_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|ASPG VI - IOWA|
20|FH_F114931_0_0|SrvcGrp|80063|2022|PDM|1850.00|99|0.00|HEMORRHOIDECTOMY|
20|FH_F66408_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F90817_0_0|SrvcGrp|37642|2022|PDM|2068.00|99|0.00|LAP HERNIORRHAPY|
20|FH_F36590_0_0|SrvcGrp|129|2022|PCT|0.70|99|0.00|COCHLEAR IMPLANTS|
20|FH_F128191_28642_0|SrvcGrp|48385|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F149400_83301_0|SrvcGrp|88620|2022|PDM|90.00|99|0.00|SKILLED NURSING RN|
20|FH_F132008_85226_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F116575_0_0|SrvcGrp|59841|2022|PDM|1250.00|99|0.00|SUBMUCOUS RESECTION|
20|FH_F147330_34761_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150925_33936_0|SrvcGrp|82037|2022|PDM|2275.00|99|0.00|AETNA ICU|
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|1716.00|99|0.00|AEG 7 (NO REV)|
20|FH_F124749_90211_0|SrvcGrp|105819|2022|PDM|1605.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F136395_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1575124_HCPCS_  MOD TC|
20|FH_F127579_44321_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F137799_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F133972_27103_0|SrvcGrp|86839|2022|PDM|35.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F88744_71103_0|CSTM-ALL|CSTM-00|2020|PDM|852.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F116040_24637_0|SrvcGrp|86829|2022|PDM|30.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F111662_80601_0|SrvcGrp|104329|2022|PCT|1.00|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F142690_31774_0|SrvcGrp|14893|2022|PDM|92.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F151608_30236_0|CSTM-ALL|CSTM-00|2020|PDM|2218.00|99|0.00|AEG 9 (NO REV)|
20|FH_F90791_79106_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F68970_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F88456_0_0|SrvcGrp|63468|2022|PDM|897.00|99|0.00|CPT 52281|
20|FH_F119535_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.44|99|0.00|GENERAL ACUTE CARE|
20|FH_F132988_0_0|SrvcGrp|112146|2022|PDM|4493.01|99|0.00|REPAIR LOWER LEG TENDONS|
20|FH_F132988_0_0|SrvcGrp|112157|2022|PDM|2057.62|99|0.00|REPAIR FINGER DISLOCATION|
20|FH_F114389_50131_0|SrvcGrp|86840|2022|PDM|227.22|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F87822_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F49637_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115312_78550_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F41392_0_0|CSTM-ALL|CSTM-00|2020|PDM|851.00|99|0.00|ASPG V|
20|FH_F97565_83301_0|SrvcGrp|73605|2022|PDM|2103.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F90811_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|466.00|99|0.00|COVENTRY ENHANCED GROUPER 1 MOD 50|
20|FH_F125672_92663_0|SrvcGrp|105442|2022|PDM|500.00|99|0.00|ABH OP TERANIAL MAGN|
20|FH_F49354_0_0|SrvcGrp|36809|2022|PCT|1.00|99|0.00|OCN F/S PRICING:POS FACILITY  GLOBAL (DME)|
20|FH_F55375_0_0|SrvcGrp|17065|2022|PDM|920.00|99|0.00|ASPG I|
20|FH_F123039_44147_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139707_84010_0|SrvcGrp|116276|2022|PDM|36200.00|99|0.00|JOINT RECONSTRUCTION/REPLACEMENT|
20|FH_F147147_50265_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F50415_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|NURSING CARE MOD TE|
20|FH_F141156_04401_0|CSTM-ALL|CSTM-00|2020|PDM|801.00|99|0.00|AEG 4 (NO REV)|
20|FH_F98860_96706_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F124695_33401_0|SrvcGrp|109921|2022|PDM|769.00|99|0.00|RESIDENTIAL TREATMENT (13-17 YRS)|
20|FH_F124318_29020_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130925_34652_0|SrvcGrp|108484|2022|PDM|609.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F98622_45005_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F137616_48823_0|SrvcGrp|75754|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F93920_0_0|SrvcGrp|72992|2022|PDM|2000.00|99|0.00|AEG 2|
20|FH_F143528_0_0|SrvcGrp|102481|2022|PDM|2625.00|99|0.00|CPT 29898|
20|FH_F116291_11570_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F71644_0_0|SrvcGrp|16274|2022|PCT|1.00|99|0.00|ORGAN ACQUISITION|
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89112_16509_0|SrvcGrp|64098|2022|PDM|3031.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 9|
20|FH_F100665_07939_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F44135_0_0|SrvcGrp|38327|2022|PCT|1.00|99|0.00|HILLCREST IV THERAPY DRUGS|
20|FH_F97565_83301_0|SrvcGrp|73603|2022|PDM|9293.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F121338_37756_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150679_32534_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F90223_0_0|SrvcGrp|86831|2022|PDM|3.80|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147304_75965_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124484_83837_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F149003_62208_0|SrvcGrp|48396|2022|PDM|93.36|99|0.00|OT SERVICES|
20|FH_F94643_90501_0|SrvcGrp|86844|2022|PDM|55.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F134394_92101_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F120040_72703_0|SrvcGrp|86722|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F35432_0_0|SrvcGrp|3208|2022|PDM|529.00|99|0.00|SUBACUTE CARE|
20|FH_F39756_0_0|SrvcGrp|31521|2022|PDM|853.60|99|0.00|CUMBERLAND SURGERY CTR - ASPG V|
20|FH_F41167_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39162_0_0|SrvcGrp|21814|2022|PDM|135.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F149023_44122_0|CSTM-ALL|CSTM-00|2020|PDM|2375.00|99|0.00|AEG 6 (NO REV)|
20|FH_F130203_29601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143412_70503_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F134595_06226_0|SrvcGrp|75545|2022|PDM|485.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F58856_0_0|SrvcGrp|21350|2022|PDM|9000.00|99|0.00|MS DRG 287 ONLY|
20|FH_F138627_82901_0|SrvcGrp|86845|2022|PDM|85.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F140616_43338_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120152_0_0|SrvcGrp|72121|2022|PDM|6600.00|99|0.00|ARTHOSCOPY|
20|FH_F62394_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147059_28806_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138280_75215_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134791_98034_0|SrvcGrp|88621|2022|PDM|307.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135758_98229_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135763_20678_0|SrvcGrp|108484|2022|PDM|1550.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F72823_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F104180_0_0|SrvcGrp|472|2022|PDM|594.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F141907_74021_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F97542_32960_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F115505_21014_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F51541_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F100784_59923_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F57396_0_0|SrvcGrp|46586|2022|PDM|160.00|99|0.00|CPT 99205|
20|FH_F117372_07442_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F94300_0_0|SrvcGrp|93602|2022|PDM|4200.00|99|0.00|TOTAL KNEE(HCFA)|
20|FH_F150882_84041_0|SrvcGrp|86854|2022|PDM|61.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F110824_83221_0|SrvcGrp|103503|2022|PCT|0.85|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F141287_14830_0|SrvcGrp|112224|2022|PDM|110.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F119946_36109_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F47424_0_0|SrvcGrp|26001|2022|PDM|170.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F38753_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% ASP NEBRASKA|
20|FH_F122377_91007_0|SrvcGrp|44564|2022|PDM|1204.00|99|0.00|NEWBORN NURSERY|
20|FH_F98000_59102_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F150931_65201_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140608_0_0|SrvcGrp|48394|2022|PDM|61.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F140137_15235_0|SrvcGrp|57968|2022|PDM|118.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F49552_0_0|SrvcGrp|29816|2022|PCT|0.48|99|0.00|IMPLANTS/PROSTHETICS/DRUGS|
20|FH_F136250_73026_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F116698_07470_0|SrvcGrp|22384|2022|PCT|1.05|99|0.00|HOME VISIT PRENATAL|
20|FH_F35685_0_0|SrvcGrp|8968|2022|PDM|2536.00|99|0.00|NICU LEVEL III & IV|
20|FH_F123943_84041_0|SrvcGrp|80920|2022|PDM|605.00|99|0.00|HOSPICE SERVICES|
20|FH_F110925_01104_0|SrvcGrp|41458|2022|PDM|2.10|99|0.00|ENTERAL - PEDIATRICS (SPEC METABOLIC NEED)|
20|FH_F40026_0_0|SrvcGrp|16|2022|PDM|891.00|99|0.00|ACUTE REHABILITATION|
20|FH_F52854_0_0|SrvcGrp|17081|2022|PDM|3194.00|99|0.00|ASPG IX|
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|AEG 2 (NO REV)|
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|849.00|99|0.00|AEG 2 (NO REV)|
20|FH_F131254_92211_0|SrvcGrp|22589|2022|PDM|50.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F133329_40202_0|SrvcGrp|87537|2022|PDM|754.00|99|0.00|MED REHAB DAY PROGRAM (FULL)|
20|FH_F142078_73110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141753_63334_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F97621_75801_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F151046_10036_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F31547_0_0|SrvcGrp|15423|2022|PDM|167.86|99|0.00|ENGERIX-B HEPATITIS B|
20|FH_F103760_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.23|99|0.00|HSS ASC|
20|FH_F75944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147167_75605_0|SrvcGrp|108484|2022|PDM|550.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F134707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F90196_10467_0|SrvcGrp|89022|2022|PDM|39.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F97880_63501_0|SrvcGrp|73605|2022|PDM|2467.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F34735_0_0|SrvcGrp|16|2022|PDM|1050.00|99|0.00|ACUTE REHABILITATION|
20|FH_F50218_0_0|SrvcGrp|46250|2022|PDM|120.00|99|0.00|HOME VISIT CATHETER CARE|
20|FH_F33642_0_0|SrvcGrp|48950|2022|PCT|0.60|99|0.00|RADIOLOGY (WITHOUT MRI AND CT SCANS)|
20|FH_F38842_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|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_F123943_84041_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F123473_65109_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F79625_0_0|SrvcGrp|75185|2022|PCT|0.00|99|0.00|AETNA BLOOD PRODUCTS|
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|989.00|99|0.00|AEG 4 (NO REV)|
20|FH_F110521_98034_0|SrvcGrp|73842|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F110509_71351_0|SrvcGrp|73008|2022|PDM|3500.00|99|0.00|AEG 10|
20|FH_F109394_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122532_46385_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F84712_0_0|SrvcGrp|81859|2022|PDM|3911.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F86375_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132810_0_0|SrvcGrp|98969|2022|PDM|60.00|99|0.00|HIT ANTI TNF (HCFA)|
20|FH_F137236_17603_0|SrvcGrp|113069|2022|PDM|1143.00|99|0.00|PSYCH (>=18 YRS)|
20|FH_F134846_06437_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47600_0_0|SrvcGrp|32390|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKE (DME)|
20|FH_F49037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|1998.00|99|0.00|AEG 3 (NO REV)|
20|FH_F143829_74066_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125048_94583_0|SrvcGrp|73842|2022|PDM|450.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F37659_0_0|CSTM-ALL|CSTM-00|2020|PDM|1547.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F96201_01824_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F133909_19805_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F83113_0_0|SrvcGrp|12401|2022|PDM|66.00|99|0.00|RN VISIT|
20|FH_F110521_98034_0|SrvcGrp|89417|2022|PDM|318.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F138107_15201_0|SrvcGrp|73842|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F93076_85016_0|SrvcGrp|9914|2022|PDM|736.16|99|0.00|PEDIATRIC REHABILITATION|
20|FH_F82631_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|TRC VACV 28 FS %  MOD TC|
20|FH_F139110_33912_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138584_30912_0|SrvcGrp|113377|2022|PDM|1700.00|99|0.00|RECONSTRUCTION MIDFACE LEFORT I|
20|FH_F129427_92262_0|SrvcGrp|108484|2022|PDM|800.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F116393_07002_0|SrvcGrp|87104|2022|PDM|76.49|99|0.00|X-RAY EXAM LOWER SPINE|
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_F129888_0_0|CSTM-ALL|CSTM-00|2020|PDM|984.66|99|0.00|2005 ASPG GROUPER IV|
20|FH_F146116_34233_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94300_0_0|SrvcGrp|93595|2022|PDM|4200.00|99|0.00|ARTHROPLASTY(HCFA)|
20|FH_F146139_37604_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F50974_0_0|SrvcGrp|42974|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F118303_0_0|CSTM-ALL|CSTM-00|2020|PDM|510.00|99|0.00|AEG 3 (NO REV)|
20|FH_F113146_15001_0|SrvcGrp|105018|2022|PDM|448.00|99|0.00|AETNA RESIDENTIAL TREATMENT (18-999 YRS)|
20|FH_F41142_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F36579_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALLIED MED-MOD AV|
20|FH_F144022_32118_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F150880_90036_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134707_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F128366_32901_0|SrvcGrp|89417|2022|PDM|371.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F35730_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113957_73554_0|SrvcGrp|72996|2022|PDM|1680.00|99|0.00|AEG 4|
20|FH_F113765_0_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES|
20|FH_F40627_0_0|SrvcGrp|12670|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F134397_27513_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F94585_19040_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40490_0_0|SrvcGrp|88|2022|PCT|0.58|99|0.00|OP LITHOTRIPSY|
20|FH_F143536_47546_0|SrvcGrp|22379|2022|PCT|1.00|99|0.00|CPT CODE 94010|
20|FH_F33925_0_0|SrvcGrp|3477|2022|PDM|37.00|99|0.00|CLINIC VISIT|
20|FH_F40634_0_0|CSTM-ALL|CSTM-00|2020|PDM|1061.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135236_02840_0|SrvcGrp|103913|2022|PCT|1.01|99|0.00|OP DIALYSIS|
20|FH_F130747_0_0|SrvcGrp|67068|2022|PDM|36414.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F92119_0_0|CSTM-ALL|CSTM-00|2020|PDM|785.00|99|0.00|AEG 6 (NO REV)|
20|FH_F149919_85390_0|SrvcGrp|75419|2022|PDM|721.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F143783_0_0|SrvcGrp|113613|2022|PDM|105.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F142073_0_0|SrvcGrp|109965|2022|PDM|5980.00|99|0.00|THORAX SPINE DISK SURGERY|
20|FH_F33559_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148500_50129_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F119824_0_0|SrvcGrp|29428|2022|PDM|424.00|99|0.00|HOME/CHRONIC HEMODIALYSIS TREATMENT|
20|FH_F55054_0_0|SrvcGrp|20752|2022|PDM|25750.00|99|0.00|MSDRG 619-621 ONLY BARIATRIC SURGERY|
20|FH_F56136_0_0|SrvcGrp|919|2022|PCT|0.92|99|0.00|OP URGENT CARE|
20|FH_F135260_18655_0|SrvcGrp|90854|2022|PDM|577.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F62700_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125849_67052_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110263_0_0|SrvcGrp|27402|2022|PDM|7575.00|99|0.00|LASER PROCEDURES|
20|FH_F88639_80204_0|SrvcGrp|78377|2022|PDM|1362.11|99|0.00|AETNA IP DETOX (BHIPDETOX)|
20|FH_F150303_19150_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F109242_18466_0|SrvcGrp|52952|2022|PDM|113.00|99|0.00|PSYCHIATRIC CPT 90847|
20|FH_F136359_0_0|SrvcGrp|99172|2022|PDM|6500.00|99|0.00|CPT 28740|
20|FH_F112023_12866_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F130329_64114_0|SrvcGrp|111384|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F39988_0_0|SrvcGrp|701|2022|PDM|2031.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F54552_0_0|SrvcGrp|16559|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F113585_20155_0|SrvcGrp|14949|2022|PDM|90.00|99|0.00|HOME INFUSION|
20|FH_F138876_25302_0|SrvcGrp|24750|2022|PDM|15.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F138876_25302_0|SrvcGrp|86846|2022|PDM|45.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F114572_0_0|CSTM-ALL|CSTM-00|2020|PDM|660.00|99|0.00|AEG 1 (NO REV)|
20|FH_F150324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|227.96|99|0.00|HAPA WPA-NWPA 2012-13 ASC 126 W/O REV|
20|FH_F151440_84095_0|SrvcGrp|75419|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F151501_30265_0|SrvcGrp|100043|2022|PDM|13352.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F132268_07060_0|SrvcGrp|90487|2022|PDM|32.03|99|0.00|WHEELCHAIR MANAGEMENT|
20|FH_F122116_60942_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122152_70123_0|SrvcGrp|57968|2022|PDM|35.66|99|0.00|CONTINUOUS HOMECARE|
20|FH_F144928_02703_0|SrvcGrp|90854|2022|PDM|896.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F31927_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F135572_89106_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP WITHOUT CPT 99601|
20|FH_F136164_63965_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116404_20191_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F116527_70443_0|SrvcGrp|100765|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F133468_74873_0|SrvcGrp|90397|2022|PDM|1750.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F130766_04967_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|AEG 5  (NO REV)|
20|FH_F130766_04967_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F101665_10027_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121763_07202_0|SrvcGrp|67684|2022|PDM|115.00|99|0.00|PSYCH VISIT|
20|FH_F146125_0_0|SrvcGrp|26274|2022|PDM|3150.00|99|0.00|CPT 29877|
20|FH_F67425_0_0|SrvcGrp|21826|2022|PDM|3149.00|99|0.00|PTCA (MS DRG ONLY)|
20|FH_F134315_89106_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F87153_0_0|CSTM-ALL|CSTM-00|2020|PDM|305.49|99|0.00|AETNA SLEEP STUDIES|
20|FH_F118482_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131000_0_0|SrvcGrp|27346|2022|PDM|4457.00|99|0.00|REPAIR BLADDER DEFECT|
20|FH_F132328_0_0|SrvcGrp|82112|2022|PDM|2581.00|99|0.00|KNEE ARTHROSCOPY SURGERY|
20|FH_F132328_0_0|SrvcGrp|86233|2022|PDM|2066.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F72666_0_0|SrvcGrp|997|2022|PCT|0.80|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F72666_0_0|SrvcGrp|69687|2022|PCT|0.65|99|0.00|OP DEEP BRAIN STIMULATION|
20|FH_F87557_33309_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F136698_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F129240_10028_0|SrvcGrp|86848|2022|PDM|35.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F129220_18445_0|SrvcGrp|31753|2022|PDM|565.00|99|0.00|SPINAL CORD CARE|
20|FH_F148554_85016_0|CSTM-ALL|CSTM-00|2020|PDM|744.00|99|0.00|AEG 10 (NO REV)|
20|FH_F88512_0_0|SrvcGrp|73860|2022|PDM|7421.90|99|0.00|C-SECTION|
20|FH_F133018_84037_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F150904_22306_0|SrvcGrp|48394|2022|PDM|47.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F68947_0_0|SrvcGrp|59840|2022|PDM|2991.00|99|0.00|TYMPANOSTOMY|
20|FH_F150100_39301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147995_67037_0|SrvcGrp|109594|2022|PCT|0.50|99|0.00|HIGH COST DRUGS BASE|
20|FH_F105921_80014_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F101104_0_0|SrvcGrp|95761|2022|PDM|125.00|99|0.00|NURSING CARE (HCFA)|
20|FH_F132802_68022_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F70331_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|2089.00|99|0.00|ASPG IX|
20|FH_F59872_0_0|CSTM-ALL|CSTM-00|2020|PDM|4195.00|99|0.00|ASPG VIII|
20|FH_F119107_22601_0|SrvcGrp|73700|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F141829_0_0|SrvcGrp|13262|2022|PDM|5.48|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 10 (NO REV)|
20|FH_F85894_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|JERSEY SHORE LABS- GH|
20|FH_F131964_89120_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F123820_91316_0|SrvcGrp|108061|2022|PDM|300.00|99|0.00|OP THERAPY SERVICES|
20|FH_F93292_62234_0|SrvcGrp|90496|2022|PDM|15.83|99|0.00|FLUVIRIN VACC 3 YRS & > IM|
20|FH_F138627_82901_0|SrvcGrp|41424|2022|PDM|1.50|99|0.00|ENTERAL FORMULA - BLENDERIZED|
20|FH_F137335_08096_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F31563_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PDM|650.00|99|0.00|OBSERVATION SVCS - UP TO 23 HRS|
20|FH_F146895_28751_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124687_64024_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F58636_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122571_53555_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116199_75042_0|SrvcGrp|104077|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F134537_03060_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|248.02|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1601 W/O REV|
20|FH_F75842_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (HCFA) INPATIENT|
20|FH_F136314_19013_0|SrvcGrp|73842|2022|PDM|199.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138778_90066_0|SrvcGrp|89417|2022|PDM|475.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F151603_27609_0|CSTM-ALL|CSTM-00|2020|PDM|2960.20|99|0.00|AEG 9 (NO REV)|
20|FH_F119067_94080_0|SrvcGrp|48398|2022|PDM|120.00|99|0.00|PT SERVICES|
20|FH_F55893_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41481_0_0|SrvcGrp|17069|2022|PDM|560.00|99|0.00|ASPG III|
20|FH_F37294_0_0|SrvcGrp|3544|2022|PCT|1.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F124926_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F72162_0_0|SrvcGrp|114262|2022|PDM|135.00|99|0.00|HHC RN E&M PLAN SVS|
20|FH_F124212_33407_0|SrvcGrp|74668|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F122608_84123_0|SrvcGrp|76531|2022|PDM|112.00|99|0.00|HOSPICE IN HOME|
20|FH_F125465_43078_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F91155_16105_0|SrvcGrp|73659|2022|PDM|1464.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|930.00|99|0.00|AEG 2 (NO REV)|
20|FH_F119079_41018_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F109920_39180_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132988_0_0|SrvcGrp|75002|2022|PDM|6358.80|99|0.00|ARTHOSCOPY|
20|FH_F124586_14850_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F114629_19131_0|SrvcGrp|72602|2022|PDM|986.00|99|0.00|ECT|
20|FH_F113809_47302_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116393_07002_0|SrvcGrp|12512|2022|PDM|2565.00|99|0.00|ACUTE REHABILITATION|
20|FH_F92677_08003_0|SrvcGrp|86850|2022|PDM|52.50|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F126663_91423_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F144017_33873_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F106940_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40591_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F126733_83713_0|SrvcGrp|87317|2022|PDM|861.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F91937_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F128130_10027_0|SrvcGrp|90356|2022|PCT|1.93|99|0.00|OP DIALYSIS|
20|FH_F77787_0_0|SrvcGrp|27249|2022|PDM|114.00|99|0.00|PT|
20|FH_F146361_66215_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123538_21206_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F55375_0_0|SrvcGrp|51471|2022|PDM|80.00|99|0.00|HOME HEALTH AID VISIT|
20|FH_F89015_74017_0|SrvcGrp|73701|2022|PDM|40.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F39723_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (HCFA)|
20|FH_F77787_0_0|SrvcGrp|26949|2022|PDM|1128.00|99|0.00|EMERGENCY ROOM|
20|FH_F120407_84070_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38016_0_0|SrvcGrp|701|2022|PDM|1731.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F97480_08204_0|SrvcGrp|73559|2022|PDM|17811.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F137986_0_0|SrvcGrp|63471|2022|PDM|3000.00|99|0.00|CPT 64590|
20|FH_F149662_85015_0|SrvcGrp|115728|2022|PDM|3270.00|99|0.00|ARTHROSCOPY|
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|1339.00|99|0.00|AEG 9 (NO REV)|
20|FH_F97101_98003_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F34853_0_0|SrvcGrp|13216|2022|PCT|2.00|99|0.00|OTHER DIAGNOSTIC TESTING (CPT CODES 90000-99999)|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|487.28|99|0.00|SALLY BALIN,999182,ASC 203|
20|FH_F84872_18510_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE|
20|FH_F97880_63501_0|CSTM-ALL|CSTM-00|2020|PCT|0.58|99|0.00|OP SVCS|
20|FH_F124714_64081_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F90199_24083_0|SrvcGrp|472|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F91938_70121_0|SrvcGrp|26001|2022|PDM|131.83|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F97620_75904_0|SrvcGrp|88977|2022|PDM|5558.00|99|0.00|C-SECTION DELIVERY|
20|FH_F102224_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 10 (NO REV)|
20|FH_F132371_19083_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97104_53545_0|SrvcGrp|73605|2022|PDM|2103.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F63422_0_0|SrvcGrp|12496|2022|PDM|428.00|99|0.00|ACUTE REHABILITATION|
20|FH_F39857_0_0|SrvcGrp|110|2022|PDM|728.00|99|0.00|CD - REHABILITATION|
20|FH_F91078_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135219_68506_0|SrvcGrp|115250|2022|PCT|1.18|99|0.00|RADIOLOGY SERVICES|
20|FH_F130682_0_0|SrvcGrp|27344|2022|PDM|4980.00|99|0.00|OP SURGERY (CPT 42821)|
20|FH_F92091_0_0|SrvcGrp|73000|2022|PDM|1750.00|99|0.00|AEG 6|
20|FH_F125899_07645_0|SrvcGrp|92958|2022|PCT|1.93|99|0.00|SLEEP STUDIES|
20|FH_F82173_72712_0|CSTM-ALL|CSTM-00|2020|PDM|1452.00|99|0.00|AEG 1 (NO REV) W/O URINARY SVCS|
20|FH_F116647_0_0|SrvcGrp|28787|2022|PDM|26.52|99|0.00|CPT CODE 90993|
20|FH_F31991_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132559_0_0|CSTM-ALL|CSTM-00|2020|PDM|2163.00|99|0.00|AEG 7 (NO REV)|
20|FH_F145508_0_0|SrvcGrp|104226|2022|PDM|181.21|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F62614_0_0|SrvcGrp|46605|2022|PDM|30.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F113815_0_0|SrvcGrp|73008|2022|PDM|233.00|99|0.00|AEG 10|
20|FH_F113815_0_0|SrvcGrp|73006|2022|PDM|233.00|99|0.00|AEG 9|
20|FH_F138457_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145641_06902_0|CSTM-ALL|CSTM-00|2020|PDM|610.00|99|0.00|AEG 1 (NO REV)|
20|FH_F42095_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F110940_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F138681_39301_0|SrvcGrp|46903|2022|PDM|652.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F57953_0_0|SrvcGrp|30208|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F83792_0_0|SrvcGrp|73485|2022|PDM|1837.00|99|0.00|AETNA REHAB|
20|FH_F41236_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88893_0_0|SrvcGrp|27345|2022|PDM|3520.00|99|0.00|OP SURGERY (CPT 49650)|
20|FH_F151503_30067_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F151515_77901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132268_07060_0|SrvcGrp|72379|2022|PDM|79.42|99|0.00|SPEECH THERAPY|
20|FH_F135608_19348_0|SrvcGrp|89417|2022|PDM|367.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F135851_25414_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F135972_18509_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F135978_06851_0|SrvcGrp|100859|2022|PDM|290.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F136041_87107_0|SrvcGrp|73842|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F131228_01826_0|SrvcGrp|86701|2022|PDM|393.50|99|0.00|ECHO TRANSESOPHAGEAL 4|
20|FH_F131112_99163_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F131407_07607_0|SrvcGrp|86847|2022|PDM|30.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F31955_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F116370_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121761_44130_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPT CARE OF MUNCY FH -KM|
20|FH_F148639_0_0|SrvcGrp|58634|2022|PDM|3495.00|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F149661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F33788_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F37778_0_0|SrvcGrp|14614|2022|PDM|3100.00|99|0.00|LITHOTRIPSY|
20|FH_F150801_19380_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133677_15601_0|SrvcGrp|48398|2022|PDM|107.00|99|0.00|PT SERVICES|
20|FH_F125656_92868_0|SrvcGrp|86831|2022|PDM|7.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F133569_17202_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F76826_0_0|SrvcGrp|73949|2022|PDM|306.00|99|0.00|AMBULANCE - BASIC LIFE SUPPORT|
20|FH_F124413_30067_0|SrvcGrp|75419|2022|PDM|560.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F146266_0_0|SrvcGrp|92410|2022|PDM|15190.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F128386_60124_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F75903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F132371_19083_0|SrvcGrp|29347|2022|PDM|24.00|99|0.00|HOME HEALTH AIDE|
20|FH_F116633_37217_0|SrvcGrp|106963|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143467_0_0|SrvcGrp|70746|2022|PDM|1424.00|99|0.00|CPT 28292|
20|FH_F33498_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|OP SVCS|
20|FH_F34112_0_0|SrvcGrp|290|2022|PDM|4550.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F143973_28040_0|SrvcGrp|75419|2022|PDM|435.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F123400_04605_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F123922_84102_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39479_0_0|SrvcGrp|30555|2022|PDM|85.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F148325_0_0|SrvcGrp|57968|2022|PDM|37.74|99|0.00|CONTINUOUS HOMECARE|
20|FH_F131254_92211_0|SrvcGrp|26869|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F145815_30540_0|SrvcGrp|113231|2022|PDM|105.33|99|0.00|COVID-19 NEUTRLZG ANTB SARSCOV2 TITER|
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)|
20|FH_F66481_0_0|SrvcGrp|42974|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F115063_78550_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F125693_92660_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F132736_0_0|SrvcGrp|3078|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F114916_30309_0|SrvcGrp|75002|2022|PDM|4500.00|99|0.00|ARTHOSCOPY|
20|FH_F103800_70811_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F112453_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41539_0_0|SrvcGrp|33827|2022|PDM|677.00|99|0.00|KANSAS ENHANCED GROUPERS ASPG 5|
20|FH_F141018_70125_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147081_02130_0|SrvcGrp|74668|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F123620_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F48348_61605_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F133021_00910_0|SrvcGrp|30391|2022|PDM|200.00|99|0.00|OP DIALYSIS|
20|FH_F141893_65655_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F98640_0_0|CSTM-ALL|CSTM-00|2020|PDM|2533.00|99|0.00|AEG 7 (NO REV)|
20|FH_F126858_43113_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F134487_14843_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
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_F139825_0_0|SrvcGrp|62740|2022|PDM|5738.00|99|0.00|SURGERY CARVE OUTS|
20|FH_F51438_0_0|SrvcGrp|9774|2022|PDM|1473.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F150782_19444_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F130182_0_0|SrvcGrp|109444|2022|PDM|1457.00|99|0.00|RIGHT HEART CATH|
20|FH_F75207_0_0|SrvcGrp|59358|2022|PDM|140.00|99|0.00|CCPD TRAINING|
20|FH_F147159_62615_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36715_0_0|SrvcGrp|8950|2022|PDM|2472.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F122377_91007_0|SrvcGrp|12809|2022|PCT|0.46|99|0.00|RADIATION THERAPY SVCS|
20|FH_F131371_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F124383_39056_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F122377_91007_0|SrvcGrp|75479|2022|PDM|5340.00|99|0.00|AEG 1|
20|FH_F33719_0_0|SrvcGrp|115|2022|PDM|522.00|99|0.00|SKILLED NURSING CARE|
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 10 (NO REV)|
20|FH_F139792_26034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120531_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F59732_0_0|SrvcGrp|24754|2022|PDM|19.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F84778_0_0|SrvcGrp|11000|2022|PCT|1.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F102302_0_0|SrvcGrp|98560|2022|PDM|39100.00|99|0.00|LUMBAR|
20|FH_F39101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F55054_0_0|SrvcGrp|941|2022|PDM|3245.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F102302_0_0|SrvcGrp|98562|2022|PDM|39100.00|99|0.00|THORAX SPINE FUSION|
20|FH_F122687_0_0|SrvcGrp|35669|2022|PDM|8742.00|99|0.00|CPT 63650|
20|FH_F129766_48236_0|SrvcGrp|71083|2022|PCT|1.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F120693_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150303_19150_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118123_67226_0|SrvcGrp|13929|2022|PDM|10.00|99|0.00|GROWTH HORMONE|
20|FH_F110453_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F81698_10457_0|SrvcGrp|86839|2022|PDM|31.50|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F112863_0_0|SrvcGrp|104252|2022|PDM|1141.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F43861_0_0|SrvcGrp|27725|2022|PDM|40.00|99|0.00|SKILLED RN HOURLY|
20|FH_F143571_0_0|SrvcGrp|83519|2022|PDM|153.00|99|0.00|HOSPICE CARE (ALL OTHER)|
20|FH_F93176_73750_0|SrvcGrp|79699|2022|PCT|0.80|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F118144_33418_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F136318_0_0|SrvcGrp|89337|2022|PDM|1103.00|99|0.00|DETOXIFICATION|
20|FH_F127992_34952_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F111292_33136_0|SrvcGrp|88978|2022|PDM|4480.00|99|0.00|VAGINAL DELIVERY|
20|FH_F111292_33136_0|SrvcGrp|72998|2022|PDM|5737.00|99|0.00|AEG 5|
20|FH_F111363_33169_0|SrvcGrp|66517|2022|PCT|0.00|99|0.00|NICU|
20|FH_F111363_33169_0|SrvcGrp|73002|2022|PDM|2483.00|99|0.00|AEG 7|
20|FH_F145587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F41780_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F129240_10028_0|SrvcGrp|26869|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F129220_18445_0|SrvcGrp|105371|2022|PDM|146.00|99|0.00|PSYCH DIAGNOSTIC EVALUATION (HCFA)|
20|FH_F101320_26062_0|SrvcGrp|10577|2022|PDM|18.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F143542_0_0|SrvcGrp|62740|2022|PDM|5738.00|99|0.00|SURGERY CARVE OUTS|
20|FH_F134202_0_0|SrvcGrp|104448|2022|PDM|6043.25|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE|
20|FH_F148100_22406_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F118517_33316_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F128559_43524_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F119437_0_0|SrvcGrp|88065|2022|PDM|4750.00|99|0.00|TOTAL DISC ARTHROPLASTY|
20|FH_F72750_0_0|SrvcGrp|131|2022|PCT|0.40|99|0.00|PACEMAKER DEVICE|
20|FH_F90921_77702_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F106540_26330_0|SrvcGrp|58623|2022|PDM|615.00|99|0.00|C T SCANS|
20|FH_F102822_84065_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111467_33761_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F125870_0_0|SrvcGrp|73006|2022|PDM|1187.00|99|0.00|AEG 9|
20|FH_F133749_84604_0|SrvcGrp|92139|2022|PDM|60.75|99|0.00|SKILLED NURSING LPN|
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_F133207_0_0|SrvcGrp|107362|2022|PDM|5032.00|99|0.00|ALLOGRAFT FOR SPINE SURGERY|
20|FH_F85777_77030_0|SrvcGrp|9866|2022|PDM|6670.00|99|0.00|IP OBSERVATION SVCS|
20|FH_F81294_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|1119.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F38349_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.65|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_F87333_0_0|SrvcGrp|73002|2022|PDM|1922.29|99|0.00|AEG 7|
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 7 (NO REV)|
20|FH_F111602_17102_0|SrvcGrp|73841|2022|PDM|330.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|3160.00|99|0.00|AEG 5  (NO REV)|
20|FH_F126770_43050_0|SrvcGrp|94780|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F118171_00674_0|SrvcGrp|81340|2022|PCT|1.00|99|0.00|AETNA LABORATORY|
20|FH_F140887_43338_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA IP MCARE2 OCN F/S PRICING|
20|FH_F129448_43235_0|SrvcGrp|88621|2022|PDM|98.00|99|0.00|SKILLED NURSING LPN|
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|1484.00|99|0.00|AEG 2 (NO REV)|
20|FH_F131047_0_0|CSTM-ALL|CSTM-00|2020|PDM|2986.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F113791_32055_0|SrvcGrp|93800|2022|PDM|1910.00|99|0.00|AETNA PET SCAN (HCFA)|
20|FH_F138855_84067_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F117085_40207_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F134796_70001_0|CSTM-ALL|CSTM-00|2020|PCT|1.60|99|0.00|HSS ASC|
20|FH_F46938_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE|
20|FH_F42399_0_0|SrvcGrp|33164|2022|PDM|302.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F42694_0_0|SrvcGrp|26179|2022|PDM|80.00|99|0.00|OT|
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|514.00|99|0.00|AEG 3 (NO REV)|
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125677_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132928_64114_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PDM|1166.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F118193_06241_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F118959_44830_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147922_10031_0|SrvcGrp|90643|2022|PDM|20.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F101945_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109652_0_0|SrvcGrp|84957|2022|PDM|17704.00|99|0.00|MS DRG 518 - 520|
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1137.00|99|0.00|AEG 6 (NO REV)|
20|FH_F89037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F142448_15701_0|SrvcGrp|73701|2022|PDM|20.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F114666_30342_0|SrvcGrp|26275|2022|PDM|1600.00|99|0.00|CPT 29826|
20|FH_F144039_0_0|CSTM-ALL|CSTM-00|2020|PDM|2338.00|99|0.00|AEG 7 (NO REV)|
20|FH_F122832_61938_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F115664_72758_0|SrvcGrp|104464|2022|PDM|1750.00|99|0.00|VAGINAL DELIVERY (W/ OR W/O EPISIOTOMY)|
20|FH_F116199_75042_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F147599_76240_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141611_43113_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F67379_0_0|SrvcGrp|11920|2022|PCT|0.74|99|0.00|PHARMACY SVCS|
20|FH_F133458_18929_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F115327_45320_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142991_43920_0|SrvcGrp|13262|2022|PDM|7.70|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F148886_60621_0|SrvcGrp|79804|2022|PDM|1623.00|99|0.00|AETNA MEDICAL/SURGICAL|
20|FH_F128000_30121_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141870_85224_0|SrvcGrp|21920|2022|PDM|50.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F128554_87102_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F34706_0_0|SrvcGrp|14625|2022|PDM|7733.00|99|0.00|DRG 310 ONLY - TRANSURETHRL PROCEDURES W/CC|
20|FH_F44701_0_0|SrvcGrp|38907|2022|PDM|950.00|99|0.00|CPT 66170 - FISTULIZATION OF SCLERA FOR GLAUCOMA|
20|FH_F88956_0_0|SrvcGrp|73806|2022|PCT|0.52|99|0.00|AETNA ER|
20|FH_F87594_81501_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F44855_0_0|SrvcGrp|30207|2022|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER TC (DME)|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|220.25|99|0.00|ASPG 219|
20|FH_F126666_44053_0|SrvcGrp|105368|2022|PDM|39.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MINS(HCFA)|
20|FH_F128246_0_0|SrvcGrp|85564|2022|PDM|841.00|99|0.00|REVISION OF IRIS|
20|FH_F125471_34471_0|SrvcGrp|3178|2022|PDM|941.00|99|0.00|ACUTE PSYCH|
20|FH_F55375_0_0|SrvcGrp|51476|2022|PCT|0.65|99|0.00|HIGH COST DRUGS|
20|FH_F150982_0_0|SrvcGrp|26278|2022|PDM|2202.00|99|0.00|CPT 29881|
20|FH_F114571_34613_0|SrvcGrp|93919|2022|PDM|675.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F124291_44122_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F34918_0_0|SrvcGrp|3029|2022|PDM|564.00|99|0.00|NEWBORN NURSERY|
20|FH_F127487_60169_0|SrvcGrp|48394|2022|PDM|25.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F37312_0_0|SrvcGrp|10540|2022|PDM|44.00|99|0.00|HOME HEALTH AIDE|
20|FH_F101083_0_0|SrvcGrp|74588|2022|PDM|2100.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F119946_36109_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F90232_15126_0|SrvcGrp|86842|2022|PDM|52.50|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F150312_89103_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F127040_63867_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F74845_0_0|SrvcGrp|16|2022|PDM|1234.00|99|0.00|ACUTE REHABILITATION|
20|FH_F119029_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F37482_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F111044_0_0|SrvcGrp|99155|2022|PDM|1648.00|99|0.00|WRST ARTHROS SURG|
20|FH_F143214_92506_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (BREAKOUT)|
20|FH_F143347_16001_0|SrvcGrp|75507|2022|PCT|2.00|99|0.00|CHEMOTHERAPY|
20|FH_F102224_0_0|SrvcGrp|108269|2022|PDM|11000.00|99|0.00|REVISE HIP JOINT COMPONENT|
20|FH_F100742_00616_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F125048_94583_0|SrvcGrp|89149|2022|PDM|450.00|99|0.00|OP INTENSIVE|
20|FH_F110925_01104_0|SrvcGrp|41457|2022|PDM|3.16|99|0.00|ENTERAL FORMULA - PEDIATRICS (HYDROLYZED)|
20|FH_F118050_77565_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F122687_0_0|SrvcGrp|54962|2022|PDM|3825.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)|
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37756_0_0|SrvcGrp|63|2022|PDM|992.00|99|0.00|SUBACUTE CARE|
20|FH_F88199_0_0|SrvcGrp|48398|2022|PDM|82.50|99|0.00|PT SERVICES|
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|730.40|99|0.00|ASPG IV|
20|FH_F31714_0_0|SrvcGrp|10905|2022|PDM|398.00|99|0.00|EMERGENCY ROOM LEVEL III|
20|FH_F146117_0_0|SrvcGrp|88157|2022|PDM|3118.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F126341_27284_0|SrvcGrp|21920|2022|PDM|30.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F149304_64137_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146016_34108_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F80513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS|
20|FH_F133253_62226_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111602_17102_0|SrvcGrp|86723|2022|PDM|330.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F136299_75218_0|SrvcGrp|75506|2022|PCT|2.58|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F136371_29720_0|SrvcGrp|73842|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149501_34471_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F35212_0_0|SrvcGrp|12403|2022|PDM|26.25|99|0.00|CONTINUOUS HOMECARE|
20|FH_F127132_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F40885_0_0|SrvcGrp|26425|2022|PDM|550.00|99|0.00|CPT 95805  MOD TC|
20|FH_F117762_0_0|SrvcGrp|99163|2022|PDM|1430.00|99|0.00|CPT 27703|
20|FH_F97183_25304_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F110732_31513_0|SrvcGrp|30623|2022|PDM|4327.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F131571_63301_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F140233_35216_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F95800_0_0|SrvcGrp|35669|2022|PDM|1852.00|99|0.00|CPT 63650|
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)|
20|FH_F116571_70433_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F118792_63379_0|SrvcGrp|73559|2022|PDM|2178.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F103241_06002_0|SrvcGrp|472|2022|PDM|733.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F40649_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F59732_0_0|SrvcGrp|27968|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135268_11231_0|SrvcGrp|106048|2022|PDM|550.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|834.00|99|0.00|AEG 5  (NO REV)|
20|FH_F82114_0_0|SrvcGrp|74663|2022|PDM|633.74|99|0.00|AETNA SLEEP STUDIES|
20|FH_F40332_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127550_43026_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F117082_66216_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129011_15857_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MCARE2 OCN F/S PRICING W/O HOME HEALTH|
20|FH_F135056_06401_0|SrvcGrp|73842|2022|PDM|165.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 4 (NO REV)|
20|FH_F86872_15215_0|SrvcGrp|86829|2022|PDM|50.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F129975_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F47433_0_0|SrvcGrp|9521|2022|PDM|3300.00|99|0.00|LITHOTRIPSY|
20|FH_F43539_0_0|SrvcGrp|30553|2022|PDM|80.00|99|0.00|EARLY INTERVENTION SPEECH THERAPY|
20|FH_F42494_0_0|SrvcGrp|36037|2022|PCT|1.00|99|0.00|TISSUE PLASMINOGEN ACTIVATOR|
20|FH_F148494_0_0|SrvcGrp|40002|2022|PDM|15500.00|99|0.00|TOTAL HIP|
20|FH_F130195_44143_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118542_60188_0|SrvcGrp|43568|2022|PDM|130.00|99|0.00|SKILLED NURSING - RN|
20|FH_F143053_89501_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F149605_0_0|SrvcGrp|73656|2022|PDM|661.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F117446_31322_0|SrvcGrp|101562|2022|PCT|1.00|99|0.00|HOSPICE/PHYSICIAN|
20|FH_F148760_12953_0|SrvcGrp|27969|2022|PDM|42.00|99|0.00|HOME HEALTH AIDE|
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|1537.00|99|0.00|ASPG VI|
20|FH_F139707_84010_0|SrvcGrp|115557|2022|PDM|8712.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F139927_0_0|SrvcGrp|78455|2022|PCT|0.60|99|0.00|HIGH COST DRUGS|
20|FH_F120040_72703_0|SrvcGrp|90388|2022|PDM|914.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F141156_04401_0|CSTM-ALL|CSTM-00|2020|PDM|1285.00|99|0.00|AEG 8 (NO REV)|
20|FH_F138410_19130_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F64839_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F122377_91007_0|SrvcGrp|109220|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F150953_74953_0|SrvcGrp|79099|2022|PDM|1870.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F35930_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151008_92625_0|SrvcGrp|46903|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F101360_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)|
20|FH_F131173_17043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F151741_15090_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47600_0_0|SrvcGrp|31186|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC (DME)|
20|FH_F126585_45039_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F84911_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|HOME HEALTH CARE|
20|FH_F129656_15005_0|SrvcGrp|13929|2022|PDM|25.00|99|0.00|GROWTH HORMONE|
20|FH_F124738_0_0|SrvcGrp|72996|2022|PDM|620.00|99|0.00|AEG 4|
20|FH_F86332_75081_0|SrvcGrp|16544|2022|PDM|65.00|99|0.00|TOCOLYTIC THERAPY|
20|FH_F118057_47906_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 020-022|
20|FH_F64440_0_0|SrvcGrp|108691|2022|PDM|972.00|99|0.00|MRI/MRA W/ CONTRAST|
20|FH_F31968_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F132768_0_0|SrvcGrp|75545|2022|PDM|1150.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F125011_74467_0|SrvcGrp|73008|2022|PDM|1365.00|99|0.00|AEG 10|
20|FH_F88635_32955_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F62977_0_0|CSTM-ALL|CSTM-00|2020|PDM|333.00|99|0.00|ASPG I|
20|FH_F113143_0_0|SrvcGrp|73002|2022|PDM|1045.00|99|0.00|AEG 7|
20|FH_F115971_0_0|SrvcGrp|72996|2022|PDM|701.00|99|0.00|AEG 4|
20|FH_F114666_30342_0|SrvcGrp|84313|2022|PDM|1250.00|99|0.00|TENDON REPAIR|
20|FH_F109279_0_0|SrvcGrp|79589|2022|PDM|600.00|99|0.00|UPPER GI|
20|FH_F137951_0_0|SrvcGrp|89980|2022|PDM|4508.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F133472_27607_0|SrvcGrp|74668|2022|PDM|340.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F31204_0_0|SrvcGrp|3328|2022|PDM|210.00|99|0.00|OP PSYCH HOSPITALIZATION - ADOLESCENT|
20|FH_F44079_0_0|SrvcGrp|10542|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F133478_40165_0|SrvcGrp|73496|2022|PDM|891.00|99|0.00|AETNA ER LEVEL V|
20|FH_F101811_64116_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F150024_08079_0|CSTM-ALL|CSTM-00|2020|PDM|3010.00|99|0.00|AEG 9 (NO REV)|
20|FH_F33319_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 4 (NO REV)|
20|FH_F118542_60188_0|SrvcGrp|14948|2022|PDM|74.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|327.00|99|0.00|HAPA EPA ASC 38|
20|FH_F67861_0_0|SrvcGrp|73980|2022|PDM|13200.00|99|0.00|OP SLEEVE GASTRECTOMY|
20|FH_F151141_24014_0|CSTM-ALL|CSTM-00|2020|PDM|1213.00|99|0.00|AEG 2 (NO REV)|
20|FH_F147226_48154_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122394_75979_0|SrvcGrp|46903|2022|PDM|530.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F138995_0_0|SrvcGrp|87677|2022|PDM|800.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F56472_0_0|SrvcGrp|29406|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F146859_0_0|SrvcGrp|114847|2022|PDM|2539.00|99|0.00|ELBOW REPAIR|
20|FH_F35990_0_0|SrvcGrp|115|2022|PDM|908.00|99|0.00|SKILLED NURSING CARE|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|100.59|99|0.00|SALLY BALIN,999182,ASC 226|
20|FH_F150925_33936_0|SrvcGrp|36093|2022|PCT|0.00|99|0.00|ACUTE REHABILITATION|
20|FH_F37078_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F140296_32068_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F62713_0_0|SrvcGrp|12403|2022|PDM|788.55|99|0.00|CONTINUOUS HOMECARE|
20|FH_F98480_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126054_30022_0|SrvcGrp|103385|2022|PDM|30.00|99|0.00|MED NUTRITION, INDIV, INIT (HCFA)|
20|FH_F32732_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F75382_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F45792_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F115685_64064_0|SrvcGrp|104093|2022|PDM|100.00|99|0.00|SKILLED NURSING - RN (HCFA)|
20|FH_F92276_32308_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F128853_43560_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41458_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F100662_27534_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F49338_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F49338_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F81698_10457_0|SrvcGrp|86854|2022|PDM|31.50|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F131100_0_0|SrvcGrp|111739|2022|PDM|1500.00|99|0.00|DRAINAGE OF PELVIS LESION|
20|FH_F51135_0_0|SrvcGrp|12403|2022|PDM|36.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F120417_63124_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F108160_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145708_89030_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F150222_98026_0|SrvcGrp|46903|2022|PDM|1000.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F138951_41101_0|SrvcGrp|21920|2022|PDM|40.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F121225_98902_0|SrvcGrp|73501|2022|PCT|0.85|99|0.00|AETNA OBSERVATION|
20|FH_F120670_0_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 6 (NO REV)|
20|FH_F123646_91350_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F122552_03103_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F71027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F146672_47424_0|SrvcGrp|75419|2022|PDM|355.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F136386_30901_0|SrvcGrp|26649|2022|PDM|9890.00|99|0.00|MS DRG 309 ONLY|
20|FH_F134032_19611_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149647_92651_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117189_60085_0|SrvcGrp|75419|2022|PDM|404.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F137817_17050_0|SrvcGrp|86722|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F97720_70084_0|SrvcGrp|73601|2022|PDM|6927.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F130400_26505_0|SrvcGrp|109219|2022|PCT|0.74|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F133178_0_0|SrvcGrp|112204|2022|PDM|728.00|99|0.00|DESTRUCTION PENIS LESION|
20|FH_F114389_50131_0|SrvcGrp|99003|2022|PDM|102.25|99|0.00|INFUSION THERAPY (HCFA)|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PDM|88.00|99|0.00|PSYCHOLOGICAL TESTING|
20|FH_F132721_0_0|SrvcGrp|112077|2022|PDM|48747.00|99|0.00|CV SURGERY|
20|FH_F149543_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F116393_07002_0|SrvcGrp|15480|2022|PDM|230.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F147586_44124_0|SrvcGrp|88144|2022|PDM|2836.00|99|0.00|LAPAROSCOPY BIOPSY|
20|FH_F128341_41139_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125479_17501_0|SrvcGrp|90572|2022|PDM|212.00|99|0.00|INTENSIVE OP PSYCH (HCFA)|
20|FH_F135236_02840_0|SrvcGrp|115534|2022|PCT|1.21|99|0.00|LABORATORY SERVICES|
20|FH_F33642_0_0|SrvcGrp|12146|2022|PDM|1800.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F135051_37130_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F91876_0_0|SrvcGrp|70749|2022|PDM|2010.00|99|0.00|CPT 29823|
20|FH_F58313_0_0|CSTM-ALL|CSTM-00|2020|PCT|76.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125028_19061_0|SrvcGrp|86840|2022|PDM|63.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F116115_14437_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F102184_0_0|SrvcGrp|89404|2022|PDM|7215.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F129653_0_0|SrvcGrp|103593|2022|PDM|4000.00|99|0.00|XTRNL CAROTID|
20|FH_F110967_0_0|CSTM-ALL|CSTM-00|2020|PDM|1965.09|99|0.00|ASPG VI|
20|FH_F138147_18018_0|SrvcGrp|111304|2022|PDM|9.62|99|0.00|PSYCH DIAG EVAL W/ MED (HCFA)|
20|FH_F49197_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F82571_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|COVENTRY ENHANCED GROUPER 10|
20|FH_F86132_27105_0|SrvcGrp|75545|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F130017_02302_0|SrvcGrp|113560|2022|PDM|2464.89|99|0.00|OBSERVATION W/ ER|
20|FH_F145702_22192_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F50053_0_0|SrvcGrp|12674|2022|PCT|1.20|99|0.00|IMPLANTS|
20|FH_F96721_99504_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F133207_0_0|SrvcGrp|87054|2022|PDM|3809.00|99|0.00|CYSTOSCOPY CHEMODENERVATION|
20|FH_F101100_50314_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA - APC GROUPER K|
20|FH_F115972_92675_0|SrvcGrp|73842|2022|PDM|330.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F123604_72104_0|SrvcGrp|73339|2022|PCT|0.90|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140647_66210_0|SrvcGrp|86723|2022|PDM|1012.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F145762_0_0|CSTM-ALL|CSTM-00|2020|PDM|577.00|99|0.00|AEG 2 (NO REV)|
20|FH_F134270_0_0|SrvcGrp|74585|2022|PCT|0.00|99|0.00|AETNA OP IMPLANTS|
20|FH_F93252_0_0|SrvcGrp|33984|2022|PDM|2000.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F83115_0_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F87822_0_0|SrvcGrp|37047|2022|PDM|481.95|99|0.00|HEMO/HOME DIALYSIS SVCS|
20|FH_F134817_30339_0|SrvcGrp|46605|2022|PDM|110.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F147479_75077_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141967_89509_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F58053_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F121016_32607_0|SrvcGrp|83802|2022|PDM|73.00|99|0.00|LACTATION CLASS|
20|FH_F42260_0_0|CSTM-ALL|CSTM-00|2020|PDM|1362.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F108940_15642_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F92792_0_0|CSTM-ALL|CSTM-00|2020|PDM|853.60|99|0.00|AEG 3 (NO REV)|
20|FH_F133493_90255_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|1804.00|99|0.00|AEG 4 (NO REV)|
20|FH_F60112_0_0|SrvcGrp|474|2022|PDM|260.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F121476_0_0|SrvcGrp|108831|2022|PDM|52.00|99|0.00|FLEXHD/ALLOPATCHHD/MATRIXHD|
20|FH_F125124_0_0|SrvcGrp|79590|2022|PDM|1884.00|99|0.00|CPT 43248|
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|970.00|99|0.00|AEG 1 (NO REV)|
20|FH_F118135_38109_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114844_17061_0|SrvcGrp|471|2022|PDM|437.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F111912_30720_0|SrvcGrp|16429|2022|PCT|0.67|99|0.00|OBSERVATION SVCS|
20|FH_F134191_75025_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|2292.00|99|0.00|AEG 6 (NO REV)|
20|FH_F40026_0_0|SrvcGrp|3066|2022|PCT|0.73|99|0.00|HIGH-COST DRUGS|
20|FH_F36263_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F150982_0_0|SrvcGrp|67072|2022|PDM|3854.00|99|0.00|CPT 22845|
20|FH_F119999_0_0|CSTM-ALL|CSTM-00|2020|PDM|5885.00|99|0.00|AEG 8 (NO REV)|
20|FH_F115616_0_0|SrvcGrp|103671|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F124743_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137350_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F132606_0_0|SrvcGrp|111995|2022|PDM|499.39|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F121476_0_0|SrvcGrp|108823|2022|PDM|2302.00|99|0.00|CATHETER BALLOON DILATATION|
20|FH_F121225_98902_0|SrvcGrp|83379|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F120484_31419_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117206_0_0|SrvcGrp|16289|2022|PDM|650.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F124173_66215_0|SrvcGrp|26868|2022|PDM|25.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F93375_0_0|SrvcGrp|73000|2022|PDM|945.00|99|0.00|AEG 6|
20|FH_F133478_40165_0|SrvcGrp|73498|2022|PDM|791.00|99|0.00|AETNA ER LEVEL III|
20|FH_F145870_0_0|CSTM-ALL|CSTM-00|2020|PDM|1705.00|99|0.00|AEG 8 (NO REV)|
20|FH_F144532_19606_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F113586_0_0|SrvcGrp|75479|2022|PDM|816.00|99|0.00|AEG 1|
20|FH_F68947_0_0|CSTM-ALL|CSTM-00|2020|PDM|1850.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F128418_88260_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124608_0_0|SrvcGrp|89404|2022|PDM|9149.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|ASPG X|
20|FH_F133168_62035_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F150463_50701_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F124727_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F37490_0_0|CSTM-ALL|CSTM-00|2020|PDM|1198.67|99|0.00|ASPG VI|
20|FH_F90183_80031_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146266_0_0|SrvcGrp|74039|2022|PDM|7892.00|99|0.00|LAMINECTOMY|
20|FH_F141247_18902_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F132153_06450_0|SrvcGrp|75545|2022|PDM|437.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F124322_64131_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F97084_91911_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F34675_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F147227_48302_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|638.00|99|0.00|ASPG XI- GNADEN HUETTEN (UNGROUPED)|
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_F117581_21211_0|SrvcGrp|473|2022|PDM|380.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F116793_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|414.00|99|0.00|AEG 1 (NO REV)|
20|FH_F33719_0_0|SrvcGrp|11083|2022|PDM|1117.00|99|0.00|NORMAL DELIVERY (MOTHER ONLY)|
20|FH_F143347_16001_0|CSTM-ALL|CSTM-00|2020|PDM|2147.00|99|0.00|AEG 2 (NO REV)|
20|FH_F54974_0_0|SrvcGrp|8950|2022|PDM|1005.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F131254_92211_0|SrvcGrp|86843|2022|PDM|50.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F51074_0_0|CSTM-ALL|CSTM-00|2020|PDM|3704.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F119578_0_0|SrvcGrp|108180|2022|PDM|435.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F115736_77459_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F88864_29601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F125473_0_0|CSTM-ALL|CSTM-00|2020|PDM|4256.00|99|0.00|AEG 6 (NO REV)|
20|FH_F41021_0_0|SrvcGrp|17075|2022|PDM|4474.00|99|0.00|ASPG VI|
20|FH_F129536_0_0|SrvcGrp|111357|2022|PDM|1200.00|99|0.00|REVISE/GRAFT EYELID LINING|
20|FH_F77762_0_0|SrvcGrp|43956|2022|PDM|120.00|99|0.00|NURSING CARE|
20|FH_F110345_37919_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F150161_63361_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F149079_70809_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79824_0_0|SrvcGrp|85177|2022|PDM|4028.00|99|0.00|DIAGNOSTIC CARDIAC CATH|
20|FH_F80613_0_0|SrvcGrp|48428|2022|PDM|75.00|99|0.00|RESPIRATORY THERAPY INITIAL|
20|FH_F96160_32207_0|SrvcGrp|86854|2022|PDM|75.91|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F137610_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F121476_0_0|SrvcGrp|104448|2022|PDM|5628.00|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE|
20|FH_F143335_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC|
20|FH_F84712_0_0|SrvcGrp|84439|2022|PDM|3154.00|99|0.00|AETNA MATERNITY CARE (NORMAL DELIVERY)|
20|FH_F131964_89120_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F133269_78624_0|SrvcGrp|89417|2022|PDM|410.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F133478_40165_0|SrvcGrp|28162|2022|PDM|60730.00|99|0.00|MS DRG 217 ONLY|
20|FH_F35381_0_0|SrvcGrp|941|2022|PDM|2100.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F136424_34470_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F142547_70002_0|SrvcGrp|10577|2022|PDM|25.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F138584_30912_0|SrvcGrp|103922|2022|PCT|1.00|99|0.00|CYTOPATH CELLR ENHANCE NO CE|
20|FH_F150800_44256_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122386_70578_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115982_0_0|SrvcGrp|72994|2022|PDM|720.00|99|0.00|AEG 3|
20|FH_F136887_0_0|CSTM-ALL|CSTM-00|2020|PDM|1755.00|99|0.00|AEG 2 (NO REV)|
20|FH_F35753_33770_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F34882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F35678_0_0|SrvcGrp|18193|2022|PDM|16952.00|99|0.00|MS DRG 024|
20|FH_F35174_0_0|SrvcGrp|13217|2022|PCT|0.75|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F95800_0_0|CSTM-ALL|CSTM-00|2020|PDM|565.00|99|0.00|AEG 3 (NO REV)|
20|FH_F38966_0_0|SrvcGrp|29971|2022|PDM|529.00|99|0.00|DIALYSIS|
20|FH_F116040_24637_0|SrvcGrp|14945|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F134612_0_0|SrvcGrp|111995|2022|PDM|10000.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F117465_0_0|SrvcGrp|75487|2022|PDM|1600.00|99|0.00|AEG 5|
20|FH_F134029_06517_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F137147_75006_0|SrvcGrp|88147|2022|PDM|7980.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA|
20|FH_F140450_18104_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F109982_33592_0|SrvcGrp|89337|2022|PDM|584.00|99|0.00|DETOXIFICATION|
20|FH_F92852_0_0|SrvcGrp|92659|2022|PDM|880.00|99|0.00|REPAIR OF RETINAL DETACHMENT|
20|FH_F90833_62821_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F91832_06106_0|SrvcGrp|46605|2022|PDM|89.25|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F72690_0_0|SrvcGrp|58649|2022|PDM|200.00|99|0.00|INTENSIVE OUTPATIENT|
20|FH_F100640_48097_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F38436_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87856_0_0|SrvcGrp|75481|2022|PDM|579.00|99|0.00|AEG 2|
20|FH_F114684_80547_0|SrvcGrp|90662|2022|PDM|149.00|99|0.00|EVALUATION AND MANAGEMENT CPT 99214|
20|FH_F122608_84123_0|SrvcGrp|112728|2022|PDM|632.50|99|0.00|HOSPICE INPATIENT|
20|FH_F43321_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F117069_15236_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F113709_0_0|SrvcGrp|112891|2022|PDM|70.20|99|0.00|RSV DNA/MA AMP PROBE|
20|FH_F119413_95123_0|SrvcGrp|75419|2022|PDM|700.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F137951_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|AEG 5  (NO REV)|
20|FH_F119220_75068_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F128130_10027_0|CSTM-ALL|CSTM-00|2020|PDM|8269.00|99|0.00|AEG 9 (NO REV)|
20|FH_F51438_0_0|SrvcGrp|13526|2022|PCT|1.80|99|0.00|CPT CODES 80000-89999 - (LAB)|
20|FH_F88956_0_0|SrvcGrp|73605|2022|PDM|1141.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F50420_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F76662_0_0|SrvcGrp|14494|2022|PDM|38.51|99|0.00|CONTINUOUS HOMECARE|
20|FH_F77787_0_0|SrvcGrp|61579|2022|PCT|0.90|99|0.00|ALTEPLASE W/636  & J2997|
20|FH_F97566_79902_0|SrvcGrp|73656|2022|PDM|329.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F133627_89113_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F151155_26508_0|SrvcGrp|113325|2022|PDM|2171.00|99|0.00|MED ASSIST TX INJECT (HFCA)|
20|FH_F115990_0_0|SrvcGrp|72998|2022|PDM|1235.00|99|0.00|AEG 5|
20|FH_F35140_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|5712182 CSRS PT OT ST RENTAL|
20|FH_F143564_0_0|SrvcGrp|92417|2022|PDM|3800.00|99|0.00|LAPAROSCOPY|
20|FH_F114090_19023_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112823_0_0|SrvcGrp|103974|2022|PCT|0.00|99|0.00|CARDIAC CATH INCIDENTAL CODES|
20|FH_F32653_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS|
20|FH_F124322_64131_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F39912_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SURGERY|
20|FH_F123726_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH|
20|FH_F114206_37203_0|SrvcGrp|86852|2022|PDM|35.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F39378_0_0|SrvcGrp|30200|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV (DME)|
20|FH_F150299_22046_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
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_F131430_17566_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F97582_46307_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F39343_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|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_F119435_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F131412_0_0|SrvcGrp|84185|2022|PDM|165.42|99|0.00|RESPITE CARE|
20|FH_F132968_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|3000.00|99|0.00|DEVICE INSERTION|
20|FH_F124564_78411_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122740_71038_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F42169_0_0|SrvcGrp|22461|2022|PCT|0.85|99|0.00|INPATIENT HOSPICE SVCS|
20|FH_F46752_0_0|SrvcGrp|29088|2022|PDM|75.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F126806_44125_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|160.49|99|0.00|HAPA WPA-NWPA 2012-13 ASC 237 W/O REV|
20|FH_F117335_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87559_0_0|CSTM-ALL|CSTM-00|2020|PDM|512.65|99|0.00|AETNA POLYSOMNOGRAPHY|
20|FH_F50974_0_0|SrvcGrp|15402|2022|PDM|47.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PDM|626.00|99|0.00|ADOLESCENT SA PARTIAL HOSPITALIZATION|
20|FH_F132543_79549_0|SrvcGrp|72984|2022|PCT|2.00|99|0.00|CHEMOTHERAPY|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.13|99|0.00|5780852_USTN_LAB_MODTC|
20|FH_F43539_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC|
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|448.00|99|0.00|AEG 2 (NO REV)|
20|FH_F111403_37167_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F47479_0_0|SrvcGrp|43958|2022|PDM|70.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F148599_98034_0|CSTM-ALL|CSTM-00|2020|PCT|3.02|99|0.00|HSS APC L PROCEDURE NOT ON FS OR W/O WEIGHT|
20|FH_F151083_66223_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121338_37756_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F139215_32218_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132254_40207_0|SrvcGrp|17016|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F116332_0_0|CSTM-ALL|CSTM-00|2020|PDM|1094.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132371_19083_0|SrvcGrp|48385|2022|PDM|102.00|99|0.00|SPEECH THERAPY|
20|FH_F36372_0_0|SrvcGrp|11785|2022|PDM|28.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F131236_84041_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
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_F69807_0_0|CSTM-ALL|CSTM-00|2020|PCT|56.56|99|0.00|GENERAL ACUTE CARE|
20|FH_F145815_30540_0|SrvcGrp|111926|2022|PDM|35.92|99|0.00|COVID-19 LAB TESTING|
20|FH_F148324_93101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F129653_0_0|SrvcGrp|90978|2022|PDM|2000.00|99|0.00|INJECTION CERVICAL OR THORACIC TRANSFORAMINAL EPIDURAL|
20|FH_F40957_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PDM|646.80|99|0.00|AEG 2 (NO REV)|
20|FH_F129683_45255_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F148122_49435_0|SrvcGrp|98701|2022|PDM|285.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F90362_0_0|SrvcGrp|41334|2022|PDM|11670.00|99|0.00|TOTAL KNEE|
20|FH_F130032_72034_0|SrvcGrp|105349|2022|PDM|237.00|99|0.00|AETNA PARTIAL SUBSTANCE ABUSE|
20|FH_F129334_43016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40338_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.61|99|0.00|ASPG IX|
20|FH_F37659_0_0|SrvcGrp|26991|2022|PDM|65881.00|99|0.00|LUNG - SINGLE TRANSPLANT|
20|FH_F143928_21061_0|SrvcGrp|46605|2022|PDM|126.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F149179_0_0|CSTM-ALL|CSTM-00|2020|PDM|2652.00|99|0.00|AEG 5  (NO REV)|
20|FH_F145641_06902_0|SrvcGrp|35671|2022|PDM|5672.00|99|0.00|TRANSPLANT FOREARM TENDON|
20|FH_F109400_80026_0|SrvcGrp|29346|2022|PDM|47.27|99|0.00|SKILLED NURSING- LPN|
20|FH_F138047_77027_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F119213_66209_0|SrvcGrp|90491|2022|PCT|1.00|99|0.00|EVALUATE SPEECH PRODUCTION|
20|FH_F115430_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)|
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PDM|830.00|99|0.00|ASPG III - FH SW CUSTOM GROUPERS|
20|FH_F75087_0_0|SrvcGrp|63469|2022|PDM|900.00|99|0.00|CPT 55700|
20|FH_F77665_0_0|SrvcGrp|74840|2022|PDM|6.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F115950_08648_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|849.00|99|0.00|AEG 2 (NO REV)|
20|FH_F33389_0_0|SrvcGrp|14886|2022|PCT|0.70|99|0.00|TRANSPORTATION|
20|FH_F136489_25428_0|SrvcGrp|89024|2022|PDM|80.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F138542_40324_0|SrvcGrp|89417|2022|PDM|370.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F140343_89052_0|SrvcGrp|26868|2022|PDM|30.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F70665_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|106% OF ASP DRUGS/IMMUN UPDATE QUARTERLY|
20|FH_F117221_23434_0|SrvcGrp|472|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)|
20|FH_F131759_06032_0|SrvcGrp|472|2022|PDM|495.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F124246_71655_0|SrvcGrp|108484|2022|PDM|320.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F67820_15009_0|SrvcGrp|33414|2022|PDM|175.00|99|0.00|SNF VENTILATOR SUPPORT|
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|1714.00|99|0.00|AEG 7 (NO REV)|
20|FH_F120856_78247_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F143895_47631_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PDM|829.00|99|0.00|AEG 6 (NO REV)|
20|FH_F143528_0_0|SrvcGrp|90795|2022|PDM|1914.15|99|0.00|EXCISION INFERIOR TURBINATE|
20|FH_F120899_72758_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F121566_91360_0|SrvcGrp|46903|2022|PDM|1433.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F87219_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.20|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)|
20|FH_F62579_0_0|SrvcGrp|50163|2022|PDM|67.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 8 HRS|
20|FH_F134590_53223_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122455_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141447_0_0|SrvcGrp|113114|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F149345_45044_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F48092_0_0|SrvcGrp|30096|2022|PDM|28.75|99|0.00|SPEECH THERAPY|
20|FH_F134828_30531_0|SrvcGrp|115332|2022|PDM|167.00|99|0.00|OFFICE NEW PATIENT (HCFA)|
20|FH_F140787_66427_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114389_50131_0|SrvcGrp|86831|2022|PDM|16.09|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F122689_92009_0|SrvcGrp|108420|2022|PDM|19.00|99|0.00|BLOOD GLUCOSE TEST|
20|FH_F43295_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|CV SERVICES (MS DRG)|
20|FH_F67820_15009_0|SrvcGrp|81879|2022|PCT|1.00|99|0.00|LABORATORY W/ REV/HCPC|
20|FH_F140035_0_0|SrvcGrp|42972|2022|PDM|98.00|99|0.00|HOME HEALTH AIDE|
20|FH_F42779_0_0|SrvcGrp|38|2022|PDM|4664.00|99|0.00|NORMAL DELIVERY|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD RR KE"|
20|FH_F115324_78852_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F142967_65065_0|SrvcGrp|89500|2022|PCT|1.00|99|0.00|SPEECH SOUND LANGUAGE|
20|FH_F46196_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F141870_85224_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121016_32607_0|SrvcGrp|54670|2022|PDM|3150.00|99|0.00|NORMAL DELIVERY|
20|FH_F132667_62025_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116311_02657_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F69965_0_0|SrvcGrp|59426|2022|PDM|110.00|99|0.00|PT|
20|FH_F48215_0_0|SrvcGrp|13703|2022|PDM|26.75|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F50475_0_0|SrvcGrp|82096|2022|PDM|1020.00|99|0.00|ASPG X - FH SW CUSTOM GROUPERS|
20|FH_F100680_43130_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F122930_0_0|SrvcGrp|109251|2022|PDM|3274.00|99|0.00|CILIARY BODY DESTRUCTION|
20|FH_F71669_0_0|SrvcGrp|38797|2022|PDM|342.00|99|0.00|PSYCHIATRIC PARTIAL HOSPITALIZATION - IP|
20|FH_F119310_20850_0|SrvcGrp|73485|2022|PDM|2147.00|99|0.00|AETNA REHAB|
20|FH_F78009_0_0|SrvcGrp|35964|2022|PDM|45.00|99|0.00|SPEECH THERAPY|
20|FH_F146859_0_0|SrvcGrp|114842|2022|PDM|557.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT C/T LEV 1|
20|FH_F140552_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|PRIMARY CHILDREN'S MED CTR 15%_FIRST CHOICE|
20|FH_F136250_73026_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F116756_77477_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F59732_0_0|SrvcGrp|21920|2022|PDM|70.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F145758_20745_0|CSTM-ALL|CSTM-00|2020|PDM|1010.82|99|0.00|AEG 6 (NO REV)|
20|FH_F71848_0_0|SrvcGrp|31734|2022|PDM|882.00|99|0.00|OP SURGERY SERVICES (RC 490)|
20|FH_F132374_0_0|SrvcGrp|112030|2022|PDM|1395.44|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F113410_0_0|SrvcGrp|96539|2022|PDM|2416.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F91632_46360_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F38360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F41201_0_0|SrvcGrp|361|2022|PCT|0.73|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F89563_29407_0|SrvcGrp|94742|2022|PCT|1.00|99|0.00|FLUVIRIN VACC IM (>=3 YRS)|
20|FH_F41992_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F109242_18466_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F115315_43011_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F140289_52246_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139147_0_0|SrvcGrp|65625|2022|PDM|5305.00|99|0.00|CPT 30520|
20|FH_F98940_70506_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F120057_0_0|SrvcGrp|73008|2022|PDM|612.00|99|0.00|AEG 10|
20|FH_F149240_0_0|SrvcGrp|113620|2022|PDM|87.23|99|0.00|HOSPICE CARE|
20|FH_F140036_07702_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F143536_47546_0|SrvcGrp|100243|2022|PCT|0.00|99|0.00|CULTURE SCREEN|
20|FH_F38980_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|LONG-TERM ACUTE CARE|
20|FH_F141387_63108_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115954_0_0|CSTM-ALL|CSTM-00|2020|PDM|618.00|99|0.00|AEG 7 (NO REV)|
20|FH_F151526_28208_0|SrvcGrp|107885|2022|PDM|3771.00|99|0.00|TRLUML BALO ANGIOP 1ST VEIN|
20|FH_F129968_98004_0|SrvcGrp|100499|2022|PDM|916.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD KN) - CPD 1963706|
20|FH_F118311_35211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F90874_0_0|SrvcGrp|111388|2022|PDM|843.00|99|0.00|ACUTE KIDNEY INJURY - IPD/CAPD/CCPD - NO ESRD|
20|FH_F129305_45614_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F32461_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132243_29571_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125028_19061_0|SrvcGrp|22389|2022|PDM|15.75|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F130112_0_0|CSTM-ALL|CSTM-00|2020|PDM|1273.00|99|0.00|AEG 10 (NO REV)|
20|FH_F66410_0_0|SrvcGrp|33165|2022|PDM|425.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F118270_30606_0|SrvcGrp|57968|2022|PDM|32.97|99|0.00|CONTINUOUS HOMECARE|
20|FH_F136037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F132883_31602_0|SrvcGrp|86848|2022|PDM|20.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F112023_12866_0|SrvcGrp|104376|2022|PDM|6049.00|99|0.00|AEG 7 W/O CARDIAC CATH (CPT 93452-93461, 93530-93533)|
20|FH_F49552_0_0|SrvcGrp|17079|2022|PDM|1167.37|99|0.00|ASPG VIII|
20|FH_F135622_34471_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F31714_0_0|SrvcGrp|11191|2022|PDM|15100.00|99|0.00|DRG 551 PERMANENT CARDIAC PACEMAKER|
20|FH_F143561_16001_0|SrvcGrp|48398|2022|PDM|89.00|99|0.00|PT SERVICES|
20|FH_F85353_16407_0|CSTM-ALL|CSTM-00|2020|PCT|1.55|99|0.00|HAPA WPA/NWPA 2018 RAD 100%|
20|FH_F121476_0_0|SrvcGrp|108830|2022|PDM|35248.00|99|0.00|IMPLT NROSTM PLS GEN DUA NON|
20|FH_F121303_15501_0|SrvcGrp|112785|2022|PCT|1.00|99|0.00|TELEHEALTH SERVICES|
20|FH_F134509_14075_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146479_20782_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133581_84790_0|CSTM-ALL|CSTM-00|2020|PDM|1365.93|99|0.00|AEG 6 (NO REV)|
20|FH_F118152_20151_0|SrvcGrp|86852|2022|PDM|35.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F138584_30912_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|AEG 10 (NO REV) W/O REPAIR CRANIOFACIAL FRACTURE|
20|FH_F117153_34113_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F117189_60085_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F113794_0_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F137067_0_0|SrvcGrp|93431|2022|PDM|25200.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F62624_0_0|SrvcGrp|3448|2022|PDM|550.00|99|0.00|MRI|
20|FH_F47736_0_0|SrvcGrp|12403|2022|PDM|30.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F92676_15063_0|SrvcGrp|79053|2022|PDM|573.06|99|0.00|MON VALLEY ASC 128|
20|FH_F90811_0_0|SrvcGrp|90418|2022|PDM|2800.00|99|0.00|ENLARGE BREAST WITH IMPLANT|
20|FH_F49046_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F144728_33541_0|SrvcGrp|35005|2022|PCT|1.00|99|0.00|HOSPICE PHYSICIAN SERVICES|
20|FH_F134434_30607_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F100666_81301_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F133627_89113_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F146211_68144_0|CSTM-ALL|CSTM-00|2020|PDM|3672.00|99|0.00|AEG 4 (NO REV) W/O NOSE REPAIR PROCEDURES|
20|FH_F113324_17055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148925_61531_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97563_83201_0|SrvcGrp|73643|2022|PDM|845.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F38049_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F89674_18640_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F128741_92879_0|SrvcGrp|65621|2022|PDM|90.65|99|0.00|RN NURSING|
20|FH_F116959_0_0|CSTM-ALL|CSTM-00|2020|PDM|1550.00|99|0.00|AEG 7 (NO REV)|
20|FH_F120555_68405_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121225_98902_0|SrvcGrp|26869|2022|PDM|105.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD RR KE"|
20|FH_F96160_32207_0|SrvcGrp|24750|2022|PDM|68.65|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F145641_06902_0|SrvcGrp|88820|2022|PDM|6671.00|99|0.00|CPT 24359|
20|FH_F85894_0_0|SrvcGrp|10363|2022|PDM|474.00|99|0.00|CPT CODE 99283|
20|FH_F80087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F146806_33157_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F39346_0_0|SrvcGrp|3637|2022|PCT|0.70|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F46433_0_0|SrvcGrp|24747|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F149541_85258_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F109920_39180_0|SrvcGrp|75483|2022|PDM|825.00|99|0.00|AEG 3|
20|FH_F147926_19063_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F34904_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F36524_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F124225_92506_0|SrvcGrp|87317|2022|PDM|970.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F100906_0_0|SrvcGrp|73006|2022|PDM|1254.00|99|0.00|AEG 9|
20|FH_F140373_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F87155_04105_0|SrvcGrp|24750|2022|PDM|57.78|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F143993_07621_0|SrvcGrp|114052|2022|PCT|1.00|99|0.00|COVID-19 ADMIN|
20|FH_F133550_90630_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F97182_21502_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F69071_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133490_90650_0|SrvcGrp|109219|2022|PDM|3212.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F135179_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F40340_0_0|SrvcGrp|16|2022|PDM|720.00|99|0.00|ACUTE REHABILITATION|
20|FH_F118819_76226_0|SrvcGrp|73841|2022|PDM|530.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F37625_0_0|SrvcGrp|26885|2022|PDM|150.00|99|0.00|DIALYSIS|
20|FH_F38601_0_0|SrvcGrp|13631|2022|PDM|100.00|99|0.00|CPT 99213|
20|FH_F85002_0_0|CSTM-ALL|CSTM-00|2020|PCT|36500.00|99|0.00|TIMELY FILING|
20|FH_F139527_15642_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F127418_0_0|SrvcGrp|99164|2022|PDM|16174.66|99|0.00|CPT 22846|
20|FH_F40853_0_0|SrvcGrp|115|2022|PDM|220.00|99|0.00|SKILLED NURSING CARE|
20|FH_F122282_30080_0|SrvcGrp|74668|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149400_83301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124322_64131_0|SrvcGrp|21920|2022|PDM|25.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F46433_0_0|SrvcGrp|17008|2022|PDM|90.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS|
20|FH_F35557_0_0|SrvcGrp|10567|2022|PDM|160.00|99|0.00|HOME INFUSION|
20|FH_F148181_0_0|SrvcGrp|63297|2022|PDM|155.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F140231_60540_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F89219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|MT NITTANY ASC 2|
20|FH_F123157_0_0|SrvcGrp|114519|2022|PDM|4000.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F117465_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F138958_78410_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117295_70006_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101945_0_0|SrvcGrp|55071|2022|PDM|2081.00|99|0.00|ARTHROSCOPY SHOULDER|
20|FH_F137818_31602_0|SrvcGrp|86722|2022|PDM|262.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F91067_0_0|SrvcGrp|73002|2022|PDM|1229.00|99|0.00|AEG 7|
20|FH_F119214_0_0|SrvcGrp|75493|2022|PDM|1646.00|99|0.00|AEG 8|
20|FH_F114389_50131_0|SrvcGrp|86849|2022|PDM|130.65|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F136708_06443_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F139113_21804_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F43332_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147560_30809_0|CSTM-ALL|CSTM-00|2020|PCT|1.80|99|0.00|HSS ASC|
20|FH_F74264_15301_0|SrvcGrp|10431|2022|PDM|55.00|99|0.00|SPEECH THERAPY|
20|FH_F122648_0_0|CSTM-ALL|CSTM-00|2020|PDM|631.00|99|0.00|AEG 4 (NO REV)|
20|FH_F91262_77036_0|SrvcGrp|90340|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F55375_0_0|SrvcGrp|17075|2022|PDM|4800.00|99|0.00|ASPG VI|
20|FH_F100740_15206_0|SrvcGrp|73643|2022|PDM|1811.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F144851_60123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114519_0_0|SrvcGrp|72998|2022|PDM|1372.00|99|0.00|AEG 5|
20|FH_F139607_0_0|CSTM-ALL|CSTM-00|2020|PDM|2297.00|99|0.00|AEG 7 W/O SURG CARVEOUT (NO REV)|
20|FH_F101923_98104_0|SrvcGrp|89269|2022|PDM|141.00|99|0.00|PSYTX PT/FAMILY 45 MINUTES|
20|FH_F129535_0_0|SrvcGrp|75493|2022|PDM|934.00|99|0.00|AEG 8|
20|FH_F111813_08080_0|SrvcGrp|93268|2022|PCT|1.00|99|0.00|LOVENOX/ENOXAPARIN|
20|FH_F148040_90631_0|SrvcGrp|90854|2022|PDM|1250.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
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_F41392_0_0|CSTM-ALL|CSTM-00|2020|PDM|654.00|99|0.00|ASPG II|
20|FH_F148644_06890_0|SrvcGrp|101820|2022|PDM|4500.00|99|0.00|HYSTEROSCOPY RESECT SEPTUM|
20|FH_F129130_92562_0|SrvcGrp|111451|2022|PDM|72553.00|99|0.00|CARDIOVASCULAR SURGERY (0-6 DAYS)|
20|FH_F129130_92562_0|SrvcGrp|88978|2022|PDM|9185.23|99|0.00|VAGINAL DELIVERY|
20|FH_F134732_0_0|CSTM-ALL|CSTM-00|2020|PDM|342.00|99|0.00|AEG 1 (NO REV)|
20|FH_F150947_37660_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F101083_0_0|SrvcGrp|56558|2022|PCT|1.02|99|0.00|AICD REV 278|
20|FH_F47659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F137767_01841_0|CSTM-ALL|CSTM-00|2020|PDM|3225.00|99|0.00|AEG 5  (NO REV)|
20|FH_F137798_0_0|SrvcGrp|104230|2022|PDM|140.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F144831_0_0|SrvcGrp|46605|2022|PDM|21.09|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F149002_80014_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116915_30308_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F119924_14070_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F120851_66112_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F100783_03431_0|SrvcGrp|88978|2022|PDM|7190.00|99|0.00|VAGINAL DELIVERY|
20|FH_F140007_0_0|SrvcGrp|96349|2022|PDM|7887.00|99|0.00|NECK SPINE FUSE|
20|FH_F143467_0_0|SrvcGrp|100044|2022|PDM|4435.00|99|0.00|INCISION OF HEEL BONE|
20|FH_F137574_68130_0|SrvcGrp|90339|2022|PCT|1.00|99|0.00|SKILLED NURSING RN|
20|FH_F51672_0_0|SrvcGrp|100947|2022|PDM|75.00|99|0.00|HOME HEALTH RN SERVICE|
20|FH_F32509_0_0|SrvcGrp|9808|2022|PDM|16970.00|99|0.00|PTCA WITH STENT|
20|FH_F126153_44663_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F111835_0_0|CSTM-ALL|CSTM-00|2020|PDM|1545.19|99|0.00|ASPG VIII|
20|FH_F128887_57225_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130840_21738_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F102009_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137460_42103_0|SrvcGrp|86723|2022|PDM|265.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F128950_53538_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100661_63640_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F38700_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|MS DRG 237|
20|FH_F145865_78130_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150000_30152_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F82136_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112905_62088_0|CSTM-ALL|CSTM-00|2020|PCT|0.81|99|0.00|OP SVCS|
20|FH_F127284_84403_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2501000 MOD KM (HCFA)|
20|FH_F119795_0_0|SrvcGrp|99073|2022|PDM|1.38|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F38742_0_0|SrvcGrp|28935|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MOD AV (A & K CODES)|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|152.00|99|0.00|HAPA EPA ASC 25|
20|FH_F149020_78653_0|SrvcGrp|46903|2022|PDM|675.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F140295_0_0|SrvcGrp|26278|2022|PDM|3289.00|99|0.00|CPT 29881|
20|FH_F147327_19010_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149582_01534_0|SrvcGrp|115383|2022|PCT|1.00|99|0.00|COVID-19 INFUSION ADMINISTRATION - REGENERON|
20|FH_F150914_17350_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F108680_0_0|SrvcGrp|88487|2022|PDM|7700.00|99|0.00|AETNA PERQ VERTEBRAL AUGMENTATION|
20|FH_F130371_0_0|SrvcGrp|92759|2022|PCT|0.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F124270_46256_0|SrvcGrp|26160|2022|PCT|1.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F90196_10467_0|SrvcGrp|86747|2022|PCT|1.05|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F146859_0_0|SrvcGrp|101845|2022|PDM|1443.00|99|0.00|OPEN TREATMENT OF DISTAL RADIAL 3 OR MORE FRAGMENTS|
20|FH_F147333_18704_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F50137_0_0|SrvcGrp|46250|2022|PDM|120.00|99|0.00|HOME VISIT CATHETER CARE|
20|FH_F33642_0_0|SrvcGrp|15370|2022|PCT|0.60|99|0.00|OTHER DIAGNOSTIC|
20|FH_F141471_0_0|SrvcGrp|12664|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F97104_53545_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F37194_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146803_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F149442_0_0|SrvcGrp|112223|2022|PDM|95.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F150982_0_0|SrvcGrp|89989|2022|PDM|5200.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F100762_51104_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F79212_0_0|SrvcGrp|76094|2022|PDM|146.41|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F93557_15147_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F127550_43026_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F62974_0_0|SrvcGrp|17139|2022|PDM|498.00|99|0.00|HOSPICE CARE|
20|FH_F150239_75569_0|SrvcGrp|24745|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|1811.00|99|0.00|AEG 7 (NO REV)|
20|FH_F150165_06032_0|SrvcGrp|42472|2022|PDM|2163.00|99|0.00|CPT 58670|
20|FH_F34852_0_0|SrvcGrp|3364|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F80513_0_0|SrvcGrp|30458|2022|PCT|0.74|99|0.00|DRUGS|
20|FH_F120795_27514_0|SrvcGrp|941|2022|PDM|5768.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F115950_08648_0|SrvcGrp|89417|2022|PDM|345.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F123741_20850_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F53732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F151604_44266_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F129892_0_0|SrvcGrp|93641|2022|PDM|1715.00|99|0.00|KNEE ARTHROSCOPIC SURGERY|
20|FH_F56274_0_0|SrvcGrp|23683|2022|PDM|185.00|99|0.00|SKILLED NURSING RN|
20|FH_F120901_0_0|SrvcGrp|89404|2022|PDM|8973.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F122588_53073_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F113713_17013_0|SrvcGrp|104420|2022|PDM|75.00|99|0.00|OFFICE/OUTPATIENT VISIT EST (HCFA)(MOD AF)|
20|FH_F71947_15227_0|SrvcGrp|10503|2022|PDM|47.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F128246_0_0|SrvcGrp|84160|2022|PDM|726.00|99|0.00|OCCULAR RECONST/AMNIOTIC MEMB|
20|FH_F130632_44145_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39558_0_0|SrvcGrp|17083|2022|PDM|389.00|99|0.00|ASPG X|
20|FH_F129364_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F72387_0_0|SrvcGrp|1306|2022|PDM|350.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F46255_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|UOI HEMO J CODES|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|274.04|99|0.00|DELAWARE VALLEY- ASC 212|
20|FH_F61493_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F110804_11373_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F36165_0_0|SrvcGrp|19966|2022|PDM|175.00|99|0.00|HORMONAL THERAPY (LEUPROLIDE/GOSERLINE)|
20|FH_F84833_17109_0|SrvcGrp|103739|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F97480_08204_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F47212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|HCPC CODES VNA MIDLANDS W/MOD SH|
20|FH_F97280_20018_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|179.00|99|0.00|HAPA EPA ASC 28|
20|FH_F141270_89103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132039_92008_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F35557_0_0|SrvcGrp|10565|2022|PDM|140.00|99|0.00|HOME INFUSION|
20|FH_F33649_0_0|SrvcGrp|110|2022|PDM|625.00|99|0.00|CD - REHABILITATION|
20|FH_F131241_54154_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124322_64131_0|SrvcGrp|10577|2022|PDM|25.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F47812_0_0|SrvcGrp|42870|2022|PDM|40.12|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F143976_80504_0|SrvcGrp|46903|2022|PDM|500.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F66687_0_0|SrvcGrp|21102|2022|PDM|111984.00|99|0.00|MS DRG 219 ONLY|
20|FH_F86752_0_0|SrvcGrp|75495|2022|PDM|821.00|99|0.00|AEG 9|
20|FH_F67261_0_0|SrvcGrp|47260|2022|PCT|0.50|99|0.00|IMPLANTS 274-276, 278  LINE LEVEL|
20|FH_F135259_21090_0|SrvcGrp|74668|2022|PDM|625.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F142073_0_0|SrvcGrp|109966|2022|PDM|5980.00|99|0.00|DECOMPRESS SPINE CORD ADD-ON|
20|FH_F148440_16506_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|AEG 9 (NO REV)|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 028-030 SPINE SURGERY|
20|FH_F93332_0_0|SrvcGrp|88159|2022|PDM|6386.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F150840_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F114963_62062_0|SrvcGrp|48394|2022|PDM|63.04|99|0.00|SKILLED NURSING SERVICES|
20|FH_F125138_63663_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F100320_0_0|SrvcGrp|75491|2022|PDM|1065.00|99|0.00|AEG 7|
20|FH_F60019_0_0|SrvcGrp|34086|2022|PCT|0.75|99|0.00|PT/OT/ST|
20|FH_F141877_0_0|CSTM-ALL|CSTM-00|2020|PDM|468.00|99|0.00|AEG 3 (NO REV)|
20|FH_F43417_0_0|SrvcGrp|40820|2022|PDM|1280.00|99|0.00|ICU/CCU|
20|FH_F46832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|2010 B CODES (MOD NU)|
20|FH_F133972_27103_0|SrvcGrp|86853|2022|PDM|35.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F111942_92647_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F110345_37919_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F80172_0_0|SrvcGrp|13606|2022|PDM|4.35|99|0.00|HOME INFUSION|
20|FH_F82357_0_0|SrvcGrp|10649|2022|PDM|8.00|99|0.00|HOME INFUSION|
20|FH_F39633_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F43867_0_0|SrvcGrp|37404|2022|PDM|90.00|99|0.00|PT SVCS|
20|FH_F138907_01040_0|SrvcGrp|48396|2022|PDM|103.00|99|0.00|OT SERVICES|
20|FH_F81823_0_0|SrvcGrp|59426|2022|PDM|75.00|99|0.00|PT|
20|FH_F151508_60435_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F144989_07701_0|SrvcGrp|73524|2022|PCT|1.00|99|0.00|PHYSICAL THERAPY|
20|FH_F145528_76501_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F123191_15012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F97501_31501_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43239_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135924_02906_0|SrvcGrp|73497|2022|PDM|1446.80|99|0.00|AETNA ER LEVEL IV|
20|FH_F136220_63638_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131506_18901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131132_44077_0|SrvcGrp|16|2022|PDM|1677.00|99|0.00|ACUTE REHABILITATION|
20|FH_F116397_33404_0|SrvcGrp|13929|2022|PDM|15.00|99|0.00|GROWTH HORMONE|
20|FH_F116463_76501_0|SrvcGrp|89337|2022|PDM|650.00|99|0.00|DETOXIFICATION|
20|FH_F42098_0_0|SrvcGrp|11072|2022|PDM|50.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F67425_0_0|SrvcGrp|12359|2022|PDM|2329.00|99|0.00|TELEMETRY SVCS|
20|FH_F132097_66845_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111341_80501_0|SrvcGrp|75545|2022|PDM|309.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F111880_50003_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F87153_0_0|SrvcGrp|83884|2022|PDM|78.70|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)|
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PDM|789.00|99|0.00|ASPG V|
20|FH_F54272_0_0|SrvcGrp|11000|2022|PCT|0.45|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F131000_0_0|SrvcGrp|67066|2022|PDM|15494.00|99|0.00|CERVICAL SURGERY|
20|FH_F132328_0_0|SrvcGrp|111954|2022|PDM|2425.00|99|0.00|MALE GENITAL PROCEDURES|
20|FH_F102322_32233_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F102862_30606_0|SrvcGrp|26668|2022|PDM|34914.00|99|0.00|MS DRG 461 ONLY|
20|FH_F102902_33764_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F102940_35034_0|SrvcGrp|27969|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132347_01605_0|SrvcGrp|89781|2022|PDM|110.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F32987_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130652_51101_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F68301_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133287_40215_0|SrvcGrp|112334|2022|PCT|0.53|99|0.00|OBSERVATION W/ SURGERY|
20|FH_F37886_0_0|SrvcGrp|25038|2022|PDM|1225.00|99|0.00|SLEEP STUDIES|
20|FH_F90817_0_0|SrvcGrp|91046|2022|PDM|1443.00|99|0.00|RPR I/HERN INIT REDUC>5 YR (HCFA)|
20|FH_F149023_44122_0|SrvcGrp|89404|2022|PDM|13541.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F112754_98057_0|SrvcGrp|27969|2022|PDM|72.06|99|0.00|HOME HEALTH AIDE|
20|FH_F149516_65233_0|SrvcGrp|75419|2022|PDM|392.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F142370_0_0|SrvcGrp|113921|2022|PDM|13.00|99|0.00|COVID-19 SPECIMEN HANDLING PT-LAB (HCFA)|
20|FH_F137363_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F151042_60659_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F35778_33321_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|OP SVCS|
20|FH_F114951_20002_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F90817_0_0|SrvcGrp|91024|2022|PDM|7520.00|99|0.00|REPAIR OF RUPTURED TENDON (HCFA)|
20|FH_F134847_0_0|SrvcGrp|67064|2022|PDM|5135.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F97080_85122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F111246_80027_0|SrvcGrp|93291|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA ESRD USE|
20|FH_F151019_14094_0|SrvcGrp|115830|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F131356_19131_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F36485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% 2007 MEDICARE TN DME MOD AU|
20|FH_F140349_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.00|99|0.00|AEG 9 (NO REV)|
20|FH_F35452_0_0|CSTM-ALL|CSTM-00|2020|PDM|975.00|99|0.00|ASPG III|
20|FH_F98001_27603_0|SrvcGrp|73659|2022|PDM|14890.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F147215_48105_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150925_33936_0|SrvcGrp|10391|2022|PDM|1800.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F98840_31021_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113869_40215_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F150521_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122330_75771_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117615_30525_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F141278_80218_0|SrvcGrp|86728|2022|PCT|1.00|99|0.00|RHOGAM INJECTION|
20|FH_F37304_0_0|CSTM-ALL|CSTM-00|2020|PDM|2997.00|99|0.00|MS DRG 767-768, 774-775 NORMAL DELIVERY|
20|FH_F123726_0_0|CSTM-ALL|CSTM-00|2020|PDM|788.00|99|0.00|AEG 5  (NO REV)|
20|FH_F138410_19130_0|SrvcGrp|112785|2022|PCT|1.00|99|0.00|TELEHEALTH SERVICES|
20|FH_F131387_76001_0|SrvcGrp|86722|2022|PDM|202.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F38999_0_0|CSTM-ALL|CSTM-00|2020|PDM|1573.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136887_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_F44132_0_0|SrvcGrp|33165|2022|PDM|400.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F40644_0_0|SrvcGrp|6|2022|PDM|1940.00|99|0.00|OP SURGERY|
20|FH_F74424_0_0|SrvcGrp|42871|2022|PDM|275.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F149023_44122_0|SrvcGrp|115572|2022|PDM|2042.00|99|0.00|VERTEBROPLASTY/ENDOSCOPY/ARTHROSCOPY|
20|FH_F131356_19131_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F150926_17404_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130023_0_0|SrvcGrp|111476|2022|PDM|279.00|99|0.00|WOUND CARE|
20|FH_F90817_0_0|SrvcGrp|76604|2022|PDM|1692.00|99|0.00|CPT 25447|
20|FH_F150938_02062_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F139822_30338_0|SrvcGrp|74668|2022|PDM|300.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F139951_92870_0|SrvcGrp|74668|2022|PDM|500.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F143249_89801_0|SrvcGrp|29076|2022|PDM|30.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F143347_16001_0|SrvcGrp|80298|2022|PDM|9522.00|99|0.00|AETNA PTCA|
20|FH_F131067_57105_0|SrvcGrp|73496|2022|PDM|2243.00|99|0.00|AETNA ER LEVEL V|
20|FH_F151755_03303_0|SrvcGrp|471|2022|PDM|652.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F151762_17042_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47600_0_0|SrvcGrp|30198|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 53 (DME)|
20|FH_F47952_0_0|SrvcGrp|43955|2022|PDM|90.00|99|0.00|NURSING CARE|
20|FH_F120839_19380_0|SrvcGrp|73842|2022|PDM|170.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F116915_30308_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F119913_31545_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F148548_37909_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F118667_95131_0|SrvcGrp|48396|2022|PDM|120.00|99|0.00|OT SERVICES|
20|FH_F120390_91316_0|SrvcGrp|73605|2022|PDM|900.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F120437_85202_0|SrvcGrp|86832|2022|PDM|11.26|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|1465.39|99|0.00|HAPA WPA-NWPA 2012-13 ASC 905 W/O REV|
20|FH_F123545_44512_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F118363_30305_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F60101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: ALL|
20|FH_F117275_16936_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F33241_0_0|SrvcGrp|14610|2022|PDM|90.00|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F146211_68144_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F151054_06473_0|SrvcGrp|111926|2022|PCT|1.00|99|0.00|COVID-19 LAB TESTING|
20|FH_F151082_18020_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F63232_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114510_33445_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F109242_18466_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F58396_0_0|SrvcGrp|42831|2022|PDM|47.00|99|0.00|DIETICIAN VISIT|
20|FH_F138302_15701_0|SrvcGrp|22593|2022|PDM|25.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F72584_0_0|SrvcGrp|42826|2022|PDM|130.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F40903_0_0|SrvcGrp|13597|2022|PDM|174.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F71342_0_0|CSTM-ALL|CSTM-00|2020|PDM|2503.00|99|0.00|AEG 7 (NO REV)|
20|FH_F136226_28638_0|SrvcGrp|26001|2022|PDM|195.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F119885_13753_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131265_84106_0|SrvcGrp|89412|2022|PDM|509.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F131132_44077_0|CSTM-ALL|CSTM-00|2020|PDM|2393.00|99|0.00|AEG 2 (NO REV)|
20|FH_F116397_33404_0|SrvcGrp|86852|2022|PDM|65.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F111292_33136_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F111363_33169_0|SrvcGrp|16|2022|PDM|1273.00|99|0.00|ACUTE REHABILITATION|
20|FH_F141651_0_0|SrvcGrp|59840|2022|PDM|1650.00|99|0.00|TYMPANOSTOMY|
20|FH_F69202_0_0|SrvcGrp|40403|2022|PDM|750.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F145587_0_0|SrvcGrp|88154|2022|PDM|1779.93|99|0.00|LASER TREATMENT OLD RETINA|
20|FH_F148243_0_0|SrvcGrp|98469|2022|PDM|1450.00|99|0.00|AMPUTATION METATARSAL|
20|FH_F33081_0_0|SrvcGrp|11259|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F150619_0_0|SrvcGrp|23585|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F78889_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51272_0_0|SrvcGrp|15774|2022|PCT|0.75|99|0.00|TREATMENT ROOM|
20|FH_F131000_0_0|SrvcGrp|88740|2022|PDM|4457.00|99|0.00|SP BONE ALGRFT|
20|FH_F72666_0_0|SrvcGrp|24703|2022|PDM|417.00|99|0.00|NEWBORN NURSERY|
20|FH_F128695_50049_0|SrvcGrp|48396|2022|PDM|140.00|99|0.00|OT SERVICES|
20|FH_F102322_32233_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F98300_30236_0|SrvcGrp|89647|2022|PCT|2.00|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F148119_30165_0|CSTM-ALL|CSTM-00|2020|PCT|0.59|99|0.00|OP SVCS|
20|FH_F119413_95123_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F106243_92780_0|SrvcGrp|79720|2022|PDM|1268.00|99|0.00|ACUTE REHAB II|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|168.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 132 W/O REV|
20|FH_F111809_93003_0|SrvcGrp|10365|2022|PDM|7667.00|99|0.00|CPT CODE 99285|
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PDM|598.00|99|0.00|ADULT PARTIAL HOSPITALIZATION|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PDM|1194.00|99|0.00|ASPG VII|
20|FH_F80834_0_0|SrvcGrp|24598|2022|PDM|2516.00|99|0.00|MS DRG 945-946 ONLY|
20|FH_F50461_0_0|SrvcGrp|38797|2022|PDM|342.00|99|0.00|PSYCHIATRIC PARTIAL HOSPITALIZATION - IP|
20|FH_F114206_37203_0|SrvcGrp|16750|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129340_43212_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F149273_0_0|SrvcGrp|10986|2022|PDM|5098.00|99|0.00|ARTHROSCOPIC KNEE REPAIR|
20|FH_F147210_70633_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122392_78207_0|SrvcGrp|87317|2022|PDM|828.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F149023_44122_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 1 (NO REV)|
20|FH_F41363_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|OCN F/S PRICING: ALL|
20|FH_F139167_42240_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F92431_80033_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131495_77407_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F136806_0_0|CSTM-ALL|CSTM-00|2020|PDM|1248.00|99|0.00|AEG 5  (NO REV)|
20|FH_F117762_0_0|SrvcGrp|99067|2022|PDM|2201.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F39162_0_0|SrvcGrp|24651|2022|PDM|135.00|99|0.00|HEMODIALYSIS - HOME TRAINING|
20|FH_F36594_0_0|SrvcGrp|9830|2022|PDM|102.00|99|0.00|OT SVCS|
20|FH_F134847_0_0|SrvcGrp|28547|2022|PDM|3629.00|99|0.00|VITRECTOMY|
20|FH_F40607_0_0|SrvcGrp|16746|2022|PDM|45.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F137769_85234_0|SrvcGrp|113126|2022|PDM|79.57|99|0.00|BILIRUBIN LIGHT WITH PHOTOMETER (MOD RR) (HCFA)|
20|FH_F31990_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F71064_0_0|SrvcGrp|14320|2022|PCT|0.40|99|0.00|OP IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F150982_0_0|SrvcGrp|105639|2022|PDM|1976.00|99|0.00|INCISION OF ACHILLES TENDON|
20|FH_F147237_40006_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130371_0_0|SrvcGrp|75505|2022|PCT|0.92|99|0.00|CARDIAC STUDIES|
20|FH_F146204_0_0|SrvcGrp|114509|2022|PDM|1500.00|99|0.00|D&C AFTER DELIVERY|
20|FH_F90151_24382_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F117711_73080_0|SrvcGrp|73000|2022|PDM|1260.00|99|0.00|AEG 6|
20|FH_F34983_0_0|SrvcGrp|439|2022|PDM|2040.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F112863_0_0|CSTM-ALL|CSTM-00|2020|PDM|1074.00|99|0.00|AEG 6 (NO REV)|
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|911.00|99|0.00|AEG 6 (NO REV)|
20|FH_F38246_66606_0|SrvcGrp|3259|2022|PDM|946.00|99|0.00|ACUTE REHABILITATION|
20|FH_F34882_0_0|SrvcGrp|18120|2022|PCT|0.65|99|0.00|MS DRG 003|
20|FH_F35678_0_0|SrvcGrp|16|2022|PDM|1024.00|99|0.00|ACUTE REHABILITATION|
20|FH_F67281_0_0|SrvcGrp|46482|2022|PDM|159.00|99|0.00|S9083 PER VISIT|
20|FH_F150932_15143_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F133677_15601_0|SrvcGrp|47411|2022|PDM|118.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F149522_83221_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138410_19130_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143536_47546_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F75903_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F101700_0_0|SrvcGrp|90976|2022|PDM|509.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT|
20|FH_F101709_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F151753_03104_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F47969_0_0|SrvcGrp|12403|2022|PDM|25.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|1553.00|99|0.00|ASPG VII|
20|FH_F120233_24368_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F136273_37601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132371_19083_0|SrvcGrp|88620|2022|PDM|102.00|99|0.00|SKILLED NURSING RN|
20|FH_F120747_19129_0|SrvcGrp|76501|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F116698_07470_0|SrvcGrp|86828|2022|PDM|10.50|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F116908_33461_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120974_27607_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135438_29030_0|SrvcGrp|108484|2022|PDM|764.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F135493_07514_0|SrvcGrp|89149|2022|PDM|186.00|99|0.00|OP INTENSIVE|
20|FH_F135608_19348_0|SrvcGrp|86723|2022|PDM|367.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F135609_37027_0|SrvcGrp|104186|2022|PDM|5.00|99|0.00|PEER SERVICE (15 MINS)|
20|FH_F91735_92653_0|SrvcGrp|80918|2022|PDM|94.50|99|0.00|RESPITE CARE|
20|FH_F135969_33904_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135978_06851_0|CSTM-ALL|CSTM-00|2020|PDM|280.00|99|0.00|AETNA INTENSIVE OUTPATIENT CD (<=18 YRS)|
20|FH_F136070_46410_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136170_76132_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136186_46307_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F136216_27526_0|SrvcGrp|112591|2022|PCT|1.00|99|0.00|DRUGS|
20|FH_F100765_73735_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130756_04901_0|SrvcGrp|113275|2022|PCT|1.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT|
20|FH_F131132_44077_0|SrvcGrp|84939|2022|PDM|27050.00|99|0.00|SHOULDER JOINT|
20|FH_F111292_33136_0|SrvcGrp|97968|2022|PDM|1376.00|99|0.00|CT SCAN|
20|FH_F111363_33169_0|SrvcGrp|2738|2022|PCT|0.63|99|0.00|IMPLANTS|
20|FH_F134322_98001_0|SrvcGrp|112566|2022|PCT|1.00|99|0.00|CEFAZOLI INJECTION|
20|FH_F65882_0_0|SrvcGrp|42826|2022|PDM|54.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F36476_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F102282_06795_0|SrvcGrp|93098|2022|PDM|153.62|99|0.00|HOSPICE CARE|
20|FH_F111594_0_0|SrvcGrp|88164|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F119526_60435_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F113131_19013_0|SrvcGrp|102279|2022|PDM|131.00|99|0.00|AETNA METHADONE MAINTENANCE (HCFA)|
20|FH_F103360_68845_0|SrvcGrp|73479|2022|PDM|13248.00|99|0.00|C-SECTION DELIVERY MSDRG 765-766 REPLACEMENT 783-788|
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F128421_27016_0|SrvcGrp|89297|2022|PCT|0.80|99|0.00|INPATIENT DETOXIFICATION SERVICES|
20|FH_F143668_0_0|SrvcGrp|114063|2022|PDM|35.00|99|0.00|SEGMENTAL PNEUMATIC CHEST (MOD RR)|
20|FH_F90151_24382_0|SrvcGrp|33165|2022|PDM|315.00|99|0.00|SKILLED NURSING - LEVEL II|
20|FH_F150982_0_0|SrvcGrp|83639|2022|PDM|2202.00|99|0.00|CPT 29886|
20|FH_F31904_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F39443_0_0|SrvcGrp|30354|2022|PDM|119.00|99|0.00|HAPA WPA ASC 310|
20|FH_F101441_0_0|SrvcGrp|96352|2022|PDM|6077.00|99|0.00|ANKLE JOINT|
20|FH_F122264_75972_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127324_0_0|SrvcGrp|110675|2022|PDM|11480.00|99|0.00|NERVOUS SYSTEM|
20|FH_F35446_0_0|SrvcGrp|12628|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|3329.00|99|0.00|AEG 7 (NO REV)|
20|FH_F136779_0_0|SrvcGrp|11043|2022|PDM|1174.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F34853_0_0|SrvcGrp|10924|2022|PDM|12040.00|99|0.00|PTCA W/O STENT|
20|FH_F141228_23181_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131327_0_0|CSTM-ALL|CSTM-00|2020|PDM|6364.00|99|0.00|AEG 7 (NO REV)|
20|FH_F80974_0_0|SrvcGrp|33166|2022|PDM|400.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F132860_0_0|SrvcGrp|58|2022|PDM|6760.00|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F147532_0_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F40104_0_0|SrvcGrp|8962|2022|PDM|107.71|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F151699_01752_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125214_12428_0|SrvcGrp|12491|2022|PCT|0.70|99|0.00|PACEMAKER|
20|FH_F114206_37203_0|SrvcGrp|22593|2022|PDM|35.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F102525_73134_0|SrvcGrp|73008|2022|PDM|1636.00|99|0.00|AEG 10|
20|FH_F122377_91007_0|SrvcGrp|75497|2022|PDM|8796.00|99|0.00|AEG 10|
20|FH_F92278_01440_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F137788_72632_0|SrvcGrp|74403|2022|PCT|0.90|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F148519_83201_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F35990_0_0|SrvcGrp|16679|2022|PDM|4743.00|99|0.00|LAPAROSCOPIC PROCEDURES|
20|FH_F47836_0_0|SrvcGrp|68059|2022|PDM|1300.00|99|0.00|CPT 61782|
20|FH_F127467_44202_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F37943_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137719_28269_0|SrvcGrp|87131|2022|PDM|505.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F146266_0_0|SrvcGrp|93059|2022|PDM|5527.00|99|0.00|SPINAL BONE AUTOGRAFT|
20|FH_F123386_0_0|SrvcGrp|3418|2022|PDM|2800.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F112754_98057_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78009_0_0|SrvcGrp|472|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F127418_0_0|SrvcGrp|110758|2022|PDM|30935.95|99|0.00|CERVCAL OPEN TX OF VERTEBRAL FX|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F74825_0_0|SrvcGrp|471|2022|PDM|660.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F43293_0_0|SrvcGrp|31134|2022|PDM|950.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F97881_38703_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|409.77|99|0.00|SALLY BALIN,999182,ASC 208|
20|FH_F117799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140233_35216_0|CSTM-ALL|CSTM-00|2020|PDM|1250.00|99|0.00|AEG 4 (NO REV)|
20|FH_F143207_72301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143347_16001_0|SrvcGrp|11663|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F90559_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35345_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95629_0_0|CSTM-ALL|CSTM-00|2020|PDM|2533.00|99|0.00|AEG 9 (NO REV)|
20|FH_F93740_0_0|SrvcGrp|91577|2022|PDM|10500.00|99|0.00|FEM/POPL REVASC STNT & ATHER|
20|FH_F151753_03104_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F48459_0_0|SrvcGrp|44326|2022|PDM|60.00|99|0.00|PT & OT (VISIT LVL) OT MOD GO|
20|FH_F133478_40165_0|SrvcGrp|50169|2022|PDM|55050.00|99|0.00|MSDRG 227 ONLY|
20|FH_F134828_30531_0|SrvcGrp|112653|2022|PDM|43.00|99|0.00|XRAY EXAM OF NECK SPINE (HCFA)|
20|FH_F134828_30531_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F126581_45638_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F49338_0_0|SrvcGrp|30197|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26 (DME)|
20|FH_F136684_0_0|SrvcGrp|112364|2022|PDM|70.75|99|0.00|BEVACIZUMAB INJECTION|
20|FH_F66687_0_0|SrvcGrp|17542|2022|PDM|11481.00|99|0.00|OP EP STUDY|
20|FH_F141410_13045_0|SrvcGrp|12840|2022|PCT|0.39|99|0.00|PACEMAKER|
20|FH_F143888_32205_0|SrvcGrp|105323|2022|PCT|1.00|99|0.00|ESTABLISH PATIENT OFF/OP VST|
20|FH_F32888_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F123820_91316_0|SrvcGrp|74668|2022|PDM|700.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F69968_0_0|SrvcGrp|12343|2022|PDM|3886.14|99|0.00|PET SCAN|
20|FH_F93180_73772_0|SrvcGrp|78504|2022|PCT|0.83|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F142654_73034_0|SrvcGrp|113276|2022|PCT|1.05|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F147725_06002_0|SrvcGrp|100044|2022|PDM|3700.00|99|0.00|INCISION OF HEEL BONE|
20|FH_F107926_0_0|SrvcGrp|68282|2022|PDM|1875.00|99|0.00|CPT 67042|
20|FH_F105591_17601_0|SrvcGrp|72998|2022|PDM|1352.00|99|0.00|AEG 5|
20|FH_F122933_0_0|SrvcGrp|72990|2022|PDM|500.00|99|0.00|AEG 1|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PDM|85.23|99|0.00|NEUROPSYCHOLOGICAL TESTING|
20|FH_F43859_0_0|SrvcGrp|37403|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F121707_85745_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F112187_98272_0|SrvcGrp|3087|2022|PDM|1627.00|99|0.00|CD - DETOX|
20|FH_F138487_85297_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F99920_63141_0|SrvcGrp|83521|2022|PDM|110.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|838.00|99|0.00|ASPG V|
20|FH_F90199_24083_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F124441_0_0|SrvcGrp|89856|2022|PDM|2850.00|99|0.00|LAMIN EXCIS EXTRADURAL LUMB|
20|FH_F90698_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 1 (NO REV)|
20|FH_F149881_03038_0|SrvcGrp|473|2022|PDM|391.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F150022_32539_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100661_63640_0|SrvcGrp|73659|2022|PDM|4715.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F91262_77036_0|SrvcGrp|26160|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F45977_0_0|SrvcGrp|40414|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD RR|
20|FH_F44383_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67861_0_0|SrvcGrp|24808|2022|PCT|0.60|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F134497_47126_0|SrvcGrp|89024|2022|PDM|70.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F150900_19104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79863_0_0|SrvcGrp|77225|2022|PDM|90.00|99|0.00|AETNA HOME THERAPY S9370|
20|FH_F71049_0_0|SrvcGrp|38607|2022|PDM|636.00|99|0.00|SKILLED NURSING|
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_F35221_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120735_40012_0|SrvcGrp|73605|2022|PDM|806.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F134398_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F110660_85741_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138240_64114_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F88357_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88744_71103_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F129440_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|NON-ANESTHESIOLOGY (HANE) (HSMI) (SAMD)|
20|FH_F50703_0_0|SrvcGrp|46966|2022|PDM|90.00|99|0.00|NUTRITIONAL ASSESSMENT (S9465)|
20|FH_F134615_38478_0|SrvcGrp|75419|2022|PDM|600.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F92598_21236_0|SrvcGrp|48394|2022|PDM|44.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F34145_0_0|SrvcGrp|6|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F131706_72404_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F60273_0_0|SrvcGrp|14614|2022|PDM|3333.96|99|0.00|LITHOTRIPSY|
20|FH_F62915_0_0|SrvcGrp|26001|2022|PDM|266.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F115043_77954_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F142073_0_0|SrvcGrp|35667|2022|PDM|1060.00|99|0.00|CPT 20680|
20|FH_F32996_0_0|SrvcGrp|8950|2022|PDM|2700.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F37679_0_0|SrvcGrp|27143|2022|PDM|3.75|99|0.00|HOME INFUSION THERAPY (MOD SJ)|
20|FH_F97102_83501_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F130682_0_0|SrvcGrp|99174|2022|PDM|4980.00|99|0.00|CPT 30140|
20|FH_F122433_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F142608_02842_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F53732_0_0|SrvcGrp|23683|2022|PDM|125.00|99|0.00|SKILLED NURSING RN|
20|FH_F138627_82901_0|SrvcGrp|41451|2022|PDM|0.54|99|0.00|ENTERAL FORMULA - CALORICALLY DENSE|
20|FH_F109884_36117_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F86412_32258_0|SrvcGrp|76501|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F149086_0_0|SrvcGrp|84185|2022|PDM|169.00|99|0.00|RESPITE CARE|
20|FH_F69968_0_0|SrvcGrp|46516|2022|PDM|6685.29|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F136374_34461_0|SrvcGrp|108484|2022|PDM|637.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F138607_02760_0|CSTM-ALL|CSTM-00|2020|PDM|220.00|99|0.00|THER CGM SUPPLY ALLOWANCE (MOD NU)|
20|FH_F109632_0_0|SrvcGrp|74381|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY|
20|FH_F91472_96001_0|SrvcGrp|103753|2022|PCT|0.40|99|0.00|PACEMAKER GENERATOR ONLY IMPLANT/REPLACEMENT|
20|FH_F109513_0_0|SrvcGrp|90429|2022|PDM|2700.00|99|0.00|REPAIR WRIST BONE FRACTURE|
20|FH_F40397_0_0|SrvcGrp|9494|2022|PDM|300.00|99|0.00|SUBACUTE CARE|
20|FH_F42704_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F126627_33155_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F118889_17701_0|SrvcGrp|471|2022|PDM|591.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F36274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F103281_32086_0|SrvcGrp|11663|2022|PCT|0.31|99|0.00|IMPLANTS|
20|FH_F143147_80124_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|700.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F45121_0_0|CSTM-ALL|CSTM-00|2020|PDM|25.00|99|0.00|CD RESIDENTIAL TREATMENT|
20|FH_F37751_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.06|99|0.00|2008 Q1 AWP F/S|
20|FH_F133477_90247_0|CSTM-ALL|CSTM-00|2020|PDM|1867.00|99|0.00|AEG 2 (NO REV)|
20|FH_F73502_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.13|99|0.00|5780852_USTN_LAB_MOD26|
20|FH_F128605_20910_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F71162_0_0|SrvcGrp|73362|2022|PCT|1.10|99|0.00|VACCINE SERVICES|
20|FH_F68161_0_0|CSTM-ALL|CSTM-00|2020|PDM|2923.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F125244_0_0|SrvcGrp|16732|2022|PDM|4000.00|99|0.00|HYSTEROSCOPY ABLATION|
20|FH_F138292_60914_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138302_15701_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F145930_45236_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122526_22203_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F130657_04614_0|SrvcGrp|75505|2022|PCT|0.86|99|0.00|CARDIAC STUDIES|
20|FH_F66422_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116700_11787_0|SrvcGrp|89149|2022|PDM|165.00|99|0.00|OP INTENSIVE|
20|FH_F86319_16365_0|SrvcGrp|73461|2022|PDM|845.00|99|0.00|AETNA NICU IV|
20|FH_F148500_50129_0|SrvcGrp|75506|2022|PCT|0.80|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F130204_40807_0|SrvcGrp|89149|2022|PDM|184.00|99|0.00|OP INTENSIVE|
20|FH_F145742_64862_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143930_16101_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F37945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1319.00|99|0.00|ASPG V|
20|FH_F40953_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F118169_27514_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F134126_11554_0|SrvcGrp|112528|2022|PDM|1508.00|99|0.00|PSYCH/DETOX/REHAB|
20|FH_F137147_75006_0|SrvcGrp|112967|2022|PCT|1.58|99|0.00|LABORATORY SERVICES|
20|FH_F142448_15701_0|SrvcGrp|24744|2022|PDM|80.00|99|0.00|PICC LINE INSERTION|
20|FH_F149663_45219_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117105_77619_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F138732_60016_0|SrvcGrp|90854|2022|PDM|872.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F109484_0_0|SrvcGrp|72992|2022|PDM|446.00|99|0.00|AEG 2|
20|FH_F128370_76132_0|SrvcGrp|58509|2022|PDM|315.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F129225_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.03|99|0.00|2005 ASPG GROUPER I|
20|FH_F50336_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|COMPREHENSIVE DAY TREATMENT|
20|FH_F149480_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (BREAKOUT)|
20|FH_F45226_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|ST CLAIRS S CODES MOD SJ|
20|FH_F103109_33462_0|SrvcGrp|89149|2022|PDM|175.00|99|0.00|OP INTENSIVE|
20|FH_F146266_0_0|SrvcGrp|35667|2022|PDM|2040.00|99|0.00|CPT 20680|
20|FH_F140143_24874_0|SrvcGrp|107353|2022|PDM|233.93|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)|
20|FH_F124322_64131_0|SrvcGrp|14949|2022|PDM|125.00|99|0.00|HOME INFUSION|
20|FH_F136779_0_0|SrvcGrp|3932|2022|PDM|3787.00|99|0.00|LITHOTRIPSY|
20|FH_F37487_0_0|SrvcGrp|9934|2022|PDM|1100.00|99|0.00|GENERAL ACUTE CARE W/VENTILATOR SVCS|
20|FH_F101441_0_0|CSTM-ALL|CSTM-00|2020|PDM|4344.00|99|0.00|AEG 9 (NO REV)|
20|FH_F128299_44134_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F118964_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128796_57445_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F63250_0_0|SrvcGrp|46424|2022|PDM|105.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F139594_0_0|SrvcGrp|113637|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F42807_0_0|SrvcGrp|11663|2022|PCT|0.75|99|0.00|IMPLANTS|
20|FH_F117993_32054_0|SrvcGrp|107764|2022|PCT|1.10|99|0.00|AETNA RADIOLOGY (POS 72)|
20|FH_F133477_90247_0|SrvcGrp|11663|2022|PCT|0.25|99|0.00|IMPLANTS|
20|FH_F97141_93933_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F150023_75002_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141754_21703_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123373_0_0|SrvcGrp|11259|2022|PCT|0.52|99|0.00|DRUGS|
20|FH_F81373_64064_0|SrvcGrp|30623|2022|PDM|9778.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F88512_0_0|SrvcGrp|46522|2022|PDM|24749.14|99|0.00|TOTAL KNEE|
20|FH_F88511_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F150904_22306_0|SrvcGrp|23683|2022|PDM|53.00|99|0.00|SKILLED NURSING RN|
20|FH_F144188_76502_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
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_F126990_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANESTHESIOLOGIST/CRNA (HAN4) SAME DOS|
20|FH_F50703_0_0|SrvcGrp|38755|2022|PDM|75.00|99|0.00|ALL SPECIALTY AMINO ACIDS|
20|FH_F35221_0_0|SrvcGrp|97|2022|PDM|3900.00|99|0.00|C-SECTION|
20|FH_F34182_0_0|SrvcGrp|13649|2022|PDM|2729.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F85777_77030_0|SrvcGrp|3477|2022|PCT|0.75|99|0.00|CLINIC VISIT|
20|FH_F99161_0_0|SrvcGrp|75487|2022|PDM|1529.09|99|0.00|AEG 5|
20|FH_F48846_0_0|SrvcGrp|27579|2022|PDM|85.00|99|0.00|RESPIRATORY THERAPY INITIAL VISIT|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|223.61|99|0.00|HAPA WPA-NWPA 2012-13 ASC 310 W/O REV|
20|FH_F102200_06416_0|SrvcGrp|86836|2022|PDM|15.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F132988_0_0|SrvcGrp|92011|2022|PDM|895.82|99|0.00|REMOVAL OF IMPLANT|
20|FH_F141336_16947_0|SrvcGrp|73497|2022|PDM|1196.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F146937_27609_0|SrvcGrp|92760|2022|PCT|1.15|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F58153_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49005_0_0|SrvcGrp|44703|2022|PDM|150.00|99|0.00|NURSING CARE|
20|FH_F116233_33612_0|SrvcGrp|89417|2022|PDM|312.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F103004_75840_0|SrvcGrp|78579|2022|PDM|1302.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
20|FH_F151002_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F113025_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F138784_32216_0|SrvcGrp|73841|2022|PDM|454.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F133468_74873_0|SrvcGrp|46903|2022|PDM|1550.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F132328_0_0|SrvcGrp|105638|2022|PDM|2143.00|99|0.00|HIP ARTHROSCOPY|
20|FH_F112105_24924_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F138018_17313_0|SrvcGrp|17009|2022|PDM|91.79|99|0.00|HOME INFUSION THERAPY|
20|FH_F150322_68301_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F36715_0_0|SrvcGrp|177|2022|PDM|1631.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F116332_0_0|SrvcGrp|25518|2022|PDM|4333.00|99|0.00|LAPAROSCOPY SURGICAL CHOLECYSTECTOMY|
20|FH_F117626_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 2 (NO REV)|
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|1750.00|99|0.00|AEG 8 (NO REV)|
20|FH_F105921_80014_0|SrvcGrp|73700|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F44795_0_0|SrvcGrp|30960|2022|PDM|40.00|99|0.00|NURSING CARE|
20|FH_F116428_0_0|SrvcGrp|82222|2022|PDM|148.79|99|0.00|HOSPICE CARE|
20|FH_F37778_0_0|SrvcGrp|27312|2022|PDM|1240.00|99|0.00|HERNIA REPAIR|
20|FH_F116159_0_0|SrvcGrp|114930|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F125348_84660_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F123324_0_0|SrvcGrp|9537|2022|PDM|3249.00|99|0.00|CARDIAC CARE UNIT|
20|FH_F34706_0_0|SrvcGrp|14951|2022|PDM|12269.00|99|0.00|DRG 123 ONLY - CIRCULATORY DISORDERS|
20|FH_F149099_23901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37910_0_0|SrvcGrp|12852|2022|PCT|0.85|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F134647_35244_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F113325_80004_0|SrvcGrp|103319|2022|PCT|1.00|99|0.00|CASPOFUNGIN ACETATE|
20|FH_F143568_85006_0|SrvcGrp|74794|2022|PCT|2.23|99|0.00|SLEEP STUDY|
20|FH_F137334_90405_0|SrvcGrp|73841|2022|PDM|527.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F134651_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119214_0_0|SrvcGrp|11663|2022|PCT|1.02|99|0.00|IMPLANTS|
20|FH_F141336_16947_0|SrvcGrp|104363|2022|PCT|0.55|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F124636_85008_0|SrvcGrp|89337|2022|PDM|1200.00|99|0.00|DETOXIFICATION|
20|FH_F130039_80228_0|SrvcGrp|73842|2022|PDM|220.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F134674_06473_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F54612_07631_0|SrvcGrp|9830|2022|PDM|109.50|99|0.00|OT SVCS|
20|FH_F66922_66211_0|SrvcGrp|11000|2022|PCT|0.55|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F67086_0_0|SrvcGrp|17140|2022|PDM|139.76|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151410_00717_0|SrvcGrp|92760|2022|PCT|2.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143542_0_0|SrvcGrp|109348|2022|PDM|2869.00|99|0.00|EXCISION OF LESION OF EYELID|
20|FH_F32401_0_0|CSTM-ALL|CSTM-00|2020|PCT|46.00|99|0.00|OP SVCS|
20|FH_F140295_0_0|CSTM-ALL|CSTM-00|2020|PDM|2180.00|99|0.00|AEG 4 (NO REV)|
20|FH_F141247_18902_0|SrvcGrp|73841|2022|PDM|400.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F148544_60439_0|SrvcGrp|75419|2022|PDM|745.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F40442_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F92677_08003_0|SrvcGrp|14948|2022|PDM|151.20|99|0.00|HOME INFUSION THERAPY|
20|FH_F128445_85704_0|SrvcGrp|88819|2022|PDM|1048.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F119775_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|589.20|99|0.00|HAPA WPA-NWPA 2012-13 ASC 301 W/O REV|
20|FH_F113792_0_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F92677_08003_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AMFS NBN INFUSIONS|
20|FH_F97103_53295_0|SrvcGrp|73601|2022|PDM|12366.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F133530_11237_0|SrvcGrp|112352|2022|PDM|1152.00|99|0.00|AETNA ENDOSCOPIC PROCEDURES|
20|FH_F127432_18015_0|SrvcGrp|537|2022|PCT|0.38|99|0.00|OBSERVATION SERVICES|
20|FH_F72648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F92676_15063_0|SrvcGrp|78974|2022|PDM|1425.60|99|0.00|MON VALLEY ASC 11|
20|FH_F41401_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF|
20|FH_F124371_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F77585_0_0|SrvcGrp|43322|2022|PDM|100.00|99|0.00|INDIVIDUAL THERAPY|
20|FH_F148547_01908_0|SrvcGrp|115386|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F81377_0_0|SrvcGrp|47545|2022|PDM|2750.00|99|0.00|INSERTION/REPLACEMENT OF PERIPHERAL/GASTRIC NEUROSTIMULATOR|
20|FH_F125870_0_0|SrvcGrp|28551|2022|PDM|2445.00|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F121476_0_0|SrvcGrp|88267|2022|PDM|5679.00|99|0.00|CONNECTIVE TISSUE|
20|FH_F134495_84321_0|SrvcGrp|43569|2022|PDM|50.00|99|0.00|SKILLED NURSING - NEWBORN|
20|FH_F67200_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|152.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 234 W/O REV|
20|FH_F80064_0_0|SrvcGrp|21975|2022|PDM|1575.00|99|0.00|INPATIENT SERVICES|
20|FH_F51938_0_0|SrvcGrp|33166|2022|PDM|550.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F49029_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING|
20|FH_F137611_30909_0|SrvcGrp|46903|2022|PDM|589.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F72766_0_0|SrvcGrp|29930|2022|PDM|400.00|99|0.00|DIALYSIS|
20|FH_F115966_16801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132928_64114_0|SrvcGrp|48394|2022|PDM|65.03|99|0.00|SKILLED NURSING SERVICES|
20|FH_F63276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131357_17545_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F151543_95630_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F129587_27360_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F137147_75006_0|SrvcGrp|67065|2022|PDM|36750.00|99|0.00|CERVICAL SURGERY|
20|FH_F120152_0_0|SrvcGrp|27261|2022|PDM|24750.00|99|0.00|CPT 27446|
20|FH_F125249_0_0|SrvcGrp|35672|2022|PDM|3200.00|99|0.00|CPT 23412|
20|FH_F148179_48065_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138627_82901_0|SrvcGrp|86836|2022|PDM|50.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F147879_93309_0|SrvcGrp|27969|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F109652_0_0|SrvcGrp|33662|2022|PDM|28838.00|99|0.00|CYBERKNIFE|
20|FH_F91472_96001_0|SrvcGrp|103707|2022|PCT|0.40|99|0.00|CARDIAC SEPTAL DEFECT REPAIR W/ TISSUE GRAFT|
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|ADULT PSYCH RESIDENTIAL TREATMENT|
20|FH_F98040_89406_0|CSTM-ALL|CSTM-00|2020|PCT|0.27|99|0.00|OP SVCS|
20|FH_F117442_0_0|SrvcGrp|82222|2022|PDM|148.79|99|0.00|HOSPICE CARE|
20|FH_F88456_0_0|SrvcGrp|111868|2022|PDM|897.00|99|0.00|LAPAROSCOPY|
20|FH_F114389_50131_0|SrvcGrp|86846|2022|PDM|130.65|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F114985_32073_0|CSTM-ALL|CSTM-00|2020|PDM|67.00|99|0.00|PSYCHOLOGICAL TESTING|
20|FH_F81893_23114_0|SrvcGrp|87536|2022|PCT|0.00|99|0.00|MED REHAB DAY PROGRAM (HALF)|
20|FH_F100789_0_0|CSTM-ALL|CSTM-00|2020|PDM|1684.00|99|0.00|AEG 1 (NO REV)|
20|FH_F138787_32258_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1610.38|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1 W/O REV|
20|FH_F113544_62946_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F123184_20906_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F135583_17331_0|SrvcGrp|29444|2022|PCT|0.75|99|0.00|IMPLANTS/ PROSTHETICS|
20|FH_F111292_33136_0|SrvcGrp|88977|2022|PDM|7052.00|99|0.00|C-SECTION DELIVERY|
20|FH_F139128_49503_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F36039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F141860_60610_0|SrvcGrp|75419|2022|PDM|434.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F117613_08221_0|SrvcGrp|76501|2022|PDM|250.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F122388_0_0|SrvcGrp|72990|2022|PDM|385.00|99|0.00|AEG 1|
20|FH_F138532_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117559_08619_0|SrvcGrp|113299|2022|PDM|40.00|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - MODERNA|
20|FH_F31093_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134490_62801_0|SrvcGrp|11673|2022|PDM|2605.00|99|0.00|CPT 29888|
20|FH_F121068_18036_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F71323_68114_0|SrvcGrp|21004|2022|PDM|2901.00|99|0.00|MS DRGS 101-103 ONLY SEIZURE AND HEADACHE|
20|FH_F41976_0_0|CSTM-ALL|CSTM-00|2020|PDM|265.00|99|0.00|MARLBORO GASTRO GI PROCEDURES 265|
20|FH_F133490_90650_0|SrvcGrp|72984|2022|PCT|1.40|99|0.00|CHEMOTHERAPY|
20|FH_F103281_32086_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS|
20|FH_F151142_35406_0|CSTM-ALL|CSTM-00|2020|PDM|1398.00|99|0.00|AEG 7 (NO REV)|
20|FH_F114444_19602_0|SrvcGrp|86864|2022|PDM|85.00|99|0.00|AETNA PSYCH DIAGNOSITC EVALUATION (MOD TD)(HCFA)|
20|FH_F110423_33401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F145641_06902_0|SrvcGrp|106256|2022|PDM|769.00|99|0.00|INJECTION FOR NERVE BLOC 7|
20|FH_F73403_0_0|SrvcGrp|62539|2022|PDM|130.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F138584_30912_0|SrvcGrp|107091|2022|PCT|1.00|99|0.00|BONE BIOPSY OPEN SUPERFICIAL|
20|FH_F147922_10031_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F117240_37334_0|SrvcGrp|79099|2022|PDM|2000.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F90876_18447_0|SrvcGrp|53145|2022|PDM|118.65|99|0.00|SOCIAL WORKER|
20|FH_F51374_0_0|CSTM-ALL|CSTM-00|2020|PCT|69.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69785_0_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F104840_32565_0|SrvcGrp|73485|2022|PCT|0.69|99|0.00|AETNA REHAB|
20|FH_F33856_0_0|SrvcGrp|675|2022|PDM|700.00|99|0.00|PEDIATRIC INPATIENT SVCS|
20|FH_F95282_77975_0|SrvcGrp|27969|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132973_28054_0|SrvcGrp|89417|2022|PDM|204.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F112371_19047_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F114572_0_0|SrvcGrp|35669|2022|PDM|5000.00|99|0.00|CPT 63650|
20|FH_F135438_29030_0|SrvcGrp|89149|2022|PDM|239.00|99|0.00|OP INTENSIVE|
20|FH_F100852_61068_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F44113_0_0|SrvcGrp|58432|2022|PDM|900.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)|
20|FH_F102901_85006_0|CSTM-ALL|CSTM-00|2020|PCT|0.56|99|0.00|OP SVCS|
20|FH_F150620_53402_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150745_03301_0|SrvcGrp|95660|2022|PDM|837.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F117583_21208_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F117762_0_0|SrvcGrp|99174|2022|PDM|1352.00|99|0.00|CPT 30140|
20|FH_F126116_0_0|SrvcGrp|67994|2022|PDM|982.00|99|0.00|CPT 58120|
20|FH_F128246_0_0|SrvcGrp|111041|2022|PDM|841.00|99|0.00|DRAINAGE OF ABCESS|
20|FH_F119128_93619_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F94165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F108700_63857_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F36579_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALLIED MED-MOD NU|
20|FH_F90921_77702_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS HOME HEALTH|
20|FH_F101840_76054_0|SrvcGrp|21132|2022|PDM|15337.00|99|0.00|MS DRG 495 ONLY|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|259.52|99|0.00|HAPA WPA-NWPA 2012-13 ASC 122 W/O REV|
20|FH_F49329_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F120839_19380_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F116698_07470_0|SrvcGrp|29023|2022|PDM|81.90|99|0.00|HOME INFUSION THERAPY|
20|FH_F82671_0_0|CSTM-ALL|CSTM-00|2020|PDM|698.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F120853_61201_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120887_78750_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F118950_33312_0|SrvcGrp|89337|2022|PDM|1275.00|99|0.00|DETOXIFICATION|
20|FH_F84611_30281_0|SrvcGrp|20072|2022|PDM|971.00|99|0.00|MS DRG 880-887, 894-897|
20|FH_F36420_0_0|SrvcGrp|186|2022|PDM|1900.00|99|0.00|INTENSIVE & INTERMEDIATE UNIT CARE|
20|FH_F51276_0_0|SrvcGrp|24745|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F119491_19904_0|SrvcGrp|88621|2022|PDM|73.50|99|0.00|SKILLED NURSING LPN|
20|FH_F115315_43011_0|SrvcGrp|106244|2022|PCT|0.95|99|0.00|PRESCRIPTION DRUG|
20|FH_F141927_71901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F97182_21502_0|SrvcGrp|88977|2022|PDM|9653.00|99|0.00|C-SECTION DELIVERY|
20|FH_F113324_17055_0|SrvcGrp|105192|2022|PCT|1.00|99|0.00|ENTERNAL SOLUTIONS|
20|FH_F149864_32905_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134362_32535_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F48846_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD KN"|
20|FH_F134167_10032_0|SrvcGrp|48385|2022|PDM|109.00|99|0.00|SPEECH THERAPY|
20|FH_F114800_68510_0|SrvcGrp|48385|2022|PDM|92.00|99|0.00|SPEECH THERAPY|
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|432.90|99|0.00|2005 ASPG GROUPER I|
20|FH_F115347_0_0|CSTM-ALL|CSTM-00|2020|PDM|561.00|99|0.00|AEG 10 (NO REV)|
20|FH_F142376_0_0|SrvcGrp|12491|2022|PCT|0.00|99|0.00|PACEMAKER|
20|FH_F87775_15106_0|SrvcGrp|22589|2022|PDM|65.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F70863_0_0|SrvcGrp|14949|2022|PDM|74.00|99|0.00|HOME INFUSION|
20|FH_F130364_01331_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F143067_0_0|SrvcGrp|105470|2022|PDM|74.28|99|0.00|TRAINING INCL A TREATMENT|
20|FH_F122551_75605_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F102200_06416_0|SrvcGrp|86848|2022|PDM|45.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F120811_53525_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F133667_83642_0|SrvcGrp|3178|2022|PDM|1200.00|99|0.00|ACUTE PSYCH|
20|FH_F132234_97703_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F93553_65065_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F79525_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.20|99|0.00|GENERAL ACUTE CARE|
20|FH_F120352_52556_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121183_75093_0|SrvcGrp|86723|2022|PDM|386.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F125927_75093_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F135236_02840_0|SrvcGrp|111927|2022|PDM|290.30|99|0.00|COVID-19 NON CDC|
20|FH_F137615_16335_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F103100_47150_0|SrvcGrp|73008|2022|PDM|692.00|99|0.00|AEG 10|
20|FH_F124443_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134152_70563_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142273_51012_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|OP SVCS|
20|FH_F142730_20646_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139456_47501_0|SrvcGrp|113186|2022|PCT|1.35|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F36915_0_0|SrvcGrp|9811|2022|PDM|325.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F129448_43235_0|SrvcGrp|48398|2022|PDM|113.00|99|0.00|PT SERVICES|
20|FH_F39538_0_0|CSTM-ALL|CSTM-00|2020|PDM|594.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F109652_0_0|SrvcGrp|73006|2022|PDM|7737.00|99|0.00|AEG 9|
20|FH_F115875_0_0|CSTM-ALL|CSTM-00|2020|PDM|1185.00|99|0.00|AEG 1 (NO REV)|
20|FH_F131494_0_0|SrvcGrp|27347|2022|PDM|473.00|99|0.00|CPT 58558|
20|FH_F91998_0_0|SrvcGrp|73008|2022|PDM|679.00|99|0.00|AEG 10|
20|FH_F136930_73114_0|SrvcGrp|77305|2022|PCT|0.50|99|0.00|DIAGNOSTIC DRUGS|
20|FH_F101320_26062_0|SrvcGrp|24754|2022|PDM|18.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F42165_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F67419_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|INFUSION- IV SERVICES (MOD SJ)|
20|FH_F41457_0_0|SrvcGrp|177|2022|PDM|1150.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F130661_04441_0|SrvcGrp|104363|2022|PCT|0.86|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F132503_73086_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F132571_24739_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F50372_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|CPT 99201|
20|FH_F145988_06105_0|SrvcGrp|10364|2022|PDM|3567.00|99|0.00|CPT CODE 99284|
20|FH_F132594_78229_0|SrvcGrp|48385|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F127327_27401_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F123373_0_0|SrvcGrp|15363|2022|PCT|0.52|99|0.00|DME/ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F117508_90232_0|SrvcGrp|3178|2022|PDM|1150.00|99|0.00|ACUTE PSYCH|
20|FH_F37698_0_0|SrvcGrp|105574|2022|PCT|0.50|99|0.00|TPA/THROMBOLYTIC AGENTS|
20|FH_F149021_44514_0|SrvcGrp|112757|2022|PCT|1.00|99|0.00|DEXAMETHASONE 9% INJECTION|
20|FH_F88744_71103_0|SrvcGrp|58380|2022|PDM|17292.00|99|0.00|MS DRG 239 ONLY|
20|FH_F74024_0_0|SrvcGrp|17419|2022|PDM|70.00|99|0.00|SPEECH THERAPY|
20|FH_F147991_65625_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1393.10|99|0.00|AEG 9 (NO REV)|
20|FH_F143620_81504_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150161_63361_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F133401_33404_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F40063_0_0|SrvcGrp|15|2022|PDM|3574.00|99|0.00|PEDIATRIC INTENSIVE CARE UNIT|
20|FH_F117385_48091_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F44607_0_0|SrvcGrp|29893|2022|PDM|95.00|99|0.00|ST|
20|FH_F141967_89509_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F36409_0_0|SrvcGrp|15873|2022|PDM|26.25|99|0.00|HOSPICE SERVICE - CONTINUOUS HOME CARE|
20|FH_F148907_01810_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120437_85202_0|SrvcGrp|14893|2022|PDM|82.17|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F130755_04401_0|SrvcGrp|73806|2022|PCT|0.93|99|0.00|AETNA ER|
20|FH_F150300_23320_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149099_23901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134593_60007_0|SrvcGrp|115519|2022|PCT|0.85|99|0.00|CULTURED CHONDROCYTES IMPLANT|
20|FH_F49552_0_0|SrvcGrp|35083|2022|PDM|81.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F145642_15108_0|SrvcGrp|86834|2022|PDM|10.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F70804_0_0|SrvcGrp|13606|2022|PDM|45.67|99|0.00|HOME INFUSION|
20|FH_F143611_84065_0|SrvcGrp|75545|2022|PDM|400.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F52713_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123511_64076_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39857_0_0|SrvcGrp|115|2022|PDM|468.00|99|0.00|SKILLED NURSING CARE|
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_F149086_0_0|SrvcGrp|80918|2022|PDM|169.00|99|0.00|RESPITE CARE|
20|FH_F63516_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125415_64701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146139_37604_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151155_26508_0|SrvcGrp|113334|2022|PDM|212.00|99|0.00|MED ASSIST TX NO DRUG|
20|FH_F130748_43762_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133920_64057_0|SrvcGrp|48394|2022|PDM|42.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F123633_70506_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150281_76309_0|SrvcGrp|113194|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F106964_0_0|CSTM-ALL|CSTM-00|2020|PDM|929.00|99|0.00|AEG 3 (NO REV)|
20|FH_F121685_75093_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F117206_0_0|SrvcGrp|79593|2022|PDM|721.00|99|0.00|CPT 45378|
20|FH_F128379_0_0|SrvcGrp|93069|2022|PDM|7553.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F126341_27284_0|SrvcGrp|14893|2022|PDM|80.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F120795_27514_0|SrvcGrp|74586|2022|PCT|0.57|99|0.00|AETNA OP HIGH COST DRUGS|
20|FH_F133269_78624_0|SrvcGrp|46903|2022|PDM|575.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F130657_04614_0|SrvcGrp|104363|2022|PCT|0.86|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F70493_0_0|SrvcGrp|64200|2022|PCT|1.00|99|0.00|RAD AND LAB|
20|FH_F126070_0_0|SrvcGrp|24954|2022|PDM|100.00|99|0.00|SIGMOIDOSCOPY|
20|FH_F39740_0_0|SrvcGrp|20293|2022|PDM|20024.00|99|0.00|MS DRG 235-236 ONLY CV SURGERY|
20|FH_F72546_0_0|SrvcGrp|14356|2022|PCT|0.63|99|0.00|OP SURGERY|
20|FH_F91973_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41201_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F116115_14437_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F120362_23321_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F128274_81501_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F76303_0_0|SrvcGrp|53144|2022|PDM|18.00|99|0.00|SPEECH THERAPY|
20|FH_F150759_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F120285_32960_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F51554_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40046_0_0|SrvcGrp|14492|2022|PCT|0.65|99|0.00|DURABLE MEDICAL EQUIPMENT (DME)|
20|FH_F73985_0_0|SrvcGrp|13711|2022|PDM|4462.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F143784_16801_0|SrvcGrp|74668|2022|PDM|287.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129653_0_0|SrvcGrp|36591|2022|PDM|4000.00|99|0.00|CPT 63685|
20|FH_F120152_0_0|SrvcGrp|99073|2022|PDM|1.22|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F135653_0_0|SrvcGrp|3932|2022|PDM|3700.00|99|0.00|LITHOTRIPSY|
20|FH_F72049_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100620_37027_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F93252_0_0|SrvcGrp|93015|2022|PDM|2500.00|99|0.00|CERVICAL DISC REPLACEMENT SURGERIES|
20|FH_F146990_80206_0|SrvcGrp|46903|2022|PDM|530.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F101702_0_0|SrvcGrp|111498|2022|PCT|0.00|99|0.00|ONCOTYPE DX COLON|
20|FH_F114666_30342_0|SrvcGrp|99067|2022|PDM|2100.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F113845_32746_0|SrvcGrp|105421|2022|PDM|375.00|99|0.00|AETNA TERANIAL MAGN STIM TX PLAN|
20|FH_F113713_17013_0|SrvcGrp|91780|2022|PDM|65.00|99|0.00|AETNA GROUP THERAPY MOD (MOD AJ)(HCFA)|
20|FH_F115210_21043_0|SrvcGrp|41334|2022|PDM|8200.00|99|0.00|TOTAL KNEE|
20|FH_F102947_44084_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F92871_0_0|SrvcGrp|86919|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|288.64|99|0.00|HAPA WPA-NWPA 2012-13 ASC 229 W/O REV|
20|FH_F102063_0_0|SrvcGrp|88621|2022|PDM|140.00|99|0.00|SKILLED NURSING LPN|
20|FH_F85353_16407_0|SrvcGrp|63844|2022|PDM|449.78|99|0.00|HAPA WPA-NWPA 2012-13 ASC 221|
20|FH_F123623_03246_0|SrvcGrp|109293|2022|PCT|1.00|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F149266_38556_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93176_73750_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F114527_39047_0|SrvcGrp|89149|2022|PDM|196.00|99|0.00|OP INTENSIVE|
20|FH_F120484_31419_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F145641_06902_0|SrvcGrp|87677|2022|PDM|1899.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F138050_52301_0|SrvcGrp|78180|2022|PDM|595.00|99|0.00|AETNA RESIDENTIAL TREATMENT|
20|FH_F150953_74953_0|SrvcGrp|10365|2022|PDM|934.00|99|0.00|CPT CODE 99285|
20|FH_F93268_0_0|SrvcGrp|471|2022|PDM|668.30|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F124270_46256_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F114206_37203_0|SrvcGrp|24745|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F51276_0_0|SrvcGrp|17014|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F35133_0_0|SrvcGrp|701|2022|PDM|2250.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F128878_11203_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F40525_0_0|SrvcGrp|32993|2022|PDM|475.00|99|0.00|MOD SU-CT SCANS|
20|FH_F128878_11203_0|SrvcGrp|91399|2022|PDM|95.00|99|0.00|AETNA PSYCH PT & FAMILY 45MINS (MOD AJ)|
20|FH_F135228_98003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91876_0_0|SrvcGrp|73002|2022|PDM|2671.00|99|0.00|AEG 7|
20|FH_F82173_72712_0|SrvcGrp|116079|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F87031_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F34735_0_0|SrvcGrp|18817|2022|PCT|0.75|99|0.00|MS DRG 222|
20|FH_F114930_71101_0|SrvcGrp|105747|2022|PCT|1.05|99|0.00|SPEECH THERAPY|
20|FH_F90691_0_0|SrvcGrp|73006|2022|PDM|1211.00|99|0.00|AEG 9|
20|FH_F47173_0_0|SrvcGrp|977|2022|PCT|0.85|99|0.00|RADIOLOGY SVCS|
20|FH_F133869_19947_0|SrvcGrp|106048|2022|PDM|927.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F70883_0_0|SrvcGrp|12073|2022|PDM|58.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F127157_43614_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F110503_10016_0|SrvcGrp|73841|2022|PDM|621.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F150939_0_0|SrvcGrp|91631|2022|PDM|48.00|99|0.00|OFFICE VISIT|
20|FH_F54552_0_0|SrvcGrp|17001|2022|PDM|150.00|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F89580_0_0|SrvcGrp|82137|2022|PCT|0.66|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F118986_0_0|SrvcGrp|75497|2022|PDM|796.43|99|0.00|AEG 10|
20|FH_F113527_31023_0|SrvcGrp|3273|2022|PCT|0.75|99|0.00|IMPLANTS|
20|FH_F151302_80227_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F151319_64040_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151421_21244_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97501_31501_0|SrvcGrp|73643|2022|PDM|943.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F36492_0_0|SrvcGrp|73008|2022|PDM|1080.00|99|0.00|AEG 10|
20|FH_F97141_93933_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F91764_93710_0|SrvcGrp|112224|2022|PCT|2.19|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F135767_60714_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135877_74403_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F119886_25504_0|SrvcGrp|27969|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F100880_67735_0|SrvcGrp|58623|2022|PDM|588.00|99|0.00|C T SCANS|
20|FH_F116463_76501_0|SrvcGrp|104075|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F131361_18235_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F63881_0_0|SrvcGrp|16703|2022|PDM|325.00|99|0.00|HEMO/HOME DIALYSIS SVCS|
20|FH_F128370_76132_0|SrvcGrp|89412|2022|PDM|315.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F111303_19087_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F134264_67226_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F134322_98001_0|SrvcGrp|91738|2022|PCT|1.00|99|0.00|STER CEFUR SOD PR 750MG/12MX|
20|FH_F134930_0_0|SrvcGrp|30089|2022|PDM|550.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F48581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F131000_0_0|CSTM-ALL|CSTM-00|2020|PDM|2185.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132328_0_0|SrvcGrp|89888|2022|PDM|2819.00|99|0.00|AETNA SUSPENSION OF TESTIS|
20|FH_F132328_0_0|SrvcGrp|105637|2022|PDM|2049.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F125054_16365_0|SrvcGrp|27969|2022|PDM|42.44|99|0.00|HOME HEALTH AIDE|
20|FH_F102222_19720_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129220_18445_0|SrvcGrp|110042|2022|PDM|23.70|99|0.00|BEHAVIOR IDENTIFICATION ASSESSMENT 15 MINS|
20|FH_F102960_50613_0|SrvcGrp|12659|2022|PDM|1190.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F143648_0_0|SrvcGrp|11663|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F132544_0_0|SrvcGrp|96979|2022|PDM|3454.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F139825_0_0|SrvcGrp|109758|2022|PDM|11475.00|99|0.00|COLLAGEN CROSSLINKING CORNEA|
20|FH_F82215_0_0|SrvcGrp|80140|2022|PDM|675.00|99|0.00|END STATE RENAL DIALYSIS|
20|FH_F115329_79424_0|SrvcGrp|73842|2022|PDM|250.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F146108_66762_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F32916_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|1825.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F90817_0_0|SrvcGrp|91038|2022|PDM|1880.00|99|0.00|REPAIR NASAL STENOSIS (HCFA)|
20|FH_F117023_0_0|SrvcGrp|107290|2022|PDM|3928.00|99|0.00|AETNA IMPLANT NEUROELECTRODES|
20|FH_F134847_0_0|SrvcGrp|67066|2022|PDM|22398.00|99|0.00|CERVICAL SURGERY|
20|FH_F141287_14830_0|SrvcGrp|73500|2022|PDM|623.00|99|0.00|AETNA ER LEVEL I|
20|FH_F125214_12428_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147213_48609_0|SrvcGrp|42622|2022|PDM|625.00|99|0.00|SUBACUTE - LEVEL IV|
20|FH_F124703_65711_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F115982_0_0|SrvcGrp|35668|2022|PDM|1500.00|99|0.00|CPT 29824|
20|FH_F38742_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SUNSHINE HHC INFUSION THERAPY|
20|FH_F37152_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140143_24874_0|SrvcGrp|2067|2022|PDM|595.64|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F130044_0_0|SrvcGrp|111385|2022|PCT|1.20|99|0.00|PATHOLOGY|
20|FH_F138478_0_0|SrvcGrp|110703|2022|PDM|3383.82|99|0.00|INSERTION OF HEART ELECTRODE|
20|FH_F35678_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F47558_0_0|SrvcGrp|40419|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- NO MOD|
20|FH_F139565_0_0|SrvcGrp|109762|2022|PDM|4590.00|99|0.00|REMOVE EYELID LESION(S)|
20|FH_F37960_0_0|SrvcGrp|27726|2022|PCT|0.80|99|0.00|OP SURGERY|
20|FH_F117583_21208_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F36743_0_0|SrvcGrp|51|2022|PDM|12500.00|99|0.00|KNEE REPLACEMENT|
20|FH_F124514_21215_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146859_0_0|SrvcGrp|114859|2022|PDM|3502.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F147333_18704_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119355_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|BEHAVIOR TREATMENT (HCFA)|
20|FH_F107922_0_0|SrvcGrp|472|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F149273_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 10 (NO REV)|
20|FH_F97084_91911_0|SrvcGrp|73643|2022|PDM|1775.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F132860_0_0|CSTM-ALL|CSTM-00|2020|PDM|5541.00|99|0.00|MSDRG 286-287 CARDIAC CATH|
20|FH_F147299_02072_0|SrvcGrp|29347|2022|PDM|39.00|99|0.00|HOME HEALTH AIDE|
20|FH_F146204_0_0|SrvcGrp|42472|2022|PDM|2376.00|99|0.00|CPT 58670|
20|FH_F111723_0_0|SrvcGrp|73842|2022|PDM|178.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138018_17313_0|SrvcGrp|17001|2022|PDM|205.00|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F137772_27320_0|SrvcGrp|57968|2022|PDM|41.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F37342_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F127464_15106_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F124487_89502_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F125656_92868_0|SrvcGrp|98991|2022|PDM|31.00|99|0.00|HYDRATION THERAPY 1 LITER (HCFA)|
20|FH_F76382_0_0|SrvcGrp|14997|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F131525_32159_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F147218_48026_0|SrvcGrp|42623|2022|PDM|528.00|99|0.00|SUBACUTE - LEVEL III|
20|FH_F111857_68005_0|SrvcGrp|91294|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F45535_0_0|CSTM-ALL|CSTM-00|2020|PDM|1568.00|99|0.00|ASPG X- GNADEN HUETTEN (LAP/ARTH)|
20|FH_F41808_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137986_0_0|SrvcGrp|85778|2022|PDM|4138.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F38742_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F108460_32746_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F146859_0_0|SrvcGrp|104097|2022|PDM|2782.00|99|0.00|INCISION OF TENDON & MUSCLE|
20|FH_F112045_90301_0|SrvcGrp|3178|2022|PDM|1276.00|99|0.00|ACUTE PSYCH|
20|FH_F140187_61061_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101700_0_0|SrvcGrp|100660|2022|PDM|362.31|99|0.00|AETNA SURGERY|
20|FH_F103140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F102224_0_0|SrvcGrp|92365|2022|PDM|6800.00|99|0.00|FUSION OF SACROILIAC JOINT|
20|FH_F131107_43140_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|873.00|99|0.00|GA RETINA SURG CTR ASC 19|
20|FH_F48473_0_0|SrvcGrp|9832|2022|PDM|88.00|99|0.00|ST SVCS|
20|FH_F119993_71913_0|SrvcGrp|22529|2022|PDM|266.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F84394_17402_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|478.62|99|0.00|HAPA WPA-NWPA 2012-13 ASC 206 W/O REV|
20|FH_F43433_0_0|SrvcGrp|37316|2022|PCT|0.60|99|0.00|THROMBOLYTIC|
20|FH_F88223_0_0|SrvcGrp|48398|2022|PDM|88.00|99|0.00|PT SERVICES|
20|FH_F141790_85374_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F72750_0_0|CSTM-ALL|CSTM-00|2020|PDM|1720.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PDM|598.00|99|0.00|ADULT SA PARTIAL HOSPITALIZATION|
20|FH_F133006_48067_0|SrvcGrp|73841|2022|PDM|360.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F148761_33311_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132727_61108_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114444_19602_0|SrvcGrp|70642|2022|PDM|14.09|99|0.00|CONSULTANT THERAPIST|
20|FH_F146039_89511_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F59652_0_0|SrvcGrp|3577|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F145558_43950_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138739_21157_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|283.76|99|0.00|HAPA WPA-NWPA 2012-13 ASC 113 W/O REV|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|272.13|99|0.00|HAPA WPA-NWPA 2012-13 ASC 114 W/O REV|
20|FH_F131451_61455_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143772_75225_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F149888_68506_0|CSTM-ALL|CSTM-00|2020|PDM|972.00|99|0.00|AEG 2 (NO REV)|
20|FH_F72764_0_0|SrvcGrp|32703|2022|PDM|1900.00|99|0.00|ICU|
20|FH_F120001_0_0|SrvcGrp|79720|2022|PDM|995.00|99|0.00|ACUTE REHAB II|
20|FH_F49338_0_0|SrvcGrp|43320|2022|PDM|303.00|99|0.00|CT SCANS|
20|FH_F37679_0_0|SrvcGrp|14948|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129477_70403_0|SrvcGrp|48398|2022|PDM|80.00|99|0.00|PT SERVICES|
20|FH_F109821_0_0|CSTM-ALL|CSTM-00|2020|PDM|867.00|99|0.00|AEG 4 (NO REV)|
20|FH_F107926_0_0|CSTM-ALL|CSTM-00|2020|PDM|1068.00|99|0.00|AEG 6 (NO REV)|
20|FH_F132988_0_0|SrvcGrp|100066|2022|PDM|4493.01|99|0.00|REPAIR RADIUS FRACTURE|
20|FH_F114389_50131_0|SrvcGrp|10577|2022|PDM|130.65|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F124679_64052_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F55694_0_0|SrvcGrp|361|2022|PDM|965.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F101442_0_0|SrvcGrp|98462|2022|PDM|1427.10|99|0.00|REVISON OF FOOT|
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1697.44|99|0.00|AEG 5  (NO REV)|
20|FH_F132347_01605_0|SrvcGrp|48398|2022|PDM|147.00|99|0.00|PT SERVICES|
20|FH_F131389_33169_0|SrvcGrp|46903|2022|PDM|603.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F122267_62656_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F132160_0_0|SrvcGrp|42550|2022|PDM|5738.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F134887_33409_0|SrvcGrp|85017|2022|PCT|1.05|99|0.00|DME|
20|FH_F150982_0_0|SrvcGrp|114442|2022|PDM|2808.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F148482_20136_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS|
20|FH_F150122_75020_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F121416_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F115274_15235_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97562_29803_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F141947_63367_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133493_90255_0|SrvcGrp|106261|2022|PDM|3212.00|99|0.00|AETNA CARDIAC CATHERTERIZATION|
20|FH_F101853_77840_0|SrvcGrp|89149|2022|PDM|185.00|99|0.00|OP INTENSIVE|
20|FH_F49776_0_0|SrvcGrp|12263|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F149840_80002_0|SrvcGrp|27969|2022|PDM|45.00|99|0.00|HOME HEALTH AIDE|
20|FH_F117793_90405_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F90032_15234_0|SrvcGrp|471|2022|PDM|460.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F44312_0_0|CSTM-ALL|CSTM-00|2020|PDM|555.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F37309_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1180.00|99|0.00|AEG 6 (NO REV)|
20|FH_F148866_84123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|527.00|99|0.00|AEG 10 (NO REV)|
20|FH_F130914_51103_0|SrvcGrp|89337|2022|PDM|870.00|99|0.00|DETOXIFICATION|
20|FH_F103220_0_0|SrvcGrp|107757|2022|PDM|13750.00|99|0.00|LAP PARAESOPH HER RPR W/ MESH|
20|FH_F133788_74006_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F112908_0_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|470.43|99|0.00|HAPA WPA-NWPA 2012-13 ASC 225 W/O REV|
20|FH_F42258_0_0|SrvcGrp|439|2022|PDM|1400.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F134655_14221_0|SrvcGrp|76501|2022|PDM|375.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F80224_0_0|SrvcGrp|3443|2022|PCT|0.76|99|0.00|BARIATRIC SURGERY SERVICES|
20|FH_F121476_0_0|SrvcGrp|111428|2022|PDM|1770.00|99|0.00|CATHETER EXTRAVASCULAR TISSUE ABLATION|
20|FH_F49601_0_0|CSTM-ALL|CSTM-00|2020|PDM|325.00|99|0.00|OP SURGERY MOD SG|
20|FH_F130763_0_0|SrvcGrp|33982|2022|PDM|2927.00|99|0.00|CPT 28296|
20|FH_F74024_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F42438_0_0|CSTM-ALL|CSTM-00|2020|PDM|1542.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F38889_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F115788_02904_0|SrvcGrp|104076|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F34477_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DURABLE MEDICAL EQUIPMENT (DME) W/MOD AV - WINN|
20|FH_F49033_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING|
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2647.00|99|0.00|AEG 8 (NO REV)|
20|FH_F131207_19947_0|SrvcGrp|90631|2022|PDM|132.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F134917_0_0|CSTM-ALL|CSTM-00|2020|PDM|3294.50|99|0.00|AEG 8 (NO REV)|
20|FH_F140579_0_0|CSTM-ALL|CSTM-00|2020|PCT|82.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125011_74467_0|SrvcGrp|47545|2022|PDM|3150.00|99|0.00|INSERTION/REPLACEMENT OF PERIPHERAL/GASTRIC NEUROSTIMULATOR|
20|FH_F88254_33411_0|SrvcGrp|22389|2022|PDM|10.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F39819_0_0|SrvcGrp|31254|2022|PDM|7477.00|99|0.00|NY DRG 132 ONLY|
20|FH_F125867_78748_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F66409_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F128878_11203_0|SrvcGrp|86645|2022|PDM|97.50|99|0.00|AETNA PSYTX PT & FAM 45 MINS (MOD TD)|
20|FH_F113723_10457_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F102302_0_0|SrvcGrp|98593|2022|PDM|10850.00|99|0.00|REMOVAL OF SPINAL LAMINA|
20|FH_F118169_27514_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F137247_40160_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97602_40121_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F40063_0_0|SrvcGrp|15864|2022|PDM|2276.00|99|0.00|PEDIATRIC MEDICAL|
20|FH_F129262_33813_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F39819_0_0|SrvcGrp|31250|2022|PDM|15040.00|99|0.00|NY DRG 121 ONLY|
20|FH_F94461_63090_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F142448_15701_0|SrvcGrp|82223|2022|PDM|178.89|99|0.00|HOSPICE CARE|
20|FH_F149644_91367_0|SrvcGrp|90854|2022|PDM|1200.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F90876_18447_0|SrvcGrp|73523|2022|PDM|118.65|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F32232_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109513_0_0|SrvcGrp|99067|2022|PDM|4500.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F40144_0_0|SrvcGrp|16232|2022|PCT|0.73|99|0.00|DURABLE MEDICAL EQUIPMENT|
20|FH_F125163_0_0|SrvcGrp|107746|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F135491_0_0|SrvcGrp|85966|2022|PDM|1143.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F114389_50131_0|SrvcGrp|22589|2022|PDM|130.65|99|0.00|CHEMOTHERAPY NOC|
20|FH_F114389_50131_0|SrvcGrp|46104|2022|PDM|188.41|99|0.00|HOME VISIT - PRENATAL|
20|FH_F132348_16214_0|SrvcGrp|29347|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F115631_65201_0|SrvcGrp|27261|2022|PDM|6628.00|99|0.00|CPT 27446|
20|FH_F41738_0_0|CSTM-ALL|CSTM-00|2020|PDM|968.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F42551_0_0|CSTM-ALL|CSTM-00|2020|PDM|3465.00|99|0.00|OP SVCS|
20|FH_F36854_0_0|SrvcGrp|177|2022|PDM|1842.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F78265_0_0|SrvcGrp|9911|2022|PCT|0.70|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F151425_19111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135379_61530_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135494_10941_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F123036_0_0|SrvcGrp|107348|2022|PDM|2723.00|99|0.00|EXTERNAL RECHARG SYS INTERN|
20|FH_F150882_84041_0|SrvcGrp|104226|2022|PDM|100.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F90151_24382_0|SrvcGrp|472|2022|PDM|367.50|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F100782_0_0|SrvcGrp|29817|2022|PDM|3693.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F70607_0_0|SrvcGrp|9830|2022|PDM|115.99|99|0.00|OT SVCS|
20|FH_F76028_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34477_0_0|SrvcGrp|16495|2022|PDM|850.00|99|0.00|POLYSOMNOGRAPHY|
20|FH_F38431_0_0|SrvcGrp|23015|2022|PDM|800.00|99|0.00|V5244|
20|FH_F59732_0_0|SrvcGrp|31973|2022|PDM|19.00|99|0.00|HOME THERAPY|
20|FH_F61292_0_0|SrvcGrp|12597|2022|PCT|0.49|99|0.00|DIALYSIS|
20|FH_F37443_0_0|SrvcGrp|16|2022|PDM|953.00|99|0.00|ACUTE REHABILITATION|
20|FH_F131234_32207_0|SrvcGrp|73842|2022|PDM|193.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130214_30144_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F71185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS|
20|FH_F135897_0_0|SrvcGrp|92544|2022|PDM|935.00|99|0.00|FOLLOW-UP SURGERY OF EYE|
20|FH_F97102_83501_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F71068_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2007 DME (TN) DBL MODIFIERS - UE/KF|
20|FH_F130032_72034_0|SrvcGrp|73841|2022|PDM|477.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F151780_0_0|SrvcGrp|87077|2022|PDM|140.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F33712_0_0|SrvcGrp|10904|2022|PDM|750.00|99|0.00|EMERGENCY ROOM LEVEL II|
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|894.00|99|0.00|AEG 10 (NO REV)|
20|FH_F90818_0_0|SrvcGrp|79594|2022|PDM|2880.00|99|0.00|CPT 45380|
20|FH_F136485_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142547_70002_0|SrvcGrp|86831|2022|PDM|3.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F97600_46151_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F90876_18447_0|SrvcGrp|23681|2022|PDM|66.15|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F119838_0_0|CSTM-ALL|CSTM-00|2020|PDM|3446.00|99|0.00|AEG 7 (NO REV)|
20|FH_F40397_0_0|SrvcGrp|32407|2022|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL (RADIOLOGY)|
20|FH_F141336_16947_0|SrvcGrp|3378|2022|PDM|3300.00|99|0.00|OBSERVATION SVCS|
20|FH_F122608_84123_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115154_45069_0|SrvcGrp|75419|2022|PDM|420.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F147539_68359_0|SrvcGrp|79699|2022|PCT|0.98|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F147528_72114_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148645_0_0|CSTM-ALL|CSTM-00|2020|PDM|2514.93|99|0.00|AEG 4 (NO REV)|
20|FH_F135453_70726_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F116431_76104_0|SrvcGrp|79458|2022|PDM|0.25|99|0.00|MED RECORD COPY|
20|FH_F111363_33169_0|SrvcGrp|72992|2022|PDM|1353.00|99|0.00|AEG 2|
20|FH_F138852_75228_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133223_0_0|SrvcGrp|111927|2022|PDM|95.00|99|0.00|COVID-19 NON CDC|
20|FH_F146859_0_0|SrvcGrp|114852|2022|PDM|629.00|99|0.00|INJECT SPINE L/S CD|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|363.87|99|0.00|SALLY BALIN,999182,ASC 212|
20|FH_F127324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34777_0_0|SrvcGrp|17350|2022|PDM|6995.00|99|0.00|CARDIAC ABLATION|
20|FH_F147226_48154_0|SrvcGrp|108622|2022|PDM|453.00|99|0.00|SUB ACUTE CARE LEVEL II|
20|FH_F119491_19904_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F33155_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|PORTNEUF-MSDRG PERCENT|
20|FH_F68868_0_0|SrvcGrp|16|2022|PDM|1185.00|99|0.00|ACUTE REHABILITATION|
20|FH_F100785_54660_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F133068_75965_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118790_98640_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F132969_84003_0|SrvcGrp|86848|2022|PDM|25.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F70607_0_0|SrvcGrp|8962|2022|PDM|168.71|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F111580_77004_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|GENERAL ACUTE CARE|
20|FH_F130154_33607_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F140427_0_0|SrvcGrp|109506|2022|PDM|2500.00|99|0.00|INSRT PULSE GEN W/ DUAL LEADS|
20|FH_F93126_63108_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148255_72703_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97440_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116161_28112_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F78343_0_0|SrvcGrp|474|2022|PDM|245.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F77504_0_0|SrvcGrp|30451|2022|PCT|1.00|99|0.00|TISSUE PLASMINOGEN ACTIVATOR|
20|FH_F56137_0_0|SrvcGrp|15132|2022|PDM|1000.00|99|0.00|ACUTE IP MEDICAL SVCS|
20|FH_F32869_0_0|SrvcGrp|11919|2022|PCT|0.40|99|0.00|ORGAN TRANSPLANT SVCS|
20|FH_F139515_0_0|SrvcGrp|16289|2022|PDM|1626.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F128190_45342_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F115047_78526_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F89495_0_0|SrvcGrp|72994|2022|PDM|529.00|99|0.00|AEG 3|
20|FH_F88639_80204_0|SrvcGrp|88819|2022|PDM|1021.85|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F123809_26155_0|SrvcGrp|537|2022|PCT|0.72|99|0.00|OBSERVATION SERVICES|
20|FH_F58856_0_0|SrvcGrp|29607|2022|PDM|34600.00|99|0.00|MS DRG 221 ONLY|
20|FH_F114865_77488_0|SrvcGrp|105011|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117267_07728_0|SrvcGrp|105465|2022|PCT|5.06|99|0.00|AETNA THERAPIES|
20|FH_F147799_18052_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97660_29401_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F142344_16693_0|SrvcGrp|108484|2022|PDM|557.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F94786_07974_0|SrvcGrp|86846|2022|PDM|36.75|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F132627_0_0|SrvcGrp|17004|2022|PDM|80.58|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS|
20|FH_F130267_57248_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F150910_0_0|SrvcGrp|88157|2022|PDM|10950.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F129103_17545_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136914_64081_0|SrvcGrp|76528|2022|PDM|146.00|99|0.00|HOSPICE LTCH|
20|FH_F115733_33012_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F48772_66044_0|SrvcGrp|82223|2022|PDM|528.00|99|0.00|HOSPICE CARE|
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1851.87|99|0.00|2005 ASPG GROUPER IX|
20|FH_F38949_0_0|SrvcGrp|97|2022|PDM|3933.00|99|0.00|C-SECTION|
20|FH_F48836_0_0|SrvcGrp|31188|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKC (DME)|
20|FH_F150760_44833_0|SrvcGrp|48385|2022|PDM|150.00|99|0.00|SPEECH THERAPY|
20|FH_F150882_84041_0|SrvcGrp|86829|2022|PDM|24.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F148966_37865_0|SrvcGrp|46903|2022|PDM|578.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F140215_93301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F143580_0_0|SrvcGrp|13597|2022|PDM|245.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F145545_01602_0|SrvcGrp|87441|2022|PDM|504.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F148480_03079_0|SrvcGrp|78702|2022|PDM|1260.00|99|0.00|AETNA EXTRACAPSULAR CATARAC|
20|FH_F65440_0_0|SrvcGrp|38364|2022|PDM|4821.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F136347_30328_0|SrvcGrp|46903|2022|PDM|731.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F136358_06070_0|SrvcGrp|472|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F136373_17055_0|SrvcGrp|88621|2022|PDM|112.00|99|0.00|SKILLED NURSING LPN|
20|FH_F118152_20151_0|SrvcGrp|24745|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F122067_0_0|CSTM-ALL|CSTM-00|2020|PDM|1320.00|99|0.00|AEG 8 (NO REV)|
20|FH_F137813_39232_0|SrvcGrp|92761|2022|PCT|0.80|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F110000_0_0|SrvcGrp|29286|2022|PCT|1.00|99|0.00|KS FS 1698 RAD MOD TC|
20|FH_F106822_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F105362_44601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135491_0_0|SrvcGrp|114518|2022|PDM|4950.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F114389_50131_0|SrvcGrp|84559|2022|PCT|1.61|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F129973_48030_0|SrvcGrp|111385|2022|PCT|1.00|99|0.00|PATHOLOGY|
20|FH_F138219_0_0|SrvcGrp|81023|2022|PDM|164.00|99|0.00|AETNA CAPD CCPD IPD DIALYSIS PROC|
20|FH_F115206_80923_0|SrvcGrp|72602|2022|PDM|859.00|99|0.00|ECT|
20|FH_F107360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F52772_0_0|SrvcGrp|473|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F32803_0_0|SrvcGrp|1121|2022|PCT|0.65|99|0.00|OP PTCA ANGIOPLASTY|
20|FH_F54272_0_0|SrvcGrp|9522|2022|PDM|5000.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F117762_0_0|SrvcGrp|36864|2022|PDM|13520.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F139147_0_0|SrvcGrp|79595|2022|PDM|1804.00|99|0.00|CPT 45385|
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_F118542_60188_0|SrvcGrp|53987|2022|PCT|1.00|99|0.00|PHOTOTHERAPY|
20|FH_F141612_19605_0|SrvcGrp|105440|2022|PDM|353.00|99|0.00|AETNA TERANIAL MAGN STIM REDETEMINE|
20|FH_F89932_10940_0|SrvcGrp|31074|2022|PDM|950.00|99|0.00|MS DRG 795 ONLY|
20|FH_F87155_04105_0|SrvcGrp|17015|2022|PDM|18.91|99|0.00|HOME INFUSION THERAPY|
20|FH_F42117_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111412_33777_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148865_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F38394_0_0|SrvcGrp|14614|2022|PDM|3500.00|99|0.00|LITHOTRIPSY|
20|FH_F128246_0_0|SrvcGrp|111042|2022|PDM|841.00|99|0.00|BIOPSY OF EYELID|
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|1334.00|99|0.00|AEG 6 (NO REV)|
20|FH_F56793_0_0|SrvcGrp|29744|2022|PDM|45.00|99|0.00|SKILLED NURSING CARE - MOD TD|
20|FH_F148639_0_0|SrvcGrp|63472|2022|PDM|3400.00|99|0.00|CPT 64581|
20|FH_F125019_67665_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F66259_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1147.00|99|0.00|ASPG V|
20|FH_F121603_46761_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132609_0_0|SrvcGrp|51672|2022|PDM|3989.00|99|0.00|MS DRG 286-287 ONLY|
20|FH_F109632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131759_06032_0|SrvcGrp|471|2022|PDM|588.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F44358_0_0|CSTM-ALL|CSTM-00|2020|PDM|233.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F132968_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F122184_65674_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150226_0_0|SrvcGrp|13262|2022|PDM|3.68|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F113910_16508_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138280_75215_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
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_F43833_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|CT|
20|FH_F115631_65201_0|SrvcGrp|54943|2022|PDM|3177.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F115631_65201_0|SrvcGrp|96781|2022|PDM|1141.00|99|0.00|INJECTION FOR NERVE BLOCK 5|
20|FH_F38831_0_0|CSTM-ALL|CSTM-00|2020|PDM|1635.00|99|0.00|BRAIN INJURY REHAB|
20|FH_F113180_23507_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145208_63640_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F135978_06851_0|SrvcGrp|90576|2022|PDM|459.00|99|0.00|AETNA PARTIAL HOSPITALIZATION (<=18 YRS) (HCFA)|
20|FH_F140629_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132096_89118_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F136382_0_0|SrvcGrp|104719|2022|PDM|2214.00|99|0.00|RELIEVE INNER EYE PRESSURE|
20|FH_F98360_11554_0|SrvcGrp|73659|2022|PDM|8639.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F124492_30040_0|SrvcGrp|113248|2022|PDM|56.44|99|0.00|COVID-19 SARS-COV-2 AMP PRB (HCFA)|
20|FH_F116237_43235_0|SrvcGrp|73841|2022|PDM|363.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F33500_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36822_0_0|SrvcGrp|72|2022|PDM|791.00|99|0.00|NEWBORN NURSERY|
20|FH_F150982_0_0|SrvcGrp|111805|2022|PDM|4404.00|99|0.00|REMOVAL OF FACE WRINKLES|
20|FH_F149888_68506_0|SrvcGrp|115828|2022|PDM|2355.00|99|0.00|SURGERY|
20|FH_F73209_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|1103.00|99|0.00|AEG 4 (NO REV)|
20|FH_F131961_06040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136510_0_0|SrvcGrp|104358|2022|PDM|2886.00|99|0.00|CONJUNCTIVOPLASTY|
20|FH_F124026_53188_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F145588_75081_0|SrvcGrp|75419|2022|PDM|430.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F69862_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92659_0_0|CSTM-ALL|CSTM-00|2020|PDM|1714.00|99|0.00|AEG 9 (NO REV)|
20|FH_F135219_68506_0|CSTM-ALL|CSTM-00|2020|PDM|4397.95|99|0.00|AEG 4 (NO REV)|
20|FH_F40043_0_0|SrvcGrp|33262|2022|PDM|897.00|99|0.00|GA ASPG II|
20|FH_F148123_91301_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F31508_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125323_43213_0|SrvcGrp|27968|2022|PDM|31.00|99|0.00|SKILLED NURSING LPN|
20|FH_F126923_33612_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F142073_0_0|SrvcGrp|78096|2022|PDM|2400.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F126926_32250_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137946_0_0|SrvcGrp|113251|2022|PDM|41.38|99|0.00|COVID-19 SARS-COV-2 W/ OPTIC (HCFA)|
20|FH_F124783_92408_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F92091_0_0|SrvcGrp|89988|2022|PDM|3000.00|99|0.00|REPAIR HALLUX RIGIDUS|
20|FH_F145755_08050_0|SrvcGrp|114290|2022|PCT|1.00|99|0.00|COVID-19 ADMIN|
20|FH_F140765_30315_0|SrvcGrp|113297|2022|PDM|40.00|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - PFIZER|
20|FH_F119023_91406_0|SrvcGrp|22593|2022|PDM|35.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F129438_08234_0|SrvcGrp|86723|2022|PDM|340.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F79025_0_0|SrvcGrp|75545|2022|PDM|540.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER NU|
20|FH_F132627_0_0|SrvcGrp|46617|2022|PDM|177.00|99|0.00|SKILLED NURSING HOME VISIT OR PROCEDURE|
20|FH_F133002_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F130274_63033_0|SrvcGrp|27968|2022|PDM|27.00|99|0.00|SKILLED NURSING LPN|
20|FH_F141147_02571_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE|
20|FH_F141336_16947_0|SrvcGrp|111927|2022|PDM|56.44|99|0.00|COVID-19 NON CDC|
20|FH_F124059_64055_0|SrvcGrp|26869|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F67172_0_0|SrvcGrp|80|2022|PDM|1627.00|99|0.00|ACUTE PSYCH|
20|FH_F113785_35763_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F137447_0_0|SrvcGrp|13262|2022|PDM|4.00|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F102947_44084_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F48772_66044_0|SrvcGrp|65621|2022|PDM|80.00|99|0.00|RN NURSING|
20|FH_F132772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F102844_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 2 (NO REV)|
20|FH_F46433_0_0|SrvcGrp|21711|2022|PDM|165.00|99|0.00|TOTAL PARENTERAL NUTRITION; LESS THAN 2 LITERS|
20|FH_F150324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|308.79|99|0.00|HAPA WPA-NWPA 2012-13 ASC 118 W/O REV|
20|FH_F151427_04106_0|SrvcGrp|116008|2022|PDM|81.65|99|0.00|THER/PROPH/DIAG IV INF ADD ON (HCFA)|
20|FH_F151511_14094_0|CSTM-ALL|CSTM-00|2020|PDM|2568.13|99|0.00|AEG 6 (NO REV)|
20|FH_F136216_27526_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116397_33404_0|SrvcGrp|16750|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F34686_0_0|CSTM-ALL|CSTM-00|2020|PCT|68.00|99|0.00|OP SVCS|
20|FH_F98626_29118_0|SrvcGrp|88978|2022|PDM|8925.00|99|0.00|VAGINAL DELIVERY|
20|FH_F37081_0_0|SrvcGrp|18338|2022|PDM|25400.00|99|0.00|MS DRG 471|
20|FH_F97082_90012_0|SrvcGrp|73559|2022|PDM|15206.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F98000_59102_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F130661_04441_0|SrvcGrp|103717|2022|PCT|0.86|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F141287_14830_0|SrvcGrp|12837|2022|PCT|0.39|99|0.00|INTRAOCULAR LENSES|
20|FH_F120437_85202_0|SrvcGrp|88807|2022|PDM|185.71|99|0.00|TOTAL PARENTERAL NUTRITION; < 2 LITERS (HCFA)|
20|FH_F148599_98034_0|SrvcGrp|73479|2022|PDM|13934.00|99|0.00|C-SECTION DELIVERY MSDRG 765-766 REPLACEMENT 783-788|
20|FH_F61494_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118373_21205_0|SrvcGrp|537|2022|PCT|0.65|99|0.00|OBSERVATION SERVICES|
20|FH_F150019_19380_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133477_90247_0|SrvcGrp|10944|2022|PDM|1159.00|99|0.00|EMERGENCY ROOM|
20|FH_F139594_0_0|CSTM-ALL|CSTM-00|2020|PDM|1955.00|99|0.00|AEG 7 (NO REV)|
20|FH_F144789_48304_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|1348.00|99|0.00|ASPG VI|
20|FH_F139873_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F124829_75231_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F109886_36303_0|SrvcGrp|86749|2022|PCT|1.10|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F147725_06002_0|SrvcGrp|115162|2022|PDM|5408.00|99|0.00|FOOT AND TOES REPAIR|
20|FH_F91472_96001_0|SrvcGrp|103702|2022|PDM|14871.00|99|0.00|LITHOTRIPSY|
20|FH_F63459_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F142427_36607_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F139708_54880_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F39622_0_0|SrvcGrp|1306|2022|PDM|520.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F137767_01841_0|SrvcGrp|88978|2022|PDM|7500.00|99|0.00|VAGINAL DELIVERY|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|286.34|99|0.00|SALLY BALIN,999182,ASC 107|
20|FH_F38039_0_0|SrvcGrp|9832|2022|PDM|77.00|99|0.00|ST SVCS|
20|FH_F141913_65560_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132279_63775_0|SrvcGrp|79786|2022|PCT|0.50|99|0.00|SLEEP STUDIES|
20|FH_F132992_04662_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F106600_99202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F44557_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37640_0_0|CSTM-ALL|CSTM-00|2020|PDM|540.00|99|0.00|ASPG II|
20|FH_F151046_10036_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F130752_43701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F85732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150165_06032_0|SrvcGrp|96380|2022|PDM|9654.00|99|0.00|AETNA INS/REP SUBQ DEFIBRILLATOR|
20|FH_F134362_32535_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135627_77070_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|407.73|99|0.00|HAPA WPA-NWPA 2012-13 ASC 213 W/O REV|
20|FH_F143742_60410_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F143650_0_0|SrvcGrp|82107|2022|PDM|1800.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F112082_30720_0|SrvcGrp|14945|2022|PDM|6.30|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F121225_98902_0|SrvcGrp|26868|2022|PDM|105.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F54592_0_0|SrvcGrp|14945|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|128.47|99|0.00|HAPA WPA-NWPA 2012-13 ASC 134 W/O REV|
20|FH_F130032_72034_0|SrvcGrp|73842|2022|PDM|228.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F110363_0_0|SrvcGrp|103949|2022|PDM|662.00|99|0.00|HOSPICE IN SNF|
20|FH_F127946_32514_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40252_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F98801_93274_0|SrvcGrp|90854|2022|PDM|4185.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F139236_0_0|CSTM-ALL|CSTM-00|2020|PDM|521.00|99|0.00|AEG 1 (NO REV)|
20|FH_F116443_0_0|SrvcGrp|104098|2022|PDM|4100.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F138876_25302_0|SrvcGrp|17014|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F72606_0_0|SrvcGrp|14210|2022|PDM|450.00|99|0.00|PSYCH INTENSIVE OUTPATIENT|
20|FH_F100765_73735_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48355_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F132328_0_0|SrvcGrp|46906|2022|PDM|3839.00|99|0.00|CORNEAL TISSUE|
20|FH_F112092_46845_0|SrvcGrp|90498|2022|PCT|1.00|99|0.00|NOS FLU VACC 3 YRS & > IM|
20|FH_F131449_19073_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124739_64429_0|SrvcGrp|75545|2022|PDM|312.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|100% 2007 MEDICARE TN DME MOD AW|
20|FH_F35769_32765_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|99|0.00|OP SVCS|
20|FH_F92153_74017_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F47902_0_0|SrvcGrp|43848|2022|PCT|1.00|99|0.00|DME POS FACILITY GLOBAL|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|364.86|99|0.00|HAPA WPA-NWPA 2012-13 ASC 16 W/O REV|
20|FH_F38702_0_0|SrvcGrp|111934|2022|PDM|87.00|99|0.00|COVID-19 NUCLEIC ACID|
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|AEG 5  (NO REV)|
20|FH_F50615_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133129_45863_0|CSTM-ALL|CSTM-00|2020|PDM|518.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F113074_0_0|CSTM-ALL|CSTM-00|2020|PDM|686.00|99|0.00|AEG 9 (NO REV)|
20|FH_F94165_0_0|SrvcGrp|82037|2022|PCT|0.85|99|0.00|AETNA ICU|
20|FH_F127217_29650_0|SrvcGrp|105421|2022|PDM|322.00|99|0.00|AETNA TERANIAL MAGN STIM TX PLAN|
20|FH_F141654_15217_0|SrvcGrp|23683|2022|PDM|38.24|99|0.00|SKILLED NURSING RN|
20|FH_F62601_0_0|SrvcGrp|48396|2022|PDM|30.00|99|0.00|OT SERVICES|
20|FH_F38725_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133469_33404_0|SrvcGrp|58509|2022|PDM|650.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F67803_0_0|SrvcGrp|45783|2022|PDM|110.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F53592_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F149661_0_0|SrvcGrp|11606|2022|PDM|800.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)|
20|FH_F110507_33462_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F134172_33126_0|SrvcGrp|89149|2022|PDM|453.00|99|0.00|OP INTENSIVE|
20|FH_F98021_07012_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F125173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F88672_0_0|SrvcGrp|87677|2022|PDM|819.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F36381_0_0|SrvcGrp|12995|2022|PCT|0.55|99|0.00|DIALYSIS|
20|FH_F135614_83642_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124173_66215_0|SrvcGrp|22592|2022|PDM|22.00|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F139747_06241_0|SrvcGrp|472|2022|PDM|475.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F110343_38139_0|SrvcGrp|73841|2022|PDM|542.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F134593_60007_0|SrvcGrp|106201|2022|PCT|0.85|99|0.00|INJ ETEPLIRSEN|
20|FH_F133492_0_0|SrvcGrp|106906|2022|PDM|30.00|99|0.00|AETNA SURGERY DEFAULT W/O GROUPER 1 & 2|
20|FH_F146881_83661_0|SrvcGrp|95660|2022|PDM|650.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F34454_0_0|SrvcGrp|12401|2022|PDM|85.50|99|0.00|RN VISIT|
20|FH_F73142_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141801_80534_0|SrvcGrp|86722|2022|PDM|275.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F141410_13045_0|SrvcGrp|83960|2022|PCT|0.87|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F87716_0_0|SrvcGrp|30461|2022|PDM|637.00|99|0.00|SUBACUTE CARE/SKILLED NURSING|
20|FH_F72183_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|ASPG V - FH SW CUSTOM GROUPERS|
20|FH_F34138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|CARILION ANTI-INFECTIVE IV THERAPY- MOD SH|
20|FH_F119888_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132238_27615_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116431_76104_0|SrvcGrp|89417|2022|PDM|350.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F146859_0_0|SrvcGrp|114843|2022|PDM|565.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT L/S LEV 1|
20|FH_F149516_65233_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F84532_0_0|SrvcGrp|12491|2022|PCT|0.31|99|0.00|PACEMAKER|
20|FH_F120437_85202_0|SrvcGrp|91214|2022|PDM|181.20|99|0.00|MED NUTRITION|
20|FH_F150001_33064_0|SrvcGrp|86846|2022|PDM|26.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F117575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1044.00|99|0.00|AEG 4 (NO REV)|
20|FH_F117733_91362_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|534.80|99|0.00|ASPG 404|
20|FH_F136608_0_0|SrvcGrp|108043|2022|PDM|164.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F145759_18452_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143624_73069_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F149364_19335_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F110507_33462_0|SrvcGrp|73841|2022|PDM|390.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F101100_50314_0|CSTM-ALL|CSTM-00|2020|PDM|2761.00|99|0.00|MS DRG TRANSFER RATE|
20|FH_F115893_08002_0|SrvcGrp|104151|2022|PDM|1400.00|99|0.00|IP ALCOHOL/DRUG REHAB|
20|FH_F133574_91607_0|SrvcGrp|82981|2022|PDM|160.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|DRUG/INJECTABLES - RONL/HSOH|
20|FH_F148203_60190_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F128073_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97565_83301_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F71667_0_0|SrvcGrp|9826|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F38249_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|REHABILITATION|
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 6 (NO REV)|
20|FH_F115274_15235_0|SrvcGrp|97506|2022|PDM|135.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F35454_0_0|SrvcGrp|16514|2022|PDM|10.00|99|0.00|CPT 83036|
20|FH_F109846_16502_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F128787_60302_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127422_0_0|SrvcGrp|73008|2022|PDM|333.00|99|0.00|AEG 10|
20|FH_F130468_0_0|SrvcGrp|86233|2022|PDM|5835.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F145604_14850_0|SrvcGrp|86779|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
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_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|1624.00|99|0.00|ASPG VII|
20|FH_F141340_66208_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125259_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F85212_71075_0|SrvcGrp|73485|2022|PDM|1000.00|99|0.00|AETNA REHAB|
20|FH_F103220_0_0|CSTM-ALL|CSTM-00|2020|PDM|1760.00|99|0.00|AEG 4 (NO REV)|
20|FH_F54592_0_0|SrvcGrp|3327|2022|PDM|155.61|99|0.00|HOSPICE SERVICE - IP RESPITE|
20|FH_F75842_0_0|SrvcGrp|67265|2022|PDM|21379.24|99|0.00|RECHANNELING OF ARTERY|
20|FH_F146419_68504_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F144014_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36676_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|DME MOD 53|
20|FH_F42360_0_0|SrvcGrp|592|2022|PDM|525.00|99|0.00|SUB-ACUTE CARE|
20|FH_F125949_66534_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145766_64491_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F130523_04605_0|SrvcGrp|72984|2022|PCT|0.84|99|0.00|CHEMOTHERAPY|
20|FH_F39138_0_0|SrvcGrp|30096|2022|PDM|98.00|99|0.00|SPEECH THERAPY|
20|FH_F123278_20850_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F148266_45419_0|SrvcGrp|90562|2022|PDM|967.19|99|0.00|FISTULIZATION OF SCLERA|
20|FH_F66687_0_0|SrvcGrp|62295|2022|PDM|8603.00|99|0.00|CORONARY ANGIOGRAPHY|
20|FH_F122687_0_0|SrvcGrp|92409|2022|PDM|5464.00|99|0.00|PERQ CERVICOTHORACIC INJECT|
20|FH_F40519_0_0|SrvcGrp|471|2022|PDM|435.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F72183_0_0|SrvcGrp|12438|2022|PDM|4500.00|99|0.00|PTCA WITH STENT|
20|FH_F86712_60173_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F64999_0_0|CSTM-ALL|CSTM-00|2020|PDM|1036.00|99|0.00|ASPG V|
20|FH_F107200_0_0|SrvcGrp|101526|2022|PDM|5202.00|99|0.00|LAPARO-ASST VAG HYSTERECTOMY|
20|FH_F118178_37909_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F111046_0_0|SrvcGrp|13681|2022|PDM|567.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F71863_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117623_0_0|CSTM-ALL|CSTM-00|2020|PDM|36.00|99|0.00|AETNA ADAPTIVE BEHAVIOR TREATMNT MODIFIED 30 MINS|
20|FH_F116525_26003_0|SrvcGrp|103912|2022|PCT|0.62|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F132627_0_0|SrvcGrp|26869|2022|PDM|18.36|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F146800_74128_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F66411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F137248_0_0|SrvcGrp|113068|2022|PDM|4058.00|99|0.00|TREATMENT OF FRACTURE|
20|FH_F138055_16146_0|SrvcGrp|86722|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F49005_0_0|SrvcGrp|45336|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE (ADDITIONAL HOURS)|
20|FH_F123083_0_0|SrvcGrp|28551|2022|PDM|1434.49|99|0.00|REPAIR OF COMPLEX RETINAL DETACHMENT|
20|FH_F113025_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|2213.00|99|0.00|AEG 7 (NO REV)|
20|FH_F151304_31520_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116397_33404_0|SrvcGrp|86836|2022|PDM|15.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F133805_83401_0|SrvcGrp|93098|2022|PDM|122.00|99|0.00|HOSPICE CARE|
20|FH_F52956_0_0|SrvcGrp|49603|2022|PDM|339.90|99|0.00|ULTRAFILTRATION|
20|FH_F36681_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|PDM|564.00|99|0.00|AEG 9 (NO REV)|
20|FH_F68972_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|OP SVCS|
20|FH_F119310_20850_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134871_28205_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151639_90034_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F131356_19131_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F150419_64119_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F110732_31513_0|SrvcGrp|103913|2022|PCT|0.60|99|0.00|OP DIALYSIS|
20|FH_F37370_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|VERTICAL PLUS MRI MOD 26|
20|FH_F128198_34208_0|SrvcGrp|108484|2022|PDM|635.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F149579_95815_0|SrvcGrp|115706|2022|PDM|128.25|99|0.00|PSYCHIATRIC COLLABORATIVE CARE MGMT SBSQ (MOD TD)(HCFA)|
20|FH_F128672_30274_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97603_77901_0|SrvcGrp|90854|2022|PDM|1958.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F147327_19010_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F49739_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138478_0_0|SrvcGrp|12491|2022|PCT|0.63|99|0.00|PACEMAKER|
20|FH_F35557_0_0|SrvcGrp|11798|2022|PDM|54.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F150982_0_0|SrvcGrp|84704|2022|PDM|1927.00|99|0.00|CYSTOURETHROSCOPY W/ REMOVAL OF FOREIGN BODY|
20|FH_F138018_17313_0|SrvcGrp|31973|2022|PDM|38.74|99|0.00|HOME THERAPY|
20|FH_F40490_0_0|SrvcGrp|12674|2022|PCT|0.59|99|0.00|IMPLANTS|
20|FH_F147215_48105_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127487_60169_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F40727_0_0|CSTM-ALL|CSTM-00|2020|PDM|1037.59|99|0.00|ASPG V|
20|FH_F148966_37865_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F141250_95062_0|SrvcGrp|73841|2022|PDM|309.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F149582_01534_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F35452_0_0|SrvcGrp|12047|2022|PCT|1.50|99|0.00|CPT CODES 80000-89999, 36415 (LAB)|
20|FH_F146859_0_0|SrvcGrp|73610|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F134872_32168_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F151202_0_0|SrvcGrp|90854|2022|PDM|1000.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F147218_48026_0|SrvcGrp|110537|2022|PDM|392.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F36634_0_0|CSTM-ALL|CSTM-00|2020|PDM|2811.00|99|0.00|ANGIOPLASTY|
20|FH_F149522_83221_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F143347_16001_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F93740_0_0|SrvcGrp|91585|2022|PDM|4000.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F102943_0_0|SrvcGrp|71221|2022|PDM|729.94|99|0.00|EGD W/BALLOON DIALATION CPT 43249|
20|FH_F101709_0_0|SrvcGrp|97364|2022|PDM|8441.00|99|0.00|SPINE CODES|
20|FH_F101709_0_0|SrvcGrp|26274|2022|PDM|3045.00|99|0.00|CPT 29877|
20|FH_F151746_20032_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: MODIFIER QW|
20|FH_F49037_0_0|SrvcGrp|45148|2022|PDM|90.00|99|0.00|SPEECH THERAPY|
20|FH_F120799_92651_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F116739_78501_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120888_63823_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F120974_27607_0|SrvcGrp|113275|2022|PDM|100.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT|
20|FH_F125540_19462_0|SrvcGrp|89024|2022|PDM|81.60|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F109840_62832_0|SrvcGrp|75505|2022|PCT|0.80|99|0.00|CARDIAC STUDIES|
20|FH_F111813_08080_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132722_71373_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F41181_0_0|SrvcGrp|97|2022|PDM|4056.00|99|0.00|C-SECTION|
20|FH_F68121_0_0|SrvcGrp|64318|2022|PDM|100.00|99|0.00|PHYSICAL THERAPY EVAL/ RE-EVAL|
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|20000.00|99|0.00|MSDRG 235-236 CORONARY BYPASS|
20|FH_F142332_0_0|SrvcGrp|53145|2022|PDM|70.00|99|0.00|SOCIAL WORKER|
20|FH_F98002_27103_0|SrvcGrp|73659|2022|PDM|4115.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F117300_0_0|SrvcGrp|74039|2022|PDM|7360.00|99|0.00|LAMINECTOMY|
20|FH_F113764_0_0|SrvcGrp|43891|2022|PDM|85.00|99|0.00|RN HOURLY PEDS|
20|FH_F138240_64114_0|SrvcGrp|88621|2022|PDM|122.00|99|0.00|SKILLED NURSING LPN|
20|FH_F134650_07921_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136591_0_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PDM|805.00|99|0.00|ASPG V|
20|FH_F110506_98901_0|SrvcGrp|89149|2022|PDM|186.00|99|0.00|OP INTENSIVE|
20|FH_F105145_75075_0|SrvcGrp|98269|2022|PDM|9333.00|99|0.00|SHOULDER ARTHROSCOPY WITHOUT REPAIR|
20|FH_F44638_0_0|SrvcGrp|166|2022|PDM|590.00|99|0.00|CD (ADULT) - DETOXIFICATION|
20|FH_F133478_40165_0|SrvcGrp|90503|2022|PDM|26094.00|99|0.00|MSDRG 269, 271-272 ONLY|
20|FH_F111604_16505_0|SrvcGrp|86722|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F37884_0_0|SrvcGrp|13627|2022|PDM|390.00|99|0.00|SLEEP STUDY|
20|FH_F36277_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F117082_66216_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F72183_0_0|SrvcGrp|30159|2022|PCT|1.80|99|0.00|LABORATORY MOD TC|
20|FH_F102302_0_0|SrvcGrp|80283|2022|PDM|14300.00|99|0.00|AETNA REVISE/REMOVE NEUROELECTRODE|
20|FH_F123896_68114_0|CSTM-ALL|CSTM-00|2020|PCT|1.90|99|0.00|HSS ASC|
20|FH_F129656_15005_0|SrvcGrp|21920|2022|PDM|35.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F130061_84097_0|SrvcGrp|46903|2022|PDM|1300.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|1171.00|99|0.00|AEG 2 (NO REV)|
20|FH_F60072_0_0|SrvcGrp|14414|2022|PDM|515.00|99|0.00|NEWBORN NURSERY|
20|FH_F34321_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F56232_0_0|CSTM-ALL|CSTM-00|2020|PDM|1084.99|99|0.00|ASPG IV|
20|FH_F37341_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|676.00|99|0.00|ASPG I|
20|FH_F116793_0_0|SrvcGrp|87691|2022|PDM|45.00|99|0.00|AETNA THERAPIES|
20|FH_F115324_78852_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35100_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|OP SVCS|
20|FH_F56793_0_0|SrvcGrp|24761|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F147800_0_0|SrvcGrp|53066|2022|PDM|458.00|99|0.00|INJECTION(S), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL|
20|FH_F144990_44708_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118486_95060_0|SrvcGrp|73841|2022|PDM|550.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F121009_76180_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F138054_0_0|SrvcGrp|66264|2022|PDM|144.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F109815_52241_0|SrvcGrp|103740|2022|PDM|766.00|99|0.00|LEAVE OF ABSENCE|
20|FH_F120437_85202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91255_19401_0|CSTM-ALL|CSTM-00|2020|PDM|3986.00|99|0.00|AEG 7 (NO REV)|
20|FH_F133011_0_0|CSTM-ALL|CSTM-00|2020|PDM|759.00|99|0.00|AEG 9 (NO REV)|
20|FH_F63301_0_0|SrvcGrp|17139|2022|PDM|601.02|99|0.00|HOSPICE CARE|
20|FH_F49575_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F110345_37919_0|SrvcGrp|86648|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F117437_0_0|SrvcGrp|29155|2022|PDM|180.00|99|0.00|HOSPICE SVCS|
20|FH_F85353_16407_0|SrvcGrp|63826|2022|PDM|514.71|99|0.00|HAPA WPA-NWPA 2012-13 ASC 306|
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150299_22046_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F144248_0_0|SrvcGrp|46886|2022|PDM|4590.00|99|0.00|REMOVAL OF EYELID LESION|
20|FH_F142376_0_0|SrvcGrp|113979|2022|PDM|3511.00|99|0.00|REMOVE VAGUS NERVE|
20|FH_F151609_17601_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F92506_07666_0|SrvcGrp|31074|2022|PDM|1173.00|99|0.00|MS DRG 795 ONLY|
20|FH_F137334_90405_0|SrvcGrp|89417|2022|PDM|527.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F109513_0_0|SrvcGrp|90425|2022|PDM|2500.00|99|0.00|SHOULDER ARTHROSCOPY SURGERY|
20|FH_F129487_0_0|SrvcGrp|73002|2022|PDM|2685.00|99|0.00|AEG 7|
20|FH_F119581_0_0|SrvcGrp|77272|2022|PDM|1361.00|99|0.00|AETNA INSRT TUNL CVAD 2 CATH-SITE|
20|FH_F132501_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 7 (NO REV)|
20|FH_F66411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F122588_53073_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122606_53818_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F136824_08034_0|SrvcGrp|86638|2022|PDM|1197.00|99|0.00|AETNA IP PSYCHIATRIC (>=18 YRS)|
20|FH_F115244_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F54552_0_0|SrvcGrp|29075|2022|PDM|50.00|99|0.00|HYDRATION THERAPY|
20|FH_F129329_07039_0|SrvcGrp|89024|2022|PDM|85.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F131000_0_0|SrvcGrp|88492|2022|PDM|4457.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F118651_0_0|SrvcGrp|107866|2022|PDM|6259.31|99|0.00|AETNA LAPAROSCOPY SURGICAL|
20|FH_F42426_0_0|SrvcGrp|110|2022|PDM|400.00|99|0.00|CD - REHABILITATION|
20|FH_F35097_16508_0|SrvcGrp|10503|2022|PDM|50.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F117615_30525_0|SrvcGrp|107653|2022|PCT|1.30|99|0.00|IP TELEMEDICINE|
20|FH_F111594_0_0|CSTM-ALL|CSTM-00|2020|PDM|2336.00|99|0.00|AEG 5  (NO REV)|
20|FH_F118587_20721_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F126889_57030_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F51123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F136393_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71043_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F142927_52402_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97160_77436_0|SrvcGrp|73841|2022|PDM|584.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F97562_29803_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F144569_71055_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148556_13206_0|SrvcGrp|17004|2022|PDM|40.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 24HRS|
20|FH_F51123_0_0|SrvcGrp|3809|2022|PDM|675.00|99|0.00|HOSPICE CARE|
20|FH_F119007_0_0|SrvcGrp|35669|2022|PDM|3692.00|99|0.00|CPT 63650|
20|FH_F88818_0_0|SrvcGrp|75481|2022|PDM|400.00|99|0.00|AEG 2|
20|FH_F74187_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117372_07442_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F67424_0_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F145781_0_0|CSTM-ALL|CSTM-00|2020|PDM|750.00|99|0.00|AEG 4 (NO REV)|
20|FH_F133815_46526_0|SrvcGrp|110896|2022|PCT|0.00|99|0.00|VBAC DELIVERY|
20|FH_F149270_98004_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F125024_66523_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|PDM|2425.00|99|0.00|AEG 6 (NO REV)|
20|FH_F132969_84003_0|SrvcGrp|17013|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F41135_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111604_16505_0|SrvcGrp|93919|2022|PDM|520.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F102302_0_0|SrvcGrp|72996|2022|PDM|1272.00|99|0.00|AEG 4|
20|FH_F66687_0_0|SrvcGrp|74020|2022|PDM|22871.00|99|0.00|CARDIAC ABLATION|
20|FH_F102561_75146_0|SrvcGrp|33985|2022|PDM|5417.00|99|0.00|CPT 19120|
20|FH_F132729_0_0|SrvcGrp|107734|2022|PDM|4476.00|99|0.00|VAGINAL DELIVERY|
20|FH_F120434_34761_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F115330_34113_0|SrvcGrp|3178|2022|PDM|625.00|99|0.00|ACUTE PSYCH|
20|FH_F148662_01583_0|SrvcGrp|115386|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F123604_72104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132810_0_0|SrvcGrp|86849|2022|PDM|40.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F56832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|HIGH COST DRUGS|
20|FH_F140734_71105_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F33530_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F142447_72758_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F119784_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 6 (NO REV)|
20|FH_F112444_07102_0|CSTM-ALL|CSTM-00|2020|PCT|0.22|99|0.00|OP SVCS|
20|FH_F89360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112187_98272_0|SrvcGrp|3044|2022|PDM|1442.00|99|0.00|TRANSITIONAL CARE UNIT|
20|FH_F148079_06512_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139591_72401_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141267_0_0|SrvcGrp|113663|2022|PDM|172.00|99|0.00|HOSPICE ROUT HOME CARE-DIEM (HCFA)|
20|FH_F97480_08204_0|SrvcGrp|73643|2022|PDM|1044.00|99|0.00|AETNA SUBACUTE 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_F38123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F97603_77901_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F133478_40165_0|SrvcGrp|26469|2022|PDM|271.00|99|0.00|CPT CODE 90935|
20|FH_F38700_0_0|SrvcGrp|18323|2022|PCT|0.80|99|0.00|MS DRG 468|
20|FH_F93275_0_0|CSTM-ALL|CSTM-00|2020|PDM|6600.00|99|0.00|AEG 8 (NO REV)|
20|FH_F150949_0_0|SrvcGrp|98497|2022|PDM|10800.00|99|0.00|ARTHRODESIS POSTERIOR TECH|
20|FH_F144769_0_0|SrvcGrp|361|2022|PDM|2309.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F148904_85255_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F55113_0_0|SrvcGrp|13854|2022|PDM|1086.00|99|0.00|HYPERBARIC CHAMBER|
20|FH_F34706_0_0|SrvcGrp|11193|2022|PDM|18793.00|99|0.00|DRG 555 PERCUTANEOUS CARDIOVASCULAR PROCEDURE W/ MAJOR DX|
20|FH_F41814_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS|
20|FH_F145988_06105_0|SrvcGrp|73500|2022|PDM|786.00|99|0.00|AETNA ER LEVEL I|
20|FH_F67560_0_0|SrvcGrp|17083|2022|PCT|0.83|99|0.00|ASPG X|
20|FH_F111526_32226_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97882_32407_0|SrvcGrp|73656|2022|PDM|692.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKE|
20|FH_F35453_0_0|SrvcGrp|701|2022|PDM|1840.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F149779_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 10 (NO REV)|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF|
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|2324.00|99|0.00|AEG 4 (NO REV)|
20|FH_F118469_0_0|CSTM-ALL|CSTM-00|2020|PDM|1451.00|99|0.00|AEG 10 (NO REV)|
20|FH_F130763_0_0|SrvcGrp|89860|2022|PDM|7319.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F81838_0_0|SrvcGrp|20000|2022|PDM|165.00|99|0.00|CATHETER CARE SUPPLIES|
20|FH_F93122_01854_0|SrvcGrp|90388|2022|PDM|413.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F50657_0_0|SrvcGrp|31190|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC (DME)|
20|FH_F133207_0_0|CSTM-ALL|CSTM-00|2020|PDM|1214.00|99|0.00|AEG 2 (NO REV)|
20|FH_F143624_73069_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F88744_71103_0|CSTM-ALL|CSTM-00|2020|PDM|2874.00|99|0.00|AEG 8 (NO REV)|
20|FH_F133207_0_0|SrvcGrp|78096|2022|PDM|3809.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F115784_06831_0|SrvcGrp|76501|2022|PDM|368.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F146459_48154_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F146522_74133_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146839_17601_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F130657_04614_0|SrvcGrp|92958|2022|PCT|0.86|99|0.00|SLEEP STUDIES|
20|FH_F134826_19067_0|SrvcGrp|104440|2022|PDM|50.00|99|0.00|AETNA DRUG TEST PRSMV DIR OPT OBS|
20|FH_F38792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER 26|
20|FH_F41350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F82871_33160_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148262_17901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F148497_32162_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F36918_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME MOD RR|
20|FH_F33712_0_0|SrvcGrp|10947|2022|PCT|0.75|99|0.00|EMERGENCY ROOM|
20|FH_F130138_02915_0|SrvcGrp|91177|2022|PCT|0.96|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F84778_0_0|SrvcGrp|72998|2022|PDM|1680.00|99|0.00|AEG 5|
20|FH_F130747_0_0|SrvcGrp|99167|2022|PDM|8843.00|99|0.00|CPT 63057|
20|FH_F143834_06511_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F72369_0_0|SrvcGrp|25747|2022|PDM|1680.00|99|0.00|PROSTHETIC EYE, PLASTIC, CUSTOM|
20|FH_F93114_85016_0|SrvcGrp|93820|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
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_F134255_01201_0|SrvcGrp|89149|2022|PDM|110.00|99|0.00|OP INTENSIVE|
20|FH_F134011_84102_0|SrvcGrp|16750|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F142547_70002_0|SrvcGrp|14944|2022|PDM|2.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F77883_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F54652_0_0|CSTM-ALL|CSTM-00|2020|PDM|868.00|99|0.00|ASPG VI|
20|FH_F149889_39759_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123896_68114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F115464_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F86991_15122_0|SrvcGrp|111136|2022|PCT|1.00|99|0.00|PHENYLEPHRINE KETOROLAC INJECTION|
20|FH_F69968_0_0|CSTM-ALL|CSTM-00|2020|PDM|4556.41|99|0.00|MS DRG 765-766 CAESAREAN SECTION|
20|FH_F140615_73013_0|SrvcGrp|79786|2022|PCT|1.35|99|0.00|SLEEP STUDIES|
20|FH_F140890_30906_0|SrvcGrp|108484|2022|PDM|624.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F112165_0_0|SrvcGrp|12664|2022|PCT|0.41|99|0.00|IMPLANTS|
20|FH_F62579_0_0|CSTM-ALL|CSTM-00|2020|PDM|125.00|99|0.00|PEDIATRIC PHYSICAL THERAPY|
20|FH_F130841_49315_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|1123.63|99|0.00|AEG 6 (NO REV)|
20|FH_F120930_0_0|SrvcGrp|91941|2022|PDM|2200.00|99|0.00|NASAL/SINUS ENDOSCOPY WITH DILATION|
20|FH_F130017_02302_0|SrvcGrp|73601|2022|PDM|5007.69|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F132899_01002_0|SrvcGrp|112086|2022|PDM|649.00|99|0.00|PARTIAL HOSP EATING DISORDERS (0-17 YRS)|
20|FH_F77082_0_0|SrvcGrp|14048|2022|PCT|0.95|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN|
20|FH_F150161_63361_0|SrvcGrp|66265|2022|PDM|98.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F102842_0_0|CSTM-ALL|CSTM-00|2020|PCT|30.00|99|0.00|OP SVCS|
20|FH_F81483_0_0|SrvcGrp|11306|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F80224_0_0|SrvcGrp|3029|2022|PDM|856.00|99|0.00|NEWBORN NURSERY|
20|FH_F85894_0_0|SrvcGrp|17081|2022|PDM|4062.00|99|0.00|ASPG IX|
20|FH_F132960_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|950.00|99|0.00|ASPG IV|
20|FH_F151541_01436_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132263_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124017_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 10 (NO REV)|
20|FH_F41484_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41350_0_0|CSTM-ALL|CSTM-00|2020|PDM|2105.00|99|0.00|ASPG IX|
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|AEG 1 (NO REV)|
20|FH_F91077_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F69965_0_0|SrvcGrp|66480|2022|PDM|110.00|99|0.00|RN VISIT|
20|FH_F39479_0_0|SrvcGrp|30203|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (DME)|
20|FH_F118910_0_0|SrvcGrp|97703|2022|PDM|113.30|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F140931_24014_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|81.00|99|0.00|AETNA SLEEP STUDY CPT 95801|
20|FH_F123820_91316_0|SrvcGrp|87317|2022|PDM|1200.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F142267_78240_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F147744_33614_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F69582_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS SNF PPS|
20|FH_F141353_26452_0|SrvcGrp|79099|2022|PDM|325.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F49487_0_0|SrvcGrp|14945|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F133701_0_0|SrvcGrp|87077|2022|PDM|162.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F138527_64506_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F43007_0_0|CSTM-ALL|CSTM-00|2020|PDM|267.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140007_0_0|SrvcGrp|97279|2022|PDM|8045.00|99|0.00|REMOVE SPINE ELTRD PERQ ARAY|
20|FH_F31309_0_0|CSTM-ALL|CSTM-00|2020|PCT|77.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132262_60062_0|SrvcGrp|106248|2022|PDM|465.00|99|0.00|PARTIAL HOSP PSYCH|
20|FH_F145642_15108_0|SrvcGrp|16750|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F113470_74010_0|SrvcGrp|76501|2022|PDM|315.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F120583_43219_0|SrvcGrp|29347|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F92931_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F86658_0_0|SrvcGrp|20070|2022|PDM|90.00|99|0.00|HCPCS S9083|
20|FH_F146782_19034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133478_40165_0|SrvcGrp|20912|2022|PDM|48645.00|99|0.00|MS DRG 236 ONLY|
20|FH_F39346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F90157_0_0|SrvcGrp|80258|2022|PCT|0.00|99|0.00|AETNA SKILLED CARE|
20|FH_F70645_0_0|SrvcGrp|9937|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F129643_33176_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122536_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F137462_03062_0|SrvcGrp|473|2022|PDM|391.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F125028_19061_0|SrvcGrp|24754|2022|PDM|15.75|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 459-460|
20|FH_F132675_53154_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F99100_0_0|SrvcGrp|96100|2022|PDM|1801.47|99|0.00|DISECTOMY (HCFA)|
20|FH_F137087_0_0|SrvcGrp|80617|2022|PDM|21000.00|99|0.00|ARTHOPLASTY|
20|FH_F148170_04005_0|SrvcGrp|2067|2022|PDM|1454.61|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F125746_45331_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_F91663_19901_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F88096_0_0|SrvcGrp|70749|2022|PDM|2100.00|99|0.00|CPT 29823|
20|FH_F145946_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F53732_0_0|SrvcGrp|40824|2022|PDM|90.00|99|0.00|DELIVERY/SERVICE (HIGH RISK)|
20|FH_F138542_40324_0|SrvcGrp|73842|2022|PDM|171.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F140830_70056_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50519_0_0|SrvcGrp|46769|2022|PDM|40.00|99|0.00|CPT CODE 90853 PER VISIT|
20|FH_F101945_0_0|SrvcGrp|98405|2022|PDM|1025.00|99|0.00|REPAIR OF NOSE FRACTURE|
20|FH_F83997_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F109513_0_0|SrvcGrp|27343|2022|PDM|4000.00|99|0.00|OP SURGERY (CPT 25607 - 25609)|
20|FH_F135653_0_0|CSTM-ALL|CSTM-00|2020|PDM|1388.00|99|0.00|AEG 4 (NO REV)|
20|FH_F98040_89406_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F116143_0_0|SrvcGrp|104003|2022|PCT|1.00|99|0.00|INSERT AQUEOUS DRAIN DEVICES|
20|FH_F114866_77706_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F138929_0_0|CSTM-ALL|CSTM-00|2020|PDM|1210.00|99|0.00|AEG 4 (NO REV)|
20|FH_F49937_0_0|SrvcGrp|21594|2022|PDM|335.00|99|0.00|SKILLED NURSING|
20|FH_F122571_53555_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F136735_0_0|SrvcGrp|78046|2022|PCT|1.00|99|0.00|AETNA AQUEOUS SHUNT|
20|FH_F36318_0_0|SrvcGrp|16|2022|PDM|1244.00|99|0.00|ACUTE REHABILITATION|
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 5  (NO REV)|
20|FH_F43859_0_0|SrvcGrp|30961|2022|PDM|12.50|99|0.00|HOME HEALTH AIDE|
20|FH_F136778_62034_0|SrvcGrp|37918|2022|PDM|660.00|99|0.00|NUCLEAR MEDICINE SCAN|
20|FH_F116393_07002_0|SrvcGrp|111281|2022|PDM|7.65|99|0.00|URINALYSIS W/SCOPE|
20|FH_F34048_0_0|SrvcGrp|21778|2022|PCT|0.70|99|0.00|BONE MARROW TRANSPLANT|
20|FH_F48348_61605_0|SrvcGrp|10675|2022|PDM|2587.00|99|0.00|ICU/CCU|
20|FH_F81823_0_0|SrvcGrp|66480|2022|PDM|75.00|99|0.00|RN VISIT|
20|FH_F134288_33919_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F87500_16823_0|SrvcGrp|79720|2022|PDM|1231.00|99|0.00|ACUTE REHAB II|
20|FH_F150459_08021_0|SrvcGrp|46605|2022|PDM|116.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F69183_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|ASPG V - FH SW CUSTOM GROUPERS|
20|FH_F125656_92868_0|SrvcGrp|112764|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJECTION DRUGS|
20|FH_F112805_46011_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F75489_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130723_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138017_73129_0|CSTM-ALL|CSTM-00|2020|PDM|1528.00|99|0.00|AEG 3 (NO REV)|
20|FH_F134819_0_0|SrvcGrp|57863|2022|PDM|1364.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F148379_89129_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F39171_61362_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F103400_33426_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F37904_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97882_32407_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F115315_43011_0|SrvcGrp|94741|2022|PCT|1.00|99|0.00|FLULAVAL VACC IM (>=3 YRS)|
20|FH_F38508_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL|
20|FH_F35408_0_0|SrvcGrp|16900|2022|PDM|262.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F92676_15063_0|SrvcGrp|79012|2022|PDM|1007.77|99|0.00|MON VALLEY ASC 221|
20|FH_F144709_48076_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PDM|858.00|99|0.00|AEG 6 (NO REV)|
20|FH_F130656_04401_0|SrvcGrp|79699|2022|PCT|0.89|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F111903_26241_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|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_F122067_0_0|SrvcGrp|13557|2022|PCT|1.00|99|0.00|CORNEAL TISSUE SVCS|
20|FH_F122067_0_0|SrvcGrp|114518|2022|PCT|1.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F120901_0_0|SrvcGrp|11663|2022|PCT|0.40|99|0.00|IMPLANTS|
20|FH_F122184_65674_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146989_80204_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F39910_0_0|SrvcGrp|97|2022|PDM|4668.00|99|0.00|C-SECTION|
20|FH_F147899_0_0|SrvcGrp|38364|2022|PDM|6000.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F117085_40207_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147522_64114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39266_0_0|SrvcGrp|28847|2022|PDM|70.00|99|0.00|PHYSICAL THERAPY|
20|FH_F41874_0_0|CSTM-ALL|CSTM-00|2020|PDM|1015.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70762_90805_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS (CMS 1500)|
20|FH_F43575_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118986_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F151441_98664_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132258_45404_0|SrvcGrp|13929|2022|PDM|11.93|99|0.00|GROWTH HORMONE|
20|FH_F111390_32960_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F127713_30012_0|SrvcGrp|88779|2022|PDM|155.00|99|0.00|PHYSICAL THERAPY|
20|FH_F150862_75082_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F131449_19073_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F34918_0_0|SrvcGrp|6|2022|PCT|0.70|99|0.00|OP SURGERY|
20|FH_F117576_21207_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F40446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F150519_92626_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137896_0_0|SrvcGrp|107865|2022|PCT|1.00|99|0.00|AETNA INJECTABLES (J CODES)|
20|FH_F91155_16105_0|SrvcGrp|74664|2022|PDM|691.00|99|0.00|AETNA SLEEP STUDIES|
20|FH_F117027_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F42453_0_0|CSTM-ALL|CSTM-00|2020|PDM|614.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117385_48091_0|SrvcGrp|105425|2022|PDM|60.00|99|0.00|AETNA EXPOSURE ADAPTIVE BH TREATMENT 60 MINS|
20|FH_F35982_0_0|CSTM-ALL|CSTM-00|2020|PDM|612.00|99|0.00|ASPG III|
20|FH_F142818_34209_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101104_0_0|SrvcGrp|90338|2022|PDM|125.00|99|0.00|SKILLED NURSING RN (HCFA)|
20|FH_F38663_0_0|SrvcGrp|11798|2022|PDM|85.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F97541_33021_0|SrvcGrp|88977|2022|PDM|7855.00|99|0.00|C-SECTION DELIVERY|
20|FH_F130755_04401_0|SrvcGrp|92958|2022|PCT|0.93|99|0.00|SLEEP STUDIES|
20|FH_F146663_25311_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103320_0_0|SrvcGrp|73004|2022|PDM|1429.00|99|0.00|AEG 8|
20|FH_F41660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F132969_84003_0|SrvcGrp|29076|2022|PDM|25.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 5  (NO REV)|
20|FH_F67887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F54592_0_0|SrvcGrp|40706|2022|PDM|26.66|99|0.00|ANTIBIOTIC AEROSOLIZED THERAPY W/ MOD SJ|
20|FH_F84712_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F122680_53511_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122727_64030_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F47999_0_0|SrvcGrp|42826|2022|PDM|104.50|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F144648_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F122038_34606_0|SrvcGrp|87317|2022|PDM|743.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F139447_40336_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F149083_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F40690_0_0|CSTM-ALL|CSTM-00|2020|PDM|1210.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38860_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F139167_42240_0|SrvcGrp|89417|2022|PDM|372.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F124760_34997_0|SrvcGrp|73841|2022|PDM|435.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F116793_0_0|SrvcGrp|75545|2022|PDM|245.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F136887_0_0|SrvcGrp|40003|2022|PDM|14057.00|99|0.00|TOTAL KNEE|
20|FH_F40762_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148548_37909_0|SrvcGrp|58634|2022|PDM|5175.00|99|0.00|NEUROELECTRODES IMPLANT|
20|FH_F34706_0_0|SrvcGrp|3711|2022|PDM|7792.00|99|0.00|DRG 534 EXTRACRANIAL VASCULAR PROCEDURES W/O CC|
20|FH_F109404_0_0|SrvcGrp|82603|2022|PCT|0.90|99|0.00|AETNA HUMAN IG IM|
20|FH_F67861_0_0|SrvcGrp|11000|2022|PCT|0.60|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F119379_0_0|SrvcGrp|107826|2022|PDM|1700.00|99|0.00|REMOVAL OF WRIST BONE|
20|FH_F109360_32514_0|SrvcGrp|86722|2022|PDM|215.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F133585_0_0|SrvcGrp|107544|2022|PDM|8230.00|99|0.00|ILIAC REVASC W/ STENT|
20|FH_F145781_0_0|SrvcGrp|114308|2022|PDM|1300.00|99|0.00|PARTIAL REMVL OF EYE FLUID|
20|FH_F133658_60053_0|SrvcGrp|66264|2022|PDM|106.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F134826_19067_0|SrvcGrp|58509|2022|PDM|350.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F151139_0_0|SrvcGrp|100959|2022|PDM|7500.00|99|0.00|AMB SRVC CONVNTION AIR TRANSPORT 1 WAY|
20|FH_F131207_19947_0|SrvcGrp|73842|2022|PDM|104.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F129656_15005_0|SrvcGrp|14947|2022|PDM|95.00|99|0.00|HOME INFUSION|
20|FH_F116311_02657_0|SrvcGrp|89412|2022|PDM|372.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F77903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F143969_71129_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F73013_0_0|SrvcGrp|26001|2022|PDM|451.32|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129019_62650_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120152_0_0|SrvcGrp|103563|2022|PDM|2420.00|99|0.00|REPAIR HAND TENDON|
20|FH_F137898_46540_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F137973_24457_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F124757_45750_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|OP SVCS|
20|FH_F97660_29401_0|SrvcGrp|73603|2022|PDM|6245.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 1 (NO REV)|
20|FH_F133002_0_0|SrvcGrp|45583|2022|PDM|1716.00|99|0.00|CPT 65730|
20|FH_F118909_0_0|SrvcGrp|80920|2022|PDM|566.50|99|0.00|HOSPICE SERVICES|
20|FH_F141336_16947_0|CSTM-ALL|CSTM-00|2020|PDM|1541.00|99|0.00|AEG 3 (NO REV)|
20|FH_F136786_25302_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F147305_90755_0|SrvcGrp|29346|2022|PDM|53.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F147446_76844_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147586_44124_0|SrvcGrp|88147|2022|PDM|2836.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA|
20|FH_F123445_0_0|SrvcGrp|89781|2022|PDM|198.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F142087_0_0|SrvcGrp|113855|2022|PDM|3000.00|99|0.00|SPINE FIXATION|
20|FH_F107360_0_0|SrvcGrp|73601|2022|PDM|1693.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F113527_31023_0|SrvcGrp|75487|2022|PCT|0.80|99|0.00|AEG 5|
20|FH_F151425_19111_0|SrvcGrp|113911|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F135350_60014_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F100763_24202_0|SrvcGrp|73601|2022|PDM|4750.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F89732_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.48|99|0.00|OP SVCS|
20|FH_F130027_76201_0|SrvcGrp|89149|2022|PDM|177.00|99|0.00|OP INTENSIVE|
20|FH_F140215_93301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F130179_62447_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F149046_53022_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F124695_33401_0|SrvcGrp|113929|2022|PDM|292.00|99|0.00|INTENSIVE OUTPATIENT (13-17 YRS)|
20|FH_F81312_0_0|SrvcGrp|29815|2022|PDM|5096.00|99|0.00|MS DRG 003-004, 207-208 ONLY|
20|FH_F97100_23462_0|SrvcGrp|73602|2022|PDM|1664.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F110783_93013_0|SrvcGrp|86839|2022|PDM|35.00|99|0.00|HCPCS S9345 (HCFA)|
20|FH_F90172_81301_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OP SVCS|
20|FH_F147360_06415_0|SrvcGrp|114471|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F147339_08837_0|SrvcGrp|74039|2022|PDM|3400.00|99|0.00|LAMINECTOMY|
20|FH_F48215_0_0|SrvcGrp|10410|2022|PDM|42.25|99|0.00|SKILLED NURSING CARE|
20|FH_F127262_68064_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F82033_0_0|SrvcGrp|79937|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F142448_15701_0|SrvcGrp|88620|2022|PDM|115.00|99|0.00|SKILLED NURSING RN|
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137818_31602_0|SrvcGrp|58509|2022|PDM|342.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F112526_0_0|SrvcGrp|63297|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F63436_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F91873_12723_0|SrvcGrp|82369|2022|PCT|1.60|99|0.00|AETNA LABORATORY|
20|FH_F108800_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 10 (NO REV)|
20|FH_F86911_0_0|SrvcGrp|86338|2022|PDM|95.00|99|0.00|CHEMOTHERAPY TWO DRUGS|
20|FH_F80513_0_0|SrvcGrp|21075|2022|PDM|25933.00|99|0.00|MS DRG 025 ONLY|
20|FH_F131702_17022_0|SrvcGrp|48396|2022|PDM|117.00|99|0.00|OT SERVICES|
20|FH_F150982_0_0|SrvcGrp|44066|2022|PDM|4184.00|99|0.00|CPT 57288|
20|FH_F125323_43213_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F120714_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83198_44125_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F45179_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F97563_83201_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F44601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|PROFESSIONAL FEES ON CMS1500|
20|FH_F92677_08003_0|SrvcGrp|41444|2022|PDM|1.16|99|0.00|ENTERAL FORMULA - NUTRITIONALLY COMPLETE|
20|FH_F111695_30286_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F146117_0_0|CSTM-ALL|CSTM-00|2020|PDM|2448.00|99|0.00|AEG 4 (NO REV)|
20|FH_F127651_44124_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F129509_0_0|SrvcGrp|77483|2022|PDM|610.00|99|0.00|AETNA OBSERVATION|
20|FH_F138447_22041_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F126099_34237_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F111908_07677_0|SrvcGrp|96403|2022|PCT|1.00|99|0.00|CIPROFLOXACIN IV|
20|FH_F134208_21502_0|CSTM-ALL|CSTM-00|2020|PDM|545.70|99|0.00|AEG 2 (NO REV)|
20|FH_F136591_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F131630_0_0|CSTM-ALL|CSTM-00|2020|PDM|2918.00|99|0.00|AEG 7 (NO REV)|
20|FH_F138353_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134488_14086_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F38076_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78446_0_0|SrvcGrp|75503|2022|PDM|45.00|99|0.00|SPEECH THERAPY|
20|FH_F134995_37055_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F93881_15009_0|SrvcGrp|111578|2022|PCT|1.22|99|0.00|BEHAVIORAL HEALTH|
20|FH_F145766_64491_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F103100_47150_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F141548_33410_0|SrvcGrp|75419|2022|PDM|575.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F93212_0_0|SrvcGrp|11663|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F148341_21222_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149889_39759_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37679_0_0|SrvcGrp|27065|2022|PDM|15.25|99|0.00|CHEMOTHERAPY (MOD SJ)|
20|FH_F93881_15009_0|SrvcGrp|99362|2022|PDM|178.00|99|0.00|DX MAMMO INCL CAD BI|
20|FH_F114064_0_0|SrvcGrp|77461|2022|PDM|1250.00|99|0.00|CPT 52356|
20|FH_F93363_63123_0|SrvcGrp|53145|2022|PCT|0.00|99|0.00|SOCIAL WORKER|
20|FH_F137033_87108_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142547_70002_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F120152_0_0|SrvcGrp|88162|2022|PDM|11000.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F118789_92211_0|SrvcGrp|74668|2022|PDM|335.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F118926_30135_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147941_06023_0|SrvcGrp|106295|2022|PDM|1186.00|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1|
20|FH_F137898_46540_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F114916_30309_0|SrvcGrp|97895|2022|PDM|18500.00|99|0.00|REVISE KNEE 2|
20|FH_F104840_32565_0|SrvcGrp|75483|2022|PCT|0.69|99|0.00|AEG 3|
20|FH_F132627_0_0|SrvcGrp|111526|2022|PDM|291.00|99|0.00|HOME INFUSION THERAPY (HCFA)|
20|FH_F88933_0_0|SrvcGrp|87528|2022|PDM|5065.00|99|0.00|AETNA GYN SURGICAL PROCEDURES|
20|FH_F88933_0_0|SrvcGrp|87521|2022|PDM|2251.00|99|0.00|AETNA REPAIR OF KNEE LIGAMENT|
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 7 (NO REV)|
20|FH_F127995_84010_0|SrvcGrp|24752|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F97040_31901_0|SrvcGrp|73603|2022|PDM|9293.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F113870_10536_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F115631_65201_0|SrvcGrp|100067|2022|PDM|3177.00|99|0.00|ANKLE ARTHROSCOPY SURGERY|
20|FH_F116199_75042_0|SrvcGrp|94880|2022|PDM|138.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F126104_0_0|SrvcGrp|108041|2022|PDM|450.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F98361_12065_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F48836_0_0|SrvcGrp|30205|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU (DME)|
20|FH_F67169_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.00|99|0.00|OP SVCS|
20|FH_F50053_0_0|SrvcGrp|16277|2022|PCT|1.20|99|0.00|HIGH COST DRUGS|
20|FH_F90334_23323_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149079_70809_0|SrvcGrp|11199|2022|PDM|500.00|99|0.00|HYPERBARIC CHAMBER|
20|FH_F69606_0_0|SrvcGrp|64105|2022|PDM|785.20|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 4|
20|FH_F80087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133219_89119_0|SrvcGrp|66264|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F134828_30531_0|SrvcGrp|111929|2022|PDM|15.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F143528_0_0|SrvcGrp|104007|2022|PDM|4861.50|99|0.00|ENDOSCOPIC DCMPR 1|
20|FH_F38709_0_0|SrvcGrp|8950|2022|PDM|1751.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F148221_06477_0|SrvcGrp|93100|2022|PDM|168.00|99|0.00|RESPITE CARE|
20|FH_F139551_0_0|SrvcGrp|26278|2022|PDM|2800.00|99|0.00|CPT 29881|
20|FH_F130013_16509_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F139509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F122240_0_0|SrvcGrp|107749|2022|PDM|164.00|99|0.00|CAPD/CCPD|
20|FH_F39894_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|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_F123818_43452_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93358_63084_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F114916_30309_0|SrvcGrp|89842|2022|PDM|8000.00|99|0.00|LUMBAR|
20|FH_F92493_0_0|SrvcGrp|92369|2022|PDM|2601.06|99|0.00|REPAIR OF ANKLE LIGAMENTS|
20|FH_F40919_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35685_0_0|SrvcGrp|9889|2022|PDM|717.00|99|0.00|NICU LEVEL I & II|
20|FH_F98624_15701_0|SrvcGrp|73605|2022|PDM|2103.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F47693_16148_0|SrvcGrp|81878|2022|PCT|1.00|99|0.00|RADIOLOGY W/ REV/HCPC|
20|FH_F47462_0_0|SrvcGrp|15477|2022|PDM|130.00|99|0.00|PHYSICAL THERAPY SVCS INITIAL EVAL|
20|FH_F122076_17543_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F132328_0_0|SrvcGrp|111956|2022|PDM|2425.00|99|0.00|MALE GENITAL PROCEDURES|
20|FH_F129240_10028_0|SrvcGrp|86779|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F139677_77087_0|SrvcGrp|73841|2022|PDM|395.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F76826_0_0|SrvcGrp|18008|2022|PDM|201.00|99|0.00|DOPPLER FLOW TESTING|
20|FH_F151003_33162_0|SrvcGrp|108484|2022|PDM|670.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F149579_95815_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|INTENSIVE OP EATING DISORDER|
20|FH_F89640_98133_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F35280_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|CARDIAC EVENT MONITORING (MOD 26) F/S - TMSS|
20|FH_F119351_95377_0|CSTM-ALL|CSTM-00|2020|PCT|2.50|99|0.00|HSS ASC|
20|FH_F125478_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F144308_44512_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150500_85253_0|SrvcGrp|75419|2022|PDM|500.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD NU KC"|
20|FH_F128097_68801_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F142904_50322_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F145917_37604_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F103781_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133367_40065_0|SrvcGrp|11108|2022|PDM|792.00|99|0.00|NEWBORN NURSERY|
20|FH_F146282_08244_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142028_45714_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F88956_0_0|SrvcGrp|32542|2022|PDM|11072.00|99|0.00|MS DRG 248-251 ONLY|
20|FH_F125212_76301_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F146666_75154_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F34747_0_0|CSTM-ALL|CSTM-00|2020|PDM|1309.00|99|0.00|ASPG VII|
20|FH_F83978_66739_0|SrvcGrp|72994|2022|PDM|836.00|99|0.00|AEG 3|
20|FH_F145641_06902_0|SrvcGrp|92010|2022|PDM|3085.00|99|0.00|LESION OF TENDON SHEATH OR JOINT CAPSULE|
20|FH_F145702_22192_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F135666_37601_0|SrvcGrp|88620|2022|PDM|80.00|99|0.00|SKILLED NURSING RN|
20|FH_F149359_33301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F128816_43537_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F120735_40012_0|SrvcGrp|89149|2022|PDM|171.00|99|0.00|OP INTENSIVE|
20|FH_F142376_0_0|SrvcGrp|98580|2022|PDM|20878.00|99|0.00|ARTHRODESIS SACROILIAC JOINT|
20|FH_F41979_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F119555_0_0|SrvcGrp|40864|2022|PDM|2710.00|99|0.00|SUBACUTE CARE|
20|FH_F137937_20032_0|SrvcGrp|92760|2022|PCT|2.39|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F98041_10027_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114389_50131_0|SrvcGrp|98954|2022|PDM|102.25|99|0.00|HIT LONGTERM INFUSION (HCFA)|
20|FH_F135327_0_0|CSTM-ALL|CSTM-00|2020|PDM|953.00|99|0.00|AEG 9 (NO REV)|
20|FH_F36132_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP MAFS  MOD 26|
20|FH_F146760_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F100161_17325_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F151514_35242_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|AEG 10 (NO REV)|
20|FH_F132258_45404_0|SrvcGrp|86835|2022|PDM|11.93|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F135410_30013_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F116460_19464_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139666_26175_0|SrvcGrp|111931|2022|PDM|35.91|99|0.00|COVID-19 CDC TESTING LAB|
20|FH_F137748_95231_0|SrvcGrp|79786|2022|PCT|1.00|99|0.00|SLEEP STUDIES|
20|FH_F92716_0_0|SrvcGrp|92561|2022|PDM|465.00|99|0.00|AETNA AEG 1 GASTROINTESTINAL INSTITUTE|
20|FH_F92454_0_0|SrvcGrp|35669|2022|PDM|5900.00|99|0.00|CPT 63650|
20|FH_F74845_0_0|SrvcGrp|61198|2022|PCT|1.15|99|0.00|AZT|
20|FH_F150938_02062_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F119448_07083_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F150479_53223_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F35411_0_0|SrvcGrp|6|2022|PCT|0.65|99|0.00|OP SURGERY|
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_F117950_37110_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F56332_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F133477_90247_0|SrvcGrp|79786|2022|PCT|0.00|99|0.00|SLEEP STUDIES|
20|FH_F146117_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|ENTERAL NUTRITION VIA BOLUS|
20|FH_F121640_75062_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145641_06902_0|SrvcGrp|114241|2022|PDM|3709.00|99|0.00|REMOVAL OF FOOT FOREIGN BODY|
20|FH_F116959_0_0|SrvcGrp|97019|2022|PDM|4000.00|99|0.00|ARTHROSCOPY BICEPS TENODESIS|
20|FH_F117300_0_0|SrvcGrp|89404|2022|PDM|7360.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F111349_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F83754_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|OP SVCS|
20|FH_F137147_75006_0|SrvcGrp|73805|2022|PDM|15819.00|99|0.00|AETNA MSDRG 621 ONLY|
20|FH_F38332_0_0|SrvcGrp|18130|2022|PDM|12064.00|99|0.00|MS DRG 243|
20|FH_F79305_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102760_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F113794_0_0|SrvcGrp|48385|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F100640_48097_0|SrvcGrp|73659|2022|PDM|4683.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F117623_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138751_0_0|SrvcGrp|108042|2022|PDM|424.00|99|0.00|DIALYSIS PROC-ACUTE KIDNEY INJURY-NO ESRD|
20|FH_F94786_07974_0|SrvcGrp|17013|2022|PDM|36.75|99|0.00|HOME INFUSION THERAPY|
20|FH_F141131_20850_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114389_50131_0|SrvcGrp|54233|2022|PDM|163.41|99|0.00|WALKER|
20|FH_F115971_0_0|SrvcGrp|72998|2022|PDM|799.00|99|0.00|AEG 5|
20|FH_F37703_0_0|SrvcGrp|3809|2022|PDM|550.00|99|0.00|HOSPICE CARE|
20|FH_F122610_73139_0|SrvcGrp|67944|2022|PDM|376.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F43418_0_0|CSTM-ALL|CSTM-00|2020|PDM|2334.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F116345_78626_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F147586_44124_0|SrvcGrp|33965|2022|PDM|4669.00|99|0.00|CPT 58552|
20|FH_F147699_83704_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|1875.00|99|0.00|2006 MEDICARE ASPG IX|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|200.41|99|0.00|HAPA WPA-NWPA 2012-13 ASC 130 W/O REV|
20|FH_F121763_07202_0|SrvcGrp|100859|2022|PDM|115.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F134315_89106_0|SrvcGrp|14947|2022|PCT|1.00|99|0.00|HOME INFUSION|
20|FH_F87153_0_0|CSTM-ALL|CSTM-00|2020|PDM|490.27|99|0.00|AETNA POLYSOMNOGRAPHY|
20|FH_F87557_33309_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F139597_07009_0|SrvcGrp|75545|2022|PDM|400.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F150945_15904_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F108180_29526_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F97521_30824_0|CSTM-ALL|CSTM-00|2020|PDM|617.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC) (HCFA)|
20|FH_F148498_75028_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F91198_46714_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117872_33462_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F129175_0_0|SrvcGrp|110766|2022|PDM|94.56|99|0.00|3RD LEVEL INJ PARAVERT F JNT C/T|
20|FH_F111482_33020_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F49354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53|
20|FH_F39433_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150024_08079_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146227_66210_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92977_64067_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F149265_64429_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126896_60010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120795_27514_0|CSTM-ALL|CSTM-00|2020|PDM|2127.00|99|0.00|EATING DISORDER|
20|FH_F120811_53525_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116040_24637_0|SrvcGrp|86827|2022|PDM|55.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F35708_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F144014_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38591_0_0|SrvcGrp|33793|2022|PDM|11936.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F149086_0_0|SrvcGrp|82222|2022|PDM|169.00|99|0.00|HOSPICE CARE|
20|FH_F113410_0_0|SrvcGrp|81571|2022|PDM|1996.00|99|0.00|NASAL ENDOSCOPY W/ SINUS OSTIA DILATION|
20|FH_F151562_26003_0|SrvcGrp|113619|2022|PDM|520.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F129305_45614_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F122433_0_0|SrvcGrp|109083|2022|PDM|1400.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F77042_0_0|SrvcGrp|74384|2022|PDM|18.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F48346_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|397.72|99|0.00|HAPA WPA-NWPA 2012-13 ASC 210 W/O REV|
20|FH_F91787_0_0|CSTM-ALL|CSTM-00|2020|PDM|467.00|99|0.00|AEG 1 (NO REV)|
20|FH_F100762_51104_0|SrvcGrp|73601|2022|PDM|5186.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F148324_93101_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F137067_0_0|SrvcGrp|88596|2022|PDM|2625.00|99|0.00|EXC OF TRIANG FIBROCARTILAGE|
20|FH_F40191_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 216-237 CV SURGERY|
20|FH_F123733_70714_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F118193_06241_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F149647_92651_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F137850_32826_0|SrvcGrp|106048|2022|PDM|788.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|1884.00|99|0.00|AEG 9 (NO REV)|
20|FH_F77923_0_0|SrvcGrp|46631|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY|
20|FH_F62252_0_0|SrvcGrp|472|2022|PDM|405.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F124611_64804_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F118848_0_0|CSTM-ALL|CSTM-00|2020|PDM|2800.00|99|0.00|AEG 9 (NO REV)|
20|FH_F114666_30342_0|SrvcGrp|77021|2022|PDM|5200.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F135752_98290_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35685_0_0|CSTM-ALL|CSTM-00|2020|PDM|24255.00|99|0.00|DRG 110 ONLY MAJOR CARDIOVASCULAR PROCEDURE W/CC|
20|FH_F62761_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|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_F132268_07060_0|SrvcGrp|90488|2022|PDM|84.72|99|0.00|ORAL FUNCTION THERAPY|
20|FH_F135432_16335_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F112146_87102_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F146124_06112_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F120930_0_0|SrvcGrp|92368|2022|PDM|2500.00|99|0.00|REPAIR OF LEG TENDON|
20|FH_F40780_0_0|SrvcGrp|167|2022|PDM|500.00|99|0.00|CD (ADULT) - REHABILITATION|
20|FH_F112712_63005_0|SrvcGrp|64541|2022|PCT|0.90|99|0.00|INJECTION PROTEINASE|
20|FH_F128148_0_0|SrvcGrp|34865|2022|PDM|55.00|99|0.00|HOME HEALTH AIDE|
20|FH_F37877_0_0|CSTM-ALL|CSTM-00|2020|PDM|1412.00|99|0.00|ASPG IX|
20|FH_F81698_10457_0|SrvcGrp|17013|2022|PDM|31.50|99|0.00|HOME INFUSION THERAPY|
20|FH_F127148_63011_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F131668_97526_0|SrvcGrp|109949|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F111288_0_0|SrvcGrp|87842|2022|PDM|25500.00|99|0.00|LAPAROSCOPY - GASTRIC|
20|FH_F33592_0_0|SrvcGrp|11442|2022|PDM|480.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F141407_76226_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F135219_68506_0|SrvcGrp|73806|2022|PCT|0.81|99|0.00|AETNA ER|
20|FH_F130523_04605_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|AEG 2 (NO REV)|
20|FH_F147701_31093_0|CSTM-ALL|CSTM-00|2020|PDM|2164.00|99|0.00|AEG 1 (NO REV)|
20|FH_F41801_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F125206_0_0|SrvcGrp|11663|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F100763_24202_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F100763_24202_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F65959_0_0|SrvcGrp|45883|2022|PDM|110.00|99|0.00|OT|
20|FH_F112166_72143_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38475_0_0|CSTM-ALL|CSTM-00|2020|PDM|45.00|99|0.00|LPN HI TECH - HOURLY|
20|FH_F41317_0_0|SrvcGrp|24585|2022|PDM|400.00|99|0.00|SKILLED NURSING|
20|FH_F89851_83854_0|SrvcGrp|44282|2022|PCT|0.43|99|0.00|OBSERVATION SVCS|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF|
20|FH_F148881_33018_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F91255_19401_0|SrvcGrp|88978|2022|PDM|5985.00|99|0.00|VAGINAL DELIVERY|
20|FH_F37562_0_0|SrvcGrp|12263|2022|PDM|19.50|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F148556_13206_0|SrvcGrp|24744|2022|PDM|75.00|99|0.00|PICC LINE INSERTION|
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|2678.00|99|0.00|AEG 8 (NO REV)|
20|FH_F128421_27016_0|SrvcGrp|75506|2022|PCT|0.80|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F127383_46825_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118379_32079_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F71647_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F133877_84117_0|SrvcGrp|83521|2022|PDM|93.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F75862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F48997_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143620_81504_0|SrvcGrp|46605|2022|PDM|120.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F67173_0_0|SrvcGrp|63058|2022|PDM|945.00|99|0.00|UNLISTED CODES OP SURGERY|
20|FH_F117206_0_0|SrvcGrp|72990|2022|PDM|416.00|99|0.00|AEG 1|
20|FH_F54592_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F130657_04614_0|SrvcGrp|94040|2022|PCT|0.86|99|0.00|OBSERVATION SERVICES FOR ER SERVICES|
20|FH_F111580_77004_0|SrvcGrp|11663|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F131965_0_0|SrvcGrp|97506|2022|PDM|100.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F78706_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.26|99|0.00|OP SVCS|
20|FH_F79704_0_0|SrvcGrp|76528|2022|PDM|32.61|99|0.00|HOSPICE LTCH|
20|FH_F127711_0_0|CSTM-ALL|CSTM-00|2020|PDM|2633.00|99|0.00|AEG 8 (NO REV)|
20|FH_F141548_33410_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F146255_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F127415_45822_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F125473_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F138020_20016_0|SrvcGrp|13227|2022|PDM|276.15|99|0.00|CPT CODE 99283|
20|FH_F93881_15009_0|SrvcGrp|74614|2022|PDM|208.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F52854_0_0|SrvcGrp|31579|2022|PDM|10984.00|99|0.00|BRACHYTHERAPY SVCS|
20|FH_F83352_06114_0|SrvcGrp|48394|2022|PDM|31.50|99|0.00|SKILLED NURSING SERVICES|
20|FH_F135187_80229_0|SrvcGrp|92761|2022|PCT|1.10|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134160_19006_0|SrvcGrp|107353|2022|PDM|336.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY (HCFA)|
20|FH_F108680_0_0|SrvcGrp|87679|2022|PDM|1595.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F36590_0_0|CSTM-ALL|CSTM-00|2020|PDM|616.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F130309_17044_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F132069_63128_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35757_34652_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F112306_81428_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F50415_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|HOME INF- REV 640 MOD SJ|
20|FH_F112863_0_0|SrvcGrp|104262|2022|PDM|1141.00|99|0.00|COMPOSITE SKIN GRAFT|
20|FH_F119946_36109_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F76522_0_0|CSTM-ALL|CSTM-00|2020|PDM|2298.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F126554_0_0|CSTM-ALL|CSTM-00|2020|PDM|1210.00|99|0.00|AEG 10 (NO REV)|
20|FH_F139309_0_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F131392_17004_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F132254_40207_0|SrvcGrp|17015|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F110722_19966_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40739_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|ACUTE PSYCH|
20|FH_F97623_38008_0|CSTM-ALL|CSTM-00|2020|PCT|0.36|99|0.00|OP SVCS|
20|FH_F150441_76132_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F75606_0_0|SrvcGrp|27761|2022|PDM|2836.00|99|0.00|ICU/CCU|
20|FH_F35557_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F138018_17313_0|SrvcGrp|24745|2022|PDM|103.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F150882_84041_0|SrvcGrp|95761|2022|PDM|47.00|99|0.00|NURSING CARE (HCFA)|
20|FH_F98940_70506_0|SrvcGrp|73559|2022|PDM|5801.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F76826_0_0|SrvcGrp|74446|2022|PDM|199.00|99|0.00|RADIOACTIVE DYE|
20|FH_F110193_70444_0|SrvcGrp|3178|2022|PDM|898.00|99|0.00|ACUTE PSYCH|
20|FH_F133519_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F97603_77901_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F100662_27534_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F33712_0_0|SrvcGrp|10903|2022|PDM|750.00|99|0.00|EMERGENCY ROOM LEVEL I|
20|FH_F81033_0_0|SrvcGrp|78659|2022|PDM|892.50|99|0.00|AETNA HYMENOTOMY, SIMPLE INCISION|
20|FH_F148265_06067_0|SrvcGrp|26275|2022|PDM|3630.00|99|0.00|CPT 29826|
20|FH_F132051_74464_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F34496_0_0|SrvcGrp|360|2022|PDM|1338.75|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F120338_83226_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1654.00|99|0.00|AEG 9 (NO REV)|
20|FH_F112755_43215_0|SrvcGrp|104303|2022|PCT|0.15|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F89372_0_0|SrvcGrp|109151|2022|PDM|14288.00|99|0.00|IP SURGICAL SVCS|
20|FH_F87480_0_0|SrvcGrp|41335|2022|PDM|7500.00|99|0.00|TOTAL HIP|
20|FH_F137127_72761_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F67239_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IMPLANTS, PROSTHETICS, OR SUPPLIES|
20|FH_F117219_77515_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|884.00|99|0.00|AEG 1 (NO REV)|
20|FH_F146797_44906_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F147014_33612_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F123620_0_0|SrvcGrp|106291|2022|PDM|271.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|991.63|99|0.00|2005 ASPG GROUPER X|
20|FH_F88893_0_0|CSTM-ALL|CSTM-00|2020|PDM|3850.00|99|0.00|LAPAROSCOPY|
20|FH_F97143_80012_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F135920_32211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127399_0_0|SrvcGrp|101523|2022|PDM|1665.00|99|0.00|CERCLAGE OF CERVIX|
20|FH_F101200_19020_0|SrvcGrp|98040|2022|PDM|13.13|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F38013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112086_33713_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F128185_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F129220_18445_0|SrvcGrp|104443|2022|PDM|116.00|99|0.00|AETNA OFFICE/OP VISIT EST (HCFA)|
20|FH_F128500_37215_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149662_85015_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F76285_0_0|SrvcGrp|44884|2022|PDM|172.00|99|0.00|PT SVCS INITIAL EVAL 97001 VISIT LEVEL|
20|FH_F34706_0_0|SrvcGrp|1337|2022|PDM|14575.00|99|0.00|DRG 003 CRANIOTOMY|
20|FH_F144628_21146_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117821_90049_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F35453_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F87155_04105_0|SrvcGrp|29347|2022|PDM|31.52|99|0.00|HOME HEALTH AIDE|
20|FH_F148009_71322_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133487_24293_0|SrvcGrp|23683|2022|PDM|50.00|99|0.00|SKILLED NURSING RN|
20|FH_F34706_0_0|SrvcGrp|115|2022|PDM|583.00|99|0.00|SKILLED NURSING CARE|
20|FH_F149781_37404_0|SrvcGrp|67066|2022|PDM|4668.00|99|0.00|CERVICAL SURGERY|
20|FH_F117385_48091_0|CSTM-ALL|CSTM-00|2020|PDM|30.00|99|0.00|AETNA OBSERVATIONS BEHAVIORAL 30 MINS|
20|FH_F148644_06890_0|SrvcGrp|27346|2022|PDM|4635.00|99|0.00|REPAIR BLADDER DEFECT|
20|FH_F130659_44410_0|SrvcGrp|12840|2022|PCT|1.05|99|0.00|PACEMAKER|
20|FH_F130911_06001_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148927_0_0|SrvcGrp|16684|2022|PCT|0.33|99|0.00|DRUGS|
20|FH_F114527_39047_0|SrvcGrp|67944|2022|PDM|477.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F134327_12853_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F88744_71103_0|CSTM-ALL|CSTM-00|2020|PDM|2442.00|99|0.00|AEG 6 (NO REV)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|489.24|99|0.00|HAPA WPA-NWPA 2012-13 ASC 308 W/O REV|
20|FH_F117325_19342_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F71863_0_0|SrvcGrp|9828|2022|PDM|49.50|99|0.00|HOME HEALTH AIDE|
20|FH_F102041_35010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47694_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F126345_0_0|SrvcGrp|106718|2022|PDM|1480.00|99|0.00|INDUCED ABORTION BY DILATION AND CURETTAGE|
20|FH_F132348_16214_0|SrvcGrp|88620|2022|PDM|121.00|99|0.00|SKILLED NURSING RN|
20|FH_F124246_71655_0|SrvcGrp|73605|2022|PDM|650.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F133701_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122674_94904_0|CSTM-ALL|CSTM-00|2020|PCT|3.50|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F136927_45690_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F136429_0_0|SrvcGrp|38364|2022|PDM|1400.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F131235_36049_0|SrvcGrp|108484|2022|PDM|715.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F82357_0_0|SrvcGrp|9828|2022|PDM|39.00|99|0.00|HOME HEALTH AIDE|
20|FH_F122106_60035_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F145528_76501_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F98860_96706_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F132160_0_0|SrvcGrp|85966|2022|PDM|7459.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F117950_37110_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F33972_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35411_0_0|CSTM-ALL|CSTM-00|2020|PDM|3326.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F111789_25301_0|SrvcGrp|102420|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATHETERIZATION INCIDENTAL CODES|
20|FH_F37230_0_0|SrvcGrp|15389|2022|PDM|117.00|99|0.00|SOCIAL WORKER (MEDICAL)|
20|FH_F45798_0_0|SrvcGrp|9537|2022|PDM|2933.00|99|0.00|CARDIAC CARE UNIT|
20|FH_F111266_30339_0|SrvcGrp|19742|2022|PDM|55.00|99|0.00|MID-LINE INSERTION|
20|FH_F76826_0_0|CSTM-ALL|CSTM-00|2020|PDM|1160.00|99|0.00|SKILLED NURSING|
20|FH_F35056_0_0|SrvcGrp|14740|2022|PCT|0.84|99|0.00|MENTAL HEALTH / DETOX|
20|FH_F123745_0_0|SrvcGrp|89404|2022|PDM|17000.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F36634_0_0|SrvcGrp|360|2022|PDM|1352.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F112128_63017_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150961_89169_0|SrvcGrp|48396|2022|PDM|95.00|99|0.00|OT SERVICES|
20|FH_F40624_0_0|SrvcGrp|12290|2022|PDM|1657.00|99|0.00|DETOXIFICATION|
20|FH_F136806_0_0|SrvcGrp|112952|2022|PDM|5909.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F149001_37055_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F140295_0_0|SrvcGrp|80617|2022|PDM|14935.00|99|0.00|ARTHOPLASTY|
20|FH_F147532_0_0|SrvcGrp|65720|2022|PDM|144.84|99|0.00|RESPITE CARE|
20|FH_F115483_62002_0|SrvcGrp|112834|2022|PCT|1.55|99|0.00|RADIOLOGY SERVICES|
20|FH_F149641_87113_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117905_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|80.00|99|0.00|ACUTE REHABILITATION|
20|FH_F82375_28601_0|SrvcGrp|73701|2022|PDM|54.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F47792_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 786 70% HCPCS MOD NU KC|
20|FH_F132371_19083_0|SrvcGrp|48398|2022|PDM|102.00|99|0.00|PT SERVICES|
20|FH_F132426_33844_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F112712_63005_0|SrvcGrp|17015|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F32739_0_0|CSTM-ALL|CSTM-00|2020|PCT|50.00|99|0.00|LABORATORY|
20|FH_F118815_61021_0|SrvcGrp|86746|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F84394_17402_0|CSTM-ALL|CSTM-00|2020|PDM|5716.00|99|0.00|AEG 9 (NO REV)|
20|FH_F128120_76513_0|SrvcGrp|87317|2022|PDM|815.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F144348_22601_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F72859_0_0|SrvcGrp|15507|2022|PDM|6.78|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F118708_33455_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F34706_0_0|SrvcGrp|9059|2022|PDM|16359.00|99|0.00|DRG 497 ONLY|
20|FH_F136608_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F136330_0_0|SrvcGrp|80098|2022|PDM|40.00|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE|
20|FH_F32509_0_0|SrvcGrp|11029|2022|PDM|19795.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F94300_0_0|SrvcGrp|67065|2022|PDM|3675.00|99|0.00|CERVICAL SURGERY|
20|FH_F141870_85224_0|SrvcGrp|86850|2022|PDM|35.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F70711_0_0|CSTM-ALL|CSTM-00|2020|PDM|1392.00|99|0.00|ASPG V|
20|FH_F130721_04769_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|OP SVCS|
20|FH_F130775_61701_0|SrvcGrp|90854|2022|PDM|741.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F100782_0_0|SrvcGrp|97584|2022|PDM|846.08|99|0.00|WINDBER MEDICAL CNTR ASC 211|
20|FH_F43861_0_0|SrvcGrp|27769|2022|PDM|25.00|99|0.00|SKILLED LPN HOURLY|
20|FH_F110507_33462_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F136359_0_0|SrvcGrp|82107|2022|PDM|2825.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F71685_0_0|SrvcGrp|28271|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F117344_75062_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F102200_06416_0|SrvcGrp|111742|2022|PCT|1.00|99|0.00|ADULT ENTERAL FORMULA|
20|FH_F129839_63640_0|SrvcGrp|91357|2022|PDM|54.07|99|0.00|ASA CODES & CPT4 CODE|
20|FH_F129839_63640_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37359_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.54|99|0.00|OP SVCS|
20|FH_F89779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F123280_67002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141410_13045_0|SrvcGrp|12491|2022|PCT|0.39|99|0.00|PACEMAKER|
20|FH_F120371_63136_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F41053_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F141410_13045_0|SrvcGrp|73498|2022|PDM|992.00|99|0.00|AETNA ER LEVEL III|
20|FH_F117392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147799_18052_0|SrvcGrp|43567|2022|PDM|109.57|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F77448_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F97660_29401_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|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F104840_32565_0|SrvcGrp|79977|2022|PCT|0.69|99|0.00|RADIOPHARMACEUTICALS|
20|FH_F33856_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F94740_32904_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114389_50131_0|SrvcGrp|86830|2022|PDM|47.34|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F119266_0_0|SrvcGrp|105357|2022|PDM|500.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F112187_98272_0|CSTM-ALL|CSTM-00|2020|PDM|8861.00|99|0.00|AEG 8 (NO REV)|
20|FH_F111857_68005_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147339_08837_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|AEG 9 (NO REV)|
20|FH_F149602_07109_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F149579_95815_0|SrvcGrp|115689|2022|PDM|51.29|99|0.00|PHYSIOLOGIC MONITORING REM 1ST 20 MINS|
20|FH_F36039_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F117576_21207_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|3125.00|99|0.00|AEG 7 (NO REV)|
20|FH_F132544_0_0|SrvcGrp|44461|2022|PDM|7850.00|99|0.00|INSERTION / REPLACEMENT OF SPINAL NEUROSTIMULATOR GENERATOR|
20|FH_F41275_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F123181_75057_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150003_22630_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38630_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|100% 2007 MEDICARETN  DME  MOD RR|
20|FH_F133473_21702_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101840_76054_0|SrvcGrp|26666|2022|PDM|13164.00|99|0.00|MS DRG 482 ONLY|
20|FH_F88223_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F142755_33916_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F44257_0_0|SrvcGrp|8936|2022|PCT|0.75|99|0.00|CV SURGERY 104-107 AND 109|
20|FH_F125352_90034_0|SrvcGrp|89337|2022|PDM|1325.00|99|0.00|DETOXIFICATION|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|363.00|99|0.00|HAPA EPA ASC 1|
20|FH_F97042_64804_0|SrvcGrp|73461|2022|PDM|3405.00|99|0.00|AETNA NICU IV|
20|FH_F121910_27104_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F126354_91321_0|SrvcGrp|73605|2022|PDM|860.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F112908_0_0|SrvcGrp|27968|2022|PDM|23.00|99|0.00|SKILLED NURSING LPN|
20|FH_F149300_53158_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150160_01301_0|SrvcGrp|115592|2022|PCT|1.00|99|0.00|IMMUNIZATIONS AND VACCINES|
20|FH_F133749_84604_0|SrvcGrp|47765|2022|PDM|60.00|99|0.00|HOME INFUSION NURSING SERVICE - INITIAL VISIT|
20|FH_F133207_0_0|SrvcGrp|84910|2022|PDM|3529.00|99|0.00|ENDOSCOPY|
20|FH_F42467_0_0|SrvcGrp|177|2022|PDM|950.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F97861_62223_0|SrvcGrp|73559|2022|PDM|12268.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F101100_50314_0|SrvcGrp|31704|2022|PDM|1643.00|99|0.00|MS DRG 790 ONLY|
20|FH_F115811_33410_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F127504_22556_0|SrvcGrp|87077|2022|PDM|156.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F119760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F100761_02539_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F132190_0_0|SrvcGrp|111136|2022|PDM|600.00|99|0.00|PHENYLEPHRINE KETOROLAC INJECTION|
20|FH_F113546_0_0|SrvcGrp|48398|2022|PDM|90.00|99|0.00|PT SERVICES|
20|FH_F126939_32405_0|SrvcGrp|73841|2022|PDM|360.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F38910_0_0|CSTM-ALL|CSTM-00|2020|PDM|1170.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148497_32162_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91078_0_0|SrvcGrp|86722|2022|PDM|170.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F130061_84097_0|SrvcGrp|75442|2022|PDM|770.00|99|0.00|OBSERVATION - REV 762|
20|FH_F89475_71202_0|SrvcGrp|109057|2022|PCT|1.90|99|0.00|CARDIAC STUDIES|
20|FH_F58856_0_0|SrvcGrp|22404|2022|PDM|2000.00|99|0.00|ASPG IV (REV CODE + CPT)|
20|FH_F136398_23502_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F126567_0_0|SrvcGrp|107748|2022|PDM|1200.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F140548_60527_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140571_46514_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F75804_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|PROFESSIONAL FEES ON CMS1500|
20|FH_F102184_0_0|SrvcGrp|36591|2022|PDM|7699.00|99|0.00|CPT 63685|
20|FH_F122687_0_0|SrvcGrp|90063|2022|PDM|3825.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F128358_46072_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150982_0_0|SrvcGrp|100921|2022|PDM|3303.00|99|0.00|SPI  PROSTH DEVICE|
20|FH_F63141_0_0|SrvcGrp|14210|2022|PDM|370.00|99|0.00|PSYCH INTENSIVE OUTPATIENT|
20|FH_F118195_44039_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F140787_66427_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F92636_90230_0|SrvcGrp|73701|2022|PDM|26.25|99|0.00|AETNA - SKILLED NURSING|
20|FH_F109885_35473_0|SrvcGrp|46903|2022|PDM|637.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F115452_15235_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F147725_06002_0|SrvcGrp|84307|2022|PDM|2475.00|99|0.00|TENDON REPAIR|
20|FH_F109821_0_0|SrvcGrp|78704|2022|PDM|3570.00|99|0.00|AETNA FRAGMENTING OF KIDNEY STONE|
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|864.00|99|0.00|COVENTRY ENHANCED DEFAULT 10021-69990|
20|FH_F129487_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F106822_0_0|SrvcGrp|82744|2022|PDM|9.58|99|0.00|URINE CULTURE COLONY COUNT|
20|FH_F118962_0_0|CSTM-ALL|CSTM-00|2020|PDM|712.07|99|0.00|AEG 3 (NO REV)|
20|FH_F42837_0_0|SrvcGrp|12045|2022|PDM|825.00|99|0.00|SLEEP STUDIES|
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|1925.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F36476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F111853_0_0|SrvcGrp|43741|2022|PDM|870.00|99|0.00|REHABILIATION - SEMI-PRIVATE 3/4 BEDS|
20|FH_F150745_03301_0|SrvcGrp|80918|2022|PDM|718.00|99|0.00|RESPITE CARE|
20|FH_F40530_0_0|SrvcGrp|38|2022|PDM|2500.00|99|0.00|NORMAL DELIVERY|
20|FH_F36299_0_0|SrvcGrp|58|2022|PCT|0.85|99|0.00|IP LITHOTRIPSY SVCS|
20|FH_F129340_43212_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73262_0_0|SrvcGrp|59445|2022|PDM|525.00|99|0.00|MRI|
20|FH_F134874_80120_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F123144_0_0|SrvcGrp|73004|2022|PDM|1093.00|99|0.00|AEG 8|
20|FH_F151521_45882_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F126735_38018_0|SrvcGrp|89337|2022|PDM|765.00|99|0.00|DETOXIFICATION|
20|FH_F117829_45227_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 252-254 CV SURGERY|
20|FH_F63235_0_0|SrvcGrp|72996|2022|PDM|2499.00|99|0.00|AEG 4|
20|FH_F130715_98503_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F110184_0_0|SrvcGrp|9875|2022|PDM|1100.00|99|0.00|ACUTE IP MEDICAL SERVICES|
20|FH_F133774_06062_0|SrvcGrp|471|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F125053_0_0|SrvcGrp|73006|2022|PDM|1547.00|99|0.00|AEG 9|
20|FH_F91873_12723_0|SrvcGrp|72998|2022|PDM|3040.00|99|0.00|AEG 5|
20|FH_F62624_0_0|SrvcGrp|27160|2022|PDM|5440.00|99|0.00|MS DRG 242-243 ONLY|
20|FH_F134817_30339_0|SrvcGrp|23683|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F39622_0_0|CSTM-ALL|CSTM-00|2020|PDM|3500.00|99|0.00|ACUTE IP SVCS ONE DAY STAY|
20|FH_F62680_0_0|SrvcGrp|1168|2022|PDM|528.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F136130_10029_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F123162_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 6 (NO REV)|
20|FH_F148554_85016_0|SrvcGrp|115467|2022|PDM|1428.00|99|0.00|RIGHT HEART CATH|
20|FH_F133028_08021_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F39723_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM (HCFA)|
20|FH_F141612_19605_0|SrvcGrp|105421|2022|PDM|341.00|99|0.00|AETNA TERANIAL MAGN STIM TX PLAN|
20|FH_F142900_32792_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133291_33563_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97161_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 2 (NO REV)|
20|FH_F121016_32607_0|SrvcGrp|83799|2022|PDM|1000.00|99|0.00|VAGINAL DELIVERY-NO ANTEPARTUM|
20|FH_F111809_93003_0|CSTM-ALL|CSTM-00|2020|PCT|0.97|99|0.00|OP SVCS|
20|FH_F126808_15005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40030_0_0|SrvcGrp|13293|2022|PCT|0.70|99|0.00|HIGH-COST DRUGS|
20|FH_F97103_53295_0|SrvcGrp|88978|2022|PDM|6626.00|99|0.00|VAGINAL DELIVERY|
20|FH_F146320_27610_0|SrvcGrp|107878|2022|PDM|3142.00|99|0.00|INTRO CATH DIALYSIS CIRCUIT|
20|FH_F150123_60515_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87577_80016_0|SrvcGrp|111768|2022|PCT|0.50|99|0.00|CHEMOTHERAPY DRUGS|
20|FH_F123324_0_0|SrvcGrp|3418|2022|PDM|2914.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PDM|5417.00|99|0.00|AEG 7 (NO REV)|
20|FH_F59274_0_0|SrvcGrp|48396|2022|PDM|32.00|99|0.00|OT SERVICES|
20|FH_F70606_0_0|SrvcGrp|472|2022|PDM|650.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F151159_46322_0|SrvcGrp|66264|2022|PDM|97.75|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F121338_37756_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129130_92562_0|SrvcGrp|111455|2022|PDM|45950.00|99|0.00|SPINAL PROCEDURES (0-4 DAYS)|
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|1716.66|99|0.00|AEG 9 (NO REV)|
20|FH_F143611_84065_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F118300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|69.66|99|0.00|HAPA WPA-NWPA 2012-13 ASC 246 W/O REV|
20|FH_F145641_06902_0|SrvcGrp|100044|2022|PDM|3697.00|99|0.00|INCISION OF HEEL BONE|
20|FH_F150225_03051_0|SrvcGrp|115818|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F116806_0_0|SrvcGrp|107069|2022|PDM|1923.16|99|0.00|REPAIR SALIVARY DUCT|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109360_32514_0|SrvcGrp|89149|2022|PDM|215.00|99|0.00|OP INTENSIVE|
20|FH_F132969_84003_0|SrvcGrp|48394|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F112023_12866_0|SrvcGrp|103617|2022|PDM|3329.00|99|0.00|NORMAL DELIVERY (MOM)|
20|FH_F72262_0_0|SrvcGrp|10391|2022|PDM|1600.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F84652_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F102200_06416_0|SrvcGrp|86832|2022|PDM|10.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F146655_80226_0|SrvcGrp|104079|2022|PCT|1.25|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F132028_68776_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS ASC|
20|FH_F111823_32539_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F37772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F132130_0_0|SrvcGrp|86505|2022|PDM|1500.00|99|0.00|DENTAL SURGERY|
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 6 (NO REV)|
20|FH_F126858_43113_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F114024_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|AEG 1 (NO REV)|
20|FH_F130652_51101_0|SrvcGrp|472|2022|PDM|485.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F132285_89103_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148680_33311_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F151142_35406_0|SrvcGrp|115762|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F151155_26508_0|SrvcGrp|69074|2022|PDM|140.00|99|0.00|CPT 99203|
20|FH_F119379_0_0|SrvcGrp|76602|2022|PDM|885.00|99|0.00|CPT 25000|
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|980.00|99|0.00|AEG 8 (NO REV)|
20|FH_F120603_66112_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F142376_0_0|SrvcGrp|98564|2022|PDM|17545.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F132802_68022_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
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_F70883_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|106% OF ASP DRUGS/IMMUN UPDATE QUARTERLY|
20|FH_F132937_88201_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F133478_40165_0|SrvcGrp|19633|2022|PDM|63925.00|99|0.00|MS DRG 226 ONLY|
20|FH_F111666_06517_0|SrvcGrp|112868|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F46732_0_0|SrvcGrp|29402|2022|PDM|144.00|99|0.00|HOME HEALTH THERAPY VISITS OP|
20|FH_F120952_25303_0|SrvcGrp|48385|2022|PDM|130.00|99|0.00|SPEECH THERAPY|
20|FH_F66687_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.87|99|0.00|GENERAL ACUTE CARE|
20|FH_F127375_28621_0|SrvcGrp|30571|2022|PDM|2126.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F149869_03253_0|SrvcGrp|53987|2022|PDM|75.00|99|0.00|PHOTOTHERAPY|
20|FH_F118050_77565_0|SrvcGrp|46903|2022|PDM|475.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F117504_31088_0|SrvcGrp|92502|2022|PDM|599.33|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F125249_0_0|SrvcGrp|100070|2022|PDM|1200.00|99|0.00|REVISION OF UNSTABLE KNEECAP|
20|FH_F130846_28304_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F147941_06023_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F44855_0_0|SrvcGrp|33643|2022|PCT|0.85|99|0.00|OCN F/S PRICING: GLOBAL (DME)|
20|FH_F88512_0_0|SrvcGrp|73867|2022|PDM|4148.45|99|0.00|NORMAL DELIVERY|
20|FH_F150900_19104_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F40599_0_0|SrvcGrp|10|2022|PDM|12360.00|99|0.00|ANGIOPLASTY|
20|FH_F117366_33162_0|SrvcGrp|86728|2022|PCT|1.00|99|0.00|RHOGAM INJECTION|
20|FH_F127545_45227_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130763_0_0|SrvcGrp|36864|2022|PDM|13330.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F34603_0_0|CSTM-ALL|CSTM-00|2020|PCT|89.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F113453_80020_0|SrvcGrp|472|2022|PDM|433.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F150165_06032_0|SrvcGrp|71666|2022|PDM|4429.00|99|0.00|CPT 63655|
20|FH_F130327_03867_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144248_0_0|SrvcGrp|85966|2022|PDM|7459.00|99|0.00|EXTRACAPSULAR CATARACT|
20|FH_F133972_27103_0|SrvcGrp|74147|2022|PDM|4.00|99|0.00|INFUSION S-CODE PER MONTH|
20|FH_F80172_0_0|SrvcGrp|11784|2022|PDM|70.64|99|0.00|HOME INFUSION THERAPY|
20|FH_F150141_63103_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F81037_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|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_F133133_32433_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111581_77401_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F144014_0_0|SrvcGrp|87077|2022|PDM|180.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F31227_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F36171_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F132960_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F100761_02539_0|SrvcGrp|73605|2022|PDM|2783.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F128272_60640_0|SrvcGrp|86832|2022|PDM|8.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F110066_36608_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F93791_0_0|SrvcGrp|11673|2022|PDM|2520.00|99|0.00|CPT 29888|
20|FH_F116393_07002_0|SrvcGrp|111278|2022|PDM|14.21|99|0.00|URINE BACTERIA CULTURE|
20|FH_F100906_0_0|SrvcGrp|11673|2022|PDM|3500.00|99|0.00|CPT 29888|
20|FH_F41213_0_0|SrvcGrp|472|2022|PDM|520.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F102282_06795_0|SrvcGrp|48394|2022|PDM|66.42|99|0.00|SKILLED NURSING SERVICES|
20|FH_F128753_32501_0|SrvcGrp|73605|2022|PCT|0.64|99|0.00|AETNA ACUTE PSYCH|
20|FH_F150459_08021_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F41033_0_0|SrvcGrp|17065|2022|PDM|366.00|99|0.00|ASPG I|
20|FH_F78185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115327_45320_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39844_0_0|CSTM-ALL|CSTM-00|2020|PDM|7426.00|99|0.00|MS DRG 248-251 PTCA|
20|FH_F57372_0_0|SrvcGrp|45884|2022|PDM|110.00|99|0.00|ST|
20|FH_F67803_0_0|SrvcGrp|42826|2022|PDM|120.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F145864_65084_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F49046_0_0|SrvcGrp|44860|2022|PDM|600.00|99|0.00|SKILLED NURSING, BARIATRIC|
20|FH_F133021_00910_0|SrvcGrp|112306|2022|PDM|1300.00|99|0.00|ULTRASOUND|
20|FH_F35411_0_0|SrvcGrp|13169|2022|PCT|0.65|99|0.00|RADIATION THERAPY SVCS|
20|FH_F117901_27526_0|SrvcGrp|471|2022|PDM|565.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F151081_85225_0|SrvcGrp|108484|2022|PDM|437.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F133922_70563_0|SrvcGrp|42723|2022|PDM|110.79|99|0.00|SLEEP STUDIES CPT 95806 W/MODIFIER TC|
20|FH_F138024_40509_0|SrvcGrp|112868|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133895_61530_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F127091_62016_0|SrvcGrp|66265|2022|PDM|98.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F133585_0_0|SrvcGrp|35664|2022|PDM|1786.00|99|0.00|VNUS CLOSURE|
20|FH_F127071_82435_0|SrvcGrp|75419|2022|PDM|1100.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F110589_70809_0|SrvcGrp|73841|2022|PDM|452.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F120384_0_0|SrvcGrp|108082|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|771.15|99|0.00|HAPA WPA-NWPA 2012-13 ASC 302 W/O REV|
20|FH_F114823_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F150165_06032_0|SrvcGrp|106264|2022|PDM|6450.00|99|0.00|NSL/SINS NDSC W/ SINS DILATION|
20|FH_F105145_75075_0|SrvcGrp|75506|2022|PCT|0.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F116697_11703_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112374_0_0|SrvcGrp|17100|2022|PDM|832.00|99|0.00|SKILLED NURSING|
20|FH_F111826_0_0|SrvcGrp|73008|2022|PDM|1045.00|99|0.00|AEG 10|
20|FH_F37679_0_0|SrvcGrp|27129|2022|PDM|3.75|99|0.00|INTERMITTENT ANTICOAGULANT THERAPY (MOD SJ)|
20|FH_F141410_13045_0|SrvcGrp|111930|2022|PDM|14.30|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|AEG 10 (NO REV)|
20|FH_F48346_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125138_63663_0|SrvcGrp|27968|2022|PDM|60.00|99|0.00|SKILLED NURSING LPN|
20|FH_F109645_0_0|SrvcGrp|42404|2022|PDM|42.00|99|0.00|VENIPUNCTURE|
20|FH_F148265_06067_0|SrvcGrp|115356|2022|PDM|4773.00|99|0.00|WEDGING OF CLUBFOOT CAST|
20|FH_F78162_0_0|CSTM-ALL|CSTM-00|2020|PDM|440.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132092_0_0|SrvcGrp|65720|2022|PDM|169.00|99|0.00|RESPITE CARE|
20|FH_F132860_0_0|SrvcGrp|97|2022|PDM|5238.00|99|0.00|C-SECTION|
20|FH_F92454_0_0|CSTM-ALL|CSTM-00|2020|PDM|757.12|99|0.00|AEG 2 (NO REV)|
20|FH_F147306_70115_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F92413_07631_0|SrvcGrp|27968|2022|PDM|45.68|99|0.00|SKILLED NURSING LPN|
20|FH_F148667_0_0|SrvcGrp|54943|2022|PDM|2856.00|99|0.00|REPAIR OF SLAP LESION|
20|FH_F125656_92868_0|SrvcGrp|24750|2022|PDM|35.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F131028_49735_0|SrvcGrp|97507|2022|PDM|130.00|99|0.00|AETNA HOSPICE|
20|FH_F39443_0_0|SrvcGrp|30294|2022|PDM|332.00|99|0.00|HAPA WPA ASC 106|
20|FH_F150459_08021_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F86332_75081_0|SrvcGrp|16555|2022|PDM|65.00|99|0.00|DIURETIC THERAPY|
20|FH_F143820_28405_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F136629_0_0|CSTM-ALL|CSTM-00|2020|PCT|81.50|99|0.00|OP SVCS|
20|FH_F88634_33952_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136299_75218_0|SrvcGrp|109057|2022|PCT|2.58|99|0.00|CARDIAC STUDIES|
20|FH_F119023_91406_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F92852_0_0|SrvcGrp|46887|2022|PDM|2200.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F129483_77030_0|SrvcGrp|29076|2022|PDM|35.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F115264_0_0|SrvcGrp|78702|2022|PDM|1392.00|99|0.00|AETNA EXTRACAPSULAR CATARAC|
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|2758.00|99|0.00|AEG 3 (NO REV)|
20|FH_F131087_0_0|SrvcGrp|106906|2022|PDM|511.00|99|0.00|AETNA SURGERY DEFAULT W/O GROUPER 1 & 2|
20|FH_F114666_30342_0|SrvcGrp|97895|2022|PDM|18500.00|99|0.00|REVISE KNEE 2|
20|FH_F135748_60455_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141170_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 8 (NO REV)|
20|FH_F147519_52627_0|SrvcGrp|114925|2022|PDM|5346.64|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F138936_01040_0|SrvcGrp|109057|2022|PCT|1.40|99|0.00|CARDIAC STUDIES|
20|FH_F44293_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.70|99|0.00|OP SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|295.01|99|0.00|HAPA WPA-NWPA 2012-13 ASC 120 W/O REV|
20|FH_F109264_33431_0|SrvcGrp|46903|2022|PDM|665.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F135623_53115_0|SrvcGrp|97506|2022|PDM|100.00|99|0.00|AETNA HOSPICE ALL OTHER CARE|
20|FH_F47370_0_0|CSTM-ALL|CSTM-00|2020|PDM|60.00|99|0.00|OP SVCS|
20|FH_F67887_0_0|SrvcGrp|13703|2022|PDM|31.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F95631_33705_0|SrvcGrp|73461|2022|PDM|5957.00|99|0.00|AETNA NICU IV|
20|FH_F37679_0_0|SrvcGrp|10579|2022|PDM|35.00|99|0.00|HYDRATION THERAPY - 2 LITERS|
20|FH_F123464_63841_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F47733_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38526_0_0|SrvcGrp|38|2022|PDM|2100.00|99|0.00|NORMAL DELIVERY|
20|FH_F151526_28208_0|SrvcGrp|107792|2022|PDM|11273.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F79704_0_0|SrvcGrp|22954|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F34550_0_0|SrvcGrp|290|2022|PDM|5200.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F118194_50841_0|SrvcGrp|48385|2022|PDM|190.00|99|0.00|SPEECH THERAPY|
20|FH_F122898_63011_0|SrvcGrp|84559|2022|PCT|1.00|99|0.00|AETNA ENTERAL & PARENTERAL|
20|FH_F69968_0_0|SrvcGrp|17077|2022|PDM|2546.77|99|0.00|ASPG VII|
20|FH_F138584_30912_0|SrvcGrp|113403|2022|PDM|800.00|99|0.00|EXCISION OF BONE MANDIBLE|
20|FH_F109885_35473_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F80366_0_0|SrvcGrp|73000|2022|PCT|0.94|99|0.00|AEG 6|
20|FH_F87201_0_0|SrvcGrp|3809|2022|PDM|725.00|99|0.00|HOSPICE CARE|
20|FH_F36318_0_0|SrvcGrp|22798|2022|PCT|0.85|99|0.00|CARDIAC CATHETER|
20|FH_F113847_20910_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147311_37421_0|SrvcGrp|109036|2022|PDM|615.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F38476_0_0|SrvcGrp|10540|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE|
20|FH_F41989_0_0|SrvcGrp|110|2022|PDM|525.00|99|0.00|CD - REHABILITATION|
20|FH_F130996_34110_0|SrvcGrp|99073|2022|PDM|1.28|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F101558_80443_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F111292_33136_0|CSTM-ALL|CSTM-00|2020|PDM|3413.00|99|0.00|AETNA OP PET SCANS (PET)|
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1225.00|99|0.00|ASPG II|
20|FH_F118651_0_0|SrvcGrp|33965|2022|PDM|4959.71|99|0.00|CPT 58552|
20|FH_F140102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150741_81506_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122841_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F37192_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36715_0_0|SrvcGrp|413|2022|PCT|0.75|99|0.00|TRANSPLANT SVCS|
20|FH_F101747_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F89112_16509_0|SrvcGrp|30623|2022|PDM|5861.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F115907_12206_0|SrvcGrp|98319|2022|PDM|302.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY (HCFA)|
20|FH_F125943_66071_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62532_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98922_40351_0|SrvcGrp|73485|2022|PDM|3135.00|99|0.00|AETNA REHAB|
20|FH_F148200_26554_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F120952_25303_0|SrvcGrp|88621|2022|PDM|120.00|99|0.00|SKILLED NURSING LPN|
20|FH_F121564_35080_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F148342_80621_0|SrvcGrp|46903|2022|PDM|750.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F139241_0_0|SrvcGrp|26281|2022|PDM|1858.00|99|0.00|CPT 58353|
20|FH_F125690_67211_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118121_46001_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 581|
20|FH_F140841_07410_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F110000_0_0|SrvcGrp|3418|2022|PDM|2813.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F117299_0_0|SrvcGrp|103237|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42932_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS|
20|FH_F42169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 4 (NO REV)|
20|FH_F134612_0_0|CSTM-ALL|CSTM-00|2020|PDM|1051.00|99|0.00|AEG 10 (NO REV)|
20|FH_F139238_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138876_25302_0|SrvcGrp|47183|2022|PDM|64.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F113390_0_0|SrvcGrp|104907|2022|PDM|3135.00|99|0.00|EXCISE PAROTID GLAND/LESION|
20|FH_F148859_0_0|SrvcGrp|85978|2022|PDM|1270.00|99|0.00|CPT 52351|
20|FH_F98000_59102_0|SrvcGrp|73659|2022|PDM|7457.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F124441_0_0|SrvcGrp|106266|2022|PDM|3325.00|99|0.00|NSL/SINS NDSC TOT W/ SPHENDT|
20|FH_F136493_0_0|SrvcGrp|97507|2022|PDM|56.00|99|0.00|AETNA HOSPICE|
20|FH_F131261_19111_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40593_0_0|SrvcGrp|474|2022|PDM|275.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F92151_74104_0|CSTM-ALL|CSTM-00|2020|PCT|0.58|99|0.00|OP SVCS|
20|FH_F117762_0_0|SrvcGrp|88023|2022|PDM|7280.00|99|0.00|REMOVAL OF ANTERIOR INSTRUMENTATION|
20|FH_F74845_0_0|SrvcGrp|10427|2022|PCT|0.85|99|0.00|TRAUMA CARE|
20|FH_F124322_64131_0|SrvcGrp|73742|2022|PDM|3.50|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F33632_52349_0|SrvcGrp|90356|2022|PCT|0.88|99|0.00|OP DIALYSIS|
20|FH_F98900_42001_0|SrvcGrp|73659|2022|PDM|4840.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F131942_50833_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F36743_0_0|SrvcGrp|115|2022|PDM|755.00|99|0.00|SKILLED NURSING CARE|
20|FH_F148859_0_0|SrvcGrp|89655|2022|PDM|18.36|99|0.00|SPECIAL RADIATION DOSIMETRY|
20|FH_F35990_0_0|SrvcGrp|361|2022|PDM|2063.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F116753_0_0|CSTM-ALL|CSTM-00|2020|PDM|1473.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F136677_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F110722_19966_0|SrvcGrp|75545|2022|PDM|340.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F84532_0_0|SrvcGrp|78878|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F136947_0_0|SrvcGrp|13422|2022|PDM|400.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F137731_92262_0|SrvcGrp|58509|2022|PDM|500.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F140289_52246_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119376_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F150459_08021_0|SrvcGrp|92502|2022|PDM|654.00|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F54056_0_0|SrvcGrp|26001|2022|PDM|139.76|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F131942_50833_0|SrvcGrp|48396|2022|PDM|120.00|99|0.00|OT SERVICES|
20|FH_F40799_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F146266_0_0|SrvcGrp|88160|2022|PDM|8444.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F150459_08021_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F45798_0_0|SrvcGrp|329|2022|PDM|17000.00|99|0.00|DRG 288 GASTROPLASTY PROCEDURE OBESITY|
20|FH_F113765_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F33632_52349_0|SrvcGrp|12659|2022|PDM|770.58|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F140094_16125_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F72749_0_0|SrvcGrp|27726|2022|PCT|0.69|99|0.00|OP SURGERY|
20|FH_F93740_0_0|SrvcGrp|91587|2022|PDM|10500.00|99|0.00|VASCULAR EMBOLIZATION OR OCCLUSION|
20|FH_F131153_66203_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F48994_0_0|CSTM-ALL|CSTM-00|2020|PDM|2089.00|99|0.00|ASPG IX- MOD 50|
20|FH_F120216_68134_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F136299_75218_0|CSTM-ALL|CSTM-00|2020|PDM|13390.00|99|0.00|AEG 9 (NO REV)|
20|FH_F132394_15317_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132387_60465_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F32928_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F118879_93063_0|SrvcGrp|73700|2022|PDM|50.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F51276_0_0|SrvcGrp|22590|2022|PDM|80.00|99|0.00|PAIN MANAGAMENT - INTERMITTENT|
20|FH_F51276_0_0|SrvcGrp|17013|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F148498_75028_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F150602_59718_0|SrvcGrp|95660|2022|PDM|543.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F100665_07939_0|SrvcGrp|73659|2022|PDM|5729.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F40465_0_0|SrvcGrp|177|2022|PDM|2288.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F133021_00910_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F44296_0_0|SrvcGrp|32394|2022|PDM|48.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F111813_08080_0|SrvcGrp|87911|2022|PCT|1.00|99|0.00|CYCLOSPORINE ORAL 100MG|
20|FH_F50221_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F126762_91311_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKL|
20|FH_F69104_0_0|SrvcGrp|58672|2022|PDM|670.19|99|0.00|ASPG I W/O CPT 64479-64480, 64483-64484|
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PDM|3903.00|99|0.00|AEG 5  (NO REV)|
20|FH_F109842_28337_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|85.97|99|0.00|HAPA WPA-NWPA 2012-13 ASC 144 W/O REV|
20|FH_F116145_0_0|SrvcGrp|3809|2022|PDM|573.47|99|0.00|HOSPICE CARE|
20|FH_F148740_93230_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F134895_0_0|CSTM-ALL|CSTM-00|2020|PDM|1369.00|99|0.00|AEG 9 (NO REV)|
20|FH_F124262_0_0|CSTM-ALL|CSTM-00|2020|PDM|758.00|99|0.00|AEG 1 (NO REV)|
20|FH_F146372_28681_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F127651_44124_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F120608_19901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F81377_0_0|SrvcGrp|68048|2022|PDM|2750.00|99|0.00|CPT 64581|
20|FH_F143563_32828_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F85055_0_0|SrvcGrp|73008|2022|PDM|525.00|99|0.00|AEG 10|
20|FH_F149679_0_0|SrvcGrp|13595|2022|PDM|198.55|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F129782_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115685_64064_0|SrvcGrp|86829|2022|PDM|35.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F92034_0_0|SrvcGrp|72996|2022|PDM|831.00|99|0.00|AEG 4|
20|FH_F90157_0_0|SrvcGrp|22529|2022|PCT|0.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F136130_10029_0|SrvcGrp|86635|2022|PCT|1.05|99|0.00|DME|
20|FH_F34272_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F90213_30084_0|SrvcGrp|26001|2022|PDM|140.02|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F129757_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115982_0_0|SrvcGrp|72998|2022|PDM|863.00|99|0.00|AEG 5|
20|FH_F50078_0_0|SrvcGrp|64716|2022|PDM|95.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F115120_19083_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F82931_18847_0|SrvcGrp|11659|2022|PDM|1996.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F83451_0_0|SrvcGrp|78096|2022|PDM|1300.00|99|0.00|AETNA ARTHROSCOPY BICEPS|
20|FH_F103902_89118_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD HOME HEALTH|
20|FH_F126585_45039_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F121925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1017.00|99|0.00|AEG 7 (NO REV)|
20|FH_F110142_39056_0|SrvcGrp|57968|2022|PDM|31.20|99|0.00|CONTINUOUS HOMECARE|
20|FH_F135051_37130_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122725_32216_0|SrvcGrp|104805|2022|PDM|61.00|99|0.00|PSYTX CRISIS EA ADDL 30 MIN|
20|FH_F139690_0_0|SrvcGrp|108043|2022|PDM|214.00|99|0.00|ACUTE KIDNEY INJURY-IPD/CAPD/CCPD-NO ESRD|
20|FH_F138558_60107_0|SrvcGrp|73841|2022|PDM|379.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F129427_92262_0|SrvcGrp|46903|2022|PDM|800.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F77983_0_0|SrvcGrp|68781|2022|PCT|1.00|99|0.00|SPECIAL STAINS GROUP 1|
20|FH_F91873_12723_0|SrvcGrp|74588|2022|PDM|2365.00|99|0.00|AETNA ARTHROSCOPY|
20|FH_F88456_0_0|SrvcGrp|63469|2022|PDM|952.00|99|0.00|CPT 55700|
20|FH_F124180_0_0|SrvcGrp|109738|2022|PDM|3000.00|99|0.00|OCULR RECNSTR; LIMBL CONJNCT|
20|FH_F124180_0_0|SrvcGrp|91381|2022|PDM|1800.00|99|0.00|REMOVAL OF ADENOIDS|
20|FH_F146896_78636_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F121799_0_0|SrvcGrp|82222|2022|PDM|103.00|99|0.00|HOSPICE CARE|
20|FH_F122740_71038_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F42244_0_0|SrvcGrp|269|2022|PCT|0.70|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F54552_0_0|SrvcGrp|27052|2022|PDM|47.50|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3HRS(MOD SH)|
20|FH_F116461_77536_0|SrvcGrp|104075|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F129682_07034_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F149579_95815_0|SrvcGrp|115667|2022|PDM|53.54|99|0.00|THERAPEUTIC MONITORING REM 1ST 20 MINS (HCFA)|
20|FH_F137896_0_0|SrvcGrp|107770|2022|PCT|1.00|99|0.00|INJECTABLES (S CODES)|
20|FH_F44019_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKC|
20|FH_F129644_0_0|SrvcGrp|103551|2022|PDM|171.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F130659_44410_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|GENERAL ACUTE CARE|
20|FH_F139678_25601_0|SrvcGrp|87317|2022|PDM|700.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F124146_46321_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F133972_27103_0|SrvcGrp|111527|2022|PDM|70.00|99|0.00|HOME INFUSION (HCFA)|
20|FH_F109652_0_0|SrvcGrp|74581|2022|PCT|0.24|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F100620_37027_0|SrvcGrp|473|2022|PDM|385.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F132988_0_0|SrvcGrp|71666|2022|PDM|27385.00|99|0.00|CPT 63655|
20|FH_F32792_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F124059_64055_0|SrvcGrp|21920|2022|PDM|25.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F136796_24016_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F64900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147528_72114_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F109963_0_0|SrvcGrp|72996|2022|PDM|715.00|99|0.00|AEG 4|
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|611.24|99|0.00|ASPG III|
20|FH_F72606_0_0|SrvcGrp|30216|2022|PCT|0.85|99|0.00|ECMO|
20|FH_F100880_67735_0|SrvcGrp|41334|2022|PDM|33000.00|99|0.00|TOTAL KNEE|
20|FH_F127713_30012_0|SrvcGrp|27969|2022|PDM|32.50|99|0.00|HOME HEALTH AIDE|
20|FH_F123745_0_0|SrvcGrp|97895|2022|PDM|16500.00|99|0.00|REVISE KNEE 2|
20|FH_F40118_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F137748_95231_0|SrvcGrp|31125|2022|PDM|7426.00|99|0.00|MS DRG 789-794 ONLY SICK BABY|
20|FH_F37081_0_0|SrvcGrp|18834|2022|PDM|52864.00|99|0.00|MS DRG 225|
20|FH_F114848_50533_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F150938_02062_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F107980_08005_0|SrvcGrp|73842|2022|PDM|150.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F133287_40215_0|CSTM-ALL|CSTM-00|2020|PCT|0.53|99|0.00|OP SVCS|
20|FH_F34706_0_0|CSTM-ALL|CSTM-00|2020|PDM|13694.00|99|0.00|DRG 519 ONLY|
20|FH_F102062_35447_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149841_73114_0|SrvcGrp|75419|2022|PDM|392.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F133333_74132_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F92677_08003_0|SrvcGrp|24752|2022|PDM|15.75|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F91155_16105_0|SrvcGrp|74800|2022|PCT|1.00|99|0.00|AETNA CHEMOTHERAPY AND ALL OTHER DRUGS|
20|FH_F133261_78041_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F142041_44846_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F50462_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F110642_17901_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F148439_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F121225_98902_0|SrvcGrp|17011|2022|PDM|105.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F119937_0_0|SrvcGrp|82222|2022|PDM|127.00|99|0.00|HOSPICE CARE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|2026.41|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1 W/O REV|
20|FH_F134229_0_0|SrvcGrp|112538|2022|PDM|15000.00|99|0.00|KNEE REPLACEMENT|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|602.26|99|0.00|HAPA WPA-NWPA 2012-13 ASC 209 W/O REV|
20|FH_F126348_23824_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125011_74467_0|SrvcGrp|72984|2022|PCT|0.00|99|0.00|CHEMOTHERAPY|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 216-218 CARDIAC VALVE PROCEDURE W/ CARDIAC CATH|
20|FH_F128883_89521_0|SrvcGrp|88621|2022|PDM|105.00|99|0.00|SKILLED NURSING LPN|
20|FH_F130452_48801_0|SrvcGrp|109268|2022|PCT|1.00|99|0.00|TELEMEDICINE/LEAVE OF ABSENCE|
20|FH_F141527_36830_0|SrvcGrp|86841|2022|PDM|53.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F40834_0_0|SrvcGrp|118|2022|PCT|0.80|99|0.00|LONG-TERM CARE|
20|FH_F136374_34461_0|SrvcGrp|112864|2022|PDM|849.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F109513_0_0|SrvcGrp|90384|2022|PDM|10000.00|99|0.00|TOTAL HIP ARTHROPLASTY|
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|2409.00|99|0.00|AEG 6 (NO REV)|
20|FH_F123774_0_0|SrvcGrp|72996|2022|PDM|898.00|99|0.00|AEG 4|
20|FH_F54432_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36344_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F101620_47401_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F101852_78758_0|SrvcGrp|89149|2022|PDM|185.00|99|0.00|OP INTENSIVE|
20|FH_F71468_0_0|SrvcGrp|10545|2022|PDM|70.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F134410_46807_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|26279|2022|PDM|2202.00|99|0.00|CPT 29884|
20|FH_F134916_16421_0|SrvcGrp|13681|2022|PDM|247.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F130309_17044_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F147200_61944_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F112796_63703_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97181_33143_0|SrvcGrp|89417|2022|PDM|1000.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F45435_0_0|SrvcGrp|12702|2022|PDM|45.00|99|0.00|RN, INTERMITTENT VISIT|
20|FH_F141940_50023_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F111401_29425_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F45977_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F93421_0_0|SrvcGrp|3809|2022|PDM|591.08|99|0.00|HOSPICE CARE|
20|FH_F135466_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 1 (NO REV)|
20|FH_F136751_0_0|CSTM-ALL|CSTM-00|2020|PDM|2700.00|99|0.00|AEG 3 (NO REV)|
20|FH_F111316_0_0|SrvcGrp|86723|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F69084_0_0|CSTM-ALL|CSTM-00|2020|PDM|576.00|99|0.00|AEG 10 (NO REV)|
20|FH_F92531_0_0|SrvcGrp|88162|2022|PDM|3383.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F98002_27103_0|SrvcGrp|73605|2022|PDM|2098.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F83754_0_0|SrvcGrp|113017|2022|PDM|1410.00|99|0.00|NORMAL NEWBORN VIA C-SECTION|
20|FH_F129440_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F144228_0_0|SrvcGrp|98133|2022|PDM|1770.00|99|0.00|AMPUTATION TOE|
20|FH_F127849_43920_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F42626_0_0|SrvcGrp|31834|2022|PCT|1.00|99|0.00|TRANSPORTATION SERVICES|
20|FH_F117344_75062_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
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_F148266_45419_0|CSTM-ALL|CSTM-00|2020|PDM|451.00|99|0.00|AEG 1 (NO REV)|
20|FH_F107800_34609_0|SrvcGrp|3178|2022|PDM|637.00|99|0.00|ACUTE PSYCH|
20|FH_F38875_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|RAD MOD TC|
20|FH_F109581_0_0|SrvcGrp|75497|2022|PDM|886.00|99|0.00|AEG 10|
20|FH_F123285_54157_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148486_03110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F37679_0_0|SrvcGrp|26845|2022|PDM|30.50|99|0.00|IMMUNOTHERAPY (MOD SH)|
20|FH_F125999_77064_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122893_29135_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F80284_16354_0|SrvcGrp|76012|2022|PDM|418.00|99|0.00|EMERGENCY ROOM SVCS LEVEL V|
20|FH_F109346_0_0|SrvcGrp|2047|2022|PDM|2860.00|99|0.00|BIRTHING CENTER|
20|FH_F122536_0_0|CSTM-ALL|CSTM-00|2020|PDM|3796.00|99|0.00|ASPG II|
20|FH_F133671_89102_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F111288_0_0|SrvcGrp|113480|2022|PDM|32640.00|99|0.00|GASTRIC RESTRICTIVE|
20|FH_F134011_84102_0|SrvcGrp|22593|2022|PDM|25.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F138778_90066_0|SrvcGrp|73842|2022|PDM|325.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149647_92651_0|SrvcGrp|106722|2022|PDM|1250.00|99|0.00|IP REHAB|
20|FH_F129504_02871_0|SrvcGrp|43567|2022|PDM|118.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F117105_77619_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F91067_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F114916_30309_0|SrvcGrp|97730|2022|PDM|18000.00|99|0.00|REVERSE HIP JOINT|
20|FH_F119266_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136570_32084_0|SrvcGrp|89149|2022|PDM|107.00|99|0.00|OP INTENSIVE|
20|FH_F81832_13827_0|SrvcGrp|46424|2022|PDM|204.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F122610_73139_0|SrvcGrp|73004|2022|PDM|8727.00|99|0.00|AEG 8|
20|FH_F115144_71373_0|SrvcGrp|3099|2022|PDM|153.00|99|0.00|OP SURGERY|
20|FH_F36704_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F120630_33161_0|SrvcGrp|73842|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F145468_60615_0|SrvcGrp|23683|2022|PDM|55.00|99|0.00|SKILLED NURSING RN|
20|FH_F135583_17331_0|SrvcGrp|24598|2022|PDM|3100.00|99|0.00|MS DRG 945-946 ONLY|
20|FH_F97142_94535_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F101661_08879_0|SrvcGrp|90854|2022|PDM|755.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F107840_07006_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F113806_53083_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F117617_80439_0|SrvcGrp|107589|2022|PDM|165.00|99|0.00|HOSPICE CARE PROV NURSING LTC FAC (HCFA)|
20|FH_F119008_0_0|SrvcGrp|29155|2022|PDM|100.00|99|0.00|HOSPICE SVCS|
20|FH_F148432_01585_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F124608_0_0|SrvcGrp|11673|2022|PDM|4284.00|99|0.00|CPT 29888|
20|FH_F141870_85224_0|SrvcGrp|86830|2022|PDM|5.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F44342_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F146218_50009_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35615_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149999_33150_0|SrvcGrp|74668|2022|PDM|275.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F42453_0_0|SrvcGrp|167|2022|PDM|367.00|99|0.00|CD (ADULT) - REHABILITATION|
20|FH_F41181_0_0|SrvcGrp|13811|2022|PDM|442.00|99|0.00|PSYCH PARTIAL HOSP|
20|FH_F54552_0_0|SrvcGrp|24762|2022|PDM|150.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F113131_19013_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|981.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 4|
20|FH_F44952_0_0|SrvcGrp|22954|2022|PDM|135.11|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F80952_45669_0|CSTM-ALL|CSTM-00|2020|PDM|1043.55|99|0.00|AEG 4 (NO REV)|
20|FH_F117550_0_0|SrvcGrp|83057|2022|PDM|28.00|99|0.00|AETNA THERAPEUTIC EXERCISES|
20|FH_F89011_75006_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F51129_0_0|SrvcGrp|11336|2022|PCT|0.55|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F42719_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F119783_46360_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|564.40|99|0.00|HAPA WPA-NWPA 2012-13 ASC 306 W/O REV|
20|FH_F134590_53223_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F145697_52302_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|825.00|99|0.00|AEG 5  (NO REV)|
20|FH_F145852_67203_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F80062_27612_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F129467_45449_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39352_0_0|SrvcGrp|43|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F90876_18447_0|SrvcGrp|73524|2022|PDM|118.65|99|0.00|PHYSICAL THERAPY|
20|FH_F139350_70056_0|SrvcGrp|113132|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F117525_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F91873_12723_0|SrvcGrp|73008|2022|PDM|2200.00|99|0.00|AEG 10|
20|FH_F124059_64055_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F129549_01238_0|SrvcGrp|43567|2022|PDM|107.62|99|0.00|SKILLED NURSING - POSTNATAL|
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_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|2466.00|99|0.00|AEG 10 (NO REV)|
20|FH_F138685_18017_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F151503_30067_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 3 (NO REV)|
20|FH_F119892_47586_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F100880_67735_0|SrvcGrp|12889|2022|PDM|90.00|99|0.00|RADIOLOGY|
20|FH_F140629_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F146125_0_0|SrvcGrp|75181|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F143648_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F139627_80537_0|SrvcGrp|112725|2022|PCT|1.85|99|0.00|DIAGNOSTIC RADIOLOGY|
20|FH_F64799_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F41033_0_0|SrvcGrp|17071|2022|PDM|693.00|99|0.00|ASPG IV|
20|FH_F137951_0_0|SrvcGrp|16289|2022|PDM|890.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|TOCOLYTIC THERAPY|
20|FH_F133021_00910_0|SrvcGrp|10391|2022|PDM|1280.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F111809_93003_0|CSTM-ALL|CSTM-00|2020|PDM|12530.00|99|0.00|AEG 10 W/O SURG CARVEOUT (NO REV)|
20|FH_F141654_15217_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121016_32607_0|SrvcGrp|78422|2022|PDM|3150.00|99|0.00|VBAC DELIVERY|
20|FH_F128564_43235_0|SrvcGrp|103739|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F67683_0_0|SrvcGrp|43525|2022|PDM|250.00|99|0.00|INTENSIVE OUTPATIENT PROGRAM - PSYCHIATRIC|
20|FH_F118672_29036_0|CSTM-ALL|CSTM-00|2020|PDM|4743.00|99|0.00|AEG 6 (NO REV)|
20|FH_F117838_12901_0|SrvcGrp|472|2022|PDM|335.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F151155_26508_0|SrvcGrp|113350|2022|PDM|97.85|99|0.00|OFF BASE OPIOID TX ADD 30 MIN|
20|FH_F151199_77511_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111500_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.80|99|0.00|HSS ASC|
20|FH_F77082_0_0|CSTM-ALL|CSTM-00|2020|PDM|9367.00|99|0.00|2007 MEDICARE ASPG VI|
20|FH_F111986_0_0|SrvcGrp|104110|2022|PDM|927.00|99|0.00|REMOVAL OF SKIN LESION|
20|FH_F64639_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131127_0_0|CSTM-ALL|CSTM-00|2020|PDM|3940.00|99|0.00|AEG 7 (NO REV)|
20|FH_F111942_92647_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F144228_0_0|SrvcGrp|104978|2022|PDM|4711.00|99|0.00|REPAIR METATARSAL FRACTURE|
20|FH_F135666_37601_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F80172_0_0|SrvcGrp|17015|2022|PCT|0.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F146668_30189_0|SrvcGrp|98523|2022|PDM|2800.00|99|0.00|CAPSULOTOMY|
20|FH_F131698_01862_0|SrvcGrp|88621|2022|PDM|70.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133478_40165_0|SrvcGrp|29609|2022|PDM|55540.00|99|0.00|MS DRG 232 ONLY|
20|FH_F91198_46714_0|SrvcGrp|90854|2022|PDM|800.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F111791_33308_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148430_06278_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120290_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F92676_15063_0|SrvcGrp|78980|2022|PDM|1304.59|99|0.00|MON VALLEY ASC 205|
20|FH_F141852_78102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117087_0_0|SrvcGrp|106064|2022|PDM|2494.00|99|0.00|REVISE MIDDLE EAR & MASTOID|
20|FH_F128144_45697_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133922_70563_0|CSTM-ALL|CSTM-00|2020|PDM|341.14|99|0.00|ELECTROENCEPHALOGRAM (MOD TC)|
20|FH_F148927_0_0|CSTM-ALL|CSTM-00|2020|PDM|2228.00|99|0.00|AEG 5  (NO REV)|
20|FH_F72543_0_0|SrvcGrp|46183|2022|PCT|0.75|99|0.00|WOUND CARE / MEDICAL SUPPLIES|
20|FH_F85691_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F84712_0_0|SrvcGrp|81405|2022|PDM|15.00|99|0.00|URINALYSIS W/ MICROSCPY|
20|FH_F40403_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127415_45822_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F131311_64804_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F56137_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143821_60559_0|SrvcGrp|33722|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F135237_31015_0|SrvcGrp|46605|2022|PDM|150.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F39917_0_0|SrvcGrp|3404|2022|PDM|120.00|99|0.00|CPT 99211|
20|FH_F34691_0_0|SrvcGrp|14888|2022|PCT|0.75|99|0.00|NUCLEAR MEDICINE|
20|FH_F41776_0_0|SrvcGrp|19514|2022|PDM|579.00|99|0.00|MS DRG 795|
20|FH_F87031_0_0|SrvcGrp|72990|2022|PDM|520.00|99|0.00|AEG 1|
20|FH_F86319_16365_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F50184_0_0|SrvcGrp|33164|2022|PDM|315.00|99|0.00|SKILLED NURSING - LEVEL I|
20|FH_F77482_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.40|99|0.00|OP SVCS|
20|FH_F40661_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F143528_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F97601_67218_0|SrvcGrp|73601|2022|PDM|8079.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F138471_84663_0|SrvcGrp|29347|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE|
20|FH_F140343_89052_0|SrvcGrp|86830|2022|PDM|30.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F48292_0_0|SrvcGrp|44250|2022|PDM|192.00|99|0.00|CCPD TRAINING|
20|FH_F137937_20032_0|CSTM-ALL|CSTM-00|2020|PCT|2.32|99|0.00|HSS APC GROUPED|
20|FH_F38807_0_0|SrvcGrp|17081|2022|PDM|1339.00|99|0.00|ASPG IX|
20|FH_F119581_0_0|CSTM-ALL|CSTM-00|2020|PDM|1432.00|99|0.00|AEG 9 (NO REV)|
20|FH_F120671_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F43694_0_0|SrvcGrp|12591|2022|PDM|160.00|99|0.00|CD FULL DAY|
20|FH_F36318_0_0|SrvcGrp|22796|2022|PDM|2428.00|99|0.00|NORMAL DELIVERY (MOTHER & BABY)|
20|FH_F136831_78728_0|SrvcGrp|73842|2022|PDM|195.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F113713_17013_0|SrvcGrp|105374|2022|PDM|95.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MIN|
20|FH_F116233_33612_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F41463_0_0|SrvcGrp|17016|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F100681_73104_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F34269_0_0|CSTM-ALL|CSTM-00|2020|PCT|94.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72445_0_0|SrvcGrp|22954|2022|PDM|160.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F79429_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F91764_93710_0|SrvcGrp|114898|2022|PCT|1.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F32803_0_0|SrvcGrp|10716|2022|PCT|0.65|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F134847_0_0|SrvcGrp|74039|2022|PDM|6110.00|99|0.00|LAMINECTOMY|
20|FH_F39443_0_0|SrvcGrp|30357|2022|PDM|564.00|99|0.00|HAPA WPA ASC 402|
20|FH_F129966_18017_0|SrvcGrp|90854|2022|PDM|966.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F151029_52241_0|SrvcGrp|104733|2022|PDM|303.00|99|0.00|INPATIENT DIALYSIS PER TREATMENT|
20|FH_F144851_60123_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100666_81301_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F93375_0_0|SrvcGrp|73008|2022|PDM|535.00|99|0.00|AEG 10|
20|FH_F148599_98034_0|SrvcGrp|73497|2022|PDM|1316.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F117446_31322_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F51545_0_0|SrvcGrp|42824|2022|PDM|135.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F146668_30189_0|SrvcGrp|75182|2022|PCT|1.10|99|0.00|AETNA IMPLANTS|
20|FH_F146812_50401_0|CSTM-ALL|CSTM-00|2020|PDM|1118.00|99|0.00|AEG 1 (NO REV)|
20|FH_F146812_50401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120795_27514_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F94665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F77504_0_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F56136_0_0|SrvcGrp|38980|2022|PCT|0.85|99|0.00|MSDRG 246-249 ONLY|
20|FH_F41452_0_0|CSTM-ALL|CSTM-00|2020|PDM|687.50|99|0.00|ASPG 4- PROGRESSIVE SURG|
20|FH_F82714_18848_0|SrvcGrp|31931|2022|PDM|556.00|99|0.00|SKILLED NURSING CARE|
20|FH_F116065_06708_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F33322_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F72143_0_0|SrvcGrp|3069|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F121488_77478_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F63433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129656_15005_0|SrvcGrp|24750|2022|PDM|45.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F136386_30901_0|SrvcGrp|58389|2022|PDM|15750.00|99|0.00|MS DRG 291 ONLY|
20|FH_F109883_35007_0|SrvcGrp|86746|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F90880_15108_0|SrvcGrp|89502|2022|PCT|1.00|99|0.00|NEUROMUSCULAR REEDUCATION|
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|2918.00|99|0.00|AEG 7 (NO REV)|
20|FH_F39581_0_0|CSTM-ALL|CSTM-00|2020|PDM|15620.00|99|0.00|OP SVCS|
20|FH_F71365_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113392_0_0|SrvcGrp|83838|2022|PDM|2750.00|99|0.00|SUSPENSION OF BREAST|
20|FH_F132627_0_0|SrvcGrp|17014|2022|PDM|80.58|99|0.00|HOME INFUSION THERAPY|
20|FH_F37703_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72416_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.41|99|0.00|OP SVCS|
20|FH_F134694_94945_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F101388_0_0|SrvcGrp|112098|2022|PCT|2.00|99|0.00|COVID-19 CODES|
20|FH_F132163_17601_0|SrvcGrp|91390|2022|PDM|210.00|99|0.00|AETNA PSYCH DIAG EVAL W/MED (MOD AF)|
20|FH_F135572_89106_0|SrvcGrp|26868|2022|PCT|1.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F143739_33440_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39586_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F110268_02891_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F120740_45817_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F71049_0_0|SrvcGrp|12403|2022|PDM|65.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F80594_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F121601_47446_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F119227_01752_0|SrvcGrp|86844|2022|PDM|38.00|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F146399_0_0|SrvcGrp|107748|2022|PDM|424.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F134568_12946_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F101100_50314_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA - APC GROUPER E|
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PDM|982.00|99|0.00|AEG 2 (NO REV)|
20|FH_F135261_33144_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F102184_0_0|SrvcGrp|90343|2022|PDM|7215.00|99|0.00|CERVICE CORPECTOMY 1 LEVEL|
20|FH_F109000_0_0|SrvcGrp|19922|2022|PDM|4600.20|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F37067_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F89779_0_0|SrvcGrp|84939|2022|PDM|17000.00|99|0.00|SHOULDER JOINT|
20|FH_F139173_0_0|SrvcGrp|95661|2022|PDM|409.24|99|0.00|RESPITE CARE (HCFA)|
20|FH_F33642_0_0|SrvcGrp|360|2022|PDM|725.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F128878_11203_0|SrvcGrp|86867|2022|PDM|105.00|99|0.00|AETNA PSYTX PT & FAM W E&M 45 MINS (MOD TD)|
20|FH_F130253_65082_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F131176_28712_0|SrvcGrp|98701|2022|PDM|318.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F72183_0_0|SrvcGrp|29817|2022|PDM|2600.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F141169_0_0|SrvcGrp|113728|2022|PDM|72.00|99|0.00|ULTRASOUND (HCFA)|
20|FH_F56136_0_0|SrvcGrp|20077|2022|PCT|0.85|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR|
20|FH_F32375_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141370_20866_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148139_48328_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F86851_0_0|SrvcGrp|84981|2022|PDM|391.00|99|0.00|CPT 44380|
20|FH_F88639_80204_0|SrvcGrp|12659|2022|PDM|1021.85|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F78403_15552_0|SrvcGrp|11336|2022|PCT|0.34|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F119064_01581_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F109983_98607_0|SrvcGrp|73842|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F98041_10027_0|SrvcGrp|73643|2022|PDM|1482.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F106822_0_0|SrvcGrp|100282|2022|PDM|5.00|99|0.00|IM ADMIN EACH ADDL COMPONENT (HCFA)|
20|FH_F116323_0_0|CSTM-ALL|CSTM-00|2020|PDM|2141.00|99|0.00|AEG 4 (NO REV)|
20|FH_F89037_0_0|SrvcGrp|73000|2022|PDM|995.60|99|0.00|AEG 6|
20|FH_F49487_0_0|SrvcGrp|14893|2022|PDM|40.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F132864_71101_0|SrvcGrp|113275|2022|PDM|100.00|99|0.00|COVID-19 AMP PRB HGH THRUPUT|
20|FH_F134670_95628_0|SrvcGrp|108484|2022|PDM|660.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F115206_80923_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F40345_0_0|CSTM-ALL|CSTM-00|2020|PDM|1133.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35381_0_0|SrvcGrp|189|2022|PCT|0.70|99|0.00|DURABLE MEDICAL EQUIPMENT|
20|FH_F114853_0_0|SrvcGrp|35669|2022|PDM|4812.00|99|0.00|CPT 63650|
20|FH_F40073_0_0|SrvcGrp|17075|2022|PCT|0.70|99|0.00|ASPG VI|
20|FH_F135972_18509_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F135670_01749_0|SrvcGrp|86849|2022|PDM|35.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F145641_06902_0|CSTM-ALL|CSTM-00|2020|PDM|642.00|99|0.00|AEG 9 (NO REV)|
20|FH_F77597_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F90496_13159_0|SrvcGrp|52953|2022|PDM|60.00|99|0.00|PSYCHIATRIC CPT 90853|
20|FH_F150308_48180_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F133972_27103_0|SrvcGrp|24750|2022|PDM|35.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F120555_68405_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F85894_0_0|SrvcGrp|17069|2022|PDM|1256.00|99|0.00|ASPG III|
20|FH_F150200_0_0|SrvcGrp|67068|2022|PDM|10000.00|99|0.00|LUMBAR SPINE FUSION COMBINED|
20|FH_F110109_32901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F125849_67052_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125983_82301_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F38377_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|CHILDREN'S MERCY IV THERAPY- MOD SH|
20|FH_F93332_0_0|SrvcGrp|88760|2022|PDM|7416.00|99|0.00|CERVICAL ARTHRODESIS|
20|FH_F52854_0_0|SrvcGrp|17071|2022|PDM|1610.00|99|0.00|ASPG IV|
20|FH_F72546_0_0|SrvcGrp|9518|2022|PCT|0.63|99|0.00|EMERGENCY ROOM|
20|FH_F121547_46805_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128272_60640_0|SrvcGrp|86843|2022|PDM|50.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F120490_64133_0|SrvcGrp|14893|2022|PDM|42.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F123489_0_0|CSTM-ALL|CSTM-00|2020|PDM|1125.00|99|0.00|AEG 3 (NO REV)|
20|FH_F65239_0_0|SrvcGrp|61358|2022|PDM|1147.00|99|0.00|SURGICAL CARVEOUTS (3)|
20|FH_F101945_0_0|SrvcGrp|59705|2022|PDM|1025.00|99|0.00|SEPTOPLASTY|
20|FH_F115208_0_0|SrvcGrp|106180|2022|PDM|2652.00|99|0.00|PARTIAL THYROID EXCISION|
20|FH_F130400_26505_0|SrvcGrp|111482|2022|PCT|7.36|99|0.00|CARDIAC STUDIES|
20|FH_F122198_20708_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F41885_0_0|SrvcGrp|97|2022|PDM|2600.00|99|0.00|C-SECTION|
20|FH_F92599_0_0|SrvcGrp|75493|2022|PDM|1424.00|99|0.00|AEG 8|
20|FH_F132595_0_0|SrvcGrp|701|2022|PDM|3383.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F50516_15014_0|SrvcGrp|13985|2022|PDM|47.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|27.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1001 W/O REV|
20|FH_F115616_0_0|SrvcGrp|106226|2022|PDM|4474.00|99|0.00|CERV ARTIFIC DISC|
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|986.00|99|0.00|AEG 7 (NO REV)|
20|FH_F54592_0_0|SrvcGrp|49022|2022|PDM|80.00|99|0.00|NURSING VISIT W/INFUSION THERAPY|
20|FH_F146501_68025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F126844_44333_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F38798_0_0|SrvcGrp|10542|2022|PDM|100.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F96902_0_0|SrvcGrp|9529|2022|PDM|660.00|99|0.00|HOSPICE SVCS|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PDM|1709.00|99|0.00|ASPG II|
20|FH_F35271_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F129255_34952_0|CSTM-ALL|CSTM-00|2020|PDM|515.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F120349_38774_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF|
20|FH_F123170_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F147530_49441_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135351_0_0|SrvcGrp|27330|2022|PDM|809.00|99|0.00|CPT 27096|
20|FH_F121219_0_0|CSTM-ALL|CSTM-00|2020|PDM|5699.00|99|0.00|AEG 8 (NO REV)|
20|FH_F151306_21030_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151503_30067_0|SrvcGrp|92366|2022|PDM|4606.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F122069_75935_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135388_48601_0|SrvcGrp|13262|2022|PDM|13.40|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F42939_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33785_0_0|SrvcGrp|3409|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F43237_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|OP SVCS|
20|FH_F134322_98001_0|SrvcGrp|112568|2022|PCT|1.00|99|0.00|ERTAPENEM INJECTION|
20|FH_F129220_18445_0|SrvcGrp|90662|2022|PDM|116.00|99|0.00|EVALUATION AND MANAGEMENT CPT 99214|
20|FH_F140295_0_0|SrvcGrp|86233|2022|PDM|19096.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F36803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1553.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|506.00|99|0.00|AEG 3 (NO REV)|
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.92|99|0.00|AEG 2 (NO REV)|
20|FH_F144532_19606_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141930_72032_0|CSTM-ALL|CSTM-00|2020|PDM|1401.00|99|0.00|AEG 8 (NO REV)|
20|FH_F42168_0_0|SrvcGrp|12117|2022|PDM|790.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F141411_0_0|SrvcGrp|86462|2022|PDM|9000.00|99|0.00|AREOLA RECONSTRUCTION|
20|FH_F88818_0_0|SrvcGrp|87818|2022|PDM|300.00|99|0.00|INTERMEDIATE WOUND REPAIR OF FACE/MM|
20|FH_F112853_22408_0|SrvcGrp|41458|2022|PDM|1.15|99|0.00|ENTERAL - PEDIATRICS (SPEC METABOLIC NEED)|
20|FH_F36576_0_0|SrvcGrp|97|2022|PDM|3910.00|99|0.00|C-SECTION|
20|FH_F112587_37058_0|SrvcGrp|75545|2022|PDM|313.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F151119_66018_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151159_46322_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F49279_0_0|CSTM-ALL|CSTM-00|2020|PDM|1105.00|99|0.00|ASPG V|
20|FH_F97861_62223_0|SrvcGrp|90854|2022|PDM|2103.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F143650_0_0|SrvcGrp|82108|2022|PDM|1800.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F126188_59404_0|SrvcGrp|705|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F121225_98902_0|SrvcGrp|17009|2022|PCT|0.85|99|0.00|HOME INFUSION THERAPY|
20|FH_F114432_75035_0|SrvcGrp|473|2022|PDM|364.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F77665_0_0|SrvcGrp|10539|2022|PDM|65.00|99|0.00|HOME HEALTH AIDE|
20|FH_F131665_50129_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133667_83642_0|SrvcGrp|73842|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F111584_07002_0|SrvcGrp|89417|2022|PDM|338.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F134828_30531_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|1.02|99|0.00|AEG 7 (NO REV)|
20|FH_F72183_0_0|SrvcGrp|20107|2022|PDM|1000.00|99|0.00|INPATIENT HOSPICE SVCS|
20|FH_F35271_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F40026_0_0|SrvcGrp|31755|2022|PCT|0.73|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F118165_0_0|CSTM-ALL|CSTM-00|2020|PCT|18000.00|99|0.00|TIMELY FILING|
20|FH_F130724_06437_0|SrvcGrp|75545|2022|PDM|390.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F125876_78254_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F115905_0_0|CSTM-ALL|CSTM-00|2020|PDM|1300.00|99|0.00|ASPG 10 HEARTLAND HEALTHCARE|
20|FH_F92276_32308_0|SrvcGrp|99068|2022|PDM|73815.00|99|0.00|MS DRG 228-229 ONLY OTHER CARDIOTHORACIC PROC|
20|FH_F106020_0_0|CSTM-ALL|CSTM-00|2020|PDM|602.00|99|0.00|AEG 1 (NO REV)|
20|FH_F147941_06023_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS|
20|FH_F82173_72712_0|CSTM-ALL|CSTM-00|2020|PDM|3298.00|99|0.00|AEG 4 (NO REV)|
20|FH_F140575_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88639_80204_0|SrvcGrp|91437|2022|PDM|413.96|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F123752_44502_0|SrvcGrp|107267|2022|PDM|280.00|99|0.00|HEMODIALYSIS|
20|FH_F138019_79705_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148961_33403_0|SrvcGrp|108484|2022|PDM|850.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F146266_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132849_0_0|SrvcGrp|35950|2022|PDM|1515.00|99|0.00|CD DETOX|
20|FH_F110732_31513_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F150982_0_0|SrvcGrp|82110|2022|PDM|2202.00|99|0.00|KNEE ARTHROSCOPY DIAGNOSTIC|
20|FH_F124739_64429_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F136887_0_0|SrvcGrp|112976|2022|PDM|6365.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F34882_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MS DRG 005-006 LIVER TRANSPLANT|
20|FH_F47037_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117583_21208_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F140629_0_0|SrvcGrp|88030|2022|PDM|8400.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F111341_80501_0|SrvcGrp|104329|2022|PCT|1.00|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|ASPG IX|
20|FH_F87557_33309_0|SrvcGrp|14944|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PDM|529.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F124441_0_0|SrvcGrp|109832|2022|PDM|12825.00|99|0.00|SHOULDER / ELBOW ARTHROPLASTY|
20|FH_F36079_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|SHEEPLESS NIGHTS MOD RR|
20|FH_F150920_19490_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F128912_44313_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F147995_67037_0|SrvcGrp|73497|2022|PDM|722.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F148556_13206_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F101840_76054_0|SrvcGrp|31926|2022|PDM|21180.00|99|0.00|MS DRG 458 ONLY|
20|FH_F116806_0_0|SrvcGrp|104907|2022|PDM|1923.16|99|0.00|EXCISE PAROTID GLAND/LESION|
20|FH_F51258_0_0|SrvcGrp|472|2022|PDM|377.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|310.66|99|0.00|HAPA WPA-NWPA 2012-13 ASC 225 W/O REV|
20|FH_F102142_80014_0|SrvcGrp|27969|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F115903_43560_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F44638_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F132307_06010_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F32996_0_0|SrvcGrp|11606|2022|PDM|918.00|99|0.00|ACUTE CARE (MEDICAL & SURGICAL)|
20|FH_F70984_0_0|SrvcGrp|67993|2022|PDM|1350.00|99|0.00|CPT58555 58558-58559 58562|
20|FH_F131128_0_0|SrvcGrp|16289|2022|PDM|1273.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F89475_71202_0|SrvcGrp|110581|2022|PCT|0.00|99|0.00|INPATIENT DETOXIFICATION SERVICES|
20|FH_F130038_08021_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F140988_22041_0|SrvcGrp|82981|2022|PDM|122.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F118079_37642_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F32156_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F93517_0_0|CSTM-ALL|CSTM-00|2020|PDM|1885.00|99|0.00|AEG 7 (NO REV)|
20|FH_F86872_15215_0|SrvcGrp|24750|2022|PDM|45.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F86917_61108_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - IP|
20|FH_F137231_25550_0|SrvcGrp|46605|2022|PDM|92.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F129427_92262_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F91873_12723_0|SrvcGrp|64558|2022|PCT|0.00|99|0.00|99201-99215|
20|FH_F131494_0_0|SrvcGrp|101527|2022|PDM|481.00|99|0.00|HYSTEROSCOPY LYSIS|
20|FH_F119214_0_0|SrvcGrp|75485|2022|PDM|1200.00|99|0.00|AEG 4|
20|FH_F33825_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F132348_16214_0|SrvcGrp|94781|2022|PDM|95.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F146907_24521_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127995_84010_0|SrvcGrp|86849|2022|PDM|25.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F115181_78602_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F39355_0_0|SrvcGrp|115|2022|PDM|490.00|99|0.00|SKILLED NURSING CARE|
20|FH_F116431_76104_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F140340_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F96960_35404_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150820_83843_0|CSTM-ALL|CSTM-00|2020|PDM|6741.50|99|0.00|AEG 9 (NO REV)|
20|FH_F38049_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98940_70506_0|SrvcGrp|73485|2022|PDM|2592.00|99|0.00|AETNA REHAB|
20|FH_F147147_50265_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92716_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132732_0_0|SrvcGrp|39|2022|PCT|0.69|99|0.00|TISSUE PLASMINOGEN ACTIVATOR|
20|FH_F129782_0_0|SrvcGrp|110827|2022|PCT|1.00|99|0.00|REPAIR OF EYE WOUND|
20|FH_F130840_21738_0|SrvcGrp|112072|2022|PDM|1550.00|99|0.00|RESIDENITAL TREATMENT EATING DISORDER (AGE 0-17)|
20|FH_F123950_19111_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
20|FH_F135173_06519_0|SrvcGrp|108484|2022|PDM|714.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F118194_50841_0|SrvcGrp|24754|2022|PDM|33.51|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F69968_0_0|SrvcGrp|17069|2022|PDM|1339.37|99|0.00|ASPG III|
20|FH_F134032_19611_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F134156_32174_0|SrvcGrp|89149|2022|PDM|229.00|99|0.00|OP INTENSIVE|
20|FH_F142390_20866_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118955_48239_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F132736_0_0|SrvcGrp|47427|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY MODIFIER RR|
20|FH_F41516_0_0|CSTM-ALL|CSTM-00|2020|PDM|275.00|99|0.00|NEUROREHABILITATION IP SVCS|
20|FH_F131047_0_0|SrvcGrp|359|2022|PDM|1112.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL I|
20|FH_F78204_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.54|99|0.00|ASPG X|
20|FH_F84893_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147017_35976_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92493_0_0|SrvcGrp|84939|2022|PDM|12999.53|99|0.00|SHOULDER JOINT|
20|FH_F124676_45503_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F122933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138716_20151_0|SrvcGrp|78420|2022|PDM|1000.00|99|0.00|INTERIM LABOR|
20|FH_F122608_84123_0|SrvcGrp|23683|2022|PDM|50.70|99|0.00|SKILLED NURSING RN|
20|FH_F72222_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111385_33308_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F40260_0_0|SrvcGrp|439|2022|PDM|1600.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F150841_84757_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117023_0_0|SrvcGrp|41334|2022|PDM|5000.00|99|0.00|TOTAL KNEE|
20|FH_F117762_0_0|SrvcGrp|90822|2022|PDM|3120.00|99|0.00|NASAL/SINUS ENDOSCOPY SURGERY|
20|FH_F134819_0_0|SrvcGrp|91382|2022|PDM|1773.00|99|0.00|REMOVAL OF TONSILS|
20|FH_F147210_70633_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F97080_85122_0|SrvcGrp|73601|2022|PDM|7312.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F114207_35243_0|SrvcGrp|22389|2022|PDM|15.00|99|0.00|HORMONAL INJECTION THERAPY|
20|FH_F143035_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149004_67025_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F110783_93013_0|SrvcGrp|17014|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F84433_0_0|SrvcGrp|23683|2022|PDM|46.68|99|0.00|SKILLED NURSING RN|
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|50.00|99|0.00|INTRAOCULAR LENS|
20|FH_F147361_19806_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F138017_73129_0|SrvcGrp|112834|2022|PCT|1.57|99|0.00|RADIOLOGY SERVICES|
20|FH_F127553_44321_0|SrvcGrp|94780|2022|PDM|130.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F127553_44321_0|SrvcGrp|65720|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F125656_92868_0|SrvcGrp|115834|2022|PCT|0.82|99|0.00|J CODES/NDC|
20|FH_F140295_0_0|SrvcGrp|67119|2022|PDM|5303.00|99|0.00|ARTHODESIS|
20|FH_F102525_73134_0|SrvcGrp|21124|2022|PDM|36000.00|99|0.00|MS DRG 471 ONLY|
20|FH_F129289_54153_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147082_02359_0|SrvcGrp|74668|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138420_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F132849_0_0|CSTM-ALL|CSTM-00|2020|PDM|797.00|99|0.00|ADULT PSYCHIATRIC|
20|FH_F37342_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NU|
20|FH_F134738_0_0|SrvcGrp|27344|2022|PDM|3000.00|99|0.00|OP SURGERY (CPT 42821)|
20|FH_F40624_0_0|SrvcGrp|20900|2022|PDM|18909.00|99|0.00|MS DRG 248 ONLY|
20|FH_F124695_33401_0|SrvcGrp|109358|2022|PDM|734.00|99|0.00|RESIDENTIAL TREATMENT (>= 18 YRS)|
20|FH_F90232_15126_0|SrvcGrp|86847|2022|PDM|56.70|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|1109.68|99|0.00|AEG 4 (NO REV)|
20|FH_F149579_95815_0|SrvcGrp|115705|2022|PDM|128.25|99|0.00|PSYCHIATRIC COLLABORATIVE CARE MGMT SBSQ (MOD AJ)|
20|FH_F101752_0_0|SrvcGrp|88978|2022|PDM|2561.00|99|0.00|VAGINAL DELIVERY|
20|FH_F101752_0_0|SrvcGrp|80259|2022|PCT|0.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F101606_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|GENERAL ACUTE CARE|
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|AEG 7 (NO REV)|
20|FH_F48476_0_0|SrvcGrp|43958|2022|PDM|90.00|99|0.00|ENTEROSTOMAL THERAPY SERVICES|
20|FH_F48994_0_0|SrvcGrp|30076|2022|PCT|1.00|99|0.00|IMPLANTS, PROSTHETICS, OR SUPPLIES|
20|FH_F132472_32547_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116579_45822_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F119918_38201_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120887_78750_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F126970_45601_0|SrvcGrp|104874|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F118845_71111_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F118874_29926_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F46158_0_0|SrvcGrp|17073|2022|PCT|0.65|99|0.00|ASPG V|
20|FH_F120430_32177_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123181_75057_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F132992_04662_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100666_81301_0|SrvcGrp|88977|2022|PDM|7431.00|99|0.00|C-SECTION DELIVERY|
20|FH_F133287_40215_0|SrvcGrp|72984|2022|PCT|0.53|99|0.00|CHEMOTHERAPY|
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_F146227_66210_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F46192_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F148021_80907_0|SrvcGrp|26160|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|712.00|99|0.00|AEG 4 (NO REV)|
20|FH_F33908_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F109882_36695_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F103281_32086_0|SrvcGrp|73497|2022|PDM|1200.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F111415_33180_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F62579_0_0|SrvcGrp|42322|2022|PDM|60.00|99|0.00|HOME THERAPY|
20|FH_F37970_0_0|SrvcGrp|27698|2022|PDM|40.00|99|0.00|ONE TO ONE PERSONAL SITTERS|
20|FH_F138021_0_0|CSTM-ALL|CSTM-00|2020|PDM|1435.00|99|0.00|AEG 9 (NO REV)|
20|FH_F74024_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F77585_0_0|SrvcGrp|38439|2022|PDM|1200.00|99|0.00|DIAGNOSTIC TESTING|
20|FH_F132822_95125_0|SrvcGrp|88620|2022|PDM|125.00|99|0.00|SKILLED NURSING RN|
20|FH_F74024_0_0|SrvcGrp|29021|2022|PCT|0.65|99|0.00|DME AND SUPPLIES|
20|FH_F85353_16407_0|SrvcGrp|63838|2022|PDM|468.97|99|0.00|HAPA WPA-NWPA 2012-13 ASC 219|
20|FH_F116124_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|560.00|99|0.00|AEG 1 (NO REV)|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|546.56|99|0.00|HAPA WPA-NWPA 2012-13 ASC 103 W/O REV|
20|FH_F35128_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134488_14086_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133581_84790_0|CSTM-ALL|CSTM-00|2020|PDM|1186.09|99|0.00|AEG 5  (NO REV)|
20|FH_F83257_32404_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F36280_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129708_54403_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F90492_0_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F139241_0_0|SrvcGrp|59840|2022|PDM|1147.00|99|0.00|TYMPANOSTOMY|
20|FH_F117079_01085_0|SrvcGrp|75545|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F90817_0_0|SrvcGrp|26275|2022|PDM|1574.00|99|0.00|CPT 29826|
20|FH_F138453_74135_0|SrvcGrp|90854|2022|PDM|780.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F128753_32501_0|SrvcGrp|79977|2022|PCT|0.64|99|0.00|RADIOPHARMACEUTICALS|
20|FH_F151005_17044_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F98022_89015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F100663_56537_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F146266_0_0|SrvcGrp|92367|2022|PDM|1325.00|99|0.00|TRANSPLANT HAND TENDON|
20|FH_F89640_98133_0|SrvcGrp|83539|2022|PDM|1513.00|99|0.00|AETNA NON TRAUMATIC STUPOR AND COMA|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|3400.00|99|0.00|ASPG VIII|
20|FH_F132571_24739_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F49776_0_0|SrvcGrp|42824|2022|PDM|88.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F117340_68144_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F133487_24293_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F149605_0_0|SrvcGrp|74546|2022|PDM|543.00|99|0.00|HOSPICE SERVICES|
20|FH_F118379_32079_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148040_90631_0|SrvcGrp|89412|2022|PDM|500.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F106420_18510_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
20|FH_F34998_0_0|SrvcGrp|360|2022|PDM|800.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F97103_53295_0|SrvcGrp|73603|2022|PDM|4875.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F49776_0_0|SrvcGrp|12856|2022|PDM|53.00|99|0.00|NURSING CARE|
20|FH_F148662_01583_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F62579_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F90416_73013_0|SrvcGrp|48385|2022|PDM|105.00|99|0.00|SPEECH THERAPY|
20|FH_F141210_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F83113_0_0|SrvcGrp|9830|2022|PDM|50.00|99|0.00|OT SVCS|
20|FH_F80594_0_0|SrvcGrp|471|2022|PDM|472.50|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F133808_73401_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F87775_15106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|181.15|99|0.00|HAPA WPA-NWPA 2012-13 ASC 314 W/O REV|
20|FH_F72427_0_0|SrvcGrp|11301|2022|PDM|470.00|99|0.00|MAGNETIC RESONANCE IMAGING|
20|FH_F142288_44714_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F146895_28751_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F124234_33410_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97083_90670_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F114638_25309_0|SrvcGrp|80|2022|PDM|992.00|99|0.00|ACUTE PSYCH|
20|FH_F92871_0_0|SrvcGrp|89239|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F54552_0_0|SrvcGrp|12403|2022|PDM|834.43|99|0.00|CONTINUOUS HOMECARE|
20|FH_F147214_48162_0|SrvcGrp|111140|2022|PCT|1.00|99|0.00|DRUG ADMINISTRATION|
20|FH_F129811_53573_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F35678_0_0|SrvcGrp|18143|2022|PDM|11300.00|99|0.00|MS DRG 247|
20|FH_F37493_0_0|SrvcGrp|8968|2022|PDM|2536.00|99|0.00|NICU LEVEL III & IV|
20|FH_F98360_11554_0|SrvcGrp|88977|2022|PDM|7071.00|99|0.00|C-SECTION DELIVERY|
20|FH_F67379_0_0|SrvcGrp|63184|2022|PDM|1270.00|99|0.00|R&B|
20|FH_F35051_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112854_53225_0|SrvcGrp|471|2022|PDM|510.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F49554_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148639_0_0|SrvcGrp|11669|2022|PDM|2959.00|99|0.00|OP SURG|
20|FH_F82572_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101840_76054_0|SrvcGrp|28121|2022|PDM|17529.00|99|0.00|MS DRG 469 ONLY|
20|FH_F42779_0_0|SrvcGrp|36589|2022|PCT|0.65|99|0.00|HIGH COST DRUGS|
20|FH_F102681_34237_0|SrvcGrp|72992|2022|PDM|396.00|99|0.00|AEG 2|
20|FH_F94300_0_0|CSTM-ALL|CSTM-00|2020|PDM|683.00|99|0.00|AEG 1 (NO REV)|
20|FH_F44135_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HILLCREST IV THERAPY - MOD SH|
20|FH_F126666_44053_0|SrvcGrp|86871|2022|PDM|39.00|99|0.00|AETNA PSYTX PT & FAMILY 30 MINS (MOD TD)(HCFA)|
20|FH_F92833_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F136751_0_0|SrvcGrp|67072|2022|PDM|16000.00|99|0.00|CPT 22845|
20|FH_F144324_67467_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36756_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|REHAB PLUS MOD RR|
20|FH_F143057_15767_0|SrvcGrp|105376|2022|PDM|2.75|99|0.00|SKILLS TRAINING DEVELOPMENT - 15 MIN|
20|FH_F116753_0_0|CSTM-ALL|CSTM-00|2020|PDM|2833.00|99|0.00|AEG 6 (NO REV)|
20|FH_F85651_33549_0|SrvcGrp|83802|2022|PDM|80.00|99|0.00|LACTATION CLASS|
20|FH_F81852_0_0|SrvcGrp|29817|2022|PDM|3297.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F87775_15106_0|SrvcGrp|29347|2022|PDM|17.00|99|0.00|HOME HEALTH AIDE|
20|FH_F126341_27284_0|SrvcGrp|86119|2022|PDM|0.97|99|0.00|AETNA FACTOR IX COMPLEX|
20|FH_F123644_0_0|SrvcGrp|73841|2022|PDM|300.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138250_64145_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135627_77070_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F112468_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F51135_0_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124792_44515_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F127908_60640_0|SrvcGrp|105046|2022|PCT|1.40|99|0.00|AETNA RES TREATMENT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F110541_99336_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F121225_98902_0|SrvcGrp|19973|2022|PCT|5.50|99|0.00|CAT SCAN|
20|FH_F129525_48446_0|CSTM-ALL|CSTM-00|2020|PCT|1.35|99|0.00|IP/OP MBPR SERVICES|
20|FH_F130657_04614_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|AEG 5  (NO REV)|
20|FH_F55054_0_0|SrvcGrp|9774|2022|PDM|2143.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F116268_19064_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93292_62234_0|SrvcGrp|90489|2022|PDM|89.95|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F129441_19134_0|SrvcGrp|108484|2022|PDM|540.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F107926_0_0|SrvcGrp|68281|2022|PDM|1875.00|99|0.00|CPT 67041|
20|FH_F130460_33166_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132627_0_0|SrvcGrp|24744|2022|PDM|153.00|99|0.00|PICC LINE INSERTION|
20|FH_F114389_50131_0|SrvcGrp|17011|2022|PDM|93.83|99|0.00|HOME INFUSION THERAPY|
20|FH_F36318_0_0|SrvcGrp|360|2022|PDM|1206.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F124679_64052_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F113913_70065_0|SrvcGrp|472|2022|PDM|440.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F136778_62034_0|SrvcGrp|72984|2022|PCT|1.20|99|0.00|CHEMOTHERAPY|
20|FH_F101665_10027_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F42098_0_0|SrvcGrp|11090|2022|PDM|60.00|99|0.00|NURSING CARE|
20|FH_F111301_33122_0|SrvcGrp|82748|2022|PDM|45.00|99|0.00|HEMO/PLATELET CNT AUTOMATED|
20|FH_F47906_0_0|SrvcGrp|29954|2022|PCT|1.00|99|0.00|DME MOD 53|
20|FH_F36344_0_0|SrvcGrp|19967|2022|PDM|29.00|99|0.00|LIPIDS|
20|FH_F125054_16365_0|SrvcGrp|48398|2022|PDM|108.00|99|0.00|PT SERVICES|
20|FH_F116437_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.10|99|0.00|AEG 2 (NO REV)|
20|FH_F120083_13501_0|SrvcGrp|473|2022|PDM|285.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F119376_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F37312_0_0|SrvcGrp|26160|2022|PDM|16.50|99|0.00|HOME HEALTH AIDE VISIT|
20|FH_F80834_0_0|SrvcGrp|107756|2022|PDM|6474.00|99|0.00|NORMAL DELIVERY|
20|FH_F141627_43725_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F40728_0_0|SrvcGrp|30401|2022|PCT|1.05|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F43296_0_0|SrvcGrp|31134|2022|PDM|2095.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F97103_53295_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F115274_15235_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F42117_0_0|SrvcGrp|38004|2022|PDM|4000.00|99|0.00|CPT CODE 59400|
20|FH_F80955_0_0|SrvcGrp|472|2022|PDM|385.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F132685_63146_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141930_72032_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AEG 3 (NO REV)|
20|FH_F114519_0_0|SrvcGrp|72990|2022|PDM|457.00|99|0.00|AEG 1|
20|FH_F105842_70433_0|SrvcGrp|30089|2022|PDM|420.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F49637_0_0|SrvcGrp|19731|2022|PDM|10500.00|99|0.00|MS DRG 469-470 ONLY|
20|FH_F148599_98034_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PACKAGE APC Q2 PAYMENT SAME DOS|
20|FH_F122245_0_0|SrvcGrp|103236|2022|PDM|7468.00|99|0.00|AETNA INSJ STABLJ DEV|
20|FH_F115990_0_0|SrvcGrp|73004|2022|PDM|1450.00|99|0.00|AEG 8|
20|FH_F116809_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.00|99|0.00|AEG 7 (NO REV)|
20|FH_F40266_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F133749_84604_0|SrvcGrp|112454|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F145641_06902_0|SrvcGrp|89989|2022|PDM|4224.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F114407_19002_0|SrvcGrp|48396|2022|PDM|84.00|99|0.00|OT SERVICES|
20|FH_F42467_0_0|SrvcGrp|701|2022|PDM|1600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F93122_01854_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F40526_0_0|SrvcGrp|32584|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F117344_75062_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F74583_0_0|SrvcGrp|45924|2022|PDM|32.00|99|0.00|HOME HEALTH AIDE|
20|FH_F79644_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F102200_06416_0|SrvcGrp|14949|2022|PDM|120.00|99|0.00|HOME INFUSION|
20|FH_F131904_18915_0|SrvcGrp|46104|2022|PDM|112.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F59732_0_0|SrvcGrp|14945|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F126730_84737_0|SrvcGrp|75442|2022|PDM|722.00|99|0.00|OBSERVATION - REV 762|
20|FH_F102184_0_0|SrvcGrp|98500|2022|PDM|7215.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F37659_0_0|SrvcGrp|91|2022|PDM|43921.00|99|0.00|KIDNEY TRANSPLANT|
20|FH_F141515_50010_0|SrvcGrp|46903|2022|PDM|469.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F127032_33573_0|SrvcGrp|57965|2022|PDM|162.78|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F135207_76053_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|811.00|99|0.00|AEG 2 (NO REV)|
20|FH_F86851_0_0|SrvcGrp|84982|2022|PDM|391.00|99|0.00|CPT 44385|
20|FH_F120248_77008_0|SrvcGrp|46903|2022|PDM|520.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F148549_60523_0|SrvcGrp|48396|2022|PDM|120.00|99|0.00|OT SERVICES|
20|FH_F39138_0_0|CSTM-ALL|CSTM-00|2020|PDM|28660.00|99|0.00|MSDRG 228-230|
20|FH_F38360_0_0|SrvcGrp|16746|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F150026_0_0|SrvcGrp|80920|2022|PDM|475.00|99|0.00|HOSPICE SERVICES|
20|FH_F130840_21738_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F40834_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F39071_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31111_0_0|SrvcGrp|112106|2022|PDM|87.00|99|0.00|COVID-19 AMP PRB (HCFA)|
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PDM|3145.00|99|0.00|AEG 9 (NO REV)|
20|FH_F149441_28401_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F151608_30236_0|SrvcGrp|11000|2022|PCT|0.00|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F129483_77030_0|SrvcGrp|86854|2022|PDM|50.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F97720_70084_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F138929_0_0|SrvcGrp|88164|2022|PDM|13750.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F132988_0_0|SrvcGrp|83641|2022|PDM|8647.09|99|0.00|CPT 29889|
20|FH_F36318_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F87856_0_0|SrvcGrp|83839|2022|PDM|4000.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F130021_77904_0|SrvcGrp|111510|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F125048_94583_0|SrvcGrp|89417|2022|PDM|600.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F101711_0_0|SrvcGrp|29346|2022|PCT|0.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F116923_85259_0|SrvcGrp|89149|2022|PDM|313.00|99|0.00|OP INTENSIVE|
20|FH_F131254_92211_0|SrvcGrp|86845|2022|PDM|35.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F123505_64468_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F115063_78550_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|355.53|99|0.00|HAPA WPA-NWPA 2012-13 ASC 307 W/O REV|
20|FH_F78603_0_0|SrvcGrp|53152|2022|PDM|16838.92|99|0.00|MS DRG 259 ONLY|
20|FH_F102948_43606_0|SrvcGrp|89412|2022|PDM|431.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F113181_72202_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F150939_0_0|SrvcGrp|82744|2022|PDM|6.60|99|0.00|URINE CULTURE COLONY COUNT|
20|FH_F110233_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|OP SVCS|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|433.33|99|0.00|HAPA WPA-NWPA 2012-13 ASC 102 W/O REV|
20|FH_F122024_75751_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F135376_83440_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121701_70420_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F119376_0_0|SrvcGrp|108119|2022|PDM|1257.61|99|0.00|ARTERY-VEIN FUSION|
20|FH_F40590_0_0|CSTM-ALL|CSTM-00|2020|PDM|1081.00|99|0.00|SPINAL CORD REHAB|
20|FH_F101441_0_0|SrvcGrp|19921|2022|PDM|4862.00|99|0.00|ARTHROSCOPICALLY LIGAMENT REPAIR|
20|FH_F110729_15068_0|SrvcGrp|89417|2022|PDM|260.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F119076_41001_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F129175_0_0|CSTM-ALL|CSTM-00|2020|PDM|1109.00|99|0.00|AEG 8 (NO REV)|
20|FH_F86293_0_0|CSTM-ALL|CSTM-00|2020|PDM|1950.00|99|0.00|AEG 8 (NO REV)|
20|FH_F92531_0_0|CSTM-ALL|CSTM-00|2020|PDM|2770.00|99|0.00|AEG 7 (NO REV)|
20|FH_F101840_76054_0|SrvcGrp|55084|2022|PDM|6608.00|99|0.00|CPT 52648|
20|FH_F92676_15063_0|SrvcGrp|79049|2022|PDM|596.48|99|0.00|MON VALLEY ASC 311|
20|FH_F118393_21032_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F97543_33542_0|SrvcGrp|73559|2022|PDM|15512.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F144068_17901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109574_62859_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F122958_45014_0|SrvcGrp|74668|2022|PDM|325.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F115313_11216_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_F136393_0_0|SrvcGrp|108193|2022|PDM|6400.00|99|0.00|TIB/PER REVASC W/TLA|
20|FH_F115274_15235_0|SrvcGrp|97507|2022|PDM|140.00|99|0.00|AETNA HOSPICE|
20|FH_F113326_80014_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146790_0_0|SrvcGrp|114755|2022|PDM|3200.00|99|0.00|PROSTATE PROCEDURES|
20|FH_F150024_08079_0|SrvcGrp|115019|2022|PDM|1100.00|99|0.00|PERQ NJX ALGC FLUOR LMBR 1ST|
20|FH_F150165_06032_0|SrvcGrp|111955|2022|PDM|2980.00|99|0.00|MALE GENITAL PROCEDURES|
20|FH_F91412_0_0|SrvcGrp|88490|2022|PDM|1619.20|99|0.00|AETNA SPINE INJECTIONS|
20|FH_F127638_44720_0|SrvcGrp|87799|2022|PDM|130.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F110921_53014_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE|
20|FH_F85214_70360_0|SrvcGrp|30089|2022|PDM|420.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F121650_60153_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F41660_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|HOME HEALTH CARE|
20|FH_F115934_70605_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F34050_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F133133_32433_0|SrvcGrp|110042|2022|PDM|19.00|99|0.00|BEHAVIOR IDENTIFICATION ASSESSMENT 15 MINS|
20|FH_F38341_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KM|
20|FH_F52854_0_0|SrvcGrp|12592|2022|PDM|4103.00|99|0.00|OP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F101021_0_0|SrvcGrp|89783|2022|PDM|144.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F139551_0_0|SrvcGrp|70749|2022|PDM|2788.00|99|0.00|CPT 29823|
20|FH_F91622_0_0|SrvcGrp|3178|2022|PDM|918.00|99|0.00|ACUTE PSYCH|
20|FH_F47963_0_0|SrvcGrp|12263|2022|PDM|16.50|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F73985_0_0|SrvcGrp|102799|2022|PDM|16895.00|99|0.00|ANGIOPLASTY|
20|FH_F83451_0_0|SrvcGrp|15473|2022|PDM|1350.00|99|0.00|CPT CODE 42820|
20|FH_F134151_17509_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F99420_91326_0|SrvcGrp|38871|2022|PCT|0.90|99|0.00|TRAUMA SERVICES - OP|
20|FH_F132099_67487_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F40541_0_0|SrvcGrp|27536|2022|PDM|605.00|99|0.00|HAPA EPA ASC 57 UNGROUPED|
20|FH_F130661_04441_0|SrvcGrp|73806|2022|PCT|0.86|99|0.00|AETNA ER|
20|FH_F131392_17004_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F97080_85122_0|SrvcGrp|73603|2022|PDM|5698.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F146266_0_0|SrvcGrp|108351|2022|PDM|14441.00|99|0.00|REPAIR RADIUS FRACTURE|
20|FH_F69249_0_0|CSTM-ALL|CSTM-00|2020|PDM|2500.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115963_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F41463_0_0|SrvcGrp|35717|2022|PDM|128.70|99|0.00|OXYGEN RENTAL (E0439 ONLY)|
20|FH_F147083_46304_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139167_42240_0|SrvcGrp|73841|2022|PDM|379.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F149273_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F75606_0_0|SrvcGrp|12299|2022|PCT|0.68|99|0.00|PROSTHETICS/IMPLANTS/DEVICES|
20|FH_F134396_80045_0|SrvcGrp|89417|2022|PDM|460.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F133140_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F147339_08837_0|SrvcGrp|115042|2022|PCT|1.25|99|0.00|INSJ STABLJ DEV W/DCMPRN|
20|FH_F117737_75001_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F45798_0_0|SrvcGrp|11659|2022|PDM|2933.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F148553_85016_0|SrvcGrp|108171|2022|PDM|1752.00|99|0.00|FEM/POPL REVAS W/TLA|
20|FH_F132721_0_0|SrvcGrp|33793|2022|PDM|13426.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F43418_0_0|SrvcGrp|37018|2022|PDM|250.00|99|0.00|BOARDER BABY|
20|FH_F134691_33445_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141170_0_0|SrvcGrp|27330|2022|PDM|3820.00|99|0.00|CPT 27096|
20|FH_F35685_0_0|SrvcGrp|9520|2022|PDM|3969.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|2296.16|99|0.00|AEG 8 (NO REV)|
20|FH_F113390_0_0|SrvcGrp|44144|2022|PDM|2200.00|99|0.00|CPT 42440|
20|FH_F151503_30067_0|SrvcGrp|92197|2022|PDM|6737.00|99|0.00|CORRECTION OF BUNION|
20|FH_F36492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135607_21613_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F116397_33404_0|SrvcGrp|86850|2022|PDM|40.00|99|0.00|HCPCS S9061 (HCFA)|
20|FH_F116447_21601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F121808_70390_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F38288_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126023_70748_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F101620_47401_0|SrvcGrp|93919|2022|PDM|639.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F40527_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|HEAD INJURY REHABILITATION|
20|FH_F94303_0_0|SrvcGrp|73002|2022|PDM|2280.00|99|0.00|AEG 7|
20|FH_F43324_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AV|
20|FH_F47836_0_0|SrvcGrp|56225|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F88956_0_0|SrvcGrp|20096|2022|PDM|40692.00|99|0.00|MS DRG 222-223 ONLY|
20|FH_F132269_34202_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F50974_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F146211_68144_0|SrvcGrp|114505|2022|PCT|1.20|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F127217_29650_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F38865_0_0|SrvcGrp|131|2022|PCT|0.75|99|0.00|PACEMAKER DEVICE|
20|FH_F107082_21015_0|SrvcGrp|472|2022|PDM|498.75|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F71323_68114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F32509_0_0|SrvcGrp|9911|2022|PCT|0.80|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F91155_16105_0|SrvcGrp|73701|2022|PDM|39.30|99|0.00|AETNA - SKILLED NURSING|
20|FH_F122245_0_0|SrvcGrp|72992|2022|PDM|568.00|99|0.00|AEG 2|
20|FH_F78167_0_0|SrvcGrp|35964|2022|PDM|45.00|99|0.00|SPEECH THERAPY|
20|FH_F109812_37043_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F89311_0_0|CSTM-ALL|CSTM-00|2020|PDM|1277.00|99|0.00|COVENTRY ENHANCED GROUPER 8|
20|FH_F117087_0_0|SrvcGrp|77582|2022|PDM|2093.00|99|0.00|CPT 31255|
20|FH_F32033_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F151085_15905_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F49287_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F127486_06776_0|SrvcGrp|89783|2022|PDM|161.70|99|0.00|RESPITE CARE (HCFA)|
20|FH_F89551_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F147984_63664_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F93173_73401_0|SrvcGrp|78504|2022|PCT|0.68|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F116473_0_0|SrvcGrp|80617|2022|PDM|15000.00|99|0.00|ARTHOPLASTY|
20|FH_F83831_0_0|SrvcGrp|14371|2022|PDM|17.00|99|0.00|DISPOSABLE DRUG DELIVERY|
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|1393.70|99|0.00|AETNA GLENNVILLE 2016 AEG 6|
20|FH_F117217_80304_0|SrvcGrp|90643|2022|PDM|28.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F91472_96001_0|SrvcGrp|111614|2022|PCT|0.40|99|0.00|CARDIAC STENT IMPLANT DRUG ELUTING|
20|FH_F91067_0_0|SrvcGrp|72996|2022|PDM|779.00|99|0.00|AEG 4|
20|FH_F82933_0_0|SrvcGrp|30623|2022|PDM|8288.53|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F110000_0_0|SrvcGrp|10906|2022|PDM|794.00|99|0.00|EMERGENCY ROOM LEVEL IV|
20|FH_F120901_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F93252_0_0|SrvcGrp|89569|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F34652_0_0|SrvcGrp|10671|2022|PDM|5694.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F136734_46410_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114666_30342_0|SrvcGrp|35669|2022|PDM|4000.00|99|0.00|CPT 63650|
20|FH_F77234_0_0|SrvcGrp|705|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F115206_80923_0|SrvcGrp|90388|2022|PDM|859.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F42399_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113250_71901_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134263_15628_0|SrvcGrp|108484|2022|PDM|637.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F150782_19444_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F35990_0_0|SrvcGrp|177|2022|PDM|2111.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F36597_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|100% 2007 MEDICARE DMETN  MOD KM|
20|FH_F51438_0_0|SrvcGrp|45884|2022|PDM|120.00|99|0.00|ST|
20|FH_F45176_0_0|SrvcGrp|39606|2022|PDM|2400.00|99|0.00|TONSILS & ADENOIDS|
20|FH_F44257_0_0|SrvcGrp|16|2022|PDM|974.00|99|0.00|ACUTE REHABILITATION|
20|FH_F128299_44134_0|SrvcGrp|89783|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F92676_15063_0|SrvcGrp|68180|2022|PCT|2.43|99|0.00|MON VALLEY RAD W/ ER|
20|FH_F150909_70032_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F111401_29425_0|SrvcGrp|48398|2022|PDM|125.00|99|0.00|PT SERVICES|
20|FH_F109845_85207_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F64943_0_0|CSTM-ALL|CSTM-00|2020|PDM|614.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F92648_90248_0|SrvcGrp|88834|2022|PDM|89.25|99|0.00|SKILLED NURSING SERVICES (15 MINS)|
20|FH_F128648_44256_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F151059_60435_0|SrvcGrp|48385|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F98860_96706_0|SrvcGrp|73659|2022|PDM|8136.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F35245_0_0|SrvcGrp|9937|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F122377_91007_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138478_0_0|SrvcGrp|109497|2022|PDM|1193.56|99|0.00|REPOSITION PACING-DEFIB LEA|
20|FH_F117762_0_0|SrvcGrp|86233|2022|PDM|1430.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F138017_73129_0|CSTM-ALL|CSTM-00|2020|PDM|682.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F93172_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F117617_80439_0|SrvcGrp|46605|2022|PDM|150.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F147379_15001_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F112128_63017_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F148496_17112_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F88483_0_0|CSTM-ALL|CSTM-00|2020|PDM|1329.00|99|0.00|AEG 9 (NO REV)|
20|FH_F132254_40207_0|SrvcGrp|14949|2022|PDM|110.00|99|0.00|HOME INFUSION|
20|FH_F122377_91007_0|SrvcGrp|8950|2022|PDM|5217.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F102525_73134_0|SrvcGrp|73006|2022|PDM|3056.00|99|0.00|AEG 9|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F40627_0_0|SrvcGrp|29|2022|PCT|0.85|99|0.00|ELECTROPHYSIOLOGY|
20|FH_F36715_0_0|SrvcGrp|8968|2022|PDM|2921.00|99|0.00|NICU LEVEL III & IV|
20|FH_F74825_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F137788_72632_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F97183_25304_0|SrvcGrp|73603|2022|PDM|10014.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F140295_0_0|SrvcGrp|88740|2022|PDM|3443.00|99|0.00|SP BONE ALGRFT|
20|FH_F134847_0_0|SrvcGrp|77451|2022|PDM|5429.00|99|0.00|CPT 53440|
20|FH_F117603_92210_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131545_64057_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119946_36109_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F93961_0_0|SrvcGrp|91859|2022|PDM|352.00|99|0.00|SIGMOIDOSCOPY W/ ENDOSCOPIC|
20|FH_F140131_62870_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140210_60643_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F143249_89801_0|SrvcGrp|65621|2022|PDM|50.00|99|0.00|RN NURSING|
20|FH_F143347_16001_0|SrvcGrp|113465|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F101806_0_0|SrvcGrp|75485|2022|PDM|696.60|99|0.00|AEG 4|
20|FH_F131067_57105_0|CSTM-ALL|CSTM-00|2020|PDM|4338.00|99|0.00|AEG 10 (NO REV)|
20|FH_F47600_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL|
20|FH_F136296_73170_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132446_19063_0|SrvcGrp|29347|2022|PDM|18.00|99|0.00|HOME HEALTH AIDE|
20|FH_F116595_92506_0|SrvcGrp|89149|2022|PDM|300.00|99|0.00|OP INTENSIVE|
20|FH_F116907_75093_0|SrvcGrp|93337|2022|PDM|350.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F37353_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F138283_0_0|SrvcGrp|113278|2022|PDM|107.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F144494_62526_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F50297_0_0|SrvcGrp|22954|2022|PDM|112.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F100788_01420_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F103781_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F106580_33321_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F108940_15642_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F52112_0_0|SrvcGrp|48968|2022|PDM|5700.00|99|0.00|RENAL ABLATION|
20|FH_F111540_16823_0|SrvcGrp|104416|2022|PDM|134.00|99|0.00|OFFICE/OUTPATIENT VISIT EST (HCFA)(MOD AF)|
20|FH_F125222_83211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F40914_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F112665_0_0|SrvcGrp|98496|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR ATLAS|
20|FH_F145641_06902_0|SrvcGrp|72121|2022|PDM|6458.00|99|0.00|ARTHOSCOPY|
20|FH_F127585_45069_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F121225_98902_0|SrvcGrp|50942|2022|PCT|7.50|99|0.00|MRI|
20|FH_F133909_19805_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F126341_27284_0|SrvcGrp|24745|2022|PCT|1.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F36552_0_0|SrvcGrp|18127|2022|PDM|17955.00|99|0.00|MS DRG 242|
20|FH_F121476_0_0|SrvcGrp|108857|2022|PDM|1770.00|99|0.00|SURGICAL SUPPLY|
20|FH_F71748_0_0|SrvcGrp|17140|2022|PDM|172.08|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F70208_0_0|SrvcGrp|12982|2022|PDM|575.00|99|0.00|NEONATAL INTENSIVE CARE II|
20|FH_F120670_0_0|SrvcGrp|93069|2022|PDM|6500.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F121628_19533_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|431.28|99|0.00|HAPA WPA-NWPA 2012-13 ASC 207 W/O REV|
20|FH_F71843_0_0|SrvcGrp|59163|2022|PCT|0.50|99|0.00|OP SURGICAL ANCILLARY SERVICES|
20|FH_F119227_01752_0|SrvcGrp|92096|2022|PDM|750.00|99|0.00|AETNA HOME VENT INVASIVE INTERFACE|
20|FH_F117206_0_0|SrvcGrp|63471|2022|PDM|1500.00|99|0.00|CPT 64590|
20|FH_F134472_84624_0|SrvcGrp|86661|2022|PDM|71.00|99|0.00|SPEECH THERAPY|
20|FH_F102200_06416_0|SrvcGrp|16750|2022|PDM|119.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F133583_77074_0|SrvcGrp|88819|2022|PDM|933.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F38341_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F102185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116092_83254_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F94261_0_0|SrvcGrp|88621|2022|PDM|78.75|99|0.00|SKILLED NURSING LPN|
20|FH_F148265_06067_0|SrvcGrp|67064|2022|PDM|6283.00|99|0.00|MUSCULOSKELETAL SYSTEM|
20|FH_F140762_0_0|CSTM-ALL|CSTM-00|2020|PDM|1414.00|99|0.00|AEG 7 (NO REV)|
20|FH_F131236_84041_0|SrvcGrp|80918|2022|PDM|93.00|99|0.00|RESPITE CARE|
20|FH_F37970_0_0|SrvcGrp|27695|2022|PCT|1.00|99|0.00|TRANSPORTATION|
20|FH_F121699_73703_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F149106_07042_0|SrvcGrp|30141|2022|PDM|3606.00|99|0.00|PARTIAL MASTECTOMY|
20|FH_F118307_60103_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|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_F143624_73069_0|SrvcGrp|48396|2022|PDM|110.00|99|0.00|OT SERVICES|
20|FH_F133922_70563_0|SrvcGrp|21458|2022|PDM|448.71|99|0.00|SLEEP STUDIES|
20|FH_F92276_32308_0|SrvcGrp|114288|2022|PCT|0.00|99|0.00|PROFESSIONAL FEES (NON-CLINICAL)|
20|FH_F132779_0_0|SrvcGrp|29755|2022|PDM|39419.00|99|0.00|MS DRG 245 ONLY|
20|FH_F148489_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F125028_19061_0|SrvcGrp|14944|2022|PDM|3.15|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F116093_47327_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F87577_80016_0|SrvcGrp|47082|2022|PDM|1585.00|99|0.00|MRI|
20|FH_F103281_32086_0|SrvcGrp|70381|2022|PDM|337.00|99|0.00|PSYCH PARTIAL HOSP (FULL & PARTIAL DAY) PER VISIT|
20|FH_F121168_0_0|SrvcGrp|89781|2022|PDM|100.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|31300.00|99|0.00|MS DRG 219-221|
20|FH_F150165_06032_0|SrvcGrp|111802|2022|PDM|2140.00|99|0.00|REVISION OF PENIS|
20|FH_F112004_15401_0|SrvcGrp|88621|2022|PDM|100.00|99|0.00|SKILLED NURSING LPN|
20|FH_F97861_62223_0|SrvcGrp|88978|2022|PDM|7023.00|99|0.00|VAGINAL DELIVERY|
20|FH_F135670_01749_0|SrvcGrp|86852|2022|PDM|42.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F118803_0_0|SrvcGrp|107875|2022|PDM|349.70|99|0.00|SELECTIVE CATHETER PLACEMENT|
20|FH_F41135_0_0|SrvcGrp|17071|2022|PDM|608.96|99|0.00|ASPG IV|
20|FH_F138056_64055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F110470_98335_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F145601_32159_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|276.95|99|0.00|HAPA WPA-NWPA 2012-13 ASC 117 W/O REV|
20|FH_F70205_0_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F84712_0_0|SrvcGrp|66517|2022|PCT|0.00|99|0.00|NICU|
20|FH_F139887_0_0|CSTM-ALL|CSTM-00|2020|PDM|743.00|99|0.00|AEG 3 (NO REV)|
20|FH_F72704_0_0|SrvcGrp|49862|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F38591_0_0|SrvcGrp|180|2022|PDM|2745.00|99|0.00|INTENSIVE CARE SERVICES|
20|FH_F148169_33138_0|SrvcGrp|114113|2022|PDM|25.46|99|0.00|COVID-19 SPECIMEN COLLECT|
20|FH_F139515_0_0|SrvcGrp|89861|2022|PDM|8549.00|99|0.00|LUMBAR LAMINOTOMY|
20|FH_F125254_30306_0|SrvcGrp|46903|2022|PDM|755.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F114976_78539_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F135207_76053_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F122687_0_0|SrvcGrp|92408|2022|PDM|7103.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F119593_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F112272_0_0|SrvcGrp|79804|2022|PDM|1456.00|99|0.00|AETNA MEDICAL/SURGICAL|
20|FH_F119660_0_0|SrvcGrp|82222|2022|PDM|90.00|99|0.00|HOSPICE CARE|
20|FH_F140651_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F123922_84102_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F92392_0_0|SrvcGrp|11336|2022|PCT|0.50|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F142547_70002_0|SrvcGrp|19742|2022|PDM|50.00|99|0.00|MID-LINE INSERTION|
20|FH_F142741_03264_0|SrvcGrp|73605|2022|PDM|1240.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F138627_82901_0|SrvcGrp|86853|2022|PDM|50.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F140343_89052_0|SrvcGrp|86848|2022|PDM|30.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F119023_91406_0|SrvcGrp|86834|2022|PDM|12.50|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F147801_90703_0|SrvcGrp|94879|2022|PDM|154.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F90791_79106_0|SrvcGrp|88834|2022|PDM|95.00|99|0.00|SKILLED NURSING SERVICES (15 MINS)|
20|FH_F97040_31901_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F133694_89117_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137248_0_0|SrvcGrp|97019|2022|PDM|4058.00|99|0.00|ARTHROSCOPY BICEPS TENODESIS|
20|FH_F147311_37421_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F41652_0_0|SrvcGrp|110|2022|PDM|324.00|99|0.00|CD - REHABILITATION|
20|FH_F36372_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F35381_0_0|SrvcGrp|903|2022|PDM|2349.00|99|0.00|PTC ANGIOPLASTY|
20|FH_F138684_44484_0|SrvcGrp|73841|2022|PDM|375.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138687_77477_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F149059_19702_0|SrvcGrp|113773|2022|PCT|1.00|99|0.00|TELEMEDICINE (MOD 95, GT)|
20|FH_F96721_99504_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F142930_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F136359_0_0|SrvcGrp|112851|2022|PDM|5980.00|99|0.00|SHOULDER SERVICES|
20|FH_F58713_0_0|CSTM-ALL|CSTM-00|2020|PDM|833.00|99|0.00|ASPG III|
20|FH_F137943_0_0|CSTM-ALL|CSTM-00|2020|PDM|800.00|99|0.00|AEG 6 (NO REV)|
20|FH_F100761_02539_0|SrvcGrp|73643|2022|PDM|2675.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F149888_68506_0|SrvcGrp|84901|2022|PDM|2119.00|99|0.00|ARTHROSCOPY - KNEE|
20|FH_F149839_80002_0|SrvcGrp|88621|2022|PDM|125.00|99|0.00|SKILLED NURSING LPN|
20|FH_F78446_0_0|SrvcGrp|75501|2022|PDM|45.00|99|0.00|PHYSICAL THERAPY|
20|FH_F102500_0_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F82753_18840_0|CSTM-ALL|CSTM-00|2020|PDM|6232.00|99|0.00|AETNA AMBULATORY SURGERY W/O URINARY SYSTEM|
20|FH_F126730_84737_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F41776_0_0|CSTM-ALL|CSTM-00|2020|PDM|937.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F62614_0_0|SrvcGrp|48395|2022|PDM|30.00|99|0.00|OT SERVICES|
20|FH_F71628_0_0|SrvcGrp|48394|2022|PDM|7.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F134254_33462_0|SrvcGrp|108484|2022|PDM|749.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F149610_76543_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F107200_0_0|SrvcGrp|101521|2022|PDM|6242.00|99|0.00|T1H UTERUS (>250G)|
20|FH_F149653_19702_0|SrvcGrp|74668|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F118943_64506_0|SrvcGrp|26868|2022|PDM|25.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F112080_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F91472_96001_0|SrvcGrp|83423|2022|PDM|14850.00|99|0.00|LAPROSCOPIC CHOLECYSTECTOMY|
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)|
20|FH_F134747_83404_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F114166_0_0|SrvcGrp|111926|2022|PDM|36.99|99|0.00|COVID-19 LAB TESTING|
20|FH_F34864_0_0|CSTM-ALL|CSTM-00|2020|PDM|1799.00|99|0.00|ASPG IV|
20|FH_F75806_0_0|SrvcGrp|100948|2022|PDM|216.00|99|0.00|HOME HEALTH LPN SERVICE|
20|FH_F139150_75206_0|SrvcGrp|113201|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES HH AMFS(H) DEFAULT|
20|FH_F120040_72703_0|SrvcGrp|46903|2022|PDM|695.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F115483_62002_0|SrvcGrp|89317|2022|PCT|0.60|99|0.00|AETNA SLEEP STUDIES|
20|FH_F97623_38008_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43244_0_0|SrvcGrp|31931|2022|PDM|1979.00|99|0.00|SKILLED NURSING CARE|
20|FH_F115274_15235_0|SrvcGrp|97702|2022|PDM|135.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F125540_19462_0|SrvcGrp|110150|2022|PDM|190.00|99|0.00|INTENSIVE OUTPATIENT (<=17 YRS) (HCFA)|
20|FH_F134430_86301_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F129175_0_0|SrvcGrp|45063|2022|PDM|300.00|99|0.00|CPT 64493  INJECTION CARVE OUT|
20|FH_F127163_74437_0|SrvcGrp|86723|2022|PDM|400.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F57592_0_0|SrvcGrp|12197|2022|PDM|1500.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F127197_23111_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F113288_38104_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F101922_98055_0|SrvcGrp|93121|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F111809_93003_0|CSTM-ALL|CSTM-00|2020|PDM|6180.00|99|0.00|AEG 3 (NO REV)|
20|FH_F55872_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F31714_0_0|SrvcGrp|1151|2022|PDM|39000.00|99|0.00|DRG 104 CARDIAC VALVE PX & OTHER MJR CARDIOTHORACIC PX WO/CC|
20|FH_F134992_34112_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F112672_11788_0|SrvcGrp|113276|2022|PCT|1.10|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F134324_26354_0|SrvcGrp|75506|2022|PCT|0.84|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F112791_0_0|SrvcGrp|72992|2022|PDM|468.00|99|0.00|AEG 2|
20|FH_F114407_19002_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85213_02840_0|SrvcGrp|111926|2022|PDM|203.10|99|0.00|COVID-19 LAB TESTING|
20|FH_F84552_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F75862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133585_0_0|SrvcGrp|108190|2022|PDM|3092.00|99|0.00|ARTERY-VEIN GRAFT|
20|FH_F126308_44515_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F117208_0_0|CSTM-ALL|CSTM-00|2020|PDM|742.50|99|0.00|AEG 1 (NO REV)|
20|FH_F79743_0_0|SrvcGrp|105689|2022|PCT|0.57|99|0.00|RADIOLOGY SERVICES|
20|FH_F85353_16407_0|SrvcGrp|63896|2022|PDM|175.49|99|0.00|HAPA WPA-NWPA 2012-13 ASC 134|
20|FH_F90332_07060_0|SrvcGrp|89925|2022|PCT|1.00|99|0.00|AETNA CARVEOUT INJECTIONS/THERAPY|
20|FH_F122425_75082_0|SrvcGrp|471|2022|PDM|705.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F132088_34981_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F134828_30531_0|SrvcGrp|12526|2022|PDM|38.00|99|0.00|RADIOLOGY SVCS|
20|FH_F145542_70503_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F149839_80002_0|SrvcGrp|93098|2022|PDM|144.00|99|0.00|HOSPICE CARE|
20|FH_F134813_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129408_48034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F75307_0_0|SrvcGrp|57649|2022|PDM|77.00|99|0.00|PHYSICAL THERAPY SVCS MOD GP|
20|FH_F88254_33411_0|SrvcGrp|29077|2022|PDM|10.00|99|0.00|HOME TRANSFUSION|
20|FH_F131995_04730_0|SrvcGrp|48385|2022|PDM|140.00|99|0.00|SPEECH THERAPY|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PDM|937.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F31340_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120248_77008_0|SrvcGrp|58509|2022|PDM|250.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F147941_06023_0|SrvcGrp|90489|2022|PCT|1.15|99|0.00|PNEUMOCOCCAL VACCINE|
20|FH_F38357_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F137718_80107_0|SrvcGrp|73842|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148892_0_0|SrvcGrp|92408|2022|PDM|4704.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F53732_0_0|SrvcGrp|24762|2022|PDM|150.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F125053_0_0|SrvcGrp|79588|2022|PDM|1783.50|99|0.00|CPT 43235|
20|FH_F98801_93274_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F119760_0_0|SrvcGrp|95661|2022|PDM|107.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F148266_45419_0|SrvcGrp|115360|2022|PDM|967.19|99|0.00|REVISION OF AQUEOUS SHUNT|
20|FH_F125973_63830_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|1235.00|99|0.00|AEG 7 (NO REV)|
20|FH_F82753_18840_0|SrvcGrp|75506|2022|PCT|0.87|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F40834_0_0|SrvcGrp|701|2022|PDM|2146.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F109652_0_0|SrvcGrp|11259|2022|PCT|0.26|99|0.00|DRUGS|
20|FH_F102760_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118661_0_0|SrvcGrp|72990|2022|PDM|1028.00|99|0.00|AEG 1|
20|FH_F97721_01053_0|SrvcGrp|73485|2022|PDM|2782.00|99|0.00|AETNA REHAB|
20|FH_F36584_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F55812_0_0|SrvcGrp|53746|2022|PDM|35.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F136778_62034_0|SrvcGrp|10364|2022|PDM|1333.00|99|0.00|CPT CODE 99284|
20|FH_F116173_40217_0|SrvcGrp|104302|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F116393_07002_0|SrvcGrp|106490|2022|PDM|77.98|99|0.00|STRAPING OF KNEE|
20|FH_F133100_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|AEG 3 (NO REV)|
20|FH_F136186_46307_0|SrvcGrp|88620|2022|PDM|120.00|99|0.00|SKILLED NURSING RN|
20|FH_F69202_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ACUTE PSYCH|
20|FH_F149579_95815_0|SrvcGrp|115676|2022|PDM|41.36|99|0.00|COMPLEX CHRONIC CARE ADDL 30 MINS|
20|FH_F124722_66067_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117762_0_0|SrvcGrp|99168|2022|PDM|2201.00|99|0.00|CPT 22899|
20|FH_F129764_48084_0|SrvcGrp|71083|2022|PCT|1.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F88451_0_0|SrvcGrp|29137|2022|PDM|28.00|99|0.00|HOME HEALTH AIDE|
20|FH_F138636_0_0|CSTM-ALL|CSTM-00|2020|PDM|471.00|99|0.00|AEG 1 (NO REV)|
20|FH_F40347_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F139267_30253_0|SrvcGrp|113546|2022|PDM|14.30|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F118943_64506_0|SrvcGrp|17015|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F92506_07666_0|SrvcGrp|14494|2022|PDM|59.76|99|0.00|CONTINUOUS HOMECARE|
20|FH_F117214_84020_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F40081_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F132988_0_0|SrvcGrp|89980|2022|PDM|6410.83|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F124246_71655_0|SrvcGrp|75419|2022|PDM|250.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F124567_33144_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122740_71038_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F136930_73114_0|SrvcGrp|66459|2022|PDM|717.00|99|0.00|CT SCAN|
20|FH_F141170_0_0|SrvcGrp|88163|2022|PDM|8010.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F41934_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F54552_0_0|SrvcGrp|20480|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138989_02861_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148243_0_0|CSTM-ALL|CSTM-00|2020|PDM|1169.00|99|0.00|AEG 9 (NO REV)|
20|FH_F147228_49441_0|SrvcGrp|92502|2022|PDM|804.46|99|0.00|HOSPICE GENERAL IP CARE|
20|FH_F125782_66763_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F36534_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118698_32054_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F102561_75146_0|SrvcGrp|77021|2022|PDM|9785.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F106540_26330_0|SrvcGrp|9517|2022|PDM|167.00|99|0.00|MAMMOGRAPHY|
20|FH_F102721_38118_0|SrvcGrp|72998|2022|PDM|1150.00|99|0.00|AEG 5|
20|FH_F119079_41018_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F117087_0_0|SrvcGrp|107178|2022|PDM|2494.00|99|0.00|TYMPANOPLASTY W/O MASTOIDECT|
20|FH_F40176_0_0|SrvcGrp|32016|2022|PDM|140.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F134447_12883_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PDM|910.00|99|0.00|ASPG IV|
20|FH_F36552_0_0|SrvcGrp|18182|2022|PDM|8005.00|99|0.00|MS DRG 259|
20|FH_F110503_10016_0|SrvcGrp|73842|2022|PDM|339.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F145641_06902_0|SrvcGrp|104112|2022|PDM|3588.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F133749_84604_0|SrvcGrp|59795|2022|PDM|50.00|99|0.00|TPN|
20|FH_F127282_98004_0|CSTM-ALL|CSTM-00|2020|PDM|491.00|99|0.00|PARTIAL HOSPITALIZATION PSYCHIATRIC|
20|FH_F93190_26456_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F125105_67361_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90500_32446_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|411.17|99|0.00|HAPA WPA-NWPA 2012-13 ASC 226 W/O REV|
20|FH_F110308_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_F146974_19709_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F54752_0_0|CSTM-ALL|CSTM-00|2020|PDM|425.00|99|0.00|ASPG I|
20|FH_F76163_0_0|SrvcGrp|26001|2022|PDM|150.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F100681_73104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F46918_0_0|SrvcGrp|15846|2022|PDM|47.00|99|0.00|HOME VISIT|
20|FH_F132947_45342_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132720_0_0|SrvcGrp|107733|2022|PDM|6266.00|99|0.00|CESAREAN SECTION|
20|FH_F66469_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F102862_30606_0|SrvcGrp|31017|2022|PDM|18915.20|99|0.00|MS DRG 468 ONLY|
20|FH_F137797_70123_0|SrvcGrp|66264|2022|PDM|103.00|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F125214_12428_0|SrvcGrp|11259|2022|PCT|0.55|99|0.00|DRUGS|
20|FH_F148008_0_0|SrvcGrp|471|2022|PDM|603.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1313.00|99|0.00|AEG 6 (NO REV)|
20|FH_F139847_66205_0|SrvcGrp|81779|2022|PCT|1.10|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F35820_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|1575124_HCPCS_  MOD AW|
20|FH_F40980_0_0|SrvcGrp|20162|2022|PDM|28018.00|99|0.00|BARIATRIC SERVICES|
20|FH_F38016_0_0|SrvcGrp|20299|2022|PDM|3461.00|99|0.00|MS DRG 228-230 ONLY OTHER CARDIOTHORACIC PROC|
20|FH_F72024_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F44135_0_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F87155_04105_0|SrvcGrp|22592|2022|PDM|57.78|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F127432_18015_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F141872_20707_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F36002_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F106540_26330_0|SrvcGrp|107807|2022|PCT|0.43|99|0.00|LABORATORY SERVICES|
20|FH_F132331_89107_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F101840_76054_0|SrvcGrp|91879|2022|PDM|6608.00|99|0.00|PROSTATE LASER ENUCLEATION|
20|FH_F133472_27607_0|SrvcGrp|105819|2022|PDM|1349.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F119007_0_0|SrvcGrp|87677|2022|PDM|785.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F151141_24014_0|CSTM-ALL|CSTM-00|2020|PDM|1261.00|99|0.00|AEG 10 (NO REV)|
20|FH_F151160_61350_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129130_92562_0|CSTM-ALL|CSTM-00|2020|PDM|9943.00|99|0.00|AEG 10 W/O SURG CARVEOUT (NO REV)|
20|FH_F138784_32216_0|SrvcGrp|89417|2022|PDM|463.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F138422_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|AEG 4 (NO REV)|
20|FH_F113527_31023_0|SrvcGrp|75485|2022|PCT|0.80|99|0.00|AEG 4|
20|FH_F135355_73112_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135607_21613_0|SrvcGrp|112323|2022|PDM|400.00|99|0.00|LABORATORY|
20|FH_F135952_74501_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F131407_07607_0|SrvcGrp|17014|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F101819_0_0|CSTM-ALL|CSTM-00|2020|PCT|45.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130766_04967_0|SrvcGrp|72984|2022|PCT|0.88|99|0.00|CHEMOTHERAPY|
20|FH_F150839_03833_0|SrvcGrp|48396|2022|PDM|170.00|99|0.00|OT SERVICES|
20|FH_F148962_08109_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F32902_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F136677_0_0|CSTM-ALL|CSTM-00|2020|PDM|1178.00|99|0.00|AEG 7 (NO REV)|
20|FH_F42352_0_0|SrvcGrp|411|2022|PCT|0.65|99|0.00|OP CARDIAC CATH|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PDM|6395.00|99|0.00|ASPG IX|
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|810.00|99|0.00|AEG 5  (NO REV)|
20|FH_F92676_15063_0|SrvcGrp|78926|2022|PDM|4174.09|99|0.00|MON VALLEY ASC 1|
20|FH_F145901_45205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36383_0_0|SrvcGrp|177|2022|PDM|2250.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F118790_98640_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F88512_0_0|SrvcGrp|13774|2022|PDM|1418.01|99|0.00|SKILLED NURSING CARE|
20|FH_F132487_0_0|SrvcGrp|30609|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F115406_79902_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F132571_24739_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F67379_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|OP SVCS|
20|FH_F121385_89102_0|SrvcGrp|73806|2022|PDM|10243.00|99|0.00|AETNA ER|
20|FH_F149660_0_0|SrvcGrp|13597|2022|PDM|208.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/NON-EMERG TRANSPORT|
20|FH_F109387_35630_0|SrvcGrp|89417|2022|PDM|542.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F85212_71075_0|SrvcGrp|73483|2022|PDM|530.00|99|0.00|AETNA SUBACUTE III|
20|FH_F137310_0_0|SrvcGrp|98062|2022|PDM|432.00|99|0.00|HOSPICE INPATIENT RESPITE CARE PER DIEM|
20|FH_F140668_68745_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F141274_0_0|CSTM-ALL|CSTM-00|2020|PDM|10.00|99|0.00|LABORATORY (MOD 26)|
20|FH_F149375_26101_0|SrvcGrp|74668|2022|PDM|183.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F80366_0_0|SrvcGrp|73502|2022|PCT|0.94|99|0.00|AETNA PT OT ST|
20|FH_F117091_28144_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F38221_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F91873_12723_0|SrvcGrp|89414|2022|PDM|1590.00|99|0.00|SLEEP STUDIES|
20|FH_F91873_12723_0|SrvcGrp|89146|2022|PDM|345.00|99|0.00|HOME SLEEP STUDIES|
20|FH_F39956_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F85655_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F124637_77080_0|SrvcGrp|104079|2022|PCT|1.50|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F127995_84010_0|SrvcGrp|87799|2022|PDM|107.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F114666_30342_0|SrvcGrp|36591|2022|PDM|6500.00|99|0.00|CPT 63685|
20|FH_F42964_0_0|SrvcGrp|40820|2022|PDM|1000.00|99|0.00|ICU/CCU|
20|FH_F113390_0_0|SrvcGrp|84910|2022|PDM|2475.00|99|0.00|ENDOSCOPY|
20|FH_F40334_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F135485_20171_0|SrvcGrp|29346|2022|PDM|26.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F135867_60625_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F111301_33122_0|SrvcGrp|11663|2022|PCT|0.63|99|0.00|IMPLANTS|
20|FH_F32703_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F132972_78589_0|SrvcGrp|89149|2022|PDM|190.00|99|0.00|OP INTENSIVE|
20|FH_F92299_62016_0|SrvcGrp|73806|2022|PDM|780.00|99|0.00|AETNA ER|
20|FH_F36343_0_0|SrvcGrp|10646|2022|PDM|137.75|99|0.00|MIDLINE INSERTION KIT|
20|FH_F149480_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F116332_0_0|SrvcGrp|84939|2022|PDM|18490.00|99|0.00|SHOULDER JOINT|
20|FH_F115406_79902_0|SrvcGrp|73842|2022|PDM|202.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120841_16201_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F92676_15063_0|SrvcGrp|78965|2022|PDM|2218.82|99|0.00|MON VALLEY ASC 504|
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_F117272_24333_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150519_92626_0|SrvcGrp|109036|2022|PDM|850.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F141790_85374_0|SrvcGrp|105201|2022|PDM|3025.00|99|0.00|MUSCLE FLAP|
20|FH_F128825_45211_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130329_64114_0|SrvcGrp|88621|2022|PDM|75.00|99|0.00|SKILLED NURSING LPN|
20|FH_F113435_19027_0|SrvcGrp|73842|2022|PDM|165.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F150310_07035_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F141447_0_0|SrvcGrp|106880|2022|PDM|924.00|99|0.00|PARAVERTEBRAL FACET JOINT NERVE DESTRUCTION|
20|FH_F143624_73069_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F115877_63556_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132250_12550_0|SrvcGrp|86868|2022|PDM|104.60|99|0.00|AETNA PSYTX PT & FAM 45 MINS (MOD TD)(HCFA)|
20|FH_F38431_0_0|SrvcGrp|23006|2022|PDM|650.00|99|0.00|V5255|
20|FH_F42360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (GLOBAL) - CPD 1963706|
20|FH_F58692_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F93881_15009_0|SrvcGrp|75493|2022|PDM|3095.00|99|0.00|AEG 8|
20|FH_F134995_37055_0|SrvcGrp|87317|2022|PDM|1029.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F118056_29464_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117901_27526_0|SrvcGrp|94738|2022|PCT|1.10|99|0.00|FLUZONE VACC IM (>=3 YRS)|
20|FH_F89952_0_0|SrvcGrp|87297|2022|PCT|0.00|99|0.00|HCPCS CODES|
20|FH_F137938_29036_0|SrvcGrp|73610|2022|PCT|0.55|99|0.00|AETNA IMPLANTS|
20|FH_F110720_0_0|SrvcGrp|104099|2022|PDM|2998.00|99|0.00|REPAIR OF THIGH MUSCLE|
20|FH_F44195_0_0|CSTM-ALL|CSTM-00|2020|PDM|365.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127995_84010_0|SrvcGrp|95660|2022|PDM|107.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F134727_30650_0|SrvcGrp|13187|2022|PCT|0.60|99|0.00|INTRAOCULAR LENSES|
20|FH_F112505_51503_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F42654_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|PHOENIX HH S CODES W/MOD SH|
20|FH_F133536_0_0|SrvcGrp|69978|2022|PDM|2415.00|99|0.00|ARTHROPLASTY|
20|FH_F151514_35242_0|CSTM-ALL|CSTM-00|2020|PDM|925.00|99|0.00|AEG 6 (NO REV)|
20|FH_F130766_04967_0|SrvcGrp|114019|2022|PCT|2.25|99|0.00|CHEMOTHERAPY AND ALL OTHER DRUGS|
20|FH_F139132_36532_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138018_17313_0|SrvcGrp|29075|2022|PDM|105.00|99|0.00|HYDRATION THERAPY|
20|FH_F122574_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114188_15205_0|SrvcGrp|73701|2022|PDM|33.11|99|0.00|AETNA - SKILLED NURSING|
20|FH_F42142_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F120040_72703_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F146220_72112_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F118957_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F84712_0_0|SrvcGrp|82758|2022|PDM|54.00|99|0.00|CHEMISTRY|
20|FH_F105143_26062_0|SrvcGrp|88697|2022|PCT|0.70|99|0.00|DRUGS|
20|FH_F131989_66030_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125118_99201_0|SrvcGrp|75419|2022|PDM|409.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F149666_33460_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125323_43213_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F126585_45039_0|SrvcGrp|73700|2022|PDM|45.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F78603_0_0|SrvcGrp|439|2022|PDM|4054.02|99|0.00|INTENSIVE CARE UNIT|
20|FH_F31056_0_0|SrvcGrp|361|2022|PDM|2311.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F138713_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F138607_02760_0|SrvcGrp|114133|2022|PDM|11.30|99|0.00|DISPOSABLE SENSOR (MOD NU)|
20|FH_F140616_43338_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F119021_03060_0|SrvcGrp|86746|2022|PCT|1.06|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F124584_28204_0|SrvcGrp|89149|2022|PDM|222.00|99|0.00|OP INTENSIVE|
20|FH_F43246_0_0|SrvcGrp|40820|2022|PDM|1120.00|99|0.00|ICU/CCU|
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151441_98664_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F40073_0_0|SrvcGrp|17069|2022|PCT|0.70|99|0.00|ASPG III|
20|FH_F116469_92543_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F127399_0_0|SrvcGrp|88162|2022|PDM|3849.00|99|0.00|REMOVE SPINAL LAMINA ADD-ON|
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1888.00|99|0.00|AEG 9 (NO REV)|
20|FH_F36385_0_0|SrvcGrp|11000|2022|PCT|1.10|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F116005_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F137030_46256_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F140447_84106_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149646_71129_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F118932_07652_0|SrvcGrp|73000|2022|PDM|4774.00|99|0.00|AEG 6|
20|FH_F36217_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.74|99|0.00|GENERAL ACUTE CARE|
20|FH_F117221_23434_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F137329_81224_0|SrvcGrp|86722|2022|PDM|200.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F109907_0_0|SrvcGrp|48396|2022|PDM|92.60|99|0.00|OT SERVICES|
20|FH_F67999_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F88456_0_0|SrvcGrp|104448|2022|PDM|7907.00|99|0.00|CYSTOSCOPY IMPLANT 4 OR MORE|
20|FH_F134027_0_0|SrvcGrp|99981|2022|PDM|2223.00|99|0.00|LAPAROSCOPY SERVICES|
20|FH_F129973_48030_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F143577_0_0|SrvcGrp|82981|2022|PDM|129.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F42980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38826_0_0|SrvcGrp|177|2022|PDM|2200.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F147362_33137_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F39633_0_0|SrvcGrp|17073|2022|PDM|1330.00|99|0.00|ASPG V|
20|FH_F151427_04106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F122114_91364_0|SrvcGrp|113276|2022|PCT|1.10|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F111301_33122_0|CSTM-ALL|CSTM-00|2020|PDM|11518.00|99|0.00|HIGH GASTRIC BYPASS|
20|FH_F114166_0_0|SrvcGrp|111927|2022|PDM|52.85|99|0.00|COVID-19 NON CDC|
20|FH_F36344_0_0|SrvcGrp|474|2022|PDM|225.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F132328_0_0|SrvcGrp|83639|2022|PDM|2049.00|99|0.00|CPT 29886|
20|FH_F129240_10028_0|SrvcGrp|17013|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F139430_63017_0|SrvcGrp|48398|2022|PDM|101.00|99|0.00|PT SERVICES|
20|FH_F47558_0_0|SrvcGrp|40416|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD UE KE|
20|FH_F35164_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F127292_85705_0|SrvcGrp|89337|2022|PDM|800.00|99|0.00|DETOXIFICATION|
20|FH_F150922_02452_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125214_12428_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130939_40353_0|SrvcGrp|46903|2022|PDM|522.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F121009_76180_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|451.38|99|0.00|HAPA WPA-NWPA 2012-13 ASC 211 W/O REV|
20|FH_F39716_0_0|CSTM-ALL|CSTM-00|2020|PDM|97.09|99|0.00|ASPG 124|
20|FH_F148494_0_0|SrvcGrp|98564|2022|PDM|15000.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F125222_83211_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F142973_62448_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111403_37167_0|SrvcGrp|89149|2022|PDM|230.00|99|0.00|OP INTENSIVE|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|454.54|99|0.00|HAPA WPA-NWPA 2012-13 ASC 210 W/O REV|
20|FH_F129535_0_0|SrvcGrp|75485|2022|PDM|600.00|99|0.00|AEG 4|
20|FH_F37568_0_0|SrvcGrp|10540|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE|
20|FH_F111403_37167_0|SrvcGrp|46903|2022|PDM|912.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F150527_33844_0|SrvcGrp|87077|2022|PDM|100.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F117087_0_0|SrvcGrp|107185|2022|PDM|2494.00|99|0.00|REVISION OF STAPEDECTOMY|
20|FH_F149302_75032_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133801_87107_0|SrvcGrp|23683|2022|PDM|35.00|99|0.00|SKILLED NURSING RN|
20|FH_F133972_27103_0|SrvcGrp|86833|2022|PDM|30.00|99|0.00|HCPCS S9560 (HCFA)|
20|FH_F70208_0_0|SrvcGrp|9520|2022|PDM|3000.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F110305_70403_0|SrvcGrp|3809|2022|PDM|631.60|99|0.00|HOSPICE CARE|
20|FH_F112004_15401_0|SrvcGrp|48398|2022|PDM|145.00|99|0.00|PT SERVICES|
20|FH_F112967_0_0|SrvcGrp|90477|2022|PDM|115.00|99|0.00|HOSPICE|
20|FH_F115895_0_0|SrvcGrp|67072|2022|PDM|4774.00|99|0.00|CPT 22845|
20|FH_F138929_0_0|SrvcGrp|88820|2022|PDM|2310.00|99|0.00|CPT 24359|
20|FH_F113809_47302_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F122689_92009_0|SrvcGrp|86309|2022|PDM|101.00|99|0.00|PROVISION OF TEST MATERIALS/EQUIPMENT FOR HOME INR MONITORIN|
20|FH_F112371_19047_0|SrvcGrp|12840|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F103004_75840_0|SrvcGrp|82369|2022|PCT|0.80|99|0.00|AETNA LABORATORY|
20|FH_F138992_72703_0|SrvcGrp|92958|2022|PDM|1366.00|99|0.00|SLEEP STUDIES|
20|FH_F106500_0_0|SrvcGrp|12845|2022|PDM|322.00|99|0.00|SUPPLIES|
20|FH_F112946_0_0|SrvcGrp|87684|2022|PCT|0.65|99|0.00|OP SURGERY-ALL OTHER|
20|FH_F91764_93710_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F116461_77536_0|SrvcGrp|89337|2022|PDM|650.00|99|0.00|DETOXIFICATION|
20|FH_F132328_0_0|SrvcGrp|111957|2022|PDM|5368.00|99|0.00|PERCUTANEOUS INTRADISCAL|
20|FH_F132090_60915_0|CSTM-ALL|CSTM-00|2020|PDM|2043.30|99|0.00|AEG 6 (NO REV)|
20|FH_F138487_85297_0|SrvcGrp|94879|2022|PDM|88.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F138017_73129_0|SrvcGrp|113308|2022|PDM|14341.62|99|0.00|KNEE JOINT RECONSTRUCTION|
20|FH_F146266_0_0|SrvcGrp|86233|2022|PDM|17338.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F148554_85016_0|CSTM-ALL|CSTM-00|2020|PDM|515.00|99|0.00|AEG 2 (NO REV)|
20|FH_F96061_63834_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39640_0_0|SrvcGrp|26732|2022|PDM|850.00|99|0.00|CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE|
20|FH_F150579_16652_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F74084_15206_0|SrvcGrp|10503|2022|PDM|52.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL|
20|FH_F133390_07626_0|SrvcGrp|87077|2022|PDM|125.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F134447_12883_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F111417_33613_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F89932_10940_0|SrvcGrp|31706|2022|PDM|2560.00|99|0.00|MS DRG 792 ONLY|
20|FH_F146212_57108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1155.00|99|0.00|AEG 8 (NO REV)|
20|FH_F33659_0_0|SrvcGrp|15392|2022|PDM|95.00|99|0.00|PHYSICAL THERAPY|
20|FH_F133167_82930_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F130662_07032_0|SrvcGrp|86723|2022|PDM|325.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F145852_67203_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F143567_62207_0|SrvcGrp|88620|2022|PDM|135.00|99|0.00|SKILLED NURSING RN|
20|FH_F133749_84604_0|SrvcGrp|112446|2022|PDM|10.00|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F114409_18447_0|SrvcGrp|63297|2022|PDM|125.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F116849_0_0|SrvcGrp|23130|2022|PDM|23.32|99|0.00|1:1 SUPERVISION|
20|FH_F146881_83661_0|SrvcGrp|82222|2022|PDM|140.00|99|0.00|HOSPICE CARE|
20|FH_F143467_0_0|SrvcGrp|33982|2022|PDM|1424.00|99|0.00|CPT 28296|
20|FH_F130145_98043_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97500_32025_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F90840_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F113255_0_0|SrvcGrp|86424|2022|PDM|737.00|99|0.00|REMOVE INT/EXT HEM 1 GROUP|
20|FH_F148160_29732_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120639_73078_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F143832_0_0|SrvcGrp|2738|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F130620_18940_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116397_33404_0|SrvcGrp|29076|2022|PDM|40.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F121763_07202_0|SrvcGrp|90631|2022|PDM|120.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION|
20|FH_F141035_0_0|SrvcGrp|101800|2022|PDM|7008.00|99|0.00|SKELETAL FIXATION|
20|FH_F124318_29020_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119491_19904_0|SrvcGrp|48396|2022|PDM|84.00|99|0.00|OT SERVICES|
20|FH_F89851_83854_0|SrvcGrp|58421|2022|PDM|12869.00|99|0.00|MS DRG 738 ONLY|
20|FH_F104963_15146_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148579_17057_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111546_84010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133412_84129_0|SrvcGrp|471|2022|PDM|608.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F117880_91730_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER TC|
20|FH_F102561_75146_0|SrvcGrp|73498|2022|PDM|725.00|99|0.00|AETNA ER LEVEL III|
20|FH_F136812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F99720_0_0|SrvcGrp|73004|2022|PDM|3067.00|99|0.00|AEG 8|
20|FH_F51438_0_0|SrvcGrp|9939|2022|PDM|1273.00|99|0.00|ACUTE MEDICAL SVCS|
20|FH_F125465_43078_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|GENERAL ACUTE CARE|
20|FH_F151155_26508_0|SrvcGrp|113348|2022|PDM|527.00|99|0.00|OFF BASE OPIOID TX 60 MIN|
20|FH_F118267_45005_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F88357_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F125244_0_0|SrvcGrp|33977|2022|PDM|1500.00|99|0.00|CPT 59820|
20|FH_F126341_27284_0|SrvcGrp|64601|2022|PDM|40.50|99|0.00|HIGH COST DRUGS J1557|
20|FH_F124369_0_0|SrvcGrp|92197|2022|PDM|17765.00|99|0.00|CORRECTION OF BUNION|
20|FH_F138026_46143_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F150179_23124_0|CSTM-ALL|CSTM-00|2020|PDM|1350.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49996_0_0|CSTM-ALL|CSTM-00|2020|PDM|983.00|99|0.00|ASPG IV|
20|FH_F135900_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F73864_0_0|SrvcGrp|48394|2022|PDM|7.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F118138_60532_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F135626_20176_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149079_70809_0|SrvcGrp|30089|2022|PDM|450.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F133941_70360_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132883_31602_0|SrvcGrp|24753|2022|PDM|10.00|99|0.00|GROWTH HORMONE INJECTION THERAPY|
20|FH_F36552_0_0|SrvcGrp|18190|2022|PDM|6685.00|99|0.00|MS DRG 261|
20|FH_F124161_95932_0|SrvcGrp|72984|2022|PCT|1.56|99|0.00|CHEMOTHERAPY|
20|FH_F115811_33410_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F131671_72301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F73768_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F130520_43947_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F115127_0_0|SrvcGrp|103551|2022|PDM|265.00|99|0.00|DIALYSIS PROC OTHER THAN HEMODIALYSIS|
20|FH_F132092_0_0|SrvcGrp|97702|2022|PDM|169.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F138010_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F34691_0_0|SrvcGrp|16|2022|PDM|1245.00|99|0.00|ACUTE REHABILITATION|
20|FH_F114930_71101_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148265_06067_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128333_71001_0|SrvcGrp|48394|2022|PDM|34.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F131321_38135_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|147.82|99|0.00|AETNA SLEEP STUDIES|
20|FH_F123783_03860_0|SrvcGrp|88620|2022|PDM|154.00|99|0.00|SKILLED NURSING RN|
20|FH_F136374_34461_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134075_78230_0|SrvcGrp|48398|2022|PDM|125.00|99|0.00|PT SERVICES|
20|FH_F149269_73120_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|GENERAL ACUTE CARE|
20|FH_F120332_0_0|SrvcGrp|88621|2022|PDM|70.00|99|0.00|SKILLED NURSING LPN|
20|FH_F137719_28269_0|SrvcGrp|46903|2022|PDM|731.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F101441_0_0|SrvcGrp|97039|2022|PDM|3497.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F98020_50138_0|CSTM-ALL|CSTM-00|2020|PCT|0.66|99|0.00|OP SVCS|
20|FH_F126147_45241_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F85772_0_0|CSTM-ALL|CSTM-00|2020|PDM|783.00|99|0.00|AEG 2 (NO REV)|
20|FH_F134472_84624_0|SrvcGrp|471|2022|PDM|608.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|214.05|99|0.00|SALLY BALIN,999182,ASC 307|
20|FH_F138017_73129_0|SrvcGrp|97488|2022|PDM|6196.00|99|0.00|ENDOSCOPY BILE DUCT/PANCREAS|
20|FH_F122336_67042_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F110783_93013_0|SrvcGrp|26869|2022|PDM|35.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F149515_66002_0|SrvcGrp|90854|2022|PDM|567.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F66545_0_0|SrvcGrp|62097|2022|PDM|35.00|99|0.00|HOME HEALTH AIDE|
20|FH_F35410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|INFUSION INNOVATION -B CODES|
20|FH_F135613_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F102525_73134_0|SrvcGrp|31926|2022|PDM|41000.00|99|0.00|MS DRG 458 ONLY|
20|FH_F104640_21204_0|SrvcGrp|472|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F114207_35243_0|SrvcGrp|26868|2022|PDM|35.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F123570_0_0|SrvcGrp|72998|2022|PDM|1014.18|99|0.00|AEG 5|
20|FH_F50398_0_0|SrvcGrp|45150|2022|PDM|85.00|99|0.00|PHYSICAL THERAPY|
20|FH_F148667_0_0|SrvcGrp|108347|2022|PDM|2856.00|99|0.00|REPAIR OF KNEE FRACTURE|
20|FH_F37934_0_0|SrvcGrp|3932|2022|PDM|3350.00|99|0.00|LITHOTRIPSY|
20|FH_F39211_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F147080_02446_0|SrvcGrp|90397|2022|PDM|284.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F101280_63111_0|SrvcGrp|46903|2022|PDM|507.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F84058_0_0|SrvcGrp|82449|2022|PDM|368.31|99|0.00|AMBULANCE SVC BASIC LIFE SUPPT EMER|
20|FH_F40885_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|596.00|99|0.00|ASPG III|
20|FH_F76285_0_0|SrvcGrp|44885|2022|PDM|154.00|99|0.00|PHYSICAL THERAPY SVCS RE-EVAL PER VISIT|
20|FH_F146859_0_0|SrvcGrp|114900|2022|PDM|4858.00|99|0.00|AMPUTATION FOLLOW-UP SURGERY|
20|FH_F46284_0_0|SrvcGrp|9937|2022|PDM|147.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F139910_0_0|CSTM-ALL|CSTM-00|2020|PDM|412.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132137_67218_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F122841_0_0|SrvcGrp|42550|2022|PDM|1769.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F94643_90501_0|SrvcGrp|86828|2022|PDM|45.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F146266_0_0|SrvcGrp|76603|2022|PDM|1900.00|99|0.00|CPT 25111|
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 9 (NO REV)|
20|FH_F120119_0_0|CSTM-ALL|CSTM-00|2020|PDM|564.00|99|0.00|AEG 3 (NO REV)|
20|FH_F124492_30040_0|SrvcGrp|113237|2022|PDM|39.51|99|0.00|COVID-19 NCOV DIAGNOSTIC P (HCFA)|
20|FH_F150982_0_0|SrvcGrp|101519|2022|PDM|2527.00|99|0.00|T1H UTERUS (<250G)|
20|FH_F115269_0_0|SrvcGrp|73842|2022|PDM|190.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130836_53406_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F114206_37203_0|SrvcGrp|22589|2022|PDM|35.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F36683_0_0|SrvcGrp|65|2022|PDM|1202.00|99|0.00|OBSTETRICAL CARE|
20|FH_F143230_33026_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F143410_77845_0|SrvcGrp|46903|2022|PDM|635.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F143410_77845_0|SrvcGrp|90854|2022|PDM|805.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
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_F93740_0_0|SrvcGrp|91579|2022|PDM|2100.00|99|0.00|AV FISTULA / GRAFT|
20|FH_F131093_49690_0|SrvcGrp|97703|2022|PDM|130.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F131093_49690_0|SrvcGrp|83522|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F151719_02138_0|SrvcGrp|105819|2022|PDM|999.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F151719_02138_0|SrvcGrp|107666|2022|PDM|453.00|99|0.00|AETNA PARTIAL HOSP EATING DIS HALF DAY|
20|FH_F47036_0_0|SrvcGrp|29898|2022|PDM|95.00|99|0.00|RN VISIT|
20|FH_F48476_0_0|SrvcGrp|42975|2022|PDM|90.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F49286_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|2009 MED DMERC (MOD UE)|
20|FH_F116698_07470_0|SrvcGrp|88621|2022|PDM|63.00|99|0.00|SKILLED NURSING LPN|
20|FH_F116835_94538_0|SrvcGrp|107155|2022|PDM|1677.00|99|0.00|AETNA IP PSYCHIATRIC (12-150 YRS)|
20|FH_F120974_27607_0|SrvcGrp|39870|2022|PDM|26335.00|99|0.00|MS DRG 619-621 ONLY|
20|FH_F120974_27607_0|SrvcGrp|8950|2022|PDM|4495.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F127820_62626_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|GENERAL ACUTE CARE|
20|FH_F118879_93063_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F84411_32063_0|SrvcGrp|220|2022|PCT|0.69|99|0.00|INTRAOCULAR LENSES|
20|FH_F84394_17402_0|SrvcGrp|114230|2022|PDM|7539.00|99|0.00|SPINE|
20|FH_F38289_0_0|SrvcGrp|58755|2022|PDM|5270.78|99|0.00|INJECTION PROC FOR JOINT|
20|FH_F39274_0_0|SrvcGrp|26001|2022|PDM|300.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F33925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1305.00|99|0.00|ASPG II|
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|1001.00|99|0.00|AEG 4 (NO REV)|
20|FH_F41696_0_0|CSTM-ALL|CSTM-00|2020|PDM|562.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130606_41144_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F67202_0_0|SrvcGrp|23235|2022|PCT|1.00|99|0.00|DME (GLOBAL)|
20|FH_F133018_84037_0|SrvcGrp|26868|2022|PDM|25.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F90811_0_0|SrvcGrp|87059|2022|PDM|2700.00|99|0.00|REPAIR OF TENDON|
20|FH_F72859_0_0|SrvcGrp|10545|2022|PDM|101.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F50618_0_0|SrvcGrp|46905|2022|PDM|1008.60|99|0.00|OBSERVATION SVCS|
20|FH_F129260_0_0|CSTM-ALL|CSTM-00|2020|PDM|918.50|99|0.00|AEG 6 (NO REV)|
20|FH_F128912_44313_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F132032_0_0|SrvcGrp|33722|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F132080_0_0|SrvcGrp|97704|2022|PDM|169.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F55375_0_0|SrvcGrp|51473|2022|PDM|140.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F138951_41101_0|SrvcGrp|14948|2022|PDM|55.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F81838_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F143581_02130_0|SrvcGrp|76501|2022|PDM|413.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F136359_0_0|SrvcGrp|38909|2022|PDM|4750.00|99|0.00|CPT 67036 - VITRECTOMY, MECHANICAL|
20|FH_F49485_0_0|SrvcGrp|24289|2022|PDM|40.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F39378_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72543_0_0|SrvcGrp|46109|2022|PDM|113.40|99|0.00|HI-TECH NURSING (1 HOUR)|
20|FH_F122672_44089_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115966_16801_0|SrvcGrp|65645|2022|PDM|125.00|99|0.00|NURSING CARE IN HOME - S9123|
20|FH_F150102_0_0|CSTM-ALL|CSTM-00|2020|PDM|2402.00|99|0.00|AEG 4 (NO REV)|
20|FH_F91034_0_0|SrvcGrp|87077|2022|PDM|128.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F125249_0_0|SrvcGrp|108263|2022|PDM|700.00|99|0.00|AETNA DRAINAGE OF ARM LESION|
20|FH_F102302_0_0|SrvcGrp|72994|2022|PDM|1034.00|99|0.00|AEG 3|
20|FH_F129135_68756_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F39943_0_0|SrvcGrp|13551|2022|PDM|320.00|99|0.00|NEWBORN NURSERY|
20|FH_F131357_17545_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148892_0_0|CSTM-ALL|CSTM-00|2020|PDM|1029.60|99|0.00|AEG 5  (NO REV)|
20|FH_F115685_64064_0|SrvcGrp|88806|2022|PDM|140.00|99|0.00|TOTAL PARENTERAL NUTRITION; < 3 LITERS (HCFA)|
20|FH_F62614_0_0|SrvcGrp|48399|2022|PDM|30.00|99|0.00|SPEECH THERAPY|
20|FH_F118193_06241_0|CSTM-ALL|CSTM-00|2020|PDM|32.05|99|0.00|AETNA OBSERVATIONS BEHAVIORAL 30 MINS|
20|FH_F117552_0_0|SrvcGrp|35669|2022|PDM|4400.00|99|0.00|CPT 63650|
20|FH_F137951_0_0|SrvcGrp|84939|2022|PDM|12000.00|99|0.00|SHOULDER JOINT|
20|FH_F118959_44830_0|SrvcGrp|92760|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F129892_0_0|SrvcGrp|35668|2022|PDM|1715.00|99|0.00|CPT 29824|
20|FH_F143450_0_0|SrvcGrp|92703|2022|PDM|1700.00|99|0.00|ENDOSCOPIC RETRO CHOLANGIOPANCREATOGRAPHY|
20|FH_F109513_0_0|SrvcGrp|90423|2022|PDM|3500.00|99|0.00|FUSION GRAFT OF WRIST JOINT|
20|FH_F113541_0_0|SrvcGrp|104108|2022|PDM|1955.00|99|0.00|EXCISION OF BREAST LESION ID|
20|FH_F124687_64024_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F114645_34952_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F114666_30342_0|SrvcGrp|88164|2022|PDM|6500.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F122610_73139_0|SrvcGrp|74670|2022|PCT|0.50|99|0.00|AETNA OP INTRAOCULAR LENS|
20|FH_F132090_60915_0|SrvcGrp|94560|2022|PDM|4500.00|99|0.00|REPAIR CLAVICLE FRACTURE|
20|FH_F120207_0_0|CSTM-ALL|CSTM-00|2020|PDM|3787.00|99|0.00|LAP INC HERNIA REPAIR|
20|FH_F41808_0_0|SrvcGrp|22954|2022|PDM|135.11|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F151009_07649_0|SrvcGrp|115181|2022|PCT|1.00|99|0.00|COVID-19 TESTING|
20|FH_F74622_0_0|CSTM-ALL|CSTM-00|2020|PDM|1249.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F148425_01507_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F122245_0_0|SrvcGrp|27402|2022|PDM|1800.00|99|0.00|LASER PROCEDURES|
20|FH_F125050_33765_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132934_63005_0|SrvcGrp|89149|2022|PDM|651.00|99|0.00|OP INTENSIVE|
20|FH_F67560_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F111551_32825_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 028-030 SPINE SURGERY|
20|FH_F37909_0_0|SrvcGrp|15403|2022|PDM|70.00|99|0.00|SPEECH THERAPY SVCS INITIAL EVAL|
20|FH_F117954_17961_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F120605_0_0|SrvcGrp|73006|2022|PDM|2139.00|99|0.00|AEG 9|
20|FH_F145988_06105_0|SrvcGrp|98360|2022|PDM|14371.00|99|0.00|AETNA LAMINECTOMY W/FACE-LUMBAR|
20|FH_F49732_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113586_0_0|SrvcGrp|75491|2022|PDM|1173.00|99|0.00|AEG 7|
20|FH_F130755_04401_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|AEG 7 (NO REV)|
20|FH_F138147_18018_0|SrvcGrp|98041|2022|PDM|9.62|99|0.00|AETNA MOBILE THERAPY SERVICES|
20|FH_F52801_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F34182_0_0|SrvcGrp|18881|2022|PDM|2729.00|99|0.00|MS DRG 233|
20|FH_F49552_0_0|SrvcGrp|537|2022|PCT|0.57|99|0.00|OBSERVATION SERVICES|
20|FH_F127091_62016_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F79743_0_0|SrvcGrp|29817|2022|PDM|6854.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F135610_06451_0|SrvcGrp|29155|2022|PDM|128.00|99|0.00|HOSPICE SVCS|
20|FH_F149272_64057_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120811_53525_0|SrvcGrp|107288|2022|PCT|1.00|99|0.00|INJ INTERFERON BETA|
20|FH_F133292_75042_0|SrvcGrp|3178|2022|PDM|875.00|99|0.00|ACUTE PSYCH|
20|FH_F82753_18840_0|CSTM-ALL|CSTM-00|2020|PDM|1416.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F141527_36830_0|SrvcGrp|86836|2022|PDM|11.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F34735_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MSDRG 231-232 CORONARY BYPASS|
20|FH_F72369_0_0|SrvcGrp|69461|2022|PDM|255.00|99|0.00|REDUCTION OF OCULAR PROSTHESIS|
20|FH_F45220_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|99|0.00|OP SVCS|
20|FH_F128288_57058_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121090_07848_0|SrvcGrp|73841|2022|PDM|421.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F71070_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F72944_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135259_21090_0|SrvcGrp|73605|2022|PDM|1199.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F44582_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|ASPG VII|
20|FH_F137614_17602_0|SrvcGrp|89149|2022|PDM|210.00|99|0.00|OP INTENSIVE|
20|FH_F102500_0_0|SrvcGrp|36864|2022|PDM|29351.00|99|0.00|COCHLEAR IMPLANTS|
20|FH_F86851_0_0|SrvcGrp|84964|2022|PDM|520.00|99|0.00|CPT 43216|
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|1483.00|99|0.00|ASPG IV|
20|FH_F132810_0_0|SrvcGrp|86831|2022|PDM|8.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F62577_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93292_62234_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134126_11554_0|SrvcGrp|107733|2022|PDM|11878.00|99|0.00|CESAREAN SECTION|
20|FH_F134654_0_0|SrvcGrp|110042|2022|PDM|75.00|99|0.00|BEHAVIOR IDENTIFICATION ASSESSMENT 15 MINS|
20|FH_F149527_62859_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F131420_29693_0|SrvcGrp|86635|2022|PCT|1.00|99|0.00|DME|
20|FH_F35631_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|1083.00|99|0.00|AEG 6 (NO REV)|
20|FH_F38332_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F90613_05001_0|SrvcGrp|43523|2022|PDM|268.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F33483_0_0|CSTM-ALL|CSTM-00|2020|PCT|98.00|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_F119581_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134270_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_F134670_95628_0|SrvcGrp|89417|2022|PDM|480.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F113713_17013_0|SrvcGrp|91390|2022|PDM|190.00|99|0.00|AETNA PSYCH DIAG EVAL W/MED (MOD AF)|
20|FH_F134087_0_0|SrvcGrp|11673|2022|PDM|4286.00|99|0.00|CPT 29888|
20|FH_F79429_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F138876_25302_0|SrvcGrp|19742|2022|PDM|60.00|99|0.00|MID-LINE INSERTION|
20|FH_F58013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136217_63112_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F58974_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|OP SVCS|
20|FH_F97480_08204_0|SrvcGrp|90854|2022|PDM|2084.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F73803_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144288_46322_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F36409_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|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_F51129_0_0|SrvcGrp|17969|2022|PCT|0.55|99|0.00|INVESTIGATIONAL DEVICES|
20|FH_F87615_80033_0|SrvcGrp|91437|2022|PDM|929.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F36118_0_0|SrvcGrp|13703|2022|PDM|40.00|99|0.00|LICENSED PRACTICAL NURSE- HOURLY|
20|FH_F133118_33143_0|SrvcGrp|109330|2022|PCT|1.14|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F144668_62526_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133021_00910_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MATERNITY DELIVERY|
20|FH_F94300_0_0|SrvcGrp|41334|2022|PDM|4200.00|99|0.00|TOTAL KNEE|
20|FH_F120437_85202_0|SrvcGrp|17005|2022|PDM|47.27|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 8HRS|
20|FH_F102062_35447_0|SrvcGrp|73701|2022|PDM|65.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F144769_0_0|SrvcGrp|78579|2022|PDM|2503.00|99|0.00|AETNA ACUTE IP MEDICAL SVCS|
20|FH_F133487_24293_0|SrvcGrp|88620|2022|PDM|125.00|99|0.00|SKILLED NURSING RN|
20|FH_F73304_0_0|CSTM-ALL|CSTM-00|2020|PDM|725.00|99|0.00|ASPG X|
20|FH_F84676_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F129130_92562_0|SrvcGrp|50169|2022|PDM|29626.00|99|0.00|MSDRG 227 ONLY|
20|FH_F71550_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|100% ASP NEBRASKA|
20|FH_F145594_02809_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F73864_0_0|CSTM-ALL|CSTM-00|2020|PDM|12.00|99|0.00|SKILLED NURSING HCPC|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.59|99|0.00|HAPA WPA/NWPA NISC 2018 100%|
20|FH_F112987_46222_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F143650_0_0|SrvcGrp|72996|2022|PDM|2200.00|99|0.00|AEG 4|
20|FH_F139240_81055_0|CSTM-ALL|CSTM-00|2020|PCT|0.94|99|0.00|OP SVCS|
20|FH_F133207_0_0|SrvcGrp|86463|2022|PDM|3809.00|99|0.00|FRACTURE NASAL INFERIOR|
20|FH_F83754_0_0|SrvcGrp|43939|2022|PCT|0.86|99|0.00|SLEEP STUDIES|
20|FH_F88744_71103_0|SrvcGrp|72984|2022|PCT|2.15|99|0.00|CHEMOTHERAPY|
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|1540.00|99|0.00|AEG 9 (NO REV)|
20|FH_F146798_44011_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F33515_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F34626_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|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_F116341_12180_0|SrvcGrp|104077|2022|PCT|1.05|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F148356_18104_0|SrvcGrp|108484|2022|PDM|650.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F35271_0_0|SrvcGrp|361|2022|PDM|650.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F132092_0_0|SrvcGrp|97704|2022|PDM|169.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F73013_0_0|SrvcGrp|42976|2022|PDM|208.99|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F148600_30328_0|CSTM-ALL|CSTM-00|2020|PDM|622.00|99|0.00|AEG 2 (NO REV)|
20|FH_F93741_85006_0|SrvcGrp|30089|2022|PDM|431.00|99|0.00|HEMODIALYSIS SERVICES|
20|FH_F114970_28403_0|SrvcGrp|91214|2022|PDM|20.00|99|0.00|MED NUTRITION|
20|FH_F148480_03079_0|CSTM-ALL|CSTM-00|2020|PDM|1207.50|99|0.00|AEG 10 (NO REV)|
20|FH_F73985_0_0|SrvcGrp|26213|2022|PDM|7592.00|99|0.00|LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F148239_74012_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F109000_0_0|SrvcGrp|102959|2022|PDM|7260.00|99|0.00|NECK SPINE FUSE|
20|FH_F86159_15139_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F137048_60714_0|SrvcGrp|48385|2022|PDM|100.00|99|0.00|SPEECH THERAPY|
20|FH_F119090_91502_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F69364_0_0|CSTM-ALL|CSTM-00|2020|PDM|2646.00|99|0.00|ASPG IX|
20|FH_F112064_0_0|SrvcGrp|103900|2022|PDM|641.00|99|0.00|HOSPICE/HOME HLTH IN ASST LVG|
20|FH_F39919_0_0|CSTM-ALL|CSTM-00|2020|PDM|453.36|99|0.00|ASPG II|
20|FH_F134612_0_0|SrvcGrp|110101|2022|PDM|2400.00|99|0.00|TRLUML BALO ANGIOP 1ST ART|
20|FH_F120630_33161_0|SrvcGrp|86722|2022|PDM|191.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F138992_72703_0|CSTM-ALL|CSTM-00|2020|PDM|971.00|99|0.00|AEG 1 (NO REV)|
20|FH_F135447_53226_0|SrvcGrp|104468|2022|PDM|562.00|99|0.00|ANTEPARTUM CARE ONLY (4-6 VISITS)|
20|FH_F114844_17061_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F109577_0_0|SrvcGrp|90338|2022|PDM|135.00|99|0.00|SKILLED NURSING RN (HCFA)|
20|FH_F149272_64057_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F120603_66112_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121225_98902_0|SrvcGrp|65621|2022|PDM|45.00|99|0.00|RN NURSING|
20|FH_F63398_0_0|SrvcGrp|38223|2022|PDM|575.00|99|0.00|ADULT DETOX|
20|FH_F122551_75605_0|SrvcGrp|87317|2022|PDM|906.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F133253_62226_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F111836_12901_0|SrvcGrp|104078|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F148719_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F135219_68506_0|SrvcGrp|27261|2022|PDM|13353.31|99|0.00|CPT 27446|
20|FH_F121090_07848_0|SrvcGrp|104442|2022|PDM|76.88|99|0.00|AETNA OFFICE/OP VISIT EST (HCFA)|
20|FH_F148182_23324_0|SrvcGrp|88621|2022|PDM|84.00|99|0.00|SKILLED NURSING LPN|
20|FH_F139551_0_0|CSTM-ALL|CSTM-00|2020|PDM|3140.00|99|0.00|AEG 9 (NO REV)|
20|FH_F89779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F128237_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F98920_46526_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F125011_74467_0|SrvcGrp|110023|2022|PDM|8400.00|99|0.00|INCISE & DRAIN BLADDER|
20|FH_F148323_84070_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136315_98144_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137147_75006_0|SrvcGrp|91746|2022|PDM|6902.00|99|0.00|MSDRG 395 ONLY|
20|FH_F139559_21001_0|SrvcGrp|113601|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F125053_0_0|SrvcGrp|73002|2022|PDM|1077.00|99|0.00|AEG 7|
20|FH_F140765_30315_0|SrvcGrp|113301|2022|PDM|40.00|99|0.00|COVID-19 IMMUN ADMIN 1ST DOSE - ASTRAZENECA|
20|FH_F129504_02871_0|SrvcGrp|80920|2022|PDM|720.00|99|0.00|HOSPICE SERVICES|
20|FH_F63462_0_0|CSTM-ALL|CSTM-00|2020|PDM|1845.00|99|0.00|ASPG VII|
20|FH_F69751_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136693_17754_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F148487_28210_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136796_24016_0|SrvcGrp|103539|2022|PDM|2907.56|99|0.00|NASAL ENDOSCOPY|
20|FH_F115144_71373_0|SrvcGrp|11283|2022|PDM|510.00|99|0.00|HYPERBARIC CHAMBER|
20|FH_F115266_66736_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F100780_24153_0|CSTM-ALL|CSTM-00|2020|PCT|0.37|99|0.00|OP SVCS|
20|FH_F48772_66044_0|SrvcGrp|82222|2022|PDM|528.00|99|0.00|HOSPICE CARE|
20|FH_F50516_15014_0|SrvcGrp|81878|2022|PCT|1.00|99|0.00|RADIOLOGY W/ REV/HCPC|
20|FH_F150530_63031_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116809_0_0|SrvcGrp|91465|2022|PDM|438.00|99|0.00|COLORECTAL CANCER SCREENING (HCFA)|
20|FH_F88672_0_0|CSTM-ALL|CSTM-00|2020|PDM|1026.00|99|0.00|AEG 8 (NO REV)|
20|FH_F114444_19602_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F38069_0_0|SrvcGrp|27726|2022|PCT|0.87|99|0.00|OP SURGERY|
20|FH_F145708_89030_0|SrvcGrp|29346|2022|PDM|40.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F32165_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F111986_0_0|SrvcGrp|97480|2022|PDM|1236.00|99|0.00|BASAL/SINUS ENDOSCOPY|
20|FH_F96721_99504_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F150227_63301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F140407_63841_0|SrvcGrp|113624|2022|PCT|0.75|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F118955_48239_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F147879_93309_0|SrvcGrp|23683|2022|PDM|82.50|99|0.00|SKILLED NURSING RN|
20|FH_F91472_96001_0|SrvcGrp|103759|2022|PCT|0.40|99|0.00|REVISION HIP REPLACEMENT|
20|FH_F113738_27006_0|SrvcGrp|48385|2022|PDM|130.00|99|0.00|SPEECH THERAPY|
20|FH_F98041_10027_0|SrvcGrp|88977|2022|PDM|7427.00|99|0.00|C-SECTION DELIVERY|
20|FH_F73231_0_0|SrvcGrp|44703|2022|PDM|105.45|99|0.00|NURSING CARE|
20|FH_F130400_26505_0|SrvcGrp|109248|2022|PCT|1.50|99|0.00|LABORATORY SERVICES|
20|FH_F146903_72901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F91998_0_0|SrvcGrp|72992|2022|PDM|481.00|99|0.00|AEG 2|
20|FH_F124653_64062_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F136907_44833_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F141170_0_0|SrvcGrp|67066|2022|PDM|7500.00|99|0.00|CERVICAL SURGERY|
20|FH_F129850_0_0|SrvcGrp|111414|2022|PCT|5.50|99|0.00|MEDICINE CODES|
20|FH_F151304_31520_0|CSTM-ALL|CSTM-00|2020|PDM|1311.00|99|0.00|AEG 7 (NO REV)|
20|FH_F131361_18235_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F121701_70420_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F33081_0_0|SrvcGrp|411|2022|PDM|4000.00|99|0.00|OP CARDIAC CATH|
20|FH_F119203_0_0|SrvcGrp|105357|2022|PDM|435.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F34985_0_0|CSTM-ALL|CSTM-00|2020|PDM|869.00|99|0.00|CPT CODE 99285|
20|FH_F133519_0_0|CSTM-ALL|CSTM-00|2020|PDM|584.00|99|0.00|AEG 2 (NO REV)|
20|FH_F132212_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119496_37917_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150540_63401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)|
20|FH_F69063_0_0|SrvcGrp|42974|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPIST|
20|FH_F125570_66104_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109882_36695_0|SrvcGrp|93919|2022|PDM|637.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F146159_89102_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F42238_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143054_26147_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F136417_0_0|SrvcGrp|111786|2022|PCT|0.00|99|0.00|MENTAL HEALTH CRISIS INTERVENTION|
20|FH_F120437_85202_0|SrvcGrp|111580|2022|PDM|181.20|99|0.00|MEDICAL NUTRITION THERAPY (HCFA)|
20|FH_F111522_81067_0|SrvcGrp|104336|2022|PCT|1.00|99|0.00|DENOSUMAB INJECTION|
20|FH_F88512_0_0|SrvcGrp|46532|2022|PDM|742.95|99|0.00|EMERGENCY ROOM LEVEL 3|
20|FH_F144191_0_0|SrvcGrp|89404|2022|PDM|9875.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F151155_26508_0|SrvcGrp|113345|2022|PDM|38.11|99|0.00|ADD 30 MINS COUNSEL (HCFA)|
20|FH_F151241_15139_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130721_04769_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 8 (NO REV)|
20|FH_F150165_06032_0|SrvcGrp|109790|2022|PDM|7200.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F116506_0_0|SrvcGrp|75489|2022|PDM|925.00|99|0.00|AEG 6|
20|FH_F95623_84015_0|SrvcGrp|80317|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F138024_40509_0|SrvcGrp|90854|2022|PDM|718.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F43197_0_0|SrvcGrp|11074|2022|PDM|80.00|99|0.00|NURSING CARE|
20|FH_F54592_0_0|SrvcGrp|26617|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F102200_06416_0|SrvcGrp|24752|2022|PDM|15.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F39346_0_0|SrvcGrp|20077|2022|PDM|32117.00|99|0.00|MS DRG 226-227 ONLY CARDIAC DEFIBRILLATOR|
20|FH_F147005_0_0|SrvcGrp|35982|2022|PDM|68.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F38910_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F141471_0_0|SrvcGrp|107792|2022|PDM|5842.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F149839_80002_0|SrvcGrp|95660|2022|PDM|618.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F141407_76226_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F135690_20814_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F68944_0_0|SrvcGrp|15559|2022|PDM|2870.00|99|0.00|ACUTE MED & SURG SVCS|
20|FH_F61072_0_0|SrvcGrp|42824|2022|PDM|100.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F118127_30078_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F139169_0_0|SrvcGrp|88739|2022|PDM|4000.00|99|0.00|IMPLANT SPINAL CANAL|
20|FH_F136780_0_0|SrvcGrp|75545|2022|PDM|395.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F134593_60007_0|SrvcGrp|14893|2022|PDM|31.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F145642_15108_0|SrvcGrp|86847|2022|PDM|30.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F133869_19947_0|SrvcGrp|3178|2022|PDM|927.00|99|0.00|ACUTE PSYCH|
20|FH_F117437_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F146103_63851_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F111986_0_0|SrvcGrp|14614|2022|PDM|3296.00|99|0.00|LITHOTRIPSY|
20|FH_F37117_0_0|SrvcGrp|25340|2022|PDM|700.00|99|0.00|MRI|
20|FH_F69606_0_0|SrvcGrp|64111|2022|PDM|260.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 16|
20|FH_F67820_15009_0|SrvcGrp|10431|2022|PDM|47.00|99|0.00|SPEECH THERAPY|
20|FH_F134087_0_0|SrvcGrp|88163|2022|PDM|9017.00|99|0.00|LUMBAR SPINE FUSION|
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_F72445_0_0|SrvcGrp|12401|2022|PDM|76.00|99|0.00|RN VISIT|
20|FH_F100880_67735_0|SrvcGrp|73461|2022|PDM|6320.00|99|0.00|AETNA NICU IV|
20|FH_F132854_77379_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150839_03833_0|SrvcGrp|48398|2022|PDM|167.00|99|0.00|PT SERVICES|
20|FH_F131449_19073_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|942.00|99|0.00|AEG 10 (NO REV)|
20|FH_F137950_0_0|CSTM-ALL|CSTM-00|2020|PDM|2420.00|99|0.00|AEG 7 (NO REV)|
20|FH_F97181_33143_0|SrvcGrp|46903|2022|PDM|1200.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F105921_80014_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD HOMEHEALTH|
20|FH_F71644_0_0|SrvcGrp|16277|2022|PCT|0.50|99|0.00|HIGH COST DRUGS|
20|FH_F133018_84037_0|SrvcGrp|103739|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F120745_0_0|SrvcGrp|15122|2022|PCT|0.90|99|0.00|CARDIAC CATH LAB SVCS|
20|FH_F37568_0_0|SrvcGrp|10538|2022|PDM|65.00|99|0.00|NURSING CARE|
20|FH_F47857_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F132969_84003_0|SrvcGrp|86847|2022|PDM|25.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F125407_68756_0|SrvcGrp|103913|2022|PCT|0.98|99|0.00|OP DIALYSIS|
20|FH_F133207_0_0|SrvcGrp|26432|2022|PDM|3529.00|99|0.00|OP SURGICAL SERVICES|
20|FH_F134431_92647_0|SrvcGrp|87131|2022|PDM|502.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F86137_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|227.08|99|0.00|HAPA WPA-NWPA 2012-13 ASC 231 W/O REV|
20|FH_F85211_0_0|SrvcGrp|83625|2022|PDM|11000.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F146795_44122_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134828_30531_0|SrvcGrp|94299|2022|PDM|167.00|99|0.00|NEW PT OFFICE VISIT|
20|FH_F50137_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F125249_0_0|CSTM-ALL|CSTM-00|2020|PDM|2230.00|99|0.00|AEG 9 (NO REV)|
20|FH_F93880_95476_0|SrvcGrp|91564|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F35202_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36366_0_0|SrvcGrp|13626|2022|PDM|648.00|99|0.00|SLEEP STUDIES|
20|FH_F73013_0_0|SrvcGrp|10407|2022|PDM|91.41|99|0.00|HOME INFUSION|
20|FH_F101607_0_0|SrvcGrp|74587|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F41201_0_0|SrvcGrp|701|2022|PDM|2600.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F58252_0_0|SrvcGrp|46604|2022|PDM|35.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F140791_20678_0|SrvcGrp|89149|2022|PDM|180.00|99|0.00|OP INTENSIVE|
20|FH_F119023_91406_0|SrvcGrp|86832|2022|PDM|7.00|99|0.00|HCPCS S5498 (HCFA)|
20|FH_F109884_36117_0|SrvcGrp|93919|2022|PDM|637.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F147726_18017_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F101161_0_0|SrvcGrp|4003|2022|PDM|2500.00|99|0.00|CPT CODE 99291- CRITICAL CARE|
20|FH_F116043_0_0|SrvcGrp|33722|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F114866_77706_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132864_71101_0|SrvcGrp|73485|2022|PDM|1140.00|99|0.00|AETNA REHAB|
20|FH_F124584_28204_0|SrvcGrp|89417|2022|PDM|478.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F87856_0_0|SrvcGrp|86460|2022|PDM|2332.00|99|0.00|REVISE BREAST RECONSTRUCTION|
20|FH_F136708_06443_0|SrvcGrp|108484|2022|PDM|554.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F112371_19047_0|SrvcGrp|104749|2022|PDM|5290.00|99|0.00|IMPLANT NEUROELECTRODES 29|
20|FH_F103004_75840_0|SrvcGrp|100099|2022|PDM|579.00|99|0.00|CT SCAN|
20|FH_F38476_0_0|SrvcGrp|15846|2022|PDM|47.00|99|0.00|HOME VISIT|
20|FH_F150939_0_0|SrvcGrp|45307|2022|PDM|10.00|99|0.00|ADMIN OF INFLUENZA VIRUS VACCINE|
20|FH_F131000_0_0|SrvcGrp|85792|2022|PDM|3954.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F139441_91324_0|SrvcGrp|89337|2022|PDM|3010.00|99|0.00|DETOXIFICATION|
20|FH_F122396_90024_0|SrvcGrp|87317|2022|PDM|1463.70|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|1112.00|99|0.00|AEG 5  (NO REV)|
20|FH_F109000_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137943_0_0|SrvcGrp|85565|2022|PDM|1660.00|99|0.00|PARTIAL REMOVAL OF EYE FLUID|
20|FH_F38730_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|HOSPICE SERVICES|
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|1628.00|99|0.00|AEG 7 (NO REV)|
20|FH_F52854_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ST LUKES  OCN F/S PRICING: GLOBAL|
20|FH_F125028_19061_0|SrvcGrp|86831|2022|PDM|4.20|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F39917_0_0|SrvcGrp|3405|2022|PDM|120.00|99|0.00|CPT 99212|
20|FH_F121533_26241_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F122911_92240_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F62614_0_0|SrvcGrp|48394|2022|PDM|6.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F151603_27609_0|SrvcGrp|71666|2022|PDM|30612.24|99|0.00|CPT 63655|
20|FH_F39956_0_0|SrvcGrp|701|2022|PDM|1442.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F113809_47302_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F139113_21804_0|SrvcGrp|73485|2022|PDM|1022.00|99|0.00|AETNA REHAB|
20|FH_F144039_0_0|SrvcGrp|95819|2022|PDM|6885.00|99|0.00|GONIOTOMY|
20|FH_F115210_21043_0|SrvcGrp|16289|2022|PDM|1379.00|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F91331_0_0|CSTM-ALL|CSTM-00|2020|PDM|1166.16|99|0.00|ASPG VIII|
20|FH_F46433_0_0|SrvcGrp|17001|2022|PDM|145.00|99|0.00|TOTAL PARENTERAL NUTRITION; ONE LITER PER DAY|
20|FH_F151304_31520_0|CSTM-ALL|CSTM-00|2020|PDM|831.00|99|0.00|AEG 10 (NO REV)|
20|FH_F151503_30067_0|SrvcGrp|27310|2022|PDM|2090.00|99|0.00|ENDOSCOPIC PLANTAR FASCIOTOMY|
20|FH_F132328_0_0|SrvcGrp|88154|2022|PDM|4110.00|99|0.00|LASER TREATMENT OLD RETINA|
20|FH_F101320_26062_0|SrvcGrp|22593|2022|PDM|78.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F148887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F134537_03060_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F122425_75082_0|SrvcGrp|473|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
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|360|2022|PDM|2003.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F146773_78414_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133448_44094_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134828_30531_0|SrvcGrp|112665|2022|PDM|38.00|99|0.00|XRAY EXAM OF HAND (HCFA)|
20|FH_F48133_0_0|SrvcGrp|42869|2022|PDM|40.12|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F37756_0_0|CSTM-ALL|CSTM-00|2020|PDM|1323.00|99|0.00|ASPG I|
20|FH_F38526_0_0|SrvcGrp|49|2022|PDM|12500.00|99|0.00|HIP REPLACEMENT|
20|FH_F118703_0_0|SrvcGrp|73002|2022|PDM|1138.00|99|0.00|AEG 7|
20|FH_F137067_0_0|SrvcGrp|27315|2022|PDM|6825.00|99|0.00|TENDON REPAIR|
20|FH_F82753_18840_0|SrvcGrp|113465|2022|PCT|1.10|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F37679_0_0|SrvcGrp|27064|2022|PDM|30.50|99|0.00|CHEMOTHERAPY (MOD SH)|
20|FH_F131254_92211_0|SrvcGrp|86846|2022|PDM|35.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F38377_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: BREAKOUT|
20|FH_F126730_84737_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F69423_0_0|CSTM-ALL|CSTM-00|2020|PDM|684.00|99|0.00|AEG 2 (NO REV)|
20|FH_F148167_43950_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|HSS ASC|
20|FH_F126242_32796_0|SrvcGrp|73841|2022|PDM|477.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F136510_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131254_92211_0|SrvcGrp|26868|2022|PDM|35.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F119795_0_0|SrvcGrp|70749|2022|PDM|5202.00|99|0.00|CPT 29823|
20|FH_F43417_0_0|SrvcGrp|9539|2022|PDM|300.00|99|0.00|SUBACUTE CARE|
20|FH_F117131_45209_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F37680_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F31783_0_0|SrvcGrp|18148|2022|PDM|14070.00|99|0.00|MS DRG 249|
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|784.00|99|0.00|AEG 2 (NO REV)|
20|FH_F143898_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F144828_0_0|SrvcGrp|114196|2022|PDM|1176.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F136355_0_0|SrvcGrp|82981|2022|PDM|155.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F119725_0_0|SrvcGrp|106294|2022|PDM|412.72|99|0.00|AMBULANCE SERVICE EMERGENCY TRANSPORT LEVEL 1 (HFCA)|
20|FH_F122635_06410_0|SrvcGrp|48394|2022|PDM|48.80|99|0.00|SKILLED NURSING SERVICES|
20|FH_F138681_39301_0|SrvcGrp|73842|2022|PDM|171.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138876_25302_0|SrvcGrp|17016|2022|PDM|45.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F143581_02130_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133747_80634_0|SrvcGrp|74403|2022|PCT|0.92|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F131858_38732_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130657_04614_0|SrvcGrp|107637|2022|PCT|0.86|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F125760_67039_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F132190_0_0|CSTM-ALL|CSTM-00|2020|PDM|1296.00|99|0.00|AEG 7 (NO REV)|
20|FH_F46001_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122926_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 7 (NO REV)|
20|FH_F93881_15009_0|SrvcGrp|87114|2022|PDM|37.00|99|0.00|COMPREHENSIVE AUDIOMETRY|
20|FH_F39945_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97500_32025_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F38677_0_0|SrvcGrp|25688|2022|PDM|300.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S AZ/NV - MOD NU|
20|FH_F33513_0_0|SrvcGrp|34868|2022|PCT|0.77|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F86991_15122_0|SrvcGrp|73004|2022|PDM|1130.00|99|0.00|AEG 8|
20|FH_F129793_0_0|CSTM-ALL|CSTM-00|2020|PDM|740.75|99|0.00|2006 MEDICARE ASPG III|
20|FH_F118932_07652_0|SrvcGrp|75505|2022|PCT|1.50|99|0.00|CARDIAC STUDIES|
20|FH_F38699_0_0|SrvcGrp|17067|2022|PDM|657.00|99|0.00|ASPG II|
20|FH_F38948_0_0|SrvcGrp|115|2022|PCT|0.80|99|0.00|SKILLED NURSING CARE|
20|FH_F112080_0_0|SrvcGrp|73006|2022|PDM|1942.00|99|0.00|AEG 9|
20|FH_F109648_0_0|CSTM-ALL|CSTM-00|2020|PDM|973.00|99|0.00|AEG 8 (NO REV)|
20|FH_F105362_44601_0|SrvcGrp|73842|2022|PDM|145.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F147085_92780_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F135747_76208_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F41463_0_0|SrvcGrp|34355|2022|PDM|126.00|99|0.00|NURSING CARE|
20|FH_F133579_0_0|SrvcGrp|90601|2022|PDM|2205.00|99|0.00|REMOVAL OF LENS MATERIAL|
20|FH_F113544_62946_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135440_32561_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116527_70443_0|SrvcGrp|10393|2022|PDM|1700.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F139430_63017_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F35738_33180_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|GENERAL ACUTE CARE|
20|FH_F137986_0_0|SrvcGrp|41334|2022|PDM|9393.00|99|0.00|TOTAL KNEE|
20|FH_F150941_68124_0|SrvcGrp|75419|2022|PDM|411.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F122377_91007_0|SrvcGrp|75491|2022|PDM|9041.00|99|0.00|AEG 7|
20|FH_F39517_0_0|SrvcGrp|16|2022|PCT|0.80|99|0.00|ACUTE REHABILITATION|
20|FH_F112165_0_0|SrvcGrp|73008|2022|PDM|2350.00|99|0.00|AEG 10|
20|FH_F51123_0_0|SrvcGrp|10618|2022|PDM|122.50|99|0.00|CPT CODE 99344|
20|FH_F80513_0_0|SrvcGrp|39870|2022|PDM|15026.00|99|0.00|MS DRG 619-621 ONLY|
20|FH_F129367_89117_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F148322_93060_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F110023_33936_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F100962_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|321.40|99|0.00|ASPG I|
20|FH_F90196_10467_0|SrvcGrp|89024|2022|PDM|77.00|99|0.00|PHARMACOLOGIC MANAGEMENT SUBOXONE|
20|FH_F150982_0_0|SrvcGrp|89853|2022|PDM|2753.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG|
20|FH_F42929_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F138478_0_0|SrvcGrp|108078|2022|PDM|1193.56|99|0.00|ARTERY-VEIN FUSION|
20|FH_F133677_15601_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F148432_01585_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F107082_21015_0|SrvcGrp|471|2022|PDM|708.78|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F118698_32054_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F97563_83201_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F137638_0_0|SrvcGrp|100499|2022|PDM|1061.00|99|0.00|PARTIAL HOSPITALIZATION EATING DISORDERS|
20|FH_F100666_81301_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F148886_60621_0|CSTM-ALL|CSTM-00|2020|PDM|1470.00|99|0.00|AEG 5  (NO REV)|
20|FH_F150039_34236_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F63049_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134593_60007_0|SrvcGrp|86854|2022|PDM|47.00|99|0.00|HCPCS S9494 (HCFA)|
20|FH_F138828_78629_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F150300_23320_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F85652_98034_0|CSTM-ALL|CSTM-00|2020|PCT|2.92|99|0.00|AETNA - APC GROUPER E|
20|FH_F126267_24219_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F133868_40202_0|SrvcGrp|90854|2022|PDM|676.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F116806_0_0|SrvcGrp|107046|2022|PDM|1923.16|99|0.00|DRAINAGE OF MOUTH LESION|
20|FH_F119575_0_0|SrvcGrp|108041|2022|PDM|435.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F110702_0_0|SrvcGrp|36093|2022|PDM|812.00|99|0.00|ACUTE REHABILITATION|
20|FH_F80366_0_0|SrvcGrp|76257|2022|PCT|0.94|99|0.00|CARDIAC STUDIES|
20|FH_F129053_0_0|SrvcGrp|11673|2022|PDM|2705.00|99|0.00|CPT 29888|
20|FH_F69504_0_0|SrvcGrp|48396|2022|PDM|23.00|99|0.00|OT SERVICES|
20|FH_F149899_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|AEG 2 (NO REV)|
20|FH_F48752_0_0|SrvcGrp|9539|2022|PDM|250.00|99|0.00|SUBACUTE CARE|
20|FH_F136729_62704_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F114666_30342_0|SrvcGrp|105637|2022|PDM|9000.00|99|0.00|KNEE ARTHROSCOPY|
20|FH_F136824_08034_0|SrvcGrp|88905|2022|PDM|1233.00|99|0.00|PSYCHIATRIC CARE (AGE 0-17)|
20|FH_F136914_64081_0|SrvcGrp|92518|2022|PDM|115.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F39266_0_0|SrvcGrp|28919|2022|PDM|34.00|99|0.00|CPT 97750|
20|FH_F48772_66044_0|SrvcGrp|80918|2022|PCT|0.00|99|0.00|RESPITE CARE|
20|FH_F70083_0_0|CSTM-ALL|CSTM-00|2020|PDM|1542.00|99|0.00|HAPA WPA 2012-13 16 GROUPERS ASC 9 W/O REV|
20|FH_F139916_0_0|SrvcGrp|108484|2022|PDM|649.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F138680_53005_0|SrvcGrp|86722|2022|PDM|205.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F138876_25302_0|SrvcGrp|86848|2022|PDM|40.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F151379_21045_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F130756_04901_0|SrvcGrp|109057|2022|PCT|0.89|99|0.00|CARDIAC STUDIES|
20|FH_F44396_0_0|SrvcGrp|38797|2022|PDM|260.00|99|0.00|PSYCHIATRIC PARTIAL HOSPITALIZATION - IP|
20|FH_F75806_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F141035_0_0|SrvcGrp|107836|2022|PDM|7396.00|99|0.00|REPAIR FOREARM TENDON/MUSCLE|
20|FH_F141155_34952_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC INVOICE|
20|FH_F139668_42701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148900_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F98600_91730_0|SrvcGrp|29347|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE|
20|FH_F34894_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F133477_90247_0|SrvcGrp|705|2022|PCT|0.25|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F148639_0_0|SrvcGrp|93807|2022|PDM|3593.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F35368_0_0|SrvcGrp|11971|2022|PCT|0.95|99|0.00|TRAUMA CARE|
20|FH_F132886_0_0|SrvcGrp|106291|2022|PDM|359.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F149940_02645_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F105921_80014_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F150123_60515_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F132547_39180_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_F31184_0_0|SrvcGrp|18107|2022|PDM|21500.00|99|0.00|MS DRG 236|
20|FH_F82973_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148680_33311_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F121476_0_0|SrvcGrp|108859|2022|PDM|2627.00|99|0.00|METATARSAL JOINT IMPLANT|
20|FH_F100782_0_0|SrvcGrp|97589|2022|PDM|797.86|99|0.00|WINDBER MEDICAL CNTR ASC 216|
20|FH_F149106_07042_0|SrvcGrp|115719|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F125164_15206_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146702_70508_0|SrvcGrp|92760|2022|PCT|1.05|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131430_17566_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F43698_0_0|CSTM-ALL|CSTM-00|2020|PDM|175.00|99|0.00|CD PARTIAL HOSPITALIZATION|
20|FH_F124660_0_0|SrvcGrp|72998|2022|PDM|847.00|99|0.00|AEG 5|
20|FH_F137616_48823_0|SrvcGrp|78067|2022|PCT|0.60|99|0.00|SUBACUTE CARE|
20|FH_F135219_68506_0|SrvcGrp|114917|2022|PCT|0.00|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F91819_0_0|SrvcGrp|91687|2022|PDM|1100.00|99|0.00|OPHTHALMOLOGY SURGERY PROCEDURE|
20|FH_F42153_0_0|SrvcGrp|941|2022|PDM|3195.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
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_F113178_44035_0|SrvcGrp|75749|2022|PDM|469.00|99|0.00|AMBULATORY DETOX REHAB|
20|FH_F113226_30025_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F141837_0_0|SrvcGrp|13683|2022|PDM|900.00|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F132268_07060_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F122089_68010_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F104800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87496_17055_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F114206_37203_0|SrvcGrp|29077|2022|PDM|15.00|99|0.00|HOME TRANSFUSION|
20|FH_F133087_61107_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F98820_81401_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F42879_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F95980_20016_0|SrvcGrp|94843|2022|PDM|170.00|99|0.00|AETNA MEDICARE INTENSIVE OP|
20|FH_F40980_0_0|CSTM-ALL|CSTM-00|2020|PDM|46408.00|99|0.00|MS DRG 237|
20|FH_F47479_0_0|SrvcGrp|48428|2022|PDM|70.00|99|0.00|RESPIRATORY THERAPY INITIAL|
20|FH_F144008_11413_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F133552_77006_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F91155_16105_0|SrvcGrp|73609|2022|PDM|3040.00|99|0.00|AETNA MATERNITY CARE (NORMAL DELIVERY)|
20|FH_F50420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F143742_60410_0|SrvcGrp|11259|2022|PCT|1.03|99|0.00|DRUGS|
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PDM|545.00|99|0.00|ASPG I - FH SW CUSTOM GROUPERS|
20|FH_F121225_98902_0|SrvcGrp|24761|2022|PCT|0.85|99|0.00|HOME INFUSION THERAPY|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PDM|708.00|99|0.00|ASPG IV|
20|FH_F149141_27262_0|SrvcGrp|74668|2022|PDM|225.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F120719_27540_0|SrvcGrp|92958|2022|PCT|0.71|99|0.00|SLEEP STUDIES|
20|FH_F51124_0_0|SrvcGrp|15385|2022|PDM|141.75|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F131711_25550_0|SrvcGrp|79099|2022|PDM|520.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F133491_74012_0|SrvcGrp|87799|2022|PDM|130.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F73768_0_0|SrvcGrp|71102|2022|PDM|10.00|99|0.00|HCPCS A4230|
20|FH_F34513_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S AZ/NV - MOD NU|
20|FH_F52172_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F137460_42103_0|CSTM-ALL|CSTM-00|2020|PDM|648.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F145538_34997_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F125249_0_0|SrvcGrp|85792|2022|PDM|2000.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F38392_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|RADIOLOGY BASE (100%)|
20|FH_F33642_0_0|SrvcGrp|9938|2022|PCT|0.75|99|0.00|SPEECH THERAPY|
20|FH_F135267_19002_0|SrvcGrp|94880|2022|PDM|146.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F47137_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141802_17042_0|CSTM-ALL|CSTM-00|2020|PDM|656.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRAHCPC)|
20|FH_F93094_21227_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F122687_0_0|SrvcGrp|102481|2022|PDM|2732.00|99|0.00|CPT 29898|
20|FH_F136510_0_0|SrvcGrp|114518|2022|PDM|5746.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F132810_0_0|SrvcGrp|108454|2022|PCT|0.85|99|0.00|IVIG NON-LYOPHILIZED NOS|
20|FH_F136475_89119_0|SrvcGrp|48396|2022|PDM|85.00|99|0.00|OT SERVICES|
20|FH_F61312_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F47902_0_0|SrvcGrp|43837|2022|PCT|1.00|99|0.00|DME MOD NUKC|
20|FH_F134738_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F130939_40353_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F34914_0_0|SrvcGrp|3259|2022|PDM|750.00|99|0.00|ACUTE REHABILITATION|
20|FH_F137729_19703_0|SrvcGrp|89417|2022|PDM|300.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F38584_0_0|SrvcGrp|17077|2022|PDM|1599.00|99|0.00|ASPG VII|
20|FH_F91940_0_0|CSTM-ALL|CSTM-00|2020|PDM|633.00|99|0.00|AEG 1 (NO REV)|
20|FH_F147080_02446_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F124548_12414_0|SrvcGrp|73842|2022|PDM|125.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F74844_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141278_80218_0|SrvcGrp|104451|2022|PDM|7344.00|99|0.00|MATERNITY SERVICES|
20|FH_F136382_0_0|SrvcGrp|83991|2022|PDM|1350.00|99|0.00|REMOVE BY LIGAT INT HEM GRPS|
20|FH_F117762_0_0|SrvcGrp|26279|2022|PDM|2577.00|99|0.00|CPT 29884|
20|FH_F102525_73134_0|SrvcGrp|21122|2022|PDM|49000.00|99|0.00|MS DRG 459 ONLY|
20|FH_F40710_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151699_01752_0|SrvcGrp|86847|2022|PDM|45.00|99|0.00|HCPCS S9348 (HCFA)|
20|FH_F74507_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47558_0_0|SrvcGrp|40414|2022|PCT|1.00|99|0.00|KS FS 3247 (A,E&K CODES)- MOD RR|
20|FH_F131392_17004_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134869_08854_0|SrvcGrp|3178|2022|PDM|1107.00|99|0.00|ACUTE PSYCH|
20|FH_F112306_81428_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F114207_35243_0|SrvcGrp|29075|2022|PDM|30.00|99|0.00|HYDRATION THERAPY|
20|FH_F122394_75979_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F45113_0_0|CSTM-ALL|CSTM-00|2020|PCT|44.90|99|0.00|OP SVCS|
20|FH_F148667_0_0|SrvcGrp|35667|2022|PDM|2052.00|99|0.00|CPT 20680|
20|FH_F50432_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150938_02062_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)|
20|FH_F128698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126781_92630_0|SrvcGrp|87131|2022|PDM|502.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F117645_90034_0|SrvcGrp|73841|2022|PDM|550.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F137719_28269_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F151699_01752_0|SrvcGrp|86836|2022|PDM|15.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F37385_0_0|SrvcGrp|15388|2022|PDM|125.00|99|0.00|SPEECH THERAPY|
20|FH_F71468_0_0|SrvcGrp|22954|2022|PDM|120.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F36634_0_0|SrvcGrp|12394|2022|PCT|0.70|99|0.00|PROSTHETICS/IMPLANTS/DEVICES|
20|FH_F147237_40006_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F149601_64111_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139913_33407_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F143249_89801_0|SrvcGrp|14945|2022|PDM|3.00|99|0.00|HOME INFUSION THERAPY - DOUBLE AND/OR TRIPLE LUMEN|
20|FH_F143347_16001_0|SrvcGrp|113988|2022|PCT|0.65|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F143367_81003_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|GENERAL ACUTE CARE|
20|FH_F103060_0_0|SrvcGrp|58993|2022|PDM|7803.00|99|0.00|DISKECTOMY|
20|FH_F115208_0_0|SrvcGrp|106169|2022|PDM|1061.00|99|0.00|FRACTURE NASAL INFERIOR|
20|FH_F115208_0_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AEG 4 (NO REV)|
20|FH_F130925_34652_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F131067_57105_0|SrvcGrp|72984|2022|PCT|1.70|99|0.00|CHEMOTHERAPY|
20|FH_F49489_0_0|CSTM-ALL|CSTM-00|2020|PDM|2459.23|99|0.00|ASPG VIII|
20|FH_F136250_73026_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F136289_73099_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F136299_75218_0|SrvcGrp|11000|2022|PCT|0.30|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F132495_33157_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112679_85711_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112712_63005_0|SrvcGrp|24744|2022|PCT|1.00|99|0.00|PICC LINE INSERTION|
20|FH_F116595_92506_0|SrvcGrp|93337|2022|PDM|475.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F125648_67005_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39028_0_0|SrvcGrp|29665|2022|PCT|1.00|99|0.00|DME MOD NU|
20|FH_F148548_37909_0|CSTM-ALL|CSTM-00|2020|PDM|2461.00|99|0.00|AEG 6 (NO REV)|
20|FH_F148554_85016_0|SrvcGrp|115439|2022|PDM|1836.00|99|0.00|UPGRADE OF IMPLANTED PACEMAKER|
20|FH_F136393_0_0|SrvcGrp|112881|2022|PDM|2000.00|99|0.00|REMOVE PACEMAKER SYSTEM|
20|FH_F89932_10940_0|SrvcGrp|72996|2022|PDM|2731.00|99|0.00|AEG 4|
20|FH_F141870_85224_0|SrvcGrp|24761|2022|PDM|5.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F136507_0_0|SrvcGrp|80918|2022|PDM|130.00|99|0.00|RESPITE CARE|
20|FH_F97042_64804_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F138611_0_0|CSTM-ALL|CSTM-00|2020|PDM|4518.00|99|0.00|AEG 6 (NO REV)|
20|FH_F135714_01922_0|SrvcGrp|104229|2022|PDM|145.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F41785_0_0|SrvcGrp|31187|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER NUKF (DME)|
20|FH_F113288_38104_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132543_79549_0|SrvcGrp|88978|2022|PDM|2500.00|99|0.00|VAGINAL DELIVERY|
20|FH_F42520_0_0|CSTM-ALL|CSTM-00|2020|PDM|1438.00|99|0.00|ASPG VII|
20|FH_F31107_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128130_10027_0|CSTM-ALL|CSTM-00|2020|PDM|2923.00|99|0.00|AETNA OP MRI AND MRA SCANS (MRIMRA)|
20|FH_F92677_08003_0|SrvcGrp|86841|2022|PDM|147.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F111401_29425_0|SrvcGrp|88621|2022|PDM|120.00|99|0.00|SKILLED NURSING LPN|
20|FH_F117647_0_0|CSTM-ALL|CSTM-00|2020|PDM|645.00|99|0.00|AEG 2 (NO REV)|
20|FH_F103821_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F136037_0_0|SrvcGrp|46903|2022|PDM|655.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F126003_79403_0|SrvcGrp|89417|2022|PDM|597.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F132938_33710_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|280.61|99|0.00|HAPA WPA-NWPA 2012-13 ASC 116 W/O REV|
20|FH_F88744_71103_0|SrvcGrp|114975|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F126581_45638_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F116602_0_0|CSTM-ALL|CSTM-00|2020|PCT|49.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F115772_26250_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F82173_72712_0|SrvcGrp|51471|2022|PDM|113.00|99|0.00|HOME HEALTH AID VISIT|
20|FH_F32778_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F42360_0_0|SrvcGrp|33166|2022|PDM|355.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F32718_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F141427_22003_0|SrvcGrp|48396|2022|PDM|84.00|99|0.00|OT SERVICES|
20|FH_F38982_0_0|SrvcGrp|361|2022|PDM|2391.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F33642_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 459-460|
20|FH_F134939_0_0|CSTM-ALL|CSTM-00|2020|PCT|83.20|99|0.00|OP SVCS|
20|FH_F120365_30043_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: ALL|
20|FH_F123809_26155_0|SrvcGrp|89939|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F136378_07104_0|SrvcGrp|73842|2022|PDM|210.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F118152_20151_0|SrvcGrp|107697|2022|PCT|1.00|99|0.00|AETNA ALL DRUGS AGENTS INJ|
20|FH_F120441_33065_0|SrvcGrp|75419|2022|PDM|875.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F120490_64133_0|SrvcGrp|86846|2022|PDM|25.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F77782_66061_0|SrvcGrp|3029|2022|PDM|803.00|99|0.00|NEWBORN NURSERY|
20|FH_F138583_60644_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F149563_75840_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119021_03060_0|SrvcGrp|86648|2022|PCT|1.06|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F72943_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F113392_0_0|SrvcGrp|86462|2022|PDM|1177.00|99|0.00|AREOLA RECONSTRUCTION|
20|FH_F55812_0_0|SrvcGrp|10545|2022|PDM|70.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F114629_19131_0|SrvcGrp|105349|2022|PDM|511.00|99|0.00|AETNA PARTIAL SUBSTANCE ABUSE|
20|FH_F148553_85016_0|SrvcGrp|112276|2022|PDM|5167.00|99|0.00|TIBIA WITH ATHERECTOMY|
20|FH_F116393_07002_0|SrvcGrp|111272|2022|PDM|34.97|99|0.00|ASSAY OF ARSENIC|
20|FH_F111292_33136_0|SrvcGrp|11258|2022|PCT|0.33|99|0.00|DRUGS|
20|FH_F132123_91360_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113957_73554_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F143668_0_0|SrvcGrp|114061|2022|PDM|37.00|99|0.00|SEGMENTAL PNEUMATIC TRUNK (MOD RR)|
20|FH_F111044_0_0|CSTM-ALL|CSTM-00|2020|PDM|1645.00|99|0.00|AEG 8 (NO REV)|
20|FH_F126676_43537_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F44296_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F117009_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F92676_15063_0|SrvcGrp|79086|2022|PDM|232.11|99|0.00|MON VALLEY ASC 144|
20|FH_F144869_15701_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133021_00910_0|SrvcGrp|112293|2022|PDM|7000.00|99|0.00|ELECTROPHYSIOLOGY|
20|FH_F132289_89145_0|SrvcGrp|29346|2022|PDM|35.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F72859_0_0|SrvcGrp|15596|2022|PDM|30.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F148924_44003_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F83978_66739_0|SrvcGrp|72998|2022|PDM|977.00|99|0.00|AEG 5|
20|FH_F143650_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132965_60459_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110507_33462_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F77082_0_0|SrvcGrp|33793|2022|PDM|20740.00|99|0.00|MSDRG 246-251 ONLY ANGIOPLASTY|
20|FH_F147502_0_0|SrvcGrp|29346|2022|PDM|85.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F112962_0_0|CSTM-ALL|CSTM-00|2020|PDM|505.00|99|0.00|AEG 2 (NO REV)|
20|FH_F39701_0_0|CSTM-ALL|CSTM-00|2020|PDM|1121.00|99|0.00|AEG 8 (NO REV)|
20|FH_F145921_73139_0|SrvcGrp|29347|2022|PDM|25.75|99|0.00|HOME HEALTH AIDE|
20|FH_F126114_31788_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F85353_16407_0|SrvcGrp|81779|2022|PCT|1.55|99|0.00|AETNA OP RADIOLOGY (RADHCPC)|
20|FH_F120425_11106_0|SrvcGrp|90854|2022|PDM|700.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F98780_35022_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F80513_0_0|SrvcGrp|27817|2022|PDM|7346.00|99|0.00|MSDRG 282 ONLY CIRCULATORY DISORDERS W/O CC|
20|FH_F131711_25550_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132928_64114_0|SrvcGrp|88779|2022|PDM|147.60|99|0.00|PHYSICAL THERAPY|
20|FH_F134826_19067_0|SrvcGrp|89412|2022|PDM|350.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F127375_28621_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114980_78061_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F89453_75069_0|SrvcGrp|87401|2022|PDM|30.00|99|0.00|HCPCS G0156 (HCFA)|
20|FH_F147941_06023_0|SrvcGrp|109218|2022|PDM|145.00|99|0.00|PSYCH/NEUROPSYCH TEST EACH ADD'L 30 MINUTES|
20|FH_F52854_0_0|SrvcGrp|3409|2022|PDM|740.00|99|0.00|NEWBORN NURSERY|
20|FH_F33782_0_0|SrvcGrp|11442|2022|PDM|480.00|99|0.00|HOSPICE SERVICE - GENERAL IP CARE (NON-RESPITE)|
20|FH_F141590_90049_0|SrvcGrp|87131|2022|PDM|565.63|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F129105_21713_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131277_29340_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93881_15009_0|SrvcGrp|75505|2022|PCT|0.55|99|0.00|CARDIAC STUDIES|
20|FH_F138682_0_0|CSTM-ALL|CSTM-00|2020|PDM|483.00|99|0.00|AEG 7 (NO REV)|
20|FH_F128079_67456_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37443_0_0|CSTM-ALL|CSTM-00|2020|PDM|1559.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123943_84041_0|SrvcGrp|65720|2022|PDM|90.00|99|0.00|RESPITE CARE|
20|FH_F89736_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F88635_32955_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F118152_20151_0|SrvcGrp|86846|2022|PDM|35.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F118169_27514_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F93178_73448_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS|
20|FH_F137147_75006_0|SrvcGrp|88158|2022|PDM|9875.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F119004_06850_0|SrvcGrp|12664|2022|PCT|0.00|99|0.00|IMPLANTS|
20|FH_F33513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|DME F/S (MOD NU) - MHAC|
20|FH_F130682_0_0|CSTM-ALL|CSTM-00|2020|PDM|1370.00|99|0.00|AEG 6 (NO REV)|
20|FH_F57312_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F123895_52722_0|SrvcGrp|87914|2022|PCT|1.00|99|0.00|EPOETIN ALFA NON-ESRD|
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|1681.00|99|0.00|AEG 10 (NO REV)|
20|FH_F99100_0_0|SrvcGrp|88495|2022|PDM|669.80|99|0.00|AETNA PERCUTANEOUS INTRADISCAL|
20|FH_F128333_71001_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F42822_0_0|CSTM-ALL|CSTM-00|2020|PDM|225.00|99|0.00|ADOLESCENT PARTIAL HOSPITALIZATION|
20|FH_F120172_92653_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151543_95630_0|SrvcGrp|88819|2022|PDM|1146.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F118198_38119_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129483_77030_0|SrvcGrp|111025|2022|PCT|0.83|99|0.00|SUPPLIES|
20|FH_F53094_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F117105_77619_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F109652_0_0|SrvcGrp|41367|2022|PDM|35315.00|99|0.00|MS DRG 242-244 ONLY|
20|FH_F112153_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 1 (NO REV)|
20|FH_F82432_0_0|SrvcGrp|63297|2022|PDM|105.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F92493_0_0|SrvcGrp|92405|2022|PDM|8263.20|99|0.00|PERQ LUMBOSACRAL INJECTION|
20|FH_F147584_37664_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F100906_0_0|SrvcGrp|97466|2022|PDM|1530.00|99|0.00|REPAIR INITIAL INGUINAL HERNIA|
20|FH_F91641_0_0|CSTM-ALL|CSTM-00|2020|PDM|1948.67|99|0.00|AEG 6 (NO REV)|
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1430.00|99|0.00|ASPG III|
20|FH_F130249_62034_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F139590_98908_0|SrvcGrp|92760|2022|PCT|1.10|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150820_83843_0|CSTM-ALL|CSTM-00|2020|PDM|5317.00|99|0.00|AEG 8 (NO REV)|
20|FH_F115483_62002_0|SrvcGrp|3378|2022|PCT|0.60|99|0.00|OBSERVATION SVCS|
20|FH_F150360_68112_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F114207_35243_0|SrvcGrp|86846|2022|PDM|30.00|99|0.00|HCPCS S9325 (HCFA)|
20|FH_F147227_48302_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124435_03882_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F129970_34986_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F124452_31322_0|SrvcGrp|29347|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE|
20|FH_F36350_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F125528_81147_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120605_0_0|SrvcGrp|72990|2022|PDM|531.00|99|0.00|AEG 1|
20|FH_F150519_92626_0|SrvcGrp|109330|2022|PCT|1.15|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F81771_0_0|SrvcGrp|3809|2022|PDM|500.00|99|0.00|HOSPICE CARE|
20|FH_F102721_38118_0|SrvcGrp|63148|2022|PDM|100.00|99|0.00|ACUTE PSYCH - IOP|
20|FH_F33554_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F125348_84660_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|IMMUNOMODULATING AGENTS VIG|
20|FH_F147800_0_0|SrvcGrp|115145|2022|PDM|660.00|99|0.00|NJX AA&/STRD PUDENDAL NERVE|
20|FH_F121976_44505_0|SrvcGrp|73841|2022|PDM|450.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
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_F127598_43232_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F109577_0_0|SrvcGrp|103612|2022|PDM|123.00|99|0.00|DIABETIC MGMT PROGRAM - DIETICIAN|
20|FH_F92475_15931_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F112446_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.86|99|0.00|OP SVCS|
20|FH_F38023_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|PDM|1457.00|99|0.00|AEG 2 (NO REV)|
20|FH_F110212_17013_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F144828_0_0|SrvcGrp|114199|2022|PDM|1176.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F122608_84123_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F42169_0_0|CSTM-ALL|CSTM-00|2020|PDM|900.00|99|0.00|PEDIATRIC IP SVCS|
20|FH_F69623_0_0|SrvcGrp|13985|2022|PDM|47.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F115210_21043_0|SrvcGrp|35668|2022|PDM|2122.00|99|0.00|CPT 29824|
20|FH_F72404_0_0|CSTM-ALL|CSTM-00|2020|PDM|1851.00|99|0.00|AEG 8 (NO REV)|
20|FH_F133536_0_0|SrvcGrp|69964|2022|PDM|2200.00|99|0.00|CPT 23120|
20|FH_F151503_30067_0|SrvcGrp|109787|2022|PDM|950.00|99|0.00|EXC FOOT/TOE TUM SC < 1.5 CM|
20|FH_F127399_0_0|SrvcGrp|73006|2022|PDM|3433.00|99|0.00|AEG 9|
20|FH_F111363_33169_0|SrvcGrp|111183|2022|PDM|12178.00|99|0.00|GASTRIC SLEEVE|
20|FH_F88831_84123_0|SrvcGrp|87798|2022|PDM|90.00|99|0.00|HOSPICE CARE (ALL OTHER)(HCFA)|
20|FH_F102960_50613_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F117711_73080_0|SrvcGrp|79099|2022|PDM|1575.00|99|0.00|AETNA IP OBSERVATION >= 24 HOURS|
20|FH_F134819_0_0|SrvcGrp|106169|2022|PDM|1364.00|99|0.00|FRACTURE NASAL INFERIOR|
20|FH_F37312_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD KF|
20|FH_F139825_0_0|SrvcGrp|46906|2022|PDM|9754.00|99|0.00|CORNEAL TISSUE|
20|FH_F106841_0_0|CSTM-ALL|CSTM-00|2020|PDM|837.35|99|0.00|AEG 5  (NO REV)|
20|FH_F128554_87102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F40591_0_0|SrvcGrp|12670|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|1460.00|99|0.00|HAPA EPA ASC 9|
20|FH_F101840_76054_0|SrvcGrp|73000|2022|PDM|2370.00|99|0.00|AEG 6|
20|FH_F145865_78130_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F132446_19063_0|SrvcGrp|48398|2022|PDM|76.00|99|0.00|PT SERVICES|
20|FH_F133018_84037_0|SrvcGrp|24745|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F121936_17543_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F100982_75601_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F120603_66112_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F119554_16506_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127589_45459_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F100782_0_0|SrvcGrp|97674|2022|PDM|2169.09|99|0.00|WINDBER MEDICAL CNTR ASC 703|
20|FH_F134223_83617_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F110604_0_0|SrvcGrp|113144|2022|PDM|6050.00|99|0.00|REMOVE VAGUS NERVE|
20|FH_F145642_15108_0|SrvcGrp|24752|2022|PDM|10.00|99|0.00|HORMONE INJECTION THERAPY|
20|FH_F110346_38501_0|SrvcGrp|86753|2022|PCT|1.10|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F132599_0_0|SrvcGrp|82981|2022|PDM|115.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F135610_06451_0|SrvcGrp|23683|2022|PDM|38.19|99|0.00|SKILLED NURSING RN|
20|FH_F89219_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|MT NITTANY ASC 4|
20|FH_F96160_32207_0|SrvcGrp|14893|2022|PDM|65.28|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F102142_80014_0|SrvcGrp|88620|2022|PDM|90.00|99|0.00|SKILLED NURSING RN|
20|FH_F63625_0_0|CSTM-ALL|CSTM-00|2020|PDM|4630.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116056_73018_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F133478_40165_0|SrvcGrp|20744|2022|PDM|36046.00|99|0.00|MS DRG 242 ONLY|
20|FH_F102267_0_0|SrvcGrp|471|2022|PDM|580.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F67121_0_0|SrvcGrp|474|2022|PDM|360.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F110263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1368.00|99|0.00|AEG 10 (NO REV)|
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_F120338_83226_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F116955_16801_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F121090_07848_0|SrvcGrp|108728|2022|PDM|50.00|99|0.00|DRUG TEST PRSMV INSTRUMENT|
20|FH_F120268_0_0|CSTM-ALL|CSTM-00|2020|PCT|40.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KL|
20|FH_F138050_52301_0|SrvcGrp|73461|2022|PDM|555.00|99|0.00|AETNA NICU IV|
20|FH_F132969_84003_0|SrvcGrp|108456|2022|PCT|1.00|99|0.00|ALL DRUGS/AGENTS/INJ DRUGS|
20|FH_F150165_06032_0|SrvcGrp|115166|2022|PDM|4244.00|99|0.00|EXTERNAL EAR PROCEDURES|
20|FH_F126244_43567_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F100782_0_0|SrvcGrp|105077|2022|PDM|570.81|99|0.00|WINDBER MEDICAL CNTR ASC 122|
20|FH_F49459_0_0|SrvcGrp|3259|2022|PDM|762.00|99|0.00|ACUTE REHABILITATION|
20|FH_F49979_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F111986_0_0|SrvcGrp|92197|2022|PDM|1854.00|99|0.00|CORRECTION OF BUNION|
20|FH_F149145_33460_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F71702_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.85|99|0.00|ASPG II|
20|FH_F75842_0_0|SrvcGrp|79978|2022|PCT|0.53|99|0.00|IMPLANTS/PROSTHETICS/DRUGS|
20|FH_F46373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.84|99|0.00|GENERAL ACUTE CARE|
20|FH_F92993_0_0|CSTM-ALL|CSTM-00|2020|PDM|73.56|99|0.00|AETNA SLEEP STUDY|
20|FH_F46094_0_0|SrvcGrp|41103|2022|PDM|90.00|99|0.00|NURSING CARE|
20|FH_F42706_0_0|SrvcGrp|17739|2022|PDM|1400.00|99|0.00|ICU/CCU|
20|FH_F40652_0_0|CSTM-ALL|CSTM-00|2020|PDM|150.00|99|0.00|OP SVCS|
20|FH_F126595_32308_0|CSTM-ALL|CSTM-00|2020|PCT|1.40|99|0.00|HSS ASC|
20|FH_F115739_78722_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F125891_45219_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F120352_52556_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F142073_0_0|SrvcGrp|115169|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F100460_0_0|SrvcGrp|86537|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F90691_0_0|SrvcGrp|114518|2022|PDM|1050.00|99|0.00|INSERTION DRAINAGE DEVICE|
20|FH_F125935_44024_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F86872_15215_0|SrvcGrp|24745|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PDM|428.49|99|0.00|AETNA POLYSOMNOGRAPHY|
20|FH_F32995_0_0|CSTM-ALL|CSTM-00|2020|PDM|3275.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F137249_30046_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140627_68651_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
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_F129411_24540_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F137814_61820_0|SrvcGrp|89417|2022|PDM|393.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F37294_0_0|SrvcGrp|33154|2022|PDM|1391.00|99|0.00|NICU LEVEL III & IV|
20|FH_F43665_0_0|SrvcGrp|26901|2022|PDM|892.00|99|0.00|VENTILATOR REHAB SERVICES|
20|FH_F55493_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140007_0_0|SrvcGrp|97259|2022|PDM|7887.00|99|0.00|INCISE SPINAL COLUMN NERVES|
20|FH_F130302_0_0|SrvcGrp|72998|2022|PDM|1892.00|99|0.00|AEG 5|
20|FH_F52772_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130756_04901_0|SrvcGrp|75506|2022|PCT|0.89|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F34272_0_0|CSTM-ALL|CSTM-00|2020|PCT|84.00|99|0.00|OP SVCS|
20|FH_F121225_98902_0|SrvcGrp|17015|2022|PCT|0.85|99|0.00|HOME INFUSION THERAPY|
20|FH_F90332_07060_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F49279_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_F85353_16407_0|SrvcGrp|63861|2022|PDM|358.19|99|0.00|HAPA WPA-NWPA 2012-13 ASC 309|
20|FH_F130763_0_0|SrvcGrp|26274|2022|PDM|3450.00|99|0.00|CPT 29877|
20|FH_F132883_31602_0|SrvcGrp|17014|2022|PDM|20.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F95623_84015_0|SrvcGrp|73700|2022|PDM|35.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F77943_0_0|SrvcGrp|105321|2022|PCT|0.70|99|0.00|PACEMAKER|
20|FH_F111662_80601_0|SrvcGrp|93291|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA ESRD USE|
20|FH_F34477_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DURABLE MEDICAL EQUIPMENT (DME)  - WINN|
20|FH_F63403_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F128358_46072_0|SrvcGrp|76501|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F151400_0_0|SrvcGrp|98569|2022|PDM|2215.00|99|0.00|POSTERIOR NON-SEGMENTAL INST|
20|FH_F129656_15005_0|SrvcGrp|43567|2022|PDM|60.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F40258_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F99441_0_0|SrvcGrp|112581|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F67063_0_0|SrvcGrp|23585|2022|PCT|1.10|99|0.00|IMPLANTS|
20|FH_F32786_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145550_62034_0|SrvcGrp|104228|2022|PDM|130.00|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F38151_0_0|SrvcGrp|28281|2022|PCT|0.85|99|0.00|CV SURGERY|
20|FH_F143528_0_0|SrvcGrp|80617|2022|PDM|12600.00|99|0.00|ARTHOPLASTY|
20|FH_F142400_75090_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140727_16046_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120152_0_0|SrvcGrp|104112|2022|PDM|3850.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F119067_94080_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F119021_03060_0|SrvcGrp|86748|2022|PCT|1.06|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F129838_17555_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F115895_0_0|CSTM-ALL|CSTM-00|2020|PDM|2295.00|99|0.00|AEG 2 (NO REV)|
20|FH_F133178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 5  (NO REV)|
20|FH_F132627_0_0|SrvcGrp|22592|2022|PDM|80.58|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F83231_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F47421_0_0|CSTM-ALL|CSTM-00|2020|PDM|780.00|99|0.00|ASPG X|
20|FH_F85154_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F91898_0_0|SrvcGrp|73485|2022|PDM|3693.00|99|0.00|AETNA REHAB|
20|FH_F137248_0_0|SrvcGrp|19991|2022|PDM|5722.00|99|0.00|NERVOUS SYSTEM SERVICES|
20|FH_F147519_52627_0|SrvcGrp|72984|2022|PCT|2.20|99|0.00|CHEMOTHERAPY|
20|FH_F136429_0_0|SrvcGrp|79588|2022|PDM|525.00|99|0.00|CPT 43235|
20|FH_F112092_46845_0|SrvcGrp|471|2022|PDM|600.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F143668_0_0|SrvcGrp|114058|2022|PDM|60.00|99|0.00|PNEUMATIC COMPRESSOR (MOD RR)|
20|FH_F38123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER KF|
20|FH_F75944_0_0|SrvcGrp|68362|2022|PDM|1084.00|99|0.00|COVENTRY ENHANCED GROUPER 10 WITH REV CODES|
20|FH_F111266_30339_0|SrvcGrp|24750|2022|PDM|30.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F124322_64131_0|SrvcGrp|29075|2022|PDM|25.00|99|0.00|HYDRATION THERAPY|
20|FH_F109543_63552_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117224_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F92614_0_0|CSTM-ALL|CSTM-00|2020|PCT|71.20|99|0.00|GENERAL ACUTE CARE|
20|FH_F129659_0_0|SrvcGrp|87077|2022|PDM|170.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F91080_67212_0|SrvcGrp|73485|2022|PDM|1153.00|99|0.00|AETNA REHAB|
20|FH_F120437_85202_0|SrvcGrp|22589|2022|PDM|97.36|99|0.00|CHEMOTHERAPY NOC|
20|FH_F100740_15206_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F150001_33064_0|SrvcGrp|86827|2022|PDM|53.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F133155_0_0|SrvcGrp|93098|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F133124_33837_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F54592_0_0|SrvcGrp|15596|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F102200_06416_0|SrvcGrp|15596|2022|PDM|10.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F125440_04043_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F135232_34471_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F93212_0_0|CSTM-ALL|CSTM-00|2020|PDM|1073.00|99|0.00|AEG 2 (NO REV)|
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_F145544_93536_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F38961_0_0|SrvcGrp|473|2022|PDM|325.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F93279_0_0|SrvcGrp|93759|2022|PCT|0.00|99|0.00|CARDIAC CATH|
20|FH_F66970_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F145758_20745_0|SrvcGrp|88163|2022|PDM|2856.00|99|0.00|LUMBAR SPINE FUSION|
20|FH_F147941_06023_0|SrvcGrp|53145|2022|PDM|247.00|99|0.00|SOCIAL WORKER|
20|FH_F141607_27021_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F65159_0_0|SrvcGrp|3259|2022|PDM|1897.00|99|0.00|ACUTE REHABILITATION|
20|FH_F136400_70360_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F140616_43338_0|SrvcGrp|111930|2022|PCT|1.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F91472_96001_0|SrvcGrp|107674|2022|PCT|2.05|99|0.00|AETNA RADIOLOGY|
20|FH_F130035_0_0|SrvcGrp|111471|2022|PDM|141.75|99|0.00|HEPATITIS B VACCINE|
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|AEG 2 (NO REV)|
20|FH_F123620_0_0|SrvcGrp|106300|2022|PDM|247.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F132721_0_0|SrvcGrp|3078|2022|PCT|0.65|99|0.00|DRUGS|
20|FH_F141170_0_0|SrvcGrp|74039|2022|PDM|5010.00|99|0.00|LAMINECTOMY|
20|FH_F148344_0_0|SrvcGrp|46903|2022|PDM|754.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F134612_0_0|SrvcGrp|112594|2022|PDM|500.00|99|0.00|TRLUML BALO ANGIOP 1ST ART|
20|FH_F139707_84010_0|SrvcGrp|114704|2022|PDM|5016.00|99|0.00|THYROID PROCEDURES|
20|FH_F101441_0_0|SrvcGrp|3932|2022|PDM|4450.00|99|0.00|LITHOTRIPSY|
20|FH_F71468_0_0|SrvcGrp|15850|2022|PDM|70.00|99|0.00|HOSPICE SVCS|
20|FH_F132374_0_0|SrvcGrp|83824|2022|PCT|0.00|99|0.00|AETNA CADIAC CATH INCIDENTAL CODES|
20|FH_F116703_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS|
20|FH_F120294_46322_0|SrvcGrp|48385|2022|PDM|95.00|99|0.00|SPEECH THERAPY|
20|FH_F123895_52722_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F66687_0_0|SrvcGrp|20910|2022|PDM|73092.00|99|0.00|MS DRG 234 ONLY|
20|FH_F143903_06249_0|SrvcGrp|108484|2022|PDM|450.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F40026_0_0|SrvcGrp|3016|2022|PCT|0.73|99|0.00|HEMODIALYSIS|
20|FH_F151156_0_0|CSTM-ALL|CSTM-00|2020|PDM|35.00|99|0.00|AEG 8 (NO REV)|
20|FH_F134160_19006_0|SrvcGrp|13681|2022|PDM|247.00|99|0.00|AMBULANCE SVC/BASIC LIFE SUPPORT/EMERGENCY TRANSPORT|
20|FH_F140652_92626_0|SrvcGrp|73842|2022|PDM|365.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F149511_62626_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F86815_0_0|SrvcGrp|78448|2022|PCT|0.00|99|0.00|AETNA IMAGING ENHANCING SUBSTANCE|
20|FH_F117255_68520_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F147839_33983_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138873_0_0|SrvcGrp|113115|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|267.97|99|0.00|DELAWARE VALLEY- ASC 108|
20|FH_F145784_0_0|SrvcGrp|11663|2022|PCT|1.05|99|0.00|IMPLANTS|
20|FH_F141070_64093_0|SrvcGrp|29346|2022|PDM|44.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F40603_0_0|SrvcGrp|13632|2022|PDM|220.00|99|0.00|CPT 99215|
20|FH_F89582_0_0|SrvcGrp|76094|2022|PDM|149.93|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F114666_30342_0|SrvcGrp|74039|2022|PDM|6050.00|99|0.00|LAMINECTOMY|
20|FH_F113845_32746_0|SrvcGrp|73842|2022|PDM|145.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F74283_0_0|SrvcGrp|42784|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F98624_15701_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|2346.00|99|0.00|AEG 6 (NO REV)|
20|FH_F129248_0_0|CSTM-ALL|CSTM-00|2020|PDM|1142.38|99|0.00|2005 ASPG GROUPER VI|
20|FH_F131361_18235_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F139487_60076_0|SrvcGrp|46605|2022|PDM|100.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F36454_0_0|CSTM-ALL|CSTM-00|2020|PDM|207.32|99|0.00|SALLY BALIN,999182,ASC 113|
20|FH_F35747_34223_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F92092_74055_0|CSTM-ALL|CSTM-00|2020|PCT|0.52|99|0.00|GENERAL ACUTE CARE|
20|FH_F148501_21550_0|SrvcGrp|113706|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F125049_44131_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F126812_44137_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F90921_77702_0|SrvcGrp|48398|2022|PDM|100.00|99|0.00|PT SERVICES|
20|FH_F100740_15206_0|SrvcGrp|73605|2022|PDM|2759.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F128559_43524_0|SrvcGrp|48398|2022|PDM|115.00|99|0.00|PT SERVICES|
20|FH_F55375_0_0|SrvcGrp|3810|2022|PDM|156.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F134568_12946_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F124262_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F83054_0_0|SrvcGrp|81379|2022|PDM|94.55|99|0.00|AETNA PT/OT/ST|
20|FH_F116806_0_0|SrvcGrp|107007|2022|PDM|2499.85|99|0.00|ADJUST BONE FIXATION DEVICE|
20|FH_F51258_0_0|SrvcGrp|474|2022|PDM|260.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F139169_0_0|CSTM-ALL|CSTM-00|2020|PDM|857.29|99|0.00|AEG 3 (NO REV)|
20|FH_F129474_92701_0|SrvcGrp|46903|2022|PDM|1200.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F131087_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F116664_0_0|SrvcGrp|106655|2022|PCT|0.90|99|0.00|PARSABIV|
20|FH_F131505_0_0|SrvcGrp|101527|2022|PDM|481.00|99|0.00|HYSTEROSCOPY LYSIS|
20|FH_F146882_84532_0|CSTM-ALL|CSTM-00|2020|PCT|0.93|99|0.00|OP SVCS|
20|FH_F124235_92840_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F124681_69337_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F114985_32073_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133579_0_0|SrvcGrp|111966|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F39633_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F40535_0_0|SrvcGrp|9518|2022|PDM|300.00|99|0.00|EMERGENCY ROOM|
20|FH_F135583_17331_0|SrvcGrp|112751|2022|PDM|53549.00|99|0.00|MS DRG 521-522 ONLY|
20|FH_F91764_93710_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F140629_0_0|SrvcGrp|88144|2022|PDM|2497.00|99|0.00|LAPAROSCOPY BIOPSY|
20|FH_F32938_0_0|CSTM-ALL|CSTM-00|2020|PDM|1485.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F127713_30012_0|SrvcGrp|88620|2022|PDM|185.00|99|0.00|SKILLED NURSING RN|
20|FH_F138977_64468_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F37493_0_0|SrvcGrp|8950|2022|PDM|3602.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F43433_0_0|SrvcGrp|12287|2022|PCT|0.60|99|0.00|IP PET SCAN|
20|FH_F43433_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.63|99|0.00|OP SVCS|
20|FH_F87577_80016_0|SrvcGrp|86403|2022|PDM|283.00|99|0.00|HOME HOSPICE|
20|FH_F35454_0_0|SrvcGrp|16856|2022|PDM|9.00|99|0.00|PREGNANCY TEST|
20|FH_F111444_33401_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F133003_49012_0|SrvcGrp|90854|2022|PDM|550.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F117550_0_0|SrvcGrp|106522|2022|PDM|38.00|99|0.00|OCCUPATIONAL THERAPY SVCS RE-EVAL|
20|FH_F44257_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F42646_0_0|SrvcGrp|177|2022|PDM|950.00|99|0.00|ACUTE IP SURGICAL SVCS|
20|FH_F42438_0_0|SrvcGrp|40147|2022|PDM|977.00|99|0.00|CVTY ENHANCED UNGROUPED|
20|FH_F143573_01610_0|SrvcGrp|472|2022|PDM|517.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F50657_0_0|SrvcGrp|16746|2022|PDM|80.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F88744_71103_0|SrvcGrp|73485|2022|PDM|1037.00|99|0.00|AETNA REHAB|
20|FH_F90232_15126_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F150148_71901_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F120930_0_0|SrvcGrp|33984|2022|PDM|2500.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F149322_19023_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150223_30720_0|SrvcGrp|115602|2022|PCT|1.00|99|0.00|TELEMEDICINE|
20|FH_F116753_0_0|SrvcGrp|10944|2022|PDM|933.00|99|0.00|EMERGENCY ROOM|
20|FH_F127071_82435_0|SrvcGrp|89337|2022|PDM|785.00|99|0.00|DETOXIFICATION|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F128828_44122_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F149199_73005_0|SrvcGrp|114521|2022|PDM|6094.00|99|0.00|LITHOTRIPSY ESWL|
20|FH_F88274_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148200_26554_0|SrvcGrp|79699|2022|PCT|0.75|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F130747_0_0|SrvcGrp|92408|2022|PDM|4162.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F123064_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 4 (NO REV)|
20|FH_F146789_0_0|CSTM-ALL|CSTM-00|2020|PCT|63.70|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_F135767_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136183_72756_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F140629_0_0|SrvcGrp|77460|2022|PDM|2497.00|99|0.00|CPT 38571|
20|FH_F51272_0_0|SrvcGrp|36138|2022|PDM|6500.00|99|0.00|ACUTE IP SURGICAL SVCS - FIRST DAY|
20|FH_F131000_0_0|SrvcGrp|89860|2022|PDM|6450.00|99|0.00|SPINAL DISK SURGERY ADD-ON|
20|FH_F132328_0_0|SrvcGrp|77021|2022|PDM|6097.00|99|0.00|LAMINOTOMY/HEMILAMINECTOMY|
20|FH_F118651_0_0|SrvcGrp|107867|2022|PDM|4959.71|99|0.00|AETNA REMOVAL OF UTERUS LESION|
20|FH_F139597_07009_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40530_0_0|CSTM-ALL|CSTM-00|2020|PDM|1309.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151699_01752_0|SrvcGrp|86853|2022|PDM|45.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F136493_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_F100682_97401_0|CSTM-ALL|CSTM-00|2020|PCT|0.73|99|0.00|OP SVCS|
20|FH_F50974_0_0|CSTM-ALL|CSTM-00|2020|PDM|22.00|99|0.00|ANTIBIOTIC THERAPY Q8 (MOD SH)|
20|FH_F143054_26147_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F80855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F79944_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F120670_0_0|SrvcGrp|91528|2022|PDM|6500.00|99|0.00|SPINAL CORD IMPLANT|
20|FH_F129548_44130_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F148922_32073_0|CSTM-ALL|CSTM-00|2020|PCT|1.19|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F133585_0_0|SrvcGrp|12993|2022|PDM|121.00|99|0.00|ACTIVASE|
20|FH_F130707_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127651_44124_0|SrvcGrp|88621|2022|PDM|95.00|99|0.00|SKILLED NURSING LPN|
20|FH_F126506_68118_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133951_48310_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F121476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90391_33774_0|SrvcGrp|473|2022|PDM|315.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F52754_0_0|SrvcGrp|47133|2022|PDM|95.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|185.71|99|0.00|HAPA WPA-NWPA 2012-13 ASC 128 W/O REV|
20|FH_F54212_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F90840_0_0|CSTM-ALL|CSTM-00|2020|PDM|2103.00|99|0.00|AEG 9 (NO REV)|
20|FH_F93791_0_0|SrvcGrp|80617|2022|PDM|4200.00|99|0.00|ARTHOPLASTY|
20|FH_F92392_0_0|SrvcGrp|79720|2022|PDM|3348.00|99|0.00|ACUTE REHAB II|
20|FH_F76303_0_0|SrvcGrp|43568|2022|PDM|150.00|99|0.00|SKILLED NURSING - RN|
20|FH_F100662_27534_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F57912_0_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|OP SVCS|
20|FH_F143870_19134_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F73142_0_0|SrvcGrp|70445|2022|PDM|825.00|99|0.00|MRI/MRA|
20|FH_F125899_07645_0|SrvcGrp|110240|2022|PCT|1.84|99|0.00|DRUGS OR DRUG AGENTS|
20|FH_F145546_52732_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F123885_60062_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F109472_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.79|99|0.00|OP SVCS|
20|FH_F62915_0_0|SrvcGrp|42830|2022|PDM|208.00|99|0.00|MEDICAL SOCIAL WORKER VISIT|
20|FH_F53732_0_0|SrvcGrp|27968|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F75944_0_0|SrvcGrp|68189|2022|PDM|1381.00|99|0.00|CVTY ENHANCED + REV CODES ASPG 5|
20|FH_F114568_08097_0|SrvcGrp|86746|2022|PCT|1.05|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F114207_35243_0|SrvcGrp|86845|2022|PDM|35.00|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F122396_90024_0|SrvcGrp|104079|2022|PCT|1.25|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F139785_92629_0|SrvcGrp|87317|2022|PDM|2835.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F76285_0_0|SrvcGrp|73302|2022|PDM|225.00|99|0.00|SPEECH THERAPY RE-EVALUATION|
20|FH_F137719_28269_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F131356_19131_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F147220_49417_0|SrvcGrp|108622|2022|PDM|453.00|99|0.00|SUB ACUTE CARE LEVEL II|
20|FH_F50461_0_0|SrvcGrp|1306|2022|PDM|342.00|99|0.00|OP PSYCH PARTIAL HOSP|
20|FH_F128397_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150982_0_0|SrvcGrp|87679|2022|PDM|2080.00|99|0.00|LUMBAR OR SACRAL SURGERY|
20|FH_F132944_06480_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F114568_08097_0|SrvcGrp|104796|2022|PDM|145.00|99|0.00|PSYCH DIAG EVAL W/ MED SVCS|
20|FH_F36251_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F101441_0_0|SrvcGrp|112026|2022|PDM|8105.00|99|0.00|TOTAL KNEE ARTHROPLASTY|
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_F108460_32746_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F149662_85015_0|SrvcGrp|10986|2022|PDM|4650.00|99|0.00|ARTHROSCOPIC KNEE REPAIR|
20|FH_F97881_38703_0|SrvcGrp|73559|2022|PDM|13357.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F112823_0_0|CSTM-ALL|CSTM-00|2020|PDM|1259.00|99|0.00|AEG 7 (NO REV)|
20|FH_F148326_0_0|SrvcGrp|114924|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F138420_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F148667_0_0|SrvcGrp|105658|2022|PDM|2856.00|99|0.00|REPAIR FRACTURE OF RADIUS|
20|FH_F89640_98133_0|SrvcGrp|83538|2022|PDM|1513.00|99|0.00|AETNA MULTIPLE SCLEROSIS AND CEREBEL ATAXIA|
20|FH_F110821_31513_0|SrvcGrp|42784|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY  SRVCS|
20|FH_F137458_08857_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F39443_0_0|SrvcGrp|13361|2022|PDM|235.00|99|0.00|EMERGENCY ROOM SVCS LEVEL III|
20|FH_F124703_65711_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116549_0_0|SrvcGrp|103552|2022|PDM|50.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F138478_0_0|SrvcGrp|104635|2022|PDM|5518.23|99|0.00|INSERT PULSE GEN SNGL LEAD|
20|FH_F44279_0_0|SrvcGrp|9866|2022|PDM|600.00|99|0.00|IP OBSERVATION SVCS|
20|FH_F147009_0_0|CSTM-ALL|CSTM-00|2020|PDM|630.00|99|0.00|AEG 4 (NO REV)|
20|FH_F124441_0_0|CSTM-ALL|CSTM-00|2020|PDM|4987.50|99|0.00|AEG 9 (NO REV)|
20|FH_F131392_17004_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F139823_32250_0|SrvcGrp|73841|2022|PDM|453.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F143347_16001_0|SrvcGrp|89628|2022|PDM|21751.00|99|0.00|KYPHOPLASTY|
20|FH_F143536_47546_0|SrvcGrp|100251|2022|PCT|1.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (2.6 - 7.5 CM)|
20|FH_F143536_47546_0|SrvcGrp|100257|2022|PCT|1.00|99|0.00|REPAIR SUPERFICIAL WOUND(S) (5.1 -7.5 CM)|
20|FH_F103060_0_0|SrvcGrp|34606|2022|PDM|3121.00|99|0.00|CPT 29827|
20|FH_F131107_43140_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F47056_0_0|SrvcGrp|22954|2022|PDM|127.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F120240_37013_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116546_78723_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F116698_07470_0|SrvcGrp|26869|2022|PDM|39.90|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F116739_78501_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F119993_71913_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120866_51652_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F120921_75835_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F120977_50510_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F39028_0_0|SrvcGrp|29959|2022|PCT|1.00|99|0.00|DME MOD KM|
20|FH_F51276_0_0|SrvcGrp|17012|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F89112_16509_0|SrvcGrp|29294|2022|PDM|1206.00|99|0.00|ACUTE REHAB|
20|FH_F129812_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F83031_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|INTERIM INFUSION REV CODE 949|
20|FH_F132863_65240_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F134211_17961_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150160_01301_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134593_60007_0|SrvcGrp|24750|2022|PDM|48.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F60112_0_0|SrvcGrp|12496|2022|PDM|753.00|99|0.00|ACUTE REHABILITATION|
20|FH_F84973_46733_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F145714_44135_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F87053_0_0|SrvcGrp|13990|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F116040_24637_0|SrvcGrp|24744|2022|PDM|55.00|99|0.00|PICC LINE INSERTION|
20|FH_F110220_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143817_71322_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F33712_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|ASPG IX|
20|FH_F93114_85016_0|SrvcGrp|73742|2022|PCT|0.00|99|0.00|AETNA - ROUTINE VENIPUNCTURE|
20|FH_F76402_0_0|CSTM-ALL|CSTM-00|2020|PCT|26780.00|99|0.00|CAPD/CCPD SUPPLEMENT|
20|FH_F148165_29169_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F88639_80204_0|SrvcGrp|75493|2022|PDM|15388.78|99|0.00|AEG 8|
20|FH_F136300_67206_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F134126_11554_0|SrvcGrp|42782|2022|PDM|143.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F71549_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: GLOBAL/ALL|
20|FH_F134770_14420_0|CSTM-ALL|CSTM-00|2020|PCT|0.92|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F98626_29118_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132791_44122_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F139676_76901_0|SrvcGrp|46903|2022|PDM|425.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F49300_0_0|SrvcGrp|42046|2022|PDM|595.00|99|0.00|HOSPICE CARE|
20|FH_F114676_91911_0|SrvcGrp|86648|2022|PCT|1.20|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F147231_49440_0|SrvcGrp|57967|2022|PDM|208.00|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|1028.00|99|0.00|AEG 7 (NO REV)|
20|FH_F129764_48084_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|RADIOLOGY W/MOD 26|
20|FH_F136779_0_0|SrvcGrp|112930|2022|PDM|8864.00|99|0.00|NECK AND SPINE FUSION|
20|FH_F129682_07034_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F113826_51445_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F80855_0_0|SrvcGrp|73000|2022|PDM|1025.00|99|0.00|AEG 6|
20|FH_F131282_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|AEG 7 (NO REV)|
20|FH_F131433_0_0|SrvcGrp|87077|2022|PDM|149.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F38700_0_0|SrvcGrp|18318|2022|PCT|0.80|99|0.00|MS DRG 467|
20|FH_F117891_19034_0|SrvcGrp|29347|2022|PDM|31.50|99|0.00|HOME HEALTH AIDE|
20|FH_F49354_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRBA|
20|FH_F128564_43235_0|SrvcGrp|87799|2022|PDM|138.00|99|0.00|HOSPICE IN HOME S9126 (HCFA)|
20|FH_F122245_0_0|SrvcGrp|77461|2022|PDM|2879.99|99|0.00|CPT 52356|
20|FH_F133552_77006_0|SrvcGrp|108484|2022|PDM|520.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKC|
20|FH_F140472_0_0|SrvcGrp|10391|2022|PDM|800.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F133517_49221_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F91044_74010_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F133021_00910_0|SrvcGrp|21732|2022|PDM|6000.00|99|0.00|LITHOTRIPSY|
20|FH_F145845_37167_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133943_01606_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F50657_0_0|SrvcGrp|31189|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF (DME)|
20|FH_F116506_0_0|SrvcGrp|75495|2022|PDM|1125.00|99|0.00|AEG 9|
20|FH_F96160_32207_0|SrvcGrp|86845|2022|PDM|68.65|99|0.00|HCPCS S9349 (HCFA)|
20|FH_F70863_0_0|SrvcGrp|1168|2022|PDM|1198.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F130017_02302_0|CSTM-ALL|CSTM-00|2020|PDM|4603.40|99|0.00|AEG 7 (NO REV)|
20|FH_F81698_10457_0|SrvcGrp|86779|2022|PDM|47.25|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F143739_33440_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F46258_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.25|99|0.00|WALGREENS S CODE MOD SJ|
20|FH_F107600_0_0|CSTM-ALL|CSTM-00|2020|PDM|1457.00|99|0.00|AEG 9 (NO REV)|
20|FH_F128272_60640_0|SrvcGrp|86829|2022|PDM|15.00|99|0.00|HCPCS S5517 (HCFA)|
20|FH_F99100_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)|
20|FH_F49338_0_0|SrvcGrp|31189|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF (DME)|
20|FH_F87272_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F103100_47150_0|SrvcGrp|72992|2022|PDM|905.00|99|0.00|AEG 2|
20|FH_F39886_0_0|SrvcGrp|16|2022|PDM|742.00|99|0.00|ACUTE REHABILITATION|
20|FH_F123926_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|AEG 5  (NO REV)|
20|FH_F101201_0_0|SrvcGrp|46903|2022|PDM|412.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F129627_06037_0|SrvcGrp|46104|2022|PDM|118.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F142473_07663_0|SrvcGrp|29347|2022|PCT|1.00|99|0.00|HOME HEALTH AIDE|
20|FH_F142347_75140_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F41665_0_0|SrvcGrp|32407|2022|PCT|0.65|99|0.00|OCN F/S PRICING: GLOBAL (RADIOLOGY)|
20|FH_F89475_71202_0|SrvcGrp|2738|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F38875_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129536_0_0|SrvcGrp|105604|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F110925_01104_0|SrvcGrp|86129|2022|PDM|1.11|99|0.00|AETNA XYNTHA INJ|
20|FH_F125693_92660_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F45973_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F129669_57701_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100790_10512_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F50218_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|GENERAL ACUTE CARE|
20|FH_F129656_15005_0|SrvcGrp|27969|2022|PDM|17.11|99|0.00|HOME HEALTH AIDE|
20|FH_F107200_0_0|SrvcGrp|88147|2022|PDM|4422.00|99|0.00|LAPAROSCOPY REMOVE ADNEXA|
20|FH_F134150_01801_0|SrvcGrp|105682|2022|PDM|188.00|99|0.00|INTENSIVE OUTPATIENT >=18 YRS|
20|FH_F146912_90025_0|SrvcGrp|108484|2022|PDM|1190.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F136570_32084_0|SrvcGrp|73842|2022|PDM|107.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F113785_35763_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F138527_64506_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F43833_0_0|SrvcGrp|9518|2022|PDM|600.00|99|0.00|EMERGENCY ROOM|
20|FH_F42754_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98161_0_0|SrvcGrp|72994|2022|PDM|587.00|99|0.00|AEG 3|
20|FH_F131501_0_0|SrvcGrp|63297|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F138734_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F138784_32216_0|SrvcGrp|90854|2022|PDM|1008.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F151379_21045_0|SrvcGrp|73006|2022|PDM|1589.00|99|0.00|AEG 9|
20|FH_F131000_0_0|SrvcGrp|102480|2022|PDM|2494.00|99|0.00|CPT 29897|
20|FH_F71362_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127464_15106_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F149579_95815_0|SrvcGrp|115672|2022|PDM|49.85|99|0.00|CARE MGMT BH|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|243.00|99|0.00|HAPA EPA ASC 32|
20|FH_F67261_0_0|CSTM-ALL|CSTM-00|2020|PDM|3083.00|99|0.00|ASPG VII - FH SW CUSTOM GROUPERS|
20|FH_F130747_0_0|SrvcGrp|80617|2022|PDM|26010.00|99|0.00|ARTHOPLASTY|
20|FH_F62719_0_0|SrvcGrp|17140|2022|PDM|150.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F75382_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|GENERAL ACUTE CARE|
20|FH_F31798_0_0|CSTM-ALL|CSTM-00|2020|PDM|524.00|99|0.00|MULTIPLE BIRTHS|
20|FH_F148320_02130_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F100320_0_0|SrvcGrp|75489|2022|PDM|884.00|99|0.00|AEG 6|
20|FH_F142654_73034_0|SrvcGrp|113986|2022|PDM|682.00|99|0.00|INPATIENT SERVICES|
20|FH_F140329_78570_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F101945_0_0|SrvcGrp|10986|2022|PDM|3967.00|99|0.00|ARTHROSCOPIC KNEE REPAIR|
20|FH_F85757_0_0|SrvcGrp|33722|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F66711_0_0|SrvcGrp|43432|2022|PDM|15.00|99|0.00|HOME HEALTH AIDE HOURLY|
20|FH_F103961_63017_0|SrvcGrp|98742|2022|PDM|105.00|99|0.00|HOSPICE OR HOME CARE|
20|FH_F113541_0_0|CSTM-ALL|CSTM-00|2020|PDM|2670.00|99|0.00|AEG 9 (NO REV)|
20|FH_F128880_0_0|SrvcGrp|87077|2022|PDM|120.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F46333_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132864_71101_0|SrvcGrp|114504|2022|PCT|2.00|99|0.00|LABORATORY SERVICES|
20|FH_F124414_92653_0|SrvcGrp|73605|2022|PDM|970.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F42024_0_0|SrvcGrp|9984|2022|PDM|135.00|99|0.00|URGENT CARE|
20|FH_F100780_24153_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F47872_83330_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F141471_0_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|AEG 10 (NO REV)|
20|FH_F35381_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F54552_0_0|SrvcGrp|27049|2022|PDM|24.66|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 6HRS (MOD SJ)|
20|FH_F135438_29030_0|SrvcGrp|86723|2022|PDM|430.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F34266_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132720_0_0|SrvcGrp|360|2022|PDM|2059.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL II|
20|FH_F37361_0_0|SrvcGrp|9828|2022|PDM|40.70|99|0.00|HOME HEALTH AIDE|
20|FH_F40530_0_0|SrvcGrp|97|2022|PDM|3500.00|99|0.00|C-SECTION|
20|FH_F131574_64131_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40350_0_0|SrvcGrp|19973|2022|PDM|650.00|99|0.00|CAT SCAN|
20|FH_F118542_60188_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133021_00910_0|SrvcGrp|112309|2022|PDM|4000.00|99|0.00|TIPPS (TRANS JUGULAR INTRAHEPATIC PORTOSYSTEMIC)|
20|FH_F51545_0_0|SrvcGrp|43894|2022|PDM|150.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F41396_0_0|SrvcGrp|34271|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE (DME)|
20|FH_F151159_46322_0|SrvcGrp|48394|2022|PDM|50.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F116506_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F145642_15108_0|SrvcGrp|22589|2022|PDM|25.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F116806_0_0|SrvcGrp|107008|2022|PDM|2499.85|99|0.00|REMOVAL OF BONE FOR GRAFT|
20|FH_F50958_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F75087_0_0|SrvcGrp|14614|2022|PDM|4000.00|99|0.00|LITHOTRIPSY|
20|FH_F110346_38501_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F127579_44321_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F95631_33705_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F56683_0_0|CSTM-ALL|CSTM-00|2020|PCT|88.00|99|0.00|OP SVCS|
20|FH_F110342_0_0|SrvcGrp|72998|2022|PDM|1560.00|99|0.00|AEG 5|
20|FH_F114567_43235_0|SrvcGrp|73842|2022|PDM|266.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F70484_0_0|CSTM-ALL|CSTM-00|2020|PCT|53.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|600.00|99|0.00|AEG 1 (NO REV)|
20|FH_F113713_17013_0|SrvcGrp|91394|2022|PDM|85.00|99|0.00|AETNA PSYCH DIAGNOSTIC EVALUATION (MOD HO)|
20|FH_F127207_0_0|SrvcGrp|29155|2022|PDM|90.00|99|0.00|HOSPICE SVCS|
20|FH_F135438_29030_0|SrvcGrp|86722|2022|PDM|239.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F130847_53098_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116397_33404_0|SrvcGrp|86779|2022|PDM|125.00|99|0.00|HOME INFUSION THERAPY  (HCFA)|
20|FH_F124903_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50218_0_0|SrvcGrp|10518|2022|PDM|120.00|99|0.00|ENTEROSTOMAL VISIT F/U VISIT|
20|FH_F56136_0_0|SrvcGrp|22816|2022|PCT|0.92|99|0.00|ROTATOR CUFF|
20|FH_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|453.98|99|0.00|HAPA WPA-NWPA 2012-13 ASC 404 W/O REV|
20|FH_F133021_00910_0|CSTM-ALL|CSTM-00|2020|PDM|950.00|99|0.00|ERCP|
20|FH_F150062_92501_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F43141_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UEKF|
20|FH_F114931_0_0|CSTM-ALL|CSTM-00|2020|PDM|447.00|99|0.00|AEG 1 (NO REV)|
20|FH_F129130_92562_0|SrvcGrp|111453|2022|PDM|30183.00|99|0.00|ANGIOPLASTY|
20|FH_F77044_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120697_68526_0|SrvcGrp|89149|2022|PDM|190.00|99|0.00|OP INTENSIVE|
20|FH_F116207_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F70303_0_0|SrvcGrp|17140|2022|PDM|211.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F132899_01002_0|SrvcGrp|112084|2022|PDM|371.00|99|0.00|INTENSIVE OUTPATIENT EATING DISORDERS (0-17 YRS)|
20|FH_F114444_19602_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F125870_0_0|SrvcGrp|110211|2022|PDM|1295.00|99|0.00|INCISE INNER EYE ADHESIONS|
20|FH_F84712_0_0|SrvcGrp|82737|2022|PDM|34.00|99|0.00|URINALYSIS|
20|FH_F105145_75075_0|SrvcGrp|80679|2022|PCT|2.00|99|0.00|AETNA RADIOLOGY|
20|FH_F75842_0_0|SrvcGrp|48682|2022|PDM|659.53|99|0.00|MS DRG 795 ONLY & REV CODES 170-172 NORMAL NEWBORN|
20|FH_F151139_0_0|SrvcGrp|115962|2022|PDM|4250.00|99|0.00|NON-EMERGENT AIR TRANSPORT 1 WAY (MOD NE)|
20|FH_F128982_44221_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F125062_0_0|CSTM-ALL|CSTM-00|2020|PCT|9000.00|99|0.00|TIMELY FILING|
20|FH_F123464_63841_0|SrvcGrp|471|2022|PDM|327.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F145593_92660_0|SrvcGrp|87317|2022|PDM|975.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F135171_22601_0|SrvcGrp|89417|2022|PDM|400.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F148266_45419_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|AEG 4 (NO REV)|
20|FH_F126730_84737_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|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_F119578_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148166_0_0|SrvcGrp|80098|2022|PDM|56.00|99|0.00|AETNA HOSPICE CONTINUOUS HOME CARE|
20|FH_F145766_64491_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F40421_0_0|SrvcGrp|43|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F123844_0_0|SrvcGrp|95660|2022|PDM|678.00|99|0.00|HOSPICE SERVICES (HCFA)|
20|FH_F40043_0_0|SrvcGrp|14834|2022|PCT|0.76|99|0.00|TRANS VEGUS NERVE|
20|FH_F131357_17545_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F72183_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F41201_0_0|SrvcGrp|10400|2022|PDM|2200.00|99|0.00|IP SURGERY|
20|FH_F88639_80204_0|SrvcGrp|87132|2022|PDM|5789.77|99|0.00|EATING DISORDER|
20|FH_F34418_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134147_19342_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149663_45219_0|SrvcGrp|84939|2022|PDM|15965.00|99|0.00|SHOULDER JOINT|
20|FH_F114365_73162_0|SrvcGrp|471|2022|PDM|514.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F97040_31901_0|SrvcGrp|88977|2022|PDM|6772.00|99|0.00|C-SECTION DELIVERY|
20|FH_F147331_90045_0|SrvcGrp|73701|2022|PDM|79.56|99|0.00|AETNA - SKILLED NURSING|
20|FH_F42688_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F100906_0_0|SrvcGrp|97464|2022|PDM|2000.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F40334_0_0|SrvcGrp|3029|2022|PDM|556.00|99|0.00|NEWBORN NURSERY|
20|FH_F135978_06851_0|SrvcGrp|112508|2022|PDM|280.00|99|0.00|INTENSIVE OUTPATIENT PSYCH (0-18 YRS)|
20|FH_F100765_73735_0|SrvcGrp|73659|2022|PDM|4846.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F116431_76104_0|SrvcGrp|10391|2022|PDM|1311.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1628.70|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1404 W/O REV|
20|FH_F124369_0_0|SrvcGrp|89989|2022|PDM|11220.00|99|0.00|FUSION OF BIG TOE JOINT|
20|FH_F129509_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_F63318_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|(DME) OCN F/S PRICING: ALL|
20|FH_F141587_40242_0|CSTM-ALL|CSTM-00|2020|PDM|820.00|99|0.00|AETNA BEHAVIOR OBSERVATION|
20|FH_F125966_68776_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F125028_19061_0|SrvcGrp|86842|2022|PDM|57.75|99|0.00|HCPCS S9373 (HCFA)|
20|FH_F43858_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F135228_98003_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F123473_65109_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F78363_0_0|SrvcGrp|68820|2022|PDM|700.00|99|0.00|SKILLED NURSING|
20|FH_F148266_45419_0|CSTM-ALL|CSTM-00|2020|PDM|593.00|99|0.00|AEG 2 (NO REV)|
20|FH_F148162_29412_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148221_06477_0|SrvcGrp|48394|2022|PDM|55.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F115985_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F93881_15009_0|SrvcGrp|75491|2022|PDM|3134.00|99|0.00|AEG 7|
20|FH_F92276_32308_0|SrvcGrp|39136|2022|PDM|50715.00|99|0.00|MSDRG 226-227 ONLY CARDIAC|
20|FH_F86851_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA AMFS OCN F/S PRICING - OP|
20|FH_F142690_31774_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151608_30236_0|CSTM-ALL|CSTM-00|2020|PDM|700.00|99|0.00|AEG 1 (NO REV)|
20|FH_F117371_77059_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F117211_15143_0|SrvcGrp|23683|2022|PDM|38.00|99|0.00|SKILLED NURSING RN|
20|FH_F83997_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|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35347_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139372_34698_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F60292_0_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F110509_71351_0|SrvcGrp|103913|2022|PCT|1.30|99|0.00|OP DIALYSIS|
20|FH_F143674_34208_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F118123_67226_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F127616_17403_0|SrvcGrp|75545|2022|PDM|320.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F112023_12866_0|SrvcGrp|73496|2022|PDM|1285.00|99|0.00|AETNA ER LEVEL V|
20|FH_F51934_0_0|SrvcGrp|48399|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F80224_0_0|SrvcGrp|29387|2022|PDM|115906.00|99|0.00|MS DRG 008 ONLY - SIMULT-PANCREAS/KIDNEY TRANSPLANT|
20|FH_F79743_0_0|SrvcGrp|105688|2022|PCT|0.57|99|0.00|SLEEP STUDIES|
20|FH_F45692_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.74|99|0.00|GENERAL ACUTE CARE|
20|FH_F115786_57701_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1614.00|99|0.00|COVENTRY ENHANCED GROUPER 9|
20|FH_F135055_63016_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F34550_0_0|SrvcGrp|12670|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETICS/DEVICES|
20|FH_F125118_99201_0|SrvcGrp|75442|2022|PDM|803.00|99|0.00|OBSERVATION - REV 762|
20|FH_F128682_57701_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|PDM|964.00|99|0.00|AEG 7 (NO REV)|
20|FH_F123943_84041_0|SrvcGrp|89781|2022|PDM|90.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F54552_0_0|SrvcGrp|26868|2022|PDM|80.00|99|0.00|DIURETIC IV THERAPY|
20|FH_F135389_43123_0|SrvcGrp|73842|2022|PDM|227.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148243_0_0|SrvcGrp|90976|2022|PDM|400.00|99|0.00|INJECTION PARAVERTEBRAL FACET JOINT|
20|FH_F41463_0_0|SrvcGrp|35107|2022|PCT|0.88|99|0.00|CARECENTRIX AWP - 12%|
20|FH_F134387_60106_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F125113_0_0|CSTM-ALL|CSTM-00|2020|PDM|705.00|99|0.00|AEG 1 (NO REV)|
20|FH_F119008_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F125182_0_0|SrvcGrp|79588|2022|PDM|1783.50|99|0.00|CPT 43235|
20|FH_F120437_85202_0|SrvcGrp|98978|2022|PDM|185.71|99|0.00|TPN ONE LITER PER DAY (HCFA)|
20|FH_F97581_60141_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F42984_0_0|CSTM-ALL|CSTM-00|2020|PDM|373.00|99|0.00|RESIDENTIAL PSYCH / CD (ADOLESCENT)|
20|FH_F128545_29569_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40154_0_0|CSTM-ALL|CSTM-00|2020|PDM|1385.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F128559_43524_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F122928_39563_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F148555_0_0|SrvcGrp|115439|2022|PDM|4120.00|99|0.00|UPGRADE OF IMPLANTED PACEMAKER|
20|FH_F123545_44512_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F146790_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 3 (NO REV)|
20|FH_F101840_76054_0|SrvcGrp|73606|2022|PDM|580.00|99|0.00|AETNA SKILLED NURSING CARE|
20|FH_F148021_80907_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F42340_0_0|SrvcGrp|30199|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU (DME)|
20|FH_F148879_33018_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38560_0_0|SrvcGrp|29544|2022|PCT|0.70|99|0.00|PACEMKR/PROSTHETIC/ORTHOTIC/IMPLANT/DME|
20|FH_F130721_04769_0|CSTM-ALL|CSTM-00|2020|PDM|955.00|99|0.00|AETNA OP CT SCANS (CTSCAN)|
20|FH_F130775_61701_0|SrvcGrp|89412|2022|PDM|350.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F127651_44124_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F146120_45040_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118042_33401_0|SrvcGrp|73841|2022|PDM|475.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F97861_62223_0|SrvcGrp|73643|2022|PDM|1636.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F113457_17011_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100782_0_0|SrvcGrp|105078|2022|PDM|559.39|99|0.00|WINDBER MEDICAL CNTR ASC 123|
20|FH_F141169_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117300_0_0|SrvcGrp|35669|2022|PDM|4909.00|99|0.00|CPT 63650|
20|FH_F114444_19602_0|SrvcGrp|91752|2022|PDM|65.00|99|0.00|AETNA GROUP THERAPY (MOD TD)|
20|FH_F149263_0_0|SrvcGrp|93641|2022|PDM|3450.00|99|0.00|KNEE ARTHROSCOPIC SURGERY|
20|FH_F134229_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F149319_07670_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F148186_0_0|SrvcGrp|13422|2022|PDM|285.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE SVC|
20|FH_F148600_30328_0|SrvcGrp|13187|2022|PCT|0.00|99|0.00|INTRAOCULAR LENSES|
20|FH_F71042_0_0|SrvcGrp|14610|2022|PCT|0.70|99|0.00|SPEECH PATHOLOGY VISIT|
20|FH_F116056_73018_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131737_15025_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133658_60053_0|SrvcGrp|23683|2022|PDM|63.00|99|0.00|SKILLED NURSING RN|
20|FH_F133478_40165_0|SrvcGrp|112341|2022|PCT|0.54|99|0.00|ORTHOPEDIC PROCEDURES|
20|FH_F148255_72703_0|SrvcGrp|26869|2022|PDM|31.50|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F151541_01436_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F145755_08050_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149939_91942_0|SrvcGrp|73605|2022|PDM|1100.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F120349_38774_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F78852_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS|
20|FH_F82714_18848_0|SrvcGrp|73498|2022|PDM|992.00|99|0.00|AETNA ER LEVEL III|
20|FH_F93920_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|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_F136510_0_0|SrvcGrp|82570|2022|PDM|1733.00|99|0.00|REVISION EYELID/EXCESS SKIN|
20|FH_F88639_80204_0|SrvcGrp|73498|2022|PDM|2087.79|99|0.00|AETNA ER LEVEL III|
20|FH_F35308_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD 26) - BDSS|
20|FH_F127079_33026_0|SrvcGrp|104465|2022|PDM|1250.00|99|0.00|AETNA RESIDENTIAL TREATMNT-EATING DISORDERS|
20|FH_F99441_0_0|CSTM-ALL|CSTM-00|2020|PDM|452.00|99|0.00|AEG 2 (NO REV)|
20|FH_F116237_43235_0|SrvcGrp|89149|2022|PDM|172.00|99|0.00|OP INTENSIVE|
20|FH_F92091_0_0|SrvcGrp|73006|2022|PDM|2835.00|99|0.00|AEG 9|
20|FH_F78324_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134159_80228_0|SrvcGrp|108484|2022|PDM|750.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F137209_60515_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F149586_77535_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F82933_0_0|CSTM-ALL|CSTM-00|2020|PDM|2984.46|99|0.00|COVENTRY ENHANCED GROUPER 1|
20|FH_F91832_06106_0|SrvcGrp|48398|2022|PDM|89.25|99|0.00|PT SERVICES|
20|FH_F32227_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F105623_77901_0|SrvcGrp|88834|2022|PDM|110.00|99|0.00|SKILLED NURSING SERVICES (15 MINS)|
20|FH_F40875_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|DX IMAG CVTY POS FACILITY MOD 26|
20|FH_F141207_0_0|SrvcGrp|90707|2022|PDM|205.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F94786_07974_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F116664_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F122194_66104_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F146882_84532_0|SrvcGrp|79699|2022|PCT|0.93|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F102947_44084_0|SrvcGrp|87317|2022|PDM|677.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F123083_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F91975_0_0|SrvcGrp|91859|2022|PDM|352.00|99|0.00|SIGMOIDOSCOPY W/ ENDOSCOPIC|
20|FH_F79429_0_0|SrvcGrp|3809|2022|PDM|540.00|99|0.00|HOSPICE CARE|
20|FH_F151513_44718_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F135979_66451_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F131407_07607_0|SrvcGrp|86841|2022|PDM|80.00|99|0.00|HCPCS S9364 (HCFA)|
20|FH_F116469_92543_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F111292_33136_0|SrvcGrp|111183|2022|PDM|12653.00|99|0.00|GASTRIC SLEEVE|
20|FH_F114569_0_0|SrvcGrp|105716|2022|PDM|12.94|99|0.00|AETHA ANNUAL ALCOHOL SCREEN 15 MINS (MOD GT)(HCFA)|
20|FH_F128987_65737_0|SrvcGrp|111245|2022|PDM|550.00|99|0.00|HEMODIALYSIS|
20|FH_F31547_0_0|SrvcGrp|12709|2022|PDM|202.58|99|0.00|OP DIALYSIS|
20|FH_F149480_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F37018_0_0|SrvcGrp|63|2022|PDM|650.00|99|0.00|SUBACUTE CARE|
20|FH_F140373_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F142904_50322_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111461_32607_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
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_F68622_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37886_0_0|SrvcGrp|13638|2022|PDM|150.00|99|0.00|CPT 99244|
20|FH_F42557_0_0|CSTM-ALL|CSTM-00|2020|PDM|135.00|99|0.00|OP SVCS|
20|FH_F148060_01001_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F120290_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F142814_16511_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F76662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130108_0_0|CSTM-ALL|CSTM-00|2020|PDM|1550.00|99|0.00|ASPG III|
20|FH_F143684_0_0|CSTM-ALL|CSTM-00|2020|PDM|676.00|99|0.00|AEG 1 (NO REV)|
20|FH_F132331_89107_0|SrvcGrp|88620|2022|PDM|85.00|99|0.00|SKILLED NURSING RN|
20|FH_F150602_59718_0|SrvcGrp|104229|2022|PDM|153.00|99|0.00|HOSPICE IN HOME (HCFA)|
20|FH_F97565_83301_0|SrvcGrp|90854|2022|PDM|2103.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F97543_33542_0|SrvcGrp|73601|2022|PDM|10673.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F103106_04101_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F133021_00910_0|SrvcGrp|112330|2022|PDM|19595.00|99|0.00|MITRAL VALVE REPLACEMENT|
20|FH_F146471_63110_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117245_0_0|SrvcGrp|72996|2022|PDM|1040.00|99|0.00|AEG 4|
20|FH_F134615_38478_0|SrvcGrp|74668|2022|PDM|400.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F117255_68520_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F117126_12801_0|SrvcGrp|2738|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F90880_15108_0|SrvcGrp|90494|2022|PCT|1.00|99|0.00|AFLURIA VACC 3 YRS & > IM|
20|FH_F95880_02726_0|SrvcGrp|94743|2022|PDM|56.65|99|0.00|FLUZONE VACC IM (>=3 YRS)|
20|FH_F100640_48097_0|SrvcGrp|73643|2022|PDM|2418.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F39426_0_0|SrvcGrp|473|2022|PDM|380.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F132627_0_0|SrvcGrp|17013|2022|PDM|80.58|99|0.00|HOME INFUSION THERAPY|
20|FH_F116393_07002_0|SrvcGrp|106519|2022|PDM|22.95|99|0.00|ANTIBODY|
20|FH_F147586_44124_0|SrvcGrp|93432|2022|PDM|18000.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F135763_20678_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F38013_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|SAOF OP SERVICES MOD 26|
20|FH_F102228_08846_0|SrvcGrp|89412|2022|PDM|508.00|99|0.00|AMBULATORY DETOX ALCOHOL AND DRUGS REHAB|
20|FH_F147181_27514_0|SrvcGrp|112223|2022|PCT|1.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F132254_40207_0|SrvcGrp|86827|2022|PDM|100.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F90817_0_0|SrvcGrp|91004|2022|PDM|1997.00|99|0.00|REPAIR METACARPAL FRACTURE (HCFA)|
20|FH_F108680_0_0|SrvcGrp|100919|2022|PDM|9900.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F133154_27401_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F75706_0_0|SrvcGrp|73103|2022|PCT|1.00|99|0.00|HCPCS AND CPT CODE|
20|FH_F133268_63703_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113586_0_0|SrvcGrp|75497|2022|PDM|1020.00|99|0.00|AEG 10|
20|FH_F44855_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40465_0_0|SrvcGrp|3586|2022|PDM|63650.00|99|0.00|DRG 525 OTHER HEART ASSIST SYSTEM IMPLANT|
20|FH_F92677_08003_0|SrvcGrp|24745|2022|PDM|63.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F44135_0_0|SrvcGrp|10542|2022|PDM|70.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F121420_06418_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F33785_0_0|SrvcGrp|13133|2022|PCT|0.70|99|0.00|PT/OT/ST|
20|FH_F38268_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OPT CARE OF MUNCY FH -UE|
20|FH_F134263_15628_0|SrvcGrp|105047|2022|PDM|145.00|99|0.00|AETNA PSYCH DIAG EVAL W/ MED SVCS (HCFA)|
20|FH_F47906_0_0|SrvcGrp|43844|2022|PCT|1.00|99|0.00|DME MOD UEKC|
20|FH_F72666_0_0|SrvcGrp|69688|2022|PCT|0.75|99|0.00|OP ELECTROPHYSIOLOGY SERVICES|
20|FH_F112045_90301_0|SrvcGrp|96063|2022|PDM|34186.00|99|0.00|AETNA PTCA|
20|FH_F142327_0_0|SrvcGrp|113923|2022|PDM|450.00|99|0.00|IRIS SUPPORTED INTRAOCULAR|
20|FH_F129765_43015_0|SrvcGrp|35982|2022|PDM|50.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F147214_48162_0|SrvcGrp|42623|2022|PDM|539.00|99|0.00|SUBACUTE - LEVEL III|
20|FH_F148552_68114_0|CSTM-ALL|CSTM-00|2020|PDM|1362.72|99|0.00|AEG 10 (NO REV)|
20|FH_F109669_28376_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F112587_37058_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150904_22306_0|SrvcGrp|27969|2022|PDM|21.00|99|0.00|HOME HEALTH AIDE|
20|FH_F106243_92780_0|SrvcGrp|22529|2022|PCT|0.00|99|0.00|DAY HOSPITAL HALF DAY|
20|FH_F103400_33426_0|SrvcGrp|89149|2022|PDM|228.00|99|0.00|OP INTENSIVE|
20|FH_F120407_84070_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F142084_82009_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HSS ASC|
20|FH_F92648_90248_0|SrvcGrp|48385|2022|PDM|89.25|99|0.00|SPEECH THERAPY|
20|FH_F101840_76054_0|SrvcGrp|31916|2022|PDM|15337.00|99|0.00|MS DRG 473 ONLY|
20|FH_F62560_0_0|SrvcGrp|32373|2022|PCT|0.60|99|0.00|PHYSICIANS SERVICES (CMS 1500)|
20|FH_F49663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD RR KF"|
20|FH_F148863_33021_0|SrvcGrp|75419|2022|PDM|716.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F151060_02493_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F151279_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F135622_34471_0|SrvcGrp|58509|2022|PDM|374.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F150165_06032_0|SrvcGrp|113890|2022|PDM|1650.00|99|0.00|REMOVE VAGINA LESION|
20|FH_F123157_0_0|SrvcGrp|75483|2022|PDM|486.00|99|0.00|AEG 3|
20|FH_F131128_0_0|SrvcGrp|73610|2022|PCT|0.00|99|0.00|AETNA IMPLANTS|
20|FH_F114444_19602_0|SrvcGrp|105375|2022|PDM|95.00|99|0.00|PSYCH TREATMENT PATIENT & FAMILY - 30 MIN (HCFA)|
20|FH_F40427_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F100662_27534_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F115047_78526_0|SrvcGrp|76501|2022|PDM|325.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F34735_0_0|SrvcGrp|361|2022|PDM|1950.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F86660_0_0|CSTM-ALL|CSTM-00|2020|PDM|2147.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F134087_0_0|SrvcGrp|67066|2022|PDM|6712.00|99|0.00|CERVICAL SURGERY|
20|FH_F138491_0_0|SrvcGrp|95661|2022|PDM|85.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F135916_33614_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F116527_70443_0|SrvcGrp|79786|2022|PCT|1.00|99|0.00|SLEEP STUDIES|
20|FH_F111390_32960_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F40698_0_0|SrvcGrp|13631|2022|PDM|90.00|99|0.00|CPT 99213|
20|FH_F117581_21211_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F134869_08854_0|SrvcGrp|69075|2022|PDM|120.00|99|0.00|CPT 99213|
20|FH_F132818_24701_0|SrvcGrp|79699|2022|PCT|0.88|99|0.00|CARDIAC CATHETERIZATION INJECTIONS|
20|FH_F116806_0_0|SrvcGrp|107080|2022|PDM|1923.16|99|0.00|EXCISION SUBLINGUAL GLAND|
20|FH_F124381_27610_0|SrvcGrp|73842|2022|PDM|193.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F108500_62702_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F144831_0_0|SrvcGrp|95762|2022|PDM|175.11|99|0.00|HOSPICE CARE (HCFA)|
20|FH_F118672_29036_0|CSTM-ALL|CSTM-00|2020|PDM|1479.00|99|0.00|AEG 1 (NO REV)|
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|1005.00|99|0.00|AEG 3 (NO REV)|
20|FH_F133397_23233_0|SrvcGrp|79720|2022|PDM|2550.00|99|0.00|ACUTE REHAB II|
20|FH_F141767_62312_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150579_16652_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F144471_19805_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38508_0_0|SrvcGrp|12962|2022|PCT|0.85|99|0.00|DME|
20|FH_F119437_0_0|SrvcGrp|67065|2022|PDM|4750.00|99|0.00|CERVICAL SURGERY|
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_F133287_40215_0|CSTM-ALL|CSTM-00|2020|PDM|2683.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 6 (NO REV)|
20|FH_F121962_75009_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F111986_0_0|SrvcGrp|104112|2022|PDM|2472.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F124369_0_0|SrvcGrp|99169|2022|PDM|2113.10|99|0.00|CPT 28200|
20|FH_F138056_64055_0|SrvcGrp|88621|2022|PDM|115.00|99|0.00|SKILLED NURSING LPN|
20|FH_F138240_64114_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F112082_30720_0|SrvcGrp|22592|2022|PDM|91.67|99|0.00|CONTINUOUS ANTI-COAGULANTS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|157.81|99|0.00|HAPA WPA-NWPA 2012-13 ASC 234 W/O REV|
20|FH_F121225_98902_0|SrvcGrp|22596|2022|PDM|236.25|99|0.00|HOSPICE CARE|
20|FH_F150165_06032_0|SrvcGrp|67065|2022|PDM|11000.00|99|0.00|CERVICAL SURGERY|
20|FH_F133581_84790_0|SrvcGrp|109219|2022|PDM|1500.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F60273_0_0|SrvcGrp|56463|2022|PDM|4321.80|99|0.00|CPT 53852|
20|FH_F122649_0_0|SrvcGrp|94781|2022|PDM|112.00|99|0.00|HOSPICE IN LTCH (HCFA)|
20|FH_F116341_12180_0|SrvcGrp|89022|2022|PDM|42.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F109240_21201_0|SrvcGrp|102990|2022|PDM|2684.00|99|0.00|PROTON TREATMENT, COMPLEX|
20|FH_F146803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 3 (NO REV)|
20|FH_F40519_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|2007 DME DBL MODIFIERS - NU/KC|
20|FH_F32461_0_0|CSTM-ALL|CSTM-00|2020|PCT|72.00|99|0.00|OP SVCS|
20|FH_F133550_90630_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F148721_67205_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F134235_70403_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F133749_84604_0|SrvcGrp|112438|2022|PDM|25.00|99|0.00|ANIT-HEMOPHILIC FACTORS|
20|FH_F145641_06902_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F32657_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F139299_0_0|SrvcGrp|90854|2022|PDM|875.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F130364_01331_0|SrvcGrp|106251|2022|PCT|4.25|99|0.00|LABORATORY SERVICES|
20|FH_F149263_0_0|SrvcGrp|115611|2022|PDM|7000.00|99|0.00|CATH DIALYSIS CIRCUIT|
20|FH_F150241_60714_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145584_15010_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F86552_0_0|CSTM-ALL|CSTM-00|2020|PDM|1650.00|99|0.00|AEG 6 (NO REV)|
20|FH_F39346_0_0|SrvcGrp|38|2022|PDM|1350.00|99|0.00|NORMAL DELIVERY|
20|FH_F45832_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|OP SVCS|
20|FH_F47884_0_0|SrvcGrp|701|2022|PDM|1732.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F126717_66103_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F90811_0_0|SrvcGrp|90365|2022|PDM|2700.00|99|0.00|REPAIR METACARPAL FRACTURE|
20|FH_F132992_04662_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F129526_0_0|CSTM-ALL|CSTM-00|2020|PDM|819.00|99|0.00|OP SVCS|
20|FH_F149219_01966_0|SrvcGrp|103320|2022|PCT|1.00|99|0.00|AZTREONAM 500 MG INJECTION|
20|FH_F117206_0_0|SrvcGrp|74039|2022|PDM|3605.00|99|0.00|LAMINECTOMY|
20|FH_F129440_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AMBULATORY SURGERY W/O CPT|
20|FH_F127529_43230_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F127071_82435_0|SrvcGrp|87131|2022|PDM|410.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F81377_0_0|CSTM-ALL|CSTM-00|2020|PDM|722.00|99|0.00|AEG 4 (NO REV)|
20|FH_F119732_37660_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F112791_0_0|SrvcGrp|73006|2022|PDM|1405.00|99|0.00|AEG 9|
20|FH_F111957_30024_0|SrvcGrp|473|2022|PDM|695.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F127686_67432_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F146806_33157_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F38360_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F143834_06511_0|SrvcGrp|89022|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION|
20|FH_F130157_84049_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F151146_0_0|SrvcGrp|109286|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F139580_0_0|SrvcGrp|107749|2022|PDM|182.00|99|0.00|CAPD/CCPD|
20|FH_F102184_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 2 (NO REV)|
20|FH_F116760_68512_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40834_0_0|SrvcGrp|97|2022|PDM|4494.00|99|0.00|C-SECTION|
20|FH_F127072_30458_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F91994_0_0|SrvcGrp|91866|2022|PDM|1360.00|99|0.00|AETNA CYSTOSCOPY/VASECTOMY|
20|FH_F142073_0_0|SrvcGrp|67279|2022|PDM|11900.00|99|0.00|CERVICAL SURGERY|
20|FH_F140833_19454_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151603_27609_0|SrvcGrp|88491|2022|PDM|6118.37|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F147900_48038_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F147839_33983_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F117211_15143_0|SrvcGrp|48396|2022|PDM|70.00|99|0.00|OT SERVICES|
20|FH_F91472_96001_0|SrvcGrp|103747|2022|PCT|0.40|99|0.00|TOTAL ANKLE REPLACEMENT|
20|FH_F37625_0_0|SrvcGrp|16704|2022|PDM|250.00|99|0.00|HOME HEMO TRAINING|
20|FH_F40536_0_0|CSTM-ALL|CSTM-00|2020|PDM|252.51|99|0.00|DELAWARE VALLEY- ASC 109|
20|FH_F97721_01053_0|SrvcGrp|73603|2022|PDM|9293.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PDM|1765.00|99|0.00|AEG 9 (NO REV)|
20|FH_F42937_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116383_63026_0|SrvcGrp|86722|2022|PDM|233.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F39272_0_0|SrvcGrp|17419|2022|PDM|65.00|99|0.00|SPEECH THERAPY|
20|FH_F103004_75840_0|SrvcGrp|73461|2022|PDM|811.00|99|0.00|AETNA NICU IV|
20|FH_F139115_32504_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93138_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119573_95864_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F121476_0_0|SrvcGrp|108850|2022|PDM|1656.00|99|0.00|IMPLANTABLE BREAST PROSTHESIS|
20|FH_F51393_0_0|SrvcGrp|26001|2022|PDM|170.00|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F141210_0_0|SrvcGrp|71340|2022|PDM|1751.00|99|0.00|GI SURGERY CARVEOUTS|
20|FH_F90332_07060_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F88698_18951_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F145686_52591_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149199_73005_0|SrvcGrp|10944|2022|PDM|770.00|99|0.00|EMERGENCY ROOM|
20|FH_F134488_14086_0|SrvcGrp|473|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F75842_0_0|SrvcGrp|79977|2022|PCT|0.49|99|0.00|RADIOPHARMACEUTICALS|
20|FH_F59732_0_0|SrvcGrp|14947|2022|PDM|65.00|99|0.00|HOME INFUSION|
20|FH_F99441_0_0|SrvcGrp|112862|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
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_F145534_02155_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F135065_08043_0|SrvcGrp|112641|2022|PCT|1.20|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F93881_15009_0|SrvcGrp|87106|2022|PDM|74.00|99|0.00|X-RAY EXAM OF HAND|
20|FH_F120338_83226_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148184_29527_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141410_13045_0|SrvcGrp|73497|2022|PDM|1162.00|99|0.00|AETNA ER LEVEL IV|
20|FH_F109277_0_0|SrvcGrp|11577|2022|PDM|652.00|99|0.00|DIALYSIS|
20|FH_F139551_0_0|SrvcGrp|88492|2022|PDM|4574.00|99|0.00|AETNA SPINAL BONE AUTOGRAFT|
20|FH_F129653_0_0|SrvcGrp|74039|2022|PDM|4000.00|99|0.00|LAMINECTOMY|
20|FH_F74342_0_0|SrvcGrp|14893|2022|PDM|36.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F143820_28405_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113410_0_0|SrvcGrp|100014|2022|PDM|3677.00|99|0.00|REPAIR RADIUS OR ULNA|
20|FH_F39977_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|OP SVCS|
20|FH_F97600_46151_0|SrvcGrp|73602|2022|PDM|4185.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F137276_83127_0|SrvcGrp|48396|2022|PDM|85.50|99|0.00|OT SERVICES|
20|FH_F119285_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 4 (NO REV)|
20|FH_F91873_12723_0|SrvcGrp|12280|2022|PCT|0.68|99|0.00|IMPLANTS|
20|FH_F132988_0_0|SrvcGrp|11669|2022|PDM|4493.01|99|0.00|OP SURG|
20|FH_F100787_69162_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F111143_28659_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F113585_20155_0|SrvcGrp|26869|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F131407_07607_0|SrvcGrp|65621|2022|PDM|25.00|99|0.00|RN NURSING|
20|FH_F127399_0_0|SrvcGrp|74039|2022|PDM|3849.00|99|0.00|LAMINECTOMY|
20|FH_F101581_16371_0|SrvcGrp|75545|2022|PDM|324.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F125253_15601_0|SrvcGrp|471|2022|PDM|656.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F120154_77498_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD DEFAULT W/O G0151-G0156, G0299-G0300|
20|FH_F35750_0_0|CSTM-ALL|CSTM-00|2020|PDM|992.00|99|0.00|ACUTE PSYCH|
20|FH_F75547_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F149030_37919_0|SrvcGrp|58772|2022|PDM|2493.12|99|0.00|HEMORRHOIDOPEXY|
20|FH_F92155_74437_0|SrvcGrp|82137|2022|PCT|0.69|99|0.00|AETNA AMBULATORY SURGERY (DEFAULTSUR)|
20|FH_F35741_32216_0|CSTM-ALL|CSTM-00|2020|PCT|0.46|99|0.00|GENERAL ACUTE CARE|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER UE|
20|FH_F133473_21702_0|SrvcGrp|48398|2022|PDM|169.74|99|0.00|PT SERVICES|
20|FH_F132886_0_0|SrvcGrp|106300|2022|PDM|381.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT (HCFA)|
20|FH_F141930_72032_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_F117891_19034_0|SrvcGrp|48396|2022|PDM|126.00|99|0.00|OT SERVICES|
20|FH_F85257_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F75842_0_0|SrvcGrp|46526|2022|PDM|21379.24|99|0.00|OP AICD|
20|FH_F141587_40242_0|SrvcGrp|90854|2022|PDM|820.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F65681_0_0|SrvcGrp|474|2022|PDM|285.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F125986_62656_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F32289_0_0|CSTM-ALL|CSTM-00|2020|PCT|99.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F35276_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME F/S (MOD RR) - PMRS|
20|FH_F93171_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F125249_0_0|SrvcGrp|100005|2022|PDM|2100.00|99|0.00|FUSION RADIOULNAR JNT/ULNA|
20|FH_F123953_84003_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F93791_0_0|SrvcGrp|93600|2022|PDM|4200.00|99|0.00|TOTAL HIP ARTHOPLASTY(HCFA)|
20|FH_F128580_0_0|CSTM-ALL|CSTM-00|2020|PDM|342.00|99|0.00|AEG 1 (NO REV)|
20|FH_F134029_06517_0|SrvcGrp|471|2022|PDM|609.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F142547_70002_0|SrvcGrp|13929|2022|PDM|10.00|99|0.00|GROWTH HORMONE|
20|FH_F119004_06850_0|CSTM-ALL|CSTM-00|2020|PDM|745.00|99|0.00|AEG 2 (NO REV)|
20|FH_F41481_0_0|SrvcGrp|17081|2022|PDM|1525.00|99|0.00|ASPG IX|
20|FH_F147744_33614_0|CSTM-ALL|CSTM-00|2020|PCT|1.15|99|0.00|HSS ASC INVOICE|
20|FH_F137934_51054_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F90876_18447_0|SrvcGrp|29464|2022|PDM|66.15|99|0.00|HOME HEALTH VISIT NEWBORN CARE|
20|FH_F76172_0_0|SrvcGrp|28074|2022|PCT|0.90|99|0.00|HIGH COST PHARMACEUTICALS|
20|FH_F116323_0_0|SrvcGrp|106667|2022|PDM|12868.00|99|0.00|AETNA LOW BACK DISK SURGERY|
20|FH_F95341_08701_0|SrvcGrp|91462|2022|PCT|0.80|99|0.00|PT/OT|
20|FH_F132973_28054_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F42840_0_0|SrvcGrp|36647|2022|PCT|0.65|99|0.00|WIG, ANY TYPE|
20|FH_F43779_0_0|SrvcGrp|115|2022|PDM|733.00|99|0.00|SKILLED NURSING CARE|
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|2200.00|99|0.00|COVENTRY ENHANCED GROUPER 6|
20|FH_F140007_0_0|CSTM-ALL|CSTM-00|2020|PDM|3218.00|99|0.00|AEG 6 (NO REV)|
20|FH_F135351_0_0|CSTM-ALL|CSTM-00|2020|PDM|693.00|99|0.00|AEG 2 (NO REV)|
20|FH_F116492_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F68341_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140629_0_0|SrvcGrp|113687|2022|PDM|2497.00|99|0.00|LAPARO ABLATE RENAL CYST|
20|FH_F40899_0_0|SrvcGrp|31189|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RRKF (DME)|
20|FH_F114825_32789_0|SrvcGrp|86723|2022|PDM|368.00|99|0.00|OP PARTIAL HOSPITALIZATION (HCFA)|
20|FH_F148887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F130134_08724_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F115736_77459_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F58014_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F107800_34609_0|SrvcGrp|89149|2022|PDM|160.00|99|0.00|OP INTENSIVE|
20|FH_F89495_0_0|SrvcGrp|23585|2022|PCT|0.45|99|0.00|IMPLANTS|
20|FH_F123784_03264_0|SrvcGrp|46605|2022|PDM|163.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F123733_70714_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F78402_15905_0|SrvcGrp|3178|2022|PDM|1377.00|99|0.00|ACUTE PSYCH|
20|FH_F139456_47501_0|SrvcGrp|109057|2022|PCT|0.80|99|0.00|CARDIAC STUDIES|
20|FH_F81761_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F97660_29401_0|SrvcGrp|73643|2022|PDM|941.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F73025_0_0|SrvcGrp|48398|2022|PDM|30.00|99|0.00|PT SERVICES|
20|FH_F124542_0_0|SrvcGrp|80539|2022|PDM|496.00|99|0.00|AETNA MEDICARE OUTPATIENT GROUPER 3|
20|FH_F122076_17543_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F100880_67735_0|SrvcGrp|29817|2022|PDM|3750.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F127399_0_0|SrvcGrp|70749|2022|PDM|3121.00|99|0.00|CPT 29823|
20|FH_F121407_73701_0|SrvcGrp|30623|2022|PDM|9781.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F132090_60915_0|SrvcGrp|40003|2022|PDM|9500.00|99|0.00|TOTAL KNEE|
20|FH_F37487_0_0|SrvcGrp|16618|2022|PDM|80.00|99|0.00|ST SVCS|
20|FH_F38986_0_0|SrvcGrp|3029|2022|PDM|370.00|99|0.00|NEWBORN NURSERY|
20|FH_F109160_63129_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|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_F132528_64014_0|SrvcGrp|102159|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F37491_0_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143199_33403_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F50472_0_0|SrvcGrp|44946|2022|PDM|65.00|99|0.00|PHYSICAL THERAPY|
20|FH_F126889_57030_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127422_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F142967_65065_0|SrvcGrp|104193|2022|PCT|1.00|99|0.00|PHYSICAL THERAPY|
20|FH_F133154_27401_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F149880_33150_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F37042_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|IP SVCS|
20|FH_F139450_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117087_0_0|SrvcGrp|79101|2022|PDM|1368.00|99|0.00|AETNA NASAL ENDOSCOPY|
20|FH_F38407_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MOD RR|
20|FH_F77787_0_0|SrvcGrp|6|2022|PDM|3322.00|99|0.00|OP SURGERY|
20|FH_F101104_0_0|SrvcGrp|95779|2022|PDM|142.50|99|0.00|HOSPICE CARE|
20|FH_F101840_76054_0|SrvcGrp|26664|2022|PDM|13146.00|99|0.00|MS DRG 481 ONLY|
20|FH_F141930_72032_0|CSTM-ALL|CSTM-00|2020|PDM|894.00|99|0.00|AEG 10 (NO REV)|
20|FH_F146229_60031_0|SrvcGrp|74668|2022|PDM|258.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F130715_98503_0|SrvcGrp|87317|2022|PDM|1275.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F63114_0_0|SrvcGrp|48398|2022|PDM|30.00|99|0.00|PT SERVICES|
20|FH_F147726_18017_0|SrvcGrp|114443|2022|PDM|1167.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F129450_17201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129514_79605_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F117154_43017_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F33744_0_0|CSTM-ALL|CSTM-00|2020|PDM|7950.00|99|0.00|MS DRG 243-244|
20|FH_F91818_02828_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F86911_0_0|SrvcGrp|86059|2022|PCT|1.00|99|0.00|INFUSION THERAPY|
20|FH_F39941_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138875_78041_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148553_85016_0|SrvcGrp|115443|2022|PDM|1275.00|99|0.00|REPAIR LEAD PACE DEFIB ONE|
20|FH_F42980_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135761_70127_0|SrvcGrp|89337|2022|PDM|1825.00|99|0.00|DETOXIFICATION|
20|FH_F115708_15317_0|SrvcGrp|473|2022|PDM|349.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F140007_0_0|SrvcGrp|113594|2022|PDM|8045.00|99|0.00|SPINE PROSTH DEVICE|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|288.64|99|0.00|HAPA WPA-NWPA 2012-13 ASC 121 W/O REV|
20|FH_F145531_61614_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F112082_30720_0|SrvcGrp|24744|2022|PDM|140.00|99|0.00|PICC LINE INSERTION|
20|FH_F103780_64804_0|SrvcGrp|48762|2022|PDM|1036.00|99|0.00|MSDRG 949 950|
20|FH_F146266_0_0|SrvcGrp|26278|2022|PDM|2770.00|99|0.00|CPT 29881|
20|FH_F98840_31021_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F34777_0_0|CSTM-ALL|CSTM-00|2020|PDM|1660.00|99|0.00|ACUTE IP MED SVCS|
20|FH_F148882_20814_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F35774_33573_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F114171_0_0|CSTM-ALL|CSTM-00|2020|PDM|1114.00|99|0.00|AEG 9 (NO REV)|
20|FH_F40739_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F100665_07939_0|SrvcGrp|73603|2022|PDM|9831.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F122648_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F133021_00910_0|SrvcGrp|33751|2022|PDM|1800.00|99|0.00|OP SURGERY|
20|FH_F31184_0_0|CSTM-ALL|CSTM-00|2020|PDM|4000.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F126560_43606_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|WV HH  S CODES|
20|FH_F126198_44236_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97861_62223_0|SrvcGrp|73603|2022|PDM|9293.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F121639_06830_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138147_18018_0|SrvcGrp|111303|2022|PDM|27.31|99|0.00|MOBILE THERAPY SERVICES (HCFA)|
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|873.93|99|0.00|AEG 4 (NO REV)|
20|FH_F133943_01606_0|SrvcGrp|93280|2022|PCT|1.00|99|0.00|DARBEPOETIN ALFA NON-ESRD|
20|FH_F134167_10032_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115786_57701_0|SrvcGrp|46605|2022|PDM|94.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F111584_07002_0|SrvcGrp|90643|2022|PDM|139.00|99|0.00|AETNA MEDICATION ASSISTED TREATMENT MAINTENANCE INJECTION|
20|FH_F130747_0_0|SrvcGrp|69981|2022|PDM|4682.00|99|0.00|CPT 24358|
20|FH_F148205_75149_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36681_0_0|CSTM-ALL|CSTM-00|2020|PDM|850.00|99|0.00|ASPG IV|
20|FH_F92034_0_0|SrvcGrp|72994|2022|PDM|675.00|99|0.00|AEG 3|
20|FH_F135897_0_0|SrvcGrp|111044|2022|PDM|1210.00|99|0.00|REMOVAL OF EYE LESION|
20|FH_F117783_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F113410_0_0|CSTM-ALL|CSTM-00|2020|PDM|578.00|99|0.00|AEG 1 (NO REV)|
20|FH_F75826_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F49005_0_0|SrvcGrp|44984|2022|PDM|70.00|99|0.00|DIETICIAN VISIT - IP|
20|FH_F41675_0_0|CSTM-ALL|CSTM-00|2020|PDM|1205.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33381_0_0|SrvcGrp|9795|2022|PDM|862.00|99|0.00|SUBACUTE REHAB|
20|FH_F117715_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F135583_17331_0|SrvcGrp|10391|2022|PDM|6937.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F141035_0_0|CSTM-ALL|CSTM-00|2020|PDM|1019.00|99|0.00|AEG 1 (NO REV)|
20|FH_F138467_32216_0|SrvcGrp|86722|2022|PDM|695.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F37370_0_0|SrvcGrp|22137|2022|PDM|435.00|99|0.00|MRI|
20|FH_F116159_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120707_0_0|SrvcGrp|103391|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F125348_84660_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F148599_98034_0|CSTM-ALL|CSTM-00|2020|PCT|2.30|99|0.00|HSS APC M PROCEDURE NOT ON FS OR W/O WEIGHT|
20|FH_F102561_75146_0|SrvcGrp|85638|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH INCIDENTAL CODES|
20|FH_F71162_0_0|SrvcGrp|44131|2022|PDM|67.00|99|0.00|SPEECH THERAPY VISIT|
20|FH_F102681_34237_0|SrvcGrp|85022|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F125328_0_0|SrvcGrp|85000|2022|PDM|2410.50|99|0.00|CPT 45384|
20|FH_F54592_0_0|SrvcGrp|21920|2022|PDM|70.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F111602_17102_0|SrvcGrp|46903|2022|PDM|520.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F37443_0_0|CSTM-ALL|CSTM-00|2020|PDM|4500.00|99|0.00|NORMAL DELIVERY|
20|FH_F118338_94952_0|SrvcGrp|93919|2022|PDM|1100.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F141587_40242_0|SrvcGrp|90388|2022|PDM|630.00|99|0.00|ELECTROCONVULSIVE THERAPY (HCFA)|
20|FH_F135069_0_0|CSTM-ALL|CSTM-00|2020|PDM|934.00|99|0.00|AEG 8 (NO REV)|
20|FH_F39917_0_0|SrvcGrp|3406|2022|PDM|120.00|99|0.00|CPT 99214|
20|FH_F100660_56303_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F117504_31088_0|SrvcGrp|92501|2022|PDM|140.44|99|0.00|HOSPICE IP RESPITE CARE|
20|FH_F43446_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F87411_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F78267_18702_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151605_78209_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F129483_77030_0|SrvcGrp|86122|2022|PCT|0.68|99|0.00|AETNA GAMMAGARD LIQUID INJ|
20|FH_F86911_0_0|SrvcGrp|86061|2022|PCT|1.00|99|0.00|MED/SURG SUPPLIES|
20|FH_F142319_19403_0|SrvcGrp|46903|2022|PDM|629.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F131047_0_0|CSTM-ALL|CSTM-00|2020|PDM|5831.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F133002_0_0|SrvcGrp|49205|2022|PDM|1716.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F32402_0_0|CSTM-ALL|CSTM-00|2020|PCT|42.00|99|0.00|OP SVCS|
20|FH_F135761_70127_0|SrvcGrp|109798|2022|PCT|1.00|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F116199_75042_0|SrvcGrp|94879|2022|PDM|138.00|99|0.00|AETNA BRIDGE APPOINTMENT|
20|FH_F135431_33414_0|SrvcGrp|82846|2022|PCT|1.00|99|0.00|AETNA DME|
20|FH_F136247_28804_0|SrvcGrp|90854|2022|PCT|0.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F33725_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F112166_72143_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F98300_30236_0|SrvcGrp|73601|2022|PDM|3142.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F138424_83402_0|SrvcGrp|74614|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F117629_06514_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125214_12428_0|SrvcGrp|104976|2022|PCT|0.00|99|0.00|IP IMAGING ENHANCING SUBSTANCE|
20|FH_F139177_0_0|CSTM-ALL|CSTM-00|2020|PDM|512.00|99|0.00|AEG 1 (NO REV)|
20|FH_F47659_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|OP SVCS|
20|FH_F111288_0_0|SrvcGrp|72121|2022|PDM|5724.00|99|0.00|ARTHOSCOPY|
20|FH_F125138_63663_0|SrvcGrp|88621|2022|PDM|60.00|99|0.00|SKILLED NURSING LPN|
20|FH_F109240_21201_0|SrvcGrp|102986|2022|PDM|1126.00|99|0.00|DESIGN MLC DEVICE FOR IMRT|
20|FH_F41887_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143528_0_0|SrvcGrp|90157|2022|PDM|1914.15|99|0.00|AETNA REMOVAL OF TONSILS|
20|FH_F110161_31329_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS W/TOB 23X|
20|FH_F67101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F53732_0_0|SrvcGrp|16750|2022|PDM|120.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F140573_46517_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|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_F97761_04072_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F111925_0_0|CSTM-ALL|CSTM-00|2020|PDM|1208.00|99|0.00|AEG 9 (NO REV)|
20|FH_F40800_0_0|SrvcGrp|97|2022|PDM|2600.00|99|0.00|C-SECTION|
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_F113226_30025_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F138807_32207_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F84139_0_0|SrvcGrp|66645|2022|PDM|200.00|99|0.00|INTENSIVE OUTPATIENT SERVICES|
20|FH_F151379_21045_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132205_45342_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F123194_97222_0|SrvcGrp|89337|2022|PDM|950.00|99|0.00|DETOXIFICATION|
20|FH_F40412_0_0|CSTM-ALL|CSTM-00|2020|PCT|73.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132073_0_0|SrvcGrp|82222|2022|PDM|143.00|99|0.00|HOSPICE CARE|
20|FH_F129240_10028_0|SrvcGrp|43568|2022|PDM|70.00|99|0.00|SKILLED NURSING - RN|
20|FH_F138347_77701_0|SrvcGrp|75419|2022|PDM|403.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F150746_31210_0|SrvcGrp|115845|2022|PCT|1.10|99|0.00|PALLIATIVE SERVICES|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|48650.00|99|0.00|MSDRG 219-221 CARDIAC VLV PX+OTR MJR CARDIOTHORACIC PX W/CC|
20|FH_F146859_0_0|SrvcGrp|16242|2022|PDM|3711.00|99|0.00|ROTATOR CUFF|
20|FH_F90172_81301_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL (HCFA)|
20|FH_F129765_43015_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|IP/OP MBPR SERVICES|
20|FH_F149515_66002_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F37312_0_0|SrvcGrp|25941|2022|PDM|99.00|99|0.00|PHYSICAL THERAPY|
20|FH_F50398_0_0|SrvcGrp|33166|2022|PDM|515.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F127079_33026_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F117711_73080_0|SrvcGrp|72984|2022|PCT|1.25|99|0.00|CHEMOTHERAPY|
20|FH_F125656_92868_0|SrvcGrp|10577|2022|PDM|35.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F117023_0_0|SrvcGrp|36591|2022|PDM|3575.00|99|0.00|CPT 63685|
20|FH_F120099_86305_0|SrvcGrp|87131|2022|PDM|834.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F116642_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F131068_43055_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F90817_0_0|SrvcGrp|75182|2022|PCT|1.00|99|0.00|AETNA IMPLANTS|
20|FH_F90817_0_0|SrvcGrp|90367|2022|PDM|1692.00|99|0.00|NASAL/SINUS ENDOSCOPY|
20|FH_F126189_89129_0|SrvcGrp|46903|2022|PDM|675.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|683.00|99|0.00|ASPG I|
20|FH_F116005_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|AEG 8 (NO REV)|
20|FH_F59312_0_0|SrvcGrp|474|2022|PDM|248.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F92299_62016_0|CSTM-ALL|CSTM-00|2020|PDM|1450.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134819_0_0|CSTM-ALL|CSTM-00|2020|PDM|774.00|99|0.00|AEG 2 (NO REV)|
20|FH_F94643_90501_0|SrvcGrp|24754|2022|PDM|25.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F148939_62650_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|PDM|1500.00|99|0.00|AEG 10 (NO REV)|
20|FH_F134797_0_0|SrvcGrp|72996|2022|PDM|1205.00|99|0.00|AEG 4|
20|FH_F97881_38703_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F134738_0_0|CSTM-ALL|CSTM-00|2020|PDM|2750.00|99|0.00|AEG 6 (NO REV)|
20|FH_F127199_0_0|SrvcGrp|89781|2022|PDM|114.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F38123_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F147080_02446_0|CSTM-ALL|CSTM-00|2020|PDM|473.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F130182_0_0|CSTM-ALL|CSTM-00|2020|PDM|1198.00|99|0.00|AEG 6 (NO REV)|
20|FH_F148496_17112_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F35987_0_0|SrvcGrp|108|2022|PCT|0.75|99|0.00|EXTRA CORPOREAL MEMBRANE OXYGEN|
20|FH_F35056_0_0|SrvcGrp|14657|2022|PDM|663.00|99|0.00|MENTAL HEALTH / DETOX|
20|FH_F134847_0_0|SrvcGrp|78285|2022|PDM|3258.00|99|0.00|CPT 58671|
20|FH_F123570_0_0|SrvcGrp|104041|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F115269_0_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F124441_0_0|SrvcGrp|100001|2022|PDM|14250.00|99|0.00|WRIST REPLACEMNT TOT WRIST|
20|FH_F146266_0_0|SrvcGrp|114327|2022|PDM|4433.00|99|0.00|PARTIAL REMOVAL OF ULNA|
20|FH_F137363_0_0|SrvcGrp|16732|2022|PDM|1854.00|99|0.00|HYSTEROSCOPY ABLATION|
20|FH_F76826_0_0|SrvcGrp|61967|2022|PCT|0.38|99|0.00|IMPLANTS W/OP SURG OR CARD CATH|
20|FH_F93268_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F127292_85705_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F143210_72211_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F143488_84770_0|CSTM-ALL|CSTM-00|2020|PDM|1598.00|99|0.00|AEG 7 (NO REV)|
20|FH_F84061_0_0|SrvcGrp|472|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F93287_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|PDM|900.00|99|0.00|AEG 6 (NO REV) INTERVENTIONAL PAIN CTR|
20|FH_F131090_44622_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131093_49690_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F131173_17043_0|SrvcGrp|95661|2022|PDM|130.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F132479_90290_0|SrvcGrp|74668|2022|PDM|750.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F116571_70433_0|CSTM-ALL|CSTM-00|2020|PCT|0.78|99|0.00|GENERAL ACUTE CARE|
20|FH_F116698_07470_0|SrvcGrp|86843|2022|PDM|52.50|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F83292_0_0|SrvcGrp|14187|2022|PDM|2026.00|99|0.00|MRI|
20|FH_F125287_92374_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F46352_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OP SVCS|
20|FH_F38725_0_0|CSTM-ALL|CSTM-00|2020|PDM|415.00|99|0.00|ASPG I|
20|FH_F38079_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F132127_61053_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117550_0_0|SrvcGrp|88858|2022|PDM|102.00|99|0.00|EVALUATION OF SPEECH FLUENCY|
20|FH_F95980_20016_0|SrvcGrp|86747|2022|PCT|1.05|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F45977_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HOME INF- REV 643|
20|FH_F109606_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|1950.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F49617_0_0|SrvcGrp|9494|2022|PDM|550.00|99|0.00|SUBACUTE CARE|
20|FH_F148880_26807_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150165_06032_0|SrvcGrp|26275|2022|PDM|2249.00|99|0.00|CPT 29826|
20|FH_F112650_85016_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F138418_51201_0|SrvcGrp|104363|2022|PCT|0.90|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F114683_0_0|SrvcGrp|105731|2022|PDM|5000.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F100782_0_0|SrvcGrp|105155|2022|PDM|258.76|99|0.00|WINDBER MEDICAL CNTR ASC 315|
20|FH_F60112_0_0|SrvcGrp|472|2022|PDM|377.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134620_73112_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F69708_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|OCN F/S PRICING: ALL|
20|FH_F134488_14086_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F75842_0_0|SrvcGrp|46532|2022|PDM|641.79|99|0.00|EMERGENCY ROOM LEVEL 3|
20|FH_F126783_80021_0|SrvcGrp|46903|2022|PDM|1595.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F133558_87111_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141470_71913_0|SrvcGrp|73483|2022|PDM|1350.00|99|0.00|AETNA SUBACUTE III|
20|FH_F129653_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F41279_0_0|CSTM-ALL|CSTM-00|2020|PDM|372.00|99|0.00|ADOLESCENT PSYCH|
20|FH_F127946_32514_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.68|99|0.00|OP SVCS|
20|FH_F121467_75165_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F139515_0_0|CSTM-ALL|CSTM-00|2020|PDM|1854.00|99|0.00|AEG 9 (NO REV)|
20|FH_F35259_0_0|SrvcGrp|30618|2022|PCT|0.66|99|0.00|LEADS|
20|FH_F93593_33414_0|SrvcGrp|86648|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F87092_60101_0|SrvcGrp|72994|2022|PDM|2520.00|99|0.00|AEG 3|
20|FH_F89495_0_0|SrvcGrp|73004|2022|PDM|1006.00|99|0.00|AEG 8|
20|FH_F145946_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136474_95742_0|SrvcGrp|46903|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F62978_0_0|CSTM-ALL|CSTM-00|2020|PDM|991.00|99|0.00|ASPG VI|
20|FH_F36554_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.10|99|0.00|OCN F/S PRICING: ALL|
20|FH_F117023_0_0|SrvcGrp|72996|2022|PDM|1038.00|99|0.00|AEG 4|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1087.00|99|0.00|HAPA EPA ASC 7|
20|FH_F122282_30080_0|SrvcGrp|109037|2022|PDM|958.00|99|0.00|IP PSYCH EATING DISORDERS|
20|FH_F149030_37919_0|CSTM-ALL|CSTM-00|2020|PDM|2420.50|99|0.00|AEG 5  (NO REV)|
20|FH_F35771_32578_0|CSTM-ALL|CSTM-00|2020|PCT|0.51|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_F122649_0_0|SrvcGrp|30609|2022|PDM|29.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F131371_0_0|CSTM-ALL|CSTM-00|2020|PDM|699.00|99|0.00|AEG 1 (NO REV)|
20|FH_F142587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146859_0_0|SrvcGrp|109670|2022|PDM|4328.00|99|0.00|CERV ARTIFIC DISKECTOMY|
20|FH_F36590_0_0|SrvcGrp|131|2022|PCT|0.70|99|0.00|PACEMAKER DEVICE|
20|FH_F150938_02062_0|SrvcGrp|115840|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUG|
20|FH_F40346_0_0|CSTM-ALL|CSTM-00|2020|PDM|1100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73505_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F127189_49503_0|SrvcGrp|29155|2022|PDM|130.00|99|0.00|HOSPICE SVCS|
20|FH_F129682_07034_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F139715_0_0|SrvcGrp|114709|2022|PDM|35654.00|99|0.00|JOINT RECONSTRUCTION/REPLACEMENT|
20|FH_F128583_45154_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F132818_24701_0|SrvcGrp|89149|2022|PDM|161.00|99|0.00|OP INTENSIVE|
20|FH_F97603_77901_0|SrvcGrp|88978|2022|PDM|4567.00|99|0.00|VAGINAL DELIVERY|
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_F124514_21215_0|SrvcGrp|76501|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F37493_0_0|CSTM-ALL|CSTM-00|2020|PDM|1003.00|99|0.00|ACUTE PSYCH|
20|FH_F139048_0_0|CSTM-ALL|CSTM-00|2020|PDM|1233.00|99|0.00|AEG 6 (NO REV)|
20|FH_F131389_33169_0|SrvcGrp|90854|2022|PDM|739.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F132595_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F146266_0_0|SrvcGrp|110757|2022|PDM|7231.00|99|0.00|CERVICAL VERTEBRAL CORPECTOMY|
20|FH_F140094_16125_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F140233_35216_0|SrvcGrp|90383|2022|PDM|8000.00|99|0.00|RECONSTRUCT SHOULDER JOINT|
20|FH_F140268_17960_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F143451_50635_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F84631_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|I/P MS DRG TRANSFER RATE|
20|FH_F101752_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F131173_17043_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F47692_0_0|CSTM-ALL|CSTM-00|2020|PDM|79.00|99|0.00|GA RETINA SURG CTR ASC 1|
20|FH_F48937_0_0|SrvcGrp|27968|2022|PDM|40.00|99|0.00|SKILLED NURSING LPN|
20|FH_F132416_92270_0|SrvcGrp|105350|2022|PDM|520.00|99|0.00|AETNA PARTIAL HOSPITALIZATION|
20|FH_F112670_47150_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116633_37217_0|SrvcGrp|106962|2022|PDM|44.82|99|0.00|EDUCATION AND TRAINING|
20|FH_F120974_27607_0|SrvcGrp|76884|2022|PCT|0.50|99|0.00|HOSPITAL BASED CLINIC FACILITY FEES|
20|FH_F36274_0_0|SrvcGrp|14306|2022|PDM|50.00|99|0.00|WELL MOM/WELL BABY VISIT|
20|FH_F141612_19605_0|CSTM-ALL|CSTM-00|2020|PDM|1406.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F113146_15001_0|SrvcGrp|73842|2022|PDM|162.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F97560_23249_0|SrvcGrp|73485|2022|PDM|3395.00|99|0.00|AETNA REHAB|
20|FH_F117132_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|DEVICE INSERTION|
20|FH_F102721_38118_0|SrvcGrp|16429|2022|PCT|0.40|99|0.00|OBSERVATION SVCS|
20|FH_F97542_32960_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F132338_18901_0|SrvcGrp|108484|2022|PDM|570.76|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F45436_0_0|SrvcGrp|17766|2022|PDM|120.00|99|0.00|HOME HEALTH - PT/OT/ST|
20|FH_F115823_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|AEG 6 (NO REV)|
20|FH_F119227_01752_0|SrvcGrp|86852|2022|PDM|38.00|99|0.00|HCPCS S9336 (HCFA)|
20|FH_F149199_73005_0|SrvcGrp|114925|2022|PDM|2200.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F89645_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F85764_33308_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133920_64057_0|SrvcGrp|48385|2022|PDM|123.00|99|0.00|SPEECH THERAPY|
20|FH_F138951_41101_0|SrvcGrp|86838|2022|PDM|15.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F72963_0_0|SrvcGrp|3418|2022|PDM|3000.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F93881_15009_0|SrvcGrp|75489|2022|PDM|2633.00|99|0.00|AEG 6|
20|FH_F34710_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F45632_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|OCN F/S PRICING: MODIFIER UEKE|
20|FH_F100962_0_0|SrvcGrp|72994|2022|PDM|884.00|99|0.00|AEG 3|
20|FH_F82714_18848_0|CSTM-ALL|CSTM-00|2020|PDM|1496.00|99|0.00|AETNA AMBULATORY SURGERY (NO REV) W/O AEG 1-8|
20|FH_F128992_90808_0|SrvcGrp|89149|2022|PDM|363.00|99|0.00|OP INTENSIVE|
20|FH_F70165_0_0|CSTM-ALL|CSTM-00|2020|PCT|56.00|99|0.00|OP SVCS|
20|FH_F91973_0_0|SrvcGrp|74585|2022|PCT|0.85|99|0.00|AETNA OP IMPLANTS|
20|FH_F37679_0_0|SrvcGrp|17009|2022|PDM|61.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F72143_0_0|SrvcGrp|15150|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F123784_03264_0|SrvcGrp|27968|2022|PDM|53.04|99|0.00|SKILLED NURSING LPN|
20|FH_F142530_60148_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F129483_77030_0|SrvcGrp|86853|2022|PDM|40.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F36045_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110160_0_0|SrvcGrp|72994|2022|PDM|812.00|99|0.00|AEG 3|
20|FH_F86911_0_0|SrvcGrp|44709|2022|PDM|90.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F130439_85014_0|SrvcGrp|89149|2022|PDM|212.00|99|0.00|OP INTENSIVE|
20|FH_F136667_23603_0|SrvcGrp|108484|2022|PDM|652.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F139771_54534_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F81832_13827_0|SrvcGrp|46104|2022|PDM|105.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F122608_84123_0|SrvcGrp|76528|2022|PDM|112.00|99|0.00|HOSPICE LTCH|
20|FH_F134691_33445_0|SrvcGrp|73605|2022|PDM|1240.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F43503_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|MSDRG 246-251 ANGIOPLASTY|
20|FH_F141035_0_0|SrvcGrp|113717|2022|PDM|4029.00|99|0.00|RELEASE FINGER CONTRACTURE|
20|FH_F148667_0_0|SrvcGrp|86233|2022|PDM|11000.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F141270_89103_0|SrvcGrp|48394|2022|PDM|35.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F114676_91911_0|SrvcGrp|86747|2022|PCT|1.20|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F76222_0_0|SrvcGrp|3499|2022|PCT|0.77|99|0.00|IMPLANTS|
20|FH_F149585_46012_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124281_44286_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
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_F110724_33064_0|SrvcGrp|75754|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148554_85016_0|SrvcGrp|115476|2022|PDM|3164.00|99|0.00|PERC D-E COR REVASC T CABG S|
20|FH_F133470_97068_0|SrvcGrp|112073|2022|PDM|1375.00|99|0.00|RESIDENITAL TREATMENT EATING DISORDER (AGE 18-99)|
20|FH_F72859_0_0|SrvcGrp|15497|2022|PDM|39.15|99|0.00|TOTAL PARENTERAL NUTRITION|
20|FH_F38700_0_0|SrvcGrp|361|2022|PDM|2311.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F42452_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|GENERAL ACUTE CARE|
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_F144109_63376_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F150948_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.43|99|0.00|HSS ASC|
20|FH_F146320_27610_0|SrvcGrp|107879|2022|PDM|3142.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F63129_0_0|SrvcGrp|46605|2022|PDM|25.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F135656_74820_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F87775_15106_0|SrvcGrp|29076|2022|PDM|60.00|99|0.00|TOCOLYTIC INFUSION THERAPY|
20|FH_F100782_0_0|SrvcGrp|97657|2022|PDM|1344.57|99|0.00|WINDBER MEDICAL CNTR ASC 402|
20|FH_F117206_0_0|SrvcGrp|705|2022|PCT|1.00|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F145791_67205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124173_66215_0|SrvcGrp|19742|2022|PDM|83.00|99|0.00|MID-LINE INSERTION|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|37.89|99|0.00|HAPA WPA-NWPA 2012-13 ASC 247 W/O REV|
20|FH_F85314_0_0|CSTM-ALL|CSTM-00|2020|PDM|640.00|99|0.00|AEG 2 (NO REV)|
20|FH_F98780_35022_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F105361_80104_0|SrvcGrp|16|2022|PDM|2831.00|99|0.00|ACUTE REHABILITATION|
20|FH_F116040_24637_0|SrvcGrp|86838|2022|PDM|10.00|99|0.00|HCPCS S9537 (HCFA)|
20|FH_F50137_0_0|SrvcGrp|46245|2022|PDM|115.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F143989_19090_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F129969_33908_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F110166_32757_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131190_21042_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F50673_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.95|99|0.00|GENERAL ACUTE CARE|
20|FH_F123385_03561_0|SrvcGrp|27968|2022|PDM|54.90|99|0.00|SKILLED NURSING LPN|
20|FH_F69322_0_0|CSTM-ALL|CSTM-00|2020|PDM|680.00|99|0.00|DUAL DIAGNOSIS|
20|FH_F134150_01801_0|CSTM-ALL|CSTM-00|2020|PDM|377.00|99|0.00|PARTIAL HOSPITALIZATION (<=17 YRS)|
20|FH_F142742_44112_0|SrvcGrp|75419|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F148739_47129_0|SrvcGrp|74668|2022|PDM|900.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F66687_0_0|CSTM-ALL|CSTM-00|2020|PDM|11452.00|99|0.00|CARDIAC CATH|
20|FH_F52854_0_0|SrvcGrp|17075|2022|PDM|2178.00|99|0.00|ASPG VI|
20|FH_F135219_68506_0|SrvcGrp|72984|2022|PCT|0.00|99|0.00|CHEMOTHERAPY|
20|FH_F148400_33401_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F100660_56303_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F130138_02915_0|SrvcGrp|111511|2022|PCT|0.96|99|0.00|RESIDENTIAL TREATMENT - PSYCH|
20|FH_F137460_42103_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F116092_83254_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F110086_21742_0|CSTM-ALL|CSTM-00|2020|PDM|1428.00|99|0.00|AEG 8 (NO REV)|
20|FH_F123809_26155_0|SrvcGrp|90356|2022|PCT|0.72|99|0.00|OP DIALYSIS|
20|FH_F136347_30328_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F136383_98118_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F91472_96001_0|SrvcGrp|103716|2022|PCT|0.40|99|0.00|ANTERIOR LUMBAR INTERBODY FUSION|
20|FH_F108800_0_0|SrvcGrp|36591|2022|PDM|8000.00|99|0.00|CPT 63685|
20|FH_F116323_0_0|SrvcGrp|41334|2022|PDM|30112.00|99|0.00|TOTAL KNEE|
20|FH_F32914_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|OP SVCS|
20|FH_F38450_0_0|SrvcGrp|29093|2022|PDM|85.00|99|0.00|PT / OT / ST|
20|FH_F136510_0_0|SrvcGrp|46887|2022|PDM|3882.00|99|0.00|REPAIR DETACHED RETINA|
20|FH_F90940_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F123385_03561_0|SrvcGrp|88620|2022|PDM|157.00|99|0.00|SKILLED NURSING RN|
20|FH_F93136_0_0|SrvcGrp|73006|2022|PDM|1339.00|99|0.00|AEG 9|
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_F129504_02871_0|SrvcGrp|14893|2022|PDM|54.00|99|0.00|HOME INFUSION NURSING SERVICES|
20|FH_F76172_0_0|SrvcGrp|33166|2022|PDM|515.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F97660_29401_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F88933_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F93252_0_0|SrvcGrp|93023|2022|PDM|1300.00|99|0.00|MENISCAL REPAIR|
20|FH_F132348_16214_0|SrvcGrp|88621|2022|PDM|121.00|99|0.00|SKILLED NURSING LPN|
20|FH_F124671_64844_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F124676_45503_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43135_0_0|CSTM-ALL|CSTM-00|2020|PDM|710.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F43295_0_0|SrvcGrp|24|2022|PCT|0.75|99|0.00|CARDIAC CATH|
20|FH_F134727_30650_0|SrvcGrp|12840|2022|PCT|0.60|99|0.00|PACEMAKER|
20|FH_F112505_51503_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F116233_33612_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F101581_16371_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F112135_80910_0|SrvcGrp|33659|2022|PDM|551.00|99|0.00|DIALYSIS SERVICES|
20|FH_F101557_81004_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F37493_0_0|SrvcGrp|26328|2022|PCT|1.10|99|0.00|PROSTHETICS|
20|FH_F148667_0_0|SrvcGrp|85792|2022|PDM|2856.00|99|0.00|OPEN TREATMENT OF DISTAL|
20|FH_F114206_37203_0|SrvcGrp|19742|2022|PDM|60.00|99|0.00|MID-LINE INSERTION|
20|FH_F150925_33936_0|SrvcGrp|8950|2022|PDM|2075.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F73485_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92972_0_0|SrvcGrp|78504|2022|PCT|0.63|99|0.00|AETNA CARDIAC CATHETERIZATION|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|INTERFERON|
20|FH_F77025_0_0|CSTM-ALL|CSTM-00|2020|PDM|2487.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F41739_0_0|SrvcGrp|9595|2022|PDM|19260.00|99|0.00|DRG 808|
20|FH_F118388_34952_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40350_0_0|SrvcGrp|14187|2022|PDM|750.00|99|0.00|MRI|
20|FH_F125266_44515_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F97061_85012_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F41438_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F113264_71860_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F108700_63857_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141870_85224_0|SrvcGrp|86847|2022|PDM|40.00|99|0.00|HCPCS S9348 (HCFA)|
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_F62802_0_0|CSTM-ALL|CSTM-00|2020|PDM|720.00|99|0.00|ASPG II|
20|FH_F121385_89102_0|SrvcGrp|103913|2022|PCT|2.07|99|0.00|OP DIALYSIS|
20|FH_F149199_73005_0|SrvcGrp|104363|2022|PCT|0.55|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F142376_0_0|SrvcGrp|106218|2022|PDM|2805.00|99|0.00|SP BONE ALGRFT|
20|FH_F142376_0_0|SrvcGrp|98586|2022|PDM|15987.00|99|0.00|REPLACEMENT OF VAGUS NERVE|
20|FH_F119072_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129638_0_0|SrvcGrp|104363|2022|PCT|0.00|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F103320_0_0|SrvcGrp|72994|2022|PDM|750.00|99|0.00|AEG 3|
20|FH_F110311_17078_0|SrvcGrp|93269|2022|PCT|1.00|99|0.00|LINEZOLID INJECTION|
20|FH_F146292_0_0|CSTM-ALL|CSTM-00|2020|PDM|2617.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116657_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F101100_50314_0|CSTM-ALL|CSTM-00|2020|PDM|541.00|99|0.00|AETNA - APC GROUPER P|
20|FH_F77665_0_0|SrvcGrp|10542|2022|PDM|60.00|99|0.00|OCCUPATIONAL THERAPY SVCS|
20|FH_F146668_30189_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 3 (NO REV)|
20|FH_F131665_50129_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F117113_0_0|SrvcGrp|43985|2022|PCT|0.00|99|0.00|BLOOD AND BLOOD PRODUCTS|
20|FH_F126678_44870_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129666_71901_0|SrvcGrp|104579|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F48215_0_0|SrvcGrp|9830|2022|PDM|85.50|99|0.00|OT SVCS|
20|FH_F102500_0_0|SrvcGrp|73006|2022|PDM|2087.00|99|0.00|AEG 9|
20|FH_F115740_78957_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F37679_0_0|SrvcGrp|24758|2022|PDM|15.00|99|0.00|HOME INJECTABLE THERAPY|
20|FH_F109601_0_0|SrvcGrp|75481|2022|PDM|550.00|99|0.00|AEG 2|
20|FH_F40332_0_0|SrvcGrp|3029|2022|PDM|220.00|99|0.00|NEWBORN NURSERY|
20|FH_F139580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F46094_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW|
20|FH_F73662_0_0|SrvcGrp|15472|2022|PDM|549.00|99|0.00|CPT CODE 62284|
20|FH_F130013_16509_0|SrvcGrp|473|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F125899_07645_0|SrvcGrp|110239|2022|PDM|985.00|99|0.00|3D RENDERING W/ INTERPRETA|
20|FH_F88398_15601_0|SrvcGrp|73700|2022|PDM|52.55|99|0.00|AETNA - SKILLED NURSING|
20|FH_F56276_0_0|SrvcGrp|52943|2022|PDM|137.00|99|0.00|PSYCHIATRIC INITIAL EVALUATION CPT 90801|
20|FH_F135771_0_0|SrvcGrp|90707|2022|PDM|169.46|99|0.00|AETNA HOSPICE CARE|
20|FH_F130747_0_0|CSTM-ALL|CSTM-00|2020|PDM|936.00|99|0.00|AEG 1 (NO REV)|
20|FH_F37440_0_0|SrvcGrp|115|2022|PDM|315.00|99|0.00|SKILLED NURSING CARE|
20|FH_F122687_0_0|CSTM-ALL|CSTM-00|2020|PDM|1576.00|99|0.00|AEG 6 (NO REV)|
20|FH_F86712_60173_0|SrvcGrp|74546|2022|PDM|525.00|99|0.00|HOSPICE SERVICES|
20|FH_F134011_84102_0|SrvcGrp|111660|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F134126_11554_0|SrvcGrp|104363|2022|PCT|1.27|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F77782_66061_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F131047_0_0|SrvcGrp|83557|2022|PCT|0.57|99|0.00|OP CARADIAC CATH|
20|FH_F82432_0_0|SrvcGrp|30609|2022|PDM|24.15|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F124116_79410_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F116097_0_0|SrvcGrp|80285|2022|PDM|148.79|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F69623_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.45|99|0.00|OP SVCS|
20|FH_F35685_0_0|SrvcGrp|11207|2022|PDM|12679.00|99|0.00|DRG 545 REVISION OF HIP OR KNEE REPLACEMENT|
20|FH_F117509_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F91764_93710_0|SrvcGrp|113232|2022|PCT|2.12|99|0.00|COVID-19 SARS-COV-2 ANTB QUANTITATIVE|
20|FH_F111292_33136_0|SrvcGrp|82745|2022|PDM|106.00|99|0.00|CULT BACT NO URINE/BLD/STOOL|
20|FH_F134322_98001_0|SrvcGrp|108180|2022|PDM|1100.00|99|0.00|DIALYSIS ACUTE KIDNEY INJRY NO ESRD|
20|FH_F136806_0_0|SrvcGrp|106710|2022|PDM|3546.00|99|0.00|PAIN STIM SURGERY|
20|FH_F133632_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|PDM|604.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F124316_28112_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F90935_29073_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F35123_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F69071_0_0|SrvcGrp|2067|2022|PDM|995.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F141611_43113_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F63618_0_0|SrvcGrp|361|2022|PDM|3000.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F46854_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F102062_35447_0|SrvcGrp|88621|2022|PDM|125.00|99|0.00|SKILLED NURSING LPN|
20|FH_F151047_20860_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119227_01752_0|SrvcGrp|94093|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O SKILLED NURSING|
20|FH_F112060_07514_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F141210_0_0|SrvcGrp|109016|2022|PDM|5150.00|99|0.00|REMOVAL OF ADENOIDS|
20|FH_F146124_06112_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS|
20|FH_F110268_02891_0|SrvcGrp|102279|2022|PDM|20.00|99|0.00|AETNA METHADONE MAINTENANCE (HCFA)|
20|FH_F144291_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139780_75605_0|SrvcGrp|29346|2022|PDM|40.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F140830_70056_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149514_99701_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F119023_91406_0|SrvcGrp|16750|2022|PDM|100.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PDM|1199.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F117525_0_0|SrvcGrp|73002|2022|PDM|2000.00|99|0.00|AEG 7|
20|FH_F91873_12723_0|SrvcGrp|30623|2022|PDM|9240.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F109484_0_0|SrvcGrp|73000|2022|PDM|826.00|99|0.00|AEG 6|
20|FH_F89037_0_0|SrvcGrp|73008|2022|PDM|749.80|99|0.00|AEG 10|
20|FH_F133025_0_0|CSTM-ALL|CSTM-00|2020|PDM|1731.00|99|0.00|AEG 9 (NO REV)|
20|FH_F87816_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F124235_92840_0|SrvcGrp|108061|2022|PDM|300.00|99|0.00|OP THERAPY SERVICES|
20|FH_F135762_70001_0|SrvcGrp|74668|2022|PDM|900.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F132133_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138219_0_0|SrvcGrp|113091|2022|PDM|164.00|99|0.00|ACUTE KIDNEY INJURY|
20|FH_F91975_0_0|CSTM-ALL|CSTM-00|2020|PDM|635.00|99|0.00|AEG 4 (NO REV)|
20|FH_F36479_0_0|SrvcGrp|13472|2022|PDM|1748.00|99|0.00|ICU/CCU|
20|FH_F38268_0_0|SrvcGrp|23343|2022|PCT|0.50|99|0.00|DME|
20|FH_F134315_89106_0|SrvcGrp|19742|2022|PCT|1.00|99|0.00|MID-LINE INSERTION|
20|FH_F98300_30236_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F150982_0_0|SrvcGrp|114443|2022|PDM|2808.00|99|0.00|EXTRACAPSULAR CATARACT REMOVAL, INSERT LENS|
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 4 (NO REV)|
20|FH_F34777_0_0|SrvcGrp|17366|2022|PCT|0.85|99|0.00|TRANSPLANT SVCS|
20|FH_F108260_63141_0|SrvcGrp|88621|2022|PDM|88.00|99|0.00|SKILLED NURSING LPN|
20|FH_F146211_68144_0|SrvcGrp|112676|2022|PCT|1.00|99|0.00|COVID-19 SARS-COV-2 ANTIBODY|
20|FH_F101754_63141_0|SrvcGrp|97987|2022|PDM|200.00|99|0.00|LITH ION BATT CID EAR LEVEL|
20|FH_F120032_0_0|CSTM-ALL|CSTM-00|2020|PDM|570.00|99|0.00|AEG 2 (NO REV)|
20|FH_F119220_75068_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ANCD HOME HEALTH|
20|FH_F91255_19401_0|SrvcGrp|88277|2022|PCT|0.40|99|0.00|PT/OT/ST|
20|FH_F144008_11413_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F44607_0_0|SrvcGrp|30612|2022|PCT|1.00|99|0.00|LAB AND RAD|
20|FH_F43917_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53|
20|FH_F134650_07921_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F130123_24171_0|SrvcGrp|88621|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F49913_0_0|SrvcGrp|43785|2022|PDM|90.00|99|0.00|OCCUPATIONAL THERAPY SERVICES|
20|FH_F133207_0_0|SrvcGrp|76604|2022|PDM|3136.00|99|0.00|CPT 25447|
20|FH_F86112_63501_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132969_84003_0|SrvcGrp|24745|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY, PAIN MGMT|
20|FH_F86836_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F146848_73072_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38431_0_0|SrvcGrp|23017|2022|PDM|450.00|99|0.00|V5243|
20|FH_F90958_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F143297_0_0|SrvcGrp|46890|2022|PDM|2245.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F90197_0_0|CSTM-ALL|CSTM-00|2020|PCT|66.00|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_F111522_81067_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111802_22003_0|SrvcGrp|76501|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F115405_06010_0|SrvcGrp|104080|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F118309_0_0|CSTM-ALL|CSTM-00|2020|PDM|492.80|99|0.00|AEG 2 (NO REV)|
20|FH_F137930_51546_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F128027_0_0|CSTM-ALL|CSTM-00|2020|PCT|2.25|99|0.00|HSS ASC|
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|1500.00|99|0.00|AEG 8 (NO REV)|
20|FH_F62767_0_0|SrvcGrp|85099|2022|PCT|1.00|99|0.00|PHYSICIANS SERVICES|
20|FH_F40603_0_0|SrvcGrp|12043|2022|PDM|220.00|99|0.00|CPT 99205|
20|FH_F124671_64844_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F97083_90670_0|SrvcGrp|88978|2022|PDM|9912.00|99|0.00|VAGINAL DELIVERY|
20|FH_F114985_32073_0|SrvcGrp|52951|2022|PDM|97.00|99|0.00|PSYCHIATRIC CPT 90846|
20|FH_F134815_35016_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|1942.00|99|0.00|AEG 9 (NO REV)|
20|FH_F37850_0_0|SrvcGrp|6|2022|PDM|3245.00|99|0.00|OP SURGERY|
20|FH_F138777_43140_0|SrvcGrp|89149|2022|PDM|201.00|99|0.00|OP INTENSIVE|
20|FH_F116397_33404_0|SrvcGrp|86853|2022|PDM|43.00|99|0.00|HCPCS S9370 (HCFA)|
20|FH_F132155_66209_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F90817_0_0|SrvcGrp|90369|2022|PDM|855.00|99|0.00|PROBE NASOLACRIMAL DUCT|
20|FH_F129297_97828_0|SrvcGrp|73806|2022|PDM|3950.00|99|0.00|AETNA ER|
20|FH_F134847_0_0|SrvcGrp|67993|2022|PDM|1968.00|99|0.00|CPT58555 58558-58559 58562|
20|FH_F62982_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119206_35007_0|SrvcGrp|76501|2022|PDM|350.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F103400_33426_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F146211_68144_0|SrvcGrp|104363|2022|PCT|1.20|99|0.00|HOSPITAL OP DIALYSIS|
20|FH_F31093_0_0|SrvcGrp|10412|2022|PDM|1100.00|99|0.00|SLEEP STUDIES|
20|FH_F150534_08879_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_F117508_90232_0|SrvcGrp|104079|2022|PCT|1.10|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F132571_24739_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148556_13206_0|SrvcGrp|14944|2022|PDM|7.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F151141_24014_0|CSTM-ALL|CSTM-00|2020|PDM|2450.00|99|0.00|AEG 9 (NO REV)|
20|FH_F63235_0_0|SrvcGrp|72992|2022|PDM|1246.00|99|0.00|AEG 2|
20|FH_F38411_0_0|SrvcGrp|12116|2022|PCT|0.80|99|0.00|DRUGS|
20|FH_F113470_74010_0|SrvcGrp|99600|2022|PCT|1.05|99|0.00|PT/OT/ST|
20|FH_F149364_19335_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F96160_32207_0|SrvcGrp|14949|2022|PCT|0.00|99|0.00|HOME INFUSION|
20|FH_F123623_03246_0|SrvcGrp|109273|2022|PCT|1.00|99|0.00|IIV3 VACC NO PRSV 0.5 ML IM|
20|FH_F96160_32207_0|SrvcGrp|21920|2022|PDM|81.03|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F41348_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|ADOLESCENT PSYCHIATRIC|
20|FH_F119004_06850_0|CSTM-ALL|CSTM-00|2020|PDM|798.00|99|0.00|AEG 9 (NO REV)|
20|FH_F137813_39232_0|SrvcGrp|92760|2022|PCT|0.80|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F109652_0_0|SrvcGrp|16390|2022|PDM|6201.00|99|0.00|LITHOTRIPSY|
20|FH_F134651_0_0|CSTM-ALL|CSTM-00|2020|PCT|60.00|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_F98621_41042_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F40474_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: ALL|
20|FH_F95221_0_0|SrvcGrp|72992|2022|PDM|478.00|99|0.00|AEG 2|
20|FH_F138787_32258_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F138992_72703_0|SrvcGrp|113463|2022|PCT|0.00|99|0.00|LITHOTRIPSY ESWL INCIDENTAL CODES|
20|FH_F145531_61614_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F135494_10941_0|SrvcGrp|106048|2022|PDM|500.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F132328_0_0|SrvcGrp|35672|2022|PDM|2876.00|99|0.00|CPT 23412|
20|FH_F96560_17972_0|SrvcGrp|471|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F147532_0_0|SrvcGrp|90478|2022|PDM|144.84|99|0.00|HOSPICE|
20|FH_F50100_0_0|SrvcGrp|22954|2022|PDM|183.42|99|0.00|HOSPICE SVCS - ROUTINE HOME CARE|
20|FH_F37444_0_0|SrvcGrp|16615|2022|PCT|0.72|99|0.00|RN VISIT|
20|FH_F132212_0_0|SrvcGrp|60856|2022|PDM|90.00|99|0.00|HOSPICE SERVICE - ROUTINE HOME CARE|
20|FH_F128564_43235_0|SrvcGrp|89781|2022|PDM|138.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F122245_0_0|SrvcGrp|109039|2022|PDM|1356.77|99|0.00|PROSTATE SATURATION SAMPLING|
20|FH_F148886_60621_0|SrvcGrp|10944|2022|PDM|563.00|99|0.00|EMERGENCY ROOM|
20|FH_F44312_0_0|CSTM-ALL|CSTM-00|2020|PDM|575.00|99|0.00|CHILD PSYCHIATRIC|
20|FH_F117872_33462_0|SrvcGrp|79280|2022|PDM|711.00|99|0.00|AETNA RESIDENTIAL TREATMENT CD|
20|FH_F71947_15227_0|SrvcGrp|81878|2022|PCT|1.00|99|0.00|RADIOLOGY W/ REV/HCPC|
20|FH_F127217_29650_0|SrvcGrp|72602|2022|PDM|691.00|99|0.00|ECT|
20|FH_F138054_0_0|SrvcGrp|44042|2022|PDM|161.00|99|0.00|SKILLED NURSING - LPN|
20|FH_F147995_67037_0|SrvcGrp|73500|2022|PDM|193.00|99|0.00|AETNA ER LEVEL I|
20|FH_F130825_65742_0|SrvcGrp|72981|2022|PDM|425.00|99|0.00|RESIDENTIAL SKILLED NURSING|
20|FH_F133922_70563_0|SrvcGrp|21457|2022|PDM|691.73|99|0.00|CPT CODE 95811|
20|FH_F80172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F85353_16407_0|SrvcGrp|63797|2022|PDM|922.07|99|0.00|HAPA WPA-NWPA 2012-13 ASC 504|
20|FH_F118123_67226_0|SrvcGrp|24754|2022|PDM|10.00|99|0.00|INTERFERON INJECTION THERAPY|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|911.90|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1303 W/O REV|
20|FH_F126506_68118_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F149263_0_0|SrvcGrp|115610|2022|PDM|4578.00|99|0.00|VENTRAL HERN INIT REPAIR|
20|FH_F149051_01605_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125173_0_0|SrvcGrp|108041|2022|PDM|400.00|99|0.00|HEMODIALYSIS PROC, IP/OP OR HOME|
20|FH_F118803_0_0|SrvcGrp|107873|2022|PDM|349.70|99|0.00|SELECTIVE CATHETER PLACEMENT|
20|FH_F32998_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|523.08|99|0.00|HAPA WPA-NWPA 2012-13 ASC 105 W/O REV|
20|FH_F115616_0_0|SrvcGrp|106227|2022|PDM|3121.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F121306_32207_0|SrvcGrp|82846|2022|PCT|1.07|99|0.00|AETNA DME|
20|FH_F43953_0_0|SrvcGrp|38422|2022|PCT|0.70|99|0.00|INTERLUKEN II & DRUGS (OP))|
20|FH_F115543_0_0|CSTM-ALL|CSTM-00|2020|PDM|914.00|99|0.00|AEG 10 (NO REV)|
20|FH_F105593_0_0|SrvcGrp|48396|2022|PDM|80.00|99|0.00|OT SERVICES|
20|FH_F119072_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|HSS ASC|
20|FH_F132606_0_0|SrvcGrp|16289|2022|PDM|780.30|99|0.00|CARPAL TUNNEL RELEASE|
20|FH_F95623_84015_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F113470_74010_0|SrvcGrp|471|2022|PDM|545.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F49485_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD KN"|
20|FH_F33645_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F84712_0_0|SrvcGrp|73006|2022|PDM|6686.00|99|0.00|AEG 9|
20|FH_F115909_38133_0|SrvcGrp|16069|2022|PDM|553.00|99|0.00|ELECTROSHOCK THERAPY TREATMENT|
20|FH_F131964_89120_0|SrvcGrp|88621|2022|PDM|88.00|99|0.00|SKILLED NURSING LPN|
20|FH_F133133_32433_0|SrvcGrp|89337|2022|PDM|660.00|99|0.00|DETOXIFICATION|
20|FH_F99960_0_0|SrvcGrp|26278|2022|PDM|1174.00|99|0.00|CPT 29881|
20|FH_F40834_0_0|SrvcGrp|997|2022|PCT|0.85|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F91994_0_0|SrvcGrp|87026|2022|PDM|750.00|99|0.00|CYSTOSCOPY AND TREATMENT|
20|FH_F78762_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F151146_0_0|SrvcGrp|113677|2022|PDM|2060.00|99|0.00|UNLISTED LIVER LAPAROSCOPY|
20|FH_F66501_0_0|SrvcGrp|15850|2022|PDM|70.00|99|0.00|HOSPICE SVCS|
20|FH_F91332_0_0|SrvcGrp|28818|2022|PCT|1.10|99|0.00|SUPPLIES AND DEVICES|
20|FH_F137067_0_0|SrvcGrp|84318|2022|PDM|7350.00|99|0.00|SPINE INFUSION|
20|FH_F139551_0_0|SrvcGrp|41334|2022|PDM|17500.00|99|0.00|TOTAL KNEE|
20|FH_F75382_0_0|SrvcGrp|30623|2022|PDM|4662.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F149839_80002_0|SrvcGrp|89781|2022|PDM|144.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F88391_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F116203_63901_0|SrvcGrp|46605|2022|PDM|90.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F87915_0_0|SrvcGrp|13630|2022|PDM|647.00|99|0.00|CPT 99204|
20|FH_F118152_20151_0|SrvcGrp|14947|2022|PDM|4.00|99|0.00|HOME INFUSION|
20|FH_F142313_14788_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F142330_43701_0|SrvcGrp|75419|2022|PDM|426.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F53732_0_0|SrvcGrp|20480|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F125408_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F119011_08701_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F36217_0_0|SrvcGrp|15122|2022|PCT|0.70|99|0.00|CARDIAC CATH LAB SVCS|
20|FH_F147801_90703_0|SrvcGrp|88906|2022|PDM|1092.00|99|0.00|PSYCHIATRIC CARE (AGE 18-64)|
20|FH_F91472_96001_0|SrvcGrp|11108|2022|PDM|5614.00|99|0.00|NEWBORN NURSERY|
20|FH_F120210_0_0|CSTM-ALL|CSTM-00|2020|PDM|394.00|99|0.00|AEG 1 (NO REV)|
20|FH_F145784_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 10 (NO REV)|
20|FH_F77662_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150910_0_0|SrvcGrp|86233|2022|PDM|11960.00|99|0.00|AETNA RECONSTRUCT ANKLE JOINT|
20|FH_F114666_30342_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F43696_0_0|CSTM-ALL|CSTM-00|2020|PDM|2052.00|99|0.00|ACUTE PSYCH|
20|FH_F136913_68803_0|SrvcGrp|79786|2022|PCT|0.75|99|0.00|SLEEP STUDIES|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|1036.25|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1303 W/O REV|
20|FH_F151501_30265_0|SrvcGrp|92366|2022|PDM|4606.00|99|0.00|REPAIR ACHILLES TENDON|
20|FH_F113276_38506_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F114525_72401_0|SrvcGrp|73841|2022|PDM|325.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F84912_0_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|MANDIBULAR ORTHOPEDIC|
20|FH_F146655_80226_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F115952_44484_0|SrvcGrp|86648|2022|PCT|1.05|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F134828_30531_0|SrvcGrp|89214|2022|PDM|34.00|99|0.00|X-RAY EXAM OF HAND|
20|FH_F135220_21532_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F88335_71019_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F40063_0_0|SrvcGrp|15860|2022|PDM|1371.00|99|0.00|SUB-ACUTE REHAB|
20|FH_F109000_0_0|SrvcGrp|40002|2022|PDM|11110.00|99|0.00|TOTAL HIP|
20|FH_F115064_78582_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F56972_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F75307_0_0|SrvcGrp|42976|2022|PDM|105.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F53872_0_0|SrvcGrp|10528|2022|PDM|45.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F148265_06067_0|CSTM-ALL|CSTM-00|2020|PDM|1909.00|99|0.00|AEG 2 (NO REV)|
20|FH_F66222_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|(IMMUN) OCN F/S PRICING: ALL|
20|FH_F149780_00783_0|SrvcGrp|82981|2022|PDM|150.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F56152_0_0|SrvcGrp|3499|2022|PCT|0.50|99|0.00|IMPLANTS|
20|FH_F141527_36830_0|SrvcGrp|17015|2022|PDM|11.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F136475_89119_0|SrvcGrp|48398|2022|PDM|85.00|99|0.00|PT SERVICES|
20|FH_F65239_0_0|CSTM-ALL|CSTM-00|2020|PDM|1385.00|99|0.00|AEG 8 (NO REV)|
20|FH_F140343_89052_0|SrvcGrp|31973|2022|PDM|10.00|99|0.00|HOME THERAPY|
20|FH_F124180_0_0|SrvcGrp|86035|2022|PDM|3500.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F122194_66104_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124663_65608_0|SrvcGrp|104967|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F131494_0_0|CSTM-ALL|CSTM-00|2020|PDM|210.00|99|0.00|AEG 1 (NO REV)|
20|FH_F131888_71852_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F49016_0_0|SrvcGrp|42824|2022|PDM|60.00|99|0.00|SKILLED NURSING VISIT|
20|FH_F65979_0_0|CSTM-ALL|CSTM-00|2020|PDM|2640.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F54612_07631_0|SrvcGrp|11073|2022|PDM|132.20|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F90184_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|ASPG X|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|263.34|99|0.00|HAPA WPA-NWPA 2012-13 ASC 119 W/O REV|
20|FH_F80513_0_0|SrvcGrp|26692|2022|PDM|23808.00|99|0.00|MS DRG 026 ONLY|
20|FH_F143903_06249_0|SrvcGrp|46903|2022|PDM|450.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F54172_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|ZERO ALLOWABLE - INPATIENT SERVICES|
20|FH_F114918_78748_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|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_F143976_80504_0|SrvcGrp|108484|2022|PDM|500.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F36118_0_0|SrvcGrp|9828|2022|PDM|42.00|99|0.00|HOME HEALTH AIDE|
20|FH_F78205_0_0|SrvcGrp|19973|2022|PDM|802.95|99|0.00|CAT SCAN|
20|FH_F149979_15701_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F146135_87112_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F80855_0_0|SrvcGrp|33982|2022|PDM|2100.00|99|0.00|CPT 28296|
20|FH_F118486_95060_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F133021_00910_0|SrvcGrp|112300|2022|PDM|200.00|99|0.00|LOCALIZATION DEVICE|
20|FH_F113866_0_0|SrvcGrp|30609|2022|PDM|23.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F130656_04401_0|SrvcGrp|72984|2022|PCT|0.89|99|0.00|CHEMOTHERAPY|
20|FH_F98002_27103_0|SrvcGrp|73603|2022|PDM|5613.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F110580_71106_0|CSTM-ALL|CSTM-00|2020|PDM|773.00|99|0.00|AEG 10 (NO REV)|
20|FH_F133887_17013_0|SrvcGrp|472|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|477.00|99|0.00|AEG 2 (NO REV)|
20|FH_F111882_51560_0|SrvcGrp|104304|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F127589_45459_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F135670_01749_0|SrvcGrp|86843|2022|PDM|50.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F126043_30339_0|SrvcGrp|73841|2022|PDM|428.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F135670_01749_0|SrvcGrp|10577|2022|PDM|35.00|99|0.00|HOME ADMINISTRATION DRUG THERAPY|
20|FH_F120719_27540_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F101100_50314_0|SrvcGrp|97741|2022|PDM|21260.00|99|0.00|REVISE KNEE|
20|FH_F131128_0_0|CSTM-ALL|CSTM-00|2020|PDM|855.00|99|0.00|AEG 2 (NO REV)|
20|FH_F119660_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F136510_0_0|SrvcGrp|106235|2022|PDM|5746.00|99|0.00|CYPASS|
20|FH_F128132_69361_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F129683_45255_0|SrvcGrp|93734|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F130492_66212_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F126242_32796_0|SrvcGrp|73842|2022|PDM|265.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F125249_0_0|SrvcGrp|100067|2022|PDM|1800.00|99|0.00|ANKLE ARTHROSCOPY SURGERY|
20|FH_F102184_0_0|SrvcGrp|98493|2022|PDM|7699.00|99|0.00|THORACIC|
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.00|99|0.00|COVENTRY ENHANCED GROUPER 5|
20|FH_F90136_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F120489_63552_0|SrvcGrp|75495|2022|PCT|0.75|99|0.00|AEG 9|
20|FH_F93363_63123_0|SrvcGrp|27969|2022|PDM|22.00|99|0.00|HOME HEALTH AIDE|
20|FH_F140343_89052_0|SrvcGrp|86849|2022|PDM|30.00|99|0.00|HCPCS S9355 (HCFA)|
20|FH_F140627_68651_0|CSTM-ALL|CSTM-00|2020|PCT|0.96|99|0.00|GENERAL ACUTE CARE|
20|FH_F80284_16354_0|SrvcGrp|111928|2022|PDM|15.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F117108_37841_0|SrvcGrp|75505|2022|PCT|0.30|99|0.00|CARDIAC STUDIES|
20|FH_F109652_0_0|SrvcGrp|75797|2022|PCT|0.57|99|0.00|EMERGENCY ROOM LEVEL 4|
20|FH_F90791_79106_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F98040_89406_0|SrvcGrp|73603|2022|PDM|9293.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F97740_01605_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F130419_72476_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124927_0_0|CSTM-ALL|CSTM-00|2020|PDM|1400.00|99|0.00|AEG 9 (NO REV)|
20|FH_F55812_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F32957_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F146239_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F133694_89117_0|SrvcGrp|88781|2022|PDM|115.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F98101_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.49|99|0.00|OP SVCS|
20|FH_F43295_0_0|SrvcGrp|31134|2022|PDM|1221.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
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_F150939_0_0|SrvcGrp|111061|2022|PDM|65.26|99|0.00|TOXOIDS VACCINES|
20|FH_F145248_19477_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F97501_31501_0|SrvcGrp|73603|2022|PDM|7195.00|99|0.00|AETNA NEWBORN NURSERY II & III|
20|FH_F135584_10977_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F84132_48026_0|SrvcGrp|73004|2022|PDM|1458.00|99|0.00|AEG 8|
20|FH_F134247_66049_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F93219_26354_0|SrvcGrp|88620|2022|PDM|99.00|99|0.00|SKILLED NURSING RN|
20|FH_F114526_33401_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F42258_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133875_80027_0|SrvcGrp|88819|2022|PDM|1067.00|99|0.00|AETNA ELECTROCONVULSIVE THERAPY|
20|FH_F110245_46016_0|SrvcGrp|92761|2022|PCT|1.00|99|0.00|INPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F34626_0_0|SrvcGrp|42973|2022|PDM|95.00|99|0.00|SPEECH  THERAPIST|
20|FH_F151146_0_0|SrvcGrp|81904|2022|PDM|2266.00|99|0.00|LAP PARASOPHAG HERNIA REPAIR|
20|FH_F93136_0_0|SrvcGrp|73002|2022|PDM|995.00|99|0.00|AEG 7|
20|FH_F129536_0_0|SrvcGrp|108914|2022|PCT|0.00|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F130247_35045_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|GENERAL ACUTE CARE|
20|FH_F39760_0_0|SrvcGrp|27302|2022|PDM|14.00|99|0.00|CPT 92568|
20|FH_F83293_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F148170_04005_0|SrvcGrp|100961|2022|PCT|2.00|99|0.00|AMB SRVC NEONAT TRNSPRT BS RATE EMERG 1 WAY|
20|FH_F128272_60640_0|SrvcGrp|86836|2022|PDM|25.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F90422_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F84139_0_0|SrvcGrp|12290|2022|PDM|800.00|99|0.00|DETOXIFICATION|
20|FH_F116468_49660_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F101442_0_0|SrvcGrp|98461|2022|PDM|1825.25|99|0.00|OPEN TXMT TALOTARSAL DISLOCATION|
20|FH_F102940_35034_0|SrvcGrp|23683|2022|PDM|60.00|99|0.00|SKILLED NURSING RN|
20|FH_F98880_50158_0|SrvcGrp|73601|2022|PDM|8054.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F41363_0_0|CSTM-ALL|CSTM-00|2020|PDM|1299.00|99|0.00|ASPG VIII|
20|FH_F134869_08854_0|CSTM-ALL|CSTM-00|2020|PDM|1107.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F41167_0_0|SrvcGrp|439|2022|PDM|1300.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F128197_84123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37081_0_0|SrvcGrp|97|2022|PDM|5375.00|99|0.00|C-SECTION|
20|FH_F148641_92505_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F133351_84003_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F147995_67037_0|SrvcGrp|73498|2022|PDM|495.00|99|0.00|AETNA ER LEVEL III|
20|FH_F71323_68114_0|SrvcGrp|37344|2022|PDM|2800.00|99|0.00|MS DRG 194 ONLY|
20|FH_F97560_23249_0|SrvcGrp|88978|2022|PDM|6296.00|99|0.00|VAGINAL DELIVERY|
20|FH_F129007_21532_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F80855_0_0|SrvcGrp|73006|2022|PDM|1400.00|99|0.00|AEG 9|
20|FH_F85257_0_0|SrvcGrp|2738|2022|PCT|0.55|99|0.00|IMPLANTS|
20|FH_F148121_21734_0|SrvcGrp|75419|2022|PDM|450.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F90818_0_0|SrvcGrp|26278|2022|PDM|5500.00|99|0.00|CPT 29881|
20|FH_F39694_0_0|SrvcGrp|10111|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F93171_0_0|CSTM-ALL|CSTM-00|2020|PCT|12000.00|99|0.00|TIMELY FILING|
20|FH_F123481_90049_0|SrvcGrp|107483|2022|PCT|1.10|99|0.00|OP THERAPY SERVICE|
20|FH_F38034_0_0|SrvcGrp|3418|2022|PDM|3634.00|99|0.00|NEONATAL INTENSIVE CARE UNIT|
20|FH_F92659_0_0|SrvcGrp|92550|2022|PDM|652.00|99|0.00|TREATMENT OF RETINA|
20|FH_F115685_64064_0|SrvcGrp|88807|2022|PDM|130.00|99|0.00|TOTAL PARENTERAL NUTRITION; < 2 LITERS (HCFA)|
20|FH_F129536_0_0|CSTM-ALL|CSTM-00|2020|PDM|703.00|99|0.00|AEG 5  (NO REV)|
20|FH_F120872_74120_0|SrvcGrp|108484|2022|PDM|461.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F146885_0_0|SrvcGrp|46903|2022|PDM|650.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F39273_0_0|SrvcGrp|30201|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AW (DME)|
20|FH_F118193_06241_0|SrvcGrp|104075|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F36861_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F139350_70056_0|SrvcGrp|87077|2022|PDM|183.73|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F115895_0_0|SrvcGrp|103527|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F124180_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F124059_64055_0|SrvcGrp|48385|2022|PDM|83.00|99|0.00|SPEECH THERAPY|
20|FH_F114666_30342_0|SrvcGrp|67072|2022|PDM|3424.00|99|0.00|CPT 22845|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|345.11|99|0.00|HAPA WPA-NWPA 2012-13 ASC 407 W/O REV|
20|FH_F84159_0_0|CSTM-ALL|CSTM-00|2020|PCT|41.80|99|0.00|OP SVCS|
20|FH_F151306_21030_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F119885_13753_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F148243_0_0|SrvcGrp|84974|2022|PDM|879.00|99|0.00|CPT 43255|
20|FH_F102940_35034_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F76382_0_0|SrvcGrp|43893|2022|PDM|110.00|99|0.00|OCCUPATIONAL THERAPY VISIT|
20|FH_F130309_17044_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F143530_0_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F42755_0_0|CSTM-ALL|CSTM-00|2020|PDM|585.00|99|0.00|ACUTE PSYCH|
20|FH_F53373_0_0|CSTM-ALL|CSTM-00|2020|PDM|1742.00|99|0.00|ASPG IX|
20|FH_F53872_0_0|SrvcGrp|32189|2022|PDM|35.00|99|0.00|RESPITE CARE|
20|FH_F130504_33756_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|2497.00|99|0.00|AEG 4 (NO REV)|
20|FH_F136374_34461_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F136426_19006_0|SrvcGrp|106291|2022|PDM|271.00|99|0.00|AMBULANCE SERVICE NON-ER TRANSPORT LEVEL 1 (HCFA)|
20|FH_F120490_64133_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F138541_54840_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F117240_37334_0|SrvcGrp|44564|2022|PDM|700.00|99|0.00|NEWBORN NURSERY|
20|FH_F101945_0_0|SrvcGrp|35668|2022|PDM|2726.00|99|0.00|CPT 29824|
20|FH_F129053_0_0|CSTM-ALL|CSTM-00|2020|PDM|2429.00|99|0.00|AEG 6 (NO REV)|
20|FH_F73231_0_0|SrvcGrp|44709|2022|PDM|168.71|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F87201_0_0|SrvcGrp|42975|2022|PDM|100.00|99|0.00|PHYSICAL THERAPIST|
20|FH_F131505_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|AEG 5  (NO REV)|
20|FH_F112485_61032_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F138876_25302_0|SrvcGrp|86840|2022|PDM|40.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F100880_67735_0|SrvcGrp|12152|2022|PCT|0.98|99|0.00|AIR AMBULANCE SVCS|
20|FH_F33725_0_0|SrvcGrp|13380|2022|PDM|75.00|99|0.00|RN VISIT|
20|FH_F101661_08879_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F141651_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|AEG 1 (NO REV)|
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F150820_83843_0|CSTM-ALL|CSTM-00|2020|PDM|1000.00|99|0.00|AEG 2 (NO REV)|
20|FH_F146204_0_0|CSTM-ALL|CSTM-00|2020|PDM|1942.00|99|0.00|AEG 9 (NO REV)|
20|FH_F49394_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F50100_0_0|SrvcGrp|46110|2022|PDM|58.08|99|0.00|HI-TECH NURSING (ADDITIONAL HOUR)|
20|FH_F49300_0_0|SrvcGrp|42973|2022|PDM|100.00|99|0.00|SPEECH  THERAPIST|
20|FH_F147231_49440_0|SrvcGrp|73523|2022|PDM|42.46|99|0.00|OCCUPATIONAL THERAPY|
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_F90183_80031_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F101922_98055_0|SrvcGrp|73004|2022|PDM|4700.00|99|0.00|AEG 8|
20|FH_F129105_21713_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F78922_0_0|SrvcGrp|11258|2022|PCT|0.20|99|0.00|DRUGS|
20|FH_F37639_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116924_91203_0|SrvcGrp|705|2022|PCT|1.10|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F130716_76013_0|SrvcGrp|88778|2022|PDM|105.00|99|0.00|PHYSICAL THERAPY|
20|FH_F58252_0_0|SrvcGrp|48399|2022|PDM|31.25|99|0.00|SPEECH THERAPY|
20|FH_F118152_20151_0|SrvcGrp|86830|2022|PDM|4.00|99|0.00|HCPCS S5502 (HCFA)|
20|FH_F140447_84106_0|SrvcGrp|29347|2022|PDM|17.50|99|0.00|HOME HEALTH AIDE|
20|FH_F151610_77304_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F109982_33592_0|SrvcGrp|87317|2022|PDM|584.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F76144_0_0|SrvcGrp|26275|2022|PDM|2317.30|99|0.00|CPT 29826|
20|FH_F92852_0_0|CSTM-ALL|CSTM-00|2020|PDM|746.90|99|0.00|AETNA GLENNVILLE 2016 AEG 2|
20|FH_F117371_77059_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F109652_0_0|SrvcGrp|87992|2022|PCT|0.00|99|0.00|CARDIAC CATHETERIZATION INCIDENTIAL|
20|FH_F69364_0_0|CSTM-ALL|CSTM-00|2020|PDM|2012.00|99|0.00|ASPG VIII|
20|FH_F135491_0_0|SrvcGrp|77507|2022|PCT|1.21|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F149899_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136662_45345_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F141170_0_0|SrvcGrp|93807|2022|PDM|4770.00|99|0.00|REVISE SPINE ELTRD PERQ ARAY|
20|FH_F115181_78602_0|SrvcGrp|105012|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F115664_72758_0|SrvcGrp|106268|2022|PDM|2.97|99|0.00|NEWBORN METABOLIC SCREENING|
20|FH_F70762_90805_0|CSTM-ALL|CSTM-00|2020|PDM|440.00|99|0.00|YOUTH RESIDENTIAL TREATMENT PSYCH/CHEM DEPENDENCY|
20|FH_F116443_0_0|SrvcGrp|106799|2022|PDM|3500.00|99|0.00|THRMBC/NFS DIALYSIS CIRCUIT|
20|FH_F91764_93710_0|CSTM-ALL|CSTM-00|2020|PDM|6251.00|99|0.00|AEG 7 (NO REV)|
20|FH_F136183_72756_0|SrvcGrp|109798|2022|PCT|1.30|99|0.00|FHBH OP THERAPY SERVICE|
20|FH_F88831_84123_0|SrvcGrp|53746|2022|PDM|90.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F139430_63017_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|1038.00|99|0.00|AEG 6 (NO REV)|
20|FH_F138460_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125182_0_0|SrvcGrp|79594|2022|PDM|2259.00|99|0.00|CPT 45380|
20|FH_F119538_60959_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F148419_01453_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F143030_02895_0|SrvcGrp|471|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F97562_29803_0|SrvcGrp|90854|2022|PDM|3449.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F144388_19904_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F127994_19301_0|SrvcGrp|73841|2022|PDM|324.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F125660_46706_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F67173_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F134492_85201_0|SrvcGrp|106722|2022|PDM|1167.00|99|0.00|IP REHAB|
20|FH_F134496_66062_0|SrvcGrp|3178|2022|PDM|896.00|99|0.00|ACUTE PSYCH|
20|FH_F85553_0_0|SrvcGrp|14239|2022|PDM|185.00|99|0.00|EMERGENCY ROOM SVCS LEVEL I|
20|FH_F120805_92672_0|SrvcGrp|73605|2022|PDM|1250.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F82173_72712_0|SrvcGrp|3378|2022|PDM|2350.00|99|0.00|OBSERVATION SVCS|
20|FH_F146569_0_0|SrvcGrp|30609|2022|PDM|25.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F146569_0_0|SrvcGrp|90707|2022|PDM|100.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F127375_28621_0|SrvcGrp|79458|2022|PDM|0.25|99|0.00|MED RECORD COPY|
20|FH_F129019_62650_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118152_20151_0|SrvcGrp|47183|2022|PDM|100.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F120490_64133_0|SrvcGrp|86831|2022|PDM|4.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F93180_73772_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F93185_63141_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131472_0_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F88456_0_0|CSTM-ALL|CSTM-00|2020|PDM|2241.00|99|0.00|AEG 9 (NO REV)|
20|FH_F144828_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F43800_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F43653_0_0|SrvcGrp|16|2022|PDM|500.00|99|0.00|ACUTE REHABILITATION|
20|FH_F43833_0_0|SrvcGrp|31387|2022|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F136778_62034_0|SrvcGrp|112994|2022|PCT|0.71|99|0.00|OBSERVATION W/ ER|
20|FH_F147305_90755_0|SrvcGrp|48396|2022|PDM|140.00|99|0.00|OT SERVICES|
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 6 (NO REV)|
20|FH_F133107_73071_0|SrvcGrp|46605|2022|PDM|95.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F138730_22602_0|SrvcGrp|78420|2022|PDM|1000.00|99|0.00|INTERIM LABOR|
20|FH_F91735_92653_0|SrvcGrp|73523|2022|PDM|110.25|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F135923_60453_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F131407_07607_0|SrvcGrp|86840|2022|PDM|30.00|99|0.00|HCPCS S9338 (HCFA)|
20|FH_F116397_33404_0|SrvcGrp|47183|2022|PDM|68.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F54272_0_0|CSTM-ALL|CSTM-00|2020|PDM|1075.00|99|0.00|ASPG I|
20|FH_F150769_02302_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F35410_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|100% OF AWP DRUGS/IMMUN UPDATE QUARTILE|
20|FH_F136779_0_0|SrvcGrp|112929|2022|PDM|10609.00|99|0.00|INSRT PULSE GEN W/ DUAL LEADS|
20|FH_F139967_37205_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F83451_0_0|CSTM-ALL|CSTM-00|2020|PDM|436.00|99|0.00|AEG 1 (NO REV)|
20|FH_F58313_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|OP SVCS|
20|FH_F126730_84737_0|SrvcGrp|9866|2022|PCT|0.40|99|0.00|IP OBSERVATION SVCS|
20|FH_F113410_0_0|SrvcGrp|105248|2022|PDM|3047.00|99|0.00|HYSTEROSCOPY/LAPAROSCOPY|
20|FH_F141515_50010_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F120308_07901_0|SrvcGrp|108484|2022|PDM|1095.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F138778_90066_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F38221_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE|
20|FH_F39303_0_0|CSTM-ALL|CSTM-00|2020|PDM|1492.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F40144_0_0|SrvcGrp|997|2022|PCT|0.73|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F104840_32565_0|SrvcGrp|88397|2022|PCT|0.69|99|0.00|AETNA MATERNITY DELIVERY|
20|FH_F124180_0_0|SrvcGrp|58755|2022|PDM|3000.00|99|0.00|INJECTION PROC FOR JOINT|
20|FH_F36318_0_0|SrvcGrp|24368|2022|PDM|5548.00|99|0.00|OP SURGERY|
20|FH_F114666_30342_0|SrvcGrp|33984|2022|PDM|1430.00|99|0.00|HAMMERTOE CORRECTION|
20|FH_F138456_33543_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F122635_06410_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136796_24016_0|SrvcGrp|67279|2022|PDM|2022.18|99|0.00|CERVICAL SURGERY|
20|FH_F115631_65201_0|SrvcGrp|58993|2022|PDM|3177.00|99|0.00|DISKECTOMY|
20|FH_F115631_65201_0|SrvcGrp|106256|2022|PDM|1141.00|99|0.00|INJECTION FOR NERVE BLOC 7|
20|FH_F42333_0_0|CSTM-ALL|CSTM-00|2020|PDM|330.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F54552_0_0|SrvcGrp|15596|2022|PDM|18.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F138876_25302_0|SrvcGrp|86835|2022|PDM|15.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F132258_45404_0|SrvcGrp|14947|2022|PDM|45.58|99|0.00|HOME INFUSION|
20|FH_F131344_61832_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F33785_0_0|SrvcGrp|14373|2022|PDM|5200.00|99|0.00|LITHOTRIPSY SVCS|
20|FH_F34864_0_0|SrvcGrp|12401|2022|PDM|99.00|99|0.00|RN VISIT|
20|FH_F132328_0_0|SrvcGrp|67072|2022|PDM|5826.00|99|0.00|CPT 22845|
20|FH_F139128_49503_0|SrvcGrp|109036|2022|PDM|550.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F148667_0_0|CSTM-ALL|CSTM-00|2020|PDM|1467.00|99|0.00|AEG 10 (NO REV)|
20|FH_F131548_32003_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F127189_49503_0|SrvcGrp|82222|2022|PDM|130.00|99|0.00|HOSPICE CARE|
20|FH_F38249_0_0|SrvcGrp|28608|2022|PCT|1.00|99|0.00|AMBULANCE SVCS|
20|FH_F120437_85202_0|SrvcGrp|111579|2022|PDM|181.20|99|0.00|MEDICAL NUTRITION THERAPY|
20|FH_F69242_0_0|SrvcGrp|46729|2022|PDM|35.00|99|0.00|RESPITE CARE|
20|FH_F97042_64804_0|SrvcGrp|73602|2022|PDM|1967.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F81771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F42992_0_0|CSTM-ALL|CSTM-00|2020|PDM|1476.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100788_01420_0|SrvcGrp|73605|2022|PDM|2627.00|99|0.00|AETNA ACUTE PSYCH|
20|FH_F107140_0_0|SrvcGrp|48385|2022|PDM|65.00|99|0.00|SPEECH THERAPY|
20|FH_F45324_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F142973_62448_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F45513_0_0|SrvcGrp|41336|2022|PDM|3300.00|99|0.00|VAGINAL HYSTERECTOMY|
20|FH_F37562_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD AV|
20|FH_F148555_0_0|SrvcGrp|115437|2022|PDM|3605.00|99|0.00|INSERT HEART PM ATRIAL & VENT|
20|FH_F111456_33884_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38411_0_0|SrvcGrp|19590|2022|PCT|0.80|99|0.00|MS DRG 913|
20|FH_F145965_50325_0|SrvcGrp|74668|2022|PDM|224.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F62600_0_0|CSTM-ALL|CSTM-00|2020|PDM|816.00|99|0.00|ASPG III|
20|FH_F145694_84770_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F71669_0_0|SrvcGrp|10681|2022|PDM|182.00|99|0.00|INTENSIVE  SVCS|
20|FH_F100782_0_0|SrvcGrp|105165|2022|PDM|1339.36|99|0.00|WINDBER MEDICAL CNTR ASC 505|
20|FH_F104700_0_0|SrvcGrp|73004|2022|PDM|1500.00|99|0.00|AEG 8|
20|FH_F115495_0_0|SrvcGrp|82981|2022|PDM|140.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F112064_0_0|SrvcGrp|103896|2022|PDM|140.00|99|0.00|HOSPICE ROUTINE HOME CARE|
20|FH_F95282_77975_0|SrvcGrp|88834|2022|PDM|95.00|99|0.00|SKILLED NURSING SERVICES (15 MINS)|
20|FH_F131656_51401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F127448_0_0|SrvcGrp|73006|2022|PDM|1800.00|99|0.00|AEG 9|
20|FH_F43418_0_0|SrvcGrp|31134|2022|PDM|1040.00|99|0.00|SURGICAL - ADULT/PEDIATRIC|
20|FH_F134689_60190_0|SrvcGrp|74668|2022|PDM|700.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F134694_94945_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F41695_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F48772_66044_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F69245_84047_0|SrvcGrp|108484|2022|PDM|562.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F97261_06098_0|SrvcGrp|73656|2022|PDM|944.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F151303_50703_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F151380_90701_0|SrvcGrp|98701|2022|PDM|384.00|99|0.00|AETNA OP EATING DISORDERS|
20|FH_F144948_83704_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F136016_67209_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F136186_46307_0|SrvcGrp|27968|2022|PDM|25.00|99|0.00|SKILLED NURSING LPN|
20|FH_F129967_18915_0|SrvcGrp|106469|2022|PDM|95.90|99|0.00|AETNA OFFICE OUTPATIENT VISIT EST (MOD TD) (HCFA)|
20|FH_F47906_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|MRI|
20|FH_F87153_0_0|CSTM-ALL|CSTM-00|2020|PDM|129.24|99|0.00|AETNA SLEEP STUDIES|
20|FH_F126853_19053_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F123036_0_0|SrvcGrp|57607|2022|PCT|0.63|99|0.00|LABORATORY/PATHOLOGY|
20|FH_F116583_0_0|SrvcGrp|106933|2022|PDM|650.00|99|0.00|HOSPICE IN LTCH|
20|FH_F124492_30040_0|SrvcGrp|113250|2022|PDM|156.89|99|0.00|COVID-19 SARSCOV2&INF A&B&RSV AMP PRB (HCFA)|
20|FH_F39772_0_0|SrvcGrp|30250|2022|PDM|65.00|99|0.00|CPT CODES 00100-01999|
20|FH_F132944_06480_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F139167_42240_0|SrvcGrp|3178|2022|PDM|836.00|99|0.00|ACUTE PSYCH|
20|FH_F146211_68144_0|SrvcGrp|88159|2022|PDM|5453.71|99|0.00|LOW BACK DISK SURGERY|
20|FH_F88280_0_0|SrvcGrp|537|2022|PDM|74.00|99|0.00|OBSERVATION SERVICES|
20|FH_F141870_85224_0|SrvcGrp|14944|2022|PDM|5.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F117555_72802_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F38161_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|FL VISTA RADIOLOGY MOD TC|
20|FH_F149243_64114_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)|
20|FH_F133631_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F141870_85224_0|SrvcGrp|34566|2022|PDM|40.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F144888_15370_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40812_0_0|CSTM-ALL|CSTM-00|2020|PDM|613.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130725_33020_0|SrvcGrp|73841|2022|PDM|570.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F138951_41101_0|SrvcGrp|47183|2022|PDM|64.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F136359_0_0|SrvcGrp|102120|2022|PDM|2875.00|99|0.00|REVISE EYE MUSCLE|
20|FH_F96780_0_0|SrvcGrp|28548|2022|PDM|1786.00|99|0.00|VITRECTOMY|
20|FH_F97861_62223_0|SrvcGrp|73601|2022|PDM|7438.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F111163_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|AEG 10 (NO REV)|
20|FH_F99161_0_0|SrvcGrp|75481|2022|PDM|1000.00|99|0.00|AEG 2|
20|FH_F44278_0_0|SrvcGrp|22092|2022|PDM|850.00|99|0.00|MAGNETIC RESONANCE IMAGING (MRI)|
20|FH_F144248_0_0|CSTM-ALL|CSTM-00|2020|PDM|781.00|99|0.00|AEG 1 (NO REV)|
20|FH_F142930_0_0|SrvcGrp|82223|2022|PDM|100.00|99|0.00|HOSPICE CARE|
20|FH_F120583_43219_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|637.00|99|0.00|AEG 3 (NO REV)|
20|FH_F141050_46410_0|SrvcGrp|48385|2022|PDM|110.00|99|0.00|SPEECH THERAPY|
20|FH_F34652_0_0|SrvcGrp|701|2022|PDM|2055.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F42654_0_0|SrvcGrp|29462|2022|PDM|40.00|99|0.00|HOME HEALTH AIDE - MOD TF|
20|FH_F47113_0_0|CSTM-ALL|CSTM-00|2020|PDM|939.00|99|0.00|AEG 5  (NO REV)|
20|FH_F151501_30265_0|SrvcGrp|33982|2022|PDM|2090.00|99|0.00|CPT 28296|
20|FH_F111301_33122_0|SrvcGrp|82739|2022|PDM|40.00|99|0.00|LIPID PROFILE|
20|FH_F32371_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102862_30606_0|CSTM-ALL|CSTM-00|2020|PCT|1.50|99|0.00|HSS APC HOLD HARMLESS|
20|FH_F139553_30084_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F144029_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F90232_15126_0|SrvcGrp|86827|2022|PDM|85.05|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F133519_0_0|SrvcGrp|112205|2022|PDM|586.00|99|0.00|BIOPSY OF PENIS|
20|FH_F114585_11501_0|SrvcGrp|90644|2022|PDM|20.00|99|0.00|AETNA MEDICATION ASSISTED TRTMT MAINTENANCE INJECTION (HCFA)|
20|FH_F113545_11201_0|SrvcGrp|58509|2022|PDM|295.00|99|0.00|DRUGS AND ALCOHOL REHAB|
20|FH_F80834_0_0|SrvcGrp|27726|2022|PCT|0.59|99|0.00|OP SURGERY|
20|FH_F148554_85016_0|CSTM-ALL|CSTM-00|2020|PDM|437.00|99|0.00|AEG 1 (NO REV)|
20|FH_F35575_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F118393_21032_0|SrvcGrp|471|2022|PDM|808.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F98921_64503_0|SrvcGrp|73643|2022|PDM|2572.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F118456_30012_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F146110_48433_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41181_0_0|CSTM-ALL|CSTM-00|2020|PDM|1144.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151049_18702_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151141_24014_0|SrvcGrp|107793|2022|PDM|11576.00|99|0.00|DIALYSIS CIRCUIT PROCEDURE|
20|FH_F111023_13905_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F143742_60410_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F131127_0_0|SrvcGrp|84182|2022|PDM|3060.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE|
20|FH_F143335_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F59872_0_0|SrvcGrp|10905|2022|PDM|750.00|99|0.00|EMERGENCY ROOM LEVEL III|
20|FH_F133175_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F134331_61021_0|SrvcGrp|88620|2022|PDM|150.00|99|0.00|SKILLED NURSING RN|
20|FH_F58396_0_0|SrvcGrp|44167|2022|PDM|68.00|99|0.00|HOME HEALTH - PT/OT/ST|
20|FH_F83995_16748_0|SrvcGrp|14081|2022|PDM|98.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F56512_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F144228_0_0|SrvcGrp|114149|2022|PDM|1142.00|99|0.00|ESOPH ENDOSCOPY DILATION|
20|FH_F90501_71101_0|SrvcGrp|75506|2022|PCT|1.00|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F148659_28134_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F124161_95932_0|SrvcGrp|73002|2022|PDM|6242.00|99|0.00|AEG 7|
20|FH_F66705_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F131711_25550_0|SrvcGrp|109057|2022|PCT|0.88|99|0.00|CARDIAC STUDIES|
20|FH_F49573_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F74227_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.55|99|0.00|OP SVCS|
20|FH_F37756_0_0|SrvcGrp|27221|2022|PCT|0.60|99|0.00|HIGH COST DRUGS|
20|FH_F139551_0_0|SrvcGrp|88491|2022|PDM|5769.00|99|0.00|AETNA TRANSPEDICULAR, 1 SEG,LUMBAR|
20|FH_F32675_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F130807_20721_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F112946_0_0|CSTM-ALL|CSTM-00|2020|PDM|550.00|99|0.00|COVENTRY ENHANCED GROUPER 3|
20|FH_F132202_67490_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F116488_79925_0|SrvcGrp|48394|2022|PDM|30.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F31881_0_0|CSTM-ALL|CSTM-00|2020|PCT|92.00|99|0.00|OP SVCS|
20|FH_F111363_33169_0|SrvcGrp|10391|2022|PDM|1975.00|99|0.00|ACUTE MEDICAL & SURGICAL|
20|FH_F116430_0_0|CSTM-ALL|CSTM-00|2020|PDM|964.00|99|0.00|AEG 3 (NO REV)|
20|FH_F98300_30236_0|SrvcGrp|73806|2022|PDM|820.00|99|0.00|AETNA ER|
20|FH_F138742_33125_0|SrvcGrp|89149|2022|PDM|120.00|99|0.00|OP INTENSIVE|
20|FH_F139667_84078_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F132595_0_0|SrvcGrp|22147|2022|PDM|142.00|99|0.00|PSYCH PARTIAL HOSP (HALF DAY)|
20|FH_F151661_78526_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150439_03110_0|SrvcGrp|113194|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F98623_97006_0|SrvcGrp|73461|2022|PDM|9773.00|99|0.00|AETNA NICU IV|
20|FH_F133018_84037_0|SrvcGrp|14944|2022|PDM|2.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F129535_0_0|SrvcGrp|75481|2022|PDM|425.00|99|0.00|AEG 2|
20|FH_F106700_02906_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F130721_04769_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 1 (NO REV)|
20|FH_F134627_74030_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F77943_0_0|SrvcGrp|3029|2022|PDM|1310.18|99|0.00|NEWBORN NURSERY|
20|FH_F150144_39452_0|SrvcGrp|87317|2022|PDM|1200.00|99|0.00|AETNA IP REHAB (BHIPRHBONLY)|
20|FH_F83978_66739_0|SrvcGrp|110874|2022|PDM|11035.00|99|0.00|ORTHOPEDIC SURGERIES 2|
20|FH_F125133_20601_0|SrvcGrp|110077|2022|PDM|21.22|99|0.00|CONTACT LAYER >16 <=48 SQ IN|
20|FH_F130123_24171_0|SrvcGrp|90707|2022|PDM|145.00|99|0.00|AETNA HOSPICE CARE|
20|FH_F150166_91401_0|SrvcGrp|46903|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F139767_15217_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F83380_0_0|SrvcGrp|44711|2022|PDM|105.00|99|0.00|PT SVCS|
20|FH_F149302_75032_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F150200_0_0|CSTM-ALL|CSTM-00|2020|PDM|992.00|99|0.00|AEG 1 (NO REV)|
20|FH_F37884_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|D01 FEE SCHEDULE MOD AW|
20|FH_F36822_0_0|CSTM-ALL|CSTM-00|2020|PDM|774.00|99|0.00|ACUTE PSYCH|
20|FH_F137087_0_0|CSTM-ALL|CSTM-00|2020|PDM|3800.00|99|0.00|AEG 6 (NO REV)|
20|FH_F118703_0_0|SrvcGrp|72996|2022|PDM|719.00|99|0.00|AEG 4|
20|FH_F123505_64468_0|SrvcGrp|96163|2022|PCT|1.00|99|0.00|TIGECYCLINE INJECTION|
20|FH_F86332_75081_0|SrvcGrp|43571|2022|PDM|100.00|99|0.00|MID-LINE INSERTION|
20|FH_F33513_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|DME F/S (MOD AV) - MHAC|
20|FH_F39866_0_0|SrvcGrp|11119|2022|PDM|600.00|99|0.00|CT SCANS|
20|FH_F49653_0_0|SrvcGrp|16|2022|PDM|1340.00|99|0.00|ACUTE REHABILITATION|
20|FH_F66222_0_0|SrvcGrp|48004|2022|PDM|102.78|99|0.00|HOME HEALTH AIDE|
20|FH_F78922_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138020_20016_0|SrvcGrp|13226|2022|PDM|147.00|99|0.00|CPT CODE 99282|
20|FH_F138677_43793_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F138876_25302_0|SrvcGrp|86825|2022|PDM|60.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F138992_72703_0|SrvcGrp|113085|2022|PDM|7479.00|99|0.00|CARDIAC CATH|
20|FH_F148061_11223_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F140105_0_0|CSTM-ALL|CSTM-00|2020|PDM|888.00|99|0.00|AEG 6 (NO REV)|
20|FH_F119355_0_0|SrvcGrp|107550|2022|PDM|50.00|99|0.00|EXPOSE BEHAV ASSESSMENT (HCFA)|
20|FH_F148554_85016_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F37569_0_0|SrvcGrp|3483|2022|PDM|2650.00|99|0.00|CPT CODE 59400|
20|FH_F117880_91730_0|SrvcGrp|88621|2022|PDM|90.00|99|0.00|SKILLED NURSING LPN|
20|FH_F53032_0_0|CSTM-ALL|CSTM-00|2020|PCT|65.00|99|0.00|OP SVCS|
20|FH_F132080_0_0|SrvcGrp|97507|2022|PDM|169.00|99|0.00|AETNA HOSPICE|
20|FH_F143054_26147_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|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_F67989_0_0|CSTM-ALL|CSTM-00|2020|PDM|717.60|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1201 W/O REV|
20|FH_F32869_0_0|CSTM-ALL|CSTM-00|2020|PDM|33000.00|99|0.00|MS DRG 309-310 CARDIAC ARRHYTHMIA|
20|FH_F67136_0_0|SrvcGrp|16274|2022|PCT|1.00|99|0.00|ORGAN ACQUISITION|
20|FH_F98002_27103_0|SrvcGrp|73601|2022|PDM|4233.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F70205_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|GENERAL ACUTE CARE|
20|FH_F38790_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F143578_63033_0|CSTM-ALL|CSTM-00|2020|PCT|0.35|99|0.00|OP SVCS|
20|FH_F91412_0_0|CSTM-ALL|CSTM-00|2020|PDM|932.78|99|0.00|AEG 3 (NO REV)|
20|FH_F63312_0_0|SrvcGrp|10538|2022|PDM|25.00|99|0.00|NURSING CARE|
20|FH_F109266_33319_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F134593_60007_0|SrvcGrp|86848|2022|PDM|48.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F105145_75075_0|SrvcGrp|98267|2022|PDM|24731.00|99|0.00|REVISION OF KNEE JOINT|
20|FH_F48692_0_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F59732_0_0|SrvcGrp|13929|2022|PDM|19.00|99|0.00|GROWTH HORMONE|
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_F142073_0_0|CSTM-ALL|CSTM-00|2020|PDM|1795.00|99|0.00|AEG 7 (NO REV)|
20|FH_F124050_75089_0|SrvcGrp|29346|2022|PDM|30.00|99|0.00|SKILLED NURSING- LPN|
20|FH_F82696_16335_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F41021_0_0|SrvcGrp|17083|2022|PCT|0.74|99|0.00|ASPG X|
20|FH_F127209_45365_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD OCN F/S PRICING - OP W/O HOME HEALTH|
20|FH_F32529_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F118884_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130717_85006_0|SrvcGrp|92760|2022|PCT|1.52|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F125210_32901_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F102185_0_0|SrvcGrp|472|2022|PDM|425.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F126242_32796_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F99420_91326_0|SrvcGrp|11920|2022|PCT|0.85|99|0.00|PHARMACY SVCS|
20|FH_F131387_76001_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F39443_0_0|SrvcGrp|30304|2022|PDM|178.00|99|0.00|HAPA WPA ASC 116|
20|FH_F122425_75082_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F49984_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.25|99|0.00|2009 MEDCARE DME "MOD UE KC"|
20|FH_F148939_62650_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F93961_0_0|SrvcGrp|91860|2022|PDM|611.00|99|0.00|ENDOSCOPY PROCEDURES|
20|FH_F94643_90501_0|SrvcGrp|86827|2022|PDM|75.00|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F36590_0_0|SrvcGrp|16|2022|PDM|855.00|99|0.00|ACUTE REHABILITATION|
20|FH_F134847_0_0|CSTM-ALL|CSTM-00|2020|PDM|2218.00|99|0.00|AEG 4 (NO REV)|
20|FH_F134603_0_0|CSTM-ALL|CSTM-00|2020|PDM|3499.00|99|0.00|AEG 5  (NO REV)|
20|FH_F40653_0_0|SrvcGrp|33152|2022|PCT|0.90|99|0.00|STEREOTACTIC RADIOSURGERY|
20|FH_F112755_43215_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117799_0_0|SrvcGrp|67065|2022|PDM|19627.00|99|0.00|CERVICAL SURGERY|
20|FH_F111266_30339_0|SrvcGrp|86857|2022|PDM|10.00|99|0.00|AETNA CYTOPATHOLOGY|
20|FH_F124739_64429_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F39211_0_0|SrvcGrp|30202|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KF (DME)|
20|FH_F46284_0_0|SrvcGrp|24639|2022|PDM|147.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F34853_0_0|CSTM-ALL|CSTM-00|2020|PDM|3383.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F138018_17313_0|SrvcGrp|26871|2022|PDM|103.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3 HRS|
20|FH_F98940_70506_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F124727_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F98001_27603_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114204_53191_0|SrvcGrp|472|2022|PDM|410.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F113957_73554_0|SrvcGrp|75507|2022|PCT|1.25|99|0.00|CHEMOTHERAPY|
20|FH_F150982_0_0|SrvcGrp|33987|2022|PDM|2147.00|99|0.00|CPT 57522|
20|FH_F34882_0_0|SrvcGrp|16|2022|PDM|1124.00|99|0.00|ACUTE REHABILITATION|
20|FH_F140233_35216_0|SrvcGrp|90376|2022|PDM|10500.00|99|0.00|REVISION OF KNEE JOINTLANT|
20|FH_F140233_35216_0|CSTM-ALL|CSTM-00|2020|PDM|2600.00|99|0.00|AEG 9 (NO REV)|
20|FH_F143447_53204_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F101752_0_0|SrvcGrp|75506|2022|PCT|0.90|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F131104_98007_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132427_33853_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F132495_33157_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F119998_39823_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F120871_14068_0|SrvcGrp|73841|2022|PDM|500.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F120885_66224_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA ANCD OCN F/S PRICING - IP|
20|FH_F126243_32132_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F113595_29527_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F113649_01752_0|SrvcGrp|24744|2022|PDM|90.00|99|0.00|PICC LINE INSERTION|
20|FH_F51276_0_0|SrvcGrp|22594|2022|PDM|80.00|99|0.00|IMIGLUCERASE|
20|FH_F69347_0_0|SrvcGrp|30623|2022|PDM|7550.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F103281_32086_0|SrvcGrp|537|2022|PDM|4500.00|99|0.00|OBSERVATION SERVICES|
20|FH_F35411_0_0|SrvcGrp|9510|2022|PDM|875.00|99|0.00|SKILLED NURSING CARE|
20|FH_F47479_0_0|SrvcGrp|42973|2022|PDM|70.00|99|0.00|SPEECH  THERAPIST|
20|FH_F34706_0_0|SrvcGrp|2115|2022|PDM|17904.00|99|0.00|DRG 120 OTH CIRCULATORY OR PROC|
20|FH_F117725_38036_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F148021_80907_0|SrvcGrp|90339|2022|PDM|100.00|99|0.00|SKILLED NURSING RN|
20|FH_F141835_78676_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F148867_20191_0|SrvcGrp|48396|2022|PDM|124.00|99|0.00|OT SERVICES|
20|FH_F85340_98195_0|CSTM-ALL|CSTM-00|2020|PCT|2.83|99|0.00|AETNA - APC GROUPER L|
20|FH_F81838_0_0|SrvcGrp|9228|2022|PDM|83.00|99|0.00|RESPIRATORY THERAPY SVCS|
20|FH_F111702_07652_0|SrvcGrp|104475|2022|PCT|1.00|99|0.00|INJ FILGRASTIM EXCL BIOSIMIL|
20|FH_F130017_02302_0|SrvcGrp|72602|2022|PDM|832.91|99|0.00|ECT|
20|FH_F71669_0_0|SrvcGrp|46903|2022|PDM|480.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F126063_43078_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F133749_84604_0|SrvcGrp|48393|2022|PDM|36.00|99|0.00|SKILLED NURSING SERVICES (PER HOUR)|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|1818.28|99|0.00|HAPA WPA-NWPA 2012-13 ASC 14 W/O REV|
20|FH_F110465_30328_0|SrvcGrp|89149|2022|PDM|297.00|99|0.00|OP INTENSIVE|
20|FH_F115865_78621_0|SrvcGrp|472|2022|PDM|420.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133589_54722_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133133_32433_0|SrvcGrp|89149|2022|PDM|200.00|99|0.00|OP INTENSIVE|
20|FH_F92276_32308_0|SrvcGrp|88978|2022|PDM|3087.00|99|0.00|VAGINAL DELIVERY|
20|FH_F127375_28621_0|CSTM-ALL|CSTM-00|2020|PCT|0.69|99|0.00|OP SVCS|
20|FH_F114980_78061_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F118056_29464_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F102185_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93212_0_0|SrvcGrp|80999|2022|PCT|0.00|99|0.00|AETNA CARDIAC CATH|
20|FH_F72183_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|ASPG II - FH SW CUSTOM GROUPERS|
20|FH_F32888_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F122649_0_0|SrvcGrp|53746|2022|PDM|112.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F110132_23451_0|SrvcGrp|48394|2022|PDM|40.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F88398_15601_0|SrvcGrp|53987|2022|PDM|40.90|99|0.00|PHOTOTHERAPY|
20|FH_F88639_80204_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F93185_63141_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F114092_83350_0|SrvcGrp|112047|2022|PCT|2.80|99|0.00|RADIOLOGY|
20|FH_F119021_03060_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F70665_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F97780_43614_0|SrvcGrp|73643|2022|PDM|1784.00|99|0.00|AETNA SUBACUTE CARE|
20|FH_F87054_0_0|SrvcGrp|84123|2022|PDM|2100.00|99|0.00|INSERT ANT SEGMENT DRAIN EXT|
20|FH_F116485_17033_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F39398_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F128360_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F139662_51106_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F118651_0_0|CSTM-ALL|CSTM-00|2020|PDM|1591.35|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_F94643_90501_0|SrvcGrp|17014|2022|PDM|38.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F90817_0_0|SrvcGrp|91005|2022|PDM|1198.00|99|0.00|FUSION OF FINGER JOINT (HCFA)|
20|FH_F35781_33133_0|CSTM-ALL|CSTM-00|2020|PCT|0.57|99|0.00|GENERAL ACUTE CARE|
20|FH_F123745_0_0|SrvcGrp|71666|2022|PDM|15000.00|99|0.00|CPT 63655|
20|FH_F117629_06514_0|SrvcGrp|472|2022|PDM|691.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F114707_0_0|SrvcGrp|82981|2022|PDM|90.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F110360_0_0|CSTM-ALL|CSTM-00|2020|PDM|857.50|99|0.00|AEG 10 (NO REV)|
20|FH_F117901_27526_0|SrvcGrp|104847|2022|PCT|0.95|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F118393_21032_0|SrvcGrp|472|2022|PDM|549.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F133129_45863_0|CSTM-ALL|CSTM-00|2020|PDM|699.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F44135_0_0|SrvcGrp|36068|2022|PDM|47.00|99|0.00|SKILLED NURSING NON IV RELATED|
20|FH_F148555_0_0|CSTM-ALL|CSTM-00|2020|PDM|712.00|99|0.00|AEG 10 (NO REV)|
20|FH_F145988_06105_0|SrvcGrp|31324|2022|PCT|1.00|99|0.00|TRAUMA|
20|FH_F38770_0_0|SrvcGrp|12596|2022|PCT|0.55|99|0.00|OP RADIOLOGY|
20|FH_F148903_51101_0|SrvcGrp|48394|2022|PDM|53.05|99|0.00|SKILLED NURSING SERVICES|
20|FH_F132541_39120_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F87592_85614_0|SrvcGrp|73488|2022|PCT|1.00|99|0.00|AETNA HOSPITAL OP DIALYSIS|
20|FH_F130636_78572_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F98620_43920_0|SrvcGrp|73601|2022|PDM|7953.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F69104_0_0|SrvcGrp|17075|2022|PDM|1672.71|99|0.00|ASPG VI|
20|FH_F123085_21921_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F46473_0_0|CSTM-ALL|CSTM-00|2020|PDM|611.00|99|0.00|ASPG I|
20|FH_F121404_32216_0|SrvcGrp|108777|2022|PDM|133.00|99|0.00|RAD W/O BACKUP NON-INV INTFC (MOD KH, KI, KJ, KX, RR) (HCFA)|
20|FH_F133808_73401_0|SrvcGrp|88621|2022|PDM|85.00|99|0.00|SKILLED NURSING LPN|
20|FH_F126341_27284_0|SrvcGrp|82821|2022|PDM|37.50|99|0.00|INJECTION, IMMUNE GLOBULIN (BIVIGAM)|
20|FH_F57453_0_0|SrvcGrp|11663|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F71843_0_0|CSTM-ALL|CSTM-00|2020|PDM|24.60|99|0.00|HAPA WPA-NWPA 2012-13 ASC 1001 W/O REV|
20|FH_F46113_0_0|SrvcGrp|13368|2022|PCT|0.88|99|0.00|OP SURGERY|
20|FH_F123616_30117_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F31714_0_0|SrvcGrp|9059|2022|PDM|17200.00|99|0.00|DRG 497 ONLY|
20|FH_F115966_16801_0|SrvcGrp|88781|2022|PDM|74.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F35216_0_0|SrvcGrp|11336|2022|PCT|0.60|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F135173_06519_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F139551_0_0|SrvcGrp|96539|2022|PDM|7400.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F40605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F139580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F55532_0_0|SrvcGrp|471|2022|PDM|825.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F130747_0_0|SrvcGrp|27261|2022|PDM|26010.00|99|0.00|CPT 27446|
20|FH_F148265_06067_0|SrvcGrp|114225|2022|PDM|13536.00|99|0.00|UPPER EXTREMITY|
20|FH_F137067_0_0|SrvcGrp|90063|2022|PDM|6825.00|99|0.00|REPAIR BICEPS TENDON RUPTURE|
20|FH_F83257_32404_0|SrvcGrp|33166|2022|PDM|420.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F62886_0_0|SrvcGrp|58834|2022|PCT|1.05|99|0.00|OCN F/S HOME HEALTH/HIVT/DME/HOSPICE|
20|FH_F137047_73120_0|SrvcGrp|73559|2022|PDM|1545.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F53732_0_0|SrvcGrp|50165|2022|PDM|88.00|99|0.00|ANTI INFECTIVE THERAPY - 1 DOSE IN EVERY 4 HRS|
20|FH_F140760_07003_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PHYSICIAN CLINIC VISIT NATL F/S (MOD 26)|
20|FH_F77862_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F91622_0_0|SrvcGrp|16429|2022|PDM|1351.00|99|0.00|OBSERVATION SVCS|
20|FH_F148549_60523_0|SrvcGrp|48398|2022|PDM|120.00|99|0.00|PT SERVICES|
20|FH_F79746_0_0|SrvcGrp|42404|2022|PCT|1.00|99|0.00|VENIPUNCTURE|
20|FH_F125062_0_0|CSTM-ALL|CSTM-00|2020|PCT|96.00|99|0.00|OP SVCS|
20|FH_F35202_0_0|SrvcGrp|8962|2022|PDM|84.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F118366_17110_0|SrvcGrp|80918|2022|PDM|100.00|99|0.00|RESPITE CARE|
20|FH_F137231_25550_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F132627_0_0|SrvcGrp|14494|2022|PDM|291.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F132627_0_0|SrvcGrp|22589|2022|PDM|80.58|99|0.00|CHEMOTHERAPY NOC|
20|FH_F33825_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132348_16214_0|CSTM-ALL|CSTM-00|2020|PCT|1.05|99|0.00|AETNA ANCD OCN F/S PRICING W/O HOME HEALTH|
20|FH_F129761_43920_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114666_30342_0|CSTM-ALL|CSTM-00|2020|PDM|572.00|99|0.00|AEG 1 (NO REV)|
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|2887.00|99|0.00|AEG 9 (NO REV)|
20|FH_F112947_47303_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F138876_25302_0|SrvcGrp|86834|2022|PDM|15.00|99|0.00|HCPCS S9559 (HCFA)|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|400.00|99|0.00|HAPA WPA-NWPA 2012-13 ASC 107 W/O REV|
20|FH_F145528_76501_0|SrvcGrp|48396|2022|PDM|113.00|99|0.00|OT SERVICES|
20|FH_F91735_92653_0|SrvcGrp|87401|2022|PDM|52.50|99|0.00|HCPCS G0156 (HCFA)|
20|FH_F119892_47586_0|SrvcGrp|29347|2022|PDM|20.00|99|0.00|HOME HEALTH AIDE|
20|FH_F69123_0_0|SrvcGrp|43567|2022|PDM|80.00|99|0.00|SKILLED NURSING - POSTNATAL|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|487.00|99|0.00|HAPA EPA ASC 2|
20|FH_F94643_90501_0|SrvcGrp|14948|2022|PDM|225.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F114024_0_0|SrvcGrp|75479|2022|PDM|425.00|99|0.00|AEG 1|
20|FH_F63301_0_0|CSTM-ALL|CSTM-00|2020|PDM|135.00|99|0.00|PEDS OT SVCS (MOD TJ)|
20|FH_F130649_98055_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F112853_22408_0|SrvcGrp|90340|2022|PDM|110.00|99|0.00|SKILLED NURSING LPN|
20|FH_F45752_0_0|CSTM-ALL|CSTM-00|2020|PDM|1005.00|99|0.00|ASPG IV|
20|FH_F144011_60616_0|SrvcGrp|29817|2022|PDM|5928.00|99|0.00|MS DRG 767-768, 774-775  ONLY NORMAL DELIVERY|
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1114.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 5|
20|FH_F40728_0_0|CSTM-ALL|CSTM-00|2020|PDM|2019.00|99|0.00|ASPG IX|
20|FH_F132934_63005_0|SrvcGrp|4109|2022|PDM|1267.00|99|0.00|ACUTE PSYCH|
20|FH_F146792_0_0|CSTM-ALL|CSTM-00|2020|PDM|3846.00|99|0.00|AEG 7 (NO REV)|
20|FH_F38016_0_0|SrvcGrp|997|2022|PCT|0.60|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F148425_01507_0|SrvcGrp|113171|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F148548_37909_0|CSTM-ALL|CSTM-00|2020|PDM|1800.00|99|0.00|AEG 5  (NO REV)|
20|FH_F113074_0_0|SrvcGrp|105013|2022|PDM|1950.00|99|0.00|AETNA RETNAL CODES|
20|FH_F89851_83854_0|SrvcGrp|88036|2022|PDM|5162.00|99|0.00|IMPLANT NEUROELECTRODES|
20|FH_F150883_14727_0|SrvcGrp|74694|2022|PDM|1819.65|99|0.00|AETNA INPATIENT SERVICES|
20|FH_F133095_30024_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F106580_33321_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F118845_71111_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F113139_0_0|CSTM-ALL|CSTM-00|2020|PDM|520.00|99|0.00|AEG 1 (NO REV)|
20|FH_F113906_0_0|SrvcGrp|73006|2022|PDM|665.00|99|0.00|AEG 9|
20|FH_F134662_54853_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F50334_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145926_45243_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F133748_77081_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F110343_38139_0|SrvcGrp|86746|2022|PCT|1.10|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F134568_12946_0|SrvcGrp|473|2022|PDM|450.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F109513_0_0|SrvcGrp|90435|2022|PDM|5300.00|99|0.00|NECK SPINE DISK SURGERY|
20|FH_F134027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F135761_70127_0|SrvcGrp|46903|2022|PDM|1550.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F97143_80012_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F87153_0_0|CSTM-ALL|CSTM-00|2020|PDM|114.61|99|0.00|AETNA POLYSOMNOGRAPHY (MOD 26)|
20|FH_F148243_0_0|SrvcGrp|12491|2022|PCT|1.00|99|0.00|PACEMAKER|
20|FH_F101620_47401_0|SrvcGrp|3178|2022|PDM|876.00|99|0.00|ACUTE PSYCH|
20|FH_F149641_87113_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F150442_28451_0|SrvcGrp|99073|2022|PCT|1.00|99|0.00|INJ BUPIVACAINE LIPOSOME|
20|FH_F119444_72903_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F119095_08536_0|CSTM-ALL|CSTM-00|2020|PCT|0.72|99|0.00|GENERAL ACUTE CARE|
20|FH_F57592_0_0|SrvcGrp|11000|2022|PCT|0.50|99|0.00|OP IMPLANTS/PROSTHETICS/ORTHOTICS|
20|FH_F92833_0_0|SrvcGrp|84278|2022|PDM|2992.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F44607_0_0|SrvcGrp|35670|2022|PDM|22000.00|99|0.00|SPINAL NEUROSTIMULATORS PROCEDURE|
20|FH_F87362_15746_0|SrvcGrp|75545|2022|PDM|352.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
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_F133627_89113_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F151085_15905_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F151159_46322_0|SrvcGrp|46605|2022|PDM|115.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F60112_0_0|SrvcGrp|42828|2022|PDM|84.50|99|0.00|SPEECH THERAPY VISIT|
20|FH_F98002_27103_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F127486_06776_0|SrvcGrp|46104|2022|PDM|115.50|99|0.00|HOME VISIT - PRENATAL|
20|FH_F139723_30066_0|SrvcGrp|113132|2022|PCT|1.00|99|0.00|COVID-19 TESTING CODES|
20|FH_F142376_0_0|SrvcGrp|113966|2022|PDM|4221.00|99|0.00|PERQ LAMOT/LAM CRV/THRC|
20|FH_F69142_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|CMS SNF PART B SERVICES|
20|FH_F143748_02904_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111288_0_0|SrvcGrp|42550|2022|PDM|2552.00|99|0.00|OP SURGERY CPT 66984|
20|FH_F93880_95476_0|SrvcGrp|82242|2022|PCT|1.10|99|0.00|AETNA PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY|
20|FH_F150462_30458_0|SrvcGrp|17008|2022|PDM|50.00|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 4HRS|
20|FH_F137454_64068_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F73985_0_0|SrvcGrp|33132|2022|PDM|191.00|99|0.00|OP OFFICE VISIT|
20|FH_F39041_0_0|CSTM-ALL|CSTM-00|2020|PDM|6085.00|99|0.00|MS DRG 765-766 C-SECTION|
20|FH_F37753_0_0|SrvcGrp|27266|2022|PCT|0.80|99|0.00|SPLINTS - HCPCS|
20|FH_F140873_0_0|SrvcGrp|104230|2022|PDM|152.00|99|0.00|RESPITE CARE (HCFA)|
20|FH_F43867_0_0|SrvcGrp|35468|2022|PDM|75.00|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F112092_46845_0|SrvcGrp|93267|2022|PCT|1.00|99|0.00|INJECTION|
20|FH_F87534_19464_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126853_19053_0|SrvcGrp|23683|2022|PDM|35.00|99|0.00|SKILLED NURSING RN|
20|FH_F150679_32534_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149049_28401_0|CSTM-ALL|CSTM-00|2020|PDM|200.00|99|0.00|AEG 10 (NO REV)|
20|FH_F149585_46012_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F121306_32207_0|SrvcGrp|92760|2022|PCT|1.07|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F141833_31707_0|SrvcGrp|2067|2022|PDM|1275.00|99|0.00|SPECIALTY CARE TRANSPORT|
20|FH_F144191_0_0|CSTM-ALL|CSTM-00|2020|PDM|1700.00|99|0.00|AEG 7 (NO REV)|
20|FH_F100661_63640_0|SrvcGrp|73485|2022|PDM|3150.00|99|0.00|AETNA REHAB|
20|FH_F35176_0_0|SrvcGrp|8962|2022|PDM|82.50|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F117786_71446_0|CSTM-ALL|CSTM-00|2020|PCT|0.64|99|0.00|GENERAL ACUTE CARE|
20|FH_F118704_0_0|SrvcGrp|107748|2022|PDM|1519.00|99|0.00|HEMODIALYSIS IN CENTER|
20|FH_F125348_84660_0|SrvcGrp|87131|2022|PDM|457.00|99|0.00|AMB DETOX AND DRUG REHAB|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|139.00|99|0.00|HAPA EPA ASC 22|
20|FH_F100665_07939_0|SrvcGrp|73461|2022|PDM|11510.00|99|0.00|AETNA NICU IV|
20|FH_F128564_43235_0|SrvcGrp|94780|2022|PDM|138.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F133307_14580_0|SrvcGrp|82981|2022|PDM|125.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F118661_0_0|SrvcGrp|107808|2022|PDM|1079.00|99|0.00|AETNA AEG 2 W/O DIGESTIVE/PROF SVCS|
20|FH_F124789_44514_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F109244_19808_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F117300_0_0|CSTM-ALL|CSTM-00|2020|PDM|2138.00|99|0.00|AEG 3 (NO REV)|
20|FH_F126484_30078_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F81835_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F113906_0_0|SrvcGrp|73004|2022|PDM|665.00|99|0.00|AEG 8|
20|FH_F130763_0_0|SrvcGrp|84910|2022|PDM|4367.00|99|0.00|ENDOSCOPY|
20|FH_F35966_0_0|SrvcGrp|19609|2022|PDM|38.50|99|0.00|NONEMERGENCY TRANSPORTATION, WHEELCHAIR VAN|
20|FH_F134398_0_0|CSTM-ALL|CSTM-00|2020|PDM|530.00|99|0.00|AEG 3 (NO REV)|
20|FH_F150147_24541_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|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_F146461_75428_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138584_30912_0|SrvcGrp|113405|2022|PDM|750.00|99|0.00|PALATAL OR MAXILLARY FRACTURE|
20|FH_F138627_82901_0|SrvcGrp|99034|2022|PDM|105.00|99|0.00|ANTIBIOTIC Q18H (HCFA)|
20|FH_F40402_0_0|SrvcGrp|97|2022|PDM|1273.00|99|0.00|C-SECTION|
20|FH_F129504_02871_0|SrvcGrp|23683|2022|PDM|54.00|99|0.00|SKILLED NURSING RN|
20|FH_F137812_12118_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F39303_0_0|SrvcGrp|43|2022|PCT|0.80|99|0.00|IMPLANTS|
20|FH_F109652_0_0|SrvcGrp|78839|2022|PDM|501.00|99|0.00|DIALYSIS|
20|FH_F109652_0_0|SrvcGrp|103698|2022|PDM|125.00|99|0.00|RADIOLOGY SERVICES|
20|FH_F110720_0_0|SrvcGrp|97139|2022|PDM|4882.00|99|0.00|LAMINECTOMY W/FACETECTOMY|
20|FH_F109513_0_0|SrvcGrp|90434|2022|PDM|2000.00|99|0.00|BREAST RECONSTRUCTION|
20|FH_F79025_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F81731_0_0|SrvcGrp|92607|2022|PDM|695.00|99|0.00|SUB-ACUTE CARE LEVEL IV|
20|FH_F122610_73139_0|SrvcGrp|108818|2022|PCT|0.50|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F131529_0_0|SrvcGrp|73656|2022|PDM|475.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F116393_07002_0|SrvcGrp|111275|2022|PDM|17.48|99|0.00|ASSAY, IGA/IGD/IGG/IGM EACH|
20|FH_F38808_0_0|SrvcGrp|17077|2022|PDM|1095.00|99|0.00|ASPG VII|
20|FH_F135925_32548_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F136188_04005_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F131407_07607_0|SrvcGrp|21920|2022|PDM|30.00|99|0.00|UNCLASSIFIED INFUSION THERAPY|
20|FH_F111363_33169_0|SrvcGrp|111184|2022|PDM|7104.00|99|0.00|GASTRIC SLEEVE WITH HERNIA REPAIR|
20|FH_F134290_67209_0|SrvcGrp|90854|2022|PDM|824.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F102282_06795_0|SrvcGrp|89781|2022|PDM|151.62|99|0.00|RESPITE CARE (HCFA)|
20|FH_F31087_0_0|SrvcGrp|1168|2022|PDM|33.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F150925_33936_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F117581_21211_0|SrvcGrp|104307|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F136668_0_0|CSTM-ALL|CSTM-00|2020|PDM|2000.00|99|0.00|AEG 6 (NO REV)|
20|FH_F150024_08079_0|CSTM-ALL|CSTM-00|2020|PDM|832.00|99|0.00|AEG 2 (NO REV)|
20|FH_F117911_86403_0|SrvcGrp|48398|2022|PDM|125.00|99|0.00|PT SERVICES|
20|FH_F102561_75146_0|SrvcGrp|98010|2022|PDM|435.00|99|0.00|DEBRIDEMENT-SUBCUTANEOUS TISSUE|
20|FH_F129175_0_0|SrvcGrp|110767|2022|PDM|95.81|99|0.00|2ND LEVEL INJ PARAVERT F JNT L/S|
20|FH_F101840_76054_0|SrvcGrp|19846|2022|PDM|14730.00|99|0.00|MS DRG 249 ONLY|
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|1531.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 8|
20|FH_F130573_02882_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F147995_67037_0|SrvcGrp|72984|2022|PCT|1.00|99|0.00|CHEMOTHERAPY|
20|FH_F117230_0_0|CSTM-ALL|CSTM-00|2020|PDM|1040.00|99|0.00|AEG 4 (NO REV)|
20|FH_F121980_66104_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F63229_0_0|SrvcGrp|59395|2022|PDM|290.00|99|0.00|CCPD|
20|FH_F142376_0_0|SrvcGrp|113971|2022|PDM|462.00|99|0.00|SPINAL FLUID TAP DIAGNO 5|
20|FH_F149148_15330_0|SrvcGrp|88620|2022|PDM|91.00|99|0.00|SKILLED NURSING RN|
20|FH_F119613_90035_0|SrvcGrp|75419|2022|PDM|550.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F121476_0_0|SrvcGrp|108865|2022|PDM|7249.00|99|0.00|PACEMAKER DUAL CHAMBER|
20|FH_F103122_0_0|CSTM-ALL|CSTM-00|2020|PDM|446.00|99|0.00|AEG 2 (NO REV)|
20|FH_F145781_0_0|SrvcGrp|89404|2022|PDM|11500.00|99|0.00|AETNA TOTAL HIP ARTHROPLASTY|
20|FH_F127199_0_0|SrvcGrp|63297|2022|PDM|114.00|99|0.00|HOSPICE CARE/ IN HOME S9126|
20|FH_F51136_0_0|CSTM-ALL|CSTM-00|2020|PDM|1475.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116040_24637_0|SrvcGrp|86828|2022|PDM|45.00|99|0.00|HCPCS S5521 (HCFA)|
20|FH_F35216_0_0|SrvcGrp|1943|2022|PDM|850.00|99|0.00|NEONATAL INTENSVE CARE II & III|
20|FH_F100742_00616_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F121539_27511_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F129679_20850_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F148663_48601_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F37587_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OP SVCS|
20|FH_F98801_93274_0|SrvcGrp|73602|2022|PDM|4683.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F150527_33844_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F125368_24153_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F43539_0_0|SrvcGrp|38022|2022|PDM|65.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F37778_0_0|CSTM-ALL|CSTM-00|2020|PDM|1749.00|99|0.00|ASPG VII|
20|FH_F101840_76054_0|SrvcGrp|26672|2022|PDM|19719.00|99|0.00|MS DRG 462 ONLY|
20|FH_F115543_0_0|SrvcGrp|106235|2022|PDM|1600.00|99|0.00|CYPASS|
20|FH_F130775_61701_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120417_63124_0|CSTM-ALL|CSTM-00|2020|PDM|745.00|99|0.00|AEG 4 (NO REV)|
20|FH_F138302_15701_0|SrvcGrp|13929|2022|PDM|10.00|99|0.00|GROWTH HORMONE|
20|FH_F90496_13159_0|SrvcGrp|86722|2022|PDM|140.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F150145_20124_0|CSTM-ALL|CSTM-00|2020|PDM|1301.00|99|0.00|RESIDENT TRTMNT-EATING DISORDERS|
20|FH_F105143_26062_0|SrvcGrp|102341|2022|PDM|744.00|99|0.00|ER LEVEL II W/ SURGERY|
20|FH_F133581_84790_0|CSTM-ALL|CSTM-00|2020|PDM|1041.55|99|0.00|AEG 4 (NO REV)|
20|FH_F133478_40165_0|SrvcGrp|42783|2022|PCT|0.00|99|0.00|HIGH COST DRUGS|
20|FH_F131702_17022_0|SrvcGrp|48385|2022|PDM|117.00|99|0.00|SPEECH THERAPY|
20|FH_F148348_16803_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F126439_92627_0|SrvcGrp|73063|2022|PDM|880.00|99|0.00|OBSERVATION SERVICES|
20|FH_F122687_0_0|SrvcGrp|89848|2022|PDM|12020.00|99|0.00|SPINE FUSION EXTRA SEGMENT|
20|FH_F128887_57225_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F147941_06023_0|SrvcGrp|46769|2022|PDM|167.00|99|0.00|CPT CODE 90853 PER VISIT|
20|FH_F138214_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F77504_0_0|SrvcGrp|33236|2022|PCT|1.00|99|0.00|ORTHOTICS/PROSTHETICS/IMPLANTS|
20|FH_F32521_0_0|CSTM-ALL|CSTM-00|2020|PCT|95.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F38591_0_0|SrvcGrp|12280|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F133211_0_0|SrvcGrp|111926|2022|PDM|35.91|99|0.00|COVID-19 LAB TESTING|
20|FH_F80771_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31525_0_0|SrvcGrp|109|2022|PDM|490.00|99|0.00|CD - DETOX|
20|FH_F91039_0_0|CSTM-ALL|CSTM-00|2020|PDM|753.00|99|0.00|AEG 5  (NO REV)|
20|FH_F114389_50131_0|SrvcGrp|86827|2022|PDM|123.08|99|0.00|HCPCS S5522 (HCFA)|
20|FH_F134687_14226_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F41463_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F54552_0_0|SrvcGrp|33166|2022|PDM|635.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|2860.00|99|0.00|AEG 9 (NO REV)|
20|FH_F85353_16407_0|SrvcGrp|63807|2022|PDM|616.25|99|0.00|HAPA WPA-NWPA 2012-13 ASC 201|
20|FH_F43197_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME FS 3247 GLOBAL|
20|FH_F100782_0_0|SrvcGrp|105173|2022|PDM|1046.50|99|0.00|WINDBER MEDICAL CNTR ASC 1201|
20|FH_F133775_83401_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78524_0_0|CSTM-ALL|CSTM-00|2020|PDM|90.00|99|0.00|OP SVCS|
20|FH_F110509_71351_0|SrvcGrp|75506|2022|PCT|1.25|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F150148_71901_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F39776_0_0|SrvcGrp|13297|2022|PCT|1.00|99|0.00|IMPLANTS|
20|FH_F34422_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|140.43|99|0.00|HAPA WPA-NWPA 2012-13 ASC 133 W/O REV|
20|FH_F36439_0_0|SrvcGrp|23002|2022|PDM|1300.00|99|0.00|V5259|
20|FH_F86332_75081_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F48998_0_0|SrvcGrp|43892|2022|PDM|18.00|99|0.00|PHYSICAL THERAPY VISIT|
20|FH_F32097_0_0|CSTM-ALL|CSTM-00|2020|PCT|97.00|99|0.00|OP SVCS|
20|FH_F72830_0_0|SrvcGrp|70048|2022|PDM|2900.00|99|0.00|CVTY ENHANCED + REV CODE ASPG 8|
20|FH_F148265_06067_0|SrvcGrp|97730|2022|PDM|22560.00|99|0.00|REVERSE HIP JOINT|
20|FH_F131321_38135_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F86332_75081_0|SrvcGrp|12076|2022|PDM|30.00|99|0.00|HOME THERAPY|
20|FH_F149086_0_0|SrvcGrp|29155|2022|PDM|169.00|99|0.00|HOSPICE SVCS|
20|FH_F34487_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|2004 NATIONAL DME F/S NV - MOD AU|
20|FH_F91819_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F91617_0_0|CSTM-ALL|CSTM-00|2020|PDM|500.00|99|0.00|PROLONGED SERVICE (MOD 25)|
20|FH_F116955_16801_0|SrvcGrp|48396|2022|PDM|90.00|99|0.00|OT SERVICES|
20|FH_F122687_0_0|SrvcGrp|88159|2022|PDM|8742.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F137352_43912_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F136373_17055_0|SrvcGrp|48394|2022|PDM|120.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F93180_73772_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|GENERAL ACUTE CARE|
20|FH_F132733_0_0|SrvcGrp|16|2022|PDM|1616.00|99|0.00|ACUTE REHABILITATION|
20|FH_F149374_38855_0|SrvcGrp|46903|2022|PDM|600.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F80366_0_0|SrvcGrp|73004|2022|PCT|0.94|99|0.00|AEG 8|
20|FH_F129438_08234_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F113744_80301_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F72845_0_0|CSTM-ALL|CSTM-00|2020|PDM|3392.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F124613_64735_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F144039_0_0|SrvcGrp|84279|2022|PDM|9754.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F141170_0_0|SrvcGrp|103590|2022|PDM|6000.00|99|0.00|CAROTID ART|
20|FH_F134087_0_0|SrvcGrp|93432|2022|PDM|10455.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F136096_02860_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F100880_67735_0|SrvcGrp|20677|2022|PCT|0.49|99|0.00|HYPERBARIC OXYGEN|
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_F69202_0_0|SrvcGrp|9936|2022|PDM|125.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F131495_77407_0|SrvcGrp|73701|2022|PDM|30.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F123745_0_0|SrvcGrp|109571|2022|PDM|7500.00|99|0.00|REPAIR OF ANKLE FRACTURE|
20|FH_F138017_73129_0|SrvcGrp|54962|2022|PDM|6883.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)|
20|FH_F150929_17325_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F115330_34113_0|SrvcGrp|89149|2022|PDM|150.00|99|0.00|OP INTENSIVE|
20|FH_F133015_36305_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F143578_63033_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F81838_0_0|SrvcGrp|3809|2022|PDM|616.00|99|0.00|HOSPICE CARE|
20|FH_F144228_0_0|CSTM-ALL|CSTM-00|2020|PDM|2275.00|99|0.00|AEG 6 (NO REV)|
20|FH_F54592_0_0|SrvcGrp|33166|2022|PDM|635.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F72963_0_0|SrvcGrp|17081|2022|PDM|5535.00|99|0.00|ASPG IX|
20|FH_F102200_06416_0|SrvcGrp|86843|2022|PDM|45.00|99|0.00|HCPCS S9329 (HCFA)|
20|FH_F133658_60053_0|SrvcGrp|46605|2022|PDM|125.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F137239_0_0|SrvcGrp|89417|2022|PDM|451.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F118168_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F97540_32114_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F138636_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F94942_0_0|SrvcGrp|105399|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F128002_27260_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148170_04005_0|SrvcGrp|13683|2022|PDM|1230.82|99|0.00|ADVANCED LIFE SUPPORT (ALS) LEVEL 2|
20|FH_F119384_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39943_0_0|SrvcGrp|526|2022|PDM|1850.00|99|0.00|CARDIAC CARE UNIT|
20|FH_F132051_74464_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F88335_71019_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F129115_85716_0|SrvcGrp|104079|2022|PCT|1.00|99|0.00|AETNA OP THERAPY SERVICE|
20|FH_F38320_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F141527_36830_0|SrvcGrp|113820|2022|PCT|1.05|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F130350_0_0|CSTM-ALL|CSTM-00|2020|PDM|1509.00|99|0.00|AEG 9 (NO REV)|
20|FH_F130747_0_0|SrvcGrp|26275|2022|PDM|5202.00|99|0.00|CPT 29826|
20|FH_F86752_0_0|SrvcGrp|75487|2022|PDM|932.00|99|0.00|AEG 5|
20|FH_F137087_0_0|SrvcGrp|54962|2022|PDM|9250.00|99|0.00|RECONSTRUCTION OF SHOULDER CUFF (ROTATOR)|
20|FH_F86872_15215_0|SrvcGrp|86825|2022|PDM|90.00|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F141274_0_0|SrvcGrp|113738|2022|PDM|10.00|99|0.00|LABORATORY (MOD 26)|
20|FH_F151608_30236_0|SrvcGrp|96539|2022|PDM|7840.00|99|0.00|REVISION OF ANKLE LIGAMENT|
20|FH_F112064_0_0|SrvcGrp|103899|2022|PDM|165.00|99|0.00|HOSPICE OR HOME HLTH IN HOME|
20|FH_F82432_0_0|SrvcGrp|80919|2022|PDM|105.00|99|0.00|HOSPICE CARE (ALL OTHER)|
20|FH_F124059_64055_0|SrvcGrp|46605|2022|PDM|50.00|99|0.00|CLINICAL SOCIAL WORKER SERVICES|
20|FH_F124679_64052_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F81893_23114_0|SrvcGrp|106676|2022|PDM|388.00|99|0.00|VENOUS DOPPLER|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PDM|734.00|99|0.00|ASPG X|
20|FH_F115144_71373_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F116173_40217_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F138700_76802_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|536.25|99|0.00|HAPA WPA-NWPA 2012-13 ASC 202 W/O REV|
20|FH_F100763_24202_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
20|FH_F33725_0_0|CSTM-ALL|CSTM-00|2020|PDM|75.00|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F111363_33169_0|SrvcGrp|107506|2022|PDM|231.00|99|0.00|X-RAY EXAM CHEST TWO VIEWS|
20|FH_F130120_75862_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F150662_20901_0|SrvcGrp|88621|2022|PDM|135.00|99|0.00|SKILLED NURSING LPN|
20|FH_F150745_03301_0|SrvcGrp|46104|2022|PDM|161.00|99|0.00|HOME VISIT - PRENATAL|
20|FH_F92154_74023_0|CSTM-ALL|CSTM-00|2020|PCT|0.71|99|0.00|OP SVCS|
20|FH_F108460_32746_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F41463_0_0|SrvcGrp|30076|2022|PDM|107.60|99|0.00|IMPLANTS, PROSTHETICS, OR SUPPLIES|
20|FH_F131356_19131_0|SrvcGrp|76501|2022|PDM|385.00|99|0.00|SUB-ACUTE - LEVEL I|
20|FH_F98020_50138_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F123486_61764_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F103902_89118_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F139551_0_0|SrvcGrp|93432|2022|PDM|17500.00|99|0.00|REVIS RECONSTRUCT SHOULDER JOINT|
20|FH_F143894_70001_0|CSTM-ALL|CSTM-00|2020|PCT|2.00|99|0.00|HSS APC GROUPED|
20|FH_F77504_0_0|SrvcGrp|10014|2022|PDM|1275.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F70510_0_0|SrvcGrp|14494|2022|PDM|32.00|99|0.00|CONTINUOUS HOMECARE|
20|FH_F75307_0_0|SrvcGrp|46424|2022|PDM|105.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F109926_0_0|CSTM-ALL|CSTM-00|2020|PDM|1235.00|99|0.00|AEG 8 (NO REV)|
20|FH_F134254_33462_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F137147_75006_0|SrvcGrp|28120|2022|PDM|36309.00|99|0.00|MS DRG 467 ONLY|
20|FH_F140787_66427_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F140875_63363_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F129511_44044_0|SrvcGrp|23683|2022|PDM|45.00|99|0.00|SKILLED NURSING RN|
20|FH_F90880_15108_0|SrvcGrp|90487|2022|PCT|1.00|99|0.00|WHEELCHAIR MANAGEMENT|
20|FH_F129053_0_0|SrvcGrp|59840|2022|PDM|1873.00|99|0.00|TYMPANOSTOMY|
20|FH_F110000_0_0|SrvcGrp|3081|2022|PCT|0.70|99|0.00|OBSERVATION SVCS|
20|FH_F117001_0_0|SrvcGrp|106602|2022|PDM|1300.00|99|0.00|HEARING AID, DIGIT, BIN, ITC|
20|FH_F132800_0_0|SrvcGrp|112105|2022|PDM|87.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HCFA)|
20|FH_F137067_0_0|SrvcGrp|89842|2022|PDM|21000.00|99|0.00|LUMBAR|
20|FH_F141151_75150_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F77662_0_0|SrvcGrp|472|2022|PDM|485.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F124180_0_0|SrvcGrp|104719|2022|PDM|2000.00|99|0.00|RELIEVE INNER EYE PRESSURE|
20|FH_F130929_60438_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F100906_0_0|SrvcGrp|97465|2022|PDM|1800.00|99|0.00|REMOVE PROSTATE REGROWTH|
20|FH_F40715_0_0|SrvcGrp|6|2022|PCT|0.83|99|0.00|OP SURGERY|
20|FH_F44754_0_0|SrvcGrp|10541|2022|PDM|80.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F111292_33136_0|SrvcGrp|72984|2022|PCT|0.86|99|0.00|CHEMOTHERAPY|
20|FH_F116275_0_0|SrvcGrp|103552|2022|PDM|25.00|99|0.00|DIALYSIS PT TRAINING INCL HELPER|
20|FH_F96480_15224_0|SrvcGrp|92158|2022|PCT|1.00|99|0.00|PALIVIZUMAB PER 50MG|
20|FH_F147221_49442_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F139785_92629_0|SrvcGrp|89337|2022|PDM|3010.00|99|0.00|DETOXIFICATION|
20|FH_F147009_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F40541_0_0|CSTM-ALL|CSTM-00|2020|PDM|1371.00|99|0.00|HAPA EPA ASC 55|
20|FH_F92300_37303_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA ANCD GUARDIAN HOME CARE|
20|FH_F119351_95377_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F32779_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.82|99|0.00|GENERAL ACUTE CARE|
20|FH_F146376_53188_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F97141_93933_0|SrvcGrp|73461|2022|PDM|21757.00|99|0.00|AETNA NICU IV|
20|FH_F44795_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR|
20|FH_F128559_43524_0|SrvcGrp|48385|2022|PDM|115.00|99|0.00|SPEECH THERAPY|
20|FH_F81860_0_0|CSTM-ALL|CSTM-00|2020|PCT|61.20|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_F88280_0_0|SrvcGrp|28963|2022|PDM|17228.00|99|0.00|MS DRG 461-462 ONLY|
20|FH_F148639_0_0|CSTM-ALL|CSTM-00|2020|PDM|1346.00|99|0.00|AEG 7 (NO REV)|
20|FH_F106540_26330_0|SrvcGrp|73006|2022|PDM|6116.00|99|0.00|AEG 9|
20|FH_F140790_0_0|CSTM-ALL|CSTM-00|2020|PDM|411.00|99|0.00|AEG 1 (NO REV)|
20|FH_F101751_25302_0|SrvcGrp|55677|2022|PDM|2091.13|99|0.00|VAGINAL DELIVERY ONLY|
20|FH_F114931_0_0|SrvcGrp|27345|2022|PDM|3200.00|99|0.00|OP SURGERY (CPT 49650)|
20|FH_F130721_04769_0|CSTM-ALL|CSTM-00|2020|PCT|0.89|99|0.00|AEG 3 (NO REV)|
20|FH_F93333_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 4 (NO REV)|
20|FH_F148799_50125_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F132969_84003_0|SrvcGrp|48396|2022|PDM|85.50|99|0.00|OT SERVICES|
20|FH_F129548_44130_0|SrvcGrp|48396|2022|PDM|115.00|99|0.00|OT SERVICES|
20|FH_F133922_70563_0|SrvcGrp|86476|2022|PDM|59.10|99|0.00|AETNA SLEEP STUDY (MOD 26)|
20|FH_F119379_0_0|SrvcGrp|88597|2022|PDM|1428.00|99|0.00|INTERNAL FIX FOR FRACT/INSTA|
20|FH_F109821_0_0|SrvcGrp|103079|2022|PDM|1224.00|99|0.00|PODIATRIC SURGERY|
20|FH_F38601_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F38688_0_0|SrvcGrp|17077|2022|PDM|1500.00|99|0.00|ASPG VII|
20|FH_F138327_39402_0|SrvcGrp|92760|2022|PCT|0.80|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F140505_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F62761_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F41874_0_0|SrvcGrp|110|2022|PDM|483.00|99|0.00|CD - REHABILITATION|
20|FH_F100906_0_0|SrvcGrp|98661|2022|PDM|2016.00|99|0.00|AETNA AEG 7 WITHOUT HERNIA|
20|FH_F138936_01040_0|SrvcGrp|72602|2022|PDM|1082.00|99|0.00|ECT|
20|FH_F136174_89146_0|SrvcGrp|23683|2022|PDM|40.00|99|0.00|SKILLED NURSING RN|
20|FH_F100763_24202_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F140629_0_0|SrvcGrp|63465|2022|PDM|1016.00|99|0.00|CPT 52214|
20|FH_F87496_17055_0|SrvcGrp|48396|2022|PDM|104.00|99|0.00|OT SERVICES|
20|FH_F139707_84010_0|SrvcGrp|107521|2022|PDM|12141.00|99|0.00|IMPLANTATION OF DRUG INFUSION DEVICE|
20|FH_F35678_0_0|SrvcGrp|11920|2022|PCT|0.75|99|0.00|PHARMACY SVCS|
20|FH_F137729_19703_0|SrvcGrp|108484|2022|PDM|541.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F113115_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149536_76642_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F43236_0_0|SrvcGrp|40820|2022|PDM|1150.00|99|0.00|ICU/CCU|
20|FH_F120207_0_0|SrvcGrp|78283|2022|PDM|2870.00|99|0.00|CPT 49505|
20|FH_F139587_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F109242_18466_0|SrvcGrp|46903|2022|PDM|533.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F141940_50023_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119007_0_0|CSTM-ALL|CSTM-00|2020|PDM|1452.00|99|0.00|AEG 8 (NO REV)|
20|FH_F145328_90301_0|SrvcGrp|113324|2022|PDM|1775.00|99|0.00|MED ASSIST TX INJECT|
20|FH_F141835_78676_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F81373_64064_0|SrvcGrp|13880|2022|PCT|0.25|99|0.00|IMPLANTS|
20|FH_F128571_29532_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F68363_0_0|CSTM-ALL|CSTM-00|2020|PDM|55.00|99|0.00|CPT 99201|
20|FH_F92677_08003_0|SrvcGrp|26868|2022|PDM|52.50|99|0.00|DIURETIC IV THERAPY|
20|FH_F88956_0_0|SrvcGrp|21350|2022|PDM|5537.00|99|0.00|MS DRG 287 ONLY|
20|FH_F141890_64865_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F37970_0_0|SrvcGrp|474|2022|PDM|848.00|99|0.00|SUB-ACUTE REHAB - LEVEL I|
20|FH_F123646_91350_0|SrvcGrp|54142|2022|PDM|255.00|99|0.00|OP INTENSIVE SERVICES|
20|FH_F100782_0_0|SrvcGrp|97580|2022|PDM|870.20|99|0.00|WINDBER MEDICAL CNTR ASC 207|
20|FH_F116806_0_0|SrvcGrp|83842|2022|PDM|1923.16|99|0.00|REPAIR EYE SOCKET FRACTURE|
20|FH_F79245_0_0|SrvcGrp|66481|2022|PDM|75.00|99|0.00|SOCIAL WORKER|
20|FH_F51500_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|MS DRG 001-002, 005-008, 010, 014-015, 652 TRANSPLANT|
20|FH_F138240_64114_0|SrvcGrp|88620|2022|PDM|122.00|99|0.00|SKILLED NURSING RN|
20|FH_F143650_0_0|SrvcGrp|72992|2022|PDM|1175.00|99|0.00|AEG 2|
20|FH_F120720_24541_0|SrvcGrp|108404|2022|PCT|1.00|99|0.00|OP SVCS AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F132213_17543_0|SrvcGrp|104329|2022|PCT|0.85|99|0.00|INJECTION GLATIRAMER ACETATE|
20|FH_F79904_0_0|SrvcGrp|26001|2022|PDM|126.35|99|0.00|HOSPICE RESPITE SVCS|
20|FH_F135897_0_0|SrvcGrp|54084|2022|PDM|2475.00|99|0.00|IMPLANT EYE SHUNT|
20|FH_F42755_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F42024_0_0|SrvcGrp|9774|2022|PDM|4170.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F138876_25302_0|SrvcGrp|16750|2022|PDM|70.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F136223_60954_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F131463_19096_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F141651_0_0|SrvcGrp|83644|2022|PDM|3300.00|99|0.00|CPT 30465|
20|FH_F87153_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F33081_0_0|SrvcGrp|14302|2022|PDM|3600.00|99|0.00|VAGINAL HYSTERECTOMY|
20|FH_F40423_0_0|CSTM-ALL|CSTM-00|2020|PDM|480.00|99|0.00|SKILLED NURSING CARE|
20|FH_F143542_0_0|SrvcGrp|42428|2022|PDM|1721.00|99|0.00|OP SURGERY CPT 65855|
20|FH_F40346_0_0|SrvcGrp|19973|2022|PCT|0.75|99|0.00|CAT SCAN|
20|FH_F102525_73134_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA IMAGING ENHANC. SUBSTANCES (IMAGENHANCE)|
20|FH_F146204_0_0|SrvcGrp|109258|2022|PDM|2873.00|99|0.00|WEDGE RESECTION|
20|FH_F149003_62208_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F127143_68716_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97881_38703_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F132693_0_0|CSTM-ALL|CSTM-00|2020|PDM|995.00|99|0.00|AEG 7 (NO REV)|
20|FH_F128717_54449_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F38663_0_0|SrvcGrp|10541|2022|PDM|74.00|99|0.00|PHYSICAL THERAPY SVCS|
20|FH_F129535_0_0|SrvcGrp|111365|2022|PDM|550.00|99|0.00|CORRECT RECTAL PROLAPSE|
20|FH_F144528_48081_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F149106_07042_0|SrvcGrp|113988|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F75842_0_0|SrvcGrp|36504|2022|PCT|0.49|99|0.00|MS DRG 286 287 INPATIENT CARDIAC CATH OTLR|
20|FH_F132898_06088_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F35216_0_0|SrvcGrp|3029|2022|PDM|300.00|99|0.00|NEWBORN NURSERY|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DME,MOD_KF|
20|FH_F129658_77043_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F120251_21122_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F113682_0_0|SrvcGrp|45184|2022|PDM|247.23|99|0.00|OCCUPATIONAL THERAPY|
20|FH_F149866_07401_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F91451_0_0|SrvcGrp|3178|2022|PDM|1005.00|99|0.00|ACUTE PSYCH|
20|FH_F102302_0_0|SrvcGrp|80281|2022|PDM|14300.00|99|0.00|AETNA REVISE/REMOVE NEURORECEIVER|
20|FH_F37651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|OP SVCS|
20|FH_F151146_0_0|CSTM-ALL|CSTM-00|2020|PDM|2205.00|99|0.00|AEG 6 (NO REV)|
20|FH_F130013_16509_0|SrvcGrp|471|2022|PDM|625.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F148339_71303_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F91575_0_0|CSTM-ALL|CSTM-00|2020|PDM|1095.00|99|0.00|AEG 7 (NO REV)|
20|FH_F63552_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|OP SVCS|
20|FH_F108180_29526_0|SrvcGrp|86748|2022|PCT|1.00|99|0.00|AETNA REGISTER NURSE (MOD TD)|
20|FH_F147327_19010_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F69183_0_0|CSTM-ALL|CSTM-00|2020|PDM|3000.00|99|0.00|MS DRG 765-766 ONLY C-SECTION|
20|FH_F37764_0_0|SrvcGrp|24289|2022|PDM|40.00|99|0.00|RESPIRATORY THERAPY|
20|FH_F97184_26101_0|SrvcGrp|112223|2022|PDM|100.00|99|0.00|COVID-19 CDC TESTING LAB (HIGH VOLUME)|
20|FH_F37341_0_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|ASPG V|
20|FH_F45226_0_0|SrvcGrp|39995|2022|PDM|100.00|99|0.00|HOSPICE CARE/ IN HOME|
20|FH_F94643_90501_0|SrvcGrp|14947|2022|PDM|45.00|99|0.00|HOME INFUSION|
20|FH_F151005_17044_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149003_62208_0|SrvcGrp|88621|2022|PDM|105.00|99|0.00|SKILLED NURSING LPN|
20|FH_F91076_0_0|SrvcGrp|86746|2022|PCT|1.00|99|0.00|AETNA SPECIALTY BHMD (MOD AF)|
20|FH_F114188_15205_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F119652_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F149023_44122_0|SrvcGrp|103585|2022|PDM|2815.00|99|0.00|REMOVE SPINE ELTRD PLATE|
20|FH_F119029_0_0|CSTM-ALL|CSTM-00|2020|PDM|669.00|99|0.00|AEG 4 (NO REV)|
20|FH_F125207_32904_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F92431_80033_0|SrvcGrp|88621|2022|PDM|146.00|99|0.00|SKILLED NURSING LPN|
20|FH_F149273_0_0|SrvcGrp|115605|2022|PDM|4998.00|99|0.00|NECK SPINE FUSE|
20|FH_F136947_0_0|SrvcGrp|13595|2022|PDM|525.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F101824_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F111080_18103_0|SrvcGrp|86749|2022|PCT|1.00|99|0.00|AETNA SPECIALTY MASTER DEGREE (MOD HO)|
20|FH_F37490_0_0|SrvcGrp|26278|2022|PDM|914.75|99|0.00|CPT 29881|
20|FH_F139576_0_0|SrvcGrp|19920|2022|PDM|2497.00|99|0.00|ARTHROSCOPY OF SHOULDER|
20|FH_F63385_0_0|CSTM-ALL|CSTM-00|2020|PDM|806.00|99|0.00|ASPG II|
20|FH_F73643_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F76222_0_0|SrvcGrp|3271|2022|PDM|5523.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F104640_21204_0|SrvcGrp|471|2022|PDM|672.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F114207_35243_0|SrvcGrp|86836|2022|PDM|15.00|99|0.00|HCPCS S9542 (HCFA)|
20|FH_F124441_0_0|SrvcGrp|63472|2022|PDM|6650.00|99|0.00|CPT 64581|
20|FH_F117574_49022_0|SrvcGrp|89149|2022|PDM|157.00|99|0.00|OP INTENSIVE|
20|FH_F122841_0_0|SrvcGrp|112137|2022|PDM|2232.00|99|0.00|XCAPSL CTRC RMVL W/ECP|
20|FH_F147143_18706_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F124695_33401_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F92299_62016_0|SrvcGrp|73002|2022|PCT|0.75|99|0.00|AEG 7|
20|FH_F97640_37043_0|SrvcGrp|73656|2022|PDM|482.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F112045_90301_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F97881_38703_0|SrvcGrp|73602|2022|PDM|1840.00|99|0.00|AETNA NEWBORN NURSERY I|
20|FH_F37364_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F143564_0_0|SrvcGrp|87844|2022|PDM|4488.00|99|0.00|LAPARASCOPY - GASTRIC|
20|FH_F124714_64081_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F37104_0_0|CSTM-ALL|CSTM-00|2020|PDM|1162.00|99|0.00|ASPG VII|
20|FH_F90817_0_0|SrvcGrp|91044|2022|PDM|1574.00|99|0.00|KNEE ARTHROSCOPY/SURGERY (HCFA)|
20|FH_F141330_65075_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F111723_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F36715_0_0|CSTM-ALL|CSTM-00|2020|PDM|758.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F109251_62269_0|SrvcGrp|103232|2022|PDM|92.60|99|0.00|APPL MULTLAY COMPRS ARM/HAND|
20|FH_F143249_89801_0|SrvcGrp|24750|2022|PDM|30.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F143412_70503_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F75305_0_0|SrvcGrp|45005|2022|PCT|1.90|99|0.00|LABORATORY|
20|FH_F93281_0_0|CSTM-ALL|CSTM-00|2020|PDM|430.00|99|0.00|AEG 4 (NO REV)|
20|FH_F101700_0_0|SrvcGrp|98588|2022|PDM|1476.00|99|0.00|REMOVE SPINE INFUSION DEVI16|
20|FH_F102224_0_0|SrvcGrp|92408|2022|PDM|4000.00|99|0.00|PERQ VERTEBRAL AUGMENTATION|
20|FH_F47036_0_0|SrvcGrp|45536|2022|PDM|95.00|99|0.00|SKILLED NURSING|
20|FH_F48224_0_0|SrvcGrp|62737|2022|PDM|1060.00|99|0.00|SURGERY CARVE OUTS|
20|FH_F48476_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F120191_91360_0|SrvcGrp|46903|2022|PDM|875.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F120233_24368_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F132479_90290_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F132472_32547_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F119992_67062_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F120888_63823_0|SrvcGrp|75545|2022|PDM|300.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F120974_27607_0|SrvcGrp|74581|2022|PCT|0.44|99|0.00|AETNA IP HIGH COST DRUGS|
20|FH_F120974_27607_0|SrvcGrp|111928|2022|PDM|51.31|99|0.00|COVID-19 BARTONELLA|
20|FH_F126243_32132_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F35133_0_0|SrvcGrp|17553|2022|PCT|0.60|99|0.00|IMPLANTS|
20|FH_F108860_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|SPEECH THERAPY SERVICES|
20|FH_F97562_29803_0|CSTM-ALL|CSTM-00|2020|PCT|0.33|99|0.00|OP SVCS|
20|FH_F109840_62832_0|SrvcGrp|90356|2022|PCT|0.80|99|0.00|OP DIALYSIS|
20|FH_F62292_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F42453_0_0|SrvcGrp|16|2022|PDM|614.00|99|0.00|ACUTE REHABILITATION|
20|FH_F37568_0_0|SrvcGrp|25941|2022|PDM|90.00|99|0.00|PHYSICAL THERAPY|
20|FH_F46552_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.65|99|0.00|MS DRG UNGROUPABLE INPATIENT|
20|FH_F38410_0_0|SrvcGrp|28628|2022|PDM|102.00|99|0.00|SKILLED NURSING|
20|FH_F101851_78024_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F36579_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|ALLIED MED-MOD QW|
20|FH_F37554_0_0|SrvcGrp|27006|2022|PDM|670.00|99|0.00|MRI W/O CONTRAST|
20|FH_F120437_85202_0|SrvcGrp|108454|2022|PDM|87.00|99|0.00|IVIG NON-LYOPHILIZED NOS|
20|FH_F37640_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|MAXIM HEALTHCARE MOD UE|
20|FH_F148002_78209_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F89112_16509_0|SrvcGrp|10365|2022|PDM|1054.00|99|0.00|CPT CODE 99285|
20|FH_F151155_26508_0|SrvcGrp|113331|2022|PDM|7061.00|99|0.00|MED TX INSERT/REMOVE IMP (HFCA)|
20|FH_F83978_66739_0|SrvcGrp|36591|2022|PDM|28529.00|99|0.00|CPT 63685|
20|FH_F124369_0_0|SrvcGrp|107988|2022|PDM|3740.00|99|0.00|PARTIAL REMOVAL OF TOE|
20|FH_F133398_43204_0|CSTM-ALL|CSTM-00|2020|PDM|420.00|99|0.00|AETNA ABH IP OBSERVATION >= 24 HOURS|
20|FH_F129895_50263_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F102184_0_0|SrvcGrp|88164|2022|PDM|7699.00|99|0.00|ARTHRODESIS POSTERIOR LUMBAR|
20|FH_F141129_0_0|SrvcGrp|24029|2022|PDM|34.00|99|0.00|RN HOURLY|
20|FH_F93881_15009_0|SrvcGrp|12290|2022|PDM|1335.00|99|0.00|DETOXIFICATION|
20|FH_F150699_0_0|SrvcGrp|88481|2022|PDM|38826.00|99|0.00|AETNA RMVL & RPLCMT DFB GEN MLT LEAD|
20|FH_F40063_0_0|SrvcGrp|11258|2022|PCT|0.50|99|0.00|DRUGS|
20|FH_F86332_75081_0|SrvcGrp|10575|2022|PDM|65.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F63095_0_0|SrvcGrp|59291|2022|PDM|1580.00|99|0.00|DAY HOSPITAL FULL DAY|
20|FH_F137235_66061_0|SrvcGrp|46903|2022|PDM|400.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F134654_0_0|SrvcGrp|110057|2022|PDM|1.63|99|0.00|BEHAVIOR ID ASSESSMENT 15 MINS|
20|FH_F147741_80012_0|SrvcGrp|114646|2022|PCT|2.10|99|0.00|DIAGNOSTIC RADIOLOGY SERVICES|
20|FH_F91067_0_0|SrvcGrp|84182|2022|PDM|2500.00|99|0.00|AETNA REMOVAL OF BREAST CAPSULE|
20|FH_F143450_0_0|SrvcGrp|113576|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F113794_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F103880_85014_0|SrvcGrp|48385|2022|PDM|85.00|99|0.00|SPEECH THERAPY|
20|FH_F148424_01440_0|SrvcGrp|81622|2022|PCT|0.85|99|0.00|GENERAL PHARMACY|
20|FH_F119725_0_0|SrvcGrp|106317|2022|PDM|705.97|99|0.00|SPECIALTY CARE TRANSPORT (HCFA)|
20|FH_F36127_0_0|CSTM-ALL|CSTM-00|2020|PCT|80.00|99|0.00|OP SVCS|
20|FH_F112086_33713_0|SrvcGrp|99600|2022|PCT|1.00|99|0.00|PT/OT/ST|
20|FH_F102325_62691_0|SrvcGrp|73700|2022|PDM|60.00|99|0.00|AETNA - SKILLED NURSING|
20|FH_F37777_0_0|SrvcGrp|11259|2022|PCT|0.80|99|0.00|DRUGS|
20|FH_F149579_95815_0|SrvcGrp|115675|2022|PDM|41.36|99|0.00|COMPLEX CHRONIC CARE ADDL 30 MINS (HCFA)|
20|FH_F73803_0_0|CSTM-ALL|CSTM-00|2020|PDM|1069.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F144022_32118_0|SrvcGrp|84117|2022|PCT|1.00|99|0.00|TELEHEALTH SERVICES|
20|FH_F82215_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
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_F41804_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F112852_73112_0|SrvcGrp|8950|2022|PDM|1625.00|99|0.00|INTERMEDIATE ICU/CCU|
20|FH_F130652_51101_0|SrvcGrp|104306|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F79902_0_0|SrvcGrp|14243|2022|PDM|638.00|99|0.00|EMERGENCY ROOM SVCS|
20|FH_F108700_63857_0|SrvcGrp|94780|2022|PDM|108.00|99|0.00|HOSPICE OR HH IN HOME (HCFA)|
20|FH_F34102_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.76|99|0.00|GENERAL ACUTE CARE|
20|FH_F146135_87112_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F92676_15063_0|SrvcGrp|79095|2022|PDM|1102.12|99|0.00|MON VALLEY ASC 407|
20|FH_F132613_84601_0|SrvcGrp|111348|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F39180_0_0|SrvcGrp|12280|2022|PCT|0.70|99|0.00|IMPLANTS|
20|FH_F112852_73112_0|SrvcGrp|10393|2022|PDM|1820.00|99|0.00|INTENSIVE/CORONARY CARE UNIT|
20|FH_F134904_0_0|CSTM-ALL|CSTM-00|2020|PDM|1328.00|99|0.00|AEG 7 (NO REV)|
20|FH_F93359_63084_0|SrvcGrp|86747|2022|PCT|1.00|99|0.00|AETNA CLINICAL PSY (MOD AH)|
20|FH_F126244_43567_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F149150_75407_0|SrvcGrp|9866|2022|PDM|750.00|99|0.00|IP OBSERVATION SVCS|
20|FH_F149219_01966_0|SrvcGrp|104965|2022|PCT|0.85|99|0.00|HEMOPHILIA CLOTTING FACTOR|
20|FH_F44299_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_F111601_15203_0|SrvcGrp|86722|2022|PDM|161.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F44075_0_0|CSTM-ALL|CSTM-00|2020|PDM|1153.90|99|0.00|ASPG VII|
20|FH_F130032_72034_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F140575_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|CARDIAC CATHETERIZATION|
20|FH_F40417_0_0|SrvcGrp|65|2022|PDM|2300.00|99|0.00|OBSTETRICAL CARE|
20|FH_F72407_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F92120_0_0|SrvcGrp|92021|2022|PCT|1.25|99|0.00|MISCELLANEOUS IMPLANTS|
20|FH_F122725_32216_0|SrvcGrp|90635|2022|PDM|118.00|99|0.00|AETNA PSYTX PT & FAMILY 60 MINUTES|
20|FH_F143539_0_0|CSTM-ALL|CSTM-00|2020|PDM|1042.00|99|0.00|AEG 2 (NO REV)|
20|FH_F46832_0_0|SrvcGrp|24750|2022|PDM|60.00|99|0.00|ANTI-EMETICS INJECTION THERAPY|
20|FH_F140496_38627_0|SrvcGrp|108484|2022|PDM|678.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F80284_16354_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HAPA WPA/NWPA 2014 NISC 100%|
20|FH_F123278_20850_0|SrvcGrp|472|2022|PDM|400.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F76402_0_0|CSTM-ALL|CSTM-00|2020|PCT|56650.00|99|0.00|HOME HEMODIALYSIS|
20|FH_F97104_53545_0|SrvcGrp|73559|2022|PDM|12228.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F111288_0_0|SrvcGrp|47142|2022|PDM|4866.00|99|0.00|CPT 49650|
20|FH_F36081_0_0|SrvcGrp|22137|2022|PDM|435.00|99|0.00|MRI|
20|FH_F82173_72712_0|CSTM-ALL|CSTM-00|2020|PDM|5835.00|99|0.00|AEG 9 (NO REV)|
20|FH_F37882_0_0|CSTM-ALL|CSTM-00|2020|PCT|79.00|99|0.00|OP SVCS|
20|FH_F114975_78596_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F134126_11554_0|SrvcGrp|13187|2022|PCT|0.45|99|0.00|INTRAOCULAR LENSES|
20|FH_F137047_73120_0|SrvcGrp|73601|2022|PDM|1350.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F149586_77535_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F91472_96001_0|SrvcGrp|83437|2022|PCT|0.40|99|0.00|PACEMAKER/CARDIAC RESYNCHRONIZATION THERAPY|
20|FH_F125163_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114389_50131_0|SrvcGrp|26871|2022|PDM|160.95|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3 HRS|
20|FH_F124234_33410_0|SrvcGrp|74668|2022|PDM|700.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F148424_01440_0|SrvcGrp|104303|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F147331_90045_0|SrvcGrp|66264|2022|PDM|71.40|99|0.00|PHYSICAL THERAPY SERVICES|
20|FH_F147559_70433_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F147520_61614_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F40855_0_0|SrvcGrp|439|2022|PDM|1600.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F47605_0_0|SrvcGrp|43322|2022|PDM|100.00|99|0.00|INDIVIDUAL THERAPY|
20|FH_F151501_30265_0|SrvcGrp|100017|2022|PDM|14114.00|99|0.00|FUSION OF FOOT BONES|
20|FH_F132258_45404_0|SrvcGrp|53987|2022|PCT|1.00|99|0.00|PHOTOTHERAPY|
20|FH_F97143_80012_0|SrvcGrp|112224|2022|PDM|100.00|99|0.00|COVID-19 NON-CDC TESTING LAB (HIGH VOLUME)|
20|FH_F136042_90066_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F112135_80910_0|SrvcGrp|79720|2022|PDM|1644.00|99|0.00|ACUTE REHAB II|
20|FH_F102862_30606_0|SrvcGrp|28121|2022|PDM|22609.00|99|0.00|MS DRG 469 ONLY|
20|FH_F120154_77498_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F150382_80821_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F148419_01453_0|SrvcGrp|104964|2022|PCT|0.85|99|0.00|UNCLASSIFIED BIOLOGICS|
20|FH_F148492_28027_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F43078_0_0|SrvcGrp|3809|2022|PDM|580.00|99|0.00|HOSPICE CARE|
20|FH_F38153_0_0|CSTM-ALL|CSTM-00|2020|PCT|78.40|99|0.00|GENERAL ACUTE CARE|
20|FH_F51658_0_0|SrvcGrp|44430|2022|PDM|105.00|99|0.00|SPEECH THERAPY SVCS (VISIT LVL)|
20|FH_F132690_87571_0|SrvcGrp|111927|2022|PDM|51.31|99|0.00|COVID-19 NON CDC|
20|FH_F31542_0_0|CSTM-ALL|CSTM-00|2020|PDM|2658.00|99|0.00|ASPG VIII|
20|FH_F115391_63123_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F117835_14551_0|SrvcGrp|471|2022|PDM|525.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F136401_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F117385_48091_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F132727_61108_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133867_84075_0|SrvcGrp|48397|2022|PDM|85.50|99|0.00|PT SERVICES|
20|FH_F135670_01749_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F130763_0_0|SrvcGrp|100067|2022|PDM|4159.00|99|0.00|ANKLE ARTHROSCOPY SURGERY|
20|FH_F120719_27540_0|SrvcGrp|107734|2022|PDM|3714.00|99|0.00|VAGINAL DELIVERY|
20|FH_F121472_0_0|CSTM-ALL|CSTM-00|2020|PDM|2300.00|99|0.00|AEG 9 (NO REV)|
20|FH_F119065_92029_0|SrvcGrp|46903|2022|PDM|950.00|99|0.00|RESIDENTIAL TREATMENT|
20|FH_F117093_40041_0|SrvcGrp|104306|2022|PCT|0.88|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F38807_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F114916_30309_0|SrvcGrp|100067|2022|PDM|2500.00|99|0.00|ANKLE ARTHROSCOPY SURGERY|
20|FH_F133002_0_0|SrvcGrp|84280|2022|PDM|1716.00|99|0.00|CORNEAL TRANSPLANT|
20|FH_F63185_0_0|SrvcGrp|48393|2022|PDM|6.50|99|0.00|SKILLED NURSING SERVICES (PER HOUR)|
20|FH_F138456_33543_0|SrvcGrp|89417|2022|PDM|421.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F43859_0_0|SrvcGrp|27769|2022|PDM|25.00|99|0.00|SKILLED LPN HOURLY|
20|FH_F147699_83704_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F147404_37863_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F42333_0_0|CSTM-ALL|CSTM-00|2020|PDM|330.00|99|0.00|CHEMICAL DEPENDENCY|
20|FH_F151511_14094_0|CSTM-ALL|CSTM-00|2020|PDM|2931.99|99|0.00|AEG 8 (NO REV)|
20|FH_F139156_30060_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F84833_17109_0|SrvcGrp|88620|2022|PDM|95.00|99|0.00|SKILLED NURSING RN|
20|FH_F142169_62002_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F141870_85224_0|SrvcGrp|22589|2022|PDM|35.00|99|0.00|CHEMOTHERAPY NOC|
20|FH_F133268_63703_0|SrvcGrp|112229|2022|PDM|13.20|99|0.00|LAIV4 VACINE INTRANASAL|
20|FH_F126626_80906_0|SrvcGrp|75754|2022|PCT|1.10|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F142028_45714_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F130573_02882_0|SrvcGrp|27968|2022|PCT|1.00|99|0.00|SKILLED NURSING LPN|
20|FH_F98620_43920_0|SrvcGrp|90854|2022|PDM|2351.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F67639_0_0|SrvcGrp|63460|2022|PDM|1100.00|99|0.00|CPT 55040|
20|FH_F58973_0_0|CSTM-ALL|CSTM-00|2020|PDM|784.00|99|0.00|COVENTRY ENHANCED GROUPER 2|
20|FH_F124957_60473_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F46552_0_0|SrvcGrp|9508|2022|PCT|0.80|99|0.00|HOSPICE SERVICES|
20|FH_F117385_48091_0|CSTM-ALL|CSTM-00|2020|PDM|120.00|99|0.00|AETNA BEHAVIORAL ID ASSESSMENT|
20|FH_F38663_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|BURMANS APOTHECARY INFUSION SERVICES|
20|FH_F138256_68803_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC INVOICE|
20|FH_F110604_0_0|CSTM-ALL|CSTM-00|2020|PDM|880.00|99|0.00|AEG 2 (NO REV)|
20|FH_F43861_0_0|SrvcGrp|37405|2022|PDM|90.00|99|0.00|OT SVCS|
20|FH_F87541_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F130763_0_0|SrvcGrp|111602|2022|PDM|3050.00|99|0.00|LARYNGOSCOPY|
20|FH_F150148_71901_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F85213_02840_0|SrvcGrp|115534|2022|PCT|1.21|99|0.00|LABORATORY SERVICES|
20|FH_F150299_22046_0|SrvcGrp|48398|2022|PDM|95.00|99|0.00|PT SERVICES|
20|FH_F132606_0_0|CSTM-ALL|CSTM-00|2020|PDM|988.38|99|0.00|AEG 5  (NO REV)|
20|FH_F72963_0_0|SrvcGrp|17077|2022|PDM|5484.00|99|0.00|ASPG VII|
20|FH_F105361_80104_0|SrvcGrp|30623|2022|PDM|4530.00|99|0.00|MS DRG 765-766 ONLY C-SECTION REPLACEMENT 783-788|
20|FH_F59732_0_0|SrvcGrp|14949|2022|PDM|80.00|99|0.00|HOME INFUSION|
20|FH_F110925_01104_0|SrvcGrp|64541|2022|PDM|4.57|99|0.00|INJECTION PROTEINASE|
20|FH_F91640_98166_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F83198_44125_0|SrvcGrp|76421|2022|PDM|420.00|99|0.00|HEMODIALYSIS|
20|FH_F141790_85374_0|SrvcGrp|104248|2022|PDM|3025.00|99|0.00|SKIN TISSUE REARRANGEMENT|
20|FH_F67861_0_0|SrvcGrp|46029|2022|PDM|13200.00|99|0.00|GASTRIC REDUCTION - LAP BANDING|
20|FH_F49637_0_0|SrvcGrp|38664|2022|PDM|8715.00|99|0.00|MS DRG 328 ONLY|
20|FH_F34672_0_0|CSTM-ALL|CSTM-00|2020|PCT|87.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F111806_33020_0|SrvcGrp|473|2022|PDM|350.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F42779_0_0|SrvcGrp|27825|2022|PCT|0.75|99|0.00|HOME HEALTH SERVICES|
20|FH_F132785_17961_0|SrvcGrp|109029|2022|PCT|0.38|99|0.00|CARDIAC CATHERTERIZATION|
20|FH_F44342_0_0|CSTM-ALL|CSTM-00|2020|PDM|250.00|99|0.00|PSYCH PARTIAL HOSPITALIZATION|
20|FH_F148740_93230_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|GENERAL ACUTE CARE|
20|FH_F151047_20860_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F81698_10457_0|SrvcGrp|86825|2022|PDM|57.75|99|0.00|HCPCS S5523 (HCFA)|
20|FH_F134593_60007_0|SrvcGrp|26869|2022|PDM|48.00|99|0.00|HOME INFUSION THERAPY - ANTI-SPASMOTIC|
20|FH_F139873_0_0|CSTM-ALL|CSTM-00|2020|PDM|1338.00|99|0.00|AEG 10 (NO REV)|
20|FH_F128379_0_0|CSTM-ALL|CSTM-00|2020|PDM|1144.00|99|0.00|AEG 3 (NO REV)|
20|FH_F79623_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F118144_33418_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F139289_0_0|SrvcGrp|108899|2022|PDM|1025.00|99|0.00|HOSPICE INPATIENT RESPITE CARE|
20|FH_F131808_74525_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_F89475_71202_0|SrvcGrp|103618|2022|PDM|5506.00|99|0.00|C-SECTION DELIVERY (MOM)|
20|FH_F41442_0_0|CSTM-ALL|CSTM-00|2020|PCT|100.00|99|0.00|OP SVCS|
20|FH_F76171_0_0|SrvcGrp|73300|2022|PDM|172.00|99|0.00|PHYSICAL THERAPY TREATMENT|
20|FH_F48315_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.83|99|0.00|OP SVCS|
20|FH_F129627_06037_0|SrvcGrp|29347|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE|
20|FH_F97102_83501_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F137547_32750_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F140931_24014_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F136426_19006_0|SrvcGrp|13595|2022|PDM|285.00|99|0.00|ADVANCED LIFE SUPPORT AMBULANCE W/PARAMEDIC|
20|FH_F110160_0_0|SrvcGrp|73004|2022|PDM|1312.00|99|0.00|AEG 8|
20|FH_F130439_85014_0|SrvcGrp|73842|2022|PDM|212.00|99|0.00|AETNA INTENSIVE OUTPATIENT|
20|FH_F138929_0_0|SrvcGrp|82107|2022|PDM|3520.00|99|0.00|SHOULDER ARTHROSCOPY|
20|FH_F116525_26003_0|SrvcGrp|75505|2022|PCT|0.62|99|0.00|CARDIAC STUDIES|
20|FH_F128027_0_0|SrvcGrp|82455|2022|PDM|1120.00|99|0.00|DIAGNOSTIC COLONOSCOPY|
20|FH_F141147_02571_0|SrvcGrp|13807|2022|PCT|0.78|99|0.00|OBSERVATION SVCS|
20|FH_F124225_92506_0|SrvcGrp|108061|2022|PCT|1.00|99|0.00|OP THERAPY SERVICES|
20|FH_F122591_84010_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F134817_30339_0|SrvcGrp|88620|2022|PDM|110.00|99|0.00|SKILLED NURSING RN|
20|FH_F147519_52627_0|SrvcGrp|75506|2022|PCT|0.89|99|0.00|VASCULAR DIAGNOSTIC STUDIES|
20|FH_F136429_0_0|CSTM-ALL|CSTM-00|2020|PDM|450.00|99|0.00|AEG 3 (NO REV)|
20|FH_F97261_06098_0|SrvcGrp|73659|2022|PDM|10644.00|99|0.00|AETNA MED & SURG SVCS|
20|FH_F92871_0_0|SrvcGrp|77507|2022|PCT|1.00|99|0.00|AETNA CORNEAL TISSUE HANDLING|
20|FH_F114853_0_0|CSTM-ALL|CSTM-00|2020|PDM|1613.00|99|0.00|AEG 2 (NO REV)|
20|FH_F86294_0_0|CSTM-ALL|CSTM-00|2020|PDM|495.00|99|0.00|2006 MEDICARE ASPG I|
20|FH_F151410_00717_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F151421_21244_0|CSTM-ALL|CSTM-00|2020|PCT|0.40|99|0.00|OP SVCS|
20|FH_F129131_27519_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F115768_15301_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA REFERENCE LAB|
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_F135178_84049_0|SrvcGrp|108484|2022|PDM|1300.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|353.82|99|0.00|HAPA WPA-NWPA 2012-13 ASC 104 W/O REV|
20|FH_F40525_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: POS FACILITY MOD 53|
20|FH_F122536_0_0|CSTM-ALL|CSTM-00|2020|PDM|2050.00|99|0.00|ASPG I|
20|FH_F93332_0_0|CSTM-ALL|CSTM-00|2020|PDM|7416.00|99|0.00|LUMB ARTIF DISKECTOMY ADDL (HCFA)|
20|FH_F40417_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.75|99|0.00|OP SVCS|
20|FH_F95200_16201_0|CSTM-ALL|CSTM-00|2020|PCT|2.66|99|0.00|HSS APC GROUPED|
20|FH_F62924_0_0|CSTM-ALL|CSTM-00|2020|PCT|55.00|99|0.00|OP SVCS|
20|FH_F44774_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER KN|
20|FH_F33271_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F138958_78410_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F62683_0_0|SrvcGrp|471|2022|PDM|550.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F118914_43015_0|SrvcGrp|75545|2022|PDM|310.00|99|0.00|SUB-ACUTE - LEVEL I AND II|
20|FH_F147363_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F97721_01053_0|SrvcGrp|90854|2022|PDM|2103.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F39910_0_0|CSTM-ALL|CSTM-00|2020|PDM|2068.00|99|0.00|OP SVCS|
20|FH_F41035_0_0|SrvcGrp|72994|2022|PDM|565.00|99|0.00|AEG 3|
20|FH_F124584_28204_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F148553_85016_0|SrvcGrp|115442|2022|PDM|3060.00|99|0.00|INSERT 2 ELECTRODE PM DEFIB|
20|FH_F116393_07002_0|SrvcGrp|111276|2022|PDM|17.48|99|0.00|HGB-A1C|
20|FH_F120112_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F151404_71655_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F145251_45107_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F111301_33122_0|SrvcGrp|110744|2022|PCT|2.24|99|0.00|ALL DRUGS OR DRUG AGENTS|
20|FH_F44336_0_0|CSTM-ALL|CSTM-00|2020|PDM|354.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F125656_92868_0|SrvcGrp|47183|2022|PDM|105.00|99|0.00|HOME INFUSION NURSING SVCS|
20|FH_F124441_0_0|SrvcGrp|88159|2022|PDM|5700.00|99|0.00|LOW BACK DISK SURGERY|
20|FH_F134410_46807_0|SrvcGrp|89337|2022|PDM|1825.00|99|0.00|DETOXIFICATION|
20|FH_F151699_01752_0|SrvcGrp|86844|2022|PDM|67.50|99|0.00|HCPCS S9379 (HCFA)|
20|FH_F148432_01585_0|SrvcGrp|471|2022|PDM|619.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F33331_0_0|CSTM-ALL|CSTM-00|2020|PCT|91.50|99|0.00|GENERAL ACUTE CARE|
20|FH_F37568_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|100% OF AWP DRUGS W/ DIRECT RATES|
20|FH_F63625_0_0|SrvcGrp|31981|2022|PCT|0.60|99|0.00|HIGH COST DRUGS|
20|FH_F116114_37033_0|SrvcGrp|93337|2022|PDM|403.00|99|0.00|AETNA INTENSIVE OP EATING DISORDERS|
20|FH_F123372_0_0|SrvcGrp|12918|2022|PDM|2367.00|99|0.00|GYNECOLOGICAL MED/SURG|
20|FH_F135161_33128_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F130747_0_0|SrvcGrp|76603|2022|PDM|4682.00|99|0.00|CPT 25111|
20|FH_F68365_0_0|CSTM-ALL|CSTM-00|2020|PDM|826.00|99|0.00|COVENTRY ENHANCED GROUPER 4|
20|FH_F148346_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|GENERAL ACUTE CARE|
20|FH_F123848_03257_0|SrvcGrp|27968|2022|PDM|52.00|99|0.00|SKILLED NURSING LPN|
20|FH_F136314_19013_0|SrvcGrp|73841|2022|PDM|306.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP|
20|FH_F35212_0_0|SrvcGrp|8962|2022|PDM|82.50|99|0.00|MEDICAL SOCIAL WORKER|
20|FH_F146994_74462_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|99|0.00|GENERAL ACUTE CARE|
20|FH_F150910_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.11|99|0.00|OP SVCS|
20|FH_F122635_06410_0|SrvcGrp|94119|2022|PCT|1.00|99|0.00|AETNA OP SERVICES HH AMFS(H) DEFAULT|
20|FH_F43833_0_0|CSTM-ALL|CSTM-00|2020|PDM|734.00|99|0.00|ASPG IV|
20|FH_F38037_0_0|SrvcGrp|12401|2022|PDM|88.00|99|0.00|RN VISIT|
20|FH_F48836_0_0|SrvcGrp|17419|2022|PDM|80.00|99|0.00|SPEECH THERAPY|
20|FH_F54552_0_0|SrvcGrp|27053|2022|PDM|31.66|99|0.00|ANTI-INFECTIVE THERAPIES 1 IN EVERY 3HRS(MOD SJ)|
20|FH_F101741_16823_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F131000_0_0|SrvcGrp|84910|2022|PDM|3343.00|99|0.00|ENDOSCOPY|
20|FH_F137986_0_0|SrvcGrp|97484|2022|PDM|1458.00|99|0.00|ENDO CHOLANGIOPANCREATOGRAPH|
20|FH_F134707_0_0|SrvcGrp|705|2022|PCT|0.44|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F138478_0_0|SrvcGrp|109502|2022|PDM|10435.89|99|0.00|INSERT PULSE GEN MULT LEADS|
20|FH_F35452_0_0|SrvcGrp|16|2022|PDM|400.00|99|0.00|ACUTE REHABILITATION|
20|FH_F94643_90501_0|SrvcGrp|86835|2022|PDM|25.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F117603_92210_0|SrvcGrp|75522|2022|PDM|725.00|99|0.00|RESIDENTIAL TREATMENT PSYCHIATIC OR CD|
20|FH_F118366_17110_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F72830_0_0|SrvcGrp|941|2022|PDM|1808.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL IV|
20|FH_F72947_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.62|99|0.00|OP SVCS|
20|FH_F90492_0_0|SrvcGrp|43523|2022|PDM|215.00|99|0.00|PARTIAL HOSPITALIZATION PROGRAM - PSYCHIATRIC|
20|FH_F38591_0_0|SrvcGrp|16|2022|PDM|1432.00|99|0.00|ACUTE REHABILITATION|
20|FH_F74602_0_0|SrvcGrp|10927|2022|PDM|680.00|99|0.00|COMPUTED TOMOGRAPHY (CT)|
20|FH_F89372_0_0|SrvcGrp|43522|2022|PDM|343.00|99|0.00|ELECTRIC CONVULSIVE THERAPY|
20|FH_F132810_0_0|SrvcGrp|24744|2022|PDM|80.00|99|0.00|PICC LINE INSERTION|
20|FH_F134155_07016_0|SrvcGrp|100859|2022|PDM|276.00|99|0.00|INTENSIVE OUTPATIENT PSYCH|
20|FH_F138548_24090_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OP SVCS|
20|FH_F119065_92029_0|SrvcGrp|89337|2022|PDM|1350.00|99|0.00|DETOXIFICATION|
20|FH_F117214_84020_0|SrvcGrp|75419|2022|PDM|600.00|99|0.00|OP PARTIAL HOSPITALIZATION|
20|FH_F34371_0_0|SrvcGrp|10537|2022|PDM|52.00|99|0.00|NURSING CARE|
20|FH_F109652_0_0|SrvcGrp|80020|2022|PDM|4636.00|99|0.00|ARTHROSCOPY|
20|FH_F109652_0_0|SrvcGrp|101419|2022|PDM|42.00|99|0.00|LABORATORY SERVICES|
20|FH_F124828_74074_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F39646_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.20|99|0.00|FS 2501000 GLOBAL (HCFA)|
20|FH_F114267_0_0|CSTM-ALL|CSTM-00|2020|PDM|836.00|99|0.00|AEG 4 (NO REV)|
20|FH_F114916_30309_0|SrvcGrp|67279|2022|PDM|6600.00|99|0.00|CERVICAL SURGERY|
20|FH_F42512_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HEARING AIDS|
20|FH_F136473_0_0|CSTM-ALL|CSTM-00|2020|PDM|1200.00|99|0.00|AEG 10 (NO REV)|
20|FH_F88933_0_0|SrvcGrp|87527|2022|PDM|11255.00|99|0.00|AETNA RECONSTRUCT SHOULDER JOINT|
20|FH_F93252_0_0|SrvcGrp|88739|2022|PDM|2500.00|99|0.00|IMPLANT SPINAL CANAL|
20|FH_F74102_0_0|SrvcGrp|11072|2022|PDM|105.00|99|0.00|SPEECH THERAPY SVCS|
20|FH_F114705_77018_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F136796_24016_0|SrvcGrp|58638|2022|PDM|7788.11|99|0.00|CPT 63688|
20|FH_F112465_28401_0|SrvcGrp|471|2022|PDM|500.00|99|0.00|SUB-ACUTE REHAB - LEVEL IV|
20|FH_F82196_0_0|CSTM-ALL|CSTM-00|2020|PCT|75.00|99|0.00|OP SVCS|
20|FH_F132720_0_0|SrvcGrp|47427|2022|PCT|0.65|99|0.00|IMPLANTS|
20|FH_F144651_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F151007_90048_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F149539_06032_0|SrvcGrp|114719|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F149160_02180_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F89952_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F97622_75051_0|SrvcGrp|73461|2022|PDM|6662.00|99|0.00|AETNA NICU IV|
20|FH_F45435_0_0|SrvcGrp|12263|2022|PDM|25.00|99|0.00|HOME HEALTH AIDE- HOURLY|
20|FH_F148579_17057_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F126698_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F126589_62881_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31204_0_0|CSTM-ALL|CSTM-00|2020|PDM|692.00|99|0.00|ACUTE PSYCH|
20|FH_F142779_64083_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F149660_0_0|SrvcGrp|13262|2022|PDM|3.70|99|0.00|GROUND MILEAGE, PER STATUTE MILE|
20|FH_F133747_80634_0|SrvcGrp|74469|2022|PCT|0.92|99|0.00|AETNA CHEMOTHERAPY|
20|FH_F145640_32503_0|CSTM-ALL|CSTM-00|2020|PCT|1.45|99|0.00|HSS ASC PROCEDURES NOT ON FEE SCHEDULE|
20|FH_F109821_0_0|SrvcGrp|86234|2022|PDM|1836.00|99|0.00|AETHA IMPLANT SPINAL CANAL CATH|
20|FH_F124923_23518_0|SrvcGrp|88621|2022|PDM|80.00|99|0.00|SKILLED NURSING LPN|
20|FH_F116525_26003_0|SrvcGrp|74403|2022|PCT|0.62|99|0.00|AETNA OBSERVATION SERVICES|
20|FH_F141053_17201_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F50415_0_0|SrvcGrp|44706|2022|PDM|80.00|99|0.00|NURSING CARE|
20|FH_F124233_92648_0|SrvcGrp|89337|2022|PDM|1500.00|99|0.00|DETOXIFICATION|
20|FH_F114666_30342_0|SrvcGrp|67066|2022|PDM|3500.00|99|0.00|CERVICAL SURGERY|
20|FH_F134764_73568_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F71867_0_0|CSTM-ALL|CSTM-00|2020|PDM|119.88|99|0.00|HAPA WPA-NWPA 2012-13 ASC 141 W/O REV|
20|FH_F131000_0_0|SrvcGrp|86463|2022|PDM|3608.00|99|0.00|FRACTURE NASAL INFERIOR|
20|FH_F34853_0_0|SrvcGrp|17100|2022|PDM|1166.00|99|0.00|SKILLED NURSING|
20|FH_F37341_0_0|CSTM-ALL|CSTM-00|2020|PDM|41.00|99|0.00|ANESTHESIA SERVICES|
20|FH_F149001_37055_0|SrvcGrp|33722|2022|PDM|36.00|99|0.00|CONTINUOUS HOSPICE CARE|
20|FH_F148351_33012_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F138018_17313_0|SrvcGrp|86824|2022|PDM|247.00|99|0.00|CPT CODE 99601 (HCFA)|
20|FH_F75724_0_0|SrvcGrp|33166|2022|PDM|447.00|99|0.00|SKILLED NURSING - LEVEL III|
20|FH_F126589_62881_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F42140_0_0|CSTM-ALL|CSTM-00|2020|PDM|407.00|99|0.00|HAPA EPA ASC 46|
20|FH_F128929_33030_0|SrvcGrp|86722|2022|PDM|202.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F109624_15401_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F148040_90631_0|SrvcGrp|108484|2022|PDM|745.00|99|0.00|AETNA RES TREATMNT PSYCH/CHEMICAL DEPENDENCY|
20|FH_F146221_72560_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F101853_77840_0|SrvcGrp|73849|2022|PDM|465.00|99|0.00|AETNA OP PSYCH PARTIAL HOSP - REV 913|
20|FH_F40350_0_0|SrvcGrp|9774|2022|PDM|2000.00|99|0.00|INTENSIVE CARE UNIT|
20|FH_F89112_16509_0|SrvcGrp|10362|2022|PDM|274.00|99|0.00|CPT CODE 99282|
20|FH_F146211_68144_0|SrvcGrp|100006|2022|PDM|5172.00|99|0.00|RECONSTRUCT ELBOW MED LIGMNT|
20|FH_F119437_0_0|SrvcGrp|88740|2022|PDM|4750.00|99|0.00|SP BONE ALGRFT|
20|FH_F50462_0_0|SrvcGrp|45950|2022|PDM|140.00|99|0.00|SPEECH THERAPY|
20|FH_F121476_0_0|SrvcGrp|108860|2022|PDM|4664.00|99|0.00|MCP JOINT REPL 2 PC OR MORE|
20|FH_F145759_18452_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F50657_0_0|SrvcGrp|29021|2022|PCT|1.00|99|0.00|DME AND SUPPLIES|
20|FH_F131490_29909_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F57032_0_0|SrvcGrp|53486|2022|PDM|11.00|99|0.00|LANCET|
20|FH_F127209_45365_0|SrvcGrp|88620|2022|PDM|105.00|99|0.00|SKILLED NURSING RN|
20|FH_F90940_0_0|SrvcGrp|82981|2022|PDM|137.00|99|0.00|AETNA GLOBAL FEE URGENT CARE CENTERS|
20|FH_F139580_0_0|SrvcGrp|107750|2022|PDM|25.00|99|0.00|TRAINING INCL A TREATMENT|
20|FH_F151541_01436_0|SrvcGrp|104305|2022|PCT|0.85|99|0.00|UNCLASSIFIED DRUGS|
20|FH_F138197_0_0|SrvcGrp|112809|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F134264_67226_0|SrvcGrp|89417|2022|PDM|428.00|99|0.00|PARTIAL HOSPITALIZATION|
20|FH_F125253_15601_0|SrvcGrp|473|2022|PDM|339.00|99|0.00|SUB-ACUTE REHAB - LEVEL II|
20|FH_F129240_10028_0|SrvcGrp|86835|2022|PDM|25.00|99|0.00|HCPCS S9558 (HCFA)|
20|FH_F150745_03301_0|SrvcGrp|53987|2022|PDM|87.00|99|0.00|PHOTOTHERAPY|
20|FH_F150882_84041_0|SrvcGrp|115816|2022|PCT|1.00|99|0.00|ALL DRUGS, AGENTS, INJ DRUGS|
20|FH_F128764_57501_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F119203_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA INPATIENT DENIAL (INTERCHANGABLE SC1)|
20|FH_F133223_0_0|SrvcGrp|111928|2022|PDM|95.00|99|0.00|COVID-19 BARTONELLA|
20|FH_F149043_72021_0|SrvcGrp|73339|2022|PCT|1.00|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F97420_75052_0|SrvcGrp|46424|2022|PDM|95.00|99|0.00|HI TECH SKILLED NURSING SERVICES|
20|FH_F97042_64804_0|SrvcGrp|73656|2022|PDM|629.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F35453_0_0|SrvcGrp|290|2022|PDM|4140.00|99|0.00|IP LAPAROSCOPIC CHOLECYSTECTOMY|
20|FH_F92676_15063_0|SrvcGrp|79069|2022|PDM|369.13|99|0.00|MON VALLEY ASC 136|
20|FH_F43027_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|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_F49354_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.88|99|0.00|OCN F/S PRICING: POS FACILITY GLOBAL|
20|FH_F41396_0_0|SrvcGrp|34270|2022|PCT|1.00|99|0.00|OCN F/S PRICING: MODIFIER RR (DME)|
20|FH_F114310_0_0|CSTM-ALL|CSTM-00|2020|PDM|1647.00|99|0.00|AEG 9 (NO REV)|
20|FH_F151159_46322_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F125069_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130897_03103_0|SrvcGrp|113276|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F133875_80027_0|SrvcGrp|89337|2022|PDM|1195.00|99|0.00|DETOXIFICATION|
20|FH_F132899_01002_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAMPTON ROADS GAST MOD AW|
20|FH_F85353_16407_0|SrvcGrp|63823|2022|PDM|537.46|99|0.00|HAPA WPA-NWPA 2012-13 ASC 213|
20|FH_F96721_99504_0|SrvcGrp|73559|2022|PDM|25105.00|99|0.00|AETNA INTENSIVE CARE|
20|FH_F90416_73013_0|SrvcGrp|27969|2022|PDM|30.00|99|0.00|HOME HEALTH AIDE|
20|FH_F132958_79903_0|SrvcGrp|107859|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT W/O HOME HEALTH|
20|FH_F142043_45503_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|GENERAL ACUTE CARE|
20|FH_F149940_02645_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F75786_0_0|CSTM-ALL|CSTM-00|2020|PDM|615.00|99|0.00|COVENTRY ENHANCED DEFAULT 10021-69990|
20|FH_F89851_83854_0|CSTM-ALL|CSTM-00|2020|PDM|6711.00|99|0.00|AEG 8 (NO REV)|
20|FH_F127217_29650_0|SrvcGrp|105439|2022|PDM|217.00|99|0.00|AETNA TERANIAL MAGN STIM TX DELI|
20|FH_F41181_0_0|SrvcGrp|705|2022|PCT|0.65|99|0.00|PROSTHETICS/ORTHOTICS|
20|FH_F74263_0_0|CSTM-ALL|CSTM-00|2020|PDM|2246.00|99|0.00|SURGICAL SPECIALTY CENTER  ASC GROUPER 10|
20|FH_F49617_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.80|99|0.00|OCN F/S PRICING: MODIFIER AU|
20|FH_F111589_0_0|CSTM-ALL|CSTM-00|2020|PCT|85.00|99|0.00|OP SVCS|
20|FH_F109242_18466_0|SrvcGrp|89149|2022|PDM|225.00|99|0.00|OP INTENSIVE|
20|FH_F101751_25302_0|SrvcGrp|78418|2022|PDM|2091.13|99|0.00|VAGINAL DELIVERY|
20|FH_F113586_0_0|SrvcGrp|75495|2022|PDM|1479.00|99|0.00|AEG 9|
20|FH_F112627_26062_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F50462_0_0|SrvcGrp|27969|2022|PDM|36.00|99|0.00|HOME HEALTH AIDE|
20|FH_F100782_0_0|SrvcGrp|105116|2022|PDM|731.91|99|0.00|WINDBER MEDICAL CNTR ASC 221|
20|FH_F145641_06902_0|SrvcGrp|110205|2022|PDM|2469.00|99|0.00|REPAIR HAND JOINT WITH GRAFT|
20|FH_F142376_0_0|SrvcGrp|113977|2022|PDM|4221.00|99|0.00|NDSC DCMPRN 1 NTRSPC LUMBAR|
20|FH_F123609_28451_0|SrvcGrp|3178|2022|PDM|928.00|99|0.00|ACUTE PSYCH|
20|FH_F100782_0_0|SrvcGrp|105149|2022|PDM|704.00|99|0.00|WINDBER MEDICAL CNTR ASC 309|
20|FH_F116727_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F31960_0_0|CSTM-ALL|CSTM-00|2020|PCT|90.00|99|0.00|OP SVCS|
20|FH_F115786_57701_0|SrvcGrp|48394|2022|PDM|21.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F146798_44011_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F132971_77063_0|SrvcGrp|86722|2022|PDM|175.00|99|0.00|AETNA INTENSIVE OUTPATIENT (HCFA)|
20|FH_F82173_72712_0|SrvcGrp|112032|2022|PDM|7293.00|99|0.00|LAPAROSCOPIC PROCEDURES|
20|FH_F102185_0_0|SrvcGrp|96201|2022|PDM|45.00|99|0.00|PT/OT/ST|
20|FH_F128159_45356_0|SrvcGrp|48398|2022|PDM|110.00|99|0.00|PT SERVICES|
20|FH_F100662_27534_0|SrvcGrp|73656|2022|PDM|622.00|99|0.00|AETNA HOSPICE SVCS|
20|FH_F82033_0_0|CSTM-ALL|CSTM-00|2020|PDM|6300.00|99|0.00|AEG 5  (NO REV)|
20|FH_F109180_18015_0|SrvcGrp|90635|2022|PDM|108.00|99|0.00|AETNA PSYTX PT & FAMILY 60 MINUTES|
20|FH_F100662_27534_0|SrvcGrp|73601|2022|PDM|5672.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F109601_0_0|SrvcGrp|75485|2022|PDM|750.00|99|0.00|AEG 4|
20|FH_F125323_43213_0|SrvcGrp|104530|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F38847_0_0|CSTM-ALL|CSTM-00|2020|PDM|1150.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F51276_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F133876_27405_0|SrvcGrp|106048|2022|PDM|686.00|99|0.00|AETNA IP REHAB ALCOHOL DRUG|
20|FH_F112665_0_0|SrvcGrp|103965|2022|PCT|0.00|99|0.00|IMAGING ENHANCING SUBSTANCE|
20|FH_F110453_0_0|SrvcGrp|73002|2022|PDM|1070.00|99|0.00|AEG 7|
20|FH_F38345_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HAMPTON ROADS GAST MOD NU|
20|FH_F100680_43130_0|SrvcGrp|92759|2022|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F120795_27514_0|SrvcGrp|3378|2022|PDM|7699.00|99|0.00|OBSERVATION SVCS|
20|FH_F132964_06484_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F79551_0_0|CSTM-ALL|CSTM-00|2020|PDM|1217.00|99|0.00|AEG 8 (NO REV)|
20|FH_F115119_10003_0|CSTM-ALL|CSTM-00|2020|PCT|0.60|99|0.00|OP SVCS|
20|FH_F67939_0_0|CSTM-ALL|CSTM-00|2020|PDM|515.55|99|0.00|HAPA WPA-NWPA 2012-13 ASC 301 W/O REV|
20|FH_F128190_45342_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F78285_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.90|99|0.00|OP SVCS|
20|FH_F115685_64064_0|SrvcGrp|88827|2022|PDM|5.80|99|0.00|HOME INFUSION (HCFA)|
20|FH_F150462_30458_0|SrvcGrp|17014|2022|PDM|50.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F151543_95630_0|SrvcGrp|90854|2022|PDM|1238.00|99|0.00|AETNA IP DETOXIFICATION SERVICES|
20|FH_F58052_0_0|SrvcGrp|27579|2022|PDM|85.00|99|0.00|RESPIRATORY THERAPY INITIAL VISIT|
20|FH_F139719_0_0|SrvcGrp|111929|2022|PDM|7.00|99|0.00|COVID-19 LAB TRANSFER PHYSICIAN TO LAB|
20|FH_F135219_68506_0|SrvcGrp|110083|2022|PDM|22295.52|99|0.00|TOTAL KNEE ARTHROPLASTY|
20|FH_F60072_0_0|SrvcGrp|361|2022|PDM|3000.00|99|0.00|NEONATAL INTENSIVE CARE LEVEL III|
20|FH_F118194_50841_0|SrvcGrp|86848|2022|PDM|145.00|99|0.00|HCPCS S9361 (HCFA)|
20|FH_F110086_21742_0|SrvcGrp|103836|2022|PDM|600.00|99|0.00|AETNA LASER SURG PENIS LESION|
20|FH_F136467_0_0|SrvcGrp|34606|2022|PDM|3022.00|99|0.00|CPT 29827|
20|FH_F135763_20678_0|SrvcGrp|112138|2022|PCT|1.00|99|0.00|TELEMEDICINE SERVICES|
20|FH_F135972_18509_0|SrvcGrp|104966|2022|PCT|0.85|99|0.00|NOC DRUGS|
20|FH_F100880_67735_0|SrvcGrp|73601|2022|PDM|5095.00|99|0.00|AETNA INTERMEDIATE ICU/CCU|
20|FH_F130620_18940_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F121761_44130_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F145587_0_0|SrvcGrp|33983|2022|PDM|1262.70|99|0.00|CPT 28080|
20|FH_F148243_0_0|SrvcGrp|105632|2022|PDM|1450.00|99|0.00|AMPUTATION OF TOE|
20|FH_F131000_0_0|SrvcGrp|89853|2022|PDM|3343.00|99|0.00|NASAL/SINUS ENDOSCOPY-SURG|
20|FH_F144831_0_0|SrvcGrp|29347|2022|PDM|50.00|99|0.00|HOME HEALTH AIDE|
20|FH_F131605_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F37580_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|OP SVCS|
20|FH_F148554_85016_0|SrvcGrp|115463|2022|PDM|2250.00|99|0.00|INSERT SUBQ CAR RHYTHM MONITOR|
20|FH_F90955_06053_0|SrvcGrp|88620|2022|PDM|84.00|99|0.00|SKILLED NURSING RN|
20|FH_F57956_0_0|CSTM-ALL|CSTM-00|2020|PCT|70.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93331_0_0|CSTM-ALL|CSTM-00|2020|PDM|1442.00|99|0.00|AEG 3 (NO REV)|
20|FH_F127188_0_0|SrvcGrp|87077|2022|PDM|90.00|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F31542_0_0|SrvcGrp|10924|2022|PDM|3800.00|99|0.00|PTCA W/O STENT|
20|FH_F149300_53158_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA MCARE2 OCN F/S PRICING|
20|FH_F31481_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.85|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_F127282_98004_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|PROFESSIONAL SERVICES (CMS-1500)|
20|FH_F134593_60007_0|SrvcGrp|86831|2022|PDM|4.00|99|0.00|HCPCS S5501 (HCFA)|
20|FH_F134208_21502_0|SrvcGrp|87677|2022|PDM|420.00|99|0.00|CERVICAL OR THORACIC SURGERY|
20|FH_F110268_02891_0|SrvcGrp|101679|2022|PDM|30.00|99|0.00|OP SUBOXONE ADMINISTRATION (HCFA)|
20|FH_F54592_0_0|SrvcGrp|17011|2022|PDM|80.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F63178_0_0|CSTM-ALL|CSTM-00|2020|PDM|1199.00|99|0.00|COVENTRY ENHANCED GROUPER 7|
20|FH_F133710_21811_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|HSS ASC|
20|FH_F101711_0_0|SrvcGrp|48385|2022|PDM|75.00|99|0.00|SPEECH THERAPY|
20|FH_F125744_66048_0|SrvcGrp|73339|2022|PCT|0.80|99|0.00|CMS SNF PPS WITH REV 022|
20|FH_F127072_30458_0|SrvcGrp|89337|2022|PDM|1003.00|99|0.00|DETOXIFICATION|
20|FH_F128272_60640_0|SrvcGrp|17015|2022|PDM|25.00|99|0.00|HOME INFUSION THERAPY|
20|FH_F126581_45638_0|SrvcGrp|27968|2022|PDM|30.00|99|0.00|SKILLED NURSING LPN|
20|FH_F135248_84651_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F145538_34997_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|AETNA OUTPATIENT DENIAL INTERCHANGEABLE SC2|
20|FH_F129594_02842_0|SrvcGrp|87077|2022|PDM|169.83|99|0.00|AETNA URGENT CARE CENTERS|
20|FH_F34550_0_0|CSTM-ALL|CSTM-00|2020|PDM|1091.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F145590_45242_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F50218_0_0|SrvcGrp|14081|2022|PDM|120.00|99|0.00|HOME VISIT - POSTNATAL|
20|FH_F148265_06067_0|SrvcGrp|93071|2022|PDM|8311.00|99|0.00|POSTERIOR SEGMENTAL INSTRU|
20|FH_F137054_22041_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F133517_49221_0|SrvcGrp|111930|2022|PDM|13.00|99|0.00|COVID-19 LAB TRANSFER PATIENT TO LAB|
20|FH_F125672_92663_0|CSTM-ALL|CSTM-00|2020|PCT|0.70|99|0.00|OP SVCS|
20|FH_F97182_21502_0|SrvcGrp|114253|2022|PCT|1.00|99|0.00|COVID-19 VACCINE ADMINISTRATION|
20|FH_F71644_0_0|SrvcGrp|20149|2022|PDM|131762.00|99|0.00|HEART TRANSPLANT|
20|FH_F117880_91730_0|SrvcGrp|48396|2022|PDM|100.00|99|0.00|OT SERVICES|
20|FH_F126506_68118_0|CSTM-ALL|CSTM-00|2020|PCT|1.30|99|0.00|HSS ASC|
20|FH_F148885_23226_0|CSTM-ALL|CSTM-00|2020|PCT|0.50|99|0.00|OP SVCS|
20|FH_F117206_0_0|SrvcGrp|79594|2022|PDM|721.00|99|0.00|CPT 45380|
20|FH_F133209_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F146124_06112_0|SrvcGrp|73203|2022|PCT|0.00|99|0.00|AETNA ER|
20|FH_F133774_06062_0|SrvcGrp|472|2022|PDM|595.00|99|0.00|SUB-ACUTE REHAB - LEVEL III|
20|FH_F149081_63028_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|AETNA NATIONAL CONTRACT DEFAULT - ANCD|
20|FH_F151300_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F93122_01854_0|SrvcGrp|86753|2022|PCT|1.00|99|0.00|AETNA SOCIAL WORKER (MOD AJ)|
20|FH_F110503_10016_0|SrvcGrp|109330|2022|PCT|1.00|99|0.00|OUTPATIENT THERAPY SERVICES|
20|FH_F118123_67226_0|SrvcGrp|14944|2022|PDM|4.00|99|0.00|HOME INFUSION THERAPY - SINGLE LUMEN|
20|FH_F88094_0_0|CSTM-ALL|CSTM-00|2020|PDM|1093.01|99|0.00|HAPA WPA-NWPA 2012-13 ASC 501 W/O REV|
20|FH_F111584_07002_0|SrvcGrp|104443|2022|PDM|121.00|99|0.00|AETNA OFFICE/OP VISIT EST (HCFA)|
20|FH_F38242_0_0|CSTM-ALL|CSTM-00|2020|PCT|93.00|99|0.00|OP SVCS|
20|FH_F117902_0_0|SrvcGrp|107658|2022|PDM|725.00|99|0.00|AETNA CARVE OUT CODES SERIES C|
20|FH_F125676_02892_0|SrvcGrp|92760|2022|PCT|1.00|99|0.00|OUTPATIENT SERVICES AMFS(H) DEFAULT|
20|FH_F46359_0_0|SrvcGrp|9828|2022|PDM|63.00|99|0.00|HOME HEALTH AIDE|
20|FH_F112755_43215_0|SrvcGrp|104302|2022|PCT|1.00|99|0.00|HIGH COST DRUGS|
20|FH_F109240_21201_0|SrvcGrp|89589|2022|PDM|222.00|99|0.00|RADIATION PHYSICS CONSULT|
20|FH_F36081_0_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F130424_41102_0|CSTM-ALL|CSTM-00|2020|PCT|0.00|99|0.00|GENERAL ACUTE CARE|
20|FH_F72183_0_0|SrvcGrp|38980|2022|PDM|3500.00|99|0.00|MSDRG 246-249 ONLY|
20|FH_F64440_0_0|SrvcGrp|108694|2022|PDM|1106.00|99|0.00|OP SLEEP STUDIES (MOD TC) (HCFA)|
20|FH_F37651_0_0|CSTM-ALL|CSTM-00|2020|PCT|1.00|99|0.00|DBPT DME BASE MOD UE|
20|FH_F135065_08043_0|SrvcGrp|112703|2022|PDM|600.00|99|0.00|PSYCH SERVICES|
20|FH_F126153_44663_0|SrvcGrp|48394|2022|PDM|45.00|99|0.00|SKILLED NURSING SERVICES|
20|FH_F40191_0_0|SrvcGrp|11336|2022|PCT|0.46|99|0.00|IMPLANTS/PROSTHETICS/ORTHOTICS|
99|12359|130595|142956